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- a group of people with common characteristics or interests living together within a territory or geographical boundary - place where people under usual conditions are found What is community health ? - part of paramedical and medical intervention/approach which is concerned on the health of the whole population - aims: 1. health promotion 2. disease prevention 3. management of factors affecting health What is nursing ? - assisting sick individuals to become healthy and healthy individuals achieve optimum wellness. What is Community Health Nursing ? “The utilization of the nursing process in the different levels of clientele-individuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation.” - Maglaya, et al BASIC PRINCIPLES OF CHN • • • • • COMMUNITY is the patient in CHN. FAMILY is the unit of care. The client is considered as an ACTIVE partner NOT PASSIVE recipient of care. The goal of CHN is achieved through MULTI-SECTORAL EFFORTS. CHN is a part of health care system and the larger human services system.
HEALTH TEACHING is a primary responsibility of a CHN nurse • CHN must be available to all regardless of race, creed and socioeconomic status. • The CHN Nurse makes use of available community health resources. • There must be provision for periodic evaluation of CHN services. Roles of the PUBLIC HEALTH NURSE • • • • CLINICIAN, who is a health care provider, taking care of the sick people at home or in the RHU HEALTH EDUCATOR, who aims towards health promotion and illness prevention through dissemination of correct information; educating people FACILITATOR, who establishes multi-sectoral linkages by referral system SUPERVISOR, who monitors and supervises the performance of midwives
FIVE FOLD MISSION OF CHN 1. 2. 3. 4. 5. Health promotion Health protection Health balance Disease prevention Social justice
COMMUNITY HEALTH NURSING PROCESS A. Assessment 1. Initiate contact 2. Demonstrate caring attitude 3. Mutual trust and confidence 4. Collect data from all possible sources 5. Identify health problems Categories: Health deficit- occurs when there is a gap between actual and achievable health status. Health threats- conditions that promote disease or injury and prevent people from realizing their health potential. Foreseeable crisis- includes stressful occurrences such as death or illnesses of a family member. Health need- exists when there is a health problem that can be alleviated with medical or social technology. Health problem- is a situation in which there is a demonstrated health need. 6. Assess coping ability. 7. Analyze and interpret data. B. Planning 1. Prioritize needs. 2. Establish goals based on needs and capabilities . 3. Construct action and operational plan. 4. Develop evaluation parameters. C. Implementation of Planned Care 1. Put plan into action 2. Coordinate care/ services 3. Utilize community resources 4. Delegate, supervise and monitor services provided 5. Document responses to nursing actions D. Evaluation of care and services rendered 1. Monitor outcomes 2. Performance appraisal 3. Estimate cost benefit ratio 4. Assessment problems 5. Identify needed alterations 6. Revise plan as needed MODERN CONCEPT OF HEALTH - Refers to the optimum level of individuals, families and communities FACTORS AFFECTING OLOF: BHHEPS • Behavioral • Heredity • Health Care delivery system • Environment • Political • Socio-economic
TEN DETERMINANTS OF HEALTH 1. Gender 2. Genetics 3. Education 4. Employment 5. Culture 6. Health services 7. Income 8. Personal behavior 9. Physical environment 10. Social support network COMMUNITY HEALTH NURSING GOAL: To raise the health of the citizenry. Main activity: Health teaching (health promotion) PHILOSOPHY: Worth and dignity of man. DEPARTMENT OF HEALTH VISION: The DOH is the leader, staunch advocate and model in promoting Health for All in the Philippines. MISSION: NEW- guarantee equitability, sustainability and quality of life for all Filipinos especially for the poor and shall lead the quest for excellence in heath OLD: ensure accessibility and quality of life, for all Filipinos especially the poor GOAL: Health Sector Reform Agenda (HSRA) Framework for implementation of HSRA: FOURmula ONE for Health GOALS of FOURmula ONE for Health: (BEM) 1. Better health outcomes 2. Equitable health care financing 3. More responsive health systems FOUR elements of the strategy: • Health Care Financing • Health regulation • Health service delivery • Good health governance ROLES OF DOH (LEA) 1. Leadership in Health 2. Enabler and Capacity Builder 3. Administrator of specific services
PRIMARY HEALTH CARE GOAL: Health for all Filipinos in the year 2000 and in the hands of the people in the year 2020 MISSION: Strengthen health care delivery system 5 STAKEHOLDERS OF HEALTH 1. 2. 3. 4. 5. LGU DOH Philhealth Insurance Corporation Communities NGO’s
NURSING ROADMAP - Originated 2007 - Transformation Program of Nursing Profession - adopted from Public governance system (PGS), as instituted by Institute for Solidarity in Asia (ISA) June 5, 2008 - signing of the nursing roadmap by the COORDINATING BODY FOR GOOD GOVERNANCE OF THE NURSING PROFESSION (CBGGNP) and PHILIPPINE NURSNG ORGANIZATION (PNA) Association of Deans of Philippine College of Nursing (ADPCN)- minor player for nursing roadmap. VISION: By 2030, the Philippines shall be the lead in promoting professional nursing in the Asia Pacific Region. MISSION: We, the Filipino nurses are committed to provide society with professional nursing service through innovations in education and training, research and management that will improve the well-being and quality of life BALANCED SCOREBOARD implementation of nursing roadmap Developed by OHNAP for executing the Nursing Roadmap
4 BROAD PERSPECTIVES: 1. Learning and Growth 2. Internal processes 3. Customer perspectives 4. Financial perspectives STRATEGIC OBJECTIVES DSL GG 1. 2. 3. 4. 5. Dynamic leaders Standards Good governance Linkages Growth and Productivity
NATIONAL HEALTH PLAN The blueprint defining the country’s: PPST PROBLEMS, POLICY THRUSTS, STRATEGIES and THRUSTS Caters from 1995-2020 A long term directional plan for health.
