NCM 204 LEC Community Health Nursing

dale, rei, tubs, joyce (❛ ֊ ❛„)♡

● Conditions that are conducive to disease and
COVERAGE accident or may result to failure to maintain wellness
I. Family Coping Index or realize health potential.
II. Expanded Program of Immunization A) Presence of risk factors of specific diseases
III. Family Nursing Care Plan (FNCP) ○ e.g. lifestyle diseases, metabolic syndrome
IV. Implementing Family Care Plan
V. Essential Intrapartal, Newborn Care and Screening B) Threat of cross infection from communicable disease
VI. BEmONC, CEmONC case
VII. Family Nursing Process C) Family Size beyond what family resources can
VIII. NTP adequately provide
IX. Tropical Disease Control Program
D) Accident Hazards
1. Broken chairs
TYPOLOGY OF NURSING PROBLEMS 2. Pointed/ sharp objects, poisons and medicines
IN FAMILY NURSING PRACTICE improperly kept
3. Fire hazards
4. Fall hazards
FIRST LEVEL ASSESSMENT 5. Others specify
E) Faulty/ Unhealthful Nutritional/ Eating Habits or
I. Presence of Wellness Condition Feeding Techniques/ Practices. Specify.
II. Presence of Health Threats
1. Inadequate food intake both in quality and
III. Presence of Health Deficits
quantity
IV. Presence of Foreseeable Crisis/ Stress Points
2. Excessive intake of certain nutrients
3. Faulty eating habits
I. Presence of Wellness Condition 4. Ineffective breastfeeding
● Stated as potential or readiness 5. Faulty feeding techniques
● Readiness F) Stress Provoking Factors
○ A clinical or nursing judgment about a client in 1. Strained marital relationship
transition from a specific level of wellness or 2. Strained parent-sibling relationship
capability to a higher level 3. Interpersonal conflicts between family members
● Wellness Potential 4. Care-giving burden
○ A nursing judgment on wellness state or condition
based on a client’s performance, current G) Poor Home/ Environmental Condition/ Sanitation
competencies, or performance, clinical data, or 1. Inadequate living space
explicit expression of the desire to achieve a 2. Lack of food storage facilities
higher level of state or function in a specific area 3. Polluted water supply
on health promotion and maintenance. 4. Presence of breeding or resting sights of vectors
A) Potential for Enhanced Capability for: of diseases
5. Improper garbage/ refuse disposal
1. Healthy Lifestyle 6. Unsanitary waste disposal
○ e.g. nutrition / diet, exercise / activity 7. Improper drainage system
2. Health Maintenance / Health Management 8. Poor lighting and ventilation
3. Parenting 9. Noise pollution
10. Air pollution
4. Breastfeeding
5. Spiritual Well-being H) Unsanitary Food Handling and Preparation
○ Process of client’s developing/ unfolding of
I) Unhealthy Lifestyle and Personal Habits / Practices
mystery through harmonious
interconnectedness that comes from inner 1. Alcohol drinking
strength/ sacred source/ God (NANDA 2001) 2. Cigarette/ tobacco smoking
3. Walking barefooted or inadequate footwear
6. Others: Specify _____
4. Eating raw meat or fish
B) Readiness for Enhanced Capability for: 5. Poor personal hygiene
6. Self-medication/ substance abuse
1. Healthy Lifestyle 7. Sexual promiscuity
2. Health Maintenance / Health Management
8. Engaging in dangerous sports
3. Parenting
9. Inadequate rest or sleep
4. Breastfeeding
10. Lack of/ inadequate exercise / physical activity
5. Spiritual Well-being
11. Lack of / relaxation activities
6. Others: Specify _____
12. Non-use of self-protection measures (e.g.
II. Presence of Health Threats non-use of bed nets in malaria and filariasis
endemic areas)

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J) Inherent Personal Characteristics
○ e.g. poor impulse control SECOND LEVEL ASSESSMENT
K) Health History, which may Participate/ Induce the I.
Inability to Recognize the Presence of the
Occurrence of Health Deficit Condition or Problem
○ e.g. previous history of difficult labor.
● Due to:
L) Inappropriate Role Assumption A) Lack of / inadequate knowledge
○ e.g. child assuming mother’s role, father not B) Denial about its existence or severity as a result of
assuming his role. fear of consequences of a diagnosis of the problem,
specifically:
M) Lack of Immunization/ Inadequate Immunization
1. Social-stigma, loss of respect of peer/significant
Status Especially of Children
others
N) Nursing Disinuity 2. Economic/cost implications
1. Self-oriented behavior of member(s) 3. Physical consequences
2. Unresolved conflicts of member(s) 4. Emotional/ psychological issues/concerns
3. Intolerable disagreement
C) Attitude/ Philosophy in life, which hinders recognition/
O) Others. Specify. _________ acceptance of a problem

III. Presence of Health Deficits D) Others. Specify _________

● Instances of failure in health maintenance II. Inability to Make Decision with Respect to
● Examples include: Taking Appropriate Health Action
A. Illness States
○ Regardless of whether it is diagnosed or ● Due to:
undiagnosed by medical practitioner. A) Failure to comprehend the nature / magnitude of the
B. Failure to Thrive / Develop problem / condition
○ According to normal rate B) Low salience of the problem / condition
C. Disability
○ Whether congenital or arising from illness; C) Feeling of confusion, helplessness, and/or
transient/ temporary (e.g. aphasia or temporary resignation brought about by perceived magnitude/
paralysis after a CVA) or permanent (e.g. leg severity of the situation or problem
amputation secondary to diabetes, blindness from ○ i.e. failure to break down problems into
measles, lameness from polio) manageable units of attack
D) Lack of/ inadequate knowledge/ insight as to
IV. Presence of Stress Points/ Foreseeable Crisis alternative courses of action open to them
Situations E) Inability to decide which action to take from among a
● Anticipated periods of unusual demand on the list of alternatives
individual or family in terms of adjustment/ family F) Conflicting opinions among family members/
resources. significant others regarding action to take
● Examples of this include:
A. Marriage G) Lack of/ inadequate knowledge of community
B. Pregnancy, labor, puerperium resources for care
C. Parenthood H) Fear of consequences of action, specifically:
D. Additional member 1. Social consequences
○ (e.g. newborn, lodger) 2. Economic consequences
E. Abortion 3. Physical consequences
F. Entrance at school 4. Emotional/ psychological consequences
G. Adolescence
H. Divorce or separation I) Negative attitude towards the health condition or
I. Menopause problem
J. Loss of job ○ By negative attitude is meant one that interferes
K. Hospitalization of a family member with rational decision-making
L. Death of a member J) Inaccessibility of appropriate resources for care,
M. Resettlement in a new community specifically:
N. Illegitimacy ○ Physical Inaccessibility
O. Others, specify. ________ ○ Costs constraints or economic/ financial
inaccessibility
K) Lack of trust/ confidence in the health personnel/
agency
L) Misconceptions or erroneous information about the
proposed course(s) of action

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M) Others specify. _________
III. Inability to Provide Adequate Nursing Care to
the Sick, Disabled, Dependent, or Vulnerable/
At-risk Member of the Family
A) Lack of/ inadequate knowledge about the disease/
health condition (nature, severity, complications,
prognosis, and management)
B) Lack of / inadequate knowledge about child
development and care
C) Lack of / inadequate knowledge of the nature or
extent of nursing care needed
D) Lack of the necessary facilities, equipment, and
supplies of care
E) Lack of / inadequate knowledge or skill in carrying
out the necessary intervention or treatment/
procedure of care.
○ i.e. complex therapeutic regimen or healthy
lifestyle program
F) Inadequate family resources of care specifically:
1. Absence of responsible member
2. Financial constraints
3. Limitation of luck/ lack of physical resources
G) Significant person’s unexpressed feelings (e.g.
hostility/anger, guilt, fear/anxiety, despair, rejection)
which affect his/her capacities to provide care
H) Philosophy in life which negates / hinder caring for
the sick, disabled, dependent, vulnerable/ at-risk
member
I) Member’s preoccupation with concerns / interests
J) Prolonged disease or disabilities, which exhaust
supportive capacity of family members
K) Altered role performance, specify.
1. Role denials or ambivalence
2. Role strain
3. Role dissatisfaction
4. Role conflict
5. Role confusion
6. Role overload
L) Others. Specify.____
IV. Inability to Provide a Home Environment
Conducive to Health Maintenance and
Personal Development
● Due to:
A) Inadequate family resources specifically:
1. Financial constraints/ limited financial resources
2. Limited physical resources
○ i.e.lack of space to construct facility
B) Failure to see benefits (specifically long term ones) of
investments in home environment improvement
C) Lack of / inadequate knowledge of importance of
hygiene and sanitation
D) Lack of / inadequate knowledge of preventive
measures
E) Lack of skill in carrying out measures to improve
home environment
F) Ineffective communication pattern within the family
G) Lack of supportive relationship among family
members
H) Negative attitudes / philosophy in life which is not
conducive to health maintenance and personal
development
I) Lack of / inadequate competencies in relating to each
other for mutual growth and maturation
○ e.g. reduced ability to meet the physical and
psychological needs of other members as a result
of family’s preoccupation with a current problem
or condition
J) Others specify. _________
V. Failure to Utilize Community Resources for
Health Care
● Due to:
A) Lack of/ inadequate knowledge of community
resources for health care
B) Failure to perceive the benefits of health care/
services
C) Lack of trust/ confidence in the agency / personnel
D) Previous unpleasant experience with health worker
E) Fear of consequences of action (preventive,
diagnostic, therapeutic, rehabilitative) specifically:
1. Physical / psychological consequences
2. Financial consequences
3. Social consequences
F) Unavailability of required care / services
G) Inaccessibility of required services due to:
1. Cost constraints
2. Physical inaccessibility
H) Lack of or inadequate family resources, specifically
1. Manpower resources, e.g. babysitter
2. Financial resources, cost of medicines prescribe
I) Feeling of alienation to/ lack of support from the
community, e.g. stigma due to mental illness, AIDS,
etc.
J) Negative attitude/ philosophy in life which hinders
effective/ maximum utilization of community
resources for health care
K) Others, specify __________
FAMILY NURSING CARE PLAN
Formulate an FNCP
● First, you need to prioritize the problems using the
criteria
● Identify the Nature of the problem
○ Wellness state
○ Health threat
○ Health deficit
○ Stress point/ foreseeable crisis
● Second, the Modifiability of the problem
● Third, the Preventive potential
● Last would be the Salience
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1ST Step: PRIORITIZATION nang sa gawas.” The trash collected already
attracted rodents.
● Eg.
Criteria Weight
○ Poor Home Sanitation Specifically Improper
1. Nature of the Condition garbage disposal
or Problem presented ○ Poor Home/Environment Sanitation Specifically
Scale: Presence of breeding sights of vectors of
Wellness state 3 diseases
Health Deficit 3 1
Health Threat 2
Stress point/ Foreseeable 1
3rd Step: FAMILY NURSING PROBLEM
Crisis ● Check the Second Level Assessment then specify
● Make sure that the family nursing problem supports
2. Modifiability of the
the health problem.
Problem or Condition
Scale: ● The reason behind the health problem is because of
Easily modifiable 2 the family nursing problem.
Partially modifiable 1 2
Not modifiable 0 Family Nursing Problem
● Scenario: The patient’s home environment is
covered in trash. Since the family doesn’t have
3. Preventive Potential money to buy trash bins, they just throw it outside the
Scale: beach. And since the neighbors are also doing it. The
High 3
patient verbalized “wala kayo nako ginatagan na
Moderate 2 1
Low 1 boss kay ang importante hinlo sa balay, bahala na
nang sa gawas.” The trash collected already
4. Salience attracted rodents.
Scale: ● Health Problem: Poor Home/ Environment
- A condition or problem 2 Sanitation Specifically Presence of breeding sights of
needing immediate vectors of diseases
attention
● Family Nursing Problem: Inability to make
- A condition or problem 1 1
not needing immediate decisions with respect to taking appropriate health
attention action due to low salience of the problem
- Not perceived as a 0 ○ Or Failure to comprehend the nature/ magnitude
problem or condition of the problem
needing change
4th Step: Create a Goal of Care and Objectives of
● You need to prioritize all the problems that were Care
identified and depending on the situation, choose a ● Goal of care: After nursing intervention, the family
number of top problems and create an FNCP will be able to clean their environment and get rid of
● You look for cues that would support the Health the rodents occupying in their house.
problem as well as the Family Nursing Problem ● Objectives of care: Within an hour of nursing
2nd Step: HEALTH PROBLEM intervention, the couple will be able to:
○ Remove the trash near their home
● Identify the Nature of the problem from the typology ○ Segregate their trash from Recycles,
○ Wellness state Biodegradable, and Non-biodegradable
○ Health threat ○ Enumerate methods that would not attract rodents
○ Health deficit such as:
○ Stress point/ foreseeable crisis ■ Not leaving any food in the table
● Once identified, specify. ■ Not throwing food property in the
● Can be seen in the typology as the First Level biodegradable bin
Assessment then specify. ■ Decluttering of unnecessary items at home.
Health Problem
● Scenario: The patient’s home environment is 5th Step: Enumerate the Nursing Interventions
covered in trash. Since the family doesn’t have ● Then identify the Nurse-Family contact
money to buy trash bins, they just throw it outside the ● As well as the resources required:
beach. And since the neighbors are also doing it. The ○ Usually the resources are materials/ methods
patient verbalized “wala kayo nako ginatagan na used to make the FNCP
boss kay ang importante hinlo sa balay, bahala na
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6th Step: Evaluation FULLY IMMUNIZED CHILD (FIC)
● Goal met ● 1997 - Child who received 1 dose of BCG, 3 doses of
● After nursing interventions, the family was able to: DVT, 3 doses of HEPA, 3 doses of OPV, 1 dose of
○ Remove the trash near their home measles at the right time and interval before the
○ Segregate their trash from Recycles, child reaches 1 year old.
Biodegradable and Non-biodegradable ● 2013 - Child who received 1 dose of BCG, 3 doses of
○ Enumerate methods that would not attract rodents Penta, 3 doses of PCV, 3 doses of OPV, 1 dose of
such as: measles at the right time and interval before the
■ Not leaving any food in the table child reaches 1 year old.
■ Not throwing food property in the
biodegradable bin COMPLETE IMMUNIZATION
■ Decluttering of unnecessary items at home. ● Child who received 1 dose of BCG, 3 doses of DVT,
Family Nursing Care Plan 3 doses of HEPA, 3 doses of OPV, 1 dose of measles
but not on the desired age and time.
● NOTE; You cannot give vaccine before the
prescribed age

