I. COMMUNICABLE DISEASES A. Tuberculosis – a highly infectious chronic diseases caused by the TB bacilli.

It is primarily a respiratory disease common among malnourished individuals living in crowded areas. It often occurs among children in underdeveloped and developing countries. The Strengthened National Tuberculosis Control Program General Objective – To control tuberculosis, which is a public health problem, by the year 2000 through the reduction of:  Annual Risk of Infection from 2.5% to 1.0%  Prevalence Rate from 6.6 to 1.9 per 1000 population  Mortality Rate due to Tuberculosis from 39.4 to 19.2 per 100,000 population Specific Objectives: 1. To vaccinate with BCG the eligible population under the Expanded Program for Immunization scheme in towns, schools, clinics and hospitals with at least 90% coverage. 2. To identify at least 45%, the prevalence of infectious cases annually. 3. To treat effectively and adequately all sputum positive cases including those with moderate and far advanced radiographic abnormalities with cavitary lung lesion for a period of 6 months with the use of the short course chemotherapy. Nursing Responsibilities: 1. BCG vaccination of newborn, infants and grade I/school entrants. 2. Educate the public in mode of spread and methods of control and the importance of early diagnosis. 3. Improve social conditions, which increase the risk of becoming infected, such as overcrowding. 4. Make available medical, laboratory and x-ray facilities for examination of patients, contacts and suspects and facilities for early treatment of cases and persons at high risk of infection and beds for those needing hospitalization. 5. Provide public health nursing and outreach services for home supervision of patients to supervise therapy directly and to arrange for examination and preventive treatment of contacts.

B. Pneumonias – an acute infectious disease of the lings usually caused by the pneumococcus resulting in the consolidation of one or more lobes of either one or both lungs. Control of Acute Respiratory Infections (CARI)  Acute Respiratory Infections (ARI) especially pneumonia remains to be the leading cause of illness and death among Filipino children. In 1989, which was the launching year of the Program for the Control of Acute Respiratory Infections (CARI), almost 25,000 children aged under five died de to pneumonia alone. General Objective – The CARI program is mandated to reduce mortality due to pneumonia among under fives by 25% from baseline levels by year 2000. It hopes to accomplish this through the following strategies: 1. Training government and private health workers in the standard management of ARI. 2. Enabling BHWs to identify pneumonia cases, refer cases for treatment and educating patients and caretakers. 3. Assuring the adequate supply of antibiotics and other essential drugs. 4. Teaching parents and communities on how to recognize symptoms of pneumonia and other ARI. 5. Mobilizing non-government organizations and field workers to communicate with parents and communities. 6. Advocacy and social mobilization to gain the support of local government officials, NGOs, private and educational institutions. Nursing Responsibilities 1. Bedrest 2. Adequate salt, calorie and vitamin intake. Water requirement increases because of fever, sweating and increased respiratory rate. Plasma chlorides tend to fall in pneumonia, hence sodium chloride should be given by mouth or by vein if necessary. 3. Adequate urine output is essential for excretions of toxins and for avoidance of serious urinary complications due to medications. 4. Adequate caloric and vitamin (Vitamin C). 5. Tepid sponge for fever 6. Frequent turning from side to side 7. Antibiotics based on CARI of DOH.

C. Diarrheal Diseases - a major cause of mortality in the Philippines. Over the past 20 years, it has ranked 1st to 4th leading cause of morbidity and mortality. Among children under the age of five, it is a major cause of illness and death. Control of Diarrheal Diseases (CDD)  Diarrheal disease in general and in particular among children under five is a serious public health and development problem. In view of this, the DOH launched a national program to control diarrheal disease (CDD) in 1980. Objectives: To reduce mortality from diarrhea particularly among children under five through extensive case management utilizing oral rehydration therapy (ORT), environmental sanitation, maternal and child health, nutrition and health education activities. Nursing Responsibilities 1. Assist mothers in breastfeeding 2. Improved weaning practices 3. Use plenty of clean water 4. Facilitate Proper Handwashing 5. Use of latrines 6. Proper disposal of babies’ stools 7. Measles immunization 8. Convince and help community members to adopt the practices and to continue the practice them on an on-going basis.

