COMMUNITY HEALTH NURSING

THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM

DEFINITION OF: HEALTH CARE DELIVERY
 HEALTH
 PUBLIC HEALTH
 PUBLIC HEALTH NURSING
PUBLIC SECTOR PRIVATE SECTOR
CLASSIC CONCEPT OF NURSING “Subsidized” a. Non Profit b. Profit
 A state of complete, physical, mental, and social
well-being, not merely the absence of disease or LEAD AGENCY: DEPARTMENT OF HEALTH
infirmity.
MODERN CONCEPT OF HEALTH (OLOF) Vision by 2030:
 Optimum level of functioning of individuals, families  A GLOBAL LEADER for attaining better health
and communities. outcomes, competitive and responsive health care
PUBLIC HEALTH system, and equitable health financing
 Art of applying science to reduce inequalities in MISSION
health while ensuring the best health for the  Guarantee EQUITABLE, SUSTAINABLE AND QUALITY
greatest number. HEALTH for all Filipinos especially the poor, and to
PUBLIC HEALTH NURSING lead the quest for excellence in health.
 Special field of nursing that combines the skills of VISION
nursing, public health, and social assistance.  To be a leader, staunch advocate. Ad model in
promoting health for all in the Philippines.

DEFINITION PERSON *the local government units acts as active partners in the
PH enable every citizen to delivery of health care services to people
realize his birth right of Winslow
health and longevity SUBSPECIALITES OF CHN
Philosophy of CHN is based  Occupational health nursing
on the worth and dignity of Margaret Shetland  School nursing
man
CHN is a service rendered by 100 EMPLOYEES REQUIRES CHN
Freeman
a professional nurse
Ultimate goal of CHN is the 1960’s to 1970’s
Jacobson  PHC (Primary Health Care)
promotion of OLOF
CHN for attainment of  From WHO & UNICEF (bumuo)
highest level of well-being Hanlon 1985 to 1990’s
and longevity  Aquino
1995
CONCEPTS OF COMMUNITY HEALTH NURSING  Fidel V. Ramos
 Devolution (decentralization)
 PROMOTING HEALTH Is the primary focus of CHN  Local government unit are partners
practice  RA 7160 – LOCAL GOVERNMENT CODE
 Community health nurse are GENERALISTS 1999
 Community health nursing is based on the  Erap
RECOGNIZED NEEDS of communities, families,  HSRA (Health Sector Reform Agenda) (1999-2004)
groups and individuals  Poverty
 FAMILY is the unity of service  Increased burden of disease
 HEALTH EDUCATION is the primary responsibility of  Endemic – constantly present in the country
the community health  Epidemic – sudden outbreaks
 It is a slow process  Degenerative – hpn, renal failure, DM
 Continuous flexible learning  Increased morbidity, mortality
 Best needed when still healthy 2000 to 2004
 GMA
 HSRA with strategy 4MULA 1 FOR HEALTH

