COMMUNITY

HEALTH
NURSING in the
Philippines

(Mark
10:45)

Discipleship is a lifestyle
Not just a biblical truth
Nor a Christian ideal but a way of
life
For the Son of Man also came not to
be served
But to serve and to give His life as
a ransom for many.

COVERAGE FOR LOCAL BOARD
EXAM : CHN
I. Safe and Quality Care, Health
Education, and Communication,
Collaboration and Teamwork
1. Principles and Standard of
CHN
2. Levels of care
3. Types of Clientele
4. Health Care Delivery System
5. PHC as a Strategy
6.Family-based Nursing
Services(Family Health
Nursing Process)
7.Population Group-based
Nursing Services
8.Community-based Nursing
Services/Community Health
Nursing Process
9.Community Organizing
10.Public Health Programs
II. Research and Quality
Improvement

1. Research in the Community
2. National Health Situation
3. Vital Statistics
4. Epidemiology
5. Demography
III.Management of
Resources & Environment
and Records Management
1. Field Health Services
And Information
System
2. Target-setting
3. Environmental
Sanitation
IV. Ethico-Moral-Legal
Responsibility
1. Socio-cultural values,
beliefs, and practices of
individuals, families, groups
and communities
2. Code of Ethics for Government
Workers
3. WHO, DOH, LGU policies on
health
4. Local Government Code
5. Issues
V. Personal And Professional
Development
1. Self-assessment of CHN
competencies, importance,
methods and tools
2. Strategies and methods of
updating ones self,
enhancing competence in
community health nursing
and related areas.
HISTORY OF CHN
Date Event
1901 - Act # 157 ( Board of Health of the
Philippines) ; Act # 309 ( Provincial and
Municipal Boards of Health) were created.
1905 - Board of Health was abolished;
functions were transferred to the Bureau
of Health.
1912 Act # 2156 or Fajardo Act created the
Sanitary Divisions, the forerunners of present
MHOs; male nurses performs the functions of
doctors
1919 Act # 2808 (Nurses Law was created)
- Carmen del Rosario , 1
st
Fil. Nurse
supervisor under Bureau of Health
Oct. 22, 1922 Filipino Nurses Organization
(Philippine Nurses Organization) was
organized.

1923 Zamboanga General Hospital School
of Nursing & Baguio General Hospital
were established; other government
schools of nursing were organized
several years after.
1928- 1
st
Nursing convention was held
1940 Manila Health Department was
created.
1941 Dr. Mariano Icasiano became
the first city health officer; Office
of Nursing was created through the
effort of Vicenta Ponce (chief nurse)
and Rosario Ordiz (assistant chief
nurse)


Dec. 8, 1941 Victims of World War II were
treated by the nurses of Manila.
July 1942 Nursing Office was created; Dr.
Eusebio Aguilar helped in the release
of 31 Filipino nurses in Bilibid Prison as
prisoners of war by the Japanese.
Feb. 1946 Number of nurses decreased from
556 308.
1948 First training center of the Bureau of
Health was organized by the Pasay City Health
Department. Trinidad Gomez, Marcela
Gabatin, Costancia Tuazon, Ms. Bugarin,
Ms. Ramos, and Zenaida Nisce composed the
training staff.
1950 Rural Health Demonstration and
Training Center was created.
1953 The first 81 rural health units
were organized.
1957 RA 1891 amended some sections of
RA 1082 and created the eight
categories of rural health unit causing
an increase in the demand for the
community health personnel.
1958-1965 Division of Nursing was
abolished (RA 977) and Reorganization
Act (EO 288)

1961 Annie Sand organized the National
League of Nurses of DOH.
1967 Zenaida Nisce became the nursing
program supervisor and consultant on the
six special diseases (TB, leprosy, V.D.,
cancer, filariasis, and mental health
illness).
1975 Scope of responsibility of nurses and
midwives became wider due to restructuring
of the health care delivery system.
1976-1986 The need for Rural Health
Practice Program was implemented.
1990- 1992- Local Government Code of 1991 (RA
7160)
1993-1998 Office of Nursing did not
materialize in spite of persistent
recommendation of the officers, board
members, and advisers of the National
League of Nurses Inc.
Jan. 1999 Nelia Hizon was positioned
as the nursing adviser at the Office
of Public Health Services through
Department Order # 29.
May 24, 1999 EO # 102, which redirects
the functions and operations of DOH,
was signed by former President Joseph
Estrada.
R.A. 7160 - or the Local Government
Code. This involves the devolution of
powers, functions and responsibilities
to the local government both rural &
urban.The Code aims to transform local
government units into self-reliant
communities and active partners in the
attainment of national goals thru a
more responsive and accountable local
government structure instituted thru
a system of decentralization. Hence,
each province, city and municipality
has a LOCAL HEALTH BOARD ( LHB ) which
is mandated to propose annual budgetary
allocations for the operation and
maintenance of their own health
facilities.

Composition of LHB
Provincial Level
1.Governor- chair
2. Provincial Health Officer vice
chair
3. Chair , Committee on Health of
Sangguniang
Panlalawigan
4. DOH rep.
5. NGO rep.
Composition of LHB
City and Municipal Level
1. Mayor chair
2. MHO vice chair
3. Chair, Committee on Health of
Sangguniang
Bayan
4. DOH rep
5. NGO rep
EFFECTIVE LHS DEPENDS ON:


1. the LGUs financial capability
2. a dynamic and responsive political
leadership
3. community empowerment


R.A. 2382 Philippine Medical Act. This act
defines the practice of medicine in the
country.

R.A. 1082 Rural Health Act. It created the 1
st

81 Rural Health Units.
-amended by RA 1891 ; more
physicians, dentists, nurses, midwives and
sanitary inspectors will live in the rural
areas where they are assigned in order to
raise the health conditions of barrio people
,hence help decrease the high incidence of
preventable diseases

R.A. 6425 Dangerous Drugs Act. It
stipulates that the sale,
administration, delivery,
distribution and transportation of
prohibited drugs is punishable by
law.
R.A. 9165 the new Dangerous Drug Act
of 2002

P.D. No. 651 requires that all
health workers shall identify and
encourage the registration of all
births within 30 days following
delivery.

P.D. No. 996 requires the compulsory
immunization of all children below 8
yrs. of age against the 6 childhood
immunizable diseases.
P.D. No. 825 provides penalty for
improper disposal of garbage.
R.A. 8749 Clean Air Act of 2000
P.D. No. 856 Code on Sanitation. It
provides for the control of all factors
in mans environment that affect health
including the quality of water, food,
milk, insects, animal carriers,
transmitters of disease, sanitary and
recreation facilities, noise, pollution
and control of nuisance.
R.A. 6758 standardizes the salary of
government employees including the nursing
personnel.
R.A. 6675 Generics Act of 1988 which
promotes, requires and ensures the production
of an adequate supply, distribution, use and
acceptance of drugs and medicines identified
by their generic name.
R.A. 6713 Code of Conduct and Ethical
Standards of Public Officials and Employees.
It is the policy of the state to promote high
standards of ethics in public office. Public
officials and employees shall at all times be
accountable to the people and shall
discharges their duties with utmost
responsibility, integrity, competence and
loyalty, act with patriotism and justice,
lead modest lives uphold public interest over
personal interest.
R.A. 7305 Magna Carta for Public Health
Workers. This act aims: to promote and improve
the social and economic well-being of health
workers, their living and working conditions
and terms of employment; to develop their
skills and capabilities in order that they
will be more responsive and better equipped to
deliver health projects and programs; and to
encourage those with proper qualifications and
excellent abilities to join and remain in
government service.
R.A. 8423 created the Philippine Institute of
Traditional and Alternative Health Care.
P.D. No. 965 requires applicants for marriage
license to receive instructions on family
planning and responsible parenthood.

P.D. NO. 79 defines , objectives, duties and
functions of POPCOM

RA 4073 advocates home treatment
for leprosy

Letter of Instruction No. 949
legal basis of PHC dated OCT. 19,
1979
- promotes development of health
programs on the community level





RA 3573 requires reporting of all
cases of communicable diseases and
administration of prophylaxis

Ministry Circular No. 2 of 1986
includes AIDS as notifiable disease



R.A. 7875 National Health Insurance
Act
R.A. 7432 Senior Citizens Act
R. A. 7719 - National Blood Services
Act
R.A. 8172 Salt Iodization Act (
ASIN LAW)
R.A. 7277- Magna Carta for PWDs,
provides their rehabilitation,
self-development and self-reliance
and integration into the mainstream
of society
A. O. No. 2005-0014- National
Policies on Infant and Young Child
Feeding:
1.All newborns be breastfeed within 1
hr after birth
2. Infants be exclusively breastfeed
for 6 mos.
3. Infants be given timely, adequate
and safe complementary foods
4. Breastfeeding be continued up to 2
years and beyond


EO 51- Phil. Code of Marketing of
Breastmilk Substitutes
R.A.- 7600 Rooming In and
Breastfeeding Act of 1992
R.A. 8976- Food Fortification Law
R.A. 8980- prolmulgates a
comprehensive policy and a national
system for ECCD
A..O. No. 2006- 0015- defines the
Implementing guidelines on
Hepatitis B Immunization for
Infants
R.A. 7846- mandates Compulsory
Hepatitis B Immunization among
infants and children less than 8
yrs old
R.A. 2029- madates Liver Cancer
and Hepatitis B Awareness Month Act
( February)
A.O. No. 2006-0012- specifies the
Revised Implementing Rules and
Regulations of E.O. 51 or Milk
Code, Relevant International
Agreements, Penalizing Violations
thereof and for other purposes
Public Health
- science and art of preventing
diasease,
prolonging life, promoting health and
efficiency thru organized community
effort for the sanitation of the
environment, control of communicable
diseases, the education of individuals in
personal hygiene, the organization of
medical and nursing services for the
early diagnosis and preventive treatment
of diseases and the development of social
machinery to ensure everyone a standard
of living adequate for the maintenance of
health, so organizing these benefits as
to enable every citizen to realize his
birthright off birth and longevity ( DR.
C.E. Winslow)
Community Health Nursing
- special field of nursing that
combines the skills of nursing,
public health and some phases of
social assistance and functions as
part of the total public health
program for the promotion of
health, the improvement of the
conditions in the social and
physical environment,
rehabilitation of illness and
disability ( WHO Expert Committee
of Nursing )
CHN
- a learned practice discipline with the
ultimate goal of contributing as
individuals and in collaboration with
others to the promotion of the clients
optimum level of functioning thru
teaching and delivery of care ( Jacobson
)
- a service rendered by a professional
nurse to IFCs, population groups in
health centers, clinics, schools ,
workplace for the promtion of health,
preventionof illness, care of the sick at
home and rehabilitation (DR. Ruth B.
Freeman)
Concepts
The primary focus of community health
nursing is health promotion.
Community health nurses provide care
necessary to meet the requirements of an
individual all throughout the life
cycle.
Knowledge on different fields
(biological and social sciences,
clinical nursing, and community health
organizations) is used.
Nursing process in community health
nursing changes based on the needs of
the community.
Goal
To elevate the level health of the
multitude.

Worth and dignity of man.


1.The need of the community is the basis
of community health nursing.
2.The community health nurse must
understand fully the objectives and
policies of the agency she represents.


Philosophy
Principles
3. The family is the unit of service.
4. CHN must be available to all
regardless of race,creed and
socioeconomic status
5. The CHN works as a member of the
health team
6. There must be provision for periodic
evaluation of community health nursing
services
7. Opportunities for continuing staff
education programs for nurses must be
provided by the community health
nursing agency and the CHN as well
8. The CHN makes use of available
community health resources

9. The CHN taps the already existing active organized
groups in the community
10. There must be provision for educative supervision in
community health nursing
11. There should be accurate recording and reporting in
community health nursing
12. Health teaching is the primary responsibility of the
community health nurse
Standards in CHN
I. Theory
Applies theoretical concepts as
basis for decisions in practice
II. Data Collection
Gathers comprehensive , accurate
data systematically
Standards
III. Diagnosis
Analyzes collected data to determine
the needs/ health problems of IFC
IV. Planning
At each level of prevention, develops
plans that specify nursing actions
unique to needs of clients
Standards
V. Intervention
Guided by the plan, intervenes to
promote, maintain or restore
health, prevent illness and
institute rehabilitation
VI. Evaluation
Evaluates responses of clients to
interventions to note progress
toward goal achievement, revise
data base, diagnoses and plan
Standards
VII. Quality Assurance and
Professional Development
Participates in peer review and
other means of evaluation to assure
quality of nursing practice
Assumes professional development
Contributes to development of others
Standards
VIII. Interdisciplinary Collaboration

Collaborates with other members of
the health team, professionals and
community representatives in
assessing, planning, implementing
and evaluating programs for
community health
Standards
IX. Research
Indulges in research to contribute to
theory and practice in
community health nursing

LEVELS OF CARE/ PREVENTION
1. PRIMARY

2. SECONDARY

3. TERTIARY
Types of Clientele
1. INDIVIDUALS
2. FAMILIES
3. COMMUNITIES
4. POPULATION GROUPS
- Aggregate of people who share common
characteristics, developmental stage or
common exposure to particular
environmental factors thus resulting in
common health problems ( Clark, 1995:5)
e.g. children . elderly, women, workers
etc.
Phil.Health Care Delivery
System
1.PRIMARY LEVEL FACILITIES

2. SECONDARY LEVEL FACILITIES

3. TERTIARY LEVEL FACILITIES
Classify as to what level the
ff. belong
1. Teaching and Training Hospitals
2. City Health Services
3. Emergency and District Hospitals
4. Private Practitioners
5. Heart Institutes
6. Puericulture Centers
7. RHU

THE DEPARTMENT OF HEALTH
VISION: Health for all Filipinos
MISSION: Ensure accessibility &
quality of health care to improve
the quality of life of all
Filipinos, especially the poor.

