Community Health Nursing (complete)
supervises the performance of midwives
1. 1. COMMUNITY HEALTH NURSING: AN
OVERVIEWWhat is a community? 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
2. 2. What is health? Health-illness
continuum High-level wellness Agent-
host-environment Health belief
Evolutionary-based Health promotion
WHO definition
3. 3. What is community health? part of
paramedical and medical intervention/
approach which is concerned on the health of
the whole population aims:1. health
promotion2. disease prevention3.
management of factors affecting health
4. 4. What is nursing?- assisting sick
individuals to become healthy and healthy
individuals achieve optimum wellness
5. 5. Public Health Nursing: the term used before
for Community Health NursingAccording to Dr.
C.E. Winslow, Public Health is a science & art
of 3 PsPrevention of
DiseaseProlonging lifePromotion of
health and efficiency through organized
community effort
6. 6. 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
7. 7. COMMUNITY HEALTH NURSING
(CHN): a specialized field of nursing
practice a science of Public Health
combined with Public Health Nursing Skills
and Social Assistance with the goal of raising
the level of health of the citizenry, to raise
optimum level of functioning of the citizenry
(Characteristic of CHN)
8. 8. BASIC PRINCIPLES OF CHN The
community is the patient in CHN, the family is
the unit of care and there are four levels of
clientele: individual, family, population group
(those who share common characteristics,
developmental stages and common exposure
to health problems e.g. children, elderly),
and the community. In CHN, the client is
considered as an ACTIVE partner NOT
PASSIVE recipient of care
9. 9. BASIC PRINCIPLES OF CHN CHN
practice is affected by developments in health
technology, in particular, changes in society,
in general The goal of CHN is achieved
through multi-sectoral efforts CHN is a part
of health care system and the larger human
services system.
10. 10. ROLES OF THE PUBLIC HEALTH
NURSEClinician, who is a health care
provider, taking care of the sick people at
home or in the RHUHealth Educator, who
aims towards health promotion and illness
prevention through dissemination of correct
information; educating peopleFacilitator, who
establishes multi-sectoral linkages by referral
systemSupervisor, who monitors and
11. 11. TARGET POPULATION (IFC) ARE:1. I
ndividual2. F amily3. C ommunity
12. 12. 3 Elements considered in CHN:v
Science of Public Health (core foundation in
CHN),v Public Health Nursing Skills andv
Social Assistance Functions
13. 13. OBJECTIVES OF PUBLIC HEALTH:
CODESC ontrol of Communicable DiseasesO
rganization of Medical and Nursing ServicesD
evelopment of Social MachineriesE ducation
of IFC on personal Hygiene Health
Education is the essential task of every health
workerS anitation of the environment
14. 14. 3 ELEMENTS IN HEALTH EDUCATION:
IECI nformation: to share ideas to keep
population group knowledgeable and
awareE ducation: change within the
individual 3 Key Elements of Education: K
nowledge A ttitude S kills
15. 15. 3 ELEMENTS IN HEALTH EDUCATION:
IECC ommunication: interaction involving
2 or more persons or agencies 3 Elements of
Communication: Message Sender Receiver
16. 16. PUBLIC HEALTH WORKERS
(PHW)PHWs: are members of the health
team who are professionals
namelyMedical Officer (MO)-
PhysicianPublic Health Nurse (PHN)-
Registered NurseRural Health Midwife
(RHM)-Registered Midwife-
DentistNutritionistMedical
TechnologistPharmacistRural Sanitary
Inspector (RSI)-must be a sanitary engineer
17. 17. 5 MAJOR FUNCTIONS:1. Ensure equal
access to basic health services2. Ensure
formulation of national policies for proper
division of labor and proper coordination of
operations among the government agency
jurisdictions3. Ensure a minimum level of
implementation nationwide of services
regarded as public health goods4. Plan and
establish arrangements for the public health
systems to achieve economies of scale5.
Maintain a medium of regulations and
standards to protect consumers and guide
providers
18. 18. BASIC HEALTH SERVICES UNDER
OPHS OF DOHE ducation regarding HealthL
ocal Endemic DiseasesE xpanded Program
on ImmunizationM aternal & Child Health
ServicesE ssential drugs and Herbal plantsN
utritional Health Services (PD 491): Creation
of Nutrition Council of the Phils.T reatment of
Communicable & Non communicable
DiseasesS anitation of the environment (PD
856): Sanitary Code of the PhilippinesD ental
Health PromotionA ccess to and use of
hospitals as Centers of WellnessM ental
Health Promotion
19. 19. VISION BY 2030 (DREAM OF DOH)A
Global Leader for attaining better health
outcomes, competitive and responsive health
care systems, and equitable health financing
20. 20. MISSION To guarantee EQUITABLE,
SUSTAINABLE and QUALITY health for all
Filipinos, especially the poor and to lead the
quest for excellence in health
21. 21. Principles to attain the vision of
DOHEquity: equal health services for all-
no discriminationQuality: DOH is after the 29.
quality of service not the quantity Philosophy
of DOH: Quality is above
quantityAccessibility: DOH utilize 30.
strategies for delivery of health services
22. 22. HEALTH CARE DELIVERY SYSTEMthe
totality of all policies, facilities, equipment,
products, human resources and services
which address the health needs, problems
and concerns of the people. It is large,
complex, multi-level and multi-disciplinary.
23. 23. THREE STRATEGIES IN DELIVERING
HEALTH SERVICES (ELEMENTS)
Creation of Restructured Health Care Delivery
System (RHCDS) regulated by PD 568
(1976) Management Information Systems
regulated by R.A. 3753: Vital Health Statistics
Law Primary Health Care (PHC) regulated
by LOI 949 (1984): Legalization of
Implementation of PHC in the Philippines
24. 24. CREATION OF RHCDSRHO (National
Health Agency) or existing national agencies
like PGH or specialized agencies like Heart
Center for Asia, NKIMHO & PHO
(Municipal/Provincial Health Office) BHS &
RHU (Barangay Health Station/Rural Health
Unit)
25. 25. 3 LEVELS OF HEALTH CARE1. Primary-
prevention of illness or promotion of health2.
Secondary-curative3. Tertiary-rehabilitative
26. 26. According to Increasing Complexity of
According to the Type of Service the Services
ProvidedType Service Type Example Health
Promotion, Preventive Care, Health Promotion
and Information Dissemination Continuing
Care for common illness PreventionPrimary
health problems, attention to psychological
and social care, referrals Surgery, Medical
services by Diagnosis and Treatment
ScreeningSecondary Specialists Advanced,
specialized, diagnostic,Tertiary therapeutic &
rehabilitative care Rehabilitation PT/OT
27. 27. LEVELS OF PREVENTION PRIMARY
LEVEL SECONDARY LEVEL TERTIARY
LEVEL Health Promotion and Illness
Prevention of Complications thru Early
Prevention of Disability, etc. Prevention Dx
and TxProvided at ! When hospitalization is
deemed ! When highly-specialized medical!
Health care/RHU necessary and referral is
made to care is necessary! Brgy. Health
Stations emergency (now district), ! referrals
are made to hospitals and!Main Health Center
provincial or regional or private medical center
such as PGH,!Community Hospital and Health
hospitals PHC, POC, National Center for
Center Mental Health, and other govt!Private
and Semi-private private hospitals at the
municipal agencies level
28. 28. Referral System in Levels of the Health
Care: Barangay Health Station (BHS) is
under the management of Rural Health
Midwife (RHM) Rural Health Unit (RHU) is
under the management or supervision of
PHN Public Health Nurse (PHN) caters to 38.
