COMMUNITY HEALTH NURSING

I - Definition of Terms
Community- derived from a latin word comunicas which means
a group of people.
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
Healt - is the OLOF (Optimum Level of Functioning)
Community Healt - part of paramedical and medical interventionapproach which is concerned
on the health of the whole population
Aims!
!. health promotion
". disease prevention
#. management of factors affecting health
Nursin" - both profession $ a vocation. %ssisting sic& individuals to become healthy and healthy
individuals achieve optimum wellness
II - Community Healt Nursin"
'he utili(ation 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.
Goal! 'o raise the level of citi(enry by helping communities and families to cope with the
discontinuities in and threats to health in such a way as to ma*imi(e their potential for
high-level wellness
MISSION O# CHN
+ealth ,romotion
+ealth ,rotection
+ealth -alance
.isease prevention
/ocial 0ustice
$HILOSO$HY O# CHN
'he philosophy of 1+2 is based on the worth and dignity on the worth and dignity of
man.
$rin%i&les of Community Healt!
!. 'he community is the patient in 1+2) the family is the unit of care and there are four levels of
clientele3 individual) family) population group (those who share common characteristics)
developmental stages and common e*posure to health problems 4 e.g. children) elderly)) and
the community.
". 5n 1+2) the client is considered as an %1'567 partner 2O' ,%//567 recipient of care
#. 1+2 practice is affected by developments in health technology) in particular) changes in
society) in general
8. 'he goal of 1+2 is achieved through multi-sectoral efforts
9. 1+2 is a part of health care system and the larger human services system.
Role of CH Nurse!
1linician - who is a health care provider) ta&ing care of the sic& people at home or in
the :+;
+ealth %dvocator 4 spea&s on behalf of the client
%dvocator 4 act on behalf of the client
/upervisor - who monitors and supervises the performance of midwives
Facilitator - who establishes multi-sectoral lin&ages by referral system
1ollaborator 4 wor&ing with other health team member
COMMON $ROCEDURE IN CHN!
+O<7 65/5'
-%= '71+25>;7
31
/'7:5L5?%'5O2
/,715<72 1OLL71'5O2
- ;:527
- F717/
- /,;';<
Le'els of Client in CHN!
!. %pplication of 2ursing ,rocess to3
()a #amily
()a)( #amily Co&in" In*e+
,hysical 5ndependence - ability of the family to move in $ out of bed $
performed activities of daily living
'herapeutic 5ndependence - ability of the family to comply with the therapeutic
regimen (diet) medication $ usage of appliances)
@nowledge of +ealth 1ondition- wisdom of the family to understand the disease
process
%pplication of =eneral $,ersonal +ygiene- ability of the family to perform
hygiene $ maintain environment conducive for living
7motional 1ompetence 4 ability of the family to ma&e decision maturely $
appropriately (facing the reality of life)
Family Living ,attern- the relationship of the family towards each other with love)
respect $ trust
;tili(ation of 1ommunity :esources 4 ability of the family to &now the function $
e*istence of resources within the vicinity
+ealth 1are %ttitude 4 relationship of the family with the health care provider
,hysical 7nvironment 4 ability of the family to maintain environment conducive
for living
()a), #amily Life Cy%le
/tage 5 4 -eginning Family (newly wed couples)
'%/@3 compliance with the ,. AB9 $ acceptance of the new member of the family
/tage 55 4 7arly 1hild -earing Family(C-#C months old)
'%/@3 emphasi(e the importance of pregnancy $ immuni(ation $ learn the concept
of parenting
/tage 555 4Family with ,re- school 1hildren (#-Byrs old)
'%/@3 learn the concept of responsible parenthood
/tage 56 4 Family with /chool age 1hildren (B-!"yrs old)
'%/@3 :einforce the concept of responsible parenthood
/tage 6 - Family with 'een %gers (!#-"9yrs old)
'%/@3 ,arents to learn the concept of let go system and understands the
generation gap
/tage 65 4 Launching 1enter (!
st
child will get married up to the last child)
'%/@3 compliance with the ,. AB9 $ acceptance of the new member of the family
/tage 655 -Family with <iddle %dult parents (#B-BCyrs old)
'%/@3 provide a healthy environment) adDust with a new lifestyle and adDust with the
financial aspect
/tage 6555 4 %ging Family (B!yrs old up to death)
'%/@3 learn the concept of death positively
()- 1ommunity
COMMUNITY ASSESSMENT!
/tatus
/tructure
,rocess
TY$ES O# COMMUNITY ASSESSMENT!
() COMMUNITY DIAGNOSIS
% 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.
32
, Ty&es!
Com&reensi'e Community Dia"nosis $ro-lem-Oriente* Community Dia"nosis
- aims to obtain general information about the
community
- type of assessment responds to a particular
need
STE$S!
,reparatory ,hase
!. site selection
". preparation of the community
#. statement of the obDectives
8. determine the data to be collected
9. identify methods and instruments for data collection
B. finali(e sampling design and methods
E. ma&e a timetable
5mplementation ,hase
!. data collection
". data organi(ationcollation
#. data presentation
8. data analysis
9. identification of health problems
B. priority (ation of health problems
E. development of a health plan
F. validation and feedbac&
7valuation ,hase
.IOSTATISTICS
".! .7<O=:%,+G - study of population si(e) composition and spatial distribution as affected by
births) deaths and migration.