GOAL: To enable the Filipino to achieve a level of health that is accessible. OBJECTIVE: Equity- Achieve “ Health for all by year 2020” PRIMARY HEALTH CARE- strategy of NHP MAJOR HEALTH PLANS TOWARDS “HEALTH IN THE HANDS OF THE PEOPLE IN THE YEAR 2020” “23 IN 1993” • refers to the 23 programs, projects, activities of the DOH for the year 1993, which marks the beginning of its journey towards DOH vision “Health for more in ‘94” • activities in 1994 focused on Cancer prevention, Reproductive health, • Mental health and maintenance of a safe environment “Health Focus in 1995”… “Think Health, Health Link” In lieu of “Five in ‘95”, DOH characterized what a… Healthy __________________ should be: BARRIO► Residents actively participate in attaining good health; they are • PARTNERS in health care • Highlight Project: BOTIKA SA PASO CAMPAIGN Goal : to maintain herbal plants in pots for family use CITY ► The physical environment in the workplace, streets, and public places promotes health, safety, order, and cleanliness through structural manpower support • Health-related Strategies: Construction of well-maintained, income-generating public toilets; designation of a “Pook-Sakayan, Pook-Babaan” MARKET ► adequate water supply ► proper drainage ► well-maintained toilet facilities ► proper garbage and waste disposal is observed by vendors ► cleanliness maintained ► affordable quality foods ► has a well-organized and honest market system HOSPITAL ► A “CENTER OF WELLNESS” ► Promotes preventive care ► provides clean and adequate resources, affordable and accessible services ► Patient-centered ► Governed by competent health team members and personnel
SCHOOL ► Health instructions provided through classroom/extra-curricular activities ► Maintains adequate, basic health services to both pupils, teachers, and other personnel Sample School Initiative : Little Doctor Program - outstanding students are chosen yearly on the bases of their healthy conditions and lifestyles STREET ► Well-maintained roads and public waiting areas ► Well-marked traffic signs and pedestrian crossing lane and visible street names ► Clean and obstruction-free sidewalks ► With minimal traffic problems ► With adequate strict law enforcement Project: Pook-Tawiran (Kapag ikaw ay nahuli, walang sisihan) Goal : To promote and reorient people especially erring pedestrians on the use of pedestrian crossings. PRISON ► Physical Environment: clean, safe detention place with adequate facilities ► Psychosocial Environment: services address the mental, spiritual, physical, social and economic needs of inmates; has an atmosphere that actively promotes JUSTICE, PEACE, REHABILITATION and a HEALTHY LIFESTYLE PRIMARY HEALTH CARE • PHC was declared in the ALMA ATA CONFERENCE in 1978, as a strategy to community health development. It is a strategy aimed to provide essential health care that is: • Community-based • Accessible • Part and parcel of the total socio-economic development effort of the nation • Acceptable • Sustainable at an affordable cost. Framework People’s Empowerment and Partnership is the Key Strategy to achieve the goal, “Health For all Filipinos by the year 2000 And Health in the Hands of the People by the year 2020” 4 PILLARS OF PHC: (MAPS) 1. Multi-sectoral approach 2. Appropriate technology 3. Participation active 4. Support system available
3 LEVELS OF PREVENTION PRIMARY LEVEL Health Promotion and Illness Prevention
Provided at – ► Health care/RHU ► Brgy. Health Stations ►Main Health Center ►Community Hospital and Health Center ►Private and Semiprivate agencies
SECONDARY LEVEL TERTIARY LEVEL Prevention Prevention of Disability,etc ofComplications thru EarlyDx and Tx
When hospitalization is deemed necessary and referral is made to emergency (now district), provincial or regional or private hospitals When highlyspecialized medical care is necessary ► referrals are made to hospitals and medical center such as PGH, PHC, POC, National Center for Mental Health, and other gov’t private hospitals at the municipal level hospitals
TYPES OF PRIMARY HEALTH WORKERS Village/Grassroots Health Workers
EXAMPLE Trained Community Health worker; • health Auxiliary volunteer; • Traditional Birth Attendant • • • Initial link, 1st contact of the Community Work in liaison w/ the local health service workers Provide elementary curative preventive health care measures •
Intermediate Level Health Personnel of First-Line Hospitals
• • • • General Medical Practitioners Public Health Nurses Midwives • • • Physicians with specialty area Nurses Dentists
1st source of professional health care • Attend to health problems beyond the competence of village health Workers • Provide support to the frontline health workers in terms of supervision, training, referral services and supplies thru linkages with other sectors
Establish close contact with the village and intermediate level health workers to promote the continuity of acre from hospital to community to home Provide back-up health services for cases requiring hospital or diagnostic facilities not available in health care.
