PHC aND

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Review COPAR, TB, contraceptives category, EPI
Dengue and IMCI
Aqua privies is level 1
Breast self exam is a secondary level of prevention

Cretinism is iodine deficiency

Iron must be with vit. C
Calcium is with vit D
IRON is in chicken liver and MONGO
brown vials of vaccines protects against sunlight to maintain potency
Thick creamy cheese substance - candidiasis
*Breastmilk stool-mashy, , golden yellow
*lactalbumin- breastmilk

*Content of colustrum
- antibody IgA
*Tetanus neonaturum
-
cord care mgt - alcohol
-hand hygiene - to break chain of infection

*Dosages of immunization- opv , dpt, hep.b- 3 doses

Dosages- 0.5 ml IM( DPT,HEP.�
0.5 ml SQ(Measles)
0.05 ml ID(BCG)
2 DROPS ORAL ( ROTA & OPV)
4 months or a 17 months baby completed the doses of 1 bcg dpt1-3 opv1-3 hepb1-3

*Crude birthrate- TOTAL LIVEBIRTHS ÷TOTAL POPULATION x 1000

*Crude death rate - Total deaths ÷total population x1000

*Chain of infection- handwashing

Weakest link- mode of transmission
*
Benedict's and acid test
Roll over test- Sims or sidelying
Severe abdominal pain - 90 degree angle or Fowler's
Feeding in bed - 90 degree or fowlers
2nd degree burn - painful and blister
Syphilis bacteria is in the painless ulcers or sores
PHC- C,D madami then A

Review:
*Iron
- chicken liver, monggo
*Vit A
- squash, papaya, yellow camote, yellow corn, banana
*Cretinism or mental retardation / Iodine
*
TB
- intensive phase category 1&2
*COPAR
- courtesy call at pre entry, immersion or integration at entry,
IFR* individual funding request.
*IMCI/ danger signs
- CUVA

Stridor/chest indrawing - severe pneumonia

Fast breathing (0-2 mos= 60cpm ,, 2-12 mos = 50 ,, 12-5 years old = 40 ** pneumonia

Pneumonia first line antibiotics - amoxicillin

Cholera- vibruo eltor and cholerae in rainy season

Dirty water
Salmonellosis sa canned goods Or spoiled proteins
HIV attacks CD4 T helper cells in immune system

Measles* cough, runny nose, conjunctivitis and rashes

Koplik spots also
Measles- Sq At 9 mos
Airborne ang measles

*Post partum management/

*foul lochial discharge- puerperal sepsis or ensometriosis

*Cold chain
- system to maintain potency of vaccine
*Colustrum
*Storage of breastmilk
-4-6hours if room temperature
*Prolactin - hormone that produces milk
*Prenatal visit- at least 4 visits
36 weeks to term is everyweek
Home based mothers record
- panel 1- maternal obstetrical history and info
Panel 2- present pregnancy, danger signs, TT, FESO4, LAB RESULTS
PANEL 3 - ACTION MADE ON REFERRAL
PANEL 4 - POSTPARTUM CARES
*BSE- 7 DAYS AFTER MENSTRUATION

Gonorrhea
- BACTERIA- PRODUCES STERILITY ,
*Choalasma-melanin MSH
CONTRACEPTIVE METHODS MEDICAL ELIGIBILITY CRITERIA

CATEGORY1 - NO RESTRICTION....NO CONDITION WHICH CONTRADICTS THE USE OF THE

METHOD... IN SHORT THE PATIENT CAN USE ANY METHOD

CATEGORY 2 - THE ADVANTAGE IS GREATER THAN THE RISK WHEN THE MOTHER USED THE
METHOD... PWEDE PARING GAMITIN ANG ISANG METHOD KASI MASMAGANDA ANG BENEFIT NA
MAKUKUHA NI MOTHER KESA SA RISK

CATEGORY 3 - DI NA PWEDE NA GAMITIN NI MOTHER ANG METHOD MALIBANNA.LANG IF MAY

ALTERNATIVE METHOD.... IN SHORT ... METHOD NOT TO BE USED BECAUSE THE USE OF THE
METHOD .. THE RISK WILL NOW OUTWEIGH THE ADVANTAGE... OR THE RISK ORDIS ADVANTAGE
IS GREATER THAN THE ADVANTAGE OR BENEFIT OF THE METHOD

CATEGORY 4--- NO NEVER USE THE METHOD BECAUSE ACONDITION IS PRESENT THAT
CONTRADICTS THE USE OF THE METHOD... IN SHORT MAY SAKIT SI MOTHER NA PWEDENG KONTRA
SA METHOD NA MAPIPILI NYA... EXAMPLE MAG IUD SANA SYA KASO MAY PELVIC INFLAMMATORY
DISEASE SYA KAYA BAWAL NA OR BAWAL NA ANG IUD KASI MAY ECTOPIC SYA DATI...OR
PWEDENG MAY SAKIT SA PUSO NA NAGBABAWAL SA PILLS USE NAMAN
Mothers with risk factor is as frequent as necessary
IMCI - Integrated Management of Childhood Illness
 to reduce the infant mortality rate by two thirds by 2015.
General Danger Signs:
 Convulsion
 Unable to eat or unable to breastfed
 Vomits everything persistently
 Abnormally sleepy or difficult to awaken

GREEN - (Home management)

YELLOW - (Treatment at outpatient health facility)
PINK - (URGENT REFERRAL)

NO PNEUMONIA : COUGH OR COLD

 No fast breathing no stridor and no chest indrawing but with cough and colds

Soothe the Throat, Relieve the Cough with a Safe Remedy

 Kalamansi Sampalok Luya & breastfed infant.
 Increase fluid intake.

PNEUMONIA
presence of Cough and Fast breathing
Remember:
◦ 0 to 2 months fast breathing if you count 60 breaths per minute or more
◦ 2 months up to 12 months fast breathing if you count 50 breaths per minute or
more
◦ 12 months up to 5 years fast breathing if you count 40 breaths per minute or
more.
 Give an appropriate antibiotic amoxicillin for 5 days
 Give paracetamol for fever > 38.5oC for every 5-6hours

SEVERE PNEUMONIA
 Any general danger sign or
 Chest indrawing or Stridor in a calm child
 Give first dose of an appropriate antibiotic
 Give Vitamin A
 Treat the child to prevent low blood sugar
 Refer urgently to the hospital
 Give paracetamol for fever > 38.5oC
Green:
NO DEHYDRATION
 Not enough signs
 Home Care
 Give fluid and food to treat diarrhea at home ( Plan A )
 Give fluid, zinc supplements, and food
ORS solution, food-based fluids (such as soup, rice water, and yoghurt drinks), or
clean water.

