COMMUNITY HEALTH

COMMUNITY HEALTH
NURSING
NURSING
Mrs. Laarne Estenzo-Pontillas
Mrs. Laarne Estenzo-Pontillas
BSN , R.N., MSN
BSN , R.N., MSN

(Mark 10:45)
(Mark 10:45)
Discipleship is a lifestyle
Discipleship is a lifestyle
Not just a biblical truth
Not just a biblical truth
Nor a Christian ideal but a way of life
Nor a Christian ideal but a way of life
For the Son of Man also came not to be served
For the Son of Man also came not to be served
But to serve and to give His life as a ransom for
But to serve and to give His life as a ransom for
many.
many.

COVERAGE FOR LOCAL
COVERAGE FOR LOCAL
BOARD EXAM : CHN
BOARD EXAM : CHN

I.
I.
Safe and Quality Care, Health
Safe and Quality Care, Health
Education, and Communication,
Education, and Communication,
Collaboration and Teamwork
Collaboration and Teamwork
1.
1.
Principles and Standard of CHN
Principles and Standard of CHN
2.
2.
Levels of care
Levels of care
3.
3.
Types of Clientele
Types of Clientele
4.
4.
Health Care Delivery System
Health Care Delivery System
5.
5.
PHC as a Strategy
PHC as a Strategy

1. 1.
Family-based Nursing
Family-based Nursing
Services(Family Health Nursing
Services(Family Health Nursing
Process)
Process)
2. 2.
Population Group-based Nursing
Population Group-based Nursing
Services
Services
3. 3.
Community-based Nursing
Community-based Nursing
Services/Community Health Nursing
Services/Community Health Nursing
Process
Process
4. 4.
Community Organizing
Community Organizing
5. 5.
Public Health Programs
Public Health Programs

I.
I.
Research and Quality
Research and Quality
Improvement
Improvement
3. 3.
Research in the Community
Research in the Community
4. 4.
National Health Situation
National Health Situation
5. 5.
Vital Statistics
Vital Statistics
6. 6.
Epidemiology
Epidemiology
7. 7.
Demography
Demography

I.
I.
Management of Resources &
Management of Resources &
Environment and Records
Environment and Records
Management
Management
2.
2.
Field Health Services And
Field Health Services And
Information System
Information System
3.
3.
Target-setting
Target-setting
4.
4.
Environmental Sanitation
Environmental Sanitation

I.
I.
Ethico-Moral-Legal Responsibility
Ethico-Moral-Legal Responsibility
2.
2.
Socio-cultural values, beliefs, and
Socio-cultural values, beliefs, and
practices of individuals, families,
practices of individuals, families,
groups and communities
groups and communities
3.
3.
Code of Ethics for Government
Code of Ethics for Government
Workers
Workers
4.
4.
WHO, DOH, LGU policies on health
WHO, DOH, LGU policies on health
5.
5.
Local Government Code
Local Government Code
6.
6.
Issues
Issues

Þ
Personal And Professional
Personal And Professional
Development
Development

1. 1.
Self-assessment of CHN
Self-assessment of CHN
competencies, importance, methods
competencies, importance, methods
and tools
and tools
2. 2.
Strategies and methods of updating
Strategies and methods of updating
one’s self, enhancing competence in
one’s self, enhancing competence in
community health nursing and
community health nursing and
related areas.
related areas.

HISTORY OF CHN
HISTORY OF CHN
Date
Date
Event
Event
1901
1901
- Act # 157 ( Board of Health of the
- Act # 157 ( Board of Health of the
Philippines) ;
Philippines) ;
Act # 309 ( Provincial
Act # 309 ( Provincial
and
and
Municipal Boards of
Municipal Boards of
Health)
Health)
were created.
were created.
1905 - Board of Health was abolished;
1905 - Board of Health was abolished;
functions were
functions were
transferred to the
transferred to the
Bureau of Health.
Bureau of Health.
1912 – Act # 2156 or Fajardo Act created the Sanitary
1912 – Act # 2156 or Fajardo Act created the Sanitary
Divisions, the forerunners of present MHOs; male
Divisions, the forerunners of present MHOs; male
nurses performs the functions of doctors
nurses performs the functions of doctors
1919 – Act # 2808 (Nurses Law was created)
1919 – Act # 2808 (Nurses Law was created)
- Carmen del Rosario , 1
- Carmen del Rosario , 1
st st
Fil. Nurse supervisor
Fil. Nurse supervisor
under Bureau of Health
under Bureau of Health
Oct. 22, 1922 – Filipino Nurses Organization
Oct. 22, 1922 – Filipino Nurses Organization
(Philippine Nurses’ Organization) was
(Philippine Nurses’ Organization) was
organized.
organized.

Þ
1923 – Zamboanga General Hospital School
1923 – Zamboanga General Hospital School
of
of
Nursing & Baguio General Hospital
Nursing & Baguio General Hospital
were
were
established; other government schools of nursing
established; other government schools of nursing
were organized several years
were organized several years
after.
after.
Þ
1928- 1
1928- 1
st st
Nursing convention was held
Nursing convention was held
Þ
1940 – Manila Health Department was
1940 – Manila Health Department was
created.
created.
Þ
1941 – Dr. Mariano Icasiano became the first
1941 – Dr. Mariano Icasiano became the first
city health officer; Office of Nursing was
city health officer; Office of Nursing was
created through the effort of Vicenta
created through the effort of Vicenta
Ponce
Ponce
(chief nurse) and Rosario Ordiz (assistant chief
(chief nurse) and Rosario Ordiz (assistant chief
nurse)
nurse)

Þ
Dec. 8, 1941 – Victims of World War II were
Dec. 8, 1941 – Victims of World War II were
treated by the nurses of Manila.
treated by the nurses of Manila.
Þ
July 1942 – Nursing Office was created; Dr.
July 1942 – Nursing Office was created; Dr.
Eusebio Aguilar helped in the release of 31
Eusebio Aguilar helped in the release of 31
Filipino
Filipino
nurses in Bilibid Prison as prisoners of
nurses in Bilibid Prison as prisoners of
war
war
by
by
the Japanese.
the Japanese.
Þ
Feb. 1946 – Number of nurses decreased from 556 – 308.
Feb. 1946 – Number of nurses decreased from 556 – 308.
Þ
1948 – First training center of the Bureau of Health
1948 – First training center of the Bureau of Health
was organized by the Pasay City Health
was organized by the Pasay City Health
Department. Trinidad Gomez, Marcela Gabatin,
Department. Trinidad Gomez, Marcela Gabatin,
Costancia Tuazon, Ms. Bugarin, Ms. Ramos, and
Costancia Tuazon, Ms. Bugarin, Ms. Ramos, and
Zenaida Nisce composed the training staff.
Zenaida Nisce composed the training staff.

Þ
1950 – Rural Health Demonstration and
1950 – Rural Health Demonstration and
Training Center was created.
Training Center was created.
Þ
1953 – The first 81 rural health units were
1953 – The first 81 rural health units were
organized.
organized.
Þ
1957 – RA 1891 amended some sections of
1957 – RA 1891 amended some sections of
RA
RA
1082 and created the eight categories
1082 and created the eight categories
of rural
of rural
health unit causing an increase in
health unit causing an increase in
the demand
the demand
for the community health
for the community health
personnel.
personnel.
Þ
1958-1965 – Division of Nursing was abolished
1958-1965 – Division of Nursing was abolished
(RA 977) and Reorganization Act (EO 288)
(RA 977) and Reorganization Act (EO 288)

Þ
1961 – Annie Sand organized the National
1961 – Annie Sand organized the National
League of
League of
Nurses of DOH.
Nurses of DOH.
Þ
1967 – Zenaida Nisce became the nursing
1967 – Zenaida Nisce became the nursing
program
program
supervisor and consultant on the six special
supervisor and consultant on the six special
diseases (TB, leprosy, V.D., cancer, filariasis, and
diseases (TB, leprosy, V.D., cancer, filariasis, and
mental health illness).
mental health illness).
Þ
1975 – Scope of responsibility of nurses and
1975 – Scope of responsibility of nurses and
midwives
midwives
became wider due to restructuring
became wider due to restructuring
of
of
the health
the health
care delivery system.
care delivery system.
Þ
1976-1986 – The need for Rural Health
1976-1986 – The need for Rural Health
Practice
Practice
Program was implemented.
Program was implemented.
Þ
1990- 1992- Local Government Code of 1991
1990- 1992- Local Government Code of 1991
(RA 7160)
(RA 7160)

Þ
1993-1998 – Office of Nursing did not
1993-1998 – Office of Nursing did not
materialize in spite of persistent
materialize in spite of persistent
recommendation of the officers, board
recommendation of the officers, board
members, and advisers of the National
members, and advisers of the National
League
League
of Nurses Inc.
of Nurses Inc.
Þ
Jan. 1999 – Nelia Hizon was positioned as the
Jan. 1999 – Nelia Hizon was positioned as the
nursing adviser at the Office of Public
nursing adviser at the Office of Public
Health Services through Department
Health Services through Department
Order #
Order #
29.
29.
Þ
May 24, 1999 – EO # 102, which redirects the
May 24, 1999 – EO # 102, which redirects the
functions and operations of DOH, was
functions and operations of DOH, was
signed by former President Joseph Estrada.
signed by former President Joseph Estrada.

LAWS AFFECTING
LAWS AFFECTING
PUBLIC HEALTH
PUBLIC HEALTH
AND PRACTICE
AND PRACTICE
OF COMMUNITY
OF COMMUNITY
HEALTH NURSING
HEALTH NURSING

R.A. 7160 - or the Local Government Code. This
R.A. 7160 - or the Local Government Code. This
involves the devolution of powers, functions and
involves the devolution of powers, functions and
responsibilities to the local government both rural
responsibilities to the local government both rural
& urban.The Code aims to transform local
& urban.The Code aims to transform local
government units into self-reliant communities and
government units into self-reliant communities and
active partners in the attainment of national goals
active partners in the attainment of national goals
thru’ a more responsive and accountable local
thru’ a more responsive and accountable local
government structure instituted thru’ a system of
government structure instituted thru’ a system of
decentralization. Hence, each province, city and
decentralization. Hence, each province, city and
municipality has a LOCAL HEALTH BOARD
municipality has a LOCAL HEALTH BOARD
( LHB ) which is mandated to propose annual
( LHB ) which is mandated to propose annual
budgetary allocations for the operation and
budgetary allocations for the operation and
maintenance of their own health facilities.
maintenance of their own health facilities.

Composition of LHB
Composition of LHB
Provincial Level
Provincial Level
1.Governor- chair
1.Governor- chair
2. Provincial Health Officer – vice chair
2. Provincial Health Officer – vice chair
3. Chair , Committee on Health of Sangguniang
3. Chair , Committee on Health of Sangguniang
Panlalawigan
Panlalawigan
4. DOH rep.
4. DOH rep.
5. NGO rep.
5. NGO rep.

Composition of LHB
Composition of LHB
City and Municipal Level
City and Municipal Level
2. 2.
Mayor – chair
Mayor – chair
2. MHO – vice chair
2. MHO – vice chair
3. Chair, Committee on Health of Sangguniang
3. Chair, Committee on Health of Sangguniang
Bayan
Bayan
4. DOH rep
4. DOH rep
5. NGO rep
5. NGO rep

EFFECTIVE LHS DEPENDS
EFFECTIVE LHS DEPENDS
ON:
ON:
1. the LGU’s financial capability
1. the LGU’s financial capability
2. a dynamic and responsive political leadership
2. a dynamic and responsive political leadership
3. community empowerment
3. community empowerment

R.A. 2382 – Philippine Medical Act. This act defines the
R.A. 2382 – Philippine Medical Act. This act defines the
practice of medicine in the country.
practice of medicine in the country.
R.A. 1082 – Rural Health Act. It created the 1
R.A. 1082 – Rural Health Act. It created the 1
st st
81 Rural
81 Rural
Health Units.
Health Units.


-amended by RA 1891 ; more physicians, dentists,
-amended by RA 1891 ; more physicians, dentists,
nurses, midwives and sanitary inspectors will live in the
nurses, midwives and sanitary inspectors will live in the
rural areas where they are assigned in order to raise the
rural areas where they are assigned in order to raise the
health conditions of barrio people ,hence help decrease the
health conditions of barrio people ,hence help decrease the
high incidence of preventable diseases
high incidence of preventable diseases

R.A. 6425 – Dangerous Drugs Act. It stipulates
R.A. 6425 – Dangerous Drugs Act. It stipulates
that the sale, administration, delivery,
that the sale, administration, delivery,
distribution and transportation of prohibited
distribution and transportation of prohibited
drugs is punishable by law.
drugs is punishable by law.
R.A. 9165 – the new Dangerous Drug Act of 2002
R.A. 9165 – the new Dangerous Drug Act of 2002
P.D. No. 651 – requires that all health workers
P.D. No. 651 – requires that all health workers
shall identify and encourage the registration of
shall identify and encourage the registration of
all births within 30 days following delivery.
all births within 30 days following delivery.

P.D. No. 996 – requires the compulsory
P.D. No. 996 – requires the compulsory
immunization of all children below 8 yrs. of age
immunization of all children below 8 yrs. of age
against the 6 childhood immunizable diseases.
against the 6 childhood immunizable diseases.
P.D. No. 825 – provides penalty for improper
P.D. No. 825 – provides penalty for improper
disposal of garbage.
disposal of garbage.
R.A. 8749 – Clean Air Act of 2000
R.A. 8749 – Clean Air Act of 2000
P.D. No. 856 – Code on Sanitation. It provides for
P.D. No. 856 – Code on Sanitation. It provides for
the control of all factors in man’s environment that
the control of all factors in man’s environment that
affect health including the quality of water, food,
affect health including the quality of water, food,
milk, insects, animal carriers, transmitters of
milk, insects, animal carriers, transmitters of
disease, sanitary and recreation facilities, noise,
disease, sanitary and recreation facilities, noise,
pollution and control of nuisance.
pollution and control of nuisance.

R.A. 6758 – standardizes the salary of government
R.A. 6758 – standardizes the salary of government
employees including the nursing personnel.
employees including the nursing personnel.
R.A. 6675 – Generics Act of 1988 which promotes, requires
R.A. 6675 – Generics Act of 1988 which promotes, requires
and ensures the production of an adequate supply,
and ensures the production of an adequate supply,
distribution, use and acceptance of drugs and medicines
distribution, use and acceptance of drugs and medicines
identified by their generic name.
identified by their generic name.
R.A. 6713 – Code of Conduct and Ethical Standards of
R.A. 6713 – Code of Conduct and Ethical Standards of
Public Officials and Employees. It is the policy of the
Public Officials and Employees. It is the policy of the
state to promote high standards of ethics in public office.
state to promote high standards of ethics in public office.
Public officials and employees shall at all times be
Public officials and employees shall at all times be
accountable to the people and shall discharges their duties
accountable to the people and shall discharges their duties
with utmost responsibility, integrity, competence and
with utmost responsibility, integrity, competence and
loyalty, act with patriotism and justice, lead modest lives
loyalty, act with patriotism and justice, lead modest lives
uphold public interest over personal interest.
uphold public interest over personal interest.

R.A. 7305 – Magna Carta for Public Health Workers.
R.A. 7305 – Magna Carta for Public Health Workers.
This act aims: to promote and improve the social
This act aims: to promote and improve the social
and economic well-being of health workers, their
and economic well-being of health workers, their
living and working conditions and terms of
living and working conditions and terms of
employment; to develop their skills and capabilities
employment; to develop their skills and capabilities
in order that they will be more responsive and better
in order that they will be more responsive and better
equipped to deliver health projects and programs;
equipped to deliver health projects and programs;
and to encourage those with proper qualifications
and to encourage those with proper qualifications
and excellent abilities to join and remain in
and excellent abilities to join and remain in
government service.
government service.
R.A. 8423 – created the Philippine Institute of
R.A. 8423 – created the Philippine Institute of
Traditional and Alternative Health Care.
Traditional and Alternative Health Care.

P.D. No. 965 – requires applicants for marriage license to
P.D. No. 965 – requires applicants for marriage license to
receive instructions on family planning and responsible
receive instructions on family planning and responsible
parenthood.
parenthood.
P.D. NO. 79 – defines , objectives, duties and functions of
P.D. NO. 79 – defines , objectives, duties and functions of
POPCOM
POPCOM

Þ
RA 4073 – advocates home treatment for
RA 4073 – advocates home treatment for
leprosy
leprosy
Þ
Letter of Instruction No. 949 – legal basis of
Letter of Instruction No. 949 – legal basis of
PHC dated OCT. 19, 1979
PHC dated OCT. 19, 1979
Þ
- promotes development of health programs on the
- promotes development of health programs on the
community level
community level

Þ
RA 3573 – requires reporting of all cases of
RA 3573 – requires reporting of all cases of
communicable diseases and administration of
communicable diseases and administration of
prophylaxis
prophylaxis
Þ
Ministry Circular No. 2 of 1986 – includes
Ministry Circular No. 2 of 1986 – includes
AIDS as notifiable disease
AIDS as notifiable disease

R.A. 7875 – National Health Insurance Act
R.A. 7875 – National Health Insurance Act
R.A. 7432 – Senior Citizens Act
R.A. 7432 – Senior Citizens Act
R. A. 7719 - National Blood Services Act
R. A. 7719 - National Blood Services Act
R.A. 8172 – Salt Iodization Act ( ASIN LAW)
R.A. 8172 – Salt Iodization Act ( ASIN LAW)
R.A. 7277- Magna Carta for PWD’s, provides
R.A. 7277- Magna Carta for PWD’s, provides
their rehabilitation, self-development and self-
their rehabilitation, self-development and self-
reliance and integration into the mainstream of
reliance and integration into the mainstream of
society
society

Þ
A. O. No. 2005-0014- National Policies on
A. O. No. 2005-0014- National Policies on
Infant and Young Child Feeding:
Infant and Young Child Feeding:
1.All newborns be breastfeed within 1 hr after
1.All newborns be breastfeed within 1 hr after
birth
birth
2. Infants be exclusively breastfeed for 6 mos.
2. Infants be exclusively breastfeed for 6 mos.
3. Infants be given timely, adequate and safe
3. Infants be given timely, adequate and safe
complementary foods
complementary foods
4. Breastfeeding be continued up to 2 years and
4. Breastfeeding be continued up to 2 years and
beyond
beyond

Þ
EO 51- Phil. Code of Marketing of Breastmilk
EO 51- Phil. Code of Marketing of Breastmilk
Substitutes
Substitutes
Þ
R.A.- 7600 – Rooming In and Breastfeeding
R.A.- 7600 – Rooming In and Breastfeeding
Act of 1992
Act of 1992
Þ
R.A. 8976- Food Fortification Law
R.A. 8976- Food Fortification Law
Þ
R.A. 8980- prolmulgates a comprehensive
R.A. 8980- prolmulgates a comprehensive
policy and a national system for ECCD
policy and a national system for ECCD

Þ
A..O. No. 2006- 0015- defines the
A..O. No. 2006- 0015- defines the
Implementing guidelines on Hepatitis B
Implementing guidelines on Hepatitis B
Immunization for Infants
Immunization for Infants
Þ
R.A. 7846- mandates Compulsory Hepatitis B
R.A. 7846- mandates Compulsory Hepatitis B
Immunization among infants and children less
Immunization among infants and children less
than 8 yrs old
than 8 yrs old
Þ
R.A. 2029- madates Liver Cancer and
R.A. 2029- madates Liver Cancer and
Hepatitis B Awareness Month Act ( February)
Hepatitis B Awareness Month Act ( February)

Þ
A.O. No. 2006-0012- specifies the Revised
A.O. No. 2006-0012- specifies the Revised
Implementing Rules and Regulations of E.O.
Implementing Rules and Regulations of E.O.
51 or Milk Code, Relevant International
51 or Milk Code, Relevant International
Agreements, Penalizing Violations thereof and
Agreements, Penalizing Violations thereof and
for other purposes
for other purposes

Public Health
Public Health
Þ
-” science and art of preventing diasease,
-” science and art of preventing diasease,


prolonging life, promoting health and efficiency thru’
prolonging life, promoting health and efficiency thru’
organized community effort for the sanitation of the
organized community effort for the sanitation of the
environment, control of communicable diseases, the
environment, control of communicable diseases, the
education of individuals in personal hygiene, the
education of individuals in personal hygiene, the
organization of medical and nursing services for the
organization of medical and nursing services for the
early diagnosis and preventive treatment of diseases
early diagnosis and preventive treatment of diseases
and the development of social machinery to ensure
and the development of social machinery to ensure
everyone a standard of living adequate for the
everyone a standard of living adequate for the
maintenance of health, so organizing these benefits as
maintenance of health, so organizing these benefits as
to enable every citizen to realize his birthright off
to enable every citizen to realize his birthright off
birth and longevity”
birth and longevity”
( DR. C.E. Winslow)
( DR. C.E. Winslow)

Community Health Nursing
Community Health Nursing
Þ
- special field of nursing that combines the
- special field of nursing that combines the
skills of nursing, public health and some
skills of nursing, public health and some
phases of social assistance and functions as
phases of social assistance and functions as
part of the total public health program for the
part of the total public health program for the
promotion of health, the improvement of the
promotion of health, the improvement of the
conditions in the social and physical
conditions in the social and physical
environment, rehabilitation of illness and
environment, rehabilitation of illness and
disability ( WHO Expert Committee of
disability ( WHO Expert Committee of
Nursing )
Nursing )

CHN
CHN
Þ
- a learned practice discipline with the ultimate goal
- a learned practice discipline with the ultimate goal
of contributing as individuals and in collaboration
of contributing as individuals and in collaboration
with others to the promotion of the client’s optimum
with others to the promotion of the client’s optimum
level of functioning thru’ teaching and delivery of
level of functioning thru’ teaching and delivery of
care ( Jacobson )
care ( Jacobson )
Þ
- a service rendered by a professional nurse to IFCs,
- a service rendered by a professional nurse to IFCs,
population groups in health centers, clinics, schools ,
population groups in health centers, clinics, schools ,
workplace for the promtion of health, preventionof
workplace for the promtion of health, preventionof
illness, care of the sick at home and rehabilitation
illness, care of the sick at home and rehabilitation
(DR. Ruth B. Freeman)
(DR. Ruth B. Freeman)

º
Concepts
Concepts
Þ
The primary focus of community health nursing
The primary focus of community health nursing
is health promotion.
is health promotion.
Þ
Community health nurses provide care necessary
Community health nurses provide care necessary
to meet the requirements of an individual all
to meet the requirements of an individual all
throughout the life cycle.
throughout the life cycle.
Þ
Knowledge on different fields (biological and
Knowledge on different fields (biological and
social sciences, clinical nursing, and community
social sciences, clinical nursing, and community
health organizations) is used.
health organizations) is used.
Þ
Nursing process in community health nursing
Nursing process in community health nursing
changes based on the needs of the community.
changes based on the needs of the community.

º
Goal
Goal
Þ
To elevate the level health of the multitude.
To elevate the level health of the multitude.
Þ
Worth and dignity of man.
Worth and dignity of man.
1.The need of the community is the basis of
1.The need of the community is the basis of
community health nursing.
community health nursing.
2.The community health nurse must
2.The community health nurse must
understand fully the objectives and policies
understand fully the objectives and policies
of the agency she represents.
of the agency she represents.
º
Philosophy
Philosophy
º
Principles
Principles

3. The family is the unit of service.
3. The family is the unit of service.
4. CHN must be available to all regardless of
4. CHN must be available to all regardless of
race,creed and socioeconomic status
race,creed and socioeconomic status
5. The CHN works as a member of the health team
5. The CHN works as a member of the health team
6. There must be provision for periodic evaluation
6. There must be provision for periodic evaluation
of community health nursing services
of community health nursing services
7. Opportunities for continuing staff education
7. Opportunities for continuing staff education
programs for nurses must be provided by the
programs for nurses must be provided by the
community health nursing agency and the CHN
community health nursing agency and the CHN
as well
as well
8. The CHN makes use of available community
8. The CHN makes use of available community
health resources
health resources

9. The CHN taps the already existing
active organized groups in the
community
10. There must be provision for educative
supervision in community health nursing
11. There should be accurate recording
and reporting in community health
nursing
12. Health teaching is the primary
responsibility of the community health
nurse

Standards in CHN
Standards in CHN
I. Theory
I. Theory
Applies theoretical concepts as basis for
Applies theoretical concepts as basis for
decisions in practice
decisions in practice
II. Data Collection
II. Data Collection
Gathers comprehensive , accurate data
Gathers comprehensive , accurate data
systematically
systematically

Standards
Standards
III. Diagnosis
III. Diagnosis
Analyzes collected data to determine the needs/
Analyzes collected data to determine the needs/
health problems of IFC
health problems of IFC
IV. Planning
IV. Planning
At each level of prevention, develops plans that
At each level of prevention, develops plans that
specify nursing actions unique to needs of
specify nursing actions unique to needs of
clients
clients

Standards
Standards
V. Intervention
V. Intervention
Guided by the plan, intervenes to promote,
Guided by the plan, intervenes to promote,
maintain or restore health, prevent illness and
maintain or restore health, prevent illness and
institute rehabilitation
institute rehabilitation
VI. Evaluation
VI. Evaluation
Evaluates responses of clients to interventions to
Evaluates responses of clients to interventions to
note progress toward goal achievement, revise
note progress toward goal achievement, revise
data base, diagnoses and plan
data base, diagnoses and plan

Standards
Standards
VII. Quality Assurance and Professional
VII. Quality Assurance and Professional
Development
Development
Participates in peer review and other means of
Participates in peer review and other means of
evaluation to assure quality of nursing practice
evaluation to assure quality of nursing practice
Assumes professional development
Assumes professional development
Contributes to development of others
Contributes to development of others

Standards
Standards
VIII. Interdisciplinary Collaboration
VIII. Interdisciplinary Collaboration
Collaborates with other members of the health
Collaborates with other members of the health
team, professionals and community
team, professionals and community
representatives in assessing, planning,
representatives in assessing, planning,
implementing and evaluating programs for
implementing and evaluating programs for
community health
community health

Standards
Standards
I. I.
Research
Research
Indulges in research to contribute to theory and
Indulges in research to contribute to theory and
practice in community health nursing
practice in community health nursing

LEVELS OF CARE/ PREVENTION
LEVELS OF CARE/ PREVENTION
Þ
1. PRIMARY
1. PRIMARY
Þ
2. SECONDARY
2. SECONDARY
Þ
3. TERTIARY
3. TERTIARY

Types of Clientele
Types of Clientele
Þ
1. INDIVIDUALS
1. INDIVIDUALS
Þ
2. FAMILIES
2. FAMILIES
Þ
3. COMMUNITIES
3. COMMUNITIES
Þ
4. POPULATION GROUPS
4. POPULATION GROUPS
- Aggregate of people who share common
- Aggregate of people who share common
characteristics, developmental stage or common
characteristics, developmental stage or common
exposure to particular environmental factors thus
exposure to particular environmental factors thus
resulting in common health problems ( Clark, 1995:5)
resulting in common health problems ( Clark, 1995:5)
e.g. children . elderly, women, workers etc.
e.g. children . elderly, women, workers etc.