WHAT DOES ESSENTIAL HEALTH CARE IN PHC MEANS? Acronym: ELEMENTS + DAM • Education of prevailing Health Problems • Locally-endemic Disease Prevention and Control • Expanded Program of Immunization • Maternal and Child Health and Family Planning • Environmental Sanitation and Safe Water Supply • Nutrition and Food Supply • Treatment of Communicable & Non-communicable Diseases/ Conditions • Supply and Proper use of Essential Drugs and Herbal Medicine • Dental Health Promotion • Access to and use of hospitals as Centers of Wellness • Mental Health Promotion MILLENIUM DEVELOPMENTAL GOALS -Formulated in the year 2000 by the UN general assembly. PEGCMMEG • Poverty eradication(2015) • Education • Gender equality • Child mortality to decrease • Malaria/AIDS to combat • Maternal health • Environment sustainability • Global partnership Expanded Program on Immunization Goal: morbidity and mortality reduction of immunizable diseases • LEGAL BASIS- PD 996-Compulsary, Basic Immunization for children 8 years old and below (0-8 y/o), thus covers 2 age groups - infants WEDNESDAY- designated as IMMUNIZATION DAY ELEMENTS OF EPI: • Target setting • Information, education and communication • Cold chain logistic management • Surveillance and evaluation PRINCIPLES IN VACCINATING CHILDREN • • • • • • It is safe and immunologically effective to administer all EPI vaccines on the same day at different sites of the body. The vaccination schedule should not be restarted from he beginning even if the interval between doss exceeded the recommended intervals by months or years. Giving doses of a vaccine at less than the recommended 4 weeks interval may lessen the antibody response. Lengthening the interval between doses of vaccine leads to higher antibody levels. No extra doses must be given to children/mother who missed a dose of DPT/HB/OPV/TT. The vaccination must be continued as if no time had elapsed between doses. It is safe and effective with mild side effects after vaccination. Local reaction, fever and systemic symptoms can result as part of the normal immune response. Use one syringe one needle per child during vaccination.
Schedule: • • • • At birth: BCG 1 ½ months: First doses of DPT, Hep B, OPV 2 ½ months: Second doses of DPT, Hep B, OPV 3 ½ months: Third doses of DPT, Hep B, OPV
Tetanus Toxoid: • First Pregnancy: TT1- 5th to 6th mo of pregnancy, after 4 weeks TT2 (3 years immunity) • Second Pregnancy: TT3 (1st booster dose) – 5th to 6th (5 years immunity) • Third Pregnancy: TT4 (2nd booster dose) – 5th to 6th (10 years immunity) • Fourth Pregnancy: TT5 (3rd booster dose) – 5th to 6th (life-long long immunity) Administration: • • • • • • • BCG: (infants) 0.05 ml intradermal (school entrants) 0.10 ml intradermal DPT: 0.5 ml intramuscular Hepa B: 0.5 ml intramuscular OPV: 2 drops per orem Measles: 0.5 ml subcutaneous Tetanus toxoid: 0.5 ml intramuscular
TARGET-SETTING • involves the calculation of the eligible population. “Eligible population consists of any group of people targeted for specific immunizations due to their susceptibility to one or several of the EPI diseases.”