Yellow: SOME DEHYDRATION

Two of the signs:
 Restless, irritable
 Sunken eyes
 Drinks eagerly, thirsty
 Skin pinch goes back slowly

 (Plan �- giving frequent sips of ORS every 4 hours

 Advise the mother to continue breastfeeding
 If the child vomits, wait 10 minutes. Then continue, but more slowly.
 ORS over 4-hour period
approximate amount of ORS required (in ml) can also be calculated by multiplying
the child's weight (in kg) x 75

Pink: SEVERE DEHYDRATION

Two of the following signs:
 Lethargic or unconscious
 Sunken eyes
 Not able to drink or drinking poorly
 Skin pinch goes back very slowly
If child has no other severe classification:
 Give fluid for severe dehydration (Plan C)
 Refer URGENTLY to hospital with mother
 giving frequent sips of ORS on the way
 Advise the mother to continue breastfeeding
 give antibiotic for cholera - tetracycline

Yellow: DYSENTERY
 Blood in the stool or bloody diarrhea
 FOR DYSENTERY give FIRST-LINE ANTIBIOTIC: Oral Ciprofloxacin 3 days
 IMCI fever?
feels hot or temperature 37.5°C* or above or high fever (38.5°C or above)- - -*Give
one dose of paracetamol in clinic for high fever (38.5°C or above)
Pink: MASTOIDITIS
 Tender swelling behind the ear.
Mgt
 Give first dose of an appropriate antibiotic
 Give first dose of paracetamol for pain
(COPAR) - Community Organizing Participatory Action Research
Pre-entry /Preparatory Phase
 Profiling of community
 Site selection
 Preliminary social investigation (PSI)
 Ocular survey
 PAy courtesy call to community leaders.

Entry Phase
Integration with the community
 Self Awareness Leadership T raining
 Organization phase
 core group formation
social preparation
spotting & developing potential leaders
 A-R-A-S (Action- Reflection- Action-Session)
 community diagnosis
Action Phase
 Organization and training of (BHWs):
 PIME of health services (Project Implementation Monitoring and Evaluation)
 Setting up of linkages/ network/ referral systems

Sustenance and Strengthening Phase

 Formulation of by-laws
 Identification and development of “ secondary” leaders
 Setting up of a financing scheme
 Rates
 relationship between a vital event and those persons exposed to event
 Ratio
 relationship between two (2) numerical quantities
 Infant Mortality Rate
 good index of the general health condition of a community
 Swaroops index
 is the proportion of deaths of people aged 50 years and up.
 3 CRITERIA FOR LAM use:
 Amenorrhea
 Fully or nearly fully breast feeding her infant
 BF on demand basis (evey 2-4 hrs during the day, 4-6 hrs at night
 Infant is less than 6 mos
Gonorrhea
Male:
purulent yellow penile discharge
 Females: - Greenish vaginal discharge
Genital Human Papillomavirus
HPV
 condylomata, cauliflower-like warts
 Acetic acid swabbing (will whiten lesion)
 Condylomata acuminata
Hepatitis B
 Spread through infected blood and bodily fluids such as semen
HIV – AIDS
 Retrovirus (HIV1 & HIV2)
 Attacks and kills CD4+ lymphocytes (T-helper)
 MOT:
 Sexual intercourse ( vaginal and anal)
Exposure to contaminated blood, semen, breast milk
 Needlestick injuries
 HIGH RISK GROUP
 Homosexual or bisexual
 Sexual contact with HIV+
 Intravenous drug users
 HIV TEST
 Elisa – Enzyme Link Immunosorbent Assay ( first test conducted)
 Western Blot - confirmatory
 HIV+
2 consecutive positive ELISA and
1 positive Western Blot Test
 Full blown AIDS
CD4 is less than 200/ml
Pelvic Inflammatory Disease
 Chronic pelvic pain, fever, flu-like symptoms, pain during or after
intercourse(CBQ), vaginal bleeding, foul smelling discharge, tenderness in lower
abdomen, and chills
 Can cause ectopic pregnancies, infertility and abscesses in the pelvis. Can be
life threatening - very serious.
8. Candidacies
 Yeast infection
 With white cheesy patches (moniliasis)(CBQ)
 Oral trush in the newborn (CBQ)
Medications:
 Nystatin
Trichomoniasis
strawberry cervix
frothy, foul-smelling ("fishy" smell
) vaginal discharge
 Trichomona vaginalis, single cell protozoan
S/sx: Females: Yellow gray frothy
discharge
Dx:
- elevated vaginal pH 5.5+ ( alkaline
Mgmt: Metronidazole (Flagyl);
Bacterial vaginosis
foul, fishy smelling, thin gray vaginal discharge
 presence of CLUE CELLS (CBQ)
LOI 949 - legal basis of PHC
Goal of PHC:
 Health for ALL Filipinos and Health in the Hands of the People by the Year 2020
Mission of PHC:
 SELF RELIANCE
 PHC
is universal and it extends even to people in the hospital, both sick and well.
-Accessible
-Available
-Affordable
-Acceptable
-Appropriatene

Four Cornerstones/Pillars in Primary Health Care

 Intra and Inter-sectoral Linkages
 Use of Appropriate Technology
 Support mechanism made available Department of Health (DOH)
 Active Community Participation
Levels of Primary Health Care Workers
Primary level- Villagers/Grassroots
BHW
Traditional birth attendants
Arbularyo or healers.

