CHN Rle - Nur8109: The Manila Health Department

CHN RLE - NUR8109 The Manila Health Department
● a working arm of the City Government of Manila,

Philippine HCDS Delivering Primary Health Care Services
● The DOH and Welfare in the City of Manila, later
● organized plan of rendering if healthcare services to the
renamed MANILA HEALTH DEPARTMENT, was
people
established by Commonwealth Act 561 on July 1, 1940.
● Compromise of network of health facilities and
personnel which carries out the duties of providing
VISION
healthcare to the people
To be a strong and dominant force in the healthcare system of
Manila by providing a high standard or health care service.
Department of Health (DOH)
— Secretary of Health: Dr. Francisco T. Duque, III, MSc
— Vision
MISSION
● Filipinos are among the healthiest people in Southeast
To conduct health care services in the highest form of
Asia by 2022 & Asia by 2040.
professionalism guided by the highest standards of competence,
— Mission
integrity & excellence. The Department is concerned mainly on
● To lead the country in the development of a productive,
the promotion of health and prevention of diseases to the Manila
resilient, equitable & people-centered health system.
Constituents with special focus on the poor families. It
— Mandate
administers free specialized services and implements regular
❖ The principal agency in the Philippines
activities on the different thrust programs of Maternal and Child
❖ Overall technical authority on health
Care, Communicable & non-Communicable Diseases Control,
❖ Provide national policy direction & develop national
Environmental Sanitation, Dental & School Health.
plans, technical standards, & guidelines on health
❖ Regulator of all health services & products
undergoes inspections & certifications of DOH FACILITIES
❖ Provider of special & tertiary healthcare services and of
technical assistance to other health providers especially 51 health centers 1 Public Health Laboratory
to LGU
12 Lying-in clinics 2 Cemeteries (North & South)
❖ “The primary function of the DOG is the promotion,
protection, preservation or restoration of the health of 4 Community Reference Infirmaries 1 Insect and Vermin Control Office
the people through the provision & delivery of health
1 Satellite Clinic 1 Venereal Disease Clinic
services and through the regulation and encouragement
of providers of health goods and services” 4 Flying Squads Stations 1 Mortuary Complex
1 City Government Employees Clinic 1 Drug Rehabilitation/Treatment Clinic
1 Geriatric Clinic
Levels of Primary Secondary Tertiary

Prevention
Target Well individuals, early sick late sick;

families, groups & convalescent,
communities disabled, RHU Team
complicated,
terminally ill ● Municipal Health Officer (MHO)
○ Manila: Dr. Arnold M. Pangan
Aspects of ➖ General health ➖ Early diagnosis ➖
➖ Rehabilitation ● Dentist
Prevention
➖
promotion
Specific ➖
& prompt treatment
Prevention of
Prevention of
permanent ● Public Health Nurse (PHN)
➖
disease prevention
Specific
protection
complication disability/disability
limitation
●
●
Rural Health Midwife (RHM)
Medical Technologist
● Sanitary Inspector (SI)
Page 1 of 25 E. Fineza | 2NUR4

● Community Volunteer Health Workers/ Barangay
Control of Non-communicable Diseases
Health Workers (CVHW/BHW)
○ e.g. student nurses PROGRAM SERVICES
Cardiovascular ● Blood pressure monitoring

Reproductive Health & Maternal Services Diseases ● ECG and laboratory examinations
● Dietary and exercise counseling
● Provision of anti-hypertensive drugs
PROGRAM SERVICES
● Anti-smoking campaign
● Promotion of Healthy Lifestyle
Safe Motherhood and ● Pre-marital and parenthood counseling
Women's Health ● Pap's Smear
Cancer ● Pap’s smear to all women ages 40 years
● Natural Family Planning counseling
and above
● Self-breast examination to detect early
Maternal Care ● Maternal Care Prenatal and Postpartum signs of cancer
consultation ● Lectures on anti-smoking campaign
● Vitamin A and Iron Supplementation ● Promotion of Healthy Lifestyle
● Essential Intrapartum and Newborn Care
● Monitoring of Malnourished Pregnant
Visual Health ● Visual acuity testing
Women
Program ● Consultation and treatment of common
eye problems
● Eye Exercises
Early Child Care Services
Diabetes ● Blood chemistry for screening and
monitoring
Newborn Care ● Routine Newborn Care ● Diet counseling
● Newborn Screening and Hearing Test
● Early Initiation of Breastfeeding
Integrated Management of Childhood Illnesses Environmental Health
Under-5 Clinic and Growth Monitoring PROGRAM SERVICES
Breastfeeding Program Water & Sanitation ● Water and food sampling including
swabbing of utensils
Nutrition Program ● Inspection and issuance of Sanitary
Permits to industrial and commercial
establishments (food and non-food)
Expanded Program on Immunization ● Inspection of water and toilet facilities
● Inspection and regulation of water
refilling station
Control of Communicable Diseases Insect & Vermin ● Fogging and spraying

Control ● Larvi trapping in Barangay households
PROGRAM SERVICES ● Domestics Pests Control
● Educational Campaign for the Control of
Insect Vectors
Tuberculosis ● Provisions of Anti-TB drugs (Directly
Observed Treatment Short Course
Chemotherapy-DOTS) to qualified Urban Cleaning and ● Zero Waste Management
patients Greening ● Garbage Recycling
● Sputum Microscopy-case finding and ● Tree Planting
follow-up ● Herbal and Vegetable Gardening
● Chest X-ray ● Health Education
Leprosy Control ● Provision of anti-leprosy drugs to

qualified patients
● Laboratory diagnostic examination (skin Dental Health
slit
● smear) SERVICES
● Contact tracing
● Consultation and treatment
Sexually Transmitted ● Reactive Plasma Reagin, Urethral and ● Orally Fit Child Program
Diseases (STDs) Pap’s Smear ● Sealant application
● Provision of drugs to positive cases ● Health education
● Consultations in the Social Hygiene
Clinic and in Health Centers
● Voluntary Confidential Counseling and
Testing for HIV patients School Health
Dengue ● Health education activities in schools SERVICES
and in barangays
● Fogging, spraying and larviciding
● Larvitrap implantation for larval index ● Medical-Dental consultation and treatment
● Determination in Dengue hotspot areas ● Health inspections of classroom and school premises
● Annual P.E. of students, athletes, teachers and other school
personnel
Rabies
● Special programs and projects. Adolescent Counseling, Drug Abuse
Education Program and others

MNCHN Core Package of Services
A. PRE-PREGNANCY
● provision of iron and folate supplementation
● advice on family planning and healthy lifestyle
● provision of family planning services, prevention and
management of infection and lifestyle-related diseases
B. PRENATAL
DIMASALANG HEALTH CENTER ● first prenatal visit at first trimester

— under Health District III ● at least 4 prenatal visits throughout the course of
— Isagani Cor. Tiago St., Sta. Cruz, Manila pregnancy (DOH’)
— has the following: ● to detect and manage danger signs and complications
● Charting Area of pregnancy
● Consultation & Treatment Area
● Waiting Area
● Reproductive Health Service
● Immunization & Treatment Area
○ Refrigerator for vaccines
○ Vaccine bag ● Micronutrient Supplementation
● Vaccine Storage Units ○ provision of iron and folate supplementation for
● Drug Dispensary 3 months
● TB-DOTS Facility ○ Iron = pregnancy may cause anemia
○ Tuberculosis clients ○ Folic acid = for brain development
○ Sputum Collecting Room ○ iodine supplementation
● Microscopy Room
● Lecture Room
● 2 tetanus toxoid immunization (0.5mL, IM, Deltoid)

○ Supposed to be 5 doses
○ 3 doses in the course of pregnancy depending
on how early the mother seeked for help
● counselling on healthy lifestyle and breastfeeding,

prevention and management of infection, as well as oral
health services
Assessment during Pregnancy
A. HISTORY TAKING
DEMOGRA Name, Age, Religion, Address,

-PHIC DATA Telephone number, & E
mergency
Contact Details
CHIEF do not assume that Pt. is pregnant

COMPLAINT — ask the client the reason for coming
to the health center - for instance, the
fact that she is or thinks she is pregnant

— to help confirm pregnancy, inquire the smoking
date of her last menstrual period ● first-hand or second-hand,
(LMP) or whether she had or used a had been shown to be
home pregnancy test harmful to fetal growth
— elicit information about early signs of
pregnancy: nausea, vomiting, breast Alcohol Intake excessive intake can lead to poor
changes, or fatigue nutrition, fetal alcohol syndrome, and
may cause preterm birth
FAMILY Marital Status to identify the support persons available ● Number of bottles
HISTORY during pregnancy ● Alcohol %
● Frequency in a week/month
current living to identify availability of living space for
situation/set-up when the baby arrives, or potential Use of ● marijuana
household hazard for pregnant woman Recreational ● cocaine
drugs ● intravenous drugs
client and sexual genetic screening may be necessary if which can increase risk of exposure to
HIV or hepatitis B
partner's age age >35
educational level estimates the level of teaching a nurse GYNECO- MIDAS Menarche age of first menstrual period
will plan LOGIC interval
HISTORY duration
amount
occupation or Does it involve heavy lifting, standing for symptoms or discomfort: degree of
nature of work long hours, exposure to toxic menstrual discomfort helps anticipate
substances? level of family the need for additional counseling in
dependence/financial hardship because preparation for labor, as well as
➖
of stopping work
financial provider of the family
discomfort associated with resumption
of period postpartum
Identify Hx of can be a potential problem to the mother Sexual History identify number of sexual partners and
family illnesses during pregnancy or on the infant at use of safe sex practices; to establish
➖
birth, such as: risk of contracting STIs
● cardiovascular diseases head’s up
● renal diseases
● cognitive impairment
Use of — intrauterine device still in place
● blood disorders
● any known genetically contraceptives among pregnant women must be
inherited/ congenital removed to prevent infection during
anomalies pregnancy (presence of iodine)
— document whether the client took an
oral contraceptive not realizing she is
PAST Medical ● kidney disease pregnant, as estrogen can harm fetal
ILLNESS Conditions ● heart disease: coarctation of growth
the aorta and rheumatic
fever cause problem more
often Past medical
● hypertension problems with
reproductive
● STDs: including hepatitis B tract/breast
and HIV
● diabetes
● recurrent seizures Past surgery of history of ectopic pregnancy:
the reproductive tract increased risk for another tubal
● gallbladder disease
● UTIs pregnancy
● varicosities
● phenylketonuria uterine surgery: uterus may not
● TB and asthma expand and contract properly and a
Caesarean birth may be necessary
Childhood ● chickenpox dilation and curettage: cervix may be

