MULTI-EDUCATIONAL REVIEW GROUP EXPERTS, INC.

*BAGUIO CITY*ILOILO CITY * DAVAO CITY *CABANATUAN CITY*

MAKATI CITY*METRO CEBU*VIGAN CITY*GEN SANTOS CITY *PAMPANGA*
MANILA HEAD OFFICE
www.merge-review.com

COMMUNITY HEALTH NURSING

NATIONAL HEALTH SITUATION

Demographic profile:
a. Leading Causes of Mortality among Filipinos in 2002
1. Diseases of the Heart
2. Diseases of the Vascular System
3. Malignant Neoplasm
4. Pneumonias
5. Accidents
6. Tuberculosis
b. Leading Causes of Infant Mortality in 2002
1. Respiratory conditions of the fetus and newborns -2002 -2008
2. Pneumonias- 1995-2001
3. Bacterial sepsis of newborn
4. Diarrhea and Gastroenteritis
5. Congenital malformation of the heart
c. Leading Causes of Maternal Mortality in 2002
1. Other complications related to pregnancy
occurring in the course of labor and delivery
2. Hypertension complicating pregnancy and childbirth
3. Postpartum Hemorrhage
4. Pregnancy with abortive outcome
5. Hemorrhage related to pregnancy
d. Leading Causes of Morbidity in 2002
1. Pneumonias 2002-2008
2. Diarrheas 1998-2001
3. Bronchitis
4. Influenza
5. Hypertension
6. Tuberculosis

DEPARTMENT OF HEALTH
 Lead agency in the health sector and sets the goals for the nations health.

Roles and Functions of DOH

 Leadership in Health
 Enabler and Capacity Builder
 Administrator of specific services

VISION of DOH:
“The Leader of Health For All in the Philippines”

MISSION of DOH:
“Guarantee equitable, sustainable and quality health for all
Filipinos, especially the poor and to lead the quest for excellence
in health “

OBJECTIVES of DOH:
 General health status of the population must be improved.
 Reduce morbidity, mortality, disability and complications from the different
diseases and disorders.
 Eliminate the following diseases as public health problems
(Schistosomiasis, Malaria, Filariasis, Leprosy, Rabies, Vaccine preventable
diseases, Vit. A and Iodine deficiency)
 Eradicate poliomyelitis
 Promote Healthy Lifestyle
 Promote the health and nutrition of families
 Promote Environmental Health

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GOAL of DOH:
 HEALTH SECTOR REFORM AGENDA (HSRA)

FRAMEWORK FOR IMPLEMENTATION OF HSRA: FOURmula 1 for Health

FOURmula 1 for Health

“…speed, precision, and effective coordination towards improving the efficiency, effectiveness & equity of
health care delivery.”

FOURmula One COMPONENTS or ELEMENTS

1. HEALTH REGULATION
2. HEALTH FINANCING
3. HEALTH SERVICE DELIVERY
4. GOOD GOVERNANCE IN HEALTH

NATIONAL HEALTH PLAN:

 It is the blue print, which is followed by the Department of Health. It defines the
country’s health problems, policy thrusts, strategies and targets.

HEALTH CARE DELIVERY SYSTEM:

 Is the totality of all policies, infrastructures, facilities, equipment, products, human
resources and services that address the health needs, problems and concerns of all
people.

HEALTH CARE SERVICES:

 Promotive and Preventive:
 Curative and Rehabilitative:

Local Government Code (RA 7160)

The Code aims to:
a. transform local government units into self reliant communities
b. and active partners in the attainment of national goals through
a more responsive and accountable local government structure
instituted through a system of decentralization.

Inter Local Health System

 In order to ensure quality health care services at the local level
 Clustering municipalities into
“Inter Local Health Zone”
 Each ILHZ has a defined population within a defined geographical area
 Partnership as the basic framework

Composition of ILHZ:
1. People
2. Boundaries
3. Health Facilities
4. Health Workers

PRIMARY HEALTH CARE: (WHO)

Is “essential health care based on practical and socially acceptable methods and technology made
universally accessible to I-F-C

GOAL: “ Health for All Filipinos and Health in the Hands of the People by the year 2020. ”

MISSION: To strengthen the health care system by increasing opportunities and supporting the
conditions wherein people will manage their own health care.