Secondary- Intermediate
Public Health Nurse
Rural Sanitary Inspector
Midwives.
 Health deficits- TB, DM, hydrocephalus, polio,leprosy
 Health Threats – lack of immunization, no or lack prenatals
 Foreseeable crisis – Abortion - Divorce or separation Marriage -Entrance at
school –newborn
- Death of a member

Malaria
Causative Agent: - PLASMODIUM (protozoa) P. Falciparum (most fatal)
Vector
 Anopheles female mosquito

Signs & Symptoms:

 Chills to convulsion,
 Elevated temperature
Treatment: chloroquine

Schistosomiasis
Causative Agent: Schistosoma japonicum
Snail : oncomelania quadrasi
Signs & Symptoms: Bulging abdomen, Abdominal pain, Loose bowel movement(black
tarry), Low grade fever, Seizure
 Preventive measures
Proper excreta disposal
Agricultural & vegetation improvement
Let water stand 2-3 days before usage
Mollucides use
Educate in Hand hygiene
Rubber boots use
 Treatment:
 Praziquantel (drug of choice)

Expanded Program for Immunization (EPI)

Wednesday - immunization day
 FULLY IMMUNIZED CHILD
 before the child's first birthday.
 fully immunized child must have completed
 BCG 1
 DPT 3
 OPV 3
 HB 3
 measles vaccines
Bacillus Calmette-Guérin - Birth or anytime after birth

 Diphtheria-Pertussis-Tetanus Vaccine
6 weeks(DPT 1)
10 weeks (DPT 2)
14 weeks (DPT 3)
 Oral Polio Vaccine – SABIN -
 6 weeks(OPV 1)
 10 weeks (OPV2)
 14 weeks (OPV3)

OPV- Number of doses per vial/amp: 20

HEPA B , Measles & BCG

Number of doses per vial/amp: 10

Dosages of immunization- opv , dpt, hep.b- 3 doses

Dosages- 0.5 ml IM( DPT,HEP.�
0.5 ml SQ(Measles)
0.05 ml ID(BCG)
2 DROPS ORAL ( ROTA & OPV)

*Crude birthrate- TOTAL LIVEBIRTHS ÷TOTAL POPULATION x 1000

*Crude death rate - Total deaths ÷total population x1000

*Chain of infection- handwashing

Weakest link- mode of transmission
*
Benedict's and acid test
VIT.D- RICKETS
CRETINISM
RABIES - lyssa - head bites is most dangerous
BREASTFEEDING

COPAR...
ORGANIZATIONAL PHASE

HERBAL MEDS. BAWANG. LAGUNDI. NIYOG NIYOGAN

LEVEL 2 WATER FACILITY

SPORADIC
HBMR
OPV-- SABIN VACCINE

ORESOL EVERY 4 HOURS

PLAN C -- insertion IVF

COURTESY CALL-- PRE ENTRY PHASE

HEALTH DEFICIT - HYDROCEPHALUS

Keeps the Philippines polio-free IN YR 2000

 Hepatitis B Vaccine - At birth – RNA RECUMBINANT, PLASMA
Upper outer portion of the thigh, Vastus Lateralis (R-L-R)
 Measles Vaccine - 9 months old – SQ - Upper outer portion of the arms, Right
deltoid
85% of measles can be prevented by immunization at 9 MOS.
 VVM or Vaccine vial monitor
 - a thermochromic label put on vials which gives a visual indication of vaccine
potency
Cold Chain
 is a system used to maintain potency of a vaccine from that of manufacture to the
time it is given to child or pregnant woman.
 Timeframes for the storage of vaccines
◦ 6months- Regional Level
◦ Not more than 5days - Health centers using transport boxes.
Half life packs:
4hours -BCG, DPT, Polio,
8 hours -measles, TT, Hepa B.
 “Eligible population”
- group of people targeted for specific immunizations susceptible to EPI diseases.”
 Rotavirus vaccine
 protects a child from diarrheal diseases caused by rotavirus.
Rotavirus vaccine- 6 WEEKS – ORAL
-GIVEN BEFORE 8 MOS 2 DOSES
PENTA – 6 WEEKS – IM
MMR- 12 MOS-SQ
Maternal and child health
 Home Based Mother’s Record (HBMR)
Tool used when rendering prenatal care containing risk factors and danger signs
- guide in the identification of risk factors
 Fe supplementation: 60 mg with 400 mcg of Folic Acid
Postpartum visit- Home deliveries
- 1st visit - 24 hours after delivery
 Health care facility
1st- within 1 week
 3 C of Delivery
CLEAN Hands
CLEAN Surface
CLEAN Cord

 Vitamin A Supplement to Infants, Preschoolers (6mos – 7 yeas and Mothers

 Pregnant women
 10, 000 IU 2x a week starting on the 4th month of pregnancy
 Do not give vit. A supplementation before the 4th month of pregnancy. It might
congenital problems in the baby.
 Postpartum women - 200, 000 IU - 1 cap; 1 dose only within 4 weeks after delivery
 Viamin A Deficiency (CBQ) - XEropthalmia – night blindness

Water Supply
Level 1 (Point Source) - protected well or developed spring
 Level II - With a source, reservoir, piped distribution network and communal
faucets
 Level III
 Individual House Connections or Waterworks System
 With a source, reservoir, piped distributor network and household taps
 Level I - pit latrines , pour flush toilet & aqua privies
 Level II - with septic vault/tank disposal - water-sealed and flush type
 Level III - connected to septic tanks and/or to sewerage system to treatment
plant.
Bag technique
-a tool making use of public health bag
 Public health bag - is an essential and indispensable equipment of the public
health nurse
Removed BP Cuff inside bag
Home visit
 is a family-midwife contact which allows the health worker to assess the home and
family situations in order to provide the necessary nursing care and health related
activities
cleanest to dirtiest dapat
priority sunod sunod na to – pregnant – newborn – postpartum – last ang may mga
sakit
Epidemiology - the study of disease occurrence and distribution

Infection- entry and development or multiplication of an infectious agent in the

body of man or animals.

Contamination- presence of an infectious agent on a body surface, on or in clothes,

beddings, toys, surgical instruments or dressings, or other articles or substances
including water and food

4 types of disease distribution

1. Epidemic- “The unusual occurrence in a community of disease- sudden outbreak of

a disease
2. Endemic- constant presence of a disease or infectious agent within a given
geographic area or population group.
3. Pandemic- worlwide distribution….geographic area such as a section of a nation,
the entire nation, a continent or the world
4. Sporadic- “scattered about”. The cases occur irregularly, The cases are few and
separated widely in time and place
- On and off scattered cases –habitual occurence

Nosocomial (hospital acquired)

- urinary tract infections.

Carriers- “an infected person or animal that harbors a specific infectious agent in
the absence of discernible (visible) clinical disease and serves as a potential
source of infection to others.

