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SCOPE OF NURSING LICENSURE EXAMINATION (NLE

)
Nursing Board Exam/Nursing Licensure Exam Coverage (Nursing Practice I)
NURSING BOARD EXAM SCOPE/COVERAGE
NURSING PRACTICE I
TEST DESCRIPTION: Theories, concepts, principles and processes basic to the
practice of nursing with emphasis on health promotion and health maintenance. It
includes basic nursing skills in the care of clients across age groups in any setting.
Moreover, it encompasses the varied roles, functions and responsibilities of the
professional nurse in varied health care settings.
TEST SCOPE:
I. Personal and Professional Growth and Development

A. Historical Perspective in Nursing
HISTORICAL FOUNDATION OF NURSING

The Four Great Periods of Nursing
1. INTUITIVE NURSING
*This untaught nursing was instinctive.
*Dated from pre-historic times.
*Practice among primitive tribes and lasted through Christian era.
*Performed out of feeling of compassion to others.
*Out of wish to do good- HELPING

2. APPRENTICE NURSING
*Extends from the founding of religious orders in the 6th century through the
crusades which began in the 11th century to 1836.
*The Deacons School of Nursing at Kaisserwerth, Germany established by
pastor Fliedner and his wife.
*Period of “on the job training”- desired of person to be trained

3. EDUCATED NURSING
*Began in 1860.
*Florence Nightingale School of Nursing opened at St. Thomas’ in London.
First program of formal education for nurses started.

4. CONTEMPORARY NURSING
*Began at the end of World War II (1945)
*Scientific and Technological developments of many social changes occurs.

INTUITIVE NURSING
*Cause of illness was believed to be the invasion of the victims’ body by an evil
spirit.
*Uses black magic or voodoo to harm or driven out by using supernatural power.
*Believed in medicine man (shaman or witch doctor) that had the power to heal
by using white magic.
 They made use of hypnosis, charms, dances, incantations, purgatives,
massage,fire, water, herbs or other vegetations and even animals.
*Performing a trephine
 Drilling a hole in the skull with a rock or stone without benefit of anesthesia.
 Goal of this therapy is to drive the evil spirit from the victim’s body.
*Nurse’s role was instinctive – directive toward comforting, practicing midwifery
and being wet nurse to a child.
*Act performed without training and direction.

Babylonia
*Practice of medicine is far advanced.
*Code of Hammurabi.
-Legal and Civil measures is establish
-Regulate the practice of physicians
-Greater safety of patient provided
*No mention of Nurses or nursing this time

Egypt
*Art of embalming enhance their knowledge of human anatomy
*Developed the ability to make keen clinical observations and left a record of 250
recognized diseases.
*Control of health was in the hands of Gods. The first acknowledged physicians
was Imhotep.
*Made great progress in the field of hygiene and sanitation.
*Reference to nurses in Moses’ 5th book is a midwife and wet nurse.

Palestine
*The Hebrews book of genesis emphazised the teachings of Judaism regarding
hospitality to the stranger and acts of charity.
*Implementation of laws like
-controlling the spread of communicable disease
-cleanliness
-preparation of food
-purification of man (bathing and his food.
*The ritual of circumcision of the male child on the 8th day
*The established of the High Priest Aaron as the physician of people.

China
*Culture was imbued with the belief in spirits and demons.
*Gave the world the knowledge of material medica (pharmacology); method of
treating wounds, infection and muscular afflictions.
*Chan Chun Ching – Chinese Hippocrates.
*Emperor Shen Nung – said to be the father of Chinese medicine and the
inventor of acupuncture technique.
*No mention of nursing in Chinese writings so it is assumed that care of the sick
will fall to the female members of the household.

India
*First recorded reference to the nurse’s taking care of patients on the writings of
shushurutu.
*Functions and Qualifications of nurse includes:
- Knowledge in drug preparation and administration.
- Cleverness.
- Devotedness to the patient.
- Purity of both mind and body.
*King Asoke, a Buddhist, published an edict to established hospitals throughout
India where nurses were employed.

Greece
*Made contribution in the area aesthetic arts and clinical medicine, but nursing
was the task of the untrained slave.
*Aesculapius, The Father of Medicine in Greek mythology to whom we associate
the Caduceus, (known insignia of medical profession today)
*Hippocrates, the Father of Medicine” insisted that magic and philosophical
theories had no place in medicine.
*The work of women was restricted to the household. Where mistress of the
mansion gave nursing care to the sick slaves.

Rome
*Acquired their knowledge of medicine from the Greeks.
*Emperor Vespasian opened schools to teach medicine.
*Developed military medicine – First aid, field ambulance service and hospitals for
wounded soldiers.
*Translated Greek medical terminologies into Latin terms which has been used in
medicine ever since.

APPRENTICE NURSING
*Religious orders of Christian Church played a major role in this kind of nursing.

The Crusades (11th Century)
*Series of holy wars were conducted by Christian in an attempt to recapture the
Holy land from the Turks.
*Military religious orders founded during the crusades established hospitals and
staffed them with men who served as nurses. Among these were:
- The knights of St. John of Jerusalem served both as warriors in battle and
nurses in the hospital and was called Knights Hospitallers.
- The Teutonic Knights built hospitals cared for sick and denfended the faith.
- The Knights of St. Lazarus established primarily for the nursing of lepers,
forerunners of our now known communicable diseases hospital (also called
lazarettos).

The Rise of Religious Nursing Orders
* The Regular Orders – established monasteries to house travelers, paupers and
patient under one roof. Later as society became better organized hospitals
tended to become separate institutions apart from monsteries.
*The Secular Orders – developed for the primary purpose of nursing; were similar
to the regular orders by their temporary vows, uniformity in dress and religious
observation.
*The Nursing Orders – definitely organized. The sisters advanced the stage of
probationer to wearing the white robe to receiving the hood; “They were all under
the superintendent of nurses” or director of nursing; later adopted a uniform dress
that eventually became entirely standardized.

Nursing Saints
* St. Hildegarde – a Benedictine abbess in Germany, actually prescribed cures in
her 2 books on medicine and natural history.
* St. Francis and Clara – took vows of poverty, obedience, service and chastity
and took care of the sick and the afflicted; founders of the Franciscan Order and
the Order of the Poor Clares respectively.
* St. Elizabeth of Hungary – the patroness of nurses; built a hospital for the sick
and the needy.
* St. Catherine of Siena – the 1st “lady with a lamp”; became a tertiary of St.
Dominic and engaged in works of mercy among the sick and of the Church.

The Reformation
* St. Vincent de Paul – set up the first program of social service in France and
organized the “Community of the Sisters of Charity”. His 1st superior and co-
founder was Louise de Gras (nee de Marillac).

The Intellectual Revolution (17th Century)
 Characterized by the development of natural science, medicine, arts and as
well as interest in human beings and their welfare. Among the leaders for reform
were:
* St. John of God – founder of the Brother Hospitallers and declared the “patron
of all hospitals and sick folk” by Pope Leo XIII in 1930.
* George Fox – founder of the sect known as the Soicety of Friends (Quakers)
who advocated equality of men and women, thus making it easier for women to
become active in Nursing.
* John Howard – introduced prison reforms (fresh air and plenty of water).
* Philippe Pinel – introduced his modern open-door treatment of the mentally ill.
* Elizabeth Fry – greatly improved prison conditions by developing work fo the
prisoners and the segregations of sexes, later established the Insitute of Nursing
sisters, the first organization of women to be trained as private duty nurse.
* Mother Mary Catherine MccAuley – founder of the “Order of the Sisters of
Mercy”, 2nd largest of the Roman Catholic Orders.
* Theodor Fliedner and his wife Friederike Mumster – established the Institute of
Kaisserwerth on the Rhine for the practical training of Deaconesses (1836), which
is considered as the 1st Organized training school for nurses. It was here where
Florence Nightingale received some of her training and the inspiration for the
establishment of her school of nursing. Some of its features includes:
1. A rotating 3 year experience in cooking and housekeeping, laundry and
linen and nursing care in the women’s and men’s wards; and
2. A preliminary and probationary 3 months period of trial and error for both
school and student.

The “Dark Period of Nursing” (17th – 19th Century)
* Many hospitals were closed; the wealth took care of their sick at home; the
indigent sick were taken care of by uneducated, illiterate women who had no
background for nursing.
* Charles Dickens in his book entitled Martin Chuzzleswit published the selfish and
cruel conduct of 2 private duty nurses namely Sairey Gamp and Betsy Prig.

THE PERIOD OF EDUCATED NURSING

England
* June 15, 1860 marked the day when 15 probationers entered St. Thomas’
Hospital in London to establish the Nightingale system of Nursing, founded
by Florence Nightingale (May 12, 1820). Among the highlights in her life are the
following:
- At age of 31, obtained parental consent to enter the Deaconess School at
Kaisserwerth.

- Had 3 months training at Kaisserwerth; later superintendent of the
“Establishment for Gentlewomen During Illness” (1853) during which time she
initiated the policy of admitting and visiting the patients of all faiths.
- In 1854 a Volunteered for Crimean war service together with 38 women at
Scutari in the Crimea upon the request of Sir Sidney Herbert, Minister of War in
England. At first their work is not accepted because it consisted of cleaning the
area, thus reducing the infections, clothing for the men, writing letters to their
families; their work served as inspiration for the Red Cross later on.
- In 1860 started the Nightingale System of Nursing at the St. Thomas Hospital
in London believed that schools should be self-supporting; that schools of nursing
should have decent living quarters for their student; that they should have paid
nurse instructors; that the school should correlate theory to practice and these
students should be taught the “why” not just “how” in nursing.
- 2 books written – Note on Nursing and Notes on Hospital, contain many
timely portions applicable in the 1970’s as they were in 1859.

United States
* At the time that Florence Nightingale was opening her school in London; the U.S
was on the brink of the civil war. However though the country was in a condition of
chaos, nursing had many supporters and the needs to train nurses were
recognized.
- Linda Richards is the first graduate nurse in the U.S completed her training at
the New England Hospital for Women and Children in Boston, Massachusetts,
patterned after the DeaconessesSchool of Kaisserwerth.
- In 1873 3 schools of nursing opened, patterned after the Nightingale plan –
the Bellevue Training School for Nurse in the New York City , the Connecticut
training. School in New Haven and the Massachusetts General Hospital in Boston.
- In 1881 – founding of American Red Cross by Clara Barton.
- In 1889 John Hopkins hospital opened a school of Nursing with Isabel
Hampton Robb as its 1st principal and the person most influential in directing the
development of nursing in the U.S.
- In 1893 the groundwork for the estimate of the 2 new nursing organization
was lad:
1. The Associated Alumnae, later known as the American Nurses
Association was begun at the Chicago Worlds fair and
2. The American Society of Superintendent of Training Schools for Nurses,
later known as the National League for Nursing Education, also began.
- During the Spanish American War (1898 – 1899) nurse were concerned with
the care of the wounded as well as care of those inflected with malaria and yellow
fever.
Nurse Clara Louise Maas gave her life for the advancement of medical science in
the search for control yellow fever.

the start of Aero-medical nursing (flight nursing) .Opening of more nursing schools as a result of the construction of more hospitals.the practice of nursing was gradually infiltrated with educational objectives. * 1913 – 1937 . CONTEMPORARY NURSING * Creation of United Nations in San Francisco California in 1945.the concept of family centered care as methods to help patient help themselves.consept of creative nursing. . . . established in Geneva.there was a growing awareness for the preventive measures that could be uses to maintaing the heath of the nation. social justice and economic progress.There was beginning specialization in medicine.N.granting of permanent commissioned rank for both army and navy nurses.S public Health Service. World Health Organization (WHO) . * World War II (1942 – 1945) . 2 folds purpose are: . * Worl War I (1917 – 1918) . Machinery for peaceful disputes and provisions. which has necessitated the need for laundering definitive studies of all aspects of nursing thus helping to raise the standards to a professional level.The 20th Century *In 1900 – 1912 . . .International peace and international security with provisions for equal justice. . . government service and pre-maternal nursing. public health nursing.Private duty nurses were now nursing in the hospitals rather than in homes.  Julia Stimson was the first woman to hold rank of major. . private duty nursing. Lucille Ptery Leone as director and later the 1st woman to serve as assistant surgeon of the U. .S Cadet Nurses Corps with Mrs.advancement in hospital nursing.Creation of the U.Increase demand for public health nurse for preventice aspects of care.Special agency of U.a standard curriculum for schools of nursing was prepared by the National League for Nursing Education. Switzerland in 1948 . . .Provisions for assuring human rights. school nursing.concept of psychosomatic medicine and early ambulation.Awareness of the need for military ranking among nurses for which a bill was later introduced and passed.

Scientific and Technical Research used in disease prevention and health care. Founded by Brother Juan Clemente. supported purely by alms and contributions from charitable persons.belief in the powers of “herbolarios” (albularyo) * Hospitals existed as early as 15th Century. technology efficiency and nursing involvement with minority groups. Among their early hospitals are: The Earliest Hospitals Established were the following: HOSPITAL REAL de MANILA (1577) – established primarily for king’s soldiers and Spanish civilians. HOSPITAL de INDIOS (1586) – established by the Franciscan Order: offered general services. administered by the hospitallers of San Juan de Dios. prepared health care. SAN LAZARO HOSPITAL (1578) – exclusively for the service of leprous patients. . HOSPITAL de CONVALENSCECIA (1656) – estimated by the Brotherhood of San Juan de Dios on the little island on the Pasig River. living standards and environmental conditions of all people.providing health information in fighting diseases and improving the nutrition. which were established by the religious and also by Spanish administration.Social Force affecting Nursing – Legislation. Founded by Brother J. patients of San Juan de Dios Hospital who were in the convalescent stage were sent there for their complete recovery. SAN JUAN de DIOS HOSPITAL (1596) – founded by brotherhood of misericordia. . Francisco de Sande. this was near medicinal spring.believed in the powers of witch. HOSPITAL de AGUAS SANTAS (1590) – convalescent hospital in Pansol. NURSING IN THE PHILIPPINES Early Care of the Sick * Early life of Filipinos had been more or less mixed with superstitious belief. . Founded by Gov. HOSPITAL de DULAC (1602 – 1603) – located in Paco and existed only for 1 year. . . . Bautista of the Franciscan Order. Laguna. * Franciscan Order is more than any other religious group. HOSPITAL de NUEVA CACERES (1655) – general hospital located in Bicol. Named after San Lazaro. patron saint of lepers. where the Hospicio de San Jose now stands. which cured several patients.

*In the early development of nursing. prepared food and gave comfort even without previous trainings. alleviate pains. also provided nursing services to her troop. Melchora Aquino (Tandang Sora) – Nurse the wounded Filipino soldiers and gave them shelter and food. Josephine Bracken – wife of Jose Rizal Installed a field hospital in an estate house in tejeros. * These were the prominent women who volunteered and gave nursing service. Mrs. the work of the nurse and those of the physician were not clearly defined. Nursing Service during the Philippine Revolution * The women during the Philippine revolutions took active part in nursing the wounded soldier. *Fray Juan Clemente was one of the 1st member’s of the Mission of the Order of St. Trinidad Tecson – “Ina ng Biac na Bato”. Provided nursing care for the Filipino soldier during the revolution. provided nursing care to the wounded when not in combat. stayed in the hospital at Biac na Bato to care for the wounded soldier. he work hand in hand with Dona Hilaria de Aguinaldo and they led other Filipino women to form the Filipino Red Cross in 1899. . HOSPITAL de CAVITE (1842) – a general hospital estimated and managed by Brotherhood of San Juan de Dios. Organized the Filipino Red Cross under the inspiration of Apolinario Mabini. *Persons who really did nursing care of the sick were religious group (called hospitallers) but they were assisted by Filipino attendants. . converted their house into quarters for the Filipino soldier.Performed both the function of a physician and those of a nurse. Rosa Sevilla de Alvaro – volunteered her service for the wounded soldier at age of 18. Dona Hilaria de Aguinaldo – wife of Emilio Aguinaldo. . Captain Salome – A revolutionary leader in Nueva Ecija. President of the Filipino Red Cross branch in Batangas.HOSPITAL de ZAMBOANGA (1842) – this is a governement military hospital run and finance by Spanish governement. Dona Maria de Aguinaldo – second wife of Emilio Aguinaldo. Francis in the Philippines in 1578. Provided nursing care to the wounded night and day. They dress wounds. HOSPITAL de SAN GABRIEL (1866) – exclusively for Chinese patients . during the Philippine – American war that broke out in 1899. Agueda Kahabagan – Revolutionary leader in Laguna.Collected native herbs for medicine later set a little pharmacy which he filled with various medical remedies.

1. Vitiliana Beltran was the first Filipino superintendent of nurses. . 1906) . . . 1907) . *A small dispensary in Manila opened for civil officers and employees.S physicians and graduate nurses.* The Filipino Red Cross had its own constitution approved by the revolutionary government. 1907) . In 1907. *In 1906 the idea of training Filipino girls to become nurses intiated the growth of nursing schools. St. It began as a small dispensary in 1903. .The hospital was established by the Archbishop of Manila. Paul’s Hospital School of Nursing (Manila. *The need for doctors and nurses to help eradicate the epidemics of cholera and smallpox led to the employment of U.In 1907. was the first Filipino to occupy the position of chief nurse and superintendent in the Philippines. was the first superintendent. called Civil Hospital. 2. dispensaries and laboratories led to the establishement of the Board of Health in July 1901. .The Hospital is an Episcopalian Institution.It was located in Intramuros and it provided general hospital services. 5. -First trained nursing student graduated after 3 years. 1907) . The Most Reverend Jeremiah Harty. Iloilo Mission Hospital School of Nursing (Iloilo City. under the supervision of the Sisters of St.Miss Librada Javelera was the first Filipino director of the school.It was called Bethany Dispensary and was founded by the Methodist Mission.Miss Rose Nicolet.It was ran by the Baptist Foreign Mission Society of America. 3.Miss Flora Ernst.Mrs. 4. 1899 with Dona Hilaria Aguinaldo as president and Dona Sabina Herrera as secretary. a graduate of New England Hospital for woman and children in Boston. -No standard requirements for admission except willingness to work. Philippine Christian Mission Institute School of Nursing. Mary Johnston Hospital and School of Nursing (Manila. Massachusetts. succeeded her. Luke’s Hospital School of Nursing (Quezon City.Anastacia Giron-Tupas. . with the support of the Governor General Forbes and the Director of Health and among others. This was founded on February 17. took charge of the school in 1942. she opened classes in nursing under the auspices of the Bureau of Education. Paul de Chartres. 6. The Rise of Hospital and Nursing Schools *The need for hospitals.It started as a small dispensary on Calle Cervantes (now Avenida) . St. an American nurse. Philippine General Hospital School of Nursing (1907) . the school opened with three Filipino girls admitted. .

Marian School of Nursing (1960) 22. . 10. Cebu (Velez) General Hospital School of Nursing (1951) 19. De Ocampo Memorial School of Nursing (1954) 21. 1913) . Rita Hospital and School of Midwifery (1956) and Nursing (1960) Advantages of University Hospitals over Hospital Schools of Nursing: 1. Manila.1903) 2. Siliman University School of Nursing (Dumaguete. 1911) 3. Occidental Negros Provincial Hospital School of Nursing (1946) 18.Was destroyed during the war with a new hospital built along Dewey Boulevard. Mary Chiles Hospital School of Nursing (Manila. Southern Island Hospital School of Nursing (Cebu. Emmanuel Hospital School of Nursing (Capiz. 1913) 9. Baguio General Hospital School of Nursing (1923) 13. St. North General Hospital School of Nursing (1946) 16. 1947) 17. 8. Quezon Memorial Hospital School of Nursing (1957) 15.The hospital was established under the Bureau of Health with Anastacia Giron-Tupas as the organizer. Zamboanga general Hospital School of Nursing (1921) 11. Frank Dunn Memorial Hospital 7. . Brokenshire School of Nursing (Nueva Ecija. operated Three schools of Nursing: 1. Chinese General Hospital School of Nursing (1921) 12.The United Christian Missionary of Indianapolis. San Juan de Dios Hospital School of Nursing (Intramuros. Ilocos Norte. Manila Sanitarium and Hospital School of Nursing (1930) 14. 1918) . students are treated as students and not as employees. Sallie Long Read Memorial Hospital School of Nursing (Laoag. 1960) 20.

adequate financial support.The first basic collegiate school for Nursing in the Philippines. 3 female graduated in 1909 as “Qualified Surgical and Medical Nurses”. 1947) e. 2. 3. 4 women started training in nursing. Founder of PNA (Philippine Nurses Association) *Cesaria Tan – First Filipino to receive a master’s degree abroad. Ms. *Rosa Militar – Pioneered in School Health Education. *1909 – A nursing school was established under the Bureau of Education by Authority of Act No. University of the Philippines College of Nursing (1948). Some Highlights in the History of Nursing in the Philippines *1906 – at the Union Mission Hospital (now Iloilo Mission Hospital) in Iloilo City. *Sor Ricarda Mendoza – Pioneer in Nursing Education. 4. 1975 recognized the school under the Bureau of Health. regarded as the Florence Nightingale of Iloilo. *Socorro Diaz – First Editor of the PNA magazine called “The Message” *Conchita Ruiz – First full-time editor of the PNA magazine called “The Filipino Nurse”.Julita Sotejo was its first Dean d. *1907 – 19 students admitted to a preliminary course in nursing as the Philippine Normal College. FEU Institute of Nursing (1955) j. Manila Central University College of Nursing (1948) c. Philippine Union College of Nursing (1947) f. . *1910 – Act No. *Socorro Sirilan – Pioneered in Hospital Social Service in San Lazaro Hospital where she was the Chief Nurse. 1958) Nursing Leaders in the Philippines *Anastacia Giron-Tupaz – First Filipino nurse to hold the position of Chief Nurse Superintendent. Saint Paul College of Nursing (Manila. b. *Loreta Tupaz – Dean of the Philippine Nursing. University of Santo Tomas . The First Colleges of Nursing in the Philippines a.College of Nursing (1946) . The school continued as one of the activities of the newly opened Philippine General Hospital and became known as the Philippine General Hospital School of Nursing. Southwestern College College School of Nursing (Cebu. UE College of Nursing (1958) k. The head of the school is responsible only for the education of students in nursing and. Central Philippine College of Nursing (1947) g. The environment for the university school of nursing school education. 1931. Philippine Women’s University College of Nursing (1951) i. Siliman University College of Nursing (1947) h.

. *1920 – 1st Board Examination for Nurse was conducted by the Board of Examiners. and/or conduct nursing studies and research.P College of Nursing. .The idea was conceived by Julita V. *1955 – The UPCN offered a Master of Arts in (Nursing) Degree program to prepare BSN holders of demonstrated competence and scholarship for senior positions in nursing and to encourage nursing research. *1919 – Act No. 1966 1970 and 1972. . *1965 – The Academy of Nursing of the Philippines (ANPHI) approved its constitution.theoretical exam was held at the UP Amphitheater of the College of Medicine and Surgery. .A program was opened for graduate of the 3 year hospital nursing course to obtain a B. a Nurse and Lawyer. Sotejo. encourage.A 4704. 1933 and 1950. institute and workshops. Practical Exam at the PGH Library.It also provided the holding of exam for the practice of nursing on the 2nd Monday of June and December of each year.Anna Dahlgren.A one-year course leading to a certificate of Public Health Nursing was opened at the UPCN. promote. seminar.A 877 was approved.First attempt to offer a 4 year basic nursing course leading to a B.Public Health Nursing in the Bureau of Health began in accordance with Act No.S Nursing Degree at the U. . .Among its objectives are initiate. *1966 – R. First President – Rosario Delgado Founder – Anastacia Giron-Tupas *1924 – A standard curriculum for school of Nursing was published by the PNA. 68 passed with the highest rating of 93.5% . This program ended in 1975. . Minor revisions were incorporated in 1957.The 1st attempt to elevate nursing as profession by enriching and broadening the preparation of nurses and by educating them in a University Setting. 2468 authorized the granting of the titles of graduate in nursing and graduate in midwifery to nursing midwifery students of the PGHSN. enacted regulating the practice of the nursing profession in the Philippines Islands. 2468. amending R.S Nursing Degree . *1968 – A movement toward accreditation of Nursing Schools in the Philippines was started. 877 (Nursing Practice Law) was approved. who later became the 1st Dean of the School. *1953 – Republic Act No. *1922 – Filipino Nurses Association was established (now PNA) as the National Organization of Filipino Nurses. *1951 – Republic Act 649 provided for the standardization of nurses’ salaries both in institution and in public health.*1915 – Act No. This program ended in 1969. 2808 (Nurses Law) was passed. . *1948 – UP College of Nursing was established. sponsor. and to serve as a medium of exchange through conference. 93 candidates took the exam. This act was later amended in 1922.

Nursing Leaders  Florence Nightingale (1820-1910) -recognized as nursing’s first scientist-theorist for her work. The Workshop drafted an experimental 4-year Nurse-Midwifery curriculum. -developed the Nightingale Training School of Nurses.The Psychiatric-Nursing Specialists. The focus tended to be on developing the profession within hospitals. Notes on Nursing: What It is. . the 1st independent Nurse Practitioners groups. .A 877 and 4704 was approved. concerning the employment of Nursing Personnel and the conditions of their life and work. were adopted in Geneva. *1978 – The Declaration of the Economic and School Welfare of Filipino Nurses was passed by the PNA. *1977 – ILO convention 149 and recommendations 157. Its graduates traveled to other countries to manage hospitals and institute nurse-training programs.  Clara Barton (1812-1921) -organized the American Red Cross. management and government were involved. The scchool served as a model for other training schools. *1975 – A National Health Plan was formulated. its theme “Nursing Issues in the 80’s”. which operated in 1860.It redefined the functions and responsibilities of nurses and other health workers with implication for Nursing Education and Community Health Nursing. *2002 – Philippine Nursing Act of 2002 (R. *1975 – A national seminar on Public Health Nursing Education was held with WHO technical assistance. *1972 – A national seminar on Public Health Nursing Education was held with WHO technical assistance.S Congress ratified the Geneva Convention in 1882. which linked with the International Red Cross when the U. was only partially addressed in the early days of nursing.R.Labor.*1970 – WHO started an ongoing project in nursing education on family planning to prepare faculty members to introduce family planning in basic nursing curricula. . . . Inc.A 9173) 1. and What It is Not -considered the founder of modern nursing. *1979 – The 1st National Nurse Congress was held. (PNSI).A 6136 amending R. . *1976 – A National Workshop on the Proposed Nurse-Midwife Curriculum of Schools of Nursing in the Ministry of Health was sponsored by the Ministry. -Nightingale’s vision of nursing. was established. which include public health and healt promotion roles for nurses.The 1st National Tripartite Conference on employment and conditions of life and work of Nursing and other Health Personnel was held.  Lilian Wald (1867-1941) -considered the founder of Public Health Nursing.

5. 3. To provide a needed service to the society. NURSING .  Lydia Hall -developed the Care. To advance knowledge in its field. Characteristics of a Profession: 1.  Margaret Sanger (1879-1966) -a nurse activist. A profession has a theoretical body of knowledge leaing to defined skills. abilities and norms. Criteria of Profession: 1. . .is an art and science. and Cure Theory -Goal: To Care. 2. Cure the DISEASE. 3. 4. Dock (1858-1956) -active in the protest movement for women’s right that resulted in the U. B. To protect its memebers and make it possible to practice effectively. The profesion has a code of ethics for practice. skill and preparation. Characteristics of Nursing: 1. as well as a basic liberal foundation.  Lavinia L. . Core. NURSE – originated from a Latin word NUTRIX. and Cure Core’s disease. was imprisoned for opening the first birth control information clinic in Baltimore in 1916. Nursing as a Profession NURSING AS A PROFESSION Profession – is a calling that requires special knowledge. A basic profession requires an extended education of its members. allowing women to vote. 2. A profession provides a specific service. to nourish.S Constitution amendment in 1920.is a helping profession.is service-oriented to maintain health and well-being of people. Nursing is caring. -Care for the patient’s BODY. An occupation that requires advanced knowledge and skills and that it grows out society’s needs for special services.is a desciplined involved in the delivery of health care to the society. . considered the founder of planned Parenthood. Treat the PERSON ( or patient) as the Core. Members of a profession have autonomy in decision-making and practice.

. Nursing involves close personal contact with the recipient of care. creed. 2. Change agent . Must have a license to prac tice nursing in the country.“mothering actions” of the nurse.helps client to recognize and cope with stressful psychologic or social problems. Nursing is concerned with services that take humans into account as physiological. . to develop an improve interpersonal relationships and to promote personal growth. legal. . Teacher . 2.activities involves knowledge and sensitivity to what matters and what is important to clients. .2. psychological. 5. 4.interprets information to the client. Promotes healthy lifestyle. .the traditional and most essential role.Encourages the client to look at alternative behaviors recognize the choices and develop a sense of control. and sociological organism. 6. Counselor . . Caregiver/Care provider .encourages compliance with prescribed therapy. is a person who has completed a basic nursing education program and is licensed in his country to practice professional nursing.provides information and helps the client to learn or acquire new knowledge and technical skills. . community. . Personal Qualities of a Nurse: 1. Nursing is committed to personalized services for all persons without regard to color. social or economic status. comforter. 3. Roles of a Professional 1. . provider.A professional nurse therefore. Nursing is committed to involvement in ethical. 3. Must be physically and mentally fit. family. Must have a Bachelor of Science degree in Nursing. Nursing is committed to promoting individual. and national health goals in its best manner possible. 3. and political issues in the delivery of health care. 4.provides direct care and promotes comfort of client.show concern for client welfare and acceptance of the client as a person.functions as nurturer.

. develop staff. Nurse-Midwife – . give the reward fairly and represent both staff and administrations as needed.initiate changes or assist clients to make modifications in themselves or in the system of care.a nurse who has completed a program in midwifery. participates in education health care professionals and ancillary. Clinical Specialists – . 4. counselling. . She provides expert care to individuals.plans. Manager .participates in scientific investigation and must be a consumer of research findings.E. provides prenatal and postnatal care and delivers babies to woman with uncomplicated pregnancies. 6. .participates in identifying significant researchable problems. She is skilled at making nursing assessments. give direction. .makes decisions. acts as a clinical consultant and participates in research. 2. Expanded role as of the Nurse 1.anguage and support client’s decisions. . Nurse Practitioner – -is a nurse who has completed either as a certificate program or a master’s degree in a specialty and is also cerified by the appropriate specialty organization. teaching and treating minor and self-limiting illness. 7.is a nurse who has completed a master’s degree in specialty and has considerable clinical expertise in that specialty. monitor operations. Researcher . -must be aware of the research process.promotes what is best for the client.. ensuring that the client’s needs are met and protecting the client’s right. performing P. 3. allocate resource evaluate care and personnel. language of research.. a sensitive to issues related to protecting the rights of human subjects. Nurse Anesthetist – . Client advocate .a nurse who completed the course of study in an anesthesia school and carries out pre-operative status of clients. 5. coordinates activities of others.involves concern for and actions in behalf of the client to bring about a change.provides explanation in client’s .

who beaches in clinical or educational settings. .a nurse who has an advanced degree.Health . Fields and Opportunities in Nursing 1. 6. teaches theoretical knowledge. 3.a nurse usually with advanced degree. Independent Nursing Practice – private practice. Example: brgy.Environment . Public Health Nursing/Community Health Nursing – usually deals with families and communities. Nursing Theory and Theorists 4 Essential concepts common among nursing theories: . lying-in. ( no confinement.5.Independent Nurse Practtioner. Clinic Nurse – nurses working in a private and public clinic. etc. home service. BP monitoring.I. 6. Nurse Entrepreneur - . Private Duty/Special Duty Nurse – privatey hired. 8. office. Military Nurse – nurses working in a military base. Nurse Administrator – . 7. 2. 7. Hospital/Institutional Nursing – a nurse working in an institution with patients. clinical skills and conduct research. Nursing Education – nurses working in school. Health Center. 4.Individual .a nurse who functions at various levels of management in health settings. companies. and manages health-related business. review center and hospital as a C.Nursing . responsible for the management and administration of resources and personnel involved in giving patient care. OPD only ). 5. Example: rehabilitation. Nurse Educator – . Industrial/Occupational Nursing – a nurse working in factories.

light. Environmental Theory *Disease is a reparative process.Defined Nursing: “The act of utilizing the environment of the patient to assist him in his recovery.Defined Nursing: “The act of assisting others in the provision and management of self-care to maintain/improve human functioning at home level of effectiveness.Modern Nursing.Identified 5 environmental factors: fresh air. well-ventilated. · Sets forth meaning through analysis. -Has a strong health promotion and maintainance focus. Ernestine Wiedenbach .Helping Art of Clinical Nursing * “…nursing is nurturing or caring for someone in a motherly fashion. and logical argument. *Did not agree with the “germ theory of disease” although she accepted the ill effects of contamination from organic materials from the patients and the environment hence found sanitation as important. Florence Nightingale . .Considered a clean. C. warmth. *Also renowned for pioneering statistical analysis of healthcare. and nursing) in each of the conceptual models of nursing. DOROTHEA OREM’S SELF-CARE THEORY . reasoning. and that the manipulation of the environment - ventilation. . health and well-being. It provides a broad understanding and direction. efficient drainage. cleanliness.” *Proposed that nurses identify patient’s need-for-help by: .” . cleanliness/sanitation and light/direct sunlight.Deficiencies in these 5 factors produce illness or luch of health but with a nurturing environment.would contribute to the process and health of the patient.” . diet. environment. the body could repair itself.Focuses on changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act.Focuses on activities that adult individuals perform on their own behalf to maintain life.FLORENCE NIGHTINGALE’S ENVIRONMENTAL THEORY . and noise . pure water. health. quiet environment essential for recovery. . Theoretical Foundation of Nursing Applied in Health Care Situations THEORETICAL FOUNDATION OF NURSING I. Philosophy · Specifies the definition of the metaparadigm concepts (person.

Eliminate 10. Eat and drink 9. Breathe 8.o Observing behaviors regarding comfort. Communicate 4.Definition of Nursing. and Cure *The theory consists of 3 major tenets: o The nurse functions differently in the 3 interlocking aspects of the patient: -Cure (Disease) shared with doctors -Core (Person) addressed by therapeutic use of self. Lydia Hall . o Exploring meanings of the behavior. Clean body and intact integument 2. will. Worship 5. Motion and position 11. o Knowing the cause of discomfort. in the performance of those activities contributing to health or to recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength. involves intimate bodily care like feeding. religious ministry. o Knowing if they can solve on their own or need help. -Care (Body) exclusive to nurses.Learn Faye Glenn Abdellah . Rest and sleep 12. Virginia Henderson . Nurses should be sensitized to humanistic aspects of caring .Play 7. *Contributed to nursing theory development through the systematic analysis of research reports to formulate the 21 nursing problems that served as an early guide for comprehensive nursing care. Core. bathing and toileting o As the patient needs less medical care.Care.Work 6. or knowledge and to do this in such a way as to help him gain independence as rapidly as possible” *14 Basic Needs: 1. etc. Carative Factors *Caring is a universal social phenomenon that is only effective when practiced interpersonally. 14 Basic Needs *“The unique function of the nurse is to assist the individual.Philosophy and Science of Caring. shared with psychiatry/psychology.21 Nursing Problems *Problem solving was seen as the way of presenting nursing(patient) problems as the patient moved towards health. Temperature 14. Clothing 13. he needs more professional nursing care o Wholly professional nursing care will hasten recovery Jean Watson . Safe environment 3. sick or well.

which improves decision making. Form humanistic-altruistic values 6. *Differentiates important factors from less inportant aspects of care. and governed by context-free rules and regulations rather than experience. Proficient *Has 3 to 5 years of experience. Develop helping-trust relationship 9. and Expert). STAGE IV. Scientific problem-solving method for decisions 2. *Principles to guide actions begin to be formulated and are focused on experience. Advanced Beginner *Demonstrate marginally acceptable performance. *Novices have no “life experience” in the application of rules. Competent *Has 2 to 3 years of experience.” STAGE II. Provide supportive. *Uses maxims as guides for what to consider in a situation. or corrective environemnt 4. *Perceives situations as a whole rather than in terms of parts as in Stage II. STAGE V. protective. * Recognizes the meaningful “aspect” of a real situation. Instill faith-hope 7. *Develops when the nurse begins to see his or her actions in terms of long-range goals or plans which he or she is consciously aware of.. Promote interpersonal teaching-learning 3. BENNER’S STAGES OF NURSING EXPERTISE STAGE I. Assist gratifying human needs 5. *Focuses on long-terms goals. Nursing Student) *Performance is limited inflexible. *Has experienced enough real situations to make judgement about them. Cultivate sensitivity 8. *Has holistic understanding of the client. Proficient. *”Just tell me what I need to do and I do it. Novice *Has no experience (e. Allowance for existential-phenomeno- logical forces Patricia Benner . Promote and accept expression of positive and negative 10. STAGE III.*10 Carative Factors 1. Competent. *Coordinates multiple complex care demands. Advanced beginner. Expert .g.Novice to Expert *Validated the Dreyfus Model of Skill Acquisition in nursing practice with the systematic description of the 5 stages (Novice. *Demonstrates organizational and planning abilities.

Conservation Model *Major Concepts: o Wholism (Holism) o Adaptation . (3)response to stress. no longer requires rules guidelines. (2)inflammatory response. *Concepts that specify their interrelationship to form an organized perspective for viewing the phenomena Grand Theories *Derived from models but as “theories”. flexible.help the patient do for himself. or maxims to connect an understanding of the situation to appropriate action.3 Types: Wholly Compensatory . Conceptual Models *Frameworks or paradigms that give a broad frame of reference for systematic approaches to the concerned phenomena.(1)Fight or flight. Supportive Educative . they propose testable truths or outcomes based on use of the model in Practice.help the patient learn to do for himself.process whereby patients retain integrity. establish body economy to safeguard stability: Environment Organismic Response .Nursing intervention is based on the conservation of the patients: Energy Structural Integrity Personal Integrity Social Integrity *Composed of 3 Theories.” II. . and highly proficient. nurse has important role in designing nursing care. *Is inclined to take a certain action because “it felt right. Dorothea Orem . *Demonstrates highly-skilled intuitive and analytical ability in new situations.4 principles of conservation .*Performance is fluid. Myra Estrin Levine .do for the patient.alternative to nursing diagnosis o Conservation .Self.Care Deficit Theory *Composed of 3 Theories: o Theory of Self Care o Theory of Self-Care Deficit o Theory of Nursing Systems .(1) conservation (2) redundancy (3) therapeutic intention. (4)perceptual awareness Trophicogenesis . Partly Compensatory .

Life evolves irreversibly and unidirectionally along space and time. and innovative patterning. and interdependence *Through adaptive mechanisms.continuous mutual process of person and environment. Resonancy .Martha Rogers . thinking being . Helicy . a person shows adaptive or ineffective response that need nursing intervention.spiral development in continuous.Behavioral Systems Model *Considered attachment or affiliative subsystem as cornerstone of social organizations *Nursing problems arise because there are disturbances in the structure or function of the subsystems: Dependency Achievement Aggressive Ingestive Eliminative Sexual Sister Callista Roy . such as physiological self- concept. judgement and actions of nurse and patient lead to reaction. sensation and emotion. explore means of attaining goals. Pattern and organization identify man and reflect his innovative wholeness. regulator and cognator.patterning changes with development from lower to higher frequency(intensity).man has capacity for abstraction and imagery. non-repeating. Integrality .Man and environment continuously exchange matter and energy. Imogene King . Sentient. Goal Attainment Theory *Nursing is a process of human interaction between nurses and patients who communicate to set goals. *Theoretical Assertions Energy . role function.Interacting Systems Framework. and agree on what means to use *Perceptions.Adaptation Model *Proposed that humans are biophychosocial beings who exist within an environment *Environment and self provides 3 types of stimuli: (1) focal (2) residual (3) contextual *Human stimuli create needs in adaptation modes.Unitary Human Beings *Principles of Homeodynamics Helicy . interaction and transaction *Interacting systems: . Dorothy Johnson . language and thought.Man as a whole is more than the sum of his parts. Openness .

Leader 2.organization. and stress Social System . Theories *Group of related concepts that proposes actions that guide practice. Temperature 2. III. body image. Counselor . Eat and drink 10. *The individuality of living is the way in which the individual attends to ALs in regard to place on life span and dependence-independence continuum and as influenced by the 5 factors. *4 Phases of Nurse-Patient Relationship Orientation Identification Exploitation Resolution *6 Nursing Roles 1. Mobility 3. decision making. Teacher 6. Express sexuality 5. Environmental. Breathe 9. power-authority status. Psychological. Eliminate 11.Resource Person 5. Sleep 6. Mother of Psychiatric Nursing *Stressed the importance of the nurse’s ability to understand one’s own behavior to help others identify felt difficulties.Psychodynamic Nursing. Logan. Surrogate 3. Socio-cultural. Communicate 8. transaction. Maintain safe environment 7. Stranger 4. Work and play 4.Model for Nursing Based on a Model of Living · Conceptual Components o 12 Activities of Living (AL) . Dying Life span . Roper. Personal cleansing and dressing 12.complex process of living in the view of an amalgam of activities 1.role. Personal System . growth and development Interpersonal System . Politicoeconomic. May be broad but limited only to particular aspects Middle-range Theories *The least abstract level because they include specific details in nursing practice like population. Hildegard Peplau . self. condition and location.concept of continuous change from birth to death Dependence-independence continuum 5 factors influencing AL: Biological. and Tierney . communication.perception. interaction.

emotional support. object attachment. developmental tasks. psycho- spiritual. attitude. Emerging identities 3. finance. andenvironmental needs *Intervening factors influence client’s perception of comfort: age. and adaptive coping potential *Views nursing as self-care based on the person’s perception of the world and adaptation to stressors *Promotes growth and development while recognizing individual differences according to worldview and inherent endowment. experience. . Rapport Katherine Kolcaba . Dynamic Nurse-Patient Relationship *Focused on patient’s verbal and nonverbal expressions of need and the nurse’s reactions to the behavior *3 Elements of a Nursing Situation Patient behaviors Nurse reactions Nurse actions *Used the nursing process to meet patient’s needs through deliberate action. Developing empathy 4.Human-to-Human Relationship Model *Nursing was accomplished through human-to-human relationship: 1.*4 Psychobiological Experiences that compel destructive or constructive responses Needs Frustrations Conflicts Anxieties Ida Jean Orlando . Sense of ease. and contentment 3. Tomlin and Swain . Relief when specific need is fulfilled 2. Joyce Travelbee .Nursing Process. Transcendence or rising above the problems of pain Erikson. Developing sympathy 5. social. Original encounter 2.Theory of Comfort *Defined healthcare needs as those needs for comfort including physical.Modeling and Role-Modeling *Synthesis of multiple theories related to basic needs. advanced nursing beyond automatic response to disciplined and professional response. calm. prognosis *Types of comfort: 1.

retention of relevant care values unique to culture Cultural Care Accommodation or Negotiation .Human Becoming *A unique. humanistic approach instead of a physiological basis for nursing *Nursing is a human science that is not dependent on medicine or any discipline for its practice *Major concepts include: Imaging Connecting-separating Valuing Powering Languaging Originating Revealing-concealing Transforming Enabling-limiting Merle Mishel . knowledge and practice. culture. caring. *Caring includes assistive. . and cultural variations *Caring is seen as the central theme in nursing care. cultural values. Kathryn Barnard .changing life-ways while still respecting culture for a healthier outcome. teaching. Rosemarie Rizzo Parse . Madeleine Leininger . facilitative acts towards people with actual or anticipated needs *3 types of Nursing Actions Cultural Care Preservation or Maintenance .Transcultural Care Theory. *Developed a complex theory to explain the factors impacting the maternal role over time. Ethnonursing *Some of the major concepts are care.Uncertainty in Illness *Researched into experiences with uncertainty as it relates to chronic and life- threatening illness. Child Health Assessment Interaction Theory *Individual characteristics of each member influence the parent-infant system and that adaptive behavior modifies those characteristics to meet the needs of the system *The theory is based on scales developed to measure feeding.adapting culture with professional care providers Cultural Care Repatterning or Restructuring . *Later reconceptualized to accommodate the responses to uncertainty over time in people with chronic conditions who may not resolve the uncertainty.Parent-Child Interaction.Maternal Role Attainment *Focused on parenting and maternal role attainment in diverse populations. and environment.Ramona Mercer . supportive.

. space and consciousness. 2. Provides sound decision making in the care of individuals/groups. Ensures continuity of care.. D. Professional Organizations in Nursing F. 9.Margaret Newman .Health Promotion Model *The goal of nursing care is the optimal health of the individual *Developed the idea that promoting optimal health supersedes disease prevention *Identifies cognitive-perceptual factors of a person. beliefs. 6. role of the professional. Evelyn Adam . Sets priorities in nursing care based on patients’ need. and major units *Included goal of the profession. but to help people use the power within them as they evolve toward a higher level of consciousness. 7.Conceptual Model for Nursing *Used a model from Dorothy Johnson and definition of nursing from Virginia Henderson *Identified assumptions. Nola Pender . 5. Demonstrate knowledge based on the health/Illness status of indiidual groups. like importance of health- promotion behavior and its perceived barriers.Model of Health *Major concepts are movement. 3. and situational and behavioral factors. Time is a function of movement. and these factors are modified by demographics. the intervention of the professional. time. beneficiary of the professional service. Time is a measure of consciousness. and the consequence. and values. “Movement is a reflection of consciousness. Formulates a plan of care in collaboration with patients and other members of the health team. 8. 4. Administersmedications and other health therapeutics. The Nurse in Health Care 1. interpersonal influences. Continuing Professional Education E. source of the beneficiary’s difficulty. Utilizes the nursing process as framework for nursing. biology. Implements planned nursing care to achieve identified outcomes.” *The goal of nursing is not to promote wellness or to prevent illness. Promote wholeness and well-being including safety and comfort of patients. SAFE AND QUALITY NURSING CARE 1. Eleven Key Areas of Responsibility ELEVEN KEY AREAS OF RESPONSIBILITY A.

4. 4. Evaluates the outcome of health education. HEALTH EDUCATION 1. Recommends improvement of systems and processes. G. informed consent. Possesses positive attitude towards change and criticism. MANAGEMENT OF RESOURCES AND ENVIRONMENT 1. 3. LEGAL RESPONSIBILITY 1. 5. Identifies and reports variances. Identifies own learning needs. Pursues continuing education. 6. Adheres to organizational policies and procedures. Personal and Professional Development 1. 5. Adheres to practice in accordance with the nursing law and other relevant legislation including contracts. 5. 2.10. 3. Responds to the urgency of the patient’s condition. Respects the rights of individuals/groups. 2. 11. B. Practices stewardship in the management of resources. Develops learning materials for health education. Documents care rendered to patients. Projects a professional image of the nurse. 3. C. 6. 4. Participtaes in nursing audits and rounds. Utilizes resources to support Patient care. 2. Performs function according to professional standards. 5. Organizes work load to facilitate patient care. Implements the healtheducation plan. 2. Ensures availability of human resorces. . Maintains a safe and therapeutic environment. Gets involved in professional organizations and civic activities. Utilizes data for quality improvement 2. Adheres to the national and international code pf ethics for nurses. Checks proper functioning of equipment/facilities. Evaluates progress toward expected outcomes. 3. 3. Assess the learning needs of the patient and family. Recommends solutions to identified causes of the problems.Accepts responsibility and accountability for own decisions and actions. Ethico-Moral Responsibility 1. F. local and national. Develops health education plan based on assessed and anticipated needs. 2. Quality Improvement 1. 4. 3. D. E.

4. groups and communities. I. 2. 4. Responds to needs of individuals. First Aid Measures 6. Disseminates results of research findings. Communication 1. Record Management 1. 4. families. Uses appropriate information technology to facilitate communication. Recommends actions for implementation. Safe and Quality Care A. Utilizes varied methods of inquiry in solving problems. 3. Records outcome of patient care. 3.It is a systematic. Utilizes effective communicationin therapeutic use of self to meet the needs of clients. Utilizes effective communication in relating with clients. Maintains accurate and updated documentation of patient care. 2. Collaboration and Teamwork 1. Asepsis and Infection Control 5. Observes legal imperatives in record keeping. Maintains an effective recording and reporing system. 5. Utilizes formal and informal channels. Physical Examination and Health Assessment 3. B. Administration of Medications 4. 2. The Nursing Process NURSING PROCESS Definition . Functions effectively as a team player. Fields of Nursing 3. J. 2. Perioperative Care . members with the team and the public in general. Establishes collaborative relationship with colleagues and other members of the health team for the health plan. Applies research findings in nursing practice. Roles and Functions II. K. Reasearch 1. Basic Nursing Skills 1. Vital Signs 2. 2. client-centered method for structuring the delivery of nursing care.H. Wound Care 7. 3.

Post-mortem Care C. Oxygenation 2. Nursing Care Systems G. Patient Care Classification F. Health Education A. Concepts and Principles of Organization E. Stewardship 6. Confidentiality 8. Justice 4. Related Laws Affecting the Practice of Nursing VI. The Philippine Nursing Law of 2002 (R. Non-maleficence 3. Truth Telling 7. Theories and Principles of Management B. Delegation and Accountability . Urinary Elimination 6. Code of Ethics in Nursing V. Privacy 9. Discharge Planning IV.A 9173) C. Teaching and Learning Principles in the Care of Client B. Informed Consent B. Bioethical Principles 1.8. Mobility and Immobility III. Beneficence 2. Management of Environment and Resources A. Health Education in All Levels of Care C. Bowel Elimination 7. Rest and Sleep 4. Activity. Principles and Styles of Leadership D. Measures to meet physiological needs 1. Legal Aspects in the Practice of Nursing B. Ethico-Moral Responsibility A. Post-operative Care 9. Comfort and Hygiene 8. Fluid and Electrolyte Balance 5. Nursing Administration and Management C. Safety. Patient’s Bill of Rights C. Legal Responsibility A. Autonomy 5. Theories. Nutrition 3.

Anecdotal Report B. Use of Information Technology XI. Inter-agency Partnership C. Quality Improvement A. Accreditation/Certification in Nursing Practice D. Quality Assurance IX. Documentation F. Endorsement and End of Shift Report G. Networking B. Therapeutic Use of Self E. Utilization and Dissemination of Research Findings X. Ethics and Science of Research C. Nurse-Client Relationship C. Hospital Manual E. Teamwork Strategies D. Research Process E. Records Management A. Professional-Professional Relationship D. Research Designs and Methodology 1. Collaboration and Teamwork A. Memorandum D. Nursing Audit C. Incident Report C. The Scientific Approach D. Dynamics of Communication B. Qualitative 2. Quantitative F. Nursing and Partnership with Other Profession and Agencies .VII. Referral VIII. Standards of Nursing Practice B. Research A. Problem Identification B. Communication A.

other government schools of nursing were organized several years after. . male nurses performs the functions of doctors. This includes care of high risk and at-risk mothers. families.Carmen del Rosario. groups and communities to promote health and prevent illness. Health Education and Communication. concepts. 1923 – Zamboanga General Hospital School of Nursing and Baguio General Hospital were established. functions were transferred to the Bureau of Health.Nursing Board Exam/Nursing Licensure Exam Coverage (Nursing Practice II) NURSING BOARD EXAM SCOPE/COVERAGE NURSING PRACTICE II TEST DESCRIPTION: Theories. the forerunners of present MHOs. 1st Filipino Nurse supervisor under Bureau of Health. October 22. 1928 – 1st Nursing convention was held 1940 – Manila Health Department was created. Collaboration and Team work COMMUNITY HEALTH NURSING HISTORY OF CHN Date 1901 – Act # 157 (Board of Health of the Philippines) . and alleviate pain and discomfort. 1922 – Filipino Nurses Organization (Philippines Nurses’ Organization) was organized. Safe and Quality Care. TEST SCOPE: Part I: CHN I. Act # 309 (Provincial and Municipal Boards of Health) were created. 1912 – Act # 2156 or Fajardo Act created the Sanitary Divisions. utilizing the nursing process as framework. principle and processes in the care of individuals. 1919 – Act # 2808 (Nurses Law was created) . children and families during the various stages of life cycle. 1095 – Board of Health was abolished.

city and municipality has a LOCAL HEALTH BOARD ( LHB ) which is mandated to propose annual budgetary allocations for the operation and maintenance of their own health facilities.D. Hence. 1999 – EO # 102. This involves the devolution of powers. 1941 – Victims of World War II were treated by the nurses of Manila. Leprosy.A 7160 – or the Local Government Code.1941 – Dr. 1975 – Scope of responsibility of nurses and midwives became wider due to restructuring of the health care delivery system. Bugarin. February 1946 – Number of Nurses decreased from 556 – 308. Eusebio Aguilar helped in the release of 31 Filipino Nurses in Bilibid Prison as Prisoners of War by the Japanese. functions and responsibilities to the local government both rural and urban. 1957 – RA 1891 Ammended some sections of RA 1082 and created the eight categories of Rural Health Unit causing an increase in the demand for the community health personnel. The Code aims to transform local government unit into self-reliant communities and active partners in the attainment of national goals thru’ a more responsive and accountable local government structure instituted thru’ a system of decentralization. Ramos. 1958 – 1965 – Division of Nursing was abolished (RA 977) and Reorganization Act (EO 288) 1961 – Annie Sand organized the National Nurses of DOH. and Mental Health Illness). and Zenaida Nisce composed the training staff. and advisers of the National League of Nurses Inc. board members. Constancia Tuazon. was signed by former President Joseph Estrada. 1953 – The first 81 Rural Health Units were organized. which redirects the functions and operations of DOH. Trinidad Gomez. January 1999 – Nelia Hizon was positioned as the nursing adviser at the Office of Public Health Services through Department Order # 29. Mariano Icasiano became the first ciy health officer. 1967 – Zenaida Nisce became the nursing program supervisor and consultant on the six special diseases (TB. Marcela Gabatin. Cancer. Laws Affecting Public Health andPractice of Community Health Nursing R. 1948 – First training center of the Bureau of Health was organized by the Pasay City Health Department. Dr. Composition of Local Health Board ( LHB ) . 1990 – 1992 – Local Government Code of 1991 (RA 7160) 1993 – 1998 – Office of Nursing did not materialize in spite of persistent recommendation of the officers. Ms. 1950 – Rural Health Demonstration and Training Center was created. V. Ms. July 1942 – Nursing Office was created. Filariasis. Office of Nursing was created through the effort of Vicenta Ponce (Chief Nurse) and Rosario Ordiz (assistant chief nurse) December 8. 1976 – 1986 – The need for Rural Health Practice Program was implemented. each province.. May 24.

dentists.D No. transmitters of disease. 4. . Governor – Chair 2. Chair. The LGU’s financial capability. animal carriers. P. Community Empowerment R.A 9165 – The New Dangerous Draug Act of 2002. R. A dynamic and responsive political leadership 3. R. distribution and transportation of prohibited drugs is punishable by law. P. hence help decrease the high incidence of preventable diseases. 5. Committee on Health of Sangguniang Panlalawigan. insects. MHO – vise chair 3. DOH Representative 5. P. Committee on Health of Sangguniang Bayan.D No. more physicians. R. requires and ensures the production of an adequate supply.A 6425 – Dangerous Drugs Act.A 1082 – Rural Health Act. midwives and sanitary inspectors will live in the rural areas where they are assigned in order to raise the health conditions of barrio people. It provides for the control of all factors in man’s environment that affect health including the quality of water. sanitary and recreation facilities. 825 – provides pernalty for improper disposal of garbage.A 8749 – Clean Air Act of 2000 P. R. City and Municipal Level 1. It stipulates that the sale. nurses. 996 – requires the compulsary immunization of all children below 8 years of age against the 6 childhood immunizable diseases. 4. It is thepolicy of the state to promote high standards of ethics in public . NGO Respresentative. pollution and control of nuisance. 651 – requires that all Health Workers shall identify and encourage the registration of all births within 30 days following delivery. R. nilse.amended by R. food. Mayor – Chair 2. milk. It created the 1st 81 Rural Health Units. DOH Representative. delivery. Provincial Health Officer – vice chair 3.A 6675 – Generics Act of 1988 which promotes.A 1891. R.A 6758 – Standardizes the salary of government employees including the nursing personnel. Chair. 856 – Code of Sanitation.D No.Provincial Level 1.A 2382 – Philippine Medical Act. 2. NGO Representative Effective LHS Depends on: 1. distribution. administration.D No.A 6713 – Code of Conduct and Ethical Standards of Public Officials and Employees. This act defines the practice of medicine in the country. use and acceptance of drugs and medicines identified by their generic name. R.