Illnesses ● mumps weakened or unable to remain closed
● measles for 9 months
● German measles
● poliomyelitis
Stress — ask for loss of bladder control on
incontinence laughing, coughing, deep inspiration,
Allergies jogging or running, as it may intensify
during pregnancy
Past Surgeries adhesions from past abdominal surgery — weakness commonly occurs from
may interfere with uterine growth difficult births, birth of large infants,
grand multiparity, and instrumental
births, increasing abdominal pressure
DAY 24-hour recall ask the client to describe a typical day in
and bladder tension, causing emptying
HISTORY her life to elicit information regarding her
current diet and nutrition, elimination,
sleep, routine and recreation OBSTETRIC GTPALM a comprehensive system classifying
HISTORY pregnancy status providing greater
detail on pregnancy history
Medication ask the client whether she takes any
— do not include current pregnancy
History prescribed, over-the-counter, or herbal
in TPALM, include it if they have been
medications, because their effect on a
DELIVERED.
growing fetus will have to be evaluated
Gravida - the number of times the
SOCIAL Smoking habits identify pack years: woman has been pregnant, including
PROFILE or exposure ● number of packs smoked the current pregnancy
● years the client has been Term - the number of full-term infants

(≥ 37 weeks) ecchymosis on the face, forearms, abdomen or
Preterm - the number of preterm infants buttocks; such marks typically progress through
(< 37 weeks) purple to yellow changes
Abortion - the number of spontaneous
or induced abortion (those terminated HEAD & SCALP — assess head for symmetry, normal contour, and
before the age of viability, generally tenderness
accepted at 20-24 weeks) — assess hair for thickness as hair growth usually
Live births
speeds up during pregnancy, excessive dryness or
Multiple pregnancies oiliness, cleanliness, or use of hair dye which may be
carcinogenic over prolonged use
LMP Last menstrual period — assess face for chloasma (extra pigment on face
— first day of last menstruation due to melanocyte-stimulating hormone)
EDD Naegele’s formula EYES — assess for edema of eyelids which may suggest
April to December: -3m | +7d | +1y pregnancy-induced hypertension
January to March: +9m | +7d | +0y — client may also complain of red spots before their
eyes or diplopia (double vision)
— educate the client poor vision as a potential
AOG
➗
= sum of days (from LMP to Date today
or date of birth) 7
If no LMP, check for ultrasound
danger sign of pregnancy
If AOG is not matched with the patient’s NOSE & EARS — assess for appearance of swollen nasal
words (with regards of GTPALM), membranes or complaints of nasal congestion as it
double check with the patient may be caused by increased level of estrogen
associated with pregnancy
Nose affects the ears, vice versa
— feeling of fullness in the ears or dampening of
B. PHYSICAL EXAMINATION sounds may be associated with nasal stuffiness as it
can lead to blocked eustachian tubes
WEIGHT & HEIGHT — The amount of weight gain during pregnancy is
important for the health of the client's pregnancy and MOUTH, TEETH, & — assess for gingival hypertrophy: gums may be
for the long-term health of her and her baby THROAT slightly swollen and tender to touch, but not
— The amount of weight gain during pregnancy is reddened; may result from estrogen stimulation
based on your body mass index (BMI) before Use soft bristles & brush thoroughly
pregnancy — assess for cracked corners of the mouth: may
indicated Vitamin A deficiency
— if there is a presence of dental caries, refer the
client to a dentist
NECK — slight thyroid hypertrophy may be noticed due to

overall increase in metabolic rate
— advise the client to continue use of iodized salt
during pregnancy
Larger breasts: 1-3 lbs (about 0.5 - 1.4 kg)

LYMPH NODES — no palpable lymph nodes should be observed
Larger uterus: 2 lbs (about 0.9 kg)
(+) lymph nodes = possible infection
Placenta: 1 1/2 lbs (about 0.7 kg)
Amniotic fluid: 2 lbs (about 0.9 kg)
⬆ blood volume: 3-4 lbs (about 1.4-1.8 kg) EXTREMITIES & — assess for palmar erythema and itching; may be
⬆ fluid volume: 2-3 lbs (about 0.9-1.4 kg) SKIN associated with high estrogen level
Fat stores: 6-8 lbs (about 2.7-3.6 kg) — assess for presence of subclinical jaundice; due
to reabsorption of bilirubin due to slowed intestinal
peristalsis
VITAL SIGNS
— observe lower extremities for varicosities,
capillary refill (should be <5seconds), and presence
BP Some women have high blood pressure during
of edema (edema more than ankle swelling may be a
pregnancy. This can put risk for problems to the
danger sign of pregnancy); may be caused by
mother (pre-eclampsia, eclampsia, abruptio placenta)
impaired venous return
and her baby (preterm delivery) during the
Also check paleness of the sick
pregnancy. High blood pressure can also cause
problems during and after delivery.
Pre-eclampsia - h ypertension during pregnancy BREAST — areola darkens; second areola may develop
Eclampsia - h ypertension induced seizure during surrounding natural ones
pregnancy — Montgomery tubercles ( sebaceous glands in the
Abruptio placenta - placenta is touching the uterine areola) become prominent
wall — overall breast size increases
— breast consistency firms
— blue streaking of veins becomes prominent
— colostrum may be expelled as early as 16th week
of pregnancy
— nipple may darken and enlarge in size
HEART — normal HR 70 to 80 beats per minute

— no accessory murmurs should be heard; if heart
murmurs are assessed, the client may need further
evaluation to discern between physiologic changes
GENERAL — reveals how women feel about their pregnancy as and undetected heart condition
APPEARANCE not all women are happy about being pregnant — occasional palpitation may be noticed when
lying supine; advised client to lie on their left side to
— inspect the client for hygiene: unwashed hair,
unkempt or inappropriate clothing, or sad facial avoid this problem
expression
May lead to postpartum depression SPINE & BACK — assess for complaints of back pain associated
— potential signs of intimate partner abuse: with accentuation of lumbar spine when standing to

maintain body posture
— assess the spine for any abnormal curve
suggesting scoliosis; the client may need a referral to
orthopedist to ascertain that the condition is not
worsening
RECTUM — assess the rectum for hemorrhoids, which

commonly occurs from uterine pressure on pelvic
veins preventing venous return; hemorrhoids are
common occurrence during pregnancy and reassure
client if verbalizes discomfort IV. Identifies the engagement of the fetal presenting part
Bend over (tuwad) to reduce pressure ● Engagement refers to the descent of the
presenting part through the pelvic brim
ABDOMEN — striae gravidarum are atrophic linear scars that
represent one of the most common connective tissue ● the amount of the presenting part palpable is
changes during pregnancy used to describe descent into the pelvis
— linea nigra is a narrow, brown line forming,
running from the umbilicus to the symphysis pubis, ● if 2/5th or less of the presenting part is
separating the abdomen into right & left hemispheres palpable, it is engaged
FUNDAL HEIGHT & — A fundal height measurement is generally defined

FUNDAL HEART as the distance in centimeters from the pubic bone to
SOUNDS the top of the uterus
— measurement is typically done to determine if a
baby is small for its gestational age, as the
expectation is that after week 20 of pregnancy the
fundal height for a normally growing baby will match
the number of weeks of pregnancy — +/- 2 cm
— For example, if the client is 27 weeks pregnant, it
is expected that fundal height is about 27 cm.
LEOPOLD’S MANEUVER C. LABORATORY EXAMINATIONS

I. Determines the gestational age & fetal lie - ideally CBC hemoglobin/hematocrit/RBC determines presence of
cephalic (longitudinal, transverse, or oblique situation) anemia, WBC to determine infection, platelet count to
determine clotting ability
SEROLOGIC TEST for syphilis or gonorrhea
BLOOD TYPING & Rh blood may be needed if the woman has bleeding
FACTOR early in pregnancy
ANTIBODY TITERS for rubella, hepatitis (HBsAg), and varicella
HIV SCREENING
II. Establishes the position of the back (placed on the
back of the fetus, the fetal heart can be auscultated at MATERNAL SERUM done at 16-18 wks AOG; normal value is 2.5 MOM
this time) & small parts. AFP (multiples of the mean)
● ⬆ AFP = (+) neural tube or abdominal
defect in fetus
● ⬇ AFP = (+) chromosomal anomaly
INDIRECT COOMB’S detect the presence of antibodies against circulating

TEST RBCs in the body, which induce hemolysis: if titers
are not elevated, an Rh-negative woman will receive
RhIG (RhoGAM) at 28 weeks and after any
procedure that might cause placental bleeding
ORAL GLUCOSE done toward the end of 1st Trimester (28 weeks) to
TOLERANCE TEST determine gestational diabetes who has:
III. Confirms fetal presentation ● history of previously unexplained fetal
A. CEPHALIC - ideally vertex presentation loss
● family history of diabetes
● had babies who were large for gestational
age (wt >9 lb)
● obesity
● glycosuria
URINALYSIS to test proteinuria, glycosuria, and pyuria

for pre-eclampsia, gestational diabetes, & urinary
tract infection, respectively
TB SCREENING PPD test (purified protein derivative)
ULTRASOUND to date pregnancy or confirm fetal health

B. BREECH

COMMON DISCOMFORTS DURING PREGNANCY DANGER SIGNS OF PREGNANCY
Breast Tenderness — encourage to wear a bra with wide shoulder strap

