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Community Health Nursing Notes 1

Nursing (Centro Escolar University)

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COMMUNITY HEALTH NURSING FINAL REVIEWER

Public Health Laws

The Scope of Public Health Law

• Public health nurses must practice within the scope of public health law as defined by their respective state.

• Public health law typically includes certain public health interventions of a legal nature.

R.A. 7160 or the Local Government Code

• This involves the devolution of powers, functions and responsibilities to the local government both rural & urban.

▪ The Code aims to transform local government units into self- reliant communities and active partners in the attainment of national
goals thru’ a more responsive and accountable local government structure instituted thru’ a system of decentralization. Hence, each
province, city and municipality has a LOCAL HEALTH BOARD (LHB) which is mandated to propose annual budgetary
allocations for the operation and maintenance of their own health facilities.

R.A. 2382 Philippine Medical act

• This act defines the practice of medicine in the country.

• Objectives.- This Act provides for and shall govern

(a) the standardization and regulation of medical education;

(b) the examination for registration of physicians; and

(c) the supervision, control and regulation of the practice of medicine in the Philippines.

R.A. 1082 or Rural Health Act

• It created the 1st 81 Rural Health Units.

• amended by RA 1891; more physicians, dentists, nurses, midwives and sanitary inspectors will live in the rural areas where they
are assigned in order to raise the health conditions of barrio people ,hence help decrease the high incidence of preventable diseases

R.A. 6425 or Dangerous Drugs Act

• It stipulates that the sale, administration, delivery, distribution and transportation of prohibited drugs is punishable by law.

• Under this Act, the Dangerous Drugs Board (DDB) remains as the policy-making and strategy-formulating body in planning
and formulation of policies and program on drug prevention and control.

R.A. 9165 – the new Dangerous Drug Act of 2002

• It is the policy of the State to safeguard the integrity of its territory and the well-being of its citizenry particularly the youth, from
the harmful effects of dangerous drugs on their physical and mental well-being, and to defend the same against acts or omissions
detrimental to their development and preservation.

• In view of the foregoing, the State needs to enhance further the efficacy of the law against dangerous drugs, it being one of
today's more serious social ills.

P.D. No. 651

• Requires that all health workers shall identify and encourage the registration of all births within 30 days following delivery.

• Registration of births. All babies born in hospitals, maternity clinics, private homes, or elsewhere within the period starting from
January 1, 1974 up to the date when this decree becomes effective, irrespective of the nationality, race, culture, religion or belief of
their parents, whether the mother is a permanent resident or transient in the Philippines, and whose births have not yet been
registered must be reported for registration in the office of the local civil registrar of the place of birth by the physician, nurse,
midwife, hilot, or hospital or clinic administrator who attended the birth or in default thereof, by either parent or a responsible
member of the family or a relative, or any person who has knowledge of the birth of the individual child.

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P.D. No. 996

• Requires the compulsory immunization of all children below 8 yrs. of age against the 6 childhood immunizable diseases.

• REPUBLIC ACT 10152

• An act providing for mandatory basic immunization services for infants and children, repealing for the purpose of
presidential decree no. 996, as amended

P.D. No. 825

• Provides penalty for improper disposal of garbage.

R.A. 8749 – Clean Air Act of 2000

• otherwiseknownasthePhilippine Clean Air Act,isa comprehensive air quality management policy and program which aims
to achieve and maintain healthy air for all Filipinos

P.D. No. 856 - Code on Sanitation

• It provides for the control of all factors in man’s environment that affect health including the quality of water, food, milk,
insects, animal carriers, transmitters of disease, sanitary and recreation facilities, noise, pollution and control of nuisance

RA 6758 “Compensation and Position Classification Act of 1989

Standardizes the salary of government employees including the nursing personnel.

▪ It is hereby declared the policy of the State to provide equal pay for substantially equal work and to base differences in pay upon
substantive differences in duties and responsibilities, and qualification requirements of the positions. In determining rates of pay,
due regard shall be given to, among others, prevailing rates in the private sector for comparable work.

R.A. 6675 –Generics Act of 1988

• Which promotes, requires and ensures the production of an adequate supply, distribution, use and acceptance of drugs and
medicines identified by their generic name.

R.A. 6713 Code of Conduct and Ethical Standards of Public Officials and Employees

• It is the policy of the state to promote high standards of ethics in public office. Public officials and employees shall at all times
be accountable to the people and shall discharges their duties with utmost responsibility, integrity, competence and loyalty, act
with patriotism and justice, lead modest lives uphold public interest over personal interest.

R.A. 7305 Magna Carta for Public Health Workers

• This act aims: to promote and improve the social and economic well-being of health workers, their living and working conditions
and terms of employment;

▪ to develop their skills and capabilities in order that they will be more responsive and better equipped to deliver health projects
and programs;

▪ and to encourage those with proper qualifications and excellent abilities to join and remain in government service.

R.A. 8423

Created the Philippine Institute of Traditional and Alternative Health Care

It is hereby declared the policy of the State to improve the quality and delivery of health care services to the Filipino people through
the development of traditional and alternative health care and its integration into the national health care delivery system.

It shall also be the policy of the State to seek a legally workable basis by which indigenous societies would own their knowledge
of traditional medicine. When such knowledge is used by outsiders, the indigenous societies can require the permitted users to
acknowledge its source and can demand a share of any financial return that may come from its authorized commercial use.

P.D. No. 965 A DECREE REQUIRING APPLICANT FOR MARRIAGE LICENSE TO RECEIVE INSTRUCTIONS ON
FAMILY PLANNING AND RESPONSIBLE PARENTHOOD.

• Requires applicants for marriage license to receive instructions on family planning and responsible parenthood.

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P.D. No. 965 REQUIRING APPLICANT FOR MARRIAGE LICENSE TO RECEIVE INSTRUCTIONS ON FAMILY
PLANNING AND RESPONSIBLE PARENTHOOD.

• There is hereby created in every city and municipality an Office of Family Planning to be headed by the city or municipal health
officer. He shall be assisted by the city or rural health nurse, members of the city or rural health unit, and such other personnel from
the different agencies of the government involved in the family planning program, who shall perform family planning duties in
addition to their regular duties. Private entities or individuals duly accredited by the Commission on Population engaged in family
planning activities may also be impressed into the service.