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 G ender equality
FORMULA ONE FOR HEALTH CHI reduce child mortality
MA maternal
ELEMENTS Ma malaria and other disease
1. HEALTH FINANCING – to preform INVESTMENTS in EN environmental sustainability
health PA partnership with global community
a. National health insurance program CHIMAMA – PRIOPRITY HEALTH PROGRAMS
(PhilHealth)
b. RA 7875 – NATIONAL HEALTH INSURANCE Duterte Health Agenda
ACT  All for health towards health for all
2. HEALTH REGULATION – to ensure QUALITY AND Sustainable development goals (17)
AFFORDABILITY of health goods and services 1. Poverty
a. SENTRONG SIGLA MOVEMENT - quality 2. Hunger
assurance program (for sentrong sigla seal) 3. Health and well-being
b. PILLARS 4. Education
i. Quality assurance pillar 5. Equality
ii. Grants and technical assistance 6. Water sanitation
iii. Recognition and awards 7. Energy
iv. Health promotion
c. STANDARDS LEVELS OF PREVENTION IN CHN PRACTICE
i. Structure PRIMARY SECONDARY TERTIARY
ii. Process (prepathogenesis) (pathogenesis (convalescence)
iii. Outcomes assumed to be
sick)
** SEAL CHECKED TWICE A YEAR
1. PROMOTION 1. EARLY 1. Rehabilitation-
OF GENERAL DETECTION Optimizing the
3. HEALTH SERVICE DELIVERY – to ensure ACCESIBILITY
HEALTH  Screening – remaining
and AVILABILITY of essential health care
*wellness basis risk function after
a. ILHS (sharing resources) – inter local health
 Nutrition factor being sick
resources 200,000 population zone
 Healthy (operation
b. WHO 5000 – 1 Rural health midwife
lifestyle timbang for
10,000 – 1 PHN
 Regular DM/obese)
20,000 – 1 health officer
checkup  Diagnostics –
 Stress with s/s
4. GOOD GOVERNANCE – to enhance health system
manageme  Signs and
PERFORMANCE
nt symptoms
a. Local health board – advisory board
i. Composition: 2. PREVENTION 2. PROMPT 2. Palliation
o Chairperson (head) OF SPECIFIC TREATMENT OR Symptoms (pain)
o Vice chair (health officer) DISEASES MANAGEMENT OF
 Local council  Vaccination ACUTE CONDITION
 NGO  Isolation  Pharmacologic
 DOH (period of management
communicabil  Surgical
THE AQUINO HEALTH AGENDA ity) management
KALUSUGANG PANGKALAHATAN  Quarantine  Nursing
(UNIVERSAL HEALTH CARE) (incubation management
GOALS: period)
 Financial risk protection  Personal
 Responsive health system surveillance
 Better health outcomes

The 8 Millennium Development Goals

P overty
E ducation

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PRIMARY HEALTH CARE ELEMENTS/COMPONENTS OF PHC
 Essential health care made available to the people E DUCATION FOR HEALTH
 Adopted through LOI 949 under Marcos L OCALLY ENDEMIC, NON-COMMUNICABLE AND
 Underlying theme: Health in the hands of People by 2020 COMMUNICABLE DISEASE
 Most important principle: SELF-RELIANCE E XPANDED PROGRAM ON IMMUNIZATION
M ATERNAL AND CHILD HEALTH AND FAMILY PLANNING
First international Conference on Primary Health Care E SSENTIAL DRUGS
 Alma Ata, USSR N UTRITION
 September 6-12, 1978 T REATMENT OF EMERGENCY CASES
 Sponsored by World Health Organization and UNICEF S AFE WATER AND SANITATION (2 MINUTES BOILING)

PILLARS OF PHC LEVELS OF PHC WORKERS

M ulti-sectoral lingkages (network) Village/Barangay Health Workers (unlicensed)
A ppropriate technology  Trained community health workers, health auxiliary
articipation of the people (most important;must be volunteer, traditional birth attendant, healer
P Intermediate Level Health Workers
active)
S upport mechanism made available  General medical practioners, public health nurse, rural
sanitary inspectors, midwives
Essential Health Care Service must be First Line Hospital Personnel
 Community based  Staff nurse, attending physician
 Acceptable
 Sustainable PRIMARY
 Accessible  Barangay health station, peuriculture center, community
hospital, private practitioner
 Affordable
SECONDARY
Multi-sectoral  District hospital, OPD of provincial hosp.
TERTIARY
 Intrasectoral – happens within the health sector
 General hospital, PH. health center.
 Intersector – other sectors
PRIORITY HEALTH PROGRAM
Appropriate
 Safe and effective Scientifically sound I. INTEGRATED MANAGEMENT OF CHILDHOOD
 Tested
ILLNESS (1996)
 Indigenous – locally available
 An INTEGRATED approach to child health that focuses
ion well-being of the whole child
Vaccines
 Aims to reduce death, illness and disability, and to
1970’s
promote improved growth and development among
 BCG
children under 5 years of age
 DPT
 Includes both PREVENTIVE and CURATIVE elements that
 OPV
are implemented by families and communities as well as
 MEASLES by health facilities
1992
 HEPA B The ABC’s of IMCI
2010
 MMR – measles, mumps, rubella A – CTIVE participation of the caregiver is encouraged
 Pentavax – DPT, Hepa B, HiB vaccine B – ased on a limited number of carefully-selected CLINICAL
2011 SIGNS
 rotavaccine C – ombination of clinical signs leads to given
2012 CLASSIFICATIONS
 pneumococcal vaccine D – ecision-making based on INTEGRATED CASES
MANAGEMENT PROCESS (uniform approach)
Acceptable – herbal E – DUCATING and COUNSELING the caregivers in the
management of the child’s condition

