The College of Maasin Nisi Dominus Frustra College of Nursing Maasin City, Southern Leyte

SUPPLEMENTAL REVIEW KEY POINTS IN COMMUNITY HEALTH NURSING (Prepared by Rhenier S. Ilado RN) Some test taking techniques: A-ssimilate essential principles in the care of patients in the

community These principles may include: 1. have a purpose or objective when conducting home visit 2. plan ahead 3. priority should be given to the recognized needs of the family 4. there is no definite rule as to the frequency of a home visit 5. frequency of home visit should take into account, the physical, psychological and educational needs of the individual and family 6. the initial step in conducting a home visit is to GREET the client and introduce yourself 7. soiled articles with discharge should be boiled in water 30 minutes before laundering B- ag Technique - steps which are carried out by the nurse to facilitate the performance of nursing procedures with ease and deafness Remember the: Bag and its contents must be protected from any possible contamination Always wash your hands to prevent the spread of infection Gather all necessary articles and supplies to answer emergency needs Note: blood pressure apparatus and stethoscope are carried separately Consider the following principles: 1. prevention of contamination Note: place waste paper bag outside the work areas 2. protection of the caregiver Note: clean and alcoholize all articles after use 3. make articles readily accessible Note: place the articles in one corner of the work area 4. make follow-up care Note: set the date and time for the next visit

C- ommunity Based Rehabilitation Program • the goal of this program is the improvement of quality of life and productivity of disabled persons • R.A 7277, Magna Carta for Disabled Persons, serves as the legal basis of the program • The components of the program include: social preparations, services preparation, training, information, education and communication and monitoring, supervision and evaluation • The VISION of the Department of Health is: health for all Filipinos • The MISSION of the Department of Health is: Ensure accessibility of health care to improve the quality of life of all Filipinos especially the poor • The basic principles to achieve improvement in health include: E – nsure universal access to basic health services E – pidemiological shift from infectious to degenerative disease must be managed E – nhance the performance of health sector E – nsure the priotization of health and nutrition of vulnerable groups • The primary strategies to achieve health goals include: S – upport for frontline health workers and to local system development A – ssurance of health care I – ncreasing investment for primary health care D – evelopment of national standard and objectives for health • Primary health Care (PHC), according to the World Health organization is an essential health care made universally accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country can afford at every stage of development • The goal of PHC is health for all Filipinos and Health in the hands of the people by the year 2020 • Letter of instruction (LOI) 949 (October 19, 1979) is the legal basis of PHC • The first international conference on primary health care was held in Alma, Ata, USSR on September 6-12, 1978 sponsored by the WHO and UNICEF • The framework for meeting the goal of primary health care is organizational strategy, it calls for among communities, private and government agencies with the end view of health development • The four cornerstone/pillars in primary health care includes: 1. active community participation 2. intra and inter sectoral linkages 3. use of appropriate technology 4. support mechanism made available • The expanded program on immunization aims to reduce the morbidity and mortality among infants and children caused by the six childhood immunizable diseases. It was launched in July 1976.