Phil.Health Care Delivery System
Phil.Health Care Delivery System
Þ
1.PRIMARY LEVEL FACILITIES
1.PRIMARY LEVEL FACILITIES
Þ
2. SECONDARY LEVEL FACILITIES
2. SECONDARY LEVEL FACILITIES
Þ
3. TERTIARY LEVEL FACILITIES
3. TERTIARY LEVEL FACILITIES

Classify as to what level the ff.
Classify as to what level the ff.
belong
belong
Þ
1. Teaching and Training Hospitals
1. Teaching and Training Hospitals
Þ
2. City Health Services
2. City Health Services
Þ
3. Emergency and District Hospitals
3. Emergency and District Hospitals
Þ
4. Private Practitioners
4. Private Practitioners
Þ
5. Heart Institutes
5. Heart Institutes
Þ
6. Puericulture Centers
6. Puericulture Centers
Þ
7. RHU
7. RHU

THE DEPARTMENT OF
THE DEPARTMENT OF
HEALTH
HEALTH
VISION: Health for all Filipinos
VISION: Health for all Filipinos
MISSION: Ensure accessibility & quality of
MISSION: Ensure accessibility & quality of
health care to improve the quality of life of
health care to improve the quality of life of
all Filipinos, especially the poor.
all Filipinos, especially the poor.

NATIONAL OBJECTIVES
NATIONAL OBJECTIVES
1. 1.
Improve the general health status of the population
Improve the general health status of the population
(reduce infant mortality rate, reduce child morality rate,
(reduce infant mortality rate, reduce child morality rate,
reduce maternal mortality rate, reduce total fertility rate,
reduce maternal mortality rate, reduce total fertility rate,
increase life expectancy & the quality of life years).
increase life expectancy & the quality of life years).
2. 2.
Reduce morbidity, mortality, disability & complications
Reduce morbidity, mortality, disability & complications
from Diarrheas, Pneumonias, Tuberculosis, Dengue,
from Diarrheas, Pneumonias, Tuberculosis, Dengue,
Intestinal Parasitism, Sexually Transmitted Diseases,
Intestinal Parasitism, Sexually Transmitted Diseases,
Hepatitis B, Accident & Injuries, Dental Caries &
Hepatitis B, Accident & Injuries, Dental Caries &
Periodontal Diseases, Cardiovascular Diseases, Cancer,
Periodontal Diseases, Cardiovascular Diseases, Cancer,
Diabetes, Asthma & Chronic Obstructive Pulmonary
Diabetes, Asthma & Chronic Obstructive Pulmonary
Diseases, Nephritis & Chronic Kidney Diseases, Mental
Diseases, Nephritis & Chronic Kidney Diseases, Mental
Disorders, Protein Energy Malnutrition, Iron Deficiency
Disorders, Protein Energy Malnutrition, Iron Deficiency
Anemia & Obesity.
Anemia & Obesity.

3.Eliminate the ff. diseases as public health problems:
3.Eliminate the ff. diseases as public health problems:
Þ
Schistosomiasis
Schistosomiasis
Þ
Malaria
Malaria
Þ
Filariasis
Filariasis
Þ
Leprosy
Leprosy
Þ
Rabies
Rabies
Þ
Measles
Measles
Þ
Tetanus
Tetanus
Þ
Diphtheria & Pertussis
Diphtheria & Pertussis
Þ
Vitamin A Deficiency & Iodine Deficiency
Vitamin A Deficiency & Iodine Deficiency
Disorders
Disorders

4. Eradicate Poliomyelitis
4. Eradicate Poliomyelitis
5. Promote healthy lifestyle through healthy diet &
5. Promote healthy lifestyle through healthy diet &
nutrition, physical activity & fitness, personal
nutrition, physical activity & fitness, personal
hygiene, mental health & less stressful life &
hygiene, mental health & less stressful life &
prevent violent & risk-taking behaviors.
prevent violent & risk-taking behaviors.
6. Promote the health & nutrition of families &
6. Promote the health & nutrition of families &
special populations through child, adolescent &
special populations through child, adolescent &
youth, adult health, women’s health, health of
youth, adult health, women’s health, health of
older persons, health of indigenous people, health
older persons, health of indigenous people, health
of migrant workers and health of different disabled
of migrant workers and health of different disabled
persons and of the rural & urban poor.
persons and of the rural & urban poor.

7. Promote environmental health and sustainable
7. Promote environmental health and sustainable
development through the promotion and
development through the promotion and
maintenance of healthy homes, schools,
maintenance of healthy homes, schools,
workplaces, establishments and communities
workplaces, establishments and communities
towns and cities.
towns and cities.

Basic Principles to Achieve
Basic Principles to Achieve
Improvement in Health
Improvement in Health
1. 1.
Universal access to basic health services
Universal access to basic health services
must be ensured.
must be ensured.
2. 2.
The health and nutrition of vulnerable groups
The health and nutrition of vulnerable groups
must be prioritized.
must be prioritized.
3. 3.
The epidemiological shift from infection to
The epidemiological shift from infection to
degenerative diseases must be managed.
degenerative diseases must be managed.
4. 4.
The performance of the health sector must be
The performance of the health sector must be
enhanced.
enhanced.

Primary Strategies to Achieve
Primary Strategies to Achieve
Goals
Goals
1. 1.
Increasing investment for Primary Health
Increasing investment for Primary Health
Care.
Care.
2. 2.
Development of national standards and
Development of national standards and
objectives for health.
objectives for health.
3. 3.
Assurance of health care.
Assurance of health care.
4. 4.
Support to the local system development.
Support to the local system development.
5. 5.
Support for frontline health workers.
Support for frontline health workers.

PHC as a Strategy
PHC as a Strategy

PRIMARY HEALTH CARE (PHC)
PRIMARY HEALTH CARE (PHC)
Þ
May 1977 -30
May 1977 -30
th th
World Health Assembly decided
World Health Assembly decided
that the main health target of the government and
that the main health target of the government and
WHO is the
WHO is the
attainment of a level of health that
attainment of a level of health that
would permit them to lead a socially and
would permit them to lead a socially and
economically productive life by the year 2000
economically productive life by the year 2000
.
.
Þ
September 6-12, 1978 - First International
September 6-12, 1978 - First International
Conference on PHC in Alma Ata, Russia (USSR)
Conference on PHC in Alma Ata, Russia (USSR)
The
The
Alma Ata
Alma Ata
Declaration
Declaration
stated that PHC was the
stated that PHC was the
key to attain the “health for all” goal
key to attain the “health for all” goal

October 19, 1979 - Letter of Instruction (LOI)
October 19, 1979 - Letter of Instruction (LOI)
949), the legal basis of PHC was signed by Pres.
949), the legal basis of PHC was signed by Pres.
Ferdinand E. Marcos,
Ferdinand E. Marcos,
which adopted PHC as an approach towards the
which adopted PHC as an approach towards the
design, development and implementation of
design, development and implementation of
programs focusing on health development at
programs focusing on health development at
community level.
community level.

RATIONALE FOR ADOPTING PRIMARY HEALTH CARE:


Magnitude of Health Problems
Magnitude of Health Problems


Inadequate and unequal distribution of
Inadequate and unequal distribution of
health resources
health resources


Increasing cost of medical care
Increasing cost of medical care


Isolation of health care activities from other
Isolation of health care activities from other
development activities
development activities


DEFINITION OF PRIMARY HEALTH CARE
DEFINITION OF PRIMARY HEALTH CARE
>
essential health care made universally accessible to
essential health care made universally accessible to
individuals and families in the community by means
individuals and families in the community by means
acceptable to them, through their full participation
acceptable to them, through their full participation
and at cost that the community can afford at every
and at cost that the community can afford at every
stage of development.
stage of development.
>
a practical approach to making health benefits
a practical approach to making health benefits
within the reach of all people.
within the reach of all people.
>
an approach to health development, which is carried
an approach to health development, which is carried
out through a set of activities and whose ultimate
out through a set of activities and whose ultimate
aim is the continuous improvement and maintenance
aim is the continuous improvement and maintenance
of health status of the community.
of health status of the community.

GOAL OF PRIMARY HEALTH CARE:
GOAL OF PRIMARY HEALTH CARE:
HEALTH FOR ALL FILIPINOS by the year 2000
HEALTH FOR ALL FILIPINOS by the year 2000
AND HEALTH IN THE HANDS OF THE
AND HEALTH IN THE HANDS OF THE
PEOPLE by
PEOPLE by
the year 2020.
the year 2020.

An improved state of health and quality of life for all
An improved state of health and quality of life for all
people attained through
people attained through
SELF-RELIANCE
SELF-RELIANCE
.
.
 
KEY STRATEGY TO ACHIEVE THE GOAL:
KEY STRATEGY TO ACHIEVE THE GOAL:
Partnership with and Empowerment of the people
Partnership with and Empowerment of the people
-
-
permeate as the core strategy in the effective provision of
permeate as the core strategy in the effective provision of
essential health services that are community based,
essential health services that are community based,
accessible, acceptable, and sustainable, at a cost, which the
accessible, acceptable, and sustainable, at a cost, which the
community and the government can afford.
community and the government can afford. 

OBJECTIVES OF PRIMARY HEALTH CARE
OBJECTIVES OF PRIMARY HEALTH CARE

Þ

• Improvement in the level of health care of the community Improvement in the level of health care of the community
Þ

• Favorable population growth structure Favorable population growth structure
Þ

• Reduction in the prevalence of preventable, communicable and Reduction in the prevalence of preventable, communicable and
other disease. other disease.
Þ

• Reduction in morbidity and mortality rates especially among infants Reduction in morbidity and mortality rates especially among infants
and children. and children.
Þ

• Extension of essential health services with priority given to the Extension of essential health services with priority given to the
underserved sectors. underserved sectors.
Þ

• Improvement in Basic Sanitation Improvement in Basic Sanitation
Þ

• Development of the capability of the community aimed at self- Development of the capability of the community aimed at self-
reliance. reliance.
Þ

• Maximizing the contribution of the other sectors for the social and Maximizing the contribution of the other sectors for the social and
economic development of the community. economic development of the community.

MISSION:
MISSION:
Þ
To strengthen the health care system by
To strengthen the health care system by
increasing opportunities and supporting the
increasing opportunities and supporting the
conditions wherein people will manage their
conditions wherein people will manage their
own health care.
own health care.
TWO LEVELS OF PRIMARY HEALTH CARE
TWO LEVELS OF PRIMARY HEALTH CARE
WORKERS
WORKERS

3. 3.
Barangay Health Workers - trained community health
Barangay Health Workers - trained community health
workers or health auxiliary volunteers or traditional birth
workers or health auxiliary volunteers or traditional birth
attendants or healers.
attendants or healers.
4. 4.
Intermediate level health workers include the Public
Intermediate level health workers include the Public
Health Nurse, Rural Sanitary Inspector and midwives.
Health Nurse, Rural Sanitary Inspector and midwives.

PRINCIPLES OF PRIMARY HEALTH CARE
PRINCIPLES OF PRIMARY HEALTH CARE
Þ
1.
1.
4 A's
4 A's
= Accessibility, Availability,
= Accessibility, Availability,
Affordability &
Affordability &
Acceptability,
Acceptability,
Appropriateness
Appropriateness
of health services. The health services should be
of health services. The health services should be
present where the supposed recipients are.
present where the supposed recipients are.
They should make use of the available resources
They should make use of the available resources
within the community, wherein the focus would
within the community, wherein the focus would
be more on health promotion and prevention of
be more on health promotion and prevention of
illness.
illness.
Þ
2.
2.
COMMUNITY PARTICIPATION
COMMUNITY PARTICIPATION

=heart and soul of PHC
=heart and soul of PHC

Þ
3.
3.
People are the center, object and subject
People are the center, object and subject
of
of
development
development
.
.

Þ
Thus, the success of any undertaking that aims at serving
Thus, the success of any undertaking that aims at serving
the people is dependent on people’s participation at all
the people is dependent on people’s participation at all
levels of decision-making; planning, implementing,
levels of decision-making; planning, implementing,
monitoring and evaluating. Any undertaking must also be
monitoring and evaluating. Any undertaking must also be
based on the people’s needs and problems (PCF, 1990)
based on the people’s needs and problems (PCF, 1990)
Þ
Part of the people’s participation is the partnership between
Part of the people’s participation is the partnership between
the community and the agencies found in the community;
the community and the agencies found in the community;
social mobilization and decentralization.
social mobilization and decentralization.
Þ
In general, health work should start from where the people
In general, health work should start from where the people
are and building on what they have. Example: Scheduling of
are and building on what they have. Example: Scheduling of
Barangay Health Workers in the health center
Barangay Health Workers in the health center

BARRIERS OF COMMUNITY INVOLVEMENT
BARRIERS OF COMMUNITY INVOLVEMENT

Þ
Lack of motivation
Lack of motivation
Þ
Attitude
Attitude
Þ
Resistance to change
Resistance to change
Þ
Dependence on the part of community
Dependence on the part of community
people
people
Þ
Lack of managerial skills
Lack of managerial skills



4.
4.
SELF-RELIANCE
SELF-RELIANCE
5.
5.
Partnership between the community
Partnership between the community
and the health agencies in the provision
and the health agencies in the provision
of quality of life.
of quality of life.

Providing linkages between the
Providing linkages between the
government and the non-
government and the non-
government
government
organization and people’s organization.
organization and people’s organization.

6. Recognition of interrelationship between the
6. Recognition of interrelationship between the
health and development
health and development
HEALTH
HEALTH

Þ
is not merely the absence of disease. Neither it is only a
is not merely the absence of disease. Neither it is only a
state of physical and mental well-being. Health being a
state of physical and mental well-being. Health being a
social phenomenon recognizes the interplay of political,
social phenomenon recognizes the interplay of political,
socio-cultural and economic factors as its determinant.
socio-cultural and economic factors as its determinant.
Good Health therefore, is manifested by the progressive
Good Health therefore, is manifested by the progressive
improvements in the living conditions and quality of life
improvements in the living conditions and quality of life
enjoyed by the community residents (PCF,
enjoyed by the community residents (PCF,
DEVELOPMENT
DEVELOPMENT
is the quest for an improved quality of
is the quest for an improved quality of
life for all. Development is multi-dimensional. It has a
life for all. Development is multi-dimensional. It has a
political, social, cultural, institutional and environmental
political, social, cultural, institutional and environmental
dimensions(Gonzales 1994). Therefore, it is measured by
dimensions(Gonzales 1994). Therefore, it is measured by
the ability of people to satisfy their basic needs.
the ability of people to satisfy their basic needs.

7. SOCIAL MOBILIZATION
7. SOCIAL MOBILIZATION

It enhances people participation or governance,
It enhances people participation or governance,
support system provided by the Government,
support system provided by the Government,
networking and developing secondary
networking and developing secondary
leaders.
leaders.
8. DECENTRALIZATION

MAJOR STRATEGIES OF PRIMARY
MAJOR STRATEGIES OF PRIMARY
HEALTH CARE
HEALTH CARE
A. ELEVATING HEALTH TO A COMPREHENSIVE AND
A. ELEVATING HEALTH TO A COMPREHENSIVE AND
SUSTAINED NATIONAL EFFORTS.
SUSTAINED NATIONAL EFFORTS.
Þ
Attaining Health for all Filipino will require expanding
Attaining Health for all Filipino will require expanding
participation in health and health related programs whether
participation in health and health related programs whether
as service provider or beneficiary. Empowerment to
as service provider or beneficiary. Empowerment to
parents, families and communities to make decisions of
parents, families and communities to make decisions of
their health is really the desired outcome.
their health is really the desired outcome.
Þ
Advocacy must be directed to National and Local policy
Advocacy must be directed to National and Local policy
making to elicit support and commitment to major health
making to elicit support and commitment to major health
concerns through legislations, budgetary and logistical
concerns through legislations, budgetary and logistical
considerations.
considerations.

B. PROMOTING AND SUPPORTING COMMUNITY
B. PROMOTING AND SUPPORTING COMMUNITY
MANAGED
MANAGED
HEALTH CARE
HEALTH CARE
The health in the hands of the
The health in the hands of the
people brings the government closest
people brings the government closest
to the people. It necessitates a process
to the people. It necessitates a process
of capacity building of communities
of capacity building of communities
and organization to plan, implement
and organization to plan, implement
and evaluate health programs at their
and evaluate health programs at their
levels.
levels.

C. INCREASING EFFICIENCIES IN THE
C. INCREASING EFFICIENCIES IN THE
HEALTH SECTOR
HEALTH SECTOR
Þ
Using appropriate technology will make services
Using appropriate technology will make services
and resources required for their delivery, effective,
and resources required for their delivery, effective,
affordable, accessible and culturally acceptable. The
affordable, accessible and culturally acceptable. The
development of human resources must correspond
development of human resources must correspond
to the actual needs of the nation and the policies it
to the actual needs of the nation and the policies it
upholds such as PHC. The DOH will continue to
upholds such as PHC. The DOH will continue to
support and assist both public and private
support and assist both public and private
institutions particularly in faculty development,
institutions particularly in faculty development,
enhancement of relevant curricula and development
enhancement of relevant curricula and development
of standard teaching materials.
of standard teaching materials.



D. ADVANCING ESSENTIAL NATIONAL
D. ADVANCING ESSENTIAL NATIONAL
HEALTH RESEARCH
HEALTH RESEARCH
Essential National Health Research
Essential National Health Research
(ENHR) is an integrated strategy for
(ENHR) is an integrated strategy for
organizing and managing research
organizing and managing research
using intersectoral, multi-disciplinary
using intersectoral, multi-disciplinary
and scientific approach to health
and scientific approach to health
programming and delivery.
programming and delivery.

Þ
FOUR CORNERSTONES/ PILLARS IN
FOUR CORNERSTONES/ PILLARS IN
PRIMARY HEALTH CARE
PRIMARY HEALTH CARE
1. Active Community Participation
1. Active Community Participation
2. Intra and Inter-sectoral Linkages
2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
3. Use of Appropriate Technology
4.
4.


Support mechanism made available
Support mechanism made available

Þ
Divide the decoction into
3 parts:
×
For asthma and cough,
drink 1 part 3 times a day.
×
For fever and body
pains, drink 1 part every 4
hrs.
1. Asthma
2. Cough
3. Body Pain
4. Fever
1.Five-leaf
Chaste tree
(Lagundi)
Dosage Indications Name
HERBAL MEDICINES ENDORSED BY THE
DEPARTMENT OF HEALTH

Þ
Divide
decoction into
3 parts and
drink 1 part 3
times a day.
1. Swelling
2. Inducing
diuresis
( anti-
urolithiasis)
3. Sambong
Þ
Divide
decoction into
2 parts and
drink 1 part
every 3 hours.
1. Body pain 2. Marsh-Mint;
Peppermint
(Yerba Buena)

5. Ulasimang
Bato/Pansit-
Pansitan
4. Tsaang
Gubat
Þ
Divide the
decoction into 3 parts
and drink 1 part 3
times a day after
meals.
1. Gouty Arthritis
Þ
Drink the warm
decoction. If it
persists, or if there is
no improvement an
hour after drinking
the decoction,
consult a doctor.
1. Stomachache

Þ
Chew and
swallow only
dried seeds 2
hours after dinner
according to the
following:
Þ
ADULTS = 8-10
seeds
9-12 y/o = 6-7 seeds
6-8 y/o = 5-6 seeds
4-5 y/o = 4-5 seeds
1. Ascariasis 7. Niyog-
Niyogan
Þ
Eat 6 cloves of
garlic together
with meals
1. Hypertension
2. Htperlipidemia
6. Garlic

Þ
For wound cleaning, use
decoction for washing the
wound 2 times a day
Þ
For tooth decay and
swelling of gums, gargle
with warm decoction 3
times a day
1. Cleaning
wounds
2. Mouth wash
for mouth
infection,
sore gums &
tooth decay
8. Guava

Þ
Apply the juice on the affected area 1
to 2 times a day
Þ
If the person develops an allergy
while using the above preparation,
prepare the following:
o
Put 1 cup of chopped fresh leaves in
an earthen jar. Pour in 2 glasses of
water and cover it.
o
Boil the mixture until the 2 glasses of
water originally poured have been
reduced to 1 glass of water
o
Strain the mixture. Use it while it is
warm.
o
Apply the warm decoction on the
affected area 1 to 2 times a day.
¤
Ring worm
¤
Athlete’s
foot
¤
Scabies
9.
Akapulko

Þ
Drink ½ cup
of cooled or
warm
decoction 3
times a day
after meals.
1. Mild Non-
Insulin
Dependent
Diabetes
Mellitus
10.
Bitter Gourd/
Melon
(Ampalaya)

Þ
An abortifacient if taken in
large amounts; should not be
used by persons with
cholelithiasis unless directed
by the physician; may
increase the risk of bleeding
when used concurrently with
anticoagulants &
antiplatelets.
Þ
Chop and Mash a piece of
ginger root, and mix in a glass of
water
Þ
Boil the mixture
Þ
Drink the cooled or warm
decoction as needed.
1. Motion
sickness, sore
throat, nausea
& vomiting,
migraine
headaches,
arthritis
11. Ginger
(Zingiber
officinale)

ELEMENTS OF PRIMARY HEALTH
ELEMENTS OF PRIMARY HEALTH
CARE:
CARE:
Is one of the potent methodologies for
Is one of the potent methodologies for
information dissemination. It promotes
information dissemination. It promotes
the partnership of both the family
the partnership of both the family
members and health workers in the
members and health workers in the
promotion of health as well as prevention
promotion of health as well as prevention
of illness.
of illness.


Education For Health

The control of endemic disease focuses
The control of endemic disease focuses
on the prevention of its occurrence to
on the prevention of its occurrence to
reduce morbidity rate. Example
reduce morbidity rate. Example
Malaria Control and Schistosomiasis
Malaria Control and Schistosomiasis
Control
Control
Locally Endemic Disease
Control

This program exists to control the
This program exists to control the
occurrence of preventable illnesses
occurrence of preventable illnesses
especially of children below 6 years old.
especially of children below 6 years old.
Immunizations on poliomyelitis,
Immunizations on poliomyelitis,
measles, tetanus, diphtheria and other
measles, tetanus, diphtheria and other
preventable disease are given for free
preventable disease are given for free
by the government and ongoing
by the government and ongoing
program of the DOH
program of the DOH
Expanded Program on Immunization
Expanded Program on Immunization

The mother and child are the most delicate
The mother and child are the most delicate
members of the community. So the
members of the community. So the
protection of the mother and child to
protection of the mother and child to
illness and other risks would ensure good
illness and other risks would ensure good
health for the community. The goal of
health for the community. The goal of
Family Planning includes spacing of
Family Planning includes spacing of
children and responsible parenthood.
children and responsible parenthood.


