CHN

I Definition of Terms
Community- derived from a latin word comunicas which means
a group of people.

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

Health is the OLOF (Optimum Level of Functioning)

Community Health part of paramedical and medical intervention/approach
which is concerned on the health of the whole population
Aims:
1. health promotion
2. disease prevention
3. management of factors affecting health
Nursing both profession & a vocation. Assisting sick individuals to become
healthy and healthy individuals achieve optimum wellness
II Community Health Nursing

The utilization of the nursing process in the different levels of clienteleindividuals, families, population groups and communities, concerned with the
promotion of health, prevention of disease and disability and rehabilitation.

Goal: To raise the level of citizenry by helping communities and families to cope
with the discontinuities in and threats to health in such a way as to maximize their
potential for high-level wellness
MISSION OF CHN

Health Promotion

Health Protection

Health Balance

Disease prevention

Social Justice

PHILOSOPHY OF CHN

The philosophy of CHN is based on the worth and dignity on the worth and
dignity of man.

Principles of Community Health:

1. The community is the patient in CHN, the family is the unit of care and there are
four levels of clientele: individual, family, population group (those who share
common characteristics, developmental stages and common exposure to health
problems e.g. children, elderly), and the community.
2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE
care

recipient of

3. CHN practice is affected by developments in health technology, in particular,

changes in society, in general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is a part of health care system and the larger human services system.
Role of CH Nurse:

Clinician who is a health care provider, taking care of the sick people at
home or in the RHU

Health Advocator speaks on behalf of the client

Advocator act on behalf of the client

Supervisor who monitors and supervises the performance of midwives

Facilitator who establishes multi-sectoral linkages by referral system

Collaborator working with other health team member

COMMON PROCEDURE IN CHN:

HOME VISIT

BAG TECHNIQUE

STERILIZATION

SPECIMEN COLLECTION

- URINE
- FECES
- SPUTUM
Levels of Client in CHN:
1. Application of Nursing Process to:
1.a Family
1.a.1 Family Coping Index

Physical Independence - ability of the family to move in & out of bed &
performed activities of daily living

Therapeutic Independence - ability of the family to comply with the

therapeutic regimen (diet, medication & usage of appliances)

Knowledge of Health Condition- wisdom of the family to understand the

disease process

Application of General &Personal Hygiene- ability of the family to perform

hygiene & maintain environment conducive for living

Emotional Competence ability of the family to make decision maturely &

appropriately (facing the reality of life)

Family Living Pattern- the relationship of the family towards each other with
love, respect & trust

Utilization of Community Resources ability of the family to know the

function & existence of resources within the vicinity

Health Care Attitude relationship of the family with the health care provider
Physical Environment ability of the family to maintain environment
conducive for living

1.a.2 Family Life Cycle

Stage I Beginning Family (newly wed couples)

TASK: compliance with the PD 965 & acceptance of the new member of the family

Stage II Early Child Bearing Family(0-30 months old)

TASK: emphasize the importance of pregnancy & immunization & learn the concept
of parenting

Stage III Family with Pre- school Children (3-6yrs old)

TASK: learn the concept of responsible parenthood

Stage IV Family with School age Children (6-12yrs old)

TASK: Reinforce the concept of responsible parenthood

Stage V - Family with Teen Agers (13-25yrs old)

TASK: Parents to learn the concept of let go system and understands the
generation gap

Stage VI Launching Center (1st child will get married up to the last child)

TASK: compliance with the PD 965 & acceptance of the new member of the family

Stage VII -Family with Middle Adult parents (36-60yrs old)

TASK: provide a healthy environment, adjust with a new lifestyle and adjust with
the financial aspect

Stage VIII Aging Family (61yrs old up to death)

TASK: learn the concept of death positively

1.b Community
COMMUNITY ASSESSMENT:

Status

Structure

Process

TYPES OF COMMUNITY ASSESSMENT:

1. COMMUNITY DIAGNOSIS

A process by which the nurse collects data about the community in order to
identify factors which may influence the deaths and illnesses of the
population, to formulate a community health nursing diagnosis and develop
and implement community health nursing interventions and strategies.

2 Types:
Comprehensive Community
Diagnosis

Problem-Oriented Community
Diagnosis

- aims to obtain general information

about the community

- type of assessment responds to a

particular need

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

Implementation Phase

1. data collection

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

Evaluation Phase

BIOSTATISTICS
2.1 DEMOGRAPHY - study of population size, composition and spatial distribution as
affected by births, deaths and migration.
Sources : Census complete enumeration of the population
2 Ways of Assigning People:
1. De Jure People were assigned to the place where assigned to the
usually live regardless of where they are at the time of census.

place they

2.De Facto People were assigned to the place where they are physically present at
are at the time of census regardless, of their usual place of residence.
Components:
1. Population size
2. Population composition
* Age Distribution
* Sex Ratio
* Population Pyramid
* Median age age below which 50% of the population fall and above
which 50% of the population fall. The lower the median
age, the younger the population (high fertility, high death rates).
* Age Dependency Ratio used as an index of age-induced economic drain
on
human resources
* Other characteristics:
- occupational groups
- economic groups

- educational attainment
- ethnic group
3. Population Distribution
* Urban-Rural shows the proportion of people living in urban compared to the rural
areas
* Crowding Index indicates the ease by which a communicable disease can be
transmitted from 1 host to another susceptible host.
* Population Density determines congestion of the place
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.

TYPES:

Fertility Rate
1. A.

CRUDE BIRTH RATE

total # of livebirths in a given calendar year

X 1000

estimated population as of July 1 of the same given year

1. B.

GENERAL FERTILITY RATE

total # of livebirths in a given calendar year

X 1000

Total number of reproductive age

Mortality Rate
A. CRUDE DEATH RATE
Total # of death in a given calendar year

X 1000

Estimated population as of July 1 of the same calendar year

B. INFANT MORTALITY RATE
Total # of death below 1 yr in a given calendar year

X 1000

Estimated population as of July 1 of the same calendar year

C. MATERNAL MORTALITY RATE
Total # of death among all maternal cases in a given calendar year
Estimated population as of July 1 of the same calendar year

X 1000

Morbidity Rate
A. PREVALENCE RATE
Total # of new & old cases in a given calendar year

X 100

Estimated population as of July 1 of the same calendar year

B. INCIDENCE RATE
Total # of new cases in a given calendar year

X 100

Estimated population as of July 1 of the same calendar year

C. ATTACK RATE
Total # of person who are exposed to the disease

X 100

Estimated population as of July 1 of the same calendar year

III 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

1. a.

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 susceptibles 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
Endemic
habitual presence of a disease in a given geographic location accounting for
the low number of both immunes and susceptibles
e.g. Malaria is a disease endemic at Palawan.
area.

the causative factor of the disease is constantly available or present to the

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

Steps in EPIDEMIOLOGICAL IVESTIGATION:

1. Establish fact of presence of epidemic
2. Establish time and space relationship of the disease
3. Relate to characteristics of the group in the community
4. Correlate all data obtained
1. b.

Role of the Nurse

Case Finding

Health Teaching

Counseling

Follow up visit

IV. Health Situation of the Philippines

Philippine Scenario:

In the past 20 years some infectious degenerative diseases are on the rise.

Many Filipinos are still living in remote and hard to reach areas where it is
difficult to deliver the health services they need

The scarcity of doctors, nurses and midwives add to the poor health delivery
system to the poor
VITAL HEALTH STATISTICS 2005

PROJECTED POPULATION :

MALE 42,874,766
FEMALE 42,362,147
BOTH SEXES - 85,236,913

LIFE EXPECTANCY

FEMALE - 70 yrs. old

MALE

64 yrs. Old

LEADING CAUSES OF MORBIDITY

Most of the top ten leading causes of morbidity are communicable disease


These include the diarrhea, pneumonia, bronchitis, influenza, TB, malaria
and varicella

Leading non CD are heart problem, HPN, accidents and malignant neoplasm

LEADING CAUSES OF MORTALITY

The top 10 leading causes of mortality are due to non CD

Diseases of the heart and vascular system are the 2 most common causes of
deaths.