Leptospirosis
Causative Agent: Leptospira interrogans

Sign/Symptoms: High fever, Chills, Vomiting, Red/ orange eyes, Diarrhea, Severe
headache, muscle aches, may include jaundice (yellow skin and eyes), abdominal pain
Treatment: PET - Penicillins G, Erythromycin, Tetracycline, Doxycycline as
prophylactic drug

Dengue - mosquito-borne infection

- female aedes aegypti in stagnant water
treatment is supportive therapy.
 Intravenous fluids
 A platelet transfusion

DENGUE DIAGNOSIS:
- Tourniquet test (capillary fragility test or Rumpel Leads Test), a presumptive
test which is positive in the presence of more than 20 petechiae within an inch
square, after 5 minutes of test

TOURNIQUET TEST - (BP Cuff):

o fluids (most important treatment) like oresol and IV
o paracetamol ( do not give aspirin)
o for nose bleeding, flex the neck lean forward to prevent aspiration
o avoid unnecessary movement
o assist in the management of shock. Dorsal recumbent to trendelenburg position

Communicable Diseases (Chronic)

Tuberculosis / PTB- a highly infectious chronic disease that usually affects the
lungs.
Causative Agent: Mycobacterium Tuberculosis

Sign/Symptoms:
 cough
 afternoon fever
 weight loss
 night sweat
 blood stain sputum - hemoptysis - ***sign
Preventing Tuberculosis
 BCG vaccination
Case finding – direct Sputum Microscopy and X-ray examination of TB symptomatics
who are negative after 2 or more sputum exams
Direct observation of treatmen : assign and supervise a treatment partner for
patients who will undergo DOTS.

PULMONARY TUBERCULOSIS DIAGNOSIS:

Sputum smear and culture- confirms the diagnosis
Tuberculin test (Mantoux test- detects the presence of antibodies
(Results read within 48-72 hours from skin testing, posistive if within duration of
10mm or more.
Below 5 y/o - > or = 10 mm is positive,
Older than 5 y/o > or = to 5 mm is positive)

Mantoux test- A positive reaction means that the client has been
exposed to TB
A positive reaction consists of palpable swelling and induration of
 10mm and above for normal
 5mm and above for immunocompromised.
It can be read
 48 to 72 hours after the injection.

Chest x-ray - determines the presence and extent of disease

the primary diagnostic tool in TB case finding is DSSM

.
 The only contraindication for sputum collection is hemoptysis
 Treatment – shall be given free and on an ambulatory basis, except those with
acute complications and emergencies
 Direct Observed Treatment Short Course – comprehensive strategy to detect and
cure TB patients.
DOTS (Direct Observed Treatment Short Course)

Class 0 Class I Class II Class III Class IV Class V

No exposure TB exposure TB infection TB disease TB inactive Suspected disease
Not infected (+) exposure; (-) signs and symptoms; (-) x-ray (+/-) exposure; (+)
tuberculin test;(-) signs and symptoms; (-) x-ray (+)history; (+) tuberculin test;
(+) signs and symptoms; (+) sputum (+) x-ray (+/-) previous chemotherapy; (+) x-ray
of healed TB; (+) tuberculin test;
(-) signs and symptoms; (-) smear Diagnosis pending

Category Type of TB patient Intensive phase Continuation phase

I
6 months
treatment -new smear (+) PTB
-new smear (-) PTB with extensive lesions on CXR
-EPTB
-Severe concominant HIV disease 2 RIPE 4 RI
II -treatment failure
-relapse
-return after default
-other 2 RIPES/1 RIPE 5 RIE
III -new smear (-) PTB with minimal lesion on CXR 2 RIPE 4 RI
IV -chronic Refer to specialized facility or DOTS Plus Center
Refer to Provincial/City NTP Coordinator

Isoniazid (INH) Rifampicin Pyrazinamide (PZA) Ethambutol Streptomycin

-hepatic enzyme elevation, peripheral neuropathy
(completes with vitamin b6 absoption)
-take before meals
-10-50 mg pyridoxine as prohpylaxis, 50-100 mg as treatment -orange discoloration
of secretion and urine
-Best taken on empty stomach but causes gastric irritation hence should be taken
with food (also at bedtime)
-protect drug from light -rapidly bacteriostatic and slowly bactericidal
-hepatotoxic, ototoxic, nephrotoxic, GI upset
-may lead to hyperurecemia; arthralgia (shoulder)
-protect drug from light -lead to optic neuritis. skin rash
-not given to children under 6 years or younger because they cannot reliably
monitor vision -renal impairment, tinnitus and auditory impairment

Rifampicin causes urine discoloration.

Isoniazid causes peripheral neuropathy. – supplement Vit. B6
Pyrazinamide - causes G.I upset.
Ethambutol causes- optic neuritis.
Streptomycin causes- tinnitus and auditory impairment/ OTOTOXICITY.

Leprosy
RA 4073- Liberization and Treatment of Leprosy (February as Leprosy Month)
• Hansen's disease
• , an aerobic, acid fast, rod-shaped mycobacterium
• Gerhard Armauer Hansen

Management:
• Multi-Drug-Therapy (MDT)
• Dapsone, Lamprene clofazimine and rifampin
• All patients who have complied w/ MDT are considered cured
• LEPROMATOUS TYPE is the most disfiguring type of LEPROSY
Helminths - most common is ascariasis
1. Beef tapeworm - Taenia saginata
- ingestion of undercooked beef

Paragonimiasis, Lung Fluke

Lungs is affected
- ingestion of raw or undercooked freshwater crabs crayfishes or other crustaceans
-
2. Ancylostomiasis/Hookworm – causes anemia
- common in tropical, warm, moist climates
penetration of skin - walking barefooted

3. Roundworm -Baylisascariasis
- Baylisascaris procyonis
- stool from raccoons
4. Pinworms/ enterobiasis
- small, thin worms that commonly infect young children, although anyone can be
infected.
- best way to diagnose this infection is through a tape test.