ELEMENTS OF PHC:
E- Education for Health
L- Locally Endemic Disease Control
E- Expanded Program on Immunization
M-Maternal and Child Health
E- Essential Drugs – (Botika sa Baryo or Barangay, Botika sa Paso)
N- Nutrition
T-Treatment of Communicable and Non- Communicable Diseases
S- Safe water and Sanitation

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COMPONENTS OF HEALTH CARE DELIVERY SYSTEM:

A. LEVELS OF CLIENTELE
1. Individual
2. Family
3. Community
4. Population Groups

 Infants and Young Children

 School age
 Adolescents
 Mothers
 Males
 Old People

TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

FIRST LEVEL ASSESSMENT

Health Threats
 Conditions that are conducive to disease, accidents, or failure to realize one ’s own health potential
Ex. Family history, family size, accident hazards, poor environmental conditions

Health Deficits
 Instances of failure in health maintenance (disease, disability, developmental lag, etc.)
Ex. Illness states, Malnutrition, Disability

Stress Point / Foreseeable Crisis

 Anticipated periods of unusual demand on the family in terms of adjustment or to family resources
Ex. Unemployment, Death of a family member, Unexpected pregnancy, marriage

Community Health Nursing: An Overview

What is COMMUNITY?
*a social group of people interacting with each other, determined by geographic
boundaries,
*living together to attain certain and common goals and sharing the same interest.

Characteristics of a healthy community

1. The members are aware of their own health and biologic status.
2. Members give credit to the governing authority.
3. The natural and biological resources are open for everybody, but the consumption is controlled to
help in preserving this resources.
4. Has a strong and reliable governing body.
5. The people work together to attain independence.
6. Environmental and physiologic needs are sustained by the community and families.
7. Parents and guardians serves as role models for the children.
8. The people are concerned with their health status.
9. Health needs are accessible and affordable to the public and free for the indigent.
10. Everyone is working to attain Health Citizenry.

What is HEALTH?
Modern Concept:

 Health refers to:

(Optimum Level of Functioning-OLOF)
of an I-F-C
 Eco- System influence the OLOF

What is NURSING?-
assisting sick or well I-F-C to become healthy and to achieve optimum level of
wellness

QUALIFICATIONS, ROLES AND FUNCTIONS OF A COMMUNITY HEALTH NURSE

A. QUALIFICATIONS OF PUBLIC HEALTH NURSE: a nurse working in the community

 BSN
 Registered Nurse

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Roles Functions

MANAGER
 Plans and organizes the nursing service plan of the health unit
 Participates in the preparation and implementation of municipal health
plan
 Monitors and evaluates the implementation of the nursing service plan
 Manages the RHU in the absence of the Rural Health Physician
 Allocates and distributes materials and equipments at local levels

SUPERVISOR
 Formulates and implements a supervisory plan
 Monitors and evaluates midwives in the implementation of public
health programs
 Maintains records and reports
TRAINOR
 Identifies and interprets training needs of midwives, BHW and
Hilots.
 Formulates Training Program for midwives, BHW and Hilots.
 Evaluates effects of training on work performance

CLINICIAN or PROVIDER OF NURSING CARE

 Provides direct nursing care to the sick, disabled in the home, clinic and
place of work


HEALTH EDUCATOR
 Conducts health education activities ( mothers class, IEC)

COUNSELOR
 Conducts pre-marital counseling

COMMUNITY ORGANIZER
 Responsible for motivating and enhancing community participation

COORDINATOR or FACILITATOR
 Coordinates nursing program with other health programs
 Multi-sectoral linkages
HEALTH MONITOR
 Detects deviation from health of individuals, families and communities
through follow-up care.
ROLE MODEL
 Provides good example of healthful living to the public

CHANGE AGENT
 Motivates Changes in health behavior

RECORDER/REPORTER
 Maintains and submits accurate and complete data

RESEARCHER
 Participates, Assists or Conducts researches on nursing and health
related subjects.