Sour%es ! 1ensus 4 complete enumeration of the population

, /ays of Assi"nin" $eo&le!
!. De Jure - ,eople were assigned to the place where assigned to the place they
usually live regardless of where they are at the time of census.
".De Facto - ,eople were assigned to the place where they are physically present at are
at the time of census regardless) of their usual place of residence.

COM$ONENTS!
!. ,opulation si(e
". ,opulation composition
H %ge .istribution
H /e* :atio
H ,opulation ,yramid
H <edian age - age below which 9CI of the population fall and above
which 9CI of the population fall. 'he lower the median
age) the younger the population (high fertility) high death rates).
H %ge 4 .ependency :atio - used as an inde* of age-induced economic drain on human
resources
H Other characteristics3
- occupational groups
- economic groups
- educational attainment
- ethnic group
#. ,opulation .istribution
33
H ;rban-:ural - shows the proportion of people living in urban compared to the rural
areas
H 1rowding 5nde* - indicates the ease by which a communicable disease can be
transmitted from ! host to another susceptible host.
H ,opulation .ensity - determines congestion of the place
0ITAL STATISTICS
the application of statistical measures to vital events (births) deaths and common
illnesses) that is utili(ed to gauge the levels of health) illness and health services of a
community.
TY$ES!
#ERTILITY RATE
A) CRUDE .IRTH RATE
total J of livebirths in a given calendar year K !CCC
estimated population as of 0uly ! of the same given year
.) GENERAL #ERTILITY RATE
total J of livebirths in a given calendar year K !CCC
'otal number of reproductive age
MORTALITY RATE
A) CRUDE DEATH RATE

'otal J of death in a given calendar year K !CCC

7stimated population as of 0uly ! of the same calendar year
.) IN#ANT MORTALITY RATE
'otal J of death below ! yr in a given calendar year K !CCC
7stimated population as of 0uly ! of the same calendar year
C) MATERNAL MORTALITY RATE
1
D 'otal J of death among all maternal cases in a given calendar year K !CCC
7stimated population as of 0uly ! of the same calendar year
MOR.IDITY RATE
A) $RE0ALENCE RATE
E 'otal J of new $ old cases in a given calendar year K !CC
7stimated population as of 0uly ! of the same calendar year
.) INCIDENCE RATE
F
G 'otal J of new cases in a given calendar year K !CC
7stimated population as of 0uly ! of the same calendar year
C) ATTAC1 RATE
'otal J of person who are e*posed to the disease K !CC
7stimated population as of 0uly ! of the same calendar year
34
III - E&i*emiolo"y
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
a) ,atterns of disease occurrence
E&i*emi%
- a situation when there is a high incidence of new cases of a specific disease in
e*cess of the e*pected.
- when the proportion of the susceptibles are high compared to the proportion of
the immunes
E&i*emi% &otential
- an area becomes vulnerable to a disease upsurge due to causal factors such as
climatic changes) ecologic changes) or socio-economic changes
En*emi%
- 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.
S&ora*i%
- disease occurs every now and then affecting only a small number of people
relative to the total population
- intermittent
$an*emi%
- global occurrence of a disease
/teps in 7,5.7<5OLO=51%L 567/'5=%'5O23
!. 7stablish fact of presence of epidemic
". 7stablish time and space relationship of the disease
#. :elate to characteristics of the group in the community
8. 1orrelate all data obtained
-) :ole of the 2urse
1ase Finding
+ealth 'eaching
1ounseling
Follow up visit
I0) Healt Situation of te $ili&&ines
$ili&&ine S%enario!
5n the past "C years some infectious degenerative diseases are on the rise.
<any Filipinos are still living in remote and hard to reach areas where it is difficult to
deliver the health services they need
'he scarcity of doctors) nurses and midwives add to the poor health delivery system to the
poor
0ITAL HEALTH STATISTICS ,223
,:O071'7. ,O,;L%'5O2 3
<%L7 - 8")FE8)EBB
F7<%L7 - 8")#B")!8E
-O'+ /7K7/ - F9)"#B)A!#
L5F7 7K,71'%21G
F7<%L7 - EC yrs. old
<%L7 - B8 yrs. Old
LEADING CAUSES O# MOR.IDITY
<ost of the top ten leading causes of morbidity are communicable disease
'hese include the diarrhea) pneumonia) bronchitis) influen(a) '-) malaria and varicella
35
Leading non 1. are heart problem) +,2) accidents and malignant neoplasms
LEADING CAUSES O# MORTALITY
'he top !C leading causes of mortality are due to non 1.
.iseases of the heart and vascular system are the " most common causes of deaths.
,neumonia) ,'- and diarrheal diseases consistently remain the !C leading causes of
deaths.
0) Healt Care Deli'ery System
the totality of all policies) facilities) eLuipments) products) human resources and services
which address the health needs) problems and concerns of the people. 5t is large)
comple*) multi-level and multi-disciplinary.
