CONTENTS OUTLINE

Bag Technique
Breastfeeding or Lactation Management Education Training
Communicable Disease (Vector Borne)
Communicable Diseases (Chronic)
Control of Acute Respiratory Infections (CARI)
Control of Diarrheal Diseases (CDD)
Expanded Program for Immunization (EPI)
Herbal Medicine Plants Approved by the DOH
Integrated Management of Childhood Illnesses (IMCI)
Management of a Child with an Ear Problem
Maternal and Child Health Nursing Program
Non-Communicable Diseases and Rehabilitation
Family Planning Program

Bag Technique
Definition
Bag technique-a tool making use of public health bag through which the nurse, during his/her home visit, can perform
nursing procedures with ease and deftness, saving time and effort with the end in view of rendering effective nursing care.
Public health bag is an essential and indispensable equipment of the public health nurse which he/she has to carry
along when he/she goes out home visiting. It contains basic medications and articles which are necessary for giving care.

Rationale
To render effective nursing care to clients and /or members of the family during home visit.

Principles
The use of the bag technique should minimize if not totally prevent the spread of infection from
individuals to families, hence, to the community.
2.
Bag technique should save time and effort on the part of the nurse in the performance of nursing
procedures.
3.
Bag technique should not overshadow concern for the patient rather should show the effectiveness
of total care given to an individual or family.
4.
Bag technique can be performed in a variety of ways depending upon agency policies, actual home
situation, etc., as long as principles of avoiding transfer of infection is carried out.
1.

1.
2.
3.
4.
5.
6.

Special Considerations in the Use of the Bag

The bag should contain all necessary articles, supplies and equipment which may be used to
answer emergency needs.
The bag and its contents should be cleaned as often as possible, supplies replaced and ready for
use at any time.
The bag and its contents should be well protected from contact with any article in the home of the
patients. Consider the bag and its contents clean and /or sterile while any article belonging to the patient
as dirty and contaminated.
The arrangement of the contents of the bag should be the one most convenient to the user to
facilitate the efficiency and avoid confusion.
Hand washing is done as frequently as the situation calls for, helps in minimizing or avoiding
contamination of the bag and its contents.
The bag when used for a communicable case should be thoroughly cleaned and disinfected before
keeping and re-using.
Contents of the Bag
Paper lining
Extra paper for making bag for waste materials (paper bag)
Plastic linen/lining
Apron
Hand towel in plastic bag
Soap in soap dish
Thermometers in case [one oral and rectal]
2 pairs of scissors [1 surgical and 1 bandage]
2 pairs of forceps [ curved and straight]
Syringes [5 ml and 2 ml]

Hypodermic needles g. 19, 22, 23, 25

Sterile dressings [OS, C.B]
Sterile Cord Tie
Adhesive Plaster
Dressing [OS, cotton ball]
Alcohol lamp
Tape Measure
Babys scale
1 pair of rubber gloves
2 test tubes
Test tube holder
Medicines
betadine
70% alcohol
ophthalmic ointment (antibiotic)
zephiran solution
hydrogen peroxide
spirit of ammonia
acetic acid
benedicts solution
Note: Blood Pressure Apparatus and Stethoscope are carried separately.

Steps/Procedures
Actions

Rationale

1. Upon arriving at the clients home, place the

bag on the table or any flat surface lined with
paper lining, clean side out (folded part touching
the table). Put the bags handles or strap beneath
the bag.

To protect the bag from contamination.

2. Ask for a basin of water and a glass of water if

faucet is not available. Place these outside the
work area.

To be used for handwashing.

To protect the work field from being wet.

3. Open the bag, take the linen/plastic lining and

spread over work field or area. The paper lining,
clean side out (folded part out).

To make a non-contaminated work field or area.

4. Take out hand towel, soap dish and apron and

the place them at one corner of the work area
(within the confines of the linen/plastic lining).

To prepare for handwashing.

5. Do handwashing. Wipe, dry with towel. Leave

the plastic wrappers of the towel in a soap dish in
the bag.

Handwashing prevents possible infection from one care provid

to the client.

6. Put on apron right side out and wrong side with

crease touching the body, sliding the head into

To protect the nurses uniform. Keeping the crease creates

the neck strap. Neatly tie the straps at the back.

aesthetic appearance.

7. Put out things most needed for the specific

case (e.g.) thermometer, kidney basin, cotton
ball, waste paper bag) and place at one corner of
the work area.

To make them readily accessible.

8. Place waste paper bag outside of work area.

To prevent contamination of clean area.

9. Close the bag.

To give comfort and security, maintain personal hygiene and

hasten recovery.

10. Proceed to the specific nursing care or

treatment.

To prevent contamination of bag and contents.

11. After completing nursing care or treatment,

clean and alcoholize the things used.

To protect caregiver and prevent spread of infection to others

12. Do handwashing again.

13. Open the bag and put back all articles in their
proper places.
14. Remove apron folding away from the body,
with soiled sidefolded inwards, and the clean side
out. Place it in the bag.
15. Fold the linen/plastic lining, clean; place it in
the bag and close the bag.
16. Make post-visit conference on matters
relevant to health care, taking anecdotal notes
preparatory to final reporting.

To be used as reference for future visit.

17. Make appointment for the next visit (either

home or clinic), taking note of the date, time and
purpose.

For follow-up care.

After Care
1.
2.

Before keeping all articles in the bag, clean and alcoholize them.
Get the bag from the table, fold the paper lining ( and insert), and place in between the flaps and
cover the bag.
Evaluation and Documentation

1.

Record all relevant findings about the client and members of the family.

2.
3.
4.

Take note of environmental factors which affect the clients/family health.

Include quality of nurse-patient relationship.
Assess effectiveness of nursing care provided.

Breastfeeding or Lactation Management

Education Training
Introduction
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 factorpromotes growth of the Lactobacillusinhibits the growth of pathogenic bacilli
Positions in Breastfeeding of the baby:

1.
2.
3.

