ra gapuz

COMMUNITY HEALTH NURSING BY: LEA D. FOY-OS, R.N. (MAN in progress) HOW TO ANSWER QUESTIONS RELATED TO COMMUNITY HEALTH NURSING FOCUS ON THE FOLLOWING PRINCIPLES (H-E-A-L-T-H) HEALTH SCREENING EPI ASSESSMENT OF RISK FACTORS LEARN THE BASICS IN CHN THERAPEUTIC DIET HERBAL MEDICINE HEALTH MODERN CONCEPT: O.L.O.F. of individuals, families and communities Families from the lower income groups are the ones mostly served GOAL of Public Health: to contribute to the most effective total development and life of the individual and his society. ECO-SYSTEM influences the OLOF FACTORS: Political Behavioral Heredity Health care delivery system Environment Socioeconomic influence Community Health Nursing GOAL: Promotion of OLOF thru teaching and delivery of care GOAL: PHILOSOPHY: based on the WORTH & DIGNITY of man PHILOSOPHY: Primary FOCUS: Health Promotion FOCUS: NURSES: Generalists NURSES: Based on recognized needs of communities, families, groups and individuals FAMILY: Unit of Service FAMILY: HEALTH TEACHING: Primary responsibility of the community Health Nurse. TEACHING: FIVE FOLD MISSION OF CHN: 1. 2. 3. 4. Health Promotion Health Protection Health Balance Disease Prevention a. Primary prevention b. Secondary Prevention c. Tertiary Prevention 5. Social Justice INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz RURAL HEALTH MIDWIFE Under the general supervision of the PHN Works with the PHN in planning and evaluating health services at the Barangay level Plans for activities in the clinic BHS; follow-up in homes and field visit in the community Mobilizes community for health action QUALIFICATIONS: Supervising Public Health Nurse: at least FIVE YEARS experience as PHN Nurse: Nurse Instructor II: MAN, 3 years experience as CHN II: Regional Training Nurse: six years nursing experience , three of which in training or Nurse: Nursing education Regional Nurse Supervisor: at least FIVE YEARS experience in CHN, TWO years of Supervisor: which are in supervisory position Nursing Program Supervisor: at least SEVEN years in CHN training Supervisor: Chief Nurse: at least FIVE YEARS experience in CHN - 3 either as supervisor or Nurse: assistant chief nurse CHN CLINIC VISIT PRE-CONSULTATION CONFERENCE: Clinical Hx taking Vital signs Physical assessment Lab exams and documentation MEDICAL EXAMINATION: Ensure privacy, safety and comfort of the patient throughout procedure POST-CONSULTATION: Explain findings & needed care Refer as needed Make appointment for next clinic/home visit HOME VISIT Professional face-to-face contact made by a nurse to a patient or the family to provide necessary health care activities and to further attain an objective of the agency Should have a PURPOSE/ OBJECTIVE Planning for a home visit should make use of all available information about the patient and his/her family. Frequency of Home Visit A - acceptance of the family & ability to recognize own needs P O P E - physical, psychological & educational needs - other health agencies involved - Policy of a given agency - Evaluate of past services given to the family BAG TECHNIQUE TOOL making use of the public health bag through which the nurse during the visit can perform nursing procedures with ease and deftness, saving time & effort at the end in deftness, view of rendering effective nursing care. PUBLIC HEALTH BAG essential & indispensable equipment PRINCIPLES: To minimize if not totally prevent the spread of infection; INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz Save TIME & EFFORT Special consideration: HAND WASHING Contents of the bag: BP apparatus & stethoscope are carried separately; Medicines include: betadine, 70% alcohol, benedicts solution Place waste paper bag outside of work area to prevent contamination of clean area INTRAVENOUS THERAPY Refers to the insertion of a needle/catheter/cannula into a vein based on physicians written prescription ANSAP (Association of Nursing Service Administration of the Phil) - accrediting body INDICATIONS Maintenance/correction of dehydration in px unable to tolerate adequate volumes of oral fluid medications; Parenteral nutrition Administration of drugs Blood transfusion CONTRAINDICATIONS Administration of irritant fluids/drugs through peripheral access (e.g. Sodium chloride; Hypertonic potassium chloride) DEPARTMENT OF HEALTH

VISION Health for all Filipinos (old) THE LEADER OF HEALTH FOR ALL IN THE PHILIPPINES (new) MISSION Enhance accessibility & quality of health care to improve the quality of life of all Filipinos, especially the poor (old) Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to lead the quest for excellence in health. (new) BASIC PRINCIPLES Ensured universal access to basic health services Health & nutrition of vulnerable groups must be prioritized PRIMARY STRATEGIES S support to local health system & frontliners A - assurance of health care I - increased investment for PHC D - devt of national standards & objectives for health PRIMARY HEALTH CARE Essential health care made universally accessible to individuals & families in the community by means acceptable to them. GOAL Health for all Filipinos & Health in the Hands of the People by the year 2020. MISSION To strengthen the health care system by increasing opportunities & supporting the conditions wherein people will manage their own health care. CONCEPT Core Strategy: PARTNERSHIP & EMPOWERMENT towards SELF-RELIANCE Strategy: INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz PHC components/elements C H E I - CDD/ Control of Communicable Diseases - Health Education - Environmental Sanitation - Immunization