HEALTH SECTORS
=O67:2<72' /71'O:/
De&artment of Healt
0ision! +ealth for all by year "CCC ands +ealth in the +ands of the ,eople by "C"C
Mission! 5n partnership with the people) provide eLuity) Luality and access to health care esp. the
marginali(ed
3 Ma4or #un%tions!
!. 7nsure eLual access to basic health services
". 7nsure formulation of national policies for proper division of labor and proper
coordination of operations among the government agency Durisdictions
#. 7nsure a minimum level of implementation nationwide of services regarded as public
health goods
8. ,lan and establish arrangements for the public health systems to achieve economies
of scale
9. maintain a medium of regulations and standards to protect consumers and guide
providers
2O2 =O67:2<72' /71'O:/
,:56%'7 /71'O:/
$RIMARY STRATEGIES TO ACHIE0E HEALTH GOALS
/upport for health goal
%ssurance of health care
5ncreasing investment for ,+1
.evelopment of 2ational /tandard
MILESTONE IN HEALTH CARE DELI0RY SYSTEM
:% !CF" - :+; %ct
:% !FA! - /trengthen +ealth /ervices
,. 9BF - :estructuring +1./
:% E!BC - L=; 1ode
0I 5 National Healt $lan
2ational +ealth ,lan is a long-term directional plan for healthM the blueprint defining the
countryNs health 4 ,:O-L7</) ,OL51G '+:;/'/ /':%'7=57/) '+:;/'/
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 e*pectancy) low infant
mortality) low maternal mortality and less disability through measures that will guarantee
access of everyone to essential health care
O.6ECTI0ES!
36
promote eLuity in health status among all segments of society
address specific health problems of the population
upgrade the status and transform the +1./ 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 peopleNs participation in health care
MA6OR HEALTH $LANS TO/ARDS 7HEALTH IN THE HANDS O# THE
$EO$LE IN THE YEAR ,2,28
A) MA6OR HEALTH $LAN
"# 52 A#
+ealth for more in A8
'hin& healthOO +ealth Lin&
9 in A9
.) $RIORITY $ROGRAM IN YEAR ,222
,lan 9C
,lan 9CC
PomenNs health
1hildrenNs health
+ealthy Lifestyle
,revention $ 1ontrol of 5nfectious .isease
C) $RIORITY $ROGRAM IN THE YEAR ,223
Ligtas -untis 1ampaign
<ag healthy Lifestlye tayo
'- 2etwor&
-lood .onation ,rogram (:% EE!A)
.'O<5/
Ligtas 'igdas 1ampaign
<urang =amot
%nti 'obacco /ignature 1ampaign
.octors to the -arrios ,rogram
Food Fortification ,rogram
/entrong /igla <ovement
D) NATIONAL HEALTH E0ENTS #OR ,229
6ANUARY
2ational 1ancer 1onsciousness Pee& - (!B-"")
#E.RUARY
+eart <onth
.ental +ealth <onth
:esponsible ,arenthood 1ampaign 2ational +ealth 5nsurance ,rogram
MARCH
PomenQs +ealth <onth
:abies %wareness <onth
-urn 5nDury ,revention <onth
:esponsible ,arenthood 1ampaign
1olon and :ectal 1ancer %wareness <onth
Porld '- .ay - ("8)
A$RIL
1ancer in 1hildren %wareness <onth
Porld +ealth .ay - (E)
-right 1hild Pee& ,hase 5 -
=arantisadong ,ambata (!!-!E)
MAY
2atural Family ,lanning <onth
37
1ervical 1ancer %wareness <onth
%5./ 1andlelight <emorial .ay - ("!)
Porld 2o 'obacco .ay - (#!)
6UNE
.engue %wareness <onth
2o /mo&ing <onth
2ational @idney <onth
,rostate 1ancer %wareness <onth
6ULY
2utrition <onth
2ational -lood .onation <onth
2ational .isaster 1onsciousness <onth
AUGUST
2ational Lung <onth
2ational 'uberculosis %wareness <onth
/ight-/aving <onth
Family ,lanning <onth
Lung 1ancer %wareness <onth
SE$TEM.ER
=enerics %wareness <onth
Liver 1ancer %wareness <onth
OCTO.ER
2ational 1hildrenQs <onth
-reast 1ancer %wareness <onth
2ational 2ewborn /creening Pee& (#-A)
-right 1hild Pee& ,hase 55 =arantisadong ,ambata (!C-!B)
NO0EM.ER
Filariasis %wareness <onth
1ancer ,ain <anagement %wareness <onth
'raditional and %lternative +ealth 1are <onth
1ampaign on 6iolence %gainst Pomen and 1hildren
DECEM.ER
Firecrac&er 5nDury ,revention 1ampaign3
O,L%2 5P%/ ,%,;'O@
0II - INTEGRATED MANAGEMENT O# CHILDHOOD ILLNESSES :IMCI;
INTEGRATED MANAGEMENT O# CHILDHOOD ILLNESSES :IMCI;
5<15 is an integrated approach to child health that focuses on the well-being of the whole
child.
5<15 strategy is the main intervention proposed to achieve a significant reduction in the
number of deaths from communicable diseases in children under five
Goal!
-y "C!C) 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 "C!9.
AIM!
to reduce death) illness and disability) and to promote improved growth and development
among children under 9 years of age.
5<15 includes both preventive and curative elements that are implemented by families and
communities as well as by health facilities.
IMCI O.6ECTI0ES!
'o reduce significantly global mortality and morbidity associated with the maDor causes of
disease in children
'o contribute to the healthy growth $ development of children
IMCI COM$ONENTS O# STRATEGY!
5mproving case management s&ills of health wor&ers
5mproving the health systems to deliver 5<15
5mproving family and community practices
HHFor many sic& children a single diagnosis may not be apparent or appropriate
38
$resentin" %om&laint!
