ABC’S OF Primary Health Care

Comprehensive review on ABC’S of PHC (created by RSI)

A. PRIMARY HEALTH CARE
- As defined by the World Health Organization (WHO), Primary health care is essential
health care based on practical, scientifically sound and socially acceptable methods and
technology, made universally accessible to individuals and families in the community through
their full participation and at a cost that the community can afford to maintain at every stage of
their development in the spirit of self-reliance and self- determination.
- PHC was declared in the Alma-Ata Conference in 1978, as a strategy to community
health development. It is a strategy aimed to provide essential health care that is:
C – ommunity based
A – ccessible
P – art and parcel of the total socio-economic development effort of the nation
A – cceptable
S – ustainable at an affordable cost
- Framework : People’s empowerment and partnership is the Key Strategy to achieve the
GOAL, “Health for all Filipinos by the year 2000 and Health in the Hands of the People by the
year 2020”.

B. Mission of PHC
- PHC aims to strengthen the health care system by increasing opportunities and
supporting the conditions wherein people will manage their own health care.

C. Principles of PHC
1. Partnership and empowerment as the core strategy.
2. Focuses responsibility for health on the individual, his family and the community.
3. Full participation and active involvement of the community towards the development of
self-reliant people.
4. Interrelationship between health and the overall political, socio-cultural and economic
development of society
4 As of Primary health care
A – ccessibility
A – vailability
A – cceptability
A – ffordability

D. Objectives of PHC
1. improvement in the level of health care of the community.
2. favorable population growth structure.
3. reduction in the prevalence of preventable, communicable and other diseases.
4. reduction in morbidity and mortality rates especially among infants and children.
5. extension of essential health care services with priority given to the underserved
sectors.
6. improvement in basic sanitation
7. development of the capability of the community aimed to the underserved sectors.
8. development of the capability of the community aimed at self-reliance.
9. maximizing the contribution of the other sectors for the social and economic
development of the community.

E. Four Cornerstone/Pillars in PHC

1. active community participation
2. intra and inter –sectoral linkages
3. use of appropriate technology
4. support mechanism made available

F. Strategies
1. Reorientation and reorganization of the national health care system in support of the
mandate of devolution under the Local Government Code of 1991.
 2. Effective preparation and enabling process for health action at all levels.
3. Mobilization of the people to know their communities and identifying their basic health
needs.
4. Development and utilization of appropriate technology focusing on local indigenous
resources available.
5. Organization of communities arising from their expressed needs.
6. Increase opportunities for community participation in local level planning, management,
monitoring and evaluation within the context of regional national objectives.
7. Development of intra-sectoral linkages with other government and private agencies.
8. Emphasizing partnership.

G. Elements of Primary Health Care (Elements Dam)

E – ducation on prevailing health problems
L – ocally endemic Disease Prevention and Control
E – xpanded Program of immunization
M – aternal and Child Health and Family Planning
E – nvironmental Sanitation and Safe Water Supply
N – nutrition and Food Supply
T – reatment of Communicable & Non-communicable Diseases
S – supply and proper use of Essential Drugs and Herbal Medicine
D – ental Health Promotion
A – ccess to and use of hospitals as centers of wellness
M – ental health promotion

H. Primary health Care Workers

- Various categories of health care workers make up the primary health care team. The
types vary in different communities depending upon:
a. Available health manpower resources
b. Local health needs and problems
c. Political and financial feasibility
- In general, the PHC team may consist of physician, nurses, midwives, nurse auxiliaries,
locally trained community health workers, traditional birth attendants and healers.
- types:
1. Village or Barangay Health Workers (V/ BHWs)
- This refers to trained community health workers or health auxiliary
volunteer or a traditional birth attendant or healer
2. Intermediate Level Health Workers
- General medical practioners or their assistants, Public Health Nurse, Rural
Sanitary Inspectors and Midwives.

I. Levels of Health Care Services

- Health problems that are beyond the capability of PHC units and beyond the competence
of the PHC workers are referred to an intermediate health facility or Rural health Units
(RHU)
- The RHU team generally consists of the physician, dentist, public health nurse, midwife,
sanitarian and other health workers.
- The higher the level the more qualified the health personnel and the more sophisticated
the health equipment.
3 levels:
1. Primary level - Barangay Health station, Private practitioners ,Community
Hospitals, Health Centers and Rural Health Unit
2. Secondary Level - Emergency/ District Hospitals, Provincial/ City Hospitals and
Provincial/ City Health Services
3. Tertiary Level - Teaching and Training Hospitals, Medical Centers and National
Health Services

J. Philippine health Care Delivery System

The Health Care Delivery System (Major players)
 – Composed of 2 sectors
1. PUBLIC SECTOR – financed with a tax based – budgeting system at both national
and local levels and where health care is generally given for free at the point of
service
- Consists of the national and local government agencies providing health
services
- The DOH –the national level lead agency in health
- has regional field office in every region
- maintains specialty hospitals, regional hospitals and medical centers
- LGU’s – it now run the local health system because of the devolution of
health care services
a. Provincial government: manages provincial and district hospitals
b. City/Municipal Government: manages health centers, RHU and BHSs
- every province, city or municipality has a local health board chaired
by local chief executive

2. PRIVATE SECTOR (for profit and nonprofit providers) – market oriented and
where health care is paid through user fees at the point of service
- Includes providing health services in the clinics and hospitals, health
insurance, manufacture of medicines, vaccines, medical supplies, equipment,
nutrition products and other health related services

K. Philippine Department of Health

- Has the new role as the national authority on health providing technical and other
resources assistance to concerned groups as mandated by EO 102.
EO 102 – mandates the DOH to provide assistance to local government units, people’s
organization and other members of civic society in effectively implementing programs, projects
and services that will promote the health and well being of every Filipino; prevent and control
diseases among population at risks; protect individuals, families and communities exposed to
hazards and risk that could affect their health; and treat, manage and rehabilitative individuals
affected by diseases and disability
Roles and Functions:
1. Leadership in health
a. Serve as the national policy and regulatory institution
b. Provides leadership in the formulation, monitoring and evaluation of national
health policies, plans and programs
c. Serve as advocate in the adoption of health policies, plans and programs
1. Enabler and Capacity builder
a. Innovate new strategies in health
b. Exercise oversight functions and monitoring and evaluation of national health
plans, programs and policies
c. Ensure the highest achievable standards of quality health care, health
promotion and health protection
1. Administrator of Specific Services
a. Manage selected national health facilities and hospitals with modern and
advanced facilities
b. Administer direct services for emergent health concerns that require newly
complicated technologies
c. Administer health emergency response services