PHC cornerstones/Pillars M multisectoral linkages A Active community participation U Use of appropriate technology S Support mechanism made available PRIMARY HEALTH WORKERS The higher the level the more qualified the health personnel & the more sophisticated the health equipment Concept: TEAMWORK TWO levels: Village/BHWs trained community health workers, health auxillary volunteers, traditional birth attendants, healers Intermediate Level professional group HRDP CO-PAR COMMUNITY ORGANIZING A continuous process of awareness building, organizing and mobilizing community members towards community development. PHASES AND ACTIVITIES I. PRE-ENTRY PHASE Preparation of the staff Site selection II. ENTRY PHASE integration with the community Courtesy calls Information campaigns Identification of potential leaders III. CORE-GROUP FORMATION & MOBILIZING integration with core group IV. ORGANIZATION-BUILDING Organizing Barrio Health committees Setting up community organization V. CONSOLATION & EXPANSION PHASE Networking, linkages Implementation of livelihood projects developing secondary leaders ALTERNATIVE THERAPIES HERBAL MEDICINES 10 herbal medicines being advocated by the DOH L LAGUNDI U ULASIMANG BATO B BAWANG B BAYABAS Y YERBA BUENA INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz S A N T A S H A R E D

5 SAMBONG AMPALAYA NIYOG-NIYOGAN TSAANG GUBAT AKAPULKO

1. LAGUNDI SKIN DISEASES HEADACHE ASTHMA, COUGH, FEVER RHEUMATISM, SPRAIN, INSECT BITES ECZEMA DYSENTERY 2. ULASIMANG BATO o U Uric acid excretion 2. BAWANG o BawHaT: Bawang for HYPERTENSION & TOOTHACHE 3. BAYABAS o DIARRHEA o WASHING OF WOUNDS o GARGLE TO RELIEVE TOOTHACHE 4. YERBA BUENA o S SWOLLEN GUMS o P PAIN o I INSECT BITES o T TOOTHACHE o M MENSTRUAL & GAS PAIN o A ARTHRITIS o N NAUSEA & FAINTING o D DIARRHEA 5. SAMBONG (A-D-A) o A ANTI-EDEMA o D DIURETIC o A ANTI-UROLITHIASIS 6. AMPALAYA o Mild Diabetes Mellitus (NIDDM) 7. NIYUG-NIYOGAN o Anti-helmithic: ASCARIASIS 8. TSAANG-GUBAT o STOMACHACHE o TSAANG GUBAT o DIARRHEA 9. AKAPULKO o Anti-fungal stimulant stamina; immune booster; Tonic anti-inflammation; steam inhalation sedative: acne

GINGER ALE: GINSENG: EUCALYPTUS: LEMON GRASS:

Reminders (BONUS) Boiling: remove cover One kind of plant for each type of sx No insecticides Use clay pot and plant part advocated Stop in case of untoward reactions; seek consultation if s/sx not relieved after 2-3 doses

INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz ACUPRESSURE QI Principle: traditional Chinese medicine upon birth life energy enters the body HEALTH: state of balance of the YIN and YANG YIN: cold, yielding, feminine, negative force YANG: warm, dominating masculine positive force Posture: Lying down; sitting-up Frequency: Usually once a day; or every four hours 2-3x a week for those with chronic illness CONTRAINDICATIONS: o Pregnancy o Full stomach o Cardiac ailments FOODS TO AVOID (during treatment) o C cold/iced beverages/ food o A alcoholic beverages o P peanuts o S sour food o S seafood o S salty food AHSHI POINTS Painful spots/ nodes taken as Acupressure points TSUN MEASUREMENT: use of the patients hands/fingers/palms ACUPUNCTURE GOAL: Manipulation of energy flow throughout the body following a thorough assessment by a practitioner HSUEH POINTS: Anatomic points being stimulated INDICATIONS: MOTION disabilities ACUTE/CHRONIC PAIN PRECAUTIONS PREGNANCY HEMOPHILIA ACUTE CVD AROMATHERAPY USE OF ESSENTIAL OILS OF PLANTS TO TREAT SYMPTOMS Based on olfactory stimuli used to help balance the DOSHAS DOSHAS: Mediators between the physiologic & psychologic processes INDICATIONS INSOMNIA STRESS/RELAXATION INDUCE SLEEP

REPUBLIC ACT NO. 8423 INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz T.A.M.A. OF 1997 (TRADITIONAL AND ALTERNATIVE MEDICINE ACT) Created PITAHC (Phil. Institute of Traditional & Alternative Health Care) - scientific research & development of traditional & alternative health care system that have impact on public health care. DOH PROGRAMS MONTHLY HEALTH ACTIVITIES

JANUARY: Cancer Consciousness Week FEBRUARY: Dental Health Week Leprosy Control week MARCH: Womens Health Month Burn Injury Prevention Month Rabies Awareness Month World TB Day (24) APRIL: Garantisadong Pambata World Health Day (7) MAY: National Family Planning Month Cervical Cancer Awareness Month Safe Motherhood Week (10-16) JUNE: Kidney Month No smoking month Dengue Awareness Month Prostate Cancer Awareness Month World Environment Day (5) JULY: Nutrition Month National Voluntary Blood Donation Month National Disaster Preparedness Month AUGUST: National Lung Month Sight-Saving Month Family Planning Day (1) Hospital as Centers of Wellness Week Asthma Week SEPTEMBER: Liver Cancer Awareness Month Generics Awareness Month OCTOBER: Elderly Filipino Week National Mental Health Week National Newborn Screening NOVEMBER Substance Abuse Prevention Week DECEMBER OPLAN IWAS PAPUTOK World AIDS Day (1) HEALTH ACTIVITIES Family planning/ Reproductive Health Nutrition Womens Health and Safe Motherhood Adolescent Health

INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz Breastfeeding: Milk Code Dental Health Integrated Management of Childhood Illnesses (IMCI) Newborn screening CDD: Control of Diarrheal Diseases Health Programs for Older Person Environmental health Occupational Health: Industrial Hygiene Cardiovascular Disease, Visual Health Cancer, Asthma, COPD Diabetes, Osteo, Arthritis, Musculoskeletal Community Base Rehabilitation Rabies Philippine Registry for Disabled Persons REPRODUCTIVE HEALTH Exercise of reproductive right with responsibility VISION Reproductive health practice as a way of life for every man & woman throughout life GOALS 3 Es Every pregnancy should be intended Every birth should be healthy Every sex act should be free of coercion & infection A - Achieve a desired family size FRAMEWORK INTERNATIONAL Focus on WOMENS HEALTH Ultimate Goal: QUALITY OF LIFE LOCAL Both Men and Women; based on its elements Components of RH MATERNAL & CHILD HEALTH FAMILY PLANNING PREVENTION & CONTROL OF RTI INCLUDING STDs/HIV/AIDS ADOLESCENT SEXUAL & REPRODUCTIVE HEALTH PREVENTION OF ABORTION & MGT OF ITS COMPLICATIONS MENS REPRODUCTIVE HEALTH PREVENTION OF REPRODUCTIVE TRACT CANCER & OTHER GYNECOLOGICAL PROBLEMS COUNSELING & EDUCATION FOR HUMAN SEXUALITY INFERTILITY MANAGEMENT VIOLENCE AGAINST WOMEN (VAW) FAMILY PLANNING

Planning intended to determine the number of children based on a couples beliefs, health and economic circumstances Proper spacing of child Giving birth at the right age and at the right time Importance of FP For the health of the mother For health of the new borne For the health of the entire providing INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz Executive Order 199: created the PFPP (Philippine Family Planning Program) NATURAL FP CERVICAL MUCUS METHOD/ BILLINGS OVULATION Sensations & mucus BASAL BODY TEMPERATURE LACTATIONAL AMENORRHEA METHOD SYMTO-THERMAL METHOD Makes use of the womans BBT, cervical mucus at the vulva & other signs Advantages of natural FP N no physical side effects E effect is reversible E enables woman to know more about her body C can lead to early diagnosis of some gynecological disorder ARTIFICIAL FP

TEMPORARY ORAL CONTRACEPTIVES: composed of synthetic hormones which when taken regularly, prevents pregnancy IUD - small plastic sterile device that is introduction into the uterus to prevent preganancy. Depo-Medroxyprogesterone Acetate (DMPA) effective for 3 months Condom Diaphragm PERMANENT Tubal ligation blocking of fallopian tubes to prevent sperm & egg Vasectomy tying & cutting of vas deference 10 leading causes: MORBIDITY Diarrhea Bronchitis/Bronchiolitis Pneumonias Influenza Hypertension PTB Diseases of the Heart Malaria Measles Chickenpox STATISTICS

10 leading causes: MORTALITY Diseases of the Heart Diseases of the vascular system Pneumonia Malignant neoplasm Accidents TB, all forms COPD Diabetes Mellitus Other diseases of the respiratory system Kidney Failure MORTALITY among Immunizable Diseases Measles INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz Tetanus TB of meninges Diphtheria Other TB Acute poliomyelitis MATERNAL MORTALITY: main cause Normal delivery and other complications r/t pregnancy occurring in the course of labor, delivery and peurperium PIH/ Hypertension Postpartum hemorrhage Pregnancy with abortive outcome Hemorrhage r/t pregnancy PNEUMONIA: top leading cause of child mortality LIFE EXPECTANCY: Male: 66.93 y/o Female: 72.18 y/o STOP TB: D.O.T.S. A Primer for Health Workers

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Most common sign of TB: Cough lasting for 2 weeks Biggest threat to economic development in the Philippines. 1997 Prevalence Survey: more than 16 million Filipinos are infected with TB and 600, 000 TB cases are actively spreading the disease. ELEMENTS: Microscopes Anti-TB drugs Health Care Providers/ Treatment Partners Reporting Books Funding & Support Quality service through DOTS S - Screening; supervise sputum collection E - Examination of sputum specimens R - Recording, Reporting; Referral V - Verbalize with Px at the level of his understanding I - Instruct the Px & Tx partner on the importance of compliance C - Counseling on Compliance E - Enlighten community & govt on DOTS What DOTS can do: Cure TB patients: cure rate 95% Prevents new infections. (every TB case will infect 10 others within a year) Prevents Resistance to anti-TB drugs No hospitalization required Saves money (WHO: the most cost effective of all health interventions) TB Tx Regimen category I II III

INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz Indication

11 New cases (+) sputum; Seriously ill RIPE 2 mos RI 4 mos 6 months Relapses Failures New cases sputum (-) 3x; PTB minimal;Not serious extrapulmonary RIP 2 mos RI 2 mos 4 months