This act aims: To promote and improve the social and economic well-being of health workers. 79 – defines. adequate and safe complementary foods 4. E. 1979. self- development and self-reliance and integration into the mainstream of society.D No. 2 of 1986 – includes AIDS as notifiable disease. 2006 – 0015 – Defines the Implementing guidelines on Hepatitis B Immunization for infants. R. No. *A.A 7719 – National Blood Services Act R. and functions of POPCOM.O 51 – Philippine Code of Marketing of Breastmilk Substitutes. Misnistry Circular No. R. R.A 7277 – Magna Carta for PWD’S. P. 2005 – 0014 – National Policies on Infant and Young Child Feeding: 1. duties. R. -.office. objectives.A 7600 – Rooming In and Breastfeeding Act of 1992. competence and loyalty.A 4073 – advocates home treatment for lepsrosy. Infants be given timely. R. R.A 7305 – Magna Carta for Public Health Workers.A 8976 – Food Fortification Law R. 965 – requires applicants for marriage license to receive instructions on family planning and responsible parenthood. A. Breastfeeding be continued up to 2 years and beyond. provides their rehabilitation. R.A 7875 – National Health Insurance Act R.O. 949 – legal basis of PHC dated october 19. R. Public officials and employeesshall at all times be accountable to the people and shall discharges their duties with utmost responsibility. P. lead modest lives uphold public interest over personal interest.A 7432 – Senior Citizens Act R.D No.promotes development of health programs on the community level.A 8423 – Created the philippine Institute of Traditional and Alternative Health Care. 3. and to encouragethose with proper qualifications and excellent abilities to join and remain in government service.O No. . to develop their skills and capabilities in order that they will be more responsive and better equipped to deliver health projects and programs.A 8980 – Promulgates a comprehensive policy and a national system for ECCD. All newborns be breastfeed within 1 hour after birth. Letter of Instruction No. 2.A 7846 – Mandates Compulsary Hepatitis B Immunization among infants and children less than 8 years old.A 8172 – Salt Iodization Act ( ASIN LAW) R. Infants be exclusively breastfeed for 6 months. their living and working conditions and terms of employment. integrity. act with patriotism and justice.A 3573 – requires reporing of all cases of communicable diseases and administration of prophylaxis.

and would develop the following: (S) – Signs and Symptoms (S) – Syndrome.state of complete physical.Dynamic state. . HIGH-LEVEL GOOD NORMAL ILLNESS DEATH WELLNES HEALTH HEALTH HEALTH – ILLNESS CONTINUUM. 2. . mental and social well being. represents the process of achieving HIGH LEVEL OF WELLNESS or the consequences of unhealthy lifestyle.Primarily used to predict an illness . These are: (A) – Awareness.A predictive grid that displays the Likelihood of a person to participate in preventive health care. 1. -Health is a fundamental human right.O 51 or Milk Code. . -It primarily affects the physical well-being of people in a society. not merely the absence of disease or infirmity. I. (E) – Education. -A multifactorial approach. matters as a person adopts to change in internal and a holistic well – being. AGENT – HOST ENVIRONMENT MODEL . Penalizing Violations thereof and for other purposes. and (D) – Disorder or disability which may lead disease or premature death. as shown here.a group of people with common characteristics or interests living together within a territory or geographical boundary.R. will be on the other side of the grid. In this figure. -A personal and social responsibility.A 2029 – Mandates Liver Cancer and Hepatitis B Awareness Month Act ( February ).A Degree of client wellness ranging from optimum wellness to death. A. Otherwise. Relevant International Agreements. (WHO).place where people under usual conditions are found. there are three parameters on how to achieve high level of wellness.O No. 2006 – 0012 – Specifies the Revised Implementing Rules and Regulations of E. HEALTH – is the OLOF (Optimum level of Functioning). Definition of Terms Community – derived from a latin word “communicas” which means a group of people. and (G) – Growth. HEALTH – ILLNESS CONTINUUM . . an individual who continuously live an unhealthy lifestyle.

with intrinsic factor ENVIRONMENT – All factors external to the host that may or may not predispose the person to the development of the disease. AGENT – Any environmental factor or stressor. Chemical. Extrinsic Factors 1. Educational attainment- 4.carcinogens.Virus AGENT HOST A. physical.Weak emotional. that by its presence or absence can lead to illness or disease. chemical.- political boundary 3.physical. Biological environment 3. morbidity: 2. etc 4.excess or deficiency 6. HEALTH BELIEF MODEL .Usefool tools in developing programs for helping people change to healthier lifestyles and develop a more positive attitudetoward preventivehealthier measures. Nutritive. Sex (m or f) helminthes. common diseases allergens M . geography 2. Prior immunologic. poisons. Natural boundaries. Mechanical. Environmental/physical. Ex: Etiologic factor of Dengue? --.fungi.Causative etiologic factor HOST – Persons who may or may not be at risk of acquiring the disease. mechanical. Etiologic Factors: B. ectoparasites F . . Age . GMO’s – carcinogen diseases) MSG. . protozoa. -Requires the individual to maintain a continuum of balance and purposeful direction with environment. psychosocial. Intrinsic Factors & 1.response 5.car accidents.Mortality ( killer Ex. Biological infections----virus. Behavior 3. 2. occupation heatstroke 5. Environmental Factors bacteria 1. .poison 3.Helps determine whether an individual is likely to participate in disease prevention and promotion activities. Socioeconomic env’t. . Psychological C.

sociophysiologic variables. Lifestyle determinants – personal & learned adaptive strategies a person uses to make lifestyle changes c. possible MOT--.unprotected sex. Viability emotions –affective reactions developed from life events f.based on Darwin’s “Survival of the fittest theory” Elements: a. MODIFYING FACTORS: Includes demographic variables.seriousness and threat. Susceptibility to an illness.Increase susceptibility of transmission HIV infection (commercial sex farers. Ex. sea workers. continuous use of condom Do not penetrate (SOP) HIV infected age groups Males age 40-49 seafarers ratio: 1: 5 anal sex. and cues to action. HEALTH PROMOTION MODEL . structural variable. medical team Susceptibility. Life events – developmental variables & those associated with changes b. Health determinants 5. LIKELIHOOD TO ACTION: Depends on the perceived benefit versus the perceived barriers.won’t get pregnant. Benefits of taking actions. common in rural Vaginal: 1: 1000 Females 20-29 Anal: 1: 200-----highest risk Oral – lowest risk 4. Evolutionary viability within the social context –extent to which a person fx to promote survival d. Control perceptions e. COMPONENTS: INDIVIDUAL PERCEPTIONS: Includes perceived susceptivility.occupational hazard Prevention: Safer Sex Practices Abstinence Be faithful Correct. EVOLUTIONARY – BASED MODEL ● illness & death serve an evolutionary function. consistent. Seriousness of an illness. Male infected w/ STD & female non-infectious----.

promoting health and efficiency through organized community effort for the sanitation of the environment. health promotion 2. disease prevention 3. * Directed at increasing clients well – being. Virginia Henderson . the organization of medical and nursing services for the early diagnosis and preventive treatment of diseases and the development of social machinery to ensure everyone a standard of living adequate for the maintenance of health. Winslow ) the ”science and art of preventing disease.( Dr C. INDIVIDUAL CLIENT: APPLIED STUDY: COMMUNITY AS CLIENT: Anatomy Structure Demographic – study of population Physic Function Sociology Pathos Malfunction Epidemiology – study of disease NURSING – both profession and a vocation. the education of individuals in personal hygiene.  Art of Applying Science in the context of Politics so as to reduce Inequalities in Health while ensuring the best health for the greatest number. Sex education Combating any possible disease ( no existing disease ) Illness – Highly subjective feeling of being sick or ill.fetus.  PUBLIC HEALTH – ( Dr.E Winslow ). 1. control of communicable diseases.Providing assistance to clients to achieve self-care towards optimum wellness. C. prolonging life.12 years/ younger adults. * All efforts increasing well – being ( no threat ) ex.self care.E. Early years. Florence Nightingale . management of factors affecting health.Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness 2.12-24 years Orem. Dorothea Orem . autonomy----independent patient 3. Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness. COMMUNITY HEALTH – part of paramedical and medical intervention/approach which is concerned on the health of the whole population. Aims: 1. so organizing these benefits as to enable every citizen to realize his birthright of birth and longevity”.

.individual capable of self-repair and there is something to repair in an individual. (WHO Expert Committee of Nursing) – . families.a service rendered by a professional nurse to IFC’s population groups in health centers.is a learned practice disciplined with the ultimate goal of contributing as individual and incollaboration with others.The Utilization of the nursing process in the different levels of clientele – individuals. prevention of disease and disability and rehabilitation. Application of principles of management and organization in the delivery of health services to the community. clinics schools. (Maglaya) – . the improvement of the conditions in the social and physical environment. workplace for the promotion of health. Nursing Process. that will promote optimum capacity for self-reparative process .” 2.. Priority of health-promotive and disease-preventive startegies over curative interventions. (Dr. grps. in H centers. . 1. analytical and organizational skills are applied to problems of health as they affect the community. Tools for measuring and analyzing Community Health problems. Ruth B. Utilitarianism: “greatest good for the greatest number. in school. 4. to the promotion of clients optimum level of functioning through teaching and delivery of care. service rendered by a professional nurse with the comm. public health and some phases of social assistance and functions as part of the total public health program for the promotion of health. 5. in places of work for the ff: 1. care of the sick at home and rehabilitation. Prevention of illness . 3. interpersonal. families. COMMUNITY HEALTH NURSING -Synthesis of public and nursing practice.. Promotion of health 2.Placing an individual in an environment. in clinics. prevention of illness.special field of nursing that combines the skills of nursing. (Jacobson) – . -Unique blend of nursing & public health practice aimed at developing & enhancing health capabilities of the people . Freeman) – . rehabilitation of illness and disability. concerned with the promotion of health. population groups and communities. and indiv at home.Technical nursing.a specialized field of nursing practice.

The nature of CHN practice requires that current knowledge derived from the biological. planning. Environmental Influences 6. Political 2. Health Care Delivery System 5. family. and Local Hospital Tertiary Health Care: Sophisticated Medical Center – Heart Center.self-reliance Factors affecting Optimum Level of Functioning (OLOF) 1. 4. Municipal. ecology. clinical nursing and community health organizations be utilized. Ultimate goal – raise level of number of citizenry. KI 7. Primary goal – self reliance in health or enhanced capabilities. 2. Nursing Function: Independent – without supervision of MD Collaborative – in collaboration with other Health team ( interdisciplinary. evaluation and a continuum of the cycle until the termination of nursing is implicit in the practice of Community Health Nursing. and community *CHN is integrated and comprehensive 3. social science. intrasectoral ) II. Levels of Health Care: Primary Health Care: Management at the level of community Secondary Health Care: Regional. Community Health Nursing . Hereditary 4. Behavioral 3. Contact with the client and or family may continue over a long period of time which includes all ages and all types of health care. Philosophy of CHN – Worth and dignity of man. District. Community Health Nurses are generalist in terms of their practice through life but the whole community – its full range of health problems and needs. Care of the sick at home and rehab . 6. Community Health Nurses are generalist in terms of their practice through life continuity in its full range of health problems and needs. The primary focus of community health nursing practice is on health promotion and disease prevention. Socio economic Influences Concepts 1. implementing and intervening provide measurements of progress. The dynamic process of assessing. 5. CHN practices – to benefit the individual. special groups.3.

*Health Balance – activities designed to maintain well being. -Other Responsibilities of a Nurse. prevention of disease and disability and rehabilitation. the Public Health Nurse will take charge of the MHO’s responsibilites. COLLABORATOR – working with other health team member. SUPERVISOR – who monitors and supervises the performance of midwives. -Developmental/Utilization of Family Nursing Care Plan in the provision of Care. tertiary. *Social Justice – activities related to practice practice equity among clients. ADVOCATOR – acts on behalf of the client. and puerperium.. taking care of the sick people at home or in the RHU.. PHILOSOPHY OF CHN *The philosophy of CHN is based on the worth and dignity of man. labor. *Provisions of First aid measures and Emergency Care. Etc. . *Disease Prevention – activities relate to avoid complication = primary. *Recommending Herbal and Symptomatic Meds. educating people. secondary. *Suturing lacerations in the absence of a Physicians. families. population groups and communities.who is a health care providers. FACILITATOR – who establishes multi – sectoral linkages by referral system.The utilization of the nursing process in the different levels of clientele- individuals.. -In the event that the Municipal Health Officer ( MHO ) is unable to perform his duties/functions or is not available. HEALTHEDUCATOR – who aims towards health promotion and Illness prevention through dissemination of correctr information. Goal: “To raise the level of citizenry by helping and families to cope with the discontinuities in and threats to health in such a way as to maximize their potential for high-level wellness. et al To elevate the level health of the multitude.” –Nisce. In the Care of the Families: -Provision of Primary Health Care Services. *Performance of Internal Examination and Delivery of Babies. MISSION OF CHN ( FIVE FOLD MISSION ) *Health Promotion – activities related to enhancement of health. *Health Protection – activities designed to protect the people. spelled by the implementing rules and regulations of RA 7164 ( Philippine Nursing Act of 1991 ) includes: *supervision and care of women during pregnancy. concerned with the promotion of health. Roles of COMMUNITY HEALTH NURSE / PUBLIC HEALTH NURSE CLINICIANS .

clinics. BHWs. she is responsible for the formulation of the municipal health plan ● Provides technical assistance to rural health midwives in health matters like target setting. Provider of Nursing care. ● educating people 7. hilots who aim towards H promo & illness prevention through dissemination of correct info. -Program planning.identifies needs. 5.coordination with other health team & other gov’t org (GOs & NGOs) to other health programs as env’t. allocates. -Influencing executive and legislative individuals or bodies concerning health and develoment.formulates care plan for the: 4 Clientele: a. Coordinator of Health Services. policies. Researcher. org. disabled in the homes. Health Monitor----evaluating what deviates from normal 9.In the Care of the Communities: -Community organizing mobilization. Requisitions.provides direct nsg care to the sick. sanitation health education. 6. schools. & NGOs in the implementation of studies/ researches ● participates in the conduct of surveys studies & researches on Nsg and H related subjs. dental health & mental health.conducts training for RHMs. Conducts regular supervisory visits & meetings to diff RHMs & gives feedbacks on accomplishments 4.Formulates nursing component of H plans ● In doctorless areas. & circulars c. priorities & problems if individual. 2. and People empowerment. Manager/ Supervisor. Change Agent . distributes materials (meds & medical supplies & records & reports equips b. implementing and evaluating Health programs/ services. Community Organizer. Implementation. Trainer/ Health educator/ counselor. and Evaluation. . Planner/ Programmer. & comm.motivates & enhance community participation in terms of planning. Manager ---under the nurse---midwives 10. Interprets and implements programs.coordinates with govt. ROLES OF THE COMMUNITY HEALTH NURSE 1. Community development. memoranda. or places of work ● provide continuity of patient care 3. family. 8.

-Provide opprotunities for professional growth and continuing education for staff development. -Maintain coordination/linkages with other health team members. HANLON . promoting health and efficiency through organized community effort for the: a.Most effective goal towards total development and life of the individual & his society 3. NGO/government agencies in the provision of public health services. -Provide quality nursing services to the three levels of clientele. b. PUBLIC HEALTH 1. -Conduct researches relevant to CHN services to improve provision of health care. Major concepts: 1.Prioritizes the survival of human being PUBLIC HEALTH NURSING (Cuevas. People’s participation towards self-reliance 2. sanitation of the environment.The science & art of preventing disease. it is implementation and evaluation for communities. Client Advocate Responsibilities of COMMUNITY HEALTH NURSE -Be a part in developing an overall health plan. mid year & later . control of communicable diseases.Applies holism in early years of life. families. . and communities cared for. young. prolonging life.. prolonging life. Concepts 1. adults. Health promotion 2. WINSLOW . PURDOM . Science and Art of Preventing diseases. promoting health & efficiency through organized community effort ● To enable each citizen to realize his birth right of health & longevity. the public health nurse is strategically positioned to make a difference in the health outcomes of individuals.11. 2007) -In the light of the changing national and global helath situation and the acknowledgement that nursing is a significant contributor to health.

food. Customs and Traditions . This vision is exemplified by the “Millenium Development Goals” (MDG’s) which are based on the fundamental values of: FREEDOM EQUALITY SOLIDARITY TOLERANCE HEALTH HEALTH: MILLENIUM DEVELOPMENT GOALS RESPECT FOR NATURE MDG 1: Eradicate extreme poverty and hunger Target: Halve. etc.. Health Protection 4. water. Personal Behavior and coping skills . so organizing these benefits as to enable every citizen to realize his birthright of health and longevity. Health public policy including those in relation to environmental hazards such as in the work place. the proportion of people whose income is less than one dollar a day.socioeconomic f. Culture.Environment d.socioeconomic b.socioeconomic c.socieconomic e.c. housing. Promotion of health and equitable health gain. Gender – Heredity -ECOSYSTEM influence on OLOF ( Blum 1974 ). Determinants of Health *Factors that can affect health a. decided to adopt a common vision of poberty reduction and sustainable development in september 2000. d. Income and social status .Behavior g.Behavior i. Injury Prevention 3. In response to above trends. and the development of social machinery to ensure everyone a standard of living adequate for the maintenance of health. Education . Employment and working conditions . between 1990 and 2015. Genetics . . Physical Environment . Health Services – Health Care Delivery System j. CORE “Busy”ness of Public Health: 1. 5. organization of medical and nursing services for early diagnosis and preventive treatment of disease. the global community.Heredity h. the education of individuals in personal hygiene. represented by the United Nations General Assembly. Disease control 2. Social support networks .

MDG 4: Decreased child mortality Target: Reduce by 2/3. SHARED RESPONSIBILITY MDG 2: Achieve universal primary education Target: Ensure that. MDG 5: Increased maternal health Target: Reduce by three – quarters. by 2015. between 1990 and 2015. will be able to complete a full course of primary schooling. between 1990 and 2015. by 2015. MDG 3: Promote gender equality and women empowerment Target: Eliminate gender disparity in primary and secondary education preferably by 2005 and to all levels of education no later than 2015. MDG 7: Ensure environmental sustainability Target : Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources. the proportion of people without sustainable access to safe drinking water . Target: Halve. boys and girls alike. Malaria and other diseases Target: Have halted by 2015 and begun to reverse the spread of HIV / AIDS Target: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases. Target : Halve. the proportion of people who suffer from hunger. between 1990 and 2015. the under – five mortality rate. the maternal mortality ratio. children everywhere. MDG 6: Combat HIV/AIDS.

*Defined as “the practice of or groups. Target: Address the special needs of the least developed countries. -Epidemiological surveillance/disease prevention and control and all. Assurance such as home health. predictable. MDG 8: Develop a global partnership for development. *Directs care to individuals. families. Target: Address the special needs of landlocked countries and small island developing States. non-discriminatory trading and financial system. this care. *More General Specialty area that *CORE FUNCTIONS: encompasses subspecialties that a. Policy development other developing fields of practice c. Target : Develop further an open. rule-based. nursing social and public health *knowldge = nursing and PHN sciences. practice. Principles and Standards of CHN PRINCIPLES AND STANDARD OF CHN . in turn promoting and protecting health of contributes to the health of the total populations using knowledge from population. Target: By 2020. Target: Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term. hospice care. A. -Heart monitoring and analysis. COMMUNITY HEALTH NURSING PUBLIC HEALTH NURSING ( ART ) and Science ( SCIENCE ) and Art *Synthesis of nursing practice and *Synthesis of public health and public health practice applied to nursing practice. *Essential Functions: and independent nursing practice. to have achieved a significant improvement in the lives of at least 100 million slum dwellers. Assessment include Public Health Nursing and b. promoting and preserving the health *Specific/subspecialty nursing of the populations.

intervenes to promote. develops plans that specify nursing actions unique to needs of clients. The CHN taps the already existing active organized groups in the community. Interdisciplinary Collaboration . III. IV. CHN must be available to all regardless of race. diagnose and plan. The need of the community is the basis of community health nursing.There should be accurate recording and reporting in community health nursing. creed and socioeconomic status. 3. The CHN makes use of available community health resources. Planning At each level of prevention. 2. Health teaching is the primary responsibility of the community health nurse. Diagnosis Analyzes collected data to determine the needs / health problems of Individual. 8. Theory Applies theoretical concepts as basisfor decisions in practice.PRINCIPLES 1. 7. 9. Evaluation Evaluates responses of clients to interventions to note progress toward goal achievement. maintain or restore health. prevent illness and institute rehabilitation. 5. V. Quality Assurance and Professional Development Participates in peer review and other means of evaluation to assure quality of nursing practice. accurate data systematically. Assumes professional development. STANDARDS IN CHN I. There must be provision for periodic evaluation of community health nursing service. 4. Data Collection Gathering comprehensive. II. Contributes to development of others. The community health nurse must understand fully the objectives and policies of the agency she represents. Intervention Guided by the plan. revise data base. There must be provision for educative supervision in community health nuraing. The family is the unit of service. 10. 11. VII. Family. VIII. Community. The CHN works as a member of the health team 6. Opportunities for continuing staff education programs for nurses must be provided by the community health nurisng agency and the CHN as well. VI. 12.

It is health care provided by center physicians. Example: Breast self-examination.activites that prevent a problem before it occurs. Research Indulges in research to contribute to theory and practice in community health nursing. public health nurses. . professionals and community representatives in assessing. SECONDARY – -Secondary care is given by physicians with basic health training. . Types of Clientele TYPES OF CLIENTELE INDIVIDUAL – .. e.activities that correct a disease state and prevent it from further deteriorating. IX. implementing and evaluating programs for community health. Prenatal Supervision Well – Child Follow – ups. Collaborates with other members of the health team. and specialized hospitals such as the Philippine Heart Center. rural health midwives. . traditional healers and others at the barangay health stations and rural health units. Complicated cases and intensive care requires tertiary care and all these can be provided by the tertiary care facility.g. Morbidity Service Teaching Client on Insulin Administration Basic approaches in looking at the individual: . Example: Immunization. This serves as a referral center for the primary health facilities. The primary health facility is usually the first contact between the community members and the other levels of health facility. barangay health workers. Secondary facilities are capable of performing minor surgeris and perform some simple laboratory examinations. planning. Operation timbang. This is usually given in health facilities and district hospitals and out-patient departments of provincial hospitals.activities that provide early detection/diagnosis and treatment and Intervention. HIV screening. .People who visits the health center. The tertiary health facility is the referral center for the secondary care facilities. Levels of Care LEVELS OF CARE/PREVENTION PRIMARY – -Is devolved to the cities and the municipalities. Example: Teaching Insulin Administration in the home C. B. TERTIARY – -Is rendered by specialists in health facilities including medical centers as well as regional and provincial hospitals.People who receives health services.

1.gender --. Behaviorism d. a. Social constructionism c. BIOLOGICAL a.behavior --.psychological --. PSYCHOLOGICAL a. .a sociological concept --.musculinity or femininity --. use concepts of biology which in turn refers to essentialism --.a biological concept (male / female) --. titio’s and tita’s c.2 or more individuals who commit to live together for an extended period of time not necessarily with marital affinity or blood relations. ANTHROPOLOGICAL a. diporphism 2. 2. Psychosocial c. Social learning 4. Dyad – married but without kids. Cohabiting – live-in. unified whole b. holistic – suprasystems – sociological in nature – social constructionism – nurture – behavior SEX --. d.based on culture. Essentialism b. Extended – with lolo’s and lala’s.Culture 3. MODELS: Stages of Family Development by Evelyn Duvall .on sexual orientation: attracted to Opposite sex – heterosexual Same sex – homosexual Both – bisexual Perspective in understanding the individual: 1. SOCIOLOGICAL a. Family and kinship b. holon c.human behavior is dictated by experience. atomistic – the basic constituents of an individual. Social groups FAMILY – . Not married but with kids. Psychosexual b. --.Considered as the basic unit of care. Nuclear b.

TASK: Learn the concept of Responsible Parenthood. STAGE 7 – Family with Middle Adult Parents ( 36 – 60 years old ). STAGE 8 – The Aging Family ( 61 years old upto death ). STAGE 2 – The Early Child Bearing Family ( 0 – 30 months ).high crime rate ● Placement of members in larger society. STAGE 5 – The Family with Teenagers (13 – 25 years old ). TASK: Reinforce the concept of Responsible Parenthood. 8 Family Tasks or Basic Tasks of Developmental Model: ● Physical maintenance ● Allocation of resources. TASK: Learn the concept of Death Positively.STAGE 1 – The Beginning Family ( newly wed couples ). TASK: Parents to learn the concept of “let go system” and understand the “generation gap”. recruitment & release ● *Maintenance of order. TASK: Compliance with the PD 965 and acceptance of the new member of the Family. TASK: Emphasize the importance of pregnancy and immunization and learn the concept of parenting STAGE 3 – The Family with Preschool Children ( 3 – 6 years old ).Indication family’s success ● Maintenance of motivation & morale Criticisms: very limited & cannot apply to all situation STRUCTURAL – FUNCTIONAL Initial Data Base a. TASK: Compliance with the PD 965 and acceptance of the new member of the family. adjust with a new lifestyle and adjust with the financial aspect. TASK: Provide a Healthy Environment. STAGE 6 – Launching Center ( 1st Child will get married upto the last child ). Family Structure and Characteristics Nuclear – basic family . STAGE 4 – The Family with School Age Children ( 6 -12 years old).income given to wife ● Division of labor – joint parenting ● Socialization of family members ● Reproduction.

drugs. civil status ) Live – in = married/ common law WIFE Male – Patriarchal Female – Matriarchal *types and structure of family *dominant members in health *general family relationship Assessment: Family -Initial data base -1st level assessment -2nd level assessment b. Environmental Factors *housing. And transportatx facilities d. short attention span . excessive drinking Inherent personality characteristics – short temperedness. or grandparents relations *members of household in relation to head *demographic data ( sex –male or female. HPN Nutritional problem – eating salty foods Personal behavior – smoking. sexual practices. Health Assessment of Each Member – PE e.number of rooms for sleeping *kind of neighborhood *social health facilities available *comm. Socio-economic and cultural Factors *resources and expenses *educational attainment *ethnic background *religious affiliation *SO ( do not live with the family but influences decision ) *Influences to larger communities c. Extended – in-law relations. age. Value Placed on Prevention of Disease *Immunization *Compliance behavior First Level Assessment *Health Threats: -Conditions that are conducive to disease. self – medication. accident or failure to realize one’s health potential -Example: Family history of illness – hereditary like DM.

dwarfism *Stree points / Forseeable Crisis Situation: -Anticipated periods of unusual demand on the individual or family in terms of adjustment or family resources ( nature situations ) -Example: Entrance in school Adolescents (circumcision. edema b. colorblindness. Developmental Problem like mental retardation. abortion. falls. or accidents- Family size beyond what resources can provide - *Health Deficits: -Instances of failure in health maintenance ( disease. unemployment. disability. gigantism. deafness c. marasmus.Short cross infection – Poor home environment – Lack / Inadequate immunization – Hazards – fire. puerperium Death. hormonal. polio. Disease / Illness – URTI. developmental lag ) 3 TYPES: a. scabies. puberty) Courtship (falling inlove. pregnancy. menarche. breaking up) Marriage. board exam Second Level Assessment (Family tasks involved) Family tasks that can’t be performed *Recognition of the problem *Decision on appropriate health action *Care to affected family member *Provision of health home environment *Utilization of community resources for health care Problem Prioritization: *Natur eof the Problem Health Deficit Health Threat Forseeable Crisis *Preventive Potential High Moderate Low *Modifiability Easily modifiable . transfer or relocation. Disabilities – blindness. graduation.

COMMUNITY – Patient . respect and trust. HIV *Mother – 1/3 of population health problem ( pregnancy. Family Living Pattern – the relationship of the family towards each other with love. with common values and interests. Partially modifiable Not modifiable *Salience High Moderate Low Family Service and Progress Record Family Coping Index Physical Independence – ability of the family to move in and out of bed and performed activities of daily living. delivery. Knowledge of Health Condition – wisdom of the family to understand the disease process. workers. elderly.g. Physical Environment – ability of the family to maintain environment conducive for living.Vulnerable Groups: or “High Risk Groups” ( before ) *Infants and Young Children – dependent to caretakers *School age – most negected *Adolescents – identify crisis. Therapeutic Independence – abilty of the family to comply with the therapeutic regimen ( diet.Defined by geographic boundaries with certain identifiable characteristics. etc. puerperium ) *Males – too macho to consult . . Health Care Attitude – relationship of the family with the health care provider. developmental stage or common exposure to particular environmental factors thus resulting in common health problems ( Clark. POPULATION GROUPS- -Aggregation of people who share common chaaracteristics. children. women. Emotional Competence – ability of the family to make decision maturely and appropriately ( facing the reality of life ). Utilization of Community Resources – ability of the family to know the function and existence of resources within the vicinity. medication and usage of appliances ). Application of General and Personal Hygiene – ability of the family to perform hygiene and maintain environment conducive for living. 1995: 5 ) e.

safe toilet ● School community. Health Care Delivery System PHILIPPINE HEALTH CARE DELIVERY SYSTEM The Philippine health care delivery system is composed of two sectors: (1) the public sector. community networks. increase mental wellness of people. safe environment.health education/ counselor direct & undirect Healthful School Living. Components: School Health Services.food sanitation. mental health. Focus: Mental Health Promotion – no need to identify disease.health monitor ● Mental health. and the basic sciences. screening all children.comm. hearing. sexual H ● Environmental health. risk minimization. Nursing: Strengthening the support mechanism Psychiatric Nursing-Focus: Mental Disease Prevention Focus: Mental Disease Prevention – identify disease and shorten disease process *OCCUPATIONAL HEALTH NURSING – the application of nursing principles and procedures in conserving the health of workers in all occupations. social psychology.visual. psychology. which largely financed through a tax-based budgeting system at both national and local levels and where health care is generally given free at the point of service and (2) the private sector (for profit and non-profit providers) which is largely market-oriented and where health care is paid through user fees at the point of service. water supply. scoliosis Health Instruction.Specialized Fields: *COMMUNITY MENTAL HEALTH NURSING – a unique process which includes an integration of concepts from nursing. Organizer D. .maintain school clinic.linkage.substance abuse. *Old People – degenerative disease . ensuring safe work place from industrial to service *SCHOOL AND HEALTH NURSING – the application of nursing theories and principles in the care of the school population. Aims: Health promotion and prvention of disease and injuries.

At the national level. regional hospitals and medical centers. With the devolution of health services. research and development. the Department of Health (DOH) is mandated as the lead agency in health. medical supplies. RHU Primary Level Facilities Primary – RHU. Brgy health centers Secondary – District Hospitals Tertiary – Provincial Hospitals. specifically for malaria and schistosomiasis. Heart Institutes _______________ 6. Puericulture Centers _______________ 7. TERTIARY LEVEL FACILITIES Classify as to what level the following belong 1. and other health and nutrition products. Their involvement in maintaining the people’s health is enormous. The private sector includes for-profit and non-profit health providers. City Hospitals THE DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH . In every province. equipment. 1. PRIMARY LEVEL FACILITIES 2. City Health Services _______________ 3. It has a regional field office in every region and maintains specialty hospitals. Private Practitioners _______________ 5. manufacture of medicines. the local health system is now run by Local Government Units (LGUs). there is a local health board chaired by the local chief executive. health insurance. SECONDARY LEVEL FACILITIES 3. Other national government agencies providing health care services such as the Philippine General Hospital are also part of this sector. It also maintains provincial health teams made up of DOH representatives to the local health boards and personnel involved in communicable disease control. The public sector consists of the national and local government agencies providing health services. Its function is mainly to serve as advisory body to the local executive and the sanggunian or local legislative council on health-related matters. human resource development and other health-related services. vaccines. city or municipality. The provincial and district hospitals are under the provincial government while the city/municipal government manages the health centers/rural health units (RHUs) and barangay health stations (BHSs). This includes providing health services in clinics and hospitals. Emergency and District Hospitals _______________ 4. Teaching and Training Hospitals _______________ 2.

*Ensure the highest achievable standards of quality health care. *Provide leadership in the formulation. . program and policies. Promulgation 5. Development Roles of DOH: 1. New: A global leader for attaining better health outcomes. Administrator of specific services *Manage selected national health facilities and hospitals with modern and advanced facilities. monitoring and evaluation of the national health policies. and equitable health financing by 2030. Issuance 4. *Administer direct services for emergent health concerns that require new complicated technologies. competetive and responsive health care system. Primary Function of of DOH -Promotion -Protection -Preservation -Restoration VISION: Old: Health for all Filipinos New: The Leader of health for all in the Philippines New: The DOH is the leader. Leadership in Health *Serve as the national policy and regulatory institution. plans and programs.-Lead agency in the Health Sector -Sets the goals for the nation’s health status -Establishes PARTNERSHIP DOH MANDATE 1. *Exercise oversight functions and monitoring and evaluation of national health plans. plans and programs 2. promotion and protection 3. Support 3. Formulation 2. staunch advocate and model in promoting Health for all in the Philippines. *Serve as advocate in the adoption of health policies. Enabler and Capacity builder *Innovate new strategies in health.

MISSION: -Old: Ensure accessability and quality of health care services to improve the quality of life of all Filipinos. *Rising burden from chronic and degenerative diseases. H – Health. especially the poor. sustainable and quality health for all Filipinos. More responsive health systems 3. and to lead the quest for excellence in health. Framework for the Implementation of HSRA: FOURmula One for Health Goals of FOURmula ONE for Health: 1. -New:To guarantee equitable. *High burden from infectious diseases. *Unattended emerging health risks from environmenmental and work related factors. *Burden of disease is heaviest on the poor. *Persistence of large variations in health status across population groups and geographic areas. S – Shifting from infectious to degenerative diseases must be managed. U – Universal Access to basic health services. and nutrition of vulnerable group must be prioritized. especially the poor. D – development of national standards. A – assurance of health care for all. Health financing – to foster greater. better and sustained investments in health. Rationale for HSRA: *Slowing down in the reduction of Infant Mortality and Maternal Mortality Rates. I – increase investment of PHC. GOAL: Heal Sector Reform Agenda ( HSRA ). Equitable health care financing Elements of the Strategy: 1. Better health outcomes 2. STRATEGIES OF DOH SAID!!! S – support the local health system and front – line workers. PHILOSOPHY OF DOH: -Quality is above Quantity! PRINCIPLES OF DOH P – Performance of health sector must be enhanced. .

*Expand the coverage of social health insurance.Rabies .Filariasis . reduce maternal mortality rate.Measles . *Reduce the cost and sure the quality of essential drugs.Vitamin A Deficiency and Iodine deficiency disorders. *Eradicate Poliomyelitis *Promote healthy lifestyle and environmental health. Goals and Objectives of the Health Sector: *Improve general health status of the population. *Institute safety nets for the vulnerable and margenalized groups. ( reduce the infant mortality rate. *Reduce morbidity and mortality from certain diseases.Tetanus . *Strengthen health governance and management support systems.Malaria . *Strenthen national and local health systems to ensure better health service delivery. increase life expectancy and the quality of life years ). *Protect vulnerable groups with special health and nutrition needs. *Pursue public health and hospital reforms. . 4. reduce total fertility rate.Leprosy . Health service delivery – to improve and ensure the accessibility and availability of basic and essential health care in both public and private facilities and services.Schistosomiasis . Good governance – to enhance health system performance at the national and local levels. Health regulation – to ensure quality and affordability of health goods and services. current strategies based on field experience. and laying down new avenues for improved interventions. *Eliminate certain diseases as public health problems.2. 3. *Institute health regulatory reforms.Diphtheria and Pertussis . Roadmap for All Stakeholders in Health: National Objectives for Health 2005 – 2010. reduce child mortality rate. *Mobilize more resources for health . National Objective for Health: sets the target and the critical indicators.

Basic Principles to Achieve Improvement in Health 1. E. Support to the local system development. 3. development and implementation of programs focusing on health development at community level. 5. 1979 – Letter of Instruction ( LOI 949 ). production and utilization of resources for health. the legal basis of PHC was signed by President Ferdinand E. LOI 949 – signed by President Marcon with an underlying theme: “Health in the hands of the People by 2020”. Development of national standards and objectives for health. Marcos. 4. Increasing investment for primary Health Care. Universal access to basic health servicesmust be ensured. Support for frontline health workers. The health and nutrrition of vulnerable groups must be prioritized 3. Russia ( USSR ) the Alma Ata Declaration stated that PHC was the key to attain the “health for all“ goal. *September 6 – 12. 2. DEFINITION OF PRIMARY HEALTH CARE . which adopted PHC as an approacch toward the design. 1978 – First InternationalConference on PHC in Alma Ata. PHC as a Strategy PHC as a Strategy PRIMARY HEALTH CARE (PHC) *May 1977 – 30th World Health Assembly decided that the main health target of the government and WHO is the attainment of a level of health that would permit them to lead a socially and economically productive life by the year 2000. Rationale for Adopting PRIMARY HEALTH CARE: *Magnitude of Health Problems. *Isolation of health care activities from other development activities. *Increasing cost of medical care. *Inadequate and unequal distribution of health resources.*Improve efficiency in the allocation. *October 19. Primary Strategies to Achieve Goals 1. 4. 2. Assurance of health care. The epidemiological shift from infection to degenerative diseases must be managed. The performance of the health sector must be enhanced.

*Favorable population growth structure. 2. which is carried out through a set of activities and whose ultimate aim is the continuous improvement and maintenance of health status of the community. . MISSION: *To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care. *Development of the capability of the community aimed at self – reliance. *A practice approach to making health benefits within the reach of all people. *Reduction in the prevalence of preventable. communicable and other disease. Two levels of PRIMARY HEALTH CARE WORKERS 1. Concept of PHC KEY STRATEGY TO ACHIEVE THE GOAL: . Rural Sanitary Inspector and Midwives. *Improvement in Basic Sanitation. *An approach to health development. Goal of PRIMARY HEALTH CARE: *Health for all Filipinos by the year 2000 and health in the Hands of the people by the year 2020. acceptable and sustainable at a cost. Barangay Health Workers – trained community health workers or health auxiliary volunteers or traditional birth attendants or healers. which the community and the government can afford.*Essential health care made universally accessible to individuals and families in the community by means acceptable to them. *Extension of essential health services with priority given to the underserved sectors. An improved state of health and quality of life for all people attained through SELF- RELIANCE. *Maximizing the contribution of the other sectors for the social and economic development of the community.charactterized by partnership and empowerment of the people that shall permeate as the core strategy in the effective provision of essential health service that are community based. OBJECTIVES OF PRIMARY HEALTH CARE *Improvement in the level of health care of the community. through their full participation and at cost that the community can afford at every stage of development. accessible. *Reductionin morbidity and mortality rates especially among infants and children. Intermediate Level Health Workers include the Public Health Nurse.

Tertiary Level of Care – Care rendered by Specialists in Health Facilitis including Medical Centers as well as Regional and Provincial Hospitals and specialized Hospitals. PRINCIPLES OF PRIMARY HEALTH CARE 1. municipal and district hospitals and OPD of Provincial Hospitals. given in Health Facilities which are privately owned or government operated such as infirmaries. implementing.Barangay Health Workers and other at the Baragay Heath Station and Rural Health Units. . the success of any undertaking that aims at serving the people is dependent on people’s participation at all levels of decision . Appropriateness of Health Services. 2.Part of the people’s participation is the partnership between the community and the agencies found in the community. 1990 ). Barriers of COMMUNITY INVOLVEMENT .Thus. planning.Resistance to change . Partnership between the community and the health agencies in the provision of quality of life = Providing linkages between the government and the non government organization and people’s organization. Availability. Any undertaking must also be based on the people’s needs and problems ( PCF. SELF – RELIANCE 5. Affordability and Acceptability. 3. Example: Scheduling of Barangay Health Workers in the Health Centers. PHN. object and subject of development = . Secondary Level of Care – Given by physicians with Basic Health Training.Lack of motivation . 2. . . They should make use of the available resources within the community wherein the focus would be more on health promotion and prevention of illness.Dependence on the part of community people .Attitude .making. 3.Levels of Health Care and Referral System 1. The Health Services should ebe present where the supposed recipients are. People are the center. health work should start from where the people are and building on what they have.In general. social mobilization and decentralization. Rural Health Midwives. 4 A’s = Accessibility. Community Participation = Heart and Soul of Primary Health Care. serves as the Referral Center for Primary Health Facilities. Primary Level of Care – Health care provided by center physicians. monitoring and evaluating.Lack of managerial skills 4.

Therefore. Neither it is only a state of physical and mental well – being. Reorientation ond reorganization of the national health care system.Attaining Health for aal Filipino will require expanding participation in health and health related programs whether as service provider oe beneficiary. Development of intra – intersectoral linkages. cultural. Increase opportunities for community participation. Organization of communities. Emphasizing partnership. institutional and environmental dimensions ( Gonzales 1994 ).Advocacy must be directed to National and Local policy making to elicit support and commitment to major health concerns through legislations. ELEVATING HEALTH TO A COMPREHENSIVE AND SUSTAINED NATIONAL EFFORT . 6. -Development is mulit – dimentional.It enhances people participation or governance. . social. support system provided by the Government. 7.Good Health therefore. it is measured by the ability of people to satisfy their basic needs. 3. Empowerment to parents. 8. 7. budgetary and logistical considerations. 4. SOCIAL MOBILIZATION = . 2. MAJOR STRATEGIES OF PRIMARY HEALTH CARE A. It has a political. Development and utilization of appropriate technology. families and communities to make decisions of their health is really the desired outcome. DECENTRALIZATION Strategies of PRIMARY HEALTH CARE 1. PROMOTING AND SUPPORTING COMMUNITY MANAGED HEALTH CARE .is not merely the absence of disease. 5. Recognition of interrelationship between the health and development = HEALTH . Mobilization of the people to know their communities and identifying their basic health needs. socio – cultural and economic factors as its determinant. . networking and developing secondary leaders. . is manifested by the progressive improvements in the living conditions and quality of life enjoyed by the community residents (PCF. B. Effective preparation and enabling process for health action at all levels.Health being a soical phenomenon recognizes the interplay of political. DEVELOPMENT is the quest for an improved quality of life for all.6. 8.

affordable. swollen every 3 hours.The Health in the hands of the people brings the government closest to the people. also used as a mouth or if there is no wash since the leaves of improvement an hour . multi – disciplinary and scientific approach to health programming and delivery.toothache. rheumatism. 1. C. Blumea camphora 1. 2. parts and drink 1 part BUENA (Clinopodium headache. ADVANCING ESSENTIAL NATIONAL HEALTH RESEARCH -Essential National Health Research ( ENHR ) is an integrated strategy for organizing and managing research using intersectoral.. FOUR CORNERSTONES/PILLARS IN PRIMARY HEALTH CARE 1. 4. Inducing diuresis ( parts and drink 1 parts 3 balsamifera) anti – urolithiasis ) times a day. INCREASING EFFICIENCIES IN THE HEALTH SECTOR . TSAANG GUBAT 1. *Divide decoction into 2 Peppermint YERBA e. Cough 3 parts: 3. Five – leaf Chaste tree 1. The development of human resources must correspond to the actual needs of the nation and the policies it upholds such as PHC. effective. -For fever and body pains. If it persists.Using appropriate technology will make services and resources required for their delivery. Body Pain -For asthma and cough. intestinal motility and decoction. 3. It necessitates a process of capacity builiding of communities and organization to plan. menstrual and gas pain. Intra – Intersectoral linkages 3. Active community participation 2. Fever drink 1 part 3 times a day. enhancementof relevant curricula and development of standard teaching materials. The DOH will continue to support and assist both public and private institutions particularly in faculty development. Body aches and pain. Use of appropriate technology 4. Swelling *Divide decoction into 3 SAMBONG (Blumea 2. D.drink 1 part every 4 hours. Effective in treating *Drink the warm (Ehretia microphylla Lam). Marsh – Mint. Support mechanism made available HERBAL MEDICINES ENDORSED BY THE DEPARTMENT OF HEALTH NAME INDICATIONS DOSAGE 1. accessible and culturally acceptable. douglasii) gums. 4. implement and ealuate health prgrams at their levels..g. Asthma *Divide the decoction into LAGUNDI (Vitex negundo) 2.

Strain. (Hypertension. Garlic 1. gargle with warm decoction 3 times a day. boil a cup of clean chopped leaves in 2 cups of water. Guava 1. ULASIMANG BATO 1.) particularly the ascaris dinner according to the and trichina. a day. a salad or decocted and PANSITAN. together with meals. (Cassia alata) 1. helps control blood pressure. Athlete’s foot an allergy while using the 3. 6. 5. . decoction. sore gums and tooth *For tooth decay and decay. Chinese honeysuckle 1. use BAYABAS (Psidium clean/disinfect wounds) decoction for washing the Guajava) 2. Reduces cholesterol *Eat 6 cloves of garlic BAWANG (Allium sativum) in the blood and hence. Mouth wash infection. Effective in fighting *The leaves can be eaten (Peperomia pellucida). Elimination of *Chew and swallow only NIYOG – NIYOGAN Intestinal worms. Boil for 15 to 20 minutes. Ringworm bush Treatment of ringworms *Apply the juice on the AKAPULKO also known and skin fungal affected area 1 to 2 times as “bayabas – bayabasan” infections. following: ADULTS = 8 -10 seeds 9 – 12 years old = 6 – 7 seeds 6 – 8 years old = 5 – 6 seeds 4 – 5 years old = 4 – 5 seeds 8. Hyperlipidemia) 7. consult a doctor. Scabies above preparation. wound 2 times a day. swelling of gums. 9. let cool and drink a cup after meals (3 time a day). fresh (about a cupful) as -also known as “PANSIT. dried seeds 2 hours after (Quisqualis Indica L.” drunk as tea. arthritis and gout. For the Decoction. this shrub has high after drinking the flouride content. ANTISEPTIC (to *For wound cleaning. Ring worm *If the person develops 2.

10. and mix in a glass of water. Bitter gourd or Bitter 1. Use a clay pot and remove cover while boiling at low heat. 2003 Reminders on the Use of Herbal Medicine: 1. sore *An abortifacient if taken officinale) throat. arthritis. 11. *Boil the mixture. *Drink the cold or warm decoction as needed. should vomiting. Avoid the use of insecticides 2. Charantia) = Lowers Blood Sugar Levels. prepare the following: = Put 1 cup of chopped fresh leaves in an earthen jar. migraine not be used by persons headaches. Pour in 2 glasses of water and cover it. = Boil the mixture until the 2 glasses of water originally poured have been reduced to 1 glass of water. Use it while it is warm. nausea and in large amounts. Mild Non – Insulin *Drink ½ cup of cold or melon Dependent Diabetes warm decoction 3 times a AMPALAYA (Momordica Meelitus day after meals. = Apply the warm decoctionon the affected area 1 to 2 times a day. = Strain the mixture. *Chop and Mash a piece of ginger root. . *AC 196 – A: Ampalaya was deleted in 10 herbal plants advised by DOH in October 9. may increase the risk of bleeding when used concurrently with anticoagulants and antiplatelets. Motion Sickness. Ginger (Zingiber 1. with cholelithiasis unless directed by the physician.

Infusion  To prepare a tea (use lipton bag). Stop giving the herbal medication in cases of untoward reactions. Juice/Syrup  To prepare a papaya juice. If signs and symptoms are not relieved after 2-3 doses. mango & caimito e. Cream/Ointment-for topical use . fruits. 5. 7. Use only one kind of herbal plant for each type of symptom or sickness. Poultice  Done by pounding or chewing leaves used by herbolaryo  Example: Akapulko leaves-when pounded. follow accurate dose of suggested preparation. 6. keep standing for 15 minutes in a cup of warm water where a brown solution is collected. pectin which serves as an adsorbent and astringent  Used for diarrhea and for pneumonia so PHN discourages to buy commercially prepared cough syrup→ expectorant: Nature of Cough 1) Dry→ mucolytic→ liquefy mucus Example: Carbocisteine. 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 c. Use only the part being advocated 4. consult a doctor. add sugar then heat to dissolve sugar & mix it  For problems of constipation  Example: papaya. leaves 3. 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 b. Know parts of plants with therapeutic value: roots. 3. Know indications 2. Know official procedure/preparation  Procedures/Preparations: a. use ripe papaya & mechanically mashed then put inside a blender & add water  To produce it into a syrup. Decoction  Gather leaves & wash thoroughly. Guafenesin 2) Productive→ expectorant→ irritants to the mucus gland Example: Bromhexine (Bisolvon) 3) Non stop coughing→ antitussive Example: Dextromethorpan (Robitussin)→ contains codeine Robitussin AC→ contains atropine & codeine d. Policies to abide: 1.

measles. baby or any oil- serves as moisturizer) to the prepared cream to keep it lubricated while being massage on the affected area Elements/Components of Primary Health Care: E L E M E N T S D A M *Education For Health -Is one of the potent methodologies for information dissemination. Water is necessary for the maintenance of healthy lifestyle. *Expanded Program of Immunization -This program exists to control the occurrence of preventable illnesses especially of children below 6 years old. diphtheria and other preventable disease are given for free by the government and ongoing program of the DOH. -Water is a basic need for life and one factor in man’s environment. *Locally Endemic Disease Prevention and Control -The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate. *Maternal and Child Health and Family Planning -The mother and child are the most delicate members of the community. *Environmental Sanitation and Promotion of Safe Water Supply -Environmental Sanitation is defined as the study of all factors in the man’s environment. There are many food resources found in the communities but because of knowledge regarding proper food planning. Example Malaria Control and Schistosomiasis Control. The goal of Family Planning includes spacing of children and responsible parenthood. Tuberculosis is one of the communicable diseases continuously occupies . Immunizations on poliomyelitis. -Safe Water and Sanitation is necessary for basic promotion of health. *Nutrition and Promotion of Adequate Food Supply -One basic need of the family is food. which exercise or may exercise deleterious effect on his well – being and survival. *Treatment of Communicable Diseases and Common Illness -The diseases spread through direct contact pose a great risk to those who can be infected. Malnutrition is one of the problems that we have in the country. It promotes the partnership of both the family members and health workers in the promotion of health as well as prevention of illness. So the protection of the mother and child to illness and other risks would ensure good health for the community. And if food is properly prepared then one may be assured healthy family.  Cream is water based & used for wet skin lesions  Ointment is oil based & used for dry lesions  Example: Akapulko Leaves  start with poultice (pound leaves) to turn it semi-solid  add flour to keep preparation pasty & make it adhere to skin lesions  to make it into an ointment: add oil (mineral. tetanus.

Provide the needed support and assistance to the family.An activity with or on behalf of a particular family or individual. the GENERIC ACT of the Phiippines is enacted. . Amoxycillin. Collaborating and Coordinating Function 7. control and treatment of these illness. emotional.the top ten causes of death. Management Function 2.Family of Orientation . .Quinine. Health Promotion and Education Function 6.Family of Procriation Family Nurse Contact: Definition . Most communicable diseases are also preventable. and.Ensure family’s understanding and acceptance of their problems. . Nifedipine. Family-based Nursing Services (Family Health Nursing Process) FAMILY – BASED NURSING SERVICES (FAMILY HEALTH NURING PROCESS) FAMILY HEALTH NURSING FAMILY – Basic unit of society. It includes the following drugs: Cotrimoxazole. The Government focuses on the prevention. and social support of its members.Research Function F.Health Care Provider Nursing Care Function 5. . INH (isoniazid) and Pyrazinamide. Streptomycin. *Supply and Proper Use of Essential Drugs and Herbal Medicine -This focuses on the information campaign on the utilization and acquisition of drugs. *Dental Health Promotion *Acces to and Use of Hospitals as Centers of Wellness *Mental Health Promotion Functions of the PRIMARY HEALTH NURSING: 1. -In response to this campaign. Family Nurse Contact: Objectives . Paracetamol.A crucial approach in delivering community health nursing service for the family.Assess health needs and problems of the family.Training Function 3.Supervisory Function 4. Ethambutol. . Oresol. Two Types: . a primary entity of health care or institution responsible for the physical. Rifampicin. Albendazole.Develop the individual’s and/or family’s competence to cope with their health problems.

Contribute to the personal and social development of the family through varied health activities. RELATING . IMPLEMENTATION . Results in positive outcomes such as good quality of data. 3. First Level Assessment – Data on status / conditions of family household members. partnership in addressing identified health need and problems. Second Level Assessment – Data on family assumption of health tasks on each problem identified in the First Level Assessment. describe rationale. FAMILY NURSING PROCESS *It is a means by which the health care provider addresses the health needs and problems of the client. health as its goal and nursing as its medium or channel of care. Concept of Family as a Basic Unit of Society *The Universal Declaration of Human Rights in Article 16 states that the family is the natural and fundamental unit of society and is entitled to protection both by society and the State. way of processing information gathered from different source and translating into meaningful actions or interventions. . TWO TYPES OF ASSESSMENT a.Establishing a working relationship. 2. . FAMILY HEALTH NURSING *Is a special field in nursing in which the family is the unit of care. set goals / objectives.Determination of how to assist client in resolving concerns related to restoration. selects strategies. b.Data Collection. *It is a logocal and systematic. 4. Family Case Load *the number and kind of families a nurse handles at any given time. *variable for cases are added or dropped based on the need for nursing care and supervision. STEPS: 1. and satisfaction of the nurse and the client. PLANNING .Establishment of priorities. Maintenance or promotion of health. ASSESSMENT . Data Analysis and Data Interpretation and Problem definition or Nursing Diagnosis.

sex. Effectiveness 2.A systematic. The family’s status can be inferred from the manifestations of problem areas reflected in the following: 1. Observation – is use of all sensory capacities.. d. Physical Examination – is done through inspection. Methods of Data Collection a.The process of identifying the types or kinds of data needed. -Determines progress and evaluate the implemented intervention as to: 1. 5. Interview – by completing health history for each member. used and tolerated by family members.The carring out of plan of care by client and nurse. prevent and control or resolve problems in order to achieve health and well – being among its members. c. 2. Acceptability 5. document responses. 3. e. Steps in Nursing Assessment 1. Health history determines current health status. percussion.Specify the methods necessary to collect such data. Demographic data . and auscultation. Adequacy 4. Record Review – is the review existing records and reports pertinent to the client / family such as diagnostic reports and immunization records. update / revise plan. Role perceptions / tasks assumptions by each member including decision – making patterns. Data Collection . Appropriateness I. make ongoing assessment. Communication and interaction pattern expected. Laboratory / Diagnostic Tests 5 Types of Date in Family Nursing Assessment (Initial Data Base) A. . civil status. Conditions in the home and environment b. EVALUATION . Efficiency 3.age. Family Structure. position in the family . Characteristics and Dynamics 1. their ability to maintain wellness. Members of the household and relationship to the head of the family 2. NURSING ASSESSMENT -Involves a set of actions by which the nurse measures the status of the family as a client. continuous process of comparing the client’s response with written goal and objective. palpation.

Dominant family members in terms of decision-making. providing nursing care to the sick. communication / interaction pattern among members. .presence of any obvious / readily observable conflict between members.whether living with the family or elsewhere. characteristic. Type of family structure .g.e. *HEALTH TASKS OF THE FAMILY (Freeman. 4. disabled and dependent member of the family • 5. especially in matters of health care. 6. General family relationship / dynamics . seeking health care • 3. maintaining a home environment conducive to good health and personal development • 6. nuclear or extended Nuclear – Extended – Three generational – Dyad – Single – Parent – Step – Parent – Blended or Reconstituted – Single adult living alone – Cohabiting / Living – in – No – kin – Compound – Gay – Commune – Stages of Family Life Cycle Newly married couple Childbearing Preschool age Teenage Launching Middle – aged (empty nest – retirement) Period from retirement to death of both spouses. maintaining a reciprocal relationship with the community and health institutions 5. managing health and non-health crises • 4. Place of residence of each member . recognizing interruptions of health or development • 2. matriarchal or patriarchal. 1981) • 1. 3.

B. Socio-economic and Cultural Characteristics
1. Income and expenses
a. Occupation, place of work and income of each working member
b. Adequacy to meet basic necessities (food, clothing, shelter)
c. Who makes decisions about money and how it is spent
2. Educational attainment of each member
3. Ethnic background and religious affiliation
4. Significant Others - role(s) they play in family's life
5. Relationship of the family to larger community - Nature and extent of
participation of the family in community activities.