Principles
● Epidemiological situation
● Mass approach
● Basic health services

EXPANDED IMMUNIZATION PROGRAM
● The Expanded Program on Immunization (EPI) was
established in 1976 to ensure that infants/ children
and mothers have access to routinely recommended
infant/ childhood vaccines.
● Six vaccine-preventable diseases were initially
included in the EPI:
1. Tuberculosis
2. Poliomyelitis
3. Diphtheria
4. Tetanus
5. Pertussis
6. Measles
MANDATES
● Republic Act No. 10152
○ “Mandatory Infants and Children Health
Immunization Act of 2011”
○ Signed by President Benigno Aquino III in July 26,
2010.
○ The mandatory includes basic immunization for
children under 5 including other types that will be
determined by the Secretary of Health.
● Presidential Decree No. 996
○ September 16, 1976
○ “Providing for Compulsory Basic Immunization for
Infants and Children below eight years of age”
○ Basic immunization against certain diseases shall
be compulsory for infants and children below eight
years of age;
Target Settings
● Infants 0-12 months
● Pregnant and Post Partum Women
● School Entrants/ Grade 1/ 7 years old
COLD CHAIN LOGISTIC MANAGEMENT
● Vaccine distribution through cold chain is designed to
ensure that the vaccines were maintained under proper
environmental condition until the time of administration.
● Cold Chain is a system used to maintain potency of a
vaccine from that of manufacture to the time it is given
to child or pregnant woman.
● The allowable timeframes for the storage of vaccines
at different levels are:
○ 6 months - Regional Level
○ 3 months - Provincial Level/ District Level
○ 1 month - Main health centers - with ref.
○ Not more than 5 days - Health centers using
transport boxes
● Most sensitive to heat: Freezer (-15 to -25 degrees C)
○ OPV
○ Measles
● Sensitive to heat and freezing (body of ref. +2 to +8
degrees Celcius)
○ BCG
○ DPT
○ Hepa B
○ TT
● FEFO (“first expiry and first out”) - vaccine is
practiced to assure that all vaccines are utilized before
the expiry date. Proper arrangement of vaccines and/or

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 labeling of vaccines expiry date are done to identify Immunization Schedule
those near to expire vaccines. Vaccine Minimum # of Dosage Interval Route Site
Age of Doses between
● VVM (Vaccine Vial Monitoring) First doses
Dose
○ Thermo chromic label - colored lilac
■ Indicator that the vaccine was kept at the BCG At birth 1 0.05 mL - ID R Deltoid
region of
temperature that the potency required. the arm

The inner square is lighter than outer Pentaval 6 weeks 3 0.5 mL 4 weeks IM Vastus
circle. If the expiry date has not ent Lateralis
passed, USE the vaccine.
OPV 6 weeks 3 2 drops 4 weeks Oral Mouth

As time passes, the inner square is Hep B At birth 3 0.5 mL 4 weeks IM Vastus
still lighter than the outer circle. If the Lateralis
expire date has not passed, USE the
Measles 9 months 1 0.5 mL - SQ Upper
vaccine. Outer
Portion of
Discard point: the colour of the the Arm

inner square matches that of the MMR 12-15 1 0.5 mL - SQ Upper

outer circle. DO NOT use the months Outer
vaccine. Portion of
the Arm

Beyond the discard point: inner IPV 14 weeks 1 0.5 mL 4 weeks IM Vastus
square is darker than the outer Lateralis
circle. DO NOT use the vaccine.
PCV 6, 10, 14 3 0.5 mL 4 weeks IM Vastus
weeks Lateralis
DOH Advertisement
RTV 6, 10, 14 3 1 mL 4 weeks PO Side of the
weeks mouth
Schedule ng Pagbibigay ng Bakuna para sa mga Batang Isang
Taon Pababa
CONSIDERATIONS
● OPV:
○ Ask if the patient has fever or any other condition or
illness
○ Dependent on HC protocol, OPV is not given if the
patient is on antibiotics
○ If with BM, instruct the parent to come back after 1
week to give another dose of OPV to complete
dosage of OPV
○ Do not feed the baby 30 mins before giving OPV
Mga Paalala
Nagsisimula ang pagbabakuna ng bata sa
kapanganakan. Sundin ang schedule ng bakuna at
SITES OF INJECTION
siguruhing makumpleto ang mga ito hanggang sumapit ● IM
ang kanyang unang kaarawan. Ang mga bakunang hindi ● Vastus Lateralis -
nakalista ay maaring makuha sa pribadong ospital o Antero-Lateral Mid Aspect of
doktor. the Thigh (penta, hep B, IPV,
Sample Immunization Card PCV)
● Note: Pentavalent should
always be given at the right
side.
● BCG - Intradermal: deltoid region of the arm
● OPV - oral
● SQ - Measles and MMR (Upper Outer Portion of the
Arm)
Routes
● Intramuscular: 90°
● Subcutaneous: 45°
● Intravenous: 25°
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● Intradermal: 10-15°
● Epidermis – Dermis – Subcutaneous tissue – Muscle
IMPLEMENTING FAMILY CARE PLAN
Categories of Intervention
● PROMOTIVE
○ Enabling people to increase control over and
improve their health.
○ It involves the population as a whole in the context
of their everyday lives, rather than focusing on
people at risk for specific diseases, and is directed
toward action on the determinants or causes of
health
There are four core service elements related to health
promotion:
1. Prevention of disease, injury, and illness;
2. health education, anticipatory guidance and
parenting skill development;
3. support that builds confidence and is reassuring for
mothers, fathers and carers; and
4. community capacity building.
● PREVENTIVE
○ Deals with the prevention of illness to decrease the
burden of disease and associated risk factors.
○ Focuses on preventing disease and illness and
promoting overall general health and well-being.
○ Nurses work to prevent risk factors for disease
through patient education.
○ They provide instruction on healthy diets,
immunizations, and exercise.
● CURATIVE
○ Is to cure a disease or promote recovery from an
illness, injury, or condition; involves treatment
intended to alleviate the symptoms or cure a current
medical condition.
○ It strives to reduce pain, improve function, and help
improve the quality of life for patients’ impairment.
● REHABILITATIVE
○ Nurses assist patients with temporary and
long-term disabilities or chronic illnesses.
○ They assist in adapting to their conditions, meeting
their highest potential, and living more independent
lives.
Tools of Public Health Nurse
● PHN Bag
○ Public health bag - is an essential and
indispensable equipment of the public health nurse
which he/she has to carry along when he/she goes
out home visiting. It contains basic medications and
articles which are necessary for giving care.
● Bag technique
○ A tool making use of public health bag through
which the nurse, during his/her home visit, can
perform nursing procedures with ease and
deftness, saving time and effort with the end in view
of rendering effective nursing care.
Types of Family Nurse Contact
● Clinic Visit
○ Health care services provided to patients on an
ambulatory basis, rather than by admission to a
hospital or other health care facility. The services
may be a part of a hospital, augmenting its inpatient
services, or may be provided at a free-standing
facility.
● Home Visit
○ Is a family-nurse contact which allows the health
worker to assess the home and family situations in
order to provide the necessary nursing care and
health-related activities. In performing home visits, it
is essential to prepare a plan of visit to meet the
needs of the client and achieve the best results of
desired outcome.
● Group Conference
○ Often involves the entire family and can be done at
home, clinic, school, or work place. It is useful in a
situation where the family has a chronic problem
that is having a negative effect on the entire family.
● Telephone calls
○ May be effective, efficient, and appropriate if the
objectives and outcomes of care require immediate
access to data, given problems on distance or
travel time.
● Written Communication
○ Is another less time-consuming option for the nurse
when there are a large number of families needing
follow-up on top problems of distance and travel
time if the family is motivated and independent.
Interprofessional Care in the Community
● Interprofessional Practice (IPP)
○ Is a collaborative practice that occurs when
healthcare providers work with people from within
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 their own profession, with people outside their
profession, and with patients and their families.
■ Rural Health Unit Personnel
■ Local Government Units
■ Government Organizations
Government Organizations
● DSWD
○ The Department of Social Welfare and
Development (DSWD) is the primary government
agency mandated to develop, implement, and
coordinate social protection and poverty-reduction
solutions for and with the poor, vulnerable, and
disadvantaged.
○ The following agencies are attached to the DSWD:
■ Council for the Welfare of Children
■ Inter-Country Adoption Board
■ National Youth Commission
■ National Council on Disability Affairs
ESSENTIAL INTRAPARTAL AND NEWBORN
CARE
EINC
● Is a package of evidence-based practices
recommended as the standard care in all births by
skilled attendants in all government and private
settings by:
○ Department of Health (DOH)
○ Philippines Health Insurance Corporation
(Philhealth), and
○ World Health Organization (WHO)
● Basic component of DOH’s Maternal Newborn and
Child Health and Nutrition (MNCHN) strategy.
● EINC practices at birth:
○ Bound chronologically - ordered
○ Standard procedures

