COMMUNITY HEALTH COMMUNITY HEALTH NURSINGNURSING

Mrs. Laarne Estenzo-PontillasMrs. Laarne Estenzo-Pontillas

BSN , R.N., MSNBSN , R.N., MSN

(Mark 10:45)(Mark 10:45)

Discipleship is a lifestyleDiscipleship is a lifestyle

Not just a biblical truth Not just a biblical truth

Nor a Christian ideal but a way of lifeNor a Christian ideal but a way of life

For the Son of Man also came not to be servedFor the Son of Man also came not to be served

But to serve and to give His life as a ransom for But to serve and to give His life as a ransom for many.many.

COVERAGE FOR LOCAL COVERAGE FOR LOCAL BOARD EXAM : CHNBOARD EXAM : CHN

I.I. Safe and Quality Care, Health Safe and Quality Care, Health Education, and Communication, Education, and Communication, Collaboration and TeamworkCollaboration and Teamwork

1.1. Principles and Standard of CHNPrinciples and Standard of CHN

2.2. Levels of careLevels of care

3.3. Types of Clientele Types of Clientele

4.4. Health Care Delivery SystemHealth Care Delivery System

5.5. PHC as a StrategyPHC as a Strategy

6.6. Family-based Nursing Family-based Nursing Services(Family Health Nursing Services(Family Health Nursing Process)Process)

7.7. Population Group-based Nursing Population Group-based Nursing ServicesServices

8.8. Community-based Nursing Community-based Nursing Services/Community Health Nursing Services/Community Health Nursing ProcessProcess

9.9. Community OrganizingCommunity Organizing

10.10. Public Health ProgramsPublic Health Programs

II.II. Research and Quality Research and Quality ImprovementImprovement

1.1. Research in the CommunityResearch in the Community

2.2. National Health Situation National Health Situation

3.3. Vital Statistics Vital Statistics

4.4. Epidemiology Epidemiology

5.5. DemographyDemography

III.III. Management of Resources & Management of Resources & Environment and Records Environment and Records ManagementManagement

1.1. Field Health Services And Field Health Services And Information SystemInformation System

2.2. Target-settingTarget-setting

3.3. Environmental SanitationEnvironmental Sanitation

IV.IV. Ethico-Moral-Legal ResponsibilityEthico-Moral-Legal Responsibility1.1. Socio-cultural values, beliefs, and Socio-cultural values, beliefs, and

practices of individuals, families, practices of individuals, families, groups and communitiesgroups and communities

2.2. Code of Ethics for Government Code of Ethics for Government Workers Workers

3.3. WHO, DOH, LGU policies on healthWHO, DOH, LGU policies on health

4.4. Local Government CodeLocal Government Code

5.5. IssuesIssues

V.V. Personal And Professional Personal And Professional DevelopmentDevelopment

1.1. Self-assessment of CHN Self-assessment of CHN competencies, importance, methods competencies, importance, methods and toolsand tools

2.2. Strategies and methods of updating Strategies and methods of updating one’s self, enhancing competence in one’s self, enhancing competence in community health nursing and community health nursing and related areas.related areas.

HISTORY OF CHNHISTORY OF CHN DateDate EventEvent19011901 - Act # 157 ( Board of Health of the - Act # 157 ( Board of Health of the Philippines) ; Philippines) ;

Act # 309 ( Provincial Act # 309 ( Provincial and and Municipal Boards of Municipal Boards of Health) Health) were created.were created.

1905 - Board of Health was abolished; 1905 - Board of Health was abolished; functions functions were transferred to the were transferred to the Bureau of Health.Bureau of Health.

1912 – Act # 2156 or Fajardo Act created the Sanitary 1912 – Act # 2156 or Fajardo Act created the Sanitary Divisions, the forerunners of present MHOs; male Divisions, the forerunners of present MHOs; male nurses performs the functions of doctorsnurses performs the functions of doctors

1919 – Act # 2808 (Nurses Law was created)1919 – Act # 2808 (Nurses Law was created)- Carmen del Rosario , 1- Carmen del Rosario , 1stst Fil. Nurse supervisor Fil. Nurse supervisor

under Bureau of Healthunder Bureau of HealthOct. 22, 1922 – Filipino Nurses Organization Oct. 22, 1922 – Filipino Nurses Organization

(Philippine Nurses’ Organization) was (Philippine Nurses’ Organization) was organized.organized.

1923 – Zamboanga General Hospital School 1923 – Zamboanga General Hospital School of of Nursing & Baguio General Hospital Nursing & Baguio General Hospital were were established; other government schools of nursing established; other government schools of nursing were organized several years were organized several years after.after.

1928- 11928- 1stst Nursing convention was held Nursing convention was held 1940 – Manila Health Department was 1940 – Manila Health Department was

created.created. 1941 – Dr. Mariano Icasiano became the first 1941 – Dr. Mariano Icasiano became the first

city health officer; Office of Nursing was city health officer; Office of Nursing was created through the effort of Vicentacreated through the effort of VicentaPonce (chief Ponce (chief nurse) and Rosario Ordiz (assistant chief nurse) nurse) and Rosario Ordiz (assistant chief nurse)

Dec. 8, 1941 – Victims of World War II were Dec. 8, 1941 – Victims of World War II were treated by the nurses of Manila.treated by the nurses of Manila.

July 1942 – Nursing Office was created; Dr. July 1942 – Nursing Office was created; Dr. Eusebio Aguilar helped in the release of 31 Eusebio Aguilar helped in the release of 31 Filipino Filipino nurses in Bilibid Prison as prisoners of nurses in Bilibid Prison as prisoners of war war by by the Japanese.the Japanese.

Feb. 1946 – Number of nurses decreased from 556 – 308.Feb. 1946 – Number of nurses decreased from 556 – 308. 1948 – First training center of the Bureau of Health 1948 – First training center of the Bureau of Health

was organized by the Pasay City Health was organized by the Pasay City Health Department. Department. Trinidad Gomez, Marcela Gabatin, Trinidad Gomez, Marcela Gabatin, Costancia Tuazon, Costancia Tuazon, Ms. Bugarin, Ms. Ramos, and Ms. Bugarin, Ms. Ramos, and Zenaida Nisce Zenaida Nisce composed the training staff.composed the training staff.

1950 – Rural Health Demonstration and 1950 – Rural Health Demonstration and Training Center was created.Training Center was created.

1953 – The first 81 rural health units were 1953 – The first 81 rural health units were organized.organized.

1957 – RA 1891 amended some sections of 1957 – RA 1891 amended some sections of RA 1082 and created the eight categories RA 1082 and created the eight categories of of rural health unit causing an increase in rural health unit causing an increase in the the demand for the community health demand for the community health personnel. personnel.

1958-1965 – Division of Nursing was abolished 1958-1965 – Division of Nursing was abolished (RA 977) and Reorganization Act (EO 288) (RA 977) and Reorganization Act (EO 288)

1961 – Annie Sand organized the National 1961 – Annie Sand organized the National League League of of Nurses of DOH.Nurses of DOH.

1967 – Zenaida Nisce became the nursing 1967 – Zenaida Nisce became the nursing program program supervisor and consultant on the six special supervisor and consultant on the six special diseases diseases (TB, leprosy, V.D., cancer, filariasis, and (TB, leprosy, V.D., cancer, filariasis, and mental health mental health illness).illness).

1975 – Scope of responsibility of nurses and 1975 – Scope of responsibility of nurses and midwives became wider due to restructuring midwives became wider due to restructuring of of the health care delivery system.the health care delivery system.

1976-1986 – The need for Rural Health 1976-1986 – The need for Rural Health Practice Practice Program was implemented.Program was implemented.

1990- 1992- Local Government Code of 19911990- 1992- Local Government Code of 1991 (RA (RA 7160) 7160)

1993-1998 – Office of Nursing did not 1993-1998 – Office of Nursing did not materialize in spite of persistent materialize in spite of persistent recommendation of the officers, board recommendation of the officers, board members, and advisers of the National members, and advisers of the National League League of Nurses Inc.of Nurses Inc.

Jan. 1999 – Nelia Hizon was positioned as the Jan. 1999 – Nelia Hizon was positioned as the nursing adviser at the Office of Public nursing adviser at the Office of Public Health Health Services through Department Services through Department Order # 29. Order # 29.

May 24, 1999 – EO # 102, which redirects the May 24, 1999 – EO # 102, which redirects the functions and operations of DOH, was functions and operations of DOH, was signed signed by former President Joseph Estrada.by former President Joseph Estrada.

LAWS AFFECTING LAWS AFFECTING PUBLIC HEALTH PUBLIC HEALTH AND PRACTICE AND PRACTICE

OF COMMUNITY OF COMMUNITY HEALTH NURSINGHEALTH NURSING

R.A. 7160 - or the Local Government Code. This R.A. 7160 - or the Local Government Code. This involves the devolution of powers, functions and involves the devolution of powers, functions and responsibilities to the local government both rural responsibilities to the local government both rural & urban.The Code aims to transform local & urban.The Code aims to transform local government units into self-reliant communities and government units into self-reliant communities and active partners in the attainment of national goals active partners in the attainment of national goals thru’ a more responsive and accountable local thru’ a more responsive and accountable local government structure instituted thru’ a system of government structure instituted thru’ a system of decentralization. Hence, each province, city and decentralization. Hence, each province, city and municipality has a LOCAL HEALTH BOARD municipality has a LOCAL HEALTH BOARD ( LHB ) which is mandated to propose annual ( LHB ) which is mandated to propose annual budgetary allocations for the operation and budgetary allocations for the operation and maintenance of their own health facilities.maintenance of their own health facilities.

Composition of LHBComposition of LHB

Provincial LevelProvincial Level

1.Governor- chair1.Governor- chair

2. Provincial Health Officer – vice chair2. Provincial Health Officer – vice chair

3. Chair , Committee on Health of Sangguniang3. Chair , Committee on Health of Sangguniang

PanlalawiganPanlalawigan

4. DOH rep.4. DOH rep.

5. NGO rep.5. NGO rep.

Composition of LHBComposition of LHB

City and Municipal LevelCity and Municipal Level

1.1. Mayor – chairMayor – chair

2. MHO – vice chair2. MHO – vice chair

3. Chair, Committee on Health of Sangguniang3. Chair, Committee on Health of Sangguniang

BayanBayan

4. DOH rep4. DOH rep

5. NGO rep5. NGO rep

EFFECTIVE LHS DEPENDS EFFECTIVE LHS DEPENDS ON:ON:

1. the LGU’s financial capability1. the LGU’s financial capability

2. a dynamic and responsive political leadership2. a dynamic and responsive political leadership

3. community empowerment3. community empowerment

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

R.A. 1082 – Rural Health Act. It created the 1R.A. 1082 – Rural Health Act. It created the 1stst 81 Rural 81 Rural Health Units. Health Units.

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

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

R.A. 9165 – the new Dangerous Drug Act of 2002R.A. 9165 – the new Dangerous Drug Act of 2002

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

P.D. No. 996 – requires the compulsory P.D. No. 996 – requires the compulsory immunization of all children below 8 yrs. of age immunization of all children below 8 yrs. of age against the 6 childhood immunizable diseases.against the 6 childhood immunizable diseases.

P.D. No. 825 – provides penalty for improper P.D. No. 825 – provides penalty for improper disposal of garbage.disposal of garbage.

R.A. 8749 – Clean Air Act of 2000R.A. 8749 – Clean Air Act of 2000P.D. No. 856 – Code on Sanitation. It provides for P.D. No. 856 – Code on Sanitation. It provides for

the control of all factors in man’s environment that the control of all factors in man’s environment that affect health including the quality of water, food, affect health including the quality of water, food, milk, insects, animal carriers, transmitters of milk, insects, animal carriers, transmitters of disease, sanitary and recreation facilities, noise, disease, sanitary and recreation facilities, noise, pollution and control of nuisance. pollution and control of nuisance.

R.A. 6758 – standardizes the salary of government R.A. 6758 – standardizes the salary of government employees including the nursing personnel.employees including the nursing personnel.

R.A. 6675 – Generics Act of 1988 which promotes, requires R.A. 6675 – Generics Act of 1988 which promotes, requires and ensures the production of an adequate supply, and ensures the production of an adequate supply, distribution, use and acceptance of drugs and medicines distribution, use and acceptance of drugs and medicines identified by their generic name.identified by their generic name.

R.A. 6713 – Code of Conduct and Ethical Standards of R.A. 6713 – Code of Conduct and Ethical Standards of Public Officials and Employees. It is the policy of the Public Officials and Employees. It is the policy of the state to promote high standards of ethics in public office. state to promote high standards of ethics in public office. Public officials and employees shall at all times be Public officials and employees shall at all times be accountable to the people and shall discharges their duties accountable to the people and shall discharges their duties with utmost responsibility, integrity, competence and with utmost responsibility, integrity, competence and loyalty, act with patriotism and justice, lead modest lives loyalty, act with patriotism and justice, lead modest lives uphold public interest over personal interest. uphold public interest over personal interest.

R.A. 7305 – Magna Carta for Public Health Workers. R.A. 7305 – Magna Carta for Public Health Workers. This act aims: to promote and improve the social This act aims: to promote and improve the social and economic well-being of health workers, their and economic well-being of health workers, their living and working conditions and terms of living and working conditions and terms of employment; to develop their skills and capabilities employment; to develop their skills and capabilities in order that they will be more responsive and better in order that they will be more responsive and better equipped to deliver health projects and programs; equipped to deliver health projects and programs; and to encourage those with proper qualifications and to encourage those with proper qualifications and excellent abilities to join and remain in and excellent abilities to join and remain in government service.government service.

R.A. 8423 – created the Philippine Institute of R.A. 8423 – created the Philippine Institute of Traditional and Alternative Health Care.Traditional and Alternative Health Care.

P.D. No. 965 – requires applicants for marriage license to receive P.D. No. 965 – requires applicants for marriage license to receive instructions on family planning and responsible parenthood.instructions on family planning and responsible parenthood.

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

RA 4073 – advocates home treatment for RA 4073 – advocates home treatment for leprosyleprosy

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

community levelcommunity level

RA 3573 – requires reporting of all cases of RA 3573 – requires reporting of all cases of communicable diseases and administration of communicable diseases and administration of prophylaxisprophylaxis

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

R.A. 7875 – National Health Insurance ActR.A. 7875 – National Health Insurance Act

R.A. 7432 – Senior Citizens ActR.A. 7432 – Senior Citizens Act

R. A. 7719 - National Blood Services ActR. A. 7719 - National Blood Services Act

R.A. 8172 – Salt Iodization Act ( ASIN LAW)R.A. 8172 – Salt Iodization Act ( ASIN LAW)

R.A. 7277- Magna Carta for PWD’s, provides R.A. 7277- Magna Carta for PWD’s, provides their rehabilitation, self-development and self-their rehabilitation, self-development and self-reliance and integration into the mainstream of reliance and integration into the mainstream of societysociety

A. O. No. 2005-0014- National Policies on A. O. No. 2005-0014- National Policies on Infant and Young Child Feeding:Infant and Young Child Feeding:

1.All newborns be breastfeed within 1 hr after 1.All newborns be breastfeed within 1 hr after birthbirth

2. Infants be exclusively breastfeed for 6 mos.2. Infants be exclusively breastfeed for 6 mos.3. Infants be given timely, adequate and safe 3. Infants be given timely, adequate and safe

complementary foodscomplementary foods4. Breastfeeding be continued up to 2 years and 4. Breastfeeding be continued up to 2 years and

beyondbeyond

EO 51- Phil. Code of Marketing of Breastmilk EO 51- Phil. Code of Marketing of Breastmilk SubstitutesSubstitutes

R.A.- 7600 – Rooming In and Breastfeeding R.A.- 7600 – Rooming In and Breastfeeding Act of 1992Act of 1992

R.A. 8976- Food Fortification LawR.A. 8976- Food Fortification Law R.A. 8980- prolmulgates a comprehensive R.A. 8980- prolmulgates a comprehensive

policy and a national system for ECCDpolicy and a national system for ECCD

A..O. No. 2006- 0015- defines the A..O. No. 2006- 0015- defines the Implementing guidelines on Hepatitis B Implementing guidelines on Hepatitis B Immunization for InfantsImmunization for Infants

R.A. 7846- mandates Compulsory Hepatitis B R.A. 7846- mandates Compulsory Hepatitis B Immunization among infants and children less Immunization among infants and children less than 8 yrs oldthan 8 yrs old

R.A. 2029- madates Liver Cancer and R.A. 2029- madates Liver Cancer and Hepatitis B Awareness Month Act ( February)Hepatitis B Awareness Month Act ( February)

A.O. No. 2006-0012- specifies the Revised A.O. No. 2006-0012- specifies the Revised Implementing Rules and Regulations of E.O. Implementing Rules and Regulations of E.O. 51 or Milk Code, Relevant International 51 or Milk Code, Relevant International Agreements, Penalizing Violations thereof and Agreements, Penalizing Violations thereof and for other purposesfor other purposes

Public HealthPublic Health -” science and art of preventing diasease,-” science and art of preventing diasease, prolonging life, promoting health and efficiency thru’ prolonging life, promoting health and efficiency thru’

organized community effort for the sanitation of the organized community effort for the sanitation of the environment, control of communicable diseases, the environment, control of communicable diseases, the education of individuals in personal hygiene, the education of individuals in personal hygiene, the organization of medical and nursing services for the organization of medical and nursing services for the early diagnosis and preventive treatment of diseases early diagnosis and preventive treatment of diseases and the development of social machinery to ensure and the development of social machinery to ensure everyone a standard of living adequate for the everyone a standard of living adequate for the maintenance of health, so organizing these benefits maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright off as to enable every citizen to realize his birthright off birth and longevity”birth and longevity” ( DR. C.E. Winslow) ( DR. C.E. Winslow)

Community Health NursingCommunity Health Nursing

- special field of nursing that combines the - special field of nursing that combines the skills of nursing, public health and some skills of nursing, public health and some phases of social assistance and functions as phases of social assistance and functions as part of the total public health program for the part of the total public health program for the promotion of health, the improvement of the promotion of health, the improvement of the conditions in the social and physical conditions in the social and physical environment, rehabilitation of illness and environment, rehabilitation of illness and disability ( WHO Expert Committee of disability ( WHO Expert Committee of Nursing )Nursing )

CHNCHN

- a learned practice discipline with the ultimate goal - a learned practice discipline with the ultimate goal of contributing as individuals and in collaboration of contributing as individuals and in collaboration with others to the promotion of the client’s optimum with others to the promotion of the client’s optimum level of functioning thru’ teaching and delivery of level of functioning thru’ teaching and delivery of care ( Jacobson )care ( Jacobson )

- a service rendered by a professional nurse to IFCs, - a service rendered by a professional nurse to IFCs, population groups in health centers, clinics, schools , population groups in health centers, clinics, schools , workplace for the promtion of health, preventionof workplace for the promtion of health, preventionof illness, care of the sick at home and rehabilitation illness, care of the sick at home and rehabilitation (DR. Ruth B. Freeman)(DR. Ruth B. Freeman)

ConceptsConcepts The primary focus of community health nursing The primary focus of community health nursing

is health promotion.is health promotion. Community health nurses provide care necessary Community health nurses provide care necessary

to meet the requirements of an individual all to meet the requirements of an individual all throughout the life cycle.throughout the life cycle.

Knowledge on different fields (biological and Knowledge on different fields (biological and social sciences, clinical nursing, and community social sciences, clinical nursing, and community health organizations) is used.health organizations) is used.

Nursing process in community health nursing Nursing process in community health nursing changes based on the needs of the community.changes based on the needs of the community.

GoalGoal To elevate the level health of the multitude.To elevate the level health of the multitude.

Worth and dignity of man.Worth and dignity of man.

1.The need of the community is the basis of 1.The need of the community is the basis of community health nursing.community health nursing.

2.The community health nurse must 2.The community health nurse must understand fully the objectives and policies understand fully the objectives and policies of the agency she represents.of the agency she represents.

PhilosophyPhilosophy

Principles Principles

3. The family is the unit of service.3. The family is the unit of service.

4. CHN must be available to all regardless of 4. CHN must be available to all regardless of race,creed and socioeconomic statusrace,creed and socioeconomic status

5. The CHN works as a member of the health team5. The CHN works as a member of the health team

6. There must be provision for periodic evaluation 6. There must be provision for periodic evaluation of community health nursing servicesof community health nursing services

7. Opportunities for continuing staff education 7. Opportunities for continuing staff education programs for nurses must be provided by the programs for nurses must be provided by the community health nursing agency and the CHN community health nursing agency and the CHN as wellas well

8. The CHN makes use of available community 8. The CHN makes use of available community health resourceshealth resources

9. The CHN taps the already existing active organized groups in the community10. There must be provision for educative supervision in community health nursing11. 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 CHNStandards in CHN

I. TheoryI. Theory

Applies theoretical concepts as basis for Applies theoretical concepts as basis for decisions in practicedecisions in practice

II. Data CollectionII. Data Collection

Gathers comprehensive , accurate data Gathers comprehensive , accurate data systematicallysystematically

StandardsStandards

III. DiagnosisIII. Diagnosis

Analyzes collected data to determine the needs/ Analyzes collected data to determine the needs/ health problems of IFChealth problems of IFC

IV. PlanningIV. Planning

At each level of prevention, develops plans that At each level of prevention, develops plans that specify nursing actions unique to needs of specify nursing actions unique to needs of clientsclients

StandardsStandards

V. InterventionV. Intervention

Guided by the plan, intervenes to promote, Guided by the plan, intervenes to promote, maintain or restore health, prevent illness and maintain or restore health, prevent illness and institute rehabilitationinstitute rehabilitation

VI. EvaluationVI. Evaluation

Evaluates responses of clients to interventions to Evaluates responses of clients to interventions to note progress toward goal achievement, revise note progress toward goal achievement, revise data base, diagnoses and plandata base, diagnoses and plan

StandardsStandards

VII. Quality Assurance and Professional VII. Quality Assurance and Professional DevelopmentDevelopment

Participates in peer review and other means of Participates in peer review and other means of evaluation to assure quality of nursing practiceevaluation to assure quality of nursing practice

Assumes professional developmentAssumes professional development

Contributes to development of othersContributes to development of others

StandardsStandards

VIII. Interdisciplinary CollaborationVIII. Interdisciplinary Collaboration

Collaborates with other members of the health Collaborates with other members of the health team, professionals and community team, professionals and community representatives in assessing, planning, representatives in assessing, planning, implementing and evaluating programs for implementing and evaluating programs for community healthcommunity health

StandardsStandards

IX.IX. ResearchResearch

Indulges in research to contribute to theory and Indulges in research to contribute to theory and practice in community health nursingpractice in community health nursing

LEVELS OF CARE/ PREVENTIONLEVELS OF CARE/ PREVENTION

1. PRIMARY1. PRIMARY

2. SECONDARY2. SECONDARY

3. TERTIARY3. TERTIARY

Types of ClienteleTypes of Clientele

1. INDIVIDUALS1. INDIVIDUALS 2. FAMILIES2. FAMILIES 3. COMMUNITIES3. COMMUNITIES 4. POPULATION GROUPS4. POPULATION GROUPS

- Aggregate of people who share common - Aggregate of people who share common characteristics, developmental stage or common characteristics, developmental stage or common exposure to particular environmental factors thus exposure to particular environmental factors thus resulting in common health problems ( Clark, 1995:5) resulting in common health problems ( Clark, 1995:5) e.g. children . elderly, women, workers etc.e.g. children . elderly, women, workers etc.

Phil.Health Care Delivery Phil.Health Care Delivery SystemSystem

1.PRIMARY LEVEL FACILITIES1.PRIMARY LEVEL FACILITIES

2. SECONDARY LEVEL FACILITIES2. SECONDARY LEVEL FACILITIES

3. TERTIARY LEVEL FACILITIES3. TERTIARY LEVEL FACILITIES

Classify as to what level the ff. Classify as to what level the ff. belongbelong

1. Teaching and Training Hospitals1. Teaching and Training Hospitals 2. City Health Services2. City Health Services 3. Emergency and District Hospitals3. Emergency and District Hospitals 4. Private Practitioners4. Private Practitioners 5. Heart Institutes5. Heart Institutes 6. Puericulture Centers6. Puericulture Centers 7. RHU7. RHU

THE DEPARTMENT OF THE DEPARTMENT OF HEALTHHEALTH

VISION: Health for all Filipinos VISION: Health for all Filipinos

MISSION: Ensure accessibility & quality of MISSION: Ensure accessibility & quality of health care to improve the quality of life of health care to improve the quality of life of all Filipinos, especially the poor.all Filipinos, especially the poor.