D. Malaria – continues to be a major health problem in the country having an annual parasite incidence of 5.1/1000 population, In 1994, it was aimed that there be a 20% reduction in morbidity annually. The nature of malaria as a public health problem requires sustained and systematic efforts towards two major strategies, namely prevention and transmission through vector control and the detection and early treatment of cases to reduce morbidity and prevent mortality. Malaria Control Service – Sustainable Preventive and Vector Control Measures  refer to the adoption of measures for the prevention and control against the malaria parasite and the mosquito vector. Such measures being affordable, applicable and appropriate under our local conditions so that these measures can be sustained throughout the duration of malaria control operations. Objective: To reduce the source of infection in the human populations-vector contact and the density of the mosquito vector population. Nursing Responsibilities: 1. Wearing of clothing that covers arms and legs in the evening. 2. Avoiding outdoor night activities, particularly during vector’s peak biting hours from 9 pm to 3 am. 3. Using mosquito repellents such as mosquito coils, soap lotion, or other personal application measures advocated by DOH/MCS 4. Planting of Neem tree which are mosquito repellents. 5. Zooprophylaxis-typing of domestic animals near human dwellings to deviate mosquito bites from man to these animals. 6. All cases should be given drug treatment and followed-up until clinically found negative. 7. Continuous surveillance measures should be implemented.

E. Measles – an acute highly communicable infection characterized by fever, rashes and symptoms referable to upper respiratory tract. Death is due to complication, e.g. secondary pneumonia usually in children under 2 yrs. old. Measles is severe among malnourished children with fatality 95-100%. Expanded Program on Immunization (EPI) – was launched in July 1976 by DOH in cooperation with WHO and UNICEF. Presidential Proclamation No.4 (July 29,1998) – “ declaring the period from September 16 – October 14,1998 as the Ligtas Tigdas Month” and launching the Philippines Measles Elimination Campaign. Objective: To reduce the morbidity and mortality among infants and children caused by the six childhood communicable diseases. (measles, diphtheria, polio, hepatitis, etc.) Principles : 1. The program is based in epidemiological situation; the schedules are drawn on the basis of the occurrence and characteristic epidemiological features of the disease. 2. The whole community rather than just the individual is to be protected, thus mass approach is utilized. 3. Immunization is a basic health service and such it is integrated in to the health services being provided for by the RHU. Elements: • Target Setting • Cold chain logistic management • Information, Education and Communication • Assessment and Evaluation of the Program’s Overall Performance • Surveillance, studies and research Nursing Responsibilities: 1. Emphasize the need for immediate isolation when early catarrhal symptoms appear. 2. If immune serum globulin is available ( gamma Globulin), explain this to the family and refer to the physician or clinic giving the service. 3. Observe closely the patient for complications during and after the acute stage. 4. Teach, demonstrate, guide and supervise adequate nursing care indicated. 5. Explain proceedings in proper disposal of nose and throat discharges. 6. Teach concurrent and terminal disinf

II. NON-COMMUNICABLE DISEASES A. Cardiovascular Diseases (CVD) – have become the greatest threat to Filipinos today. CVD have varied and multi causes and risk factors, ranging from infectious agents, environmental and constitutional causes, some inherited and some acquired. A.1 Congenital Heart Disease (CHD) – by far the most prevalent type of heart disease among children. They may involve the heart and its great vessels alone or may exist together with abnormalities in other systems. A.2 Rheumatic Fever/Rheumatic Heart Disease (RHD) - an auto-immune disease, that is, the patient develops antibodies which react to the body’s own antigens in the connective tissues of the heart, as well as in other systems. A.3 Hypertension – is a persistent elevation of the arterial blood pressure. Hypertension is very common chronic condition which affects a significant proportion of adult population and which makes an important contribution to human mortality. A.4 Ischemic Heart Disease- usually caused by the occlusion of the coronary arteries by thrombus formation in areas of narrowing and hardening in these arteries. Cardiovascular Disease Control Program General Strategies of Disease Control: 1. promote the factors that prevent the occurrence of impede the progression of the disease, and 2. remove/diminish the factors that cause or contribute to the occurrence and progression of the disease. In Cardiovascular Disease Control, efforts should be concentrated on primary prevention. Prevention of CVD occurrence: 1. Spare the individual from a lifetime of pain, suffering and limited activity, from unfulfilled dreams, or early death because of the progressive nature of the disease. 2. Spare the family from tremendous expense, abnormal family life and anguish. 3. Spare the community from huge capital and operating expenses for medical facilities for the chronically ill CVD patients and from unhealthy and unproductive members who otherwise can contribute to community development. Specific protection from CVD is also achieved by the removal of the risk factors or reduction in their levels. Nursing Responsibilities 1. Maintenance of Ideal Body Weight Weight control is useful for preventing and correcting high blood pressure and diabetes. The goal of the body weight should be within 15% of desirable weight. 2. Diet and Modification of Dietary Fats