● Nutritional Council 4 Time Bounded Interventions

○ National Nutrition Council Core Functions:
1. Immediate Drying
1. Formulate national food and nutrition policies and
2. Early skin-to-skin contact
strategies and serve as the policy, coordinating
3. Properly-timed cord clamping and cutting (after 1-3
and advisory body of food, nutrition, and health
mins)
concerns
4. Non-separation of the baby from the mother and
2. Coordinate planning, monitoring, and evaluation
breastfeeding initiation
of the national nutrition program
3. Coordinate the hunger mitigation and malnutrition PURPOSE
prevention program to achieve Millineum ● Immediate drying and early skin-to-skin contact -
Development Goals; prevents hypothermia, sepsis, increase colonization
4. Strengthen competencies and capabilities of of bacteria
stakeholders through public education, capacity ● Properly timed cord clamping and cutting of umbilical
building, and skills development cord - prevents anemia
5. Coordinate the release of funds, loans, and grants ● Breastfeeding initiation within the first hour of life
from government organizations (GO’s) and prevents neonatal deaths
non-government organizations (NGO’s); and
Changes in Practices in the Delivery Room
6. Call on any department, bureau, office, agency,
and other instrumentalities of the government for DONT’S:
assistance in the form of personnel, facilities, and ● Manipulation of routine secretions if the baby is
resources as the need arises. crying and breathing normally
○ Don’t suction
● The Commission on Population (POPCOM)
● Putting the newborn on a cold or wet surface
○ Is a government agency mandated as the overall
● Wiping off vernix caseosa if present
coordinating, monitoring, and policy-making body of
● Foot printing
the population program. It is the lead agency
● Bathing earlier than 6 hours of life
promoting population activities.
● Unnecessary separation of the newborn (to the
mother)
Non-Government Organizations ○ Weighing
○ Anthropometric measurements
1. Socio-Civic Organizations ○ Vit K administration
○ A nonprofit organization or corporation that is ○ Hepatitis B vaccine
operated exclusively for the promotion of social ○ BCG
welfare ● Transferring of newborn to nursery/NICU without
2. Religious Organizations indication
3. Schools
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 NEWBORN SCREENING
Newborn Screening (NBS) Program
● NBS - integrated as part of the country’s public health
delivery system with the enactment of the Republic
Act No. 9288 (Newborn Screening Act of 2004)
● Department of Health (DOH)
○ Lead agency in the implementation of the law and
collaborates with other National Government
Agencies (NGA) and key stakeholders
○ It is also a service that has been available in the
Philippines since 1996.
○ Under DOH, NBS is part of the Child Development
and Disability Prevention Program at the Disease
Prevention and Control Bureau.
PURPOSES
● Ensures early detection and management of several
congenital metabolic disorders
● Early dx and initiation of treatment with long-term
care
● Ensure normal growth and development
Vision
○ The National Comprehensive Newborn Screening
System envisions all Filipino children will be born
healthy and well, with an inherent right to life,
endowed with human dignity; and reaching their full
potential with the right opportunities and accessible
resources
Mission
○ To ensure that all Filipino children will have access
to and avail of total quality care for the optimal
growth and development of their full potential.
Goal
○ To reduce preventable deaths of all Filipino
newborns due to more common and rare congenital
disorders through timely screening and proper
management.
WHY IS NBS PROTOCOL NEEDED
● Proper sequencing or order of newborn care services
needs to be standardized based on current evidence
that show a reduction in neonatal mortality and
morbidity.
● Achieving United Nations Millennium Development
Goal 4 of Reducing Under 5 Child Mortality (through
reduction of neonatal deaths)
DEPARTMENT OF HEALTH RELATED
PROGRAMS
I. BEMONC
II. CEMONC
III. NUTRITION
IV. MHGAP
BASIC EMERGENCY OBSTETRIC AND NEWBORN
CARE (BEMONC)
● Provider Facilities
○ Barangay Health Station (BHS)
○ Rural Health Unit (RHU)
○ District
○ Community Hospitals
Services provided by the Provider Facilities:
1. Pre-pregnancy package of services include the
following provisions:
● Micronutrient supplementation consisting of
important minerals and vitamins such as zinc, iodine,
calcium, vitamin A capsules and iron tablets
○ Iron folate 60 mg tables 1 tablet daily
○ Vitamin A at least 5000 IU every week (a daily
multivitamin supplement may be taken as an option
when the required vitamin A is not available)
○ Promotion of use of iodized salt
● Tetanus toxoid immunization following the
recommended schedule
● Family planning
○ IEC and FP counseling with focus on modern
methods and fertility awareness and observing the
principles of informed choice, birth spacing,
responsible parenthood and respect for life; and
contraceptive provision as appropriate
● Provision of oral health services
● Counseling on STI/HIV/AIDS, nutrition, personal
hygiene, and the consequences of abortion
● STI screening using syndromic approach
● Adolescent and youth health services including peer
and professional counselling and RH education
● Promotion of healthy lifestyle including advice relative
to smoking cessation, healthy diet, regular exercise
and moderate alcohol intake.
,
● Management of lifestyle-related diseases like
diabetes, cardiovascular disease (CVD), etc.
● Prevention and Management of other diseases
including tuberculosis, malaria (e.g provision of
insecticide-treated bed nets for malaria-infested
areas), schistosomiasis, and anemia.
9
2. Complete Pre-Natal Package:
● Provision of eight essential antenatal care services
○ Monitoring of height and weight
○ Taking the blood pressure
○ Screening and blood testing including Complete
Blood Count, blood Typing, urinalysis, VDRL or
RPR, HbSAg, blood sugar screening, pregnancy
test, cervical cancer screening using acetic acid
wash and papanicolau smear.
○ Micronutrient supplementation (iron, folate and
vitamin A supplementation) Malaria prophylaxis
where appropriate
○ Deworming
○ Birth planning
● Promotion of exclusive breastfeeding (up to 6 months
but can also be up to 2 years), newborn screening,
BCG, and Hepatitis B birth dose immunization
● Counselling on:
1. Use of modern FP methods especially lactation
amenorrhea (LAM), with focus on health caring
and health-seeking behaviors; and
2. Contraception including surgical procedures
where appropriate: bilateral tubal ligation (BTL),
no-scalpel vasectomy (NSV), and management of
complications resulting from contraception.
● Laboratory screening and medical management of
STI-HIV cases and their complications.
● Counselling on Healthy Lifestyle with a focus on
smoking cessation, healthy diet and nutrition, regular
exercise, STI control, HIV prevention, and oral health
● Prevention and management of early bleeding in
pregnancy.
● Administration of antenatal loading dose of steroids
for threatened premature delivery.
● Early detection and management of signs of
complications of pregnancy.
● Measurement of fundic height against the age of
gestation, fetal heartbeat, and fetal movement count
to assess the adequacy of fetal growth and
well-being.
● Prevention and management of other conditions as
indicated:
○ Hypertension
○ Anemia
○ Diabetes
○ Tuberculosis
○ Malaria
○ Schistosomiasis
○ STI/HIV/AIDS
● Provision of other support services:
○ Antenatal registration through active tracking by the
WHTs
○ Birth Planning
○ Home visits and follow up
○ Safe blood supply
○ Transportation and communication support services
3. Complete Childbirth Package:
For the Mother:
● Monitoring vital signs and the progress of labor using
the partograph.
● Identification of early signs and symptoms and
administration of appropriate management of
prolonged labor, hypertension, abnormal
presentation, and bleeding
● Active management of the third stage of labor.
● Provision of immediate post-partum nursing care
(prior to discharge from the delivery room)
● Post-partum nursing care
○ Perineal washing
○ Changing of hospital gown
○ Checking vital signs
○ Rooming-in
For the Newborn:
● Drying to keep the baby warm
● Provision of appropriate thermal care through mother
and newborn skin-to-skin contact, maintaining a
delivery room temperature of 25-28 degrees
centigrade and wrapping the newborn with a clean,
dry cloth.
● Immediate latching on and initiation of breastfeeding
within the first hour after birth.
● Non-immediate cord clamping (1-3 minutes or until
cord pulsation stops)
Should complications occur, a BEmONC provider facility
must be able to administer the following emergency care
services:
● Parenteral administration of oxytocin in the third
stage of labor.
● Parenteral administration of loading doses of
anti-convulsant.
● Parenteral administration of initial dose of antibiotics.
● Assisted vaginal delivery during imminent breech
delivery.
● Manual removal of placenta
● Removal of retained placental products
● Administration of loading dose of steroids for
premature labor.
● Administration of intravenous fluid, blood volume
expander, and/or blood transfusion
● Newborn resuscitation
● Treatment of neonatal sepsis as necessary.
● Oxygen support for newborns
4. Complete Post-Partum and Post-Natal Package:
For the Mother:
● Post-partum check-up including identification of early
signs and symptoms of postpartum complications like
hemorrhage, infection, and hypertension
● Micronutrient supplementation, including iron and
folate.
● Counselling on:
10
 ○ Proper Nutrition ● Family Planning
○ Benefits of exclusive breastfeeding up to six ○ IEC and FP counseling with focus on modern
months. methods and fertility awareness and observing the
○ Benefits of skin-to-skin contact especially among principles of informed choice, birth spacing,
preterm babies responsible parenthood and respect for life; and
○ Essential neonatal care ○ Contraceptive provision as appropriate
● Laboratory screening and medical management of ● Provision of oral health services
STI-HIV cases and their complications ● Counselling on STI/HIV/AIDS, nutrition, personal
● Provision of FP services and contraception including hygiene, and the consequences of abortion
surgical procedures where appropriate: bilateral tubal ● Laboratory screening for STIs
ligation (BTL), no-scalpel vasectomy (NSV), and ● Adolescent and youth health services including peer
management of complications resulting from and professional counseling and RH education
contraception. ● Promotion of healthy lifestyle including advice relative
● Prevention and management of other diseases as to smoking cessation, healthy diet, regular exercise,
indicated: and moderate alcohol intake.
○ Hypertension ● Management of lifestyle-related diseases like
○ Diabetes diabetes, CVD, etc.
○ Anemia ● Prevention and Management of other diseases
○ Tuberculosis including tuberculosis, malaria (e.g. provision of
○ Malaria insecticide-treated bed nets for malaria-infested
○ Schistosomiasis areas), schistosomiasis, and anemia
○ STI/HIV/AIDS
Prenatal care package
For the Baby:
● Post-natal care required within 24 hours after birth The following antenatal services provided at the
includes BEmONC provider facilities shall likewise be provided in
○ Cord care a CEmONC facility:
○ Breastfeeding ● Provision of eight essential antenatal care services
○ Vitamin K injection 1. Monitoring of height and weight
○ Eye prophylaxis 2. Taking the blood pressure
○ Delayed bathing until 6 hours of life 3. Screening and blood testing including CBC, blood