NATIONAL OBJECTIVESNATIONAL OBJECTIVES1.1. Improve the general health status of the population Improve the general health status of the population

(reduce infant mortality rate, reduce child morality rate, (reduce infant mortality rate, reduce child morality rate, reduce maternal mortality rate, reduce total fertility rate, reduce maternal mortality rate, reduce total fertility rate, increase life expectancy & the quality of life years).increase life expectancy & the quality of life years).

2.2. Reduce morbidity, mortality, disability & complications Reduce morbidity, mortality, disability & complications from Diarrheas, Pneumonias, Tuberculosis, Dengue, from Diarrheas, Pneumonias, Tuberculosis, Dengue, Intestinal Parasitism, Sexually Transmitted Diseases, Intestinal Parasitism, Sexually Transmitted Diseases, Hepatitis B, Accident & Injuries, Dental Caries & Hepatitis B, Accident & Injuries, Dental Caries & Periodontal Diseases, Cardiovascular Diseases, Cancer, Periodontal Diseases, Cardiovascular Diseases, Cancer, Diabetes, Asthma & Chronic Obstructive Pulmonary Diabetes, Asthma & Chronic Obstructive Pulmonary Diseases, Nephritis & Chronic Kidney Diseases, Mental Diseases, Nephritis & Chronic Kidney Diseases, Mental Disorders, Protein Energy Malnutrition, Iron Deficiency Disorders, Protein Energy Malnutrition, Iron Deficiency Anemia & Obesity.Anemia & Obesity.

3.Eliminate the ff. diseases as public health problems:3.Eliminate the ff. diseases as public health problems: SchistosomiasisSchistosomiasis MalariaMalaria FilariasisFilariasis LeprosyLeprosy RabiesRabies Measles Measles TetanusTetanus Diphtheria & PertussisDiphtheria & Pertussis Vitamin A Deficiency & Iodine Deficiency Vitamin A Deficiency & Iodine Deficiency

DisordersDisorders

4. Eradicate Poliomyelitis4. Eradicate Poliomyelitis

5. Promote healthy lifestyle through healthy diet & 5. Promote healthy lifestyle through healthy diet & nutrition, physical activity & fitness, personal nutrition, physical activity & fitness, personal hygiene, mental health & less stressful life & hygiene, mental health & less stressful life & prevent violent & risk-taking behaviors.prevent violent & risk-taking behaviors.

6. Promote the health & nutrition of families & 6. Promote the health & nutrition of families & special populations through child, adolescent & special populations through child, adolescent & youth, adult health, women’s health, health of youth, adult health, women’s health, health of older persons, health of indigenous people, health older persons, health of indigenous people, health of migrant workers and health of different disabled of migrant workers and health of different disabled persons and of the rural & urban poor.persons and of the rural & urban poor.

7. Promote environmental health and sustainable 7. Promote environmental health and sustainable development through the promotion and development through the promotion and maintenance of healthy homes, schools, maintenance of healthy homes, schools, workplaces, establishments and communities workplaces, establishments and communities towns and cities. towns and cities.

Basic Principles to Achieve Basic Principles to Achieve Improvement in Health Improvement in Health

1.1. Universal access to basic health services Universal access to basic health services must be ensured.must be ensured.

2.2. The health and nutrition of vulnerable groups The health and nutrition of vulnerable groups must be prioritized.must be prioritized.

3.3. The epidemiological shift from infection to The epidemiological shift from infection to degenerative diseases must be managed.degenerative diseases must be managed.

4.4. The performance of the health sector must be The performance of the health sector must be enhanced. enhanced.

Primary Strategies to Achieve Primary Strategies to Achieve GoalsGoals

1.1. Increasing investment for Primary Health Increasing investment for Primary Health Care.Care.

2.2. Development of national standards and Development of national standards and objectives for health.objectives for health.

3.3. Assurance of health care.Assurance of health care.

4.4. Support to the local system development.Support to the local system development.

5.5. Support for frontline health workers.Support for frontline health workers.

PHC as a StrategyPHC as a Strategy

PRIMARY HEALTH CARE (PHC)PRIMARY HEALTH CARE (PHC)

May 1977    -30May 1977    -30thth World Health Assembly decided World Health Assembly decided that the main health target of the government and that the main health target of the government and WHO is the WHO is the attainment of a level of health that attainment of a level of health that would permit them to lead a socially and would permit them to lead a socially and economically productive life by the year 2000economically productive life by the year 2000 ..

September 6-12, 1978 - First International September 6-12, 1978 - First International Conference on PHC in Alma Ata, Russia (USSR) Conference on PHC in Alma Ata, Russia (USSR) The The Alma AtaAlma Ata DeclarationDeclaration stated that PHC was the stated that PHC was the key to attain the “health for all” goalkey to attain the “health for all” goal

October 19, 1979 - Letter of Instruction (LOI) October 19, 1979 - Letter of Instruction (LOI) 949), the legal basis of PHC was signed by Pres. 949), the legal basis of PHC was signed by Pres. Ferdinand E. Marcos, Ferdinand E. Marcos, which adopted PHC as an approach towards the which adopted PHC as an approach towards the design, development and implementation of design, development and implementation of programs focusing on health development at programs focusing on health development at community level.community level.

RATIONALE FOR ADOPTING PRIMARY HEALTH CARE:

  Magnitude of Health ProblemsMagnitude of Health Problems

  Inadequate and unequal distribution of Inadequate and unequal distribution of health resourceshealth resources

  Increasing cost of medical careIncreasing cost of medical care

  Isolation of health care activities from other Isolation of health care activities from other development activitiesdevelopment activities

DEFINITION OF PRIMARY HEALTH CAREDEFINITION OF PRIMARY HEALTH CARE

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

a practical approach to making health benefits a practical approach to making health benefits within the reach of all people.within the reach of all people.

an approach to health development, which is carried an approach to health development, which is carried out through a set of activities and whose ultimate out through a set of activities and whose ultimate aim is the continuous improvement and maintenance aim is the continuous improvement and maintenance of health status of the community.of health status of the community.

GOAL OF PRIMARY HEALTH CARE: GOAL OF PRIMARY HEALTH CARE: HEALTH FOR ALL FILIPINOS by the year 2000 HEALTH FOR ALL FILIPINOS by the year 2000

AND HEALTH IN THE HANDS OF THE AND HEALTH IN THE HANDS OF THE PEOPLE by PEOPLE by the year 2020.the year 2020.

An improved state of health and quality of life for all An improved state of health and quality of life for all people attained through people attained through SELF-RELIANCESELF-RELIANCE. .

KEY STRATEGY TO ACHIEVE THE GOAL: KEY STRATEGY TO ACHIEVE THE GOAL: Partnership with and Empowerment of the peoplePartnership with and Empowerment of the people - -

permeate as the core strategy in the effective provision of permeate as the core strategy in the effective provision of essential health services that are community based, essential health services that are community based, accessible, acceptable, and sustainable, at a cost, which the accessible, acceptable, and sustainable, at a cost, which the community and the government can afford.community and the government can afford.

OBJECTIVES OF PRIMARY HEALTH CAREOBJECTIVES OF PRIMARY HEALTH CARE   Improvement in the level of health care of the communityImprovement in the level of health care of the community   Favorable population growth structureFavorable population growth structure   Reduction in the prevalence of preventable, communicable and Reduction in the prevalence of preventable, communicable and

other disease.other disease. Reduction in morbidity and mortality rates especially among infants Reduction in morbidity and mortality rates especially among infants

and children.and children.   Extension of essential health services with priority given to the Extension of essential health services with priority given to the

underserved sectors.underserved sectors.   Improvement in Basic SanitationImprovement in Basic Sanitation   Development of the capability of the community aimed at self-Development of the capability of the community aimed at self-

reliance.reliance.   Maximizing the contribution of the other sectors for the social and Maximizing the contribution of the other sectors for the social and

economic development of the community.economic development of the community.

MISSION:MISSION: To strengthen the health care system by To strengthen the health care system by

increasing opportunities and supporting the increasing opportunities and supporting the conditions wherein people will manage their conditions wherein people will manage their own health care.own health care.

TWO LEVELS OF PRIMARY HEALTH CARE TWO LEVELS OF PRIMARY HEALTH CARE

WORKERSWORKERS 1.1. Barangay Health Workers - trained community health Barangay Health Workers - trained community health

workers or health auxiliary volunteers or traditional birth workers or health auxiliary volunteers or traditional birth attendants or healers.attendants or healers.

2.2. Intermediate level health workers include the Public Intermediate level health workers include the Public Health Nurse, Rural Sanitary Inspector and midwives.Health Nurse, Rural Sanitary Inspector and midwives.

PRINCIPLES OF PRIMARY HEALTH CAREPRINCIPLES OF PRIMARY HEALTH CARE   4 A's4 A's = Accessibility, Availability, = Accessibility, Availability,

Affordability & Affordability & Acceptability, Acceptability, Appropriateness Appropriateness of health services. The health services should be of health services. The health services should be present where the supposed recipients are. They present where the supposed recipients are. They should make use of the available resources should make use of the available resources within the community, wherein the focus would within the community, wherein the focus would be more on health promotion and prevention of be more on health promotion and prevention of illness.illness.

  COMMUNITY PARTICIPATIONCOMMUNITY PARTICIPATION =heart and soul of PHC=heart and soul of PHC

3. 3. People are the center, object and subjectPeople are the center, object and subject of of developmentdevelopment..

Thus, the success of any undertaking that aims at serving Thus, the success of any undertaking that aims at serving the people is dependent on people’s participation at all the people is dependent on people’s participation at all levels of decision-making; planning, implementing, levels of decision-making; planning, implementing, monitoring and evaluating. Any undertaking must also be monitoring and evaluating. Any undertaking must also be based on the people’s needs and problems (PCF, 1990)based on the people’s needs and problems (PCF, 1990)

Part of the people’s participation is the partnership between Part of the people’s participation is the partnership between the community and the agencies found in the community; the community and the agencies found in the community; social mobilization and decentralization. social mobilization and decentralization.

In general, health work should start from where the people In general, health work should start from where the people are and building on what they have. Example: Scheduling of are and building on what they have. Example: Scheduling of Barangay Health Workers in the health center Barangay Health Workers in the health center

BARRIERS OF COMMUNITY INVOLVEMENTBARRIERS OF COMMUNITY INVOLVEMENT

Lack of motivationLack of motivation AttitudeAttitude Resistance to changeResistance to change Dependence on the part of community Dependence on the part of community

peoplepeople Lack of managerial skillsLack of managerial skills

4.4.SELF-RELIANCESELF-RELIANCE

5.5.Partnership between the community Partnership between the community and the health agencies in the provision and the health agencies in the provision of quality of life.of quality of life.

Providing linkages between the Providing linkages between the government and the non-government and the non-government government organization and people’s organization.organization and people’s organization.

6. Recognition of interrelationship between the 6. Recognition of interrelationship between the health and developmenthealth and development

HEALTHHEALTH is not merely the absence of disease. Neither it is only a is not merely the absence of disease. Neither it is only a

state of physical and mental well-being. Health being a state of physical and mental well-being. Health being a social phenomenon recognizes the interplay of political, social phenomenon recognizes the interplay of political, socio-cultural and economic factors as its determinant. socio-cultural and economic factors as its determinant. Good Health therefore, is manifested by the progressive Good Health therefore, is manifested by the progressive improvements in the living conditions and quality of life improvements in the living conditions and quality of life enjoyed by the community residents (PCF, enjoyed by the community residents (PCF, DEVELOPMENTDEVELOPMENT is the quest for an improved quality of is the quest for an improved quality of life for all. Development is multi-dimensional. It has a life for all. Development is multi-dimensional. It has a political, social, cultural, institutional and environmental political, social, cultural, institutional and environmental dimensions(Gonzales 1994). Therefore, it is measured by dimensions(Gonzales 1994). Therefore, it is measured by the ability of people to satisfy their basic needs.the ability of people to satisfy their basic needs.

7. SOCIAL MOBILIZATION7. SOCIAL MOBILIZATION

It enhances people participation or governance, It enhances people participation or governance, support system provided by the Government, support system provided by the Government, networking and developing secondary networking and developing secondary leaders. leaders.

8. DECENTRALIZATION

MAJOR STRATEGIES OF PRIMARY MAJOR STRATEGIES OF PRIMARY HEALTH CAREHEALTH CARE

A. ELEVATING HEALTH TO A COMPREHENSIVE AND A. ELEVATING HEALTH TO A COMPREHENSIVE AND SUSTAINED NATIONAL EFFORTS.SUSTAINED NATIONAL EFFORTS.

Attaining Health for all Filipino will require Attaining Health for all Filipino will require expanding participation in health and health related expanding participation in health and health related programs whether as service provider or beneficiary. programs whether as service provider or beneficiary. Empowerment to parents, families and communities to Empowerment to parents, families and communities to make decisions of their health is really the desired outcome.make decisions of their health is really the desired outcome.

Advocacy must be directed to National and Local Advocacy must be directed to National and Local policy making to elicit support and commitment to major policy making to elicit support and commitment to major health concerns through legislations, budgetary and health concerns through legislations, budgetary and logistical considerations.logistical considerations.

B. PROMOTING AND SUPPORTING COMMUNITY B. PROMOTING AND SUPPORTING COMMUNITY

MANAGED MANAGED HEALTH CAREHEALTH CARE

The health in the hands of the The health in the hands of the people brings the government closest people brings the government closest to the people. It necessitates a process to the people. It necessitates a process of capacity building of communities of capacity building of communities and organization to plan, implement and organization to plan, implement and evaluate health programs at their and evaluate health programs at their levels.levels.

C. INCREASING EFFICIENCIES IN THE HEALTH C. INCREASING EFFICIENCIES IN THE HEALTH SECTORSECTOR

Using appropriate technology will make Using appropriate technology will make services and resources required for their delivery, services and resources required for their delivery, effective, affordable, accessible and culturally effective, affordable, accessible and culturally acceptable. The development of human resources acceptable. The development of human resources must correspond to the actual needs of the nation must correspond to the actual needs of the nation and the policies it upholds such as PHC. The DOH and the policies it upholds such as PHC. The DOH will continue to support and assist both public and will continue to support and assist both public and private institutions particularly in faculty private institutions particularly in faculty development, enhancement of relevant curricula and development, enhancement of relevant curricula and development of standard teaching materials.development of standard teaching materials.

D. ADVANCING ESSENTIAL NATIONAL D. ADVANCING ESSENTIAL NATIONAL HEALTH RESEARCHHEALTH RESEARCH

Essential National Health Essential National Health Research (ENHR) is an integrated Research (ENHR) is an integrated strategy for organizing and managing strategy for organizing and managing research using intersectoral, multi-research using intersectoral, multi-disciplinary and scientific approach to disciplinary and scientific approach to health programming and delivery.health programming and delivery.

FOUR CORNERSTONES/ PILLARS IN FOUR CORNERSTONES/ PILLARS IN PRIMARY HEALTH CAREPRIMARY HEALTH CARE

1.      Active Community Participation 1.      Active Community Participation

2.      Intra and Inter-sectoral Linkages2.      Intra and Inter-sectoral Linkages

3.      Use of Appropriate Technology3.      Use of Appropriate Technology

4.4.            Support mechanism made availableSupport mechanism made available

HERBAL MEDICINES ENDORSED BY THE HERBAL MEDICINES ENDORSED BY THE DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH

NameName IndicationsIndications DosageDosage1.1.Five-leaf Five-leaf

Chaste tree Chaste tree

(Lagundi) (Lagundi)

1.1. AsthmaAsthma

2.2. CoughCough

3.3. Body Pain Body Pain

4.4. Fever Fever

Divide the decoction into Divide the decoction into 3 parts:3 parts:For asthma and cough, For asthma and cough, drink 1 part 3 times a day.drink 1 part 3 times a day.For fever and body For fever and body pains, drink 1 part every 4 pains, drink 1 part every 4 hrs.hrs.

2.2. Marsh-Mint; Marsh-Mint; Peppermint Peppermint (Yerba Buena) (Yerba Buena)

1.1. Body pain Body pain Divide Divide decoction into decoction into 2 parts and 2 parts and drink 1 part drink 1 part every 3 hours.every 3 hours.

3.3. Sambong Sambong 1.1. Swelling Swelling

2. Inducing 2. Inducing diuresis diuresis

( anti-( anti-urolithiasis)urolithiasis)

Divide Divide decoction into decoction into 3 parts and 3 parts and drink 1 part 3 drink 1 part 3 times a day. times a day.

4.4. Tsaang Tsaang Gubat Gubat

1.1. StomachacheStomachache Drink the warm Drink the warm decoction. If it decoction. If it persists, or if there is persists, or if there is no improvement an no improvement an hour after drinking hour after drinking the decoction, the decoction, consult a doctor.consult a doctor.

5.5. Ulasimang Ulasimang Bato/Pansit- Bato/Pansit- Pansitan Pansitan

1.1. Gouty Arthritis Gouty Arthritis Divide the Divide the decoction into 3 parts decoction into 3 parts and drink 1 part 3 and drink 1 part 3 times a day after times a day after meals. meals.

6.6. Garlic Garlic 1.1. HypertensionHypertension

2.2. Htperlipidemia Htperlipidemia

Eat 6 cloves of Eat 6 cloves of garlic together garlic together with meals with meals

7.7. Niyog- Niyog-Niyogan Niyogan

1.1. Ascariasis Ascariasis Chew and Chew and swallow only swallow only dried seeds 2 dried seeds 2 hours after dinner hours after dinner according to the according to the following:following: ADULTS = 8-10ADULTS = 8-10

seedsseeds

9-12 y/o = 6-7 seeds 9-12 y/o = 6-7 seeds 6-8 y/o = 5-6 seeds6-8 y/o = 5-6 seeds

4-5 y/o = 4-5 seeds4-5 y/o = 4-5 seeds

8.8. Guava Guava 1.1. Cleaning Cleaning wounds wounds

2.2. Mouth wash Mouth wash for mouth for mouth infection, infection, sore gums & sore gums & tooth decay tooth decay

For wound cleaning, use For wound cleaning, use decoction for washing the decoction for washing the wound 2 times a daywound 2 times a dayFor tooth decay and For tooth decay and swelling of gums, gargle swelling of gums, gargle with warm decoction 3 with warm decoction 3 times a day times a day

9.9. Akapulko Akapulko

1.1. Ring wormRing worm

2.2. Athlete’s Athlete’s footfoot

3.3. ScabiesScabies

Apply the juice on the affected area 1 Apply the juice on the affected area 1 to 2 times a dayto 2 times a dayIf the person develops an allergy If the person develops an allergy while using the above preparation, while using the above preparation, prepare the following:prepare the following:oPut 1 cup of chopped fresh leaves in Put 1 cup of chopped fresh leaves in an earthen jar. Pour in 2 glasses of an earthen jar. Pour in 2 glasses of water and cover it.water and cover it.oBoil the mixture until the 2 glasses of Boil the mixture until the 2 glasses of water originally poured have been water originally poured have been reduced to 1 glass of waterreduced to 1 glass of wateroStrain the mixture. Use it while it is Strain the mixture. Use it while it is warm.warm.oApply the warm decoction on the Apply the warm decoction on the

affected area 1 to 2 times a day.affected area 1 to 2 times a day.

10.10.

Bitter Gourd/ Bitter Gourd/ Melon Melon (Ampalaya) (Ampalaya)

1.1. Mild Non-Mild Non-Insulin Insulin Dependent Dependent Diabetes Diabetes Mellitus Mellitus

Drink ½ cup Drink ½ cup of cooled or of cooled or warm warm decoction 3 decoction 3 times a day times a day after meals. after meals.

11.11. Ginger Ginger

(Zingiber (Zingiber officinale) officinale)

1.1. Motion Motion sickness, sore sickness, sore throat, nausea throat, nausea & vomiting, & vomiting, migraine migraine headaches, headaches, arthritis arthritis

An abortifacient if taken in An abortifacient if taken in large amounts; should not be large amounts; should not be used by persons with used by persons with cholelithiasis unless directed cholelithiasis unless directed by the physician; may by the physician; may increase the risk of bleeding increase the risk of bleeding when used concurrently with when used concurrently with anticoagulants & anticoagulants & antiplatelets.antiplatelets.Chop and Mash a piece of Chop and Mash a piece of ginger root, and mix in a glass of ginger root, and mix in a glass of waterwaterBoil the mixtureBoil the mixtureDrink the cooled or warm Drink the cooled or warm decoction as needed. decoction as needed.

ELEMENTS OF PRIMARY HEALTH ELEMENTS OF PRIMARY HEALTH CARE:CARE:

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

Education For Health

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

Locally Endemic Disease Control

This program exists to control the This program exists to control the occurrence of preventable illnesses occurrence of preventable illnesses especially of children below 6 years old. especially of children below 6 years old. Immunizations on poliomyelitis, Immunizations on poliomyelitis, measles, tetanus, diphtheria and other measles, tetanus, diphtheria and other preventable disease are given for free preventable disease are given for free by the government and ongoing by the government and ongoing program of the DOHprogram of the DOH

Expanded Program on ImmunizationExpanded Program on Immunization

The mother and child are the most delicate The mother and child are the most delicate members of the community. So the members of the community. So the protection of the mother and child to protection of the mother and child to illness and other risks would ensure good illness and other risks would ensure good health for the community. The goal of health for the community. The goal of Family Planning includes spacing of Family Planning includes spacing of children and responsible parenthood.children and responsible parenthood.

Maternal and Child Health and Family Planning

Environmental Sanitation is defined as the Environmental Sanitation is defined as the study of all factors in the man’s environment, study of all factors in the man’s environment, which exercise or may exercise deleterious effect which exercise or may exercise deleterious effect on his well-being and survival.on his well-being and survival.

Water is a basic need for life and one factor in Water is a basic need for life and one factor in man’s environment. Water is necessary for the man’s environment. Water is necessary for the maintenance of healthy lifestyle. maintenance of healthy lifestyle.

Safe Water and Sanitation is necessary for basic Safe Water and Sanitation is necessary for basic promotion of health.promotion of health.

Environmental Sanitation and Environmental Sanitation and Promotion of Safe Water SupplyPromotion of Safe Water Supply

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

Nutrition and Promotion of Adequate Food Supply

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

Treatment of Communicable Diseases Treatment of Communicable Diseases and Common Illnessand Common Illness

This focuses on the information campaign This focuses on the information campaign on the utilization and acquisition of drugs.on the utilization and acquisition of drugs.

