COMMUNITY HEALTH NURSING

By: Mr. Ritchel S. Acua

Community- a group of people with common characteristics or interest living together within a territory or geographical
boundary.
Classifications of Communities:
1.URBAN- increased in population; industrial-type of work
2. RURAL- decreased in population; agricultural-type of work
3. RURBAN- combination of rural and urban
4. SUBURBAN- periphery around the urban areas
5. METROPOLITAN- expanding urban areas
4 Aspects of Community:
1.Social- communication and interaction of the people.
2. Cultural- norms, values and beliefs of the people.
3. Political- governance and leadership of the people.
4. Geographical- boundaries of the community.
Components of a Community:
A. PEOPLE
B. 8 SUBSYSTEMS
1. Housing
2. Education
3. Fire and Safety
4. Politics and Environment
5. Health
6. Communication
7. Economics
8. Recreation
Health - is the state of complete physical, mental and social well-being and not merely the absence of disease or
infirmity.
New concept in determinants of health
- OLOF (Optimum Level Of Functioning)
Factors that affects OLOF:
- Ecosystem
Composition of Ecosystem:
1. Political
2. Behavior
3. Heredity
4. Environment
5. Socio-Economic
6. Health Care Delivery System
Nursing- an art and science of rendering care to individual, families and community.
- assisting an individual, sick or well, in the performance of those activities contributing to health or its recovery
in such a way as to help gain independence. (OLOF)
Community Health Nursing - a direct goal oriented and adaptable to the needs of the individual, the family and
community during health and illness. - (ANA, 1973)
- an area of human services directed toward developing and enhancing the health
capabilities of people either singly, as an individual or collectively as groups and communities. - (John Henrich, 1981)
- the utilization of the nursing process in different level of clientele concerned with the promotion of
health, prevention of disease and disability and rehabilitation. - (Aracelli Maglaya)
*** a service rendered by a professional nurse with the community, groups, families and individuals at
home, in health centers, in clinics, in schools, in places of work for the promotion of health, prevention of illness, care of
the sick at home and rehabilitation.
PRIMARY GOAL OF CHN: - Enhance peoples capability.
ULTIMATE GOAL OF CHN: - To raise the level of health of the citizenry.
PHILOSOPHY OF CHN:- CHN is based on the worth and dignity of man. - (Margaret Shetland)
EMPHASIS/FOCUS: - Health promotion and Disease prevention.
Important Concepts of CHN:
1. The primary focus of CHN is on health promotion.
2. Recognized needs of individuals, families and communities provide the basis for CHN.
3. The family is the unit of service.
4. Contact with the client may continue over a long period of time which include all ages and all types of health care.
5. CH nurses are generalists in terms of their practice throughout lifes continuum its full range of health problems and
needs.
6. CHN practice is extended to benefit not only the individual but the whole family and community
Roles and Functions of CH Nurse:
1. Provider of Care
2. Clinician
3. Hospice Care
4. Advocate
5. Role Model
6. Educator
7. Manager
8. Coordinator
9. Counselor
10. Change Agent
Levels of Clientele:
1. Individual - point entry
2. Family - center of delivery of care.
3. Group - point of specific care.
4. Community - point of entire care
PLACES IN CHN:
A. Public Health Nursing - is a 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 health program.
Public Health - the science and art of preventing disease, prolonging life and promoting life and efficiency. (C. E.
Winslow)
- is the art of applying science in the context of politics to reduce inequalities while ensuring the best health for
the greatest number. (WHO)
B. School Health Nursing
> Home Visitation effective implementation of total school program
> RA 124 it mandates the school to provide clinics for the minor treatment and attendance to emergency cases
> Assessment:
1. Arms 5. Ears
2. Eyes and Visual Acuity 6. Neck and Chest
3. Nose 7. Hair
4. Mouth and Teeth 8. Lower extremities
> Feeding Program
- Should run for 120 days
- Deworming with consent
C. Occupational Health Nursing
> RA 1054 Occupational Health Act
> Business Firm must employ an occupational health nurse when it has at least _____________? 101 employees
FAMILY NURSE CONTACT:
I. HOME VISIT - professional face to face contact done by a nurse to the family.
Purposes:
1. Give nursing to the sick, post partum mother & newborn.
2. Assess living condition of client and their health practices.
3. Give health teachings.
4. Establish relationship with health agency and public.
5. Make use of inter-referral system and promote utilization of community services.