VACCINE COMPUTATION: I. Compute for the eligible population= Total population x : Infant/school age= 0.03 Pregnant woman= 0.035 Polio outbreak= 11.5 Measles outbreak= 14.5 II. Determine Annual Dose-doses required in a year for complete coverage AD = EP x BCG- 1 OPV-3 HB-3 MEASLES-1 TT-5 III. Determine Wastage Allowance Wastage Dose = Annual Dose x % wastage allowance AD X BCG e, DPT/TT,OPV} 1.67 HB- 1.2 M-2 BCG I- 2.5
IV. COMPUTED ALLOWANCE= Wastage allowance # of recipients All vaccines are 20 except BCG E, MEASLES= 10 OPV=25 V. OVERALL TOTAL= CA X 1.25 After rounding off, always add 1 COLD CHAIN A system used to maintain the potency of a vaccine from that of manufacture to the time it is given to child or pregnant woman. Principles: I. Storage Storage of vaccine should not exceed: • - 6 mos. @ the Regional Level • - 3 mos. @ the Provincial Level/District Level • - 1 mo. @ Main Health Centers (with refrigerators) • - not more than 5 days @ Health Centers (using transport boxes) Important points to remember: Arranging of stored vaccine according to : • Type • Expiration date • Duration of Storage • # of times they have been brought out to the field EPIDEMIOLOGY - Backbone in the prevention of the disease. - the study of occurrence and distribution of a disease as well as the distribution and determinants of health states or events in a specified population The EPIDEMIOLOGIC TRIANGLE: Agent- the intrinsic property of microorganisms to survive and multiply in the environment to produce disease Host- (intrinsic factors)- influences exposure, susceptibility or response to agents Environment- (extrinsic factors)- influences the existence of the agent, exposure, or susceptibility to agent. OUTLINE PLAN FOR EPIDEMIOLOGICAL INVESTIGATION 1. Establish fact of the presence of epidemic • Verify diagnosis- do clinical and laboratory studies t confirm the data 2. Establish time and space relationship of the disease • Are the cases limited to or concentrated in any particular geographical subdivision of the affected community? • Relation of cases by days of onset to onset of the first known cases- maybe done by days, week or months. 3. Relations to characteristic of the group of community • Relation of cases to age, group, sex, color, occupation, school attendance, past immunization • Relation to milk and food supply • Relation of cases and known carriers if any
4. Correlation of all data obtained • Summarize the data clearly with the aid of such tables and charts which are necessary to give a clear picture of the situation • Build up the case for the final conclusion carefully utilizing all the evidence available. STAGES OF A DISEASE: BACKBONE TO CONTROL A DISEASE • • • • Incubation period- exposure to an infection to the appearance of the first symptom Prodromal period- from the appearance of the first symptom to the appearance of a pathognomonic sign Stage of illness- a stage where the patient manifest most of the signs and symptoms Convalescence- stage of recovery, and a gradual decrease of symptoms manifested
Patterns of Disease Occurrence • • • • Epidemic-high incidence of new cases of a specific disease in excess of the expected. Endemic- habitual presence of a disease. Sporadic- disease occurs every now and then. Pandemic- global occurrence of a disease
National Epidemic Sentinel System (NESS) - hospital-based information system that monitors the occurrence of infectious diseases with outbreak potential. Why is there a need to investigate an outbreak? 1. Control and prevention measure 2. Severity and risks to others 3. Research opportunities 4. Public, political and legal concerns 5. Program consideration 6. training VITAL STATISTICS Refers to the systematic study of vita events such as births, illnesses, marriages, divorce, separation and deaths. RATE- the relationship between a vital event and those persons exposed to the occurrence of the said event RATIO- the relationship between two numerical quantities or measures of events without taking particular consideration to the time or place. USE OF VITAL STATTISTICS: 1. Indices of the health and illness status of the community 2. Serves as the bases for planning, implementing, monitoring and evaluating community health nursing programs and services SOURCES OF DATA: 1. Population census 2. Registration of vital data 3. Health survey 4. Studies and researches
CRUDE OR GENERAL RATES- refers to the total living population SPECIFIC RATE- the relationship for a specific population class or group CRUDE BIRTH RATE- natural growth or increase of a population CBR- Total # of live births in a given calendar year Estimated population as July 1 of same year x 1,000 CRUDE DEATH RATE CDR- Total # of deaths in a given calendar year Estimated population as July 1 of same year