In response to this campaign, the In response to this campaign, the GENERIC ACT of the Philippines is GENERIC ACT of the Philippines is enacted . It includes the following drugs: enacted . It includes the following drugs: Cotrimoxazole, Paracetamol, Cotrimoxazole, Paracetamol, Amoxycillin, Oresol, Nifedipine, Amoxycillin, Oresol, Nifedipine, Rifampicin, INH(isoniazid) and Rifampicin, INH(isoniazid) and Pyrazinamide,Ethambutol, Pyrazinamide,Ethambutol, Streptomycin,Albendazole,QuinineStreptomycin,Albendazole,Quinine

Supply of Essential Drugs

FAMILY HEALTH NURSINGFAMILY HEALTH NURSING

- that level of CHN practice directed to the - that level of CHN practice directed to the FAMILY as the unit of care with HEALTH as FAMILY as the unit of care with HEALTH as the goal and NURSING as the medium, the goal and NURSING as the medium, channel or provider of carechannel or provider of care

Family Case LoadFamily Case Load

- the no. and kind of families a nurse handles - the no. and kind of families a nurse handles at any given timeat any given time

- variable for cases are added or dropped based - variable for cases are added or dropped based on the need for nursing care and supervisionon the need for nursing care and supervision

Types of FamiliesTypes of Families

1. Nuclear1. Nuclear 2. Extended2. Extended 3. Three generational3. Three generational 4. Dyad4. Dyad 5. Single- Parent5. Single- Parent 6. Step- Parent6. Step- Parent 7. Blended or reconstituted7. Blended or reconstituted

Types of FamiliesTypes of Families

8. Single adult living alone8. Single adult living alone 9. Cohabiting/ Living –in9. Cohabiting/ Living –in 10. No- kin10. No- kin 11. Compound11. Compound 12. Gay12. Gay 14. Commune14. Commune

Stages of Family Life CycleStages of Family Life Cycle

1. Newly married couple1. Newly married couple 2. Childbearing2. Childbearing 3. Preschool age 3. Preschool age 4. Schoolage4. Schoolage 5. Teenage5. Teenage 6. Launching6. Launching 7. Middle-aged ( empty nest –retirement)7. Middle-aged ( empty nest –retirement) 8. Period from retirement to Death of both spouses8. Period from retirement to Death of both spouses

HEALTH TASKS OF THE HEALTH TASKS OF THE FAMILY( Freeman, 1981)FAMILY( Freeman, 1981)

1. recognizing interruptions of health or development1. recognizing interruptions of health or development 2. seeking health care2. seeking health care 3. managing health and non-health crises3. managing health and non-health crises 4. providing nursing care to the sick, disabled and 4. providing nursing care to the sick, disabled and

dependent member of the familydependent member of the family 5. maintaining a home environment conducive to 5. maintaining a home environment conducive to

good health and personal developmentgood health and personal development 6. maintaining a reciprocal relationship with the 6. maintaining a reciprocal relationship with the

community and health institutionscommunity and health institutions

Family Nursing ProblemFamily Nursing Problem

Arises when the family cannot effectively Arises when the family cannot effectively perform its health tasksperform its health tasks

Nurse’s Roles in Family Health Nurse’s Roles in Family Health Nursing Nursing

1. HEALTH MONITOR1. HEALTH MONITOR 2. PROVIDER OF CARE TO A SICK2. PROVIDER OF CARE TO A SICK FAMILY MEMBERFAMILY MEMBER 3. COORDINATOR OF FAMILY3. COORDINATOR OF FAMILY SERVICESSERVICES 4. FACILITATOR4. FACILITATOR 5. TEACHER5. TEACHER 6. COUNSELOR6. COUNSELOR

INITIAL DATA BASE FOR INITIAL DATA BASE FOR FAMILY NURSING PRACTICEFAMILY NURSING PRACTICE Family structure, Characteristics, and Family structure, Characteristics, and

DynamicsDynamics1.1. Members of the household and relationship to Members of the household and relationship to

the head of the familythe head of the family2.2. Demographic data – age, sex, civil status, Demographic data – age, sex, civil status,

position in the familyposition in the family3.3. Place of residence of each member – whether Place of residence of each member – whether

living with the family or elsewhereliving with the family or elsewhere

4.4. Type of family structure – e.g. matriarchal Type of family structure – e.g. matriarchal or patriarchal, nuclear or extendedor patriarchal, nuclear or extended

5.5. Dominant family members in terms of Dominant family members in terms of decision-making, especially in matters of decision-making, especially in matters of health carehealth care

6.6. General family relationship/dynamics – General family relationship/dynamics – presence of any readily observable conflict presence of any readily observable conflict between members; characteristics between members; characteristics communication patterns among memberscommunication patterns among members

Socio-economic and Cultural Socio-economic and Cultural CharacteristicsCharacteristics

1.1. Income and Expenses Income and Expenses Occupation, place of work and income of Occupation, place of work and income of

each working memberseach working members Adequacy to meet basic necessities Adequacy to meet basic necessities Who makes decisions about money and how Who makes decisions about money and how

it is spentit is spent

2.2. Educational attainment of each other Educational attainment of each other

3.3. Ethnic background and religious Ethnic background and religious affiliationaffiliation

4.4. Significant Others – role(s) Significant Others – role(s) they play in family’s lifethey play in family’s life

5.5. Relationship of the family to Relationship of the family to larger community – Nature and larger community – Nature and extent of participation of the extent of participation of the family in community activitiesfamily in community activities

Home and EnvironmentHome and Environment1.1. Housing Housing

Adequacy of living peaceAdequacy of living peace Sleeping arrangement Sleeping arrangement Presence of breeding or resting sites of vectors of Presence of breeding or resting sites of vectors of

diseasesdiseases Presence of accidents hazardsPresence of accidents hazards Food storage and cooking facilities Food storage and cooking facilities Water supply – source, ownership, portabilityWater supply – source, ownership, portability Toilet facility – type, ownership, sanitary conditionToilet facility – type, ownership, sanitary condition Drainage system – type, sanitary conditionDrainage system – type, sanitary condition

2.2. Kind of neighborhood, e.g. Kind of neighborhood, e.g. congested, slum, etc.congested, slum, etc.

3.3. Social and health facilities Social and health facilities availableavailable

4.4. Communication and Communication and transportation facilities transportation facilities available available

Health Status of each Family MemberHealth Status of each Family Member1.1. Medical and nursing history indicating current Medical and nursing history indicating current

or past significant illnesses or beliefs and or past significant illnesses or beliefs and practices conducive to health illnesspractices conducive to health illness

2.2. Nutritional assessment Nutritional assessment Anthropometric data: Measures of nutritional status Anthropometric data: Measures of nutritional status

of children, weight, height, mid-upper arm of children, weight, height, mid-upper arm circumference: Risk assessment measures of circumference: Risk assessment measures of obesity: body mass index, waist circumference, obesity: body mass index, waist circumference, waist hip ratio waist hip ratio

Dietary history specifying quality and quantity of Dietary history specifying quality and quantity of food/nutrient intake per dayfood/nutrient intake per day

Eating/ feeding habits/ practicesEating/ feeding habits/ practices

3.3. Developmental assessments of infants, toddlers, Developmental assessments of infants, toddlers, and preschoolers – e.g., Metro Manilaand preschoolers – e.g., Metro Manila

4.4. Risk factor assessment indicating presence of Risk factor assessment indicating presence of major and contributing modifiable risk factors major and contributing modifiable risk factors for specific lifestyles, cigarette smoking, for specific lifestyles, cigarette smoking, elevated blood lipids, obesity, diabetes mellitus, elevated blood lipids, obesity, diabetes mellitus, inadequate fiber intake, stress, alcohol drinking inadequate fiber intake, stress, alcohol drinking and other substance abuseand other substance abuse

5.5. Physical assessment indicating Physical assessment indicating presence of illness state/s presence of illness state/s

6.6. Results of laboratory/ Results of laboratory/ diagnostic and other screening diagnostic and other screening procedures supportive of procedures supportive of assessment findings assessment findings

Values, Habits, Practices on Health Values, Habits, Practices on Health Promotion, Maintenance and Disease Promotion, Maintenance and Disease

Prevention.Prevention.Examples include:Examples include:

1.1. Immunization status of family membersImmunization status of family members2.2. Healthy lifestyle practices. Specify.Healthy lifestyle practices. Specify.3.3. Adequacy of:Adequacy of:

rest and sleeprest and sleep exerciseexercise use of protective measures- e.g. adequate footwear use of protective measures- e.g. adequate footwear

in parasite-infested areas;in parasite-infested areas; relaxation and other stress management activitiesrelaxation and other stress management activities

4.4. Use of promotive-preventive health servicesUse of promotive-preventive health services

A TYPOLOGY OF NURSING A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PROBLEMS IN FAMILY NURSING

PRACTICEPRACTICE

FIRST-LEVEL ASSESSMENTFIRST-LEVEL ASSESSMENTI.I. Presence of Wellness Condition – stated as Potential Presence of Wellness Condition – stated as Potential

or Readiness- a clinical or nursing judgment about a or Readiness- a clinical or nursing judgment about a client in transition from a specific level of wellness client in transition from a specific level of wellness or capability to a higher level. or capability to a higher level. Wellness potentialWellness potential is is a nursing judgment on wellness state or condition a nursing judgment on wellness state or condition based on client’s performance, current competencies based on client’s performance, current competencies or clinical data but or clinical data but nono explicit expression of client explicit expression of client desire. desire. Readiness for enhanced wellnessReadiness for enhanced wellness state is a state is a nursing judgment on wellness state or condition nursing judgment on wellness state or condition based on client’s current competencies or based on client’s current competencies or performance, clinical data explicit expression of performance, clinical data explicit expression of desire to achieve a higher level of state or function in desire to achieve a higher level of state or function in specific area on health promotion and maintenance.specific area on health promotion and maintenance.

Examples of these are the following:Examples of these are the following:

1.1. Potential for Enhanced Capability for:Potential for Enhanced Capability for: Healthy lifestyle – e.g. nutrition/diet, exercise/ Healthy lifestyle – e.g. nutrition/diet, exercise/

activityactivity Health MaintenanceHealth Maintenance ParentingParenting BreastfeedingBreastfeeding Spiritual Well-being – process of a client’s Spiritual Well-being – process of a client’s

unfolding of mystery through harmonious unfolding of mystery through harmonious interconnectedness that comes from inner interconnectedness that comes from inner strength/sacred source/GOD (NANDA 2001)strength/sacred source/GOD (NANDA 2001)

Others, Others,

2.2. Readiness for Enhanced Capability for:Readiness for Enhanced Capability for: Healthy LifestyleHealthy Lifestyle Health MaintenanceHealth Maintenance ParentingParenting BreastfeedingBreastfeeding Spiritual Well-beingSpiritual Well-being Others, Others,

I.I. Presence of Health Threats – Presence of Health Threats – conditions that are conducive to conditions that are conducive to disease, accident or failure top disease, accident or failure top realize one’s health potential. realize one’s health potential.

Examples of these are the following:Examples of these are the following:

1.1. Family history of hereditary Family history of hereditary condition, e.g. diabetescondition, e.g. diabetes

2.2. Threat of cross infection from a Threat of cross infection from a communicable disease casecommunicable disease case

3.3. Family size beyond what family Family size beyond what family resources can adequately provideresources can adequately provide

4.4. Accidental hazardsAccidental hazards Broken stairsBroken stairs Sharp objects, poison, and Sharp objects, poison, and

medicines improperly keptmedicines improperly kept Fire hazardsFire hazards

5.5. Faulty nutritional habits or Faulty nutritional habits or feeding practices. feeding practices.

Inadequate food intake both in Inadequate food intake both in quality & quantityquality & quantity

Excessive intake of certain Excessive intake of certain nutrientsnutrients

Faulty eating habitsFaulty eating habits Ineffective breastfeedingIneffective breastfeeding Faulty feeding practicesFaulty feeding practices

6.6. Stress-provoking factors – Stress-provoking factors – Strained marital relationshipStrained marital relationship Strained parent-sibling Strained parent-sibling

relationshiprelationship Interpersonal conflicts between Interpersonal conflicts between

family membersfamily members Care-giving burdenCare-giving burden

Inadequate living spaceInadequate living space Lack of food storage Lack of food storage

facilitiesfacilities Polluted water supplyPolluted water supply Presence of breeding Presence of breeding

sites of vectors of sites of vectors of diseasedisease

Improper garbageImproper garbage

7.7. Poor home condition-Poor home condition-

Unsanitary waste Unsanitary waste disposaldisposal

Improper Improper drainage systemdrainage system

Poor ventilationPoor ventilation Noise pollutionNoise pollution Air pollutionAir pollution

8.8. Unsanitary food handling and preparationUnsanitary food handling and preparation9.9. Unhealthful lifestyles and personal habits-Unhealthful lifestyles and personal habits-

Alcohol drinking Alcohol drinking Cigarette smokingCigarette smoking Inadequate footwearInadequate footwear Eating raw meatEating raw meat Poor personal hygienePoor personal hygiene Self-medicationSelf-medication Sexual promiscuitySexual promiscuity Engaging in dangerous sportsEngaging in dangerous sports Inadequate restInadequate rest Lack of inadequate exerciseLack of inadequate exercise Lack of relaxation activitiesLack of relaxation activities Non-use of self protection measuresNon-use of self protection measures

10.10. Inherent personal characteristics – e.g. Inherent personal characteristics – e.g. poor impulse controlpoor impulse control

11.11. Health history which induce the Health history which induce the occurrence of a health deficit, e.g. occurrence of a health deficit, e.g. previous history of difficult laborprevious history of difficult labor

12.12. Inappropriate role assumption – e.g. child Inappropriate role assumption – e.g. child assuming mother's role, father not assuming mother's role, father not assuming his roleassuming his role

13.13. Lack of immunization/ inadequate Lack of immunization/ inadequate immunization status specially of childrenimmunization status specially of children

14.14. Family disunity –Family disunity – Self-oriented behavior of Self-oriented behavior of

member(s)member(s) Unresolved conflicts of member(s)Unresolved conflicts of member(s) Intolerable disagreementIntolerable disagreement OtherOther

15.15. Other Other

III.III. Presence of Health Deficits – instances Presence of Health Deficits – instances of failure in health maintenance.of failure in health maintenance.

Examples include:Examples include:

1.1. Illness states, regardless of whether it is Illness states, regardless of whether it is diagnosed or by medical practitionerdiagnosed or by medical practitioner

2.2. Failure to thrive/ develop according to Failure to thrive/ develop according to normal ratenormal rate

3.3. Disability – whether congenital or Disability – whether congenital or arising from illness; temporaryarising from illness; temporary

IV.IV. Presence of stress Points/ Foreseeable Crisis Presence of stress Points/ Foreseeable Crisis Situations – anticipated periods of unusual demand of Situations – anticipated periods of unusual demand of the individual or family in terms of family resources.the individual or family in terms of family resources.

Examples of these include:Examples of these include:

1.1. MarriageMarriage 9.9. Menopause Menopause

2.2. PregnancyPregnancy 10.10. Loss of jobLoss of job

3.3. ParenthoodParenthood 11.11. Hospitalization of a Hospitalization of a

4.4. Additional memberAdditional member family memberfamily member

5.5. AbortionAbortion 12.12. Death of a mannerDeath of a manner

6.6. Entrance at schoolEntrance at school 13.13. Resettlement in a Resettlement in a

7.7. Adolescence Adolescence new communitynew community

8.8. Divorce Divorce 14.14. illegitimacy illegitimacy

Second Level AssessmentSecond Level Assessment Focus on determining family’s capacity to perform the Focus on determining family’s capacity to perform the

health taskshealth tasks Statements on family health nursing problem:Statements on family health nursing problem:a.a. Inability to recognize the presence of the condition or Inability to recognize the presence of the condition or

problemproblemb.b. Inability to make decisions with respect to taking Inability to make decisions with respect to taking

appropriate health actionappropriate health actionc.c. Inability to provide adequate nursing care to the sick, Inability to provide adequate nursing care to the sick,

disabled , dependent or vulnerable member of the familydisabled , dependent or vulnerable member of the familyd.d. Inability to provide a home environment conducive to health Inability to provide a home environment conducive to health

maintenance or personal developmentmaintenance or personal developmente.e. Failure to utilize community resources for health careFailure to utilize community resources for health care

Scale for Ranking Health Conditions Scale for Ranking Health Conditions and Problems according to prioritiesand Problems according to priorities Criteria:Criteria:

a.a. Nature of the condition or problem presentedNature of the condition or problem presented

( wellness state, health deficit, health threat, forseeable ( wellness state, health deficit, health threat, forseeable crisis)crisis)

b. Modifiability of the condition or problemb. Modifiability of the condition or problem

( easily, partially, not modifiable)( easily, partially, not modifiable)

c. Preventive Potential (high, moderate , low)c. Preventive Potential (high, moderate , low)

d. Salience ( needs immediate attention, not immediate, d. Salience ( needs immediate attention, not immediate, not perceived as a problem)not perceived as a problem)

COMMUNITY HEALTH CARE COMMUNITY HEALTH CARE PROCESSPROCESS

Assessment Assessment Purpose : To identify the health needs of the peoplePurpose : To identify the health needs of the people

Planning of nursing actionsPlanning of nursing actionsPurpose : To act on the determined needs of the Purpose : To act on the determined needs of the

community peoplecommunity people ImplementationImplementation

Purpose : To achieve the optimum level of health of the Purpose : To achieve the optimum level of health of the community peoplecommunity people

EvaluationEvaluationPurpose : To determine the effectiveness of health care programsPurpose : To determine the effectiveness of health care programs

NURSING PROCEDURESNURSING PROCEDURES CLINIC VISITCLINIC VISIT- process of checking the client’s health condition - process of checking the client’s health condition

in a medical clinicin a medical clinic HOME VISITHOME VISIT- a professional face to face contact made by the - a professional face to face contact made by the

nurse with a patient or the family to provide nurse with a patient or the family to provide necessary health care activities and to further necessary health care activities and to further attain the objectives of the agencyattain the objectives of the agency

BAG TECHNIQUEBAG TECHNIQUE-a tool making of the public health bag through -a tool making of the public health bag through

which the nurse during the home visit can which the nurse during the home visit can perform nursing procedures with ease and perform nursing procedures with ease and deftness saving time and effort with the end in deftness saving time and effort with the end in view of rendering effective nursing careview of rendering effective nursing care

THERMOMETER TECHNIQUETHERMOMETER TECHNIQUE

-to assess the client’s health condition through -to assess the client’s health condition through body temperature readingbody temperature reading

NURSING CARE IN THE HOMENURSING CARE IN THE HOME

- giving to the individual patient the nursing care - giving to the individual patient the nursing care required by his/her specific illness or trauma to required by his/her specific illness or trauma to help him/her reach a level of functioning at help him/her reach a level of functioning at which he/she can maintain himself/herself or which he/she can maintain himself/herself or die peacefully in dignitydie peacefully in dignity

ISOLATION TECHNIQUE IN THE HOMEISOLATION TECHNIQUE IN THE HOME

-done by :-done by :

1. separating the articles used by a client with 1. separating the articles used by a client with communicable disease to prevent the spread of communicable disease to prevent the spread of infection:infection:

2. frequent washing and airing of beddings and 2. frequent washing and airing of beddings and other articles and disinfections of roomother articles and disinfections of room

3. wearing a protective gown , to be used only 3. wearing a protective gown , to be used only within the room of the sick memberwithin the room of the sick member

4. discarding properly all nasal and throat 4. discarding properly all nasal and throat discharges of any member sick with discharges of any member sick with communicable diseasecommunicable disease

5. burning all soiled articles if could be or 5. burning all soiled articles if could be or contaminated articles be boiled first in water contaminated articles be boiled first in water 30 minutes before laundering30 minutes before laundering

INTRAVENOUS THERAPYINTRAVENOUS THERAPY- insertion of a needle or catheter into a vein to insertion of a needle or catheter into a vein to

provide medication and fluids based on provide medication and fluids based on physician’s written prescriptionphysician’s written prescription

- can be done only by nurses accredited by - can be done only by nurses accredited by ANSAPANSAP

PRINCIPLES OF HEALTH PRINCIPLES OF HEALTH EDUCATIONEDUCATION

It considers the health status of the people, It considers the health status of the people, which is determined by the economic and which is determined by the economic and social conscience of the country.social conscience of the country.

It is a process whereby people learn to It is a process whereby people learn to improve their personal habits and attitudes, improve their personal habits and attitudes, to work responsibly for the improvement of to work responsibly for the improvement of health conditions of the family, community, health conditions of the family, community, and nation.and nation.

It involves motivation, experience, and It involves motivation, experience, and change in conduct and thinking, while change in conduct and thinking, while stimulating active interest. It develops stimulating active interest. It develops and provides experience for change in and provides experience for change in people’s attitudes, customs, and habits in people’s attitudes, customs, and habits in relation to health and everyday living.relation to health and everyday living.

It should be recognized as the basic It should be recognized as the basic function of all health workers.function of all health workers.

It takes place in the home, in the It takes place in the home, in the school, and in the community.school, and in the community.

It is a cooperative effort requiring It is a cooperative effort requiring all categories of health personnel to all categories of health personnel to work together in close teamwork work together in close teamwork with families, groups, and the with families, groups, and the community.community.

It meets the needs, interests, and It meets the needs, interests, and problems of the people affected.problems of the people affected.

It finds means and ways of It finds means and ways of carrying out plans by carrying out plans by encouraging individual and encouraging individual and community participation.community participation.

It is a slow, continuous process that It is a slow, continuous process that involves constant changes and involves constant changes and revisions until objectives are revisions until objectives are achieved.achieved.

Makes use of supplementary aids Makes use of supplementary aids and devices to help with the verbal and devices to help with the verbal instructions.instructions.

It utilizes community resources by It utilizes community resources by careful evaluation of the different careful evaluation of the different services and resources found in the services and resources found in the community.community.

It is a creative process requiring It is a creative process requiring methods and techniques with various methods and techniques with various characteristics, not following a rigid and characteristics, not following a rigid and flexible pattern.flexible pattern.

It aims to help people make use of their It aims to help people make use of their own efforts and education to improve own efforts and education to improve their conditions of living, their conditions of living,

It makes careful evaluation of the It makes careful evaluation of the planning, organization, and planning, organization, and implementation of all health education implementation of all health education programs and activities.programs and activities.

THE COMMUNITY HEALTH THE COMMUNITY HEALTH NURSENURSE

Qualifications Qualifications

1.1. Bachelor of Science in Bachelor of Science in NursingNursing

2.2. Registered Nurse of the Registered Nurse of the PhilippinesPhilippines

Planner/ProgrammerPlanner/Programmer1.1. Identifies needs, priorities, and problems Identifies needs, priorities, and problems

of individuals, families, and communitiesof individuals, families, and communities

2.2. Formulates municipal health plan in the Formulates municipal health plan in the absence of a medical doctorabsence of a medical doctor

3.3. Interprets and implements nursing plan, Interprets and implements nursing plan, program policies, memoranda, and circular program policies, memoranda, and circular for the concerned staff personnelfor the concerned staff personnel

4.4. Provides technical assistance to rural Provides technical assistance to rural health midwives in health mattershealth midwives in health matters

Provider of Nursing CareProvider of Nursing Care1.1. Provides direct nursing care to Provides direct nursing care to

sick or disabled in the home, sick or disabled in the home, clinic, school, or workplaceclinic, school, or workplace

2.2. Develops the family’s Develops the family’s capability to take care of the capability to take care of the sick, disabled, or dependent sick, disabled, or dependent membermember

Manager/SupervisorManager/Supervisor1.1. Formulates individual, family, group, and Formulates individual, family, group, and

community-centered plancommunity-centered plan2.2. Interprets and implements programs, Interprets and implements programs,

policies, memoranda, and circularspolicies, memoranda, and circulars3.3. Organizes work force, resources, equipments, Organizes work force, resources, equipments,

and supplies at local leveland supplies at local level4.4. Provides technical and administrative Provides technical and administrative

support to Rural Health Midwives (RHM)support to Rural Health Midwives (RHM)5.5. Conducts regular supervisory visits and Conducts regular supervisory visits and

meetings to different RHMs and gives meetings to different RHMs and gives feedback on accomplishmentsfeedback on accomplishments

Community OrganizerCommunity Organizer

1.1. Motivates and enhances Motivates and enhances community participation in terms community participation in terms of planning, organizing, of planning, organizing, implementing, and evaluating implementing, and evaluating health serviceshealth services

2.2. Initiates and participates in Initiates and participates in community development activitiescommunity development activities

Coordinator of ServicesCoordinator of Services1.1. Coordinates with individuals, families, Coordinates with individuals, families,

and groups for health related services and groups for health related services provided by various members of the provided by various members of the health teamhealth team

2.2. Coordinates nursing program with Coordinates nursing program with other health programs like other health programs like environmental sanitation, health environmental sanitation, health education, dental health, and mental education, dental health, and mental healthhealth

Trainer/Health EducatorTrainer/Health Educator1.1. Identifies and interprets training needs of the Identifies and interprets training needs of the

RHMs, Barangay Health Workers (BHW), RHMs, Barangay Health Workers (BHW), and hilotsand hilots

2.2. Conducts training for RHMs and hilots on Conducts training for RHMs and hilots on promotion and disease preventionpromotion and disease prevention

3.3. Conducts pre and post-consultation Conducts pre and post-consultation conferences for clinic clients; acts as a conferences for clinic clients; acts as a resource speaker on health and health-resource speaker on health and health-related services related services

4.4. Initiates the use of tri-media (radio/TV, Initiates the use of tri-media (radio/TV, cinema plugs, and print ads) for health cinema plugs, and print ads) for health education purposeseducation purposes

5.5. Conducts pre-marital counseling Conducts pre-marital counseling

Health MonitorHealth Monitor

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

Role ModelRole Model

1.1. Provides good example Provides good example of healthful living to of healthful living to the members of the the members of the communitycommunity

Change AgentChange Agent

1.1. Motivates changes in health Motivates changes in health behavior in individuals, behavior in individuals, families, groups, and families, groups, and communities that also include communities that also include lifestyle in order to promote and lifestyle in order to promote and maintain health maintain health

Recorder/Reporter/StatisticianRecorder/Reporter/Statistician1.1. Prepares and submits required reports Prepares and submits required reports

and recordsand records

2.2. Maintain adequate, accurate, and Maintain adequate, accurate, and complete recording and reportingcomplete recording and reporting

3.3. Reviews, validates, consolidates, Reviews, validates, consolidates, analyzes, and interprets all records analyzes, and interprets all records and reportsand reports

4.4. Prepares statistical data/chart and other Prepares statistical data/chart and other data presentationdata presentation

Researcher Researcher 1.1. Participates in the conduct of Participates in the conduct of

survey studies and researches on survey studies and researches on nursing and health-related subjectsnursing and health-related subjects

2.2. Coordinates with government and Coordinates with government and non-government organization in non-government organization in the implementation of the implementation of studies/researchstudies/research

Community OrganizingCommunity Organizing

Approaches to community devt.:Approaches to community devt.:

a.a. Welfare approachWelfare approach

b.b. Technological approachTechnological approach

c.c. Transformatory approahTransformatory approah

Community OrganizingCommunity Organizing

Principles of CO:Principles of CO: 1. People esp. the oppressed, exploited and 1. People esp. the oppressed, exploited and

deprived sectors are most open to change, have deprived sectors are most open to change, have the capacity to change and are able to bring the capacity to change and are able to bring about change. Hence , CO is based on the ff:about change. Hence , CO is based on the ff:

A. Power must reside in the peopleA. Power must reside in the people B. Devt. is from the people to the peopleB. Devt. is from the people to the people C. People participationC. People participation

Principles of COPrinciples of CO

2.-must be based on the poorest sectors of 2.-must be based on the poorest sectors of society. The solutions of problems commonly society. The solutions of problems commonly shared by these sectors must be focused on shared by these sectors must be focused on collective organizations, planning and actioncollective organizations, planning and action

3. – should lead to self-reliant communities3. – should lead to self-reliant communities

THE HRDP-COPAR PROCESSTHE HRDP-COPAR PROCESS

1. PRE-ENTRY PHASE1. PRE-ENTRY PHASE 2. ENNTRY PHASE2. ENNTRY PHASE 3. COMMUNITY STUDY/DIAGNOSIS 3. COMMUNITY STUDY/DIAGNOSIS

PHASE/RESEARCH PHASEPHASE/RESEARCH PHASE 4.COMMUNITY ORGANIZATION AND 4.COMMUNITY ORGANIZATION AND

CAPABILITY-BUILDING PHASECAPABILITY-BUILDING PHASE 5. COMMUNITY ACTION PHASE5. COMMUNITY ACTION PHASE 6. SUSTENANCE AND STRENGTHENING 6. SUSTENANCE AND STRENGTHENING

PHASEPHASE

Classify the ff. CO activities as to Classify the ff. CO activities as to phase of COPAR each belong:phase of COPAR each belong:

1.Conducts community meetings to draw up 1.Conducts community meetings to draw up guidelines for the organization of CHOguidelines for the organization of CHO

2. Trains BHWs2. Trains BHWs 3. Sets up of linkages/network and referral systems3. Sets up of linkages/network and referral systems 4. PIME of health services and or community devt. 4. PIME of health services and or community devt.

