Professional Documents
Culture Documents
NURSING
Mrs. Laarne Estenzo-Pontillas
BSN , R.N., MSN
(Mark 10:45)
Discipleship is a lifestyle
Not just a biblical truth
Nor a Christian ideal but a way of life
For the Son of Man also came not to be
served
But to serve and to give His life as a
ransom for many.
COVERAGE FOR LOCAL
BOARD EXAM : CHN
I. Safe and Quality Care, Health
Education, and Communication,
Collaboration and Teamwork
1. Principles and Standard of CHN
2. Levels of care
3. Types of Clientele
4. Health Care Delivery System
5. PHC as a Strategy
6. Family-based Nursing
Services(Family Health Nursing
Process)
7. Population Group-based Nursing
Services
8. Community-based Nursing
Services/Community Health
Nursing Process
9. Community Organizing
10.Public Health Programs
II. Research and Quality
Improvement
1. Research in the Community
2. National Health Situation
3. Vital Statistics
4. Epidemiology
5. Demography
III. Management of Resources
& Environment and Records
Management
1. Field Health Services And
Information System
2. Target-setting
3. Environmental Sanitation
IV. Ethico-Moral-Legal
Responsibility
1. Socio-cultural values, beliefs, and
practices of individuals, families,
groups and communities
2. Code of Ethics for Government
Workers
3. WHO, DOH, LGU policies on health
4. Local Government Code
5. Issues
V. Personal And Professional
Development
1. Self-assessment of CHN
competencies, importance,
methods and tools
2. Strategies and methods of
updating ones self, enhancing
competence in community health
nursing and related areas.
HISTORY OF CHN
Date Event
1901 - Act # 157 ( Board of Health of the
Philippines) ; Act # 309 ( Provincial and
Municipal Boards of Health) were created.
1905 - Board of Health was abolished; functions
were transferred to the Bureau of Health.
1912 Act # 2156 or Fajardo Act created the
Sanitary Divisions, the forerunners of present
MHOs; male nurses performs the functions of
doctors
1919 Act # 2808 (Nurses Law was created)
- Carmen del Rosario , 1
st
Fil. Nurse supervisor
under Bureau of Health
Oct. 22, 1922 Filipino Nurses Organization
(Philippine Nurses Organization) was
organized.
1923 Zamboanga General Hospital School
of Nursing & Baguio General Hospital
were established; other government
schools of nursing were organized several
years after.
1928- 1
st
Nursing convention was held
1940 Manila Health Department was
created.
1941 Dr. Mariano Icasiano became the
first city health officer; Office of Nursing
was created through the effort of Vicenta
Ponce (chief nurse) and Rosario Ordiz
(assistant chief nurse)
Dec. 8, 1941 Victims of World War II were
treated by the nurses of Manila.
July 1942 Nursing Office was created; Dr.
Eusebio Aguilar helped in the release of 31
Filipino nurses in Bilibid Prison as prisoners of
war by the Japanese.
Feb. 1946 Number of nurses decreased from 556
308.
1948 First training center of the Bureau of Health
was organized by the Pasay City Health
Department. Trinidad Gomez, Marcela Gabatin,
Costancia Tuazon, Ms. Bugarin, Ms. Ramos,
and Zenaida Nisce composed the training
staff.
1950 Rural Health Demonstration and
Training Center was created.
1953 The first 81 rural health units were
organized.
1957 RA 1891 amended some sections of
RA 1082 and created the eight categories
of rural health unit causing an increase in
the demand for the community health
personnel.
1958-1965 Division of Nursing was
abolished (RA 977) and Reorganization Act
(EO 288)
1961 Annie Sand organized the National
League of Nurses of DOH.
1967 Zenaida Nisce became the nursing
program supervisor and consultant on the six
special diseases (TB, leprosy, V.D., cancer,
filariasis, and mental health illness).
1975 Scope of responsibility of nurses and
midwives became wider due to restructuring
of the health care delivery system.
1976-1986 The need for Rural Health Practice
Program was implemented.
1990- 1992- Local Government Code of 1991 (RA
7160)
1993-1998 Office of Nursing did not
materialize in spite of persistent
recommendation of the officers, board
members, and advisers of the National
League of Nurses Inc.
Jan. 1999 Nelia Hizon was positioned as
the nursing adviser at the Office of
Public Health Services through Department
Order # 29.
May 24, 1999 EO # 102, which redirects the
functions and operations of DOH, was
signed by former President Joseph
Estrada.
LAWS AFFECTING
PUBLIC HEALTH AND
PRACTICE OF
COMMUNITY HEALTH
NURSING
R.A. 7160 - or the Local Government Code. This
involves the devolution of powers, functions
and responsibilities to the local government
both rural & urban.The Code aims to transform
local government units into self-reliant
communities and active partners in the
attainment of national goals thru a more
responsive and accountable local government
structure instituted thru a system of
decentralization. Hence, each province, city
and municipality has a LOCAL HEALTH
BOARD ( LHB ) which is mandated to propose
annual budgetary allocations for the operation
and maintenance of their own health facilities.
Composition of LHB
Provincial Level
1.Governor- chair
2. Provincial Health Officer vice chair
3. Chair , Committee on Health of
Sangguniang
Panlalawigan
4. DOH rep.
5. NGO rep.
Composition of LHB
City and Municipal Level
1. Mayor chair
2. MHO vice chair
3. Chair, Committee on Health of
Sangguniang
Bayan
4. DOH rep
5. NGO rep
EFFECTIVE LHS DEPENDS
ON:
1. the LGUs financial capability
2. a dynamic and responsive political
leadership
3. community empowerment
R.A. 2382 Philippine Medical Act. This act defines the
practice of medicine in the country.
R.A. 1082 Rural Health Act. It created the 1
st
81 Rural
Health Units.
-amended by RA 1891 ; more physicians,
dentists, nurses, midwives and sanitary inspectors will
live in the rural areas where they are assigned in order
to raise the health conditions of barrio people ,hence
help decrease the high incidence of preventable
diseases
R.A. 6425 Dangerous Drugs Act. It
stipulates that the sale, administration,
delivery, distribution and transportation of
prohibited drugs is punishable by law.
R.A. 9165 the new Dangerous Drug Act of
2002
P.D. No. 651 requires that all health
workers shall identify and encourage the
registration of all births within 30 days
following delivery.
P.D. No. 996 requires the compulsory
immunization of all children below 8 yrs. of
age against the 6 childhood immunizable
diseases.
P.D. No. 825 provides penalty for improper
disposal of garbage.
R.A. 8749 Clean Air Act of 2000
P.D. No. 856 Code on Sanitation. It provides
for the control of all factors in mans
environment that affect health including the
quality of water, food, milk, insects, animal
carriers, transmitters of disease, sanitary and
recreation facilities, noise, pollution and
control of nuisance.
R.A. 6758 standardizes the salary of government
employees including the nursing personnel.
R.A. 6675 Generics Act of 1988 which promotes,
requires and ensures the production of an adequate
supply, distribution, use and acceptance of drugs
and medicines identified by their generic name.
R.A. 6713 Code of Conduct and Ethical Standards of
Public Officials and Employees. It is the policy of the
state to promote high standards of ethics in public
office. Public officials and employees shall at all
times be accountable to the people and shall
discharges their duties with utmost responsibility,
integrity, competence and loyalty, act with patriotism
and justice, lead modest lives uphold public interest
over personal interest.