INTEGRATED CASE MANAGEMENT PROCESS

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Table Format: ASSESS – CLASSIFY – TREAT  After 3 days – taking oral antibiotics, suffer fever,
 Identify the pt. receives bronchodilators (wheezing)
 Ask for the purpose of the visit/child’s problem  After 5 days – persistent diarrhea, children with
 Ask for the patient’s age feeding problems
o Check for general danger signs (if severe,  After 7 days – children with persisting fever
REFER!)  After 14 days – children taking iron supplement
C – onvulsions (with anemia)
U – nable to drink/breastfeed  After 30 days – all children (regular checkup)
V – omits everything
A – bnormally sleeping (lethargic; difficult II. EXPANDED PROGRAM ON IMMUNIZATION
to awaken)
*main symptoms*  Launched in July 1976 by the Department of Health
o Assess for cough or difficulty of breathing in cooperation with WHO and UNICEF
o Assess for diarrhea  To reduce the morbidity and mortality among
o Assess for fever infants and children cause by the immunizable
o Assess for ear problem diseases
*assess status*
o Check for acute malnutrition and anemia LEGAL PROVISIONS
o Check for HIV/AIDS status
o Check for immunization status PD No. 996
o Check for Vit. A status (retinol/fat soluble) - (sept. 1976) Providing for compulsory basic
 For immunity to reduce immunization for infants and children below 8 years
severity of disease old
o Assess other problems (deworming- 1yr& - BCG, DPT, OPV, MEASLES
up Every 6mos until 5y/o) RA 7846
 Classify Conditions - An act requiring for the compulsory immunization
 Treat the Child against hepatitis B for infants and children below 8
yrs old
PINK: SEVERE (Referral, pre-referral) Presidential Proclamation No. 147
- National Immunization Day
YELLOW: Specific treatment  3rd Wednesday
 Reach every barangay
GREEN: mild (home management)
 Open Vial Policy
RA 10152
 Give follow up care: 1,3, 5, 7, 14, 30 ( to clients
- Mandatory infants and children health immunization
belong to yellow & green)
act of 2011
 Counsel the mother
- Under 5 y/o; mmr, rotavax, pneumococcal, pentavax
The Target Population
IMMUNITY ANTIGEN AND ANTIBODY
Young Infant: less than 2 mos
ACTIVE PASSIVE
Young Child: 2 mos to less than 5y/o
- Introduced antigen, - Pinasa lang; donated
Child: More than 12 mos less tha __ y/o
body responds with (antibodies because
antibody antigen was not
1st LINE ORAL ANTIBIOTIC FOR PNEUMONIA
met)
NATURAL NATURAL
AMOXICILLIN
- Disease - Transplacental
 Parenteral antibiotic
ARTIFICIAL ARTIFICAL
GENTAMYCIN + BENZYL PENICILLIN
- Vaccine - Immunoglobulin
 Bloody stools – CIPROFLOXACIN
“antiserum”
 Ear Infections – QUINOLONES
 Malaria – QUININE (IM)
- ARTESUNATE (SUPPOSITORY
- ARTEMETHER (ORAL

