Care of the Individual in - Major advantages are the

fact that a family member

the Community Setting takes the initiative of
visiting the professional
health worker, usually
indicating the family
Introduction readiness to participate in
the health care process.
Man is a biopsychosocial being, hence public health
programs should address this different dimension of - Because the nurse has
man. In the current Health Care Delivery System, the greater control over the
DOH adopts key impact programs to cater to the environment, distractions
needs of the individuals as client. are lessened and the
family may feel less
confident to discuss
family health concerns.

* Haversian canal system: helps nourishes our  Group Conference – appropriate

bones. microscopic tubes or tunnels in cortical bone for developing cooperation,
that house nerve fibers and a few capillaries. This leadership, self-reliance and or
allows bone to get oxygen and nutrition without community awareness among group
being highly vascular. These canals also members.
communicate with bone cells using special - The opportunity to share
connections, or canaliculi. experiences and practical
solutions to common
health concerns is a
Fundamental unit of Care strength of this type of
family-nurse contact.
Fundamental working unit of our society = family

 Written Communication – used

* Primary health care - Refers to the essential care to give specific information to
that is made accessible acceptable, affordable, and families, such as instructions
sustainable. given to parents through school
children.

Home Visit
Family-Nurse Contacts
 Home visit is a professional, purposeful
 The family-nurse relationship is developed
interaction that takes place in the family’s
through family-nurse contacts, which may
residence aimed at promoting, maintaining
take the form of a clinic visit, group
and restoring the health of the family or its
conference, telephone contact, written
members.
communication, or home visit.
 Clinic Visit – takes place in a private
clinic, health center, barangay health
station. Happens inside a facility.

Advantages:
1) It allows first hand assessment
of the home situation.
2) The nurse is able to seek out
previously unidentified needs.
3) It gives the nurse an
opportunity to adapt
interventions according to
family resources.
4) It promotes family
participation and focuses on
the family as a unit.
5) Teaching family members in
the home is made easier by
the familiar environment and
the recognition of the need to
learn as they are faced by the
actual home situation.
6) The personalized nature of
home visit gives family a sense
of confidence in themselves
and in the agency.
Disadvantages:
1) The cost in terms of time and
effort.
2) There are more distractions
because the nurse is unable to
control the environment.
3) Nurse’s safety.
Determining patients willingness – scheduling the
home visit – reviewing the records of the patient
Phases of Home Visit
 Pre-visit Phase – Nurse
contacts the family, determines
the willingness for a home visit,
is formulated during the phase.
The ff. are specific principles in
planning for a home visit:
 Being a professional contact
with the family, the home visit
should have a purpose:
- To have a more accurate
assessment
- To educate the family
about measures of health
promotion, disease
prevention and control of
health problems.
- To provide supplemental
interventions for the sick,
disabled or dependent
family member.
- To provide family with
greater access to health
resources in the
community
 Use the information about the
family collected from all
possible sources such as
records, other personnel or
agency, or previous contacts
with the family.
 The home visit plan focuses on
identified family needs;
particular needs organized by
the family as requiring urgent
attention.
 The client and the family
should actively participate in
planning for continuing care.
 The plan should be practical
and adaptable.
 In-home phase – This phase begins as
the nurse seeks permission to enter
and lats until he or se leaves the
family’s home. It consists of initiation,
implementation, and termination.
 Initiation - it is customary to
knock or ring the doorbell and
at the same time, in a
reasonably loud but
 nonthreatening voice say, “Tao
po. Si Jenny po ito, nurse sa
health center.”
- On entering the home,
the nurse
acknowledges the
family members with a
greeting and
introduces himself and
the agency he
represents.
- Establish rapport by
initiating a short
conversation.
- State the purpose of
visiting the source of
information.
 Implementation – Involves
the application of the nursing
process, assessment, provision
of direct nursing care as
needed, and evaluation.
 Termination – Consistent of
summarizing with the family,
the events during the visit, and
setting a subsequent home
visit or another form of family-
nurse contact.
- Use this time to record
findings such as vital
signs of family
members and body
weight.
 Post-visit Phase – Takes place when
the nurse has returned to the health
facility
 Involves documentation of the
visit.
The Nursing Bag
 Frequently call the PHN bag. It is a tool used
by the nurse during home or community
visits to be able to provide care safely and
efficiently.
 Serves as a reminder of the need for hand
hygiene and other measures to prevent the
spread of infection.
 Nursing bag usually has the ff. contents:
1) Articles for infection control
2) Articles for assessment of family
members
3) Note that the stethoscope and
sphygmomanometer are carried
separately.
4) Articles for nursing care
5) Sterile items
6) Clean articles
7) Pieces of paper
The use of the Nursing Bag
 Bag technique helps the nurse in infection
control.
 Bag technique allows the nurse to give care
efficiently.
 It saves time and effort by ensuring that the
articles needed for nursing care are available.
 Bag technique should not take away the
nurse’s focus on the patient and the family.
 Bag technique may be performed in different
ways, principles of asepsis are of the essence
and should be practiced at all times.
For infection control, the ff. activities
should be practiced during home visits:
1) Remember to proceed from “clean” to
“contaminated”
2) The bag and its contents should be well
protected from contact with any article the
patient’s home. – by limiting the number of
opening the bag
3) Line the table/flat surface
paper/washable protector on which the bag
and all of the articles to be used are placed.
4) Wash your hands before and after physical
assessment and physical care of each family
member.
5) Bring out only the articles needed.
6) Do not put any of the family’s articles on your
paper lining/washable protector.
7) Wash your articles before putting them back
into your bag.
8) Confine the contaminated surface by folding
the contaminated side inward.
9) Wash the inner cloth lining of the bag as
necessary.
Child Health Programs
 Infant and Young Child Feeding
- There is global evidence that good
nutrition in the early months and
years of life play a very significant
role, affecting not only the health and
with survival of infants and children but
also their intellectual and social
developments, resulting in lifelong
impact on school performance and
overall productivity. Breastfeeding,
especially exclusive breastfeeding
(EBF) during the first 6 months of life
is an important factor that can
prevent infant and childhood
morbidity and mortality.
Key messages in Infant and Young Child
feeding:
1. Initiate breastfeeding within 1 hour after
birth (Latching-on) – to ensure that the
baby would be given colostrum (rich
number of antibodies) especially the
first milk of the mother
2. Exclusive Breast Feeding for the 1 st six
months of life
3. (Encouraged) Complementary feeding
from 6 months to 2 years and beyond
with appropriate food plus continuing of
breastfeeding
Breastfeeding is important for a number of
reasons:
1. Infants
a. Provides nutritionally complete
foods for the young infant
b. Strengthens the infant immune
system, preventing many
infections
 c. Safely rehydrates and provides
essential nutrients to a sick child
d. Reduces the infant’s exposure to
infections
e. Increase IQ points
2. Mothers
a. Reduces woman’s risk of excessive
blood lose after birth
b. Provides natural method of
delaying pregnancy
c. Reduces the risk of ovarian and
breast cancers and osteoporosis
3. Household and Community
a. Conserve funds that otherwise
would be spent on breastmilk
substitute, supplies and fuel to
prepare them
b. Saves medical cost by preventing
illnesses and by providing
immediate postpartum protection.
Complementary Feeding should be:
1. Timely
2. Adequate
3. Safe
4. Properly prepared and fed
Facts on breastmilk and breastfeeding:
1. Breastmilk is the best food for the baby
from birth up to 6 months (EBF)
2. Gives colostrum to the baby
3. Do not give plain water, sugared water,
chewed sticky rice, herbal preparation or
starve the baby while waiting for the milk
to come in
4. Give breast milk and no other food or
drink to the baby from birth up to 6
months (EBF – Exclusive Breast Feeding)
5. Breastfed as often as the baby wants day
and night
6. Use both breasts alternately at each
feeding
7. After one breast is emptied, offer first the
breast that has not been emptied after
the next feeding.
Key messages on feeding babies after 6
months (Complementary Feeding)
1. Breastfeeding for 2 years or longer helps a
child to develop and grow strong and
healthy
2. Starting other foods in addition to
breastmilk at 6 complemented month
helps a child grow well
3. Foods that are thick enough to stay in the
spoon give more energy to the child
4. Animal source foods are especially good
for children to help them grow strong and
lively
a. Peas, bean lentils, nuts and
seeds are also good for children
b. Dark green leaves and yellow-
colored fruits and vegetables
helps a child have healthy eyes
and fewer infections.
c. A growing child needs 3 meals
plus snacks
d. A growing child needs
increasing amount of food
e. A growing child needs to learn
to eat, encourage and give help
with patience.
f. Encourage child to drink and
eat during illness and provide
extra food after illness.
Laws that protect Infant and Young Child
Feeding
1. Milk Code (E.C. 51)
2. Rooming-in and Breastfeeding (Act of
1992 Mother-Baby friendly Hospitals)
3. Food Fortification Law
A. Expanded Program on
Immunization
The introduction and conception of the disease
reduction initiative in early 90s contributed to
the decline of numerous cases of immunizable
diseases.
4 Major Strategies of Expanded Program
on Immunization (EPI)
1. Sustaining high routine FIC coverage of at
least 90% in all provinces and cities
2. Sustaining the polio free country for
global certification
3. Eliminating measles
4. Eliminating neonatal
Concepts and Importance of Vaccination
Immunization is the process by which vaccines are
introduced into the body before infection sets in.
Vaccines are administered to induce immunity
thereby causing the recipients immune system to
react to the vaccine and produce antibody to fight
infection.
Principles in Vaccinating Children
1. It is safe and immunologically effective to
administer all EPI vaccines on the same
day at different sites of the body.
2. Measles vaccine should be given as soon
as the child is 9 months old, regardless of
whether the vaccines will be given on that
same day.
3. The vaccination schedule should not be
restarted from the beginning even if the
interval between doses exceeded the
recommended interval by months or
years.
4. Moderate fever, malnutrition, mild
respiratory infection, cough, diarrhea and
vomiting are not contraindications to
vaccination.
Absolute contraindications to
immunization are:
a. DPT2 or DPT3- convulsion, shock
within 3 days of the previous dose.
b. Vaccines containing pertussis
should not be given if child has an
evolving neurological condition
c. Live vaccines like BCG must not
begin to individuals who are
d. Immunocompromised
5. It is safe and effective with mild side
effects after vaccination.
6. Giving doses of a vaccine at less than the
recommended 4 weeks interval may
lessen antibody response.
7. No extra doses must be given if a dose of
DP/HB/OPV/TT is missed.
8. Strictly follow the principles of never ever
reconstituting the freeze dried.
9. Vaccines in anything other than the
diluent supplied with them.
10. False contraindications to immunizations
are children with malnutrition, low grade
fever, mild respiratory infections and
other minor illnesses and diarrhea.
 11. Repeat BCG vaccination if the child does
not develop a scar after 1st injection.
12. Use 1 syringe – 1 needle per child during
each vaccination
Routine EPI Schedule for Infants
1. Bacillus Calmette-Geurin Vaccine
(DPT)
- One (1) dose only is given at birth or
any time after birth
- It protects the possibility of TB
meningitis and other TB infections in
which infants are prone
- Dosage is 0.5 intradermal at right
deltoid
EPI Vaccines and its Characteristics
2. Diphtheria Pertussis and Tetanus
Vaccine (DPT)
- Given at 6 weeks
- Reduces the chance of sever pertussis
as well as diphtheria and neonatal
tetanus
- 3 doses at 4 weeks interval
- Dosage is 0.5ml intramuscular at
upper outer portion of the thigh.
3. Oral Polio Vaccine (OPV)
- Given at 6 weeks
- Protects against polio infection
- 3 doses at 4 weeks interval
- 2 drops are given via mouth
Thermostat Setting for Vaccine storage
4. Hepatitis B
- Given at birth
- Reduces the chance of becoming
hepatitis B infected and thus
becoming a carrier
- 3 doses, 6 weeks interval between 1st
and 2nd dose and 8 weeks interval
between 2nd and 3rd dosage is 0.5ml
intramuscular at upper outer portion
of the thigh.
5. Anti-Measles Vaccine
- Given at 9-month-old, 1 dose given
- Protects one against measles infection
 Tetanus Toxoid for Women
- TT1 is given as early as possible during
pregnancy
- TT2 given 4 weeks later from 1st dose
- TT3 given 6 weeks later from 2nd dose
- TT4 given at least 1 year later
- TT5 given at least 1 year later
a. Vaccines most sensitive to heat
1. OPV (Live attenuated) - this is stored
at the freezer
2. Measles (Freeze dried) - this is
stored at the freezer
b. Vaccines least sensitive to heat
1. DPT – stored in the body of the
refrigerator
2. Hepatitis B- stored in the body of
the refrigerator
3. BCG (Freeze dried) - stored in the
body of the refrigerator
4. Tetanus Toxoid - stored in the body
of the refrigerator
Freezer: -15 degrees centigrade to –25
degrees centigrade
Body: +2 degrees centigrade to +8 degrees
centigrade
Management of Childhood Illnesses
The Integrated Management for Childhood Illnesses
(IMCI) has been established as an approach to
strengthen the provision of comprehensive and
essential health package to children.
Steps in managing the childhood illnesses
according to IMCI protocol
1. Assessing the patient
- Taking the history of the patient is
one way of getting information about
the disease condition. This can be
done by interviewing SOs and
observing the patient’s condition to
explore possible causes.
2. Classifying the disease
- A thorough assessment supported by
laboratory results is necessary for
classification of illnesses and
confirmation of the disease as mild,
moderate and severe.
3. Treat
- This is the curative part of the
management and varies on patient’s
condition.
4. Counsel
- Provision of health education on
significant others to promote health
and prevent/ avoid risk of infection.
Color Classification Level of
Presentation of Disease Management
Green Mild Homecare
Yellow Moderate Rural Health
Unit
Pink Severe Urgent referral
in Hospital
Nutrition Program
Malnutrition continues to be the public health
concerns in the country.
Common Nutritional deficiencies
1. Vitamin A deficiency
2. Iron deficiency anemia
3. Iodine deficiency
Strategies adopted to combat malnutrition
1. Food based interventions for sustained
improvements in nutritional status
2. Life cycle approach with strategic attention to
under 3-year-old children, adolescents and
pregnant/ lactating women
3. Effective complementation of nutritional
interventions with other services
4. Geographical focus to needier areas
Programs and Projects
1. Micronutrient Supplementation
2. Food fortification
3. Essential Maternal and Child Health service
Package
4. Nutrition IEC
5. Home, school and community food
production
6. Food assistance
7. Livelihood assistance
The Adolescent Health Program
Adolescents is defined by the World Health
Organization as the period of life between 10 years
and 20 years of age while the youths are those
between 15 years - 24 years of age.
Essential health care package for the
adolescents and youths
Management of Illness
1. Counselling on substance abuse,
sexuality and STIs
2. Nutrition and diet counselling
3. Mental health
4. Family planning and responsible
sexual practices and behavior
5. Dental care
Programs for Adult Male
Adults are those belonging to the 25-59 age ranges.
They comprise to about 19% of the population in the
Philippines. There are diseases that are primarily of
male concern like the occurrence of BPH and
prostatic malignancies. DOH data also shows that
85% of HIV happens on males from 19 years -49
years old. Prevalence of smoking among males
correlates the data fact that two of three cases of
lung cancer happen among males. Essential Health
Package for this group include:
a. Management of illnesses
b. Counselling
c. Nutrition and diet
d. Mental health
e. Family planning and responsible sexual
behavior
f. Dental care
g. Screening and management of lifestyle
diseases
Programs for Adult Females
Cardiovascular diseases are the leading causes of
death among adult women. Most adult women also
suffer from degenerative and lifestyle related
diseases. The essential components of the health
care package for adult male and female is similar,
except that of gender specific services related to
reproductive health like prevention of breast and
cervical malignancies.
Programs for the Older Person
Population aging is a demographic phenomenon
indicated by a steady increase in the number of
proportions of the elderly and a corresponding
decline in the proportion of younger age groups. This
is due to increased life expectancy, mortality
reduction d fertility reduction brought about by
improved medical technology and care as well as
improved socio-cultural conditions. The elderly
population suffers from the double burden of
degenerative and communicable diseases because
the natural aging process also includes aging of the
body’s immune system.
Leading causes of morbidity. Essential care for older
persons includes:
1. Management of illnesses
2. Counselling
3. Nutrition and diet