Intensive Mainte-nance Duration

RIPES (2mos) RIPE (1 mo.) RIE 5 mos 8 months

Rabies: P.R.O. Pinoy Responsible Owner of Dog DOH primer 350-400 Filipinos die of rabies every year. WHAT TO DO IF BITTEN BY A DOG Wash wound immediately with soap & water. Consult a health worker at the nearest health center. Observe the dog for 14 days for any change in behavior. If the dog cannot be observed (stray) or if suspected to be rabid, consult your physician immediately for immunization. If dog shows s/sx of rabies, it usually dies within 3-7 days. Pinoy Responsible Pet Owner P.R.O. Have your pet immunized against rabies at 3 months old & every year thereafter Current WHO Guide for Rabies Pre & Post Exposure Tx General considerations in Post-exposure Tx: WHO advocates the use of modern vaccines for PET Abandon the production of BRAIN-TISSUE VACCINES Immediate washing/flushing & disinfection of the wound Disinfecting with ETHANOL (700ml) or Iodine tincture Rapid administration of purified Ig TREATMENT MODALITIES CATEGORY I INDICATION II III

Touching, Minor scratches/ Single/ multiple feeding animals, abrasions transdermal lick intact skin without bites, bleeding/ licks scratches, on broken skin contamination of mucous membrane with saliva Use Ig + vaccine

NURSING No exposure; no Use vaccine INTERVENTION Tx alone

Administration of RIG Infiltrate into the depth of the wound & around the wound Any remaining amount, administer IM to distal part (e.g. anterior thigh) INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz 12 Quantities/vol. Of RIG 20 IU/kg for Human RIG 40 IU/kg for Equine RIG If the calculated dose is insufficient to infiltrate all wounds, sterile saline may be used to dilute it 2 to 3 fold to permit thorough infiltration. Post exposure Tx IM TWO IM schedule for modern vaccine Vaccine shouldnt be injected into the gluteal region CLASSICAL 5 DOSE IM (Essen regimen) 1 dose: days 0, 3, 7, 14 & 28 Deltoid antero-lateral thigh: children Post exposure Tx IM ALTERNATIVE: the 2-1-1 regimen 2 doses: day 0 deltoid, R & L 1 dose : deltoid on day 7 1 dose : on day 21 Post exposure Tx Intradermal Economical: use 1 ml syringe & short hypodermic needles 3 vaccines: HDCV (Human Diploid Cell Vaccine) RABIVAC PVRV (Purified Verocell Vaccine) VERORAB, IMOVAX, Rabies vero PCECV (Purified Chick Embryo Cell Vaccine) RABIPUR 8 SITE ID METHOD: 8-0-4-0-1-1 for use with HDC (Rabivac); PCECV (Rabipur) When no RIG is available in emergency For use: Rabivac & Rabipur 0.1ml per ID site 2 SITE ID: 2-2-2-0-1-1 for use with: PVRV (Verorab, Imovax, Rabies Vero, TRC verorab) 0.1ml PCECV (Rabipur) 0.2ml ID minimum value of 2.5IU/ampule Control of Acute Respiratory Infection (CARI) OBJECTIVE: To decrease pneumonia mortality among under fives 45,000 children die every year because of pneumonia STRATEGIES (TENA) Training of workers with the standard management of ARI Enable BHW to identify & refer cases for treatment NGO mobilization Advocacy and Social Mobilization Contributory Fx to Pneumonia Mothers failure to recognize early s/sx Indiscriminate use of antibiotics Not standardized management by health workers IMCI: Integrated Management of Childhood Illness ASSESS & CLASSIFY THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS Check for GENERAL DANGER SIGNS INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz Vomits everything Convulsion/seizure Difficulty drinking/breastfeeding Drowsiness/lethargy/difficult to awaken Assess COUGH/ DIFFICULTY BREATHING Cough/ difficulty breathing: HOW LONG? Fast breathing Chest Indrawing Stridor in calm child COLOR SYSTEM PINK ROW: severe classification; needs immediate attention and referral Any general SEVERE PNEUMONIA or Give first dose of appropriate danger sign VERY SEVERE DISEASE antibiotics Chest indrawing Stridor in calm child Give Vit. A Treat the child to prevent low blood sugar Refer URGENTLY to hospital YELLOW ROW: needs appropriate antibiotic/ other treatment FAST PNEUMONIA Give an appropriate antibiotic BREATHING for 5 days Soothe the throat & relieve the cough with safe remedy Advise mother when to return immediately Follow-up in two days

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GREEN ROW: no need for specific medical treatment such as antibiotics NO signs NO PNEUMONIA If coughing more than 30 Of pneumonia or days, refer for assessment very severe disease COUGH/ COLD Soothe the throat & relieve the cough with safe remedy Advise mother when to return immediately Follow-up in 5 days if not improving

