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Definition of terms:
Community Webster: place where people live
WHO: Comprising of group of inhabitants in an area following general rules and regulations, having common interests, functions, heads and organizations to attain objectives.
Health - absence of disease condition WHO: Dynamic state in the life cycle of an individual and not merely the absence of a disease Public Health Science and art of preventing disease, prolonging life, promoting health and efficiency through organized community effort.
Community Health Nursing MAGLAYA: Utilization of the nursing process in the different level of clientele-individuals, families, population groups and communities concerned with the promotion of health, prevention of disease and disability, and rehabilitation. Community Health part of paramedical and medical intervention or approach which is concerned on the health of the whole population.
MAGLAYA: utilization of nursing process to benefit the individual, family and community. WHO: combination of nursing skills, sociology and public health. FREEMAN: developing and enhancing health capabilities of people. JACOBSON: achievement of OLOF through teaching and delivery of care
Philosophy of CHN
Goal of CHN
Nisce: To raise the level of citizenry by helping communities and families to cope with the discontinuities in the threats to health in such a way as to maximize their potential for high-level wellness.
The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual, family, population group and the community.
Principle of Health Care for All: 3 As: A ccesibility (geographical proximity) A ffordability (economical capacity) A cceptability (in tuned with values, customs, beliefs and tradition)
Problem Prioritizing:
Nature of the problem
Health threat potential Health deficit actual Foreseeable crisis least
Cornerstones of PHC
Support mechanism Community participation Appropriate technology Multisectoral linkages
PHC
Decision making
Technology Outcome
Top to bottom
Curative-based Reliance to health professional
Bottom to top
Promotive & preventive services Self-reliance of community
Major players:
Public sector -National government and LGU -given free at point of service Private sector -market-oriented -paid offering of service
DOH
Vision: The DOH is the leader, staunch advocate and model in promoting health in the Philippines Mission: Guarantee equitable, sustainable and quality health care for all Filipinos
ELEMENTS
Health financing
Joined by DOH and National Health Insurance Corporation
Health regulation
Goal: assure quality and affordable health goods and services
Good governance
Goal: enhance health system performance
DOH Programs:
Started 1993 23 in 1993 Flavier 1994 health for more Focus: Infants, mother, males, adolescents, elderly.
Barriers
IUD ( copper T) Side effect: ectopic pregnancy
6 9 years During menstruation Post pregnancy up to 6 weeks Dilated cervix Contraindications: any type of STD, any type of Pelvic inflammatory Disease most reliable protection against STD most common used in the Philippines
Cervical cap done facing up Foam most effective spermicidal Gel least effective
Natural
Calendar method Basal body temperature Symphto-thermal Cervical mucus clear, stretchable, fertile Coitus interruptions
Permanent (Surgical/Reversible)
Tubal ligation Vasectomy most uncommon
Principles: Every pregnancy should be intended Every birth should be healthy Every sex act should be free of coercion and infection Achieved a desired family size
3. Nutrition
Sangkap Pinoy is a term used by the DOH for micronutrients added to enclose its nutritional quality.
Vit. A, Iron, Iodine cant be synthesized by body
Fortification of foods with micronutrients is generally recognize as the most cost effective long term strategy for eliminating micronutrient nutrition Sangkap Pinoy Seal makes public awareness MSG & Vit A
FIDEL Fortification for Iodine Deficiency Elimination Nutrition Surveillance System system of keeping close watch in the state of nutrition and the causes if malnutrition within a locality. Tool utilized for Anthropometric measurements
Weight for Age most commonly used Measures degree and presence of wasting (acute malnutrition for 6 months or less) or stunting (chronic malnutrition more than 6 months).
Rule For every increment of an inch above 5 feet For a height of 5 feet
Degrees of Malnutrition
110% and above 90 109 obese normal
75 89
60 - 75 60% and below
1st degree
2nd degree 3rd degree
Fe Supplementation
5th month of pregnancy to two months post partum (100 120mg/day for 210 days) Laboratory exam: Heat-acetic acid test. Benedicts test Oral dental exam
Benedict s test
test sugar / glucose in urine
impending diabetes 5ml of benedict blue 10 gtts of urine heat 5 minutes
Yellow
Orange Red
Yellow
Orange Red
+2
+3 +4 Brick red
5. Adolescent Health
RH Drug dependence and Substance abuse Complex is nature and not only physical or psychological, also involves sociological and cultural.