NATIONAL OBJECTIVES
1. Improve the general health status of the population
(reduce infant mortality rate, reduce child morality
rate, reduce maternal mortality rate, reduce total
fertility rate, increase life expectancy & the quality
of life years).
2. Reduce morbidity, mortality, disability &
complications from Diarrheas, Pneumonias,
Tuberculosis, Dengue, Intestinal Parasitism, Sexually
Transmitted Diseases, Hepatitis B, Accident &
Injuries, Dental Caries & Periodontal Diseases,
Cardiovascular Diseases, Cancer, Diabetes, Asthma &
Chronic Obstructive Pulmonary Diseases, Nephritis &
Chronic Kidney Diseases, Mental Disorders, Protein
Energy Malnutrition, Iron Deficiency Anemia & Obesity.
3.Eliminate the ff. diseases as public
health problems:
Schistosomiasis
Malaria
Filariasis
Leprosy
Rabies
Measles
Tetanus
Diphtheria & Pertussis
Vitamin A Deficiency & Iodine
Deficiency Disorders
4. Eradicate Poliomyelitis
5. Promote healthy lifestyle through healthy
diet & nutrition, physical activity &
fitness, personal hygiene, mental health &
less stressful life & prevent violent & risk-
taking behaviors.
6. Promote the health & nutrition of families &
special populations through child, adolescent
& youth, adult health, womens health, health
of older persons, health of indigenous
people, health of migrant workers and health
of different disabled persons and of the
rural & urban poor.
7. Promote environmental health and
sustainable development through the
promotion and maintenance of
healthy homes, schools, workplaces,
establishments and communities
towns and cities.
Basic Principles to Achieve
Improvement in Health
1. Universal access to basic health
services must be ensured.
2. The health and nutrition of
vulnerable groups must be
prioritized.
3. The epidemiological shift from
infection to degenerative diseases
must be managed.
4. The performance of the health
sector must be enhanced.
Primary Strategies to Achieve
Goals
1. Increasing investment for Primary
Health Care.
2. Development of national standards
and objectives for health.
3. Assurance of health care.
4. Support to the local system
development.
5. Support for frontline health
workers.
PHC as a Strategy
PRIMARY HEALTH CARE (PHC)

May 1977 -30
th
World Health Assembly
decided that the main health target of
the government and WHO is the attainment
of a level of health that would permit
them to lead a socially and economically
productive life by the year 2000.
September 6-12, 1978 - First
International Conference on PHC in Alma
Ata, Russia (USSR) The Alma Ata
Declaration stated that PHC was the key
to attain the health for all goal
October 19, 1979 - Letter of Instruction (LOI)
949), the legal basis of PHC was signed by Pres.
Ferdinand E. Marcos,
which adopted PHC as an approach towards the
design, development and implementation of
programs focusing on health development at
community level.

RATIONALE FOR ADOPTING PRIMARY HEALTH CARE:
Magnitude of Health Problems
Inadequate and unequal
distribution of health resources
Increasing cost of medical care
Isolation of health care
activities from other development
activities
DEFINITION OF PRIMARY HEALTH CARE
G essential health care made universally
accessible to individuals and families
in the community by means acceptable to
them, through their full participation
and at cost that the community can
afford at every stage of development.
Ga practical approach to making health
benefits within the reach of all people.
Gan approach to health development, which
is carried out through a set of
activities and whose ultimate aim is the
continuous improvement and maintenance
of health status of the community.

GOAL OF PRIMARY HEALTH CARE:
HEALTH FOR ALL FILIPINOS by the year 2000
AND HEALTH IN THE HANDS OF THE PEOPLE by the
year 2020.
An improved state of health and quality
of life for all people attained through
SELF-RELIANCE.
` KEY STRATEGY TO ACHIEVE THE GOAL:
Partnership with and Empowerment of the
people - permeate as the core strategy in the
effective provision of essential health
services that are community based, accessible,
acceptable, and sustainable, at a cost, which
the community and the government can afford.
OBJECTIVES OF PRIMARY HEALTH CARE
Improvement in the level of health care of the
community
Favorable population growth structure
Reduction in the prevalence of preventable,
communicable and other disease.
Reduction in morbidity and mortality rates especially
among infants and children.
Extension of essential health services with priority
given to the underserved sectors.
Improvement in Basic Sanitation
Development of the capability of the community aimed
at self-reliance.
Maximizing the contribution of the other sectors for
the social and economic development of the community.

MISSION:
To strengthen the health care
system by increasing opportunities
and supporting the conditions
wherein people will manage their
own health care.
TWO LEVELS OF PRIMARY HEALTH CARE WORKERS
1. Barangay Health Workers - trained community
health workers or health auxiliary volunteers
or traditional birth attendants or healers.
2. Intermediate level health workers include the
Public Health Nurse, Rural Sanitary Inspector
and midwives.
PRINCIPLES OF PRIMARY HEALTH CARE
1. 4 A's = Accessibility,
Availability, Affordability &
Acceptability, Appropriateness of
health services. The health services
should be present where the supposed
recipients are. They should make use
of the available resources within the
community, wherein the focus would be
more on health promotion and prevention
of illness.
2. COMMUNITY PARTICIPATION
=heart and soul of PHC
3. People are the center, object and
subject of development.
Thus, the success of any undertaking that aims
at serving the people is dependent on peoples
participation at all levels of decision-
making; planning, implementing, monitoring and
evaluating. Any undertaking must also be
based on the peoples needs and problems (PCF,
1990)
Part of the peoples participation is the
partnership between the community and the
agencies found in the community; social
mobilization and decentralization.
In general, health work should start from
where the people are and building on what they
have. Example: Scheduling of Barangay Health
Workers in the health center
BARRIERS OF COMMUNITY INVOLVEMENT
Lack of motivation
Attitude
Resistance to change
Dependence on the part of
community people
Lack of managerial skills

4.SELF-RELIANCE
5.Partnership between the
community and the health
agencies in the provision of
quality of life.
Providing linkages between
the government and the non-
government organization and
peoples organization.

6. Recognition of interrelationship
between the health and development
HEALTH
is not merely the absence of disease. Neither
it is only a state of physical and mental
well-being. Health being a social phenomenon
recognizes the interplay of political, socio-
cultural and economic factors as its
determinant. Good Health therefore, is
manifested by the progressive improvements in
the living conditions and quality of life
enjoyed by the community residents (PCF,
DEVELOPMENT is the quest for an improved
quality of life for all. Development is
multi-dimensional. It has a political,
social, cultural, institutional and
environmental dimensions(Gonzales 1994).
Therefore, it is measured by the ability of
people to satisfy their basic needs.
7. SOCIAL MOBILIZATION
It enhances people participation or
governance, support system
provided by the Government,
networking and developing
secondary leaders.

8. DECENTRALIZATION
MAJOR STRATEGIES OF PRIMARY HEALTH CARE
A. ELEVATING HEALTH TO A COMPREHENSIVE AND SUSTAINED
NATIONAL EFFORTS.
Attaining Health for all Filipino will
require expanding participation in health and
health related programs whether as service
provider or beneficiary. Empowerment to
parents, families and communities to make
decisions of their health is really the
desired outcome.
Advocacy must be directed to National and
Local policy making to elicit support and
commitment to major health concerns through
legislations, budgetary and logistical
considerations.
B. PROMOTING AND SUPPORTING COMMUNITY MANAGED HEALTH
CARE
The health in the hands of
the people brings the
government closest to the
people. It necessitates a
process of capacity building
of communities and
organization to plan,
implement and evaluate health
programs at their levels.

C. INCREASING EFFICIENCIES IN THE HEALTH SECTOR
Using appropriate technology will
make services and resources required for
their delivery, effective, affordable,
accessible and culturally acceptable.
The development of human resources must
correspond to the actual needs of the
nation and the policies it upholds such
as PHC. The DOH will continue to
support and assist both public and
private institutions particularly in
faculty development, enhancement of
relevant curricula and development of
standard teaching materials.
D. ADVANCING ESSENTIAL NATIONAL HEALTH
RESEARCH
Essential National Health
Research (ENHR) is an
integrated strategy for
organizing and managing
research using
intersectoral, multi-
disciplinary and scientific
approach to health
programming and delivery.
FOUR CORNERSTONES/ PILLARS IN PRIMARY
HEALTH CARE
1. Active Community Participation
2. Intra and Inter-sectoral
Linkages
3. Use of Appropriate Technology
4. Support mechanism made
available

HERBAL MEDICINES ENDORSED BY THE DEPARTMENT OF
HEALTH
Name Indication
s
Dosage
1.Five-
leaf
Chaste
tree
(Lagundi)
1. Asthma
2. Cough
3. Body Pain
4. Fever
Divide the
decoction into 3
parts:
For asthma and
cough, drink 1 part
3 times a day.
For fever and body
pains, drink 1 part
every 4 hrs.
2. Marsh-
Mint;
Peppermint
(Yerba
Buena)
1. Body pain Divide
decoction
into 2 parts
and drink 1
part every 3
hours.
3. Sambong 1. Swelling
2. Inducing
diuresis
(
anti-
urolithia
sis)

Divide
decoction
into 3 parts
and drink 1
part 3 times
a day.
4. Tsaang
Gubat
1. Stomachache Drink the warm
decoction. If
it persists, or
if there is no
improvement an
hour after
drinking the
decoction,
consult a
doctor.
5.
Ulasimang
Bato/Pansi
t-
Pansitan
1. Gouty
Arthritis
Divide the
decoction into 3
parts and drink
1 part 3 times a
day after meals.
6. Garlic 1. Hypertension
2. Htperlipidemia
Eat 6 cloves
of garlic
together with
meals
7. Niyog-
Niyogan
1. Ascariasis Chew and
swallow only
dried seeds 2
hours after
dinner
according to
the following:
ADULTS = 8-10
seeds
9-12 y/o = 6-7
seeds 6-8 y/o =
5-6 seeds
4-5 y/o = 4-5
seeds
8. Guava 1. Cleaning
wounds
2. Mouth wash
for mouth
infection,
sore gums &
tooth decay
For wound cleaning,
use decoction for
washing the wound 2
times a day
For tooth decay and
swelling of gums,
gargle with warm
decoction 3 times a
day
9.
Akapulko
1. Ring worm
2. Athletes
foot
3. Scabies
Apply the juice on the
affected area 1 to 2 times a
day
If the person develops an
allergy while using the above
preparation, prepare the
following:
oPut 1 cup of chopped fresh
leaves in an earthen jar. Pour
in 2 glasses of water and cover
it.
oBoil the mixture until the 2
glasses of water originally
poured have been reduced to 1
glass of water
oStrain the mixture. Use it
while it is warm.
oApply the warm decoction on
the affected area 1 to 2 times
a day.
10.
Bitter
Gourd/
Melon
(Ampalaya)
1.Mild
Non-
Insulin
Dependen
t
Diabetes
Mellitus
Drink
cup of
cooled or
warm
decoction
3 times a
day after
meals.
11.
Ginger
(Zingibe
r
officina
le)
1. Motion
sickness,
sore
throat,
nausea &
vomiting,
migraine
headaches,
arthritis
An abortifacient if
taken in large
amounts; should not be
used by persons with
cholelithiasis unless
directed by the
physician; may
increase the risk of
bleeding when used
concurrently with
anticoagulants &
antiplatelets.
Chop and Mash a piece of
ginger root, and mix in a
glass of water
Boil the mixture
Drink the cooled or warm
decoction as needed.
ELEMENTS OF PRIMARY HEALTH CARE:

Is one of the potent
methodologies for information
dissemination. It promotes the
partnership of both the family
members and health workers in
the promotion of health as well
as prevention of illness.

Education For Health
The control of endemic
disease focuses on the
prevention of its
occurrence to reduce
morbidity rate. Example
Malaria Control and
Schistosomiasis Control

Locally Endemic Disease Control
This program exists to control the
occurrence of preventable illnesses
especially of children below 6 years old.
Immunizations on poliomyelitis, measles,
tetanus, diphtheria and other preventable
disease are given for free by the government
and ongoing program of the DOH
Expanded Program on Immunization
The mother and child are the
most delicate members of the
community. So the protection
of the mother and child to
illness and other risks would
ensure good health for the
community. The goal of Family
Planning includes spacing of
children and responsible
parenthood.
Maternal and Child Health and
Family Planning
Environmental Sanitation is defined
as the study of all factors in the
mans environment, which exercise or
may exercise deleterious effect on his
well-being and survival.
Water is a basic need for life and one
factor in mans environment. Water is
necessary for the maintenance of
healthy lifestyle.
Safe Water and Sanitation is necessary
for basic promotion of health.

Environmental Sanitation and
Promotion of Safe Water Supply
One basic need of the family is
food. And if food is properly
prepared then one may be assured
healthy family. There are many
food resources found in the
communities but because of faulty
preparation and lack of knowledge
regarding proper food planning,
Malnutrition is one of the problems
that we have in the country.

Nutrition and Promotion of Adequate
Food Supply
The diseases spread through direct
contact pose a great risk to those
who can be infected. Tuberculosis is
one of the communicable diseases
continuously occupies the top ten
causes of death. Most communicable
diseases are also preventable. The
Government focuses on the prevention,
control and treatment of these
illnesses.