P.D. NO. 79 National Policy on Population creating the Commission on Population

• Defines, objectives, duties and functions of POPCOM

• The Government of the Philippines hereby declares that for the purpose of furthering the national development, increasing the
share of each Filipino in the fruits of economic progress and meeting the grave social and economic challenge of high rate of
population growth, a national program of family planning involving both public and private sectors which respect the religious
beliefs and values of the individuals involved shall be undertaken.

RA 4073

advocates home treatment for leprosy

Persons afflicted with leprosy not to be segregated. - Except when certified by the Secretary of Health or his authorized
representatives that the stage of the disease requires institutional treatment, no persons afflicted with leprosy shall be confined in a
leprosarium

Letter of Instruction No. 949

• legal basis of PHC dated OCT. 19, 1979

• promotes development of health programs on the community level

A. O. No. 2005-0014 - National Police on Infant and Young child feeding

• All newborns be breastfeed within 1 hr after birth

• Infants be exclusively breastfeed for 6months.

• Infants be given timely, adequate and safe complementary foods

• Breastfeeding be continued up to 2 years and beyond

EO 51- Phil. Code of Marketing of Breast milk Substitutes

• The Code applies to the marketing, and practices related thereto, of the following products: breastmilk substitutes, including infant
formula; other milk products, foods and beverages, including bottle-fed complementary foods, when marketed or otherwise
represented to be suitable, with or without modification, for use as a partial or total replacement of breastmilk; feeding bottles and
teats. It also applies to their quality and availability, and to information concerning their use.

R.A. – 7600 – Rooming In and Breastfeeding Act of 1992

• states the rules and regulations which contain standard procedures to be followed for rooming-in and breastfeeding in all private
and government health institutions.

• Specific provisions are made for complicated births. The right of the mother to breastfeed and the right of the infant to receive
breast milk is expressed, and mothers may only exercise their right to bottle feed after being fully informed of the benefits of
breastfeeding and by expressing their intention to formula feed in writing.

R.A. 8976- Food Fortification Law

• Objectives:

• 1. To provide the basis for the need for a food fortification program in the Philippines: The Micronutrient Malnutrition Problem

• 2. To discuss various types of food fortification strategies

• 3. To provide an update on the current situation of food fortification in the Philippines

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A.O. No. 2006 - 0015

• defines the Implementing guidelines on Hepatitis B Immunization for Infants

R.A. 7846

• mandates Compulsory Hepatitis B Immunization among infants and children less than 8 yrs old

A.O. No. 2006 - 0012

• specifies the Revised Implementing Rules and Regulations of E.O. 51 or Milk Code, Relevant International Agreements,
Penalizing Violations thereof and for other purposes

Rooming In and Breastfeeding Act of 2002

Rooming-In Definition

• Mother and baby are together in one room from birth to discharge
• Goal: Babies stay in mother's room for at least 23 out of 24 hours.
• When separations are clinically indicated, encourage visitation and closeness as appropriate.

Republic Act No. 7600 known as “The Rooming –In and Breastfeeding Act of 1992”

 An act providing incentives to to all government and private hospitals with rooming-in and breastfeeding practices and
for other purposes

DECLARATION OF POLICY

 The state adopts rooming-in as a national policy to encourage, protect and support the practice of breastfeeding.
 It shall create an environment where basic physical, emotional and psychological needs of mothers and infants are
fulfilled through the practice of rooming-in Breastfeeding.

ROOMING-IN AND BREASTFEEDING INFANTS

1. Applicability- to all private and government health institutions

2. Normal Spontaneous Deliveries.

 Immediate latch on after birth

 Rooming-in within 30 minutes

A. Well infants/ Well infants

B. Low birth weight infants / Low birth weight infants but able to suck

3. Deliveries of Caesarean Section.

 Roomed-in and breastfed within 3-4 hours after birth

4. Deliveries outside Health Institutions

- Be Roomed-in-

5. Exception

 Mothers and babies with complications or problems hence do not permit rooming-in and breastfeeding. These infants shall
be fed expressed breastmilk.

RIGHT OF THE MOTHER TO BREASTFEED

 It shall be the right of the mother to breastfeed her child who equally has the right to her breastmilk.

HUMAN MILK BANK

• Provision of Facilities for Breastmilk Collection and Storage

• Continuing Education, Re-education and Training of Health Personnel on Current Updated Lactation Management

• Information Dissemination to Pregnant Women

A. In Prenatal Clinic

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B. At home or in the Ward

C. Post Natal Clinic

• Administrative Order 2005-0014: National Policies on Infant and Young Child Feeding

• Supporting Legislation

– Executive Order No. 51: Milk Code

– Executive Order No. 382: National Food Fortification Day

• Exclusive breastfeeding –infant receives breast milk and allows the infant to receive ORS, drops, syrups (vitamins,
minerals, medicines), but nothing else

• Early initiation of breastfeeding – initiating breastfeeding of the newborn after birth within 90 minutes of life in accordance to
the essential newborn care protocol

PROMOTING BREASTFEEDING

• To promote the practice of breastfeeding, providing mothers and families with adequate, accurate and timely information
and opportunities for developing necessary skills for good breastfeeding practices is essential.

• The nurse then makes a health education plan based on the mother’s needs

– Benefits of Breastfeeding

– Techniques of Breastfeeding

IMPORTANCE: ATTACHMENT

• Compared to “tradtional care”, mothers rooming-in show

• INCREASED POSITIVE INTERACTIONS: Looking, Touching,Talking to their babies

• DECREASED AVOIDANCE BEHAVIORS: Watching TV, Talking on the phone

IMPORTANCE: BONDING

• Hormonally sensitive period

• Skin to skin and breastfeeding trigger release of oxytocin leading mom to practice “mothering and bonding behaviors”

To make BF successful contraception: 3 E’s:

1. Early – start BF as early as possible

-NSD- 30 mins after, start BF

-CS- 3-4 hrs after, start BF

2. Exclusive - BF for first 6 mos. - never alternate w/ supplementary feeding.

3. Extensive – BF can be extended to 2yrs

Storage of breastmilk – keep in ref for 24 hours

Preservation- keep in the freezer minimum of 3 mos/ maximum of 6 mos.