1ough andor fast breathing
Lethargy;nconsciousness
<easles rash
6ery sic& young infant
$ossi-le %ourse< asso%iate* %on*ition!
,neumonia) /evere anemia) ,. falciparum malaria
1erebral malaria) meningitis) severe dehydration
,neumonia) .iarrhea) 7ar infection
,neumonia) <eningitis) /epsis
#i'e Disease #o%us of IMCI!
%cute :espiratory 5nfection
.iarrhea
Fever
<alaria
<easles
.engue Fever
7ar 5nfection
<alnutrition
THE IMCI CASE MANAGEMENT $ROCESS
%ssess and classify
5dentify appropriate treatment
'reatrefer
1ounsel
Follow-up
THE INTEGRATED CASE MANAGEMENT $ROCESS
1hec& for =eneral .anger /igns3
% general danger sign is present if3
- the child is not able to drin& or breastfeed
- the child vomits everything
- the child has had convulsions
- the child is lethargic or unconscious
ASSESS MAIN SYM$TOMS
1ough.O-
.iarrhea
Fever
7ar problems
ASSESS AND CLASSI#Y COUGH OR DI##ICULTY O# .REATHING
- :espiratory infections can occur in any part of the respiratory tract such as the nose) throat)
laryn*) trachea) air passages or lungs.
Assess an* %lassify $NEUMONIA
cough or difficult breathing
an infection of the lungs
-oth bacteria and viruses can cause pneumonia
1hildren with bacterial pneumonia may die from hypo*ia (too little o*ygen) or sepsis
(generali(ed infection).
HH % child with cough or difficult breathing is assessed for3
+ow long the child has had cough or difficult breathing
Fast breathing
1hest indrawing
/tridor in a calm child.
REMEM.ER!
39
** If the child is 2 months up to 12 months the child has fast breathing if you count ! breaths per
minute or more
** If the child is 12 months up to years the child has fast breathing if you count "! breaths per
minute or more.
IMCI COLOR CODING
$IN1
:URGENT RE#ERRAL;
YELLO/
:Treatment at out&atient
ealt fa%ility;
GREEN
:Home mana"ement;
O;',%'572' +7%L'+
F%15L5'G
,re-referral treatments
%dvise parents
:efer child
O;',%'572' +7%L'+
F%15L5'G
'reat local infection
=ive oral drugs
%dvise and teach careta&er
Follow-up
+O<7
1areta&er is counseled on3
+ome treatments
Feeding and fluids
Phen to return immediately
Follow-up
:7F7::%L F%15L5'G
7mergency 'riage and
'reatment ( 7'%')
.iagnosis) 'reatment
<onitoring) follow-up
/767:7 ,27;<O25% O:
67:G /767:7 .5/7%/7
R=ive first dose of an
appropriate antobiotic
R=ive 6itamin %
R'reat the child to prevent low
blood sugar
R:efer urgently to the hospital
R=ive paracetamol for fever S
#F.9
o
1
R%ny general danger sign or
R1hest indrawing or
R/tridor in calm child
,27;<O25%
R=ive an appropriate antibiotic
for 9 days
R/oothe the throat and relieve
cough with a safe remedy
R%dvise mother when to return
immediately
RFollow up in " days
R=ive ,aracetamol for fever S
#F.9
o
1
Fast breathing 2O ,27;<O25% 3 1O;=+
O: 1OL.
R5f coughing more than more
than #C days) refer for
40
assessment
R/oothe the throat and relieve
the cough with a safe remedy
R%dvise mother when to
return immediately
Follow up in 9 days if not
improving
R2o signs of pneumonia or
very severe disease
Assess an* %lassify DIARRHEA

A %il* =it *iarroea is assesse* 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
'wo of the following signs T
%bnormally sleepy or difficult to
awa&en
/un&en eyes
2ot able to drin& or drin&ing
poorly
/&in pinch goes bac& very slowly
/767:7
.7+G.:%'5O2
5f child has no other severe
classification3
- =ive fluid for severe
dehydration ( ,lan 1 ) O:
5f child has another severe
classification 3
- :efer ;:=72'LG to hospital
with mother giving freLuent sips of
O:/ on the way
- %dvise the mother to
continue breastfeeding
5f child is " years or older and
there is cholera in your area) give
antibiotic for cholera
'wo of the following signs 3
:estless) irritable
/un&en eyes
.rin&s eagerly) thirsty
/&in pinch goes bac& slowly
/O<7 .7+G.:%'5O2
R=ive fluid and food for some
dehydration ( ,lan - )
R 5f child also has a severe
classification 3
- :efer ;:=72'LG to hospital
with mother giving freLuent sips of
O:/ on the way
- %dvise mother when to return
immediately
R Follow up in 9 days if not
improving
R+ome 1are
41
R2ot enough signs to classify as
some or severe dehydration
2O .7+G.:%'5O2
R =ive fluid and food to treat
diarrhea at home ( ,lan % )
R%dvise mother when to return
immediately
RFollow up in 9 days if not
improving
.ehydration present /767:7 ,7:/5/'72'
.5%::+7%
R'reat dehydration before referral
unless the child has another
severe classification
R =ive 6itamin a
R :efer to hospital
2o dehydration ,7:/5/'72'
.5%::+7%
R%dvise the mother on feeding a
child who has persistent diarrhea
R =ive 6itamin %
R Follow up in 9 days
-lood in the stool .G/72'7:G
R'reat for 9 days with an oral
antibiotic recommended for
/higella in your area
R Follow up in " days
=ive also referral treatment
Does te %il* a'e fe'er>
**Decide :
- <alaria :is&
- 2o <alaria :is&
- <easles
- .engue
Malaria Ris?