ProjectsProjects 5. Provides continuing education to leaders or 5. Provides continuing education to leaders or

residentsresidents 6. Trains secondary leaders6. Trains secondary leaders 7. Selects site for adoption7. Selects site for adoption 8. Identifies key leaders8. Identifies key leaders

Continued….Continued….

9. Develops criteria for site selection9. Develops criteria for site selection 10. Forms the core group10. Forms the core group 11.Conducts SALT11.Conducts SALT 12.Selects members of the research team12.Selects members of the research team 13. Assists the research team in presenting results 13. Assists the research team in presenting results

during the general assemblyduring the general assembly 14. Helps the people identifying the community 14. Helps the people identifying the community

needs and health problemsneeds and health problems 15. Facilitates for the formulation and ratification of 15. Facilitates for the formulation and ratification of

the constitution and by-laws of the organizationthe constitution and by-laws of the organization

Public Health ProgramsPublic Health Programs

COMPREHENSIVE MATERNAL COMPREHENSIVE MATERNAL AND CHILD HEALTH PROGRAMAND CHILD HEALTH PROGRAM

1.1. EPI (Expanded Program on EPI (Expanded Program on Immunization)Immunization)

2.2. CDD (Control of Diarrheal Diseases)CDD (Control of Diarrheal Diseases)3.3. CARI (Control of Acute Respiratory CARI (Control of Acute Respiratory

Infections)Infections)4.4. UFC (Under-Five Clinics)UFC (Under-Five Clinics)5.5. MC (Maternal Care)MC (Maternal Care)

6.6. BF (Breastfeeding)BF (Breastfeeding)

7.7. MRP (Malnutrition Rehabilitation MRP (Malnutrition Rehabilitation Program)Program)

8.8. VAD ( Vitamin A Deficiency)VAD ( Vitamin A Deficiency)

9.9. IDD/IDA (Iodine Deficiency IDD/IDA (Iodine Deficiency Disorders/ Iron Deficiency Anemia)Disorders/ Iron Deficiency Anemia)

10.10. FP (Family Planning)FP (Family Planning)

EPI (EXPANDED PROGRAM ON EPI (EXPANDED PROGRAM ON IMMUNIZATION)IMMUNIZATION)

TARGET SETTING:TARGET SETTING:1.1. INFANTS 0-12 MONTHSINFANTS 0-12 MONTHS2.2. PREGNANT AND POST PARTUM WOMENPREGNANT AND POST PARTUM WOMEN3.3. SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS

OLDOLD   OBJECTIVES OF EPI:OBJECTIVES OF EPI:

TO REDUCE MORBIDITY AND TO REDUCE MORBIDITY AND MORTALITY RATES AMONG INFANTS AND MORTALITY RATES AMONG INFANTS AND CHILDREN from SIX CHILDHOOD CHILDREN from SIX CHILDHOOD IMMUNIZABLE DISEASEIMMUNIZABLE DISEASE

ELEMENTS OF EPI:ELEMENTS OF EPI:1.1. TARGET SETTINGTARGET SETTING

2.2. COLDCHAIN LOGISTIC MANAGEMENT- COLDCHAIN LOGISTIC MANAGEMENT- Vaccine distribution through cold chain is Vaccine distribution through cold chain is designed to ensure that the vaccine were designed to ensure that the vaccine were maintained under proper environmental maintained under proper environmental condition until the time of administration.condition until the time of administration.

3.3. IECIEC

4.4. Assessment and evaluation of Over-all Assessment and evaluation of Over-all performance of the programperformance of the program

5.5. Surveillance and research studiesSurveillance and research studies

EXPANDED PROGRAM ON IMMUNIZATIONEXPANDED PROGRAM ON IMMUNIZATION

VaccineVaccine Minimum Minimum Age of 1Age of 1stst DoseDose

Number Number ofof DosesDoses

Minimum Minimum Interval Interval Between Between DosesDoses

ReasonReason

1.1. BCGBCG

(Bacillus(Bacillus

CalmetteCalmette

Guerin)Guerin)

Birth orBirth or

anytime anytime afterafter

birth birth

School School entranentrants ts

11 BCG is given BCG is given at the earliest at the earliest possible age possible age protects against protects against the possibility the possibility of TB infection of TB infection from the other from the other family family

membersmembers

2.2. DPT DPT (Diphtheria (Diphtheria

Pertusis Pertusis Tetanus)Tetanus)

6 weeks6 weeks 33 4 weeks4 weeks An early start with An early start with DPT reduces the DPT reduces the chance of severe chance of severe pertussispertussis

3.3. OPV OPV (Oral Polio (Oral Polio

Vaccine)Vaccine)

6 weeks6 weeks 33 4 weeks4 weeks The extent of The extent of protection against protection against polio is increased the polio is increased the earlier OPV is given.earlier OPV is given.

4.4. Hepatitis Hepatitis BB

6 weeks6 weeks 33 4 weeks4 weeks An early start of An early start of Hepatitis B reduces the Hepatitis B reduces the chance of being infected chance of being infected and becoming a carrier. and becoming a carrier.

5.5. Measles Measles 9 months9 months 11 At least 85% of measles At least 85% of measles can be prevented by can be prevented by immunization at this age. immunization at this age.

CDD (CONTROL OF DIARRHEAL DISEASES)CDD (CONTROL OF DIARRHEAL DISEASES)MANAGEMENT OF THE PATIENT WITH MANAGEMENT OF THE PATIENT WITH

DIARRHEADIARRHEA

A.   NO DEHYDRATIONA.   NO DEHYDRATION Condition – well, alertCondition – well, alert Mouth and Tongue – moistMouth and Tongue – moist Eyes – normalEyes – normal Thirst – drinks normally, not thirstyThirst – drinks normally, not thirsty Tears – presentTears – present Skin pinch – goes back quicklySkin pinch – goes back quickly TREATMENT PLAN A- HOME TTT.TREATMENT PLAN A- HOME TTT.

1.Give the child more fluids than usual1.Give the child more fluids than usual

    use home fluid such as cereal grueluse home fluid such as cereal gruel

  give ORESOL, plain watergive ORESOL, plain water

THREE RULES FOR HOME THREE RULES FOR HOME TREATMENTTREATMENT

2.     Give the child plenty of food to prevent 2.     Give the child plenty of food to prevent undernutritionundernutrition

              continue to breastfeed frequentlycontinue to breastfeed frequently

              if child is not breastfeed, give usual milkif child is not breastfeed, give usual milk

              if child is less than 6 months and not yet taking if child is less than 6 months and not yet taking solid food, dilute milk for 2 dayssolid food, dilute milk for 2 days

              if child is 6 months or older and already taking if child is 6 months or older and already taking solid food, give cereal or other starchy food mixed solid food, give cereal or other starchy food mixed with vegetables, meat or fish; give fresh fruit juice with vegetables, meat or fish; give fresh fruit juice or mashed banana to provide potassium; feed child or mashed banana to provide potassium; feed child at least 6 times a day. After diarrhea stops, give an at least 6 times a day. After diarrhea stops, give an extra meal each day for two weeks.extra meal each day for two weeks.

3.     3.     Take the child to the health worker if Take the child to the health worker if the child does not get better in 3 days or the child does not get better in 3 days or develops any of the followingdevelops any of the following::

              many watery stoolsmany watery stools              repeated vomitingrepeated vomiting              marked thirstmarked thirst              eating or drinking poorlyeating or drinking poorly              feverfever              blood in the stoolblood in the stool

ORESOL TREATMENTORESOL TREATMENT AgeAge Amount of ORS Amount of ORS

to give after to give after each loose stooleach loose stool

Amount of ORS to Amount of ORS to provide for use at provide for use at homehome

< 24 < 24 monthsmonths

50-100 ml.50-100 ml. 500 ml./day500 ml./day

2 – 2 – 10 years10 years

100-200 ml.100-200 ml. 1000 ml./day1000 ml./day

10 10 years upyears up

As much as As much as wantedwanted

2000 ml./day2000 ml./day

B.   SOME DEHYDRATIONB.   SOME DEHYDRATION Condition – restless, irritableCondition – restless, irritable Mouth and Tongue – dryMouth and Tongue – dry Eyes – sunkenEyes – sunken Thirst – thirsty, drinks eagerlyThirst – thirsty, drinks eagerly Tears – absentTears – absent Skin pinch – goes back slowlySkin pinch – goes back slowly WEIGH PT, TTT. PLAN BWEIGH PT, TTT. PLAN B

APPROX. AMT. OF ORS- TO GIVE IN 1APPROX. AMT. OF ORS- TO GIVE IN 1STST 4 4 HRSHRS

AGEAGE WEIGHTWEIGHT

KGKG

ORSORS

MLML

4 MOS.4 MOS. 5 5 200-400200-400

4-11MOS4-11MOS 5-7.95-7.9 400-600400-600

12-23MOS12-23MOS 8-10.98-10.9 600-800600-800

2-4YRS2-4YRS 11-15.911-15.9 800-1200800-1200

5-14YRS5-14YRS 16-29.916-29.9 1200-22001200-2200

15 YRS UP15 YRS UP 30 UP30 UP 2200-40002200-4000

1.1. If the child wants more ORS than shown, give moreIf the child wants more ORS than shown, give more

2.2. Continue breastfeedingContinue breastfeeding

3.3. For infants below 6 mos. who are not breastfeed, give For infants below 6 mos. who are not breastfeed, give 100-200 ml clean water during the period100-200 ml clean water during the period

4.4. For a child less than 2 years give a teaspoonful every 1-2 For a child less than 2 years give a teaspoonful every 1-2 min.min.

5.5. If the child vomits, wait for 10 min, then continue giving If the child vomits, wait for 10 min, then continue giving ORS, 1 tbsp/2-3 minORS, 1 tbsp/2-3 min

6.6. If the child’s eyelids become puffy, stop ORS , give plain If the child’s eyelids become puffy, stop ORS , give plain water or breast milk, Resume ORS when puffiness is gonewater or breast milk, Resume ORS when puffiness is gone

7.7. If ( -) signs of DHN- shift to Plan AIf ( -) signs of DHN- shift to Plan A

Use of Drugs during DiarrheaUse of Drugs during Diarrhea

Antibiotics should only be used for Antibiotics should only be used for dysentery and suspected choleradysentery and suspected cholera

Antiparasitic drugs should only be used Antiparasitic drugs should only be used for amoebiasis and giardiasisfor amoebiasis and giardiasis

C. SEVERE DEHYDRATIONC. SEVERE DEHYDRATIONCondition – lethargic or unconscious; floppyCondition – lethargic or unconscious; floppyEyes – very sunken and dryEyes – very sunken and dryTears – absentTears – absentMouth and tongue – very dryMouth and tongue – very dryThirst- drinks poorly or not able to drinkThirst- drinks poorly or not able to drinkSkin pinch – goes back very slowlySkin pinch – goes back very slowlyTTT PLAN C- ttt. quicklyTTT PLAN C- ttt. quickly1.Bring pt. to hospital1.Bring pt. to hospital2. IVF – Lactated Ringers Solution or Normal Saline2. IVF – Lactated Ringers Solution or Normal Saline3.Re-assess pt. Every 1-2 hrs3.Re-assess pt. Every 1-2 hrs4. Give ORS as soon as the pt. can drink4. Give ORS as soon as the pt. can drink

ROLE OF BREASTFEEDING IN THE ROLE OF BREASTFEEDING IN THE CONTROL OF DIARRHEAL DISEASES CONTROL OF DIARRHEAL DISEASES

PROGRAMPROGRAM

1.1. Two problems in CDDTwo problems in CDD 1. High child mortality due to 1. High child mortality due to

diarrheadiarrhea 2. High diarrhea incidence among 2. High diarrhea incidence among

under fivesunder fives

2.2. Highest incidence in age 6 – 23 monthsHighest incidence in age 6 – 23 months

3.3. Highest mortality in the first 2 years of lifeHighest mortality in the first 2 years of life

4.4. Main causes of death in diarrhea :Main causes of death in diarrhea : DEHYDRATIONDEHYDRATION MALNUTRITIONMALNUTRITION

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

6.6. For undernutrition, continue feeding during For undernutrition, continue feeding during diarrhea especially breastfeeding.diarrhea especially breastfeeding.

7.7. Interventions to prevent diarrheaInterventions to prevent diarrhea

1.      breastfeeding1.      breastfeeding

2.      improved weaning practices2.      improved weaning practices

3.      use of plenty of clean water3.      use of plenty of clean water

44.      .      hand washinghand washing

5. use of latrines5. use of latrines

6.6. proper disposal of stools of proper disposal of stools of small children small children

7. measles immunization7. measles immunization

8.8. Risk of severe diarrhea 10-30x higher in Risk of severe diarrhea 10-30x higher in bottle fed infants than in breastfed infants.bottle fed infants than in breastfed infants.

9.9. Advantages of breastfeeding in relation to Advantages of breastfeeding in relation to CDDCDD

1.Breast milk is sterile1.Breast milk is sterile

2.Presence of antibodies protection against 2.Presence of antibodies protection against diarrheadiarrhea

3.Intestinal Flora in BF infants prevents 3.Intestinal Flora in BF infants prevents growth of diarrhea causing bacteria.growth of diarrhea causing bacteria.

10.10. Breastfeeding decreases incidence rate by Breastfeeding decreases incidence rate by 8-20% and mortality by 24-27% in 8-20% and mortality by 24-27% in infants under 6 months of age.infants under 6 months of age.

11.11. When to wean?When to wean?

4-6 months – soft mashed foods 2x a day4-6 months – soft mashed foods 2x a day

6 months – variety of foods 4x a day6 months – variety of foods 4x a day

12.12. Summary of WHO-CDD recommended strategies Summary of WHO-CDD recommended strategies to prevent diarrheato prevent diarrhea

1. Improved Nutrition1. Improved Nutrition

- exclusive breastfeeding for the first 4-6 months of - exclusive breastfeeding for the first 4-6 months of life and partially for at least one year.life and partially for at least one year.

- Improved weaning practices- Improved weaning practices

2.Use of safe water2.Use of safe water

- collecting plenty of water from the cleanest source- collecting plenty of water from the cleanest source

- protecting water from contamination at the source - protecting water from contamination at the source and in the homeand in the home

3.Good personal and domestic hygiene3.Good personal and domestic hygiene

- handwashing- handwashing

- use of latrines- use of latrines

- proper disposal of stools of young children- proper disposal of stools of young children

4.Measles immunization4.Measles immunization

CARI (CONTROL OF ACUTE RESPIRATORY CARI (CONTROL OF ACUTE RESPIRATORY INFECTIONS)INFECTIONS)

CLASSIFICATION: CLASSIFICATION: A.A.      NO PNEUMONIA: COUGH OR COLDNO PNEUMONIA: COUGH OR COLD

1.1.        No chest in drawingNo chest in drawing2.2.        No fast breathing ( <2 mos- <60/min,2-No fast breathing ( <2 mos- <60/min,2-

12 mos. – less than 50 per minute; 12 mos. – 5 12 mos. – less than 50 per minute; 12 mos. – 5 years – less than 40 per minute)years – less than 40 per minute)

TREATMENT:TREATMENT:1.1.  If coughing more than 30 days, refer for If coughing more than 30 days, refer for assessmentassessment2.2.  Assess and treat ear problems/sore throat if Assess and treat ear problems/sore throat if presentpresent3.3.  Advise mother to give home careAdvise mother to give home care4.Treat fever/wheezing if present4.Treat fever/wheezing if present

HOME CARE:HOME CARE:

1.1. FEED THE CHILDFEED THE CHILD

1.1. Feed the child during illnessFeed the child during illness

2.2. Increase feeding after illnessIncrease feeding after illness

3.3. Clear the nose if it interferes with feedingClear the nose if it interferes with feeding

2.2. INCREASE FLUIDSINCREASE FLUIDS

1.1. offer the child extra to drinkoffer the child extra to drink

2.2. Increase breastfeedingIncrease breastfeeding

3.3. SOOTHE THE THROAT AND SOOTHE THE THROAT AND RELIEVE THE COUGH WITH A RELIEVE THE COUGH WITH A SAFE REMEDYSAFE REMEDY

4.4. WATCH FOR THE FOLLOWING WATCH FOR THE FOLLOWING SIGNS AND SYMPTOMS AND SIGNS AND SYMPTOMS AND RETURN QUICKLY IF THEY RETURN QUICKLY IF THEY OCCUROCCUR

1.1. Breathing becomes difficultBreathing becomes difficult

2.2. Breathing becomes fastBreathing becomes fast

3.3. Child is not able to drinkChild is not able to drink

4.4. Child becomes sickerChild becomes sicker

B.B.    PNEUMONIAPNEUMONIA

1. No chest in drawing1. No chest in drawing

2. Fast breathing ( less than 2 mos- 60/min 2. Fast breathing ( less than 2 mos- 60/min or more ; 2-12 mos. – 50/min or more; 12 or more ; 2-12 mos. – 50/min or more; 12 mos. – 5 years – 40/min or more)mos. – 5 years – 40/min or more)

TREATMENTTREATMENT

1.Advise mother to give home care1.Advise mother to give home care

2.Give an antibiotic2.Give an antibiotic

3.Treat fever/wheezing if present3.Treat fever/wheezing if present

4.If the child’s condition gets worst,refer 4.If the child’s condition gets worst,refer urgently to hospital; if improving, finish 5 days urgently to hospital; if improving, finish 5 days of antibiotic.of antibiotic.

ANTIBIOTICS RECOMMENDED BY ANTIBIOTICS RECOMMENDED BY WHOWHO

*Co-trimoxazole,*Co-trimoxazole,

*Amoxycillin, Ampicillin, (p.o) *Amoxycillin, Ampicillin, (p.o)

*or Procaine penicillin (I.M.)*or Procaine penicillin (I.M.)

C. Severe PneumoniaC. Severe Pneumonia

Chest indrawingChest indrawing Nasal flaringNasal flaring Grunting ( short sounds made with the voice)Grunting ( short sounds made with the voice) CyanosisCyanosisTTT.TTT.1.1. Refer urgently to hospitalRefer urgently to hospital2.2. Treat fever ( paracetamol), wheezing Treat fever ( paracetamol), wheezing

( salbutamol)( salbutamol)

D. Very Severe DiseaseD. Very Severe Disease

Not able to drinkNot able to drink ConvulsionsConvulsions Abnormally sleepy or difficult to wakeAbnormally sleepy or difficult to wake Stridor in calm childStridor in calm child Severe undernutritionSevere undernutrition

TTT. TTT.

Refer urgently to hospitalRefer urgently to hospital

ASSESSMENT OF RESPIRATORY ASSESSMENT OF RESPIRATORY INFECTIONINFECTION

ASK THE MOTHER:ASK THE MOTHER:

1.1. How old is the child?How old is the child?

2.2. Is the child coughing? For how long?Is the child coughing? For how long?

3.3. Age 2 months up to 5 years: Is the child able Age 2 months up to 5 years: Is the child able to drink?to drink?

Age less than 2 months: Has the young infant Age less than 2 months: Has the young infant stopped feeding well?stopped feeding well?

4.4. Has the child had fever? For how long?Has the child had fever? For how long?

5.5. Has the child had convulsions?Has the child had convulsions?

LOOK, LISTEN:LOOK, LISTEN:

1.1.        Count the breaths in one minute.Count the breaths in one minute.

2.2.Look for chest in drawing.Look for chest in drawing.

3.3.Look and listen for stridor.Look and listen for stridor.

Stridor occurs when there is a narrowing of the Stridor occurs when there is a narrowing of the larynx, trachea or epiglottis which interferes larynx, trachea or epiglottis which interferes with air entering the lungs.with air entering the lungs.

Age0Age0 Fast BreathingFast Breathing

Less than 2 monthsLess than 2 months 60/minute or more60/minute or more

2 months – 12 months2 months – 12 months 50/minute or more50/minute or more

12 months – 5 years12 months – 5 years 40/minute or more40/minute or more

4.4. Look and listen for wheezeLook and listen for wheeze

Wheeze is a soft musical noise which Wheeze is a soft musical noise which shows signs that breathing out(exhale) shows signs that breathing out(exhale) is difficult.is difficult.

5.5. See if the child is abnormally sleepy or See if the child is abnormally sleepy or difficult to wake. (Suspect meningitis)difficult to wake. (Suspect meningitis)

6.6. Feel for fever or low body temperature.Feel for fever or low body temperature.

7.7. Check for severe under nutritionCheck for severe under nutrition

MANAGEMENT OF A CHILD MANAGEMENT OF A CHILD WITH AN EAR PROBLEMWITH AN EAR PROBLEM

Classification of Ear InfectionClassification of Ear Infection

A. MASTOIDITISA. MASTOIDITIS – tender swelling behind the ear – tender swelling behind the ear (in infants, swelling may be above the ear)(in infants, swelling may be above the ear)

TREATMENTTREATMENT

1. Antibiotics1. Antibiotics

2.Surgical intervention2.Surgical intervention

B. ACUTE EAR INFECTIONB. ACUTE EAR INFECTION – pus draining – pus draining from the ear for less than 2 weeks, ear pain, from the ear for less than 2 weeks, ear pain, red, immobile ear drum (Acute Otitis Media)red, immobile ear drum (Acute Otitis Media)

TREATMENTTREATMENT

1.Cotrimoxazole,Amoxycillin,or Ampicillin1.Cotrimoxazole,Amoxycillin,or Ampicillin

2.Dry the ear by wicking2.Dry the ear by wicking

C. CHRONIC EAR INFECTIONC. CHRONIC EAR INFECTION – pus draining from the – pus draining from the ear for more than 2 weeks (Chronic Otitis Media) ear for more than 2 weeks (Chronic Otitis Media)

TREATMENTTREATMENT Most important & effective treatment: Most important & effective treatment: Keep the ear dry Keep the ear dry

by wicking.by wicking. Paracetamol maybe given for pain or high fever.Paracetamol maybe given for pain or high fever. Precautions for a child with a draining ear:Precautions for a child with a draining ear:1.1. Do not leave anything in the ear such as cotton, wool Do not leave anything in the ear such as cotton, wool

between wicking treatments.between wicking treatments.2.2. Do not put oil or any other fluid into the ear.Do not put oil or any other fluid into the ear.3.3. Do not let the child go swimming or get water in the Do not let the child go swimming or get water in the

ear.ear.