To use: remove from the freezer 2 hours before use

Colostrum – 1st expressed milk

ADVANTAGES OF BREASTFEEDING

• B- “Breastmilk is best for babies “(as mandated by EO 51)

• R- reduced allergy
• E- economical
• A- always available
• S- Safe; soft stool
• T- right temperature
• F- fresh
• E- emotional bonding

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• E- easily established
• D- digested easily- with lactalbumin
• I- immunoglobulin against CD: measles and chicken pox (IgA)
• N- nutritious
• G- GIT disorder is reduced (ex. Diarrhea)

Filipino Culture, Values and Practices in relation to Health Care of Individual and Family
Coping Styles

Coping styles common among elderly Filipino in times of illness or crisis include

1. Patience and Endurance (Tiyaga): the ability to tolerate uncertain situations

2. Flexibility (Lakas ng Loob): being respectful and honest with oneself
3. Humor (Tatawanan ang problema): the capacity to laugh at oneself in times of adversity
4. Fatalistic Resignation (Bahala Na): the view that illness and suffering are the unavoidable and predestined will of God,
in which the patient, family members and even the physician should not interfere

“Seeking medical advice from family members or friends who are health professionals is also a common practice among Filipino
older adults and their family members, especially if severe somatic symptoms arise.”

Health Beliefs and Behaviors: Indigenous Health Beliefs

 This concept is central to Filipino self-care practices and is applied to all social relationships and encounters.
 Health is thought to be a result of balance, while illness due to humoral pathology and stress is usually the result of
some imbalance.
 Rapid shifts from “hot” to “cold” cause illness and disorder.

HUMORAL BALANCES THAT INFLUENCE FILIPINO HEALTH PERCEPTIONS

 Rapid shifts from “hot” to “cold” lead to illness

 “Warm” environment is essential for maintaining optimal health
 Cold drinks or cooling foods should be avoided in the morning
 An overheated body is vulnerable to disease; a heated body can get “shocked”
 When cooled quickly, it can cause illness
 A layer of fat maintains warmth, protecting the body’s vital energy
 Imbalance from worry and overwork create stress and illness
 Emotional restraint is a key element in restoring balance
 A sense of balance imparts increased body awareness (Adapted from Becker, 2003)

HEALTH BELIEFS AND BEHAVIORS: THEORIES OF ILLNESS

Mystical Causes

● Mystical causes are often attributed to experiences or behaviors such as ancestral retribution for unfinished tasks or obligations. Some believe
that the soul goes out from the body and wanders, a phenomenon known as Bangungot, or that having nightmares after a heavy meal
may result in death.

Naturalistic Causes

● Naturalistic causes include a host of factors ranging from natural forces (thunder, lightning, drafts, etc.) to excessive stress, food and
drug incompatibility, infection, or familial susceptibility.

Personalistic Causes

● Personalistic causes are associated with social punishment or retribution from supernatural forces such as evil spirit, witch (Manga ga mud)
or sorcerer (mangkukulam).

● The forces cast these spells on people if they are jealous or feel disliked. Witch doctors (Herbularyo) or priests are asked to counteract and
cast out these evil forces through the use of prayers, incantations, medicinal herbs and plants.

● For protection the healer may recommend using holy oils, or wearing religious objects, amulets or talismans (anting anting).

Filipino families greatly influence patients’ decisions about health care. Patients subjugate personal needs and tend to go along with
the demands of a more authoritative family figure in order to maintain group harmony.

Before seeking professional help, Filipino older adults tend to manage their illnesses by self-monitoring of symptoms, ascertaining
possible causes, determining the severity and threat to functional capacity, and considering the financial and emotional burden to
the family.

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Health Beliefs and Behaviors: Basic Logic of Health and Illness

 The basic logic of health and illness consists of prevention (avoiding inappropriate behavior that leads to imbalance) and curing
(restoring balance); it is a system oriented to moderation.
 Parallel to this holistic belief system is the understanding of modern medicine with its own basic logic and principles for
treating certain types of diseases.

Health Promotion/Treatment Concepts

FLUSHING

The body is thought to be a vessel or container that collects and eliminates impurities through physiological processes such as sweating,
vomiting, expelling gas, or having an appropriate volume of menstrual bleeding.

HEATING

Adapts the concept of balanced between “hot” and “cold” to prevent occurrence of illness and disorders.

PROTECTION

Safeguards the body’s boundaries from outside influences such as supernatural and natural force

RESPONSE TO ILLNESS

Filipino older adults tend to cope with illness with the help of family and friends, and by faith in

God. Complete cure or even the slightest improvement in a malady or illness is viewed as a miracle.

Filipino families greatly influence patients’ decisions about health care.

Patients subjugate personal needs and tend to go along with the demands of a more authoritative family figure in order to
maintain group harmony.

Health Superstitions

Get rid of a hiccup by placing a short thread wet with saliva on the forehead.

 Several factors can cause hiccups, including swallowing air and eating or drinking too much or too fast.
 Bite on a slice of lemon, slowly sip ice-cold water while placing gentle pressure on your nose as you swallow, or hold
your breath for a short time

By showing fondness or affection when meeting a baby for the first time, you may cause the baby to feel uneasy or make the baby
cry non-stop which is commonly referred to as "na-usog.”

 To avoid passing the negative energy and cure the infant of usog, superstition practice says you must dab your saliva on
the baby’s forehead or abdomen. Often, most people would also greet the child by saying “pwera usog” meaning for
protection from the hex.

Hitting the sack right after a shower is believed to cause blindness and insanity.

 Rubbing wet hair against your pillow can cause hair damage or breakage. The friction will also lead to you having to deal
with a bad hair day the next morning

Washing sweaty hands can lead to spasmodic hands or pasma

 Hand tremors, sweaty hands, numbness, and pain in the hands are symptoms that are often related to diabetes mellitus,
thyroid dysfunction and nervous system dysfunction.

Not patting your sweat dry with a towel can cause you to get pneumonia.

 Many Filipinos believe this superstition in fear of suffering from this serious lung disease. Although, like most
pamahiins, there is no scientific basis for this particular belief.

Stepping over a child will stunt his or her growth.

 As we all know, the growth of a child depends on various factors that influence development, including nutrition, genes,
sex, hormones, and socioeconomic status.

Frog urine causes warts.