Cradle Hold = head and neck are supported

Football Hold
Side Lying Position
BEST FOR BABIES
REDUCE INCIDENCE OF ALLERGENS
ECONOMICAL
ANTIBODIES PRESENT
STOOL INOFFENSIVE (GOLDEN YELLOW)
TEMPERATURE ALWAYS IDEAL
FRESH MILK NEVER GOES OFF
EMOTIONALLY BONDING
EASY ONCE ESTABLISHED
DIGESTED EASILY
IMMEDIATELY AVAILABLE
NUTRITIONALLY OPTIMAL
GASTROENTERITIS GREATLY REDUCED

Communicable Disease (Vector Borne)

Leptospirosis (Weils disease)

An infectious disease that affects humans and animals, is considered the most common zoonosis in
the world
Causative Agent:
Leptospira interrogans

Sign/Symptoms:
High fever
Chills
Vomiting
Red eyes
Diarrhea
Severe headache
muscle aches
may include jaundice (yellow skin and eyes)
abdominal pain

Treatment:
PET > Penicillins, Erythromycin, Tetracycline

Malaria

Malaria (from Medieval Italian: mala aria bad air; formerly called ague or marsh fever) is an
infectious disease that is widespread in many tropical and subtropical regions.
Causative Agent:
Anopheles female mosquito

Signs & Symptoms:

Chills to convulsion
Hepatomegaly
Anemia
Sweats profusely
Elevated temperature
Treatment:
Chemoprophylaxis chloroquine taken at weekly interval, starting from 1-2 weeks before entering
the endemic area.
Anti-malarial drugs sulfadoxine, quinine sulfate, tetracycline, quinidine
Insecticide treatment of mosquito nets, house spraying, stream seeding and clearing, sustainable
preventive and vector control meas
Preventive Measures: (CLEAN)
Chemically treated mosquito nets
Larvae eating fish
Environmental clean up
Anti mosquito soap/lotion
Neem trees/eucalyptus tree
Filariasis

name for a group of tropical diseases caused by various thread-like parasitic round worms
(nematodes) and their larvae
larvae transmit the disease to humans through a mosquito bite
can progress to include gross enlargement of the limbs and genitalia in a condition called
elephantiasis
Sign/Symptoms:
Asymptomatic Stage

Characterized by the presence of microfilariae in the peripheral blood

No clinical signs and symptoms of the disease
Some remain asymptomatic for years and in some instances for life
Acute Stage

Lymphadenitis (inflammation of lymph nodes)

Lymphangitis (inflammation of lymph vessels)
In some cases the male genitalia is affected leading to orchitis (redness, painful and tender
scrotum)
Chronic Stage

Hydrocoele (swelling of the scrotum)

Lyphedema (temporary swelling of the upper and lower extremities
Elephantiasis (enlargement and thickening of the skin of the lower and / or upper extremities,
scrotum, breast)
Management:
Diethylcarbamazine citrate or Hetrazan
Ivermectin,
Albendazolethe
No treatment can reverse elephantiasis
Schistosomiasis

parasitic disease caused by a larvae

Causative Agent:
Schistosoma intercalatum, Schistosoma japonicum, Schistosoma mansoni

Signs & Symptoms: (BALLIPS)

Bulging abdomen
Abdominal pain
Loose bowel movement
Low grade fever
Inflammation of liver & spleen
Pallor
Seizure

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

Treatment:
Diethylcarbamazepine citrate (DEC) or Praziquantel (drug of choice)

Dengue

DENGUE is a mosquito-borne infection which in recent years has become a major international
public health concern..
It is found in tropical and sub-tropical regions around the world, predominantly in urban and semiurban areas.
Sign/Symptoms: (VLINOSPARD)
Vomiting
Low platelet
Nausea
Onset of fever

Severe headache
Pain of the muscle and joint
Abdominal pain
Rashes
Diarrhea
Treatment:
The mainstay of treatment is supportive therapy.

Intravenous fluids

A platelet transfusion

Communicable Diseases (Chronic)

Tuberculosis
TB is a highly infectious chronic disease that usually affects the lungs.
Causative Agent:
Mycobacterium Tuberculosis

Sign/Symptoms:
cough
afternoon fever
weight loss
night sweat
blood stain sputum

Prevalence/Incidence:
ranks sixth in the leading causes of morbidity (with 114,221 cases) in the Philippines
Sixth leading cause of mortality (with 28507 cases) in the Philippines.

Nursing and Medical Management

Ventilation systems
Ultraviolet lighting
Vaccines, such as the bacillus Calmette Guerin (BCG) vaccine
drug therapy

Preventing Tuberculosis
BCG vaccination
Adequate rest
Balanced diet
Fresh air
Adequate exercise
Good personal Hygiene

National Tuberculosis Control Program Key policies

Case finding direct Sputum Microscopy and X-ray examination of TB symptomatics who are
negative after 2 or more sputum exams
Treatment shall be given free and on an ambulatory basis, except those with acute complications
and emergencies
Direct Observed Treatment Short Course comprehensive strategy to detect and cure TB
patients.

DOTS (Direct Observed Treatment Short Course)

Category 1- new TB patients whose sputum is positive; seriously ill patients with severe forms of
smear-negative PTB with extensive parenchymal involvement (moderately- or far advanced) and extrapulmonary TB (meningitis, pleurisy, etc.)
Intensive Phase (given daily for the first 2 months) Rifampicin + Isioniazid + pyrazinamide
+ ethambutol.
If sputum result becomes negative after 2 months, maintenance phase starts. But if sputum
is still positive in 2 months, all drugs are discontinued from 2-3 days and a sputum specimen is examined
for culture and drug sensitivity. The patient resumes taking the 4 drugs for another month and then
another smear exam is done at the end of the 3rd month.
Maintenance Phase (after 3rd month, regardless of the result of the sputum exam)-INH +
rifampicin daily
Category 2-previously-treated patients with relapses or failures.
Intensive Phase (daily for 3 months, month 1, 2 & 3)-Isioniazid+ rifampicin+ pyrazinamide+
ethambutol+ streptomycin for the first 2 months Streptomycin+ rifampicin pyrazinamide+ ethambutol
on the 3rd month. If sputum is still positive after 3 months, the intensive phase is continued for 1 more
month and then another sputum exam is done. If still positive after 4 months, intensive phase is
continued for the next 5 months.
Maintenance Phase (daily for 5 months, month 4, 5, 6, 7,& 8)-Isionazid+ rifampicin+
ethambutol
Category 3 new TB patients whose sputum is smear negative for 3 times and chest x-ray result
of PTB minimal
Intensive Phase (daily for 2 months) Isioniazid + rifampicin + pyrazinamide
Maintenance Phase (daily for the next 2 months) Isioniazid + rifampicin
Leprosy

Sometimes known as Hansens disease

is an infectious disease caused by , an aerobic, acid fast, rod-shaped mycobacterium
Gerhard Armauer Hansen
Historically, leprosy was an incurable and disfiguring disease
Today, leprosy is easily curable by multi-drug antibiotic therapy
Signs & Symptoms
Early stage (CLUMP)
Change in skin color

Late Stage (GMISC)

Gynocomastia

Loss in sensation

Madarosis(loss of eyebrows)

Ulcers that do not heal

Inability to close eyelids (Lagopthalmos)

Muscle weakness

Sinking nosebridge

Painful nerves

Clawing/contractures of fingers & nose

Prevalence Rate
Metro Manila, the prevalence rate ranged from 0.40 3.01 per one thousand population.

