CONTENTS

OUTLINE

Bag Technique
Breastfeeding or Lactation Management Education Training
Communicable Disease (Vector Borne)
Communicable Diseases (Chronic)
Control of Acute Respiratory Infections (CARI)
Control of Diarrheal Diseases (CDD)
Expanded Program for Immunization (EPI)
Herbal Medicine Plants Approved by the
DOH
Integrated Management of Childhood Illnesses (IMCI)
Management of a Child with an Ear Problem

Non-Communicable Diseases and

Rehabilitation Family Planning Program
 Bag Technique
Definition

Bag technique-a tool making use of public health bag through which the nurse, during his/her home visit, can

perform nursing procedures with ease and deftness, saving time and effort with the end in view of rendering

effective nursing care.

Public health bag – is an essential and indispensable equipment of the public health nurse which he/she has to

carry along when he/she goes out home visiting. It contains basic medications and articles which are necessary

for giving care.

Rationale

To render effective nursing care to clients and /or members of the family during home visit.

Principles
1. The use of the bag technique should minimize if not totally prevent the spread of
infection from individuals to families, hence, to the community.
2. Bag technique should save time and effort on the part of the nurse in the performance
of nursing procedures.
3. Bag technique should not overshadow concern for the patient rather should show the
effectiveness of total care given to an individual or family.
4. Bag technique can be performed in a variety of ways depending upon agency policies,
actual home situation, etc., as long as principles of avoiding transfer of infection is carried out.

Special Considerations in the Use of the Bag

1. The bag should contain all necessary articles, supplies and equipment which may be
used to answer emergency needs.
2. The bag and its contents should be cleaned as often as possible, supplies replaced and
ready for use at any time.
3. The bag and its contents should be well protected from contact with any article in the
home of the patients. Consider the bag and it’s contents clean and /or sterile while any article
belonging to the patient as dirty and contaminated.
4. The arrangement of the contents of the bag should be the one most convenient to
the user to facilitate the efficiency and avoid confusion.
5. Hand washing is done as frequently as the situation calls for, helps in minimizing or
avoiding contamination of the bag and its contents.
6. The bag when used for a communicable case should be thoroughly cleaned and
disinfected before keeping and re-using.

Contents of the Bag

▪ Paper lining
▪ Extra paper for making bag for waste materials (paper bag)
▪ Plastic linen/lining
▪ Apron
▪ Hand towel in plastic bag
▪ Soap in soap dish
▪ Thermometers in case [one oral and rectal]
▪ 2 pairs of scissors [1 surgical and 1 bandage]
▪ 2 pairs of forceps [ curved and straight]
▪ Syringes [5 ml and 2 ml]
 ▪ Hypodermic needles g. 19, 22, 23, 25
▪ Sterile dressings [OS, C.B]
▪ Sterile Cord Tie
▪ Adhesive Plaster
▪ Dressing [OS, cotton ball]
▪ Alcohol lamp
▪ Tape Measure
▪ Baby’s scale
▪ 1 pair of rubber gloves
▪ 2 test tubes
▪ Test tube holder
▪ Medicines
▪ betadine
▪ 70% alcohol
▪ ophthalmic ointment (antibiotic)
▪ zephiran solution
▪ hydrogen peroxide
▪ spirit of ammonia
▪ acetic acid
▪ benedict’s solution

Note: Blood Pressure Apparatus and Stethoscope are carried separately.

Steps/Procedures
Actions Rationale

1. Upon arriving at the client’s home, place the

bag on the table or any flat surface lined with
paper lining, clean side out (folded part touching
the table). Put the bag’s handles or strap beneath
the bag. To protect the bag from contamination.

2. Ask for a basin of water and a glass of water if

faucet is not available. Place these outside the To be used for handwashing.
work area. To protect the work field from being wet.

3. Open the bag, take the linen/plastic lining and

spread over work field or area. The paper lining,
clean side out (folded part out). To make a non-contaminated work field or area.

4. Take out hand towel, soap dish and apron and

the place them at one corner of the work area
(within the confines of the linen/plastic lining). To prepare for handwashing.

5. Do handwashing. Wipe, dry with towel. Leave

the plastic wrappers of the towel in a soap dish in Handwashing prevents possible infection from one care provi
the bag. to the client.

6. Put on apron right side out and wrong side with To protect the nurses’ uniform. Keeping the crease creates
crease touching the body, sliding the head into
the neck strap. Neatly tie the straps at the back. aesthetic appearance.

7. Put out things most needed for the specific

case (e.g.) thermometer, kidney basin, cotton
ball, waste paper bag) and place at one corner of
the work area. To make them readily accessible.

8. Place waste paper bag outside of work area. To prevent contamination of clean area.

To give comfort and security, maintain personal hygiene and

9. Close the bag. hasten recovery.

10. Proceed to the specific nursing care or

treatment. To prevent contamination of bag and contents.

11. After completing nursing care or treatment,

clean and alcoholize the things used. To protect caregiver and prevent spread of infection to others

12. Do handwashing again.

13. Open the bag and put back all articles in their
proper places.

14. Remove apron folding away from the body,

with soiled sidefolded inwards, and the clean side
out. Place it in the bag.

15. Fold the linen/plastic lining, clean; place it in

the bag and close the bag.

16. Make post-visit conference on matters

relevant to health care, taking anecdotal notes
preparatory to final reporting. To be used as reference for future visit.

17. Make appointment for the next visit (either

home or clinic), taking note of the date, time and
purpose. For follow-up care.

After Care

1. Before keeping all articles in the bag, clean and alcoholize them.
2. Get the bag from the table, fold the paper lining ( and insert), and place in between the flaps
and cover the bag.

Evaluation and Documentation

1. Record all relevant findings about the client and members of the family.
2. Take note of environmental factors which affect the clients/family health.
3. Include quality of nurse-patient relationship.
4. Assess effectiveness of nursing care provided.

Breastfeeding or Lactation Management

Education Training
Introduction

Breastfeeding practices has been proved to be very beneficial to both mother and baby thus the creation of the

following laws support the full implementation of this program:

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

Program Objectives and Goals

▪ Protection and promotion of breastfeeding and lactation management education training

Activities and Strategies

1. Full Implementation of Laws Supporting the Program

a. EO 51 THE MILK CODE – protection and promotion of breastfeeding to ensure the safe and adequate

nutrition of infants through regulation of marketing of infant foods and related products. (e.g. breast milk

substitutes, infant formulas, feeding bottles, teats etc. )

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

▪ An act providing incentives to government and private health institutions promoting and
practicing rooming-in and breast-feeding.
▪ Provision for human milk bank.
▪ Information, education and re-education drive
▪ Sanction and Regulation
 2. Conduct Orientation/Advocacy Meetings to Hospital/ Community

Advantages of Breastfeeding:

Mother

▪ Oxytocin help the uterus contracts

▪ Uterine involution
▪ Reduce incidence of Breast Cancer
▪ Promote Maternal-Infant Bonding
▪ Form of Family planning Method (Lactational Amenorrhea)

Baby

▪ Provides Antibodies
▪ Contains Lactoferin (binds with Iron)
▪ Leukocytes
▪ Contains Bifidus factorpromotes growth of the Lactobacillusinhibits the growth of pathogenic
bacilli

Positions in Breastfeeding of the baby:

1. Cradle Hold = head and neck are supported

2. Football Hold
3. Side Lying Position

BEST FOR BABIES

REDUCE INCIDENCE OF ALLERGENS

ECONOMICAL

ANTIBODIES

PRESENT
STOOL INOFFENSIVE (GOLDEN YELLOW)

TEMPERATURE

ALWAYS IDEAL
FRESH MILK NEVER

GOES OFF
EMOTIONALLY

BONDING
EASY ONCE
ESTABLISHED

DIGESTED EASILY

IMMEDIATELY

AVAILABLE
NUTRITIONALLY
OPTIMAL

GASTROENTERITIS GREATLY REDUCED

 Communicable Disease (Vector Borne)
Leptospirosis (Weil’s disease)

▪ An infectious disease that affects humans and animals, is considered the most common
zoonosis in the world

Causative Agent:

Leptospira interrogans

Sign/Symptoms:
▪ High fever
▪ Chills
▪ Vomiting
▪ Red eyes
▪ Diarrhea
▪ Severe headache
▪ muscle aches
▪ may include jaundice (yellow skin and eyes)
▪ abdominal pain
 Treatment:

PET – > Penicillins, Erythromycin, Tetracycline

Malaria

▪ Malaria (from Medieval Italian: mala aria – “bad air”; formerly called ague or marsh
fever) is an infectious disease that is widespread in many tropical and subtropical regions.

Causative Agent:

Anopheles female mosquito

Signs & Symptoms:

▪ Chills to convulsion
▪ Hepatomegaly
▪ Anemia
▪ Sweats profusely
▪ Elevated temperature

Treatment:
▪ Chemoprophylaxis – chloroquine taken at weekly interval, starting from 1-2 weeks before
entering the endemic area.
▪ Anti-malarial drugs – sulfadoxine, quinine sulfate, tetracycline, quinidine
▪ Insecticide treatment of mosquito nets, house spraying, stream seeding and clearing,
sustainable preventive and vector control meas

Preventive Measures: (CLEAN)

▪ Chemically treated mosquito nets
▪ Larvae eating fish
▪ Environmental clean up
▪ Anti mosquito soap/lotion
▪ Neem trees/eucalyptus tree

Filariasis

▪ name for a group of tropical diseases caused by various thread-like parasitic

round worms (nematodes) and their larvae
▪ larvae transmit the disease to humans through a mosquito bite
▪ can progress to include gross enlargement of the limbs and genitalia in a
condition called elephantiasis

Sign/Symptoms:

Asymptomatic Stage

▪ Characterized by the presence of microfilariae in the peripheral blood

▪ No clinical signs and symptoms of the disease
▪ Some remain asymptomatic for years and in some instances for life

Acute Stage
▪ Lymphadenitis (inflammation of lymph nodes)
▪ Lymphangitis (inflammation of lymph vessels)
▪ In some cases the male genitalia is affected leading to orchitis (redness, painful
and tender scrotum)

Chronic Stage

▪ Hydrocoele (swelling of the scrotum)

▪ Lyphedema (temporary swelling of the upper and lower extremities
▪ Elephantiasis (enlargement and thickening of the skin of the lower and / or upper
extremities, scrotum, breast)

Management:
▪ Diethylcarbamazine citrate or Hetrazan
▪ Ivermectin,
▪ Albendazolethe
▪ No treatment can reverse elephantiasis

Schistosomiasis

▪ parasitic disease caused by a larvae

Causative Agent:

Schistosoma intercalatum, Schistosoma japonicum, Schistosoma mansoni

Signs & Symptoms: (BALLIPS)

▪ Bulging abdomen
▪ Abdominal pain
▪ Loose bowel movement
▪ Low grade fever
▪ Inflammation of liver & spleen
▪ Pallor
▪ Seizure

Preventive measures
▪ health education regarding mode of transmission and methods of protection; proper
disposal of feces and urine; improvement of irrigation and agriculture practices
▪ Control of patient, contacts and the immediate environment

Treatment:
▪ Diethylcarbamazepine citrate (DEC) or Praziquantel (drug of choice)

Dengue

▪ DENGUE is a mosquito-borne infection which in recent years has become a major

international public health concern..
▪ It is found in tropical and sub-tropical regions around the world, predominantly in urban
and semi- urban areas.

Sign/Symptoms: (VLINOSPARD)
▪ Vomiting
▪ Low platelet
▪ Nausea
▪ Onset of fever
▪ Severe headache
▪ Pain of the muscle and joint
▪ Abdominal pain
▪ Rashes
▪ Diarrhea

Treatment:
▪ The mainstay of treatment is supportive therapy.
▪ Intravenous fluids
▪ A platelet transfusion

Communicable Diseases (Chronic)

Tuberculosis
▪ TB is a highly infectious chronic disease that usually affects the lungs.

Causative Agent:

Mycobacterium Tuberculosis

Sign/Symptoms:
▪ cough
▪ afternoon fever
▪ weight loss
▪ night sweat
▪ blood stain sputum

Prevalence/Incidence:
▪ ranks sixth in the leading causes of morbidity (with 114,221 cases) in the Philippines
▪ Sixth leading cause of mortality (with 28507 cases) in the Philippines.

Nursing and Medical Management

▪ Ventilation systems
▪ Ultraviolet lighting
▪ Vaccines, such as the bacillus Calmette Guerin (BCG) vaccine
▪ drug therapy

Preventing Tuberculosis
▪ BCG vaccination
▪ Adequate rest
▪ Balanced diet
▪ Fresh air
▪ Adequate exercise
▪ Good personal Hygiene

National Tuberculosis Control Program – Key policies

▪ Case finding – direct Sputum Microscopy and X-ray examination of TB
symptomatics who are negative after 2 or more sputum exams
▪ Treatment – shall be given free and on an ambulatory basis, except those with acute
complications and emergencies
▪ Direct Observed Treatment Short Course – comprehensive strategy to detect and
cure TB patients.
 DOTS (Direct Observed Treatment Short Course)
▪ Category 1- new TB patients whose sputum is positive; seriously ill patients with severe
forms of smear-negative PTB with extensive parenchymal involvement (moderately- or far
advanced) and extra- pulmonary TB (meningitis, pleurisy, etc.)
▪ Intensive Phase (given daily for the first 2 months) – Rifampicin + Isioniazid +
pyrazinamide
+ ethambutol.
▪ If sputum result becomes negative after 2 months, maintenance phase starts. But if
sputum is still positive in 2 months, all drugs are discontinued from 2-3 days and a sputum
specimen is examined for culture and drug sensitivity. The patient resumes taking the 4 drugs for
another month and then another smear exam is done at the end of the 3rd month.
▪ Maintenance Phase (after 3rd month, regardless of the result of the sputum
exam)-INH + rifampicin daily
▪ Category 2-previously-treated patients with relapses or failures.
▪ Intensive Phase (daily for 3 months, month 1, 2 & 3)-Isioniazid+ rifampicin+
pyrazinamide+ ethambutol+ streptomycin for the first 2 months Streptomycin+ rifampicin
pyrazinamide+ ethambutol on the 3rd month. If sputum is still positive after 3 months, the
intensive phase is continued for 1 more month and then another sputum exam is done. If still
positive after 4 months, intensive phase is continued for the next 5 months.
▪ Maintenance Phase (daily for 5 months, month 4, 5, 6, 7,& 8)-Isionazid+
rifampicin+ ethambutol
▪ Category 3 – new TB patients whose sputum is smear negative for 3 times and chest
x-ray result of PTB minimal
▪ Intensive Phase (daily for 2 months) – Isioniazid + rifampicin + pyrazinamide
▪ Maintenance Phase (daily for the next 2 months) – Isioniazid + rifampicin

Leprosy

▪ Sometimes known as Hansen’s disease

▪ is an infectious disease caused by , an aerobic, acid fast, rod-shaped mycobacterium
▪ Gerhard Armauer Hansen
▪ Historically, leprosy was an incurable and disfiguring disease
▪ Today, leprosy is easily curable by multi-drug antibiotic therapy

Signs & Symptoms

Early stage (CLUMP) Late

Stage (GMISC) Change in skin color Gynocomastia

Loss in sensation Madarosis(loss of eyebrows)

Ulcers that do not heal Inability to close eyelids (Lagopthalmos)

Muscle weakness Sinking nosebridge

Painful nerves Clawing/contractures of fingers & nose

Prevalence Rate
▪ Metro Manila, the prevalence rate ranged from 0.40 – 3.01 per one thousand population.

Management:
▪ Dapsone, Lamprene
▪ clofazimine and rifampin
▪ Multi-Drug-Therapy (MDT)
▪ six month course of tablets for the milder form of leprosy and two years for the more severe form
 Leprosy Control Program
▪ WHO Classification – basis of multi-drug therapy
▪ Paucibacillary/PB – non-infectious types. 6-9 months of treatment.
▪ Multibacillary/MB – infectious types. 24-30 months of treatment.
▪ Multi-drug therapy – use of 2 or more drugs renders patients non-infectious a week
after starting treatment
▪ Patients w/ single skin lesion and a negative slit skin smear are treated w/ a
single dose of ROM regimen
▪ For PB leprosy cases- Rifampicin+Dapsone on Day 1 then Dapsone from Day 2-
28. 6 blister packs taken monthly within a max. period of 9 mos.
▪ All patients who have complied w/ MDT are considered cured and no longer regarded as
a case of leprosy, even if some sequelae of leprosy remain.
▪ Responsibilities of the nurse:
▪ Prevention – health education, healthful living through proper nutrition,
adequate rest, sleep and good personal hygiene;
▪ Casefinding
▪ Management and treatment – prevention of secondary injuries, handling of
utensils; special shoes w/ padded soles; importance of sustained therapy, correct dosage,
effects of drugs and the need for medical check-up from time to time; mental & emotional
support
▪ Rehabilitation-makes patients capable, active and self-respecting member of society.

Control of Acute Respiratory

Infections (CARI)
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

▪ Feed the child during illness

▪ Increase feeding after illness
▪ Clear the nose if it interferes with feeding

2. Increase Fluids

▪ offer the child extra to drink

▪ 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

▪ Breathing becomes difficult

▪ Breathing becomes fast
▪ Child is not able to drink
▪ 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 child’s 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

1. Chest indrawing
2. Nasal flaring
3. Grunting ( short sounds made with the voice)
4. Cyanosis

Treatment

▪ Refer urgently to hospital

 ▪ Treat fever ( paracetamol), wheezing ( salbutamol)

D. Very Severe Disease

1. Not able to drink

2. Convulsions
3. Abnormally sleepy or difficult to wake
4. Stridor in calm child
5. Severe undernutrition

Treatment

▪ 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 less than 2 months: Has the young infant stopped feeding well?
4. Age 2 months up to 5 years: Is the child able to drink?
5. Has the child had fever? For how long?
6. Has the child had convulsions?

Look, Listen

1. Count the breaths in one minute.

Age 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

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.

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

 Control of
Diarrheal
Diseases (CDD)
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 Treatment.

Three Rules for Home Treatment

1. Give the child more fluids than usual

▪ use home fluid such as cereal gruel
▪ give ORESOL, plain water
2. Give the child plenty of food to prevent under nutrition
▪ 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

Amount of ORS to give after each loose Amount of ORS to provide for use at
Age stool 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

Approximate amount of ORS to give in 1st 4 hours

Age Weight (kg) ORS (ml)

4 months 5 200- 400

4- 11 months 5- 7.9 400- 600

12-23 months 8- 10.9 600- 800

2-4 yrs. 11- 15.9 800- 1200

5-14 yrs. 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 child’s 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
▪ Treatment PLAN C- treat 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

Two problems in CDD

1. High child mortality due to diarrhea
2. High diarrhea incidence among under fives
▪ Highest incidence in age 6 – 23 months
▪ Highest mortality in the first 2 years of life
▪ Main causes of death in diarrhea :
▪ Dehydration
▪ 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
▪ Malnutrition
▪ For under nutrition, continue feeding during diarrhea especially breastfeeding.

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

Breastfeeding
1. Risk of severe diarrhea 10-30x higher in bottle fed infants than in breastfed infants.
2. Advantages of breastfeeding in relation to CDD

a. Breast milk is sterile

b. Presence of antibodies protection against diarrhea

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

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

4. When to wean?

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

▪ 6 months – variety of foods 4x a day

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

Expanded Program for Immunization (EPI)

Principles of EPI

1. Epidemiological situation

2. Mass approach
3. Basic Health Service

The 7 immunizable diseases

1. Tuberculosis
2. Diptheria
3. Pertussis
4. Measles
5. Poliomyelitis
6. Tetanus
7. Hepatitis B

Target Setting

▪ Infants 0-12 months

▪ Pregnant and Post Partum Women
▪ 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

▪ Target Setting
▪ Cold chain Logistic Management- Vaccine distribution through cold chain is designed to
ensure that the vaccines were maintained under proper environmental condition until the time of
administration.
▪ Information, Education and Communication (IEC)
▪ Assessment and evaluation of Over-all performance of the program
▪ Surveillance and research studies

Administration of vaccines

Form # of
Vaccine Content & Doses Route
Dosage
BCG (Bacillus Calmette Live attenuated Freeze dried 1 ID
Guerin) bacteria
 Infant- 0.05ml

Preschool-0.1ml

DT- weakened
toxin

DPT (Diphtheria Pertussis

Tetanus) P-killed bacteria liquid-0.5ml 3 IM

OPV (Oral Polio Vaccine) weakened virus liquid-2drops 3 Oral

Plasma
Hepatitis B derivative Liquid-0.5ml 3 IM

Freeze dried-
Measles Weakened virus 0.5ml 1 Subcutaneous

Schedule of Vaccines

Vacci Age at Interval

ne 1st dose between dose Protection

BCG is given at the earliest possible age protects against the

BCG At birth possibility of TB infection from the other family members

DPT 6 weeks 4 weeks An early start with DPT reduces the chance of severe pertussis

The extent of protection against polio is increased the earlier OPV

OPV 6weeks 4weeks given.

An early start of Hepatitis B reduces

Hepa @birth,6th
B @ birth week,14th week the chance of being infected and becoming a carrier.