○ BCG and first dose of Hepatitis B Immunization Typing, urinalysis, VDRL or RPR, HbSAg, blood
○ Newborn screening sugar screening, pregnancy test, cervical cancer
● Counselling on post-partum/post-natal check-up, screening using papanicolau smear
home care, and immunization 4. Micronutrient supplementation (iron, folate,
Vitamin A supplementation)
5. Provision of other support services 5. Tetanus toxoid immunization
● Birth registration 6. Malaria prophylaxis where appropriate
● Safe blood 7. Deworming 20
● Transportation and communication 8. Birth planning
● Promotion of exclusive breastfeeding, newborn
screening, BCG, and Hepatitis B birth dose
COMPREHENSIVE EMERGENCY OBSTETRIC AND immunization.
NEWBORN CARE (CEMONC) ● Counseling on:
○ Use of modern FP methods especially lactation
Pre-pregnancy amenorrhea (LAM), with focus on health caring and
● Micronutrient supplementation consisting of important health-seeking behaviors; and
minerals and vitamins such as zinc, iodine, calcium, ○ Contraception including surgical procedures where
vitamin A capsules, and iron tablets appropriate: bilateral tubal ligation (BTL), no-scalpel
○ Iron folate 60 mg tablets, 1 tablet daily for 3-6 vasectomy (NSV) and management of
months complications resulting from contraception.
○ Vitamin A at least 5000 IU every week (a daily ● Counselling on Healthy Lifestyle with focus on
multivitamin supplement may be taken as an option smoking cessation, healthy diet and nutrition, regular
when the required vitamin A is not available). exercise, STI control, and HIV prevention and oral
○ Promotion of use of iodized salt health
● Prevention and Management of early bleeding in
● Tetanus toxoid immunization following the
pregnancy and its complications
recommended schedule
11
● Administration of antenatal loading dose of steroids ● Administration of loading dose of steroids for
for threatened premature delivery. premature labor.
● Early detection and management of danger signs ● Intravenous fluid administration, blood volume
and complications of pregnancy. expander, and/or blood transfusion.
● Measurement of fundic height against the age of ● Newborn resuscitation.
gestation, fetal heartbeat, and fetal movement count ● Treatment of neonatal sepsis
to assess the adequacy of fetal growth and wellbeing ● Oxygen support for the newborn.
● Prevention and management of other diseases as
indicated: COMPREHENSIVE EMERGENCY OBSTETRIC AND
○ Hypertension NEWBORN CARE
○ Anemia
● Caesarian section
○ Diabetes
● Blood transfusion
○ Tuberculosis
● Management of newborn complications
○ Malaria
○ Schistosomiasis
○ STI/HIV/AIDS POSTPARTUM/POSTNATAL CARE
● Provision of other support services
○ Antenatal registration by active tracking by WHTs Postpartum care package
○ Assistance in birth planning ● Post-partum check-up including identification of early
○ Safe blood supply signs and symptoms of postpartum complications
○ Transportation and communication support services such as hemorrhage, infection, and hypertension.
Complete Childbirth Package: ● Micronutrient supplementation, including iron and
folate
For the Mother: ● Counseling on:
● Monitoring vital signs and the progress of labor using ○ Nutrition
the partograph. ○ Excessive breastfeeding up to six months
● Identification of early signs and symptoms and ○ Essential neonatal care
administration of appropriate management of ○ Special neonatal care for preterm and “problematic”
prolonged labor, hypertension, abnormal babies
presentation, and bleeding. ○ Laboratory screening and medical management of
● Active management of the third stage of labor. STI-HIV cases and their complications
● Provision of immediate post-partum nursing care ○ Provision of FP services including contraception:
(prior to discharge from the delivery room) bilateral tubal ligation (BTL), no-scalpel vasectomy
○ Perineal washing (NSV) and management of complications resulting
○ Change hospital gown from contraception.
○ Check vital signs ○ Prevention and management of other diseases as
○ Rooming-in in the case of non-problematic cases indicated:
○ Return to ward if the baby is preterm and needs to ■ Hypertension
be confined at the Newborn Intensive Care Unit ■ Anemia
(NICU). Advice should be given relative to ■ Diabetes
breastfeeding schedules at the NICU. ■ Tuberculosis
For the Newborn: ■ Malaria
● Drying to keep the baby warm ■ Schistosomiasis
● Non-immediate cord clamping ■ STI/HIV/AIDS
● Provision of warmth through skin-to-skin contact with ○ Counseling on post-partum/ post-natal check-up,
the mother, immediate latching on, and initiate home care, and immunization
breastfeeding within first hour after birth
Immediate postnatal care package (required within
24 hours after birth)
BASIC EMERGENCY OBSTETRIC AND NEWBORN CARE
● Cord care
● Prenatal administration of oxytocin in the third stage ● Initiation of breastfeeding within the first hour of life
of labor. ● Vitamin K injection
● Prenatal administration of initial dose of antibiotics. ● Eye prophylaxis
● Assisted vaginal delivery during imminent breech ● Delayed bathing to 6 hours of life
delivery. ● BCG and first dose of Hepatitis B immunization
● Manual removal of placenta. ● Newborn screening
● Removal of retained placental products. ● Other services
12
● Birth registration
● In addition, the CEmONC provider facilities shall
provide comprehensive emergency postnatal care
that includes life support management for
○ Low birth weight newborns
○ Premature newborns
○ Sick newborns
■ Sepsis
■ Fetal alcohol syndrome
■ Asphyxia
■ Severe birth trauma
■ Severe jaundice
■ Others
NUTRITION
Micronutrient Program
● Goal of Micronutrient:
○ Achievement of better health outcomes, sustained
health financing and responsive health system by
ensuring that all FIlipinos especially the
disadvantaged group (lowest 2 income quantiles)
have equitable access to affordable health care.
● Objectives:
1. Contribute to the reduction of disparities related to
nutrition through a focus on population groups and
areas highly affected or at risk of malnutrition
2. To provide Vitamin A capsules, iron, and iodine
supplements to treat or prevent specific
micronutrient deficiencies
3. Go to scale with key interventions on micronutrient
supplementation, food fortification, salt iodization,
and nutrient education.
4. Revive, identify, document, and adopt good
practices and models for nutrition improvement.
5. Build nutrition human resources in relevant
departments/agencies.
Interventions/Strategies Employed or Implemented
1. Micronutrient Supplementation - is the provision of
pharmaceutically prepared vitamins & minerals for
the treatment or prevention of specific micronutrient
deficiency.
2. Food Fortification - the addition of essential
micronutrients to widely consumed food product at
levels above its normal state.
3. Improving diet/ dietary diversification - the
adoption of proper food and nutrition practices thru
nutrition education food production & consumption.
4. Growth monitoring and promotion - is an
educational strategy for promoting child health,
human development, and quality of life through
sequential measurement of physical growth and
development of individuals in the community.
The following policies were fomulated and implemented
● AO No. 2010-0010: revised Policy on Micronutrient
Supplementation to support achievement of 2015
MDG Targets to reduce under-five and maternal
deaths and micronutrient needs of other population
groups
● AO No. 2007-0045: Zinc Supplementation and
reformulated Oral rehydration salt in the
management of diarrhea among children
● ASIN Law - R.A. 8172, “An act promoting salt
iodization nationwide and for other purposes”, signed
into law on Dec. 20, 1995
● Food fortification law, RA 8976, “An act
establishing the Philippine Food Fortification Program
and for other purposes” mandating fortification of
flour, oil, sugar with Vit A and flour and rice with iron
by November 7, 2004 and promoting voluntary
fortification through the SPSP, signed into law on
November 7, 2000
● Department Memorandum No. 2011-0303
“Micronutrient powder supplementation for children
6-23 months”
● Micronutrient supplementation manual of operations
was developed to guide local, regional, and national
managers and implementers in providing good
quality micronutrient supplementation services to
targeted populations nationwide.
MENTAL HEALTH GAP ACTION PROGRAMME
mhGAP
● Is WHO’s action plan to scale up services for mental,
neurological, and substance use disorders for
countries, especially with low and lower middle
incomes
● The priority conditions addressed by mhGAP are:
depression, schizophrenia, and other psychotic
disorders, suicide, epilepsy, dementia, disorders due
to use of alcohol, disorders due to use of illicit drugs,
and mental disorders in children.
● The mhGAP package consists of interventions for
prevention and management for each of these
priority conditions.
13
 ● ACTIVE CASE FINDING - a health worker’s
NATIONAL TB PROGRAM (NTP)
purposive effort to find TB cases
● PASSIVE CASE FINDING - finding cases among TB
NTP Status of the outcome targets symptomatic who present themselves in a DOTS
facility
Indicators Target 2015 Status
accomplishment
POLICIES
Incidence Less than 322/100,000 Achieved
Rate the ● DSSM shall be the primary diagnostic tool in NTP
baseline case finding
● All TB symptomatics identifies shall be asked to
Mortality 23/ 13/100,000 Achieved undergo DSSM for diagnosis before start of the
Rate 100,000 treatment
● The only contraindication for DSSM is hemoptysis
Prevalence 414/ <414/100,000 Achieved
● Pulmonary TB symptomatics can only undergo other
Rate 100,000
diagnostic tests (such as cxr/culture) if necessary
Source: WHO Global TB Report, 2016
only after they have undergone DSSM with 3 sputum
specimens
VISION: GOAL: ● No TB diagnosis shall be made based on the results
A country where TB is no -Cure at least 85% of the of chest Xray examination alone. PPD result should
longer a public health new sputum smear not also be used as bases for TB diagnosis.
problem positive TB cases
discovered MANTOUX TEST
-Detect at least 70% of ≥ 5 mm
the estimated new sputum ● HIV positive
smear positive cases ● Recent contact with an active
TB patient
● Nodular or fibrotic changes on
OBJECTIVES chest X-ray
● Improvement of access to and quality of services ● Organ transplant
● Enhancement of patient’s health seeking behavior
≥ 10 mm
● Sustainability of support for TB control activities ● Recent arrivals (< 5 yrs) from
● Strengthening management of TB control services at high- prevalence countries
all levels ● IV drugs users
● Resident/employee of high-risk
congregate settings
CASEFINDING ● Mycobacteriology lab
personnel
● Is a method of identifying and diagnosing TB cases ● Comorbid conditions
among individuals suspected signs and symptoms of ● Children < 4 yrs old
TB. ● Infants, children, &
● Fundamental to case finding is the detection of adolescents exposed to high
infectious cases through DSSM risk categories
○ DSSM is the principal diagnostic method accepted
≥ 15 mm
by the NTP
● Persons with no known risk
■ Provides a definitive diagnosis of active TB factors for TB
■ The procedure is simple
■ It is economical, and
■ A microscopy center can be put up even in IDENTIFYING TB SYMPTOMATICS
remote areas
○ DSSM result serve as bases for categorizing TB ● Identify TB symptomatics consulting at the DOTS
symptomatics according to standard case definition facility
○ DSSM is used to: Signs and Symptoms:
■ Monitor progress of patients with sputum smear
● 6 Other symptoms:
positive TB while they are receiving anti TB
○ Motivate TB symptomatics to undergo DSSM
treatment, and
○ Record details of each specimen submission (name
■ Confirm cure at the end of treatment
of pt., date of submission, and result)

