Community Health Nursing

Pre Test Rationale

Jaypee G. Valenzuela, RN
RA 8423

Philippine Institute of Traditional and

Alternative Health Care

 Herbalmedicines
 Acupressure
 Acupuncture
Herbal plants used as medicines
 Lagundi – ascof forte
 Yerba Buena – headache, stomach ache,
rheumatism arthritis
 Sambong – anti edema, diuretic, anti urolithiasis
 Tsaang Gubat – anti spasmodic, stomach ache,
diarrhea
 Niyug-niyogan – anti helmintic

- should not be given 4 years old and below

 Bayabas – washing wounds, diarrhea, gargle
for toothache
 Akapulko – anti fungal
 Ulasimang Bato (pansit pansitan) – lowers uric
acid, gouty arthritis
 Bawang – lowers cholesterol, HPN, toothache
 Ampalaya – mild DM non insulin dependent
Salient points:
 Avoid use of insecticides
 In preparation, use clay pot and remove
cover while boiling at low heat
 Use only the part of the plant advocated
 Follow accurate dose of suggested
preparation
 Use one kind of herbal plant for each
type of symptom or disease
 Stop giving herbal medication if untoward
reaction occurs
 If signs and symptoms are not relieved in
2 – 3 doses, consult physician
Acupressure
 -amethod of maintaining health, treating
disease, and alleviating pain by applying
pressure or massaging center points on
the body surfaces.
Salient points:
 Qi- life energy

2 aspects:
 Yin- negative and feminine force
 Yang- positive and masculine force

***Imbalance indicates illness

Application Of Acupressure
 Posture: lying or sitting
 Manipulation: thumb pressure (small
circular movements, 2-3 cycles per
second)
 Precautions:

-room should be warm and well ventilated

 clean and warm practitioner’s hand
 never done with full stomach, pregnant, and
cardiac patients
 foods to avoid: iced drink or food
Sour food
Alcohol drink
Spicy foods
Seafoods
Peanuts and salty
 Selection of acupressure points:
 use of prescribed points
 use of Ashi points

 Location of acupressure points:

 use of anatomical landmarks
 use of Tsun measurement.
Control of Diarrheal Diseases (CDD)

 Diarrhea
– unusual frequency of bowel
movements more than 3x a day

 3 classifications:
 mild:5–9
 moderate: 10 – 15

 severe: > 15
 Types:
 Acute:3 loose stools; less than 2 weeks
 Chronic: LBM on and off for more than 2 weeks

 Management:
 Fluids
 Oral Rehydration Therapy
 Fruit juice, “AM”

 Home made soup

 Frequent Feeding
 continue breastfeeding - 6 month old - Cal
CHO – 6x a day
 If subsided, additional feeding for 2 weeks

 Fast Referral
Treatment plans

 PLAN A (no dehydration)

 home treatment
 follow up after 5 days
 PLAN B (some dehydration)
 two of the following signs:
 restless,irritable
 sunken eyes

 poor skin turgor

 Treatment:
 1stday: home care / ORS
 2nd day: refer
 PLAN C (severe dehydration)
 two of the following:
 abnormally sleepy, difficult to awake
 sunken eyes

 unable to drink

 poor skin turgor

 Treatment:
 Refer

 Give ORS (frequent sips) along the way

ORS
 1 pack : 1 L water
 Good for 24 hours
 Boiled water

Contents:
 glucose for Na absorption
 NaCl for fluid retention

 NaHCO3 – buffer system

 KCl for smooth muscle/cardio contraction

***STOP giving ORS if there is puffiness in

eyelids already
Measures of Diarrhea Prevention:
 Breast feed infants
 Provide appropriate supplemental feeding
 Handwashing
 Utilize clean and portable water
 Clean toilet and observe proper feces disposal
 Immunize the child with measles
 No to antibiotic unless with cholera, thyroid,
or amoebiasis
Tuberculosis
 -a highly infectious chronic disease caused by
the tubercle bacilli.
S/S:
 Cough of two weeks or more
 low grade afternoon fever
 Chest back pains
 Hemoptysis
 Significant weight loss
 Sweating, Fatigue, Body malaise
 SOB
Modes of transmission:
 Airborne droplet (coughing, singing,
sneezing)
 Direct invasion through mucous
membranes or breaks in the skin
 Ingestion of unpasteurized cattle milk
Methods of control
 Promotion:
 Healtheducation regarding disease
 Improvement of social conditions

 Prevention:
 BCG immunization
 Prompt diagnosis and treatment
DOH Program: National Tuberculosis Control
Program

 Vision: A country where TB is no longer a public

health problem

 Mission: Ensure that TB DOTS services are

available, accessible and affordable to communities
in collaboration with the LGUs and other partner
 Goal:To reduce prevalence and mortality
from TB by the year 2015