R.A. 7305 Magna Carta for Public Health
Workers. This act aims: to promote and
improve the social and economic well-being of
health workers, their living and working
conditions and terms of employment; to develop
their skills and capabilities in order that they will
be more responsive and better equipped to
deliver health projects and programs; and to
encourage those with proper qualifications and
excellent abilities to join and remain in
government service.
R.A. 8423 created the Philippine Institute of
Traditional and Alternative Health Care.
P.D. No. 965 requires applicants for marriage license
to receive instructions on family planning and
responsible parenthood.
P.D. NO. 79 defines , objectives, duties and functions
of POPCOM
RA 4073 advocates home treatment for
leprosy
Letter of Instruction No. 949 legal basis
of PHC dated OCT. 19, 1979
- promotes development of health programs
on the community level
RA 3573 requires reporting of all cases
of communicable diseases and
administration of prophylaxis
Ministry Circular No. 2 of 1986 includes
AIDS as notifiable disease
R.A. 7875 National Health Insurance Act
R.A. 7432 Senior Citizens Act
R. A. 7719 - National Blood Services Act
R.A. 8172 Salt Iodization Act ( ASIN LAW)
R.A. 7277- Magna Carta for PWDs,
provides their rehabilitation, self-
development and self-reliance and
integration into the mainstream of society
A. O. No. 2005-0014- National Policies
on Infant and Young Child Feeding:
1.All newborns be breastfeed within 1 hr
after birth
2. Infants be exclusively breastfeed for 6
mos.
3. Infants be given timely, adequate and
safe complementary foods
4. Breastfeeding be continued up to 2 years
and beyond
EO 51- Phil. Code of Marketing of
Breastmilk Substitutes
R.A.- 7600 Rooming In and
Breastfeeding Act of 1992
R.A. 8976- Food Fortification Law
R.A. 8980- prolmulgates a comprehensive
policy and a national system for ECCD
A..O. No. 2006- 0015- defines the
Implementing guidelines on Hepatitis B
Immunization for Infants
R.A. 7846- mandates Compulsory
Hepatitis B Immunization among infants
and children less than 8 yrs old
R.A. 2029- madates Liver Cancer and
Hepatitis B Awareness Month Act (
February)
A.O. No. 2006-0012- specifies the Revised
Implementing Rules and Regulations of
E.O. 51 or Milk Code, Relevant
International Agreements, Penalizing
Violations thereof and for other purposes
Public Health
- science and art of preventing diasease,
prolonging life, promoting health and efficiency
thru organized community effort for the
sanitation of the environment, control of
communicable diseases, the education of
individuals in personal hygiene, the organization
of medical and nursing services for the early
diagnosis and preventive treatment of diseases
and the development of social machinery to
ensure everyone a standard of living adequate
for the maintenance of health, so organizing
these benefits as to enable every citizen to
realize his birthright off birth and longevity ( DR.
C.E. Winslow)
Community Health Nursing
- special field of nursing that combines the
skills of nursing, public health and some
phases of social assistance and functions
as part of the total public health program
for the promotion of health, the
improvement of the conditions in the social
and physical environment, rehabilitation of
illness and disability ( WHO Expert
Committee of Nursing )
CHN
- a learned practice discipline with the ultimate
goal of contributing as individuals and in
collaboration with others to the promotion of the
clients optimum level of functioning thru
teaching and delivery of care ( Jacobson )
- a service rendered by a professional nurse to
IFCs, population groups in health centers,
clinics, schools , workplace for the promtion of
health, preventionof illness, care of the sick at
home and rehabilitation (DR. Ruth B. Freeman)
Concepts
The primary focus of community health
nursing is health promotion.
Community health nurses provide care
necessary to meet the requirements of an
individual all throughout the life cycle.
Knowledge on different fields (biological
and social sciences, clinical nursing, and
community health organizations) is used.
Nursing process in community health
nursing changes based on the needs of the
community.
Goal
To elevate the level health of the
multitude.
Worth and dignity of man.
1.The need of the community is the basis
of community health nursing.
2.The community health nurse must
understand fully the objectives and
policies of the agency she represents.
Philosophy
Principles
3. The family is the unit of service.
4. CHN must be available to all regardless of
race,creed and socioeconomic status
5. The CHN works as a member of the health
team
6. There must be provision for periodic
evaluation of community health nursing
services
7. Opportunities for continuing staff education
programs for nurses must be provided by
the community health nursing agency and
the CHN as well
8. The CHN makes use of available community
health resources
9. The CHN taps the already existing active
organized groups in the community
10. There must be provision for educative
supervision in community health nursing
11. There should be accurate recording and
reporting in community health nursing
12. Health teaching is the primary
responsibility of the community health nurse
Standards in CHN
I. Theory
Applies theoretical concepts as basis for
decisions in practice
II. Data Collection
Gathers comprehensive , accurate data
systematically
Standards
III. Diagnosis
Analyzes collected data to determine the
needs/ health problems of IFC
IV. Planning
At each level of prevention, develops plans
that specify nursing actions unique to
needs of clients
Standards
V. Intervention
Guided by the plan, intervenes to promote,
maintain or restore health, prevent illness
and institute rehabilitation
VI. Evaluation
Evaluates responses of clients to
interventions to note progress toward goal
achievement, revise data base, diagnoses
and plan
Standards
VII. Quality Assurance and Professional
Development
Participates in peer review and other means
of evaluation to assure quality of nursing
practice
Assumes professional development
Contributes to development of others
Standards
VIII. Interdisciplinary Collaboration
Collaborates with other members of the
health team, professionals and community
representatives in assessing, planning,
implementing and evaluating programs for
community health
Standards
IX. Research
Indulges in research to contribute to theory
and practice in community health
nursing
LEVELS OF CARE/ PREVENTION
1. PRIMARY
2. SECONDARY
3. TERTIARY
Types of Clientele
1. INDIVIDUALS
2. FAMILIES
3. COMMUNITIES
4. POPULATION GROUPS
- Aggregate of people who share common
characteristics, developmental stage or common
exposure to particular environmental factors
thus resulting in common health problems (
Clark, 1995:5) e.g. children . elderly, women,
workers etc.
Phil.Health Care Delivery
System
1.PRIMARY LEVEL FACILITIES
2. SECONDARY LEVEL FACILITIES
3. TERTIARY LEVEL FACILITIES
Classify as to what level the ff.
belong
1. Teaching and Training Hospitals
2. City Health Services
3. Emergency and District Hospitals
4. Private Practitioners
5. Heart Institutes
6. Puericulture Centers
7. RHU
THE DEPARTMENT OF
HEALTH
VISION: Health for all Filipinos
MISSION: Ensure accessibility & quality
of health care to improve the quality of
life of all Filipinos, especially the poor.
NATIONAL OBJECTIVES
1. Improve the general health status of the population
(reduce infant mortality rate, reduce child morality
rate, reduce maternal mortality rate, reduce total
fertility rate, increase life expectancy & the quality of
life years).
2. Reduce morbidity, mortality, disability &
complications from Diarrheas, Pneumonias,
Tuberculosis, Dengue, Intestinal Parasitism,
Sexually Transmitted Diseases, Hepatitis B,
Accident & Injuries, Dental Caries & Periodontal
Diseases, Cardiovascular Diseases, Cancer,
Diabetes, Asthma & Chronic Obstructive Pulmonary
Diseases, Nephritis & Chronic Kidney Diseases,
Mental Disorders, Protein Energy Malnutrition, Iron
Deficiency Anemia & Obesity.