Principles:
1. Have purpose and objectives.
2. Use available information.
3. Consider and prioritize essential needs of the individual and family.
4. Should involve the individual and family.
5. Plan should be flexible.
2 Important Steps of Home Visit:
1. Greet client and family then introduce yourself.
2. Explain the purpose of the visit.
Phases:
1. Preparatory Phase
a. review existing records of referral data of the family
b. notifies the family of the intention to make a home visit
2. Home Visit Phase
a. actual visits of the family
b. makes plans, interventions, evaluation with the family and set schedule for the next visit
3. Post Visit Phase
a. records data and plans for the next visit and referrals
Priorities During Home Visit:
1. Newborn
2. Post partum
3. Pregnant women
4. Morbid individuals
Factors affecting Frequency of Home Visit:
1. Physical, psychological and educational
2. Acceptance of family
3. Policies given by the agency
II. CLINIC VISIT
2 Programs:
1. Program-based
2. Non-program based
Standard Procedure in Conducting Clinic Visit:
1. Registration/Admission
2. Waiting Time
3. Medical Investigation
4. Triaging
5. Laboratory
6. Referral
7. Prescription
8. Health Education
Phases:
1. Pre-consultation
a. establish relationship
b. assessment on chief complaint, VS, PE
2. Consultation
A. Medical Consultation
B. Nursing Intervention
3. Post-consultation
a. explaining intervention to be done at home
b. follow-up care
c. referral (if possible)
Bag Technique: a tool making use of a public health bag and which the public health nurse can perform procedures
during home visits.
Rationale : Helps render effective nursing care to clients.
Principles:
1. Minimize if not totally prevent the spread of infection.
2. Save time and effort.
*** Open bag TWICE during home visit.
Special Consideration:
B - bag and its contents must be free from any contamination.
A - always perform handwashing.
G - gather necessary equipments to render effective nursing care.
PRIMARY HEALTH CARE
In Sept. 8, 1978 : UNICEF and WHO held the First International Conference on Primary Health Care in Alma Ata,
USSR
PHC Goal : Health for All by 2000! (1978)
In 1994, modified goal to Health for All by 2000 and Beyond because original goal was unattainable.
Legal Basis: LOI 949 : was signed by Pres Marcos on Oct 19, 1979 making Primary Health Care the thrust of the
Department of Health.
Vision : Health for All Filipinos was set by DOH Sec Juan Flavier.
Goal : Health for All Filipinos and Health in the Hands of the people by the Year 2020 (the 2
nd
phrase was suggested by
the NGO : Bukluran Para sa Kalusugan).
Mission : In partnership with the people, provide equity, access and quality health care especially to the marginalized
which brought about the Sentrong Sigla movement in order to achieve it.
RA 7160 : The Local government Code of 1991 which resulted in devolution, which transferred the power and authority
from the national to the local government units, aimed to build their capabilities for self-government and develop
them fully as self-reliant communities.
- Devolution Code (Mandate of Devolution)
Local Government Code
Primary Health Care Team:
1. Local Chief Executive
2. Physician
3. Nurse
4. Medical technologist
5. Midwife
6. Sanitary Inspector
7. Auxiliaries
- BHW
- PHW
4 Pillars/Cornerstones of Primary Health Care:
1. Active community participation
2. Intra and inter- sectoral linkages
3. Use of appropriate technology
4. Support mechanisms made available
Levels of PHC Workers:
1. Village or Brgy. Health Workers - health auxiliary or volunteers
2. Intermediate Level Health Workers Physician, Sanitary Inspector, Midwife
LEVELS OF PREVENTION
1. Primary Prevention - health promotion, specific protection
Behaviors:
1. Quit smoking
2. Avoid/limit alcohol intake
3. Exercise regularly
4. Eat well-balance diet
5. Reduce fat and increase fiber in the diet
6. Complete immunization program (EPI: PD: 996)
7. Wear hazard devices in work site
2. Secondary Prevention - early diagnosis/detection/screening, prompt treatment
Behaviors:
1. Have annual physical examination
2. Regular Pap smear for women
3. Monthly BSE for women who are 20 yrs old and above
4. Sputum examination for Tuberculosis
5. Annual stool Guaiac test and rectal exam for clients over age 50 yrs old
3. Tertiary Prevention - prevention of complication
- optimal health status after a disease or disability
Behaviors:
1. Self-monitoring of blood glucose among diabetics
2. Physical therapy after CVA
3. Attending self-management education for diabetes
4. Undergoing speech therapy after laryngectomy
Levels of Health Care Facilities
1. Primary Level of Facilities
1. Rural Health Units
2. Community Hospitals and Health Center
3. Private Practitioners (Puericulture Centers)
4. Brgy. Health Stations
2. Secondary Level of Facilities
1. Provincial/City Health Services and Hospitals
2. Emergency and District Hospitals
3. Tertiary Level of Facilities
1. National and Regional Health Services
2. Teaching and Training Hospitals
HERBAL MEDICINES (PITAHC)
Legal Basis: RA 8423 promotes the use of herbal medicines
S - Sambong - anti-edema, diuretic, anti-urolithiasis
A - Ampalaya -DM
N - Niyog-niyogan -anti-helmintic

