COMMUNITY

HEALTH NURSING

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12/09/2021 2
 Community Health Nursing:
The 3 Broad Concepts
1. What is a community?
– a group of people with
common characteristics or
interests living together within
a territory or geographical
boundary

–  place where people under

usual conditions are found

– The community is the object

or focus of care in CHN, with
the family as the unit of
service.
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 FACTS of CHN
Focus : promotion and preservation of health
Area of Content: skills and knowledge
relevant to both nursing and public
health
Clients : general populations (individuals,
families, communities)
Time : continual, not limited to episodic care
Scope : comprehensive and general, not
limited to a particular age or group
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 Concepts on Community Health
Nursing:
 CLIENTS of Community Health
Nurse
 Composed of different levels
of clientele: Individual, family,
population group, and
community

• Community as a SETTING for

CHN PRACTICE
 School Health Nursing-
School
 Occupational Health
Nursing- Workplace
 Public Health Nursing-Home

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 2. What Is Health?

A state of complete
physical, mental,
and social well-
being and not
merely the absence
of disease and
infirmity (WHO,
1995).
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 What is Health?
It carries the mandate that health is a
basic human right.

It is seen as a spectrum or a continuum

• The modern concept of health refers to
Optimum Level of Functioning (OLOF) of
individuals, families, and communities, which
is influenced by the ecosystem through a
myriad
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of factors. 7
 What influences OLOF?
• Behavioral (culture, habits, mores, ethnic customs)
• Socio-economic (employment, education, housing)
• Political (safety, oppression, people, empowerment)
• Hereditary (genetic endowment, familial, racial)
• Health Care Delivery System (promotive, preventive,
curative, rehabilitative)
• Environment (air, food, water, wastes, noise, radiation,
pollution, congestion)
 3. What is Nursing?

 The diagnosis and treatment

of human responses to actual
or potential health problems
(ANA, 1980).

 Nursing, together with public

health, is one of the helping
professions in the health care
system which operates at
three levels of clientele –
individuals, families or groups,
and communities

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It operates within the realm of health care
both independently and interdependently.
The objective of nursing is to assist clients
to achieve, maintain, or recover a high
level of functioning.
Assisting sick individuals to become
healthy and healthy individuals achieve
optimum wellness (Henderson)

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The PHILOSOPHY of CHN

• is based on the
worth and
dignity of man
(Shetland)
 •Concepts and
Principles pertaining
to CHN
 Knowledge-base of CHN
• Biological and social sciences

• Ecology

• Clinical Nursing

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• Utilizes
COMMUNITY
HEALTH
ORGANIZATIONS
 it is population-focused – “the greatest
good for the greatest number”
> Community diagnosis
> Vital statistics
> Priority setting

 it is a promotive-preventive service
– adheres to Primary Health Care
> Health education
> Preventive treatment

• It is a generalist practice – deals with all

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cases 15
 The ULTIMATE GOAL of CHN
• By:

RAISE the  help communities and

families cope with
discontinuities in health and
level of threats
 Maximize their potential for

health of high level wellness

 Promote reciprocally
supportive relationship

citizenry between people and their

physical and social
environment
…
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 The PRIMARY FOCUS of CHN

health promotion wherein health

teaching is the primary
responsibility of the community
health nurse, who is a generalist
in terms of practice

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 Principles of CHN
E – ducation as primary tool and responsibility
M – ade available to all regardless of race, creed and socio-economic
status
P – olicies and objectives of the agency is fully understood by the nurse
O – rganizing for health, with the family as the unit of service
W – orks as a member of the health team (PHN)
E – xisting active organizations are utilized
R – ecording and reporting are accurate
M – onitoring and evaluation of services is periodically done
E – xisting indigenous resources of the community is used
N – eeds of clienteles is recognized and serves as basis for CHN
T – raining and development as opportunities for continuing staff education
programs

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 REMEMBER that in CHN:
1. The patient in CHN is the Community which is composed of
different population groups and several families (the basic unit of
care), and In turn compose of individuals.

2. Client is ACTIVE and NOT PASSIVE recipient of care

 
3. CHN practice is affected by any changes in society and environment

4. Multi-sectoral effort is the key to goal achievement

5. CHN is a part of health care system and the larger human services
system. 
 

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 Quick Review
Exercises

(QRX)

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 QRX
In terms of CHN practice, the nurse in the
community is trained as
a. Certified in public health
b. Specialist in CHN
c. 4-year BSN graduate
d. Generalist in nursing

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Ans: d. Generalist in
nursing
 QRX
The thrusts of CHN must be embodied in the hearts
of health care providers. Which one strengthens
the health care system?
a. Supporting conditions for healthy habits
b. Increasing opportunities to be healthy
c. Letting the people manage their own health
d. Financing health care program

Ans: c.Letting the people manage their own health

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Ans:
c.Letting the people
manage their own
health
 QRX
As a Public Health Nurse, what is your
primary function or responsibility?

a. Reporting of cases
b. Health Promotion
c. Community Diagnosis
d. Health Teaching

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• Ans:

d. Health
Teaching
 QRX
The philosophy of CHN practice is based on
the belief that the family is the smallest unit
in a democratic society. Which age group
should be the priority of the nurses in the
community?
a. Older persons and terminally ill
b. Adolescents and adults
c. Infants and children
d. All ages regardless of status
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Ans:
d. All ages
regardless of
status
 HIGHLIGHTS in CHN Concepts

CHN is based on the recognized needs of

communities, families, groups, ands
individuals.

• CHN is a unique blend of nursing and

public health practice, and is oftentimes
used interchangeably with the term
“Public Health Nursing”.
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 Philosophy of Public Health
Health and longevity as birthrights

Longevity – average lifespan or life expectancy

• 50 years – Swaroop’s Index
• Untimely death – person died without reaching
the average lifespan

Combined (M/F) – 69.6 y/o

Male – 66.74 y/o
Female – 72.61 y/o

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 Objectives of Public Health

3 P’s:
Promote health
Prevent Disease
Prolong Life

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 Basic Public Health Services
• Environmental Sanitation
• Health Education
• Prevention of Communicable Diseases
• Medical Services
• Nursing Services
• Vital Statistics
• Public Health Laboratories
• Maternal and Child Health Services

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 Basic Competencies Needed by the
Public Health Nurse
• Teaching
• Management
• Critical Thinking
• Physical Caregiving
• Application of the Nursing Process
• Application of the Epidemiological
Process
• Documentation
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 Functions of the PHN
Manager
> Planner, Programmer, Supervisor, Coordinator of services
Health Care Provider
> Direct nursing care
Researcher
> Epidemiologist, Health Monitor, Recorder, Statistician
Community Organizer
> Change Agent
Trainer
> Health Educator, Counselor
Role Model

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In the care of the families:

Provision of primary health care services

 Developmental/Utilization of family
nursing care plan in the provision of care

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In the care of the communities:
 
• Community organizing mobilization, community development
and people empowerment
• Case finding and epidemiological investigation

• Program planning, implementation and evaluation

• Influencing executive and legislative individuals or bodies

concerning health and development

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 Responsibilities of CHN:
– be a part in developing an overall health plan, its implementation
and evaluation for communities
– provide quality nursing services to the three levels of clientele,
the standards ser for CHN practice
– maintain coordination/linkages with other health team members,
NGO/government agencies in the provision of public health
services
– conduct researches relevant to CHN services to improve
provision of health care
– provide opportunities for professional growth and continuing
education for personal growth thru staff development