LAWS AFFECTING COMMUNITY HEALTH NURSING PRACTICE

1. RA 9173----------------Phil. Nursing Act of 2002

2. RA 7160 ---------------Local Government Code
3. RA 7610 ---------------Child Abuse Law
4. RA 2382 ---------------Phil. Medical Act
5. RA 1082 ---------------Rural Health Act
6. RA 7305 ---------------MagnaCarta for Public Health Workers
7. RA 7277---------------MagnaCarta for Disabled Person
8. RA 3573--------------- Communicable Diseases should be reported
9. RA 9165--------------- Dangerous Drugs Act
10. RA 9262--------------- Domestic Violence Act
11. RA 9257 ---------------Expanded Senior Citizen Act 2003
12. RA 6758 ---------------Salary Standardization Law
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13. RA 8423 -------------- Phil. Institute of Traditional and Alternative Health Care
14. RA 6713 ---------------Code of Conduct and Ethical Standards
15. RA 8749 ---------------Clean Air Act
16. PD No. 856 -------------Sanitation Code of the Phil.
17. PD No. 825 ------------Penalty for Improper Garbage Disposal
18. PD No. 807 ------------Civil Service Rules and Regulations
19. PD.No. 651-------------Registration of all births within 30 days following delivery
20. PD No. 996 ------------Compulsory Basic Immunization for Infants and
Children Below 8 years old
21. EO No. 94--------------Reorganization of Govt. Offices and Created the
Division Of Nursing
22. Act No. 1407 ----------Reorganization Act/ Abolition of the Board of Health

VITAL AND HEALTH STATISTICS

 Refers to the systematic study of vital events such as births, illnesses and deaths.
 Statistics of disease (morbidity) and death indicate the state of health of a
community and the success or failure of health work.

1. Crude Birth Rate: Total No.of Livebirths registered x 1,000

Estimated population as Jul. 1 of the same year

2. Crude Death Rate: Total No. of Deaths registered x 1,000

Estimated population as Jul. 1 of the same year

3. Infant Mortality Rate: Total No. of Deaths under 1 year of age x 1,000
Total No. of registered livebirths

4. Maternal Mortality Rate: Total No. of Deaths from maternal cause x 1,000
Total No. of registered livebirths

5. Incidence Rate: Number of new cases of a particular disease x 100,000

Estimated population as Jul. 1 of the same year

6. Prevalence Rate: Number of new and old cases of a certain disease x 100
Total No. of persons examined at the same given time

HEALTH PROGRAMS, SERVICES AND STRATEGIES

I. MATERNAL AND CHILD HEALTH CARE PROGRAM

A. MATERNAL CARE – Safe Motherhood Program

a. Prenatal Care
 To reach all a pregnant women, to give sufficient care, ensure a healthy
pregnancy and the birth of a full term healthy baby
History Taking
 To compute the EDC ( Expected Date of Confinement) use the
Naegel’ s Rule:

1st get the (LMP) Last Menstruation Period

2nd use the following: -3 + 7 +1 ( constant)

Example: LMP- Aug. 13, 2005

8 13 2005
-3 + 7 + 1
5 20 2006 – EDC

 To compute the AOG ( Age of Gestation)

1st get the (LMP) Last Menstruation Period

Example: LMP- Jan. 24, 2005

2nd get the latest consultation date

Example: April 7, 2005

Jan 31-24= 7
Jan - 7
Feb - 28
Mar - 31
Apr - 7
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 73 divide 7 = 10 wks and 3 days – AOG
Child Care
UNDER FIVE CLINIC PROGRAM

Breast Feeding
B- est for babies up to 6 months to 2 years
R- apid involution is promoted
E - conomical (money, time)
A- lways available
S- atisfies infant’s needs
T- emperature is always right
F- eeding promotes bonding
E- asy to digest
E- ffortless
D- ecrease incidence of breast cancer
I – llness prevention
N- ormally contains antibodies
G - astroenteritis is less likely to occur

Breast Feeding Positions:

 Cradle Position
 Side-lying Position
 Football Position

EXPANDED PROGRAM ON IMMUNIZATION –launched in July 1976

Objective: To reduce the morbidity and mortality among infants and children
caused by the six childhood immunizable diseases.