%ny general danger sign or
/tiff nec&
67:G /767:7 F7-:5L7
.5/7%/7 <%L%:5%
=ive first dose of Luinine
( under medical supervision or
if a hospital is not accessible
within 8hrs )
=ive first dose of an
appropriate antibiotic
'reat the child to prevent
low blood sugar
=ive one dose of
paracetamol in health center
for high fever (#F.9
o
1) or
above
/end a blood smear with the
patient
:efer ;:=72'LG to
hospital
-lood smear ( U )
5f blood smear not done3
2O runny nose) and
2O measles) and
2O other causes of fever
<%L%:5%
'reat the child with an oral
antimalarial
=ive one dose of
paracetamol in health center
for high fever (#F.9
o
1) or
above
%dvise mother when to
return immediately
Follow up in " days if fever
persists
42
5f fever is present everyday
for more than E days) refer for
assessment
-lood smear ( - )) or
:unny nose) or
<easles) or
Other causes of fever
F767: 3 <%L%:5% ;2L5@7LG
=ive one dose of
paracetamol in health center
for high fever (#F.9
o
1) or
above
%dvise mother when to
return immediately
Follow up in " days if fever
persists
5f fever is present everyday
for more than E days) refer for
assessment

No Malaria Ris?
%ny general danger sign or
/tiff nec&
67:G /767:7
F7-:5L7 .5/7%/7
=ive first dose of an appropriate
antibiotic
'reat the child to prevent low
blood sugar
=ive one dose of paracetamol in
health center for high fever (#F.9
o
1)
or above
:efer ;:=72'LG to hospital
2o signs of very severe
febrile disease
F767: 3 2O <%L%:5%
=ive one dose of paracetamol in
health center for high fever (#F.9
o
1)
or above
%dvise mother when to return
immediately
Follow up in " days if fever
persists
5f fever is present everyday for
more than E days) refer for
assessment
Measles
1louding of cornea or
.eep or e*tensive mouth
ulcers
/767:7 1O<,L51%'7.
<7%/L7/
=ive 6itamin %
=ive first dose of an
appropriate antibiotic
5f clouding of the cornea or
pus draining from the eye)
apply tetracycline eye ointment
:efer ;:=72'LG to
hospital
,us draining from the eye or
<outh ulcers
<7%/L7/ P5'+ 7G7 O:
<O;'+ 1O<,L51%'5O2/
=ive 6itamin %
5f pus draining from the eye)
apply tetracycline eye ointment
5f mouth ulcers) teach the
mother to treat with gentian
violet
43
<easles now or within the
last # months
MEASLES
=ive 6itamin %
Den"ue #e'er
-leeding from nose or gums
or
-leeding in stools or
vomitus or
-lac& stools or vomitus or
/&in petechiae or
1old clammy e*tremities or
1apillary refill more than #
seconds or
%bdominal pain or
6omiting
'ourniLuet test ( U )
SE0ERE DENGUE
HEMORRHAGIC #E0ER
5f s&in petechiae or
'ourniLuet test)are the only
positive signs give O:/
5f any other signs are
positive) give fluids rapidly as
in ,lan 1
'reat the child to prevent
low blood sugar
.O 2O' =567 %/,5:52
:efer all children ;rgently
to hospital
2o signs of severe dengue
hemorrhagic fever
F767:3 .72=;7
+7<O::+%=51 ;2L5@7LG
.O 2O' =567 %/,5:52
=ive one dose of
paracetamol in health center
for high fever (#F.9
o
1) or
above
Follow up in " days if fever
persists or child shows signs
of bleeding
%dvise mother when to
return immediately
Does te %il* a'e an ear &ro-lem>
'ender swelling behind the
ear
<%/'O5.5'5/
=ive first dose of appropriate
antibiotic
=ive paracetamol for pain
:efer ;:=72'LG
44
,us seen draining from the
ear and discharge is reported
for less than !8 days or
7ar pain
%1;'7 7%: 52F71'5O2
=ive antibiotic for 9 days
=ive paracetamol for pain
.ry the ear by wic&ing
Follow up in 9 days
,us seen draining from the
ear and discharge is reported
for less than !8 days
1+:O251 7%: 52F71'5O2
.ry the ear by wic&ing
Follow up in 9 days
2o ear pain and no pus seen
draining from the ear
2O 7%: 52F71'5O2
2o additional treatment
45
Ce%? for Malnutrition an* Anemia
Gi'e an A&&ro&riate Anti-ioti%!