Pneumonia, PTB and diarrheal diseases consistently remain the 10 leading

causes of deaths.
V. Health Care Delivery System

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.

HEALTH SECTORS

GOVERNMENT SECTORS

Department of Health
Vision: Health for all by year 2000 ands Health in the Hands of the People by 2020
Mission: In partnership with the people, provide equity, quality and access to
health care esp. the marginalized
5 Major Functions:
1. Ensure equal access to basic health services
2. Ensure formulation of national policies for proper division of labor and proper
coordination of operations among the government agency jurisdictions
3. Ensure a minimum level of implementation nationwide of services regarded
as public health goods
4. Plan and establish arrangements for the public health systems to achieve
economies of scale
5. maintain a medium of regulations and standards to protect consumers and
guide providers

NON GOVERNMENT SECTORS

PRIVATE SECTORS

PRIMARY STRATEGIES TO ACHIEVE HEALTH GOALS

Support for health goal

Assurance of health care

Increasing investment for PHC

Development of National Standard

MILESTONE IN HEALTH CARE DELIVRY SYSTEM

RA 1082 - RHU Act

RA 1891 - Strengthen Health Services

PD 568 - Restructuring HCDS

RA 7160 - LGU Code

VI National Health Plan

National Health Plan is a long-term directional plan for health;

the blueprint defining the countrys health PROBLEMS, POLICY THRUSTS
STRATEGIES, THRUSTS

GOAL :

to enable the Filipino population to achieve a level of health which will allow
Filipino to lead a socially and economically-productive life, with longer life
expectancy, low infant mortality, low maternal mortality and less disability
through measures that will guarantee access of everyone to essential health
care

OBJECTIVES:

promote equity in health status among all segments of society

address specific health problems of the population

upgrade the status and transform the HCDS into a responsive, dynamic and
highly efficient, and effective one in the provision of solutions to changing the
health needs of the population

promote active and sustained peoples participation in health care

MAJOR HEALTH PLANS TOWARDS HEALTH IN THE HANDS OF THE

PEOPLE IN THE YEAR 2020
A. MAJOR HEALTH PLAN

23 IN 93

Health for more in 94

Think health Health Link

5 in 95

B. PRIORITY PROGRAM IN YEAR 2000

Plan 50

Plan 500

Womens health

Childrens health

Healthy Lifestyle

Prevention & Control of Infectious Disease

C. PRIORITY PROGRAM IN THE YEAR 2005

Ligtas Buntis Campaign

Mag healthy Lifestlye tayo

TB Network
Blood Donation Program (RA 7719)
DTOMIS
Ligtas Tigdas Campaign
Murang Gamot
Anti Tobacco Signature Campaign
Doctors to the Barrios Program
Food Fortification Program
Sentrong Sigla Movement
D. NATIONAL HEALTH EVENTS FOR 2006

JANUARY

National Cancer Consciousness Week (16-22)

FEBRUARY

Heart Month

Dental Health Month

Responsible Parenthood Campaign National Health Insurance Program

MARCH

Womens Health Month

Rabies Awareness Month

Burn Injury Prevention Month

Responsible Parenthood Campaign

Colon and Rectal Cancer Awareness Month

World TB Day (24)

APRIL

Cancer in Children Awareness Month

World Health Day (7)

Bright Child Week Phase I -

GarantisadongPambata (11-17)

MAY

Natural Family Planning Month

Cervical Cancer Awareness Month

AIDS Candlelight Memorial Day (21)

World No Tobacco Day (31)

JUNE

Dengue Awareness Month

No Smoking Month

National Kidney Month

Prostate Cancer Awareness Month

JULY

Nutrition Month

National Blood Donation Month

National Disaster Consciousness Month

AUGUST

National Lung Month

National Tuberculosis Awareness Month

Sight-Saving Month

Family Planning Month

Lung Cancer Awareness Month

SEPTEMBER

Generics Awareness Month

Liver Cancer Awareness Month

OCTOBER

National Childrens Month

Breast Cancer Awareness Month

National Newborn Screening Week (3-9)

Bright Child Week Phase II GarantisadongPambata (10-16)

NOVEMBER

Filariasis Awareness Month

Cancer Pain Management Awareness Month

Traditional and Alternative Health Care Month

Campaign on Violence Against Women and Children

DECEMBER

Firecracker Injury Prevention Campaign:

OPLAN IWAS PAPUTOK

VII INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

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 OR 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.
IMCI COLOR CODING
PINK(URGENT
REFERRAL)

OUTPATIENT HEALTH
FACILITY

YELLOW(Treatment at
GREEN(Home
outpatient health
management)
facility)
OUTPATIENT HEALTH
FACILITY

Pre-referral
treatments

Treat local
infection

Give oral drugs

Advise parents

Refer child

Advise and teach

caretaker

Follow-up
REFERRAL FACILITY

Emergency Triage
and Treatment
( ETAT)

Diagnosis,
Treatment

Monitoring,

SEVERE PNEUMONIA OR
VERY SEVERE DISEASE

HOMECaretaker is
counseled on:

Home treatment/s

Feeding and fluids

When to return
immediately

Follow-up

Give first dose of

an appropriate
antobiotic

Give Vitamin A

Treat the child to

prevent low blood
sugar

follow-up

Any general
danger sign or

Chest indrawing
or

PNEUMONIA

Refer urgently to
the hospital

Give paracetamol
for fever > 38.5oC

Give an
appropriate
antibiotic for 5 days

Soothe the throat

and relieve cough
with a safe remedy

Advise mother
when to return
immediately

Follow up in 2 days

Give Paracetamol
for fever > 38.5oC

If coughing more
than more than 30
days, refer for
assessment

Soothe the throat

and relieve the
cough with a safe
remedy

Advise mother
when to return
immediately

Stridor in calm
child

Fast breathing

NO PNEUMONIA : COUGH
OR COLD

Follow up in 5 days if not

improving

No signs of
pneumonia or very
severe disease

Assess and classify DIARRHEA

A child with diarrhoea 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

- Give fluid for severe

dehydration ( Plan C ) OR

Two of the following signs ?

Abnormally sleepy or
difficult to awaken

Sunken eyes

Not able to drink or

drinking poorly

SEVERE
DEHYDRATION

Skin pinch goes back very

slowly

Two of the following signs :

Restless, irritable

Sunken eyes

Drinks eagerly, thirsty

SOME
DEHYDRATION

Skin pinch goes back slowly

Not enough signs to

classify as some or
severe dehydration

If child has no other

severe classification:

NO DEHYDRATION

If child has another

severe classification :

- Refer URGENTLY to hospital

with mother giving frequent
sips of ORS on the way
Advise the mother to
continue breastfeeding

If child is 2 years or
older and there is
cholera in your area,
give antibiotic for
cholera

Give fluid and food for

some dehydration
( Plan B )

If child also has a

severe classification :

- Refer URGENTLY to hospital

with mother 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 has
persistent diarrhea

Give Vitamin A

Follow up in 5 days

Treat for 5 days with

an oral antibiotic
recommended for
Shigella in your area

Follow up in 2 days

SEVERE PERSISTENT
DIARRHEA

Dehydration present

PERSISTENT
DIARRHEA

No dehydration

Blood in the stool

DYSENTERY

Give also referral treatment

Does the child have fever?
**Decide :
- Malaria Risk
- No Malaria Risk
- Measles
- Dengue
Malaria Risk