P.D. 996 (September 16, 1976) provides for compulsory basic immunization for infants and children below 8 years of age. The EPI program is based on epidemiological situations. Presidential proclamation no. 147 (March 3, 1993) declares April 21 and May 19, 1993 and every third Wednesday of January and February thereafter for two years as National Immunization Days. R.A. 7846 (December 30, 1994) requires compulsory immunization against hepatitis B for infants and children below 8 years old • the ultimate goal of promotion of reproductive health is “QUALITY OF LIFE”. The focus of the Philippine framework of the program is Reproductive Health status in terms of, its elements. The ten elements of Reproductive Health includes: 1. maternal and child health and nutrition 2. family planning 3. prevention and management of abortion complications 4. prevention and treatment of reproductive tract infection (RTI’s) including STD’s, HIV and AIDS 5. education and counseling on sexuality and sexual health 6. breast and reproductive tract cancers and other gynecological conditions 7. men’s reproductive health 8. violence against women 9. prevention and treatment of infertility and sexual disorders 10. adolescent reproductive • the goal of the 2000 Nutritional Guidance for Filipinos is the improvement of nutritional status, productivity and quality of life of the population through adoption of desirable dietary practices and healthy lifestyle. An example is the exclusive breastfeeding of infants from birth to 4-6 months and the use of iodized salt. • The use of fluoride in the prevention of tooth decay is carried out by making four application of fluoride about a week apart among children who are aged 3, 7, 10 and 13 because at these ages new teeth have erupted • The goal for health care and services for older persons is to provide a longer disability-free life. This is carried out through a holistic care approach • To reduce the blindness prevalence rate in the Philippines, the prevention of blindness program was conceived. It is subdivided into four programs namely, cataract program, primary eye care, vitamin A deficiency program and other eye care program • The goals of the mental health program include: promotion of mental health, decreased health-related effects of stressful lifestyle and reduction of prevalence of mental ill health and disorders in the Philippines • The Sentrong sigla movement aims to promote availability of quality health services in health centers and hospitals and to make these services accessible to every Filipino

• “Sang Milyong Sepilyo” is a strategy for social mobilization of Dental health program. It aims to emphasize the importance of oral health in relation to total body health to increase public awareness on the prevention of common dental diseases D- OH PROGRAMS D OHPROGRAMSental health Program steoporosis prevention ealth education and Community Organization rimary Health Care eproductive health lder Persons health Services uidelines for Good Nutrition espiratory Infection control ccupressures aternal and Child care entrong Sigla Movement

E- pidemiology Systematic and scientific study of the distribution patterns and determinants of health, disease and condition for the purpose of promoting wellness and preventing disease conditions • Basic concepts that guide epidemiological study include: biostatistics, aggregate at risk, the natural life history of a disease, levels of prevention, host-agent-environment relationships, multiple causation, person-place-time-relationships • When monitoring incidence of infectious disease, the term used to distinguish relative frequency in time and space include the following: Sporadic – presence of occasional cases of the disease Endemic – constant long-term presence of the disease Epidemic – presence of the disease at a much higher frequency over a short period of time Pandemic – presence of a disease in many countries in a relatively short period of time • Effective implementation of the epidemiological process requires a multi disciplinary approach • A community health nurse must apply the principles of epidemiology in order to provide preventive services to the community • Community health nurses participate in may epidemiological activities like: case finding, health teaching, counseling and follow up essential to the prevention of diseases and other conditions •

F- ormulas for Mortality and Morbidity Statistics CRUDE BIRTH RATE (CBR) – a measure of one characteristics of the natural growth or increase of a population CBR= total number of live births registered in a given calendar year x 1000 Estimated population as July 1 of same year CRUDE DEATH RATE (CDR) – a measure of one mortality from all causes which may result in a decrease of population CDR= total number of deaths registered in a given calendar year x 1000 Estimated population as of July 1 of same year INFANT MORTALITY RATE (IMR) –measure the risk of dying during the 1st year if life IMR= total number of deaths under 1 year of age registered in a given calendar year x 1000 total number of registered live births of same calendar year

MATERNAL MORTALITY RATE (MMR) – it measures the risk of dying from causes related to pregnancy, childbirth and puerperum MMR= total number of deaths from maternal causes registered For a given year x 1000 total number of live births registered of same year INCIDENCE RATE (IR) –measures the frequency of occurrence of the phenomenon during a given period of time. Deals only with new cases IR= no of new cases of a particular disease registered During a specified period of time Estimated population as of July of same year

x 100, 000

PREVALENCE RATE (PR) –measures the proportion of the population which exhibits a particular disease at a particular time. Deals with total (old and new) number cases PR= no of new and old cases of a certain disease registered At a given time x 100 Total no of persons examined at same year given time