Meas 9m0s.- At least 85% of measles can be prevented by immunization at thi

les 11m0s. age.

▪ 6 months – earliest dose of measles given in case of outbreak

▪ 9months-11months- regular schedule of measles vaccine
▪ 15 months- latest dose of measles given
▪ 4-5 years old- catch up dose
▪ Fully Immunized Child (FIC)– less than 12 months old child with complete immunizations
of DPT, OPV, BCG, Anti Hepatitis, Anti measles.
 Tetanus Toxiod Immunization

Schedule for Women

%
Vaccine Minimum age interval protected Duration of Protection

TT1 As early as possible 0% 0

TT2 4 weeks later 80% 3 years

TT3 6 months later 95% 5 years

1year later/during next

TT4 pregnancy 99% 10 years

TT5 1 year later/third pregnancy 99% Lifetime

▪ There is no contraindication to immunization except when the child is immunosuppressed

or is very, very ill (but not slight fever or cold). Or if the child experienced convulsions after a DPT
or measles vaccine, report such to the doctor immediately.
▪ Malnutrition is not a contraindication for immunizing children rather; it is an
indication for immunization since common childhood diseases are often severe to
malnourished children.

Cold Chain under EPI

▪ Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to
the time it is given to child or pregnant woman.
▪ The allowable timeframes for the storage of vaccines at different levels are:
▪ 6months- Regional Level
▪ 3months- Provincial Level/District Level
▪ 1month-main health centers-with ref.
▪ Not more than 5days- Health centers using transport boxes.
▪ Most sensitive to heat: Freezer (-15 to -25 degrees C)
▪ OPV
▪ Measles
▪ Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius)
▪ BCG
▪ DPT
▪ Hepa B
▪ TT
▪ Use those that will expire first, mark “X”/ exposure, 3rd- discard,
▪ Transport-use cold bags let it stand in room temperature for a while before storing DPT.
▪ Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B.
▪ FEFO (“first expiry and first out”) – vaccine is practiced to assure that all vaccines are
utilized before the expiry date. Proper arrangement of vaccines and/or labeling of vaccines expiry
date are done to identify those near to expire vaccines.
 Herbal Medicine Plants Approved by the DOH

Lagundi (Vitex

negundo) Uses

& Preparation:

▪ Asthma, Cough & Fever – Decoction ( Boil raw fruits or leaves in 2 glasses of water
for 15 minutes)Dysentery, Colds & Pain – Decoction ( Boil a handful of leaves & flowers in
water to produce a glass, three times a day)
▪ Skin diseases (dermatitis, scabies, ulcer, eczema) -Wash & clean the skin/wound
with the decoction
▪ Headache – Crush leaves may be applied on the forehead
▪ Rheumatism, sprain, contusions, insect bites – Pound the leaves and apply on affected area

Yerba (Hierba ) Buena (Mentha cordifelia)

Uses & Preparation:

▪ Pain (headache, stomachache) – Boil chopped leaves in 2 glasses of water for 15
minutes. Divide decoction into 2 parts, drink one part every 3 hours.
▪ Rheumatism, arthritis and headache – Crush the fresh leaves and squeeze sap.
Massage sap on painful parts with eucalyptus
▪ Cough & Cold – Soak 10 fresh leaves in a glass of hot water, drink as tea. (expectorant)
▪ Swollen gums – Steep 6 g. of fresh plant in a glass of boiling water for 30 minutes. Use
as a gargle solution
▪ Toothache – Cut fresh plant and squeeze sap. Soak a piece of cotton in the sap and
insert this in aching tooth cavity
▪ Menstrual & gas pain – Soak a handful of leaves in a lass of boiling water. Drink infusion.
▪ Nausea & Fainting – Crush leaves and apply at nostrils of patients
▪ Insect bites – Crush leaves and apply juice on affected area or pound leaves until like a
paste, rub on affected area
▪ Pruritis – Boil plant alone or with eucalyptus in water. Use decoction as a wash on affected area.

Sambong (Blumea balsamifera)

Uses & Preparation:

▪ Anti-edema, diuretic, anti-urolithiasis – Boil chopped leaves in a glass of water for 15 minutes until
one glassful remains. Divide decoction into 3 parts, drink one part 3 times a day.
▪ Diarrhea – Chopped leaves and boil in a glass of water for 15 minutes. Drink one part every 3 hours.

Tsaang Gubat (Carmona retusa)

Uses & Preparation:

▪ Diarrhea – Boil chopped leaves into 2 glasses of water for 15 minutes. Divide decoction into 4 parts.
Drink 1 part every 3 hours
▪ Stomachache – Boil chopped leaves in 1 glass of water for 15 minutes. Cool and strain.

Niyug-niyogan (Quisqualis indica L.)

Uses & Preparation:

▪ Anti-helmintic – The seeds are taken 2 hours after supper. If no worms are expelled, the dose may
be repeated after one week. (Caution: Not to be given to children below 4 years old)

Bayabas/Guava (Psidium guajava L.)

Uses & Preparation:

▪ For washing wounds – Maybe use twice a day
▪ Diarrhea – May be taken 3-4 times a day
As gargle and for toothache – Warm decoction is used for gargle. Freshly pounded leaves are used for
toothache. Boil chopped leaves for 15 minutes at low fire. Do not cover and then let it cool and strain

Akapu
lko
(Cassi
a alata
L.)

Uses & Preparation:

▪ Anti-fungal (tinea flava, ringworm, athlete’s foot and scabies) – Fresh, matured leaves are
pounded. Apply soap to the affected area 1-2 times a day

Ulasimang Bato (Peperonica

pellucida) Uses & Preparation:

▪ Lowers uric acid (rheumatism and gout) – One a half cup leaves are boiled in two glass of water
over low fire. Do not cover pot. Divide into 3 parts and drink one part 3 times a day
Bawang (Allium sativum)
 Uses & Preparation:
▪ Hypertension – Maybe fried, roasted, soaked in vinegar for 30 minutes, or blanched in boiled
water for 15 minutes. Take 2 pieces 3 times a day after meals.
▪ Toothache – Pound a small piece and apply to affected area

Ampalaya (Mamordica

Charantia) Uses &

Preparation:
▪ Diabetes Mellitus (Mild non-insulin dependent) – Chopped leaves then boil in a glass of water for
15 minutes. Do not cover. Cool and strain. Take 1/3 cup 3 times a day after meals

Reminders on the Use of Herbal Medicine

1. Avoid the use of insecticide as these may leave poison on plants.
2. In the preparation of herbal medicine, use a clay pot and remove cover while boiling at low heat.
3. Use only part of the plant being advocated.
4. Follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each type of symptoms or sickness.
6. Stop giving the herbal medication in case untoward reaction such as allergy occurs.
7. If signs and symptoms are not relieved after 2 to 3 doses of herbal medication, consult a doctor.

Integrated Management of Childhood Illnesses

(IMCI)
Definition
▪ IMCI is an integrated approach to child health that focuses on the well-being of the whole child.
▪ IMCI strategy is the main intervention proposed to achieve a significant reduction in the
number of deaths from communicable diseases in children under five

Goal

▪ By 2010, to reduce the infant and under five mortality rate at least one third, in pursuit
of the goal of reducing it by two thirds by 2015.

Aim
▪ To reduce death, illness and disability, and to promote improved growth and
development among children under 5 years of age.
▪ IMCI includes both preventive and curative elements that are implemented by
families and communities as well as by health facilities.

IMCI Objectives
▪ To reduce significantly global mortality and morbidity associated with the major causes of
disease in children
▪ To contribute to the healthy growth & development of children
 IMCI Components of Strategy
▪ Improving case management skills of health workers
▪ § Improving the health systems to deliver IMCI
▪ Improving family and community practices

**For many sick children a single diagnosis may not be apparent or appropriate

Presenting complaint:
▪ Cough and/or fast breathing
▪ Lethargy/Unconsciousness
▪ Measles rash
▪ “Very sick” young infant

Possible course/ associated condition:

▪ Pneumonia, Severe anemia, P. falciparum malaria
▪ Cerebral malaria, meningitis, severe dehydration
▪ Pneumonia, Diarrhea, Ear infection
▪ Pneumonia, Meningitis, Sepsis

Five Disease Focus of IMCI:

▪ Acute Respiratory Infection
▪ Diarrhea
▪ Fever
▪ Malaria
▪ Measles
▪ Dengue Fever
▪ Ear Infection
▪ Malnutrition

The IMCI Case Management Process

▪ Assess and classify
▪ Identify appropriate treatment
▪ Treat/refer
▪ Counsel
▪ Follow-up

The Integrated Case Management Process

Check for General Danger Signs:

▪ A general danger sign is present if:
▪ The child is not able to drink or breastfeed
▪ The child vomits everything
▪ The child has had convulsions
▪ The child is lethargic or unconscious

Assess Main Symptoms

▪ Cough/DOB
▪ Diarrhea
▪ Fever
▪ Ear problems

Assess and Classify Cough of Difficulty of Breathing

▪ Respiratory infections can occur in any part of the respiratory tract such as the nose,
throat, larynx, trachea, air passages or lungs.
 Assess and classify PNEUMONIA

▪ Cough or difficult breathing

▪ An infection of the lungs
▪ Both bacteria and viruses can cause pneumonia
▪ Children with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis
(generalized infection).

** A child with cough or difficult breathing is assessed for:

▪ How long the child has had cough or difficult breathing

▪ Fast breathing
▪ Chest indrawing
▪ Stridor in a calm child.

Remember:

▪ ** If the child is 2 months up to 12 months the child has fast breathing if you
count 50 breaths per minute or more
▪ ** If the child is 12 months up to 5 years the child has fast breathing if you count 40
breaths per minute or more.

Color Coding

YELLOW
PINK (Treatment at outpatient GREEN
(URGENT REFERRAL) health facility) (Home management)

OUTPATIENT HEALTH FACILITY HOME

OUTPATIENT HEALTH FACILITY ▪ Treat local infection ▪ Caretaker is counseled on:

▪ Give oral drugs ▪ Home treatment/s
▪ Pre-referral treatments ▪ Advise and teach ▪ Feeding and fluids
▪ Advise parents caretaker ▪ When to return immediately
▪ Refer child ▪ Follow-up ▪ Follow-up

▪ Give first dose of an appropriate

REFERRAL FACILITY antibiotic
▪ Give Vitamin A
▪ Emergency Triage and Treat the child to prevent low
SEVERE PNEUMONIA OR VERY ▪
Treatment ( ETAT) bloo
▪ Diagnosis, Treatment SEVERE DISEASE ▪ sugar
▪ Monitoring, follow-up ▪ Refer urgently to the hospital
Give paracetamol for fever >
38.5
▪ Give an appropriate antibiotic fo
days
▪ ▪ Soothe the throat and relieve cou
with a safe remedy
▪ Any general danger sign ▪ Advise mother when to return
▪or immediately
Chest indrawing or PNEUMONIA ▪ Follow up in 2 days
 ▪ If coughing more than more
than days, refer for assessment
▪ Soothe the throat and relieve the
NO PNEUMONIA : COUGH OR cough with a safe remedy
▪ Advise mother when to return
▪ COLD immediately
Fast breathing ▪ Follow up in 5 days if not improvin
▪
No signs of pneumonia or
very severe disease
Assess and classify DIARRHEA

A child with diarrhea is assessed for:

▪ How long the child has had diarrhoea

▪ Blood in the stool to determine if the child has dysentery
▪ Signs of dehydration.

Classify DYSENTERY
▪ Child with diarrhea and blood in the stool

▪ If child has no other severe classification:

▪ Give fluid for severe dehydration ( Pl
Two of the following signs? C ) OR
▪ Abnormally sleepy or ▪ If child has another severe classification :
difficult to awaken ▪ Refer URGENTLY to hospital with mot
▪ Sunken eyes giving frequent sips of ORS on the way
▪ Not able to drink or ▪ Advise the mother to continue
drinking poorly SEVERE breastfeeding
▪ Skin pinch goes back very DEHYDRATION ▪ If child is 2 years or older and there is choler
slowly in your area, give antibiotic for cholera

▪ Give fluid and food for some dehydration ( P

B)
Two of the following signs : ▪ If child also has a severe classification :
▪ Refer URGENTLY to hospital with
▪ Restless, irritable mot giving frequent sips of ORS on the way
▪ Sunken eyes SOME ▪ Advise mother when to return
▪ Drinks eagerly, thirsty DEHYDRATION immediately
▪ Skin pinch goes back slowly ▪ Follow up in 5 days if not improving

▪ Home Care
▪ Give fluid and food to treat diarrhea at hom
▪ Not enough signs to ( Plan A )
classify as some or severe NO DEHYDRATION ▪ Advise mother when to return immediately
dehydration ▪ Follow up in 5 days if not improving

SEVERE ▪ Treat dehydration before referral unless the

PERSISTENT child has another severe classification
DIARRHEA ▪ Give Vitamin a
▪ Dehydration present ▪ Refer to hospital

▪ Advise the mother on feeding a child who ha

PERSISTENT persistent diarrhea
DIARRHEA ▪ Give Vitamin A
▪ No dehydration ▪ Follow up in 5 days
 ▪ Treat for 5 days with an oral antibiotic
recommended for Shigella in your area
▪ DYSENTERY ▪ Follow up in 2 days
Blood in the stool ▪ Give also referral treatment
Does the child have fever?

**Decide:

▪ Malaria Risk
▪ No Malaria Risk
▪ Measles
▪ Dengue

Malaria Risk

▪ Give first dose of quinine ( under medical supervision

if a hospital is not accessible within 4hrs )
▪ Give first dose of an appropriate antibiotic
VERY SEVERE ▪ Treat the child to prevent low blood sugar
FEBRILE DISEASE / ▪ Give one dose of paracetamol in health center for hig
▪ Any general fever (38.5oC) or above
danger sign or MALARIA ▪ Send a blood smear with the patient
▪ Stiff neck ▪ Refer URGENTLY to hospital
▪ Blood smear ( +
)

If blood smear not

done: ▪ Treat the child with an oral antimalarial

▪ Give one dose of paracetamol in health center for hig
▪ NO runny nose, fever (38.5oC) or above
and ▪ Advise mother when to return immediately
▪ NO measles, and ▪ Follow up in 2 days if fever persists
▪ NO other causes ▪ If fever is present everyday for more than 7 days,
MALARIA
of fever ref for assessment

▪ Give one dose of paracetamol in health center for hig

▪ Blood smear fever (38.5oC) or above
( – ), or ▪ Advise mother when to return immediately
▪ Runny nose, or FEVER : MALARIA ▪ Follow up in 2 days if fever persists
▪ Measles, or UNLIKELY ▪ If fever is present everyday for more than 7 days,
Other causes of fever ref for assessment

No Malaria Risk

▪ Give first dose of an appropriate antibiotic

▪ Treat the child to prevent low blood sugar
▪ Any general danger VERY SEVERE ▪ Give one dose of paracetamol in health center for
sign or FEBRILE DISEASE high fever (38.5oC) or above
▪ Stiff neck ▪ Refer URGENTLY to hospital
▪ No signs of very FEVER : NO ▪ Give one dose of paracetamol in health center for
severe febrile disease MALARIA high fever (38.5oC) or above
▪ Advise mother when to return immediately
▪ Follow up in 2 days if fever persists
 ▪ If fever is present everyday for more than 7
days, refer for assessment

Measles

▪ Give Vitamin A
▪ Clouding of cornea ▪ Give first dose of an appropriate antibiotic
or SEVERE COMPLICATED ▪ If clouding of the cornea or pus draining fro
▪ Deep or extensive the eye, apply tetracycline eye ointment
MEASLES
mouth ulcers ▪ Refer URGENTLY to hospital

▪ Give Vitamin A
▪ If pus draining from the eye, apply tetracycli
▪ Pus draining from MEASLES WITH EYE OR eye ointment
the eye or MOUTH COMPLICATIONS ▪ If mouth ulcers, teach the mother to treat
▪ Mouth ulcers w
gentian violet
▪
Measles now or MEASLES
within the last 3 months ▪ Give Vitamin A
Dengue Fever
▪ Bleeding from nose or
gums or
▪ Bleeding in stools or
vomitus or
▪ Black stools or vomitus
or
▪ Skin petechiae or
▪ Cold clammy extremities ▪ If skin petechiae or Tourniquet test,are
or th only positive signs give ORS
▪ Capillary refill more than ▪ If any other signs are positive, give fluids
3 seconds or rapidly as in Plan C
▪ Abdominal pain or ▪ Treat the child to prevent low blood suga
SEVERE DENGUE
▪ Vomiting ▪ DO NOT GIVE ASPIRIN
HEMORRHAGIC FEVER
▪ Tourniquet test ( + ) ▪ Refer all children Urgently to hospital

▪ DO NOT GIVE ASPIRIN

▪ Give one dose of paracetamol in health
center for high fever (38.5oC) or above
FEVER: DENGUE ▪ Follow up in 2 days if fever persists or chi
▪ No signs of severe shows signs of bleeding
HEMORRHAGIC UNLIKELY
dengue hemorrhagic fever ▪ Advise mother when to return immediatel

Does the child have an ear problem?

▪ Give first dose of

appropriate antibiotic
▪ Give paracetamol fo
MASTOIDITIS pain
▪ Tender swelling behind the ear ▪ Refer URGENTLY
▪ Pus seen draining from the ear and discharge is ACUTE EAR ▪ Give antibiotic for 5
reported for less than 14 days or INFECTION days
▪ Ear pain ▪ Give paracetamol
pain
for
 ▪ Dry the ear by
▪ wickin Follow up in
5 days
▪
CHRONIC EAR
Pus seen draining from the ear and discharge is INFECTION ▪ Dry the ear by
reported for less than 14 days ▪ wickin Follow up in
5 days
▪ NO EAR
INFECTION ▪ No additional
Check No
forear pain and no and
Malnutrition pus seen draining from the ear
Anemia treatment

Give an Appropriate Antibiotic:

A. For Pneumonia, Acute ear infection or Very Severe disease

COTRIMOXAZOLE AMOXYCILLIN

BID FOR 5 DAYS BID FOR 5 DAYS

Adult Tablet Syrup

Age or Weight tablet Syrup

2 months up to 12 months

( 4 – < 9 kg ) 1/2 5 ml 1/2 5 ml

12 months up to 5 years (
10
1 7.5 ml 1 10 ml
– 19kg )

B. For Dysentery

COTRIMOXAZOLE AMOXYCILLIN
 BID FOR 5 DAYS

BID FOR 5 DAYS

TABLET SYRUP SYRUP 250MG/5ML

AGE OR WEIGHT

2 – 4 1.25 ml ( ¼ tsp )

months ( 4 ½

– < 6kg ) 5 ml

4 – 12 ½ 2.5 ml ( ½ tsp )

months ( 6 – 5 ml

< 10 kg )

1 – 5 years old 1 ( 1 tsp )

( 10 – 19 kg ) 7.5 ml

C. For Cholera

TETRACYCLINE COTRIMOXAZOLE

QID FOR 3 DAYS BID FOR 3 DAYS

 AGE OR WEIGHT Capsule 250mg Tablet Syrup

2 – 4 months ( 4 – < 6kg ) ¼ 1/2 5ml

4 – 12 months ( 6 – < 10 kg ) ½ 1/2 5 ml

1 – 5 years old ( 10 – 19 kg) 1 1 7.5ml

Give an Oral Antimalarial

Primaquine

Give single
Primaquine
CHOLOROQUINE
dose in
Sulfadoxine +
health Give daily
Give for 3 days Pyrimethamine
center for for 14 days

P. for P. Vivax Give single

dose
Falciparum

TABLET TABLET TABLET

AGE TABLET ( 150MG ) ( 15MG) ( 15MG) ( 15MG)

DAY1 DAY2 DAY3

2months

– ½ ½ ½ ¼

5months
 5 months –

12 months ½ ½ ½ 1/2

12months –

3 years old

1 1 ½ ½ ¼ ¾

3 years old –

5 years old 1½ 1½ 1 3/4 1/2 1

GIVE VITAMIN A

AGE VITAMIN A CAPSULES 200,000 IU

6 months – 12 months 1/2

12 months – 5 years old 1

GIVE IRON

Iron/Folate Tablet Iron Syrup

FeSo4 200mg + 250mcg Folate (60mg FeSo4 150 mg/5ml
AGE or WEIGHT elemental iron) (6mg elemental iron per ml )

2months-4months
(4 – <6kg ) 2.5 ml

4months – 12months
(6 – <10kg ) 4 ml

12months – 3 years (10

– <14kg) 1/2 5 ml
 3years – 5 years ( 14 – 19kg
) 1/2 7.5 ml

GIVE PARACETAMOL FOR HIGH FEVER (38.5oC OR MORE) OR EAR PAIN

AGE OR WEIGHT TABLET ( 500MG ) SYRUP ( 120MG / 5ML )

2 months – 3 years ( 4 – <14kg ) ¼ 5 ml

3 years up to 5 years (14 – 19 kg ) 1/2 10 ml

GIVE MEBENDAZOLE

▪ Give 500mg Mebendazole as a single dose in health center if :

▪ hookworm / whipworm are a problem in children in your area, and
▪ the child is 2 years of age or older, and
▪ the child has not had a dose in the previous 6 months

Management of a Child with an Ear Problem

Classification of Ear Infection
1. Mastoiditis – tender swelling behind the ear (in infants, swelling may be above the ear)
▪ Treatment
a. Antibiotics
b. Surgical intervention
2. Acute Ear Infection – pus draining from the ear for less than 2 weeks, ear pain, red, immobile
ear drum (Acute Otitis Media)
▪ Treatment
a. Cotrimoxazole,Amoxycillin,or Ampicillin
b. Dry the ear by wicking
3. Chronic Ear Infection – pus draining from the ear for more than 2 weeks (Chronic Otitis Media)
▪ Treatment
a. Most important & effective treatment: Keep the ear dry by wicking.
b. Paracetamol maybe given for pain or high fever.
c. Precautions for a child with a draining ear:
▪ Do not leave anything in the ear such as cotton, wool
between wicking treatments.
▪ Do not put oil or any other fluid into the ear.
▪ Do not let the child go swimming or get water in the ear.
 Maternal and Child Health Nursing Program
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 complication – referred to most skilled source of
medical and hospital care

Home Based Mother’s 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
▪ 1st – as early as pregnancy, 1st trimester
▪ 2nd – 2nd trimester
▪ 3rd & subsequent visits – 3rd trimester
▪ More frequent visits for those at risk with complications
 Tetanus Toxiod Immunization Schedule for Women
Per
cent
Prot
Vac Minimum ecte
cine Age Interval d Duration of Protection

As early as
possible during
TT1 pregnancy 0% None

At least 4 weeks Infants born to the mother will be protected from neonatal tetanus. Gives
TT2 later 80% years protection for the mother from the tetanus.

