1 COMMUNITY HEALTH NURSING Public Health Nursing: the term used before for Community Health Nursing  According

to Dr. C.E. Winslow, Public Health is a science & art of 3 P’s 1. Prevention of Disease 2. Prolonging life 3. Promotion of health and efficiency through organized community effort  Public Elements are: 1. People 2. Government 3. Environment Areas/Fields of Nursing: 1. Nursing Education • To be in college of Nursing • Goal: Preparing students to become professional nurse • Dean→ Asst. Dean→ Secretary→ Coordinators→ Faculty→ Clinical Instructor Level II Level III Level IV 2. Nursing Practice • There are clients whom care is to be provided • 2 Concepts: 1. Clients 2. Provision of Care Areas Clients Community Health Nurse Individual, Family, Community Hospital Nurse Institutional clients who suffered medical problems Military Nurse Serving the government: AFP, PNP, Navy School Nurse Students, entire constituents of schools, personnel (rank and file) Occupational/Industrial/Company Employees Nurse Private Duty Nurse Private patients Independent Nurse Practitioner Operate a clinic-a venue where health services are provided Example: Immunization regulated by PD 996: Compulsory Basic Immunization to all children before reaching the age of 8 years old→ Infants (0-6 months)→ BCG, DPT, OPV, Hepatitis B and Measles vaccine School Entrants-6 years old (Grade 1)→ Booster of BCG 3. Nursing Administration • Administrator: a person in authority to supervise his levels of subordinates Nursing Service in Hospital (Nurse Practitioner) ↓ Chief Nurse/Directress of Nursing Service ↓ Asst. Chief Nurse ↓ Supervisor ↓ Head Nurse Staff Nurse Nursing Aide


Community Health Nursing (CHN):  a specialized field of nursing practice  a science of Public Health combined with Public Health Nursing Skills and Social Assistance with the goal of raising the level of health of the citizenry, to raise optimum level of functioning of the citizenry (Characteristic of CHN) Target Population (IFC) are: 1. I ndividual 2. F amily 3. C ommunity Public Health (core foundation in Public Health Nursing Skills and Social Assistance Functions According to Nightingale, Nursing is an art and the science (4) Disciplines of Care: 1. Promotion of Health 2. Prevention of Illness/Disease 3. Curative Discipline of Care 4. Rehabilitative Discipline of Care Winslow enumerated the 5 Objectives of Public Health: CODES 1. C ontrol of Communicable Diseases 2. O rganization of Medical and Nursing Services 3. D evelopment of Social Machineries 4. E ducation of IFC on personal Hygiene→ Health Education is the essential task of every health worker 5. S anitation of the environment 3 Elements in Health Education: IEC 1. I nformation: to share ideas to keep population group knowledgeable and aware 2. E ducation: change within the individual 3 Key Elements of Education: a. K nowledge of theories/principles/facts/generalization b. A ttitude c. S kills 3. C ommunication: interaction involving 2 or more persons or agencies 3 Elements of Communication: a. Message b. Sender c. Receiver Regulatory Laws in CHN: r.a.: Re-organizational Act-formulated, approved, implemented & advocated before 1946 R.A.: Republic Act-laws approved & enacted after 1946 (WW II) P.D.: Presidential Decree P.P.: Presidential Proclamation E.O.: Executive Order LOI: Letter of Instruction A.C.: Administrative Circular H.B.: House Bill S.B.: Senate Bill Control of Communicable Diseases:

3 Elements considered in CHN: science of CHN),

3 A. Control of Communicable Disease regulated under r.a. 3573: Public Health Workers (PHW) to report any occurrence and incidence of communicable diseases PHW’s: are members of the health team who are professionals namely 1. Medical Officer (MO)-Physician------------------------ has immediate 2. Public Health Nurse (PHN)-Registered Nurse → responsibility to 3. Rural Health Midwife (RHM)-Registered Midwife-- implement r.a. 3573 4. Dentist 5. Nutritionist 6. Medical Technologist 7. Pharmacist 8. Rural Sanitary Inspector (RSI)-must be a sanitary engineer 2 Concepts of Communicable Disease: 1. Causative Agent-microorganism causing communicable disease 2. Transmission Contagious Easily transmitted through direct or indirect mode Transmitted via: a. Airborne-measles, pneumonia b. Droplet-PTB, Hepatitis A, Diphtheria Infectious Not easily transmitted Transmitted via: a. Blood Transfusion-AIDS, Hepatitis B, b. Sexual Intercourse: multiple sex partners 1) Bacterial-gonorrhea, syphilis, STD 2) Viral-AIDS, Hepatitis B 3) Fungal-Candidiasis 4) Protozoal-Trichomonas vaginalis c. Contaminated Article/Equipment -needles and syringes -Example: 1) Rabies-bite of a rabid dog→ rhabdo virus 2) Tetanus-wounds→ Clostridium tetani d. Placental Transfer

5 Communicable Diseases to be reported weekly and monthly: 1. Rabies 2. Measles 3. Polio 4. Neonatal Tetanus-children delivered at home by midwives/”hilots” 5. Sexually Transmitted Disease (STD)-all forms Diarrhea-not a disease but a symptom which should be reported by PHN monthly Treatment of Communicable Diseases: 1. TB: Program of DOH for its treatment-DOTS 2. Pneumonia: Care & Control of Acute Respiratory Infection (CARI) for under 5 children 3 Leading Infections: a. Pneumonia-a leading cause of morbidity & mortality of children under 5 b. Ear infection c. Throat infection Morbidity Report-report of diseases affecting the population group (BQ) while Mortality Report-reports of deaths

4 1. Diarrhea 2. Pneumonia 3. Bronchitis 4. Influenza 5. PTB 6. Hypertension

B. TB law or Liberalization of Treatment of TB regulated under R.A. 1136 Policies: 1. Preventive Program a. Immunization-BCG b. Strict isolation to prevent infection of the family c. Health education 2. Case Finding/Surveillance • 6 Concerns: 1) Disease 4) Diagnostic Procedure 2) Other name 5) Signs and Symptoms 3) Causative Agents 6) Treatment 3. Chemotherapy: a. Multiple Drug Therapy (MDT) • Purpose: 1) To prevent drug resistance against 3 combined drugs  if sensitive to one of the drugs, stop taking the identified drug but continue the other 2 2) To shorten the duration of treatment of TB  Minimum of 6 months Maximum of 12 months 3) To eradicate the organism preventing relapse b. Short Course Chemotherapy (SCC) 1) Intensive phase-2 months: RIP 2) Maintenance phase-4 months: RI 3) Extensive phase-2 months: RI • After 6 months of SCC: Do sputum examination to monitor the (+) tubercle bacilli: If (-), discontinue If (+), 2 months extension of RI then sputum culture recheck If (+), 2 months extension again of RI, the whole steps can be repeated for a total of 1 year treatment (from intensive to extensive phase) • After 8 months of SCC: do sputum examination If (-), stop medicines If (+), continue RI for 2 months • After 12 months of SCC, do sputum examination If still (+), do chest x-ray to determine the infiltration of MO to the lung lobes: a) Extensive infiltration-diagnosed as Far Advanced Pulmonary TB (FAPTB) & treated with Parenteral Streptomycin b) Minimal infiltration-diagnosed as Minimal Pulmonary TB (MPTB) & stay with SCC Program c. Directly Observed Treatment for Short Course Chemotherapy (DOTS)  Liberation of the Treatment of PTB wherein treatment is domiciliary (home setting)  DOTS was 1st introduced by WHO on 1998 in China & Indonesia where PTB was #3 as morbidity.  In the Philippines, WHO decided to include us in the program because PTB is #5 as morbidity and was implemented from 19982004.  In October 2002, a pre-evaluation was done and showed that Category I & II patients responded to DOTS Program, however, Category III patients did not respond to DOTS after 4 months of treatment.

4073 Policies: 1. PHN is a microscopist 2) Training & Health Education of Health Workers: PHN keeps the key to Botika & distributes SCC to registered PTB patients 3) Appropriate Funding: DOTS is funded by WHO & beneficiary is DOH 4) Recording and Reporting (R/R) for proper documentation:  r.5  DOTS was not terminated in 2004 but instead a replication was made known as Tuberculosis Incentives for Private Sectors (TIPS) which was funded by United States Agency International Development (USAID) and its beneficiary is the private sector 5 Elements of DOTS: 1) Sputum Microscopy: to rule out TB. Chemotherapy-isolation 4.A. Leprosy Law regulated by R. Multi-bacillary: contagious type (24-30 months) • Lepromatous and Borderline • TreatmentRifampicin once a month→ bactericidal DDS 100 mg once a day→ bacteriostatic Clofazimine (Lamprene) 50 mg once a day→ bacteriostatic . non segregation of leprosy victims Chemotherapy depending on the Category: 1. 3753: Vital Health Statistics-PHN reports the PTB patients so that WHO will prepare the medicines for those registered & serves as baseline information 5) Chemotherapy: based on the 3 Categories of WHO WHO Categories of PTB Category I Category II & (+)/(+) (+)/(-) 3x Far PTB Advanced FAPTB who has started treatment but prematurely stopped Relapse PTB Re-treatment Extensive pulmonary infiltration 6 months regimen 8 months regimen 1st 2 months: RIPE 1st 2 months: Last 4 months: RI RIPES *E given once a 3rd month: RIPE day 4-8th month: RIE Category III (+)/(+) (+)/(-) 3x Minimal PTB Signs Symptoms Sputum examination Diagnosis Chest x-ray result Treatment Treatment Schedule Minimal pulmonary infiltration 4 months regimen 1st 2 months: RIP Last 2 months: RI For SCC Treatment: 2 months RIP 4 months RI C.a. #304 dictates non discrimination. Rehabilitative-occupational therapy where P. Pauci-bacillary: non-contagious type (6-9 months) • Tuberculoid and Intermediate • TreatmentRifampicin once a month Diamino-diphenyl-sulfone (DDS) or Dapsone once a day 2. Case Surveillance-health education 3. Preventive-immunization (BCG) 2.P.

A. A. Organizing. Children: Infants and School Entrants→ 7 Immunizable Diseases 2. BCG c. # 6 2 Target Population: 1. OPV → 1st dose given at 6 weeks. Pregnant Women: 5 doses of Tetanus Toxoid G. Administrative Role: process of administration 1) 4 Major Management Processes: Planning. Door to door “patak” (Feb. DPT--d. A. Compulsory Immunization of All Children before 8 years old against the 6 Childhood Immunizable Diseases regulated by PD 996 Target Population of Immunization: 1.P.integrated in Directing • Coordinating-• Recording & reporting (R/R)-• Budgetary → integrated in Controlling • Evaluation---------------------- Association of Nursing Services & Administrators of the Philippines (ANSAP): responsible for shortening the 9 Management Processes into 4 where members are all chief nurses of hospital (government & private) b. OPV booster E.integrated in Planning • Planning-------• Organizing----.P. 2nd dose given a month after st the 1 e. 2002 & Mar. BCG booster b. Technical Role:  PHN acts as a generalist or general practitioner  PHN can act as a physician except to prescribe medicines because only 3 persons are licensed to prescribe: Physician.C. AFP Elimination Program regulated under P. Knock Out Polio (KOP) 3. Directing & Controlling 2) 9 Integrated Traditional Management Processes: • Assessment----. School Entrants at age 6 a.6 D. Compulsory Immunization of All Children with HBV before the age 8 regulated under F. 63A-include HBV in EPI Program I.9 or 12 months and earlier at 6 months when there is epidemic 2. 242-Hepatitis B is one of the reportable & reported to be immunizable Organization of Medical and Nursing Service: 1. regulated under RA 6675: Generics Act .integrated in Organizing • Staffing--------• Delegating----. # 1064 1.C. DPT booster c. Universal Mother & Child Immunization Law regulated under P.C. Infants b. 2-8 2002) H. HBV-dose. 114-Roles & Functions/Responsibilities of PHN in the Rural Health Setting Categories: a. 3rd dose given a month after the 2nd dose f. Polio Eradication Program (PEP) 2. Dentist & Veterinarian  PHN can act as a pharmacist which is made possible through the program “Oplan Walang Reseta” where PHN can dispense drugs in generics even without doctor’s order or prescription. Measles Vaccine.