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 The myth is rooted in frogs having bumps on their skin that looks like warts. While some may believe this superstition,
warts are actually brought about by viruses that cause an overproduction of keratin.

Showering salt over the threshold of the front door of your new house can help you and your family ward off sickness

 Some Filipinos still practice this pamahiin because they believe it’s “better to be safe than sorry.” Spreading salt can’t
protect you from getting sick, but having a healthy diet and taking multivitamins to boost immunity will

Nursing Core Values as a Community Health Nurse

Core Values

Mission

The National League for Nursing promotes excellence in nursing education to build a strong and diverse nursing workforce
to advance the health of our nation and the global community.

1. Caring
2. Diversity
3. Integrity
4. Excellence
5. Human dignity
6. Autonomy
7. Altruism
8. Social justice

CARING

 A culture of caring, as a fundamental part of the nursing profession, characterizes our concern and consideration for
the whole person, our commitment to the common good, and our outreach to those who are vulnerable.
 All organizational activities are managed in a participative and personcentered way, demonstrating an ability to understand
the needs of others and a commitment to act always in the best interests of all stakeholders.

DIVERSITY

 A culture of inclusive excellence encompasses many identities, influenced by the intersections of race, ethnicity,
gender, sexual orientation, socio-economic status, age, physical abilities, religious and political beliefs, or other
ideologies.
 It also addresses behaviors across academic and health enterprises. Differences affect innovation so we must work
to understand both ourselves and one another.

INTEGRITY

 A culture of integrity is evident when organizational principles of open communication, ethical decision-making, and
humility are encouraged, expected, and demonstrated consistently.
 Not only is doing the right thing simply how we do business, but our actions reveal our commitment to truth telling and to
how we always see ourselves from the perspective of others in a larger community

EXCELLENCE

 A culture of excellence reflects a commitment to continuous growth, improvement, and understanding.

 It is a culture where transformation is embraced, and the status quo and mediocrity are not tolerated.

HUMAN DIGNITY

 Can be thought of as an individual's sense of self-worth and self-respect.

 It can encompass many things, including the right to fill basic needs, like food, shelter, and personal safety.
 In the healthcare environment, human dignity is more focused on aspects of privacy, respect, and autonomy

AUTONOMY

 Professional autonomy means having the authority to make decisions and the freedom to act in accordance with
one's professional knowledge base.
 Relevance to clinical practice: To gain autonomous practice, nurses must be competent and have the courage to take
charge in situations where they are responsible.

ALTRUISM

 Is concern for the welfare and well-being of others.

 In professional practice, altruism is reflected by the nurse's concern and advocacy for the welfare of patients, other nurses,
and healthcare providers

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SOCIAL JUSTICE

 Social justice is a core nursing value and the foundation of public health nursing.
 Social justice ideology requires nursing students to uphold moral, legal, and humanistic principles related to health
 Social justice implies that there is a fair and equitable distribution of benefits and burdens in a society

Health-Related Entrepreneurial Activities in the Community Setting

Project EntrepreNurse

• Initiative of Department of Labor and Employment (DOLE)

• Introduces HOME HEALTHCARE INDUSTRY IN THE PHILIPPINES

• FRAMEWORK: FOURmula ONE for HEALTH

4 ELEMENTS

 Good Governance
 Health Financing
 Health Regulation
 Health Service Delivery

GOALS:

• Better Health Outcome

• Equitable Healthcare Financing
• More responsive healthcare system

LEGAL BASIS:

 RA 9173 Article VI Sec 28

 A 7164 Article V Sec 27

THE POSSIBLE ENTREPRENEURSHIP AND JOB OPTIONS FOR MEDICAL

PRACTITIONERS ACADEMIC SECTOR JOB OPPORTUNITIES OR JOB OPTIONS

 Teachers/ professors
 Clinical instructors for nurses
 Academic research assistants
 Field coordinators

HEALTH SECTOR JOB OPPORTUNITIES OR JOB OPTIONS

 Part time RHU / hospital nurses

 Manage/ operate birthing centers
 Manage/ operate care homes for elderly, differently-abled persons and other patients needing chronic care
 Part time or fulltime private nurses (in the homes of patients who can afford to pay)
 Medical Representative for drug stores/companies
 Medical Research Consultants/Assistants
 Technical Assistance Consultants/Providers

BUSINESS SECTOR OPPORTUNITIES OR JOB OPTIONS

 Transcription services (international) and engage in other non-nursing related enterprise

BUSINESS PLANS

 Manage Nurses’ Clinic

 Medical Transcription Services
 Tourism Health Care Services
 Outsourcing Primary Healthcare
 Health care training management
 Review center
 Hospice, domiciliary and health care facilities
 Public health advocacy

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 Home Healthcare Services

 Emergency Medical Services
 Wellness and Fitness Management
 Medical Mission
 Periodic Physical Examination

SOURCES OF REVENUE

 Senators and Congressman

 Requiring Long Term Care
 Government Units
 Health Maintenance Organizations
 Elderly (Home for the Aged)
 Local and Foreign Donors
 PhilHealth

AIMS:

 Reduce the cost of Quality Healthcare

 Employment Opportunities for RN’s
 Achieve Millennium Development Goal on Maternal and Child Health

COLLABORATING AGENCIES:

1. DOLE
2. DOH
3. OHNAP
4. UPCN
5. PRC-BON
6. PNA
7. DTI

CONCEPT MAPPING
-Is a visual representation that allows you graphically show the connections between a client’s many problems.
-Is an effective learning strategy to understand the relationship that exist between client problems.
Application to Nursing Practice
-A concept map allows the student to organize and link information about a client in unique and meaningful ways.
-The relationship seen between multiple nursing diagnoses allow students to plan interventions that are therapeutic for
more than one problem area.
- Use of concept maps helps students to reflect and critically think about relationships between clinical information in
a way that promotes clinical decision making.
ETIOLOGY
- is defined as the science of finding causes and origins.
- An example of etiology is knowing that some of the causes of high blood pressure are smoking, lack of exercise,
stress and a diet high in salt and fats
RISK FACTORS
- are conditions that increase your risk of developing a disease.
a. Modifiable risk factors- meaning you can take measures to change them