K- ey Points to EPI • A fully immunized child should have received one (1) dose of BCG, three (3) doses of DPT, three (3) doses of OP, three (3) doses of hepatitis B and one (1) dose of measles, before the child’s birthday Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindications to vaccination DPT2 or DPT3 is not given to a child who has had convulsion or shock within 3 days of the pervious dose BCG vaccine is not given to a child with clinical AIDS Measles and polio vaccines are most sensitive to heat ADMNISTRATION OF VACCINES Dose Route of Site of Administration administration InfantIntradermal Right deltoid region of the arm Left deltoid region of the arm Upper, outer portion of the thigh Mouth

• • • •

Vaccine BCG


School entrance0.5 ML

age Intradermal Intramuscular


2 drops, or Oral depending on manufacturer’s instructions 0.5 ml Subcutaneous 0.5 ml Deep Intramuscular

Outer Part of the Upper arm Deltoid region of the upper arm

K- ey Points in Vaccine Administration • BCG- lay the syringe and needle almost flat along the child’s arm - if the vaccine is injected correctly into the skin, a flat wheal with the surface pitted like an orange peer will appear at the injection site

OPV – if necessary open the child’s mouth by squeezing the cheeks gently between your fingers to make lips point upwards - put drops of vaccine straight from the dropper onto the child’s tongue but do not let the dropper touch the child’s tongue - if the child spit out the vaccine, give another dose •

HEPA and DPT – the best injection site is the outer part of the child’s midthigh - ask the mother of the child to hold the child’s legs MEASLES –the best injection site is on the outer side of the upper arm TETANUS TOXOID –the best injection site for a woman is the outer side of the left upper arm Timing of Vaccination 5-6 months of pregnancy 1 month/ 4 weeks after TT1 at least 6 months later at least 1 year later at least 1 year later

Vaccine Dose TT1 TT2 TT3 TT4 TT5

Note: TT1 gives initial protection, TT2 provides 3 years protection for the mother, TT3 provides 5 years protection, TT4 provides 10 years protection and TT5 provides lifetime protection of the mother

M- edicinal Plants Herbal Plant Akapulko Ampalaya Bawang Use/s Anti-fungal Diabetes Mellitus Hypertension (to lower cholesterol levels in the blood)

Toothache Remember: BawHaT (Bawang for Hypertension, toothache) Bayabas/ Guavas Diarrhea Washing of wounds Gargle to relieve toothache Lagundi S-kin diseases H-eadache A-sthma, cough and fever R-heumatism, sprain, insect bites E-czema Dysentery

Niyug-niyogan Sambong Diuretic Anti-urolithiasis Tsaang Gubat Stomach ache Tsaang gubat Diarrhea

Anti helminthic Anti-edema


Yerba Buena S-wollen gums P-ain I-nsect bites T-oothache M-enstrual and gas pain A-rthritis N-ausea and fainting D-iarrhea Ulasimang bato Uric acid excretion (pansit pansitan) Remember: Ulasimang bato, uric acid REVIEW BULLETS FOR CHN • Acupressure - traditional Chinese medicine believes that life is the result of QI or life energy - when there is an imbalance of YIN and YANG forces, there is illness - YIN is the yielding negative and feminine force: YIN principle: give Chinese cold deserts after surgery - Yang is the dominating, positive and masculine force - posture: lying down or sitting up -foods to avoid; iced food/drinks, sour food, alcohol drink, pepper and spices, seafood, peanuts, salty foods - TSUN measurement- method of locating points in the body using the patient’s own hands or fingers as a base for measurement - contraindications: pregnancy, full stomach and cardiac illness Acupuncture - stimulating specific anatomic points called HSUEH - goal: manipulation of energy flow throughout the body following as thorough assessment by a practitioner - indication: acute and chronic pain and motion disabilities - contraindications: pregnancy, hemophlia, acute CVD Aromatherapy