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 CHN Process
1. Establishing a working relationship with
the client
• Initiating contact
• Communicating interest in the client’s
welfare
• Showing willingness to help with
expressed need of the client
• Maintaining a two-way communication
with the client
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 CHN Process
2. Assessment of needs, taking into consideration
personal, environmental and psycho-socio- cultural
factors influencing health
• Situation and trends revealed in personal, socio-
economic and environmental history
• Physical, emotional, intellectual ability to perform a
function
• Attitudes, knowledge and perceptions of health and
illness
• Health behavior and patterns of health care
• Resources available to meet own needs
• Other factors affecting health
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A. Collection of Data
A. Community
 Demographic data
 Vital statistics
 Community Dynamics
 Disease surveillance
 Economic, cultural , and environmental characteristics
 Health service utilization

B. Family and Individual

- Health status/ education
- Socio-cultural factors
- Occupation
- Family dynamics
- Environment
- Patterns of coping

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B. Categories of Health Problem
A. Wellness State
B. Health Deficit
C. Health Threat
D. Foreseeable Crisis

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 CHN Process

3. Planning of care

• Summarizing problems and needs

• Establishing priorities of care
• Setting objectives of care
• Determining approaches or strategies
to meet identified objectives

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 CHN Process

4. Implementation of care

• Actual delivery of care

• Institution of planned interventions
• Application of coordination,
supervision, social mobilization,
health education, therapeutic
communication
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 CHN Process
5. Evaluation of care

• Monitoring of status
• Systematic documentation of
results
• Analysis of effectiveness of care
provided
(Structural elements, Process
Elements, and Outcome elements)
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 Levels of Clientele
Individual
 
• Basic approaches in
looking at the
individual:
 
– Atomistic
 
– Holistic

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Family
 
Models:

Developmental
 
Stages of Family Development
 
Stage 1 – The Beginning Family
 
 
Stage 2 – The Early Child-bearing Family
 
 
Stage 3 – The Family with Preschool Children
 
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Stage 4 – The Family with School Age Children
 
Stage 5 – The Family with Teen-agers
 
 Stage 6 – The Family as Launching Center
 
Stage 7 – The Middle-aged Family
 
Stage 8 – The Aging Family 

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 Structural-Functional

Initial Data Base

Family structure and Characteristics

Socio-economic and Cultural Factors

Environmental Factors

Health Assessment of Each Member

Value Placed on Prevention of Disease

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First Level Assessment
Health threats:
 conditions that are conducive to disease, accident or failure to realize one’s
health potential
 
Health deficits:
 instances of failure in health maintenance (disease, disability, developmental
lag)
 
Stress points/ Foreseeable crisis situation:
 anticipated periods of unusual demand on the individual or family in terms of
adjustment or family resources

Wellness State/ Potential 

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Second Level Assessment:
 
• Recognition of the problem
• Decision on appropriate health action
• Care to affected family member
• Provision of healthy home environment
• Utilization of community resources for
health care

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 Problem Prioritization:

Nature of the problem

Wellness State
Health deficit
Health threat
Foreseeable Crisis

Preventive potential
High
Moderate
Low

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• Modifiability
Easily modifiable
Partially modifiable
Not modifiable

• Salience
High
Moderate
Low

*Family Service and Progress Record

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Population Group

• Vulnerable Groups:
 
Infants and Young Children
School age
Adolescents
Mothers
Males
Old People
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 CHN Process
Community Diagnosis
• Determining the health status of the
populations in the community as well as the
factors that directly or indirectly affect their
health status
• It is an integral part of the assessment phase
of the CHN Process
• It is also known as community assessment
or situational analysis
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• A process by which the people in the
community and the health team assess
the community’s health problems and
needs as bases for health program
development.
• A learning process for the community to
identify their own health problems and
needs.
• A profile that depicts the health problems
and potentials of the community.
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2 types of Community Diagnosis:

1. Comprehensive- provides general health

profile of the community

2. Specific or Problem-Oriented- yields a

comprehensive profile of a particular
health problem

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STEPS:
Preparatory Phase
 
1. site selection
2. preparation of the community
3. statement of the objectives
4. determine the data to be collected
5. identify methods and instruments for data
collection
6. finalize sampling design and methods
7. make a timetable
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Implementation Phase

1. data collection
2. data organization/collation
3. data presentation
4. data analysis
5. identification of health problems
6. prioritization of health problems
7. development of a health plan
8. validation and feedback

Evaluation
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 CHN Process
Parts of Community Diagnosis:
A. Demographic Variables
• Total population and population density
• Age and sex composition, Population Pyramid
• Sex Ratio
• Civil Status
• Population movement/patterns of migration
• Growth Rate, Life Expectancy
• Crude Birth Rate, Crude Death Rate
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 CHN Process
Parts of Community Diagnosis:
B. Social Indicators
• Literacy Rate
• Educational attainment
• Communication network
• Transportation system
• Housing conditions (types, ownership,
lighting, ventilation, crowding/congestion)
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 CHN Process
Parts of Community Diagnosis:
C. Economic Indicators
• Dependency Ratio
• Occupation
• Income
• Poverty index
• Unemployment Rate
• Underemployment Rate
• Types of industry present in the community
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 CHN Process
Parts of Community Diagnosis:
D. Cultural Factors
• Ethnicity
• Race
• Language
• Religion
• Beliefs (superstitions and traditions)

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 CHN Process
Parts of Community Diagnosis:
E. Environmental Indicators
• Topographical characteristics
• Water supply
• Garbage disposal/collection system
• Excreta disposal
• General sanitary condition

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 CHN Process
Parts of Community Diagnosis:
F. Health Patterns
• Food storage
• Infant feeding practice
• Immunization status
• Health seeking behavior
• Source of health information
• Leading causes of mortality, morbidity, infant
mortality, infant morbidity, maternal mortality

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 CHN Process
Parts of Community Diagnosis:
G. Health Resources
• manpower-population ratio
• manpower distribution
• manpower policies
• health budget and policies
• sources of health funding
• categories of health institutions available
• categories of health services available
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 CHN Process
Parts of Community Diagnosis:
H.Political and Leadership Patterns
• Power structures in the community
• Confidence of people to authority
• Conditions that cause developmental conflicts
• Prevailing issues
• Practices that are usually utilized in settling
concerns of the community
• Stakeholder Analysis
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 CHN Process
Steps in Conducting Community Diagnosis:
1. Determining the objectives
2. Defining the study population
3. Determining the data to be collected
4. Developing an instrument
• survey questionnaire
• interview schedule
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 CHN Process
Steps in Conducting Community Diagnosis:
5. Data gathering
• Records review
• Observation
• Surveys
• Interviews
6. Data collation
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 CHN Process
Steps in Conducting Community Diagnosis:
7. Data presentation
8. Data analysis
9. Identification of CHN Problems
• Health status
• Health resources
• Health-related
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 CHN Process
Steps in Conducting Community Diagnosis:
10.Prioritization of CHN Problems
• Nature
• Magnitude
• Modifiability
• Preventive potential
• Social concern
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 Biostatistics

A. Demography
A study of population size, composition,
and spatial distribution as affected by
births, deaths, and migration

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SOURCES OF DEMOGRAPHIC
DATA:

1. Survey
1. Census- De jure or De facto
2. Sample Survey
2. Continuing Population Registers
3. Other Records and Registration Systems

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COMPONENTS:
Population Size
1. Natural increase
2. Net migration
3. Rate of natural increase
Population Composition
4. Age Distribution
5. Median Age
6. Dependency Ratio
7. Sex Ratio
8. Population Pyramid
9. Others: occupational groups, economic groups,
educational attainment, and ethnic groups
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Population Distribution
1. Urban-Rural
• Shows the proportion of people living in urban
compared to the rural areas
2. Crowding Index
• Indicates the ease by which a communicable
disease can be transmitted from 1 host to another
susceptible host
3. Population Density
• Determines the congestion of the place

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B. VITAL STATISTICS
The application of statistical measures to
vital events (births, deaths and common
illnesses) that is utilized to gauge the
levels of health, illness and health services
of a community.

