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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 6 th 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.

obtained parental consent to enter the Deaconess School at Kaisserwerth. clothing for the men. 1820). * Theodor Fliedner and his wife Friederike Mumster – established the Institute of Kaisserwerth on the Rhine for the practical training of Deaconesses (1836). their work served as inspiration for the Red Cross later on. which is considered as the 1st Organized training school for nurses. 2nd largest of the Roman Catholic Orders. It was here where Florence Nightingale received some of her training and the inspiration for the establishment of her school of nursing. The “Dark Period of Nursing” (17th – 19th Century) * Many hospitals were closed. the wealth took care of their sick at home. . 1860 marked the day when 15 probationers entered St. * 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. A preliminary and probationary 3 months period of trial and error for both school and student. and 2.In 1854 a Volunteered for Crimean war service together with 38 women at Scutari in the Crimea upon the request of Sir Sidney Herbert. Among the highlights in her life are the following: . that they should have paid . the first organization of women to be trained as private duty nurse. laundry and linen and nursing care in the women’s and men’s wards. Thomas Hospital in London believed that schools should be self-supporting.* John Howard – introduced prison reforms (fresh air and plenty of water). * Mother Mary Catherine MccAuley – founder of the “Order of the Sisters of Mercy”. 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.At age of 31. A rotating 3 year experience in cooking and housekeeping. illiterate women who had no background for nursing. later established the Insitute of Nursing sisters. * Philippe Pinel – introduced his modern open-door treatment of the mentally ill. Thomas’ Hospital in London to establish the Nightingale system of Nursing. . thus reducing the infections. Minister of War in England. THE PERIOD OF EDUCATED NURSING England * June 15. At first their work is not accepted because it consisted of cleaning the area. writing letters to their families. that schools of nursing should have decent living quarters for their student. the indigent sick were taken care of by uneducated. . * Elizabeth Fry – greatly improved prison conditions by developing work fo the prisoners and the segregations of sexes.Had 3 months training at Kaisserwerth. Some of its features includes: 1. founded by Florence Nightingale (May 12.In 1860 started the Nightingale System of Nursing at the St.

patterned after the Nightingale plan – the Bellevue Training School for Nurse in the New York City .nurse instructors. The 20th Century *In 1900 – 1912 .There was beginning specialization in medicine.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. also began. School in New Haven and the Massachusetts General Hospital in Boston. . . .2 books written – Note on Nursing and Notes on Hospital. * 1913 – 1937 . .the practice of nursing was gradually infiltrated with educational objectives. . The American Society of Superintendent of Training Schools for Nurses.S was on the brink of the civil war.In 1873 3 schools of nursing opened. patterned after the DeaconessesSchool of Kaisserwerth. that the school should correlate theory to practice and these students should be taught the “why” not just “how” in nursing. . The Associated Alumnae. school nursing. Nurse Clara Louise Maas gave her life for the advancement of medical science in the search for control yellow fever.In 1881 – founding of American Red Cross by Clara Barton. However though the country was in a condition of chaos. United States * At the time that Florence Nightingale was opening her school in London.Linda Richards is the first graduate nurse in the U. later known as the National League for Nursing Education. the Connecticut training. later known as the American Nurses Association was begun at the Chicago Worlds fair and 2. .S completed her training at the New England Hospital for Women and Children in Boston. private duty nursing.S.In 1893 the groundwork for the estimate of the 2 new nursing organization was lad: 1. contain many timely portions applicable in the 1970’s as they were in 1859. . public health nursing. Massachusetts. . . .advancement in hospital nursing.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.a standard curriculum for schools of nursing was prepared by the National League for Nursing Education.there was a growing awareness for the preventive measures that could be uses to maintaing the heath of the nation. nursing had many supporters and the needs to train nurses were recognized. government service and pre-maternal nursing. the U.

. CONTEMPORARY NURSING * Creation of United Nations in San Francisco California in 1945.Scientific and Technical Research used in disease prevention and health care. World Health Organization (WHO) . social justice and economic progress.N. Lucille Ptery Leone as director and later the 1st woman to serve as assistant surgeon of the U.Special agency of U.Increase demand for public health nurse for preventice aspects of care. . .Opening of more nursing schools as a result of the construction of more hospitals.S Cadet Nurses Corps with Mrs.concept of psychosomatic medicine and early ambulation.S public Health Service. * World War II (1942 – 1945) . .* Worl War I (1917 – 1918) . established in Geneva. 2 folds purpose are: .granting of permanent commissioned rank for both army and navy nurses. Switzerland in 1948 .  Julia Stimson was the first woman to hold rank of major.International peace and international security with provisions for equal justice. Machinery for peaceful disputes and provisions. prepared health care.providing health information in fighting diseases and improving the nutrition. technology efficiency and nursing involvement with minority groups. . living standards and environmental conditions of all people. .Creation of the U. .the concept of family centered care as methods to help patient help themselves. . .Social Force affecting Nursing – Legislation. .the start of Aero-medical nursing (flight nursing) .Private duty nurses were now nursing in the hospitals rather than in homes.Awareness of the need for military ranking among nurses for which a bill was later introduced and passed. .Provisions for assuring human rights.consept of creative nursing. which has necessitated the need for laundering definitive studies of all aspects of nursing thus helping to raise the standards to a professional level.

SAN LAZARO HOSPITAL (1578) – exclusively for the service of leprous patients. . HOSPITAL de ZAMBOANGA (1842) – this is a governement military hospital run and finance by Spanish governement. HOSPITAL de AGUAS SANTAS (1590) – convalescent hospital in Pansol. HOSPITAL de CONVALENSCECIA (1656) – estimated by the Brotherhood of San Juan de Dios on the little island on the Pasig River. Founded by Brother Juan Clemente. HOSPITAL de CAVITE (1842) – a general hospital estimated and managed by Brotherhood of San Juan de Dios. HOSPITAL de NUEVA CACERES (1655) – general hospital located in Bicol. . *Fray Juan Clemente was one of the 1st member’s of the Mission of the Order of St.Collected native herbs for medicine later set a little pharmacy which he filled with various medical remedies. Bautista of the Franciscan Order. Named after San Lazaro. administered by the hospitallers of San Juan de Dios. . HOSPITAL de SAN GABRIEL (1866) – exclusively for Chinese patients .Performed both the function of a physician and those of a nurse. supported purely by alms and contributions from charitable persons. which cured several patients. patron saint of lepers. HOSPITAL de DULAC (1602 – 1603) – located in Paco and existed only for 1 year. Founded by Brother J. * Franciscan Order is more than any other religious group. Founded by Gov.believed in the powers of witch. HOSPITAL de INDIOS (1586) – established by the Franciscan Order: offered general services. Francisco de Sande. . SAN JUAN de DIOS HOSPITAL (1596) – founded by brotherhood of misericordia. Laguna. this was near medicinal spring. which were established by the religious and also by Spanish administration. 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. NURSING IN THE PHILIPPINES Early Care of the Sick * Early life of Filipinos had been more or less mixed with superstitious belief. patients of San Juan de Dios Hospital who were in the convalescent stage were sent there for their complete recovery.belief in the powers of “herbolarios” (albularyo) * Hospitals existed as early as 15th Century. . where the Hospicio de San Jose now stands. Francis in the Philippines in 1578.

converted their house into quarters for the Filipino soldier. alleviate pains. Josephine Bracken – wife of Jose Rizal Installed a field hospital in an estate house in tejeros. provided nursing care to the wounded when not in combat. This was founded on February 17. Dona Maria de Aguinaldo – second wife of Emilio Aguinaldo. President of the Filipino Red Cross branch in Batangas. . Provided nursing care to the wounded night and day. Captain Salome – A revolutionary leader in Nueva Ecija.S physicians and graduate nurses. the work of the nurse and those of the physician were not clearly defined. Rosa Sevilla de Alvaro – volunteered her service for the wounded soldier at age of 18. called Civil Hospital. *In the early development of nursing. during the Philippine – American war that broke out in 1899. Melchora Aquino (Tandang Sora) – Nurse the wounded Filipino soldiers and gave them shelter and food. 1899 with Dona Hilaria Aguinaldo as president and Dona Sabina Herrera as secretary. They dress wounds. dispensaries and laboratories led to the establishement of the Board of Health in July 1901. *In 1906 the idea of training Filipino girls to become nurses intiated the growth of nursing schools. Mrs. Organized the Filipino Red Cross under the inspiration of Apolinario Mabini. he work hand in hand with Dona Hilaria de Aguinaldo and they led other Filipino women to form the Filipino Red Cross in 1899. * These were the prominent women who volunteered and gave nursing service. *A small dispensary in Manila opened for civil officers and employees. Agueda Kahabagan – Revolutionary leader in Laguna. Provided nursing care for the Filipino soldier during the revolution. * The Filipino Red Cross had its own constitution approved by the revolutionary government.*Persons who really did nursing care of the sick were religious group (called hospitallers) but they were assisted by Filipino attendants. prepared food and gave comfort even without previous trainings. Trinidad Tecson – “Ina ng Biac na Bato”. The Rise of Hospital and Nursing Schools *The need for hospitals. stayed in the hospital at Biac na Bato to care for the wounded soldier. Dona Hilaria de Aguinaldo – wife of Emilio Aguinaldo. *The need for doctors and nurses to help eradicate the epidemics of cholera and smallpox led to the employment of U. Nursing Service during the Philippine Revolution * The women during the Philippine revolutions took active part in nursing the wounded soldier. also provided nursing services to her troop.

was the first superintendent.Miss Flora Ernst. 1913) .It started as a small dispensary on Calle Cervantes (now Avenida) . operated Three schools of Nursing: 1. an American nurse.It was called Bethany Dispensary and was founded by the Methodist Mission. . San Juan de Dios Hospital School of Nursing (Intramuros. Paul’s Hospital School of Nursing (Manila. Mary Johnston Hospital and School of Nursing (Manila.The Hospital is an Episcopalian Institution. Vitiliana Beltran was the first Filipino superintendent of nurses. took charge of the school in 1942. . 1911) 3. Philippine Christian Mission Institute School of Nursing.Anastacia Giron-Tupas. . the school opened with three Filipino girls admitted. . 4. with the support of the Governor General Forbes and the Director of Health and among others. 5. 1907) . . Iloilo Mission Hospital School of Nursing (Iloilo City. a graduate of New England Hospital for woman and children in Boston. . Ilocos Norte. In 1907.Was destroyed during the war with a new hospital built along Dewey Boulevard. Luke’s Hospital School of Nursing (Quezon City.1. Paul de Chartres.In 1907.The United Christian Missionary of Indianapolis. Emmanuel Hospital School of Nursing (Capiz. Frank Dunn Memorial Hospital 7. . 1913) .Miss Rose Nicolet. 8. It began as a small dispensary in 1903.It was located in Intramuros and it provided general hospital services.1903) 2. Mary Chiles Hospital School of Nursing (Manila. 1907) . 6. 1906) . -No standard requirements for admission except willingness to work. The Most Reverend Jeremiah Harty. St. she opened classes in nursing under the auspices of the Bureau of Education.It was ran by the Baptist Foreign Mission Society of America. -First trained nursing student graduated after 3 years. Sallie Long Read Memorial Hospital School of Nursing (Laoag. Manila. under the supervision of the Sisters of St.The hospital was established by the Archbishop of Manila.Mrs. 3. was the first Filipino to occupy the position of chief nurse and superintendent in the Philippines. 1907) . St. 2.Miss Librada Javelera was the first Filipino director of the school. Philippine General Hospital School of Nursing (1907) . Massachusetts. succeeded her.

The environment for the university school of nursing school education. Ms. Quezon Memorial Hospital School of Nursing (1957) 15. 1947) 17. adequate financial support.9. Baguio General Hospital School of Nursing (1923) 13. 2. Rita Hospital and School of Midwifery (1956) and Nursing (1960) Advantages of University Hospitals over Hospital Schools of Nursing: 1. Manila Central University College of Nursing (1948) c. 1947) e. The First Colleges of Nursing in the Philippines a.The hospital was established under the Bureau of Health with Anastacia Giron-Tupas as the organizer. University of the Philippines College of Nursing (1948).The first basic collegiate school for Nursing in the Philippines. Siliman University School of Nursing (Dumaguete. Manila Sanitarium and Hospital School of Nursing (1930) 14. 1960) 20. The head of the school is responsible only for the education of students in nursing and. b. St. 4. Brokenshire School of Nursing (Nueva Ecija. 10. 3. students are treated as students and not as employees. Chinese General Hospital School of Nursing (1921) 12. Philippine Union College of Nursing (1947) f. North General Hospital School of Nursing (1946) 16. Zamboanga general Hospital School of Nursing (1921) 11. Southwestern College College School of Nursing (Cebu. Cebu (Velez) General Hospital School of Nursing (1951) 19. De Ocampo Memorial School of Nursing (1954) 21.Julita Sotejo was its first Dean d.College of Nursing (1946) . Marian School of Nursing (1960) 22. 1918) . Occidental Negros Provincial Hospital School of Nursing (1946) 18. Central Philippine College of Nursing (1947) . University of Santo Tomas . Southern Island Hospital School of Nursing (Cebu.

enacted regulating the practice of the nursing profession in the Philippines Islands. FEU Institute of Nursing (1955) j. Practical Exam at the PGH Library. *Loreta Tupaz – Dean of the Philippine Nursing.theoretical exam was held at the UP Amphitheater of the College of Medicine and Surgery. regarded as the Florence Nightingale of Iloilo. . *Socorro Sirilan – Pioneered in Hospital Social Service in San Lazaro Hospital where she was the Chief Nurse. . *1920 – 1st Board Examination for Nurse was conducted by the Board of Examiners. 2808 (Nurses Law) was passed. 1958) Nursing Leaders in the Philippines *Anastacia Giron-Tupaz – First Filipino nurse to hold the position of Chief Nurse Superintendent.It also provided the holding of exam for the practice of nursing on the 2nd Monday of June and December of each year. 2468 authorized the granting of the titles of graduate in nursing and graduate in midwifery to nursing midwifery students of the PGHSN. *1922 – Filipino Nurses Association was established (now PNA) as the National Organization of Filipino Nurses.5% . *1915 – Act No. 1975 recognized the school under the Bureau of Health. *Rosa Militar – Pioneered in School Health Education. *1907 – 19 students admitted to a preliminary course in nursing as the Philippine Normal College. Philippine Women’s University College of Nursing (1951) i.Public Health Nursing in the Bureau of Health began in accordance with Act No. 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. 4 women started training in nursing. 2468. *1910 – Act No. 93 candidates took the exam. This act was later amended in 1922. 1933 and 1950.Anna Dahlgren. g. UE College of Nursing (1958) k. Siliman University College of Nursing (1947) h. . *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”. 68 passed with the highest rating of 93. *1919 – Act No. 1931. *1909 – A nursing school was established under the Bureau of Education by Authority of Act No. 3 female graduated in 1909 as “Qualified Surgical and Medical Nurses”. Founder of PNA (Philippine Nurses Association) *Cesaria Tan – First Filipino to receive a master’s degree abroad. *Sor Ricarda Mendoza – Pioneer in Nursing Education. Some Highlights in the History of Nursing in the Philippines *1906 – at the Union Mission Hospital (now Iloilo Mission Hospital) in Iloilo City. Saint Paul College of Nursing (Manila.

A one-year course leading to a certificate of Public Health Nursing was opened at the UPCN. *1970 – WHO started an ongoing project in nursing education on family planning to prepare faculty members to introduce family planning in basic nursing curricula. institute and workshops.A 6136 amending R. amending R. . *1966 – R.A 4704. Sotejo. *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. *1951 – Republic Act 649 provided for the standardization of nurses’ salaries both in institution and in public health. sponsor. Minor revisions were incorporated in 1957. 877 (Nursing Practice Law) was approved.The Psychiatric-Nursing Specialists. *1965 – The Academy of Nursing of the Philippines (ANPHI) approved its constitution.It redefined the functions and responsibilities of nurses and other health workers with implication for Nursing Education and Community Health Nursing. was established. *1953 – Republic Act No. . seminar. . (PNSI).A 877 was approved. *1975 – A National Health Plan was formulated. 1966 1970 and 1972. *1976 – A National Workshop on the Proposed Nurse-Midwife Curriculum of Schools of Nursing in the Ministry of Health was sponsored by the Ministry. *1975 – A national seminar on Public Health Nursing Education was held with WHO technical assistance.S Nursing Degree at the U.First attempt to offer a 4 year basic nursing course leading to a B. encourage.S Nursing Degree .The 1st attempt to elevate nursing as profession by enriching and broadening the preparation of nurses and by educating them in a University Setting. . who later became the 1st Dean of the School. . and to serve as a medium of exchange through conference. .The idea was conceived by Julita V. . This program ended in 1969. a Nurse and Lawyer.Among its objectives are initiate. promote. The Workshop drafted an experimental 4-year Nurse-Midwifery curriculum.First President – Rosario Delgado Founder – Anastacia Giron-Tupas *1924 – A standard curriculum for school of Nursing was published by the PNA. *1968 – A movement toward accreditation of Nursing Schools in the Philippines was started.R. .A program was opened for graduate of the 3 year hospital nursing course to obtain a B. *1972 – A national seminar on Public Health Nursing Education was held with WHO technical assistance.P College of Nursing. the 1 st independent Nurse Practitioners groups.A 877 and 4704 was approved. This program ended in 1975. Inc. . *1948 – UP College of Nursing was established. and/or conduct nursing studies and research.

.  Lydia Hall -developed the Care.  Clara Barton (1812-1921) -organized the American Red Cross. Its graduates traveled to other countries to manage hospitals and institute nurse-training programs.The 1st National Tripartite Conference on employment and conditions of life and work of Nursing and other Health Personnel was held. Nursing as a Profession . allowing women to vote.A 9173) 1.Labor. *2002 – Philippine Nursing Act of 2002 (R. -Nightingale’s vision of nursing. management and government were involved. Treat the PERSON ( or patient) as the Core. *1979 – The 1st National Nurse Congress was held. Nursing Leaders  Florence Nightingale (1820-1910) -recognized as nursing’s first scientist-theorist for her work. The focus tended to be on developing the profession within hospitals. concerning the employment of Nursing Personnel and the conditions of their life and work. was only partially addressed in the early days of nursing. Notes on Nursing: What It is. *1978 – The Declaration of the Economic and School Welfare of Filipino Nurses was passed by the PNA. and Cure Theory -Goal: To Care.  Lilian Wald (1867-1941) -considered the founder of Public Health Nursing. considered the founder of planned Parenthood. was imprisoned for opening the first birth control information clinic in Baltimore in 1916. Cure the DISEASE.*1977 – ILO convention 149 and recommendations 157.  Lavinia L. Core. which operated in 1860. -developed the Nightingale Training School of Nurses. . Dock (1858-1956) -active in the protest movement for women’s right that resulted in the U. -Care for the patient’s BODY.S Constitution amendment in 1920. B.S Congress ratified the Geneva Convention in 1882. which include public health and healt promotion roles for nurses.  Margaret Sanger (1879-1966) -a nurse activist. and What It is Not -considered the founder of modern nursing. its theme “Nursing Issues in the 80’s”. which linked with the International Red Cross when the U. The scchool served as a model for other training schools. were adopted in Geneva. and Cure Core’s disease.

A profession has a theoretical body of knowledge leaing to defined skills. community. psychological. 2. 5. 5. The profesion has a code of ethics for practice. NURSING . family.is service-oriented to maintain health and well-being of people. NURSE – originated from a Latin word NUTRIX. Must have a license to prac tice nursing in the country. To provide a needed service to the society. . Nursing is committed to involvement in ethical. 4.NURSING AS A PROFESSION Profession – is a calling that requires special knowledge. 3. and national health goals in its best manner possible. A basic profession requires an extended education of its members. Nursing is concerned with services that take humans into account as physiological. Nursing is committed to promoting individual. 6. 3. creed. Nursing is committed to personalized services for all persons without regard to color. and sociological organism. Members of a profession have autonomy in decision-making and practice. legal. and political issues in the delivery of health care. 4.is a helping profession.is an art and science. 3. as well as a basic liberal foundation.is a desciplined involved in the delivery of health care to the society. . . Nursing involves close personal contact with the recipient of care. Characteristics of a Profession: 1. 2. skill and preparation. 2. Characteristics of Nursing: 1. Must be physically and mentally fit. Nursing is caring. social or economic status. A profession provides a specific service. . Personal Qualities of a Nurse: 1. abilities and norms. 2. Must have a Bachelor of Science degree in Nursing. Criteria of Profession: 1. To protect its memebers and make it possible to practice effectively. An occupation that requires advanced knowledge and skills and that it grows out society’s needs for special services. 3. To advance knowledge in its field. to nourish.

Change agent . provider.provides information and helps the client to learn or acquire new knowledge and technical skills. coordinates activities of others. develop staff.initiate changes or assist clients to make modifications in themselves or in the system of care. . .functions as nurturer. comforter.helps client to recognize and cope with stressful psychologic or social problems. Promotes healthy lifestyle.provides explanation in client’s . 4.. .promotes what is best for the client.A professional nurse therefore. Teacher . . . 2. Caregiver/Care provider . 3. give direction.involves concern for and actions in behalf of the client to bring about a change.the traditional and most essential role. monitor operations.plans. .show concern for client welfare and acceptance of the client as a person.anguage and support client’s decisions.encourages compliance with prescribed therapy. Roles of a Professional 1. . 6.makes decisions. ensuring that the client’s needs are met and protecting the client’s right. .interprets information to the client. allocate resource evaluate care and personnel. is a person who has completed a basic nursing education program and is licensed in his country to practice professional nursing. . Client advocate . Counselor . .provides direct care and promotes comfort of client. Manager . to develop an improve interpersonal relationships and to promote personal growth.Encourages the client to look at alternative behaviors recognize the choices and develop a sense of control. give the reward fairly and represent both staff and administrations as needed. 5. . .“mothering actions” of the nurse.activities involves knowledge and sensitivity to what matters and what is important to clients.

Researcher .a nurse who has completed a program in midwifery. Nurse Anesthetist – . She is skilled at making nursing assessments. teaching and treating minor and self-limiting illness. teaches theoretical knowledge. and manages health-related business. Nurse Administrator – . Hospital/Institutional Nursing – a nurse working in an institution with patients. acts as a clinical consultant and participates in research.7. 7. 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. Nurse Entrepreneur - ..participates in scientific investigation and must be a consumer of research findings. Fields and Opportunities in Nursing 1. counselling. Nurse-Midwife – . responsible for the management and administration of resources and personnel involved in giving patient care. 3. performing P.a nurse who has an advanced degree. .a nurse who functions at various levels of management in health settings. -must be aware of the research process.is a nurse who has completed a master’s degree in specialty and has considerable clinical expertise in that specialty.participates in identifying significant researchable problems. She provides expert care to individuals. language of research. who beaches in clinical or educational settings.E. 4. Clinical Specialists – .a nurse usually with advanced degree. clinical skills and conduct research. 5. a sensitive to issues related to protecting the rights of human subjects. Nurse Educator – . Expanded role as of the Nurse 1.a nurse who completed the course of study in an anesthesia school and carries out pre-operative status of clients. . 6. 2. provides prenatal and postnatal care and delivers babies to woman with uncomplicated pregnancies. participates in education health care professionals and ancillary.

Individual . lying-in.” .Health . Example: brgy. BP monitoring. office. Private Duty/Special Duty Nurse – privatey hired. OPD only ). home service. 6. 5.Environment . efficient drainage. Nursing Theory and Theorists 4 Essential concepts common among nursing theories: . etc. . 7.Nursing FLORENCE NIGHTINGALE’S ENVIRONMENTAL THEORY . the body could repair itself. companies. ( no confinement. DOROTHEA OREM’S SELF-CARE THEORY .I. Public Health Nursing/Community Health Nursing – usually deals with families and communities. . Nursing Education – nurses working in school.Focuses on changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act.Example: rehabilitation. . cleanliness/sanitation and light/direct sunlight. 3. pure water. 8.Deficiencies in these 5 factors produce illness or luch of health but with a nurturing environment. Industrial/Occupational Nursing – a nurse working in factories. Military Nurse – nurses working in a military base. 2. Independent Nursing Practice – private practice. Health Center. quiet environment essential for recovery. review center and hospital as a C. well-ventilated.Identified 5 environmental factors: fresh air.Considered a clean. .Defined Nursing: “The act of utilizing the environment of the patient to assist him in his recovery.Independent Nurse Practtioner. Clinic Nurse – nurses working in a private and public clinic. 4.

It provides a broad understanding and direction. and logical argument. Environmental Theory *Disease is a reparative process. warmth.Helping Art of Clinical Nursing * “…nursing is nurturing or caring for someone in a motherly fashion.Definition of Nursing. o Knowing if they can solve on their own or need help. environment.would contribute to the process and health of the patient. -Has a strong health promotion and maintainance focus. o Exploring meanings of the behavior.” . 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. and that the manipulation of the environment - ventilation. will. o Knowing the cause of discomfort.” *Proposed that nurses identify patient’s need-for-help by: o Observing behaviors regarding comfort. and nursing) in each of the conceptual models of nursing. Ernestine Wiedenbach . health. · Sets forth meaning through analysis. *Also renowned for pioneering statistical analysis of healthcare. *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. Breathe 8. Florence Nightingale .Modern Nursing.Focuses on activities that adult individuals perform on their own behalf to maintain life. Clean body and intact integument . light. Philosophy · Specifies the definition of the metaparadigm concepts (person. sick or well. health and well-being. C. 14 Basic Needs *“The unique function of the nurse is to assist the individual. or knowledge and to do this in such a way as to help him gain independence as rapidly as possible” *14 Basic Needs: 1. and noise ..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. Virginia Henderson . diet. Theoretical Foundation of Nursing Applied in Health Care Situations THEORETICAL FOUNDATION OF NURSING I. cleanliness. reasoning.

he needs more professional nursing care o Wholly professional nursing care will hasten recovery Jean Watson . Worship 5.Novice to Expert .Learn Faye Glenn Abdellah . religious ministry. Communicate 4. 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. Scientific problem-solving method for decisions 2. *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. Nurses should be sensitized to humanistic aspects of caring *10 Carative Factors 1. bathing and toileting o As the patient needs less medical care.Play 7. -Care (Body) exclusive to nurses. shared with psychiatry/psychology. Develop helping-trust relationship 9. Eliminate 10. Core. Allowance for existential-phenomeno- logical forces Patricia Benner . Form humanistic-altruistic values 6. involves intimate bodily care like feeding. or corrective environemnt 4.2. protective. Safe environment 3. Assist gratifying human needs 5.Care. Instill faith-hope 7. Promote interpersonal teaching-learning 3. Provide supportive.21 Nursing Problems *Problem solving was seen as the way of presenting nursing(patient) problems as the patient moved towards health. Cultivate sensitivity 8. Temperature 14. Clothing 13.Work 6. Lydia Hall .Philosophy and Science of Caring. Motion and position 11. etc. Promote and accept expression of positive and negative 10. Eat and drink 9. Carative Factors *Caring is a universal social phenomenon that is only effective when practiced interpersonally. Rest and sleep 12.

Novice *Has no experience (e. and governed by context-free rules and regulations rather than experience. *Has experienced enough real situations to make judgement about them. STAGE IV. *Demonstrates highly-skilled intuitive and analytical ability in new situations.g. Competent. *Principles to guide actions begin to be formulated and are focused on experience. *Differentiates important factors from less inportant aspects of care. *Is inclined to take a certain action because “it felt right. Advanced Beginner *Demonstrate marginally acceptable performance. *Demonstrates organizational and planning abilities. .. *”Just tell me what I need to do and I do it. *Perceives situations as a whole rather than in terms of parts as in Stage II. Competent *Has 2 to 3 years of experience. *Coordinates multiple complex care demands. * Recognizes the meaningful “aspect” of a real situation. STAGE V. Proficient *Has 3 to 5 years of experience. Conceptual Models *Frameworks or paradigms that give a broad frame of reference for systematic approaches to the concerned phenomena. *Focuses on long-terms goals. *Has holistic understanding of the client. or maxims to connect an understanding of the situation to appropriate action. STAGE III.*Validated the Dreyfus Model of Skill Acquisition in nursing practice with the systematic description of the 5 stages (Novice. Nursing Student) *Performance is limited inflexible. *Concepts that specify their interrelationship to form an organized perspective for viewing the phenomena Grand Theories *Derived from models but as “theories”. and highly proficient. BENNER’S STAGES OF NURSING EXPERTISE STAGE I. Expert *Performance is fluid. *Uses maxims as guides for what to consider in a situation. they propose testable truths or outcomes based on use of the model in Practice. Proficient.” II. which improves decision making.” STAGE II. no longer requires rules guidelines. flexible. Advanced beginner. and Expert). *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. *Novices have no “life experience” in the application of rules.

3 Types:  Wholly Compensatory . establish body economy to safeguard stability: Environment Organismic Response . Integrality . sensation and emotion. nurse has important role in designing nursing care.Unitary Human Beings *Principles of Homeodynamics Helicy .Conservation Model *Major Concepts: o Wholism (Holism) o Adaptation .help the patient do for himself.help the patient learn to do for himself.(1)Fight or flight.  Supportive Educative . Openness . (2)inflammatory response.do for the patient. thinking being .process whereby patients retain integrity. *Theoretical Assertions Energy .alternative to nursing diagnosis o Conservation . Sentient. Helicy . Myra Estrin Levine . Resonancy . non-repeating. Pattern and organization identify man and reflect his innovative wholeness.Life evolves irreversibly and unidirectionally along space and time.continuous mutual process of person and environment.Man as a whole is more than the sum of his parts. Dorothea Orem . and innovative patterning.Nursing intervention is based on the conservation of the patients: Energy Structural Integrity Personal Integrity Social Integrity *Composed of 3 Theories.Care Deficit Theory *Composed of 3 Theories: o Theory of Self Care o Theory of Self-Care Deficit o Theory of Nursing Systems . . language and thought.Self. (4)perceptual awareness Trophicogenesis . Martha Rogers .Man and environment continuously exchange matter and energy.  Partly Compensatory .4 principles of conservation . (3)response to stress.patterning changes with development from lower to higher frequency(intensity).man has capacity for abstraction and imagery.(1) conservation (2) redundancy (3) therapeutic intention.spiral development in continuous.

organization. Eliminate 11.Model for Nursing Based on a Model of Living · Conceptual Components o 12 Activities of Living (AL) . a person shows adaptive or ineffective response that need nursing intervention. Express sexuality 5.perception. Temperature 2. interaction. Roper.Dorothy Johnson . and stress Social System . Breathe 9.role.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 . Eat and drink 10. Sleep 6. interaction and transaction *Interacting systems: Personal System . Dying . and Tierney . transaction. Mobility 3. Logan. and interdependence *Through adaptive mechanisms. judgement and actions of nurse and patient lead to reaction. communication. explore means of attaining goals. self. growth and development Interpersonal System . regulator and cognator. Work and play 4. and agree on what means to use *Perceptions. Communicate 8. Imogene King . decision making. Personal cleansing and dressing 12.Interacting Systems Framework. such as physiological self- concept. role function. body image. power-authority status. Maintain safe environment 7.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. Goal Attainment Theory *Nursing is a process of human interaction between nurses and patients who communicate to set goals.complex process of living in the view of an amalgam of activities 1.

concept of continuous change from birth to death Dependence-independence continuum 5 factors influencing AL: Biological. Socio-cultural. 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. Stranger 4. Leader 2. Psychological. *4 Phases of Nurse-Patient Relationship Orientation Identification Exploitation Resolution *6 Nursing Roles 1. Mother of Psychiatric Nursing *Stressed the importance of the nurse’s ability to understand one’s own behavior to help others identify felt difficulties. Counselor *4 Psychobiological Experiences that compel destructive or constructive responses Needs Frustrations Conflicts Anxieties Ida Jean Orlando . Theories *Group of related concepts that proposes actions that guide practice. condition and location.Nursing Process. 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 .Psychodynamic Nursing. Hildegard Peplau .Resource Person 5. Environmental. Politicoeconomic. Surrogate 3. *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. Life span . III. Teacher 6.