Infants born to the mother will be protected from neonatal tetanus.

At least 6 months
TT3 later 90% Gives 5 years protection for the mother.

At least 1 year
TT4 later 99% Gives 10 years protection for the mother

At least 1 year Gives lifetime protection for the mothers. All Infants born to that mother
TT5 later 99% be protected.

Dose: 0.5ml

Route: Intramuscular

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, Leopold’s 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 5th 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
 Non-Communicable Diseases and
Rehabilitation
Prevention and Control of Cardiovascular Diseases
▪ heart – 1st leading cause of death ; blood vessels – 2nd
▪ Congenital Heart Disease (CHD): Result of the abnormal development of the heart
that exhibits septal defect, patent ductus arteriosus, aortic and pulmonary stenosis, and
cyanosis; most prevalent in children
▪ Causes: environmental factors, maternal diseases or genetic aberrations
▪ Rheumatic Fever or Rheumatic Heart Disease: Systematic inflammatory disease
that may develop as a delayed reaction to repeated and an inadequately treated infection of
the upper respiratory tract by group A beta-hemolytic streptococci.
▪ Hypertension: Persistent elevation of the arterial blood pressure.(primary or
essential) ;frequent among females but severe, malignat form is more common among males
▪ Ischemic Heart Disease/ Atherosclerosis: Condition usually caused by the
occlusion of the coronary arteries by thrombus or clot formation.
▪ higher among males than females for the latter are protected by
estrogen before menopause
▪ Predisposing Factor: Hypertension (HPN),Diabetes Mellitus (DM), Smoking
▪ Minor Risk Factor: stress, strong family history, obesity

Cardiovascular Disease
Period of Life Type of CVD Prevalence

At birth to early 2/ 1000 school children (aged 5-15

childhood Congenital Heart Disease yrs. old)

1/1000 school children (aged 5-15 y

Early to late childhood Rheumatic Fever/ Rheumatic Heart Disease old)

Diseases of Heart Muscles Essential

Early Adulthood Hypertension 10/100 adults

Middle age to old age Coronary Artery Disease Cerebrovascular 5/100 adults

Accident
 Cardiovascular Disease
Diseases Causes/ Risk factors

Congenital Heart Disease Maternal Infections, Drug intake, Maternal Disease, Genetic

Rheumatic Fever/Rheumatic Heart

Disease Frequent Streptoccocal Sore Throat

Essential Hypertension Heredity, High Salt Intake

Coronary Artery Disease Smoking, Obesity, Hypertension, Stress Hyperlipidemia, Diabetes Mellitus
(Heart Attack) Sedentary Life Style

Cerebrovascular Accident
(Stroke) Hypertension, Arteriosclerosis

Primary Prevention: CVD

Disease Primordial Specific Protection

Congenital Heart ▪ Prevention of viral infection and intake of ▪ Adequate treatment of

harmful drugs during pregnancy. viral infection during pregnanc
Disease ▪ Avoidance of marriage between blood ▪ Genetic counseling of
relatives blood related married couples.

Rheumatic Heart ▪ Identification of cases o

▪ Prevention of recurrent sore throat thru rheumatic fever
Disease adequate environmental sanitation; avoidance of ▪ Prophylaxis with penicill
overcrowding; adequate treatment or erythromycin

Essential
▪ From early childhood
Hypertension ▪
low salt diet ▪ Continued low salt diet
▪
adequate physical exercise adequate exercise

▪ cessation of smoking
Coronary Heart ▪ Prevention of development/ acquisition of risk ▪ control /treatment of
Disease (Heart factors diabetes, hypertension
▪ cigarette smoking ▪ weight reduction
Attack) ▪ high fat intake ▪ change to proper diet
▪ high salt intake ▪ Adjustment of
activities
Cerebrovascular ▪ all measures to prevent hypertension & ▪ all measures to control
Accident arteriosclerosis hypertension & progression of

(Stroke)
arteriosclerosis

Primary Prevention thru health education is the main focus of the program:
 1. Maintenance of ideal body wt.
2. diet – low fat
3. alcohol/smoking avoidance
4. exercise
5. regular BP check up

Cancer Prevention and Early Detection

▪ Any malignant tumor arising from the abnormal and uncontrolled division of cells
causing the destruction in the surrounding tissues.
▪ Common Cancer: Lung cancer, cervical cancer, colon cancer, cancer of the mouth,
breast cancer, skin cancer, prostate cancer.
▪ 3rd leading cause of illness and death (Phil.)
▪ Incidence can only be reduced thru prevention and early detection

Nine Warning Signs of Cancer:

▪ Change in blood bowel or bladder habits
▪ A sore that does not heal
▪ Unusual bleeding or discharge
▪ Thickening or lump in breast or elsewhere
▪ Indigestion or difficulty in swallowing
▪ Obvious change in wart or mole
▪ Nagging cough or hoarseness
▪ Unexplained anemia
▪ Sudden unexplained weight loss

Prevention & Early Detection

CA
type Prevention Detection

Lung No smoking None

Uterin
e Monogamy, Safe sex Pap’s smear every 1-3 yrs

Cervic
al Monogamy, Safe sex Pap’s smear every 1-3 yrs

Hep B vaccination, Less alcohol intake,

Liver Avoidance of moldy foods None

Regular medical checkup

Colon High fiber diet after 40 yrs of age

Rectu
m Low fat intake Fecal occult blood test DRE Sigmoidoscopy

No smoking, betel nut chewing, Oral

Mouth hygiene Regular dental check-ups

Monthly SBE, Yearly exam by doctor, Mammography

Breast none fo 50 yrs old and above females
Skin No excessive sun exposure Assessment of skin

Prosta
te none Digital transrectal exam

Principles of Treatment of Malignant Diseases

▪ One third of all cancers are curable if detected early and treated properly.

Three major forms of treatment of cancer:

1. Surgery
2. Radiation Therapy
3. Chemotherapy

Nat’l Diabetes Prevention and Control Program

Aim:
▪ Controlling and assimilating healthy lifestyle in the Filipino culture (2005- 2010) thru IEC

Main Concern:
▪ modifiable risk factors ( diet, body wt., smoking, alcohol, stress, sedentary living, birth wt.
,migration

Prevention and Control of Kidney Disease

1. Acute or Rapidly Progressive Renal Failure : A sudden decline in renal function

resulting from the failure of the renal circulation or by glomerular or tubular damage causing the
accumulation of substances that is normally eliminated in the urine in the body fluids leading to
disruption in homeostatic, endocrine, and metabolic functions.
2. Acute Nephritis: A severe inflammation of the kidney caused by infection, degenerative
disease, or disease of the blood vessels.
3. Chronic Renal Failure: A progressive deterioration of renal function that ends as uremia
and its complications unless dialysis or kidney transplant is performed.
4. Neprolithiasis: A disorder characterized by the presence of calculi in the kidney.
5. Nephrotic Syndrome: A clinical disorder of excessive leakage of plasma proteins into
the urine because of increased permeability of the glomerular capillary membrane
6. Urinary Tract Infection: A disease caused by the presence of pathogenic
microorganisms in the urinary tract with or without signs and symptoms.
7. Renal Tubular Defects: An abnormal condition in the reabsorption of selected materials
back into the blood and secretion, collection, and conduction of urine.
8. Urinary Tract Obstruction: A condition wherein the urine flow is blocked or clogged.

Program on Mental Health and Mental Disorders

Mental Health
▪ Mental health is not merely the absence of mental illness. According to the World
Health Organization (WHO) Manual on Mental Health, a person is in a state of sound
mental health when,
▪ o He feels physically well
▪ o His thought are organized
▪ o His feelings are modulated
▪ o His behaviors are coordinated and appropriate
(*note: behaviors considered “normal” may vary according to cultural norms)
▪ Any person may develop mental illness regardless of race, nationality, age, sex civil
status and socio-economic background may develop mental illness.

Causes of Mental Illness

A Combination or One of These:

1. Biological factors
▪ Like hereditary predisposition, poor nutrition
2. Physical Factors
▪ Physical injuries, intoxication
3. Psychological Factors
▪ Failure to adjust to the difficulties in life.
4. Socio-economic Factors
▪ Unemployment, housing problems

How is Mental Illness Detected?

1. Interview and assessment by the Clinical Social Worker.

2. Psychological testing and evaluation.
3. Psychiatric interview and mental status examination.

Is Mental Illness Curable?

▪ Yes. Mental illness is curable if detected early and prompt and adequate treatment
is given. Treatment depends on severity of illness and includes:
▪ Pharmacotherapy (use of medicines)
▪ Various therapies (physical, recreational, occupational, environmental)
▪ Psychotherapy and others

Prevention of Mental Illness

1. Maintain good physical health.
2. Choose worthwhile activities and develop a hobby
3. Solve problems as they come and avoid excessive worrying.
4. Cultivate friendships and choose a friend to confide in.
5. Strike a happy medium between work and play.
6. Recognize early signs and symptoms.

Some Early Signs of Symptoms Mental Illness

▪ Persistent disturbance in sleep and appetite
▪ Over sensitiveness and excessive irritability
▪ Loss of interest in activities or responsibilities of previous concern
▪ Constant complaint of headaches, weakness of hands and feet and other bodily complaints.
▪ Persistent seclusion of oneself from other people.
▪ Frequent attacks of palpitations usually expressed as “nerbiyos” & associated with
unexplained fears.
▪ Frequent attacks of dizziness & fainting.
▪ Exaggerated and /or unfounded suspicions
▪ Persistent worrying, forgetfulness & absentmindedness.

Program on Drug Dependence/ Substance Abuse

Community-Based Rehabilitation Program

▪ A creative application of the primary health care approach in rehabilitation services,
which involves measures taken at the community level to use and build on the resources of the
community with the community people, including impaired, disabled and handicapped persons as
well.
 Goal
▪ To improve the quality of life and increase productivity of disabled, handicapped persons.

Aim:
▪ To reduce the prevalence of disability through prevention, early detection and
provision of rehabilitation services at the community level.

Program on the Elderly/Geriatric Nursing Services

Leading causes of illness: elderly

▪ Influenza, HPN, diarrhea,
▪ bronchitis, TB, diseases. of the heart,
▪ pneumonia, malaria,
▪ malignant neoplasm, chickenpox

Leading causes of death: elderly

▪ Diseases of heart and vascular system
▪ Pneumonia, TB, CCOPD
▪ Malignant neoplasms
▪ Diabetes
▪ Nephritis
▪ Accidents

Programs on Blindness, Deafness and Osteoporosis

▪ Cataract- main causes of blindness

▪ VAD- main cause of childhood blindness; most serious eye problem of Filipino children
below 6 yrs. old
▪ Osteoporosis special problem in women, highest bet. 50—79 yrs. old, MENOPAUSE main cause

Nursing Procedures in the Community

 Clinic Visit
▪ process of checking the client’s 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

Thermometer Technique

▪ to assess the client’s 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

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
physician’s written prescription
▪ can be done only by nurses accredited by ANSAP
 Family Planning Program
Overview
▪ The Philippine Family Planning Program is a national program that systematically
provides information and services needed by women of reproductive age to plan their families
according to their own beliefs and circumstances.

Goals and Objectives

▪ Universal access to family planning information, education and services.

Mission
▪ To provide the means and opportunities by which married couples of reproductive age
desirous of spacing and limiting their pregnancies can realize their reproductive goals.

Types of Methods

NATURAL METHODS
a. Calendar or Rhythm Method
b. Basal Body Temperature Method
c. Cervical Mucus Method
d. Sympto-Thermal Method
e. Lactational Amennorhea

ARTIFICIAL METHODS
a. Chemical Methods
i. Ovulation suppressant such as PILLS
ii. Depo-Provera
iii. Spermicidals
iv. Implant
b. Mechanical Methods
i. Male and Female Condom
ii. Intrauterine Device
iii. Cervical Cap/Diaphragm
c. Surgical Methods
i. Vasectomy
ii. Tubal Ligation

Warning Signs

Pills
▪ Abdominal pain (severe)
▪ Chest pain (severe)
▪ Headache (severe)
▪ Eye problems (blurred vision, flashing lights, blindness)
▪ Severe leg pain (calf or thigh)
▪ Others: depression, jaundice, breast lumps

IUD
▪ Period late, no symptoms of pregnancy, abnormal bleeding or spotting
▪ Abdominal pain during intercourse
▪ Infection or abnormal vaginal discharge
▪ Not feeling well, has fever or chills
▪ String is missing or has become shorter or longer

Injectables
▪ Dizziness
▪ Severe headache
▪ Heavy bleeding

BTL
▪ Fever
▪ Weakness
▪ Rapid pulse
▪ Persistent abdominal pain
▪ Vomiting
▪ Dizziness
▪ Pus or tenderness at incision site
▪ Amenorrhea

Vasectomy
▪ Fever
▪ Scrotal blood clots or excessive swelling
COPAR NURSING

Community Organizing Participatory Action Research (COPAR) - is a continuous and a sustained process of:
1. Educating the people - to understand and develop their critical consiousness
2. Working with people - to work collectively and effectively on their immediate and long term problems
3. Mobilizing with people - develop their capability and readiness to respond, take action on their
immediate needs towards solving the long term problems

The process and structure through which members of a community are/or become organized for participation
in health care and community development activities

Process:
- the sequence of steps whereby members of a community come together to critically assess to evaluate
community conditions and work together to improve those conditions.

Structure:
- refers to a particular group of community members that work together for a common health and health
related goals.

Emphasis of COPAR:
1. Community working to solve its own problem
2. Direction is established internally and externally
3. Development and implementation of a specific project less important than the development of the
capacity of the community to establish the project
4. Consciousness raising involves perceiving health and medical care within the total structure of society

Importance of COPAR:
 COPAR maximizes community participation and involvement
 COPAR could be an alternative in situations wherein health interventions in Public Health Care do not
require direct involvement of modern medical practitioners
 COPAR gets people actively involved in selection and support of community health workers
 Through COPAR, community resources are mobilized for selected health services
 COPAR improves both projects effectiveness during implementation

Phases of COPAR Process:

1. Pre-Entry Phase - is the intial phase of the organizing process where the community organizer looks
for communities to serve and help. Acitivities include:

Preparation of the Institution

o Train faculty and students in COPAR.

o Formulate plans for institutionalizing COPAR.
o Revise/enrich curriculum and immersion program.
o Coordinate participants of other departments.

Site Selection

o Initial networking with local government.

o Conduct preliminary special investigation.
o Make long/short list of potential communities.
o Do ocular survey of listed communities.
Criteria for Initial Site Selection

o Must have a population of 100-200 families.

o Economically depressed.
o No strong resistance from the community.
o No serious peace and order problem.
o No similar group or organization holding the same program.

Identifying Potential Municipalities

o Make long/short list.

Identifying Potential Barangay

o Do the same process as in selecting municipality.

o Consult key informants and residents.
o Coordinate with local government and NGOs for future activities.

Choosing Final Barangay

o Conduct informal interviews with community residents and key informants.

o Determine the need of the program in the community.
o Take note of political development.
o Develop community profiles for secondary data.
o Develop survey tools.
o Pay courtesy call to community leaders.
o Choose foster families based on guidelines.

Identifying Host Family

o House is strategically located in the community.

o Should not belong to the rich segment.
o Respected by both formal and informal leaders.
o Neighbors are not hesitant to enter the house.
o No member of the host family should be moving out in the community.

2. Entry Phase - sometimes called the social preparation phase. Is crucial in determining which
strategies for organizing would suit the chosen community. Success of the activities depend on how
much the community organizers has integrated with the commuity.

Guidelines for Entry

o Recognize the role of local authorities by paying them visits to inform their presence and activities.
o Her appearance, speech, behavior and lifestyle should be in keeping with those of the community
residents without disregard of their being role model.
o Avoid raising the consciousness of the community residents; adopt a low-key profile.

Activities in the Entry Phase

o Integration - establishing rapport with the people in continuing effort to imbibe community life.
 living with the community
 seek out to converse with people where they usually congregate
  lend a hand in household chores
 avoid gambling and drinking

o Deepening social investigation/community study

 verification and enrichment of data collected from initial survey
 conduct baseline survey by students, results relayed through community assembly

Core Group Formation

o Leader spotting through sociogram.

Key persons - approached by most people

Opinion leader - approach by key persons
Isolates - never or hardly consulted

3. Organization-building Phase

Entails the formation of more formal structure and the inclusion of more formal procedure of planning,
implementing, and evaluating community-wise activities. It is at this phase where the organized leaders
or groups are being given training (formal, informal, OJT) to develop their style in managing their own
concerns/programs.

Key Activities

o Community Health Organization (CHO)

 preparation of legal requirements
 guidelines in the organization of the CHO by the core group
 election of officers
o Research Team Committee
o Planning Committee
o Health Committee Organization
o Others
o Formation of by-laws by the CHO

4. Sustenance and Strengthening Phase

Occurs when the community organization has already been established and the community members are
already actively participating in community-wide undertakings. At this point, the different committees
setup in the organization-building phase are already expected to be functioning by way of planning,
implementing and evaluating their own programs, with the overall guidance from the community-wide
organization.

Key Activities

o Training of CHO for monitoring and implementing of community health program.

o Identification of secondary leaders.
o Linkaging and networking.
o Conduct of mobilization on health and development concerns.
o Implementation of livelihood projects.
Department of Health (DOH) Philippines
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, and Iron
Deficiency Anemia & Obesity.
3. Eliminate the ff. diseases as public health problems:
a. Schistosomiasis
b. Malaria
c. Filariasis
d. Leprosy
e. Rabies
f. Measles
g. Tetanus
h. Diphtheria & Pertussis
i. 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, women’s 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.