- based on olfactory stimuli used to help balance the DOSHAS, the mediators between physiologic and psychologic process - done often at night to induce sleep - use of essential oils of plants to treat symptoms • Bag Technique - a tool making use of the public health bag through which the nurse during the visit can perform nursing procedures with ease and deftness, saving time and effort at the end in view of rendering effective nursing care - PUBLIC HEALTH BAG –essential and indispensable equipment of the public health nurse - principles: should minimize if not totally prevent the spread of infection: should save time and effort - special consideration: hand washing - content of the bag: Bp apparatus and stethoscope are carried separately; medicines also include – betadine, 70% alcohol, benedict’s solution - place waste paper bag outside of work area to prevent contamination of clean area Sample Questions: 1. this is the tool trough which the nurse, during home visit can perform nursing procedures with ease and deftness, saving time and effort with the end of view of rendering effective nursing care: a. public health bag b. bag technique c. home visit d. all of the above 2 the public health bag contains basic medications and articles which are necessary for giving care during home visits. Its contents are he following EXCEPT: a. soap, adhesive plaster and tape measure b. betadine, acetic acid and benedict’s solution c. surgical scissors and forceps d. stethoscope and sphygmomanometer

CARE OF THE OLDER PERSON - first cause of morbidity among the 50+ years old: influenza - top cause of mortality among the 60+ years old: Diseases of the heart - common health problems: difficulty in walking, difficulty in chewing, impaired vision in at least one eye, hearing problem - goal: “A longer disability free life’ - Resolution 46: the UN principle for older persons to add life to years that have been added to life

COMMUNITY HEALTH NURSING: - Goal: promotion of the client’s optimum level of functioning through teaching and delivery of care - Philosophy: based on the worth and dignity of man - the primary focus of CHN practice is HEALTH PROMOTION - community health nurse are generalists in terms of their practice - family is the unit of service - HEALTH TEACHING is the primary responsibility of the community health nurse Sample Question: 1. the key role for the community health nurse in dealing with communities is to: a. make sure that people in the community are empowered and able to participate b. provide incentives for community members to follow the protocols of any study or drug trial c. establish project teams that will collect and analyze data d. closely direct community members so that the community assessments are done appropriately CHN ROLES OF THE NURSE: - Clinician: focus on the health of individuals in the larger context of the community - Advocate: advocates self-care, people’s ability to be active participants in their own health, and self-determination, the right to make their own decisions - Collaborator: brings together strengths and resources of people involved toward a common goal - Counselor; key tasks include listening and providing feedback and information - Educator: provides skills, knowledge and attitudes that the people need to make appropriate choices or decisions _ Hospice care: providing care skills in a home or other setting and balancing the client’s needs Sample questions: 1. the community health nurse acting in the role of clinician would be more likely to: a. work to participate the special needs of a population such as homeless people b. focus on reducing the incidence of disease in a population c. address the spiritual needs of a group without performing any screening or treatment d. coordinate the various components of care to different areas of thr health system

2. the CHN acting in the role of advocate would be most likely to promote; a. self-care and self-determination for the population b. telling the people in a community that the medical experts know what is best for them c. smoking cessation d. that health care options should be pursued without the influence of friends or families 3. which of the following is not a role for the community health nurse providing hospice or end of life care? a. providing resources for caregivers to prevent burnout b. ensuring that the client is given every reasonable chance to extend life and is encouraged not to give up too easily c. working as part of a multidisciplinary team to meet client’s, family and community needs d. promoting and coordinating palliative care and services COMMUNITY ASSESSMENT: - process of examining the community in collaboration with the community members to develop strategies that improve health and quality of life for the community - community competence refers to the community’s ability to identify needs, achieve working consequence and agree and work together to meet goals - three dimensions include: status, structure and process - status- information about morbidity and mortality, life expectancy, crime rates and education - structure – socioeconomic, age, gender, resources - process – how the community operates and functions as a whole Sample questions: 1. a community is best described as: a. people living in the same place b. organizations, family groups and friend groups that interact c. groups that have common interest or needs d. all of the above 2. a community that is described as having community competence has which of the following characteristics? a. the ability to perform their own cross-sectional epidemiological studies b. the ability to delegate any community processes to an outside expert such as community health nurse c. the ability to identify their own needs, achieve consensus, plan and implement goals d. the ability to predict morbidity and mortality rates for the population 3. all of the following are part of the community assessment process, EXCEPT: a. identifying available resources such as time, money and team skills