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Examples:
a) tobacco use
b) alcohol consumption
c) overweight and obesity
d) physical activity
e) Healthy eating.
b. Non-modifiable- which means they cannot be changed.
Examples:
a) Age-according to American Heart Association computations, about 80 percent of people who die
from cardiovascular disease are 65 years and older.
b) Gender-Heart disease has long been considered to be primarily a men’s disease
c) Family history
d) Race
PATHOPHYSIOLOGY
- is the study of the physical and biological abnormalities occurring within the body as a result of the disease.
MEDICAL DIAGNOSIS
- The process of identifying a disease, condition, or injury from its signs and symptoms. A health history, physical
exam, and tests, such as blood tests, imaging tests, and biopsies, may be used to help make a diagnosis.
CLINICAL MANIFESTATION
- that can be either objective when observed by a physician, or subjective when perceived by the patient.
MEDICAL AND SURGICAL MANAGEMENT
- A medical condition involves a more systemic, pharmaceutical approach to treatment.
- A surgical disease is one that requires some form of localized intervention such as, of course, surgery, although
various vascular interventions and radiation techniques would also fall into this category.
DIAGNOSTIC TEST
- is any approach used to gather clinical information for the purpose of making a clinical decision .
SIGNIFICANCE/ PERTINENT FINDINGS
- History and Physical Examination that formulate a differential diagnosis
- For example, if the patient's chief complaint is chest pain, pertinent findings would include things like:
Positive Findings.
- Clinical significance is essentially a subjective interpretation of research findings as meaningful for patient under
care, and therefore likely to influence the behavior of healthcare provider
NURSING DIAGNOSIS
- is a clinical judgment concerning human response to health conditions/life processes, or a vulnerability for
that response, by an individual, family, group, or community.
NURSING INTERVENTIONS
- are the actual treatments and actions that are performed to help the patient to reach the goals that are set for them.

EXPECTED OUTCOMES
- are forecasted results
- relate directly to program goals and objectives.

Discharge planning is when the patient, carer, family and any staff involved make the necessary arrangements to ensure
there is a smooth transition from hospital to home, residential care or somewhere else. It involves taking into account
things like: follow-up tests and appointments. your personal health goals.

M-edications- a substance used in treating disease or relieving pain. : the act or process of treating a person or disease
with medicine.

E-xercise- bodily or mental exertion, especially for the sake of training or improvement of health:

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Example- Walking is good exercise. Something done or performed as a means of practice or training: exercises for
the piano. A putting into action, use, operation, or effect: the exercise of caution.

Environment- means anything that surround us. It can be living (biotic) or non-living (abiotic) things. It includes
physical, chemical and other natural forces.

Treatment- an act or manner of treating. action or behavior toward a person, animal, etc. management in the application
of medicines, surgery, etc.

Health Teaching/Health education is a social science that draws from the biological, environmental, psychological,
physical and medical sciences to promote health and prevent disease, disability and premature death through
education- driven voluntary behavior change activities.

The goal of health education is to promote, maintain, and improve individual and community health through
the educational process.

Outpatient follow up- was defined as an office visit with any primary care or specialist physician or to a
federally qualified health center, as indicated by a professional claim with a Current Procedural Terminology
(CPT) code for evaluation and management.

Diet- In nutrition, diet is the sum of food consumed by a person . The word diet often implies the use of specific intake
of nutrition for health or weight-management reasons (with the two often being related).

Spirituality- involves the recognition of a feeling or sense or belief that there is something greater than myself, something
more to being human than sensory experience, and that the greater whole of which we are part is cosmic or divine in nature.
An opening of the heart is an essential aspect of true spirituality.

MEDICATION
 A substance used in the diagnosis, treatment, cure, relief, or prevention of health problems.
 A substance that modify body functions when taken into living organism.

RA 9711 - Act strengthening and rationalizing the regulatory capacity and renaming the BFAD to Food and Drug
Administration (FDA), amending certain sections of RA no. 3720

RA 9502 - Act known as the "Universally Accessible Cheaper and Quality Medicines Act of 2008. Amends RA No.
6675, or the Generics Act of 1998 and other laws (RA 5921-Pharmacy Act & RA 8293-Intellectual Property Code)

RA 9178 - Phil Nursing Act 2002, article VI, Sec 28 (a) administration of written prescription for treatment,
therapies, oral topical and parenteral medications

Pharmacological Concepts
Medication Names
 Chemical name - exact description of its composition and molecular
structure. ex. N-acetyl-para-aminophenol known as Tylenol / Biogesic
 Generic or nonproprietary name - the official name listed in official publications such as the USP.
ex. Acetaminophen or paracetamol, amoxicillin.
 Trade name, brand name, or proprietary name - the name under which a manufacturer markets a medication.
Has the symbol (™) at the upper right of the name
ex. Tylenol, Biogesic, Tempra
Classification
> Indicates the effect of the medication on a body system, the symptoms the medication relieves, or its desired effect.
Ex. Antibiotics/ antibacterial, Antihypertensive, antipyretics, antiemetics
Medication Forms
 Medications are available in a variety of forms, or preparations such as tablets, capsules, elixirs, syrups
and suppositories.
 It determines its route of administration

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PHARMACOKINETICS

Pharmacokinetics is the study of how medications enter the body, reach their site of action, metabolize, and exit the body
 The movement of drugs in the body… that involves:
 Absorption
- is the passage of medication molecules into the blood from the site of medication administration
 Route of Administration – ex. Oral, Perenteral (IV,IM,SQ,ID) Topical
 Ability of the Medication to Dissolve
 Blood Flow to the Site of Administration
 Body Surface Area
 Lipid Solubility
 Distribution
- After a medication is absorbed, it is distributed within the body to tissues and organs
and ultimately to its specific site of action.
 Circulation
 Membrane Permeability
 Protein Binding
 Metabolism
- After a medication reaches its site of action, it becomes metabolized into a less active or
inactive form that is easier to excrete
 Biotransformation occurs under the influence of enzymes that detoxify, break down,
and remove biologically active chemicals
 Liver main organ of biotransformation lungs, kidneys, blood, and intestines
 Excretion
- After medications are metabolized, they exit the body through the:
 Kidneys – main organ for excretion
 Liver, bowel, lungs, and exocrine glands

Types of Medication Action

Therapeutic Effects - is the expected or predicted physiological response that a medication causes. Ex. prednisone,
a steroid, decreases swelling, inhibits inflammation, reduces allergic responses.