Any general
danger sign or

Stiff neck

VERY SEVERE FEBRILE

DISEASE / MALARIA

Give first dose of

quinine ( under
medical supervision
or 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
high fever (38.5oC)
or above

Send a blood smear

with the patient

Refer URGENTLY to
hospital

Treat the child with

an oral antimalarial

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

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

Blood smear ( + )

If blood smear not done:

NO runny nose,
and

NO measles, and

MALARIA

NO other causes of fever

Blood smear ( ), FEVER : MALARIA

UNLIKELY
or

Runny nose, or

Measles, or

Other causes of fever

if fever persists

If fever is present
everyday for more
than 7 days, refer
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

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

Pus draining from

MEASLES WITH EYE OR
the eye or
MOUTH COMPLICATIONS
Mouth ulcers

Measles now or
within the last 3
months

MEASLES

Refer URGENTLY to
hospital

Give Vitamin A

If pus draining from

the eye, apply
tetracycline eye
ointment

If mouth ulcers, teach the

mother to treat with
gentian violet

Give Vitamin A

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

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

SEVERE DENGUE
HEMORRHAGIC FEVER

Capillary refill
more than 3
seconds or

Abdominal pain or

Vomiting

Tourniquet test ( +
)

No signs of severe
dengue hemorrhagic
fever

FEVER: DENGUE
HEMORRHAGIC UNLIKELY

Give one dose of

paracetamol in
health center for
high fever (38.5oC)
or above

Follow up in 2 days
if fever persists or
child shows signs of
bleeding

Advise mother
when to return
immediately

Give first dose of

appropriate
antibiotic

Give paracetamol
for pain

Refer URGENTLY

Give antibiotic for

5 days

Give paracetamol
for pain

Dry the ear by

wicking

Follow up in 5 days

Dry the ear by

wicking

Follow up in 5 days

No additional
treatment

Does the child have an ear problem?

Tender swelling
behind the ear

MASTOIDITIS

Pus seen draining

from the ear and
discharge is
ACUTE EAR INFECTION
reported for less
than 14 days or
Ear pain

Pus seen draining

from the ear and
CHRONIC EAR INFECTION
discharge is
reported for less
than 14 days
No ear pain and
no pus seen
draining from the
ear

NO EAR INFECTION

Check for Malnutrition and Anemia

Give an Appropriate Antibiotic:
1. A.

For Pneumonia, Acute ear infection or Very Severe disease

COTRIMOXAZOLEBID FOR 5
DAYS

2.
Age or Weight

Adulttablet

AMOXYCILLINBID FOR 5 DAYS

Syrup

Tablet

Syrup

2 months up to
12 months ( 4 < 1 / 2
9 kg )

5 ml

1/2

5 ml

12 months up to
5 years ( 10
19kg )

7.5 ml

10 ml

B. For Dysentery
COTRIMOXAZOLEBID FOR 5
DAYS
AGE OR
WEIGHT
24
months( 4
< 6kg )

TABLET

SYRUP

AMOXYCILLINBID FOR 5 DAYS

SYRUP 250MG/5ML

5 ml

1.25 ml ( tsp )

4 12
months( 6 <
10 kg )

5 ml

2.5 ml ( tsp )

1 5 years
old( 10 19
kg )

7.5 ml

( 1 tsp )

C. For Cholera
TETRACYCLINEQID
COTRIMOXAZOLEBID FOR 3 DAYS
FOR 3 DAYS
AGE OR WEIGHT

Capsule 250mg

2 4 months( 4 < 6kg )

Tablet
1/2

Syrup
5ml

4 12 months( 6 < 10
kg )

1/2

5 ml

1 5 years old( 10 19
kg

7.5m

Give an Oral Antimalarial

CHOLOROQUINE
Give for 3 days

PrimaquineGiv
e single dose PrimaquineGive Sulfadoxine +
in health
daily for 14 days PyrimethamineGiv
center for P.
for P. Vivax
e single dose
Falciparum

AGE

TABLET( 15MG)TABLET( 15MG) TABLET( 15MG)

TABLET ( 150MG )
DAY1 DAY2 DAY3

2months
5months

5 months
12 months

1/2

12months
1
3 years old

3 years old
1
-5 years old

3/4

1/2

GIVE VITAMIN A
AGE

VITAMIN A CAPSULES200,000 IU

6 months 12 months

1//2

12 months 5 years old

GIVE IRON

AGE or WEIGHT

Iron/Folate TabletFeSo4 200mg Iron SyrupFeSo4 150

+ 250mcg Folate (60mg
mg/5ml( 6mg elemental

elemental iron)

iron per ml )

2months-4months( 4
<6kg )

2.5 ml

4months 12months( 6
<10kg )

4 ml

12months 3 years ( 10
<14kg )

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

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
VIII DOH PROGRAMS
DENTAL HEALTH PROGRAM
To improve the quality of life of the people through the attainment of the highest
possible oral health.
Objective: To prevent and control dental diseases and conditions like dental
caries and periodontal diseases thus reducing their prevalence.
OSTEOPOROSIS PROGRAM

It is characterized by a decrease in bone mass and density that progresses

without a symptom or pain until a fracture occurs generally in the hip, spine or
wrist.

Objectives:

To increase awareness on the prevention and control of osteoporosis as a

chronic debilitating condition;


To increase awareness by physicians and other health professionals on the
screening, treatment and rehabilitation of osteoporosis;

To empower people with knowledge and skills to adopt healthy lifestyle in

preventing the occurrence of osteoporosis.
HEALTH EDUCATION & CO

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
Communication
Education

Sequence of steps in health education:

Creating awareness

Creating motivation

Decision making action

REPRODUCTIVE HEALTH
1. Family Planning
2. MCH & Nutrition
3. Prevention / treatment of Reproductive Tract Infection & STD
4. Prevention of abortion & its complication
5. Education & counseling on sexuality & sexual health
6. Adolescent sexual reproductive health
7. Violence against women
8. Mens reproductive health ( Male sexual disorder )
9. Breast CA & other gyne problem
10.

Prevention / treatment of infertility

OLDER PERSONS HEALTH SERVICES

Participation in the celebration of Healthy National Elderly Week ( Oct 1-7)

- Lecture on healthy lifestyle for the elderly

Provision of drugs for the elderly( 20% discount)

GUIDELINES FOR GOOD NUTRITION


Nutritional Guidelines are primary recommendations to promote good health
through proper nutrition.
ACTIVITIES:
1.Malnutrition Rehabilitation Program

Targeted Food Task Force Assistance Program (TFAP)

Nutrition Rehabilitation Ward

Akbayan sa Kalusugan sa Kabataan (ASK Project)

2.Micronutrient Supplementation Program

23 in 93

Fortified Vitamin Rice

Health for More in 94

Buwan ng Kabataan, Pag-asa ng Bayan

National Focus: National Micronutrient Day or Araw ng Sangkap Pinoy

PROTEIN ENERGY MALNUTRITION

1. Marasmus looks like an old worried man
- less subcutaneous fats
2. Kwashiorkor a moon face child
- with flag sign (hair changes)
VITAMIN A DEFICIENCY
Early symptoms: Xeropthalmia (Nigtblindess)
Bitots spot (silvery foamy spot located @ lateral sclera)

Corneal Xerosis (eye lesion)

Conjunctival

Xerosis(scar in the eyes)

Keratomalacia ( whitish to grayish sclera)

BLINDNESS
RESPIRATORY INFECTION CONTROL
Provision of medicines
Consultative meetings with CARI coordinators

 Monitoring of health facilities on the implementation of the program

ALTERNATIVE MEDICINE

RA 8423
23 IN 93
1. A.

