Professional Documents
Culture Documents
COMMUNITY
A group determined by geographic boundaries and/or common values or interests. interests It functions within a particular sociocultural context, which means that no two communities are alike (Maglaya, 2003).
Characteristics of a Community
1. 2. 3. 4.
Has a population aggregate concept Defined geographic boundaries With common interest that binds the members together Made up of institutions & social system forming a complex network
Awareness that we r commty.; Conservation of natural resources; Recognition of and respect for the existence of subgroups (sg); Participation of sg in community affairs; Preparation to meet crises; Ability to solve problems Communication through open-channel Resources available to all; Settling of disputes through legitimate mechanisms; Participation by citizens in decision making; Wellness of a high degree among its members
COMMUNICATE well and listen to all members Affirms and supports all of its members; Respect for others is valued Sense of trust Plays together and humor is present Balanced Interaction with each other Shares leisure time together Shared sense of responsibility Has traditions and rituals Shares a religious core Privacy of members is honored Family opens its boundaries to admit and seek help with problems
HEALTH
State of complete physical, mental, and social well-being not merely the absence of disease or infirmity (WHO).
Determinants of Health
(GPE)2+ICSH=DM)
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Genetics Gender Personal Behavior and coping skills Physical envt Education Employment and working conditions Income and social status Culture Social support network Health Services
Ecosystem influences on OLOF: *Political Behavioral Hereditary HCDS Environmental influences *Socio-economic influences
CHN (Jacobson):
Nursing practice in a wide variety of community services and consumer advocate areas and in a variety of roles, at times including independent practice
community nursing is certainly not confined to public health nursing agencies. agencies.
Philosophy Basic ethical principles Focus Ultimate goal Objectives Concepts Principles Standards
CHN:
Roles of CHNurse
Case manager Advocate Teacher Partner & Collaborator Health planner/programmer Manager/Supervisor Community organizer Health educator/trainer Case finder Epidemiologist Recorder/Reporter/S tatistician Community leader
Do you know what they are? 1. Eradicate extreme poverty and hunger
2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce child mortality 5. Improve maternal health 6. Combat HIV/AIDS, malaria, and other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development
PHCDS:
Significant events Major players DOH Local Health System Primary Health Care Levels of Health Care
Restructured HCDS
Combination of main health center and satellite BHS which is essentially the basis for the implementation of the new system Objectives: Strengthen the rural health services and to effect a more effective HCDS in the country
MANDATE OF DOH:
Provide assistance to LGUs, Peoples organizations and other members of the society in effectively implementing programs, projects and services that will:
Promote health and W-B of every Filipino; W Prevent and control diseases among pop at risks; Protect IFCs exposed to hazards and risks that could affect their health; and Treat, manage and rehabilitate individuals affected by disease and disability (EO 102
NOH 2005-2010 Targets: 20051.) Maintain the country free of polio and avian flu It is the target of NOH for 2005-2010 to 2.) Eliminate as major health ELIMINATE the ff major problems: b.) health problems: 3.) Intensified disease a.) Poliomyelitis, SARS prevention and control and Avian flu measures are the strategic b.) Leprosy, malaria, thrusts for TB, HIV/AIDS, filariasis, vaccine preventable schistosomiasis and diseases & other major CDs. rabies c.) Cancer, DM & other 4.) Strengthen health degenerative diseases promotion measures and HL d.) Leprosy, malaria, campaigns are the strategis filariasis, approaches for CVD, CA, DM schistosomiasis & other major degenerative diseases
BQ
Objectives of LHS:
1. Effective and efficient delivery of health care services; 2. Upgrade the HC Mgt and service capabilities of local health facilities 3. Promote inter-LGU linkages and cost-sharing schemes intercostincluding local HC financing systems for better utilization of local health resources; 4. Foster participation of the private sector, NGOs and communities in local health systems devt. 5. Ensure the quality of health service delivery at the local level
Guiding Principles
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Financial and administrative autonomy Strong political Support Strategic synergies and partnerships Community participation Equity of access to health services, esp. the poor Affordability of HS Appropriateness of health program Decentralized mgt Sustainability of health initiatives Upholding of standards of QHS
The conference strongly reaffirms WHOs definition of Health Existing gross inequality in health status b/w developed and developing countries Economic and social development is of basic importance to health for all Right of the people to participate individually and collectively in planning and implementation of hc Governments have responsibility for health of the people PHC definition All governments must formulate respective health policies, strategies and plan of action All countries must cooperate in a spirit of partnership and services to ensure PHC for all people
Principles of PHC
People as the center of development Concern for equity-DDU are priorities of the DOH Respect for area-based knowledge and capacities Social accountability to community Devolution as an opportunity for empowerment Balancing promotive, preventive, curative and rehabilitative care Continuing concern for strengthening the capacity for PHC Paradigm shift as a requirement of PHC
H-ospital as a center of welleness O-ral and dental health M-ental Health E-lderly care
E-xpanded program on immunization M-aternal & child health E-ssential drugs N-utrition T-reatment of communicable diseases S-afe water and sanitation M-edical care and E-mergency treatment
Strategies of PHC
Reorientation and reorganization of the national health care system with establishment of functional support system (RA 7160); Effective preparation and enabling process for health action at all levels Mobilization of the people to know their communities and identifying their basic health needs with the end in view of providing appropriate solutions leading to self-reliance and self determination Development and utilization of appropriate technology focusing on local indigenous resources available in and acceptable to the community
Organization of communities arising from their expressed needs which they have decided to address and that this continually evolving in pursuit of their own development Increase opportunities for community participation in local level planning, mgt, monitoring and evaluation within the context of regional and national objectives. Development of inter-sectoral linkages with other government and private agencies so that the program of the health sector is closely linked with those of other socio-economic sectors at the national, intermediate and community levels Emphasizing partnership so that the health workers and the community leaders/members view each other as partners rather than merely providers and receivers of health care
