Community Health Nursing NRS 2109-2

BSN 2-2
A.Y. 2021-2022
12/11/2021
[LECTURE]
UNIT TITLE/S

→ To eliminate maternal and neonatal tetanus

→ To control diphtheria, pertussis, hepatitis b and German
OUTLINE: measles.
MODULE 7: DEPARTMENT OF HEALTH (DOH) → To prevent extra pulmonary tuberculosis among children.
PROGRAMS RELATED TO FAMILY HEALTH – PART 1 STRATEGIES IN EXPANDED PROGRAM ON IMMUNIZATION
I. Expanded program of immunization (EPI) (DOH) TO IMMUNIZE ALL INFANTS/CHILDREN AGAINST THE
a. Goals MOST COMMON VACCINE-PREVENTABLE DISEASES
b. Strategies in expanded program on → Conduct of Routine Immunization for
immunization (DOH) to immunize all Infants/Children/Women through the Reaching Every
infants/children against the most common Barangay (REB) strategy.
vaccine-preventable diseases → REB strategy
c. Republic act no. 10152 – mandatory infants a. Adaptation of the WHO-UNICEF Reaching Every
and children health immunization act of 2011 District (RED)
a. Introduced in 2004 aimed to improve the access to
II. Integrated management of childhood illnesses routine immunization and reduce dropouts
(IMCI) b. There are 5 components of the strategy, namely:
a. Goals  Data analysis for action
b. Partner Institutions  Re-establish outreach services
c. Components of IMCI  Strengthen links between the community and
d. Strategies and Principles of IMCI (DOH, service
Philippines)  Supportive supervision
e. General guidelines for classifying the child’s  Maximizing resources.
illnesses → Supplemental Immunization Activity (SIA)
f. IMCI: Integrated Case Management a. Used to reach children who have not been vaccinated
or have not developed sufficient immunity after
III. Early Essential Intrapartum and Newborn Care previous vaccinations
(EEINC) c. Conducted either national or subnational – in selected
a. Goals areas
b. Partner Institutions → Strengthening Vaccine-Preventable Diseases
Surveillance
IV. Newborn Screening a. This is critical for the eradication/elimination efforts,
a. 3 Parts of Newborn Screening especially in identifying true cases of measles and
b. Common Newborn Screening in the indigenous wild poliovirus.
Philippines → Procurement of adequate and potent vaccines and
c. Policies and Laws needles and syringes to all health facilities nationwide
d. Goals REPUBLIC ACT NO. 10152 – MANDATORY INFANTS AND
e. Partner Institutions CHILDREN HEALTH IMMUNIZATION ACT OF 2011
MODULE 7 → The purpose of the act is to play a proactive job in the
preventive medical services of babies and kids
DEPARTMENT OF HEALTH (DOH) → This act covers the listed vaccine to prevent diseases
PROGRAMS RELATED TO FAMILY HEALTH – PART 1 which are considered as the mandatory basic
EXPANDED PROGRAM OF IMMUNIZATION (EPI) immunization offered to the children and infants:
→ WHO (2002) – 1.4 million children die from preventable a. Measles
disease; 14% global mortality in children under 5 years of d. Mumps
age e. Rubella (German Measles)
→ Initiated in May 1947 f. Tuberculosis
o To vaccinate children throughout the world g. Hepatitis-B
→ Established in Philippines in 1976 h. Diphtheria, tetanus, and pertussis
o Major programs of DOH; has been in existence i. Influenza type B (HIB)
j. Poliomyelitis
for almost 40 years
k. Other types can be considered for as long as it is
→ WHO (2013)
determined by the DOH Secretary in a department
o It remains as the most important and cost-
circular. Mandatory basic immunization will be given
effective approach to reduce the mortality rate
for free at any administration medical clinic or center
among infants because of diseases that can be
to babies and youngsters up to five (5) years old.
prevented by vaccine
VACCINES
→ Seeks to ensure that children (infants) and their mothers
have access to vaccines BCG (Bacille Calmette-Guerin)
GOALS  Live bacteria
→ To immunize all infants/children against the most common  1 dose of 0.5 ml
vaccine-preventable diseases.  At or ASAP after birth
→ To sustain the polio-free status of the Philippines.  Should NOT be given to infants that with symptomatic HIV
→ To eliminate measles infection. Infection

TP: Initials. Surname TB: Initials. Surname & Initials. Surname

  Correct intradermal administration special syringe (upper → First adapted by DOH in Region I, III, X, XI
right arm) o Funded by United States Agency for International
DPT (Diphtheria, Pertussis, Tetanus Vaccine) Development
 Diphtheria and tetanus as toxoids; pertussis as killed → 2001 – added to be a curriculum in Community Health
whole-cell bacterium Nursing (Handbook IMCI)
 3 primary doses of 0.5 ml → Integrated approach to child health that focuses on the
 6, 10, 14 weeks of age well-being of the whole child
 Intramuscular – muscle of upper thigh (vastus lateralis) → Based on Worldwide Statistics, there are 5 preventable
Oral Polio Vaccine (OPV) diseases that causes death in children:
 Live Oral Polio Vaccine o Pneumonia, diarrhea, dengue, malaria, measles
 Against polio myelitis (and malnutrition)
 3 doses of 2 drops → Target Population: Filipino Children
→ Children involved in the IMCI protocol:
 6, 10, 14 weeks of age
o Sick Young Infant – sick children from birth up
 Oral – mouth
to 2 months
 Make sure infant is/will not vomit
o Sick Child – sick children from 2 months up to 5
 Do not feed milk for 30 minutes
years old
 May cause fever or inflammation on injection site GOALS
Measles
→ To reduce infant mortality
 Malaise, fever, rash, rarely encephalitis, anaphylaxis
→ To minimize the severity of illnesses of a child
 One dose of 5 ml
→ To help the growth and development during the first five
 Outer mid-thigh/ upper arm depending on the age years of a child's life
 Subcutaneous PARTNER INSTITUTIONS
Hepatitis B Vaccine
→ Department of Health (DOH)
 Recombinant DNA or Plasma Derived
→ Commission on Higher Education (CHED)
 3 doses of 0.5 ml (usually along with DPT) → Association of Deans of Philippines Colleges of Nursing
 Several options (6, 10, 14 weeks) (ADPCN)
 May cause fever → Association of Philippines School of Midwifery (APSOM)
 Intramuscular – vastus lateralis → Professional Regulation Commission (PRC)
AMR vaccine COMPONENTS OF IMCI
 Anti-measles → Improve health workers’ skills
 9 months only a. Mostly refers to clinical and communication skills and
MMR (Measles, Mumps, Rubella Vaccine) covers both pre-service education and in-service
 2 doses of 0.5 ml training, public and private sector
 9 months, 15 months l. Healthcare workers should be skilled and trained
 Not to be taken if already had AMR especially in managing that said illness of a child
 Left upper arm → Improve health system
 SQ a. Improving health systems to deliver IMCI concerns
PCV (Pneumococcal Conjugate Vaccine) policy, planning and management, organization of
 3 doses of 0.5 ml work and distribution of tasks at health facilities,
 6, 10, 14 weeks human resources, availability of drugs and supplies,
 Right lateral thigh referral, monitoring and health information system
 IM → Improve family and community practices
TT (Tetanus toxoid) m. Currently refers to 16 key family and community
 For childbearing women practices related to child health and development
n. Would potentially contribute to improving child
 5 of 0.5
survival, growth, and development
STRATEGIES AND PRINCIPLES OF IMCI (DOH, PHILIPPINES)
→ All sick children aged 2 months up to 5 years are
examined for General Danger signs and all Sick Young
Infants Born up to 2 months are examined for Very Severe
disease and local bacterial infection. These signs indicate
immediate referral or admission to hospital
→ The children and infants are then assessed for main
symptoms.
a. For sick children, the main symptoms include cough
or difficulty breathing, diarrhea, fever, and ear
infection.
o. For sick young infants, local bacterial infection,
diarrhea, and jaundice.
p. All sick children are routinely assessed for nutritional,
[Recommended age for different types of community vaccines immunization and deworming status and for other
issued by Department of Health] problems
INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES → Only a limited number of clinical signs are used
(IMCI) → A combination of individual signs leads to a child’s
→ Introduced in 1995 by WHO and UNICEF classification within one or more symptom groups rather
→ 1996 – done in developed countries than a diagnosis.
→ 1997 – done in Philippines

Agbayani, Domasin, Ereno, Lantin, Medina, Melitante, Mendoza, Pacheco, Paguirigan, Ramos, Trinidad (2021-2022)
 → IMCI management procedures use limited number of
essential drugs and encourage active participation of
caretakers in the treatment of children
→ Counseling of caretakers on home care, correct feeding
and giving of fluids, and when to return to clinic is an
essential component of IMCI
GENERAL GUIDELINES FOR CLASSIFYING THE CHILD’S
ILLNESSES
→ PINK
a. Child with any general danger sign needs URGENT
attention; complete the assessment and any pre-
referral treatment immediately so referral is not
delayed
→ YELLOW
a. Classification needing specific medical treatment and
advice
→ GREEN
a. It is not serious that in most cases the need of drugs
is not required. Simple advice on home management
is given and may require home made safe remedy
[Table 1: Classification of treatment according to color]
[Table 2: Classification of child’s illness according to color]
IMCI: INTEGRATED CASE MANAGEMENT
→ Steps of the IMCI Case management Process
a. Assess and classify
 Doing physical examination, identify and
classify the severity of illnesses.
q. Identify appropriate treatment
 The charts above (Table 1 and 2) must be
followed to recommend appropriate
treatment for each classification.
Agbayani, Domasin, Ereno, Lantin, Medina, Melitante, Mendoza, Pacheco, Paguirigan, Ramos, Trinidad (2021-2022)
r.Treat or refer
 Provide prescribed treatment, home
remedies, and teach mothers on how to
carry the treatments.
s. Counsel
 Includes the teaching on what the food to
give and when to do the follow-up
t. Follow-up
 Describing what to do in the following check-
up for the child to avoid the severity of
illness.
EARLY ESSENTIAL INTRAPARTUM AND NEWBORN CARE
(EEINC)
→ Aim to give a series of time-bound, chronologically
ordered, standard procedures received by babies at birth
to ensure their survival
→ Centered on 4 time-bound interventions, named as
follows:
o Immediate drying
 Bathing newborns, an old practice, was
prohibited because of a high rate of
having hypothermia.
 WHO recommends that newborns
should be bathed six hours after birth or
longer
 Removing the Vernix caseosa (a
protective defense) of a newborn
increase the risk of E. coli and Group B
Strep infection.
o Skin-to-skin contact
 If prohibited, this impairs not only the
bonding relationship but also the early
chance of the newborn getting warmth
and being breastfed
 Decreases neonatal sepsis for it is an
early measure of hospital infection
control
o Proper cord clamping and cutting
 No known benefit to newborns, but
many studies showed that these result
in hematologic diseases on term and
preterm newborns
o Non-separation of the baby from mother and
breastfeeding initiation
 Not separating the baby from the mother
at birth, promotes breastfeeding and
lessens the chance of having metabolic
disorders
→ Implementation of Essential Intrapartum and Newborn
Care (EINC) made a significant change in Filipino
newborns
o Decrease in admitting neonatal ICU by 50-75%,
neonatal sepsis by 70%, and neonatal deaths by
50% (DOH-EINC, 2013)
→ Coverage – Nationwide
→ Target Population: Newborn and Filipino pregnant women
 → Maple Syrup Urine Disease (MSUD)
a. Inherited metabolic disorder
b. Could lead to brain damage, trauma, or dead
c. Named for the sweet odor of the urine of untreated
infant
→ Critical Congenital Heart Disease (CCHD)
→ Otoacoustic Emissions (OAE)
→ Auditory brain stem response (ABR)
POLICIES AND LAWS
→ RA 9288 or the Newborn Screening Act of 2004
→ DOH AO No. 2014-0045 or the Guidelines on the
Implementation of the Expanded Newborn Screening
Program
GOALS
→ To screen all Filipino newborns by 2030
→ To strengthen the quality of service, intensify the
GOALS
monitoring and evaluating the implantation
→ To promote breastfeeding → To sustain the financial scheme
→ To ensure optimal health service delivery to the mother → To strengthen patient management
and her child PARTNER INSTITUTIONS
→ To eliminate stereotyped newborn care practices like
→ National Technical Working Group on Newborn Screening
unnecessary suctioning and bathing
Program (NTWG- NBS)
PARTNER INSTITUTIONS
→ National Institutes of Health (NIH)
→ National Technical Working Group on Newborn Screening → NIH-Newborn Screening Reference Center (NIH-NSRC)
Program (NTWG- NBS) → DOH Epidemiology Bureau (EB)
→ National Institutes of Health (NIH) → DOH Health Facilities and Services Regulatory Bureau
→ NIH-Newborn Screening Reference Center (NIH-NSRC) (HFSRB)
→ DOH Epidemiology Bureau (EB) → DOH Health Facility Development Bureau (HFDB)
→ DOH Health Facilities and Services Regulatory Bureau → DOH National Center for Health Promotion (NCHP)
(HFSRB) → NIH - Institute of Human Genetics (NIH-IHG)
→ DOH Health Facility Development Bureau (HFDB) → Department of the Interior and Local Government (DILG)
→ DOH National Center for Health Promotion (NCHP) → Council for the Welfare of Children (CWC)
→ NIH - Institute of Human Genetics (NIH-IHG) → Philippine Health Insurance Corporation (PhilHealth)
→ Department of the Interior and Local Government (DILG)
→ Council for the Welfare of Children (CWC)
→ Philippine Health Insurance Corporation (PhilHealth)
NEWBORN SCREENING
→ Going on for 5 years since 1996 in the Philippines
→ Aims to provide early detection and management of
congenital disorders
→ Helps to lessen the causes of congenital disorders which
may hinder the development of mental ability, to mental
retardation and/or worst, death
→ Leads to disease prevention that affects the growth and
development of every Filipino newborn
→ National Comprehensive Newborn Screening System
(NCNBSS)
→ Coverage – Nationwide
→ Target Population: Filipino newborn
3 PARTS OF NEWBORN SCREENING
→ Blood Test (Heel Stick)
a. Viable blood sample only lasts from 24 to 48 hours
b. Beyond 48 hours, some diseases become
undetectable already
→ Hearing Screen
a. To determine hearing loss
→ Pulse Oximetry
a. In infant, used in palm or foot
COMMON NEWBORN SCREENING IN THE PHILIPPINES
→ Congenital Hypothyroidism (CH)
a. Affect 3000 of every 4000 babies
c. May develop to mental retardation and growth failure,
deafness, neurologic abnormalities
→ Congenital Adrenal Hyperplasia (CAH)
a. Affects 1 out of 5000 babies
→ Phenylketonuria (PKU)
→ Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency
→ Galactosemia (GAL)

Agbayani, Domasin, Ereno, Lantin, Medina, Melitante, Mendoza, Pacheco, Paguirigan, Ramos, Trinidad (2021-2022)