Maternal and Child Health and
Family Planning

Environmental Sanitation is defined as the
Environmental Sanitation is defined as the
study of all factors in the man’s environment,
study of all factors in the man’s environment,
which exercise or may exercise deleterious effect
which exercise or may exercise deleterious effect
on his well-being and survival.
on his well-being and survival.
Water is a basic need for life and one factor in
Water is a basic need for life and one factor in
man’s environment. Water is necessary for the
man’s environment. Water is necessary for the
maintenance of healthy lifestyle.
maintenance of healthy lifestyle.
Safe Water and Sanitation is necessary for basic
Safe Water and Sanitation is necessary for basic
promotion of health.
promotion of health.
Environmental Sanitation and
Environmental Sanitation and
Promotion of Safe Water Supply
Promotion of Safe Water Supply

One basic need of the family is food. And if
One basic need of the family is food. And if
food is properly prepared then one may be
food is properly prepared then one may be
assured healthy family. There are many food
assured healthy family. There are many food
resources found in the communities but
resources found in the communities but
because of faulty preparation and lack of
because of faulty preparation and lack of
knowledge regarding proper food planning,
knowledge regarding proper food planning,
Malnutrition is one of the problems that we
Malnutrition is one of the problems that we
have in the country.
have in the country.
Nutrition and Promotion of Adequate
Food Supply

The diseases spread through direct contact
The diseases spread through direct contact
pose a great risk to those who can be infected.
pose a great risk to those who can be infected.
Tuberculosis is one of the communicable
Tuberculosis is one of the communicable
diseases continuously occupies the top ten causes
diseases continuously occupies the top ten causes
of death. Most communicable diseases are also
of death. Most communicable diseases are also
preventable. The Government focuses on the
preventable. The Government focuses on the
prevention, control and treatment of these
prevention, control and treatment of these
illnesses.
illnesses.
Treatment of Communicable Diseases
Treatment of Communicable Diseases
and Common Illness
and Common Illness

This focuses on the information campaign
This focuses on the information campaign
on the utilization and acquisition of drugs.
on the utilization and acquisition of drugs.
In response to this campaign, the
In response to this campaign, the
GENERIC ACT of the Philippines is
GENERIC ACT of the Philippines is
enacted . It includes the following drugs:
enacted . It includes the following drugs:
Cotrimoxazole, Paracetamol,
Cotrimoxazole, Paracetamol,
Amoxycillin, Oresol, Nifedipine,
Amoxycillin, Oresol, Nifedipine,
Rifampicin, INH(isoniazid) and
Rifampicin, INH(isoniazid) and
Pyrazinamide,Ethambutol,
Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine
Streptomycin,Albendazole,Quinine
Supply of Essential Drugs

FAMILY HEALTH NURSING
FAMILY HEALTH NURSING
Þ
- that level of CHN practice directed to the
- that level of CHN practice directed to the
FAMILY as the unit of care with HEALTH as
FAMILY as the unit of care with HEALTH as
the goal and NURSING as the medium,
the goal and NURSING as the medium,
channel or provider of care
channel or provider of care

Family Case Load
Family Case Load
Þ
- the no. and kind of families a nurse handles
- the no. and kind of families a nurse handles
at any given time
at any given time
Þ
- variable for cases are added or dropped based
- variable for cases are added or dropped based
on the need for nursing care and supervision
on the need for nursing care and supervision

Types of Families
Types of Families
Þ
1. Nuclear
1. Nuclear
Þ
2. Extended
2. Extended
Þ
3. Three generational
3. Three generational
Þ
4. Dyad
4. Dyad
Þ
5. Single- Parent
5. Single- Parent
Þ
6. Step- Parent
6. Step- Parent
Þ
7. Blended or reconstituted
7. Blended or reconstituted

Types of Families
Types of Families
Þ
8. Single adult living alone
8. Single adult living alone
Þ
9. Cohabiting/ Living –in
9. Cohabiting/ Living –in
Þ
10. No- kin
10. No- kin
Þ
11. Compound
11. Compound
Þ
12. Gay
12. Gay
Þ
14. Commune
14. Commune

Stages of Family Life Cycle
Stages of Family Life Cycle
Þ
1. Newly married couple
1. Newly married couple
Þ
2. Childbearing
2. Childbearing
Þ
3. Preschool age
3. Preschool age
Þ
4. Schoolage
4. Schoolage
Þ
5. Teenage
5. Teenage
Þ
6. Launching
6. Launching
Þ
7. Middle-aged ( empty nest –retirement)
7. Middle-aged ( empty nest –retirement)
Þ
8. Period from retirement to Death of both spouses
8. Period from retirement to Death of both spouses

HEALTH TASKS OF THE
HEALTH TASKS OF THE
FAMILY( Freeman, 1981)
FAMILY( Freeman, 1981)
Þ
1. recognizing interruptions of health or development
1. recognizing interruptions of health or development
Þ
2. seeking health care
2. seeking health care
Þ
3. managing health and non-health crises
3. managing health and non-health crises
Þ
4. providing nursing care to the sick, disabled and
4. providing nursing care to the sick, disabled and
dependent member of the family
dependent member of the family
Þ
5. maintaining a home environment conducive to
5. maintaining a home environment conducive to
good health and personal development
good health and personal development
Þ
6. maintaining a reciprocal relationship with the
6. maintaining a reciprocal relationship with the
community and health institutions
community and health institutions

Family Nursing Problem
Family Nursing Problem
Þ
Arises when the family cannot effectively
Arises when the family cannot effectively
perform its health tasks
perform its health tasks

Nurse’s Roles in Family Health
Nurse’s Roles in Family Health
Nursing
Nursing
Þ
1. HEALTH MONITOR
1. HEALTH MONITOR
Þ
2. PROVIDER OF CARE TO A SICK
2. PROVIDER OF CARE TO A SICK


FAMILY MEMBER
FAMILY MEMBER
Þ
3. COORDINATOR OF FAMILY
3. COORDINATOR OF FAMILY


SERVICES
SERVICES
Þ
4. FACILITATOR
4. FACILITATOR
Þ
5. TEACHER
5. TEACHER
Þ
6. COUNSELOR
6. COUNSELOR

INITIAL DATA BASE FOR
INITIAL DATA BASE FOR
FAMILY NURSING PRACTICE
FAMILY NURSING PRACTICE
Þ
Family structure, Characteristics, and
Family structure, Characteristics, and
Dynamics
Dynamics
2. 2.
Members of the household and relationship to
Members of the household and relationship to
the head of the family
the head of the family
3. 3.
Demographic data – age, sex, civil status,
Demographic data – age, sex, civil status,
position in the family
position in the family
4. 4.
Place of residence of each member – whether
Place of residence of each member – whether
living with the family or elsewhere
living with the family or elsewhere


4.
4.
Type of family structure – e.g. matriarchal
Type of family structure – e.g. matriarchal
or patriarchal, nuclear or extended
or patriarchal, nuclear or extended
2. 2.
Dominant family members in terms of
Dominant family members in terms of
decision-making, especially in matters of
decision-making, especially in matters of
health care
health care
3. 3.
General family relationship/dynamics –
General family relationship/dynamics –
presence of any readily observable conflict
presence of any readily observable conflict
between members; characteristics
between members; characteristics
communication patterns among members
communication patterns among members

Þ
Socio-economic and Cultural
Socio-economic and Cultural
Characteristics
Characteristics
2. 2.
Income and Expenses
Income and Expenses
Þ
Occupation, place of work and income of
Occupation, place of work and income of
each working members
each working members
Þ
Adequacy to meet basic necessities
Adequacy to meet basic necessities
Þ
Who makes decisions about money and how
Who makes decisions about money and how
it is spent
it is spent
3. 3.
Educational attainment of each other
Educational attainment of each other
4. 4.
Ethnic background and religious
Ethnic background and religious
affiliation
affiliation

1.
1.
Significant Others – role(s)
Significant Others – role(s)
they play in family’s life
they play in family’s life
2.
2.
Relationship of the family to
Relationship of the family to
larger community – Nature and
larger community – Nature and
extent of participation of the
extent of participation of the
family in community activities
family in community activities

Þ
Home and Environment
Home and Environment
2. 2.
Housing
Housing
Þ
Adequacy of living peace
Adequacy of living peace
Þ
Sleeping arrangement
Sleeping arrangement
Þ
Presence of breeding or resting sites of vectors of
Presence of breeding or resting sites of vectors of
diseases
diseases
Þ
Presence of accidents hazards
Presence of accidents hazards
Þ
Food storage and cooking facilities
Food storage and cooking facilities
Þ
Water supply – source, ownership, portability
Water supply – source, ownership, portability
Þ
Toilet facility – type, ownership, sanitary condition
Toilet facility – type, ownership, sanitary condition
Þ
Drainage system – type, sanitary condition
Drainage system – type, sanitary condition

1.
1.
Kind of neighborhood, e.g.
Kind of neighborhood, e.g.
congested, slum, etc.
congested, slum, etc.
2.
2.
Social and health facilities
Social and health facilities
available
available
3.
3.
Communication and
Communication and
transportation facilities
transportation facilities
available
available

Þ
Health Status of each Family Member
Health Status of each Family Member
2. 2.
Medical and nursing history indicating current
Medical and nursing history indicating current
or past significant illnesses or beliefs and
or past significant illnesses or beliefs and
practices conducive to health illness
practices conducive to health illness
3. 3.
Nutritional assessment
Nutritional assessment
Þ
Anthropometric data: Measures of nutritional status
Anthropometric data: Measures of nutritional status
of children, weight, height, mid-upper arm
of children, weight, height, mid-upper arm
circumference: Risk assessment measures of
circumference: Risk assessment measures of
obesity: body mass index, waist circumference,
obesity: body mass index, waist circumference,
waist hip ratio
waist hip ratio
Þ
Dietary history specifying quality and quantity of
Dietary history specifying quality and quantity of
food/nutrient intake per day
food/nutrient intake per day
Þ
Eating/ feeding habits/ practices
Eating/ feeding habits/ practices

3.
3.
Developmental assessments of infants, toddlers,
Developmental assessments of infants, toddlers,
and preschoolers – e.g., Metro Manila
and preschoolers – e.g., Metro Manila

4.
4.
Risk factor assessment indicating presence of
Risk factor assessment indicating presence of
major and contributing modifiable risk factors
major and contributing modifiable risk factors
for specific lifestyles, cigarette smoking,
for specific lifestyles, cigarette smoking,
elevated blood lipids, obesity, diabetes mellitus,
elevated blood lipids, obesity, diabetes mellitus,
inadequate fiber intake, stress, alcohol drinking
inadequate fiber intake, stress, alcohol drinking
and other substance abuse
and other substance abuse

5.
5.
Physical assessment indicating
Physical assessment indicating
presence of illness state/s
presence of illness state/s
6.
6.
Results of laboratory/
Results of laboratory/
diagnostic and other screening
diagnostic and other screening
procedures supportive of
procedures supportive of
assessment findings
assessment findings

Þ
Values, Habits, Practices on Health
Values, Habits, Practices on Health
Promotion, Maintenance and Disease
Promotion, Maintenance and Disease
Prevention.
Prevention.
Examples include: Examples include:
3. 3.
Immunization status of family members
Immunization status of family members
4. 4.
Healthy lifestyle practices. Specify.
Healthy lifestyle practices. Specify.
5. 5.
Adequacy of:
Adequacy of:
Þ
rest and sleep
rest and sleep
Þ
exercise
exercise
Þ
use of protective measures- e.g. adequate footwear
use of protective measures- e.g. adequate footwear
in parasite-infested areas;
in parasite-infested areas;
Þ
relaxation and other stress management activities
relaxation and other stress management activities
6. 6.
Use of promotive-preventive health services
Use of promotive-preventive health services

A TYPOLOGY OF NURSING
A TYPOLOGY OF NURSING
PROBLEMS IN FAMILY NURSING
PROBLEMS IN FAMILY NURSING
PRACTICE
PRACTICE

FIRST-LEVEL ASSESSMENT
FIRST-LEVEL ASSESSMENT
º
Presence of Wellness Condition – stated as Potential
Presence of Wellness Condition – stated as Potential
or Readiness- a clinical or nursing judgment about a
or Readiness- a clinical or nursing judgment about a
client in transition from a specific level of wellness
client in transition from a specific level of wellness
or capability to a higher level.
or capability to a higher level.
Wellness potential
Wellness potential
is
is
a nursing judgment on wellness state or condition
a nursing judgment on wellness state or condition
based on client’s performance, current competencies
based on client’s performance, current competencies
or clinical data but
or clinical data but
no
no
explicit expression of client
explicit expression of client
desire.
desire.
Readiness for enhanced wellness
Readiness for enhanced wellness
state is a
state is a
nursing judgment on wellness state or condition
nursing judgment on wellness state or condition
based on client’s current competencies or
based on client’s current competencies or
performance, clinical data explicit expression of
performance, clinical data explicit expression of
desire to achieve a higher level of state or function in
desire to achieve a higher level of state or function in
specific area on health promotion and maintenance.
specific area on health promotion and maintenance.

Þ
Examples of these are the following:
Examples of these are the following:
1. 1.
Potential for Enhanced Capability for:
Potential for Enhanced Capability for:
×
Healthy lifestyle – e.g. nutrition/diet, exercise/
Healthy lifestyle – e.g. nutrition/diet, exercise/
activity
activity
×
Health Maintenance
Health Maintenance
×
Parenting
Parenting
×
Breastfeeding
Breastfeeding
×
Spiritual Well-being – process of a client’s
Spiritual Well-being – process of a client’s
unfolding of mystery through harmonious
unfolding of mystery through harmonious
interconnectedness that comes from inner
interconnectedness that comes from inner
strength/sacred source/GOD (NANDA 2001)
strength/sacred source/GOD (NANDA 2001)
×
Others,
Others,

1. 1.
Readiness for Enhanced Capability for:
Readiness for Enhanced Capability for:
+
Healthy Lifestyle
Healthy Lifestyle
+
Health Maintenance
Health Maintenance
+
Parenting
Parenting
+
Breastfeeding
Breastfeeding
+
Spiritual Well-being
Spiritual Well-being
+
Others,
Others,

I. I.
Presence of Health Threats –
Presence of Health Threats –
conditions that are conducive to
conditions that are conducive to
disease, accident or failure top
disease, accident or failure top
realize one’s health potential.
realize one’s health potential.
Examples of these are the following:
Examples of these are the following:
3. 3.
Family history of hereditary
Family history of hereditary
condition, e.g. diabetes
condition, e.g. diabetes
4. 4.
Threat of cross infection from a
Threat of cross infection from a
communicable disease case
communicable disease case

1.
1.
Family size beyond what family
Family size beyond what family
resources can adequately provide
resources can adequately provide
2.
2.
Accidental hazards
Accidental hazards
4
Broken stairs
Broken stairs
4
Sharp objects, poison, and
Sharp objects, poison, and
medicines improperly kept
medicines improperly kept
4
Fire hazards
Fire hazards

1.
1.
Faulty nutritional habits or
Faulty nutritional habits or
feeding practices.
feeding practices.
Inadequate food intake both in
Inadequate food intake both in
quality & quantity
quality & quantity
Excessive intake of certain
Excessive intake of certain
nutrients
nutrients
Faulty eating habits
Faulty eating habits
Ineffective breastfeeding
Ineffective breastfeeding
Faulty feeding practices
Faulty feeding practices

1.
1.
Stress-provoking factors –
Stress-provoking factors –
O
Strained marital relationship
Strained marital relationship
O
Strained parent-sibling
Strained parent-sibling
relationship
relationship
O
Interpersonal conflicts between
Interpersonal conflicts between
family members
family members
O
Care-giving burden
Care-giving burden

O
Inadequate living space
Inadequate living space
O
Lack of food storage
Lack of food storage
facilities
facilities
O
Polluted water supply
Polluted water supply
O
Presence of breeding
Presence of breeding
sites of vectors of
sites of vectors of
disease
disease
O
Improper garbage
Improper garbage
1. Poor home condition-
O
Unsanitary waste
disposal
O
Improper
drainage system
O
Poor ventilation
O
Noise pollution
G
Air pollution

1. 1.
Unsanitary food handling and preparation
Unsanitary food handling and preparation
2. 2.
Unhealthful lifestyles and personal habits-
Unhealthful lifestyles and personal habits-
Alcohol drinking
Alcohol drinking
Cigarette smoking
Cigarette smoking
Inadequate footwear
Inadequate footwear
Eating raw meat
Eating raw meat
Poor personal hygiene
Poor personal hygiene
Self-medication
Self-medication
Sexual promiscuity
Sexual promiscuity
Engaging in dangerous sports
Engaging in dangerous sports
Inadequate rest
Inadequate rest
Lack of inadequate exercise
Lack of inadequate exercise
Lack of relaxation activities
Lack of relaxation activities
Non-use of self protection measures
Non-use of self protection measures

1. 1.
Inherent personal characteristics – e.g.
Inherent personal characteristics – e.g.
poor impulse control
poor impulse control
2. 2.
Health history which induce the
Health history which induce the
occurrence of a health deficit, e.g.
occurrence of a health deficit, e.g.
previous history of difficult labor
previous history of difficult labor
3. 3.
Inappropriate role assumption – e.g. child
Inappropriate role assumption – e.g. child
assuming mother's role, father not
assuming mother's role, father not
assuming his role
assuming his role
4. 4.
Lack of immunization/ inadequate
Lack of immunization/ inadequate
immunization status specially of children
immunization status specially of children

1.
1.
Family disunity –
Family disunity –
Self-oriented behavior of
Self-oriented behavior of
member(s)
member(s)
Unresolved conflicts of
Unresolved conflicts of
member(s)
member(s)
Intolerable disagreement
Intolerable disagreement
Other
Other
2.
2.
Other
Other

I. I.
Presence of Health Deficits – instances
Presence of Health Deficits – instances
of failure in health maintenance.
of failure in health maintenance.
Examples include:
Examples include:
3. 3.
Illness states, regardless of whether it is
Illness states, regardless of whether it is
diagnosed or by medical practitioner
diagnosed or by medical practitioner
4. 4.
Failure to thrive/ develop according to
Failure to thrive/ develop according to
normal rate
normal rate
5. 5.
Disability – whether congenital or
Disability – whether congenital or
arising from illness; temporary
arising from illness; temporary

I. I.
Presence of stress Points/ Foreseeable Crisis
Presence of stress Points/ Foreseeable Crisis
Situations – anticipated periods of unusual demand of
Situations – anticipated periods of unusual demand of
the individual or family in terms of family resources.
the individual or family in terms of family resources.
Examples of these include: Examples of these include:
º
Marriage
Marriage
9.
9.
Menopause
Menopause
º
Pregnancy
Pregnancy
10.
10.
Loss of job
Loss of job
º
Parenthood
Parenthood
11.
11.
Hospitalization of a
Hospitalization of a
º
Additional member
Additional member
family member
family member
º
Abortion
Abortion
12.
12.


Death of a manner
Death of a manner
º
Entrance at school
Entrance at school


13.
13.
Resettlement in a
Resettlement in a
º
Adolescence
Adolescence
new community
new community
º
Divorce
Divorce
14.
14.


illegitimacy
illegitimacy

Second Level Assessment
Second Level Assessment
Þ
Focus on determining family’s capacity to perform the Focus on determining family’s capacity to perform the
health tasks health tasks
Þ
Statements on family health nursing problem: Statements on family health nursing problem:
c. c. Inability to recognize the presence of the condition or Inability to recognize the presence of the condition or
problem problem
d. d. Inability to make decisions with respect to taking Inability to make decisions with respect to taking
appropriate health action appropriate health action
e. e. Inability to provide adequate nursing care to the sick, Inability to provide adequate nursing care to the sick,
disabled , dependent or vulnerable member of the family disabled , dependent or vulnerable member of the family
f. f. Inability to provide a home environment conducive to health Inability to provide a home environment conducive to health
maintenance or personal development maintenance or personal development
g. g. Failure to utilize community resources for health care Failure to utilize community resources for health care

Scale for Ranking Health Conditions
Scale for Ranking Health Conditions
and Problems according to priorities
and Problems according to priorities
Þ
Criteria:
Criteria:
b. b.
Nature of the condition or problem presented
Nature of the condition or problem presented
( wellness state, health deficit, health threat, forseeable
( wellness state, health deficit, health threat, forseeable
crisis)
crisis)
b. Modifiability of the condition or problem
b. Modifiability of the condition or problem
( easily, partially, not modifiable)
( easily, partially, not modifiable)
c. Preventive Potential (high, moderate , low)
c. Preventive Potential (high, moderate , low)
d. Salience ( needs immediate attention, not immediate,
d. Salience ( needs immediate attention, not immediate,
not perceived as a problem)
not perceived as a problem)

COMMUNITY HEALTH CARE
COMMUNITY HEALTH CARE
PROCESS
PROCESS
Þ
Assessment
Assessment
Purpose : To identify the health needs of the people
Purpose : To identify the health needs of the people
Þ
Planning of nursing actions
Planning of nursing actions
Purpose : To act on the determined needs of the
Purpose : To act on the determined needs of the
community people
community people
Þ
Implementation
Implementation

Purpose : To achieve the optimum level of health of the
Purpose : To achieve the optimum level of health of the
community people
community people
Þ
Evaluation Evaluation
Purpose : To determine the effectiveness of health care programs Purpose : To determine the effectiveness of health care programs

NURSING PROCEDURES
NURSING PROCEDURES
Þ
CLINIC VISIT
CLINIC VISIT
- process of checking the client’s health condition
- process of checking the client’s health condition
in a medical clinic
in a medical clinic
Þ
HOME VISIT
HOME VISIT
- a professional face to face contact made by the
- a professional face to face contact made by the
nurse with a patient or the family to provide
nurse with a patient or the family to provide
necessary health care activities and to further
necessary health care activities and to further
attain the objectives of the agency
attain the objectives of the agency
Þ
BAG TECHNIQUE
BAG TECHNIQUE
-a tool making of the public health bag through
-a tool making of the public health bag through
which the nurse during the home visit can
which the nurse during the home visit can
perform nursing procedures with ease and
perform nursing procedures with ease and
deftness saving time and effort with the end in
deftness saving time and effort with the end in
view of rendering effective nursing care
view of rendering effective nursing care

Þ
THERMOMETER TECHNIQUE
THERMOMETER TECHNIQUE
-to assess the client’s health condition through
-to assess the client’s health condition through
body temperature reading
body temperature reading
Þ
NURSING CARE IN THE HOME
NURSING CARE IN THE HOME
- giving to the individual patient the nursing care
- giving to the individual patient the nursing care
required by his/her specific illness or trauma
required by his/her specific illness or trauma
to help him/her reach a level of functioning at
to help him/her reach a level of functioning at
which he/she can maintain himself/herself or
which he/she can maintain himself/herself or
die peacefully in dignity
die peacefully in dignity

Þ
ISOLATION TECHNIQUE IN THE HOME
ISOLATION TECHNIQUE IN THE HOME
-done by :
-done by :
1. separating the articles used by a client with
1. separating the articles used by a client with
communicable disease to prevent the spread of
communicable disease to prevent the spread of
infection:
infection:
2. frequent washing and airing of beddings and
2. frequent washing and airing of beddings and
other articles and disinfections of room
other articles and disinfections of room
3. wearing a protective gown , to be used only
3. wearing a protective gown , to be used only
within the room of the sick member
within the room of the sick member
4. discarding properly all nasal and throat
4. discarding properly all nasal and throat
discharges of any member sick with
discharges of any member sick with
communicable disease
communicable disease

5. burning all soiled articles if could be or
5. burning all soiled articles if could be or
contaminated articles be boiled first in water
contaminated articles be boiled first in water
30 minutes before laundering
30 minutes before laundering
Þ
INTRAVENOUS THERAPY
INTRAVENOUS THERAPY
-
insertion of a needle or catheter into a vein to
insertion of a needle or catheter into a vein to
provide medication and fluids based on
provide medication and fluids based on
physician’s written prescription
physician’s written prescription
- can be done only by nurses accredited by
- can be done only by nurses accredited by
ANSAP
ANSAP

PRINCIPLES OF HEALTH
PRINCIPLES OF HEALTH
EDUCATION
EDUCATION
Þ
It considers the health status of the people,
It considers the health status of the people,
which is determined by the economic and
which is determined by the economic and
social conscience of the country.
social conscience of the country.
Þ
It is a process whereby people learn to
It is a process whereby people learn to
improve their personal habits and attitudes,
improve their personal habits and attitudes,
to work responsibly for the improvement of
to work responsibly for the improvement of
health conditions of the family, community,
health conditions of the family, community,
and nation.
and nation.

Þ
It involves motivation, experience, and
It involves motivation, experience, and
change in conduct and thinking, while
change in conduct and thinking, while
stimulating active interest. It develops
stimulating active interest. It develops
and provides experience for change in
and provides experience for change in
people’s attitudes, customs, and habits in
people’s attitudes, customs, and habits in
relation to health and everyday living.
relation to health and everyday living.
Þ
It should be recognized as the basic
It should be recognized as the basic
function of all health workers.
function of all health workers.

Þ
It takes place in the home, in the
It takes place in the home, in the
school, and in the community.
school, and in the community.
Þ
It is a cooperative effort requiring
It is a cooperative effort requiring
all categories of health personnel to
all categories of health personnel to
work together in close teamwork
work together in close teamwork
with families, groups, and the
with families, groups, and the
community.
community.

Þ
It meets the needs, interests, and
It meets the needs, interests, and
problems of the people affected.
problems of the people affected.
Þ
It finds means and ways of
It finds means and ways of
carrying out plans by
carrying out plans by
encouraging individual and
encouraging individual and
community participation.
community participation.

Þ
It is a slow, continuous process
It is a slow, continuous process
that involves constant changes
that involves constant changes
and revisions until objectives are
and revisions until objectives are
achieved.
achieved.
Þ
Makes use of supplementary
Makes use of supplementary
aids and devices to help with the
aids and devices to help with the
verbal instructions.
verbal instructions.

Þ
It utilizes community resources by
It utilizes community resources by
careful evaluation of the different
careful evaluation of the different
services and resources found in the
services and resources found in the
community.
community.
Þ
It is a creative process requiring
It is a creative process requiring
methods and techniques with various
methods and techniques with various
characteristics, not following a rigid and
characteristics, not following a rigid and
flexible pattern.
flexible pattern.

Þ
It aims to help people make use of their
It aims to help people make use of their
own efforts and education to improve
own efforts and education to improve
their conditions of living,
their conditions of living,
Þ
It makes careful evaluation of the
It makes careful evaluation of the
planning, organization, and
planning, organization, and
implementation of all health education
implementation of all health education
programs and activities.
programs and activities.