Hepatitis Types
Hepatitis A or Infectious Hepatitis: oral-fecal route
2 – Hepatitis B or Serum Hepatitis: blood-borne, oral-oral
3 – Hepatitis C or Non-A, non-B Hepatitis: blood-borne
4 – Hepatitis D: follows Hep B, blood-borne
Management and Control measures for PSP (Red tide poisoning)
NO definite medication indicated
Induce vomiting
(Source DOH book pp 287)
Drinking pure coconut milk weakens the toxic effect of red tide sodium bicarbonate
solution (25 grams in ½ glass of water may be taken).
Rabies/ Lysa Mgt.
 observe the dog for 14 days. If it dies or shows signs suggestive of rabies,
consult a physician.
Rabies - hydrophobia, a morbid fear of water
CATEGORIZATION OF ANIMAL BITE
CATEGORY I
 Licking of intact skin
 Observe the dog for 14 days

CATEGORY II
 Abrasion, laceration, punctured wound on the lower extremities
 Give active vaccine
- Observe dog for 14 days

CATEGORY III
 Abrasion, laceration on upper extremities, head and neck.
 Dog is killed, lost died, stray
 Give active vaccine plus Passive vaccine
ACTIVE IMMUNIZATION –
PCEC (Purified Chick Embryo Vaccine), RABIPUR and the new cheap drug VEROWELL
-
Viral Infection
Varicella (Chicken Pox)
- Varicella Virus
Communicable 1 day before eruption of vesicles to 6 days after first crop of
vesicles have formed
• Antiviral agents – acyclovir
Fifth’s Disease

Symptoms
 Classic rash of erythema on face (cheeks), “slapped face appearance”

Rubeola (measles)
• Viral infection
• RNA virus of the genus Morbillivirus within the family Paramyxoviridae
• Transmitted by respiratory secretions, blood and urine of infected person
Communicable just before the rash appears
1. Pre-Eruptive Stage:
• fever, coughing, sneezing, and running of nose and redness of eyes.
• Koplik spots—bluish-gray specks or “grains of sand” on a red base—develop on the
buccal mucosa

Mumps - PAROTITIS
• Viral infection
• Transmitted by direct contact of saliva and respiratory droplet
• Communicable immediately before swelling begins

Rubella
(German measles)
• Viral Infection
• Communicable 7 days before to 5 days after rash
**Pregnant people must avoid infected child=fetal death

Pertussis (whooping cough)

• Bacterial infection

Middle East respiratory syndrome coronavirus (MERS-CoV)

• a viral respiratory disease caused by a novel coronavirus (MERS‐CoV) that was
first identified in Saudi Arabia in 2012.
Source of the virus
• MERS-CoV is a zoonotic virus
- originated in bats and was transmitted to camels sometime in the distant past.
• camels - major reservoir host for MERS-CoV and an animal source of MERS infection
in humans.

The main symptoms of MERS

 cough, shortness of breath and difficulty breathing
 diarrhea
 high fever (over 38°C or 100.4°F)

Prevention and treatment

• No vaccine or specific treatment is currently available.
• Treatment is supportive and based on the patient’s clinical condition.
• avoid contact with camels, drinking raw camel milk or camel urine, or eating meat
that has not been properly cooked.
• Wash your hands often with soap and water for 20 seconds, and help young children
do the same. If soap and water are not available, use an alcohol-based hand
sanitizer.
• Cover your nose and mouth with a tissue when you cough or sneeze, then throw the
tissue in the trash.
• Avoid touching your eyes, nose and mouth with unwashed hands.
• Avoid personal contact, such as kissing, or sharing cups or eating utensils, with
sick people.
• Clean and disinfect frequently touched surfaces and objects, such as doorknobs.

Ebola virus disease

• FROM FRUIT BATS OR BUSHMEATS

WHERE EBOLA OCCURS

• Ebola was discovered in 1976 near the Ebola River in the in Africa.
• Ebola can ONLY spread between humans by direct contact with infected body fluids
including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and
semen.

Immunizable bacterial disease

Diphtheria
• Diphtheria is an acute infection caused by
• bacteria Corynebacterium diphtheriae.

transmission
• Respiratory droplets (such as from a cough or sneeze).
• bacteria most commonly infects your nose and throat.
• The throat infection MOUSY PSEUDOMEMBRANE causes a gray to black, tough, fiber-
like covering, which can block your airways

Zika virus
Key facts
• Zika virus disease is caused by a virus transmitted by Aedes mosquitoes.
• People with Zika virus disease usually have symptoms that can include mild fever,
skin rashes, conjunctivitis, muscle and joint pain, malaise or headache. These
symptoms normally last for 2-7 days.
Brazil
Transmission
Zika virus is transmitted to people through the bite of an infected mosquito mainly
Aedes aegypti
Zika virus RNA in the blood or other body fluids, such as urine or saliv, semen and
blood.
must support the efforts of the local government to reduce the density of
mosquitoes in their locality.

PGD – ---------------------------

MISFEASANCE – IMPROPER PERFORMANCE OF A LAWFUL ACT

• conspiracy - two or more person agreed and committed the felony commission of a
crime
• 1. Principal – the doer, mastermind

ð by direct participation
ð by inducement (order, command, influence, convince, persuade)
ð by indispensable cooperation
• 2. Accomplice - accessory before the fact
• 3. Accessory - accessory after the fact
ð profiting themselves or assisting others to profit
ð concealing, destroying body of the crime, effects, instruments to prevent its
discovery
ð harboring concealing, assisting the escape of the principal
Justifying Circumstances - free from criminal and civil liability

• J Self - defense
1. Unlawful aggression
2. Reasonable necessity of the means employed prevent/repel it
3. Lack of sufficient provocation on the person defending himself
• J Defense of relatives - up to 4th degree by consanguinity; that in the case of
provocation was given by the attacked, that the one making defense had no part
therein
• J Defense of a stranger - defending not induced by resentment, revenge or other
evil motive
• J Who acts in fulfillment of a duty or in a lawful exercise of a right or office