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Side Effects - are predictable and often unavoidable secondary effects produced at a usual therapeutic dose.
Ex. antihypertensive medications cause impotence in men.

Adverse Effects - unintended, undesirable, and often unpredictable severe responses to medication onset can be immediate,
may take weeks or months to develop.

Toxic effects - develop after prolonged intake of a medication or when a medication accumulates in the blood because
of impaired metabolism or excretion. Ex. toxic levels of morphine causes death.

Idiosyncratic reaction, in which a patient overreacts or underreacts to a medication or has a reaction different from
normal. Ex, a child who receives diphenhydramine (Benadryl), an antihistamine, becomes extremely agitated or excited
instead of drowsy. (opposite of the effect)

Allergic Reactions – unpredictable responses when patients become immunologically sensitized to the initial dose of
a medication

Medication allergy – varied medication or chemical action as an antigen, triggering the release of the antibodies in
the body that causes allergic reaction. Considered as mild allergic reaction.

Anaphylactic reactions, life threatening allergic reaction, are characterized by sudden constriction of bronchiolar muscles,
edema of the pharynx and larynx, and severe wheezing and shortness of breath

Medication Interactions

 Medication interaction is when one medication modifies the action of another medication

Routes of Administration

Oral Routes- the easiest and the most commonly used route. Medications are given by mouth and swallowed with
fluid. Oral medications have a slower onset of action and a more prolonged effect than parenteral medications

Sublingual medication Drug is place under the tongue where it dissolves

 Short time due blood vessels underside of the tongue, DO NOT swallow to follow desired effect
Ex. Nitroglycerin

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Buccal Administration Pertaining to the cheek, held in the mouth against the mucus membrane of the cheek until dissolve.
Acts locally on the mucus membrane systematically when swallowed in the saliva.

Parenteral Routes

 Involves injecting a medication into body tissues. The following are the four
 major sites of injection:
a) Intradermal (ID): Injection into the dermis just under the epidermis
b) Subcutaneous (SQ): Injection into tissues just below the dermis of the skin
c) Intramuscular (IM): Injection into a muscle
d) Intravenous (IV): Injection into a vein

Other route parenterally:

 Epidural route is administered in the epidural space used for regional analgesia for surgical procedures
 Intrathecal Route catheter placed in the subarachnoid space or one of the ventricles of the brain,
administration is often associated with long-term medication
 Intraosseous the infusion of medication directly into the bone marrow. Commonly used in infants and
toddlers who have poor access to their intravascular space, IV access is impossible
 Intraperitoneal Medications administered into the peritoneal cavity are absorbed into the circulation
 Intrapleural syringe and needle or a chest tube is used to administer intrapleural medications directly into
the pleural space
 Intraarterial administered directly into the arteries. Intraarterial infusions are common in patients who
have arterial clots and collection of arterial blood gas ABG.

Topical Route Medications generally have local effects. application to body surfaces such as the skin or
mucous membranes to treat ailments via a large range of classes including creams, foams, gels, lotions, and
ointments

Inhalation Route The deeper passages of the respiratory tract provide a large surface area for medication
absorption: inhaled medications through the nasal and oral passages or endotracheal or tracheostomy tubes

Intraocular Route medication delivery involves inserting a medication similar to a contact lens into the patient’s eye.
It can be maintained for 1 wk.

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TYPES OF ORDERS

Standing Orders or Routine Medication Orders A standing order is carried out until the preprescriber cancels it
by another order or a prescribed number of days elapse.

Ex. Tetracycline 500 mg PO q6h Decadron 10 mg daily × 5 days

prn Orders scriber orders a medication to be given only when a patient requires it

 Use objective and subjective assessment and discretion in determining whether or not the patient needs
the medication.

Ex Morphine sulfate 2mg IV q2h prn for incisional pain

Single (One-Time) Orders medication to be given only once at a specified time. This is common for
preoperative medications or medications given before diagnostic examinations,

Ex Ativan1mg IV on call to MRI

STAT Orders order signifies that a single dose of a medication is to be given immediately and only once. STAT orders
are often written for emergencies when a patient’s condition changes suddenly.

Ex. Apresoline10mg IV STAT

Now Orders more specific than a one-time order and is used when a patient needs a medication quickly but not right
away, as in a STAT order. When receiving a now order, the nurse has up to 90 minutes to administer the
medication. Only administer now medications one time.

For example: Vancomycin1g IV piggyback now

PRESCRIPTION

 Prescriptions given to patients who are to take medications outside the hospital or healthcare facility. The
prescription includes information than a regular order because the patient needs to understand how to take
the medication and when to refill the prescription if necessary.

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MEDICATION ERROR

A medication error can cause or lead to inappropriate medication use or patient harm. Medication errors include

 inaccurate prescribing,
 administering the wrong medication,
 giving the medication using the wrong route or time interval
 administering extra doses
 Failing to administer a medication..

10 RIGHTS OF MEDICATION ADMINISTRATION

1. RIGHT PATIENT

 Always check patient’s identification bracelet.

 Ask patient to state their name and birth date.
 Compare medication order to identification bracelet and patient’s stated name and birth date.
 Verify patient’s allergies with chart and with patient

2. RIGHT MEDICATION

 Perform a triple check of the medication’s label

 When retrieving the medication.
 When preparing the medication.
 Before administering medication to patient.
 Always check the medication label with the physician’s orders.
 Never administer medication prepared by another person
 Never administer medication that is not labeled.

3. RIGHT DOSE

 Check label for medication concentration.

 Compare prepared dose with medication order.
 Triple all medication calculations.
 Check all medication calculations with another nurse.
 Verify that dosage is within appropriate dose range for patient and medication.

4. RIGHT TIME

 Verify schedule of medication with order.

a. Date
b. Time
c. Specified period of time
 Check last dose of medication given to patient.
 Administer medication within 30 minutes of schedule.

5. RIGHT ROUTE

 Verify medication route with medication order before administering.

 Medication may only be administered via route specified in order.

6. RIGHT EDUCATION

 Inform patient of medication being administered.

 Inform patient of desired effects of medication.
 Inform patient of side effects of medication.
 Ask patient if they have any known allergies to medication.