Treatment of Communicable Diseases
and Common Illness
This focuses on the information campaign on
the utilization and acquisition of drugs.
In response to this campaign, the GENERIC
ACT of the Philippines is enacted . It
includes the following drugs: Cotrimoxazole,
Paracetamol, Amoxycillin, Oresol, Nifedipine,
Rifampicin, INH(isoniazid) and
Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine
Supply of Essential Drugs
FAMILY HEALTH NURSING
- that level of CHN practice
directed to the FAMILY as the unit
of care with HEALTH as the goal and
NURSING as the medium, channel or
provider of care
Family Case Load
- the no. and kind of families a
nurse handles at any given time
- variable for cases are added or
dropped based on the need for
nursing care and supervision
Types of Families
1. Nuclear
2. Extended
3. Three generational
4. Dyad
5. Single- Parent
6. Step- Parent
7. Blended or reconstituted
Types of Families
8. Single adult living alone
9. Cohabiting/ Living in
10. No- kin
11. Compound
12. Gay
14. Commune
Stages of Family Life Cycle
1. Newly married couple
2. Childbearing
3. Preschool age
4. Schoolage
5. Teenage
6. Launching
7. Middle-aged ( empty nest retirement)
8. Period from retirement to Death of
both spouses
HEALTH TASKS OF THE FAMILY(
Freeman, 1981)
1. recognizing interruptions of health or
development
2. seeking health care
3. managing health and non-health crises
4. providing nursing care to the sick,
disabled and dependent member of the
family
5. maintaining a home environment
conducive to good health and personal
development
6. maintaining a reciprocal relationship
with the community and health
institutions
Family Nursing Problem
Arises when the family cannot
effectively perform its health
tasks
Nurses Roles in Family
Health Nursing
1. HEALTH MONITOR
2. PROVIDER OF CARE TO A SICK
FAMILY MEMBER
3. COORDINATOR OF FAMILY
SERVICES
4. FACILITATOR
5. TEACHER
6. COUNSELOR
INITIAL DATA BASE FOR FAMILY
NURSING PRACTICE
Family structure,
Characteristics, and Dynamics
1. Members of the household and
relationship to the head of the
family
2. Demographic data age, sex, civil
status, position in the family
3. Place of residence of each member
whether living with the family or
elsewhere

4. Type of family structure e.g.
matriarchal or patriarchal,
nuclear or extended
5. Dominant family members in terms
of decision-making, especially
in matters of health care
6. General family
relationship/dynamics presence
of any readily observable
conflict between members;
characteristics communication
patterns among members
Socio-economic and Cultural
Characteristics
1. Income and Expenses
Occupation, place of work and
income of each working members
Adequacy to meet basic necessities
Who makes decisions about money
and how it is spent
2. Educational attainment of each
other
3. Ethnic background and religious
affiliation
4.Significant Others
role(s) they play in
familys life
5. Relationship of the
family to larger
community Nature and
extent of participation
of the family in
community activities
Home and Environment
1. Housing
Adequacy of living peace
Sleeping arrangement
Presence of breeding or resting sites of
vectors of diseases
Presence of accidents hazards
Food storage and cooking facilities
Water supply source, ownership,
portability
Toilet facility type, ownership,
sanitary condition
Drainage system type, sanitary
condition
2.Kind of neighborhood,
e.g. congested, slum,
etc.
3.Social and health
facilities available
4.Communication and
transportation
facilities available
Health Status of each Family
Member
1. Medical and nursing history
indicating current or past
significant illnesses or beliefs and
practices conducive to health
illness
2. Nutritional assessment
Anthropometric data: Measures of
nutritional status of children, weight,
height, mid-upper arm circumference:
Risk assessment measures of obesity:
body mass index, waist circumference,
waist hip ratio
Dietary history specifying quality and
quantity of food/nutrient intake per day
Eating/ feeding habits/ practices
3. Developmental assessments of
infants, toddlers, and preschoolers
e.g., Metro Manila
4. Risk factor assessment indicating
presence of major and contributing
modifiable risk factors for specific
lifestyles, cigarette smoking,
elevated blood lipids, obesity,
diabetes mellitus, inadequate fiber
intake, stress, alcohol drinking and
other substance abuse
5. Physical assessment
indicating presence of
illness state/s
6. Results of laboratory/
diagnostic and other
screening procedures
supportive of assessment
findings
Values, Habits, Practices on
Health Promotion, Maintenance
and Disease Prevention.
Examples include:
1. Immunization status of family
members
2. Healthy lifestyle practices.
Specify.
3. Adequacy of:
rest and sleep
exercise
use of protective measures- e.g.
adequate footwear in parasite-infested
areas;
relaxation and other stress management
activities
4. Use of promotive-preventive health
services
A TYPOLOGY OF NURSING PROBLEMS IN
FAMILY NURSING PRACTICE
FIRST-LEVEL ASSESSMENT
I. Presence of Wellness Condition stated
as Potential or Readiness- a clinical or
nursing judgment about a client in
transition from a specific level of
wellness or capability to a higher level.
Wellness potential is a nursing judgment
on wellness state or condition based on
clients performance, current
competencies or clinical data but no
explicit expression of client desire.
Readiness for enhanced wellness state is
a nursing judgment on wellness state or
condition based on clients current
competencies or performance, clinical
data explicit expression of desire to
achieve a higher level of state or
function in specific area on health
promotion and maintenance.
Examples of these are the following:
1. Potential for Enhanced Capability
for:
Healthy lifestyle e.g.
nutrition/diet, exercise/ activity
Health Maintenance
Parenting
Breastfeeding
Spiritual Well-being process of a
clients unfolding of mystery through
harmonious interconnectedness that
comes from inner strength/sacred
source/GOD (NANDA 2001)
Others,
2. Readiness for Enhanced
Capability for:
+ Healthy Lifestyle
+ Health Maintenance
+ Parenting
+ Breastfeeding
+ Spiritual Well-being
+ Others,
I. Presence of Health Threats conditions
that are conducive to disease, accident
or failure top realize ones health
potential.
Examples of these are the following:
1. Family history of hereditary condition,
e.g. diabetes
2. Threat of cross infection from a
communicable disease case
3.Family size beyond what
family resources can
adequately provide
4.Accidental hazards
4 Broken stairs
4 Sharp objects, poison, and
medicines improperly kept
4 Fire hazards
5. Faulty nutritional habits or feeding
practices.
Inadequate food intake both in quality
& quantity
Excessive intake of certain nutrients
Faulty eating habits
Ineffective breastfeeding
Faulty feeding practices
6.Stress-provoking
factors
Strained marital
relationship
Strained parent-sibling
relationship
Interpersonal conflicts
between family members
Care-giving burden
O Inadequate living
space
O Lack of food
storage facilities
O Polluted water
supply
O Presence of
breeding sites of
vectors of disease
O Improper garbage

7. Poor home
condition-
O Unsanitary
waste
disposal
O Improper
drainage
system
O Poor
ventilation
O Noise
pollution
G Air pollution
8. Unsanitary food handling and
preparation
9. Unhealthful lifestyles and personal
habits-
w Alcohol drinking
w Cigarette smoking
w Inadequate footwear
w Eating raw meat
w Poor personal hygiene
w Self-medication
w Sexual promiscuity
w Engaging in dangerous sports
w Inadequate rest
w Lack of inadequate exercise
w Lack of relaxation activities
w Non-use of self protection measures
10. Inherent personal characteristics e.g.
poor impulse control
11. Health history which induce the occurrence
of a health deficit, e.g. previous history
of difficult labor
12. Inappropriate role assumption e.g. child
assuming mother's role, father not
assuming his role
13. Lack of immunization/ inadequate
immunization status specially of children
14.Family disunity
gSelf-oriented behavior of
member(s)
gUnresolved conflicts of
member(s)
gIntolerable disagreement
gOther
15.Other
III.Presence of Health Deficits
instances of failure in health
maintenance.
Examples include:
1. Illness states, regardless of
whether it is diagnosed or by
medical practitioner
2. Failure to thrive/ develop
according to normal rate
3. Disability whether
congenital or arising from
illness; temporary
IV. Presence of stress Points/ Foreseeable Crisis
Situations anticipated periods of unusual demand
of the individual or family in terms of family
resources.
Examples of these include:
1. Marriage 9. Menopause
2. Pregnancy 10. Loss of job
3. Parenthood 11. Hospitalization of
a
4. Additional member family member
5. Abortion 12. Death of a manner
6. Entrance at school 13. Resettlement in a
7. Adolescence new community
8. Divorce 14. illegitimacy
Second Level Assessment
Focus on determining familys capacity to
perform the health tasks
Statements on family health nursing problem:
a. Inability to recognize the presence of the
condition or problem
b. Inability to make decisions with respect to
taking appropriate health action
c. Inability to provide adequate nursing care to
the sick, disabled , dependent or vulnerable
member of the family
d. Inability to provide a home environment
conducive to health maintenance or personal
development
e. Failure to utilize community resources for
health care
Scale for Ranking Health
Conditions and Problems
according to priorities
Criteria:
a. Nature of the condition or problem
presented
( wellness state, health deficit, health
threat, forseeable crisis)
b. Modifiability of the condition or
problem
( easily, partially, not modifiable)
c. Preventive Potential (high, moderate ,
low)
d. Salience ( needs immediate attention,
not immediate, not perceived as a
problem)
COMMUNITY HEALTH CARE PROCESS
Assessment
Purpose : To identify the health needs of the
people
Planning of nursing actions
Purpose : To act on the determined needs of the
community people
Implementation
Purpose : To achieve the optimum level of health
of the community people
Evaluation
Purpose : To determine the effectiveness of health care
programs

NURSING PROCEDURES
CLINIC VISIT
- process of checking the clients health
condition in a medical clinic
HOME VISIT
- a professional face to face contact
made by the nurse with a patient or the
family to provide necessary health care
activities and to further attain the
objectives of the agency
BAG TECHNIQUE
-a tool making of the public health bag
through which the nurse during the home
visit can perform nursing procedures
with ease and deftness saving time and
effort with the end in view of
rendering effective nursing care

THERMOMETER TECHNIQUE
-to assess the clients health condition
through body temperature reading
NURSING CARE IN THE HOME
- giving to the individual patient the
nursing care required by his/her
specific illness or trauma to help
him/her reach a level of functioning
at which he/she can maintain
himself/herself or die peacefully in
dignity

ISOLATION TECHNIQUE IN THE HOME
-done by :
1. separating the articles used by a
client with communicable disease to
prevent the spread of infection:
2. frequent washing and airing of
beddings and other articles and
disinfections of room
3. wearing a protective gown , to be used
only within the room of the sick member
4. discarding properly all nasal and
throat discharges of any member sick
with communicable disease


5. burning all soiled articles if could
be or contaminated articles be boiled
first in water 30 minutes before
laundering
INTRAVENOUS THERAPY
- insertion of a needle or catheter into
a vein to provide medication and
fluids based on physicians written
prescription
- can be done only by nurses accredited
by ANSAP
PRINCIPLES OF HEALTH EDUCATION
It considers the health status of
the people, which is determined by
the economic and social conscience
of the country.
It is a process whereby people
learn to improve their personal
habits and attitudes, to work
responsibly for the improvement of
health conditions of the family,
community, and nation.
It involves motivation,
experience, and change in
conduct and thinking, while
stimulating active interest.
It develops and provides
experience for change in
peoples attitudes, customs,
and habits in relation to
health and everyday living.
It should be recognized as the
basic function of all health
workers.
It takes place in the
home, in the school, and
in the community.
It is a cooperative effort
requiring all categories
of health personnel to
work together in close
teamwork with families,
groups, and the community.
It meets the needs,
interests, and problems
of the people affected.
It finds means and ways
of carrying out plans by
encouraging individual
and community
participation.
It is a slow, continuous
process that involves
constant changes and
revisions until
objectives are achieved.
Makes use of
supplementary aids and
devices to help with the
verbal instructions.
It utilizes community
resources by careful
evaluation of the different
services and resources found
in the community.
It is a creative process
requiring methods and
techniques with various
characteristics, not following
a rigid and flexible pattern.
It aims to help people make
use of their own efforts and
education to improve their
conditions of living,
It makes careful evaluation of
the planning, organization,
and implementation of all
health education programs and
activities.
THE COMMUNITY HEALTH NURSE

1.Bachelor of Science
in Nursing
2.Registered Nurse of
the Philippines
Planner/Programmer
1. Identifies needs, priorities, and problems
of individuals, families, and communities
2. Formulates municipal health plan in the
absence of a medical doctor
3. Interprets and implements nursing plan,
program policies, memoranda, and circular
for the concerned staff personnel
4. Provides technical assistance to rural
health midwives in health matters

1.Provides direct nursing
care to sick or
disabled in the home,
clinic, school, or
workplace
2.Develops the familys
capability to take care
of the sick, disabled,
or dependent member

1. Formulates individual, family, group,

and community-centered plan
2. Interprets and implements programs,
policies, memoranda, and circulars
3. Organizes work force, resources,
equipments, and supplies at local
level
4. Provides technical and administrative
support to Rural Health Midwives
(RHM)
5. Conducts regular supervisory visits
and meetings to different RHMs and
gives feedback on accomplishments
Community Organizer
1.Motivates and enhances
community participation in
terms of planning,
organizing, implementing,
and evaluating health
services
2.Initiates and participates
in community development
activities

1.Coordinates with
individuals, families, and
groups for health related
services provided by various
members of the health team
2.Coordinates nursing program
with other health programs
like environmental
sanitation, health
education, dental health,
and mental health
Trainer/Health Educator
1. Identifies and interprets training
needs of the RHMs, Barangay Health
Workers (BHW), and hilots
2. Conducts training for RHMs and
hilots on promotion and disease
prevention
3. Conducts pre and post-consultation
conferences for clinic clients; acts
as a resource speaker on health and
health-related services
4. Initiates the use of tri-media
(radio/TV, cinema plugs, and print
ads) for health education purposes
5. Conducts pre-marital counseling

1.Detects deviation from
health of individuals,
families, groups, and
communities through
contacts/visits with
them