J Who acts in obedience to an order by a superior for some lawful purpose

• Exempting Circumstances - no criminal liability only civil liability
• No crime at all, exempted from criminal liability
• 1. Imbecile or insane person, unless he acted with lucid interval
• 2. The person is under 9 years of age
• 3. Over 9 years but under 15 years unless he/she acted with discernment (know the
own consequences)
• 4. When it is mere accident (force majoure)
• 5. When the person acted under the impulse of an uncontrolled fear
• 6. When the person acted under the compulsion of an irrestible force e.g. in
school – loco parenti (parental authority and custody transfer in teacher)
3. Mitigating Circumstances
- lessens the liability
• 1. Under 18 or over 70
2. No intention to commit so grave a wrong
3. Sufficient provocation or threat on the part of the offended party immediately
preceded the act
4. Voluntary surrender
5. Deaf, dumb or blind or suffering from physical defect
6. Such illness that would diminish the exercise of his will power
• 7. Committed in the immediate vindication of a grave offense to the one
committing the felony, his/her spouse, ascendants, descendants, legitimate, natural
or adopted brothers or sisters, relative by affinity within the same degree
• 8. Acted upon an impulse so powerful as naturally to have produced an obfuscation
• 4. Aggravating Circumstances
- increases liability
• Committed with plan, 1° higher
•
• 1. When one takes advantage of public position
• 2. When there is an abused of confidence
• 3. When the crime is committed inside the Church
• 4. When the crime is committed on the occasion of fire, shipwreck, epidemic/
other calamity
• 5. When it is committed because of a price reward
• 6. When it is committed in times of natural calamities
• 7. When it is committed with evident premeditation
• 8. When it is committed with craft, fraud and disguise
• * One’s you commit in confidence to your patient
• 5. Alternating (either mitigating or aggravating)
• 1. Relationship, intoxication, degree of education

2. Education is not mitigating in rape, forcible abduction, arson, treason,

seduction, acts of lasciviousness, heinous crimes

• Profession:
• A calling by which members profess to have special knowledge by training, by
experience
• Act No. 310. - practice of midwifery was first regulated
.
• RA 2644 - The first law enacted considering Midwifery as an INDEPENDENT &
AUTONOMOUS Profession
• Republic Act No. 7392

- An Act Revising Republic Act No. 2644, As Amended, Otherwise Known as the
Philippine Midwifery Act of 1992
Approved: April 10, 1992

Lifam Yoj
BOM Chairman: ALEJANDRO R. SAN PEDRO
DOH Secretary:- Present to old
Paulyn ubial
Janette garin
Dr. Enrique T. Ona
Esperenza cabral
Francisco duque
Manuel dayrit
Rumualdez

Dr. Florentino C. Doble as new PRC Chairman

• Dr. Jose F. Fabella, who later became the known as the “Father of Midwifery” in
the country
• Dr. Fabella opened the FIRST School of Midwifery of Dr. Jose Fabella Memorial
Hospital in 1922 in Manila
• Dr. Ricardo Gonzales –Father of Modern Midwifery
(CBQ)
• MoseS- father of Sanitation
• IMAP first president Ms. Juana Reyes
• New IMAP President
• Ms. Corazon L. Paras----3 years term
• Integrated Midwives Association of the Philippines (IMAP)
• -national organization of the registered midwives 1.Active– are graduate
registered midwives with a right to vote and participate.
• 2.Affiliate – are members of a graduating class, but with no voting privilege.
• 3.Associate
– a registered nurse, a registered midwife and/or graduated a 4-year course degree
but has no right to vote.
• Ms. Cecilia Banca-Santos -- was the founder & the PRESIDENT of the Philippine
League of Government Midwives
• PLGPMI was launched through the General Assembly of Midwives in April 1999.
• PRC - The office who has the custody of records of administrative cases and
investigations All records, including examination papers, examinations results
minutes of deliberation, records of administrative cases and investigations of the
Board shall be kept by the Commission.
• Architect Yolanda D. Reyes as new PRC Commissioner appointed by the President
• for a term of seven (7) years without reappointment
• Professional Regulation Commission was first created as a national government
agency by
• .
• PRC was placed under the Office of the President
• Quasi-Judicial - Investigates cases against erring examinees and professionals.
• Quasi-Legislative- Formulates rules and policies on professional regulation.
• Executive- Administer, implements, and enforces the regulatory policies Republic
Act 8981, otherwise known as the "PRC Modernization Act Of 2000
• Note: that PRC fix the time and place of examination
•
• Note: DECS or CHED has the power to close Midwifery schools
• Qualification of Board Members
1. Be a citizen and resident of the Philippines;
2. Be of good moral character;
3 thirty (30) years of age; and
4. Not be a member of the faculty
• The Chairman - 1. Be a registered obstetrician
2. Have at least ten (10) years practice
• Three (3) members of the Board shall at the time of their appointment:
1. Be registered midwives;
2. Be degree holders, preferably in the field of health and social sciences; and
3. Have at least ten (10) years practice
• One (1) member:

1. Be a registered nurse -midwife; and

2. Have at least ten (10) years practice as a nurse -midwife.
• NOTE: misdemeanor (P10,000.00) - (P30,000.00)
• Ad interim system - appointed to fill a position that is temporarily open
(vacancy),
•
• Merit system appointment - Based on performance and qualifications

Powers of the board

Quasi- legislative power –promulgates laws, rules and regulations
Quasi- judicial power –conducting a hearing or investigations in violations of
Midwifery act
•

Term of office – the time that an officer may claim to hold the office
- 3years and 1 reappointment
• Scope of Examination(a) Infant care and feeding – LEAST
(d) Obstetrics – Core of Midwifery
• integrated with the above subjects:
Sociology
Bacteriology
Anatomy and Physiology
Psychology
Nutrition
Parasitology
Microbiology
Pharmacology
• Prerequisite and Qualifications of Applicants for Examination:
• Ratings in the Board Examination.-
candidate must obtain a general rating of seventy five percent (75%) in the written
test

with no grade lower than fifty percent (50%) in any subject.