INFANT MORTALITY RATE- a good index of the general health condition of a community. IMR- Total # of death under 1 year of age registered in a given year Total # of live births of the same calendar year x 1,000 MATERNAL MORTALITY RATE- an index of the obstetrical care needed and received by women in a community MMR- Total # of deaths from maternal causes registered in a given year Total # of live births of the same calendar year x 1,000 FETAL DEATH RATE- measures pregnancy wastage FDR- Total # of FETAL deaths registered in a given year Total # of live births of the same calendar year x 1,000 NEONATAL DEATH RATE- an index of the effects of prenatal care and obstetrical management of the newborn NDR- Total # of deaths under 28 days of age registered in a given year Total # of live births of the same calendar year x 1,000 SPECIFIC DEATH RATE SDR- Deaths in specific class or group registered in a given calendar year x 100,000 Estimated population as July 1 of same specified class or group of the sad year EXAMPLES: CSDR, ASDR, SSDR CSDR- # of deaths from a specific cause registered in a given calendar year Estimated population as July 1 of same year x 100,000 ASDR- # of deaths in particular age group registered in a given calendar year Estimated population as July 1 of same year x 100,000 SSDR- # of deaths in certain sex registered in a given calendar year Estimated population as July 1 of same year x 100,000 ATTACK RATE- a more accurate measure of the risk of exposure AR- # of persons acquiring a disease # of exposed to same disease in same year x 100 INCIDENCE RATE- measures the frequency of occurrence of the phenomenon during a given period of time IR- # of new cases of particular disease during a specified period of time Estimated population as of July 1 of the same year x 100,000
PREVALENCE RATE PR- # of new and old cases of a certain disease during a specified period of time Total # of persons examined at same given time x 100 CASE FATALITY RATIO- index of a killing power of a disease CFR- # of registered deaths from a specific disease for a given year # of registered cases from same specific disease in same year FIELD HEALTH SERVICE INFORMATION SYSYTEM (FHSIS) A recording system that may give a picture about the accomplished indicators at the brgy. Community, district, provincial, regional and national levels. COMPONENTS: 1. Family Treatment record- the fundamental building block - the form or piece of paper upon which recorded the presenting symptoms or complaints of the patient 2. Target client list - to plan and carry out patient care and service delivery - to report services delivered 2. Tally/ Reporting forms- only mechanism through which date are routinely transmitted from one facility to another. Reports are submitted directly to the PROVINCIAL HEALTH OFFICE. TALLY/REPORTING FORMS FHIS/ E- deaths E-1- notification of death form E-2- Maternal death form E-3- Perinatal Death form FHSIS/M- monthly M-1- Monthly Field Health service Activity report M-2- Monthly natality report M-3- Monthly Mortality report M-4- Monthly laboratory report M-5- Monthly Dental report M-6- Family Planning Subsidized Surgical Procedure Report M-7- Monthly Social Hygiene Clinic Activity Report FHSIS/Q- Quarterly Q-1- Quarterly Field Health Service Activity Report Q-2- Quarterly Dental Facility Inspection Report Q3- Quarterly Environmental Health Activities Q-4- Quarterly Reports of Malaria Control Activities Q-5- Drugs And Supplies Quarterly Status Report Q-6- Laboratory Supplies Quarterly Status Report DISEASES UNDER SURVELLANCE (NESS): Laboratory diagnosed: 1. Cholera 2. Hepatitis A 3. Hepatitis B 4. Malaria 5. Typhoid fever
Clinically diagnosed: 1. DHF 2. Diphtheria 3. Measles 4. Meningococcal disease 5. Neonatal tetanus 6. Non neonatal tetanus 7. Pertussis 8. Rabies 9. Leptospirosis 10. Poliomyelitis Under Surveillance system: 1. Poliomyelitis 2. Measles 3. Maternal and neonatal tetanus 4. Paralytic shellfish poisoning 5. Fireworks and related injury 6. HIV/AIDS COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH
-A process in which the PHN and the community are identifying community problems that will serve as basis in formulating community programs -It is derived and will be the bases for developing and implementing CHN intervention and strategies. -
To bring about social - A PROCESS of enhancing community participation and and behavioral development to prepare people to changes, social organizations, ideology become the manager of their own and change agents are community in the future. needed. Often termed as EMPOWERMENT of building the capability of people for future community action.
COPAR Pre entry phase: Selection of Site 1. Underserved community 2. Lack of health services in the community 3. Poor health status 4. Relative peace and order 5. Acceptable by the community 6. No health related organizations/programs conducted in the place to prevent duplication and competition Entry phase 1. Organize core group criteria 2. Educate the people 3. Collect the data 4. Involve the people in the prioritization of identified needs and problems Organization and Building phase 1. Community organization 2. Election of officers Sustenance and strengthening phase Phase out
COMMUNITY ORGANIZING PARTICIPATORY ACTION COMMUNITY ORGANIZING RESEARCH I. Pre- entry Community Analysis/ Diagnosis/ Mapping
ACTIVITIES 1. 2. 3. 4. 5. 6. 1. 2. Area selection Contact persons Courtesy calls Introduction of self Leaders meet Agenda setting Family hosting Core group formation
II. Entry phase
Design and Initiation
III. Organization and Building Implementation phase IV. Sustenance and strengthening phase V. Phase out Program maintenanceConsolidation Dissemination/ Reassessment Commitment Organization How can I leave the people ? When to leave the people?