VISION - The DOH is the leader, staunch advocate and model in promoting health for all in the
Philippines
MISSION – Guarantee equitable, sustainable and quality health for all Filipinos, especially the
poor and shall lead the quest for excellence in health
GOAL – Health Sector Reform Agenda (HSRA)
Rationale for Health Sector reform:
1. Slowing down in the reduction in the infant mortality rate (IMR) and the maternal
mortality rate (MMR)
 2. Persistence of large variations in health status across population groups and
geographic areas
3. High burden form infectious diseases
4. Rising burden from chronic and degenerative diseases
5. Unattended emerging health risk from environmental and work related factors
6. Burden of disease is heaviest on the poor
The reasons why the above conditions are still seen among the population can be explained by
the following factors
1. Inappropriate health care delivery system
2. Inadequate regulatory mechanisms for health services
3. Poor health care financing and inefficient sourcing or generation of funds for
health care
The following are the implications of the above situation:
1. There is poor coverage of public health and primary care services
2. There is inequitable access (physical and financial) to personal health care
services
3. There is low quality and high cost of both public and personal health care
Framework for Implementation of HSRA: FOURmula ONE for health
Goals of FOURmula ONE for health:
1. Better health outcomes
2. More responsive health systems
3. Equitable health care financing
The four elements of the strategy are:
1. Health financing – the goal of this health reform area is to foster greater, better and
sustained investments in health
2. Health regulation – the goal is to ensure the quality and affordability of health goods
and services
3. Health service delivery – the goal is to improve and ensure the accessibility and
availability of basic and essential health care
4. Good governance – the goal is to enhance health system performance at the national
and local levels
National Health Insurance Program (NHIP) – the main lever to effect desire changes and
outcomes of the four elements implementation components in terms of financing, governance,
regulation, service delivery.

DOH PROGRAMS (Selected)

L. Maternal Health Program:
Introduction
– To reduce the MMR by three quarters by 2015 to achieve its millennium development
goal. This means a MMR of 112/100,000 live births in 2010 and 80/100,000 live births
by 2015
– The percentage of pregnant women with at least four prenatal visits decreased from
77% in 1998 to 70.4% in 2003
– Women who received at least two doses of tetanus toxoid also decreased from 38% in
1998 to 37.3% in 2003
– The 200 Philippine health Statistics revealed that 25% of all maternal death are due to
hypertension, 20.3% to postpartum hemorrhage, 9% pregnancy with abortive
outcomes
– Underlying causes of maternal deaths are delays in taking critical actions (the 3 delays)
1. Delay in deciding to seek medical care
2. Delay in identifying and reaching the appropriate health facility and
3. Delay in receiving appropriate and adequate care at the health facility
Overall GOAL: to improve the survival, health and well being of mothers and unborn through
a package of services for the pre pregnancy, prenatal, natal and post natal stages
The STRATEGIC THRUSTS for 2005-2010 includes:
a. Implementation of the Basic Emergency Obstetric Care (BEmOC) and Comprehensive
Obstetric Care (CEmOC) strategy in coordination with the DOH.
EmOC – Emergency Obstetric Care
- part of essential obstetric care which includes pre and post-natal care, clean and safe
delivery, neonatal care and family planning
2 functions:
a. BEmOC – entails the establishment of facilities for every 125,000 population, can be reached
within 30 minutes from each catchment barangay
- it is an RHU or hospital facility which:
1. administer parenteral antiobiotics
2. adminster parenteral oxytocin
3. adminster parenteral anticonvulsants for pre-eclampsia/eclampsia
4. perform manual removal of placenta
5. perform removal of retained placental products; and
6. perform assisted vaginal delivery
b. CEmOC – for every 500,000 popultion, referring facility, reach within 1 hour from a BEmOC
facility
- a hospital facility which:
1. perform the six functions of a BEmOC facility, plus
2. perform caesarean section and hysterectomy; and
3. give safe blood transfusion
b. improve the quality of prenatal and postnatal care
c. reduce women’s exposure to health risk
health risk women:
1. All women of reproductive age especially those who are less than 18 years old
and over 35 years of age
2. low educational resources
3. low financial resources
4. with unmanaged chronic illness
5. who just given birth in the last 18 months

Essential health Service Packages Available in the Health Care facilities:

– these are packages of services that every women has to receive before and after
pregnancy and or delivery of a baby
A. Antenatal registration
- the standard prenatal visits that a woman has to receive during pregnancy are as follows
PRENATAL PERIOD OF PREGNANCY
VISITS

1st visit as early in pregnancy as possible

before four months or during the first
trimester

2nd visit during the 2nd trimester

3rd visit during the 3rd trimester

Every 2 weeks after 8th month pregnancy till delivery

B. Tetanus Toxoid Immunization

- a series of 2 doses of Tetanus Toxoid vaccination must be received by a woman one month
before delivery to protect baby from neonatal tetanus
- the 3 booster dose shots to complete the five doses that provides full protection for both
mother and child. The mother then is called as a “Fully Immunized Mother” (FIM)
Tetanus Toxoid schedule for Women:
Vaccine:
TT1 – given as early as possible during pregnancy
TT2 – at least 4 weeks later, gives 80% protection and 3 years protection for the mother
TT3 – at least 6 months later, 95% protection and gives 5 years protection for the mother
TT4 – at least one year later, 99% protection and gives 10 years protection for the mother
TT5 – at least one year later, 99% protection and gives lifetime protection for the mother
 C. Micronutrient Supplementation
- these are necessary to prevent anemia, vitamin A deficiency and other nutritional disorders.
Vitamins Dose Duration Remarks

Vitamin A 1 capsule/tablet Twice a week Vitamin A should not be given to

of 10,000 IU pregnant women before 4th
Start from the 4th of month of pregnancy. It might
pregnancy until delivery cause congenital problems in
the baby

Iron 60mg/400 ug 1 tablet OD for 6 months

tablet or 180 days during the
pregnancy period
Contains 60 mg
elemental iron OR
with 400 mcg folic
acid 2 tablets per day if
prenatal consultations are
done during the 2nd and
3rd trimester

D. Treatment of Diseases and Other Conditions

- these conditions may endanger her health and complication could occur
Conditions/Diseases What to Do Do not give

Difficulty of 1. Clear airway

breathing/obstruction of
airway 2. Place in her best position

3. Refer woman to hospital with

EmOC capabilities

Unconscious 1. Keep on her back arms at the a. Do not give Oral

side Rehydration Solution
to a woman who is
2. Tilt head backwards (unless unconscious or has
trauma is suspected) convulsions
3. Lift chin to open airway b. Do not give IVF if you
4. Clear secretions from throat are not trained to do
so
5. Give IVF to prevent or correct
shock