Targets:
 cure at least 85% of TB positive patients
 detect at least 70% of the estimated new
TB infected individuals.
Direct Observed Treatment
Shortcourse (DOTS)
DOTS strategy:
 sustained political commitment
 access to quality-assumed sputum microscopy
 standardized short-course chemotherapy for all
cases of TB
 uninterrupted supply of quality-assured drugs
 proper recording and reporting system
TB drugs
 Rifampicin R
 Isoniazid I
 Pyrazinamide P
 Ethambutol E
 Streptomycin S
TB drugs
 Rifampicin R
 Isoniazid H
 Pyrazinamide Z
 Ethambutol E
 Streptomycin S
 TB drugs
 FDC(Fixed-Dose Formulation)
CATEGORIES I &III
Body Intensive phase Continuation phase
weight No. of tabs per day No. of tabs per day
2 months 4 months

30 – 37 2 2
38 – 54 3 3
55 – 70 4 4
> 70 5 5
CATEGORY II
INTENSIVE PHASE CONTINUATION
BODY PHASE
WEIGHT
First 2 months 3rd mo FDC-B
FDC-A E
HRZE S HRZE HR 400mg

30 - 37 2 0.75g 2 2 1
38 - 54 3 0.75g 3 3 2
55 –70 4 0.75g 4 4 3
> 70 5 0.75g 5 5 3
 SDF (Single Drug Formulation)

I II III
Intensive HRZE HRZES 2 HRZE
2 months HRZE 1 2 months

Continuation HR HRE HR
4 months 5 months 4 months
Control of Acute Respiratory Infection

Classifications:
 Very Severe Disease
 Severe Pneumonia
 Pneumonia
 No Pneumonia
 Very Severe Disease
(2 months up to 5 years)
Danger signs:
o Not able to drink
o Convulsions
o Abnormally sleepy or difficult to wake
o Stridor
o Severe under-nutrition
***Urgent referral!!!
 Very Severe Disease
(age less than 2 months)
Danger signs:
o Stopped feeding well
o Convulsions
o Abnormally sleepy or difficult to wake
o Stridor or wheezing
o Fever
***Urgent referral!!!
 Severe Pneumonia

Signs:
-fast breathing with chest indrawing

***urgent referral!!!
 Pneumonia
Signs:
-Fast breathing
-cough and colds
Management:
 Give CMZ twice a day for 5 consecutive days
 Monitor for danger signs
 Follow up after 5 days or asap
 No Pneumonia: cough and cold

-no chest indrawing or danger signs

Management:
 Increase feeding and fluid intake
 Home care with monitoring for 2 days
Expanded Program on Immunization

-to decrease the morbidity and mortality of

the six immunizable diseases.
 PD 996 - basic compulsory immunization
 PP 6 – universal child immunization law
 PP 46 – reaffirmation of the Universal
mother and child Immunization law
 SB 642 - inclusion of Hepa B in the
immunization program
Four major strategies:
 Sustaining high routine FIC coverage of at
least 90% in all provinces and cities
 Sustaining the polio free country for global
certification
 Eliminating measles by 2008
 Eliminating neonatal tetanus by 2008
 Contraindications:
 If the child was born with clinical AIDS
 If the child is with serious illness needing
immediate hospitalization
 If the child has fever with temperature
higher than 38.5ºC
***moderate fever, malnutrition, mild
respiratory infection, cough, diarrhea and
vomiting are not contraindications.
 BCG
-live attenuated bacteria
-for prevention of PTB
1st dose: anytime after birth but not later
than 11 months
 0.05cc ID at right deltoid
2nd dose: school entrance
 0.1cc ID
 DPT
 1st dose: 6 weeks old
 2nd dose: 10 weeks old
 3r dose: 14 weeks old

 Dose: 0.5 cc
 Route: IM
 Site: Vastus lateralis
 SE: fever for one day
Pain and swelling for 3 – 4 days
Nursing instructions:
 Do not massage site
 Apply warm compress

 If the child had convulsion, bring back

immediately to the health center
 OPV

-live attenuated virus

-sabin vac (pinkish or orange but never
colorless)
 1st dose: 6 weeks old
 2nd dose: 10 weeks old
 3r dose: 14 weeks old
 Dose: 2 – 3 drops
 Route: PO
Nursing instruction:
 Child should be on NPO for 30 minutes
 If child vomited, repeat giving the dose
 AMV

-live attenuated virus

 Age: 9 months old (Dept Circular # 60)
 Dose: 0.5cc

 Route: Subcutaneous

 Site: left deltoid

 SE: may have fever 5 – 7 days after
immunization accompanied by mild rashes for 1
– 3 days
 HEPA B
-RNA recombinants
-easily destroyed by heating and freezing
 1st dose: 6 weeks old
 2nd dose: 10 weeks old
 3r dose: 14 weeks old
 Dose: 0.5cc
 Route: IM (Z-track)
 Site: vastus lateralis
 SE: pain and swelling
Salient points:
 ColdChain – maintains potency of
vaccine
 Regional: 6 months
 Provincial: 3 months

 Municipal: 1 month

 RHU: 5 days
 BHS: 3 days
 Cold Dog – transport of vaccines
 OPV, Measles
 most sensitive to heat
 put to coldest