Community Assessment
Community Assessment
 Status
 Structure
 Process
Types of Community Assessment
Community Diagnosis
 A process by which the nurse collects data about the community in order to identify
factors which may influence the deaths and illnesses of the population, to formulate a
community health nursing diagnosis and develop and implement community health
nursing interventions and strategies.
2 Types:
Comprehensive Community Diagnosis  Problem-Oriented Community Diagnosis

 aims to obtain general information about the  type of assessment responds to a

community particular need
    Steps:
    Preparatory Phase
1. site selection
2. preparation of the community
3. statement of the objectives
4. determine the data to be collected
5. identify methods and instruments for data collection
6. finalize sampling design and methods
7. make a timetable
Implementation Phase
1. data collection
2. data organization/collation
3. data presentation
4. data analysis
5. identification of health problems
6. prioritization of health problems
7. development of a health plan
8. validation and feedback

Evaluation Phase
Biostatistics
 DEMOGRAPHY – study of population size, composition and spatial distribution as
affected by births, deaths and migration.
 Sources: Census – complete enumeration of the population
2 Ways of Assigning People
1. De Jure – People were assigned to the place where assigned to the place they usually
live regardless of where they are at the time of census.
2. De Facto – People were assigned to the place where they are physically present at are
at the time of census regardless, of their usual place of residence.
Components
1. Population size
2. Population composition
 Age Distribution
 Sex Ratio
 Population Pyramid
 Median age – age below which 50% of the population falls and above which 50% of
the population falls. The lower the median age, the younger the population (high
fertility, high death rates).
 Age – Dependency Ratio – used as an index of age-induced economic drain on
human resources
 Other characteristics:
 occupational groups
 economic groups
 educational attainment
 ethnic group
3. Population Distribution
 Urban-Rural – shows the proportion of people living in urban compared to the
rural areas
 Crowding Index – indicates the ease by which a communicable disease can be
transmitted from 1 host to another susceptible host.
  Population Density – determines congestion of the place

Vital Statistics
 The application of statistical measures to vital events (births, deaths and common
illnesses) that is utilized to gauge the levels of health, illness and health services of
a community.
Types of Vital Statistics

Fertility Rate
1. Crude Birth Rate
Total # of livebirths in a given calendar year                          X 1000
  Estimated population as of July 1 of the same given year

2. General Fertility Rate

Total # of livebirths in a given calendar year                     X 1000
  Total number of reproductive age

Mortality Rate
1. Crude Death Rate
_Total # of death in a given calendar year_                        X 1000
  Estimated population as of July 1 of the same calendar year

2. Infant Mortality Rate

Total # of death below 1 yr in a given calendar year              X 1000
Estimated population as of July 1 of the same calendar year

3. Maternal Mortality Rate

Total # of death among all maternal cases in a given calendar year          X 1000
Estimated population as of July 1 of the same calendar year

Morbidity Rate
1. Prevalence Rate
Total # of new & old cases in a given calendar year                     X 100
Estimated population as of July 1 of the same calendar year

2. Incidence Rate
Total # of new cases in a given calendar year_                            X 100
     Estimated population as of July 1 of the same calendar year
3. Attack Rate
Total # of person who are exposed to the disease                         X 100
    Estimated population as of July 1 of the same calendar year

Epidemiology
 the study of distribution of disease or physiologic condition among human population s
and the factors affecting such distribution
 the study of the occurrence and distribution of health conditions such as disease, death,
deformities or disabilities on human populations
1. Patterns of disease occurrence
  Epidemic
 A situation when there is a high incidence of new cases of a specific disease in
excess of the expected.
 when the proportion of the susceptible are high compared to the proportion of the
immunes
  
 Epidemic potential
 an area becomes vulnerable to a disease upsurge due to causal factors such as
climatic changes, ecologic changes, or socio-economic changes
  Endemic
 habitual presence of a disease in a given geographic location accounting for the low
number of both immunes and susceptibles.E.g. Malaria is a disease endemic at
Palawan.
 The causative factor of the disease is constantly available or present to the area.
  
Sporadic
 disease occurs every now and then affecting only a small number of people relative to
the total population
 intermittent

 Pandemic
 global occurrence of a disease
    
Steps in Epidemiological Investigation:
1. Establish fact of presence of epidemic
2. Establish time and space relationship of the disease
3. Relate to characteristics of the group in the community
4. Correlate all data obtained

2. Role of the Nurse

 Case Finding
 Health Teaching
 Counseling
 Follow up visit

Community Health Nurse Roles and

Functions
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 family’s capability to take care of the sick, disabled, or dependent
member

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
 Detects deviation from health of individuals, families, groups, and communities through
contacts/visits with them
Role Model
 Provides good example of healthful living to the members of the community
Change Agent
 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 Health Nursing: An Overview

Community
 a group of people with common characteristics or interests living together within a
territory or geographical boundary
 place where people under usual conditions are found
 Derived from a latin word “comunicas” which means a group of people.
Health
 OLOF (Optimum Level of Functioning)
 Health-illness continuum
 High-level wellness
 Agent-host-environment
 Health belief
 Evolutionary-based
 Health promotion
 WHO definition
Community Health
 Part of paramedical and medical intervention/approach which is concerned on the health
of the whole population
 Aims:
1. Health promotion
2. Disease prevention
3. Management of factors affecting health
Nursing
 Both profession & a vocation. Assisting sick individuals to become healthy and healthy
individuals achieve optimum wellness
Community Health Nursing
 “The utilization of the nursing process in the different levels of clientele-individuals,
families, population groups and communities, concerned with the promotion of health,
prevention of disease and disability and rehabilitation.” ( Maglaya, et al)
 Goal: “To raise the level of citizenry by helping communities and families to cope with the
discontinuities in and threats to health in such a way as to maximize their potential for
high-level wellness” ( Nisce, et al)
 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)
 A learned practice discipline with the ultimate goal of contributing as individuals and in
collaboration with others to the promotion of the client’s 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 promotion of health, prevention of illness, care of the
sick at home and rehabilitation (DR. Ruth B. Freeman)
Public Health
 “Public Health is directed towards assisting every citizen to realize his birth rights and
longevity.”“The science and art of preventing disease, prolonging life and efficiency
through organized community effort for:
1. The sanitation of the environment
2. The control of communicable infections
3. The education of the individual in personal hygiene
4. The organization of medical and nursing services for the early diagnosis and preventive
treatment of disease
5. The development of a social machinery to ensure every one a standard of living,
adequate for maintenance of health to enable every citizen to realize his birth right of
health and longevity (Dr. C.E Winslow)
Mission of CHN
 Health Promotion
 Health Protection
 Health Balance
 Disease prevention
 Social Justice
Philosophy of CHN
 “The philosophy of CHN is based on the worth and dignity on the worth and dignity of
man.”(Dr. M. Shetland)
Basic Principles of CHN
1. The community is the patient in CHN, the family is the unit of care and there are four levels
of clientele: individual, family, population group (those who share common
characteristics, developmental stages and common exposure to health problems – e.g.
children, elderly), and the community.
2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care
3. CHN practice is affected by developments in health technology, in particular, changes in
society, in general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is a part of health care system and the larger human services system.
Roles of the PUBLIC HEALTH NURSE
 Clinician, who is a health care provider, taking care of the sick people at home or in the
RHU
 Health Educator, who aims towards health promotion and illness prevention through
dissemination of correct information; educating people
 Facilitator, who establishes multi-sectoral linkages by referral system
 Supervisor, who monitors and supervises the performance of midwives
 Health Advocator, who speaks on behalf of the client
 Advocator, who act on behalf of the client
 Collaborator, who working with other health team member
*In the event that the Municipal Health Officer (MHO) is unable to perform his
duties/functions or is not available, the Public Health Nurse will take charge of the MHO’s
responsibilities.

Other Specific Responsibilities of a Nurse, spelled by the implementing rules and

Regulations of RA 7164 (Philippine Nursing Act of 1991) includes:
 Supervision and care of women during pregnancy, labor and puerperium
 Performance of internal examination and delivery of babies
 Suturing lacerations in the absence of a physician
 Provision of first aid measures and emergency care
 Recommending herbal and symptomatic meds…etc.
In the care of the families:
 Provision of primary health care services
 Developmental/Utilization of family nursing care plan in the provision of care
In the care of the communities:
 Community organizing mobilization, community development and people empowerment
 Case finding and epidemiological investigation
 Program planning, implementation and evaluation
 Influencing executive and legislative individuals or bodies concerning health and
development
Responsibilities of CHN
 be a part in developing an overall health plan, its implementation and evaluation for
communities
 provide quality nursing services to the three levels of clientele
 maintain coordination/linkages with other health team members, NGO/government
agencies in the provision of public health services
 conduct researches relevant to CHN services to improve provision of health care
 provide opportunities for professional growth and continuing education for staff
development
Standards in CHN
1. Theory
 Applies theoretical concepts as basis for decisions in practice
2. Data Collection
 Gathers comprehensive, accurate data systematically
3. Diagnosis
 Analyzes collected data to determine the needs/ health problems of IFC
4. Planning
 At each level of prevention, develops plans that specify nursing actions unique to
needs of clients
5. Intervention
 Guided by the plan, intervenes to promote, maintain or restore health, prevent illness
and institute rehabilitation
6. Evaluation
 Evaluates responses of clients to interventions to note progress toward goal
achievement, revise data base, diagnoses and plan
7. 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
8. Interdisciplinary Collaboration
 Collaborates with other members of the health team, professionals and community
representatives in assessing, planning, implementing and evaluating programs for
community health
9. Research
 Indulges in research to contribute to theory and practice in community health nursing

Community Organizing Participatory

Action Research (COPAR)
Definitions of COPAR
 A social development approach that aims to transform the apathetic, individualistic and
voiceless poor into dynamic, participatory and politically responsive community.
 A collective, participatory, transformative, liberative, sustained and systematic process of
building people’s organizations by mobilizing and enhancing the capabilities and
resources of the people for the resolution of their issues and concerns towards effecting
change in their existing oppressive and exploitative conditions (1994 National Rural
Conference)
 A process by which a community identifies its needs and objectives, develops
confidence to take action in respect to them and in doing so, extends and develops
cooperative and collaborative attitudes and practices in the community (Ross 1967)
 A continuous and sustained process of educating the people to understand and develop
their critical awareness of their existing condition, working with the people collectively
and efficiently on their immediate and long-term problems, and mobilizing the people to
develop their capability and readiness to respond and take action on their immediate
needs towards solving their long-term problems (CO: A manual of experience, PCPD)
Importance of COPAR
1. COPAR is an important tool for community development and people empowerment as
this helps the community workers to generate community participation in development
activities.
2. COPAR prepares people/clients to eventually take over the management of a
development programs in the future.
3. COPAR maximizes community participation and involvement; community resources are
mobilized for community services.
Principles of COPAR
1. People, especially the most oppressed, exploited and deprived sectors are open to
change, have the capacity to change and are able to bring about change.
2. COPAR should be based on the interest of the poorest sectors of society
3. COPAR should lead to a self-reliant community and society.
COPAR Process
 A progressive cycle of action-reflection action which begins with small, local and concrete
issues identified by the people and the evaluation and the reflection of and on the action
taken by them.
 Consciousness through experimental learning central to the COPAR process because it
places emphasis on learning that emerges from concrete action and which enriches
succeeding action.
 COPAR is participatory and mass-based because it is primarily directed towards and
biased in favor of the poor, the powerless and oppressed.
 COPAR is group-centered and not leader-oriented. Leaders are identified, emerge and are
tested through action rather than appointed or selected by some external force or entity.
COPAR Phases of Process
1. Pre-entry Phase
 Is the initial phase of the organizing process where the community/organizer looks for
communities to serve/help.
 It is considered the simplest phase in terms of actual outputs, activities and strategies
and time spent for it
Activities include:

 Designing a plan for community development including all its activities and
strategies for care development.
 Designing criteria for the selection of site
 Actually selecting the site for community care
2. Entry Phase
 Sometimes called the social preparation phase as to the activities done here includes the
sensitization of the people on the critical events in their life, innovating them to share
their dreams and ideas on how to manage their concerns and eventually mobilizing them
to take collective action on these.
 This phase signals the actual entry of the community worker/organizer into the
community. She must be guided by the following guidelines however.

 Recognizes the role of local authorities by paying them visits to inform them of their
presence and activities.
 The appearance, speech, behavior and lifestyle should be in keeping with those of the
community residents without disregard of their being role models.
 Avoid raising the consciousness of the community residents; adopt a low-key profile.
3. Organization Building Phase
 Entails the formation of more formal structures and the inclusion of more formal
procedures of planning, implementation, and evaluating community-wide activities. It is
at this phase where the organized leaders or groups are being given trainings (formal,
informal, OJT) to develop their skills and in managing their own concerns/programs.
4. Sustenance and Strengthening Phase
 Occurs when the community organization has already been established and the
community members are already actively participating in community-wide undertakings.
At this point, the different communities setup in the organization building phase are
already expected to be functioning by way of planning, implementing and evaluating their
own programs with the overall guidance from the community-wide organization.
Strategies used may include:

 Education and training
 Networking and linkaging
 Conduct of mobilization on health and development concerns
 Implementing of livelihood projects
  Developing secondary leaders

Family Care Plan

Definition
 It is the blue print of the care that the nurse designs to systematically minimize or
eliminate the identified health and nursing problem through explicitly formulated
outcomes of care (goals and objectives) and deliberately chosen set of interventions,
resources and evaluation criteria, standards, methods and tools.
Characteristics, which are Based on the Concept of Planning as a
Process:
1. The nursing care plan focuses on actions, which are designed to solve or minimize
existing problem.
 The cores of the plan are the approaches, strategies, activities, methods and
materials, which the nurse hopes, will improve the problem.
2. The nursing care plan is a product of the liberate systematic process.
3. The nursing care plan as with all other plans relate to the future.
 It utilizes events in the past and what is happening in the present to determine
patterns. It also projects the future scenario if the situation is not corrected.
4. The nursing care plan is based upon identified health and nursing problems.
5. The nursing care plan is a means to an end, not an end in itself.
 The goal in planning is to deliver the most appropriate care to the client by
eliminating barriers to the family health development.
6. The nursing care plan is a continuous process not a one shot deal.
 The results of evaluation of the plan’s effectiveness trigger another cycle of the
planning process until the health and nursing problems are eliminated.
Desirable Qualities of a Nursing Care Plan
1. It should be based on clear, explicit definition of the problem(s).
2. A good plan is realistic.
3. The nursing care plan is prepared jointly with the family.
4. The nursing care plan is most useful in written form.
Importance of Planning Care
1. They individualize care to clients.
2. The nursing care plan helps in setting priorities by providing information about the client
as well as the nature of his problem.
3. The nursing care plan promotes systematic communication among those involve in the
health care effort.
4. Continuity of care is facilitated through the use of nursing care plans.
 Gaps and duplications in the services provided are minimized, if not totally
eliminated.
5. Nursing care plans facilitate the coordination of care by making known to other
members of the health team what the nurse is doing.
Steps in Developing Care Plan
1. The prioritized conditions of the problem
2. Goals and objectives of the nursing care
3. The plan of interventions
4. The plan for evaluating care
Prioritizing Health Problems
Four Criteria for Determining Priorities:
1. Nature of the condition or problem – categorized into wellness state/potential, health
threat, health deficit of foreseeable crisis.
2. Modifiability of the condition or problem-refers to the probability of success in enhancing
the wellness state improving the condition minimizing, alleviating or totally eradicating
the problem through intervention.
3. Preventive potential-refers to the nature and magnitude of future problem that can be
minimized or totally prevented if interventions are done on the condition or problem
under consideration.
4. Salience-refers to the family’s perception and evaluation of the condition or problem in
terms of seriousness and urgency of attention needed or family readiness.
Factors Affecting Priority Setting
Nature of the problem
 The biggest weight is given to the wellness state or potential because of the premium on
client’s effort or desire to sustain/maintain high level of wellness.
 The same weight is given to health deficit because of its sense of clinical urgency, which
may require immediate intervention.
 Foreseeable crisis is given the least weight because culture linked variables/factors
usually provide our families with adequate support to cope with developmental or
situational crisis.
Modifiability if the problem
 Current knowledge, technology and interventions to enhance the wellness state or
manage the problem.
 Resources of the family
 Resources of the nurse
 Resources of the community
Preventive potential
 Gravity or severity of the problem-refers to the progress of the disease/problem indicating
extent of damage on the patient/family; also indicates prognosis, reversibility or
modifiability of the problem. In general, the more severe the problem is, the lower is the
preventive potential of the problem.
 Duration of the problem-refers to the length of time the problem has existed. Generally
speaking, duration of the problem has a direct relationship to gravity; the nature of the
problem is variable that may, however, alter this relationship. Because of this relationship
to gravity of the problem, duration has also a direct relationship to preventive potential.
 Current management-refers to the presence and appropriateness of intervention measures
instituted to enhance the wellness state or remedy the problem. The institution of
appropriate intervention increases condition’s preventive potential.
 Exposure of any vulnerable or high risk group-increases the preventive potential of condition
or problem
Formulation of Goals and Objectives
 GOAL-is a general statement of condition or state to be brought about by specific
courses of action.
 OBJECTIVE-refers to a more specific statement of the desired results or outcomes of
care. They specify the criteria by which the degree of effectiveness of care is to be
measured.
*A cardinal principle in goal setting states that goal must be set jointly with the family. This
ensures family commitment to realization.

* Basic to the establishment of mutually acceptable goals is the family’s recognition and
acceptance of existing   health needs and problems.

Barriers to Joint Goal Setting Between the Nurse and the Family:
1. Failure on the part of the family to perceive the existence of the problem.
2. The family may realize the existence of the health condition or problem but is too busy at
the moment.
3. Sometimes the family perceives the existence of the problem but does not see it as
serious enough to warrant attention.
4. The family may perceive the presence of the problem and the need to take action. It may
however refuse to face and do something about the situation.
 Reasons to this kind of behavior:
a. Fear of consequences of taking actions.
b. Respect for tradition.
c. Failure to perceive the benefits of action.
d. Failure to relate the proposed action to the family’s goals.
5. A big barrier to collaborative goal setting between the nurse and the family is the working
relationship.
Focus on Interventions to Help The Family Performs Health Tasks:
1. Help the family recognize the problem
 Increasing the family’s knowledge on the nature, magnitude and cause of the
problem.
 Helping the family see the implications of the situation or the consequences of the
condition.
 Relating the health needs to the goals of the family.
 Encouraging positive or wholesome emotional attitude toward the problem by
affirming the family’s                    capabilities/qualities/resources and providing
information on available actions.
2. Guide the family on how to decide on appropriate health actions to take.
 Identifying  or exploring with the family courses of action available and the resources
needed for each.
 Discussing the consequences of action available.
 Analyzing with the family of the consequences of inaction.
3. Develop the family’s ability and commitment to provide nursing care to each member.
 Contracting-is a creative intervention that can maximize the opportunities to develop
the ability and commitment of the family to provide nursing care to its members.
4. Enhance the capability of the family to provide home environment conducive to health
maintenance and personal development.
 The family can be taught specific competencies to ensure such home environment
through environmental manipulation or management to minimize or eliminate health
threats or risks or to install facilities of nursing care.
5. Facilitate the family’s capability to utilize community resources for health care.
 Involves maximum use of available resources through the coordination, collaboration
and teamwork provided by effective referral system.
Criteria for Selecting the Type of Nurse Family Contact
1. Effectivity
2. Efficiency
3. Appropriateness
Types of Nurse Family Contact
Home Visit
 While it is expensive in terms of time, effort and logistics for the nurse, it is an effective
and appropriate type of family nurse contact if the objectives and outcomes of care
require accurate appraisal of family relationship, home and environment and family
competencies. i.e. The best opportunity to serve the actual care given by family
members.
Clinic or Office Conference
 It is less expensive for the nurse and provides the opportunity to use equipment that
can’t be taken to the home. In some cases, the other team members in the clinic may be
consulted or called in to provide additional service.
Telephone Conference
 May be effective, efficient, and appropriate if the objectives and outcomes of care require
immediate access to data given problems on distance or travel time. Such data include
monitoring of health status or progress during the acute phase of an illness state,
change in schedule of visit or family decision, and updates on outcomes or responses to
care and treatment.
Written Communication
 It is another less time consuming option for the nurse in instances when there are large
number of families needing follow-up on top of problems of distance or travel time.
School Visit or Conference
 It is done to work with family and school authorities on how to appraise the degree of
vulnerability of and worked out interventions to help children and adolescence on
specific health risks, hazards or adjustment problems.
Industrial or Job Site Visit
 It is done when the nurse and family need to make an accurate assessment of health
risks or hazards and work with employer or supervisor on what can be done to improve
on provisions for health and safety of workers.
Implementing the Nursing Care Plan
 During this phase, the nurse encounters the realities in family nursing practice that
motivates her to try out creative innovations or overwhelm her to frustration or inaction.
A dynamic attitude on personal and professional development is, therefore, necessary if
she has to face up challenges of nursing practice.
Implementation Phase: A Phenomenological Experience
 Meeting the challenges of this phase is the essence of family nursing practice. During
this phase, the nurse experiences with the family a lived meaningful world of mutual,
dynamic interchange of meanings, concerns, perceptions, biases, emotions and skills.
Just as the self aims to achieve body-mind integration to achieve wholeness in the
experience of “being” and “becoming” in expert caring. Unless there is such a dynamic
and active involvement between the nurse and the family in understanding and making
choices in this meaningful world of coping, aspirations, emotions and skills the nurse
can’t hope to achieve expert caring.
Expert Caring: Methods and Possibilities
 Expert caring in the implementation phase is demonstrated phase is demonstrated when
the nurse carries out interventions based on the family’s understanding of the lived
experience of coping and being in the world. Expert caring is developing the capability of
 the family for “engage care” through the nurses skilled practice, the family learns to
choose and carry out the best possibilities of caring given the meanings, concerns,
emotions and resources(skills & equipments) as experienced in the situation. While the
challenge for expert caring is a reality, the nurse is enriched as a result of such an
experience (Benner & Wrubel 1989).
 …By being experts in caring, nurses must takeover and transform the notions of
expertise. Expert caring has nothing to do with possessing privileged information that
increases one’s control and domination of another. Rather, expert caring unleashes the
possibilities inherent in the self and the situation. Expert caring liberates and facilitates in
such a way that the one caring is enriched in the process.
 While expert caring does not happen overnight to the novice nurse, there are methods
and possibilities that can enhance learning towards expert caring. Such methods and
possibilities need to be carried out and experienced in real contexts and real
relationships to achieve skillfully comportment and excellence in the current situation.
Two such major methods and possibilities:
1. Performance-focus learning through competency-based teaching
2. Maximizing caring possibilities for personal and professional development
Competency-Based Teaching
 A substantive part of the implementation phase is directed towards developing the
family’s competencies to perform the health tasks. Competencies include the cognitive
(knowledge), psychomotor (skills) and attitudinal or affective(emotions, feelings, values).
The following are examples of these family health competencies using the
corresponding health task in our case illustration:
 Health Task: The family recognizes the possibility of cross-infection of scabies to other
family members.
Cognitive Competency:
1. The family explains the cause of scabies
2. The family enumerates ways by which cross-infection of scabies can occur among the
family members.
3. Health Task: The family provides a home environment conducive to health maintenance
and personal development of its members.
Psychomotor Competency:
 The family carries out the agreed-upon measures to improve home sanitation and
personal hygiene of family members.
 Health Task: The family decides to take appropriate health action.
Attitudinal or Affective Competencies:
1. Family members express feelings or emotions that act as barriers to decision-making
2. Family members acknowledge the existence of these feelings or emotions.
 In order to systematically work towards development of the family’s competencies,
such competencies need to be explicitly defined. Cognitive and psychomotor
 competencies are reflected explicitly as objectives in the family nursing care plan.
The attitudinal or affective competencies may also be translated into objective of
care as feelings, emotions or philosophy in life that enhance the family’s desire or
commitment to behavior change and sustain the needed action.
Learning Principles and Teaching- Learning Methods and Techniques that the
Nurse Can Use in Competency-Based Teaching:
1. Learning is both intellectual and emotional process.
2. Learning is facilitated when experience has meaning.
3. Learning is individual matter.
Learning is Both Intellectual and Emotional Process
Six General Methods and Techniques:
1. Provide information to shape attitude
2. Provide experiential learning activities to shape attitudes
3. Provide examples or models to shape attitudes
4. Providing opportunities for small group discussion
5. Role playing exercises
6. Explore the benefits of power of silence
Learning is Facilitated When Experience Has Meaning
1. Analyze and process family members all teaching-learning based on their grasp on the
live experience of the situation in terms of the meaning for the self.
2. Involve the family actively in determining areas for teaching-learning based on the health
tasks that members made to perform.
3. Used examples or illustrations that the family is familiar with.
Learning is Individual Matter: Ensure Mastery of Competencies for Sustained
Actions:
Some Techniques to Develop Mastery:
1. Make the learning active by providing opportunities for the family to do specific activities,
answer questions or apply learning in solving problems.
2. Ensure clarity. Use words, examples, visual materials and handouts that the family can
understand.
3. Ensure adequate evaluation, feedback, monitoring and support for sustained action by:
 Explaining well how the family is doing
 Giving the necessary affirmations or reassurances
 Explaining how the skill can be improved
 Exploring with the family how modifications can be carried out to maximize situated
possibilities or best options.
 Family Coping Index
Purpose:
 To provide a basis for estimating the nursing needs of a particular family.
Health Care Need
A family health care need is present when:

1. The family has a health problem with which they are unable to cope.
2. There is a reasonable likelihood that nursing will make a difference in the in the family’s
ability to cope.
Relation to Coping Nursing Need:
 COPING may be defined as dealing with problems associated with health care with
reasonable success.
 When the family is unable to cope with one or another aspect of health care, it may be
said to have a “coping deficit”
Direction for Scaling
 Two parts of the Coping index:
1. A point on the scale
2. A justification statement
 The scale enables you to place the family in relation to their ability to cope with the nine
areas of family nursing at the time observed and as you would expect it to be in 3
months or at the time of discharge if nursing care were provided. Coping capacity is
rated from 1 (totally unable to manage this aspect of family care) to 5 (able to handle
this aspect of care without help from community sources). Check “no problem” if the
particular category is not relevant to the situation.
 The justification consists of brief statement or phrases that explain why you have rated
the family as you have.
General Considerations
1. It is the coping capacity and not the underlying problem that is being rated.
2. It is the family and not the individual that is being rated.
3. Rating should be done after 2-3 home visits when the nurse is more acquainted with the
family.
4. The scale is as follows:
 0-2 or no competence
 3-5 coping in some fashion but poorly
 6-8 moderately competent
  9 fairly competent
5. Justification- a brief statement that explains why you have rated the family as you have.
These statements should be expressed in terms of behavior of observable facts.
Example: “Family nutrition includes basic 4 rather than good diet.
6. Terminal rating is done at the end of the given period of time. This enables the nurse to
see progress the family has made in their competence; whether the prognosis was
reasonable; and whether the family needs further nursing service and where emphasis
should be placed.
Scaling Cues
 The following descriptive statements are “cues” to help you as you rate family coping.
They are limited to three points – 1 or no competence, 3 for moderate competence and 5
for complete competence.
Areas to Be Assessed
1. Physical independence: This category is concerned with the ability to move about to get out
of bed, to take care of daily grooming, walking and other things which involves the daily
activities.
2. Therapeutic Competence: This category includes all the procedures or treatment prescribed
for the care of ill, such as giving medication, dressings, exercise and relaxation, special
diets.
3. Knowledge of Health Condition: This system is concerned with the particular health
condition that is the occasion of care
4. Application of the Principles of General Hygiene: This is concerned with the family action in
relation to maintaining family nutrition, securing adequate rest and relaxation for family
members, carrying out accepted preventive measures, such as immunization.
5. Health Attitudes: This category is concerned with the way the family feels about health
care in general, including preventive services, care of illness and public health measures.
6. Emotional Competence: This category has to do with the maturity and integrity with which
the members of the family are able to meet the usual stresses and problems of life, and
to plan for happy and fruitful living.
7. Family Living: This category is concerned largely with the interpersonal with the
interpersonal or group aspects of family life – how well the members of the family get
along with one another, the ways in which they take decisions affecting the family as a
whole.
8. Physical Environment: This is concerned with the home, the community and the work
environment as it affects family health.
9. Use of Community Facilities: generally keeps appointments. Follows through referrals.
Tells others about Health Departments services
 Family Health Nursing
Definition of Family
Family
 Basic unit in society, and is shaped by all forces surround it.
 Values, beliefs, and customs of society influence the role and function of the family
(invades every aspect of the life of the family)
 Is a unit of interacting persons bound by ties of blood, marriage or adoption.
 Constitute a single household, interacts with each other in their respective familial
roles and create and maintain a common culture.
 An open and developing system of interacting personalities with structure and process
enacted in relationships among the individual members regulated by resources and
stressors and existing within the larger community (Smith & Maurer, 1995)
 Two or more people who live in the same household (usually), share a common
emotional bond, and perform certain interrelated social tasks (Spradly & Allender, 1996)
 An organization or social institution with continuity (past, present, and future). In which
there are certain behaviors in common that affect each other.
The Filipino Family
  Based on the Philippine Constitution, Family Code with focus on religious, legal, and
cultural aspects of the definition of family.
Section 1
 The state recognizes the Filipino family as the foundation of the nation. Accordingly, it
shall strengthen its solidarity and actively promote its total development
Section 2
 Marriage, as an inviolable social institution, is the foundation of family and shall be
protected by the state.
Section 3
The state shall defend –

1. the right of spouses to found a family in accordance with their religious convictions and
the demands of responsible parenthood
2. the right of children to assistance including proper care and nutrition, and special
protection from all forms of neglect, abuse, cruelty, exploitation and other conditions
prejudicial to their development
3. the right of the family to a family living wage income
4. the right of families or family associations to participate in the planning and
implementation of policies and programs of that affect them
Section 4
 The family has the duty to care for its elderly members but the state may also do so
through just programs of social security
The Filipino Family and its Characteristics
The basic social units of Philippine society are the nuclear family
1. Although the basic unit is the nuclear family, the influence of kinship is felt in all
segments of social organizations
2. Extensions of relationships and descent patterns are bilateral
3. Kinship circles is considerably greater because effective range often includes the third
cousin
4. Kin group is further enlarged by a finial, spiritual or ceremonial ties. Filipino marriage is
not an individual but a family affair
5. Obligation goes with this kingship system
6. Extended family has a profound effect on daily decisions
7. There is a great degree of equality between husband and wife
8. Children not only have to respect their parents and obey them, but also have to learn to
repress their repressive tendencies
9. The older siblings have something of authority of their parents.
Types of Family
 There are many types of family. They change overtime as a consequence of BIRTH,
DEATH, MIGRATION, SEPARATION and GROWTH OF FAMILY MEMBERS
A. Structure
 NUCLEAR- a father, a mother with child/children living together but apart from both sets
of parents and other relatives.
 EXTENDED- composed of two or more nuclear families economically and socially related
to each other. Multigenerational, including married brothers and sisters, and the families.
 SINGLE PARENT-divorced or separated, unmarried or widowed male or female with at
least one child.
 BLENDED/RECONSTITUTED-a combination of two families with children from both
families and sometimes children of the newly married couple. It is also a remarriage with
children from previous marriage.
 COMPOUND-one man/woman with several spouses
 COMMUNAL-more than one monogamous couple sharing resources
 COHABITING/LIVE-IN-unmarried couple living together
 DYAD—husband and wife or other couple living alone without children
 GAY/LESBIAN-homosexual couple living together with or without children
 NO-KIN- a group of at least two people sharing a relationship and exchange support who
have no legal or blood tie to each other
 FOSTER- substitute family for children whose parents are unable to care for them
FUNCTIONAL TYPE:

 FAMILY OF PROCREATION- refers to the family you yourself created.

 FAMILY OF ORIENTATION-refers to the family where you came from.
B. Decisions in the family (Authority)
 PATRIARCHAL – full authority on the father or any male member of the family e.g. eldest
son, grandfather
 MATRIARCHAL – full authority of the mother or any female member of the family, e.g.
eldest sister, grandmother
 EGALITARIAN- husband and wife exercise a more or less amount of authority, father and
mother decides
 DEMOCRATIC – everybody is involve in decision making
 AUTHOCRATIC-
 LAISSEZ-FAIRE- “full autonomy”
 MATRICENTRIC- the mother decides/takes charge in absence of the father (e.g. father is
working overseas)
 PATRICENTIC- the father decides/ takes charge in absence of the mother
C. Decent (cultural norms, which affiliate a person with a particular group of
kinsman for certain social purposes)
 PATRILINEAL – Affiliates a person with a group of relatives who are related to him
though his father
 BILATERAL- both parents
 MATRILINEAL – related through mother
D. Residence
 PATRILOCAL – family resides / stays with / near domicile of the parents of the husband
 MATRILOCAL – live near the domicile of the parents of the wife
Ackerman States that the Function of Family are:
1. Insuring the physical survival of the species
2. Transmitting the culture, thereby insuring man’s humanness
 Physical functions of the family are met through parents providing food, clothing and
shelter, protection against danger provision for bodily repairs after fatigue or illness,
and through reproduction
 Affect ional function – the family is the primary unit in which he child test his
emotional reactions
 Social functions – include providing social togetherness, fostering self esteem and a
personal identity tied to family identity, providing opportunity for observing and
learning social and sexual roles, accepting responsibility for behavior and supporting
individual creativity and initiative.
Universal Function of the Family by Doode
 REPRODUCTION – for replacement of members of society: to perpetuate the human
species
 STATUS PLACEMENT of individual in society
 BIOLOGICAL and MAINTENANCE OF THE YOUNG and dependent members
 Socialization and care of the children;
 Social control
The Family as a Unit of Care
Rationale for Considering the Family as a Unit of Care:
 The family is considered the natural and fundamental unit of society
 The family as a group generates, prevents, tolerates and corrects health problems within
its membership
 The health problems of the family members are interlocking
 The family is the most frequent focus of health decisions and action in personal care
 The family is an effective and available channel for much of the effort of the health
worker
The Family as the Client
Characteristics of a Family as a Client
 The family is a product of time and place-

 A family is different from other family who lives in another location in many ways.
 A family who lived in the past is different from another family who lives at present in
many ways.
 The family develops its own lifestyle

 Develop its own patterns of behavior and its own style in life.
 Develops their own power system which either be:
 Balance-the parents and children have their own areas of decisions and control.
 Strongly Bias-one member gains dominance over the others.
 The family operate as a group

 A family is a unit in which the action of any member may set of a whole series of
reaction within a group, and entity whose inner strength may be its greatest single
supportive factor when one of its members is stricken with illness or death.
 The family accommodates the needs of the individual members.

 An individual is unique human being who needs to assert his or herself in a way that
allows him to grow and develop.
 Sometimes, individual needs and group needs seem to find a natural balance;
1. The need for self-expression does not over shadow consideration for others.
 2. Power is equitably distributed.
3. Independence is permitted to flourish.
 The family relates to the community

 Family develops a stance with respect to the community:
1. The relationship between the families is wholesome and reciprocal; the family
utilizes the community resources and in turn, contributes to the improvement of
the community.
2. There are families who feel a sense of isolation from the community.
 Families who maintain proud, “We keep to ourselves” attitude.
 Families who are entirely passive taking the benefits from the community
without either contributing to it or demanding changes to it.
 The family has a growth cycle

 Families pass through predictable development stages (Duvall & Miller, 1990)
 STAGES:
 Stage 1: MARRIAGE & THE FAMILY
 Involves merging of values brought into the relationship from the families of
orientation.
 Includes adjustments to each other’s routines (sleeping, eating, chores, etc.),
sexual and economic aspects.
 Members work to achieve 3 separate identifiable tasks:
1. Establish a mutually satisfying relationship
2. Learn to relate well to their families of orientation
3. If applicable, engage in reproductive life planning
 Stage 2: EARLY CHILDBEARING FAMILY
 Birth or adoption of a first child which requires economic and social role
changes
 Oldest child: 2-1/2 years
 Stage 3: FAMILY WITH PRE-SCHOOL CHILDREN 
 This is a busy family because children at this stage demand a great deal of
time related to growth and development needs and safety considerations.
 Oldest child: 2-1/2 to 6 years old
 Stage 4: FAMILY WITH SCHOOL AGE CHILDREN 
 Parents at this stage have important responsibility of preparing their children
to be able to function in a complex world while at the same time maintaining
their own satisfying marriage relationship.
 Oldest child: 6-12 years old
 Stage 5: FAMILY WITH ADOLESCENT CHILDREN 
 A family allows the adolescents more freedom and prepare them for their
own life as technology advances-gap between generations increases
 Oldest child: 12-20 years old
  Stage 6: THE LAUNCHING CENTER FAMILY 
 Stage when children leave to set their own household-appears to represent
the breaking of the family
 Empty nests
 Stage 7: FAMILY OF MIDDLE YEARS 
 Family returns to two partners nuclear unit
 Period from empty nest to retirement
 Stage 8: FAMILY IN RETIREMENT/OLDER AGE 
 Stage 9: PERIOD FROM RETIREMENT TO DEATH OF BOTH SPOUSES 
12 Behaviors Indicating a Well Family
 Able to provide for physical emotional and spiritual needs of family members
 Able to be sensitive to the needs of the family members
 Able to communicate thought and feelings effectively
 Able to provide support, security and encouragement
 Able to initiate and maintain growth producing relationship
 Maintain and create constructive and responsible community relationships
 Able to grow with and through children
 Ability to perform family roles flexibly
 Able to help oneself and to accept help when appropriate
 Demonstrate mutual respect for the individuality of family members
 Ability to use a crisis experience as a means of growth
 Demonstrate concern of family unity, loyalty and interfamily cooperation
Family Health Task
 Health task differ in degrees from family to family
 TASK- is a function, but with work or labor overtures assigned or demanded of the
person
 Duvall & Niller identified 8 task essential for a family to function as a unit:
Eight Family Tasks (Duvall & Niller)
1. Physical maintenance- provides food shelter, clothing, and health care to its members
being certain that a family has ample resources to provide
2. Socialization of Family– involves preparation of children to live in the community and
interact with people outside the family.
3. Allocation of Resources- determines which family needs will be met and their order of
priority.
4. Maintenance of Order– task includes opening an effective means of communication
between family members, integrating family values and enforcing common regulations
for all family members.
5. Division of Labor – who will fulfill certain roles e.g., family provider, home manager,
children’s caregiver
6. Reproduction, Recruitment, and Release of family member
7. Placement of members into larger society –consists of selecting community activities such
as church, school, politics that correlate with the family beliefs and values
8. Maintenance of motivation and morale– created when members serve as support people to
each other
5 Family Health Tasks (Maglaya, A., 2004)
 Recognizing interruptions of health development
 Making decisions about seeking health care/ to take action
 Dealing effectively health and non-health situations
 Providing care to all members of the family
 Maintaining a home environment conducive to health maintenance
Family Roles
 Nurturing figure– primary caregiver to children or any dependent member.
 Provider – provides the family’s basic needs.
 Decision maker– makes decisions particularly in areas such as finance, resolution, of
conflicts, use of leisure time etc.
 Problem-solver– resolves family problems to maintain unity and solidarity.
 Health manager– monitors the health and ensures that members return to health
appointments.
 Gate keeper-Determines what information will be released from the family or what new
information cam be introduced.
Theoretical Approaches to Family Health Care (family apgar)
Family Models
 the use of family model provides a perspective of focus for understanding the family
 have categorized according to their basic focus as developmental, interactional
structural-functional, and systems model
Developmental Models
    Duvall’s and Stevenson’s Family development model
 Evelyn Duvall’ (1977) family developmental framework provides guide to examine and
analyze the basic changes and developmental tasks common to most families during
their life cycle. Although each family has unique characteristics normative patterns of
sequential development are common to all families
 These stages and developmental tasks illustrate common family behaviors that may be
expected at specific times in the family life cycle. The stages are marked by the age of
the oldest child however some overlapping occurs in families with several children.
 STAGES OF DEVELOPMENT  BASIC FAMILY TASK

    Beginning FamiliesEarly Physical maintenance

 childbearing
Families with preschoolers
Allocation of resources
Families with school children
Division of labor
Families with teen-agers
Socialization of members.
Launching center families
Reproduction, recruitment and release of Members
Middle-aged families
Maintenance of order

Aging Families Placement of members in larger community Maintenance of motivation and

morale

 Duvall’s developmental model is an excellent guide for assessing, analyzing and planning
around basic family tasks developmental stage, however, this model does not include
the family structure or physiological aspects, which should be considered for a
comprehensive view of the family. This model is applicable for nuclear families with
growing children and families who are experiencing health-related problems.
Stevenson’s Family Developmental Model
 Joanne Stevenson (1977) describes the basic tasks and responsibilities of families in
four stages.
 STAGES  HEALTH TASKS

Emerging family (from marriage for 7  Couple strives for independence from their parents and to
to 10 years) develop a sense of responsibility for family life.

 Crystallizing family (with teenage  To assume responsibility for growth and development of
children) individual members and outside organizations

 Interacting family(children grown and  Assumption of responsibility for “continued survival and
small grandchildren) enhancement of the nation.”

 Actualizing family (aging couple alone  Assume the responsibility for sharing the wisdom of age,
again) reviewing life and putting affairs in order

 She views family tasks as maintaining a common household rearing children and finding
satisfying work and leisure. It also includes sustaining appropriate health patterns and
providing mutual support and acculturation of family members.
 This model is useful for nuclear families because it examines psychosocial patterns to
specific stage of development, however, it also does not include family structure, nor it
addresses health promotion and health-related concerns that the family may face.
Structural- Functional Model
Friedman’s Structural- Functional Family Model
 Was developed from sociological frameworks and systems theory by Marilyn Friedman
(1986)
  The family is the focus of this model as it interacts with supra-systems in the community
and with individual family members in the subsystem.
Friedman’s Family Model Components
 STRUCTURAL COMPONENTS  FUNCTIONAL COMPONENTS

 Family composition  Affective

 Value systems  Physical necessities and care

 Communication patterns  Economic

 Role structure  Reproductive

 Socialization and social placement

 Power structure Family coping

 Structural component examines the family unit, how it is organized and how members
relate to one another in terms of values, communication network, role system and power
while functional components refers to the interaction outcomes resulting from family
organizational structure.
 The structural-functional components and parts all intimately interrelate and interact; the
others affect each component and part.
 This model provides a broad framework for examining the interactions among family and
within the community. This incorporates physical, psychosocial and cultural aspects of
the family along with interacting relationships.
 This model is very applicable to any type of family and their health-related problems
Systems Model
Calgary’s Family Model (system’s model)
 Is an integrated conceptual framework of several theorists.
 Model is based on three major categories: family structure, function and development.
Each is further subdivided into parts that interacts with others and changes the whole
family configuration.
Calgary Family Model
Family Structure                        Family Development                     Family Functions
Internal                                             developmental stage                            daily living activities
Family composition                          developmental tasks                            allocation of tasks
Rank order of member’s                 attachments
Subsystems in family
Boundaries of familyExternal                                     Expressive
Culture                                         Communication
Religion                                        Problem-solving
Social class status                       Roles
And mobility                               Control
Environment                              Beliefs
Extended family                        Alliances/coalitions
 This model is comprehensive and incorporates three major areas, namely, the structure,
function and development of the family.
 It is complex, with too many sub concepts for the health worker to explore and focus.
 It can be applied to any type of family with any health-related problems.

Family Apgar Questionnaire (SMILKESTEIN, 1978)

 HARDLY
 ALWAYS  SOMETIMES EVER
(2 PTS.) (1 pt.) (0 PT.)

 I am satisfied with the help I receive from my family when

something is troubling me.

 I am satisfied with the way my family discovers items of

common interest and shares problem-solving with me.