b. collecting and analyzing information c. withholding results from the community until they can be statistically confirmed, to avoid alarming people d. setting action priorities based on the needs of the community and available resources 4. a valid way to collect data for a community assessment is: a. using a library database for literative review b. reading government documents to find out about previous data c. using surveys or questionnaires to gather information from the community members d. all of the above CHN CLINIC VISIT: - PRE-CONSUATION VISIT: clinical history taking, vital sings, physical assessments, laboratory exams and documentation - MEDICAL EXAMINATION: ensure privacy, safety and comfort of the patient throughout procedure - POST-CONSULATION: explain findings and needed care, refer as needed, make appointment for nest clinic/ home visit Sample questions: 1. during clinic visits, all of the following are done in the consultation conference, EXCEPT: a. take clinical history after greeting and making client at ease b. refer client to other related staff or agency if necessary c. take temperature, BP, height and weight d. perform physical assessment and selective laboratory examination COMMUNITY ORGANIZING: - a continuous of awareness building, organizing and mobilizing community members towards community development - phases of activities: PRE-ENTRY- preparation of the staff - site selection ENTRY PHASE – integration with the community - courtesy calls, information campaigns, identification of potential leaders CORE-GROUP FORMATION AND MOBILIZING - integration with the core group ORGANIZATIO- BUILDING - organizing barrio health committee, setting up the community organization CONSOLIDATION AND EXPANSION PHASE - networking and establishing linkages, implementation of livelihood-projects and developing secondary leaders Sample questions;

1. one of the primary tasks of the community health nurses during the pre-entry phase is the selection of the barangay to become the initial site for their organizing efforts. The following are the steps in the selection of the project site by the team, EXCEPT: a. developing criteria for site selection b. identifying potential barangays and choosing the final project village c. identification of potential leaders d. identification of the host family 2. it is during this period that one member of the team formed was given the ole of a community organizer: a. organizing-building phase b. core stoup formation phase c. consolidation phase d. expansion phase 3. for potential leaders to perform their roles effectively, they have to possess certain characteristics. Among these are the following, EXCEPT: a. they must belong to the poor sector b. they must be respected members of the community c. preferably informal leaders d. formal leaders with many community responsibilities 4. this phase signals the start of community self-management of any development program: a. consolidation and expansion phase b. core group formation c. entry phase d. organization building phase 5. under this phase of the education and training process, the conduct of training, monitoring and documentation of training are included in: a. implementation phase b. planning phase c. evaluation phase d. post-training phase DENTAL HEALTH PROGRAM: - vision: a lifetime oral health and no tooth decay for the nest generations -objective: to prevent and control dental diseases and conditions - “Sang milyong Sepilyo”- project for social mobilization of dental health program DEPARTMENT OF HEALTH: - Vision: health for all filipinos - mission: enhance accessibility and quality of health care to improve the quality of life of all Filipinos, especially the poor - basic principles to achieve improvement of health 1. ensured universal access to basic health services 2. health and nutrition of vulnerable groups must be prioritized

3. epidemiological shift from infection to degenerative diseases must be managed 4. performance of the health sector must be enhanced - primary strategies: 1. assurance of health care 2. increased investment for primary health care 3. development of national standards and objectives for health 4. support to local health system development and frontline health workers Sample questions: Situation: the department of health formulated plan, programs and projects with the vision, “health for all Filpinos’ 1. which of the following is the mission of the department of health? a. promote healthy lifestyle b. ensure accessibility and quality of health care c. reduce morbidity and mortality d. improve general health status of the people 2. which of the following is not a basic principle in the achievement of improved health? a. health and nutrition priorities b. universal access to health service c. enhancement of performance of health sector d. investment for primary health care 3. which of the following is not a primary strategies to achieve health goals? a. support of local health system b. development of national standards for health c. assurance of health care for all d. funding from non-government organization

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