Types of PHC Workers depends on: Available health manpower resources Local health needs and problems Political and financial feasibility
2 Levels of PHC workers: 1. Village or BHWs (V/BHW) 2. Intermediate level health workers
Primary Level of HC
Services offered are to individuals in fair health and to patients with disease in the early symptomatic stages. Devolved to the cities and the municipalities RHU/BHS Private practitioners Puericulture center Given by center physician to BHWs; usually the 1st contact b/w the community members and the other levels of health facility;
SUMMARY OF PHC
WHAT
An approach/partnership/concept Community-based Community Knowledgeable response to the interrelated needs of the community
WHY
Making health care accessible, affordable, sustainable for all Towards self-reliance self Towards devt and social transformation
HOW
Partnership and Community participation Linkages Provision of community services Use of appropriate technoogy and organizing
SelfReliance
PHNS QUALIFICATIONS
BSN, RN Has the ff personal and professional qualifications: Good physical and mental health Leadership potential Active membership to professional nursing organizations Resourcefulness and creativity Honesty and integrity Capacity and ability to: Relate the practice with on going CH and health related activities Work cooperatively with other disciplines and other members of the community Accept and take actions needed to improve self and and service Analyze combination of factors and conditions that influence health of populations Apply nsg process in meeting the health and nsg needs of the community Mobilize resources in the community
PHNS FUNCTIONS:
Management Process; Nsg service; Program mgt Supervisory Supervisory plan and visit, eg. SSM Nursing Care Inherent fxn, Process, HV, Referral Collaborating and Coordinating Linkages, communication Health Promotion and Education Role in HL, Demo KS on advocacy, creating supportive envt, Mobilize community, CO Training Staff devt, support students affiliates Research Conducts and make use of research findings; Disease surveillance Demonstrating Professional responsibility and accountability
COMPETENCIES(SK) OF PHNs
CHN process Nursing procedures during clinic and home visits Community Organizing Health Promotion and Education Surveillance Records and reports
NURSING PROCESS
FAMILY
Types of family structure Stages
Beginning Childbearing Family with preschooler Family with school aged children Family with teenagers Launching center family Middle aged-family Aging family
COMMUNITY
Process: 1. Det. the objectives 2. Def. and study population 3. Det. Data to be collected 4. Collecting the data (thru RSIP) 5. Developing instrument (survey q., Int. guide, Obs. Chcklst) 6. Actual Data gathering 7. Data collation (categories for classification & Summarizing) 8. Data presentation 9. Data analysis: to establish trends and patterns 10.Id. the CHN problems (HS, HRes, HRel:SEEP) 11.Priority settings (NMMPS, 34332, 13411)
Planning
Situational analysis Goal and Objective Setting Strategy/Activity Setting Evaluation
Intervention
CO Partnership and Collaboration Advocacy Supervision
Evaluation
Structure, Process and Outcome Appropriateness, Efficiency and Effectiveness Quantitative and Qualitative Program Evaluation
Decide what to evaluate(Relevance, progress, effectiveness, impact and efficiency) Design the evaluation plan Collect relevant data Analyze data Make decision Report or give feedback (eg. Executive summary)
Community Organizing
is a process whereby the community members develop the capability to assess their health needs and problems, plan and implement actions to solve these problems, put up and sustain organizational structures which will support and monitor implementation of health initiative by the people.
Phases of CO
I.
Preparatory Phase 1. Area selection 2. Community profiling 3. Entry in the community and integration with the people Organizational Phase Social preparation (Nurse will be introduced in the community) Spotting and developing potential leaders Core group formation Setting up community organization Education and Training Phase Conducting CDx Training of CHWorkers Health Services and mobilization Leadership formation activities Intersectoral Collaboration Phase (For sourcing of additional resources) Phase Out
COPAR PROCESS
A collective, participatory, transformative, liberalized, sustained, and systematic process of building peoples organization by mobilizing and enhancing the capabilities and resources of the people for the resolution of the issues and concerns towards effecting change in the existing oppressive and exploitative condition
Phases of COPAR
Pre-entry phase
Looking for a community to be served
Entry Phase
or social preparation phase
Sensitization of the people on the critical events in their life, motivating them to share their dreams and ideas on its mgt and eventually mobilizing them to take action
Community Analysis Design and Initiative Implementation Program MaintenanceConsolidation Dissemination and Reassessment
I.Community Analysis:
AKA: CDx, Cmmty needs assessment, HE Planning, and Mapping
Process of assessing and defining needs, opportunities and resources involved in initiating CH action program 5 Components: Demographic, and socio-economic profile Health Risk profile (social, Behavioral & Envtl) Health/wellness outcomes profile (Mort/Morb) Survey of current health promotion program Studies conducted in certain target groups Steps: Define the Community Collect data Assess Community capacity Assess Community barriers Assess readiness for change Synthesis data and set priorities
Identify, select and recruit org members Define the org mission and goals Clarify roles and responsibilities of people involved Provide training and recognition
III. Implementation
Generate broad citizen participation Develop a sequential work plan Use comprehensive integrated strategies Integrate community values into the programs, materials and messages
V. Dissemination-Reassessment
Update the community analysis Assess effectiveness of interventions and programs Chart future directories and modifications Summarize and disseminate the results
Health Education
Any combination of learning experience designed to facilitate voluntary adoptions of behaviors conducive to health (Green et al, 1980) Covers all levels of prevention
Levels of Prevention
A. Primary Prevention Directed to healthy pop. focusing on prevention of emergence of risk factors(Primordial) and removal of the risk factors or reduction of their levels (specific). B. Secondary Prevention Aims to id. and treat existing health problems at the earliest possible time, eg.screening, case finding, disease surveillance. C. Tertiary Prevention Limits disability progression. Nurse attempts to reduce the magnitude or severity of the residual effects of disease.