6. Monitor blood pressure, pulse

and shortness of breath every
15 minutes

7. Monitor fluid given. If

difficulty of breathing and
puffiness develops. Stop
infusion

8. Monitor urine output

Post partum bleeding 1. Massage uterus and expel a. Do not give

clots ergometrine if woman
has eclampsia, pre-
2. If bleeding persists: eclmapsia oor
a. Place cupped palmed on hypertension
uterine fundus and feel for
sate of contraction
 b. Massage fundus in a
circular motion

c. Apply bimanual uterine

compression if
ergometrine treatment
done and postpartum
bleeding still persists

d. Give ergometrine 0.2 mg

IM and another dose after
15 minutes

Intestinal parasite 1. Give Mebendazole 500mg a. Do not give

infection tablet single dose
2. Give anytime from
months of pregnancy
mebendazole in the
first 1-3 months of
4-9 pregnancy. This might
cause congenital
problems in baby

Malaria 1. Give sulfadoxin-

pyrimethamine to women
from malaria endemic area
who are in 1st or 2nd
pregnancy, 500 mg

2. Give 25 mg tab, 3 tabs at the

beginning of 2nd to 3rd
trimesters not less than one
month interval

Recommended Schedule of Post Partum Visits:

1st visit 1st week post partum preferable 3-5 days

2nd visit 6 weeks post partum

M. Child Health Programs (newborns, infants and children)

- Newborns, infants and children are vulnerable age group for common childhood diseases.
- to address problems, child health programs have been created and available in all
health facilities which includes:
1. Infant and Young Child Feeding
- Overall objective: To improve the survival of infants and young children by
improving their nutritional status, growth and development through optimal feeding.
- The National Plan of Action for 2005-2010 for Infant and Young child
feeding:
Goal: reduce child mortality rate by 2/3 by 2015
Objective: To improve health and nutrition status of infants and young
children
Outcome: To improve exclusive and extended breastfeeding and
complementary feeding
- Key Messages on Infant and Young Child Feeding
a. initiate breastfeeding within 1 hour after birth
b. exclusive for the first 6 months of life (only breastmilk and nothing
else)
c. Complemented at 6 months with appropriate foods, excluding milk
supplements
d. Extend breastfeeding up to two years and beyond
- Laws that protects Infant and Young Child feeding
 a. Milk Code (EO 51) – consists of breast milk substitutes, including
infant formula; other milk products, foods and beverages, including bottle-fed complementary
foods.
b. Rooming In and Breastfeeding Act of 1992 – requires both
public and private health institutions to promote rooming in and to encourage, protect and
support breastfeeding.
- one of the 10th steps to Mother Baby Friendly Hospitals wherein
the mother and the baby should be together for 24 hours and as long as both are in the hospital.
c. Food fortification Law – declares a policy to improve the
nutritional status of the children which is cost effective and has sustainable intervention to
address micronutrient deficiencies.
- requires a mandatory food fortification of staple foods –
flour( with iron and Vit. A), cooking oil, refine sugar (with Vit. A), rice (with Iron) and the voluntary
fortification of processed foods through the “Sangkap Pinoy Seal”.

2. Expanded program on immunization

a. the expanded program on immunization was launch in July 1976 by the
department of health in cooperation with the World Health Organization and the UNICEF.
b. the original objective was to reduce the morbidity and mortality among infants
and children caused by the seven childhood immunizable diseases
c. Principles:
1. the program based on the epidemiological situation
2. the whole community rather than just the individual is to be protected,
thus mass approach is utilized
3. immunization is a basic health service and such it is integrated in to the
health services being provided for by the Rural health Unit
d. Elements of EPI
1. target setting
2. cold chain logistic management
3. information, education and communication
4. assessment and evaluation of the program’s overall performance
5. surveillance, studies and research
e. Legal basis/existing policies
1. Presidential Decree No. 996
- providing for compulsory basic immunization for infants and children
below eight years of age
2. presidential proclamation No. 6
- implementing a united nations goal on “Universal Child
Immunization”
3. Presidential Proclamation No. 147
- declaring every third Wednesday of January and February thereafter,
for two years, as “National Immunization Days”
4. Republic Act 7846
- an act requiring compulsory immunization against Hepaptitis B for
infants and children below eight years old

f. Importance of vaccination
1. Immunization is the process by which vaccines are introduced into the
body before infection sets in.
2. vaccines are administered to promote immunity and to protect the children
from disease-causing agents
g. Concepts of Vaccinations
1. it is safe and immunologically effective to administer all EPI vaccines on
the same day at different sites of the body
2. measles vaccine should be given as soon as the child is 9 months old,
regardless of whether other vaccines will be given on that day. Measles vaccines given at 9
months provide 85% protection against measles infection
 3. moderate fever, malnutrition, mild respiratory infection, cough, diarrhea
and vomiting are not contraindications to vaccination.
4. absolute contraindications to immunizations are: DPT2 or DPT3 to child
who has had convulsions or shock within 3 days after the previous dose. Live vaccines like BCG
vaccine must not be given to individuals who are immunosupressed due to malignant disease
(e.g. child with AIDS)
5. it is safe and effective with mild side effects after vaccination. Local
reaction, fever and systemic symptoms can result as part of the normal immune response
6. false contraindications to immunizations are children with malnutrition, low
grade fever, mild respiratory infections and other minor illness and diarrhea should not be
considered a contraindication to OPV vaccination.
7. repeat BCG vaccination if the child does not develop a scar after the first
injection
8. use one syringe one needle per child during vaccination
h. The EPI Target Diseases
1. vaccination among infants and newborns (0-12 months) against the seven
vaccination preventable diseases.
2. these include: Tuberculosis, Diphtheria, Pertussis, Tetanus, Poliomyelitis,
measles and hepatitis
i. The EPI Routine Schedule of Immunization
1. every Wednesday is designated as immunization day and is adopted in all
parts of the country
2. A child is said to be “Fully Immunized Child” when a child receives one
dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of HB and one dose of measles before a
child’s first birthday
Vaccine Minimum Number of Minimum Reason
Age of 1st Doses Interval
Dose Between
Doses
BCG Birth of 1 BCG given at BCG given at
anytime after earliest possible age protects
birth the possibility of TB and other
TB infections
DPT 6 weeks 3 4 weeks An early start with DPT reduces
the chance of severe pertussis
OPV 6 weeks 3 4 weeks The extent of protection against
polio is increased the earlier the
OPV is given
Hepa B At birth 3 6 weeks An early start of Hepa B reduces
interval from the chance of being infected
1st dose to and becoming a carrier prevent
second dose liver cirrhosis and liver cancer.
and 8 weeks
interval from
second dose
to third dose
Measles 9 months At least 85% of measles can be
prevented by immunization at
this age

j. Tetanus Toxoid Immunization Schedule for Women

1. tetanus toxoid vaccination for women is important to prevent tetanus in
both mother and the baby
2. completing the five doses following the schedule provide lifetime immunity

