Lecturer: Ana Lee V.

Pendon, RN

Goal: Promotion of the clients optimum level of functioning through teaching and delivery of care Mission of DOH: Ensure accessibility of health care to improve the quality of life of all Filipino , especially the poor

Basic Principle: To improve health

Ensure Universal access to basic health services
Epidemiological shift from infectious to degenerative

disease must be managed

Enhance the performance of health sectors Ensure the prioritization of health and nutrition of

vulnerable groups

- Philosophy:
Based on the worth and dignity of man - Primary focus: Health Promotion - Family is the unit of service - Health teaching is the primary responsibility of the community health nurse

 Republic Act 7160

Laws Affecting Public Health practice and CHN

Local Government Code: Responsibility for the delivery of basic services and facilities of the national government has been transferred to local government

Republic Act 9165- Dangerous Drug act

Republic Act 8749-Clean Air Act Presidential Decree 79: Population Act Republic Act 7305 Magna Carta for Public Health Workers

Program of DOH

Vision: A lifetime oral health and no tooth decay for the next generation Objective: To prevent and control dental diseases and conditions Sang Milyong Sepilyo project for Social Mobilization of Dental Health Program

Community Organizing Participatory Research (COPAR)

A Continuous process of

awareness building, organizing and mobilizing community development Phases and Activities I. Pre-entry II. Entry phase III. Core-Group Formation and Mobilizing IV. Organization Building

-Preparation of the staff -Site Selection

Integration with the community Courtesy calls; information Campaigns: identification of potential leaders

III. Core-Group Formation and Mobilizing

Integration with core group

Networking and establishing Linkages; Implementation of livelihood projects; developing secondary leaders

The Primary Health Care

According to the World Health Organization is an

essential health care made universally accessible to individuals and families in the community by means acceptable to them through their full participation and at the cost that the community and country can afford at every stage of development

Goal OF PHC
Health for all Filipinos and health in the hands of

the people by the year 2020

Letter of instruction (LOI)949, October 19, 1979

The Four Cornerstones/Pillars in Primary Health Care include:

Active community participation Intra and inter sectoral linkages

Use of appropriate technology

Support mechanism made available

Reproductive Health
Exercise of reproductive right with responsibility Vision: Reproductive health practice as a way of life for

every man and woman throughout life

Goals
Every pregnancy should be intended Every birth should be healthy Every sex act should be free of coercion and infection Achieve a desired family size

Care of Older Persons

First cause of morbidity among the 50 plus year old Influenza Top cause of mortality among the 60 plus year old: Disease of the Heart

Goal: A longer Disability Free Life

Resolution 46: The UN principle for older persons to add life to years that have been added to life

Nutritional Guidelines for Filipinos

Goal: Improvement of the nutritional status, productivity and quality of life of the population, through adoption of desirable dietary practices and healthy lifestyle

Acupuncture

- Goal

: Manipulation of energy flow throughout the body following a thorough assessment by a practitioner

- Indication: acute & chronic pain and motion disability - Contraindicated: Pregnant, Hemoplilia and Acute CVD

Maternal and Child Health Nursing

Goal: Promotion and maintenance of optimal health

of women and their foetuses/newborn

There should be at least three prenatal visits during

pregnancy:
1st trimester
2nd trimester 3rd trimester

-Home deliveries only in the following circumstances: 1. In areas where there are no licensed 2. Trained Hilot (TBAs) may be allowed to attend health personnel in maternal care or when the personnel is not available

 Iron Supplementation shall be given from 5th month of

pregnancy up to 2 months post partum, 100-200 mg P.O for 210 days

- Home Deliviries Pointers: 3 cleans: Clean hand, Clean surface & Clean cord - First Postpartum visit: within 24 hours after delivery, next visit at least one week after

- Check the sucking reflex and breastfeeding practices and problems

-Under the supervision of the public health nurse

- Plans for activities in the clinic BHS, follow up in homes and field visit in the community
- Mobilize community for health action

- Aim: To promote availability of quality health services

- Main Component: Certification recognition program that develops and promote standards for health facilities

Four Pillars
Quality assurance Grants and technical assistance

Health promotion
Award

Epidemiology
Systematic and scientific study of the distribution

patterns and determinants of health , disease and condition.