FOLLOW UP CARE
 After 1 day – NB with Physiologic jaundice
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IMMUNIZATION (measles) attenuated SQ
TETANUS TIME OF LEVEL OF DURATION Virus
TOXOID DOSE GIVEN PROTECTION OF MCV2 Live 12- FD
PROTECTION (MMR) attenuated 15mos
Virus SQ`
TT1 At 1st contact 0% none
TT2 Atleast after 80% 3 years
Points to ponder
1 month
- Birthdose HEPA B – monovalent (only 1 pathogen)
TT3 Atleast after 95% 5 years
- Rotavax – oral gastroenteritis
6mos
- PCV – is now in geriatric 60 and above y/o (1DOSE)
TT4 Atleast 1 yr 99% 10 years
TT5 Atleast 1 99% Lifetime, all PROTOCOL
year child bearing - MCV1 Vit A. (blue) – 100,000 IU <1y/o
years, 30 - MCV2 Vit A (red/gold) – 200,000 IU 1y/o and above
years - Tablet 10,000 IU

*TT1-TT5 during labor and delivery VACCINE AQUIRED PARALYTIC POLIOMYELITIS

PASSIVE – TT4-TT5 from mothers; effect on baby 6-12mos - LIVE – SABIN
- INACTIVATED – SALK
IM - .5mL LEFT deltoid > tetanus,
- RIGHT > diptheria, mumps rubella MULTIDOSE VIAL STORAGE
VACCINE TYPE DOSES PREPARATION
- If already opened and drawn 1st dose can use up to
BCG Live 1 FREEZE ID
28 DAYS
attenuated birthdos DRIED/ – R. 0.05 if at
bacteria e, LYPHOL birth
- Aspirate aseptically all doses/auto disable needles
(weakened) anytime IZED - L 0.1 - Discard if exposed to direct sunlight
after - Don’t submerge to water
birth
Hepa B RNA 1 IM at liquid VACCINE VIAL MONITOR
recombinant, birth - Purple/brown with white at center
plasma - Square is lighter than circle
derived
(virus)
DPT(pent D-toxoid THREE Liquid DPT & HB
avax) P-killed 6wks FD HiB
bacteria 10wks
T-toxoid 14wks
HB-Rna
recombinant
HiB-conjugate
vax
(haemophilus
influenza/bac
terial
meningitis)
OPV Live THREE liquid
attenuated 6wks
Virus 10wks LOGISTICS
14wks Bioref – 1mo
Rotavax Live TWO FD Without Bioref – 1wk
attenuated 6wks Freezer
Virus oral
- 15-25˚c
10wks
- Most sensitive to heat
PCV Conjugate FOUR liquid
2mos - Measles, OPV
4mos Body
6mos - Sensitive to heat and cold
12- - + 2˚c up to +8˚c
15mos - Other vax

MCV1 Live 6-9mos FD

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ELEMENTS OF IMMUNIZATION PROGRAM EPINEPHRINE
T – target setting < 2y/o .05mL Trendelenburg
- Target Population – 2-6 .15mL Only up to 3 doses
- Infants – 6-12 .3mL Interval – 5mins
- Pregnant Women – 12 and .5mL
I – information, education, communication campaign above
G – giving importance to COLD CHAIN
To maintain potency of vaccines III. ESSENTIAL DRUGS AND ALTERNATIVE
1. Expiration 2 yrs MEDICINE
2. Storage conditions RA 4823
A – assessment and evaluation of each child - Traditional and alternative medicine act (TAMA)
S – surveillance and research of immunizable diseases
Establishment of PITAHC
PRINCIPLES OF IMMUNIZATION PROGRAM - PH. Institute for traditional and alternative
E – pidemiologic situation healthcare
P – opulation focus
I – mmunization as a basic health service HERBAL MEDICING PERPARATION