THE COMMUNITY HEALTH
THE COMMUNITY HEALTH
NURSE
NURSE
Þ
Qualifications
Qualifications

2.
2.
Bachelor of Science in
Bachelor of Science in
Nursing
Nursing
3.
3.
Registered Nurse of the
Registered Nurse of the
Philippines
Philippines

Þ
Planner/Programmer
Planner/Programmer
2. 2.
Identifies needs, priorities, and problems
Identifies needs, priorities, and problems
of individuals, families, and communities
of individuals, families, and communities
3. 3.
Formulates municipal health plan in the
Formulates municipal health plan in the
absence of a medical doctor
absence of a medical doctor
4. 4.
Interprets and implements nursing plan,
Interprets and implements nursing plan,
program policies, memoranda, and circular
program policies, memoranda, and circular
for the concerned staff personnel
for the concerned staff personnel
5. 5.
Provides technical assistance to rural
Provides technical assistance to rural
health midwives in health matters
health midwives in health matters

Þ
Provider of Nursing Care
Provider of Nursing Care
2.
2.
Provides direct nursing care to
Provides direct nursing care to
sick or disabled in the home,
sick or disabled in the home,
clinic, school, or workplace
clinic, school, or workplace
3.
3.
Develops the family’s
Develops the family’s
capability to take care of the
capability to take care of the
sick, disabled, or dependent
sick, disabled, or dependent
member
member

Þ
Manager/Supervisor
Manager/Supervisor
2. 2.
Formulates individual, family, group, and
Formulates individual, family, group, and
community-centered plan
community-centered plan
3. 3.
Interprets and implements programs,
Interprets and implements programs,
policies, memoranda, and circulars
policies, memoranda, and circulars
4. 4.
Organizes work force, resources, equipments,
Organizes work force, resources, equipments,
and supplies at local level
and supplies at local level
5. 5.
Provides technical and administrative
Provides technical and administrative
support to Rural Health Midwives (RHM)
support to Rural Health Midwives (RHM)
6. 6.
Conducts regular supervisory visits and
Conducts regular supervisory visits and
meetings to different RHMs and gives
meetings to different RHMs and gives
feedback on accomplishments
feedback on accomplishments

Þ
Community Organizer
Community Organizer
2.
2.
Motivates and enhances
Motivates and enhances
community participation in terms
community participation in terms
of planning, organizing,
of planning, organizing,
implementing, and evaluating
implementing, and evaluating
health services
health services
3.
3.
Initiates and participates in
Initiates and participates in
community development activities
community development activities

Þ
Coordinator of Services
Coordinator of Services
2. 2.
Coordinates with individuals, families,
Coordinates with individuals, families,
and groups for health related services
and groups for health related services
provided by various members of the
provided by various members of the
health team
health team
3. 3.
Coordinates nursing program with
Coordinates nursing program with
other health programs like
other health programs like
environmental sanitation, health
environmental sanitation, health
education, dental health, and mental
education, dental health, and mental
health
health

Þ
Trainer/Health Educator
Trainer/Health Educator
2. 2.
Identifies and interprets training needs of the
Identifies and interprets training needs of the
RHMs, Barangay Health Workers (BHW),
RHMs, Barangay Health Workers (BHW),
and hilots
and hilots
3. 3.
Conducts training for RHMs and hilots on
Conducts training for RHMs and hilots on
promotion and disease prevention
promotion and disease prevention
4. 4.
Conducts pre and post-consultation
Conducts pre and post-consultation
conferences for clinic clients; acts as a
conferences for clinic clients; acts as a
resource speaker on health and health-
resource speaker on health and health-
related services
related services
5. 5.
Initiates the use of tri-media (radio/TV,
Initiates the use of tri-media (radio/TV,
cinema plugs, and print ads) for health
cinema plugs, and print ads) for health
education purposes
education purposes
6. 6.
Conducts pre-marital counseling
Conducts pre-marital counseling

Þ
Health Monitor
Health Monitor
2.
2.
Detects deviation from health of
Detects deviation from health of
individuals, families, groups,
individuals, families, groups,
and communities through
and communities through
contacts/visits with them
contacts/visits with them

Þ
Role Model
Role Model
2.
2.
Provides good example
Provides good example
of healthful living to
of healthful living to
the members of the
the members of the
community
community

Þ
Change Agent
Change Agent
2.
2.
Motivates changes in health
Motivates changes in health
behavior in individuals,
behavior in individuals,
families, groups, and
families, groups, and
communities that also include
communities that also include
lifestyle in order to promote and
lifestyle in order to promote and
maintain health
maintain health

Þ
Recorder/Reporter/Statistician
Recorder/Reporter/Statistician
Þ
Prepares and submits required reports
Prepares and submits required reports
and records
and records
Þ
Maintain adequate, accurate, and
Maintain adequate, accurate, and
complete recording and reporting
complete recording and reporting
Þ
Reviews, validates, consolidates,
Reviews, validates, consolidates,
analyzes, and interprets all records
analyzes, and interprets all records
and reports
and reports
Þ
Prepares statistical data/chart and other
Prepares statistical data/chart and other
data presentation
data presentation

Þ
Researcher
Researcher
2.
2.
Participates in the conduct of
Participates in the conduct of
survey studies and researches on
survey studies and researches on
nursing and health-related subjects
nursing and health-related subjects
3.
3.
Coordinates with government and
Coordinates with government and
non-government organization in
non-government organization in
the implementation of
the implementation of
studies/research
studies/research

Community Organizing
Community Organizing
Þ
Approaches to community devt.:
Approaches to community devt.:
b. b.
Welfare approach
Welfare approach
c. c.
Technological approach
Technological approach
d. d.
Transformatory approah
Transformatory approah

Community Organizing
Community Organizing
Þ
Principles of CO:
Principles of CO:
Þ
1. People esp. the oppressed, exploited and
1. People esp. the oppressed, exploited and
deprived sectors are most open to change, have
deprived sectors are most open to change, have
the capacity to change and are able to bring
the capacity to change and are able to bring
about change. Hence , CO is based on the ff:
about change. Hence , CO is based on the ff:
Þ
A. Power must reside in the people
A. Power must reside in the people
Þ
B. Devt. is from the people to the people
B. Devt. is from the people to the people
Þ
C. People participation
C. People participation

Principles of CO
Principles of CO
Þ
2.-must be based on the poorest sectors of
2.-must be based on the poorest sectors of
society. The solutions of problems commonly
society. The solutions of problems commonly
shared by these sectors must be focused on
shared by these sectors must be focused on
collective organizations, planning and action
collective organizations, planning and action
Þ
3. – should lead to self-reliant communities
3. – should lead to self-reliant communities

THE HRDP-COPAR PROCESS
THE HRDP-COPAR PROCESS
Þ
1. PRE-ENTRY PHASE
1. PRE-ENTRY PHASE
Þ
2. ENNTRY PHASE
2. ENNTRY PHASE
Þ
3. COMMUNITY STUDY/DIAGNOSIS
3. COMMUNITY STUDY/DIAGNOSIS
PHASE/RESEARCH PHASE
PHASE/RESEARCH PHASE
Þ
4.COMMUNITY ORGANIZATION AND
4.COMMUNITY ORGANIZATION AND
CAPABILITY-BUILDING PHASE
CAPABILITY-BUILDING PHASE
Þ
5. COMMUNITY ACTION PHASE
5. COMMUNITY ACTION PHASE
Þ
6. SUSTENANCE AND STRENGTHENING
6. SUSTENANCE AND STRENGTHENING
PHASE
PHASE

Classify the ff. CO activities as to
Classify the ff. CO activities as to
phase of COPAR each belong:
phase of COPAR each belong:
Þ
1.Conducts community meetings to draw up
1.Conducts community meetings to draw up
guidelines for the organization of CHO
guidelines for the organization of CHO
Þ
2. Trains BHWs
2. Trains BHWs
Þ
3. Sets up of linkages/network and referral systems
3. Sets up of linkages/network and referral systems
Þ
4. PIME of health services and or community devt.
4. PIME of health services and or community devt.
Projects
Projects
Þ
5. Provides continuing education to leaders or
5. Provides continuing education to leaders or
residents
residents
Þ
6. Trains secondary leaders
6. Trains secondary leaders
Þ
7. Selects site for adoption
7. Selects site for adoption
Þ
8. Identifies key leaders
8. Identifies key leaders

Continued….
Continued….
Þ
9. Develops criteria for site selection
9. Develops criteria for site selection
Þ
10. Forms the core group
10. Forms the core group
Þ
11.Conducts SALT
11.Conducts SALT
Þ
12.Selects members of the research team
12.Selects members of the research team
Þ
13. Assists the research team in presenting results
13. Assists the research team in presenting results
during the general assembly
during the general assembly
Þ
14. Helps the people identifying the community
14. Helps the people identifying the community
needs and health problems
needs and health problems
Þ
15. Facilitates for the formulation and ratification of
15. Facilitates for the formulation and ratification of
the constitution and by-laws of the organization
the constitution and by-laws of the organization

Public Health Programs
Public Health Programs

COMPREHENSIVE MATERNAL
COMPREHENSIVE MATERNAL
AND CHILD HEALTH PROGRAM
AND CHILD HEALTH PROGRAM
Þ
EPI (Expanded Program on
EPI (Expanded Program on
Immunization)
Immunization)
Þ
CDD (Control of Diarrheal Diseases)
CDD (Control of Diarrheal Diseases)
Þ
CARI (Control of Acute Respiratory
CARI (Control of Acute Respiratory
Infections)
Infections)
Þ
UFC (Under-Five Clinics)
UFC (Under-Five Clinics)
Þ
MC (Maternal Care)
MC (Maternal Care)

Þ
BF (Breastfeeding)
BF (Breastfeeding)
Þ
MRP (Malnutrition Rehabilitation
MRP (Malnutrition Rehabilitation
Program)
Program)
Þ
VAD ( Vitamin A Deficiency)
VAD ( Vitamin A Deficiency)
Þ
IDD/IDA (Iodine Deficiency
IDD/IDA (Iodine Deficiency
Disorders/ Iron Deficiency Anemia)
Disorders/ Iron Deficiency Anemia)
Þ
FP (Family Planning)
FP (Family Planning)

EPI (EXPANDED PROGRAM ON
EPI (EXPANDED PROGRAM ON
IMMUNIZATION)
IMMUNIZATION)
Þ
TARGET SETTING:
TARGET SETTING:
Þ
INFANTS 0-12 MONTHS
INFANTS 0-12 MONTHS
Þ
PREGNANT AND POST PARTUM WOMEN
PREGNANT AND POST PARTUM WOMEN
Þ
SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS
SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS
OLD
OLD

Þ
OBJECTIVES OF EPI:
OBJECTIVES OF EPI:
TO REDUCE MORBIDITY AND
TO REDUCE MORBIDITY AND
MORTALITY RATES AMONG INFANTS AND
MORTALITY RATES AMONG INFANTS AND
CHILDREN from SIX CHILDHOOD
CHILDREN from SIX CHILDHOOD
IMMUNIZABLE DISEASE
IMMUNIZABLE DISEASE

Þ
ELEMENTS OF EPI:
ELEMENTS OF EPI:
Þ
TARGET SETTING
TARGET SETTING
Þ
COLDCHAIN LOGISTIC MANAGEMENT-
COLDCHAIN LOGISTIC MANAGEMENT-
Vaccine distribution through cold chain is
Vaccine distribution through cold chain is
designed to ensure that the vaccine were
designed to ensure that the vaccine were
maintained under proper environmental
maintained under proper environmental
condition until the time of administration.
condition until the time of administration.
Þ
IEC
IEC
Þ
Assessment and evaluation of Over-all
Assessment and evaluation of Over-all
performance of the program
performance of the program
Þ
Surveillance and research studies
Surveillance and research studies

EXPANDED PROGRAM ON IMMUNIZATION
EXPANDED PROGRAM ON IMMUNIZATION
BCG is given
at the earliest
possible age
protects against
the possibility
of TB infection
from the other
family
members
1 Birth or
anytime
after
birth
School
entrants
¤
BCG
(Bacillus
Calmette
Guerin)
Reason Minimum
Interval
Between
Doses
Number
of Doses
Minimum
Age of 1
st

Dose
Vaccine

An early start of
Hepatitis B reduces the
chance of being infected
and becoming a carrier.
4 weeks
3
6 weeks
4. Hepatitis
B
An early start with
DPT reduces the
chance of severe
pertussis
4 weeks
3
6 weeks
2. DPT
(Diphtheria
Pertusis
Tetanus)
At least 85% of measles
can be prevented by
immunization at this age.
1
9 months
5. Measles
The extent of
protection against
polio is increased the
earlier OPV is given.
4 weeks
3
6 weeks
3. OPV
(Oral Polio
Vaccine)

CDD (CONTROL OF DIARRHEAL DISEASES)
CDD (CONTROL OF DIARRHEAL DISEASES)
MANAGEMENT OF THE PATIENT WITH
MANAGEMENT OF THE PATIENT WITH
DIARRHEA
DIARRHEA
A. NO DEHYDRATION
A. NO DEHYDRATION
Þ
Condition – well, alert
Condition – well, alert
Þ
Mouth and Tongue – moist
Mouth and Tongue – moist
Þ
Eyes – normal
Eyes – normal
Þ
Thirst – drinks normally, not thirsty
Thirst – drinks normally, not thirsty
Þ
Tears – present
Tears – present
Þ
Skin pinch – goes back quickly
Skin pinch – goes back quickly
Þ
TREATMENT PLAN A- HOME TTT.
TREATMENT PLAN A- HOME TTT.

1.Give the child more fluids than usual
1.Give the child more fluids than usual




use home fluid such as cereal gruel
use home fluid such as cereal gruel


give ORESOL, plain water
give ORESOL, plain water
THREE RULES FOR HOME
THREE RULES FOR HOME
TREATMENT
TREATMENT

2. Give the child plenty of food to prevent
2. Give the child plenty of food to prevent
undernutrition
undernutrition




continue to breastfeed frequently
continue to breastfeed frequently




if child is not breastfeed, give usual milk
if child is not breastfeed, give usual milk




if child is less than 6 months and not yet taking
if child is less than 6 months and not yet taking
solid food, dilute milk for 2 days
solid food, dilute milk for 2 days




if child is 6 months or older and already taking
if child is 6 months or older and already taking
solid food, give cereal or other starchy food mixed
solid food, give cereal or other starchy food mixed
with vegetables, meat or fish; give fresh fruit juice
with vegetables, meat or fish; give fresh fruit juice
or mashed banana to provide potassium; feed child
or mashed banana to provide potassium; feed child
at least 6 times a day. After diarrhea stops, give an
at least 6 times a day. After diarrhea stops, give an
extra meal each day for two weeks.
extra meal each day for two weeks.

3.
3.
Take the child to the health worker if
Take the child to the health worker if
the child does not get better in 3 days or
the child does not get better in 3 days or
develops any of the following
develops any of the following
:
:




many watery stools
many watery stools




repeated vomiting
repeated vomiting




marked thirst
marked thirst




eating or drinking poorly
eating or drinking poorly




fever
fever




blood in the stool
blood in the stool

ORESOL TREATMENT
ORESOL TREATMENT
As much as
wanted
100-200 ml.
50-100 ml.
Amount of ORS
to give after
each loose stool
1000 ml./day 2 –
10 years
Amount of ORS to
provide for use at
home
Age
2000 ml./day 10
years up
500 ml./day < 24
months

B. SOME DEHYDRATION
B. SOME DEHYDRATION
Þ
Condition – restless, irritable
Condition – restless, irritable
Þ
Mouth and Tongue – dry
Mouth and Tongue – dry
Þ
Eyes – sunken
Eyes – sunken
Þ
Thirst – thirsty, drinks eagerly
Thirst – thirsty, drinks eagerly
Þ
Tears – absent
Tears – absent
Þ
Skin pinch – goes back slowly
Skin pinch – goes back slowly
Þ
WEIGH PT, TTT. PLAN B
WEIGH PT, TTT. PLAN B

APPROX. AMT. OF ORS- TO GIVE IN 1
APPROX. AMT. OF ORS- TO GIVE IN 1
ST ST
4
4
HRS
HRS
1200-2200 16-29.9 5-14YRS
2200-4000 30 UP 15 YRS UP
800-1200 11-15.9 2-4YRS
600-800 8-10.9 12-23MOS
400-600 5-7.9 4-11MOS
200-400 5 4 MOS.
ORS
ML
WEIGHT
KG
AGE

1. 1.
If the child wants more ORS than shown, give more
If the child wants more ORS than shown, give more
2. 2.
Continue breastfeeding
Continue breastfeeding
3. 3.
For infants below 6 mos. who are not breastfeed, give
For infants below 6 mos. who are not breastfeed, give
100-200 ml clean water during the period
100-200 ml clean water during the period
4. 4.
For a child less than 2 years give a teaspoonful every 1-2
For a child less than 2 years give a teaspoonful every 1-2
min.
min.
5. 5.
If the child vomits, wait for 10 min, then continue giving
If the child vomits, wait for 10 min, then continue giving
ORS, 1 tbsp/2-3 min
ORS, 1 tbsp/2-3 min
6. 6.
If the child’s eyelids become puffy, stop ORS , give plain
If the child’s eyelids become puffy, stop ORS , give plain
water or breast milk, Resume ORS when puffiness is gone
water or breast milk, Resume ORS when puffiness is gone
7. 7.
If ( -) signs of DHN- shift to Plan A
If ( -) signs of DHN- shift to Plan A

Use of Drugs during Diarrhea
Use of Drugs during Diarrhea
Antibiotics should only be used for
Antibiotics should only be used for
dysentery and suspected cholera
dysentery and suspected cholera
Antiparasitic drugs should only be used
Antiparasitic drugs should only be used
for amoebiasis and giardiasis
for amoebiasis and giardiasis

C. SEVERE DEHYDRATION
C. SEVERE DEHYDRATION
Condition – lethargic or unconscious; floppy
Condition – lethargic or unconscious; floppy
Eyes – very sunken and dry
Eyes – very sunken and dry
Tears – absent
Tears – absent
Mouth and tongue – very dry
Mouth and tongue – very dry
Thirst- drinks poorly or not able to drink
Thirst- drinks poorly or not able to drink
Skin pinch – goes back very slowly
Skin pinch – goes back very slowly
TTT PLAN C- ttt. quickly
TTT PLAN C- ttt. quickly
1.Bring pt. to hospital
1.Bring pt. to hospital
2. IVF – Lactated Ringers Solution or Normal Saline
2. IVF – Lactated Ringers Solution or Normal Saline
3.Re-assess pt. Every 1-2 hrs
3.Re-assess pt. Every 1-2 hrs
4. Give ORS as soon as the pt. can drink
4. Give ORS as soon as the pt. can drink

ROLE OF BREASTFEEDING IN THE
ROLE OF BREASTFEEDING IN THE
CONTROL OF DIARRHEAL DISEASES
CONTROL OF DIARRHEAL DISEASES
PROGRAM
PROGRAM
1. 1.
Two problems in CDD
Two problems in CDD
Þ
1. High child mortality due to
1. High child mortality due to
diarrhea
diarrhea
Þ
2. High diarrhea incidence among
2. High diarrhea incidence among
under fives
under fives

>
Highest incidence in age 6 – 23 months
Highest incidence in age 6 – 23 months
>
Highest mortality in the first 2 years of life
Highest mortality in the first 2 years of life
>
Main causes of death in diarrhea :
Main causes of death in diarrhea :
Þ
DEHYDRATION
DEHYDRATION
Þ
MALNUTRITION
MALNUTRITION

1. 1.
To prevent dehydration, give home fluids
To prevent dehydration, give home fluids
“am” as soon as diarrhea starts and if
“am” as soon as diarrhea starts and if
dehydration is present, rehydrate early,
dehydration is present, rehydrate early,
correctly and effectively by giving ORS
correctly and effectively by giving ORS
3. 3.
For undernutrition, continue feeding during
For undernutrition, continue feeding during
diarrhea especially breastfeeding.
diarrhea especially breastfeeding.

>
Interventions to prevent diarrhea
Interventions to prevent diarrhea
1. breastfeeding
1. breastfeeding
2. improved weaning practices
2. improved weaning practices
3. use of plenty of clean water
3. use of plenty of clean water
4
4
.
.
hand washing
hand washing
5. use of latrines
5. use of latrines
6.
6.
proper disposal of stools of
proper disposal of stools of
small children
small children
7. measles immunization
7. measles immunization

1. 1.
Risk of severe diarrhea 10-30x higher in
Risk of severe diarrhea 10-30x higher in
bottle fed infants than in breastfed infants.
bottle fed infants than in breastfed infants.
2. 2.
Advantages of breastfeeding in relation to
Advantages of breastfeeding in relation to
CDD
CDD
1.Breast milk is sterile
1.Breast milk is sterile
2.Presence of antibodies protection against
2.Presence of antibodies protection against
diarrhea
diarrhea
3.Intestinal Flora in BF infants prevents
3.Intestinal Flora in BF infants prevents
growth of diarrhea causing bacteria.
growth of diarrhea causing bacteria.

1. 1.
Breastfeeding decreases incidence rate by
Breastfeeding decreases incidence rate by
8-20% and mortality by 24-27% in
8-20% and mortality by 24-27% in
infants under 6 months of age.
infants under 6 months of age.
2. 2.
When to wean?
When to wean?
4-6 months – soft mashed foods 2x a day
4-6 months – soft mashed foods 2x a day
6 months – variety of foods 4x a day
6 months – variety of foods 4x a day

1. 1.
Summary of WHO-CDD recommended strategies
Summary of WHO-CDD recommended strategies
to prevent diarrhea
to prevent diarrhea
1. Improved Nutrition
1. Improved Nutrition
- exclusive breastfeeding for the first 4-6 months of
- exclusive breastfeeding for the first 4-6 months of
life and partially for at least one year.
life and partially for at least one year.
- Improved weaning practices
- Improved weaning practices
2.Use of safe water
2.Use of safe water
- collecting plenty of water from the cleanest source
- collecting plenty of water from the cleanest source
- protecting water from contamination at the source
- protecting water from contamination at the source
and in the home
and in the home

3.Good personal and domestic hygiene
3.Good personal and domestic hygiene
- handwashing
- handwashing
- use of latrines
- use of latrines
- proper disposal of stools of young children
- proper disposal of stools of young children
4.Measles immunization
4.Measles immunization

CARI (CONTROL OF ACUTE RESPIRATORY
CARI (CONTROL OF ACUTE RESPIRATORY
INFECTIONS)
INFECTIONS)
CLASSIFICATION:
CLASSIFICATION:
A.
A.


NO PNEUMONIA: COUGH OR COLD
NO PNEUMONIA: COUGH OR COLD
1.
1.


No chest in drawing
No chest in drawing
2.
2.


No fast breathing ( <2 mos- <60/min,2-12
No fast breathing ( <2 mos- <60/min,2-12
mos. – less than 50 per minute; 12 mos. – 5
mos. – less than 50 per minute; 12 mos. – 5
years – less than 40 per minute)
years – less than 40 per minute)
TREATMENT:
TREATMENT:
1.
1.
If coughing more than 30 days, refer for
If coughing more than 30 days, refer for
assessment
assessment
2.
2.
Assess and treat ear problems/sore throat if
Assess and treat ear problems/sore throat if
present
present
3.
3.
Advise mother to give home care
Advise mother to give home care
4.Treat fever/wheezing if present
4.Treat fever/wheezing if present

HOME CARE:
HOME CARE:
1.
1.
FEED THE CHILD
FEED THE CHILD
3. 3.
Feed the child during illness
Feed the child during illness
4. 4.
Increase feeding after illness
Increase feeding after illness
5. 5.
Clear the nose if it interferes with feeding
Clear the nose if it interferes with feeding

2.
2.
INCREASE FLUIDS
INCREASE FLUIDS
2. 2.
offer the child extra to drink
offer the child extra to drink
3. 3.
Increase breastfeeding
Increase breastfeeding
3.
3.
SOOTHE THE THROAT AND
SOOTHE THE THROAT AND
RELIEVE THE COUGH WITH A
RELIEVE THE COUGH WITH A
SAFE REMEDY
SAFE REMEDY

4.
4.
WATCH FOR THE FOLLOWING
WATCH FOR THE FOLLOWING
SIGNS AND SYMPTOMS AND
SIGNS AND SYMPTOMS AND
RETURN QUICKLY IF THEY
RETURN QUICKLY IF THEY
OCCUR
OCCUR
2. 2.
Breathing becomes difficult
Breathing becomes difficult
3. 3.
Breathing becomes fast
Breathing becomes fast
4. 4.
Child is not able to drink
Child is not able to drink
5. 5.
Child becomes sicker
Child becomes sicker

B.
B.


PNEUMONIA
PNEUMONIA
1. No chest in drawing
1. No chest in drawing
2. Fast breathing ( less than 2 mos- 60/min
2. Fast breathing ( less than 2 mos- 60/min
or more ; 2-12 mos. – 50/min or more; 12
or more ; 2-12 mos. – 50/min or more; 12
mos. – 5 years – 40/min or more)
mos. – 5 years – 40/min or more)
TREATMENT
TREATMENT
1.Advise mother to give home care
1.Advise mother to give home care
2.Give an antibiotic
2.Give an antibiotic
3.Treat fever/wheezing if present
3.Treat fever/wheezing if present
4.If the child’s condition gets worst,refer
4.If the child’s condition gets worst,refer
urgently to hospital; if improving, finish 5 days
urgently to hospital; if improving, finish 5 days
of antibiotic.
of antibiotic.

ANTIBIOTICS RECOMMENDED BY
ANTIBIOTICS RECOMMENDED BY
WHO
WHO
*Co-trimoxazole,
*Co-trimoxazole,
*Amoxycillin, Ampicillin, (p.o)
*Amoxycillin, Ampicillin, (p.o)
*or Procaine penicillin (I.M.)
*or Procaine penicillin (I.M.)

C. Severe Pneumonia
C. Severe Pneumonia
Þ
Chest indrawing
Chest indrawing
Þ
Nasal flaring
Nasal flaring
Þ
Grunting ( short sounds made with the voice)
Grunting ( short sounds made with the voice)
Þ
Cyanosis
Cyanosis
TTT.
TTT.
6. 6.
Refer urgently to hospital
Refer urgently to hospital
7. 7.
Treat fever ( paracetamol), wheezing
Treat fever ( paracetamol), wheezing
( salbutamol)
( salbutamol)

D. Very Severe Disease
D. Very Severe Disease
Þ
Not able to drink
Not able to drink
Þ
Convulsions
Convulsions
Þ
Abnormally sleepy or difficult to wake
Abnormally sleepy or difficult to wake
Þ
Stridor in calm child
Stridor in calm child
Þ
Severe undernutrition
Severe undernutrition
TTT.
TTT.
Refer urgently to hospital
Refer urgently to hospital

ASSESSMENT OF RESPIRATORY
ASSESSMENT OF RESPIRATORY
INFECTION
INFECTION

ASK THE MOTHER:
ASK THE MOTHER:
2. 2.
How old is the child?
How old is the child?
3. 3.
Is the child coughing? For how long?
Is the child coughing? For how long?
4. 4.
Age 2 months up to 5 years: Is the child able
Age 2 months up to 5 years: Is the child able
to drink?
to drink?
Age less than 2 months: Has the young infant
Age less than 2 months: Has the young infant
stopped feeding well?
stopped feeding well?
6. 6.
Has the child had fever? For how long?
Has the child had fever? For how long?
7. 7.
Has the child had convulsions?
Has the child had convulsions?

Þ
LOOK, LISTEN:
LOOK, LISTEN:
1.
1.