Legal Basis:
Pres. Decree No. 996 - Compulsory Basic Immunization for Children below 8 years old
Pres. Proclam No. 6 - Universal Child Immunization
Pres. Proclam No. 46 - Universal Child and Mother Immunization
Pres. Proclam No.147 - National Immunization Days
Pres. Proclam.No. 773 - Knock Out
Pres. Proclam No. 1066 - Neonatal Tetanus Elimination Campaign
Rep. Act 7846 - Compulsory Immunization Againts Hep.

IMMUNIZATION SCHEDULE

Vaccine Age to be given Doses Dosage Interval Route Site

1. BCG Infants: 1 0.05 ml ID R Deltoid
anytime at birth
School Entrance: 1 0.1 ml ID L Deltoid
6 yrs old

2. DPT 6 weeks 3 0.5 ml 4 wks IM Thigh-Vastus

Lateralis

3. OPV 6 weeks 3 2-3 drops 4 wks PO Mouth

Salk- parenteral
Sabin- oral ( liquid form)

4. Hep. B 6 weeks 3 0.5 ml 4 wks IM Thigh-Vastus

Lateralis

5. Measles 9 mos 1 0.5 ml SC Deltoid- Thigh

(Ligtas Tigdas Campaign-February 2004)

(PMEC)- the ultimate goal is to interrupt the circulation of measles virus in all communities by 2008
Target Participants: 9 months to less than 8 years old children

VACCINE COMPUTATION:

For infants, target-setting should be based on the 3% of the total population, while for pregnant
women, it must be based on the 3.5% of the total population.

infants

Eligible Population = total population x 0.03

school entrants

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 x 0.035 pregnant women

Example: How many amp of BCG and vial of DPT and TT will you request for a
population of 5000 per year.

1. Compute eligible population:

Formula:
Eligible Population= total population x constant percentage

Constant Percentage
a. Infants- 3%=.03
b. School entrance- 3%=.03
c. Pregnant mother- 3.5%=.035

Infants: 5000 x .03 = 150 infants

Pregnant Mother: 5000 x .035 = 175 pregnant

2. Compute Doses needed per year:

Formula:
Doses needed per year= Eligible Population x constant doses

Constant Doses:
BCG-1 dose
DPT- 3 doses
OPV- 3 doses
Hep.B- 3 doses
Measles-1 dose
TT - 2 doses

BCG: 150 x 1 dose – 150 doses of BCG

DPT: 150 x 3 dose – 450 doses of DPT
TT: 175 X 2 dose – 350 doses of TT

3. Compute Doses with Wastage Allowance:

Formula:
Doses with Wastage Allowance= Doses needed per year x constant wastage allowance

Constant Wastage Allowance per vaccine

a. Infant-BCG ---------------- 2.50
b.SE-BCG---------------------- 1.67
c.DPT, OPV--------------------1.67
d Hep. B.------------------------1.20
e.Measles -----------------------2.0

BCG- 150 dose x 2.50 = 375 doses of BCG

DPT – 450 doses x 1.67 = 752 doses of DPT

4. Compute Ampule and vial request per year:

Formula:
Ampule and vial request per year= Doses with Wastage Allowance
Constant stock doses per ampule or per vial

Constant stock doses per ampule or per vial

a.BCG, OPV, TT------------ 20 doses
b.DPT, Measles, Hep.B---- 10 doses

BCG: 375 doses

20 doses/ampule
= 19 ampules/ year
DPT : 752 doses
10 doses/vial
= 38 vials/year

HEALTH EDUCATION AND COMMUNITY ORGANIZATION

HEALTH EDUCATION

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 
Process whereby knowledge, attitude and practice of people are changed to
improve individual, family and community health.
HEALTH EDUCATION TEACHING METHODS AND STRATEGIES:

 Interviewing
 Counseling
 Lecture- Discussion
 Work shops
 Case study
 Role play

QUALITIES OF A GOOD HEALTH EDUCATOR

 Knowledgeable
 Credible
 Patience
 Possess teaching skills
 Creative
 Encourage Group Participation

COMMUNITY ORGANIZATION:

 Process by which people, health services and agencies of the community are
brought together.

