Professional Documents
Culture Documents
What is a community?
§ a group of people with common
characteristics or interests living together
within a territory or geographical
boundary
§ place where people under usual
conditions are found
What is health?
§ Health-illness continuum
§ High-level wellness
§ Agent-host-environment
§ Health belief
§ Evolutionary-based
§ Health promotion
§ WHO definition
§ What is community health?
§ part of paramedical and medical intervention/
approach which is concerned on the health of
the whole population
§ aims:
1. health promotion
2. disease prevention
3. management of factors affecting health
§ What is nursing?
- assisting sick individuals to become healthy
and healthy individuals achieve optimum
wellness
Public Health Nursing: the term used before for
Community Health Nursing
Clinician, who is a health care provider, taking care of the sick people
at home or in the RHU
Health Educator, who aims towards health promotion and illness
prevention through dissemination of correct information; educating
people
Facilitator, who establishes multi-sectoral linkages by referral system
Supervisor, who monitors and supervises the performance of
midwives
TARGET POPULATION (IFC) ARE:
1. I ndividual
2. F amily
3. C ommunity
3 Elements considered in CHN:
3 Elements of Communication:
Message
Sender
Receiver
PUBLIC HEALTH WORKERS (PHW)
PHW’s: are members of the health team who are
professionals namely
§ Medical Officer (MO)-Physician
§ Public Health Nurse (PHN)-Registered Nurse
§ Rural Health Midwife (RHM)-Registered Midwife-
§ Dentist
§ Nutritionist
§ Medical Technologist
§ Pharmacist
§ Rural Sanitary Inspector (RSI)-must be a sanitary engineer
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
5. Maintain a medium of regulations and standards to protect
consumers and guide providers
BASIC HEALTH SERVICES UNDER OPHS OF DOH
E ducation regarding Health
L ocal Endemic Diseases
E xpanded Program on Immunization
M aternal & Child Health Services
E ssential drugs and Herbal plants
N utritional Health Services (PD 491): Creation of Nutrition Council of the Phils.
T reatment of Communicable & Non communicable Diseases
S anitation of the environment (PD 856): Sanitary Code of the Philippines
To guarantee EQUITABLE,
SUSTAINABLE and QUALITY
health for all Filipinos,
especially the poor and to
lead the quest for
excellence in health
Principles to attain the vision of DOH
Acceptable
Accessible
Affordable
Available
Sustainable
Attainable
UTILIZES APPROPRIATE TECHNOLOGIES USED
BY PHC: ACCEFS
Co-Trimoxazole:
§ it’s a combination of 2 generics of drugs which is antibacterial
Trimethoprim(TMP)
§ Has a bacteriostatic action that stops/inhibits multiplication
of bacteria
§ For GUT, GIT & URTI (TMP combined with SMX)
Sulfamethoxazole (SMX)
§ Has bactericidal action that kills bacteria
§ For GUT, GIT, URTI & Skin Infections
8 COMMONLY AVAILABLE GENERICS (CARIPPON)
Amoxicillin/Ampicillin
§ An antibacterial drug that comes from the Penicillin
family
§ Effect is generally bacteriostatic (when source of
infection is bacterial)
§ These 2 drugs provide the least sensitivity reaction
(rashes & GI) and the adverse effect of other antibiotics
is anaphylactic shock
8 COMMONLY AVAILABLE GENERICS (CARIPPON)
TB DRUGS:
Rifampicin (RIF)
Isoniazid (INH)
Pyrazinamide (PZA)
8 COMMONLY AVAILABLE GENERICS (CARIPPON)
Paracetamol
Has an analgesic & anti-pyretic effect
Oresol:
a management for diarrhea to prevent dehydration
under the Control of Diarrheal Diseases (CDD)
Program
8 COMMONLY AVAILABLE GENERICS (CARIPPON)
Nifedipine:
§ An anti-hypertensive drug
§ According to DOH, 16% of population
belonging to 25 years old & above in the
community are hypertensive
C. HERBAL PLANTS
Know indications
Know parts of plants with therapeutic value: roots,
fruits, leaves
Know official procedure/preparation
Procedures/Preparations:
Decoction
Ø Gather leaves & wash thoroughly, place in a
container the washed leaves & add water
Ø Let it boil without cover to vaporize/steam to
release toxic substance & undesirable taste
Ø Use extracts for washing
PROCEDURES/PREPARATIONS:
Poultice
Ø Done by pounding or chewing leaves used by
herbolaryo
Ø Example: Akapulko leaves-when pounded, it releases
extracts coming out from the leaves contains enzyme
(serves as anti-inflammatory) then apply on affected
skin or spewed it over skin
Ø For treatment of skin diseases
PROCEDURES/PREPARATIONS:
Infusion
The report of nurse at the RHU/MHC are the Annual Form 1 which is the report
on vital statistics: demographic, environmental, natality and mortality.