Statistician-computes & reports morbidity. Officer) Division Services (OPHS) ↓ ↓ National Executive Council (NEC) Center for Health Services ↓ Regional Health Officer (RHO)-under the Congressman (MD) ↓ Provincial Health Officer (PHO)-under the Governor (MD) ↓ Municipal Health Officer (MHO)-under the Mayor (MD) ↓ Rural Health Unit (RHU)-under the Mayor (PHN) ↓ Barangay Health Station-under the Mayor (Rural health Midwife) . Estrella (2 months). DOH Secretaries-Flavier. 2001 to Present-under President Gloria Macapagal-Arroyo. Galves Tan (5 months). 1998 to January 20. 1986 to 1992-EDSA 1 under President Corazon Aquino where reorganization of MOH to Department of Health (DOH). endemic. 1992 to 1998-under President Fidel Ramos. Epidemiologist-determine the pattern/distribution of diseases: epidemic.O. Dr. 2001-EDSA 2 under President Joseph Estrada. Duque DOH Organizational Chart Department of Health Secretary ------------------------------------------------------------------------↓ ↓ ↓ ↓ ↓ Rules and Financial and Office of Office for Regulations Administrative Personnel Public Health RA 4226 (Med. Coordinator b. January 21. mortality & fertility to determine health status of the population c. Counselor f. DOH Secretary-Dr. Community Organizer f. diagnose & provide appropriate treatment as in dispensing drugs & administering IVF  Other activities or functions (dependent. DOH Secretary. Dr. 119-Reorganization of the Ministry of Health to Department of Health a.Dr.Dr. F. Microscopist-acts like medical technologist as in DOTS i. Supplementary/Complimentary 2. September 21. Facilitator d. sporadic or pandemic h. Jesus Azurin d. independent and interdependent) of PHN which implicates specific skills: a. Manuel Dayrit. Alberto Romualdez g. February 25. Supportive Role: Characteristics/Qualifications of PHN a. Environmentalist-matters related to environmental sanitation g. Health Educator c. 1919-BOH was abolished & was changed to Bureau of Health c. E. 1918-Creation of Board of Health (BOH) b. Hilarion Ramiro (2 years). Alfredo Benzon e.7  PHN are allowed to assess. Health Care Provider e. Clinician c. DOH Secretary-Dr. 1972 to 1986-Declaration of Martial Law by President Ferdinand Marcos where all agencies of the government were given the title Ministry under PD 1081. Carmencita Rheodica (1st lady secretary of DOH) f. Motivator e. Health Educator d. MOH Secretary. Manager b.

Three levels of health care 2.a. Creation of Restructured Health Care Delivery System (RHCDS) regulated by PD 568 (1976) 2. Vision (Dream of DOH)→ Health for All Filipinos  Formulated by former Secretary Flavier in 1993→ Health for All Year 2000 and Beyond  Health under the Hands of the People 2020  Health for All Filipinos as edited by Dr. Accessibility: DOH utilize strategies for delivery of health services Three Strategies in Delivering Health Services (ELEMENTS): 1. Dependent-giving of medications 2. Management Information Systems regulated by r. NKI 2° MHO & PHO (Muunicipal/Provincial Health Office) 1° BHS & RHU (Barangay Health Station/Rural Health Unit)  Accredited from use of RHCDS: 1.8 ------------------------------------↓ ↓ Station Satellite (8H Operation) (24H Operations. Romualdez 2. Example: doing your referral or collaboration with another person . Interdependent-involvement of 2 persons or agency. Referral 3. Independent-TSB for a highly febrile patient 3. Primary Health Care (PHC) regulated by LOI 949 (1984): Legalization of Implementation of PHC in the Philippines Creation of RHCDS  represented by: 3° RHO (National Health Agency) or existing national agencies like PGH or specialized agencies like Heart Center for Asia. PHN has an expanded role & responsibility (going beyond the standard function)  Standard Functions of Nurse: 1. Equity: equal health services for all-no discrimination b. an annex of Hospital) Basic Health Services under OPHS of DOH: E ducation regarding Health L ocal Endemic Diseases E xpanded Program on Immunization M aternal & Child Health Services→ Integrated Comprehensive MCHS E ssential drugs and Herbal plants N utritional Health Services (PD 491): Creation of Nutrition Council of the Phils. T reatment of Communicable & Non communicable Diseases S anitation of the environment (PD 856): Sanitary Code of the Philippines Basic Health Services of DOH: D rug Abuse Control Program O ral Health Services/Dental H ospitals are centers for wellness not for illnesses Goal of DOH: 1. 3753: Vital Health Statistics Law 3. Mission: Principles to attain the vision of DOH a. Quality: DOH is after the quality of service not the quantity • Philosophy of DOH: “Quality is above quantity” c.

Breastfeeding (BF)  Two (2) Beneficiaries of BF Program: a. CS: after 3-4 hours b. Exclusive : for the 1st six months. referral/coordination/collaboration outside Management Information Systems (MIS) Components of FHSIS (Field Health Service Information System): I. acts as managers in the implementation of the policies and activities of RHU. CDD (Control of Diarrheal Diseases) Program Policies to implement CDD: 1.A. never alternate BF with any supplementary feeding c. referral within the DOH 2.9 For PHN. Target/Client Lists Record done weekly and the following Special Programs are: A. Primary-prevention of illness or promotion of health 2. directly under the supervision of MHO (who acts as administrator) • Referral System: BHS→ RHU→ MHO→ PHO→ RHO→ National Agencies→ Specialized Agencies 1. Inter-sectoral: not used by RHCDS. nurse or midwife • Rural Health Unit (RHU) is under the management or supervision of PHN • Public Health Nurse (PHN) caters to 1:10. Extensive : BF can be extended to 2 years  Advantages of BF: Breast milk: EO 51-best for babies Reduced allergy • . Intra-sectoral: used by RHCDS. Early : start BF as early as possible→ NSD: after 30 minutes. Secondary-curative 3. Mother-regulated by R.000 population. Family/Individual Treatment Record done daily II. Health Education on Personal Hygiene  washing of hands before eating & after use of toilet 2. 7600: Breastfeeding and Rooming-In Act • Breastfeeding is an effective contraceptive method because it stimulates the anterior pituitary gland to produce prolactin hormone→ putting the female in an anovulatory stage→ there’s amenorrhea for 6 months from the time she gave birth • Rooming-in (RI) is putting together of mother and the newborn and it stimulates the posterior pituitary gland to release oxytocin hormone→ stimulates the uterine muscle contraction that inhibits the implantation of fertilized zygote in the endometrium→ no pregnancy occurs b. Tertiary-rehabilitative  Referral System in Levels of the Health Care: • Barangay Health Station (BHS) is under the management of Rural Health Midwife (RHM) together with Traditional Birth Attendants (TBA) or “Hilots” • TBA is under the management of RHM where before were not accepted by Medical Officer (MO) but now are considered an asset especially if there’s no obstetrician. giving medicines is not a dependent function but is independent  3 Levels of Health Care: Objectives to be fulfilled 1. Children-regulated by EO 51: Milk Code of the Philippines Dictum of Milk Code: Never commercialized a brand name of milk  3 Principles to make breastfeeding effective: 3 E’s a.

10 Easily established Always available Safe making stool soft Temperature: right temperature 24°C body reference→ if to be frozen.5 grams Buffer content of solution Bicarbonate/NaHCO3 Neutralizer content of solution Potassium Chloride/KCl 1.5 grams Stimulates smooth muscle contractility especially the heart & GIT  Never advice mother to buy brand names like pedialyte or gatorade Preparation of Proper Homemade Oresol A volume or one liter homemade oresol Smaller volume or a glass homemade oresol Water 1000 ml. or 1 liter 250 ml.5 grams For retention of water/fluid Sodium 2. Plan A: for prevention of dehydration . Frequency of passing out stool=≥3x/day b. Oresol: a management for diarrhea to prevent dehydration 2 Concepts of Diarrhea: a. No dehydration-uses oresol b. Severe dehydration-uses IVF Objectives/Plan/Policies of the Use of the following Program: a. Some dehydration-uses oresol c. Measles: immunization-preventive & prophylactic 4. a protein substance Immunity: colostrum contains Ig A that protects baby for the 1st 3 months Nutritious (optional) GIT diseases such as diarrhea is minimize/lessen because it’s sterile 3. preservation is minimum of 3 months & maximum of 6 months Fresh always Emotional bonding Economical Digestible: contains lactalbumin. Sugar 8 teaspoon 2 teaspoon Salt 1 teaspoon ¼ teaspoon or a pinch of salt=10-12 granules of rock salt: iodized salt=tips of thumb & index finger are penetrated with salt  For making solution=use 250 ml of water  For drinking medicines=a glass is 240 ml of water 3 Categories of Dehydration: a. Consistency of the stool=watery Contents of One Pack Oresol Dissolved in One Liter drinking Water Glucose 20 grams 1° Significance: For re-absorption of Na Facilitates assimilation of Na 2° Significance: Provides heat & energy Sodium Chloride/NaCl 3.

Condition a. always give the maximum amount 2-10 years old: 100-200 ml. Tongue & Lips: moist or wet Thirst: drinks normally 5. Condition a. 12-23 months: 600-800 ml. 5-11 months: 400-600 ml. Alert 2. Restless b. Mouth. Plan C: for treatment of dehydration-severe Assessment 1.11 b. Normal b. tongue & lips Eagerness to drink 5. Eyeballs-normal Tears-present 4. 1. mango. Dry mouth. Irritable 2. Sunken eyeballs & absent tears 4. Increase feeding: 3. Fast referral Plan B-Treatment of mild & Moderate DHN using oresol If less than 2 years old: use age in months If < 4 months: 200-400 ml. 2-4 y/o: 800-1200 ml. Plan B: for treatment of dehydration-mild & moderate c. Skin Turgor-returns back quickly which is done at forearm CDD Management Chart Category Treatment No dehydration Plan A-prevention of DHN 3 Principles/3 F’s: 1. K & Ca which are lost in diarrhea Oresol is given/LBM or every time stool is passed out: < 2 years old: 50-100 ml. Skin returns back slowly Some dehydration . Fontanel-normal 3. guyabano Oresol-am or buko where 3 electrolytes are present: Na. Increase fluid: Tea-lipton tea bag left standing in a cup of water for 15 minutes & there is brownish discoloration =pectin. a diuretic & has an absorbent effect Fruit Juices-not from highly fibrous fruits like pineapple. 10 years old & above: as much as tolerated & desired 2. 5-14 y/o: 1200-2200 ml. Sunken fontanel 3. Well c.

D5W 5. add 1 tablespoon of toasted rice or bread & allow to stand for 20-30 minutes→ produces a blackish discoloration which is pectin B. UFC (Under Five Children) Program-basic health service for children under 5 Policies to implement UFC: GOBIC G rowth Monitoring: age. milky substances (dagta) found on the inside of the skin Duhat: wash first the fruit then sprinkle with rock salt & shake. LRS-Lactated Ringer’s or Hartman solution is the most appropriate choice if no D5LRS 3. eat the extracts. Adult: give 3-4 liters of IVF in 1st 4 hours Example: 9am-1pm=4 liters=1 liter/hour If still severe dehydration. Unconsciousness b. D10W 1. weight & height O resol: CDD policies B reast feeding I mmunization C ARI Program (Care & Control of Acute Respiratory Infection (Pneumonia. Tea.12 15 & above: 2200-4000 ml. Lethargic c. Child: give 100 mg/kg body weight in the 1st 4 hours Example: 8 kg=800 ml. Skin returns back very. toasted bread or toasted rice beads which has activated charcoal that acts as absorbent Direction: In a cup of warm water. Very sunken eyeballs & absent tears 4. Plain NSS or 0. Very dry mouth. notice extracts to come out of the fruit. Condition a. Ear & Throat Infection) . Apple. Very sunken fontanel 3. guyabano & kaimito flesh BRAT Diet: Banana. IVF to be infused on the 1st 4 hours for patient with severe dehydration (8am-12noon) b. mango. very slowly best done at the abdomen Severe dehydration 2 Victims of Severe Dehydration: a. tongue & lips Refuses to drink orally 5. pineapple flesh. D5LRS-best or 1st choice if available for severe DHN since dextrose gives additional source of energy & improves appetite D5-is glucose LRS-has 3 chlorides 2. eat both skin & flesh Fruits to avoid during diarrhea: Papaya flesh. 2-6pm=infuse 4 liters IVF Fruits for Diarrhea: Apple: has pectin & tarum which has an absorbent property. Treatment Plan: 1st 4 hours always give the maximum Plan C-treatment of severe DHN using IVF Priority-choice of IVF: 1. Floppy-apathetic or passive 2. Rice. eat the skin Banana: has K+ Caimito: eat the flesh in cases of constipation but in diarrheal cases.9 NaCl 4.