POSITIVE FAST BREATHING 0-2 mos >60bpm 2mos 1 yr 50bpm 1-5y/o 40bpm INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz Age LESS THAN 2 MONTHS VERY SEVERE DISEASE SEVERE PNEUMONIA NO PNEUMONIA/ COUGH/COLD LESS THAN 2 MOS: NO PNEUMONIA MANAGEMENT Keep WARM Breastfeed frequently Clear nose if it interferes with feeding Return quickly if: Breathing becomes FAST & DIFFICULT Feeding becomes a problem Becomes SICKER 2 MOS-5 YEARS: PNEUMONIA MANAGEMENT Antibiotics for FIVE DAYS Mothers told to bring back the child after 2 days for reassessment/ earlier if condition worsens Home care COTRIMOXAZOLE BID for FIVE DAYS PROCAINE PENICILLIN OD for FIVE DAYS (IM) <2 MOS (<5kg) 200, 000 units 2-12 MOS (6-9kg) 400, 000 units 12 MOS- 5 YRS 800, 000 units (10-19 kg) C.D.D.: CONTROL OF DIARRHEAL DISEASES

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TYPES OF DIARRHEA ACUTE : < 14DAYS PERSISTENT: 14 DAYS or more DYSENTERY: Blood in the stool; with or without mucus CLASSIFY DEHYDRATION SEVERE DEHYDRATION Two of the ff: Abnormally sleepy Sunken eyes Drinks poorly Skin pinch goes very slowly Tx PLAN C: Referral to hospital for IVF!!! SOME DEHYDRATION Two of the ff: Restless, irritable Sunken eyes THIRSTY: drinks eagerly Skin pinch goes back Tx PLAN B O.R.S: first 4hours after assessment 200-400ml 0-4mos 400-700ml 4-12mos 700-900ml 1-2 yrs 900ml-1L 2-5yrs INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz NO DEHYDRATION Not enough signs to classify some or severe Tx PLAN A Give extra fluids 50-100ml after each watery stool (0-2y/o) 100-200ml (2 y/o & above) as tolerated (10y/o & above) Continue feeding Return if with danger sign/s LEPROSY CONTROL PROGRAM KILATIS KUTIS PROGRAM MOT: prolonged skin-to-skin; droplet Prev./Control & Rehab: BCG Avoid MOT Hygiene Adequate nutrition Health education SCHISTOSOMIASIS CONTROL PROGRAM Endemic area Bicol Samar Leyte Davao PREVENTION Proper excreta disposal Toilet facilities Use of footware protection Mollucides Environmental sanitation Drug of choice: PRAZIQUANTEL

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MALARIA CONTROL PROGRAM NATIONAL SITUATION An average of 3 Filipinos die daily due to malaria despite governments intensified efforts to control the occurrence of the ailment. THREE causes of Malarial treatment failure in the Philippines Drug resistance Non-compliance of patients Deficient drug absorption Other reasons: Self-medication Resorting to herbal remedies Seeking help when the disease is already severe MOSTLY AFFECTED: MALE YOUNG ADULTS MOST VULNERABLE GROUPS: PREGNANT CHILDREN CURRENT INITIATIVES Global funding Infectious disease control and surveillance INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz 16 PROGRAM THRUST: VISION: Malaria-free Philippines by the year 2020. MISSION: To empower the health workers, the population ar risk, and all concerned to eliminate malaria in the Philippines. GOAL: Malaria is eliminated as a public health problem in all endemic provinces. STRATEGIES Provision of early diagnosis and prompt treatment Planning and implementation of selective & sustainable preventive measures Early detection, containment, prevention of malaria epidemics MAJOR CHALLENGES Improving the managerial and technical capacities of the MCP Working beyond the health sector to reach out to remote communities Empowering the communities at risk, including the indigenous people to become active partners and not just passive recipients of health services Detecting and expanding early to control outbreaks and preventing its occurrence Combating drug resistance MANAGEMENT (mosquito-borne) A. PREVENTION Prophylactic drugs (e.g. Chloroquine, Mefloquine) CLEAN program of the DOH C - chemically treated mosquito nets L - larvae-eating fish E - Environmental sanitation A - Anti-mosquito soaps N - Neem tree B. CONTROL - fumigation

HIV/AIDS PREVENTION PROGRAM PREVENTION (-MASS) M- monogamy A avoid promiscuous activity S- sterilization S- screening of blood donors 4Cs COMPLIANCE COUNSELING / EDUCATION CONTACT TRACING CONDOMS Nurses Role PREVENTION Case finding Supportive Care FUNCTIONS OF THE COMMUNITY HEALTH NURSE IN COMMUNICABLE DISEASE CONTROL PROGRAM Assists family in recognizing & solving health problems Provides nursing care Supervision in recognizing need to medical care/ treatment Referral INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz I.E.C. Collaborates services

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OBJECTIVE: To reduce the morbidity & mortality among infants and children caused by the seven childhood immunizable diseases ELEMENTS (TICAS) TARGET SETTING I.E.C. Cold chain logistics mgt Assessment & evaluation of overall performance Surveillance, studies & research PRINCIPLES Based on EPIDEMIOLOGICAL SITUATION Mass approach Immunization is a basic health service (it is integrated into the health system) PD 996 Providing for compulsory basic immunization for infants & children below 8 y/o Presidential Proclamation No.6 Implementing a United Nations goal on Universal Child Immunization R.A. 7846 An act requiring compulsory immunization against Hepa B for infants & children below 8y/o LIGTAS TIGDAS 2004 Target: 9 mos - <8 y/o All shall be vaccinated