Annual Form 2 is the report that lists all diseases and their occurrence in the
municipality/city. The report is broken down by age and sex.
Annual Form 3 is the report of all deaths occurred in the municipality/city. The
report is also broken down by age and sex.
FLOW OF REPORT
OFFICE PERSON RECORDING FORMS FREQUENCY SCHEDULE OF
TOOLS SUBMISION
BHS Midwife - ITR Monthly Form Monthly Every 2nd week of the
- TCL (M1 & M2) succeeding month
- ST
A-BHS Form Annually Every 2nd week of
January
Statistical Approaches:
1. Central Tendencies: 3 M’s
Mean=average
Median=range (Highest – Lowest Score)
Mode=frequency of occurrence of a variable, used if
there’s too many variable occur
2. Standard Deviation: used if there are too many
variables available to be treated which is seldom
used in CHN
SD=√ ∑ (x-x) ∑=summation of
n-1 x=variables available
x=mean (given special attention)
n=# of existing variables
3. Percentile (%) Method:
most commonly used in CHN by adding all cores
then multiply by 100
Presentation of Data
Sales
Series
1. Table/Chart Categ 1 1st Qtr
Categ
Series
2. Graph: Categ
2
2nd Qtr
Categ
Pie Series
0 20 3 6
Bar-2 variables only 4 Series
2 1
Line 0
Series
Catego
Catego
Catego
Catego
2
Polygon-connecting the results
Histograph-2 or more variables & appear adjacent to
each other
TYPOLOGY OF NURSING PROBLEMS
1. Preparatory
2. Organizing
3. Mobilizing
4. Educating
5. Collaborating
6. Phase Out
1. PREPARATORY PHASE
A. Area of Selection
§ It should be DOPE Community: Depressed,
Oppressed, Poor & Exploited, a new criteria for
community organization
§ “Old Criteria”→ it must be a virgin
community=meaning no agency has gone there.
§ This is a dangerous situation that’s why RA 7305:
Magna Carta for Public Workers was provided-a PHN
is to receive a hazard pay of 20-25% of monthly
salary
1. PREPARATORY PHASE
C. Integration/Immersion
§ Immersion is imbibing the life situation/
condition of the community by living, eating &
sleeping with the family to be able to
understand their situation
§ It requires 2 Qualities of PHN:
§ Empathy
§ Sympathy (Integration)
1. PREPARATORY PHASE
Health Resource(s):
5 M’s-Manpower/Man, money, machinery, material & methods
(+) available facilities-Hospital/Clinic, mode of transportation,
market, school & movie houses for recreation
PRIORITIZATION OF COMMUNITY PROBLEMS
NATURE
Health Status (HS) 3
Health Resource(s) 2
Health Related 1
Mobilization
- let the members of the community do the work.