C. Home and Environment
1. Housing
a. Adequacy of living space
b. Sleeping arrangement
c. Presence of breeding or resting sites of vectors of disease (e.g.
mosquitoes, roaches, flies, rodents, etc)
d. Presence of accident hazards
e. Food storage and cooking facilities
f. Water supply - source, ownership, sanitary condition
g. Garbage/ refuse disposal - type, sanitary condition
h. Drainage system - type, sanitary condition
2. Kind of neighborhood, e.g. congested, slum
3. Social and health facilities available
4. Communication and transportation facilities available

D. Health Status of each Family Member
1. Medical and nursing history indicating current or past significant illnesses or
beliefs and practices conducive to health and illness.
2. Nutritional assessment ( specially for vulnerable or risk at-risk
members)
a. Anthropometric data: Measures of nutritional status of children- weight,
height, mid-upper arm circumference.
b. Dietary history specifying quality and quantity of food/ nutrient intake per
day
c. Eating/feeding habits /practices
3. Developmental assessment of infants, toddlers, and preschoolers -
e.g., Metro Manila Developmental Screening Test (MMDST)
4. Risk factor assessment indicating presence of major and contributing
modifiable risk factors for - e.g. hypertension¸ physical inactivity,
sedentary lifestyle, cigarette/ tobacco smoking, elevated blood lipids/
cholesterol, obesity, diabetes mellitus, inadequate fiber intake, stress,
alcohol drinking and other substance abuse.

5. Physical assessment indicating presence of illness state/s (diagnosed
or undiagnosed by medical practitioners.
6. Results of laboratory / diagnostic and other screening procedures
supportive of assessment findings.

E. Values, Habits, Practices on Health Promotion, Maintenance and Disease
Prevention Such as:
1. Immunization status of family members.
2. Healthy lifestyle practices.
3. Adequacy of :
a. rest and sleep
b. exercise / activities
c. Use of protective measures - e.g. adequate footwear in parasite-
infested areas; use of bednets and protective clothing in malaria and
filariasis endemic areas.
d. Use of relaxation and other stress management activities
4. Use of promotive-preventive health services.

2. Data Analysis
Steps:
1. Sorting of data for broad categories (such as those related with health
status or practices – about home and environment).
2. Clustering of related cues to determine relationship among data.
3. Distinguishing relevant from irrelevant data. This will help in deciding what
information is pertinent to the situation at hand and what information is
immaterial.
4. Identifying patterns such as physiologic function, developmental,
nutritional/dietary, coping/adaptation or communication patterns.
5. Compare patterns with norms or standards of health, family functioning
and assumption of health tasks.
6. Interpreting results of comparisons to determine signs and symptoms or
cues of specific wellness state/s, health deficit/s, health threat/s,
foreseeable crises/stress point/s and their underlying causes or associated
factors.
7. Making conclusions about the reasons for the existence of the health
condition or problem, or risk for non-maintenance of wellness state/s which
can be attributed to non-performance of family tasks.

3. Problem Definition/Nursing Diagnosis
 End result of 2 major types of assessment.

*Family Nursing Problem - Stated as an inability to perform specific health task
and the reasons / etiology) why the family cannot perform such task.

 Consists of 2 parts: main category of problem (coming from unattained
health task) and specific problems (statement of factors contributory for the
existence of the main problem.
 Example: (general): Inability to utilize resources for health care due to lack
of adequate family resources, specifically: (specific)
a. financial resources
b. manpower resources
c. time
 The more specific the problem definition, the more useful
is the nursing diagnosis in determining the nursing
intervention. Therefore, as many as three or four levels
of problem definition can be stated.

*Nurse’s Roles in Family Health Nursing
1. Health Monitor
2. Provider of Care to a sick Family Member
3. Coordinator of Family Services
4. Facilitator
5. Teacher
6. Counselor

INITIAL DATA BASE FOR FAMILY NURSING PRACTICE
*FAMILY STRUCTURE, CHARACTERISTICS, AND DYNAMICS
1. Members of the household and relationship to the head of the family
2. Demographic data – age, sex, civil status, position in the family
3. Place of residence of each member – whether living with the family or
elsewhere.
4. Type of family structure – e.g. matriarchal or patriarchal, nuclear or extended.
5. Dominant family members in terms of decision – making, especially in matters
of health care.
6. General family relationship / dynamic – presence of any readily observable
conflict between members; characteristics communication patterns among
members.
*SOCIO – ECONOMIC AND CULTURAL CHARACTERISTICS
1. Income and Expenses
– Occupation, place of work and income of each working members
– Adequacy to meet basic necessities
– Who makes decisions about money and how it is spent
2. Educational attainment of each other
3. Ethnic background and religious affiliation
4. Significant Others – role(s) they play in family’s life

5. Relationship of the family to larger community – Nature and extent of
participation of the family in community activities.
*HOME AND ENVIRONMENT
1. Housing
– Adequacy of living peace
– Sleeping arrangement
– Presence of breeding or resting sites of vectors of diseases
– Presence of accidents hazards
– Food storage and cooking facilities
– Water supply – source, ownership, portability
– Toilet facility – type, ownership, sanitary condition
– Drainage system – type, sanitary condition
2. Kind of neighborhood, e.g. congested, slum, etc.
3. Social and health facilities available
4. Communication and transportation facilities available
*HEALTH STATUS OF EACH FAMILY MEMBER
1. Medical and nursing history indicating current or past significant illnesses or
beliefs and practices conducive to health illness
2. Nutritional assessment
– Anthropometric data: Measures of nutritional status of children,
weight, height, mid-upper arm circumference: Risk assessment
measures of obesity: body mass index, waist circumference, waist
hip ratio
– Dietary history specifying quality and quantity of food/nutrient intake
per day
– Eating/ feeding habits/ practices
3. Developmental assessments of infants, toddlers, and preschoolers – e.g.,
Metro Manila
4. Risk factor assessment indicating presence of major and contributing
modifiable risk factors for specific lifestyles, cigarette smoking, elevated blood
lipids, obesity, diabetes mellitus, inadequate fiber intake, stress, alcohol drinking
and other substance abuse
5. Physical assessment indicating presence of illness state/s
6. Results of laboratory/ diagnostic and other screening procedures supportive
of assessment findings
*VALUES, HABITS, PRACTICES ON HEALTH PROMOTION, MAINTENANCE
AND DISEASE PREVENTION
Examples include:
1. Immunization status of family members
2. Healthy lifestyle practices. Specify.
3. Adequacy of:
– rest and sleep
– exercise

– use of protective measures- e.g. adequate footwear in parasite-
infested areas;
– relaxation and other stress management activities
4. Use of promotive-preventive health services

Typology of Nursing Problems in Family Nursing Practice

1. First Level of Assessment – process whereby existing potential health
conditions/problems of the family are determined.

a. Presence of Wellness Condition – states as potential or readiness –
a clinical or nursing judgement about a client in transition from a
specific level of wellness or capability to a higher level.

b. Presence of Health Deficits - Instances of failure in health
maintenance.
A. Illness States, regardless of whether it is diagnosed or undiagnosed by
medical practitioner
B. Failure to thrive/ develop according to normal rate
C. Disability - whether (1) congenital or (2) arising from illness.

c. Presence of Health Threats - Conditions that are conducive to
disease, accident or failure to realize one's health potential.
A. Family history of hereditary condition / disease
B. Threat of cross infection from a communicable disease case
C. Family size beyond what family resources can adequately provide
D. Accident hazards .
1. broken stairs
2. pointed /sharp objects, poisons, & medicines improperly kept
3. fire hazards
4. fall hazards
5. others (specify):________
E. Faulty / unhealthy nutritional / eating habits or feeding techniques /
practices.
1. inadequate food intake both in quality and quantity
2. excessive intake of certain nutrients
3. faulty eating habits
4. ineffective breastfeeding
5. faulty feeding techniques
F. Stress-provoking factors
1. strained marital relationship
2. strained parent-sibling relationship
3. interpersonal conflicts between family members
4. care-giving burden

G. Poor home / environmental condition/ sanitation
1. inadequate living space
2. lack of food storage facilities
3. polluted water supply
4. presence of breeding or resting sites of vectors of diseases
5. improper garbage / refuse disposal
6. unsanitary waste disposal
7. poor lightning and ventilation
8. noise pollution
9. air pollution
H. Unsanitary food handling and preparation
I. Unhealthy lifestyle and personal habits /practices
1. alcohol drinking
2. cigarette / tobacco smoking
3. walking barefooted or inadequate footwear
4. eating raw meat or fish
5. poor personal hygiene
6. self-medication/ substance abuse
7. sexual promiscuity
8. engaging in dangerous sports
9. inadequate rest or sleep
10. lack of / inadequate exercise / physical activity
11. lack of / inadequate activities
12. non-use of self-protection measures (e.g. non-use of bednets in
Malaria and Filariasis endemic areas)
J. inherent personal characteristics - such as poor impulses control
K. Health history which may precipitate / induce the occurrence of a health
deficit, e.g. previous history of difficult labor.
L. Inappropriate role assumption - e.g. child assuming mother's role, father
not assuming his role
M. Lack of immunization / inadequate immunization status specially of
children
N. Family disunity - e.g. self-oriented behavior of members (s), unresolved
conflicts of members(s), intolerable disagreement
O. Others, specify : _____________

d. Presence of Stress Points / Foreseeable Crisis - Anticipated periods
of unusual demand on the individual or family in terms of adjustment /
family resources.
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member - e.g. newborn, lodger
E. Abortion

failure to break down problems into manageable units of attacks D. Other. I. specify __________ II. Lack of / or inadequate knowledge of community resources for care H. Death of a Member M. social-stigma. loss of respect of peers / significant others 2.e. physical consequences 4. Failure to comprehend the nature/ magnitude of the problem / condition B. Lack of / or inadequate knowledge / insight as to alternative courses of action to take E. Menopause J. Denial about its existence or severity as a result of fear of consequences of diagnosis of problem. Low salience of the problem / condition C. D. Adolescence H. Feeling of confusion. economic / cost implications 3. Conflicting opinions among family members / significant others regarding action to take G. Second Level of Assessment – defines the nature or type of nursing problems that the family encounters in performing health. Attitude / philosophy in life which hinders recognition / acceptance of a problem. Specify ______________ 2. specially:  social consequences  economic consequences  physical / psychological consequences . Inability to decide which action to take among the list of alternatives F. helplessness and / or resignation brought by perceived magnitudes / severity of the situation or problem. Lack of or inadequate knowledge B. F. Hospitalization of a family member L. Entrance at school G. emotional / psychological issues / concerns C. Fear of consequence of action. Divorce or separation I. Inability to make decisions with respect to taking appropriate health action due to: A. Resettlement in a new community N. Loss of Job K. Inability to recognize the presence of the condition or problem due to: A. Others. i.. specifically : 1. Illegitimacy O.

Altered role performance – specify : a. Lack of the necessary facilities. specify______________ III. Negative attitude towards the health problem – By negative attitude is meant one that interferes with rational decision making J. B. Member’s preoccupation with own concerns / interests I. Philosophy in life which negates / hinder caring the sick.g. complex therapeutic regimen or healthy lifestyle program). prognosis and management ). Prolonged disease or disability progression which exhausts supportive capacity of family members J. Others. Lack of / inadequate knowledge about the child development and care. Others. Lack of / inadequate knowledge of the nature and extent of nursing care needed. hostility / anger. C. Inability to provide a home environment conducive to health maintenance and personal development due to : A. cost constraints or economic / financial inaccessibility K. guilt. despair. Inadequate family resources. E. role confusion f. Significant person’s unexpressed feelings (e. role conflict e. Inability to provide adequate nursing care to sick. Lack of / inadequate knowledge about the disease / health condition (nature. role dissatisfaction d. specify _________________ IV. equipment and supplies for care.. role overload K. specifically: a. specifically: 1.g. disabled. dependent or vulnerable / at-risk member of the family due to: A. financial constraints / limited financial resources . vulnerable / At – risk member H. rejection) which disable his / her capacities to provide care. specifically:  Absence of responsible member  Financial constraints  Limitations / lack of physical resources – e. role denial or ambivalence b. Lack of trust / confidence in the health personnel / agency L. D. Inaccessibility of appropriate resources for care. Inadequate family resources for care. G. isolation room F. complications. Lack of or inadequate knowledge and skill in carrying out the necessary interventions / treatment / procedure / care (e. I. role strain c. fear / anxiety. physical inaccessibility 2. disabled. severity.g. dependent.

Failure to see benefits (specifically long-term ones) of investment in home environment improvement C. Rehabilitative ). AIDS. financial resources – e. cost constraints b. PLANNING . specifically .e. specifically : a. Others. loss of esteem of peer / significant others F.g. J. Lack of / inadequate competencies in relating to each other for mutual growth and maturation (e. Lack of / inadequate knowledge of community resources for health care B.g. financial consequences c. reduced ability to meet the physical and psychological needs of other members as a result of J. Inaccessibility of required care / service due to: a. stigma due to mental illness. Feeling of alienation to / lack of support from the community. specify -------------------------- V. Unavailability of required care / service G.. location of facility H. a. Ineffective communication patterns within the family G. limited physical resources – e.g. etc. family’s preoccupation with current problem or condition) K.. social consequences – e. Lack of or inadequate family resources. manpower resources – e. lack of space to construct facility B. i. Lack of supportive relationship among family members H. Negative attitude / philosophy in life which is not conducive to health maintenance and personal development I.g. specify---------------- II. diagnostic. Failure to perceive the benefits of health care / services C. Previous unpleasant experience with health worker E. Others. b. cost of medicine prescribed I. therapeutic.g. Lack of / inadequate knowledge of preventive measures E. Failure to utilize community resources for health care due to : A. baby sitter b. Negative attitude / philosophy in life which hinders effective / maximum utilization of community resources for health care K. physical / psychological consequences b. Lack of trust / confidence in the agency / personnel D. Fear of consequences of action (preventive. e. Lack of / inadequate knowledge of importance of hygiene and sanitation D. .g.The step in the process which answers the following questions: *What is to be done? . Lack of skill in carrying out measures to improve home environment F. physical inaccessibility.

Preventive Potentials .Refers to the probability of success in enhancing. *How is to be done? *When it is to be done? -It is actually the phase wherein the health care provider formulates a care plan. Salience . The highest score is 5 equivalent to the total weight. Decide a score for each of the criteria 2. CRITERIA Weight 1.Categorized into wellness state. 2. alleviating or totally eradicating the problem through intervention.Refers to the family's perception and evaluation of the problem in terms of seriousness and urgency of attention needed or family readiness. Prioritizing Health Problems 1. Sum up the score of all criteria. Prioritized problems 2. health threat. Goals and Objectives of the Nursing Care 3. minimizing. 3. 4. improving. Plan for Evaluating Care. health deficit and foreseeable crisis. Nature of the problems Presented 1 Scale: -Health deficit / Wellness 3 -Health threat 2 -Foreseeable crisis 1 2. Modifiability of the problem 2 Scale: -Easily modifiable 2 . Nature of the Problem Presented . divide the score by the highest possible & multiply by the weight  Score x weight Highest score 3.Refers to the nature and magnitude of future problems that can be minimized or totally prevented if intervention is done on the problem under consideration. Steps in developing a Family Nursing Care Plan 1. Plan of Intervention 4. Modifiability of the Problem/Condition . Scoring 1.

Factors affecting priority setting: The nurse considers the availability of the following in determining the modifiability of a health condition or problem.refers to the presence and appropriateness of intervention 4. Also indicates the prognosis. Current Knowledge. Resources of the family – Physical. Preventive potential 1 Scale: -High 3 -Moderate 2 -Low 1 4. 1. Gravity or severity of the problem . Current Management .Refers to the progress of the disease/ problem indicating extent of damage on the patient / family. Salience 1 Salience: -A condition / problem needing Immediate 2 attention *A condition / problem not needing 1 Immediate attention *Not perceived as a problem or condition 0 needing change.refers to the length of time the problem has been existing 3. Resources of the nurse – Knowledge. Characteristics of Family Nursing Care Plan . Duration of the problem .-Partially modifiable 1 -Not modifiable 0 3. methods and tools. Resources of the Community – Facilities and Community organization or support. Exposure of any high risk group Family Nursing Care Plan * It is the blueprint of care that the nurse designs to systematically minimize or eliminate the identified family health problem through explicitly formulated outcomes of care (goal and objectives) and deliberately chosen set of interventions/resources and evaluation criteria. standards. Financial and Manpower 3. Factors in Deciding Appropriate Score for Preventive Potential 1. Technology and Interventions 2. Skills and Time 4. reversibility of the problem 2.

This ensures family commitment to their realization. Barriers to Joint Goal Setting 1. family or community level. 2. It is a mean to an end and not a end to itself. It is a product of deliberate systematic process. Operationalizing the plan . 6. Goal * It is a general statement of the condition or state to be brought about by specific courses of action. Specific . 3. 5. * Basic to the establishment of mutually acceptable goal in the family’s recognition and acceptance of existing health needs and problems. not one shot deal. The FNCP as with other plans relates to the future. Cardinal Principle in Goal setting * It must be set jointly with the family.  This should be stated in terms of client outcomes whether at the individual. Sometimes the family perceives the existence of the problem but does not see it as serious enough to warrant attention. A good plan is realistic. Failure in the part of the family to perceive the existence of the problem. It’s drawn with the family. 2. 2. 4. meaning it can be implemented with reasonable chance of success 3. It revolves around identified health problems. It focuses on actions which are designed to solve or alleviate & existing problem. It should be consistent with the goals and philosophy of the health agency. It is a continuous process. Selecting specific interventions.setting of priorities. Desirable Qualities of Family Nursing Care Plan 1. 3. Characteristics of Goals/ Objectives 1. 2. Delineating alternative approaches to meet goals. 4. It’s best kept in written form. 4. 5. It should be based on a clear definition of the problem.  The mutual setting of goals which is the cornerstone of effective planning consists of: 1. Identifying possible resources.1. Setting/ Formulating Goals & Objectives  This will set direction of the plan.

Plan of Actions/ Interventions  Its aim is to minimize all the possible reasons for causes of the family’s inability to do certain tasks. Time bound Objective  Refers to a more specific statement of desired outcome of care. Types of Objective 1. Attainable 4. It is highly dependent on 2 Major Variables: 1. Short term or Immediate Objective  Formulated for problem situation which require immediate attention & results can be observed in a relatively short period of time.  They are accomplished with few HCP-family contacts & relatively less resources.  Determines the resolution of the problem or the need to reassess.  Determination whether nursing care rendered to the family are effective. 2. Measurable 3. and re-plan and re-implement nursing interventions. Supplemental . 3. Evaluation  Determination whether goals / objectives are met.the HCP is the direct provider of care. Facilitative . IV.  They specify the criteria by which the degree of effectiveness of care is to be measured. Developmental . Long Term or Ultimate Objective  This requires several HCP-family contacts & an investment of more resources. Realistic 5.improves client’s capacity.HCP removes barriers to needed services. nature of the problem 2. III. . 2. the resources available to solve the problem Typology of Interventions 1. Medium or Intermediate objective  Objectives which is not immediately achieved & is required to attain the long ones. 2. 3. Implementation  Actual doing of interventions to solve health problems.

What does the data mean? 5. progress. what factors aid in the success and determine barriers to the care.  Diagnosis – if identified family nursing problems were resolved. Report / Give Feedbacks Dimensions of Evaluation 1. .  Planning – are the interventions appropriate & adequate enough to resolve identified problems. Effectiveness – focused on the attainment of the objectives. Make Decisions  If interventions are effective. efficiency and effectiveness.  Implementation – determine how the plan was implemented.  Ex-post Evaluation – undertaken years after the care was provided Steps in Evaluation: 1. Types of Evaluation:  On-going Evaluation – analysis during the implementation of the activity. improved or controlled. Collect Relevant Data that will support the outcome 4. its relevance. effectiveness. give recommendations 6. Analyze Data . impact and efficiency 2.  Determine relevance. Decide what to Evaluate.  Terminal Evaluation – undertaken 6-12 months after the care was completed.  Qualitative – descriptive transcription of the outcome conducted through interview to acquire an in-depth understanding of the outcome. interventions done can be applied to other client / group with the similar circumstances  If ineffective. 3. Design the Evaluation Plan  Quantitative – a quantifiable means of evaluation which can be done through numerical counting of the evaluation source.According to Alfaro-LeFevre: Evaluation is being applied through the steps of the nursing process:  Assessment – changes in health status.

Health status of each member 5. Records review 3. The prioritized condition/s or problems 2. Developing the Nursing Care Plan Steps in developing a family care plan: 1. The goals and objectives of nursing care 3. Appropriateness – refer its ability to solve or correct the existing problem.1 Family Based Nursing Services (Family Health Nursing Process) Nursing Assessment of Family: First Level Assessment: 1. perceptions about and attitudes related to the assumption or performance of family health tasks on each health condition or problem identified during the first level assessment. Family structure. Efficiency – related to cost whether in terms on money. Socio-economic and cultural characteristics 3. Values and practices on health promotion/maintenance and disease prevention Second Level Assessment data include those that specify or describe the family’s realities. characteristics and dynamics 2. 4. Direct observation 2. Tools Being used during Evaluation  Instruments are tools are being used to evaluate the outcome of the nursing interventions:  Thermometer  Tape measure  Ruler  BP apparatus  Weighing scale  Checklist  Key Guide Questionnaires  Return Demonstrations Methods of Evaluation 1. The plan of interventions 4. The plan for evaluating care Implementing the Nursing Care Plan . Review of questionnaire 4. a question which involves professional judgment. Home and environment 4. 2. Simulation exercises 1. 3. Adequacy – pertains to its comprehensiveness. effort or materials.

Population Group-based Nursing Services POPULATION – FOCUSED APPROACH .During this phase the nurse encounters the realities in family nursing practice which can motivate her to try out creative innovations or overwhelm her to frustration or inaction. A dynamic attitude on personal and professional development is. Planning . H. necessary if she has to face up to challenges of nursing practice. senses) b. 3. . and for those who do not receive health services (social jusctice) *SCIENTIFIC APPROACH AND POPULATION FOCUS = 1. G. process & measurable outcome or objective 4 Tools/ Instruments for Data Collection: .interview & observations.purpose is to achieve the optimum level of health of the community people.assessment: purpose is to identify the health needs of the people. Categories of health problems 2. 4.Concentrates on specific groups of people and focuses on health promotion and disease prevention. Information about the community. Implementation . Evaluation- . a. Evaluation of Family Health Services. systems. *Intervenes with communities. GOAL: To promote Healthy Communities *A population focused involves concern for those who do. Assessment/Diagnosis . 1998).to determine the effectiveness of health care programs. Community-based Nursing Services/ Community Health Nursing Process COMMUNITY HEALTH NURSING PROCESS 1. *Considers broad determinants of health. regardless of geographical location (Baldwin et al. Collection of data ( subjective: expressed by client or. therefore. As the nurse practitioner works with clients she experiences varying degrees of demands on her resources. individuals and families. 2003) *Focuses on the entire population *Is based on assessment of the population health status. *Emphasizes all levels of prevention.In short (Minesota Department of Health.purpose is to act on determined needs of the community people. objective: measurable. 3 elements : structural . Epidemiology 2.

-Utilize service of a health agency. -Make Appointment for next client or home visit. -Inform Physician of relevant findings. Waiting time 1. Fecalysis.objective (analyzed by RN) NURSING PROCEDURES Clinic visit – . -Work with Physician during Exam. Give priority numbers to clients .E) -Consult about signs and symptoms of illness. -Evaluate through some diagnostic procedures PRE – CONSULTATION CONFERENCE (CuTe PaLa We?) -Take Clinical History after greeting and making client at ease. Prepare the family record or retrieve records of old clients 3. Sputum Exam. Standard procedures performed during clinic visits: I.R. -Ensure Privacy. -Render some treatment procedures. Greet client and establish rapport 2. Height. Nursing history – subjective 2. safety and comfort of patient. -Observe Confidentiality of Exam result. Perform physical examination on the client and record it accordingly II. Process recording. -Refer patient to other health agency in necessary. Elicit and record the client’s chief complaint and clinical history 4.Objective 3. Lab. POST CONSULTATION CONFERENCE (E. PE. -Perform a through Physical Assessment -Do Selective Laboratory Exams: Urinalysis. Registration/ Admission 1.. BP.A) -Explain Findings and needed care or intervention. PURPOSE: (C.Objective 4.U. -Take Temperature.patient visits the Health center to avail of the services there to offered by the facility primarily for consultation on matters that ailed them physically. 1. during and after exam by Physician.R. Weight. -Write Findings on clients record. -Process of checking the client’s health condition in a medical clinic. MEDICAL EXAMINATION (A IWan PO!) -Assist before.

Inform the client on the nature of the illness. Health education 1. first served” policy except for emergency cases III. Prescription/dispensing 1. Clinical evaluation 1. 2. Nurse arrives at evidence-based diagnosis and provides rational treatment based on DOH programs 3. Manage program-based cases (like the IMCI) 2. Triaging 1. Implement the “first come. Preparatory phase  Introduce self to client  Make sure client is relaxed and has rested for at least 5 minutes  Explain the procedure  Assist to a seated or supine position 2. Give appointments for the next visit Blood pressure measurement Procedure: 1. appropriate treatment and prevention and control measures V. Referral system 1. Applying the BP cuff and stethoscope  Bare client’s arm  Apply cuff around upper arm 2-3 cm above brachial artery  Keep manometer at eye level  Keep arm level with his heart by placing it on a table or a chair arm or by supporting it . Reinforce health education and counseling messages 3. Conduct one-on-one counseling with the patient 2. Give proper instructions on drug intake VIII. Laboratory and other diagnostic examinations 1. Accompany the patient when an emergency referral is needed VII. Identify a designated referral laboratory when needed VI. Validate clinical history and physical exam 2. Provide first aid treatment to emergency cases and refer to the next level when necessary IV. Refer patient if he needs further management following the 2-way referral system 2. Refer all non-program based cases to the physician 3.

 Palpate brachial pulse correctly just below or slightly medial to the antecubital area 3. listen for pulse sounds (Korotkoff sounds) (1 st clear tapping sound – Systolic BP and disappearance of sound – Diastolic BP 4. inflate the cuff rapidly by pumping the bulb until the column reaches 30 mmHg above the palpatd SBP  Deflate the cuff slowly at a rate of 2-3 mmHg per beat  While the cuff is deflating. To give health teachings regarding prevention and control of diseases 4. Post-Partum. To assess living conditions of the patient and his family and their health practices 3.a professional face – to – face contact made by the nurse with a patient or the family to provide necessary health care activities and to further attain the objectives of the agency. close valve or pressure bulb and inflate cuff until pulse disappears  Note point at which pulse disappeared – palpated systolic BP  Deflate cuff fully  Wait 1-2 minutes before inflating cuff again Obtaining the BP reading by auscultation  Place earpieces of stethoscope in ears and stethoscope head over the brachial pulse  Use the bell of the stethoscope to auscultate pulse  Watching the manometer. Pregnant Mother. Obtaining the BP reading by using palpatory method  While palpating the brachial or radial pulse. repeat procedure with other arm. take the mean of 2 reading. To make use of the inter-referral system and to promote the utilization of community services . with a higher BP reading Home visit – . obtained at least 2 minutes apart  If first visit. Subsequent BP readings should be performed on the arm. Purpose of Home Visit: 1. To give nursing care to the clients 2. Morbid Individual (Last). . Recording BP and other guidelines  For every visit. To establish close relationships between the health agencies and the public 5. -PRIORITY during HOME VISITS: Newborn (First).family nurse contact which allows the health worker to assess the home and family situations in order to provide the necessary nursing care and health related activities.

Put the bag in a convenient place then proceed to perform the bag technique 5. Past services given to families 6. Needs of the client (Physical. Greet the patient and introduce yourself 2. Make an appointment for a return visit Bag Technique: tool by which the nurse. *Public Health Bag: an essential and indispensable equipment of a public health nurse which she has to carry along during her home visits. Minimize. Principles of Bag Technique: 1. Can be performed in a variety of ways Important points to consider in the use of the bag technique: HANDWASING 1. Other health agencies and personnel involved in care of family 5. Policy of a specific agency 4. Psychological. Observe the patient and determine the health needs 4. Perform nursing care needed and give health teachings 6. Record all important data. supplies and equipments that will be used 2. Should show effectiveness of total care given to an individual or family 4. observation and care rendered 7. Must have a purpose or objective 2. The bag and its contents should be cleaned very often. State the purpose of the visit 3. Saves time and effort of the nurse 3.a tool making of the public health bag through which the nurse during the home visit can perform nursing procedures with ease and deftness saving time and effort with the end in view of rendering effective nursing care. The bag should contain all necessary articles. Should be flexible Guidelines to consider regarding the Frequency of Home Visits 1. and Educational needs) 2. if not prevent the spread of infection 2. to save time and effort . supplies replaced and ready for use anytime . Ability of clients to recognize own needs Steps in conducting home visits 1.Principles involve in Preparing for a Home visit: 1. Should make use of all available information about a patient 3. Acceptance of the family 3. during her visit will enable her to perform a nursing procedure with ease and deftness. Should consider and give priority to needs of clients 4. Should involve the clients 5.

Nursing care given at home should be used as a teaching opportunity to the patient or to any responsible member of the family 4. Alcohol. Ammonia – -Placed waste paper bag outside of work area to prevent contamination of clean area. observing patients attitude towards care given and the progress of the patient Isolation technique in the home Done by: 1. The arrangement of the contents of the bag should be the one most convenient for the user. Nursing care utilizes a medical plan of care and treatment 2. Acetic Acid – For Albumin Detection 3. Principles in Nursing Care: 1. Benedict’s Solution – For sugar detection 2. Performance of nursing care should recognize dangers in the patient’s over-prolonged acceptance of support and comfort 5. 3. -Contents of the BAG: *BP Apparatus .It helps render effective nursing care. Stethoscope and umbrella are carried separately *Medicines include: Betadine. to facilitate efficiency and avoid confusion. . Betadine – 5. Zephiram Solution – Soaking Solution 4. Wearing a protective gown. -RATIONALE IN THE USE OF PHN BAG : *Technique during home visit . to be used only within the room of the sick member. Frequent washing and airing of beddings and other articles and disinfections of room. The bag and its contents should be well-protected from contact with any article in the patient’s home. Performance of nursing care utilizes skills that would give maximum comfort and security to the individual 3. Nursing care is a good opportunity for detecting abnormal signs and symptoms.giving to the individual patient the nursing care required by his / her specific illness or trauma to help him / her reach a level of functioning at which he / she can maintain himself / herself or die peacefully in dignity. 3. Separating the articles used by a client with communicable disease to prevent the spread of infection: 2. 70% alcohol. Nursing care in the Home . Benedict’s solution SOLUTION: 1. 4.

) . 5. -SPUTUM – NPO midnight first collection early AM then submit at the health center immediately. -It is a process whereby people learn to improve their personal habits and attitudes. customs. Intravenous Therapy . continuous process that involves constant changes and revisions until objectives are achieved. and habits in relation to health and everyday living. Small amount of feces only.INDICATIONS: *Maintenance /Correction of dehydration in patient unable to tolerate adequate volume of oral fluid medications *Parenteral Nutrition *Administration of Drugs *Blood Transfusion . -It is a cooperative effort requiring all categories of health personnel to work together in close teamwork with families. and problems of the people affected. It develops and provides experience for change in people’s attitudes. which is determined by the economic and social conscience of the country. Hypertonic Potassium Chloride). experience. in the school. PRINCIPLES OF HEALTH EDUCATION -It considers the health status of the people. while stimulating active interest. and nation. -It is a slow. -It meets the needs.Can be done only by nurses accredited by ANSAP(Association of Nursing Service Administration of the Philippine. -It involves motivation. Discarding properly all nasal and throat discharges of any member sick with communicable disease. instruct the patient to take a deep breath four times then cough out. -It should be recognized as the basic function of all health workers. and the community. Midstream Collection -FECES – Clean Container. to work responsibly for the improvement of health conditions of the family. -It finds means and ways of carrying out plans by encouraging individual and community participation. Specimen Collection -URINE – Sterile Bottle. .. -It takes place in the home.g. interests. and change in conduct and thinking. Sodium Chloride. and in the community. groups. then second collection following day early in the AM then submit at the health center then collect the third sputum.4.CONTRAINDICATIONS: *Administration of irritant fluids / drugs through peripheral access (e. Burning all soiled articles if could be or contaminated articles be boiled first in water 30 minutes before laundering. community.Insertion of a needle or catheter into a vein to provide medication and fluids based on physician’s written prescription .

clinic. Provides technical and administrative support to Rural Health Midwives (RHM) 5. 2.-Makes use of supplementary aids and devices to help with the verbal instructions. memoranda. Interprets and implements nursing plan. -It utilizes community resources by careful evaluation of the different services and resources found in the community. BSN 2. and problems of individuals. program policies. Organizes work force. implementing. 4. and implementation of all health education programs and activites. family. -It is a creative process requiring methods and techniques with various characteristics. Formulates municipal health plan in the absence of medical doctor 3. and evaluating health services 2. organizing. 2. organization. THE COMMUNITY HEALTH NURSE QUALIFICATIONS 1. COORDINATOR OF SERVICES . memoranda. or dependent member. disabled. Formulates individual. Provides direct nursing care to sick or disabled in the home. or workplace. school. priorities. and communities. -It aims to help people make use of their own efforts and education to improve their conditions of living. MANAGER / SUPERVISOR 1. Provides technical assistance to rural health midwives in health matters. 2. 4. Conducts regular supervisory visits and meetings to different RHMs and gives feedback on accomplishments. COMMUNITY ORGANIZER 1. policies. Develops the family’s capability to take care of the sick. not following a rigid and flexible pattern. resources. and circular for the concerned staff personnel. group. PROVIDER OF NURSING CARE 1. families. and community – centered plan. Identifies needs. Motivates and enhances community participation in terms of planning. and supplies at local level. Interprets and implements programs. RN of the Philippines PLANNER / PROGRAMMER 1. 3. equipment. -It makes careful evaluation of the planning. and circulars. Initiates and participates in community development activities.

4. Family. Barangay Health Workers (BHW). groups. analyzes. Conducts training for RHMs and hilots on promotion and disease prevention 3. RECORDER / REPORTER / STATISTICIAN 1. families. Special Population & Community 5. Ultimate Goal in CHN – Raise the level of health of the citizenry 3. CHANGE AGENT 1. Conducts pre and post – consultation conferences for clinic clients. Prepares statistical data / chart and other data presentation. 2. Levels of Clientele – Individual. ROLE MODEL 1. Initiates the use of tri – media (radio / TV. Primary Goal in CHN – Self-reliance in health 2. and complete recording and reporting. validates. Coordinates with government and non – government organization in the implementation of studies / research. CHN NOTES: 1. 2. and mental health. and interprets all records and reports. TRAINER / HEALTH EDUCATOR 1. Maintain adequate.Family 4. families. and groups for health related services provided by various members of the health team. 2. cinema plug. 5. Primary Focus – Health Promotion & Disease Prevention 6. acts as a resources speaker on health and health – related services. dental health. Coordinates with individuals. consolidates. Reviews. Philosophy Of CHN – Uphold the worth & dignity of man . HEALTH MONITOR 1. Motivates changes in health behavior in individuals. Conducts pre – marital counseling. Prepares and submits required reports and records. and communities that also include lifestyle in order to promote and maintain health. Detects deviation from health of individuals. Coordinates nursing program with other health programs like environmental sanitation. accurate. and communities through contracts / visits with them. Provides good example of healthful living to the members of the community. 4. health education. 3. RESEARCHER 1.1. 2. and print ads ) for health education purposes. and hilots. groups. families. Identifies and interprets training needs of the RHMs. Participates in the conduct of survey studies and researches on nursing and health – related subjects. Unit of care .

Based on scientifically sound and socially acceptable methods and technology . oppressed (i. minimum level of people’s participation c.g. e. focus on health I. herbal medicine and accupressure d. and mobilizing.7.At a cost they can afford at any given stage of their development . Theoretical Bases of CHN Practice – Theories & Principles of Nursing & Public Health 8.Essential care (i. for. not all) but struggling segments of the society Goal of Community Organizing (CO): Community Development – the creation of a society that provides equal access to all benefits and opportunities the society can offer to the people Application of CO in Health: PRIMARY HEALTH CARE PRIMARY HEALTH CARE .Towards self. families. and communities . Appropriate technology – underwent experimentation and with high empirical basis.e. deprived. and among the people  Anyone is capable of change  Self-willed changes have more meaning than imposed ones Context of Community Organizing (CO): Current situation towards the poor. Community Organizing COMMUNITY ORGANIZING Maglaya DOH Preparatory Phase Community Analysis Organizational Phase Design and Initiation Education and training Implementation Collaboration Phase Program Maintenance – Consolidation Phase Out Dissemination Reassessment COMMUNITY ORGANIZING – a continuous and sustained (i.Through their full participation . CHN as : People-oriented. comprehensive & integrated.reliance and self-determination Major Pillars of Primary Health Care a. People’s participation Partnership – or shared leadership. with. Multi-sectoral approach (inter. not alternative) .and intra-sectoral linkages) b.e.e. Awareness – primary motivation to action Basic Concepts and Principles  Based on concrete analysis of actual situation  Basic trust on the people  By. organizing.Made universally available to individuals. never-ending) process of awareness-raising. Support mechanism made available .

SMALL GROUP FORMATION . draw objectives Methods: house-to-house. COMMUNITY DIAGNOSIS . LAUNCHING – social preparation ends 8.done before entry to community .manageable units . start the following: a. ENTRY – low-key or low-profile approach Upon entry.Starts upon entry. develop mutual trust. SOCIAL PREPARATION – tampering the grounds for setting up health programs Target: community leaders .Deepen rapport. Virgin community – without people’s organization Phases of CO: 1. Community Integration 3.continuous appraisal of community situation through primary data sources 2. develop trust. Deepening Social Investigation b.data processing of community diagnosis is being done 6.COMMUNITY ORGANIZING IN HEALTH Two types of community: a.secondary data sources are utilized . Social Preparation c. COMMUNITY INTEGRATION – imbibing the community way of life Target: community . direct participation in the production process (best method) 5.g.baseline information from secondary data sources (e. Records Review)  Deepening Social Investigation . SOCIAL INVESTIGATION  Preliminary Investigation . clarify intentions and expectations . ends with launching Methods: courtesy call and attendance to meetings 4. ELECTION OF CHWs 7. Organized community – with people’s organization b. going to places where people are.cluster of 8-15 households .Establish rapport.

Preliminary Social Investigation ENTRY 1. Deepening social investigation ORGANIZATION FORMATION PHASE 1. Organizational meetings . CORE GROUP FORMATION . Endorsement to sectoral organizing 2. Community clinics 2. Outcome: Problems and needs of the people 9. Actual training 4. Community analysis“The process of assessing and defining needs. Curriculum development – based on problems identified 3. PHASE OUT – so that people can practice self-reliance . Evaluation session 2. Training needs assessment – COMMUNITY DIAGNOSIS 2. TRAINING AND SERVICES Advanced community health workers have the leadership traits 10.Group of advanced CHWs 11.Provide opportunity for the health workers to stand on their own Indicator of Phase-out: Advanced CHWs are able to assume staff level functions COMMUNITY ORGANIZING PROCESS (COPAR) PRE-ENTRY 1.to clarify matters TRAINING PHASE 1. Training evaluation SERVICES PHASE 1. Small group formation 2. middle-aged. Core group formation 2. Election of CHW (women. opportunities and resources involved in initiating community health action . married) 3. Community integration 3. Social preparation 2. Other services LEADERSHIP FORMATION PHASE 1. Formation of regional coordinating bodies 1. Site selection 2. Staff development SUSTENANCE AND MAINTENANCE PHASE 1. Advanced training CONSOLIDATION PHASE 1.

” “health education planning. These include the following: •Leadership board or council – existing local leaders working for a common cause •Coalition – linking organizations and groups to work on community issues. 2. social and economic profile of the community derived from secondary data  Health risk profile  Health/wellness outcome profile  Survey of current health promotion programs  Studies conducted in certain target groups Steps in community analysis  Define the community . Design and initiation In designing and initiating interventions the following should be done:  Establish a core planning group and select a local organizer - Five to eight committed members of the community may be selected to do the planning and management of the program. This is usually done in consultation with representatives of the various sectors.  Collect data – As earlier mentioned. Current programs have to be assessed including the potential of the various types of leaders/influential. organization and programs.  Assess community capacity – This entails and evaluation of the “driving forces” which may facilitate or impede the advocated change.There are several organization structures which can be utilized to activate community participation.” and “mapping. . and will become the basis for designing prospective community interventions for health promotion. program.” 5 components  Demographic.Determine the geographic boundaries of the target community. their perception on the importance of the problem. This process may be referred to as “community diagnosis.  Choose an organizational structure . several types of data have to be collected and analyzed.  Synthesis of data and set priorities – This will provide a community profile of the needs and resources.  Assess community barriers – Are there features of the new program which run counter to existing customs and traditions? Is the community resilient to change?  Assess readiness for change _ Data gathered will help in the assessment of community interest.” “community needs assessment.

The community language.This will specify the what. Recognition of the program’s accomplishment and individual’s contribution to the success of the program and boost morale of the members. values and norms have to be incorporated into the program. One of them is organizing task force.This is done to establish a smooth working relationship and avoid overlapping of responsibilities. Chosen representative have power for the groups they represent.As much as possible.. where. •“Lead” or official agency – a single agency takes the primary responsibility of a liaison for health promotion activities in the community.  Integrate community values into the programs. 4.  Provide trainings and recognition . materials and messages. To do so. Program maintenance – consolidation .  Use comprehensive integrated strategies .  Develop a sequential work plan . the following must be done:  Generate broad citizen participation . plan has to be modified as events unfold. Community members may have to constantly monitor implementation steps. when and extent of the organizational objectives. Implementation Implementation put design phase into action. organizations sectors should be represented. Generally the program utilize more than one strategies that must complement each other.There are several ways to generate citizen participation.Activities should be planned sequentially. •Grass-roots – informal structures in the community like the neighborhood residents. 3. •Citizen panels – a group of citizens (5-10) emerge to form a partnership with a government agency •Networks and consortia – Network develop because of certain concerns. with appropriate guidance can provide the necessary support. Oftentimes. who.  Clarify roles and responsibilities of people involved in the organization . select and recruit organizational members .Active involvement in planning and management of programs may require skills development training. who.  Identify.  Define the organization mission and goals . different groups.

This can be affected through implementation problems.  Summarize and disseminate results .Quantitative and qualitative methods of evaluation can be used to determine participation.Is there a change in leadership. before any programs reach its final step. Dissemination of information is vital to gain and maintain community support. Revitalization of collaboration and networking may be vital in support of new ventures.  Establish an ongoing recruitment plan. a dissemination plan maybe helpful in diffusion of information to further boost support to the organization’s endeavor. The organization and program is gaining acceptance in the community. However..A positive environment is a critical element in maintaining cooperation and preventing fast turnover of members. Formative evaluation is done to provide timely modification of strategies and activities. Thus.  Establish a positive organizational structure . GUIDE ON HOW TO DO AN EFFECTIVE COMMUNITY DIAGNOSIS Community Diagnosis: an in-depth process of finding out the profiles. respect. 5. This requires a built in mechanism for continuous recruitment and training of new members.  Integrate intervention activities into community networks .It should be expected that volunteers may leave the organization. The organization and program is gaining acceptance in the community.  Disseminate results . This is the result of good group based on trust. evaluation is done for future direction. The program at this point has experienced some degree of success and has weathered through implementation problems. support and behavior change level of decision- making and other factors deemed important to the program  Chart future directories and modifications . resources and participation? This may necessitate reorganization and new collaboration with other organizations. Some organizations die because of the lack of visibility.Continuous feedback to the community on results of activities enhances visibility and acceptance of the organization.This may mean revision of goals and objectives and development of new strategies.  Update the community analysis .  Assess effectiveness of interventions/programs . and openness. health . Dissemination – reassessment Continuous assessment is part of the monitoring aspect in the management of the program.

population. physical features. Population Density. spot map 2. types of families. civil status. sex ratio. dependency ratio.1 Intervention strategies 5. domestic animals 2.7 Morbidity and mortality data – leading cause of morbidity.4 Methodology and tool used – a description of the adoption. length of residency 2. Conclusion . age and sex distribution.4 Socio-economic indicators – educational attainment. housing.6 Health profile – food storage. valid. mortality. infant feeding practices.status of the community and the factors affecting the present status Contents: 1.5 Environmental indicators – Water supply. communication resource and family planning 2. boundaries. 2.1 Identification of health problems 3.1 Geographical Identifiers – historical background.2 Purpose – to analyze the data in order to develop responsive intervention strategies that address the root cause of the problem 1. garbage disposal.3 Statement of Objective – what are to be accomplished to attain the study 1. Target Community Profile 2. Analysis of Data 3. timely and relevant information on the community profile and health problems are essential so that resources can be maximized 1. location. health seeking behaviors. literacy rate. community facilities. religious distribution. place of origin. occupation. Introduction 1.5 Limitation of the study – state any limitations that exist in the reference or given population or area of assignment 2. excreta disposal. ventilation 2.2 Prioritized problems identified 4. number of households. construction and administration of instruments 1. immunization. income.2 Population Profile – Total estimated population of Barangay.1 Rationale – accurate. climate. infant mortality and maternal mortality 3. pet ownership.3 Socio-demographic Profile – total population of families surveyed. Action plan based from prioritized problem identified 4.

Data analysis and interpretation 5. Make graph or chart of each data gathered 4. Data collection techniques 3. Community assembly 2. ENTRY PHASE integration with the community Courtesy calls Information campaigns Identification of potential leaders  III. Preparation of action plan /project plan HRDP CO-PAR COMMUNITY ORGANIZING A continuous process of awareness building. CONSOLATION & EXPANSION PHASE Networking. PHASES AND ACTIVITIES  I.6. organizing and mobilizing community members towards community development. Ocular survey c. ORGANIZATION-BUILDING Organizing Barrio Health committees Setting up community organization  V. linkages Implementation of livelihood projects developing secondary leaders . Conduct of survey proper using the format/survey form a. Identify barangay to survey or required by the health center b. Guidelines in filling survey form c. Random sampling or saturation b. Recommendation Community Diagnosis 1. PRE-ENTRY PHASE Preparation of the staff Site selection  II. Preparation of Community Diagnosis a. CORE-GROUP FORMATION & MOBILIZING integration with core group  IV.

Micronutrients Supplementation . 3. health and well-being of mothers and the unborn through a package of services for the pre-pregnancy. 2nd visit During the 2nd trimester. *mother is then called as a “fully immunized mother”. Tetanus Toxoid Immunization *A series of 2 doses of Tetanus Toxoid vaccination must be received by a woman one month before delivery to protect the baby from neonatal tetanus. natal and postnatal packages. NGOs and other stakeholders must advocate for health through resource generation and allocation for health services to be provided for the mother and the unborn a. 4. Reduce mortality and morbidity among Filipino adults and improve their quality of life. c.  Improve the quality of prenatal and postnatal care  Reduce women’s exposure to health risks through the institutionalization of responsible parenthood and provision of appropriate health care package to all women of reproductive age  LGUs. 2. Reduce morbidity and mortality rates for children 0-9 years. b. Antental Registration Prenatal Visits Period of Pregnancy 1st visit As early as possible before 4 months or during the 1st trimester. *3 booster dose shots are needed to complete the five doses following the recommended schedule to provide full protection for both mother and child.  The Maternal Health Program Strategic thrusts for 2005-2010  Launch and implement the Basic Emergency Obstetric Care or BEMOC strategy in coordination with the DOH. Improve the survival. 5. prenatal. Reduce morbidity and mortality of older persons and improve their quality of life. Public Health Programs PUBLIC HEALTH PROGRAMS FAMILY HEALTH Aims to: 1. 3rd visit During the 3rd trimester. Reduce mortality from preventable causes among adolescents and young people. Every 2 weeks After 8th month until delivery.J.

6. teach and counsel the woman on important MCH messages: *birth registration *importance of breastfeeding *Newborn Screening for babies delivered in RHU or at home within 48 hours up to 2 weeks after birth *Schedule when to return for consultation for post partum visits 1st visit 1st week post partum preferably 3 . 11. Determine the stage of labor. Give supportive care throughout labor. experiences andsociocultural beliefs. Continue care after one hour postpartum.5 days 2nd vist 6 weeks post partum  The Family Planning Program FAMILY PLANNING The concept of enhancing the quality of families which includes: *Started 1960’s *2 – 3 years spacing of child *2 – 3 years children is ideal *5 pregnancy is a risk factor *COUPLES FOR CHRIST – DOH Partner *Regulating and spacing childbirth *Helping subfertile couples beget children *Counseling parents and would-be parents *The privilege and the obligation of the (married) couple exclusively to decide w/ love when andhow many children provided: the motive is justified and the means are moral. 9. . 4. 10. 1. 2. Decide if the woman can safely deliver. It involves thorough planning to be certain that the method chosen isacceptable and can be used effectively. Educate and counsel on Family Planning and provide Family Planning Method if available and decisions made by the woman. Do a quick check upon admission for emergency signs. Assess the woman in labor.000 IU 2x a week starting on 4th month of pregnancy Iron: 600mg/400ug tablet daily d. Inform. 7. Monitor closely within one hour after delivery and give supportive care. Treatment of Diseases and other Conditions ???? e. Make the woman comfortable/ 3. *Involves personal decisions based on each individual’s background.Vit A: 10. Monitor and manage labor. 5. 8. Clean and safety delivery.

FAMILY PLANNING Aims to contribute to: .Neonatal deaths .Under – five deaths . -Ensure that quality Family Planning services are available in DOH retained hospitals. . LGU managed health facilities. give information and allow an individual/couple to decide his/her/their course of action according to what he/she think is appropriate for them and in accordance to their own personal. reassure. FAMILY PLANNING SERVICES *Temporary conception control -Methods used to prevent conception -Methods used to prevent ovulation -Methods used to prevent implantation *Sterilization / Permanent conception control -Tubal occlusion / Bilateral Tubal Ligation -Vasectomy or Vas Ligation (never advice a permanent method of planning). NGOs and private sector. religious beliefs & values Goal: Provide universal access to family planning information and services wherever and whenever these are needed. Strategies: *Focus service delivery to urban and rural poor *Reestablish the FP outreach program *Strengthen FP provision in regions with high unmet needs *Promote frontline participation of hospitals *Mainstream modern natural family planning *Promote and implement CSR strategy MISSION: -To provide the means and opportunities by which married couples of reproductive age desirous of spacing and limiting their pregnancies can realize their reproductive goals.Maternal deaths Objectives: -Addresses the need to help couples and individuals achieve their desired family size within the context of responsible parenthood and improve their reproductive health to attain sustainable development.societal. Function of the Health Professional in Family Planning *To counsel.Reduced infant deaths .

98% effective . BBT (Basal Body Temperature) .Spinbarkeit Test .Clear. Sympto – Thermal method . Cervical Mucus / Billing Method .Mark coitus schedule .Family Planning: 4 Pillars BIRR!!! B- I- R- R- Important Concept!!! COUPLE – Decision – maker DOH – Regulator Community Health Nurse – Facilitator Important Concept!!! High – risk Pregnancies -Too early -Too late -Too Frequent -Too many The family planning methods: Natural Family Planning 1.Graph .91 – 99% effective .Combination of basal body temperature and billing method 4.Taken per mouth or per axilla .91 -99% effective .Cervical mucus is pasty – Not Fertile 3.91 – 99% effective .Take temperature upon waking up .Mark time of menstruation Important Concept!!! Progesterone CAUSES AN INCREASE IN TEMPERATURE Estrogen CAUSES A DROP IN TEMPERATURE 2. stretchable and mucus is abundant – Fertile .Observe temperature for six (6) months or more . Lactational Amenorrhea Method (LAM) .Done for six (6) months .

Best time for insertion . every 3 months . .% effective .Do not engage in coitus three (3) days before and after the procedure .Cervix is slightly open .Best time: * Post – partum * Within four (4) to six (6) hours after delivery . Condom .Mother is most responsible in inserting the condom. supplementary food Artificial Family Planning 1.Fertility after 6 months Permanent Family Planning 1.You know you are not pregnant .Usually taken at night .Injectable.97% effective . Pills .COC’s (Combine Oral Contraceptives) * Not given on breast feeding mother * With estrogen and progesterone . Tubal Ligation .98% effective .Restrict lifting of objects heavier than newborn… .No pacifier. * Nulliparous * History of Pelvic Inflammatory Disease * History of Sexually Transmitted Disease 3.POC’s (Progestin Only Contraceptives) * Taken by breastfeeding mothers 2. 4. Intrauterine Device (IUD) .99% effective . water. Depo Medroxyl Progesterone Acetate (DMPA) .During the second (2nd) day of menses .ABSOLUTE CONTRAINDICATION * When you have abnormal uterine bleeding.Sterile plastic device .Three Criteria for LAM: * Child less than six (6) months * Menses are still absent * Pure Breast – Feeding .98% effective .

Breastfeeding benefits To Infants:  Provides a nutritional complete food for the young infant  Strengthens infants’ immune system .There is a waiting time of six (6) months .Vas deferens is cut . not properly managed when sick. . The risk of infection among children is higher when not screened for metabolic disorder. excluding milk supplements * Extend breastfeeding up to 2 years and beyond.Sperm is still stored .Does not give immediate sterility . child health programs have been created and available in all health facilities which includes:  Infants and Young Child Feeding National Plan of Action for 2005 – 2010 for infant and young Child Feeding Goal: Reduce child mortality rate by 2/3 by 2015 Objective: To improve health and nutrition status of infants and young children Outcome: To improve exclusion and extended breastfeeding and complementary feeding Key Messages on infant and young child feeding * Initiate breastfeeding within 1 hour after birth * Exclusive for the first 6 months of life * Complemented at 6 months with appropriate foods.Calendar Method Misconception about Family Planning Methods: *Some family planning methods cause abortion *Using contraceptives will render couples sterile *Using contraceptive methods will results to loss of sexual desire  The Child Health Programs (Newborns. infants and children are vulnerable age group for common childhood diseases. patient can engage in unprotected coitus. Vasectomy .99% effective .2. not given with vitamin supplementation and many others.After six months. not exclusively breastfed.Not Popular among Filipinos Nursing Alert!!! Methods that are not part of Natural Family Planning: (not accepted by the DOH) .Withdrawal . Infants and Children) Newborns. To address problems. unvaccinated.

*Absolute contraindications: DPT 2 or DPT3 to a child who had convulsions or shock within 3 days after DPT administration. diarrhea and vomiting are not contraindications to vaccination. after birth 0. cough. Storage Type/ form at 1st dose Doses interval Dosage. temp of vaccine between Site doses BCG Birth or anytime 1 ID 2-8 C in Freeze dried. *Vaccination schedule should not be restarted from beginning even if interval exceeds recommended interval. low-grade fever.05 ml body of live Right ref attenuated arm bacteria DPT 6 weeks 3 4 weeks IM 2-8 C in D– 0. mild respiratory infection.5 ml body of weakened Thigh ref toxin (vastus P – killed lateralis) bacteria . *Measles vaccine should be given as soon as the child is 9m/o. BCG to immunosuppressed clients *Giving doses of a vaccine at less than the recommended 4 weeks interval may lessen antibody response *False contraindications: malnutrition. mild respiratory infections. and other minor illnesses and diarrhea Vaccine Minimum age # of Minimum Route.  Safely rehydrates and provides essential nutrients  Reduces infants exposure to infection  Increase IQ points To Mother:  Reduces woman’s risk of excessive blood loss after birth  Provides natural methods of delaying pregnancies  Reduces the risk of ovarian and breast cancers and osteoporosis To Household and the Community:  Conserve funds that would be spent on breastmilk substitute  Saves medical cost to families  Newborn Screening??????  Expanded Program on Immunization Goal of EPI: Reduction of morbidity and mortality of immunizable diseases Not all diseases are immunizable Principles in Vaccinating Children: *It is safe and immunologically effective to administer all EPI vaccines on the same day at different sites of the body. malnutrition. *Moderate fever.

