Professional Documents
Culture Documents
CHN Notes
CHN Notes
HEALTH
NURSING
Community
- a group of people with common characteristics
or interest living together within a territory or
geographical boundary.
Classifications of Communities:
1.URBAN
- increased in population; industrial-type of work
2. RURAL
- decreased in population; agricultural-type of work
3. RURBAN
- combination of rural and urban
4. SUBURBAN
- periphery around the urban areas
5. METROPOLITAN
- expanding urban areas
4 Aspects of Community:
1.Social
- communication and interaction of the people.
2. Cultural
- norms, values and beliefs of the people.
3. Political
- governance and leadership of the people.
4. Geographical
- boundaries of the community.
Components of a Community:
A. PEOPLE
B. 8 SUBSYSTEMS
1. Housing
2. Education
3. Fire and Safety
4. Politics and Environment
5. Health
6. Communication
7. Economics
8. Recreation
Health
- is the state of complete physical, mental and
social well-being and not merely the absence of
disease or infirmity. (World Health Organization)
Determinants of health
- factors or things that make people healthy or not.
1. Income and social status
2. Education
3. Physical environment
4. Employment and working conditions
5. Social support network
6. Culture
7. Genetics
8. Personal behavior and coping skills
9. Health services
10. Gender
New concept in determinants of health
- OLOF (Optimum Level Of Functioning)
Factors that affects OLOF:
- Ecosystem
Composition of Ecosystem:
1. Political – power, authority, empowerment, safety
2. Behavior – lifestyle related such as diet, exercise
3. Heredity – genes, familial history
4. Environment – air, water, garbage, food, noise
5. Socio-Economic – education, employment, housing
6. Health Care Delivery System – availability, accessibility
and affordability of services and facilities
Nursing
- an art and science of rendering care to
individual, families and community.
PHILOSOPHY OF CHN:
- CHN is based on the worth and dignity of man.
- (Margaret Shetland)
EMPHASIS/FOCUS:
- Health promotion and Disease prevention.
Important Concepts of CHN:
1. The primary focus of CHN is on health promotion.
2. Recognized needs of individuals, families and
communities provide the basis for CHN.
3. The family is the unit of service.
4. Contact with the client may continue over a long period
of time which include all ages and all types of health care.
5. CH nurses are generalists in terms of their practice
throughout life’s continuum –its full range of health
problems and needs.
6. CHN practice is extended to benefit not only the
individual but the whole family and community
Roles and Functions of CH Nurse:
1. Advocate
- defends the rights of the client for self-determination
- intercedes, supports, pleads or acts as guardian of the
client’s rights to autonomy and free choice for self-care
2. Supervisor
- provides administrative support
- oversees, monitors and evaluates the function of the
subordinates
3. Counselor
- encourages client to verbalize and express feelings and
concerns
- key task is active listening
4. Educator
- teaches the client to provide skills, knowledge and
attitude
- primary task is to assess readiness to learn
5. Trainer
- provides technical support
- identifies training needs, formulates training program
designs
- arranges and conducts training to provide learning
experiences to subordinates and clients
Levels of Clientele:
1. Individual
- “point entry”
2. Family
- center of delivery of care.
3. Group
- point of specific care.
4. Community
- point of entire care
PLACES IN CHN:
Public Health
- the science and art of preventing disease, prolonging
life and promoting life and efficiency. (C. E. Winslow)
- is the art of applying science in the context of politics to
reduce inequalities while ensuring the best health for the
greatest number. (WHO)
B. School Health Nursing
> Home Visitation – effective implementation of total school
program
> RA 124 – it mandates the school to provide clinics for the
minor treatment and attendance to emergency cases
> Assessment:
1. Arms 5. Ears
2. Eyes and Visual Acuity 6. Neck and Chest
3. Nose 7. Hair
4. Mouth and Teeth 8. Lower extremities
> Feeding Program
- Should run for 120 days
- Deworming with consent
C. Occupational Health Nursing
> RA 1054
– Occupational Health Act
Rationale :
- Helps render effective nursing care to clients.
Principles:
1. Minimize if not totally prevent the spread of infection.
2. Save time and effort.
*** Open bag TWICE during home visit.
Special Consideration:
B
- bag and its contents must be free from any
contamination.
A
- always perform handwashing.
G
- gather necessary equipments to render effective
nursing care.
Steps in Performing The Bag Technique Actions:
1. Upon arrival, place the bag on the table lined with a clean
paper. (the clean side must be out and folded part, touching
the table)
2. Ask for a basin of water.
3. Open the bag and take out the towel and soap.
4. Wash hands.
5. Take out the apron and put it on with the right side.
6. Put out all the necessary articles needed for the specific
care.
7. Close the bag and put it in one corner of the working area.
8. Perform nursing care and treatment.
9. After giving the treatment, clean all things that were used
and perform handwashing.
10. Open the bag and return all things that were used in their
proper place
11. Remove apron, folding it away fro the person, the soiled
side in and the clean side out. Place it in the bag.
12. Fold the lining, place it inside the bag. Close the bag.
13. Take the record and have a talk with the mother.
14. Make an appointment for the next visit.
II. CLINIC VISIT
Advantage:
- it is inexpensive in time and usually in cost both for the
service and for the family.
Standard Procedure in Conducting Clinic Visit:
I. Registration/Admission
1. Greet the client and establish rapport
2. Prepare records
3. Elicit client’s chief complaint and clinical history
4. Perform PE
II. Waiting Time
* Implement the “first come”, “first served” except for
emergency and urgent cases
III. Triaging
* Manage program-based cases
* Refer all non-program based cases
IV. Clinical Evaluation
* Validate clinical history and PE
* Inform client of the nature of the illness, treatment,
prevention and control measures
V. Laboratory and other diagnostic examinations
* Identify a designated referral laboratory when needed
VI. Referral System
1. Refer if needs further management (BHS to RHU, RHU
to RHU, RHU to Hospital)
2. Accompany patient if it is an emergency referral
VII. Prescription/ Dispensing
* 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
Phases:
1. Pre-consultation
a. establish relationship
b. assessment on chief complaint, VS, PE
2. Consultation
A. Medical Consultation
B. Nursing Intervention
3. Post-consultation
a. explaining intervention to be done at home
b. follow-up care
c. referral (if possible)
PRIMARY HEALTH CARE
- is an essential health care made universally
accessible to individuals and families in the community by
means acceptable to them.
*** in Sept. 6-12, 1978 : UNICEF and WHO held the First
International Conference on Primary Health Care in Alma
Ata, USSR
Legal Basis:
LOI 949 : was signed by Pres Marcos on Oct 19, 1979
making Primary Health Care the thrust of the
Department of Health.
Vision :
Health for All Filipinos
Goal :
Health for All Filipinos and Health in the Hands of the
people by the Year 2020
Mission :
In partnership with the people, provide equity, access
and quality health care especially to the marginalized
Principles:
1. 4 A’s; Accessibility, Availability, Affordability and
Acceptability of health services
2. Community Participation
- is the heart and soul of PHC
3. People are the center, object and subject of development
4. Self – reliance
5. Partnership between the community and the health
agencies in provision of quality life
6. Recognition of interrelationship between the health and
development
7. Social mobilization
8. Decentralization
RA 7160 :
The Local government Code of 1991 which
resulted in devolution, which transferred the
power and authority from the national to the
local government units, aimed to build their
capabilities for self-government and develop
them fully as self-reliant communities.
Legal Basis:
RA 8423 – Traditional and Alternative Medicine Act
** S A N T A L U B B Y **
S - Sambong
* anti-edema, diuretic, anti-urolithiasis
A - Ampalaya
* DM
N - Niyog-niyogan
* anti-helmintic
T- Tsaang Gubat
* diarrhea, stomachache, mouth wash
A - Akapulko (Bayabas-bayabasan)
* anti-fungal
L - Lagundi
* asthma, cough, fever, dysentery, skin diseases
U - Ulasimang Bato (Pansit-pansitan)
* lowers uric acid
B - Bawang
* lowers cholesterol levels, hypertension, toothache
B - Bayabas
* washing of wounds, diarrhea, gargle for toothache
Y - Yerba Buena
* pain, rheumatism, arthritis, headache, cough and
colds, swollen gums, toothache, menstrual and gas
pain, nausea, fainting, insects bites and pruritus
Reminders on the Use of Herbal Medicine
1. Avoid the use of insecticides.
2. Use a clay pot and remove cover while boiling at low
heat.
3. Use only the part of the plant being advocated.
4. Follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each sickness.
6. Stop giving in case with untoward reaction.
7. If signs and symptoms are not relieved after 2 or 3
doses, consult a doctor.
DOH
(Department of Health)
Vision:
- A leader, staunch advocate and model in promoting
health for all in the Philippines.
Mission:
- Guarantee equitable, sustainable and quality health for
all Filipinos, especially the poor and shall lead the quest for
excellence in health.
3 Roles and Functions of DOH:
- Executive Order 102
1. Leadership in health
- serves as an advocate in the adoption of health
policies, plans and programs to address national and sectoral
concerns.
2. Administrator of Specific Service
- administer health emergency responsive services
including referral and networking system.
3. Enabler and Capacity Builder
- innovates new strategies in health to improve the
effectiveness of health programs.
Overriding Goal of DOH:
- Health Sector Reform Agenda (HSRA)
Framework for its Implementation:
- FOURmula One for Health --- *Arroyo
- Universal HealthCare (Kalusugan Pangkalahatan)
---*Aquino ( Executive Order 36)
Goals:
1. Financial Protection
2. Better Health Outcomes
3. Responsiveness
Values:
1. Equitable and inclusive to all
2. Transparent and accountable
3. Uses resources efficiently
4. Provides high quality services
Strategies:
1. Advance quality, health promotion and primary care.
2. Cover all Filipinos against health-related financial risk.
3. Harness the power of strategic HRH development.
4. Invest in eHealth and data for decision-making.
5. Enforce standards, accountability and transparency.
6. Value all clients and patients, especially the poor, marginalized
and vulnerable.
7. Elicit multi-sectoral and multi-stakeholder support for health.
8 MILLENIUM DEVELOPMENT GOALS
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
Goal:
- To achieve “Better Quality Life among Filipinos”
1. Female Sterilization
- safe and simple surgical procedure which provides
permanent contraception for women who do not want more
children. Also known as BTL that involves cutting or blocking the
two fallopian tubes.
- performed during first 2 weeks of her menstrual cycle or
within the first 3 days after delivery.
2. Male Sterilization
- permanent method wherein the vas deferens (passage of
sperm) is tied and cut or block through a small opening on the
scrotal skin. It is also known as Vasectomy.
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3. Pill
- contains hormones estrogen and progesteron taken daily to
prevent contraceptions. Advised for women who are anemic
because of the reduced menstrual flow.
- taken some time everyday preferably at night.
Common side effects:
- dizziness, headache, nausea, spotting, weight gain, breast
fullness.
Adverse effects: Contraindications:
1. Abdominal pain 1. pregnancy or suspected
2. Chest pain 2. history of diabetes
3. Headache 3. high blood pressure
4. Eyes blurred 4. weak heart
5. Severe leg pain 5. CA of the breast
6. over 50 years old
Important facts to remember about a Pill
1. Pill are advised for women who are anemic because of the
reduced menstrual flow
2. Take pill same time everyday
3. A packet of pills contain 28 tablets; 21 pills are “active pills”, 7
contain no hormones, only iron
4. Follow the direction of the arrows of the pill. When empty, start a
new pack on the next day without missing a day
5. For 1 missed pill: take the pill as soon as possible; take regular pill
at night
6. For 2 missed pill: take 2 pills next day, then take 2 pills the next
day again
7. For 3 missed pill: discard and substitute method, start on next
pack on next menstrual period.
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4. Male Condom
- thin sheath of latex rubber made to fit on a man’s erect
penis to prevent the passage of sperm cell and sexually
transmitted disease organism into the vagina.
- the shelf life is 3 years in the Phils., if stored in a cool dry
place.
5. Injectables
- contain synthetic hormones, progestin which suppresses
ovulation, thickens cervical mucus, making it difficult for sperm to
pass through and changes uterine lining.
6. Basal Body Temperature
- used to measure changes of temperature during ovulation.
Temp. slightly decreases before ovulation and increases during
ovulation day. It must be measured on the same time of the day,
before rising, with the same thermometer.
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7. Lactating Amenorhea Method or LAM
- temporary introductory postpartum method of postponing
pregnancy based on physiological infertility experienced by Breast
Feeding women.
Criteria:
1. Amenorrhea
2. Fully or nearly fully breastfeeding
3. Infant is less than 6 months
8. Mucus/Billings/Ovulation
- abstaining from sexual intercourse during fertile (wet) days
prevent s pregnancy.
9. Abstinence
- best way to prevent pregnancy and STI’s
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10. Sympto-Thermal Method
- method in identifying the fertile and infertile days of the
menstrual cycle as determined through a combination of
observations made on the cervical mucus, basal body temp
recording and other sign of ovulation.
11. IUD
- changes the nature of internal secretions of woman’s body.,
disturbs transport and decreases number of viable sperms
Contraindications:
1. PID
2. Septic Abortion
3. Endometritis
4. Anemia
5. Suspected pregnancy
t
Adverse effects:
1. Period that is late
2. Abdominal pain
3. Increase in temperature
4. Noticeable discharge – foul smelling
5. Severe bleeding
> an outpatient procedure; examined 1 month after insertion,
then after 6 months then after 1 year.
12. Standard Days Method
- A new method of natural family planning in which all users
with menstrual cycles between 26 and 32 days are counseled to
abstain from sexual intercourse on days 8-19 to avoid pregnancy.
-The couples use color coded cycle beads to mark the fertile
and infertile days of the menstrual cycle.
NUTRITION PROGRAMS
Goal:
- To improve the quality life of Filipinos through better
nutrition, increased productivity and improved health.
U – unexplained anemia
S – sudden unexplained weight loss
Specific Guidelines for Early Detection of Common Cancers
1. Breast Cancer
A. BSE - cheapest and most affordable
- done 1 week after menstrual period while
taking a shower
B. Mammography
- if a mass detected and confirmed
2. Cervical Cancer
A. Pap Smear
- primary screening tool for women over age
18
3. Colon Rectal Cancer
A. Annual digital rectal exam starting at age 40
B. Annual stool blood test starting at age 50
C. Annual inspection of colon
4. Prostate Cancer
A. Digital rectal exam
B. PSA (prostate Specific Antigen) – confirms
diagnosis
5. Lung Cancer
A. Chest X-ray
B. Sputum Cytology
LEVELS OF PREVENTION:
Primary Prevention:
- elimination of conditions causing cancer
Secondary Prevention:
- Definitive Treatment and Management
(a.) Chemotherapy, (b.) Radiation, (c. )Surgery
Tertiary Prevention:
- Supportive or Palliative Care
a. Physical
b. Psychological, Social, Spiritual
National Voluntary Blood Services Program
- promotes voluntary blood donation to provide
sufficient supply of safe blood and to regulate blood
banks.
Legal basis:
RA 7719 “Blood Services Act of 1994”
Criteria for Eligible donor:
B = BP 90/60 – 160/100mmHg
A = 16 – 65 years old
W = 45 – 50 kgs minimum
A = At least 12.5 hemoglobin
S = Status in good condition
Main Objectives:
1. to promote and encourage voluntary blood donation
by the citizenry and to instill public consciousness of the
principle that blood donation is a humanitarian act
Mission:
- Ensure that TB DOTS services are available, accessible and
affordable to the communities.
Treatment:
- Quality of SDF (Single Dose Formulation) & FDC (Fixed
Dose Combination)
Case Finding:
1. DSSM ( Direct Sputum Smear Microscopy)
- 3X collection
1st specimen – SPOT specimen collected on the day of
consultation
2nd specimen – early morning specimen on the next day
3rd specimen – SPOT specimen collected on the 2nd day
after submission of early morning specimen
2. Chest X-ray
- to identify the extent of the disease
HRZE
HR
Category II: Previously treated patient
with relapses or failure
Treatment partner:
-watching the TB patient take medicines everyday
during the whole course of treatment.
a. Staff of the Health Care facilities
b. LGU officials
c. Family members of the patient
5 ELEMENTS OF DOTS:
1. Political will
2. Sputum microscopy service
3. Regular drug supply
4. Record of patient’s progress
5. Supervision of drug intake
Leprosy Control Program
Leprosy
- known as Hansen’s Disease
- cause: Mycobacterium leprae
- MOT: prolonged intimate skin to skin contact;
droplet infection
Diagnostic procedure:
= Slit Skin Smear
Preventive Measures:
- BCG immunization
- Health education on the MOT
DOMICILLARY TREATMENT:
(Republic Act 4073)
PAUCIBACILLARY : 6-9 months
A. Intermediate type
- flat, with not well defined patches, with slight to no
sensory loss and pale in color.
B. Tuberculoid type
- flat, with some raised patches, definite sensory loss
and rough to touch.
Treatment:
Day 1: Rifampicin and Dapsone
Succeeding days (2-28 days): Dapsone
MULTIBACILLARY: : 24-30 months
A. Borderline type
- many raised patches at different sizes and shapes,
usually enlarged nerves and occasionally with
deformities.
B. Lepromatous type
- thickened skin and earlobes and with hair loss in
eyebrows.
Treatment:
Day 1: Rifampicin, Dapsone, Clofaximine or Lamprene
Day 2-28: Dapsone, Clofaximine or Lamprene
THE MATERNAL and CHILD HEALTH PROGRAM
Overall Goal:
- To improve the survival, health and well being of
mothers and unborn through a package of services for the
pre pregnancy, prenatal, natal and post natal stages.
Benefits of BF to Infants:
1. Increases immune system resistance
2. Provides complete nutrition
3. Increases IQ points
Benefits of BF to mothers:
1. Prevent unplanned pregnancy
2. Prevent post partum bleeding
3. Prevent occurrence of cancer
New Breastfeeding Act….
REPUBLIC ACT 10028
Storage Full-term Pre-term
Room Temperature 8-10 hours 4 hours
Refrigerator 48 hours 24 hours
Freezer 3 months 3 months
Pregnant mothers:
- 5 Tetanus Toxoid
- RA 1066 (tetanus elimination)
3 Principles of EPI:
1. Based on epidemiological situation
2. Main focus: eligible population
3. Immunization is a basic health service
Elements of EPI:
Target setting:
calculation of eligible population
Formula: EP = total population x constant percentage
Constant percentage:
Infants = 3% or .03
School Entrants = 3% or .03
Pregnant Mothers = 3.5% or .035
Cold Chain System
- to maintain potency of the vaccine
Refrigerator:
Freezer:
(-15° to -25 °C) – OPV, Measles
Body:
(2° to 8°C) - DPT, Hepa B, BCG, TT
HEALTH CENTER
* Health centers using cold box or transport boxes
- 5 days
* Check temperature 2x a day: first and last hour of the
clinic
Vaccine Age Doses Interval ROUTE Dosage
1. Diptheria
2. Pertussis or whooping cough
3. Tetanus
4. Hepatitis – B
5. Hemaphilus influenza type B
- to prevent pneumonia and meningitis to
babies
- injected intramuscularly
- given at age 6 weeks up to 11 months
CONTENT OF VACCINES:
BCG:
- live attenuated bacteria
OPV and MEASLES:
- live attenuated virus
DIPTHERIA & TT:
- weakened bacterial toxins
PERTUSSIS:
- killed bacteria
HEPA B:
- derived from plasma (plasma derivatives)
RNA recombinants
PRINCIPLES OF VACCINATION…
Open OPV vials can be used for the next immunization if:
a. Expiry date has not passed
b. Vaccines stored at 0°C to 8°C
c. Not taken out at the health center for outreach
activities
ENVIRONMENTAL HEALTH AND SANITATION
- the study of all factors in man’s physical environment, which
may exercise a deleterious effect on his well-being and survival.
FACTORS:
1. water sanitation 7. steam pollution
2. food sanitation 8. air pollution
3. refuse and garbage disposal 9. noise
4. excreta disposal 10. radiological protection
5. housing 11. institutional sanitation
6. insect vector and rodent control
Legal basis:
PD 856, 1978
Different Laws relating to Environmental Sanitation:
1. Garbage Disposal Law
- PD 825
2. Ecological Solid Waste Management Act
- RA 9003
3. Clean Air Act
- RA 8749
4. Clean Water Act
- RA 9275
5. Toxic Substances and Hazardous and Nuclear Waste Control Act
- RA 6969
WATER SUPPLY SANITATION PROGRAM
Approved type of water supply facilities:
LEVEL I
(Point Source)
- a protected well or a developed spring with an outlet but
without a distribution system.
- serves 15 to 25 households
- outreach must not be more than 250 meters from the
farthest user
LEVEL II
(Communal Faucet System or Stand-Posts)
- a system composed of a source, a reservoir, a piped
distribution network and communal faucets.
- with one faucet per 4-6 households
- located at not more than 25 meters from the farthest
house
LEVEL III
(Waterworks System or Individual House Connections)
- a system with a source, a reservoir, a piped distributor
network and household taps.
- generally suited for densely populated urban areas
- requires minimum treatment or disinfection
PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM
Approved types of toilet facilities:
LEVEL I
Non-water carriage toilet facility – no water is necessary to
wash the waste into the receiving space.
Ex. Pit latrines, Reed odorless earth closet
Toilet facility requiring small amount of water to wash the waste
into the receiving space.
Ex. Pour flush toilet, Aqua privies
LEVEL II
on site toilet facilities of the carriage type with water-sealed and
flushed type with septic tank/vault disposal facilities
LEVEL III
- water carriage types of toilet facilities connected to septic
and/or to sewerage system to treatment plant
FOOD SANITATION PROGRAM
3. Right cooking
- cook food thoroughly and ensure that temperature on all parts
of the food should reach 70 degrees centigrade
- eat cooked food immediately
- wash hands thoroughly before and after
4. Right storage
- cooked foods should not left at room temperature for NOT more
than 2 hours
- store foods carefully: 4 -5 hours
hot conditions : at least or above 60 degrees centigrade
cold conditions: below or equal to 10 degrees centigrade
- do not overburden the refrigerator
- reheat stored food before eating
--at least 70 degrees centigrade
Legal Mandate:
1. PD 1566 (1978)
- creation of the National Disaster Coordinating Council
- creation of the Multi-level Organization
- funding for a 2% reserve for calamities
2. RA 7160
- transfer of responsibilities from the national to local
government units giving more power, authority and
resources
- allocation of 5% calamity fund for emergency operations
Terms:
1. Disaster
- is a serious disruption of the functioning of a society,
causing wide spread human, material or environmental
losses
2. Emergency
- as any occurrence, which requires an immediate response
3. Hazards
- any phenomenon, which has the potential to cause
disruption or damage to humans and their environment
4. Risk
- the level of loss or damage that can be predicted from a
particular hazard affecting particular place at a particular
time from the point of view of the community.
2 components:
A. Susceptibility
- the factors which allows a hazard to cause an emergency
B. Vulnerability
- the factors which allows a hazard to cause a disaster
Classification of disaster
A. According to its Cause
1. Natural disaster – force of nature
2. Human generated/Manmade –
transportation/technological disasters
B. According to Onset
1. Acute or sudden impact events
2. Slow or chronic genesis (Creeping disaster)
Contributing factors to Disaster:
1. human vulnerability resulting from poverty and social
inequality
2. environmental degradation resulting from poor land use
3. rapid population growth especially among the poor
General Principles of Disaster Management:
1. The first priority is the protection of people who are at risk.
2. The second priority is the protection of critical resources and
systems on which communities depend.
3. Disasters management must be an integral function of national
development plans and objectives.
4. Disaster management relies upon an understanding of hazard
risks.
5. Capabilities must be developed prior to the impact on a hazard.
6. Disaster management must be based upon interdisciplinary
collaboration.
7. Disaster management will only be as effective as the extent to
which commitment, knowledge and capabilities ca be applied.
The Disaster Spectrum Cycle
1. Disaster Impact
2. Relief
3. Rehabilitation
4. Prevention
5. Mitigation
6. Readiness
More Specific within Preparedness includes:
1. vulnerability assessment and dissemination of information
related to particular hazards and emergencies.
2. emergency planning
3. training and education
4. warning system
5. specialized communication system
6. resources and information databases and management
systems and resource stocks
7. emergency exercises/drills
Principles of Emergency Preparedness:
1. It is the responsibility of all.
2. Should be woven into the community and administrative levels of
both government and government organizations.
3. It is an important aspect of emergency management.
4. It is connected to other aspects of emergency management.
5. Should concentrate on process and people rather than
documentation.
6. Should not be done in isolation.
7. Should not concentrate only on disasters but integrate prevention
and response strategies for any scale of emergency.
8. Hospital plays a very vital role in the management of disaster.
9. The main objective is to decrease mortality, morbidity and to
prevent disaster.
10. Every hospital should have a regular updated disaster plan.
PURPOSE OF THE DISASTER PLAN:
1. To provide policy for effective response to both internal and
external disaster situations that can create impact to the
operation of the hospital and may affect hospital staff, patients,
visitors and the community.
2. Identify hospital capability to handle mass casualty.
3. Identify responsibilities of individuals and departments in the
event of a disaster situation.
4. Identify standard operating guidelines for emergency activities
and responses.
VITAL STATISTICS
- refers to the systematic study of vital events such as births,
illnesses, marriages, divorce, separation and deaths.
5 Components:
1. demographic, social and economic profile
2. health risk profile
3. health/wellness outcome profile
4. survey of current health promotion programs
5. studies conducted in certain target groups
Steps:
1. Define the community.
2. Collect data.
3. Assess community capacity.
4. Assess community barriers.
5. Assess readiness for change.
6. Synthesis data and set priorities
Stage 2. Design and Initiation
1. Young Infant
– up to less than 1 week up to 2 months
(1 week up to 1 month and 29 days)
2. Young Child
– 2 months up to 5 years
(2 months up to 4 years and 11 months)
Principles in IMCI:
1. All sick children must be examined for
GENERAL DANGER SIGNS:
C
> convulsions (fits, jerky movement, spasm)
U
> unable to drink or breastfeed (not eat)
V
> vomiting
A
> abnormally sleepy (difficult to awaken)
2. Assess for MAIN SYMPTOMS:
For Older children For Young infants:
a. Cough/DOB a. Local bacterial infection
b. Diarrhea b. Diarrhea
c. Fever c. Jaundice
d. Ear problems
Identify Treatment
Follow - up
If YES
If NO
Then ASK about the next main symptoms: diarrhoea, fever, ear problems. CHECK for malnutrition and anaemia,
immunization status and for other problems
Classify Cough
SEVERE
Any general danger sign or PNEUMONIA
Lower chest indrawing or OR
Stridor in calm child VERY SEVERE
DISEASE
Safe remedies:
- Instruct
- Follow –up care NO PNEUMONIA:
COUGH OR COLD
after 5 days
1. Give 3 days antibiotic.
1st line of drugs:
Amoxicillin 2 times daily for 3 days
2nd line of drugs:
Cotrimoxazole 2times daily for 3 days
2. Soothe the throat & relieve the cough using safe
remedies: PNEUMONIA
- B, T, L, C
Breastmilk, Tamarind, Luya, Calamansi)
•Never give cough syrup, antitussive, decongestant,
mucolytics.
3. Instruct the mother when too return the baby
immediately.
4. Follow up after 2 days.
Pre-referral Treatment:
1. Give 1st dose antibiotic
SEVERE
2. Give Vitamin A PNEUMONIA
- 2 months to 12 months: OR
100,000 IU (blue) VERY SEVERE
-12 months to 5 y/o : DISEASE
200,000 IU (red)
If NO
CLASSIFY the child's illness using the color-coded classification tables for
diarrhea.
Then ASK about the next main symptoms: fever, ear problem, and CHECK for malnutrition and
anaemia, immunization status and for other problems.
Classify Diarrhea
SIGNS CLASSIFY AS
Two of the following signs:
Lethargic or unconscious
Sunken eyes
Not able to drink or drinking poorly SEVERE DEHYDRATION
Skin pinch goes back very slowly
SIGNS CLASSIFY AS
Dehydration present SEVERE PERSISTENT DIARRHEA
PINK
PLAN C
YELLOW
PLAN B
Green
PLAN A
Yellow
1. Give Vit. A
2. Advise mother recommended feeding
3. Follow-up after 5 days
→ if still breastfeeding:
= breastfeed day and night
→ if taking milk supplements:
= replace milk supplements with increased breastfeeding
= replace half of the milk & nutrient rich, semi-solid foods
* Do not use condensed or evaporated milk
= because it is high in CASEINE
SEVERE PERSISTENT DIARRHEA
Pink
1. Give Vitamin A
2. Give IVF = Plan C
Pink Yellow
IF YES:
If No Decide the Malaria Risk: Yes or No
THEN ASK: LOOK AND FEEL:
If the child has measles now or within the last 3 months: Look for mouth ulcers.
Are they deep and extensive?
Look for pus draining from the eye.
Look for clouding of the cornea.
Decide Dengue Risk: Yes or No
Ask: Look and Feel:
o Has the child had any bleeding from the nose or gums, or •Look for bleeding from the nose or gums?
in the vomitus or stool? •Look for skin petechiae
o Has the child had black vomitus? •Feel for cold and clammy?
o Has the child evacuated black stool? •Check for slow capillary refill.
o Has the child had persistent abdominal pain? •If none of the above ask , look and feel signs are
o Has the child been persistent vomiting? present and the child is 6 months and older and fever
has been present for more than 3 days, perform
tourniquet test.
CLASSIFY the child's illness using the colour-coded classification tables for fever.
Then ASK about the next main symptom: ear problem, and CHECK for malnutrition and anaemia, immunization status
and for other problems.
Malaria Risk
Signs Classification
Signs Classification
Any general danger signs Very Severe Febrile Disease/Malaria
Stiff neck
Blood Smear (+)
If Blood smear is not done; Malaria
No runny nose, and
No measles, and
No other cause of fever
Blood Smear (-) or
Runny nose, or Fever: Malaria Unlikely
Measles, or
Other cause of fever
No Malaria Risk
Signs Classification
Signs Classification
Any general danger sign Very Severe Febrile Disease
Stiff Neck
Pre-referral Treatment:
1. Give first dose antibiotic
2. IM Quinine
Very Severe Febrile
3. Give paracetamol Disease/Malaria
4. Treat lowering of blood sugar
5. REFER!
No Malaria Risk Treatment
Pre-referral Treatment:
Pre-referral treatment:
Severe Dengue
1. Rapid fluid replacement Hemorrhagic Fever
2. Paracetamol for fever of 38.5 ˚C without
ASA
3. Treat child to prevent lowering of blood
sugar
4. REFER!
1. Give Paracetamol for fever of 38.5 ˚C w/o
ASA
2. Advise to bring if signs of severe dengue Fever: Dengue
Hemorrhagic Fever
fever occurs Unlikely
3. Follow up after 2 days
Ear Problem
For ALL sick children ask the mother about the child’s problem, check for general danger signs, ask about cough or
difficult breathing, diarrhoea, fever and then
ASK: DOES THE CHILD HAVE AN EAR PROBLEM?
If No If Yes
CLASSIFY the child's illness using the color-coded classification table for
ear problem.
Then CHECK for malnutrition and anemia, immunization status and for other problems.
Classify Ear Problem
SIGNS CLASSIFICATION
Tender swelling behind the ear. MASTOIDITIS
If Yes
If No Check for Malnutrition
Not very low weight for age and no other signs NOT VERY LOW WEIGHT
or malnutrition.
Classify Anemia
Severe palmar pallor SEVERE ANEMIA
For ALL sick children ask the mother about the child’s problem, check for general danger signs,
ask about cough or difficult breathing, diarrhoea, fever, ear problem, and then check for
malnutrition and anaemia and
CHECK IMMUNIZATION STATUS.
AGE VACCINES
IMMUNIZATION Birth BCG Hep B 1
SCHEDULE: 6 weeks DPT-1 OPV-1 Hep B 2
10 weeks DPT-2 OPV-2
14 weeks DPT-3 OPV-3 Hep B 3
9 months Measles
DECIDE if the child needs an immunization today, or if the mother should be told to
come back with the child at a later date for an immunization.
Note: Remember there are no contraindications to immunization of a sick child if the
child is well enough to go home.
CLASSIFY the infant's illness using the colour-coded classification table for possible
bacterial infection.
Then ASK about diarrhoea. CHECK for feeding problem or low weight, immunization status
and for other problems.
Classify Sick Young Infant
Signs Classification
Pre-referral treatment:
1. Give first dose antibiotic:
Gentamycin - (IM) Right
Vastus lateralis VERY SEVERE
Benzyl penicillin: Left DISEASE
Vastus lateralis
2. Keep warm
3. Treat child to prevent hypoglycemia
4. Refer.
1.Give 3 days antibiotics P.O.
2.Apply gentian violet on affected area LOCAL BACTERIAL
(FULL STRENGHT) INFECTION
3.Follw-up after 2 days.
SEVERE DISEASE OR
LOCAL BACTERIAL
DISEASE UNLIKELY
Assess Jaundice
Look:
Look for jaundice (yellow eyes and skin)
Look at young infant’s palms. Are they yellow
Classify Jaundice
Signs Classification
Any jaundice if age less than 24 hours or
Yellow palms and soles at any age SEVERE JAUNDICE
No Jaundice NO JAUNCICE
Check for Low Weight Infants for Age in Breastfed Infants
ASK: Look, Listen and Feel
Is the infant breastfed? If yes,
How many times in 24 hours? •Determine the weight
Does the infant usually receive for age
any •Look for white ulcers
other foods or drinks? or white patches in the
If yes, how often? mouth
What do you use to feed the
infant?
ASSESS BREASTFEEDING:
Has the infant breastfed in the If the infant has not fed in the previous hour, ask the mother to put her infant to
previous hour? the breast. Observe the breastfeed for 4 minutes.
(If the infant was fed during the last hour, ask the mother if she can wait and tell
you when the infant is willing to feed again.)
Is the infant able to attach?
no attachment at all not well attached good attachment
TO CHECK ATTACHMENT, LOOK FOR:
Chin touching breast
Mouth wide open
Lower lip turned outward
More areola visible above then below the mouth
(All these signs should be present if the attachment is good.)
Is the infant suckling effectively (that is, slow deep sucks, sometimes
pausing)?
no suckling at all not suckling effectively suckling effectively
Clear a blocked nose if it interferes with breastfeeding.
Look for ulcers or white patches in the mouth (thrush).
Classify the Feeding Problem
Signs Classification
At birth up to 6 months
> exclusively breastfeed
> 8 times or more than 8 times within 24 hours.
SIGNS OF HUNGER:
1. Beginning to fuss.
2. Sucking fingers and fist
3. Sucking movements with their lips.
>6 months up to 12 months:
breastfeeding + 3 times a day complementary food.
If not on breastfeeding:
5 times a day complementary food.