PHN should only SUPERVISE
4. HEALTH EDUCATION
6. PHASE OUT
EPIDEMIOLOGY
is the pattern of occurrences & distribution of diseases, defects &
deaths
2 Population in Distribution
Patterns Susceptible Immune
(at risk to develop, acquire (those that did not
or experience the disease) experience the disease,
usually individuals develop
resistance against the
disease)
Epidemic 80% (more than 50%) 20%
Endemic 50% 50%
Sporadic 20% 80%
Pandemic ----- -----
EPIDEMIC
§ Greater than 50% of populations are susceptible or less immune
individual
§ Greater % of the population is affected by the occurring disease
§ Assessment
§ Nursing Care
§ Treatment
§ Health Education
§ Referral (if care fails)
PRIORITIES (IN THE CARE): TO PREVENT CROSS
CONTAMINATION
1. Newborn
2. Post partum
3. Pregnant mothers
4. Morbid cases
The families need the assistance of the health center that’s why
home visit was done to the family
The person who makes the home visit is rendering services on
behalf of the health center
PHASES OF HOME VISIT:
1. Planning
ü Starts at the health center
ü Makes a study on the status of the family
ü Statement of the problem
ü Formation of objective
2. Socialization –first activity is to establish rapport
& to gain the trust of the family
PHASES OF HOME VISIT:
3. Activity
ü Intervention/Professional Phase
ü Opportunity to provide or extend health services
ü Standard Role of the Nurse: Independent, Dependent and
Interdependent
ü To be effective, come in complete uniform (also bring a long
umbrella with pointed end which serve as protection)
4. Summarization - ability to put into record & report
(orally) about the outcome of the activity
PUBLIC HEALTH BAG:
§ Cleaning
ü The inner part of the bag should be clean & sterile
ü Should be done every after home visit
ü Never endorse the bag
GUIDING PRINCIPLES IN THE USE OF PUBLIC
HEALTH BAG:
§ Contamination
§ The less one opens the bag, the lesser
chance of contamination
§ In general, the bag is open 3x:
ü Putting out materials for hand washing
ü Putting out materials used for nursing
care
ü Returning all what have been used
GUIDING PRINCIPLES IN THE USE OF PUBLIC
HEALTH BAG:
C ase Finding
H ealth Education
E nvironmental Sanitation
S nail Eradication
CASE FINDING:
6 Aspects or Thing to Know
§ Disease: Schistosomiasis
§ Other name: Bilhariasis or Snail Fever
§ Causative agent: Schistosoma-a blood fluke (parasite)
3 Types of Species:
ü Schistosoma japonicum-endemic in the Philippines &
affecting Indonesia, China, Japan, Korea Vector: Oncomelania
quadrasi
ü Schistosoma mansoni
ü Schistosoma haematobium
§ Laboratory Procedures to rule out Schistosomiasis:
Blood Examination: ↑ eosinophil level indicates parasitism
Fecalysis: Kato Katz (plain stool exam that uses a special
apparatus resembling a feeding bottle sterilizer)
Procedure:
ü Collect specimen
ü Have the test tube undergo centrifugation for 20
minutes
ü Get specimen from precipitate & swab it on glass slide
ü Observe it on microscope
§ Signs & Symptoms
A. Safe Pregnancy
ü Right age to be pregnant=20-35 years old,
not less than 20 & not more than 35
ü Right interval of pregnancy=once in 2 or 3
years
ü Home Base Mother’s Record (HBMR): the
record used for care of mothers in CHN
Laboratory Examinations:
Benedict’s Test: test for sugar in the urine; test for diabetes
§ Heat test tube with 5 cc of Benedict’s Solution (blue) in the
burner then add 3-5 gtts of urine (amber yellow) then heat again.