13 C. Honey or sugar b. Paracetamol Stridor. CARI (Control of Acute Respiratory Infection) Program Categories of Pneumonia: < 5 years old ---------------------------------------------↓ ↓ < 2 months > 2 months-5 years old 1) Very severe disease (VSds) 1) VSds with Severe Pneumonia 2) Severe Pneumonia (SP) 2) Pneumonia 3) No pneumonia (NP) 3) NP with cough & colds CARI Management Chart: A ssessment C ategorize T reatment CARI Management Chart for < 2 Months Assessment Categorize Treatment Stops feeding VSdses Referral (Hospital): Fever: (+)/(-) convulsions 1. Co-trimoxazole on inhalation 4. IV Fluids ↑ Fever: (+)/(-) 2. Co-trimoxazole starts at home for 5 days Tx Mother to bring child at . Salabat ↑) Official preparation is (1-5 years=40/min & ↑) initiated by: Poultice-pounding chewing Decoction-boiling 2. Co-trimoxazole Always sleepy 4. IF Fluids Always sleepy 2. Kalamansi 3. Oxygen inhalation convulsions 3. Oxygen inhalation Stridor-noisy breathing 3. Phenobarbital on exhalation Chest Indrawing (CI) SP Referral (Hospital): Fast Breathing (FB) Same as above RR: 60/min and ↑ NV: 40-60/min for NB No Danger Signs of VSds NP with cough & colds Home care-↑ feeding CI (BF) FB Mother to observe child of any danger signs of (VSdses)→ refer urgently CARI Management Chart for > 2 Months-5 years old Assessment Categorize Treatment Stops eating VSdses Referral (Hospital): Malnutrition 1. Tea-infusion: a. wheeze & CI 5. Paracetamol Wheeze-noisy breathing 5. Phenobarbital (only sign for severe pneumonia) Fast Breathing P Home care with home RR: remedies: (2-12 months=50/min & 1.

Prevalence Rate (PR)-determine sum total of new + old cases of diseases per percent population 3. 8 (Samar & Leyte) & 11 (Davao-North) Malarial Control Program (MCP): Palawan & Mindoro III. “Ligtas Tigdas”: Measles Elimination Program regulated by P. Morbidity-Illnesses affecting the population group a. Crude Death rate (CDR)-overall total reported death b. SCP & MCP (Schistosomiasis & Malarial Control) Program: local endemic diseases-regular. Tally Record & Reporting (R/R) prepared by PHN monthly Example: Influenza llll-llll-llll Cholera lll Amoebiasis ll Parasitism llll-llll IV. Maternal Mortality Rate (MMR)-maternal deaths due to maternal causes .14 the health center after 2 days of treatment for proper evaluation No Danger Signs CI FB NP with cough & colds Home care with home remedies Mother to observe & report of danger signs Mother to report if cough persists even after 30 days D. Outcome R/R done quarterly (once in 3 months/4x a year) and annually (done in December only) PHN has the responsibility to prepare & report on the following Health Indicators: 1. constant & habitual=always Schistosomiasis Control Program (SCP): Region 5 (Sorsogon).P. Mortality-Reports causes of deaths a. Fertility-Crude Birth Rate (CBR) 2. Incidence Rate (IR)-reported new cases affecting the population group b. # 4 (1996) Example: Lanting Epidemic Measles-mass immunization (6 months-8 years) receive measles vaccine Eligible Age=0-59 months→ 5 years Example: BCG=booster 6 years & SE “Ligtas Buntis”: MWRA-Married Women of Reproductive Age MCRA-Married Couple of Reproductive Age FRA-Females of Reproductive Age HBMR: Home Based Mothers (BQ) Record Reproductive Age: 15-49 (New) & 15-44 (Old) 15-average age of menarche 49-average age of menopause Estimate for the age of menopause: Age of menarche + 35 (constant # of years of function of ovaries) Example: 12 + 35=age of menopause EO 209: Family Code under President Aquino-married women PD 651: Birth & Death Registration Law-PHN who attended delivery should register the attended birth at the Local Civil Registrar with a grace period of 30 days→ PHN prepares the birth certificate RA 9255: Acknowledgement of children with pregnancy out of wedlock E.

000.15 c. IR of measles=8 cases . Infant Mortality Rate (IMR): Reported # of infant (0 to 12 months of age) deaths per 1000 RLB IMR=# of infant deaths x RLB 1000 5. Prevalence rate (PR): Reported new cases of disease + old cases of disease per percent of population PR=new cases + old cases x 100 Population 3.000). Neonatal Mortality Rate (NMR): Reported # of neonatal (0 to 28 days or <1 month) deaths per 1000 RLB NMR=# of neonatal deaths x 1000 RLB 6. Crude Death Rate (CDR): Overall total reported deaths per 1000 population CDR=overall total deaths x 1000 Population b. Swaroop’s Index (SI): Reported # of deaths among individuals> 50 years old over total deaths SI=# of deaths (individual >50 years old) Total Deaths x 100 Multiplying Factors (MF) to use: 100 : Morbidity 1000 : Fertility & Mortality except in Swaroop’s 100. Neonatal Mortality Rate (NMR)-# of deaths among neonates (newborn 0-28 days. Swaroops Index (SI)-deaths among individual in the age group of 50 and above Formulas: 1. Infant Mortality Rate (IMR)-# of infant deaths (0-12 months) or less than 1 year old d. Mortality: a. Maternal Mortality Rate (MMR): Reported maternal deaths per 1000 registered live births (RLB) MMR= # of maternal deaths x 1000 RLB 4. Fertility: Crude Birth Rate (CBR) Overall total reported births per 1000 population CBR=overall total reported births x 1000 Population 2. < 1 month) e. Morbidity: a. Incidence Rate (IR): Reported new cases of disease per percent (100/population) population IR=new cases of disease x 100 Population b. If the numerator is too small enough to represent denominator Example: Lanting Community (Population: 1.000: 1.

Romualdez & up to present  PHC as defined by WHO is an essential health care made universally accessible to IFC (Individual.000. Utilizes Appropriate Technologies used by PHC: ACCEFS A ffordable. accessible. that’s why the term PHN was changed to CHN 2. Juan Flavier  2000. Acceptable 2. Switzerland wherein other nations were invited including the Philippines (DOH delegates attended) making the PHC international  1984.000 Primary Health Care (PHC):  1978. ASAID. Attainable Concepts of Family Health Care: 1. DECS) or internationally based (WHO. plaque. LOI 949 approves for the legalization of implementation of PHC in the Philippines  1993. USAID. Family.7 1.000=. Health Promotion 2. “Save our Ship” (SOS): if after computing. available C ost wise=economical in nature C omplex procedures which provide a simple outcome E ffective F easibility of use=possibility of use at all times S cope of technology is safe & secure . acceptable. BFAD. Granted Facilities 3. Inter-sectoral=outside DOH wherein it establishes linkages with other locally based (DSWD. Russia during the Alma Ata Conference (AAC) Goal: Health for All for the Year 2000 & beyond to develop self-reliance BQ: PHC conference was held in Alma Ata  1979. WHO & UNICEF sponsored the PHC in Alma Ata. Affordable 3. Awards: Cash. UNESCO & JAPHIEGO=an international organization based in Japan focused on family planning) 3. internationally replicated the conference in Geneva.000007 x (not a significant result) 2.16 IR= 7 100.000 x 100. Health for All Filipinos by Dr. Utilizes Multi-Sectoral Approaches-makes referral system • 2 Modalities of Referral used by PHC: a. Community Organization Participatory Research (COPAR) 4. certificate Characteristics of PHC: 1. Accessible 5. Utilizes People Empowerment-population is involved in implementing programs & making decision a.000=. Available 6. Community) “Sentrong Sigla Movement” (SSM) was established by DOH with LGUs having a logo of a Sun with 8 Rays and composed of 4 Pillars: 1. Sustainable 4. Community Based-community focused & oriented. Intra-sectoral=RHCDS=within DOH b. Technical Assistance 4. DOH: Health for All Filipinos was advocated by Dr. substitute the MF with 100. your answer is not in the choices available. Community Immersion Program (CIP): imbibing with the community b.

Analgesic . Rifampicin (RIF)---------For TB Program: 4. receive no salary but are given incentive in the form of honorarium from the local government since 1993 2. RA 6675: Generics Act of 1988: implementing “Oplan Walang Reseta Program”-solution to the absence of a medical officer who prescribed the medicines so PHN are given the responsibility to prescribe generic medicines and “Walong Wastong Gamot Program”-available generics in “Botika sa Baryo” & Health Center  Father of Generics Act: Dr.name given by the manufacturer 8 Commonly available Generics in “Botika sa Baryo & Health Center”: CARIPPON 1. didn’t undergo formal training. Training of Health Workers 2. Pyrazinamide (PZA)-----All came from Aminoglycoside  Rifampicin & Isoniazid are the only TB drugs given to children  Adverse Effect of RIF: Hepatotoxic INH: Peripheral neuritis 6. Alfredo Bengzon  Generic Name-ingredients of drugs expected to provide therapeutic value Brand Name. Paracetamol  Has an analgesic & anti-pyretic effect  Acetyl Salicylic Acid (ASA) or Aspirin is never kept in the “Botika” because of its effects: b. Trimethoprim(TMP) • Has a bacteriostatic action that stops/inhibits multiplication of bacteria • For GUT. Co-trimoxazole:  it’s a combination of 2 generics of drugs which is antibacterial a. Intermediate-these are professionals including the 8 members of the PHWs 3. Isoniazid (INH) → All are antibacterial (bactericidal) 5. Creation of Botika sa Baryo & Botika sa Health Center 3. Herbal Plants 4. URTI & Skin Infections  The drug of choice of DOH for pneumonia is the combination of TMP & SMX (Co-trimoxazole) 2. First Line Personnel-the specialist (Oncologist. Barangay Health Volunteers (BHV) and Barangay Health Workers (BHW)  Non professionals. nephrologists) Creation of “Botika sa Baryo & Botika sa Health Center” A. cardiologist. GIT & URTI (TMP combined with SMX) b. GIT. Grassroot/Village  Includes the Traditional Birth Attendants (TBA) or “Hilots” who attends to delivery. Sulfamethoxazole (SMX) • Has bactericidal action that kills bacteria • For GUT. Oresol Training of Health Workers 3 Levels of Training: 1.17 4 Contributions of PHC to DOH & Economy: 1. Amoxicillin/Ampicillin  An antibacterial drug that comes from the Penicillin family  Effect is generally bacteriostatic (when source of infection is bacterial)  These 2 drugs provide the least sensitivity reaction (rashes & GI) and the adverse effect of other antibiotics is anaphylactic shock 3.

Esmolol. it is normal for 25 years old & above ABCD’s or Groups of Drugs for Hypertension (HPN): A ngiotensin Converting Enzyme (ACE) Inhibitors  Mechanism: acts as an inhibitor or blocker  Angiotensin is a constrictor to blood vessels  Generics ending in -pril  Example: Captopril (Capoten). Anticoagulant-highly dangerous to Dengue patients that’s why it’s not available in “Botika” & Health Center 7. M ethamphetamine (Shabu) -zepam. Anti-inflammatory e.18 c. commonly used & available in Botika sa Health Center). Adalat. RA 9165: New Dangerous Drugs Act (old RA 6425): needs S2 license and prescription pad Prohibited Drugs Regulated Drugs Contents: Contents: C ocaine/Codeine Benzodiazepines/drugs ending in – O piates zepine. -zepate E ucaine/Ecstasy Barbiturates (barbital): L ysergic Acid Diethylamine (LSD) a. –thal (for anesthesia)-Pentothal b. Amlodipine D iuretics  Use to ↑ elimination of fluids from tissue cells→ pressure in blood vessels→ constriction  Example: Furosemide (Lasix)-a loop diuretic which is commonly used & the safest a. Metropolol. Nicardipine. –bital (for phenos)-Phenobarbital Side Effects: Side Effects: CO-Dizziness/drowsiness Sedative-calm/relax METH-Habit forming leading to Hypnotic-sleep addiction Example: Diazepam-2 mg LSD-Hallucinations (white)=sedative 5 mg (yellow) 10mg . Oresol: a management for diarrhea to prevent dehydration under the Control of Diarrheal Diseases (CDD) Program 8. 16% of population belonging to 25 years old & above in the community are hypertensive • If BP level=150/90. Atenolol C alcium Channel Blockers  Calcium stimulates the heart muscle to contract  Generics ending in -dipine  Example: Nifedipine (Calcibloc-a gel capsule taken sublingually. -zepate  Example: Benzodiazepines Diazepam (Valium) 2 & 5 mg for HPN 10 mg as hypnotic B. Site: Loop of Henle b. Nifedipine • An anti-hypertensive drug • According to DOH. Anti-pyretic d. Enalapril B eta Blockers  Mechanism: a vasodilator  Generics ending in -olol  Example: Propranolol. -zepam. Action: It dilates blood vessels→ ↓ BP S edative (optional)  Use to keep client calm & relax  Generics ending in –zepine. Tinolol.