Count the breaths in one minute.
Count the breaths in one minute.
2.
2.
Look for chest in drawing.
Look for chest in drawing.
3.
3.
Look and listen for stridor.
Look and listen for stridor.
Stridor occurs when there is a narrowing of the
Stridor occurs when there is a narrowing of the
larynx, trachea or epiglottis which interferes
larynx, trachea or epiglottis which interferes
with air entering the lungs.
with air entering the lungs.
40/minute or more
50/minute or more
60/minute or more
Fast Breathing
2 months – 12 months
Age0
12 months – 5 years
Less than 2 months

4.
4.
Look and listen for wheeze
Look and listen for wheeze
Wheeze is a soft musical noise
Wheeze is a soft musical noise
which shows signs that breathing
which shows signs that breathing
out(exhale) is difficult.
out(exhale) is difficult.
5.
5.
See if the child is abnormally sleepy
See if the child is abnormally sleepy
or difficult to wake. (Suspect
or difficult to wake. (Suspect
meningitis)
meningitis)
6.
6.
Feel for fever or low body
Feel for fever or low body
temperature.
temperature.
7.
7.
Check for severe under nutrition
Check for severe under nutrition

MANAGEMENT OF A CHILD
MANAGEMENT OF A CHILD
WITH AN EAR PROBLEM
WITH AN EAR PROBLEM
Classification of Ear Infection
Classification of Ear Infection
A. MASTOIDITIS
A. MASTOIDITIS
– tender swelling behind the ear
– tender swelling behind the ear
(in infants, swelling may be above the ear)
(in infants, swelling may be above the ear)
TREATMENT
TREATMENT
1. Antibiotics
1. Antibiotics
2.Surgical intervention
2.Surgical intervention

B. ACUTE EAR INFECTION
B. ACUTE EAR INFECTION
– pus draining
– pus draining
from the ear for less than 2 weeks, ear pain,
from the ear for less than 2 weeks, ear pain,
red, immobile ear drum (Acute Otitis Media)
red, immobile ear drum (Acute Otitis Media)
TREATMENT
TREATMENT
1.Cotrimoxazole,Amoxycillin,or Ampicillin
1.Cotrimoxazole,Amoxycillin,or Ampicillin
2.Dry the ear by wicking
2.Dry the ear by wicking

C. CHRONIC EAR INFECTION
C. CHRONIC EAR INFECTION
– pus draining from the
– pus draining from the
ear for more than 2 weeks (Chronic Otitis Media)
ear for more than 2 weeks (Chronic Otitis Media)
TREATMENT
TREATMENT
Most important & effective treatment:
Most important & effective treatment:
Keep the ear dry
Keep the ear dry
by wicking.
by wicking.
>
Paracetamol maybe given for pain or high fever.
Paracetamol maybe given for pain or high fever.
>
Precautions for a child with a draining ear:
Precautions for a child with a draining ear:
Þ
Do not leave anything in the ear such as cotton, wool
Do not leave anything in the ear such as cotton, wool
between wicking treatments.
between wicking treatments.
Þ
Do not put oil or any other fluid into the ear.
Do not put oil or any other fluid into the ear.
Þ
Do not let the child go swimming or get water in the
Do not let the child go swimming or get water in the
ear.
ear.

Maternal and Child Health Nursing
Maternal and Child Health Nursing
Philosophy
Philosophy
Þ
Pregnancy, labor and delivery and puerperium
Pregnancy, labor and delivery and puerperium
are part of the continuum of the total life cycle
are part of the continuum of the total life cycle
Þ
Personal, cultural and religious attitudes and
Personal, cultural and religious attitudes and
beliefs influence the meaning of pregnancy for
beliefs influence the meaning of pregnancy for
individuals and make each experience unique
individuals and make each experience unique
Þ
MCN is FAMILY CENTERED- the father
MCN is FAMILY CENTERED- the father
is as important as the mother
is as important as the mother

Þ
Goals
Goals
Þ
To ensure that expectant mother and nursing
To ensure that expectant mother and nursing
mother maintain good health, learn the art of
mother maintain good health, learn the art of
child care, has a normal delivery and bear
child care, has a normal delivery and bear
healthy children
healthy children
Þ
That every child lives and grows up in a family
That every child lives and grows up in a family
unit with love and security, in healthy
unit with love and security, in healthy
surroundings, receives adequate nourishment,
surroundings, receives adequate nourishment,
health supervision and efficient medical attention
health supervision and efficient medical attention
and is taught the elements of healthy living
and is taught the elements of healthy living

Classification of pregnant
Classification of pregnant
women
women
Þ
Normal – healthy pregnancy
Normal – healthy pregnancy
Þ
With mild complications- frequent home visits
With mild complications- frequent home visits
Þ
With serious or potentially serious cx –
With serious or potentially serious cx –
referred to most skilled source of medical and
referred to most skilled source of medical and
hospital care
hospital care

Home Based Mother’s Record
Home Based Mother’s Record
( HBMR )
( HBMR )
Þ
Tool used when rendering prenatal care
Tool used when rendering prenatal care
containing risk factors and danger signs
containing risk factors and danger signs

*Risk Factors
*Risk Factors
Þ
145 cm tall ( 4 ft & 9 inches)
145 cm tall ( 4 ft & 9 inches)
Þ
Below 18 yrs old, above 35 yrs old
Below 18 yrs old, above 35 yrs old
Þ
Have had 4 pregnancies
Have had 4 pregnancies
Þ
With TB, goiter, heart disease, DM, bronchial
With TB, goiter, heart disease, DM, bronchial
asthma, severe anemia
asthma, severe anemia
Þ
Last baby born was less than 2 years ago
Last baby born was less than 2 years ago
Þ
Previous cesarian section delivery
Previous cesarian section delivery
Þ
History of 2 or more abortions, difficult delivery,
History of 2 or more abortions, difficult delivery,
given birth to twins , 2 or more babies born before
given birth to twins , 2 or more babies born before
EDD, stillbirth
EDD, stillbirth
Þ
Weighs less than 45 kgs. or more than 80 kgs.
Weighs less than 45 kgs. or more than 80 kgs.

*Danger Signs
*Danger Signs
Þ
1. any type of vaginal bleeding
1. any type of vaginal bleeding
Þ
2. headache, dizziness, blurred vision
2. headache, dizziness, blurred vision
Þ
3. puffiness of face and hands
3. puffiness of face and hands
Þ
4. pallor
4. pallor

Prenatal Care
Prenatal Care
Þ
Schedule of Visits
Schedule of Visits
Þ
1
1
st st
– as early as pregnancy, 1
– as early as pregnancy, 1
st st
trimester
trimester
Þ
2
2
nd nd
- 2
- 2
nd nd
trimester
trimester
Þ
3
3
rd rd
& subsequent visits - 3
& subsequent visits - 3
rd rd
trimester
trimester
Þ
More frequent visits for those at risk with cx
More frequent visits for those at risk with cx

TETANUS TOXOID IMMUNIZATION SCHEDULE
TETANUS TOXOID IMMUNIZATION SCHEDULE
FOR WOMEN
FOR WOMEN

80%
Percent
Protected
As early as possible
during pregnancy
Minimum Age
Interval

Duration of
Protection
Vaccine

TT1

Infants born to the
mother will be
protected
from neonatal
tetanus.
Gives 3 years
protection for
the mother from
tetanus.
80%
At least 4
weeks later
TT2

Infants born to the mother
will be protected
from neonatal
tetanus.
Gives 5 years protection
for the mother.

90%
At least 6
months later

TT3

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

99% At least 1 year
later
Gives lifetime
protection for
the mother.
All infants
born to that
mother
will be
protected.
TT5
Dose:0.5ml
Dose:0.5ml
Route: Intramuscularly
Route: Intramuscularly
Site: Right or Left Deltoid/Buttocks
Site: Right or Left Deltoid/Buttocks

Components of Prenatal Visits
Components of Prenatal Visits
Þ
History – taking
History – taking
Þ
Determination of obstetrical score- G, P,
Determination of obstetrical score- G, P,
TPAL,AOG,EDD
TPAL,AOG,EDD
Þ
U/A for Proteinuria, glycosuria and infxtn
U/A for Proteinuria, glycosuria and infxtn
Þ
Dental exam
Dental exam
Þ
Wt. Ht. BP taking
Wt. Ht. BP taking
Þ
Exam of conjunctiva and palms for pallor
Exam of conjunctiva and palms for pallor
Þ
Abdominal exam - fundic ht, Leopold’s
Abdominal exam - fundic ht, Leopold’s
maneuver and FHT
maneuver and FHT

Þ
Exam of breasts, face, hands and feet for edema and
Exam of breasts, face, hands and feet for edema and
neck for thyroid enlargement
neck for thyroid enlargement
Þ
Health teachings- nutrition, personal hygiene,
Health teachings- nutrition, personal hygiene,
common complaints
common complaints
Þ
Tetanus toxoid immunization
Tetanus toxoid immunization
Þ
Iron supplementation – from 5
Iron supplementation – from 5
th th
mo. of pregnancy -
mo. of pregnancy -
2 mos. Postpartum
2 mos. Postpartum
Þ
In goiter endemic areas – iodized capsule once a
In goiter endemic areas – iodized capsule once a
year
year
Þ
In malaria infested areas- prophylactic Chloroquine
In malaria infested areas- prophylactic Chloroquine
( 150 mg/tab ) 2 tabs/ wk for the whole duration of
( 150 mg/tab ) 2 tabs/ wk for the whole duration of
pregnancy
pregnancy

Þ
UNDER FIVE CLINIC
UNDER FIVE CLINIC

The first five years of life form the foundations
The first five years of life form the foundations
of the child’s physical and mental growth and
of the child’s physical and mental growth and
development. Studies have shown the mortality and
development. Studies have shown the mortality and
morbidity are high among this age group. The
morbidity are high among this age group. The
Department of Health established the Under Five
Department of Health established the Under Five
Clinic Program to address this
Clinic Program to address this
problem.
problem.



Þ
PROGRAM OBJECTIVES AND GOALS:
PROGRAM OBJECTIVES AND GOALS:


Monitor growth and development of the child
Monitor growth and development of the child
until 5 years of age.
until 5 years of age.


Identify factors that may hinder the growth and
Identify factors that may hinder the growth and
development of the child.
development of the child.

Þ
ACTIVITIES AND STRATEGIES:
ACTIVITIES AND STRATEGIES:
1. 1.
Regular height and weight determination/ monitoring
Regular height and weight determination/ monitoring
until 5 years old.
until 5 years old.
0-1 year old=monthly
0-1 year old=monthly


1 year old and above =quarterly
1 year old and above =quarterly
2. Recording of immunization, vitamins supplementation,
2. Recording of immunization, vitamins supplementation,


deworming and feeding.
deworming and feeding.
3. Provision of IEC materials (ex. Posters, charts, toys)
3. Provision of IEC materials (ex. Posters, charts, toys)
that promote and enhance child’s proper growth and
that promote and enhance child’s proper growth and
development.
development.
4. Provision of a safe and learning – oriented environment
4. Provision of a safe and learning – oriented environment
for the child.
for the child.
5. Monitoring and Evaluation.
5. Monitoring and Evaluation.

Þ
BREASTFEEDING/ LACTATION MANAGEMENT
BREASTFEEDING/ LACTATION MANAGEMENT
EDUCATION TRAINING
EDUCATION TRAINING
Breastfeeding practices has been proved to be very
Breastfeeding practices has been proved to be very
beneficial to both mother and baby thus the creation of
beneficial to both mother and baby thus the creation of
the following laws support the full implementation of
the following laws support the full implementation of
this program:
this program:
Executive Order 51
Executive Order 51
Republic Act 7600
Republic Act 7600
The Rooming-In and Breastfeeding Act of 1992
The Rooming-In and Breastfeeding Act of 1992

Þ
PROGRAM OBJECTIVES AND GOALS:
PROGRAM OBJECTIVES AND GOALS:
=Protection and promotion of breastfeeding
=Protection and promotion of breastfeeding
and lactation management education
and lactation management education
training
training

ACTIVITIES AND STRATEGIES:
ACTIVITIES AND STRATEGIES:
1.FULL IMPLEMENTATION OF LAWS
1.FULL IMPLEMENTATION OF LAWS


SUPPORTING THE PROGRAM
SUPPORTING THE PROGRAM
A.
A.
EO 51 THE MILK CODE – protection and
EO 51 THE MILK CODE – protection and
promotion of breastfeeding to ensure the safe and
promotion of breastfeeding to ensure the safe and
adequate nutrition of infants through regulation of
adequate nutrition of infants through regulation of
marketing of infant foods and related products.
marketing of infant foods and related products.
(e.g. breast milk substitutes, infant formulas,
(e.g. breast milk substitutes, infant formulas,
feeding bottles, teats etc. )
feeding bottles, teats etc. )

B.
B.
RA 7600 THE ROOMING –IN and
RA 7600 THE ROOMING –IN and
BREASTFEEDING ACT of 1992
BREASTFEEDING ACT of 1992
=An act providing incentives to government and
=An act providing incentives to government and
private health institutions promoting and
private health institutions promoting and
practicing rooming-in and breast-feeding.
practicing rooming-in and breast-feeding.
=Provision for human milk bank.
=Provision for human milk bank.
=Information, education and re-education drive
=Information, education and re-education drive
=Sanction and Regulation
=Sanction and Regulation

2. CONDUCT ORIENTATION/ADVOCACY
2. CONDUCT ORIENTATION/ADVOCACY
MEETINGS TO HOSPITAL/ COMMUNITY.
MEETINGS TO HOSPITAL/ COMMUNITY.
ADVANTAGES OF BREASTFEEDING:
ADVANTAGES OF BREASTFEEDING:

MOTHER
MOTHER
Þ




Oxytocin help the uterus contracts
Oxytocin help the uterus contracts
Þ




Uterine involution
Uterine involution
Þ




Reduce incidence of Breast Cancer
Reduce incidence of Breast Cancer
Þ




Promote Maternal-Infant Bonding
Promote Maternal-Infant Bonding
Þ




Form of Family planning Method (Lactational
Form of Family planning Method (Lactational
Amenorrhea)
Amenorrhea)

BABY
BABY
Þ




Provides Antibodies
Provides Antibodies
Þ




Contains Lactoferin (binds with Iron)
Contains Lactoferin (binds with Iron)
Þ




Leukocytes
Leukocytes
Þ




Contains Bifidus factor-promotes
Contains Bifidus factor-promotes
growth of the Lactobacillus-inhibits the
growth of the Lactobacillus-inhibits the
growth of pathogenic bacilli
growth of pathogenic bacilli

Þ
POSITIONS IN BF THE BABY: POSITIONS IN BF THE BABY:
Þ
1. Cradle Hold = head and neck are supported 1. Cradle Hold = head and neck are supported
Þ
2. Football Hold 2. Football Hold
Þ
3. Side Lying Position 3. Side Lying Position
BEST FOR BABIES BEST FOR BABIES
REDUCE INCIDENCE OF ALLERGENS REDUCE INCIDENCE OF ALLERGENS
ECONOMICAL ECONOMICAL
ANTIBODIES PRESENT ANTIBODIES PRESENT
STOOL INOFFENSIVE (GOLDEN YELLOW) STOOL INOFFENSIVE (GOLDEN YELLOW)
EMPERATURE ALWAYS IDEAL EMPERATURE ALWAYS IDEAL
FRESH MILK NEVER GOES OFF FRESH MILK NEVER GOES OFF
EMOTIONALLY BONDING EMOTIONALLY BONDING
EASY ONCE ESTABLISHED EASY ONCE ESTABLISHED
DIGESTED EASILY DIGESTED EASILY
IMMEDIATELY AVAILABLE IMMEDIATELY AVAILABLE
NUTRITIONALLY OPTIMAL NUTRITIONALLY OPTIMAL
GASTROENTERITIS GREATLY REDUCED GASTROENTERITIS GREATLY REDUCED

Þ
GARANTISADONG PAMBATA (GP)
GARANTISADONG PAMBATA (GP)
Garantisadong Pambata is a biannual week long
Garantisadong Pambata is a biannual week long
delivery of a package of health services to children between
delivery of a package of health services to children between
the ages of 0-59 months old with the purpose of reducing
the ages of 0-59 months old with the purpose of reducing
morbidity and mortality among under fives through the
morbidity and mortality among under fives through the
promotion of positive Filipino values for proper child
promotion of positive Filipino values for proper child
growth and development.
growth and development.

1. WHAT ARE THE HEALTH SERVICES OFFERED
1. WHAT ARE THE HEALTH SERVICES OFFERED
IN GP AND WHO ARE THE TARGETS?
IN GP AND WHO ARE THE TARGETS?
GP offers the following:
GP offers the following:
1.1 Routine Health Services:
1.1 Routine Health Services:

12-59
months old,
nationwide
9-12 month
old infants
receiving
AMV
nationwide
Orally by
drops
200,000 IU
or 1 capsule
100,000 IU
or ½ cap or 3
drops
Vitamin A
capsule
Target
Population
Route of
Administra
tion
Dosage Health
Service

2-11 months old
infants in Mindanao
area, including
evacuation centers
in armed conflict
areas.
Orally
by drops
0.3ml(2-6
mos)
once a day

0.6ml(6-
11mos) once a
day
Ferrous
Sulfate
(25 mg.
Elemental
Iron per ml;
30 ml. Bottle
as taken
home
medicine with
instructions)

Nationwide

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

0-59 mos,
nationwide
Weighing
36-59 mos,
nationwide

Orally
1 tablet
as single
dose
Dewormin
g drug
(if
available)

Þ
* The child should not have received
* The child should not have received
megadose of Vit. A above the recommended
megadose of Vit. A above the recommended
dosage within the past 4 weeks except if the
dosage within the past 4 weeks except if the
child has measles or signs and symptoms of
child has measles or signs and symptoms of
Vit A. deficiency.
Vit A. deficiency.
Þ
** For any child between 12-23 months, who
** For any child between 12-23 months, who
missed any of his routine immunization, the
missed any of his routine immunization, the
health worker should give the child the
health worker should give the child the
necessary antigen to complete FIC and shall be
necessary antigen to complete FIC and shall be
recorded as such.
recorded as such.

GARANTISADONG PAMBATA
GARANTISADONG PAMBATA
Sangkap Pinoy
Sangkap Pinoy
-
-
Vitamin A, Iron and Iodine
Vitamin A, Iron and Iodine
-Sources: green leafy and yellow vegetables,
-Sources: green leafy and yellow vegetables,
fruits, liver, seafoods, iodized salt, pan de
fruits, liver, seafoods, iodized salt, pan de
bida and other fortified foods.
bida and other fortified foods.
These micronutrients are not produced by
These micronutrients are not produced by
the body, and must be taken in the food we
the body, and must be taken in the food we
eat; essential in the normal process of growth
eat; essential in the normal process of growth
and development:
and development:

a) a)
Helps the body to regulate itself
Helps the body to regulate itself
b) b)
Necessary in energy metabolism
Necessary in energy metabolism
c) c)
Vital in brain cell formation and mental development
Vital in brain cell formation and mental development
d) d)
Necessary in the body immune system to protect the
Necessary in the body immune system to protect the
body from severe infection.
body from severe infection.

e) e)
Eating Sangkap Pinoy-rich foods can prevent and
Eating Sangkap Pinoy-rich foods can prevent and
control:
control:
1. 1.
Protein Energy Malnutrition
Protein Energy Malnutrition
2. 2.
Vitamin A Deficiency
Vitamin A Deficiency
3. 3.
Iron Deficiency
Iron Deficiency
Anemia
Anemia

4. 4.
Iodine Deficiency Disorder
Iodine Deficiency Disorder

Þ
BREASTFEEDING
BREASTFEEDING
Breast milk is best for babies up to 2 years
Breast milk is best for babies up to 2 years
old. Exclusive breastfeeding is recommended
old. Exclusive breastfeeding is recommended
for the first six months of life. At about
for the first six months of life. At about
six
six

months, give carefully selected nutritious
months, give carefully selected nutritious
foods as supplements.
foods as supplements.
Breastfeeding provides physical and
Breastfeeding provides physical and
psychological benefits for children and
psychological benefits for children and
mothers as well as economic benefits for
mothers as well as economic benefits for
families and societies
families and societies
.
.

BENEFITS :
BENEFITS :
For infants
For infants
c. c.
Provides a nutritional complete food for the
Provides a nutritional complete food for the
young infant.
young infant.
d. d.
Strengthens the infant’s immune system,
Strengthens the infant’s immune system,
preventing many infections.
preventing many infections.
e. e.
Safely rehydrates and provides essential
Safely rehydrates and provides essential
nutrients to a sick child, especially to those
nutrients to a sick child, especially to those
suffering from diarrheal diseases.
suffering from diarrheal diseases.
f. f.
Reduces the infant’s exposure to infection.
Reduces the infant’s exposure to infection.

Þ
For the Mother
For the Mother
a. a.
Reduces a woman’s risk of excessive blood loss
Reduces a woman’s risk of excessive blood loss
after birth
after birth
b. b.
Provides a natural method of delaying
Provides a natural method of delaying
pregnancies.
pregnancies.
c. c.
Reduces the risk of ovarian and breast cancers and
Reduces the risk of ovarian and breast cancers and
osteoporosis.
osteoporosis.
Þ
For the Family and Community
For the Family and Community
d. d.
Conserves funds that otherwise would be spent on
Conserves funds that otherwise would be spent on
breast milk substitute, supplies and fuel to prepare
breast milk substitute, supplies and fuel to prepare
them.
them.
e. e.
Saves medical costs to families and governments
Saves medical costs to families and governments
by preventing illnesses and by providing
by preventing illnesses and by providing
immediate postpartum contraception.
immediate postpartum contraception.

COMPLEMENTARY FEEDING FOR BABIES 6-11
COMPLEMENTARY FEEDING FOR BABIES 6-11
MONTHS OLD
MONTHS OLD

Þ
What are Complementary Foods?
What are Complementary Foods?
c. c.
foods introduced to the child at the age
foods introduced to the child at the age
6 months to supplement breastmilk
6 months to supplement breastmilk
e. e.
given progressively until the child is used to three
given progressively until the child is used to three
meals and in-between feedings at the age of one
meals and in-between feedings at the age of one
year.
year.
Þ
Why is there a Need to Give Complementary Foods?
Why is there a Need to Give Complementary Foods?
g. g.
breastmilk can be a single source of nourishment
breastmilk can be a single source of nourishment
from birth up to six months of life.
from birth up to six months of life.

a. a.
The child’s demands for food increases as he
The child’s demands for food increases as he
grows older and breastmilk alone is not enough to
grows older and breastmilk alone is not enough to
meet his increased nutritional needs for rapid
meet his increased nutritional needs for rapid
growth and development
growth and development
b. b.
Breastmilk should be supplemented with other
Breastmilk should be supplemented with other
foods so that the child can get additional nutrients
foods so that the child can get additional nutrients
c. c.
Introduction of complementary foods will
Introduction of complementary foods will
accustom him to new foods that will also provide
accustom him to new foods that will also provide
additional nutrients to make him grow well
additional nutrients to make him grow well
d. d.
Breastfeeding, however, should continue for as
Breastfeeding, however, should continue for as
long as the mother is able and has milk which
long as the mother is able and has milk which
could be as long as two years
could be as long as two years

Þ
How to Give Complementary Foods for
How to Give Complementary Foods for
Babies 6-11 Months Old?
Babies 6-11 Months Old?
b. b.
Prepare mixture of thick lugao/ cooked rice, soft
Prepare mixture of thick lugao/ cooked rice, soft
cooked vegetables. Egg yolk, mashed beans, flaked
cooked vegetables. Egg yolk, mashed beans, flaked
fish/chicken/ground meat and oil.
fish/chicken/ground meat and oil.
c. c.
Give mixture by teaspoons 2-4 times daily,
Give mixture by teaspoons 2-4 times daily,
increasing the amount of teaspoons and number of
increasing the amount of teaspoons and number of
feeding until the full recommended amount is
feeding until the full recommended amount is
consumed
consumed
d. d.
Give bite-sized fruit separately
Give bite-sized fruit separately
e. e.
Give egg alone or combine with above food mixture
Give egg alone or combine with above food mixture

FAMILY PLANNING
FAMILY PLANNING
The Philippine Family Planning Program is a national
The Philippine Family Planning Program is a national
program that systematically provides information and
program that systematically provides information and
services needed by women of reproductive age to plan their
services needed by women of reproductive age to plan their
families according to their own beliefs and circumstances.
families according to their own beliefs and circumstances.
GOALS AND OBJECTIVES:
GOALS AND OBJECTIVES:


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

MISSION:
MISSION:


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

TYPES OF METHODS:
TYPES OF METHODS:
A
A
.
.


NATURAL METHODS
NATURAL METHODS
1
1
.
.


Calendar or Rhythm Method
Calendar or Rhythm Method
2. Basal Body Temperature Method
2. Basal Body Temperature Method
3. Cervical Mucus Method
3. Cervical Mucus Method
4. Sympto-Thermal Method
4. Sympto-Thermal Method
5. Lactational Amennorhea
5. Lactational Amennorhea

B
B
.
.
ARTIFICIAL METHODS
ARTIFICIAL METHODS
I. CHEMICAL METHODS
I. CHEMICAL METHODS
1
1
.
.
Ovulation suppressant such as PILLS
Ovulation suppressant such as PILLS
2. Depo-Provera
2. Depo-Provera
3. Spermicidals
3. Spermicidals
4. Implant
4. Implant

II. MECHANICAL METHODS
II. MECHANICAL METHODS
1.
1.


Male and Female Condom
Male and Female Condom
2. Intrauterine Device
2. Intrauterine Device
3. Cervical Cap/Diaphragm
3. Cervical Cap/Diaphragm
III. SURGICAL METHODS
III. SURGICAL METHODS
1.
1.


Vasectomy
Vasectomy
Þ
2. Tubal Ligation
2. Tubal Ligation

WARNING SIGNS
WARNING SIGNS
Pills
Pills
Þ
A
A
bdominal pain ( severe)
bdominal pain ( severe)
Þ
C
C
hest pain ( severe)
hest pain ( severe)
Þ
H
H
eadache ( severe)
eadache ( severe)
Þ
E
E
ye problems ( blurred vision, flashing lights,
ye problems ( blurred vision, flashing lights,
blindness)
blindness)
Þ
S
S
evere leg pain ( calf or thigh )
evere leg pain ( calf or thigh )
Þ
Others: depression, jaundice, brest lumps
Others: depression, jaundice, brest lumps

WARNING SIGNS
WARNING SIGNS
IUD
IUD
*
*
P
P
eriod late, no symptoms of pregnancy,
eriod late, no symptoms of pregnancy,
abnormal bleeding or spotting
abnormal bleeding or spotting
*
*
A
A
bdominal pain during intercourse
bdominal pain during intercourse
*
*
I
I
nfection or abnormal vaginal discharge
nfection or abnormal vaginal discharge
*
*
N
N
ot feeling well, has fever or chills
ot feeling well, has fever or chills
*
*
S
S
tring is missing or has become shorter or
tring is missing or has become shorter or
longer
longer

WARNING SIGNS
WARNING SIGNS
Þ
INJECTABLES
INJECTABLES
Þ
D
D
izziness
izziness
Þ
S
S
evere headache
evere headache
Þ
H
H
eavy bleeding
eavy bleeding

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

WARNING SIGNS
WARNING SIGNS
Vasectomy
Vasectomy
Þ
Fever
Fever
Þ
Scrotal blood clots or excessive swelling
Scrotal blood clots or excessive swelling

Nutrition
Nutrition
Þ
Goal
Goal
To improve the nutritional status,
To improve the nutritional status,
productivity and quality of life of
productivity and quality of life of
the population thru adoption of
the population thru adoption of
desirable dietary practices and
desirable dietary practices and
healthy lifestyle
healthy lifestyle

Þ
Objectives
Objectives
Þ
Increase food and dietary energy
Increase food and dietary energy
intake of the average Filipino
intake of the average Filipino
Þ
Prevent nutritional deficiency
Prevent nutritional deficiency
diseases and nutrition-related chronic
diseases and nutrition-related chronic
degenerative diseases
degenerative diseases
Þ
Promote a healthy well-balanced diet
Promote a healthy well-balanced diet
Þ
Promote food safety
Promote food safety

Nutrition
Nutrition
is a state of well-being achieved by eating
is a state of well-being achieved by eating
the right food in every meal and the proper
the right food in every meal and the proper
utilization of the nutrients by the body.
utilization of the nutrients by the body.
Proper nutrition is important because
Proper nutrition is important because
:
:




it helps in the development of the brain, especially during
it helps in the development of the brain, especially during
the first years of the child’s life.
the first years of the child’s life.