T- Tsaang Gubat -diarrhea, stomachache
A - Akapulko (Bayabas-bayabasan)- anti-fungal
L- Lagundi- asthma, cough, fever, dysentery, skin diseases
U- Ulasimang Bato (Pansit-pansitan)- lowers uric acid
B - Bawang - lowers cholesterol levels, hypertension, toothache
B - Bayabas - washing of wounds, diarrhea, gargle for tootache
Y- Yerba Buena- pain, rheumatism, arthritis, headache, cough and colds, swollen gums, toothache,
menstrual and gas pain, nausea, fainting, insects bites and pruritus
** S A N T A L U B B Y **
DOH (Department of Health)
Vision: A leader, staunch advocate and model in promoting health for all in the Philippines.
Mission: Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor and shall lead the quest
for excellence in health.
3 Roles and Functions of DOH:
1. Leadership in health - serves as an advocate in the adoption of health policies, plans and programs to address
national and sectoral concerns.
2. Administrator of Specific Service - administer health emergency responsive services including referral and networking
system.
3. Enabler and Capacity Builder - innovates new strategies in health to improve the effectiveness of health programs.
Overriding Goal of DOH: Health Sector Reform Agenda (HSRA)
Framework for its Implementation: FOURmula One for Health (Pres. Gloria Macapagal Arroyo)
Goals:
1. Better health outcome
2. Equitable health gain
3. Responsive health system

UNIVERSAL HEALTHCARE (KALUSUGAN PANGKALAHATAN) CURRENT: Pres. Noynoy S. Aquino
Elements of Strategy:
1. Health Financing to foster investment of health care.
2. Health Regulation to ensure affordability of resources.
3. Health Delivery System to ensure availability and accessibility of resources.
4. Good Governance to enhance the performance of health sector.
THE MATERNAL and CHILD HEALTH PROGRAM
Overall Goal: To improve the survival, health and well being of mothers and unborn through a package of services for
the pre pregnancy, prenatal, natal and post natal stages.

Essential Health Service Packages:
A. Prenatal Registration
1
St
visit as early in pregnancy as possible before four months or during the first trimester
2
nd
visit during the 2
nd
trimester
3
rd
visit during the 3
rd
visit
Every 2 weeks after 8
th
month of pregnancy until delivery
B. Deliver Tetanus Toxoid Immunization
OLD TT Immunization Schedule:
TT1= given anytime during pregnancy
TT2 = 1 month after the first dose
TT3 = 1
st
booster dose; 6 months interval from TT2
TT4 = 1 year interval from TT3
TT5 = booster dose 1 year interval from TT4
NEW TT Immunization Schedule:
TT1 = 5
th
or 6
th
month of pregnancy
TT2 = after 1 month of TT1
TT3 = succeeding pregnancy (5
th
or 6
th
month pregnant)
TT4 = succeeding pregnancy (5
th
or 6
th
month pregnant)
TT5 = succeeding pregnancy (5
th
or 6
th
month pregnant)
Lifespan of TT Vaccines:
TT1 = 80% protection; 0 yr protection
TT2 = 80% protection; 3 yrs protection
TT3 = 95% protection; 5 yrs protection
TT4 = 99% protection; 10 yrs protection
TT5 = 99% protection; lifetime protection
C. Micronutrient Supplementation
1. Vitamin A 10,000 IU 2X a week starting on the 4
th
month of pregnancy
10,000 IU once a day for 4 weeks if with Xeropthalmia
200,000 IU post-partum; one dose within 4 weeks
2. Iron 60 mg/day 1
st
trimester
120 mg/day 2
nd
/3
rd
trimester
60 mg/day X 3 mos Post-partum