Developing empathy 4. experience. Joyce Travelbee . Tomlin and Swain .Theory of Comfort *Defined healthcare needs as those needs for comfort including physical. social.*Used the nursing process to meet patient’s needs through deliberate action.Transcultural Care Theory. andenvironmental needs *Intervening factors influence client’s perception of comfort: age.Maternal Role Attainment *Focused on parenting and maternal role attainment in diverse populations. and environment. object attachment. teaching. Developing sympathy 5. and contentment 3. Sense of ease. developmental tasks. attitude. Relief when specific need is fulfilled 2. Emerging identities 3. 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. *Developed a complex theory to explain the factors impacting the maternal role over time. Rapport Katherine Kolcaba . Original encounter 2. psycho- spiritual. advanced nursing beyond automatic response to disciplined and professional response. Transcendence or rising above the problems of pain Erikson. 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. Ramona Mercer . prognosis *Types of comfort: 1. finance. Ethnonursing .Modeling and Role-Modeling *Synthesis of multiple theories related to basic needs. Madeleine Leininger . calm. emotional support.Human-to-Human Relationship Model *Nursing was accomplished through human-to-human relationship: 1.Parent-Child Interaction. Kathryn Barnard .

facilitative acts towards people with actual or anticipated needs *3 types of Nursing Actions Cultural Care Preservation or Maintenance . cultural values. and values. time.changing life-ways while still respecting culture for a healthier outcome. beliefs. culture.Human Becoming *A unique. Rosemarie Rizzo Parse . supportive. Margaret Newman .retention of relevant care values unique to culture Cultural Care Accommodation or Negotiation . 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 .Conceptual Model for Nursing *Used a model from Dorothy Johnson and definition of nursing from Virginia Henderson *Identified assumptions. *Caring includes assistive.Uncertainty in Illness *Researched into experiences with uncertainty as it relates to chronic and life- threatening illness.” *The goal of nursing is not to promote wellness or to prevent illness. “Movement is a reflection of consciousness. but to help people use the power within them as they evolve toward a higher level of consciousness. Time is a function of movement.Model of Health *Major concepts are movement. and cultural variations *Caring is seen as the central theme in nursing care.*Some of the major concepts are care. space and consciousness. and major units . Time is a measure of consciousness. caring.adapting culture with professional care providers Cultural Care Repatterning or Restructuring . Evelyn Adam . *Later reconceptualized to accommodate the responses to uncertainty over time in people with chronic conditions who may not resolve the uncertainty. knowledge and practice.

Formulates a plan of care in collaboration with patients and other members of the health team. MANAGEMENT OF RESOURCES AND ENVIRONMENT 1.. B. Promote wholeness and well-being including safety and comfort of patients. Implements planned nursing care to achieve identified outcomes.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. Evaluates progress toward expected outcomes. and situational and behavioral factors. and the consequence. 6. 11. 2. the intervention of the professional. Utilizes resources to support Patient care. 5. 4. 10. 2. SAFE AND QUALITY NURSING CARE 1. 5. and these factors are modified by demographics. Responds to the urgency of the patient’s condition. 8. beneficiary of the professional service. Professional Organizations in Nursing F. Continuing Professional Education E. C. Practices stewardship in the management of resources. like importance of health- promotion behavior and its perceived barriers. 9. Utilizes the nursing process as framework for nursing. 3. Demonstrate knowledge based on the health/Illness status of indiidual groups. Ensures continuity of care. biology. Eleven Key Areas of Responsibility ELEVEN KEY AREAS OF RESPONSIBILITY A.*Included goal of the profession. Checks proper functioning of equipment/facilities. Organizes work load to facilitate patient care. Ensures availability of human resorces. role of the professional. Nola Pender . Administersmedications and other health therapeutics. source of the beneficiary’s difficulty. interpersonal influences. 6. Assess the learning needs of the patient and family. 7. 3. 4. Sets priorities in nursing care based on patients’ need. . The Nurse in Health Care 1. D. Maintains a safe and therapeutic environment. HEALTH EDUCATION 1. Provides sound decision making in the care of individuals/groups.

Maintains accurate and updated documentation of patient care. Develops health education plan based on assessed and anticipated needs. Projects a professional image of the nurse. Personal and Professional Development 1. Quality Improvement 1. Adheres to the national and international code pf ethics for nurses. 4. Respects the rights of individuals/groups. Identifies own learning needs. Gets involved in professional organizations and civic activities. 3. Recommends solutions to identified causes of the problems. 2. 4. LEGAL RESPONSIBILITY 1. 2. Disseminates results of research findings. I. Documents care rendered to patients. 5. Reasearch 1. F. Possesses positive attitude towards change and criticism. Ethico-Moral Responsibility 1. 2. J. 3. H. Utilizes data for quality improvement 2. Participtaes in nursing audits and rounds.2. Develops learning materials for health education. Observes legal imperatives in record keeping. local and national. Applies research findings in nursing practice. D. G. 6. 2. Recommends actions for implementation. Evaluates the outcome of health education. Recommends improvement of systems and processes. Implements the healtheducation plan. Adheres to practice in accordance with the nursing law and other relevant legislation including contracts. Identifies and reports variances. 3. Adheres to organizational policies and procedures. Communication . 4. Performs function according to professional standards. 2. Utilizes varied methods of inquiry in solving problems. 3. informed consent. 3. 5. E. 3. 3. Records outcome of patient care.Accepts responsibility and accountability for own decisions and actions. 4. Maintains an effective recording and reporing system. Pursues continuing education. Record Management 1. 5. 4.

Utilizes formal and informal channels. Measures to meet physiological needs 1. Asepsis and Infection Control 5. Collaboration and Teamwork 1. Administration of Medications 4. Roles and Functions II. Comfort and Hygiene 8. Oxygenation 2. members with the team and the public in general. K.It is a systematic. Functions effectively as a team player. Bowel Elimination 7. Safe and Quality Care A. Responds to needs of individuals. Fluid and Electrolyte Balance 5. Safety. Utilizes effective communicationin therapeutic use of self to meet the needs of clients. client-centered method for structuring the delivery of nursing care. First Aid Measures 6. Perioperative Care 8. 5. Wound Care 7. Mobility and Immobility . Establishes collaborative relationship with colleagues and other members of the health team for the health plan. 4. Post-operative Care 9. Rest and Sleep 4. 2. Utilizes effective communication in relating with clients. Vital Signs 2. Physical Examination and Health Assessment 3. Activity. B. Post-mortem Care C. Nutrition 3. Urinary Elimination 6. Basic Nursing Skills 1. families.1. Uses appropriate information technology to facilitate communication. 2. 2. groups and communities. The Nursing Process NURSING PROCESS Definition . Fields of Nursing 3. 3.

Teaching and Learning Principles in the Care of Client B. The Philippine Nursing Law of 2002 (R. Discharge Planning IV. Ethico-Moral Responsibility A. Referral VIII. Legal Aspects in the Practice of Nursing B. Documentation F. Patient Care Classification F. Health Education in All Levels of Care C. Truth Telling 7. Justice 4. Memorandum D.III. Theories. Endorsement and End of Shift Report G.A 9173) C. Legal Responsibility A. Principles and Styles of Leadership D. Patient’s Bill of Rights C. Autonomy 5. Theories and Principles of Management B. Beneficence 2. Records Management A. Standards of Nursing Practice . Incident Report C. Confidentiality 8. Bioethical Principles 1. Related Laws Affecting the Practice of Nursing VI. Non-maleficence 3. Code of Ethics in Nursing V. Nursing Administration and Management C. Nursing Care Systems G. Health Education A. Quality Improvement A. Privacy 9. Stewardship 6. Delegation and Accountability VII. Anecdotal Report B. Informed Consent B. Hospital Manual E. Management of Environment and Resources A. Concepts and Principles of Organization E.

The Scientific Approach D. Qualitative 2. Ethics and Science of Research C. Problem Identification B. Safe and Quality Care. This includes care of high risk and at-risk mothers. concepts. Collaboration and Teamwork A. Networking B. principle and processes in the care of individuals. Research Designs and Methodology 1. Quality Assurance IX. Health Education and Communication. utilizing the nursing process as framework. Professional-Professional Relationship D. families. Use of Information Technology XI. Collaboration and Team work . Accreditation/Certification in Nursing Practice D. and alleviate pain and discomfort. Research Process E. Communication A. Nursing and Partnership with Other Profession and Agencies Nursing Board Exam/Nursing Licensure Exam Coverage (Nursing Practice II) NURSING BOARD EXAM SCOPE/COVERAGE NURSING PRACTICE II TEST DESCRIPTION: Theories. Therapeutic Use of Self E. Teamwork Strategies D. groups and communities to promote health and prevent illness. Inter-agency Partnership C. Research A. children and families during the various stages of life cycle. Quantitative F. Utilization and Dissemination of Research Findings X. Dynamics of Communication B.B. Nursing Audit C. TEST SCOPE: Part I: CHN I. Nurse-Client Relationship C.

October 22. February 1946 – Number of Nurses decreased from 556 – 308. 1923 – Zamboanga General Hospital School of Nursing and Baguio General Hospital were established. Mariano Icasiano became the first ciy health officer. 1928 – 1st Nursing convention was held 1940 – Manila Health Department was created. Filariasis.COMMUNITY HEALTH NURSING HISTORY OF CHN Date 1901 – Act # 157 (Board of Health of the Philippines) . 1912 – Act # 2156 or Fajardo Act created the Sanitary Divisions. July 1942 – Nursing Office was created. 1976 – 1986 – The need for Rural Health Practice Program was implemented. 1941 – Dr. other government schools of nursing were organized several years after. Cancer. Leprosy. V. functions were transferred to the Bureau of Health. 1st Filipino Nurse supervisor under Bureau of Health. and Zenaida Nisce composed the training staff. 1941 – Victims of World War II were treated by the nurses of Manila. 1922 – Filipino Nurses Organization (Philippines Nurses’ Organization) was organized. the forerunners of present MHOs. 1095 – Board of Health was abolished. 1990 – 1992 – Local Government Code of 1991 (RA 7160) . and Mental Health Illness). 1919 – Act # 2808 (Nurses Law was created) . Ramos. Ms. Trinidad Gomez. 1948 – First training center of the Bureau of Health was organized by the Pasay City Health Department. Bugarin. Marcela Gabatin. male nurses performs the functions of doctors.Carmen del Rosario. 1975 – Scope of responsibility of nurses and midwives became wider due to restructuring of the health care delivery system. Office of Nursing was created through the effort of Vicenta Ponce (Chief Nurse) and Rosario Ordiz (assistant chief nurse) December 8.D. 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. Constancia Tuazon. 1953 – The first 81 Rural Health Units were organized.. Eusebio Aguilar helped in the release of 31 Filipino Nurses in Bilibid Prison as Prisoners of War by the Japanese. Act # 309 (Provincial and Municipal Boards of Health) were created. Ms. 1950 – Rural Health Demonstration and Training Center was created. 1958 – 1965 – Division of Nursing was abolished (RA 977) and Reorganization Act (EO 288) 1961 – Annie Sand organized the National Nurses of DOH. 1967 – Zenaida Nisce became the nursing program supervisor and consultant on the six special diseases (TB. Dr.

DOH Representative. functions and responsibilities to the local government both rural and urban. board members.amended by R. which redirects the functions and operations of DOH. It created the 1st 81 Rural Health Units. 1999 – EO # 102. 2. The LGU’s financial capability. . 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. NGO Respresentative. . R. This act defines the practice of medicine in the country. hence help decrease the high incidence of preventable diseases. Chair. This involves the devolution of powers. DOH Representative 5.A 2382 – Philippine Medical Act. 4. each province. Community Empowerment R. Composition of Local Health Board ( LHB ) Provincial Level 1.A 7160 – or the Local Government Code. Governor – Chair 2. NGO Representative Effective LHS Depends on: 1.1993 – 1998 – Office of Nursing did not materialize in spite of persistent recommendation of the officers. Provincial Health Officer – vice chair 3. January 1999 – Nelia Hizon was positioned as the nursing adviser at the Office of Public Health Services through Department Order # 29. Mayor – Chair 2. Committee on Health of Sangguniang Bayan. 5. Hence. more physicians. dentists. and advisers of the National League of Nurses Inc.A 1891. Chair. midwives and sanitary inspectors will live in the rural areas where they are assigned in order to raise the health conditions of barrio people. Committee on Health of Sangguniang Panlalawigan. was signed by former President Joseph Estrada. A dynamic and responsive political leadership 3. Laws Affecting Public Health andPractice of Community Health Nursing R. City and Municipal Level 1. May 24. 4.A 1082 – Rural Health Act. nurses. MHO – vise chair 3. 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.

and functions of POPCOM. and to encouragethose with proper qualifications and excellent abilities to join and remain in government service. 996 – requires the compulsary immunization of all children below 8 years of age against the 6 childhood immunizable diseases. objectives. 965 – requires applicants for marriage license to receive instructions on family planning and responsible parenthood. 1979. sanitary and recreation facilities. R. duties. R. -. P. P. their living and working conditions and terms of employment. administration. R. R. Public officials and employeesshall at all times be accountable to the people and shall discharges their duties with utmost responsibility. transmitters of disease. R. distribution and transportation of prohibited drugs is punishable by law.A 9165 – The New Dangerous Draug Act of 2002. It is thepolicy of the state to promote high standards of ethics in public office.A 6675 – Generics Act of 1988 which promotes. R. animal carriers. 825 – provides pernalty for improper disposal of garbage. delivery. 949 – legal basis of PHC dated october 19.R.A 7875 – National Health Insurance Act R. P.A 8749 – Clean Air Act of 2000 P. R. P. 2 of 1986 – includes AIDS as notifiable disease. 651 – requires that all Health Workers shall identify and encourage the registration of all births within 30 days following delivery.A 7432 – Senior Citizens Act . act with patriotism and justice.A 8423 – Created the philippine Institute of Traditional and Alternative Health Care.A 7305 – Magna Carta for Public Health Workers. insects. to develop their skills and capabilities in order that they will be more responsive and better equipped to deliver health projects and programs. P.D No. distribution. R.D No.D No.D No.A 3573 – requires reporing of all cases of communicable diseases and administration of prophylaxis. lead modest lives uphold public interest over personal interest.A 6758 – Standardizes the salary of government employees including the nursing personnel. R.D No. requires and ensures the production of an adequate supply. competence and loyalty.A 6713 – Code of Conduct and Ethical Standards of Public Officials and Employees. food. pollution and control of nuisance. nilse.A 4073 – advocates home treatment for lepsrosy. R.D No. use and acceptance of drugs and medicines identified by their generic name. 79 – defines. Letter of Instruction No. This act aims: To promote and improve the social and economic well-being of health workers. 856 – Code of Sanitation. integrity. It stipulates that the sale. milk.promotes development of health programs on the community level. Misnistry Circular No.A 6425 – Dangerous Drugs Act. It provides for the control of all factors in man’s environment that affect health including the quality of water.

HEALTH – is the OLOF (Optimum level of Functioning). Definition of Terms Community – derived from a latin word “communicas” which means a group of people. Infants be given timely. 3. adequate and safe complementary foods 4. *A. R. -It primarily affects the physical well-being of people in a society. HEALTH – ILLNESS CONTINUUM . A.A predictive grid that displays the Likelihood of a person to participate in preventive health care. No. I. 1. -A personal and social responsibility.A 2029 – Mandates Liver Cancer and Hepatitis B Awareness Month Act ( February ). Breastfeeding be continued up to 2 years and beyond.place where people under usual conditions are found. .R. R. All newborns be breastfeed within 1 hour after birth. Infants be exclusively breastfeed for 6 months. 2006 – 0012 – Specifies the Revised Implementing Rules and Regulations of E. self- development and self-reliance and integration into the mainstream of society.A 7600 – Rooming In and Breastfeeding Act of 1992. E.O. (WHO). -Health is a fundamental human right. Penalizing Violations thereof and for other purposes. provides their rehabilitation.O No. 2006 – 0015 – Defines the Implementing guidelines on Hepatitis B Immunization for infants. Relevant International Agreements.O 51 – Philippine Code of Marketing of Breastmilk Substitutes.A 8976 – Food Fortification Law R. 2. mental and social well being.A 7846 – Mandates Compulsary Hepatitis B Immunization among infants and children less than 8 years old.A 7277 – Magna Carta for PWD’S.A 8980 – Promulgates a comprehensive policy and a national system for ECCD. R. R.O No.state of complete physical. 2005 – 0014 – National Policies on Infant and Young Child Feeding: 1.a group of people with common characteristics or interests living together within a territory or geographical boundary. A.A 8172 – Salt Iodization Act ( ASIN LAW) R.O 51 or Milk Code. -A multifactorial approach. not merely the absence of disease or infirmity.A 7719 – National Blood Services Act R. . .

. GMO’s – carcinogen diseases) MSG.Causative etiologic factor HOST – Persons who may or may not be at risk of acquiring the disease. common diseases allergens M .carcinogens. 2. protozoa. . (E) – Education. that by its presence or absence can lead to illness or disease. physical. Intrinsic Factors & 1. -Requires the individual to maintain a continuum of balance and purposeful direction with environment. Behavior 4. Ex: Etiologic factor of Dengue? --. and (G) – Growth. psychosocial.Primarily used to predict an illness AGENT – Any environmental factor or stressor.poison 3. chemical. AGENT – HOST ENVIRONMENT MODEL . Age . and (D) – Disorder or disability which may lead disease or premature death.Virus AGENT HOST A. HIGH-LEVEL GOOD NORMAL ILLNESS DEATH WELLNES HEALTH HEALTH HEALTH – ILLNESS CONTINUUM. 2. poisons. morbidity: 2.Weak emotional.Mortality ( killer Ex. Etiologic Factors: B. ectoparasites F . represents the process of achieving HIGH LEVEL OF WELLNESS or the consequences of unhealthy lifestyle. will be on the other side of the grid. there are three parameters on how to achieve high level of wellness. an individual who continuously live an unhealthy lifestyle. as shown here. Chemical. Educational attainment- . matters as a person adopts to change in internal and a holistic well – being.fungi.with intrinsic factor ENVIRONMENT – All factors external to the host that may or may not predispose the person to the development of the disease. These are: (A) – Awareness. In this figure. Sex (m or f) helminthes. . and would develop the following: (S) – Signs and Symptoms (S) – Syndrome.Dynamic state.A Degree of client wellness ranging from optimum wellness to death. . mechanical. Biological infections----virus. Otherwise. Environmental Factors bacteria 1.

Mechanical. sea workers. HEALTH BELIEF MODEL . Biological environment 3. etc occupation 4. Natural boundaries. 5. Seriousness of an illness.occupational hazard Prevention: Safer Sex Practices Abstinence Be faithful Correct. Male infected w/ STD & female non-infectious----.excess or deficiency C. Susceptibility to an illness.Increase susceptibility of transmission HIV infection (commercial sex farers.- political boundary 3. COMPONENTS: INDIVIDUAL PERCEPTIONS: Includes perceived susceptivility. Environmental/physical.car accidents. Socioeconomic env’t. sociophysiologic variables. MODIFYING FACTORS: Includes demographic variables. consistent. 3. Psychological 1. geography 2. Nutritive. Ex.response heatstroke 5.Usefool tools in developing programs for helping people change to healthier lifestyles and develop a more positive attitudetoward preventivehealthier measures.physical. medical team Susceptibility. Prior immunologic. common in rural Vaginal: 1: 1000 .unprotected sex. structural variable.won’t get pregnant. and cues to action. . possible MOT--. continuous use of condom Do not penetrate (SOP) HIV infected age groups Males age 40-49 seafarers ratio: 1: 5 anal sex. LIKELIHOOD TO ACTION: Depends on the perceived benefit versus the perceived barriers. Benefits of taking actions.Helps determine whether an individual is likely to participate in disease prevention and promotion activities.seriousness and threat. Extrinsic Factors 6.

Aims: 1. Sex education Combating any possible disease ( no existing disease ) Illness – Highly subjective feeling of being sick or ill. Females 20-29 Anal: 1: 200-----highest risk Oral – lowest risk 4. control of communicable diseases. disease prevention 3. PUBLIC HEALTH – ( Dr. management of factors affecting health.E Winslow ). so organizing these benefits as to enable every citizen to realize his birthright of birth and longevity”. prolonging life.based on Darwin’s “Survival of the fittest theory” Elements: a. the education of individuals in personal hygiene. EVOLUTIONARY – BASED MODEL ● illness & death serve an evolutionary function.( Dr C. C. Winslow ) the ”science and art of preventing disease. HEALTH PROMOTION MODEL * Directed at increasing clients well – being. Evolutionary viability within the social context –extent to which a person fx to promote survival d. Health determinants 5. Control perceptions e. health promotion 2. INDIVIDUAL CLIENT: APPLIED STUDY: COMMUNITY AS CLIENT: Anatomy Structure Demographic – study of population .E. Lifestyle determinants – personal & learned adaptive strategies a person uses to make lifestyle changes c. promoting health and efficiency through organized community effort for the sanitation of the environment. COMMUNITY HEALTH – part of paramedical and medical intervention/approach which is concerned on the health of the whole population. 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. Life events – developmental variables & those associated with changes b. * All efforts increasing well – being ( no threat ) ex. Viability emotions –affective reactions developed from life events f.

1. Virginia Henderson . 4. 1. (WHO Expert Committee of Nursing) – . COMMUNITY HEALTH NURSING -Synthesis of public and nursing practice. Priority of health-promotive and disease-preventive startegies over curative interventions. 5.Providing assistance to clients to achieve self-care towards optimum wellness.” 2. Dorothea Orem . Early years. 3. Florence Nightingale . . .special field of nursing that combines the skills of nursing.self care. rehabilitation of illness and disability.12 years/ younger adults.12-24 years Orem. (Jacobson) – is a learned practice disciplined with the ultimate goal of contributing as individual and incollaboration with others. Tools for measuring and analyzing Community Health problems.individual capable of self-repair and there is something to repair in an individual.Placing an individual in an environment. Utilitarianism: “greatest good for the greatest number. that will promote optimum capacity for self-reparative process . public health and some phases of social assistance and functions as part of the total public health program for the promotion of health.Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness 2. (Maglaya) – The Utilization of the nursing process in the different levels of clientele – individuals.a specialized field of nursing practice.fetus.Physic Function Sociology Pathos Malfunction Epidemiology – study of disease NURSING – both profession and a vocation. prevention of disease and disability and rehabilitation. Nursing Process. concerned with the promotion of health. to the promotion of clients optimum level of functioning through teaching and delivery of care. the improvement of the conditions in the social and physical environment. autonomy----independent patient 3. Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness. Application of principles of management and organization in the delivery of health services to the community. population groups and communities. families.

families. Municipal. Ultimate goal – raise level of number of citizenry. CHN practices – to benefit the individual. Primary goal – self reliance in health or enhanced capabilities. Socio economic Influences Concepts 1. Hereditary 4. Environmental Influences 6. grps. Community Health Nurses are generalist in terms of their practice through life but the whole community – its full range of health problems and needs. service rendered by a professional nurse with the comm. 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. workplace for the promotion of health. in H centers. Behavioral 3. and indiv at home. ecology. Political 2..a service rendered by a professional nurse to IFC’s population groups in health centers. Health Care Delivery System 5. and Local Hospital . clinics schools. District. The primary focus of community health nursing practice is on health promotion and disease prevention. Prevention of illness 3. Philosophy of CHN – Worth and dignity of man. 4. analytical and organizational skills are applied to problems of health as they affect the community.Technical nursing. prevention of illness. The nature of CHN practice requires that current knowledge derived from the biological. Care of the sick at home and rehab . in clinics. in places of work for the ff: 1. special groups. .(Dr. Ruth B. Freeman) – . in school. Community Health Nurses are generalist in terms of their practice through life continuity in its full range of health problems and needs.self-reliance Factors affecting Optimum Level of Functioning (OLOF) 1. family. -Unique blend of nursing & public health practice aimed at developing & enhancing health capabilities of the people . 5. and community *CHN is integrated and comprehensive 3. Levels of Health Care: Primary Health Care: Management at the level of community Secondary Health Care: Regional. interpersonal. Promotion of health 2. 6. 2. care of the sick at home and rehabilitation. clinical nursing and community health organizations be utilized. social science.

PHILOSOPHY OF CHN *The philosophy of CHN is based on the worth and dignity of man. ADVOCATOR – acts on behalf of the client. Community Health Nursing . Roles of COMMUNITY HEALTH NURSE / PUBLIC HEALTH NURSE CLINICIANS . population groups and communities. et al To elevate the level health of the multitude.The utilization of the nursing process in the different levels of clientele- individuals. KI 7.” –Nisce. *Social Justice – activities related to practice practice equity among clients. 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. FACILITATOR – who establishes multi – sectoral linkages by referral system. SUPERVISOR – who monitors and supervises the performance of midwives. implementing and intervening provide measurements of progress. evaluation and a continuum of the cycle until the termination of nursing is implicit in the practice of Community Health Nursing. The dynamic process of assessing. Tertiary Health Care: Sophisticated Medical Center – Heart Center. educating people. COLLABORATOR – working with other health team member. MISSION OF CHN ( FIVE FOLD MISSION ) *Health Promotion – activities related to enhancement of health. prevention of disease and disability and rehabilitation. concerned with the promotion of health. intrasectoral ) II. -In the event that the Municipal Health Officer ( MHO ) is unable to perform his duties/functions or is not available. families. . Nursing Function: Independent – without supervision of MD Collaborative – in collaboration with other Health team ( interdisciplinary. planning. HEALTHEDUCATOR – who aims towards health promotion and Illness prevention through dissemination of correctr information. *Health Balance – activities designed to maintain well being. the Public Health Nurse will take charge of the MHO’s responsibilites. *Disease Prevention – activities relate to avoid complication = primary. taking care of the sick people at home or in the RHU.who is a health care providers. secondary. tertiary. *Health Protection – activities designed to protect the people.

labor. disabled in the homes.provides direct nsg care to the sick. and Evaluation. *Recommending Herbal and Symptomatic Meds.coordination with other health team & other gov’t org (GOs & NGOs) to other . ROLES OF THE COMMUNITY HEALTH NURSE 1. Provider of Nursing care. . and People empowerment. Manager/ Supervisor. -Influencing executive and legislative individuals or bodies concerning health and develoment. & circulars c. schools. she is responsible for the formulation of the municipal health plan ● Provides technical assistance to rural health midwives in health matters like target setting. Implementation. clinics. In the Care of the Communities: -Community organizing mobilization.Formulates nursing component of H plans ● In doctorless areas. In the Care of the Families: -Provision of Primary Health Care Services. Community development. Conducts regular supervisory visits & meetings to diff RHMs & gives feedbacks on accomplishments 4. -Developmental/Utilization of Family Nursing Care Plan in the provision of Care. implementing and evaluating Health programs/ services.-Other Responsibilities of a Nurse. Community Organizer. spelled by the implementing rules and regulations of RA 7164 ( Philippine Nursing Act of 1991 ) includes: *supervision and care of women during pregnancy. *Suturing lacerations in the absence of a Physicians. *Provisions of First aid measures and Emergency Care.formulates care plan for the: 4 Clientele: a. -Program planning. Planner/ Programmer. priorities & problems if individual. *Performance of Internal Examination and Delivery of Babies. Coordinator of Health Services. and puerperium. org. Interprets and implements programs. Etc. memoranda. allocates. & comm. or places of work ● provide continuity of patient care 3. 5. family.motivates & enhance community participation in terms of planning.identifies needs.. 2. policies.. Requisitions. distributes materials (meds & medical supplies & records & reports equips b.

Manager ---under the nurse---midwives 10. hilots who aim towards H promo & illness prevention through dissemination of correct info. & NGOs in the implementation of studies/ researches ● participates in the conduct of surveys studies & researches on Nsg and H related subjs. NGO/government agencies in the provision of public health services. -Provide quality nursing services to the three levels of clientele. Researcher. adults.Applies holism in early years of life.. health programs as env’t.The science & art of preventing disease. mid year & later . WINSLOW . it is implementation and evaluation for communities. PUBLIC HEALTH 1. Health promotion 2. -Maintain coordination/linkages with other health team members. 6.Most effective goal towards total development and life of the individual & his society 3. PURDOM . BHWs. -Provide opprotunities for professional growth and continuing education for staff development.conducts training for RHMs. promoting health & efficiency through organized community effort ● To enable each citizen to realize his birth right of health & longevity. ● educating people 7.coordinates with govt. dental health & mental health.Prioritizes the survival of human being . Change Agent 11. sanitation health education. prolonging life. People’s participation towards self-reliance 2. Trainer/ Health educator/ counselor. -Conduct researches relevant to CHN services to improve provision of health care. HANLON . young. Client Advocate Responsibilities of COMMUNITY HEALTH NURSE -Be a part in developing an overall health plan. 8. Health Monitor----evaluating what deviates from normal 9. Major concepts: 1.

socioeconomic c. organization of medical and nursing services for early diagnosis and preventive treatment of disease. Gender – Heredity -ECOSYSTEM influence on OLOF ( Blum 1974 ). Determinants of Health *Factors that can affect health a. the global community. 5. Income and social status . control of communicable diseases. Customs and Traditions . Genetics . so organizing these benefits as to enable every citizen to realize his birthright of health and longevity. water. Culture. prolonging life. Social support networks . d. Injury Prevention 3. sanitation of the environment. housing.socioeconomic b.Behavior i. the public health nurse is strategically positioned to make a difference in the health outcomes of individuals.Environment d. Health Services – Health Care Delivery System j. Employment and working conditions . . Health public policy including those in relation to environmental hazards such as in the work place. In response to above trends. b. Education . CORE “Busy”ness of Public Health: 1. c. represented by the United Nations General Assembly.Heredity h. Personal Behavior and coping skills . the education of individuals in personal hygiene. Concepts 1. and the development of social machinery to ensure everyone a standard of living adequate for the maintenance of health.socieconomic e..socioeconomic f.PUBLIC HEALTH NURSING (Cuevas. families. Health Protection 4. 2007) -In the light of the changing national and global helath situation and the acknowledgement that nursing is a significant contributor to health. Science and Art of Preventing diseases. promoting health and efficiency through organized community effort for the: a.Behavior g. etc. Promotion of health and equitable health gain. Disease control 2. and communities cared for. decided to adopt a common vision of poberty reduction and sustainable development in september 2000. Physical Environment . food.

