Community Health Nursing (complete) systemSupervisor, who monitors and
supervises the performance of midwives
11. 11. TARGET POPULATION (IFC) ARE:1. I 1. 1. COMMUNITY HEALTH NURSING: AN ndividual2. F amily3. C ommunity OVERVIEWWhat is a community? a group 12. 12. 3 Elements considered in CHN:v of people with common characteristics or Science of Public Health (core foundation in interests living together within a territory or CHN),v Public Health Nursing Skills andv geographical boundary place where Social Assistance Functions people under usual conditions are found 13. 13. OBJECTIVES OF PUBLIC HEALTH: 2. 2. What is health? Health-illness CODESC ontrol of Communicable DiseasesO continuum High-level wellness Agent- rganization of Medical and Nursing ServicesD host-environment Health belief evelopment of Social MachineriesE ducation Evolutionary-based Health promotion of IFC on personal Hygiene Health WHO definition Education is the essential task of every health 3. 3. What is community health? part of workerS anitation of the environment paramedical and medical intervention/ 14. 14. 3 ELEMENTS IN HEALTH EDUCATION: approach which is concerned on the health of IECI nformation: to share ideas to keep the whole population aims:1. health population group knowledgeable and promotion2. disease prevention3. awareE ducation: change within the management of factors affecting health individual 3 Key Elements of Education: K 4. 4. What is nursing?- assisting sick nowledge A ttitude S kills individuals to become healthy and healthy 15. 15. 3 ELEMENTS IN HEALTH EDUCATION: individuals achieve optimum wellness IECC ommunication: interaction involving 5. 5. Public Health Nursing: the term used before 2 or more persons or agencies 3 Elements of for Community Health NursingAccording to Dr. Communication: Message Sender Receiver C.E. Winslow, Public Health is a science & art 16. 16. PUBLIC HEALTH WORKERS of 3 PsPrevention of (PHW)PHWs: are members of the health DiseaseProlonging lifePromotion of team who are professionals health and efficiency through organized namelyMedical Officer (MO)- community effort PhysicianPublic Health Nurse (PHN)- 6. 6. What is Community Health Registered NurseRural Health Midwife Nursing? The utilization of the nursing (RHM)-Registered Midwife- process in the different levels of clientele- DentistNutritionistMedical individuals, families, population groups and TechnologistPharmacistRural Sanitary communities, concerned with the promotion of Inspector (RSI)-must be a sanitary engineer health, prevention of disease and disability 17. 17. 5 MAJOR FUNCTIONS:1. Ensure equal and rehabilitation. - Maglaya, et al access to basic health services2. Ensure 7. 7. COMMUNITY HEALTH NURSING formulation of national policies for proper (CHN): a specialized field of nursing division of labor and proper coordination of practice a science of Public Health operations among the government agency combined with Public Health Nursing Skills jurisdictions3. Ensure a minimum level of and Social Assistance with the goal of raising implementation nationwide of services the level of health of the citizenry, to raise regarded as public health goods4. Plan and optimum level of functioning of the citizenry establish arrangements for the public health (Characteristic of CHN) systems to achieve economies of scale5. 8. 8. BASIC PRINCIPLES OF CHN The Maintain a medium of regulations and community is the patient in CHN, the family is standards to protect consumers and guide the unit of care and there are four levels of providers clientele: individual, family, population group 18. 18. BASIC HEALTH SERVICES UNDER (those who share common characteristics, OPHS OF DOHE ducation regarding HealthL developmental stages and common exposure ocal Endemic DiseasesE xpanded Program to health problems e.g. children, elderly), on ImmunizationM aternal & Child Health and the community. In CHN, the client is ServicesE ssential drugs and Herbal plantsN considered as an ACTIVE partner NOT utritional Health Services (PD 491): Creation PASSIVE recipient of care of Nutrition Council of the Phils.T reatment of 9. 9. BASIC PRINCIPLES OF CHN CHN Communicable & Non communicable practice is affected by developments in health DiseasesS anitation of the environment (PD technology, in particular, changes in society, 856): Sanitary Code of the PhilippinesD ental in general The goal of CHN is achieved Health PromotionA ccess to and use of through multi-sectoral efforts CHN is a part hospitals as Centers of WellnessM ental of health care system and the larger human Health Promotion services system. 19. 19. VISION BY 2030 (DREAM OF DOH)A 10. 10. ROLES OF THE PUBLIC HEALTH Global Leader for attaining better health NURSEClinician, who is a health care outcomes, competitive and responsive health provider, taking care of the sick people at care systems, and equitable health financing home or in the RHUHealth Educator, who 20. 20. MISSION To guarantee EQUITABLE, aims towards health promotion and illness SUSTAINABLE and QUALITY health for all prevention through dissemination of correct Filipinos, especially the poor and to lead the information; educating peopleFacilitator, who quest for excellence in health establishes multi-sectoral linkages by referral 21. 21. Principles to attain the vision of RHU, directly under the supervision of MHO DOHEquity: equal health services for all- (who acts as administrator) no discriminationQuality: DOH is after the 29. 29. REFERRAL SYSTEM:BHS RHU quality of service not the quantity Philosophy MHO PHO RHO National Agencies of DOH: Quality is above Specialized Agencies quantityAccessibility: DOH utilize 30. 30. CHARACTERISTICS OF strategies for delivery of health services PHCAcceptableAccessibleAffordableAvailable 22. 22. HEALTH CARE DELIVERY SYSTEMthe SustainableAttainable totality of all policies, facilities, equipment, 31. 31. UTILIZES APPROPRIATE products, human resources and services TECHNOLOGIES USED BY PHC: ACCEFSA which address the health needs, problems ffordable, accessible, acceptable, availableC and concerns of the people. It is large, ost wise=economical in natureC omplex complex, multi-level and multi-disciplinary. procedures which provide a simple outcomeE 23. 23. THREE STRATEGIES IN DELIVERING ffectiveF easibility of use=possibility of use at HEALTH SERVICES (ELEMENTS) all timesS cope of technology is safe & secure Creation of Restructured Health Care Delivery 32. 32. SENTRONG SIGLA MOVEMENT System (RHCDS) regulated by PD 568 (SSM)was established by DOH with LGUs (1976) Management Information Systems having a logo of a Sun with 8 Rays and regulated by R.A. 3753: Vital Health Statistics composed of 4 Pillars:1. Health Promotion2. Law Primary Health Care (PHC) regulated Granted Facilities3. Technical Assistance4. by LOI 949 (1984): Legalization of Awards: Cash, plaque, certificate Implementation of PHC in the Philippines 33. 33. 4 CONTRIBUTIONS OF PHC TO DOH 24. 24. CREATION OF RHCDSRHO (National &ECONOMY: Training of Health Workers Health Agency) or existing national agencies Creation of Botika sa Baryo & Botika sa like PGH or specialized agencies like Heart Health Center Herbal Plants Oresol Center for Asia, NKIMHO & PHO 34. 34. A. TRAINING OF HEALTH WORKERS3 (Municipal/Provincial Health Office) BHS & Levels of Training:Grassroot/Village RHU (Barangay Health Station/Rural Health Includes Barangay Health Volunteers Unit) (BHV) and Barangay Health Workers (BHW) 25. 25. 3 LEVELS OF HEALTH CARE1. Primary- Non professionals, didnt undergo formal prevention of illness or promotion of health2. training, receive no salary but are given Secondary-curative3. Tertiary-rehabilitative incentive in the form of honorarium from the 26. 