1.Provides good
example of
healthful living
to the members of
the community

1.Motivates changes in
health behavior in
individuals, families,
groups, and communities
that also include
lifestyle in order to
promote and maintain
health
Recorder/Reporter/Statistician
1. Prepares and submits required reports and
records
2. Maintain adequate, accurate, and complete
recording and reporting
3. Reviews, validates, consolidates,
analyzes, and interprets all records and
reports
4. Prepares statistical data/chart and other
data presentation
Researcher
1. Participates in the conduct of survey
studies and researches on nursing and
health-related subjects
2. Coordinates with government and non-
government organization in the
implementation of studies/research
Community Organizing
Approaches to community devt.:
a. Welfare approach
b. Technological approach
c. Transformatory approah
Community Organizing
Principles of CO:
1. People esp. the oppressed,
exploited and deprived sectors are
most open to change, have the
capacity to change and are able to
bring about change. Hence , CO is
based on the ff:
A. Power must reside in the people
B. Devt. is from the people to the
people
C. People participation
Principles of CO
2.-must be based on the poorest
sectors of society. The solutions
of problems commonly shared by
these sectors must be focused on
collective organizations, planning
and action
3. should lead to self-reliant
communities
THE HRDP-COPAR PROCESS
1. PRE-ENTRY PHASE
2. ENNTRY PHASE
3. COMMUNITY STUDY/DIAGNOSIS
PHASE/RESEARCH PHASE
4.COMMUNITY ORGANIZATION AND
CAPABILITY-BUILDING PHASE
5. COMMUNITY ACTION PHASE
6. SUSTENANCE AND STRENGTHENING
PHASE
Classify the ff. CO activities
as to phase of COPAR each
belong:
1.Conducts community meetings to draw up
guidelines for the organization of CHO
2. Trains BHWs
3. Sets up of linkages/network and
referral systems
4. PIME of health services and or
community devt. Projects
5. Provides continuing education to
leaders or residents
6. Trains secondary leaders
7. Selects site for adoption
8. Identifies key leaders
Continued.
9. Develops criteria for site selection
10. Forms the core group
11.Conducts SALT
12.Selects members of the research team
13. Assists the research team in
presenting results during the general
assembly
14. Helps the people identifying the
community needs and health problems
15. Facilitates for the formulation and
ratification of the constitution and by-
laws of the organization
Public Health Programs
COMPREHENSIVE MATERNAL AND CHILD
HEALTH PROGRAM
1. EPI (Expanded Program on
Immunization)
2. CDD (Control of Diarrheal
Diseases)
3. CARI (Control of Acute
Respiratory Infections)
4. UFC (Under-Five Clinics)
5. MC (Maternal Care)
6. BF (Breastfeeding)
7. MRP (Malnutrition
Rehabilitation Program)
8. VAD ( Vitamin A Deficiency)
9. IDD/IDA (Iodine Deficiency
Disorders/ Iron Deficiency
Anemia)
10.FP (Family Planning)
EPI (EXPANDED PROGRAM ON IMMUNIZATION)
TARGET SETTING:
1.INFANTS 0-12 MONTHS
2.PREGNANT AND POST PARTUM WOMEN
3.SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS OLD

OBJECTIVES OF EPI:
TO REDUCE MORBIDITY AND MORTALITY
RATES AMONG INFANTS AND CHILDREN from
SIX CHILDHOOD IMMUNIZABLE DISEASE
ELEMENTS OF EPI:
1. TARGET SETTING
2. COLDCHAIN LOGISTIC MANAGEMENT- Vaccine
distribution through cold chain is
designed to ensure that the vaccine
were maintained under proper
environmental condition until the time
of administration.
3. IEC
4. Assessment and evaluation of Over-all
performance of the program
5. Surveillance and research studies
EXPANDED PROGRAM ON IMMUNIZATION
Vaccine Minimum Age
of 1
st
Dose
Number
of Doses
Minimum
Interval
Between
Doses
Reason
1. BCG
(Bacillus
Calmette
Guerin)
Birth or
anytime
after
birth
School
entrants
1 BCG is given
at the
earliest
possible age
protects
against the
possibility
of TB
infection
from the
other family
members
2. DPT
(Diphthe
ria
Pertusis
Tetanus)

6 weeks 3 4 weeks An early start
with DPT reduces
the chance of
severe pertussis
3. OPV
(Oral
Polio
Vaccine)

6 weeks 3 4 weeks The extent of
protection against
polio is increased
the earlier OPV is
given.
4.
Hepatiti
s B
6 weeks 3 4 weeks An early start of
Hepatitis B
reduces the chance
of being infected
and becoming a
carrier.
5.
Measles
9 months 1
At least 85% of
measles can be
prevented by
immunization at this
age.
CDD (CONTROL OF DIARRHEAL DISEASES)
MANAGEMENT OF THE PATIENT WITH DIARRHEA
A. NO DEHYDRATION
Condition well, alert
Mouth and Tongue moist
Eyes normal
Thirst drinks normally, not
thirsty
Tears present
Skin pinch goes back quickly
TREATMENT PLAN A- HOME TTT.


1.Give the child more fluids
than usual
use home fluid such as
cereal gruel
give ORESOL, plain water

THREE RULES FOR HOME
TREATMENT
2. Give the child plenty of food to prevent
undernutrition
continue to breastfeed frequently
if child is not breastfeed, give usual
milk
if child is less than 6 months and not
yet taking solid food, dilute milk for 2 days
if child is 6 months or older and
already taking solid food, give cereal or
other starchy food mixed with vegetables, meat
or fish; give fresh fruit juice or mashed
banana to provide potassium; feed child at
least 6 times a day. After diarrhea stops,
give an extra meal each day for two weeks.
3. Take the child to the health
worker if the child does not get
better in 3 days or develops any
of the following:
many watery stools
repeated vomiting
marked thirst
eating or drinking poorly
fever
blood in the stool
ORESOL TREATMENT
Age Amount of ORS
to give after
each loose
stool
Amount of ORS to
provide for use
at home

< 24
months
50-
100 ml.
500
ml./day

2 10
years
100-
200 ml.
1000
ml./day

10
years
up
As much as
wanted
2000
ml./day
B. SOME DEHYDRATION
Condition restless, irritable
Mouth and Tongue dry
Eyes sunken
Thirst thirsty, drinks eagerly
Tears absent
Skin pinch goes back slowly
WEIGH PT, TTT. PLAN B
APPROX. AMT. OF ORS- TO GIVE IN 1
ST
4 HRS
AGE WEIGHT
KG
ORS
ML
4 MOS. 5 200-400
4-11MOS 5-7.9 400-600
12-23MOS 8-10.9 600-800
2-4YRS 11-15.9 800-1200
5-14YRS

16-29.9

1200-2200
15 YRS UP 30 UP 2200-4000
1. If the child wants more ORS than shown, give
more
2. Continue breastfeeding
3. For infants below 6 mos. who are not
breastfeed, give 100-200 ml clean water
during the period
4. For a child less than 2 years give a
teaspoonful every 1-2 min.
5. If the child vomits, wait for 10 min, then
continue giving ORS, 1 tbsp/2-3 min
6. If the childs eyelids become puffy, stop ORS
, give plain water or breast milk, Resume ORS
when puffiness is gone
7. If ( -) signs of DHN- shift to Plan A
Use of Drugs during Diarrhea
Antibiotics should only be
used for dysentery and
suspected cholera
Antiparasitic drugs should
only be used for amoebiasis
and giardiasis

C. SEVERE DEHYDRATION
Condition lethargic or unconscious;
floppy
Eyes very sunken and dry
Tears absent
Mouth and tongue very dry
Thirst- drinks poorly or not able to
drink
Skin pinch goes back very slowly
TTT PLAN C- ttt. quickly
1.Bring pt. to hospital
2. IVF Lactated Ringers Solution or
Normal Saline
3.Re-assess pt. Every 1-2 hrs
4. Give ORS as soon as the pt. can drink
ROLE OF BREASTFEEDING IN THE CONTROL OF
DIARRHEAL DISEASES PROGRAM
1.Two problems in CDD
1. High child mortality due
to diarrhea
2. High diarrhea incidence
among under fives
2. Highest incidence in age 6 23
months

3. Highest mortality in the first 2
years of life

4. Main causes of death in
diarrhea :
DEHYDRATION
MALNUTRITION

5. To prevent dehydration, give home
fluids am as soon as diarrhea
starts and if dehydration is
present, rehydrate early,
correctly and effectively by
giving ORS

6. For undernutrition, continue
feeding during diarrhea especially
breastfeeding.
7. Interventions to prevent diarrhea
1. breastfeeding

2. improved weaning practices
3. use of plenty of clean
water
4. hand washing
5. use of latrines
6. proper disposal of stools of
small children
7. measles immunization
8. Risk of severe diarrhea 10-30x
higher in bottle fed infants than
in breastfed infants.
9. Advantages of breastfeeding in
relation to CDD
1.Breast milk is sterile
2.Presence of antibodies
protection against diarrhea
3.Intestinal Flora in BF infants
prevents growth of diarrhea
causing bacteria.
10.Breastfeeding decreases
incidence rate by 8-20% and
mortality by 24-27% in infants
under 6 months of age.
11.When to wean?
4-6 months soft mashed foods
2x a day
6 months variety of foods 4x
a day
12.Summary of WHO-CDD recommended
strategies to prevent diarrhea
1. Improved Nutrition
- exclusive breastfeeding for the first
4-6 months of life and partially for
at least one year.
- Improved weaning practices
2.Use of safe water
- collecting plenty of water from the
cleanest source
- protecting water from contamination at
the source and in the home
3.Good personal and domestic
hygiene
- handwashing
- use of latrines
- proper disposal of stools of
young children
4.Measles immunization

CARI (CONTROL OF ACUTE RESPIRATORY INFECTIONS)
CLASSIFICATION:
A. NO PNEUMONIA: COUGH OR COLD
1. No chest in drawing
2. No fast breathing ( <2 mos- <60/min,2-12 mos.
less than 50 per minute; 12 mos. 5 years less than
40 per minute)
TREATMENT:
1. If coughing more than 30 days, refer for assessment
2. Assess and treat ear problems/sore throat if present
3. Advise mother to give home care
4.Treat fever/wheezing if present
HOME CARE:
1. FEED THE CHILD
1. Feed the child during illness
2. Increase feeding after illness
3. Clear the nose if it interferes with feeding

2. INCREASE FLUIDS
1. offer the child extra to drink
2. Increase breastfeeding
3. SOOTHE THE THROAT AND
RELIEVE THE COUGH WITH A SAFE
REMEDY
4. WATCH FOR THE FOLLOWING SIGNS
AND SYMPTOMS AND RETURN
QUICKLY IF THEY OCCUR
1. Breathing becomes difficult
2. Breathing becomes fast
3. Child is not able to drink
4. Child becomes sicker

B. PNEUMONIA
1. No chest in drawing
2. Fast breathing ( less than 2 mos- 60/min or more
; 2-12 mos. 50/min or more; 12 mos. 5 years
40/min or more)
TREATMENT
1.Advise mother to give home care
2.Give an antibiotic
3.Treat fever/wheezing if present
4.If the childs condition gets worst,refer urgently to
hospital; if improving, finish 5 days of antibiotic.

ANTIBIOTICS RECOMMENDED BY WHO
*Co-trimoxazole,
*Amoxycillin, Ampicillin, (p.o)
*or Procaine penicillin (I.M.)
C. Severe Pneumonia
Chest indrawing
Nasal flaring
Grunting ( short sounds made with
the voice)
Cyanosis
TTT.
1. Refer urgently to hospital
2. Treat fever ( paracetamol),
wheezing ( salbutamol)
D. Very Severe Disease

Not able to drink
Convulsions
Abnormally sleepy or difficult to
wake
Stridor in calm child
Severe undernutrition
TTT.
Refer urgently to hospital
ASSESSMENT OF RESPIRATORY INFECTION
ASK THE MOTHER:
1. How old is the child?
2. Is the child coughing? For how long?
3. Age 2 months up to 5 years: Is the child able to
drink?
Age less than 2 months: Has the young infant
stopped feeding well?
4. Has the child had fever? For how long?
5. Has the child had convulsions?
LOOK, LISTEN:
1. Count the breaths in one minute.





2. Look for chest in drawing.
3. Look and listen for stridor.
Stridor occurs when there is a narrowing of the larynx,
trachea or epiglottis which interferes with air entering
the lungs.
Age0 Fast Breathing
Less than 2 months 60/minute or more
2 months 12 months 50/minute or more
12 months 5 years 40/minute or more
4. Look and listen for wheeze
Wheeze is a soft musical noise which
shows signs that breathing out(exhale) is
difficult.
5. See if the child is abnormally sleepy or
difficult to wake. (Suspect meningitis)
6. Feel for fever or low body temperature.
7. Check for severe under nutrition
MANAGEMENT OF A CHILD WITH
AN EAR PROBLEM
Classification of Ear Infection
A. MASTOIDITIS tender swelling behind
the ear (in infants, swelling may be
above the ear)
TREATMENT
1. Antibiotics
2.Surgical intervention
B. ACUTE EAR INFECTION pus draining
from the ear for less than 2 weeks,
ear pain, red, immobile ear drum
(Acute Otitis Media)
TREATMENT
1.Cotrimoxazole,Amoxycillin,or
Ampicillin
2.Dry the ear by wicking
C. CHRONIC EAR INFECTION pus draining from
the ear for more than 2 weeks (Chronic Otitis
Media)
TREATMENT
Most important & effective treatment: Keep
the ear dry by wicking.
GParacetamol maybe given for pain or high
fever.
GPrecautions for a child with a draining ear:
1.Do not leave anything in the ear such as
cotton, wool between wicking treatments.
2.Do not put oil or any other fluid into the
ear.
3.Do not let the child go swimming or get water
in the ear.
Maternal and Child Health
Nursing

Philosophy
Pregnancy, labor and delivery and
puerperium are part of the continuum
of the total life cycle
Personal, cultural and religious
attitudes and beliefs influence the
meaning of pregnancy for individuals
and make each experience unique
MCN is FAMILY CENTERED- the
father is as important as the mother
Goals
To ensure that expectant mother and
nursing mother maintain good health,
learn the art of child care, has a
normal delivery and bear healthy
children

That every child lives and grows up in
a family unit with love and security,
in healthy surroundings, receives
adequate nourishment, health
supervision and efficient medical
attention and is taught the elements
of healthy living
Classification of pregnant
women
Normal healthy pregnancy
With mild complications- frequent
home visits
With serious or potentially serious
cx referred to most skilled
source of medical and hospital care
Home Based Mothers Record (
HBMR )

Tool used when rendering prenatal
care
containing risk factors and danger
signs
*Risk Factors
145 cm tall ( 4 ft & 9 inches)
Below 18 yrs old, above 35 yrs old
Have had 4 pregnancies
With TB, goiter, heart disease, DM,
bronchial asthma, severe anemia
Last baby born was less than 2 years ago
Previous cesarian section delivery
History of 2 or more abortions, difficult
delivery, given birth to twins , 2 or more
babies born before EDD, stillbirth
Weighs less than 45 kgs. or more than 80
kgs.