Prevention:
Promotion of mental health among families and the community through advocacy of wholesome family living sports and other participative activities Anticipatory guidance of vulnerable age groups Recognition of mental health hazards and how to minimize them Participation in drug abuse prevention education
F Fresh E Emotional attachment E Easily established D Digestible I Immunity N Nutritious G GIT disorders are decreased
Fullterm 8 10 hours
Preterm 4 hours
48 hours
3 months
24 hours
3 months
Deep freezer
6 12 months
6 months
7. Dental Health
98/100 Filipinos suffered from tooth decay 50/100 gum disease
Vision: A lifetime of oral health and no tooth decay for succeeding generations.
Sang Milyong Sipilyo Monthly Dental Health services to the Philippine School for the Deaf Replacement of Fluoride with Tsaang Gubat Orientation training on Comprehensive Dental Health
Past and previous illness Past and previous medication Over all health status
9. CARI
No pneumonia/ cough and cold
no fast breathing no stridor / wheeze cough for less than 30 days
Treatment:
home remedies ginger Chicken soup basic steam inhalation
Pneumonia
fast breathing stridor, wheeze on exertion
Treatment:
antibiotic for 5 days observe after 2 days
Severe Pneumonia
fast breathing plus any danger signs stridor, wheeze on a calm child chest indrawing decrease LOC stops feeding malnutrition
Treatment:
1st dose of antibiotic Vitamin A Treat hypoglycemia Refer
Newborn Screening
Disorder Screened CH (Congenital Hypothyroidism) CAH (Congenital Adrenal Hyperplasia) GAL (Galactosemia) PKO (Phenylketonuria) Effects if not screened Several Mental Retardation Death Death or Cataracts Several Mental Retardation Severe Anemia Kerricterus
G6PD
Types:
Acute: 3 loose stools; less than 2 weeks Chronic: LBM on and off for more than 2 weeks
Management:
Fluids
Oral Rehydration Therapy Fruit juice, AM Home made soup
Frequent Feeding
continue breastfeeding - 6 month old Cal CHO 6x a day If subsided, additional feeding for 2 weeks
Fast Referral
Treatment Plans
PLAN A (no dehydration)
home treatment follow up after 5 days
Treatment:
1st day: home care / ORS 2nd day: refer
Treatment:
Refer Give ORS (frequent sips) along the way
ORS
1 pack : 1 L water Good for 24 hours Boiled water
Contents:
glucose for Na absorption NaCl for fluid retention NaHCO3 buffer system KCl for smooth muscle/cardio contraction ***STOP giving ORS if there is puffiness in eyelids already
Treatment:
Refer Give ORS (frequent sips) along the way
Objective: To control TB by reducing annual risk of infection (prevalence and mortality rate). Prevention:
BCG vaccines under EPI Annual identification of at least 45% of its prevalence Public Health Education regarding PTB mode of transmission, methods of control and importance of early diagnosis
Case Finding:
Direct sputum microscopy for identified TB symptomatic X-ray exam of TB symptomatic who are (-) after 2 or more sputum exam
Sputum culture best CXR extent Mantoux exposure AFB - communicability
Establishment of passive and active collection points Case finding and treatment services shall be made available in the BHS/RHUs
Treatment:
Intensive Phase to make patient non-communicable Maintenance cure Standard Regimen
SEI Intensive SEI 2 months Maintenance EI 10 months (SCC DOTS) Short Course Chemotherapy Direct Observed Treatment Short Course 6 months
Category II 8 months
TB relapse and failures Intensive RIPES 2 months RIPE 1 month Maintenance RIE 5 months
LEPROSY
is a chronic disease of the skin and peripheral nerves caused by mycobacterium leprae.
leonine appearance duration of treatment 6 to 9 months
Types:
Paucibillary
Tuberculoid, indeterminate Non infectious Treatment: 6 9 months
MDT
Multibacillary
Lepromatous and borderline Treatment: 24 30 months
MDT
Prevention:
Health education BCG vaccination Case finding (SSS) Validate old regular cases Early referral of suspected leprosy patients
Treatment:
Ambulatory RA 4073:
Advocacy of home treatment Domiciliary chemotherapy through the case of MDT
Level II Communal System on Stand Post - with reservoir - piped distribution system Level III Water works System
-with
household taps
Level II water carriage type with water sealed and flushed type with septic tank disposal facilities Level III connected to sewerage system
2 ways:
Burial deposited in XXXXX deep pits covered with soil, located 25m away from water supply. Open burning animal feeding, composting, grinding and disposal sewerage.
Program Components:
IEC Mobilization Policy development and legislation Training and counselors in smoking Cessation clinics for specialty hospitals Resource management and monitoring