Levels of Prevention
1. Primary
Health promotion Specific protection
2. Secondary
Early Diagnosis & prompt treatment
Prevent spread to others Cure the disease process to prevent sequalae
3. Tertiary
Disability limitation Rehabilitation
Epidemiology
Study of the occurrences and distribution of diseases as well as the distribution and determinants of health states or events in specified population and population, the application of this study to the control of health problems
Steps of EP
1. Determine the nature, extent and scope of the problem A. Natural life hx of dis B. Determinants influencing condition 1. Primary data (essential agent) e.g parasite, nutritional, psychosocial 2. Contributory data (agent-host-envt) C. Distribution patterns 1. Person 2. Place 3. Time. Place D. Condition frequencies 1. Prevalence 2. Incidence 3. Other biostatistical measures Formulate develop tentative hypotheses Collect and analyze further data to test hypotheses Plan for control Implement control plan Evaluate control plan Make appropriate report Conduct Research
2. 3. 4. 5. 6. 7. 8.
Uses of Epidemiology
1. 2. 3. 4. 5. 6. 7. Study hx of health population and the rise and fall of diseases and changes in their character Dx the health of the community and the condition of the people Study the work of health services with a view of improving them Estimate the risk of the disease, accident, defects and disease the chances of avoiding them Identify syndromes by describing the distribution and association of clinical phenomena in the population Complete the clinical picture of chronic disease and describe their natural history Search for causes of health and disease by comparing the experience of groups that are clearly defined by their composition, inheritance, exp, behavior and environment
Epidemiologic Triangle
Host
Any organism that harbors and provides nourishment for another organism
Agent
Intrinsic property of microorganism to survive and multiply in the environment to produce the disease
Environment
Sum total of external condition and influences that affects the development of an organism which can be biological, social and physical
Disease Distribution
Epidemiology Variables: Variables: Time: 1. Time Refers to both the period during which the cases of the disease being studied were exposed to the source of infection and the period during which the illness occurred. Persons:Refers to the character of 2. Persons individuals who were exposed and who contacted the infection or the disease in question 3. Place Refers to the feature, factor or Place: conditions which existed in or described the envt in which disease occurred.
Patterns of Occurrence and Distribution Sporadic Occurrence Endemic Occurrence Epidemic Occurrence Pandemic
STATISTICAL TERMS
Rate Rel. b/w a vital event and persons exposed Rate: to the occurrence of said event w/in a given area and during a specified unit of time. Ratio: Rel. b/w 2 numerical quantities or measures Ratio of events without taking particular considerations to the time and place. Crude/General Rate Refers to the total living Rate: population. It must be presumed that the total population was exposed to the risk of occurrence of the event. Specific rate: Rel is for a specific population class or group. It limits the occurrence of the event to the portion of population definitely exposed to it.
NDR measures the risk of dying during the 1st month of life. It serves as an index of the effects of prenatal care and obstetrical mgt of the NB
# of Ds under 28 days of age reg in a given cal yr./ No. of LB reg of the same yr.X 1,000 X
IR measures the frequency of occurrence of the phenomenon during a given period of time.
# of new cases of a particular disease reg during a specified period of time / population at risk X 100,000
CFR index of a killing power of a disease and is influenced by incomplete reporting and poor morbidity data.
# of reg deaths from a specific disease for a given yr. / # of reg cases from specific disease in same yr. X 100
BQs
The estimate of the past and present occurrence of disease in a given locality is referred to as: a.) Prevalence rate b.) Incidence rate c.) Case fatality ratio d.) Swaroops index
The habitual occurrence of a disease is referred which indicates low number of both immune and susceptible is referred to as: a.) Endemic b.) Pandemic c.) Herd immunity d.) Epidemic
Components of FHSIS:
Family Treatment Record Target Client List Its Purposes: List:
To plan and carry out patient care and service delivery. To facilitate the monitoring and supervision for services To report services delivered To provide a clinic-level data base which can be accessed for further studies.