Registration of Nurse -Midwife - having actually handled twenty (20) delivery cases
and passing the midwifery exam
• Reciprocity - agreement between 2 countries with the same matter
Practice of Midwifery
Traditional Function of the Midwife
Gives supervision care and advice to women during pregnancy, labor and post-partum
period.
• 1. supervision and care of women during pregnancy, labor and puerperium
2. management of normal deliveries,
3. performance internal examination during labor except when patient is with
antenatal bleeding;
4. health education of the patient, family and community;
• 5. primary health care services in the community,
6. nutrition and family planning,
7. carrying out the written order of physicians with regard to antenatal, intra-
natal and post-natal care of the normal pregnant mother,
• Expanded Function of the Midwifes
• Oral and parenteral dispensing of oxytocic drugs after delivery of the placenta
• Suturing perineal lacerations to control bleeding
• Giving of intravenous fluids during obstetrical emergencies
• Injecting of vitamin K. to the Newborn
• Replacement of Lost Certificate.- provide affidavit of loss
• license validity - 3 years
passport validity - 5 years
• NSO birth certificate – is the most important document in securing passport given
by the DFA
• Visa – is given by the foreign embassy
• Ethics
– rules, principles that guide nursing decisions or conduct in terms of the
rightness or wrongness of that decisions or actions.
Serves the purpose of governing conduct to ensure the protection of individual’s
rights.
Ethics – part of philosophy that deals with systematic approaches to questions of
morality.
• A term for the study of how we make judgments regarding right and wrong.
• A system of MORAL PRINCIPLES or moral standards governing conduct.
• Totality – The whole is greater than its parts (HOLISM)
Epikia – There is always an exemption to the rule
• 1. Autonomy—respect ,support of independent decision making.
• 2. Beneficence- compassion; taking positive action to help others; desire to do
good
• 3. Nonmaleficence- avoidance of harm or hurt
• 4. Fidelity- loyalty, fairness, truthfulness- agreement to keep our promises.
- concept of keeping a commitment.
• 5. Justice- refers to an equal and fair
6. Paternalism
– giving care like a good father/mother of a family

• a. Deontology- relationship between duty and the morality of human actions

• b. Utilitarianism- what is best for most people, the belief that a morally good
action is one that helps the greatest number of people

• 7. Veracity - Honesty; credibility; truthfulness

•
8. Temperance - moderation or self-restraint in action, practice of always
controlling your actions, thoughts, or feelings
self-control.
•
9. Tact - saying the right thing at the right time.
Tact is the act of using gentle language and behaving in a sensitive manner when
dealing with potentially controversial issues.
• 12. OPTIMISM – viewing into the bright side of life – POSITIVISM

13. PESSIMISTIC - viewing into the negative side of life –NEGATIVISM

•
Two-fold effect
– an act is foreseen to have both good and bad effects
• double effect
bioethical principle is involved when the midwife is faced with problem of whom to
save the mother or baby
•
Logic
• Using awareness of correct decision in performing midwifery procedures to avoid
complaints
•
•
Confidentiality
– observing the seal of secrecy
a. Privileged communication
b. Invasion of privacy

• Confidentiality - is also known as PRIVILEGED COMMUNICATION

• the patient agrees to divulge such information with written consent
• the information is material in a criminal case investigation
• if public safety is jeopardized (communicable disease)
• such information is relevant to his care to be utilized by other health team

conscience – is a branch of science that judges the ethical nature of one's actions
and thoughts
in regard to one's behavior
a sense of right and wrong that urges one to act morally
• Negligence
commission or omission of an act, pursuant to a duty, that a reasonably person in
the same or similar circumstance would or would not do, and acting or the non-
acting of which is the proximate cause of injury to another person or his property

•
Negligence is a failure to exercise the care that a reasonably prudent person would
exercise in like circumstances.
- by carelessness, not intentional harm.

•
Specific Examples of Negligence
1. Failure to report observations to attending physicians.
• Example:
 Incorrect sponge counts
 burns: heating pads ,solutions & steam vaporizers
 failure to take & observe appropriate actions – forgetting to take vital signs to
a newly post –operative client.
 Falls: side rails left down, baby left unattended
 loss of or damage to a patient’s property
 failure or ignore to report to the superiors or client’s family
 mistaken identity, wrong medicine, dose & route
• 4. Wrong medicine, wrong concentration, wrong route, and wrong dose.
5. Defects in equipments that may result in injuring the patients.
6. Errors due to family assistance.
7. Administration of medicine without a doctor prescription.
• 2. Malpractice - “you do things beyond your scope of practice”
• Also denotes stepping beyond one’s authority with serious consequences.
• 3. Incompetence - Is the lack of ability, legal qualifications or fitness to
discharge the required duty.

-there is ground for revocation or suspension of her certificates of registration.

• Three Doctrines that Affects Liability (Negligence)
• 1. The Doctrine of Res Ipsa Loquitor
“The thing speaks for itself.”

• 2. Doctrine of Force Majeure

• It means an irresistible force, one that is unforeseen or inevitable.
• “you cannot stop it from happening”
• circumstances such as floods, fire, earthquakes and accidents fall under this
doctrine
• Doctrine of Respondeat Superior
“let the master answer for the acts of the subordinate”
*the liability is expanded to include the master as well as the employee and not a
shift of liability from the subordinate to the master
• Consent
- Is defined as a “free and rational act that presupposes knowledge of the thing
which consent is being given by a person who is legally capable to give consent.”

Assault
- An attempt or threat to touch another person unjustifiably
Example:
- A person who threatens someone with a club or closed fist.
- Midwife threatens a client with an injection after refusing to take the meds
orally.
• Battery
- Willful touching of a person, person’s clothes or something the person is
carrying that may or may not cause harm but the touching was done without
permission, without consent, is embarrassing or causes injury.
• False Imprisonment
Unjustifiable detention of a person without legal warrant to confine the person
Occurs when clients are made to wrongful believe that they cannot leave the place
• Example:
1. Telling a client no to leave the hospital until bill is paid
2. Use of physical or chemical restraints
3. False Imprisonment Forceful Restraint=Battery
• Invasion of Privacy
- intrusion into the client’s private domain
right to be left alone
•
Libel – defamation by means of print, writing or picture
Example:
o writing in the chart/midwife’s notes that doctor A is incompetent because he
didn’t respond immediately to a call
• 2. Slander – defamation by the spoken word stating unprivileged (not legally
protected) or false word by which a reputation is damaged
• 3 Branches of the Government
• 1. Executive body (OP)
2. Legislative body (Senates)
3. Judicial body (Court)
Criminal Action
• Complainant – person who file a case with a court against another, a concise
statement of the ultimate facts constituting cause of action.
• Respondent – the person against whom the case
b. Civil Action
• Plaintiff – person who file a case with PRC
• Defendant – the person against whom the case
• Witness- Individual held upon to testify in reference to a case either for the
accused or against the accuser
• Written orders of court
• Writ – legal notes from the court
• 1. Subpoena
a. Subpoena– a writ/notice to an individual/ordering him to appear in court at a
specific time and date as witness.
b. Subpoena Duces Tecum- notice given to a witness to appear in court to testify
including all important documents
•
2. Summon – notice to a defendant/accused ordering him to appear in court to answer
the complaint against him
• Due Process
- a fair investigation and hearing by a neutral body wherein parties concerned or a
person is given an opportunity to be heard
- Hears before it condemns
• 3. Warrant of Arrest - court order to arrest or detain a person
4. Search warrant - court order to search for properties.
• certiorari – order from a supreme court to an inferior court to send records in
question
• Decision – a legal judgement of the court
• Vedict- the decision of the jury
• .
• Philippine constitution
- all laws must be in harmony with,
- the supreme law of the society
•