26. According to Increasing Complexity of local government since 1993Intermediate - According to the Type of Service the Services these are professionals including the 8 ProvidedType Service Type Example Health members of the PHWsFirst Line Personnel - Promotion, Preventive Care, Health Promotion the specialist and Information Dissemination Continuing 35. 35. B. CREATION OF BOTIKA SA BARYO & Care for common illness PreventionPrimary BOTIKA SA HEALTH CENTERRA 6675: health problems, attention to psychological Generics Act of 1988: ImplementingOplan and social care, referrals Surgery, Medical Walang Reseta Program-solution to the services by Diagnosis and Treatment absence of a medical officer who prescribed ScreeningSecondary Specialists Advanced, the medicines so PHN are given the specialized, diagnostic,Tertiary therapeutic & responsibility to prescribe generic medicines rehabilitative care Rehabilitation PT/OT andWalong Wastong Gamot Program- 27. 27. LEVELS OF PREVENTION PRIMARY available generics in Botika sa Baryo & LEVEL SECONDARY LEVEL TERTIARY Health CenterFather of Generics Act: Dr. LEVEL Health Promotion and Illness Alfredo Bengzon Prevention of Complications thru Early 36. 36. 8 COMMONLY AVAILABLE GENERICS Prevention of Disability, etc. Prevention Dx (CARIPPON)Co-Trimoxazole: its a and TxProvided at ! When hospitalization is combination of 2 generics of drugs which is deemed ! When highly-specialized medical! antibacterial Trimethoprim(TMP) Has a Health care/RHU necessary and referral is bacteriostatic action that stops/inhibits made to care is necessary! Brgy. Health multiplication of bacteria For GUT, GIT & Stations emergency (now district), ! referrals URTI (TMP combined with SMX) are made to hospitals and!Main Health Center Sulfamethoxazole (SMX) Has bactericidal provincial or regional or private medical center action that kills bacteria For GUT, GIT, such as PGH,!Community Hospital and Health URTI & Skin Infections hospitals PHC, POC, National Center for 37. 37. 8 COMMONLY AVAILABLE GENERICS Center Mental Health, and other govt!Private (CARIPPON)Amoxicillin/AmpicillinAn and Semi-private private hospitals at the antibacterial drug that comes from the municipal agencies level Penicillin familyEffect is generally 28. 28. Referral System in Levels of the Health bacteriostatic (when source of infection is Care: Barangay Health Station (BHS) is bacterial)These 2 drugs provide the least under the management of Rural Health sensitivity reaction (rashes & GI) and the Midwife (RHM) Rural Health Unit (RHU) is adverse effect of other antibiotics is under the management or supervision of anaphylactic shock PHN Public Health Nurse (PHN) caters to 38. 38. 8 COMMONLY AVAILABLE GENERICS 1:10,000 population, acts as managers in the (CARIPPON)TB DRUGS:Rifampicin implementation of the policies and activities of (RIF)Isoniazid (INH)Pyrazinamide (PZA) 39. 39. 8 COMMONLY AVAILABLE GENERICS release toxic substance & undesirable (CARIPPON)ParacetamolHas an analgesic & taste Use extracts for washing anti-pyretic effectAcetyl Salicylic Acid (ASA) or 55. 55. PROCEDURES/PREPARATIONS: Aspirin is never kept in the Botika because Poultice Done by pounding or chewing of its effects: Anticoagulant-highly leaves used by herbolaryo Example: dangerous to Dengue patients thats why its Akapulko leaves-when pounded, it releases not available in Botika & Health Center extracts coming out from the leaves contains 40. 40. 8 COMMONLY AVAILABLE GENERICS enzyme (serves as anti-inflammatory) then (CARIPPON)Oresol:a management for apply on affected skin or spewed it over diarrhea to prevent dehydration under the skin For treatment of skin diseases Control of Diarrheal Diseases (CDD) Program 56. 56. PROCEDURES/PREPARATIONS:Infusio 41. 41. 8 COMMONLY AVAILABLE GENERICS nTo prepare a tea (use lipton bag), keep (CARIPPON)Nifedipine: An anti- standingfor 15 minutes in a cup of warm water hypertensive drug According to DOH, 16% where abrown solution is collected, pectin of population belonging to 25 years old & which servesas an adsorbent and astringent above in the community are hypertensive 57. 57. PROCEDURES/PREPARATIONS: 42. 42. C. HERBAL PLANTSRA 8423: Alternative Juice/SyrupTo prepare a papaya juice, use Traditional Medicine Lawa program where ripe papaya &mechanically mashed then put patient may opt to use herbal plants especially inside a blender& add waterTo produce it into for drugs that are not available in dosage form a syrup, add sugar then heat todissolve sugar or patients has no financial means to buy the & mix it drugTraditional Medicine:Use of herbal 58. 58. PROCEDURES/PREPARATIONS:Cream/ plants OintmentStart with poultice (pound leaves) to 43. 43. 10 ADVOCATED HERBAL PLANTS BY turn it semi-solidAdd flour to keep preparation DOH: LUBBY SANTALagundi Vitex Asthma, pasty & make it adhere to skinlesionsTo make Leaves Decoction negundo cough, colds & it into an ointment: add oil (mineral, baby or Poultice fever (ASCOF) Pain and any oil-serves as moisturizer) to the prepared inflammation cream to keep itlubricated while being 44. 44. 10 ADVOCATED HERBAL PLANTS BY massage on the affected area DOH: LUBBY SANTAUlasimang Peperonia 59. 59. D. ORESOLGlucose 20 grams 1 Gout Leaves DecoctionBato pellucida Arthritis Significance: For re-absorption of Na Poultice Rheumatism Facilitates assimilation of Na 2 Significance: 45. 45. 10 ADVOCATED HERBAL PLANTS BY Provides heat & energySodium Chloride/NaCl DOH: LUBBY SANTABayabas Psidium 3.5 grams For retention of water/fluidSodium Diarrhea Leaves Decoction quajava 2.5 grams Buffer content of Toothache Mouth and wound wash solutionBicarbonate/NaHCO3 Neutralizer 46. 46. 10 ADVOCATED HERBAL PLANTS BY content of solutionPotassium Chloride/KCl 1.5 DOH: LUBBY SANTABawang Allium HPN grams Stimulates smooth muscle contractility Clove/Bulb Poultice sativum Toothache especially the heart & GIT 47. 47. 10 ADVOCATED HERBAL PLANTS BY 60. 60. PREPARATION OF PROPER DOH: LUBBY SANTAYerta Mentha Same as HOMEMADE ORESOLA volume or one liter Leaves DecoctionBuena cordifelia Lagundi homemade oresol Smaller volume or a glass Poultice except asthma homemade oresolWater 1000 ml. or 1 liter 48. 48. 10 ADVOCATED HERBAL PLANTS BY 250 ml.Sugar 8 teaspoon 2 teaspoonSalt 1 DOH: LUBBY SANTASambong Blumea teaspoon ! teaspoon or a pinch of salt=10-12 Edema Leaves Decoction balsanifera Diuretic granules of rock salt: iodized salt=tips of 49. 49. 10 ADVOCATED HERBAL PLANTS BY thumb & index finger are penetrated with salt DOH: LUBBY SANTAAkapulko Cassia All 61. 61. UNIVERSAL HEALTH CARE (UHC), forms Leaves Decoction alata of skin Poultice ALSO REFERRED TO AS KALUSUGAN diseases Cream PANGKALAHATAN (KP)is the provision to 50. 50. 10 ADVOCATED HERBAL PLANTS BY every Filipino of the highest possible quality of DOH: LUBBY SANTANiyog Quisqualis health care that is accessible, efficient, Intestinal Seeds Decoctionniyogan indica equitably distributed, adequately funded, fairly Parasitism Poultice (Nematodes) Juice financed, and appropriately used by an 51. 51. 10 ADVOCATED HERBAL PLANTS BY informed and empowered public DOH: LUBBY SANTATsaang Carmona 62. 62. UNIVERSAL HEALTH CARE (UHC), Diarrhea Leaves DecoctionGubat resuta ALSO REFERRED TO AS KALUSUGAN Infantile Poultice colic (Kabag) Dental caries PANGKALAHATAN (KPThe Aquino 52. 52. 10 ADVOCATED HERBAL PLANTS BY administration puts it as the availability and DOH: LUBBY SANTAAmpalaya Mamordica accessibility of health services and necessities Type II Leaves Decoction charantia Diabetes for all Filipinos.It is a government mandate (NIDDM) aiming to ensure that every Filipino shall 53. 53. POLICIES TO ABIDE:Know receive affordable and quality health indicationsKnow parts of plants with benefits.This involves providing adequate therapeutic value: roots, fruits, leavesKnow resources health human resources, health official procedure/preparation facilities, and health financing. 