3.Eliminate the ff. diseases as public health
problems:
Schistosomiasis
Malaria
Filariasis
Leprosy
Rabies
Measles
Tetanus
Diphtheria & Pertussis
Vitamin A Deficiency & Iodine Deficiency
Disorders
4. Eradicate Poliomyelitis
5. Promote healthy lifestyle through healthy diet
& nutrition, physical activity & fitness, personal
hygiene, mental health & less stressful life &
prevent violent & risk-taking behaviors.
6. Promote the health & nutrition of families &
special populations through child, adolescent
& youth, adult health, womens health, health
of older persons, health of indigenous people,
health of migrant workers and health of
different disabled persons and of the rural &
urban poor.
7. Promote environmental health and
sustainable development through the
promotion and maintenance of healthy
homes, schools, workplaces,
establishments and communities towns
and cities.
Basic Principles to Achieve
Improvement in Health
1. Universal access to basic health services
must be ensured.
2. The health and nutrition of vulnerable
groups must be prioritized.
3. The epidemiological shift from infection
to degenerative diseases must be
managed.
4. The performance of the health sector
must be enhanced.
Primary Strategies to Achieve
Goals
1. Increasing investment for Primary Health
Care.
2. Development of national standards and
objectives for health.
3. Assurance of health care.
4. Support to the local system
development.
5. Support for frontline health workers.
PHC as a Strategy
PRIMARY HEALTH CARE (PHC)
May 1977 -30
th
World Health Assembly
decided that the main health target of the
government and WHO is the attainment of a
level of health that would permit them to
lead a socially and economically productive
life by the year 2000.
September 6-12, 1978 - First International
Conference on PHC in Alma Ata, Russia
(USSR) The Alma Ata Declaration stated that
PHC was the key to attain the health for all
goal
October 19, 1979 - Letter of Instruction (LOI)
949), the legal basis of PHC was signed by
Pres. Ferdinand E. Marcos,
which adopted PHC as an approach towards
the design, development and implementation of
programs focusing on health development at
community level.
RATIONALE FOR ADOPTING PRIMARY HEALTH CARE:
Magnitude of Health Problems
Inadequate and unequal distribution of
health resources
Increasing cost of medical care
Isolation of health care activities from
other development activities
DEFINITION OF PRIMARY HEALTH CARE
G essential health care made universally
accessible to individuals and families in the
community by means acceptable to them,
through their full participation and at cost that
the community can afford at every stage of
development.
Ga practical approach to making health benefits
within the reach of all people.
Gan approach to health development, which is
carried out through a set of activities and whose
ultimate aim is the continuous improvement and
maintenance of health status of the community.
GOAL OF PRIMARY HEALTH CARE:
HEALTH FOR ALL FILIPINOS by the year
2000 AND HEALTH IN THE HANDS OF THE
PEOPLE by the year 2020.
An improved state of health and quality of life for
all people attained through SELF-RELIANCE.
` KEY STRATEGY TO ACHIEVE THE GOAL:
Partnership with and Empowerment of the people -
permeate as the core strategy in the effective
provision of essential health services that are
community based, accessible, acceptable, and
sustainable, at a cost, which the community and the
government can afford.
OBJECTIVES OF PRIMARY HEALTH CARE
Improvement in the level of health care of the community
Favorable population growth structure
Reduction in the prevalence of preventable, communicable
and other disease.
Reduction in morbidity and mortality rates especially among
infants and children.
Extension of essential health services with priority given to the
underserved sectors.
Improvement in Basic Sanitation
Development of the capability of the community aimed at self-
reliance.
Maximizing the contribution of the other sectors for the social
and economic development of the community.
MISSION:
To strengthen the health care system by
increasing opportunities and supporting
the conditions wherein people will
manage their own health care.
TWO LEVELS OF PRIMARY HEALTH CARE
WORKERS
1. Barangay Health Workers - trained community
health workers or health auxiliary volunteers or
traditional birth attendants or healers.
2. Intermediate level health workers include the Public
Health Nurse, Rural Sanitary Inspector and
midwives.
PRINCIPLES OF PRIMARY HEALTH CARE
1. 4 A's = Accessibility, Availability,
Affordability & Acceptability,
Appropriateness of health services. The
health services should be present where
the supposed recipients are. They should
make use of the available resources within
the community, wherein the focus would be
more on health promotion and prevention
of illness.
2. COMMUNITY PARTICIPATION
=heart and soul of PHC
3. People are the center, object and subject
of development.
Thus, the success of any undertaking that aims at
serving the people is dependent on peoples
participation at all levels of decision-making; planning,
implementing, monitoring and evaluating. Any
undertaking must also be based on the peoples
needs and problems (PCF, 1990)
Part of the peoples participation is the partnership
between the community and the agencies found in the
community; social mobilization and decentralization.
In general, health work should start from where the
people are and building on what they have. Example:
Scheduling of Barangay Health Workers in the health
center
BARRIERS OF COMMUNITY INVOLVEMENT
Lack of motivation
Attitude
Resistance to change
Dependence on the part of community
people
Lack of managerial skills
4.SELF-RELIANCE
5.Partnership between the community
and the health agencies in the
provision of quality of life.
Providing linkages between the
government and the non-
government organization and peoples
organization.
6. Recognition of interrelationship
between the health and development
HEALTH
is not merely the absence of disease. Neither it is only
a state of physical and mental well-being. Health
being a social phenomenon recognizes the interplay
of political, socio-cultural and economic factors as its
determinant. Good Health therefore, is manifested by
the progressive improvements in the living conditions
and quality of life enjoyed by the community residents
(PCF, DEVELOPMENT is the quest for an improved
quality of life for all. Development is multi-
dimensional. It has a political, social, cultural,
institutional and environmental dimensions(Gonzales
1994). Therefore, it is measured by the ability of
people to satisfy their basic needs.
7. SOCIAL MOBILIZATION
It enhances people participation or
governance, support system provided by
the Government, networking and
developing secondary leaders.
8. DECENTRALIZATION
MAJOR STRATEGIES OF PRIMARY
HEALTH CARE
A. ELEVATING HEALTH TO A COMPREHENSIVE
AND SUSTAINED NATIONAL EFFORTS.
Attaining Health for all Filipino will require
expanding participation in health and health related
programs whether as service provider or beneficiary.
Empowerment to parents, families and communities to
make decisions of their health is really the desired
outcome.
Advocacy must be directed to National and Local
policy making to elicit support and commitment to
major health concerns through legislations, budgetary
and logistical considerations.
B. PROMOTING AND SUPPORTING COMMUNITY
MANAGED HEALTH CARE
The health in the hands of the
people brings the government
closest to the people. It
necessitates a process of capacity
building of communities and
organization to plan, implement and
evaluate health programs at their
levels.
C. INCREASING EFFICIENCIES IN THE
HEALTH SECTOR
Using appropriate technology will make
services and resources required for their
delivery, effective, affordable, accessible and
culturally acceptable. The development of
human resources must correspond to the actual
needs of the nation and the policies it upholds
such as PHC. The DOH will continue to
support and assist both public and private
institutions particularly in faculty development,
enhancement of relevant curricula and
development of standard teaching materials.
