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MATERNAL AND CHILD HEALTH (MCH) PROGRAMS
Key Points and need to
remember
Goals
4 Prenatal visit
2 Test
The 5 TT
Vitamins
Newborn Screening
R.A
Goals
• To ensure that expectant mother and nursing
mother maintain good health, learn the art of
child care, has a normal delivery and bear healthy
children
• That every child lives and grows up in a family unit
with love and security, in healthy surroundings,
receives adequate nourishment, health
supervision and efficient medical attention and
taught the elements of healthy living
Classification of pregnant women
• Normal - healthy pregnancy
• With mild complications- frequent home visits
• With serious or potentially serious complication
referred to most skilled source of medical and
hospital care
Home Based Mother's Record (HBMR)
• Tool used when rendering prenatal care
containing risk factors and danger
• Nakalagy dito yung mga info about mother
• Hinihingian din yung mother na number na 5
pwedeng mag donate ng dugo (blood donor) kung
sakali na may excessively hemorrhage.
Risk Factors
• 145 cm tall (4 ft & 9 inches) (Size of pelvis, CPD)
• Below 18 yrs. old, above 35 yrs. old
(Teenage more bleeding)
• Have had 4 pregnancies (Multiparous,
yung uterus mo na stretch na nagiging risk
na sya)
• With TB, goiter, heart disease, DM,
bronchial asthma, severe anemia.
• Last baby born was less than 2 years ago
• Previous cesarian section delivery
• History of 2 or more abortions, difficult delivery,
given birth to twins, 2 or more babies born before
EDD, stillbirth
• Weighs less than 45 kgs (kasama na yung baby
dito). or more than 80 kgs.
Legal Bases of Maternal Health Programs
• Dapat suportado ng batas.
RA 10354
• The Responsible Parenthood and Reproductive
Health Act of 2012
• Tinuturuan yung nanay at tatay sa family
plannging yung spacing etc.
P.D. No. 965
• Requires applicants for marriage license to
receive instructions on family planning and
responsible parenthood.
Strategic Thrusts
• BEMONC(Basic Emergency Maternal Obstetric
and Neonatal Care)
o Dapat traine sila kung paano mag paanak.
• Entails the establishment of facilities that provide
emergency obstetric care for every 125,000
population and which are located strategically.
• The strategy calls for families and communities to
plan for childbirth and the upgrading of technical
capabilities of local health providers
BEMONC Signal Functions
Signal Functions - are life-saving procedures
available in maternal facilities which include:
• 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
o Magnesium sulfate best drug of choice
to prevent pre-eclampsia
• Assisted delivery during imminent breech
delivery Manual removal of placenta (active
management of 3rd stage of labor)
• Removal of retained placental products
• Intravenous fluid administration, blood volume
expander and/or and blood transfusion
• Administration of loading dose of corticosteroids
for. threatened pre-mature delivery
• Newborn resuscitation with Oxygen support
(CPR)
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CEMONC (Comprehensive Emergency Maternal
Obstetric and NeonatalCare)
• Usually, mga OB na to
• Signal functions under BEMONC plus the
following
• Operative delivery (C section)
• Blood Transfusion services
• Advanced life support management for low
birth weight, premature and sick newborn like
sepsis, asphyxia, severe birth trauma, severe
jaundice etc.

Four (4) Prenatal visits

o 1st - as early as pregnancy, 1st trimester
(Nung nalaman mo na buntis ka mag pa
check-up ka agad!)
o 2nd 2nd trimester
o At least 2 visits - 3rd trimester
o More frequent visits for those at risk with
complications
o FHSIS record to sa RHU/laying in kung
nakailang beses nag pa check yung
mother.
• Responsible parenthood and provision of
appropriate health package to women of
reproductive age 18-35 years.
LABORATORY EXAMINATION
• Benedict's Test (Para sa diabetes, malalaman
natin dito kung diabetic ang isang tao. Yung
specimen ay urine)
• Acetic Acid Test (Proteinuria)
Acetic Acid Test
• Test for albumin in urine; test for Pregnancy- Induced
Hypertension (PIH)
• Collect urine in test tube, heat it in burner then add 3-
5gtts of acetic solution (clear white).
o We use acetic acid
o Dito unang ilalagay sa test tube yung urine tas
I heat ito then add ng 3-5 drops ng urine.
Then observe mo yung pag iba ng kulay nya
kung magiging cloudy ba (See the picture
below)
• Observe for change in color:

Benedict's Test
• Test for sugar in the urine; test for diabetes
• Heat test tube with 5cc of Benedict's Solution (blue)
in the burner then add 3-5gtts of urine (amber yellow)
then heat again.
o Sa test tube unang nilalagay ay 5ml ng TETANUS TOXIOD IMMUNIZATION SCHEDULE FOR
benedict solution tapos I heat yun tapos mag WOMEN
add ka ng 3 drops ng ihi then observe mo na • Pag di
kung mag iiba yung kulay. • Dose: 0.5ml
o Yung blue na benedict solution mag babago • Route: Intramuscular
ng kulay ibigsabihin may diabetes (See the • Site: Right or Left Deltoid/Buttocks
picture below :<)
• Observe for the change in color:
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• Yung bata and mother ang nag receive ng Vitamin