14
 ○ Encourage household members of identified TB
cases, who are also TB symptomatics to undergo
DSSM
COLLECTION AND TRANSPORT OF SPUTUM
SPECIMEN
● Submit three sputum specimen within 2 days. If
quality sputum is not collected within 2 days, the
patient is given 1 week to complete the three
specimen. If the patient fails to complete the three
specimen collection within one week, another three
set of three should be collected.
a. First spot specimen/on the spot - is collected at
the time of consultation or as soon as the TB
symptomatics is identified
b. Early Morning Specimen - first sputum produced
early in the morning immediately after waking up. It
is collected by the patient according to instructions
given by the DOTS facility staff.
Instructions on How to Produce Quality Sputum
● Rinse mouth with water
● Breathe deeply, hold breath, then exhale slowly.
Repeat the entire sequence twice
● Cough strongly at the height of deep inspiration after
inhaling deeply for the third time and spit the sputum
in the container
c. Third specimen or second spot specimen - is
collected when the TB symptomatics comes back to
the DOTS facility to submit the second specimen
INTERPRETATION OF SPUTUM RESULTS/
LABORATORY DIAGNOSIS
● Smear Positive - at least 2 positive sputum smear
results
● Doubtful - only 1 positive out of 3 sputum
specimens. ACTION TO TAKE: Request for another
set of 3 sputum specimens
Result:
1. If at least 1 specimen from the second set specimens
is positive = diagnosis is positive
2. If all 3 specimens from the second set of specimens
are negative = diagnosis is negative
○ NOTE: The specimen out of the smear (+) results
with highest number is the final AFB quantification
● Smear-Negative - all three sputum smear results are
negative
Decision on Pt’s Diagnosis Based on Lab Results:
1. If POSITIVE - refer to physician for assessment and
initiation of treatment
2. If DOUBTFUL - ask patient to submit another 3
sputum specimens within one week
3. If NEGATIVE - re-assess smear negative with
persistent symptoms, refer patient for CXR, if CXR
findings are suggestive of TB, refer to TBDC
CASE HOLDING
● Is the procedure which ensure that patients complete
their treatment
● The shortest duration of treatment is 6 months
● Treatment compliance is necessary to cure TB and
avoid development of drug resistance
○ OBJECTIVE: Effective and complete treatment of TB
cases, especially pulmonary sputum smear positive
cases
○ DIRECTLY OBSERVED TREATMENT - is a strategy
developed to ensure treatment compliance providing
constant and motivational supervision to TB patients
● DOT works by having a responsible person referred
to as TREATMENT PARTNER, watch the TB pt. Take
medicines everyday during the whole course of
treatment
● QUALIFIED TREATMENT PARTNERS
A. DOTS facility staff (midwife or nurse)
B. Trained community member (BHW, Local
government official, or former TB patient)
C. Family member
CLASSIFICATION OF TB
● Pulmonary TB
● Extra Pulmonary TB
Types of TB Cases
1. NEW - has never had treatment for TB or who has
taken anti TB drugs for less than one month
2. RELAPSE - previously treated for TB, declared cured
or treatment completed, and is diagnosed with
bacteriologically positive (smear or culture) TB
3. TREATMENT FAILURE - a patient who, while on
treatment, is sputum smear positive at five months or
later during the course of treatment
4. RETURN AFTER DEFAULT (RAD) - returns to
treatment with positive bacteriology following
interruption of treatment for 2 months or more
5. TRANSFER IN - transferred to another facility
adopting NTP policies with proper referral slip to
continue treatment
Two Formulations of Anti TB Drugs
● Fixed Dose Combination (FDC’s) - 2 or more first
line anti TB drugs are combined in one tablet
● Single Drug Formulation (SDF) - each drug is
prepared individually
15
 Category of Tuberculosis Regimen For Adults 4. FAIL
Intensive Phase Maintenanc
5. DEFAULT
Category Types of TB
patients e Phase 6. TRANSFERRED OUT`

I -New Smear HRZE (2 HR (4 TROPICAL DISEASE CONTROL PROGRAM

Positive months) months)
-New Smear
Negative Communicable & Non-communicable Diseases
-PTB with
extensive LEPROSY CONTROL PROGRAM
parenchymal
lesions on LEPROSY
chest xray ● Causative Agent: Mycobacterium Leprae/ Hansens
-Extra
bacillus
pulmonary TB
● Mode of Transmission: prolonged skin contact,
II -Treatment HRZES (2 HRE (5 droplet infection
Failure months) + HRZE months) ● Incubation Period: 5 ½ months - 5 years
-Relapse (1 month)
● Laboratory/ Diagnostic Test: Skin Slit test
-RAD

III -New Smear HRZE (2 HR (4 Early Signs:

negative months) months)
-PTB with ● Reddish or white change in skin color,
minimal ● Loss of sensation on the skin lesion,
parenchymal ● Decrease/loss of sweating and hair growth over the
lesions on
chest xray
lesion,
● Thickened and or painful nerves,
IV Chronic (still SECOND LINE ● Muscle weakness
smear positive GENERATION ● Pain or redness of the eye,
after ANTIBIOTICS
supervised BASED ON ● Nasal obstruction/bleeding,
treatment) RESULTS OF ● Ulcers that do not heal
CULTURE AND
SENSITIVITY Late Signs:
TEST
● Loss of eyebrow (madarosis)
Tuberculosis treatment for children ● Inability to close eyelids (lagopthalmos)
● Clawing of fingers and toes
TYPES OF TB INTENSIVE MAINTENANCE
● Contractures
PHASE PHASE
● Sinking of the nose bridge
Pulmonary TB HRZ (2 months) HR (4 months) ● Enlargement of the breast in males (gynecomastia)
● Chronic ulcers
Extrapulmonary HRZS (2 months) HR (10 months)
TB PREVENTION:

● BCG vaccination
ANTI TB DRUGS AND ITS MINOR ADVERSE ● Avoidance of prolonged skin to skin contact with
REACTIONS [RIPES] active untreated case
● Good Personal Hygiene
1. RIFAMPICIN - GI intolerance, orange colored urine, ● Adequate Nutrition
flu like symptoms, mild skin reaction ● Health Education
2. ISONIAZID - peripheral neuropathy, GI intolerance,
mild skin reactions Patient Classification of Leprosy:
3. PYRAZINAMIDE - hyperuricemia and mild skin
reactions 1. Paucibacillary (PB):
4. ETHAMBUTOL - optic neuritis ○ (-) Skin Slit test or 5 lesions or less
5. STREPTOMYCIN - ototoxicity, pain on the injection 2. Multibacillary (MB):
site ○ (+) Skin Slit test & more than 5 lesions

TREATMENT OUTCOME Treatment & Management of Leprosy:

1. CURED ● Multi-Drug Therapy

2. COMPLETE TREATMENT ○ Use of two (2) or more drugs such as:
3. DIED ■ Rifampicin
16
 ■ Clofazimine ● Say no to indiscriminate fogging
■ Dapsone ● Self protection
Benefits of Early Treatment:
SCHISTOSOMIASIS CONTROL PROGRAM
1. Cured within a shorter period
2. Will not be able to infect other susceptible members ● Causative Agent: Schistosoma japonicum, S.
of the household mansoni, S. Haematobium
3. Prevent the progress of skin lesions in the body. ● Vector: Oncomelania quadrasi (snail)
4. Prevent nerve damage leading to deformities. ● Mode of Transmission: Vehicle (water), Indirect
5. Prevent relapse & resistance to drugs. (skin pores)
● Incubation Period: 2 months
● Laboratory/ Diagnostic Test: Direct Stool exam
DENGUE CONTROL PROGRAM
1. COPT (Cercum Ova Precipetin Test)
DENGUE 2. Kato Katz Technique
● A viral infection characterized by sudden onset of
fever which would last for 2-7 days. Prevention & Control:
● Types of dengue: ● Treatment of cases
1. Dengue fever ● Environmental Sanitation
2. Dengue hemorrhagic fever ● Snail Control
3. Undifferentiated fever ● Health Education
● Carriers:
1) Aedes Aegypti – primary vector of the disease; MALARIA CONTROL PROGRAM
prefers to breed indoor in artificial container. (marsh fever, periodic fever, King of tropical dse)
2) Aedes Albopictus – most common in rural areas;
secondary vector of dengue ● Causative Agent: Protozoa genus Plasmodium
● Symptoms: Recurrent fever preceded by chills and
● Causative Agent: Dengue virus 1,2,3,4 and
profuse sweating (triad signs), Malaise, Anemia
Chikungunya virus
● Mode of Transmission: bite of female anopheles
● Vector: aedes aegypti, aedes albopictus
mosquito
● Mode of Transmission: Bite of mosquito (vector)
● Laboratory/ Diagnostic Examination:
● Incubation Period: 3-15 days
1. History of having been in a malaria-endemic area:
● Laboratory/ Diagnostic Exam:
Palawan & Mindoro
○ Rumpel Lead’s Test/Tourniquet Test - Presumptive
2. Blood smear
Test
3. Rapid Diagnostic Test (RDT)
○ Platelt Count - confirmatory test
○ Viral isolate antigen Activities/Strategies:
Classification: ● PROMOTIVE:
○ Community health education
● Grade I: Flu-like symptoms
○ Rash ● PREVENTIVE:
○ (+) Tourniquet Test ○ Treated mosquito nets
○ Indoor residual spraying
● Grade II: Manifestations of Grade I plus spontaneous
○ Seeding of streams
bleeding (Toxic Stage)
○ Clearing of streams
● Grade III: Manifestations of Grade II plus beginning ○ Other personal protection measures
signs of circulatory failure
● CURATIVE:
● Grade IV: Grade III plus shock ○ Early diagnosis & prompt treatment

New Classification of Dengue: ● SUPPORT MECHANISMS:

○ Surveillance
● Dengue with warning sign ○ Epidemiological Investigation
● Dengue without warning sign
● Severe dengue Treatment:

4S in Dengue Prevention: ● ORAL:

○ Chloroquine phosphate 250 mg - All species
● Search and Destroy breeding places of mosquito except P. malariae
● Seek immediate treatment ○ Sulfadoxine 50 mg - For resistant P. falciparum
17
 ○ Primaquine - For relapse P. vivax & ovale Strategies:
○ Pyrimethamine 25 mg/tab
1. Use of mosquito nets
○ Quinine Sulfate 300 mg/tab
2. Residual spraying
○ Tetracycline HCl 250 mg/cap
3. Screening of houses
○ Quinidine Sulfate 200 mg
4. Use of protective clothing among plantation workers.
● PARENTERAL: 5. Elimination of mosquito breeding places.
○ Quinine hydrochloride 300 mg/ml, 2ml 6. Mass Treatment
○ Quinidine glucolate 80 mg (50 mg) 1 vial

MALARIA PREVENTION AND CONTROL:

FAMILY HEALTH ASSESSMENT
1. Mosquito control
2. Chemical methods Steps in Family Nursing Assessment
3. Biological methods
4. Zooprophylaxis 1. Data Collection (for First Level Assessment)
5. Environmental methods
● Involves gathering of five types of data which will
6. Screening of houses
generate the categories of health conditions or
7. Educational methods
problems of the family. These data include:
8. Mechanical methods
1. Family Structure, characteristics and dynamics
9. Universal Precaution
2. Socio-Economic and cultural characteristics
10. Screening of blood donors
3. Home and Environment
4. Health Status of each member, and
FILARIASIS CONTROL PROGRAM 5. Values and Practices on health promotion/
maintenance and disease prevention
● Endemic in the Philippines (DOH, 2010).
● The WHO classification for endemicity is based on Methods of Data Collection
the elimination level of a microfilaria rate (MFR) of 1. Observation
less than one percent, and an antigen rate of less 2. Physical Examination
than one percent per Implementing Unit (IU). 3. Interview
● Out of 80 endemic provinces, 43 provinces have not 4. Record Review
reached the target level due to lack of awareness 5. Laboratory/Diagnostic Tests
and understanding about the disease and its
elimination. 2. Data Analysis
● Causative Agent: Wuchereria brancrofti, Burgia ● SUBSTEPS
malayi 1. Sort Data
● Vector: Aedes poicillus, Culex quiquefasciatus 2. Cluster/Group Related Data
● Laboratory/ Diagnostic Examination: Circulating 3. Distinguish Relevant from Irrelevant data
Filarial Antigen (CFA) - finger prick how and when is 4. Identify Patterns (functions, behavior, lifestyle)
this best done? 5. Compare Patterns with Norms or Standards
● Treatment: Diethylcarbamazine citrate (Hetrazan) 6. Interpret Results
● Prevention: Eradication of vectors 7. Make Inferences or Conclusions

GOAL: 3. Problem Definition or Nursing Diagnosis

● The goal of National Filariasis Elimination Program Levels of Assessment:
(NFEP) is to: 1. First Level Assessment - identifying potential and
○ Eliminate filariasis as a public health problem by existing health problems:
2015 with a prevalence rate of microfilaremia of ○ Presence of Wellness Condition
less than 1 percent. ○ Presence of Health Threat
○ Presence of Health Deficits
Signs and Symptoms:
○ Presence of Stress Points/Foreseeable Crisis
● Chills 2. Second Level Assessment - problems encountered
● Fever by the family in performing health tasks with the
● Myalgia given health condition or problem
● Lymphangitis with gradual thickening of the skin
(commonly affecting limbs, scrotum) resulting in
elephantiasis and hydrocele.