7. RIGHT EDUCATION

 The legally responsible party (patient, parent, family member, guardian, etc.) for patient’s care has the right
to refuse any medication.
 Inform responsible party of consequences of refusing medication.

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 Verify that responsible party understands all of these consequences.

 Notify physician that ordered medication and document notification.
 Document refusal of medication and that responsible party understands consequences.

8. RIGHT ASSESSMENT

 Properly assess patient and tests to determine if medication is safe and appropriate.
 If deemed unsafe or inappropriate, notify ordering physician and document notification.
 Document that medication was not administered and the reason that dose was skipped.

9. RIGHT EVALUATION (AFTER ADMINISTRATION OF DRUG)

 Assess patient for any adverse side effects.

 Assess patient for effectiveness of medication.
 Compare patient’s prior status with post medication status.
 Document patient’s response to medication.

10. RIGHT DOCUMENTATION

 Never document before medication is administered

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MEDICATION ADMINISTRATION

Oral Administration

 The easiest and most desirable way to administer medications is by mouth.

Patients usually are able to ingest or self-administer oral medications with a minimum of problems. Food delays stomach
emptying, which may decrease the therapeutic effects of oral medications. Therefore most oral medications best if given
30 minutes to 1 hour before meals. In addition, some medications must be taken with food. Some situations
contraindicate the patient’s receiving medications by mouth(ex. Vomiting, no gag
 Nurse knowledge about these interactions to determine the best time to give oral medications is important.
(read medication inserts, if available)
 When administering any oral preparation, nurse ensures protection of patients from aspiration.
 Aspiration occurs when food, fluid, or medication intended for GI administration inadvertently enters
the respiratory tract. Protect the patient from aspiration by assessing his or her ability to swallow.
 Proper positioning is essential in preventing aspiration. Position a patient in a seated position at a 90-degree
angle when administering oral medications if not contraindicated by his or her condition. Usually having the
patient slightly flex the head in a chin-down position reduces aspiration.
 When liquid medications are not available, crush simple tablets or open gelatin capsules and dilute them in
sterile water. Do not use tap water it may contain contaminants.
 Use oral syringes, Flush tubes with at least 15 mL of sterile water before and after giving medications.

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Topical Medication Applications

Topical medications are medications that are applied locally, most often to intact skin and other areas of the body such
as the nose, ear, eyes, vagina, and rectum.

SKIN APPLICATION

 Skin application involves application of ointments, creams, paste, lotions, liniments and transdermal patch.
 Application of topical medication involves using gloves and applicators.
 Use sterile technique if the patient has an open wound. Skin encrustation and dead tissues harbor
microorganisms and block contact of medications with the tissues to be treated.
 Before applying medications, clean the skin thoroughly by washing the area gently with soap and water,
soaking an involved site, or locally debriding tissue.
 Apply each type of medication according to directions to ensure proper penetration and absorption. When
applying ointments or pastes, spread the medication evenly over the involved surface and cover the area well
without applying an overly thick layer.
 Application of medication on wound: cream is commonly applied to wet wound and ointment is for dry wound.
 Prescribers sometimes order a gauze dressing to be applied over the medication to prevent soiling clothes
and wiping away the medication.
 Lightly spread lotions and creams onto the surface of the skin; rubbing often causes irritation.
 Apply a liniment by rubbing it gently but firmly into the skin.
 Topical application of transdermal patch that remains in place for an extended amount of time (e.g., 12 hours or
7 days).
 Before applying the part of the body shall be aseptically cleansed and upon application, the carefully nurse
must consider wearing gloves due to the content of the patch may affect them with bare hand.
 A new patch, remove the old one. Medication remains on the patch even after its recommended duration of use.
 Nurses and patients have inadvertently left old transdermal patches in place, resulting in the patient receiving
an overdose of the medication. medication
 ex .Fentanyl opioid medication for severe pain (anesthesia)

NASAL INSTILLATION

 Patients with nasal sinus alterations sometimes receive medications by spray, drops, or tampons
 Commonly administered form of nasal instillation is decongestant spray or drops, used to relieve symptoms
of sinus congestion and colds.
 Caution patients to avoid abuse of medications because overuse leads to a rebound effect in which the
nasal congestion worsens.
 When excess decongestant solution is swallowed, serious systemic effects also develop, especially in
children. Saline drops are safer than nasal preparations

EYE INSTILLATION

 Common medications used by patients are eyedrops and ointments, including OTC preparations such as
artificial tears and vasoconstrictors.
 Older adults, receive prescribed ophthalmic medications for eye conditions such as glaucoma or after
cataract extraction.
 Age-related problems, including poor vision, hand tremors, and difficulty grasping or manipulating
containers, affect the older adult’s ability to self-administer eye medications.
 Instruct patients and family members about the proper techniques for administering them (Skill
 Determine the patient’s and family’s ability to self-administer through by showing patients and the patient’s
family the procedure for instilling eye drops can improve adherence.
 Follow these principles when administering eye medications:
 Avoid instilling any form of eye medications directly onto the cornea (Just at the lower conjunctival
sac). The cornea of the eye has many pain fibers and thus is very sensitive to anything applied to it.
 Avoid touching the eyelids or other eye structures with eyedroppers or ointment tubes. The risk
of transmitting infection from one eye to the other is high.
 Use eye medication only for the patient’s affected eye.
 Never allow a patient to use another patient’s eye medications.

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EAR INSTILLATION

 Internal ear structures are very sensitive to temperature extremes. Instill eardrops at room temperature to
prevent vertigo, dizziness, or nausea. Although the structures of the outer ear are not sterile, sterile solutions are
used in case the eardrum is ruptured.
 The entrance of nonsterile solutions into middle ear structures can result in infection.
 If a patient has ear drainage, be sure that the eardrum has not ruptured.
 Never occlude or block the ear canal with the dropper or irrigating syringe.
 Forcing medication into an occluded ear canal creates pressure that injures the eardrum.