It speeds up the growth and development of the body
It speeds up the growth and development of the body
including the formation of teeth and bones
including the formation of teeth and bones




It helps fight infection and diseases
It helps fight infection and diseases




It speeds up the recovery of a sick person
It speeds up the recovery of a sick person




It makes people happy and productive
It makes people happy and productive




Proper nutrition is eating a balanced diet in every meal
Proper nutrition is eating a balanced diet in every meal

Balanced diet
Balanced diet
is made up of a
is made up of a
combination of the 3 basic groups
combination of the 3 basic groups
eaten in correct amounts. The
eaten in correct amounts. The
grouping serves as a guide in
grouping serves as a guide in
selecting and planning everyday
selecting and planning everyday
meals for the family.
meals for the family.

THE THREE (3) BASIC FOOD GROUPS ARE:
THE THREE (3) BASIC FOOD GROUPS ARE:
1. Body –building food
1. Body –building food
which are rich in protein
which are rich in protein
and needed by the body for:
and needed by the body for:
< normal growth and repair of worn-out body tissues
< normal growth and repair of worn-out body tissues
< supplying additional energy
< supplying additional energy
< fighting infections
< fighting infections
< Examples of protein-rich food are:
< Examples of protein-rich food are:
fish; pork;
fish; pork;
chicken; beef; cheese; butter; kidney beans;
chicken; beef; cheese; butter; kidney beans;
mongo; peanuts; bean curd; shrimp; clams
mongo; peanuts; bean curd; shrimp; clams

Þ
2. Energy-giving food
2. Energy-giving food
which are rich in
which are rich in
carbohydrates and fats and needed by the body for:
carbohydrates and fats and needed by the body for:
Þ
< providing enough energy to make the body strong
< providing enough energy to make the body strong
Þ
< Examples of energy-giving food are:
< Examples of energy-giving food are:
rice; corn;
rice; corn;
bread; cassava; sweet potato; banana; sugar
bread; cassava; sweet potato; banana; sugar
cane; honey; lard; cooking oil; coconut milk;
cane; honey; lard; cooking oil; coconut milk;
margarine; butter
margarine; butter

Þ
3. Body-regulating food
3. Body-regulating food
which are rich in
which are rich in
Vitamins and minerals and needed by the body
Vitamins and minerals and needed by the body
for:
for:
Þ
< normal development of the eyes, skin, hair,
< normal development of the eyes, skin, hair,
bones, and teeth
bones, and teeth
Þ
< increased protection against diseases
< increased protection against diseases
Þ
< Examples of body-regulating food are:
< Examples of body-regulating food are:
tisa;
tisa;
ripe papaya; mango; guava; yellow corn;
ripe papaya; mango; guava; yellow corn;
banana; orange; squash; carrot
banana; orange; squash; carrot

Low Fat Tips
Low Fat Tips
1. 1.
Eat at least 3 meals/day
Eat at least 3 meals/day
2. 2.
Eat more fruits, vegetables, grain and cereals
Eat more fruits, vegetables, grain and cereals
e.g. rice, noodles and potato
e.g. rice, noodles and potato
3. 3.
If you use butter or margarine, pat it on thinly
If you use butter or margarine, pat it on thinly
4. 4.
Choose low fat substitute i.e. replace whole
Choose low fat substitute i.e. replace whole
milk with skimmed milk, low fat cheese
milk with skimmed milk, low fat cheese
5. 5.
Become a label reader. Look for foods that
Become a label reader. Look for foods that
have less than 5 g /100 g of product
have less than 5 g /100 g of product

1. 1.
Eat less high fat snacks and take away potato
Eat less high fat snacks and take away potato
chips, sausage rolls or breaded meats
chips, sausage rolls or breaded meats
2. 2.
Cut all visible fat from meat, remove skin
Cut all visible fat from meat, remove skin
from chicken fat drippings and cream sauces
from chicken fat drippings and cream sauces
3. 3.
Aim for thin palm-size serving of lean meat,
Aim for thin palm-size serving of lean meat,
poultry and fish/ meal
poultry and fish/ meal
4. 4.
Grill, bake, steam, stew, stir –fry and
Grill, bake, steam, stew, stir –fry and
microwave, try not to fry
microwave, try not to fry
5. 5.
Drink lots of water all day- it’s a food
Drink lots of water all day- it’s a food
quencher
quencher

Ambulate
Ambulate
Þ
Start by walking for 10 min.
Start by walking for 10 min.
Þ
Build up to 30-40 min/day
Build up to 30-40 min/day
Þ
Go for 3-4 times / week of any exercise you
Go for 3-4 times / week of any exercise you
enjoy
enjoy

Filipino Food Pyramid
Filipino Food Pyramid
Þ
Drink a lot-
Drink a lot-
water, clear broth
water, clear broth
Þ
Eat most
Eat most
– rice, root crops, corn, noodles,
– rice, root crops, corn, noodles,
bread and cereals
bread and cereals
Þ
Eat more –
Eat more –
vegetables, green salads, fruits or
vegetables, green salads, fruits or
juices
juices
Þ
Eat some
Eat some
– fish, poultry, dry beans, nuts,
– fish, poultry, dry beans, nuts,
eggs, lean meats, low fat dairy
eggs, lean meats, low fat dairy
Þ
Eat a little – fats, oils, sugar, salt
Eat a little – fats, oils, sugar, salt

IMPORTANT VITAMINS AND
IMPORTANT VITAMINS AND
MINERALS
MINERALS

Maintain normal vision, skin
health, bone and tooth
growth reproduction and
immune function; prevents
xerophthalmia.
Food sources:
Breastmilk;poultry;eggs; liver;
meat;carrots;squash;
papaya;mango;tiesa;
malunggay;kangkong;
camotetops; ampalaya tops
Vitamin A
FUNCTIONS VITAMINS

Help release energy
from nutrients;
support normal
appetite and nerve
function, prevent
beri-beri.
Thiamine

Help release energy from nutrients;
support skin, nervous and digestive
system, prevents pellagra.
Niacin
Helps release energy from nutrients,
support skin health, prevent deficiency
manifested by cracks and redness at
corners of mouth; inflammation of the
tongue and dermatitis.
Riboflavin

Help in energy
metabolism.
Pantothenic
Help energy and
amino acid
metabolism; help in
the synthesis of fat
glycogen.
Biotin

Help in the formation of the new
cells; maintain nerve cells, assist in
the metabolism of fatty acids and
amino acids.
Vitamin B 12
Help in the formation of DNA and
new blood cells including red blood
cells; prevent anemia and some
amino acids.
Folic acid

Help in the formation of protein,
collagen, bone, teeth cartilage, skin
and scar tissue; facilitate in the
absorption of iron from the
gastrointestinal tract; involve in
amino acid metabolism; increase
resistance to infection, prevent
scurvy.
Food sources:
Guava;pomelo;lemon;orange;
calamansi; tomato; cashew
Vitamin C

Help in the
mineralization of bones
by enhancing
absorption of calcium.
Vitamin D

Involve in the synthesis of blood
clotting proteins and a bone protein
that regulates blood calcium level.
Vitamin K
Strong anti-oxidant; help prevent
arteriosclerosis; protect neuro-
muscular system; important for
normal immune function.
Vitamin E

Mineralization of bones and teeth,
regulator of many of the body’s
biochemical processes, involve in blood
clotting, muscle contraction and
relaxation, nerve functioning, blood
pressure and immune defenses.
Calcium
Maintain normal fluid and electrolyte
balance.
Chloride
FUNCTIONS MINERALS

Necessary for absorption and use
of iron in the formation of
hemoglobin.
Copper
Work with insulin and is
required for release of energy
from glucose.
Chromium

As part of the two thyroid hormones,
iodine regulates growth, physical
and mental development and
metabolic rate.
Aids in the development of the brain
and body especially in unborn
babies
Food sources:
Seaweeds;squids;shrimps;crabs;
fermented shrimp;mussels;snails;
dried dilis; fish
Iodine
Involve in the formation of bones and
teeth; prevents tooth decay.
Fluoride

Essential in the formation of
blood. It is involved in the
transport and storage of
oxygen in the blood and is a
co-factor bound to several
non-hemo enzymes required
for the proper functioning of
cells.
Food sources:
Pork; beef; chicken; liver and
other internal organs; dried
dilis; shrimp; eggs; pechay;
saluyot; alugbati
Iron

Mineralization of bones
and teeth, building of
proteins, normal muscle
contraction, nerve
impulse transmission,
maintenance of teeth
and functioning of
immune system.
Magnesium

Facilitate many cell
processes.
Molybdenum
Facilitate many cell
processes.
Manganese

Work with vitamin E to
protect body compound
from oxidation.
Selenium
Mineralization of bones
and teeth; part of every
Cell; used in energy
transfer and maintenance
of acid-base balance.
Phosphorus

Maintain normal fluid and
electrolyte balance, assists
nerve impulse insulin.
Sodium
Work with vitamin E to
protect body compound from
oxidation.
Selenium

Essential for normal growth,
development reproduction
and immunity.
Zinc
Integral part of vitamins,
biotin and thiamine as well
as the hormone.
Sulfur

MALNUTRITION
MALNUTRITION
MALNUTRITION
MALNUTRITION
An abnormal condition of the body
An abnormal condition of the body
resulting from the lack or excess of
resulting from the lack or excess of
one or more nutrients like protein,
one or more nutrients like protein,
carbohydrates, fats, vitamins and
carbohydrates, fats, vitamins and
minerals.
minerals.

PRIMARY CAUSE:
PRIMARY CAUSE:
POVERTY
POVERTY
1. 1.
Lack of money to buy food
Lack of money to buy food
Majority of the victims of malnutrition comes from
Majority of the victims of malnutrition comes from
families of farmers, fisherfolk, and laborers
families of farmers, fisherfolk, and laborers
who cannot afford to buy nutritious foods.
who cannot afford to buy nutritious foods.
3. 3.
Lack of food supply
Lack of food supply
4. 4.
Lack of information on proper nutrition and
Lack of information on proper nutrition and
food values
food values

SECONDARY CAUSES
SECONDARY CAUSES
1. 1.
Early weaning of child and improper
Early weaning of child and improper
introduction of supplementary food
introduction of supplementary food
2. 2.
Incomplete immunization of babies and children
Incomplete immunization of babies and children
3. 3.
Bad eating habits
Bad eating habits
4. 4.
Poor hygiene and environmental sanitation:
Poor hygiene and environmental sanitation:
a. a.
lack of potable water
lack of potable water
b. b.
lack of sanitary toilet
lack of sanitary toilet
c. c.
poor waste disposal
poor waste disposal

FORMS OF MALNUTRTION
FORMS OF MALNUTRTION
Þ
Protein-Energy Malnutrition (PEM)
Protein-Energy Malnutrition (PEM)
is a
is a
nutritional problem resulting from a
nutritional problem resulting from a
prolonged inadequate intake of body-
prolonged inadequate intake of body-
building and/or energy-giving food in the
building and/or energy-giving food in the
diet.
diet.
Kinds:
Kinds:
a.)MARASMUS
a.)MARASMUS
b.)
b.)
KWASHIORKOR
KWASHIORKOR

a) a)
MARASMUS
MARASMUS
This child does not get the right amount and
This child does not get the right amount and
kind of energy food. She/He:
kind of energy food. She/He:
< is always hungry
< is always hungry
< has the face of an old man
< has the face of an old man
< is very thin
< is very thin
< easily gets sick
< easily gets sick
< looks weak
< looks weak
THIS CHILD IS JUST SKIN AND BONES!
THIS CHILD IS JUST SKIN AND BONES!

a) a)
KWASHIORKOR
KWASHIORKOR
This child does not get enough body-building food,
This child does not get enough body-building food,
although she/he may be getting enough energy. She/He:
although she/he may be getting enough energy. She/He:
< has swollen face, hands, and feet
< has swollen face, hands, and feet
< easily gets sick
< easily gets sick
< has dry, thin, pale hair
< has dry, thin, pale hair
< has sores on the skin
< has sores on the skin
< has thin upper arms
< has thin upper arms
< looks sad
< looks sad
< has dry skin
< has dry skin
< is underweight
< is underweight
THIS CHILD IS SKIN, BONES, AND WATER!
THIS CHILD IS SKIN, BONES, AND WATER!

2. VITAMIN A DEFICIENCY (VAD)
2. VITAMIN A DEFICIENCY (VAD)

a condition in which the level of Vitamin A in
a condition in which the level of Vitamin A in
the body is low.
the body is low.
Causes:
Causes:
Þ
not eating enough foods rich in vitamin A
not eating enough foods rich in vitamin A
e.g.
e.g.
yellow vegetables and yellow fruits
yellow vegetables and yellow fruits
Þ
lack of fat or oil in the diet which help the
lack of fat or oil in the diet which help the
body absorb Vitamin A.
body absorb Vitamin A.
Þ
poor absorption or rapid utilization of
poor absorption or rapid utilization of
Vitamin A during illness
Vitamin A during illness


Eye Signs
Eye Signs
Þ
night blindness (early stage); total blindness
night blindness (early stage); total blindness
(later stage)
(later stage)
Þ
bitot’s spot (foamy soapsuds-like spots on
bitot’s spot (foamy soapsuds-like spots on
white part of the eye)
white part of the eye)
Þ
dry, hazy and rough appearing cornea
dry, hazy and rough appearing cornea
Þ
crater-like defect on cornea
crater-like defect on cornea
Þ
softened cornea; sometimes bulging
softened cornea; sometimes bulging

Other Manifestations
Other Manifestations
Þ
increased cases of childhood sickness, and death
increased cases of childhood sickness, and death
and decreased resistance to infection
and decreased resistance to infection
Þ
susceptibility to childhood malnutrition and
susceptibility to childhood malnutrition and
infection (measles, diarrhea and pneumonia)
infection (measles, diarrhea and pneumonia)

Prevention
Prevention
Þ
eating foods rich in Vitamin A, such as liver,
eating foods rich in Vitamin A, such as liver,
eggs, milk, crab meat, cheese, dilis, malunggay,
eggs, milk, crab meat, cheese, dilis, malunggay,
gabi leaves, kamote tops, kangkong, alugbati,
gabi leaves, kamote tops, kangkong, alugbati,
saluyot, carrots, squash, ripe mango, including
saluyot, carrots, squash, ripe mango, including
fats and oils
fats and oils
Þ
breastfeeding the child
breastfeeding the child
Þ
immunizing the child
immunizing the child
Þ
taking correct dose of Vitamin A capsules as
taking correct dose of Vitamin A capsules as
prescribed
prescribed

VAD is most common in children suffering
VAD is most common in children suffering
from PEM and other infectious diseases.
from PEM and other infectious diseases.
Bottle-fed infants are also at risk of VAD
Bottle-fed infants are also at risk of VAD
especially if the milk formula used is not
especially if the milk formula used is not
fortified with Vitamin A.
fortified with Vitamin A.

Common among preschoolers and infants
Common among preschoolers and infants
( FNRI)
( FNRI)

SCHEDULE FOR RECEIVING VITAMIN A SUPPLEMENT TO SCHEDULE FOR RECEIVING VITAMIN A SUPPLEMENT TO
INFANTS PRESCHOOLERS AND MOTHERS INFANTS PRESCHOOLERS AND MOTHERS
After delivery
of each child
only
200,000 IU 100,000 IU Give after 6
months High
risk
Condition
Present
200,000 IU
Within one
month
200,000 IU 100,000 IU Give 1 Dose
Post Partum
Mother
Preschoolers
(12-83 mos)
Infants(6-11
mos)
Schedule

SCHEDULE FOR TREATMENT OF VITAMIN A
SCHEDULE FOR TREATMENT OF VITAMIN A
DEFICIENCY
DEFICIENCY
200,000 IU 100,000 IU Give After 2
Weeks
200,000 IU 100,000 IU Give Tomorrow
200,000 IU 100,000 IU Give Today
Preschoolers (12-
83 mos.)
Infants (6-11
mos.)
Schedule

3.
3.
ANEMIA
ANEMIA
- a condition characterized by the lack of
- a condition characterized by the lack of
iron in the body resulting in paleness.
iron in the body resulting in paleness.
Þ
S/S: paleness of the eyelids, inner cheeks, palms and
S/S: paleness of the eyelids, inner cheeks, palms and
nailbeds; frequent dizziness and easy fatigability
nailbeds; frequent dizziness and easy fatigability
Þ
Common cause: inadequate intake of food rich in
Common cause: inadequate intake of food rich in
iron ; can also be caused by blood loss during
iron ; can also be caused by blood loss during
menstruation, pregnancy and parasitic infections.
menstruation, pregnancy and parasitic infections.
Þ
Prevention:
Prevention:
Eating iron-rich food such as liver and other internal
Eating iron-rich food such as liver and other internal
organs; green leafy vegetables; and foods rich in
organs; green leafy vegetables; and foods rich in
Vitamin C
Vitamin C

Prevention of Iron Deficiency
Prevention of Iron Deficiency

1 mg daily Children ( 12-59 months)
0.7 mg. Daily Infants ( 6-12 months)
Dosage Recommended Iron
Requirements

Treatment of Iron Deficiency
Treatment of Iron Deficiency

3-6 mg./kg. Body wt./day Children 0-59 month
Dosage



4.
4.
GOITER
GOITER

- enlargement of thyroid gland due to lack
- enlargement of thyroid gland due to lack
of iodine in the body.
of iodine in the body.
-common in areas where the iodine content
-common in areas where the iodine content
in the soil, water and food are deficient.
in the soil, water and food are deficient.

- Effect of Iodine deficiency to fetus:
- Effect of Iodine deficiency to fetus:
may be born mentally and physically
may be born mentally and physically
retarded.
retarded.


- Goiter can be prevented by:
- Goiter can be prevented by:
< daily intake of food rich in iodine
< daily intake of food rich in iodine
< use of iodized salt
< use of iodized salt

Iodine Supplementation
Iodine capsules (200mg)
potassium iodate in oil
orally once a year.
Children 0-59 months
( in endemic areas)
Dosage

CHECKING THE NUTRITIONAL STATUS
CHECKING THE NUTRITIONAL STATUS
WEIGHT
WEIGHT
Þ
1.1 Weight is a very important indicator of a person’s
1.1 Weight is a very important indicator of a person’s
nutritional status. It is measured in relation to either
nutritional status. It is measured in relation to either
AGE or HEIGHT. Normally, a well-nourished child
AGE or HEIGHT. Normally, a well-nourished child
gains weight as she/he grows older.
gains weight as she/he grows older.
Þ
1.2 On the other hand, a malnourished child either
1.2 On the other hand, a malnourished child either
decreases in weight or maintains his/her previous weight.
decreases in weight or maintains his/her previous weight.
Þ
1.3 The nutritional status of a person can also be
1.3 The nutritional status of a person can also be
checked by looking for specific signs and symptoms of
checked by looking for specific signs and symptoms of
the different forms of nutritional deficiencies.
the different forms of nutritional deficiencies.

Þ
IMPORTANT:
IMPORTANT:
Þ
1.1Weigh the child in minimal clothing, with no
1.1Weigh the child in minimal clothing, with no
shoes, clogs or slippers on; and hands and
shoes, clogs or slippers on; and hands and
pockets free of objects.
pockets free of objects.
Þ
1.2The same type of scale should be used for
1.2The same type of scale should be used for
subsequent weighing.
subsequent weighing.
Þ
1.3Observe the proper maintenance of the
1.3Observe the proper maintenance of the
weighing scale.
weighing scale.
Þ
1.4Do not use a bathroom scale to avoid
1.4Do not use a bathroom scale to avoid
inaccurate readings of weight.
inaccurate readings of weight.

< BRING THE MALNOURISHED CHILD
< BRING THE MALNOURISHED CHILD
TOGETHER WITH THE PARENTS TO THE
TOGETHER WITH THE PARENTS TO THE
HEALTH CENTER FOR PROPER
HEALTH CENTER FOR PROPER
NUTRITIONAL ADVICE AND TREATMENT.
NUTRITIONAL ADVICE AND TREATMENT.
< VISIT THE MALNOURISHED CHILD
< VISIT THE MALNOURISHED CHILD
REGULARLY AND MONITOR HIS/HER
REGULARLY AND MONITOR HIS/HER
WEIGHT.
WEIGHT.
< ADVISE PARENTS AND THE WHOLE
< ADVISE PARENTS AND THE WHOLE
COMMUNITY ABOUT BETTER NUTRITION
COMMUNITY ABOUT BETTER NUTRITION
AND PROPER FEEDING ESPECIALLY OF
AND PROPER FEEDING ESPECIALLY OF
INFANTS, CHILDREN AND SICK PERSONS.
INFANTS, CHILDREN AND SICK PERSONS.

NUTRITIONAL GUIDELINES
NUTRITIONAL GUIDELINES
2. 2.
Eat a variety of food everyday.
Eat a variety of food everyday.
3. 3.
Breastfeed infants exclusively from birth to 4-6
Breastfeed infants exclusively from birth to 4-6
months, and then, give appropriate foods while
months, and then, give appropriate foods while
continuing breastfeeding.
continuing breastfeeding.
4. 4.
Maintain children’s normal growth through proper
Maintain children’s normal growth through proper
diet and monitor their growth regularly.
diet and monitor their growth regularly.
5. 5.
Consume fish, lean meat, poultry or dried beans.
Consume fish, lean meat, poultry or dried beans.
6. 6.
Eat more vegetables, fruits, and root crops.
Eat more vegetables, fruits, and root crops.
7. 7.
Eat foods cooked in edible/cooking oil daily.
Eat foods cooked in edible/cooking oil daily.

Þ
Consume milk, milk products or other calcium-
Consume milk, milk products or other calcium-
rich foods such as small fish and dark green leafy
rich foods such as small fish and dark green leafy
vegetables everyday. Use iodized salt, but avoid
vegetables everyday. Use iodized salt, but avoid
excessive intake of salty foods.
excessive intake of salty foods.
Þ
Use iodized salt, avoid excessive intake of salty
Use iodized salt, avoid excessive intake of salty
foods
foods
9. Eat clean and safe food.
9. Eat clean and safe food.
10. For a healthy lifestyle and good nutrition, exercise
10. For a healthy lifestyle and good nutrition, exercise
regularly, do not smoke, avoid drinking alcoholic
regularly, do not smoke, avoid drinking alcoholic
beverages.
beverages.

AIMS AND RATIONALE OF EACH OF
AIMS AND RATIONALE OF EACH OF
THE GUIDELINES
THE GUIDELINES

Guideline No. 1 is intended to give the
Guideline No. 1 is intended to give the
message that no single food provides all the
message that no single food provides all the
nutrients the body needs. Choosing different
nutrients the body needs. Choosing different
kinds of foods from all food groups is the
kinds of foods from all food groups is the
first step to obtain a well-balanced diet. This
first step to obtain a well-balanced diet. This
will help correct the common practice of
will help correct the common practice of
confining of choice to a few kinds of foods,
confining of choice to a few kinds of foods,
resulting in an unbalanced diet.
resulting in an unbalanced diet.

Guidelines No.2 is entitled to promote exclusive
Guidelines No.2 is entitled to promote exclusive
breastfeeding from birth to 4-6 months and to encourage
breastfeeding from birth to 4-6 months and to encourage
the continuance of breastfeeding for as long as two years
the continuance of breastfeeding for as long as two years
or longer. This is to ensure a complete and safe food for
or longer. This is to ensure a complete and safe food for
the newborn and the growing infant besides imparting
the newborn and the growing infant besides imparting
the other benefits of breastfeeding. The guideline also
the other benefits of breastfeeding. The guideline also
strongly advocates the giving of appropriate
strongly advocates the giving of appropriate
complementary food in addition to breast milk once the
complementary food in addition to breast milk once the
infant is ready for solid foods at 6 months. Malnutrition
infant is ready for solid foods at 6 months. Malnutrition
most commonly occurs between the age of 6 months to 2
most commonly occurs between the age of 6 months to 2
years, therefore there is a need to pay close attention to
years, therefore there is a need to pay close attention to
feeding the child properly during this very critical
feeding the child properly during this very critical
period.
period.

Guideline No. 3
Guideline No. 3
gives advise on proper
gives advise on proper
feeding of children. In addition, the
feeding of children. In addition, the
guideline promotes regular weighing to
guideline promotes regular weighing to
monitor the growth of children, as it is a
monitor the growth of children, as it is a
simple way to assess nutritional status.
simple way to assess nutritional status.

Guidelines No. 4,5,6 and 7
Guidelines No. 4,5,6 and 7
are intended to correct the
are intended to correct the
deficiencies in the current dietary pattern of Filipinos.
deficiencies in the current dietary pattern of Filipinos.
Including fish, lean meat, poultry and dried beans, which
Including fish, lean meat, poultry and dried beans, which
will provide good quality protein and dietary energy, as well
will provide good quality protein and dietary energy, as well
as iron and zinc, key nutrients lacking in the diet of
as iron and zinc, key nutrients lacking in the diet of
Filipinos as a whole. Eating more vegetables, fruits and
Filipinos as a whole. Eating more vegetables, fruits and
root crops will supply the much needed vitamins, minerals
root crops will supply the much needed vitamins, minerals
and dietary fiber that are deficient in our diet. In addition,
and dietary fiber that are deficient in our diet. In addition,
they provide defense against chronic degenerative diseases.
they provide defense against chronic degenerative diseases.
Including foods cooked in edible oils will provide
Including foods cooked in edible oils will provide
additional dietary energy as a partial remedy to calorie
additional dietary energy as a partial remedy to calorie
deficiency of the average Filipino. Including milk and other
deficiency of the average Filipino. Including milk and other
calcium-rich foods in the diet will serve to supply not only
calcium-rich foods in the diet will serve to supply not only
calcium for healthy bones but to provide high quality
calcium for healthy bones but to provide high quality
protein and other nutrients for growth.
protein and other nutrients for growth.