Target: Halve. between 1990 and 2015. MDG 6: Combat HIV/AIDS. 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. by 2015. children everywhere. SHARED RESPONSIBILITY MDG 2: Achieve universal primary education Target: Ensure that. the proportion of people who suffer from hunger. the under – five mortality rate. between 1990 and 2015. the maternal mortality ratio. Malaria and other diseases Target: Have halted by 2015 and begun to reverse the spread of HIV / AIDS . between 1990 and 2015. the proportion of people whose income is less than one dollar a day. between 1990 and 2015. MDG 5: Increased maternal health Target: Reduce by three – quarters. will be able to complete a full course of primary schooling.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. boys and girls alike. MDG 4: Decreased child mortality Target: Reduce by 2/3.

families. Target: Address the special needs of the least developed countries. rule-based. Target: Address the special needs of landlocked countries and small island developing States. promoting and preserving the health *Specific/subspecialty nursing of the populations. Target : Develop further an open. to have achieved a significant improvement in the lives of at least 100 million slum dwellers. *Directs care to individuals. predictable. 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. Target: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases. Target : Halve. the proportion of people without sustainable access to safe drinking water Target: By 2020. non-discriminatory trading and financial system. in turn promoting and protecting health of contributes to the health of the total populations using knowledge from population. 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. this care. nursing social and public health *knowldge = nursing and PHN sciences. by 2015. practice. MDG 8: Develop a global partnership for development. . *Defined as “the practice of or groups. MDG 7: Ensure environmental sustainability Target : Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources.

-Heart monitoring and analysis. Theory Applies theoretical concepts as basisfor decisions in practice.There should be accurate recording and reporting in community health nursing. Principles and Standards of CHN PRINCIPLES AND STANDARD OF CHN PRINCIPLES 1. Assessment include Public Health Nursing and b. A. Health teaching is the primary responsibility of the community health nurse. 7. hospice care. V. Data Collection Gathering comprehensive. 11. 2. 9. Intervention . Planning At each level of prevention. Family. There must be provision for periodic evaluation of community health nursing service. CHN must be available to all regardless of race. The CHN works as a member of the health team 6. accurate data systematically. The family is the unit of service. -Epidemiological surveillance/disease prevention and control and all. 5. IV. *More General Specialty area that *CORE FUNCTIONS: encompasses subspecialties that a. 10. STANDARDS IN CHN I. The need of the community is the basis of community health nursing. develops plans that specify nursing actions unique to needs of clients. The CHN taps the already existing active organized groups in the community. *Essential Functions: and independent nursing practice. 8. 4. The community health nurse must understand fully the objectives and policies of the agency she represents. creed and socioeconomic status. There must be provision for educative supervision in community health nuraing. 3. Opportunities for continuing staff education programs for nurses must be provided by the community health nurisng agency and the CHN as well. Assurance such as home health. Diagnosis Analyzes collected data to determine the needs / health problems of Individual. 12. III. The CHN makes use of available community health resources. II. Policy development other developing fields of practice c. Community.

public health nurses. VIII. Levels of Care LEVELS OF CARE/PREVENTION PRIMARY – -Is devolved to the cities and the municipalities. The primary health facility is usually the first contact between the community members and the other levels of health facility. prevent illness and institute rehabilitation. Secondary facilities are capable of performing minor surgeris and perform some simple laboratory examinations. Contributes to development of others. barangay health workers. Evaluation Evaluates responses of clients to interventions to note progress toward goal achievement. Research Indulges in research to contribute to theory and practice in community health nursing. intervenes to promote. IX. . Operation timbang. . This is usually given in health facilities and district hospitals and out-patient departments of provincial hospitals.activities that correct a disease state and prevent it from further deteriorating.activities that provide early detection/diagnosis and treatment and Intervention. TERTIARY – -Is rendered by specialists in health facilities including medical centers as well as regional and provincial hospitals. Quality Assurance and Professional Development Participates in peer review and other means of evaluation to assure quality of nursing practice. implementing and evaluating programs for community health. SECONDARY – -Secondary care is given by physicians with basic health training. and specialized hospitals such as the Philippine Heart Center. VI.activites that prevent a problem before it occurs. HIV screening. revise data base. B. traditional healers and others at the barangay health stations and rural health units. This serves as a referral center for the primary health facilities. Example: Breast self-examination. Interdisciplinary Collaboration Collaborates with other members of the health team. Guided by the plan. rural health midwives. Example: Immunization. maintain or restore health. diagnose and plan. VII. Example: Teaching Insulin Administration in the home . planning. The tertiary health facility is the referral center for the secondary care facilities. professionals and community representatives in assessing. Assumes professional development. It is health care provided by center physicians. Complicated cases and intensive care requires tertiary care and all these can be provided by the tertiary care facility. .

--. unified whole b.a biological concept (male / female) --. Social learning 4.behavior --. Types of Clientele TYPES OF CLIENTELE INDIVIDUAL – . BIOLOGICAL a. e.. holistic – suprasystems – sociological in nature – social constructionism – nurture – behavior SEX --. Social constructionism c. Prenatal Supervision Well – Child Follow – ups. ANTHROPOLOGICAL a.human behavior is dictated by experience.People who receives health services. PSYCHOLOGICAL a. Family and kinship b.People who visits the health center. 2. Behaviorism d. Psychosocial c.g. holon c.gender --.psychological --.on sexual orientation: attracted to Opposite sex – heterosexual Same sex – homosexual Both – bisexual Perspective in understanding the individual: 1. use concepts of biology which in turn refers to essentialism --.based on culture. Social groups . atomistic – the basic constituents of an individual. Psychosexual b.Culture 3.C. SOCIOLOGICAL a. . Essentialism b. Morbidity Service Teaching Client on Insulin Administration Basic approaches in looking at the individual: 1.a sociological concept --. diporphism 2.musculinity or femininity --.

TASK: Learn the concept of Death Positively. . Extended – with lolo’s and lala’s.FAMILY – . TASK: Compliance with the PD 965 and acceptance of the new member of the family. d. Dyad – married but without kids.income given to wife ● Division of labor – joint parenting . Nuclear b. TASK: Learn the concept of Responsible Parenthood. Not married but with kids. Cohabiting – live-in. TASK: Reinforce the concept of Responsible Parenthood. TASK: Parents to learn the concept of “let go system” and understand the “generation gap”. MODELS: Stages of Family Development by Evelyn Duvall STAGE 1 – The Beginning Family ( newly wed couples ). TASK: Provide a Healthy Environment.2 or more individuals who commit to live together for an extended period of time not necessarily with marital affinity or blood relations. adjust with a new lifestyle and adjust with the financial aspect. 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 ). titio’s and tita’s c. STAGE 8 – The Aging Family ( 61 years old upto death ). 8 Family Tasks or Basic Tasks of Developmental Model: ● Physical maintenance ● Allocation of resources. STAGE 4 – The Family with School Age Children ( 6 -12 years old). STAGE 6 – Launching Center ( 1st Child will get married upto the last child ). STAGE 5 – The Family with Teenagers (13 – 25 years old ). STAGE 7 – Family with Middle Adult Parents ( 36 – 60 years old ). TASK: Compliance with the PD 965 and acceptance of the new member of the Family.Considered as the basic unit of care. a. STAGE 2 – The Early Child Bearing Family ( 0 – 30 months ).

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.number of rooms for sleeping *kind of neighborhood *social health facilities available *comm. And transportatx facilities d. Value Placed on Prevention of Disease *Immunization *Compliance behavior . 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. or grandparents relations *members of household in relation to head *demographic data ( sex –male or female.Indication family’s success ● Maintenance of motivation & morale Criticisms: very limited & cannot apply to all situation STRUCTURAL – FUNCTIONAL Initial Data Base a. Family Structure and Characteristics Nuclear – basic family Extended – in-law relations. recruitment & release ● *Maintenance of order. Health Assessment of Each Member – PE e. ● Socialization of family members ● Reproduction. Environmental Factors *housing. age.high crime rate ● Placement of members in larger society.

excessive drinking Inherent personality characteristics – short temperedness. marasmus. disability.First Level Assessment *Health Threats: -Conditions that are conducive to disease. breaking up) Marriage. drugs. sexual practices. puberty) Courtship (falling inlove. graduation. short attention span Short cross infection – Poor home environment – Lack / Inadequate immunization – Hazards – fire. Disease / Illness – URTI. or accidents- Family size beyond what resources can provide - *Health Deficits: -Instances of failure in health maintenance ( disease. gigantism. transfer or relocation. edema b. developmental lag ) 3 TYPES: a. Developmental Problem like mental retardation. colorblindness. unemployment. 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. self – medication. hormonal. Disabilities – blindness. puerperium Death. HPN Nutritional problem – eating salty foods Personal behavior – smoking. polio. accident or failure to realize one’s health potential -Example: Family history of illness – hereditary like DM. scabies. 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 . falls. deafness c. abortion. menarche. pregnancy.

COMMUNITY – Patient . Health Care Attitude – relationship of the family with the health care provider. Physical Environment – ability of the family to maintain environment conducive for living. Knowledge of Health Condition – wisdom of the family to understand the disease process. respect and trust. Emotional Competence – ability of the family to make decision maturely and appropriately ( facing the reality of life ).Defined by geographic boundaries with certain identifiable characteristics. . medication and usage of appliances ). Utilization of Community Resources – ability of the family to know the function and existence of resources within the vicinity. Therapeutic Independence – abilty of the family to comply with the therapeutic regimen ( diet. Application of General and Personal Hygiene – ability of the family to perform hygiene and maintain environment conducive for living. with common values and interests. Family Living Pattern – the relationship of the family towards each other with love.Problem Prioritization: *Natur eof the Problem Health Deficit Health Threat Forseeable Crisis *Preventive Potential High Moderate Low *Modifiability Easily modifiable 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.

mental health.food sanitation.Vulnerable Groups: or “High Risk Groups” ( before ) *Infants and Young Children – dependent to caretakers *School age – most negected *Adolescents – identify crisis. etc. women. risk minimization. elderly. water supply. screening all children.maintain school clinic. workers.linkage. 1995: 5 ) e. safe toilet ● School community.comm. Aims: Health promotion and prvention of disease and injuries. Organizer . Focus: Mental Health Promotion – no need to identify disease.g.Specialized Fields: *COMMUNITY MENTAL HEALTH NURSING – a unique process which includes an integration of concepts from nursing. developmental stage or common exposure to particular environmental factors thus resulting in common health problems ( Clark. delivery.visual. 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.POPULATION GROUPS- -Aggregation of people who share common chaaracteristics. HIV *Mother – 1/3 of population health problem ( pregnancy. 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. sexual H ● Environmental health. children. social psychology. hearing. psychology.health education/ counselor direct & undirect Healthful School Living. scoliosis Health Instruction. Components: School Health Services. community networks. . safe environment. and the basic sciences. puerperium ) *Males – too macho to consult *Old People – degenerative disease .substance abuse.health monitor ● Mental health. increase mental wellness of people.

human resource development and other health-related services. equipment. health insurance. 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. At the national level. Their involvement in maintaining the people’s health is enormous. 1. the local health system is now run by Local Government Units (LGUs). It has a regional field office in every region and maintains specialty hospitals. regional hospitals and medical centers. specifically for malaria and schistosomiasis. research and development. With the devolution of health services. City Health Services _______________ 3. Health Care Delivery System PHILIPPINE HEALTH CARE DELIVERY SYSTEM The Philippine health care delivery system is composed of two sectors: (1) the public sector. city or municipality. 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 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). there is a local health board chaired by the local chief executive. vaccines. The private sector includes for-profit and non-profit health providers. Emergency and District Hospitals _______________ 4. Private Practitioners _______________ . This includes providing health services in clinics and hospitals. TERTIARY LEVEL FACILITIES Classify as to what level the following belong 1. and other health and nutrition products.D. In every province. Its function is mainly to serve as advisory body to the local executive and the sanggunian or local legislative council on health-related matters. the Department of Health (DOH) is mandated as the lead agency in health. The public sector consists of the national and local government agencies providing health services. PRIMARY LEVEL FACILITIES 2. SECONDARY LEVEL FACILITIES 3. Teaching and Training Hospitals _______________ 2. manufacture of medicines. medical supplies.

Development Roles of DOH: 1. program and policies. Issuance 4. Enabler and Capacity builder *Innovate new strategies in health. City Hospitals THE DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH -Lead agency in the Health Sector -Sets the goals for the nation’s health status -Establishes PARTNERSHIP DOH MANDATE 1. monitoring and evaluation of the national health policies. Puericulture Centers _______________ 7. *Serve as advocate in the adoption of health policies. promotion and protection 3. *Ensure the highest achievable standards of quality health care. Brgy health centers Secondary – District Hospitals Tertiary – Provincial Hospitals. plans and programs 2. 5. Promulgation 5. RHU Primary Level Facilities Primary – RHU. Support 3. *Provide leadership in the formulation. Administrator of specific services *Manage selected national health facilities and hospitals with modern and advanced facilities. Formulation 2. Leadership in Health *Serve as the national policy and regulatory institution. Heart Institutes _______________ 6. *Administer direct services for emergent health concerns that require new complicated technologies. Primary Function of of DOH -Promotion -Protection -Preservation . *Exercise oversight functions and monitoring and evaluation of national health plans. plans and programs.

H – Health. especially the poor. D – development of national standards. A – assurance of health care for all. STRATEGIES OF DOH SAID!!! S – support the local health system and front – line workers. and to lead the quest for excellence in health. I – increase investment of PHC. S – Shifting from infectious to degenerative diseases must be managed.-Restoration VISION: Old: Health for all Filipinos New: The Leader of health for all in the Philippines New: The DOH is the leader. *Rising burden from chronic and degenerative diseases. PHILOSOPHY OF DOH: -Quality is above Quantity! PRINCIPLES OF DOH P – Performance of health sector must be enhanced. *Persistence of large variations in health status across population groups and geographic areas. New: A global leader for attaining better health outcomes. U – Universal Access to basic health services. MISSION: -Old: Ensure accessability and quality of health care services to improve the quality of life of all Filipinos. sustainable and quality health for all Filipinos. . competetive and responsive health care system. and nutrition of vulnerable group must be prioritized. GOAL: Heal Sector Reform Agenda ( HSRA ). *Burden of disease is heaviest on the poor. *Unattended emerging health risks from environmenmental and work related factors. Rationale for HSRA: *Slowing down in the reduction of Infant Mortality and Maternal Mortality Rates. and equitable health financing by 2030. especially the poor. staunch advocate and model in promoting Health for all in the Philippines. *High burden from infectious diseases. -New:To guarantee equitable.

2.Filariasis . Equitable health care financing Elements of the Strategy: 1. 4.Malaria . better and sustained investments in health. reduce maternal mortality rate. *Eradicate Poliomyelitis *Promote healthy lifestyle and environmental health. Health regulation – to ensure quality and affordability of health goods and services. . Good governance – to enhance health system performance at the national and local levels. *Eliminate certain diseases as public health problems.Diphtheria and Pertussis . Better health outcomes 2. 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. ( reduce the infant mortality rate. and laying down new avenues for improved interventions. reduce total fertility rate.Tetanus . *Reduce morbidity and mortality from certain diseases. Roadmap for All Stakeholders in Health: National Objectives for Health 2005 – 2010. National Objective for Health: sets the target and the critical indicators. Goals and Objectives of the Health Sector: *Improve general health status of the population. current strategies based on field experience.Framework for the Implementation of HSRA: FOURmula One for Health Goals of FOURmula ONE for Health: 1.Rabies . reduce child mortality rate. Health financing – to foster greater.Schistosomiasis .Leprosy .Vitamin A Deficiency and Iodine deficiency disorders. More responsive health systems 3. 3. increase life expectancy and the quality of life years ).Measles . *Protect vulnerable groups with special health and nutrition needs. .

1979 – Letter of Instruction ( LOI 949 ). LOI 949 – signed by President Marcon with an underlying theme: “Health in the hands of the People by 2020”. 5. 2. *Expand the coverage of social health insurance. the legal basis of PHC was signed by President Ferdinand E. *Reduce the cost and sure the quality of essential drugs. 4. which adopted PHC as an approacch toward the design. *Institute safety nets for the vulnerable and margenalized groups. The performance of the health sector must be enhanced. The health and nutrrition of vulnerable groups must be prioritized 3. 2. . *Institute health regulatory reforms. production and utilization of resources for health. Basic Principles to Achieve Improvement in Health 1. The epidemiological shift from infection to degenerative diseases must be managed. 1978 – First InternationalConference on PHC in Alma Ata. E. Marcos. development and implementation of programs focusing on health development at community level. Support to the local system development. *Strengthen health governance and management support systems. *Pursue public health and hospital reforms.*Strenthen national and local health systems to ensure better health service delivery. *Mobilize more resources for health *Improve efficiency in the allocation. 3. Increasing investment for primary Health Care. *October 19. Primary Strategies to Achieve Goals 1. Support for frontline health workers. Russia ( USSR ) the Alma Ata Declaration stated that PHC was the key to attain the “health for all“ goal. Development of national standards and objectives for health. 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. 4. Universal access to basic health servicesmust be ensured. Assurance of health care. *September 6 – 12.

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. 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. *Isolation of health care activities from other development activities. *An approach to health development. acceptable and sustainable at a cost. *Maximizing the contribution of the other sectors for the social and economic development of the community. *Reductionin morbidity and mortality rates especially among infants and children. *A practice approach to making health benefits within the reach of all people. DEFINITION OF PRIMARY HEALTH CARE *Essential health care made universally accessible to individuals and families in the community by means acceptable to them. communicable and other disease. *Reduction in the prevalence of preventable. *Development of the capability of the community aimed at self – reliance. *Improvement in Basic Sanitation. Concept of PHC KEY STRATEGY TO ACHIEVE THE GOAL: . *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.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. MISSION: .Rationale for Adopting PRIMARY HEALTH CARE: *Magnitude of Health Problems. *Inadequate and unequal distribution of health resources. accessible. 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. which the community and the government can afford. *Favorable population growth structure. *Increasing cost of medical care.

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

SELF – RELIANCE 5. Mobilization of the people to know their communities and identifying their basic health needs. 4. Reorientation ond reorganization of the national health care system. Emphasizing partnership. 5. support system provided by the Government. cultural.is not merely the absence of disease. is manifested by the progressive improvements in the living conditions and quality of life enjoyed by the community residents (PCF.Dependence on the part of community people . it is measured by the ability of people to satisfy their basic needs. networking and developing secondary leaders. institutional and environmental dimensions ( Gonzales 1994 ). 6. Effective preparation and enabling process for health action at all levels. 2. It has a political. SOCIAL MOBILIZATION = . 8. 8. 6. DECENTRALIZATION Strategies of PRIMARY HEALTH CARE 1. DEVELOPMENT is the quest for an improved quality of life for all. Neither it is only a state of physical and mental well – being. -Development is mulit – dimentional.Good Health therefore. .Lack of managerial skills 4. 3. MAJOR STRATEGIES OF PRIMARY HEALTH CARE A. Increase opportunities for community participation.Health being a soical phenomenon recognizes the interplay of political. 7. . social. 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. Organization of communities.It enhances people participation or governance. Therefore. ELEVATING HEALTH TO A COMPREHENSIVE AND SUSTAINED NATIONAL EFFORT . 7. socio – cultural and economic factors as its determinant. Recognition of interrelationship between the health and development = HEALTH . Development of intra – intersectoral linkages. Development and utilization of appropriate technology..

-For fever and body pains. enhancementof relevant curricula and development of standard teaching materials. Use of appropriate technology 4. multi – disciplinary and scientific approach to health programming and delivery. Five – leaf Chaste tree 1. 4. The development of human resources must correspond to the actual needs of the nation and the policies it upholds such as PHC. families and communities to make decisions of their health is really the desired outcome.drink 1 part every 4 hours. Empowerment to parents. rheumatism. 2. . accessible and culturally acceptable. douglasii) gums.. Cough 3 parts: 3. 1. Support mechanism made available HERBAL MEDICINES ENDORSED BY THE DEPARTMENT OF HEALTH NAME INDICATIONS DOSAGE 1. Intra – Intersectoral linkages 3. implement and ealuate health prgrams at their levels.The Health in the hands of the people brings the government closest to the people. PROMOTING AND SUPPORTING COMMUNITY MANAGED HEALTH CARE . budgetary and logistical considerations. Body Pain -For asthma and cough. Body aches and pain. FOUR CORNERSTONES/PILLARS IN PRIMARY HEALTH CARE 1. INCREASING EFFICIENCIES IN THE HEALTH SECTOR . Fever drink 1 part 3 times a day. Marsh – Mint. B.Attaining Health for aal Filipino will require expanding participation in health and health related programs whether as service provider oe beneficiary. affordable. Active community participation 2.Using appropriate technology will make services and resources required for their delivery.toothache. It necessitates a process of capacity builiding of communities and organization to plan. effective.Advocacy must be directed to National and Local policy making to elicit support and commitment to major health concerns through legislations. *Divide decoction into 2 Peppermint YERBA e. Asthma *Divide the decoction into LAGUNDI (Vitex negundo) 2. D. 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.. C.g. swollen every 3 hours. . The DOH will continue to support and assist both public and private institutions particularly in faculty development.

Effective in fighting *The leaves can be eaten (Peperomia pellucida). together with meals. Inducing diuresis parts and drink 1 parts 3 balsamifera) ( anti – urolithiasis ) times a day. If it persists. gargle . Hyperlipidemia) 7. Reduces cholesterol *Eat 6 cloves of garlic BAWANG (Allium sativum) in the blood and hence. let cool and drink a cup after meals (3 time a day). Guava 1. use BAYABAS (Psidium clean/disinfect wounds) decoction for washing the Guajava) 2. swelling of gums. Blumea camphora 1. (Hypertension. ULASIMANG BATO 1. 6. 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. 4.” drunk as tea.) particularly the ascaris dinner according to the and trichina. TSAANG GUBAT 1. Effective in treating *Drink the warm (Ehretia microphylla Lam). Elimination of *Chew and swallow only NIYOG – NIYOGAN Intestinal worms. wound 2 times a day. also used as a mouth or if there is no wash since the leaves of improvement an hour this shrub has high after drinking the flouride content. sore gums and tooth *For tooth decay and decay. 3. helps control blood pressure. Chinese honeysuckle 1. ANTISEPTIC (to *For wound cleaning. For the Decoction. Strain. menstrual and gas pain. boil a cup of clean chopped leaves in 2 cups of water. Garlic 1. Mouth wash infection. intestinal motility and decoction. dried seeds 2 hours after (Quisqualis Indica L. arthritis and gout. Swelling *Divide decoction into 3 SAMBONG (Blumea 2. decoction. Boil for 15 to 20 minutes. consult a doctor. 5. fresh (about a cupful) as -also known as “PANSIT. a salad or decocted and PANSITAN.

prepare the following: = Put 1 cup of chopped fresh leaves in an earthen jar. (Cassia alata) 1. may increase the risk of bleeding when used concurrently with anticoagulants and antiplatelets. . 10. = Apply the warm decoctionon the affected area 1 to 2 times a day. Scabies above preparation. migraine not be used by persons headaches. 9. arthritis. Mild Non – Insulin *Drink ½ cup of cold or melon Dependent Diabetes warm decoction 3 times a AMPALAYA (Momordica Meelitus day after meals. and mix in a glass of water. Charantia) = Lowers Blood Sugar Levels. 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. nausea and in large amounts. *Chop and Mash a piece of ginger root. Athlete’s foot an allergy while using the 3. Use it while it is warm. with warm decoction 3 times a day. = Boil the mixture until the 2 glasses of water originally poured have been reduced to 1 glass of water. Motion Sickness. 11. Pour in 2 glasses of water and cover it. should vomiting. Ring worm *If the person develops 2. a day. Ginger (Zingiber 1. Bitter gourd or Bitter 1. = Strain the mixture. *Boil the mixture. sore *An abortifacient if taken officinale) throat. with cholelithiasis unless directed by the physician.

2003 Reminders on the Use of Herbal Medicine: 1. 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. follow accurate dose of suggested preparation. *Drink the cold or warm decoction as needed. Poultice  Done by pounding or chewing leaves used by herbolaryo  Example: Akapulko leaves-when pounded. Avoid the use of insecticides 2. 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 . 7. Use only one kind of herbal plant for each type of symptom or sickness. 6. Stop giving the herbal medication in cases of untoward reactions. keep standing for 15 minutes in a cup of warm water where a brown solution is collected. If signs and symptoms are not relieved after 2-3 doses. consult a doctor. 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. Know parts of plants with therapeutic value: roots. Use only the part being advocated 4. Know indications 2. 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. Infusion  To prepare a tea (use lipton bag). 3. *AC 196 – A: Ampalaya was deleted in 10 herbal plants advised by DOH in October 9. Know official procedure/preparation  Procedures/Preparations: a. leaves 3. Policies to abide: 1. Use a clay pot and remove cover while boiling at low heat. 5. fruits.

*Environmental Sanitation and Promotion of Safe Water Supply -Environmental Sanitation is defined as the study of all factors in the man’s environment. mango & caimito e. *Expanded Program of Immunization -This program exists to control the occurrence of preventable illnesses especially of children below 6 years old. tetanus. d. Water is necessary for the maintenance of healthy lifestyle. Cream/Ointment-for topical use  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. *Locally Endemic Disease Prevention and Control -The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate. Example Malaria Control and Schistosomiasis Control. *Nutrition and Promotion of Adequate Food Supply . 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. diphtheria and other preventable disease are given for free by the government and ongoing program of the DOH. use ripe papaya & mechanically mashed then put inside a blender & add water  To produce it into a syrup. So the protection of the mother and child to illness and other risks would ensure good health for the community. add sugar then heat to dissolve sugar & mix it  For problems of constipation  Example: papaya. measles. *Maternal and Child Health and Family Planning -The mother and child are the most delicate members of the community. The goal of Family Planning includes spacing of children and responsible parenthood. -Water is a basic need for life and one factor in man’s environment. -Safe Water and Sanitation is necessary for basic promotion of health. which exercise or may exercise deleterious effect on his well – being and survival. Juice/Syrup  To prepare a papaya juice. It promotes the partnership of both the family members and health workers in the promotion of health as well as prevention of illness. Immunizations on poliomyelitis.

-In response to this campaign. Health Promotion and Education Function 6. Streptomycin.Training Function 3.Health Care Provider Nursing Care Function 5. And if food is properly prepared then one may be assured healthy family. control and treatment of these illness. Nifedipine. Ethambutol. Family-based Nursing Services (Family Health Nursing Process) FAMILY – BASED NURSING SERVICES (FAMILY HEALTH NURING PROCESS) FAMILY HEALTH NURSING FAMILY – Basic unit of society.An activity with or on behalf of a particular family or individual. Malnutrition is one of the problems that we have in the country. a primary entity of health care or institution responsible for the physical. It includes the following drugs: Cotrimoxazole. Tuberculosis is one of the communicable diseases continuously occupies the top ten causes of death.Supervisory Function 4. Paracetamol. and social support of its members. *Dental Health Promotion *Acces to and Use of Hospitals as Centers of Wellness *Mental Health Promotion Functions of the PRIMARY HEALTH NURSING: 1. *Treatment of Communicable Diseases and Common Illness -The diseases spread through direct contact pose a great risk to those who can be infected.Research Function F. .Quinine.-One basic need of the family is food. Amoxycillin.Family of Orientation . Collaborating and Coordinating Function 7.Family of Procriation Family Nurse Contact: Definition . Two Types: . Management Function 2. *Supply and Proper Use of Essential Drugs and Herbal Medicine -This focuses on the information campaign on the utilization and acquisition of drugs. . The Government focuses on the prevention. There are many food resources found in the communities but because of knowledge regarding proper food planning. Rifampicin. Oresol.A crucial approach in delivering community health nursing service for the family. emotional. Albendazole. Most communicable diseases are also preventable. INH (isoniazid) and Pyrazinamide. the GENERIC ACT of the Phiippines is enacted.

RELATING . Family Case Load *the number and kind of families a nurse handles at any given time.Develop the individual’s and/or family’s competence to cope with their health problems. *variable for cases are added or dropped based on the need for nursing care and supervision. way of processing information gathered from different source and translating into meaningful actions or interventions.Family Nurse Contact: Objectives . . health as its goal and nursing as its medium or channel of care. PLANNING .Establishing a working relationship. Data Analysis and Data Interpretation and Problem definition or Nursing Diagnosis.Contribute to the personal and social development of the family through varied health activities. 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. 3. First Level Assessment – Data on status / conditions of family household members. b. . Results in positive outcomes such as good quality of data.Assess health needs and problems of the family. and. partnership in addressing identified health need and problems. and satisfaction of the nurse and the client.Provide the needed support and assistance to the family.Data Collection. 2. TWO TYPES OF ASSESSMENT a. FAMILY HEALTH NURSING *Is a special field in nursing in which the family is the unit of care. FAMILY NURSING PROCESS *It is a means by which the health care provider addresses the health needs and problems of the client. STEPS: 1. *It is a logocal and systematic. .Ensure family’s understanding and acceptance of their problems. ASSESSMENT . Second Level Assessment – Data on family assumption of health tasks on each problem identified in the First Level Assessment. .

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

Type of family structure . maintaining a reciprocal relationship with the community and health institutions 5. Members of the household and relationship to the head of the family 2. managing health and non-health crises • 4. matriarchal or patriarchal. Place of residence of each member . Demographic data . providing nursing care to the sick. sex. position in the family 3. . especially in matters of health care. 1981) • 1. seeking health care • 3. 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.5 Types of Date in Family Nursing Assessment (Initial Data Base) A. *HEALTH TASKS OF THE FAMILY (Freeman.whether living with the family or elsewhere. 4.g. Family Structure. Characteristics and Dynamics 1. disabled and dependent member of the family • 5. Dominant family members in terms of decision-making. maintaining a home environment conducive to good health and personal development • 6.age. civil status.e. recognizing interruptions of health or development • 2.

Significant Others .role(s) they play in family's life 5. etc) d. Drainage system . place of work and income of each working member b. mosquitoes. Developmental assessment of infants. Educational attainment of each member 3.type. slum 3. sanitary condition g. Who makes decisions about money and how it is spent 2. hypertension¸ physical inactivity. Metro Manila Developmental Screening Test (MMDST) 4. toddlers. mid-upper arm circumference. Occupation. Medical and nursing history indicating current or past significant illnesses or beliefs and practices conducive to health and illness. and preschoolers - e. Presence of breeding or resting sites of vectors of disease (e.presence of any obvious / readily observable conflict between members. flies. Anthropometric data: Measures of nutritional status of children.Nature and extent of participation of the family in community activities. Adequacy of living space b. Dietary history specifying quality and quantity of food/ nutrient intake per day c. height.g. 6. General family relationship / dynamics .source. Risk factor assessment indicating presence of major and contributing modifiable risk factors for . Home and Environment 1. . Social and health facilities available 4. rodents. B. b. clothing. Eating/feeding habits /practices 3. Communication and transportation facilities available D. Ethnic background and religious affiliation 4. Presence of accident hazards e. Relationship of the family to larger community .g. Adequacy to meet basic necessities (food. Garbage/ refuse disposal . 2. congested. shelter) c.. Sleeping arrangement c. sanitary condition h. C.g.e. Water supply . Nutritional assessment ( specially for vulnerable or risk at-risk members) a. characteristic. roaches. ownership. e.g. Food storage and cooking facilities f. communication / interaction pattern among members. Housing a. Health Status of each Family Member 1.weight. Kind of neighborhood. Socio-economic and Cultural Characteristics 1. sanitary condition 2. Income and expenses a.type.