1:10,000 population, acts as managers in the
implementation of the policies and activities of
RHU, directly under the supervision of MHO
(who acts as administrator)
29. REFERRAL SYSTEM:BHS RHU
MHO PHO RHO National Agencies
Specialized Agencies
30. CHARACTERISTICS OF
PHCAcceptableAccessibleAffordableAvailable
SustainableAttainable
31. 31. UTILIZES APPROPRIATE
TECHNOLOGIES USED BY PHC: ACCEFSA
ffordable, accessible, acceptable, availableC
ost wise=economical in natureC omplex
procedures which provide a simple outcomeE
ffectiveF easibility of use=possibility of use at
all timesS cope of technology is safe & secure
32. 32. SENTRONG SIGLA MOVEMENT
(SSM)was established by DOH with LGUs
having a logo of a Sun with 8 Rays and
composed of 4 Pillars:1. Health Promotion2.
Granted Facilities3. Technical Assistance4.
Awards: Cash, plaque, certificate
33. 33. 4 CONTRIBUTIONS OF PHC TO DOH
&ECONOMY: Training of Health Workers
Creation of Botika sa Baryo & Botika sa
Health Center Herbal Plants Oresol
34. 34. A. TRAINING OF HEALTH WORKERS3
Levels of Training:Grassroot/Village
Includes Barangay Health Volunteers
(BHV) and Barangay Health Workers (BHW)
Non professionals, didnt undergo formal
training, receive no salary but are given
incentive in the form of honorarium from the
local government since 1993Intermediate -
these are professionals including the 8
members of the PHWsFirst Line Personnel -
the specialist
35. 35. B. CREATION OF BOTIKA SA BARYO &
BOTIKA SA HEALTH CENTERRA 6675:
Generics Act of 1988: ImplementingOplan
Walang Reseta Program-solution to the
absence of a medical officer who prescribed
the medicines so PHN are given the
responsibility to prescribe generic medicines
andWalong Wastong Gamot Program-
available generics in Botika sa Baryo &
Health CenterFather of Generics Act: Dr.
Alfredo Bengzon
36. 36. 8 COMMONLY AVAILABLE GENERICS
(CARIPPON)Co-Trimoxazole: its a
combination of 2 generics of drugs which is
antibacterial Trimethoprim(TMP) Has a
bacteriostatic action that stops/inhibits
multiplication of bacteria For GUT, GIT &
URTI (TMP combined with SMX)
Sulfamethoxazole (SMX) Has bactericidal
action that kills bacteria For GUT, GIT,
URTI & Skin Infections
37. 37. 8 COMMONLY AVAILABLE GENERICS
(CARIPPON)Amoxicillin/AmpicillinAn
antibacterial drug that comes from the
Penicillin familyEffect is generally
bacteriostatic (when source of infection is
bacterial)These 2 drugs provide the least
sensitivity reaction (rashes & GI) and the
adverse effect of other antibiotics is
anaphylactic shock
38. 8 COMMONLY AVAILABLE GENERICS
(CARIPPON)TB DRUGS:Rifampicin
(RIF)Isoniazid (INH)Pyrazinamide (PZA)
39. 39. 8 COMMONLY AVAILABLE GENERICS
(CARIPPON)ParacetamolHas an analgesic &
anti-pyretic effectAcetyl Salicylic Acid (ASA) or
Aspirin is never kept in the Botika because
of its effects: Anticoagulant-highly
dangerous to Dengue patients thats why its
not available in Botika & Health Center
40. 40. 8 COMMONLY AVAILABLE GENERICS
(CARIPPON)Oresol:a management for
diarrhea to prevent dehydration under the
Control of Diarrheal Diseases (CDD) Program
41. 41. 8 COMMONLY AVAILABLE GENERICS
(CARIPPON)Nifedipine: An anti-
hypertensive drug According to DOH, 16%
of population belonging to 25 years old &
above in the community are hypertensive
42. 42. C. HERBAL PLANTSRA 8423: Alternative
Traditional Medicine Lawa program where
patient may opt to use herbal plants especially
for drugs that are not available in dosage form
or patients has no financial means to buy the
drugTraditional Medicine:Use of herbal
plants
43. 43. 10 ADVOCATED HERBAL PLANTS BY
DOH: LUBBY SANTALagundi Vitex Asthma,
Leaves Decoction negundo cough, colds &
Poultice fever (ASCOF) Pain and
inflammation
44. 44. 10 ADVOCATED HERBAL PLANTS BY
DOH: LUBBY SANTAUlasimang Peperonia
Gout Leaves DecoctionBato pellucida Arthritis
Poultice Rheumatism
45. 45. 10 ADVOCATED HERBAL PLANTS BY
DOH: LUBBY SANTABayabas Psidium
Diarrhea Leaves Decoction quajava
Toothache Mouth and wound wash
46. 46. 10 ADVOCATED HERBAL PLANTS BY
DOH: LUBBY SANTABawang Allium HPN
Clove/Bulb Poultice sativum Toothache
47. 47. 10 ADVOCATED HERBAL PLANTS BY
DOH: LUBBY SANTAYerta Mentha Same as
Leaves DecoctionBuena cordifelia Lagundi
Poultice except asthma
48. 48. 10 ADVOCATED HERBAL PLANTS BY
DOH: LUBBY SANTASambong Blumea
Edema Leaves Decoction balsanifera Diuretic
49. 49. 10 ADVOCATED HERBAL PLANTS BY
DOH: LUBBY SANTAAkapulko Cassia All
forms Leaves Decoction alata of skin Poultice
diseases Cream
50. 50. 10 ADVOCATED HERBAL PLANTS BY
DOH: LUBBY SANTANiyog Quisqualis
Intestinal Seeds Decoctionniyogan indica
Parasitism Poultice (Nematodes) Juice
51. 51. 10 ADVOCATED HERBAL PLANTS BY
DOH: LUBBY SANTATsaang Carmona
Diarrhea Leaves DecoctionGubat resuta
Infantile Poultice colic (Kabag) Dental caries
52. 52. 10 ADVOCATED HERBAL PLANTS BY
DOH: LUBBY SANTAAmpalaya Mamordica
Type II Leaves Decoction charantia Diabetes
(NIDDM)
53. 53. POLICIES TO ABIDE:Know
indicationsKnow parts of plants with
therapeutic value: roots, fruits, leavesKnow
official procedure/preparation
54. 54. Procedures/Preparations: Decoction
Gather leaves & wash thoroughly, place in a
container the washed leaves & add water
Let it boil without cover to vaporize/steam to
release toxic substance & undesirable
taste Use extracts for washing
55. 55. PROCEDURES/PREPARATIONS:
Poultice Done by pounding or chewing
leaves used by herbolaryo Example:
Akapulko leaves-when pounded, it releases
extracts coming out from the leaves contains
enzyme (serves as anti-inflammatory) then
apply on affected skin or spewed it over
skin For treatment of skin diseases
56. 56. PROCEDURES/PREPARATIONS:Infusio
nTo prepare a tea (use lipton bag), keep
standingfor 15 minutes in a cup of warm water
where abrown solution is collected, pectin
which servesas an adsorbent and astringent
57. 57. PROCEDURES/PREPARATIONS:
Juice/SyrupTo prepare a papaya juice, use
ripe papaya &mechanically mashed then put
inside a blender& add waterTo produce it into
a syrup, add sugar then heat todissolve sugar
& mix it
58. 58. PROCEDURES/PREPARATIONS:Cream/
OintmentStart with poultice (pound leaves) to
turn it semi-solidAdd flour to keep preparation
pasty & make it adhere to skinlesionsTo make
it into an ointment: add oil (mineral, baby or
any oil-serves as moisturizer) to the prepared
cream to keep itlubricated while being
massage on the affected area
59. 59. D. ORESOLGlucose 20 grams 1
Significance: For re-absorption of Na
Facilitates assimilation of Na 2 Significance:
Provides heat & energySodium Chloride/NaCl
3.5 grams For retention of water/fluidSodium
2.5 grams Buffer content of
solutionBicarbonate/NaHCO3 Neutralizer
content of solutionPotassium Chloride/KCl 1.5
grams Stimulates smooth muscle contractility
especially the heart & GIT
60. 60. PREPARATION OF PROPER
HOMEMADE ORESOLA volume or one liter
homemade oresol Smaller volume or a glass
homemade oresolWater 1000 ml. or 1 liter
250 ml.Sugar 8 teaspoon 2 teaspoonSalt 1
teaspoon ! teaspoon or a pinch of salt=10-12
granules of rock salt: iodized salt=tips of
thumb & index finger are penetrated with salt
61. 61. UNIVERSAL HEALTH CARE (UHC),
ALSO REFERRED TO AS KALUSUGAN
PANGKALAHATAN (KP)is the provision to
every Filipino of the highest possible quality of
health care that is accessible, efficient,
equitably distributed, adequately funded, fairly
financed, and appropriately used by an
informed and empowered public
62. 62. UNIVERSAL HEALTH CARE (UHC),
ALSO REFERRED TO AS KALUSUGAN
PANGKALAHATAN (KPThe Aquino
administration puts it as the availability and
accessibility of health services and necessities
for all Filipinos.It is a government mandate
aiming to ensure that every Filipino shall
receive affordable and quality health
benefits.This involves providing adequate
resources health human resources, health
facilities, and health financing.