WHEN? • Change in attitude • Objectives meet • Resources maximized HOW? • Pull out intervention • Institutionalization • Consultancy services 10 MEDICINAL PLANTS: LUBBY SANTA Lagundi Sambong Ulasimang-Bato Ampalaya Bawang Niyog-niyogan Bayabas Tsaang gubat Yerba-buena Akapulko RA 8423: utilization of medicinal plants as alternative for high cost medications. Policies: 1. The indications/uses of plants 2. The part of the plant to be used 3. Preparation of a. Decoction e. oils b. Poultice f. ointment c. Infusion g. tincture d. Syrup h. Elixir
HERBAL MEDICINES COMMON NAME SCIENTIFIC NAME INDICATIONS
S- skin diseases A-aromatic bath R- rheumatism A- asthma, body aches H- headache, cough Gouty arthritis Hypertension, toothache Mouthwash, wound wash, diarrhea SARAH + menstrual pains, insect bites, headaches, body pans S- skin diseases A-aromatic bath R- rheumatism A- asthma, body aches H- headache, cough Gouty arthritis Hypertension, toothache Mouthwash, wound wash, diarrhea SARAH + menstrual pains, insect bites, headaches, body pans
Ulasimang bato Bawang Bayabas Yerba Buena
Peperonia pellucida Allium sativum Psidium guava Mentha cordifolia
Ulasimang bato Bawang Bayabas Yerba Buena
Peperonia pellucida Allium sativum Psidium guava Mentha cordifolia
CHN PROCEDURES CLINIC VISIT I. Admission/Registration II. Waiting time III. Triaging a. IMCI b. Control of diarrheal diseases IV. Clinical evaluation a. Evaluate the c/c,hx, P.E b. Evidenced based practice/medicine c. Illness, treatment and prevention V. Laboratory test and other DX examinations a. Benedict´s test b. Heat and acetic acid test VI. Referral-2-way referral system VII. Prescription and Dispensing VIII. Health education
HEAT AND ACETIC ACID TEST Place 3-5 m of urine + 6-8 drops of heat + acetic acid solution then pre heat in bunsen burner Observe for precipitation or cloudiness Cloudy- + for protein (PIH)
BENEDICT’S TEST – determination of glucose content - Pour 3-5 ml of benedict’s solution + 6-8 drops of urine - Heat for 3 minutes in a bunsen burner RESULT: Blue- negative Green- trace (+1)-normal for pregnant woman Yellow- +2 Orange- +3 Red-+4 HOME VISIT- a nurse –family contact which allows the health worker to asssess the home and family situations in order to provide the necessary nursing care and health related activities PUROSES OF A HOME VISIT: 1. Give nursing care to the sick, postpartum mother and her newborn 2. Assess the living condition of the patient and his family and the health practices 3. Give health teaching regarding the prevention and control of disease 4. Establish close relationship between agencies and the public for the promotion of health 5. Make use of the inter-referral system and to promote the utilization of community services PRINCIPLES OF A HOME VISIT • • • • • Must have a purpose or objective. Must use all available information about the patient and his family Must give priority to the essential needs of the family The planning and delivery must involve the individual and his family. Must be flexible
IMPORTANT POINTS TO REMEMBER: 4 C’s + H 1. Contains all the necessary articles, supplies and equipment to answer emergency needs 2. Cleaned very often, supplies replaced and ready for use anytime. 3. Consider the bag and its contents clean and sterile, while articles belonging to the patient as dirty and contaminated. 4. Collection of article should be convenient to the user, to facilitate efficiency and avoid confusion, proper arrangement must be maintained. 5. Handwashing is done as frequently as situation for, helps minimizing and avoiding contamination of the bag and its contents.