A) #or $neumonia@ A%ute ear infe%tion or 0ery Se'ere *isease
COTRIMOAABOLE
-5. FO: 9 .%G/
AMOAYCILLIN
-5. FO: 9 .%G/
A"e or /ei"t A*ult
ta-let
Syru& Ta-let Syru&
" months up to !" months ( 8
- V A &g )
! " 9 ml ! " 9 ml
!" months up to 9 years ( !C
4 !A&g )
! E.9 ml ! !C ml
.) #or Dysentery
COTRIMOAABOLE
-5. FO: 9 .%G/
AMOAYCILLIN
-5. FO: 9 .%G/
AGE OR /EIGHT TA.LET SYRU$ SYRU$ ,32MG<3ML
" 4 8 months
( 8 - V B&g )
W 9 ml !."9 ml ( X tsp )
8 4 !" months
( B - V !C &g )
W 9 ml ".9 ml ( W tsp )
! 4 9 years old
( !C 4 !A &g )
! E.9 ml ( ! tsp )
46
C) #or Colera
TETRACYCLINE
>5. FO: # .%G/
COTRIMOAABOLE
-5. FO: # .%G/
AGE OR /EIGHT Ca&sule ,32m" Ta-let Syru&
" 4 8 months
( 8 - V B&g )
C ! " 9ml
8 4 !" months
( B - V !C &g )
D ! " 9 ml
! 4 9 years old
( !C 4 !A &g
! ! E.9ml
Gi'e an Oral Antimalarial
1+OLO:O>;527
=ive for # days
,rimaLuine
=ive single dose in
health center for ,.
Falciparum
,rimaLuine
=ive daily for !8 days for ,.
6iva*
/ulfado*ine U
,yrimethamine
=ive single dose
%=7 '%-L7' ( !9C<= ) '%-L7'
( !9<=)
'%-L7'
( !9<=)
'%-L7'
( !9<=)
.%G! .%G" .%G#
"months 4
9months
W W W C
9 months 4
!" months
W W W (<,
!"months 4
# years old
! ! W D C E
# years old -
9 years old
! W ! W ! #8 !" !
GI0E 0ITAMIN A
47
%=7 65'%<52 % 1%,/;L7/
"CC)CCC 5;
B months 4 !" months !"
!" months 4 9 years old !
GI0E IRON
%=7 or P75=+' 5ronFolate 'ablet
Fe/o8 "CCmg U "9Cmcg Folate (BCmg elemental
iron)
5ron /yrup
Fe/o8 !9C mg9ml
( Bmg elemental iron per ml )
"months-8months
( 8 - VB&g )
".9 ml
8months 4 !"months
( B - V!C&g )
8 ml
!"months 4 # years ( !C - V!8&g ) !" 9 ml
#years 4 9 years ( !8 4 !A&g ) !" E.9 ml
GI0E $ARACETAMOL #OR HIGH #E0ER : FG)3
o
C OR MORE ; OR EAR $AIN
%=7 O: P75=+' '%-L7' ( 9CC<= ) /G:;, ( !"C<= 9<L )
" months 4 # years ( 8 - V!8&g ) X 9 ml
# years up to 9 years ( !8 4 !A &g ) !" !C ml
GI0E ME.ENDABOLE
=ive 9CCmg <ebenda(ole as a single dose in health center if 3
S hoo&worm whipworm are a problem in children in your area) and
S the child is " years of age or older) and
S the child has not had a dose in the previous B months
48
0III - DOH $ROGRAMS
DENTAL HEALTH $ROGRAM
'o improve the Luality of life of the people through the attainment of the highest possible oral
health.
O-4e%ti'e! 'o prevent and control dental diseases and conditions li&e dental caries and periodontal
diseases thus reducing their prevalence.
OSTEO$OROSIS $ROGRAM
5t is characteri(ed by a decrease in bone mass and density that progresses without a symptom or
pain until a fracture occurs generally in the hip) spine or wrist.
ObDectives3
'o increase awareness on the prevention and control of osteoporosis as a chronic debilitating
conditionM
'o increase awareness by physicians and other health professionals on the screening) treatment
and rehabilitation of osteoporosisM
'o empower people with &nowledge and s&ills to adopt healthy lifestyle in preventing the occurrence
of osteoporosis.
HEALTH EDUCATION H CO
%ccepted activity at all levels of public health used as a means of improving the health of the
people through techniLues which may influence peoples thought motivation) Dudgment and action.
Tree as&e%ts of ealt e*u%ation!
5nformation
1ommunication
7ducation
SeIuen%e of ste&s in ealt e*u%ation!
1reating awareness
1reating motivation
.ecision ma&ing action
RE$RODUCTI0E HEALTH
!. Family ,lanning
". <1+ $ 2utrition
#. ,revention treatment of :eproductive 'ract 5nfection $ /'.
8. ,revention of abortion $ its complication
9. 7ducation $ counseling on se*uality $ se*ual health
B. %dolescent se*ual reproductive health
E. 6iolence against women
F. <enNs reproductive health ( <ale se*ual disorder )
A. -reast 1% $ other gyne problem
!C. ,revention treatment of infertility
OLDER $ERSONS HEALTH SER0ICES
,articipation in the celebration of +ealthy 2ational 7lderly Pee& ( Oct !-E)
- Lecture on healthy lifestyle for the elderly
,rovision of drugs for the elderly( "CI discount)
GUIDELINES #OR GOOD NUTRITION
2utritional =uidelines are primary recommendations to promote good health through proper
nutrition.
ACTI0ITIES!