63. 63. UHCS THREE THRUSTS1) Financial
risk protection through expansion in
enrollment and benefit delivery of the National
Health Insurance Program (NHIP);2) 2)
Improved access to quality hospitals and
 health care facilities; and3) 3) Attainment of
health-related Millennium Development Goals
(MDGs).
64. 64. FINANCIAL RISK
PROTECTIONProtection from the financial
impacts of health care is attained by making
any Filipino eligible to enroll, to know their
entitlements and responsibilities, to avail of
health services, and to be reimbursed by
PhilHealth with regard to health care
expenditures.
65. 65. MPROVED ACCESS TO QUALITY
HOSPITALS AND HEALTH CARE
FACILITIESImproved access to quality
hospitals and health facilities shall be
achieved in a number of creative approaches.
First, the quality of government-owned and
operated hospitals and health facilities is to be
upgraded to accommodate larger capacity, to
attend to all types of emergencies, and to
handle non- communicable diseases.
66. 66. The Health Facility Enhancement Program
(HFEP) shall provide funds to improve facility
preparedness for trauma and other
emergencies. The aim of HFEP was to
upgrade 20% of DOH- retained hospitals, 46%
of provincial hospitals, 46% of district
hospitals, and 51% of rural health units(RHUs)
by end of 2011.
67. 67. ATTAINMENT OF HEALTH-RELATED
MDGSFurther efforts and additional resources
are to be applied on public health programs to
reduce maternal and child mortality, morbidity
and mortality from Tuberculosis and Malaria,
and incidence of HIV/AIDS. Localities shall be
prepared for the emerging disease trends, as
well as the prevention and control of non-
communicable diseases.The organization of
Community Health Teams (CHTs) in each
priority population area is one way to achieve
health-related MDGs. CHTs are groups of
volunteers, who will assist families with their
health needs, provide health information, and
68. 68. ATTAINMENT OF HEALTH-RELATED
MDGSRNheals nurses will be trained to
become trainers and supervisors to coordinate
with community-level workers and CHTs. By
the end of 2011, it is targeted that there will be
20,000 CHTs and 10,000 RNheals.Another
effort will be the provision of necessary
services using the life cycle approach. These
services include family planning, ante-natal
care, delivery in health facilities, newborn
care, and the Garantisadong Pambata
package.Better coordination among
government agencies, such as DOH, DepEd,
DSWD, and DILG, would also be essential for
the achievement of these MDGs.
69. 69. GOAL 1: ERADICATE EXTREME
POVERTY AND HUNGERTarget : Halve,
between 1990 and 2015, the proportion of
people whose income is less than one dollar a
dayTarget : Halve, between 1990 and 2015,
the proportion of people who suffer from
hunger
70. 70. GOAL 2: ACHIEVE UNIVERSAL
PRIMARYEDUCATIONTarget : Ensure that,
by 2015, children everywhere, boys and girls
alike, will be able to complete a full course of
primary schooling
71. 71. GOAL 3: PROMOTE GENDER
EQUALITY AND EMPOWER WOMENTarget :
Eliminate gender disparity in primary and
secondary education preferably by 2005 and
to all levels of education no later than 2015
72. 72. GOAL 4: REDUCE CHILD
MORTALITYTarget : Reduce by two-thirds,
between 1990 and 2015, the under-five
mortality rate
73. 73. GOAL 5: IMPROVE MATERNAL
HEALTHTarget : Reduce by three-quarters,
between 1990 and 2015, the maternal
mortality ratio
74. 74. GOAL 6: COMBAT HIV/AIDS, MALARIA
AND OTHER DISEASESTarget : Have halted
by 2015 and begun to reverse the spread of
HIV/AIDSTarget : Have halted by 2015 and
begun to reverse the incidence of malaria and
other major diseases
75. 75. GOAL 7: ENSURE ENVIRONMENTAL
SUSTAINABILITYTarget : Integrate the
principles of sustainable development into
country policies and programmes and reverse
the loss of environmental resourcesTarget :
Halve, by 2015, the proportion of people
without sustainable access to safe drinking
waterTarget: By 2020, to have achieved a
significant improvement in the lives of at least
100 million slum dwellers
76. 76. GOAL 8: DEVELOP A GLOBAL
PARTNERSHIP FOR DEVELOPMENTTarget
: Develop further an open, rule-based,
predictable, non- discriminatory trading and
financial systemTarget: Address the special
needs of the least developed countriesTarget:
Address the special needs of landlocked
countries and small island developing
StatesTarget: Deal comprehensively with the
debt problems of developing countries through
national and international measures in order
to make debt sustainable in the long term
77. 77. FIELD HEALTH SERVICE
INFORMATION SYSTEM (FHSIS) It is a
network of information It is intended to
address the short term needs of DOH and
LGU staff withmanagerial or supervisory
functions in facilities and program areas. It
monitors health service delivery nationwide.
78. 78. OBJECTIVES OF FHSISTo provide
summary data on health service delivery and
selected program accomplishment indicators
at the barangay, municipality/ city, and district,
provincial, regional and national levels.To
provide data which when combined with data
from other sources, can be used for program
monitoring and evaluation purposes.To
provide a standardized, facility-level data base
that can be accessed for more in-depth
studies.To minimize the recording and
reporting burden at the service delivery level
in order to allow more time for patient care
and promote activities.
79. 79. IMPORTANCE OF FHSIS Helps local
government determine public health
priorities. Basis for monitoring and evaluating
health program implementation. Basis for
planning, budgeting, logistics and decision
making at alllevels. Source of data to detect
unusual occurrence of a disease. Needed to
monitor health status of the community.
Helps midwives in following up clients.
 Documentation of RHM/PHN day to day
activities.
80. 80. COMPONENTS OF FHSIS1. Individual
Treatment Record (ITR)2. Target Client List
(TCL)3. Summary Table4. The Monthly
Consolidation Table (MCT)
81. 81. INDIVIDUAL TREATMENT RECORD
(ITR)The fundamental building block or
foundation of the Field Health Service
Information System is the INDIVIDUAL
TREATMENT RECORD.This is a document,
form or piece of paper upon which is recorded
the date, name, address of patient, presenting
symptoms or complaint of the patient on
consultation and the diagnosis (if available),
treatment and date of treatment.
82. 82. TARGET CLIENT LIST (TCL)The Target
Client Lists constitute the second building
block of the FHSIS and are intended to serve
several purposesFirst is to plan and carry out
patient care and service delivery. 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
83. 83. TARGET CLIENT LIST (TCL)The second
purpose of Target Client Lists is to facilitate
the monitoring and supervision of service
delivery activities.The third purpose is to
report services delivered.The fourth purpose
of the Target Client Lists is to provide a clinic-
level data base which can be accessed for
further studies
84. 84. TARGET CLIENT LISTS TO BE
MAINTAINED IN THE FHSIS1. Target Client
List for Prenatal Care2. Target Client List for
Post-Partum Care3. Target Client List of
Under 1 Year Old Children4. Target Client
List for Family Planning5. Target Client List
for Sick Children6. NTP TB Register7.