18
 FAMILY HEALTH TASK
Eight Family Tasks (Duvall & Niller)
1. Physical maintenance
● Provides food, shelter, clothing, and health care to
its members being certain that a family has ample
resources to provide
2. Socialization of Family
● Involves preparation of children to live in the
community and interact with people outside the
family.
3. Allocation of Resources
● Determines which family needs will be met and their
order of priority.
4. Maintenance of Order
● Task includes opening an effective means of
communication between family members,
integrating family values, and enforcing common
regulations for all family members.
5. Division of Labor
● Who will fulfill certain roles e.g., family provider,
home manager, children’s caregiver
6. Reproduction, Recruitment, and Release of family
member
7. Placement of members into larger society
● Consists of selecting community activities such as
church, school, politics that correlate with the family
beliefs and values
8. Maintenance of motivation and morale
● Created when members serve as support people
FAMILY HEALTH/COPING INDEX
Purpose:
● To provide a basis for estimating the nursing needs
of a particular family.
Health Care Need
A family health care need is present when:
1. The family has a health problem with which they are
unable to cope.
2. There is a reasonable likelihood that nursing will
make a difference in the family’s ability to cope.
Related to Coping Nursing Need:
COPING
● May be defined as dealing with problems associated
with health care with reasonable success
● When the family is unable to cope with one or
another aspect of health care, it may be said to have
a “coping deficit”
Nine Areas to be Assessed
1. Physical independence:
● This category is concerned with the ability to move
about to get out of bed, to take care of daily
grooming, walking, and other things which involves
the daily activities
2. Therapeutic Competence:
● This category includes all procedures or treatment
prescribed for the care of ill, such as giving
medication, dressings, exercise, and relaxation,
special diets
Scaling Cues:
● The following descriptive statements are “cues” to
help you as you rate family coping. They are limited
to three points –
○ 1 or no competence;
○ 3 for moderate competence; and
○ 5 for complete competence
3. Knowledge of Health Condition:
● This system is concerned with the particular health
condition that is the occasion of care
4. Application of the Principles of General Hygiene:
● This is concerned with the family action in relation
to maintaining family nutrition, securing adequate
rest and relaxation for family members, carrying out
accepted preventive measures, such a
immunization
5. Health Attitudes:
● This catergory is concerned with the way the family
feels about health care in general, including
preventive services, care of illness and public
health measures
6. Emotional Competence:
● This category has to do with the maturity and
integrity with which the members of the family are
able to meet the usual stresses and problems of
life, and to plan for happy and fruitful living.
7. Family Living:
● This category is concerned largely with the
interpersonal or group aspects of family life- how
well the members of the family get along with one
another, the ways in which they take decisions
affecting the family as a whole.
8. Physical Environment:
● This is concerned with the home, the community,
and the work environment as it affects family health.
9. Use of Community Facilities:
● Generally keeps appointments. Follows through
referrals. Tells others about Health Departments
services.
19
Direction for Scaling:
● Two parts of the Coping index:
1. A point on the scale
2. A justification statement
○ The scale enables you to place the family in relation
to their ability to cope with the nine areas of family
nursing at the time observed and as you would
expect it to be in 3 months or at the time of
discharge if nursing care were provided.
○ Coping capacity is rated from 1 (totally unable to
manage this aspect of family care) to 5 (able to
handle this aspect of care without help from
community sources)
○ The justification consists of brief statement or
phrases that explain why you have rated the family
as you have.
GENERAL CONSIDERATIONS
1. It is the coping capacity and not the underlying
problem that is being rated.
2. It is the family and not the individual that is being
rated.
3. Rating should be done after 2-3 home visits when the
nurse is more acquainted with the family.
4. Justification - a brief statement that explains why
you have rated the family as you have. These
statements should be expressed in terms of behavior
of observable facts.
5. Terminal rating is done at the end of the given
period of time. This enables the nurse to see
progress the family has made in their competence;
whether the prognosis was reasonable; and whether
the family needs further nursing service and where
emphasis should be placed.
Family Data Analysis
● Socio-Economic and Cultural Characteristics
● Home Environment
● Family Health Status
● Family Values and Health Practices
FAMILY NURSING DIAGNOSIS
Health Problem
● Is a situation or condition which interferes with the
promotion and/or maintenance of health and
recovery from illness or injury, and which is subject to
change/modification through nursing intervention.
Family Nursing Problem
● It is stated as the family’s failure to perform
adequately specific health tasks for a particular
health problem. This is called nursing diagnosis in
family nursing practice.
PLANNING
● The nursing care plan focuses on actions, which are
designed to solve or minimize existing problem.
○ The cores of the plan are the approaches,
strategies, activities, methods, and materials, which
the nurse hopes, will improve the problem.
● The nursing care plan is based upon identified health
and nursing problems.
● The nursing care plan is a means to an end, not an
end in itself.
○ The goal in planning is to deliver the most
appropriate care to the family by eliminating barriers
to the family health development
● The nursing care plan is a continuous process, not
a one-shot deal.
Four (4) Standard Steps:
● Prioritization - start if there are multiple identifies
problems
● Formulation of objectives - planning a procedure
will start here if there is only one problem
● Developing strategies of action
● Formulation of evaluation tools for the identified
strategy developed
Formulating Family Nursing Care Plan
PRIORITY SETTING
Prioritizing Health Problems
A. Nature of the Condition or Problem
● Wellness state, hx deficit, health threat and stress
point/ foreseeable crisis
● Factors Affecting Nature of the Problem:
○ The biggest weight is given to the wellness state or
potential because of the premium on client’s effort
or desire to sustain/maintain a high level of
wellness.
B. Modifiability of the Problem
● Probability of success in enhancing the wellness
state, improving condition, minimizing, alleviating, or
totally eradicating the problem through intervention.
● Factors in Determining Modifiability of the Problem:
20
 ○ Current knowledge, technology, and interventions
High 3
○ Resources of the family Moderate 2 1
○ Resources of the nurse Low 1
○ Resources of the community
4. Salience
C. Preventive Potential Scale:
- A condition or problem 2
● Nature or magnitude of the problem that can be
needing immediate
minimized or totally eradicated/prevented if attention
interventions are done on the condition or problem - A condition or problem 1 1
under consideration. not needing immediate
● Scoring Preventive Potential: attention
- Not perceived as a 0
○ Gravity or severity of the problem
problem or condition
○ Duration of the problem needing change
○ Current management
○ Exposure of high-risk groups D. Salience
● Factors Affecting Preventive Potential:
● Refers to the family’s perception and evaluation of
○ Gravity or severity of the problem – refers to the
the condition or problem in terms of seriousness and
progress of the disease/problem indicating the
urgency of attention needed or family readiness
extent of damage on the patient/family; also
indicated prognosis, reversibility or modifiability of
the problem. In general, the more severe the
Planning
problem, the lower the preventive potential of the
Establishing Goals and Objectives
problem.
Goals
○ Duration of the problem - refers to the length of
time the problem has existed. Generally speaking, ● General statement of the condition or state to be
the duration of the problem has a direct relationship brought about by specific course of actions
to gravity. Because of this relationship to gravity of ● Desired observable family response to planned
the problem, duration has also a direct relationship interventions in response to a mutually identified
to preventive potential. family need
○ Current management - refers to the presence and ● Ex: to improve nutrition status of the family
appropriateness of intervention measures instituted
Cardinal Principle in Goal Setting
to enhance the wellness state or remedy the
● Goal must be set jointly with the family
problem. The institution of appropriate intervention
● Ensures family commitment to realization
increases the condition’s preventive potential.
● Basic to the establishment of mutually acceptable
○ Exposure of any vulnerable or high-risk group -
goals is the family’s recognition and acceptance of
increases the preventive potential of condition or
existing health needs and problems.
problem
● Workable, well-stated objectives should be SMART:
Criteria Weight ○ Specific, Measurable, Attainable, Relevant,
Time-bound
1. Nature of the Condition
or Problem presented Barriers to Joint Setting of Goals
Scale:
1. Failure to perceive the problem
Wellness state 3
Health Deficit 3 1 2. Realized the problem but too busy at the moment
Health Threat 2 3. Do not see the problem as serious enough to be
Stress point/ Foreseeable 1 solved
Crisis 4. The problem that needs to take action:
a. Fear of the consequences
2. Modifiability of the b. Respect for tradition
Problem or Condition
c. Failure to perceive the benefits
Scale:
Easily modifiable 2 d. Failure to relate actions with family goal
Partially modifiable 1 2 5. Failure to develop working relationship from both
Not modifiable 0 nurses and family

Objectives
3. Preventive Potential
● Refers to a more specific statement of the desired
Scale:
result or outcomes of care
21
● The more specific the objective, the easier is the
evaluation of their attainment
● The desired step by step family responses as they
work toward a goal
INTERVENTIONS
● This is the capacity to provide management
● It is the professional phase of nursing process
● It is the time when the PHN executes the standard
function of an RN (promotive, preventive, curative,
rehabilitative)
Categories of Intervention
● PROMOTIVE
○ Enabling people to increase control over and
improve their health.
○ It involves the population as a whole in the context
of their everyday lives, rather than focusing on
people at risk for specific diseases, and is directed
toward action on the determinants or causes of
health.
There are four core service elements related to health
promotion:
1. Prevention of disease, injury, and illness;
2. health education, anticipatory guidance, and
parenting skill development;
3. support that builds confidence and is reassuring for
mothers, fathers, and carers; and
4. community capacity building.
● PREVENTIVE
○ Deals with the prevention of illness to decrease the
burden of disease and associated risk factors.
○ Focuses on preventing disease and illness and
promoting overall general health and well-being.
○ Nurses work to prevent risk factors for disease
through patient education.
○ They provide instruction on healthy diets,
immunizations, and exercise.
● CURATIVE
○ Is to cure a disease or promote recovery from an
illness, injury, or condition; involves treatment
intended to alleviate the symptoms or cure a current
medical condition.
○ It strives to reduce pain, improve function, and help
improve the quality of life for patients’ impairment.
● REHABILITATIVE
○ Nurses assist patients with temporary and
long-term disabilities or chronic illnesses.
○ They assist in adapting to their conditions, meeting
their highest potential, and living more independent
lives.
Three (3) Standard Functions of RN:
● Dependent - giving of medicines
● Independent - monitor, assess, provide, educate
● Interdependent - referrals
Categories of Nursing Interventions
(Freeman and Heinrich):
● Supplemental Interventions - actions that nurse
performs on behalf of the family when it is unable to
do things for itself (direct nursing care)
● Facilitative interventions - actions that remove
barriers to appropriate health action such as assisting
the family to avail of maternal and early child care
services.
● Developmental interventions - aim to improve the
capacity of the family to provide for its own health
needs such as guiding the family to make
responsible health decisions.
EVALUATION
● To evaluate is to determine or fix the value
○ Formative evaluation - judgment made about the
effectiveness of nursing interventions as they are
implemented.
,
○ Summative evaluation - determining the end results
of family nursing care and usually involves measuring
outcomes or the degree to which goals have been
achieved.
Three (3) Things to be evaluated: SPO
● Structure of program & activity - measure the
adequacy of articles, equipment, supplies, and
manpower utilized
● Process utilized - measures the adequacy of PHN’s
actions and activities
● Outcome of activity - measures the results of care
which can be:
○ Desirable - to be implemented, advocated,
strengthen
○ Undesirable - to be avoided
Aspects of Evaluation
● Effectiveness - determination of whether goals and
objectives were attained.
● Appropriateness - suitability of the goals/objectives
and interventions
● Adequacy - degree of sufficiency of goals/objectives
and interventions
● Efficiency - relationship of resources used to attain
the desired outcomes
22