● Menorrhea
for support ○ Vaginal bleeding
— if actual pain exists, conditions such as nipple
fissure or breast abscess, should be ruled out
○ cause preterm labor
● Chills and Fever
Palmar erythema — calamine lotion is soothing ○ may indicate intrauterine infection
— reassure client this is normal occurrence
● Abdominal pain
Constipation — increase amount of roughage in diet: raw fruits, ○ may be a sign of ectopic pregnancy, abruptio
vegetables, and increase oral fluid intake placenta
— enema should be avoided; stool softeners may be
prescribed
■ Placenta previa: placenta blocks the
cervix, cause of prolapsed cord
Fatigue — encourage to increase amount of rest and sleep ○ or non-pregnancy problems, such as
— modified Sim's position, with the top leg forward is
advised to put the weight of the fetus on the bed appendicitis, ulcer, or pancreatitis
side-lying position ● Chest pain
○ may indicate pulmonary embolus
Muscle cramps — elevate lower extremities frequently during the day
to improve circulation ■ embolus = dislodged blood clot that
— avoid full leg extension, such as stretching with travels & sticks to blood vessels that
with the toes pointed
— in relieving an actual leg cramp, press down the will cause blockage because platelets
knees and pressing the toes backward (dorsiflexion) will adhere
● Pregnancy-induced Hypertension:
Hemorrhoids — knee-chest position shifts the weight of the uterus
forward, promoting free flow of urine from kidneys ○ Rapid weight gain: >2 lb per week (2nd
(preventing UTI), and better circulation in the rectal Trimester), >1 lb per week (3rd Trimester)
area
○ Swelling of face or fingers
Incontinence — although largely unpreventable, doing Kegel ○ Flashes of lights or spots before the eyes
exercises help strengthens perineal muscles for birth ○ Dimness or blurring vision
○ Severe, continuous headache
Backache — wear shoes with low to moderate heels to reduce
the amount of spinal curvature necessary to maintain ○ Decreased urine output
upright posture
— encourage client to walk with pelvis tilted forward
Like waddling gait IDENTIFICATION OF HIGH-RISK PRENATALS
— advice to squat instead of bending over to pick up
objects
● Age
Headache — rest with cold towels on their forehead usually
○ <15y & >35y
provides relief ● Parity
— a headache that is unusually intense or
continuous may be a danger sign caused by high
○ >5 pregnancies
blood pressure ● Weight
○ <95 lbs
Dyspnea — to relieve nighttime dyspnea, advise client to sleep
upright with two or more pillows, to allow the weight
○ assessed monthly
of the uterus to fall away from her diaphragm ● Height
○ < 4’10”
Ankle edema — as long as hypertension and proteinuria is absent,
ankle edema is a natural occurrence
● Hemoglobin count
— sitting with legs elevated for half an hour in the ○ <8.5 gms
afternoon and evening is helpful
— avoid wearing constricting clothing to avoid
● Symptoms of HPN disorders
impeding lower extremity circulation and venous ● Poor OB history
return
● Associated medical conditions
Nausea & Vomiting — experienced through the 1st 3 mos. of pregnancy ● Vaginal bleeding
— sensation usually occurs on arising or while ○ premature rupture of BOW
preparing meals or smelling food
— vomiting at least once a day is common
— eating dry crackers may relieve nausea
— eat light breakfast or delay breakfast past the time C. POSTPARTUM
her nausea seems to persist, and compensate for
any missed meals later in the day ● visit within 72 hours and on the 7th day postpartum to
eat a late evening snack to compensate for late
breakfast
check for conditions such as bleeding or infections
— avoid taking antacids (e.g. sodium bicarbonate), ○ 1st: within 24 hours – 48 hours after delivery
which may cause fluid retention ○ 2nd: 1 week after delivery
— if vomiting persist beyond 4th month or it interferes
with nutrition, it may indicate hyperemesis ○ 3rd: 2 to 4 weeks after delivery
gravidarum ○ 4th: 4 to 6 weeks after delivery (visit to the
health facility)
● Vitamin A supplements to the mother
● there should be no bleeding at the cord site: bleeding
suggest cord clamp is loosened or bedclothes causes
friction which tugs the cord loose
● the base of the cord should appear dry: moist or
odorous cord suggest infection, requiring immediate
● counselling on family planning and available services, treatment before it enters the bloodstream and cause
maternal nutrition and lactation counseling septicemia
● postnatal visit of the newborn together with her visit ● inspect the base of the cord to be sure no abdominal
wall defect (e.g. umbilical hernia) is present
POSTPARTUM CARE c. Take the temperature of both mother & child

— Ensure the health & well being of the mother & child
a. Visit the mother & child d. Inspect the breast & nipples
● full and firm to palpation
HEALTH Family Profile — support systems
HISTORY — other children ● blue veins prominent under skin
— type of housing and community ● only slightly tender
setting
— other information necessary to ● no palpable lumps or nodules; if one portion of breast is
evaluate the impact the new child will erythematous or tender, mastitis may be present; an
have on the mother and her family
occasional filled milk gland may present as a lump, so
Pregnancy — GPTPAL try to reexamine after feeding
History — EDC ● Breastfeeding mothers:
— whether the pregnancy was planned:
to help the nurse gauge the woman's ○ note if nipples are normally erect and not
potential for bonding inverted
— complications during pregnancy
○ assess for cracks, fissures, or presence of
Labor & Delivery — length of labor caked milk
History — position of fetus ○ avoid squeezing nipples as this can be painful;
— type of birth (NSD/CS)
— any analgesia or anesthesia used manipulation also increases risk of mastitis
— problems during labor ● Choosing a nursing bra:
e.g. fetal distress
— supine hypotension syndrome ○ two sizes larger than her pregnancy breast
presence of perineal sutures size
○ straps of bra should be properly fitted but not
Infant Data — gender of the infant
— anthropometric measurements: too tight leaving erythremic marks on
weight, length, head & chest shoulders
circumference
— difficulty at birth ○ bra fits firmly and snugly, not too tight
e.g. need for resuscitation ● Non-nursing mothers:
— newborn reflexes
— any congenital anomalies ○ returns to prepregnancy size
○ No palpable nodules or lumps
Postpartal — general appearance
Course — activity level since the birth
— difficulty with elimination e. Feel for the fundus of the uterus
— plans to breastfeed or formula-feed ● place one hand on the base of uterus, just above the
— success with infant feeding
— response of her support person to symphysis pubis; the other hand at the umbilicus
parenting ● press in and downward with the hand at umbilicus until
you feel against a firm globular mass in the abdomen
b. Inspect the cord ● never palpate the uterus without supporting the lower
● 1st hour of birth: segment, to avoid uterine inversion which can result in
○ appearance of stump: massive hemorrhage
white gelatinous ● assess for consistency: firm, soft,
appearance with red or boggy
(1 artery) and blue ● assess for location: midline
(2 veins) streaks ● assess for height: measure in
○ cord begins to dry and fingerbreadths (1cm)
shrink, turns brown like ○ 1st hour: at the umbilicus
the dead end of the vine or slightly above
● 2nd-3rd DOL: cord has turned black ○ fundus descends 1 fingerbreadth per day
● 6th-10th DOL: cord breaks free and leaves a ○ 9th or 10th day: uterus will become so small
granulating area a few centimeters wide that heals it's no longer palpable around symphysis pubis
during the following week

f. Inspect the legs for tenderness or edema — Retained Placental Fragments
— assess legs for DVT: ● a portion of placental retained keeps the uterus from
● assess edema at the ankle and over the tibia on the contracting fully, leading to uterine bleeding
lower leg ● assessment usually reveals the uterus is not fully
● dorsiflex the ankle and ask if the client notices pain in contracted
the calf on that motion; (+) Homan's sign ● placental fragments may be detected by sonography
● assess for redness in the calf area ● Management: dilatation and curettage
thrombophlebitis may be present even with a (-) — Disseminated Intravascular Coagulation
Homan's sign ● a deficiency in clotting ability caused by vascular injury
— Subinvolution
● incomplete return of uterus to its prepregnant size and
g. Take note of smell & odor of lochia shape
● lochia is a combination of ● uterus is still enlarged and soft at 4th or 6th week
blood, fragments of decidua, postpartum
WBC, mucus, and some ● Management:
bacteria passed off as a uterine ○ oral administration of Methergine
discharge similar to a ○ if endometritis, an oral antibiotic may be
menstrual flow prescribed
● this is the byproduct of — Disseminated Intravascular Coagulation
sloughing process at the ● a deficiency in clotting ability caused by vascular injury
placental site to facilitate — Subinvolution
cleansing and healing, which incomplete return of uterus to its prepregnant size and shape
usually takes approximately 6 ● uterus is still enlarged and soft at 4th or 6th week
weeks postpartum
● Management:
h. Bathe & cloth the child ○ oral administration of Methergine
○ if endometritis, an oral antibiotic may be
i. Observe for any abnormality in both the mother & prescribed
newborn: — Perineal Hematomas
— Uterine atony ● a collection of blood in the
● relaxation of uterus, the most frequent cause of subcutaneous layer of the perineal
postpartal hemorrhage tissue
● Management: ● Assessment: severe pain in the
○ uterine massage perineal area, feeling of pressure
○ IV infusion of oxytocin (Pitocin) between legs, purplish discoloration,swelling 2cm to
○ IM methylergonovine (Methergine) 8cm in diameter, area is tender on palpation
○ urinary catheterization to reduce bladder ● Management:
pressure that pushes a uterus to an even more ○ mild analgesic
uncontracted state ○ ice pack
○ bimanual massage ○ Incision & ligation of the bleeding vessel
○ prostaglandin administration — Endometritis
promotes strong, sustained ● an infection of the endometrium, the
uterine contractions lining of the uterus; bacteria gain entry
○ blood replacement to the uterus through the vagina either
○ hysterectomy at the time of the birth or postpartum
— Cervical laceration ● Assessment:
● lacerations found on the sides of ○ fever on the third or fourth day postpartal
the cervix, near the branch of the ○ increased WBC to 20,000 to 30,000 cells/mm3
uterine artery ○ chills, loss of appetite, generalized malaise
● Management: surgical repair of ○ uterus not well contracted and painful to touch
cervical laceration ○ lochia is dark brown and has a foul odor
— Vaginal laceration ● Management:
● Management: vaginal repair with packing to maintain ○ antibiotic administration
pressure on suture line ○ vaginal swab culture
— Perineal laceration ○ oxytocic agent to encourage uterine
● Management: episiotomy repair contraction
○ additional fluids to combat fever