Contracts
– meeting if the minds between two persons whereby one binds himself, with respect
to the other, to give something or to render some services
• A. Formal Contract – in written legal form eg. Marriage contract, business and
career contract, job contract
• B. Informal Contract- the parties state the terms, either orally or in writing,
at the time of its formation
• Types of Informal Contract
• 1. Expressed –when 2 parties discuss and agree orally or in writing the terms and
conditions during the creation of the contract.
• 2. Implied – one that has not been explicitly agreed to by the parties, but that
the law considers to exist. – understood contract
• Implied
- presumed or inferred from acts
ü Duo ut des
- i give that you give

• CRIMINAL CASE:
• 1. Homicide – killing of any person without criminal intent may be done as self-
defense
• 2. Murder - killing of any person with criminal intent
- unlawful killing, with malice aforethought, of another human, and generally this
premeditated state of mind
• List of types of killings:
• 1. Aborticide – (Abortion – killing of a fetus before it reaches the age of
viability)
• 2. Suicide – intentional killing of self.
• 3. Infanticide – the act of killing a child under 3 days old of its life.
• 5. Parricide – (also Parenticide) the killing of one's mother or father or other
close relative.
• **Arson – willful burning of property
• Theft VS Robbery
• Theft – act of stealing without the use of Force

Robbery - act of stealing WITH use of Force

• Adultery
is committed by any married woman who shall have sexual intercourse with a man not
her husband
– Concubinage
Any husband who shall keep a mistress in the conjugal dwelling, or shall have
sexual intercourse, under scandalous circumstances, with a woman who is not his
wife,
• Paramour - (Kabit na lalaki)
• Will- written declaration of man‟s decision to be done with possession upon his
death
• holographic- written in the hand of the testator; in many jurisdictions, the
signature and the material terms of the holographic will must be in the handwriting
of the testator
• 1. Testator – person who makes a will

2. Testatrix – a female testator

Intestate – person died without leaving a will

Decedent
- a person who died without a will but his properties were transmitted thru
succession
• 4. Probate – proving the validity of a will.
5. Escheat - transfer of title of property or an estate to the state when an
individual dies without a will and legal heirs
• 6. Heir - a person who has the legal right to receive the property of someone who
dies
• Stages of execution
• 1. Attempted – when the offender commences the commission of the same directly by
overt acts and does not perform the acts which shall produce the felony.
• 2. Frustrated – when the offender performs all the acts or execution which will
produce the felony as a consequence but producing no result.
• 3. Consummated – when all the elements necessary for its execution and
accomplishment are present
• Criminal Negligence – crime committed by means of fault (culpa)
• Kinds:
• 1. Reckless imprudence – doing or failing to do an act resulting to injuries or
death due to an inexcusable lack of precaution

2. Simple Imprudence – lack of precaution; impending danger is not openly visible

• 3. Sexual harassment - words, gestures actions which tend to annoy and verbally
abuse another person
• Simulation of birth – FILING BIRTH WITHOUT ACTUALLY OCCUR
• 5. Misdemeanor -
a. a person who practices midwifery without certificate of registration

• Appeal – elevation of a case to a higher court

• Etiquette – acceptable social norms
• Doctrine of Citizenship
• 1. Expatriation – turning back one’s citizenship
• 2. Repatriation- withdrawing back or regaining back ones citizenship after
expatriation
• A. Jus soli – citizenship based on place of birth
• B. Jus Sanguinis – blood relation citizenship
(used in the Philippines)
• C. Naturalization – A foreigner can be clothe as Filipino given the privilege
like a Filipino citizen
•
LAWS AFFECTING THE MIDWIFERY PRACTICE IN THE PHILIPPINES
• PD 48 – four (4) children with paid maternity leave privilege
• PD 69 – four (4) children for personal tax exemption
• PD 223 – Creation of Professional Regulation Commission (PRC) in 1973
• PD 442 – New Labor code
• PD 491 – Nutrition program
• July – Nutrition month
• Presidential Decree 603 – Child and Youth Welfare Act /
• PD 651 – Birth registration following delivery (all health workers shall identify
and encourage the registration of all births within 30 days following delivery)
• PD 965 – Family Planning and responsible parenthood instructions prior to
issuance of marriage license

***passed on July 20, 1976

• PD 996 September 16, 1976 – Compulsory immunization for all children below eight
(8) years
• EXECUTIVE ORDERS
EO 51 – Milk Code
EO 209– Family Code of the Philippines (amended by RA 6609)
• Executive Order 226 – Command responsibility
• BOM # 557 Series 1988 – Code of Ethics
• Proclamation No. 1275 – Declaring the third week of October every year as
“Midwifery Week”
• Proc. # 4 – Philippine Measles Elimination Campaign – Declaring the period of
September 16 – October 14, 1998 as the “Ligtas Tigdas Month”
Proc. # 1275 - Midwifery week – every third week of October

LOI 1000 – Government agencies should be given preference to members of the

accredited professional organization when hiring
• REPUBLIC ACTS
RA. 1080 – Civil Service eligibility for all degrees with licensure examinations
• RA. 1082 – Creation of 1st Rural Health Act in 1953
-It created the first 81 Rural Health
• RA. 3573 – Reporting communicable Disease
RA. 4226 – Hospital licensure

RA. 9165 – Dangerous Drug Act.

RA. 6675 – Generics Act
• RA. 6713 –public office is a public trust.
• RA. 6972 – Day Care Center in every Barangay
RA. 7160 – Local Government/Autonomy Code (the devolution of powers, functions and
responsibility to the local government units)
• RA. 7305 – Magna Carta for Public Health workers 10 % night differential pay

RA. 7600 – Rooming –In and Breast feeding Act of 1992 (30 mins after birth)

RA. 7610 – Anti-Child Abuse Law (Special Protection of Children against Child
abuse, Exploitation & Discrimination)
• RA. 8423 – Traditional and Alternative Medicine