Herbal Medicine(LUBBY SANTA)

Herbal Medicine

USES

Skin diseases
Lagundi ( Vitex Negundo)

Headache,

SHARED

Asthma,fever,cough&colds
Rheumatism
Eczema
Dysentery

Ulasimang Bato (Peperonia

Pellucida)
Bawang ( Allium Sativum) HAT

Lowers uric acid

Headache and Tootache

Bayabas ( Psidium Guajava)

Anti septic, Anti-diarrheal

Yerba Buena (Mentha Cordifolia)

Rheumatism and other body

aches, analgesics

Sambong (Blumea Balsamifera)

Edema, diuretics

Akapulko

Fungal infection, skin diseases

Niog Niogan (Quisqualis Indica)

Anti-helminthic

Tsaang Gubat (Carmona Retusa)

Diarrhea

Ampalaya (Momordica Charantia) DM

MATERNAL- CHILD CARE
I Maternal Care

A.

FAMILY PLANNING

I.

Spacing / Artificial Method

A. Hormonal
B. Mechanical & Barrier
C. Biologic
D. Natural
II.

Permanent (surgical/irreversible)

A. Tubal Ligation
B. Vasectomy
III. Behavioral Method

B. BREASTFEEDING
II CHILD CARE
A. 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
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
B. EXPANDED PROGRAM ON IMMUNIZATION

LEGAL BASIS

PD #996 Compulsory basic

PP #147 National Immunization Day

PP #773 Knock out Polio Days

PP # 1064 polio eradication campaign

PP #4 - Ligtas Tigdas month

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

Components of Mental Health Program

Stress Management and Crisis Intervention

Drugs and Alcohol Abuse Rehabilitation

Treatment and Rehabilitation of Mentally-Ill Patients

Special Project for Vulnerable Groups

SENTRONG SIGLA MOVEMENT

AIM: to promote availability of quality health services
4 pillars:

Quality assurance

Grants & technical assistance

Health promotion

Award

COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH

Community Organizing

a continuous and sustained process of

EDUCATING THE PEOPLE,

CRITICAL AWARENESS

MOBILIZING

Participatory Action Research

A combination of education, research and action.

The purpose is the EMPOWERMENT of people

4 Phases:

Pre entry

Entry

Organizational Building

Sustenance and Strengthening

Laws Affecting CHN Implementation:

RA 8749 Clean Air Act (2000)
RA 6425 Dangerous Drug Act: sale, administration and distribution of prohibited
drugs is punishable by law
RA 9173

RA 2382 Philippines Medical Act: define the practice of medicine in the Philippines
RA 1082 Rural Health Act: employment of more physicians, nurses, midwives who
will live in the rural areas to help raise the health condition.
RA 3573

Reporting of Communicable Disease

RA 6675 Generic Act: promotes, requires and ensures the production of an

adequate supply, distribution, use of drugs identified by their generic names.
RA 6365
RA 6758
RA 4703
RA 7305 Magna Carta for Public Health Workers (approved by Pres. Corazon C.
Aquino): aims to promote and improve the social and economic well being of health
workers, their living and conditions.
RA 7160 Local Government Code: responsibility for the delivery of basic services
of the national government
IX CHRONIC COMMUNICABLE DISEASES
I TUBERCULOSIS

TB is a highly infectious chronic disease that usually affects the lungs.

Causative Agent: Mycobacterium Tuberculosis

S/S:

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

DOTS (Direct Observed Treatment Short Course)

Regimen

Regimen I

Type of TB Patient

New pulmonary smear (+) cases

New seriously ill pulmonary smear

(-) cases w/ extensive lung
lesions

New severely ill extra-pulmo TB

New pulmonary smear (+) case

New seriously ill pulmonary smear

(-) cases w/ extensive lung lesions

2RIPE / 4RI

Regimen II
2RIPES/
1RIPE / 5RIE

New severely ill extra-pulmo

TB
Regimen III

New smear(-) but with minimal

pulmonary TB on radiography as
confirmed by a medical officer

2RIP / 4RI

New extra-pulmo TB (not serious)

II 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
Loss in sensation
Ulcers that do not heal

Late Stage(GMISC)
Gynocomastia
Madarosis(loss of eyebrows)
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

X Vector Borne Communicable Disease

I LEPTOSPIROSIS

an infectious disease that affects humans and animals, is considered the

most common zoonosis in the world

Causative Agent: Leptospira interrogans

S/S:
-high fever

-severe headache

-chills

-muscle aches

-vomiting

-may include jaundice (yellow skin and eyes)

-red eyes

-abdominal pain

-diarrhea
TREATMENT:
PET - > Penicillins , Erythromycin, Tetracycline

II 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.
Preventive Measures: (CLEAN)
Chemically treated mosquito nets
Larvae eating fish
Environmental clean up
Anti mosquito soap/lotion
Neem trees/eucalyptus tree
III FILIARIASIS

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

S/S:
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

Ivermectin,

Albendazolethe

No treatment can reverse elephantiasis

VI 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
Treatment: Diethylcarbamazepine citrate (DEC) or Hetrazan (drug of choice)
VII 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 semi-urban areas.

S/S: (VLINOSPARD)

Vomiting

Low platelet

Nausea

Onset of fever

Severe headache

Pain of the muscle and joint

Abdominal pain

Rashes

Diarhhea

TREATMENT:

The mainstay of treatment is supportive therapy.

- intravenous fluids
- A platelet transfusion
Millenium Goals
Posted: September 17, 2011 in CHN
0
Goal 1. Eradicate extreme poverty and hunger

Target 1. Halve, between 1990 and 2015, the proportion of people whose
income is less than one dollar a day
o

Poorest quintiles share in national income or consumption, per cent

(WB)

Population below $1 (PPP) per day consumption, percentage

Population below national poverty line, rural, percentage

Population below national poverty line, total, percentage

Population below national poverty line, urban, percentage

Poverty gap ratio

Purchasing power parities (PPP) conversion factor, local currency unit

to international dollar

Target 2. Halve, between 1990 and 2015, the proportion of people who suffer
from Hunger

Children under 5 moderately or severely underweight, percentage

Children under 5 severely underweight, percentage

Population undernourished, number of people

Population undernourished, percentage

Goal 2. Achieve universal primary education

Target 3. Ensure that, by 2015, children everywhere, boys and girls alike, will
be able to complete a full course of primary schooling
o

Literacy rates of 15-24 years old, both sexes, percentage

Literacy rates of 15-24 years old, men, percentage

Literacy rates of 15-24 years old, women, percentage

Net enrolment ratio in primary education, both sexes

Net enrolment ratio in primary education, boys

Net enrolment ratio in primary education, girls

Percentage of pupils starting grade 1 reaching grade 5, both sexes

Percentage of pupils starting grade 1 reaching grade 5, boys

Percentage of pupils starting grade 1 reaching grade 5, girls

Primary completion rate, both sexes

Primary completion rate, boys

Primary completion rate, girls

Goal 3. Promote gender equality and empower women

Target 4. Eliminate gender disparity in primary and secondary education,

preferably by 2005, and to all levels of education no later than 2015
o

Gender Parity Index in primary level enrolment

Gender Parity Index in secondary level enrolment

Gender Parity Index in tertiary level enrolment

Seats held by men in national parliament

Seats held by women in national parliament

Seats held by women in national parliament, percentage

Share of women in wage employment in the non-agricultural sector

Total number of seats in national parliament

Women to men parity index, as ratio of literacy rates, 15-24 years old

Goal 4. Reduce child mortality

Target 5. Reduce by two thirds, between 1990 and 2015, the under-five
mortality rate
o

Children 1 year old immunized against measles, percentage

Children under five mortality rate per 1,000 live births

Infant mortality rate (0-1 year) per 1,000 live births

Goal 5. Improve maternal health

Target 6. Reduce by three quarters, between 1990 and 2015, the maternal
mortality ratio
o

