December 2012 Pnle Pearls of Success Part 3: Community Health Nursing

WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS

PART 3: COMMUNITY HEALTH NURSING
A. DOH Vision 2030
A Global Leader for attaining better health outcomes,
competitive and responsive health care systems, and
equitable health financing.
B. DOH Mission
To guarantee EQUITABLE, SUSTAINABLE and QUALITY
health for all Filipinos, especially the poor and to lead the
quest for excellence in health.
C. Levels of Prevention
PRIMARY
LEVEL
SECONDARY
LEVEL
TERTIARY
LEVEL
Health
Promotion and
Illness
Prevention
Prevention of
Complications
thru Early Dx
and Tx
Prevention of
Disability, etc.
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
govt private
hospitals at the
municipal level
Provided at
Health
care/RHU
Brgy. Health
Stations
Main Health
Center
Community
Hospital and
Health Center
Private and
Semi-private
agencies
D. 8 Common Generic Drugs (Botika sa Baranggay)

1.
2.
3.
4.
5.
6.
7.
8.
Co-Trimoxazole : GUT/GIT/URT Infection

Amoxicillin / Ampicillin
Rifampicin
Isoniazid
Pyrazinamide
Paracetamol
Oresol
Nifidipine: HPN
Bayabas
Psidium quajava
Bawang
Allium sativum
Yerta Buena
Mentha cordifelia
Sambong
Akapulko
Blumea
balsanifera
Cassia alata
Niyog niyogan
Quisqualis indica
Tsaang Gubat
Carmona resuta
Ampalaya
Mamordica
charantia
F. Homemade Oresol
A volume or one liter
homemade oresol
Water 1000 ml. or 1 liter
Sugar
8 teaspoon
Salt
1 teaspoon
Plant Name
Lagundi
Scientific Name
Vitex negundo
Ulasimang Bato
Peperonia
pellucida
Indications
Asthma, cough,
colds & fever
Pain and
inflammation
Gout
Arthritis
Rheumatism
Smaller volume or a glass

homemade oresol
250 ml.
2 teaspoon
teaspoon or a pinch of
salt=10-12 granules of rock
salt: iodized salt=tips of thumb
& index finger are penetrated
with salt
G. Millennium Goal Development (MDG)

1.
2.
3.
4.
5.
6.
7.
8.
ERADICATE EXTREME POVERTY AND HUNGER

ACHIEVE UNIVERSAL PRIMARY EDUCATION
PROMOTE GENDER EQUALITY AND EMPOWER
WOMEN
REDUCE CHILD MORTALITY (Phil. focus)
IMPROVE MATERNAL HEALTH (Phil. focus)
COMBAT HIV/AIDS, MALARIA AND OTHER
DISEASES
ENSURE ENVIRONMENTAL SUSTAINABILITY
DEVELOP A GLOBAL PARTNERSHIP FOR
DEVELOPMENT
H. Field Health Service Information System ( FHSIS)
E. Herbal Plants
Diarrhea
Toothache
Mouth and wound
wash
HPN
Toothache
Same as Lagundi
except asthma
Edema
Diuretic
All forms of skin
diseases
Intestinal
Parasitism
(Nematodes)
Diarrhea
Infantile colic
(Kabag)
Dental caries
Type II Diabetes
(NIDDM)
Individual Treatment Record (ITR)

Fundamental building block or foundation
FHSIS.
Target Client List (TCL)
Such lists will be of considerable value to
midwives/nurses in monitoring service
delivery to clients in general and in
particular to groups of patients identified as
targets or eligibles for one or another
program of the Department
POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING DECEMBER 2012 PNLE
*Patterned on the previous board exams from December 2006 December 2011 the purpose of this note is to GUIDE students
on the possible topics that might be part of the upcoming Dec. 2012 PNLE