Purpose of promoting wellness and preventing disease

conditions

The terms used to distinguish relative frequency in time and space include the following
Sporadic presence of occasional cases of the disease Endemic constant long term presence of disease Epidemic presence of the disease at a much higher

frequency over a short period of time Pandemic- presence of a disease in many countries in a relatively short period of time

Formulas

No. Of live birth _________________________________ X 1,000 Estimate midyear population

No. Of overall deaths during one year _________________________ X 1, 000 Average mid-year population at risk

No. Of new cases of specified illness during specific Time interval ______________________________________ X 1,000 Estimated mid-interval population at risk

No. Of death from puerperal cause during one year _________________________________ X 1,000

No. Of women giving birth the same year

No. Of deaths under one year of age during one year ______________________________ x 1,000 livebirths

No. Of livebirths of the same year

No. Of old new cases of specific illness during Specified time interval ________________________________ x 1,000

Estimated mid-interval population at risk

Expanded Program of Immunization

Objective:

-To reduce the mortality and morbidity among infants and children caused by six childhood immunizable diseases
Elements: Target setting

Presidential Degree No. 996 Providing for compulsory basic immunization for infants and children below 8 years of age
Presidential proclamation No.6 Implementing a United Nations goal on Universal Child Immunization Basic Immunization should be completed on or before a childs first birthday

Administration of vaccines:
Vaccine BCG Content Live attenuated bacteria Form & Dosage Freeze dried infant- 0.05ml Preschool-0.1ml DPT DT- weakened toxin P-killed bacteria liquid-0.5ml 3 IM # of Doses 1 Route ID

OPV
Hepa B Measles

weakened virus
Plasma derivative Weakened virus

liquid-2drops
Liquid-0.5ml Freeze dried0.5ml

3
3 1

Oral
IM Subcutaneous

Schedule of Vaccines:
Vaccine Age at 1st dose Interval between dose At birth 6 weeks 4 weeks DPT Protection

BCG DPT

OPV
Hepa B

6weeks
@ birth

4weeks

Poliomyelitis

@birth,6th HepaB week,14th week measles

Measles

9m0s.-11m0s.

6 months earliest dose of measles

given in case of outbreak

9months-11months- regular
schedule of measles vaccine

15 months- latest dose of measles given 4-5 years old- catch up dose

Fully Immunized Child (FIC)less than 12 months old child with complete immunizations of DPT, OPV, BCG, Anti Hepatitis, Anti measles.
Vaccine Minimum age interval As early as possible 4 weeks later
6 months later 1year later/during next pregnany 1 year later/third pregnancy

% protected

Duration of Protection 0 3 years

5 years 10 years

TT1 TT2
TT3 TT4

0% 80%
95% 99%

TT5

99%

Lifetime

Cold Chain under EPI:

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.

The allowable timeframes for the storage of vaccines at different levels are:
o o o o

6months- Regional Level 3months- Provincial Level/District Level 1month-main health centers-with ref. Not more than 5days- Health centers using transport boxes.

Most sensitive to heat: Freezer (15 to -25 degrees C)

o

OPV Measles

Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celcius)

o
o

o
o

BCG DPT Hepa B TT

- Use those that will expire first, mark X/ exposure, 3rd- discard, - Transport-use cold bags, let it stand in room temperature for a while before storing DPT. - Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B.

- FEFO (first expiry and first out) vaccine is practiced to assure that all vaccines are utilized before the expiry date.
- Proper arrangement of vaccines and/or labeling of vaccines expiry date are done to identify those near to expire vaccines.

Lagundi
Uses & Preparation:

Asthma, Cough & Fever - Decoction ( Boil raw fruits or leaves in 2 glasses of water for 15 minutes)Dysentery, Colds & Pain - Decoction ( Boil a handful of leaves & flowers in water to produce a glass, three times a day) Skin diseases (dermatitis, scabies, ulcer, eczema) - Wash & clean the skin/wound with the decoction Headache - Crush leaves may be applied on the forehead Rheumatism, sprain, contusions, insect bites - Pound the leaves and apply on affected area

Yerba (Hierba) Buena ( Mentha cordifelia)

Uses & Preparation:

Pain (headache, stomachache) Boil chopped leaves in 2 glasses of water for 15 minutes. Divide decoction into 2 parts, drink one part every 3 hours. Rheumatism, arthritis and headache Crush the fresh leaves and squeeze sap. Massage sap on painful parts with eucalyptus Cough & Cold Soak 10 fresh leaves in a glass of hot water, drink as tea. (expectorant) Swollen gums Steep 6 g. of fresh plant in a glass of boiling water for 30 minutes. Use as a gargle solution