D. Treatment of Diseases and Other Conditions
- Unconscious
- Difficulty of breathing
- Post partum bleeding
- Parasitism
E. Clean and Safe Delivery
- ensure hygiene during labor and delivery
Qualifications for Home Care Delivery:
1. Full Term 7. No history of previous infection
2. G1-G4 8. No PROM
3. Cephalic Presentation 9. Adequate pelvis
4. No history of previous CS 10. No history of prolonged labor
5. No history of previous Complications
6. Enlargement of abdomen is equal to AOG
3 Priorities for a Safe Home Care Delivery:
1. Clean Hands
2. Clean Surface
3. Clean Cord
Post Partum Visits:
1
st
visit within a week (3-5 days)
2
nd
visit 6
th
week post delivery
3 Cardinal Signs of Post Partum Infection:
1. Board-like abdomen
2. Fever
3. Foul-smelling vaginal discharges
F. Support Breastfeeding
Benefits of BF to Infants:
1. Increases immune system resistance
2. Provides complete nutrition
3. Increases IQ points
Benefits of BF to mothers:
1. Prevent unplanned pregnancy
2. Prevent post partum bleeding
3. Prevent occurrence of cancer
G. Family Planning Counseling
- right choice of FP methods
- birth spacing is .. 3-5 years
MATERNAL, NEWBORN AND CHILD HEALTH AND NUTRITION
- ensures to improve the health, well-being and survival of mothers and their child.
OBJECTIVES:
1. Every pregnancy to be wanted, planned and supported
2. Every pregnancy to be adequately managed throughout course
3. Every delivery to be facility-based and managed by skilled birth attendants/ skilled health professionals
4. Every mother and newborn pair to secure proper post-partum and newborn care with smooth transitions to the
womens health care package for the mother and child survival package for the newborn
KEY STRATEGIES:
1. Ensuring universal access to and utilization of an MNCHN Core Package of services and interventions
2. Establishment of a service delivery network at all levels of care to provide the package of services and interventions
3. Organized use of instruments for health systems development to bring all localities to create and sustain their service
delivery networks
4. Rapid build-up of institutional capacities of DOH and PhilHealth being the lead national agencies that will provide
support to local planning and development
- to avoid delays that may lead to maternal and newborn mortality.
3 DELAYS:
1. Delay in identification of complication
2. Delay in referral
3. Delay in the management of complication
CHILDHEALTH PACKAGE:
1. Skilled birth attendances/skilled health professional-assisted delivery and facility-based deliveries
2. Proper management of pregnancy and delivery complications and newborn complications
3. Access to Basic emergency Obstetric and Newborn Care or Comprehensive Emergency Obstetric and Newborn Care
Services
POST-PARTUM PACKAGE:
1. Post-partum visits
2. Micronutrient supplementation
3. Counseling on nutrition, child care, family planning and other available services
RA 10028 - New Breastfeeding Act
Storage Full-term Pre-term
Room Temperature 8-10 hours 4 hours
Refrigerator 48 hours 24 hours
Freezer 3 months 3 months
THE FAMILY PLANNING PROGRAM
Overall Goal: To provide universal access to family planning information and services wherever and whenever these are
needed.
Strategies:
1. Focus service delivery to the urban and rural poor
2. Reestablish the FP outreach program
3. Strengthen FP provision in regions with high unmet needs
4. Promote frontline participation of hospitals
5. Mainstream modern natural family planning
6. Promote and implement CSR strategy
The Family Planning Methods:
1. Female Sterilization Perfect Use: 99.5%, Typical Use: 99.5%
- safe and simple surgical procedure which provides permanent contraception for women who do not
want more children. Also known as BTL that involves cutting or blocking the two fallopian tubes.
2. Male Sterilization Perfect Use: 99.9%, Typical Use: 99.8%
- permanent method wherein the vas deferens (passage of sperm) is tied and cut or block through a
small opening on the scrotal skin. It is also known as vasectomy.
3. Pill Perfect Use: 99.7%, Typical Use:92.2%
- Contains hormones estrogen and progesteron taken daily to prevent contraceptions.
4. Male Condom Perfect Use: 98%, Typical Use: 85%
- Thin sheath of latex rubber made to fit on a mans erect penis to prevent the passage of sperm
cell and sexually transmitted disease organism into the vagina. It provide dual protection from STIs including HIV
preventing transmission of disease microorganism during intercourse.
5. Injectables Perfect Use: 99.7%, Typical Use: 97.0%
- Contain synthetic hormones, progestin which suppresses ovulation, thickens cervical mucus, making it
difficult for sperm to pass through and changes uterine lining.
6. Lactating Amenorhea Method or LAM Percect Use: 99.5%,
Typical Use, 98%
- Temporary introductory postpartum method of postponing pregnancy based
on physiological infertility experienced by Breast Feeding women.
7. Mucus/Billings/Ovulation Perfect Use: 97%, Typical Use: 80%
- Abstaining from sexual intercourse during fertile (wet) days prevent s pregnancy.
8. Basal Body Temperature Perfect Use: 99%, Typical Use: 80%
- BBT Methods is identifying the fertile period of a womans cycle by daily taking and recording of the
rise in body temperature during and after ovulation.
9. Sympto-Thermal Method Perfect Use: 9%, Typical Use: 80%
- method in identifying the fertile and infertile days of the menstrual cycle as determined through a
combination of observations made on the cervical mucus, basal body temp recording and other sign of ovulation.
10. Two Day Method Perfect Use: 96.5%, Typical Use: 86%
- Is a simple fertility awareness based method of FP that involve:
1. cervical secretions as an indicator of fertility
2. woman checking the presence of secretions everyday.
11. Standard Days Method Perfect Use: 95%, Typical Use: 88%
- A new method of natural family planning in which all users with menstrual cycles between 26 and 32
days are counseled to abstain from sexual intercourse on days 8-19 to avoid pregnancy.
-The couples use color coded cycle beads to mark the fertile and infertile days of the menstrual cycle.
ORAL HEALTH PROGRAMS
Goal: To reduce the prevalence rate of dental caries and periodontal diseases from 92% in 1998 to 85% and from 78% in
1998 to 60% by the end of 2010 among general population.
Objectives:
1. To increase the proportion of Orally Fit Children under 6 years old to 80% by 2010.
2. To control oral health risks among the young people.
3. To improve the oral health conditions of pregnant women by 20% and older persons by 10% every year until 2010.
Basic Package of Oral Health Care:
Classification of Oral Interventions:
1. Preventive
- Oral Examination- Pit and Fissure Sealent Program
- Oral Hygiene- Flouride Utilization Program
2. Curative
- Permanent Filling- Temporary Filling
- Gum Treatment- Extraction
- Altraumatic Restorative Treatment
- Treatment of post extraction complication
- Drainage of localized oral abscess
3. Promotive
- includes health educationa ctivities directed to the priority groups thru individual or group approach using
accepted tools and media
PHILLIPINE REPRODUCTIVE HEALTH
Goal: To achieve Better Quality Life among Filipinos
RA 10354 Responsible Parenthood and Reproductive Health Act 2012
Local Framework Focuses on: Health needs of women, men, adolescents, children and underserved groups.