Management:
Dapsone, Lamprene
clofazimine and rifampin
Multi-Drug-Therapy (MDT)
six month course of tablets for the milder form of leprosy and two years for the more severe form

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 Acute Respiratory

Infections (CARI)
Classification
A. No Pneumonia: Cough or Cold
1.
2.

No chest in drawing
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.
2.
3.
4.

If coughing more than 30 days, refer for assessment

Assess and treat ear problems/sore throat if present
Advise mother to give home care
Treat fever/wheezing if present

Home Care:
1. Feed the Child

Feed the child during illness

Increase feeding after illness
Clear the nose if it interferes with feeding
2. Increase Fluids

offer the child extra to drink

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

Breathing becomes difficult

Breathing becomes fast
Child is not able to drink
Child becomes sicker
B. Pneumonia

1.
2.

No chest in drawing
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.
2.
3.
4.

Advise mother to give home care

Give an antibiotic
Treat fever/wheezing if present
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

1.
2.
3.
4.

Chest indrawing
Nasal flaring
Grunting ( short sounds made with the voice)
Cyanosis
Treatment

Refer urgently to hospital

Treat fever ( paracetamol), wheezing ( salbutamol)

D. Very Severe Disease

1.
2.
3.
4.
5.

Not able to drink

Convulsions
Abnormally sleepy or difficult to wake
Stridor in calm child
Severe undernutrition
Treatment
Refer urgently to hospital

Assessment of Respiratory Infection

Ask the Mother
1.
2.
3.
4.
5.
6.

How old is the child?

Is the child coughing? For how long?
Age less than 2 months: Has the young infant stopped feeding well?
Age 2 months up to 5 years: Is the child able to drink?
Has the child had fever? For how long?
Has the child had convulsions?
Look, Listen
1. Count the breaths in one minute.
Age

Fast Breathing

Less than 2 months

60/minute or more

2 months- 12 months

50/minute or more

12 months 5 years

40/minute or more

2. Look for chest in drawing.

3. Look and listen for stridor. Stridor occurs when there is a narrowing of the larynx, trachea or epiglottis which interferes
with air entering the lungs.
4. Look and listen for wheeze. Wheeze is a soft musical noise which shows signs that breathing out (exhale) is difficult.
5. See if the child is abnormally sleepy or difficult to wake. (Suspect meningitis)
6. Feel for fever or low body temperature.
7. Check for severe under nutrition

Control of Diarrheal
Diseases (CDD)
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 Treatment.

Three Rules for Home Treatment

1.

2.

3.

Give the child more fluids than usual

use home fluid such as cereal gruel
give ORESOL, plain water
Give the child plenty of food to prevent under nutrition
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.
Take the child to the health worker if the child does not get better in 3 days or develops any of the
following:
many watery stools
repeated vomiting
marked thirst
eating or drinking poorly
fever
blood in the stool
Oresol Treatment

Age

Amount of ORS to give after each loose

stool

Amount of ORS to provide for use at

home

< 24 months

50-100 ml

500 ml/day

2-10 years

100- 200 ml

1000 ml/day

10 years up

As much as wanted

2000 ml/day

B. Some Dehydration
Condition restless, irritable
Mouth and Tongue dry
Eyes sunken
Thirst thirsty, drinks eagerly
Tears absent
Skin pinch goes back slowly
WEIGH PT, TTT. PLAN B
Approximate amount of ORS to give in 1st 4 hours
Age

Weight (kg)

ORS (ml)

4 months

200- 400

4- 11 months

5- 7.9

400- 600

12-23 months

8- 10.9

600- 800

2-4 yrs.

11- 15.9

800- 1200

5-14 yrs.

16- 29.9

1200- 2200

15 yrs. up

30 up

2200- 4000

1.
2.
3.
4.
5.
6.

If the child wants more ORS than shown, give more

Continue breastfeeding
For infants below 6 mos. who are not breastfeed, give 100-200 ml clean water during the period
For a child less than 2 years give a teaspoonful every 1-2 min.
If the child vomits, wait for 10 min, then continue giving ORS, 1 tbsp/2-3 min
If the 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

1.
2.
3.
4.

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
Treatment PLAN C- treat quickly
Bring pt. to hospital
IVF Lactated Ringers Solution or Normal Saline
Re-assess pt. Every 1-2 hrs
Give ORS as soon as the pt. can drink

Role of Breastfeeding in the Control of Diarrheal Diseases Program

Two problems in CDD
High child mortality due to diarrhea
High diarrhea incidence among under fives
Highest incidence in age 6 23 months
Highest mortality in the first 2 years of life
Main causes of death in diarrhea :
Dehydration

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

Malnutrition

For under nutrition, continue feeding during diarrhea especially breastfeeding.

1.
2.

1.
2.
3.
4.
5.
6.
7.

Interventions to prevent diarrhea

breastfeeding
improved weaning practices
use of plenty of clean water
hand washing
use of latrines
proper disposal of stools of small children
measles immunization
Breastfeeding
1. Risk of severe diarrhea 10-30x higher in bottle fed infants than in breastfed infants.
2. Advantages of breastfeeding in relation to CDD
a. Breast milk is sterile
b. Presence of antibodies protection against diarrhea
c. Intestinal Flora in BF infants prevents growth of diarrhea causing bacteria.
3. Breastfeeding decreases incidence rate by 8-20% and mortality by 24- 27% in infants under 6 months of age.
4. When to wean?

4-6 months soft mashed foods 2x a day

6 months variety of foods 4x a day
Summary of WHO-CDD recommended strategies to prevent diarrhea
1. Improved Nutrition

Exclusive breastfeeding for the first 4-6 months of life and partially for at least one year.
Improved weaning practices
2. Use of safe water

collecting plenty of water from the cleanest source

protecting water from contamination at the source and in the home
3. Good personal and domestic hygiene

handwashing
use of latrines
proper disposal of stools of young children

4. Measles immunization

Expanded Program for Immunization (EPI)

Principles of EPI
1.
2.
3.
1.
2.
3.
4.
5.
6.
7.