D. ADVANCING ESSENTIAL NATIONAL
HEALTH RESEARCH
Essential National Health
Research (ENHR) is an integrated
strategy for organizing and
managing research using
intersectoral, multi-disciplinary and
scientific approach to health
programming and delivery.
FOUR CORNERSTONES/ PILLARS IN
PRIMARY HEALTH CARE
1. Active Community Participation
2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. Support mechanism made available
HERBAL MEDICINES ENDORSED BY THE
DEPARTMENT OF HEALTH
Name Indications Dosage
1.Five-leaf
Chaste tree
(Lagundi)
1. Asthma
2. Cough
3. Body Pain
4. Fever
Divide the decoction
into 3 parts:
For asthma and
cough, drink 1 part 3
times a day.
For fever and body
pains, drink 1 part
every 4 hrs.
2. Marsh-Mint;
Peppermint
(Yerba Buena)
1. Body pain Divide
decoction into
2 parts and
drink 1 part
every 3 hours.
3. Sambong 1. Swelling
2. Inducing
diuresis
( anti-
urolithiasis)
Divide
decoction into
3 parts and
drink 1 part 3
times a day.
4. Tsaang
Gubat
1. Stomachache
Drink the warm
decoction. If it
persists, or if there is
no improvement an
hour after drinking the
decoction, consult a
doctor.
5.
Ulasimang
Bato/Pansit-
Pansitan
1. Gouty Arthritis Divide the
decoction into 3
parts and drink 1
part 3 times a day
after meals.
6. Garlic 1. Hypertension
2. Htperlipidemia
Eat 6 cloves of
garlic together
with meals
7. Niyog-
Niyogan
1. Ascariasis
Chew and swallow
only dried seeds 2
hours after dinner
according to the
following:
ADULTS = 8-10
seeds
9-12 y/o = 6-7 seeds
6-8 y/o = 5-6 seeds
4-5 y/o = 4-5 seeds
8. Guava 1. Cleaning
wounds
2. Mouth wash
for mouth
infection,
sore gums &
tooth decay
For wound cleaning,
use decoction for
washing the wound 2
times a day
For tooth decay and
swelling of gums,
gargle with warm
decoction 3 times a day
9.
Akapulko
1. Ring worm
2. Athletes
foot
3. Scabies
Apply the juice on the affected
area 1 to 2 times a day
If the person develops an allergy
while using the above preparation,
prepare the following:
oPut 1 cup of chopped fresh
leaves in an earthen jar. Pour in 2
glasses of water and cover it.
oBoil the mixture until the 2
glasses of water originally poured
have been reduced to 1 glass of
water
oStrain the mixture. Use it while it
is warm.
oApply the warm decoction on the
affected area 1 to 2 times a day.
10.
Bitter Gourd/
Melon
(Ampalaya)
1. Mild Non-
Insulin
Depende
nt
Diabetes
Mellitus
Drink cup
of cooled or
warm
decoction 3
times a day
after meals.
11.
Ginger
(Zingiber
officinale)
1. Motion
sickness,
sore throat,
nausea &
vomiting,
migraine
headaches,
arthritis
An abortifacient if taken
in large amounts; should
not be used by persons
with cholelithiasis unless
directed by the physician;
may increase the risk of
bleeding when used
concurrently with
anticoagulants &
antiplatelets.
Chop and Mash a piece of
ginger root, and mix in a glass
of water
Boil the mixture
Drink the cooled or warm
decoction as needed.
ELEMENTS OF PRIMARY HEALTH
CARE:
Is one of the potent methodologies
for information dissemination. It
promotes the partnership of both the
family members and health workers in
the promotion of health as well as
prevention of illness.
Education For Health
The control of endemic disease
focuses on the prevention of its
occurrence to reduce morbidity
rate. Example Malaria Control
and Schistosomiasis Control
Locally Endemic Disease Control
This program exists to control the
occurrence of preventable illnesses
especially of children below 6 years
old. Immunizations on poliomyelitis,
measles, tetanus, diphtheria and
other preventable disease are given
for free by the government and
ongoing program of the DOH
Expanded Program on
Immunization
The mother and child are the most
delicate members of the community.
So the protection of the mother and
child to illness and other risks would
ensure good health for the
community. The goal of Family
Planning includes spacing of children
and responsible parenthood.
Maternal and Child Health and
Family Planning
Environmental Sanitation is defined as the
study of all factors in the mans environment,
which exercise or may exercise deleterious
effect on his well-being and survival.
Water is a basic need for life and one factor in
mans environment. Water is necessary for
the maintenance of healthy lifestyle.
Safe Water and Sanitation is necessary for
basic promotion of health.
Environmental Sanitation and
Promotion of Safe Water Supply
One basic need of the family is food. And
if food is properly prepared then one may
be assured healthy family. There are
many food resources found in the
communities but because of faulty
preparation and lack of knowledge
regarding proper food planning,
Malnutrition is one of the problems that we
have in the country.
Nutrition and Promotion of Adequate
Food Supply
The diseases spread through direct
contact pose a great risk to those who can
be infected. Tuberculosis is one of the
communicable diseases continuously
occupies the top ten causes of death. Most
communicable diseases are also
preventable. The Government focuses on
the prevention, control and treatment of
these illnesses.
Treatment of Communicable
Diseases and Common Illness
This focuses on the information campaign on the utilization and
acquisition of drugs.
In response to this campaign, the GENERIC ACT of the
Philippines is enacted . It includes the following drugs:
Cotrimoxazole, Paracetamol, Amoxycillin, Oresol, Nifedipine,
Rifampicin, INH(isoniazid) and Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine
Supply of Essential Drugs
FAMILY HEALTH NURSING
- that level of CHN practice directed to
the FAMILY as the unit of care with
HEALTH as the goal and NURSING as
the medium, channel or provider of care
Family Case Load
- the no. and kind of families a nurse
handles at any given time
- variable for cases are added or dropped
based on the need for nursing care and
supervision
Types of Families
1. Nuclear
2. Extended
3. Three generational
4. Dyad
5. Single- Parent
6. Step- Parent
7. Blended or reconstituted
Types of Families
8. Single adult living alone
9. Cohabiting/ Living in
10. No- kin
11. Compound
12. Gay
14. Commune
Stages of Family Life Cycle
1. Newly married couple
2. Childbearing
3. Preschool age
4. Schoolage
5. Teenage
6. Launching
7. Middle-aged ( empty nest retirement)
8. Period from retirement to Death of both
spouses
HEALTH TASKS OF THE FAMILY(
Freeman, 1981)
1. recognizing interruptions of health or
development
2. seeking health care
3. managing health and non-health crises
4. providing nursing care to the sick, disabled
and dependent member of the family
5. maintaining a home environment conducive to
good health and personal development
6. maintaining a reciprocal relationship with the
community and health institutions
Family Nursing Problem
Arises when the family cannot effectively
perform its health tasks
Nurses Roles in Family Health
Nursing
1. HEALTH MONITOR
2. PROVIDER OF CARE TO A SICK
FAMILY MEMBER
3. COORDINATOR OF FAMILY
SERVICES
4. FACILITATOR
5. TEACHER
6. COUNSELOR
INITIAL DATA BASE FOR FAMILY
NURSING PRACTICE
Family structure, Characteristics, and
Dynamics
1. Members of the household and relationship
to the head of the family
2. Demographic data age, sex, civil status,
position in the family
3. Place of residence of each member
whether living with the family or elsewhere
4. Type of family structure e.g.
matriarchal or patriarchal, nuclear or
extended
5. Dominant family members in terms of
decision-making, especially in matters
of health care
6. General family relationship/dynamics
presence of any readily observable
conflict between members;
characteristics communication patterns
among members
Socio-economic and Cultural
Characteristics
1. Income and Expenses
Occupation, place of work and income of
each working members
Adequacy to meet basic necessities
Who makes decisions about money and
how it is spent
2. Educational attainment of each other
3. Ethnic background and religious
affiliation
4. Significant Others role(s)
they play in familys life
5. Relationship of the family to
larger community Nature
and extent of participation of
the family in community
activities
Home and Environment
1. Housing
Adequacy of living peace
Sleeping arrangement
Presence of breeding or resting sites of
vectors of diseases
Presence of accidents hazards
Food storage and cooking facilities
Water supply source, ownership, portability
Toilet facility type, ownership, sanitary
condition
Drainage system type, sanitary condition
2. Kind of neighborhood, e.g.
congested, slum, etc.