 Dietary education must be initiated. Dietary changes recommended for obese individuals with or without hypertension. 3. Smoking/Tobacco Avoidance  Complete cessation of cigarette smoking should be advised to all individuals, whether he/she is hypertensive or not and particularly those with special risk of CHD. Nicotine increases blood pressure activity 4. Exercise  regular exercise programs, facilitate weight control and increase cardiopulmonary stamina. 5. Monitor non-pharmacological methods and drug administration.

B. Cancer – ranks third in leading cause of morbidity and mortality in the Philippines. A disturbance of growth characterized primarily by an excessive proliferation of cells without apparent relation to the physiological demands of the organ involved. Cancer Control Program (CCP) – presently the two most important modes recognized in the reduction of cancer incidence are prevention and early detection.One-third of all cancers are curable if detected early and treated properly. Treatment of cancer needs a multi-disciplinary team approach. There are three major forms of treatment of cancer: 1. Surgery 2. Radiation Therapy 3. Chemotherapy Cancer that cannot be detected early, which is usually present at an advanced stage at diagnosis and which can be cured, can be offered supportive or palliative care. This is the active, holistic care of patients and their families given by a multi-disciplinary team of physicians, nurses, nutritionists, etc. The DOH-PCCP has supported the Palliative Care of Filipino Cancer Patients by providing free morphine tablets to indigent patients, particularly in government hospitals. The DOH-PCCP also support Philippine Cancer Society, Inc.-Hospice Care Program, recognizing at as the first and lead agency. Nursing Responsibilities

1. Refer immediately any case of suspected disease to physician. 2. Share with patient and family knowledge on available resources for accurate diagnosis and adequate treatment. 3. Assist and guide families in availing of existing health resources and facilities. 4. Record history of symptoms , which will help physician arrive at an accurate diagnosis. 5. Assist physician in the performance of examinations and diagnosis test as aids to diagnosis and treatment. 6. Conduct nursing demonstrations to patient or families on proper nursing care, particularly on post-operative care of discharged hospital cases and terminal cancer patients who have to be taken care of at home. 7. Assist the patient and family in making necessary adjustment and developing proper attitudes towards prescribed treatment. 8. Provide guidance, counseling and supervision in the management of case at home. 9. Participate in the planning and implementation of rehabilitation program for post-op and other cases in need of this service. 10. Help patient and family understand the most important facts about cancer. 11. Conduct and participate in health education programs on cancer for allied health workers and the general public. C. Kidney Diseases – there are about 6,500 yearly deaths in the country secondary to various kidney diseases. Renal diseases threaten to be one of the leading causes of death if there will not be an effective prevention and control programs to address the problem. Preventive Nephrology Program – reduce the occurrence of kidney diseases and endstage renal diseases to 3000 cases a year. Increase awareness and practice of preventing renal diseases among high risk groups to 80%. Increase awareness on signs and symptoms of kidney diseases. Improve access and median waiting time for renal transplantation. Nursing Responsibilities 1. Increase awareness and practice of preventing renal disease through:  adequate water intake  balanced diet  good personal hygiene  regular exercise  regular BP check-up  complete immunization for infants and children  proper management of throat and skin infections  yearly urinalysis

2. Increase awareness of signs and symptoms of kidney disease as edema and high blood pressure. 3. Routine screening for urinary tract infection, diabetes and kidney diseases.

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