Epidemiological situation
Mass approach
Basic Health Service
The 7 immunizable diseases
Tuberculosis
Diptheria
Pertussis
Measles
Poliomyelitis
Tetanus
Hepatitis B
Target Setting

Infants 0-12 months

Pregnant and Post Partum Women
School Entrants/ Grade 1 / 7 years old
Objectives of EPI

To reduce morbidity and mortality rates among infants and children from six childhood immunizable
disease
Elements of EPI

Target Setting
Cold chain Logistic Management- Vaccine distribution through cold chain is designed to ensure that
the vaccines were maintained under proper environmental condition until the time of administration.
Information, Education and Communication (IEC)
Assessment and evaluation of Over-all performance of the program
Surveillance and research studies

Administration of vaccines

Vaccine
BCG (Bacillus Calmette
Guerin)

Content
Live attenuated
bacteria

Form &
Dosage
Freeze dried

# of
Doses
1

Route
ID

Infant- 0.05ml
Preschool-0.1ml
DT- weakened
toxin
DPT (Diphtheria Pertussis
Tetanus)
OPV (Oral Polio Vaccine)

P-killed bacteria
weakened virus
Plasma
derivative

Hepatitis B

Measles

Weakened virus

liquid-0.5ml

IM

liquid-2drops

Oral

Liquid-0.5ml

IM

Freeze dried0.5ml

Subcutaneous

Schedule of Vaccines

Vacci
ne

Age at
1st dose

Interval
between dose

BCG

At birth

DPT

6 weeks

4 weeks

OPV

6weeks

4weeks

Protection
BCG is given at the earliest possible age protects against the
possibility of TB infection from the other family members
An early start with DPT reduces the chance of severe pertussis

The extent of protection against polio is increased the earlier OPV

given.
An early start of Hepatitis B reduces

Hepa
B

@ birth

Meas
les

9m0s.11m0s.

@birth,6th
week,14th week

the chance of being infected and becoming a carrier.

At least 85% of measles can be prevented by immunization at this

age.

6 months earliest dose of measles given in case of outbreak

9months-11months- regular schedule of measles vaccine
15 months- latest dose of measles given
4-5 years old- catch up dose
Fully Immunized Child (FIC) less than 12 months old child with complete immunizations of DPT,
OPV, BCG, Anti Hepatitis, Anti measles.

Tetanus Toxiod Immunization

Schedule for Women
%
protected

Vaccine

Minimum age interval

TT1

As early as possible

0%

TT2

4 weeks later

80%

3 years

TT3

6 months later

95%

5 years

99%

10 years

99%

Lifetime

TT4
TT5

1year later/during next

pregnancy
1 year later/third pregnancy

Duration of Protection

There is no contraindication to immunization except when the child is immunosuppressed or is very,

very ill (but not slight fever or cold). Or if the child experienced convulsions after a DPT or measles
vaccine, report such to the doctor immediately.
Malnutrition is not a contraindication for immunizing children rather; it is an indication for
immunization since common childhood diseases are often severe to malnourished children.

Cold Chain under EPI

Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to the time
it is given to child or pregnant woman.
The allowable timeframes for the storage of vaccines at different levels are:
6months- Regional Level
3months- Provincial Level/District Level
1month-main health centers-with ref.
Not more than 5days- Health centers using transport boxes.
Most sensitive to heat: Freezer (-15 to -25 degrees C)
OPV
Measles
Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius)
BCG
DPT
Hepa B
TT
Use those that will expire first, mark X/ exposure, 3rd- discard,
Transport-use cold bags let it stand in room temperature for a while before storing DPT.
Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B.
FEFO (first expiry and first out) vaccine is practiced to assure that all vaccines are utilized
before the expiry date. Proper arrangement of vaccines and/or labeling of vaccines expiry date are done to
identify those near to expire vaccines.

Herbal Medicine Plants Approved by the DOH

Lagundi (Vitex negundo)
Uses & Preparation:

Asthma, Cough & Fever Decoction ( Boil raw fruits or leaves in 2 glasses of water for 15
minutes)Dysentery, Colds & Pain Decoction ( Boil a handful of leaves & flowers in water to produce a
glass, three times a day)
Skin diseases (dermatitis, scabies, ulcer, eczema) -Wash & clean the skin/wound with the
decoction
Headache Crush leaves may be applied on the forehead
Rheumatism, sprain, contusions, insect bites Pound the leaves and apply on affected area
Yerba (Hierba ) Buena (Mentha cordifelia)

Uses & Preparation:

Pain (headache, stomachache) Boil chopped leaves in 2 glasses of water for 15 minutes.
Divide decoction into 2 parts, drink one part every 3 hours.
Rheumatism, arthritis and headache Crush the fresh leaves and squeeze sap. Massage sap
on painful parts with eucalyptus
Cough & Cold Soak 10 fresh leaves in a glass of hot water, drink as tea. (expectorant)
Swollen gums Steep 6 g. of fresh plant in a glass of boiling water for 30 minutes. Use as a gargle
solution
Toothache Cut fresh plant and squeeze sap. Soak a piece of cotton in the sap and insert this in
aching tooth cavity

Menstrual & gas pain Soak a handful of leaves in a lass of boiling water. Drink infusion.
Nausea & Fainting Crush leaves and apply at nostrils of patients
Insect bites Crush leaves and apply juice on affected area or pound leaves until like a paste, rub
on affected area
Pruritis Boil plant alone or with eucalyptus in water. Use decoction as a wash on affected area.
Sambong (Blumea balsamifera)

Uses & Preparation:

Anti-edema, diuretic, anti-urolithiasis Boil chopped leaves in a glass of water for 15 minutes until one glassful
remains. Divide decoction into 3 parts, drink one part 3 times a day.
Diarrhea Chopped leaves and boil in a glass of water for 15 minutes. Drink one part every 3 hours.
Tsaang Gubat (Carmona retusa)

Uses & Preparation:

Diarrhea Boil chopped leaves into 2 glasses of water for 15 minutes. Divide decoction into 4 parts. Drink 1 part
every 3 hours
Stomachache Boil chopped leaves in 1 glass of water for 15 minutes. Cool and strain.
Niyug-niyogan (Quisqualis indica L.)