3. Social and health facilities
available
4. Communication and
transportation facilities
available
Health Status of each Family Member
1. Medical and nursing history indicating
current or past significant illnesses or
beliefs and practices conducive to health
illness
2. Nutritional assessment
Anthropometric data: Measures of nutritional
status of children, weight, height, mid-upper
arm circumference: Risk assessment
measures of obesity: body mass index, waist
circumference, waist hip ratio
Dietary history specifying quality and quantity
of food/nutrient intake per day
Eating/ feeding habits/ practices
3. Developmental assessments of infants,
toddlers, and preschoolers e.g., Metro
Manila
4. Risk factor assessment indicating presence
of major and contributing modifiable risk
factors for specific lifestyles, cigarette
smoking, elevated blood lipids, obesity,
diabetes mellitus, inadequate fiber intake,
stress, alcohol drinking and other substance
abuse
5. Physical assessment
indicating presence of illness
state/s
6. Results of laboratory/
diagnostic and other
screening procedures
supportive of assessment
findings
Values, Habits, Practices on Health
Promotion, Maintenance and Disease
Prevention.
Examples include:
1. Immunization status of family members
2. Healthy lifestyle practices. Specify.
3. Adequacy of:
rest and sleep
exercise
use of protective measures- e.g. adequate
footwear in parasite-infested areas;
relaxation and other stress management
activities
4. Use of promotive-preventive health
services
A TYPOLOGY OF NURSING
PROBLEMS IN FAMILY NURSING
PRACTICE
FIRST-LEVEL ASSESSMENT
I. Presence of Wellness Condition stated as
Potential or Readiness- a clinical or nursing
judgment about a client in transition from a
specific level of wellness or capability to a
higher level. Wellness potential is a nursing
judgment on wellness state or condition based
on clients performance, current competencies
or clinical data but no explicit expression of
client desire. Readiness for enhanced
wellness state is a nursing judgment on
wellness state or condition based on clients
current competencies or performance, clinical
data explicit expression of desire to achieve a
higher level of state or function in specific area
on health promotion and maintenance.
Examples of these are the following:
1. Potential for Enhanced Capability for:
Healthy lifestyle e.g. nutrition/diet,
exercise/ activity
Health Maintenance
Parenting
Breastfeeding
Spiritual Well-being process of a clients
unfolding of mystery through harmonious
interconnectedness that comes from inner
strength/sacred source/GOD (NANDA 2001)
Others,
2. Readiness for Enhanced Capability
for:
+ Healthy Lifestyle
+ Health Maintenance
+ Parenting
+ Breastfeeding
+ Spiritual Well-being
+ Others,
I. Presence of Health Threats
conditions that are conducive to
disease, accident or failure top
realize ones health potential.
Examples of these are the following:
1. Family history of hereditary
condition, e.g. diabetes
2. Threat of cross infection from a
communicable disease case
3. Family size beyond what family
resources can adequately
provide
4. Accidental hazards
4Broken stairs
4Sharp objects, poison, and
medicines improperly kept
4Fire hazards
5. Faulty nutritional habits or
feeding practices.
Inadequate food intake both in
quality & quantity
Excessive intake of certain
nutrients
Faulty eating habits
Ineffective breastfeeding
Faulty feeding practices
6. Stress-provoking factors
Strained marital relationship
Strained parent-sibling
relationship
Interpersonal conflicts
between family members
Care-giving burden
O Inadequate living
space
O Lack of food storage
facilities
O Polluted water supply
O Presence of breeding
sites of vectors of
disease
O Improper garbage
7. Poor home condition-
O Unsanitary
waste disposal
O Improper
drainage
system
O Poor ventilation
O Noise pollution
G Air pollution
8. Unsanitary food handling and preparation
9. Unhealthful lifestyles and personal habits-
w Alcohol drinking
w Cigarette smoking
w Inadequate footwear
w Eating raw meat
w Poor personal hygiene
w Self-medication
w Sexual promiscuity
w Engaging in dangerous sports
w Inadequate rest
w Lack of inadequate exercise
w Lack of relaxation activities
w Non-use of self protection measures
10.Inherent personal characteristics
e.g. poor impulse control
11.Health history which induce the
occurrence of a health deficit, e.g.
previous history of difficult labor
12.Inappropriate role assumption e.g.
child assuming mother's role, father
not assuming his role
13.Lack of immunization/ inadequate
immunization status specially of
children
14.Family disunity
gSelf-oriented behavior of
member(s)
gUnresolved conflicts of
member(s)
gIntolerable disagreement
gOther
15.Other
III. Presence of Health Deficits
instances of failure in health
maintenance.
Examples include:
1. Illness states, regardless of whether
it is diagnosed or by medical
practitioner
2. Failure to thrive/ develop according
to normal rate
3. Disability whether congenital or
arising from illness; temporary
IV. Presence of stress Points/ Foreseeable Crisis
Situations anticipated periods of unusual
demand of the individual or family in terms of
family resources.
Examples of these include:
1. Marriage 9. Menopause
2. Pregnancy 10. Loss of job
3. Parenthood 11. Hospitalization of a
4. Additional member family member
5. Abortion 12. Death of a manner
6. Entrance at school 13. Resettlement
in a
7. Adolescence new community
8. Divorce 14. illegitimacy
Second Level Assessment
Focus on determining familys capacity to perform the
health tasks
Statements on family health nursing problem:
a. Inability to recognize the presence of the condition or
problem
b. Inability to make decisions with respect to taking
appropriate health action
c. Inability to provide adequate nursing care to the sick,
disabled , dependent or vulnerable member of the
family
d. Inability to provide a home environment conducive to
health maintenance or personal development
e. Failure to utilize community resources for health care
Scale for Ranking Health
Conditions and Problems according
to priorities
Criteria:
a. Nature of the condition or problem presented
( wellness state, health deficit, health threat,
forseeable crisis)
b. Modifiability of the condition or problem
( easily, partially, not modifiable)
c. Preventive Potential (high, moderate , low)
d. Salience ( needs immediate attention, not
immediate, not perceived as a problem)
COMMUNITY HEALTH CARE
PROCESS
Assessment
Purpose : To identify the health needs of the people
Planning of nursing actions
Purpose : To act on the determined needs of the
community people
Implementation
Purpose : To achieve the optimum level of health of
the community people
Evaluation
Purpose : To determine the effectiveness of health care
programs
NURSING PROCEDURES
CLINIC VISIT
- process of checking the clients health
condition in a medical clinic
HOME VISIT
- a professional face to face contact made by
the nurse with a patient or the family to
provide necessary health care activities
and to further attain the objectives of the
agency
BAG TECHNIQUE
-a tool making of the public health bag
through which the nurse during the home
visit can perform nursing procedures with
ease and deftness saving time and effort
with the end in view of rendering effective
nursing care
THERMOMETER TECHNIQUE
-to assess the clients health condition
through body temperature reading
NURSING CARE IN THE HOME
- giving to the individual patient the nursing
care required by his/her specific illness or
trauma to help him/her reach a level of
functioning at which he/she can maintain
himself/herself or die peacefully in dignity
ISOLATION TECHNIQUE IN THE HOME
-done by :
1. separating the articles used by a client with
communicable disease to prevent the
spread of infection:
2. frequent washing and airing of beddings
and other articles and disinfections of room
3. wearing a protective gown , to be used only
within the room of the sick member
4. discarding properly all nasal and throat
discharges of any member sick with
communicable disease
5. burning all soiled articles if could be or
contaminated articles be boiled first in
water 30 minutes before laundering
INTRAVENOUS THERAPY
- insertion of a needle or catheter into a
vein to provide medication and fluids
based on physicians written prescription
- can be done only by nurses accredited by
ANSAP
PRINCIPLES OF HEALTH
EDUCATION
It considers the health status of the
people, which is determined by the
economic and social conscience of the
country.