54. 54. Procedures/Preparations: Decoction 63. 63. UHCS THREE THRUSTS1) Financial Gather leaves & wash thoroughly, place in a risk protection through expansion in container the washed leaves & add water enrollment and benefit delivery of the National Let it boil without cover to vaporize/steam to Health Insurance Program (NHIP);2) 2) Improved access to quality hospitals and health care facilities; and3) 3) Attainment of 71. 71. GOAL 3: PROMOTE GENDER health-related Millennium Development Goals EQUALITY AND EMPOWER WOMENTarget : (MDGs). Eliminate gender disparity in primary and 64. 64. FINANCIAL RISK secondary education preferably by 2005 and PROTECTIONProtection from the financial to all levels of education no later than 2015 impacts of health care is attained by making 72. 72. GOAL 4: REDUCE CHILD any Filipino eligible to enroll, to know their MORTALITYTarget : Reduce by two-thirds, entitlements and responsibilities, to avail of between 1990 and 2015, the under-five health services, and to be reimbursed by mortality rate PhilHealth with regard to health care 73. 73. GOAL 5: IMPROVE MATERNAL expenditures. HEALTHTarget : Reduce by three-quarters, 65. 65. MPROVED ACCESS TO QUALITY between 1990 and 2015, the maternal HOSPITALS AND HEALTH CARE mortality ratio FACILITIESImproved access to quality 74. 74. GOAL 6: COMBAT HIV/AIDS, MALARIA hospitals and health facilities shall be AND OTHER DISEASESTarget : Have halted achieved in a number of creative approaches. by 2015 and begun to reverse the spread of First, the quality of government-owned and HIV/AIDSTarget : Have halted by 2015 and operated hospitals and health facilities is to be begun to reverse the incidence of malaria and upgraded to accommodate larger capacity, to other major diseases attend to all types of emergencies, and to 75. 75. GOAL 7: ENSURE ENVIRONMENTAL handle non- communicable diseases. SUSTAINABILITYTarget : Integrate the 66. 66. The Health Facility Enhancement Program principles of sustainable development into (HFEP) shall provide funds to improve facility country policies and programmes and reverse preparedness for trauma and other the loss of environmental resourcesTarget : emergencies. The aim of HFEP was to Halve, by 2015, the proportion of people upgrade 20% of DOH- retained hospitals, 46% without sustainable access to safe drinking of provincial hospitals, 46% of district waterTarget: By 2020, to have achieved a hospitals, and 51% of rural health units(RHUs) significant improvement in the lives of at least by end of 2011. 100 million slum dwellers 67. 67. ATTAINMENT OF HEALTH-RELATED 76. 76. GOAL 8: DEVELOP A GLOBAL MDGSFurther efforts and additional resources PARTNERSHIP FOR DEVELOPMENTTarget are to be applied on public health programs to : Develop further an open, rule-based, reduce maternal and child mortality, morbidity predictable, non- discriminatory trading and and mortality from Tuberculosis and Malaria, financial systemTarget: Address the special and incidence of HIV/AIDS. Localities shall be needs of the least developed countriesTarget: prepared for the emerging disease trends, as Address the special needs of landlocked well as the prevention and control of non- countries and small island developing communicable diseases.The organization of StatesTarget: Deal comprehensively with the Community Health Teams (CHTs) in each debt problems of developing countries through priority population area is one way to achieve national and international measures in order health-related MDGs. CHTs are groups of to make debt sustainable in the long term volunteers, who will assist families with their 77. 77. FIELD HEALTH SERVICE health needs, provide health information, and INFORMATION SYSTEM (FHSIS) It is a 68. 68. ATTAINMENT OF HEALTH-RELATED network of information It is intended to MDGSRNheals nurses will be trained to address the short term needs of DOH and become trainers and supervisors to coordinate LGU staff withmanagerial or supervisory with community-level workers and CHTs. By functions in facilities and program areas. It the end of 2011, it is targeted that there will be monitors health service delivery nationwide. 20,000 CHTs and 10,000 RNheals.Another 78. 78. OBJECTIVES OF FHSISTo provide effort will be the provision of necessary summary data on health service delivery and services using the life cycle approach. These selected program accomplishment indicators services include family planning, ante-natal at the barangay, municipality/ city, and district, care, delivery in health facilities, newborn provincial, regional and national levels.To care, and the Garantisadong Pambata provide data which when combined with data package.Better coordination among from other sources, can be used for program government agencies, such as DOH, DepEd, monitoring and evaluation purposes.To DSWD, and DILG, would also be essential for provide a standardized, facility-level data base the achievement of these MDGs. that can be accessed for more in-depth 69. 69. GOAL 1: ERADICATE EXTREME studies.To minimize the recording and POVERTY AND HUNGERTarget : Halve, reporting burden at the service delivery level between 1990 and 2015, the proportion of in order to allow more time for patient care people whose income is less than one dollar a and promote activities. dayTarget : Halve, between 1990 and 2015, 79. 79. IMPORTANCE OF FHSIS Helps local the proportion of people who suffer from government determine public health hunger priorities. Basis for monitoring and evaluating 70. 70. GOAL 2: ACHIEVE UNIVERSAL health program implementation. Basis for PRIMARYEDUCATIONTarget : Ensure that, planning, budgeting, logistics and decision by 2015, children everywhere, boys and girls making at alllevels. Source of data to detect alike, will be able to complete a full course of unusual occurrence of a disease. Needed to primary schooling monitor health status of the community. Helps midwives in following up clients. Documentation of RHM/PHN day to day indicators categorized as maternal care, child activities. care, family planning and disease 80. 80. COMPONENTS OF FHSIS1. Individual control.Morbidity Report (M2)The Monthly Treatment Record (ITR)2. Target Client List Morbidity Disease Report contains a list of all (TCL)3. Summary Table4. The Monthly diseases by age and sex. The Midwife uses Consolidation Table (MCT) the form for the monthly consolidation report 81. 81. INDIVIDUAL TREATMENT RECORD of Morbidity Diseases and is submitted to the (ITR)The fundamental building block or PHN for quarterly consolidation. foundation of the Field Health Service 89. 89. THE QUARTERLY FORMProgram Report Information System is the INDIVIDUAL (Q1)The Quarterly Form is the TREATMENT RECORD.This is a document, municipality/city health report and contains the form or piece of paper upon which is recorded three-month total of indicators categorized as the date, name, address of patient, presenting maternal care, family planning, child care, symptoms or complaint of the patient on dental health and disease controlMorbidity consultation and the diagnosis (if available), Report (Q2)The PHN uses the form for the treatment and date of treatment. Quarterly Consolidation Report of Morbidity 82. 82. TARGET CLIENT LIST (TCL)The Target Diseases to consolidate the Monthly Morbidity Client Lists constitute the second building Diseases taken from the Summary Table. block of the FHSIS and are intended to serve 90. 