Expanded Program on Immunization

Main component: PMEC PMEC- Phil. Measles Elimination Campaign Includes co tinuing routine vaccination of infants @ 9 months old after LIGTAS TIGDAS 2004 May be repeated every 4 or 5 years BAKUNADOORS: vaccination team COMMON QUESTIONS My child has been vaccinated against measles. Is she exempted? Ans: NO. this will increase her protection from measles My child had measles previously. Is she exempted? Ans: NO. there are many measles like disease. This wont harm Is there any overdose? Ans. NONE. Antibodies in the blood which provide protection against the disease decrease as the child grows older What will happen to my child after receiving the measles immunization? Ans: NOTHING, some develop SLIGHT FEVER (1-2days) Give Paracetamol q 4 hours increase fluids; rest, sleep The ROOMING-IN & BREASTFEEDING ACT of 1992 RA 7600 ADVANTAGES of breastfeeding Infant-maternal bonding First preventive health measure to the child at birth economical APPLICABILITY NSD: room in the ff within 30 min: Well infants regardless of AOG With low birth weight but can suck INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz Caesarean Within 3 to 4 hours after birth NSD outside health institutions Immediately on admission EXEMPTIONS: mothers who are: Seriously ill Taking medications contraindicated to breastfeeding Violent psychotics Other conditions as determined by the doctor Complicated births Sick baby/mother or both Breastfeed first with: EBM: expressed breast milk Wet-nursing SICK INFANTS Breastmilk, especially colostrum: given as tolerated Newborn: No prelacteal feeds: Sterile water Glucose water Milk formula Acceptable medical condition for supplemental feeding Special milk formula: inborn errors of metabolism Galactosemia; phenylketonuria Continue breastfeeding for mild to moderate mothers illness: Malaria STD Diabetes CHD TB (-) sputum The ff DO NOT permit rooming-in & breastfeeding Seriously illl (eclampsia, CHD class IV, severe infection) Taking meds contraindicated to nursing (e.g. anticancer) Bromocriptine Cimetidine Chloramphenicol Corticosteroids: Dexamethasone Hypnotics & sedatives (Diazepam) Lithium Thiouracil Reserpine Sex hormones: Estradiol, Stilbestrol Fresh refrigerated unsterilized milk can be used within 24 hours If to be frozen: 00F (-180C) refrigerator freezer: can be kept for a month MILK CODE: EO 51

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NOT PERMITTED: USE of professional services for teaching parents/staff in promoting branded milk products Common breastfeeding problem Breast engorgement Sore nipples INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz Mastitis ------Continue breast feeding!!! GMA 50% DOH undertaking to effect the SONA pledge of PGMA

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Primary goal Ensure that A Affordable S Safe H High quality E Effective Drugs & meds are always available, especially to the poor. Sample comparative price Asthma: SALBUTAMOL (Ventolin/ Ventorlin) 100mcg/ dose x 200 doses Price in private outlets: P 294.75 Price in DOH hospital: P197.60 Price difference: 97.15

Doctors to the Barrios Program DttB Doctors to the Barrios Prog Deployment of doctors as Rural Health Physicians to doctorless municipalities OBJECTIVES Ensure quality health care services (depressed, marginalized, underserved areas) Effect changes in the approach to Health Care Delivery by the stakeholders in Health SENTRONG SIGLA MOVEMENT SSM

GOAL Improvement of the Quality of Services provided by HEALTH CENTERS through accreditation of health centers that are able to provide services according to standards set by the DOH AIM To promote availability of quality services in health centers and hospitals and to make these services accessible to every Filipino Main component CERTIFICATION RECOGNITION PROGRAM Develops and promotes standards for health facilities FOUR PILLARS (Q-GAH) QUALITY ASSURANCE PILLAR GRANTS & TECHNICAL ASSISTANCE HEALTH PROMOTION AWARDS Standard list: evaluation of: Nutrition supplements Environmental health & sanitation FP EPI Disease Surveillance CARI CDD Control of STD Cancer Control INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz DENTAL HEALTH PROGRAM VISION: A lifetime of oral health and no tooth decay for the next generation. GENERAL OBJECTIVE TO PREVENT & CONTROL DENTAL DISEASES AND CONDITIONS. STRATEGIES SOCIAL MOBILIZATION Coordination & partnership with sectoral groups Networking Capability building & work value formation Monitoring feedback Operation research studies DIRECT SERVICES Dental Health Promotion & Advocacy Dental Preventive Prog Dental Curative Prog Oral Rehabilitation SUPPORT SERVICES Dental Health Planning Training Program Dental Research Prog Monitoring & Evaluation Sang Milyong Sipilyo Project for SOCIAL MOBILIZATION Shall solicit ONE MILLION toothbrushes from concerned citizens through dropboxes RECIPIENTS: school children in marginalized & depressed areas AIM: To emphasize the importance of oral health in relation to total body health ---to increase public awareness on the prevention of common dental diseases.