Births attended by skilled health personnel, percentage

Maternal mortality ratio per 100,000 live births

Goal 6. Combat HIV/AIDS, malaria and other diseases

Target 7. Have halted by 2015 and begun to reverse the spread of HIV/AIDS
o

AIDS deaths

Condom use to overall contraceptive use among currently married

women 15-49 years old, percentage

Contraceptive use among currently married women 15-49 years old,

any method, percentage

Contraceptive use among currently married women 15-49 years old,

condom, percentage

Contraceptive use among currently married women 15-49 years old,

modern methods, percentage

Men 15-24 years old, who know that a person can protect himself from
HIV infection by consistent condom use, percentage

People living with HIV, 15-49 years old, percentage

Ratio of school attendance rate of orphans to school attendance rate of

non orphans

Women 15-24 years old, who know that a healthy-looking person can
transmit HIV, percentage

Women 15-24 years old, who know that a person can protect himself
from HIV infection by consistent condom use, percentage

Target 8. Have halted by 2015 and begun to reverse the incidence of malaria
and other major diseases

Tuberculosis death rate per 100,000 population

Tuberculosis detection rate under DOTS, percentage

Tuberculosis prevalence rate per 100,000 population

Tuberculosis treatment success rate under DOTS, percentage

Goal 7. Ensure environmental sustainability

Target 9. Integrate the principles of sustainable development into country

policies and programmes and reverse the loss of environmental resources
o

Carbon dioxide emissions (CO2), metric tons of CO2 per capita (CDIAC)

Carbon dioxide emissions (CO2), thousand metric tons of CO2 (CDIAC)

Consumption of all Ozone-Depleting Substances in ODP metric tons

Consumption of ozone-depleting CFCs in ODP metric tons

Energy use (Kg oil equivalent) per $1,000 (PPP) GDP

Land area covered by forest, percentage

Protected area to total surface area, percentage

Protected areas, sq. km.

Target 10. Halve by 2015 the proportion of people without sustainable access
to safe drinking water
o

Proportion of the population using improved drinking water sources,

rural

Proportion of the population using improved drinking water sources,

total

Proportion of the population using improved drinking water sources,

urban

Proportion of the population using improved sanitation facilities, rural

Proportion of the population using improved sanitation facilities, total

Proportion of the population using improved sanitation facilities, urban

Target 11. By 2020 to have achieved a significant improvement in the lives of

at least 100 million slum dwellers
o

Slum population as percentage of urban, percentage

Slum population in urban areas

Goal 8. Develop a global partnership for development

Target 15. Deal comprehensively with the debt problems of developing

countries through national and international measures in order to make debt
sustainable in the long term
o

Debt service as percentage of exports of goods and services and net

income from abroad

Target 16. In cooperation with developing countries, develop and implement

strategies for decent and productive work for youth
o

Ratio of youth unemployment rate to adult unemployment rate, both

sexes

Ratio of youth unemployment rate to adult unemployment rate, men

Ratio of youth unemployment rate to adult unemployment rate,

women

Share of youth unemployed to total unemployed, both sexes

Share of youth unemployed to total unemployed, men

Share of youth unemployed to total unemployed, women

Share of youth unemployed to youth population, both sexes

Share of youth unemployed to youth population, men

Share of youth unemployed to youth population, women

Youth unemployment rate, aged 15-24, both sexes

Youth unemployment rate, aged 15-24, men

Youth unemployment rate, aged 15-24, women

Target 18. In cooperation with the private sector, make available the benefits
of new technologies, especially information and communications
o

Internet users

Internet users per 100 population

Personal computers

Personal computers per 100 population

Telephone lines and cellular subscribers

Telephone lines and cellular subscribers per 100 population

Components of a Community Health Care: Components of A Community

Posted: September 17, 2011 in CHN
0

1. The CORE
Represents the people that make up the community included in the community
CORE are the demographic of the population as well as the values, beliefs and
history of the people.
2. Eights (8) subsystems of the community
a.Housing what type of housing facilities are there in the community, are there
enough housing facilities available; are there housing laws/regulations governing
the people? What are these?
b. Education these include laws, regulations, facilities, activities affecting
education, ratio of health educators to learners, distribution of educational facilities,
who utilizes these, what informal educational facilities and activities exist in the
community.
c. Fire and Safety fire protection facilities and fire prevention activities, distribution
of these.
d.Politics and government political structures present in the community, decisionmaking process/pattern leadership style observed, etc.
e. Health health facilities and activities: distribution, utilization, ratio of providers
to clientele served; priorities in health, programs developed, etc
f. Communication systems, types of communication existing, forms of
communication, be it formal or informal; etc..
g. Economics occupation, types of economic activities, income, etc
h. Recreation recreational activities/facilities: types, consumers, appropriateness
to consumers, etc
ELEMENTS OF A HEALTH COMMUNITY
1. People are partners in health care
2. People work together to attain goals.
3. Physical environment promotes health, safety, order and cleanliness.
4. Safe water and nutritious food.
5. Families provide members with basic needs.
6. Available, affordable health care.
A HEALTH COMMUNITY
1. prompts its members to have a high degree of awareness that we are
community
2. uses its natural resources while taking steps to conserve them for future
generations.
3. openly recognizes the existence of sub-groups and welcomes their
participation in community affairs.
4. is prepared to meet crises.
5. is a problem-solving community; it identifies, analyzes & organizes organizes
to meet its own needs.
6. has open channels of communication that allows information to flow among all

subgroups of its citizens in all directions

7. seeks to make each of its systems resources available to all members of the
community.
8. has legitimate and effective ways to settle disputes and meet needs that arise
within the community.
9. encourages maximum citizen participation in decision-making.
10. promotes a high level wellness among all its members.
CHN Complete
Posted: September 17, 2011 in CHN
0
Community Health Nursing
CHW group of people with common chrematistics or interest within a territory or
geographical boundary
Community
1. Patient/Client
2. Setting - outside curative institutions

home family HNSg

school SHSg

places of work occupational HNSg

World Views:
1. Community integral part of society compose of families
Eg. poor community

2.

under nutrition

poor food supply

level of knowledge poor

o

intrapersonal conflict choosing what to wear

intrapersonal family

intrapersonal community (interfamilial) regionalism parochial

intra sociedad (inter societal)

Conflicts/contradiction always present in the community

Note: Should be positive in dealing with conflict.

3.

Condition in the family is always changing

Health
1. Wellness Illness continuum
Optimum internal - death
Wellness - external
External
Macro system

political

economic

socio cultural education, customs, beliefs, practices, tradition, mass media

o

maintain continuum balance and purpose direction with environment

progress toward a high level of FXU, lice to the fullest potential

Epidemiologic model

2.

High Level Wellness

3.

Agent Host Environmental Model

Agent (Etiologic Facts)

1. Infections/biological factor
2. Mechanical
3. Physical
4. Carcinogenetics pringels, tobleron (GMOs chemical
5. Poison eg. MSG
6. Allergies
7. Nutritive elements
8. Psychological
Host intrinsic factor age, sex

exposure

response susceptibility

- resistance
environment extrinsic factor
4.

Health Belief Model

relationship bet a persons belief and his behavior in health

3 components
1. Susceptibility to illness
2. Seriousness of an illness
3. Benefits taking the action
AN/AIDS
Common in
1. Commercial Sex Worker unprotactive penetrated sex
2. Sea farers
3. Religious Nums
Vaginal male and female 1:000
Oral male to male also common in male to female 1:200
Felacio mouth to penis
Oral cumaningus mount to vagina
Aningus mouth to amus
Preventive :
1. abstinence sex (safe)
2. Be Faithful Mutual/Monogamy
3. Correct continous consistent use of condom
4. Do no penetrate
5.

Evolutionary Based Model

illness and death sometimes serves an evolutionary function

Elements:

life events

life style determinants

control perception

viability emotions

health out comes

o

clients won being

health is not merely the absence of DSE illness of infirmity

state of complete physical mental, and social wen being

6.