Maternal and Child Health NursingMaternal and Child Health Nursing

PhilosophyPhilosophy Pregnancy, labor and delivery and puerperium Pregnancy, labor and delivery and puerperium

are part of the continuum of the total life cycleare part of the continuum of the total life cycle Personal, cultural and religious attitudes and Personal, cultural and religious attitudes and

beliefs influence the meaning of pregnancy for beliefs influence the meaning of pregnancy for individuals and make each experience uniqueindividuals and make each experience unique

MCN is FAMILY CENTERED- the father MCN is FAMILY CENTERED- the father is as important as the mother is as important as the mother

GoalsGoals To ensure that expectant mother and nursing To ensure that expectant mother and nursing

mother maintain good health, learn the art of mother maintain good health, learn the art of child care, has a normal delivery and bear child care, has a normal delivery and bear healthy childrenhealthy children

That every child lives and grows up in a family That every child lives and grows up in a family unit with love and security, in healthy unit with love and security, in healthy surroundings, receives adequate nourishment, surroundings, receives adequate nourishment, health supervision and efficient medical attention health supervision and efficient medical attention and is taught the elements of healthy livingand is taught the elements of healthy living

Classification of pregnant Classification of pregnant womenwomen

Normal – healthy pregnancyNormal – healthy pregnancy With mild complications- frequent home visits With mild complications- frequent home visits With serious or potentially serious cx – With serious or potentially serious cx –

referred to most skilled source of medical and referred to most skilled source of medical and hospital carehospital care

Home Based Mother’s Record Home Based Mother’s Record ( HBMR )( HBMR )

Tool used when rendering prenatal care Tool used when rendering prenatal care

containing risk factors and danger signscontaining risk factors and danger signs

*Risk Factors*Risk Factors 145 cm tall ( 4 ft & 9 inches)145 cm tall ( 4 ft & 9 inches) Below 18 yrs old, above 35 yrs oldBelow 18 yrs old, above 35 yrs old Have had 4 pregnanciesHave had 4 pregnancies With TB, goiter, heart disease, DM, bronchial With TB, goiter, heart disease, DM, bronchial

asthma, severe anemiaasthma, severe anemia Last baby born was less than 2 years agoLast baby born was less than 2 years ago Previous cesarian section deliveryPrevious cesarian section delivery History of 2 or more abortions, difficult delivery, History of 2 or more abortions, difficult delivery,

given birth to twins , 2 or more babies born before given birth to twins , 2 or more babies born before EDD, stillbirthEDD, stillbirth

Weighs less than 45 kgs. or more than 80 kgs.Weighs less than 45 kgs. or more than 80 kgs.

*Danger Signs*Danger Signs

1. any type of vaginal bleeding1. any type of vaginal bleeding 2. headache, dizziness, blurred vision2. headache, dizziness, blurred vision 3. puffiness of face and hands3. puffiness of face and hands 4. pallor4. pallor

Prenatal CarePrenatal Care

Schedule of VisitsSchedule of Visits 11stst – as early as pregnancy, 1 – as early as pregnancy, 1stst trimester trimester

22ndnd - 2 - 2ndnd trimester trimester

33rdrd & subsequent visits - 3 & subsequent visits - 3rdrd trimester trimester

More frequent visits for those at risk with cxMore frequent visits for those at risk with cx

TETANUS TOXOID IMMUNIZATION SCHEDULE TETANUS TOXOID IMMUNIZATION SCHEDULE FOR WOMENFOR WOMEN

VaccineVaccine Minimum Age Minimum Age IntervalInterval

Percent Percent ProtectedProtected

Duration of Duration of ProtectionProtection

TT1TT1

As early as possible As early as possible during pregnancyduring pregnancy

80%80%

  

TT2 TT2 At least 4 At least 4 weeks laterweeks later

80%80%   Infants born to the Infants born to the mother will be mother will be protectedprotected

from neonatalfrom neonatal

tetanus. tetanus.

Gives 3 years Gives 3 years protection forprotection for

the mother from the mother from tetanus.tetanus.

TT3TT3

At least 6 At least 6 months latermonths later

90%90%

Infants born to the mother Infants born to the mother will be protected will be protected

from neonatal from neonatal

tetanus.tetanus.

Gives 5 years protection Gives 5 years protection for the mother.for the mother.

TT4TT4 At least 1 year At least 1 year laterlater

99%99%   Gives 10 Gives 10 protection protection for the for the mothermother

TT5 TT5 At least 1 year At least 1 year later later

99% 99% Gives lifetime Gives lifetime protection forprotection for

the mother.the mother.

All infants All infants born to that born to that

mothermother

will be will be protected. protected.

Dose:0.5mlDose:0.5mlRoute: IntramuscularlyRoute: Intramuscularly

Site: Right or Left Deltoid/ButtocksSite: Right or Left Deltoid/Buttocks

Components of Prenatal VisitsComponents of Prenatal Visits History – takingHistory – taking Determination of obstetrical score- G, P, Determination of obstetrical score- G, P,

TPAL,AOG,EDDTPAL,AOG,EDD U/A for Proteinuria, glycosuria and infxtnU/A for Proteinuria, glycosuria and infxtn Dental examDental exam Wt. Ht. BP takingWt. Ht. BP taking Exam of conjunctiva and palms for pallorExam of conjunctiva and palms for pallor Abdominal exam - fundic ht, Leopold’s Abdominal exam - fundic ht, Leopold’s

maneuver and FHTmaneuver and FHT

Exam of breasts, face, hands and feet for edema and Exam of breasts, face, hands and feet for edema and neck for thyroid enlargementneck for thyroid enlargement

Health teachings- nutrition, personal hygiene, Health teachings- nutrition, personal hygiene, common complaintscommon complaints

Tetanus toxoid immunizationTetanus toxoid immunization Iron supplementation – from 5Iron supplementation – from 5 thth mo. of pregnancy - mo. of pregnancy -

2 mos. Postpartum 2 mos. Postpartum In goiter endemic areas – iodized capsule once a In goiter endemic areas – iodized capsule once a

yearyear In malaria infested areas- prophylactic Chloroquine In malaria infested areas- prophylactic Chloroquine

( 150 mg/tab ) 2 tabs/ wk for the whole duration of ( 150 mg/tab ) 2 tabs/ wk for the whole duration of pregnancypregnancy

UNDER FIVE CLINICUNDER FIVE CLINIC

  

The first five years of life form the The first five years of life form the foundations of the child’s physical and mental foundations of the child’s physical and mental growth and development. Studies have shown the growth and development. Studies have shown the mortality and morbidity are high among this age mortality and morbidity are high among this age group. The Department of Health established the group. The Department of Health established the Under Five Clinic Program to address thisUnder Five Clinic Program to address this problem.problem.

PROGRAM OBJECTIVES AND GOALS:PROGRAM OBJECTIVES AND GOALS:

Monitor growth and development of the child Monitor growth and development of the child until 5 years of age.until 5 years of age.

Identify factors that may hinder the growth and Identify factors that may hinder the growth and development of the child.development of the child.

ACTIVITIES AND STRATEGIES:ACTIVITIES AND STRATEGIES:1. 1. Regular height and weight determination/ monitoring Regular height and weight determination/ monitoring

until 5 years old.until 5 years old.

0-1 year old=monthly0-1 year old=monthly

1 year old and above =quarterly1 year old and above =quarterly

2. Recording of immunization, vitamins supplementation,2. Recording of immunization, vitamins supplementation,

deworming and feeding.deworming and feeding.

3. Provision of IEC materials (ex. Posters, charts, toys) 3. Provision of IEC materials (ex. Posters, charts, toys) that promote and enhance child’s proper growth and that promote and enhance child’s proper growth and development.development.

4. Provision of a safe and learning – oriented environment 4. Provision of a safe and learning – oriented environment for the child.for the child.

5. Monitoring and Evaluation.5. Monitoring and Evaluation.

BREASTFEEDING/ LACTATION MANAGEMENT BREASTFEEDING/ LACTATION MANAGEMENT EDUCATION TRAININGEDUCATION TRAINING

Breastfeeding practices has been proved to be very Breastfeeding practices has been proved to be very beneficial to both mother and baby thus the creation of beneficial to both mother and baby thus the creation of the following laws support the full implementation of the following laws support the full implementation of this program:this program:

Executive Order 51Executive Order 51Republic Act 7600 Republic Act 7600 The Rooming-In and Breastfeeding Act of 1992 The Rooming-In and Breastfeeding Act of 1992 

PROGRAM OBJECTIVES AND GOALS:PROGRAM OBJECTIVES AND GOALS:

=Protection and promotion of breastfeeding =Protection and promotion of breastfeeding and lactation management education and lactation management education trainingtraining

ACTIVITIES AND STRATEGIES:ACTIVITIES AND STRATEGIES:1.FULL IMPLEMENTATION OF LAWS1.FULL IMPLEMENTATION OF LAWS

SUPPORTING THE PROGRAMSUPPORTING THE PROGRAM

A.A. EO 51 THE MILK CODE – protection and EO 51 THE MILK CODE – protection and promotion of breastfeeding to ensure the safe and promotion of breastfeeding to ensure the safe and adequate nutrition of infants through regulation of adequate nutrition of infants through regulation of marketing of infant foods and related products. marketing of infant foods and related products. (e.g. breast milk substitutes, infant formulas, (e.g. breast milk substitutes, infant formulas, feeding bottles, teats etc. )feeding bottles, teats etc. )

B.B. RA 7600 THE ROOMING –IN and RA 7600 THE ROOMING –IN and BREASTFEEDING ACT of 1992 BREASTFEEDING ACT of 1992

=An act providing incentives to government and =An act providing incentives to government and private health institutions promoting and private health institutions promoting and practicing rooming-in and breast-feeding.practicing rooming-in and breast-feeding.

=Provision for human milk bank.=Provision for human milk bank.=Information, education and re-education drive=Information, education and re-education drive=Sanction and Regulation=Sanction and Regulation

2. CONDUCT ORIENTATION/ADVOCACY 2. CONDUCT ORIENTATION/ADVOCACY MEETINGS TO HOSPITAL/ COMMUNITY.MEETINGS TO HOSPITAL/ COMMUNITY.

ADVANTAGES OF BREASTFEEDING:ADVANTAGES OF BREASTFEEDING:

  

MOTHERMOTHER             Oxytocin help the uterus contractsOxytocin help the uterus contracts             Uterine involutionUterine involution             Reduce incidence of Breast CancerReduce incidence of Breast Cancer             Promote Maternal-Infant BondingPromote Maternal-Infant Bonding           Form of Family planning Method (Lactational Form of Family planning Method (Lactational

Amenorrhea) Amenorrhea) 

BABYBABY           Provides AntibodiesProvides Antibodies           Contains Lactoferin (binds with Iron)Contains Lactoferin (binds with Iron)           LeukocytesLeukocytes        Contains Bifidus factor-promotes Contains Bifidus factor-promotes

growth of the Lactobacillus-inhibits the growth of the Lactobacillus-inhibits the growth of pathogenic bacilligrowth of pathogenic bacilli

POSITIONS IN BF THE BABY:POSITIONS IN BF THE BABY: 1.     Cradle Hold = head and neck are supported1.     Cradle Hold = head and neck are supported 2.     Football Hold2.     Football Hold 3.     Side Lying Position3.     Side Lying Position

BEST FOR BABIESBEST FOR BABIES

REDUCE INCIDENCE OF ALLERGENSREDUCE INCIDENCE OF ALLERGENS

ECONOMICALECONOMICAL ANTIBODIES PRESENTANTIBODIES PRESENT STOOL INOFFENSIVE (GOLDEN YELLOW)STOOL INOFFENSIVE (GOLDEN YELLOW) EMPERATURE ALWAYS IDEALEMPERATURE ALWAYS IDEALFRESH MILK NEVER GOES OFFFRESH MILK NEVER GOES OFF

   EMOTIONALLY BONDINGEMOTIONALLY BONDING EASY ONCE ESTABLISHEDEASY ONCE ESTABLISHEDDIGESTED EASILYDIGESTED EASILYIMMEDIATELY AVAILABLEIMMEDIATELY AVAILABLE NUTRITIONALLY OPTIMALNUTRITIONALLY OPTIMALGASTROENTERITIS GREATLY REDUCEDGASTROENTERITIS GREATLY REDUCED

GARANTISADONG PAMBATA (GP)GARANTISADONG PAMBATA (GP)

Garantisadong Pambata is a biannual week long Garantisadong Pambata is a biannual week long delivery of a package of health services to children between delivery of a package of health services to children between the ages of 0-59 months old with the purpose of reducing the ages of 0-59 months old with the purpose of reducing morbidity and mortality among under fives through the morbidity and mortality among under fives through the promotion of positive Filipino values for proper child promotion of positive Filipino values for proper child growth and development.growth and development.

  

1.     WHAT ARE THE HEALTH SERVICES OFFERED 1.     WHAT ARE THE HEALTH SERVICES OFFERED IN GP AND WHO ARE THE TARGETS?IN GP AND WHO ARE THE TARGETS?

GP offers the following:GP offers the following:

1.1     Routine Health Services:1.1     Routine Health Services:

Health Health ServiceService

DosageDosage Route of Route of AdministraAdministra

tiontion

Target Target PopulationPopulation

Vitamin A Vitamin A

capsulecapsule 200,000 IU 200,000 IU or 1 capsuleor 1 capsule

100,000 IU 100,000 IU or ½ cap or 3 or ½ cap or 3

dropsdrops

Orally by Orally by dropsdrops

12-59 12-59 months old, months old, nationwidenationwide

9-12 month 9-12 month old infants old infants receiving receiving AMV AMV

nationwidenationwide

Ferrous Ferrous SulfateSulfate(25 mg. (25 mg. Elemental Elemental Iron per ml; Iron per ml; 30 ml. Bottle 30 ml. Bottle as taken as taken home home medicine withmedicine with

instructions)instructions)

0.3ml(2-6 0.3ml(2-6 mos)mos)

once a dayonce a day

  

0.6ml(6-0.6ml(6-11mos) once a 11mos) once a

dayday

Orally Orally by dropsby drops

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

Routine Routine ImmunizatiImmunizationon -BCG*-BCG*

-DPT*-DPT*

  -OPV*-OPV*

-AMV*-AMV*

-Hepa B (if -Hepa B (if available)available)

0.05ml0.05ml

0.5ml 0.5ml 

2 drops2 drops

0.5ml0.5ml

0.5ml0.5ml

Intradermal on right Intradermal on right deltoid deltoid

Intramuscularly on Intramuscularly on anterior thighanterior thigh

OrallyOrally

Subcutaneously onSubcutaneously on

deltoiddeltoid

IntramuscularlyIntramuscularly

NationwideNationwide

0-11 mos0-11 mos

0-11 mos0-11 mos

0-11 mos0-11 mos

9-11 mos9-11 mos

0-11 mos0-11 mos

DeworminDeworming drugg drug

(if (if available)available) 1 tablet 1 tablet

as single as single dosedose

OrallyOrally 36-59 mos, 36-59 mos, nationwidenationwide

WeighingWeighing 0-59 mos,0-59 mos,

nationwidenationwide

* The child should not have received * The child should not have received megadose of Vit. A above the recommended megadose of Vit. A above the recommended dosage within the past 4 weeks except if the dosage within the past 4 weeks except if the child has measles or signs and symptoms of child has measles or signs and symptoms of Vit A. deficiency.Vit A. deficiency.

** For any child between 12-23 months, who ** For any child between 12-23 months, who missed any of his routine immunization, the missed any of his routine immunization, the health worker should give the child the health worker should give the child the necessary antigen to complete FIC and shall be necessary antigen to complete FIC and shall be recorded as such.recorded as such.

GARANTISADONG PAMBATAGARANTISADONG PAMBATASangkap PinoySangkap Pinoy

- - Vitamin A, Iron and IodineVitamin A, Iron and Iodine-Sources: green leafy and yellow vegetables, -Sources: green leafy and yellow vegetables,

fruits, liver, seafoods, iodized salt, pan de fruits, liver, seafoods, iodized salt, pan de bida and other fortified foods. bida and other fortified foods. 

These micronutrients are not produced These micronutrients are not produced by the body, and must be taken in the food we by the body, and must be taken in the food we eat; essential in the normal process of growth eat; essential in the normal process of growth and development:and development:

a)a) Helps the body to regulate itselfHelps the body to regulate itself

b)b) Necessary in energy metabolismNecessary in energy metabolism

c)c) Vital in brain cell formation and mental developmentVital in brain cell formation and mental development

d)d) Necessary in the body immune system to protect the Necessary in the body immune system to protect the body from severe infection.body from severe infection.  

e)e) Eating Sangkap Pinoy-rich foods can prevent and Eating Sangkap Pinoy-rich foods can prevent and control:control:

1.1. Protein Energy MalnutritionProtein Energy Malnutrition

2.2. Vitamin A DeficiencyVitamin A Deficiency

3.3. Iron DeficiencyIron Deficiency Anemia Anemia

4.4. Iodine Deficiency DisorderIodine Deficiency Disorder

BREASTFEEDINGBREASTFEEDING

Breast milk is best for babies up to 2 Breast milk is best for babies up to 2 years old. Exclusive breastfeeding is years old. Exclusive breastfeeding is recommended for the first six months of life. recommended for the first six months of life. At about At about sixsix months, give carefully selected months, give carefully selected nutritious foods as supplements.nutritious foods as supplements.

Breastfeeding provides physical and Breastfeeding provides physical and psychological benefits for children and psychological benefits for children and mothers as well as economic benefits for mothers as well as economic benefits for families and societiesfamilies and societies..

BENEFITS :BENEFITS :

For infantsFor infants

a.a. Provides a nutritional complete food for the Provides a nutritional complete food for the young infant.young infant.

b.b. Strengthens the infant’s immune system, Strengthens the infant’s immune system, preventing many infections.preventing many infections.

c.c. Safely rehydrates and provides essential Safely rehydrates and provides essential nutrients to a sick child, especially to those nutrients to a sick child, especially to those suffering from diarrheal diseases.suffering from diarrheal diseases.

d.d. Reduces the infant’s exposure to infection.Reduces the infant’s exposure to infection.

For the MotherFor the Mothere.e. Reduces a woman’s risk of excessive blood loss Reduces a woman’s risk of excessive blood loss

after birthafter birthf.f. Provides a natural method of delaying Provides a natural method of delaying

pregnancies.pregnancies.g.g. Reduces the risk of ovarian and breast cancers and Reduces the risk of ovarian and breast cancers and

osteoporosis.osteoporosis. For the Family and CommunityFor the Family and Community

h.h. Conserves funds that otherwise would be spent on Conserves funds that otherwise would be spent on breast milk substitute, supplies and fuel to prepare breast milk substitute, supplies and fuel to prepare them.them.

i.i. Saves medical costs to families and governments Saves medical costs to families and governments by preventing illnesses and by providing by preventing illnesses and by providing immediate postpartum contraception.immediate postpartum contraception.

COMPLEMENTARY FEEDING FOR BABIES 6-11 COMPLEMENTARY FEEDING FOR BABIES 6-11 MONTHS OLDMONTHS OLD  

What are Complementary Foods?What are Complementary Foods?

a.a. foods introduced to the child at the age foods introduced to the child at the age

6 months to supplement breastmilk6 months to supplement breastmilk

a.a. given progressively until the child is used to three given progressively until the child is used to three meals and in-between feedings at the age of one meals and in-between feedings at the age of one year.year.

Why is there a Need to Give Complementary Foods?Why is there a Need to Give Complementary Foods?

c.c. breastmilk can be a single source of nourishment breastmilk can be a single source of nourishment from birth up to six months of life.from birth up to six months of life.

c.c. The child’s demands for food increases as he The child’s demands for food increases as he grows older and breastmilk alone is not enough to grows older and breastmilk alone is not enough to meet his increased nutritional needs for rapid meet his increased nutritional needs for rapid growth and developmentgrowth and development

d.d. Breastmilk should be supplemented with other Breastmilk should be supplemented with other foods so that the child can get additional nutrientsfoods so that the child can get additional nutrients

e.e. Introduction of complementary foods will Introduction of complementary foods will accustom him to new foods that will also provide accustom him to new foods that will also provide additional nutrients to make him grow welladditional nutrients to make him grow well

f.f. Breastfeeding, however, should continue for as Breastfeeding, however, should continue for as long as the mother is able and has milk which long as the mother is able and has milk which could be as long as two yearscould be as long as two years

How to Give Complementary Foods for How to Give Complementary Foods for Babies 6-11 Months Old?Babies 6-11 Months Old?

a.a. Prepare mixture of thick lugao/ cooked rice, soft Prepare mixture of thick lugao/ cooked rice, soft cooked vegetables. Egg yolk, mashed beans, flaked cooked vegetables. Egg yolk, mashed beans, flaked fish/chicken/ground meat and oil.fish/chicken/ground meat and oil.

b.b. Give mixture by teaspoons 2-4 times daily, Give mixture by teaspoons 2-4 times daily, increasing the amount of teaspoons and number of increasing the amount of teaspoons and number of feeding until the full recommended amount is feeding until the full recommended amount is consumedconsumed

c.c. Give bite-sized fruit separatelyGive bite-sized fruit separately

d.d. Give egg alone or combine with above food mixtureGive egg alone or combine with above food mixture

FAMILY PLANNINGFAMILY PLANNINGThe Philippine Family Planning Program is a national The Philippine Family Planning Program is a national

program that systematically provides information and program that systematically provides information and services needed by women of reproductive age to plan their services needed by women of reproductive age to plan their families according to their own beliefs and circumstances. families according to their own beliefs and circumstances.

GOALS AND OBJECTIVES: GOALS AND OBJECTIVES:   Universal access to family planning information, education Universal access to family planning information, education

and services.and services.  MISSION: MISSION:   To provide the means and opportunities by which married To provide the means and opportunities by which married

couples of reproductive age desirous of spacing and limiting couples of reproductive age desirous of spacing and limiting their pregnancies can realize their reproductive goals.their pregnancies can realize their reproductive goals.

TYPES OF METHODS:TYPES OF METHODS:

AA.. NATURAL METHODSNATURAL METHODS

11.   .       Calendar or Rhythm Method Calendar or Rhythm Method

2.     Basal Body Temperature Method2.     Basal Body Temperature Method

3.     Cervical Mucus Method3.     Cervical Mucus Method

4.     Sympto-Thermal Method4.     Sympto-Thermal Method

5.     Lactational Amennorhea5.     Lactational Amennorhea

BB.. ARTIFICIAL METHODS ARTIFICIAL METHODS

I. CHEMICAL METHODSI. CHEMICAL METHODS11..Ovulation suppressant such as PILLSOvulation suppressant such as PILLS

2. Depo-Provera2. Depo-Provera

3. Spermicidals3. Spermicidals

4. Implant4. Implant

II. MECHANICAL METHODS II. MECHANICAL METHODS

1.1.          Male and Female CondomMale and Female Condom

2.     Intrauterine Device2.     Intrauterine Device

3.     Cervical Cap/Diaphragm3.     Cervical Cap/Diaphragm

III. SURGICAL METHODSIII. SURGICAL METHODS

1. 1.         VasectomyVasectomy 2.     Tubal Ligation2.     Tubal Ligation

WARNING SIGNSWARNING SIGNS

PillsPills AAbdominal pain ( severe)bdominal pain ( severe) CChest pain ( severe)hest pain ( severe) HHeadache ( severe)eadache ( severe) EEye problems ( blurred vision, flashing lights, ye problems ( blurred vision, flashing lights,

blindness)blindness) SSevere leg pain ( calf or thigh )evere leg pain ( calf or thigh ) Others: depression, jaundice, brest lumpsOthers: depression, jaundice, brest lumps

WARNING SIGNSWARNING SIGNS

IUDIUD

**PPeriod late, no symptoms of pregnancy, eriod late, no symptoms of pregnancy, abnormal bleeding or spottingabnormal bleeding or spotting

**AAbdominal pain during intercoursebdominal pain during intercourse

**IInfection or abnormal vaginal dischargenfection or abnormal vaginal discharge

**NNot feeling well, has fever or chillsot feeling well, has fever or chills

**SString is missing or has become shorter or tring is missing or has become shorter or longerlonger

WARNING SIGNSWARNING SIGNS

INJECTABLESINJECTABLES DDizzinessizziness SSevere headacheevere headache HHeavy bleedingeavy bleeding

WARNING SIGNSWARNING SIGNS

BTLBTL FeverFever WeaknessWeakness Rapid pulseRapid pulse Persistent abdominal painPersistent abdominal pain VomitingVomiting DizzinessDizziness Pus or tenderness at incision sitePus or tenderness at incision site AmenorrheaAmenorrhea

WARNING SIGNSWARNING SIGNS

VasectomyVasectomy

FeverFever Scrotal blood clots or excessive swellingScrotal blood clots or excessive swelling

NutritionNutrition

GoalGoal

To improve the nutritional status, To improve the nutritional status, productivity and quality of life of productivity and quality of life of the population thru adoption of the population thru adoption of desirable dietary practices and desirable dietary practices and healthy lifestylehealthy lifestyle

ObjectivesObjectives Increase food and dietary energy Increase food and dietary energy

intake of the average Filipinointake of the average Filipino Prevent nutritional deficiency Prevent nutritional deficiency

diseases and nutrition-related chronic diseases and nutrition-related chronic degenerative diseasesdegenerative diseases

Promote a healthy well-balanced dietPromote a healthy well-balanced diet Promote food safetyPromote food safety

Nutrition Nutrition is a state of well-being achieved by eating is a state of well-being achieved by eating the right food in every meal and the proper the right food in every meal and the proper utilization of the nutrients by the body.utilization of the nutrients by the body.