National Leprosy Control Program Form 2-
Central Registration Form
85. 85. SUMMARY TABLEThe Summary Tables
is a form with 12-month columns retained at
the facility (BHS) where the midwife records
monthly all relevant data. The Summary Table
is composed of:(1) Health Program
Accomplishment this can serve as proof of
accomplishments to show LGU officials
whenever they visit the facility.(2) Morbidity
Diseases the source of ten leading causes of
morbidity for the municipality/city. This
summary table will help the nurse and MHO to
get the monthly trend of diseases.
86. 86. THE MONTHLY CONSOLIDATION
TABLE (MCT) The Consolidation Table is
an essential form in the FHSIS where the
nurse at the RHU records the reported data
per indicator by each BHS or midwife. This
is the source document of the nurse for the
Quarterly Form. The Consolidation Table
shall serve as the Output Table of the RHU as
it already contains listing of BHS per indicator.
87. 87. FHSIS REPORTINGThese are summary
data that are transmitted or submitted on a
monthly, quarterly and on annual basis to
higher level. The source of data for this
component is dependent on the records.
88. 88. THE MONTHLY FORMProgram Report
(M1)The Monthly Form contains selected
indicators categorized as maternal care, child
care, family planning and disease
control.Morbidity Report (M2)The Monthly
Morbidity Disease Report contains a list of all
diseases by age and sex. The Midwife uses
the form for the monthly consolidation report
of Morbidity Diseases and is submitted to the
PHN for quarterly consolidation.
89. 89. THE QUARTERLY FORMProgram Report
(Q1)The Quarterly Form is the
municipality/city health report and contains the
three-month total of indicators categorized as
maternal care, family planning, child care,
dental health and disease controlMorbidity
Report (Q2)The PHN uses the form for the
Quarterly Consolidation Report of Morbidity
Diseases to consolidate the Monthly Morbidity
Diseases taken from the Summary Table.
90. 90. THE ANNUAL FORMS (A-BHS, A1, A2 &
A3)ABHS Form is the report of midwife which
contains data on demographic,environmental
and natality.The report of nurse at the
RHU/MHC are the Annual Form 1 which is the
report on vital statistics: demographic,
environmental, natality and mortality.Annual
Form 2 is the report that lists all diseases and
their occurrence in the municipality/city. The
report is broken down by age and sex.Annual
Form 3 is the report of all deaths occurred in
the municipality/city. Thereport is also broken
down by age and sex.
91. 91. FLOW OF REPORTOFFICE PERSON
RECORDING FORMS FREQUENCY
SCHEDULE OF TOOLS SUBMISIONBHS
Midwife - ITR Monthly Form Monthly Every
2nd week of the - TCL (M1 & M2) succeeding
month - ST A-BHS Form Annually Every 2nd
week of JanuaryRHU PHN - ST Quarterly
Quarterly Every 3rd week of the 1st - MCT
Form month of succeeding (Q1 & Q2) quarter
Annual Forms Every 3rd week of - A1
January - A2 - A3
92. 92. FertilityCrude Birth Rate (CBR) -
Overall total reported birthsMorbidity-Illnesses
affecting the population groupIncidence
Rate (IR)-reported new cases affecting the
population groupPrevalence Rate (PR)-
determine sum total of new + old cases of
diseases per percent population
93. 93. Mortality-Reports causes of
deathsCrude Death Rate (CDR)-overall
total reported deathMaternal Mortality Rate
(MMR)-maternal deaths due to maternal
causesInfant Mortality Rate (IMR)-# of
infant deaths (0-12 months) or less than 1
year oldNeonatal Mortality Rate (NMR)-#
of deaths among neonates (newborn 0-28
days, < 1 month)Swaroops Index (SI)-
deaths among individual in the age group of
50 and above
94. 94. CRUDE BIRTH RATE (CBR)CBR=
Overall total reported births x 1000 --------------
------------------------------ Population
95. 95. INCIDENCE RATE (IR)IR= new cases of
disease x 100 ------------------------------------
Population
96. 96. PREVALENCE RATE (PR):PR= new
cases + old cases x 100 ----------------------------
---------- Population
97. 97. CRUDE DEATH RATE (CDR)CDR =
overall total deaths x 1000 -------------------------
--------- Population
98. 98. MATERNAL MORTALITY RATE
(MMR)MMR= # of maternal deaths x 1000 ----
------------------------------ RLB
99. 99. INFANT MORTALITY RATE (IMR)IMR = #
of infant deaths x 1000 ------------------------------
--- RLB
100. 100. NEONATAL MORTALITY RATE
(NMR)NMR = # of neonatal deaths x 1000 ----
----------------------------------- RLB
101. 101. SWAROOPS INDEX (SI)SI= # of
deaths (individual >50 years old) x 100 ---------
--------------------------------------------------- Total
Deaths
102. 102. FAMILY HEALTH NURSING
PROCESSa systematic approach of solving
an existing problem/meeting the needs of
familyR apportA ssessmentP lanningI
nterventionE valuation
103. 103. I. RAPPORT Trust building
Knowing your client Adjusting to the
situation and environment RESPECT
104. 104. II. ASSESSMENTData
Gathering: tools or instruments used
duringsurvey:InterviewObservationQu 114.
estionnaires-mostly patronized & used in
CHNRecords & Reports
availableConsolidation or Collation: collecting
back the questionnaires, tabulate and
summarize
105. 105. Validation: uses statistical
approachesStatistical Approaches:1. Central
Tendencies: 3
MsMean=averageMedian=range (Highest
Lowest Score)Mode=frequency of occurrence
of a variable, used if theres too many variable
occur
106. 106. 2. Standard Deviation: used if
there are too many variables available to be
treated which is seldom used in CHN SD=
(x-x) =summation of n-1 x=variables
available x=mean (given special attention)
n=# of existing variables
107. 107. 3. Percentile (%) Method:most
commonly used in CHN by adding all cores
then multiply by 100
108. 108. Presentation of Data Sales
Series1. Table/Chart Categ 1 1st Qtr Categ
Series2. Graph: Categ 2 2nd Qtr CategPie
Series 0 20 3 6Bar-2 variables only 4 Series 2
1Line 0 Series Catego Catego Catego Catego
2Polygon-connecting the resultsHistograph-2
or more variables & appear adjacent to each
other
109. 109. TYPOLOGY OF NURSING
PROBLEMSA. First Level Assessment: to
determine problems of familySources of
Problems using IDBFamily: use of Initial Data
Base (IDB)Nature: Health Deficit (HD), Health
Threat (HT), Foreseeable Crisis (FC)
110. 110. USE OF INITIAL DATA BASE
(IDB): 1. Family Chart Structure:Nuclear -
Father, mother, childrenExtended (3rd
generation)-Relatives staying with the
familyMulti-generational extended-apo sa
tuhod or apo sa talampakanDyad -Husband
& wife only (childless couple)Blended -widow
married another widow & have childrenGay -
Same sex living togetherMatriarchal -Mother
is the decision makerPatriarchal -Father is the
decision makerCommunal -different families
forming a community
111. 111. 2. Socio-economic: poverty level,
educationalattainment & nature of occupation
of membersof the family (sources of income)3.
Socio-cultural: different nature of religion4.
Home environment: assessment according
toES, treatment of garbage, preparation of
food,availability of toilet, water & food
sanitation,sources of diseases
112. 112. 4. Medical history: history of
certain disease, family member with disease
5. Resources available in community for use
by the family:5 Generalized Ms in resources
available in community: Man/Manpower
Money Machine Materials
Methods
113. 113. DEFINE THE PROBLEM AFTER
IDENTIFYING ITACCORDING TO
NATUREHealth 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)
114. 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
115. 115. Jobless FatherSuffering from TB
thWife is pregnant for the 8 time2 y/o
youngest child lacks immunization rd9 y/o
eldest child is 3 degreemalnourishedPoor
environmental sanitation
116. 116. III. PLANNING Four (4) Standard
Steps:Prioritization -start if there are multiple
identified problemsFormulation of objectives -
planning a procedure will start here if there is
only one problemDeveloping strategies of
actionFormulation of evaluation tools for the
identified strategy developed
117. 117. CRITERIA IN IDENTIFYING THE
PROBLEMCriteria Score WeightI. Nature:
assess by PHW Health deficit (HD) 3 1 Health
threat (HT) 2 Foreseeable Crisis (FC) 1II.