5 ml body of recombinant from 1st Thigh ref dose to 2nd (vastus dose.5 ml 25C live attenua- Outer (freezer) ted virus part of upper arm Types and Schedule of Vaccines: BCG: Infant – 0. Koch’s Phenomenon (Nisie) . .O. Freeze dried. T – toxin OPV 6 weeks 3 4 weeks Oral -15 to . 8 lateralis) weeks interval from 2nd to 3rd dose Measles 9 months 1 SQ -15 to .05ml – ID Will not totally eliminate TB School entrants – 0.1 ml ID (double dose) Will inhibit Leprosy AT BIRTH 1 ½ months 2½ 3 ½ months 9-12 months months 1st BCG DPT1 DPT2 DPT3 MEASLES OPV1 OPV1 OPV3 HEPB 1 HEPB 2 HEPB 3 DPT: HepB 5 ml IM – destroyed by freezing TT Measles . Live 2 drops 25C attenuated Mouth (freezer) virus Hepa B At birth 3 6 weeks IM 2-8 C in RNA interval 0.Trivalent ( 3 types) SIDE-EFFECTS OF BCG: a. SQ Most sensitive to heat & destroyed by heat OPV – 2 gtts/ P.Inflammation of the site of injection after 2-4 days .5ml. 0.

. Deep abscess at site – even after 12 wks.: Incision & drainage Treatment: Powedered INH c.Warm complex after vaccination b. Fever for a day (always bring antipyretic)-----------------------Normal ● Soreness at site within 3-4 days Treatment: Warm compress-----Normal ● Abscess after a week or more.) .abscess (2-3 weeks abscess will leave scar 12 weeks after) SIDE-EFFECTS OF DPT: . Indolent ulceration. Fever 5-7 days after within 1-4 days------Normal ●Mild rashes --------if it does not disappear-----Roseola Remember the Principles: * Even if the interval exceeded that of the expected interval. * MALNUTRITION is not a contraindication.2 to 3 wks.. * Immunization can still be given until the child reaches 6 y/o * If there has been a reported epidemic of measles. EXCEPT when the child had convulsions upon giving the 1st dose of DPT. *COLD CHAIN – A system used to maintain the potency of a vaccine from that of manufacturer to the time it is given to child or pregnant woman. Abscess will ulcerate then heals leaving a scar (12 wks. Glandular enlargement. measles vaccine can be given as early as six months * BCG booster dose must be given to school entrants regardless of presence of BCG scar. but RATHER AN INDICATION for immunization since common childhood disease are often severe to malnourished children. continue to give the doses of the vaccine.ulcer after 12 weeks Treatment: Powedered INH d.incision & drainage ------Not normal ● Convulsions-----Emergency: post-pone giving of next dose SIDE-EFFECT OF MEASLES: . * There is no contraindication to immunization.

1 month @ main health centers (with refrigerators) .Not more than 5 days @ health centers (using transport boxes) Important Points To Remember: ● Arranging of stored vaccine according to: ● Type ● Expiration date ● Duration of storage ● # of times they have been brought out to the field ● The vaccine stored the LONGEST & THOSE THAT WILL EXPIRE FIRST should be distributed or used 1st.Principles: I. it must already BE DISCARDED.it should not exceed: . II. vaccines must be placed in a special cold pack during immunization sessions. Vaccine Half life BCG 4 hours DPT Polio Measles 8 hours TT HepaB TARGET SETTING: ● Involves the calculation of the eligible population. Transport Use of cold dogs III. Storage.3 months @ the provincial/ district level . because if a VACCINE IS NOT USED on the 3 rd trip.6 months @ the regional level . ● It is a MUST to mark ampules/vials with an “X” mark each time they are carried to the field. . Handling Once opened or reconstituted.

● “ELIGIBLE POPULATION” consists of any group of people targeted for specific immunizations due to susceptibility to one or several of the EPI diseases. Objective: Aims to reduce death. Goal: By 2010. ***For many sick children a single diagnosis may not be apparent or appropriate. IMCI includes both prventive and curative elements that are implemented by families and communities as well as by health facilities. *Improving family and community practices. illness and disability. IMCI Components of Strategy: *Improving case management skills of health workers. Presenting Complaint: *Cough and / or fast breathing *Lethargy / Unconsciousness *Measles rash *”Very sick” young infant Steps in IMCI Process - - - - . *Improving the health systems to deliver IMCI. *To contribute to healthy gorth and development of children. and to promote improved growth and development among children under five years old. and to promote improved growth and development among children under 5 years of age.  Management of Childhood Illnesses (IMCI) INTEGRATED MANAGEMENT AND CHILDHOOD ILLNESSES Definition: The Integrated Management of Childhood Illness (IMCI) is a strategy to address the most common causes of illness (morbidity) and deaths(mortality) among children under 5 which was developed and initiated by the World Health Organization (WHO) in collaboration with UNICEF in 1995. in pursuit of the goal of reducing it by two thirds by 2015. illness and disability. *To reduce SSIGNIFICANTLY global mortality and morbidity associated with the major causes of disease in children. AIM: To reduce death. to reduce the infant and under five mortality rate at least one third.

- - Principles of the Integrated Care o Assess for General Danger Signs * Vomits everything * Convulsion / Seizure * Difficulty drinking / breastfeeding * Drowsiness / Lethargy / Difficulty to awaken o Assess for Main Symptoms * Cough / DOB * Diarrhea * Ear Problem * Fever *M Color Classification Classification of Disease Level of Management *Green –. Managed at the RHU *Pink --. Mild--. Urgent Referral in Hospital Assess and Identify Classifications A. Sever--. Cough and Difficulty  Micronutrient Supplementation  Dental health Early Child Development  Child Health Injuries Its main goal is to reduce morbidity and mortality rates for children 0-9 years with the strategies necessary for program implementation.  Essential Packages of Health Services for Newborn. Infant and Child  The Adolescent Health Program . Home Care *Yellow –. Moderate--.

through the promotion of healthy lifestyle aimed at preventing the three commonly shared major risk factors. Cancer 3. kidney problem.MORTALITY statistics showed that 7 out of 10 leading causes of deaths in the country are diseases which are lifestyle related: diseases of the heart and the vascular system. non-communicable diseases. contributing 60% of deaths worldwide. . . chronic obstructive pulmonary diseases. cancer. Physical inactivity and smoking. chronic diseases also caused disability. 2002 – Life expectancy of Filipinos has gone up to 69. 2003 – The result of the National Nutrition and Health Survey conducted that recently 90% of Filipinos has one or more risk factors associated with chronic. One DAILY can be thought of as one lost healthy year of life. which combines the number of years of healthy life lost to premature death with time spent in less than full health. chronic obstructive pulmonary diseases and diabetes mellitus. Cardiovascular diseases 2. Integrated Community Based Non-Communicable Disease Prevention and Control Program FOUR MAJOR NON – COMMUNICABLE DISEASES 1. cancers. The projected burden of disease of these diseases is approximately half or 48% of the global burden of disease. Chronic Obstructive Pulmonary Diseases 4. diabetes. The most widely used summary measure of the burden of disease is the disability adjusted life year or DAILY. unhealthy diet.6 years. Diabetes Mellitus 2005 – It was estimated that 35 million deaths would have occurred due to these diseases. . I. 2020 – The diseases are expected to account for 73% of deaths and 60% of the disease burden.  The Adult Men Health Program  The Adult Women Health Program  The Older Person Health Program  Philippine Reproductive Health NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL AIM: Preventing the four major non – communicable / Chronic / Lifestyle related disease.MORBIDITY statistics also showed that hypertension and diseases of the heart are among the top 10 leading causes of illnesses in the country. As well as a high death toll. often for decades of a person’s life. accidents.

3. This would include practices that promotes healthy such as healthy diet and nutrition.6% HEALTHY LIFESTYLE – defined as a way of life that promotes and protects health and well-being. Analyze the social. economic. Smoking 34. Physical Inactivity 60. Community – Based Approach 3. Hypertension 22. workplaces and communities. GOAL: Reduce the toll of morbidity. To hasten this. Providing financial measures to support NCD prevention and control. c. disability and premature deaths due to chronic.9% (BMI > 30) f. b. and c. avoidance of substances that can be abused such as tobacco. Strengthen health care for people with NCD through health sector reforms and cost effective interventions. the following approaches should characterize the program: 1. paying particular attention to the most vulnerable population. 2.5% b. Developing policy guidelines. alcohol and other addicting substances.8% c.5% (SBP > 140 or DBP > 90) d. In order to contribute health status individuals and respond to the community’s basic health care needs. there must be enhance capability to take action to address these major NCD risk factors.THE RISK FACTORS WITH THE CORRESPONDING PREVALENCE RATES: a. Comprehensive Approach Focused on Primary Prevention 2. political and behavioral determinants of NCD that will serve as bases for: a. Hypercholesterolemia 8. OBJECTIVES: 1. Communicating the consequences of major risk factors of NCD. b. regular and adequate physical activity and leisure. To achieve significant reduction in morbidity and mortality from major NCD’s. Obesity 4. the health sector lobby for a healthy protective environment by: a. and practices that offer protection from health risks such as safe sex and immunization. Setting legislative and political directions. Integrated Approach . Proposing healthy public policies that encouraged health – promoting settings in school. adequate stress management and relaxation.5% (TC > 240) e. Diabetes 4. Reduce exposure of individuals and population to major determinants of NCD while preventing emergence of preventable common risk factors. Encouraging government to provide protection against activities by industry and commerce that promote unhealthy products and lifestyles. non- communicable lifestyle related disease.

It is important to convey the problem. . needs demands of the people are amplified and eventually become the framework for decision – making. They should be motivated to make own choices and decisions about habits and practices that are determined to health. Telling people about health is not enough. the PHN helps the people toward optimal degree of independence in decision – making and in asserting their right to their right to a safer and better community. Changing environments 3. physical inactivity and fat and sugar rich diet. Motivate the people. should conduct healthier education in a variety of settings. 2. In non- communicable disease prevention and control. The people must be assured that they have the right responsibility to make decisions and that they do not to change their decisions because of others’ objections. Supporting people’s right to make a choice and to act on the choice. 2. Health Educator Health Education is an essential tool to achieve community health. show it affects people in the community and describe possible actions to take. as well as educators and media personel. In this manner. Changing Lifestyle 4. Thoroughly discussing with the people the nature of the alternatives. The health educator aims to: 1. support and eventually. This involves: 1. The advocate affirms the decision made by the people by getting powerful individuals or groups to listen. indulgence in alcohol. 4. prevention and control of non-communicable diseases. such as cigarette smoking. Misconceptions and ignorance will be corrected by disseminating scientific knowledge about causes. their content and consequences. make substantial changes to solve the problem. factors. health education focuses on establishing or inducing changes in personal and group attitudes and behavior that promote healthier living. Informing the people about the rightness of the cause.KEY INTERVENTION STRATEGIES 1. PHNs. 3. Reorienting health services THE ROLE OF PUBLIC HEALTH NURSE IN NCD PREVENTION AND CONTROL Health Advocate Public Health Nursing promote active community participation in NCD prevention and control through advocacy work. Influencing public opinion. Inform the people. As a health advocate. Health education creates an awareness of health needs and problems which consequently make the people become conscious of their own responsibilities towards their own healthy. Establishing program direction and infrastructure 2.

*Influencing executive and legislative bodies to create and enforce policies that favor a healthy environment. Guide people into action. the ultimate goal of the PHN is community health development and empowerment of the people. It is inextricably related to community health practices since it provides the theoretical bases for developing appropriate and responsive intervention programs and strategies. . Healthy Trainer The PHN provides technical assistance in the assessment of the skills of auxiliary health workers in NCD prevention and control. secondary and tertiary health care services in any setting including the community and workplace. Diseases of the Heart and Blood Vessels 1. Hypertension Description *Hypertension or high blood pressure is defined as a sustained elevation in mean arterial pressure. This is achieve by: *Raising the level of awareness of the community regarding non – communicable diseases. II.3. prevention and control. Researcher Research is an integral part of a primary health care approach to non – communicable disease prevention and control program. its causes. reporting and utilization of health information related to non – communicable diseases. Causes and Risk Factors of Major NCDs A. Health Care Provider The Public Health Nurse is a care provider to individuals. Community Organizer As an organizer. *Organizing and mobilizing the community in taking action for the reduction of risk factors. people need to supported in their effort to adopt or maintain healthy practices and lifestyles. Oftentimes. teaching and supervision on clinical management of non – communicable diseases and other community – based services and recording. As care provider. emphasis of care is on health promotion and disease prevention focusing on promotion of rational diet and physical activity and cessation of smoking and alcohol drinking. action is directed towards the reduction of risk factors of non – communicable diseases. families and communities rendering primary. Primary prevention must be family – oriented because the family members live and eat together and the roots of chronic diseases are related to personal habits and lifestyle. In addition.

advancing age. *Risk factors include family health history. *Although exact cause is unknown. *AGE -Older person are at greater risk for hypertension than younger persons. *FAMILY HISTORY -People with a positive family history of hypertension are twice at risk than those with no history. . not treated. intake of potassium (diet high in sodium is generally low in potassium. hypertension is classified into primary and secondary hypertension. excess alcohol consumption. increasing potassium in diet increase elimination of sodium). calcium. For the rest of these session. *Hypertension is also a major risk factor for the development of others CVDs like coronary heart disease and stroke. systolic hypertension common in older persons was considered benign and. therefore. -The aging processes that increase BP include stiffening of the arteries. a variety of symptoms. and magnesium. *Other lifestyle factors interact with these risk and contribute to the development of hypertension such as obesity. *OBESITY -Risk for hypertension is two times greater among overweight / obese persons compared to people of normal weight. reduce BP in all hypertensives. Primary hypertension has no definite cause. Secondary hypertension is usually the result of some other primary diseases leading to hypertension such as renal disease. RISK FACTORS *There is no single cause for primary hypertension but several risk factors have been implicated in its development. which is more common. *HIGH SALTH INTAKE -Excessive salt intake does not cause hypertension in all people. ETIOLOGY / CAUSE *In terms of etiology. decreased baroreceptor sensitivity. -For years. the Framingham study showed that there was two to five times increased in death from CVD associated with isolated systolic hypertension. stress. we will be focusing on primary hypertension. and a range of responses to therapy. Some people are more susceptible than others to effects of increased salt intake. and three times more than that of underweight persons. increase peripheral resistance and decreased renal blood flow. primary hypertension is attributed to atherosclerosis. It is also called essential hypertension. race and high salt intake. However.*It is not a single disease state but a disorder with many causes. nor does reducing salt intake. and use of contraceptive drugs.

supply of blood and oxygen to the heart muscle is affected. controlled for 5 years. *When there is decreased oxygen supplied to the heart muscle. *CAD can cause myocardial infarction (heart attack). arrhythmias. It is also known as Ischemic Heart Disease. *Smoking cessation – tobacco use promotes atherosclerosis that may contribute to hypertension. -The exact mechanism of how obesity contributes to the development of hypertension is unknown. Whatever the cause. *Prevent becoming overweight or obese – weight reduction through proper nutrition and exercise. *EXCESSIVE ALCOHOL INTAKE -As much as 10% of hypertension cases could be related to alcohol consumption. quitting smoking anytime is beneficial. . heart failure. *Atherosclerosis usually occurs when a person has high level of cholesterol in the blood. *Identify people with risk factors and encouraged regular check – ups for possible hypertension and modification of risk factors. and sudden death. 2. KEY AREAS FOR PREVENTION OF HYPERTENSION *Encouraged proper nutrition – reduce salt and fat intake. decreasing and sometimes completely cutting off the supply of oxygen and nutrients to the heart. ETIOLOGY / CAUSES *The most common cause is atherosclerosis. coronary arteries and the large vessels that supply the brain. When the level of cholesterol in the blood is high. there is a greater chance that it will be deposited onto the artery walls. This is the thickening of the inside wall of arteries due to deposition of a fat like substance.-Fat distribution is more important risk factor than actual weight as measured by waist – to – hip ratio. This thickening narrows the space through which blood can flow. Coronary Artery Disease Description *Coronary Artery Disease (CAD) is heart disease cause by impaired coronary blood flow. this refers to both active and passive smokers. *When the coronary arteries become narrowed or clogged. chest pain (called ANGINA) occurs. more than doubled the success of withdrawal of drug therapy. Systolic pressures were more markedly affected than diastolic pressure. -Weight loss or sodium restriction in hypertensives. It affects large and medium – sized arteries like the aorta. Regular consumption of 3 or more drinks per day increased risk of hypertension. weight loss is effective in reducing BP in obese hypertensive patients.

Hypertension c. When HDL level is below normal. prevent obesity and improves optimum functioning of the heart.density lipoprotein) level is a risk factor of CAD. -High LDL(low. smoking. Stress ELEVATED BLOOD LIPIDS/ CHOLESTEROL -Increased blood cholesterol is an important risk factor in the development of CAD. Regular exercise and moderate alcohol consumption increased HDL levels. myocardial infarction and stroke. Reports have shown that modest reduction in total cholesterol can significantly lessen CVD morbidity and mortality. often resulting in coronary artery disease. particular those younger than 50 years old. Smoking d. -Not all cholesterol is bad. this becomes a risk factor for CAD. obesity and diabetes mellitus. exercise increases HDL. Diabetes mellitus e. SMOKING/TOBACCO USE -Risk of death from CAD is 70-200 times greater for men who smoke one or more packs of cigarettes per day compared to those who do not smoke. Physical inactivity/ sedentary lifestyle g. In . atherosclerosis is accelerated. obesity. unrefined cereals and wheat breads. It is decreased in smoking. Elevated blood lipids and cholesterol level (hyperlipidemia) b. HDL facilitates reverse transport of cholesterol to the liver where it may be excreted and therefore prevent atherosclerosis. sedentary lifestyle. fruits. HDL (high – density lipoprotein) is now acknowledged as a protective factor against coronary heart disease. friends and co-workers of active smokers.*In diabetes mellitus. It is called the “bad” cholesterol because it is the main carrier of cholesterol and contributes to atherosclerosis. LDL level is increased by saturated fat intake. androgens and certain drugs. Obesity f. limiting salt intake and increasing intake of dietary fiber by eating more vegetables. This risk is most seen in young people. RISK FACTORS OF CAD a. • Encourage proper nutrition particularly by limiting intake of saturated fats that increased LDL. KEY AREAS FOR PREVENTION OF CAD • Promote regular physical activity and exercise. • Advise smoking cessation for active smokers and prevent exposures to second- hand smoke by family members. • Maintain body weight and prevent obesity through proper nutrition and physical activity/ exercise.

there is usually an increase in cancer incidence. KEY AREAS FOR PREVENTION OF STROKE *Treatment and control of hypertension . 3. -the immune system seems to play a role in the development and spread of cancer. Cancer -cancer is not a single disease. It occurs as the cancer cells get into the bloodstream or lymph vessels of our body. Some of them have been fatal even in first time cocaine users. Cerebrovascular Disease or Stroke Description *Stroke is the loss or alteration of bodily function that result from insufficient supply of blood to some parts of the brain. and for men. -cancer develops when cell in a part of the body begin to grow out of control. -they compete with normal cells for the blood supply and nutrients that normal cells need thus causing weight loss. *Smoking cessation and promoting a smoke-free environment. *Prevent all other risk factors of atherosclerosis. not more than one drink per day. When the immune system is impaired as in people with immunodeficiency diseases. isolated cancer cells will usually be detected and removed from the body. • Early diagnosis. a . Health workers need to remind these persons to take their medications as prescribed.free environment through advocacy and community mobilization. or in AIDS. *Prevent thrombus formation in rheumatic heart disease and arrhythmias with appropriate medications. not more than two drinks per day. People can inherit damage DNA which account for inherited cancers. promote a smoke. *Avoid intravenous drug abuse and cocaine. *Limit alcohol consumption for women. Many times though. heart attacks and a variety of other cardiovascular complications. from prompt treatment and control of diabetes and hypertension. CAUSES OF CANCER -Normal cells transform into cancer cells because of damage to DNA. general. these diseases are risk factors and contribute to the development of coronary artery disease. For human brain to function at emboli.many people believe that effective treatment of high blood pressure is a key reason for the rapid decline in the death rates for stroke. When the immune system is intact. This process is called metastasis. people with organ transplant who are receiving immunosuppressant drugs. -cancer cells often travels to the other part of the body where they begin to grow and replace normal tissue. Cocaine use has been closely related to strokes. These medications are usually taken on a daily basis. B.

person’s DNA becomes damaged by exposure to something toxic in the environment such as chemicals. sex and family medical history. *Many cancers are associated with lifestyle risk factors such as smoking. x-rays. Polycyclic hydrocarbons produced from animal fat in the process of broiling meats and are present in smoked meats and fish.g tinapa or smoked fish). radiation or viruses. *Formation of nitrosamines may be inhibited by the presence of antioxidants such as Vit. c in the stomach. diet and sun exposure. longganisa. Viruses * a virus can enter a host cell and cause cancer. or in food such as smoke foods. certain leukemias. the greater the risk of cancer. cigar. *Other includes benzopyrene. and a lot more. industrial agent. Limit eating preserved food and eat more vegetables and fruits that are rich in dietary fiber.risk factors for cancer include a person's age. Still others are related to lifestyle factors such as tobacco and alcohol use. This is found in cervical cancer(human papilloma virus). the larger the dose or the longer the exposure. Avoid reusing cooking oil. Other are linked to cancer thus causing factors in the environment. Benzopyrene *Produced when meat and fish are charcoal broiled or smoked (e. *Aflatoxin is found in peanuts and peanut butter. chewing tobacco and snuf. Radiation *Radiation can also cause cancer including ultraviolet rays from sunlight. nitrosamines. Nitrosamines *These are powerful carcinogens use as preservatives in food like tocino. Chemicals and Environmental Agents *Polycyclic hydrocarbons are chemicals found in cigarette smoke. an environmental agent. bacon and hotdog. *Also produced when food is fried in fat that has been reused repeatedly. dietary factors and alcohol consumption. radioactive chemicals and other forms of radiation. *Effect of carcinogenic agents usually depend on the dose or amount of exposure. Avoid eating burned food and eat smoked foods in moderation. lymphoma an nasopharyngeal cancer( epstain barr virus). This maybe a chemical. including cigarettes. RISK FACTORS OF CANCER . Carcinogens *a carcinogen is an agent capable of causing cancer. liver cancer( hepatitis B virus). *Radiation exposure . radiation and viruses. CANCER RISK FACTOR Lung Cancer *Tobacco use.

*Age: 50 – 70 years old. smokeless tobacco) *Excessive alcohol use *Chronic Irritation (e. cigar. Bladder Cancer *Tobacco use (cigarette. fumes *Gender: 4 – 5 times more common in man *Age: more than 60 years. *Family history of cervical cancer. cigar. cigar. pipe. Esophageal Cancer *Tobacco use (cigarette. pipe. pipe smokeless tobacco). cigar. Ill fitting dentures) *Vitamin A deficiency Laryngeal Cancer *Tobacco used (cigarette. *High fat diet . *Second – hand smoke Oral Cancer *Tobacco use (cigarette. Breast Cancer *early menarche or late menopause *Age – changes in hormone levels throughout life. *Chronic bladder inflammation. number of pregnancies. paint. Renal Cancer *Tobacco used (cigarette. cigar. smokeless tobacco): increase risk by 40%. pipe. *Human papillomavirus infection *Chlamydia infection *Diet: low in fruits and vegetables. pipe. smokeless tobacco) *Poor nutrition *Alcohol *Weakened immune system *Occupational exposure to wood dust. and age at menopause. smokeless tobacco) *Occupational exposure: dry solvents. pipes. Cervical Cancer *Tobacco use (cigarette. such as age at first menstration.g. *Obesity *Diet: well cooked meat * Occupational exposure: asbestos organic solvents. smokeless tobacco) *Gender: 3 times more common in man *Alcohol *Diet: low in fruits and vegetables. cigar.

*Drink alcohol beverages in moderation. Uterine endometrial Cancer *Estrogen replacement therapy. CAD tends to occur at an earlier age and with greater severity in persons with diabetes. several factors can increase the chances of developing the disease. *The sooner a cancer is diagnosed and treatment begins. More than half of diabetic persons will die of coronary heart disease. . Colonic Cancer *Personal or family history of polyps. Skin Cancer *Unprotected exposure to strong sunlight. *Avoid / control obesity through proper nutrition and exercise. *Encourage Proper Nutrition. *Race: more common among African – American man than among white man *High fat diet. *Occupational exposure. *Age: > 50 years. *Fair complexion. corn and rice. *Early menarche / late menopause. such as advancing age. *Obesity *Physical inactivity *Some studies have also shown a connection between alcohol consumption and an increase risk of breast cancer. Prostate Cancer *While all man are at risk. Liver Cancer *Certain types of viral hepatitis *Cirrhosis of the liver *Long – term exposure to aflatoxin (carcinogenic substance produced by a fungus that often contaminates peanuts. soybeans. *High fat diet or low fiber diet *History of ulcerative colitis. Diabetes Mellitus Diabetes Mellitus (DM) is one of the leading causes of disability in persons over 45. *Man with a father or brother who has had prostate cancer are more likely to get prostate cancer themselves. KEY AREAS FOR PRIMARY PREVENTION OF CANCER *Smoking Cessation. C. the better the chances of living longer and enjoying a better quality of life. race and diet. wheat.

peripheral insulin resistance and increased hepatic glucose production.g.90 mmol/L) and/or triglyceride level > 250 mg/dl (2. mumps. It may develop into full – blown diabetes. parents or siblings with diabetes) *Overweight (BMI 23 kg/m ) and obesity (BMI > 30 kg/m ) *Sedentary lifestyle *Hypertension *HDL cholesterol < 35 mg/dl (0.28mmol/L) *History of Gestational Diabetes Mellitus (GDM) or delivery of a baby weighing 9 Ibs (4. NIDDM is more common.It also increases the risk of dying of cardiovascular disease like heart attack or stroke among women. occurring in about 90 – 95% of all persons with diabetes. congenital rubella) and chemical toxins (e. ETIOLOGY / CAUSES *Specific cause depends in the type of diabetes. environment. Type 1 DM *Characterized by absolute lack of insulin due to damaged pancreas.. lack of exercise). Description *Diabetes mellitus is not a single disease. Risk Factors of Type 2 DM *Family history of diabetes (i. prone to develop ketosis. poor nutrition. Type 2 DM *Characterized by fasting hyperglycemia despite availability of insulin. Nitrosamines). hyperosmolar hyperglycemic nonketotic coma (HHNK) and hypoglycemia especially in type 1 diabetic. TYPES OF DIABETES Type 1 Diabetes is insulin – dependent diabetes mellitus (IDDM) and Type 2 is noninsulin – dependent diabetes mellitus (NIDDM) – Gestational Diabetes is diabetes that develops during pregnancy. *Usually occurs in older and overweight persons (about 80%). with hyperglycemia present at time of diagnosis. . however it is easier to think of diabetes as an interaction between two factors: Genetic Predisposition (diabetogenic genes) and Environment / Lifestyle (obesity. It is also more preventable because it is associated with obesity and diet. *Genetic.g.e. or may be acquired due to viruses (e.0 Kgs) *Previously identified to have Impaired Glucose Tolerance (IGT) Complications *Acute complications include diabetic ketoacidosis (DKA). and dependent on insulin injections. *Possible causes include impaired insulin secretion. It is genetically and clinically heterogeneous group of metabolic disorders characterized by glucose intolerance.

and pulmonary vascular abnormalities reduce the lung’s capacity for gas exchange. both of which are due to cigarette smoking. peripheral airways obstruction. COMPLICATIONS -Respiratory failure – In advanced COPD. particularly at night or in the early morning. later on. COPD is currently the fourth leading cause of death in the world. chest tightness and coughing. CAUSES AND RISK FACTORS *COPD is usually due to chronic bronchitis and emphysema. or dyspnea. and / or a history of exposure to risk factors for the disease. KEY AREAS FOR PREVENTION AND CONTROL OF DIABETES *Maintain body weight and prevent obesity *Encourage proper nutrition *Promote regular physical activity and exercise *Advise smoking cessation for active smokers and prevent exposure to secondhand smoke. . is the major cardiovascular complication of COPD). The diagnosis is confirmed by spirometry. E. It is an inflammatory disorder of the airways in which many cells and cellular elements play a role. neuropathy and foot ulcers. Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. which develops late in the course of severe COPD). Chronic inflammation causes an associated increase in airway hyper responsiveness that leads to recurrent episodes of wheezing. hypercapnea. DIAGNOSIS *A diagnosis of COPD should be considered in any patient who has symptoms of cough. Bronchial Asthma Asthma is a chronic disease.*Chronic complications cause most of the disability associated with disease. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. producing hypoxemia and. parenchymal destruction. Cigarette smoking is the primary cause of COPD. and more cases and deaths due to COPD can be predicted in the coming decades because of smoking. sputum production. D. These include chronic renal disease (nephropathy). and is associated with the development of cor pulmonale and a poor prognosis. Description *COPD is a disease state characterized by airflow limitation that is not fully reversible. breathlessness. blindness (retinopathy) coronary artery disease and stroke. -Cardiovascular disease – Pulmonary hypertension.

carpets. house dust mite found in pillows. but can exacerbate established asthma. *Genetic Predisposition *Airway hyperresponsiveness *Gender *Race / Ethnicity b.CAUSES AND RISK FACTORS Asthma development has both genetic and environment component. Environmental Factors: *Indoor allergens *Outdoor allergens *Occupational sensitizers *Tobacco smoke *Air pollution *Respiratory infections *Parasitic infections *Socioeconomic factors *Family size *Diet and drugs *Obesity Asthma triggers Triggers are risk factors for asthma exacerbations. Other form of triggers are irritant gases and smoke. RISK FACTORS KEY AREAS FOR PREVENTION *Elevated blood lipid PROMOTE PROPER NUTRITION (Hyperlipidemia) *Limit intake of fatty. certain foods. They induce inflammation and / or provoke acute bronchoconstriction. cold air. These cannot cause asthma to develop initially. inhaled allergens. Host Factors: predispose individuals to protect them from developing asthma. early introduction to cow’s milk may predispose baby to allergens and possible asthma. additives and drugs. KEY AREAS FOR PRIMARY PREVENTION AND EXACERBATION OF ASTHMA *Recognize triggers that exacerbate asthma *Avoid these triggers if possible. particularly smoking *Promote exclusive breastfeeding as long as possible. mattresses. salty and *High intake of fatty foods preservative foods. exercise. respiratory infection. *Inadequate intake of *Increase intake of vegetable and . weather changes. It involves further exposure to causal factors (allergens and occupational agents) that have already sensitized the airways of the person with asthma. a.

. Risk Assessment and Screening Procedures The basis of non-communicable disease (NCD) prevention is the identification of the major common risk factors and their prevention and control. *Start developing healthy habits in children. amount smoked by current and former smokers. characteristics or exposure of an individual. *Avoid high caloric low nutrient value food like junk food. softdrinks. *Integrate physical activity and exercise into regular day -to. *Excessive use of alcohol DISCOURAGE EXCESSIVE DRINKING OF ALCOHOLIC BEVERAGES *Hyperlipidemia. Instant noodles. Mellitus III. Diabetes PROMPT TREATMENT. A “risk factors” refers to any attribute.day activities. *Overweight and obesity. Smoking status should be recorded and updated at regular intervals. In order to monitor trends. *Smoking. houses and closed areas. *Walking is one form of exercise that is possible for including older persons with cardiovascular disease. Every client should be asked about tobacco use. *EARLY DIAGNOSIS AND Hypertension. Assessment of these risk factors and screening for NCDs in individuals and communities important in preventing and controlling future diseases. collect information not only on smoking status but also on age of onset. and quit attempts. both active or PROMOTE SMOKE – FREE passive / second hand ENVIRONMENT *Smoking cessation for active smokers to reduce risk. which increases the likelihood of developing NCD. dietary fiber fruits. ENCOURAGE MORE PHYSICAL *Sedentary lifestyle ACTIVITY AND EXERCISE *Moderate physical activity of atleast 30 minutes for most days. Risk Factor Assessment: A. *Prohibit smoking inside living areas. Cigarette Smoking * Assess smoking status by asking individuals whether they smoke or not.

which are often culture – specific. Comprehensive nutritional assessment involves detailed recall methods (e. 1 serving is a vitamin C rich fruit. Weight – In children and adults. one serving of which is green or yellow leafy vegetables. *Sodium / Salt – How often preserved. regular weighing is the simplest way of knowing if energy balance is being achieved. canned and instant foods are eaten per weak. questionnaires and estimation of nutrients based on food composition tables. These include: *Vegetables – Number of servings of vegetables per day and usual types of vegetables eaten. How much salt is added when cooking food. Nutrition/Diet * Diet is a combination of related behaviors. *Fat – Number of servings of meat and poultry. C. 24 – hours food diary) or extensive food frequency. GUIDELINES FOR ADEQUATE VEGETABLE AND FRUIT INTAKE *Eat 2 – 3 servings of vegetables each day.. The use of weight – for – age or weight – for – height tables will help determines the desirable weight either according to age (children) or height (adults). Body Mass Index (BMI) – BMI is calculated using the following formula: BMI = Weight in kgs / Height in meters. does not indicate fat distribution. BMI correlates closely with total body fat in relation to height and weight. *Fruits – Number of fruits per day. this does not compensable for frame size. However.g.B. One serving of fruit depends on type of fruit. One serving means: Raw vegetables 1 cup Cooked vegetables ½ cup *Eat at least 2 serving of fruit per day. skin of chicken) How often fried foods are eaten How often fast foods / restaurants are visited. the following questions should be ask to determine the contribution of the patient’s nutrition to NCD development. Which part (e.g. and cannot be adjusted for age. At the very least. Overweight/Obesity * Body fat can best be assessed using Body Mass Index (BMI) and waist circumference. .

9 Obese 1 >30.85 (women) = normal WHR *Equal to or greater than 1. Clinical Thresholds: Men <90 cm (35 inches) Women <80 cm(31.0 Overweight 23.9 Healthy weight >23. arms at the sides. If vigorous intensity: 3 or more days of the week.0 – 24. Minimum Recommended amount of physical activity needed to achieve health benefit: Regular Physical Activity: Minimum 30 minutes per day most days of the week preferably daily. Physical Inactivity/Sedentary Lifestyle *Assessment of physical activity includes on type of work. feet together. GUIDELINE Based on Asia – Pacific Obesity Guidelines: BMI Interpretation <18.9 At risk 25.6 – 22. measure and do not compress the skin. If moderate intensity: 5 or more days of the week. WHR = Waist circumference (cm) / Hip circumference (cm) WHR Interpretation: *Less than 1.0 (men) and 0. means of transportation and leisure – time activities like sports and formal exercise.0 (men). less than 0. D. Remember that the central obesity is a significant risk factor to heart disease and stroke.0 Obese 2 Waist Circumference (WC) – This alone is an accurate measure of the amount of visceral fat.85 (women) = android or central obesity. ASSESSING DEGREE OF RISK CO – MORBID CONDITIONS BASED ON BMI AND WC Measuring Waist Circumference Procedure: Subject should be unclothed at the waist. Use non – stretchable.5 Underweight 18.0 – 29. and standing with abdomen relaxed.5 inches) Greater than these value is not normal and the person is at risk even if BMI is normal. . Waist Hip Ratio (WHR) – Another useful measures of obesity is the waist – to – hip ration by dividing the waist circumference at the narrowest point by the hip circumference at the widest point.

only water is allowed. Drinking water is acceptable. For those with family history and symptoms of DM. B. C. Screening Guidelines and Procedures: According to WHO. **Two – hour Blood Sugar Test – Performed two hours after using 75g glucose dissolved in water or after a good meal. Screening for Diabetes Mellitus *The hallmark of diagnosis of diabetes mellitus is the presence of Hyperglycemia. juices. **Fasting Blood Sugar (FBS) – Fasting is defined as no caloric intake for at least eight hours. Screening programs are usually disease specific and thus may be called “hypertension screening” or “diabetes screening. Screening for Cancer *Early detection and prompt treatment are keys to curing cancer. WARNING SIGNS FOR CANCER (CAUTION US) C – Change in bowel or bladder habits . Guideline: At least 30 minutes of cumulative physical activity moderate in intensity for most days of the week. Screening for Hypertension *Hypertension is defined as a sustained systolic BP of 140 mmHg or more and sustained diastolic BP of 90 mmHg or more based on measurements done during at least 2 visits taken at least 1 week apart. milk. Oral Glucose Tolerance Test (OGTT) is not recommended for routine clinical use nor screening purposes.” A. D. Prior to testing. examination or other procedures which can be applied rapidly. Screening for Elevated Cholesterol in the Blood *The recommended screening test for cholesterol is taking a small blood sample and testing for total blood cholesterol. make sure that the person has not eaten any food nor taken any drinks containing calories for at least eight hours. this include no food. E.” The primary goal of screening is to detect a disease in its early stages to be able to treat it and prevent further development of the disease. screening is the “presumptive identification of unrecognized disease or defect by the application of tests. such as driving or operating machinery while intoxicated. Excessive Alcohol Drinking *Assess habitual alcohol intake and risky behavior. advise blood test for serum or plasma glucose.

Early Detection *Pap’s Smear – Primary screening tool for women over age 18 .g. Prostate Cancer a. If with family history of breast cancer. :Sexually active. 4. b. mammogram is suggested for all women between the ages of 35 – 39 and yearly mammogram after age 40. Early Detection *Annual digital rectal exam starting at age 40. b. A – A sore that does not heal U – Unusual bleeding or discharge T – Thickening or lump in the breast or elsewhere I – Indigestion and difficulty swallowing O – Obvious change in wart or mole N – Nagging cough of hoarseness in voice U – Unexplained anemia S – Sudden weight loss SPECIFIC GUIDELINES FOR EARLY DETECTION OF COMMON CANCERS 1. Warning Signs includes skin changes (Edema. de orange” – orange peal like skin. Post – Coital bleeding) b. . *Annual stool blood starting at age 50. rectal bleeding. pressure on the rectum. abdominal pai. *Annual inspection of colon. :Have multiple partners :Commercial sex workers. mammogram should be started at age 30. Warning Signs include change in stool. Abnormal Contours (Variation in size and shape of breasts). Warning Signs *Symptoms of urethral outflow obstruction: . Put in mind that BSE does not take the place of mammogram or vice versa. Colon . Breast Cancer a. The best time to do BSE is one week after menstrual period while taking a shower. facing the mirror standing up or lying down. Cervical Cancer a.should be done in between menses (two weeks after menses). *Breast mammography – Baseline. Dimpling or inflammation “peau. Nipple abnormalities (Retraction. 3.Rectal Cancer a. These include those who are.for persons at high risk. Rashes or Discharge). Warning Signs includes often asymptomatic and Abnormal vaginal bleeding (e.. it should be done yearly. 2. Ulceration. Prominent venous pattern). Early Detection *Breast Self-Examination – cheapest and most affordable screening procedure for breast cancer.

or members of the household during home visits. Early Detection *Chest X-ray every six months for patients who have history of smoking two packs per day. confirms diagnosis. Allergic rhinitis or atopy. dull intermittent. Early Warning Signs are those with a long history of smoking and / or smoking two or more packs or cigarette per day. *A family history of Asthma. chest discomfort). Every client not only the patient seeking consultation. Temporal waxing and waning and /or nocturnal occurrence of symptoms. Early Detection *Digital Rectal Exam for mean *Prostate Specific Antigen (PSA) determination a blood test. . 3. One or a combination of cardinal symptoms ( dyspnea. Screening for Asthma *Suspect Asthma in Persons with the following: 1. should be assessed for the presence of risk factors and early signs of NCD. history of weight loss. Educate people on how to prevent the NCD risk factors through a healthier diet. 2. localized pain. Screening for COPD *Characteristics and symptoms: -cough -sputum production -dyspnea upon exertion *SPIROMETRY – done to determine degree of obstruction. A history of any of the following: *Symptoms triggered by exogenous factors. 2. E. This includes the mother bringing her newborn infant for immunization. 3. cough. b. engaging in moderate physical activity and not smoking. 5. Lung Cancer a. Educate as many people and in every opportunity on the warning signs of NCDs and other risk. F. -Urinary frequency -Nocturia -Decrease in stream -Post – void dribbling b. *Sputum cystology. the grandmother or aunt bringing a sick child for consultation. ROLE OF PUBLIC HEALTH NURSE IN RISK ASSESSMENT AND SCREENING 1. chronic cough or nagging cough. wheezing. *An improvement of symptoms with bronchodilator use.

UNDERSTANDING PHYSICAL ACTIVITY AND EXERCISES *Physical Activity – is something done at home. Walking or jogging for three kilometers each day before or after work is a structured exercise. V. measurement of height and weight. and joints. like instead of climbing the stairs one takes the elevator. or instead of walking around while using the phone one opts to sit down. even the barangay health workers and barangay nutrition scholars on performing risk factor assessment. *Helps older adults become stronger and better able to move about without falling or becoming excessively fatigued. *Exercise – “is a planned. *Lowers the risk of developing high blood pressure. It is also what is done outside the house. like sweeping or raking leaves in the yard or gardening. She has the responsibility of increasing their knowledge and skills needed to engage in physical activities and exercise as well as motivating them enough to start being physically active and to encourage them to main. *Helps people achieve and maintain a healthy body weight. 4. sweeping the floor. and cleaning the house. or walking to the neighborhood store or jeepney terminal instead of riding the tricycle. Promoting Physical Activity and Exercise Health Benefits of Regular Physical Activity *Reduces the risk of dying from coronary heart disease (CHD). It is something that one might be avoiding doing in the office. ROLE OF PUBLIC HEALTH NURSE *The public health nurse play a big role in motivating individuals and groups to prevent living sedentary lifestyles that increase their risk for NCD. It will be good to periodically check their skills like BP taking. *Reduces the risk of developing colon cancer. Train other health workers. *Lowers the risk of developing non – insulin – dependent (Type 2) diabetes mellitus. like washing the dishes.” It involves energy expenditure and planning. *Reduces the risk of having a second heart attack in people who have already experienced one heart attack. using BMI table. Promoting Proper Nutrition ????? . muscles. *Helps reduce blood pressure in people who already have hypertension. *Lowers both total blood cholesterol and triglycerides and many increase high – density lipoprotein (HDL or the “good” cholesterol). *Reduces feeling of depression and anxiety. structured and repetitive movement done to improve or maintain one or more components of physical fitness. Another example is attending a regular aerobics class 3 times a week is structured exercise. *Promotes psychological well –being and reduces feelings of stress *Helps build and maintain healthy bones. IV.

or being open to experiences. Stressful situations can trigger different types of responses. stress is not only inevitable and essential. Some may be physical. not wordly. But one can learn ways to handle the stress of daily life efficiently. possessing the nature of qualities of a spirit. relating to matters of sacred nature. stress management is largely a learnable skill. day to day living confronts even the most well managed life with continuous stream of potentially stressful experiences. And in between. It is very effective method of relaxation. SPIRITUALITY -is a state or quality of being spiritual. Thus. However. Recent research demonstrates that 90% of illness is stress – related. Everybody can learn effectively handle stress even when pressures persist. Mediation – is a way of reaching the world beyond the senses. The idea of mediation is to focus one’s thoughts on one relaxing thing for a sustained period of time. Promoting a Smoke-Free Environment ????? VII. . It increases sensitivity to the inner self and relationship with the world around. it is important to remain attentive to negative stress symptoms and to learn to identify the situations that evoke them. some may be psychological and some maybe behavioral. helps muscle relax -Gives the body time to eliminate lactic acid and other waste products -Eliminates stressful thoughts -Helps with clear thinking -Helps with focus and concentration -Reduces stress headaches 2. It is pure. but also normal part of life. and to manage reactions to stress and minimize its negative impact. *People respond to stressful situations in different ways. STRESS MANAGEMENT TECHNIQUES 12 Stress Management Techniques 1. ranging from the negative extreme of actual physical danger to exhilaration of falling in love or achieving some long desired success. normal does not necessarily mean healthy. ecclesiastica. These will vary between individuals. getting in touch with one’s feelings. the risk for serious health problems is greater because stress can exhaust the immune system. When these symptoms persist.VI. holy. Mediation can have the following effects: -Lowers blood pressure -Slows breathing. *Fortunately. Promoting Stress Management *Stress is an everyday fact of life and everyone experience stress from time to time. Stress is any change that one must adapt to. However. It is not possible to live without stress. SELF – AWARENESS -it means knowing one’s self.

It also gives the body the exercise it badly needs. and no special skills and can be done anywhere and anytime.3. perhaps by comforting them. STRETCHING -are simple movements performed at a rhythmical and slow pace executed at the start of a demanding activity loosen muscles. unknotting tensed and aching muscles. it improves the functioning of many of the body’s systems. It requires no special equipment. SOCIALS -a man is a social being who exist in relationships with his physical environment and in relationship with people and society. Time is a tool that can be drawn upon to help accomplish results. a break or recharging of “battery” in order to improve productivity. It relieves stress tension and one wakes up invigorated and set for the next activity. SOUNDS AND SONGS . short rest. It is a natural reaction to reach out and touch whether to feel the shape or texture of something or to respond to another person. no special clothes. Performance of an individual scored high when siesta is observed with a 15 – 30 minutes nap. A resource is something that lies ready for use. On the contrary without socialization life will be boring and empty. Massage helps to soothe away stress. lubricate joints. But massage is also invigorating. happy and worthy. SIESTA -it means taking a nap. leaving with a feeling of renewed energy. or something that can be drawn upon for aid. an assistant in solving problems. promotes healing and tones muscles. 6. Through socialization life becomes meaningful. It had been proven thru a study that siesta invigorates one’s body. Managing time really refers to managing one’s self in such a way as to optimize the time available in order to achieve gratifying results. SENSATION TECHNIQUE -The sense of touch is a powerful and highly sensitive forms of communication. an aid that can take care of a need. SPORTS -Engaging in sports and in physical activities like these have been known to relieve stress. Socialization plays a very important role in the development of intrapersonal relationships. relieving headaches and helping sleep problems. 4. 7. 8. It helps relax the mind and body muscles. 5. SCHEDULING: TIME MANAGEMENT -time is a resource. 9. and increase body’s oxygen supply.

Programs for the Prevention and Control of other non- communicable diseases -The following are some of the programs that addresses other non- communicable diseases particularly blindness. SMILE . It is the way they obtain understanding. National Prevention of Blindness Program VISION 2020: The Right to Sight is a global initiative to eliminate avoidable blindness by the year 2020. as well as information about stress management. or mental. Communication is the means by which people make their needs known. It is also considered one of the ingredients or factors that motivates and encourages people to work harder and improve their level of performance in anything they do. Talking to someone when feeling overwhelmed or unable to deal with stress or feeling “helpless” is often the best way of coping with stress. It also a way to relieve tension. renal disease and programs for disables persons. VIII. A. It provides a medium of expression for thoughts and emotions. Music adds to the quality of life of a person. Smile is an expression of pleasure. 10. physical. reinforcement and assistance from others.It has been observed that people who always “smile” are healthy people. mental disorders. Communication is aimed at a goal. 12. Interpersonal conflicts generally are resolved most effectively by open communications that accept the feelings of the persons involved and leas to better resolution of problems. SPEAK TO ME -the world is designed as a mutual support system in which all things relate to each other. The program is a partnership between the World Health Organization (WHO) and the International Agency for Prevention of . STRESS DEBRIEFING -Critical Incident is any usually strong or overwhelming emotional reactions which have potential to interfere with work during the event or thereafter in the majority of those exposed. -Critical Incident Stress Debriefing means to assist crisis workers/ team member to deal positively with the emotional impact of a severe event/ disaster and to provide education about current and anticipated stress responses. -music plays an important part in the everyday life of a person. It has been found out through research that it relieves all kinds of stresses. so it must remain open until the goal is reached. 11.

06% in the population). partners and stake holders commit to: 1. Objectives: *General Objective no. Goal: -Reduce the prevalence of avoidable blindness in the Philippines through the provision of quality eye care.20% by the year 2010.43%. *General Objective no. Empower communities to take proactive roles in the promotion of eye health and prevention of blindness. and affordable to everyone. Provide access to quality eye care services for all. school clinics and health workers. 3. 1: Increase Cataract Surgical Rate from 730 to 2. contact lenses or surgery.2: Reduce visual impairment due to refractive errors by 10% by the year 2010.500 by the year 2010. . as well as improving the delivery of cataract services. INTERVENTIONS BY EYE DISORDER: 1. *General Objective no. Screening of children for any sign of visual impairment can be done by pediatricians. Vision 2020 Philippines envisions to eliminate avoidable blindness though three strategies: *Ensuring that cataract surgery is available. Cataract The pacification of the normally clear lens of the eye. 3. Errors of Refraction It is the most common cause of visual impairment in the country (prevalence is 2. Childhood Blindness The prevalence of blindness among children (up to age 19) is 0. 4.06% while the prevalence of visual impairment in the same age group is 0.Blindness (IAPB). Work towards poverty alleviation through preservation and restoration of sight to indigent Filipinos. Strengthen partnership among and with stakeholders to eliminate avoidable blindness in the Philippines. VISION/ MISSION/ GOALS/ OBJECTIVS Vision All Filipinos enjoy the right to sight be year 2020. is the most common cause of blindness worldwide.43% to 0. 2. 2. Mission The Department of Health. accessible. It is corrected either with spectacle glasses. which is the umbrella organization for eye care professional groups and non – governmental organizations (NGOs) involved in eye care. Local Health Units. Interventions will therefore consist of increasing awareness about cataract and cataract surgery.3: Reduce the prevalence of visual disability in children from 0.

Stigma is a mark of shame. Hidden Burden of Mental Illness – Refers to the stigma and violations of human rights. and special population such as military. disgrace or disapproval that results in a person being shunned or rejected by others. Mental Disorder Objectives: *Promotion of mental health and prevention of mental illness across the lifespan and across sectors (children and adolescents. . elderly. *Pooling of resources of government and non – government agencies to address the problem of cataract. increasing social problems and unrest inherited from the existing burden.*Reduction of the prevalence of cataract. refugees. *To identify programs that could address psychosocial consequences and mental health issues of persons with extreme life experiences. Future Burden – Refers to the burden in the future resulting from the aging of the population. blinding error or refraction. *To categorize / prioritize the extreme life experiences which may be the concern of mental health. Objectives: *To increase awareness among the population on mental health and psychosocial issues. Mental Health Sub – Programs A. *To identify situations which may be extreme life experiences. *To ensure access of preventive and promotive mental health services. and Vitamin A deficiency. Wellness of Daily Living The process of attaining and maintaining mental – well – being across the life cycle through the promotion of healthy life style with emphasis on coping with psychosocial issues. adults. FOUR FACETS AS A PUBLIC HEALTH BURDEN: Defined Burden – Refers to the burden currently affecting persons with mental disorders and is measured in terms of prevalence and other indicators such as the quality of life indicators and disability adjusted life years (DALY). persons with disabilities). Undefined Burden – The portion of the burden relating to the impact of mental health problems to persons other than the individual directly affected. OFWs. Extreme Life Experience An extreme life experience is one that is out the ordinary and which threatens personal equilibrium. Mental Health and Mental Disorders -World Health Organization (WHO) defines mental health as a stage of well – being where a person can realize his or her own abilities to cope with normal stresses of life and work productively. blinding error of refraction and vitamin A deficiency thru enhanced services. B. C. B. Objectives: *To differentiate between critical incident and extreme life experiences.

*Be aware of the potential causes of breakdown and when necessary take some possible prevention action. Rehabilitation *Initiate patient participation in occupational activities best suited to patient’s capabilities. Workplace. Substance Abuse and Military Other Forms of Addiction Objectives: *To provide implementers for advocacy accurate. *Help patient assess his / her capacities and his / her handicaps in working towards a solution of his / her problem. education. . *Recognized pathological deviations from normal in terms of acting. Community. long standing physical illness. capacities and interest. psychiatric emergency management and other basic nursing care.being. *Help the family to understand and accept the patient’s health status and behavior so that all its members may offer as much support in the readjustments to home and community. *Utilize opportunities in his / her everyday contacts with other members of the community to extend the general knowledge on mental hygiene. *Encourage feeling of achievement be setting health goals that patients can attain. divorce or abandonment of children. *Encouraged patients to express his / her anxieties so that fears and misconceptions can be cleared up. the desired and undesirable effect of the tranquilizers. and feeling and make early referral so that diagnosis and treatment could be done early. Industry) through existing DOH programs and responsible agencies. *To promote protective factors against the development of substance abuse/ addition in the following key settings (Family. etc. 3. *To rationalize and enhance the drug program to different key settings as a form of deterring factor. experience and training. In Prevention and Control *Recognize mental health hazards and stress situations as unemployment. D. Health Care Setting. School. *Help people in the community understand basic emotional needs and the factors that promote mental well . Nursing Responsibilities and Functions 1. 2. all of which may make heavy demands on the emotional resources of the persons concerned. *Teach parents the importance of providing emotional support to their children during critical periods in their lives as first day in school graduation. technical information about the psychosocial effects of drugs. vices. thinking. *Impairment information and guidance about the treatment scheme of the patients. In Mental Health Promotion *Participate in the promotion of mental health among families and the community.

both local and national through: *Conduct training on nephrology. *Have a friend in whom you can confide and ventilate your problems. substance abuse and excessive alcohol. recreation). curative and rehabilitative measures. *Develop and sustain solid spiritual values. *Avoid smoking. *Internal and external quality assurance. *Advice the family about the importance of regular follow – up at the clinic. 6. Renal Disease Control Program It is started as a Department of Health (DOH) – Preventive Nephrology Project (PNP) in June 1994. 5. *Don’t live in the past and avoid worrying about the future. for use of medical practitioners and other related professions. THE GOALS OF THE PROGRAM ARE AS FOLLOWS: 1. 3. funding assistance and implementation. equipment. sleep. C. To formulate guidelines and protocols on the proper implementation of the different levels of prevention and care of renal diseases. To assist in the development of dialysis and transplant centers / units in strategic locations all over the Philippines. and related specialties to enhance the expertise of medical practitioners and related professions. *Live – one day at a time. To give recommendations to lawmakers for health for policy development. 2. To establish an efficient and effective networking system with other programs and agencies. To conduct researches / studies that will establish the true incidence of existing renal problems and its sequel in the country. In Research and Epidemiology *Participate actively in epidemiology survey to be aware of the size and extent of mental health problems of the community and organize a program for better preventive. To assist the existing health facilities. urology. IMPORTANT INFORMATION ABOUT KIDNEY DISEASES AND ORGAN TRANSPLANTATION . mental and emotional stress. *Have a realistic goal in life. exercise. *Facilitation of sourcing out of funds for the development and upgrading of manpower. POINTERS FOR HAVING MENTAL HEALTH *Maintain good physical health *Undergo annual medical examination or more often as needed *Develop and maintain a wholesome lifestyle (balanced die. *Encourage and initiate patients to partake in activities of CIVIC organization in the community through the cooperation of patient’s family. 4. both GOs and NGOs. adequate rest. etc. *Make regular home visits to observe patients conditions during conversation and follow – up of medication. 4. with the National Kidney and Transplant Institute(NKTI) as the main implementing agency. *Avoid excessive physical.

Community-based Rehabilitation Program ??? COMMUNICABLE DISEASE PREVENTION AND CONTROL COMMUNICABLE DISEASE *It is an illness caused by an infectious agent or its toxic products that are transmitted directly or indirectly to a well person through an agent. • Disinfectant -chemical used on non living objects • Antiseptic – chemical used on living things. sneezes • Pathogens are transferred by virtue of gravity . vector.Kidney diseases rank as the number 10 killer in the Philippines. TWO TYPES INFECTIOUS DISEASE *Not easily transmitted by ordinary contact but require a direct inoculation through a break in the previously intact skin or mucous membrane CONTAGIOUS DISEASE *Easily transmitted from one person to another through direct or indirect means TERMINOLOGIES • DISINFECTION –destruction of pathogenic microorganism outside the body by directly applying physical or chemical means  Concurrent – method of disinfection done immediately after the infected individual discharges infectious material/secretions. • Bactericidal – kills microorganism • Sterilization – complete destruction of all microorganism General Principles • Pathogens move through spaces or air current • Pathogens are transferred from one surface to another whenever objects touch • Hand washing removes microorganism • Pathogens are released into the air on droplet nuclei when person speaks. This method of disinfection is when the patient is still the source of infection  Terminal – applied when the patient is no longer the source of infection. causing death to about 7. breaths. Kidney Diseases • Chronic glomerulonephritis • Diabetic kidney disease • Hypertensive Kidney Disease • Chronic and repeated kidney infection(Pyelonephritis) • These often lead to End-Stage Renal • Disease (ESRD) due to the inability to recognize them in the early stages. or inanimate object.000 Filipinos every year. D.