Uses & Preparation:

Anti-helmintic The seeds are taken 2 hours after supper. If no worms are expelled, the dose may be repeated
after one week. (Caution: Not to be given to children below 4 years old)
Bayabas/Guava (Psidium guajava L.)

Uses & Preparation:

For washing wounds Maybe use twice a day
Diarrhea May be taken 3-4 times a day
As gargle and for toothache Warm decoction is used for gargle. Freshly pounded leaves are used for toothache. Boil
chopped leaves for 15 minutes at low fire. Do not cover and then let it cool and strain
Akapulko
(Cassia alata L.)

Uses & Preparation:

Anti-fungal (tinea flava, ringworm, athletes foot and scabies) Fresh, matured leaves are pounded. Apply
soap to the affected area 1-2 times a day
Ulasimang Bato (Peperonica pellucida)

Uses & Preparation:

Lowers uric acid (rheumatism and gout) One a half cup leaves are boiled in two glass of water over low fire.
Do not cover pot. Divide into 3 parts and drink one part 3 times a day
Bawang (Allium sativum)

Uses & Preparation:

Hypertension Maybe fried, roasted, soaked in vinegar for 30 minutes, or blanched in boiled water for 15
minutes. Take 2 pieces 3 times a day after meals.
Toothache Pound a small piece and apply to affected area
Ampalaya (Mamordica Charantia)

1.
2.
3.
4.
5.
6.
7.

Uses & Preparation:

Diabetes Mellitus (Mild non-insulin dependent) Chopped leaves then boil in a glass of water for 15 minutes.
Do not cover. Cool and strain. Take 1/3 cup 3 times a day after meals
Reminders on the Use of Herbal Medicine
Avoid the use of insecticide as these may leave poison on plants.
In the preparation of herbal medicine, use a clay pot and remove cover while boiling at low heat.
Use only part of the plant being advocated.
Follow accurate dose of suggested preparation.
Use only one kind of herbal plant for each type of symptoms or sickness.
Stop giving the herbal medication in case untoward reaction such as allergy occurs.
If signs and symptoms are not relieved after 2 to 3 doses of herbal medication, consult a doctor.

Integrated Management of Childhood Illnesses

(IMCI)

Definition
IMCI is an integrated approach to child health that focuses on the well-being of the whole child.
IMCI strategy is the main intervention proposed to achieve a significant reduction in the number of
deaths from communicable diseases in children under five
Goal

By 2010, to reduce the infant and under five mortality rate at least one third, in pursuit of the goal
of reducing it by two thirds by 2015.
Aim

To reduce death, illness and disability, and to promote improved growth and development among
children under 5 years of age.
IMCI includes both preventive and curative elements that are implemented by families and
communities as well as by health facilities.
IMCI Objectives
To reduce significantly global mortality and morbidity associated with the major causes of disease in
children
To contribute to the healthy growth & development of children

IMCI Components of Strategy

Improving case management skills of health workers
Improving the health systems to deliver IMCI
Improving family and community practices

**For many sick children a single diagnosis may not be apparent or appropriate

Presenting complaint:
Cough and/or fast breathing
Lethargy/Unconsciousness
Measles rash
Very sick young infant

Possible course/ associated condition:

Pneumonia, Severe anemia, P. falciparum malaria
Cerebral malaria, meningitis, severe dehydration
Pneumonia, Diarrhea, Ear infection
Pneumonia, Meningitis, Sepsis

Five Disease Focus of IMCI:

Acute Respiratory Infection
Diarrhea
Fever
Malaria
Measles
Dengue Fever
Ear Infection
Malnutrition

The IMCI Case Management Process

Assess and classify
Identify appropriate treatment
Treat/refer
Counsel
Follow-up
The Integrated Case Management Process

Check for General Danger Signs:

A general danger sign is present if:
The child is not able to drink or breastfeed
The child vomits everything
The child has had convulsions
The child is lethargic or unconscious
Assess Main Symptoms
Cough/DOB
Diarrhea
Fever
Ear problems
Assess and Classify Cough of Difficulty of Breathing

Respiratory infections can occur in any part of the respiratory tract such as the nose, throat, larynx,
trachea, air passages or lungs.

Assess and classify PNEUMONIA

Cough or difficult breathing
An infection of the lungs
Both bacteria and viruses can cause pneumonia
Children with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis (generalized
infection).

** A child with cough or difficult breathing is assessed for:

How long the child has had cough or difficult breathing
Fast breathing
Chest indrawing
Stridor in a calm child.

Remember:
** If the child is 2 months up to 12 months the child has fast breathing if you count 50
breaths per minute or more
** If the child is 12 months up to 5 years the child has fast breathing if you count 40 breaths
per minute or more.

Color Coding

PINK
(URGENT REFERRAL)

YELLOW
(Treatment at outpatient
health facility)

GREEN
(Home management)
HOME

OUTPATIENT HEALTH FACILITY

OUTPATIENT HEALTH

FACILITY

Pre-referral treatments

Advise parents
Refer child

Treat local infection

Give oral drugs
Advise and teach
caretaker
Follow-up

Caretaker is counseled on:

Home treatment/s
Feeding and fluids
When to return immediately
Follow-up

Give first dose of an appropriate

antibiotic
Give Vitamin A
Treat the child to prevent low bloo
sugar
Refer urgently to the hospital
Give paracetamol for fever > 38.5

REFERRAL FACILITY

Emergency Triage and

Treatment ( ETAT)
Diagnosis, Treatment
Monitoring, follow-up

SEVERE PNEUMONIA OR VERY

SEVERE DISEASE

Give an appropriate antibiotic for

days

Any general danger sign

or

Chest indrawing or
Stridor in calm child

PNEUMONIA

Soothe the throat and relieve coug

with a safe remedy
Advise mother when to return
immediately
Follow up in 2 days
Give Paracetamol for fever > 38.5

NO PNEUMONIA : COUGH OR
COLD

Fast breathing

If coughing more than more than

days, refer for assessment
Soothe the throat and relieve the
cough with a safe remedy
Advise mother when to return
immediately
Follow up in 5 days if not improvin

No signs of pneumonia or
very severe disease
Assess and classify DIARRHEA
A child with diarrhea is assessed for:
How long the child has had diarrhoea
Blood in the stool to determine if the child has dysentery
Signs of dehydration.