• Fertility Rate

– Crude Birth Rate

– General Fertility Rate
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Mortality Rates
Crude Death Rate
Specific Mortality Rate
Infant Mortality Rate
Neonatal Mortality Rate
Post-neonatal Mortality Rate
Maternal Mortality Rate
Proportionate Mortality Rate
Swaroop’s Index
Case Fatality Rate
Cause-of- Death Rate
Morbidity Rate
Prevalence
Incidence Rate
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C. EPIDEMIOLOGY

– The study of distribution of disease or

physiologic condition among human
population s and the factors affecting such
distribution

– The study of the occurrence and distribution

of health conditions such as disease, death,
deformities or disabilities on human
populations
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Basic Concepts:

– Epidemiologic Triad
– Transmission
– Incubation period
– Herd immunity

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Factors affecting distribution:

• PERSON
– intrinsic characteristics
• PLACE
– extrinsic factors
• TIME
– temporal patterns

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Patterns of Disease Occurrence:
• Epidemic
– a situation when there is a high incidence of new cases of a
specific disease in excess of the expected.
– when the proportion of the susceptible are high compared to the
proportion of the immunes
• Epidemic potential
– an area becomes vulnerable to a disease upsurge due to causal
factors such as climatic changes, ecologic changes, or socio-
economic changes

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• Endemic
– habitual presence of a disease in a given geographic location
accounting for the low number of both immunes and susceptible
e.g. Malaria is a disease endemic at Palawan.
– the causative factor of the disease is constantly available or
present to the area.
• Sporadic
– disease occurs every now and then affecting only a small
number of people relative to the total population
– intermittent
• Pandemic
– global occurrence of a disease

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THE NATIONAL HEALTH SITUATION

 Health Care Delivery System

Health Care Delivery System is

“the totality of all policies, facilities,
equipments, products, human resources
and services which address the health
needs, problems and concerns of the
people. It is large, complex, multi-level and
multi-disciplinary.”
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According to Increasing Complexity According to the Type of
of the Services Provided Service

Type Service Type Example

Primary Health Promotion, Health Information
Preventive Care, Continuing Promotion Disseminati
Care for common health and illness on
problems, attention to Prevention
psychological and social
care, referrals

Secondary Surgery, Medical services by Diagnosis and Screening

Specialists Treatment

Tertiary Advanced, specialized, Rehabilitation PT/OT

diagnostic, therapeutic &
rehabilitative care

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 The
Health
DOH
Sector LGU

NGO/PS

Self-Reliant, Healthy Filipino

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 The Health
Sector
Department of Health
Vision: Leader and staunch advocate and model
in promoting Health for ALL in the Philippines

Mission: Guarantee equitable, sustainable, and

quality health for all Filipinos, specially the poor
and shall lead the quest for excellence in health

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3 Major Functions:

1. LEADERSHIP in health

National policy – formulation, monitoring and evaluation
Regulatory institution
Advocates adoption of health policies, plans and programs

2. Enabler and Capacity Builder

Innovate new strategies to improve health programs
Exercise oversight function
Ensure highest achievable standards

3. Administrator of Specific Services

Manage selected national health facilities and hospitals
Administer direct services for emergent health concerns
Administer health emergency response services
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 DOH Programs
D – ental Health
O – perations for Environmental Sanitation
H – ealth Education and Community Organizing
P – revention and Control of Communicable Diseases
R – eproductive Health
O – lder Persons Health Services
G – uidelines for Nutrition
R – ehabilitation and Management of Non-communicable Dse.
A – lternative Health Care Practices (HerbalMeds/Acupressure)
M – aternal and Child Health and IMCI
S – entrong Sigla Movement
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Local Government Units (LGU)
RA 7160 Local Government Code

Private Sector
Composed of both commercial and business
organizations, non-business organizations

Non-Government Organizations
Assumes the following roles:
 Policy and Legislative Advocates
 Organizers, Human Rights Advocates
 Research and Documentation
 Health Resource Development Personnel
 Relief and Disaster Management
 Networking

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 PRIMARY LEVEL SECONDARY LEVEL TERTIARY LEVEL
Health Promotion and Prevention of Prevention of Disability,
Illness Prevention Complications thru Early etc.
Dx and Tx

Provided at – ► When hospitalization ► When highly-

► Health care/RHU is deemed specialized medical care
► Brgy. Health Stations necessary and referral is is necessary
►Main Health Center made to emergency ► Referrals are made to
►Community Hospital (now district), provincial hospitals and medical
and Health Center or regional or private center such as PGH,
►Private and Semi- hospitals PHC, POC, National
private agencies Center for Mental Health,
and other gov’t private
hospitals at the municipal
level

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 Primary Health Care
WHO: PHC was declared in the ALMA ATA
CONFERENCE(USSR) in September 6-
12, 1978, as a strategy to community
health development.
Philippines: Adopted through LOI 949
signed by President Marcos on October
19, 1979 with the theme-
“Health in The Hands of the People by 2020”

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 Primary Health Care
Community-
Based

Affordable Accessible

PHC

Acceptable Sustainable

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 Framework

People
Empowerment

“Health for All

Filipinos by the
Year 2000 and
Health in the
Hands of the
People by
2020”

Partnership

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 How can PHC be possible?
Control of Communicable Diseases
Offers Health Education
Maternal and Child Care
Provision of Medical Care and Emergency Treatment
Offers “Immunization”
Nutrition and Food Supply
Environmental Sanitation
N “Family Planning”
Treatment of Locally Endemic Diseases
Supply and Proper Use of Essential Drugs

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 S P S
C U
E R
O P
C O
M P
T P
M. O
O E
R R R
P T
A
A
L T
R M
E
T E
L C
I C
I H
P H
N N
A A
K O
T N
A L
I I
G O
O S
E G
N M
S Y

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 PILLARS
A. Multi-sectoral approach
Intersectoral linkages (population control, private
sectors, social welfare, public service, enrironmental,
etc.)