PHN
in
Redirected Approach in School Health Nursing (RASHN)-Utilizing PHC Concept (RASHN)I. Activities of the program:
School health survey Functional school clinic Comprehensive pupil health assessment Referral of cases School plant inspection Attending to emergency cases Organize and reactivating school community health council Intensify health education activities Establishing data in school health activities
SKILLS NEEDED BY SN
Assessment and screening skills Health counseling skills Social mobilization skills Good oral and written communication skills Basic management skills
Functions of SN
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. School health and nutrition survey Putting up a functional school clinic Health assessment Standard vision testing for school children Ear examination Height and weight measurement and nutritional status determination Medical referrals Attendance to emergency cases; Student health counseling Health and nutrition education activities Organization of school-CH and nutrition councils schoolCD control Establishment of data bank on school Health and nutrition activities; School plant inspection for healthy envt; Rapid classroom inspection Home visitation
BQs
During physical assessment of school children, Nurse Dyosa found three children having visual acuity of 20/50, 20/30 and 20/40. The appropriate next action of Nurse Dyosa is: a.) Do anything as these are normal findings in children below 12 y/o b.) Refer all children for further examination c.) Refer children with visual acuity of 20/40 or poorer for further examination d.) Tell the teacher of the students to make the student sit on the 1st row
Nurse Dyesebel is to assess the nutritional status of grade 2 pupils. Her initial assessment will include: a.) BMI b.) Ht and Wt measurement c.) CBC d.) Measurement of arm circumference
Functions of OHNurses
1. Work with the occupational health team to lead the sanitary and industrial hygiene accdg to the sanitation code and its IRR 2. Recommends to local health authority the issuance/suspension or revocation of license/business permit 3. Coordinates with other government agencies relative to the implementation of the IRR 4. Attends to complaints of all establishments related to industrial hygiene and recommends appropriate measures for immediate compliance 5. Participates to provide, install and maintain in good condition all control facilities and protective barriers for potential and actual hazards.
6. Informs all affected workers regarding the nature of hazards and the reasons for the control measures and protective equipment 7. Makes a periodic testing for phy.examination of the workers and other health examinations related to workers exposure to potential and actual hazards in the workplace 8. Provides control measures to reduce noise, dust, health and other hazards 9. Ensure strict compliance with the regular use and proper maintenance of Personal Protective Equipment (PPE) 10. Provides employees/workers an occupational health services and facilities 11. Refers or elevates to higher authority all unsolved issues in relation to occupational and environmental health problems 12. Prepares and submits yearly reports to the local and national government
The mission of OH and Safety (OHS)is to assure so far as possible every working man and woman in the country is safe and in healthful working conditions .
Statistics on MH
1. 2. 3. Reduce the MMR by 3/4 by 2015 to achieve the MDG (112/100,000 LB in 2010; 80/100,000 LB by 2015) Pregnant women w/ at least 4 prenatal visits decreased from 77% in 1998 to 70.4 in 2003; Pregnant women who receive at least 2 doses of TT decreased from 38% in 1998 to 37.3% in 2003; Percentage of women with at least one prenatal visit increased from 43% in 1998 to 51% in 2003 Births attended by health professionals increased from 56% in 1998 to 59.8% in 2003
4.
5.
6. Only 76.8% of pregnant women received iron supplementation 7. Only 44.6% of postpartum women received a dose of Vitamin A 8. Proportion of births occurring at home declined from 66% in 1998 to 61% in 2003 9. of home deliveries, 61% were deliveries, assisted by hilots or traditional birth attendant; only 34% were midwife-assisted midwife-
OTHER FACTORS:
Closely spaced births Frequent pregnancies Poor detection and mgt of of high-risk pregnancies Poor access to health facilities Health care and health staff who lack competence in handling obstetrical emergencies
2. 3.
4.
I. Antenatal Registration
Prenatal Visits
1st Visit
Period of Pregnancy
As early in pregnancy as possible before 4 mos. or during the 1st trimester During the 2nd trimester During 3rd trimester After 8th month of pregnancy til delivery
TT1
As early as possible during pregnancy At least 4 wks later At least 6 mos later At least 1 yr later 80 Infant born protected from NT: 3 yrs protection for mother Infant born protected from NT; 5 yrs protection for mother Infant born protected from NT; 10 yrs protection for mother Infants born protected from NT; all childbearing years protection for mother (Lifetime Protection)
TT2
TT3
95
TT4
99
TT5
At least 1 yr later
99
Iron
60mg/ 400ug
Unconscious
Postpartum bleeding
Massage uterus and expel clots If bleeding persists: Massage fundus in a circular motion Apply bimanual uterine compression if ergometrine tx done and postpartum bleeding still persists Give ergometrine 0.2 mg IM and another dose after 15 mins Mebendazole 500mg single dose anytime from 4-9 mos of pregnancy if none was given in the past 6 mos. Sulfadoxin-pyrimethamine to women from malaria endemic areas who are in 1st or 2nd pregnancy, 500mg-25mg, 3 tabs at the beginning of 2nd and 3rd trimester not less than 1 month interval; OR Chloroquine 150 mg 2 tabs per week as prophylaxis for the whole duration of pregnancy
Intestinal parasite
Malaria
In goiter endemic areas, 1 iodized oil capsule 200 mg iodine may given annually
All of the following should be observed in home deliveries, except: a.) Clean hands b.) Clean delivery surface c.) Clean cord cutting and care d.) Clean sheets
When rendering prenatal care, the CHNurse uses this as guide in the identification of risk factors and danger signs and in doing appropriate measures. This is known as: a.) Treatment record b.) HBMR c.) Target Client List d.) Nutrition Record
Stages of Labor FIRST STAGE: Not yet in active labor, cervix is dilated 0-3cm and contractions are weak, less than 2 to 10 min.