Proper nutrition is important becauseProper nutrition is important because::    it helps in the development of the brain, especially during it helps in the development of the brain, especially during

the first years of the child’s life.the first years of the child’s life.    It speeds up the growth and development of the body It speeds up the growth and development of the body

including the formation of teeth and bonesincluding the formation of teeth and bones    It helps fight infection and diseasesIt helps fight infection and diseases    It speeds up the recovery of a sick personIt speeds up the recovery of a sick person    It makes people happy and productiveIt makes people happy and productive    Proper nutrition is eating a balanced diet in every mealProper nutrition is eating a balanced diet in every meal

Balanced dietBalanced diet is made up of a is made up of a combination of the 3 basic groups combination of the 3 basic groups eaten in correct amounts. The eaten in correct amounts. The grouping serves as a guide in grouping serves as a guide in selecting and planning everyday selecting and planning everyday meals for the family.meals for the family.

THE THREE (3) BASIC FOOD GROUPS ARE:THE THREE (3) BASIC FOOD GROUPS ARE:

1.     Body –building food1.     Body –building food which are rich in protein which are rich in protein and needed by the body for:and needed by the body for:

< normal growth and repair of worn-out body tissues< normal growth and repair of worn-out body tissues

< supplying additional energy< supplying additional energy

< fighting infections< fighting infections

< Examples of protein-rich food are:< Examples of protein-rich food are: fish; pork; fish; pork; chicken; beef; cheese; butter; kidney beans; chicken; beef; cheese; butter; kidney beans; mongo; peanuts; bean curd; shrimp; clamsmongo; peanuts; bean curd; shrimp; clams

2. Energy-giving food2. Energy-giving food which are rich in which are rich in carbohydrates and fats and needed by the body for:carbohydrates and fats and needed by the body for:

< providing enough energy to make the body strong< providing enough energy to make the body strong < Examples of energy-giving food are: < Examples of energy-giving food are: rice; corn; rice; corn;

bread; cassava; sweet potato; banana; sugar bread; cassava; sweet potato; banana; sugar cane; honey; lard; cooking oil; coconut milk; cane; honey; lard; cooking oil; coconut milk; margarine; buttermargarine; butter

3. Body-regulating food3. Body-regulating food which are rich in which are rich in Vitamins and minerals and needed by the body Vitamins and minerals and needed by the body for:for:

< normal development of the eyes, skin, hair, < normal development of the eyes, skin, hair, bones, and teethbones, and teeth

< increased protection against diseases< increased protection against diseases < Examples of body-regulating food are: < Examples of body-regulating food are: tisa; tisa;

ripe papaya; mango; guava; yellow corn; ripe papaya; mango; guava; yellow corn; banana; orange; squash; carrotbanana; orange; squash; carrot

Low Fat TipsLow Fat Tips1.1. Eat at least 3 meals/dayEat at least 3 meals/day

2.2. Eat more fruits, vegetables, grain and cereals Eat more fruits, vegetables, grain and cereals e.g. rice, noodles and potatoe.g. rice, noodles and potato

3.3. If you use butter or margarine, pat it on thinlyIf you use butter or margarine, pat it on thinly

4.4. Choose low fat substitute i.e. replace whole Choose low fat substitute i.e. replace whole milk with skimmed milk, low fat cheese milk with skimmed milk, low fat cheese

5.5. Become a label reader. Look for foods that Become a label reader. Look for foods that have less than 5 g /100 g of producthave less than 5 g /100 g of product

6.6. Eat less high fat snacks and take away potato Eat less high fat snacks and take away potato chips, sausage rolls or breaded meatschips, sausage rolls or breaded meats

7.7. Cut all visible fat from meat, remove skin Cut all visible fat from meat, remove skin from chicken fat drippings and cream saucesfrom chicken fat drippings and cream sauces

8.8. Aim for thin palm-size serving of lean meat, Aim for thin palm-size serving of lean meat, poultry and fish/ mealpoultry and fish/ meal

9.9. Grill, bake, steam, stew, stir –fry and Grill, bake, steam, stew, stir –fry and microwave, try not to frymicrowave, try not to fry

10.10. Drink lots of water all day- it’s a food Drink lots of water all day- it’s a food quencherquencher

AmbulateAmbulate

Start by walking for 10 min.Start by walking for 10 min. Build up to 30-40 min/dayBuild up to 30-40 min/day Go for 3-4 times / week of any exercise you Go for 3-4 times / week of any exercise you

enjoyenjoy

Filipino Food PyramidFilipino Food Pyramid

Drink a lot-Drink a lot- water, clear broth water, clear broth Eat mostEat most – rice, root crops, corn, noodles, – rice, root crops, corn, noodles,

bread and cerealsbread and cereals Eat more –Eat more – vegetables, green salads, fruits or vegetables, green salads, fruits or

juices juices Eat someEat some – fish, poultry, dry beans, nuts, – fish, poultry, dry beans, nuts,

eggs, lean meats, low fat dairyeggs, lean meats, low fat dairy Eat a little – fats, oils, sugar, saltEat a little – fats, oils, sugar, salt

IMPORTANT VITAMINS AND IMPORTANT VITAMINS AND MINERALSMINERALS

VITAMINSVITAMINS FUNCTIONSFUNCTIONS Vitamin A Vitamin A Maintain normal vision, skin Maintain normal vision, skin

health, bone and tooth health, bone and tooth growth reproduction and growth reproduction and immune function; prevents immune function; prevents xerophthalmia. xerophthalmia.

Food sources:Food sources:

Breastmilk;poultry;eggs; Breastmilk;poultry;eggs; liver; meat;carrots;squash; liver; meat;carrots;squash; papaya;mango;tiesa; papaya;mango;tiesa; malunggay;kangkong; malunggay;kangkong; camotetops; ampalaya topscamotetops; ampalaya tops

Thiamine Thiamine Help release energy Help release energy from nutrients; from nutrients; support normal support normal appetite and nerve appetite and nerve function, prevent function, prevent beri-beri. beri-beri.

Riboflavin Riboflavin Helps release energy from nutrients, Helps release energy from nutrients, support skin health, prevent deficiency support skin health, prevent deficiency manifested by cracks and redness at manifested by cracks and redness at corners of mouth; inflammation of the corners of mouth; inflammation of the tongue and dermatitis.tongue and dermatitis.

Niacin Niacin Help release energy from nutrients; Help release energy from nutrients; support skin, nervous and digestive support skin, nervous and digestive system, prevents pellagra.system, prevents pellagra.

BiotinBiotin Help energy and Help energy and amino acid amino acid metabolism; help in metabolism; help in the synthesis of fat the synthesis of fat glycogen.glycogen.

PantothenicPantothenic Help in energy Help in energy metabolism. metabolism.

Folic acid Folic acid Help in the formation of DNA and Help in the formation of DNA and new blood cells including red blood new blood cells including red blood cells; prevent anemia and some cells; prevent anemia and some amino acids.amino acids.

Vitamin B 12Vitamin B 12 Help in the formation of the new Help in the formation of the new cells; maintain nerve cells, assist in cells; maintain nerve cells, assist in the metabolism of fatty acids and the metabolism of fatty acids and amino acids.amino acids.

Vitamin CVitamin C Help in the formation of protein, Help in the formation of protein, collagen, bone, teeth cartilage, skin collagen, bone, teeth cartilage, skin and scar tissue; facilitate in the and scar tissue; facilitate in the absorption of iron from the absorption of iron from the gastrointestinal tract; involve in gastrointestinal tract; involve in amino acid metabolism; increase amino acid metabolism; increase resistance to infection, prevent resistance to infection, prevent scurvy.scurvy.

Food sources:Food sources:

Guava;pomelo;lemon;orange; Guava;pomelo;lemon;orange; calamansi; tomato; cashewcalamansi; tomato; cashew

Vitamin DVitamin D Help in the Help in the mineralization of bones mineralization of bones by enhancing by enhancing absorption of calcium.absorption of calcium.

Vitamin EVitamin E Strong anti-oxidant; help prevent Strong anti-oxidant; help prevent arteriosclerosis; protect neuro-arteriosclerosis; protect neuro-muscular system; important for muscular system; important for normal immune function.normal immune function.

Vitamin KVitamin K Involve in the synthesis of blood Involve in the synthesis of blood clotting proteins and a bone protein clotting proteins and a bone protein that regulates blood calcium level.that regulates blood calcium level.

MINERALSMINERALS FUNCTIONSFUNCTIONS

CalciumCalcium Mineralization of bones and teeth, Mineralization of bones and teeth, regulator of many of the body’s regulator of many of the body’s biochemical processes, involve in blood biochemical processes, involve in blood clotting, muscle contraction and clotting, muscle contraction and relaxation, nerve functioning, blood relaxation, nerve functioning, blood pressure and immune defenses.pressure and immune defenses.

Chloride Chloride Maintain normal fluid and electrolyte Maintain normal fluid and electrolyte balance. balance.

Chromium Chromium Work with insulin and is Work with insulin and is required for release of energy required for release of energy from glucose.from glucose.

CopperCopper Necessary for absorption and use Necessary for absorption and use of iron in the formation of of iron in the formation of hemoglobin.hemoglobin.

Fluoride Fluoride Involve in the formation of bones and Involve in the formation of bones and teeth; prevents tooth decay.teeth; prevents tooth decay.

IodineIodine As part of the two thyroid hormones, As part of the two thyroid hormones, iodine regulates growth, physical iodine regulates growth, physical and mental development and and mental development and metabolic rate.metabolic rate.

Aids in the development of the brain Aids in the development of the brain and body especially in unborn and body especially in unborn babiesbabies

Food sources:Food sources:

Seaweeds;squids;shrimps;crabs; Seaweeds;squids;shrimps;crabs; fermented shrimp;mussels;snails; fermented shrimp;mussels;snails; dried dilis; fishdried dilis; fish

IronIron Essential in the formation of Essential in the formation of blood. It is involved in the blood. It is involved in the transport and storage of transport and storage of oxygen in the blood and is a oxygen in the blood and is a co-factor bound to several co-factor bound to several non-hemo enzymes required non-hemo enzymes required for the proper functioning of for the proper functioning of cells.cells.

Food sources:Food sources:

Pork; beef; chicken; liver and Pork; beef; chicken; liver and other internal organs; dried other internal organs; dried dilis; shrimp; eggs; pechay; dilis; shrimp; eggs; pechay; saluyot; alugbatisaluyot; alugbati

MagnesiumMagnesium Mineralization of bones Mineralization of bones and teeth, building of and teeth, building of proteins, normal muscle proteins, normal muscle contraction, nerve contraction, nerve impulse transmission, impulse transmission, maintenance of teeth maintenance of teeth and functioning of and functioning of immune system.immune system.

Manganese Manganese Facilitate many cell Facilitate many cell processes. processes.

MolybdenumMolybdenum Facilitate many cell Facilitate many cell processes. processes.

PhosphorusPhosphorus Mineralization of bones Mineralization of bones and teeth; part of every and teeth; part of every Cell; used in energy Cell; used in energy transfer and maintenance transfer and maintenance of acid-base balance.of acid-base balance.

SeleniumSelenium Work with vitamin E to Work with vitamin E to protect body compound protect body compound from oxidation. from oxidation.

SeleniumSelenium Work with vitamin E to Work with vitamin E to protect body compound from protect body compound from oxidation. oxidation.

SodiumSodium Maintain normal fluid and Maintain normal fluid and electrolyte balance, assists electrolyte balance, assists nerve impulse insulin.nerve impulse insulin.

SulfurSulfur Integral part of vitamins, Integral part of vitamins, biotin and thiamine as well biotin and thiamine as well as the hormone.as the hormone.

ZincZinc Essential for normal growth, Essential for normal growth, development reproduction development reproduction and immunity. and immunity.

MALNUTRITIONMALNUTRITION

MALNUTRITION MALNUTRITION

An abnormal condition of the body An abnormal condition of the body resulting from the lack or excess of resulting from the lack or excess of one or more nutrients like protein, one or more nutrients like protein, carbohydrates, fats, vitamins and carbohydrates, fats, vitamins and minerals. minerals.

PRIMARY CAUSE: PRIMARY CAUSE: POVERTYPOVERTY

1.1. Lack of money to buy foodLack of money to buy food

Majority of the victims of malnutrition comes from Majority of the victims of malnutrition comes from families of farmers, fisherfolk, and laborers families of farmers, fisherfolk, and laborers who cannot afford to buy nutritious foods.who cannot afford to buy nutritious foods.

2.2. Lack of food supplyLack of food supply

3.3. Lack of information on proper nutrition and Lack of information on proper nutrition and food valuesfood values

SECONDARY CAUSESSECONDARY CAUSES

1.1. Early weaning of child and improper Early weaning of child and improper introduction of supplementary foodintroduction of supplementary food

2.2. Incomplete immunization of babies and childrenIncomplete immunization of babies and children

3.3. Bad eating habitsBad eating habits

4.4. Poor hygiene and environmental sanitation:Poor hygiene and environmental sanitation:a.a. lack of potable waterlack of potable water

b.b. lack of sanitary toiletlack of sanitary toilet

c.c. poor waste disposalpoor waste disposal

FORMS OF MALNUTRTIONFORMS OF MALNUTRTION

1.1. Protein-Energy Malnutrition (PEM)Protein-Energy Malnutrition (PEM) is a is a nutritional problem resulting from a nutritional problem resulting from a prolonged inadequate intake of body-prolonged inadequate intake of body-building and/or energy-giving food in the building and/or energy-giving food in the diet.diet.

Kinds: Kinds:

a.)MARASMUSa.)MARASMUSb.) b.) KWASHIORKORKWASHIORKOR

a)a) MARASMUSMARASMUS

This child does not get the right amount and This child does not get the right amount and kind of energy food. She/He:kind of energy food. She/He:

< is always hungry< is always hungry

< has the face of an old man< has the face of an old man

< is very thin< is very thin

< easily gets sick< easily gets sick

< looks weak< looks weak

THIS CHILD IS JUST SKIN AND BONES!THIS CHILD IS JUST SKIN AND BONES!

b)b) KWASHIORKORKWASHIORKOR

This child does not get enough body-building food, This child does not get enough body-building food, although she/he may be getting enough energy. She/He:although she/he may be getting enough energy. She/He:

< has swollen face, hands, and feet< has swollen face, hands, and feet

< easily gets sick< easily gets sick

< has dry, thin, pale hair< has dry, thin, pale hair

< has sores on the skin< has sores on the skin

< has thin upper arms< has thin upper arms

< looks sad< looks sad

< has dry skin< has dry skin

< is underweight< is underweight

THIS CHILD IS SKIN, BONES, AND WATER!THIS CHILD IS SKIN, BONES, AND WATER!

2. VITAMIN A DEFICIENCY (VAD)2. VITAMIN A DEFICIENCY (VAD)

a condition in which the level of Vitamin A in a condition in which the level of Vitamin A in the body is low.the body is low.

Causes:Causes: not eating enough foods rich in vitamin A not eating enough foods rich in vitamin A

e.g. e.g. yellow vegetables and yellow fruitsyellow vegetables and yellow fruits lack of fat or oil in the diet which help the lack of fat or oil in the diet which help the

body absorb Vitamin A.body absorb Vitamin A. poor absorption or rapid utilization of poor absorption or rapid utilization of

Vitamin A during illnessVitamin A during illness  

Eye SignsEye Signs night blindness (early stage); total blindness night blindness (early stage); total blindness

(later stage)(later stage) bitot’s spot (foamy soapsuds-like spots on bitot’s spot (foamy soapsuds-like spots on

white part of the eye)white part of the eye) dry, hazy and rough appearing corneadry, hazy and rough appearing cornea crater-like defect on corneacrater-like defect on cornea softened cornea; sometimes bulgingsoftened cornea; sometimes bulging

Other ManifestationsOther Manifestations increased cases of childhood sickness, and death increased cases of childhood sickness, and death

and decreased resistance to infectionand decreased resistance to infection susceptibility to childhood malnutrition and susceptibility to childhood malnutrition and

infection (measles, diarrhea and pneumonia)infection (measles, diarrhea and pneumonia)

PreventionPrevention eating foods rich in Vitamin A, such as liver, eating foods rich in Vitamin A, such as liver,

eggs, milk, crab meat, cheese, dilis, malunggay, eggs, milk, crab meat, cheese, dilis, malunggay, gabi leaves, kamote tops, kangkong, alugbati, gabi leaves, kamote tops, kangkong, alugbati, saluyot, carrots, squash, ripe mango, including saluyot, carrots, squash, ripe mango, including fats and oils fats and oils

breastfeeding the childbreastfeeding the child immunizing the childimmunizing the child taking correct dose of Vitamin A capsules as taking correct dose of Vitamin A capsules as

prescribedprescribed

VAD is most common in children suffering VAD is most common in children suffering from PEM and other infectious diseases. from PEM and other infectious diseases. Bottle-fed infants are also at risk of VAD Bottle-fed infants are also at risk of VAD especially if the milk formula used is not especially if the milk formula used is not fortified with Vitamin A.fortified with Vitamin A.

• Common among preschoolers and infantsCommon among preschoolers and infants

( FNRI)( FNRI)

SCHEDULE FOR RECEIVING VITAMIN A SUPPLEMENT TO SCHEDULE FOR RECEIVING VITAMIN A SUPPLEMENT TO INFANTS PRESCHOOLERS AND MOTHERSINFANTS PRESCHOOLERS AND MOTHERS

ScheduleSchedule Infants(6-11 Infants(6-11 mos)mos)

PreschoolersPreschoolers(12-83 mos)(12-83 mos)

Post Partum Post Partum MotherMother

Give 1 DoseGive 1 Dose 100,000 IU100,000 IU 200,000 IU200,000 IU 200,000 IU 200,000 IU Within one Within one

monthmonth

Give after 6 Give after 6 months High months High

risk risk Condition Condition

PresentPresent

100,000 IU100,000 IU 200,000 IU200,000 IU After delivery After delivery of each child of each child

onlyonly

SCHEDULE FOR TREATMENT OF VITAMIN A SCHEDULE FOR TREATMENT OF VITAMIN A DEFICIENCYDEFICIENCY

ScheduleSchedule Infants (6-11 Infants (6-11 mos.)mos.)

Preschoolers (12-Preschoolers (12-83 mos.)83 mos.)

Give TodayGive Today 100,000 IU100,000 IU 200,000 IU200,000 IU

Give TomorrowGive Tomorrow 100,000 IU100,000 IU 200,000 IU200,000 IU

Give After 2 Give After 2 WeeksWeeks

100,000 IU100,000 IU 200,000 IU200,000 IU

3. 3. ANEMIAANEMIA - a condition characterized by the lack of - a condition characterized by the lack of iron in the body resulting in paleness.iron in the body resulting in paleness.

S/S: paleness of the eyelids, inner cheeks, palms and S/S: paleness of the eyelids, inner cheeks, palms and nailbeds; frequent dizziness and easy fatigabilitynailbeds; frequent dizziness and easy fatigability

Common cause: inadequate intake of food rich in Common cause: inadequate intake of food rich in iron ; can also be caused by blood loss during iron ; can also be caused by blood loss during menstruation, pregnancy and parasitic infections.menstruation, pregnancy and parasitic infections.

Prevention:Prevention:

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

Prevention of Iron DeficiencyPrevention of Iron Deficiency Recommended Iron Recommended Iron RequirementsRequirements

DosageDosage

Infants ( 6-12 months)Infants ( 6-12 months) 0.7 mg. Daily0.7 mg. Daily

Children ( 12-59 months)Children ( 12-59 months) 1 mg daily1 mg daily

Treatment of Iron DeficiencyTreatment of Iron Deficiency DosageDosage

Children 0-59 monthChildren 0-59 month 3-6 mg./kg. Body wt./day3-6 mg./kg. Body wt./day

4.4.GOITERGOITER

- enlargement of thyroid gland due to lack - enlargement of thyroid gland due to lack of iodine in the body. of iodine in the body. 

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

- Effect of Iodine deficiency to fetus:- Effect of Iodine deficiency to fetus:

may be born mentally and physically may be born mentally and physically retarded.retarded.

    - Goiter can be prevented by:- Goiter can be prevented by:

< daily intake of food rich in iodine< daily intake of food rich in iodine

< use of iodized salt< use of iodized salt

Iodine Supplementation

DosageDosage

Children 0-59 monthsChildren 0-59 months

( in endemic areas)( in endemic areas)

Iodine capsules (200mg) Iodine capsules (200mg) potassium iodate in oil potassium iodate in oil

orally once a year.orally once a year.

CHECKING THE NUTRITIONAL STATUSCHECKING THE NUTRITIONAL STATUS

WEIGHTWEIGHT 1.1      Weight is a very important indicator of a person’s 1.1      Weight is a very important indicator of a person’s

nutritional status. It is measured in relation to either nutritional status. It is measured in relation to either AGE or HEIGHT. Normally, a well-nourished child AGE or HEIGHT. Normally, a well-nourished child gains weight as she/he grows older.gains weight as she/he grows older.

1.2      On the other hand, a malnourished child either 1.2      On the other hand, a malnourished child either decreases in weight or maintains his/her previous weight.decreases in weight or maintains his/her previous weight.

1.3      The nutritional status of a person can also be 1.3      The nutritional status of a person can also be checked by looking for specific signs and symptoms of checked by looking for specific signs and symptoms of the different forms of nutritional deficiencies.the different forms of nutritional deficiencies.

IMPORTANT:IMPORTANT: 1.1Weigh the child in minimal clothing, with no 1.1Weigh the child in minimal clothing, with no

shoes, clogs or slippers on; and hands and shoes, clogs or slippers on; and hands and pockets free of objects.pockets free of objects.

1.2The same type of scale should be used for 1.2The same type of scale should be used for subsequent weighing.subsequent weighing.

1.3Observe the proper maintenance of the 1.3Observe the proper maintenance of the weighing scale.weighing scale.

1.4Do not use a bathroom scale to avoid 1.4Do not use a bathroom scale to avoid inaccurate readings of weight.inaccurate readings of weight.

< BRING THE MALNOURISHED CHILD < BRING THE MALNOURISHED CHILD TOGETHER WITH THE PARENTS TO THE TOGETHER WITH THE PARENTS TO THE HEALTH CENTER FOR PROPER HEALTH CENTER FOR PROPER NUTRITIONAL ADVICE AND TREATMENT.NUTRITIONAL ADVICE AND TREATMENT.

< VISIT THE MALNOURISHED CHILD < VISIT THE MALNOURISHED CHILD REGULARLY AND MONITOR HIS/HER REGULARLY AND MONITOR HIS/HER WEIGHT.WEIGHT.

< ADVISE PARENTS AND THE WHOLE < ADVISE PARENTS AND THE WHOLE COMMUNITY ABOUT BETTER NUTRITION COMMUNITY ABOUT BETTER NUTRITION AND PROPER FEEDING ESPECIALLY OF AND PROPER FEEDING ESPECIALLY OF INFANTS, CHILDREN AND SICK PERSONS.INFANTS, CHILDREN AND SICK PERSONS.

NUTRITIONAL GUIDELINESNUTRITIONAL GUIDELINES

1.1. Eat a variety of food everyday.Eat a variety of food everyday.

2.2. Breastfeed infants exclusively from birth to 4-6 Breastfeed infants exclusively from birth to 4-6 months, and then, give appropriate foods while months, and then, give appropriate foods while continuing breastfeeding.continuing breastfeeding.

3.3. Maintain children’s normal growth through proper Maintain children’s normal growth through proper diet and monitor their growth regularly.diet and monitor their growth regularly.

4.4. Consume fish, lean meat, poultry or dried beans.Consume fish, lean meat, poultry or dried beans.

5.5. Eat more vegetables, fruits, and root crops.Eat more vegetables, fruits, and root crops.

6.6. Eat foods cooked in edible/cooking oil daily.Eat foods cooked in edible/cooking oil daily.

7.7. Consume milk, milk products or other calcium-Consume milk, milk products or other calcium-rich foods such as small fish and dark green leafy rich foods such as small fish and dark green leafy vegetables everyday. Use iodized salt, but avoid vegetables everyday. Use iodized salt, but avoid excessive intake of salty foods.excessive intake of salty foods.