Types of Family-Nurse Contact
● Clinic Visit
● Telephone Conference
● Written Communication
● School Visit
● Industrial or Job Site Visit
● Home Visit
● CLINIC VISIT
○ Takes place in private clinic health center, barangay
health station
○ Advantage - family member takes the initiative of
visiting the professional health worker, usually
indicating the family readiness to participate in the
health care process
○ Because the nurse has greater control over the
environment, distractions are lessened and the
family may feel less confident to discuss family
health concerns
○ The services may be a part of a hospital,
augmenting its inpatient services, or may be
provided at a free-standing facility
● TELEPHONE CONFERENCE
○ May be effective, efficient, and appropriate if the
objectives and outcomes of care require immediate
access to data, given problems on distance or
travel time.
○ Such data include monitoring of health status or
progress of an illness state, change in schedule of
visit or family decision, and updates on outcomes or
responses to care and treatment
● GROUP CONFERENCE
○ Involves the entire family and can be done at home,
clinic, school, or workplace.
○ It is useful in a situation where the family has a
chronic problem that is having a negative effect on
the entire family.
● WRITTEN COMMUNICATION
○ Less time-consuming given option for the nurse in
instances when there are a large number of families
needing follow-up on top of problems of distance or
travel time
○ Used to give specific information to families, such
as instructions given to parents through school
children
○ Usually in areas with no signal and telephone
● SCHOOL VISIT
○ It is done to work with family and school authorities
on how to appraise the degree of vulnerability of
and worked out interventions to help children and
adolescence on specific health risks, hazards, or
adjustment problems.
● INDUSTRIAL OR JOB SITE VISIT
○ It is done when the nurse and family need to make
an accurate assessment of health risks or hazards
with employer or supervisor on what can be done to
improve on provisions for health and safety of
workers.
● HOME VISIT
○ A professional, purposeful interaction that takes
place in the family’s residence aimed at promoting,
maintaining, and restoring the health of the family or
its members.
○ The services provided is an extension of the Health
Service Agency (Health Center)
○ The best opportunity to serve the actual care given
by family members.
PRINCIPLES OF HOME VISIT
● Must have a purpose or objective
○ Examples include
■ Assessment
■ Nursing care
■ Treatment
■ Health education
■ Referral (if care fails)
● Must use every available information about the
patient and his family through family records
● Priority should focus on the essential needs of the
individual and his family
● Should involve the individual and family
● Plan should be flexible
● Planning continuing care should involve a
responsible family member
ADVANTAGES OF HOME VISIT
● It allows first-hand assessment of the home
situation.
● The nurse is able to seek out previously unidentified
needs.
● It gives the nurse an opportunity to adapt
interventions according to family resources.
● It promotes family participation and focuses on the
family as a unit.
● Teaching family members in the home is made easier
by the familiar environment and the recognition of the
need to learn as they are faced by the actual home
situation.
● The personalized nature of home visit gives family a
sense of confidence in themselves and in the
agency
DISADVANTAGES OF HOME VISIT
● The cost in terms of time and effort.
● There are more distractions because the nurse is
unable to control the environment.
● Nurse’s safety
23
Priority Patients for Home Visit
● Newborn
● Post-partum
● Pregnant mothers
● Morbid cases
PHASES OF HOME VISIT
● Pre-visit phase (Planning Phase)
○ Nurse contacts the family, determines the
willingness for a home visit, and sets an
appointment with them
○ A plan for the home visit is formulated during this
phase.
○ Starts at the health center
○ Makes a study on the status of the family
○ Statement of the problem
○ Formulation of objective
● In-home phase
○ Begins as the nurse seeks permission to enter and
lasts until he or she leaves the family’s home. It
consists of initiation, implementation, and
termination.
○ Initiation (Socialization)
■ First activity is to establish rapport and to gain the
trust of the family
■ It is customary to knock or ring the doorbell and at
the same time, in a reasonably loud but
nonthreatening voice say, “Tao po. Si Nurse Regie
po ito, nurse po sa health center?”
■ On entering the home, the nurse acknowledges
the family members with a greeting and
introduces himself and the agency he represents.
■ Observes the environment for his own safety and
sits as the family directs him to sit.
■ Establish rapport by initiating a short conversation
■ States the purpose of the visit the source of
information
○ Implementation (Activity)
■ Intervention/Professional Phase
■ Involves the application of the nursing process,
assessment, provision of direct nursing care as
needed, and evaluation
■ Opportunity to provide or extend health services
■ Standard Role of the Nurse: Independent,
Dependent, and Interdependent
■ To be effective, come in complete uniform (also
bring a long umbrella with pointed end which
serves as protection)
○ Termination (Summarization)
■ Consists of summarizing with the family the
events during the home visit and setting a
subsequent home visit or another form of
family-nurse contact
■ Use this time to record findings, such as vital
signs of family members and body weight
● Post-visit phase
○ Takes place when the nurse has returned to the
health facility.
○ Involves documentation of the visit.
● PUBLIC HEALTH BAG (PHN Bag)
○ Frequently called the PHN bag is an indispensable
tool that should be organized to save time & effort
and to prevent cross infection & contamination
○ Serves as a reminder of the need for hand hygiene
and other measures to prevent the spread of
infection,
○ Nursing bag usually has the ff. contents:
■ Articles for infection control
■ Articles for assessment of family members
■ Note that the stethoscope and
sphygmomanometer are carried separately
■ Articles for nursing care
■ Sterile items
■ Clean articles
■ Pieces of paper
● BAG TECHNIQUE
○ A tool making use of public health bag through
which the nurse, during his/her home visit, can
perform nursing procedures with ease and
deftness, saving time and effort with the end in view
of rendering effective nursing care.
○ Performed before and after handling a client in the
home to prevent transmission of infection to and
from the client
○ Helps the nurse in infection control
○ Allows the nurse to give care efficiently
○ Saves time and effort by ensuring that the articles
needed for nursing care are available
○ Should not take away the nurse’s focus on the
patient and the family
○ May be performed in different ways, principles of
asepsis are of the essence and should be
practiced at all times
FOR INFECTION CONTROL these activities should be
practiced during home visits:
● Remember to proceed from “clean” to “contaminated”
● The bag and its contents should be well protected
from contact with any article in the patient’s home
○ Contents should be prepared by the one who will
make the home visit
○ Note: BP apparatus is kept separately from PHN
bag
● Line the table/flat surface with paper/washable
protector on which the bag and all of the articles to
be used are placed.
○ The inner part of the bag should be clean and
sterile
● Wash your hands before and after physical
assessment and physical care of each family
member.
24
● Bring out only the articles needed.
○ The less one opens the bag, the lesser chance of
contamination
○ In general, the bag is open 3x:
■ Putting out materials for handwashing
■ Putting out materials used for nursing care
■ Returning all what have been used
● Do not put any of the family’s articles on your paper
lining/washable protector
● Wash your articles before putting them into your bag
● Confine the contaminated surface by folding the
contaminated side inward
● Wash the inner cloth lining of the bag as necessary
● 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
FAMILY NURSING CARE PLAN
● The blueprint of the care that the nurse designs to
systematically minimize or eliminate the identified
health and family nursing problems through explicitly
formulated outcomes of care (goals and objectives)
and deliberately chosen of intervention, resources
and evaluation criteria, standards, methods and tools
Desirable Qualities of a Family Nursing Care Plan
1. It should be based on clear, explicit definition of the
problems. A good nursing plan is based on a
comprehensive analysis of the problem situation
2. A good plan is realistic
3. The nursing care plan is prepared jointly with the
family. The nurse involves the family in determining
health needs and problems, in establishing priorities,
in selecting appropriate courses of action,
implementing them and evaluating outcomes.
4. The nursing care plan is most useful in written form
Interprofessional Care in the Community
● Interprofessional Practice (IPP)
○ Is a collaborative practice which occurs when
healthcare providers work with people from within
their own profession, with people outside their
profession, and with patients and their families.
■ Rural Health Unit Personnel
■ Local Government Units
■ Government Organizations
● Department of Social Welfare and Development
(DSWD)
○ is the primary government agency mandated to
develop, implement, and coordinate social
protection and poverty-reduction solutions for and
with the poor, vulnerable, and disadvantaged.
○ The following agencies are attached to the DSWD:
■ Council for the Welfare of Children
■ Inter-Country Adoption Board
■ National Youth Commission
■ National Council on Disability Affairs
● Nutritional Council
○ National Nutrition Council Core Functions:
1. Formulate national food and nutrition policies and
strategies and serve as the policy, coordinating
and advisory body of food, nutrition, and health
concerns
2. Coordinate planning, monitoring, and evaluation
of the national nutrition program
3. Coordinate the hunger mitigation and malnutrition
prevention program to achieve Millineum
Development Goals;
4. Strengthen competencies and capabilities of
stakeholders through public education, capacity
building, and skills development
5. Coordinate the release of funds, loans, and grants
from government organizations (GO’s) and
non-government organizations (NGO’s); and
6. Call on any department, bureau, office, agency,
and other instrumentalities of the government for
assistance in the form of personnel, facilities, and
resources as the need arises.
● Population Commission
○ The Commission on Population (POPCOM) is a
government agency mandated as the overall
coordinating, monitoring, and policy-making body of
the population program.
○ It is the lead agency promoting population
activities
○ They are the ones who do survey on families
○ They determine the number of children, pregnant,
etc. in the community
● Non-government Organization
○ Socio-Civic Organizations
■ A nonprofit organization or corporation that is
operated exclusively for the promotion of social
welfare
○ Religious Organizations
○ Schools
25