Main objectives:
1. Reducing maternal mortality rate.
2. Reducing child mortality.
3. Halting and reversing spread of HIV/AIDS.
4. Increasing access to reproductive health information and services.
10 Elements:
1. Family Planning
2. Maternal and Child Health and Nutrition
3. Adolescent Reproductive Health
4. Prevention and Management of Reproductive Tract Infections including STIs and HIV/AIDS
5. Prevention and Management of Abortion and its Complication
6. Education and Counseling on Sexuality and Sexual Health
7. Prevention and Management of Breast and Reproductive Tract Cancers and other Gynecological Conditions.
8. Mens Reproductive Health
9. Violence Against Women and Children
10. Prevention and Management of Infertility and Sexual Dysfunctions
NUTRITION PROGRAMS
Goal: - To improve the quality life of Filipinos through better nutrition, increased productivity and improved health.
3 Most Common Deficiencies:
1. Iron
2. Vitamin A
3. Iodine
Strategies:
1. Food based intervention for sustained improvements in nutritional status.
2. Life-cycle approach with strategic attention to 0-3 years old children, adolescent females and pregnant/lactating
women.
3. Effective complementation of nutrition interventions with other services.
4. Geographical focus to needier areas.
Programs and Projects:
1. Micronutrient Supplementation - is one of the interventions to address the health and nutritional needs of infants
and children and improve their growth and survival.
Araw ng Sangkap Pinoy (ASAP)
Garantisadong Pambata/Child Health Week
2. Food Fortification (RA 8976)- to improve the nutritional status of the populace including children.
3. Essential Maternal and Child Health Services- this ensures the right of the child to survival, development, protection
and participation.
4. Nutrition, information, communication and education - promotion of Nutritional Guidelines for Filipinos.
10 NUTRITIONAL GUIDELINES FOR FILIPINOS (PLEASE MEMORIZE):
1. Intended to give the message that no single food provides all nutrients the body needs.
2. Promoting exclusive breastfeeding from 0 to 4-6 months
3. Gives advice on proper feeding of children. It also includes regular weighing to monitor the growth of the children.
4. Eating of fish, meat , poultry products and beans.
5. Eating more vegetables.
6. Eat food cooked in edible oil.
7. Consume milk and milk products.
8. Using iodized salt to prevent iodine deficiency.
9. Preventing food-borne diseases.
10. Promoting healthy lifestyles.

5. Home, School and Community Food Production - establishment of kitchens, gardens in home, schools and in
communities in urban and rural areas.
6. Food Assistance - it involves complementary feeding for wasted/stunted children and pregnant women with
delivering low birthweight.
7. Livelihood AssistancE - provision of credit and livelihood opportunities to poor households especially those with
malnourished children through linkage with lending and financial institutions.
Expanded Program on Immunization (EPI)
Legal Basis: PD No. 996 providing for compulsory basic immunization for infants and children below 8 yrs old.
( September 16, 1976)
> launched in July 1976
> free vaccines: BCG, DPT, OPV, Measles
Objective: To reduce morbidity and mortality among infants and children caused by the 6 childhood immunizable
diseases
Target for Immunization Program
a. Infant : 12 months old
b. School Entrants : 6-7 years old
c. Pregnant Mother
Infants:
- 1 BCG - 3 Hepa B
- 3 DPT - 1 Measles
- 3 OPV
School entrants:
- 1 booster dose of BCG
Pregnant mothers:
- 5 Tetanus Toxoid