*Danger Signs

1. any type of vaginal bleeding
2. headache, dizziness, blurred
vision
3. puffiness of face and hands
4. pallor

Prenatal Care
Schedule of Visits
1
st
as early as pregnancy, 1
st
trimester

2
nd
- 2
nd
trimester

3
rd
& subsequent visits - 3
rd
trimester

More frequent visits for those at risk
with cx
TETANUS TOXOID IMMUNIZATION SCHEDULE FOR WOMEN
Vaccine Minimum Age
Interval
Percent
Protecte
d
Duration of
Protection

TT1
As early as
possible during
pregnancy

80%


TT2
At least 4
weeks later

80%
Infants born
to the mother
will be
protected
from neonatal
tetanus.
Gives 3 years
protection for
the mother
from tetanus.

TT3
At least 6
months
later

90%
Infants born to the
mother will be
protected
from neonatal
tetanus.
Gives 5 years
protection for the
mother.

TT4

At least 1
year later

99%

Gives 10
protectio
n for the
mother

TT5 At least 1
year later
99% Gives
lifetime
protection
for
the mother.
All infants
born to
that mother
will be
protected.
Dose:0.5ml
Route: Intramuscularly
Site: Right or Left Deltoid/Buttocks
Components of Prenatal
Visits
History taking
Determination of obstetrical
score- G, P, TPAL,AOG,EDD
U/A for Proteinuria, glycosuria
and infxtn
Dental exam
Wt. Ht. BP taking
Exam of conjunctiva and palms for
pallor
Abdominal exam - fundic ht,
Leopolds maneuver and FHT
Exam of breasts, face, hands and feet
for edema and neck for thyroid
enlargement
Health teachings- nutrition, personal
hygiene, common complaints
Tetanus toxoid immunization
Iron supplementation from 5
th
mo. of
pregnancy - 2 mos. Postpartum
In goiter endemic areas iodized
capsule once a year
In malaria infested areas- prophylactic
Chloroquine ( 150 mg/tab ) 2 tabs/ wk
for the whole duration of pregnancy


UNDER FIVE CLINIC

The first five years of life form
the foundations of the childs physical
and mental growth and development.
Studies have shown the mortality and
morbidity are high among this age group.
The Department of Health established the
Under Five Clinic Program to address
this problem.
PROGRAM OBJECTIVES AND GOALS:

Monitor growth and development of

the child until 5 years of age.

Identify factors that may hinder
the growth and development of the
child.
ACTIVITIES AND STRATEGIES:
1. Regular height and weight determination/
monitoring until 5 years old.
0-1 year old=monthly
1 year old and above =quarterly
2. Recording of immunization, vitamins
supplementation,
deworming and feeding.
3. Provision of IEC materials (ex. Posters,
charts, toys) that promote and enhance childs
proper growth and development.
4. Provision of a safe and learning oriented
environment for the child.
5. Monitoring and Evaluation.

BREASTFEEDING/ LACTATION MANAGEMENT EDUCATION
TRAINING
Breastfeeding practices has been proved to
be very beneficial to both mother and baby
thus the creation of the following laws
support the full implementation of this
program:
Executive Order 51
Republic Act 7600
The Rooming-In and Breastfeeding Act of
1992

PROGRAM OBJECTIVES AND GOALS:
=Protection and promotion of
breastfeeding and lactation
management education training
ACTIVITIES AND STRATEGIES:
1.FULL IMPLEMENTATION OF LAWS
SUPPORTING THE PROGRAM

A. EO 51 THE MILK CODE protection and
promotion of breastfeeding to ensure
the safe and adequate nutrition of
infants through regulation of
marketing of infant foods and related
products. (e.g. breast milk
substitutes, infant formulas, feeding
bottles, treats etc. )
B. RA 7600 THE ROOMING IN and
BREASTFEEDING ACT of 1992
=An act providing incentives to government
and private health institutions promoting
and practicing rooming-in and breast-
feeding.
=Provision for human milk bank.
=Information, education and re-education
drive
=Sanction and Regulation

2. CONDUCT ORIENTATION/ADVOCACY MEETINGS
TO HOSPITAL/ COMMUNITY.
ADVANTAGES OF BREASTFEEDING:

MOTHER
Oxytocin help the uterus
contracts
Uterine involution
Reduce incidence of Breast Cancer
Promote Maternal-Infant Bonding
Form of Family planning Method
(Lactational Amenorrhea)
BABY
Provides Antibodies
Contains Lactoferin (binds
with Iron)
Leukocytes
Contains Bifidus factor-
promotes growth of the
Lactobacillus-inhibits the
growth of pathogenic bacilli

POSITIONS IN BF THE BABY:
1. Cradle Hold = head and neck are supported
2. Football Hold
3. Side Lying Position
BEST FOR BABIES
REDUCE INCIDENCE OF ALLERGENS
ECONOMICAL
ANTIBODIES PRESENT
STOOL INOFFENSIVE (GOLDEN YELLOW)
EMPERATURE ALWAYS IDEAL
FRESH MILK NEVER GOES OFF
EMOTIONALLY BONDING
EASY ONCE ESTABLISHED
DIGESTED EASILY
IMMEDIATELY AVAILABLE
NUTRITIONALLY OPTIMAL
GASTROENTERITIS GREATLY REDUCED
GARANTISADONG PAMBATA (GP)
Garantisadong Pambata is a biannual week
long delivery of a package of health services
to children between the ages of 0-59 months
old with the purpose of reducing morbidity and
mortality among under fives through the
promotion of positive Filipino values for
proper child growth and development.

1. WHAT ARE THE HEALTH SERVICES OFFERED IN
GP AND WHO ARE THE TARGETS?
GP offers the following:
1.1 Routine Health Services:

Health
Service
Dosage Route of
Administr
ation
Target
Populatio
n
Vitamin A
capsule
200,000 IU
or 1
capsule
100,000 IU
or cap
or 3 drops
Orally
by drops
12-59
months
old,
nationwid
e
9-12
month old
infants
receiving
AMV
nationwid
e
Ferrous
Sulfate
(25 mg.
Elemental
Iron per
ml; 30 ml.
Bottle as
taken home
medicine
with
instruction
s)


0.3ml(2-6
mos)
once a day

0.6ml(6-
11mos) once
a day


Orally
by
drops


2-11 months old
infants in
Mindanao area,
including
evacuation
centers in
armed conflict
areas.

Routine
Immuniza
tion
-BCG*

-DPT*

-OPV*

-AMV*
-Hepa B (if
available)




0.05ml

0.5ml

2 drops
0.5ml

0.5ml



Intradermal on
right deltoid
Intramuscularly
on anterior thigh
Orally
Subcutaneously on
deltoid
Intramuscularly
Nationwide


0-11 mos


0-11 mos

0-11 mos
9-11 mos

0-11 mos
Deworming
drug
(if
available
)




1
tablet
as
single
dose




Orally



36-59 mos,
nationwide
Weighing 0-59 mos,
nationwide
* The child should not have
received megadose of Vit. A above
the recommended dosage within the
past 4 weeks except if the child
has measles or signs and symptoms
of Vit A. deficiency.
** For any child between 12-23
months, who missed any of his
routine immunization, the health
worker should give the child the
necessary antigen to complete FIC
and shall be recorded as such.
GARANTISADONG PAMBATA
Sangkap Pinoy

- Vitamin A, Iron and Iodine
-Sources: green leafy and yellow
vegetables, fruits, liver,
seafoods, iodized salt, pan de
bida and other fortified foods.
These micronutrients are not
produced by the body, and must be
taken in the food we eat;
essential in the normal process of
growth and development:
a) Helps the body to regulate itself
b) Necessary in energy metabolism
c) Vital in brain cell formation and mental
development
d) Necessary in the body immune system to
protect the body from severe infection.
e) Eating Sangkap Pinoy-rich foods can prevent
and control:
1. Protein Energy Malnutrition
2. Vitamin A Deficiency
3. Iron Deficiency Anemia
4. Iodine Deficiency Disorder

BREASTFEEDING
Breast milk is best for babies up
to 2 years old. Exclusive
breastfeeding is recommended for the
first six months of life. At about
six months, give carefully selected
nutritious foods as supplements.
Breastfeeding provides physical
and psychological benefits for
children and mothers as well as
economic benefits for families and
societies.
BENEFITS :
For infants
a.Provides a nutritional complete
food for the young infant.
b.Strengthens the infants immune
system, preventing many infections.
c.Safely rehydrates and provides
essential nutrients to a sick
child, especially to those
suffering from diarrheal diseases.
d.Reduces the infants exposure to
infection.
For the Mother
e. Reduces a womans risk of excessive
blood loss after birth
f. Provides a natural method of delaying
pregnancies.
g. Reduces the risk of ovarian and breast
cancers and osteoporosis.
For the Family and Community
h. Conserves funds that otherwise would
be spent on breast milk substitute,
supplies and fuel to prepare them.
i. Saves medical costs to families and
governments by preventing illnesses
and by providing immediate postpartum
contraception.
COMPLEMENTARY FEEDING FOR BABIES 6-11 MONTHS
OLD
What are Complementary Foods?
a.foods introduced to the child at the
age
6 months to supplement breastmilk
a.given progressively until the child is
used to three meals and in-between
feedings at the age of one year.
Why is there a Need to Give Complementary
Foods?
c.breastmilk can be a single source of
nourishment from birth up to six months
of life.
c. The childs demands for food increases
as he grows older and breastmilk alone
is not enough to meet his increased
nutritional needs for rapid growth and
development
d. Breastmilk should be supplemented with
other foods so that the child can get
additional nutrients
e. Introduction of complementary foods
will accustom him to new foods that
will also provide additional nutrients
to make him grow well
f. Breastfeeding, however, should
continue for as long as the mother is
able and has milk which could be as
long as two years

How to Give Complementary Foods for
Babies 6-11 Months Old?
a.Prepare mixture of thick lugao/ cooked
rice, soft cooked vegetables. Egg yolk,
mashed beans, flaked fish/chicken/ground
meat and oil.
b.Give mixture by teaspoons 2-4 times
daily, increasing the amount of
teaspoons and number of feeding until
the full recommended amount is consumed
c.Give bite-sized fruit separately
d.Give egg alone or combine with above
food mixture

FAMILY PLANNING
The Philippine Family Planning Program is a
national program that systematically provides
information and services needed by women of
reproductive age to plan their families
according to their own beliefs and
circumstances.
GOALS AND OBJECTIVES:
Universal access to family planning
information, education and services.
MISSION:
To provide the means and opportunities by
which married couples of reproductive age
desirous of spacing and limiting their
pregnancies can realize their reproductive
goals.

TYPES OF METHODS:
A NATURAL METHODS
1. Calendar or Rhythm Method
2. Basal Body Temperature Method
3. Cervical Mucus Method
4. Sympto-Thermal Method
5. Lactational Amennorhea
B. ARTIFICIAL METHODS
I. CHEMICAL METHODS
1.Ovulation suppressant such as PILLS
2. Depo-Provera
3. Spermicidals
4. Implant
II. MECHANICAL METHODS
1. Male and Female Condom
2. Intrauterine Device
3. Cervical Cap/Diaphragm
III. SURGICAL METHODS
1. Vasectomy
2. Tubal Ligation
WARNING SIGNS
Pills
Abdominal pain ( severe)
Chest pain ( severe)
Headache ( severe)
Eye problems ( blurred vision,
flashing lights, blindness)
Severe leg pain ( calf or thigh )
Others: depression, jaundice, brest
lumps
WARNING SIGNS
IUD
*Period late, no symptoms of
pregnancy, abnormal bleeding or
spotting
*Abdominal pain during intercourse
*Infection or abnormal vaginal
discharge
*Not feeling well, has fever or
chills
*String is missing or has become
shorter or longer
WARNING SIGNS
INJECTABLES
Dizziness
Severe headache
Heavy bleeding
WARNING SIGNS
BTL
Fever
Weakness
Rapid pulse
Persistent abdominal pain
Vomiting
Dizziness
Pus or tenderness at incision site
Amenorrhea


WARNING SIGNS
Vasectomy

Fever
Scrotal blood clots or excessive
swelling

Nutrition
Goal
To improve the nutritional
status, productivity and
quality of life of the
population thru adoption of
desirable dietary practices
and healthy lifestyle
Objectives
Increase food and dietary
energy intake of the average
Filipino
Prevent nutritional
deficiency diseases and
nutrition-related chronic
degenerative diseases
Promote a healthy well-
balanced diet
Promote food safety

Nutrition is a state of well-being
achieved by eating the right food in
every meal and the proper utilization of
the nutrients by the body.
Proper nutrition is important because:
it helps in the development of the brain,
especially during the first years of the
childs life.
It speeds up the growth and development of
the body including the formation of teeth and
bones
It helps fight infection and diseases
It speeds up the recovery of a sick person
It makes people happy and productive
Proper nutrition is eating a balanced diet in
every meal
Balanced diet is made up of a
combination of the 3 basic
groups eaten in correct
amounts. The grouping
serves as a guide in
selecting and planning
everyday meals for the
family.