VAGINAL INSTILLATION

 Vaginal medications are available as suppositories, come individually packaged in foil wrappers and
are sometimes stored in the refrigerator to prevent them from melting.
 After a suppository is inserted into the vaginal cavity, body temperature causes it to melt and be distributed
and absorbed.
 Foam, jellies, and creams are administered with an applicator inserter
 Give a suppository with a gloved hand in accordance with standard precautions
 Patients often prefer administering their own vaginal medications and need privacy.
 Because vaginal medications are often given to treat infection, discharge is usually foul smelling.
 Follow aseptic technique and offer the patient frequent opportunities to maintain perineal hygiene

RECTAL INSTILLATION

 Rectal suppositories are thinner and more bullet-shaped than vaginal suppositories.
 The rounded end prevents anal trauma during insertion. Rectal suppositories contain medications that exert
local effects such as promoting defecation or systemic effects such as reducing nausea.
 Rectal suppositories are often stored in the refrigerator until administered.
 Sometimes it is necessary to clear the rectum with a small cleansing enema before inserting a suppository

Parenteral Administration.

 Parenteral medications is the administration of medications by injection into body tissues.

 It is an invasive procedure that is performed using aseptic techniques.
 After a needle pierces the skin, there is risk of infection.
 The effects of a parenterally administered medication develop rapidly,

Equipment.

 Syringes. consist of a cylindrical barrel with a tip designed to fit the hub of a hypodermic needle and a close-
fitting plunger. classified as being Luer-Lok or non–Luer-Lok. Come in a number of sizes, from 0.5 to 60 mL.
 Needles. packaged in individual sheaths, others are pre-attached to standard-size syringe, made of stainless
steel, and all are disposable. parts: 1. the hub, 2. the shaft 3. the bevel, or slanted tip.
 Disposable Injection Units. Disposable, single-dose, prefilled
- syringes are available for some medications

Preparing an Injection from an Ampule.

 Ampules contain single doses of medication in a liquid.

 Ampules are available in several sizes, from 1 mL to 10 mL or more.
 An ampule is made of glass with a constricted neck that must bensnapped off to allow access to the medication.
 A colored ring around the neck indicates or a dot marks where the ampule is prescored so you can break it easily.
 Carefully aspirate the medication into a syringe () with a filter needle. The use of a filter needle
prevents particulate matter such as small glass fragments from entering the syringe
 Replace the filter needle with an appropriate-size needle or a needleless access device before administering
the injection.
 No need of introducing air (only for vials).

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Preparing an Injection from a Vial.

 A vial is a single-dose or multidose container with a metal cap protects the seal until it is ready for use and a
rubber seal at the top
 Vials contain liquid or dry forms of medications.
 Medications that are unstable in solution are packaged dry.
 The vial label specifies the solvent or diluent used to dissolve the medication and the amount of diluent needed
to prepare a desired medication concentration.
 Normal saline and sterile distilled water are commonly used to dissolve medications.
 Unlike the ampule, the vial is a closed system, and air needs to be injected into it to permit easy withdrawal of
the solution. Failure to inject air when withdrawing creates a vacuum within the vial that makes withdrawal
difficult
 Some vials contain powder, which is mixed with a diluent during preparation and before injection (see Skill 31-4).
 After mixing multidose vials, make a label that includes the date and time of mixing and the concentration
of medication per milliliter.
 Some multidose vials require refrigeration after the contents are reconstituted.

Mixing Medications.

 If two medications are compatible, it is possible to mix them in one injection if the total dose is within
accepted limits so a patient does not have to receive more than one injection at a time.
 Check nursing units for chart list common compatible medications. If there is any uncertainty about
medication compatibilities, consult a pharmacist or a medication reference.

Mixing Medications from a Vial and an Ampule.

 When mixing medication from both a vial and ampule, prepare medication from the vial first.
 Using the same syringe and filter needle, next withdraw medication from the ampule.
 Nurses prepare the combination in this order because it is not necessary to add air to withdraw medication from
an ampule.

Mixing Medications From two Vials.

 Apply these principles when mixing medications from two vials:

1. Do not contaminate one medication with another.
2.Ensure that the final dose is accurate.
3. Maintain aseptic technique.
 Use only one syringe with a needle or needleless access device attached to mix medications from two vials ()
 Aspirate the volume of air equivalent to the dose of the first medication (vial A) (Fig. 32-15 A).
 Inject the air into vial A, making sure that the needle does not touch the solution.
 Withdraw the needle and aspirate air equivalent to the dose of the second medication (vial B).
 Inject the volume of air into vial B (Fig. 32-15, B).
 Immediately withdraw the medication from vial B into the syringe and insert the needle back into vial A,
being careful not to push the plunger and expel the medication within the syringe into the vial.
 Withdraw the desired amount of medication from vial A into the syringe (Fig. 32-15, C).
 After withdrawing the necessary amount, withdraw the needle and apply a new safety needle or needleless
access device suitable for injection.

Insulin Preparation.

 Insulin is the hormone used to treat diabetes.

 It is administered by injection because the GI tract breaks down and destroys an oral form of insulin.
 Most patients with diabetes who take insulin injections learn to administer their own injections.
 insulin concentrations are of 100 units per milliliter and in concentrations of 500 units per milliliter of
solution; U-500 insulin is 5 times as strong as U-100 insulin and is used only in rare cases when patients are
resistant to insulin (Davidson et al., 2010).
 Use a 100-unit insulin syringe or an insulin pen to prepare U-100 insulin.
 Currently there is no designed U-500 insulin syringe for U-500 insulin, many medication errors result with this
kind of insulin.

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 Before drawing up insulin doses, gently roll all cloudy insulin preparations between the palms of the hands
to resuspend the insulin.
 Do not shake insulin vials; shaking causes bubbles to form. Bubbles take up space in the syringe and alter
the dose.
 If more than one type of insulin is required to manage the patient’s diabetes, the nurse can mix two different
types of insulin into one syringe if they are compatible
 If regular and intermediate-acting insulin is ordered, prepare the regular insulin first to prevent the regular
insulin from becoming contaminated with the intermediate-acting insulin. Use the principles when mixing
insulins; clear insulin first then the cloudy insulin next.
• When preparing and administering their insulin:
1. Do not mix insulin with any other medications or diluents unless approved by the prescriber.
2. Never mix insulin glargine (Lantus) or insulin detemir (Levemir) with other types of insulin.
3. Inject rapid-acting insulins mixed with NPH insulin within 15 minutes before a meal.
4. Verify insulin doses with another nurse while preparing them if required by agency policy

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