Vaccine Minimum Age Percent Duration of protection

interval Protected
TT1 As early as
possible during
 the pregnancy
TT2 At least 4 weeks 80% Infants born to the mother will
later protected from neonatal tetanus.
Gives 5 years protection for the
mother
TT3 At least 6 months 95% Infants born to the mother will be
later protected from neonatal tetanus.
Gives 5 years protection for the
mother
TT4 At least one year 99% Infants born to the mother will be
later protected from neonatal tetanus.
Gives 10 years protection for the
mother
TT5 At least one year 99% Gives lifetime protection for the
later mother. All infants born to that
mother will be protected

k. Administration of Vaccines
Vaccine Dose Route of Site of Administration
Administration
BCG Infants 0.05 ml Intradermal Right deltoid region of the arm
DPT 0.5 ml Intramuscular Upper outer portion of the thigh
OPV 2 drops or Mouth
depending on
manufacturer’s
instructions
Measles 0.5 ml Subcutaneous Outer part of the upper arm
Hepa B 0.5 ml Intramuscular Upper outer portion of the thigh
Tetanus Toxoid 0.5 ml Intramuscular Deltoid region of the upper arm

L. the EPI vaccines and its characteristics

- Vaccines are substances very sensitive at various temperatures. To avoid
spoilage and maintain its potency, vaccines need to be stored at correct temperature.
Type/Form of vaccines Storage temperature
Most Sensitive to Oral polio (live -15C to -25C (at the freezer)
heat attenuated)
Measles (freeze dried) -15C to -25C (at the freezer)

Least Sensitive to DPT/Hep B +2C to +8C (in the body of temperature)

heat
D – toxoid which is a
weakened vaccine

P – killed bacteria

T – toxoid which is a
weakened toxin
Hep B +2C to +8C (in the body of temperature)
BCG (freeze dried) +2C to +8C (in the body of temperature)
Tetanus Toxoid +2C to +8C (in the body of temperature)

3. Management of Childhood Illnesses

- the Integrated Management of Childhood Illnesses (IMCI) has been
established as an approach to strengthen the provision of comprehensive and essential health
package to the children.
Methods in Managing Childhood Illnesses:
1. Assess the patient – taking the history of the patient is one of getting information
about the disease condition. This can be done by asking and observing the patient’s condition to
explore the possible causes.
 - Check for DANGER SIGNS: convulsions, abnormally sleepy, difficult
to awaken, unable to drink/breastfeed, vomits everything
- Assess MAIN SYMPTOMS: cough/difficulty breathing, diarrhea,
fever, ear problems
2. Classify the disease
Color- Presentation Classification of Diseases Level of Management

Green Mild Home Care

Yellow Moderate Manage at the RHU

Pink Severe Urgent Referral in Hospital

3. Treat the patient

4. Counsel the patient – providing health education to client to promote health and
avoid risk of infection.
- Counsel about home treatments, feeding and fluids, when to return
immediately, follow up

4. Nutrition Program
- Malnutrition continues to be the public health concerns in the country. The
common nutritional deficiencies are: VIT. A, IRON and IODINE.
- GOAL: “To improve quality of life of Filipinos through better nutrition,
improved and increased productivity.

Nutritional Guideline for Micronutrient Supplementation:

A. Universal Supplementation of Vitamin A
Target Preparation Dose/Duration Remarks

Infants 6-11 months 100,000 IU 1 dose only One capsule is given

anytime during the 6-
11 months but usually
given at 9 months
during measles
immunization

Children 21- 71 200, 000 IU 1 capsule every six

months months

B. Vit. A supplementation to High risk children.

Target/Illness Preparations Dose/Duration

Measles One capsule given upon

diagnosis, regardless of when
Infants (6 months-11 100, 000 IU the last dose of VAC was
months) given.
200, 000 IU
Pre-school children (12
months- 71 months)

One capsule given upon

Severe pneumonia diagnosis, except when the
Persistent Diarrhea child was given VAC less than
4 weeks before diagnosis.
Malnutrition

Infants (6 months- 11 100, 000 IU

months) 200, 000 IU
Pre-school children (12
months – 71 months)
 One capsule given upon
diagnosis, except when the
Malnutrition child was given VAC less than
School children (6 years 200, 000 IU 4 weeks before diagnosis
to 12 years old)

B. Vit. A supplementation for pregnant women and post partum women.

Targets Preparation Dose Duration Remarks

Pregnant women 10, 000 IU 1 capsule/ tablet Start from the 4th Vit. A 10, 000 IU
of 10,000 IU month of should NOT be
twice a week pregnancy until given to pregnant
delivery women who are
already taking
pre-natal
vitamins or
multiple
micronutrient
tablets that also
contain Vit. A

Post-partum 200, 000 IU 1 capsule 200, One dose only Vit. A of 200, 000
women 000 IU within 4 weeks IU should NOT be
after delivery given to pregnant
women

D. Iron supplementation for pregnant and lactating women

Targets Preparations Dose/Duration Remarks

Pregnant women Tablet containing 60 1 tablet once a day for A dose of 800 mcg of
mg elemental iron 6 months 0r 180 days folic acid is still safe to
with 400 mcg folic during the pregnancy the pregnant woman.
acid period

Or

2 tablets per day (120

mg) if prenatal
consultations are done
during the 2nd and 3rd
trimester

Lactating women Tablet containing 60 1 tablet once a day for

mg elemental iron 3 months or 90 days
with 400 mcg folic
acid

E. Iodine supplementation to specific population groups.

Targets Preparation Dose/Duration

Women 15-45 years old Iodized oil capsule with 200 1 capsule for 1 year
mg iodine
Children of school age Iodized oil capsule with 200 1 capsule for 1 year
mg iodine

Adult males 1 capsule for 1 year

Iodized oil capsule with 200
mg iodine

Elements of Primary Health Care (selected)

N. Health Education
- is a process whereby knowledge, attitude and practice of people are changed to improve
individual, family and community health.
Sequence of STEPS in health education:
C – reating awareness
M – otivation
D – ecision making action

Component of Health education:

I –nformation
E – ducation
C – ommunication

Principles:
H – ealth
E – ducation considers the health status of the people.
A – chieved by doing
L – earning
T – takes the lead in helping people to attain health through their own effort
H – uman and natural resources were utilized (community resources)

H – ealth workers consider health education as their basic function

E – ducation for health is a creative process
D – evelopment is slow but continuous and creative process
U – se of supplementary aids and devices
C – ooperative effort
T – akes place in the home, in the school and the community
I – nlvolves motivation
O –penly makes us of supplementary aids and devices
N – eeds, interests and problems of the people affected must be met

Health Education teaching methods:

a. Interviewing
b. Counseling
c. Lecture – discussion
d. Open- forum
e. Workshop
f. Case study
g. Role Play
h. Symposium
i. Community assembly