Intrasectoral linkages (people’s empowerment;

within own system)

B. Community Participation
e.g. Community Organizing
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C. Appropriate Technology

- method used to provide a socially and environmentally acceptable

level of service or quality product at the least economic cost.
Criteria:
Safe
Acceptable Example:
Feasible - ORS
Effective - - Herbal Meds
Scope-wise - -Botica sa Baryo
- -Use of
Affordable Indigenous
Complex Materials

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 10 Medicinal
Plants:
Bawang-anti cholesterol
Ulasimang-Bato-lowers uric acid
Bayabas- antiseptic; diarrhea
Lagundi-cough, asthma, and colds
Yerba Buena- toothache, pain, and arthritis
Sambong- renal calculi
Ampalaya- diabetes mellitus
Niyog-niyogan- anti-helminthic
Tsaang-Gubat- diarrhea
Akapulko- fungal infection RA 8423: utilization
of medicinal plants as
alternative for high cost
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 D. Support mechanism made
available
TYPES OF PRIMARY HEALTH WORKERS
Village/Grassroots Intermediate Level Health Personnel of
Health Workers First-Line Hospitals

Trained Community General Medical Physicians with

Health worker; health Practitioners specialty area
auxiliary volunteer; Public Health Nurses Nurses
Traditional Birth Midwives Dentists
Attendant

Establish close contact

Initial link, 1st contact of 1st source of
with the village and
the community
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intermediate level HW 98
 Strategies and Programs:
D – ental Health
O – perations for Environmental Sanitation
H – ealth Education and Community Organizing
P – revention and Control of Communicable Diseases
R – eproductive Health
O – lder Persons Health Services
G – uidelines for Nutrition
R – ehabilitation and Management of Non-communicable Dse.
A – lternative Health Care Practices (Herbal Meds/Acupressure)
M – aternal and Child Health and IMCI
S – entrong Sigla Movement
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 Reproductive Health
• Exercise of reproductive right &
responsibility
• Vision: RH practice as a way of life for every
man and woman throughout life
• Goals: 4 E’s
> Every pregnancy should be intended
> Every birth should be healthy
> Every sex act should be free of coercion
> Every family should achieve its desired size
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 Reproductive Health

• International Framework
> Focus: WOMEN’S health
> Ultimate Goal: Quality of life
• Local Framework
> Focus: RH status of both MEN and
WOMEN
> Consideration: in terms of its
ELEMENTS
12/09/2021 101
 Reproductive Health
• TEN ELEMENTS OF RH: A VERB F MP3
A – dolescent RH
V – iolence Against Women (VOW)
E – ducation & counseling on sexuality & sexual health
R – eproductive Health of Men
B – reast & reproductive tract cancers & other Gyne conditions
F – amily planning
M – aternal & child health & nutrition
P – revention & management of abortion complications
P – revention & treatment of reproductive tract infection
P – revention & treatment of infertility & sexual disorder

12/09/2021 102
 Maternal Health
Goal: promotion and maintenance of optimal health
of women and their fetuses/newborn
Philosophy: pregnancy, labor, delivery and
puerperium are part of the total life cycle; family-
centered
Prenatal Care: used to screen out the women at
RISK for closer prenatal supervision
Objectives of Prenatal Care: to reach all pregnant
women, to give sufficient care to ensure a healthy
pregnancy and the birth of a full term healthy
baby
12/09/2021 103
Strategies:
A. Provision of Regular and Quality Maternal Care
Services
► regular and quality pre-natal care
• hx-taking, utilization of HBMR (Home-Based Mother’s
Record) as a guide in the identification of risk factors
• PE: weight, height, BP-taking
• Perform head-to-toe assessment, abdominal exam
• Tetanus Toxoid Immunization
• Fe supplementation: given from 5th mo. of pregnancy to two
months postpartum (100-120 mg orally/day for 210 days)
• Laboratory exam: Heat-acetic acid test. Benedict’s test
• Oral/Dental exam

12/09/2021 104
• Classification of Pregnant Women:

> Normal Patients

> Patients with mild complications
> Patients with Serious or Potentially Serious
Complications

12/09/2021 105
• Prenatal Visits:

> 1st: as early in pregnancy as

possible, during the first trimester
> 2nd: during the second trimester
> 3rd and subsequent visits: during
the third trimester
> Every 2 weeks after the 8th month
of pregnancy until delivery

12/09/2021 106
• Iron supplementation:
> given from 5th month prenatal up to 2 months
postpartum
> 60mg(iron) /400 (folic acid) ug per orem daily
for 210 days
• In goiter endemic areas:
> one iodized oil capsule per year
• Malaria infested areas:
> Chloroquine prophylaxis
> 2 tab (150mg/tab) per week for the whole
duration of pregnancy
• Tetanus Toxoid Immunization
12/09/2021 107
TETANUS TOXOID IMMUNIZATION
Minimum Interval % Protection Duration of Protection

TT1 • As early as possible 80%

-Infants born to the mother will be

TT2 protected from neo-natal tetanus
• At least 4 weeks later 80%
-Gives 3 yrs. Protection for the mother

-Infants born to the mother will be

TT3 • At least 6 months later 90%
protected from neo-natal tetanus
-Gives 5 yrs. protection for the mother

-Infants born to the mother will be

99% protected from neo-natal tetanus
• At least 1 yr. later
TT4 -Gives 10 yrs. Protection for the
mother

-Gives Lifetime Protection For The

99% Mother
• At least 1 yr. later
TT5 -All infants born to that mother will
be protected

12/09/2021 108
►Pre-natal counseling
 
►Provision of safe, delivery care
– all birth attendants shall ensure clean and
safe deliveries at home or at the faciltiies
(RHUs/hospitals)
– at-risk pregnancies and mothers must be
immediately referred to the nearest institution
– untrained TBA’s who actively practice must be
identified, trained and supervised by a
personnel of the nearest BHS/RHU trained on
maternal care.
12/09/2021 109
High Risk Factors in
Pregnancy:
-Age
- Height
- Gravida
- History of C/S or P/P
Hemorrhage
- Having any of these
medical conditions: PTB,
Heart Dse., DM,
Bronchial Asthma, Goiter,
3 consecutive
abortions/miscarriage/
still birth

12/09/2021 110
Qualifications for Home Delivery
• Full term
• Less than 5 pregnancies
• Cephalic presentation
• Without existing diseases
• No Hx of complications like P/P hemorrhage
• No Hx of difficult delivery/prolonged labor
• No previous C/S

12/09/2021 111
►Provision of quality 3 C’s in Home deliveries:
postpartum care
Proper schedule of follow-
up must be followed:
– 1st postpartum visit for CLEAN CLEAN
home deliveries must be Hands Surface
done within 24 hours
after delivery
– 2nd, done at least 1 week
after delivery
– 3rd, done 2-4 weeks CLEAN
thereafter Cord

**Safe delivery: awareness of early

signs of complications, if present,
REFER
12/09/2021 112
B. Improvement of the health personnel’s capabilities on
newborn care, midwifery thru trainings. Trainings for
“hilots” must also be conducted. 
C. Improvement on the quality of care at the First Referral
Level
► Orientation, training should be done on the use of
proper filling-up of HBMR card
► Proper referrals/endorsements must be done for
future If-ups
D. Prevention of unwanted pregnancies through family
planning services
 
 
 
12/09/2021 113
E. Prevention and management of STDs
 
F. Promotion of Appropriate health practices
 
G. Upgrade reporting services
 
H. Mobilize political commitment and community
involvement to provide
Support to basic health care delivery

12/09/2021 114
 Expanded Program on
Immunization
• Launched in July 1976 by
the DOH in cooperation
with the WHO and the
UNICEF.
• Objective: Reduce the
morbidity and mortality
among infants and
children caused by the six
childhood immunizable
diseases. 