Health Promotion Model

7.

WHO Definition 1978 Alma Ata

Health
1. Social phenomenon Health outcome is interplay of different societal factors
outcome with interplay of different factors and society:

biological

physical

ecologic

multiple causation Theory

political

(Holistic)

economic

socio-cultural

Community Health
Part of medical paramedical intrapersonal which is concerned and the heath of the
whole population.
Major Concept
1-health promotion & DSE prevention
2- people participation
Individual
Client

Applied

Study

Community

As Client

- Anatomy - structure

- demography

- Physio - functions - Sociology

- Patho

- malfunction - epidemiology

Public Health & Longetirity (CBQ)

WINSLOW contribution to the most effective total development and life on the
Individual and the society.
HANLON priority the survival of the species the prevention of condition which
lead to the structure destruction or retardation of human function and
potential in early year of life.
Communication Health Nursing

- special field of nursing that combines the skills of nursing public health, and some
phases of social assistance and FXUS as part of the total health project and
promotion of health.
JACOBSON is a learned practice discipline with the ultimate goal of contributing as
individual and in collaboration with others, promotions of clients optimum level of
fractioning through teaching and delivery care.
Jacobson Major Roles
1. Health Educator
2. Provider of Nursing Care
FREEMAN aimed developing and enhancing health capability of people,
Individual, families and communities.
Community
People Organization (PO)
Agency
1. Ngo
2. GO DOH National Regional Province Municipal BHW
RA 7305 Magna Corta of PHWorker
RA 7160 Local Government Code
Devolution of Health Services
CHN CONCEPTS:
1. 10 Focus on CHN is an heath promotion
2. CHN practice is extended to benefit not only individual but whole & family
3. CHN are generalist in terms of their practice throughout lifes continuum its full
range of Health problems and need.
4. Contact with client may continue over a long period of time which includes all
ages and types of HC
Levels
Primary HC community
20 HC Regimal, Provincial, Municipal & District
Tertiary sophisticated medical center
Assessment:
Community Dx

health problems and needs

sources of solve to problem

Principle of Community Health Nursing

1. Recognize needs of individual
2. Knowledge and understanding of agency and policies facilitates goal
achievement
3. The family is the unit of service
Planning
1. Prioritization
2. Goal setting
3. Objectives
4. Actions/Intervention
5. Evaluation out come:
- criteria
- standard
Health Education and Counseling

common goal behavior change or modification

Basic Different
Health Education dive advice
Counseling provide all option
Implementation:
Community family focus of /unit of care
4. Respect values, customs and beliefs of clients as nurse we should not be
judgmental
5. Health education and counseling are vital parts of CHN
6. Collaborative working relationship with the health team facilitates goals
achievement.
7. Continuing staff education ensures quality client care and upgrade nursing
practice.
8. Indigenous and communication resources
appropriate tech methods and tech both scientifically sound and socially

and acceptable
9. Individual families and communities must actively participate in decision making
10. Supervising of nursing services be qualified personnel provides guidance and
direction to work.
11. Accurate recording and reporting serve as bases for evaluation and guide for
future actions.
12. Periodic and continuing education
board quest
how would you evaluate objective if both present answer this
criteria
HEALTH SITUATION
1. Health Indices
A. Basic Indicators
1. Nutrition
2. DSE Pattern

Anemia

48% of Filipinos
58% of pregnant women

- morbidity
- mortality
infant mortality rate according to DOH 18.7
life expectancy: Female 69.2
Male 63.7
HEALTH PROMOTION
Consist of activities directed towards increasing the fever of well being and
actualizing the health potential of individuals families communication and societies.
Different with prevention

not desl dysixy or health problem financial

approach behavior not

avoidance behavior

seeks to expand (+) potential for health

Multidimensional Nature of Health Promotion

1. Individual lifestyle
- personal habits & practices affecting health

-lifestyle
- lifestyle responsibility
2. Family health behavior and belief
3. Community norms
4. Environment harmony and bal bet human and surroundings
5. Society basic human needs

HEALTH PROMOTION METHODS

health education

Good standard nutrition adjusted to development phases of life

Attention to personality development

Provision of adequate housing

Recreation and agreeable working condition

Genetics counseling

Periodic selective examination self breast examination (SBE)

SCREENING METHOD
Presumptive identification of unorganized dse or defect by the application of test,
examination or other procedures that can be applied rapidly and inexpensively
population.

mass screening

case finding

contact tracing

multi phasic screening eg HIV antibody testing

surveillance

RA 7305 Jon reporting of communicable dse

Tertiary Prevention

methods

Dx

Tx

Mx

Rehabilitation

Community Organizing

Awareness raising

Organizing

Mobilizing / responsible action

Key Concepts and Principles

1. Objective analysis of objective condition scientific
2. Basic trust among people
3. By the people from the people, for the people
4. People want and can change
5. Self-willed changes will have move meaning and performance than imposed
changes.
Primary Health Care
- Essential care based on scientifically sound and socially acceptable methods and
technology made universally available to individuals families and communities at
the cost they can afford at any given stage development than their full participation
towards self-reliance and self determination.
8 Primary Health Care
1. Health Education
2. Food Supply and Nutrition
3. Immunization
4. Hw and Basic Sanitation
5. Prevent & control of common dse
6. Tx of endemic dse
7. MCH including FP
Individual
1. Assessment
a. Data collection
2 types data subject & objective
2 methods interview & observation
4 Instruments

1. Nursing History (subjective)

2. Physical Examination
3. Laboratory Exam
4. Process Recording
b. Data Analysis
2. Nsg. Dx
Health Care V/E Etiology
3. Planning
a. Prioritization
b. Goal
c. Objective
d. Nsg. Intervention
e. Evaluation Outcomes - Criteria , standard
4. Implementation
- health educator
- provider of HC
- supervisor

Client /Patient Advocate

- researcher
- health organizer
- CH, Monitor

8 Basic Tasks:
1. Physical Maintenance
2. Allocation of Resources
3. Division of Labor
4. Socialization of Family Members
5. Reproduction, recruitment and releases
6. Maintenance of order
7. Placement of members in larger society production of good member
8. Maintenance of motivation and morale

Nuclear Family Mother, Father, son & daughter

Extended grandparent relation or daughter in law.
First Level Assessment

Health Threats

Health Deficits

Forcible Crisis/Stresspoints

Family Tasks
1. Ability to recognize the presence of the problem
2. Ability to make decisions.
3. Ability to perform nursing care to sick
4. Ability to provide home environment
5. Ability to utilize community resources
Incubation Pd- entry of Pathogen to appearance of 1st SK
IMMUNITY
Passive quick to come/to go

active slow to come / to go

1. natural utero, breast feeding

1. Natural getting the dse

2. Artificial sevum prob. Antitoxin 2. Artificial utanus toxoid

Pregnant
TT1 4th month
TT2 8th month
Pregnancy 2
TT3 booster 1st
Pregnancy 3
TT4 booster 2nd
Pregnancy 4
TT5 booster lifelong immunization
Community Mental Health Nursing
1. A unique process which includes an integration of concepts from nursing mental
health, social psychology community network.
Occupational Health Nursing

- Application of Nursing principles and procedure conserving health of the

healthworkers.
School Health Nursing
Components
1. School Health Services
2. Health Instruction
a. direct nurse doing the school teaching
b. indirect
3. Health School Living
4. School Community Linkage
Median age of Filipinos is 20 yrs old
50 % 20 years old
50% above 20 years old
Vital Statistics application of statiscal measure to vital events fertility , mortality,
morbidity
RA 3753 Civil Registry Law
Requires the registration of births and deaths to local registrars
RA 3573 Law on reporting notifiable disease
Family Planning Program
Goal Improve material & child through:

proper timing of pregnancy

proper spacing of pregnancy

number of pregnancies

Pregnancy :
Ideal age: 30-30- yrs.
20 -18 - 30 35 with risk
18 35 high risk
Ideal interval 3 years
2 years with risk
4 years high risk
ideal No 3