Classify DYSENTERY
Child with diarrhea and blood in the stool

If child has no other severe classification:

Give fluid for severe dehydration ( Pla
C ) OR

If child has another severe classification :

Refer URGENTLY to hospital with moth

giving frequent sips of ORS on the way

Advise the mother to continue

breastfeeding

If child is 2 years or older and there is choler

in your area, give antibiotic for cholera

Two of the following signs?

Abnormally sleepy or
difficult to awaken
Sunken eyes
Not able to drink or
drinking poorly
Skin pinch goes back very
slowly

SEVERE
DEHYDRATION

Give fluid and food for some dehydration ( P

B)

Two of the following signs :

Restless, irritable
Sunken eyes
Drinks eagerly, thirsty
Skin pinch goes back slowly

SOME
DEHYDRATION

Not enough signs to

classify as some or severe
dehydration

Dehydration present

NO DEHYDRATION

SEVERE
PERSISTENT
DIARRHEA

No dehydration

PERSISTENT
DIARRHEA

If child also has a severe classification :

Refer URGENTLY to hospital with moth
giving frequent sips of ORS on the way
Advise mother when to return
immediately
Follow up in 5 days if not improving

Home Care
Give fluid and food to treat diarrhea at home
( Plan A )
Advise mother when to return immediately
Follow up in 5 days if not improving
Treat dehydration before referral unless the
child has another severe classification
Give Vitamin a
Refer to hospital

Advise the mother on feeding a child who ha

persistent diarrhea
Give Vitamin A
Follow up in 5 days

DYSENTERY

Blood in the stool

Treat for 5 days with an oral antibiotic

recommended for Shigella in your area
Follow up in 2 days
Give also referral treatment

Does the child have fever?

**Decide:
Malaria Risk
No Malaria Risk
Measles
Dengue

Malaria Risk

VERY SEVERE

Any general
danger sign or
Stiff neck

FEBRILE DISEASE /
MALARIA

Give first dose of quinine ( under medical supervision

if a hospital is not accessible within 4hrs )
Give first dose of an appropriate antibiotic
Treat the child to prevent low blood sugar
Give one dose of paracetamol in health center for hig
fever (38.5oC) or above
Send a blood smear with the patient
Refer URGENTLY to hospital

Blood smear ( +

If blood smear not

done:

NO runny nose,

and

NO measles, and
NO other causes
of fever

MALARIA

Blood smear

( ), or

Runny nose, or
Measles, or
Other causes of fever

FEVER : MALARIA
UNLIKELY

Treat the child with an oral antimalarial

Give one dose of paracetamol in health center for hig
fever (38.5oC) or above
Advise mother when to return immediately
Follow up in 2 days if fever persists
If fever is present everyday for more than 7 days, refe
for assessment

Give one dose of paracetamol in health center for hig

fever (38.5oC) or above
Advise mother when to return immediately
Follow up in 2 days if fever persists
If fever is present everyday for more than 7 days, refe
for assessment

No Malaria Risk

Any general danger

sign or

Stiff neck

No signs of very
severe febrile disease

VERY SEVERE
FEBRILE DISEASE
FEVER : NO
MALARIA

Give first dose of an appropriate antibiotic

Treat the child to prevent low blood sugar
Give one dose of paracetamol in health center for
high fever (38.5oC) or above
Refer URGENTLY to hospital
Give one dose of paracetamol in health center for
high fever (38.5oC) or above
Advise mother when to return immediately
Follow up in 2 days if fever persists

If fever is present everyday for more than 7 days,

refer for assessment

Measles

Clouding of cornea

or

Deep or extensive
mouth ulcers

SEVERE COMPLICATED
MEASLES

Pus draining from

the eye or
Mouth ulcers

MEASLES WITH EYE OR

MOUTH COMPLICATIONS

Measles now or
within the last 3 months

MEASLES

Give Vitamin A
Give first dose of an appropriate antibiotic
If clouding of the cornea or pus draining from
the eye, apply tetracycline eye ointment
Refer URGENTLY to hospital

Give Vitamin A
If pus draining from the eye, apply tetracycli
eye ointment
If mouth ulcers, teach the mother to treat wi
gentian violet
Give Vitamin A

Dengue Fever

Bleeding from nose or

gums or
Bleeding in stools or
vomitus or
Black stools or vomitus
or
Skin petechiae or
Cold clammy extremities
or
Capillary refill more than
3 seconds or
Abdominal pain or
Vomiting
Tourniquet test ( + )

SEVERE DENGUE
HEMORRHAGIC FEVER

No signs of severe
dengue hemorrhagic fever

FEVER: DENGUE
HEMORRHAGIC UNLIKELY

If skin petechiae or Tourniquet test,are the

only positive signs give ORS
If any other signs are positive, give fluids
rapidly as in Plan C
Treat the child to prevent low blood sugar
DO NOT GIVE ASPIRIN
Refer all children Urgently to hospital

DO NOT GIVE ASPIRIN

Give one dose of paracetamol in health
center for high fever (38.5oC) or above
Follow up in 2 days if fever persists or chil
shows signs of bleeding
Advise mother when to return immediatel

Does the child have an ear problem?

Tender swelling behind the ear

Pus seen draining from the ear and discharge is
reported for less than 14 days or
Ear pain

MASTOIDITIS
ACUTE EAR
INFECTION

Give first dose of

appropriate antibiotic
Give paracetamol for
pain
Refer URGENTLY
Give antibiotic for 5

days

Give paracetamol for

pain

CHRONIC EAR
INFECTION

Pus seen draining from the ear and discharge is

reported for less than 14 days

NO EAR
INFECTION

No ear pain and no pus seen draining from the ear

Dry the ear by wickin

Follow up in 5 days

Dry the ear by wickin

Follow up in 5 days
No additional
treatment

Check for Malnutrition and Anemia

Give an Appropriate Antibiotic:
A. For Pneumonia, Acute ear infection or Very Severe disease

COTRIMOXAZOLE

AMOXYCILLIN

BID FOR 5 DAYS

BID FOR 5 DAYS

Adult
Age or Weight

Tablet

Syrup

tablet

Syrup

1/2

5 ml

1/2

5 ml

7.5 ml

10 ml

2 months up to 12 months
( 4 < 9 kg )

12 months up to 5 years ( 10
19kg )

B. For Dysentery

COTRIMOXAZOLE

AMOXYCILLIN

BID FOR 5 DAYS

BID FOR 5 DAYS

TABLET

SYRUP

SYRUP 250MG/5ML

AGE OR WEIGHT

2 4 months
( 4 < 6kg )