It is a process whereby people learn to
improve their personal habits and
attitudes, to work responsibly for the
improvement of health conditions of the
family, community, and nation.
It involves motivation, experience,
and change in conduct and thinking,
while stimulating active interest. It
develops and provides experience
for change in peoples attitudes,
customs, and habits in relation to
health and everyday living.
It should be recognized as the basic
function of all health workers.
It takes place in the home, in the
school, and in the community.
It is a cooperative effort requiring
all categories of health
personnel to work together in
close teamwork with families,
groups, and the community.
It meets the needs, interests,
and problems of the people
affected.
It finds means and ways of
carrying out plans by
encouraging individual and
community participation.
It is a slow, continuous
process that involves
constant changes and
revisions until objectives are
achieved.
Makes use of supplementary
aids and devices to help with
the verbal instructions.
It utilizes community resources by
careful evaluation of the different
services and resources found in the
community.
It is a creative process requiring
methods and techniques with
various characteristics, not following
a rigid and flexible pattern.
It aims to help people make use of
their own efforts and education to
improve their conditions of living,
It makes careful evaluation of the
planning, organization, and
implementation of all health
education programs and activities.
THE COMMUNITY HEALTH
NURSE
Qualifications
1.Bachelor of Science in
Nursing
2.Registered Nurse of the
Philippines
Planner/Programmer
1. Identifies needs, priorities, and problems of
individuals, families, and communities
2. Formulates municipal health plan in the absence
of a medical doctor
3. Interprets and implements nursing plan, program
policies, memoranda, and circular for the
concerned staff personnel
4. Provides technical assistance to rural health
midwives in health matters
Provider of Nursing
Care
1. Provides direct nursing care to sick or
disabled in the home, clinic, school, or
workplace
2. Develops the familys capability to take
care of the sick, disabled, or
dependent member
Manager/Supervisor
1. Formulates individual, family, group, and
community-centered plan
2. Interprets and implements programs,
policies, memoranda, and circulars
3. Organizes work force, resources,
equipments, and supplies at local level
4. Provides technical and administrative
support to Rural Health Midwives (RHM)
5. Conducts regular supervisory visits and
meetings to different RHMs and gives
feedback on accomplishments
Community Organizer
1. Motivates and enhances
community participation in
terms of planning, organizing,
implementing, and evaluating
health services
2. Initiates and participates in
community development
activities
Coordinator of Services
1. Coordinates with individuals,
families, and groups for health
related services provided by
various members of the health
team
2. Coordinates nursing program with
other health programs like
environmental sanitation, health
education, dental health, and
mental health
Trainer/Health Educator
1. Identifies and interprets training needs
of the RHMs, Barangay Health Workers
(BHW), and hilots
2. Conducts training for RHMs and hilots
on promotion and disease prevention
3. Conducts pre and post-consultation
conferences for clinic clients; acts as a
resource speaker on health and health-
related services
4. Initiates the use of tri-media (radio/TV,
cinema plugs, and print ads) for health
education purposes
5. Conducts pre-marital counseling
Health Monitor
1. Detects deviation from
health of individuals,
families, groups, and
communities through
contacts/visits with them
Role Model
1.Provides good
example of healthful
living to the
members of the
community
Change Agent
1. Motivates changes in health
behavior in individuals,
families, groups, and
communities that also
include lifestyle in order to
promote and maintain health
Recorder/Reporter/Statistician
1. Prepares and submits required
reports and records
2. Maintain adequate, accurate, and
complete recording and reporting
3. Reviews, validates, consolidates,
analyzes, and interprets all records
and reports
4. Prepares statistical data/chart and
other data presentation
Researcher
1. Participates in the conduct of
survey studies and researches on
nursing and health-related
subjects
2. Coordinates with government and
non-government organization in
the implementation of
studies/research
Community Organizing
Approaches to community devt.:
a. Welfare approach
b. Technological approach
c. Transformatory approah
Community Organizing
Principles of CO:
1. People esp. the oppressed, exploited
and deprived sectors are most open to
change, have the capacity to change and
are able to bring about change. Hence ,
CO is based on the ff:
A. Power must reside in the people
B. Devt. is from the people to the people
C. People participation
Principles of CO
2.-must be based on the poorest sectors
of society. The solutions of problems
commonly shared by these sectors must
be focused on collective organizations,
planning and action
3. should lead to self-reliant communities
THE HRDP-COPAR PROCESS
1. PRE-ENTRY PHASE
2. ENNTRY PHASE
3. COMMUNITY STUDY/DIAGNOSIS
PHASE/RESEARCH PHASE
4.COMMUNITY ORGANIZATION AND
CAPABILITY-BUILDING PHASE
5. COMMUNITY ACTION PHASE
6. SUSTENANCE AND
STRENGTHENING PHASE
Classify the ff. CO activities as to
phase of COPAR each belong:
1.Conducts community meetings to draw up
guidelines for the organization of CHO
2. Trains BHWs
3. Sets up of linkages/network and referral
systems
4. PIME of health services and or community
devt. Projects
5. Provides continuing education to leaders or
residents
6. Trains secondary leaders
7. Selects site for adoption
8. Identifies key leaders
Continued.
9. Develops criteria for site selection
10. Forms the core group
11.Conducts SALT
12.Selects members of the research team
13. Assists the research team in presenting
results during the general assembly
14. Helps the people identifying the community
needs and health problems
15. Facilitates for the formulation and ratification
of the constitution and by-laws of the
organization
Public Health Programs
COMPREHENSIVE MATERNAL
AND CHILD HEALTH
PROGRAM
1. EPI (Expanded Program on
Immunization)
2. CDD (Control of Diarrheal
Diseases)
3. CARI (Control of Acute
Respiratory Infections)
4. UFC (Under-Five Clinics)
5. MC (Maternal Care)
6. BF (Breastfeeding)
7. MRP (Malnutrition Rehabilitation
Program)
8. VAD ( Vitamin A Deficiency)
9. IDD/IDA (Iodine Deficiency
Disorders/ Iron Deficiency
Anemia)
10.FP (Family Planning)
EPI (EXPANDED PROGRAM ON
IMMUNIZATION)
TARGET SETTING:
1.INFANTS 0-12 MONTHS
2.PREGNANT AND POST PARTUM WOMEN
3.SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS
OLD
OBJECTIVES OF EPI:
TO REDUCE MORBIDITY AND
MORTALITY RATES AMONG INFANTS AND
CHILDREN from SIX CHILDHOOD
IMMUNIZABLE DISEASE
ELEMENTS OF EPI:
1. TARGET SETTING
2. COLDCHAIN LOGISTIC MANAGEMENT-
Vaccine distribution through cold chain is
designed to ensure that the vaccine were
maintained under proper environmental
condition until the time of administration.