leaves 3. Know parts of plants with therapeutic value: roots. Know indications 2. Use of acupressure-allowed only to those who have undergone training 10 Advocated Herbal Plants by DOH: LUBBY SANTA Plant Name Scientific Indications Plant Part Preparation Name Used Lagundi Vitex negundo Asthma. RA 8423: Alternative Traditional Medicine Law-a program where patient may opt to use herbal plants especially for drugs that are not available in dosage form or patients has no financial means to buy the drug 2. colds Poultice & fever (ASCOF) Pain and inflammation Ulasimang Peperonia Gout Leaves Decoction Bato pellucida Arthritis Poultice Rheumatism Bayabas Psidium Diarrhea Leaves Decoction quajava Toothache Mouth and wound wash Bawang Allium sativum HPN Clove/Bulb Poultice Toothache Yerta Buena Mentha Same as Leaves Decoction cordifelia Lagundi Poultice except asthma Sambong Blumea Edema Leaves Decoction balsanifera Diuretic Akapulko Cassia alata All forms of Leaves Decoction skin diseases Poultice Cream Niyog niyogan Quisqualis Intestinal Seeds Decoction indica Parasitism Poultice (Nematodes) Juice Tsaang Gubat Carmona Diarrhea Leaves Decoction resuta Infantile colic Poultice (Kabag) Dental caries Ampalaya Mamordica Type II Leaves Decoction charantia Diabetes (NIDDM)  AC 196-A: Ampalaya was deleted in 10 herbal plants advised by DOH in October 9. fruits. Traditional Medicine: a.2003 Policies to abide: 1.19 (blue)=hypnotic Herbal Plants 1. Use of herbal plants b. Know official procedure/preparation  Procedures/Preparations: a. Leaves Decoction cough. Decoction .

20 Gather leaves & wash thoroughly. Poultice • Done by pounding or chewing leaves used by herbolaryo • Example: Akapulko leaves-when pounded. Epidemiological Condition 4. keep standing for 15 minutes in a cup of warm water where a brown solution is collected. mango & caimito e. Cream/Ointment-for topical use • Cream is water based & used for wet skin lesions • Ointment is oil based & used for dry lesions • Example: Akapulko Leaves  start with poultice (pound leaves) to turn it semi-solid  add flour to keep preparation pasty & make it adhere to skin lesions  to make it into an ointment: add oil (mineral. Juice/Syrup • To prepare a papaya juice. Community Organization 3. place in a container the washed leaves & add water • Let it boil without cover to vaporize/steam to release toxic substance & undesirable taste • Use extracts for washing b. use ripe papaya & mechanically mashed then put inside a blender & add water • To produce it into a syrup. add sugar then heat to dissolve sugar & mix it • For problems of constipation • Example: papaya. pectin which serves as an adsorbent and astringent • Used for diarrhea and for pneumonia so PHN discourages to buy commercially prepared cough syrup→ expectorant: Nature of Cough 1) Dry→ mucolytic→ liquefy mucus Example: Carbocisteine. it releases extracts coming out from the leaves contains enzyme (serves as antiinflammatory) then apply on affected skin or spewed it over skin • For treatment of skin diseases c. Guafenesin 2) Productive→ expectorant→ irritants to the mucus gland Example: Bromhexine (Bisolvon) 3) Non stop coughing→ antitussive Example: Dextromethorpan (Robitussin)→ contains codeine Robitussin AC→ contains atropine & codeine d. Home Visit 3 Concepts of FHNC: Family: Focus of care • . baby or any oilserves as moisturizer) to the prepared cream to keep it lubricated while being massage on the affected area BASIC HEALTH SERVICES OF DOH (E L E M E N T S) HEALTH EDUCATION: Generalized Activities where Health Education is provided 1. Environmental Sanitation 5. Family Health Nursing Care (FHNC) 2. Infusion • To prepare a tea (use lipton bag).

Consolidation or Collation-collecting back the questionnaires. Validation: uses statistical approaches Statistical Approaches: 1) Central Tendencies: 3 M’s a) Mean=average Mean: x=Ex (summation of=sum total of variables available) N (# of existing variables) Example: Shortening of life expectancy of Females: 71 y/o & Males: 67 y/o. What is the average life expectancy of Filipinos? 71 + 67=138 ÷ 2=69 y/o average life expectancy b) Median=range Highest-lowest score=95-35=60 passing score c) Mode=frequency of occurrence of a variable. Data Gathering: tools or instruments used during survey (windshield) 1) Interview 2) Observation 3) Questionnaires-mostly patronized & used in CHN 4) Records & Reports available b. tabulate and summarize c. Presentation of Data 1) Table/Chart Title: Variable % (result of computation as expressed) Analysis & Interpretation (A/I): This is the basis for problem identification 2) Graph: Pie Bar-2 variables only Line Polygon-connecting the results . used if there’s too many variable occurring twice or more & arrange variables from highest to lowest Example: Scores of exam=95 95 85 85 70 65 65 65 50 Uni-modal: 70 & 50=1x Bi-modal: 95=2x Tri-modal: 85 & 65=3x Quadri-modal=4x 2) Standard Deviation: used if there are too many variables available to be treated which is seldom used in CHN SD=√ ∑ (x-x) n-1 ∑=summation of x=variables available x=mean (given special attention) n=# of existing variables 3) Percentile (%) Method: most commonly used in CHN by adding all cores then multiply by 100 d. Rapport/Relating 2.21 Health: Goal of care Nursing: Medium/Channel of providing care Standard Definition of Nursing Process: a systematic approach of solving an existing problem/meeting the needs of family-RAPIE 1. Assessment: Sub-steps a.

desirable. underweight (a deficit) B. Socio-cultural: different nature of religion D. illness or disease. now known as PIH . family member with disease F. Market 5.22 Histograph-2 or more variables & appear adjacent to each other e. health interference & health disturbance 8th pregnancy=↑ risk=toxemia. Foreseeable Crisis (FC) • Use of Initial Data Base (IDB): A. the 9 y/o child is 15 kg. Methods 5 Specific M’s: 1. treatment of garbage. Family Chart Structure: Nuclear-Father. Transportation 2. Health Deficit (HD)-if identified problem is an abnormality. Machine 4. IBW=25-27 kg. availability of toilet. Baylon & Magnaya (authors of Family Health Nursing Process) I. 27 -15 12 kg. there’s a gap/difference between normal status (ideal. Home environment: assessment according to ES. expected) & actual status (the outcome/result/problem encountered on that actual day) During “operation timbang”. Identifying or Defining the Problem Typology of Nursing Problems: by Drs. Socio-economic: poverty level. (actual BW). preparation of food. educational attainment & nature of occupation of members of the family (sources of income) C. Medical history: history of certain disease. Health Threat (HT)-any condition or situation which will be conducive to health alteration. water & food sanitation. mother. Resources available in community for use by the family: 5 Generalized M’s in resources available in community: 1. children Extended (3rd generation)-Relatives staying with the family Multi-generational extended-“apo sa tuhod” or “apo sa talampakan” Dyad-Husband & wife only (childless couple) Blended-widow married another widow & have children Gay-Same sex living together Matriarchal-Mother is the decision maker Patriarchal-Father is the decision maker Communal-different families forming a community B. For a 9 y/o. Man/Manpower 2. Recreational Center • Define the problem after identifying it according to nature A. Money 3. Materials 5. School 4. Hospital/Clinic 3. Health Threat (HT). sources of diseases E. First Level Assessment: to determine problems of family Sources of Problems using IDB Family: use of Initial Data Base (IDB) Nature: Health Deficit (HD).

Prioritization-start if there are multiple identified problems b. Foreseeable Crisis (FC)-stress points. Application of Principles on Hygiene 5. Formulation of objectives-planning a procedure will start here if there is only one problem . OPV. Juan Dela Cruz is: Jobless Father FC Suffering from TB HD Wife is pregnant for the 8th time HT & FC 2 y/o youngest child lacks HT immunization 9 y/o eldest child is 3rd degree HD malnourished Poor environmental sanitation HT II.23 Without immunization (BCG. Emotional Competence 8. Planning  Four (4) Standard Steps: a. HBV. Therapeutic Competence 3. Knowledge about health 4. Measles)=HT to have 7 immunizable diseases C. Utilization: Resources Available Example: A mother said that her 5 year old child has fever T=39.6°C→ tick competent for therapeutic 3. Second Level Assessment: coping capacity of the family using coping areas (9x) Coping Index Card 9x Coping Areas Competent Marginal Incompetent (Family Health (Adequate) (Average) (Inadequate) Tasks) (5) (3) (1) 1. T=37. Attitude towards health maintenance 6. DPT. Physical Independence (liberty of the family to move around) 2. anything which is anticipated/expected to become a problem Example: Jobless=no income→ no money to buy food leads to starvation Pregnancy for the 8th time Mr.9°C & she did TSB. Family living (special competence) 7. Physical Competence 9.

99 th 8 pregnancy =3. pregnant for the 8th time. Preventive Potential Highly Moderate Low IV. malnutrition & poor environmental sanitation-there are 6 problems identified: • There are 6 problems identified.5 Step 3: Add all scores 1 + 1 + .67 + . Salience of the Problem Problem needing urgent attention Problem not needing urgent attention Not a felt problem Criteria in Identifying the Problem Score Weight 3 2 1 1 2 1 0 3 2 1 2 1 0 2 1 1  Steps: a. Decide on a score b. Developing strategies of action d.67 IV. Modifiability: 1 2 x 2=1 III. if score nearing 5 then prioritize the problem Criteria 1.17 rd Hypothetical: TB =3. Score x weight Highest score c. Nature: .45→1st priority I. child lacks immunization. Salience Problem: 1 2 x 1=. Preventive Potential: 2 3 x 1=. thus prioritize the problems which needs to be attended 1st • Make use of the Table of Reference to prioritize the Multiple Problems Criteria I.67 x 1=. Formulation of evaluation tools for the identified strategy developed  Example: TB.25→ 3 priority Jobless =2. Modifiability Easily Intermediate (moderate) Not modifiable III. Nature: assess by PHW Health deficit (HD) Health threat (HT) Foreseeable Crisis (FC) II. jobless. Get the sum total of all the scores  Interpretation: Perfect score=5.5=3.24 c. 2 & 3 has to be assessed objectively by the health worker Criteria 4 has to be assessed by the perception of the family  Example: Compute for Malnutrition Step 1: 3rd degree malnutrition=health deficit→ 3 Step 2: 3 3 x 1=1 II.

supplies are utilized Process utilized-steps used Outcome of activity-results can be: a. Interdependent-referrals 5. Area of Selection  It should be DOPE Community: Depressed. Mobilize people within the individual 3. no numerical value. HT & FC 4. Collaborating 3. Quantity-from the word “quantum”. Attitude c. 1st encounter with Dela Cruz Family Identified problem: 3rd degree malnutrition was reported to MO Feb 2005. Poor & Exploited. masigla-quality Gained 5 lbs-quantity Community Organization Objectives: Patterns to be followed 1. pneumonia  Isolate the problems according to nature: HD. Skills Phases: 1. mapaglaro. a new criteria for community organization  “Old Criteria”→ it must be a virgin community=meaning no agency has gone there. Evaluation  Three (3) Things to be evaluated: SPO Structure of program & activity-what articles. not measurable b.18 BQ: Prioritized the problem of the family of Mr. provide. MO asked about the family If PHN evaluation is: “Tumaba na. assess. Quality-characteristic or kind of outcome. Organizing 5. 9 pregnancy -FC & HT Answer: C. Educating (training) 2.25 Lacks immunization =3. strengthen b. Preparatory 4. malakas. Dependent-giving of medicines b.17 Poor ES =3. Independent-monitor.Goal: to develop self-reliance or independence and changes 2. advocated. Desirable-to be implemented. Mobilizing 6. Intervention or Implementation or Working Phase  Is the capacity to provide management  Is the professional phase of nursing process  Is the time when the PHN executes the standard function of an RN  Three (3) Standard Functions of RN: a. Jobless -FC d. Organize people----. Pneumonia -HD th b. Undesirable-to be avoided  Two (2) Aspects to be evaluated in the Outcome: a. with numerical value. Knowledge b. . Work with people 4.30→ 2nd priority Malnutrition =3. Santos: a. Oppressed. equipments. Womanizer -FC & HT c. measurable Example: Dec 2004. educate c. Phase out Policies: Preparatory Phase 1. Educate people-----a.

machinery. money. Entry: the 1st thing to do upon entering the community is to have a courtesy call with the Barangay Captain. preventive potential. Sympathy (Integration) 4. Morbidity: IR (new cases) & PR (old cases)=HS c. mode of transportation. Mortality: Deaths like children dying of pneumonia=HS Health Resource(s): methods 5 M’s-Manpower/Man. Empathy b. Health status problem is to Health Status is to be prioritized because it is from the outcome of report of health condition/status. modifiability. magnitude. Community Study: Diagnosis of Community-COPAR  Makes use of the Nursing Process/Problem Solving Approach  Prioritized which among the problems identified is to be attended 1st like in nature. material & (+) available facilities-Hospital/Clinic. purpose. activities. present the project. salience Prioritization of Community Problems NATURE Health Status (HS) Health Resource(s) Health Related MAGNITUDE OF THE PROBLEM: % problem 75-100% 50-74 % 25-49 % <25 % of the population MODIFIABILITY Easily Intermediate Low Not modifiable PREVENTIVE POTENTIAL Highly Moderate Low SALIENCE  First to be assessed is the nature of be prioritized 3 2 1 of population affected by the identified 4 3 2 1 3 2 1 0 3 2 1 the problem. 3. Integration/Immersion (CIP)  Immersion is imbibing the life situation/condition of the community by living. eating & sleeping with the family to be able to understand their situation  It requires 2 Qualities of PHN: a. Fertility: ↑ CBR=community is overpopulated=HS b. Problem identified will be the indicator of health condition→ RA 3753: Vital Health Statistics Indicators of Health Status/Condition: a. school & movie houses for recreation Health Related: Categories according to 5 Aspects of Man=PEMSS P hysical. P hysiological. etc. P sychological . introduce self & group. market.26  This is a dangerous situation that’s why RA 7305: Magna Carta for Public Workers was provided-a PHN is to receive a hazard pay of 20-25% of monthly salary 2.