1.25 ml ( tsp )

5 ml

4 12 months

( 6 < 10 kg )

1 5 years old
( 10 19 kg )

2.5 ml ( tsp )
5 ml

( 1 tsp )
7.5 ml

C. For Cholera

TETRACYCLINE

COTRIMOXAZOLE

QID FOR 3 DAYS

BID FOR 3 DAYS

AGE OR WEIGHT

Capsule 250mg

Tablet

Syrup

2 4 months ( 4 < 6kg )

1/2

5ml

4 12 months ( 6 < 10 kg )

1/2

5 ml

1 5 years old ( 10 19 kg)

7.5ml

Give an Oral Antimalarial

Primaquine
Give single
CHOLOROQUINE

Primaquine

dose in

Give for 3 days

AGE

TABLET ( 150MG )

DAY1

DAY2

DAY3

Sulfadoxine +

health

Give daily

center for P.

for 14 days

Falciparum

for P. Vivax

Give single dose

TABLET

TABLET

TABLET

( 15MG)

( 15MG)

( 15MG)

Pyrimethamine

2months
5months

5 months
12 months

1/2

3/4

1/2

12months
3 years old

3 years old
5 years old

GIVE VITAMIN A
AGE

VITAMIN A CAPSULES 200,000 IU

6 months 12 months

1/2

12 months 5 years old

GIVE IRON
Iron/Folate Tablet
FeSo4 200mg + 250mcg Folate (60mg
elemental iron)

AGE or WEIGHT

Iron Syrup
FeSo4 150 mg/5ml
(6mg elemental iron per ml )

2months-4months
(4 <6kg )

2.5 ml

4months 12months
(6 <10kg )

4 ml

12months 3 years
<14kg)

(10
1/2

5 ml

3years 5 years ( 14 19kg

)

1/2

7.5 ml

GIVE PARACETAMOL FOR HIGH FEVER (38.5oC OR MORE) OR EAR PAIN

AGE OR WEIGHT

TABLET ( 500MG )

SYRUP ( 120MG / 5ML )

2 months 3 years

( 4 <14kg )

5 ml

3 years up to 5 years

(14 19 kg )

1/2

10 ml

GIVE MEBENDAZOLE

Give 500mg Mebendazole as a single dose in health center if :

hookworm / whipworm are a problem in children in your area, and
the child is 2 years of age or older, and
the child has not had a dose in the previous 6 months

Management of a Child with an Ear Problem

1.

2.

3.

Classification of Ear Infection

Mastoiditis tender swelling behind the ear (in infants, swelling may be above the ear)
Treatment
a.
Antibiotics
b.
Surgical intervention
Acute Ear Infection pus draining from the ear for less than 2 weeks, ear pain, red, immobile ear
drum (Acute Otitis Media)
Treatment
a.
Cotrimoxazole,Amoxycillin,or Ampicillin
b.
Dry the ear by wicking
Chronic Ear Infection pus draining from the ear for more than 2 weeks (Chronic Otitis Media)
Treatment
a.
Most important & effective treatment: Keep the ear dry by wicking.
b.
Paracetamol maybe given for pain or high fever.
c.
Precautions for a child with a draining ear:

Do not leave anything in the ear such as cotton, wool between wicking
treatments.

Do not put oil or any other fluid into the ear.

Do not let the child go swimming or get water in the ear.

Maternal and Child Health Nursing Program

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 complication 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.

1.
2.
3.
4.

Danger Signs
any type of vaginal bleeding
headache, dizziness, blurred vision
puffiness of face and hands
pallor

Prenatal Care

Schedule of Visits
1st as early as pregnancy, 1st trimester
2nd 2nd trimester
3rd & subsequent visits 3rd trimester
More frequent visits for those at risk with complications

Tetanus Toxiod Immunization Schedule for Women

Vac
cine

Minimum Age
Interval

Per
cent
Prot
ecte
d

TT1

As early as
possible during
pregnancy

0%

None

TT2

At least 4 weeks
later

80%

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

Duration of Protection

Infants born to the mother will be protected from neonatal tetanus.

TT3

At least 6 months
later

90%

Gives 5 years protection for the mother.

TT4

At least 1 year
later

99%

Gives 10 years protection for the mother

TT5

At least 1 year
later

99%

Gives lifetime protection for the mothers. All Infants born to that mother w
be protected.

Dose: 0.5ml
Route: Intramuscular
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 5th mo. Of pregnancy 2 mos. Postpartum
In goiter endemic areas iodized capsule once a year
In malaria infested areas- prophylactic Chloroquine (150 mg/tab ) 2 tabs/ wk for the whole duration
of pregnancy

Non-Communicable Diseases and Rehabilitation

Prevention and Control of Cardiovascular Diseases

heart 1st leading cause of death ; blood vessels 2nd

Congenital Heart Disease (CHD): Result of the abnormal development of the heart that exhibits
septal defect, patent ductus arteriosus, aortic and pulmonary stenosis, and cyanosis; most prevalent in
children
Causes: environmental 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
Predisposing Factor: Hypertension (HPN),Diabetes Mellitus (DM), Smoking
Minor Risk Factor: stress, strong family history, obesity
Cardiovascular Disease
Period of Life
At birth to early
childhood

Type of CVD

Prevalence

Congenital Heart Disease

2/ 1000 school children (aged 5-15

yrs. old)

Early to late childhood

Rheumatic Fever/ Rheumatic Heart Disease

1/1000 school children (aged 5-15 y

old)

Early Adulthood

Diseases of Heart Muscles Essential

Hypertension

10/100 adults

Middle age to old age

Coronary Artery Disease Cerebrovascular

5/100 adults

Accident

Cardiovascular Disease
Diseases

Causes/ Risk factors

Congenital Heart Disease

Maternal Infections, Drug intake, Maternal Disease, Genetic

Rheumatic Fever/Rheumatic Heart

Disease

Frequent Streptoccocal Sore Throat

Essential Hypertension

Heredity, High Salt Intake

Coronary Artery Disease

(Heart Attack)

Smoking, Obesity, Hypertension, Stress Hyperlipidemia, Diabetes Mellitus

Sedentary Life Style

Cerebrovascular Accident
(Stroke)