5. Maintenance and Disease Prevention Such as: 1. nutritional/dietary. Adequacy of : a. Clustering of related cues to determine relationship among data. cigarette/ tobacco smoking. Use of relaxation and other stress management activities 4. Use of protective measures . developmental. d. obesity. diabetes mellitus.e. This will help in deciding what information is pertinent to the situation at hand and what information is immaterial. exercise / activities c. Results of laboratory / diagnostic and other screening procedures supportive of assessment findings. stress. health deficit/s. health threat/s. Immunization status of family members. Values. Use of promotive-preventive health services. . elevated blood lipids/ cholesterol. Habits. 2. 3. Data Analysis Steps: 1. adequate footwear in parasite- infested areas. rest and sleep b. or risk for non-maintenance of wellness state/s which can be attributed to non-performance of family tasks. Making conclusions about the reasons for the existence of the health condition or problem. Practices on Health Promotion. sedentary lifestyle. E. 7. 2. 2. Distinguishing relevant from irrelevant data. 4. 6. foreseeable crises/stress point/s and their underlying causes or associated factors. 5. Physical assessment indicating presence of illness state/s (diagnosed or undiagnosed by medical practitioners. Identifying patterns such as physiologic function. inadequate fiber intake. family functioning and assumption of health tasks. alcohol drinking and other substance abuse. 3.g. 6. use of bednets and protective clothing in malaria and filariasis endemic areas. Compare patterns with norms or standards of health. Healthy lifestyle practices. coping/adaptation or communication patterns. Interpreting results of comparisons to determine signs and symptoms or cues of specific wellness state/s. Sorting of data for broad categories (such as those related with health status or practices – about home and environment).

the more useful is the nursing diagnosis in determining the nursing intervention. financial resources b. Health Monitor 2.  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. Type of family structure – e. characteristics communication patterns among members. AND DYNAMICS 1. Members of the household and relationship to the head of the family 2. Counselor INITIAL DATA BASE FOR FAMILY NURSING PRACTICE *FAMILY STRUCTURE. matriarchal or patriarchal. Therefore. place of work and income of each working members – Adequacy to meet basic necessities – Who makes decisions about money and how it is spent . CHARACTERISTICS. Provider of Care to a sick Family Member 3. 5. Income and Expenses – Occupation. Facilitator 5.g. specifically: (specific) a. as many as three or four levels of problem definition can be stated. *Family Nursing Problem . Coordinator of Family Services 4. Place of residence of each member – whether living with the family or elsewhere. General family relationship / dynamic – presence of any readily observable conflict between members. Demographic data – age. *Nurse’s Roles in Family Health Nursing 1. manpower resources c. 6. sex. Teacher 6. position in the family 3. 4. nuclear or extended. civil status.3. Problem Definition/Nursing Diagnosis  End result of 2 major types of assessment.Stated as an inability to perform specific health task and the reasons / etiology) why the family cannot perform such task. Dominant family members in terms of decision – making.  Example: (general): Inability to utilize resources for health care due to lack of adequate family resources. *SOCIO – ECONOMIC AND CULTURAL CHARACTERISTICS 1. time  The more specific the problem definition. especially in matters of health care.

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

fall hazards 5. excessive intake of certain nutrients 3. strained marital relationship 2. Disability .e.Instances of failure in health maintenance. Accident hazards . 1.Conditions that are conducive to disease. c.g. ineffective breastfeeding 5. accident or failure to realize one's health potential. Presence of Health Deficits . & medicines improperly kept 3. faulty eating habits 4. Failure to thrive/ develop according to normal rate C. Family size beyond what family resources can adequately provide D. Faulty / unhealthy nutritional / eating habits or feeding techniques / practices. Family history of hereditary condition / disease B. Illness States. Stress-provoking factors 1.whether (1) congenital or (2) arising from illness. 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. adequate footwear in parasite- infested areas. fire hazards 4. Presence of Health Threats . Threat of cross infection from a communicable disease case C. strained parent-sibling relationship . Use of promotive-preventive health services Typology of Nursing Problems in Family Nursing Practice 1. broken stairs 2. regardless of whether it is diagnosed or undiagnosed by medical practitioner B. inadequate food intake both in quality and quantity 2. – relaxation and other stress management activities 4. – rest and sleep – exercise – use of protective measures. faulty feeding techniques F. First Level of Assessment – process whereby existing potential health conditions/problems of the family are determined. 1. poisons. b. A. a. others (specify):________ E. A. pointed /sharp objects.

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

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

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

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

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

Factors in Deciding Appropriate Score for Preventive Potential 1. Resources of the Community – Facilities and Community organization or support.refers to the length of time the problem has been existing 3.-Easily modifiable 2 -Partially modifiable 1 -Not modifiable 0 3. Current Management .Refers to the progress of the disease/ problem indicating extent of damage on the patient / family. Resources of the nurse – Knowledge. Also indicates the prognosis. reversibility of the problem 2. Technology and Interventions 2. . 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. Gravity or severity of the problem . Duration of the problem . Current Knowledge. Financial and Manpower 3.refers to the presence and appropriateness of intervention 4. Resources of the family – Physical. methods and tools. Factors affecting priority setting: The nurse considers the availability of the following in determining the modifiability of a health condition or problem. 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. standards. Skills and Time 4. Preventive potential 1 Scale: -High 3 -Moderate 2 -Low 1 4. 1.

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

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

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

Dimensions of Evaluation
1. Effectiveness – focused on the attainment of the objectives.
2. Efficiency – related to cost whether in terms on money, effort or
materials.
3. Appropriateness – refer its ability to solve or correct the existing
problem, a question which involves professional judgment.
4. Adequacy – pertains to its comprehensiveness.

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. Direct observation
2. Records review
3. Review of questionnaire
4. Simulation exercises
1.1 Family Based Nursing Services (Family Health Nursing Process)
Nursing Assessment of Family:
First Level Assessment:
1. Family structure, characteristics and dynamics
2. Socio-economic and cultural characteristics
3. Home and environment
4. Health status of each member
5. Values and practices on health promotion/maintenance
and disease prevention
Second Level Assessment data include those that specify or describe the
family’s realities, 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.
Developing the Nursing Care Plan
Steps in developing a family care plan:
1. The prioritized condition/s or problems
2. The goals and objectives of nursing care
3. The plan of interventions

4. The plan for evaluating care
Implementing the Nursing Care Plan
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. As the nurse practitioner works with clients she
experiences varying degrees of demands on her resources. A dynamic attitude
on personal and professional development is, therefore, necessary if she has
to face up to challenges of nursing practice.
Evaluation of Family Health Services.

G. Population Group-based Nursing Services
POPULATION – FOCUSED APPROACH
- Concentrates on specific groups of people and focuses on health promotion and
disease prevention, regardless of geographical location (Baldwin et al, 1998).
- In short (Minesota Department of Health, 2003)
*Focuses on the entire population
*Is based on assessment of the population health status.
*Considers broad determinants of health.
*Emphasizes all levels of prevention.
*Intervenes with communities, systems, individuals and families.

GOAL: To promote Healthy Communities
*A population focused involves concern for those who do, and for those who do
not receive health services (social jusctice)
*SCIENTIFIC APPROACH AND POPULATION FOCUS = 1.
Epidemiology 2. Information about the community.

H. Community-based Nursing Services/ Community Health Nursing Process
COMMUNITY HEALTH NURSING PROCESS
1. Assessment/Diagnosis
- assessment: purpose is to identify the health needs of the people.
a. Collection of data ( subjective: expressed by client or;
objective: measurable- interview & observations, senses)
b. Categories of health problems

2. Planning
- purpose is to act on determined needs of the community people.

3. Implementation
- purpose is to achieve the optimum level of health of the community people.

4. Evaluation-
- to determine the effectiveness of health care programs.
3 elements : structural , process & measurable outcome or objective

4 Tools/ Instruments for Data Collection:
1. Nursing history – subjective
2. PE- Objective
3. Lab- Objective
4. Process recording- objective (analyzed by RN)

NURSING PROCEDURES
Clinic visit –
- 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.
-Process of checking the client’s health condition in a medical clinic.

PURPOSE: (C.U.R.E)
-Consult about signs and symptoms of illness.
-Utilize service of a health agency.
-Render some treatment procedures.
-Evaluate through some diagnostic procedures

PRE – CONSULTATION CONFERENCE (CuTe PaLa We?)
-Take Clinical History after greeting and making client at ease.
-Take Temperature, BP, Height, Weight.
-Perform a through Physical Assessment
-Do Selective Laboratory Exams: Urinalysis, Sputum Exam, Fecalysis.
-Write Findings on clients record.

MEDICAL EXAMINATION (A IWan PO!)
-Assist before, during and after exam by Physician.
-Inform Physician of relevant findings.
-Work with Physician during Exam.
-Ensure Privacy, safety and comfort of patient.
-Observe Confidentiality of Exam result.

POST CONSULTATION CONFERENCE (E..R.A)
-Explain Findings and needed care or intervention.
-Refer patient to other health agency in necessary.
-Make Appointment for next client or home visit.

Standard procedures performed during clinic visits:
I. Registration/ Admission
1. Greet client and establish rapport
2. Prepare the family record or retrieve records of old clients
3. Elicit and record the client’s chief complaint and clinical history
4. Perform physical examination on the client and record it accordingly

II. Waiting time
1. Give priority numbers to clients
2. Implement the “first come, first served” policy except for emergency
cases

III. Triaging
1. Manage program-based cases (like the IMCI)
2. Refer all non-program based cases to the physician
3. Provide first aid treatment to emergency cases and refer to the next
level when necessary

IV. Clinical evaluation
1. Validate clinical history and physical exam
2. Nurse arrives at evidence-based diagnosis and provides rational
treatment based on DOH programs
3. Inform the client on the nature of the illness, appropriate treatment and
prevention and control measures

V. Laboratory and other diagnostic examinations
1. Identify a designated referral laboratory when needed

VI. Referral system
1. Refer patient if he needs further management following the 2-way
referral system
2. Accompany the patient when an emergency referral is needed

VII. Prescription/dispensing
1. Give proper instructions on drug intake

VIII. Health education
1. Conduct one-on-one counseling with the patient
2. Reinforce health education and counseling messages
3. Give appointments for the next visit

Blood pressure measurement
Procedure:
1. 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. 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

Morbid Individual (Last). To give nursing care to the clients 2. with a higher BP reading Home visit – . Subsequent BP readings should be performed on the arm. repeat procedure with other arm. Pregnant Mother.  Keep arm level with his heart by placing it on a table or a chair arm or by supporting it  Palpate brachial pulse correctly just below or slightly medial to the antecubital area 3. To give health teachings regarding prevention and control of diseases 4. Purpose of Home Visit: 1. Recording BP and other guidelines  For every visit. 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. obtained at least 2 minutes apart  If first visit. take the mean of 2 reading. -PRIORITY during HOME VISITS: Newborn (First). To establish close relationships between the health agencies and the public . Post-Partum.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. 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.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. To assess living conditions of the patient and his family and their health practices 3. listen for pulse sounds (Korotkoff sounds) (1 st clear tapping sound – Systolic BP and disappearance of sound – Diastolic BP 4. . Obtaining the BP reading by using palpatory method  While palpating the brachial or radial pulse.

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

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

-It should be recognized as the basic function of all health workers. Burning all soiled articles if could be or contaminated articles be boiled first in water 30 minutes before laundering. -It is a process whereby people learn to improve their personal habits and attitudes. to work responsibly for the improvement of health conditions of the family. experience. groups. PRINCIPLES OF HEALTH EDUCATION -It considers the health status of the people. Wearing a protective gown. -SPUTUM – NPO midnight first collection early AM then submit at the health center immediately.. . instruct the patient to take a deep breath four times then cough out. and change in conduct and thinking. and nation. -It involves motivation.Can be done only by nurses accredited by ANSAP(Association of Nursing Service Administration of the Philippine. community. interests. Specimen Collection -URINE – Sterile Bottle. customs. -It takes place in the home. while stimulating active interest. Intravenous Therapy . and habits in relation to health and everyday living. -It meets the needs.) .3. in the school. and in the community. then second collection following day early in the AM then submit at the health center then collect the third sputum. to be used only within the room of the sick member. 5.INDICATIONS: *Maintenance /Correction of dehydration in patient unable to tolerate adequate volume of oral fluid medications *Parenteral Nutrition *Administration of Drugs *Blood Transfusion . -It finds means and ways of carrying out plans by encouraging individual and community participation. and the community.Insertion of a needle or catheter into a vein to provide medication and fluids based on physician’s written prescription . Discarding properly all nasal and throat discharges of any member sick with communicable disease. and problems of the people affected. which is determined by the economic and social conscience of the country. 4.g.CONTRAINDICATIONS: *Administration of irritant fluids / drugs through peripheral access (e. It develops and provides experience for change in people’s attitudes. Sodium Chloride. Small amount of feces only. -It is a cooperative effort requiring all categories of health personnel to work together in close teamwork with families. Midstream Collection -FECES – Clean Container. Hypertonic Potassium Chloride).

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

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

Support mechanism made available . 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.reliance and self-determination Major Pillars of Primary Health Care a.Through their full participation .6. and communities . Appropriate technology – underwent experimentation and with high empirical basis. 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 .Made universally available to individuals. Theoretical Bases of CHN Practice – Theories & Principles of Nursing & Public Health 8. 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.At a cost they can afford at any given stage of their development . CHN as : People-oriented. oppressed (i. Multi-sectoral approach (inter. e.e.e. never-ending) process of awareness-raising.Essential care (i.g. and mobilizing. comprehensive & integrated. minimum level of people’s participation c.and intra-sectoral linkages) b. People’s participation Partnership – or shared leadership. with.e. herbal medicine and accupressure d. deprived. focus on health I. families. for. not alternative) . organizing.Towards self. Philosophy Of CHN – Uphold the worth & dignity of man 7. Awareness – primary motivation to action Basic Concepts and Principles  Based on concrete analysis of actual situation  Basic trust on the people  By.Based on scientifically sound and socially acceptable methods and technology .

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

Staff development SUSTENANCE AND MAINTENANCE PHASE 1. married) 3. Organizational meetings . Preliminary Social Investigation ENTRY 1. Deepening social investigation ORGANIZATION FORMATION PHASE 1. Social preparation 2. Curriculum development – based on problems identified 3. middle-aged. PHASE OUT – so that people can practice self-reliance . Other services LEADERSHIP FORMATION PHASE 1. Core group formation 2.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. COMMUNITY DIAGNOSIS Outcome: Problems and needs of the people 9. Training evaluation SERVICES PHASE 1. LAUNCHING – social preparation ends 8. Election of CHW (women. Evaluation session 2. TRAINING AND SERVICES Advanced community health workers have the leadership traits 10. Endorsement to sectoral organizing 2. Actual training 4. Formation of regional coordinating bodies . Advanced training CONSOLIDATION PHASE 1. Community clinics 2.to clarify matters TRAINING PHASE 1. Small group formation 2. Site selection 2. 7. Community integration 3.Group of advanced CHWs 11. CORE GROUP FORMATION . Training needs assessment – COMMUNITY DIAGNOSIS 2.

Determine the geographic boundaries of the target community.” and “mapping. This is usually done in consultation with representatives of the various sectors.  Choose an organizational structure . organization and programs. 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 .There are several organization structures which can be utilized to activate community participation.  Collect data – As earlier mentioned.  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. opportunities and resources involved in initiating community health action program. Community analysis“The process of assessing and defining needs. This process may be referred to as “community diagnosis. 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. These include the following: •Leadership board or council – existing local leaders working for . 2. 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 capacity – This entails and evaluation of the “driving forces” which may facilitate or impede the advocated change.” “health education planning.” 5 components  Demographic.” “community needs assessment. Current programs have to be assessed including the potential of the various types of leaders/influential. their perception on the importance of the problem. 1. and will become the basis for designing prospective community interventions for health promotion.

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

respect. Revitalization of collaboration and networking may be vital in support of new ventures.This can be affected through implementation problems..This may mean revision of goals and objectives and development of new strategies.  Update the community analysis .  Assess effectiveness of interventions/programs .It should be expected that volunteers may leave the organization. be incorporated into the program. evaluation is done for future direction.Quantitative and qualitative methods of evaluation can be used to determine participation. The organization and program is gaining acceptance in the community.  Disseminate results . Some organizations die because of the lack of visibility.  Summarize and disseminate results . . 4.A positive environment is a critical element in maintaining cooperation and preventing fast turnover of members. resources and participation? This may necessitate reorganization and new collaboration with other organizations.  Integrate intervention activities into community networks . This requires a built in mechanism for continuous recruitment and training of new members. Thus.  Establish an ongoing recruitment plan.Continuous feedback to the community on results of activities enhances visibility and acceptance of the organization. The organization and program is gaining acceptance in the community.Is there a change in leadership. Program maintenance – consolidation The program at this point has experienced some degree of success and has weathered through implementation problems. and openness. This is the result of good group based on trust. Formative evaluation is done to provide timely modification of strategies and activities.  Establish a positive organizational structure . support and behavior change level of decision- making and other factors deemed important to the program  Chart future directories and modifications . a dissemination plan maybe helpful in diffusion of information to further boost support to the organization’s endeavor. before any programs reach its final step. Dissemination of information is vital to gain and maintain community support. 5. Dissemination – reassessment Continuous assessment is part of the monitoring aspect in the management of the program. However.

housing. civil status.3 Socio-demographic Profile – total population of families surveyed. climate. community facilities. occupation.6 Health profile – food storage.2 Population Profile – Total estimated population of Barangay.3 Statement of Objective – what are to be accomplished to attain the study 1. types of families. Analysis of Data 3. spot map 2.1 Geographical Identifiers – historical background. ventilation 2. income. pet ownership. Introduction 1.4 Methodology and tool used – a description of the adoption. physical features.GUIDE ON HOW TO DO AN EFFECTIVE COMMUNITY DIAGNOSIS Community Diagnosis: an in-depth process of finding out the profiles. location. health seeking behaviors. literacy rate.4 Socio-economic indicators – educational attainment.7 Morbidity and mortality data – leading cause of morbidity. garbage disposal. valid. mortality. sex ratio.2 Prioritized problems identified 4. dependency ratio. population. religious distribution.2 Purpose – to analyze the data in order to develop responsive intervention strategies that address the root cause of the problem 1. communication resource and family planning 2. infant feeding practices. Target Community Profile 2. infant mortality and maternal mortality 3.5 Limitation of the study – state any limitations that exist in the reference or given population or area of assignment 2. place of origin. number of households. Population Density.5 Environmental indicators – Water supply. Action plan based from prioritized problem identified 4. timely and relevant information on the community profile and health problems are essential so that resources can be maximized 1.1 Identification of health problems 3.1 Intervention strategies . age and sex distribution. length of residency 2. 2. health status of the community and the factors affecting the present status Contents: 1. excreta disposal.1 Rationale – accurate. construction and administration of instruments 1. immunization. boundaries. domestic animals 2.

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

*3 booster dose shots are needed to complete the five doses following the recommended schedule to provide full protection for both mother and child. rd 3 visit During the 3rd trimester. Reduce morbidity and mortality rates for children 0-9 years. 3. b. 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. 5. Reduce mortality and morbidity among Filipino adults and improve their quality of life. Improve the survival. prenatal.  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. Micronutrients Supplementation . health and well-being of mothers and the unborn through a package of services for the pre-pregnancy. Reduce mortality from preventable causes among adolescents and young people. Reduce morbidity and mortality of older persons and improve their quality of life. 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. Public Health Programs PUBLIC HEALTH PROGRAMS FAMILY HEALTH Aims to: 1. *mother is then called as a “fully immunized mother”. 2.J. c. Antental Registration Prenatal Visits Period of Pregnancy st 1 visit As early as possible before 4 months or during the 1 st trimester. nd 2 visit During the 2nd trimester. 4. natal and postnatal packages. Every 2 weeks After 8th month until delivery.  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.

10. It involves thorough planning to be certain that the method chosen isacceptable and can be used effectively. Assess the woman in labor. Continue care after one hour postpartum.000 IU 2x a week starting on 4th month of pregnancy Iron: 600mg/400ug tablet daily d. Determine the stage of labor. 7. Monitor closely within one hour after delivery and give supportive care. 1. . 6. 5. 8. Give supportive care throughout labor.Vit A: 10.5 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. Clean and safety delivery. 2. Do a quick check upon admission for emergency signs. Educate and counsel on Family Planning and provide Family Planning Method if available and decisions made by the woman. Inform. 9. 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 . Decide if the woman can safely deliver. 4. Monitor and manage labor. *Involves personal decisions based on each individual’s background. experiences andsociocultural beliefs. Treatment of Diseases and other Conditions ???? e. 11. Make the woman comfortable/ 3.

LGU managed health facilities. -Ensure that quality Family Planning services are available in DOH retained hospitals.Reduced infant deaths .Under – five deaths . religious beliefs & values Goal: Provide universal access to family planning information and services wherever and whenever these are needed.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. 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. 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.Neonatal deaths . .societal. Function of the Health Professional in Family Planning *To counsel. FAMILY PLANNING Aims to contribute to: . 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.

91 -99% effective . stretchable and mucus is abundant – Fertile . BBT (Basal Body Temperature) .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.Mark time of menstruation Important Concept!!! Progesterone CAUSES AN INCREASE IN TEMPERATURE Estrogen CAUSES A DROP IN TEMPERATURE 2.91 – 99% effective .Take temperature upon waking up . Lactational Amenorrhea Method (LAM) .Done for six (6) months .Spinbarkeit Test . Cervical Mucus / Billing Method .Combination of basal body temperature and billing method 4.Graph .98% effective .Observe temperature for six (6) months or more .Mark coitus schedule .91 – 99% effective .Clear.Cervical mucus is pasty – Not Fertile 3.Taken per mouth or per axilla . Sympto – Thermal method .

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

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. Vasectomy . Infants and Children) Newborns.Not Popular among Filipinos Nursing Alert!!! Methods that are not part of Natural Family Planning: (not accepted by the DOH) . . The risk of infection among children is higher when not screened for metabolic disorder. not exclusively breastfed.After six months. Breastfeeding benefits To Infants:  Provides a nutritional complete food for the young infant  Strengthens infants’ immune system . 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. not properly managed when sick.Sperm is still stored .99% effective .2. excluding milk supplements * Extend breastfeeding up to 2 years and beyond.There is a waiting time of six (6) months . To address problems.Vas deferens is cut . infants and children are vulnerable age group for common childhood diseases. patient can engage in unprotected coitus.Does not give immediate sterility .Withdrawal . unvaccinated. not given with vitamin supplementation and many others.

low-grade fever. *Absolute contraindications: DPT 2 or DPT3 to a child who had convulsions or shock within 3 days after DPT administration.  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. cough. mild respiratory infections. and other minor illnesses and diarrhea Vaccine Minimum age # of Minimum Route. *Vaccination schedule should not be restarted from beginning even if interval exceeds recommended interval. malnutrition.05 ml body of live Right ref attenuated arm bacteria DPT 6 weeks 3 4 weeks IM 2-8 C in D– 0. after birth 0. temp of vaccine between Site doses BCG Birth or anytime 1 ID 2-8 C in Freeze dried.5 ml body of weakened Thigh ref toxin (vastus P – killed lateralis) bacteria . *Moderate fever. *Measles vaccine should be given as soon as the child is 9m/o. Storage Type/ form at 1st dose Doses interval Dosage. mild respiratory infection. diarrhea and vomiting are not contraindications to vaccination. BCG to immunosuppressed clients *Giving doses of a vaccine at less than the recommended 4 weeks interval may lessen antibody response *False contraindications: malnutrition.

SQ Most sensitive to heat & destroyed by heat OPV – 2 gtts/ P. Koch’s Phenomenon (Nisie) . 8 lateralis) weeks interval from 2nd to 3rd dose Measles 9 months 1 SQ -15 to Freeze dried. . 0.5ml.Trivalent ( 3 types) SIDE-EFFECTS OF BCG: a.O.05ml – ID Will not totally eliminate TB School entrants – 0.1 ml ID (double dose) Will inhibit Leprosy DPT: HepB 5 ml IM – destroyed by freezing TT Measles .5 ml body of recombinant from 1st Thigh ref dose to 2nd (vastus dose. T – toxin OPV 6 weeks 3 4 weeks Oral -15 to Live 2 drops -25C attenuated Mouth (freezer) virus Hepa B At birth 3 6 weeks IM 2-8 C in RNA interval 0.Inflammation of the site of injection after 2-4 days .5 ml -25C live attenua- Outer (freezer) ted virus part of upper arm Types and Schedule of Vaccines: AT BIRTH 1 ½ months 2½ 3 ½ months 9-12 months months st 1 BCG DPT1 DPT2 DPT3 MEASLES OPV1 OPV1 OPV3 HEPB 1 HEPB 2 HEPB 3 BCG: Infant – 0.

* There is no contraindication to immunization.. * Immunization can still be given until the child reaches 6 y/o * If there has been a reported epidemic of measles. Abscess will ulcerate then heals leaving a scar (12 wks. 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.incision & drainage ------Not normal ● Convulsions-----Emergency: post-pone giving of next dose SIDE-EFFECT OF MEASLES: . Glandular enlargement.Warm complex after vaccination b.) . * MALNUTRITION is not a contraindication. 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. EXCEPT when the child had convulsions upon giving the 1st dose of DPT. but RATHER AN INDICATION for immunization since common childhood disease are often severe to malnourished children. Deep abscess at site – even after 12 wks.abscess (2-3 weeks abscess will leave scar 12 weeks after) SIDE-EFFECTS OF DPT: . continue to give the doses of the vaccine.2 to 3 wks. *COLD CHAIN .: Incision & drainage Treatment: Powedered INH c. 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.ulcer after 12 weeks Treatment: Powedered INH d. Indolent ulceration.

1 month @ main health centers (with refrigerators) . II. because if a VACCINE IS NOT USED on the 3 rd trip. Handling Once opened or reconstituted. vaccines must be placed in a special cold pack during immunization sessions.– 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.it should not exceed: .3 months @ the provincial/ district level . Storage.6 months @ the regional level . it must already BE DISCARDED. Transport Use of cold dogs III. ● It is a MUST to mark ampules/vials with an “X” mark each time they are carried to the field. Vaccine Half life BCG 4 hours DPT Polio Measles 8 hours TT HepaB TARGET SETTING: . Principles: I.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.

AIM: To reduce death. IMCI Components of Strategy: *Improving case management skills of health workers.  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. IMCI includes both prventive and curative elements that are implemented by families and communities as well as by health facilities. ***For many sick children a single diagnosis may not be apparent or appropriate. *Improving the health systems to deliver IMCI. Objective: Aims to reduce death. Goal: By 2010. *To reduce SSIGNIFICANTLY global mortality and morbidity associated with the major causes of disease in children. and to promote improved growth and development among children under five years old. *To contribute to healthy gorth and development of children. ● “ELIGIBLE POPULATION” consists of any group of people targeted for specific immunizations due to susceptibility to one or several of the EPI diseases. Presenting Complaint: *Cough and / or fast breathing *Lethargy / Unconsciousness *Measles rash *”Very sick” young infant Steps in IMCI Process - - . illness and disability. to reduce the infant and under five mortality rate at least one third. and to promote improved growth and development among children under 5 years of age. in pursuit of the goal of reducing it by two thirds by 2015. ● Involves the calculation of the eligible population. illness and disability. *Improving family and community practices.

Infant and Child . Home Care *Yellow –. 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. Mild--. Sever--.- - - - 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 –. Urgent Referral in Hospital Assess and Identify Classifications A.  Essential Packages of Health Services for Newborn. Moderate--. Managed at the RHU *Pink --.

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

disability and premature deaths due to chronic. Communicating the consequences of major risk factors of NCD. Encouraging government to provide protection against activities by industry and commerce that promote unhealthy products and lifestyles. Analyze the social. alcohol and other addicting substances. In order to contribute health status individuals and respond to the community’s basic health care needs. . Hypercholesterolemia 8. regular and adequate physical activity and leisure. the health sector lobby for a healthy protective environment by: a. Proposing healthy public policies that encouraged health – promoting settings in school. Hypertension 22. avoidance of substances that can be abused such as tobacco. Smoking 34. and practices that offer protection from health risks such as safe sex and immunization. Reduce exposure of individuals and population to major determinants of NCD while preventing emergence of preventable common risk factors. GOAL: Reduce the toll of morbidity. b. non-communicable diseases. b.9% (BMI > 30) f. Obesity 4.8% c. and c. Setting legislative and political directions. Strengthen health care for people with NCD through health sector reforms and cost effective interventions. adequate stress management and relaxation. Developing policy guidelines.5% (TC > 240) e. paying particular attention to the most vulnerable population. Physical Inactivity 60. Diabetes 4. This would include practices that promotes healthy such as healthy diet and nutrition. THE RISK FACTORS WITH THE CORRESPONDING PREVALENCE RATES: a.5% b. 2. non- communicable lifestyle related disease. c. economic.6% HEALTHY LIFESTYLE – defined as a way of life that promotes and protects health and well-being. Providing financial measures to support NCD prevention and control.5% (SBP > 140 or DBP > 90) d.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. political and behavioral determinants of NCD that will serve as bases for: a. 3. To hasten this. workplaces and communities. OBJECTIVES: 1. there must be enhance capability to take action to address these major NCD risk factors.