!.<alnutrition :ehabilitation ,rogram
R'argeted Food 'as& Force %ssistance ,rogram ('F%,)
R2utrition :ehabilitation Pard
R%&bayan sa @alusugan sa @abataan (%/@ ,roDect)
".<icronutrient /upplementation ,rogram
"# in YA#
Fortified 6itamin :ice
+ealth for <ore in YA8
7#uwan ng $abataan% Pag&asa ng #ayan8
49
2ational Focus3 2ational <icronutrient .ay or 'raw ng (ang)ap Pinoy
$ROTEIN ENERGY MALNUTRITION
!. <arasmus 4 loo&s li&e an old worried man
- less subcutaneous fats
". @washior&or - a moon face child
- with flag sign (hair changes)
65'%<52 % .7F515721G
7arly symptoms3 Keropthalmia (2igtblindess)
-itotNs spot (silvery foamy spot located Z lateral sclera)

1orneal Kerosis (eye lesion)
Conjunctival Xerosis(scar in the eyes
!erato"alacia ( #hitish to $rayish sclera
%&'()(*++
RES$IRATORY IN#ECTION CONTROL
,rovision of medicines
1onsultative meetings with 1%:5 coordinators
<onitoring of health facilities on the implementation of the program
ALTERNATI0E MEDICINE
:% F8"#
"# 52 A#
,- Her-al Me*i%ine:LU..Y SANTA;
Her-al Me*i%ine USES
Lagundi ( 6ite* 2egundo)
SHARED
S&in diseases
Headache)
Asthma)fever)cough$colds
Rheumatism
Ec(ema
Dysentery
;lasimang -ato (,eperonia ,ellucida) Lowers uric acid
-awang ( %llium /ativum) HAT Headache and Tootache
-ayabas ( ,sidium =uaDava) %nti septic) %nti-diarrheal
Gerba -uena (<entha 1ordifolia) :heumatism and other body aches)
analgesics
/ambong (-lumea -alsamifera) 7dema) diuretics
%&apul&o Fungal infection) s&in diseases
2iog 2iogan (>uisLualis 5ndica) %nti-helminthic
'saang =ubat (1armona :etusa) .iarrhea
50
%mpalaya (<omordica 1harantia) .<
MATERNAL- CHILD CARE
I - Maternal Care
A) #AMILY $LANNING
I) /pacing %rtificial <ethod
%. +ormonal
-. <echanical $ -arrier
1. -iologic
.. 2atural
II) ,ermanent (surgicalirreversible)
+ %. 'ubal Ligation
5 -. 6asectomy
III) -ehavioral <ethod
.) .REAST#EEDING
II - CHILD CARE
A) UNDER #I0E CARE $ROGRAM
% pac&age of child health-related services focused to the C-9A months old children to assure their
wellness and survival
Gro=t Monitorin" Cart :GMC;
% standard tool used in health centers to record vital information related to child growth and
development) to assess signs of malnutrition.
.) EA$ANDED $ROGRAM ON IMMUNIBATION
L7=%L -%/5/
,. JAAB 4 1ompulsory basic
,, J!8E 4 2ational 5mmuni(ation .ay
,, JEE# 4 @noc& out ,olio .ays
,, J !CB8 4 polio eradication campaign
,, J8 - Ligtas 'igdas month
MENTAL HEALTH
a state of well-being where a person can reali(e his or her own abilities) to cope with the normal
stresses of life and wor& productively
Com&onents of Mental Healt $ro"ram
/tress <anagement and 1risis 5ntervention
.rugs and %lcohol %buse :ehabilitation
'reatment and :ehabilitation of <entally-5ll ,atients
/pecial ,roDect for 6ulnerable =roups
SENTRONG SIGLA MO0EMENT
AIM! to promote availability of Luality health services
J &illars!
>uality assurance
=rants $ technical assistance
+ealth promotion
%ward
COMMUNITY ORGANIBING $ARTICI$ATORY ACTION RESEARCH
Community Or"aniKin"
a continuous and sustained process of
7.;1%'52= '+7 ,7O,L7)
1:5'51%L %P%:727//
<O-5L5?52=
51
$arti%i&atory A%tion Resear%
% combination of education) research and action.
'he purpose is the 7<,OP7:<72' of people
J $ases!
,re entry
7ntry
Organi(ational -uilding
/ustenance and /trengthening
La=s Affe%tin" CHN Im&lementation!
RA GLJM - 1lean %ir %ct ("CCC)
RA 9J,3 4 .angerous .rug %ct3 sale) administration and distribution of prohibited drugs is punishable
by law
RA M(LF
RA ,FG, 4 ,hilippines <edical %ct3 define the practice of medicine in the ,hilippines
RA (2G, 4 :ural +ealth %ct3 employment of more physicians) nurses) midwives who will live in the
rural areas to help raise the health condition.
RA F3LF - :eporting of 1ommunicable .isease
RA 99L3 5 =eneric %ct3 promotes) reLuires and ensures the production of an adeLuate supply)
distribution) use of drugs identified by their generic names.
RA 9F93
RA 9L3G
RA JL2F
RA LF23 4 <agna 1arta for ,ublic +ealth Por&ers (approved by ,res. 1ora(on 1. %Luino)3 aims to
promote and improve the social and economic well being of health wor&ers) their living
and conditions.
RA L(92 4 Local =overnment 1ode3 responsibility for the delivery of basic services of the national
government
IA - CHRONIC COMMUNICA.LE DISEASES
I - TU.ERCULOSIS
'- is a highly infectious chronic disease that usually affects the lungs.
Causati'e A"ent! <ycobacterium 'uberculosis
S<S!
cough
afternoon fever
weight loss
night sweat
blood stain sputum
$re'alen%e<In%i*en%e!
ran&s si*th in the leading causes of morbidity (with !!8)""! cases) in the ,hilippines
si*th leading cause of mortality (with "F9CE cases) in the ,hilippines.