Hypertension, Arteriosclerosis

Primary Prevention: CVD

Disease

Primordial

Congenital Heart

Disease

Rheumatic Heart
Disease

Essential

Prevention of recurrent sore throat thru

adequate environmental sanitation; avoidance of
overcrowding; adequate treatment

From early childhood

low salt diet
adequate physical exercise

Prevention of development/ acquisition of risk

factors

Disease (Heart

Attack)
Cerebrovascular
Accident

Prevention of viral infection and intake of

harmful drugs during pregnancy.
Avoidance of marriage between blood
relatives

Hypertension

Coronary Heart

Specific Protection

cigarette smoking
high fat intake
high salt intake

all measures to prevent hypertension &

arteriosclerosis

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

Identification of cases of
rheumatic fever
Prophylaxis with penicilli
or erythromycin

Continued low salt diet a

adequate exercise

cessation of smoking
control /treatment of
diabetes, hypertension
weight reduction
change to proper diet
Adjustment of activities
all measures to control
hypertension & progression of

(Stroke)

1.
2.
3.
4.
5.

arteriosclerosis

Primary Prevention thru health education is the main focus of the program:
Maintenance of ideal body wt.
diet low fat
alcohol/smoking avoidance
exercise
regular BP check up

Cancer Prevention and Early Detection

Any malignant tumor arising from the abnormal and uncontrolled division of cells causing the
destruction in the surrounding tissues.
Common Cancer: Lung cancer, cervical cancer, colon cancer, cancer of the mouth, breast cancer,
skin cancer, prostate cancer.
3rd leading cause of illness and death (Phil.)
Incidence can only be reduced thru prevention and early detection

Nine Warning Signs of Cancer:

Change in blood bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty in swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
Unexplained anemia
Sudden unexplained weight loss

Prevention & Early Detection

CA
type
Lung

Prevention

Detection

No smoking

None

Uterin
e

Monogamy, Safe sex

Paps smear every 1-3 yrs

Cervic
al

Monogamy, Safe sex

Paps smear every 1-3 yrs

Liver

Hep B vaccination, Less alcohol intake,

Avoidance of moldy foods

None

Colon

High fiber diet

Regular medical checkup

after 40 yrs of age

Rectu
m

Low fat intake

Mouth

No smoking, betel nut chewing, Oral

hygiene

Fecal occult blood test DRE Sigmoidoscopy

Regular dental check-ups

Breast

none

Monthly SBE, Yearly exam by doctor, Mammography fo

50 yrs old and above females

Skin

No excessive sun exposure

Assessment of skin

none

Digital transrectal exam

Prosta
te

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:

1.
2.
3.

Surgery
Radiation Therapy
Chemotherapy
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

Prevention and Control of Kidney Disease

1.

2.
3.
4.
5.
6.
7.
8.

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.
Program on Mental Health and Mental Disorders

Mental Health
Mental health is not merely the absence of mental illness. According to the World Health
Organization (WHO) Manual on Mental Health, a person is in a state of sound mental health when,
o He feels physically well
o His thought are organized
o His feelings are modulated
o His behaviors are coordinated and appropriate
(*note: behaviors considered normal may vary according to cultural norms)

Any person may develop mental illness regardless of race, nationality, age, sex civil status and
socio-economic background may develop mental illness.

Causes of Mental Illness

A Combination or One of These:
1.

2.

3.

4.

Biological factors
Like hereditary predisposition, poor nutrition
Physical Factors
Physical injuries, intoxication
Psychological Factors
Failure to adjust to the difficulties in life.
Socio-economic Factors
Unemployment, housing problems
How is Mental Illness Detected?

1.
2.
3.

Interview and assessment by the Clinical Social Worker.

Psychological testing and evaluation.
Psychiatric interview and mental status examination.
Is Mental Illness Curable?

Yes. Mental illness is curable if detected early and prompt and adequate treatment is given.
Treatment depends on severity of illness and includes:

Pharmacotherapy (use of medicines)

Various therapies (physical, recreational, occupational, environmental)

Psychotherapy and others

1.
2.
3.
4.
5.
6.

Prevention of Mental Illness

Maintain good physical health.
Choose worthwhile activities and develop a hobby
Solve problems as they come and avoid excessive worrying.
Cultivate friendships and choose a friend to confide in.
Strike a happy medium between work and play.
Recognize early signs and symptoms.
Some Early Signs of Symptoms Mental Illness
Persistent disturbance in sleep and appetite
Over sensitiveness and excessive irritability
Loss of interest in activities or responsibilities of previous concern
Constant complaint of headaches, weakness of hands and feet and other bodily complaints.
Persistent seclusion of oneself from other people.
Frequent attacks of palpitations usually expressed as nerbiyos & associated with unexplained
fears.
Frequent attacks of dizziness & fainting.
Exaggerated and /or unfounded suspicions
Persistent worrying, forgetfulness & absentmindedness.
Program on Drug Dependence/ Substance Abuse

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.
Program on the Elderly/Geriatric Nursing Services

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
Programs on Blindness, Deafness and Osteoporosis
Cataract- main causes of blindness
VAD- main cause of childhood blindness; most serious eye problem of Filipino children below 6 yrs.

old

Osteoporosis special problem in women, highest bet. 5079 yrs. old, MENOPAUSE main cause

Nursing Procedures in the Community

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
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

1.
2.
3.
4.
5.

Separating the articles used by a client with communicable disease to prevent the spread of
infection:
Frequent washing and airing of beddings and other articles and disinfections of room
Wearing a protective gown, to be used only within the room of the sick member
Discarding properly all nasal and throat discharges of any member sick with communicable disease
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

Family Planning Program

Overview
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.
b.
c.
d.
e.
a.
i.
ii.
iii.
iv.
b.
i.
ii.
iii.
c.
i.
ii.

NATURAL METHODS
Calendar or Rhythm Method
Basal Body Temperature Method
Cervical Mucus Method
Sympto-Thermal Method
Lactational Amennorhea
ARTIFICIAL METHODS
Chemical Methods
Ovulation suppressant such as PILLS
Depo-Provera
Spermicidals
Implant
Mechanical Methods
Male and Female Condom
Intrauterine Device
Cervical Cap/Diaphragm
Surgical Methods
Vasectomy
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, breast lumps

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

Injectables
Dizziness
Severe headache
Heavy bleeding
BTL

Fever
Weakness
Rapid pulse
Persistent abdominal pain
Vomiting
Dizziness
Pus or tenderness at incision site
Amenorrhea

Vasectomy
Fever
Scrotal blood clots or excessive swelling