3 Principles of EPI:
1. Based on epidemiological situation
2. Main focus: eligible population
3. Immunization is a basic health service
Elements of EPI:
Target setting: calculation of eligible population
Formula: EP = total population x constant percentage
Constant percentage:
Infants = 3% or .03
School Entrants = 3% or .03
Pregnant Mothers = 3.5% or .035
Cold Chain System - to maintain potency of the vaccine
Refrigerator:
Freezer: (-15 to -25 C) OPV, Measles
Body: (2 to 8C) - DPT, Hepa B, BCG, TT
2 most sensitive to heat vaccine: OPV & MEASLES
2 least sensitive to heat vaccine: BCG & TT
HOW LONG CAN VACCINE BE STORED?
DOH:
REGIONAL HEALTH OFFICE :
DISTRICT/ PROVINCIAL HEALTH OFFICE:
HEALTH CENTER :
FEFO : First Expiry, First out
FIFO : First In, First out
CONTENT OF VACCINES:
BCG: - live attenuated bacteria
OPV and MEASLES: - live attenuated virus
DIPTHERIA & TT:- weakened bacterial toxins
PERTUSSIS: - killed bacteria
HEPA B: - derived from plasma (plasma derivatives) RNA recombinants
PRINCIPLES OF VACCINATION
1. No BCG to a child born positive with HIV or AIDS
2. DPT is not given to a child who has recurrent convulsions or active neurologic disease
3. DPT2 or DPT3 is not given to a child who has had convulsions or shock w/in 3 days the previous dose but you can give
DT.
4. Dont immunize children before referral
5. Moderate fever, malnutrition, mild resp. infection, cough, diarrhea & mild vomiting arent contraindication to
vaccination.
6. Safe to administer all EPI vaccines on the same day at different sites of the body.
7. No food 30 minutes after giving OPV.
8. Assess the child for allergy to egg before giving measles vaccine.
9. Measles vaccine should be given as soon as the child is 9 months old regardless of whether other vaccines will be
given on that day.
10. Vaccination schedule should not be restarted from the beginning even if the interval between doses exceeded.
11. It is safe and effective with mild side effects after vaccination.
12. Repeat BCG vaccination if the child does not develop a scar after the first injection.
13. Strictly follow the principle of never, ever reconstitute the freeze dried vaccines to any diluents.
14. Use one syringe, one needle per child during vaccination.
15. During vaccination, clean the skin with cotton ball, moistened with water only (boiled H20).
Opened vaccines should be discarded after:
> BCG & Measles : 4-6 hours
> DPT, OPV, Hepa B & TT: 8 hours
Open OPV vials can be used for the next immunization if:
a. Expiry date has not passed
b. Vaccines stored at 0C to 8C
c. Not taken out at the health center for outreach activities
Control of Acute Respiratory Infection (CARI)
Objective: Reduce mortality through early detection.
Strategies:
1. Train government & private health workers in the standard management of ARI.
2. Enabling BHW to identify pneumonia cases.
3. Assure that there are adequate supply of antibiotics and other essential drugs in all health facilities.
4. Health teaching to parents and communities
5. Mobilizing NGOs & field workers to communicate with parents and communities.
6. Advocacy & social mobilization.
Contributing Factors to Pneumonia:
1. Mothers failure to recognize signs and symptoms of Pneumonia.
2. Indiscriminate use of antibiotics.
3. Not standardized management to Pneumonia
Sign of Severe Pneumonia: - Chest Indrawing
Important Responsibility of the Nurse in preventing unnecessary death from Pneumonia - Provision of careful
assessment
Control of Diarrheal Disease (CDD)
Objective: To reduce mortality from diarrhea among children under 5 yrs old through extensive case management.
Extensive Care Management
ORT
ORS (Oresol)
1) Oresol pocket 2)AM rice H2O 3)Home Oresol
Composition of Oresol packet:
> Potassium chloride : 1.5 gms
> Na chloride : 2. 6 gms
> Tri Na citrate : 2. 9 gms
> Glucose : 13.5 gms
______________________________________________________________
20.5 gms to be diluted in 1L H2O to be consumed within 24 hrs
Home Oresol:
1 liter ORS = 1tsp salt + 8tsp sugar + 1Liter H2o
1 glass ORS = tsp salt (1 pinch of salt) + 2tsp sugar + 1glass H2o
Preventive Interventions:
1. Breastfeeding
Signs of Good Sucking:
a. slow
b. deep sucks
c. with some pausing
Signs of Good Attachment:
a. chin touching the breast
b. mouth wide open
c. lower lip turned outward
d. more areola visible above than below the mouth
Tips to show to the mother for her infant to attach:
a. touch her infants lips with her nipple
b. wait until her infants mouth is opening wide
c. move her infant quickly onto her breast aiming the infants lower lip well below the nipple
2. Handwashing
3. Measles immunization
National Cancer Control Program
9 Warning Signs:
C change in blood, bowel/bladder habits
A a sore throat that does not heal
U unusual bleeding/discharge
T thickening or lump in breast
I indigestion or difficulty in swallowing
O obvious change in wart or mole
N nagging cough or hoarseness
U unexplained anemia
S sudden unexplained weight loss
LEVELS OF PREVENTION:
Primary Prevention: elimination of conditions causing cancer
Secondary Prevention: (Early detection; Needs Multidisciplinary approach)
- Definitive Treatment and Management
a. Chemotherapy
b. Radiation
c. Surgery
Tertiary Prevention: (Late detection: Needs Multidisciplinary approach)
- Supportive or Palliative Care
a. Physical
b. Psychological, Social, Spiritual
Environmental Health and Sanitation - the study of all factors in mans physical environment, which may exercise a
deleterious effect on his well-being and survival.
FACTORS:
1. water sanitation 7. steam pollution
2. food sanitation 8. air pollution
3. refuse and garbage disposal 9. noise
4. excreta disposal 10. radiological protection
5. housing 11. institutional sanitation
6. insect vector and rodent control
Legal basis: PD 856, 1978 (WATER SUPPLY SANITATION PROGRAM )
Clean Water Act of 2004: RA 9275
Approved type of water supply facilities:
LEVEL I: (Point Source) - a protected well or a developed spring with an outlet but without a distribution system.
- serves 15 to 25 households
- outreach must not be more than 250 meters from the farthest user
LEVEL II: (Communal Faucet System or Stand-Posts)
- a system composed of a source, a reservoir, a piped distribution network and communal
faucets.
- with one faucet per 4-6 households
- located at not more than 25 meters from the farthest house
LEVEL III: (Waterworks System or Individual House Connections)
- a system with a source, a reservoir, a piped distributor network and household taps.
- generally suited for densely populated urban areas
- requires minimum treatment or disinfection

PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM
Approved types of toilet facilities:
LEVEL I: Non-water carriage toilet facility no water is necessary to wash the waste into the receiving space.
Ex. Pit latrines, Reed odorless earth closet toilet facility requiring small amount of water to wash the
waste into the receiving space.
Ex. Pour flush toilet, Aqua privies
LEVEL II :on site toilet facilities of the carriage type with water-sealed and flushed type with septic tank/vault disposal
facilities
LEVEL III - water carriage types of toilet facilities connected to septic and/or to sewerage system to treatment plant

FOOD SANITATION PROGRAM
FOUR RIGHTS IN FOOD SAFETY:
1. Right source
- always buy fresh meat, fish, fruits and vegetables
- check for expiry dates of processed foods
- avoid buying canned foods with dents, bulges, deformation, broken seals and improper seams
- use clean and safe water
- if doubt of water source boil water for at least 2 minutes
2. Right preparation
- avoid contact between raw and cooked foods
- always buy pasteurized milk and fruit juices
- wash vegetables well if eaten raw
- wash hands and kitchen utensils before and after preparing food
- sweep kitchen floors to remove food droppings
3. Right cooking
- cook food thoroughly and ensure that temperature on all parts
of the food should reach 70 degrees centigrade
- eat cooked food immediately
- wash hands thoroughly before and after
4. Right storage
- cooked foods should not left at room temperature for NOT more than 2 hours
- store foods carefully: 4 -5 hours
hot conditions : at least or above 60 degrees centigrade
cold conditions: below or equal to 10 degrees centigrade
- do not overburden the refrigerator
- reheat stored food before eating --at least 70 degrees centigrade
Rule in Food Safety:
WHEN IN DOUBT, THROW IT OOUT
National TB Control Program
Vision: A country where TB is no longer a public health problems.
Mission: Ensure that TB DOTS services are available, accessible and affordable to the communities.
Treatment: Quality of SDF (Single Dose Formulation) & FDC (Fixed Dose Combination)
Case Finding:
1. DSSM ( Direct Sputum Smear Microscopy)
- 3X collection
1
st
specimen SPOT specimen collected on the day of consultation
2
nd
specimen early morning specimen on the next day
3
rd
specimen SPOT specimen collected on the 2
nd
day after submission of early morning specimen

2. Chest X-ray - to identify the extent of the disease
3. Tuberculin Testing/Mantoux Test/PPD Testing
TB Treatment:
TB Abbreviation
SDF OLD NEW
Rifampicin R R
Isoniazid INH H
Pyrazinamide PZA Z
Ethambutol E E
Streptomycin S S
# of Tablets of FDC of Patient per Body Weight
Body Weight (kg) # of Tablets
30-37 2
38-54 3
55-70 4
>70 5
Category I: Newly Diagnosed TB Patient - - - ( + ) DSSM, ( + ) CXR
Category II: Previously treated patient with relapses or failure
Category III: Newly TB patient - - - ( - ) DSSM, ( + ) CXR
Category IV: - CHRONIC Still ( + ) smear after supervised re-treatment
- refer to specialized facility
- Provincial NTP Coordinator
Management of Children with TB:
1. Prevention: = BCG
2. Signs and Symptoms:
- cough in 2 weeks
- unexplained fever in 2 weeks
- loss of appetite
- loss of weight
- failure to respond to antibiotic treatment
- failure to regain previous state of health
3. Case Finding
A. Child with productive cough
= sputum exam
B. All TB symptomatic children 0-9 yrs old
= TT
C. Child with S/Sx of TB but with (-) TT
= CXR
D. Child expose to adult TB patient
= TT
E. Child without S/Sx of TB but with (+) TT
= CXR
Treatment to Children:

1. PTB = 6 months
2. Extra Pulmonary TB = 12 months
DOTS
- Direct Observed Treatment Short course
- Main strategy which primary health services around the world are using to detect and cure TB patients.
Treatment partner: watching the TB patient take medicines everyday during the whole course of treatment.
a. Staff of the Health Care facilities
b. LGU officials
c. Family members of the patient
5 ELEMENTS OF DOTS:
1. Political will
2. Sputum microscopy service
3. Regular drug supply
4. Record of patients progress
5. Supervision of drug intake
Leprosy Control Program
Leprosy - known as Hansens Disease
- cause: Mycobacterium leprae
- MOT: prolonged intimate skin to skin contact; droplet infection
Diagnostic procedure: = Slit Skin Smear
Preventive Measures: - BCG immunization, - Health education on the MOT
DOMICILLARY TREATMENT: (Republic Act 4073)
PAUCIBACILLARY : 6-9 months
A. Intermediate type - flat, with not well defined patches, with slight to no sensory loss and pale in color.
B. Tuberculoid type - flat, with some raised patches, definite sensory loss and rough to touch.
Treatment:
Day 1: Rifampicin and Dapsone
Succeeding days (2-28 days): Dapsone
MULTIBACILLARY: 24-30 months
A. Borderline type - many raised patches at different sizes and shapes, usually enlarged nerves
and occasionally with deformities.
B. Lepromatous type - thickened skin and earlobes and with hair loss in eyebrows.
Treatment:
Day 1: Rifampicin, Dapsone, Clofaximine or Lamprene
Day 2-28: Dapsone, Clofaximine or Lamprene
VITAL STATISTICS
- refers to the systemic study of vital events such as birth, illnesses, marriages, divorce, separation and
deaths.
* Statistics on population and the characteristics such as age and sex are obtained from.
NSO (National Statistics Office)
* Births and Deaths are registered in the.
Office of the Local Civil Registrar
* In cities, births and deaths are registered at the.
City Health Department
Uses:
1. Indices of the health and illness status of a community.
2. Serves as bases for planning, implementing, monitoring and evaluating community health programs and services.
Sources:
1. population census
2. registration of vital data
3. health survey
4. studies and researches
Rates and Ratios:
Rate
- shows the relationship between a vital event and those persons exposed to the occurrence of said event.
Numerator must come from the total population exposed to the risk of the same event Denominator.
Ratios
- is used to describe the relationship between 2 numerical quantities or measures of events without taking
particular considerations to the time and place.

Crude Birth Rate (CBR)
- a measure of one characteristic of the natural growth or increase in population.
FORMULA:
total number of live births registered in a given calendar year
CBR = ___________________________________________________ X 1000
estimated population as of July 1 of same year

Crude Death Rate (CDR) - a measure of one mortality from all causes which may result in a decrease of population.
total number of deaths registered in a given calendar year
CDR = ________________________________________ x 1000
estimated population as of July 1 of the same year
Infant Mortality Rate (IMR)
- measures the risk of dying during the 1
st
year of life.
- considers a good index of the general heath condition of the community.
total number of death under 1 year of age registered in a given calendar year
IMR = _________________________________________________________________X 1000
total number of registered live births of same calendar year

Maternal Mortality Rate (MMR)
- measures the risk of dying from causes related to pregnancy, childbirth and puerperium.
total number of deaths from maternal causes registered for a given year
MMR = ______________________________________________________________X 1000
total number of live births registered of same year

Fetal Death Rate (FDR) - measures pregnancy wastage. Death of the product of conception occurs prior to its complete
expulsion, irrespective of duration of pregnancy.
total number of fetal deaths registered in a given calendar year
FDR = _____________________________________________________ X 1000
total number of live births registered on same year
Neonatal Death Rate (NDR) - measures the risk of dying the 1
st
month of life.
number of deaths under 28 days of age registered in a given calendar year
NDR = __________________________________________________________________________ X 1000
number of live births registered of same year

Incidence Rate (IR)
- measures the frequency of occurrence of the phenomenon during a given period of time.
number of new cases of a particular disease registered during a specified period of time
IR = ___________________________________________________________________________________ X 1000
estimated population as of July of same year
Prevalence Rate (PR)
- measures the proportion of the population which exhibits a particular disease at a particular time.
number of new and old of a certain disease registered at a given time
PR = _________________________________________________________________________ X 1000
total number of persons examined at same given time
Attack Rate (AR) - a more accurate measure of the risk of exposure.
number of persons acquiring a disease registered in a given year
AR = ___________________________________________________________________ x 100
number of exposed to same disease in the same year
Proportion Mortality (Death Ratios) (PM)
- shows the numerical relationship between deaths from all causes (or group of causes), age (or group of age),
etc. and the total number of deaths from all causes in all ages taken together.
number of registered deaths from specific cause or age for a give calendar year
PM = _____________________________________________________________________________ X 100
number of registration deaths from all causes, all ages in same year
Case Fatality Ratio (CFR)
- index of a killing power of a disease and is influenced by incomplete reporting and poor morbidity data.
number of registered deaths from a specific disease for a given year
CFR = _______________________________________________________________________ X 1000
number of registered cases from same specific disease in same year