○ sitting in Fowler's position to encourage lochial ○ administration of magnesium sulfate or an
drainage antihypertensive agent
— Peritonitis ○ D&C if with retained placental fragments
● an extension of endometritis, where the infection — Mastitis
spreads through the lymphatic system or directly ● an inflammation of the breast
through the fallopian tubes or uterine wall to the ● Assessment:
peritoneal cavity ○ localized pain, swelling, redness
● Assessment: ○ breast milk becomes scant
○ rigid abdomen ● Management:
○ abdominal pain ○ broad spectrum antibiotic
○ high fever ○ cold compress or ice pack for pain relief; warm
○ rapid pulse compress for inflammation and edema
○ vomiting ○ supportive bra
● Management: ○ BF/ manual expressing of milk facilitates
○ insertion of NGT: to prevent vomiting and rest breast emptying, preventing bacterial growth
the bowel — Urinary Retention
○ parenteral fluid and nutrition ● a result of inadequate bladder emptying due to bladder
○ analgesics for pain relief edema caused by pressure of birth, leading to inability
○ large-dose antibiotics to empty, overdistention, and a urine output less than
— Thrombophlebitis 100ml
● inflammation with the formation of blood clots ● Management:
● Causes: ○ catheterization
○ increased fibrinogen level ○ bladder training
○ dilation of lower extremity veins as a result of — Urinary Tract Infection
pressure on the fetal head during pregnancy ● a bacteria may be introduced into the bladder when a
and birth mother is catheterized at the time of childbirth or during
○ relative inactivity leading to pooling, stasis, and postpartum
clotting of blood in the lower extremities ● Assessment:
● Management: ○ burning sensation on urination
○ ambulation to encourage circulation in the ○ possible blood in the urine (hematuria)
lower extremities, promotes venous return, ○ urinary frequency
and decrease possibility of clot formation ○ low-grade fever
○ wear support stockings for the first 2 weeks ○ lower abdominal pain and discomfort
after delivery if with varicose veins during ● Management:
pregnancy ○ antibiotic that is safe for nursing mothers
— Pulmonary Embolus ○ oral analgesics to reduce painful urination
● an obstruction of the pulmonary artery by a clot, which — Reproductive Tract Displacement
is a complication of thrombophlebitis ● the uterus is weakened and the ligaments may no
● Signs: longer be able to maintain the uterus in usual position
○ sudden, sharp chest pain after pregnancy
○ tachypnea, tachycardia ● Management: surgery to repair conditions
○ orthopnea — Separation of Symphysis Pubis
○ cyanosis ● ligaments of the symphysis pubis may be overstretched
● Management: during delivery that they actually tear
○ oxygen administration ● Assessment:
○ clot is dissolved until lysed or reabsorbed ○ acute pain on turning or walking
— Postpartum Pregnancy-Induced Hypertension ○ legs tend to rotate externally; waddling gait
● Assessment ○ area is swollen and tender upon palpation
○ Cardinal Signs: proteinuria, edema, high blood ● Management:
pressure ○ bed rest
○ seizures occur 6-24 hours postpartum; if it ○ application of snug pelvic binder for 4-6 weeks
occurs beyond 72 hours after birth, seizures
may be unrelated to childbearing j. Refer for appropriate management
● Management: ● Motivate mother to continue BF & follow up dose of
○ bed rest at quiet atmosphere tetanus toxoid
○ frequent monitoring of vital signs and urine
output k. Reinforce teaching on good food intake

l. Reinforce family spacing to both parents
SOAP DOCUMENTATION
m. After 42 days & bring child for immunization ● The Subjective, Objective, Assessment and Plan
(SOAP) note is an acronym representing a widely used
method of documentation for healthcare providers.
● a way for healthcare workers to document in a
structured and organized way
● helps guide healthcare workers use their clinical
reasoning to assess, diagnose, and treat a patient
based on the information provided by them
● essential piece of information about the health status of
the patient as well as a communication document
between health professionals
● The structure of documentation is a checklist that
serves as a cognitive aid and a potential index to
retrieve information for learning from the record
Subjective Data
— “subjective” experiences, personal views or feelings of a
patient or someone close to them.
— In the inpatient setting, interim information is included here.
— This section provides context for the Assessment and Plan
— Includes data verbalized by client, such as:
CHIEF COMPLAINT (CC)

● Presenting problem
● This can be a symptom, condition, previous diagnosis
or another short statement that describes what the
patient is presenting today.
● The CC is similar to the title of a paper, allowing the
reader to get a sense of what the rest of the document
will entail.
○ e.g. chest pain, decreased appetite,
shortness of breath
● a patient may have multiple CC’s, and their first
complaint may not be the most significant one.
● Encourage patients to state all of their problems, while
paying attention to detail to discover the most
compelling problem.
To identify most significant CC, use HPI
HISTORY OF PRESENT ILLNESS (HPI)

● HPI begins with a simple one line opening statement
including the patient's age, sex and reason for the visit.
● Then elaborate the client's chief complaint.
● OLD CARTS
Onset: When did the CC begin?
Location: Where is the CC located?
Duration: How long has CC been going on?
Characterization: How does the patient describe the
CC?
Alleviating and Aggravating factors: What makes the
CC better? Worse?
Radiation: Does the CC move or stay in one location?
Temporal factor: Is the CC worse (or better) at a
certain time of the day?

Severity: Using a scale of 1 to 10, 1 being the least, 10 ○ Symptoms are the patient's subjective
being the worst, how does the patient rate the CC? description and should be documented under
the subjective heading
PAST HISTORIES verbalized by the patient
● Medical history ○ A sign is an objective finding related to the
○ Pertinent current or past medical conditions associated symptom reported by the patient
● Surgical history
○ Try to include the year of the surgery and
Assessment
surgeon if possible.
● Family history ● This section documents the synthesis of S/O data to
○ Include pertinent family history. arrive at a diagnosis.
○ Avoid documenting the medical history of ● This is the assessment of the patient’s status through
every person in the patient's family. analysis of the problem, possible interaction of the
Significant/immediate family members only problems, and changes in the status of the problems.
● Social History CC fever; O 5 d ago, L g
eneralized, D 5d, C m
ainit sa
○ An acronym that may be used here is pakiramdam, nilalamig, sweating, A loose clothes & increased
HEADSS which stands for intake of water, R i ncreased activity, T m idnight (indication of
■ Home and Environment; TB), S (in terms of discomfort); Medical hx p neumonia/TB,
■ Education, Employment, Eating; Family hx TB; VS E levated temperature, increased RR, low O2
■ Activities; saturation; PE rales on auscultation; Laboratory data (+)
■ Drugs; acid-fast bacilli; ASSESSMENT fever physiologic response to
■ Sexuality; and infection, secondary to TB
■ Suicide/Depression. — diagnosis based on NANDA
REVIEW OF SYSTEMS Plan

● This is a system based list of questions that help
uncover symptoms not otherwise mentioned by the ● This section details the strategy you will be applying to
patient. relieving the patient's problem, including immediate or
○ General appearance short-term actions and long-term measures
■ Weight loss e.g. Cover of mouth, hand hygiene, adherence to TB-DOTS
■ decreased appetite regimen, eating of nutritious foods, avoiding close contact
○ Gastrointestinal with children, infection control
■ Abdominal pain
■ hematochezia
○ Musculoskeletal
■ Toe pain
■ decreased right shoulder range of
motion
CURRENT MEDICATION, ALLERGIES

● may be listed under the S/O data
● It is important that with any medication documented, to
include the medication name, dose, route, and how
often.
e.g. Cefuroxime 500mg orally 3x a day for 5 days
Objective Data
● Vital signs
● Physical exam findings
● Laboratory data
● Imaging results
● Other diagnostic data
● Recognition and review of the documentation of other
clinicians.
● A common mistake is distinguishing between symptoms
and signs.