 I find that my family accepts my wishes to take on new

activities or make changes in my lifestyle.

 I am satisfied with the way my family expresses affection

and responds to my feelings such as anger, sorrow and love

 I am satisfied with the way my family and I spend time

together.

Scoring:
Check one of the three choices:
Total Score:
 7-10 = suggests a highly functional family
 4-6 = moderately dysfunctional family
 0-3 = severely dysfunctional family

Health as a Goal of Family Health Care

 HEALTH DEFICIT- this refers to conditions of health breakdowns or advent of illness in
the family
 HEALTH THREAT- these are the conditions that make it more likely for accidents,
disease or failure to thrive or develop to occur.
 FORESEEABLE CRISIS- these are anticipated periods of unusual demand on the family in
terms of time or resources
 WELLNESS POTENTIAL- this refers to states of wellness and the likelihood for health
maintenance or improvement to occur depending on the desire of the family
Roles of Health Care Provider in Family Health Care
 HEALTH MONITOR
 PROVIDER OF CARE
 COORDINATOR
 FACILITATOR
 TEACHER
 COUNSELOR
Family Health Care Process
 DATA COLLECTION: METHODS AND TOOLS
 DATA ANALYSIS or INTERPRETATION
 PLANNING
 IMPLEMENTATION
 EVALUATION PHASE
ASSESSMENT PHASE
 first major phase of nursing process in family health nursing
 Involves a set of action by which the nurse measures the status of the family as a client.
Its ability to maintain wellness , prevent, control or resolve problems in order to achieve
health and wellness among its members
 Data about present condition or status of the family are compared against the norms
and standards of personal , social, and environmental health, system integrity and ability
to resolve social problems.
 The norms and standards are derived from values, beliefs, principles, rules or
expectation.
TWO MAJOR TYPES
1. FIRST LEVEL ASSESSMENT- a process whereby existing and potential health conditions
or problems of the family are determined (WS, HT, HD, SP or FC)
2. SECOND LEVEL ASSESSMENT- defines the nature or type of nursing problem that family
encounters in performing health task with respect to given health condition or problem
and etiology or barriers to the family’s assumption of the task
DATA COLLECTION METHODS: SELECT APPROPRIATE METHOD
 OBSERVATION

 done through use of sensory capacities
 The nurse gathers information about the family’s state of being and behavioral
responses
 the family’s health status can be inferred from the s/sx of problem areas
 a. communication and interaction patterns expected ,used, and tolerated by
family members
 b. role perception / task assumption by each member including decision making
patterns
 c. conditions in the home and environment
** Data gathered though this method have the advantage of being subjected to validation
and reliability testing by other observers

 PHYSICAL EXAMINATION

 significant data about the health status of individual members can be obtained
through direct examination through IPPA, Measurement of specific body parts and
reviewing the body systems
 data gathered from P.A form substantive part of first level assessment which may
indicate presence of health deficits (illness state )
 INTERVIEW

 Productivity of interview process depends upon the use effective communication
techniques to elicit needed response PROBLEMS ENCOUNTERED:
 How to ascertain where the client is in terms of perception of health condition or
problems and the patterns of coping utilized to resolve them
 Tendency of community health worker to readily give out advice, health teachings
or solutions once they have identified the health condition or problems.
 Provisions of models for phrasing interview questions utilization of deliberately
chosen communication techniques for an adequate nursing assessment.
 confidence in the use of communication skills
 Being familiar with and being competent in the use of type of question that aim to
explore, validate, clarify, offer feedback, encourage verbalization of thought and
feelings and offer needed support or reassurance.
 TYPES:
1. completing health history of each family member
 Health history determines current health status based on significant PAST HEALTH
HISTOI\RY e.g. developmental accomplishment, known illnesses, allergies, restorative
treatment, residence in endemic areas for certain diseases or sources of communicable
diseases.
 FAMILY HISTORY e.g. genetic history in relation to health and illness.
 SOCIAL HISTORY e.g. intra-personal and inter-personal factors affecting the family
member social adjustment or vulnerability to stress and crisis
2. Collecting data by personally asking significant family members or relatives questions
regarding health, family life experiences and home environment to generate data on what
wellness condition and health problem exist in the family ( first level assessment) and
the corresponding nursing problems for each health condition or problem ( 2nd level
assessment)
 RECORDS REVIEW

 Gather information through reviewing existing records and reports pertinent to the
client
 Individual clinical records of the family members, laboratory and diagnostic reports,
immunization records reports about home and environmental conditions
 LABORATORY/ DIAGNOSTIC TEST
ANALYZE DATA TO IDENTIFY NEEDS AND PROBLEMS
1. CRITERIA FOR ANALYSIS:
2. PROCESS FOR ANALYSIS:
 SORTING OF DATA
 CLUSTERING OF RELATED CUES
 DISTINGUISHING RELEVANT FROM IRRELEVANT CUES
 IDENTIFYING PATTERNS
 COMPARING PATTERNS
 INTERPRETING RESULTS OF COMPARISON
 MAKING INFERENCES AND DRAWING CONCLUSIONS

Health Needs and Problems of the Family

 A situation which interferes with the promotion and / or maintenance of health
 It is a health problem when it stated as the family’s failure to perform adequately specific
health task to enhance the wellness state or manage a health problem

Family Planning Program

Overview
 The Philippine Family Planning Program is a national program that systematically
provides information and services needed by women of reproductive age to plan their
families according to their own beliefs and circumstances.
Goals and Objectives
 Universal access to family planning information, education and services.
Mission
 To provide the means and opportunities by which married couples of reproductive age
desirous of spacing and limiting their pregnancies can realize their reproductive goals.
Types of Methods
NATURAL METHODS
a. Calendar or Rhythm Method
b. Basal Body Temperature Method
c. Cervical Mucus Method
d. Sympto-Thermal Method
e. Lactational Amennorhea
ARTIFICIAL METHODS
a. Chemical Methods
i. Ovulation suppressant such as PILLS
ii. Depo-Provera
iii. Spermicidals
iv. Implant
b. Mechanical Methods
i. Male and Female Condom
ii. Intrauterine Device
iii. Cervical Cap/Diaphragm
c. Surgical Methods
i. Vasectomy
ii. Tubal Ligation
Warning Signs
Pills
 Abdominal pain (severe)
 Chest pain (severe)
 Headache (severe)
 Eye problems (blurred vision, flashing lights, blindness)
 Severe leg pain (calf or thigh)
 Others: depression, jaundice, breast lumps
IUD
 Period late, no symptoms of pregnancy, abnormal bleeding or spotting
 Abdominal pain during intercourse
 Infection or abnormal vaginal discharge
 Not feeling well, has fever or chills
 String is missing or has become shorter or longer
Injectables
 Dizziness
 Severe headache
 Heavy bleeding
BTL
 Fever
 Weakness
 Rapid pulse
 Persistent abdominal pain
 Vomiting
 Dizziness
 Pus or tenderness at incision site
 Amenorrhea
Vasectomy
 Fever
 Scrotal blood clots or excessive swelling

Functions of a Health Worker

Community Health Service Provider
 Carries out health services contributing to the promotion of health, prevention of illness,
early treatment of illness and rehabilitation.
 appraises health needs and hazards (existing or potential)
Facilitator
 helps plan a comprehensive health program with the people
 continuing guidance and supervisory assistance

Health Counselor
 provides health counseling including emotional support to individuals, family, group and
community
Co-researcher
 Provides the community with stimulation necessary for a wider or more complex study
or problems.
 Enforce community to do prompt and intelligent reporting of epidemiologic investigation
of disease.
 suggest areas hat need research (by creating dissatisfaction)
 participate in planning for the study in formulating procedures
 assist in the collection of data
 helps interpret findings collectively
 act on the result of the research
Member of a Team
 in operating within the team, one must be willing to listen as well as to contribute, to
teach as well as to learn, to lead as well as to follow, to share as well as to work under it
 helps make multiple services which the family receives in the course of health care,
coordinated, continuous and comprehensive as possible
 consults with and refers to appropriate personnel for any other community services
Health Educator
 Health education is an accepted activity at all levels of public works. A health educator is
the one who improves the health of the people by employing various methods of
scientific procedures to stimulate, arouse and guide people to healthful ways of living.
She takes into consideration these aspects of health education:
 information – provision of knowledge
 education – change in knowledge, attitude and skills
 communication – exchange of information

Garantisadong Pambata (GP)

Definition
 Garantisadong Pambata is a biannual week long delivery of a package of health services
to children between the ages of 0-59 months old with the purpose of reducing morbidity
and mortality among under fives through the promotion of positive Filipino values for
proper child growth and development.
Routine Health Services
Route of
Health Service Dosage Administration Target Population

12-59 months old,

200,000 IU or 1 nationwide9-12 months old
capsule100,000 IU or infants receiving AMV
Vitamin A capsule ½ cap or 3 drops Orally by drops nationwide

Ferrous Sulfate(25 mg. 0.3ml(2-6 mos) once Orally by drops 2-11 months old infants in
Elemental Iron per ml; 30 a day Mindanao area, including
ml. Bottle as taken home 0.6ml(6- 11mos) once evacuation centers in
medicine with instructions) armed conflict areas.
 a day

0.05ml
 Routine Immunization-BCG* Intradermal on  Nationwide0-11 mos
-DPT* 0.5ml right deltoid 0-11 mos
Intramuscularly
-OPV* 2 drops on anterior thigh 0-11 mos
Orally
-AMV* 0.5ml 9-11 mos
Subcutaneously
-Hepa B (if 0.5ml on deltoid 0-11 mos

available) Intramuscularly

1 tablet as single
Deworming drug(if available) dose Orally 36-59 mos, nationwide

Weighing 0-59 mos, nationwide

 The child should not have received megadose of Vit. A above the recommended dosage
within the past 4 weeks except if the child has measles or signs and symptoms of Vit A.
deficiency.
 For any child between 12-23 months, who missed any of his routine immunization, the
health worker should give the child the necessary antigen to complete FIC and shall be
recorded as such.
Garantisadong Pambata
Sangkap Pinoy
 Vitamin A, Iron and Iodine 
 Sources: green leafy and yellow vegetables, fruits, liver, seafoods, iodized salt, pan de bida
and other fortified foods.
 These micronutrients are not produced by the body, and must be taken in the food we eat;
essential in the normal process of growth and development: 
1. Helps the body to regulate itself
2. Necessary in energy metabolism
3. Vital in brain cell formation and mental development
4. Necessary in the body immune system to protect the body from severe infection.
5. Eating Sangkap Pinoy-rich foods can prevent and control:

 Protein Energy Malnutrition
 Vitamin A Deficiency
 Iron Deficiency Anemia
 Iodine Deficiency Disorder
 Breastfeeding
 Breast milk is best for babies up to 2 years old. Exclusive breastfeeding is recommended
for the first six months of life. At about six months, give carefully selected nutritious
foods as supplements.
 Breastfeeding provides physical and psychological benefits for children and mothers as
well as economic benefits for families and societies.
Benefits:
For infants 
1. Provides a nutritional complete food for the young infant.
2. Strengthens the infant’s immune system, preventing many infections.
3. Safely rehydrates and provides essential nutrients to a sick child, especially to those
suffpering from diarrheal diseases.
4. Reduces the infant’s exposure to infection.
For the Mother
1. Reduces a woman’s risk of excessive blood loss after birth
2. Provides a natural method of delaying pregnancies.
3. Reduces the risk of ovarian and breast cancers and osteoporosis.
For the Family and Community
1. Conserves funds that otherwise would be spent on breast milk substitute, supplies and
fuel to prepare them.
2. Saves medical costs to families and governments by preventing illnesses and by
providing immediate postpartum contraception.
Complimentary Feeding for Babies 6-11 Months Old
What are Complementary Foods? 
1. foods introduced to the child at the age 6 months to supplement breastmilk
2. Given progressively until the child is used to three meals and in-between feedings at the
age of one year.
Why is there a Need to Give Complementary Foods? 
1. breastmilk can be a single source of nourishment from birth up to six months of life.
2. The child’s demands for food increases as he grows older and breastmilk alone is not
enough to meet his increased nutritional needs for rapid growth and development
3. Breastmilk should be supplemented with other foods so that the child can get additional
nutrients
4. Introduction of complementary foods will accustom him to new foods that will also
provide additional nutrients to make him grow well
5. Breastfeeding, however, should continue for as long as the mother is able and has milk
which could be as long as two years
How to Give Complementary Foods for Babies 6-11 Months Old?
1. Prepare mixture of thick lugao/ cooked rice, soft cooked vegetables. Egg yolk, mashed
beans, flaked fish/chicken/ground meat and oil.
2. Give mixture by teaspoons 2-4 times daily, increasing the amount of teaspoons and
number of feeding until the full recommended amount is consumed
3. Give bite-sized fruit separately
4. Give egg alone or combine with above food mixture

Health and Sanitation

Overview
 Environmental Sanitation is still a health problem in the country.
 Diarrheal diseases ranked second in the leading causes of morbidity among the general
population.
 Other sanitation related diseases : tuberculosis, intestinal parasitism, schistossomiasis,
malaria, infectious hepatitis, filariasis and dengue hemorrhagic fever
 DOH thru’ Environmental Health Services (EHS) unit is authorized to act on all issues and
concerns in environment and health including the very comprehensive Sanitation Code of
the Philippines (PD 856, 1978).
Water Supply Sanitation Program
EHS sets policies on:
 Approved types of water facilities
 Unapproved type of water facility
 Access to safe and potable drinking water
 Water quality and monitoring surveillance
 Waterworks/Water system and well construction
Approved type of water facilities
Level 1 (Point Source) 
 a protected well or a developed spring with an outlet but without a distribution system
 indicated for rural areas
 serves 15-25 households; its outreach is not more than 250 m from the farthest user
 yields 40-140 L/ min
Level II (Communal Faucet or Stand Posts) 
 With a source, reservoir, piped distribution network and communal faucets
 Located at not more than 25 m from the farthest house
 Delivers 40-80 L of water per capital per day to an average of 100 households
 Fit for rural areas where houses are densely clustered
Level III (Individual House Connections or Waterworks System) 
 With a source, reservoir, piped distributor network and household taps
 Fit for densely populated urban communities
 Requires minimum treatment or disinfection
Environmental Sanitation
 The study of all factors in man’s physical environment, which may exercise a deleterious
effect on his health, well-being and survival.
Includes:
 Water sanitation
 Food sanitation
 Refuse and garbage disposal
 Excreta disposal
 Insect vector and rodent control
 Housing
 Air pollution
 Noise
 Radiological Protection
 Institutional sanitation
 Stream pollution
Proper Excreta and Sewage Disposal Program
EHS sets policies on approved types of toilet facilities: 
Level I 
 Non-water carriage toilet facility – no water necessary to wash the waste into receiving
space e.g. pit latrines, reed odorless earth closet.
 Toilet facilities requiring small amount of water to wash the waste into the receiving
space e.g. pour flush toilet & aqua privies
Level II
 On site toilet facilities of the water carriage type with water-sealed and flush type with
septic vault/tank disposal.
Level III
 Water carriage types of toilet facilities connected to septic tanks and/or to sewerage
system to treatment plant.
Food Sanitation Program
 sets policy and practical programs to prevent and control food-borne diseases to
alleviate the living conditions of the population
Hospital Waste Management Program
 Disposal of infectious, pathological and other wastes from hospital which combine them
with the municipal or domestic wastes pose health hazards to the people.
 Hospitals shall dispose their hazardous wastes thru incinerators or disinfectants to
prevent transmission of nosocomial diseases
 Program on Health Risk Minimization due to Environmental
Pollution
1. Prevention of serious environmental hazards resulting from urban growth and
industrialization
2. Policies on health protection measures
3. Researches on effects of GLOBAL WARMING to health (depletion of the stratosphere
ozone layer which increases ultraviolet radiation, climate change and other conditions)
Nursing Responsibilities and Activities
 Health Education – IEC by conducting community assemblies and bench conferences.
 The Occupational Health Nurse, School Health Nurse and other Nursing staff shall impart
the need for an effective and efficient environmental sanitation in their places of work
and in school.
 Actively participate in the training component of the service like in Food Handler’s Class,
and attend training/workshops related to environmental health.
 Assist in the deworming activities for the school children and targeted groups.
 Effectively and efficiently coordinate programs/projects/activities with other government
and non-government agencies.
 Act as an advocate or facilitator to families in the community in matters of
program/projects/activities on environmental health in coordination with other members
of Rural Health Unit (RHU) especially the Rural Sanitary Inspectors.
 Actively participate in environmental sanitation campaigns and projects in the
community. Ex. Sanitary toilet campaign drive for proper garbage disposal, beautification
of home garden, parks drainage and other projects.
 Be a role model for others in the community to emulate terms of cleanliness in the home
and surrounding.

Health Care Delivery System

Definition
 The totality of all policies, facilities, equipments, products, human resources and services
which address the health needs problems and concerns of the people. It is large,
complex, multi-level and multi-disciplinary.
Health Sectors
 Government Sectors
 Non Government Sectors
 Private Sectors
Department of Health
 Vision: Health for all by year 2000 ands Health in the Hands of the People by 2020
 Mission: In partnership with the people, provide equity, quality and access to health care
esp. the marginalized
5 Major Functions:
1.
1. Ensure equal access to basic health services
2. Ensure formulation of national policies for proper division of labor and proper
coordination of operations among the government agency jurisdictions
3. Ensure a minimum level of implementation nationwide of services regarded as public
health goods
4. Plan and establish arrangements for the public health systems to achieve economies
of scale
5. Maintain a medium of regulations and standards to protect consumers and guide
providers
Primary Strategies to Achieve Health Goals
 Support for health goal
 Assurance of health care
 Increasing investment for PHC
 Development of National Standard
Milestone in Health Care Delivery System
 RA 1082 – RHU Act
 RA 1891 – Strengthen Health Services
 PD 568 – Restructuring HCDS
 RA 7160 – LGU Code

Health Education (Principles)

 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 people’s 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.

Health Situation of the Philippines

Philippine Scenario 
 In the past 20 years some infectious degenerative diseases are on the rise.
 Many Filipinos are still living in remote and hard to reach areas where it is difficult to
deliver the health services they need
 The scarcity of doctors, nurses and midwives add to the poor health delivery system to
the poor
Vital Health Statistics 2005
Projected Population:
 Male – 42,874,766
 Female – 42,362,147
 Both Sexes – 85,236,913
Life Expectancy:
 Female – 70 yrs. old
 Male – 64 yrs. Old
Leading Causes of Morbidity
 Most of the top ten leading causes of morbidity are communicable disease
 These include the diarrhea, pneumonia, bronchitis, influenza, TB, malaria and varicella
 Leading non CD are heart problem, HPN, accidents and malignant neoplasms
Leading Causes of Mortality
 The top 10 leading causes of mortality are due to non CD
 Diseases of the heart and vascular system are the 2 most common causes of deaths.
 Pneumonia, PTB and diarrheal diseases consistently remain the 10 leading causes of
deaths.

Herbal Medicine (Akapulko)

Akapulko (Cassie, alata L.)

 It is also known as “bayabas-bayabasan” and “ringworm bush” in English, this herbal
medicine is used to treat ringworms and skin fungal infections.
Parts utilized:
 leaves
Use:
 Anti-fungal: Tinea Flava, ringworm, athlete’s foot and scabies.
Preparation:
 Fresh, matured leaves pounded. Apply as soap to the affected part 1-2 times a day.

Herbal Medicine (Ampalaya)

 Ampalaya (Mamordica Charantia)
 Known as “bitter gourd” or “bitter melon” in English, it most known as a treatment of
diabetes (diabetes mellitus), for the non-insulin dependent patients.
Parts utilized:
 leaves
Use:
 Lower blood sugar levels
Preparation:
 Gather and wash young leaves very well. Chop. Boil 6 tablespoons in two glassfuls of
water for 15 minutes under low fire. Do not cover pot. Cool and strain. Take one third cup
3 times a day after meals. Remember that young leaves may be blanched/ steamed and
eaten ½ glassful 2 times a day.

Herbal Medicine (Bawang)

Bawang (Allium sativum)

 Popularly known as “garlic”, it mainly reduces cholesterol in the blood and hence, helps
control blood pressure. Also a remedy for toothache
Parts utilized:
 Garlic Bulb
Uses:
 For hypertension: Toothache; to lower cholesterol levels in blood.
Preparation:
 May be fried, roasted, soaked in vinegar for 30 minutes or blanched in boiled Water for 5
minutes. Take 2 pieces three times a day after meals.
For toothache:
 Pound a small piece and apply to affected part.
 Herbal Medicine (Bayabas)

Bayabas / Guava (Psidium Guajava L.)

 A tree about 4- 5 meters high with tiny flowers with round or oval fruits that are eaten
raw. Propagated through seeds.
Parts utilized:
 leaves
Uses:
 For washing wounds- may be used twice a day.
 For diarrhea- may be taken 3-4 twice a day.
 As gargle and to relieve toothache. Warm decoction is used for gargle. Freshly pounded
leaves are used for toothache. Guava leaves are to be washed well and chopped. Boil for
15 minutes at low fire. Do not cover pot. Cool and strain before use.