Mobilization-let the members of the community do the work. He can recommend 8. Never leave without change but be able to evaluate the population Health Education in terms of Epidemic Policies in times of Epidemic/Activities of PHN in times of Epidemic: 1. Evaluation with Expansion-there should be a perceived change before one leaves that community. fact & generalization • The problem is stated in hypothetical form using 2 Variables of Hypothesis: 1) Independent-refers to the cause 2) Dependent-refers to outcome/effect • There should be an existing relationship between the 2 variables • Example: Stated problem in hypothesis: Measles is caused by rubeola virus Dependent (outcome): Measles Independent (cause): Rubeola virus d. Community Assembly: Community Organizing Participatory Action Research (COPAR)  Attend the assembly of the family/families  Families in the community should be represented. Confirm diagnosis • Determine 1st if greater population is affected by disease • Example: Lanting Community=epidemic measles 3000: Susceptible population 1750: Affected population b. PHN should only SUPERVISE 9. Organize a team 2. Choosing Potential Community Leaders 6. any family members can represent his/her family as long as he/she is a RESPONSIBLE (one who also can comprehend) member of that family. Appraise the fact • Use an empirical approach (the utilization of human senses)=naked eyes/sense of light. Supervision of Health Education 10. Formulate hypothesis • To make an intellectual guess based on theory.  Barangay Captain/Chairman need not necessary be the leader.27 E motional M ental S ocial S piritual Organizing Phase 5. touch. Conduct an Epidemiologic Investigation (EI)  A problem solving approach that follows a scientific step Steps in Epidemiological Investigation: a. smell & hearing • PHN needs to get out & check for the victims • Example: PHN’s sense of sight=saw the pathognomonic signs of measles→ koplik’s spot & rashes c. Core Group Formation 7. Testing hypothesis • To prepare an assumption which is always paired with stated hypothesis • Assumption is the answer of the researcher to a stated problem .

Evaluative:  determines the efficacy of the management/treatment provided/procedure done  Efficacy refers to effectivity (qualitative) and efficiency (quantitative) Epidemiology is the pattern of occurrences & distribution of diseases. Descriptive: describes or defines the characteristic pattern or occurrence of epidemic as to where-place when-date. 3753: Vital Health Statistics Law 10.28 is the personal opinion of the researcher (pananaw) & does not need to be proven because it’s always true & correct • Example: Lanting Community has poor environmental sanitation (es) which caused the measles e. a DOH program  Example: The mass immunization of all children in the community (6 months to 8 years old) with measles vaccine irregardless if a 9 month old baby has just received measles vaccine. Environmental Sanitation 8. defects & deaths . Immunization  Mass immunization for measles epidemic=”Ligtas Tigdas”. there’s sudden mark decrement/decrease of polio cases  In year 2001. Collection of Specimen (optional)  Optional because it is case to case basis  Not done in measles epidemic  Done in GIT diseases like Cholera caused by bacterial agent Vibrio cholera where it is identified in stool examination 4. Recording & Reporting (R/R)-r. Analytical: determines what could have cause the occurrence of the disease c. Health Education-on personal hygiene 7. Evaluation & Reasearch  Research evaluation was only started in 2001  Year 1996-2000: Zero Polio Philippine Program  In year 2000. he will still be given. Draw a conclusion • To draw a conclusion from the statement of problem & assumption to come up with a Nursing Diagnosis • Example: Measles is caused by rubeola virus due to poor environmental sanitation 3.a. Interventional: therapeutic or experimental that determines the management/treatment for the victims of the occurrence of the disease d. No overdose will result but it’s prophylactic (Patak Polio) and not for treatment 6. time who-person b. suddenly there’s an increase incidence of polio because they don’t know the cause so they consider polio to be mutagenic  3 Strains of Polio: 1) Brunhilde 2) Leon 3) Lansing Types of Epidemiological Investigation: a. Treatment  RA 6675: providing drug of choice  Example: Cholera-give Tetracycline but contraindicated to pregnant women & children below 8 years old so may give Penicillin like Ampicillin 5. Referral 9.

Sporadic  The pattern of occurrence is on & off where: On=available causative agent Off=no available causative agent  It’s intermittent (unpredictable) in occurrence  Disease occurs only if there’s a susceptible host like in rabies 4.29 Characteristics: Patterns 2 Population in Distribution Susceptible Immune (at risk to develop. measles. Malaria: Palawan & Mindanao-reasons why it’s prevalent 1) Forested areas 2) Surrounded by bodies of water 3. Epidemic  Greater than 50% of populations are susceptible or less immune individual  Greater % of the population is affected by the occurring disease  Example 1: Health worker reports that Community Lanting has an epidemic of measles affecting children less than 7 years old Total susceptible population: 3000 Children affected by measles: 1750 1750 3000 x 100=58% (more than 50% of susceptible population=epidemic Example 2: Epidemiological Chapter is regional Measles is considered epidemic if in: Year 2004=there are 15 cases Year 2005=there are 19 cases. 33 countries are reported to have it Home Visit  Is a PROFESSIONAL contact between PHN (with 8 manpower) & the family  The services provided is an extension of the Health Service Agency (Health Center) Objectives: . Endemic-the disease occurs regularly. international. Schistosomiasis: Region V -Bicol (Sorsogon) Region VIII -Samar & Leyte Region XI -Davao b. habitually. universal. Hepatitis B. (those that did not acquire or experience the experience the disease. PTB. mumps. pneumonia  SARS is categorized by WHO as an OUTBREAK only because out of 191 nations. global in occurrence like in AIDS. disease) usually individuals develop resistance against the disease) 80% (more than 50%) 20% 50% 50% 20% 80% --------- Epidemic Endemic Sporadic Pandemic 1. constantly affecting the population group 2 Local Endemic Diseases: where causative agent is available on those places a. Pandemic-worldwide. diphtheria. because it exceeds the # of cases of previous year 2.

2. Schistosomiasis Control Program (SCP) Policies for Schistosomiasis Control Program (SCP): CHES C ase Finding H ealth Education E nvironmental Sanitation S nail Eradication . Assessment Nursing Care Treatment: under RA 6675 Health Education Referral (if care fails) Priorities (in the care): to prevent cross contamination 1. Putting out materials for hand washing b. Summarization-ability to put into record & report (orally) about the outcome of the activity. the lesser chance of contamination • In general. come in complete uniform (also bring a long umbrella with pointed end which serve as protection) 4. the bag is open 3x: a. Morbid cases  The families need the assistance of the health center that’s why home visit was done to the family  The person who makes the home visit is rendering services on behalf of the health center Public Health Bag:  Indispensable tool that should be organize to save time & effort and to prevent cross infection & contamination  Guiding Principles in the use of Public Health Bag: 1. Cleaning • The inner part of the bag should be clean & sterile • Should be done every after home visit • Never endorse the bag 3. Newborn 2.30 1. Contamination • The less one opens the bag. Post partum 3. 4. Returning all what have been used 4. Dependent and Interdependent  To be effective. Putting out materials used for nursing care c. Planning  Starts at the health center  Makes a study on the status of the family  Statement of the problem  Formation of objective 2. Pregnant mothers 4. Activity ( Health Teaching )  Intervention/Professional Phase  Opportunity to provide or extend health services  Standard Role of the Nurse: Independent. 5. Socialization-first activity is to establish rapport & to gain the trust of the family 3. Content-should be prepared by the one who will make home visit 2. Evaluation LOCAL ENDEMIC DISEASES: 2 Available Programs of DOH 1. Care of Communicable Case(s)-should be disinfected with the use of 70% isopropyl alcohol or Lysol which should be done at the health center and not at home Phases of Home Visit: 1. 3.

Laboratory Procedures to rule out Schistosomiasis: 1) Blood Examination: ↑ eosinophil level indicates parasitism 2) Fecalysis: Kato katz (plain stool exam that uses a special apparatus resembling a feeding bottle sterilizer)  Procedure: a) Collect specimen b) Have the test tube undergo centrifugation for 20 minutes c) Get specimen from precipitate & swab it on glass slide d) Observe it on microscope e.m. extend treatment for another 2 weeks. 50 kg x 60 mg/KBW/day=3000 mg/day Available Preparation: 100 mg/tablet 3000 mg/day ÷ 100 mg/tablet=30 tablets/day. • Initial treatment: 1st 2 weeks=3000 mg/day. Other name: Bilhariasis or Snail Fever c.m. Causative agent: Schistosoma-a blood fluke (parasite) • 3 Types of Species: 1) Schistosoma japonicum-endemic in the Philippines & affecting Indonesia. Diarrhea→ Chronic dysentery (prolonged diarrhea of more than 2 weeks & consistency is mucoid & bloody (with streaks of blood) Liver: Presence of infection manifested by jaundice & hepatomegaly • Parts of Hepa B Virus: Serologic Tests 1) HBsAg-Hepatitis B Surface Antigen 2) HBcAg-Hepatitis B Core Antigen • (+) HBsAg or HBcAg indicates Hepatitis B not Schistosomiasis Spleen: Infection of spleen→ inflammation→ enlargement of organ (Splenomegaly)→ abdominal distension→ abdominal pain on the right upper quadrant Blood: Anemia & weakness f. China. so 10 tablets in a. Treatment: Drug of Choice-Praziquantel (Biltricide)60 mg/KBW/day • Example: If patient is 50 kg. Disease: Schistosomiasis b. if still (+) after the extended week. then do stool exam after 2 weeks→ if still (+). Flatworms (Paragonimiasis) 3) Cestodes d. Korea Vector: Oncomelania quadrasi-a tiny snail that serves as an intermediate host responsible to transmit the disease to man 2) Schistosoma mansoni---------affects African nations 3) Schistosoma haematobium--• 3 Forms of Parasite: 1) Nematodes-pinworm 2) Trematodes-Schistosoma. No adverse effect or over dosage even if extended for a year. Repeat stool exam. Signs & Symptoms (Pathognomonic=specific s/sxs identifiable for a disease: CNS: High grade fever→ cerebral convulsion GIT: Nausea & vomiting. continue treatment for 2 weeks again. Japan. 10 tablets in noon 10 tablets in p. • Length of Treatment: takes months to a year Health Education: It affects mostly farmers so educate them to wear rubber boots Environmental Sanitation: Source of disease=snail is the 1st concern Water=where snail thrives is the 2nd concern Toilet=3rd concern Food .31 Case Finding: 6 Aspects or Thing to Know a.