90. THE ANNUAL FORMS (A-BHS, A1, A2 & several purposesFirst is to plan and carry out A3)ABHS Form is the report of midwife which patient care and service delivery. Such lists contains data on demographic,environmental will be of considerable value to and natality.The report of nurse at the midwives/nurses in monitoring service delivery RHU/MHC are the Annual Form 1 which is the to clients in general and in particular to groups report on vital statistics: demographic, of patients identified as targets or eligibles environmental, natality and mortality.Annual for one or another program of the Department Form 2 is the report that lists all diseases and 83. 83. TARGET CLIENT LIST (TCL)The second their occurrence in the municipality/city. The purpose of Target Client Lists is to facilitate report is broken down by age and sex.Annual the monitoring and supervision of service Form 3 is the report of all deaths occurred in delivery activities.The third purpose is to the municipality/city. Thereport is also broken report services delivered.The fourth purpose down by age and sex. of the Target Client Lists is to provide a clinic- 91. 91. FLOW OF REPORTOFFICE PERSON level data base which can be accessed for RECORDING FORMS FREQUENCY further studies SCHEDULE OF TOOLS SUBMISIONBHS 84. 84. TARGET CLIENT LISTS TO BE Midwife - ITR Monthly Form Monthly Every MAINTAINED IN THE FHSIS1. Target Client 2nd week of the - TCL (M1 & M2) succeeding List for Prenatal Care2. Target Client List for month - ST A-BHS Form Annually Every 2nd Post-Partum Care3. Target Client List of week of JanuaryRHU PHN - ST Quarterly Under 1 Year Old Children4. Target Client Quarterly Every 3rd week of the 1st - MCT List for Family Planning5. Target Client List Form month of succeeding (Q1 & Q2) quarter for Sick Children6. NTP TB Register7. Annual Forms Every 3rd week of - A1 National Leprosy Control Program Form 2- January - A2 - A3 Central Registration Form 92. 92. FertilityCrude Birth Rate (CBR) - 85. 85. SUMMARY TABLEThe Summary Tables Overall total reported birthsMorbidity-Illnesses is a form with 12-month columns retained at affecting the population groupIncidence the facility (BHS) where the midwife records Rate (IR)-reported new cases affecting the monthly all relevant data. The Summary Table population groupPrevalence Rate (PR)- is composed of:(1) Health Program determine sum total of new + old cases of Accomplishment this can serve as proof of diseases per percent population accomplishments to show LGU officials 93. 93. Mortality-Reports causes of whenever they visit the facility.(2) Morbidity deathsCrude Death Rate (CDR)-overall Diseases the source of ten leading causes of total reported deathMaternal Mortality Rate morbidity for the municipality/city. This (MMR)-maternal deaths due to maternal summary table will help the nurse and MHO to causesInfant Mortality Rate (IMR)-# of get the monthly trend of diseases. infant deaths (0-12 months) or less than 1 86. 86. THE MONTHLY CONSOLIDATION year oldNeonatal Mortality Rate (NMR)-# TABLE (MCT) The Consolidation Table is of deaths among neonates (newborn 0-28 an essential form in the FHSIS where the days, < 1 month)Swaroops Index (SI)- nurse at the RHU records the reported data deaths among individual in the age group of per indicator by each BHS or midwife. This 50 and above is the source document of the nurse for the 94. 94. CRUDE BIRTH RATE (CBR)CBR= Quarterly Form. The Consolidation Table Overall total reported births x 1000 -------------- shall serve as the Output Table of the RHU as ------------------------------ Population it already contains listing of BHS per indicator. 95. 95. INCIDENCE RATE (IR)IR= new cases of 87. 87. FHSIS REPORTINGThese are summary disease x 100 ------------------------------------ data that are transmitted or submitted on a Population monthly, quarterly and on annual basis to 96. 96. PREVALENCE RATE (PR):PR= new higher level. The source of data for this cases + old cases x 100 ---------------------------- component is dependent on the records. ---------- Population 88. 88. THE MONTHLY FORMProgram Report (M1)The Monthly Form contains selected 97. 97. CRUDE DEATH RATE (CDR)CDR = is the decision makerPatriarchal -Father is the overall total deaths x 1000 ------------------------- decision makerCommunal -different families --------- Population forming a community 98. 98. MATERNAL MORTALITY RATE 111. 111. 2. Socio-economic: poverty level, (MMR)MMR= # of maternal deaths x 1000 ---- educationalattainment & nature of occupation ------------------------------ RLB of membersof the family (sources of income)3. 99. 99. INFANT MORTALITY RATE (IMR)IMR = # Socio-cultural: different nature of religion4. of infant deaths x 1000 ------------------------------ Home environment: assessment according --- RLB toES, treatment of garbage, preparation of 100. 100. NEONATAL MORTALITY RATE food,availability of toilet, water & food (NMR)NMR = # of neonatal deaths x 1000 ---- sanitation,sources of diseases ----------------------------------- RLB 112. 112. 4. Medical history: history of 101. 101. SWAROOPS INDEX (SI)SI= # of certain disease, family member with disease deaths (individual >50 years old) x 100 --------- 5. Resources available in community for use --------------------------------------------------- Total by the family:5 Generalized Ms in resources Deaths available in community: Man/Manpower 102. 102. FAMILY HEALTH NURSING Money Machine Materials PROCESSa systematic approach of solving Methods an existing problem/meeting the needs of 113. 113. DEFINE THE PROBLEM AFTER familyR apportA ssessmentP lanningI IDENTIFYING ITACCORDING TO nterventionE valuation NATUREHealth Deficit (HD)- if identified 103. 103. I. RAPPORT Trust building problem is an abnormality, illness or disease, Knowing your client Adjusting to the theres a gap/difference between normal situation and environment RESPECT status (ideal, desirable, expected) & actual 104. 104. II. ASSESSMENTData status (the outcome/result/problem Gathering: tools or instruments used encountered on that actual day) duringsurvey:InterviewObservationQu 114. 114. Health Threat (HT)-any condition estionnaires-mostly patronized & used in or situation which will be conducive to health CHNRecords & Reports alteration, health interference & health availableConsolidation or Collation: collecting disturbance.Foreseeable Crisis (FC)-stress back the questionnaires, tabulate and points, anything which is anticipated/ expected summarize to become a problem 105. 105. Validation: uses statistical 115. 115. Jobless FatherSuffering from TB approachesStatistical Approaches:1. Central thWife is pregnant for the 8 time2 y/o Tendencies: 3 youngest child lacks immunization rd9 y/o MsMean=averageMedian=range (Highest eldest child is 3 degreemalnourishedPoor Lowest Score)Mode=frequency of occurrence environmental sanitation of a variable, used if theres too many variable 116. 116. III. PLANNING Four (4) Standard occur Steps:Prioritization -start if there are multiple 106. 106. 2. Standard Deviation: used if identified problemsFormulation of objectives - there are too many variables available to be planning a procedure will start here if there is treated which is seldom used in CHN SD= only one problemDeveloping strategies of (x-x) =summation of n-1 x=variables actionFormulation of evaluation tools for the available x=mean (given special attention) identified strategy developed n=# of existing variables 117. 117. CRITERIA IN IDENTIFYING THE 107. 107. 3. Percentile (%) Method:most PROBLEMCriteria Score WeightI. Nature: commonly used in CHN by adding all cores assess by PHW Health deficit (HD) 3 1 Health then multiply by 100 threat (HT) 2 Foreseeable Crisis (FC) 1II. 108. 