Modifiability Easily 2 2 Intermediate
(moderate) 1 Not modifiable 0III. Preventive
Potential Highly 3 1 Moderate 2 Low 1IV.
Salience of the Problem Problem needing
urgent 2 1 attention Problem not needing 1
urgent attention Not a felt problem 0
118. 118. Steps:a. Decide on a scoreb.
Score x weight ----------------- Highest Scoreb.
Get the sum total of all the
scoresInterpretation:Perfect score=5, if
score nearing 5 then prioritize the
problemCriteria 1, 2 & 3 has to be assessed
objectively by the health workerCriteria 4 has
to be assessed by the perception of the family
119. 119. Compute for 3rd Degree
Malnutrition
120. 120. IV. INTERVENTIONIs the
capacity to provide managementIs the
professional phase of nursing processIs the
time when the PHN executes the standard
function of an RNThree (3) Standard
Functions of RN: Dependent-giving of
 medicines Independent-monitor, assess,
provide, educate Interdependent-referrals
121. 121. V. EVALUATIONThree (3)
Things to be evaluated: SPO1. Structure of
program & activity -what articles, equipments,
supplies are utilized2. Process utilized -steps
used3. Outcome of activity -results can
be:Desirable -to be implemented,
advocated, strengthenUndesirable -to be
avoidedTwo (2) Aspects to be evaluated in the
Outcome:Quality -characteristic or kind of
outcome; no numerical value, not
measurableQuantity -from the word
quantum, with numerical value, measurable
122. 122. OBJECTIVES OF
COPARPatterns to be followed:1. Organize
people2. Mobilize people3. Work with
people4. Educate people Knowledge
Attitude Skills
123. 123. PHASES OF
COPAR1.Preparatory2.Organizing3.Mobilizi
ng4.Educating5.Collaborating6.Phase Out
124. 124. 1. PREPARATORY PHASEA.
Area of Selection It should be DOPE
Community: Depressed, Oppressed, Poor &
Exploited, a new criteria for community
organization Old Criteria it must be a
virgin community=meaning no agency has
gone there. This is a dangerous situation
thats why RA 7305: Magna Carta for Public
Workers was provided-a PHN is to receive a
hazard pay of 20-25% of monthly salary
125. 125. 1. PREPARATORY PHASEB.
Entry: the 1st thing to do upon entering the
community is to have a courtesy call with the
Barangay
126. 126. 1. PREPARATORY PHASEC.
Integration/Immersion Immersion is
imbibing the life situation/ condition of the
community by living, eating & sleeping with
the family to be able to understand their
situation It requires 2 Qualities of PHN:
Empathy Sympathy (Integration)
127. 127. 1. PREPARATORY PHASED.
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
128. 128. PRIORITIZATION OF
COMMUNITY PROBLEMSNATUREHealth
Status (HS) 3Health Resource(s) 2Health
Related 1Indicators of Health
Status/Condition:Fertility: CBR=community
is overpopulated=HSMorbidity: IR (new
cases) & PR (old cases)=HSMortality: Deaths
like children dying of pneumonia=HS
129. 129. PRIORITIZATION OF
COMMUNITY PROBLEMSNATUREHealth
Status (HS) 3Health Resource(s) 2Health
Related 1Health Resource(s):5 Ms-
Manpower/Man, money, machinery, material
& methods(+) available facilities-
Hospital/Clinic, mode of transportation,
market, school & movie houses for recreation
130. 130. PRIORITIZATION OF
COMMUNITY PROBLEMS NATURE Health
Status (HS) 3 Health Resource(s) 2 Health
Related 1Health Related: Categories
according to 5 Aspects of Man=PEMSSP
hysical, P hysiological, P sychologicalE
motionalM entalS ocialS piritual
131. 131. MAGNITUDE OF THE
PROBLEM: % of population affected by the
identifiedproblem75-100% 450-74 % 325-49
% 2<25 % of the population
1MODIFIABILITYEasily 3Intermediate 2Low
1Not modifiable 0PREVENTIVE
POTENTIALHighly 3Moderate 2Low
1SALIENCE
132. 132. 2. ORGANIZING
PHASEChoosing Potential Community
LeadersCore Group FormationCommunity
Assembly: Community Organizing
Participatory Action Research (COPAR)
Attend the assembly of the family/families
Families in the community should be
represented, any family members can
represent his/her family as long as he/ she is
a RESPONSIBLE (one who also can
comprehend) member of that family.
Barangay Captain/Chairman need not
necessary be the leader. He can recommend
133. 133. 3. MOBILIZATION
PHASEMobilization- let the members of the
community do the work. PHN should only
SUPERVISE
134. 134. 4. HEALTH
EDUCATIONAdjust on the level of
understanding of the communityReturn
demonstration is the best way of
teachingFocus on the KSARespect of
the custom and tradition
135. 135. 5. COLLABORATING6. PHASE
OUT
136. 136. EPIDEMIOLOGYis the pattern of
occurrences & distribution of diseases,
defects & deaths 2 Population in
DistributionPatterns Susceptible Immune (at
risk to develop, acquire (those that did not or
experience the disease) experience the
disease, usually individuals develop
resistance against the disease)Epidemic 80%
(more than 50%) 20%Endemic 50%
50%Sporadic 20% 80%Pandemic ----- -----
137. 137. EPIDEMICGreater than 50%
of populations are susceptible or less immune
individualGreater % of the population is
affected by the occurring diseaseExample:
Health worker reports that Community Lanting
has anepidemic of measles affecting children
less than 7 years oldTotal susceptible
population: 3000Children affected by measles:
17501750
138. 138. ENDEMICThe disease occurs
regularly, habitually, constantly affecting the
population group2 Local Endemic Diseases:
where causative agent is available on those
placesSchistosomiasis: Samar, Leyte,
Mindoro, DavaoMalaria: Palawan &
Mindanao-reasons why its prevalent
Forested areas Surrounded by bodies
of water
139. 139. SPORADICThe pattern of
occurrence is on & off where: On=available
causative agent Off=no available causative
agentIts intermittent (unpredictable) in
 occurrenceDisease occurs only if theres a
susceptible host like in rabies
140. 140. PANDEMICWorldwide,
international, universal, global in occurrence
like in AIDS, Hepatitis B, PTB, measles,
mumps, diphtheria, pneumoniaSARS is
categorized by WHO as an OUTBREAK only
because out of 191 nations, 33 countries are
reported to have it.
141. 141. HOME VISIT Is a
PROFESSIONAL contact between PHN & the
family The services provided is an
extension of the Health Service Agency
(Health Center)
142. 142. OBJECTIVES OF HOME VISIT
Assessment Nursing Care 152.
Treatment Health Education
Referral (if care fails)
143. 143. PRIORITIES (IN THE CARE): TO
PREVENT CROSS CONTAMINATION1.
Newborn2. Post partum3. Pregnant
mothers4. Morbid casesThe families need the
assistance of the health center thats why
home visit was done to the familyThe person
who makes the home visit is rendering
services on behalf of the health center
144. 144. PHASES OF HOME VISIT:1.
PlanningStarts at the health
centerMakes a study on the status of the
familyStatement of the
problemFormation of objective2.
Socialization first activity is to establish
rapport & to gain the trust of the family
145. 145. PHASES OF HOME VISIT:3.
Activity Intervention/Professional Phase
Opportunity to provide or extend health
services Standard Role of the Nurse:
Independent, Dependent and
Interdependent To be effective, come in
complete uniform (also bring a long umbrella
with pointed end which serve as protection)4.