Guideline No. 8
Guideline No. 8
promotes the use of
promotes the use of
iodized salt to prevent iodine deficiency,
iodized salt to prevent iodine deficiency,
which is a major cause of mental and
which is a major cause of mental and
physical underdevelopment in the
physical underdevelopment in the
country. At the same time, the guideline
country. At the same time, the guideline
warns against excessive intake of salty
warns against excessive intake of salty
foods as a hedge against hypertension,
foods as a hedge against hypertension,
particularly among high-risk individuals.
particularly among high-risk individuals.

Guideline No.9
Guideline No.9
is intended to
is intended to
prevent food-borne diseases. It
prevent food-borne diseases. It
explains the various sources of
explains the various sources of
contamination of our food and
contamination of our food and
simple ways to prevent it from
simple ways to prevent it from
occurring.
occurring.

Finally, Guideline No. 10
Finally, Guideline No. 10
promotes a
promotes a
healthy lifestyle through regular
healthy lifestyle through regular
exercise, abstinence from smoking and
exercise, abstinence from smoking and
avoiding consumption. If alcohol is
avoiding consumption. If alcohol is
consumed, it must be done in
consumed, it must be done in
moderation. All these lifestyle practices
moderation. All these lifestyle practices
are directly or indirectly related to good
are directly or indirectly related to good
nutrition.
nutrition.

NUTRIENTS IN FOOD
NUTRIENTS IN FOOD

Nutrients are chemical substances present in
Nutrients are chemical substances present in
the foods that keep the body healthy, supply
the foods that keep the body healthy, supply
materials for growth and repair of tissues, and
materials for growth and repair of tissues, and
provide energy for work and physical activities.
provide energy for work and physical activities.
The major nutrients include the
The major nutrients include the
macronutrients, namely; proteins, carbohydrates
macronutrients, namely; proteins, carbohydrates
and fats; the micronutrients, namely vitamins
and fats; the micronutrients, namely vitamins
such as A, D, E and K, the B complex vitamins
such as A, D, E and K, the B complex vitamins
and C and minerals such as calcium, iron, iodine,
and C and minerals such as calcium, iron, iodine,
zinc, fluoride and water.
zinc, fluoride and water.

Reproductive Health
Reproductive Health
Þ
- a state of complete physical, mental and
- a state of complete physical, mental and
social well-being and not merely the
social well-being and not merely the
absence of disease/ infirmity in all
absence of disease/ infirmity in all
matters relating to the reproductive
matters relating to the reproductive
system and to its functions and processes.
system and to its functions and processes.

Þ
Basic RH Rights
Basic RH Rights
Þ
Right to RH information and health care
Right to RH information and health care
services for safe pregnancy and childbirth
services for safe pregnancy and childbirth
Þ
Right to know different means of regulating
Right to know different means of regulating
fertility to preserve health and where to obtain
fertility to preserve health and where to obtain
them
them
Þ
Freedom to decide the number and timing of
Freedom to decide the number and timing of
birth of children
birth of children
Þ
Right to exercise satisfying sex life
Right to exercise satisfying sex life

Þ
Factors/ determinants of RH
Factors/ determinants of RH
Þ
Socioeconomic conditions – education,
Socioeconomic conditions – education,
employment, poverty, nutrition, living
employment, poverty, nutrition, living
condition/ environment, family environment
condition/ environment, family environment
Þ
Status of women – equal right in education and
Status of women – equal right in education and
in making decisions about her own RH; right
in making decisions about her own RH; right
to be free from torture and ill treatment and to
to be free from torture and ill treatment and to
participate in politics
participate in politics
Þ
Social and Gender Issues
Social and Gender Issues
Þ
Biological (individual knowledge of
Biological (individual knowledge of
reproductive organs and their functions),
reproductive organs and their functions),
cultural (country’s norms, RH practices) and
cultural (country’s norms, RH practices) and
psychosocial factors
psychosocial factors

Þ
Elements
Elements
Þ
Maternal and Child Health Nutrition
Maternal and Child Health Nutrition
Þ
Family Planning
Family Planning
Þ
Prevention and Management of Abortion
Prevention and Management of Abortion
Complications
Complications
Þ
Prevention and Treatment of Reproductive
Prevention and Treatment of Reproductive
Tract Infections, including STDs, HIV and
Tract Infections, including STDs, HIV and
AIDS
AIDS
Þ
Education and Counseling on Sexuality and
Education and Counseling on Sexuality and
Sexual Health
Sexual Health

Þ
Elements
Elements
Þ
Breast and Reproductive Tract Cancers and
Breast and Reproductive Tract Cancers and
other Gynecological Conditions
other Gynecological Conditions
Þ
Men’s Reproductive Health
Men’s Reproductive Health
Þ
Adolescent Reproductive Health
Adolescent Reproductive Health
Þ
Violence Against Women
Violence Against Women
Þ
Prevention and Treatment of Infertility and
Prevention and Treatment of Infertility and
Sexual Disorders
Sexual Disorders

Þ
Selected Concepts
Selected Concepts
Þ
RH is the exercise of reproductive right with
RH is the exercise of reproductive right with
responsibility
responsibility
Þ
It means safe pregnancy and delivery, the right of
It means safe pregnancy and delivery, the right of
access to appropriate health information and services
access to appropriate health information and services
Þ
It includes protection from unwanted pregnancy by
It includes protection from unwanted pregnancy by
having access to safe and acceptable methods of family
having access to safe and acceptable methods of family
planning of their choice
planning of their choice
Þ
It includes protection from harmful reproductive
It includes protection from harmful reproductive
practices and violence
practices and violence
Þ
It ensure sexual health for the purpose of enhancement
It ensure sexual health for the purpose of enhancement
of life and personal relations and assures access to
of life and personal relations and assures access to
information on sexuality to achieve sexual enjoyment
information on sexuality to achieve sexual enjoyment

Þ
Goal
Goal
Þ
To achieve healthy sexual development
To achieve healthy sexual development
and maturation
and maturation
Þ
To achieve their reproductive intention
To achieve their reproductive intention
Þ
To avoid diseases, injuries and
To avoid diseases, injuries and
disabilities related to sexuality and
disabilities related to sexuality and
reproduction
reproduction
Þ
To receive appropriate counseling and
To receive appropriate counseling and
care of RH problems
care of RH problems

Þ
Strategies
Strategies
Þ
Increase and improve the use of more effective or
Increase and improve the use of more effective or
modern contraceptive methods
modern contraceptive methods
Þ
Provision of care, treatment and rehabilitation for
Provision of care, treatment and rehabilitation for
RH
RH
Þ
RH care provision should be focused on adolescents,
RH care provision should be focused on adolescents,
men and unmarried and other displaced people with
men and unmarried and other displaced people with
RH problems
RH problems
Þ
Strengthen outreach activities and referral system
Strengthen outreach activities and referral system
Þ
Prevent specific RH problems through information
Prevent specific RH problems through information
dissemination and counseling of clients
dissemination and counseling of clients

HEALTH AND SANITATION
HEALTH AND SANITATION
Environmental Sanitation is still a health problem
Environmental Sanitation is still a health problem
in the country.
in the country.


Diarrheal diseases ranked second in the leading
Diarrheal diseases ranked second in the leading
causes of morbidity among
causes of morbidity among
the general
the general
population
population
.
.


Other sanitation related diseases :
Other sanitation related diseases :


tuberculosis, intestinal parasitism,
tuberculosis, intestinal parasitism,
schistossomiasis, malaria, infectious hepatitis,
schistossomiasis, malaria, infectious hepatitis,
filariasis and dengue hemorrhagic fever
filariasis and dengue hemorrhagic fever

DOH thru’
DOH thru’
Environmental Health Services
Environmental Health Services
(EHS)
(EHS)
unit is authorized to act on all issues and concerns
unit is authorized to act on all issues and concerns
in environment and health including the very
in environment and health including the very
comprehensive Sanitation Code of the Philippines
comprehensive Sanitation Code of the Philippines
(PD 856, 1978).
(PD 856, 1978).

WATER SUPPLY SANITATION
WATER SUPPLY SANITATION
PROGRAM
PROGRAM
EHS sets policies on:
EHS sets policies on:
Þ
Approved types of water facilities
Approved types of water facilities
Þ
Unapproved type of water facility
Unapproved type of water facility
Þ
Access to safe and potable drinking water
Access to safe and potable drinking water
Þ
Water quality and monitoring surveillance
Water quality and monitoring surveillance
Þ
Waterworks/Water system and well
Waterworks/Water system and well
construction
construction

Approved type of water facilities
Approved type of water facilities
Þ
Level 1 (Point Source)- a protected well or a
Level 1 (Point Source)- a protected well or a
developed spring with an outlet but without a
developed spring with an outlet but without a
distribution system
distribution system
Þ
indicated for rural areas;
indicated for rural areas;
Þ
serves 15-25 households; its outreach is not
serves 15-25 households; its outreach is not
more than 250 m from the farthest user
more than 250 m from the farthest user
Þ
yields 40-140 L/ min
yields 40-140 L/ min

Level II ( Communal Faucet or
Level II ( Communal Faucet or
Stand Posts)
Stand Posts)
Þ
With a source, reservoir, piped distribution
With a source, reservoir, piped distribution
network and communal faucets
network and communal faucets
Þ
Located at not more than 25 m from the
Located at not more than 25 m from the
farthest house
farthest house
Þ
Delivers 40-80 L of water per capital per day
Delivers 40-80 L of water per capital per day
to an average of 100 households
to an average of 100 households
Þ
Fit for rural areas where houses are densely
Fit for rural areas where houses are densely
clustered
clustered

Level III ( Individual House
Level III ( Individual House
Connections or Waterworks System)
Connections or Waterworks System)
Þ
With a source, reservoir, piped distributor
With a source, reservoir, piped distributor
network and household taps
network and household taps
Þ
Fit for densely populated urban communities
Fit for densely populated urban communities
Þ
Requires minimum treatment or disinfection
Requires minimum treatment or disinfection

ENVIRONMENTAL SANITATION
ENVIRONMENTAL SANITATION
-
-
the study of all factors in man’s
the study of all factors in man’s
physical environment, which may
physical environment, which may
exercise a deleterious effect on his
exercise a deleterious effect on his
health, well-being and survival.
health, well-being and survival.

Includes:
Includes:
1.1 Water sanitation
1.1 Water sanitation
1.2 Food sanitation
1.2 Food sanitation
1.3 Refuse and garbage disposal
1.3 Refuse and garbage disposal
1.4 Excreta disposal
1.4 Excreta disposal
1.5 Insect vector and rodent control
1.5 Insect vector and rodent control
1.6 Housing
1.6 Housing
1.7 Air pollution
1.7 Air pollution
1.8 Noise
1.8 Noise
1.9 Radiological Protection
1.9 Radiological Protection
1.10 Institutional sanitation
1.10 Institutional sanitation
1.11 Stream pollution
1.11 Stream pollution

PROPER EXCRETA AND SEWAGE DISPOSAL
PROPER EXCRETA AND SEWAGE DISPOSAL
PROGRAM
PROGRAM

EHS sets policies on:
EHS sets policies on:
Approved types of toilet facilities :
Approved types of toilet facilities :
LEVEL I LEVEL I
◙ ◙ Non-water carriage toilet facility – no water Non-water carriage toilet facility – no water
necessary to wash the waste into receiving space e.g.pit necessary to wash the waste into receiving space e.g.pit
latrines, reed odorless earth closet. latrines, reed odorless earth closet.
◙ ◙ Toilet facilities requiring small amount of water to Toilet facilities requiring small amount of water to
wash the waste into the receiving space e.g. pour flush toilet & wash the waste into the receiving space e.g. pour flush toilet &
aqua privies aqua privies

LEVEL II – on site toilet facilities
LEVEL II – on site toilet facilities
of the water carriage type with
of the water carriage type with
water-sealed and flush type with
water-sealed and flush type with
septic vault/tank disposal.
septic vault/tank disposal.

LEVEL III – water carriage types of toilet facilities
LEVEL III – water carriage types of toilet facilities
connected to septic tanks and/or to sewerage system
connected to septic tanks and/or to sewerage system
to treatment plant.
to treatment plant.

FOOD SANITATION PROGRAM
FOOD SANITATION PROGRAM
-sets policy and practical programs to prevent
-sets policy and practical programs to prevent
and control food-borne diseases to alleviate the
and control food-borne diseases to alleviate the
living conditions of the population
living conditions of the population

HOSPITAL WASTE MANAGEMENT PROGRAM
HOSPITAL WASTE MANAGEMENT PROGRAM
Disposal of infectious, pathological and other wastes
Disposal of infectious, pathological and other wastes
from hospital which combine them with the
from hospital which combine them with the
municipal or domestic wastes pose health hazards to
municipal or domestic wastes pose health hazards to
the people.
the people.


Hospitals shall dispose their hazardous wastes thru
Hospitals shall dispose their hazardous wastes thru
incinerators or disinfectants to prevent transmission of
incinerators or disinfectants to prevent transmission of
nosocomial diseases
nosocomial diseases

PROGRAM ON HEALTH RISK MINIMIZATION
PROGRAM ON HEALTH RISK MINIMIZATION
DUE TO ENVIRONMENTAL POLLUTION
DUE TO ENVIRONMENTAL POLLUTION
Foci:
Foci:
1. Prevention of serious environmental hazards resulting
1. Prevention of serious environmental hazards resulting
from urban growth and industrialization
from urban growth and industrialization
2. policies on health protection measures
2. policies on health protection measures
3. researches on effects of GLOBAL WARMING to health
3. researches on effects of GLOBAL WARMING to health
(depletion of the stratosphere ozone layer which
(depletion of the stratosphere ozone layer which
increases ultraviolet radiation, climate change and other
increases ultraviolet radiation, climate change and other
conditions)
conditions)

NURSING RESPONSIBILITIES AND ACTIVITIES
NURSING RESPONSIBILITIES AND ACTIVITIES
Þ
Health Education – IEC by conducting community
Health Education – IEC by conducting community
assemblies and
assemblies and
bench conferences.
bench conferences.
Þ
The Occupational Health
The Occupational Health
Nurse, School Health Nurse
Nurse, School Health Nurse
and other Nursing staff shall impart the need for an
and other Nursing staff shall impart the need for an
effective and efficient environmental sanitation in
effective and efficient environmental sanitation in
their places of work and in school.
their places of work and in school.

Þ
Actively participate in the training component of
Actively participate in the training component of
the
the
service like in Food Handler’s Class, and attend
service like in Food Handler’s Class, and attend
training/workshops related to environmental health.
training/workshops related to environmental health.
Þ
Assist in the deworming activities for the school
Assist in the deworming activities for the school
children and targeted groups.
children and targeted groups.
Þ
Effectively and efficiently coordinate
Effectively and efficiently coordinate
programs/projects/activities with other government and non-
programs/projects/activities with other government and non-
government agencies.
government agencies.
Þ
Act as an advocate or facilitator to families in
Act as an advocate or facilitator to families in
the
the
community in matters of program/projects/activities
community in matters of program/projects/activities
on environmental
on environmental
health in coordination with other
health in coordination with other
members of Rural Health Unit (RHU) especially the Rural
members of Rural Health Unit (RHU) especially the Rural
Sanitary Inspectors.
Sanitary Inspectors.

Þ
Actively participate in environmental
Actively participate in environmental
sanitation campaigns and projects in the
sanitation campaigns and projects in the
community. Ex. Sanitary toilet campaign
community. Ex. Sanitary toilet campaign
drive for proper garbage disposal,
drive for proper garbage disposal,
beautification of home garden, parks drainage
beautification of home garden, parks drainage
and other projects.
and other projects.
Þ
Be a role model for others in the community to
Be a role model for others in the community to
emulate terms of cleanliness in the home and
emulate terms of cleanliness in the home and
surrounding.
surrounding.

Non-Communicable Diseases and
Non-Communicable Diseases and
Rehabilitation
Rehabilitation

Þ
1. Prevention and Control of Cardiovascular Diseases
1. Prevention and Control of Cardiovascular Diseases
Þ
- heart – 1
- heart – 1
st leading cause of death st leading cause of death
; bld vessels - 2
; bld vessels - 2
nd nd
Þ
Congenital Heart Disease (CHD
Congenital Heart Disease (CHD
): Result of the abnormal
): Result of the abnormal
development of the heart that exhibits septal defect, patent
development of the heart that exhibits septal defect, patent
ductus arteriosus, aortic and pulmonary stenosis, and
ductus arteriosus, aortic and pulmonary stenosis, and
cyanosis; most prevalent in children
cyanosis; most prevalent in children
Þ
Causes: envt’l factors, maternal diseases or genetic
Causes: envt’l factors, maternal diseases or genetic
aberrations
aberrations
Þ
Rheumatic Fever or Rheumatic Heart Disease
Rheumatic Fever or Rheumatic Heart Disease
: Systematic
: Systematic
inflammatory disease that may develop as a delayed
inflammatory disease that may develop as a delayed
reaction to repeated and an inadequately treated infection
reaction to repeated and an inadequately treated infection
of the upper respiratory tract by group A beta-hemolytic
of the upper respiratory tract by group A beta-hemolytic
streptococci.
streptococci.
Þ
Hypertension
Hypertension
: Persistent elevation of the arterial blood
: Persistent elevation of the arterial blood
pressure.
pressure.
Þ
(
(
primary or essential
primary or essential
) ;frequent among females but
) ;frequent among females but
severe,malignat form is more common among males
severe,malignat form is more common among males

Ischemic Heart Disease/ Atherosclerosis
Ischemic Heart Disease/ Atherosclerosis
:
:
Condition usually caused by the occlusion of
Condition usually caused by the occlusion of
the coronary arteries by thrombus or clot
the coronary arteries by thrombus or clot
formation.
formation.
Þ
higher among males than females for the latter
higher among males than females for the latter
are protected by estrogen before menopause
are protected by estrogen before menopause
Þ
PF: HPN, DM, Smoking
PF: HPN, DM, Smoking
Þ
Minor RF: stress, strong family history,
Minor RF: stress, strong family history,
obesity
obesity

CVD
CVD
5 / 100 adults Coronary Artery Disease
Cerebrovascular
Accident
Middle age to old age
10 / 100 adults Diseases of Heart
Muscles
Essential Hypertension
Early Adulthood
1 / 1000 school children
(aged 5 – 15 y.o.)
Rheumatic Fever /
Rheumatic Heart
Disease
Early to late childhood
2 / 1000 school children
(aged 5 – 15 y.o.)
Congenital Heart
Disease
At birth to early
childhood
PREVALENCE TYPE OF CVD PERIOD OF LIFE

CVD
CVD
Hypertension, Arteriosclerosis Cerebrovascular Accident
(Stroke)
Smoking, Obesity,
Hypertension, Stress
Hyperlipidemia, Diabetes
Mellitus Sedentary Life Style
Coronary Artery Disease (Heart
Attack)
Heredity, High Salt Intake Essential Hypertension
Frequent Streptoccocal Sore
Throat
Rheumatic Fever/Rheumatic
Heart Disease
Maternal Infections, Drug
intake, Maternal Disease,
Genetic
Congenital Heart Disease
Causes / Risk factors Diseases

Primary Prevention: CVD
Primary Prevention: CVD
- Adequate treatment of
viral infection during
pregnancy.
- Genetic counseling of
blood related married
couples.
- Prevention of
viral infection and
intake of harmful
drugs during
pregnancy.
- Avoidance of
marriage between
blood relatives
Congenital
Heart
Disease
Specific Protection Primordial Disease

- Identification of
cases of
rheumatic fever
- Prophylaxis
with penicillin or
erythromycin
- Prevention of
recurrent sore
throat thru
adequate
environmental
sanitation;
avoidance of
overcrowding;
adequate
treatment
Rheumatic Heart
Disease

- Continued low
salt diet and
adequate exercise
- From early
childhood
> low salt diet
> adequate
physical exercise
Essential
Hypertension

- cessation of
smoking
- control
/treatment of
diabetes,
hypertension
-weight reduction
-change to proper
diet
-Adjustment of
activities
- Prevention of
development/
acquisition of
risk factors
> cigarette
smoking
> high fat intake
> high salt intake
Coronary Heart
Disease(Heart
Attack)

- all measures to
control
hypertension &
progression of
arteriosclerosis
- all measures to
prevent
hypertension &
arteriosclerosis
Cerebrovascular
Accident (Stroke)

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

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

NINE WARNING SIGNS OF
NINE WARNING SIGNS OF
CANCER:
CANCER:
Þ
C
C
hange in blood bowel or bladder habits
hange in blood bowel or bladder habits
Þ


A
A
sore that does not heal
sore that does not heal
Þ


U
U
nusual bleeding or discharge
nusual bleeding or discharge
Þ


T
T
hickening or lump in breast or elsewhere
hickening or lump in breast or elsewhere
Þ


I
I
ndigestion or difficulty in swallowing
ndigestion or difficulty in swallowing
Þ


O
O
bvious change in wart or mole
bvious change in wart or mole
Þ


N
N
agging cough or hoarseness
agging cough or hoarseness
Þ


U
U
nexplained anemia
nexplained anemia
Þ


S
S
udden unexplained weight loss
udden unexplained weight loss

Prevention & Early Detection
Prevention & Early Detection
Detection
None
Pap’s smear
every 1-3 yrs
None
Prevention
No smoking
Monogamy
Safe sex
Hep B
vaccination
Less aalcohol
intake
Avoidance of
moldy foods
CA type
Lung
Uterine
Cervical
Liver

Regular dental
check-ups
No smoking,
betel nut chewing
Oral hygiene
Mouth
Regular medical
check-up after 40
yrs of age
Fecal occult
blood test
DRE
Sigmoidoscopy
High fiber diet
Low fat intake
Colon
Rectum

Assessment of
skin
Digital trans-
rectal exam
No excessive sun
exposure
none
Skin
Prostate
Monthly SBE
Yearly exam by
doctor
Mammography
for 50 yrs old and
above females
none Breast

Þ
PRINCIPLES OF TREATMENT OF
PRINCIPLES OF TREATMENT OF
MALIGNANT DISEASES
MALIGNANT DISEASES
Þ


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

Three major forms of treatment of cancer:
Three major forms of treatment of cancer:
Þ
Surgery
Surgery
Þ
Radiation Therapy
Radiation Therapy
Þ
Chemotherapy
Chemotherapy

Þ
3. Nat’l Diabetes Prevention and Control
3. Nat’l Diabetes Prevention and Control
Program
Program
Þ
Aim:
Aim:
Þ
Controlling and assimilating healthy lifestyle
Controlling and assimilating healthy lifestyle
in the Filipino culture ( 2005-2010) thru
in the Filipino culture ( 2005-2010) thru
IEC
IEC
Þ
Main Concern: modifiable risk factors( diet,
Main Concern: modifiable risk factors( diet,
body wt., smoking, alcohol, stress, sedentary
body wt., smoking, alcohol, stress, sedentary
living, birth wt. ,migration
living, birth wt. ,migration

Þ
4. Prevention and Control of Kidney
4. Prevention and Control of Kidney
Disease
Disease
Þ
Acute or Rapidly Progressive Renal Failure :
Acute or Rapidly Progressive Renal Failure :
A
A
sudden decline in renal function resulting from the
sudden decline in renal function resulting from the
failure of the renal circulation or by glomerular or
failure of the renal circulation or by glomerular or
tubular damage causing the accumulation of
tubular damage causing the accumulation of
substances that is normally eliminated in the urine in
substances that is normally eliminated in the urine in
the body fluids leading to disruption in homeostatic,
the body fluids leading to disruption in homeostatic,
endocrine, and metabolic functions.
endocrine, and metabolic functions.
Þ
Acute Nephritis:
Acute Nephritis:
A severe inflammation of the
A severe inflammation of the
kidney caused by infection, degenerative disease, or
kidney caused by infection, degenerative disease, or
disease of the blood vessels.
disease of the blood vessels.
Þ
Chronic Renal Failure:
Chronic Renal Failure:
A progressive deterioration
A progressive deterioration
of renal function that ends as uremia and its
of renal function that ends as uremia and its
complications unless dialysis or kidney transplant is
complications unless dialysis or kidney transplant is
performed.
performed.

Þ
Neprolithiasis:
Neprolithiasis:
A disorder characterized by the
A disorder characterized by the
presence of calculi in the kidney.
presence of calculi in the kidney.
Þ
Nephrotic Syndrome:
Nephrotic Syndrome:
A clinical disorder of excessive
A clinical disorder of excessive
leakage of plasma proteins into the urine because of
leakage of plasma proteins into the urine because of
increased permeability of the glomerular capillary
increased permeability of the glomerular capillary
membrane
membrane
Þ
Urinary Tract Infection:
Urinary Tract Infection:
A disease caused by the
A disease caused by the
presence of pathogenic microorganisms in the urinary
presence of pathogenic microorganisms in the urinary
tract with or without signs and symptoms.
tract with or without signs and symptoms.
Þ
Renal Tubular Defects:
Renal Tubular Defects:
An abnormal condition in the
An abnormal condition in the
reabsorption of selected materials back into the blood
reabsorption of selected materials back into the blood
and secretion, collection, and conduction of urine.
and secretion, collection, and conduction of urine.
Þ
Urinary Tract Obstruction:
Urinary Tract Obstruction:
A condition wherein the
A condition wherein the
urine flow is blocked or clogged.
urine flow is blocked or clogged.

Þ
5. Program on Mental Health and Mental
5. Program on Mental Health and Mental
Disorders
Disorders


















Þ
6. Program on Drug Dependence/
6. Program on Drug Dependence/
Substance Abuse
Substance Abuse

Þ
7.Community-Based Rehabilitation Program
7.Community-Based Rehabilitation Program
Þ
A creative application of the primary health care
A creative application of the primary health care
approach in rehabilitation services, which involves
approach in rehabilitation services, which involves
measures taken at the community level to use and build
measures taken at the community level to use and build
on the resources of the community with the community
on the resources of the community with the community
people, including impaired, disabled and handicapped
people, including impaired, disabled and handicapped
persons as well.
persons as well.
Þ
Goal: To improve the quality of life and increase
Goal: To improve the quality of life and increase
productivity of disabled, handicapped persons.
productivity of disabled, handicapped persons.
Þ
Aim: To reduce the prevalence of disability through
Aim: To reduce the prevalence of disability through
prevention, early detection and provision of
prevention, early detection and provision of
rehabilitation services at the community level.
rehabilitation services at the community level.