4 with risk
4 risk

COMMUNICABLE DISEASE NURSING COMMUNICABLE DISEASE

Posted: September 17, 2011 in CHN
0
Infectious Agent or its toxic products AGENT
Directly or Indirectly MODE OF TRANSMISSION
Person, Animal or Intermediate Vector HOST
Environment ENVIRONMENT
ECOLOGIC TRIAD OF DISEASE
Agent element, substance, animate or inanimate that may serve as stimulus to
initiate a disease process
Host organism that provides nourishment for another organism
Environment physical (climate), biological (plants & animals)
CONTAGIOUS VS. INFECTIOUS
Contagious
Diseases that are easily spread directly transmitted from person to person (direct
contact) through an intermediary host
Infectious
Diseases that caused by a pathogen not transmitted by ordinary contact but require
a direct inoculation through a break in the skin or mucous membrane.
NOTE: ALL CONTAGIOUS DISEASE ARE INFECTIOUS BUT INFECTIOUS DISEASE IS NOT
ALWAYS CONTAGIOUS
What is Infection?
INFECTION the state or condition in which the body or part of the body is invaded
by a pathogenic agent ( bacteria, virus, parasites etc.) which under favorable
conditions multiplies and produces effects which are injurious
Infectious Agent
A. RESIDENT ORGANISMS
deeply seated in the epidermis, not easily removed by simple handwashing,
Ex: Staphylococci
B. TRANSIENT ORGANISM
represent recent contamination,
survive for a limited period of time, acquired during contact with the infected
colonized patient or environment,
easily removed by good handwashing
Ex: ( Klebsiella & Pseudomonas)

Infectious Agent
Bacteria heama organism, systemic
Virus nuero organism, systemic
Fungi skin organism, local
Protozoa GI organism, local
Infectious Agent
FACTORS THAT AFFECTS THE AGENT TO DEVELOP A DISEASE
Pathogenicity ability to cause a disease
Infective dose no of organism to initiate infection
Virulence ability to enter or move through tissues
Specificity ability of the organism to develop antigens
STAGES OF INFECTIOUS PROCESS
Means of Transmission
1. CONTACT most common means of transmitting microorganisms from one
person to another.
A. Direct Contact (person to person)
occurs when one person touches another
best vehicle is the Hands especially those of the Health Care workers
B. Indirect Contact (inanimate object)
- occurs when a person touches an inanimate object contaminated by an infected
patient
2. AIRBORNE
- droplet, dust, organisms in env.
3. VECTOR insects or animals
4. VEHICLE
- food (salmonella), water (shigellosis), blood (Hepa B), medication ( contaminated
infusion)
PREVENTION OF COMMUNICABLE DISEASE
Health Education primary role of the nurse
Specific Protection- handwashing, use of protective devices
Environmental Sanitation clean and conducive for health
Definition of Prevention
Actions aimed at eradicating, eliminating, or minimizing the impact of disease and
disability. The concept of prevention is best defined in the context of levels,
traditionally called primary, secondary, and tertiary prevention
Prevention of Needlestick Injuries
Dispose Used Needles in Puncture Proof Needle Containers
Dont Recap Needles (Unless using the One-handed Technique)
Use Gloves When Handling Needles (Wont Prevent Injuries but May Lessen Chance
of Transmitting Diseases)
CONTROL OF C0MMUNICABLE DIESEASE
1. Notification
2. Epidemiological Investigation
3. Case finding; early dx and prompt treatment

4. Isolation and Quarantine

5. Disinfection; disinfestation
6. Medical Asepsis
a. Handwashing
b. Concurrent disinfection
c. Personal protective equipments (PPEs)
d. Barrier Cards/Placarding
Objectives of CCD
Restoration of health, reduce deaths and disability
Interpretation of control measures to IFC for practice to prevent spread of CD.
Promotion of health and prevention of spread of CD
Diseases that require weekly monitoring:
1. Acute flaccid paralysis (AFP) polio
2. Measles
3. Severe acute diarrhea (SAD)
4. Neonatal tetanus
5. AIDS
Diseases that require reporting w/in 24 hrs
1. Acute flaccid paralysis (AFP) polio
2. Measles
Diseases targeted for eradication
1. Acute flaccid paralysis polio
2. Neonatal tetanus
3. Measles
4. Rabies
Epidemiology
Study of the occurrence and distribution of diseases in the population
Patterns of occurrence of disease frequency of disease occurrence
Sporadic
On and off occurrence of the disease
Most of the time it is not found in the community
One or two cases that occur are not related
Endemic
Persistently present in the community all year round
Ex: malaria in Palawan
Epidemic
An unexpected increase in the number of cases of disease
Pandemic
Epidemic of a worldwide proportions
Time Related Patterns of Occurrence
cyclical variation
a periodic increase in the number of cases of a disease
a seasonal disease, an increase is expected or there is usual increase- dengue fever
during rainy seasons are increased but it is not considered an epidemic because it is

expected to rise at this particular time

hot spot-a rising increase that may lead to an epidemic
Time Related Patterns of Occurrence
Short time fluctuation
A change in the frequency of occurrence of a disease over a short period of time
Maybe (+) or (-)
Secular variation
A change in the frequency of occurrence of a diseae taking place over a long period
of time
Ex: a.) the change in the pattern of occurrence of polio after being eradicated in
2000, then sudden repport of cases in 2001 due to mutant restraints.
b.) small pox virus-eradicated in 1979 (last case reported) and no another incidence
as of today
Types of Epidemiology
Descriptive Epidemiology concerned with disease frequency & distribution
Analytic Epidemiology
Is a study of the factors affecting occurrence and distribution of the disease.
Ex. Epidemiologic investigation
Therapeutic/Clinical
Study of the efficacy of a treatment of a particular disease
Ex. Clinical trial of a newly proposed therapeutic regimen
Evaluation Epidemiology
Study of the over-all effectiveness of a total/ comprehensive public health program.
Ex. Evaluation of the under five clinic
Note: We make use of the epidemiology in CHN in order to come up a community
diagnosis and also to determine the effectiveness of a particular treatment
Types of Epidemiologic Data
Demographic data
Demography is the study of population groups
Ex. Population size and distribution
Vital Statistics
Environmental data
Health services data
Ex. Ratio between nurse and the population being served
Ex. Degree of utilization of health facility/ service
Epidemiologic Investigation
1st step- Statement of the problem
2nd step- Appraisal of facts describing the epidemic in terms of time, place,
person.
3rd step- formulation of hypothesis
4th step-Testing the hypothesis
5th step- Conclusion and recommendation
TERMS
Disinfection pathogens but not spores are destroyed

Disinfectant substance use on inanimate objects

Concurrent disinfection ongoing practices in the care of the patient to limit or
control the spread of microorganisms.
Terminal disinfection practices to remove pathogens from the patients
environment after his illness is no longer communicable
FACTORS AFFECTING ISOLATION
Mode of Transmission
Source
Status of the clients defense mechanism
Ability of client to implement precautions
ISOLATION
EPI
Launched by DOH in cooperation with WHO and UNICEF last July 1976
Objective reduce morbidity and mortality among infants and children caused by
the six childhood immunizable diseases
PD No. 996 (Sept. 16, 1076) Providing for compulsary basic immunization for
infants and children below 8 y/o
PP No. 6 (April 3, 1996) Implementing a United Nations goal on Universal Child
Immunization by 1990
RA 7846 (Dec. 30, 1994) immunization hepa B
PD No. 4 (July 29, 1998) Declaring the period of September 16 to October 14,
1998 as Ligtas Tigdas Month and launching the Phil Measles Elimination Campaign
Legislation, Laws affecting EPI
Proclamation No. 46 polio eradication project
Proclamation No. 1064 AFP surveillance
Proclamation No. 1066 National Neonatal Tetanus Elimination Campaign
EPI
BCG TB
DPT Diptheria, Pertussis, Tetanu
OPV Poliomyletis
Hepatitis B
Measles
Immunization
Contraindications
-conditions that require hospitalization
For DPT 2 and 3 history of seizures/ convulsions within 3 days after the first
immunization with DPT
Nursing responsibility: ask how the child reacts to the first dose
For infant BCG clinical AIDS
The following conditions are NOT contraindications:
Fever up to 38.5 C
Simple or mild acute respiratory infection
Simple diarrhea without dehydration
Malnutrition (it is indication for immunization)