8.8. Use iodized salt, avoid excessive intake of salty Use iodized salt, avoid excessive intake of salty foodsfoods

9. Eat clean and safe food.9. Eat clean and safe food.

10. For a healthy lifestyle and good nutrition, exercise 10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke, avoid drinking alcoholic regularly, do not smoke, avoid drinking alcoholic beverages.beverages.

AIMS AND RATIONALE OF EACH OF AIMS AND RATIONALE OF EACH OF THE GUIDELINESTHE GUIDELINES

  Guideline No. 1 is intended to give the Guideline No. 1 is intended to give the

message that no single food provides all the message that no single food provides all the nutrients the body needs. Choosing different nutrients the body needs. Choosing different kinds of foods from all food groups is the kinds of foods from all food groups is the first step to obtain a well-balanced diet. This first step to obtain a well-balanced diet. This will help correct the common practice of will help correct the common practice of confining of choice to a few kinds of foods, confining of choice to a few kinds of foods, resulting in an unbalanced diet.resulting in an unbalanced diet.

Guidelines No.2 is entitled to promote exclusive Guidelines No.2 is entitled to promote exclusive breastfeeding from birth to 4-6 months and to encourage breastfeeding from birth to 4-6 months and to encourage the continuance of breastfeeding for as long as two years the continuance of breastfeeding for as long as two years or longer. This is to ensure a complete and safe food for or longer. This is to ensure a complete and safe food for the newborn and the growing infant besides imparting the newborn and the growing infant besides imparting the other benefits of breastfeeding. The guideline also the other benefits of breastfeeding. The guideline also strongly advocates the giving of appropriate strongly advocates the giving of appropriate complementary food in addition to breast milk once the complementary food in addition to breast milk once the infant is ready for solid foods at 6 months. Malnutrition infant is ready for solid foods at 6 months. Malnutrition most commonly occurs between the age of 6 months to 2 most commonly occurs between the age of 6 months to 2 years, therefore there is a need to pay close attention to years, therefore there is a need to pay close attention to feeding the child properly during this very critical feeding the child properly during this very critical period.period.

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

Guidelines No. 4,5,6 and 7 Guidelines No. 4,5,6 and 7 are intended to correct the are intended to correct the deficiencies in the current dietary pattern of Filipinos. deficiencies in the current dietary pattern of Filipinos. Including fish, lean meat, poultry and dried beans, which Including fish, lean meat, poultry and dried beans, which will provide good quality protein and dietary energy, as well will provide good quality protein and dietary energy, as well as iron and zinc, key nutrients lacking in the diet of as iron and zinc, key nutrients lacking in the diet of Filipinos as a whole. Eating more vegetables, fruits and Filipinos as a whole. Eating more vegetables, fruits and root crops will supply the much needed vitamins, minerals root crops will supply the much needed vitamins, minerals and dietary fiber that are deficient in our diet. In addition, and dietary fiber that are deficient in our diet. In addition, they provide defense against chronic degenerative diseases. they provide defense against chronic degenerative diseases. Including foods cooked in edible oils will provide Including foods cooked in edible oils will provide additional dietary energy as a partial remedy to calorie additional dietary energy as a partial remedy to calorie deficiency of the average Filipino. Including milk and other deficiency of the average Filipino. Including milk and other calcium-rich foods in the diet will serve to supply not only calcium-rich foods in the diet will serve to supply not only calcium for healthy bones but to provide high quality calcium for healthy bones but to provide high quality protein and other nutrients for growth. protein and other nutrients for growth.

Guideline No. 8 Guideline No. 8 promotes the use of promotes the use of iodized salt to prevent iodine deficiency, iodized salt to prevent iodine deficiency, which is a major cause of mental and which is a major cause of mental and physical underdevelopment in the physical underdevelopment in the country. At the same time, the guideline country. At the same time, the guideline warns against excessive intake of salty warns against excessive intake of salty foods as a hedge against hypertension, foods as a hedge against hypertension, particularly among high-risk individuals.particularly among high-risk individuals.

Guideline No.9Guideline No.9 is intended to is intended to prevent food-borne diseases. It prevent food-borne diseases. It explains the various sources of explains the various sources of contamination of our food and contamination of our food and simple ways to prevent it from simple ways to prevent it from occurring.occurring.

Finally, Guideline No. 10Finally, Guideline No. 10 promotes a promotes a healthy lifestyle through regular healthy lifestyle through regular exercise, abstinence from smoking and exercise, abstinence from smoking and avoiding consumption. If alcohol is avoiding consumption. If alcohol is consumed, it must be done in consumed, it must be done in moderation. All these lifestyle practices moderation. All these lifestyle practices are directly or indirectly related to good are directly or indirectly related to good nutrition.nutrition.

NUTRIENTS IN FOODNUTRIENTS IN FOOD  

Nutrients are chemical substances present Nutrients are chemical substances present in the foods that keep the body healthy, supply in the foods that keep the body healthy, supply materials for growth and repair of tissues, and materials for growth and repair of tissues, and provide energy for work and physical activities.provide energy for work and physical activities.

The major nutrients include the The major nutrients include the macronutrients, namely; proteins, carbohydrates macronutrients, namely; proteins, carbohydrates and fats; the micronutrients, namely vitamins and fats; the micronutrients, namely vitamins such as A, D, E and K, the B complex vitamins such as A, D, E and K, the B complex vitamins and C and minerals such as calcium, iron, iodine, and C and minerals such as calcium, iron, iodine, zinc, fluoride and water.zinc, fluoride and water.

Reproductive HealthReproductive Health

- a state of complete physical, mental and - a state of complete physical, mental and social well-being and not merely the social well-being and not merely the absence of disease/ infirmity in all absence of disease/ infirmity in all matters relating to the reproductive matters relating to the reproductive system and to its functions and processes.system and to its functions and processes.

Basic RH RightsBasic RH Rights

Right to RH information and health care Right to RH information and health care services for safe pregnancy and childbirthservices for safe pregnancy and childbirth

Right to know different means of regulating Right to know different means of regulating fertility to preserve health and where to obtain fertility to preserve health and where to obtain themthem

Freedom to decide the number and timing of Freedom to decide the number and timing of birth of childrenbirth of children

Right to exercise satisfying sex lifeRight to exercise satisfying sex life

Factors/ determinants of RHFactors/ determinants of RH Socioeconomic conditions – education, Socioeconomic conditions – education,

employment, poverty, nutrition, living employment, poverty, nutrition, living condition/ environment, family environmentcondition/ environment, family environment

Status of women – equal right in education and Status of women – equal right in education and in making decisions about her own RH; right in making decisions about her own RH; right to be free from torture and ill treatment and to to be free from torture and ill treatment and to participate in politicsparticipate in politics

Social and Gender Issues Social and Gender Issues Biological (individual knowledge of Biological (individual knowledge of

reproductive organs and their functions), reproductive organs and their functions), cultural (country’s norms, RH practices) and cultural (country’s norms, RH practices) and psychosocial factorspsychosocial factors

ElementsElements

Maternal and Child Health NutritionMaternal and Child Health Nutrition Family Planning Family Planning Prevention and Management of Abortion Prevention and Management of Abortion

ComplicationsComplications Prevention and Treatment of Reproductive Prevention and Treatment of Reproductive

Tract Infections, including STDs, HIV and Tract Infections, including STDs, HIV and AIDSAIDS

Education and Counseling on Sexuality and Education and Counseling on Sexuality and Sexual HealthSexual Health

ElementsElements

Breast and Reproductive Tract Cancers and Breast and Reproductive Tract Cancers and other Gynecological Conditionsother Gynecological Conditions

Men’s Reproductive HealthMen’s Reproductive Health Adolescent Reproductive HealthAdolescent Reproductive Health Violence Against WomenViolence Against Women Prevention and Treatment of Infertility and Prevention and Treatment of Infertility and

Sexual DisordersSexual Disorders

Selected ConceptsSelected Concepts

RH is the exercise of reproductive right with RH is the exercise of reproductive right with responsibilityresponsibility

It means safe pregnancy and delivery, the right of It means safe pregnancy and delivery, the right of access to appropriate health information and servicesaccess to appropriate health information and services

It includes protection from unwanted pregnancy by It includes protection from unwanted pregnancy by having access to safe and acceptable methods of family having access to safe and acceptable methods of family planning of their choiceplanning of their choice

It includes protection from harmful reproductive It includes protection from harmful reproductive practices and violencepractices and violence

It ensure sexual health for the purpose of enhancement It ensure sexual health for the purpose of enhancement of life and personal relations and assures access to of life and personal relations and assures access to information on sexuality to achieve sexual enjoymentinformation on sexuality to achieve sexual enjoyment

GoalGoal

To achieve healthy sexual development To achieve healthy sexual development and maturation and maturation

To achieve their reproductive intentionTo achieve their reproductive intention To avoid diseases, injuries and To avoid diseases, injuries and

disabilities related to sexuality and disabilities related to sexuality and reproductionreproduction

To receive appropriate counseling and To receive appropriate counseling and care of RH problemscare of RH problems

StrategiesStrategies

Increase and improve the use of more effective or Increase and improve the use of more effective or modern contraceptive methodsmodern contraceptive methods

Provision of care, treatment and rehabilitation for Provision of care, treatment and rehabilitation for RHRH

RH care provision should be focused on adolescents, RH care provision should be focused on adolescents, men and unmarried and other displaced people with men and unmarried and other displaced people with RH problemsRH problems

Strengthen outreach activities and referral systemStrengthen outreach activities and referral system Prevent specific RH problems through information Prevent specific RH problems through information

dissemination and counseling of clientsdissemination and counseling of clients

HEALTH AND SANITATIONHEALTH AND SANITATIONEnvironmental Sanitation is still a health problem Environmental Sanitation is still a health problem in the country. in the country.

Diarrheal diseases ranked second in the leading Diarrheal diseases ranked second in the leading causes of morbidity amongcauses of morbidity among the general the general populationpopulation. .

Other sanitation related diseases : Other sanitation related diseases : tuberculosis, intestinal parasitism, tuberculosis, intestinal parasitism,

schistossomiasis, malaria, infectious hepatitis, schistossomiasis, malaria, infectious hepatitis, filariasis and dengue hemorrhagic fever filariasis and dengue hemorrhagic fever

DOH thru’ DOH thru’ Environmental Health ServicesEnvironmental Health Services (EHS) (EHS)

unit is authorized to act on all issues and concernsunit is authorized to act on all issues and concerns

in environment and health including the veryin environment and health including the very

comprehensive Sanitation Code of the Philippines comprehensive Sanitation Code of the Philippines (PD 856, 1978). (PD 856, 1978).

WATER SUPPLY SANITATION WATER SUPPLY SANITATION PROGRAMPROGRAM

EHS sets policies on:EHS sets policies on: Approved types of water facilitiesApproved types of water facilities Unapproved type of water facilityUnapproved type of water facility Access to safe and potable drinking waterAccess to safe and potable drinking water Water quality and monitoring surveillanceWater quality and monitoring surveillance Waterworks/Water system and well Waterworks/Water system and well

constructionconstruction

Approved type of water facilitiesApproved type of water facilities

Level 1 (Point Source)- a protected well or a Level 1 (Point Source)- a protected well or a developed spring with an outlet but without a developed spring with an outlet but without a distribution systemdistribution system

indicated for rural areas; indicated for rural areas; serves 15-25 households; its outreach is not serves 15-25 households; its outreach is not

more than 250 m from the farthest usermore than 250 m from the farthest user yields 40-140 L/ minyields 40-140 L/ min

Level II ( Communal Faucet or Level II ( Communal Faucet or Stand Posts)Stand Posts)

With a source, reservoir, piped distribution With a source, reservoir, piped distribution network and communal faucetsnetwork and communal faucets

Located at not more than 25 m from the Located at not more than 25 m from the farthest housefarthest house

Delivers 40-80 L of water per capital per day Delivers 40-80 L of water per capital per day to an average of 100 householdsto an average of 100 households

Fit for rural areas where houses are densely Fit for rural areas where houses are densely clusteredclustered

Level III ( Individual House Level III ( Individual House Connections or Waterworks System)Connections or Waterworks System)

With a source, reservoir, piped distributor With a source, reservoir, piped distributor network and household tapsnetwork and household taps

Fit for densely populated urban communitiesFit for densely populated urban communities Requires minimum treatment or disinfectionRequires minimum treatment or disinfection

ENVIRONMENTAL SANITATIONENVIRONMENTAL SANITATION-- the study of all factors in man’s the study of all factors in man’s

physical environment, which may physical environment, which may exercise a deleterious effect on his exercise a deleterious effect on his health, well-being and survival. health, well-being and survival. 

Includes:Includes:1.1     Water sanitation1.1     Water sanitation1.2     Food sanitation1.2     Food sanitation1.3     Refuse and garbage disposal1.3     Refuse and garbage disposal1.4     Excreta disposal1.4     Excreta disposal1.5     Insect vector and rodent control1.5     Insect vector and rodent control1.6     Housing1.6     Housing1.7     Air pollution1.7     Air pollution1.8     Noise1.8     Noise1.9     Radiological Protection1.9     Radiological Protection1.10   Institutional sanitation1.10   Institutional sanitation1.11   Stream pollution1.11   Stream pollution

PROPER EXCRETA AND SEWAGE DISPOSAL PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAMPROGRAM

  

EHS sets policies on:EHS sets policies on:

Approved types of toilet facilities :Approved types of toilet facilities :

LEVEL ILEVEL I◙ ◙ Non-water carriage toilet facility – no water necessary Non-water carriage toilet facility – no water necessary

to wash the waste into receiving space e.g.pit latrines, reed to wash the waste into receiving space e.g.pit latrines, reed odorless earth closet.odorless earth closet.

◙ ◙ Toilet facilities requiring small amount of water to Toilet facilities requiring small amount of water to wash the waste into the receiving space e.g. pour flush toilet & wash the waste into the receiving space e.g. pour flush toilet & aqua priviesaqua privies

LEVEL II – on site toilet facilities LEVEL II – on site toilet facilities of the water carriage type with of the water carriage type with water-sealed and flush type with water-sealed and flush type with septic vault/tank disposal.septic vault/tank disposal.

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

  FOOD SANITATION PROGRAMFOOD SANITATION PROGRAM

-sets policy and practical programs to prevent -sets policy and practical programs to prevent and control food-borne diseases to alleviate the and control food-borne diseases to alleviate the living conditions of the population living conditions of the population

HOSPITAL WASTE MANAGEMENT PROGRAMHOSPITAL WASTE MANAGEMENT PROGRAM

Disposal of infectious, pathological and other wastes Disposal of infectious, pathological and other wastes from hospital which combine them with the from hospital which combine them with the municipal or domestic wastes pose health hazards to municipal or domestic wastes pose health hazards to the people. the people.

Hospitals shall dispose their hazardous wastes thru Hospitals shall dispose their hazardous wastes thru incinerators or disinfectants to prevent transmission of incinerators or disinfectants to prevent transmission of nosocomial diseasesnosocomial diseases

PROGRAM ON HEALTH RISK MINIMIZATION PROGRAM ON HEALTH RISK MINIMIZATION DUE TO ENVIRONMENTAL POLLUTIONDUE TO ENVIRONMENTAL POLLUTIONFoci: Foci:

1. Prevention of serious environmental hazards resulting 1. Prevention of serious environmental hazards resulting from urban growth and industrializationfrom urban growth and industrialization

2. policies on health protection measures2. policies on health protection measures3. researches on effects of GLOBAL WARMING to health 3. researches on effects of GLOBAL WARMING to health

(depletion of the stratosphere ozone layer which (depletion of the stratosphere ozone layer which increases ultraviolet radiation, climate change and other increases ultraviolet radiation, climate change and other conditions)conditions)

NURSING RESPONSIBILITIES AND ACTIVITIESNURSING RESPONSIBILITIES AND ACTIVITIES Health Education – IEC by conducting community Health Education – IEC by conducting community

assemblies and assemblies and bench conferences. bench conferences. The Occupational HealthThe Occupational Health Nurse, School Health Nurse Nurse, School Health Nurse

and other Nursing staff shall impart the need for an and other Nursing staff shall impart the need for an effective and efficient environmental sanitation in effective and efficient environmental sanitation in their places of work and in school.their places of work and in school.

Actively participate in the training component of Actively participate in the training component of the the service like in Food Handler’s Class, and attend service like in Food Handler’s Class, and attend training/workshops related to environmental health.training/workshops related to environmental health.

Assist in the deworming activities for the school Assist in the deworming activities for the school children and targeted groups.children and targeted groups.

Effectively and efficiently coordinate Effectively and efficiently coordinate programs/projects/activities with other government and programs/projects/activities with other government and non-government agencies.non-government agencies.

Act as an advocate or facilitator to families inAct as an advocate or facilitator to families in the the community in matters of program/projects/activities community in matters of program/projects/activities on environmental on environmental health in coordination with other health in coordination with other members of Rural Health Unit (RHU) especially the Rural members of Rural Health Unit (RHU) especially the Rural Sanitary Inspectors.Sanitary Inspectors.

Actively participate in environmental Actively participate in environmental sanitation campaigns and projects in the sanitation campaigns and projects in the community. Ex. Sanitary toilet campaign community. Ex. Sanitary toilet campaign drive for proper garbage disposal, drive for proper garbage disposal, beautification of home garden, parks drainage beautification of home garden, parks drainage and other projects.and other projects.

Be a role model for others in the community to Be a role model for others in the community to emulate terms of cleanliness in the home and emulate terms of cleanliness in the home and surrounding.surrounding.

Non-Communicable Diseases and Non-Communicable Diseases and RehabilitationRehabilitation

1. Prevention and Control of Cardiovascular Diseases1. Prevention and Control of Cardiovascular Diseases - heart – 1- heart – 1st leading cause of deathst leading cause of death ; bld vessels - 2 ; bld vessels - 2ndnd

Congenital Heart Disease (CHDCongenital Heart Disease (CHD): Result of the abnormal ): Result of the abnormal development of the heart that exhibits septal defect, patent development of the heart that exhibits septal defect, patent ductus arteriosus, aortic and pulmonary stenosis, and ductus arteriosus, aortic and pulmonary stenosis, and cyanosis; most prevalent in children cyanosis; most prevalent in children

Causes: envt’l factors, maternal diseases or genetic Causes: envt’l factors, maternal diseases or genetic aberrationsaberrations

Rheumatic Fever or Rheumatic Heart DiseaseRheumatic Fever or Rheumatic Heart Disease: Systematic : Systematic inflammatory disease that may develop as a delayed inflammatory disease that may develop as a delayed reaction to repeated and an inadequately treated infection reaction to repeated and an inadequately treated infection of the upper respiratory tract by group A beta-hemolytic of the upper respiratory tract by group A beta-hemolytic streptococci.streptococci.

HypertensionHypertension: Persistent elevation of the arterial blood : Persistent elevation of the arterial blood pressure.pressure.

( ( primary or essentialprimary or essential) ;frequent among females but ) ;frequent among females but severe,malignat form is more common among malessevere,malignat form is more common among males

Ischemic Heart Disease/ AtherosclerosisIschemic Heart Disease/ Atherosclerosis: : Condition usually caused by the occlusion of Condition usually caused by the occlusion of the coronary arteries by thrombus or clot the coronary arteries by thrombus or clot formation.formation.

higher among males than females for the latter higher among males than females for the latter are protected by estrogen before menopauseare protected by estrogen before menopause

PF: HPN, DM, SmokingPF: HPN, DM, Smoking Minor RF: stress, strong family history, Minor RF: stress, strong family history,

obesityobesity

CVDCVD

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 DiseaseCerebrovascular

Accident

5 / 100 adults

CVDCVDDiseases 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: CVDPrimary Prevention: CVDDiseaseDisease PrimordialPrimordial Specific ProtectionSpecific Protection

Congenital Congenital Heart Heart Disease Disease

- Prevention of - Prevention of viral infection and viral infection and intake of harmful intake of harmful drugs during drugs during pregnancy.pregnancy.

- Avoidance of - Avoidance of marriage between marriage between blood relatives blood relatives

- Adequate treatment of - Adequate treatment of viral infection during viral infection during pregnancy.pregnancy.

- Genetic counseling of - Genetic counseling of blood related married blood related married couples.couples.

Rheumatic Heart Rheumatic Heart Disease Disease

- Prevention of - Prevention of recurrent sore recurrent sore throat thru throat thru adequate adequate environmental environmental sanitation; sanitation; avoidance of avoidance of overcrowding; overcrowding; adequate adequate treatment treatment

- Identification of - Identification of cases of cases of rheumatic feverrheumatic fever

- Prophylaxis - Prophylaxis with penicillin or with penicillin or erythromycin erythromycin

Essential Essential Hypertension Hypertension

- From early - From early childhood childhood

> low salt diet> low salt diet

> adequate > adequate physical exercisephysical exercise

- Continued low - Continued low salt diet and salt diet and adequate exerciseadequate exercise

Coronary Heart Coronary Heart Disease(Heart Disease(Heart Attack)Attack)

- Prevention of - Prevention of development/ development/ acquisition of acquisition of risk factorsrisk factors

> cigarette > cigarette smokingsmoking

> high fat intake> high fat intake

> high salt intake > high salt intake

- cessation of - cessation of smokingsmoking

- control - control /treatment of /treatment of diabetes, diabetes, hypertensionhypertension

-weight reduction-weight reduction

-change to proper -change to proper dietdiet

-Adjustment of -Adjustment of activities activities

Cerebrovascular Cerebrovascular Accident (Stroke)Accident (Stroke)

- all measures to - all measures to prevent prevent hypertension & hypertension & arteriosclerosis arteriosclerosis

- all measures to - all measures to control control hypertension & hypertension & progression of progression of arteriosclerosisarteriosclerosis

Primary Prevention thru health education is the Primary Prevention thru health education is the main focus of the program:main focus of the program:

1. maintenance of ideal body wt.1. maintenance of ideal body wt. 2. diet - low fat2. diet - low fat 3. alcohol/smoking avoidance3. alcohol/smoking avoidance 4. exercise4. exercise 5. regular BP check up5. regular BP check up

2. Cancer Prevention and Early Detection2. Cancer Prevention and Early Detection Any malignant tumor arising from the abnormal Any malignant tumor arising from the abnormal

and uncontrolled division of cells causing the and uncontrolled division of cells causing the destruction in the surrounding tissues.destruction in the surrounding tissues.

Common Cancer: Lung cancer, cervical cancer, Common Cancer: Lung cancer, cervical cancer, colon cancer, cancer of the mouth, breast cancer, colon cancer, cancer of the mouth, breast cancer, skin cancer, prostate cancer.skin cancer, prostate cancer.

33rdrd leading cause of illness and death ( Phil.) leading cause of illness and death ( Phil.) Incidence can only be reduced thru Incidence can only be reduced thru prevention prevention

and early detectionand early detection

NINE WARNING SIGNS OF NINE WARNING SIGNS OF CANCER:CANCER:

CChange in blood bowel or bladder habitshange in blood bowel or bladder habits A A sore that does not healsore that does not heal UUnusual bleeding or dischargenusual bleeding or discharge TThickening or lump in breast or elsewherehickening or lump in breast or elsewhere IIndigestion or difficulty in swallowing ndigestion or difficulty in swallowing OObvious change in wart or molebvious change in wart or mole NNagging cough or hoarsenessagging cough or hoarseness

UUnexplained anemianexplained anemia SSudden unexplained weight lossudden unexplained weight loss

Prevention & Early DetectionPrevention & Early Detection

CA typeCA type

LungLung

UterineUterine

CervicalCervical

LiverLiver

PreventionPrevention

No smokingNo smoking

MonogamyMonogamy

Safe sexSafe sex

Hep B Hep B vaccinationvaccination

Less aalcohol Less aalcohol intakeintake

Avoidance of Avoidance of moldy foodsmoldy foods

DetectionDetection

NoneNone

Pap’s smear Pap’s smear every 1-3 yrsevery 1-3 yrs

NoneNone

ColonColon

RectumRectum

High fiber dietHigh fiber diet

Low fat intakeLow fat intake

Regular medical Regular medical check-up after 40 check-up after 40 yrs of ageyrs of age

Fecal occult Fecal occult blood testblood test

DREDRE

SigmoidoscopySigmoidoscopy

MouthMouth No smoking, No smoking, betel nut chewingbetel nut chewing

Oral hygieneOral hygiene

Regular dental Regular dental check-upscheck-ups

BreastBreast nonenone Monthly SBEMonthly SBE

Yearly exam by Yearly exam by doctordoctor

Mammography Mammography for 50 yrs old and for 50 yrs old and above femalesabove females

SkinSkin

ProstateProstate

No excessive sun No excessive sun exposureexposure

nonenone

Assessment of Assessment of skinskin

Digital trans-Digital trans-rectal examrectal exam

PRINCIPLES OF TREATMENT OF PRINCIPLES OF TREATMENT OF MALIGNANT DISEASESMALIGNANT DISEASES

One third of all cancers are curable if One third of all cancers are curable if detected early and treated properly.detected early and treated properly.