108. Presentation of Data Sales Modifiability Easily 2 2 Intermediate Series1. Table/Chart Categ 1 1st Qtr Categ (moderate) 1 Not modifiable 0III. Preventive Series2. Graph: Categ 2 2nd Qtr CategPie Potential Highly 3 1 Moderate 2 Low 1IV. Series 0 20 3 6Bar-2 variables only 4 Series 2 Salience of the Problem Problem needing 1Line 0 Series Catego Catego Catego Catego urgent 2 1 attention Problem not needing 1 2Polygon-connecting the resultsHistograph-2 urgent attention Not a felt problem 0 or more variables & appear adjacent to each 118. 118. Steps:a. Decide on a scoreb. other Score x weight ----------------- Highest Scoreb. 109. 109. TYPOLOGY OF NURSING Get the sum total of all the PROBLEMSA. First Level Assessment: to scoresInterpretation:Perfect score=5, if determine problems of familySources of score nearing 5 then prioritize the Problems using IDBFamily: use of Initial Data problemCriteria 1, 2 & 3 has to be assessed Base (IDB)Nature: Health Deficit (HD), Health objectively by the health workerCriteria 4 has Threat (HT), Foreseeable Crisis (FC) to be assessed by the perception of the family 110. 110. USE OF INITIAL DATA BASE 119. 119. Compute for 3rd Degree (IDB): 1. Family Chart Structure:Nuclear - Malnutrition Father, mother, childrenExtended (3rd 120. 120. IV. INTERVENTIONIs the generation)-Relatives staying with the capacity to provide managementIs the familyMulti-generational extended-apo sa professional phase of nursing processIs the tuhod or apo sa talampakanDyad -Husband time when the PHN executes the standard & wife only (childless couple)Blended -widow function of an RNThree (3) Standard married another widow & have childrenGay - Functions of RN: Dependent-giving of Same sex living togetherMatriarchal -Mother medicines Independent-monitor, assess, Related 1Health Related: Categories provide, educate Interdependent-referrals according to 5 Aspects of Man=PEMSSP 121. 121. V. EVALUATIONThree (3) hysical, P hysiological, P sychologicalE Things to be evaluated: SPO1. Structure of motionalM entalS ocialS piritual program & activity -what articles, equipments, 131. 131. MAGNITUDE OF THE supplies are utilized2. Process utilized -steps PROBLEM: % of population affected by the used3. Outcome of activity -results can identifiedproblem75-100% 450-74 % 325-49 be:Desirable -to be implemented, % 2<25 % of the population advocated, strengthenUndesirable -to be 1MODIFIABILITYEasily 3Intermediate 2Low avoidedTwo (2) Aspects to be evaluated in the 1Not modifiable 0PREVENTIVE Outcome:Quality -characteristic or kind of POTENTIALHighly 3Moderate 2Low outcome; no numerical value, not 1SALIENCE measurableQuantity -from the word 132. 132. 2. ORGANIZING quantum, with numerical value, measurable PHASEChoosing Potential Community 122. 122. OBJECTIVES OF LeadersCore Group FormationCommunity COPARPatterns to be followed:1. Organize Assembly: Community Organizing people2. Mobilize people3. Work with Participatory Action Research (COPAR) people4. Educate people Knowledge Attend the assembly of the family/families Attitude Skills Families in the community should be 123. 123. PHASES OF represented, any family members can COPAR1.Preparatory2.Organizing3.Mobilizi represent his/her family as long as he/ she is ng4.Educating5.Collaborating6.Phase Out a RESPONSIBLE (one who also can 124. 124. 1. PREPARATORY PHASEA. comprehend) member of that family. Area of Selection It should be DOPE Barangay Captain/Chairman need not Community: Depressed, Oppressed, Poor & necessary be the leader. He can recommend Exploited, a new criteria for community 133. 133. 3. MOBILIZATION PHASEMobilization- let the members of the organization Old Criteria it must be a community do the work. PHN should only virgin community=meaning no agency has SUPERVISE gone there. This is a dangerous situation 134. 134. 4. HEALTH thats why RA 7305: Magna Carta for Public EDUCATIONAdjust on the level of Workers was provided-a PHN is to receive a hazard pay of 20-25% of monthly salary understanding of the communityReturn 125. 125. 1. PREPARATORY PHASEB. demonstration is the best way of Entry: the 1st thing to do upon entering the teachingFocus on the KSARespect of community is to have a courtesy call with the the custom and tradition Barangay 135. 135. 5. COLLABORATING6. PHASE 126. 126. 1. PREPARATORY PHASEC. OUT Integration/Immersion Immersion is 136. 136. EPIDEMIOLOGYis the pattern of imbibing the life situation/ condition of the occurrences & distribution of diseases, community by living, eating & sleeping with defects & deaths 2 Population in the family to be able to understand their DistributionPatterns Susceptible Immune (at risk to develop, acquire (those that did not or situation It requires 2 Qualities of PHN: experience the disease) experience the Empathy Sympathy (Integration) disease, usually individuals develop 127. 127. 1. PREPARATORY PHASED. resistance against the disease)Epidemic 80% Community Study: Diagnosis of Community- (more than 50%) 20%Endemic 50% COPAR Makes use of the Nursing 50%Sporadic 20% 80%Pandemic ----- ----- Process/Problem Solving Approach 137. 137. EPIDEMICGreater than 50% Prioritized which among the problems of populations are susceptible or less immune identified is to be attended 1st like in nature, individualGreater % of the population is magnitude, modifiability, preventive potential, affected by the occurring diseaseExample: salience Health worker reports that Community Lanting 128. 128. PRIORITIZATION OF has anepidemic of measles affecting children COMMUNITY PROBLEMSNATUREHealth less than 7 years oldTotal susceptible Status (HS) 3Health Resource(s) 2Health population: 3000Children affected by measles: Related 1Indicators of Health 17501750 Status/Condition:Fertility: CBR=community 138. 138. ENDEMICThe disease occurs is overpopulated=HSMorbidity: IR (new regularly, habitually, constantly affecting the cases) & PR (old cases)=HSMortality: Deaths population group2 Local Endemic Diseases: like children dying of pneumonia=HS where causative agent is available on those 129. 129. PRIORITIZATION OF placesSchistosomiasis: Samar, Leyte, COMMUNITY PROBLEMSNATUREHealth Status (HS) 3Health Resource(s) 2Health Mindoro, DavaoMalaria: Palawan & Related 1Health Resource(s):5 Ms- Mindanao-reasons why its prevalent Manpower/Man, money, machinery, material Forested areas Surrounded by bodies & methods(+) available facilities- of water Hospital/Clinic, mode of transportation, 139. 139. SPORADICThe pattern of market, school & movie houses for recreation occurrence is on & off where: On=available 130. 130. PRIORITIZATION OF causative agent Off=no available causative COMMUNITY PROBLEMS NATURE Health agentIts intermittent (unpredictable) in Status (HS) 3 Health Resource(s) 2 Health occurrenceDisease occurs only if theres a 150. 150. POLICIES FOR susceptible host like in rabies SCHISTOSOMIASIS CONTROLPROGRAM 140. 140. PANDEMICWorldwide, (SCP): CHESC ase FindingH ealth international, universal, global in occurrence EducationE nvironmental SanitationS nail like in AIDS, Hepatitis B, PTB, measles, Eradication mumps, diphtheria, pneumoniaSARS is 151. 151. CASE FINDING:6 Aspects or categorized by WHO as an OUTBREAK only Thing to KnowDisease: because out of 191 nations, 33 countries are SchistosomiasisOther name: Bilhariasis or reported to have it. Snail FeverCausative agent: Schistosoma- 141. 141. HOME VISIT Is a a blood fluke (parasite) 3 Types of Species: PROFESSIONAL contact between PHN & the Schistosoma japonicum-endemic in the family The services provided is an Philippines & affecting Indonesia, China, extension of the Health Service Agency Japan, Korea Vector: Oncomelania quadrasi (Health Center) Schistosoma mansoni Schistosoma 142. 142. OBJECTIVES OF HOME VISIT haematobium Assessment Nursing Care 152. 152. Laboratory Procedures to rule Treatment Health Education out Schistosomiasis: Blood Examination: Referral (if care fails) eosinophil level indicates parasitism 143. 