Summarization - ability to put into record &
report (orally) about the outcome of the
activity
146. 146. PUBLIC HEALTH
BAG:Indispensable tool that should be
organize to save time & effort and to prevent
cross infection & contamination
147. 147. GUIDING PRINCIPLES IN THE
USE OF PUBLIC HEALTH BAG:Content -
should be prepared by the one who will make
home visit Note: BP Apparatus is kept
separately from PHN bagCleaning The
inner part of the bag should be clean & sterile
Should be done every after home visit
Never endorse the bag
148. 148. GUIDING PRINCIPLES IN THE
USE OF PUBLICHEALTH BAG:
Contamination The less one opens the
bag, the lesser chance of contamination In
general, the bag is open 3x: Putting out
materials for hand washing Putting out
materials used for nursing care Returning
all what have been used
149. 149. GUIDING PRINCIPLES IN THE
USE OF PUBLICHEALTH BAG:Care of
Communicable Case(s)- should be disinfected
with the use of 70% isopropyl alcohol or Lysol
which should be done at the health center and
not at home
150. 150. POLICIES FOR
SCHISTOSOMIASIS CONTROLPROGRAM
(SCP): CHESC ase FindingH ealth
EducationE nvironmental SanitationS nail
Eradication
151. 151. CASE FINDING:6 Aspects or
Thing to KnowDisease:
SchistosomiasisOther name: Bilhariasis or
Snail FeverCausative agent: Schistosoma-
a blood fluke (parasite) 3 Types of Species:
Schistosoma japonicum-endemic in the
Philippines & affecting Indonesia, China,
Japan, Korea Vector: Oncomelania quadrasi
Schistosoma mansoni Schistosoma
haematobium
152. Laboratory Procedures to rule
out Schistosomiasis: Blood Examination:
eosinophil level indicates parasitism
Fecalysis: Kato Katz (plain stool exam that
uses a special apparatus resembling a
feeding bottle sterilizer) Procedure: Collect
specimen Have the test tube undergo
centrifugation for 20 minutes Get specimen
from precipitate & swab it on glass slide
Observe it on microscope
153. 153. Signs & SymptomsCNS:
High grade fever cerebral convulsionGIT:
Nausea & vomiting, Diarrhea Chronic
dysentery (prolonged diarrhea of more than 2
weeks & consistency is mucoid & bloody (with
streaks of blood)Liver: Presence of
infection manifested by jaundice &
hepatomegalySpleen: Infection of spleen
inflammation enlargement of organ
(Splenomegaly) abdominal distension
abdominal pain on the right upper
quadrantBlood: Anemia & weakness
154. 154. Treatment: Drug of Choice-
Praziquantel (Biltricide) 60 mg/KBW/day
Example: If patient is 50 kg, 50 kg x 60
mg/KBW/day=3000 mg/day Initial
treatment: 1st 2 weeks=3000 mg/day, then do
stool exam after 2 weeks if still (+), extend
treatment for another 2 weeks. Repeat stool
exam, if still (+) after the extended week,
continue treatment for 2 weeks again. No
adverse effect or over dosage even if
extended for a year. Length of Treatment:
takes months to a year
155. 155. Health Education: It affects
mostly farmers so educate them to wear
rubber bootsEnvironmental Sanitation: Snail is
the 1st concern Water where snail thrives is
the 2nd concern Toilet=3rd concern Food
GarbageSnail Eradication: Use molluscicides
treat the entire suspected soil with chemical
solution that kills snails
156. 156. CASE FINDING:Disease:
MalariaOther name: AgueCausative
Agent: Plasmodium-a protozoa 4 Types of
Species: Plasmodium falciparum-more fatal
that affects the Philippine Vector: Female
Anopheles Mosquito (FAM) Plasmodium
vivax Plasmodium ovale Plasmodium
malariae
157. 157. Laboratory Procedure:
Malarial smear-extract blood at the height of
fever because plasmodium is very active &
ruptures at this period.Signs & Symptoms
 of Malaria:1st Stage=Cold: Chilling sensation
for 1-2 hours2nd Stage=Hot: High grade fever
lasting for 3-4 hours3rd Stage=Wet:
Diaphoresis (excessive sweating/perspiration)
158. 158. Treatment: Drug of Choice-
Quinine 2 Forms: a) Chloroquine (Aralen) b)
PrimaquineIf Quinine is not available, may use
Sulfadoxime-an antibacterial drug paired with
pyrinthamine
159. 159. PERSONAL
PROTECTION:Sleep under a mosquito
netSleep in a screened roomSleep with
long sleeve attireUse repellents that
contains DET (diethyl toluamide or toluene
which has a pungent odor that drives away
mosquitoes & an irritant to mucous membrane
of respiratory tract when inhaledPlant a
Neem Tree using the leaves
160. 160. CLEAN: Chemical
Method=insecticide spraying at night Larvae
eating fish=Tilapia Environmental Sanitation &
Health Education=insect, water, trash Anti-
mosquito soap=basil citronelli Neem
tree=banana, banaba, gabi, eucalyptus
provide repellent effect
161. 161. STRATEGIES:A. Provision of
Regular and Quality Maternal Care
Services Regular and quality pre-natal
carehx-taking, utilization of HBMR (Home-
Based Mothers Record) as a guide in the
identification of risk factorsPE: weight,
height, BP-takingPerform head-to-toe
assessment, abdominal examTetanus
Toxoid ImmunizationFe supplementation:
given from 5th mo. of pregnancy to two
months postpartum (100-120 mg orally/day for
210 days)Laboratory exam: Heat-acetic
acid test. Benedicts testOral/Dental exam
162. 162. Pre-natal counseling
Provision of safe, delivery careall birth
attendants shall ensure clean and safe
deliveries at the faciltiies
(RHUs/hospitals)at-risk pregnancies and
mothers must be immediately referred to the
nearest institution
163. 163. Provision of quality
postpartum care Proper schedule of
follow-up must be followed:1st postpartum
visit for home deliveries must be done within
24 hours after delivery2nd, done at least 1
week after delivery3rd, done 2-4 weeks
thereafter Attendants must be aware of the
early signs, symptoms and complications.
They should follow the 3 CLEANS: CLEAN
Hands CLEAN Surface CLEAN Cord
164. 164. C. Improvement of the health
personnels capabilities on newborn care,
midwifery thru trainings. Note: All deliveries
should be done in health care facilities
ONLY D. Improvement on the quality of care
at the First Referral Level Orientation,
training should be done on the use of proper
filling-up of HBMR card Proper
referrals/endorsements must be done for
future If-upsE. Prevention of unwanted
pregnancies through family planning
services F. Prevention and management of
STDs
165. 165. G. Promotion of Appropriate
health practices H. Upgrade reporting
services I. Mobilize political commitment and
community involvement to provide support to
basic health care delivery
166. 166. GOALS: A. Safe Pregnancy
Right age to be pregnant=20-35 years old, not
less than 20 & not more than 35 Right
interval of pregnancy=once in 2 or 3 years
Home Base Mothers Record (HBMR): the
record used for care of mothers in CHN
167. 167. Laboratory
Examinations:Benedicts Test: test for sugar in
the urine; test for diabetes Heat test tube
with 5 cc of Benedicts Solution (blue) in the
burner then add 3-5 gtts of urine (amber
yellow) then heat again. Observe for the
change in color:Blue : (-) sugar in urineGreen :
trace of sugar in urine +1 +Yellow : traces of
sugar in urine +2 ++Orange : more traces of
sugar in urine +3 +++Brick Red : surely
diabetic +4 ++++
168. 168. Laboratory Examinations:Acetic
Acid Test: test for albumin in urine; test
forPregnancy Induced HPN Collect urine
in test tube, heat it in burner then add 3-5 gtts
of acetic solution (clear white). Observe for
change in color:If it remains clear: (-) CHON
or albumin in urineIf it turns cloudy: (+)
CHON=proteinuria
169. 169. POLICIES:1. Non coercive (give
freedom of choice)2. Integration of Family
Planning in all Curricular Program:LOI 47
DECS states that Family Planning is to be
integrated in all school curricular programs,
either baccalaureates or non- baccalaureates,
enrolled separately as one unit3. Multi-
Sectoral Approach: establish relationship with
otheragencies which can either be:
Intrasectoral Intersectoral-Local or
International (WHO, Unicef, USAID, Japhiego)
170. 170. METHODOLOGIES: Biological A.