Changing Lifestyle 4. Thoroughly discussing with the people the nature of the alternatives. Informing the people about the rightness of the cause. their content and consequences. This involves: 1. The health educator aims to: 1. 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. support and eventually. Supporting people’s right to make a choice and to act on the choice. 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. Influencing public opinion. It is important to convey the problem. Establishing program direction and infrastructure 2. Inform the people. Health Educator Health Education is an essential tool to achieve community health. should conduct healthier education in a variety of settings. Integrated Approach KEY INTERVENTION STRATEGIES 1. needs demands of the people are amplified and eventually become the framework for decision – making. Changing environments 3. Community – Based Approach 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.To achieve significant reduction in morbidity and mortality from major NCD’s. 3. The advocate affirms the decision made by the people by getting powerful individuals or groups to listen. make substantial changes to solve the problem. 2. PHNs. In non- communicable disease prevention and control. as well as educators and media personel. Comprehensive Approach Focused on Primary Prevention 2. show it affects people in the community and describe possible actions to take. 4. Misconceptions and ignorance will be . In this manner. 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. As a health advocate. health education focuses on establishing or inducing changes in personal and group attitudes and behavior that promote healthier living. the following approaches should characterize the program: 1.

corrected by disseminating scientific knowledge about causes. indulgence in alcohol. 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. *Influencing executive and legislative bodies to create and enforce policies that favor a healthy environment. prevention and control. In addition. *Organizing and mobilizing the community in taking action for the reduction of risk factors. such as cigarette smoking. Community Organizer As an organizer. As care provider. prevention and control of non-communicable diseases. secondary and tertiary health care services in any setting including the community and workplace. They should be motivated to make own choices and decisions about habits and practices that are determined to health. Motivate the people. Healthy Trainer The PHN provides technical assistance in the assessment of the skills of auxiliary health workers in NCD prevention and control. Guide people into action. physical inactivity and fat and sugar rich diet. Oftentimes. its causes. 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. This is achieve by: *Raising the level of awareness of the community regarding non – communicable diseases. II. factors. 2. Health Care Provider The Public Health Nurse is a care provider to individuals. Causes and Risk Factors of Major NCDs . families and communities rendering primary. teaching and supervision on clinical management of non – communicable diseases and other community – based services and recording. reporting and utilization of health information related to non – communicable diseases. It is inextricably related to community health practices since it provides the theoretical bases for developing appropriate and responsive intervention programs and strategies. Telling people about health is not enough. 3. the ultimate goal of the PHN is community health development and empowerment of the people. action is directed towards the reduction of risk factors of non – communicable diseases. people need to supported in their effort to adopt or maintain healthy practices and lifestyles. Researcher Research is an integral part of a primary health care approach to non – communicable disease prevention and control program.

therefore. primary hypertension is attributed to atherosclerosis. systolic hypertension common in older persons was considered benign and. reduce BP in all hypertensives. intake of potassium (diet high in sodium is generally low in potassium. *Other lifestyle factors interact with these risk and contribute to the development of hypertension such as obesity. increase peripheral resistance and decreased renal blood flow. decreased baroreceptor sensitivity. race and high salt intake. It is also called essential hypertension. *Hypertension is also a major risk factor for the development of others CVDs like coronary heart disease and stroke. For the rest of these session. However. we will be focusing on primary hypertension. Secondary hypertension is usually the result of some other primary diseases leading to hypertension such as renal disease. and a range of responses to therapy. excess alcohol consumption. RISK FACTORS *There is no single cause for primary hypertension but several risk factors have been implicated in its development. *Although exact cause is unknown. ETIOLOGY / CAUSE *In terms of etiology. and use of contraceptive drugs. calcium. the Framingham study showed that there was two to five times increased in death from CVD associated with isolated systolic hypertension. hypertension is classified into primary and secondary hypertension. advancing age. and magnesium. Some people are more susceptible than others to effects of increased salt intake. *AGE -Older person are at greater risk for hypertension than younger persons. stress. *FAMILY HISTORY -People with a positive family history of hypertension are twice at risk than those with no history. a variety of symptoms. . Primary hypertension has no definite cause. increasing potassium in diet increase elimination of sodium). -For years. which is more common. Diseases of the Heart and Blood Vessels 1. not treated. *Risk factors include family health history. -The aging processes that increase BP include stiffening of the arteries. *It is not a single disease state but a disorder with many causes. Hypertension Description *Hypertension or high blood pressure is defined as a sustained elevation in mean arterial pressure. A. nor does reducing salt intake. *HIGH SALTH INTAKE -Excessive salt intake does not cause hypertension in all people.

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

Smoking d. there is a greater chance that it will be deposited onto the artery walls. It is called the “bad” cholesterol because it is the main carrier of cholesterol and contributes to atherosclerosis. obesity and diabetes mellitus. LDL level is increased by saturated fat intake. Obesity f. Diabetes mellitus e. myocardial infarction and stroke. androgens and certain drugs. RISK FACTORS OF CAD a. sedentary lifestyle. Physical inactivity/ sedentary lifestyle g. .density lipoprotein) level is a risk factor of CAD. KEY AREAS FOR PREVENTION OF CAD • Promote regular physical activity and exercise. coronary arteries and the large vessels that supply the brain. *Atherosclerosis usually occurs when a person has high level of cholesterol in the blood. -High LDL(low. Elevated blood lipids and cholesterol level (hyperlipidemia) b. often resulting in coronary artery disease. smoking. 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. This risk is most seen in young people. When the level of cholesterol in the blood is high. obesity. exercise increases HDL. Hypertension c. atherosclerosis is accelerated. *In diabetes mellitus. It is decreased in smoking. HDL facilitates reverse transport of cholesterol to the liver where it may be excreted and therefore prevent atherosclerosis. HDL (high – density lipoprotein) is now acknowledged as a protective factor against coronary heart disease.medium – sized arteries like the aorta. 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. Reports have shown that modest reduction in total cholesterol can significantly lessen CVD morbidity and mortality. particular those younger than 50 years old. -Not all cholesterol is bad. this becomes a risk factor for CAD. prevent obesity and improves optimum functioning of the heart. When HDL level is below normal.

• Maintain body weight and prevent obesity through proper nutrition and physical activity/ exercise. 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. -cancer cells often travels to the other part of the body where they begin to grow and replace normal tissue. • Early diagnosis. 3. heart attacks and a variety of other cardiovascular complications. from prompt treatment and control of diabetes and hypertension. *Limit alcohol consumption for women.many people believe that effective treatment of high blood pressure is a key reason for the rapid decline in the death rates for stroke. Cocaine use has been closely related to strokes. *Prevent thrombus formation in rheumatic heart disease and arrhythmias with appropriate medications. -cancer develops when cell in a part of the body begin to grow out of control. *Prevent all other risk factors of atherosclerosis. friends and co-workers of active smokers. not more than two drinks per day. limiting salt intake and increasing intake of dietary fiber by eating more vegetables. these diseases are risk factors and contribute to the development of coronary artery disease. B. -the immune system seems to play a role in the development and spread of cancer. isolated cancer cells will usually be detected and removed from the body.free environment through advocacy and community mobilization. In general. and for men. • Advise smoking cessation for active smokers and prevent exposures to second- hand smoke by family members. *Avoid intravenous drug abuse and cocaine. Cancer -cancer is not a single disease. Health workers need to remind these persons to take their medications as prescribed. Some of them have been fatal even in first time cocaine users. not more than one drink per day. unrefined cereals and wheat breads. When the immune system is impaired as in . It occurs as the cancer cells get into the bloodstream or lymph vessels of our body. These medications are usually taken on a daily basis. fruits. This process is called metastasis. When the immune system is intact. For human brain to function at emboli. *Smoking cessation and promoting a smoke-free environment. -they compete with normal cells for the blood supply and nutrients that normal cells need thus causing weight loss. KEY AREAS FOR PREVENTION OF STROKE *Treatment and control of hypertension .• Encourage proper nutrition particularly by limiting intake of saturated fats that increased LDL. promote a smoke.

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

*Age: 50 – 70 years old. Cervical Cancer *Tobacco use (cigarette. pipe. smokeless tobacco) *Gender: 3 times more common in man *Alcohol . smokeless tobacco) *Poor nutrition *Alcohol *Weakened immune system *Occupational exposure to wood dust. cigar. pipes. including cigarettes. Renal Cancer *Tobacco used (cigarette. pipe. smokeless tobacco) *Occupational exposure: dry solvents. cigar. smokeless tobacco) *Excessive alcohol use *Chronic Irritation (e. chewing tobacco and snuf. *Radiation exposure *Second – hand smoke Oral Cancer *Tobacco use (cigarette. cigar. paint. *Chronic bladder inflammation. *Family history of cervical cancer. *Human papillomavirus infection *Chlamydia infection *Diet: low in fruits and vegetables. smokeless tobacco): increase risk by 40%.others are related to lifestyle factors such as tobacco and alcohol use. cigar. cigar. diet and sun exposure. pipe. *Obesity *Diet: well cooked meat * Occupational exposure: asbestos organic solvents.g. fumes *Gender: 4 – 5 times more common in man *Age: more than 60 years. cigar. cigar. Bladder Cancer *Tobacco use (cigarette. Ill fitting dentures) *Vitamin A deficiency Laryngeal Cancer *Tobacco used (cigarette. CANCER RISK FACTOR Lung Cancer *Tobacco use. Esophageal Cancer *Tobacco use (cigarette. pipe smokeless tobacco). pipe.

Breast Cancer *early menarche or late menopause *Age – changes in hormone levels throughout life. wheat. *Race: more common among African – American man than among white man *High fat diet. KEY AREAS FOR PRIMARY PREVENTION OF CANCER *Smoking Cessation. *Encourage Proper Nutrition. number of pregnancies. and age at menopause. *Avoid / control obesity through proper nutrition and exercise. *Man with a father or brother who has had prostate cancer are more likely to get prostate cancer themselves. 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. *Age: > 50 years. *Occupational exposure. *Early menarche / late menopause. several factors can increase the chances of developing the disease. such as age at first menstration. *High fat diet or low fiber diet *History of ulcerative colitis. *Diet: low in fruits and vegetables. *Fair complexion. *High fat diet *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. Skin Cancer *Unprotected exposure to strong sunlight. . race and diet. soybeans. Colonic Cancer *Personal or family history of polyps. Uterine endometrial Cancer *Estrogen replacement therapy. corn and rice. *Drink alcohol beverages in moderation. such as advancing age.

It is genetically and clinically heterogeneous group of metabolic disorders characterized by glucose intolerance. It is also more preventable because it is associated with obesity and diet. *Genetic. or may be acquired due to viruses (e. ETIOLOGY / CAUSES *Specific cause depends in the type of diabetes. Description *Diabetes mellitus is not a single disease. It also increases the risk of dying of cardiovascular disease like heart attack or stroke among women. It may develop into full – blown diabetes. the better the chances of living longer and enjoying a better quality of life.. 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.e. mumps. C. environment.90 mmol/L) and/or triglyceride level > 250 mg/dl (2. CAD tends to occur at an earlier age and with greater severity in persons with diabetes. *Usually occurs in older and overweight persons (about 80%).*The sooner a cancer is diagnosed and treatment begins. More than half of diabetic persons will die of coronary heart disease. with hyperglycemia present at time of diagnosis. Diabetes Mellitus Diabetes Mellitus (DM) is one of the leading causes of disability in persons over 45. Type 2 DM *Characterized by fasting hyperglycemia despite availability of insulin. poor nutrition.g. prone to develop ketosis. occurring in about 90 – 95% of all persons with diabetes. and dependent on insulin injections.28mmol/L) . *Possible causes include impaired insulin secretion. congenital rubella) and chemical toxins (e. Risk Factors of Type 2 DM *Family history of diabetes (i. NIDDM is more common. Type 1 DM *Characterized by absolute lack of insulin due to damaged pancreas.g. peripheral insulin resistance and increased hepatic glucose production. 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. however it is easier to think of diabetes as an interaction between two factors: Genetic Predisposition (diabetogenic genes) and Environment / Lifestyle (obesity. Nitrosamines). lack of exercise).

and more cases and deaths due to COPD can be predicted in the coming decades because of smoking. DIAGNOSIS *A diagnosis of COPD should be considered in any patient who has symptoms of cough. The diagnosis is confirmed by spirometry. hypercapnea. Cigarette smoking is the primary cause of COPD. blindness (retinopathy) coronary artery disease and stroke. CAUSES AND RISK FACTORS *COPD is usually due to chronic bronchitis and emphysema. 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. D. COPD is currently the fourth leading cause of death in the world. sputum production. Description *COPD is a disease state characterized by airflow limitation that is not fully reversible. later on. which develops late in the course of severe COPD). parenchymal destruction. and pulmonary vascular abnormalities reduce the lung’s capacity for gas exchange. neuropathy and foot ulcers. -Cardiovascular disease – Pulmonary hypertension.0 Kgs) *Previously identified to have Impaired Glucose Tolerance (IGT) Complications *Acute complications include diabetic ketoacidosis (DKA). Bronchial Asthma . COMPLICATIONS -Respiratory failure – In advanced COPD.*History of Gestational Diabetes Mellitus (GDM) or delivery of a baby weighing 9 Ibs (4. *Chronic complications cause most of the disability associated with disease. producing hypoxemia and. These include chronic renal disease (nephropathy). and / or a history of exposure to risk factors for the disease. or dyspnea. peripheral airways obstruction. both of which are due to cigarette smoking. E. hyperosmolar hyperglycemic nonketotic coma (HHNK) and hypoglycemia especially in type 1 diabetic. Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. and is associated with the development of cor pulmonale and a poor prognosis. is the major cardiovascular complication of COPD).

These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. CAUSES AND RISK FACTORS Asthma development has both genetic and environment component. Other form of triggers are irritant gases and smoke. house dust mite found in pillows. a. certain foods. weather changes. breathlessness. carpets. mattresses. Host Factors: predispose individuals to protect them from developing asthma. cold air. They induce inflammation and / or provoke acute bronchoconstriction. additives and drugs.Asthma is a chronic disease. *Genetic Predisposition *Airway hyperresponsiveness *Gender *Race / Ethnicity b. inhaled allergens. 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. early introduction to cow’s milk may predispose baby to allergens and possible asthma. 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. Chronic inflammation causes an associated increase in airway hyper responsiveness that leads to recurrent episodes of wheezing. chest tightness and coughing. . These cannot cause asthma to develop initially. respiratory infection. It involves further exposure to causal factors (allergens and occupational agents) that have already sensitized the airways of the person with asthma. exercise. but can exacerbate established asthma. particularly at night or in the early morning. It is an inflammatory disorder of the airways in which many cells and cellular elements play a role.

Assessment of these risk factors and screening for NCDs in individuals and communities important in preventing and controlling future diseases. *Start developing healthy habits in children. characteristics or exposure of an individual.day activities. *Excessive use of alcohol DISCOURAGE EXCESSIVE DRINKING OF ALCOHOLIC BEVERAGES *Hyperlipidemia. *Overweight and obesity. *Integrate physical activity and exercise into regular day -to. Instant noodles. which increases the likelihood of developing NCD. softdrinks. Mellitus III. *EARLY DIAGNOSIS AND Hypertension. Diabetes PROMPT TREATMENT. both active or PROMOTE SMOKE – FREE passive / second hand ENVIRONMENT *Smoking cessation for active smokers to reduce risk. *Prohibit smoking inside living areas. 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. houses and closed areas. *Walking is one form of exercise that is possible for including older persons with cardiovascular disease. *Avoid high caloric low nutrient value food like junk food. *Smoking. A “risk factors” refers to any attribute. *Inadequate intake of *Increase intake of vegetable and dietary fiber fruits. ENCOURAGE MORE PHYSICAL *Sedentary lifestyle ACTIVITY AND EXERCISE *Moderate physical activity of atleast 30 minutes for most days. salty and *High intake of fatty foods preservative foods. Risk Factor Assessment: . RISK FACTORS KEY AREAS FOR PREVENTION *Elevated blood lipid PROMOTE PROPER NUTRITION (Hyperlipidemia) *Limit intake of fatty.

*Fruits – Number of fruits per day. Overweight/Obesity * Body fat can best be assessed using Body Mass Index (BMI) and waist circumference. These include: *Vegetables – Number of servings of vegetables per day and usual types of vegetables eaten. which are often culture – specific. Smoking status should be recorded and updated at regular intervals. In order to monitor trends.A. However. skin of chicken) How often fried foods are eaten How often fast foods / restaurants are visited. C. the following questions should be ask to determine the contribution of the patient’s nutrition to NCD development. Every client should be asked about tobacco use. BMI correlates closely with total body fat in relation to height and weight. amount smoked by current and former smokers.g. does not indicate fat distribution.g. Cigarette Smoking * Assess smoking status by asking individuals whether they smoke or not. canned and instant foods are eaten per weak. How much salt is added when cooking food. 1 serving is a vitamin C rich fruit. One serving means: Raw vegetables 1 cup Cooked vegetables ½ cup *Eat at least 2 serving of fruit per day. and quit attempts. this does not compensable for frame size. collect information not only on smoking status but also on age of onset. questionnaires and estimation of nutrients based on food composition tables. one serving of which is green or yellow leafy vegetables. *Sodium / Salt – How often preserved. Comprehensive nutritional assessment involves detailed recall methods (e. GUIDELINES FOR ADEQUATE VEGETABLE AND FRUIT INTAKE *Eat 2 – 3 servings of vegetables each day.. At the very least. and cannot be adjusted for age. *Fat – Number of servings of meat and poultry. . 24 – hours food diary) or extensive food frequency. One serving of fruit depends on type of fruit. Which part (e. B. Nutrition/Diet * Diet is a combination of related behaviors.

Weight – In children and adults, regular weighing is the simplest way
of knowing if energy balance is being achieved. 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.

GUIDELINE
Based on Asia – Pacific Obesity Guidelines:
BMI Interpretation
<18.5 Underweight
18.6 – 22.9 Healthy weight
>23.0 Overweight
23.0 – 24.9 At risk
25.0 – 29.9 Obese 1
>30.0 Obese 2

Waist Circumference (WC) – This alone is an accurate measure of
the amount of visceral fat. Remember that the central obesity is a
significant risk factor to heart disease and stroke.

ASSESSING DEGREE OF RISK CO – MORBID CONDITIONS
BASED ON BMI AND WC
Measuring Waist Circumference
Procedure: Subject should be unclothed at the waist, and standing
with abdomen relaxed, arms at the sides, feet together. Use non –
stretchable, measure and do not compress the skin.
Clinical Thresholds:
Men <90 cm (35 inches)
Women <80 cm(31.5 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.
WHR = Waist circumference (cm) / Hip circumference (cm)
WHR Interpretation:
*Less than 1.0 (men); less than 0.85 (women) = normal WHR
*Equal to or greater than 1.0 (men) and 0.85 (women) = android or
central obesity.
D. Physical Inactivity/Sedentary Lifestyle

*Assessment of physical activity includes on type of work, means of
transportation and leisure – time activities like sports and formal
exercise.
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.
If moderate intensity: 5 or more days of the week.
If vigorous intensity: 3 or more days of the week.

Guideline:
At least 30 minutes of cumulative physical activity moderate in
intensity for most days of the week.

E. Excessive Alcohol Drinking
*Assess habitual alcohol intake and risky behavior, such as driving or
operating machinery while intoxicated.

Screening Guidelines and Procedures:
According to WHO, screening is the “presumptive identification of
unrecognized disease or defect by the application of tests, examination
or other procedures which can be applied rapidly.” 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 programs
are usually disease specific and thus may be called “hypertension
screening” or “diabetes screening.”
A. 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.

B. 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. Prior to testing,
make sure that the person has not eaten any food nor taken any
drinks containing calories for at least eight hours. Drinking water is
acceptable.

C. Screening for Diabetes Mellitus
*The hallmark of diagnosis of diabetes mellitus is the presence of
Hyperglycemia.
For those with family history and symptoms of DM, advise blood test
for serum or plasma glucose.

**Fasting Blood Sugar (FBS) – Fasting is defined as no caloric
intake for at least eight hours; this include no food, juices, milk; only
water is allowed.
**Two – hour Blood Sugar Test – Performed two hours after using
75g glucose dissolved in water or after a good meal. Oral Glucose
Tolerance Test (OGTT) is not recommended for routine clinical use
nor screening purposes.

D. 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
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. Breast Cancer
a. Warning Signs includes skin changes (Edema, Dimpling or
inflammation “peau, de orange” – orange peal like skin, Ulceration, Prominent
venous pattern), Nipple abnormalities (Retraction, Rashes or Discharge),
Abnormal Contours (Variation in size and shape of breasts).
b. Early Detection
*Breast Self-Examination – cheapest and most affordable screening procedure for
breast cancer. The best time to do BSE is one week after menstrual period while
taking a shower, facing the mirror standing up or lying down.
*Breast mammography – Baseline, mammogram is suggested for all women
between the ages of 35 – 39 and yearly mammogram after age 40. If with family
history of breast cancer, mammogram should be started at age 30. Put in mind
that BSE does not take the place of mammogram or vice versa.
2. Cervical Cancer
a. Warning Signs includes often asymptomatic and Abnormal
vaginal bleeding (e.g., Post – Coital bleeding)
b. Early Detection
*Pap’s Smear – Primary screening tool for women over age 18
- should be done in between menses (two weeks after menses).
- for persons at high risk, it should be done yearly. These include
those who are.
:Sexually active,
:Have multiple partners

:Commercial sex workers.
3. Colon - Rectal Cancer
a. Warning Signs include change in stool, rectal bleeding, pressure
on the rectum, abdominal pai.
b. Early Detection
*Annual digital rectal exam starting at age 40.
*Annual stool blood starting at age 50.
*Annual inspection of colon.
4. Prostate Cancer
a. Warning Signs
*Symptoms of urethral outflow obstruction:
-Urinary frequency
-Nocturia
-Decrease in stream
-Post – void dribbling
b. Early Detection
*Digital Rectal Exam for mean
*Prostate Specific Antigen (PSA) determination a blood test,
confirms diagnosis.
5. Lung Cancer
a. Early Warning Signs are those with a long history of smoking
and / or smoking two or more packs or cigarette per day, chronic
cough or nagging cough, dull intermittent, localized pain, history of
weight loss.
b. Early Detection
*Chest X-ray every six months for patients who have history of
smoking two packs per day.
*Sputum cystology.

E. Screening for COPD
*Characteristics and symptoms:
-cough
-sputum production
-dyspnea upon exertion
*SPIROMETRY – done to determine degree of obstruction.

F. Screening for Asthma
*Suspect Asthma in Persons with the following:
1. One or a combination of cardinal symptoms ( dyspnea, cough,
wheezing, chest discomfort).
2. Temporal waxing and waning and /or nocturnal occurrence of
symptoms.
3. A history of any of the following:
*Symptoms triggered by exogenous factors.
*A family history of Asthma, Allergic rhinitis or atopy.
*An improvement of symptoms with bronchodilator use.

*Lowers both total blood cholesterol and triglycerides and many increase high – density lipoprotein (HDL or the “good” cholesterol). like sweeping or raking leaves in the yard or gardening. and joints. *Promotes psychological well –being and reduces feelings of stress *Helps build and maintain healthy bones. the grandmother or aunt bringing a sick child for consultation. and cleaning the house. Educate people on how to prevent the NCD risk factors through a healthier diet. Train other health workers. Promoting Physical Activity and Exercise Health Benefits of Regular Physical Activity *Reduces the risk of dying from coronary heart disease (CHD). or walking to the neighborhood store or jeepney terminal instead of riding the tricycle. 2. It is also what is done outside the house. It is something that one might be avoiding doing in the office. ROLE OF PUBLIC HEALTH NURSE IN RISK ASSESSMENT AND SCREENING 1. muscles. This includes the mother bringing her newborn infant for immunization. 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. IV. like washing the dishes. using BMI table. *Helps reduce blood pressure in people who already have hypertension. 3. or members of the household during home visits. Educate as many people and in every opportunity on the warning signs of NCDs and other risk. should be assessed for the presence of risk factors and early signs of NCD. *Reduces feeling of depression and anxiety. *Reduces the risk of having a second heart attack in people who have already experienced one heart attack. measurement of height and weight. sweeping the floor. *Reduces the risk of developing colon cancer. It will be good to periodically check their skills like BP taking. *Exercise – “is a planned. Walking or jogging for three kilometers each . Every client not only the patient seeking consultation.” It involves energy expenditure and planning. *Helps people achieve and maintain a healthy body weight. structured and repetitive movement done to improve or maintain one or more components of physical fitness. UNDERSTANDING PHYSICAL ACTIVITY AND EXERCISES *Physical Activity – is something done at home. engaging in moderate physical activity and not smoking. *Helps older adults become stronger and better able to move about without falling or becoming excessively fatigued. *Lowers the risk of developing high blood pressure. like instead of climbing the stairs one takes the elevator. 4. *Lowers the risk of developing non – insulin – dependent (Type 2) diabetes mellitus.

And in between. The idea of mediation is to focus one’s thoughts on one relaxing thing for a sustained period of time. But one can learn ways to handle the stress of daily life efficiently. *Fortunately. Stressful situations can trigger different types of responses. ranging from the negative extreme of actual physical danger to exhilaration of falling in love or achieving some long desired success. the risk for serious health problems is greater because stress can exhaust the immune system. However. but also normal part of life. Some may be physical. Recent research demonstrates that 90% of illness is stress – related. it is important to remain attentive to negative stress symptoms and to learn to identify the situations that evoke them. Mediation can have the following effects: -Lowers blood pressure . Another example is attending a regular aerobics class 3 times a week is structured exercise. When these symptoms persist. holy. and to manage reactions to stress and minimize its negative impact. normal does not necessarily mean healthy. Thus. 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. Mediation – is a way of reaching the world beyond the senses. It is pure.day before or after work is a structured exercise. However. possessing the nature of qualities of a spirit. SPIRITUALITY -is a state or quality of being spiritual. ecclesiastica. stress management is largely a learnable skill. *People respond to stressful situations in different ways. V. Everybody can learn effectively handle stress even when pressures persist. some may be psychological and some maybe behavioral. It is very effective method of relaxation. relating to matters of sacred nature. day to day living confronts even the most well managed life with continuous stream of potentially stressful experiences. Stress is any change that one must adapt to. These will vary between individuals. Promoting a Smoke-Free Environment ????? VII. Promoting Proper Nutrition ????? VI. Promoting Stress Management *Stress is an everyday fact of life and everyone experience stress from time to time. stress is not only inevitable and essential. It is not possible to live without stress. 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. STRESS MANAGEMENT TECHNIQUES 12 Stress Management Techniques 1. not wordly.

Time is a tool that can be drawn upon to help accomplish results. SCHEDULING: TIME MANAGEMENT -time is a resource. SPORTS . an aid that can take care of a need. 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. SENSATION TECHNIQUE -The sense of touch is a powerful and highly sensitive forms of communication. It relieves stress tension and one wakes up invigorated and set for the next activity. relieving headaches and helping sleep problems. an assistant in solving problems. Massage helps to soothe away stress. a break or recharging of “battery” in order to improve productivity. 4. It increases sensitivity to the inner self and relationship with the world around. SIESTA -it means taking a nap. 7. promotes healing and tones muscles. getting in touch with one’s feelings. 5. 3. perhaps by comforting them. But massage is also invigorating. It helps relax the mind and body muscles. 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. STRETCHING -are simple movements performed at a rhythmical and slow pace executed at the start of a demanding activity loosen muscles. It had been proven thru a study that siesta invigorates one’s body. Performance of an individual scored high when siesta is observed with a 15 – 30 minutes nap. leaving with a feeling of renewed energy. no special clothes. short rest. or something that can be drawn upon for aid. A resource is something that lies ready for use. lubricate joints. and increase body’s oxygen supply. 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 requires no special equipment.-Slows breathing. unknotting tensed and aching muscles. and no special skills and can be done anywhere and anytime. SELF – AWARENESS -it means knowing one’s self. it improves the functioning of many of the body’s systems. 6. or being open to experiences.

On the contrary without socialization life will be boring and empty. Communication is the means by which people make their needs known. It provides a medium of expression for thoughts and emotions. as well as information about stress management. SPEAK TO ME -the world is designed as a mutual support system in which all things relate to each other. 11. Smile is an expression of pleasure. Socialization plays a very important role in the development of intrapersonal relationships. 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. SOUNDS AND SONGS -music plays an important part in the everyday life of a person. 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. reinforcement and assistance from others. 12. 8. Through socialization life becomes meaningful. It has been found out through research that it relieves all kinds of stresses. 9. so it must remain open until the goal is reached. . It also a way to relieve tension. Communication is aimed at a goal. or mental. SMILE . 10. It is the way they obtain understanding. -Engaging in sports and in physical activities like these have been known to relieve stress. It also gives the body the exercise it badly needs. physical. happy and worthy. Talking to someone when feeling overwhelmed or unable to deal with stress or feeling “helpless” is often the best way of coping with stress. 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. Music adds to the quality of life of a person. -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.It has been observed that people who always “smile” are healthy people. SOCIALS -a man is a social being who exist in relationships with his physical environment and in relationship with people and society.

Mission The Department of Health. Local Health Units.3: Reduce the prevalence of visual disability in children from 0. is the most common cause of blindness worldwide. as well as improving the delivery of cataract services. Errors of Refraction It is the most common cause of visual impairment in the country (prevalence is 2. It is corrected either with spectacle glasses. 3. Goal: -Reduce the prevalence of avoidable blindness in the Philippines through the provision of quality eye care.2: Reduce visual impairment due to refractive errors by 10% by the year 2010.500 by the year 2010.20% by the year 2010.43% to 0. A. National Prevention of Blindness Program VISION 2020: The Right to Sight is a global initiative to eliminate avoidable blindness by the year 2020. partners and stake holders commit to: 1. *General Objective no. renal disease and programs for disables persons. Work towards poverty alleviation through preservation and restoration of sight to indigent Filipinos. 2. 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. mental disorders. The program is a partnership between the World Health Organization (WHO) and the International Agency for Prevention of Blindness (IAPB). Interventions will therefore consist of increasing awareness about cataract and cataract surgery. Cataract The pacification of the normally clear lens of the eye. . VIII. contact lenses or surgery. 2. Strengthen partnership among and with stakeholders to eliminate avoidable blindness in the Philippines. Provide access to quality eye care services for all. Objectives: *General Objective no. 4. *General Objective no. Empower communities to take proactive roles in the promotion of eye health and prevention of blindness. 1: Increase Cataract Surgical Rate from 730 to 2. which is the umbrella organization for eye care professional groups and non – governmental organizations (NGOs) involved in eye care. VISION/ MISSION/ GOALS/ OBJECTIVS Vision All Filipinos enjoy the right to sight be year 2020.06% in the population). INTERVENTIONS BY EYE DISORDER: 1.

Stigma is a mark of shame. accessible. blinding error of refraction and vitamin A deficiency thru enhanced services. Objectives: *To differentiate between critical incident and extreme life experiences. and Vitamin A deficiency. . Screening of children for any sign of visual impairment can be done by pediatricians. B. Mental Health Sub – Programs A. 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. *To ensure access of preventive and promotive mental health services. *Pooling of resources of government and non – government agencies to address the problem of cataract. Childhood Blindness The prevalence of blindness among children (up to age 19) is 0. school clinics and health workers.06% while the prevalence of visual impairment in the same age group is 0. B. increasing social problems and unrest inherited from the existing burden.43%. Undefined Burden – The portion of the burden relating to the impact of mental health problems to persons other than the individual directly affected. Vision 2020 Philippines envisions to eliminate avoidable blindness though three strategies: *Ensuring that cataract surgery is available. Extreme Life Experience An extreme life experience is one that is out the ordinary and which threatens personal equilibrium. disgrace or disapproval that results in a person being shunned or rejected by others.3. 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). Future Burden – Refers to the burden in the future resulting from the aging of the population. Hidden Burden of Mental Illness – Refers to the stigma and violations of human rights. and affordable to everyone. *Reduction of the prevalence of cataract. Objectives: *To increase awareness among the population on mental health and psychosocial issues. 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. blinding error or refraction.