143. PRIORITIES (IN THE CARE): TO Fecalysis: Kato Katz (plain stool exam that PREVENT CROSS CONTAMINATION1. uses a special apparatus resembling a Newborn2. Post partum3. Pregnant feeding bottle sterilizer) Procedure: Collect mothers4. Morbid casesThe families need the specimen Have the test tube undergo assistance of the health center thats why centrifugation for 20 minutes Get specimen home visit was done to the familyThe person from precipitate & swab it on glass slide who makes the home visit is rendering Observe it on microscope services on behalf of the health center 153. 153. Signs & SymptomsCNS: 144. 144. PHASES OF HOME VISIT:1. High grade fever cerebral convulsionGIT: PlanningStarts at the health Nausea & vomiting, Diarrhea Chronic centerMakes a study on the status of the dysentery (prolonged diarrhea of more than 2 familyStatement of the weeks & consistency is mucoid & bloody (with problemFormation of objective2. streaks of blood)Liver: Presence of Socialization first activity is to establish infection manifested by jaundice & rapport & to gain the trust of the family hepatomegalySpleen: Infection of spleen 145. 145. PHASES OF HOME VISIT:3. inflammation enlargement of organ Activity Intervention/Professional Phase (Splenomegaly) abdominal distension Opportunity to provide or extend health abdominal pain on the right upper services Standard Role of the Nurse: quadrantBlood: Anemia & weakness Independent, Dependent and 154. 154. Treatment: Drug of Choice- Interdependent To be effective, come in Praziquantel (Biltricide) 60 mg/KBW/day complete uniform (also bring a long umbrella Example: If patient is 50 kg, 50 kg x 60 with pointed end which serve as protection)4. mg/KBW/day=3000 mg/day Initial Summarization - ability to put into record & treatment: 1st 2 weeks=3000 mg/day, then do report (orally) about the outcome of the stool exam after 2 weeks if still (+), extend activity treatment for another 2 weeks. Repeat stool 146. 146. PUBLIC HEALTH exam, if still (+) after the extended week, BAG:Indispensable tool that should be continue treatment for 2 weeks again. No organize to save time & effort and to prevent adverse effect or over dosage even if cross infection & contamination extended for a year. Length of Treatment: 147. 147. GUIDING PRINCIPLES IN THE takes months to a year USE OF PUBLIC HEALTH BAG:Content - 155. 155. Health Education: It affects should be prepared by the one who will make mostly farmers so educate them to wear home visit Note: BP Apparatus is kept rubber bootsEnvironmental Sanitation: Snail is separately from PHN bagCleaning The the 1st concern Water where snail thrives is inner part of the bag should be clean & sterile the 2nd concern Toilet=3rd concern Food Should be done every after home visit GarbageSnail Eradication: Use molluscicides Never endorse the bag treat the entire suspected soil with chemical 148. 148. GUIDING PRINCIPLES IN THE solution that kills snails USE OF PUBLICHEALTH BAG: 156. 156. CASE FINDING:Disease: Contamination The less one opens the MalariaOther name: AgueCausative bag, the lesser chance of contamination In Agent: Plasmodium-a protozoa 4 Types of general, the bag is open 3x: Putting out Species: Plasmodium falciparum-more fatal materials for hand washing Putting out that affects the Philippine Vector: Female materials used for nursing care Returning Anopheles Mosquito (FAM) Plasmodium all what have been used vivax Plasmodium ovale Plasmodium 149. 149. GUIDING PRINCIPLES IN THE malariae USE OF PUBLICHEALTH BAG:Care of 157. 157. Laboratory Procedure: Communicable Case(s)- should be disinfected Malarial smear-extract blood at the height of with the use of 70% isopropyl alcohol or Lysol fever because plasmodium is very active & which should be done at the health center and ruptures at this period.Signs & Symptoms not at home of Malaria:1st Stage=Cold: Chilling sensation services I. Mobilize political commitment and for 1-2 hours2nd Stage=Hot: High grade fever community involvement to provide support to lasting for 3-4 hours3rd Stage=Wet: basic health care delivery Diaphoresis (excessive sweating/perspiration) 166. 166. GOALS: A. Safe Pregnancy 158. 158. Treatment: Drug of Choice- Right age to be pregnant=20-35 years old, not Quinine 2 Forms: a) Chloroquine (Aralen) b) less than 20 & not more than 35 Right PrimaquineIf Quinine is not available, may use interval of pregnancy=once in 2 or 3 years Sulfadoxime-an antibacterial drug paired with Home Base Mothers Record (HBMR): the pyrinthamine record used for care of mothers in CHN 159. 159. PERSONAL 167. 167. Laboratory PROTECTION:Sleep under a mosquito Examinations:Benedicts Test: test for sugar in netSleep in a screened roomSleep with the urine; test for diabetes Heat test tube long sleeve attireUse repellents that with 5 cc of Benedicts Solution (blue) in the contains DET (diethyl toluamide or toluene burner then add 3-5 gtts of urine (amber which has a pungent odor that drives away yellow) then heat again. Observe for the mosquitoes & an irritant to mucous membrane change in color:Blue : (-) sugar in urineGreen : of respiratory tract when inhaledPlant a trace of sugar in urine +1 +Yellow : traces of Neem Tree using the leaves sugar in urine +2 ++Orange : more traces of 160. 160. CLEAN: Chemical sugar in urine +3 +++Brick Red : surely Method=insecticide spraying at night Larvae diabetic +4 ++++ eating fish=Tilapia Environmental Sanitation & 168. 168. Laboratory Examinations:Acetic Health Education=insect, water, trash Anti- Acid Test: test for albumin in urine; test mosquito soap=basil citronelli Neem forPregnancy Induced HPN Collect urine tree=banana, banaba, gabi, eucalyptus in test tube, heat it in burner then add 3-5 gtts provide repellent effect of acetic solution (clear white). Observe for 161. 161. STRATEGIES:A. Provision of change in color:If it remains clear: (-) CHON Regular and Quality Maternal Care or albumin in urineIf it turns cloudy: (+) Services Regular and quality pre-natal CHON=proteinuria carehx-taking, utilization of HBMR (Home- 169. 169. POLICIES:1. Non coercive (give Based Mothers Record) as a guide in the freedom of choice)2. Integration of Family identification of risk factorsPE: weight, Planning in all Curricular Program:LOI 47 height, BP-takingPerform head-to-toe DECS states that Family Planning is to be assessment, abdominal examTetanus integrated in all school curricular programs, Toxoid ImmunizationFe supplementation: either baccalaureates or non- baccalaureates, given from 5th mo. of pregnancy to two enrolled separately as one unit3. Multi- months postpartum (100-120 mg orally/day for Sectoral Approach: establish relationship with 210 days)Laboratory exam: Heat-acetic otheragencies which can either be: acid test. Benedicts testOral/Dental exam Intrasectoral Intersectoral-Local or International (WHO, Unicef, USAID, Japhiego) 162. 162. Pre-natal counseling 170. 170. METHODOLOGIES: Biological A. Provision of safe, delivery careall birth Basal Body Temperature (BBT) Get the attendants shall ensure clean and safe temperature early morning before waking up deliveries at the faciltiies which should be monitored daily at the same (RHUs/hospitals)at-risk pregnancies and time There should be a sudden drop of mothers must be immediately referred to the temperature between 0.3-0.6C followed by nearest institution an increase of temperature by 0.3-0.6C 163. 163. Provision of quality which means that the woman is fertile postpartum care Proper schedule of 171. 