Observe for the change in color:
Blue : (-) sugar in urine
Green : trace of sugar in urine +1 +
Yellow : traces of sugar in urine +2 ++
Orange : more traces of sugar in urine +3 +++
Brick Red : surely diabetic +4 ++++
Laboratory Examinations:
Acetic Acid Test: test for albumin in urine; test for
Pregnancy Induced HPN
§ Collect urine in test tube, heat it in burner then add
3-5 gtts of acetic solution (clear white). Observe for
change in color:
If it remains clear: (-) CHON or albumin in urine
If it turns cloudy: (+) CHON=proteinuria
POLICIES:
1. Non coercive (give freedom of choice)
2. Integration of Family Planning in all Curricular Program:
§ LOI 47 DECS states that Family Planning is to be integrated in all
school curricular programs, either baccalaureates or non-
baccalaureates, enrolled separately as one unit
3. Multi-Sectoral Approach: establish relationship with other
agencies which can either be:
§ Intrasectoral
§ Intersectoral-Local or International (WHO, Unicef, USAID,
Japhiego)
METHODOLOGIES:
Biological
A. Basal Body Temperature (BBT)
§ Get the temperature early morning before waking up
which should be monitored daily at the same time
§ There should be a sudden drop of temperature between
0.3-0.6°C followed by an increase of temperature by
0.3-0.6°C which means that the woman is fertile
B. Sympto-thermal
C. Cervical Mucus Test
Ø Billing’s Method by Dr. Billing
Ø Spinnbarkheit (came from a German word Spinner which means
to play with the cervical mucus with the finger) or Wet & Dry
Method:
§ Wet Cervical Mucus (Fertile): abundant, stretchy & transparent
§ Dry Cervical Mucus (Safe & Not fertile): whitish, pasty &
adhesive
D. Calendar (Rhythm)
§ Deleted already since 1998 because it’s not recommended for
irregular cycle of menstruation
§ Menstrual cycle should be regular; obtain 4-6 months cycle
E. Lactation Amenorrhea Method (LAM): RA 7600-Breastfeeding &
Rooming In Law
§ DOH organized Maternal & Child Family Health Institute (MCFHI)
with the following members:
ü All government hospitals
ü Private hospitals (volunteer)
§ Normal involution (uterus goes back to normal) of the uterus:
after 45 days or 5-6 weeks or 1 ½ months if not breastfeeding
§ Frozen breast milk is to be put out of the freezer 2 hours before
feeding ( Body of Ref: 2-3 days / Freezer: 3-4 months)
§ Left over milk should be discarded & should not be re-preserved
or re-frozen because it is already contaminated
METHODOLOGIES:
Temporary
A. Chemical
§ Oral Pills (Logentrol)-has low dose of estrogen & progesterone that
inhibits ovulation
§ Parenteral: Depot Medroxyprogesterone Acetate (DMPA)/Depo-
provera- inhibits ovulation making women amenorrheic;
1991, DMPA was found to be causing cancer of the cervix
1994, DMPA is given IM 4x a year every 3 months (90 days interval)
§ Implants: Norplant-it inhibits ovulation effective for 5 years
but seldom advocated for use because it is usually
expensive; the client buys the device (consists of 5
capsules) & have it implanted at the health center by
minor surgical incision in:
ü upper inner arm because it is nearest to the brain
ü external oblique
ü thigh
ü gluteal muscles
B. Mechanical:
§ IUD
ü Up to 10 years protection
§ Cervical cap & Diaphragm
ü Prevent the sperm to pass the cervix
ü Works better with spermicide
ü Wore 30 minutes before coitus and keep up to 6
hours after coitus
§ Condom
ü Most effective way to prevent STD’s / STI’s
METHODOLOGIES:
C. Behavioral
Ø Abstinence
Ø Withdrawal
D. Permanent
Ø Vasectomy (reversible)-since year 2000 in the
Philippines
Ø BLT
POLICIES:
I. Nutritional Surveillance (NS): to determine victims of
malnutrition
A. Anthropometric Measurement: study of measurements of
human dimensions
Ø Age for Weight-if weight is not appropriate with the age:
ü Stunting: growth retardation
ü Wasting: connotes malnutrition
Ø Age for Height-if height is not appropriate with the age:
Stunting
Ø Weight for Height
Rule Male Female
Every height of 5 110 lbs. 105 lbs.
ft.