Schedule of immunization
Infant BCG
0 to 11 months or 0 to 1 year
at birth
0.05 ml (dose) ID, right arm
School entrance BCG
When the child enters Grade 1 with or without scar on the right arm then still go on
with the vaccination except if he is repeating Grade 1
Schedule of immunization
DPT
3 doses, 4 weeks or 1 month interval
Target age: 1 to 11 months but child is eligible up to 6 years
If 7 years old and above DT only not P
0.5 ml, IM, vastus lateralis
Schedule of immunization
OPV
3 doses, 4 weeks/1 month
Target population: same as above, eligibility until Grade 6
2-3 drops, oral route
*Feb 8-March 8: Oplan Polio Revival Drive
No side effect, but advise the mother to avoid feeding the child for 30 minutes after
the vaccine, if vomits within the 30 minute period, repeat the vaccination
Schedule of immunization
Hepa B
3 doses, 4 weeks
Can be given at birth
Target age 1 to 11 months
0.5 ml, IM, vastus lateralis
Patient may experience local tenderness
Schedule of immunization
Measles
9 to 11 months
Most babies have protection because of maternal antibodies thus this vaccine is
given at 9 months because the time where the maternal antibodies wear off, other
virus if it still active it will kill the vaccine
0.5 ml, subcutaneous, any arm
Measles
Fever and measles rash lasting for 1 to 3 days within 2 weeks after immunization
(modified measles)
Immunization
Fully Immunized Child when he received all the antigens that should be given in
the first year of life (1 dose BCG, MV; 3 doses DPT, OPV, HB)
Completely Immunized Child All vaccines given but went beyond 0ne year of age
CHN 1

Posted: September 17, 2011 in CHN

0
History
Act No. 157- Creation of Board of Health of the Philippine (BON)
Act No. 1407- Abolish BOH to DILG
1919 Mrs. Carmen Del Rosario 1st Filipino Nurse Supervisor
1990-1992 Local Revolutionary Code of 1991, RA 7160 Revolution Code
National to local
Definition
Health (WHO) state of complete physical, mental and social well being,
not merely the absence of disease or infirmity
Public health (Dr. C.E. Winslow) the science and art of preventing
disease, prolonging life, promoting health and efficiency through
organized community effeort.
Community Health Nursing (Jacobson)- is a learned practice discipline with
the ultimate goal of contributing as individual and in collaboration with
others to the promotion of clients optimum level of function through
teaching and delivery of care.
Factors affecting Optimum Level of Function (OLOF)
1. 1.

Political

2. 2.

Behavioral

3. 3.

hereditary

4. 4.

Health Care Delivery System

5. 5.

Environmental Influences

6. 6.

Socio economic Influences

Concepts
1. 1.
The primary focus of community health nursing practice is on
health promotion.
2. 2.
Community health nurses are generalist in term of their
practice through life but the whole community.
3. 3.
Community health nurses are generalist in terms of their
practice through life continuity in its full range of health problems
and needs.

4. 4.
The nature of CHN practice requires that current knowledge
derived from the biological, social science, ecology, clinical nursing
and community health organizations be utilized
5. 5.
Contact with the client and or family may continue over a long
period of time which includes all ages and all types of health care.
6. 6.
The dynamic process of assessing, planning, implementing and
intervening provide measurements of progress, evaluation and a
continuum of the cycle until the termination of nursing is implicit in
the practice of community health nursing.
Principles
1. 1.
CHN is based on recognized needs of communities, families,
groups and individuals.
2. 2.
The community health nurse must understand fully the
objectives and policies of the agency she represents.
3. 3.

In CHN, the family is the Unit of services.

4. 4.
CHN must be available to all regardless of race, creed and
socioeconomic status
5. 5.

Health teaching is a primary responsibility of the CHN.

6. 6.
The community health nurse works as a member of the health
team.
7. 7.
There must be a provision for periods evaluation of community
health team.
8. 8.
Opportunities for continuation staff education programs nurses
must be provided by the CHN agency. The community health nurse
also has a responsibility for his/her own professional growth.
9. 9.
The community health nurse makes use of available community
health resources.
10.
10. The community health nurse utilizes the already existing
active organized groups in the community.
11.

11.

There must be provision for educative supervision CHN

12.

12.

There should be accurate recording and reporting in CHN.

Public Health Nurse

1. 1.

Planner/programmer

2. 2.

Provide of Nursing Care/Caregiver

3. 3.

Manager/Supervisor

4. 4.

Community Organizer

5. 5.

Coordinator of Service

6. 6.

Trainer/ Health Educator/ Counselor

7. 7.

Health monitor

8. 8.

Role Model

9. 9.

Change Agent

10.

10.

Recorder/ Reporter/ Statistician

11.

11.

Researcher

Community Health Process

Assessment
Collection of data, collected from family, groups and community.
Examples: Demographic Data
Vital Health Statistics
Community Dynamics
Health Status
Education
Methods: Community Survey
Interview
Statistics
Epidemiological studies
Common indicators of health status
Morbidity
Mortality
Categories of Health Problems
Health Deficit (HD)
Health Treat (HT)
Foreseeable Crisis (FC)
Ex: Active TB- HD
45 yr, old male smoke- HT
Sedimentary health style- Ht

Early pregnancy- FC
Father of family losses his job FC
Death in the family- FC
Patient is sick due to pneumonia- HD
Children who are not immunized- HT
Lack of prenatal check up- HT
Eclampsia- HD
Working hazard- HT
Hypertensive- HD
With measles child- HD
Family members has liprosy (microbactria liporea)- HD
Marriage- FC
Community diagnosis
1. A.

Physical Characteristics

2. B.

Population Characteristics

3. C.

Environmental factors

4. D.

Knowledge, attitude, practices of the people

5. E.

Community resources and facilities

Planning: Based on the actual and potential problems that were identified
and prioritized
Goal: Declaration of purpose or intent, gives essential direction to action
Specific objectives: Made in terms of activities of daily living
Implementation:
Carries out nursing procedures which are consistent with nursing with
nursing care plans.
Involve the patient with his/her family
Utilized support system
Evaluation
Frame works
1. a.

Structural elements

2. b.

Process elements

3. c.

Outcome elements

Nursing Procedures
Clinic Visit
1. 1.

Pre-consultation conference

2. 2.

Medical examination

3. 3.

Nursing intervention

4. 4.

Post consultation conference

Home Visit- face to face contact with the client

Principles
1. 1.

A home visit should have a purpose or objective

2. 2.
Planning for a home visit should use every available
information about the family, and individual
3. 3.
Planning should revolve around the essential needs of the
individual
4. 4.

Planning of a continuing care involve the individual or family

5. 5.

Planning should be flexible and practical

Bag technique- Tool

Public health bag- is an indispensable equipment of the public health
nurse
Principles
1. 1.

Prevent the spread of infection

2. 2.

Save time and effort

3. 3.

should not shadow the concern for the patient

4. 4.

Can be performer in a variety of ways

Zippiram solution- disinfectant