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NUTRITIONAL GUIDELINES FOR FILIPINOS NUTRITION GOAL Improvement of the nutritional status, productivity & quality of life of the population, through adoption of desirable dietary practices and healthy lifestyle GUIDELINES Eat variety of food everyday Breastfeed infants exclusively from birth to 4-6 mos Maintain childrens normal growth Consume fish, leanmeat, poultry or dired beans Eat more vegetables, fruits & rootcrops Eat foods cooked in edible/ cooking oil daily Consume milk, milk products/ other calcium-rich foods Use Iodized salts but avoid excessive intake of salty food Eat clean & safe food HEALTHY LIFESTYLE & GOOD NUTRITION: Exercise regularly No smoking Avoid alcoholic beverages NUTRIENTS Chemical substances present in the food that keep the body healthy, supply materials for growth & repair of tissues, and provide energy fro work & physical activities INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz VITAMIN A Normal vision Skin health Bone & tooth growth Prevents XEROPHTHALMIA THIAMINE Release of energy from nutrients Nerve functioning Prevents BERI-BERI RIBOFLAVIN Skin health Prevents cracking & redness of mouth corners Prevents DERMATITIS NIACIN Supports skin, nervous & digestive system Prevents pellagra BIOTIN ENERGY & AMINO ACIDS METABOLISM Synthesis of FAT glycogen PANTHOTHENIC ACID ENERGY METABOLISM FOLIC ACID Formation of DNA Formation of new blood cells (RBC) Prevents anemia Vitamin B12 Formation of new cells Maintain nerves cells Metabolism of fatty & amino acids VITAMIN C Formation of protein, collagen, bone, teeth cartillage, skin & skin tissue Facilitates absorption of IRON Increases resistance to infection Prevents SCURVY VITAMIN D Mineralization of bones by enhancing calcium absorption VITAMIN E Strong ANTI-OXIDANT Prevents arteriosclerosis For normal immune function VITAMIN K Synthesis of blood clotting protein and a bone protein that regulates blood calcium level CHO = 55-70% Fat = 20-30% CHON= 10-15% SCHEDULE Give 1 dose 6-11MOS 100 000 IU MACRONUTRIENTS

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VITAMIN A SUPPLEMENTS 12-83 MOS POST PARTUM 200 000 IU 200 000 IU within 1 month 200 000 IU After delivery of each child only

Give after 6 mos 100 000 IU Esp if high risk condition present

SCHEDULE

VITAMIN A DEFICIENCY 6-11MOS 12-83 MOS INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz Give today Give tomorrow Give after 2 weeks

22 100 000 IU 100 000 IU 100 000 IU 200 000 IU 200 000 IU 200 000 IU

IRON REQUIREMENTS 6 12 MOS Children 12-59 mos Tx for iron deficiency Children 0-59 months

IRON SUPPLEMENTS DOSAGE 0.7 mg daily 1 mg daily 3-6 mg/kg body weight daily IODINE SUPPLEMENTATION

CHILDREN 0-59 months

IODINE CAPSULE (200mg) POTASSIUM IODATE in oil orally once a year FLUORIDE (TOOTH DECAY) Fluoride solution application FOUR applications (a week apart) 3, 7, 10 and 13 y/o LIGTAS BUNTIS 2005 CAMPAIGN GOAL To increase the visibility of FP as an essential public health service, and to dramatically improve the access of men, women an couples to FP & safe motherhood services. POINTERS Assurance of womens safety Advocates to assist Filipino couples to successfully plan their families Shall provide appropriate services based on the clients choice of health facilities Set for February to March 2005 Brings affirmation on womens co-equal importance in nation building Prioritizing and supporting the emancipation of Filipino womens risks (too many, too frequent & unsafe pregnancy) Key success features Good campaign plan & gender-culture sensitive IEC Realistic target coverage Availability of adequate logistics & health services Competent health care providers Effective supervision ENVIRONMENTAL SANITATION Study of all factors in mans physical environment, which may exercise a deleterious effect on his health well-being & survival. Factors included o W Water sanitation o A Air pollution o G Garbage disposal o E Excreta disposal o R Radiological protection o F Food sanitation o I Institutional sanitation o N Noise o I Insect/rodent control o S Stream pollution o H Housing INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz ENVIRONMENTAL HEALTH SERVICE Promotion of healthy environmental conditions Prevention of environmental related diseases Through appropriate sanitation strategies HEALTH & SANITATION Ranked FIRST in the leading causes of morbidity among the general population PRESIDENTIAL PROCLAMATION 856 SANITATION CODE OF THE PHILIPPINES o o o o o WATER SUPPLY SANITATION PROGRAM Approved toilet facilities Access to safe & potable H2O Water quality & monitoring surveillance Waterworks/watersystem Unapproved toilet facilities