What to do
Check qhr for emergency signs, frequency and duration of contractions, FHR Check q4hrs for fever, pulse, BP and cervical dilation Record time of rupture and color of amniotic fluid
Stages of Labor labor, 1st Stage In active labor 4cm or Stage: more cervical dilatation
What to do Check q30min for emergency signs Check q4hrs for fever, pulse, BP and cer.dilatation Record time or rupture of membranes and color of amniotic fluid Record findings in partograph/patients record
Not to do Do not allow woman to push unless delivery is imminent. It will just exhaust the woman Do not give medications to speed up the labor. It may endanger and cause trauma to mother and baby
2nd STAGE: Cervix dilated 10 cm or bulging thin perineum and head visible
Check q5min for perineum thinning and bulging, visible descent of the head during contraction, emergency signs, FHR, and mood and behavior
3rd STAGE: B/w birth of the baby and delivery of the placenta
Do not squeeze or massage the Deliver the placenta Check the completeness of placenta abdomen to deliver the placenta and membranes
1. When attending a home delivery, it is important to monitor the condition of the parturient. During the first stage of labor, which is the correct method of monitoring? a.) Check pulse and BP every 4 hrs b.) Check perineum every 5 mins for bulging c.) Check every hour for emergency signs d.) Check cervical dilation every 30 mins
2. The first post partum visit should be done when? a.) after 48 hrs b.) After 3 days c.) After 24 hrs d.) Within 24 hrs
DOH Protocol for Home deliveries deliveries: 1.) 1st postpartum visit-within 24 hrs 2.) 2nd visit-1 wk after delivery 3.) 3rd visit -2-4 wks after deliver 4.) Mother is advised to visit clinic within 46wks after delivery
Goal/Objectives/Strategies of FP
Overall Goal of FP Reduce infant, neonatal, under-five and maternal deaths Objective of FP Address the need to help couples and individual achieve their desired family size within the context of responsible parenthood and Improve their RH to attain sustainable development Ensure that quality FP services are
Strategies of FP
Focus service delivery to the urban and rural poor Reestablish FP outreach program Strengthen FP provision in regions with high unmet needs Promote frontline participation of hospitals Mainstream modern natural FP Promote and implement CSR strategy
Advantages Very effective 3 mos after the procedure Permanent, safe, simple and easy to perform Can be performed in a clinic, office or at a primary care center No resupplies or repeated clinic visits No apparent long term health risks An option for couples whose female partner could not undergo permanent contraception A man who had vasectomy will not lose his sexual ability and ejaculation Not affect hormonal function, erection and ejaculation Not lessen but may actually increase the couples sexual drive and enjoyment Man can have better sex since he does not fear that his partner will get pregnant
Male Sterilization/Vasectomy
Disadvantages: It may be uncomfortable due to slight pain and swelling 2-3 days after the procedure Man needs to wear condom up to 15-20 ejaculation Reversibility is difficult and expensive Bleeding may result in hematoma in the scrotum
Pills
Advantages Safe as proven through extensive studies Convenient and easy to use Makes menstrual cycle occur regularly and predictable Reduces gynecologic symptoms Reversible, rapid return to fertility Reduces the risk of ovarian and endometrial CA Does not interfere with sexual intercourse
Disadvantages: Often not used correctly and consistently, lowering its effectiveness Has SE such as nausea, dizziness, breast tenderness which are not generally harmful but which some women may find difficult to tolerate Offers no protection against STI Effectiveness may be lowered when taken with certain drugs such as rifampicin and most anti-convulsants Can suppress lactation Requires regular resupply
Male Condom
Advantages Safe and has no hormonal effect Protects against microorganisms causing STIs/HIV Encourages male participation in FP Easily accessible Used in managing premature Disadvantages: May cause allergy May decrease sensation, making sex less enjoyable for other partner Interrupts the sexual act Requires a mans cooperation for use
Injectables
Advantages Reversible No need for daily intake Does not interfere with sexual intercourse Perceived as culturally acceptable by some women Private since it is not coitally dependent No estrogen related SE nor serious complications such as thrombophlebitis or pulmonary embolism Not affect breast-feeding-quality and quantity of milk Has beneficial non-contraceptive effects
How it is used: Drug containing progestin is injected into the body to suppress ovulation making sperm difficult to pass through the uterine lining It thickens cervical mucus and changes uterine lining
LAM is universally available to all postpartum breastfeeding women Using LAM, protection from an unplanned pregnancy begins immediately postpartum No other FP commodities are required Contributes to improve maternal and child health and nutrition
Disadvantages: Considered as an introductory, short term FP method which is effective only for a maximum of 6 mos. Postpartum Effectiveness of LAM may decrease if a mother and child are separated for extended periods of time Fully or nearly full BF may be difficult to maintain for up to 6 mos due to a variety of social circumstances Disadvantage to women who do not pass any three criteria to practice lactation amenorrhea
How it is used: 1).Amenorrhea; 2). Fully or 1). nearly fully BF her infant; 3). Infant is < 6mos.