Nursin" an* Me*i%al Mana"ement
6entilation systems
;ltraviolet lighting
6accines) such as the bacillus 1almette =uerin (-1=) vaccine
drug therapy
$re'entin" Tu-er%ulosis
-1= vaccination
%deLuate rest
-alanced diet
Fresh air
%deLuate e*ercise
=ood personal +ygiene
DOTS :Dire%t O-ser'e* Treatment Sort Course;
Re"imen Ty&e of T. $atient
52
Re"imen I
":5,7 8:5

2ew pulmonary smear (U) cases
2ew seriously ill pulmonary smear (-) cases
w e*tensive lung lesions
2ew severely ill e*tra-pulmo '-
Re"imen II
":5,7/
!:5,7 9:57
2ew pulmonary smear (U) case
2ew seriously ill pulmonary smear (-) cases
w e*tensive lung lesions
2ew severely ill e*tra-pulmo '-
Re"imen III
":5, 8:5
2ew smear(-) but with minimal pulmonary '-
on radiography as confirmed by a medical
officer
2ew e*tra-pulmo '- (not serious)
II - LE$ROSY
/ometimes &nown as HansenNs *isease
is an infectious disease caused by ) an aerobic) acid fast) rod-shaped mycobacterium
=erhard %rmauer +ansen
+istorically) leprosy was an incurable and disfiguring disease
'oday) leprosy is easily curable by multi-drug antibiotic therapy
Si"ns H Sym&toms
Early sta"e:CLUM$; Late Sta"e:GMISC;
Change in s&in color Gynocomastia
Loss in sensation Madarosis(loss of eyebrows)
Ulcers that do not heal Inability to close eyelids (Lagopthalmos)
Muscle wea&ness Sin&ing nosebridge
$ainful nerves Clawingcontractures of fingers $ nose
$re'alen%e Rate
<etro <anila) the prevalence rate ranged from C.8C 4 #.C! per one thousand population.
MANAGEMENT!
.apsone) Lamprene
clofa(imine and rifampin
<ulti-.rug-'herapy (<.')
si* month course of tablets for the milder form of leprosy and two years for the more severe form
A - 0e%tor .orne Communi%a-le Disease
I 5 LE$TOS$IROSIS
an infectious disease that affects humans and animals) is considered the most common (oonosis
in the world
Causati'e A"ent! Leptospira interrogans
S<S!
-high fever -severe headache
-chills -muscle aches
-vomiting -may include Daundice (yellow s&in and eyes)
-red eyes -abdominal pain
-diarrhea
TREATMENT!
,7' - S $enicillins ) Erythromycin) Tetracycline
II - MALARIA
53
<alaria (from <edieval 5talian3 mala aria - [bad air[M formerly called ague or marsh fever) is an
infectious disease that is widespread in many tropical and subtropical regions.
Causati'e A"ent! %nopheles female mosLuito
Si"ns H Sym&toms!
Chills to convulsion
Hepatomegaly
Anemia
Sweats profusely
Elevated temperature
Treatment! 1hemoprophyla*is 4 chloroLuine ta&en at wee&ly interval) starting from !-" wee&s before
entering the endemic area.
$re'enti'e Measures! :CLEAN;
Chemically treated mosLuito nets
Larvae eating fish
Environmental clean up
Anti mosLuito soaplotion
Neem treeseucalyptus tree
III - #ILIARIASIS
name for a group of tropical diseases caused by various thread-li&e parasitic round worms
(nematodes) and their larvae
larvae transmit the disease to humans through a mosLuito bite
can progress to include gross enlargement of the limbs and genitalia in a condition called
elephantiasis
S<S!
Asym&tomati% Sta"e
1haracteri(ed by the presence of microfilariae in the peripheral blood
2o clinical signs and symptoms of the disease
/ome remain asymptomatic for years and in some instances for life
A%ute Sta"e
Lymphadenitis (inflammation of lymph nodes)
Lymphangitis (inflammation of lymph vessels)
5n some cases the male genitalia is affected leading to orchitis (redness) painful and tender
scrotum)
Croni% Sta"e
+ydrocoele (swelling of the scrotum)
Lyphedema (temporary swelling of the upper and lower e*tremities
7lephantiasis (enlargement and thic&ening of the s&in of the lower and or upper e*tremities)
scrotum) breast)
MANAGEMENT!
.iethylcarbama(ine
5vermectin)
%lbenda(olethe
2o treatment can reverse elephantiasis
0I 5 SCHISTOSOMIASIS
parasitic disease caused by a larvae
Causati'e A"ent! /chistosoma intercalatum) /chistosoma Daponicum) /chistosoma mansoni
Si"ns H Sym&toms! :.ALLI$S;
.ulging abdomen
Abdominal pain
Loose bowel movement
Low grade fever
Inflammation of liver $ spleen
$allor
Sei(ure
Treatment! .iethylcarbama(epine citrate (.71) or +etra(an (drug of choice)
54
0II 5 DENGUE
D*+,-* is a mosLuito-borne infection which in recent years has become a maDor international
public health concern..
5t is found in tropical and sub-tropical regions around the world) predominantly in urban and semi-
urban areas.
S<S! :0LINOS$ARD;
0omiting
Low platelet
Nausea
Onset of fever
Severe headache
$ain of the muscle and Doint
Abdominal pain
Rashes
Diarhhea
TREATMENT:
'he mainstay of treatment is supportive therapy.
- intravenous fluids
- % platelet transfusion
55