*Teach parents the importance of providing emotional support to their children during critical periods in their lives as first day in school graduation. Nursing Responsibilities and Functions 1.being. In Prevention and Control *Recognize mental health hazards and stress situations as unemployment. Workplace. all of which may make heavy demands on the emotional resources of the persons concerned. *Help people in the community understand basic emotional needs and the factors that promote mental well . vices. *To categorize / prioritize the extreme life experiences which may be the concern of mental health. etc.*To identify situations which may be extreme life experiences. and feeling and make early referral so that diagnosis and treatment could be done early. *Be aware of the potential causes of breakdown and when necessary take some possible prevention action. . *Utilize opportunities in his / her everyday contacts with other members of the community to extend the general knowledge on mental hygiene. persons with disabilities). adults. C. *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. thinking. 2. School. Substance Abuse and Military Other Forms of Addiction Objectives: *To provide implementers for advocacy accurate. Community. D. *To promote protective factors against the development of substance abuse/ addition in the following key settings (Family. In Mental Health Promotion *Participate in the promotion of mental health among families and the community. Health Care Setting. and special population such as military. elderly. divorce or abandonment of children. *To rationalize and enhance the drug program to different key settings as a form of deterring factor. *Recognized pathological deviations from normal in terms of acting. *Help patient assess his / her capacities and his / her handicaps in working towards a solution of his / her problem. long standing physical illness. OFWs. *To identify programs that could address psychosocial consequences and mental health issues of persons with extreme life experiences. refugees. technical information about the psychosocial effects of drugs. Industry) through existing DOH programs and responsible agencies. Mental Disorder Objectives: *Promotion of mental health and prevention of mental illness across the lifespan and across sectors (children and adolescents.

*Advice the family about the importance of regular follow – up at the clinic. . THE GOALS OF THE PROGRAM ARE AS FOLLOWS: 1. both local and national through: *Conduct training on nephrology. 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. 3. and related specialties to enhance the expertise of medical practitioners and related professions. To conduct researches / studies that will establish the true incidence of existing renal problems and its sequel in the country. *Have a friend in whom you can confide and ventilate your problems. *Have a realistic goal in life. 4. *Internal and external quality assurance. *Develop and sustain solid spiritual values. substance abuse and excessive alcohol. adequate rest. Rehabilitation *Initiate patient participation in occupational activities best suited to patient’s capabilities. equipment. psychiatric emergency management and other basic nursing care. *Facilitation of sourcing out of funds for the development and upgrading of manpower. *Avoid excessive physical. with the National Kidney and Transplant Institute(NKTI) as the main implementing agency. *Don’t live in the past and avoid worrying about the future. capacities and interest. *Encouraged patients to express his / her anxieties so that fears and misconceptions can be cleared up. education. the desired and undesirable effect of the tranquilizers. Renal Disease Control Program It is started as a Department of Health (DOH) – Preventive Nephrology Project (PNP) in June 1994. *Live – one day at a time. *Encourage and initiate patients to partake in activities of CIVIC organization in the community through the cooperation of patient’s family. 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. To assist the existing health facilities. *Impairment information and guidance about the treatment scheme of the patients. C. exercise. *Encourage feeling of achievement be setting health goals that patients can attain. recreation). curative and rehabilitative measures. 2. *Avoid smoking. mental and emotional stress. urology. etc. *Make regular home visits to observe patients conditions during conversation and follow – up of medication. sleep. experience and training.

3. 5. causing death to about 7. D. To give recommendations to lawmakers for health for policy development. for use of medical practitioners and other related professions. 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. both GOs and NGOs. • Disinfectant -chemical used on non living objects . vector. or inanimate object. To formulate guidelines and protocols on the proper implementation of the different levels of prevention and care of renal diseases. 4. IMPORTANT INFORMATION ABOUT KIDNEY DISEASES AND ORGAN TRANSPLANTATION Kidney diseases rank as the number 10 killer in the Philippines. funding assistance and implementation. 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. 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. 6.000 Filipinos every year. To establish an efficient and effective networking system with other programs and agencies. To assist in the development of dialysis and transplant centers / units in strategic locations all over the Philippines. 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.

• 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.disease that occur occasionally and irregularly with no specific pattern • ENDEMIC – those that are present in a population or community at times. breaths. • 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. 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 . • Antiseptic – chemical used on living things. Epidemiological triad: o Agent o Host o Environment Classification according to incidence: • SPORADIC . sneezes • Pathogens are transferred by virtue of gravity • 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. • EPIDEMIC – diseases that occur in a greater number than what is expected in a specific area over a specific time.

emotional and mental state • Immune system • Underlying disease ( diabetes mellitus. steroids. environmental factors • General condition. Mode of Transmission Contact transmission • Direct contact . OF MICROORGANISM . transplant) • Treatment with certain antimicrobials (prone to fungal infection).thru contaminated object . leukemia. • 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.person to person • Indirect .“microbial antagonism principle” • SECOND – inflammatory response o Phagocytic cells and WBC to destroy invading microorganism manifesting the cardinal signs • THIRD – immune response .Natural/Acquired: active/passive RISK FACTORS • Age. sex. and genes • Nutritional status. fitness. immunosuppresive drugs etc.

or spraying. applying cosmetics or handling contact lenses are prohibited in work areas. • Gloving – Wear gloves for all direct contact with patients. patient’s blood and other potentially infected materials. • Environmental disinfection – Clean surfaces with disnfectant 70% alcohol. • Use of indwelling lines and implanted foreign bodies has increased.MRSA and infectious pts. after hand contact with patients. secretions or excretions. blood products and secretions from patients are considered as infected. • Foods and drinks shall not be stored in refrigerators. broken. drinking. WORK PRACTICE CONTROL • Handwashing o Before and after using gloves. Control Measures • Masking – Wear mask if needed. Change gloves and wash hands every after each patient. • All procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing. Patient with infectious respiratory diseases should wear mask.contact with respiratory secretions thru cough. ISOLATION PRECAUTIONS . VRE • Increasing numbers of immunosuppressed patients. • Airborne Transmission • Vector Borne Transmission • Vehicle Borne Transmission Emerging problems in infectious diseases • Developing resistance to antibiotics eg: anti tb drugs. Normal clean – clean the room post discharge. • Gowning . gloves etc. final clean. recapped. mask. Microbes can travel up to 3 feet. talking. • Used needles and sharps shall not be bent. • Protective Equipment shall be removed immediately upon leaving the work area. INFECTION CONTROL MEASURES • UNIVERSAL PRECAUTION – All blood.diluted bleach)  Ex. Like apron. freezers where blood or other infectious materials are stored.Wear gown during procedures which are likely to generate splashes of blood or sprays of blood and body fluids. • Handwashing – Practice it with soap and water. sneezing. smoking. Used needles must not be removed from disposable syringes. o Place in designated area. • Eating. MRSA. o Droplet spread . • Eye protection (goggles) – wear it to prevent splashes.

to the health center to the immunizing staff and to the client. gloves and gowns and (-) pressure if possible • Contact isolation – prevent spread by close or direct contact • Respiratory isolation – prevent transmission thru air. • Enteric Isolation – direct contact with feces • Drainage/secretion precaution. o > create programs for sanitation o > be a role model Immunization – introduction of specific antibody to produce immunity to certain disease. to district hospital. 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.) PREVENTION Health Education – educate the family about • Immunization • MOT • Environmental sanitation – breeding places of mosquito. to regional store. use of single room. starting from the manufacturer. • Universal Precaution – for handling blood and body fluids. • Separation of patients with communicable diseases from others so as to reduce or prevent transmission of infectious agents. toxoid) Maintain vaccine potency by preventing: o Heat and sunlight o Freezing • Antiseptic/ disinfectants/ detergents lessen the potency of vaccine. infectous materials must be discarded. use of mask. . • COLD CHAIN SYSTEM – maintenance of correct temperature of vaccines. 7 Categories Recommended in isolation • Strict isolation – prevent spread of infection from patient to patient/staff. Use water only when cleaning fridge/ref. • TB isolation – for (+) TB or CXR suggesting active PTB. (Bloods. disposal of feces • Importance of seeking medical advice for any health problem • Preventing contamination of food and water. o Natural – passive (from placenta). pleural fluid. active (vaccine.- handwashing.prevents infection thru contact with materials or drainage from infected person. peritoneal fluid etc. holding community assemblies and conferences. active (thru immunization & recovery from diseases) o Artificial – passive (antitoxins).

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 .very ill. cough. nasal discharge. Far advance – more extensive than B MANIFESTATIONS • Primary Complex: TB in children: non contagious. children swallow phlegm. C. Consumption. S/S are present. Sputum AFB • Primary Complex o Minimal manifestations o Lymphadenopathy . fever. with exogenous TB like Pott’s disease • Primary Infection o Asymptomatic o No manifestations even at CXR. no cavity on chest X ray 2. volume affected should not extend to one lobe. Minimal – slight lesion confined to small part of the lung B. saliva Classification 1. Moderately advanced – one or both lungs are involved. • Period of communicability: all throughout the life if not treated • MOT: Droplet • Sources of infection – sputum. sputum is (-). blood.Disease Acquired Thru the Respiratory tract TUBERCULOSIS • Chronic respiratory disease affecting the lungs characterized by formation of tubercles in the tissues---> caseation –--> necrosis ---> calcification. cavity not more than 4 cm. Immigrant’s disease • Etiologic agent: – Mycobacterium tuberculosis • Incubation period: 2 – 10 wks. sputum (+) smear Classification 0-5 A. anorexia. • AKA: Phthisis. Active – (+) CXR. Inactive – asymptomatic. Koch’s. weight loss.

A. fever.DX • Tuberculin testing • CXR • Sputum AFB Prevention • BCG • Avoid overcrowding • Improve nutritional status TX • DOTS • 6 months of RIPE • Respiratory isolation. C MENINGITIS • Inflammation of the meninges usually some combination of headache. 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. stiff neck.with or without meningitis o Waterhouse Friederichsen Syndrome . Vit. increase CHON.

skin. CSF .Diagnostic exams: o Lumbar tap. Purpuric rashes o Meningeal irritation  Stiff neck  Opisthotonus  Kernig’s sign  Brudzinski sign o ALOC (Altered level of consciousness) o S/S of Increase ICP Nursing Mgt:  Administer prophylactic antibiotics: Rifampicin . 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. low glucose Manifestations: o Sudden onset of fever x 24h o Petechiae. direct or intimate contact. eyes .high WBC and CHON.drug of choice  Aquaeous Pen  Mannitol  Dexamethasone  Priority: AIRWAY. discharge from nose. fomites. ave:2-4 weeks  MOT – Droplet.

if laryngeal obstruction – tracheostomy • CBR for 2 weeks • Increase fluids. 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. adequate nutrition. dry metallic cough Complications o Due to TOXEMIA  Toxic endocarditis  Neuritis  Toxic nephritis o Due to Intercurrent Infection Bronchopneumonia Respiratory failure DX • Nose and throat swabs . pseudomembrane o Barking.grayish white. fractional dose 3.Manifestation  PSEUDOMEMBRANE . smooth. Diptheria Antitoxin – after – skin test if (+). Supportive • O2.soft food. Erythromycin 2. Penicillin.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. rich in Vit C • Ice collar 4. Isolation till 3 NEGATIVE cultures Prevention  DPT PERTUSSIS (whooping cough) .

frequency Complications: • Otitis media • Acute bronchopneumonia • Atelectasis or emphysema • Rectal prolapse. choking spells.• 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 o rapid cough 5-10x in one inspiration ending a high pitched whoop. watery nasal discharge. umbilical hernia • Convulsions (brain damage .asphyxia. nocturnal coughing. involuntary micturition and defecation. 5-10 successive forceful coughing ending with inspiratory whoop. teary eyes. colds.6th week. cyanosis • Convalescent – 4th. 1-2 weeks • Paroxysmal – Spasmodic stage. diminish in severity. • Catarrhal – slight fever in PM. hemorrhage) Dx: • Elevated WBC • Nasopharyngeal swab Nursing Management • Prevention: o DPT .

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. Cough.Pre eruptive stage / Prodromal (10-11 days) o Coryza. Eruptive stage o Maculopapular rashes o Rash is fully developed by 2nd day . whitish spot at the inner cheek o Fever. • Parenteral fluids • Erythromycin . conjunctivitis. smoke • Isolation • Gentle aspiration of secretions MEASLES • Acute viral disease with prodromal fever. cough and Koplik’s spots • AKA: Rubeola.drug of choice • Prone position during attack • Abdominal binder • Adequate ventilation. avoid dust. photophobia • 2. • MOT: Airborne • Sources of infection – secretions from eyes. Conjunctivitis o Koplik’s Spots. Most communicable during the height of rash. nose and throat Pathognomonic sign: Koplik’s spots Manifestations • 1. coryza.

lymph node involvement on 3rd to 5th day • 2.contact/respiratory • TSB . 100% when maternal infection happens on first trimester of pregnancy. IVF • Complications – bronchopneumonia. nasal ceretions. throat is sore • 3. congenital heart disease RISK for congenital malformation • 1. Supportive – O2. transplacental in congenital Manifestations • 1. rash on face.due to photophobia GERMAN MEASLES • Mild viral illness caused by rubella virus. mental retardation. otitis media. malaise. headache . Worst when rash is at it’s peak. Encephalitis. Prodromal – low grade fever. 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. Rubella syndrome – microcephaly. Eruptive – FORSCHEIMER’S SPOTS: pinkish rash on soft palate. Skin care – daily cleansing wash • Oral and nasal care • Plenty of fluids • Avoid direct glare of the sun. neuritis • 2. Antiviral drugs. MMR 15 months and then 11-12. Antibiotics – if with complications • 3. • AKA: Rubella. arms and trunk o lasts1-5 days with no pigmentation or desquamation o muscle pain • Treatment o symptomatic treatment Complications • 1. deaf mutism. . defer if with fever. • MOT: Droplet. Convalescence (7-10 days) o Desquamation of the skin Diagnostics • Nose and throat swab Treatment • 1.Isoprenosine • 2. encephalitis Nursing Management • Preventive – measles vaccine at 9 months. colds. o High grade fever –on and off o Anorexia. spreading to the neck. illness • Isolation .

Like measles tx PREVENTION.second/third trimester Nursing Management 1. direct. Encourage fluid 4. • 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 . Isolation. indirect o Direct contact thru shedding vesicles. o Indirect thru linens or fomites Manifestations • Pre eruptive: Mild fever and malaise • Eruptive: rash starts from trunk • Lesions . 4% . • MMR. • 2. 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. Room darkened – photophobia 3.red papules then becomes milky and pus like within 4 days. 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 . Pregnant women should avoid exposure to rubella patients • Administration of Immune serum globulin one week after exposure to rubella. drying on the skin Complications o pneumonia. Bed rest 2.

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.giant cells o Viral cultures of vesicle fluid o Electron microscopy o Giemsa-stained scraping – multinucleate giant epithelial cells S/S o Burning.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 Diagnostic procedure o Hx of chickenpox o Pain and burning sensation over lesions of vesicles along nerve pathway o Smear of vesicle fluid.pruritus • PREVENTION: Live attenuated varicella vaccine • VZIG .• Hygiene of patient • Cut finger nails short • Baking soda . vesicles at external auditory canal .

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. airborne . MOT: direct.droplet. bladder paralysis. • Period of communicability – 6d before and 9d post onset of parotid gland swelling. encephalitis Complications o Opthalmia herpes – blindness because of damage of gasserian ganglion o Geniculate herpes – deafness because of infection of 7 th CN (AKA: Ramsay Hunt Syndrome) Nursing Intervention o Compress of NSS or alluminum acetate over lesions o Analgesics. • Etiologic agent – filterable virus of paramyxovirus group usually found in saliva of infected person. with occasional involvement of other glandular structures. • AKA: Epidemic/ infectious parotitis • Incubation period: 14 -25 days.particularly testes in male. o 48 hrs immediately preceding the onset of swelling is the highest communicability. indirect . o Paralytic ileus.

Pain is related to extent of the swelling of the gland which reaches its peak in 2 days and continues for 7-10 days. 2. Deafness may happen 5.CLINICAL MANIFESTATIONS 1. 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 . loss of appetite 2. Antiviral drugs 2. Orchitis – testes are swollen and tender to palpation. WBC Count PREVENTION: MMR Vaccine TREATMENT MODALITIES 1. earache. warm salt water gargle o Diet – semi solid. 5. 4. Swelling of the parotid gland 3.Acetaminophen Nursing Interventions o Symptomatic o Application of warm/ cold compress o Oral care. Fever may reach 40 C during acute stage. Meningo-encephalitis -possible DIAGNOSTIC PROCEDURES 1.pain and tendeness of the abdomen 3. NSAIDS . Oophoritis. Mastitis 4. One gland may be affected first and 2 days later the other side is involved COMPLICATIONS 1. Viral culture 2. Sudden headache.

abdomen is distended • Head-ache. contaminated water. milk or other food • Sources of Infection o A person who recovered from the disease can be potential carrier. vomiting and diarrhea • RR is fast. Typhoid bacillus • Incubation period: 1-2 weeks • Period of communicability: as long as the patient is excreting the microorganism. aching all over the body • Worsening of symptoms on the 4th and 5th day • Rose spots TYPHOID STATE • Tongue protrudes. • MOT: fecal-oral route.dry and brown • sordes • (coma vigil) • (subsultus tendinus) . 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. skin is dry and hot. • Infection of the GIT affecting the lymphoid tissues(ulceration of Peyer’s patches) of the small intestine • Etiologic Agent: Salmonella typhosa and typhi.

Stool Culture (+) 4. • Etiologic agent: Vibrio cholerae.previously infected or vaccinated  Vi antigen . V. Chloramphenicol – drug of choice 2. WBC – elevated 2. Blood Culture – (+) S.carrier TREATMENT 1. Sepsis DIAGNOSTIC PROCEDURES 1. Peritonitis. Enteric precaution 4. sweating. WOF intestinal bleeding-bloody stool. typhosa 3. Heart failure. Prevent falls/ safety prec 5. loss of fluid. Restore FE balance 2.delirum sets in often ending in death Complications o Hemorrhage. comma • Pathognomonic sign: rice watery stool • Incubation period: 2-3 days • Period of Communicability: entire illness. • Severe case . vomiting. Pneumonia. • (Carphologia) • Always slip down to the foot part of the bed. Oral/personal hygiene 6.Paracetamol NURSING MANAGEMENT 1. NPO. BT CHOLERA • An acute bacterial disease of the GIT characterized by profuse diarrhea. 7-14d • MOT: fecal oral route . Widal test – blood serum agglutination test  O antigen – active typhoid  H antigen. Bedrest 3. pallor 7.

RR rapid and deep 3. Metabolic acidosis – loss of large volume of bicarbonate rich stool.Clinical manifestations o Acute. • Usually first or 2nd day if not treated. Severe dehydration . abdominal distention – paralytic ileus DIAGNOSTIC EXAMS Fecal microscopy 1. o RR – rapid and deep o Cyanosis – later o Voice becomes hoarse– speaks in whisper • Oliguria or anuria • Conscious. eyes are sunken o Pulse is low or difficult to obtain. Cotrimoxazole. Principal deficits 1. IVF.rapid replacement 2. watery diarrhea. Rectal swab 2. BP is low and later unobtainable. later drowsy • Deep shock • Death may occur as short as four hours after onset. . Hypokalemia – massive loss of K. Strict I and O 4. Antibiotics – Tetracycline. o Initial stool is brown and contains fecal material  becomes “rice water” o Nausea/ Vomiting Signs and symptoms of Dehydration o poor tissue turgor. Oral rehydration 3. Stool exam Treatment 1.circulatory collapse 2. profuse.

8. Enteric precaution 3. Protection of food and water supply from fecal contamination. Environmental sanitation PREVENTION 1. 2. VS monitoring 4. vomiting and headache • Anorexia. Medical Asepsis 2.NURSING MANAGEMENT 1. Good personal hygiene 6. Environmental sanitation. connei. in children • Nausea. Sanitary disposal of human excreta 5. contaminated water/ milk/ food. habitat exclusively in man. Proper excreta disposal 7. to 7 days • Period of communicability – during acute infection until the feces are (-) • MOT – fecal-oral route. S. Concurrent disinfection. Milk should be pasteurized. 4. Clinical manifestations • Fever esp. DYSENTERY • Acute bacterial infection of the intestine characterized by diarrhea and fever • Etiologic Agent: Shigella group o Shigella flesneri .commmon in the Philippines o Shigella boydii. dysenteria – most infectious. o S. 3. Water should be boiled/ chlorinated. they develop resistance to antibiotics • Incubation period – 7 hrs. Intake and Output 5. body weakness .

heinmedin disease. fly control.next most frequent • Type III . Tetracycline • IVF • Anti diarrheal are Contraindicated NURSING MANAGEMENT 1.most paralytogenic. Prevention. infantile paralysis • Etiologic Agent: Poliovirus (Legio Debilitans) 3 Types of Poliovirus • Type I . 3. Restrict food until nausea and vomiting subsides. Enteric precaution 4. cerebellum and the midbrain • AKA: Acute anterior poliomyelitis. Maintain fluid and electrolyte balance 2. most frequent • Type II . Excreta must be disposed properly.Ampicillin.food preparation. Cotrimoxazole. safe washing facilities.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 . 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. 5.• Cramping abdominal pain (colicky) • Diarrhea – bloody and mucoid • Tenesmus • Weight loss DIAGNOSTICS • Fecalysis • Rectal Swab/culture • Bloods – WBC elevated • Blood culture TREATMENT • Antibiotics.

Kernig’s sign Diagnostic tests: . spasms of hamstring muscles. impaired temp regulation o Encephalitic s/s • Bulbospinal o Combination • Minor Polio o Inapparent / subclinical o Abortive: recover within 72 hours. 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. vomiting • Major Polio o Paralytic: asymmetrical weakness. backache. urinary retention.3 Types of Paralysis • Spinal Paralytic o Flaccid paralysis o Autonomic involvement o Respiratory difficulty • Bulbar Form o Rapid & serious o Vagus and glossopharyngeal nerves affected o Cardiac and respiratory reflexes altered o Pulmo edema o Hypertension. flulike. constipation o Non paralytic: slight involvement of the CNS. paresthesia. stiffness and rigidity of the spine.

NTN. stool exam. • Throat swab. Preventive – Salk and Sabin Vaccine • NO morphine • Moist heat application for spasms • AIRWAY: tracheotomy • Footboard to prevent foot drop • Fluids. LP Nursing Interventions: • Supportive. 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) Clinical manifestations Prodromal/ pre icteric • S/S of URTI • Weight loss • Anorexia • RUQ pain • Malaise Icteric • Jaundice • Acholic stool .

proctogenital Clinical manifestations • Intermittent fever • Nausea. SGOT. amoeba+++) • WBC – elevated . exposure to flies. SGPT Nursing Interventions: o Provide rest periods o Increase CHO. polluted water supply. • Direct contact – sexual. • Bile-colored urine Diagnostic tests: HaV Ag. • Colic and abdominal distention • Intestinal perforation –bleeding DIAGNOSTIC EXAM • Stool Exam ( cyst. or anal. weakness • Later : anorexia. unhygienic food handlers. weight loss. 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 • Indirect . jaundice • Diarrhea – watery and foul smelling stool often containing blood streaked mucus.Histolytica cysts. Ab. oral. mod Fat. vomiting.Ingestion of food contaminated with E.

Signs and Symptoms o Stomachache o Vomiting o Passing out of worms o Complications o Energy / Protein malnutrition. Use mineral water. laparotomy o Follow-up stool exam 1-2 weeks after treatment Nursing Intervention: . oral NUSING MANAGEMENT • Enteric precaution • Health education. • Avoid washing food from open drum/pail. Tetramizole o Dicyclomine Hcl. NSAIDS for abdominal pain o For intestinal obstruction  Decompression  Fluid and electrolyte therapy  If persistent. Hx of passing out of worms (oral or anal).boil drinking water (20-30 mins). • Fly control ASCARIASIS  Helminthic infection of the small intestine caused by ASCARIS LUMBRECOIDES  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. CBC. • Wash hands after defecating and before eating. Anemia o Intestinal obstruction Treatment: o Pyrantel Pamoate o Piperazine Citrate o Mebendazole. • Observe good food preparations. Chloramphenicol o Fluid replacement – IVF.TREATMENT o Amoebacides – Metronidazole(Flagyl) 800mg TID X 7days o Bismuth gylcoarsenilate combined with Chloroquine o Antibiotic – Ampicillin. X-ray. • Cover leftover food. Tetracycline.

disease characterized by generalized rigidity and convulsive spasms of skeletal muscles caused by the endotoxin released by C. Tetani • AKA: Lockjaw • Etiologic Agent: Clostridium Tetani o Anerobic o Spore forming. .port of entry – rare o Circumcision/ ear pearcing • Incubation period: 3d-3week (ave:10days). often fatal. 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. gram positive rod • Sources: o Animal and human feces o Soil and dust o Plaster. 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 TETANUS • An acute. 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. unsterile sutures. o Isolation. rusty scissors.

rare form 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 .Signs and symptoms: • persistent contraction of muscles in the same anatomic area as the injury • Local tetanus • Cephalic tetanus .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 .

TT) • Administer antibiotics as ordered o Penicillin • Care during tetanic spasm/ convulsion o Administer Diazepam – muscle rigidity/spasm .000 units o Contains tetanus antitoxin. 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.Diagnostic procedure:  entirely clinical CSF – normal WBC . • Oxygen • NGT feeding • Tracheostomy • Adequate fluid.MV • Provide cardiac monitoring • KVO • Wound care (TIG.000 to 5. Debridement. electrolyte. caloric intake • During convalescence 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.normal or slight elevation Treatment: • Wounds should be cleaned • Necrotic tissue and foreign material should be removed • Tetanic spasms .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.

hyperexcitability. pressure sores) • WOF urinary retention. copious salivation. o Administer neuromuscular blocking agents (metocurin iodide) – relax spasms and prevent seizure • Keep on seizure precaution • Parenteral nutrition • Avoid complications of immobility (contractures. irritability. marked insomia • Sensitive to light. tingling. 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. lacrimation. malaise. mental depression. sound. anorexia. numbness. drowsiness. fractures RABIES • A viral zoonotic neuroinvasive disease that causes acute encephalitis • Etiologic agent: Rhabdovirus • AKA: Hydrophobia. sorethroat. restlessness. dilation of pupils . burning or cold sensation along nerve pathway. Lyssa • Negri bodies in the infected neurons – pathognomonic • Incubation period: 4-8 weeks. perspiration. and changes in temp • Myalgia. Clinical Manifestations Prodromal Phase / Stage of Invasion • Fever.

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. Anti-rabies vaccine • Passive immunization o 3 months o Rabuman. steady rising temp • Spasm. labored irregular respiration.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. Hyper Rab. nuchal stiffness. Imogam . involuntary twitching • Painful spasms of muscles of mouth. 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). betadine. Imovax. 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 o Severe exposure o Mild exposure • Wound treatment (local care) o Cleanse thoroughly with soap and water (or ammonium compounds. or benzalkonium cl) o Anti .Stage of Excitement • Marked excitation.e. pharynx. apprehension • Delirium.

1-2 yrs. P. falciparum • Mode of transmission o Mosquito bite VECTOR – female Anopheles mosquito DIAGNOSTICS • Malarial smear – film of blood is placed on a slide.P. vivax.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. dark environment  Close windows. 1 yr. P malariae. • Rapid diagnostic test (RDT) – done in field. wipe saliva or provide sputum jar o Provide restful environment  Quiet.rare • Incubation period: o 12days P. 10 -15 mins result blood test. 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. malariae • Period of communicability: o If not treated /inadequate – more than 3 yrs. Most common in the Philippines • P. malarie (Quartan) – less frequent. fever and chills occur every 72 hrs on the 4th day of onset • P. high parasitic densities in RBC with tendency to agglutinate and form into microemboli. stained and examined. • P. Vivax . non life threatening. 14 days P vivax and ovale. 30 days P.non life threatening except for the very young and old. o Manifests chills every 48 hrs on the 3rd day onward if not treated. ovale . . • Etiologic agent – Protozoa of genus Plasmodia • Plasmodium Falciparum (malignant tertian) o most serious. falciparum.

hepatomegaly • Hypotension o May lasts for 12 hours daily or every 2 days. abdominal pain. Diarrhea. Sulfadoxine (resistant P falciparum) Primaquine (relapse P vivax/ovale) • RBC replacement/ erythrocyte exchange transfusion Nursing management: • Isolation of patient • Use mosquito nets • Eradicate mosquitos . choleric.Clinical Manifestions: • Rapidly rising fever with severe headache • Shaking chills • Diaphoresis. • Complicated Malaria • GIT o Bleeding from GUT. Malarie). gastric. quinine. muscular pain • Splenomegaly. N/V. dysenteric • CNS or Cerebral Malaria o Changes in sensorium o Severe headache 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. tyhoid.

lots of fluid • Monitoring of serum bilirubin • Keep clothes dry. O’ nyong nyong.virus is present in the blood and will be the reservoir when sucked by mosquitoes • Stagnant water = any Diagnostic Tests: • Torniquet test • Platelet Count • Hematocrit . watch for signs of bleeding • PREVENTION o Mosquito breeding places should be destroyed o Insecticides. 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. insect repellant o Blood donor screening.• Care of exposed persons – case finding • I and O • BUN & creatinine – dialysis could be life saving • ABG • TSB. 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). ice cap on head • Hot drinks during chilling. • Dengue hemorrhagic fever – fatal characterized by bleeding and hypovolemic shock • Etiologic agent – Arbovirus group B – • AKA: Chikungunya.

Manifestations • PRODROMAL symptoms o malaise and anorexia up to 12 hrs. Ice bag on the bridge of nose and forehead. cold clammy skin PREVENTION: • Mosquito net • Eradication of breeding places of mosquito- . 5.petechia more than 10.rapid and weak o Untreated shock --. cool clammy skin o Profound thrombocytopenia o Bleeding and shock o Pulse . gum bleeding • CIRCULATORY Phase o Fall of temp on 3rd to 5th day o Restless. Kept in mosquito free environment 2. Keep pt. at rest 3.more prominent on the extremities and trunk o (+) torniquet test. VS monitoring 4. muscle pain o N &V • FEBRILE Phase o Fever persists (39-40 C) o Rash . o Fever and chills. Observe for signs of shock – VS (BP low). head-ache. o Skin appears purple with blanched areas with varied sizes ( Herman’s sign) o Generalized or abdominal pain o Hemorrhagic manifestations – epistaxis.coma – death o Treated – recovery in 2 days CLASSIFICATION • Grade 1 • Grade 2 • Grade 3 • Grade 4 Treatment: • No specific antiviral therapy for dengue • Analgesic – not aspirin for relief of pain • IV fluid • BT as necessary • O2 therapy NURSING MANAGEMENT 1.

ARF. 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. mice MANIFESTATIONS o Septic Stage  Early  Fever (40 ‘C). Hemoptysis. purpura. 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. jaundice . mud fever. skin flushed. warm. inoculation • Diagnostic tests: o Clinical manifestations o Culture SOURCE OF INFECTION o Rats. • Etiologic agent: spirochete Leptospira interrogans o found in river. floods • AKA: Weil’s disease. petechiae  Severe  Multiorgan  Conjunctival affectation. sewerage. tachycardia. dogs. head-ache. abdominal pain. ingestion. jaundice.