12/09/2021 115
 Principles:

– Based on
epidemiological
situation
– Mass approach is
utilized
– Integrated in health
services by the RHU

12/09/2021 116
 Elements of EPI:

– Target setting
– Cold chain logistic
management
– Information, education,
and communication
– Assessment and
evaluation of the
program’s overall
performance
– Surveillance, studies,
and research

12/09/2021 117
BCG
Reasons:
• BCG given at the earliest possible
age protects against the
possibility of infection from other
family members

No. of Doses: • One

Min. Age: At Birth

Interval:
Route/ST(oC): ID/+2 C to +8 C

12/09/2021 118
DPT • An early start with DPT
Reasons: reduces the chance of
severe pertussis

No. of Doses: • Three

Min. Age: 6 weeks

Interval: • 4 weeks

Route/ST(oC): IM/ +2 C/ +8 C

12/09/2021 119
OPV • The extent of protection
Reasons: against polio is increased
the earlier the OPV is given

No. of Doses: • Three

Min. Age: 6 weeks

Interval: • 4 weeks

Route/ST(oC): Oral/ -15 C to – 25 C

12/09/2021 120
Hep B
Reasons:
• An early start of Hepatitis b
reduces the chance of being
infected and becoming a carrier

No. of Doses: • Three

Min. Age: At Birth

• 1st & 2nd-6 weeks

Interval: • 2nd & 3rd- 8 weeks

Route/ST(oC): IM/ +2 C to +8 C

12/09/2021 121
Measles • At least 80% of measles
Reasons: can be prevented by
immunization at this age

No. of Doses: • One

Min. Age: 9 months

Interval:
Route/ST(oC): SQ/ -15 C to -25 C

12/09/2021 122
 Principles:
- Even if interval exceeded that of
the expected, CONTINUE doses
- Can still be given until 6 yo
- BCG should be given to school
entrants regardless of the presence
of BCG scar
- No contraindication to immunization
except when child had convulsions
after DPT1
- Malnutrition is not a contraindication
but rather an indication

12/09/2021 123
Cold Chain Principles:
 
I. Storage
► A system used to maintain the  
potency of a vaccine from that of Storage of vaccine should not
manufacture to the time it is given exceed:
to child or pregnant woman.  
  -6 mos. at the Regional Level

-3 mos. at the Provincial

Level/District Level

-1 mo. at Main Health Centers

(with refrigerators)

-not more than 5 days at Health

Centers (using transport boxes)
12/09/2021   124
 Important points to remember:

Arranging of stored vaccine

according to :
 
■ Type
■ Expiration date
■ Duration of Storage
■ Number of times they have
been brought out to the field

12/09/2021 125
 FAMILY PLANNING
METHOD
GOAL:

Improve maternal and

child health through:
- proper timing
- proper spacing= 3 years
- no. of pregnancies= 3

12/09/2021 126
 FAMILY PLANNING
I. Spacing
METHOD
A. Hormonal
1. Oral contraceptives
2. Injectables
3. Implants
B. Barrier
1. IUD
2. Condom
3. Diaphragm, Cervical cap
C. Biologic
1. LAM (Lactation-Amenorrhea Method)
D. Natural
1. BBT (Basal Body Temperature
2. Sympto-thermal
3. Cervical Mucus

12/09/2021 127
 II. Permanent
(surgical/irreversible)

A. Tubal Ligation - done in

women; a 15 min. surgical
procedure in which the fallopian
tubes are tied and cut to prevent
passage of sperms
B. Vasectomy - done in
men, was deferens is tied and
cut to block passage of sperm

12/09/2021 128
  
Under Five Care Program
UFC Program (Under
Five Care Program)

A package of child
health-related services
focused to the 0-59
months old children to
assure their wellness
and survival
 

12/09/2021 129
A. Growth and Health Monitoring

Growth Monitoring Chart (GMC)

A standard tool used in health centers to record vital
information related to child growth and development, to
assess signs of malnutrition.
• Sallen “Ming Scale”, Bar and Detect type scales are being
used
• All newborns must be enrolled for UFCP
 

12/09/2021 130
B. Oresol Therapy

Diarrhea
- Unusual frequency of bowel movements more than 3x/day
- Marked change in the amount of stool
- Increase in stool liquidity

3 CLASSIFICATIONS:
Mild -5 - 10 unformed stools/24 hours
Moderate -10 - 15 unformed stools/24 hours
Severe -> 15 unformed stools/24 hours with associated
signs/symptoms

12/09/2021 131
Dehydration
ORS, assess after 4 – 6 hours

 Management of Moderate and Severe Dehydration

 
• Intravenous fluids
• If NOT possible, assess if the child can drink (give ORS
and refer for IV)
• If cannot drink ( give fluids via NGT)

**If no NGT, refer immediately!

 

12/09/2021 132
Diarrhea Management at Home: 3 F’s
Fluids Frequent Feeding Fast Referral
► Oresol ► Continue If child doesn’t get
Rehydration breastfeeding better in 3 days, or if
Therapy ► With children over danger signs develop –
►Encourage/ensure 6 mos.: refer patient
intake of any fruit Cereals/ starchy Danger Signs:
juices, “am lugaw” foods mixed with ► Fever
homemade soup meat or fish and ► Sunken fontanel
vegetables ► Sunken eyeball
► Mashed banana or ► Frequent watery
any fresh fruit stool
► Feed the child at ► Repeated vomiting
least 6x/day ► Blood in stool
► After diarrhea ► Poor intake of meals
episode, feed 1 ► Weakness
extra meal/day for  
2 weeks

12/09/2021 133
ORS : Home-made Oresol:
1 L of water 1 glass of water
1 pack
8 tsp. of sugar OR 2 tsp. of sugar
1 L of water
1 tsp. of salt 1 pinch of salt
Contains:
• glucose for Na absorption Remember:
• NaCI for fluid retention
• NaHCO3 to serve as a buffer • Infant must be given ¼ - ½ cup
system every after LBM
• KCL for smooth muscle • Child must be given ½ - 1 cup
contraction every after LBM
• Adult must be given 1 or more cup
every after LBM
 

12/09/2021 134
Measures on Diarrhea Prevention:
 
– Breastfeed infants
– Provide appropriate supplemental feeding
– Hand washing
– Utilize clean and potable water
– Clean toilet and observe proper feces
disposal
– Immunize the child with measles
 
 
12/09/2021 135
 Breastfeeding
BEST!!!
Reduced allergic reaction
Economical
Always available
Safe/maintains the stool soft
Temperature always right
Fresh
Emotional bonding
Easily established
Digestible
Immunity
Nutritious
GIT disorders are decreased

12/09/2021 136
 BREASTMILK
-More CHO
-Less CHON
(Lactoalbumin)
-Same Fat
-3x more Linoleic
Acid
-Less Minerals

High CHON and mineral content of cow’s

milk may overwhelm the newborn’s
kidney. Casein on the other hand is
difficult to digest.
12/09/2021 137
 Nutrition
• Components of the Phil. Nutrition
Program:
> Nutritional Assessment and
Guidelines
> Nutrition Education
> Feeding Programs/Food Assistance
> Livelihood and Food Production
> Prevention and Treatment of
Condition Associated with
Malnutrition
12/09/2021 138
 Nutrition
Conditions Associated with Malnutrition
> Infections: diarrhea, vomiting, fever
(+17% in basal metabolic needs)
> Intestinal Parasitism

Common Intestinal Parasites

> Ascaris: giant roundworm
> Hookworm: blood sucker, heavy infestation is seen as
severe anemia; entry through skin pores; common to
farmers
> Pinworm: habitat is the rectum; major symptom is
pruritus
> Tapeworm: longest intestinal parasite; ave adult length =
15-25m
12/09/2021 139
 Nutrition
Anthropometry – major tool in the diagnosis of
protein deficiency (Protein Energy Malnutrition or
PEM)