Qualities of a Good HEALTH EDUCATOR

E – effective motivator to others
D – oes have knowledge or mastery of subject matter
U – tilizes the quality of Patience and flexibity
 C – redible/creative
A – able to emphatize with others
T – teaching skills
O – organizes and encourage group participation
R – ephrase or summarize ability
S – ense of humor

O. Treatment of Communicable Diseases (common)

Defining terms:
Communicable Disease – is an illness caused by an infectious agent that is transmitted
directly or indirectly to a well person through a vector or an inanimate object.
Carrier – is an individual who harbors the organism and is capable of transmitting it to a
susceptible host without showing manifestations of the disease.
Contagious Disease – is a term given to a disease that is easily transmitted from one
person to another through direct or indirect means.
Host – is a person, animal or a plant on which parasite depends for its survival
Infectious Disease – is transmitted not only by ordinary contact but requires direct
inoculation of the organism through a break on the skin or mucous membrane.
Isolation – is the separation from other persons of an individual suffering from a
communicable disease.
Quarantine – is the limitation of freedom of movement of persons or animals which have
been exposed to communicable disease for a period of time equivalent to the longest incubation
period of illness.
Surveillance – is the act of watching.
Sporadic diseases – are diseases that occur occasionally and irregularly with no specific
pattern.
Epidemic diseases – are diseases that occur in a greater number than what is expected in
a specific area over a specific time.
Pandemic diseases – is an epidemic that affects several countries or continents.
Endemic diseases – are those that are present in a population or community at times
involving few people during specific periods.

Chain of INFECTION:
1. CAUSATIVE agent – is any microbe capable of producing a disease. E.g. bacteria,
spirochete, virus, fungi. Etc.
2. RESERVOIR of Infection – refers to the environment and objects on which an organism
survives and multiplies.
3. Portal of EXIT – is the path or way in which the organism leaves the reservoir. E.g. RS,
GUT, GIT, skin and mm.
4. Mode of TRANSMISSION – is the means by which the infectious agent passes through
from the portal of exit of the reservoir to the susceptible host. This is the easiest link to break the
chain of infection.
Modes:
a. Contact Transmission – most common and can be transmitted through
direct and indirect contact and droplet spread.
b. Air-borne transmission – occurs when fine microbial particles or dust
particles containing microbes remain suspended in the air for a prolong period
c. Vehicle transmission – is the transmission of the infectious disease through
articles or substances that harbor organism until it is ingested or inoculated into the host
d. Vector-borne transmission – occurs when carriers, such as flies
intermediate intermediate and mosquitoes transfers the microbes to another living organism.
5. PORTAL of Entry – is the venue where the organism gains entrance into the susceptible
host.
6. SUSCEPTIBLE host – the human body has many defenses against the entry and
multiplication of organism.

Preventive Aspect of Care of patients with Communicable Disease:

A. Health Education
 a. availability and importance of prophylactic immunization
b. manner in which infectious illness is spread and methods of avoiding the spread
c. importance of seeking medical advice for any sign of health problem
d. importance of environmental cleanliness and personal hygiene
e. means of preventing contamination of food and water supply
B. Immunization – is the introduction of specific protective antibodies in a susceptible
person or animal, or the production of cellular immunity in such person or animal
Immunity – is a condition of being secure against any particular disease.
Types:
1. Natural
a. Natural Passive – acquired through placental transfer
b. Natural Active – acquired through immunization and or recovery
from a certain disease
2. Artificial
a. Artificial Passive – acquired through the administration of antitoxin,
antiserum, and gamma-globulins
b. Artificial Active – acquired through the administration of vaccine and
toxoid

Types of antigen:
1. Inactivated (killed organism)
- not long lasting, multiple dose needed and booster dose is needed
2. Attenuated (live organism)
- single dose needed and has long lasting immunity

C. Environmental Sanitation – the DOH, through the Environmental Health Services (EHS),
has the authority to act in all issues and concerns in environmental health including the Code on
Sanitation (PD 856
1. Water Supply Sanitation Program
a. Approved types of water facilities such as:
LEVEL 1 (Point of source) – a protected well or a developed spring with
an outlet but without a distribution system generally adoptable to rural areas
LEVEL II (Communal Faucet System or Stand Posts) – composed of a
source reservoir, a piped distribution network and communal faucet
LEVEL III – waterworks system or individual house connection
b. Unapproved type of water facility or water coming from doubtful source
such as open dug well, unimproved spring and wells are not allowed for drinking unless treated
through proper disinfection.
c. Water quality and monitoring
- examination of drinking water shall be performed only in private and
government laboratories duly accredited by the DOH
- certification of potability of an existing water source is done by the
Secretary of health or his duly authorized representative
- water supply sources need to be disinfected: (1)newly constructed
water supply facilities, (2)water supply facility that has been repaired or improved (3)water
supply sources found to be bacteriologically positive through laboratory analysis.
2. Proper Excreta and Sewage Disposal
a. Approved types of toilet facilities:
LEVEL I – non water carriage toilet facility (pit latrines)
- toilet facility requiring small amount of water to wash the
waste into receiving space (aqua privies)
LEVEL II – Water sealed and flush type with septic tank disposal
facilities
LEVEL III – water carriage toilet connected to septic tanks or to
sewerage system to treatment plant
3. Hospital Waste Management
a. all newly constructed/renovated government and private hospitals shall
prepare and implement HWM
 b. the use of appropriate technology and indigenous materials for HWM shall
be adopted
c. training of hospital personnel involved in waste management shall be an
essential part of hospital training program
4. Food Sanitation Program
a. food establishments shall be appraised as to the following sanitary
conditions:
- inspection/approval of all food sources, containers, transport vehicles
- compliance to sanitary permit requirements for all food
establishments
- provision of updated health certificates for food handlers, cook and
cook helpers
- training food handlers and operators on food sanitation

Common Communicable Diseases:

AMOEBIASIS (Amoebic Dysentery)
- a protozoal infection of human beings initially involves the colon, but may spread to soft
tissues, most commonly to the liver by lymphatic dissemination.
- Etiologic Agent: Entamoeba Histolytica
- Source: Human excreta
- Incubation period: in svere infection is 3 days.
- Period of communicability: communicable for the entire duration of illness
- Mode of transmission: 1. Fecal oral route
2. can be transmitted through direct contact and through sexual
contact ie. Orogenital, oroanal
3. Through indirect contact, the disease can infect human by ingestion
of food especially uncooked leafy vegetables or foods contaminated with fecal materials
containing E. hystolitica
- Sign and symptoms: 1. Slight attack of diarrhea, altered with periods of constipation
and often accompanied by tenesmus
2. diarrhea, watery and foul smelling stool often containing blood
streaked mucus.
3. nausea, flatulence, abdominal distension and tenderness in the
right iliac region over the colon
- Diagnostic exam: stool exam
- Treatment: Metronidazole (Flagyl)
- Nursing management: 1. Observe isolation and enteric precaution
2. Provide health education such as boiling of water for drinking; avoid
washing of food from open drum or pail, food preparation and food handling.