Herbal Medicine (Lagundi)

Lagundi (Vitex Negundo)

 A shrub known in English as the “5-leaved chase tree” which grows wild in vacant lots
and waste land. The flowers are blue and bell-shaped and small fruits turn black when
ripe. It is better to collect the leaves where are in bloom. Matured branches are planted.
Parts utilized:
 Leaves, flower.
Uses:
 Asthma, cough and fever– boil the chopped raw fruits or leaves in 2 glasses of water left
for 15 minutes until the water left in only one glass. Strain. The following dosages of the
decoction are given to age group.
 Dysentery, colds and pain in any part of the body as influenza – boil a handful of leaves and
flowers in water to produce a glass full of decoction 3 times a day.
 Skin Diseases (dermatitis, scabies, ulcer, eczema) and wounds – prepare a decoction of the
leaves. Wash and clean the skin/ wound with the decoction.
 Headache– crushed leaves may be applied on the forehead.
 Rheumatism, sprain, contusion insect bites– pound the leaves and apply on affected part.
 Aromatic bath for sick patients – prepare leaf decoction for use in sick and newly delivered
patients.

Herbal Medicine (Lagundi)

Lagundi (Vitex Negundo)

 A shrub known in English as the “5-leaved chase tree” which grows wild in vacant lots
and waste land. The flowers are blue and bell-shaped and small fruits turn black when
ripe. It is better to collect the leaves where are in bloom. Matured branches are planted.
Parts utilized:
 Leaves, flower.
Uses:
 Asthma, cough and fever– boil the chopped raw fruits or leaves in 2 glasses of water left
for 15 minutes until the water left in only one glass. Strain. The following dosages of the
decoction are given to age group.
 Dysentery, colds and pain in any part of the body as influenza – boil a handful of leaves and
flowers in water to produce a glass full of decoction 3 times a day.
 Skin Diseases (dermatitis, scabies, ulcer, eczema) and wounds – prepare a decoction of the
leaves. Wash and clean the skin/ wound with the decoction.
 Headache– crushed leaves may be applied on the forehead.
 Rheumatism, sprain, contusion insect bites– pound the leaves and apply on affected part.
 Aromatic bath for sick patients – prepare leaf decoction for use in sick and newly delivered
patients.

Herbal Medicine (Niyug-Niyogan)

Niyug- Niyogan (Quisqualis Indica L.)

 A vine known as “Chinese honey suckle” which bears tiny fruits and grows wild in
backyards. It is effective for the elimination of intestinal worms. The seeds must come
from mature. Dried but newly opened fruits. Propagated through stem cuttings about
20cm in height.
Parts utilized:
 seeds
Uses:
 An anti- helmintic used to expel round worms ascariasis. The seeds are taken 2 hours
after supper. If no worms are expelled, the dose may be repeated after one week. This is
not to be given to children below four years old.
 Special precautions: Follow recommended dosage. Overdose causes hiccups.

Herbal Medicine (Sambong)

Sambong ( Blumea Balsamifera)

 A plant that reaches 1.5 to 3 meters high with rough hairy leaves. Young plants around
mother plant may be separated when they have three or more leaves.
English name:
 Blumea camphora
Parts utilized:
 leaves
Uses:
 Anti- edema, diuretic, anti- urolithiasis -boil chopped leaves in water for 15 minutes until
one glassful remains. Cool and strain. Divide decoction into 3 parts. Drink one part 3
times a day. Remember that sambong is not a medicine for kidney infection.

Herbal Medicine (Tsaang Gubat)

Tsaang Gubat (Carmona retusa)

 A shrub with small, shiny nice- looking leaves that grows in wild uncultivated areas and
forests. Mature stems are used for planting.
Parts utilized:
 leaves
Uses:
 Diarrhea – boil the following amount of chopped leaves in 2 glasses of water for 15
minutes or until amount of water goes down to 1 glass. Cool and strain. Divide decoction
into 4 parts. Let patient drink 1 part every 3 hours.
 Stomachache- washes leaves and chops. Boil chopped leaves in 1 glass of water for 15
minutes. Cool and filter, strain and drink.

Herbal Medicine (Ulasimang Bato)

 Ulasimang- bato (Peperonia Pellucida)
 A weed, with heart-shaped leaves also known as “pansit-pansitan”, grows in shady parts
of the garden and yard. It is effective in fighting arthritis and gout. The leaves can be
eaten fresh (about a cupful) as salad or like tea.
Parts utilized:
 leaves
Use:
 Lowers uric acid. (Rheumatism and gout)
Preparation:
 Wash leaves well. One and a half cup leaves are boiled in two glassfuls of water over
lower fire. Do not cover pot. Cool and strain. Divide into three parts and drink each part
three times a day after meals.
 May also be eaten as salad. Wash the leaves well. Prepare one and a half cups of leaves.
Divide into 3 parts and take as salad three times s day.

Herbal Medicine (Yerba Buena)

Yerba Buena (Clinopodium douglasii)

 A small multi- branching aromatic herb commonly known as Peppermint. The leaves are
small, elliptical ands with soothed margin. The stem creeps to ground, and develops
roots. May also be propagated through cuttings.
Parts utilized:
 leaves, sap of plant
Uses:
 For pain in different parts of the body as headache, stomach ache – boil chopped leaves
in two glasses of water for 15 minutes. Cool and strain. Divide decoction into two parts
and drink one part every three hours.
 Rheumatism, arthritis and headache – crush the fresh leaves squeeze sap. Massage sap on
painful parts with eucalyptus.
 Cough and colds – get about 10 fresh leaves and soak in a glass of hot water. Drink as
tea. Acts as an expectorant.
 Swollen Gums – steep 6 grams of fresh plant in a glass of boiling water for 30 minutes.
Use solution as gargle.
 Toothaches – cut fresh plant and squeeze sap. Soak a piece of cotton in the sap and
insert this in aching tooth cavity. Mouth should be rinsed by gargling salt solution before
inserting the cotton. To prepare salt solution add 5 grams of table salt to one glass of
water.
 Menstrual and gas pain – soak a handful of leaves in a glass of boiling water. Drink
infusion. It induces menstrual flow and sweating.
 Nausea and fainting – crush leaves and apply at nostrils of patients.
 Insect bites – crush leaves and apply juice on affected part or pound leaves until paste-
like. Then rub this on affected part.
 Pruritis– boil plant alone or with eucalyptus in water. Use decoction as wash on affected
area.

Herbal Medicine – Others
 Aloe vera Gel – abrasions and dermatologic conditions
 American Ginseng (Panax quinquefolius) – boost energy, relieve stress, improve
concentration and enhance physical or cognitive performance.
 Ashwagandha (Withania somnifera) – stress arthritis
 Asian gingseng (Panax ginseng) – enhance health and combat stress and disease
 Bilberry (Vaccinium myrtillus) – vision and peripheral vascular disorders and as
antioxidant
 Black Cohosh (Cimicifuga racemosa) – menopausal
 Black Currant and Borage oil (Ribes nigrum and Borago offinalis) – anti-inflammatory,
rheumatoid arthritis
 Capsicum Peppers (Capsicum spp.) – arthritis, neuralgia and other painful treatment
 Chamomile (Matricaria recutita) “manzanilla”- skin inflammation, colic, or dyspepsia and
anxiety
 Chaste tree (Vitex agnus-castus) – menstrual related disorders, PMS, cyclical mastalgia
 Chodroitin – osteoarthritis
 Coenzyme Q10 – antioxidant
 Coltsfoot ( Tussilago farfara ) – cough and other respiratory disoders
 Cranberry (Vaccinium macrocarpon) – UTI
 Devil’s Claw ( Harpagophytum procumbers) – anti inflammatory and analgesic
 Echinacea (Echinacea spp.) – acute viral URI symptoms
 Ederberry (Sanbacus nigra) – respiratory tract infection
 Ephedra or Ma Huang (Ephedra sinica) Source of ephedrine and pseudoephedrine
 Evening Primrose Oil (Oenothera biennis) – eczema, breast pain associated with PMS
and inflammatory condition
 Fenugreek (Trigonella foenum-graecum) – lowering blood glucose
 Feverfew ( Tanacetum parthenium) – migraine headache prophylaxis
 Garlic (Allium sativaum)- help prevent cardiovascular disease and cancer
 Ginger (Zingiber officinale) –nausea and motion sickness, anti-inflammatory
 Ginkgo (Ginkgo biloba) – dementia and intermittent claudication, memory enhancement
and treatment of vertigo nad tinnitus
 Glucosamine – osteoarthritis
 Goldenseal ( Hydrastis Canadensis) – tonic and antibiotic
 Gotu Kola (Centella asiatica) – mental support, wound healing and venous disorders
 Hawtorn ( Crategus species) – CHF and related cardiovascular conditions
 Horebound (Marribium vulgare) – primary cough suppression and expectoration
 Horse Chestnut Seed (Aesculus hippocastanum) chronic venous insufficiency
 Ivy (Hedera helix) – coughs, rheumatic disordes and skin disease
 Kava ( piper methysticum) – mild psychoactive and antianxiety property
 Lemon Balm (Melissa officinalis) – sedative and for dyspepsia
 Licorice (Glycyrrhiza glabra) – respiratory disorders, hepatitis, inflammatory diseases,
and infections
 Melatonin – insomia, jet lag
 Milk Thistle – hepatitis, liver desease
 Mints (Mentha species) – minor calcium channel antagonists, used for upper respiratory
problems, irritable bowel syndrome, dyspepsia, and colonic spasm and as a topical
counterirritant
 Nettle (Urtica dioica) – arthritis pains, allergies, BPH, or as diuretic
 Papaya (Carica papaya) – digestive aid, dyspepsia, and for inflammatory, topically
applied to wounds
 Passion flower (Passiflora incarnata)- sedative-hypnotic or anxiolytic herb
 Pokeroot (Phytolacca Americana) – inflammatory conditions also as an emetic/cathartic
 Pygeum (Pygeum africanum) – mild symptoms of BPH
 Red Clover (Trifolium pratense) – used as a natural estrogen substitute for women’s
health
 St. John’s Wort (Hypericum perforatum) – antidepressant effect
 Tea Tree Oil (Melaleuca alternifolia) – antifungal and antibacterial
 Turmeric (Curuma longa ) – anti-inflammatory, anti-arthritis, anti cancer, and antioxidant
 Uva Ursi (Arctostaphylos uva ursi) – urinary antiseptic and diuretic
  Yohimbe – erectile dysfunction

Herbal Medicine Plants Approved by the

DOH
These are the list of the ten (10) medicinal plants that the Philippine Department of Health
(DOH) through its “Traditional Health Program” has endorsed. All ten (10) herbs have been
thoroughly tested and have been clinically proven to have medicinal value in the relief and
treatment of various aliments:

Lagundi  (Vitex negundo)

Uses & Preparation:

 Asthma, Cough & Fever – Decoction ( Boil raw fruits or leaves in 2 glasses of water for 15
minutes)Dysentery, Colds & Pain – Decoction ( Boil a handful of leaves & flowers in water
to produce a glass, three times a day)
 Skin diseases (dermatitis, scabies, ulcer, eczema) -Wash & clean the skin/wound with the
decoction
 Headache – Crush leaves may be applied on the forehead
 Rheumatism, sprain, contusions, insect bites – Pound the leaves and apply on affected area

Yerba (Hierba ) Buena (Mentha cordifelia)

 Uses & Preparation:
 Pain (headache, stomachache) – Boil chopped leaves in 2 glasses of water for 15 minutes.
Divide decoction into 2 parts, drink one part every 3 hours.

 Rheumatism, arthritis and headache – Crush the fresh leaves and squeeze sap. Massage
sap on painful parts with eucalyptus

 Cough & Cold – Soak 10 fresh leaves in a glass of hot water, drink as tea. (expectorant)

 Swollen gums – Steep 6 g. of fresh plant in a glass of boiling water for 30 minutes. Use as
a gargle solution

 Toothache – Cut fresh plant and squeeze sap. Soak a piece of cotton in the sap and insert
this in aching tooth cavity

 Menstrual & gas pain – Soak a handful of leaves in a lass of boiling water. Drink infusion.

 Nausea & Fainting – Crush leaves and apply at nostrils of patients

 Insect bites – Crush leaves and apply juice on affected area or pound leaves until like a
paste, rub on affected area

 Pruritis – Boil plant alone or with eucalyptus in water. Use decoction as a wash on
affected area.

Sambong (Blumea balsamifera)

Uses & Preparation:

 Anti-edema, diuretic, anti-urolithiasis – Boil chopped leaves in a glass of water for 15
minutes until one glassful remains. Divide decoction into 3 parts, drink one part 3 times a
day.
 Diarrhea – Chopped leaves and boil in a glass of water for 15 minutes. Drink one part
every 3 hours.
 

Tsaang Gubat (Carmona retusa)

Uses & Preparation:

 Diarrhea – Boil chopped leaves into 2 glasses of water for 15 minutes. Divide decoction
into 4 parts. Drink 1 part every 3 hours
 Stomachache – Boil chopped leaves in 1 glass of water for 15 minutes. Cool and strain.

Niyug-niyogan (Quisqualis indica L.)

Uses & Preparation:

 Anti-helmintic – The seeds are taken 2 hours after supper. If no worms are expelled, the
dose may be repeated after one week. (Caution: Not to be given to children below 4 years
old)

 
Bayabas/Guava (Psidium guajava L.)

Uses & Preparation:

 For washing wounds – Maybe use twice a day
 Diarrhea – May be taken 3-4 times a day
As gargle and for toothache – Warm decoction is used for gargle. Freshly pounded
leaves are used for toothache. Boil chopped leaves for 15 minutes at low fire. Do not
cover and then let it cool and strain

Akapulko
(Cassia alata L.)

Uses & Preparation:

 Anti-fungal (tinea flava, ringworm, athlete’s foot and scabies) – Fresh, matured leaves are
pounded. Apply soap to the affected area 1-2 times a day

 
Ulasimang Bato (Peperonica pellucida)

Uses & Preparation:

 Lowers uric acid (rheumatism and gout) – One a half cup leaves are boiled in two glass of
water over low fire. Do not cover pot. Divide into 3 parts and drink one part 3 times a day

Bawang (Allium sativum)

Uses & Preparation:

 Hypertension – Maybe fried, roasted, soaked in vinegar for 30 minutes, or blanched in
boiled water for 15 minutes. Take 2 pieces 3 times a day after meals.
 Toothache – Pound a small piece and apply to affected area

Ampalaya (Mamordica Charantia)

 

Uses & Preparation:

 Diabetes Mellitus (Mild non-insulin dependent) – Chopped leaves then boil in a glass of
water for 15 minutes. Do not cover. Cool and strain. Take 1/3 cup 3 times a day after
meals
 

Reminders on the Use of Herbal Medicine

1. Avoid the use of insecticide as these may leave poison on plants.
2. In the preparation of herbal medicine, use a clay pot and remove cover while boiling at
low heat.
3. Use only part of the plant being advocated.
4. Follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each type of symptoms or sickness.
6. Stop giving the herbal medication in case untoward reaction such as allergy occurs.
7. If signs and symptoms are not relieved after 2 to 3 doses of herbal medication, consult a
doctor.

History of Community Health Nursing

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, 1st Filipino 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
 1st 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.

Initial Data Base for Family Nursing

Practice
A. 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. patriarchal, matriarchal, nuclear or extended
5. Dominant family members in terms of decision making especially on matters of health
care
6. General family relationship/dynamics-presence of any obvious/readily observable
conflict between members; characteristics, communication/interaction patterns among
members.
B. Socio-economic and Cultural Characteristics
1. Income and expenses
a. Occupation, place of work and income of each working member
b. Adequacy to meet basic necessities (food, clothing, shelter)
c. Who makes decision about money and how it is spent
2. Educational Attainment of each Member
3. Ethnic Background and Religious Affiliation
4. Significant others-role (s) they play in family’s life
5.  Relationship of the family to larger community-nature and extent of participation of the
family in community activities
C. Home Environment
1. Housing
a. Adequacy of living space
b. Sleeping in arrangement
c. Presence of breathing or resting sites of vector of diseases (e.g. mosquitoes,
roaches, flies, rodents,  etc.)
d. Presence of accident hazard
e. Food storage and cooking facilities
f. Water supply-source, ownership, pot ability
g. Toilet facilities-type, ownership, sanitary condition
 h. Garbage/refuse disposal-type, sanitary condition
i. 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
D. Health Status of Each Family Member
1. Medical Nursing history indicating current or past significant illnesses or beliefs and
practices conducive to health and illness
2. Nutritional assessment (especially for vulnerable or at risk members)
  Anthropometric data: measures of nutritional status of children-weight, height, mid-
upper arm circumference; risk assessment measures for obesity : body mass
index(BMI=weight in kgs. divided by height in meters2), waist circumference (WC:
greater than 90 cm. in men and greater than 80 cm. in                women), waist hip
ration (WHR=waist circumference in cm. divided by hip circumference in cm. Central
obesity: WHR is equal to or greater than 1.0 cm in men and 0.85 in women)
 dietary history specifying quality and quantity of food or nutrient per day
 Eating/ feeding habits/ practices
3. Developmental assessment of infant, toddlers and preschoolers- e.g. Metro Manila
DevelopmentalScreening  Test (MMDST).
4. Risk factor assessment indicating presence of major and contributing modifiable risk
factors for specific  lifestyle diseases-e.g. hypertension, physical inactivity, sedentary
lifestyle, cigarette/ tobacco smoking,            elevated blood lipids/ cholesterol, obesity,
diabetes mellitus, inadequate fiber intake, stress, alcohol                drinking, and other
substance abuse.
5. Physical Assessment indicating presence of illness state/s (diagnosed or undiagnosed
by medical practitioners )
6. Results of laboratory/diagnostic and other screening procedures supportive of
assessment findings.
E. 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/activities
 Use of protective measure-e.g. adequate footwear in parasite-infested areas; use of
bed nets andprotective clothing in      malaria and filariasis endemic areas.
 Relaxation and other stress management activities
4. Use of promotive-preventive health services
 Laws Affecting Public Health and
Practice of CHN
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 chairman
3. Chairman, Committee on Health of Sangguniang Panlalawigan
4. DOH representative
5. NGO representative
City and Municipal Level
1. Mayor – chair
2. MHO – vice chair
3. Chairman, Committee on Health of Sangguniang Bayan
4. DOH representative
5. NGO representative
Effective Local Health System Depends on:
1. The LGU’s 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 1st 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 man’s 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 PWD’s
 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 months.
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 Breast milk Substitutes
R.A. – 7600 – Rooming In and Breastfeeding Act of 1992

R.A. 8976- Food Fortification Law

R.A. 8980

 promulgates 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
 mandates 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

Levels of Clientele in CHN

Individual
Basic approaches in looking at the individual:
1. Atomistic
2. Holistic
Perspectives in understanding the individual:
1. Biological
 unified whole
 holon
 dimorphism
2. Anthropological
 essentialism
 social constructionism
 culture
3. Psychological
 psychosexual
 psychosocial
 behaviorism
 social learning
4. Sociological
 family and kinship
 social groups

Family
Models:
1. Developmental
 Stages of Family Development
 Stage I – Beginning Family (newly wed couples)
 TASK: compliance with the PD 965 & acceptance of the new member of the family
 Stage II – Early Child Bearing Family (0-30 months old)
 TASK: emphasize the importance of pregnancy & immunization & learn the concept
of parenting
 Stage III –Family with Pre- school Children (3-6yrs old)
 TASK: learn the concept of responsible parenthood
 Stage IV – Family with School age Children (6-12yrs old)
 TASK: Reinforce the concept of responsible parenthood
 Stage V – Family with Teen Agers (13-25yrs old)
 TASK: Parents to learn the concept of “let go system” and understands the
“generation gap”
 Stage VI – Launching Center (1st child will get married up to the last child)
 TASK: compliance with the PD 965 & acceptance of the new member of the family
 Stage VII -Family with Middle Adult parents (36-60yrs old)
 TASK: provide a healthy environment, adjust with a new lifestyle and adjust with the
financial aspect
 Stage VIII – Aging Family (61yrs old up to death)
 TASK: learn the concept of death positively
2. Structural-Functional
 a. Initial Data Base
 Family structure and Characteristics
 Socio-economic and Cultural Factors
 Environmental Factors
 Health Assessment of Each MemberValue Placed on Prevention of Disease
b. First Level Assessment 
 Health threats: conditions that are conducive to disease, accident or failure to
realize one’s health potential
 Health deficits: instances of failure in health maintenance (disease, disability,
developmental lag)
 Stress points/ Foreseeable crisis situation: 
 anticipated periods of unusual demand on the individual or family in terms of
adjustment or family resources
c. Second Level Assessment: 
 Recognition of the problem
 Decision on appropriate health action
 Care to affected family member
 Provision of healthy home environment
 Utilization of community resources for health care
d. Problem Prioritization: 
1. Nature of the problem 
 Health deficit
 Health threat
 Foreseeable Crisis
2. Preventive potential 
 High
 Moderate
 Low
3.  Modifiability 
 Easily modifiable
 Partially modifiable
 Not modifiable
4. Salience 
 High
 Moderate
 Low
e. Family Service and Progress Record 
Population Group
Vulnerable Groups:
 Infants and Young Children
 School age
 Adolescents
 Mothers
 Males
 Old People
Specialized Fields:
Community Mental Health Nursing
 A unique clinical process which includes an integration of concepts from nursing, mental
health, social psychology, psychology, community networks, and the basic sciences
Occupational Health Nursing
 The application of nursing principles and procedures in conserving the health of workers
in all occupations
School Health Nursing
 The application of nursing theories and principles in the care of the school population