171. B. Sympto-thermalC. Cervical follow-up must be followed:1st postpartum Mucus Test Billings Method by Dr. Billing visit for home deliveries must be done within Spinnbarkheit (came from a German word 24 hours after delivery2nd, done at least 1 Spinner which means to play with the cervical week after delivery3rd, done 2-4 weeks mucus with the finger) or Wet & Dry Method: thereafter Attendants must be aware of the Wet Cervical Mucus (Fertile): abundant, early signs, symptoms and complications. stretchy & transparent Dry Cervical Mucus They should follow the 3 CLEANS: CLEAN (Safe & Not fertile): whitish, pasty & Hands CLEAN Surface CLEAN Cord adhesiveD. Calendar (Rhythm)Deleted 164. 164. C. Improvement of the health already since 1998 because its not personnels capabilities on newborn care, recommended for irregular cycle of midwifery thru trainings. Note: All deliveries should be done in health care facilities menstruationMenstrual cycle should be ONLY D. Improvement on the quality of care regular; obtain 4-6 months cycle 172. 172. E. Lactation Amenorrhea Method at the First Referral Level Orientation, (LAM): RA 7600-Breastfeeding & Rooming In training should be done on the use of proper LawDOH organized Maternal & Child filling-up of HBMR card Proper Family Health Institute (MCFHI) with the referrals/endorsements must be done for future If-upsE. Prevention of unwanted following members: All government pregnancies through family planning hospitals Private hospitals services F. Prevention and management of (volunteer)Normal involution (uterus goes STDs back to normal) of the uterus: after 45 days or 165. 165. G. Promotion of Appropriate 5-6 weeks or 1 months if not health practices H. Upgrade reporting breastfeedingFrozen breast milk is to be put out of the freezer 2 hours before feeding ( 181. 181. Anemia: Iron Deficiency Anemia Body of Ref: 2-3 days / Freezer: 3-4 Target age group: 0-59 months (less than months)Left over milk should be discarded 5 years) Give 3-6 mg/kbw/day Always & should not be re-preserved or re-frozen give the maximum Example: Child weighs 8 because it is already contaminated kg 8 x 6=48 mg/day for the 1st 3 months then 173. 173. METHODOLOGIES:TemporaryA. monitorIf still anemic, continue giving but ChemicalOral Pills (Logentrol)-has low compute again 6 mg/kbw dose of estrogen & progesterone that inhibits 182. 182. Goiter: Iodine Deficiency Disease ovulationParenteral: Depot (endemic in uphill)Target age group: 0-59 Medroxyprogesterone Acetate (DMPA)/Depo- monthsGive 1 capsule (200 mg) of provera- inhibits ovulation making women potassium iodate in oil once a yearFor a child amenorrheic;1991, DMPA was found to be < 5 years old, empty contents of capsule in a causing cancer of the cervix1994, DMPA is cup with warm water because he cant tolerate given IM 4x a year every 3 months (90 days itAdverse Effect of Iodine Deficiency interval) Disease that must be avoided: Mental 174. 174. Implants: Norplant-it inhibits retardation-intelligence quotient: idiot, moron ovulation effective for 5 years but seldom & imbecile Growth retardation- cretinism advocated for use because it is usually (pedia) & dwarfism (adult) expensive; the client buys the device (consists 183. 183. Macronutrient Malnutrition - of 5 capsules) & have it implanted at the available in large amount in the body (Protein health center by minor surgical incision in: Energy Malnutrition or PEM)Kwashiorkor- upper inner arm because it is nearest to the protein deficiencyMarasmus-carbohydrate brain external oblique thigh gluteal deficiency (energy giving food) muscles 184. 184. Kwashiorkor MarasmusEtiology 175. 175. B. Mechanical: IUD Up to Disease experienced by an elder Muscle 10 years protection Cervical cap & wasting child upon the birth of a new Diaphragm Prevent the sperm to pass the babyDeficiency CHON CHOAge Toddlers (1-3 cervix Works better with spermicide years old) All agesMajor Signs & Facial Wore 30 minutes before coitus and keep up to edema, moon facie Muscle wasting, old mans 6 hours after coitus Condom Most facieSymptomsHair Changes (+) color effective way to prevent STDs / STIs changes from black to (-) hair changes brown 176. 176. METHODOLOGIES:C. or from brown to golden yellow (+) sparse Behavioral Abstinence WithdrawalD. flag signSkin Dermatosis: (-) dryness, Permanent Vasectomy (reversible)-since peeling off of the skin, desquamationBehavior year 2000 in the Philippines BLT Irritable ApatheticManagement High CHON 177. 177. POLICIES:I. Nutritional diet High CHO dietHospital Setting Total Surveillance (NS): to determine victims of Parenteral Nutrition (TPN) Hyperalimentation malnutritionA. Anthropometric Measurement: process IV infusion with CHON, CHO study of measurements ofhuman regulated by a machine dimensions Age for Weight-if weight is not 185. 185. POLICIES:II. Food appropriate with the age: Stunting: growth ProductionFortification-products without any nutrient are added with nutrientsRA 8172 retardation Wasting: connotes (Asin Law): Fidel Salt (Fortification of Iodine malnutrition Age for Height-if height is not Deficiency Elimination)=Iodized Salt-Patak appropriate with the age: Stunting Weight sa Asin by Secretary Flavier on December 1- for Height 5, 2003where DOH workers go to market to 178. 178. Rule Male FemaleEvery height of check if salt sold contains iodine byplacing 5 110 lbs. 105 lbs.ft.Every increment + 6 +5of few drops of reagent:If salt color turns to blue an inch above5 ft. ADDEvery decrement - 6 - violet fortified with iodineIf salt color show 5of an inch below5 ft. SUBTRACT no change not fortified with iodineRA 832 179. 179. Skin Folds Test-pinch the (Rice Fortification): FVR (Fortified Vitamin external oblique muscle (bilbil) with your Rice) by Secretary Flavierunder FVR, Erap palmNormal: 1 inchOverweight: > 1 inch Rice under Erap, Gloria Rice or Bigas ni Middle Upper Arm Circumference (MUAC)- Gloria under PGMA used in children below 5 years old by 186. 186. ENVIRONMENTAL measuring the middle upper arm with a tape SANITATIONrefers to all factors available measureNormal: 13 cms. & aboveMalnutrition: in the environment affecting the health of the <13 cms individual or population regulated by PD 180. 180. POLICIES:I. Nutritional 856: Comprehensive Sanitation Code of the Surveillance (NS): to determine victims of Philippines malnutritionB. Biochemical Method 187. 187. ENVIRONMENTAL HEALTH Micronutrient Malnutrition -available in small SERVICE (EHS) OF DOH IS RESPONSIBLE amount in the body VADAG:Vitamin A FORPromotion of healthy environmental Deficiency: Deficiency: Xeropthalmia- conditions & prevention of environmental opacity of cornea leading to night blindnes related diseases through appropriate Infants (6-12 months) : Give 100,000 i.u. Pre- sanitation strategiesPromotion & schoolers (12-83 months) : 200,000 i.u. Post implementation of sanitation programs partum : 200,000 i.u. Never give Vitamin A through the Department of Health Field Health to infants less than 6 months & pregnant UnitsConceptualization of new women because it is toxic programs/projects to contend with emerging Odorless Earth Closet- Bored-hole- environmentally related health problems Compost Toilets requiring small amount of 188. 188. COMPONENTS: Water water to wash waste intoreceiving space- Supply Sanitation Program Proper Excreta Pour flush- Aqua privies and Sewage Disposal Program Insect and 199. 199. Pit latrines most commonly Rodent Control Food and Sanitation observed in rural area has three Program Hospital Waste Management components: the pit, a squatting plate and the Program super-structure types of pit 189. 189. 1. WATER SUPPLY includeAntipolo type, a pit type of toilet SANITATION PROGRAM Potable Free provided with concrete floor and an elevated from any particles that might cause illness to seat with a coverVentilated Improved Pit or an individual VIP, pit with a vent pipeReed Odourless Earth 190. 