9. Psychologic Data: major stressors, usual coping
Nursing Care Plan pattern, communication style
● a formal process that includes correctly identifying 10. Patterns of Health Care: healthcare resources the
existing needs, as well as recognizing potential needs client is currently using and has used in the past; family
or risks. physician, specialist, dentist, folk practitioner, health
● nursing care plans also provide a means of clinic, health center, hospital
communication among nurses, their patients, and other
healthcare providers to achieve health care outcomes Objective data
● HEALTH ASSESSMENT: first measure in order to be ● also referred to as signs or overt data
able to design a care plan. ● data detectable by the observer or can be measured or
tested against an accepted standard
COMPONENTS ● they can be seen, heard, felt, or smelled, and they are
1. Nursing diagnosis is identified based on the analyzed, obtained by observation or physical examination
clustered and organized data about the client's health.
2. Expected client outcomes are outlined. ~ objective data includes:
3. Nursing interventions are documented in the care plan. 1. Medical records: medical history, physical
4. Rationale for interventions in order to provide an examination, operative report, progress notes,
evidence-based care. consultations done by physicians; these records
5. Evaluation, which documents the outcome of nursing provides information on client's coping behaviors, health
interventions. practices, previous illnesses, and allergies
2. Records of therapies: services provided by other
Data Collection / Assessment health professionals which help the nurse obtain
relevant data not expressed by the client
● first step in writing a nursing care plan is to create a 3. Laboratory records: diagnostic studies performed to
client database using assessment techniques and data patient must be compared to the agency or performing
collection methods laboratory's normal value for the client's age, sex and
● A client database includes all the health information so on
gathered.
● In this step, the nurse can identify the related or risk
factors and define characteristics that can be used to Nursing Diagnosis
formulate a nursing diagnosis. ● nurses use critical-thinking skills to interpret
assessment data and identify client strengths and
TYPES OF DATA problems.
Subjective Data ● All the care-planning activities following this phase are
● also referred to as symptoms or covert data based on the nursing diagnoses
● data apparent only to the person affected and can be
verified only by that person TYPES OF NURSING DIAGNOSIS
Actual diagnosis
~ subjective data includes: ● a client problem that is present at the time of the
1. Demographic Data nursing assessment
2. Chief complaint ● this is based on the presence of associated signs and
3. History of Present Illness symptoms
4. Past Histories: childhood illnesses and immunizations, ● e.g. Ineffective Breathing Pattern and Anxiety
allergies, accidents and injuries, hospitalization for
serious illness, medications Risk nursing diagnosis
5. Family History of Illnesses ● a clinical judgment that a problem does not exist, but
6. Lifestyle/Functional Patterns: personal habits, diet, the presence of risk factors indicate that a problem is
sleep/rest patterns, elimination, activities of daily living, likely to develop unless nurses intervene
recreation/hobbies ● e.g. Risk for Infection
7. Review of Systems: Integumentary, Respiratory,
Cardiovascular, Nervous, Musculoskeletal, Wellness diagnosis
Gastrointestinal, Genitourinary, Reproductive, Immune ● described as the level of wellness in an individual,
System family, or community that presents a readiness for
8. Social Data: Family relationships/friendships, enhancement
ethnic/religious affiliation, educational history, ● e.g. Readiness for Enhanced Spiritual Well-being or
occupational history, economic status, home and Readiness for Enhanced Family Coping
neighborhood conditions
Possible nursing diagnosis
● when an evidence about a health problem is incomplete ● Goals provide direction for planning interventions,
or unclear serve as criteria for evaluating client progress, enable
● a possible diagnosis requires more data either to the client and nurse to determine which problems have
support or to refute it been resolved, and help motivate the client and nurse
● e.g. Possible Social Isolation by providing a sense of achievement.
● must be measurable and client-centered
Syndrome diagnosis ● Goals are constructed by focusing on problem
● a diagnosis that is associated with a cluster of other prevention, resolution, and/or rehabilitation.
diagnosis ● can be short term or long term
● e.g. Risk for Activity Intolerance, Risk for Constipation,
Risk for Injury, Impaired Gas Exchange COMPONENTS OF GOALS & DESIRED OUTCOMES
Subject
● The subject is the client, any part of the client, or some
Components of NANDA Nursing Diagnoses
attribute of the client
1. Diagnostic Label and Definition pulse, temperature, urinary output
● describes the client's health status for which nursing
therapy is given, and is stated in clear, concise words Verb
● a qualifier is added to the labels to give additional ● The verb specifies an action the client is to perform, for
meaning to the statements, such as: example, what the client is to do, learn, or experience.
○ Deficient - inadequate in amount, quality, or
degree; not sufficient; incomplete Conditions / modifiers
○ Impaired - made worse, weakened, damaged, ● These are the “what, when, where, or how” that are
reduced, deteriorated added to the verb to explain the circumstances under
○ Decreased - lesser in size, amount, or degree which the behavior is to be performed
○ Ineffective - not producing a desired effect
○ Compromised - to make vulnerable to threat Criterion of desired performance
● The criterion indicates the standard by which a
2. Etiology: Related Factors and Risk Factors performance is evaluated or the level at which the client
● the component that identifies one or more probable will perform the specified behavior.
causes of the diagnostic label, gives direction to the
required nursing therapy, and enables the nurse to
individualize the client's care
● e.g. Activity Intolerance may be related to:
○ Bedrest or immobility
○ Generalized weakness Nursing Interventions
○ Imbalance between oxygen supply/demand ● activities or actions that a nurse performs to achieve
○ Sedentary lifestyle client goals.
● Interventions chosen should focus on eliminating or
3. Defining Characteristics reducing the etiology of the nursing diagnosis.
● are clusters of signs and symptoms that indicate the ● As for risk nursing diagnosis, interventions should focus
presence of the diagnostic label on reducing the client’s risk factors.
● for actual nursing diagnosis: the defining characteristics
are the clients signs and symptoms TYPES OF NURSING INTERVENTIONS
● for risk nursing diagnosis: no subjective and objective Independent nursing interventions
signs are present ● activities that nurses are licensed to initiate based on
● defining characteristics are written following the phrase their sound judgement and skills.
“as evidenced by” or “as manifested by” in the ● Includes: ongoing assessment, emotional support,
diagnostic statement providing comfort, teaching, physical care, and making
● e.g. Activity Intolerance related to generalized referrals to other health care professionals.
weakness as evidenced by verbalization fatigue and
weakness, and poor muscle strength Dependent nursing interventions
● activities carried out under the physician’s orders or
Client Goals and Desired Outcomes supervision.
● Goals or desired outcomes describe what the nurse ● Includes orders to direct the nurse to provide
medications, intravenous therapy, diagnostic tests,
hopes to achieve by implementing the nursing
treatments, diet, and activity or rest.
interventions and are derived from the client’s nursing
diagnoses.

● Assessment and providing explanation while
CHILD CARE
administering medical orders are also part of the
dependent nursing interventions. Schedule of Consultation
Collaborative interventions 1st year of life / month

● actions that the nurse carries out in collaboration with (0-11 months)
other health team members, such as physicians, social
workers, dietitians, and therapists. 2nd year of life / 2 months
● These actions are developed in consultation with other (12-23 months)
health care professionals to gain their professional
3rd year of life / 3 months
viewpoint. (24-35 months)
4th year of life / 6 months

(36-47 months)
5th year of life / year

(48-59 months)
Newborn care until the 1st week of life

— Interventions within the first 90 minutes
RATIONALE ● Immediate drying
● a.k,a. Scientific explanation ● Skin to skin contact: mother & newborn
● underlying reasons for which the nursing intervention ● Cord clamping after 1-3 minutes
was chosen for the NCP ● Non-separation of baby from the mother
● Early initiation of breastfeeding
— Childhood care
1. Immunizations
2. Micronutrient supplementation
3. EBF up to 6 months, sustained BF up ton24 months
with complementary feeding
4. Integrated management of childhood illness
5. Injury prevention
6. Oral health
7. Insecticide-treated nets for mothers and children in
malaria endemic areas
EXPANDED GARANTISADONG PAMBANSA (GP)

● a child health program that provides immunization,
nutrition and environment information and
Evaluation
● services for children
● Collecting data related to the desired outcomes ● will cover children from birth up to 14 years old
● Comparing the data with outcomes ● health centers will continuously provide health care
● Relating nursing activities to outcomes services for children every day
● Drawing conclusions about problem status: goal met, ● promote health behaviors that can be practiced at
goal partially met, goal not met home, in school, in day care centers and in other
● Continuing, modifying, or terminating the nursing care ● settings where children are.
plan
Infant & Growing Child
Conclusion ● Infant receive ONLY breastmilk during the first 6
● a statement that the goal/desired outcome goal met, months of life
goal partially met, goal not met ● At 6 months, addition of appropriate complementary
food to breastmilk
Supporting data ● At 9 months or before 1st birthday, completion of
● list of client response that support the conclusion immunization schedule
● Receives proper nutrition from all the food groups
Goal met: oral intake 300ml more than output; good skin ● Receives Vit. A supplementation
turgor; moist mucous membranes ● Receives deworming every 6 months
IMCI Components
General Child Safety
● Provide a safe home & community free or protected ● Has three components that are complementary
from injuries ● They all need to be functioning well to fully benefit the
● Must be supervised always by a responsible adult child.
● Provide safe toys appropriate for his/her age & physical
& mental development 1. Improvement of health worker skills
● Allow to play with other children aside from siblings ● Case management guidelines
● Training of health providers (Doctors , Medical
Assistants & Nurses) who look after sick infants and
Integrated Management of Childhood illness (IMCI)
children up to 5 years (pre-service and in-service)
● a strategy for reducing mortality and morbidity ● Follow-up after train
associated with major causes of childhood illness.
● includes preventive and curative interventions, which 2. Improvement of health systems
aim to improve practices both in the health facilities and ● Targets first level health facilities
at home ● Organization of work
● It is an integrated approach to child health that focuses ● Availability of drugs and supplies
on the well being of the whole child ● Monitoring and supervision
○ need for child health programmes to go ● Referral pathways and systems
beyond single diseases and address the ● Health information systems
overall health of a child.
○ “Looking to The Child as a Whole” 3. Improvement of family and community practices in
relation to child health
● Exclusive Breastfeeding
● Complementary feeding
● Cont. feeding during illness.
● Using of iodized salt
● Routine vaccination
● Regular growth monitoring.
● Early care seeking.
● WHO and UNICEF used updated technical findings to ● Compliance to provider advice
describe management of these illnesses in a set of ● Home care of sick children
integrated guidelines for each illness. ● Recognition of severe illness
● These guidelines have been adapted to each country ● Proper waste disposal
● Antenatal care
Why is IMCI better than single-condition approaches? ● TT for pregnant ladies.
● Children brought for medical treatment in the ● Proper nutrition for pregnant ladies.
developing world are often suffering from more than
one condition
Benefits of IMCI
● This overlap means that a single diagnosis may not be
possible or appropriate and treatment may be ● Addresses major child health problems
complicated by the need to combine therapy for several ○ The strategy addresses the most important
conditions. causes of childhood death and illness
● Promotes prevention as well as cure
OVERALL GOAL OF IMCI ○ In addition to its focus on treatment, IMCI also
~ To reduce the mortality & morbidity in under five in children in provides the opportunity for important
relation to the major killers: preventive interventions such as immunization
1. Diarrheal diseases and improved infant and child nutrition,
2. Acute respiratory infections especially Pneumonia including breastfeeding
3. Malaria ● Improves health worker performance and their quality of
4. Measles care.
5. Malnutrition ● IMCI improves health worker performance and their
quality of care.
● IMCI can reduce under-five mortality and improve
nutritional status, if implemented well;
● IMCI is worth the investment, as it costs up to six times
less per child correctly managed than current care
Page 16 o
f 25 E. Fineza | 2NUR4
● Cost-effective Inappropriate management of childhood
illness wastes scarce resources
○ Although increased investment will be needed
initially for training and reorganization, the
IMCI strategy will result in cost savings.
● Improves equity
○ Nearly all children in the developed world have
ready access to simple and affordable
preventive and curative care. Millions of
children in the developing world, however, do
not have access to this same life-saving care.
The IMCI strategy addresses this inequity in
global health care.
DISEASES COVERED BY IMCI