Management of a Child with an Ear

Problem
Classification of Ear Infection
1. Mastoiditis – tender swelling behind the ear (in infants, swelling may be above the ear)
  Treatment 
a. Antibiotics
b. Surgical intervention
2. Acute Ear Infection – pus draining from the ear for less than 2 weeks, ear pain, red,
immobile ear drum  (Acute Otitis Media)
 Treatment 
a. Cotrimoxazole,Amoxycillin,or Ampicillin
b. Dry the ear by wicking
3. Chronic Ear Infection – pus draining from the ear for more than 2 weeks (Chronic Otitis
Media)
 Treatment 
a. Most important & effective treatment: Keep the ear dry by wicking.
b. Paracetamol maybe given for pain or high fever.
c. Precautions for a child with a draining ear:
 Do not leave anything in the ear such as cotton, wool between wicking
treatments.
 Do not put oil or any other fluid into the ear.
 Do not let the child go swimming or get water in the ear.
 National Health Plan
Definition
 National Health Plan is a long-term directional plan for health; the blueprint defining the
country’s health – PROBLEMS, POLICY THRUSTS STRATEGIES, THRUSTS
Goal
 to enable the Filipino population to achieve a level of health which will allow Filipino to
lead a socially and economically-productive life, with longer life expectancy, low infant
mortality, low maternal mortality and less disability through measures that will guarantee
access of everyone to essential health care
Objectives
 promote equity in health status among all segments of society
 address specific health problems of the population
 upgrade the status and transform the HCDS into a responsive, dynamic and highly
efficient, and effective one in the provision of solutions to changing the health needs of
the population
 promote active and sustained people’s participation in health care
Health Plans Towards “Health In The Hands Of The People In The
Year 2020”
1. Major Health Plan
 23 IN 93
 Health for more in 94
 Think health…… Health Link
 5 in 95
2. Priority Program in Year 2000
 Plan 50
 Plan 500
 Women’s health
 Children’s health
 Healthy Lifestyle
 Prevention & Control of Infectious Disease
3. Priority Program in the Year 2005
 Ligtas Buntis Campaign
 Mag healthy Lifestlye tayo
 TB Network
 Blood Donation Program (RA 7719)
 DTOMIS
 Ligtas Tigdas Campaign
 Murang Gamot
 Anti Tobacco Signature Campaign
 Doctors to the Barrios Program
 Food Fortification Program
 Sentrong Sigla Movement
4. National Health Events for 2006
JANUARY

 National Cancer Consciousness Week – (16-22)

FEBRUARY

 Heart Month
 Dental Health Month
 Responsible Parenthood Campaign National Health Insurance Program
MARCH

 Women’s Health Month

 Rabies Awareness Month
 Burn Injury Prevention Month
 Responsible Parenthood Campaign
 Colon and Rectal Cancer Awareness Month
 World TB Day – (24)
APRIL

 Cancer in Children Awareness Month

 World Health Day – (7)
 Bright Child Week Phase I
 Garantisadong Pambata (11-17)
MAY

 Natural Family Planning Month

 Cervical Cancer Awareness Month
 AIDS Candlelight Memorial Day – (21)
 World No Tobacco Day – (31)
JUNE

 Dengue Awareness Month

 No Smoking Month
 National Kidney Month
 Prostate Cancer Awareness Month
JULY

 Nutrition Month
 National Blood Donation Month
 National Disaster Consciousness Month
AUGUST

 National Lung Month

 National Tuberculosis Awareness Month
 Sight-Saving Month
 Family Planning Month
 Lung Cancer Awareness Month
SEPTEMBER

 Generics Awareness Month

 Liver Cancer Awareness Month
OCTOBER

 National Children’s Month

 Breast Cancer Awareness Month
 National Newborn Screening Week (3-9)
 Bright Child Week Phase II Garantisadong Pambata (10-16)
NOVEMBER

 Filariasis Awareness Month

 Cancer Pain Management Awareness Month
 Traditional and Alternative Health Care Month
 Campaign on Violence against Women and Children
DECEMBER

 Firecracker Injury Prevention Campaign:

 “OPLAN IWAS PAPUTOK”

Nutrition
 Principles of Nutrition
1. Digestion – process by which food substances are changed into forms that can be
absorbed through cell membranes
2. Absorption – the taking in of substance by cells or membranes
3. Metabolism – sum of all physical and chemical processes by which a living organism is
formed and maintained and by which energy is made available
4. Storage – some nutrients are stored when not used to provide energy; e.g. carbohydrates
are stored either as glycogen or as fat
5. Elimination – process of discarding unnecessary substances through evaporation,
excretion
 Nutrients
1. Carbohydrates – the primary sources are plant foods
Types of Carbohydrates
a. Simple (sugars) such as glucose, galactose, and fructose

b. Complex such as starches (which are polysaccharides) and fibers (supplies bulk or

roughage to the diet)
2. Proteins – organic substances made up of amino acids
3. Lipids – organic substances that are insoluble in water but soluble in alcohol and ether.

 Fatty acids – the basic structural units of all lipids and are either saturated (all the
carbon atoms are filled with hydrogen) or unsaturated (could accommodate more
hydrogen than it presently contains)
 Food sources of lipids are animal products (milk, egg yolks and meat) and plants and
plant products (seeds, nuts,oils)
4. Vitamins – organic compounds not manufactured in the body and needed in small
quantities to catalyze metabolic processes.
a. Water-soluble vitamins include C and B-complex vitamins

b. Fat-soluble vitamins include A, D, E, and K and these can be stored in limited amounts in

the body
5. Minerals – compounds that work with other nutrients in maintaining structure and function
of the body
a. Macronutrients – calcium, phosphate, sodium, potassium, chloride, magnesium and sulfur

b. Micronutrients (trace elements) – iron, iodine, copper, zinc, manganese and fluoride The
best sources are vegetables, legumes, milk and some meats
6. Water – the body’s most basic nutrient need; it serves as a medium for metabolic
reactions within cells and a transporter fro nutrients, waste products and other substances

Philippine Health Care Laws

REPUBLIC ACT – an act passed by the Congress of the Philippines, while the form of
government is Republican government.
 Republic Act 349 – Legalizes the use of human organs for surgical, medical and scientific
purposes.
 Republic Act 1054 – Requires the owner, lessee or operator of any commercial, industrial
or agricultural establishment to furnish free emergency, medical and dental assistance to
his employees and laborers.
 Republic Act 1080 – Civil Service Eligibility
 Republic Act 1082 – Rural Health Unit Act
 Republic Act 1136 – Act recognizing the Division of Tuberculosis in the DOH
 Republic Act 1612 – Privilege Tax/Professional tax/omnibus tax should be paid January
31 of each year
 Republic Act 1891 – Act strengthening Health and Dental services in the rural areas
 Republic Act 2382 – Philippine Medical Act which regulates the practice of medicines in
the Philippines
 Republic Act 2644 – Philippine Midwifery Act
 Republic Act 3573 – Law on reporting of Communicable Diseases
 Republic Act 4073 – Liberalized treatment of Leprosy
 Republic Act 4226 – Hospital Licensure Act requires all hospital to be licensed before it
can operative
 Republic Act 5181 – Act prescribing permanent residence and reciprocity as qualifications
for any examination or registration for the practice of any profession in the Philippines
 Republic Act 5821 – The Pharmacy Act
 Republic Act 5901 – 40 hours work for hospital workers
 Republic Act 6111 – Medicare Act
 Republic Act 6365 – Established a National Policy on Population and created the
Commission on population
 Republic Act 6425 – Dangerous Drug Act of 1992
 Republic Act 6511 – Act to standardize the examination and registration fees charged by
the National Boards, and for other purposes.
 Republic Act 6675 – Generics Act of 1988
 Republic Act 6713 – Code of Conduct and Ethical Standards for Public Officials and
Employees
 Republic Act 6725 – Act strengthening the prohibition on discrimination against women
with respect to terms and condition of employment
 Republic Act 6727 – Wage Rationalization Act
 Republic Act 6758 – Standardized the salaries
 Republic Act 6809 – Majority age is 18 years old
 Republic Act 6972 – Day care center in every Barangay
 Republic Act 7160 – Local Government Code
 Republic Act 7164 – Philippine Nursing Act of 1991
 Republic Act 7170 – Law that govern organ donation
 Republic Act 7192 – Women in development nation building
 Republic Act 7277 – Magna Carta of Disabled Persons
 Republic Act 7305 – The Magna Carta of public Health Workers
 Republic Act 7392 – Philippine Midwifery Act of 1992
 Republic Act 7432 – Senior Citizen Act
 Republic Act 7600 – Rooming In and Breastfeeding Act of 1992
 Republic Act 7610 – Special protection of children against abuse, exploitation and
discrimination act
 Republic Act 7624 – Drug Education Law
 Republic Act 7641 – New Retirement Law
 Republic Act 7658 – An act prohibiting the employment of children below 15 years of age
 Republic Act 7719 – National Blood Service Act of 1994
 Republic Act 7875 – National Health Insurance Act of 1995
 Republic Act 7876 – Senior Citizen Center of every Barangay
 Republic Act 7877 – Anti-sexual harassment Act of 1995
 Republic Act 7883 – Barangay Health workers Benefits and Incentives Act of 1992
 Republic Act 8042 – Migrant Workers and Overseas Filipino Act of 1995
 Republic Act 8172 – Asin Law
 Republic Act 8187 – Paternity Leave Act of 1995
 Republic Act 8203 – Special Law on Counterfeit Drugs
 Republic Act 8282 – Social Security Law of 1997 (amended RA 1161)
 Republic Act 8291 – Government Service Insurance System Act of 1997 (amended PD
1146)
 Republic Act 8344 – Hospital Doctors to treat emergency cases referred for treatment
 Republic Act 8423 – Philippine Institute of Traditional and Alternative Medicine
 Republic Act 8424 – Personal tax Exemption
 Republic Act 8749 – The Philippine Clean Air Act of 1999
 Republic Act 8981 – PRC Modernization Act of 2000
 Republic Act 9165 – Comprehensive Dangerous Drugs Act 2002
 Republic Act 9173 – Philippine Nursing Act of 2002
 Republic Act 9288 – Newborn Screening Act
PRESIDENTIAL DECREE – An order of the President. This power of the President which
allows him/her to act as legislators was exercised during the Marshall Law period.
 Presidential Decree 46 – An act making it punishable for any public officials or employee,
whether of the national or local government, to receive directly or indirectly any gifts or
valuable things
 Presidential Decree 48 – Limits benefits of paid maternity leave privileges to four children
 Presidential Decree 69 – Limits the number of children to four (4) tax exemption purposes
 Presidential Decree 79 – Population Commission
 Presidential Decree 147 – Declares April and May as National Immunization Day
 Presidential Decree 148 – Regulation on Woman and Child Labor Law
 Presidential Decree 166 – Strengthened Family Planning program by promoting
participation of private sector in the formulation and implementation of program
planning policies.
 Presidential Decree 169 – Requiring Attending Physician and/or persons treating injuries
resulting from any form of violence.
 Presidential Decree 223 – Professional Regulation Commission
 Presidential Decree 442 – Labor Code Promotes and protects employees self-organization
and collective bargaining rights. Provision for a 10% right differential pay for hospital
workers.
 Presidential Decree 491 – Nutrition Program
 Presidential Decree 539 – Declaring last week of October every as Nurse’s Week. October
17, 1958
 Presidential Decree 541 – Allowing former Filipino professionals to practice their respective
professions in the Philippines so they can provide the latent and expertise urgently
needed by the homeland
 Presidential Decree 568 – Role of Public Health midwives has been expanded after the
implementation of the Restructed Health Care Delivery System (RHCDS)
 Presidential Decree 603 – Child and Youth Welfare Act / Provision on Child Adoption
 Presidential Decree 626 – Employee Compensation and State Insurance Fund. Provide
benefits to person covered by SSS and GSIS for immediate injury, illness and disability.
 Presidential Decree 651 – All births and deaths must be registered 30 days after delivery.
 Presidential Decree 825 – Providing penalty for improper disposal garbage and other forms
of uncleanliness and for other purposes.
th
 Presidential Decree 851 – 13  Month pay
 Presidential Decree 856 – Code of Sanitation
 Presidential Decree 965 – Requiring applicants for Marriage License to receive instruction
on family planning and responsible parenthood.
 Presidential Decree 996 – Provides for compulsory basic immunization for children and
infants below 8 years of age.
 Presidential Decree 1083 – Muslim Holidays
 Presidential Decree 1359 – A law allowing applicants for Philippine citizenship to take
Board Examination pending their naturalization.
 Presidential Decree 1519 – Gives medicare benefits to all government employees
regardless of status of appointment.
 Presidential Decree 1636 – requires compulsory membership in the SSS and self-employed
 Presidential Decree 4226 – Hospital Licensure Act
PROCLAMATION – an official declaration by the Chief Executive / Office of the President of
the Philippines on certain programs / projects / situation
 Proclamation No.6 – UN’s goal of Universal Child Immunization; involved NGO’s in the
immunization program
 Proclamation No. 118 – Professional regulation Week is June 16 to 22
 Proclamation No. 499 – National AIDS Awareness Day
 Proclamation No. 539 – Nurse’s Week – Every third week of October
 Proclamation No. 1275 – Declaring the third week of October every year as “Midwifery
Week”
LETTER OF INSTRUCTION – An order issued by the President to serve as a guide to his/her
previous decree or order.
 LOI 47 – Directs all school of medicine, nursing, midwifery and allied medical professions
and social work to prepare, plan and implement integration of family planning in their
curriculum to require their graduate to take the licensing examination.
 LOI 949 – Act on health and health related activities must be integrated with other
activities of the overall national development program. Primary Health Care (10-19-79)
 LOI 1000 – Government agencies should be given preference to members of the
accredited professional organization when hiring
EXECUTIVE ORDER – an order issued by the executive branch of the government in order to
implement a constructional mandate or a statutory provision.
 Executive Order 51 – The Milk Code
 Executive Order 174 – National Drug Policy on Availability, Affordability, Safe, Effective and
Good Quality drugs to all
 Executive Order 180 – Government Workers Collective Bargaining Rights Guidelines on the
right to Organize of government employee.
 Executive Order 203 – List of regular holidays and special holidays
 Executive Order 209 – The Family Code (amended by RA 6809)
 Executive Order 226 – Command responsibility
 Executive Order 503 – Provides for the rules and regulations implementing the transfer of
personnel, assets, liabilities and records of national agencies whose functions are to be
devoted to the local government units.
 Executive Order 857 – Compulsory Dollar Remittance Law
Other Important Information
 Administrative Order 114 – Revised/updated the roles and functions of the Municipal
Health Officers, Public Health Nurses and Rural Midwives
 ILO Convention 149 – Provides the improvement of life and work conditions of nursing
personnel.

Primary Health Care (PHC)

Overview
 May 1977 -30th 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
 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.
 a practical approach to making health benefits within the reach of all people.
 an 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
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
people’s participation at all levels of decision-making; planning, implementing,
monitoring and evaluating. Any undertaking must also be based on the people’s needs
and problems (PCF, 1990)
 Part of the people’s 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
 Through community participation and cohesiveness of people’s organization they can
generate support for health care through social mobilization, networking and
mobilization of local resources. Leadership and management skills should be develop
among these people. Existence of sustained health care facilities managed by the people
is some of the major indicators that the community is leading to 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 nongovernment organization and
people’s organization.
6. Recognition of interrelationship between the health and development
 Health- Is not merely the absence of disease. Neither is it 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
multidimensional. It has 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
 This ensures empowerment and that empowerment can only be facilitated if the
administrative structure provides local level political structures with more substantive
 responsibilities for development initiators. This also facilities proper allocation of
budgetary resources.
Elements of Primary Health Care
1. Education for Health
 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.
2. Locally Endemic Disease Control
 The control of endemic disease focuses on the prevention of its occurrence to reduce
morbidity rate. Example Malaria Control and Schistosomiasis Control
3. Expanded Program on Immunization
 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
4. Maternal and Child Health and Family Planning
 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.
5. Environmental Sanitation and Promotion of Safe Water Supply
 Environmental Sanitation is defined as the study of all factors in the man’s 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 man’s environment. Water is necessary for the
maintenance of healthy lifestyle. Safe Water and Sanitation is necessary for basic
promotion of health.
6. Nutrition and Promotion of Adequate Food 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.
7. Treatment of Communicable Diseases and Common Illness
 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.
8. Supply of Essential Drugs
 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
Major Strategies of Primary Health Care
1. Elevating Health to a Comprehensive and Sustained National Effort.
 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.
2. 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.
3. 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.
4. 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

Reproductive Health
Definition
 A state of complete physical, mental and social well-being and not merely the absence of
disease/ infirmity in all matters relating to the reproductive system and to its functions
and processes.
Basic RH Rights
 Right to RH information and health care services for safe pregnancy and childbirth
 Right to know different means of regulating fertility to preserve health and where to
obtain them
 Freedom to decide the number and timing of birth of children
 Right to exercise satisfying sex life
Factors/ Determinants of RH
 Socioeconomic conditions – education, employment, poverty, nutrition, living condition/
environment, family environment
 Status of women – equal right in education and in making decisions about her own RH;
right to be free from torture and ill treatment and to participate in politics
 Social and Gender Issues
 Biological (individual knowledge of reproductive organs and their
functions), cultural (country’s norms, RH practices) and psychosocial factors
Elements
 Maternal and Child Health Nutrition
 Family Planning
 Prevention and Management of Abortion Complications
 Prevention and Treatment of Reproductive Tract Infections, including STDs, HIV and
AIDS
 Education and Counseling on Sexuality and Sexual Health
 Breast and Reproductive Tract Cancers and other Gynecological Conditions
 Men’s Reproductive Health
 Adolescent Reproductive Health
 Violence Against Women
 Prevention and Treatment of Infertility and Sexual Disorders
Selected Concepts
 RH is the exercise of reproductive right with responsibility
 It means safe pregnancy and delivery, the right of access to appropriate health
information and services
 It includes protection from unwanted pregnancy by having access to safe and
acceptable methods of family planning of their choice
 It includes protection from harmful reproductive practices and violence
 It ensures sexual health for the purpose of enhancement of life and personal relations
and assures access to information on sexuality to achieve sexual enjoyment
Goal
 To achieve healthy sexual development and maturation
 To achieve their reproductive intention
 To avoid diseases, injuries and disabilities related to sexuality and reproduction
 To receive appropriate counseling and care of RH problems
Strategies
 Increase and improve the use of more effective or modern contraceptive methods
 Provision of care, treatment and rehabilitation for RH
 RH care provision should be focused on adolescents, men and unmarried and other
displaced people with RH problems
 Strengthen outreach activities and referral system
 Prevent specific RH problems through information dissemination and counseling of
clients

Traits and Qualities of a Health Worker

Efficient
 plans with the people, organizes, conducts, directs health education activities according
to the needs of the community
 knowledgeable about everything relevant to his practice; has the necessary skills
expected of him
Good listener
 hears what’s being said and what’s behind the words
 always available for the participant to voice out their sentiments and needs
Keen observer
 keep an eye on the proceedings, process and participants’ behavior
Systematic
 knows how to put in sequence or logical order the parts of the session
Creative/Resourceful
 uses available resources
Analytical/Critical thinker
 decides on what has been analyzed
Tactful
 brings about issues in smooth subtle manner
 does not embarrass but gives constructive criticisms
Knowledgeable
 able to impart relevant, updated and sufficient input
Open
 invites ideas, suggestions, criticisms
 involves people in decision making
 accepts need for joint planning and decision relative to health care in a particular
situation; not resistant to change
Sense of humor
 knows how to place a touch of humor to keep audience alive
Change agent
 involves participants actively in assuming the responsibility for his own learning
Coordinator
 brings into consonance of harmony the community’s health care activities
Objective
 unbiased and fair in decision making
Flexible
 able to cope with different situations

Under Five Clinic Program

Overview
 The first five years of life form the foundations of the child’s physical and mental growth
and development. Studies have shown the mortality and morbidity are high among this
age group. The Department of Health established the Under Five Clinic Program to
address this problem.
Program Objectives and Goals
 Monitor growth and development of the child until 5 years of age.
 Identify factors that may hinder the growth and development of the child.
Activities and Strategies
1. Regular height and weight determination/ monitoring until 5 years old. 0-1 year
old=monthly 1 year old and above =quarterly
2. Recording of immunization, vitamins supplementation, deworming and feeding.
3. Provision of IEC materials (ex. Posters, charts, and toys) that promote and enhance
child’s proper growth and development.
4. Provision of a safe and learning – oriented environment for the child.
5. Monitoring and Evaluation.