Three major forms of treatment of cancer:Three major forms of treatment of cancer: SurgerySurgery Radiation TherapyRadiation Therapy ChemotherapyChemotherapy

3. Nat’l Diabetes Prevention and Control 3. Nat’l Diabetes Prevention and Control ProgramProgram

Aim:Aim: Controlling and assimilating healthy lifestyle Controlling and assimilating healthy lifestyle

in the Filipino culture ( 2005-2010) thru in the Filipino culture ( 2005-2010) thru IECIEC

Main Concern: modifiable risk factors( diet, Main Concern: modifiable risk factors( diet, body wt., smoking, alcohol, stress, sedentary body wt., smoking, alcohol, stress, sedentary living, birth wt. ,migrationliving, birth wt. ,migration

4. Prevention and Control of Kidney Disease4. Prevention and Control of Kidney Disease Acute or Rapidly Progressive Renal Failure : Acute or Rapidly Progressive Renal Failure : A A

sudden decline in renal function resulting from the sudden decline in renal function resulting from the failure of the renal circulation or by glomerular or failure of the renal circulation or by glomerular or tubular damage causing the accumulation of tubular damage causing the accumulation of substances that is normally eliminated in the urine in substances that is normally eliminated in the urine in the body fluids leading to disruption in homeostatic, the body fluids leading to disruption in homeostatic, endocrine, and metabolic functions.endocrine, and metabolic functions.

Acute Nephritis: Acute Nephritis: A severe inflammation of the A severe inflammation of the kidney caused by infection, degenerative disease, or kidney caused by infection, degenerative disease, or disease of the blood vessels.disease of the blood vessels.

Chronic Renal Failure: Chronic Renal Failure: A progressive deterioration A progressive deterioration of renal function that ends as uremia and its of renal function that ends as uremia and its complications unless dialysis or kidney transplant is complications unless dialysis or kidney transplant is performed.performed.

Neprolithiasis: Neprolithiasis: A disorder characterized by the A disorder characterized by the presence of calculi in the kidney.presence of calculi in the kidney.

Nephrotic Syndrome: Nephrotic Syndrome: A clinical disorder of excessive A clinical disorder of excessive leakage of plasma proteins into the urine because of leakage of plasma proteins into the urine because of increased permeability of the glomerular capillary increased permeability of the glomerular capillary membranemembrane

Urinary Tract Infection: Urinary Tract Infection: A disease caused by the A disease caused by the presence of pathogenic microorganisms in the urinary presence of pathogenic microorganisms in the urinary tract with or without signs and symptoms.tract with or without signs and symptoms.

Renal Tubular Defects: Renal Tubular Defects: An abnormal condition in the An abnormal condition in the reabsorption of selected materials back into the blood reabsorption of selected materials back into the blood and secretion, collection, and conduction of urine.and secretion, collection, and conduction of urine.

Urinary Tract Obstruction: Urinary Tract Obstruction: A condition wherein the A condition wherein the urine flow is blocked or clogged.urine flow is blocked or clogged.

5. Program on Mental Health and Mental 5. Program on Mental Health and Mental DisordersDisorders

6. Program on Drug Dependence/ 6. Program on Drug Dependence/

Substance AbuseSubstance Abuse

7.Community-Based Rehabilitation Program7.Community-Based Rehabilitation Program

A creative application of the primary health care A creative application of the primary health care approach in rehabilitation services, which involves approach in rehabilitation services, which involves measures taken at the community level to use and build measures taken at the community level to use and build on the resources of the community with the community on the resources of the community with the community people, including impaired, disabled and handicapped people, including impaired, disabled and handicapped persons as well.persons as well.

Goal: To improve the quality of life and increase Goal: To improve the quality of life and increase productivity of disabled, handicapped persons.productivity of disabled, handicapped persons.

Aim: To reduce the prevalence of disability through Aim: To reduce the prevalence of disability through prevention, early detection and provision of prevention, early detection and provision of rehabilitation services at the community level.rehabilitation services at the community level.

8. Program on the Elderly/Geriatric Nursing 8. Program on the Elderly/Geriatric Nursing ServicesServices

7 humanitarian issues: family, health, 7 humanitarian issues: family, health, income, security, employment and labor, income, security, employment and labor, social welfare, education, recreation, culltural social welfare, education, recreation, culltural activities and housingactivities and housing

Leading causes of illness:elderlyLeading causes of illness:elderly

Influenza, HPN, diarrhea,Influenza, HPN, diarrhea, bronchitis, TB, diseases. of the heart, bronchitis, TB, diseases. of the heart, pneumonia, malaria, pneumonia, malaria, malignant neoplasm, chickenpoxmalignant neoplasm, chickenpox

Leading causes of death:elderlyLeading causes of death:elderly

Diseases of heart and vascular systemDiseases of heart and vascular system Pneumonia, TB, CCOPDPneumonia, TB, CCOPD Malignant neoplasmsMalignant neoplasms DiabetesDiabetes NephritisNephritis AccidentsAccidents

9. Programs on Blindness, Deafness and 9. Programs on Blindness, Deafness and OsteoporosisOsteoporosis

Cataract- main causes of blindnessCataract- main causes of blindness VAD- main cause of childhood blindness; most VAD- main cause of childhood blindness; most

serious eye problem of Fil. children below 6 yrs. oldserious eye problem of Fil. children below 6 yrs. old Osteoporosis special problem in women, highest Osteoporosis special problem in women, highest

bet. 50—79 yrs. old, MENOPAUSE- main causebet. 50—79 yrs. old, MENOPAUSE- main cause

Prevention of NCD/Role of Nursing Prevention of NCD/Role of Nursing in Health Promotion And Advocacyin Health Promotion And Advocacy

Yosi Kadiri- anti smokingYosi Kadiri- anti smoking Edi Exercise/Hataw-regular physical activityEdi Exercise/Hataw-regular physical activity Tiya Kulit/ Iwas Sakit Diet-low salt, low fat, Tiya Kulit/ Iwas Sakit Diet-low salt, low fat,

high fiber diet high fiber diet Mag HL – exercise, no smoking, avoidance of Mag HL – exercise, no smoking, avoidance of

alcohol, healthy diet, iwas stress, watch wt.alcohol, healthy diet, iwas stress, watch wt.

Sentrong Sigla Movement ( SSM)Sentrong Sigla Movement ( SSM)-a certification recognition program which -a certification recognition program which

develops and promotes standards for health develops and promotes standards for health facilitiesfacilities

- Joint effort bet.:Joint effort bet.:1.DOH – provides technical and financial 1.DOH – provides technical and financial

assistance packages for health careassistance packages for health care2. LGUs – direct implementers of health 2. LGUs – direct implementers of health

programs & prime developers of health centers programs & prime developers of health centers and hospitals making services accessible to and hospitals making services accessible to every Filipinoevery Filipino

Pillars of SSMPillars of SSM

1. Quality Assurance1. Quality Assurance 2. Grant and Technical Assistance2. Grant and Technical Assistance 3. Health Promotion3. Health Promotion 4. Awards4. Awards

Expected Outcome: SSMExpected Outcome: SSM

Empowered individuals adopting healthy Empowered individuals adopting healthy lifestyle, improved health-seeking behavior lifestyle, improved health-seeking behavior and well-being & increased demand for quality and well-being & increased demand for quality health serviceshealth services

Institutions will develop policies, provide Institutions will develop policies, provide quality services , institute system for quality services , institute system for surveillance/ merits and advocate for lawssurveillance/ merits and advocate for laws

Programs: SSMPrograms: SSM

EPIEPI Disease SurveillanceDisease Surveillance CARICARI CDDCDD Nutrition/ Micronutrient Supplementation-Nutrition/ Micronutrient Supplementation-

*Food Fortification :*Food Fortification :Rice –Rice –ironiron; Oil and sugar – ; Oil and sugar – Vit. AVit. A; ; Flour-Flour-Vit. A & ironVit. A & iron; Salt- ; Salt- iodineiodine

Integrated Management of Integrated Management of Childhood Illness ( IMCI)Childhood Illness ( IMCI)

Integrates management of most common Integrates management of most common childhood problems ( diarrhea, pneumonia, childhood problems ( diarrhea, pneumonia, measles, malnutrition, DHF, malaria)measles, malnutrition, DHF, malaria)

Involves family members and community in Involves family members and community in the health care process for physical growth and the health care process for physical growth and mental development & disease preventionmental development & disease prevention

IMCI: Case Mgt. ProcessIMCI: Case Mgt. Process 1. Assessing the child or young infant- History 1. Assessing the child or young infant- History

taking, PEtaking, PE 2. Classifying the Illness- severity of illness2. Classifying the Illness- severity of illness 3. Identifying ttt.- classification chart3. Identifying ttt.- classification chart 4. Treating the child- giving ttt. in health centers, 4. Treating the child- giving ttt. in health centers,

prescribed drugs & teaching mothers how to carry out prescribed drugs & teaching mothers how to carry out ttt.ttt.

5. Counseling the mother- child feeding,foods and 5. Counseling the mother- child feeding,foods and fluids to give & when to bring the child back to the fluids to give & when to bring the child back to the health centerhealth center

6. Giving of follow-up care6. Giving of follow-up care

Communicable diseasesCommunicable diseases National Tuberculosis Control Program – key National Tuberculosis Control Program – key

policiespolicies Case finding – direct Sputum Microscopy and X-Case finding – direct Sputum Microscopy and X-

ray examination of TB symptomatics who are ray examination of TB symptomatics who are negative after 2 or more sputum exams negative after 2 or more sputum exams

Treatment – shall be given free and on an Treatment – shall be given free and on an ambulatory basis, except those with acute ambulatory basis, except those with acute complications and emergenciescomplications and emergencies

Direct Observed Treatment Short Course – Direct Observed Treatment Short Course – comprehensive strategy to detect and cure TB comprehensive strategy to detect and cure TB patients.patients.

Category and Treatment Category and Treatment RegimenRegimen

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

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

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

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

Intensive Phase (given daily for the first 2 months)- Intensive Phase (given daily for the first 2 months)- Rifampicin + Isioniazid + pyrazinamide + ethambutol. Rifampicin + Isioniazid + pyrazinamide + ethambutol.

If sputum result becomes negative after 2 months, If sputum result becomes negative after 2 months, maintenance phase starts. But if sputum is still positive maintenance phase starts. But if sputum is still positive in 2 months, all drugs are discontinued from 2-3 days in 2 months, all drugs are discontinued from 2-3 days and a sputum specimen is examined for culture and drug and a sputum specimen is examined for culture and drug sensitivity. The patient resumes taking the 4 drugs for sensitivity. The patient resumes taking the 4 drugs for another month and then another smear exam is done at another month and then another smear exam is done at the end of the 3the end of the 3rdrd month. month.

Maintenance Phase (after 3Maintenance Phase (after 3rdrd month, regardless of the month, regardless of the result of the sputum exam)-INH + rifampicin dailyresult of the sputum exam)-INH + rifampicin daily

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

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

Maintenance Phase (daily for 5 months, month Maintenance Phase (daily for 5 months, month 4,5,6,7,& 8)-4,5,6,7,& 8)-Isionazid+ rifampicin+ ethambutolIsionazid+ rifampicin+ ethambutol

Category 3 – new TB patients whose sputum is smear-negative for 3 times Category 3 – new TB patients whose sputum is smear-negative for 3 times

and chest x-ray result of PTB minimaland chest x-ray result of PTB minimal

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

Maintenance Phase (daily for the next 2 Maintenance Phase (daily for the next 2 months) - Isioniazid + rifampicin months) - Isioniazid + rifampicin

Stop TB ; Do it with DOTSStop TB ; Do it with DOTS AdvocacyAdvocacy is a planned and continuous effort to inform is a planned and continuous effort to inform

people about issue and instigate change. Advocacy people about issue and instigate change. Advocacy usually takes place over an extended period of time and usually takes place over an extended period of time and includes a variety of strategies to communicate a specific includes a variety of strategies to communicate a specific message.message.

TB TB is the is the number one infectious killer in the worldnumber one infectious killer in the world. . One TB suspect can infect another 10 healthy personsOne TB suspect can infect another 10 healthy persons

Leprosy Control ProgramLeprosy Control Program WHO Classification – basis of multi-drug therapy WHO Classification – basis of multi-drug therapy

Paucibacillary/PB – non-infectious types. 6-9 months of Paucibacillary/PB – non-infectious types. 6-9 months of treatment.treatment.

Multibacillary/MB – infectious types. 24-30 months of Multibacillary/MB – infectious types. 24-30 months of treatment.treatment.

Multi-drug therapy – use of 2 or more drugs renders Multi-drug therapy – use of 2 or more drugs renders patients non-infectious patients non-infectious a weeka week after starting after starting treatment treatment

Patients w/ single skin lesion and a negative slit skin smear Patients w/ single skin lesion and a negative slit skin smear are treated w/ a single dose of ROM regimenare treated w/ a single dose of ROM regimen

For PB leprosy cases- Rifampicin+Dapsone on Day 1 then For PB leprosy cases- Rifampicin+Dapsone on Day 1 then Dapsone from Day 2-28. 6 blister packs taken monthly Dapsone from Day 2-28. 6 blister packs taken monthly within a max. period of 9 mos.within a max. period of 9 mos.

All patients who have complied w/ MDT are considered All patients who have complied w/ MDT are considered cured and no longer regarded as a case of leprosy, even if cured and no longer regarded as a case of leprosy, even if some sequelae of leprosy remain.some sequelae of leprosy remain.

Responsibilities of the nurseResponsibilities of the nurse Prevention – health education, healthful living through Prevention – health education, healthful living through

proper nutrition, adequate rest, sleep and good personal proper nutrition, adequate rest, sleep and good personal hygiene;hygiene;

CasefindingCasefinding Management and treatment – prevention of secondary Management and treatment – prevention of secondary

injuries, handling of utensils; special shoes w/ padded injuries, handling of utensils; special shoes w/ padded soles; importance of sustained therapy, correct dosage, soles; importance of sustained therapy, correct dosage, effects of drugs and the need for medical check-up from effects of drugs and the need for medical check-up from time to time; mental & emotional supporttime to time; mental & emotional support

Rehabilitation-makes patients capable, active and self-Rehabilitation-makes patients capable, active and self-respecting member of society.respecting member of society.

Control of Schistosomiasis – a tropical disease caused Control of Schistosomiasis – a tropical disease caused by a blood fluke, Schistosoma by a blood fluke, Schistosoma Japonicum Japonicum ; transmitted ; transmitted by a tiny snail by a tiny snail Oncomelania quadrasiOncomelania quadrasi Preventive measures – health education regarding Preventive measures – health education regarding

mode of transmission and methods of protection; mode of transmission and methods of protection; proper disposal of feces and urine; improvement of proper disposal of feces and urine; improvement of irrigation and agriculture practicesirrigation and agriculture practices

Control of patient, contacts and the immediate Control of patient, contacts and the immediate environmentenvironment

Specific treatment- Praziquantel – drug of choiceSpecific treatment- Praziquantel – drug of choice

Programs on Filariasis, Malaria and Dengue Programs on Filariasis, Malaria and Dengue Hemorrhagic FeverHemorrhagic Fever Filariasis- a chronic prasitic infection caused Filariasis- a chronic prasitic infection caused

by a nematode, Wuchereria by a nematode, Wuchereria bancrofti. bancrofti. Young Young and adult wormsand adult worms live in the lymphatic vessels live in the lymphatic vessels and nodes, while the micro filariae are in the and nodes, while the micro filariae are in the blood; transmitted through bites from an blood; transmitted through bites from an infected female mosquito, Aedes infected female mosquito, Aedes poecilius, poecilius, that bites at night.that bites at night. Treatment: Diethylcarbamazine citrate or Treatment: Diethylcarbamazine citrate or

Hetrazan Hetrazan Elephantiasis and Hydrocoele are handled Elephantiasis and Hydrocoele are handled

through surgery, prevention and supportive carethrough surgery, prevention and supportive care

Malaria – infection caused by the bite of the Malaria – infection caused by the bite of the female female Anopheles Anopheles mosquito, mosquito, Chemoprophylaxis – Chloroquine taken at weekly Chemoprophylaxis – Chloroquine taken at weekly

intervals, starting from 1-2 weeks before entering intervals, starting from 1-2 weeks before entering the endemic area.the endemic area.

Anti-malarial drugs – sulfadoxine, quiinine Anti-malarial drugs – sulfadoxine, quiinine sulfate, tetracycline, quinidinesulfate, tetracycline, quinidine

Insecticide treatment of mosquito nets, house Insecticide treatment of mosquito nets, house spraying, stream seeding and clearing, sustainable spraying, stream seeding and clearing, sustainable preventive and vector control measpreventive and vector control meas

Dengue H-fever Dengue H-fever 4 o’clock habit4 o’clock habit

Programs on Measles. Programs on Measles. Chickenpox, Mumps, Diphtheria, Chickenpox, Mumps, Diphtheria, Pertusis, Tetanus –focused on Pertusis, Tetanus –focused on health information campaigns health information campaigns and intensive immunization of and intensive immunization of children in barangays. children in barangays.

Prevention and Control Program on Parasitic Infestations Prevention and Control Program on Parasitic Infestations ( STH e.g. Ascaris, Trichuris, Hookworm) and ( STH e.g. Ascaris, Trichuris, Hookworm) and Paragonimiasis in communities where eating of fresh or Paragonimiasis in communities where eating of fresh or inadequately cooked crab is a practiceinadequately cooked crab is a practice

Management:Management:1. Deworming1. Deworming2. Health Education re:2. Health Education re:

Good personal hygieneGood personal hygiene Use of footwearUse of footwear Washing fruits and vegetables wellWashing fruits and vegetables well Use of sanitary toiletsUse of sanitary toilets Sanitary disposal of garbageSanitary disposal of garbage Boiling drinking water at least 2-3 min. from boiling Boiling drinking water at least 2-3 min. from boiling

point or chlorinationpoint or chlorination

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

And RabiesAnd Rabies

Mgt. of RabiesMgt. of Rabies

Wash wound with soap and water, betadine or alcohol may Wash wound with soap and water, betadine or alcohol may be appliedbe applied

If dog is healthy observe for 14 days. If nothing happens- If dog is healthy observe for 14 days. If nothing happens- no need for ttt.If it dies or shows rabies, kill then bring no need for ttt.If it dies or shows rabies, kill then bring head for lab. Exam & consult doctor.head for lab. Exam & consult doctor.

Active immunization – body develops Ab against rabies up Active immunization – body develops Ab against rabies up to 3 yrs.to 3 yrs.

Passive I – giving Ab to persons with head and neck Passive I – giving Ab to persons with head and neck bites, multiple single deep bites, contamination of mucous bites, multiple single deep bites, contamination of mucous membranes or thin covering of the eyes, lips or mouth to membranes or thin covering of the eyes, lips or mouth to provide immediate protectionprovide immediate protection

RPO – immunization of pets at 3 mos. of age and yearly RPO – immunization of pets at 3 mos. of age and yearly thereafterthereafter

Prevention and Control on STIsPrevention and Control on STIs- Gonorrhea, Syphilis, HIV/AIDS, Gonorrhea, Syphilis, HIV/AIDS,

Trichomoniasis,Chlamydia, Hep B ( the most serious Trichomoniasis,Chlamydia, Hep B ( the most serious type ‘cause of severe cx. Eg. type ‘cause of severe cx. Eg. Massive liver damageMassive liver damage and and hepatocarcinomahepatocarcinoma

- 4 C’s 4 C’s in the Syndromic Mgtin the Syndromic Mgt- 1. Compliance1. Compliance- 2. Counseling/ Education2. Counseling/ Education- 3. Contact tracing to treat partner3. Contact tracing to treat partner- 4. Condom use4. Condom use- Hep B vaccinationHep B vaccination- Universal precautionsUniversal precautions- Safe sexSafe sex

Other CHN Practice SettingsOther CHN Practice Settings

I. Occupational HealthI. Occupational Health - the application of public health, medical and - the application of public health, medical and

engineering practice for the purpose of conserving, engineering practice for the purpose of conserving, restoring the health and effectiveness of workers thru restoring the health and effectiveness of workers thru their places of employmenttheir places of employment

A. Occupational Health NursingA. Occupational Health Nursing - the application of nursing principles and procedures - the application of nursing principles and procedures

in providing health service to employees in their in providing health service to employees in their place of work by means of:place of work by means of:

1. prompt and efficient nursing care of the ill 1. prompt and efficient nursing care of the ill and impairedand impaired

2. participation in teaching health and safety 2. participation in teaching health and safety practices on the jobpractices on the job

3. cooperation with plant department 3. cooperation with plant department administratorsadministrators

4.keeping the health clinic and staff ready to 4.keeping the health clinic and staff ready to handle emergencieshandle emergencies

5. advising workers in the utilization of 5. advising workers in the utilization of community and welfare servicescommunity and welfare services

Objectives of OHNObjectives of OHN

To assist, maintain and promote positive To assist, maintain and promote positive health of laborers and employees thru early health of laborers and employees thru early detection and prevention of occupational detection and prevention of occupational diseases and hazards of industrial processes diseases and hazards of industrial processes and by coordinating and cooperating with and by coordinating and cooperating with activities of other community health and activities of other community health and welfare serviceswelfare services

Nurse’s Role in OHNNurse’s Role in OHN 1. Assists/participates in developing an adequate health 1. Assists/participates in developing an adequate health

program for workers and laborers including sound program for workers and laborers including sound health education activitieshealth education activities

2. Encourages periodic P.E.2. Encourages periodic P.E. 3. Cooperates with occupational medical programs in 3. Cooperates with occupational medical programs in

the prevention of accidents as well as in the the prevention of accidents as well as in the promotion of good working atmosphere and promotion of good working atmosphere and relationships in the place of workrelationships in the place of work

4. Helps in teaching others in giving good nursing care 4. Helps in teaching others in giving good nursing care to the sick or handicapped in their own homesto the sick or handicapped in their own homes

II. School Health NursingII. School Health Nursing School Health Triad :School Health Triad :

1. SERVICE1. SERVICE

2. EDUCATION2. EDUCATION

3. ENVIRONMENT3. ENVIRONMENT

Mission of School Health Program:Mission of School Health Program:

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

School Health Team:School Health Team:

Psychologist/ CounselorPsychologist/ Counselor TeacherTeacher NutritionistNutritionist NurseNurse Social WorkersSocial Workers Maintenance PersonnelMaintenance Personnel

Targets in SHNTargets in SHN

FamilyFamily StudentsStudents TeachersTeachers Supportive PersonnelSupportive Personnel CommunityCommunity

School Health Nurse’s Roles:School Health Nurse’s Roles:

EDUCATOREDUCATOR CONSULTANT /RESEARCHERCONSULTANT /RESEARCHER STUDENT, FAMILY AND STAFF STUDENT, FAMILY AND STAFF

ADVOCATE/CHANGE AGENTADVOCATE/CHANGE AGENT HEALTH SCREENERHEALTH SCREENER HEALTH CARE PROVIDER HEALTH CARE PROVIDER

Common Health Concerns of Schoolchildren:Common Health Concerns of Schoolchildren:

1.Drug and Alcohol Abuse1.Drug and Alcohol Abuse

2. STDs/STIs2. STDs/STIs

3. Teenage Pregnancies3. Teenage Pregnancies

4. Mental Health4. Mental Health

5. Dermatological Disorders- pimples/acne, 5. Dermatological Disorders- pimples/acne, fungal infections, allergiesfungal infections, allergies

6. Respiratory Conditions- asthma, URTI6. Respiratory Conditions- asthma, URTI

7. Nutrition7. Nutrition

8. Dental Health8. Dental Health

There was a man who saw a scorpion There was a man who saw a scorpion floundering around in the water. floundering around in the water.

He decided to save it by stretching out his finger He decided to save it by stretching out his finger but the scorpion stung him.but the scorpion stung him.

The man still tried to get the scorpion out of the The man still tried to get the scorpion out of the water but the scorpion stung him again.water but the scorpion stung him again.

Another man nearby told him to stop saving the Another man nearby told him to stop saving the scorpion but the man said, “It’s the nature of the scorpion but the man said, “It’s the nature of the scorpion to sting. It’s my nature to love, why scorpion to sting. It’s my nature to love, why should I give up my nature to love just because should I give up my nature to love just because it’s the nature of the scorpion to sting?”it’s the nature of the scorpion to sting?”

Don’t give up Don’t give up loving, don’t give loving, don’t give up your goodness up your goodness even if people even if people around you sting…around you sting…

TTHHEE EENNDD