1. Diarrheal diseases
2. Acute respiratory infections especially Pneumonia Assessment
3. Malaria ~ of Sick Young Infant
4. Measles ● Data: Name, Age, Weight, Temperature, Infant’s
5. Malnutrition problems, Initial / Follow up visit
~ The IMCI guidelines address the most important but NOT ● Check for:
ALL of the major reasons a sick child or an infant is brought to ○ possible bacterial infection
the clinic with. ○ the presence of Jaundice
○ Diarrhoea
AGE GROUPS COVERED BY IMCI ○ feeding problem or low weight
~ IMCI guidelines recommend case management procedures ○ immunization
based on two age categories:- ● Assess other problems
● Children: age 2 months up to 5 years.
● Young infants: age up to 2 months ~ of Sick Child
● Data: Name, Age, Weight, Temperature, Child’s
Why not use the process for children age 5 years or more? problems, Initial / Follow up visit
● The case management process is designed for children ● Check for general danger signs for all sick children:
<5yrs of age 1. Unable to drink or BF
● although much of the advice on treatment of 2. Vomits every thing
pneumonia, diarrhea, malaria, measles and 3. Has the child had convulsions?
malnutrition, is also applicable to older children, the 4. Unconscious, lethargic
ASSESSMENT AND CLASSIFICATION of older 5. Is the child convulsing now
children would differ.
● e.g. T he cut off rate for determining fast breathing FOUR MAJOR SYMPTOMS
would be different because normal breathing rates are 1. Cough / difficulty breathing
slower in older children. 2. Diarrhea
● e.g. C hest indrawing is not a reliable sign of severe 3. Fever
pneumonia as children get older and the bones of the 4. Ear problems
chest become more firm. ● Check for nutrition, immunization, vitamin A
● In addition, certain treatment recommendations or supplementation and feeding problems
advice to mothers on feeding would differ for >5yrs old. ● Assess other problems
THE CASE MANAGEMENT PROCESS Classification the illness

● brought to a first-level health facility includes a number ● The classification tables on the assess and classify
of important elements have 3 ROWS
1. Assessment of the child or young infant ● COLOR of the row helps to IDENTIFY RAPIDLY
2. Classification the illness whether the child has a SERIOUS DISEASE requiring
3. Identification the treatment URGENT ATTENTION.
4. Referral, treatment or counselling of the child's ○ RED – means the child has a severe
caretaker (depending on the identified classification/s) classification and needs urgent attention and
5. Follow up care referral or admission for inpatient care
Page 17 o
○ YELLOW – means the child needs a specific
medical treatment such as an appropriate INFANT AND YOUNG CHILD FEEDING
antibiotic, an oral anti-malarial or other ● a global strategy jointly issued by World Health
treatment. Organization and UNICEF in 2002
■ also teaches the mother how to give ● highlights the impact of feeding practices on nutritional
oral drugs or to treat local infections status, growth and development, health, and optimal
at home survival of infants and young children
○ GREEN – not given a specific medical ● information dissemination on:
treatment such as antibiotics or other ○ period of EBF and continued BF;
treatments. ○ timing of complementary food introduction;
■ The HCW teaches the mother how to ○ types of food to be given, amount, and
care for her child at home. frequency, and how to feed safely.
○ micronutrient supplementation
e.g. Cough / Difficulty of Breathing ○ food fortification
○ diet diversification
SIGNS CLASSIFY AS IDENTIFY ○ deworming
TREATMENT
- Chest indrawing or Severe pneumonia OR - give first dose f an PHILIPPINE LEGISLATION

Stridor in a clam child Very severe disease appropriate antibiotic
- Any general danger - refer urgently to a EO No. 51 — “Milk Code”
sign hospital
● prohibits information dissemination that bottle feeding is
- fast breathing Pneumonia - give an appropriate
equal or better than breastfeeding
oral antibiotic for 5 days
- soothe the throat &
relieve the cough with a
EO No. 382
safe remedy ● declares November 7 as National Food Fortification
- advise the mother
when to return
Day
immediately
- Follow-up in 2 days
RA 7600 —“Rooming-In and Breastfeeding Act”
No signs of pneumonia Cough or Cold, No - If coughing >30 days
● Breastfeeding is initiated immediately after birth
or very severe disease pneumonia refer for assessment ● Rooming-In:
- soothe the throat and
relieve the cough with a
○ NSD: within 30mins after birth
safe remedy ○ CS delivery: 3-4hrs after birth
- Advise mother when to
return immediately
- follow up in 6 days if RA 8172 — “ASIN: Act for Salt Iodization Nationwide”
not improving ● iodization of produced, imported, traded or distributed
salt
RA 8976 — “Philippine Food Fortification Act”

● addition of micronutrients to food staples
● Sangkap Pinoy seal is conferred by DOH affixed to
food packaging certifying products fortified singly or
combined with Vitamin A, iron, and iodine
RA 10028 - “Expanded Breastfeeding Promotion Act”

● establishment of Lactation Station in public areas
AO 36, s2010 - “Expanded Garantisadong Pambata”

● availability of comprehensive and integrated services on
health, nutrition, and environment for children everyday
at various settings by government and NGOs, private
sectors, and civic groups
Nutritional Assessment of Infant & Young Child

● History Taking
● Anthropometric Assessment: measures physical
dimensions and gross composition of body
Page 18 o
● Clinical Examination: combination of history taking
CLINICAL EXAMINATION
and physical examination to recognize signs of
malnutrition SEVERE ACUTE MALNUTRITION
● Biochemical examination: assess specific ● Presence of bipedal pitting edema
components of blood or urine to measure specific Grades of edema:
aspect of metabolism
Grade + mild both feet & ankles
HISTORY TAKING Grade ++ moderate both feet, lower legs, hands, or lower arms
Health history
Grade +++ severe generalized edema of both feet, legs, hands,
● includes recent episode of infection, which can arms, and face
influence nutritional status
● Baggy pants
Dietary history:
○ loose skin on buttocks due to loss of
● Exclusive BF: ORS, drops and syrups may be allowed
subcutaneous and muscle tissues
● Predominant BF: liquids are provided in the diet
○ also indicates visible severe wasting
● Complementary feeding: introduction of infant foods
and liquids when BF is no longer sufficient
VITAMIN A DEFICIENCY (VAD)
● Bottle feeding: can be a potential interference of
● Perform eye examination to assess eye lesions
optimal BF practices, as well as association of bottle
associated to VAD
feeding vs diarrheal episodes
● Xerophthalmia - all signs and symptoms affecting the
● Early initiation of BF
eye that can be attributed to VAD
~ Xerophthalmia in VAD
ANTHROPOMETRIC ASSESSMENT
Weight-for-age
● determines if child is underweight or overweight
Length/Height-for-age
● determines if child is short or stunted due to prolonged
undernutrition or repeated illness
● consider heredity when assessing height of child
Mid-upper arm circumference (MUAC)

● rapid screening for malnutrition requiring further
assessment for treatment
● how to measure
1. with left arm flexed, find midpoint between tip
of shoulder to tip of elbow
2. relax left arm, wrap tape measure around
upper arm at level of midpoint
IRON DEFICIENCY ANEMIA
● assess for palmar pallor: if the skin of the child's palm
is pale the child has some pallor
● if the skin of the palm is very pale that it looks white, the
child has severe palmar pallor, which according to IMCI
requires urgent referral to a hospital
BIOCHEMICAL EXAMINATION
Page 19 o
● touch infant's lips with mother's nipple to stimulate
Recommended Feeding Practices
rooting reflex
● early initiation of BF ● once infant's mouth opens, move the infant towards the
● EBF for first 6months of life mother's breast
● except for infant identified with galactosemia ● aim the infant's lower lip towards the mother's nipple so
● for infant identified with phenylketonuria, BF is still that the chin will touch her breast
recommended but with close monitoring of serum
phenylalanine levels ~ signs of proper latch-on
● extended BF up to 2years ● the baby's mouth is wide open
● complementary feeding starting 6months of age to fill ● the lower lip is turned out
energy and nutrient gap ● the chin is touching the breast
● micronutrient supplementation ● more areola is visible above the baby's mouth than
● universal salt iodization below
● food fortification
● diet diversification
Micronutrient supplementation
Benefits of Breastfeeding
TO THE MOTHER:
● helps the uterus to contract and therefore reduce
bleeding
● helps return prepregnancy weight
● delays return of fertility
● lowers risk of premenopausal breast and ovarian
cancer
● economical and least expensive feeding method
TO THE CHILD:
● provides all of the nutrient the infant needs for growth in
the first 6months of life;
● contains colostrum, the yellowish fluid secreted by
mammary gland that is rich with antibodies and WBC to Deworming
protect against infection;
● abundant in IgA, an antibody that protects the mucosal
membrane in the baby's gut against pathogen,
preventing diarrhea
● lowers risk of developing later in life chronic conditions
such as allergies, asthma, obesity, diabetes, and heart
disease
● provides benefits for intellectual and motor development
of the infant
Breastfeeding Positions
LATCHING TECHNIQUE
● position fingers against her chest wall below and her
thumb above the breast
Page 20 o
EXPANDED PROGRAM ON IMMUNIZATION (EPI) Important Considerations
● EPI was established in 1976 to ensure access to ● Use only one sterile syringe and needle per client
routinely recommended infant/childhood vaccines. ● There is no need to restart a vaccination series
● The overall goal EPI is to reduce mortality and morbidity regardless of the time that has elapsed between doses
among children against the most common ● EPI vaccines to be administered at the same session
vaccine-preventable diseases such as: must be administered at different sites; if more than
○ TB one injection has to be given on the same limb, the
○ hepatitis B injection sites should be 2.5-5cm apart to prevent
○ diphtheria overlapping of local reactions
○ tetanus ● It is not recommended to mix different vaccines in one
○ pertussis syringe before injection
○ H. influenzae type B ● It is also not recommended to use a fluid vaccine to
○ poliomyelitis reconstitute a freeze-dried vaccine (e.g. BCG, AMV,
○ measles MMR)
○ mumps ● Some conditions are not considered as
○ rubella/German measles contraindications to vaccination. The healthcare worker
○ rotavirus may continue with appropriate immunizations if the
○ pneumococcal infection following symptoms is present:
○ Malnutrition - it further indicates that the child
especially needs the protection conferred by
Legislative Mandates immunization;
RA 10152 — “Mandatory Infants and Children Health ○ Low-grade fever;
Immunization Act of 2011” ○ Mild respiratory infection; and
● gives directive to government hospitals and health ○ Diarrhea
centers to provide for free mandatory basic
immunization to infants and children up to age 5 years
Vaccine Preparations
RA 7846 INACTIVATED
● An act declaring compulsory immunization against ● killed microorganisms
hepatitis B for infants and children below 8 years old ● e.g. diphtheria
● also provides hepatitis B immunization within 24 hours
after birth of babies of women with hepatitis B ATTENUATED
● altered live microorganisms that are no longer
DOH GOALS (In lieu of RA 7846) pathogenic, but are still antigenic
1. To immunize all infants/children against the ● e.g. BCG, OPV, AMV, MMR, Rotavirus
most common vaccine-preventable diseases;
2. To sustain the polio-free status of the FRAGMENTS FROM MICROORGANISMS
Philippines; ● e.g. hepatitis B
3. To eliminate measles infection;
4. To eliminate maternal and neonatal tetanus; TOXOIDS
5. To control diphtheria, pertussis, hepatitis B, ● inactivated or altered bacterial exotoxins
and German measles; and ● e.g. tetanus toxoid, Pentavalent HiB
6. To prevent extrapulmonary TB among
children.
Storage, Handling, and Transport
PP No. 4, s1998 — “Philippine Measles COLD CHAIN
Elimination Campaign” ● a system for ensuring the potency of a vaccine from the
time of manufacture to the time it is given to an eligible
PP No. 1066, s1997 — “National Neonatal Tetanus client.
Elimination Campaign” ● Role of a Nurse: Cold Chain Manager
○ maintains cold chain equipment and supplies
AO No. 30, s2003 — Policies on the nationwide (freezer/refrigerator, transport box, vaccine
implementation of EPI bags/carriers, cold chain monitors,
● Wednesday is the designated immunization day by thermometers, and cold packs)
DOH in government health facilities unless otherwise ○ implements an emergency plan in the event of
revised by local traditions, customs, and other an electrical breakdown or power outage
exceptions ● Cold Chain requirements:
Page 21 o
Vaccines & Diseases under EPI
Bacille Calmette-Guerin (BCG)