 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. coma .  Incubation Period: 2 – 6 weeks  MOT: Bathing. . 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. meningeal irritation. o Toxic stage – with or w/o jaundice.  AKA: Bilharziasis. oliguria– shock.pigs) SCHISTOSOMIASIS  Parasitic disease caused by Schistosomiasis japonicum. CHF o Convalescence – recovery MANAGEMENT 1. IVF 4.cats. Schistosomiasis Hematobium. Supportive 5. Dialysis – peritoneal 3. wading in water. swimming.dogs. Schistosomiasis mansoni. Snail fever. IV antibiotic Pen G Na Tetracycline Doxycycline 2.

mansoni.the enlargement of both the liver and the spleen. • Cystitis and ureteritis with hematuria àbladder cancer.Signs and symptoms: o Swimmers itch  Itchiness  Redness and pustule formation at site of entry of cercariae  Diarrhea  Abdominal pain  hepatosplenomegaly CLINICAL MANIFESTATIONS: • Abdominal pain • Cough • Diarrhea • Eosinophilia . • Glomerulonephritis. • Colonic polyposis with bloody diarrhea (Schistosoma mansoni mostly) • Portal hypertension with hematemesis and splenomegaly (S. S. and central nervous system lesions. • Fever • Fatigue • Hepatosplenomegaly . haematobium). mansoni. japonicum). more rarely S. • Complications: O Pulmonary hypertension . • Pulmonary hypertension (S. japonicum.extremely high eosinophil granulocyte count. S.

peripheral nerves producing skin lesions. Bloods – inc. • Incubation period – 5 1/2 mo . Tissue smear • 4. inoculation thru break in skin and mucous membrane. symmetrical and erythematous– macules and papules • Later lesions enlarge and form plaques on nodules on earlobes. ESR • 5. Lepromin skin test • 6. Tissue biopsy • 3.eight years. photophobia –blindness • Lesions are multiple. nose eyebrows and forehead • Foot drop • Raised large erythemathous plaques appear on skin with clearly defined borders. 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. Diagnosis: • 1. • Loss of eyebrows/eyelashes • Loss of function of sweat and sebaceous glands • Epistaxis . Mitsuda reaction MANIFESTATIONS • Corneal ulceration. infection and deformities. – rough hairless and hypopigmented – leaves an anesthetic scar. Identification of S/s • 2. • MOT – respiratory droplet. anesthesia.

1. 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. History of HIV / AIDS • 1959 .African man • 1981. Care of exposed persons 1.TREATMENT • multiple drug therapy • sulfone • rehab • occupational Health • isolation • moral support PREVENTION 1. injection of blood/products. BCG vaccine may be protective if given during the first 6 months. placental transmission.5 homosexual men • 1982-Designated as disease by CDC • 1983. Report cases and suspects of leprosy 2. Observe carefully for symptoms of the disease.5 million HIV-infected in USA • 1994. Household contact – Diaminodiphenylsulfone for 2 years 2.WHO reports 8-10 mil. Isolation of patient – until causative agent is still present 2.HIV 1 discovered • 1987. Worldwide & protease inhibitors introduced • 1999-First clinical trials for HIV vaccine . Nursing Interventions: 1. 3.

generalized lymphadenopathy o Major signs – loss of weight 10% BW. chronic diarrhea 1month up.The immune system o Macrophages  Humoral response  Cell-mediated response The HIV RNA virus Retrovirus Reverse transcriptase Protease 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. prolonged fever one month up. oral candidiasis. • Persistent lymphadenopathy • Cytopenias (low) .

bronchitis. Viral load. • 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.degree of viral activity • Nucleoside Reverse Transcriptase Inhibitors • Blocks reverse transcriptase . weight loss. • 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. carcinoma in situ. o Cervical dysplasia. 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.

Videx 200 mg Peripheral bid neuropathy Zalcitibine ddC.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.75 mg No antacids TID Stavudine d4T. 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. Zerit 400 mg Peripheral bid neuropathy Lamivudine 3TC. Taken with food Retrovir Bid Didanosine ddI. ZDV. 300 mg. needle stick injury prevention o Assist in early diagnosis and management of complications • 4 C’s o Compliance – info.Hivid . + drugs o Counselling – education o Contact tracing – tracing out and tx for partners o Condoms – safe sex GONORRHEA .

Drip. Salpingitis. Seminal Vesiculitis • Disseminated Gonococcal Infection (DGI) o Tenosynovitis or Polyarthritis. • A curable infection caused by the bacteria Neisseria gonorrhoea • AKA: Clap. vulvovaginitis • MOT: transmitted during vaginal. skin lesions and fever • Anorectal Infection • Pharyngeal Infection • Gonococcal Conjuctivitis o Opthalmia Neonatorum • Meningitis. 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. Pelvic Abscess • Complications : • PID • Infertility Complications: • Upper Genital Tract – male o Epididymitis. Endocarditis Diagnosis: • Culture & Sensitivity • Blood tests for N. 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 . Tetracycline. gonorrhoeae antibodies Treatment: • ANTIBIOTICS • Penicillin • Single dose Ceftriaxone IM + doxycycline PO BID for 1 week • Prophylaxis: Silver nitrate. Prostatitis. anal. G.

or difficulty in coordinating movements. Aneurysm of sinus of valsalva and aortic regurgitation.soft.flat broad whitish lesions  Fever. tongue. painless skin ulceration localized at the point of initial exposure to the bacterium appear on the genitals  can also appear on the lips. hyperactive reflexes • cardiovascular syphilis • aortitis. . Bad blood • Type of Infection: Bacterial • Modes of transmission : o Through sexual contact/ intercourse.an infectious brown skin rash that typically occurs on the bottom of the feet and the palms of the hand  condylomata lata . aortic aneurysm. bones. and ears. that left untreated will progress through four stages with increasingly serious symptoms. and other body parts. .SYPHILIS • a curable. and hair loss can also be experienced • Third stage o Will manifest 1 – 10 years after the infection o characterised by gummas . • Etiologic agent: Treponema pallidum • AKA: Lues. teeth. bacterial infection. Neurosyphilis • generalized paresis of the insane which results in personality changes.death Consequences in Infants • Congenital syphilis • extremely dangerous • Deformities • Seizures • Blindness • Damage to the brain. 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. swollen glands. o Secondary syphilis (last 2 – 6 weeks)  syphilis rash . The pox. 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. changes in emotional affect. sore throat.

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 .Test and diagnosis • Venereal Disease Research Laboratory (VDRL) test • Flourescent treponemal antibody absorption (FTA – Abs) • Micro hemagglutination test (MHA .

with 8. cough. lethargy. promote safety AAT o WOF signs and symptoms bleeding. sore throat o fever above 38 °C (100. vomiting • Joint pain Prevention: • Hepatitis B vaccine has been available since 1982.096 known infected cases and 774 deaths • Incubation period: 2-3days • MOT: Airborne Signs and symptoms: o flu like: fever.Abdominal pain • Loss of appetite • Nausea. K rich foods and minerals o Assistance to prevent injury. Vit. edema o Health education on safe sex.Signs and symptoms: • Jaundice • Pruritus • Fatigue • RUQ . gastrointestinal symptoms.4 °F) . increase in CHO. low fats. myalgia. high in CHON. 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. SEVERE OF ACUTE RESPIRATORY SYNDROME • An acute and highly contagious respiratory disease in humans • Etiologic agent: SARS coronavirus • November 2002 and July 2003.Hepa B vaccine o Proper rest periods o Prevent stress – physio/psychological o Proper NTN.

LOW • ELISA test detects antibodies to SARS o but only 21 days after the onset of symptoms • Immunofluorescence assay. .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. Canada).increased opacity in both lungs. indicative of pneumonia • SARS may be suspected • fever of 38 °C (100. 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. Hong Kong. • Suspected cases of SARS must be isolated. o Shortness of breath o Symptoms usually appear 2–10 days following exposure o require mechanical ventilation Diagnostic Test: • Chest X-ray (CXR). • probable case of SARS has the above findings plus positive chest x-ray findings of atypical pneumonia or respiratory distress syndrome Treatment • Supportive with antipyretics. sputum. with full barrier nursing precautions taken for any necessary contact with these patients • steroids • antiviral drug • SARS vaccine . tissue samples and stools • CXR . supplemental oxygen and ventilatory support as needed. preferably in negative pressure rooms. can detect antibodies 10 days after the onset of the disease.abnormal with patchy infiltrates • WBC and PLT CT. Singapore and the province of Ontario.

 Tuberculosis*  Leprosy*  Schistosomiasis*  Filariasis  Malaria*  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* .

Syphilis* iii. DPT. School Entrants: MECS: Grade 1=7 years old DECS: Grade 1=6 yrs. old (1993) Booster of BCG . Gardianella Vaginitis v. OPV& Measles HBV (1996) B. Trichomoniasis vi.  Scabies  Anthrax  Sexually Transmitted Infections i. 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 ) *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. Chlamydia iv. Infants (0-12 months): BCG. Gonorrhea* ii.

Children: Infants-5 vaccines School entrants-BCG booster dose 3. Before EPI total immunization-5 After EPI total immunization-6 (Tetanus toxoid was included) 4. Pregnant mothers-Tetanus Toxoid 2. 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 . Knock Out Polio (KOP) 2. 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. 1. Flavier in 1993-95 Initially every 3rd Wednesday of January & February (1993-1995) 1996 to present: Still being practiced 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. Zero Polio Philippines (1996-2000) 3.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.

035 = 245 to receive TT c. Pregnant Women – get the 3. 1 recorder and 1 health educator catering to a population of 1. Surveillance-------------------------------- Planning. Infants ( 0 – 12 ) – get the 3% of population b. RHM. Pregnant Women (PW) – Tetanus Toxoid *To determine Eligible Population: EP = Population of the Community x 0. Target Population is the population group meant to be benefited by the EPI Programs where DOH is responsible.03 (Infants and School Entrants) or X 0. HBV.E) – Booster of BCG c.) Tetanus Toxiod = for pregnant women EP = 7000 X . Infants (I) – BCG. Eligible Population ( EP ) rae those qualified to receive specific immunizations where PHW is responsible  PHN.03 = 210 to receive booster BCG .) DPT = for infants EP = 7000 X 0.000 Policies of EPI: I. FIC ( Full Immunized Child ) C. MV b. School Entrants – get the 3% of population ( dictum of DOH ) = 6 years c. Cold Chain III.035 (Pregnant Women) *Example: Lanting Community with a population of 7000 a. MO *3 Population Groups to benefit a. Monitoring and Health Education Administrative and Supportive Role of PHN Referral. Target Setting: 1.03 = 210 to receive DPT b. Research and Evaluation --- I. DPT.) Booster BCG = for school entrants EP = 7000 X 0. OPV. Immunization Technical Responsibilities of PHN IV. and Training--- Mobilization. Coverage A. 1 vaccinator. School Entrants (S.5 % of population ( MWKA ) = 15 – 49 years 2. Coverage-------------------------------------- A. Wastage Allowance OBJECTIVES OF EPI: To reduce morbidity and mortality rates among infants and children from 6 or 7 immunizable disease II. Target Setting B. a. Supervision. 1 runner.*RSI locates a venue for immunization called “Patak Center” and composed of 1 organizer.

Fully Immunized Child ( FIC ) – is a child who receives the 5 sets of vaccines (BCG. How many receipients = ????? -Follow DOH Dictum: On the day of immunization. OPV. b. OPV-3 doses 2nd Dose-10 wks. B. MV-1 dose 9-12 months *MV may be given 6 months if there is an epidemic. Wastage Allowance . Vaccine with 8 hours half life: DPT. Be aware of the availability of vaccines: Example: BCG CHN: vial Private Practice: ampule Frozen powder with a diluent ( 1 ml per content ) 2. Vaccine with 4 hours half life: BCG. 3rd Dose-14 wks. Hepa B and Measles and who receives 11 doses of vaccines. 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) . if 50% and above of computed recipents arrive in the health center. MV ( need to mix ) *If open at 8:00 am.DOH doesn’t ptoduce vaccines biologically and therefore dependent on suppliers abroad: Germany and Switzerland to economize: 1. open a vial but if less than 50%. 10 arrive = open a vial -Half life of Vaccines is the duration of potency: a. c. 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./1 ½ mos./2 ½ HBV-3 doses mos. HBV. don’t open. it’s good till 12:00 noon At 12:30 pm. don’t give anymore because it’s not potent anymore. Example: In 20 recipients. DPT./3 ½ mos. OPV.

5 ml=1 10 ml >10 y/o: 1 .BCG Vial: 1. When is the 2nd booster? November 20.2 .5 ml 3 doses 40% 1. Mrs Dela Cruz received the 1st booster dose (TT3) on November 20.5 ml 5 doses 40% 1.67 25(1ml=15gtts) (Sabin) bottle: 5 ml slightly pink Liquid HBV Vial: .05 ml 1 dose 60% 2.5 20 2. SE Powder .5.67 10 with 1ml diluent DPT Vial: 10 ml . <10 y/o: . 2005 . 2004.5 3 doses 10% 1.1 ml 1 dose 40% 1.67 20 liquid OPV Plastic 2-3 gtts 3 doses 40% 1. I Frozen .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 5 ml = 75 gtts = 25 recipients Right Time for Pregnant Women to receive Tetanus Toxoid Primary Dose TT1 Anytime during ? Immunity Pregnancy (5th-6th months) Primary Dose TT2 4 weeks after TT1 3 years immunity st 1 Booster TT3 6 months after 5 years immunity TT2 2nd Booster TT4 1 year after TT3 10 years immunity 3rd Booster TT5 1 year after TT4 Lifetime immunity Examples: 1. 1.5 ml 1 dose 50% 2 10 Frozen Powder with Diluent Sol’n=5ml per content TT Vial: 10 ml .5 ml MV Vial: .

you have 3 doses of DPT. is there a definite immunity? There’s no definite # of years of immunity.035 (PW) 2. 30 x 1. Cold Chain -Tools or Procedures to follow to keep vaccine potent ( expected desired effect ).03 (I & SE) or 0.5 MV 50% 2. What you need to receive are the 3 booster doses only-TT3. Determine the Complete Coverage (CC) CC=WA ÷ # of recipients per vaccine 5. TT4 & TT5 respectively. 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 1.5 or 38 vials to be given by DOH (or 8 vials allowance) II. If until 3 years she failed to receive vaccine.2.67 DPT OPV TT HBV 10% 1. WA=360 x 1. Determine the Wastage Allowance (WA) WA=computed AD x MF of the vaccine 4. Now you become pregnant. Wastage Allowances of DOH Multiplier Factors BCG (I) 60% 2. she got to start with the 1st dose. Determine the Overall Total in Allowance (OT) OT=CC x 1.25 (constant). EP=4000 x 0. AD=120 x 3 doses=360 3.0 BCG (SE) 40% 1. As a child.2 Steps to Compute the Number of Vaccine to be Requested from DOH 1. Determine the Annual Dose (AD) AD=EP x # of doses of the vaccine 3.67=601 4. CC=601 ÷ 20=30 5. Policies: 1. Determine the Eligible Population (EP) EP=Population of the Community x 0.25=37. 3. 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 .03=120 2. If as a child. only 1 dose of DPT was given.

Black: use by staff of HC during epidemic & needs 5 cold dogs b. Proper Transport . 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. identified to be RNA & DNA recombinant from blood . MV & BCG: Not damage by freezing DPT.Tools provided by DOH: Vaccine Carrier which maybe a. based & oriented) . RHCDS . 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 BCG. Proper Handling of Vaccine (After Care of Vaccine): Dictum of DOH a. OPV & MV are composed of live attenuated bacteria & virus so before discarding them. 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. HBV & TT: Damaged by freezing so not placed in the freezer 2. though not consumed.Vaccines are to be transported from the health center to the area of immunization (community: focused.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. Vaccines which are opened. chlorox or dumex BCG (Bacilli Calmette-Guerin Vaccine): live attenuated bacteria OPV & Measles Vaccine: live attenuated virus DPT. disinfect 1 st with 1% Hcl or any disinfectant like zonrox.

Never count back even though the interval exceeds weeks. 2006-can’t be used anymore after this I. continue counting in giving the doses. cough & colds and malnutrition. 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. Vaccine b. 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. in giving the immunization unless upon assessment of the practitioner that the child has serious medical problems that warrants hospitalization 3. SOA (Site of Administration) d. ROA (Route of Administration) e. Dosage c. 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). 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 4. the child develops high grade fever with convulsion. There are no contraindications such as slight fever. TT: weakened toxoid b. 2006 Jul. LBM. 4 days if still febrile) If after 1st dose of DPT. PHN should still give the 2 nd dose 3rd dose: The mother brought back the child at 2 years old. Things to consider in administering vaccines: a. 19. As long as the child is on the eligible age Example: DPT. OPV & HBV. months or years. In giving immunization with multiple doses such as DPT. OPV & HBV 1st dose: At 6 weeks (1 ½ months). 19. Immunization Guiding Principles for HW in Administering Vaccines & Screening of Children for Immunizations: 1. 2006 Jun. Side Effect: patterns of reaction that is considered normal . 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. 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.

Thus. Vaccine Dosage SOA ROA Conferred Immunity 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. no abscess & ulceration and no scar developed. 3rd & 4th Day=apply alternating cold & warm compress Adverse Effect: If convulsion occurs on 1 st dose.5 ml Thigh (vastus Intramuscular Artificial lateralis) (Z tract) Active where muscle is grasped and squeezed Side Effects: 1. an anti-bacterial. pulverized & applied on the site. there is no soreness & inflammation. Then repeat the dose again but not on the same site.05 ml I=R deltoid Intradermal Artificial Active SE=. Soreness and inflammation SOP Management: Paracetamol (anti-pyretic & analgesic) q 4 hours RTC for 1 st 3 days or till with fever Nursing Care: 1st Day=apply cold compress on site 2nd .Vaccines Dosage SOA ROA Conferred Immunity BCG I=. discontinue DPT 2 & DPT 3 .1 ml SE=L deltoid (needle is parallel to site=10-15° angle Side Effects: Wheal=10 mm that disappears after 30 minutes 1st week : develops soreness and inflammation nd th 2 -11 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. repeat the dose on same site but a little lower. there is wrong preparation of site where PHW used alcohol that kills the microorganism contained in the BCG vaccine. pounded. High grade fever due to Pertussis Component which contains killed bacteria 2.

Jones Salk Side Effect: None Nursing Care: 1.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 Active Sabin by Dr. Just apply cold compress on site to relieve discomfort .5 ml Deltoid or Intramuscular Artificial Active Gluteal muscle Side Effect: Soreness and inflammation on the site which is tolerable by pregnant woman so no need to take medicines. In case the child vomits after vaccination.5 ml Thigh (vastus Intramuscular Artificial Active lateralis) Side Effects: Soreness and inflammation on site SOP Management: Paracetamol q 4 hours RTC for 1 st 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 . give anti-histamines: Diphenydramine (Benadryl) syrup or Apply Caladryl or Calamine Lotion which has anti-histamine and cooling effect to relieve itchiness TT .5 ml Posterior Subcutaneous Artificial Active aspect of (45° angle) Deltoid Side Effect: High grade fever SOP Management: Paracetamol q 4 hours RTC for 1 st 2 days MV given on same site with BCG but MV is given at 9 months while BCG at birth In case. repeat giving the vaccine because it requires 30 minutes to absorb the OPV HBV . Albert Sabin Salk (parenteral polio vaccine) by Dr. NPO for 1st 20-30 minutes after receiving vaccine to prevent nausea & vomiting 2. rashes develop after vaccination which makes the child irritable due to itchiness.

Active b. Breastfeeding→ IgA (present in 1.To be discussed unde r Communicable Diseases. Constant exposure to disease immunizable diseases such as BCG. Carrier (person harbors the disease person but asymptomatic) of the disease Upon receiving vaccine (antigen) for 2. Immunoglobulins: IgA.2 Forms of Immunization Conferring Immunity: 1. Supervision and Training Mobilization. IgG & IgM where IgG is most predominant IV. OPV. Surveillance--------------. and Health Education Referral. Serum (Blood): colostrums) HBV 2. Monitoring. Research and Evaluation *CDD ( CONTROL OF DIARRHEAL DISEASES ) Policies to implement CDD: 1.washing of hands before eating and after use of toilet 2. Passive 2. IgE. 3. Planning. 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. MV and HBV Passive Passive 1. IgD. Health Education on Personal Hygiene . Breastfeeding ( BF ) . Perinatal→ immunity is acquired ATS (Anti-Tetanus Serum) during the term of pregnancy ADS (Anti-Diptheria Serum) 2. Natural a. Antitoxin: poison or causes infection TAT (Tetanus Antitoxin) DAT (Diptheria Antitoxin) 3. Acquired or experienced the disease DPT.

c. b.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. . Extensive: Breastfeeding can be extended to 2 years. Two problems in CDD . . Mother – regulated by R. . *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. Consistency of the stool = watery ROLE OF BREASTFEEDING IN THE CONTROL OF DIARRHEAL DISEASES PROGRAM 1. *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. Children – regulated by EO 51: Milk Code of the Philippines Dictum of Milk Code: Never commercialized a brand name of milk.Two ( 2 ) Beneficiaries of BF Program: a. Oresol: a management for diarrhea to prevent dehydration 2 Concepts of Diarrhea: a. never alternate Breastfeeding with any supplementary feeding.3 Principles to make breastfeeding effective: 3 E’s a. Early: start Breastfeeding as early as possible  Normal Spontaneous Delivery (NSD): after 30 minutes CS: after 3 – 4 hours b.A. Measles: immunization – preventive and prophylactic 4. 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. 7600: Breastfeeding and Rooming – In Act. Exclusive: for the 1st six months. Frequency of passing out stool = ≥3x/day b. preservation is minimum of 3 months and maximum of 6 months Fresh always Emotional bonding Economical Digestible: contains lactalbumin.

hand washing 5. To prevent dehydration. use of latrines 6. For undernutrition. 9. 11.• 1. Advantages of breastfeeding in relation to CDD 1.Breast milk is sterile 2. Highest mortality in the first 2 years of life 4.Presence of antibodies protection against diarrhea 3.Intestinal Flora in BF infants prevents growth of diarrhea causing bacteria. rehydrate early. use of plenty of clean water 4. Risk of severe diarrhea 10-30x higher in bottle fed infants than in breastfed infants. High child mortality due to diarrhea 2. Improved Nutrition . continue feeding during diarrhea especially breastfeeding. High diarrhea incidence among under fives 2. Summary of WHO-CDD recommended strategies to prevent diarrhea 1. give home fluids “am” as soon as diarrhea starts and if dehydration is present. Interventions to prevent diarrhea 1. correctly and effectively by giving ORS 6. When to wean? 4-6 months – soft mashed foods 2x a day 6 months – variety of foods 4x a day 12. measles immunization 8. 7. 10. proper disposal of stools of small children 7. Main causes of death in diarrhea : DEHYDRATION MALNUTRITION 5. improved weaning practices 3. Highest incidence in age 6 – 23 months 3. Breastfeeding decreases incidence rate by 8-20% and mortality by 24-27% in infants under 6 months of age. breastfeeding 2.

Good personal and domestic hygiene . or 1 liter 250 ml.protecting water from contamination at the source and in the home 3.collecting plenty of water from the cleanest source . 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 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.Measles immunization.Use of safe water .exclusive breastfeeding for the first 4-6 months of life and partially for at least one year.use of latrines . 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 .handwashing . .proper disposal of stools of young children 4.5 grams Buffer content of solution Bicarbonate/NaHCO3 Neutralizer content of solution Potassium Chloride/KCl 1.Improved weaning practices 2.5 grams For retention of water/fluid Sodium 2. .

Increase fluid: Tea- 3. K & Ca which are lost in diarrhea Oresol is given/LBM or every time stool is passed out: < 2 years old: 50-100ml. 3 Categories of Dehydration: a. Alert 3 Principles/3 F’s: 2. No dehydration-uses oresol b. mango. lipton tea bag left present standing in a cup of 4. Fontanel-normal 1. a diuretic & has back quickly which is an absorbent effect done at forearm Fruit Juices-not from highly fibrous fruits like pineapple. Skin Turgor-returns =pectin. Oresol-am or buko where 3 electrolytes are present: Na. Normal DHN b. Some dehydration-uses oresol c. Mouth. Condition No dehydration Plan A-prevention of a. Well c. Plan A: for prevention of dehydration b. Plan C: for treatment of dehydration-severe CDD MANAGEMENT CHART Assessment Category Treatment 1. Tongue & Lips: water for 15 minutes & moist or wet Thirst: there is brownish drinks normally discoloration 5. Plan B: for treatment of dehydration-mild & moderate c.*For drinking medicines = a glass is 240 ml of water. guyabano. Eyeballs-normal Tears. Severe dehydration-uses IVF Objectives/Plan/Policies of the Use of the following Program: a. always give the maximum amount 2-10 years old: 100-200 .

2-4 y/o: 800-1200 ml. ml. Very sunken eyeballs dextrose gives additional & absent tears source of 4. energy & improves tongue & lips appetite D5-is glucose Refuses to drink orally LRS-has 3 chlorides 5. Condition Some dehydration Plan B-Treatment of mild a. Very sunken fontanel severe DHN since 3. Restless & Moderate DHN using b. Lethargic Priority-choice of IVF: c. 15 & above: 2200-4000 ml. Sunken eyeballs & If less than 2 years old: absent tears use age in months 4. Condition Severe dehydration Plan C-treatment of a. LRS-Lactate Ringer’s very slowly best done at or Hartman solution is the abdomen the most appropriate choice if no D5LRS 3. Dry mouth.9 NaCl 4. Unconsciousness severe DHN using IVF b. Fast referral 1. 5-14 y/o: 1200-2200 ml. Plain NSS or 0. Sunken fontanel 3. D5W . Skin returns back very. Treatment Plan: 1st 4 hours always give the maximum 1. 5. Increase feeding: 3. Floppy-apathetic or 1. Eagerness to drink 5-11 months: 400-600 ml. D5LRS-best or 1st passive choice if available for 2. 10 years old & above: as much as tolerated & desired 2. 2. tongue & If < 4 months: 200-400 lips ml. Irritable oresol 2. Skin returns back 12-23 months: 600-800 slowly ml. Very dry mouth.

add 1 tablespoon of toasted rice or bread & allow to stand for 20-30 minutes→ produces a blackish discoloration which is pectin . milky substances (dagta) found on the inside of the skin Duhat: wash first the fruit then sprinkle with rock salt & shake. eat both skin & flesh Fruits to avoid during diarrhea: Papaya flesh. 5. Child: give 100 mg/kg body weight in the 1st 4 hours Example: 8 kg=800 ml. IVF to be infused on the 1 st 4 hours for patient with severe dehydration (8 am-12 noon) b. 2-6pm=infuse 4 liters IVF Fruits for Diarrhea: Apple: has pectin & tarum which has an absorbent property. notice extracts to come out of the fruit. D10W 2 Victims of Severe Dehydration: a. Rice. pineapple flesh. Apple. Adult: give 3-4 liters of IVF in 1st 4 hours Example: 9am-1pm=4 liters=1 liter/hour If still severe dehydration. toasted bread or toasted rice beads which has activated charcoal that acts as absorbent Direction: In a cup of warm water. eat the extracts. guyabano & kaimito flesh BRAT Diet: Banana. mango. Tea. eat the skin Banana: has K+ Caimito: eat the flesh in cases of constipation but in diarrheal cases.

(CONTROL OF ACUTE RESPIRATORY INFECTIONS ) Goal: Morality and Morbidity reduction of Pnuemonia.duration Convulsion .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. irritable Sunken eyes THIRSTY: drinks eagerly Skin pinch goes back Treat PLAN B O.R. Assessment: History: Subjective Age Cough and Duration Able to Drink or stop feeding Fever ---. Target groups: very young: <2 months Older child: 2 months – 5 years old Child with cough and colds Program: 1. TYPES OF DIARRHEA o ACUTE : < 14DAYS o PERSISTENT: 14 DAYS or more o DYSENTERY: Blood in the stool. with or without mucus *CARI CLASSIFY DEHYDRATION • SEVERE DEHYDRATION Two of the following: Abnormally sleepy Sunken eyes Drinks poorly Skin pinch goes very slowly Treat PLAN C: Referral to hospital for IVF!!! • SOME DEHYDRATION Two of the following: Restless.

Physical Examination: Objective Weight. Refer urgently to hospital 2. Chest in – drawing . Convulsion h. PNEUMONIA: Signs and Symptoms: a. VERY SEVERE DISEASE: If any 3 of the 5 Danger signs are present Signs and Symptoms: f. Cyanosis 2 Types: a. LOC . Fever . Malnutrition . Sleepy i. Not able to drink g. Severe Pneumonia . 1st dose of antibiotics 3. Level of Consciousness 2. STANDARD CLASSIFICATION OF ILLNESS: I. Treatment of Fever ( TSB ) * Wheeze (NEBULIZE) 4. Height Respiratory Rate – one whole minute Fast Breathing *Less than 2 months – 60/min or > *2 months – 1 year – 50/min or > *1. Chest in – drawing b. Grunting d. Wheeze during exhalation . Infants 2 months to 5 years old 1. Antimalarial 2.5 years old – 40/min or > Observe for : . Stridor during inhalation . Severe Malnutrition Treatment: 1. Nasal flaring c. Stridor j.

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

3. 5. breast milk substitute. -Provision for human milk bank.g. supplementation. 0 – 1 year old = monthly 1 year old and above = quarterly 2. Executive Order 51 Republic Act 7600 The Rooming – in and Breastfeeding Act of 1992. feeding bottles. Program Objectives and Goals: -Protection and promotion of breastfeeding and lactation management education training. (e. Conduct Orientation / Advocacy meetings to Hospital / Community. Monitoring and Evaluation. education and re – education drive. Provision of a sagfe and learning – oriented environment for the child. Activities and Strategies: 1. -Sanction and Regulation. toys ) that promote and enhance child’s proper growth and development. -Information. ADVANTAGES OF BREASTFEEDING: MOTHER: *Oxytocin helps the uterus contracts *Uterine involution *Reduce incidence of Breast Cancer *Promote Maternal – Infant Bonding .Activities and Strategies: 1. charts. **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. Posters. 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. Full Implementation of Laws supporting the Program A. infant formulas. 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. teats etc.) B. deworming and feeding. 3. 4. Provision of IEC materials ( ex. Regular height and weight determination / monitoring until 5 years old. Recording of immunization. vitamins.

*Form of Family planning method ( Lactational Amenorrhea ) BABY: *Provide Antibodies. Cradle Hold – head and neck are supported 2. 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. *Contains Lactoferin ( Binds with Iron ) *Leukocytes *Contains Bifidus factor – Promotes growth of the Lactobacillus inhibits the growth of pathogenic bacilli.1 Routine Health Services: Health Service Dosage Route of Target Administration Population Vitamin A 200. nationwide . Football Hold 3.000 IU or Orally by drops 12 – 59 months Capule capsule 100. Positions in BF THE BABY: 1. 1.000 old. WHAT ARE THE HEALTH SERVICES OFFERED IN GP AND WHO ARE THE TARGETS? GP offers the following: 1.