-start spraying insecticide Malaria (FAM) Dengue (AA) Night Biting D ay Biting High Flying L ow Flying Running/Free Flowing S tagnant Water Rural U rban Case Finding: 6 Concerns for Surveillance 1) Disease: Malaria 2) Other name: Ague 3) Causative Agent: Plasmodium-a protozoa • 4 Types of Species: a) Plasmodium falciparum-more fatal that affects the Philippine Vector: Female Anopheles Mosquito (FAM) b) Plasmodium vivax-------population c) Plasmodium ovale d) Plasmodium malariae 4) Laboratory Procedure: Malarial smear-extract blood at the height of fever because plasmodium is very active & ruptures at this period 5) Signs & Symptoms of Malaria: 1st Stage=Cold: Chilling sensation for 1-2 hours 2nd Stage=Hot: High grade fever lasting for 3-4 hours 3rd Stage=Wet: Diaphoresis (excessive sweating/perspiration) Signs & Symptoms of Dengue: I. Malarial Control Program (MCP): 2 Available Programs of DOH for MCP a.32 Garbage Snail Eradication: Use molluscicides-treat the entire suspected soil with chemical solution that kills snails 2. Bleeding Tendencies i. Recovery: if bleeding is controlled IV. Permithrin. Hematochezia III. Propoxur)→ “After 4 o’clock Habit” of DOH for Malaria & Dengue: 4 p. Hot II. Circulatory Collapse: if bleeding is not controlled→ Shock→ Death 6) Treatment: Drug of Choice-Quinine 2 Forms: a) Chloroquine (Aralen)-BQ b) Primaquine If Quinine is not available. Melena iv. BICEP Biological Method: Bio (refers to something which has life=living organism) build fish ponds with tilapia (only fish that eats mosquito eggs) Insecticide=kill/spray source of disease at night time (7 pm) with Baygon/Raid (Bayothrin. Epistaxis-nose bleeding ii.-remove possible venue for mosquitoes to thrive (stagnant waters) 5-5:30 p. may use Sulfadoxime-an antibacterial drug paired with pyrinthamine Environmental Sanitation: Source of Disease=1st concern + FAM Water=where mosquitoes thrive Garbage=3rd concern Food Toilet Personal Protection: 1) Sleep under a mosquito net 2) Sleep in a screened room . Hematamesis-vomiting fresh blood iii.m.m.

omega.33 3) Sleep with long sleeve attire 4) Use repellents that contains DET (diethyl toluamide or toluene which has a pungent odor that drives away mosquitoes & an irritant to mucous membrane of respiratory tract when inhaled a) Vaseline oil. Zest soap-effective because the green bar has anti-histamine effect and the yellow bar acts as a repellent c) Dry skin of lanzones. “katol” b) Anti-mosquito soap has anti-histamine (provides cooling effect). Citronelle-resembles mentholated & eucalyptic smells iii. Vicks vaporab-has mentholated smell iv. CLEAN: Chemical Method=insecticide spraying at night Larvae eating fish=Tilapia Environmental Sanitation & Health Education=insect. School Entrants: MECS: Grade 1=7 years old DECS: Grade 1=6 yrs. Infants (0-12 months): BCG. Oil of Winter Green. Before EPI total immunization-5 After EPI total immunization-6 (Tetanus toxoid was included) 4. efficascent oil v. eucalyptus provide repellent effect EXPANDED PROGRAM ON IMMUNIZATION (EPI) PD 996 Compulsory Basic Immunization to all children before reaching 8 years old Started in 1976 by MOH Target Population: A. Pregnant mothers-Tetanus Toxoid 2. trash Anti-mosquito soap=basil citronelli Neem tree=banana. banaba. OPV was given to all children under 5 years old irregardless of the # of doses & the time OPV was given PP 6 . water. off lotion. DPT. old (1993) Booster of BCG RA 7846 PP 4 Compulsory HBV before 8 years old:1996 Measles Elimination Program (September & October) 19941997-“Ligtas Tigdas” (6 months-8 years) Universal Mother & Child Immunization Law advocated by WHO from 1996 and onwards: 5 vaccines + Tetanus Toxoid Strengthens the EPI Program 1. dried banana trunk (saha ng saging) 5) Plant a Neem Tree using the leaves b. anti-itchiness. Children: Infants-5 vaccines School entrants-BCG booster dose 3. anti-inflammatory & repellent effect: i. anti-allergy. OPV& Measles HBV (1996) B. gabi. Basil ii.

000 Policies of EPI: I. RHM. MO • 3 Population Groups to benefit: a) Infants (I)-BCG.035 (PW) • Example: Lanting Community with a population of 7000 a) DPT=for infants EP=7000 x 0. Supervision & Training--Mobilization. Knock Out Polio (KOP) 2. Immunization → Technical responsibilities of PHN IV. Target Setting B. 1 runner.03 (Infant & SE) or x 0. 1 recorder & 1 health educator catering to a population of 1. Cold Chain III. Target Setting: 1) Target Population is the population group meant to be benefited by the EPI Programs where DOH is responsible a) Infants (0-12)-get the 3% of population b) School Entrants-get the 3% of population (dictum of DOH)=6 years c) Pregnant Women-get the 3. Patak Polio (< 5 years old) PP 1064 AFP (Acute Flaccid Paralysis) Elimination Program-an adverse effect of Polio PP 1066 Neonatal Tetanus Elimination • Morbidity • Mortality  RSI locates a venue for immunization called “Patak Center” and composed of 1 organizer. Coverage a. Coverage---------------------------A.03=210 to receive DPT b) Tetanus Toxoid=for pregnant women EP=7000 x . Wastage Allowance II.34 PP 147 Declaring the National Immunization Day Plus (NIDs Plus) initiated by former Sec. Monitoring & HE → Administrative & Supportive Role of PHN Referral. 1. 1 vaccinator. MV b) School entrants (SE)-Booster of BCG c) Pregnant women (PW)-Tetanus toxoid • To determine Eligible Population: EP=Population of the Community x 0. Surveillance-----------------------Planning. Research & Evaluation---I. Zero Polio Philippines (1996-2000) 3. OPV.035=245 to receive TT c) Booster BCG=for school entrants . Flavier in 1993-95 Initially every 3rd Wednesday of January & February (1993-1995) 1996 to present: Still being practiced but not every 3rd Wednesday of January & February 2002: 2nd Tuesday of March & April At present: depends on the Secretary PP 773 Launched the Polio Elimination Program (PEP) 1995-2000: Zero Polio Philippines. FIC (Fully Immunized Child) C. DPT. HBV.5% of population (MWKA)=15-49 years 2) Eligible Population (EP) are those qualified to receive specific immunizations where PHW is responsible→ PHN.

DPT. MV (need to mix) • If open at 8:00 am. 9-12 months School Entrants 1 booster dose (6 years old)  MV may be given 6 months if there is an epidemic c. TT (already in solution/liquid form ready to administer) Vaccine Table of Reference for Requesting Vaccines from DOH Availability Dosage # of Doses Wastage Number of to complete Allowance Recipients immunizatio Multiplier per n Factor Vaccines (MF) Vial: . OPV./2 ½ mos.1 ml Powder with 1 ml diluent 1 dose 1 dose 60% 2. HBV./3 ½ mos. Fully Immunized Child (FIC)-is a child who receives the 5 sets of vaccines (BCG. I 2. Hep B & Measles and who receives 11 doses of vaccines Vaccine (# of Doses) BCG-1 dose DPT-3 doses OPV-3 doses HBV-3 doses MV-1 dose Infants (0-12 months) Right age to receive the vaccine 0 age (at birth)-12 months 1st Dose-6 wks. Example: In 20 recipients. Vaccine with 8 hours half life: DPT.05 ml Frozen . it’s good till 12:00 noon At 12:30 pm.67 20 10 BCG 1. don’t open. 10 arrived=open a vial  Half life of Vaccines is the duration of potency: a. Wastage Allowance  DOH doesn’t produce vaccines biologically and therefore dependent on suppliers abroad: Germany & Switzerland to economize: 1) Be aware of the availability of vaccines: Example: BCG CHN: vial Private Practice: ampule Frozen powder with a diluent (1 ml per content) 2) How many recipients= Availability Dosage for I=.35 EP=7000 x 0.05 ml (dosage) .03=210 to receive booster BCG b. don’t give anymore because it’s not potent anymore b. Vaccine with 4 hours half life: BCG. 3rd Dose-14 wks. OPV. SE .5 40% 1. 2nd Dose-10 wks./1 ½ mos. if 50% & above of computed recipients arrive in the health center.1 ml I=1 ml (availability) SE=1 ml .1 ml =20 recipients in 1 vial/1 ml =10 recipients  Follow DOH Dictum: On the day of immunization. open a vial but if less than 50%.05 ml Dosage to be given Dosage for SE=0.

2 . When is the 2nd booster? November 20. 2004.5.5 ml=1 10 ml >10 y/o: 1 .03 (I & SE) or 0. 3. As a child.5 2. 2005 2. Determine the Wastage Allowance (WA) .0 1.67 20 liquid  Parenteral=Salk vaccine (sinasaksak) has 5 ml per content  Oral Polio Vaccine (OPV)=Sabin (sa bibig) For OPV: 5 ml (availability)→ 1 ml=15 gtts→1 ml=15 gtts=5 recipients 3 gtts (dosage) 2 ml=30 gtts=10 recipients 3 ml=45 gtts=15 recipients 4 ml=60 gtts=20 recipients 5 ml=75 gtts=25 recipients Right Time for Pregnant Women to receive Tetanus Toxoid Primary Dose TT1 Anytime during ? Immunity th th Pregnancy (5 -6 months) Primary Dose TT2 4 weeks after TT1 3 years immunity st 1 Booster TT3 6 months after 5 years immunity TT2 2nd Booster TT4 1 year after TT3 10 years immunity 3rd Booster TT5 1 year after TT4 Lifetime immunity Examples: 1. Determine the Eligible Population (EP) EP=Population of the Community x 0. she got to start with the 1st dose Wastage Allowances of DOH BCG (I) 60% MV 50% BCG (SE) 40% DPT OPV TT HBV 10% Multiplier Factors 2. <10 y/o: .035 (PW) 2.5 3 doses 10% 1. If until 3 years she failed to receive vaccine. If as a child. is there a definite immunity? There’s no definite # of years of immunity. What you need to receive are the 3 booster doses only-TT3.5 ml 3 doses 40% 1.5 ml MV Vial: . Determine the Annual Dose (AD) AD=EP x # of doses of the vaccine 3.2 Steps to Compute the Number of Vaccine to be Requested from DOH 1.5 ml 5 doses 40% 1. only 1 dose of DPT was given.67 25(1 ml=15 (Sabin) bottle: 5 ml gtts) slightly pink Liquid HBV Vial: . you have 3 doses of DPT. TT4 & TT5 respectively.67 1.36 DPT Vial: 10 ml . Now you become pregnant.67 20 liquid OPV Plastic 2-3 gtts 3 doses 40% 1.5 ml 1 dose 50% 2 10 Frozen Powder with Diluent Sol’n=5 ml per content TT Vial: 10 ml . Mrs Dela Cruz received the 1st booster dose (TT3) on November 20. 1.

WA=360 x 1. CC=601 ÷ 20=30 5. White: use by student affiliates & needs 4 cold dogs  Cold Dogs: 4 plastic containers filled with water which is placed in the freezer a day before immunization which is used as freezant to keep vaccine potent 3. Determine the Complete Coverage (CC) CC=WA ÷ # of recipients per vaccine 5.5 or 38 vials to be given by DOH (or 8 vials allowance) II. DOH usually grants an allowance of 25% of the CC Example: Determine the # of vaccines to be requested from DOH of DPT for Lanting Community with a population of 4000 1. Vaccines which are opened. Cold Chain: tools or procedures to follow to keep vaccine potent (expected desired effect) Policies: 1. Proper Storage: store vaccines in refrigerators RHO MHO PHO BHS RHU RHCDS  Freezer -15° C to -20° C Body of Refrigerator 2° C to 8° C OPV: most sensitive to heat MV 3° 2° 1° Given 6 months to store vaccines Given 3 months to store vaccines Given 1 month to store vaccines BCG DPT HBV TT: least sensitive to heat OPV & MV: highly sensitive to heat OPV. Determine the Overall Total in Allowance (OT) OT=CC x 1. 30 x 1. MV & BCG: Not damage by freezing DPT. Proper Transport  Vaccines are to be transported from the health center to the area of immunization (community: focused. though not consumed. should be discarded Reasons: can’t be used for future program because vaccines have half life (duration of potency of vaccine) BCG -4 hours half life MV Other vaccines -8 hours half life .03=120 2.25 (constant).25=37. Black: use by staff of HC during epidemic & needs 5 cold dogs b. Proper Handling of Vaccine (After Care of Vaccine): Dictum of DOH a. based & oriented)  Tools provided by DOH: Vaccine Carrier which maybe a. AD=120 x 3 doses=360 3.37 WA=computed AD x MF of the vaccine 4. EP=4000 x 0. HBV & TT: Damaged by freezing so not placed in the freezer 2.67=601 4.