Yerba (Hierba) Buena ( Mentha cordifelia)

Toothache Cut fresh plant and

squeeze sap. Soak a piece of cotton in the sap and insert this in aching tooth cavity Menstrual & gas pain Soak a handful of leaves in a lass of boiling water. Drink infusion. Nausea & Fainting Crush leaves and apply at nostrils of patients Insect bites Crush leaves and apply juice on affected area or pound leaves until like a paste, rub on affected area Pruritis Boil plant alone or with eucalyptus in water. Use decoction as a wash on affected area.

Sambong ( Blumea balsamifera)

Uses & Preparation:

Anti-edema, diuretic, antiurolithiasis Boil chopped leaves in a glass of water for 15 minutes until one glassful remains. Divide decoction into 3 parts, drink one part 3 times a day. Diarrhea Chopped leaves and boil in a glass of water for 15 minutes. Drink one part every 3 hours

Tsaang Gubat ( Carmona retusa)

Uses & Preparation:

Diarrhea - Boil chopped leaves into 2 glasses of water for 15 minutes. Divide decoction into 4 parts. Drink 1 part every 3 hours Stomachache Boil chopped leaves in 1 glass of water for 15 minutes. Cool and strain.

Niyug-Niyogan ( Quisqualis indica L.)

Uses & Preparation:

Anti-helmintic - The seeds are taken 2 hours after supper. If no worms are expelled, the dose may be repeated after one week. (Caution: Not to be given to children below 4 years old)

Bayabas/Guava( Psidium guajava L.)

Uses & Preparation:

For washing wounds Maybe use twice a day Diarrhea - May be taken 3-4 times a day As gargle and for toothache - Warm decoction is used for gargle. Freshly pounded leaves are used for toothache. Boil chopped leaves for 15 minutes at low fire. Do not cover and then let it cool and strain

Akapulko( Cassia, alata L.)

Uses & Preparation:

Anti-fungal (tinea flava, ringworm, athletes foot and scabies) - Fresh, matured leaves are pounded. Apply soap to the affected area 1-2 times a day

Ulasimang Bato( Peperonica pellucida)

Uses & Preparation:

Lowers uric acid (gouty) One a half cup leaves are boiled in two glass of water over low fire. Do not cover pot. Divide into 3 parts and drink one part 3 times a day

Bawang/Garlic
Uses & Preparation:

Hypertension - Maybe fried, roasted, soaked in vinegar for 30 minutes, or blanched in boiled water for 15 minutes. Take 2 pieces 3 times a day after meals. Toothache - Pound a small piece and apply to affected area

Ampalaya
Uses & Preparation:

Diabetes Mellitus (Mild non-insulin dependent) - Chopped leaves then boil in a glass of water for 15 minutes. Do not cover. Cool and strain. Take 1/3 cup 3 times a day after meals

Process of examining the community Three dimension - Status: mortality, morbidity, life expectancy, crime rates and education - Structure: Socioeconomic, Age, Gender & Resources -Process: How the community operates and function as a whole

Community competence refers to the communitys ability to

Identify needs

Achieve working consensus

Agree and work together to meet goals

Home Visit
Face to face contact made by the nurse to the client
Should have a purpose or objective

Frequency of home visit take into consideration the following factors

Acceptance of the family and the ability to recognize

their own needs Physical, psychological and educational needs Other health agencies involved Policy of the given agency Evaluation of past services given to the family

Bag technique a tool making use of public health bag through which the nurse, during his/her home visit, can perform nursing procedures with ease and deftness, saving time and effort with the end in view of rendering effective nursing care. Public health bag - is an essential and indispensable equipment of the public health nurse which he/she has to carry along when he/she goes out home visiting. It contains basic medications and articles which are necessary for giving care. Rationale To render effective nursing care to clients and /or members of the family during home visit.

Principles
The use of the bag technique should minimize if not totally

prevent the spread of infection from individuals to families, hence, to the community. Bag technique should save time and effort on the part of the nurse in the performance of nursing procedures.