BACILLARY DYSENTERY (Shigellosis)

- is an acute bacterial infection of the intestine characterized by diarrhea and fever
associated with the passing out of bloody mucoid stool with tenesmus.
- Etiologic Agent: Shigella (flesneri, boydii, connei and dysenteriae)
- Incubation period: 7 hours to7 days, average 3 to 5 days
- Period of communicability: capable of transmitting the microorganism during the acute
infection until the feces are negative of the organism.
- Mode of transmission: 1. through ingestion of contaminated food or drinking
contaminated water
2. transmitted by flies or through other objects contaminated by feces
of the patient
3. fecal- oral transmission
- Signs and symptoms: 1. Fever
2. tenesmus, nausea and vomiting
3. colicky or cramping abdominal pain associated with anorexia and
body weakness
4. diarrhea with bloody-mucoid stool that is watery at first
5. dehydration and loss of weight
 - Diagnostic exam: Fecalysis
- Treatment: Ampicillin, Tetracycline and Cotrimoxazole
- Nursing management: 1. Maintenance of fluid and electrolytes
2. restriction of food until nausea and vomiting subsides
3. proper disposal of excreta

CHICKENPOX (Varicella)
- is an acute and highly contagious disease of viral etiology characterized by vesicular
eruptions on the skin and mucous membrane
- Etiologic agent: Herpesvirus varicellae
- Incubation period: 10-21 days
- Mode of transmission: 1. Transmitted through direct contact with patients who shed
the virus from the vesicles
2. Indirectly through linens or fomites
3. Droplet infection
- Period of Communicability: about a day before the eruption of the first lesion up to about
5 days after the appearance of the last crop
- Signs and symptoms: 1. Pre-eruptive: mild fever and malaise
2. eruptive: rashes starts from the trunk (unexposed area), then
spread to other parts, very pruritic vesicular lesion, lesions are characterized by different stages
such as Macule-Papule-Vesicle-Pustule-Crust
- Diagnostic exam: based on the clinical symptoms
- Treatment: Zoveraz, Acyclovir
- Nursing management: 1. Respiratory isolation
2. proper personal hygiene
3. cut finger nails short hand washing to minimize spread of bacterial
infections

CHOLERA (El Tor)

- is an acute bacterial enteric disease of the GIT characterized by profuse diarrhea,
vomiting, massive loss of fluid and electrolytes that could result to hypovolemic shock and death.
- Etiologic agent: Vibrio Cholerae/Coma
- Pathognomonic sign: Rice watery stool
- Incubation period: 1-3 days
- Period of communicability: communicable during stool positive stage, usually a few days
after recovery
- Mode of transmission: 1. Fecal- oral route
2. Transmitted through ingestion of food or water contaminated with
stool
3. Flies, soiled hands and utensils serve to transmit infection
- Diagnostic exam: Rectal swab/ Stool exam
- Treatment: 1. IVF treatment
2. Oral Rehydration Therapy by oral route such Oresol and Hydrites
3. ATBC – Tetracycline
- Nursing management: 1. Hand washing
2. enteric isolation
3. VS, I/O
4. proper personal hygiene
5. proper disposal of excreta
6. health education – food/water supply, boiling of water, sanitary
disposal of human excreta

DIPTHERIA (Pseudo-membrane)
- is an acute bacterial disease that can infect the body in two areas; the throat (respiratory
diphtheria) and the skin (cutaneous diphtheria)
- Etiologic agent: Corynbacterium Diptheria (Klebs leoffler Bacillus)
- Incubation period: 2-5 days
 - Source of infection: infection comes from discharges of the nose, pharynx, eyes or
lesions on other parts of the body
- Mode of transmission: transmitted through contact with a patient or a carrier, or with
articles with discharges of infected persons
-Types: 1. Nasal – with foul-smelling serosanguinous secretions
2. Tonsilar
3. Nasopharyngeal (more severe type) – cervical lymph adenopathy, Bull’s neck
appearance
4. Wound or Cutaneous diphtheria –affects mucus membrane and any break on the
skin
- Sign and symptoms; 1. Fatigue, malaise, slight sore throat and fever
2. Cervical adenitis
3. Bull’s neck appearance due to swelling of the neck
- Diagnostic exam: Nose and Throat swab, Schick test and Molony test
- Treatment: 1. ATBC – Penicillin
2. Antitoxin – requires skin testing, given in combination with penicillin
- Nursing management: 1. Absolute CBR for 2 weeks to conserve energy
2. soft food diet/ small frequent feeding
3. encourage to drink fruit juice rich in Vit. C to increase resistance
4. Ice collar for the neck

GERMAN MEASLES (Rubella/Three day Measles)

- is a mild viral illness caused by rubella virus. It causes mild feverish illness associated
with rashes and aches in joints. It has teratogenic in fetus.
- Etiologic agent: Rubella virus
- Incubation Period: 14-21 days
- Period of communicability: one week before and four days after the onset of rashes, but
worst when the rash is at its peak
- Mode of transmission: 1. direct contact with nasopharyngeal secretions
2. air droplets
3. transplacental transmission
- Signs and symptoms: 1. Prodromal period: low grade fever, headache, malaise,
conjunctivitis, mild coryza, post-auricular, occipital, posterior cervical lymphadenopathy (3-5
days after the onset)
2. Eruptive period: Forchheimer’s spot – a pinkish rash on the soft
palate, eruption of rashes that may last for 1-5 days
- Treatment: symptomatic
- Risk of Congenital malformation: 100% - when maternal infection occurs on the first
trimester of pregnancy, 4% - second and third trimesters and 90% of congenital rubella cases
will excrete the virus at birth and are therefore infectious.
- Nursing management: 1. Isolation of patient
2. Bed rest until fever subsides
3. Darkened room to avoid photophobia
4. Irrigation of eyes with normal saline to prevent irritation
5. Health education – administration of MMR, pregnant mothers should
avoid exposure to patients infected with rubella virus, administration of Immune Serum Globulin
one week after exposure to Rubella

HERPES SIMPLEX
- is a viral disease characterized by the appearance of sores and blisters anywhere on the
skin.
- Etiologic agent: Herpes simplex virus (HSV) – Type 1: can cause cold sores characterized
by tiny, clear fluid-filled blisters most commonly affects the lips, mouth, nose, chin or cheeks last
for 7-10 days, can be transmitted through kissing, sharing or kitchen utensils or towels; Type 2:
causes genital sores, affecting the buttocks, penis, vagina or cervix 2 – 20 days after contact,
usually get through sexual contact, skin contact and is characterized by minor rash, painful
sores, fever, muscular pain and burning sensation on urination
- Treatment/Nursing management: 1. Oral anti-viral drugs such as Acyclovir
 2. Personal hygiene