 Can different vax be given at the same day with diff. BOILED
body sites? - Decoction
 Is vaccination restarted if interval is exceeded? SOAKED/BLANCHED
 Is it ok to vaccinate a child who is ill but well enough to - Infusion
go home? POUNDED/CRUSHED
 Is it ok to vaccinate a child who is ill and for referral? - Poultice
 Is it ok to vaccinate a child with cough, fever and EATEN RAW
vomiting? - Salad
 Will a child go on with the 2nd pertussis shot if he
suffered convulsions within 3 days from the 1st pertussis REMINDERS
shot? M ust consult doctor if s/s not relieved (2-3x usage)
 Is it ok to vaccinate a child with AIDS? HIV? Under A ccurate dosage is followed
IMMUNOTHERAPY?
R emove cover while boiling
 Are mild side effect after vaccination expected?
C lay pots are used
 Is it ok to reconstitute a vaccine with another vaccine’s
O nly one plant for each type of symptom
diluent?
U se of insecticide is avoided
 Are we going to repeat BCG if the child didn’t develop
scar? S top if allergies occurred
 Do we use alcoholized cotton balls to cleanse the skin to
be vaccinated? ESSENTIAL DRUGS
 Can the child get the disease to which the vaccine is
intended for instead of developing immunity? 1988
RA 6675
P+D reconstitution - GENERIC LAW
- BCG - 4˚ GMAP list (Generic Form)
- MCV - ˚
AFTER VAX BOTIKA NG BARANGAY (beneficiaries)
- LGU
SE AE
- Community Organization
Expected Danger sins (CUVA)
- Non-government Org.
Fever Convulsions
Rashes - Pertussis (killed bacteria)
WHAT ARE THE DRUGS
Local tenderness Anaphylaxis
- OTC meds
- DOB (laryngeal edema)
- Common Antibiotics
- Epinephrine IM
- Drugs for chronic ds. (antiHPN, DM, COPD)
1:1000solution on thigh
LISENCING
- BFAD (now FAD)

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REQUIREMENTS drink
- Evaluated by center for health development POULTICE Rheumatism,
- Supervising pharmacist sprain, insect
- Pharmacist assistance bites
ULASIMANG LEAVES DECOCTION
TRADITIONAL /ALTERNATIVE MEDICINE by DOST BATO/PANSIT SALAD
Uric Acid
PANSITAN
Biomedicine (westernized) (uricosuric)
Traditional (nakaugalian) LEAVES DECOCTION Diarrhea
- Herbs BAYABAS DECOCTION Wound
- Hilot (antiseptic) (washing)
Alternative medicine PH. Institute for
DECOCTION Toothache
- Reflexology traditional & alternative
(gargle)
- Acupuncture healthcare (PITAHC)
CLOVES INFUSION HPN
- Iridology (w/vinegar)
- Naturopathy BAWANG
ROAST HPN
(antiHPN)
POULTICE Toothache
(apply)
*HERBAL MED PREP LEAVES DECOCTION Pain/ache
If boiled with stem: STRONG DECOCTION INFUSION Menstrual
and gas pain
ALTERNATIVE MEDICINE (colic)
- Chinese medicine FRESH DECOCTION Swollen
- 5000yrs earlier than meds YERBA BUENA
PLANT/ gums
- Acupressure, Acupuncture (analgesic)
TALBOS (gargle)
- Imbalance means disease LEAVES ------------------- Toothache
SAP/ (cotton
YANG DAGTA w/sap to
- Strong cavity)
- Sun LEAVES DECOCTION Edema,
- Hot SAMBONG
caliculi (NOT
- Light (diuretic)
FOR UTI!)
- Masculine LEAVES DECOCTION Lowers
YIN AMPALAYA blood sugar
- Weak (for diabetic) (drink) ONLY
- Moon FOR TYPE 2
- Cold SEEDS Taken 2hrs
- Dark after dinner,
- Feminine can be
NIYUG- repeated after
Energy – Qi flows the meridians were YIN and YANG NIYUGAN 1wk.. WORMS
(antihelmentic) DOSES
PRESSURE POINTS 4-5y/o:4-5s
- TSUN 6-12y/o:6-7s
- MEASUREMENTS/THUMB Adult:8-10s
TSAANG- LEAVES DECOCTION
CONTRAINDICATION Diarrhea and
GUBAT/FUKIEN
- Cardiovascular ds stomach
TEA (gastric
- Cerebro vascular ds ache
pain reliever)
- Severe osteoporosis ACAPULCO LEAVES POULTICE
Scabicidal
(antifungal)
ACCEPTABLE (HERBAL MEDS)
NAME PART PREPARATION INDICATION
Leaves DECOCTION, Asthma,
LAGUNDI
settle 10-15 cough, fever,
(anti-pyretic)
mins and

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