STEPS IN CONDUCTING HOME VISIT I. II. III. IV. V. VI. VII. VIII. Greet Purpose Health inquiry Bag placement Physical examination Health teaching Record Appointment
BAG TECHNIQUE PHN BAG- essential and indispensable equipment of a PHN PRINCIPLES OF BAG TECHNIQUE: 1. Minimize, if not prevent the spread of any infections. 2. Saves time and effort in the performance of nursing procedure. 3. Show the effectiveness of total care of the individual and the family. 4. Variety of ways should be performed depending on the agency’s policy. PROCEDURE 1. Bag placement- L arm flexed @ 45°; not too close; not too far R arm- long, non folding black umbrella 2. Ask for basin of H2O or glass of water 3. Open/ secure towel/ get soap 4. Handwashing 5. Apron in- right side out 6. Articles out 7. Close CHN bag 8. Physical examination 9. Hand washing and clean articles 10. Articles in 11. Apron out- clean side out 12. Close CHN bag 13. RECORD 14. Setting up next schedule THERMOMETER TECHNIQUE Procedure: 1 cotton ball- dry 3 cotton ball- soap-soaked 3 cotton ball- water- soaked 1 cotton ball- alcohol- final disinfection 1 cotton ball- dry Oral- 2-3 min Rectal- 1 min Axilla- 5-8 min
ISOLATION TECHNIQUE IN THE HOME CONSIDERATIONS: 1. Articles used by the patient should not be mixed with the articles used by other family members. 2. Frequent hand washing and airing of beddings and other articles and disinfection of the room are imperative. Abundant use of soap, water, sunlight and some chemical disinfectants is necessary. 3. The one caring for the sick should be provided with a gown that should be used only within the room. 4. Al discharges from the nose and throat of a communicable disease pt should be carefully discarded. 5. Articles soiled with discharges should be boiled for 30 minutes before washing. MAJOR ENVIRONMENTAL HEALTH AND SANITATION PROGRAMS Water Supply Sanitation Program 3 Types of Approved Water Supply and Facilities: • Level I-Point Source • Level II-Communal faucet system or stand posts • Level III-Waterworks system or individual house connections Proper Excreta and Sewage Disposal System 3 Types of Approved Toilet Facilities: Level 1 Non-water carriage toilet facility: - Pit latrines - Reed Odorless Earth Closet - Bored-hole - Compost - Ventilated improved pit Toilets requiring small amount of water to wash waste into receiving space - Pour flush - Aqua privies Level 2 On site toilet facilities of the water carriage type with water sealed and flushed type with septic vault/tank disposal facilities Level 3 Water carriage types of toilet facilities connected to septic tanks an/or to sewerage system to treatment plant.
FOOD SANITATION PROGRAM 4 RIGHTS IN FOOD SAFETY: 1. Right Source • Always buy fresh meat, fish, fruits and vegetables. • Always look at the expiry date. • Use water only from clean and safe sources 2. Right Preparation • Avoid contact between raw foods and cooked foods. • Always buy pasteurized milk and fruit juices. • Wash vegetables well if to be eaten raw such as lettuce, cucumber, tomatoes and carrots. 3. Right Cooking • Cook food thoroughly and ensure that the temperature on all parts of the food should reach 70 degrees centigrade • Eat cooked food immediately. 4. Right Storage • All cooked foods should be left at room temperature for NOT more then TWO HOURS to prevent multiplication of bacteria. • Store cooked foods carefully. Be sure to use tightly sealed containers for storing food. RULE IN FOOD SAFETY: When in doubt, throw it out! HOSPITAL WASTE MANAGEMENT PROGRAM • • A Hospital Waste management program shall be prepared and implemented as a requirement for renewal /registration of licenses by hospitals. Training of all hospital personnel involved in waste management shall be an essential part of hospital training program.
OTHER PRIORITY HEALTH PROGRAMS SENTRONG SIGLA MOVEMENT -Quality assurance program GOAL: To make DOH and LGU active partners in providing quality health services. Key strategies: 1. Certificate Recognition Program= CRP 2. Continuous Quality Improvement=CQI SENTRONG SIGLA MOVEMENT: Goal: Better quality of life, quality health Objective: Better and more effective collaboration between DOH and LGUs DOH: Provider of technical and financial assistance packages for health care including regulation LGU: Prime developers of heath systems and direst implementers of health programs PILLARS OF SSM: QATH • Quality assurance • Award • Technical and grants assistance • Health promotion What are the agencies that can apply for SSM? This program is intended for RHU’s and Health Centers and not the hospitals.