– Weight for Age: ABW/EBW

> under 5 clinic: operation timbang
> do not use if the client has edema
> used in detection of:
1. Chronic undernutrition (stunting, with previous malnutrition)
2. Acute malnutrition (current malnutrition)
3. Overweight (obesity)
4. Underweight (wasting)
12/09/2021 140
 Nutrition
• Gomez’ Classification of Nutritional
Status
% of EBW = (ABW/EBW) x 100

> 110% = overweight

91 – 110% = normal
76 – 90% = 1st degree malnutrition
(mild)
61
12/09/2021
– 75% = 2 nd
degree malnutrition 141
(mod)
 Nutrition
• Height for Age: AHt/Eht
> under-5 clinic
> detection of chronic malnutrition
(stunting)
> consider heredity
• Weight for height: BMI
> Wt in kg/Ht in m2
> desirable BMI: 20-25
> detection of acute malnutrition in adults
12/09/2021 142
 Nutrition
• Mid-upper Arm Circumference
> 1-4 y/o
> rapid screening for malnutrition
> procedure:
1. Determine midpoint between
acromion and olecranon
2. Measure circumference at midpoint
3. Interpret findings
 13 cm = normal nutritional status
 13 cm = acute undernutrition wasting

12/09/2021 143
 Nutrition
Management of PEM
• 1st & 2nd degree
malnutrition
> home management
> nutritional education
• 3rd degree malnutrition
> referral to hospital
> nutritional education
12/09/2021 144
 Nutrition
Fortification – addition of a nutrient to food
during processing
– RA 8172: “Asin” Law
> sale of iodized salt
– RA 8976: Food Fortification Law
> Sangkap Pinoy seal

12/09/2021 145
 Tools utilized (anthropometric
measurements):
• Weight for Age- measures degree and presence of
wasting or stunting
• Height for Age- measures the presence of stunting;
<90% of standard- stunting or past chronic malnutrition
• Weight for height- determines the presence of muscle
wasting
• Skin fold measurement- indicates amount of body fat
with the use of fat-caliper sites: triceps, biceps,
subscapular, suprailiac
• MUAC- estimates lean body mass or skeletal muscle
reserves

12/09/2021 146
Protein Energy Malnutrition
• MARASMUS- dec.
PRO & CHO, < 1 yo
when malnutrition
started

– S/Sx: very thin (muscle

wasting), very poor wt. Treatment:
gain, old man’s face,
enlarged abdomen, “Food is the only
prominent ribs, loose cure” small,
wrinkled skin, always frequent feeding;
hungry increase food
variety

12/09/2021 147
 • KWASHIORKOR- disease of
older child when the next baby
is born, 1-3 yo when
malnutrition started

• S/Sx: very thin, fails to grow,

Considerations:
BMI:
>27.2 (M)
>26.9 (F)
-- needs weight reduction
**Nurse should be patient in
taking care of the child
light colored and weak hair
(flag sign), moon-shaped
unhappy face, enlarged
abdomen, muscle wasting,
swollen legs, face, arms and
hands (d/t dec. PRO, edema),
apathetic, dark spots in the
skin, doesn’t want to eat

12/09/2021 148
 Iron- Deficiency Anemia
– Decrease hemoglobin secondary to lack of iron

• CAUSES:
– Low intake of Fe-rich foods esp. the more absorbable Fe from
foods of animal origin
– Blood loss secondary to hookworm, menstruation, childbirth
• SOURCES:
– Heme-iron liver, internal organs, pork & chicken, blood, fish,
shellfish
– Non-heme leafy vegies (alugbati, kangkong, saluyot, pechay,
kamote tops, dried beans

12/09/2021 149
 Vitamin A deficiency
– Decrease Vitamin A in blood and liver stores

• CAUSES:
– Low intake of:
• Vitamin A rich foods
• Oil and Protein
• SOURCES:
– Breastmilk
12/09/2021 150
 Iodine-deficiency Disorder
– form mild goiter to serious
– E.g. stillbirth, congenital abnormalities, growth
and mental retardation, physical and motor
abnormalities

• CAUSES:
– Low intake of Iodine rich foods; low content of
Iodine in foods
– Goitrogens and environmental factors
• SOURCES:
12/09/2021 151
– 90% from food (seafoods)
 SUPPLY AND USE OF
ESSENTIAL DRUGS
Essential drugs are medicinal preparations
necessary to fill the basic health needs of
the population.

• GENERIC ACT OF 1998: RA 6675

– “Formally proclaims the state policy of
promoting the use of generic terminology in
the importation, manufacture, distribution,
marketing, promotion and advertising,
labeling, prescribing and dispensing of drugs.”
12/09/2021 152
– “Reinforces the NDP with regards to the
• DANGER DRUGS AT: RA 6425
– “The safe, administration and transportation of
prohibited drugs is punishable by law”
– 2 Types of Drugs
Prohibited
LSD
Eucaine
Cocaine/codeine
Opiates
Regulated
Benzodiazepines
Barbiturates

12/09/2021 153
 ENVIRONMENTAL
SANITATION
Environmental Sanitation is Components:
defined as the study of all factors  
in man’s physical environment,
– Water Supply Sanitation
which may exercise a deleterious
Program
effect on his health, well-being and
survival. – Proper Excreta and Sewage
Disposal Program
 
– Insect and Rodent Control
Goal:
– Food and Sanitation Program
To eradicate and control
– Hospital Waste Management
environmental factors in disease
transmission through the provision Program
of basic services and facilities to – Strategies on Health risk
all households. immunization

12/09/2021 154
 Water Supply Sanitation
Program
3 Types of Approved Water Supply and Facilities:

1. Level I: Point Source

A protected well or a
developed spring with
an outlet but without a
distribution system for
rural areas where
houses are thinly
scattered.

12/09/2021 155
 2. Level II: Communal
faucet system or stand
posts

A system composed of a
source, a reservoir, a
piped distribution network
and communal faucets,
located at not more than
25 meters from the
farthest house in rural
areas where houses are
clustered densely.

12/09/2021 156
3. Level III: Waterworks
system or individual
house connections

A system with a source, a

reservoir, a piped
distributor network and
household taps that is
suited for densely
populated urban areas.

12/09/2021 157
 Proper Excreta Disposal
3 Types of Approved Toilet Facilities:
Level I
Non-water carriage toilet facility:
- Pit latrines
- Reed Odorless Earth Closet
- Bored-hole
- Compost
- Ventilated improved pit
 
Toilets requiring small amount of water to wash waste into receiving
space
- Pour flush
- Aqua privies

12/09/2021 158
 Level II

On site toilet facilities

of the water carriage
type with water
sealed type with
septic vault/tank
disposal facilities.

12/09/2021 159
Level III

Water carriage types

of toilet facilities
connected to septic
tanks an/or to
sewerage system to
treatment plant.

12/09/2021 160
 Proper Solid Waste
Management
Refers to satisfactory methods of storage, collection, and final
disposal of solid wastes.