THE THREE (3) BASIC FOOD GROUPS ARE:
1. Body building food which are rich
in protein and needed by the body for:
< normal growth and repair of worn-out
body tissues
< supplying additional energy
< fighting infections
< Examples of protein-rich food are:
fish; pork; chicken; beef; cheese;
butter; kidney beans; mongo; peanuts;
bean curd; shrimp; clams
2. Energy-giving food which are rich in
carbohydrates and fats and needed by the
body for:
< providing enough energy to make the
body strong
< Examples of energy-giving food are:
rice; corn; bread; cassava; sweet
potato; banana; sugar cane; honey; lard;
cooking oil; coconut milk; margarine;
butter
3. Body-regulating food which are
rich in Vitamins and minerals and
needed by the body for:
< normal development of the eyes,
skin, hair, bones, and teeth
< increased protection against
diseases
< Examples of body-regulating food
are: tisa; ripe papaya; mango; guava;
yellow corn; banana; orange; squash;
carrot

Low Fat Tips
1. Eat at least 3 meals/day
2. Eat more fruits, vegetables, grain
and cereals e.g. rice, noodles and
potato
3. If you use butter or margarine, pat
it on thinly
4. Choose low fat substitute i.e.
replace whole milk with skimmed
milk, low fat cheese
5. Become a label reader. Look for
foods that have less than 5 g /100
g of product
6. Eat less high fat snacks and take
away potato chips, sausage rolls
or breaded meats
7. Cut all visible fat from meat,
remove skin from chicken fat
drippings and cream sauces
8. Aim for thin palm-size serving of
lean meat, poultry and fish/ meal
9. Grill, bake, steam, stew, stir fry
and microwave, try not to fry
10.Drink lots of water all day-
its a food quencher
Ambulate
Start by walking for 10 min.
Build up to 30-40 min/day
Go for 3-4 times / week of any
exercise you enjoy
Filipino Food Pyramid
Drink a lot- water, clear broth
Eat most rice, root crops, corn,
noodles, bread and cereals
Eat more vegetables, green
salads, fruits or juices
Eat some fish, poultry, dry
beans, nuts, eggs, lean meats, low
fat dairy
Eat a little fats, oils, sugar,
salt

IMPORTANT VITAMINS AND MINERALS
VITAMINS FUNCTIONS
Vitamin A

Maintain normal vision,
skin health, bone
and tooth growth
reproduction and
immune function;
prevents
xerophthalmia.
Food sources:
Breastmilk;poultry;eggs
; liver;
meat;carrots;squash;
papaya;mango;tiesa;
malunggay;kangkong;
camotetops; ampalaya
tops
Thiamine
Help release
energy from
nutrients;
support normal
appetite and
nerve function,
prevent beri-
beri.
Riboflavi
n
Helps release energy from
nutrients, support skin
health, prevent deficiency
manifested by cracks and
redness at corners of mouth;
inflammation of the tongue and
dermatitis.
Niacin
Help release energy from
nutrients; support skin,
nervous and digestive system,
prevents pellagra.
Biotin Help energy and
amino acid
metabolism; help
in the synthesis
of fat glycogen.
Pantothen
ic
Help in energy
metabolism.
Folic acid
Help in the formation of
DNA and new blood cells
including red blood cells;
prevent anemia and some
amino acids.
Vitamin B
12
Help in the formation of
the new cells; maintain
nerve cells, assist in the
metabolism of fatty acids
and amino acids.
Vitamin C
Help in the formation of
protein, collagen, bone,
teeth cartilage, skin and
scar tissue; facilitate in
the absorption of iron from
the gastrointestinal tract;
involve in amino acid
metabolism; increase
resistance to infection,
prevent scurvy.
Food sources:
Guava;pomelo;lemon;orange;
calamansi; tomato; cashew

Vitamin D
Help in the
mineralization of
bones by enhancing
absorption of
calcium.
Vitamin E
Strong anti-oxidant; help
prevent arteriosclerosis;
protect neuro-muscular
system; important for normal
immune function.
Vitamin K
Involve in the synthesis of
blood clotting proteins and a
bone protein that regulates
blood calcium level.
MINERALS FUNCTIONS
Calcium
Mineralization of bones and
teeth, regulator of many of the
bodys biochemical processes,
involve in blood clotting,
muscle contraction and
relaxation, nerve functioning,
blood pressure and immune
defenses.
Chloride
Maintain normal fluid and
electrolyte balance.
Chromium
Work with insulin and is
required for release of
energy from glucose.
Copper
Necessary for absorption
and use of iron in the
formation of hemoglobin.
Fluoride
Involve in the formation of
bones and teeth; prevents tooth
decay.
Iodine
As part of the two thyroid
hormones, iodine regulates
growth, physical and mental
development and metabolic
rate.
Aids in the development of the
brain and body especially in
unborn babies
Food sources:
Seaweeds;squids;shrimps;crabs;
fermented
shrimp;mussels;snails; dried
dilis; fish
Iron
Essential in the
formation of blood.
It is involved in the
transport and storage
of oxygen in the
blood and is a co-
factor bound to
several non-hemo
enzymes required for
the proper
functioning of cells.
Food sources:
Pork; beef; chicken;
liver and other
internal organs;
dried dilis; shrimp;
eggs; pechay;
saluyot; alugbati
Magnesium
Mineralization of
bones and teeth,
building of
proteins, normal
muscle
contraction, nerve
impulse
transmission,
maintenance of
teeth and
functioning of
immune system.
Manganese Facilitate many
cell processes.
Molybdenum Facilitate many
cell processes.
Phosphoru
s
Mineralization of
bones and teeth;
part of every Cell;
used in energy
transfer and
maintenance of acid-
base balance.
Selenium Work with vitamin E
to protect body
compound from
oxidation.
Selenium Work with vitamin E
to protect body
compound from
oxidation.
Sodium Maintain normal fluid
and electrolyte
balance, assists
nerve impulse
insulin.
Sulfur Integral part of
vitamins, biotin and
thiamine as well as
the hormone.
Zinc Essential for normal
growth, development
reproduction and
immunity.
MALNUTRITION
MALNUTRITION
An abnormal condition of the
body resulting from the lack
or excess of one or more
nutrients like protein,
carbohydrates, fats,
vitamins and minerals.
PRIMARY CAUSE: POVERTY
1. Lack of money to buy food
Majority of the victims of malnutrition
comes from families of farmers,
fisherfolk, and laborers who cannot
afford to buy nutritious foods.
2. Lack of food supply
3. Lack of information on proper
nutrition and food values

SECONDARY CAUSES
1. Early weaning of child and improper
introduction of supplementary food
2. Incomplete immunization of babies and
children
3. Bad eating habits
4. Poor hygiene and environmental
sanitation:
a. lack of potable water
b. lack of sanitary toilet
c. poor waste disposal
FORMS OF MALNUTRTION

1. Protein-Energy Malnutrition (PEM)
is a nutritional problem
resulting from a prolonged
inadequate intake of body-
building and/or energy-giving
food in the diet.
Kinds:
a.)MARASMUS
b.) KWASHIORKOR
a) MARASMUS
This child does not get the right
amount and kind of energy food.
She/He:
< is always hungry
< has the face of an old man
< is very thin
< easily gets sick
< looks weak
THIS CHILD IS JUST SKIN AND BONES!

b) KWASHIORKOR
This child does not get enough body-building
food, although she/he may be getting enough
energy. She/He:
< has swollen face, hands, and feet
< easily gets sick
< has dry, thin, pale hair
< has sores on the skin
< has thin upper arms
< looks sad
< has dry skin
< is underweight
THIS CHILD IS SKIN, BONES, AND WATER!
2. VITAMIN A DEFICIENCY (VAD)
a condition in which the level of
Vitamin A in the body is low.
Causes:
not eating enough foods rich in
vitamin A e.g. yellow vegetables and
yellow fruits
lack of fat or oil in the diet
which help the body absorb Vitamin
A.
poor absorption or rapid
utilization of Vitamin A during
illness

Eye Signs
night blindness (early stage); total
blindness (later stage)
bitots spot (foamy soapsuds-like
spots on white part of the eye)
dry, hazy and rough appearing cornea
crater-like defect on cornea
softened cornea; sometimes bulging
Other Manifestations
increased cases of childhood sickness,
and death and decreased resistance to
infection
susceptibility to childhood
malnutrition and infection (measles,
diarrhea and pneumonia)
Prevention
eating foods rich in Vitamin A, such
as liver, eggs, milk, crab meat,
cheese, dilis, malunggay, gabi
leaves, kamote tops, kangkong,
alugbati, saluyot, carrots, squash,
ripe mango, including fats and oils
breastfeeding the child
immunizing the child
taking correct dose of Vitamin A
capsules as prescribed
VAD is most common in children
suffering from PEM and other
infectious diseases. Bottle-
fed infants are also at risk of
VAD especially if the milk
formula used is not fortified
with Vitamin A.
Common among preschoolers and
infants
( FNRI)

SCHEDULE FOR RECEIVING VITAMIN A SUPPLEMENT TO INFANTS
PRESCHOOLERS AND MOTHERS
Schedule Infants(6-
11 mos)
Preschoole
rs(12-83
mos)
Post
Partum
Mother
Give 1
Dose
100,000 IU 200,000 IU 200,000 IU
Within one
month
Give after
6 months
High risk
Condition
Present
100,000 IU 200,000 IU After
delivery
of each
child only
SCHEDULE FOR TREATMENT OF VITAMIN A DEFICIENCY
Schedule Infants (6-11
mos.)
Preschoolers
(12-83 mos.)
Give Today 100,000 IU 200,000 IU
Give Tomorrow 100,000 IU 200,000 IU
Give After 2
Weeks
100,000 IU 200,000 IU
3. ANEMIA - a condition characterized by the
lack of iron in the body resulting in
paleness.
S/S: paleness of the eyelids, inner
cheeks, palms and nailbeds; frequent
dizziness and easy fatigability
Common cause: inadequate intake of food
rich in iron ; can also be caused by blood
loss during menstruation, pregnancy and
parasitic infections.
Prevention:

Eating iron-rich food such as liver and
other internal organs; green leafy
vegetables; and foods rich in Vitamin C

Prevention of Iron
Deficiency
Recommended Iron
Requirements
Dosage
Infants ( 6-12 months) 0.7 mg. Daily
Children ( 12-59
months)
1 mg daily
Treatment of Iron Deficiency
Dosage
Children 0-59 month 3-6 mg./kg. Body
wt./day
4.GOITER
- enlargement of thyroid gland
due to lack of iodine in the
body.

-common in areas where the
iodine content in the soil,
water and food are deficient.


- Effect of Iodine deficiency to
fetus:
may be born mentally and
physically retarded.
- Goiter can be prevented by:
< daily intake of food rich in
iodine
< use of iodized salt
Iodine Supplementation
Dosage
Children 0-59 months
( in endemic areas)
Iodine capsules
(200mg) potassium
iodate in oil orally
once a year.
CHECKING THE NUTRITIONAL STATUS
WEIGHT
1.1 Weight is a very important
indicator of a persons nutritional status.
It is measured in relation to either AGE or
HEIGHT. Normally, a well-nourished child
gains weight as she/he grows older.
1.2 On the other hand, a malnourished
child either decreases in weight or
maintains his/her previous weight.
1.3 The nutritional status of a person
can also be checked by looking for specific
signs and symptoms of the different forms of
nutritional deficiencies.
IMPORTANT:
1.1Weigh the child in minimal
clothing, with no shoes, clogs or
slippers on; and hands and pockets
free of objects.
1.2The same type of scale should be
used for subsequent weighing.
1.3Observe the proper maintenance of
the weighing scale.
1.4Do not use a bathroom scale to
avoid inaccurate readings of weight.

< BRING THE MALNOURISHED CHILD TOGETHER WITH
THE PARENTS TO THE HEALTH CENTER FOR
PROPER NUTRITIONAL ADVICE AND TREATMENT.
< VISIT THE MALNOURISHED CHILD REGULARLY
AND MONITOR HIS/HER WEIGHT.
< ADVISE PARENTS AND THE WHOLE COMMUNITY
ABOUT BETTER NUTRITION AND PROPER FEEDING
ESPECIALLY OF INFANTS, CHILDREN AND SICK
PERSONS.
NUTRITIONAL GUIDELINES
1. Eat a variety of food everyday.
2. Breastfeed infants exclusively from
birth to 4-6 months, and then, give
appropriate foods while continuing
breastfeeding.
3. Maintain childrens normal growth
through proper diet and monitor their
growth regularly.
4. Consume fish, lean meat, poultry or
dried beans.
5. Eat more vegetables, fruits, and root
crops.
6. Eat foods cooked in edible/cooking oil
daily.
7. Consume milk, milk products or other
calcium-rich foods such as small fish
and dark green leafy vegetables
everyday. Use iodized salt, but avoid
excessive intake of salty foods.
8. Use iodized salt, avoid excessive
intake of salty foods
9. Eat clean and safe food.
10. For a healthy lifestyle and good
nutrition, exercise regularly, do not
smoke, avoid drinking alcoholic
beverages.

AIMS AND RATIONALE OF EACH OF THE
GUIDELINES

Guideline No. 1 is intended to give
the message that no single food
provides all the nutrients the
body needs. Choosing different
kinds of foods from all food
groups is the first step to obtain
a well-balanced diet. This will
help correct the common practice
of confining of choice to a few
kinds of foods, resulting in an
unbalanced diet.
Guidelines No.2 is entitled to promote
exclusive breastfeeding from birth to 4-6
months and to encourage the continuance of
breastfeeding for as long as two years or
longer. This is to ensure a complete and
safe food for the newborn and the growing
infant besides imparting the other benefits
of breastfeeding. The guideline also
strongly advocates the giving of appropriate
complementary food in addition to breast
milk once the infant is ready for solid
foods at 6 months. Malnutrition most
commonly occurs between the age of 6 months
to 2 years, therefore there is a need to pay
close attention to feeding the child
properly during this very critical period.

Guideline No. 3 gives advise on
proper feeding of children. In
addition, the guideline promotes
regular weighing to monitor the
growth of children, as it is a
simple way to assess nutritional
status.