3. IEC
4. Assessment and evaluation of Over-all
performance of the program
5. Surveillance and research studies
EXPANDED PROGRAM ON IMMUNIZATION
Vaccine Minimum
Age of 1
st
Dose
Numbe
r of
Doses
Minimum
Interval
Between
Doses
Reason
1. BCG
(Bacillus
Calmette
Guerin)
Birth or
anytime
after
birth
School
entrants
1
BCG is given
at the earliest
possible age
protects
against the
possibility of
TB infection
from the other
family
members
2. DPT
(Diphtheria
Pertusis
Tetanus)
6 weeks
3
4 weeks
An early start with
DPT reduces the
chance of severe
pertussis
3. OPV
(Oral Polio
Vaccine)
6 weeks
3
4 weeks
The extent of
protection against
polio is increased
the earlier OPV is
given.
4.
Hepatitis B
6 weeks
3
4 weeks
An early start of
Hepatitis B reduces
the chance of being
infected and becoming
a carrier.
5. Measles
9 months
1
At least 85% of measles
can be prevented by
immunization at this age.
CDD (CONTROL OF DIARRHEAL DISEASES)
MANAGEMENT OF THE PATIENT WITH
DIARRHEA
A. NO DEHYDRATION
Condition well, alert
Mouth and Tongue moist
Eyes normal
Thirst drinks normally, not thirsty
Tears present
Skin pinch goes back quickly
TREATMENT PLAN A- HOME TTT.
1.Give the child more fluids than
usual
use home fluid such as cereal gruel
give ORESOL, plain water
THREE RULES FOR HOME
TREATMENT
2. Give the child plenty of food to prevent
undernutrition
continue to breastfeed frequently
if child is not breastfeed, give usual milk
if child is less than 6 months and not yet
taking solid food, dilute milk for 2 days
if child is 6 months or older and already
taking solid food, give cereal or other starchy
food mixed with vegetables, meat or fish; give
fresh fruit juice or mashed banana to provide
potassium; feed child at least 6 times a day.
After diarrhea stops, give an extra meal each
day for two weeks.
3. Take the child to the health worker
if the child does not get better in 3
days or develops any of the following:
many watery stools
repeated vomiting
marked thirst
eating or drinking poorly
fever
blood in the stool
ORESOL TREATMENT
Age Amount of
ORS to give
after each
loose stool
Amount of ORS to
provide for use at
home
<
24
months
50-100
ml.
500 ml./day
2
10
years
100-200
ml.
1000 ml./day
10
years
up
As much as
wanted
2000 ml./day
B. SOME DEHYDRATION
Condition restless, irritable
Mouth and Tongue dry
Eyes sunken
Thirst thirsty, drinks eagerly
Tears absent
Skin pinch goes back slowly
WEIGH PT, TTT. PLAN B
APPROX. AMT. OF ORS- TO GIVE IN 1
ST
4 HRS
AGE WEIGHT
KG
ORS
ML
4 MOS. 5 200-400
4-11MOS 5-7.9 400-600
12-23MOS 8-10.9 600-800
2-4YRS 11-15.9 800-1200
5-14YRS
16-29.9
1200-2200
15 YRS UP 30 UP 2200-4000
1. If the child wants more ORS than shown, give more
2. Continue breastfeeding
3. For infants below 6 mos. who are not breastfeed,
give 100-200 ml clean water during the period
4. For a child less than 2 years give a teaspoonful
every 1-2 min.
5. If the child vomits, wait for 10 min, then continue
giving ORS, 1 tbsp/2-3 min
6. If the childs eyelids become puffy, stop ORS , give
plain water or breast milk, Resume ORS when
puffiness is gone
7. If ( -) signs of DHN- shift to Plan A
Use of Drugs during Diarrhea
Antibiotics should only be used for
dysentery and suspected cholera
Antiparasitic drugs should only be
used for amoebiasis and giardiasis
C. SEVERE DEHYDRATION
Condition lethargic or unconscious; floppy
Eyes very sunken and dry
Tears absent
Mouth and tongue very dry
Thirst- drinks poorly or not able to drink
Skin pinch goes back very slowly
TTT PLAN C- ttt. quickly
1.Bring pt. to hospital
2. IVF Lactated Ringers Solution or Normal
Saline
3.Re-assess pt. Every 1-2 hrs
4. Give ORS as soon as the pt. can drink
ROLE OF BREASTFEEDING IN THE
CONTROL OF DIARRHEAL DISEASES
PROGRAM
1. Two problems in CDD
1. High child mortality due to
diarrhea
2. High diarrhea incidence
among under fives
2. Highest incidence in age 6 23
months
3. Highest mortality in the first 2 years of
life
4. Main causes of death in diarrhea :
DEHYDRATION
MALNUTRITION
5. To prevent dehydration, give home fluids
am as soon as diarrhea starts and if
dehydration is present, rehydrate early,
correctly and effectively by giving ORS
6. For undernutrition, continue feeding
during diarrhea especially breastfeeding.
7. Interventions to prevent diarrhea
1. breastfeeding
2. improved weaning practices
3. use of plenty of clean water
4. hand washing
5. use of latrines
6. proper disposal of stools of
small children
7. measles immunization
8. Risk of severe diarrhea 10-30x higher in
bottle fed infants than in breastfed
infants.
9. Advantages of breastfeeding in relation
to CDD
1.Breast milk is sterile
2.Presence of antibodies protection
against diarrhea
3.Intestinal Flora in BF infants prevents
growth of diarrhea causing bacteria.
10.Breastfeeding decreases incidence
rate by 8-20% and mortality by 24-
27% in infants under 6 months of
age.
11.When to wean?
4-6 months soft mashed foods 2x a
day
6 months variety of foods 4x a day
12. Summary of WHO-CDD recommended
strategies to prevent diarrhea
1. Improved Nutrition
- exclusive breastfeeding for the first 4-6 months
of life and partially for at least one year.