190. Ways to make Water Closet or ROEC, a pit completely displaced Potable:Boiling: minimum of 3 minutes to from the superstructure and connected to the maximum of 10 minutes for squatting plate by a curved chute. drinkingSterilization: 30 minutes after the 200. 200. Bored Hole Latrine consists of water starts to boilFiltration: makes use of relatively deep holes bored into the earth by filter paper or cotton cloth to separate solid mechanical or manual earth-boring particle from liquid if water comes from river equipment holes are about 10-18 inches in 191. 191. Coagulation/Flocculation: diameter and usually 15-35 feet deep. The uses aluminum crystal (tawas) that collects or hole is provided to facilitate squatting. Two absorbs particles from liquid part & becomes types of bored-hole latrines are:Wet Type - slimy In 1 gallon of water, drop tawas (the when the hole penetrates ground water table size of magi cubes) & allow to stand for 6-8 or other strata.Dry Type - when he hole does not reach ground water table; fills up at a hours Initially, water appears to be cloudy faster rate then than the wet type. then after 6-8 hours of standing, the water 201. 201. 3 TYPES OF APPROVED becomes clear TOILET FACILITIESLevel 2On site toilet 192. 192. Chlorination: uses 100% pure facilities of the water carriage type withwater concentrated chlorine bought from botika or sealed andflushed type with septic vault/tank given free by health centers To prepare disposal facilities. stock solution (SS): in 1 liter drinking water, 202. 202. 3 TYPES OF APPROVED add 1 tablespoon of concentrated chlorine TOILET FACILITIESLevel 3Water carriage which is potent for 3-4 months To prepare types of toilet facilitiesconnected to septic the chlorinated water: in 2 gallons of tanks an/or to seweragesystem to treatment drinking water (10,000 ml=10 liters), add 1 plant. tablespoon from the prepared stock solution & 203. 203. THINGS TO CONSIDER IN let it stand for 30 minutes to react with water CONSTRUCTING A TOILETFACILITY: At 193. 193. Fluoridation: adding fluoride least 25 meters away from water sources at a to prevent dental caries (primary significance) lower elevation It should be within your & whitens enamel of teeth ( 2nd financial capability It should be approved significance)Aeration: exposing drinking by the local health authorities water in air to strengthen taste within 24 hours 204. 204. CARE AND MAINTENANCE OF which is usually used in uphill areas where YOUR TOILET FACILITY: Water must be theres less or no pollution 194. 194. 3 TYPES OF APPROVED provided at all times. Use toilet paper WATER SUPPLY AND FACILITIESLevel Use lysol once a month for odor removal IPoint SourceA protected well or a developed Clean the bowl by muriatic acid to remove the spring with anoutlet but without a distribution stains. Avoid depositing solid objects on system for ruralareas where houses are thinly the bowl to prevent clogging Always check scattered. your toilet if its clean Use plunger when 195. 195. 3 TYPES OF APPROVED clogging occurs. Dont use sticks or rods to WATER SUPPLY AND FACILITIESLevel avoid the breakage of the trap or the bowl. IICommunal faucet system or stand postsA 205. 205. 3. PROPER SOLID WASTE system composed of a source, a reservoir, a MANAGEMENTrefers to satisfactory methods pipeddistribution network and communal of storage, collection and final disposal of faucets, located atnot more than 25 meters solid wastes from the farthest house inrural areas where 206. 206. SOURCES OF SOLID houses are clustered densely. WASTEHousehold Waste - these are wastes 196. 196. 3 TYPES OF APPROVED generated in or discharged from household WATER SUPPLY AND FACILITIESLevel including shops but excluding commercial IIIWaterworks system or individual activities Commercial Waste - restaurants, houseconnectionsA system with a source, a stationery shops, grocery shops or any reservoir, a pipeddistributor network and commercial activity are the main sources of household taps that issuited for densely commercial waste. Market Waste - only refers populated urban areas. to waste generated in or discharged from 197. 197. 2. PROPER EXCRETA AND markets both for whole sale and retailing SEWAGE DISPOSALSYSTEM 207. 207. SOURCES OF SOLID 198. 198. 3 TYPES OF APPROVED WASTEInstitutional Waste - these are wastes TOILET FACILITIESLevel 1Non-water generated in government, state enterprise and carriage toilet facility:- Pit latrines- Reed private firm office. Street Sweeping Waste - these are wastes generated by the street 216. 216. 3 POINTS OF sweeping cleansing service. River Waste - CONTAMINATIONPlace of production includes all the wastes generated by the river processing and source of and creek cleansing Medical Waste - these supplyTransportation and storageRetail are wastes generated in hospitals. and distribution points 208. 208. COMPONENTS OF SOLID 217. 217. 5. HOSPITAL WASTE WASTEGarbage refers to left over vegetable, MANAGEMENTRA 4226-Hospital Licensure animal and fish material from kitchen and food Act monitors the hospital license & proper establishments. These materials have the management of wastes as well as renewal of tendency to decay giving off foul odors and license to operate sometimes serve as food for flies and 218. 218. GOAL:To prevent the risk of rats. Rubbish refers to waste materials such contraction contracting nosocomial infection as bottles, broken glass, tin can, waste from type disposal of infectious, pathological papers, discarded textile materials, porcelain and other wastes from hospital wares, pieces of metal and other wrapping 219. 219. COLOR CODING OF BIN TO materials. KEEP WASTE:Green: wet wasteBlack : dry 209. 209. COMPONENTS OF SOLID wasteYellow: infectious/pathological waste WASTE Ashes are left over from burning of like blood, sputum, urine, feces & wood and coal. Ashes may become a gauzeOrange: toxic/hazardous waste nuisance because of the dust associated with them. Stable manure is animal manure collected from stables. Dead animals like dead dogs, cats, rats, pigs, and chickens that are killed by cars and trucks on streets and public highways. They include small and large animals that died from disease. 210. 210. COMPONENTS OF SOLID WASTEStreet sweeping includes dust, manure, leaves, cigarette buts, waste papers and other materials that are swept from streets. Night soil is human waste normally wrapped and thrown into sidewalks and streets. This also includes human waste from pail system of toilets. Yard cuttings includes leaves, branches, grass and other 211. 211. SANITARY WAYS OF TREATING GARBAGE:Segregation- separating biodegradable from non biodegradableCollection-adherence to the proper collection time the City of Manila coordinates with Leonel Waste Management (a private firm which collects garbage) where the truck driver coordinates with the Barangay Chairman on the time they will collect garbage so dont bring out garbage before the collection time 212. 212. WAYS OF DISPOSAL Household Burial Deposited in 1m x 1m deep pits covered with soil, located 25 m. away from water supply Open burningo Animal feedingo Compostingo Grinding and disposal sewer 213. 213. WAYS OF DISPOSAL Community Sanitary landfill or controlled tipping Excavation of soil deposition of refuse and compactingwith a solid cover of 2 feet IncinerationEcological Solid Waste Management: RA 9003- the use ofincinerator approved in 2000 but was implemented in 2003because of lack of funding to purchase 214. 214. 4. FOOD SANITATION PROGRAM 215. 215. POLICIES: Food establishment are subject to inspection (approved of all food sources containers and transport vehicles) Comply with sanitary permit requirement Comply with updated health certificates for food handlers, helpers, cooks All ambulant vendors must submit a health certificate to determine present of intestinal parasite and bacterial infection