Mucus/Billing/Ovulation
Abstaining from sexual intercourse during fertile(wet) days prevents pregnancy
Advantages Can be used by any woman or reproductive health provided she is not suffering from an unusual disease or condition that results in extraordinary vaginal discharge that makes observation difficult
Disadvantages: Cannot be used by woman with medical conditions that would make pregnancy especially dangerous
How it is used used: Recording of menstruation and dry days Inspecting underwear regularly for presence of mucus Recording the most fertile observation at the end of the day
Sympto-Thermal Method
STH method is identifying the fertile and infertile days of the menstrual cycle as determined through a combination of observations made on the cervical mucus, basal body temp recording and other signs of ovulation
2.
3.
1.
2.
3.
Provide counseling on FP methods and its advantages, disadvantages, SE, what to do if problems develop and effectiveness. Provide packages of health services among reproductive age group in all health facilities (FP, MCHN, Mgt of RTI, STIs, HIV, Violence against WC, Mgt of breast and reproductive Cancers) Ensure availability of FP supplies and logistics for the clients
RH Strategic Frameworks
1. The countrys development is reflected in the quality of life of its citizens. Its effective pursuit is premised on: a. The achievement of individual goals and aspirations towards the pursuit of societal objectives that also ensure the well being of future generations; b. Shared aspirations, where people empowerment is a major objective and a necessary means; c. The empowerment of women and the improvement of their political, social, economic and health status that is essential to its fulfillment 2. Individual development can best be achieved by more sustainable patterns of production and consumption; managed population; poverty alleviation; social and economic equality; and gender equity and equality;
3.
4.
5.
We must focus on the individual as the center of development since past population policies, which were primarily macro-level and demographically driven, achieved only moderate success; Gender equity and equality are essential for individual empowerment. empowerment Current gender roles and status in the Philippines are adversely affecting womens health and her contribution and participation in our countrys growth; Reproductive wellbeing is a major component of womens health. health In turn, RH is an integral aspect of this well being. Womens health and RH is a multi-sectoral effort;
6.
7.
RH also recognizes the right and responsibility of men for their own sexual and reproductive behavior as well as their social and family roles particularly in the promotion of the RH of their partners; Recognizing all the above, a RH Policy is necessary to promote womens health and development as a goal in itself. Achieving this will lead to a sustainable development of the Philippines;
Basic RH Rights
R to RH information and health care service for safe pregnancy and child birth R to know different means of regulating fertility Freedom to decide on the number and timing of birth of children R to exercise satisfying sex life
The 10 Elements of RH
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Family Planning Maternal and Child Health and Nutrition Prevention and Treatment of Reproductive Tract Infections Prevention and Management of Abortion and its Complications Breast and Reproductive Tract Cancers Education and Counseling on Sexuality and Sexual Health Adolescent Health Violence against Women and Children Mens Reproductive Health Infertility Prevention and Treatment
Benefits of BF
To Infants Nutritionally complete food Strengthens infants immune system, preventing many infections Safely rehydrates and provides essential nutrients to a sick child, esp. to those suffering from diarrheal diseases Reduces infants exposure to infection Increase IQ points To mother Reduces womans risk of excessive blood loss after birth Provides natural methods of delaying pregnancies Reduces the risk of ovarian and breast cancers and osteoporosis To household and community Conserve funds Saves medical cost of families and govt by preventing illnesses and by providing immediate postpartum and contraception
Polio
Diphtheria
Measles
Tetanus
Pertussis
Hepatitis B
1. 2.
3.
4.
It is safe and immunological effective to administer EPI vaccines on the same day at different sites of the body; Measles should be given as soon as the child is 9 mos old, regardless of whether other vaccines will be given on that day. MV if given at 9 month provide 85% protection and if given at 1 year and older provides 95% protection; The vaccination sched should not be restarted from the beginning even if the interval b/w doses exceeded the recommended interval by mos or years years; Moderate fever, malnutrition, mild resp infection, cough, diarrhea and vomiting are not contraindications to vaccination. Generally, one should immunize unless the child is so sick that he needs to be hospitalized;
5.
The absolute contraindications to immunization are: DPT2 or DPT3 to a child who has had convulsions or shock w/in 3 days the previous dose. Vaccines containing the whole cell pertussis should not be given to children with an evolving neurological disease;
6.
7. 8.
9.