HBV & TT can be readily discarded if not consumed DPT: Diphtheria-weakened toxoid treated with chemical solution to weaken microorganism Pertussis-killed bacteria Tetanus-weakened toxoid HBV: plasma derived. DPT: it is a normal reaction for a child to develop high grade fever because of the pertussis component (killed bacteria) SOP Management: Paracetamol q 4 hours RTC for the 1st 2 days (or 3. LBM. 2006 Jul. As long as the child is on the eligible age Example: DPT. Dosage c. Immunization Guiding Principles for HW in Administering Vaccines & Screening of Children for Immunizations: 1. SOA (Site of Administration) d. OPV & HBV. OPV & HBV 1st dose: At 6 weeks (1 ½ months). 19. Things to consider in administering vaccines: a. 2006-can’t be used anymore after this III. disinfect 1st with 1% Hcl or any disinfectant like zonrox. OPV & MV are composed of live attenuated bacteria & virus so before discarding them. 4 days if still febrile) If after 1st dose of DPT. the child develops high grade fever with convulsion. 19. chlorox or dumex BCG (Bacilli Calmette-Guerin Vaccine): live attenuated bacteria OPV & Measles Vaccine: live attenuated virus DPT. the child was given vaccination 2nd dose: The mother brought back the child when he was 8 months old instead at 10 weeks (2 ½ months). months or years.38 BCG. No BCG for a child born clinically positive to AIDS because they have a damage immune system & introducing bacteria will further aggravate their condition 2. Vaccine b. DPT 2 & 3 are not given anymore because convulsion affects the brain cells resulting to brain damage DPT vaccine is only for prophylactic/ preventive use 5. 2006 Jun. Never count back even though the interval exceeds weeks. PHN should still give the vaccine because child is still at the eligible age (0-59 months or 4 years & 11 months or 5 years old) to receive vaccine 4. PHN should still give the 2nd dose 3rd dose: The mother brought back the child at 2 years old. in giving the immunization unless upon assessment of the practitioner that the child has serious medical problems that warrants hospitalization 3. In giving immunization with multiple doses such as DPT. identified to be RNA & DNA recombinant from blood TT: weakened toxoid b. ROA (Route of Administration) . There are no contraindications such as slight fever. Vaccines which are taken out from Health Center for 3x or more are considered overly exposed & not potent anymore therefore it should be discarded Put notation (state the date) on the unopened vaccine as to when it was taken out from health center May 19. cough & colds and malnutrition. continue counting in giving the doses.

there is no soreness & inflammation. High grade fever due to Pertussis Component which contains killed bacteria 2.1 ml SOA I=R deltoid SE=L deltoid ROA Conferred Immunity Artificial Active Intradermal (needle is parallel to site=10-15° angle Side Effects: Wheal=10 mm that disappears after 30 minutes 1st week : develops soreness and inflammation 2nd -11th week : develops abscess and ulceration 12th week (3 months): heals and develops permanent scar Age of Consultation BCG Site of Injection Right Age (0-12 months) Right Deltoid Wrong Age but still eligible Left Deltoid Example: 4 years old Booster Dose at Age 6 Left Deltoid  If after BCG. an anti-bacterial. Albert Sabin Salk (parenteral polio vaccine) Conferred Immunity Artificial Active . repeat the dose on same site but a little lower. no abscess & ulceration and no scar developed.  Site preparation: Use clean cotton ball & wet with sterile water only  For non-healing abscess & ulceration: BCG was wrongly administered by IM or SQ by PHW so incision & drainage should be done by MD only and INH tablet. Thus. Soreness and inflammation SOP Management: Paracetamol (anti-pyretic & analgesic) q 4 hours RTC for 1st 3 days or till with fever Nursing Care: 1st Day=apply cold compress on site 2nd . discontinue DPT 2 & DPT 3 because of the sensitivity to DPT Component but private MD gives DT which is not available in DOH Vaccine OPV Dosage 2-3 gtts SOA Mouth ROA Oral: Sabin by Dr. there is wrong preparation of site where PHW used alcohol that kills the microorganism contained in the BCG vaccine. 3rd & 4th Day=apply alternating cold & warm compress Adverse Effect: If convulsion occurs on 1st dose.5 ml SOA Conferred Immunity Thigh (vastus Intramuscular Artificial lateralis) (Z tract) Active where muscle is grasped and squeezed ROA Side Effects: 1.05 ml SE=.39 e. pounded. Side Effect: patterns of reaction that is considered normal Vaccines BCG Dosage I=. pulverized & applied on the site. Vaccine DPT Dosage . Then repeat the dose again but not on the same site.

NPO for 1st 20-30 minutes after receiving vaccine to prevent nausea & vomiting 2.5 ml Posterior Subcutaneous Artificial Active aspect of (45° angle) Deltoid Side Effect: High grade fever SOP Management: Paracetamol q 4 hours RTC for 1st 2 days MV given on same site with BCG but MV is given at 9 months while BCG at birth In case. Active b. Jones Salk Side Effect: None Nursing Care: 1.5 ml Deltoid or Intramuscular Artificial Active Gluteal muscle Side Effect: Soreness and inflammation on the site which is tolerable by pregnant woman so no need to take medicines. Natural a. Carrier (person harbors the disease person but asymptomatic) of the disease Upon receiving vaccine (antigen) for 2. Passive 2. Acquired or experienced the disease DPT.40 by Dr. give anti-histamines: Diphenydramine (Benadryl) syrup or Apply Caladryl or Calamine Lotion which has anti-histamine and cooling effect to relieve itchiness TT . OPV. Constant exposure to disease immunizable diseases such as BCG. MV and HBV . Just apply cold compress on site to relieve discomfort 2 Forms of Immunization Conferring Immunity: 1. Artificial Natural Provided by nature No vaccine was given Duration is longer/even for a lifetime IMMUNITY Artificial Accepts vaccine Duration is shorter period Example: BCG-vaccine for protection from TB gives 7-10 years immunity so booster is needed HBV-after 3 doses booster is needed after 1 year Active=person himself is involved in Active=person himself has no the production of antibodies participation and done by another 1.5 ml Thigh (vastus Intramuscular Artificial Active lateralis) Side Effects: Soreness and inflammation on site SOP Management: Paracetamol q 4 hours RTC for 1st 2 days or till with fever HBV & DPT are given together but never administer these 2 vaccines in one site: DPT HBV 1st Dose Right Left nd 2 Dose Left Right 3rd Dose Right Left MV . 3. repeat giving the vaccine because it requires 30 minutes to absorb the OPV HBV . In case the child vomits after vaccination. rashes develop after vaccination which makes the child irritable due to itchiness.

MWRA (Married Women Reproductive Age):  15-49 years old=average age of reproduction for Filipino women • 15 years old=average age of menarche (start of menstruation/reproduction) • 49 years old=average age of menopause • Ovulation takes place only for 35 years • Age of menarche + 35 (constant)=average age of menopause  EO 209: Family Code by President Corazon Aquino-married women  PD 651: Birth & Death Registration Law-PHN must register the attended delivery to the Office of the Local Civil Registrar within 30 days • Prepare & accomplish the birth certificate • Ask the mother for a marriage contract. Observe for the change in color: Blue : (-) sugar in urine Green : trace of sugar in urine +1 + Yellow : traces of sugar in urine +2 ++ . test for diabetes  Heat test tube with 5 cc of Benedict’s Solution (blue) in the burner then add 3-5 gtts of urine (amber yellow) then heat again.41 Passive Passive 1. Philippines ranked # 7 & globally ranked # 4 DOH National Family Planning Program: Goals: a. not less than 20 & not more than 35 Right interval of pregnancy=once in 2 or 3 years Supportive of safe pregnancy=done in home setting. 2. Breastfeeding→ IgA (present in 1. Serum (Blood): colostrums) HBV 2. the child can still use his/her father’s surname. IgD. Antitoxin: poison or causes infection TAT (Tetanus Antitoxin) DAT (Diptheria Antitoxin) 3. Home Base Mother’s Record (HBMR): the record used for care of mothers in CHN • Laboratory Examinations: 1) Benedict’s Test: test for sugar in the urine. MCRA (Married Couple Reproductive Age): Both husband & wife play a significant role in the family Elements of Reproductive Health Act (HB 4110): I. Safe Pregnancy • Right age to be pregnant=20-35 years old. Surveillance: to be discussed under Communicable Diseases MATERNAL AND CHILD HEALTH SERVICES Mothers: 1. Family Planning:  Problem of Over Population: NSO usually determines the census every 5 years • In the Philippines. Immunoglobulins: IgA. IgE. granting the father affix his signature on the birth certificate. IgG & IgM where IgG is most predominant IV.7M/year • Among ASEAN Countries. Perinatal→ immunity is acquired ATS (Anti-Tetanus Serum) during the term of pregnancy ADS (Anti-Diptheria Serum) 2. approximately 85M population→ NSO predicted an increase of 1. if none=use mother’s surname • According to the new House Bill stating that with the father’s blessing/consent (even without marriage).

4°C--2. Sympto-thermal 3. Basal Body Temperature (BBT)  Get the temperature early morning before waking up which should be monitored daily at the same time  There should be a sudden drop of temperature between 0. post natal c. heat it in burner then add 3-5 gtts of acetic solution (clear white). Integration of Family Planning in all Curricular Program: • LOI 47 DECS states that Family Planning is to be integrated in all school curricular programs. enrolled separately as one unit c. test for Pregnancy Induced HPN  Collect urine in test tube. Non coercive (give freedom of choice) • AC 114: Role & Function of PHW BQ: What is the role of PHN to the Family Planning Program of DOH? Answer: Facilitator • Never force/command/dictate to the couple what contraceptive method to use b.4 Fri 37.4 Tues 37. Cervical Mucus Test . either baccalaureates or nonbaccalaureates.6°C which means that the woman is fertile  Example: 5:30 am Mon 37.3-0. Edema & Proteinuria (HEP) b) Eclampsia: Coma or convulsion b.3-0.1------increase by 0. Multi-Sectoral Approach: establish relationship with other agencies which can either be: 1) Intrasectoral 2) Intersectoral-Local or International (WHO. Safe Motherhood: prenatal.1-----Wed 37. methods of contraception III & IV are proabortion • “E” Contraceptives are used for legal cases such as rape so may give over the counter pills (pills with high amount of progesterone & estrogen) given one pack then after 12 hours another pack Methodologies: A. Unicef. Japhiego) d. Healthy Reproductive Life Policies: a.5°C---decrease by 0.6°C followed by an increase of temperature by 0. Unacceptability of Abortion: • Is the termination of pregnancy before reaching the age of viability • According to Church. USAID.1 Thurs 37. Observe for change in color: If it remains clear: (-) CHON or albumin in urine If it turns cloudy: (+) CHON=proteinuria  2 Categories of PIH: a) Pre-eclampsia: HPN.42 Orange : more traces of sugar in urine +3 +++ Brick Red : surely diabetic +4 ++++  Adverse Effect of Diabetes: Macrosomia (too large baby)=teratogenic  Advise mother to take sugar in moderate 2) Acetic Acid Test: test for albumin in urine. Biological 1.

Calendar (Rhythm)  Deleted already since 1998 because it’s not recommended for irregular cycle of menstruation  Menstrual cycle should be regular. subtract 18=26-18=8th day Longest cycle: 30 days. Behavioral 1. All government hospitals b. Chemical a. Withdrawal C. stretchy & transparent 2) Dry Cervical Mucus (Safe & Not fertile): whitish. Billing’s Method by Dr. Abstinence 2.inhibits ovulation making women amenorrheic. Lactation Amenorrhea Method (LAM): RA 7600-Breastfeeding & Rooming In Law  DOH organized Maternal & Child Family Health Institute (MCFHI) with the following members: a. Implants: Norplant-it inhibits ovulation effective for 5 years but seldom advocated for use because it is usually expensive. Temporary 1. Oral Pills (Logentrol)-has low dose of estrogen & progesterone that inhibits ovulation b. 1991. pasty & adhesive 4. Parenteral: Depot Medroxyprogesterone Acetate (DMPA)/Depoprovera. subtract 11=30-11=19th day Fertile Period: on the 8th -19th day from the start of menstrual cycle Mon Tues 6 13 R 20 R 27 Wed 7 14 T 21 TI 28 Thurs 1 8 15 I 22 LE 29 Fri 2 9 16 L 23 30mense Sat 3 10 17 E 24 31 Sun 4-1st day 5 of mense 11 12 F E 18 F 25 19 E 26 B. obtain 4-6 months cycle  Example: Aug 29 days Nov 28 days Sep 30 days Dec 29 days Oct 26 days Jan Fertile Short cycle: 26 days. Billing b. Spinnbarkheit (came from a German word Spinner which means to play with the cervical mucus with the finger) or Wet & Dry Method: 1) Wet Cervical Mucus (Fertile): abundant. the . DMPA is given IM 4x a year every 3 months (90 days interval) c. Private hospitals (volunteer)  Normal involution (uterus goes back to normal) of the uterus: after 45 days or 5-6 weeks or 1 ½ months if not breastfeeding  Frozen breast milk is to be put out of the freezer 2 hours before feeding  Left over milk should be discarded & should not be re-preserved or re-frozen because it is already contaminated 5.43 a. DMPA was found to be causing cancer of the cervix 1994.