PU B LIC HEALTH PROGRAMS • Maternal Care Program • Strategies: A. Provision of Regular and Quality Maternal Care Services regular and quality pre-natal care • hx-taking, utilization of HBMR (Home-Based Mother’s Record) • as a guide in the identification of risk factors • PE: weight, height, BP-taking • Perform head-to-toe assessment, abdominal exam • Tetanus Toxoid Immunization • Fe supplementation: given from 5th mo. of pregnancy to two months postpartum (100-120 mg orally/day for 210 days) • Laboratory exam: 1. Heat-acetic acid test. 2. Benedict’s test • Oral/Dental exam ► ► Pre-natal counseling Provision of safe, delivery care • all birth attendants shall ensure clean and safe deliveries at home or at the faciltiies (RHUs/hospitals) • at-risk pregnancies and mothers must be immediately referred to the nearest institution • untrained TBA’s who actively practice must be identified, trained and supervised by a personnel of the nearest BHS/RHU trained on maternal care. ► Provision of quality postpartum care • Proper schedule of follow-up must be followed: • 1st postpartum visit for home deliveries must be done within 2 4 hours after delivery • -2nd, done at least 1 week after delivery • -3rd, done 2- 4 weeks thereafter • Attendants must be aware of the early signs, symptoms and complications. They should follow the 3 CLEANS: CLEAN HAND S CLEAN Surface CLEAN Cor d 3 FACTORS CONTRIBUTING TO PREGNANCY RELATED ILLNESS AND DEATH AMONG MOTHERS AND INFANTS 1. too early pregnancy 2. pregnancy before age 20 or after age 35 3. pregnancy after the 4th baby NUTRITION PROGRAM Goal: The improvement of the nutritional status and quality of life of the population through the adoption of desirable dietary practices and healthy lifestyle. • Villavieja et. al. Rice is the main source of protein among Filipinos • WATER- most essential of all nutrients FILIPINO PYRAMID Fats= 1 serving (eat sparingly) Proteins= 2-4 servings (need some ) Fruits= 2-3 servings Vegetables =3-5 servings
Carbohydrates=6-11 servings (eat more) Fluid= 8-12 servings (drink a lot) Programs and projects: Micronutrient Supplementation To address the health and nutritional needs of infants and children and improve their growth and survival. • Food Fortification -Voluntary fortification of processed foods through the “Sangkap Pinoy seal.” FAMILY PLANNING PROGRAM Methods of Family Planning: I. Spacing A. Hormonal • Oral Contraceptives • Injectables • Inplants B. Barrier • IUD • Condom • Diaphragm, Cervical cap C. Biologic - Lactation-Amenorrhea Method D. Natural - Basal Body Temperature (BBT) • Sympto-thermal • Cervical Mucus ORAL CONTRACEPTIVES • • • • • • • • first 21 pills have a combination of synthetic estrogen and progesterone hormones last 7 pills of a 28-day pack have no hormones and are called spacer pills Pill stops ovulation, preventing the ovaries from releasing eggs thickens cervical mucus, making it harder for sperm to enter the uterus first 21 pills have a combination of synthetic estrogen and progesterone hormones last 7 pills of a 28-day pack have no hormones and are called spacer pills Pill stops ovulation, preventing the ovaries from releasing eggs thickens cervical mucus, making it harder for sperm to enter the uterus • -
Missed Pills: Late Start 1 day late starting the next package: Take 2 pills as soon as you remember and one pill each day after. Use a backup form of birth control for two weeks. 2 days late starting the next package: Take 2 pills per day for 2 days, then continue as usual. Use a backup form of birth control for two weeks. 3 or more days late starting the next package: Call the clinic for instructions.
CONTRACEPTIVE INPLANTS • • • • soft capsules, about 1½ inch long, under the skin in a woman’s upper, inner arm prevents pregnancy by thickening the cervical mucus so that sperm can’t get into the uterus and by stopping ovulation Effective contraception for three years. doesn't interfere with fertility once it's removed
DEPO-PROVERA: AN INJECTABLE CONTRACEPTIVE • • • • • drug very similar to progesterone, a hormone normally produced by the ovaries every month as part of the menstrual cycle prevents pregnancy for up to 3 months with each injection ("shot"). given as 1 shot in the buttock or upper arm first shot should be given within 5 days after the beginning of a normal menstrual period, and shots should be repeated every 3 months. good for 2 years unless no other form of birth control is right for you.
INTRAUTERINE DEVICE (IUD) • • • • a small object that is inserted through the cervix and placed in the uterus to prevent pregnancy can last 1-10 years usually inserted during a menstrual period when the cervix is slightly open and pregnancy is least likely recommended that women check their IUD after each period
CERVICAL CAP (FEMCAP) A silicone cup inserted into the vagina to prevent pregnancy It is recommended that spermicide be added to increase the effectiveness of this method. • Lasts for up to two years • acts by blocking the entrance to the uterus; spermicide acts by killing and immobilizing the sperm, preventing it from fertilizing the egg. II. Permanent (surgical/irreversible) A. Tubal Ligation - done in women; a 15 min. surgical procedure in which the fallopian tubes are tied and cut to prevent passage of sperms B. Vasectomy - done in men, was deferens is tied and cut to block passage of sperm MENTAL HEALTH PROGRAMS 4 FACETS OF MENTAL HEALTH: DEFINED BURDEN- burden currently affecting persons with mental disorders UNDEFINED BURDEN- burden relating to the impact of mental health problems to persons other than the individual directly affected. HIDDEN BURDEN- the stigma and violations of human rights. FUTURE BURDEN- burden in the future resulting from the aging of the population. • •