Giving of a vaccine at less than the recommended 4 weeks interval may lessen the antibody response. Lengthening the interval b/w doses of vaccines leads to higher antibody levels levels; Strictly follow the principle of never ever reconstitute the freeze dried vaccines with anything other than the diluents supplied with them them; No extra doses must be given to children/mother who missed dose of DPT/HB/OPV/TT. The vaccination must be continued as if no time had elapsed b/w doses. Use one syringe one needle per child during vaccination
Other facts:
BCG if given at earliest possible age protects the possibility of TB meningitis & other TB infections in which infants are prone Early start with DPT reduces the chance of severe pertussis The earlier OPV is given, the increased extent of protection against polio is. Keeps the Philippine polio free free. An early HepB reduces the chance of being infected and becoming a carrier. Prevent liver cirrhosis & liver cancer. About 9000 die of complications of HB. 10% of Filipinos have chronic HB infection. Eliminate HB b4 2012 (a western regional goal). At least 85% of measles can be prevented by immunization at this age. Prevents deaths (2% die), malnutrition, pneumonia, diarrhea (at least 20%) get theses complications from measles) etc Eliminates measles by 2008
Maintain polio free Phil., Eliminate HepB b4 2012 and Measles by 2008
+2C to 8C ( in the body of the refrigerator) +2C to 8C ( in the body of the refrigerator)
Administration of Vaccines
Vaccine BCG DPT OPV Dose Infants .05ml 0.5ml 2 gtts or depending on manufacturers instruction 0.5ml 0.5ml 0.5ml Route of Administration Intradermal Intramuscular Oral Site of Administration R deltoid region of the arm Outer upper portion of the arm Mouth
Measles HepB TT
Outer part of the upper arm Upper outer portion of the thigh Deltoid region of the upper arm
Facts on MCI
About 10M children aged 0-4 y/o and another 10M among five to ten years of age. The top cause of death among NB is pneumonia at the rate of 2/1,000 LB closely followed by bacterial sepsis at 1.8/1,000LB Among children 0-4 y/o, the number one cause of death is pneumonia (37.76/100,000) followed by accidents at the rate of 17.63/100,000. Accidents are identified s the top cause of mortality among older children 5 to 9 y/o followed by pneumonia and malignant neoplasm
IMCI
Assess the patient: check for the danger signs, main symptoms and other problems Classify the disease Treat the patient Counsel the patient Color Presentation Green Yellow Pink Class of Dis. Mild Moderate Severe Level of Mgt Home care Manage at the RHU Urgent referral to hospital
Common nutritional deficiencies (Vitamin A.,Iron, Iodine) Goal of Nutrition Program To improve quality of life of Filipinos through better nutrition, Program: improved health and increased productivity Objectives: 1. Reduction in the proportion of Filipino households with intake below 100% of the dietary energy requirement from 53.2% to 44%. 2. Reduction in: Underwt among pre-school children Stunting among pre school children Chronic energy deficiency among pregnant women Iron def. among children 6 mos to 5 y/o, pregnant and lactating mothers Prevalence of overwt, obesity and non-CD Reduction in the prevalence of iron def. disorder among lactating mothers Elimination of moderate and sever IDD among school children & pregnat women Reduction in the prevalence of LBW
Nutrition Program
Nutritional Guidelines
Eat a variety of foods everyday Exclusive breastfeeding from birth to 6 mos, and complementary feeding up to 2 yrs or beyond. 3. Maintains childrens normal growth through proper diet and monitoring their growth regularly 4. Consume fish, lean meat, poultry or dried beans 5. Eat more vegetables, fruits and root crops 6. Eat food cooked in edible/cooking oil daily 7. Consume milk, milk products and other calcim-rich foods such as small fish and dark green leafy vegetables 8. Use iodized salt but avoid excessive salty foods 9. Eat clean and safe food 10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke and avoid drinking alcoholic beverages 1. 2.
1 cap q 6 mos
Start from the 4th 1cap/tab of 10,000 IU twice a month of week pregnancy til delivery
PostPost-partum women
200,000 IU
1 cap 200,000 IU
Vitamin A Tx for Xeropthalmia for all age groups & Pregnant Women
Targets
6-11 months 12-59 months
Preparation
100,000 IU 200,000 IU
Dose/ Duration
Should be given immediately upon dx, 1 cap given the next day & 1 cap 2 weeks after
Remarks
10,000 IU
Do NOT give Vit A 10,000 IU if prenatal vitamins or multiple micronutrients tablets containing Vit A. are to be given. Vit A can be given regardless of age of gestation if pregnant women has night blindness.
Preparations
Tab (preferably coated) containing 60mg elemental iron(EI) w/ 400 mcg Folic Acid
Dose/Duration
1 tab once a day for 6 mos or 180 days during the pregnancy period Or 2 tablets per day (120 mg.EI) if prenatal consultations are done during the 2nd and 3rd trimester
Remarks
A dose of 800 mcg of folic acid is still safe to the pregnant woman
Lactating women
Tab (preferably coated) containing 60mg elemental iron(EI) w/ 400 mcgFolic Acid
Iron Supplementation for LBW Infant & 6-11 mos of Age 6Target LBW Preparation Drops: 15 mg EI/0.6ml Dose/Duration 0.3 ml once a day to start at 2 mos of age until 6 mos when complementary foods are given
Older persons
Essential Health Care Package for the Adult male and Female
1. 2. Management of illness Counseling on substance abuse, sexuality and reproductive tract infections Nutrition and diet counseling Mental health FP and responsible sexual behavior Dental care Screening and mgt of lifestyle related and other degenerative diseases
3. 4. 5. 6. 7.
1. 2. 3. 4. 5. 6. 7. 8. 9.