Guidelines No. 4,5,6 and 7 are intended to
correct the deficiencies in the current
dietary pattern of Filipinos. Including fish,
lean meat, poultry and dried beans, which will
provide good quality protein and dietary
energy, as well as iron and zinc, key
nutrients lacking in the diet of Filipinos as
a whole. Eating more vegetables, fruits and
root crops will supply the much needed
vitamins, minerals and dietary fiber that are
deficient in our diet. In addition, they
provide defense against chronic degenerative
diseases. Including foods cooked in edible
oils will provide additional dietary energy as
a partial remedy to calorie deficiency of the
average Filipino. Including milk and other
calcium-rich foods in the diet will serve to
supply not only calcium for healthy bones but
to provide high quality protein and other
nutrients for growth.
Guideline No. 8 promotes the
use of iodized salt to prevent
iodine deficiency, which is a
major cause of mental and
physical underdevelopment in
the country. At the same
time, the guideline warns
against excessive intake of
salty foods as a hedge against
hypertension, particularly
among high-risk individuals.
Guideline No.9 is
intended to prevent
food-borne diseases.
It explains the various
sources of
contamination of our
food and simple ways to
prevent it from
occurring.
Finally, Guideline No. 10
promotes a healthy lifestyle
through regular exercise,
abstinence from smoking and
avoiding consumption. If
alcohol is consumed, it must
be done in moderation. All
these lifestyle practices are
directly or indirectly
related to good nutrition.

NUTRIENTS IN FOOD

Nutrients are chemical substances
present in the foods that keep the
body healthy, supply materials for
growth and repair of tissues, and
provide energy for work and physical
activities.
The major nutrients include the
macronutrients, namely; proteins,
carbohydrates and fats; the
micronutrients, namely vitamins such
as A, D, E and K, the B complex
vitamins and C and minerals such as
calcium, iron, iodine, zinc, fluoride
and water.
Reproductive Health
- a state of complete physical,
mental and social well-being
and not merely the absence of
disease/ infirmity in all
matters relating to the
reproductive system and to its
functions and processes.
Basic RH Rights

Right to RH information and health
care services for safe pregnancy
and childbirth
Right to know different means of
regulating fertility to preserve
health and where to obtain them
Freedom to decide the number and
timing of birth of children
Right to exercise satisfying sex
life
Factors/ determinants of RH
Socioeconomic conditions
education, employment, poverty,
nutrition, living condition/
environment, family environment
Status of women equal right in
education and in making decisions
about her own RH; right to be free
from torture and ill treatment and
to participate in politics
Social and Gender Issues
Biological (individual knowledge of
reproductive organs and their
functions), cultural (countrys
norms, RH practices) and
psychosocial factors
Elements

Maternal and Child Health Nutrition
Family Planning
Prevention and Management of
Abortion Complications
Prevention and Treatment of
Reproductive Tract Infections,
including STDs, HIV and AIDS
Education and Counseling on
Sexuality and Sexual Health
Elements

Breast and Reproductive Tract
Cancers and other Gynecological
Conditions
Mens Reproductive Health
Adolescent Reproductive Health
Violence Against Women
Prevention and Treatment of
Infertility and Sexual Disorders
Selected Concepts

RH is the exercise of reproductive right
with responsibility
It means safe pregnancy and delivery, the
right of access to appropriate health
information and services
It includes protection from unwanted
pregnancy by having access to safe and
acceptable methods of family planning of
their choice
It includes protection from harmful
reproductive practices and violence
It ensure sexual health for the purpose of
enhancement of life and personal relations
and assures access to information on
sexuality to achieve sexual enjoyment
Goal

To achieve healthy sexual
development and maturation
To achieve their reproductive
intention
To avoid diseases, injuries and
disabilities related to
sexuality and reproduction
To receive appropriate
counseling and care of RH
problems
Strategies

Increase and improve the use of more
effective or modern contraceptive methods
Provision of care, treatment and
rehabilitation for RH
RH care provision should be focused on
adolescents, men and unmarried and other
displaced people with RH problems
Strengthen outreach activities and
referral system
Prevent specific RH problems through
information dissemination and counseling
of clients
HEALTH AND SANITATION
Environmental Sanitation is still a
health problem in the country.
Diarrheal diseases ranked second in
the leading causes of morbidity among
the general population.
Other sanitation related diseases :
tuberculosis, intestinal parasitism,
schistossomiasis, malaria, infectious
hepatitis, filariasis and dengue
hemorrhagic fever

DOH thru Environmental Health
Services (EHS)
unit is authorized to act on all
issues and concerns
in environment and health including
the very
comprehensive Sanitation Code of the
Philippines (PD 856, 1978).
WATER SUPPLY SANITATION
PROGRAM
EHS sets policies on:
Approved types of water facilities
Unapproved type of water facility
Access to safe and potable
drinking water
Water quality and monitoring
surveillance
Waterworks/Water system and well
construction
Approved type of water
facilities
Level 1 (Point Source)- a protected
well or a developed spring with an
outlet but without a distribution
system
indicated for rural areas;
serves 15-25 households; its
outreach is not more than 250 m
from the farthest user
yields 40-140 L/ min
Level II ( Communal Faucet or
Stand Posts)

With a source, reservoir, piped
distribution network and communal
faucets
Located at not more than 25 m from
the farthest house
Delivers 40-80 L of water per
capital per day to an average of
100 households
Fit for rural areas where houses
are densely clustered
Level III ( Individual House
Connections or Waterworks
System)

With a source, reservoir, piped
distributor network and household
taps
Fit for densely populated urban
communities
Requires minimum treatment or
disinfection
ENVIRONMENTAL SANITATION
- the study of all factors
in mans physical
environment, which may
exercise a deleterious effect
on his health, well-being and
survival.

Includes:
1.1 Water sanitation
1.2 Food sanitation
1.3 Refuse and garbage disposal
1.4 Excreta disposal
1.5 Insect vector and rodent control
1.6 Housing
1.7 Air pollution
1.8 Noise
1.9 Radiological Protection
1.10 Institutional sanitation
1.11 Stream pollution
PROPER EXCRETA AND SEWAGE DISPOSAL
PROGRAM

EHS sets policies on:
Approved types of toilet facilities :
LEVEL I
Non-water carriage toilet facility no water necessary
to wash the waste into receiving space e.g.pit latrines, reed
odorless earth closet.
Toilet facilities requiring small amount of water to
wash the waste into the receiving space e.g. pour flush toilet &
aqua privies
LEVEL II on site toilet
facilities of the water
carriage type with water-
sealed and flush type
with septic vault/tank
disposal.




LEVEL III water carriage types of
toilet facilities connected to septic
tanks and/or to sewerage system to
treatment plant.

FOOD SANITATION PROGRAM

-sets policy and practical programs
to prevent and control food-borne
diseases to alleviate the living
conditions of the population
HOSPITAL WASTE MANAGEMENT PROGRAM
Disposal of infectious, pathological and
other wastes from hospital which combine
them with the municipal or domestic
wastes pose health hazards to the
people.

Hospitals shall dispose their
hazardous wastes thru incinerators or
disinfectants to prevent transmission of
nosocomial diseases
PROGRAM ON HEALTH RISK MINIMIZATION DUE TO
ENVIRONMENTAL POLLUTION
Foci:
1. Prevention of serious environmental hazards
resulting from urban growth and
industrialization
2. policies on health protection measures
3. researches on effects of GLOBAL WARMING to
health (depletion of the stratosphere ozone
layer which increases ultraviolet radiation,
climate change and other conditions)
NURSING RESPONSIBILITIES AND ACTIVITIES
Health Education IEC by conducting
community assemblies and bench
conferences.
The Occupational Health Nurse, School
Health Nurse and other Nursing staff
shall impart the need for an effective
and efficient environmental sanitation
in their places of work and in school.
Actively participate in the training
component of the service like in Food
Handlers Class, and attend training/workshops
related to environmental health.
Assist in the deworming activities for
the school children and targeted groups.
Effectively and efficiently coordinate
programs/projects/activities with other
government and non-government agencies.
Act as an advocate or facilitator to families
in the community in matters of
program/projects/activities on
environmental health in coordination with
other members of Rural Health Unit (RHU)
especially the Rural Sanitary Inspectors.
Actively participate in
environmental sanitation campaigns
and projects in the community. Ex.
Sanitary toilet campaign drive for
proper garbage disposal,
beautification of home garden, parks
drainage and other projects.
Be a role model for others in the
community to emulate terms of
cleanliness in the home and
surrounding.

Non-Communicable Diseases and
Rehabilitation
1. Prevention and Control of Cardiovascular
Diseases
- heart 1
st leading cause of death
; bld vessels
- 2
nd
Congenital Heart Disease (CHD): Result of the
abnormal development of the heart that
exhibits septal defect, patent ductus
arteriosus, aortic and pulmonary stenosis,
and cyanosis; most prevalent in children
Causes: envtl factors, maternal diseases or
genetic aberrations
Rheumatic Fever or Rheumatic Heart Disease:
Systematic inflammatory disease that may
develop as a delayed reaction to repeated and
an inadequately treated infection of the
upper respiratory tract by group A beta-
hemolytic streptococci.
Hypertension: Persistent elevation of the
arterial blood pressure.
( primary or essential) ;frequent among
females but severe,malignat form is more
common among males
Ischemic Heart Disease/
Atherosclerosis: Condition usually
caused by the occlusion of the
coronary arteries by thrombus or
clot formation.
higher among males than females for
the latter are protected by
estrogen before menopause
PF: HPN, DM, Smoking
Minor RF: stress, strong family
history, obesity

CVD
PERIOD OF LIFE TYPE OF CVD PREVALENCE
At birth to early
childhood
Congenital Heart
Disease
2 / 1000 school
children (aged 5
15 y.o.)
Early to late
childhood
Rheumatic Fever /
Rheumatic Heart
Disease
1 / 1000 school
children (aged 5
15 y.o.)
Early Adulthood Diseases of Heart
Muscles
Essential
Hypertension
10 / 100 adults
Middle age to old
age
Coronary Artery
Disease
Cerebrovascular
Accident
5 / 100 adults
CVD
Diseases Causes / Risk factors
Congenital Heart Disease Maternal Infections, Drug
intake, Maternal
Disease, Genetic
Rheumatic Fever/Rheumatic
Heart Disease
Frequent Streptoccocal
Sore Throat
Essential Hypertension Heredity, High Salt
Intake
Coronary Artery Disease
(Heart Attack)
Smoking, Obesity,
Hypertension, Stress
Hyperlipidemia, Diabetes
Mellitus Sedentary Life
Style
Cerebrovascular Accident
(Stroke)
Hypertension,
Arteriosclerosis
Primary Prevention: CVD
Disease Primordial Specific Protection
Congenit
al Heart
Disease
- Prevention of
viral infection
and intake of
harmful drugs
during
pregnancy.
- Avoidance of
marriage
between blood
relatives
- Adequate treatment
of viral infection
during pregnancy.
- Genetic counseling
of blood related
married couples.
Rheumatic
Heart Disease
- Prevention
of recurrent
sore throat
thru adequate
environmental
sanitation;
avoidance of
overcrowding;
adequate
treatment
-
Identificatio
n of cases of
rheumatic
fever
- Prophylaxis
with
penicillin or
erythromycin
Essential
Hypertension
- From early
childhood
> low salt
diet
> adequate
physical
exercise
- Continued
low salt diet
and adequate
exercise
Coronary
Heart
Disease(Heart
Attack)
- Prevention
of
development/
acquisition
of risk
factors
> cigarette
smoking
> high fat
intake
> high salt
intake
- cessation
of smoking
- control
/treatment of
diabetes,
hypertension
-weight
reduction
-change to
proper diet
-Adjustment
of activities
Cerebrovascul
ar Accident
(Stroke)

- all
measures to
prevent
hypertension
&
arteriosclero
sis
- all
measures to
control
hypertension
& progression
of
arteriosclero
sis
Primary Prevention thru health
education is the main focus of the
program:
1. maintenance of ideal body wt.
2. diet - low fat
3. alcohol/smoking avoidance
4. exercise
5. regular BP check up

2. Cancer Prevention and Early
Detection
Any malignant tumor arising from the
abnormal and uncontrolled division of
cells causing the destruction in the
surrounding tissues.
Common Cancer: Lung cancer, cervical
cancer, colon cancer, cancer of the
mouth, breast cancer, skin cancer,
prostate cancer.
3
rd
leading cause of illness and death
( Phil.)
Incidence can only be reduced thru
prevention and early detection
NINE WARNING SIGNS OF CANCER:
Change in blood bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or
elsewhere
Indigestion or difficulty in swallowing
Obvious change in wart or mole
Nagging cough or hoarseness

Unexplained anemia
Sudden unexplained weight loss
Prevention & Early Detection
CA type
Lung
Uterine
Cervical
Liver
Prevention
No smoking
Monogamy
Safe sex
Hep B
vaccination
Less aalcohol
intake
Avoidance of
moldy foods
Detection
None
Paps smear
every 1-3 yrs
None
Colon
Rectum

High fiber
diet
Low fat
intake
Regular
medical
check-up
after 40 yrs
of age
Fecal occult
blood test
DRE
Sigmoidoscopy

Mouth

No smoking,
betel nut
chewing
Oral hygiene
Regular
dental check-
ups
Breast

none Monthly SBE
Yearly exam
by doctor
Mammography
for 50 yrs
old and above
females
Skin

Prostate

No excessive
sun exposure
none
Assessment of
skin
Digital
trans-rectal
exam
PRINCIPLES OF TREATMENT OF
MALIGNANT DISEASES
One third of all cancers are
curable if detected early and
treated properly.
Three major forms of treatment of
cancer:
Surgery
Radiation Therapy
Chemotherapy

3. Natl Diabetes Prevention and
Control Program

Aim:
Controlling and assimilating
healthy lifestyle in the Filipino
culture ( 2005-2010) thru IEC
Main Concern: modifiable risk
factors( diet, body wt., smoking,
alcohol, stress, sedentary living,
birth wt. ,migration
4. Prevention and Control of Kidney
Disease
Acute or Rapidly Progressive Renal
Failure : A sudden decline in renal
function resulting from the failure of
the renal circulation or by glomerular
or tubular damage causing the
accumulation of substances that is
normally eliminated in the urine in the
body fluids leading to disruption in
homeostatic, endocrine, and metabolic
functions.
Acute Nephritis: A severe inflammation
of the kidney caused by infection,
degenerative disease, or disease of the
blood vessels.
Chronic Renal Failure: A progressive
deterioration of renal function that
ends as uremia and its complications
unless dialysis or kidney transplant is
performed.
Neprolithiasis: A disorder characterized by
the presence of calculi in the kidney.
Nephrotic Syndrome: A clinical disorder of
excessive leakage of plasma proteins into
the urine because of increased permeability
of the glomerular capillary membrane
Urinary Tract Infection: A disease caused
by the presence of pathogenic
microorganisms in the urinary tract with or
without signs and symptoms.
Renal Tubular Defects: An abnormal
condition in the reabsorption of selected
materials back into the blood and
secretion, collection, and conduction of
urine.
Urinary Tract Obstruction: A condition
wherein the urine flow is blocked or
clogged.