- Improved weaning practices
2.Use of safe water
- collecting plenty of water from the cleanest
source
- protecting water from contamination at the
source and in the home
3.Good personal and domestic
hygiene
- handwashing
- use of latrines
- proper disposal of stools of young
children
4.Measles immunization
CARI (CONTROL OF ACUTE RESPIRATORY
INFECTIONS)
CLASSIFICATION:
A. NO PNEUMONIA: COUGH OR COLD
1. No chest in drawing
2. No fast breathing ( <2 mos- <60/min,2-12
mos. less than 50 per minute; 12 mos. 5
years less than 40 per minute)
TREATMENT:
1. If coughing more than 30 days, refer for
assessment
2. Assess and treat ear problems/sore throat if
present
3. Advise mother to give home care
4.Treat fever/wheezing if present
HOME CARE:
1. FEED THE CHILD
1. Feed the child during illness
2. Increase feeding after illness
3. Clear the nose if it interferes with feeding
2. INCREASE FLUIDS
1. offer the child extra to drink
2. Increase breastfeeding
3. SOOTHE THE THROAT AND
RELIEVE THE COUGH WITH A
SAFE REMEDY
4. WATCH FOR THE FOLLOWING
SIGNS AND SYMPTOMS AND
RETURN QUICKLY IF THEY
OCCUR
1. Breathing becomes difficult
2. Breathing becomes fast
3. Child is not able to drink
4. Child becomes sicker
B. PNEUMONIA
1. No chest in drawing
2. Fast breathing ( less than 2 mos- 60/min
or more ; 2-12 mos. 50/min or more; 12
mos. 5 years 40/min or more)
TREATMENT
1.Advise mother to give home care
2.Give an antibiotic
3.Treat fever/wheezing if present
4.If the childs condition gets worst,refer
urgently to hospital; if improving, finish 5 days
of antibiotic.
ANTIBIOTICS RECOMMENDED BY
WHO
*Co-trimoxazole,
*Amoxycillin, Ampicillin, (p.o)
*or Procaine penicillin (I.M.)
C. Severe Pneumonia
Chest indrawing
Nasal flaring
Grunting ( short sounds made with the
voice)
Cyanosis
TTT.
1. Refer urgently to hospital
2. Treat fever ( paracetamol), wheezing (
salbutamol)
D. Very Severe Disease
Not able to drink
Convulsions
Abnormally sleepy or difficult to wake
Stridor in calm child
Severe undernutrition
TTT.
Refer urgently to hospital
ASSESSMENT OF RESPIRATORY
INFECTION
ASK THE MOTHER:
1. How old is the child?
2. Is the child coughing? For how long?
3. Age 2 months up to 5 years: Is the child able
to drink?
Age less than 2 months: Has the young infant
stopped feeding well?
4. Has the child had fever? For how long?
5. Has the child had convulsions?
LOOK, LISTEN:
1. Count the breaths in one minute.
2. Look for chest in drawing.
3. Look and listen for stridor.
Stridor occurs when there is a narrowing of the
larynx, trachea or epiglottis which interferes
with air entering the lungs.
Age0 Fast Breathing
Less than 2 months 60/minute or more
2 months 12 months 50/minute or more
12 months 5 years 40/minute or more
4. Look and listen for wheeze
Wheeze is a soft musical noise
which shows signs that breathing
out(exhale) is difficult.
5. See if the child is abnormally sleepy
or difficult to wake. (Suspect
meningitis)
6. Feel for fever or low body
temperature.
7. Check for severe under nutrition
MANAGEMENT OF A CHILD
WITH AN EAR PROBLEM
Classification of Ear Infection
A. MASTOIDITIS tender swelling behind the
ear (in infants, swelling may be above the ear)
TREATMENT
1. Antibiotics
2.Surgical intervention
B. ACUTE EAR INFECTION pus draining
from the ear for less than 2 weeks, ear
pain, red, immobile ear drum (Acute Otitis
Media)
TREATMENT
1.Cotrimoxazole,Amoxycillin,or
Ampicillin
2.Dry the ear by wicking
C. CHRONIC EAR INFECTION pus draining from
the ear for more than 2 weeks (Chronic Otitis Media)
TREATMENT
Most important & effective treatment: Keep the
ear dry by wicking.
GParacetamol maybe given for pain or high fever.
GPrecautions for a child with a draining ear:
1. Do not leave anything in the ear such as cotton,
wool between wicking treatments.
2. Do not put oil or any other fluid into the ear.
3. Do not let the child go swimming or get water in
the ear.
Maternal and Child Health
Nursing
Philosophy
Pregnancy, labor and delivery and puerperium
are part of the continuum of the total life cycle
Personal, cultural and religious attitudes and
beliefs influence the meaning of pregnancy for
individuals and make each experience unique
MCN is FAMILY CENTERED- the father is as
important as the mother
Goals
To ensure that expectant mother and nursing
mother maintain good health, learn the art of
child care, has a normal delivery and bear
healthy children
That every child lives and grows up in a
family unit with love and security, in healthy
surroundings, receives adequate
nourishment, health supervision and efficient
medical attention and is taught the elements
of healthy living
Classification of pregnant
women
Normal healthy pregnancy
With mild complications- frequent home
visits
With serious or potentially serious cx
referred to most skilled source of medical
and hospital care
Home Based Mothers Record (
HBMR )
Tool used when rendering prenatal care
containing risk factors and danger signs
*Risk Factors
145 cm tall ( 4 ft & 9 inches)
Below 18 yrs old, above 35 yrs old
Have had 4 pregnancies
With TB, goiter, heart disease, DM, bronchial
asthma, severe anemia
Last baby born was less than 2 years ago
Previous cesarian section delivery
History of 2 or more abortions, difficult delivery,
given birth to twins , 2 or more babies born
before EDD, stillbirth
Weighs less than 45 kgs. or more than 80 kgs.
*Danger Signs
1. any type of vaginal bleeding
2. headache, dizziness, blurred vision
3. puffiness of face and hands
4. pallor
Prenatal Care
Schedule of Visits
1
st
as early as pregnancy, 1
st
trimester
2
nd
- 2
nd
trimester
3
rd
& subsequent visits - 3
rd
trimester
More frequent visits for those at risk with cx
TETANUS TOXOID IMMUNIZATION
SCHEDULE FOR WOMEN
Vaccin
e
Minimum Age
Interval
Percent
Protecte
d
Duration of
Protection
TT1
As early as possible
during pregnancy
80%
TT2
At least 4
weeks later
80%
Infants born to
the mother will
be protected
from neonatal
tetanus.
Gives 3 years
protection for
the mother from
tetanus.
TT3
At least 6
months
later
90%
Infants born to the
mother will be protected
from neonatal
tetanus.
Gives 5 years protection
for the mother.
TT4
At least 1
year later
99%
Gives 10
protection
for the
mother
TT5 At least 1 year
later
99% Gives
lifetime
protection for
the mother.
All infants
born to that
mother
will be
protected.
Dose:0.5ml
Route: Intramuscularly
Site: Right or Left Deltoid/Buttocks
Components of Prenatal Visits
History taking
Determination of obstetrical score- G, P,
TPAL,AOG,EDD
U/A for Proteinuria, glycosuria and infxtn
Dental exam
Wt. Ht. BP taking
Exam of conjunctiva and palms for pallor
Abdominal exam - fundic ht, Leopolds
maneuver and FHT
Exam of breasts, face, hands and feet for
edema and neck for thyroid enlargement
Health teachings- nutrition, personal hygiene,
common complaints
Tetanus toxoid immunization
Iron supplementation from 5
th
mo. of
pregnancy - 2 mos. Postpartum
In goiter endemic areas iodized capsule once
a year
In malaria infested areas- prophylactic
Chloroquine ( 150 mg/tab ) 2 tabs/ wk for the
whole duration of pregnancy
UNDER FIVE CLINIC
The first five years of life form the
foundations of the childs physical and mental
growth and development. Studies have shown
the mortality and morbidity are high among this
age group. The Department of Health
established the Under Five Clinic Program to
address this problem.
PROGRAM OBJECTIVES AND GOALS: