Community Health Nursing - NUR8109
adolescents love, depression
Public Health Services
● focus on public health programs
​ revent
○ Aets of intervention put together to p
diseases & health promotion
● PHN must be knowledgeable of the policies & health
standards
HEALTH EDUCATION
● A process of assisting individuals, acting separately or
collectively to make informed decisions about matters
affecting the personal health and that of others
Topic would depend on the client
If pregnant = prenatal care
PP = breastfeeding
Utilization of available health diseases
reinforce
● Multidisciplinary practice
● Catered to the poor levels of clientele
● Continuum of learning
● Help them to make voluntary decisions
PRINCIPLES OF HEALTH EDUCATION
1. Considers the ​health status​ of the people
● Felt needs ➡ people’s program
● Assess available resources in the community
2. Is ​learning
● To help individuals to improve their knowledge
● To influence their attitudes
● For them to be better people
3. Involves ​motivation​, experience, & change in conduct
& thinking
● Individual is the point of entry to the family
4. A ​basic function​ to all health workers
● Make yourself available to answer community
questions
● Address their health concerns
● To find accurate health information & how to
relay it to them
5. Takes place wherever the individual / people are
located
● Accessible to the majority
6. Is a ​cooperative​ effort
● Sense of involvement, more likely to accept
● In relation to Alma Ata, the people have the
right & duty to participate individually &
collectively in the planning and implementation
of their healthcare
● We need their participation
● We don’t spoon feed them, allow them to
make decisions
7. Meets the needs, interests, & problems of the people
affected
● e.g. school: personal hygiene, first aid
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Page 1
● e.g.
8. Achieve by ​doing
● Learning is an action process
● If i hear i forget, if i see i remember, if i do i
know
● we learn better if we practice and follow rules
9. A ​slow continuous process
● Include the benefits they are gaining
10. Makes use of ​supplementary​ aids & devices
● use of audio, brochure, PPTs, films etc.
● Let them see what they learn
Public Health Laboratories
● On diseases and status of population groups
Research Institute for Tropical Medicine ​(RITM)
● Undertake research activities in the diagnosis, control,
and prevention of tropical diseases that are major
causes of mortality & morbidity in the PH
of public health importance
Control of ​infectious / ​tropical diseases
● Conduct regular ​training courses for medical &
paramedical personnel in the control of common
tropical diseases in the country
● Provide high quality ​tertiary care to both in-patients &
out-patients suffering from tropical diseases included
within the scope of the Institute's research activities
● Manufacture of ​vaccines & biological products for use
of the DOH: BCG & Tetanus toxoid
Cheaper from other countries, RITM serves as
storage also
SERVICES
1. Microscopy examination of cervico-vaginal & urethral
smears
Pap smears, results for at least 1 week
2. Routine ​stool culture
Virus / bacteria to check for GI disorders
3. Serology​ examination
Antibodies in the body
4. Basic / routine ​hematology
CBC
5. Hemoglucotest
Like blood sugar test, usually done to diabetics
6. Routine ​clinical microscopy
Non-blood body fluids like urine
7. Water bacteriological screening
When you want to establish a water refilling station
etc.
8. Sputum examination​ for AFB
Acid-fast bacillus
9. Skin slit smears
# of bacilli & its state, for leprosy patients
10. ABO/RH ​blood typing
E. Fineza & J. Dimasacat | 2NUR4

Reproductive Health ​(RH)
● A state of complete physical, mental & social well-being
& not merely the absence of infirmity in all matters
relating to the reproductive system and to its functions
and processes
● Free vasectomy as part of family planning
programs
9. Violence against women & children​ (VAWC)
● Prevalent domestic violence & sexual violence
10. Prevention & management of Infertility & Sexual
dysfunction

Reproductive Act no. 10354

● Responsible Parenthood & Reproductive Health Act
of 2012
● a.k.a. RH Bill
● Universal access to methods on contraception, fertility
control, sexual education & maternal health
● informed choices regarding one’s infertility intention or
P.D. 79
● empowers nurses / midwives to give knowledge about
contraception
● especially of IUD
RH PROGRAM
● Life-span approach
○ Concerned with the different age brackets
○ e.g. HPD vaccines to adolescents
○ e.g. Postpartal care to mothers
○ e.g. EPI
● Client-centered
○ Services that our clients need
10 ELEMENTS OF RH
1. Family Planning
● 1st intervention
● Allow the couples to freely decide on the
number and proper spacing of births
2. MCHN
● Family planning is one of the pillars of the safe
motherhood program
● Use of safe & effective FP methods
● Proper birth spacing: ​3-5y
Ample time to regain her health & take care
of offspring
2y sa OB
3. Prevention & management of reproductive tract
infections ​including STIs & HIV/Aids
4. Adolescent RH
● Fertility awareness, human sexuality
counseling
● To promote responsible sexuality
5. Prevention & Management of ​Abortion ​& its
complications
● Prenatal care to pregnant women
6. Prevention ​& management of ​Breast & Reproductive
Tract Centers​ & other gynecological conditions
7. Education & Counselling on ​Sexuality & Sexual Health
● Basic component on family planning
● To prevent unwanted pregnancy
8. Men’s reproductive health ​(MRH) ​& involvement
● Concerned to both men & women
Counselling Services
FP Counselling
● A client-centered, face-to-face, interactive
communication process between the health service
provider & the client that helps the latter to make free &
plan
Helps clients choose & use FP methods that is
appropriate for them
Essential Content of Nurse-Client Interaction
● Effectiveness
○ When we describe effectiveness of one
method from another, grabs their attention
○ No action to little action is most effective
● Advantages & disadvantages
○ e.g. depo provera: advantage is it does not
interfere with intercourse, disadvantage is
weight gain & irregular vaginal bleeding
○ There are pills that suppress lactation
○ IUD insertion this can last as long as 10 years
● Possible ​side effects​, complications, & signs that
require immediate visit to the health facility
○ IUD insertion while pregnancy, risk for ectopic
pregnancy
● How​ to use​ the chosen method
○ Little or no action is most effective
○ Left in place after 6h after injection, if not
remove may cause infection like toxic shock
syndrome
● Prevention​ of STIs
○ The barriers won’t protect you against STI
● When ​to return​ to health facility
○ Follow up check ups
○ IUD after 48h after NSD & if CS 8wks after
Maternal Health Program
PRENATAL
● prenatal care is an important part of pregnancy
● First visit: medical history, pregnancy risk factors, &
problems, prenatal vitamins, physical assessment like
LM & Fundic height
PH STATISTICS
● MMR 209/100,000 live births (1993) to 172/100,000 live
births (1998)
○ 162/100,000 live births (2006)
○ 121/100,000 live births (2016)

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 ● Number of women with at least 4 prenatal visits: 77% ● History of preeclampsia, multiple premature
(1998] births, increase risk of early delivery
● Births attended by health professionals: 56% (1998) to 8. Associated medical conditions
84% (2017) ● CVS disorders
● To initiate preventive & promotive health interventions 9. Vaginal bleeding; premature rupture of the bag of water
such as micronutrient supplements & screenings (PROM)

PHYSICAL ASSESSMENT
● Exam of thyroid gland
○ For normal development of baby’s brain &
nervous system
○ Critical in first trimester
○ Baby will depend on mother’s supply of thyroid
● Breast exam
○ May affect in BF
● Abdominal exam
○ Fundic height, LM, FHT
ASSESSMENT DURING PREGNANCY ○ where applicable
1. Medical history ● Exam​ of face, hands & lower extremities ​for edema
● Family: diabetes & high blood pressure ○ Abnormal accumulation of body fluid
● Menstrual ○ Sigh of PIH
● OB (​LMP​, AOG, EDC)
○ first day of the last menstruation FUNDIC HEIGHT
2. Weight & height ● Measure ​after 20th AOG
3. VS, ​with special attention given to BP ● Good estimate of AOG in weeks
● ⬆ BP ​= PIH (pregnancy induced hypertension ● From pubic bone to the top of the uterus
with presence of edema) ● Inaccurate to obese
4. PE ● In HBMR, estimates are:
● Measure fundic height & compare with AOG ○ 5m = 20cm
● cm distance from pubic bone to the top of the ○ 6m = 21-24cm
uterus ○ 7m = 25-28cm
● LM, FHT, Fetal movement ○ 8m = 29-30cm
5. Laboratory examinations ○ 9m = 30-34cm
● CBC, Blood typing, Urinalysis, HIV, Blood
sugar, cervical cancer, pap smear LEOPOLD’S MANEUVER
● Void first
Identification of HIGH RISK PRENATALS Risk of touching the bladder
1. Age​ — <15y & >35y ● Position: supine / dorsal recumbent
● Young: pelvic bone is not yet developed; ● Palm not fingertips
nutritional deficiency bc of poor habits ● Provide privacy
● Old: possible serious medical condition, PIH ● After 24 AOG
also I. ​Upper pole
2. Parity​ — <5 pregnancies ● Fundal grip = fund out what is occupying the uterus
3. Weight​ — <95lbs, assessed monthly ● Fetal presentation (​cephalic / breech​)
● Excessive weight gain may be a sign of edema ● Standing & facing the patient
(& of PIH) ● Hard, rough & firm = HEAD ➡ breech
4. Height​ — <4’10 ● Soft = BUTTOCKS ➡ cephalic
5. Hgb​ — <8.5gms
● 30%-50% increase in blood volume ➡ II. ​Sides of maternal abdomen
increase in plasma ➡ ​hemodilution ​= ● Umbilical grip
physiologic anemia ● Fetal back = for FHT
● Hgb for mother & fetal RBC ● protrusion & irregularities = EXTREMITIES
6. Signs & Symptoms of HPN disorder ● smooth = BACK
● a.k.a. Hypertension
● Lead to damage to several organ systems III. ​Lower pole
● Untreated preeclampsia may lead to seizures ● Paullick grip
● Seizures = compromised blood flow ● Assess for fetal engagement (​floating / engaged​)
7. Poor OB History ● Floating or engaged
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 ● Primi: ​2wk before ​labor ➡ engagement
● Multi: ​during​ labor ➡ engagement

IV. ​Presenting part evaluation

● Facing the mother’s face, opposite of I
● Pelvic grip
● Fetal position
● Fetal attitude = brow
● Degree of flexion a.k.a. Tetanus Diphtheria — ​0.5mL IM Deltoid Muscle
● Smooth = cephalic, good flexion Upon TT2 / 2nd dose the infant is already protected from
● Ridges, presence of resistance, bumps ➡ poor flexion neonatal tetanus, hence at least ​TT2​ during pregnancy
CHILDBIRTH
1. BEmONC
2. CEmONC
3. Domiciliary Obstetrical Services (DOS)
4. Essential Intrapartal Newborn Care (EINC)

LABORATORY TESTS
● CBC
○ Anemia
● Glucose Tolerance Test​ (GTT)
○ 24-28 AOG
○ If there is history of DM
○ Requires fasting then test
■ After, drink 8oz of glucose solution
then test again after 2-3h
● Blood typing
EmONC = Emergency Obstetrics & Newborn Care
○ ABO Rh Incompatibility
○ Childbirth involves blood loss
● Urinalysis​ (UA) BEmONC
○ Proteinuria, UTI, STIs
— a.k.a. Basic Emergency Obstetrics & Newborn Care
Parenteral = IV
NUTRITION
1. Parenteral administration of ​oxytocin in the 3rd stage
● encourage balanced diet
of labor
● Especially iron because our body needs to make iron
2. Parenteral administration of loading dose of
for the extra blood that we the mothers & fetus would be
anticonvulsants
needing during the pregnancy
3. Parenteral administration of initial dose of ​antibiotics
(initial loading dose)
Micronutrient Supplementation: Prenatal Package
4. Performance of assisted deliveries (imminent breech
delivery)
5. Removal of retained products of conception
6. Manual removal of retained placenta

BEmONC-Capable Facility
— Neonatal emergency interventions
1. Newborn resuscitations
● Especially those who were asphyxiated
● May damage the brain if not breathing
Iron & Folate = blood development ● 1st minute = golden minute
Vitamin A = for vision, immune function, fetal G&D 2. Treat of neonatal sepsis / infection
Iodine = for healthy brain & spinal cord development in the fetus ● Capable of giving IV Antibiotics
● Including fluids & electrolytes, & medications
Tetanus Toxoid Immunization Schedule 3. O2 support
4. Blood transfusion (BT) services
— at least ​1 midwife​ / ​nurse with an on call physician

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Midwives can administer life-saving drugs & medicines, to
reduce maternal mortality rate UNANG YAKAP
— ​1 BEmONC facility: 125, 000 population (within ​30 minutes ● the first embrace
travel time) ● Immediate & uninterrupted skin-to-skin contact of
a. BHS mother & newborn ➡ start successful BF
b. RHU ● in 2009 by DOH
c. Lying-in Clinic ○ Maternal mortality rate were cut in half
d. Birthing home ● Evidenced-based, low cost technology that can save
e. District hospital thousands of lives
f. Any other similar structure
1. ​1st 90 minutes
a. Immediate ​& thorough​ drying
● 30s-1m
CEmONC
● Protection from cold stress & hypothermia
— a.k.a. Comprehensive Emergency Obstetrics & Newborn Care ● Removing amniotic fluid
● Tertiary level, regional hospital / medical center, in a ● Stimulates breathing
provincial hospital or upgraded district hospital b. Skin-to-skin contact​ [+ Initiation of BF]
● Capable of performing 6 signal obstetrics function as in ● Warmth & opportunity for bonding
BEmONC ● Protects against infection & hypoglycemia
○ + ​CS delivery services ● Facilitates colostrum feeding
○ + ​blood banking & transfusion services ● In prone position
○ + ​other highly specialized obstetric c. Proper cord clamping & cutting
interventions ● 1-3m; not pulsating
● + management of LBW or preterm newborn & other ○ If delayed you are reducing IDA
specialized newborn services ○ To facilitate placental transfusion
● 1 CEmONC capable-facility: 500,000 population (within ● Increases blood volume & iron reserves ➡
2h​ travel time) reduces IDA in infancy
● 5 EmOC facilities ​: 1 CEmONC : ​500,000 population ● Preterm infants: reduce the need for BT &
(WHO Guideline) lowers the incidence of brain hemorrhages
d. Rooming-in
TWO TYPES OF EmONC SERVICES ● Non-separation of mother and baby
● BEmONC provided at DH, RHU, BHS
● CEmONC provided in hospitals 2. ​After 90 minutes to 6 hours
○ ERs, RRs, admission room, pharmacy, ● Vit. K ​prophylaxis
laboratory, etc ○ To avoid vit K deficiency bleeding
● Vaccinations​: BCG & Hepa B
DOS ● Examination​ of the baby
● Additional care​ for a small baby or twin
— a.k.a. Domiciliary Obstetrical Services ○ Small baby if BW <2,500g
● Things we have done that didn’t work ○ Twins
○ Focus on Antenatal Clinics
○ TBA training 3. ​Care prior to discharge: After 90 minutes
■ a.k.a. Traditional Birth Attendant a. Unrestricted, per demand BF
■ included “hilot” b. Kangaroo Mother Care (KMC)
○ Encouraged home births ● Continuous skin-to-skin contact
● complications ➡ maternal death ● Providing warmth
● Paradigm shift: every pregnancy is a risk ● Possible, Early discharge: ⬇Maternal mortality
& morbidity also of newborn/premature
EINC ● Regulate temperature, breathing & brain
activity
— a.k.a. Essential Intrapartal Newborn Care ● Encourage mother-baby bonding
● Simple cost-effective newborn care intervention that c. Washing & bathing
can improve neonatal & maternal care ● Delay the first bath
● Evidenced-based intervention ● If you wash the baby right away, the scent of
○ We deliver time-bound intervention in the mother’s breast & amniotic fluid diminishes
immediate period after the delivery of the ● Preserve the smell to encourage the baby to
newborn latch for BF
○ e.g. drying to stimulate the baby to cry

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 ● To make sure that baby has stable
temperature
d. Look for danger signs & start resuscitation
e. Look for signs of jaundice & local infection
f. Newborn screening & newborn hearing
g. Instructions on discharge
● Include follow up schedules, health teachings
on danger signs, when to bring the newborn to
the facility, complying on newborn screening
6 weeks after for vaccination
POSTPARTUM
1. Inform, teach & counsel the woman of important MCH
concerns:
● Birth registration
○ Presidential Decree 651: the registration of the
baby is the responsibility of the attending
physician, nurse, or the hospital administration
○ Should begin as soon as the mother gives
birth
○ Registered within 30 minutes on the local city
registry office
● BF
○ Most mothers do not know the importance
○ Nurses must motivate mothers to practice BF
● Newborn Screening
○ Should be done within 48h to 2wk after birth
● Postpartum visits
○ 1st visit: within 24h
○ 2nd visit: within 1wk
○ According to DOH
2. Family Planning & Counselling
● FP method
● Proper spacing of birth & number of children
○ 3-5y interval with completely recovered health
of the mother from previous pregnancy &
childbirth
○ Risk of complications increases after the 2nd
birth
3. Micronutrient supplementation
EECD
— a.k.a. Early Childhood Care Development
A. Basic ​/​ Expanded Newborn Screening
B. Universal Hearing Screening & Intervention
C. BF Campaign Program
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Page 6
D. Expanded Program on Immunization ​/ National Immunization
Program
E. Integrated Management for Childhood Illnesses (IMCI)
● Assess, Classify & Treatment
● Malnutrition
F. The Philippine Nutrition Program
Basic / Expanded Newborn Screening
R.A. 9288​ ​— Newborn Screening Act of 2004
● The National Newborn Screening System shall ensure
that every baby born in the Philippines is offered the
opportunity to undergo newborn screening & this be
spared from heritable conditions that can lead to mental
retardation and death if undetected & untreated
● Obligation to Inform — availability, nature and benefits
to the legal guardian
● Performance of Newborn Screening (​within 24-72
hours​)
UNLESS:
○ Intensive care —must be tested by 7d of age
○ Informational brochure — made available by
DOH
shall be distributed to all health institutions
● Refusal to be tested — acknowledge in writing
○ Documented in the medical record and
national newborn screening database
○ May be due to religious beliefs
○ Make sure that legal guardian acknowledge
the refusal and the risk of refusal
● Continuing education, re-education & training health
personnel
○ Rationale, benefits, procedures of newborn
screening
○ Dissemination of information materials in
newborn screening
Should be done at least annually to all
health personnel that are involved in
maternal & pediatric care
BASIC NEWBORN SCREENING — SIX CONDITIONS that we
will be able to screen
1. Congenital hypothyroidism
● Immobility to produce thyroid hormone
Either from thyroid metabolism or iodine
deficiency
2. Congenital adrenal hyperplasia
● Inability of the adrenal gland to secrete cortisol
or aldosterone
Inherited disorders
Cortisol regulates our body’s response to
illness or stress
Aldosterone regulate Na & K levels
NO CURE but with treatment, can leave
normal lives
3. Galactosemia
E. Fineza & J. Dimasacat | 2NUR4
 ● Body is unable to metabolize galactose and ○ Confirmatory testing
the person is unable to tolerate any form of
milk
Universal Hearing Screening & Intervention
Rare genetic disorder
⬆ galactose in blood = complications R.A. 9709 ​— Universal Newborn Hearing Screening and
4. Phenylketonuria Intervention Act of 2009
● Born without the ability to properly break down All newborns in PH with consent (consent form is not
an amino acid known as phenylalanine necessary) of parents / guardians will be subject to
inherited, eats food that contain aspartate universal hearing screening;
Follow a diet that limits Phe refusal ➡waiver ➡ medical record
Found in food that contain protein ● Right time to screen?
5. Glucose-6-phosphate dehydrogenase​ (G6PD) ○ ≥ 24 hours after birth — discharge​ only
● RBC break down when the body is exposed to > 24 hours to give time of the passage of
certain drugs, food,& severe stress and vernix from auditory canal
infection ● Newborn Hearing Screening Reference Center
Hereditary, possible hemolytic episodes, (NHSRC)
paleness, rapid HR, jaundice ● UNHSP (Universal Newborn Hearing Screening
6. Maple syrup urine disease Program)
● Unable to breakdown leucine, isoleucine, & ○ Early detection
valine ○ Referral for early intervention
The body lacks enzyme to process amino ● Obligation to inform — any healthcare practitioner who
acids delivers, or assists in the delivery of a newborn
Found in protein also
● Urine smells like maple syrup BF Campaign Program
Breastfeeding : The first step to raising a bright child
DISORDER IF NOT SCREENED IF MANAGED
● average, infants are EBF only for <1month (2008)
CH 🧠severe mental retardation Normal ● BF a young child, on the average, lasted for only 12
months (2008)
CAH 💀death Normal & alive ● The study “Barriers to Breastfeeding in the Philippines”
GAL 💀death / 👁cataracts Normal & alive
— there was only a slight increase in the number of
mothers who continue to BF at 60% in 2017 compaired
PKU 🧠severe mental retardation Normal to 51% in 2013.
Because milk companies keep on promoting infant
G6PD severe anemia, Kernicterus Normal formula and that it is par with breast milk.

EXPANDED NEWBORN SCREENING EO No. 51 — ​“Milk Code”

● Basic + 22 conditions = 28 ● prohibits information dissemination that bottle
● (RA 9288) ​Newborn care package includes: feeding is equal or better than breastfeeding
○ Administration of Vit. K ● Milk companies are prohibited from sponsoring
○ First dose of Hepa B professional trainings and publications of
○ Umbilical cord care health clinic materials (e.g. baby books)
○ Eye prophylaxis ● Median duration of EBF: 0-3.9 months of age
○ Thermal care Shorter than recommended 6 months EBF
○ Php 550 ● The government must host mass BF event, where
Expanded = Php 1,500; parents would pay mothers will publicly nurse their children in an effort to
remaining Php 950 combat child deaths through BF
Before, you had to choose between the expanded ANNUAL EVENT
and basic newborn screening. As of May 2019, ● BF > Formula
automatically expanded newborn screening.
TERMS TO DESCRIBE DIFFERENT FEEDING PRACTICES
NEWBORN SCREENING FACILITIES Exclusive Breastfeeding
● 146 newborn screening facilities in NCR ● An infant receives ​only ​breast milk and no other liquids
● Drops of blood (heel prick method) or solids, not even water, with the exception of drips or
○ Blotted in paper / cardboard syrups consisting of vitamins, mineral supplements or
● Negative​: 7-14 working days from the samples are medicines
received​ (NORMAL) ● ORS is part of EBF
● Positive​: relayed immediately
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Predominant Breastfeeding
● Breast milk as the ​main source ​of nourishment, but also
given small amounts of non-nutritious drinks such as
tea, water and water-based drinks
● Karamihan ay BF
Complementary Feeding
● Giving other food ​in addition ​to breast milk
● Other food / liquid ​= ​complimentary food
● Must be nutritious food in adequate amounts
● Eating family food
Bottle Feeding
● Any liquid (including breast milk) or semi-solid food from
a bottle with nipple / teat
● Risk for Nipple confusion — broad term
○ Can refer to a baby who refuses to feed from a
bottle
○ Can refer who tries to feed from a bottle
Nalilito si baby
● Recommended within 4-6 weeks
Early Initiation of Breastfeeding
● BF of the newborn ​within 90minutes of life in
accordance to the essential newborn care protocol
○ a.k.a. Unang Yakap
○ Included is the early uninterrupted skin-to-skin
contact between mothers and infants that
should begin as soon as possible after birth or
within the first hour after delivery
Expanded Program on Immunization​ (EPI)
— a.k.a. National Immunization Program
● To ensure that infants/children and mothers have
access to routinely recommended infant/childhood
vaccines
● est. 1976 ​SIX​ vaccine preventable diseases
○ TB
○ Poliomyelitis
○ Diphtheria
○ Tetanus
○ Pertussis
○ Measles
● In 2014, PCV was included in the routine administration
● In 2016, became National Immunization program which
includes the senior citizens, school age, and
adolescent’s immunization
○ 75% - 100% coverage
RECORDING & REPORTING
Fully immunized children​ (FIC)
● those who were given BCG, 3 doses of OPV, 3 doses
of HB (Pentavalent-Hib vaccine), and one dose of
anti-measles vaccine ​before reaching one year of age
Penta-Hib = covers 5 diseases ➡ HB, DPT, Hib
Completely immunized child ​(CIC)
Page ​8​ of 18
● those who completed their immunization schedule at
the age of 12-23 months
● After one year
Child protected at birth​ (CPAB)
● a child whose mother has received:
○ 2 doses of Tetanus toxoid, provided that the
second dose was given at least a month prior
to delivery; or
○ at least 3 doses of Tetanus toxoid anytime
prior to pregnancy with this child
R.A. 10152 ​— Mandatory Infants & Children Health
Immunization Act of 2011
● Added to the 6 immunizable diseases:
○ Hepa B
○ Mumps
○ Rubella
○ Hib
● Free at any government hospitals or health centers to
infants up to ​5 y.o.
~ difference to ​P.D. 996​: it is the duty of the parents and those
who are in close custody of the child to see to it that the child is
immunized, if not they are charged with Php 200 fine
parents are penalized or jailed for a month
R.A. 7846 ​— Compulsory immunization against Hepatitis B for
infants and children below 8 y.o.
● HB immunization within 24h after birth of babies of
women with HB
SPECIFIC GOALS OF EPI
1. To immunize all infants / children against most common
vaccine-preventable diseases
2. To sustain the polio-free status of the PH
● We were declared polio-free in 2000; certified
in Kyoto, Japan. Unfortunately in September
2019 there was again an outbreak.
3. To eliminate measles infection
● AMV / MMR vaccines
● 9 months & 12-15 months, respectively
4. To eliminate maternal & neonatal tetanus
● That is why it is important to give at least 2
doses of TT / Tetanus-Diphtheria to women
● Total of 5 doses for lifetime protection
5. To control diphtheria, pertussis, hepa B, & German
measles
● Included in Penta-Hib vaccine
● 3 doses
● German measles = MMR
6. To prevent extrapulmonary TB among children
● BCG vaccine
BCG
● Against TB
● a scar is expected
● 0.05mL only because it is given ID
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HEPATITIS B Vaccine​ / HB
● At birth ➡ reduces the chance if the child becoming a
carrier
○ Monovalent Hepa B
○ The younger a baby is when infected, the
greater risk of developing chronic hepa B
■ It can scar the liver & cause liver
disease & even liver cancer
○ 90% of baby’s develop chronic hepa B
○ ➡ Chronic Hepa B is a lifelong disease
■ Possible liver cirrhosis
○ There are a lot of HB carriers
■ Don’t have manifestation but can
infect you
● Pentavalent ​(Administered 6, 10, 14 weeks)
○ Deep IM, Z-track method
○ Causes fever (usually Pertussis)
○ Should never be given at the same time / site
ROTAVIRUS​ (2012)
● Rotarix; OM
● Cause of Acute Gastroenteritis among 5 y.o.
● 1st​: 6-15 wks | ​2nd​: 10-32 wks
● Can cause severe watery diarrhea and vomiting in
infants & young children
○ Cause of dehydration & even death
PNEUMOCOCCAL Vaccines​ / PCV​ ​(2012)
● 6, 10, 14 weeks
● (PPV) Pneumococcal Polysaccharide Vaccine — given
to age 65 & older, and also those who are high risk
OPV
● OM; two drops
● Don’t let the dropper touch the tongue
● Not to give anything within 30 minutes after receiving
OPV
● Make sure that it’s locked so that it won’t disconnect
TDAP
● Diphtheria: Thick white covering at the back of the
throat
● Tetanus: tightening of muscles
● Pertussis: whooping cough; 100-day cough
~ TT: ​natural passive immunity​ from the mother
Haemophilus Influenzae B​ / Hib
● Responsible for serious illness such as meningitis &
pneumonia
Page ​9​ of 18
○ It can also cause epiglottitis (infection in the
throat; breathing difficulties)
○ Even arthritis
● Spread through droplets
● Invasive bacterial infection
● Majority: under 5 y.o.
● Vulnerable​: 4-8 months
AMV / MMR
● AM1 then AMV2 after 1 month
● We start giving at ​9 months
○ Because passive immunity is fading
○ if outbreak is present earliest is 6 months
~ SC = back part of the arm: sa taba
GENERAL PRINCIPLE OF VACCINATION
● It is safe & immunologically effective to administer all
EPI vaccines on the same day at different sites of the
body
2.5–5 cm apart to prevent overlapping of local rxn
Sometimes, 2-3 vaccines
Penta-Hib should be given at a separate time
● The vaccination schedule should ​not be restarted from
the beginning even if the intervals between doses
exceeded the recommended interval by months or
years
NEVER RESTARTED
No extra doses [DPT, HB. OPV, TT]
● Moderate fever, malnutrition, mild respiratory infection,
cough, diarrhea, and vomiting are not contraindications
to vaccination
Generally, one should immunize unless the child is
so sick that needs to be hospitalized
Be vaccinated despite the given above.
~ absolute contraindications
● DPT2 / ​DPT3 to child who has had ​convulsions or
shock​ within 3 days from the previous dose
● Live vaccines must not be given to individuals who are
immunosuppressed
e.g. BCG
● Over 5 years of age
● With recurrent convulsions or another active
neurological dose of the CNS
● Rotavirus vaccine​: Hx of hypersensitivity,
intussusceptions or intestinal malformations, or acute
gastroenteritis
E. Fineza & J. Dimasacat | 2NUR4
— It is safe & effective with mild side effects after vaccination.
Local reaction, fever and systemic symptoms can result as part
of the normal immune system.
e.g. Swelling at injection site, low grade fever, some
systemic symptoms
— ​Less than 4 weeks interval ​= ​lessen the antibody response
● Lengthening the interval ​=​ higher antibody levels
— strictly follow the principle of ​never, ever reconstituting
freeze dried vaccines in anything other than the diluent
supplied with them
powdered form + specified diluent ONLY = good for 6h
Stored at either refrigerator / room temperature
FALSE CONTRAINDICATIONS
● Malnutrition
○ The more we should vaccinate
○ Child has weak immune system
● Low-grade fever
○ Unless high grade fever
● Mild respiratory infection
○ Mild coughs & colds
● Diarrhea
○ Even if OPV is presence but the dose is not
counted, the next dose will be given & that will
be counted as first
— 1 syringe ​=​ 1 needle per child during vaccination
● Multidose vials is okay but 1 syringe 1 needle should be
followed
— all children entering day care centers/preschool & Grade 1
shall be screened for measles immunization
● Those without should be referred to the nearest facility
for vaccination
● Make referral as needed — PHN as managers
EPI VACCINATION
Attenuated vaccines
● Live microorganisms that have been altered so that
they are no longer pathogenic, but are still allergenic
● They create a strong & long lasting response
weakened = attenuated
We never give them to those immunocompromised
e.g. MMR, Rotavirus
Inactivated vaccines
● Use the killed version of the germ that caused a
disease
they don’t provide as strong as live vaccines;
several vaccines over time = BOOSTER SHOTS
e.g. flu vaccines
Toxoids
● Inactivated ​/​ altered bacterial exotoxins
e.g. TT — 5 doses for lifetime protection
Page ​10​ of 18
TARGET SETTING & VACCINE REQUIREMENTS
● Estimated # of ​infants​ ​=​ total population ✖ 2.7%
● Estimated # of ​12-59 month-old​ children​ = ​tp✖10.8%
● Estimated # of ​pregnant​ ​= ​tp ✖ 3.5%
MAINTAINING THE COLD CHAIN
● COLD CHAIN
○ System for ensuring the potency of a vaccine
from the time of manufacture to the time it is
given to an eligible client
○ Storing & transporting vaccines
○ Maintaining temperature from manufacture to
use
● Cold chain officer​ = ​Public Health Nurse
○ Directly responsible for the cold chain
management at each level
○ Maintaining the cold chain equipment and
supplies
○ Emergency plan (if power outage or natural
disaster, plan where to bring the vaccine)
MAINTAINING THE EFFICACY OF BIOLOGICALS
~ OPV is ​very sensitive to heat
● -15 to - 25 o​​ C
● in freezer
~ All other vaccines are ​sensitive to heat
[Penta-Hib, TT, MMR, HB, Rotavirus]
● +2 to +8 o​​ C
● in refrigerator compartment
● Sensitive to freezing
~ Use cold packs during transport
~ vaccine temperature is monitored 2x/day & plotted
every morning & every afternoon
usually data records kept for 3y — dependent on
institution
~ shake the ice pack, you need to hear the sound of water
because there are vaccines that are easily destroyed by freezing
During immunization sessions….
● Tale one ice pack out of the carrier and place OPV and
reconstituted vaccines on it
reconstituted vaccines = BCG, MMR, etc.
● Ice pack has holes
E. Fineza & J. Dimasacat | 2NUR4
FEFO vaccine ● Maximum of 4 weeks
● First expiry, first out ○ Expiry date gas not passed
● To ensure that all vaccines are utilized before its expiry ○ Has not been contaminated
date ○ Stopped under appropriate cold conditions
● Proper arrangement or labelling of vaccines to identify ○ Vaccine vial septum has not been submerged
in water
CONSIDERATIONS TO MAINTAIN POTENCY ○ VVM has not reached the discard point
● RHU with a refrigerator — not exceed ​1 month
● Transport boxes — max of ​5 days
DISCARDING UNUSED BIOLOGICALS
Emphasize the importance of allocation
● Discard unused portion of BCG & AMV, 6h after
FREEZERS & REFRIGERATORS reconstitution or at the end of the immunization session
● Stand-alone units (recommended by CDC) whichever comes first
ref only / freezer only They are both in powder form so you have to make
● Alternative, to use refrigerator compartment of a use of their diluent, once diluted it can only be used
combination refrigerator to store refrigerated vaccines for a maximum of 6h.
● MUST TO HAVE stand alone freezer
● It has been shown that refrigerated vaccines are CONSIDERATIONS IN BCG
compromised by exposure to freezing temperatures of a
combination unit ● Protect BCG ​FROM SUNLIGHT
● At a minimum, a combination refrigerator for home use ● Do not apply alcohol to the site of injection
must have separate exterior doors & thermostat control ● Expected side-effect:
for each compartment is acceptable BUT NOT ○ Local inflammatory reaction / superficial
RECOMMENDED especially if you use a dormitory abscess / ulcer 2-12 weeks after immunization
style refrigerator (1-door-small-ref) will leave permanent scar
○ Consistently showed unacceptable ID at right arm
performance regardless of where the vaccine ○ No side effect: repeat BCG after 2 months
was placed in the unit ○ Koch’s phenomenon
○ Severe temperature control instability issues ■ begins after 2 to 4 days (like the
● If 2-door-ref, only use the refrigerator — not freezer normal reaction)
■ No special treatment
STORAGE UNIT PLACEMENT ○ Indolent ulcer
● Place well-ventilated room ■ does not heal within 12 weeks
● Allow at least ​4” ​between storage unit & a wall ■ secondary bacterial infection
● Do not block motor cover ■ Treatment: local INH
Nice to put ‘do not unplug sign’ also ○ Deep (subcutaneous) abscess
We don’t put food in freezers ■ Wrong technique
We don’t put vaccines on shelves / freezer doors ■ Treatment: Incision & Drainage (I&D)
● Ensure unit stands level with at least ​1”—2” between + local INH
bottom of unit & floor ● HEALTH TEACHINGS
○ Do not clean site of injection using alcohol or
CONSIDERATIONS TO MAINTAIN POTENCY betadine
Vaccine Vial Monitor​ (VVM)
● Round disc of heat-sensitive material places on a PROTECT ROTAVIRUS FROM LIGHT
vaccine vial to register cumulative exposure
● Direct relationship between color change & temperature CONSIDERATIONS IN DPT
● Inject Penta-Hib or DPT by deep IM or ​Z-track
technique
stage ​I
● Side Effects:
○ Fever within 24 hours after immunization
stage ​II
○ Local tenderness for 3 to 5 days
○ tenderness on the 2nd week = wrong
stage ​III
technique, may need I&D
stage ​IV
CONSIDERATIONS IN TT
Open Vial Policy ● select non-dominant arm
● Multi Dose liquid vaccines: OPV, Penta, HB & TT
Page ​11​ of 18 E. Fineza & J. Dimasacat | 2NUR4
 ● Side effect: 1. Assess
○ Local tenderness ● Checking for danger signs
● Hx taking to know the disease condition to
explore the possible causes
CONSIDERATIONS IN OPV
DANGER SIGNS
● Withhold feeding for 30 minutes after administration ● Convulsions
● not able to BF / drink
CONSIDERATIONS IN AMV ● abnormally sleepy
● vomiting
● Measles-like rash may appear 4 MAJOR SYMPTOMS
● Fever may occur ● Cough / difficulty of breathing
○ RR >40 = fast breathing for >1y
○ RR >50 — infants
Integrated Management for Childhood Illnesses ​(IMCI) ● diarrhea
● ear problems
● Offers simple & effective methods for child survival, ● fever
healthy growth and development and is based in the
combined delivery of essential interventions at 2. Classify
community, heath facility, and health systems levels ● Child’s illness by color coded triage system
Aim is to reduce death, illness & disability f as well ● More than one condition
as to promote improved G&D among children on ● Classify according to severity
their 5 years of age 3. Identify
● Preventive & curative ● Specific treatments
Implemented by communities, families & health ● Urgent referral? then give essential treatment
facilities before referring
SECONDARY LEVEL OF PREVENTION ● Immunization status
● Sick children​ [1 week — 5 years] 4. Treatments
● What happens is that they only rely on available data & ● Instructions of oral drugs, feeding & fluids
resources ● Teach the caregivers how to feed & replace
lost fluids
THREE MAIN COMPONENTS ● Follow-up dates, how to recognize S/S or
— promotes the accurate identification of childhood illness in when the child should return immediately
out-patient settings 5. Counsel
— at home: promote proper health-seeking behavior, improve ● Mother about BF & about her own health as
nutrition & preventive care well as to follow further instructions in further
childcare
1. ​Improving case management skills of healthcare staff ● Health education
● Case management guidelines ● Promote health & avoid risk for infection
● Training of health providers (Doctors , Medical 6. Follow up care
Assistants & Nurses) who look after sick infants and ● Reassess the child for her new problems
children up to 5 years (pre-service and in-service) ● When brought back to the clinic
● Follow-up after train ● Check the child for any new problems

2. ​Improving overall health systems

● Includes drugs & necessity to referral for hospital or at
home
● Targets first level health facilities
● Organization of work
~ Pink / Red
● Availability of drugs and supplies
~ According to urgency
● Monitoring and supervision
~ In asthma action plan = they use red
● Referral pathways and systems
● Health information systems

3. ​Improving family & community health practices

● To know how to manage the sick child at home or if we
need them to be referred to the hospital

ELEMENTS OF CASE MANAGEMENT

Page ​12​ of 18 E. Fineza & J. Dimasacat | 2NUR4

 — Factors that causes this is related to poor diet
● Infection
○ diarrhea, vomiting and fever
● Intestinal parasitism
○ associated with stunting of growth, physical
weakness, and low educational performance in
children

Common Intestinal Parasites

ASCARIS
● a.k.a. giant roundworm
● nutritional competition
● takes up residence in host intestine

HOOKWORM
CHARTS ● blood sucker
According to the age group of the child ● heavy infestation is seen as severe anemia
● 2 months — 5 years ● enters the human body by skin penetration
● 1 week — 2 months ● spreads through soil
~ for consultation or immunization or because the baby is sick?
~ determine age in order to choose the correct IMCI chart & ENTEROBIUS / OXYURIS
begin the assessment process ● a.k.a. ​pinworm
● habitat is the rectum
● major symptom is pruritus ani
● highly contagious
● accidental breathing or swallowing of this worm
by contaminated food,drink & hands
● anal itch can be experienced

TAENIA SAGINATA / SOLIUM

● a.k.a. ​tapeworm
● the longest intestinal parasite (avg adult length is about
15 to 25 meters​)
● infected person who hold a contaminated food -
therefore, proper hand washing should be practiced
before and after preparing food and after using the
bathroom

Nutritional Assessment Methods:

1. Anthropometry
The Philippine Nutrition Program ● major tool in dx of protein-energy malnutrition (PEM’
● physical measurement of body
COMPONENTS OF THE PHILIPPINE NUTRITION PROGRAM ● important to determine nutritional status of the child
1. Nutritional surveillance / assessment
2. Nutritional education Weight for age
3. Food assistance / Feeding Program ● 0-71 months, ​operation timbang
4. Food Production / livelihood annual weighing of all preschoolers
5. Micronutrient supplement ​ peration timbang plus now because we also
a.k.a. o
6. Food Fortification measure the height
7. Deworming ● Not used (operation timbang) when patient has edema
8. Treatment of conditions associated with malnutrition ● Used in diagnosis of:
All Filipinos 98% believe important for government to ○ CHRONIC MALNUTRITION
provide proper information and address malnutrition ■ cause cognitive and physical delays
■ undernutrition)
Conditions associated with malnutrition ■ stunting
○ ​ACUTE
— Over and under nutrition
Page ​13​ of 18 E. Fineza & J. Dimasacat | 2NUR4
 ■current, temporary, seasonal 30-40% Moderate Obesity
malnutrition
● Overweight ➡ obesity < 40% Severe Obesity
● Underweight ➡ wasting
● Weighing is conducted anywhere that is accessible for Skin fold thickness
health care team and community people (BHS, Daycare ● Thickness of subcutaneous tissue in
center, Basketball court) ○ TRICEPS
● Local nutrition action planning ○ FEMORAL
○ Data from Operation Timbang Plus ○ ABDOMINAL
○ Provide data on effectiveness of program ● Adults to dx acute malnutrition
○ Nutritional status of children ● Using Harden caliper
○ To assess whom to prioritize nutrition
○ e.g. feeding programs 2. Biochemical examination
● more expensive than the other methods: Hgb det,
GOMEZ CLASSIFICATION OF NUTRITIONAL STATUS Serum CHON, BUN, Creatinine

➗
● Formula for computation of % of IBW ● blood and urine samples
● (Actual body weight expected body weight ) ✖100 ● serum retinol to detect of vitamin A deficiency
> 110 % overweight ● Hgb determination for iron deficiency anemia
● not readily available in health centers
91-110% NORMAL

76-90% 1st degree undernutrition (MILD)

3. Clinical examination
● examination of the patient for the symptom
61-75% 2nd degree undernutrition (MODERATE) ● Diagnosis of micronutrient deficiencies
○ Kwashiorkor
≤ 60% 3rd degree undernutrition (SEVERE)
■ Well-nourished appearance
○ Marasmus
Height for age ■ Starved appearance
● Under 5 ○ check for eyes: night blindness detection
● Dx of chronic undernutrition ➡ stunting
● linear growth failure - fail to attain appropriate height for 4. Dietary history
age ● 24 hour diary, dining out habits
● Stunting is intergenerational ● frequency of food consumption (fruits, vegetables,
● prone to overweight / obesity meat, dairy)
● e.g. adult who is depressed and alone can be more
Mild upper arm circumference prone to malnutrition because of skipping meals
● 1-4 years old
● Rapid screening for malnutrition 5. Health history
~ Procedure: ● to determine secondary factors of malnutrition, such as
1. Determine midpoint between acromion and olecranon diarrhea
2. Measure circumference at midpoint ○ possible (+) intestinal parasites
measure the dominant hand (bigger) ○ repeated diarrhea ​= long term damage in GI
not to loose nor too tight system ​= ​late / prevents absorption of nutrients
3. Interpretation: and the immune system is also affected
● >​ 13 cm​ = normal nutritional status
● <13 cm = acute undernutrition (Wasting)
Philippine Nutrition Programs
● Red​ = severe acute malnutrition (for treatment)
● Yellow = at risk for malnutrition (consult and Nutrition education
HE) ● includes nutritional guidelines for Filipinos and other
● Green​ = well nourished nutrition key messages and training of health workers.
● e.g. Pinggang Pinoy and Filipino Pyramid Activity Guide
Weight for height ● malnutrition is common in children age 4
● Done in adults ○ Direct influence on ​nutritional status
● Dx of acute malnutrition ○ SDG Goal 2 Zero Hunger
BMI =kg/m​2
Food Production
20-25% NORMAL ● includes establishments of kitchens, gardens in homes,
schools and communities in urban and rural areas.
27.5-30% Mild obesity

Page ​14​ of 18 E. Fineza & J. Dimasacat | 2NUR4

 ● Demonstration centers and nurseries and distribution of ○ appears with bitot’s spot
planting materials ○ 2-5 days of treatment
● Required to plant different vegetables in school. Study ● Bitot’s spot
shows that children involved in gardening and planting ○ foamy silvery spot on sclera
vegetables tend to eat this kind of food. Eating fruits ● Corneal opacity
and vegetables has been linked to developing good Cornea is transparent structure in front of eyeball
behavior. ○ disorder of cornea
○ Scarring which causes cornea to be light and
Food assistance cloudy
● includes center based complementary feeding for ● Keratomalacia
wasted/ stunted children and pregnant women with ○ softening of the cornea to corneal rupture to
delivering low birthweight. irreversible blindness
● Done in school - free rice distribution ○ Start as severe dryness of cornea and
● Tindahan natin program - food discounts once you buy. conjunctiva
All nutritious food is being sold.

~ medications:
Micronutrient Supplementation
● 100,000 IU ​Vitamin A capsule
MICRONUTRIENT ○ infants 6-11 months old
● Involves both vitamins and minerals in concentrated ● 200,000 IU ​Vitamin A capsule
forms ○ given to children who are 12 months to 71
● Present in the body but in very small amounts months old
● Pharmaceutical prepared ● Cut tip of vitamin A capsule then drop on mouth of baby
● A substance found in very small amounts in the body
(<.005% of body weight). ~ Vitamin A deficiency can lead to death caused by Measles,
● Major micronutrient deficiency conditions in the respiratory infection and diarrhea
Philippines
○ Vitamin A deficiency (VAD)
TARGETS PREPARATION DOSE DURATION
○ Iron-deficiency anemia (IDA)
○ Iodine deficiency disorders (IDD’s) Pregnant 10,000 IU 1 capsule/tablet Giving of Vitamin
of 10,000 IU 2x A supplement:
a week
VITAMIN A DEFICIENCY​ (VAD / xerophthalmia) 4th month until
Vitamin A a.k.a. retinol pregnancy

● For healthy vision & immune system, growth and Remember

development of fetus Vitamin A should
not be given to
● Susceptible population pregnant women
○ 1-4 years who are taking
prenatal vitamins
○ usually occurs together with PEM or multiple
● Foods rich in vitamin A micronutrient
tablets that
○ Richest: liver, egg yolk and milk - contain contain Vitamin A
retinol(vitamin A - fat soluble)
○ Best (considering socio-economic status of Postpartum 200,000 IU 1 capsule One dose only
200,000 IU within 4 weeks
family): dark green leafy vegetables, yellow after delivery
fruits and vegetables; contain carotene

~ Signs of Vitamin A deficiency VITAMIN A CAPSULE FOR CHILDREN

● Night blindness
TARGET POPULATION SCHEDULE
○ earliest sign
○ due to lack of rhodopsin (visual purple) in rods Infants 6-11 mos. old 100,000 IU once only
○ Defect on rod cells difficulty seeing in the dark
● Photophobia Children 12-71 mos old 200,000 IU every 6 mos
Vitamin A from balance healthy diet
○ Afraid of light or very sensitive to light (dairy, vegetables, fruits)
does not mean afraid of light In low income countries, children
don’t eat a balanced diet. Hence this
● Conjunctival xerosis is needed to be given as supplement
○ dryness of the conjunctiva secondary to
inadequate tears
IRON DEFICIENCY ANEMIA​ (IDA)
○ Area is rough and fine droplets or bubbles in
common cause of anemia
surface
● Susceptible population
Page ​15​ of 18 E. Fineza & J. Dimasacat | 2NUR4
 ○pregnant women ● substances that ​interfere​ with Iodine use
■ Physiologic anemia interfere with normal function of thyroid
○ ​infants gland
■ During periods of rapid growth ○ Thyroid - below adam’s apple
● Doesn’t happen overnight/ Severe deficiency can ● found in cabbage, turnips, mustard, red skin of
happen over time. peanuts, cauliflower, broccoli brussels sprout,
● Foods rich in iron cassava.
○ Liver and other intestinal organs ● Rabbits who eat cabbage have enlarged
○ Egg yolk thyroid gland
○ Dark green leafy vegetables ● Goiter
● Major sign of IDA: ​Palmar Pallor ○ difficult to swallow or breathe
● Breast milk iron is absorbed 3x than formula milk ○ common cause is lack of iodine in
● When baby is at complementary feeding, rich in iron diet
foods should be given
● Do not stretch hands or fingers backward it will appear
more pallor (hands)

ZINC SUPPLEMENT
IODINE DEFICIENCY DISORDERS​ (IDD) ● < 6 mos: 10 mg elemental zinc OD
● Most serious effect: ​mental retardation​ (cretinism) in ● 6 to 59 mos: 20 mg elemental zinc OD for 10-14 days
the baby ● Helpful for children who have Diarrhea
● Other signs of cretinism: ○ Essential for protein synthesis, cell growth,
1. Growth stunting and differentiation
2. Pasty skin ​- pale complexion ○ Boost immune system and intestinal transport
3. Protruding abdomen of electrolytes
4. Deaf mutism ​- unable to hear and speak ○ Hence, lowers incidence of diarrhea
● Iodine requirement increases during pregnancy to
ensure adequate supply to the fetus
○ Universal Salt iodization - iodized salt usage Food Fortification
● Child with cretinism
○ Puffy and dull LEGISLATION AFFECTING THE PHILIPPINE NUTRITION
PROGRAM
○ Slow reaction
○ Large, thick protruding tongue (a.k.a. R.A. 8172​ ​or​ ASIN LAW
Macroglossia) ● Act for Salt Iodization Nationwide
○ Low hairline ● Required to iodize the salt they produce /
○ Dry brittle hair manufacture / import / trade / distribute
○ (+) edema in eyelids ○ products for companies
○ Yellowing discoloration of skin ○ IDD is a broad spectrum of deficiencies
■ Reduction of intellectual & physical
~ Food rich in iodine: capacity affecting everyone with
1. SEAFOODS iodine deficiency
● naturally high in iodine ■ Most common: goiter
2. Vegetables and fruits ■ May also manifest as mental
● depends on the soil on which they are grown retardation / physical & mental
● Near coast = ⬆ iodine level defects & cretinism
● land = ⬇ level of iodine
3. Goitrogens R.A. 8976​: Philippine Fortification Act of 2000
Page ​16​ of 18 E. Fineza & J. Dimasacat | 2NUR4
 ● To increase the intake of an essential nutrient ○ Pull out worms from orifices
● Important for optimum health & to compensate for the
loss of nutrients NOT ADVISABLE if the child has any of the ff conditions:
○ Happens during food processing & storage ● Serious Illness
● This provides for ​mandatory fortification​ of the ff ○ One that requires hospital referral
products: ● Abdominal Pain
○ Rice with iron ● Diarrhea
○ Wheat flour with vit. A and Iron ● Hx of hypersensitivity to the drug
○ Refined sugar with Vit. A ● Severe malnutrition
○ Cooking oil with Vit A
● EO 382​: ​November 07 declared as ​National Food
ORAL HEALTH SERVICES
Fortification Day
● FORTIFICATION ● Fundamental to overall health, wellbeing & quality of life
○ Addition of micronutrients to staple food ○ healthy mouth to avoid difficulty eating and
● R.A. 8976​ Philippine Food Fortification Act speaking
● Sangkap Pinoy Seal ○ Enables an individual to eat, speak, and
○ placed on the label of fortified foods socialize without pain, discomfort &
○ after approval (nasa junk foods) embarrassment
○ including Iodized salt ○ Affects self-esteem

Two most common oral health diseases:

● Dental Caries
○ affects majority of Filipinos
● Periodontal Diseases
○ gum disease

Oral interventions depending on the age

1. ​0-11 months (Infants)
● 0-8 Mos:
○ Oral Examination
■ Careful checking of the oral cavity to
detect / dx oral diseases
■ Detect S/S of sexually transmitted
DEWORMING disease & if diabetic
High blood sugar = oral problems
● Free in healthcare center
are more likely to develop
● Age 1- 12 years old every 6 months
Uncontrolled diabetes = weakening
● Taken on full stomach
of WBCs — ​ body’s main defense
○ Deworming limits intestinal parasitism
against bacterial infection
● Done 2x a year - January and July
AIDS: (+) cold sore in the mouth
● Johnson and Johnson Philippines ​donated 46
○ instruction on infants’s oral health care
MILLION TABLETS OF MEBENDAZOLE
○ Advice on EBF
○ last national deworming of DOH
● 0-11 months
● Depends whether you use albendazole and
○ Same as above and topical fluoride application
mebendazole
(done in areas where fluoride content is low)
ALBENDAZOLE 400mg/tab MEBENDAZOLE 500mg/tab
2. ​1-4 years old (11-59 months old children)
12-23 mos ½ tab 1 tab
● Oral Examination
24-59 mos 1 tab 1 tab ○ Done by dentists
● Topical Fluoride Application
POSSIBLE ADVERSE EFFECTS of deworming: ○ Done in areas of ⬇ fluoride levels
● Local Sensitivity or Allergy ○ Non-invasive
○ Give antihistamine ● Supervised Tooth Brushing
● Mild Abdominal pain ● Oral Health Education
○ Anti dysphoric ● Atraumatic Restorative Treatment (ART)
● Diarrhea ● Oral prophylaxis or scaling
○ Give ORS
● Erratic Worm Migration 3. ​5-9 years old (school-aged children)
Page ​17​ of 18 E. Fineza & J. Dimasacat | 2NUR4
 ● Oral examination ● Gum Treatment
● Supervised toothbrushing ● Extraction
● Oral health education
● Pits and Fissure Sealant Promotive Services
○ non-invasive ● Health Education directed to a target group
○ preventive and control measure against tooth
decay
SOCIAL SERVICES
○ done with fluoride therapy to smoothen the
surfaces ● Range of public services provided by government and
● Temporary Filling sometimes provided by private / non-profit
● Permanent Filling organizations
○ OJT, Housing, food subsidies
4. ​10-19 years old (adolescents) ● 4 P’s
● Oral examination
● Education and counselling on good oral hygiene, diet NATIONAL HOUSEHOLD TARGETING SYSTEM (NHTS)
and adverse effects of tobacco’ smoking and alcohol ● An information management system that identifies who
and sweetened beverage and food and where the poor households are in the region and in
● Pit and Fissure Sealant Application the whole Philippines.
● Temporary filling ○ A system for generating and establishing a
● Permanent Filling socio-economic database of poor households
● Oral prophylaxis or scaling ● 30% of Filipino Families have income below needed for
● Oral Urgent Treatment (OUT) basic requirements
● Oral hygiene ● To inform the government departments & policy makers
○ Regular & proper way of toothbrushing of the socio-economic status of nearly 400,000
● Gum massage households
○ taking anticonvulsants ● We are able to generate data who will receive 4P’s
● Usage of mouthwash program

5. ​Pregnant women 4P’s

~ at high risk of developing dental caries because there cavity is ● a.k.a. Pantawid Pamilyang Pilipino Program /
more acidic Conditional Cash Transfer Program (​CCT​)
● Eat a lot of sugary food ● rights-based
○ Excess consumption ● Social development program to reduce poverty
● Increase acidity in gums ● Flagship program of Gloria Arroyo
● Nausea and vomiting ● 0-14 children given daily allowances for education
● Hormonal changes ○ Makes poverty an excuse not to go to school
● Less saliva ○ Dietary allowance also
● Dental decay = dry mouth ● Operates in all regions
● Cavity problems ● Has to belong to the poorest of the poorest family
● With that, need for preggy moms to brush teeth
● Oral examination
● Education and counselling on good oral hygiene, diet
and adverse effects of tobacco’ smoking and alcohol
and sweetened beverage and food
● Oral Prophylaxis/scaling
● Gum treatment
● Temporary filling
● Permanent filling END OF PRELIMS

CLASSIFICATION OF ORAL INTERVENTIONS

Preventive Services
● Oral Examination
● Oral Hygiene

Curative Services
● Treatment
● Permanent filling — pasta
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