05 ml Intradermal on 0 – 11 months right deltoid.11 evacuation with instructions ) months) centers in armed conflict areas. These micronutrients are not produced by the body. Bottle as taken including home medicine 0. IU or ½ cap or 3 9 -12 months old drops infants receiving AMV nationwide. -DPT 0. liver. essential in the normal process of growth and development: a. iodized. pan de bida and other fortified foods. Routine Immunization -BCG 0.) Helps the body to regulate itself b. who missed any of his routine immunization. -**For any between 12 – 23 months.6ml ( 6. 30 ml day Mindanao area. salt.3 ml ( 2 – 6 Orally by drops.5 ml Intramuscularly 0 – 11 months available ) Deworming drug 1 tablet as single Orally 36 – 59 months. Iron and Iodine -Sources: green leafy and yellow vegetables. 2 -11 months old ( 25 mg elemental months ) once a infants in Iron per ml.5 ml Subcutaneously on deltoid -Hepa B ( If 0. Garantisadong Pambata ( GP ) Sangkap Pinoy -Vitamin A.5 ml Intramuscularly 0 – 11 months on anterior thigh -OPV 2 drops Orally 0 – 11 months -AMV 0. Ferrous Sulfate 0. and must be taken in the food we eat.) Necesary in energy metabolism . seafoods. fruits. ( 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. the health worker should give the child the necessary antigen to complete FIC and shall be recorded as such.

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

*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. Give egg alone or combine with above food mixture. flaked fish / chicken / ground meat and oil. mashed beans. TYPES OF METHODS: A.d. Basal Body Temperature Method 3. soft cooked vegetable. CHEMICAL METHODS 1. *How to Give Complementary Foods for Babies 6 – 11 Months Old? a. Give mixture by teaspoons 2 – 4 times daily. Introuction of complementary foods will accustom him to new foods that will also provide additional nutrients to make him grow well. c. Ovulation suppressant such as PILLS . Egg yolk. 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. Lactational Amennorhea B. Goal and Objective: * Universal access to family planning information education and services. g. Sympto – Thermal Method 5. 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. ARTIFICIAL METHODS I. NATURAL METHODS 1. Give bite – sized fruit separately d. should continue for as long as the mother is able and has milk which could be as long as two years. f. Calendar or Rhythm Method 2. Cervical Mucus Method 4. Breastmilk should be supplemented with other foods so that the child can get additional nutrients. e. Prepare mixture of thick lugao / cooked rice. Breastfeeding. however. b. increasing the amount of teaspoons and number of feeding until the full recommended amounts is consumed.

Spermicidals 4. MECHANICAL METHODS 1. Depo – Provera 3. Implant II. Vasectomy 2. Tubal Ligation *MC ( MATERNAL CARE ) *BF ( BREAST FEEDING ) . SURGICAL METHODS 1. Cervical Cap / Diaphragm III. Male and Female Condom 2. Intrauterine Device 3.2.

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

malaria and varicella *Leading non CD are heart problem.913 LIFE EXPECTANCY FEMALE .Bacterial 2.874. Basic Health Indicators 2 Indicators to assess a national health situation A.147 BOTH SEXES . *Pneumonia.42. PTB and diarrheal diseases consistently remain the 10 leading causes of deaths. Diseases of the Heart 8. Hypertension 6. TB Respiratory 7. Pneumonia . Influenza -.236.70 yrs. HPN. Chickenpox 10. -HEALTH INDICES I. Measles **Leading Causes of Mortality** 10 Leading Causes of Mortality 1. Pneumonia -. Disease of the Heart 2. TB. Disease Patterns Context of CHN: Health Situation **Leading Causes of Morbidity** 10 Leading Causes of Morbidity 1.85. Malignant neoplasm 4. pneumonia. Old MALE . 64 yrs. Nutrition B. Old LEADING CAUSES OF MORBIDITY *Most of the top ten leading causes of morbidity are communicable disease *These include the diarrhea. Bronchitis 4. Diseases of the Vascular System 3. 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. Diarrhea 3. influenza.362. Malaria 9.42. bronchitis.Respiratory 5. MALE .766 FEMALE .

Septicemia 10. Nephrotic Syndrome III. Maternal Mortality Rate MMR= # of maternal deaths x 1000 RLB Leading Causes Of Maternal Deaths: 1. delivery & puerperium 2.TB – all forms 7. Accidents 6. Congenital Pneumonia 7. Postpartum hemorrhage 4. Disorders r/t short gestation & LBW 9. COPD 8. Nephritis. 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. HPN complicating pregnancy. Pregnancy with abortive outcome 5. Other perinatal conditions 2. childbirth & puerperium 3. Diarrhea & Gastroenteritis of presumed infectious origin 5. Hemorrhage related to pregnancy . Other congenital malformations 8. Measles *Increase IMR = decrease MCHS *Poor maternal child’s service B. Normal delivery and other complications r/t pregnancy occurring in the course of labor. Bacterial Sepsis of Newborn 4. Diabetes Mellitus 10. Conditions originating in perinatal period 9. Other Indicators A. Pneumonia 3.5.

*Life expectancy at birth—life span either: age specific or sex specific
*Median Age- 20.1 years
*The Philippines is an agricultural country- 55%

C. Life Expectancy at Birth
D. Median Age
E. Crude Rates
1. Crude Birth Rate
2. Crude Death Rate

-Health Care Delivery System – the totality of all policies, equipment, products,
human resources and services whichaddress the health needs, problems and
concerns of the people. It is large, complex, multi – level and multi – disciplinary.

Categories:
According to Increasing According to the Type of Service
Complexity of the Services
Provided
Type Service Type Service
Primary Health Promotion, Health Information
Preventive Care, Promotion Dissemination
Continuing Care for and illness
common health prevention
problems, attention
to psychological and
social care, referrals
Secondar Surgery, Medical Diagnosis Screening
y services by and
specialists Treatment
Tertiary Advanced, Rehabilitation PT/OT
specialized,
diagnostic,
therapeutic and
rehabilitative care
- 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).
-A global leader for attaining better health outcomes, competitive and responsive
health care system, and equitable health financing(NEW VISION by 2030).

MISSION:

-In partnership with the people, provide equity, quality and access to health care
especially the marginalized.(OLD)
-To guarantee equitable, sustainable and quality health for all Filipinos, especially
the poor, and to lead the quest for excellence in health.(NEW)

5 Major Functions:
1. 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. Ensure a minimum level of implementation nationwide of services regarded as
public health goods
4. Plan and establish arrangements for the public health systems to achieve
economies of scale – Phil Health.
5. 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.A. 7160 Local Govt Code – Local health board- Governor
● Municipal health officer- mayor
● Assistant - municipal
● Provincial health officer

Health Promotion- no threats, no risk- approach behavior

Health Prevention- identified health problem- avoidance behavior

-Private Sector
-Composed of both commercial and business organization, non –
business organizations

Commercial/Business Non-commercial
Profit-oriented Orientation to social development, relief
and rehabilitation, 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, Human Rights Advocates
Research and Documentation
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 - RHU Act
*RA 1891 - Strengthen Health Services
*PD 568 - Restructuring HCDS
*RA 7160 - LGU Code

NATIONAL HEALTH PLAN
*National Health Plan is a long-term directional plan for health; the blueprint
defining the country’s health – PROBLEMS, POLICY, STRATEGIES, THRUSTS

GOAL:
*To improve health indicators through access.
*To enable the Filipino population to achieve a level of health which will allow
Filipino to lead socially and economically – productive life, with longer life
expectancy, low infant mortality, low maternal mortality and less disability through
measures that will guarantee access of everyone to essential health care.

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, dynamic and
highly efficient, 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, projects, activities of the
DOH for the year 1993, which marks the beginning
of its journey towards DOG vision.

“ Health for more in ‘94”
● Activities in 1994 focused on Cancer prevention,
reproductive health, mental health, and
maintenance of a safe env’t.

“ Health Focus in 1995” – “ Think Health, 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,
community action & networking.

“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.

C. Vital Statistics
VITAL STATISTICS
Statistics – refers to a systematic approach of obtaining, organizing and analyzing
numerical facts so that conclusion may be drawn from them.
Vital Statistics – refers to the systematic study of vital events such as births,
illnesses, marriages, divorce, separation and deaths.
Statistics of disease (morbidity) and death (mortality) indicate the state of
health of a community and the success or failure of health work.
Health Indicators – a list of information which would determine the health of a
particular community like population. Crude birth rate, crude death rate, infant and
maternal death rates, neonatal death rates and tuberculosis death rate
Health Indicators
 Birth
 Death
 Marriages
 Migration

it is evedent that the person experiencing the event (Numerator) nust come from the total population exposed to the risk of same event (Denominator). These quantities need not necessarily represent the same entities. Specified Rate . Crude Death Rate – a measure of one mortality from all causes which may result in a decrease of population. monitoring and evaluating community health nursing programs and services. Crude or General Rates – referred to the total living population.the relationship is for a specific population class or group. 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. . It must be presumed that the total population was exposed to the risk of the occurrence of the event. Infant Mortality Rate – measure the risk of dying during 1st year of like. implementing. within a given area and during a specified unit of time. although the unit of measure must be the same for both numerator and denominator of the ratio.Use of Vital Statistics: *Indices of the health and illness status of a community *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. 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. It limits the occurrence of the event to the portion of the population definitely exposed to it. Crude Birth Rate – a measure of one characteristic of the natural growth or increase of a population.

It serves as an index of the effects of prenatal care and obstetrical management of the newborn. irrespective of duration of pregnancy. To understand the forces of mortality. Fetal Death Rate – measures pregnancy wastage. Death of the product of conception occurs prior to its complete expulsion. Incidence Rate – measures the frequency of occurrence of the phenomenon during a given period of time. of deaths from all causes in all ages taken together. adjustment for the differences in age. childbirth. and puerperium. sex. poor environmental sanitation or deficient health service delivery c. Specific rates render more comparable and thus reveal the problem of public health. Neonatal Death Rate – measures the risk of dying the 1st month of life. a. Proportionate Mortality (Death Ratios) . This can only be detremined following a survey of the population concerned. age (or group of age) etc. malnutrition. Specific Death Rate – describes more accurately the risk of exposure of certain classes of groups to particular diseases. and any other factors which influence vital events have to be made. the rates should be made specific provided the data are available for both the population and the event in their specifications. It is an index of the obstetrical care needed and received by women in a community. and the total no. May be artificially lowered by improving the registration of births Maternal Mortality Rate – measures the risk of dying from causes related to pregnancy. SENSITIVE INDEX of level of health in a community b. deals with the total (new and old) number of cases. . Prevalence Rate – measures the proportion of the population which exhibits a particular disease at a particular time.shows the numerical relationship between deaths from all causes (or group of causes). Adjusted or Standardized Rate – to render the rates of 2 communities comparable. HIGH IMR means LOW LEVELS of health standards secondary to poor maternal and child health care.

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. 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. GUIDELINES IN THE CLASSIFICATION OF DATA 1. INTERPRETATION OF VITAL STATISTICS Sources of Data  Vital Registration Records a. Classification of Disease and Causes of Death a. Area diagram (Pie Charts) – shows the relative importance of parts of the whole. NOT by place of residence 2. *By applying specific rates of standard population to corresponding classes or groups of the local population. 3753 requires the registration of all births and death – c/o National Census and Statistics Office b. Reckoning of Age – age is recorded as of Last Birthday 3. valleys and seasonal trends. Reckoning of Vital Events – all vital events are registered and reported by place of occurrence. Accuracy of the count of event or population concerned . Also used to show the trends of birth and death rates over a period of time.Methods: *By applying observed specific rates to some standard population. 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. For comparison of data. Presentation of Data The following are most commonly used graphs in presenting data: Line or Curved graphs – shows peaks. Definition/ Classification of the event in either numerator or denominator for consistency b. Civil Registry Law or Republic Act No.

Host and Environment. and environment. -**Study of occurrences and distribution of diseases as well as the distribution and determinants of health state or events in a specified population. Epidemiology EPIDEMIOLOGY- -**The study of distribution of disease or physiologic conditions such as deformities or disabilities and even death among human populations. Identify syndromes by describing the distribution and association of clinical phenomena in the population. epidemiology is used to: 1. defects and the chances of avoiding them. behavior. Search for causes of health and disease by comparing the experience of groups that are clearly defined by their composition. Uses of Epidemiology: According to Morris. Magnitude / Nature of the rate D. to set health problems in perspective and to define their relative importance and to identify groups needing special attention. Diagnose the health of the community and the condition of people to measure the distribution and dimension of illness in terms of incidence. 5. inheritance. And the factors affecting such distribution. Complete the clinical picture of chronic disease and describe their natural history. . 6. This emphasizes that epidemiologist are concerned not only with deaths. and the application of this study to the control of health problems. prevalence. Epidemiological triangle: Agent. 4. Study the history of the health population and the rise and fall of diseases and changes in their character. illness and disability. Study the work of health services with a view of improving them. Estimate the risk of disease. 3. disability and mortality. 7. c. accident. Operational research shows how community expectations can result in the actual provisions of service. Use of correct numerator d. 2. Aim: To identify factors of causation as basis for determining preventive and control measures. but also with more positive health states and with the means to improve health. -**Epidemiology is the backbone of the prevention of diseases. experience.

3. 2. Consider Two Factors: 1. *Chemical Agents *Physical Agenta *Infectious Agnets Host Factor (intrinsic factors) – influence exposure. picks up most cases and avoids FALSE NEGATIVES. Preventive strategies: 1. A change in any of the component will alter an existing equilibrium to increase or decrease the frequency of the disease.Agents of Disease: *Nutritive elements in excess or in deficiencies. Manipulate the environment and prevent production or presence of disease agents. *Genetics *Age *Sex *Ethnic group *Physiologic functioning *Immunologic experience *Inter – current to pre – existing disease *Human behavior Environmental factors (extrinsic factors) – influence existence of the agent. exposure or susceptibility to agents. VERIFICATION OF DIAGNOSIS -Stating one’s definition of a disease / diagnosis based on the presenting signs and symptoms.Change the people’s behavior to manipulate the environment and reduce their exposure to biological and non – biological disease agents. A. environment and agent. DESCRIPTIVE PHASE . *Physical environment *Biologic environment *Socio – economic environment The Epidemiologic Triangle consists of three component – host. organization. The model implies that each must be analyzed and understood for comprehensions and prediction of patterns of a disease. Increase man’s resistance or imunity to disase agents. . and analysisof data regarding the occurrence of disease other health conditions. susceptibility or response to agents.Deals with the collection. Sensitivity – indicates the strength of association between a sign / symptom and the disease.

Person – intrinsic characteristics such as age. or yearly basis. Outline of Plan for Epidemiological Investigation: 1. . Endemic – habitual presence of disease in a given geographic location accounting for the low number of both immunes and susceptible. Place – extrinsic factors. 3. Herd Immunity – state of resistance of a population group to a particular disease at a given time. expressed on a daily. b. Establish time and space relationship of the disease. monthly. C. 2. Factors Affecting the Community’s Reaction to Disease Agent Invasion a. genetic endowment and other factors such as occupation. B. Specificity – shows the uniqueness of the association between a sign / symptoms and the disease. income are analyzed to identify susceptible groups in a certain locality. Susceptibility Status – determined by the number of individuals with little or no immunity. Pandemic – global occurence of a disease. DESCRIPTION OF THE DISEASE / CONDITION *Factors affecting distribution: 1.2. Time – temporal patterns. 2. place of residence. 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. Establish fact of presence of epidemic. Indirect – when a factor and disease are associated only because both are related to some common underlying condition. excludes non cases or avoids FALSE POSITIVES. sex. weekly. *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. level of immunity of the group. ANALYSIS OF DISEASE PATTERN -one tries to find out if there is a statistical relationship between a disease and biological or social factors. Spurious – due to chance or bias caused by certain procedures / aspects involved in study. b. Sporadic – disease occurs every now and then affecting only a small number of people relative to the total population.

4. regardless of their usual place of residence. Population compposition or structure b. derived from two Greek word snyos. Refine hypotheses and execute additional studies 9. -Focus on three common and observable human events: a. Population Composition – pertains to all measurable characteristics of the people who make up a given population. Sex Ratio . Define and Identify cases 5. Demography DEMOGRAPHY -The emprical. Registration system Two ways of Assigning People 1. Census – complete enumeration of the population. De Facto – people are assigned to the place where they are physically present at the time of the census. Developing hypotheses 7. b. Implement control and prevention measures 10. a. Relations to characteristic of the group of community. De Jure – people are assigned to places where they usually live regardless of where they are at the time of the census.Prepare for field work 2. Perform descriptive epidemiology 6. Correlation of all data obtained. which means people and ypagly which means to draw or write.Establish existence of an outbreak 3. Sample Surveys c. Follow –up Recommendations E. statistical and mathematical study of human population. Steps in Outbreak Investigation: 1. Population size -Sources of Demographic Data a. Distribution of population in space c. Evaluate hypotheses 8. Communicate findings 11.3. 2. COMPONENTS 1. Verify diagnosis 4.

provincial. 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. Rate of Natural Increase – difference between CBR and CDR of a specific population within a specified time. district. regional and national events. 3. c. Population Density – determines congestion of the place. Age – dependency Ratio – used as an index of age – induced economic drain of human resources c. Life Expectancy at Birth – average number of years an infant is expected to live under the mortality conditions for a given year. 2007) Objectives: . . b. Population Distribution a. Management of Resources and Environment and Records Management A. Field Health Services and Information System ( FHSIS ) FIELD HEALTH SERVICES AND INFORMATION SYSTEM (Cuevas. Population Size a. 2. Median Age – age below which 50% of the population fall and above which 50% of the population fall. b. Urban – Rural Distribution – shows the proportion of people living in urban compared to the rural areas. III.To provide summary of data on health services delivery and selected program accomplished indicators at the barangay municipality / city.b. Age and Sex Composition – graphical presentation of the age and sex composition of a population through the use of a POPULATION PYRAMID d. ca be used for program monitoring and evaluation purposes. -To provide data which when combined with data from other sources. e. Crowding Index – indicates the ease by which a communicable disease can be transmitted from one host to another susceptible host.

.  First is to plan and carry out patient care and service delivery. .  The fourt purpose of the Target Client Lists is to provided a clinic – level data base which can be accessed for further studies.Basis for planning. form or pieces of paper upon which the presenting symptoms or complaints of the patient on consultation and the diagnosis. -To ensure that the data reported to the FHSIS are useful and accurate and are disseminated in a timely and easy – to – use fashion.Source of data to detect unusual occurrence of a disease. Importance of FHSIS .Needed to monitor health status of the community. treatment and date of treatment if recorded.  This is the document. logistics and decision making at all levels.Documentation of RHM / PHN day to day activities.  The Third purpose is to report services delivered.  The second purpose of Target Client Lists is to facilitate the monitoring and supervision of service delivery activities. 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. Target Client List for Prenatal Care 2. -To minimize the recording and reporting burden at the service delivery level in order to allow more time for patient care and promotive activities. budgeting. 2007) / INDIVIDUAL RECORD (Famorca. Target Client List for Post-Partum Care .-To provide a standardized. TARGET CLIENT LISTS TO BE MAINTAINED IN THE FHSIS 1. facility level data base which can be assessed for a more in – depth study /studies.Basis for monitoring and evaluatinghealth program implementation. *CLIENT LIST  Second “building block” of the FHSIS and are intended to serve several purposes. . 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. Components: *FAMILY TREATMENT RECORD (Cuevas. . .Helps midwives in following up clients. .Helps local government determine public health priorities.

e.12 column table = 12 months of calendar year .To provide clinic – level data base.monthly summary of morbidity / monthly trends of disease .Diagnosis (if available) .. Target Client List for Sick Children 6. and in some instances. FHSIS Manual of Operations has the following RECORDING TOOLS: 1. e.To carry / plan out care for patient. 2013) . . TCL for postpartum care. 3. TCL for prenatal care.Source document for the Quarterly form and the Output Table of the RHU or Health Center. .To report services delivered.g.Based on the Summary Table. Target Client List for Family Planning 5. . . (Famorca. 2. Home address of patient ..Presenting symptoms or complaint of the patient on consultation. SUMMARY TABLE . 4.  One report is prepared weekly several annually. TARGET CLIENT LIST (TCL) . every few minutes as relevant events occur. maternal and neonatal deaths.Accomplished by the Nurse .Accomplished by Midwife .Treatment and Date of treatment.serves as a source for the 10 leading causes of morbidity.Date. .3. Target Client List of Under 1 Year Old Children 4. National Leprosy Control Program Form 2-Central Registration Form *TALLY / REPORTING FORMS  Submitted monthly or quarterly (majority).g. NTP TB Register 7.Facilitate monitoring / supervision of service delivery activities. MONTHLY CONSOLIDATION TABLE . INDIVIDUAL TREATMENT RECORD (ITR) .

2.Natality and Mortality for the entire year.3 – months total indicators: Maternal Care. b. Annual Form 1 (A-1) . Family Planning. A – BHS *Report by the Midwife – Demographic . Morbidity Report (Q2) .Prepared by the Nurse . MONTHLY FORMS .Environmental .Maternal Care . Environmental.Summary Table Data are copied into this report.These are summary data that are transmitted or submitted on a monthly.Prepared by the Nurse . Morbidity Report (M2) . Child Care.If there are 2 RHU / Centers for the Municipal Health Officer / Mayor. 1.Yearly Report for morbidity by age / sex . (Famorca.Natality Data b.Family Planning . Program Report (M1) . The source of data for this components is dependent on the records.3 – months consolidation of Morbidity Report (M2) 3. 2013) b.Submitted to the Nurse a.Quartely Forms are submitted to the provincial health officr / Office. Program Report (Q1) . .Prepared by the Midwife .Disease Control . Dental Health and Disease Control.Demographic. program report.Prepared by the Nurse .Contains list of all cases of disease by age and sex. quarterly and on annual basis to higher level. c.Only one quarterly form for every Municipality / City . a. QUARTERLY FORMS . Annual Form 2 (A-2) .FHSIS Manual of Operations REPORTING FORMS: . ANNUAL FORMS a.Child Care .Report of the RHU / Health Center .

Environmental Sanitation IV. Annual Form 3 (A-3) . d. Beliefs and Practices of Individuals. Ethico-Moral-Legal Responsibility A. FLOW OF REPORT OFFIC PERSO RECORDING FORMS FREQUENCY SCHEDULE OF E N 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. Families.Yearly Report of all deaths (mortality) by age and sex. Target-setting C.Prepared by the Nurse . Socio-cultural Values. Groups and Communities .

Local Government Code E. when ready to begin school. VI. but most . Importance. Part II: MCN VII. the majority of children sit before they creep. Health Education. Tools B. Personal and Professional Development A. Self-assessment of CHN Competencies. An example of how the rate of growth changes is a comparison between that of the first year and later in life. would weigh 1. 6 in. Code of Ethics for Government Workers C.600 Ib. creep before they stand. Development also proceeds in a predictable order. And be 12 ft. Enhancing Competence in Community Health Nursing and Related Areas. 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. If this tremendous growth rate were to continue. Tall. WHO. LGU Policies on Health D. For example. Issues V. 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. DOH. An infants triples birthweights and increases height by 50% during the first year of life. sequence – from smaller to larger. a child grows new cells and learns new skills at all times. and Communication. Strategies and Methods of Updating One’s Self. the 5 –ye-old child. Methods.B. Growth and development proceed in an Growth in height occurs in only one orderly sequence. Collaboration and Teamwork A. stand before they walk. Safe and Quality Care. and walk before they run.

chest. cephalocaudal development.. is a flailing motin. Different children pass through the All stages of development have a range predictable stages at different rates.” Development proceeds from head to tail. Any movement. All body systems do not develop at the Certain body tissues mature more same rate. one child begins walking at 9 months while another at 14 months. children follow a predictable sequence of growth and development. Both are developing normally. and by 1 year. Two children may pass through the motor sequence at different rates. except to put a thumb in the mouth. of time rather than a certain point at which they are usually accomplished... Caudal means “tail. he or she can control the legs enough to crawl.. Development is cephalocaudal. the child can stand upright and perhaps walk. Development proceeds from proximal to This principle is closely related to distal body part. For example. whereas genital tissues grows little until puberty. by 5 months. A newborn can lift only his or her head off the bed when he or she lies in a prone position.. the infant has enough control to turn over . They are both following the predictable sequence. he or she can lift his or her head. Cephalo is a Greek word meaning “head”. It can be illustrated by tracing the progress of upper extremity development.ittle use of the arms or hands. Motor development has proceeded in a cephalocaudal order – from the head to the lower extremities. rapidly than others. the infant can lift his or her head and chest off the bed. For example. by 4 months. by 9 months. A newborn makes . . and part of the abdomen. By age 2 months. they are merely developing at different rates. neurologic tissue experiences its peak growth during the first year of life.

and index fingers. grasp reflex has faded nor stand steadily until the walking reflex has faded. say. Neonatal reflexes are replaced by purposeful movements. The child has passed the time of optimal learning fo that particular skill. A child who is not given the opportunity to learn developmental tasks at the appropriate or “targert” times for such tasks may have . the infant has enough arm control to support the upper body weight on the forearms.old colors best with a large crayon. age 2 years old. A child cannot learn to sit. A child who is confined to a body cast at 12 months.ore difficulty than the usual child learning the tasks later on. which is the time he or she would normally learn to walk. 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. one. Because the child is able to control distal body parts such as fingers. There is an optimum time for initiation of A child cannot learn a task until his or experiences or learning. a 12 yr-old can write with a fine pen). A great deal of skill and behavior is An infants practices taking a first step . and the infant can coordinate the hand to sccop up objects. Development proceeds from gross to This principle parallels the proceeding refined skills. the infant can coordinate the arm... until the nervous system has matured enough to allow back control. thumb. for example. no matter how much thechild’s parentshave him or her practice.. Neonatal reflexes must be lost before An infant cannot grasp with skill until the development can proceed. her nervous system is mature enogh to allow that particular learning. may take a long time to learn this skill once free of the cast at. By 10 months. he or she is able to perform fine motor skills ( a 3-year. By age 3 or 4 months.

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
versus role confusion. feelings about events
Adolescent learns who he important to him or her.
or she is and what kind of Offer support and praise
person he or she will be for decision making.
by adjusting to a new
body image, seeking
emancipation from
parents, choosing a
vocation, and determining
a value system.

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.Behavior is
entirely reflexive.
Primary circular reaction 1 – 4 months Hand – mouth and ear –
eye coordination develop.
Infant spends much time
looking at objects and

separating self from them.
Beginning intention of
behavior is present ( the
infant brings thumb to
mouth for a purpose: to
suck it ). An enjoyable
activity for the period: a
rattle or a tape of parent’s
voice.
Secondary circular 4 – 8 months Infant learns to initiate,
reaction recognize, and
repeatpleasurable
experiences from
environment. Memory
traces are present; infants
anticipates familiar events
( a parent coming near
him will pick him up ).
Good toy for this period:
mirror; good game: peek –
a – boo.
Coordination of 8 – 12 months Infant can plan activities to
secondary reaction attain specific goals; can
perceive that others can
cause activity and that
activities of own body are
separate from activity of
objects; can search for
and retrieve toy that
disappears from view; and
can recognize shapes and
sizes of familiar objects.
Because of increased
sense of separateness,
infant experiences
separation anxiety when
primary caregiver leaves.
Good toy for this period:
nesting toys ( e.g., colored
boxes ).
Tertiary circular reaction 12 – 18 months Child is able to experiment
Invention of new means 18 – 24 months
through mental

Families related to MCN. Safety 3. Standards of Maternal and Child Nursing Practice IX. Belief. DOH. Immunization 7. Ethico-Moral-Legal Responsibility A. Delivery and Postpartum E. Research and Quality Improvement A. LGU Policies on Health of Women and Children . Discipline 5. Nursing Care of High-risk Newborn 1. Prematurity 2. APGAR Scoring 2. Language Development 4. Anticipatory guidance 8. Nursing Care of Women with Complications of Pregnancy. Labor.combination Pre – operational thought 2 – 7 years Concrete operational 7 – 12 years thought Formal operational 12 years thought B. Play 6. Maintenance of Body Processes (oxygenation. Nursing Care of Women with Disturbances in Reproduction and Gynecology VIII. Delivery and Postpartum Period (High-risk conditions) G. temperature) F. Infant Morbidity and Mortality C. WHO. Nursing Care of Women during Normal Labor. Nursing Care in the Different stages of Growth and Development including 1. Maternal Mortality D. Human Sexuality and Reproduction including Family Planning D. B. Nutrition 2. and Practices of Individuals. Newborn Scoring 3. Congenital defects 3. Nursing Care of the Newborn 1. Fertility Statistics B. Socio-Cultural Values. Infections H. Values formation C.

Self-assessment of MCN Competencies. . Issues related to MCN X. Child and Youth Welfare Code E. Methods. 1999 -Emphasizes the highly subjective nature of pain. Enhancing Competence in MCN and Related Areas. concepts. -Pain is the most common reason client seek medical advice. Personal and Professional Development A. and Quality Improvement. -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. Management of Environment & Resources. principles and processes in the care of clients with altred health patterns. existing whenever the experiencing person says it does” – McCaffery and Pasero. Importance. A. Tools B. Health Education.the fifth vital sign – American Pain Society 2003. Safe & Quality Care.C. IV and V) NURSING BOARD EXAM SCOPE/COVERAGE NURSING PRACTICE III. V TEST DESCRIPTION: Theories. Nursing Board Exam/Nursing Licensure Exam Coverage (Nursing Practice III. utilizing the nursing process and integrating the key areas of nursing competencies.an unpleasant sensory and emotional experience associated with actual or potential . Strategies and Methods of Updating One’s self. Client in Pain CLIENT IN PAIN Pain. IV. Family Code D. TEST SCOPE: I. -Pain is protective mechanism or a warning to prevent further injury. -“Whatever the person says it is. TEST III 1.

Disturbances in Cellular functioning 2.THE PATHOPHYSIOLOGY OF PAIN Basic Categories of Pain: 1. intermittent pain which usually persists even after healing of the injured tissue 3. Sensory Disorders c. TEST V 1. Alterations in Human Functioning a Disturbance in Oxygenation b Disturbance in Metabolic and Endocrine Functioning c Disturbance in Elimination B. Chronic Pain (Non-Malignant). These are the free nerve endings in the skin that respond to intense.sudden pain which is usually relieved in seconds or after a few weeks. Peripheral Nervous System 3.May be acute or chronic. Cancer-Related Pain. Disturbances in Fluids and Electrolytes b. may or may not be relieved by medications. Musculo-skeletal Disorders d. potentially damaging stimuli. Client Biologic Crisis 3. Acute Pain. Emergency and Disaster Nursing C. Inflammatory and Infectious Disturbances c. Nociceptors are called pain receptors. Descending Control System 2. 2. Degenerative Disorders . 2. Disturbances in Immunologic functioning d.constant. Disturbances in Perception and Coordination a. Pain Transmission: 1. Central Nervous System 4. Alterations in Human Functioning a. Peri-operative Care 3. Neurologic Disorders b. TEST IV 1.

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