REFUSE

Garbage- Rubbish-
non-
biodegra biodegradabl
dable e; recyclable

12/09/2021 161
 Food Sanitation Program
Policies:
– Food establishment are subject to inspection (approved of all food
sources containers and transport vehicles)
– Comply with sanitary permit requirement
– Comply with updated health certificates for food handlers, helpers,
cooks
– All ambulant vendors must submit a health certificate to determine
present of intestinal parasite and bacterial infection

3 Points of Contamination:
– Place of production processing and source of supply
– Transportation and storage
– Retail and distribution points

12/09/2021 162
 Programs related to health-risk
minimization 2o to environmental
pollution
These include the following:
– Anti-smoke Belching Campaign and Air
pollution Campaign
– Zero Solid Waste Management
– Toxic, Chemical and Hazardous Waste
Management
– Red Tide Control and Monitoring
– Integrated Pest Management and Sustainable
Agriculture
– Pasig River Rehabilitation Management
12/09/2021 163
 Education prevailing health
problems:
Accepted activity at all levels of public health used as a means of improving
the health of the people through techniques which may influence peoples
thought motivation, judgment and action.
 
Three aspects of health education:
– Information – provision of knowledge
– Communication – exchange of information
– Education – change in knowledge, attitudes and skills

Sequence of steps in health education:

– Creating awareness
– Creating motivation
– Decision making action

12/09/2021 164
 COMMUNICABLE DISEASE
PREVENTION AND CONTROL

Chronic Communicable
Disease

Tubercul
Leprosy
osis
12/09/2021 165
 COMMON COMMUNICABLE
DISEASES
• Tuberculosis

a. S/Sx: cough of 2 weeks or more; fever, chest or back

pain not referable to any musculo-skeletal disorders,
hemoptysis, significant weight loss, and others
(sweating, fatigue, body malaise and shortness of
breath)
b. Infectious agent: M. tuberculosis and M. Africanum
c. MOT: Airborne droplet, direct invasion, Bovine TB

12/09/2021 166
 d. Preventive Measures:
i. Prompt diagnosis
ii. BCG vaccination of newborn, infants, and children
iii. Educate the public
iv. Improve social conditions
v. Accessibility of health facilities
vi. PHNursing and outreach services for home
supervision
e. 2 Formulation of anti-TB drugs:
i. Fixed-dose combination (FDC)-2 or more TB drugs
combined in 1 tablet
ii.Single drug formulation (SDF)- each drug is prepared
12/09/2021 individually 167
 Recommended Category of
Treatment Regimen
CAT EGO RY TY P E OF TB TR EA T ME N T R EGIM EN
PA TI EN T
IN T ENSIVE PH ASE CONT INUA T ION
PH ASE

I -New smea r-positive

P TB ,

-New smea r-negativ e

P TB with exte nsive
par enchy mal lesions
on CXR as ass essed by
t he TBDC
2HRZ E 4HR
-E P TB , and

-sev ere co nco mitan t

HIV disease

12/09/2021 168
II -Treatment failure

-Relapse 2HRZES/1HRZE 5HRE

-Return After Default

-Other

III -New smear-negative

PTB with minimal
parenchymal lesions 2HRZE 2HR
on CXR as assessed by
the TBDC

IV Chronic (Still smear- Refer to specialized facility or DOTS Plus

positive after Center
supervisedre-
treatment Refer to Provincial/City NTP Coordinator

12/09/2021 169
 Dosage Requirement
1. Fixed-Dose Formulation (FDC)
a. For Categories I & II
Body Weight No. of Tablets/ Day No. of tablets/day

INTENSIVE PHASE (2 Continuation Phase (4

months) months)

FDC-A (HRZE) FDC-B (HR)

30-37 2 2

38-54 3 3

55-70 4 4

>70 5 5

12/09/2021 170
 b. Category II: 2HRZES/HRZE/4HRE

Body Weight INTENSIVE Phae Continuation Phase

(kg)

First 2 months 3rd Month FDC-B (HR) E (400 mg)

FDC-A + S FDC-A (HRZE)

30-37 2+ 0.75 g S 2 2 1

38-54 3+ 0.75 g S 3 3 2

55-70 4+ 0.75 g S 4 4 3

>70 5 + 0.75 g S 5 5 3

12/09/2021 171
2. Single-Drug Formulation
a. Category I and II: 2 HRZE/4HR (SDF)

Anti-TB Drugs No. of Tablets per day No. of Tablets per day

Intensive Phase Continuation Phase

Isoniazid 1 1

Rifampicin 1 1

Pyrazinamide 2

Ethambutol 2

12/09/2021 172
b. Category II: 2 HRZES/1HRZE/5HRE

ANTI-TB DRUGS No. of tablets/ day No. of tablets/day

Inte nsive Phase (3 months) Continuation Ph ase

(5 months)
First 2 mont hs 3rd Mo nth

Isoniazid 1 1 1

Rifampicin 1 1 1

Pyrazinamide 2 2

Etha mbutol 2 2 2

Streptomy cin 1. vial/day

12/09/2021 173
• Leprosy

a. S/Sx: Early: change in skin

color, loss of sensation,
decrease/loss of sweating
and hair growth on the
lesion, thickened and/or
painful nerves, muscle
weakness; LATE: loss of
eyebrow (madarosis),
inability to close eyelids
(lagophthalmos), clawing of
fingers and toes,
contractures, sinking of
nosebridge, gynecomastia,
and chronic ulcers
b. Infectious agent: M. Leprae
c. MOT: Airborne; prolonged
skin-to-skin contact

12/09/2021 174
 d. Preventive Measures:
i. Avoidance of prolonged skin-to-skin contact
ii. Children should avoid close contact with active, untreated leprosy case
iii. BCG vaccination
iv. Good personal hygiene
v. Adequate Nutrition
vi. Health Education

e. Classification: Paucibacillary (tuberculoid and indeterminate- non-

infectious type)-treatment is from 6-9 months; Multi-bacillary
(Lepromatous and borderline-infectious type)
f. Management: Multi-Drug Therapy (MDT); commonly used drugs are the
following-Rifampicin, Dapsone, Ofloxacin, Minocycline.

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• Schistosomiasis

a. S/Sx: diarrhea, bloody stool, enlargement of the abdomen,

splenomegaly, weakess, anemia, and inflamed liver.
b. Infectious agent: Schistosoma mansoni, S. Japonicum, and S.
Haematobium
c. MOT: skin contact with contaminated fresh water with nails
carrying schistosomespenetrates the skin: CYCLE: infected
person urinates and defecates (in the water)eggs
hatchgrow in snails(Oncomelania quadrasi)parasite leaves
the snail into the waterpenetrate the skin of a human being
(blood vessels, bladder, and intestines)
d. Treatment: Praziquantel (Biltricide)

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• Malaria

a. S/Sx: recurrent chills, fever, profuse swelling, anemia,

malaise, hepatomegaly, and splenomegaly
b. Infectious agent: Plasmodium falciparum, P. vivax, P.
ovale, and P. malariae
c. Vector: Female Anopheles mosquito
d. Prophylaxis: Chloroquine- chemoprophylaxis being given
at weekly intervals, starting from 1-2 weeks before
entering the endemic area. Pregnant women: given
throughout the pregnancy
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 e. Prevention:
i. Insecticide-Treatment of Mosquito Net
ii. House spraying
iii. On stream seeding
iv. On stream clearing
f. Treatment Regimen: Chloroquine phosphate, sulfadoxine,
Quinine sulfate, Quinine HCl, Tetracycline HCl, Quinidine
sulfate and Quinidine glucolate

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• Dengue Hemorrhagic Fever (H-fever)

a. S/Sx: first 4 days: febrile or invasive stage starts as high

fever, abdominal pain and headache; later flushing which
may be accompanied by vomiting, conjunctival infection
and epistaxis; 4th-7th days: toxic or hemorrhagic stage-
lowering of temperature, sever abdominal pain, vomiting,
frequent GI bleeding in the form of hematemesis or
melena, unstable BP, narrow pulse pressure and shock;
7th-10th day: convalescent or recovery stage- generalized
flushing with areas of blanching, appetite regained and
blood pressure already stable