Stunting: growth retardation b. Anthropometric Measurement: study of measurements of human dimensions 1. Prevention & Control of Male & Female Reproductive Tract Infections: STD. 5 ft. SUBTRACT Example: Female 4’11” at 100 lbs. Wasting: connotes malnutrition 2. =105 lbs. Ideal Body Weight (IBW) 100 x 100=100% Normal 100 Gomez Table Reference Percentile Description 110% & above Obesity (a form of Malnutrition) 90-109% Normal 76-89% 1st Degree-needs home diet care 60-75% 2nd Degree-needs hospitalization. Mother & Child Nutrition III. Weight for Height Rule Male Every height of 5 ft. Every increment of an +6 inch above 5 ft. ADD Every decrement of an -6 inch below 5 ft. BLT II. HIV.44 client buys the device (consists of 5 capsules) & have it implanted at the health center by minor surgical incision in: 2) upper inner arm because it is nearest to the brain 3) external oblique 4) thigh 5) gluteal muscles 2. Health Education on Human Sexuality VII. use TPN Below 60% 3rd Degree-needs hospitalization. Prevention & Control of Abortion & Its Complications V. Permanent 1. +5 -5 105 -5 100 lbs. 154 . Condom D. use TPN FORMULA: Actual Body Weight x 100= % Ideal Body Weight Example: Male 5’11” at 154 lbs. Vasectomy (reversible)-since year 2000 in the Philippines 2. 110 lbs. Age for Height-if height is not appropriate with the age: Stunting 3. Age for Weight-if weight is not appropriate with the age: a. Hepatitis B VI. Cervical cap. 1” decrement=-5 Female 105 lbs. Nutritional Surveillance (NS): to determine victims of malnutrition A. Diaphragm. Violence Against Women ESSENTIAL DRUGS and HERBAL: RA 6675 and RA 9165 NUTRITIONAL HEALTH SERVICES PD 491: created the Nutrition Council of the Philippines Policies: I. Mechanical: IUD. Prevention & Control of Infertility & other Reproductive/Gynecological Disease IV.

man’s facie (-) hair changes old Skin (-) . continue giving but compute again 6 mg/kbw Goiter: Iodine Deficiency Disease (endemic in uphill) • Target age group: 0-59 months • Give 1 capsule (200 mg) of potassium iodate in oil once a year For a child < 5 years old. 2/22/06 2nd Dose: give tomorrow 100. IBW=176 lbs. moon facie (+) color changes from black to brown or from brown to golden yellow (+) sparse “flag sign” Dermatosis: Marasmus Muscle wasting CHO All ages Muscle wasting. Post partum : 200. Micronutrient Malnutrition-available in small amount in the body VADAG: Vitamin A Deficiency: • Deficiency: Xeropthalmia-opacity of cornea leading to night blindness • Infants (6-12 months) : Give 100.u.000 i.-154 lbs. =22 lbs. • Never give Vitamin A to infants less than 6 months & pregnant women because it is toxic • Example: Infant 8 months old Patterns of treatment Vitamin A 100.000 i. Growth retardation. 2/21/06 1st Dose: give today 100. Kwashiorkor-protein deficiency B .000 i.000 i.u. moron & imbecile b.45 5 ft.000 i.u. 176 x 100=88% (1st Degree Malnutrition) 11 x 6 =66 lbs. 3/08/06 3rd Dose: give after 2 weeks Anemia: Iron Deficiency Anemia • Target age group: 0-59 months (less than 5 years) • Give 3-6 mg/kbw/day • Always give the maximum • Example: Child weighs 8 kg 8 x 6=48 mg/day for the 1st 3 months then monitor If still anemic. =110 lbs.000 i. B. Macronutrient Malnutrition-available in large amount in the body (Protein Energy Malnutrition or PEM) A. Pre-schoolers (12-83 months) : 200. & above Malnutrition: <13 cms.u. underweight 4. Middle Upper Arm Circumference (MUAC)-used in children below 5 years old by measuring the middle upper arm with a tape measure Normal: 13 cms. Biochemical Method 1. Skin Folds Test-pinch the external oblique muscle (“bilbil”) with your palm Normal: 1 inch Overweight: > 1 inch 5.u.u. Marasmus-carbohydrate deficiency (energy giving food) Etiology Deficiency Age Major Signs & Symptoms Hair Changes Kwashiorkor Disease experienced by an elder child upon the birth of a new baby CHON Toddlers (1-3 years old) Facial edema. Mental retardation-intelligence quotient: idiot.cretinism (pedia) & dwarfism (adult) 2. empty contents of capsule in a cup with warm water because he can’t tolerate it • Adverse Effect of Iodine Deficiency Disease that must be avoided: a.

Food Production 1. Sugar. Poultry.with DOH seal “Sangkap Pinoy” III. Salt Eat some Meat. Minerals & Fats Pyramid for Healthy Filipino Food Lifestyle by Food & Nutrition Research Institute (FNRI)-another agency which is supportive of Nutrition Council of the Philippines Eat less Oils. Potato. Corn. Giving Multivitamins fortified with Vitamin A. Fortification-products without any nutrient are added with nutrients  RA 8172 (Asin Law): Fidel Salt (Fortification of Iodine Deficiency Elimination)=Iodized Salt-“Patak” sa Asin” by Secretary Flavier on December 1-5. pregnant women & post partum . peeling off of the skin. Fatty dairies Eat more Vegetables. Peanut. Iron & Iodine for < 5 years old. Erap Rice under Erap. Bread. Fats. Fruits. desquamation Irritable Apathetic High CHON diet High CHO diet Total Parenteral Nutrition (TPN) Hyperalimentation process IV infusion with CHON. Rice Drink a lot Water. Enrichment-adding more nutrients to products already with nutrients Canned Goods----Noodles → written in their labels: enriched with vitamin ABC… Z Junk Foods--------. Nutritional Education-sharing of information to mothers whose children are malnourished 3 Basic Food Groups: Go -CHO Grow -CHON Glow -Vitamins. it was held during the month of March & April • Immunization activities was not done at the Health Center but was held at a designated area • Rural Sanitary Inspector (RSI) will locate the venue (The Patak Center) to conduct the immunization • The Patak Center catering to the population of 1000 was composed of the following personnel: 1 Runner. 1 Recorder.46 dryness. 1 Vaccinator & 1 Health Educator • NIDs Plus Activities: 1. 2003 where DOH workers go to market to check if salt sold contains iodine by placing few drops of reagent: If salt color turns to blue violet→ fortified with iodine If salt color show no change→ not fortified with iodine  RA 832 (Rice Fortification): FVR (Fortified Vitamin Rice) by Secretary Flavier under FVR. Immunization 2. Gloria Rice or “Bigas ni Gloria” under PGMA 2. Salad Eat most Wheat. 1 Organizer. CHO regulated by a machine Behavior Management Hospital Setting II. Clear broth IV. Nutritional Rehabilitation  PP 147: declared the National Immunization Days Plus (NIDs Plus) • In 2003.

water appears to be cloudy then after 6-8 hours of standing. rodents. Tuberculosis: MDT. Sources of Disease-PHN is concerned with eradication of insects. Sterilization: 30 minutes after the water starts to boil c. Promotion & implementation of sanitation programs through the Department of Health Field Health Units 3. b. WHO. Construct a toilet for community use 5.  RA 4226: Hospital Licensure Act-creation of additional unit in every department of the hospital as Malnutrition Ward to house malnourished victims to be under the supervision of a nutritionist TREATMENT OF COMMUNICABLE & NON COMMUNICABLE DISEASES Communicable Diseases: which the DOH has special programs (other diseases under CD subject) 1. SCC & DOTS 2. the water becomes clear e. Boiling: minimum of 3 minutes to maximum of 10 minutes for drinking b. drop tawas (the size of magi cubes) & allow to stand for 6-8 hours • Initially. Locate the source of water b. Diarrhea: CDD 4. Chlorination: uses 100% pure concentrated chlorine bought from botika or given free by health centers . Filtration: makes use of filter paper or cotton cloth to separate solid particle from liquid if water comes from river d. Food Sanitation 2. Promotion of healthy environmental conditions & prevention of environmental related diseases through appropriate sanitation strategies 2. Garbage Disposal 3. Leprosy: RRC (MDT) ENVIRONMENTAL SANITATION (ES)  refers to all factors available in the environment affecting the health of the individual or population  the Environmental Health Service (EHS) of DOH is responsible for: 1. Water Sanitation • Potable-free from any particles that might cause illness to an individual • Ways to make Water Potable: a.47  Araw ng Sangkap Pinoy (ASAP): Health Centers distribute basic commodities fortified & enriched with multivitamins which is done yearly every October Example: Skim milk & canned goods donated by international organizations like UNICEF. etc. Toilet • Two Considerations in constructing toilets: a. flies & mosquitoes & cockroaches 4. Construct at a distance of 25-30 meters from identified source of water like deep well. Coagulation/Flocculation: uses aluminum crystal (tawas) that collects or absorbs particles from liquid part & becomes slimy • In 1 gallon of water. Conceptualization of new programs/projects to contend with emerging environmentally related health problems  regulated by PD 856: Comprehensive Sanitation Code of the Philippines Factors Covered by Sanitation Code Immediate Concern of PHN: 1. Pneumonia: CARI 3. faucet. Construct at a level lower than the source of water • Role of RSI: a.

her milk will be contaminated→ cancer of the blood of the child Sanitary Ways of Treating Garbage as taught to the Population: 1. Contact training & use of Condom 9. Noise. sputum. Ecological Solid Waste Management: RA 9003-the use of incinerator approved in 2000 but was implemented in 2003 because of lack of funding to purchase • Dioxin: a toxic substance emitted from burning of solid waste when inhaled by a breastfeeding mother.48 To prepare stock solution (SS): in 1 liter drinking water.000 ml=10 liters). Sanitary disposal b. Institutional Sanitation: establishments who employ professional prostitute requires license given by DOH from their employees • DOH created a center that caters for STD Prevention which requires employees who are at risk to have a certificate that they are free from STD & monitored once in 6 months • 4 C’s to prevent STD: Compliance. Plumbing: a responsibility of DPWH 8. larvae are present to become mosquitoes that causes dengue so it’s not good for drinking  Prepare chlorinated water everyday f. Compost is used as fertilizer • . feces & gauze Orange : toxic/hazardous waste 10. Fluoridation: adding fluoride to prevent dental caries (primary significance) & whitens enamel of teeth ( 2nd significance) g.000 & minimum imprisonment of 7 days 4. Pollution: Water. Air: RA 8749-Clean Air Act=a program of DENR supported by MMDA (Smoke Belchers) & LTO (Emission Testing) 7. Composting-has dual purpose: a. Segregation-separating biodegradable from non biodegradable 2. Counseling. Aeration: exposing drinking water in air to strengthen taste within 24 hours which is usually used in uphill areas where there’s less or no pollution Beyond PHN Responsibilities: 6.non pathological waste Black : dry waste--Yellow: infectious/pathological waste like blood. Collection-adherence to the proper collection time→ the City of Manila coordinates with Leonel Waste Management (a private firm which collects garbage) where the truck driver coordinates with the Barangay Chairman on the time they will collect garbage so don’t bring out garbage before the collection time 3. Hospital Waste Management: RA 4226-Hospital Licensure Act monitors the hospital license & proper management of wastes as well as renewal of license to operate • Color Coding of Bin to keep Waste: Green : wet waste--. Dumping in official site: PD 825-improper waste (garbage) disposal→ fine of P1. add 1 tablespoon from the prepared stock solution & let it stand for 30 minutes to react with water  1 gallon=4 liters  10 liters is good for use of family of 5 & good for 3 days only  On the 4th day. Burying-if area is accessible 6. add 1 tablespoon of concentrated chlorine which is potent for 3-4 months • To prepare the chlorinated water: in 2 ½ gallons of drinking water (10. urine.

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