5. Program on Mental Health and
Mental Disorders

6. Program on Drug Dependence/
Substance Abuse
7.Community-Based Rehabilitation Program

A creative application of the primary health
care approach in rehabilitation services,
which involves measures taken at the
community level to use and build on the
resources of the community with the
community people, including impaired,
disabled and handicapped persons as well.
Goal: To improve the quality of life and
increase productivity of disabled,
handicapped persons.
Aim: To reduce the prevalence of disability
through prevention, early detection and
provision of rehabilitation services at the
community level.
8. Program on the Elderly/Geriatric
Nursing Services

7 humanitarian issues: family,
health, income, security,
employment and labor, social
welfare, education, recreation,
culltural activities and housing
Leading causes of
illness:elderly
Influenza, HPN, diarrhea,
bronchitis, TB, diseases. of the
heart,
pneumonia, malaria,
malignant neoplasm, chickenpox
Leading causes of
death:elderly
Diseases of heart and vascular
system
Pneumonia, TB, CCOPD
Malignant neoplasms
Diabetes
Nephritis
Accidents

9. Programs on Blindness, Deafness
and Osteoporosis
Cataract- main causes of blindness
VAD- main cause of childhood
blindness; most serious eye
problem of Fil. children below 6
yrs. old
Osteoporosis special problem in
women, highest bet. 5079 yrs.
old, MENOPAUSE- main cause
Prevention of NCD/Role of
Nursing in Health Promotion And
Advocacy
Yosi Kadiri- anti smoking
Edi Exercise/Hataw-regular physical
activity
Tiya Kulit/ Iwas Sakit Diet-low
salt, low fat, high fiber diet
Mag HL exercise, no smoking,
avoidance of alcohol, healthy
diet, iwas stress, watch wt.

Sentrong Sigla Movement ( SSM)
-a certification recognition program
which develops and promotes
standards for health facilities
- Joint effort bet.:
1.DOH provides technical and
financial assistance packages for
health care
2. LGUs direct implementers of
health programs & prime developers
of health centers and hospitals
making services accessible to every
Filipino
Pillars of SSM
1. Quality Assurance
2. Grant and Technical Assistance
3. Health Promotion
4. Awards
Expected Outcome: SSM
Empowered individuals adopting
healthy lifestyle, improved
health-seeking behavior and well-
being & increased demand for
quality health services
Institutions will develop policies,
provide quality services ,
institute system for surveillance/
merits and advocate for laws

Programs: SSM
EPI
Disease Surveillance
CARI
CDD
Nutrition/ Micronutrient
Supplementation-
*Food Fortification :
Rice iron; Oil and sugar Vit. A;
Flour-Vit. A & iron; Salt- iodine
Integrated Management of
Childhood Illness ( IMCI)
Integrates management of most
common childhood problems (
diarrhea, pneumonia, measles,
malnutrition, DHF, malaria)
Involves family members and
community in the health care
process for physical growth and
mental development & disease
prevention
IMCI: Case Mgt. Process
1. Assessing the child or young infant-
History taking, PE
2. Classifying the Illness- severity of
illness
3. Identifying ttt.- classification
chart
4. Treating the child- giving ttt. in
health centers, prescribed drugs &
teaching mothers how to carry out ttt.
5. Counseling the mother- child
feeding,foods and fluids to give & when
to bring the child back to the health
center
6. Giving of follow-up care
Communicable diseases
National Tuberculosis Control
Program key policies
OCase finding direct Sputum Microscopy
and X-ray examination of TB
symptomatics who are negative after 2
or more sputum exams
OTreatment shall be given free and on
an ambulatory basis, except those with
acute complications and emergencies
ODirect Observed Treatment Short Course
comprehensive strategy to detect and
cure TB patients.

Category and Treatment
Regimen
Category 1- new TB patients whose sputum
is positive; seriously ill patients with
severe forms of smear-negative PTB with
extensive parenchymal involvement
(moderately- or far- advanced) and extra-
pulmonary TB (meningitis, pleurisy, etc.)

Category 2-previously-treated patients
with relapses or failures.

Category 3 new TB patients whose sputum is
smear-negative for 3 times and chest x-ray result
of PTB minimal

Category 1- new TB patients whose sputum is positive;
seriously ill patients with severe forms of smear-
negative PTB with extensive parenchymal involvement
(moderately- or far- advanced) and extra-pulmonary TB
(meningitis, pleurisy, etc.)

Intensive Phase (given daily for the first 2
months)- Rifampicin + Isioniazid +
pyrazinamide + ethambutol.
If sputum result becomes negative after 2
months, maintenance phase starts. But if
sputum is still positive in 2 months, all
drugs are discontinued from 2-3 days and a
sputum specimen is examined for culture and
drug sensitivity. The patient resumes taking
the 4 drugs for another month and then
another smear exam is done at the end of the
3
rd
month.
Maintenance Phase (after 3
rd
month,
regardless of the result of the sputum
exam)-INH + rifampicin daily

Category 2-previously-treated patients with relapses or
failures.

Intensive Phase (daily for 3 months,
month 1,2 & 3)-Isioniazid+ rifampicin+
pyrazinamide+ ethambutol+ streptomycin
for the first 2 months Streptomycin+
rifampicin pyrazinamide+ ethambutol on
the 3
rd
month. If sputum is still
positive after 3 months, the intensive
phase is continued for 1 more month
and then another sputum exam is done.
If still positive after 4 months,
intensive phase is continued for the
next 5 months.
Maintenance Phase (daily for 5 months,
month 4,5,6,7,& 8)-Isionazid+
rifampicin+ ethambutol


Category 3 new TB patients whose sputum is smear-
negative for 3 times and chest x-ray result of PTB
minimal

Intensive Phase (daily for 2 months)
Isioniazid + rifampicin +
pyrazinamide

Maintenance Phase (daily for the
next 2 months) - Isioniazid +
rifampicin
Stop TB ; Do it with DOTS
Advocacy is a planned and continuous effort
to inform people about issue and instigate
change. Advocacy usually takes place over an
extended period of time and includes a
variety of strategies to communicate a
specific message.


TB is the number one infectious killer in
the world.
One TB suspect can infect another 10 healthy
persons
Leprosy Control Program
WHO Classification basis of multi-drug
therapy
Paucibacillary/PB non-infectious types. 6-9
months of treatment.
Multibacillary/MB infectious types. 24-30 months
of treatment.
Multi-drug therapy use of 2 or more drugs
renders patients non-infectious a week after
starting treatment
Patients w/ single skin lesion and a negative slit
skin smear are treated w/ a single dose of ROM
regimen
For PB leprosy cases- Rifampicin+Dapsone on Day 1
then Dapsone from Day 2-28. 6 blister packs taken
monthly within a max. period of 9 mos.
All patients who have complied w/ MDT are
considered cured and no longer regarded as a case
of leprosy, even if some sequelae of leprosy
remain.
Responsibilities of the nurse
Prevention health education, healthful living
through proper nutrition, adequate rest, sleep
and good personal hygiene;
Casefinding
Management and treatment prevention of
secondary injuries, handling of utensils;
special shoes w/ padded soles; importance of
sustained therapy, correct dosage, effects of
drugs and the need for medical check-up from
time to time; mental & emotional support
Rehabilitation-makes patients capable, active
and self-respecting member of society.
Control of Schistosomiasis a tropical
disease caused by a blood fluke, Schistosoma
Japonicum ; transmitted by a tiny snail
Oncomelania quadrasi
Preventive measures health education
regarding mode of transmission and methods
of protection; proper disposal of feces and
urine; improvement of irrigation and
agriculture practices
Control of patient, contacts and the
immediate environment
Specific treatment- Praziquantel drug of
choice
Programs on Filariasis, Malaria
and Dengue Hemorrhagic Fever
Filariasis- a chronic prasitic
infection caused by a nematode,
Wuchereria bancrofti. Young and
adult worms live in the lymphatic
vessels and nodes, while the micro
filariae are in the blood;
transmitted through bites from an
infected female mosquito, Aedes
poecilius, that bites at night.
Treatment: Diethylcarbamazine citrate
or Hetrazan
Elephantiasis and Hydrocoele are
handled through surgery, prevention and
supportive care
Malaria infection caused by the
bite of the female Anopheles
mosquito,
Chemoprophylaxis Chloroquine taken at
weekly intervals, starting from 1-2 weeks
before entering the endemic area.
Anti-malarial drugs sulfadoxine,
quiinine sulfate, tetracycline, quinidine
Insecticide treatment of mosquito nets,
house spraying, stream seeding and
clearing, sustainable preventive and
vector control meas

Dengue H-fever
4 oclock habit

Programs on Measles.
Chickenpox, Mumps,
Diphtheria, Pertusis,
Tetanus focused on
health information
campaigns and intensive
immunization of children
in barangays.
Prevention and Control Program on Parasitic
Infestations ( STH e.g. Ascaris,
Trichuris, Hookworm) and Paragonimiasis in
communities where eating of fresh or
inadequately cooked crab is a practice

Management:
1. Deworming
2. Health Education re:
Good personal hygiene
Use of footwear
Washing fruits and vegetables well
Use of sanitary toilets
Sanitary disposal of garbage
Boiling drinking water at least 2-3 min. from
boiling point or chlorination

Prevention and Control on
Leptospirosis/ Weils Disease/ Mud
fever/Flood fever/ Spirochetal
Jaundice thru contact with the
skin/ open wound with water or moist
soil contaminated with urine of
infected rat
And Rabies

Mgt. of Rabies

Wash wound with soap and water, betadine or
alcohol may be applied
If dog is healthy observe for 14 days. If nothing
happens- no need for ttt.If it dies or shows
rabies, kill then bring head for lab. Exam &
consult doctor.
Active immunization body develops Ab against
rabies up to 3 yrs.
Passive I giving Ab to persons with head and
neck bites, multiple single deep bites,
contamination of mucous membranes or thin covering
of the eyes, lips or mouth to provide immediate
protection
RPO immunization of pets at 3 mos. of age and
yearly thereafter

Prevention and Control on STIs
- Gonorrhea, Syphilis, HIV/AIDS,
Trichomoniasis,Chlamydia, Hep B ( the
most serious type cause of severe cx. Eg.
Massive liver damage and hepatocarcinoma
- 4 Cs in the Syndromic Mgt
- 1. Compliance
- 2. Counseling/ Education
- 3. Contact tracing to treat partner
- 4. Condom use
- Hep B vaccination
- Universal precautions
- Safe sex
Other CHN Practice Settings
I. Occupational Health
- the application of public health,
medical and engineering practice for the
purpose of conserving, restoring the
health and effectiveness of workers thru
their places of employment
A. Occupational Health Nursing
- the application of nursing principles
and procedures in providing health
service to employees in their place of
work by means of:
1. prompt and efficient nursing
care of the ill and impaired
2. participation in teaching health
and safety practices on the job
3. cooperation with plant department
administrators
4.keeping the health clinic and
staff ready to handle emergencies
5. advising workers in the
utilization of community and welfare
services

Objectives of OHN
To assist, maintain and promote
positive health of laborers and
employees thru early detection and
prevention of occupational diseases
and hazards of industrial processes
and by coordinating and cooperating
with activities of other community
health and welfare services
Nurses Role in OHN
1. Assists/participates in developing an
adequate health program for workers and
laborers including sound health education
activities
2. Encourages periodic P.E.
3. Cooperates with occupational medical
programs in the prevention of accidents
as well as in the promotion of good working
atmosphere and relationships in the place
of work
4. Helps in teaching others in giving good
nursing care to the sick or handicapped in
their own homes
II. School Health Nursing
School Health Triad :

1. SERVICE

2. EDUCATION

3. ENVIRONMENT

Mission of School Health Program:


To maximize potential for learning and
participation in the educational
process by promoting optimum health
of school-age children and
adolescents
School Health Team:

Psychologist/ Counselor
Teacher
Nutritionist
Nurse
Social Workers
Maintenance Personnel

Targets in SHN

Family
Students
Teachers
Supportive Personnel
Community
School Health Nurses Roles:

EDUCATOR
CONSULTANT /RESEARCHER
STUDENT, FAMILY AND STAFF
ADVOCATE/CHANGE AGENT
HEALTH SCREENER
HEALTH CARE PROVIDER
Common Health Concerns of
Schoolchildren:
1.Drug and Alcohol Abuse
2. STDs/STIs
3. Teenage Pregnancies
4. Mental Health
5. Dermatological Disorders-
pimples/acne, fungal infections,
allergies
6. Respiratory Conditions- asthma,
URTI
7. Nutrition
8. Dental Health
There was a man who saw a scorpion
floundering around in the water.
He decided to save it by stretching
out his finger but the scorpion stung
him.
The man still tried to get the
scorpion out of the water but the
scorpion stung him again.
Another man nearby told him to stop
saving the scorpion but the man said,
Its the nature of the scorpion to
sting. Its my nature to love, why
should I give up my nature to love
just because its the nature of the
scorpion to sting?
Dont give up
loving, dont
give up your
goodness even
if people
around you
sting
Thank you
very
much!!!