• EPIDEMIC – diseases that occur in a greater number than what is expected in a specific area over a specific time.disease that occur occasionally and irregularly with no specific pattern • ENDEMIC – those that are present in a population or community at times. OF MICROORGANISM .“microbial antagonism principle” • SECOND – inflammatory response . Epidemiological triad: o Agent o Host o Environment Classification according to incidence: • SPORADIC . Influenza • Most viruses resist antiviral drugs • Opportunistic organisms can cause infection in immunocompromised patients • Most people have not received vaccinations • Increased air travel can cause the spread of virulent microorganism to heavily populated area in hours • Use of immunosupressive drugs and invasive procedures increase the risk of infection • Problems with the body’s lines of defense Three Lines of Defense • FIRST LINE OF DEFENSE o MECHANICAL BARRIERS o CHEMICAL BARRIERS o BODY’S OWN POP. • PANDEMIC – is an epidemic that affects several countries or continents Causes of INFECTION • Some bacteria develop resistance to antibiotics • Some microbes have so many strains that a single vaccine can’t protect against all of them ex. • Pathogens move slowly on dry surface but very quickly through moisture INFECTION • invasion and multiplication of microorganisms on the tissues of the host resulting to signs and symptoms as well as immunologic response • injures the patient either by: o competing with the host’s metabolism o cellular damage produced by the microbes intracellular multiplication Factors of severity of infection o disease producing ability o the number of invading microorganism o The strength of the host’s defence and some other factors.

transplant) • Treatment with certain antimicrobials (prone to fungal infection).thru contaminated object o Droplet spread . steroids. environmental factors • General condition. immunosuppresive drugs etc. sex.person to person • Indirect . MRSA.contact with respiratory secretions thru cough. leukemia. • Use of indwelling lines and implanted foreign bodies has increased. INFECTION CONTROL MEASURES . Microbes can travel up to 3 feet. o Phagocytic cells and WBC to destroy invading microorganism manifesting the cardinal signs • THIRD – immune response . talking. emotional and mental state • Immune system • Underlying disease ( diabetes mellitus.Natural/Acquired: active/passive RISK FACTORS • Age. • Airborne Transmission • Vector Borne Transmission • Vehicle Borne Transmission Emerging problems in infectious diseases • Developing resistance to antibiotics eg: anti tb drugs. Mode of Transmission Contact transmission • Direct contact . fitness. and genes • Nutritional status. sneezing. VRE • Increasing numbers of immunosuppressed patients.

• Eating. Patient with infectious respiratory diseases should wear mask. gloves etc. WORK PRACTICE CONTROL • Handwashing o Before and after using gloves.MRSA and infectious pts. smoking.- handwashing. applying cosmetics or handling contact lenses are prohibited in work areas.diluted bleach)  Ex. o Place in designated area. secretions or excretions. gloves and gowns and (-) pressure if possible • Contact isolation – prevent spread by close or direct contact • Respiratory isolation – prevent transmission thru air. • TB isolation – for (+) TB or CXR suggesting active PTB. • Environmental disinfection – Clean surfaces with disnfectant 70% alcohol. recapped. after hand contact with patients. • Protective Equipment shall be removed immediately upon leaving the work area. mask.Wear gown during procedures which are likely to generate splashes of blood or sprays of blood and body fluids. . •UNIVERSAL PRECAUTION – All blood. • Enteric Isolation – direct contact with feces • Drainage/secretion precaution. patient’s blood and other potentially infected materials. • Eye protection (goggles) – wear it to prevent splashes. • Gowning . or spraying. blood products and secretions from patients are considered as infected. drinking. Control Measures • Masking – Wear mask if needed. use of mask. • Handwashing – Practice it with soap and water. • All procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing. use of single room. Change gloves and wash hands every after each patient. • Foods and drinks shall not be stored in refrigerators.prevents infection thru contact with materials or drainage from infected person. Like apron. freezers where blood or other infectious materials are stored. broken. 7 Categories Recommended in isolation • Strict isolation – prevent spread of infection from patient to patient/staff. • Gloving – Wear gloves for all direct contact with patients. • Used needles and sharps shall not be bent. infectous materials must be discarded. final clean. Used needles must not be removed from disposable syringes. Normal clean – clean the room post discharge. ISOLATION PRECAUTIONS • Separation of patients with communicable diseases from others so as to reduce or prevent transmission of infectious agents.

Environmental Sanitation o Water Supply Sanitation Program – DOH thru EHS (Environmental Health Services) o Policies on Food Sanitation Program o Policies on Hospital Waste Management • The Community Health Nurse is in the best position to do health education such as o > development of materials for environmental sanitation o > providing group counselling. nasal discharge. peritoneal fluid etc. Koch’s. o Natural – passive (from placenta). holding community assemblies and conferences. Use water only when cleaning fridge/ref. saliva . to district hospital. pleural fluid. active (vaccine. active (thru immunization & recovery from diseases) o Artificial – passive (antitoxins). o > create programs for sanitation o > be a role model Immunization – introduction of specific antibody to produce immunity to certain disease. blood. Consumption. disposal of feces • Importance of seeking medical advice for any health problem • Preventing contamination of food and water. (Bloods. Immigrant’s disease • Etiologic agent: – Mycobacterium tuberculosis • Incubation period: 2 – 10 wks. • AKA: Phthisis. • Period of communicability: all throughout the life if not treated • MOT: Droplet • Sources of infection – sputum. Disease Acquired Thru the Respiratory tract TUBERCULOSIS • Chronic respiratory disease affecting the lungs characterized by formation of tubercles in the tissues---> caseation –--> necrosis ---> calcification. to regional store. • COLD CHAIN SYSTEM – maintenance of correct temperature of vaccines. • Universal Precaution – for handling blood and body fluids. starting from the manufacturer. toxoid) Maintain vaccine potency by preventing: o Heat and sunlight o Freezing • Antiseptic/ disinfectants/ detergents lessen the potency of vaccine.) PREVENTION Health Education – educate the family about • Immunization • MOT • Environmental sanitation – breeding places of mosquito. to the health center to the immunizing staff and to the client.

C. Sputum AFB • Primary Complex o Minimal manifestations o Lymphadenopathy DX • Tuberculin testing • CXR • Sputum AFB . Active – (+) CXR.Classification 1. Inactive – asymptomatic. Moderately advanced – one or both lungs are involved. weight loss. Minimal – slight lesion confined to small part of the lung B. easy fatigability • Adult TB o afternoon rise in temperature o night sweats o weight loss o cough dry to productive o Hemoptysis o sputum AFB (+) • Milliary TB . S/S are present. with exogenous TB like Pott’s disease • Primary Infection o Asymptomatic o No manifestations even at CXR.very ill. no cavity on chest X ray 2. cough. anorexia. children swallow phlegm. volume affected should not extend to one lobe. Far advance – more extensive than B MANIFESTATIONS • Primary Complex: TB in children: non contagious. sputum is (-). cavity not more than 4 cm. sputum (+) smear Classification 0-5 A. fever.

with or without meningitis o Waterhouse Friederichsen Syndrome Diagnostic exams: o Lumbar tap. low glucose Manifestations: o Sudden onset of fever x 24h o Petechiae. C MENINGITIS • Inflammation of the meninges usually some combination of headache. Purpuric rashes o Meningeal irritation  Stiff neck  Opisthotonus  Kernig’s sign . stiff neck. increase CHON. A.high WBC and CHON.Prevention • BCG • Avoid overcrowding • Improve nutritional status TX • DOTS • 6 months of RIPE • Respiratory isolation. and delirium • Meningococcemia: cerebrospinal fever o Etiologic agent: Neisseria meningitidis o Incubation: 2-10 days o MOT: droplet • Acute meningococcemia . • Take medicines religiously – prevent resistance • Stop smoking • Plenty of rest • Nutritious and balance meals. fever. CSF . Vit.

dry metallic cough Complications o Due to TOXEMIA  Toxic endocarditis  Neuritis  Toxic nephritis o Due to Intercurrent Infection . leathery and spider web like structure that bleeds when detached Types of Respiratory Diptheria • NASAL o serous to serosanginous purulent discharge o Pseudomebrane on septum o Dryness/ excoriation on the upper lip and nares • PHARYNGEAL o pharyngeal pseudomembrane o bull neck ( cervical adenitis) o Difficulty swallowing • LARYNGEAL o Sorethroat. pseudomembrane o Barking.  Brudzinski sign o ALOC (Altered level of consciousness) o S/S of Increase ICP Nursing Mgt:  Administer prophylactic antibiotics: Rifampicin . fomites. eyes Manifestation  PSEUDOMEMBRANE . skin. SAFETY  Maintain seizure precaution  Respiratory precaution  Handwashing  Suction secretions DIPTHERIA  Acute contagious disease characterized by generalized toxemia coming from localized inflammatory process  Etiologic agent: Corynebacterium Diptheria (Klebs loffer bacillus)  Incubation period: 2-5 days  Period of communicability: variable. ave:2-4 weeks  MOT – Droplet.grayish white. direct or intimate contact. discharge from nose.drug of choice  Aquaeous Pen  Mannitol  Dexamethasone  Priority: AIRWAY. smooth.

adequate nutrition. Penicillin. rich in Vit C • Ice collar 4. fractional dose 3.culture of specimen form beneath membrane • Virulence test • SHICK’s TEST: test for susceptibility to diptheria • MOLONEY’s TEST: test for hypersensitivity to diphtheria MANAGEMENT 1. Erythromycin 2. Diptheria Antitoxin – after – skin test if (+).soft food. Supportive • O2. Isolation till 3 NEGATIVE cultures Prevention  DPT PERTUSSIS (whooping cough) • Repeated attacks of spasmodic coughing with series of explosive expirations ending in long drawn force inspiration • Etiologic agent: Bordetella pertusis or Haemiphilus pertussis • Incubation period: 7-14 days • Period of communicability: 7 days post exposure to 3 wks post disease onset • MOT – Droplet Manifestation . Bronchopneumonia Respiratory failure DX • Nose and throat swabs . if laryngeal obstruction – tracheostomy • CBR for 2 weeks • Increase fluids.

nose and throat Pathognomonic sign: Koplik’s spots . diminish in severity. • Catarrhal – slight fever in PM. Most communicable during the height of rash. 7-day measles • Etiologic agent: Morbilli Paramyxoviridae virus • Incubation period: 10-12 days • Period of communicability: 3 days before and 5 days after the appearance of rashes. 5-10 successive forceful coughing ending with inspiratory whoop. smoke • Isolation • Gentle aspiration of secretions MEASLES • Acute viral disease with prodromal fever. involuntary micturition and defecation. coryza. avoid dust. cough and Koplik’s spots • AKA: Rubeola. cyanosis • Convalescent – 4th. umbilical hernia • Convulsions (brain damage .6th week. frequency Complications: • Otitis media • Acute bronchopneumonia • Atelectasis or emphysema • Rectal prolapse. teary eyes.drug of choice • Prone position during attack • Abdominal binder • Adequate ventilation. 1-2 weeks • Paroxysmal – Spasmodic stage. colds.asphyxia. o rapid cough 5-10x in one inspiration ending a high pitched whoop. choking spells. conjunctivitis. • MOT: Airborne • Sources of infection – secretions from eyes. hemorrhage) Dx: • Elevated WBC • Nasopharyngeal swab Nursing Management • Prevention: o DPT • Parenteral fluids • Erythromycin . watery nasal discharge. nocturnal coughing.

Cough. Supportive – O2.Manifestations • 1.Isoprenosine • 2. Conjunctivitis o Koplik’s Spots. photophobia • 2.contact/respiratory • TSB . defer if with fever. otitis media. illness • Isolation . IVF • Complications – bronchopneumonia. Antibiotics – if with complications • 3. Skin care – daily cleansing wash • Oral and nasal care • Plenty of fluids . encephalitis Nursing Management • Preventive – measles vaccine at 9 months. Eruptive stage o Maculopapular rashes o Rash is fully developed by 2nd day o High grade fever –on and off o Anorexia. MMR 15 months and then 11-12.Pre eruptive stage / Prodromal (10-11 days) o Coryza. whitish spot at the inner cheek o Fever. Antiviral drugs. Convalescence (7-10 days) o Desquamation of the skin Diagnostics • Nose and throat swab Treatment • 1. throat is sore • 3.

Prodromal – low grade fever. Isolation. nasal ceretions. lymph node involvement on 3rd to 5th day • 2. 4% . mental retardation. Bed rest 2. Rubella syndrome – microcephaly. headache . indirect o Direct contact thru shedding vesicles. deaf mutism. Encourage fluid 4. arms and trunk o lasts1-5 days with no pigmentation or desquamation o muscle pain • Treatment o symptomatic treatment Complications • 1. transplacental in congenital Manifestations • 1.due to photophobia GERMAN MEASLES • Mild viral illness caused by rubella virus. 3-Day Measles • Incubation period– from exposure to rash 14 -21d • Period of communicability – one week before and and 4 days after onset of rashes. congenital heart disease RISK for congenital malformation • 1. direct. Pregnant women should avoid exposure to rubella patients • Administration of Immune serum globulin one week after exposure to rubella.second/third trimester Nursing Management 1. spreading to the neck. . neuritis • 2. • MMR. Worst when rash is at it’s peak. colds. • 2. rash on face. Encephalitis. CHICKEN POX • Acute and highly contagious viral disease characterized by vesicular eruptions on the skin • Infectious agent – Herpes zoster virus or Varicella zoster • Incubation period – 10 -21 days • Period of communicability: 1 day before eruption up to 5 days after the appearance of the last crop • MOT: airborne. • MOT: Droplet. Like measles tx PREVENTION. • Avoid direct glare of the sun. • AKA: Rubella. 100% when maternal infection happens on first trimester of pregnancy. Room darkened – photophobia 3. malaise. Eruptive – FORSCHEIMER’S SPOTS: pinkish rash on soft palate.

sepsis Treatment • Zovirax 500mg tablet 1 tab BID X 7 days • Acyclovir • Oral antihistamine • Calamine lotion • Antipyretics NURSING MANAGEMENT • Strict isolation until all vesicles scabs disappear • Hygiene of patient • Cut finger nails short • Baking soda . • Pruritis Stages of skin affectations o Macule – flat o Papule – elevated above the skin diameter about 3 cm o Vesicle o Pustule o Crust – scab . drying on the skin Complications o pneumonia.o Indirect thru linens or fomites Manifestations • Pre eruptive: Mild fever and malaise • Eruptive: rash starts from trunk • Lesions .effective if given 96h post exposure Herpes Zoster • Acute inflammatory disease known to be caused by herpes virus varicellae or VZ virus • Infection of the sensory nerve charac by extremely painful infection along the sensory nerve pathway • Occurs as reinfection of VZ virus • MOT o Direct o Indirect – airborne • Incubation: 1-2 weeks .red papules then becomes milky and pus like within 4 days.pruritus • PREVENTION: Live attenuated varicella vaccine • VZIG .

Diagnostic procedure
o Hx of chickenpox
o Pain and burning sensation over lesions of vesicles along nerve
pathway
o Smear of vesicle fluid- giant cells
o Viral cultures of vesicle fluid
o Electron microscopy
o Giemsa-stained scraping – multinucleate giant epithelial cells
S/S
o Burning, itching, pain then erythematous patches followed by crops
of vesicles
o Eruptions are unilateral
o Lesions may last 1-2 weeks
o Fever, regional lymphadenopathy
o Paralysis of cranial nerve, vesicles at external auditory canal
o Paralytic ileus, bladder paralysis, encephalitis

Complications
o Opthalmia herpes – blindness because of damage of gasserian
ganglion
o Geniculate herpes – deafness because of infection of 7th CN (AKA:
Ramsay Hunt Syndrome)

Nursing Intervention
o Compress of NSS or alluminum acetate over lesions
o Analgesics, sedatives – weeks to mos
o Steroids
o Keep blister covered with sterile powder esp after break
o Prevent bacterial invasion
o Encourage proper disposal of secretions and usage of gown and
mask

MUMPS

• Acute viral disease manifested by swelling of one or both of the parotid
glands, with occasional involvement of other glandular
structures,particularly testes in male.
• Etiologic agent – filterable virus of paramyxovirus group usually found in
saliva of infected person.
• AKA: Epidemic/ infectious parotitis
• Incubation period: 14 -25 days.
• Period of communicability – 6d before and 9d post onset of parotid gland
swelling.
o 48 hrs immediately preceding the onset of swelling is the highest
communicability.
MOT: direct, indirect - droplet, airborne

CLINICAL MANIFESTATIONS
1. Sudden headache, earache, loss of appetite
2. Swelling of the parotid gland
3. Pain is related to extent of the swelling of the gland which reaches its peak in 2
days and continues for 7-10 days.
4. Fever may reach 40 C during acute stage,
5. One gland may be affected first and 2 days later the other side is involved

COMPLICATIONS
1. Orchitis – testes are swollen and tender to palpation.
2. Oophoritis- pain and tendeness of the abdomen
3. Mastitis
4. Deafness may happen
5. Meningo-encephalitis -possible

DIAGNOSTIC PROCEDURES
1. Viral culture
2. WBC Count

PREVENTION: MMR Vaccine

TREATMENT MODALITIES
1. Antiviral drugs
2. NSAIDS - Acetaminophen
Nursing Interventions
o Symptomatic
o Application of warm/ cold compress
o Oral care, warm salt water gargle
o Diet – semi solid, soft food easy to chew
 Acid foods/fluids – fruit juices may increase discomfort

Diseases Acquired thru GIT
• Diseases caused by Bacteria
o Typhoid Fever
o Cholera
o Dysentery
• Diseases caused by Virus
o Poliomyelitis
o Infectious Hepatitis A
• Diseases caused by Parasites
o Amoebiasis
o Ascariasis

TYPHOID FEVER
• Infection of the GIT affecting the lymphoid tissues(ulceration of Peyer’s
patches) of the small intestine
• Etiologic Agent: Salmonella typhosa and typhi, Typhoid bacillus
• Incubation period: 1-2 weeks
• Period of communicability: as long as the patient is excreting the
microorganism,
• MOT: fecal-oral route, contaminated water, milk or other food
• Sources of Infection
o A person who recovered from the disease can be potential carrier.
o Ingestion of shellfish taken from waters contaminated by sewage
disposal
o Stool and vomitus of infected person are sources of infection.

CLINICAL MANIFESTATIONS
ONSET
• Ladderlike fever
• Nausea, vomiting and diarrhea
• RR is fast, skin is dry and hot, abdomen is distended
• Head-ache, aching all over the body
• Worsening of symptoms on the 4th and 5th day
• Rose spots
TYPHOID STATE
• Tongue protrudes- dry and brown
• sordes
• (coma vigil)
• (subsultus tendinus)
• (Carphologia)
• Always slip down to the foot part of the bed,
• Severe case - delirum sets in often ending in death

Complications
o Hemorrhage, Peritonitis, Pneumonia, Heart failure, Sepsis

DIAGNOSTIC PROCEDURES
1. WBC – elevated
2. Blood Culture – (+) S. typhosa
3. Stool Culture (+)
4. Widal test – blood serum agglutination test
 O antigen – active typhoid

 H antigen- previously infected or vaccinated
 Vi antigen - carrier

TREATMENT
1. Chloramphenicol – drug of choice
2.Paracetamol

NURSING MANAGEMENT
1. Restore FE balance
2. Bedrest
3. Enteric precaution
4. Prevent falls/ safety prec
5. Oral/personal hygiene
6. WOF intestinal bleeding-bloody stool, sweating, pallor
7. NPO, BT

CHOLERA
• An acute bacterial disease of the GIT characterized by profuse diarrhea,
vomiting, loss of fluid.
• Etiologic agent: Vibrio cholerae, V. comma
• Pathognomonic sign: rice watery stool
• Incubation period: 2-3 days
• Period of Communicability: entire illness, 7-14d
• MOT: fecal oral route

Clinical manifestations
o Acute, profuse, watery diarrhea.
o Initial stool is brown and contains fecal material  becomes “rice water”
o Nausea/ Vomiting
Signs and symptoms of Dehydration
o poor tissue turgor, eyes are sunken
o Pulse is low or difficult to obtain, BP is low and later unobtainable.
o RR – rapid and deep
o Cyanosis – later

o Voice becomes hoarse– speaks in whisper
• Oliguria or anuria
• Conscious, later drowsy
• Deep shock
• Death may occur as short as four hours after onset.
• Usually first or 2nd day if not treated.

Principal deficits
1. Severe dehydration - circulatory collapse
2. Metabolic acidosis – loss of large volume of bicarbonate rich stool. RR rapid
and deep
3. Hypokalemia – massive loss of K. abdominal distention – paralytic ileus

DIAGNOSTIC EXAMS
Fecal microscopy
1. Rectal swab
2. Stool exam

Treatment
1. IVF- rapid replacement
2. Oral rehydration
3. Strict I and O
4. Antibiotics – Tetracycline, Cotrimoxazole.

NURSING MANAGEMENT
1. Medical Asepsis
2. Enteric precaution
3. VS monitoring
4. Intake and Output
5. Good personal hygiene
6. Proper excreta disposal
7. Concurrent disinfection.
8. Environmental sanitation

PREVENTION
1. Protection of food and water supply from fecal contamination.
2. Water should be boiled/ chlorinated.
3. Milk should be pasteurized.
4. Sanitary disposal of human excreta
5. Environmental sanitation.

DYSENTERY
• Acute bacterial infection of the intestine characterized by diarrhea and
fever

Maintain fluid and electrolyte balance 2. safe washing facilities. habitat exclusively in man. • Etiologic Agent: Shigella group o Shigella flesneri . Cotrimoxazole. vomiting and headache • Anorexia. connei. Prevention.commmon in the Philippines o Shigella boydii. Enteric precaution 4. in children • Nausea. 5. S. Excreta must be disposed properly. body weakness • Cramping abdominal pain (colicky) • Diarrhea – bloody and mucoid • Tenesmus • Weight loss DIAGNOSTICS • Fecalysis • Rectal Swab/culture • Bloods – WBC elevated • Blood culture TREATMENT • Antibiotics. dysenteria – most infectious. they develop resistance to antibiotics • Incubation period – 7 hrs.Ampicillin. 3. Restrict food until nausea and vomiting subsides. fly control. Tetracycline • IVF • Anti diarrheal are Contraindicated NURSING MANAGEMENT 1. Clinical manifestations • Fever esp. o S.food preparation. . contaminated water/ milk/ food. to 7 days • Period of communicability – during acute infection until the feces are (-) • MOT – fecal-oral route.

most frequent • Type II .POLIOMYELITIS • An acute infectious disease caused by any of the 3 types of poliomyelitis virus which affects mainly the anterior born cells of the spinal cord and the medulla.least frequent associated with paralytic disease 3 Strains o Brunhilde o Laasing o Leon • MOT: Fecal-Oral • Incubation period: 7-14 days ave (3-21 days) • Period of communicability: o 7-16 days before and few days after onset of s/s • Signs and Symptoms: o Febrile episodes with varying degrees of muscle weakness o Occasionally progressive Flaccid Paralysis 3 Types of Paralysis • Spinal Paralytic o Flaccid paralysis o Autonomic involvement o Respiratory difficulty • Bulbar Form . infantile paralysis • Etiologic Agent: Poliovirus (Legio Debilitans) 3 Types of Poliovirus • Type I . cerebellum and the midbrain • AKA: Acute anterior poliomyelitis.most paralytogenic. heinmedin disease.next most frequent • Type III .

stool exam. impaired temp regulation o Encephalitic s/s • Bulbospinal o Combination • Minor Polio o Inapparent / subclinical o Abortive: recover within 72 hours. urinary retention. spasms of hamstring muscles. vomiting • Major Polio o Paralytic: asymmetrical weakness. paresthesia. Bedrest • Enteric and strict precautions HEPATITIS A • Inflammation of the liver caused by hepatitis A virus • AKA: infectious hepatitis • Incubation period: 2-6weeks • MOT: oral-fecal/ enteric transmission Diagnostic test: liver function (SGOT/SGPT) . constipation o Non paralytic: slight involvement of the CNS. Preventive – Salk and Sabin Vaccine • NO morphine • Moist heat application for spasms • AIRWAY: tracheotomy • Footboard to prevent foot drop • Fluids. LP Nursing Interventions: • Supportive. with paresis o Tripod position: extend his arms behind him for support when upright o Hoyne’s sign: head falls back when he is in supine position with the shoulder elevated o Meningeal irritation: (+) Brudzinski. flulike. o Rapid & serious o Vagus and glossopharyngeal nerves affected o Cardiac and respiratory reflexes altered o Pulmo edema o Hypertension. NTN. Kernig’s sign Diagnostic tests: • Throat swab. backache. stiffness and rigidity of the spine.

SGPT Nursing Interventions: o Provide rest periods o Increase CHO. Ab.Clinical manifestations Prodromal/ pre icteric • S/S of URTI • Weight loss • Anorexia • RUQ pain • Malaise Icteric • Jaundice • Acholic stool • Bile-colored urine Diagnostic tests: HaV Ag. mod Fat. SGOT. low CHON o Intake of vits/minerals o Proper food preparation/handling o Handwashing to prevent transmission AMOEBIASIS • Involves the colon in general but may involve the liver or lungs as well • Etiologic agent: Entamoeba histolytica • Incubation: 3-4 weeks • Period of communicability: duration of illness • MOT: fecal oral route .

• Cover leftover food.boil drinking water (20-30 mins). jaundice • Diarrhea – watery and foul smelling stool often containing blood streaked mucus. exposure to flies. • Wash hands after defecating and before eating. • Colic and abdominal distention • Intestinal perforation –bleeding DIAGNOSTIC EXAM • Stool Exam ( cyst. weakness • Later : anorexia. vomiting. proctogenital Clinical manifestations • Intermittent fever • Nausea. weight loss. Tetracycline. • Avoid washing food from open drum/pail. unhygienic food handlers.Ingestion of food contaminated with E. Chloramphenicol o Fluid replacement – IVF. amoeba+++) • WBC – elevated TREATMENT o Amoebacides – Metronidazole(Flagyl) 800mg TID X 7days o Bismuth gylcoarsenilate combined with Chloroquine o Antibiotic – Ampicillin. polluted water supply. • Indirect . or anal. Use mineral water. oral NUSING MANAGEMENT • Enteric precaution • Health education. • Direct contact – sexual.Histolytica cysts. • Observe good food preparations. oral. • Fly control ASCARIASIS  Helminthic infection of the small intestine caused by ASCARIS LUMBRECOIDES .

X-ray. laparotomy o Follow-up stool exam 1-2 weeks after treatment Nursing Intervention: o Isolation. NSAIDS for abdominal pain o For intestinal obstruction  Decompression  Fluid and electrolyte therapy  If persistent. Diseases Acquired thru the Skin • Diseases caused by Trauma and Inoculation o Tetanus o Rabies o Malaria o DHF o Leptospirosis o Schistosomiasis  Diseases acquired thru contact o Leprosy . Hx of passing out of worms (oral or anal). Tetramizole o Dicyclomine Hcl. MEBENDAZOLE).not needed o Enteric precaution o Handwashing o Proper nutrition o Maintenance of hydration / fluid balance / boil of water o Improve personal hygiene o Proper food prep/handling o Administer meds (NSAIDS. Signs and Symptoms o Stomachache o Vomiting o Passing out of worms o Complications o Energy / Protein malnutrition. Anemia o Intestinal obstruction Treatment: o Pyrantel Pamoate o Piperazine Citrate o Mebendazole. CBC.  MOT: fecal-oral  Incubation period: 4-8 weeks  Communicability: as long as mature fertilized female worms live in intestine Diagnostic exams: Microscopic identification of eggs in stool.

nails and pins • MOT: o Direct or indirect contact to wounds o Traumatic wounds and burns o Umbilical stump of the newborn o Dirty and rusty hair pins o GIT.port of entry – rare o Circumcision/ ear pearcing • Incubation period: 3d-3week (ave:10days). unsterile sutures. disease characterized by generalized rigidity and convulsive spasms of skeletal muscles caused by the endotoxin released by C. Signs and symptoms: • persistent contraction of muscles in the same anatomic area as the injury • Local tetanus • Cephalic tetanus . rusty scissors.rare form . often fatal. gram positive rod • Sources: o Animal and human feces o Soil and dust o Plaster. Tetani • AKA: Lockjaw • Etiologic Agent: Clostridium Tetani o Anerobic o Spore forming.TETANUS • An acute.

supportive therapy and maintenance of an adequate airway • Tetanus immune globulin (TIG) o help remove unbound tetanus toxin o cannot affect toxin bound to nerve endings o single intramuscular dose of 3.normal or slight elevation Treatment: • Wounds should be cleaned • Necrotic tissue and foreign material should be removed • Tetanic spasms .000 to 5.a form of generalized tetanus that occurs in newborn infants Complications: o Laryngospasm  Hypostatic pneumonia  Hypoxia  Atelectasis o Trauma  Fractures o Septicemia  Nosocomial infections o Death Diagnostic procedure:  entirely clinical CSF – normal WBC . caloric intake • During convalescence . o otitis media (ear infections) • Generalized tetanus o trismus or lockjaw o stiffness of the neck o difficulty in swallowing o rigidity of abdominal muscles o elevated temperature o sweating o elevated blood pressure episodic rapid heart rate • Neonatal tetanus . electrolyte.000 units o Contains tetanus antitoxin. • Oxygen • NGT feeding • Tracheostomy • Adequate fluid.

o Determine vertebral injury o Attend to residual pulmonary disability o Physiotherapy o Tetanus Toxoid Nursing Interventions: • Prevention • DPT o Adverse Reactions o Local reactions (erythema. 10d-1yr • Period of communicability: 3-5 days before the onset of s/s until the entire course of disease • MOT: contamination of a bite of infected animals • Diagnostic procedures O History of exposure O PE/ assessment of s/s O Microscopic examination of Negri bodies using Seller’s May-Grunwald and Mann Strains O Fluorescent Rabies Antibody technique / Direct Immunofluorescent test. induration) o Fever and systemic symptoms not common o Exagerated local reactions Nursing interventions: • Prevention of CV and respiratory complications o Adequate airway o ICU – ET. . TT) • Administer antibiotics as ordered o Penicillin • Care during tetanic spasm/ convulsion o Administer Diazepam – muscle rigidity/spasm o Administer neuromuscular blocking agents (metocurin iodide) – relax spasms and prevent seizure • Keep on seizure precaution • Parenteral nutrition • Avoid complications of immobility (contractures. Debridement. pressure sores) • WOF urinary retention.MV • Provide cardiac monitoring • KVO • Wound care (TIG. fractures RABIES • A viral zoonotic neuroinvasive disease that causes acute encephalitis • Etiologic agent: Rhabdovirus • AKA: Hydrophobia. Lyssa • Negri bodies in the infected neurons – pathognomonic • Incubation period: 4-8 weeks.

restlessness. lacrimation. pharynx. progressively increasing paralysis • Death due to respiratory paralysis TREATMENT: • No cure • No specific – symptomatic/ supportive – directed toward alleviation of spasm • Employ continuing cardiac and pulmonary monitoring • Assess the extent and location of the bite – biting incident/ status of the animal .Clinical Manifestations Prodromal Phase / Stage of Invasion • Fever. involuntary twitching • Painful spasms of muscles of mouth. anorexia. nuchal stiffness. mental depression. copious salivation. sorethroat. irritability. burning or cold sensation along nerve pathway. apprehension • Delirium. labored irregular respiration. perspiration. sound. steady rising temp • Spasm. malaise. numbness. dilation of pupils Stage of Excitement • Marked excitation. hyperexcitability. tingling. and changes in temp • Myalgia. and larynx on attempting to swallow food or water or the mere sight of them – hydrophobia • Aerophobia • Precipitated by mild stimuli – touch or noise • Death – spasm from or from cardiac / respiratory failure Terminal Phase or Paralytic Stage • Quiet and unconscious • Loss of bowel and bladder control • Tachycardia. drowsiness. marked insomia • Sensitive to light.

rabies serum o Tetanus prophylaxis o Antibiotics o Suturing should be avoided • Antirabies sera o Heterologous serum obtained by hyperimmunization of different animal species i. no faucets or running water should be heard  IVF should be covered  No sight of water or electric fans MALARIA • Acute and chronic disease transmitted by mosquito bite confined mainly to tropical areas. horses o HRIG – Homologous reabies immunoglobulin – human origin • Rabies Vaccine • Active immunization o Administered 3 years duration o Used for lower extremity bites o Lyssavac (purified protein embryo). or benzalkonium cl) o Anti . Anti-rabies vaccine • Passive immunization o 3 months o Rabuman. high parasitic densities in RBC with tendency to agglutinate and form into microemboli. o Manifests chills every 48 hrs on the 3rd day onward if not treated. dark environment  Close windows. Imogam Nursing Intervention: o Isolation of patient o Provide comfort for the patient by:  Place padding of bedside or use restraints  Clean and dress wound with the use of gloves  Do not bathe the patient. • Etiologic agent – Protozoa of genus Plasmodia • Plasmodium Falciparum (malignant tertian) o most serious. Most common in the Philippines • P. .e. wipe saliva or provide sputum jar o Provide restful environment  Quiet.non life threatening except for the very young and old. betadine. Imovax. Hyper Rab. Vivax . o Severe exposure o Mild exposure • Wound treatment (local care) o Cleanse thoroughly with soap and water (or ammonium compounds.

choleric. gastric. ovale . 14 days P vivax and ovale.P. 30 days P. stained and examined. 10 -15 mins result blood test. 1-2 yrs. tyhoid. falciparum • Mode of transmission o Mosquito bite VECTOR – female Anopheles mosquito DIAGNOSTICS • Malarial smear – film of blood is placed on a slide. muscular pain • Splenomegaly. hepatomegaly • Hypotension o May lasts for 12 hours daily or every 2 days. N/V. 1 yr. vivax. P malariae. falciparum. fever and chills occur every 72 hrs on the 4th day of onset • P.rare • Incubation period: o 12days P. non life threatening. Clinical Manifestions: • Rapidly rising fever with severe headache • Shaking chills • Diaphoresis. malariae • Period of communicability: o If not treated /inadequate – more than 3 yrs. • Rapid diagnostic test (RDT) – done in field. dysenteric • CNS or Cerebral Malaria o Changes in sensorium o Severe headache . malarie (Quartan) – less frequent. abdominal pain. Diarrhea.• P. • Complicated Malaria • GIT o Bleeding from GUT. P.

insect repellant o Blood donor screening. DENGUE FEVER • Is an acute febrile disease cause by infection with one of the serotypes of dengue virus which is transmitted by mosquito (Aedes aegypti).virus is present in the blood and will be the reservoir when sucked by mosquitoes • Stagnant water = any . Malarie). lots of fluid • Monitoring of serum bilirubin • Keep clothes dry. • Dengue hemorrhagic fever – fatal characterized by bleeding and hypovolemic shock • Etiologic agent – Arbovirus group B – • AKA: Chikungunya. Sulfadoxine (resistant P falciparum) Primaquine (relapse P vivax/ovale) • RBC replacement/ erythrocyte exchange transfusion Nursing management: • Isolation of patient • Use mosquito nets • Eradicate mosquitos • Care of exposed persons – case finding • I and O • BUN & creatinine – dialysis could be life saving • ABG • TSB. quinine. west nile fever • Mode of Transmission: Bite of infected mosquito – AEDES AEGYPTI • Incubation period – 3-14 days • Period of communicability – mosquito all throughout life Sources of infection • Infected person. O’ nyong nyong. watch for signs of bleeding • PREVENTION o Mosquito breeding places should be destroyed o Insecticides. o N/V • Hemolytic • Blackwater fever o Reddish to mahogany colored urine due to hemoglobinuria o Anuria – death • Malarial lung disease MANAGEMENTS: • Antimalarial drugs – Chloroquine (all but P. ice cap on head • Hot drinks during chilling.

muscle pain o N &V • FEBRILE Phase o Fever persists (39-40 C) o Rash . cool clammy skin o Profound thrombocytopenia o Bleeding and shock o Pulse . o Skin appears purple with blanched areas with varied sizes ( Herman’s sign) o Generalized or abdominal pain o Hemorrhagic manifestations – epistaxis.rapid and weak o Untreated shock --.more prominent on the extremities and trunk o (+) torniquet test. head-ache.petechia more than 10.coma – death o Treated – recovery in 2 days CLASSIFICATION • Grade 1 • Grade 2 • Grade 3 • Grade 4 . gum bleeding • CIRCULATORY Phase o Fall of temp on 3rd to 5th day o Restless. o Fever and chills.Diagnostic Tests: • Torniquet test • Platelet Count • Hematocrit Manifestations • PRODROMAL symptoms o malaise and anorexia up to 12 hrs.

Ice bag on the bridge of nose and forehead. Observe for signs of shock – VS (BP low). ingestion. Kept in mosquito free environment 2. floods • AKA: Weil’s disease.Treatment: • No specific antiviral therapy for dengue • Analgesic – not aspirin for relief of pain • IV fluid • BT as necessary • O2 therapy NURSING MANAGEMENT 1. Swineherd’s disease • Incubation Period: 6 -15 days • Period of Communicability – found in urine between 10-20 days • MOT – contact with skin of infected urine or feces of wild/domestic animals. inoculation • Diagnostic tests: o Clinical manifestations o Culture . cold clammy skin PREVENTION: • Mosquito net • Eradication of breeding places of mosquito- o house spraying o change water of vases o scrubbing vases once a week o cleaning the surroundings o keep water containers covered o avoid too many hanging clothes inside the house LEPTOSPIROSIS • Infectious bacterial disease carried by animals whose urine contaminates water or food which is ingested or inoculated thru the skin. 5. at rest 3. mud fever. sewerage. VS monitoring 4. Keep pt. • Etiologic agent: spirochete Leptospira interrogans o found in river.

IVF 4. CHF o Convalescence – recovery MANAGEMENT 1. tachycardia. coma . purpura. Dialysis – peritoneal 3. skin flushed. petechiae  Severe  Multiorgan  Conjunctival affectation. mice MANIFESTATIONS o Septic Stage  Early  Fever (40 ‘C). warm.pigs) . Hemoptysis. head-ache. jaundice o Toxic stage – with or w/o jaundice. meningeal irritation. ARF.dogs. Symptomatic Nursing Interventions o Isolation of patient – urine must properly disposed o Care of exposed persons – keep under close surveillance o Control measures  Cleaning of the environment/ stagnant water  Eradicate rats  Avoid bathing or wading in contaminated pool of water  vaccination of animals (cattles. oliguria– shock. IV antibiotic Pen G Na Tetracycline Doxycycline 2. Supportive 5. jaundice.SOURCE OF INFECTION o Rats. dogs. abdominal pain.cats.

Schistosomiasis mansoni.  Incubation Period: 2 – 6 weeks  MOT: Bathing. Snail fever. wading in water. swimming.SCHISTOSOMIASIS  Parasitic disease caused by Schistosomiasis japonicum. Signs and symptoms: o Swimmers itch  Itchiness  Redness and pustule formation at site of entry of cercariae  Diarrhea  Abdominal pain  hepatosplenomegaly CLINICAL MANIFESTATIONS: .  AKA: Bilharziasis. Schistosomiasis Hematobium.  Vector: Oncomelania quadrasi o Cercariae: most effective stage  Diagnostic test: Ova seen in fecalysis  Diagnostic procedures:  Fecalysis • Identification of eggs  Liver and rectal biosy  Immunodiagnostic tests / circumoval precipitin test and cercarial envelope reactions.

• Cystitis and ureteritis with hematuria àbladder cancer. haematobium). inoculation thru break in skin and mucous membrane.extremely high eosinophil granulocyte count. • Abdominal pain • Cough • Diarrhea • Eosinophilia . mansoni. • Pulmonary hypertension (S. • Complications: O Pulmonary hypertension O Cor pulmonale O Myocardial damage O Portal cirrhosis Treatment: • Trivalent antimony o Tartar emetic – administered thru vein o Stibophen (FUADIN) – given per IM • PRAZIQUANTEL – per orem • Niridazole Nursing Interventions: o Administer prescribed drugs as ordered o Prevent contact with cercaria-laden waters in endemic areas like streams o Proper sanitation or disposal of feces o Creation of a program on snail control – chemical or changing snail environment LEPROSY • Chronic systemic infection characterized by progressive cutaneous lesions • Etiologic agent: Mycobacterium leprae o Acid fast bacilli that attack cutaneous tissues. S. anesthesia. and central nervous system lesions. japonicum). more rarely S. mansoni. Identification of S/s • 2. japonicum.the enlargement of both the liver and the spleen. infection and deformities. • Glomerulonephritis. • Colonic polyposis with bloody diarrhea (Schistosoma mansoni mostly) • Portal hypertension with hematemesis and splenomegaly (S. S. Tissue biopsy . • MOT – respiratory droplet. • Fever • Fatigue • Hepatosplenomegaly . Diagnosis: • 1.eight years. • Incubation period – 5 1/2 mo . peripheral nerves producing skin lesions.

Observe carefully for symptoms of the disease. photophobia –blindness • Lesions are multiple. Report cases and suspects of leprosy 2. Nursing Interventions: 1. • Loss of eyebrows/eyelashes • Loss of function of sweat and sebaceous glands • Epistaxis TREATMENT • multiple drug therapy • sulfone • rehab • occupational Health • isolation • moral support PREVENTION 1. Isolation of patient – until causative agent is still present 2. • 3. BCG vaccine may be protective if given during the first 6 months. Bloods – inc. Care of exposed persons 1. 3. . Lepromin skin test • 6. nose eyebrows and forehead • Foot drop • Raised large erythemathous plaques appear on skin with clearly defined borders. Mitsuda reaction MANIFESTATIONS • Corneal ulceration. – rough hairless and hypopigmented – leaves an anesthetic scar. ESR • 5. Household contact – Diaminodiphenylsulfone for 2 years 2. symmetrical and erythematous– macules and papules • Later lesions enlarge and form plaques on nodules on earlobes. Tissue smear • 4.

History of HIV / AIDS • 1959 . injection of blood/products.5 million HIV-infected in USA • 1994. placental transmission.HIV 1 discovered • 1987.1.African man • 1981.Disease Acquired Thru Sexual Contact HIV /AIDS • Chronic disease that depresses immune function • Characterized by opportunistic infections when T4/CD4 count drops <200 • MOT – sexual contact with infected – unprotected.WHO reports 8-10 mil. Worldwide & protease inhibitors introduced • 1999-First clinical trials for HIV vaccine The immune system o Macrophages  Humoral response  Cell-mediated response  RNA virus  Retrovirus  Reverse transcriptase  Protease .5 homosexual men • 1982-Designated as disease by CDC • 1983.

Diagnostic Tests
• ELISA
• Western Blot
• CD4 count
• Viral load testing
• Home test kits

Manifestations
o Minor signs – cough for one month, general pruritus, recurrent herpes zoster,
oral candidiasis, generalized lymphadenopathy
o Major signs – loss of weight 10% BW, chronic diarrhea 1month up, prolonged
fever one month up.
• Persistent lymphadenopathy
• Cytopenias (low)
• PCP
• Kaposis sarcoma
• Localized candida
• Bacterial infections
• TB
• STD
• Neurologic symptoms

Criteria for Diagnosis of AIDS
• CD4 counts of 200 or less
• Evidence of HIV infection and any of
o Thrush
o Bacillary angiomatosis
o Oral hairy leukoplakia
o Peripheral neuropathy
o Vulvovaginal candidiasis
o Shingles
o Idiopathic thrombocytopenia
o Fatigue, night sweats, weight loss.
o Cervical dysplasia, carcinoma in situ.
• Evidence of HIV infection and any one of the following:
O Bronchial candidiasis
O Esophageal candidiasis
O CMV disease
O CMV retinitis
O HIV encephalopathy
O Histoplasmosis
O Kaposi’s Sarcoma
O Herpes simplex ulcers, bronchitis, pneumonia
O Primary brain lymphoma

O Pneumocystis Carinii Pneumonia
O Recurrent pneumonia
O Mycobacterium infection
O Progressive multifocal leukoencepalopathy
O Salmonella septicemia
O Toxoplasmosis
O Wasting syndromes

Treatment
• Started in CD4 counts of <200
• Viral load >10,000 copies
• All symptomatic regardless of counts
• Note: CD4 reflects immune system destruction. Viral load- degree of viral
activity
• Nucleoside Reverse Transcriptase Inhibitors
• Blocks reverse transcriptase
NRT
• Acts by binding directly to the reverse transcriptase enzyme
• Not used alone
• Rapid development of resistance
• Acts by binding directly to the reverse transcriptase enzyme
• Not used alone
• Rapid development of resistance

Generic Trade Dose Notes

Zidovudine AZT, ZDV, 300 mg. Taken with food
Retrovir Bid

Didanosine ddI, Videx 200 mg Peripheral
bid neuropathy

Zalcitibine ddC,Hivid .75 mg No antacids
TID

Stavudine d4T, Zerit 400 mg Peripheral
bid neuropathy

Lamivudine 3TC, Epivir 150 mg Used as
bid resistance
develops

Lamiduvine/Zido Combivir 150/300 Bone marrow
vudine mg toxicity

Protease Inhibitors
• Introduced in 1995
• Acts by blocking protease enzyme
• Indinavir (Crixivan)

CDC Guidelines
o Combination of 2 NRTI + PI
• Nursing Management
o Administer Antiviral meds as ordered
o Universal precaution
o Reverse isolation
 gloves, needle stick injury prevention
o Assist in early diagnosis and management of complications
• 4 C’s
o Compliance – info, + drugs
o Counselling – education
o Contact tracing – tracing out and tx for partners
o Condoms – safe sex

GONORRHEA
• A curable infection caused by the bacteria Neisseria gonorrhoea
• AKA: Clap, Drip, G. vulvovaginitis
• MOT: transmitted during vaginal, anal, and oral sex
• Incubation period: 3-10 days initial manifestations
• Period of communicability: considered infectious from the time of
exposure until treatment is successful
Manifestations:
• Urethritis – both male and female
• Signs and Symptoms: dysuria and purulent discharge
• Cervicitis
• Upper Genital Tract – females (PID)
Endometritis, Salpingitis,
Pelvic Abscess
• Complications :
• PID
• Infertility

Complications:
• Upper Genital Tract – male
o Epididymitis, Prostatitis, Seminal Vesiculitis
• Disseminated Gonococcal Infection (DGI)
o Tenosynovitis or Polyarthritis, skin lesions and fever
• Anorectal Infection
• Pharyngeal Infection
• Gonococcal Conjuctivitis
o Opthalmia Neonatorum
• Meningitis, Endocarditis

Diagnosis:
• Culture & Sensitivity
• Blood tests for N. gonorrhoeae antibodies

Treatment:
• ANTIBIOTICS
• Penicillin
• Single dose Ceftriaxone IM + doxycycline PO BID for 1 week
• Prophylaxis: Silver nitrate, Tetracycline, Erythromycin

Nursing Interventions:
o Case finding
o Health teaching on importance of monogamous sexual relationship
o Treatment should be both partners to prevent reinfection
o Instruct possible complications like infertility
o Educate about s/s and importance of taking antibiotic for the entire
therapy
SYPHILIS
• a curable, bacterial infection, that left untreated will progress through four
stages with increasingly serious symptoms.
• Etiologic agent: Treponema pallidum
• AKA: Lues, The pox, Bad blood
• Type of Infection: Bacterial
• Modes of transmission :
o Through sexual contact/ intercourse, kissing
o abrasions
o Can be passed from infected mother to unborn child (transplacental)
Symptoms:
o Primary syphilis (10 – 90 days after infection)
 Chancre – a firm, painless skin ulceration localized at the
point of initial exposure to the bacterium appear on the
genitals
 can also appear on the lips, tongue, and other body
parts.
o Secondary syphilis (last 2 – 6 weeks)
 syphilis rash - an infectious brown skin rash that typically
occurs on the bottom of the feet and the palms of the hand
 condylomata lata - flat broad whitish lesions
 Fever, sore throat, swollen glands, and hair loss can also be
experienced
• Third stage
o Will manifest 1 – 10 years after the infection
o characterised by gummas - soft, tumor-like growths
 seen in the skin and mucous membranes – occurs in bones
o joint and bone damage
o increasing blindness

o Numbness in the extremities, or difficulty in coordinating movements.

Neurosyphilis
• generalized paresis of the insane which results in personality
changes, changes in emotional affect, hyperactive reflexes
• cardiovascular syphilis
• aortitis, aortic aneurysm, Aneurysm of sinus of valsalva and aortic
regurgitation, - death

Consequences in Infants
• Congenital syphilis
• extremely dangerous
• Deformities
• Seizures
• Blindness
• Damage to the brain, bones, teeth, and ears.

Test and diagnosis
• Venereal Disease Research Laboratory (VDRL) test
• Flourescent treponemal antibody absorption (FTA – Abs)
• Micro hemagglutination test (MHA - TP)
• CSF examination
Treatment
• Syphilis is easily treatable when early detected
• Penicillin & other antibiotics

Prevention:
• Abstinence
• Mutual monogamy
• Latex condoms for vaginal and anal sex
• Nursing interventions
o Case finding
o Health teaching and guidance along preventive measures
o Utilization of community health facilities
o Assist in interpretation and diagnosis
o Reinforce ff up treatment
o VD control program participation
o Medical examination of patient’s contacts

HEPATITIS B
• serious disease caused by a virus that attacks the liver
• Etiologic agent: hepatitis B virus (HBV)
• Source of infections: Blood and body secretions

Risk factors
• multiple sex partners or diagnosis of a sexually transmitted disease

• Sex contacts of infected persons
• Injection-drug users
• Household contacts of chronically infected persons
• Infants born to infected mothers
• Infants/children of immigrants from areas with high rates of HBV infection
• Health-care and public safety workerr
• Hemodialysis patients

Complications:
• Lifelong infection
• Liver cirrhosis
• Liver cancer
• Liver failure
• Death

Signs and symptoms:
• Jaundice
• Pruritus
• Fatigue
• RUQ - Abdominal pain
• Loss of appetite
• Nausea, vomiting
• Joint pain

Prevention:
• Hepatitis B vaccine has been available since 1982.
o Routine vaccination of 0-18 year olds
o Vaccination of risk groups of all ages
• Immune globulin if exposed

MEDICAL MANAGEMENT:
• Interferon alfa-2b
• Lamivudine
• Telbivudine
• Entecavir
• Adefovir dipivoxil

Nursing Interventions:
o Blood and body secretions precautions
o Prevention- Hepa B vaccine
o Proper rest periods
o Prevent stress – physio/psychological
o Proper NTN, increase in CHO, high in CHON, low fats, Vit. K rich
foods and minerals

LOW • ELISA test detects antibodies to SARS o but only 21 days after the onset of symptoms • Immunofluorescence assay. promote safety AAT o WOF signs and symptoms bleeding. Singapore and the province of Ontario. can detect antibodies 10 days after the onset of the disease.096 known infected cases and 774 deaths • Incubation period: 2-3days • MOT: Airborne Signs and symptoms: o flu like: fever. o labour and time intensive test • Polymerase chain reaction (PCR) test that can detect genetic material of the SARS virus in specimens ranging from blood.4 °F) or more AND • Either a history of: o Contact (sexual or casual) with someone with a diagnosis of SARS within the last 10 days OR o Travel to any of the regions identified by the WHO as areas with recent local transmission of SARS (affected regions as of 10 May 2003 were parts of China. • probable case of SARS has the above findings plus positive chest x-ray findings of atypical pneumonia or respiratory distress syndrome Treatment .abnormal with patchy infiltrates • WBC and PLT CT. Hong Kong. . myalgia.increased opacity in both lungs. edema o Health education on safe sex. o Assistance to prevent injury.4 °F) o Shortness of breath o Symptoms usually appear 2–10 days following exposure o require mechanical ventilation Diagnostic Test: • Chest X-ray (CXR). tissue samples and stools • CXR . indicative of pneumonia • SARS may be suspected • fever of 38 °C (100. SEVERE OF ACUTE RESPIRATORY SYNDROME • An acute and highly contagious respiratory disease in humans • Etiologic agent: SARS coronavirus • November 2002 and July 2003. lethargy. sore throat o fever above 38 °C (100. Canada). cough. gastrointestinal symptoms. sputum. with 8.

with full barrier nursing precautions taken for any necessary contact with these patients • steroids • antiviral drug • SARS vaccine  Tuberculosis*  Leprosy*  Schistosomiasis*  Filariasis  Malaria* .• Supportive with antipyretics. supplemental oxygen and ventilatory support as needed. • Suspected cases of SARS must be isolated. preferably in negative pressure rooms.

Hepatitis B*  HIV/AIDS*  Meningococcemia  “Bird Flu” or Avian influenza  SARS – Severe Acute Respiratory Syndrome* Comprehensive Maternal and Child Health Program *EPI ( EXPANDED PROGRAM ON IMMUNIZATION ) *CDD ( CONTROL OF DIARRHEAL DISEASES ) *CARI (CONTROL OF ACUTE RESPIRATORY INFECTIONS ) *UFC (UNDER – FIVE CLINICS ) *MC ( MATERNAL CARE ) *BF ( BREAST FEEDING ) . Gonorrhea* ii.  Dengue Hemorrhagic Fever (H-Fever)*  Measles*  Chicken Pox (Varicella)  Mumps (Epidemic Parotitis)*  Diptheria  Whooping Cough (Pertussis)  Tetanus Neonatorum and Tetanus among older age groups*  Influenza  Pneumonias  Cholera (El Tor)*  Typhoid Fever*  Bacillary Dysentery (Shigellosis)*  Soil Transmitted Helminthiases  Paragonimiasis  Hepatitis A*  Paralytic Shellfish Poisoning (PSP I RED TIDE POISONING)  Leptospirosis*  Rabies*  Scabies  Anthrax  Sexually Transmitted Infections i. Chlamydia iv. Trichomoniasis vi. Gardianella Vaginitis v. Syphilis* iii.

Infants (0-12 months): BCG. School Entrants: MECS: Grade 1=7 years old DECS: Grade 1=6 yrs. Flavier in 1993-95 Initially every 3rd Wednesday of January & February (1993-1995) 1996 to present: Still being practiced . old (1993) Booster of BCG RA 7846 Compulsory HBV before 8 years old:1996 PP 4 Measles Elimination Program (September & October) 1994-1997- “Ligtas Tigdas” (6 months-8 years) PP 6 Universal Mother & Child Immunization Law advocated by WHO from 1996 and onwards: 5 vaccines + Tetanus Toxoid Strengthens the EPI Program 1. DPT. OPV& Measles HBV (1996) B. OPV was given to all children under 5 years old irregardless of the # of doses & the time OPV was given PP 147 Declaring the National Immunization Day Plus (NIDs Plus) initiated by former Sec. Children: Infants-5 vaccines School entrants-BCG booster dose 3. Pregnant mothers-Tetanus Toxoid 2.*MRP ( MALNUTRITION REHABILITATION PROGRAM ) *VAD (VITAMIN A DEFICIENCY ) *IDD / IDA ( IODINE DEFICIENCY DISORDERS / IRON DEFICIENCY ANEMIA ) *FP ( FAMILY PLANNING ) *EPI (EXPANDED PROGRAM ON IMMUNIZATION ) PD 996 Compulsory Basic Immunization to all children before reaching 8 years old Started in 1976 by MOH Target Population: A. Before EPI total immunization-5 After EPI total immunization-6 (Tetanus toxoid was included) 4.

but not every 3rd Wednesday of January & February 2002: 2nd Tuesday of March & April At present: depends on the Secretary PP 773 Launched the Polio Elimination Program (PEP) 1995-2000: Zero Polio Philippines. Patak Polio (< 5 years old) PP 1064 AFP (Acute Flaccid Paralysis) Elimination Program-an adverse effect of Polio PP 1066 Neonatal Tetanus Elimination  Morbidity  Mortality *RSI locates a venue for immunization called “Patak Center” and composed of 1 organizer. and Training--- Mobilization.000 Policies of EPI: I. Infants ( 0 – 12 ) – get the 3% of population b. FIC ( Full Immunized Child ) C. Surveillance-------------------------------- Planning. Target Setting: 1. 1 runner. Target Setting B. Coverage A. Target Population is the population group meant to be benefited by the EPI Programs where DOH is responsible. Coverage-------------------------------------- A. Cold Chain III. Monitoring and Health Education Administrative and Supportive Role of PHN Referral.5 % of population ( MWKA ) = 15 – 49 years 2. Eligible Population ( EP ) rae those qualified to receive specific immunizations where PHW is responsible  PHN. Zero Polio Philippines (1996-2000) 3. Wastage Allowance OBJECTIVES OF EPI: To reduce morbidity and mortality rates among infants and children from 6 or 7 immunizable disease II. Pregnant Women – get the 3. a. Research and Evaluation --- I. School Entrants – get the 3% of population ( dictum of DOH ) = 6 years c. RHM. 1 recorder and 1 health educator catering to a population of 1. Immunization Technical Responsibilities of PHN IV. 1. Knock Out Polio (KOP) 2. Supervision. MO . 1 vaccinator.