● BCG is a vaccine for Tuberculosis (TB) disease
caused by Mycobacterium tuberculosis, which attacks
the lungs
Diluents must be kept cold and may be stored in the lower
● Symptoms of TB include:
or door shelves of the refrigerator
○ a bad cough that lasts 3 weeks or longer
○ pain in the chest
○ coughing up blood or sputum (phlegm from
deep inside the lungs)
○ sweating at night
○ fever
○ weakness or fatigue
○ weight loss
○ no appetite
○ chills
● Follow the FEFO Policy: First expiry-First out
● Storage duration of vaccines:
○ Refrigerator: should not exceed one (1) month,
○ Transport boxes: only up to a maximum of 5 CONSIDERATIONS:
days ❖ Protect BCG from sunlight
● Discard reconstituted freeze-dried vaccines after 6 ❖ Reconstitute BCG only with diluents supplied with them
hours or at the end of the immunization session ❖ DO NOT GIVE BCG to a child who has signs and
● Protect BCG from sunlight and Rotavirus vaccine from symptoms of AIDS or other immune deficiency
light conditions or who are immunosuppressed
● Take note if the vaccine container has a vaccine vial ❖ BCG injection results in a
monitor (VVM) and act accordingly. formation of wheal that forms into
a scar after about 2-12 weeks,
which is an expected response
and does not require any
management
● Abide by the open-vial policy of the DOH

● Multi-dose vial may be opened for one or two clients if
the client cannot come back for the scheduled
immunization schedule
● Taking dosage from multi-dose liquid vaccines should
follow the standard sterile procedures Hepatitis B vaccine
● Multi-dose vaccines may be used only at a maximum ● vaccine-preventable liver infection caused by the
duration of 4 weeks, while following all these hepatitis B virus (HBV), which spreads when blood,
conditions: semen, or other body fluids from a person infected with
○ The expiry date has not passed; the virus enters the body of someone who is not
○ The vaccine has not been contaminated; infected
○ The vials have been stored under correct cold ● Symptoms can include fatigue, poor appetite, stomach
chain conditions; pain, nausea, and jaundice, leading to long-term illness
○ The vaccine vial septum has not been such as cirrhosis or liver cancer
submerged in water; ● About 90% of infants with hepatitis B go on to develop
○ The VVM on the vial, if attached, has not chronic infection
reached the discard point
Page 22 o
● person with pertussis can infect others by coughing,
sneezing, or sharing a breathing space
CONSIDERATIONS: TETANUS
❖ Hepa B vaccine are damaged by freezing, so they ● infection caused by
should not be stored in the freezer toxin-creating bacteria called
❖ Hepatitis B is also provided within 24 hours after birth of Clostridium tetani, causing
babies of women with hepatitis B painful muscle contractions
❖ Only monovalent hepatitis B vaccine must be used for ● a.k.a. lockjaw
the birth dose ● tetanus disease often causes a person’s neck and jaw
❖ Pentavalent vaccine must not be used for the birth dose muscles to lock, with complaints of jaw cramping and
because DPT and HiB vaccine should not be given at trouble swallowing
birth ● bacterial spores enters the body through broken skin,
usually through injuries from contaminated objects
SIDE EFFECTS & MANAGEMENT ● Tetanus symptoms also include: muscle spasms – often
● Local soreness at the injection site of Hepatitis B in the stomach, painful muscle stiffness all over the
vaccine is common, and no treatment is necessary body, seizures, headache, fever and sweating, and
changes in blood pressure and fast heart rate
Pentavalent vaccine HAEMOPHILUS INFLUENZAE B INFECTIONS

● Pentavalent vaccine contains antigens against five ● Haemophilus influenzae, a type of bacteria, often cause
diseases: pneumonia, can also result several kinds of infections
● Diphtheria since it can invade parts of the body that are normally
● Pertussis free from germs
● Tetanus ● H. influenzae spread to others through respiratory
● Hepatitis B droplets
● Haemophilus influenzae B ● H. influenzae do not cause influenza (the flu)
● other types of invasive disease caused by HiB are:
bloodstream infection, meningitis, epiglottitis (swelling in
the throat), cellulitis (skin infection), and infectious
arthritis (inflammation of the joint)
DIPHTHERIA CONSIDERATIONS:
● caused by strains of toxin-creating bacteria called ❖ Pentavalent vaccine are damaged by freezing, so they
Corynebacterium diphtheria should not be stored in the freezer
● killing tissues in the resp. system, forming a thick, gray ❖ Pentavalent vaccine must not be used for the birth dose
coating (pseudomembrane) within 2-3 days, that can because DPT and HiB vaccine should not be given at
birth
cover tissues in the upper resp. tract, and can cause a
❖ DO NOT GIVE Pentavalent vaccine:
swollen neck (bull neck) making it very hard to breathe
and swallow ➢ to children over 5 years of age
● the bacteria usually spreads from person to person, ➢ to a child with recurrent convulsions or another
usually through respiratory droplets, or from touching active neurological disease of the CNS
infected open sores or ulcers ➢ succeeding dose (Pentavalent 2 or 3) to a
● the bacteria can also infect the skin, causing open child who has had convulsions or shock within
3 days of the most recent dose
sores or ulcers
● if the toxin gets into the blood stream, it can cause heart
(myocarditis), nerve (paralysis/polyneuropathy), and
kidney damage
PERTUSSIS
● a highly contagious respiratory disease caused by the
toxin-creating bacterium Bordetella pertussis, causing
airways to swell
● a.k.a. whooping cough
● creating fits of uncontrollable, violent coughing
(paroxysms) followed by a “whooping” sound when
taking deep breaths, appearing after 1-2 weeks of
common cold symptoms
Page 23 o
which spreads through the air when an infected person
Polio vaccine
coughs or sneezes.
● OPV provides protection against polioviruses in the ● Symptoms include:
mouth, intestines, and then in the blood ○ Fever
● IPV also provides protection in the blood and further ○ 3C's: cough, coryza (runny nose),
strengthens the protection given by OPV conjunctivitis (red, watery eyes)
○ Koplik's spots: tiny white spots inside the
mouth 2-3 days after initial symptoms
● Measles rash 3-5 days starting at head then spreads to
the rest of the body after initial symptoms, with spike of
● Poliomyelitis is a crippling and potentially fever to 40 to 41℃
deadly disease caused by the poliovirus,
which invades an infected person’s brain MUMPS
and spinal cord, causing paresthesia, ● a contagious disease that is caused by
meningitis, and paralysis ortho rubulavirus primarily affecting the
● the virus spreads through person-to-person salivary glands that are located near
contact, which enters the body by: your ears
○ Contact with the feces (poop) of an infected ● The primary sign of mumps is parotitis
person or swollen salivary glands that cause
○ Droplets from a sneeze or cough of an infected the cheeks to puff out
person (less common) ● Most complications of mumps include:
○ Orchitis - painful swelling of testicles in males
CONSIDERATIONS: who've reached puberty
❖ OPV has to be stored in the freezer with temperature of ○ Encephalitis
-15 to -25 ℃ ○ Meningitis
❖ The recommended sequence of the coadministration of ○ Pancreatitis
vaccines is OPV first, followed by Rotavirus vaccine, ○ Hearing loss
then other appropriate vaccines ○ Heart problems
❖ OPV is administered by putting drops of the vaccine ○ Miscarriage
straight from the dropper onto the child's tongue; do not
let the dropper touch the tongue RUBELLA
❖ Children with diarrhea who are due for OPV should ● a contagious viral infection best known by
receive a dose of OPV during the visit; however, the its distinctive red rash
dose is not counted. The child should turn when the ● it's also called German measles or
next dose of OPV is due three-day measles
❖ Children allergic to Streptomycin, Neomycin and ● it spreads when an infected person
Polymyxin B or to a previous IPV dose should not coughs or sneezes
receive IPV ● Rubella isn't the same as measles, but the two share
some symptoms, and rubella isn't as infectious or as
SIDE EFFECTS & MANAGEMENT severe as measles
● OPV: none ● signs and symptoms appears between 2-3 weeks after
● IPV: local soreness, fever, irritability, and malaise in exposure to the virus and usually last about one to five
some children days
○ Reassure parents and instruct them to give
antipyretic to the child CONSIDERATIONS:
❖ Children who have not received AMV1 as scheduled
and those whose parents or caregivers do not know
Measles-Mumps-Rubella (MMR) vaccine whether they have received AMV1 shall be given AMV1
● MMR vaccine protects against three diseases: as soon as possible, then AMV2 one month after the
measles, mumps, and rubella AMV1 dose
SIDE EFFECTS & MANAGEMENT