 Hepa B, Tetanus Toxoid

 leastsensitive to heat
 sensitive to cold
 FullyImmunized Child
 Completely Immunized Child
 EPI defaulter
Needles

Route Length Gauge

ID 3/8 - 5/8 26 – 27

SC 5/8 – ½ 25 – 26

IM ½-1½ C: 24 – 25
A: 23 – 24
 VITAMIN A supplementation
-for better eyesight
 Sources: retinol and carotene
Complications of Vitamin A deficiency:
 xeropthalmia- night blindness
 bitot’s spot
 corneal ulceration- leading to permanent blindness
 keratomalasia- softening of the cornes
Prevention
 Vit A 200,000iu through GP program

Treatment: (6 months to 11 months)

 100,000iu of retinol today
 100,000iu of retinol tomorrow

 100,000iu of retinol after 2 weeks

 100,000iu of retinol after 6 months

*double dosage for clients older than 11 months old

PATTERNS OF DISEASE
OCCURRENCE
 SPORADIC – intermittent in occurrence
 appearing here and there
 few, isolated and unrelated cases in given
locality
ex: PSP, leptospirosis, etc
 ENDEMIC- continues in occurrence
through out a period of time of the usual
number of causes in a given locality
ex: malaria in palawan
 EPIDEMIC- occurrence of unusual large
cases in a relatively short period of time
-with death records
ex: meninggococcemia
 PANDEMIC- simultaneous occurrence of a global
phenomenon
 epidemics in the same countries
ex: Avian Flu (2004)
SARS (2002)
AIDS (1992)
Anthrax
Bulbonic plague
Types of Crisis
 Situational

Ex: death of spouse

 Maturational

Ex: menarche
 Adventitious

Ex: tsunami
DENGUE HEMORRHAGIC FEVER

-first reported in 1953

-became a notifiable disease in 1958
 Causative agent: Dengue Virus types 1, 2,
3 and 4
Chikungunya virus
 Mode of transmission: vector borne
(aedes aegypti)
Stages:
 First 4 days: febrile or massive stage
Fever higher than 39ºC
 4th to 7th days: toxic or hemorrhagic stage
-lowering of temp
-bleeding starts
 7th to 10th days:convalescent or recovery
stage
S/S:
Febrile stage:
 high fever
 abdominal pain and vomiting
 headache
 epixtaxis
 conjunctival infection
Toxic stage:
 Petechiae
 Pain behind eyes
 Melena
 Unstable BP, narrow pulse pressure
 Shock
 Diagnostic Test: Rumpel leeds’s test
Nursing care:
 monitor for bleeding
 monitor VS
 bleeding precautions
 in case of shock, position client to
Trendelenburg and fluid challenge
MALARIA

 Causative agent:
 Plasmodium Falciparum
 Plasmodium Vivax

 Plasmodium Ovale

 Plasmodium Malariae
 Mode of Transmission: vector borme (female
Anopheles mosquito)
 Anopheles Flavirossus: thrives in clear, slow
flowing body of water
 Anopheles Mangyamos: near forrest
 Anopheles Maculatus: exposed to sunlight
 Anopheles Litorales: blackish water
 Anopheles Balabasensis: inside forrest

 Incubation period: 6 – 14 days

S/S
 -recurrent chills
 -profuse sweating
 -fever
 -malaise
 -hepatomegaly
 -spleenomegaly
 *complication: Blackwater fever
-mahogany-colored urine
-hemoglobinuria
 Diagnostic test:
 Blood smear
 Malarial IFAT

 DOC: Chloroquine
Preventive measures
 health education regarding disease
 chemoprophylaxis
 use of plants, animals, and drugs
 insecticide
 CLEAN UP Drive
 Chemically treated mosquito nets
 Larvae eating fish

 Environmental cleaning

 Anti-mosquito soap

 Neem trees
SCHISTOSOMIASIS
 (Bilhariasis,
snail fever, occupational disease)
 Causative agent: Schistosoma japonicum
 Mode of transmission: vector borne
(oncomolenia quadrasi)
 Incubation period: 4 – 6 weeks
 Diagnostic test:
 Kato kutz
 COPT
S/S:
 Diarrhea
 Bloody stool
 Enlargement of the abdomen
 Weakness
 Inflamed liver
 Swimmer’s itch
Prevention measures
 education to endemic areas regarding disease
 education on proper waste disposal

 water chlorination ( 3- 5 ml per 1L of water)

 DOC: praziquantel
Protein Energy Malnutrition (PEM)
 MARASMUS – deficiency in calorie and
protein
 muscle wasting disease
 S/S: old man’s face
 Very emaciated
 Skin and bone appearance
 Apathetic and quiet

***referral for 3rd level of prevention

 KWASIORKOR- deficiency in protein
S/S: edema
 Bloated appearance
 Mooning of the face
 Hair is very fine, thin, straight and reddish
 Under nourished
 Always crying, moaning and irritable

***referral for 3rd level of prevention