03 = 210 to receive DPT b.03 (Infants and School Entrants) or X 0. MV-1 dose 9-12 months *MV may be given 6 months if there is an epidemic.035 = 245 to receive TT c./3 ½ mos.) Tetanus Toxiod = for pregnant women EP = 7000 X . Hepa B and Measles and who receives 11 doses of vaccines. Fully Immunized Child ( FIC ) – is a child who receives the 5 sets of vaccines (BCG. DPT. Pregnant Women (PW) – Tetanus Toxoid *To determine Eligible Population: EP = Population of the Community x 0.E) – Booster of BCG c. OPV. Infants (I) – BCG. OPV. DPT.03 = 210 to receive booster BCG B. How many receipients = ????? ./1 ½ mos. c. Be aware of the availability of vaccines: Example: BCG CHN: vial Private Practice: ampule Frozen powder with a diluent ( 1 ml per content ) 2. Wastage Allowance . OPV-3 doses 2nd Dose-10 wks.DOH doesn’t ptoduce vaccines biologically and therefore dependent on suppliers abroad: Germany and Switzerland to economize: 1.035 (Pregnant Women) *Example: Lanting Community with a population of 7000 a./2 ½ HBV-3 doses mos. 3rd Dose-14 wks. *3 Population Groups to benefit a. HBV.) DPT = for infants EP = 7000 X 0. MV b. School Entrants (S.) Booster BCG = for school entrants EP = 7000 X 0. Vaccine (# of Doses) Infants (0-12 months) School Entrants Right age to receive the vaccine BCG-1 dose 0 age (at birth)-12 1 booster dose (6 years months old) DPT-3 doses 1st Dose-6 wks.

don’t open. I Frozen . it’s good till 12:00 noon At 12:30 pm.5 3 doses 10% 1.67 25(1ml=15gtts) (Sabin) bottle: 5 ml slightly pink Liquid HBV Vial: .5.5 ml 5 doses 40% 1. MV ( need to mix ) *If open at 8:00 am. b. TT (already in solution / liquid form ready to administer) Table of Reference for Requesting Vaccines from DOH Vaccine Availability Dosage # of Doses to Wastage Number of complete Allowance Recipients per immunization Multiplier Vaccines Factor (MF) BCG Vial: 1. <10 y/o: . HBV. Example: In 20 recipients. Vaccine with 4 hours half life: BCG. Vaccine with 8 hours half life: DPT.05 ml 1 dose 60% 2.5 ml MV Vial: .67 20 liquid OPV Plastic 2-3 gtts 3 doses 40% 1.5 20 2.-Follow DOH Dictum: On the day of immunization. open a vial but if less than 50%.1 ml 1 dose 40% 1. SE Powder . don’t give anymore because it’s not potent anymore.5 ml=1 10 ml >10 y/o: 1 .67 10 with 1ml diluent DPT Vial: 10 ml .5 ml 3 doses 40% 1. 1. 10 arrive = open a vial -Half life of Vaccines is the duration of potency: a.5 ml 1 dose 50% 2 10 Frozen Powder with Diluent Sol’n=5ml per content TT Vial: 10 ml .2 . OPV. if 50% and above of computed recipents arrive in the health center.67 20 liquid *Parenteral = Salk vaccine ( sinasaksak ) has 5 ml per content *Oral Polio Vaccine (OPV) = Sabin (sa bibig) For OPV: 5 ml (availability)  1 ml = 15 gtts  1 ml = 15 gtts = 5 recipients 3 gtts (dosage) 2 ml = 30 gtts = 10 recipients 3 ml = 45 gtts = 15 recipients 4 ml = 60 gtts = 20 recipients .

3.0 BCG (SE) 40% 1.25 (constant). Determine the Overall Total in Allowance (OT) OT=CC x 1. only 1 dose of DPT was given. 5 ml = 75 gtts = 25 recipients Right Time for Pregnant Women to receive Tetanus Toxoid Primary Dose TT1 Anytime during ? Immunity th Pregnancy (5 -6 th months) Primary Dose TT2 4 weeks after TT1 3 years immunity 1st Booster TT3 6 months after 5 years immunity TT2 2nd Booster TT4 1 year after TT3 10 years immunity rd 3 Booster TT5 1 year after TT4 Lifetime immunity Examples: 1. DOH usually grants an allowance of 25% of the CC Example: Determine the # of vaccines to be requested from DOH of DPT for Lanting Community with a population of 4000 1.03 (I & SE) or 0. If until 3 years she failed to receive vaccine. TT4 & TT5 respectively. What you need to receive are the 3 booster doses only-TT3.5 MV 50% 2. 2004.035 (PW) 2. she got to start with the 1st dose. As a child. Determine the Complete Coverage (CC) CC=WA ÷ # of recipients per vaccine 5.03=120 2. Determine the Wastage Allowance (WA) WA=computed AD x MF of the vaccine 4. is there a definite immunity? There’s no definite # of years of immunity. Determine the Annual Dose (AD) AD=EP x # of doses of the vaccine 3. AD=120 x 3 doses=360 .67 DPT OPV TT HBV 10% 1.2 Steps to Compute the Number of Vaccine to be Requested from DOH 1. If as a child. Wastage Allowances of DOH Multiplier Factors BCG (I) 60% 2. Mrs Dela Cruz received the 1st booster dose (TT3) on November 20. Now you become pregnant. EP=4000 x 0. Determine the Eligible Population (EP) EP=Population of the Community x 0. When is the 2nd booster? November 20. 2005 2. you have 3 doses of DPT.

White: use by student affiliates & needs 4 cold dogs .Freezer OPV: most sensitive to heat -15° C to -20° C MV Body of Refrigerator BCG 2° C to 8° C DPT HBV TT: least sensitive to heat OPV & MV: highly sensitive to heat OPV. 30 x 1. though not consumed. Proper Transport . should be discarded Reasons: can’t be used for future program because vaccines have half - life (duration of potency of vaccine) BCG -4 hours half life MV Other vaccines -8 hours half life . Cold Chain -Tools or Procedures to follow to keep vaccine potent ( expected desired effect ). Policies: 1.Tools provided by DOH: Vaccine Carrier which maybe a.3.Cold Dogs: 4 plastic containers filled with water which is placed in the freezer a day before immunization which is used as freezant to keep vaccine potent 3. Proper Handling of Vaccine (After Care of Vaccine): Dictum of DOH a. HBV & TT: Damaged by freezing so not placed in the freezer 2. Proper Storage: store vaccines in refrigerators RHO 3° Given 6 months to store vaccines MHO PHO 2° Given 3 months to store vaccines BHS RHU 1° Given 1 month to store vaccines RHCDS . Vaccines which are opened. MV & BCG: Not damage by freezing DPT. CC=601 ÷ 20=30 5. Black: use by staff of HC during epidemic & needs 5 cold dogs b.67=601 4.25=37. based & oriented) .Vaccines are to be transported from the health center to the area of immunization (community: focused.5 or 38 vials to be given by DOH (or 8 vials allowance) II. WA=360 x 1.

Never count back even though the interval exceeds weeks. BCG. Vaccines which are taken out from Health Center for 3x or more are considered overly exposed & not potent anymore therefore it should be discarded Put notation (state the date) on the unopened vaccine as to when it was taken out from health center May 19. PHN should still give the 2nd dose 3rd dose: The mother brought back the child at 2 years old. OPV & HBV. identified to be RNA & DNA recombinant from blood TT: weakened toxoid b. months or years. As long as the child is on the eligible age Example: DPT. In giving immunization with multiple doses such as DPT. 19. 2006-can’t be used anymore after this I. HBV & TT can be readily discarded if not consumed DPT: Diphtheria-weakened toxoid treated with chemical solution to weaken microorganism Pertussis-killed bacteria Tetanus-weakened toxoid HBV: plasma derived. There are no contraindications such as slight fever. 19. the child was given vaccination 2nd dose: The mother brought back the child when he was 8 months old instead at 10 weeks (2 ½ months). 2006 Jun. OPV & MV are composed of live attenuated bacteria & virus so before discarding them. in giving the immunization unless upon assessment of the practitioner that the child has serious medical problems that warrants hospitalization 3. PHN should still give the vaccine because child is still at the eligible age (0-59 months or 4 years & 11 months or 5 years old) to receive vaccine . 2006 Jul. Immunization Guiding Principles for HW in Administering Vaccines & Screening of Children for Immunizations: 1. disinfect 1st with 1% Hcl or any disinfectant like zonrox. OPV & HBV 1st dose: At 6 weeks (1 ½ months). continue counting in giving the doses. LBM. No BCG for a child born clinically positive to AIDS because they have a damage immune system & introducing bacteria will further aggravate their condition 2. cough & colds and malnutrition. chlorox or dumex BCG (Bacilli Calmette-Guerin Vaccine): live attenuated bacteria OPV & Measles Vaccine: live attenuated virus DPT.

an anti-bacterial. there is no soreness & inflammation. DPT: it is a normal reaction for a child to develop high grade fever because of the pertussis component (killed bacteria) SOP Management: Paracetamol q 4 hours RTC for the 1st 2 days (or 3. Things to consider in administering vaccines: a. the child develops high grade fever with convulsion. 4 days if still febrile) If after 1st dose of DPT. *Site preparation: Use clean cotton ball & wet with sterile water only *For non-healing abscess & ulceration: BCG was wrongly administered by IM or SQ by PHW so incision & drainage should be done by MD only and INH tablet.1 ml SE=L deltoid (needle is Active parallel to site=10-15° angle Side Effects: Wheal=10 mm that disappears after 30 minutes 1st week : develops soreness and inflammation 2nd -11th week : develops abscess and ulceration 12th week (3 months): heals and develops permanent scar Age of Consultation BCG Site of Injection Right Age (0-12 months) Right Deltoid Wrong Age but still eligible Left Deltoid Example: 4 years old Booster Dose at Age 6 Left Deltoid *If after BCG. pounded. Side Effect: patterns of reaction that is considered normal Vaccines Dosage SOA ROA Conferred Immunity BCG I=. there is wrong preparation of site where PHW used alcohol that kills the microorganism contained in the BCG vaccine. Vaccine Dosage SOA ROA Conferred . DPT 2 & 3 are not given anymore because convulsion affects the brain cells resulting to brain damage DPT vaccine is only for prophylactic/ preventive use 5. Vaccine b. repeat the dose on same site but a little lower. 4. no abscess & ulceration and no scar developed. Dosage c.05 ml I=R deltoid Intradermal Artificial SE=. SOA (Site of Administration) d. Then repeat the dose again but not on the same site. Thus. pulverized & applied on the site. ROA (Route of Administration) e.

5 ml Thigh (vastus Intramuscular Artificial lateralis) Active Side Effects: Soreness and inflammation on site SOP Management: Paracetamol q 4 hours RTC for 1st 2 days or till with fever HBV & DPT are given together but never administer these 2 vaccines in one site: DPT HBV st 1 Dose Right Left 2nd Dose Left Right 3rd Dose Right Left MV . High grade fever due to Pertussis Component which contains killed bacteria 2. Jones Salk Side Effect: None Nursing Care: 1. In case the child vomits after vaccination. 3rd & 4th Day=apply alternating cold & warm compress Adverse Effect: If convulsion occurs on 1st dose.5 ml Thigh (vastus Intramuscular Artificial lateralis) (Z tract) Active where muscle is grasped and squeezed Side Effects: 1. discontinue DPT 2 & DPT 3 because of the sensitivity to DPT Component but private MD gives DT which is not available in DOH Vaccine Dosage SOA ROA Conferred Immunity OPV 2-3 gtts Mouth Oral: Artificial Sabin by Dr. Soreness and inflammation SOP Management: Paracetamol (anti-pyretic & analgesic) q 4 hours RTC for 1st 3 days or till with fever Nursing Care: 1st Day=apply cold compress on site 2nd . Immunity DPT . repeat giving the vaccine because it requires 30 minutes to absorb the OPV HBV . NPO for 1st 20-30 minutes after receiving vaccine to prevent nausea & vomiting 2. Active Albert Sabin Salk (parenteral polio vaccine) by Dr.5 ml Posterior Subcutaneous Artificial aspect of (45° angle) Active .

MV and HBV Passive Passive 1. Acquired or experienced the disease DPT. Perinatal→ immunity is acquired ATS (Anti-Tetanus Serum) during the term of pregnancy ADS (Anti-Diptheria Serum) 2. OPV. Natural a. Serum (Blood): colostrums) HBV 2. 3. Active b. Just apply cold compress on site to relieve discomfort 2 Forms of Immunization Conferring Immunity: 1. Passive 2. rashes develop after vaccination which makes the child irritable due to itchiness.5 ml Deltoid or Intramuscular Artificial Gluteal Active muscle Side Effect: Soreness and inflammation on the site which is tolerable by pregnant woman so no need to take medicines. Antitoxin: poison or causes infection . Breastfeeding→ IgA (present in 1. Carrier (person harbors the disease person but asymptomatic) of the disease Upon receiving vaccine (antigen) for 2. Artificial IMMUNITY Natural Artificial Provided by nature Accepts vaccine No vaccine was given Duration is longer/even for a lifetime Duration is shorter period Example: BCG-vaccine for protection from TB gives 7-10 years immunity so booster is needed HBV-after 3 doses booster is needed after 1 year Active=person himself is involved in Active=person himself has no the production of antibodies participation and done by another 1. Deltoid Side Effect: High grade fever SOP Management: Paracetamol q 4 hours RTC for 1st 2 days MV given on same site with BCG but MV is given at 9 months while BCG at birth In case. Constant exposure to disease immunizable diseases such as BCG. give anti-histamines: Diphenydramine (Benadryl) syrup or Apply Caladryl or Calamine Lotion which has anti-histamine and cooling effect to relieve itchiness TT .

Two ( 2 ) Beneficiaries of BF Program: a.Advantages of Breastfeeding: Breast milk: EO 51 – best for babies Reduced allergy Easily established Always available Safe making stool soft Temperature: right teemperature 24C body reference  if to be frozen.To be discussed unde r Communicable Diseases. Monitoring. preservation is minimum of 3 months and maximum of 6 months Fresh always . Research and Evaluation *CDD ( CONTROL OF DIARRHEAL DISEASES ) Policies to implement CDD: 1. and Health Education Referral. Surveillance--------------. never alternate Breastfeeding with any supplementary feeding. Immunoglobulins: IgA. . Planning. Extensive: Breastfeeding can be extended to 2 years. IgD. Exclusive: for the 1st six months. Mother – regulated by R. Early: start Breastfeeding as early as possible  Normal Spontaneous Delivery (NSD): after 30 minutes CS: after 3 – 4 hours b. TAT (Tetanus Antitoxin) DAT (Diptheria Antitoxin) 3. Children – regulated by EO 51: Milk Code of the Philippines Dictum of Milk Code: Never commercialized a brand name of milk. IgG & IgM where IgG is most predominant IV. *Beastfeeding is an effective contraceptive method because it stimulates the anterior pituitary gland to produce prolactin hormone  putting the female in an anovulatory stage  there’s amenorrhea for 6 months form the time she gave birth. Supervision and Training Mobilization. .washing of hands before eating and after use of toilet 2. Breastfeeding ( BF ) .A. b. 7600: Breastfeeding and Rooming – In Act. *Rooming – in ( RI ) is putting together of mother and the newborn and it stimulates the posterior pituitary gland to release oxytocin hormone  stimulates the uterine muscle contraction that inhibits the implantation of fertilized zygote in the endometrium  no pregnancy occurs.3 Principles to make breastfeeding effective: 3 E’s a. IgE. Health Education on Personal Hygiene . c.

Highest mortality in the first 2 years of life 4. continue feeding during diarrhea especially breastfeeding. rehydrate early. High child mortality due to diarrhea 2. Consistency of the stool = watery ROLE OF BREASTFEEDING IN THE CONTROL OF DIARRHEAL DISEASES PROGRAM 1. Main causes of death in diarrhea : DEHYDRATION MALNUTRITION 5. Highest incidence in age 6 – 23 months 3. breastfeeding 2. a protein substance Immunity: colostrum contains Ig A that protects baby for the 1st 3 months Nutritious ( optional ) GIT diseases such as diarrhea is minimize / lessen because it’s sterile 3. use of latrines 6. Frequency of passing out stool = ≥3x/day b. correctly and effectively by giving ORS 6. hand washing 5. 7. Two problems in CDD • 1. Oresol: a management for diarrhea to prevent dehydration 2 Concepts of Diarrhea: a. For undernutrition. High diarrhea incidence among under fives 2. Measles: immunization – preventive and prophylactic 4. To prevent dehydration. improved weaning practices 3. proper disposal of stools of small children 7. Risk of severe diarrhea 10-30x higher in bottle fed infants than in breastfed infants. Advantages of breastfeeding in relation to CDD . use of plenty of clean water 4. Interventions to prevent diarrhea 1. give home fluids “am” as soon as diarrhea starts and if dehydration is present. measles immunization 8. 9. Emotional bonding Economical Digestible: contains lactalbumin.

Measles immunization. 1.protecting water from contamination at the source and in the home 3. Contents of One Pack Oresol Dissolved in One Liter drinking Water Glucose 20 grams 1° Significance: For re-absorption of Na Facilitates assimilation of Na 2° Significance: Provides heat & energy Sodium Chloride/NaCl 3.5 grams Stimulates smooth .handwashing .5 grams For retention of water/fluid Sodium 2.Presence of antibodies protection against diarrhea 3. 11.proper disposal of stools of young children 4.Improved weaning practices 2.collecting plenty of water from the cleanest source . Improved Nutrition .Use of safe water .Good personal and domestic hygiene .use of latrines . When to wean? 4-6 months – soft mashed foods 2x a day 6 months – variety of foods 4x a day 12.Intestinal Flora in BF infants prevents growth of diarrhea causing bacteria. Breastfeeding decreases incidence rate by 8-20% and mortality by 24-27% in infants under 6 months of age.Breast milk is sterile 2. 10.5 grams Buffer content of solution Bicarbonate/NaHCO3 Neutralizer content of solution Potassium Chloride/KCl 1.exclusive breastfeeding for the first 4-6 months of life and partially for at least one year. Summary of WHO-CDD recommended strategies to prevent diarrhea 1. .

Sugar 8 teaspoon 2 teaspoon Salt 1 teaspoon ¼ teaspoon or a pinch of salt=10-12 granules of rock salt: iodized salt=tips of thumb & index finger are penetrated with salt *For making solutions = use 250 ml of water *For drinking medicines = a glass is 240 ml of water. Normal DHN b. No dehydration-uses oresol b. . muscle contractility especially the heart & GIT *Never advice mother to buy brandnames like pedialyte or gatorade Preparation of Proper Homemade Oresol A volume or one liter homemade oresol Smaller volume or a glass homemade oresol Water 1000 ml. Plan C: for treatment of dehydration-severe CDD MANAGEMENT CHART Assessment Category Treatment 1. Fontanel-normal 1. or 1 liter 250 ml. a diuretic & has 5. Tongue & Lips: for 15 minutes & there is moist or wet Thirst: brownish discoloration drinks normally =pectin. 3 Categories of Dehydration: a. Condition No dehydration Plan A-prevention of a. Well c. Eyeballs-normal lipton tea bag left Tears-present standing in a cup of water 4. Severe dehydration-uses IVF Objectives/Plan/Policies of the Use of the following Program: a. mango. Plan B: for treatment of dehydration-mild & moderate c. Alert 3 Principles/3 F’s: 2. Some dehydration-uses oresol c. Plan A: for prevention of dehydration b. Skin Turgor-returns an absorbent effect back quickly which is Fruit Juices-not from done at forearm highly fibrous fruits like pineapple. Increase fluid: Tea- 3. Mouth.

5. Restless & Moderate DHN using b. Treatment Plan: 1st 4 hours always give the maximum 1. Condition Some dehydration Plan B-Treatment of mild a. Increase feeding: 3. Fast referral 1. K & Ca which are lost in diarrhea Oresol is given/LBM or every time stool is passed out: < 2 years old: 50-100ml. Unconsciousness severe DHN using IVF b. Dry mouth. guyabano. Eagerness to drink 5-11 months: 400-600 ml. 5-14 y/o: 1200-2200 ml. Sunken fontanel 3. tongue & If < 4 months: 200-400 lips ml. Lethargic Priority-choice of IVF: . 2-4 y/o: 800-1200 ml. Skin returns back 12-23 months: 600-800 slowly ml. Irritable oresol 2. Oresol-am or buko where 3 electrolytes are present: Na. Sunken eyeballs & If less than 2 years old: absent tears use age in months 4. 10 years old & above: as much as tolerated & desired 2. always give the maximum amount 2-10 years old: 100-200 ml. 15 & above: 2200-4000 ml. Condition Severe dehydration Plan C-treatment of a.

Tea. IVF to be infused on the 1st 4 hours for patient with severe dehydration (8 am-12 noon) b. Floppy-apathetic or 1. with or without mucus CLASSIFY DEHYDRATION . Apple. eat the skin Banana: has K+ Caimito: eat the flesh in cases of constipation but in diarrheal cases. LRS-Lactate Ringer’s very slowly best done at or Hartman solution is the abdomen the most appropriate choice if no D5LRS 3. Plain NSS or 0. Rice. guyabano & kaimito flesh BRAT Diet: Banana. D5W 5. notice extracts to come out of the fruit. Very sunken fontanel severe DHN since 3. D5LRS-best or 1st passive choice if available for 2. Very sunken eyeballs dextrose gives additional & absent tears source of 4. pineapple flesh. toasted bread or toasted rice beads which has activated charcoal that acts as absorbent Direction: In a cup of warm water. Skin returns back very. add 1 tablespoon of toasted rice or bread & allow to stand for 20-30 minutes→ produces a blackish discoloration which is pectin TYPES OF DIARRHEA o ACUTE : < 14DAYS o PERSISTENT: 14 DAYS or more o DYSENTERY: Blood in the stool. D10W 2 Victims of Severe Dehydration: a. Very dry mouth. 2-6pm=infuse 4 liters IVF Fruits for Diarrhea: Apple: has pectin & tarum which has an absorbent property. Child: give 100 mg/kg body weight in the 1st 4 hours Example: 8 kg=800 ml.c. mango.9 NaCl 4. eat both skin & flesh Fruits to avoid during diarrhea: Papaya flesh. eat the extracts. milky substances (dagta) found on the inside of the skin Duhat: wash first the fruit then sprinkle with rock salt & shake. Adult: give 3-4 liters of IVF in 1st 4 hours Example: 9am-1pm=4 liters=1 liter/hour If still severe dehydration. energy & improves tongue & lips appetite D5-is glucose Refuses to drink orally LRS-has 3 chlorides 5. 2.

Target groups: very young: <2 months Older child: 2 months – 5 years old Child with cough and colds Program: 1.duration Convulsion . • SEVERE DEHYDRATION Two of the following: Abnormally sleepy Sunken eyes *CARI Drinks poorly Skin pinch goes very slowly Treat PLAN C: Referral to hospital for IVF!!! • SOME DEHYDRATION Two of the following: Restless. irritable Sunken eyes THIRSTY: drinks eagerly Skin pinch goes back Treat PLAN B O. (CONTROL OF ACUTE RESPIRATORY INFECTIONS ) Goal: Morality and Morbidity reduction of Pnuemonia. Assessment: History: Subjective Age Cough and Duration Able to Drink or stop feeding Fever ---.R.S: first 4hours after assessment 200-400ml 0-4mos 400-700ml 4-12mos 700-900ml 1-2 yrs 900ml-1L 2-5yrs • NO DEHYDRATION Not enough signs to classify some or severe Treat PLAN A Give extra fluids 50-100ml after each watery stool (0-2y/o) 100-200ml (2 y/o & above) as tolerated (10y/o & above) Continue feeding Return if with danger sign/s.

Nasal flaring c. LOC . Malnutrition . Chest in – drawing b. Convulsion h. Cyanosis 2 Types: a. Stridor during inhalation . Sleepy i. Chest in – drawing . Level of Consciousness 2. cyanosis. Stridor j. Not able to drink g. STANDARD CLASSIFICATION OF ILLNESS: I. Severe Malnutrition Treatment: 1.Physical Examination: Objective Weight. Antimalarial 2. Grunting d. . Treatment of Fever ( TSB ) * Wheeze (NEBULIZE) 4. VERY SEVERE DISEASE: If any 3 of the 5 Danger signs are present Signs and Symptoms: f. grunting. PNEUMONIA: Signs and Symptoms: a. Height Respiratory Rate – one whole minute Fast Breathing *Less than 2 months – 60/min or > *2 months – 1 year – 50/min or > *1. Wheeze during exhalation . Severe Pneumonia Symptoms: Chest – indrawing. nasal flaring. Refer urgently to hospital 2. Infants 2 months to 5 years old 1.5 years old – 40/min or > Observe for : . 1st dose of antibiotics 3. Fever .

Antibiotics – for 2 days and follow up after 2 days. consume all meds finish the course of the treatment. Steam inhalation 2. b. b. Home care – TSB. No fever If with sore throat in children: Mild. *Identify factors that may hinder the growth and development of the child. Program Objectives and Goals: *Monitor growth and development of the chiild until 5 years of age. II. Treatment: Same with very severe but anti – malarial is not given. If it improves. No Chest – indrawing. PNEUMONIA Symptoms: Severe Chest – indrawing and Fast Breathing Treatment: Same as severe. The Department of Health established the Under Five Clinic Program to address this problem. Infants lessthan 2 months 1. Treatment: 1. If chronic. *UFC (UNDER – FIVE CLINICS )  The first five years of life form the foundations of the child’s physical and mental growth and development. a. .5C) Treatment: Refer urgently to hospital Keep warm Give first doses of antibiotic 2. Studies have shown the mortality and morbidity are high among this age group. NO PNEUMONIA Assess for other problems and provide home care. warm tea with syrup. 3. If worse. Nutrition. Not Severe Pneumonia Symptoms: No chest in – drawing and fast breathing. refer. VERY SEVERE DISEASE Symptoms: Stopped feeding well Convulsions Abnormally sleepy Stridor Wheeze Severe malnutrition and Fever of 38C or Hypothermia (<35. refer.

) B. (e. 4. vitamins. Program Objectives and Goals: -Protection and promotion of breastfeeding and lactation management education training. EO 51 THE MILK CODE – protection and promotion of breastfeeding to ensure the safe and adequate nutrition of infants through regulation of marketing of infant foods and related products. Provision of IEC materials ( ex. breast milk substitute. supplementation. infant formulas. teats etc.g.Activities and Strategies: 1. Monitoring and Evaluation. deworming and feeding. Executive Order 51 Republic Act 7600 The Rooming – in and Breastfeeding Act of 1992. -Sanction and Regulation. -Information. Regular height and weight determination / monitoring until 5 years old. RA 7600 THE ROOMING – IN AND BREASTFEEDING AC T OF 1992 -An act providing incentives to government and private health institutions promoting and practicing rooming – in – and breast – feeding. 0 – 1 year old = monthly 1 year old and above = quarterly 2. Provision of a sagfe and learning – oriented environment for the child. 3. 3. Conduct Orientation / Advocacy meetings to Hospital / Community. Posters. ADVANTAGES OF BREASTFEEDING: MOTHER: *Oxytocin helps the uterus contracts *Uterine involution *Reduce incidence of Breast Cancer *Promote Maternal – Infant Bonding *Form of Family planning method ( Lactational Amenorrhea ) . Full Implementation of Laws supporting the Program A. -Provision for human milk bank. **BREASTFEEDING / LACTATION MANAGEMENT EDUCATION TRAINING** -Breastfeeding practices has been proven to be very beneficial to both mother and baby thus the creation of the following laws support the full implementation of this program. Activities and Strategies: 1. feeding bottles. education and re – education drive. charts. 5. Recording of immunization. toys ) that promote and enhance child’s proper growth and development.

Side Lying Position Best for Babies Reduce Incidence of Allergens Economical Antibodies Present Stool Inoffensive ( Golden Yellow ) Temperature always ideal Fresh Milk never goes off Emotionally Bonding Easy once established Digested easily Immediately available Nutritionally optimal Gastroenteritis greatly reduced Garantisadong Pambata ( GP ) -Garantisadong Pambata is a biannual week long delivery of a package of health services to children between the ages of 0 – 59 months old with the purpose of reducing morbidity and mortality among under fives through the promotion of positive Filipino values for proper children growth and development. Football Hold 3. *Contains Lactoferin ( Binds with Iron ) *Leukocytes *Contains Bifidus factor – Promotes growth of the Lactobacillus inhibits the growth of pathogenic bacilli. nationwide IU or ½ cap or 3 9 -12 months old . 1. Positions in BF THE BABY: 1. Cradle Hold – head and neck are supported 2.000 old. WHAT ARE THE HEALTH SERVICES OFFERED IN GP AND WHO ARE THE TARGETS? GP offers the following: 1.1 Routine Health Services: Health Service Dosage Route of Target Administration Population Vitamin A 200.BABY: *Provide Antibodies.000 IU or Orally by drops 12 – 59 months Capule capsule 100.

iodized. 2 -11 months old ( 25 mg elemental months ) once a infants in Iron per ml. pan de bida and other fortified foods.) Necesary in energy metabolism c. salt. Iron and Iodine -Sources: green leafy and yellow vegetables. essential in the normal process of growth and development: a. -**For any between 12 – 23 months.3 ml ( 2 – 6 Orally by drops. Bottle as taken including home medicine 0. and must be taken in the food we eat. liver. the health worker should give the child the necessary antigen to complete FIC and shall be recorded as such. Garantisadong Pambata ( GP ) Sangkap Pinoy -Vitamin A. ( If available ) dose nationwide Weighing 0 – 59 months nationwide -*The child should not have received megadose of Vitamin A above the recommended dosage within the past 4 weeks except if the child has measles or signs and symptoms of Vitamin A deficiency. seafoods.) Helps the body to regulate itself b. who missed any of his routine immunization.5 ml Intramuscularly 0 – 11 months available ) Deworming drug 1 tablet as single Orally 36 – 59 months. These micronutrients are not produced by the body. Ferrous Sulfate 0.5 ml Intramuscularly 0 – 11 months on anterior thigh -OPV 2 drops Orally 0 – 11 months -AMV 0.6ml ( 6.11 evacuation with instructions ) months) centers in armed conflict areas.05 ml Intradermal on 0 – 11 months right deltoid.5 ml Subcutaneously on deltoid -Hepa B ( If 0. drops infants receiving AMV nationwide. 30 ml day Mindanao area. fruits. Routine Immunization -BCG 0. -DPT 0.) Vital in brain cell formation and mental developmet .

Vital A deficiency 3. Iron Deficiency Anemia 4. Conserves funds that otherwise would be spent on breast milk substitute. Breast milk can be a single source of nourishment from birth up to six months of life. At about six months. Safely rehydrates and provides essential nutrients to a sick child. *Why is there a need to Give Complementary Foods? c. d. Reduces a women’s risk of excessive blood loss after birth. b. preventing many infections. f. . BENEFITS: For INFANTS a. foods introduced to the child at the age 6 months to supplement breast milk b. Reduces the risk of ovarian and breast cancers and osteoporosis. e. Provides a natural method of delaying pregnancies. g.) Eating Sangkap Pinoy – rich foods can prevent and control: 1. -Breastfeeding provides physical and psychological benefits for children and mothers as well as economic benefits for families and societies. Reduces the infant’s exposure to infection. give carefully selected nutritious foods as supplements. Protein Energy Malnutrition 2. Exclusive breastfeeding is recommended for the first six minths of life. given progressively until the child is used to three meals and in – between feedings at the age of one year. Saves medical costs to families and governments by preventing illnesses and by providing immediate postpartum contraception. For the FAMILY AND COMMUNITY h. c. Complementary Feeding for Babies 6 – 11 moths old *What are Complementary Foods? a. Strengthens the infant’s immune system. supplies and fuel to prepare them. For the MOTHER e. especially to those suffering from diarrheal diseases. i. Iodine Deficiency Disorder Breastfeeding -Breast milk is best for babies up to 2 years old.) Necessary in the body immune system to protect the body from severe infection. Provides a nutritional complete food for the young infant.d.

Egg yolk. Spermicidals . Give bite – sized fruit separately d. however. Breastmilk should be supplemented with other foods so that the child can get additional nutrients. Lactational Amennorhea B. e. ARTIFICIAL METHODS I.d. should continue for as long as the mother is able and has milk which could be as long as two years. *How to Give Complementary Foods for Babies 6 – 11 Months Old? a. soft cooked vegetable. f. Prepare mixture of thick lugao / cooked rice. CHEMICAL METHODS 1. mashed beans. Goal and Objective: * Universal access to family planning information education and services. TYPES OF METHODS: A. Give mixture by teaspoons 2 – 4 times daily. Sympto – Thermal Method 5. Ovulation suppressant such as PILLS 2. Basal Body Temperature Method 3. c. Cervical Mucus Method 4. Introuction of complementary foods will accustom him to new foods that will also provide additional nutrients to make him grow well. *FP ( FAMILY PLANNING ) The Philippine Family Planning Program is a national program that systematically provides information and services needed by women of reproductive age to plan their families according to their own beliefs and circumstances. NATURAL METHODS 1. Give egg alone or combine with above food mixture. g. Mission: *To provide the means and opportunities by which married couples of reproductive age desirous of spacing and limiting their pregnancies can realize their reproductive goals. flaked fish / chicken / ground meat and oil. Breastfeeding. b. The child’s demands for food increases as he grows older and breastmilk alone is not enough to meet his increased nutritional needs for rapid growth and development. Calendar or Rhythm Method 2. increasing the amount of teaspoons and number of feeding until the full recommended amounts is consumed. Depo – Provera 3.

Cervical Cap / Diaphragm III. SURGICAL METHODS 1. Male and Female Condom 2. Vasectomy 2. Tubal Ligation *MC ( MATERNAL CARE ) *BF ( BREAST FEEDING ) *MRP ( MALNUTRITION REHABILITATION PROGRAM ) *VAD (VITAMIN A DEFICIENCY ) . MECHANICAL METHODS 1. Implant II. Intrauterine Device 3.4.

Research in community health serves a number of purposes.362. (3) improve the delivery of health services and implementation of existing programs. and (5) project a good image of nurses. VITAL HEALTH STATISTICS 2005 PROJECTED POPULATION : MALE .766 FEMALE . client waiting time. Research also contributes to what is called evidence-based practice. nurses and midwives add to the poor health delivery system to the poor. Research and Quality Improvement A. The practices that were passed on and were considered as gospel truth in the past should be examined and tested through research. Although it is not commonly included in the PHN’s statement of duties and responsibilities. (4) improve cost-effectiveness of programs. socio-demographic profile of those who utilize health services. supply management and effects of specific health education activities. research is nonetheless included in the scope of functions of the nurse as defined by the Nursing Law. perception of clients on the delivery of health services. referral from and to the health center.42. among which are: (1) improve our understanding of clients and their specific contexts. not only PHNs but to major decision makers in the local health system is to integrate research into the management and operation of the health facility.147 . National Health Situation NATIONAL HEALTH SITUATION Philippine Scenario: *In the past 20 years some infectious degenerative diseases are on the rise. (2) provide data needed for program and policy development and evaluation. The challenge. The PHN can initiate “small” researches on the major concerns in health service delivery and in the management of the health facility. Research topics that could be studied by the PHN by himself/herself include. response of clients to different health or nursing interventions. B. Research in the Community RESEARCH IN THE COMMUNITY Research is an important activity in public health but it is misconceived to be primarily an activity of professional researchers and academicians. *Many Filipinos are still living in remote and hard to reach areas where it is difficult to deliver the health services they need. *The scarcity of doctors.874.*IDD / IDA ( IODINE DEFICIENCY DISORDERS / IRON DEFICIENCY ANEMIA ) *FP ( FAMILY PLANNING ) II. among others.42.

BOTH SEXES . Old LEADING CAUSES OF MORBIDITY *Most of the top ten leading causes of morbidity are communicable disease *These include the diarrhea. Nutrition B. Basic Health Indicators 2 Indicators to assess a national health situation A. Chickenpox 10. TB. Disease of the Heart 2. Pneumonia -. Diseases of the Heart 8. *Pneumonia. Malignant neoplasm 4. HPN. PTB and diarrheal diseases consistently remain the 10 leading causes of deaths.Respiratory 5.913 LIFE EXPECTANCY FEMALE . Measles **Leading Causes of Mortality** 10 Leading Causes of Mortality 1. Disease Patterns Context of CHN: Health Situation **Leading Causes of Morbidity** 10 Leading Causes of Morbidity 1. pneumonia. Old MALE . Diarrhea 3. influenza. -HEALTH INDICES I.70 yrs.236. Diseases of the Vascular System 3. Accidents . TB Respiratory 7. Hypertension 6.85. malaria and varicella *Leading non CD are heart problem.Bacterial 2. Pneumonia 5. Malaria 9. accidents and malignant neoplasms LEADING CAUSES OF MORTALITY *The top 10 leading causes of mortality are due to non CD *Diseases of the heart and vascular system are the 2 most common causes of deaths. bronchitis. Bronchitis 4. 64 yrs. Influenza -.

Pregnancy with abortive outcome 5. 6. COPD 8. Pneumonia 3. delivery & puerperium 2. Maternal Mortality Rate MMR= # of maternal deaths x 1000 RLB Leading Causes Of Maternal Deaths: 1. Other Indicators A. Conditions originating in perinatal period 9. Diarrhea & Gastroenteritis of presumed infectious origin 5. Measles *Increase IMR = decrease MCHS *Poor maternal child’s service B. Nephrotic Syndrome III. HPN complicating pregnancy. Diabetes Mellitus 10.TB – all forms 7. childbirth & puerperium 3. Hemorrhage related to pregnancy *Life expectancy at birth—life span either: age specific or sex specific . Infant Mortality Rate *2002 --.21/1000 rated based on WHO global indicator >50 high Increase IMR – decrease MCHS ( poor nutrition and child health service ) INFANT MORTALITY RATE Total # of death below 1 yr in a given calendar year X 1000 Estimated population as of July 1 of the same calendar year 10 Leading Causes of Infants Deaths 1. Postpartum hemorrhage 4. Bacterial Sepsis of Newborn 4. Other perinatal conditions 2. Septicemia 10. Congenital Pneumonia 7. Normal delivery and other complications r/t pregnancy occurring in the course of labor. Disorders r/t short gestation & LBW 9. Nephritis. Other congenital malformations 8.

Categories: According to Increasing According to the Type of Service Complexity of the Services Provided Type Service Type Service Primary Health Promotion. Crude Birth Rate 2. Median Age E. Crude Rates 1. multi – level and multi – disciplinary. attention to psychological and social care. diagnostic. therapeutic and rehabilitative care . products. and equitable health financing(NEW VISION by 2030). referrals Secondary Surgery. Medical Diagnosis Screening services by and specialists Treatment Tertiary Advanced. problems and concerns of the people. Health Information Preventive Care. Life Expectancy at Birth D. complex. Promotion Dissemination Continuing Care for and illness common health prevention problems. -A global leader for attaining better health outcomes. It is large. *Median Age.55% C. equipment. competitive and responsive health care system.20. human resources and services whichaddress the health needs. Crude Death Rate -Health Care Delivery System – the totality of all policies.1 years *The Philippines is an agricultural country. MISSION: . Rehabilitation PT/OT specialized.The Health Sector GOVERNMENT SECTORS DEPARTMENT OF HEALTH (DOH) VISION: -Health for all by year 2000 and Health in the Hands of the People by 2020(OLD).

identified health problem.-In partnership with the people. Human Rights Advocates Research and Documentation . quality and access to health care especially the marginalized. Maintain a medium of regulations and standards to protect consumers and guide providers – Sentrong Sigla = Training and infrastructure -LOCAL GOVERNMENT UNIT / NON GOVERNMENT SECTORS – R.municipal ● Provincial health officer Health Promotion. Plan and establish arrangements for the public health systems to achieve economies of scale – Phil Health. no risk. and to lead the quest for excellence in health.mayor ● Assistant . Ensure a minimum level of implementation nationwide of services regarded as public health goods 4.(OLD) -To guarantee equitable.no threats. provide equity.(NEW) 5 Major Functions: 1. 7160 Local Govt Code – Local health board.A.approach behavior Health Prevention. Ensure equal access to basic health services 2. Ensure formulation of national policies for proper division of labor and proper coordination of operations among the government agency jurisdictions 3. community organizing Manufacturing Socio-civic groups companies Religious organizations/foundations Advertising agencies Private practitioners Private institutions NGOs – assumes the following roles: Policy and Legislative Advocates Organizers. relief and rehabilitation.avoidance behavior -Private Sector -Composed of both commercial and business organization.Governor ● Municipal health officer. 5. especially the poor. sustainable and quality health for all Filipinos. non – business organizations Commercial/Business Non-commercial Profit-oriented Orientation to social development.

Strengthen Health Services *PD 568 . which marks the beginning of its journey towards DOG vision.LGU Code NATIONAL HEALTH PLAN *National Health Plan is a long-term directional plan for health. with longer life expectancy. THRUSTS GOAL: *To improve health indicators through access. STRATEGIES. projects. BROAD OBJECTIVES: *promote equity in health status among all segments of society *address specific health problems of the population *upgrade the status and transform the HCDS into a responsive. . the blueprint defining the country’s health – PROBLEMS. low maternal mortality and less disability through measures that will guarantee access of everyone to essential health care.RHU Act *RA 1891 . and effective one in the provision of solutions to changing the health needs of the population *promote active and sustained people’s participation in health care “ MAJOR HEALTH PLANS TOWARDS “HEALTH IN THE HANDS OF THE PEOPLE IN THE YEAR 2020” “23 IN 1993” ● Refers to the 23 programs. activities of the DOH for the year 1993. low infant mortality.Restructuring HCDS *RA 7160 . dynamic and highly efficient. POLICY. Health Resource Development Personnel Relief and Disaster Management Networking PRIMARY STRATEGIES TO ACHIEVE HEALTH GOALS *Support for health goal *Assurance of health care *Increasing investment for PHC *Development of National Standard MILESTONE IN HEALTH CARE DELIVRY SYSTEM *RA 1082 . *To enable the Filipino population to achieve a level of health which will allow Filipino to lead socially and economically – productive life.

divorce. Health Link” ● A national & multi-sectoral health promotion strategy aimed at conveying health messages to people wherever they are aimed at building supportive environments through advocacy. and maintenance of a safe env’t. marriages. “ Health Focus in 1995” – “ Think Health. illnesses. reproductive health. Crude birth rate. “Health Sector Reform Agenda” ● Emphasizing on improvements in health care delivery by maximizing people’s participation in health “Sentrong Sigla Movement” ● Pertains to development & implementation of standards to provide quality health services to the people. separation and deaths. Health Indicators – a list of information which would determine the health of a particular community like population. Statistics of disease (morbidity) and death (mortality) indicate the state of health of a community and the success or failure of health work. community action & networking. neonatal death rates and tuberculosis death rate Health Indicators  Birth  Death  Marriages  Migration Use of Vital Statistics: *Indices of the health and illness status of a community . mental health. infant and maternal death rates. Vital Statistics – refers to the systematic study of vital events such as births. organizing and analyzing numerical facts so that conclusion may be drawn from them.“ Health for more in ‘94” ● Activities in 1994 focused on Cancer prevention. crude death rate. Vital Statistics VITAL STATISTICS Statistics – refers to a systematic approach of obtaining. C.

within a given area and during a specified unit of time. It must be presumed that the total population was exposed to the risk of the occurrence of the event. . Ratio – is used to describe the relationship between two (2) numerical quanitities or measures of events without taking particular considerations to the time or place. Crude since it is related to the total population including men.*Serves as bases for planning. Sources of Data: *Population census *Registration of Vital Data *Health Survey *Studies and researches Rates and Ratios: Rate – shows the relationship between a vital event and those persons exposed to the occurrence of said event. Crude Birth Rate – a measure of one characteristic of the natural growth or increase of a population. although the unit of measure must be the same for both numerator and denominator of the ratio. It limits the occurrence of the event to the portion of the population definitely exposed to it. it is evedent that the person experiencing the event (Numerator) nust come from the total population exposed to the risk of same event (Denominator). implementing. Measures how fast people are added to the population through birth b. Used often because of availability of data a.the relationship is for a specific population class or group. monitoring and evaluating community health nursing programs and services. children and elderly who are not capable of giving birth Crude Death Rate – a measure of one mortality from all causes which may result in a decrease of population. Crude or General Rates – referred to the total living population. Specified Rate . These quantities need not necessarily represent the same entities.

Neonatal Death Rate – measures the risk of dying the 1st month of life. poor environmental sanitation or deficient health service delivery c.a. a. and puerperium. HIGH IMR means LOW LEVELS of health standards secondary to poor maternal and child health care. It is an index of the obstetrical care needed and received by women in a community. SENSITIVE INDEX of level of health in a community b. It serves as an index of the effects of prenatal care and obstetrical management of the newborn. It is a good index of the general health condition of a community since it reflects the changes in environment and medical condition of a community. malnutrition. To understand the forces of mortality. Affected by:  Maternal health practices  Diagnostic ascertainment of maternal condition or cause of death  Completeness of registration of birth Fetal Death Rate – measures pregnancy wastage. Measures risk of dying from causes associated with childbirth b. Widely used because of availability of data Infant Mortality Rate – measure the risk of dying during 1st year of like. Crude because death is affected by different factors b. childbirth. a. May be artificially lowered by improving the registration of births Maternal Mortality Rate – measures the risk of dying from causes related to pregnancy. the rates should be made specific provided the data are available for both the . irrespective of duration of pregnancy. Specific Death Rate – describes more accurately the risk of exposure of certain classes of groups to particular diseases. Death of the product of conception occurs prior to its complete expulsion.

of deaths from all causes in all ages taken together. and the total no. Rate depends on:  Nature of the disease  Diagnostic ascertainment  Level of reporting in the population d. LOW INDEX implies that life expectancy is short b.population and the event in their specifications. Proportionate Mortality (Death Ratios) . Measures the killing power of a disease or injury b. This can only be detremined following a survey of the population concerned. Specific rates render more comparable and thus reveal the problem of public health. A HIGH CFR means a more fatal disease c. Prevalence Rate – measures the proportion of the population which exhibits a particular disease at a particular time. age (or group of age) etc. Directly proportional to the health status of a population. Expressed in PERCENTAGE. Incidence Rate – measures the frequency of occurrence of the phenomenon during a given period of time. where developed countries have higher Swaroop’s Index than developing countries Case Fatality Rate a.shows the numerical relationship between deaths from all causes (or group of causes). a. CFR from hospitals HIGHER than from the community Morbidity Rate *Incidence Rate . Swaroop’s Index a. Used in ranking cause of death by magnitude of frequency b. deals with the total (new and old) number of cases.

Bar graphs – each bar represents or expresses a quantity in terms of rates or percentages of a particular observation like causes of illness and deaths. Can be made specific for age and sex *Attack Rate a. Methods: *By applying observed specific rates to some standard population. usually during an outbreak or epidemic Prevalence Rate a. Useful in describing the occurrence of chronic conditions and as basis for making decisions in the administration of health services b. Period Prevalence Adjusted or Standardized Rate – to render the rates of 2 communities comparable. sex. Also used to show the trends of birth and death rates over a period of time. . *By applying specific rates of standard population to corresponding classes or groups of the local population. valleys and seasonal trends. Useful also in computing for carrier rates and antibody levels A. Point Prevalence B. adjustment for the differences in age. Presentation of Data The following are most commonly used graphs in presenting data: Line or Curved graphs – shows peaks. and any other factors which influence vital events have to be made. Used for a limited population group and time period. Measures the development of a disease in a group exposed to the risk of the disease in a period of time b.a.

Magnitude / Nature of the rate D. 3753 requires the registration of all births and death – c/o National Census and Statistics Office b. Epidemiology EPIDEMIOLOGY- -**The study of distribution of disease or physiologic conditions such as deformities or disabilities and even death among human populations. Use of correct numerator d. Definition/ Classification of the event in either numerator or denominator for consistency b. .For comparison of data. Reckoning of Age – age is recorded as of Last Birthday 3. Area diagram (Pie Charts) – shows the relative importance of parts of the whole. INTERPRETATION OF VITAL STATISTICS Sources of Data  Vital Registration Records a. And the factors affecting such distribution. Accuracy of the count of event or population concerned c. Civil Registry Law or Republic Act No. PD 651 – requires all health workers to register births within 30 days following delivery  Weekly Reports from Field Health Personnel  Population Censuses – done every 5 years c/o the National Census and Statistics Office. NOT by place of residence 2. Functions of the Nurse: *Collects data *Tabulates data * Analyzes and interprets data *Evaluates data *Recommends redirection and / or strengthening of specific areas of health programs as needed. GUIDELINES IN THE CLASSIFICATION OF DATA 1. Reckoning of Vital Events – all vital events are registered and reported by place of occurrence. Classification of Disease and Causes of Death a.

disability and mortality. 7. 2. This emphasizes that epidemiologist are concerned not only with deaths. inheritance. illness and disability. Complete the clinical picture of chronic disease and describe their natural history. Agents of Disease: *Nutritive elements in excess or in deficiencies. Diagnose the health of the community and the condition of people to measure the distribution and dimension of illness in terms of incidence. *Genetics *Age *Sex *Ethnic group . 5. Search for causes of health and disease by comparing the experience of groups that are clearly defined by their composition. to set health problems in perspective and to define their relative importance and to identify groups needing special attention. *Chemical Agents *Physical Agenta *Infectious Agnets Host Factor (intrinsic factors) – influence exposure. Study the work of health services with a view of improving them. -**Epidemiology is the backbone of the prevention of diseases. behavior. epidemiology is used to: 1. Operational research shows how community expectations can result in the actual provisions of service. and the application of this study to the control of health problems. Aim: To identify factors of causation as basis for determining preventive and control measures. Host and Environment. accident. and environment. defects and the chances of avoiding them. -**Study of occurrences and distribution of diseases as well as the distribution and determinants of health state or events in a specified population. susceptibility or response to agents. but also with more positive health states and with the means to improve health. Estimate the risk of disease. Study the history of the health population and the rise and fall of diseases and changes in their character. Epidemiological triangle: Agent. 3. Uses of Epidemiology: According to Morris. prevalence. experience. 6. 4. Identify syndromes by describing the distribution and association of clinical phenomena in the population.

place of residence. VERIFICATION OF DIAGNOSIS -Stating one’s definition of a disease / diagnosis based on the presenting signs and symptoms. B. A change in any of the component will alter an existing equilibrium to increase or decrease the frequency of the disease.*Physiologic functioning *Immunologic experience *Inter – current to pre – existing disease *Human behavior Environmental factors (extrinsic factors) – influence existence of the agent. A.Deals with the collection. sex. Place – extrinsic factors. Increase man’s resistance or imunity to disase agents. excludes non cases or avoids FALSE POSITIVES. 2. Sensitivity – indicates the strength of association between a sign / symptom and the disease. Factors Affecting the Community’s Reaction to Disease Agent Invasion . Person – intrinsic characteristics such as age. and analysisof data regarding the occurrence of disease other health conditions. *Physical environment *Biologic environment *Socio – economic environment The Epidemiologic Triangle consists of three component – host. Preventive strategies: 1. environment and agent. genetic endowment and other factors such as occupation. The model implies that each must be analyzed and understood for comprehensions and prediction of patterns of a disease.Change the people’s behavior to manipulate the environment and reduce their exposure to biological and non – biological disease agents. picks up most cases and avoids FALSE NEGATIVES. organization. Consider Two Factors: 1. 2. Specificity – shows the uniqueness of the association between a sign / symptoms and the disease. Manipulate the environment and prevent production or presence of disease agents. 2. DESCRIPTIVE PHASE . income are analyzed to identify susceptible groups in a certain locality. DESCRIPTION OF THE DISEASE / CONDITION *Factors affecting distribution: 1. 3. exposure or susceptibility to agents.

weekly. *Correlational *Case Reports Observational Intervention *Ecologic *Case Series (Experimental) *Cross – Sectional surveys *Case control *Trials *Cohort Experimental Non . disease in terms of person. Susceptibility Status – determined by the number of individuals with little or no immunity. Endemic – habitual presence of disease in a given geographic location accounting for the low number of both immunes and susceptible. Time – temporal patterns. *Causal – when there is evidence that shows that certain factors increase the probability of occurrence of a disease and a change in one or more of these factors produces a change in the occurrence of the disease *Non Causal – a. Sporadic – disease occurs every now and then affecting only a small number of people relative to the total population. 3. level of immunity of the group. expressed on a daily. Patterns of Disease Occurrence Epidemic – a situation when there is a high incidence of new cases of a specific disease in excess of the expected.a. C. Herd Immunity – state of resistance of a population group to a particular disease at a given time. place and causes characteristics. Indirect – when a factor and disease are associated only because both are related to some common underlying condition. b. Types of Epidemiological Study Designs Descriptive VS Analytical Provides information on patterns of Test Hypothesis about of disease. or yearly basis. monthly.Experimental . Spurious – due to chance or bias caused by certain procedures / aspects involved in study. ANALYSIS OF DISEASE PATTERN -one tries to find out if there is a statistical relationship between a disease and biological or social factors. Pandemic – global occurence of a disease. b.

occupation. group. 2. -Relation to milk and food supply. Correlation of all data obtained. STAGES OF A DISEASE: BACKBONE TO CONTROL A DISEASE Incubation period- -exposure to an infection to the appearance of the firstsymptom Prodromal period -from the appearance of the first symptom to theappearance of a pathognomonic sign Stage of illness . -Verify diagnosis – do clinical and laboratory studies to confirm the data. -Relationof cases and known carrier if any. color. sex. -Summarize the data clearly with the aid of such tables and charts which are necessary to give a clear picture of the situation. weeks or months. -Build up the case for the final conclusion carefully utilizing all the evidence available. Establish fact of presence of epidemic. 4. Establish time and space relationship of the disease. -Relation of cases to age. school attendance. -Are the cases limited to or concentrated in any paricular geographical subdividion of the affected community? -Relation of cases by days of onset to onset of the first known cases – maybe done by days.With manipulation Mere observation of study conditions *Clinical Trials *Cohort *Field Trials *Case Control *Community Intervention Trials *Proportional – Mortality Studies *Cross – Sectional *Ecologic Common Epidemiologic Studies: Retrospective Cross – Sectional Prospective Cohort Outline of Plan for Epidemiological Investigation: 1. Relations to characteristic of the group of community. past immunization. 3.

Communicate findings 11. Demography DEMOGRAPHY -The emprical. Refine hypotheses and execute additional studies 9. derived from two Greek word snyos. political and legal concerns 5. Verify diagnosis 4. Sample Surveys c.Research opportunities 4. Developing hypotheses 7. Evaluate hypotheses 8. -Focus on three common and observable human events: a. which means people and ypagly which means to draw or write. Population size -Sources of Demographic Data a. Registration system . Population compposition or structure b.stage of recovery.Prepare for field work 2. Perform descriptive epidemiology 6.Establish existence of an outbreak 3. Define and Identify cases 5.-a stage where the patient manifest most of the signs andsymptoms Convalescence .Severity and risks to others 3. Follow –up Recommendations E.Program consideration 6. Distribution of population in space c. and a gradual decrease of symptomsmanifested National Epidemic Sentinel System (NESS) -hospital-based information system that monitors the occurrence of infectiousdiseases with outbreak potential. Census – complete enumeration of the population. b.Public. Implement control and prevention measures 10. statistical and mathematical study of human population.Control and prevention measure 2.training Steps in Outbreak Investigation: 1. Why is there a need to investigate an outbreak? 1.