Every increment + 6 +5
of an inch above
5 ft. ADD
Every decrement - 6 -5
of an inch below
5 ft. SUBTRACT
Ø Skin Folds Test-pinch the external oblique muscle (“bilbil”)
with your palm
Normal: 1 inch
Overweight: > 1 inch
Ø Middle Upper Arm Circumference (MUAC)-used in children
below 5 years old by measuring the middle upper arm with a
tape measure
Normal: 13 cms. & above
Malnutrition: <13 cms
POLICIES:
I. Nutritional Surveillance (NS): to determine victims of malnutrition
B. Biochemical Method
Ø Micronutrient Malnutrition -available in small amount in the body VADAG:
Vitamin A Deficiency:
§ Deficiency: Xeropthalmia-opacity of cornea leading to night blindnes
Infants (6-12 months) : Give 100,000 i.u.
Pre-schoolers (12-83 months) : 200,000 i.u.
Post partum : 200,000 i.u.
§ Kwashiorkor-protein deficiency
§ Marasmus-carbohydrate deficiency (energy
giving food)
Kwashiorkor Marasmus
Etiology Disease experienced by an elder Muscle wasting
child upon the birth of a new baby
ü Potable
ü Free from any particles that might
cause illness to an individual
Ways to make Water Potable:
Level I
Point Source
Level III
Waterworks system or individual house
connections
A system with a source, a reservoir, a piped
distributor network and household taps that is
suited for densely populated urban areas.
2. PROPER EXCRETA AND SEWAGE DISPOSAL
SYSTEM
3 TYPES OF APPROVED TOILET FACILITIES
Level 1
Non-water carriage toilet facility:
- Pit latrines
- Reed Odorless Earth Closet
- Bored-hole
- Compost
Toilets requiring small amount of water to wash waste into
receiving space
- Pour flush
- Aqua privies
Pit latrines
Ø most commonly observed in rural area
Ø has three components: the pit, a squatting plate and the
super-structure
Ø types of pit include
“Antipolo type”, a pit type of toilet provided with concrete floor
and an elevated seat with a cover
Ventilated Improved Pit or VIP, pit with a vent pipe
Reed Odourless Earth Closet or ROEC, a pit completely displaced
from the superstructure and connected to the squatting plate
by a curved chute.
Bored Hole Latrine
ü consists of relatively deep holes bored into the earth by
mechanical or manual earth-boring equipment
ü holes are about 10-18 inches in diameter and usually
15-35 feet deep. The hole is provided to facilitate
squatting. Two types of bored-hole latrines are:
Wet Type - when the hole penetrates ground water table or
other strata.
Dry Type - when he hole does not reach ground water table;
fills up at a faster rate then than the wet type.
3 TYPES OF APPROVED TOILET FACILITIES
Level 2
Level 3
Household
○ Burial
► Deposited in 1m x 1m deep pits covered with
soil, located 25 m. away from water supply
○ Open burning
o Animal feeding
o Composting
o Grinding and disposal sewer
WAYS OF DISPOSAL
Community
○ Sanitary landfill or controlled tipping
► Excavation of soil deposition of refuse and compacting
with a solid cover of 2 feet
○ Incineration
Ecological Solid Waste Management: RA 9003- the use of
incinerator approved in 2000 but was implemented in 2003
because of lack of funding to purchase
4. FOOD SANITATION PROGRAM
POLICIES:
ü Food establishment are subject to inspection
(approved of all food sources containers and
transport vehicles)
ü Comply with sanitary permit requirement
ü Comply with updated health certificates for food
handlers, helpers, cooks
ü All ambulant vendors must submit a health
certificate to determine present of intestinal parasite
and bacterial infection
3 POINTS OF CONTAMINATION