Principles
Bag technique should not overshadow concern for the

patient rather should show the effectiveness of total care given to an individual or family. Bag technique can be performed in a variety of ways depending upon agency policies, actual home situation, etc., as long as principles of avoiding transfer of infection is carried out.

Contents of the Bag

Paper lining Extra paper for making bag for waste materials (paper

bag) Plastic linen/lining Apron Hand towel in plastic bag Soap in soap dish Thermometers in case [one oral and rectal] 2 pairs of scissors [1 surgical and 1 bandage] 2 pairs of forceps [ curved and straight] Syringes [5 ml and 2 ml]

Contents of the Bag

Hypodermic needles g. 19, 22, 23, 25

Sterile dressings [OS, C.B] Sterile Cord Tie Adhesive Plaster Dressing [OS, cotton ball] Alcohol lamp Tape Measure Babys scale 1 pair of rubber gloves 2 test tubes Test tube holder

Contents of the Bag

Medicines
betadine

70% alcohol
ophthalmic ointment (antibiotic) zephiran solution

hydrogen peroxide
spirit of ammonia acetic acid benedicts solution

Note: Blood Pressure Apparatus and Stethoscope are carried separately.

CHN Clinic Visit

Pre-Consultation Conference:

-Clinical history taking vital sign, physical assessment, laboratory exams and documentation
Medical Examination:

- Ensure privacy, safety and comfort of the patient throughout procedure Post-Consultation:

- Explain findings and needed care: Refer as needed: make appointment for next clinic/home visit

Environmental Pollution Roles

Health Education- main nursing responsibility Help in implementing P.D. 856: sanitation code of the

Philippines
Assist in the Disaster Management

Environmental Sanitations
Level 1 (Point Source) a protected well, a develop

spring; without distribution system

Level 2 (Communal faucet system / Stand post) a

source reservoir, a piped distribution network and communal faucet not more than 25 meters from the farthest house
Level 3 (waterworks system /individual house

Connections) - a source reservoir, a piped distribution network and household taps; Requires minimum treatment of disinfection

Purpose: To enhance the educational process Program Management: establish and maintain a comprehensive school program

Activities of a School Nurse

Primary prevention: Immunization, Health Education Secondary Prevention: Health screening,

communicable disease monitoring, pre-school visitation and assessment

Tertiary Prevention: preventing recurrence of acute /

chronic conditions; school environmental hygiene

CHN

The Dental Health Program of the Department of Health has committed to contribute to the improvement of the quality of life of Filipinos through its project. Isang Milyong Sepilyo. This Program Is project for:
A. Operation research studies

B. Partnership with other sectors

C. Social Mobilization D. Capability Building and Value formation

In Primary health care, what do you expect from the people of the community?
a. Active involvement and participation b. Preparation of teaching materials

c. Donation of money and materials

d. Voluntary time without cost

The mission of PHC must be embodied in the hearts of the care providers through;
a. Supporting conditions for healthy habits b. Letting people manage their own health c. Increasing opportunities to be healthy d. Financing health care program

To encourage community participation, which of the following should a nurse do?

a. Invite people from civic organizations b. Encourage sponsorship to programs

c. Refer to the doctor for prescriptions

d. Listen when people relate their problems

Which of these scientific processes is used by the nurse wherein biological and sociological sciences are utilized to obtain community resources?
a. Nursing management b. Nursing networking c. Nursing program d. Nursing process

As a nurse, you organize community groups to participate in community activities. In what way could you motivate people to participate in your program?
a. Instruct them to agree with you b. let people decide for themselves

c. Assign roles
d. conduct group work

What factor contributes at the effectiveness of care to your clients as a rural health unit nurse?
A. Interpersonal relationship with barangay officials B. Expertise in health education C. Knowledge of the objectives of health program D. Respect of customs, beliefs and values of clients

8. Which one of the following is the mission of the Department of Health?

a.Promote healthy lifestyle b.Ensure accessibility and quality of health care

c.Reduce morbidity and mortality

d.Improve general health status of the people

9. Involvement is not only cleaning surroundings and toilet construction but also sharing responsibilities and participation in one of the following:

a. Problem- solving criminals b. Meeting with barangay officers c. Social work about livelihood d. Defining health needs

10. A pregnant woman seeks the help of a trained hilot. What are the reasons why they like the hilot? a. Cumadrona s busy b. Hilot renders holistic touch c. Babylan is better than none d. Trained hilot are less expensive