R a t e o f D e a t h
80 70 60 50 40 30 20 10 0
Diseases of Diseases of Pneumonias Malignant Tuberculosis, Accidents neoplasms all forms the heart the vascular /cancers system
LEGEND: 5 YEAR AVERAGE (1991-1995) 1998
Diabetes Mellitus
Causes of Death
Goal: Reduce the morbidity, disability and premature deaths due to chronic non-cd lifestylerelated diseases Objectives: 1. Analyze the social, economic, political and behavioral determinants of NCD that will serve as bases for a. developing policy guidelines; b. setting legislative and political directions c. providing directions; financial measures to support NCDPC programs 2. Reduce exposure of individuals and population to major determinants of NCD while preventing emergence of preventable common diseases 3. Strengthen health care for people with NCD through HSR and cost effective intervention
Changing Lifestyles
Developing Personal Skills: Information, Education, Communication
Reorienting Health Services High-risk vs Population Approaches. Secondary and Tertiary Prevention
vessels (CVD)
Hypertension Coronary artery diseases Cerebrovascular Disease or Stroke
B. C. D. E.
A. Cardiovascular Diseases
1. HPN:
Risk factors:
Family hx, advancing age, race high salt intake, obesity and excessive alcohol intake (FARSOA FARSOA)
Etiology: Atherosclerosis- thickening of the walls of arteries due to fat deposits. Atherosclerosis usually occurs when there is high levels of cholesterol Risk Factors:
HPN, DM, Obesity, physical inactivity Elevated blood lipids (LDL) Smoking or tobacco use
3. Cerebrovascular Accident/Stroke
Etiology:
Atherosclerosis(thrombi/emboli)/HPN, aneurysms, trauma, erosion of bv due to tumors
Risk factors:
Increasing age, Sex, Family Hx, HPN, Cigarette smoking, DM, Heart disease, Socio-economic factor, Season and climate, IV drug abuse, alcohol
B. Cancer
Causes of CA.
Heredity Normal cells transform into CA cells because of damage to DNA (inherited). Carcinogens: Polycyclic hydrocarbons, Aflatoxin, Benzoprene, Nitrosamines, Radiation and Viruses
C. DM
Type II: Risk factors:
Heredity, Over wt, HDL cholesterol < 35mg/dl; Hx of GDM, previously identified to have IGT,
D. COPD
Characterized by airflow limitation
Complications:
Peripheral airway obstruction, parenchymal destruction, CVD (Pulmonary hypertension)
E. Bronchial Asthma
Causes and Risk Factors:
Host Factor:
Genetic predisposition, Allergy, airway hyper responsiveness, gender, race.
Envtal factors:
Indoor/outdoor allergens, Occupational sensitizers, Tobacco smoke, air pollution, Respiratory infection, parasitic infections, socioeconomic, family size, diet and drugs, obesity
Risk Factors
Smoking Nutrion/Diet Phy.Inact Obesity Alcohol Elev.BP Bld.Glucose Bld. Lipids
Condition
CVD/CVA/HPN /CHD DM CA COPD/Asthma/other Respiratory Conditions
/ / / / / / / /
/ / / / / / / /
/ / / / / / / /
/ / / / / / / /
FBS
N= 109mg/dl, Possible DM:126mg/dl
CAUTIONUS-
Roles of PHN
Nutrition assessment Nutrition education and counseling Promoting supportive envt for healthy nutrition Encourage food gardens Campaign for nutrition friendly envt Advocate for healthy policies
General Objectives
1. Increase cataract surgical rate from 730 to 2,500 by the year 2010 2. Reduce Visual impairment due to refractive errors by 10% by the 2010 3. Reduce the prevalence of visual disability in children from 0.43% to 0.20% in 2010
Vision: Healthy and empowered Filipinos by the year 2010- with reduced mortality and morbidity from kidney diseases and their sequelae
Goal: Improvement of quality of life and productivity of PWDs Objective: Reduce the prevalence of disability through prevention, early detection, and provision of rehabilitation Program Components:
Social preparation Services preparation Training Information, Education and Communication Monitoring, supervision and Evaluation Laws: RA 7277 and RA 9442
ENVIRONMENTAL HEALTH
Is the study of all factors in mans physical environment, which may have deleterious effect on his health or wellbeing and survival Factors:
H2O sanitation Food sanitation Refuse and garbage disposal Insect vector and rodent control Housing Air pollution Noise pollution Radiological protection Institutional sanitation
Environmental Sanitation
Level II: on site facilities of the h2o carriage type with h2o sealed and flush type Level III: connected to septic tank and/or sewerage system to tx plant
BOTIKA SA BARANGAY
Legal Basis: DOH Adm. Cir # 23A dtd July 5, 1996 In 2001: GMA 50
Agencies in charged: DOH, PNRC, PBCC Qualifications of Donors Steps on how to donate in BCU Storage of blood donated: 4-5 wks (whole blood and red cell concentrates) and Plasma can be stored frozen for 1 yr. After donating blood
Keep on eye on the dressing Avoid carrying heavy objects Do not smoke Eat meals and increase fluid intake
Programs
EPI, Disease surveillance, CARI, CDD, FP, STD/AIDS, EHS, CA control, Micronutrient supplementation, HL
HERBAL MEDICINE
10 DOH ADVOCATED HERBAL PLANTS SANTALUBBY RA 8423
Definition of terms:
Disaster: is a serious disruption of the functioning of a society, causing wide spread losses(human, material or environmental) which exceed the ability to cope using only its own resources Emergency: Occurrence requiring immediate response Hazards: Phenomenon which has potential to cause disruption Risk: level of loss/damage that could be predicted ( Susceptibility&Vulnerability)