Median Age – age below which 50% of the population fall and above which 50% of the population fall. COMPONENTS 1. b. e. Population Density – determines congestion of the place. 2. Crowding Index – indicates the ease by which a communicable disease can be transmitted from one host to another susceptible host. 2. De Jure – people are assigned to places where they usually live regardless of where they are at the time of the census. Population Size a. a. Life Expectancy at Birth – average number of years an infant is expected to live under the mortality conditions for a given year. Population Distribution a. c. Sex Ratio b. 3. . Age – dependency Ratio – used as an index of age – induced economic drain of human resources c. De Facto – people are assigned to the place where they are physically present at the time of the census. Urban – Rural Distribution – shows the proportion of people living in urban compared to the rural areas. Age and Sex Composition – graphical presentation of the age and sex composition of a population through the use of a POPULATION PYRAMID d. Population Composition – pertains to all measurable characteristics of the people who make up a given population. Two ways of Assigning People 1. Natural Increase – difference between the number of births and the number of deaths that occurred in a specific population within a specified period of time. regardless of their usual place of residence.

budgeting. Management of Resources and Environment and Records Management A. facility level data base which can be assessed for a more in – depth study /studies.Helps midwives in following up clients. .b. treatment and date of treatment if recorded. district.Source of data to detect unusual occurrence of a disease.Needed to monitor health status of the community.Basis for planning. logistics and decision making at all levels. . . .To provide summary of data on health services delivery and selected program accomplished indicators at the barangay municipality / city. 2013) / *INDIVIDUAL TREATMENT RECORD *TARGET CLIENT LIST *REPORTING FORMS / SUMMARY TABLE *OUTPUT REPORTS /MONTHLY CONSOLIDATION TABLE (MCT) Concept: *TREATMENT RECORD  Fundamental building block or foundation of FHSIS.  This is the document.Basis for monitoring and evaluatinghealth program implementation. -To minimize the recording and reporting burden at the service delivery level in order to allow more time for patient care and promotive activities. . Rate of Natural Increase – difference between CBR and CDR of a specific population within a specified time. 2007) Objectives: . form or pieces of paper upon which the presenting symptoms or complaints of the patient on consultation and the diagnosis. 2007) / INDIVIDUAL RECORD (Famorca. regional and national events. Components: *FAMILY TREATMENT RECORD (Cuevas. -To ensure that the data reported to the FHSIS are useful and accurate and are disseminated in a timely and easy – to – use fashion. -To provide a standardized.Helps local government determine public health priorities. . provincial. Field Health Services and Information System ( FHSIS ) FIELD HEALTH SERVICES AND INFORMATION SYSTEM (Cuevas. III.Documentation of RHM / PHN day to day activities. . Importance of FHSIS . -To provide data which when combined with data from other sources. ca be used for program monitoring and evaluation purposes.

Diagnosis (if available) . and in some instances. e.  The Third purpose is to report services delivered.Date. INDIVIDUAL TREATMENT RECORD (ITR) . National Leprosy Control Program Form 2-Central Registration Form *TALLY / REPORTING FORMS  Submitted monthly or quarterly (majority).g.  First is to plan and carry out patient care and service delivery.g. TCL for prenatal care. . Target Client List for Post-Partum Care 3. Target Client List for Family Planning 5. . Target Client List of Under 1 Year Old Children 4.To report services delivered. . TARGET CLIENT LIST (TCL) . e. .. 2.Presenting symptoms or complaint of the patient on consultation.  The fourt purpose of the Target Client Lists is to provided a clinic – level data base which can be accessed for further studies. 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. FHSIS Manual of Operations has the following RECORDING TOOLS: 1.  One report is prepared weekly several annually. TCL for postpartum care. TARGET CLIENT LISTS TO BE MAINTAINED IN THE FHSIS 1. NTP TB Register 7.*CLIENT LIST  Second “building block” of the FHSIS and are intended to serve several purposes. . Target Client List for Sick Children 6. Target Client List for Prenatal Care 2. maternal and neonatal deaths.To carry / plan out care for patient.Treatment and Date of treatment. every few minutes as relevant events occur. Home address of patient ..  The second purpose of Target Client Lists is to facilitate the monitoring and supervision of service delivery activities.To provide clinic – level data base.Facilitate monitoring / supervision of service delivery activities.

2013) FHSIS Manual of Operations REPORTING FORMS: . 2.Disease Control .serves as a source for the 10 leading causes of morbidity.Only one quarterly form for every Municipality / City .3.3 – months consolidation of Morbidity Report (M2) 3.3 – months total indicators: Maternal Care. 1. MONTHLY FORMS . ANNUAL FORMS a. program report.If there are 2 RHU / Centers for the Municipal Health Officer / Mayor.These are summary data that are transmitted or submitted on a monthly. SUMMARY TABLE .Source document for the Quarterly form and the Output Table of the RHU or Health Center. Dental Health and Disease Control. Morbidity Report (Q2) . (Famorca.Based on the Summary Table. A – BHS *Report by the Midwife – Demographic .Accomplished by Midwife . Child Care. b.Accomplished by the Nurse . 2013) b. 4. MONTHLY CONSOLIDATION TABLE .Prepared by the Midwife . The source of data for this components is dependent on the records.Submitted to the Nurse a.Quartely Forms are submitted to the provincial health officr / Office. Morbidity Report (M2) .monthly summary of morbidity / monthly trends of disease . Program Report (Q1) . . Family Planning. QUARTERLY FORMS .Contains list of all cases of disease by age and sex. .Environmental .Prepared by the Nurse .Summary Table Data are copied into this report. (Famorca.Child Care .12 column table = 12 months of calendar year . a.Family Planning . Program Report (M1) .Maternal Care . quarterly and on annual basis to higher level.

Annual Form 3 (A-3) . Since the Universal Child Immunization goal of 80% was achieved in 1989.Prepared by the Nurse .Prepared by the Nurse .  Maintenance of quality immunization Services a. Eligible Population . Target-setting TARGET SETTING -Involves the calculation of the eligible population for immunization services. Annual Form 1 (A-1) . Environmental. The two most important goals are the following:  Sustainability of the high coverage and.Demographic.Prepared by the Nurse . c. Annual Form 2 (A-2) .Natality Data b.Yearly Report for morbidity by age / sex d. the target for immunizations since 1992 onwards has increased to 90%.Natality and Mortality for the entire year.Report of the RHU / Health Center . FLOW OF REPORT OFFICE PERSON RECORDING FORMS FREQUENCY SCHEDULE OF TOOLS SUBMISSION BHS Midwife -ITR Monthly Monthly Every 2nd week -TCL Form (M1 of the -ST AND M2 ) succeeding month A-BHS Annually Form Every 2nd week of january RHU PHN -ST Quarterly Quarterly Every 3rd week -MCT Form (Q1 of the 1st month AND Q2) of succeeding quarter Annual Every 3rd week Forms of January -A1 -A2 -A3 B. .Yearly Report of all deaths (mortality) by age and sex.

Determining Needle and Syringe Requirements *How to Calculate Needle and Syringe Requirements Step One: Determine the eligible population Step Two: Determine the monthly eligible population . BCG School Entrants – use 3% of the total population in calculating the number of children entering first grade in one year. b. From step two. Target Setting must include the number of pregnancies that will terminate in live births (3% of the total population) plus the number of the pregnancies (0. Calculating Vaccine Needs *How to Calculate Vaccine Needs -Step One: Determine the eligible population. the percentage of eligible women in the total population is 3. province/city and region. Infants – for EPI in a barangay.25 C. -Step Three: Determine the wastage rate of antigen or use the wastage multiplier. multiply the product with the wastage multiplier to get the annual needs including the wastage allowance. -Step Two: Determine the number of doses required in a year by multiplying the eligible population with the number of doses for complete immunization. target setting is based on 3% of the total population. 3.5 % of the total population): thus. 2. municipality.5%. district. Pregnant Women – All pregnant women are eligible for EPI. -Step Four: Determine the number of ampoules or vials needed by dividing the annual dose by the dose per vial or ampule ANNUAL VACCINE NEEDS PER VIAL DOSE = Annual Vaccine / Dose per vial or ampule -Step Five: Determine the vaccine need per month or quarter MONTHLY VACCINE NEEDS QUARTERLY VACCINE NEEDS = Total Vials or ampules / 12 = Total Vials or ampules / 4 months quarters Step Six: Determine the vaccine need per month or quarter with reserve stock MONTHLY VACCINE NEEDS = (Total Vials or ampoules / 12 months) X 1. 1.

25 for syringes TOTAL REQUIRED NEEDLES = Monthly injections X 1. TOTAL REQUIRED SYRINGES = Monthly injections X 1. well – being and survival. located at that is suited for densely system for rural not more than 25 meters from populated urban areas . COMPONENTS:  Water Supply Sanitation Program  Proper Excreta and Sewage Disposal Program  Insect and Rodent Control  Food Sanitation Program  Hospital Waste Management Program  Strategies on Health Risk Minimization due to Environmental Pollution a. a piped distributor with an outlet but distribution network and network and household taps without a distribution communal faucets. Goal: to eradicate and control environmental factors in disease transmission through the provision of basic services and facilities to all house holds. MONTHLY ELIGIBLE POPULATION = Annual eligible population / 12 months Step Three: Multiply the monthly eligible population by the number of doses required for each antigen MONTHLY INJECTIONS = Monthly eligible population X doses required per antigen Step Four: Determine the total requirement including additional allowance for syringes and needles. a reservoir. a piped reservoir. Water Supply Sanitation Program Three Types of Approved Water Supply and Facilities Level I Level II Level III Point Source Communal Faucet System Waterworks System or or Stand Posts Individual House Connections A protected well or a A system composed of a A system with a source. a developed spring source.50 for needles C. Environmental Sanitation ENVIRONMENTAL SANITATION -is defined as the study of all factors in man’s physical environment which may exercise a deleterious effect on his health.

REFUSE is a general term applied to solid and semi – solid waste materials other than human excreta. Garbage refers to leftover vegetable. Proper Excreta and Sewage Disposal Program Three Types of Approved Toilet Facilities Level 1 Level 2 Level 3 Non. Waste material in refuse may be divided into: 1. Rubbish refers to waste materials such as bottles. These materials have the tendency to decay. Aqua Privies. -Pour flush. porcelain wares. Stable Manure is animal manure collected from stables . and fish material from kitchen and food establishments. giving off foul odor and sometimes also serve as food for flies and rats 2. facilities Compost. Proper Solid Waste Management -refers to satisfactory methods of storage collection and final disposal of solid water. pieces of metal and other wrapping materials 3. Ventilated improved pit Toilet requiring small amount of water to wash waste into receiving space. broken glass. vault/ tank disposal treatment plant Bored – Hole. with water sealed and to septic tanks and/or Reed Odorless Earth flushed type with septic sewerage system to a closet. Rural Areas – “blind drainage” type of wastewater collection and disposal facilities shall be emphasized until such time that sewer facilities and off – site treatment facilities are available. tin cans. waste paper.water carriage On site toilet facilities of Water carriage types of toilet facility the water carriage type toilet facilities connected Pit latrines.areas where houses the farthest house in rural are thinly scattered areas where houses are clustered densely Water must pass the National Standards for Drinking Water set by the DOH b. Ashes may become a nuisance because of the dust associated with them 4. discarded textile materials. animal. Ashes are leftover from burning of wood and coal. c. thus.

3. compacting with a solid Open Burning cover of 2 feet Animal Feeding -Incineration. f. 2. Policies: 1. especially incinerators. pigs and chicken that were killed by vehicles on streets and public highways. cats. Comply with updated health certificates for food handlers. rats. All ambulant vendors must submit a health certificate to determine presence of intestinal parasite and bacterial infection. located 25m away deposition of refuse and from water supply. pathological and other hospital wastes. Food Sanitation Program Policies: 1. 3 Points of Contamination *Place of production processing & source of supply *Transportation and storage *Retail & distribution points e. Composting Grinding and disposal sewer d. 3. cooks. 2. Hospital Waste Management Program Goal: to prevent the risk of contracting nosocomial infection and other diseases from the disposal of infectious. shall be institutionalized. 4. Food establishments are subject to inspection. Dead Animals include dead dogs. Strategies on Health Risk Minimization due to Environmental Pollution These include the following: . TWO WAYS OF EXCRETA DISPOSAL Household Community Burial Sanitary Landfill or >Deposited in 1 m x 1m Controlled Tipping deep pits covered with >Excavation of soil soil. 5. The use of appropriate technology and indigenous materials for HWM system shall be adopted. Comply with sanitary permit requirement for all food establishments. helpers. Local ordinances regarding the collection and disposal techniques. Training of all hospital personnel involved in waste management shall be an essential part of the hospital training program.

a. Anti-smoke belching campaign and air pollution campaign
b. Zero solid waste management
c. Toxic, chemical and hazardous waste management
d. Red tide control and monitoring
e. Integrated pest management and sustainable agriculture
f. Pasig river rehabilitation Management

g. Education of prevailing health problems
-Accepted activity at all levels of public health used as a means of improving
the health of the people through techniques w/c may influence people’s thought
motivation, judgment & action.

3 Aspects of Health Education:
*Information – provision of knowledge
*Communication – exchange of information
*Education – change in knowledge, attitudes and skills.

Sequence of Steps in Health Education
*Creating awareness.
*Creating motivation.
*Decision making action.

IV. Ethico-Moral-Legal Responsibility
A. Socio-cultural Values, Beliefs and Practices of Individuals, Families, Groups
and Communities
B. Code of Ethics for Government Workers
THE CODE OF ETHICS FOR GOVERNMENT WORKERS
C. WHO, DOH, LGU Policies on Health
D. Local Government Code
E. Issues

V. Personal and Professional Development
A. Self-assessment of CHN Competencies, Importance, Methods, Tools
B. Strategies and Methods of Updating One’s Self, Enhancing Competence in
Community Health Nursing and Related Areas.

VI. Part II: MCN

VII. Safe and Quality Care, Health Education, and Communication, Collaboration
and Teamwork
A. Principles and Theories of Growth and Development (Pediatric Nursing)

PRINCIPLES OF GROWTH AND DEVELOPMENT
PRINCIPLES EXAMPLES
Growth and development are Although there are highs and lows in
continuous processes from conception terms of the rate at which growth and
until death development proceed, a child grows
new cells and learns new skills at all
times. An example of how the rate of
growth changes is a comparison
between that of the first year and later in
life. An infants triples birthweights and
increases height by 50% during the first
year of life. If this tremendous growth
rate were to continue, the 5 –ye-old
child, when ready to begin school,
would weigh 1,600 Ib. And be 12 ft. 6 in.
Tall.
Growth and development proceed in an Growth in height occurs in only one
orderly sequence. sequence – from smaller to larger.
Development also proceeds in a
predictable order. For example, the
majority of children sit before they
creep, creep before they stand, stand
before they walk, and walk before they
run. Some children may skip a stage (
or pass through it so quickly that the
parents do not observe the stage) or
progress in a different order, but most
children follow a predictable sequence
of growth and development.
Different children pass through the All stages of development have a range
predictable stages at different rates. of time rather than a certain point at
which they are usually accomplished.
Two children may pass through the
motor sequence at different rates. For
example, one child begins walking at 9
months while another at 14 months.
Both are developing normally. They are
both following the predictable sequence;
they are merely developing at different
rates.
All body systems do not develop at the Certain body tissues mature more
same rate. rapidly than others. For example,
neurologic tissue experiences its peak

growth during the first year of life,
whereas genital tissues grows little until
puberty.
Development is cephalocaudal. Cephalo is a Greek word meaning
“head”; Caudal means “tail.”
Development proceeds from head to
tail. A newborn can lift only his or her
head off the bed when he or she lies in
a prone position. By age 2 months., the
infant can lift his or her head and chest
off the bed; by 4 months., he or she can
lift his or her head, chest, and part of
the abdomen; by 5 months., the infant
has enough control to turn over ; by 9
months., he or she can control the legs
enough to crawl; and by 1 year., the
child can stand upright and perhaps
walk. Motor development has
proceeded in a cephalocaudal order –
from the head to the lower extremities.
Development proceeds from proximal to This principle is closely related to
distal body part. cephalocaudal development. It can be
illustrated by tracing the progress of
upper extremity development. A
newborn makes ;ittle use of the arms or
hands. Any movement, except to put a
thumb in the mouth, is a flailing motin.
By age 3 or 4 months., the infant has
enough arm control to support the upper
body weight on the forearms, and the
infant can coordinate the hand to sccop
up objects. By 10 months., the infant
can coordinate the arm, thumb, and
index fingers, sufficiently well to use a
pincer-like grasp or be able to pick up
an object as fine as a piece of breakfast
cereal on a high-chair train.
Development proceeds from gross to This principle parallels the proceeding
refined skills. one. Because the child is able to control
distal body parts such as fingers, he or
she is able to perform fine motor skills (
a 3-year- old colors best with a large
crayon; a 12 yr-old can write with a fine

pen).
There is an optimum time for initiation of A child cannot learn a task until his or
experiences or learning. her nervous system is mature enogh to
allow that particular learning. A child
cannot learn to sit, for example, no
matter how much thechild’s
parentshave him or her practice, until
the nervous system has matured
enough to allow back control. A child
who is not given the opportunity to learn
developmental tasks at the appropriate
or “targert” times for such tasks may
have ,ore difficulty than the usual child
learning the tasks later on. A child who
is confined to a body cast at 12
months., which is the time he or she
would normally learn to walk, may take
a long time to learn this skill once free of
the cast at, say, age 2 years old. The
child has passed the time of optimal
learning fo that particular skill.
Neonatal reflexes must be lost before An infant cannot grasp with skill until the
development can proceed. grasp reflex has faded nor stand
steadily until the walking reflex has
faded. Neonatal reflexes are replaced
by purposeful movements.
A great deal of skill and behavior is An infants practices taking a first step
learned by practice. over and over before he or she
accomplishes this securely. If a child
falls behind the normal growth and
development rate because of illness, he
or she is capable of “catch-up” growth to
bring him or her on equal footing again
with his or her age group.

THEORIES OF DEVELOPMENT

1. Definition of Theories
Theory – a systematic statement of principles that provides a framework for
explaining some phenomenon. Developmental theories provide road maps for
explaining human development.
Developmental Task – a skill or a growth responsibility arising at a particular time
in an individual’s life, the achievement of which will provide a foundation for the

accomplishment of future tasks. It is not so much chronological as the completion
of developmental tasks that defines whether a child has passed from one
developmental stage of childhood to another. For example, a child is not a toddler
just because he or she is 1 year plus 1 day old; he or she becomes a toddler when
he or she has passed through the development stage of infancy.

2. Basic Division of Childhood
Stage Age Period
Neonate From 28 days of life
Infant 1 month – 1 year
Toddler 1 – 3 years
Preschooler 3 – 5 year
School-age child 6 – 12 years
Adolescent 13 – 20 years

3. Freud’s Stages of Childhood (Psychosexual Development)
Stage Psychosexual Stage Nursing Implications
Infant ORAL STAGE: Child explores the Provide oral stimulation
world by using his or her mouth, by giving pacifiers; do not
especially the tongue. discourage thumb
sucking. Breastfeeding
may provide more
stimulation than formula
feeding because it
requires the infant to
expend more energy.
Toddler ANAL STAGE: Child learns to Help children achieve
control urination and defecation. bowel and bladder control
without undue emphasis
on its importance. If at all
possible, continue bowel
and bladder training while
child is hospitalized.
Preschooler PHALLIC STAGE: Child learns Accept child’s sexual
sexual identity through awareness interest,such as fonding
of genital area. his or her own genitals, as
a normal area of
exploration. Helps parents
answer the child’s
questions about birth or
sexual differences.
School-age child LATENT STAGE: Child’s Help the child have
personality development appears positive experiences as

to be non-active or dormant. his or her self-esteem
continues to grow and as
he or she prepares for the
conflicts of adolescence.
Adolescent GENITAL STAGE: Adolescent Provide appropriate
develops sexual maturity and opportunities for the child
learns to establish satisfactory to relate with opposite
relationships with the opposite sex. sex; allow the child to
verbalize feelings about
new relationships.

Erikson’s Stages of Childhood (Psychosocial Development)
Stage Developmental Task Nursing Implications
Infant Developmental task is to Provide a primary
form a sense of trust caregiver.Provide
versus mistrust. Child experiences that add to
learns to love and be security such as soft
loved. sounds and touch.
Provide visual stimulation
for active child
involvement.
Toddler Developmental task is to Provide opportunities for
form a sense of autonomy decision makingsuch as
versus shame. Child offering choicesof clothes
learns to be independent to wear or toys to play
and make decisions for with. Praise ability to
himself or herself. make decisions rather
than judge or correct the
child’s decision.
Preschooler Developmental task is to Provide opportunities for
form a sense of initiative exploring new places or
versus guilt. Child learns activities. Allow play to
how to do things (basic include activities involving
problem solving) and that water, clay (for modeling),
doing things is desirable. or finger paints.
School-age child Developmental task is to Provide opportunities
form a sense of industry such as allowing child to
versus inferiority. Child assemble and complete a
learns how to do things short project so that the
well. child feels rewarded for
the accomplishement.
Adolescent Developmental task is to Provide opportunites for
form a sense of identity the adolescent to discuss

An enjoyable activity for the period: a rattle or a tape of parent’s voice. Good toy for this period: mirror. versus role confusion. or she is and what kind of Offer support and praise person he or she will be for decision making. reaction recognize. seeking emancipation from parents. feelings about events Adolescent learns who he important to him or her. by adjusting to a new body image. Primary circular reaction 1 – 4 months Hand – mouth and ear – eye coordination develop. . infants anticipates familiar events ( a parent coming near him will pick him up ). Memory traces are present. Piaget’s Stages of Cognitive Development Stage of Development Age Span Nursing Implication Sensorimotor neonatal 1 month Stimuli are assimilated reflexes into beginning mental images. good game: peek – a – boo. Infant spends much time looking at objects and separating self from them. and repeatpleasurable experiences from environment. Secondary circular 4 – 8 months Infant learns to initiate. choosing a vocation. and determining a value system. Beginning intention of behavior is present ( the infant brings thumb to mouth for a purpose: to suck it ).Behavior is entirely reflexive.

Pre – operational thought 2 – 7 years Thought becomes more . and foresees maneuvers that will succeed or fail. Invention of new means 18 – 24 months Transitional phase to the through mental pre – operational thought combination period. Good toys for this period: those with several uses such as blocks and colored plastic rings.g. can search for and retrieve toy that disappears from view..Coordination of 8 – 12 months Infant can plan activities to secondary reaction attain specific goals. Good game for this period: throw and retrieve. and can recognize shapes and sizes of familiar objects. infant experiences separation anxiety when primary caregiver leaves. can perceive that others can cause activity and that activities of own body are separate from activity of objects. solves basic problems. colored boxes ). Child uses memory and imitation to act. Object outside seff are understood as causes of actions. Tertiary circular reaction 12 – 18 months Child is able to experiment to discover new properties of objects and events and is capable of space and time perception as well as permanence. Because of increased sense of separateness. Good toy for this period: nesting toys ( e.

although thinking is basically concrete and literal.. No awareness of reversibility (for every action there is an opposite action) is present. so that at the end of a sentence.g. oranges). Concrete operational 7 – 12 years Concrete operations thought include systematic reasoning. Centering or focusing on a single aspect of an object causes distorted reasoning. Child can arrive at answers mentally instead of through physical attempt and can comprehend simple abstractions.g. Child is unable to state cause – effect relationships. Objects are sorted according to . the child is already talking about another toipc). fruit) and subgroups of concepts (e. apples. categoris or abstractions. Child is egocentric (unable to see the viewpoint of another) and displays static thinking (inability to remember what he or she started to talk about. and concept of distance is only as far as he or she can see. Concept of time is now. Good toy for this perio: Items that require imagination such as modeling clay. Uses memory to learn broad concepts (e. sympbolic.

and sees constancy despite transformation (mass or quantity remains the same even if it changes shape or position). and future. in which objects are ordered according to increasing or decreasing measures such as weight. and can deal with the past. An opposite operation or continuation of reasoning back to a starting point (follows a route through a maze and then reverses steps). Expose child to other view points by asking questions like “How do you think you’d feel if you were a nurse and had to tell someone to stay in bed?” Formal operational 12 years Adolescent can solve thought hypothetical problems with scientific reasoning. etc. Child is aware of reversibility. Good activity for this period: “talk time” to sort through attitudes and opinions. sea shells. understands conservation. and multiplication. . Good activity for this period: collecting and classifying natural objects such as native plants. seriation. present. can understand causality. attributes such as color. Adult or mature thought. in which objects are simultaneously classified and seriated using weight.

Nursing Care of Women with Complications of Pregnancy. Nursing Care of the Newborn 1. Anticipatory guidance 8. temperature) F. Nursing Care of High-risk Newborn 1. New York: Basic Books. (1961). Immunization 7. J. Safety 3. Delivery and Postpartum Period (High-risk conditions) G. Labor. Nursing Care of Women during Normal Labor. Nursing Care in the Different stages of Growth and Development including 1. Human Sexuality and Reproduction including Family Planning D. Newborn Scoring 3. Play 6. Discipline 5. Prematurity . with permission. Language Development 4.From Piaget. Maintenance of Body Processes (oxygenation. Values formation C. Delivery and Postpartum E. APGAR Scoring 2. The growth of logical thinking from childhood to adolescence. Kohlberg’s Stages of Moral Development Age Stage Description Nursing Implications (Year ) Pre – conventional (Level I) 2-3 1 B. Nutrition 2.

Nursing Care of Women with Disturbances in Reproduction and Gynecology VIII. Families related to MCN. Congenital defects 3. Enhancing Competence in MCN and Related Areas. Infections H. LGU Policies on Health of Women and Children C. Importance. Strategies and Methods of Updating One’s self. Methods. Personal and Professional Development A. Infant Morbidity and Mortality C. WHO. B. Ethico-Moral-Legal Responsibility A. Belief. and Practices of Individuals. Family Code D. Child and Youth Welfare Code E. . DOH. Issues related to MCN X. Socio-Cultural Values. Maternal Mortality D. Self-assessment of MCN Competencies. Research and Quality Improvement A. Tools B.2. Standards of Maternal and Child Nursing Practice IX. Fertility Statistics B.

Central Nervous System 4. principles and processes in the care of clients with altred health patterns. -Identifying pain as the fifth vital sign suggests that the assessment of pain should be as automatic as taking a client’s BP abd Pulse. V TEST DESCRIPTION: Theories. .the fifth vital sign – American Pain Society 2003.an unpleasant sensory and emotional experience associated with actual or potential THE PATHOPHYSIOLOGY OF PAIN Basic Categories of Pain: 1. Health Education. Pain Transmission: 1. utilizing the nursing process and integrating the key areas of nursing competencies. 2. Safe & Quality Care. Nociceptors are called pain receptors.sudden pain which is usually relieved in seconds or after a few weeks. IV. and Quality Improvement. Chronic Pain (Non-Malignant).Nursing Board Exam/Nursing Licensure Exam Coverage (Nursing Practice III.constant. -“Whatever the person says it is. Peripheral Nervous System 3. Client in Pain CLIENT IN PAIN Pain. Descending Control System . IV and V) NURSING BOARD EXAM SCOPE/COVERAGE NURSING PRACTICE III. 1999 -Emphasizes the highly subjective nature of pain. potentially damaging stimuli. Cancer-Related Pain. -Pain is the most common reason client seek medical advice. TEST SCOPE: I.May be acute or chronic. -Pain is protective mechanism or a warning to prevent further injury. These are the free nerve endings in the skin that respond to intense. Acute Pain. concepts. existing whenever the experiencing person says it does” – McCaffery and Pasero. may or may not be relieved by medications. 2. intermittent pain which usually persists even after healing of the injured tissue 3. Management of Environment & Resources. TEST III 1. A.

secondary to upper airway obstruction tachypnea: abnormally rapid respirations tidal volume: volume of air inspired and expired with eachbreath during normal breathing ventilation: movement of air in and out of airways wheezes: continuous musical sounds associated with airway narrowing or partial obstruction . discontinuous popping sounds during inspiration caused by delayed reopening of the airways diffusion: exchange of gas molecules from areas of high concentration to areas of low concentration dyspnea: labored breathing or shortness of breath egophony: abnormal change in tone of voice that is heard when auscultating lungs fremitus: vibrations of speech felt as tremors of chest wall during palpation hemoptysis: expectoration of blood from the respiratory tract hypoxemia: decrease in arterial oxygen tension in the blood hypoxia: decrease in oxygen supply to the tissues and cells obstructive sleep apnea: temporary absence of breathing during sleep secondary to transient upper airway obstruction orthopnea: inability to breathe easily except in an upright position oxygen saturation: percentage of hemoglobin that is bound to oxygen physiologic dead space: portion of the tracheobronchial tree that does not participate in gas exchange pulmonary perfusion: blood flow through the pulmonary vasculature respiration: gas exchange between atmospheric air and the blood and between the blood and cells of the body rhonchi: low-pitched wheezing or snoring sound associated with partial airway obstruction. and bronchi using an endoscope.2. Alterations in Human Functioning GLOSSARY apnea: temporary cessation of breathing bronchophony: abnormal increase in clarity of transmitted voice sounds bronchoscopy: direct examination of larynx. Peri-operative Care 3. high-pitched. cilia: short hairs that provide a constant whipping motion that serves to propel mucus and foreign substances away from the lung toward the larynx compliance: measure of the force required to expand or inflate the lungs crackles: soft. heard on chest auscultation stridor: harsh high-pitched sound heard on inspiration. usually without need of stethoscope. trachea.

Gas exchange involves delivering oxygen to the tissues through the bloodstream and expelling waste gases. the waste product of metabolism B. Maintains heat balance C. Sinuses: Air-filled cavities within the hollow bones that surround the nasal passages and provide resonance during speech. A. 2005). and laryngopharynx 4. Maintains body water levels 5. known as the upper airway. Produces speech 3. Secondary functions of the respiratory system 1. A prominent function of sinuses is to serve as a resonating chamber in speech. Removes carbon dioxide. Upper respiratory airway pg1123 1. The sinuses are a common site of infection. Larynx a. and the cardiovascular system is responsible for perfusion (Farquhar & Fantasia.. which is the most fundamental defense mechanism of the lungs. The glottis plays an important role in coughing. The respiratory system works in concert with the cardiovascular system. The opening between the true vocal cords is the glottis. Pharynx. Facilitates sense of smell 2. The upper respiratory tract.. oropharynx.a. Maintains acid-base balance 4. the false and true cords c.(unit 5 pg 486- 666) I. Anatomy and Physiology The respiratory system is composed of the upper and lower respiratory tracts. Contains 2 pairs of vocal cords. Primary functions of the respiratory system 1. warms. brunner and suddarth’s medical surgical nursing 12th ed. the two tracts are responsible for ventilation (movement of air in and out of the airways). commonly called the voice box b. Together. 3. Nclex rn 7th ed. during expiration. Passageway for the respiratory and digestive tracts located behind the oral and nasal cavities b. and filters inspired air 2. Located just below the pharynx at the root of the tongue. and Adenoids a. . the respiratory system is responsible for ventilation and diffusion. Provides oxygen for metabolism in the tissues 2. Nose: Humidifies. Tonsils. Disturbance in Oxygenation CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION Ref. such as carbon dioxide. Divided into the nasopharynx. warms and filters inspired air so that the lower respiratory tract (the lungs) can accomplish gas exchange.

is divided into 2 lobes. The visceral pleura covers the pulmonary surfaces. which propel mucus up and away from the lower airway to the trachea. Lungs*** a. the alveoli would collapse. . the major muscle of inspiration c. Acinus (plural. Bronchioles*** a. 3. and the thoracic nerves. 2. Alveolar ducts and alveoli*** a. The right bronchus is slightly wider. The parietal pleura lines the inside of the thoracic cavity. is divided into 3 lobes: the upper. g. and lower lobes. contain clusters of alveoli. The respiratory structures are innervated by the phrenic nerve. c. 4. d. Located in the pleural cavity in the thorax b. c. Extend from just above the clavicles to the diaphragm. f. a phospholipid protein that reduces the surface tension in the alveoli. Begin at the carina b. which is narrower than the right lung to accommodate the heart.which arise from the ducts. Prevents food from entering the tracheobronchial tree by closing over the glottis during swallowing D. The terminal bronchioles contain no cilia and do not participate in gas exchange. The right lung. shorter. and more vertical than the left bronchus. acini) is a term used to indicate all structures distal to the terminal bronchiole. which are the basic units of gas exchange. Mainstem bronchi a. Alveolar sacs. Branch from the secondary bronchi and subdivide into the small terminal and respiratory bronchioles. b.5. without surfactant. The left lung. b. Leaf-shaped elastic flap structure at the top of the larynx b. the vagus nerve. The bronchi are lined with cilia. d. Divide into secondary or lobar bronchi that enter each of the 5 lobes of the lung. where it can be expectorated or swallowed. 5. Branch from the respiratory bronchioles c. Trachea: Located in front of the esophagus. Type II alveolar cells in the walls of the alveoli secrete surfactant. including the upper surface of the diaphragm. Lower respiratory airway 1. e. d. which is larger than the left. Contain no cartilage and depend on the elastic recoil of the lung for patency. branches into the right and left mainstem bronchi at the carina. Epiglottis a. middle.

The diaphragm descends into the abdominal cavity during inspiration. cells by way of the circulating blood. causing negative pressure in the lungs. However. this process requires oxygen. Function of the Respiratory System -The cells of the body derive the energy they need from the oxidation of carbohydrates. The negative pressure draws air from the area of greater pressure. the thin walls of which permit easy passage or exchange of oxygen and carbon dioxide. the diaphragm and intercostal muscles relax and the lungs recoil. Blood flows throughout the lungs via the pulmonary circulation system. The respiratory process a. then travels to the rest of the body to oxygenate the body tissues.h. which raise the sternum. The respiratory system performs this function by facilitating life – sustaining processes such as oxygen transport. The movement of carbon dioxide occurs by diffusion in the opposite direction—from cell to blood. which now contains the cellular waste products carbon dioxide and water. Effective gas exchange depends on distribution of gas (ventilation) and blood (perfusion) in all portions of the lungs. Oxygen diffuses from the capillary through the capillary wall to the interstitial fluid. and the trapezius and pectoralis muscles. c. into the area of lesser pressure. Cells are in close contact with capillaries. f. which is produced by the cells lining the pleura. A thin fluid layer. . Certain vital tissues. and proteins.causing the air. 6. air passes through the terminal bronchioles into the alveoli and diffuses into surrounding capillaries. i. lubricates the visceral pleura and the parietal pleura. At the end of inspiration. pressure within the lungs becomes higher than atmospheric pressure. such as those of the brain and the heart. the sternocleidomastoid muscles. As with any type of combustion. At this point. b. it diffuses through the membrane of tissue cells. which elevate the first 2 ribs. Accessory muscles of respiration include the scalene muscles. In the lungs. respiration and ventilation and gas exchange. e. d. where it is used by mitochondria for cellular respiration. the atmosphere. fats. Oxygen Transport Oxygen is supplied to. to move from the alveoli in the lungs to the atmosphere. the lungs. As the lungs recoil. cannot survive for long without continuou supply of oxygen. allowing them to glide smoothly and painlessly during respiration. which fix the shoulders. and carbon dioxide is removed from. 7. as a produced and must be removed from the cells to prevent the buildup of acid waste products.

alveolar gas travels the same route in reverse. Ventilation During inspiration. Airway Resistance Resistance is determined chiefly by the radius or size of the airway through which the air is flowing. bronchioles. which affects airway resistance. With increased resistance. and lung compliance. During expiration. Because of this concentration gradient. Physical factors that govern air flow in and out of the lungs are collectively referred to as the mechanics of ventilation and include air pressure variances. the diaphragm relaxes and the lungs recoil. Causes of Increased Airway Resistance Common phenomena that may alter bronchial diameter. resistance to airflow. blood enters the systemic veins (where it is called venous blood) and travels to the pulmonary circulation. a tumor. which is characterized by connective tissue encircling the airways. During expiration.Respiration After these tissue capillary exchanges. oxygen diffuses from the alveoli to the blood. resulting in a decrease in the size of the thoracic cavity. air flows from the environment into the trachea. During inspiration. include the following: • Contraction of bronchial smooth muscle—as in asthma • Thickening of bronchial mucosa—as in chronic bronchitis • Obstruction of the airway—by mucus. The oxygen concentration in blood within the capillaries of the lungs is lower than in the lungs’ air sacs (alveoli). movement of the diaphragm and other muscles of respiration enlarges the thoracic cavity and thereby lowers the pressure inside the thorax to a level below that of atmospheric pressure. or a foreign body • Loss of lung elasticity—as in emphysema. . Any process that changes the bronchial diameter or width affects airway reresistance and alters the rate of air flow for a given pressure gradient during respiration. The alveolar pressure then exceeds atmospheric pressure. and alveoli. and airflows from the lungs into the atmosphere. Carbon dioxide. Air Pressure Variances Air flows from a region of higher pressure to a region of lower pressure. As a result. thereby keeping them open during both inspiration and expiration. which has a higher concentration in the blood than in the alveoli. air is drawn through the trachea and bronchi into the alveoli. diffuses from the blood into the alveoli. Movement of air in and out of the airways (ventilation) continually replenishes the oxygen and removes the carbon dioxide from the airways and lungs. greater-than-normal respiratory effort is required to achieve normal levels of ventilation. bronchi. This whole process of gas exchange between the atmospheric air and the blood and between the blood and cells of the body is called respiration.

and total lung capacity. Compliance is normal (1. in emphysema). and acute respiratory distress syndrome (ARDS). High or increased compliance occurs if the lungs have lost their elasticity and the thorax is overdistended (eg. is the elasticity and expandability of the lungs and thoracic structures. Factors that determine lung compliance are the surface tension of the alveoli (normally low with the presence of surfactant) and the connective tissue (ie. hemothorax. Compliance allows the lung volume to increase when the difference in pressure between the atmosphere and thoracic cavity (pressure gradient) causes air to flow in. Measurement of compliance is one method used to assess the progression and improvement in patients with ARDS. Lung Volumes and Capacities Lung function. * Allergies *Chest injury *Crowded living conditions *Exposure to chemicals and environmental pollutants .Compliance Compliance. pleural effusion. Diagnostic Tests A. Compliance is usually measured under static conditions. functional residual capacity.” Conditions associated with decreased compliance include morbid obesity. collagen and elastin) of the lungs. and residual volume. pulmonary edema. which are discussed in later chapters in this unit. or distensibility. Lung volumes are categorized as tidal volume. inspiratory reserve volume. Compliance is determined by examining the volume – pressure relationship in the lungs and the thorax. Lung capacity is evaluated in terms of vital capacity. Low or decreased compliance occurs if the lungs and thorax are “stiff. Risk factors for respiratory disorders. pneumothorax. atelectasis. pulmonary fibrosis. LUNG VOLUMES AND LUNG CAPACITIES Term Symbol Description Normal Value Significance Lung Volumes Tidal Volume VT or TV II. which reflects the mechanics of ventilation. inspiratory capacity. Lungs with decreased compliance require greater-thannormal energy expenditure by the patient to achieve normal levels of ventilation.0 L/cm H2O) if the lungs and thorax easily stretch and distend when pressure is applied. expiratory reserve volume. is viewed in terms of lung volumes and lung capacities.

Preprocedure a. The nurse prepares the needed suctioning equipment. Chest x-ray films (radiographs) Description: Provides information regarding the anatomical location and appearance of the lungs. b. client response. Postprocedure a. 4. Once inserted. using aseptic technique. Help the client to get dressed. 2. 3. The client is assisted to a sitting upright position such as semi.*Family history of infectious disease *Frequent respiratory illnesses *Geographical residence and travel to foreign countries *Smoking *Surgery *Use of chewing tobacco *Viral syndromes B. 8. 5. 7. and sets it to the appropriate pressure. Prepare suctioning equipment and turn on the suction. Sputum specimen Description: Specimen obtained by expectoration or tracheal suctioning to assist in the identification of organisms or abnormal cells. Assist the client to an uprughr position. Hyperoxygenate the client. Document the procedure. PRIORITY NURSING ACTIONS Tracheal Suctioning 1. Insert the catheter without suction applied.Fowler’s with the head hyperextended (unless contraindicated). Assess the client and explain the procedure. the nurse explains the procedure. turns on the suction device. Hand hygiene is performed. 9. Remove all jewelry and other metal objects from the chest area. Hyperoxygenate the client. 10. Once the nurse has assessed the client. !Question women regarding pregnancy or the possibility of pregnancy before performing radiography studies. Perform hand hygiene and don protective garb. 6. and the nurse applies appropriate protective garb. and effectiveness. Listen to breath sounds. The nurse hyperoxygenates the client with a . Assess the client’s ability to inhale and hold his or her breath. apply suction intermittently while rotating and withdrawing the catheter. C.

Reference Ignatavicius. The nurse dons sterile gloves and lubricates the catheter with sterile water or water – soluble lubricant (per agency procedure). 525. the nurse hyperoxygenates the client and encourages the client to take deep breaths if possible. trachea. Workman (2016). the nurse monitors the client for toleration of the procedure and the presence of complications. transport the specimen to the laboratory immediately. Ostendorf (2014).Remove dentures and eyeglasses.*** b.Instruct the client to take several deep breaths and then cough deeply to obtain sputum. pp. Vital signs are measured before the procedure and monitored postprocedure to detect signs of complications. Finally. . During the procedure. f. c. Potter. d. If a culture of sputum is prescribed. Obtain an early morning sterile specimen by suctioning or expectoration after a respiratory treatment if a treatment is prescribed. the nurse listens to breath sounds to assist in determining effectiveness and documents the procedure. increasing the oxygen flow rate. and bronchi with a fiberoptic bronchoscope. and then applies intermittent suction for up to 10 seconds while rotating and withdrawing the catheter. and effectiveness. p. Assess the results of coagulation studies. Preprocedure a.resuscitation bag.*** Postprocedure a. Perry. e. Obtain 15 mL of sputum. Laryngoscope and Bronchoscope Description: Direct visual examination of the larynx. b. e. 637. Determine the specific purpose of collection and check institutional policy for the appropriate method for collection. Assist the client with mouth care. c. inserts the catheter without the application of suction. Instruct the client to rinse the mouth water before collection. d. Establish an intravenous (IV) access as necessary and administer medication for sedation as prescribed. Always collect the specimen before the client begins antibiotic therapy. 631–632. the client’s response. b. !Ensure that an informed consent was obtained for any invasive procedure. Preprocedure a. Have emergency resuscitation equipment readily available. or asks the client to take deep breaths. Maintain NPO (nothing by mouth) status as prescribed. D. After suctioning.

Instruct the client to lie still during the procedure. and pneumothorax. Obtain informed consent. and identifying inflammatory diseases that affect the lungs. particularly if sedation has been administered.*** j. b. detecting infections. h. Postprocedure. or other radiopaque dyes. i. Instruct the client that he or she may feel an urge to cough. or a salty taste following injection of the dye. Monitor for bloody sputum.*** E. hypoxemia.Postprocedure a. 2. hemorrhage. Monitor for complications. Establish an intravenous access. g. Avoid taking blood pressurres for 24 hours in the extremity used for the injection. 3. A flouroscopic procedure in which a catheter is inserted through the antecubital or femoral vein into the pulmonary artery or 1 of its branches. c. b. Involves an injection of iodines or radiopaque contrast material. Maintain NPO status of the client for 8 hours before the procedure. Maintain the client in a semi – Fowler’s position. Postprocedure a. seafood. Monitor Vital Signs. Assess for the return of the gag reflex. the client is monitored for signs of bleeding and respiratory distress. f. Pulmonary Angiography Description a. Assess results of coagulation studies. Assess for allergies to iodine. b. b. Administer sedation as prescribed. such as bronchospasm or bronchial perforation. nausea. using a bronchoscope with the help of ultrasound guidance. Maintain NPO status until the gag reflex returns. Endobrochial ultrasound(EBUS) 1. dysrhytmias. such as sarcoidosis. Preprocedure a. c. c. Have emergency resuscitation equipment available. e. f. Tissue samples are used for diagnosing and staging lung cancer. F. g. Monitor Vital Signs e. Tissue samples are obtained from central lung masses and lymph nodes.*** d. Notify the health care provider (HCP) if signs of complications occur. . indicated by facial or neck crepitus. flushing. Monitor respiratory status. d. Monitor peripheral neurovascualr status of the affected extemity.

Apply a pressure dressing. Preprocedure a. c. Lung Biopsy Description: a. c. Obtain Vital Signs. G. breath deeply. If the client cannot sit up. air embolism. or move during the procedure. . I. with the arms and shoulders supported by a table at the bedside during the procedure. and pulmonary edema. Pulmonary function tests Description: Test used to evaluate lung mechanics. e. Thoracentesis Description: Removal of fluid or air from the pleural space via transthoracic aspiration. the client is placed lying in bed toward the unaffected side. b. and acid – base disturbace through spirometric measurements. Assess insertion site for bleeding. Instruct the client to refrain from smoking or eating heavy meal for 4 to 6 hours before the test.d. Postprocedure a. Remove dentures.Monitor for signs of pneumothorax. Instruct the client to void before procedure and to wear loose clothing. gas exchange. Obtain Informed Consent. Instruct the client not to cough. A transbrochial biopsy and a transbrochial needle aspiration may be performed to obtain tissue for analysis by culture or cytological examination. Note that the client is positioned sitting upright. e. Consult with the health care provide (HCP) regarding withholding bronchodilators before testing. Preprocedure a. d. Determine whether an analgesic that may depress the respiratory function is being administered. b. Monitor respiratory status. f. c. d. Postprocedure: Client may resume a normal diet and any bronchodilators and respiratory treatments that were withheld before the procedure. Assess results of coagulation studies.*** g.*** H. with the head of the bed elevated. Monitor for delayed reaction to the dye. and assess the puncture site for bleeding and crepitus. and arterial blood gas levels. if prescribed. b. lung volumes. e. Prepare the client for ultrasound or chest radiograph. Monitor Vital Signs. d. before procedure.

K. and notify the health care provider if they occur. Prepare the client for the chest radioprahy if prescribed. e. Establish an Intravenous Access. Preprocedure a. Assess the client for allergies to dye. Inform the client that a local anesthetic will be used for a needle biopsy but a sensation of pressure during needle insertion and aspiration may be felt. f. An open lung biopsy is performed in the operating room. Apply a dressing to the biopsy site and monitor for drainage or bleeding. The perfusion scan evaluates blood flow to the lungs. b. Review breathing methods that may be required during testing. iodines. Monitor for signs of respiratory distress. a ventilation – perfusion (V/Q) scan will be done. d. a. Monitor for signs of Pneumothorax and air emboli. Spiral (helical) computed tomography (CT) scan 1. d. 3. Administer analgesics and sedatives as prescribed. c. Preprocedure a. Remove jewelry around the chest area. A radionuclide may be injected for the procedure. The scanner rotates around the body.b. c. or seafood. b. J. Administer sedation as prescribed. Obtain informed consent. Postprocedure. c.*** L. d. Maintain NPO status of the client before the procedure. e. Ventilation – perfusion (V/Q) lung scan Description a. Instruct the client that the radionuclide clears from the body in about 8 hours. allowing for a 3 – dimentional picture of all regions of the lungs. and notify the health care provider (HCP) if they occur. 2. if the client cannot have a contrast medium. Have emergency resuscitation equipment available. IV injection of contrast medium is used. Skin Test Procedure . b. Skin Tests: A skin test uses an intradermal injection to help diagnose various infectious diseases. b. Monitor the client for the reaction to the radionuclide. Postprocedure*** a. Monitor Vital Signs. b. The ventilation scan determines the patency of the pulmonary airways and detects abnormalities in ventilation. g. Frequenlty used test to diagnose pulmonary embolism. Obtain informed consent. c.

time and test site. 6.35 – 7. Use a skin site that is free of excessive body hair. Circle and mark the injection test site. Ask the client to open and close the hand repeatedly. and blemishes. Determine whether the client has an arterial line in place (allows for arterial blood sampling without further puncture to the client). 5.45 7.45 PaCO2 35 – 45 mm Hg 35 – 45 mm Hg Bicarbonate (HCO3 ) 21 – 28 mEq/L A 21 – 28 mmol/L PaO2 80 – 100 mm Hg 80 – 100 mm Hg 3. 9. Preprocedure and postprocedure care. 4. Document the date. Perform the Allen’s test to determine the presence of collateral circulation (Priority Nursing Actions). Assess the color of the extremity distal to the pressure point. Instruct the client to avoid washing the test site. Document the findings. 5. Interpret the reaction at the injection site 24 to 72 hours after administration of the test antigen.base state and how well oxygen is being carried to the body. 2. and analysis of results: Collection of an ABG specimen 1. Apply the injection at the upper third of the inner surface of the left arm. Advise the client not to scratch the test site to prevent infection and possible abscess formation. dermatitis. Determine hypersensitivity or previous reactions to skin test. 2. Release pressure from the ulnar artery while compressing the radial artery. Apply pressure over the ulnar and radial arteries simultaneously. Obtain vital signs. 6. 8. M. Explain the procedure to the client. Assess the test site for the amount of induration (hard swelling) in millimeters and for the presence of erythema and vesiculation (small blister – like elevations). 2. . 7. PRIORITY NURSING ACTIONS Performing the Allens Test Before Radial Artery Puncture. 4.1. 1. 3. Measurement of the dissolved oxygen and carbon dioxide in the arterial blood helps to indicate the acid. normal esults. Normal Arterial Blood Gas Values Normal Range Laboratory Test Conventional Units SI Units pH 7. 3. 2. Arterial blood gases (ABGs) Description: 1.35 – 7.

on arterial blood gas {ABG} testing). Finally. is recorded as a percentage. Reference Perry. Pulse oximetry is a noninvasive test that registers the oxygen saturation of the clients hemoglobin. Appropriately label the specimen and transport it on ice to the laboratory. such as changes in the O2 settings. 8. 4. Ostendorf (2014). the ulnar artery is insufficient. The normal value is 95% to 100%. . Other sites. The capillary oxygen saturation (SaO2). the nurse documents the findings. If pinkness fails to return within 6 to 7 seconds. suctioning within the past 20 minutes. PaO2 . the hand should blanch. On the laboratory form. Provide emotional support to the client. such as the brachial or femoral artery. The nurse firstwould explain the procedure to the client. and client’s activities. 3.*** 4. After a hypoxic client uses up the readily available oxygen (measured as the arterial oxygen pressure.The Allen’s test is performed before obtaining an arterial blood specimen from the radial artery to determine the presence of collateral circulation and the adequacy of the ulnar artery. While applying pressure. Potter. pp. is drawn on to provide oxygen to the tissues. the reserve oxygen. 2. that oxygen attached to the hemoglobin (SaO2). the nurse applies direct pressure over the client’s ulnar and radial arteries simultaneously. 9. maintain pressure for 5 minutes or for 10minutes if the client is taking an anticoagulant. the nurse asks the client to open and close the hand repeatedly. Failure to determine the presence of adequate collateral circulation could result in severe ischemic injury to the hand if damage to the radial artery occurs with arterial puncture. 6. indicating that the radial artery should not be used for obtaining a blood specimen. !Avoid suctioning the client before drawing an ABG sample because the suctioning procedure will deplete the client’s oxygen. Apply pressure immediately to the puncture site following the blood draw. 1091–1092. Assist with the specimen draw: prepare a heparinized syringe (if not already prepackaged). 5. resulting in inaacurate ABG results. N. 7. can be used if the radial artery is not deemed adequate. To perform the test. Pulse oximetry Description 1. record the client’s temperature and the type of supplemental O2 that the client is receiving. Assess factors that may affect the accuracy of the results. The nurse then releases pressure from the ulnar artery while compressing the radial arteryand assesses the color of the extremity distal to the pressure point.

The abdomen should expand with inhalation and contract during exhalation. A pulse oximeter reading can alert the nurse to hypoxemia before clinical signs occur. Breathing retraining. nose. Procedure 1. to decrease fatigue. D – dimer 1. *The main types of exercises include pursed – lip breathing and diaphragmatic breathing. 6. and to promote carbon dioxide (CO2) elimination. *The client should inhale slowly through the nose. or stroke.The normal D – dimer level is less than or equal to 250ng/mL (250 mcg/L) D – dimer units (DDU). 2. ! A usual pulse oximetry reading is between 95% and 100%. it is also used to diagnose disseminated intravascular coagulation (DIC) and to monitor the effectiveness of treatment. which then is displayed on a monitor. instruct the client in deep breathing technique and recheck the pulse oximetry. values below 90% are acceptable only in certain chronic conditions. Huff Coughing *This is an effective coughing technique that . pulmonary embolism. Respiratory Treatments A. 3. 3. A sensor is placed on the client’s finger. normal fibrinogen is 200 to 400 mg/dL (2 to 4 g/L). If pulse oximetry readings are below normal.5. earlobe. Maintain the transducer at heart level. Do not select an extremity with an impediment to blood flow. O. A pulse oximetry reading lower than 90% necessitates HCP notification. *The client should exhale 3 times longer than inhalation by blowing through pursed lips. Helps to diagnose (a positive test result) the presence of thrombus in conditions such as deep vein thrombosis. Agency procedures and HCP prescriptions are followed regarding actions to take for specific readings. BOX 54 – 3 Client Education: Breathing Retraining and Huff Cough Breathing Retraining *This includes exercises to decrease use of the accessory muscles of breathing. 2. toe. or forehead to measure oxygen saturation. *The client should place a hand over the abdomen while inhaling. III. A blood test that measures clot formation and lysis that results from the degradation of fibrin.

1 hour before meals. *The client should take 3 or 4 deep breaths using pursed – lip and diaphragmatic breathing. or 2 to 3 hours after meals. reduces fatigue. Chest incisions C. b. Contraindications a. j. Instruct the client to assume a sitting or upright position. and postural drainage techniques are performed over the thorax to loosen secretions in the affected area of the lungs and move them into more cenral airways. Stop the procedure if cyanosis or exhaustion occurs. 2. Unstable vital signs b. l. History of pathological fractures e. Repeat in all necessary positions until the client no longer expectorates mucus. Bronchospasm d. *The client may need to splint the thorax or abdomen to achieve a maximum cough. Provide mouth care after the procedure. vibration. Maintain the position for 5 to 20 minutes after the procedure. conserves energy. k. Leaning slightly forward. Stop chest physiotherapy (CPT) if pain occurs. d. Instruct the client to place the mouth tightly around the mouthpiece of the device. h. stop the feeding and aspirate for residual before beginning chest physiotherapy. Vibrate the same area while the client exhales 4 or 5 deep breaths. Interventions Chest Physiotherapy Procedure a. Rib fractures f. Chest physiotherapy (CPT) Description: Percusssion. Percuss the area for 1 to 2 minutes. If the client is receiving a tube feeding. Increased intracranial pressure c. Position the client for postural drainage based on assessment. Monitor for respiratory tolerance to the procedure. Dispose of sputum properly. B. m. Perform chest physiotherapy (CPT) in the morning on arising. the client should cough 3 or 4 times during exhalation. Incentive spirometry Client Instruction for Incentive Spirometry 1. g. f. Place a layer of material (gown or pajamas) between the hands or percussion device and the client’s skin. and facilitates mobilization of secretions. e. i. . c.

Instruct the client to inhale slowly to raise and maintain the flow rate indicator between the 600 and 900 marks. Assess skin integrity. Remove saliva and mucus from the mask. Allows the client to breath through the nose or mouth. Simple face mask 5 – 8 L/min oxygen flow Interferes with eating and for FiO2 of 40% . Ensure that mask fits securely over nose and mouth. Instruct the client to repeat this process 10 times every hour while awake. Provide emotional support to decrease . 5. Instruct the client to hold the breath for 5 seconds and then to exhale through pursed lips.60% talking. eating or talking. mask. 24% (1 L/min) to 44% (at Doesn’t get in the way of 6 L/min). Device Oxygen Delivered Nursing Considerations Nasal cannula (nasal 1 – 6 L/min for oxygen Easily tolerated prongs) concentration (FiO2) of Can dislodge easily. IV.3. Oxygen A. Add humidification as prescribed and check water levels. Ensure that prongs are in the nares with openings facing the client Assess nasal mucosa for irritation from drying effect of higher flow rates. Minimum flow of 5L/min Can be warm and needed to flush CO2 from confining. as tubing can irritate skin. Supplemental oxygen delivery systems. 4. Provide skin care to area covered by mask. Effective oxygen concen- tration can be delivered.

delivery. Adjust flow rate to keep the reservoir bag two- thirds full during inspiration. Monitor for risk of aapiration from inability of client to clear mouth (i. thus providing a high FiO2. Partial rebreather mask 6 -15 L/min oxyge flow for The client rebreathes (mask with reservoir bag) FiO2 of 70% .e. Make sure the reservoir bag does not twist or kink. anxiet in the client who feels claustrophobic. if vomiting occurs) Venturi mask (Ventimask) 4 – 10 L/min oxygen flow Keep the air entrapment for FiO2 of 24% . Keep mask snug on face. Nonrebreather mask FiO2 of 60%-100% at a Adjust flow rate to keep rate of flow that maintains the reservoir bag inflated. Keep mask snug on the . Assess nasal mucosa for irritation.90%. which is high in oxygen. one-third of the exhaled tidal volume. Keep mask snug on the face and ensure tubing is free of kinks because the FiO2 is altered if kinking occurs or if the mask fits poorly. the bag two-thirds full.. humidity or aerosol can be added to the system as needed.55% port for the adapter open Delivers exact desired and uncovered to ensure selected concentrations adequate oxygen of O2. Deflation of the bag results in decreased oxygen delivered and rebreathing of exhaled air.

or an adequate oxygen flow endotracheal tube. Provide emotional support to decrease anxiety in the client who feels claustrophobic. Make sure the reservoir bag does not twist or kink or that the oxygen source does not disconnect. the client will suffocate. face shield) the desired amount of the delivery system oxygen to a client during inspiration and with a tracheostomy. with water and to promote ostomy. Ensure that the valves and flaps are intact and functional during each breath (valves should open during expiration and close during inhalation). face. otherwise. rate (remove and clean The face tent provides 8. the client can suffocate). expiration. in the T-piece open and uncovered (if the port is occluded. the tubing at least every 4 12 L/min and the FiO2 hr). varies due to environ. Position the T-piece so that it does not pull on the tracheostomy or endotracheal tube and cause erosion of the skin . Aspecial adaptor (T-bar Empty condensation from or T-piece) can be used the tubing to prevent the to deliver any desired client from being lavaged FiO2 to client with trache. laryngectomy.bar or T-piece (face can be used to deliver escapes from the vents of tent. Tracheostomy collar and The tracheostomy collar Ensure that aerosol mist T. Keep the exhalation port mental loss. Remove mucus and saliva from the mask.

Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP). 4. BiPAP provides positive airway pressure during inspiration and ceases airway support during expiration. at the tracheostomy insertion site. 7. 2. Simple face mask: Used for short – term oxygen therapy or to deliver oxygen in an emergency. pulse oximetry reading. usually used if CPAP is ineffective. Nasal high – flow (NHF) respiratory therapy: Used for hypoxemic clients in mild to moderate respiratory distress. beneficial in clients who have obstructive sleep apnea or acute exacerbations of COPD. 3. Nasal cannula for low flow: Used for the client with chronic airflow limitation and for longterm oxygen use.Assess color. Assess for the presence of chronic lung problems. Both CPAP and BiPAP improve oxygenation through airway support. 6. 1. 2. and vital signs before and during treatment. Humidify the oxygen if indicated. 8. B. Partial rebreather mask: Useful when the oxygen concentration needs to be raised. the T – bar or T – piece is used to deliver the desired FiO2 to the client with a tracheostomy. not usually prescribed for a client with chronic obstructive pulmonary disease (COPD). Face tent: Used instead of a tight – fitting mask for the client who has facial trauma or burns. 1. . 4. 3. Venturi mask: Used for clients at risk for or experiencing acute respiratory failure 5. Place an Oxygen in Use sign at the client’s bedside. CPAP maintains a set positive airway pressure during inspiration and expiration. C. !A client who is hypoxemic and has chronic hypercapnia requires low levels of oxygen delivery at 1 to 2 L/minute because a low arterial oxygen level is the client’s primary drive for breathing. General interventions 1. Tracheostomy collar and T – bar or T – piece: Tracheostomy collar is used to deliver high humidity and the desired oxygen to the client with a tracheostomy. 3. or endotracheal tube. laryngectomy. Nonrebreather mask: Most frequently used for the client with a deteriorating respiratory status who might require intubation. 2. there is only enough pressure provided during expiration to keep the airways open.

Assist-control a. 3. d. it is used for the pediatric or neonatal client. orofacial masks and nasal masks are used instead. and client parameters. Controlled a. and hypercapnic respiratory failure !A resuscitation bag should be available at the bedside for all clients receiving mechanical ventilation. Time – cycled ventilator: The ventilator pushes air int the lungs until a preset time has elapsed. b. The ventilator is programmed to respond to the client’s inspiratory effort if the client does initiate a breath. alarms. b. Least used mode. c.V. 3. it is used for short periods. 4. the ventilator locks out the client’s inspiratory effort. Mechanical Ventilation Types 1. An inspiratory positive airway pressure (IPAP) and an expiratory positive airway pressure (EPAP) are set on a large ventilator or a small flow generator ventilator with a desired pressure support and positive end-expiratory pressure (PEEP) level. asthma. b. if the client attempts to initiate a breath. Can be used in certain situations of COPD distress. Microprocessor ventilator a. Noninvasive positive pressure ventilation or BiPAP. heart failure. Tidal volume and ventilatory rate are preset on the ventilator. c. The client receives a set tidal volume at a set rate. Used for clients who cannot initiate respiratory effort. This type of ventilator is more responsive to clients who have severe lung disease or require prolonged weaning. Most commonly used mode*** b. a. The ventilator takes over the work of breathing for the client. Pressure – cycled ventilator: The ventilator pushes air into the lungs until a specific airway presure is reached. as in the postanesthesia care unit. The ventilator delivers the preset tidal volume when the client initiates a breath . 3. Volume – cycled ventilator a. Ventilatory support given without using an invasive artificial airway (endotracheal tube or tracheostomy tube). e. c. A constant tidal volume is delivered regardless of the changing compliance of the lungs and chest wall or the airway resistance in the client or ventilator. The ventilator pushes air into the lungs until a preset volume is delivered. b. 2. A computer or microprocessor is built into the ventilator to allow continuous monitoring of ventilatory functions. pulmonary edema. This allows more air to move into and out of the lungs without the normal muscular activity needed to do so. Mode of Ventilation 1.

Fraction of The oxygen concentration delievered to the client. Rate The number of ventilator breaths delivered per minute Sighs The volumes of air that are 1. When SIMV is used as a weaning mode. oxygen (FiO2) Peak airway The pressure needed by the ventilator to deliver a set tidal inspiratory volume at a given compliance.*** 4. and the client gradually resumes spontaneous breathing. inspired determined by the clients codition and ABG levels. (PEEP) The need for PEEP indicates a severe gas exchange disturbance Higher levels of PEEP (more than 15 cm H2O) increase the . Similar to assist-control ventilation in that the tidal volume and ventilatory rate are preset on the ventilator b. Positive pressure is exerted during the expiratory phase of expiratory ventilation. may be used to prevent atelectasis. pressure Keeps the alveoli open during inspiration and prevents alveolar collapse. Continuous The application of positive airwaypressure throughout the positive airway entire respiratory cycle for spontaneously breathing clients. the respiratory pattern is determined by the client’s efforts.which may cause hyperventilation and respiratory alkalosis. pressure Monitoring peak airway inspiratory pressure reflects changes in compliance of the lungs and resistance in the ventilator or client. Can be used as a primary ventilatorymode or as a weaning mode d.5 to 2 times the set tidal volume. Synchronized intermittent mandatory ventilation (SIMV) a. used primarily as a weaning Modality. Positive end. Ventilator controls and settings and descriptions Controls and Descriptions Settings Tidal volume The volume of air that the client receives with each breath. which improves oxygenation by enhancing gas pressure exchange and preventing atelectasis. but the ventilator delivers oxygen and provides monitoring and an alarm system. the number of SIMV breaths is decreased gradually. the ventilator continues to deliver a preset tidal volume with each breath. Allows the client to breathe spontaneously at her or his own rate and tidal volume between the ventilator breaths c. If the client’s spontaneous ventilatory rate increases. delivered 6 to 10 times per hour. No ventilator breaths are delivered.while allowing the client to control the rate of breathing. f.

As the weaning process continues. always assess the client first and then assess the ventilator. Causes of Ventilator alarms High-Pressure Alarm ▪ Increased secretions are in the airway. or bites on the oral endotracheal tube. 11. 8. Turn the client at least every 2 hours or get the client out of bed as prescribed to prevent complications of immobility. 13. 3. ▪ Client coughs. ▪ Client is anxious or fights the ventilator. 9. ▪ The endotracheal tube is displaced. 7. May be used in combination with PEEP as a weaning method. Assess ventilator settings. 12. and breathing patterns (the client will never breathe at a rate lower than the rate set on the ventilator). ▪ The ventilator tube is obstructed because of water or a kink in the tubing. Interventions !For a client receiving mechanical ventilation. . Have resuscitation equipment available at the bedside. 10. particularly in the lips and nailbeds. If a cause for an alarm cannot be determined. Assess the level of water in the humidifier and the temperature of the humidification system because extremes in temperature can damage the mucosa in the airway. 6. chance of complications. color. lung sounds. 1. Monitor skin color. such as barotrauma tension pneumothorax Pressure The application of positive pressure on inspiration that support eases the workload of breathing. the amount of pressure applied to inspiration is gradually decreased. 2. Assess the need for suctioning and observe the type. 5. 4. respiratory status. ▪ Wheezing or bronchospasm is causing decreased airway size. Empty the ventilator tubing when moisture collects. Monitor the chest for bilateral expansion. Ensure that the alarms are set. Monitor ABG results. ventilate the client manually with a resuscitation bag until the problem is corrected.Assess vital signs.Obtain pulse oximetry readings. gags. and amount of secretions.

Infections 6. Some recommendations of TJC include establishing alarm safety as a facility policy. Ventilator dependence or inability to wean Weaning: Process of going from ventilator dependence to spontaneous breathing. Alarm safety and alarm fatigue 1. The SIMVrate is decreased gradually until the client is breathing on his or her own without the use of the ventilator. establishing policies and procedures for managing alarms. !Never set ventilator alarm controls to the off position. The nurse needs to respond promptly to an alarm and immediately assess the client.Low-Pressure Alarm ▪ Disconnection or leak in the ventilator or in the client’s airway cuff occurs. The client is taken off the ventilator for short periods initially and allowed to breathe spontaneously. 4. 3. The client breathes between the preset breaths per minute rate of the ventilator. ▪ The client stops spontaneous breathing. Complications 1. It is the responsibility of the nurse to be alert to the sound of an alarm because this signals a client problem. identifying default alarm settings. b. SIMV a. c. . 2. Weaning progresses as the client is able to tolerate progressively longer periods off the ventilator. which delivers humidified oxygen. b. which increases intrathoracic pressure and inhibits blood return to the heart. 2. Muscular deconditioning 7. Malnutrition if nutrition is not maintained 5. and staff education. According to The Joint Commission (TJC). Gastrointestinal alterations such as stress ulcers 4. Hypotension caused by the application of positive pressure. 2. 3. which results when the numerous alarms and the resulting noise tends to desensitize the nursing staff and cause them to ignore alarms or even disable them. T-piece a. identifying the most important alarms to manage. the most common contributing factor related to alarm-related sentinel events is alarm fatigue. The client is taken off the ventilator and the ventilator is replaced with a T-piece or CPAP. 1. Respiratory complications such as pneumothorax or subcutaneous emphysema as a result of positive pressure.

Paradoxical respirations (inward movement of a segment of the thorax during inspiration with outward movement during expiration) b. Occurs from blunt chest trauma associated with accidents. VI.*** b. b. e. With pressure support. pressure may be maintained while the preset breaths per minute of the ventilator are decreased gradually. the amount of pressure is decreased gradually.3. c. As weaning continues. f. which may result in hemothorax and rib fractures. Tachycardia f. such as pneumothorax or pulmonary contusion b. Monitor for increased respiratory distress. Note that the ribs usually reunite spontaneously. c. Pain with movement and chest splinting results in impaired ventilation and inadequate clearance of secretions. Pain and tenderness at the injury site that increases with inspiration. Flail chest Description a. arms. b. Prepare the client for an intercostal nerve block as prescribed if the pain is severe. Administer pain medication as prescribed to maintain adequate ventilatory status. d. Place the client in a Fowler’s position. Cyanosis e. Fractures noted on chest x-ray. The loose segment of the chest wall becomes paradoxical to the expansion and contraction of the rest of the chest wall. Assessment a. d. Results from direct blunt chest trauma and causes a potential for intrathoracic injury. or a pillow. Shallow respirations. Chest Injuries Rib Fracture Description a. Hypotension . b. Instruct the client to self-splint with the hands. Severe pain in the chest c. Dyspnea d. c. Pressure support a. Pressure support is a predetermined pressure set on the ventilator to assist the client in respiratory effort. Client splints chest. Interventions a. Assessment a.

Administer pain medication as prescribed. b. Dyspnea b. d. The loss of negative intrapleural pressure results in collapse of the lung. Restlessness c. shallow respirations h. Increased bronchial secretions d. b. Monitor for increased respiratory distress. g. f. c. Monitor for increased respiratory distress. f. Hemoptysis f. A spontaneous pneumothorax occurs with the rupture of a pulmonary bleb. g. Administer oxygen as prescribed. which results in a rise in intrathoracic pressure and reduced vital capacity b. e. b. A tension pneumothorax occurs from a blunt chest injury or from mechanical ventilation with PEEP when a buildup of positive pressure occurs in the pleural space. Administer oxygen as prescribed. Place the client in a Fowler’s position. Diminished breath sounds Interventions a. Accumulation of atmospheric air in the pleural space. Characterized by interstitial hemorrhage associated with intraalveolar hemorrhage. Maintain the client in a Fowler’s position. . Prepare for mechanical ventilation with PEEP if required. Hypoxemia e. d. resulting in decreased pulmonary compliance. e. Crackles and wheezes Interventions a. Decreased breath sounds g. The major complication is acute respiratory distress syndrome. Pulmonary contusion Description a. d. Tachypnea. c. Assessment a. Maintain a patent airway and adequate ventilation. An open pneumothorax occurs when an opening through the chest wall allows the entrance of positive atmospheric air pressure into the pleural space. Prepare for intubation with mechanical ventilation. e.*** c. Maintain bed rest and limit activity to reduce oxygen demands. Encourage coughing and deep breathing. Pneumothorax Description a. Maintain bed rest and limit activity to reduce oxygen demands. with PEEP for severe flail chest associated with respiratory failure and shock.

Apply a nonporous dressing over an open chest wound. Hypotension f. 3. VII. Assessment a. oxygen may reach the alveoli but cannot be absorbed or used properly. 5. or hypoxemic respiratory failure. b. or an impairment in the function of the respiratory muscles.f. Assessment 1. or partial pressure of arterial carbon dioxide (PaCO2) greater than 50 mmHg occurring with acidemia. Absent breath sounds on affected side b. Diagnosis of pneumothorax is made by chest x-ray. d. Dyspnea 2. arterial oxygen saturation (SaO2) lower than 90%. Occurs when insufficient oxygen is transported to the blood or inadequate carbon dioxide is removed from the lungs and the client’s compensatory mechanisms fail. !Clients with a respiratory disorder should be positioned with the head of the bed elevated. Causes include a mechanical abnormality of the lungs or chest wall. f. e. Headache . Sharp chest pain g. Monitor the chest tube drainage system. contributing to the hypoxemia. which will remain in place until the lung has expanded fully. Tachycardia j. 2. Tachypnea k. Monitor for subcutaneous emphysema. Subcutaneous emphysema as evidenced by crepitus on palpation h. 4. Administer oxygen as prescribed. Tracheal deviation to the unaffected side with tension pneumothorax Interventions a. resulting in a PaO2 lower than 60 mmHg. Prepare for chest tube placement. a defect in the respiratory control center in the brain. Cyanosis c. c. Sucking sound with open chest wound i. Place the client in a Fowler’s position. In oxygenation failure.Many clients experience both hypoxemic and hypercapnic respiratory failure and retained carbon dioxide in the alveoli displaces oxygen. Dyspnea e. Acute Respiratory Failure Description 1. Manifestations of respiratory failure are related to the extent and rapidity of change in PaO2 and PaCO2 . Decreased chest expansion unilaterally d.

Acute Respiratrory Distress Syndrome Description 1. 3. The major site of injury is the alveolar capillary membrane. Alterations in respirations and breath sounds Interventions 1. trauma. Tachycardia 6.3. Restlessness 4. 2. Deteriorating ABG levels 5. 4. The interstitial edema causes compression and obliteration of the terminal airways and leads to reduced lung volume and compliance. and inhalation of toxic substances. Confusion 5. interstitial edema may not be noted until there is a 30% increase in fluid content. 3. 2. The chest x-ray shows bilateral interstitial and alveolar infiltrates. Place the client in a Fowler’s position. 5. Provide respiratory treatments as prescribed. Causes include sepsis. A form of acute respiratory failure that occurs as a complication of some other condition. Administer diuretics. Administer oxygen to maintain the PaO2 level higher than 60 to 70 mm Hg. Dysrhythmias 8. shock. 4. burns. Decreased breath sounds 4. neurological injuries. VIII. or corticosteroids as prescribed. aspiration. The ABG levels identify respiratory acidosis and hypoxemia that do not respond to an increased percentage of oxygen. Tachypnea 2. 6. 5. Pulmonary infiltrates Interventions*** 1. Restrict fluid intake as prescribed. Assessment 1. 6. anticoagulants. it is caused by a diffuse lung injury and leads to extravascular lung fluid. 2. Administer oxygen as prescribed. Dyspnea 3. Prepare the client for mechanical ventilation if supplemental oxygen cannot maintain acceptable PaO2 and PaCO2 levels.*** . Hypoxemia despite high concentrations of delivered oxygen 6. Decreased level of consciousness 9. 3. 4. drug ingestion. Place the client in a Fowler’s position. Identify and treat the cause of the acute respiratory distress syndrome. Decreased pulmonary compliance 7. 6. Identify and treat the cause of the respiratory failure. Administer bronchodilators as prescribed. Hypertension 7. fluid overload. DIC. Encourage deep breathing. 5.

*Nocturnal symptoms occur frequently. 4. and coughing associated with airflow obstruction that may resolve spontaneously. St. 3. Moderate Persistent *Daily symptoms occur. Prepare the client for intubation and mechanical ventilation using PEEP. Louis. including cigarette or cigar smoke *Sudden weather changes From Lewis S. it is often reversible with treatment. Camera I: Medical-surgical nursing: assessment and management of clinical problems. breathlessness. 2. Causes recurrent episodes of wheezing. . Chronic inflammatory disorder of the airways that causes varying degrees of obstruction in the airways. other products respiratory infection drugs and plastics processed with aerosol potatoes sprays. Marked by airway inflammation and hyperresponsiveness to a variety of stimuli or triggers. 2011. *Monosodium *Pollens glutamate. *Frequent exacerbations occur. Severity is classified based on the clinical features before treatment Classification of Asthma Severity Severe Persistent *Symptoms are continuous. Mosby. Asthma Description 1. *Perfumes or *Viral upper antiinflammatory chemical shrimp. *Smoke. Dirksen S. *Physical activity requires limitations. chest tightness. 7. Heitkemper M. Asthma Triggers Environmental Physiological Factors Medications Occupational Food Factors Exposure Additives Factors *Animal danders *Gastroesophageal *Acetylsalicylic *Metal salts *Sulfites *Cockroaches reflux disease acid (aspirin) *Wood and (bisulfites and *Exhaust fumes (GERD) *B – Adrenergic vegetables metabisulfites) *Fireplaces *Hormonal changes blockers dusts *Beer. *Molds *Stress *Nonsteroidal *Industrial dried fruit. Bucher L. wine. ed 8. IX. *Daily use of inhaled short-acting β-agonist is needed.

ed 7. *Exacerbations occur at least twice weekly and may last for days. 2013. Triggers* *Allergens *Infection *Exercise *Irritants IgE – mast cells mediated response Release of mediators from mast cells. eosinophils. Workman M: Medical-surgical nursing: patient-centered collaborative care. acute cor pulmonale. From Ignatavicius D. *Nocturnal symptoms occur more frequently than twice a month. *Nocturnal symptoms occur more frequently than once weekly. *Client is asymptomatic between exacerbations. or respiratory arrest. *Nocturnal symptoms occur twice a month or less. Status asthmaticus is a severe life – threatening asthma episodes that is refractory to treatment and may result in pneumothorax. Mild Persistent *Symptoms occur more frequently than twice weekly but less often than once daily. *Intensity of exacerbations varies. *Exacerbations may affect activity. Louis. *Exacerbations are brief (hours to days). lymphocytes Earky – phase Late – phase response response Peaks in 30 Peaks in 5 to 6 hours to 60 minutes *Bronchial smooth *Bronchial hyperreactivity muscle contraction *Mucosaledema . Saunders. St. 5. Mild Intermittent *Symptoms occur twice weekly or less. macrophages. *Exacerbations affect activity.

Pulmonary function test results that demonstrate decreased airflow rates. Assessment 1. Monitor pulse oximetry 3. Tachycardia 9. Monitor peak flow 4. Tachypnea with hyperventilation 7. Stems with asterisks are primary processes. 2. Interventions 1. Prolonged exhalation 8. IgE.*Mucus secretion *Infiltration with eosinophils and neutrophils *Vascular leakage *Inflammation Within 1 to 2 days Infiltration with monocytes and lymphocytes *Air trapping *Hypoxemia *Obstruction of large and small airways *Respiratory acidosis FIGURE 54-10 Pathophysiology in asthma. Restlessness 2. Cyanosis 12. Hyperresonance 5. Wheezing or crackles*** 3. Nursing Interventions During an Acute Asthma Episodes . Absent or diminished lung sounds 4. Immunoglobulin E. Pulsus paradoxus 10. During an acute asthma episode.Monitor vital signs. Use of accessory muscles for breathing 6. Diaphoresis 11. provide interventions to assist with breathing. Decreased oxygen saturation 13.

About the management of medication and proper administration. Cardiac dysrhythmias 11. Pulmonary function tests that demonstrate decreased vital capacity. About the correct use of a peak flowmeter.*** 12. 3. To identify possible triggers and measures to prevent episodes. Interventions 1. Chronic Obstructive Pulmonary Disease Description 1. Administer a concentration of oxygen based on ABG values and oxygen saturation by pulse oximetry as prescribed. Wheezing and crackles 4. Use of accessory muscles for breathing*** 8. Exertional dyspnea 3. pulmonary hypertension. X. 4. *Administer corticosteroids as prescribed. ABG levels that indicate respiratory acidosis and hypoxemia. 2. *Position the client in a high Fowler’s position or sitting to aid in breathing. COPD leads to pulmonary insufficiency. 4. Prolonged expiration 9. and after treatment. and consistency of sputum. Client Education 1. 5. Orthopnea 10. Sputum production 5. Also known as chronic obstructive lung disease and chronic airflow limitation 2. 3. Assessment 1. associated with an abnormal inflammatory response of the lungs that is not completely reversible. Monitor Vital Signs. Cough 2. On the intermittent nature of symptoms and need for long-term management. 2. Progressive airflow limitation occurs. Chronic obstructive pulmonarydisease is a disease state characterized by airflow obstruction caused by emphysema or chronic bronchitis. Weight loss 6. *Auscultate lung sounds before. amount. during. Congestion and hyperinflation seen on chest x –r ay. *Administer oxygen as prescribed. . About developing an asthma action plan with the primary HCP and what to do if an asthma episode occurs. and cor pulmonale.*** 13. if any. *Record the color. Barrel chest (emphysema)*** 7.

Provide respiratory treatments and CPT. 3. 5. Respiratory illness caused by a coronavirus. Recognize the signs and symptoms of respiratory infection and hypoxia. and extremely hot or cold foods. . When dusting. 4. the client may develop a dry cough and dyspnea. 10. 14. Avoid eating gas – producing foods. Adhere to activity limitations. and other environmental allergens. 9. Avoid fireplaces. 17. and consistency of sputum. called SARS – associated coronavirus. 4. 3. Place the client in a Fowler’s position and leaning forward to aid in breathing 13. Stop smoking. Encourage small. B. After 2 to 7 days. 7. frequent meals to maintain nutrition and prevent dyspnea. Severe Acute Respiratory Syndrome (SARS) A. which increase airway pressure and keep air passages open. Administer mucolytics as prescribed to thin secretions. 16. Provide a high-calorie.pets. 9. Meet nutritional requirements. high-protein diet with supplements. spicy foods. alternating rest periods with activity. use a wet cloth. and mild respiratory symptoms. Avoids extremes in temperature. unless contraindicated. body aches. 8. Encourage fluid intake up to 3000 mL/day to keep secretions thin. 7. 10. to clear the airway and prevent infection. Monitor pulse oximetry. 12. The syndrome begins witha fever. Use oxygen therapy as prescribed. 8. Use medications and inhalers as prescribed. 5. XI. Avoid powerful odors. Administer corticosteroids as prescribed for exacerbations. if necessary. 11. 6. 6. and instruct the client in the use of oral and inhalant medications. 14. 12. 15. Monitor weight. Receive immunizations as recommended. Avoid exposure to individuals with infections and avoid crowds. Administer antibiotics for infection if prescribed. Allow activity as tolerated. Suction the client’s lungs. Administer bronchodilators as prescribed. C. 11. amount. Instruct the client in diaphragmatic or abdominal breathing techniques and pursed-lip breathing techniques. feather pillows. an overall feeling of discomfort. 2. Use pursed – lip and diaphragmatic or abdominal breathing. promoting maximal carbon dioxide expiration. Client Education: (COPD) 1. Record the color. 13.

or pleural effusions. 10. 3. Sputum production Interventions 1. 2. Use of accessory muscles for breathing. Elevated temperature 3. Encourage coughing and deep breathing and use of the incentive spirometer. and amount of sputum. .D. 6. the alveoli. decreases lung compliance and vital capacity. 3. 2. avoiding travel to countries where an outbreak of SARS exists. cyanosis. 11. The edema associated with inflammation stiffens the lung. Place the client in a semi-Fowler’s position to facilitate breathing and lung expansion. and frequent hand washing if in an area where SARS exists. and causes hypoxemia. Prevention includes avoiding contact with those suspected of having SARS. Change the client’s position frequently and ambulate as tolerated to mobilize secretions. high-protein diet with small frequent meals. 5. 5. 9. Monitor and record color. and cold and clammy skin. Pnemonia Description 1. Monitor respiratory status. Pleuritic pain 4. Infection of the pulmonary tissue. 7. 7. Pneumonia can be community – acquired or hospital – acquired. Infection is spread by close person – to – person contact by direct contact with infectious material (respiratory secretions from infected persons or contact with objects contaminated with infectious droplets). avoiding close contact with crowds in areas where SARS exists. and the brochioles. Monitor pulse oximetry. 4. The white blood cell count and the erythrocyte sedimentation rate are elevated. pulmonary infiltrates. Assessment 1. Tachypnea 5. E. Chills 2. 8. Administer oxygen as prescribed. A sputum culture identifies the organism. The chest x – ray film shows lobar or segmental consolidation. 4. Monitor for labored respirations. Provide Chest Physiotherapy. Provide a high-calorie. *** XII. Mental status changes 8. consistency. including the interstial spaces. 6. Perform nasotracheal suctioning if the client is unable to clear secretions. Ronchi and wheezes 6.

16. disposing of respiratory secretions properly. b. 13. Reported symptoms are similar to those associated with influenza types A. Administer antipyretics. and adequate fluid intake 2. Administer antibiotics as prescribed. frequent and proper hand washing. 5. and cleaning and disinfecting surfaces that have become contaminated with secretions. XIII. 3. Influenza Description 1. 2. About the importance of rest. Regarding medications and the use of inhalants as prescribed 4. dyspnea. however. and C. Also known as the flu. fever. Swine (H1N1) Influenza . frequent and proper handwashing. Encourage fluids. and health care personnel providing direct care to clients (the vaccination is contraindicated in the individual with egg allegies). cough suppressants. Prevention measures include thorough cooking of poultry products. usually known as type A. proper nutrition. and C. B. Avian Influenza A(H5N1) a. 4. Client Education 1. Prevent the spread of infection by hand washing and the proper disposal of secretions. to thin secretions unless contraindicated. c. highly contagious acute viral respiratory infection. 12. human cases have been reported in some countries. May be caused by several viruses. To avoid chilling and exposure to individuals with respiratory infections or viruses 3. or increased fatigue occurs 5. Additional prevention measures include avoiding those who have developed influenza. individuals with chronic ilness or who are immunocompromised. Yearly Vaccination is recommended to prevent the disease. especially for those older than 50 years of age. bronchodilators. B. To notify the HCP if chills. !Teach clients that using proper hand – washing techniques. mucolytic agents. those living in institutions. hemoptysis. Pneumococcal vaccine as recommended by the health care provider(HCP). d. and expectorants as prescribed. up to 3 L/day. Affects birds. and cleaning and disinfecting surface that have become contaminated with secretions. and receiving vaccines will assist in preventing the spread of infection. Provide a balance of rest and activity. 15. increasing activity gradually. 6. An H5N1 vaccine has been developed for use if a pandemic virus were to emerge. does not usually affect humans. avoiding contact with wild animals. 14.

Administer antiviral medications as prescribed for the current strain of influenza. XIV. c. Acute onset of fever and muscle aches. Fatigue. Signs and symptoms are similar to those that present with seasonal flu. a. Headache 3. Interventions 1. Progressive dyspnea with decreased movement of the chest wall on the affected side 3. Provide supportive therapy such as antipyretics or antitussives as indicated. Pleural Effusion Description 1. water sonicators. Sore throat. nonproductive cough caused by bronchial irritation or mediastinal shift . 4. 2. weakness. including water vaporizers. pleurisy. Person-to-person contact does not occur. b. Encourage rest. muscle aches. and showers. 4. Acute bacterial infection caused by Legionella pneumophila. Interventions Treatment is supportive and antibiotics may be prescribed. Dry. Assessment 1. vomiting and diarrhea commonly occur. and sometimes diarrhea. 2. XV. chills. 2. anorexia. and headache that may progress to dry cough. Legionnaire’s Disease Description 1. Sources of the organism include contaminated cooling tower water and warm stagnant water supplies. Assessment 1. 2. Monitor lung sounds. 5. and human influenza viruses. the risk for infection is increased by the presence of other conditions. Any condition that interferes with secretion or drainage of this fluid will lead to pleural effusion. Pleuritic pain that is sharp and increases with inspiration 2. avian. Assessment Ifluenza – like symptoms with a high fever. and rhinorrhea. cough. Prevention measures and treatment are the same as for the seasonal flu. Encourage fluids to prevent pulmonary complications (unless contraindicated). 3. A strain of flu that consists of genetic materials from swine. 3. Pleural effusion is the collection of fluid in the pleural space. in addition. whirlpool spas.

5. Empyema Description 1. Pleural exudate on chest x – ray. Assessment 1. Treatment focuses on treating the infection. 2. 4. Place the client in a semi – Fowler’s or high – Fowler’s position. opaque. Consists of surgically stripping the parietal pleura away from the visceral pleura.4. Prepare the client for thoracentesis. and foul – smelling. Tachycardia 5. emptying the empyema cavity. reexpanding the lung. If pleural effusion is recurrent. Anorexia and weight loss 6. 2. 6. Involves the instillation of a sclerosing substance into the pleural space via a thoracotomy tube. prepare the client for pleurectomy or pleurodesis as prescribed.*** . Chest pain 3. Recent febrile illness or trauma 2. PLEURECTOMY 1. Monitor breath sounds. Identify and treat the underlying cause. Encourage coughing and deep breathing. 2. Dyspnea 5. 3. PLEURODESIS 1. The substance creates an inflammatory response that scleroses tissue together. Collection of pus within the pleural cavity. 4. The most common cause is pulmonary infection and lung abscess caused by thoracic surgery or chest trauma. 3. Monitor breath sounds. Elevated temperature 6. Night sweats 9. Cough 4. This produces an intense inflammatory reaction that promotes adhesion formation between the 2 layers during healing. The fluid is thick. Interventions 1. Malaise 7. Decreased breath sounds over affected area 7. Interventions 1. Place the client in a Fowler’s position. Elevated temperature and chills 8. 2. and controlling the infection. 2. Chest x-ray film that shows pleural effusion and a mediastinal shift away from the fluid if the effusion is more than 250 mL. XVI. in which bacteria are introduced directly into the pleural space.

Pulmonary Embolism*** Description 1. XVII. and then lodges in a branch of the pulmonary artery. this surgical procedure involves removal of the restrictive mass of fibrin and inflammatory cells. 4. 4. 6. Instruct the client to lie on the affected side to splint chest. 2. may be caused by pulmonary infarction or pneumonia. 2. 4. Administer analgesics as precribed. 2. 5. Knifelike pain aggravated on deep breathing and coughing. 3. usually in the lower lateral portions in the chest wall. Pleurisy usually occurs on 1 side of the chest. If marked pleural thickening occurs. Occurs when a thrombus forms (most commonly in a deep vein). 3. The visceral and parietal membranes rub together during respiration and cause pain. Assessment 1. Apply hot or cold applcations as prescribed. advanced age. 5. Identify and treat the cause. 2. 3. Instruct the client to splint the chest as necessary. Pleural friction rub heard on auscultation. 6. Pleurisy Description 1. Assessment 1. Fat emboli can occur as a complication following fracture of a long bone and can cause pulmonary embooli. travels to the right side of the heart. heart failure.*** XVIII. 7. if prescribed. obesity. Interventions 1. Monitor lung sounds. Treatment is aimed at prevention through risk factor recognition and elimination. including those with prolonged immobilization. Dyspnea 3. Encourage coughing and deep breathing. Apprehension and restlessness . detaches. Assist with thoracentesis or chest tube insertion to promote drainage and lung expanasion. prepare the client for decortication. 3. Clients prone to pulmonary embolism are those at risk for deep vein thrombosis. or a history of thromboembolism. Encourage coughing and deep breathing. surgery. Inflammation of the visceral and parietal membranes. Admminister antibiotics as prescribed. pregnancy.

Document the event. the interventions taken. If suspected. The nurse stays with the client. 614. Hypotension 11. Tachypnea and tachycardia Interventions Priority Nursing Actions (Suspected Pulmonary Embolism) 1. Dyspnea accompanied by anginal and pleuritic pain. p. 7. apprehension and restlessness. The nurse prepares to administer oxygen and obtains the vital signs and checks lung sounds. 2. a feeling of impending doom. 606. When prescribed. 2. Distended neck veins 8. and elevates the head of the bed. petechiae over the chest and axillae. 5. exacerbated by inspiration 9. Cyanosis 7. Workman (2016). Petechiae over the chest and axilla 12. Blood – tinged sputum 3. Crackles and wheezes on auscultation 6. Shallow repirations 13. Chest pain 4. 744 Pg. Notify the Rapid Response Team and Health care provider (HCP). Cough 5. cough. Lung cancer is a malignant tumor of the brochi and peripheral lung tissue. 6. The lungs are a common target for metastasis from other organs. Prepare for the administration of heparin therapy or other therapies. 574 XIX. Prepare to administer oxygen. Finally. 3. interventions taken. Lung Cancer and Laryngeal Cancer Lung Cancer Description 1. Reassure the client and elevate the head of the bed. prepares the client for tests prescribed to confirm the diagnosis. and the client’s response to treatment. 2. The nurse continues to monitor the client closely. the client is prepared for the administration of heparin therapy or other therapies such as embolectomy or placement of a vena cava filter if necessary. Signs and symptoms of a pulmonary embolism include the sudden onset of dyspnea. the nurse immediately notifies the Rapid Response Team and HCP. 4. Prepare to obtain an arterial blood gas. hemoptysis. Feeling of impending doom 10. and the client’s response to tretment. reassures the client. the nurse documents the event. . and prepares to obtain an arterial blood gas. crackles. Pg. Obtain Vital Signs and check lung sounds. and a decreased arterial oxygen saturation. Reference: Ignatavicius. tachypnea.

obstructions. 10.*** 6. Classified according to histological cell type. Assess for tracheal deviation. and pain. 4. Diagnosis is made by a chest x – ray study. Hoarseness 4. which demonstrate a positive cytological study for cancer cells. and active and passive range – of – motion exercises. . 2. superior vena cava syndrome. epidermal (squamous cell anaplastic carcinoma are classified as NSCLS because of their similar responses to treatment. Exposure to environmental and occupational pollutants. dysphagia. which shows a lesion or mass. Monitor Vital Signs. 3. CT scan. Chemotherapy may be prescribed for treatment of nonresectable tumors or as adjuvant therapy. Administer oxygen as prescribed and humidification to moisten and loosen secretions. respiratory changes Interventions 1. Provide respiratory treatments as prescribed. Nonsurgical interventions 1. Diminished or absent breath sounds. Hempotysis. Place in a Fowler’sposition to help easebreathing.monitor for hemoptysis. high-protein. Anorexia and weight loss 7. Assessment 1. Administer bronchodilators and corticosteroids as prescribed to decrease bronchospasm. 8. Cigarrette smoking. rest periods. Radiation therapy may be prescribed for localized intrathoracic lung cancer and for palliation of hemoptysis. Causes 1. 5. 11. Chest pain 6. 2. Weakness 8. Surgical interventions 1. Laser therapy: To relieve endobronchial obstruction. Cough 2.3. blood – tinged or purulent sputum 5. Bronchogenic cancer (tumors originate in the epithelium of the bronchus) spreads through direct extension and lymphatic dissemination. Provide a high-calorie. high vitamin diet. Monitor pulse oximetry. 4. dyspnea 3. 9. types include small cel lung cancer (NSCLC). or magnetic resonance imaging (MRI). and by bronchoscopy and sputum studies. 5. also exposure to “passive” tobacco smoke. Wheezing. and edema. 2. inflammation. Administer analgesics as prescribed for pain management.*** 7. Monitor breathing patterns and breath sounds and for signs of respiratory impairment. Provide activity as tolerated.

Diagnosis is made by laryngoscopy and biopsy showing a positive cytological study for cancer cells.)*** 4. 5. CT.. Provide activity as tolerated. preventing shifts of the mediastinum. 3. wood dust). Assess cardiac and respiratory status. 2. 2. Risk factors 1. asbestos. heart. Administer oxygen as prescribed. (See Chapter 20 for care of the client with a chest tube. 3. Monitor Vital Signs. avoid complete lateral turning. Cigarette smoking.g. monitor for excess bleeding. Monitor pulse oximetry. and remaining lung. Encourage active range – of – motion exercises of the operative shoulder as prescribed. Exposure to environmental pollutants (e. Laryngeal cancer presents as malignant ulcerations with underlying infiltration and is spread by local extension to adjacent structures in the throat and neck. Thoracotomy with segmental resection: Surgical removal of a lobe segment. 3. which drains air and blood that accumulates in the pleural space. 8. Laryngeal cancer is a malignant tumor of the larynx. 7. Explain the potential postoperative need for chest tubes. 4. and MRI are used for staging. 5. Maintain the chest tube drainage system. Note that closed chest drainage usually is not used for a pneumonectomy and the serous fluid that accumulates in the empty thoracic cavity eventually consolidates. 6. Thoracotomy with lobectomy: Surgical removal of 1 lobe of the lung for tumors confined to a single lobe. Laryngeal Cancer Description 1. monitor lung sounds. and by the lymphatic system. !The airway is the priority for a client with lung or laryngeal cancer. Thoracotomy (opening into the thoracic cavity) with pneumonectomy: Surgical removal of 1 entire lung. Preoperative interventions 1. Heavy alcohol use and the combined use of tobacco and alcohol.*** 3. 2. 2. Exposure to radiation . 2. 4. Check the healthcare providers (HCP’s) prescriptions regarding client positioning. Thoracentesis and pleurodesis: To remove pleural fluid and relieve hypoxia. chest radiography.*** Postoperative interventions 1. Laryngoscopy allows for evaluation of the throat and biopsy of tissues. 4.

Administer oxygen as prescribed. Painless neck mass. 6. Radiation therapy in specified situations 2. or gastrostomy or jejunostomy tube. and nutritional support. nasogastric tube feedings.*** 5. Surgical intervention depends on the tumor size. 2. The goal is to remove the cancer while preserving as much normal function as possible. Provide a high – calorie and high – protein diet. alternative methods of communication. Dyspnea. Types of resection include cordal stripping. 2. Dysphagia. as prescribed. Hemoptysis. Administer analgesics as prescribed for pain. suctioning. Chemotherapy. Monitor respiratory status. 10. Weakness and weight loss 9. 8. 10. 5. Burning sensation in the throat. Provide activity as tolerated. . pain control methods. 7. 4. partial laryngectomy. this airway opening is permanent and is referred to as a laryngectomy stoma. 6. location. Preoperative interventions 1. Discuss self-care of the airway. Nonsurgical interventions 1.Assessment*** 1. Monitor for signs of aspiration of food and fluid. 3. Encourage the client to express feelings about changes in body image and loss of voice. 2. A tracheostomy is performed with a total laryngectomy. 3. Interventions 1. 3. 9. 4.*** 2. Place in Fowler’s position to promote optimal air exchange. Encourage clients to stop smoking and drinking alcohol to increase effectiveness of treatments. the critical care environment. and total laryngectomy. and amount of tissue to be resected. cordectomy. Feeling of lump in the throat. Provide nutritional support via parenteral nutrition. Foul breath odor. Change in voice quality. 7. Provide respiratory treatments as prescribed. Persistent hoarseness or sore throat and ear pain.which maybe given in combination with radiation and surgery Surgical interventions 1. 4. 8.

Describe the rehabilitation program and information about the tracheostomy and suctioning. Monitor IV fluids or parenteral nutrition until nutrition is administered via a nasogastric. -Advise the client to wear loose – fitting. and carries no pitch. -Alternate rest periods with activity. 13. -Advise the client to increase humidity in the home. 12. Provide stoma and laryngectomy care Stoma Care Following Laryngectomy -Protect the neck from injury. high collared clothing to cover the stoma. Assess gag and cough reflexes and the ability to swallow. 6. showering. 5. 9. amount. Observe for hemorrhage and edema in the neck. 16. Provide oral hygiene. -Teach the client clean suctioning technique. cannot be raised or lowered. 15. -Instruct the client in range – of – motion exercises for the arms. -Instruct the client in how to clean the incision and provide stoma care. -The voice produced is monotone. and using aerosol sprays. and consistency of sputum. Assess the color. Postoperative interventions 1. shoulders. Monitor respiratory status. -Demonstrate ways to prevent debris from entering the stoma. -Advise the client to wear a MedicAlert bracelet. Maintain surgical drains in the neck area if present. Provide consultation with speech and language pathologist as prescribed. as prescribed. Increase activity as tolerated. Place the client in a high Fowler’s position. Monitor pulse oximetry. Reinforce method of communication established preoperatively. 4. monitor airway patency and provide frequent suctioning to remove bloody secretions. or jejunostomy tube. 14. 3. -Avoid exposure to persons with activity. 10. Prepare the client for rehabilitation and speech therapy (Box 48-16). and neck as prescribed. 3. -Instruct the client to wear a stoma guard to shield the stoma. 2. . Monitor Vital Signs. 8. 11. 7. gastrostomy. -Avoid swimming. Speech Rehabilitation Following Laryngectomy Esophageal Speech -The client produces esophageal speech by “burping” the air swallowed. -Increase fluid intake to 3000 mL / day as prescribed. Maintain mechanical ventilator support or a tracheostomy collar with humidification.

Carbon monoxide is a colorless. -Another device consists of a plastic tube that is placed inside the client’s mouth and vibrates on articulation. Mechanical Devices -One device. Carbon Monoxide Poisoning Description a. odorless. and out of the mouth. Oxygen molecules are displaced and carbon monoxide reversibly binds to hemoglobin to form carboxyhemoglobin. and the client articulates. the electrolarynx. -Lip and tongue movement produce the speech. XX. is placed against the side of the neck. with eventual placement of a prosthesis to produce speech. the air inside the neck and pharynx is vibrated. b. Tissue hypoxia occurs. Tracheoesophageal Fistula -A fistula is created surgically between the trachea and the esophagus. -The client must have adequate hearing because his or her mouth shapes words as they are heard. and tatsteless gas that has an affinity for hemoglobin 200 times greater than that of oxygen. c. -The prosthesis provides the client with a means to divert air from the trachea into the esophagus. Assessment*** Blood Level (%) Clinical Manifestations 1 – 10 Normal level 11 – 20 (mild poisoning) Headache Flushing Decreased visual acuity Decreased cerebral functioning Slight breathlessness 21 – 40 (moderate Headache poisoning) Nausea and vomiting Drowsiness Tinnitus and vertigo Confusion and stupor Pale to reddish – purple skin Decreased blood pressure Increased and irregular heart rate Depressed ST segment on electrocardiogram 41 – 60 (severe Coma poisoning) Seizures Cardiopulmonary instability 61 – 80 (fatal poisoning) Death .

and corticosteroids as prescribed. Transmission occurs by the inhalation of spores. Weight loss 4. Encourage coughing and deep breathing. Pleuritic pain. Assessment 1. Similar to pnuemonia: Chills. Skin nodules 6. Sarcoidosis Description 1. Monitor for nephrotoxicity form fungicidal medications. Mental status changes. antihistamines. 3. Place the client in a semi – Fowler’s position. 7. Administer antiemetics. antipyretics. Splenomegaly.*** . Tachypnea. Workman ML: Medical-surgical nursing: patientcentered collaborative care. Cough and dyspnea 5. XXI. 9.Adapted from Ignatavicius D. Positive agglutination test 4.*** 3. Philadelphia. but a high titer of Epstein – Barr virus may be noted.*** 3. Assessment 1. 2. 8. Fever 3. Administer oxygen as prescribed. Use of accessory muscles for breathing. Monitor breath sounds. Elevated temperature. Instruct the client to wear a mask and spray the floor with water before sweeping barn and chicken coops. ed 8. Histoplasmosis Description 1. XXII. 3. Kveim test: Sarcoid node antigen is injected intradermally and causes a local nodular lesion in about 1 month. hepatomegaly Interverventions 1. 2. 7. Administer fungicidal medications as prescribed. 5. 6. 2016. Saunders. Pulmonary fungal infection caused by spores of Histoplasma capsulatum. Night sweats 2. Polyarthritis. Spores also are usually found in bird droppings. Viral incidence is highest in African Americans and young adults. Monitor Vital Signs. Rhonchi and wheezes. Sputum production 2. Presence of epithelioid cell tubercles in the lung. Positive skin test for histoplasmosis. The cause is unknown. which commonly are found in contaminated soil. 4. 2.

3. and many clients are not aware of symptoms until the disease is well advanced. gases. minority group. when the bacillus reaches a susceptible site. peritoneum.Interventions 1. or extrinsic allergic alveolitis (farmer’s lung. Highly communicable disease caused by Mycobacterium tuberculosis. or refugee group. Tuberculosis*** Description 1. 5. Child younger than 5 years of age 2. 4. Monitor temperature. Because M. Increase fluid intake. it multiplies freely. intestines. XXIII. 2. Assessment 1. Administer corticosteroids to control symptoms. tuberculosis is a nonmotile. nutritious meals. and prevent progression of the disease. 2. XXIV. talcosis. Provide frequent periods of rest. Drinking unpasteurized milk if the cow is infected with bovine tuberculosis. Homeless individuals or those from a lower socioeconomic group. 2. nonsporulating. 6. Common disease classifications include occupational asthma pneumoconiosis (silicosis or coal miner’s [black lung] disease). Improper or noncompliant use of treatment programs may cause the development of mutations in the tubercle bacilli. can result in acute reversible effects or chronic lung disease.*** Interventions 1. M. diffuse interstitial fibrosis (asbestosis. acid-fast rod that secretes niacin. berylliosis). vapors. tuberculosis is an aerobic bacterium. resulting in a multidrugresistant strain of tuberculosis (MDR-TB). and allergens. such as the brain. An exudative response causes a nonspecific pneumonitis and the development of granulomas in the lung tissue. control symptoms. Occupational Lung Disease Description 1. frequent. bacterial or fungal antigens. kidney. Tuberculosis has an insidious onset. . it primarily affects the pulmonary system. 3. Manifestations depend on the type of disease and respiratory symptoms. dust. bird fancier’s lung. and liver. 5. joints. 3.*** 2. 4. where the oxygen content is highest. Encourage small. Prevention through the use of respiratory protective devices. or machine operator’s lung).*** 7. Risk factors*** 1. but also can affect other areas of the body. Treatment is based on the symptoms experienced by the client. The goal of treatment is to prevent transmission. Caused by exposure to environmental or occupational fumes. especially the upper lobes.

results of the testing 5. 4. 3. In an active phase. Identification of those in close contact with the infected individual is important so that they can be tested and treated as necessary. such as long – term care facilites. 2. Client’s country of origin and travel to foreign countries in which the incidence of tuberculosis is high 3. 4. Previous tests for tuberculosis. The defense systems of the body encapsulate the tubercle. Client history*** 1. droplet nuclei containing tuberculosis bacteria enter the air and may be inhaled by others. 5. immune dysfunction. and cause an inflammatory response termed granulomatous inflammation. Individuals in constant. 3. and damage to various parts of the body. infection. Past exposure to tuberculosis 2. the primary lesions may become dormant but can be reactivated and become a secondary infection when reexposed to the bacterium. After the infected individual has received tuberculosis medication for 2 to 3 weeks. 7. Transmission*** 1. 5. cough. pneumonia. When an infected individual coughs. travel to the lymph nodes. sneezes. and the bacteria form a tubercle lesion. the spread of necrotic tissue. . the risk of transmission is reduced greatly. Individuals with malnutrition. tuberculosis can cause necrosis and cavitation in the lesions. laughs. 6. Disease progression 1. or immunosuppressed as a result of medication therapy. Recent bacillus Calmette-Guerin (BCG) vaccine (a vaccine containing attenuated tubercle bacilli that may be given to persons in foreign countries or to persons traveling to foreign countries to produce increased resistance to tuberculosis). Primary lesions form. and mental health facilities. 4. or sings. When contacts have been identified. Via the airborne route by droplet infection. 5. Older client. these persons are assessed with a tuberculin skin test and chest x-rays to determine infection with tuberculosis. Individuals living in crowded areas. 2. leading to rupture. or foul-smelling sputum production 4. Recent historyof influenza. or human immunodeficiency virus infection. frequent contact with an untreated or undiagnosed individual. febrile illness. 8. prisons. leaving a scar. If encapsulation does not occur. bacteria may enter the lymph system. Droplets enter the lungs. Individuals who abuse alcohol or are intravenous drug users.

A sensitive and rapid test (results can be available in 24 hours) that assists in diagnosing the client Sputum cultures 1. sputum samples are obtained again to determine the effectiveness of therapy. 3. May be asymptomatic in primary infection 2. Partial obstruction of a bronchus caused by endobronchial disease or compression by lymph nodes may produce localized wheezing and dyspnea. Chest tightness and a dull.*** 2. 4. Chest assessment 1. A sputum culture identifying M. Persistent cough and the production of mucoid and mucopurulent sputum. After medications are started. Weight loss 6. A physical examination of the chest does not provide conclusive evidence of tuberculosis. If the disease is active. !An individual who has received a BCG vaccine will have a positive tuberculin skin test result and should be evaluated for tuberculosis with a chest x – ray. Most clientshavenegative cultures after 3 months of treatment. bronchial breath sounds. A positive reaction does not mean that active disease is present but indicates previous exposure to tuberculosis or the presence of inactive (dormant) disease. Sputum specimens are obtained for an acidfast smear. tuberculosis confirms the diagnosis. Dullness with percussion over involved parenchymal areas. b. Once the test result is positive. Chills 8. which is occasionally streaked with blood 10. and the person’s risk of being infected with tuberculosis and progression to disease if infected.*** 3. A chest x-ray is not definitive. Lethargy 4. aching chest pain may accompany the cough. Clinical manifestations 1. Tuberculin skin test (TST)*** 1. but the presence of multinodular infiltrates with calcification in the upper lobes suggests tuberculosis. rhonchi. and crackles indicate advanced disease. Night sweats 9. Advanced disease a. A blood analysis test by an enzyme-linked immunosorbent assay 2. Low-grade fever 7. 3.*** 4. Fatigue 3. 2. Anorexia 5. Skin test interpretation depends on 2 factors: measurement in millimeters of the induration. it will be positive in any future tests. caseation and inflammation may be seen on the chest x-ray. QuantiFERON – TB Gold Test*** 1.*** 2. .

children. 4. the door of the room must be tightly closed. Human immunodeficiency virus. . The hospitalized client*** 1. if possible. including Recent contact of a high-prevalence countries. HIV. known risk factors for Persons with fibrotic Residents and employees TB. changes on chest x-ray in high-risk congregate consistent with prior TB. Recent immigrants from Any person. The client with active tuberculosis is placed under airborne isolation precautions in a negative pressure room. Once an individual’s skin test is positive.htm. Children < 4 years of age Infants. and adolescents exposed to adults in high-risk categories. Injection drug users. 4.gov/ tb/publications/ factsheets/ testing/ skintesting. to maintain negative pressure. a chest x-ray is necessary to rule out active tuberculosis or to detect old healed lesions. laboratory personnel.Thorough hand washing is required before and after caring for the client. Clients with organ Mycobacteriology transplants. 3. at high risk. Classification of the Tuberculin Skin Test Reaction Induration 5 5 or > 5 mm Induration 5 10 or > 10 Induration 5 15 or > 15 Considered mm Considered mm Considered Positive in: Positive in: Positive in: HIV-infected persons. 2. persons with no person with TB disease. Persons with clinical suppressed for other conditions that place them reasons. tuberculosis.cdc. Settings. The nurse wears a particulate respirator (a special individually fitted mask) when caring for the client and a gown when the possibility of clothing contamination exists. From Centers for Disease Control and Prevention: Tuberculosis (TB) fact sheets (website): http://www. Personsimmuno. TB. The room should have at least 6 exchanges of fresh air per hour and should be ventilated to the outside environment.

5. 5. Respiratory isolations is discontinued when the client is no longer considered infectious. and sputum cultures. the client is required to wear a surgical mask. and vitamin C) to promote healing and to prevent recurrence of the infection. If the client needs to leave the room for a test or procedure. Instruct the client regarding the importance of compliance with treatment. the risk of transmission is reduced greatly. 13. Instruct the client to cover the mouth and nose when coughing or sneezing and to put used tissues into plastic bags. 3. follow-up care. Advise the client to resume activities gradually. 2. After the infected individual has received tuberculosis medication for 2 to 3 weeks. Advise the client of the side and adverse effects of the medication and ways of minimizing them to ensure compliance. . 10. Instruct the client about the need for adequate nutrition and a well – balanced diet (foos rich in iron. Inform the client that a sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. 9. Instruct the client to follow the medication regimen exactly as prescribed and always to have a supply of the medication on hand. Client education: Tuberculosis*** 1. as prescribed. Reassure the client that after 2 to 3 weeks of medication therapy. 11. 6. Advise the client that the medication regimen is continued up to 12 months depending on the situation. it is unlikely that the client will infect anyone. Instruct the client and family about thorough hand washing. 7. Inform the client that when the results of 3 sputum cultures are negative. 4. Advise the client to avoid excessive exposure to silicone or dust because these substances can cause further lung damage. 6. 14.*** 7. protein. Provide the client and family with information about tuberculosis and allay concerns about the contagious aspect of the infection. the client is no longer considered infectious and usually can return to former employment. 12. Inform the client and family that respiratory isolation is not necessary because family members already have been exposed. 8.

Disturbances in Fluids and Electrolytes b. Alterations in Human Functioning a. TEST IV 1. Inflammatory and Infectious Disturbances .b Disturbance in Metabolic and Endocrine Functioning c Disturbance in Elimination B.

confidentiality B. II. Degenerative Disorders 2. Disturbances in Cellular functioning 2. Collaboration and Teamwork A. Abuse and Violence d. Client Biologic Crisis 3. Somatoform. Culture Sensitivity . Maladaptive Patterns of Behavior a.c. Emotional Disorders of Infants. Anxiety Response and Anxiety Related Disorders b. Client’s Rights 1. Schizophrenia and Other Psychotic and Mood Disorders f. Disturbances in Immunologic functioning d. Refusal to take medications. and Sleep Disorders c. Psycho-physiologic Responses. Musculo-skeletal Disorders d. Informed Consent 2. Communication. Social Responses and Personality Disorders g. Emotional Responses and Mood Disorders e. Personal and Professional Development A. TEST V 1. Children and Adolescents. Continuing Education III. Network/linkage D. Sensory Disorders c. Referral C. Nurse-Client Relationship B. Disturbances in Perception and Coordination a. Substance related Disorders h. Nursing Accountability D. Ethico-Moral-Legal Responsibility A. Eating Disorders i. Sexual Disorders j. Neurologic Disorders b. Team approach B. Emergency and Disaster Nursing C. Treatment and Admission Procedures C. Documentation/charting E. Therapeutic communication IV.