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APPROVED TYPES OF H20 SUPPLY LEVEL 1: POINT SOURCE Protected well/ spring with an outlet Without distribution system 15-25 households 250 meters: farthest user 40-140 liters LEVEL II: Communal Faucet System/ Stand-post Composition 1. Source reservoir 2. Piped distribution network 3. Communal faucet 25m away: farthest 40-80 liters/capital/day Ave: 100 households 4-6 households/faucet For rural areas with clustered houses LEVEL III: Waterworks System/ Individual House Connections Composition 1. Source reservoir 2. Piped distribution network 3. Household taps Requires minimum tx disinfection For densely populated urban areas WATER PURIFICATION FILTRATION sediments CHLORINATION kills microorganism FLUORIDATION fortification BOILING 5-10 minutes from boiling point Drinking water should be replaced every 24 hours UNAPPROVED TYPES OF H20 SUPPLY Doubtful sources like: o OPEN DUG WELL o UNIMPROVED SPRING o WELLS that need priming The community must exert effort to convert to approved type of water supply facility INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz WATER QUALITY MONITORING SURVEILLANCE DISINFECTION OF WATER SUPPLY Newly constructed Repaired/improved water facility Water sources (+) bacteriologically Container disinfection of drinking water collected from: Open dug well Unimproved springs Surface water WATERWORKS/WATER SYSTEM WELL SITES: approval Comply to sanitary requirements Supply of safe & potable H20 Adequate pressure & volume in the water system distribution line PROPER EXCRETA & SEWAGE DISPOSAL PROGRAM APPROVED TYPES: TOILET FACILITIES LEVEL 1 Non-water carriage toilet facility Pit latrines Reed odorless earth closet Toilets requiring small amount of H20 Pour flush Aqua privies LEVEL II Water-sealed Flush type Septic vault/ tank disposal facilities LEVEL III o Water-carriage type o Septic tanks o Sewerage system to treatment plants o FOOD SANITATION PROGRAM Inspection/approval of food sources, containers, transport vehicles Sanitary permit Health Certificate for food handlers Banning of food unfit for human consumption Household sanitation HOSPITAL WASTE MGT PROG Prepare & implement Hospital Waste Mgt Prog. (HWM) Use of appropriate technology & indigenous materials Training of personnel Admin: PUBLIC INFO. CAMPAIGN

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METHOD OF DISPOSAL DUMPING BURIAL BURNING INCINERATOR

INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz THE ABCS OF TRANSCULTURAL NURSING

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TRANSCULTURAL NURSING Refers to the study and practice in nursing which is focused upon differences and similarities among cultures with respect to human care, health and illness based upon the peoples cultural values, beliefs and practices and to use this knowledge to provide culturally specific or culturally congruent nursing care. GOAL To provide culturally specific care. CULTURE Refers to norms and practices of a particular group that are learned and shared and guide thinking, decisions and actions. CULTURAL VALUES Refers to the individuals desirable or preferred way of acting or knowing something that is sustained over a period of time and which governs actions or decisions. Culturally diverse nursing care Refers to the variability of nursing approaches needed to provide culturally appropriate care that incorporates an individuals cultural values, beliefs and practices including sensitivity to the environment from which the individual comes and to which the individual ultimately return. (Leininger, 1985) ETHNOCENTRISM The perception that ones own way is best when viewing the world. RACE Refers to distinguishing physical features such as skin color, bone structure and blood group. ETHNOGRAPHY: The study of culture

WHO IS THE FILIPINO? According to: Tomas Andres the Filipino is The imponderable unity and uniqueness of diverse races, richness and idiosyncrasies. The monument of the Malays, the Spaniards, the Americans, the Japanese, the Chinese, the Hindus, the Dutch and the Englishman, all united into one. F - aithful; Fiesta oriented I - mitative L - oving and tender (malambing) I - ngenius P - liant I - nadequate initiative N - o discipline O - riented to: Kapalaran, kabuuan, kapayapaan WHOLISTIC, NON -DUALISTIC AND SUBJECTIVE

INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz 26 CULTURAL COMPETENCE Cultural competence, therefore is obtaining cultural information and then applying that knowledge. This would require the nurse to have : 1. 2. 3. AN UNDERSTANDING OF OWN FLEXIBILITY AND RESPECT FOR A KNOWLEDGE OF CULTURALLY WORLD VIEW OTHERS VIEW POINT INFLUENCED HEALTH BEHAVIORS

EXAMPLES OF APPLICATIONS OF TRANSCULTURAL NURSING CONCEPTS A dministration of medications must take into consideration some of the patients beliefs and practices. Examples: Catholics usually will fast on Ash Wednesday and Good Friday except for sick patients Muslims will fast during Ramadan Jehovahs witnesses-medications are acceptable to the extent necessary B e familiar with some diseases which are common in a specific race. Examples: Africans - sickle cell anemia, hypertension Asians osteoporosis Blacks cervical cancer (female) prostate cancer (male) Jewish breast cancer Whites testicular cancer C - ommunicate properly and be familiar with common communication practices across cultures. Examples: Asians rarely communicate their need for analgesics since they were taught self restraint. Hispanic women - discussions pertaining to the reproductive organs with male relatives or health care providers are considered impolite Muslim women prefer to talk to female doctors on matters related to reproductive problems D - ietary modifications must be considered when planning nursing care! Examples: Chinese cold desserts (YIN) are served after surgery Europeans main meal is served by midday and is usually followed by coffee Jewish Kosher diet ( no meat and dairy products at the same time) Muslim Halal diet (no pork) HISPANICS Present oriented society Most are Catholics Body plumpness is ideal Delivery of a baby is a womans job MIDDLE EASTERN COMMUNITY INVICTUS: I am the captain of my ship, the master of my destiny

ra gapuz - Expect to receive treatment as soon as possible - Majority are Muslims - Emphasis on personal hygiene and a healthy diet - Patients are told only the GOOD news about their disease - Maybe embarrassed by questions about their sexual concerns. - During Ramadan, many patients resist taking medications or eating during daytime. BLACK AMERICAN COMMUNITY - God is viewed as the source of both good health and serious illness

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ASIANS - A healthy body is a state of balance

1.Recognizing clinical differences among people of different ethnic and racial groups. 2. Communication 3. Ethics 4. Trust
/ldf05

INVICTUS: I am the captain of my ship, the master of my destiny