Summary Table
Composed of Health Program Accomplish
and Morbidity Diseases
The Monthly Consolidation Table (MCT)
FHSIS Reporting
Monthly Form
1. Program report (M1)
2. Morbidity report (M2)
Prepare by Midwife
Every 2nd week of the month is the
submission
Quarterly Form
1. Program report (Q1)
2. Morbidity report (Q2)
Prepared by Nurse
Every 3rd week of the succeeding quarter
month is the submission
Annual Form
1. ABHS report
Contains data on demographic,
environmental and natality.
Prepare by Midwife
Every 2nd week of January is the
submission
2. A1: Report on vital statistics: demographic,
environmental, natality and mortality.
3. A2: Lists all diseases and their occurrence in
the municipality/city. The report is broken
down by age and sex.
4. A3: All deaths occurred in the
municipality/city. The report is also broken
down by age and sex
Prepared by Nurse
Every 3rd week of January is the
submission
Maternal Mortality Rate (MMR): Reported maternal deaths

per 1000 registered live births (RLB)
MMR= # of maternal deaths
RLB
CBR=overall total reported births

Population
1000
Incidence Rate (IR): Reported new cases of disease per

percent (100/population) population
IR=new cases of disease
Population
100
Prevalence rate (PR): Reported new cases of disease + old

cases of disease per percent of population
PR=new cases + old cases
Population
100
Crude Death Rate (CDR): Overall total reported deaths per

1000 population
CDR=overall total deaths
Population
1000
1000
Infant Mortality Rate (IMR): Reported # of infant (0 to 12

months of age) deaths per 1000 RLB
IMR=# of infant deaths
RLB
1000
Neonatal Mortality Rate (NMR): Reported # of neonatal (0

to 28 days or <1 month) deaths per 1000 RLB
NMR=# of neonatal deaths
RLB
1000
Swaroops Index (SI): Reported # of deaths among

individuals> 50 years old over total deaths
SI=# of deaths (individual >50 years old) x
Total Deaths
100
J. Nature of the Family Problem
Health Deficit (HD): if identified problem is an

abnormality, illness or disease, theres a
gap/difference between normal status (ideal,
desirable, expected) & actual status (the
outcome/result/problem encountered on that
actual day)
Health Threat (HT): any condition or situation

which will be conducive to health alteration, health
interference & health disturbance.
Foreseeable Crisis (FC): stress points, anything

which is anticipated/ expected to become a
problem.
I. Health Indicators
Crude Birth Rate (CBR): Overall total reported births per
1000 population
K. Community Organizing (COPAR)

Preparatory Phase
1. Area of Selection
It should be DOPE Community: Depressed,
Oppressed, Poor & Exploited, a new criteria for
community organization
2. Entry Phase
The 1st thing to do upon entering the community is
to have a courtesy call with the Barangay Captain,
introduce self & group, purpose, present the project,
activities, etc.
3. Integration/Immersion (CIP)
Immersion is imbibing the life situation/condition
of the community .
4. Community Study: Diagnosis of Community-COPAR
Makes use of the Nursing Process/Problem Solving
Approach
Prioritized which among the problems identified is
to be attended 1st like in nature, magnitude,
modifiability, preventive potential, salience

O. Excreta Disposal
L. Epidemiology
Epidemic: a situation when there is a high

incidence of new cases of a specific disease in excess
of the expected.
Endemic : habitual presence of a disease in a given

geographic location accounting for the low number
of both immunes and susceptibles
Sporadic : disease occurs every now and then

affecting only a small number of people relative to
the total population
Pandemic: global occurrence of a disease
Household
Burial
Deposited in 1m x
1m deep pits covered
with soil, located 25
m. away from water
supply
Community
Sanitary landfill or
controlled tipping
Excavation of soil
deposition of refuse and
compacting with a solid
cover of 2 feet
Incineration
Open burning
Animal feeding
Composting
Grinding
and
disposal sewer
M . Approve Water Facilities