HERPES ZOSTER (Shingles)

- is an acute viral infection of the sensory nerve caused by a variety of chickenpox virus.
- Etiologic agent: Varicella-zoster (found to cause two diseases, varicella and herpes
zoster)
- Incubation period: communicable a day before the appearance of the first rash until to
six days after the last crust
- Mode of transmission: 1. Transmitted through direct contact, droplet infection and
airborne
2. Indirectly through articles freshly soiled by secretions and
discharges from the infected person
- Signs and symptoms: 1. Erythematous base of the skin lesion appears first and
followed by the appearance of the vesicles within 24 hours usually affects the thoracic segment
including the extremities. (Last for 1-2 weeks)
2. Paroxysmal burning and stabbing pain that occurs 1-5 days prior to
the development of rash (worst at night and is intensified by movement)
3. Fever, malaise, anorexia, headache and lymphadenopathy
- Diagnostic exam: based on the clinical manifestations
- Treatment: Symptomatic, anti-viral drugs, analgesics, anti-inflammatory
- Nursing management: 1. strict isolation of patient.
2. Apply cool, wet dressings with NSS to pruritic lesions
3. Prevention of secondary infections

INFLUENZA (La Grippe)

- is an acute viral infectious disease affecting the respiratory system
- Etiologic agent: RNA containing myxoviruses, Type A, B and C
- Incubation period: 24 – 48 hours
- Period of communicability: communicable until the 5th day of illness and up to seven days
in children
- Mode of transmission: 1. airborne transmission among crowded population
2. droplet transmission
- Signs and symptoms: 1. Chilly sensation, hyperpyrexia, malaise, sore throat, coryza,
myalgia, vomiting and headache
- Nursing management: 1. Stay at home
2. drink plenty of fluids
3. symptomatic treatment
4. TSB
5. isolate patient to decrease risk of infecting others (respiratory
isolation)
6. Health education – immunization, avoidance of crowded places,
personal hygiene

LEPTOSPIROSIS (Weil’s disease/ Hemorrhagic Jaundice)

- is a zoonotic infectious bacterial disease carried by animals whose urine contaminates
water or food which is ingested or inoculated through the skin.
- Etiologic agent: Leptospira Interrogans
- Incubation period: 6 – 15 days
- Period of communicability: leptospira is found in the urine between 10 – 20 days after the
onset
- Source of infection: Domestic animals such as Rats, Mice and Dogs
- Mode of transmission: 1. through ingestion or contact with the skin and mucous
membrane of the infected urine
2. Transmitted through the mucous membrane of the eyes, nose and
mouth and through a break on the skin
- Signs and symptoms: Stages: 1. Septic stage – marked with fever lasting 4-7 days.
Chills, headache, anorexia, abdominal pain and severe prostration
 2. Immune or Toxic stage – can be with or without jaundice and
last for 4-30 days. Headache, meningeal manifestation like disorientation, convulsion, with CSF
findings of aseptic meningitis, oliguria and anuria with progressive renal failure, shock and coma
in severe cases. Death may occur between 9 to the 16th day
3. Convalescence – at this stage, relapse may occur during the
4th to 5th week
- Treatment: Penicillin G Na
- Nursing management: 1. Isolate patient with proper disposal of urine
2. keep patient on close surveillance
3. health education – sanitation in homes, workplaces and farm,
eradication of rats and rodents

MEASLES (Rubeola/Morbilli)
- is an acute, contagious disease that usually affects children which are susceptible to
Upper Respiratory Tract Infection (URTI). The most common and serious of all childhood
diseases.
- Etiologic agent: Filterable virus/ Morbilli virus
- Incubation period: 10 – 12 days
- Period of communicability: Communicable four days before and five days after the
appearance of rashes
- Sources of infection: Virus has been found in the patient’s blood, as well as in the
secretions from the eyes, nose and throat
- Mode of transmission: 1. through direct contact with the droplets spread by coughing
and sneezing
2. Indirectly through articles or fomites freshly contaminated with
respiratory secretions of infected patients
- Signs and symptoms: Stages: 1. Pre-eruptive stage – fever, catarrhal symptoms (rhinitis,
conjunctivitis, photophpbia and coryza), Koplik’s spot

2. Eruptive stage – macula-papular rash appears

first on the cheeks, bridge of the nose, along the hairline, at the ear lobe on the 4 th day, on and
off high grade fever, anorexia and irritability
3. Convalescence stage – rashes fade away, fever subsides
- Diagnostic exam: Nose and throat swab
- Treatment: anti-viral drugs, ATBC if with complication such as Bronchopneumonia, otitis
media
- Nursing Management: 1. Isolation of patient
2. TSB to control high fever with daily cleansing bed bath
3. Oral and nasal hygiene and provision of eye/ear care free of
secretions
4. Patient’s position should be changed every 3-4 hours
4. Health education: measles vaccine, MMR vaccine

MUMPS (Infectious Parotitis)

- is an acute viral disease manifested by the swelling of one or both parotid glands, with
occasional involvement of other glandular structures, particularly the testes in male
- Etiologic agent: Paramyxovirus found in the saliva of the infected person
- Incubation period: 14 – 25 days
- Period of communicability: 6 days before and nine days after the onset of parotid gland
swelling
- Mode of transmission: Droplet infection
- Signs and symptoms: 1. sudden headache, earache, loss of appetite and swelling of
the parotid gland located in front and below the ear
2. Pain reaches its peak in about and continues for about seven to ten
days
3. moderately elevated fever
4. one gland maybe affected at first, and one to three days later, the
other side may become involved
 - Complication: Most notorious complication is Orchitis (occurs several days after the onset
of parotid swelling)
- Treatment: 1. Anti-viral drugs
2. hot and cold application for relief of pain
- Nursing management: 1. Medical aseptic protective care
2. bed rest to avoid complication
3. diversional activities
4. offer soft and solid foods and avoid acid foods

PERTUSSIS (Whooping Cough)