● AMV1: Fever 5-7 days after vaccination in some
children; sometimes, there is a mild rash
MEASLES antipyretic to the child
● a very contagious disease ● MMR/AMV2: local soreness, fever, irritability, and
caused by a virus rubeola, malaise in some children
Page 24 o
○ Reassure parents and instruct them to give ● Pneumonia is the most common infection caused by
antipyretic to the child pneumococcus, but it can also cause other types of
infections, such as:
○ meningitis
○ bacteremia
○ sepsis
○ otitis media
● In 2012, the Department of Health introduced 2 new
vaccines in the national immunization program:
Rotavirus and Pneumococcal conjugate (PCV) vaccines CONSIDERATIONS:
● The Government has allocated Php 1.6 Billion for the ❖ DO NOT GIVE the PCV when a child has a history of
procurement of these 2 vaccines hypersensitivity to a previous dose of PCV or
Pentavalent vaccine
Rotavirus SIDE EFFECTS & MANAGEMENT

● Local soreness, fever, irritability, and malaise in some
● a very contagious virus that primarily affects the large
children
intestine.
● It's the most common cause of diarrhea in infants and
antipyretic to the child
children, between ages 6 and 24 months are at greatest
risk for developing severe Rotavirus infection
● transmission is primarily by the faecal–oral route, Schedule and Manner of administration of Immunization
directly from person to person, or indirectly via
contaminated fomites
● A very contagious virus that primarily affects the large
iInitial symptoms are a fever and vomiting, followed by 3
to 8 days of watery diarrhea.
● Dehydration is a serious complication of rotavirus and a
major cause of childhood deaths in developing
countries
CONSIDERATIONS:
❖ The recommended sequence of the coadministration of EPI Recording and Reporting
vaccines is OPV first followed by Rotavirus vaccine,
then other appropriate vaccines Fully immunized children (FIC)
❖ The first dose of Rotavirus vaccine is administered only ● those who were given BCG, 3 doses of OPV, 3 doses
to infants 6 to 15 weeks after birth; the second dose is of Pentavalent vaccine, and one dose of anti-measles
given 10 weeks after birth up to a maximum of 32 vaccine before reaching one year of age
weeks
Completely immunized child
❖ DO NOT GIVE the Rotavirus vaccine when a child has
● those who completed their immunization schedule at
a history of hypersensitivity to a previous dose of the
vaccine, intussusceptions or intestinal malformation, or the age of 12-23 months
acute gastroenteritis
❖ Administer the entire dose of the Rotavirus vaccine on Child protected at birth
one side of the mouth with the tip of the applicator ● a child whose mother has received:
○ 2 doses of Tetanus toxoid, provided that the
directed toward the back of the infant's mouth
second dose was given at least a month prior
to delivery; or
SIDE EFFECTS & MANAGEMENT
● Some children develop mild vomiting and diarrhea, ○ at least 3 doses of Tetanus toxoid anytime
fever, and irritability prior to pregnancy with this child
antipyretic and Oresol to the child
Pneumococcal disease
● a name for any infection caused by bacteria
Streptococcus pneumoniae or pneumococcus
● the bacteria usually spread from person-to-person by
direct contact with respiratory secretions
Page 25 o

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CHN RLE - NUR8109 The Manila Health Department

● a working arm of the City Government of Manila,

1​ City Government Employees Clinic 1​ Drug Rehabilitation/Treatment Clinic

Levels of Primary Secondary Tertiary

Target Well​ individuals, early​ sick late​ sick;

Page​ 1 ​of 25 E. Fineza | 2NUR4

Cardiovascular ● Blood pressure monitoring

Integrated Management of Childhood Illnesses Environmental Health

Under-5 Clinic and Growth Monitoring PROGRAM SERVICES

Control of Communicable Diseases Insect & Vermin ● Fogging and spraying

Leprosy Control ● Provision of anti-leprosy drugs to

Page​ 2 ​of 25 E. Fineza | 2NUR4

DIMASALANG HEALTH CENTER ● first ​prenatal visit​ at first trimester

● 2 ​tetanus toxoid immunization ​(0.5mL, IM, Deltoid)

● counselling on healthy lifestyle and breastfeeding,

Assessment during Pregnancy

DEMOGRA Name, Age, Religion, Address,

CHIEF do not assume that Pt. is pregnant

Page​ 3 ​of 25 E. Fineza | 2NUR4

Childhood ● chickenpox dilation and curettage​: cervix may be

Page​ 4 ​of 25 E. Fineza | 2NUR4

NECK — slight ​thyroid hypertrophy ​may be noticed due to

Larger breasts​: 1-3 lbs (about 0.5 - 1.4 kg)

HEART — normal ​HR 70 to 80​ beats per minute

Page​ 5 ​of 25 E. Fineza | 2NUR4

RECTUM — assess the rectum for ​hemorrhoids​, which

FUNDAL HEIGHT & — A fundal height measurement is generally defined

LEOPOLD’S MANEUVER C. LABORATORY EXAMINATIONS

SEROLOGIC TEST for syphilis or gonorrhea

ANTIBODY TITERS for rubella, hepatitis (HBsAg), and varicella

INDIRECT COOMB’S detect the presence of antibodies against circulating

URINALYSIS to test proteinuria, glycosuria, and pyuria

TB SCREENING PPD test (purified protein derivative)

ULTRASOUND to date pregnancy or confirm fetal health

Page​ 6 ​of 25 E. Fineza | 2NUR4

Breast Tenderness — encourage to wear a bra with wide shoulder strap

POSTPARTUM CARE c. ​Take the temperature of both mother & child

Page​ 8 ​of 25 E. Fineza | 2NUR4

Page​ 9 ​of 25 E. Fineza | 2NUR4

Page​ 10 ​of 25 E. Fineza | 2NUR4

CHIEF COMPLAINT ​(CC)

HISTORY OF PRESENT ILLNESS​ (HPI)

Page​ 11 ​of 25 E. Fineza | 2NUR4

REVIEW OF SYSTEMS Plan

CURRENT MEDICATION, ALLERGIES

Page​ 12 ​of 25 E. Fineza | 2NUR4

Page​ 14 ​of 25 E. Fineza | 2NUR4

Collaborative interventions 1st year of life / ​month

4th year of life /​ 6 months

5th year of life /​ year

Newborn care until the 1st week of life

EXPANDED GARANTISADONG PAMBANSA (GP)

DISEASES COVERED BY IMCI

THE CASE MANAGEMENT PROCESS Classification the illness

- Chest indrawing or Severe pneumonia OR - give first dose f an PHILIPPINE LEGISLATION

RA 8976 — ​“Philippine Food Fortification Act”

RA 10028 - ​“Expanded Breastfeeding Promotion Act”

AO 36, s2010 - ​“Expanded Garantisadong Pambata”

Nutritional Assessment of Infant & Young Child

Mid-upper arm circumference (MUAC)

Bacille Calmette-Guerin (BCG)

● Abide by the ​open-vial policy​ of the DOH

1 City Government Employees Clinic 1 Drug Rehabilitation/Treatment Clinic

Target Well individuals, early sick late sick;

Page 1 of 25 E. Fineza | 2NUR4

Page 2 of 25 E. Fineza | 2NUR4

DIMASALANG HEALTH CENTER ● first prenatal visit at first trimester

● 2 tetanus toxoid immunization (0.5mL, IM, Deltoid)

Page 3 of 25 E. Fineza | 2NUR4

Childhood ● chickenpox dilation and curettage: cervix may be

Page 4 of 25 E. Fineza | 2NUR4

NECK — slight thyroid hypertrophy may be noticed due to

Larger breasts: 1-3 lbs (about 0.5 - 1.4 kg)

HEART — normal HR 70 to 80 beats per minute

Page 5 of 25 E. Fineza | 2NUR4

RECTUM — assess the rectum for hemorrhoids, which

Page 6 of 25 E. Fineza | 2NUR4

POSTPARTUM CARE c. Take the temperature of both mother & child

Page 8 of 25 E. Fineza | 2NUR4

Page 9 of 25 E. Fineza | 2NUR4

Page 10 of 25 E. Fineza | 2NUR4

CHIEF COMPLAINT (CC)

HISTORY OF PRESENT ILLNESS (HPI)

Page 11 of 25 E. Fineza | 2NUR4

Page 12 of 25 E. Fineza | 2NUR4

Page 14 of 25 E. Fineza | 2NUR4

Collaborative interventions 1st year of life / month

4th year of life / 6 months

5th year of life / year

RA 8976 — “Philippine Food Fortification Act”

RA 10028 - “Expanded Breastfeeding Promotion Act”

AO 36, s2010 - “Expanded Garantisadong Pambata”

● Abide by the open-vial policy of the DOH