Level I
Point
Source
Level II
Communal faucet
system or stand
posts
A protected
well or a
developed
spring with
an outlet but
without a
distribution
system for
rural areas
where
houses are
thinly
scattered.
A system composed
of a source, a
reservoir, a piped
distribution network
and communal
faucets, located at
not more than 25
meters from the
farthest house in
rural areas where
houses are clustered
densely.
Level III
Waterworks
system or
individual house
connections
A system with a
source, a reservoir,
a piped distributor
network and
household taps
that is suited for
densely populated
urban areas.
DOH PROGRAMS
EXPANDED PROGRAM ON IMMUNIZATION
Law: PD 996
Vaccine
BCG
1. I
2. SE
DPT
OPV
HBV
MV
N. 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.
Dosage
# of Doses to
complete
immunization
.05 ml
.1 ml
.5 ml
2-3 gtts
<10 y/o: .5
>10 y/o: 1
.5 ml
1 dose
1 dose
3 doses
3 doses
3 doses
1 dose
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
the beginning even if the interval between doses
exceeded the recommended interval by months or year.
DPT2 or DPT3 is not given to a child who has
convulsions or shock within 3 days after DPT1. V
Do not give live vaccines like BCG to a individuals who
are immunosuppressed due to malignant disease (child
with AIDS) , going therapy with immunosuppressive
agents or radiation.
Repeat BCG vaccination if the child does not develop a
scar after first injection
Type of Vaccine
Storage Temp.
OPV
Measles
Hepa B
DPT
Tetox
BCG
-15 to -25 C
At the freezer
Hours of Life after

opening
8 hours
2 to 8 C
Body of
refrigerator
4 hours

NATIONAL TB PROGRAM
Disease
Causative Agent
Mode of
Transmission
Tuberculosis
Primary
Complex is
less than 3
years old
Mycobacterium
Tuberculosis
Droplet Infection
( inhalation of
bacilli from patient
who coughs and
sneeze)
- any child
who does not
return to
normal health
after measles
or whooping
cough.
Most
hazardous
period:
first 6-12
months
after
infection
Highest in
risk of
developin
g: under 3
years old
Clinical
Manifestation
General
weakness
Loss of
weight,
cough and
wheeze
which does
not respond
to antibiotic
therapy.
Fever and
night sweat
Abdominal
swelling
with a hard
painless
mass and
free fluid
Hemoptysis
and chest
pain
Painful firm
or soft
swelling in a
group of
superficial
lymph
nodes.
Reservoir
Diagnostic
Exam
Treatment
Man
And
Diseased
Cattle
(Bovine
TB)
Sputum
Exam
3 sample
are taken
with 24 hrs:
- spot
sample (1st
visit)
- early
morning
specimen
- spot
sample
(2nd visit)
Note: at
least 2
sample are
positive
DOTS
- patient is
required to take
the Ant-Tb drugs
in the presence of
a health care
provider to
ensure
compliance to
treatment
regimen
Chest
Xray
Mantoux
Test
- .1 cc
injection of
PDD and
48-72 hours
reading
* 10 mm +
5 mm +
(HIV pt.)
Anti-TB drugs:
(RIPES)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Streptomycin
Nursing
Implication
Pointers for
teaching on
Anti-TB drugs:
Rifampicin:
taken befor
meals, causes
red urine urine
Isoniazide:
causes
peripheral
neuritis, given
with Vit.B6
Pyrazinamide:
cause
hyperurucemia
Ethambutol:
causes optic
neuritis/
blurring of
vision
Streptomycin:
cause tinnitus,
loss of hearing
balance, damage
to 8th cranial
nerve
Note: After 2-4
weeks of
treatment,
patient is no
longer
contagious
RECOMMENDED CATEGORY OF TREATMENT REGIMEN