STEPS IN ORGANIZING A COMMUNITY FOR HEALTH ACTION:

 PREPARATORY PHASE:
 Area Selection
 Courtesy call
 Gain Entry in the community
 Community Profiling
 Community Assembly

 ORGANIZATIONAL PHASE:
 Social Preparation
 Spotting and Developing Potential leaders
 Core Group Formation
 Setting up community organization

 EDUCATION AND TRAINING PHASE:

 Conducting community diagnosis
 Training of community health workers
 Health services and mobilization
 Leadership-formation activities

 INTERSECTORAL COLLABORATION PHASE:

 SUSTENANCE AND STRENGTHENING PHASE:

 PHASE- OUT

10 HERBAL MEDICINES:
 RA No.- 8423- Phil. Institute of Traditional and Alternative Health Care (PITAHC)
 Mnemonic is BUBLY SANTA
 B - awang ------------------------------- Hypertension, Lowers Cholesterol, Toothache
 U - lisimang Bato (Pansit-pansitan)- Lowers uric acid, Rheumatism
 B - ayabas-------------------------------- Diarrhea, Wounds, Toothache
 L - agundi--------------------------------- Cough, Asthma, Fever
 Y - erba Buena-------------------------- Muscle pain,
Arthritis, Rheumatism, Cough,
Headache
 S - ambong------------------------------- Anti edema, Diuretic, Anti- urolithiasis
 A - mpalaya------------------------------ Diabetes Mellitus
 N - iog-niogan---------------------------- Parasitism, Ascariasis, Anti-helmintic
 T - saang Gubat------------------------- Stomachache, Diarrhea
 A - kapulko ------------------------------ Scabies, Anti-fungal, and Athletes foot

TEN ELEMENTS OF REPRODUCTIVE HEALTH

 Family Planning (FP)
 MCH and Nutrition (MCH and N)

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  Prevention and Management of RTI’s and STI’s
 Adolescents Reproductive Health (ARH)
 Prevention and Management of Abortion Complications (PMAC)
 Education on breast and RT Cancers
 Education and counseling on sexual health
 Violence Against Women and Children (VAWC)
 Prevention and Management of Infertility and sexual disorders
 Men’s reproductive health

BOTIKA NG BARANGAY
 Drug outlet
 Managed by a legitimate CO, NGO and LGU
 With a trained operator and a supervising pharmacist

OBJECTIVES OF BNB
 Serve as mechanism for the DOH to establish partnership with LGU and CO
 Increase the involvement of the BHW to the community
 Rationalize the distribution of common drugs and medicines to indigents

LIST OF OTC DRUGS IN BNB

 ANALGESICS
 ANTACIDS
 ANTIHELMINTICS
 ANTIHISTAMINIC
 NSAID’ s
 ANTIVERTIGO
 ANTICOUGH- lagundi only
 DIURETIC- sambong only
 ANTITUSSIVE
 NASAL DECONGESTANT
 ANTIMOTILITY
 ORS
 LAXATIVE
 ANTI-SCABIES
 ANTI ANEMIC
 ANTIFUNGAL
 VITAMINS AND MINERALS
 ANTI-INFECTIVES- amox and cotri only
 TOPICAL NASAL DECONGESTANT
 DISINFECTANTS
 Med. For CHRONIC DISEASES like:
Metformin, Glibenclamide,
Metoprolol, Captopril
Salbutamol

Nine Warning Signs of Cancer: “CAUTION US”

C- hange in blood bowel or bladder habits

A -sore that does not heal
U- nusual bleeding or discharge
T –hickening or lump in breast
I- ndigestion or difficulty in swallowing
O-bvious change in wart or mole
N- aging cough or hoarseness

U- nexplained anemia
S- udden weight loss

LIFE IS WHAT WE MAKE IT!

ONLY those who have truly sacrificed can reach the unreachable and can find God’ s blessings.
May you be blessed a thousand fold and be a blessing to the least of our brethren.

 GOOD LUCK AND GOD BLESS 

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