Þ
8. Program on the Elderly/Geriatric Nursing
8. Program on the Elderly/Geriatric Nursing
Services
Services
Þ
7 humanitarian issues: family, health,
7 humanitarian issues: family, health,
income, security, employment and labor,
income, security, employment and labor,
social welfare, education, recreation, culltural
social welfare, education, recreation, culltural
activities and housing
activities and housing

Leading causes of illness:elderly
Leading causes of illness:elderly
Þ
Influenza, HPN, diarrhea,
Influenza, HPN, diarrhea,
Þ
bronchitis, TB, diseases. of the heart,
bronchitis, TB, diseases. of the heart,
Þ
pneumonia, malaria,
pneumonia, malaria,
Þ
malignant neoplasm, chickenpox
malignant neoplasm, chickenpox

Leading causes of death:elderly
Leading causes of death:elderly
Þ
Diseases of heart and vascular system
Diseases of heart and vascular system
Þ
Pneumonia, TB, CCOPD
Pneumonia, TB, CCOPD
Þ
Malignant neoplasms
Malignant neoplasms
Þ
Diabetes
Diabetes
Þ
Nephritis
Nephritis
Þ
Accidents
Accidents

Þ
9. Programs on Blindness, Deafness and
9. Programs on Blindness, Deafness and
Osteoporosis
Osteoporosis
Þ
Cataract- main causes of blindness
Cataract- main causes of blindness
Þ
VAD- main cause of childhood blindness; most
VAD- main cause of childhood blindness; most
serious eye problem of Fil. children below 6 yrs. old
serious eye problem of Fil. children below 6 yrs. old
Þ
Osteoporosis special problem in women, highest
Osteoporosis special problem in women, highest
bet. 50—79 yrs. old, MENOPAUSE- main cause
bet. 50—79 yrs. old, MENOPAUSE- main cause

Prevention of NCD/Role of Nursing
Prevention of NCD/Role of Nursing
in Health Promotion And Advocacy
in Health Promotion And Advocacy
Þ
Yosi Kadiri- anti smoking
Yosi Kadiri- anti smoking
Þ
Edi Exercise/Hataw-regular physical activity
Edi Exercise/Hataw-regular physical activity
Þ
Tiya Kulit/ Iwas Sakit Diet-low salt, low fat,
Tiya Kulit/ Iwas Sakit Diet-low salt, low fat,
high fiber diet
high fiber diet
Þ
Mag HL – exercise, no smoking, avoidance of
Mag HL – exercise, no smoking, avoidance of
alcohol, healthy diet, iwas stress, watch wt.
alcohol, healthy diet, iwas stress, watch wt.

Sentrong Sigla Movement ( SSM)
Sentrong Sigla Movement ( SSM)
-a certification recognition program which
-a certification recognition program which
develops and promotes standards for health
develops and promotes standards for health
facilities
facilities
-
Joint effort bet.:
Joint effort bet.:
1.DOH – provides technical and financial
1.DOH – provides technical and financial
assistance packages for health care
assistance packages for health care
2. LGUs – direct implementers of health
2. LGUs – direct implementers of health
programs & prime developers of health centers
programs & prime developers of health centers
and hospitals making services accessible to
and hospitals making services accessible to
every Filipino
every Filipino

Pillars of SSM
Pillars of SSM
Þ
1. Quality Assurance
1. Quality Assurance
Þ
2. Grant and Technical Assistance
2. Grant and Technical Assistance
Þ
3. Health Promotion
3. Health Promotion
Þ
4. Awards
4. Awards

Expected Outcome: SSM
Expected Outcome: SSM
Þ
Empowered individuals adopting healthy
Empowered individuals adopting healthy
lifestyle, improved health-seeking behavior
lifestyle, improved health-seeking behavior
and well-being & increased demand for quality
and well-being & increased demand for quality
health services
health services
Þ
Institutions will develop policies, provide
Institutions will develop policies, provide
quality services , institute system for
quality services , institute system for
surveillance/ merits and advocate for laws
surveillance/ merits and advocate for laws

Programs: SSM
Programs: SSM
Þ
EPI
EPI
Þ
Disease Surveillance
Disease Surveillance
Þ
CARI
CARI
Þ
CDD
CDD
Þ
Nutrition/ Micronutrient Supplementation-
Nutrition/ Micronutrient Supplementation-
*Food Fortification :
*Food Fortification :
Rice –
Rice –
iron
iron
; Oil and sugar –
; Oil and sugar –
Vit. A
Vit. A
;
;
Flour-
Flour-
Vit. A & iron
Vit. A & iron
; Salt-
; Salt-
iodine
iodine

Integrated Management of
Integrated Management of
Childhood Illness ( IMCI)
Childhood Illness ( IMCI)
Þ
Integrates management of most common
Integrates management of most common
childhood problems ( diarrhea, pneumonia,
childhood problems ( diarrhea, pneumonia,
measles, malnutrition, DHF, malaria)
measles, malnutrition, DHF, malaria)
Þ
Involves family members and community in
Involves family members and community in
the health care process for physical growth and
the health care process for physical growth and
mental development & disease prevention
mental development & disease prevention

IMCI: Case Mgt. Process
IMCI: Case Mgt. Process
Þ
1. Assessing the child or young infant- History
1. Assessing the child or young infant- History
taking, PE
taking, PE
Þ
2. Classifying the Illness- severity of illness
2. Classifying the Illness- severity of illness
Þ
3. Identifying ttt.- classification chart
3. Identifying ttt.- classification chart
Þ
4. Treating the child- giving ttt. in health centers,
4. Treating the child- giving ttt. in health centers,
prescribed drugs & teaching mothers how to carry out
prescribed drugs & teaching mothers how to carry out
ttt.
ttt.
Þ
5. Counseling the mother- child feeding,foods and
5. Counseling the mother- child feeding,foods and
fluids to give & when to bring the child back to the
fluids to give & when to bring the child back to the
health center
health center
Þ
6. Giving of follow-up care
6. Giving of follow-up care

Þ
Communicable diseases
Communicable diseases

Þ
National Tuberculosis Control Program – key
National Tuberculosis Control Program – key
policies
policies
O
Case finding – direct Sputum Microscopy and X-
Case finding – direct Sputum Microscopy and X-
ray examination of TB symptomatics who are
ray examination of TB symptomatics who are
negative after 2 or more sputum exams
negative after 2 or more sputum exams
O
Treatment – shall be given free and on an
Treatment – shall be given free and on an
ambulatory basis, except those with acute
ambulatory basis, except those with acute
complications and emergencies
complications and emergencies
O
Direct Observed Treatment Short Course –
Direct Observed Treatment Short Course –
comprehensive strategy to detect and cure TB
comprehensive strategy to detect and cure TB
patients.
patients.

Category and Treatment
Category and Treatment
Regimen
Regimen
Þ
Category 1- new TB patients whose sputum is
Category 1- new TB patients whose sputum is
positive; seriously ill patients with severe forms of
positive; seriously ill patients with severe forms of
smear-negative PTB with extensive parenchymal
smear-negative PTB with extensive parenchymal
involvement (moderately- or far- advanced) and
involvement (moderately- or far- advanced) and
extra-pulmonary TB (meningitis, pleurisy, etc.)
extra-pulmonary TB (meningitis, pleurisy, etc.)
Þ
Category 2-previously-treated patients with relapses
Category 2-previously-treated patients with relapses
or failures.
or failures.
Þ
Category 3 – new TB patients whose sputum is smear-negative Category 3 – new TB patients whose sputum is smear-negative
for 3 times and chest x-ray result of PTB minimal for 3 times and chest x-ray result of PTB minimal

Þ
Category 1- new TB patients whose sputum is positive; seriously ill Category 1- new TB patients whose sputum is positive; seriously ill
patients with severe forms of smear-negative PTB with extensive patients with severe forms of smear-negative PTB with extensive
parenchymal involvement (moderately- or far- advanced) and extra- parenchymal involvement (moderately- or far- advanced) and extra-
pulmonary TB (meningitis, pleurisy, etc.) pulmonary TB (meningitis, pleurisy, etc.)


Intensive Phase (given daily for the first 2 months)-
Intensive Phase (given daily for the first 2 months)-
Rifampicin + Isioniazid + pyrazinamide + ethambutol.
Rifampicin + Isioniazid + pyrazinamide + ethambutol.


If sputum result becomes negative after 2 months,
If sputum result becomes negative after 2 months,
maintenance phase starts. But if sputum is still positive
maintenance phase starts. But if sputum is still positive
in 2 months, all drugs are discontinued from 2-3 days
in 2 months, all drugs are discontinued from 2-3 days
and a sputum specimen is examined for culture and drug
and a sputum specimen is examined for culture and drug
sensitivity. The patient resumes taking the 4 drugs for
sensitivity. The patient resumes taking the 4 drugs for
another month and then another smear exam is done at
another month and then another smear exam is done at
the end of the 3
the end of the 3
rd rd
month.
month.
Maintenance Phase (after 3
Maintenance Phase (after 3
rd rd
month, regardless of the
month, regardless of the
result of the sputum exam)-INH + rifampicin daily
result of the sputum exam)-INH + rifampicin daily

Þ
Category 2-previously-treated patients with relapses or failures. Category 2-previously-treated patients with relapses or failures.
Intensive Phase (daily for 3 months, month 1,2 &
Intensive Phase (daily for 3 months, month 1,2 &
3)-
3)-
Isioniazid+ rifampicin+ pyrazinamide+
Isioniazid+ rifampicin+ pyrazinamide+
ethambutol+ streptomycin
ethambutol+ streptomycin
for the first 2 months
for the first 2 months
Streptomycin+ rifampicin pyrazinamide+
Streptomycin+ rifampicin pyrazinamide+
ethambutol on the 3
ethambutol on the 3
rd rd
month. If sputum is still
month. If sputum is still
positive after 3 months, the intensive phase is
positive after 3 months, the intensive phase is
continued for 1 more month and then another
continued for 1 more month and then another
sputum exam is done. If still positive after 4
sputum exam is done. If still positive after 4
months, intensive phase is continued for the next
months, intensive phase is continued for the next
5 months.
5 months.
Maintenance Phase (daily for 5 months, month
Maintenance Phase (daily for 5 months, month
4,5,6,7,& 8)-
4,5,6,7,& 8)-
Isionazid+ rifampicin+ ethambutol
Isionazid+ rifampicin+ ethambutol



Þ
Category 3 – new TB patients whose sputum is smear-negative for 3 times Category 3 – new TB patients whose sputum is smear-negative for 3 times
and chest x-ray result of PTB minimal and chest x-ray result of PTB minimal
Þ
Intensive Phase (daily for 2 months) –
Intensive Phase (daily for 2 months) –
Isioniazid + rifampicin + pyrazinamide
Isioniazid + rifampicin + pyrazinamide
Þ
Maintenance Phase (daily for the next 2
Maintenance Phase (daily for the next 2
months) - Isioniazid + rifampicin
months) - Isioniazid + rifampicin

Þ
Stop TB ; Do it with DOTS
Stop TB ; Do it with DOTS
Þ
Advocacy
Advocacy
is a planned and continuous effort to inform
is a planned and continuous effort to inform
people about issue and instigate change. Advocacy
people about issue and instigate change. Advocacy
usually takes place over an extended period of time and
usually takes place over an extended period of time and
includes a variety of strategies to communicate a specific
includes a variety of strategies to communicate a specific
message.
message.
Þ
TB
TB
is the
is the
number one infectious killer in the world
number one infectious killer in the world
.
.
Þ
One TB suspect can infect another 10 healthy persons
One TB suspect can infect another 10 healthy persons

Þ
Leprosy Control Program
Leprosy Control Program
Þ
WHO Classification – basis of multi-drug therapy
WHO Classification – basis of multi-drug therapy
Þ
Paucibacillary/PB – non-infectious types. 6-9 months of Paucibacillary/PB – non-infectious types. 6-9 months of
treatment. treatment.
Þ
Multibacillary/MB – infectious types. 24-30 months of Multibacillary/MB – infectious types. 24-30 months of
treatment. treatment.
Þ
Multi-drug therapy – use of 2 or more drugs renders
Multi-drug therapy – use of 2 or more drugs renders
patients non-infectious
patients non-infectious
a week
a week
after starting
after starting
treatment
treatment
Þ
Patients w/ single skin lesion and a negative slit skin smear Patients w/ single skin lesion and a negative slit skin smear
are treated w/ a single dose of ROM regimen are treated w/ a single dose of ROM regimen
Þ
For PB leprosy cases- Rifampicin+Dapsone on Day 1 then For PB leprosy cases- Rifampicin+Dapsone on Day 1 then
Dapsone from Day 2-28. 6 blister packs taken monthly Dapsone from Day 2-28. 6 blister packs taken monthly
within a max. period of 9 mos. within a max. period of 9 mos.

Þ
All patients who have complied w/ MDT are considered All patients who have complied w/ MDT are considered
cured and no longer regarded as a case of leprosy, even if cured and no longer regarded as a case of leprosy, even if
some sequelae of leprosy remain. some sequelae of leprosy remain.
Þ
Responsibilities of the nurse Responsibilities of the nurse
Þ
Prevention – health education, healthful living through Prevention – health education, healthful living through
proper nutrition, adequate rest, sleep and good personal proper nutrition, adequate rest, sleep and good personal
hygiene; hygiene;
Þ
Casefinding Casefinding
Þ
Management and treatment – prevention of secondary Management and treatment – prevention of secondary
injuries, handling of utensils; special shoes w/ padded injuries, handling of utensils; special shoes w/ padded
soles; importance of sustained therapy, correct dosage, soles; importance of sustained therapy, correct dosage,
effects of drugs and the need for medical check-up from effects of drugs and the need for medical check-up from
time to time; mental & emotional support time to time; mental & emotional support
Þ
Rehabilitation-makes patients capable, active and self- Rehabilitation-makes patients capable, active and self-
respecting member of society. respecting member of society.

Þ
Control of Schistosomiasis – a tropical disease caused
Control of Schistosomiasis – a tropical disease caused
by a blood fluke, Schistosoma
by a blood fluke, Schistosoma
Japonicum
Japonicum
; transmitted
; transmitted
by a tiny snail
by a tiny snail
Oncomelania quadrasi
Oncomelania quadrasi
Þ
Preventive measures – health education regarding
Preventive measures – health education regarding
mode of transmission and methods of protection;
mode of transmission and methods of protection;
proper disposal of feces and urine; improvement of
proper disposal of feces and urine; improvement of
irrigation and agriculture practices
irrigation and agriculture practices
Þ
Control of patient, contacts and the immediate
Control of patient, contacts and the immediate
environment
environment
Þ
Specific treatment- Praziquantel – drug of choice
Specific treatment- Praziquantel – drug of choice

Þ
Programs on Filariasis, Malaria and Dengue
Programs on Filariasis, Malaria and Dengue
Hemorrhagic Fever
Hemorrhagic Fever
Þ
Filariasis- a chronic prasitic infection
Filariasis- a chronic prasitic infection
caused by a nematode, Wuchereria
caused by a nematode, Wuchereria
bancrofti.
bancrofti.
Young and adult worms
Young and adult worms
live in the
live in the
lymphatic vessels and nodes, while the
lymphatic vessels and nodes, while the
micro filariae are in the blood; transmitted
micro filariae are in the blood; transmitted
through bites from an infected female
through bites from an infected female
mosquito, Aedes
mosquito, Aedes
poecilius,
poecilius,
that bites at
that bites at
night.
night.
Þ
Treatment: Diethylcarbamazine citrate or
Treatment: Diethylcarbamazine citrate or
Hetrazan
Hetrazan
Þ
Elephantiasis and Hydrocoele are handled
Elephantiasis and Hydrocoele are handled
through surgery, prevention and supportive
through surgery, prevention and supportive
care
care



Malaria – infection caused by the bite of the
Malaria – infection caused by the bite of the
female
female
Anopheles
Anopheles
mosquito,
mosquito,
Þ
Chemoprophylaxis – Chloroquine taken at weekly
Chemoprophylaxis – Chloroquine taken at weekly
intervals, starting from 1-2 weeks before entering
intervals, starting from 1-2 weeks before entering
the endemic area.
the endemic area.
Þ
Anti-malarial drugs – sulfadoxine, quiinine
Anti-malarial drugs – sulfadoxine, quiinine
sulfate, tetracycline, quinidine
sulfate, tetracycline, quinidine
Þ
Insecticide treatment of mosquito nets, house
Insecticide treatment of mosquito nets, house
spraying, stream seeding and clearing, sustainable
spraying, stream seeding and clearing, sustainable
preventive and vector control meas
preventive and vector control meas
Dengue H-fever
Dengue H-fever
4 o’clock habit
4 o’clock habit

Þ
Programs on Measles.
Programs on Measles.
Chickenpox, Mumps, Diphtheria,
Chickenpox, Mumps, Diphtheria,
Pertusis, Tetanus –focused on
Pertusis, Tetanus –focused on
health information campaigns
health information campaigns
and intensive immunization of
and intensive immunization of
children in barangays.
children in barangays.

Þ
Prevention and Control Program on Parasitic Infestations
Prevention and Control Program on Parasitic Infestations
( STH e.g. Ascaris, Trichuris, Hookworm) and
( STH e.g. Ascaris, Trichuris, Hookworm) and
Paragonimiasis in communities where eating of fresh or
Paragonimiasis in communities where eating of fresh or
inadequately cooked crab is a practice
inadequately cooked crab is a practice
Management:
Management:
1. Deworming
1. Deworming
2. Health Education re:
2. Health Education re:
Þ
Good personal hygiene Good personal hygiene
Þ
Use of footwear Use of footwear
Þ
Washing fruits and vegetables well Washing fruits and vegetables well
Þ
Use of sanitary toilets Use of sanitary toilets
Þ
Sanitary disposal of garbage Sanitary disposal of garbage
Þ
Boiling drinking water at least 2-3 min. from boiling Boiling drinking water at least 2-3 min. from boiling
point or chlorination point or chlorination

Þ
Prevention and Control on Leptospirosis/
Prevention and Control on Leptospirosis/
Weil’s Disease/ Mud fever/Flood fever/
Weil’s Disease/ Mud fever/Flood fever/
Spirochetal Jaundice thru contact with the
Spirochetal Jaundice thru contact with the
skin/ open wound with water or moist soil
skin/ open wound with water or moist soil
contaminated with urine of infected rat
contaminated with urine of infected rat
Þ
And Rabies
And Rabies

Þ
Mgt. of Rabies Mgt. of Rabies
Þ
Wash wound with soap and water, betadine or alcohol may Wash wound with soap and water, betadine or alcohol may
be applied be applied
Þ
If dog is healthy observe for 14 days. If nothing happens- If dog is healthy observe for 14 days. If nothing happens-
no need for ttt.If it dies or shows rabies, kill then bring no need for ttt.If it dies or shows rabies, kill then bring
head for lab. Exam & consult doctor. head for lab. Exam & consult doctor.
Þ
Active immunization – body develops Ab against rabies up Active immunization – body develops Ab against rabies up
to 3 yrs. to 3 yrs.
Þ
Passive I – giving Ab to persons with head and neck Passive I – giving Ab to persons with head and neck
bites, multiple single deep bites, contamination of mucous bites, multiple single deep bites, contamination of mucous
membranes or thin covering of the eyes, lips or mouth to membranes or thin covering of the eyes, lips or mouth to
provide immediate protection provide immediate protection
Þ
RPO – immunization of pets at 3 mos. of age and yearly RPO – immunization of pets at 3 mos. of age and yearly
thereafter thereafter

Þ
Prevention and Control on STIs
Prevention and Control on STIs
-
Gonorrhea, Syphilis, HIV/AIDS,
Gonorrhea, Syphilis, HIV/AIDS,
Trichomoniasis,Chlamydia, Hep B ( the most serious
Trichomoniasis,Chlamydia, Hep B ( the most serious
type ‘cause of severe cx. Eg.
type ‘cause of severe cx. Eg.
Massive liver damage
Massive liver damage

and
and
hepatocarcinoma
hepatocarcinoma
-
4 C’s
4 C’s
in the Syndromic Mgt
in the Syndromic Mgt
-
1. Compliance
1. Compliance
-
2. Counseling/ Education
2. Counseling/ Education
-
3. Contact tracing to treat partner
3. Contact tracing to treat partner
-
4. Condom use
4. Condom use
-
Hep B vaccination
Hep B vaccination
-
Universal precautions
Universal precautions
-
Safe sex
Safe sex

Other CHN Practice Settings
Other CHN Practice Settings
Þ
I. Occupational Health
I. Occupational Health
Þ
- the application of public health, medical and
- the application of public health, medical and
engineering practice for the purpose of conserving,
engineering practice for the purpose of conserving,
restoring the health and effectiveness of workers thru
restoring the health and effectiveness of workers thru
their places of employment
their places of employment
Þ
A. Occupational Health Nursing
A. Occupational Health Nursing
Þ
- the application of nursing principles and procedures
- the application of nursing principles and procedures
in providing health service to employees in their
in providing health service to employees in their
place of work by means of:
place of work by means of:

Þ
1. prompt and efficient nursing care of the ill
1. prompt and efficient nursing care of the ill
and impaired
and impaired
Þ
2. participation in teaching health and safety
2. participation in teaching health and safety
practices on the job
practices on the job
Þ
3. cooperation with plant department
3. cooperation with plant department
administrators
administrators
Þ
4.keeping the health clinic and staff ready to
4.keeping the health clinic and staff ready to
handle emergencies
handle emergencies
Þ
5. advising workers in the utilization of
5. advising workers in the utilization of
community and welfare services
community and welfare services

Objectives of OHN
Objectives of OHN
Þ
To assist, maintain and promote positive
To assist, maintain and promote positive
health of laborers and employees thru early
health of laborers and employees thru early
detection and prevention of occupational
detection and prevention of occupational
diseases and hazards of industrial processes
diseases and hazards of industrial processes
and by coordinating and cooperating with
and by coordinating and cooperating with
activities of other community health and
activities of other community health and
welfare services
welfare services

Nurse’s Role in OHN
Nurse’s Role in OHN
Þ
1. Assists/participates in developing an adequate health
1. Assists/participates in developing an adequate health
program for workers and laborers including sound
program for workers and laborers including sound
health education activities
health education activities
Þ
2. Encourages periodic P.E.
2. Encourages periodic P.E.
Þ
3. Cooperates with occupational medical programs in
3. Cooperates with occupational medical programs in
the prevention of accidents as well as in the
the prevention of accidents as well as in the
promotion of good working atmosphere and
promotion of good working atmosphere and
relationships in the place of work
relationships in the place of work
Þ
4. Helps in teaching others in giving good nursing care
4. Helps in teaching others in giving good nursing care
to the sick or handicapped in their own homes
to the sick or handicapped in their own homes

Þ
II. School Health Nursing
II. School Health Nursing
Þ
School Health Triad :
School Health Triad :
Þ
1. SERVICE
1. SERVICE
Þ
2. EDUCATION
2. EDUCATION
Þ
3. ENVIRONMENT
3. ENVIRONMENT

Þ
Mission of School Health Program:
Mission of School Health Program:
To maximize potential for learning and
To maximize potential for learning and
participation in the educational process by
participation in the educational process by
promoting optimum health of school-age
promoting optimum health of school-age
children and adolescents
children and adolescents

Þ
School Health Team:
School Health Team:
Þ
Psychologist/ Counselor
Psychologist/ Counselor
Þ
Teacher
Teacher
Þ
Nutritionist
Nutritionist
Þ
Nurse
Nurse
Þ
Social Workers
Social Workers
Þ
Maintenance Personnel
Maintenance Personnel

Þ
Targets in SHN
Targets in SHN
Þ
Family
Family
Þ
Students
Students
Þ
Teachers
Teachers
Þ
Supportive Personnel
Supportive Personnel
Þ
Community
Community

Þ
School Health Nurse’s Roles:
School Health Nurse’s Roles:
Þ
EDUCATOR
EDUCATOR
Þ
CONSULTANT /RESEARCHER
CONSULTANT /RESEARCHER
Þ
STUDENT, FAMILY AND STAFF
STUDENT, FAMILY AND STAFF
ADVOCATE/CHANGE AGENT
ADVOCATE/CHANGE AGENT
Þ
HEALTH SCREENER
HEALTH SCREENER
Þ
HEALTH CARE PROVIDER
HEALTH CARE PROVIDER

Þ
Common Health Concerns of Schoolchildren:
Common Health Concerns of Schoolchildren:
1.Drug and Alcohol Abuse
1.Drug and Alcohol Abuse
2. STDs/STIs
2. STDs/STIs
3. Teenage Pregnancies
3. Teenage Pregnancies
4. Mental Health
4. Mental Health
5. Dermatological Disorders- pimples/acne,
5. Dermatological Disorders- pimples/acne,
fungal infections, allergies
fungal infections, allergies
6. Respiratory Conditions- asthma, URTI
6. Respiratory Conditions- asthma, URTI
7. Nutrition
7. Nutrition
8. Dental Health
8. Dental Health

Þ
There was a man who saw a scorpion
There was a man who saw a scorpion
floundering around in the water.
floundering around in the water.
Þ
He decided to save it by stretching out his finger
He decided to save it by stretching out his finger
but the scorpion stung him.
but the scorpion stung him.
Þ
The man still tried to get the scorpion out of the
The man still tried to get the scorpion out of the
water but the scorpion stung him again.
water but the scorpion stung him again.
Þ
Another man nearby told him to stop saving the
Another man nearby told him to stop saving the
scorpion but the man said, “It’s the nature of the
scorpion but the man said, “It’s the nature of the
scorpion to sting. It’s my nature to love, why
scorpion to sting. It’s my nature to love, why
should I give up my nature to love just because
should I give up my nature to love just because
it’s the nature of the scorpion to sting?”
it’s the nature of the scorpion to sting?”

Þ
Don’t give up
Don’t give up
loving, don’t give
loving, don’t give
up your goodness
up your goodness
even if people
even if people
around you sting…
around you sting…

T
T
H
H
E
E

E
E
N
N
D
D

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