Basal Body Temperature (BBT) Get the
temperature early morning before waking up
which should be monitored daily at the same
time There should be a sudden drop of
temperature between 0.3-0.6C followed by
an increase of temperature by 0.3-0.6C
which means that the woman is fertile
171. 171. B. Sympto-thermalC. Cervical
Mucus Test Billings Method by Dr. Billing
Spinnbarkheit (came from a German word
Spinner which means to play with the cervical
mucus with the finger) or Wet & Dry Method:
Wet Cervical Mucus (Fertile): abundant,
stretchy & transparent Dry Cervical Mucus
(Safe & Not fertile): whitish, pasty &
adhesiveD. Calendar (Rhythm)Deleted
already since 1998 because its not
recommended for irregular cycle of
menstruationMenstrual cycle should be
regular; obtain 4-6 months cycle
172. 172. E. Lactation Amenorrhea Method
(LAM): RA 7600-Breastfeeding & Rooming In
LawDOH organized Maternal & Child
Family Health Institute (MCFHI) with the
following members: All government
hospitals Private hospitals
(volunteer)Normal involution (uterus goes
back to normal) of the uterus: after 45 days or
5-6 weeks or 1 months if not
breastfeedingFrozen breast milk is to be
 put out of the freezer 2 hours before feeding (
Body of Ref: 2-3 days / Freezer: 3-4
months)Left over milk should be discarded
& should not be re-preserved or re-frozen
because it is already contaminated
173. 173. METHODOLOGIES:TemporaryA.
ChemicalOral Pills (Logentrol)-has low
dose of estrogen & progesterone that inhibits
ovulationParenteral: Depot
Medroxyprogesterone Acetate (DMPA)/Depo-
provera- inhibits ovulation making women
amenorrheic;1991, DMPA was found to be
causing cancer of the cervix1994, DMPA is
given IM 4x a year every 3 months (90 days
interval)
174. 174. Implants: Norplant-it inhibits
ovulation effective for 5 years but seldom
advocated for use because it is usually
expensive; the client buys the device (consists
of 5 capsules) & have it implanted at the
health center by minor surgical incision in:
upper inner arm because it is nearest to the
brain external oblique thigh gluteal deficiency (energy giving food)
muscles
175. 175. B. Mechanical: IUD Up to
10 years protection Cervical cap &
Diaphragm Prevent the sperm to pass the
cervix Works better with spermicide
Wore 30 minutes before coitus and keep up to
6 hours after coitus Condom Most
effective way to prevent STDs / STIs
176. 176. METHODOLOGIES:C.
Behavioral Abstinence WithdrawalD.
Permanent Vasectomy (reversible)-since
year 2000 in the Philippines BLT
177. 177. POLICIES:I. Nutritional
Surveillance (NS): to determine victims of
malnutritionA. Anthropometric Measurement:
study of measurements ofhuman
dimensions Age for Weight-if weight is not
appropriate with the age: Stunting: growth
retardation Wasting: connotes
malnutrition Age for Height-if height is not
appropriate with the age: Stunting Weight
for Height
178. 178. Rule Male FemaleEvery height of
5 110 lbs. 105 lbs.ft.Every increment + 6 +5of
an inch above5 ft. ADDEvery decrement - 6 -
5of an inch below5 ft. SUBTRACT
179. 179. Skin Folds Test-pinch the
external oblique muscle (bilbil) with your
palmNormal: 1 inchOverweight: > 1 inch
Middle Upper Arm Circumference (MUAC)-
used in children below 5 years old by
measuring the middle upper arm with a tape
measureNormal: 13 cms. & aboveMalnutrition:
<13 cms
180. 180. POLICIES:I. Nutritional
Surveillance (NS): to determine victims of
malnutritionB. Biochemical Method
Micronutrient Malnutrition -available in small
amount in the body VADAG:Vitamin A
Deficiency: Deficiency: Xeropthalmia-
opacity of cornea leading to night blindnes
Infants (6-12 months) : Give 100,000 i.u. Pre-
schoolers (12-83 months) : 200,000 i.u. Post
partum : 200,000 i.u. Never give Vitamin A
to infants less than 6 months & pregnant
women because it is toxic
181. 181. Anemia: Iron Deficiency Anemia
Target age group: 0-59 months (less than
5 years) Give 3-6 mg/kbw/day Always
give the maximum Example: Child weighs 8
kg 8 x 6=48 mg/day for the 1st 3 months then
monitorIf still anemic, continue giving but
compute again 6 mg/kbw
182. 182. Goiter: Iodine Deficiency Disease
(endemic in uphill)Target age group: 0-59
monthsGive 1 capsule (200 mg) of
potassium iodate in oil once a yearFor a child
< 5 years old, empty contents of capsule in a
cup with warm water because he cant tolerate
itAdverse Effect of Iodine Deficiency
Disease that must be avoided: Mental
retardation-intelligence quotient: idiot, moron
& imbecile Growth retardation- cretinism
(pedia) & dwarfism (adult)
183. 183. Macronutrient Malnutrition -
available in large amount in the body (Protein
Energy Malnutrition or PEM)Kwashiorkor-
protein deficiencyMarasmus-carbohydrate
184. 184. Kwashiorkor MarasmusEtiology
Disease experienced by an elder Muscle
wasting child upon the birth of a new
babyDeficiency CHON CHOAge Toddlers (1-3
years old) All agesMajor Signs & Facial
edema, moon facie Muscle wasting, old mans
facieSymptomsHair Changes (+) color
changes from black to (-) hair changes brown
or from brown to golden yellow (+) sparse
flag signSkin Dermatosis: (-) dryness,
peeling off of the skin, desquamationBehavior
Irritable ApatheticManagement High CHON
diet High CHO dietHospital Setting Total
Parenteral Nutrition (TPN) Hyperalimentation
process IV infusion with CHON, CHO
regulated by a machine
185. 185. POLICIES:II. Food
ProductionFortification-products without any
nutrient are added with nutrientsRA 8172
(Asin Law): Fidel Salt (Fortification of Iodine
Deficiency Elimination)=Iodized Salt-Patak
sa Asin by Secretary Flavier on December 1-
5, 2003where DOH workers go to market to
check if salt sold contains iodine byplacing
few drops of reagent:If salt color turns to blue
violet fortified with iodineIf salt color show
no change not fortified with iodineRA 832
(Rice Fortification): FVR (Fortified Vitamin
Rice) by Secretary Flavierunder FVR, Erap
Rice under Erap, Gloria Rice or Bigas ni
Gloria under PGMA
186. 186. ENVIRONMENTAL
SANITATIONrefers to all factors available
in the environment affecting the health of the
individual or population regulated by PD
856: Comprehensive Sanitation Code of the
Philippines
187. 187. ENVIRONMENTAL HEALTH
SERVICE (EHS) OF DOH IS RESPONSIBLE
FORPromotion of healthy environmental
conditions & prevention of environmental
related diseases through appropriate
sanitation strategiesPromotion &
implementation of sanitation programs
through the Department of Health Field Health
UnitsConceptualization of new
 programs/projects to contend with emerging
environmentally related health problems
188. 188. COMPONENTS: Water
Supply Sanitation Program Proper Excreta
and Sewage Disposal Program Insect and
Rodent Control Food and Sanitation
Program Hospital Waste Management
Program
189. 189. 1. WATER SUPPLY
SANITATION PROGRAM Potable Free
from any particles that might cause illness to
an individual
190. 190. Ways to make Water
Potable:Boiling: minimum of 3 minutes to
maximum of 10 minutes for
drinkingSterilization: 30 minutes after the
water starts to boilFiltration: makes use of
filter paper or cotton cloth to separate solid
particle from liquid if water comes from river
191. 191. Coagulation/Flocculation:
uses aluminum crystal (tawas) that collects or
absorbs particles from liquid part & becomes
slimy In 1 gallon of water, drop tawas (the
size of magi cubes) & allow to stand for 6-8
hours Initially, water appears to be cloudy
then after 6-8 hours of standing, the water
becomes clear
192. 192. Chlorination: uses 100% pure
concentrated chlorine bought from botika or
given free by health centers To prepare
stock solution (SS): in 1 liter drinking water,
add 1 tablespoon of concentrated chlorine
which is potent for 3-4 months To prepare
the chlorinated water: in 2 gallons of
drinking water (10,000 ml=10 liters), add 1
tablespoon from the prepared stock solution &
let it stand for 30 minutes to react with water
193. 193. Fluoridation: adding fluoride
to prevent dental caries (primary significance)
& whitens enamel of teeth ( 2nd
significance)Aeration: exposing drinking
water in air to strengthen taste within 24 hours
which is usually used in uphill areas where
theres less or no pollution
194. 194. 3 TYPES OF APPROVED
WATER SUPPLY AND FACILITIESLevel
IPoint SourceA protected well or a developed
spring with anoutlet but without a distribution
system for ruralareas where houses are thinly
scattered.
195. 195. 3 TYPES OF APPROVED
WATER SUPPLY AND FACILITIESLevel
IICommunal faucet system or stand postsA
system composed of a source, a reservoir, a
pipeddistribution network and communal
faucets, located atnot more than 25 meters
from the farthest house inrural areas where
houses are clustered densely.
196. 196. 3 TYPES OF APPROVED
WATER SUPPLY AND FACILITIESLevel
IIIWaterworks system or individual
houseconnectionsA system with a source, a
reservoir, a pipeddistributor network and
household taps that issuited for densely
populated urban areas.
197. 197. 2. PROPER EXCRETA AND
SEWAGE DISPOSALSYSTEM
198. 198. 3 TYPES OF APPROVED
TOILET FACILITIESLevel 1Non-water
carriage toilet facility:- Pit latrines- Reed
Odorless Earth Closet- Bored-hole-
Compost Toilets requiring small amount of
water to wash waste intoreceiving space-
Pour flush- Aqua privies
199. 199. Pit latrines most commonly
observed in rural area has three
components: the pit, a squatting plate and the
super-structure types of pit
includeAntipolo type, a pit type of toilet
provided with concrete floor and an elevated
seat with a coverVentilated Improved Pit or
VIP, pit with a vent pipeReed Odourless Earth
Closet or ROEC, a pit completely displaced
from the superstructure and connected to the
squatting plate by a curved chute.
200. 200. Bored Hole Latrine consists of
relatively deep holes bored into the earth by
mechanical or manual earth-boring
equipment holes are about 10-18 inches in
diameter and usually 15-35 feet deep. The
hole is provided to facilitate squatting. Two
types of bored-hole latrines are:Wet Type -
when the hole penetrates ground water table
or other strata.Dry Type - when he hole does
not reach ground water table; fills up at a
faster rate then than the wet type.
201. 201. 3 TYPES OF APPROVED
TOILET FACILITIESLevel 2On site toilet
facilities of the water carriage type withwater
sealed andflushed type with septic vault/tank
disposal facilities.
202. 202. 3 TYPES OF APPROVED
TOILET FACILITIESLevel 3Water carriage
types of toilet facilitiesconnected to septic
tanks an/or to seweragesystem to treatment
plant.
203. 203. THINGS TO CONSIDER IN
CONSTRUCTING A TOILETFACILITY: At
least 25 meters away from water sources at a
lower elevation It should be within your
financial capability It should be approved
by the local health authorities
204. 204. CARE AND MAINTENANCE OF
YOUR TOILET FACILITY: Water must be
provided at all times. Use toilet paper
Use lysol once a month for odor removal
Clean the bowl by muriatic acid to remove the
stains. Avoid depositing solid objects on
the bowl to prevent clogging Always check
your toilet if its clean Use plunger when
clogging occurs. Dont use sticks or rods to
avoid the breakage of the trap or the bowl.
205. 205. 3. PROPER SOLID WASTE
MANAGEMENTrefers to satisfactory methods
of storage, collection and final disposal of
solid wastes
206. 206. SOURCES OF SOLID
WASTEHousehold Waste - these are wastes
generated in or discharged from household
including shops but excluding commercial
activities Commercial Waste - restaurants,
stationery shops, grocery shops or any
commercial activity are the main sources of
commercial waste. Market Waste - only refers
to waste generated in or discharged from
markets both for whole sale and retailing
207. 207. SOURCES OF SOLID
WASTEInstitutional Waste - these are wastes
generated in government, state enterprise and
private firm office. Street Sweeping Waste -
 these are wastes generated by the street 216. 216. 3 POINTS OF
sweeping cleansing service. River Waste - CONTAMINATIONPlace of production
includes all the wastes generated by the river processing and source of
and creek cleansing Medical Waste - these supplyTransportation and storageRetail
are wastes generated in hospitals. and distribution points
208. 208. COMPONENTS OF SOLID 217. 217. 5. HOSPITAL WASTE
WASTEGarbage refers to left over vegetable, MANAGEMENTRA 4226-Hospital Licensure
animal and fish material from kitchen and food Act monitors the hospital license & proper
establishments. These materials have the management of wastes as well as renewal of
tendency to decay giving off foul odors and license to operate
sometimes serve as food for flies and 218. 218. GOAL:To prevent the risk of
rats. Rubbish refers to waste materials such contraction contracting nosocomial infection
as bottles, broken glass, tin can, waste from type disposal of infectious, pathological
papers, discarded textile materials, porcelain and other wastes from hospital
wares, pieces of metal and other wrapping 219. 219. COLOR CODING OF BIN TO
materials. KEEP WASTE:Green: wet wasteBlack : dry
209. 209. COMPONENTS OF SOLID wasteYellow: infectious/pathological waste
WASTE Ashes are left over from burning of like blood, sputum, urine, feces &
wood and coal. Ashes may become a gauzeOrange: toxic/hazardous waste
nuisance because of the dust associated with
them. Stable manure is animal manure
collected from stables. Dead animals like
dead dogs, cats, rats, pigs, and chickens that
are killed by cars and trucks on streets and
public highways. They include small and large
animals that died from disease.
210. 210. COMPONENTS OF SOLID
WASTEStreet sweeping includes dust,
manure, leaves, cigarette buts, waste papers
and other materials that are swept from
streets. Night soil is human waste normally
wrapped and thrown into sidewalks and
streets. This also includes human waste from
pail system of toilets. Yard cuttings includes
leaves, branches, grass and other
211. 211. SANITARY WAYS OF
TREATING GARBAGE:Segregation-
separating biodegradable from non
biodegradableCollection-adherence to the
proper collection time the City of Manila
coordinates with Leonel Waste Management
(a private firm which collects garbage) where
the truck driver coordinates with the Barangay
Chairman on the time they will collect garbage
so dont bring out garbage before the
collection time
212. 212. WAYS OF DISPOSAL
Household Burial Deposited in 1m x 1m
deep pits covered with soil, located 25 m.
away from water supply Open burningo
Animal feedingo Compostingo Grinding and
disposal sewer
213. 213. WAYS OF DISPOSAL
Community Sanitary landfill or controlled
tipping Excavation of soil deposition of
refuse and compactingwith a solid cover of 2
feet IncinerationEcological Solid Waste
Management: RA 9003- the use ofincinerator
approved in 2000 but was implemented in
2003because of lack of funding to purchase
214. 214. 4. FOOD SANITATION
PROGRAM
215. 215. POLICIES: Food
establishment are subject to inspection
(approved of all food sources containers and
transport vehicles) Comply with sanitary
permit requirement Comply with updated
health certificates for food handlers, helpers,
cooks All ambulant vendors must submit a
health certificate to determine present of
intestinal parasite and bacterial infection