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• Measles

a. S/Sx: fever, rashes, and symptoms referable to upper respiratory tract;

eruption is preceded by about 2 days of coryza, during which stage
grayish pecks (Koplik spots) may be found on the inner surface of the
cheeks, rash affecting the face, body and the extremities on the 3rd
and 4th day ending in branny desquamation.
b. MOT: droplet or direct contact
c. Etiologic agent: Measles virus
d. Source: secretion of nose and throat of infected persons
e. Period of Communicability: During the period of coryza or catarrhal
symptoms- 9 days (from 4 days and 5 days after the rash appears)

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 HIV/STD PREVENTION AND
CONTROL
Operational Program Components:
Strategies:
• Case-finding
• Promotion of • Case management
health/health education • Training
• Diseases detection • Monitoring
• Treatment program • Reporting system
• Contact tracing • Operations research
• Clinical services

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 Mental Health
• a state of well-being where a
person can realize his or her own
abilities, to cope with the normal
stresses of life and work
productively 
• the emotional adjustment the
person achieve in which he can live
with reasonable comfort,
functioning acceptably in the
community where she lives
• involves the promotion of a healthy
state of mind among the whole
population through
• developing positive outlook in life
• strengthening coping mechanisms

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Vulnerable group to the
development of Mental
Illness:  
– Street children
– Victims of Torture or
violence
– Internal refugees
– Victims of aimed conflict
– Victims of natural and
man-made disasters
 
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Components of Mental
Health Program
– A. Stress Management
and Crisis Intervention
– B. Drugs and Alcohol
Abuse Rehabilitation
– C. Treatment and
Rehabilitation of
Mentally-Ill Patients
– D. Special Project for
Vulnerable Groups
183
DOH Events:
“Buwan ng Kabataan, Pag-asa ng Bayan”, featured in Health for
More in ’94

National Focus:
National Mental Health Week: “Linggo ng Lusog-Isip”

Rationale:
Stresses in the environment of children such as times of
disasters and national calamities, disintegration of the values,
structure and functions of the family and urbanization,
migration, drugs and physical and sexual abuse and poverty
have direct effects on physical and mental health. 

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 Other important concepts

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Family Health Nursing Practice

• Clinic Visit

• Home Visit
 Clinic Visit
Four Phases
• Pre-consultation Conference
• Medical Examination
• Nursing Intervention
• Post-consultation Conference
 Home Visit

Kinds:
• Case Finding
• Case Follow-up
 Home Visit
Principles:
• Planning should be done
• It should have a purpose or objective
• It should make use of available data
• There is no definite rule with regards to
its frequency
 Home Visit
Factors Influencing Frequency

Health Agencies involved

Acceptance of the family
Needs (physical, psychological, and d educational)
Evaluation of past services rendered
Policy of a given agency
 Home Visit
Steps:
• Greet client
• Introduce self and explain purpose
• Ask for any health concern
• Conduct 1st and 2nd level assessments
• Give appropriate health teachings/Provide
nursing care
• Schedule an appointment for next visit
 Nursing Care in the Home
Objectives:
• to give nursing care specific to
illness
• to help the client reach/maintain a
level of functioning; or
• to die peacefully in dignity
 Nursing Care in the Home
Principles:
P lan of care and treatment is instituted
U tilization of skills is necessary
G ood opportunity for detecting abnormal signs and
symptoms and observing patient’s progress and attitude
towards care given
A teaching opportunity
D angers in the patient’s over-prolonged acceptance of
support and comfort can be recognized
Isolation Technique in the Home
Objective:
To prevent cross-infection
Principles:
AND+2A
 Isolation Technique in the Home
Principles:
Aeration
Airing of beddings and other articles, disinfection of
room, and frequent hand washing are imperative
Never Mix!
All articles used by the patient should not be mixed with
the articles used by the rest of the members of the
household
Discard
All discharges should be carefully discarded
 Isolation Technique in the Home
Principles:
A protected gown should be worn by the one
caring for the sick member and should be
used only within the room of the sick

A rticles soiled with discharges should first be

boiled in water 30 minutes before
laundering.
 Bag Technique
• A tool making use of the public health bag
through which the nurse during the visit can
perform nursing procedures with ease and
deftness, saving time and effort at the end
view of rendering effective nursing care.
• PHN Bag – essential and indispensable
equipment of the public health nurse which
contains basic medications and articles
necessary for giving nursing care.
 Bag Technique
Principles:
• should minimize if not totally prevent the spread of
infection
• should save time and effort
Special considerations:
• hand washing - prevent contamination of the bag and
its contents
• place waste paper bag outside of work area – to
prevent contamination of clean area
 Thermometer Technique
Wiping Before Use:
• from clean to dirty
area (starting from
the bulb going
through the body or
stem of the
thermometer)
Thermometer Technique

Temperature-taking:
• Oral - 2-3 min
• Axilla - 5-9 min or 9 – 10 min
• Rectal - 1 min
 Thermometer Technique

Wiping After Use:

• from fingers downward to the bulb in

twisting motion
• use a dry cotton ball
• wiping should be done before reading
 Thermometer Technique
Cleaning the Thermometer:
• should be done in a downward spiral motion
• wiping from the stem to the bulb
• should follow this sequence:
1. 3 cotton balls moistened with soap
2. 3 cotton balls moistened with water
3. 1 cotton ball moistened with alcohol
 Intravenous Therapy
• It is the insertion of a needle/catheter/cannula
into a vein which is attached to a sterile tubing
• It is always based on a written physician’s
prescription
• Its purposes are to provide fluids for rehydration
and to serve as passageway of medications
• Qualified to perform IV insertion are only those
accredited by the Association of Nursing
service Administration of the Philippines
(ANSAP)
 Intravenous Therapy
Indications:
• rehydration or correction of dehydration when unable to
tolerate volumes of oral fluid medication
• parenteral nutrition
• administration of drugs
• blood transfusion

Contraindications:
• administration of irritant fluids/drugs through peripheral
access
 Intravenous Therapy
Assessment
• Note IV solution used, flow rate, volume
• Note for problems related to IV infusion such as
infiltrations, edema, thrombosis, embolism
Planning
• NCP relevant to IV therapy
Intervention
• Nursing activities for IV management of patient
Evaluation
• Appraisal of the effectiveness of care
 Laws
• RA 9174 – Phil Nursing Act of 2002
• RA 7160 – Local Government Code
• PD 996 – compulsory immunization of children below 8 y/o
against the immunizable diseases
• RA 7846 – compulsory immunization of HBV
• PP 46 – Polio Eradication Project of the Phils.
• PP 1066 – Neonatal Tetanus Elimination
• PP 4 – Measles Eradication (Ligtas Tigdas)
• RA 8172 – Asin Law
• RA 8976 – Food Fortification Law
 Laws
• PD 856 – Sanitation Code
• PD 825 – Anti-littering Act
• RA 8749 – Clean Air Act
• RA 9275 – Clean Water Act
• RA 9003 – Ecological Solid Waste Mgt Act
• RA 6365 – National Policy on Population
• PD 965 – Instructions on family planning
• LOI 949 – Primary Health Care
• RA 7305 – Magna Carta for Public Health Workers
• RA 8423 – Phil Institute for Tradional & Alternative Health
Care
Thank You!!!

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