FAMILY COPING INDEX
Nine Areas to be Assessed
I. Physical Independence: This category is
concerned with the ability to move about to get out
of bed, to take care of daily grooming, walking and
other things which involves the daily activities
● NOTE: it is the family competence that is
measured even though an individual is
dependent, if the family is able to compensate
for this, the family may be independent.
★ QUALITY AND QUANTITY OF CARE IS
IMPORTANT:
○ If the focus of care is poor
○ If the mother is giving care to a handicapped child
that he could give himself
○ If a person is giving care that should be shared with
other members
■ The independence might be considered
incomplete
★ THE AREAS OF DEPENDENCE MAY VARY AND
MAY BE DUE TO:
○ Actual physical incapacity
○ The inability or “KNOW HOW” to, unwillingness; or
○ Fear of doing the necessary tasks
★ FAMILY FAILING ENTIRELY TO PROVIDE
REQUIRED PERSONAL CARE TO ONE OR MORE
OF ITS MEMBERS:
Examples:
○ Arthritic pt. unable to get out of bed alone, no one is
available to help
○ Pt. cannot give his hypodermic medication because
of fear
★ FAMILY PROVIDING PARTIALLY FOR NEEDS OF
ITS MEMBERS, OR PROVIDING CARE FOR SOME
MEMBERS BUT NOT FOR OTHERS
Examples:
○ Mother may be doing well with own and husband’s
care but failing to give daily care efficiently to
newborn care
★ ALL FAMILY MEMBERS, WHETHER OR NOT
THERE IS INFIRMITY OR DISABILITY IN ONE OR
MORE OF ITS MEMBERS
○ Receiving the necessary care to maintain
cleanliness, including skin care
○ Able to get about as far as possible within their
physical abilities
○ Receiving assistance when needed without
interruption or undue delay
II. Therapeutic Competence: This category includes
all the procedures or treatments prescribed for the
care of ill, such as giving medication, dressings,
exercise and relaxation, and special diets.
★ FAMILY NOT CARRYING OUT PROCEDURE
PRESCRIBED OR DOING IT UNSAFELY
Examples:
○ Giving out several medications without being able
to distinguish one from the other, or taking them
inappropriately, applying braces so they throw the
limb out of line, measuring insulin incorrectly
○ Family resents, rejects or refuses to give the
necessary care
★ FAMILY CARRYING OUT SOME BUT NOT ALL OF
THE TREATMENTS
○ Giving insulin but not adhering strictly to diet
○ Giving medication correctly, but not understanding
purposes of the drug or symptom to be observed.
★ FAMILY ABLE TO DEMONSTRATE THAT THE
MEMBERS CAN CARRY OUT THE PRESCRIBED
PROCEDURES SAFELY AND EFFICIENTLY, WITH
AN UNDERSTANDING OF THE PRINCIPLES
INVOLVED AND A CONFIDENT AND WILLING
ATTITUDE
III. Knowledge of Health Condition: This system is
concerned with the particular health condition that is
the occasion of care
● Knowledge of the disease or inability to
understand communicability of disease and
modes of transmission
● Understanding of the general development of a
newborn baby, and the basic needs of infants for
physical care or tending loving care
★ TOTALLY UNINFORMED OR MISINFORMED
ABOUT THE CONDITION
Examples:
○ Believes tuberculosis is caused by a sin
○ Believes stroke patient must be bedridden, and that
is cruel to make them do something for themselves
○ Overweight in the school age is “healthy”
★ HAS SOME GENERAL KNOWLEDGE OF THE
DISEASE OR CONDITION, BUT HAS NOT
GRASPED THE UNDERLYING PRINCIPLES, OR IS
PARTIALLY INFORMED
○ May understand dietary and insulin control of
diabetes, but not the need for special care of the
feet, etc.
★ KNOWS THE SALIENT FACTS ABOUT THE
DISEASE WELL ENOUGH TO TAKE NECESSARY
ACTION AT THE PROPER TIME, UNDERSTANDS
THE RATIONALE OF CARE, ABLE TO OBSERVE
AND REPORT SIGNIFICANT SYMPTOMS
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IV. Application of the Principles of General
Hygiene: This is concerned with the family action in
relation to maintaining family nutrition, securing
adequate rest and relaxation for family members,
carrying out accepted preventive measures, such
as
● Immunization, medical appraisal, safe
homemaking habits in relation to storing and
preparing food
★ FAMILY DIET GROSSLY INADEQUATE OR
UNBALANCED, NECESSARY IMMUNIZATION NOT
SECURED FOR CHILDREN
○ House dirty, food handled unsanitary
○ Members of family working beyond reasonable
limits
○ Children and adults getting too little sleep
○ Family members unkempt, filthy
○ Inadequately clothed in relation weather
★ FAILING TO APPLY SOME PRINCIPLES OF
GENERAL HYGIENE - FOR INSTANCE
○ Keeping the house in excellent condition but
expending too much energy and becoming over
fatigue as a result
○ Secured initial immunization
★ HOUSEHOLD RUN SMOOTHLY, FAMILY MEALS
WELL SELECTED; HABITS OF SLEEP AND REST
ADEQUATE TO NEEDS
V. Health Attitudes: This category is concerned with
the way the family feels about health care in
general, including preventive services, care of
illness, and public health measures.
★ FAMILY RESENTS AND RESISTS ALL HEALTH
CARE HAS NO CONFIDENCE IN DOCTORS
○ Uses patent medicines, and quack nostrums
○ Feels illness is unavoidable and to be borne rather
than treated
○ Feels community health agencies should not
interfere or bother term
○ Practice folk medicine or superstitious rites of
illness
★ ACCEPTS HEALTH CARE IN SOME DEGREE, BUT
WITH RESERVATIONS
○ May have confidence in doctors generally but not in
the or in “FREE” doctors
○ May feel certain illnesses are hopeless (cancer), or
care unnecessary
○ Accept need for medical care for illness, but not
general preventive measures
★ UNDERSTANDS AND RECOGNIZES NEED FOR
MEDICAL CARE IN ILLNESS AND FOR THE
USUAL PREVENTIVE SERVICES
○ Arranges for periodic appraisal and follows
recommendations
○ Accepts illness calmly and recognizes the limits it
imposes while doing all possible to effect recovery
and rehabilitation.
VI. Emotional Competence: This category has to do
with the maturity and integrity with which the
members of the family are able to meet the usual
stresses and problems of life, and to plan for happy
and fruitful living.
● The degree to which the individual accepts the
necessary disciplines imposed by one’s family
and culture
● The development and maintenance of individual
responsibility and decision
● Willingness to meet responsibility and decision
● Willingness to meet reasonable obligations,
accept adversity with fortitude, to consider the
needs of others as well as one’s own
★ FAMILIES DOES NOT FACE REALITIES
★ ONE OR MORE MEMBER LACKING IN ANY
EMOTIONAL CONTROL-UNCONTROLLABLE
RAGES
★ IRRESPONSIBLE SEXUAL ACTIVITIES
★ ONE OR MORE MEMBERS ARE ALCOHOLIC
★ FAMILY TORN, SUSPICIOUS OF ONE ANOTHER
★ EVIDENCE OF GREAT INSECURITY, GUILT OR
ANXIETY
★ FAMILY MEMBERS USUALLY DO FAIRLY WELL,
BUT ONE OR MORE MEMBERS EVIDENCE LACK
OF SECURITY OR MATURITY
○ Thumbsucking in late childhood
○ Unusual concern with what the neighbors will think
○ Failure to plan ahead for foreseeable crisis
○ Leaving children unattended
○ Fighting in the family on occasion
★ ALL MEMBERS OF THE FAMILY ABLE TO
MAINTAIN A REASONABLE DEGREE OF
EMOTIONAL CALMNESS, FACE UP TO ILLNESS
REALISTICALLY AND HOPEFULLY
○ Able to discuss problems and differences with
objectivity and reasonable emotional control
VII. Family Living: This category is concerned largely
with the interpersonal or group aspects of family life
● How well the members of the family get along with
one another, and the ways in which they take
decisions affecting the family as a whole.
● Degree to which they support one another and do
things as a family
● Degree of respect and affection they show for one
another
● Ways to manage the family budget
● Kind of discipline that prevails
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 ★ FAMILY CONSIST OF A GROUP OF INDIVIDUALS ★ USES THE FACILITIES THEY NEED
INDIFFERENT OR HOSTILE TO ONE ANOTHER, APPROPRIATELY AND PROMPTLY
SO STRONGLY DOMINATED AND CONTROLLED
BY A SINGLE FAMILY MEMBER
Areas Admis Justification Discharged Justification
sison score
★ FAMILY GETS ALONG BUT HAS HABITS OR score
CUSTOMS THAT INTERFERES WITH THE UNITY
OF FAMILY Physical 5 All the family 5 All family
Independence members are remain
○ Parents expectations on their children are able to independent
sometimes unrealistic perform their from each
activities of other in
○ Children somewhat overprotected daily living doing their
properly and activities of
★ FAMILY DOES THINGS TOGETHER, EACH independently daily living
MEMBER ACTS FOR THE GOOD OF THE FAMILY appropriately
on time
AS A WHOLE
○ Children respect parents and vice versa

VIII. Physical Environment: This is concerned with the IMCI

home, the community, and the work environment as
it affects family health.
● The condition of the house such as:
○ Presence of accident hazards, screening,
plumbing system, facilities for cooking and
privacy
○ Level of community (deteriorated neighborhood),
transportation, conditions of school and
availability
● House in poor condition - unsafe, unscreened;
● Neighborhood deteriorated - juvenile and adult
delinquency
● No recreational space except streets
● House needs some repair or painting but
fundamentally sound;
● Neighborhood poor but possible to protect
children from poor social influence through
education and other community activities
● House in good repair; provides for privacy and is
free of accidents and pest hazards, free from
undesirable social elements
IX. Use of Community Facilities: This has to do with
the degree of family use and awareness of the
available community facilities for health, education,
and welfare. This includes the ways in which they
would use services of private physicians, clinics,
hospitals, schools, welfare organizations, and so
forth
★ FAMILY HAS OBVIOUS AND SERIOUS SOCIAL
NEEDS BUT HAS NOT SOUGHT OR FOUND ANY
HELP
○ A family may be borrowing unreasonable sums of
money for medical care, instead of availing of the
free hospitals or clinics
★ FAMILY IS AWARE OF AND USES SOME, BUT
NOT ALL, OF THE AVAILABLE COMMUNITY
RESOURCES THAT THEY NEED
● Integrated approach to child health that focuses on
the well-being of the whole child
● IMCI aims to reduce death, illness and disability, and
to promote improved growth and development
among children under five years of age
● Includes both preventive and curative that are
implemented by the families and communities as well
as health facilities
○ 1995 IMCI was developed WHO-UNICEF to all
developing countries
○ 1997 IMCI was brought to the philippines thru the
DOH
○ 2001 integration of IMCI to nursing and midwifery
curriculum (attended by the academe from different
nursing and midwifery school)
Reasons for Developing IMCI
● Curative care
● Aspect of Nutrition
● Immunization
● Disease prevention
● Health Promotion
Important Elements for Improving Child Health
● Improve case management of sick children
● Improve nutrition
● Ensure immunization
● Prevent injuries
● Prevent other disease
● Improve psychosocial support and stimulation
Who are the children covered by the IMCI protocol?
1. Sick children birth up to 2 months (sick young infant)
2. Sick children 2 months up to 5 years old (sick child)

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Steps in the IMCI Case Management Process

1. Assess the child’s illness

2. Classify the illness based on signs
3. Identify the treatment
4. Treat the child
5. Counsel the mother
6. Follow-up

General Danger Signs

● Not able to drink or breastfeed
● Vomits everything
● Convulsions
● Lethargic or unconscious
● Convulsing now

Main Symptoms
● Cough or difficult breathing
● Fever
● Diarrhea
● Ear problems

RA 4073
ACT LIBERAlIZING THE TREATMENT OF LEPROSY

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