- is an infectious disease characterized by repeated attacks of spasmodic coughing which
consists of a series of explosive expirations, typically ending in a long drawn forced inspiration
which produces a crowing sound, the “whoop” and usually followed by vomiting.
- Etiologic agent: Bordatella Pertussis
- Incubation period: 7 – 14 days
- Period of communicability: starts from 7 days after exposure to three weeks after typical
symptoms
- Mode of transmission: 1. direct contact and droplet
2. indirectly through soiled linens and other articles contaminated by
respiratory secretions
- Sources of infection: secretions from the nose and throat of infected persons
- Signs and symptoms: Stages: 1. Catarrhal stage – coryza. Sneezing, lacrimation and dry
cough. It is the most communicable stage and last for 1-2 weeks
2. Paroxysmal stage – occurs on the 7 to the 14 th day, cough
becomes spasmodic and recurrent with excessive explosive outburst in series of rapid 5 to 10
rapid coughs in one expiration, each cough ends in loud, crowing inspiratory whoop and choking
on mucus that causes vomiting. Last from 4-6 weeks.
3. Convalescence stage – marked by decrease in paroxysms of
coughing, both in frequency and severity, the attack subsides after about six weeks.
- Diagnostic exam: Nasopharyngeal swabs
- Treatmetn: 1. Supportive therapy
2. ATBC such as Erythromycin and Ampicillin
- Nursing management: 1. Isolation and medical asepsis
2. Suctioning equipment must be readily available at all time for
emergency
3. Decrease environmental stimuli
4. Provide warm baths and keep bed dry
5. Health education – immunization, patient isolation, case reporting

RABIES (Hydrophobia/Lyssa)
- is a specific, acute, viral infection communicated to man by the saliva of an infected
animal
- Etiologic agent: Rhabdovirus
- Incubation period: 1-7 ½ months in dogs, 10 days to 15 years in human depending on
the following:
a. distance of the site
b. extensiveness of the bite
c. specie of the animal
d. richness of the blood supply in the area of the bite
e. resistance of the host
- Period of communicability: communicable from 3-5 days before onset of symptoms until
the entire course of illness
- Signs and symptoms: Stages: 1. Prodromal/Invasion phase – characterized by fever,
anorexia, malaise, sore throat, copious salivation, lacrimation, perspiration, irritability,
restlessness, sometimes drowsy, mental depression and insomnia. Pain at the original site of the
bite, sensitive to light, sound and temperature, numbness and tingling sensation along the
peripheral nerves and site of the bite
 2. Excitement or Neurological phase – characterized by mark
excitation. There is delirium with nuchal rigidity, severe and painful spasm of the muscles of the
mouth, pharynx and larynx on attempt to swallow water or food. Patient may exhibit maniacal
behavior and profuse drooling of saliva.
3. Terminal phase – patient becomes unconscious and spasm
ceases with progressive paralysis. Death occurs due to respiratory paralysis and circulatory
collapse.
- Diagnostic exam: Fluorescent rabies anti-body (FRA), presence of negri bodies in the
dog’s brain
- Treatment: 1. Washing of wounds from the bite and scratches of dog with soap and
running water for at least 3 minutes
2. give ATS and anti-rabies vaccine
- Nursing management: 1. Isolate the patient
2. give emotional, spiritual support and optimum comfort
3. patient should not be bath and there should not be any running
water in the room or within the hearing distance of the patient
4. IVF should be wrapped and needle should be properly anchored
5. Health education – vaccination of all dogs, confinement of any dog
that has bitten a person for 10 – 14 days

TETANUS (Lockjaw)
- is an infectious disease caused by Clostridium tetani which produces potent exotoxin
with prominent systemic neuromuscular efforts manifested by generalized spasmodic
contractions of the skeletal muscles.
- Incubation period: 3 days to 3 weeks in adult, 3 – 30 days in Tetanus neonatorum
- Etiologic agent: Clostridium tetani
- Sources of infection: animal and human feces, soil and dust and plaster of paris, unsterile
sutures, pins, rusty materials, scissors
- Mode of transmission: 1. through punctured wound and burns that is contaminated by
dust, soil or animal excreta
2. Umbilical stump in newborn especially for babies delivered at home
with faulty cord dressing
3. Circumcision and ear piercing
- Signs and symptoms: Neonate:
- have feeding and sucking difficulties
- Excessive and voiceless crying
-Tonic and rigid muscular contractions
- Cyanosis, pallor
Adult:
- Muscle spasm and increase muscle tone near the wound
(localized)
- if systemic or generalized: - Hypertonicity, hyperactive deep
tendon reflexes and painful involuntary muscle contractions
- neck and facial muscle rigidity (Trismus)
- Grinning expression (Risus Sardonicus)
- Opisthotonus
- Intermittent tonic convulsions lasting for several minutes which
may result in cyanosis and sudden death due to asphyxiation
- Laryngospasm followed by accumulation of secretions in the
lower airway resulting in respiratory distress
- Treatment: Specific; 1. Patient should receive ATS within 72 hours after a punctured
wound
2. tetanus toxoid IM given in standard schedule
3. Pen G to control infection
4. Musle relaxant to decrease muscle rigidity and spasm
Non- specific; 1. Maintainance of adequate airway/ Trachestomy
2. feeding through NGT
3. adequate fluid, electrolyte and caloric intake
 4. lower environmental stimuli
5. close monitoring of VS and muscle tone
6. health education – active immunization with TT and DPT for babies
and children

TYPHOID FEVER
- is a bacterial infection transmitted by contaminated water, milk, shellfish or other food. It
is an infection of the GIT affecting the lymphoid tissues (payer’s patches) of the small intestines.
- Etiologic agent: Salmonella typhosa/typhi
- Incubation period: 5 – 40 days with a mean of 10- 20 days
- Period of communicability: as long as the patient is excreting the microorganism, he is
still capable of infecting others
- Sources of infection: 1. A person who recovered from the disease or one who took
care of a patient with typhoid and was infected
2. ingestion of shellfish (oysters) taken from waters contaminated by
sewage disposal
3. stool and vomits of infected individual
- Mode of transmission: 1. Fecal oral transmission
2. Through 5 F’s
3. ingestion of contaminated food, water and milk
- Signs and symptoms: Onset: - headache, chilly sensation, body pains, nausea
and vomiting and diarrhea
- symptoms worst at 4-5th day
- fever is higher in the morning that afternoon
- red spots on the abdominal wall on the 7-9th day
Typhoid state: - symptoms decline in severity
- Accumulation of dirty brown collection of dried mucus
and bacteria (Sordes)
- Coma vigil (blank stare)
- twitching of the tendon in the wrist
- Patient mutters deliriously and picks up aimlessly at bed
clothes with his fingers in continuous fashion (Carphologia)
- Delirium and death in severe cases
- Diagnostic exam: Typhidot
- Treatment: Chloramphenicol – drug of choice
- Nursing management: 1. Maintain or restore fluid and electrolyte balance
2. Monitoring patient’s VS
3. Prevent further injury (fall) of patient with typhoid psychosis
4. Maintain good personal hygiene and mouth care
5. Cooling measures are necessary during febrile state
6. Watch for signs of intestinal bleeding
7. Health education – sanitary disposal of excreta, proper supervision
of food handlers, enteric isolation, adequate protection or provision of safe drinking water supply