Category
II
III
IV
Type of TB Patient
New smear positive PTB

New smear positive PTB
with extensive
parenchymal lesion
EPTB and Severe
concomitant HIV disease
Treatment Failure
Relapse
Return after default
New smear-negative PTB
With minimal parenchymal
lession
Chronic ( still smearpositive after supervised
re-treatment )
Treatment
Intensive Phase
2 RIPE
2 RIPES /1 RIPE
2 RIP
Refer to
or DOTS
to City
Regimen
Continuation
Phase
Total Period
4 RI
6 mos.
5 RIE
8 mos.
4 RI
6
mos.
Specialized
Plus Center
Provincial
Coordinator
facility
refer
NTP

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS
(IMCI)
MAIN SYMPTOM: Diarrhea
Danger Sign
MAIN SYMPTOM: Cough and Difficulty Breathing

Dehydration Classification
Pneumonia Classification
A child who has had diarrhea for 14 days or more and

who has no signs of dehydration is classified as having
PERSISTENT DIARRHOEA
Classify a child with diarrhea and blood in the stool as

having DYSENTERY. A child with dysentery should be
treated for dehydration

MAIN SYMPTOM: Fever
No Malaria Risk Classification
MAIN SYMPTOM: Ear Problem
High Malaria Risk Classification
Low Malaria Risk Classification
Ear Problem Classifications

MAIN SYMPTOM: Malnutrition and Anemia
Malnutrition and Anemia Classification
COMMUNICABLE DISEASES
Cholera
Other names:El tor
Fecal-oral route 5 Fs
Incubation Period: Few hours to 5 days; Usually 3
days
Pathognomonic Sign: Rice watery stool
Diagnostic Test: Stool culture
Treatment:Oral rehydration solution (ORESOL) IVF
Drug-of-Choice: tetracycline (use straw; can cause
staining of teeth). Oral tetracycline should be
administered with meals or after milk.
Shistosomiasis
Other Names: Snail Fever Bilharziasis
Endemic in 10 regions and 24 provinces High
prevalence: Regions 5, 8, 11
Contact with the infected freshwater with cercaria and
penetrates the skin
Diarrhea Bloody stools (on and off dysentery)
Enlargement of abdomen Splenomegaly

Hepatomegaly Anemia / pallor weakness
Diagnostic Test: COPT or cercum ova precipitin test
(stool exam)
Drug-of-Choice: PRAZIQUANTEL (Biltracide)
Oxamniquine for S. mansoni Metrifonate for S.
haematobium *Death is often due to hepatic
complication
Dispose the feces properly not reaching body of water
Use molluscides Prevent exposure to contaminated
water (e.g. use rubber boots)
Apply 70% alcohol immediately to skin to kill surface
cercariae
Allow water to stand 48-72 hours before use
Malaria
Plasmodium Parasites: Vivax Falciparum (most fatal;
most common in the Philippines)
Bite of infected anopheles mosquito Night time biting
High-flying
Rural areas Clear running water
Malarial Smear best time to get the specimen is at
height of fever because the microorganisms are very
active and easily identified
Chemoprophylaxis: only chloroquine should be given
(taken at weekly intervals starting from 1-2 weeks
before entering the endemic area). In pregnant women,
it is given throughout the duration of pregnancy.
Treatment:
1. QUININE oldest drug used to treat malaria; from
the bark of Cinchona tree; ALERT: Cinchonism
quinine toxicity
2. CHLOROQUINE
3. PRIMAQUINE sometimes can also be given as
chemoprophylaxis
4. FANSIDAR combination of pyrimethamine and
sulfadoxine
CLEAN Technique
*Insecticide treatment of mosquito net
*House Spraying (night time fumigation)
*On Stream Seeding construction of bio-ponds for
fish propagation (2-4 fishes/m2 for immediate impact;
200-400/ha. for a delayed effect)
*On Stream Clearing cutting of vegetation
overhanging along stream banks
*Avoid outdoor night activities (9pm 3am)
*Wearing of clothing that covers arms and legs in the
evening*Use mosquito repellents
*Zooprophylaxis typing of domestic animals like the
carabao, cow, etc near human dwellings to deviate
mosquito bites from man to these animals Intensive
IEC campaign

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WHAT YOU SHOULD KNOW BEFORE THE PNLE