A
• TT1 as soon possible pag kalamn mo na buntis ka
• Pinapatak ito sa bunganga.
mag pa TT1 di ka pa protected dito ha.
• TT2 pag ka recive po ng TT1 after 4-week balik ka
para sa TT2 80% protected dito and tumatagal to
ng 3 years.
• TT3 pag tapos mo ma receive TT2 balik ka after 6
months para sa TT3. 90% protected ka tapos
tumatagal to ng 5years.
• TT4 pag tapos mo ma recive ang TT3 balik ka after
1 year para sa TT4 99% protected ka dito and
tumatagal to ng 5 years.
• TT5 pag tapos mo ma recive ang TT4 balik after 1
year para sa TT5 tapos 99% protected ka and pang • Pag mga preschooler red or yellow (2 drops)
life time nato. (Yeheyyy) • Infant color blue (Kalahati, 1 drops).
MICRONUTRIENT SUPPLEMENTATIONS • Ang mga buntis ay di pwedeng bigyan ng
• Micronutrient Malnutrition -available in small VITAMIN A
amount in the body .
• Vitamin A Deficiency (Good for the eye) Iron deficiency
Xeropthalmia-opacity ofcornea leading to night
blindness, observe for conjunctival xerosis
(dryness of the conjunctiva)

• Garantisadong Pambata - campaign for various
DOH programs for 0-14y/o including Vitamin A
o Magpasuso, Magpabakuna,
Magbitamina A, Magpurga, Gumamit
ng palikuran, Maghugas ng kamay,
Magsipilyo
• Usually, diba sa conjunctiva natin titigan kung
maputla yung person (anemic). Sa bata makikita
mo sa kamay ilagay mo lang to sa palad mo then
observe for pallor.
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Iodine Supplement (Endemic in Uphill)
o Madalas to sa mga nakatira sa bundok
kasi kulang sila sa Iodine malayo sila sa
dagat wala silang source ng mga
seafoods. Seafood po ang best source ng
Iodine po
• Generally addressed by salt iodization
• RA 8172 (Asin Law): Fidel Salt (Fortification of
lodine Deficiency Elimination) Degree of Protein Energy Malnutrion or PEM
• Iodized Salt – “Patak sa Asin” by Secretary Flavier
on December 1-5, 2003 where DOH workers go
to market check if salt sold contains iodine by
placing few drops of reagent:
• salt color turns to blue violet- fortified with iodine
• If salt color shows no change→ not fortified with
iodine
• Mahalaga sa mga mother na may Iodine kasi pag
wala neto maari mapektohan si baby (Mental FOOD PRODUCTION
retardation-intelligence) • Fortification - products without any nutrient are added
with nutrients
• R.A. 8976 mandates (MANDATORY) fortification of
rice, wheat flour, sugar and cooking oil with Vitamin
A, iron and/or iodine.
• For a child < 5 years old, empty contents of
• RA 832 (Rice Fortification). FVR (Fortified Vitamin
capsule in a cup with warm water because he
Rice) by Secretary Flavier under FVR, Erap Rice under
can’t tolerate it
Erap, Gloria Rice or "Bigas ni Gloria" under PGMA
• Adverse Effect of iodine Deficiency Disease that
must be avoided:
o Mental retardation-intelligence quotient:
idiot, moron & imbecile
o Growth retardation- cretinism (pedia) &
dwarfism (adult)
MACRONUTRIENT MALNUTRITION
EXPANDED NEWBORN SCREENING
• Macronutrients – available in large amount in the body
• Newborn Screening (NBS) is a simple procedure to
(Protein Energy Malnutrition or PEM)
find out if the baby has a congenital disorder that may
• Common Deficiencies
lead to mental retardation or even death if left
o Kwashiorkor – protein deficiency
untreated. (Required to)
o Marasmus – carbohydrate deficiency (energy
• Legal Basis
giving food)
o Republic Act no. 9288 (aka Newborn
Screening Act of 2004)
o Article 3 Section 5 - Obligation to inform
o Article 3 Section 6 - Performance of NBS
o Article 3 Section 7 - Refusal to be tested
(Basta I educate mo kung ano benefit ng NBS
then dapat naka document to)
How NBS is done?
1. Screening is done within 48 hours or at least 24
hours from birth but not later than 3 days after
complete delivery. A newborn placed in intensive care
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may be exempted from the 3- day requirement but
must be tested by 7 days of age.
2. A few drops of blood is drawn from pricking the
baby's heel.
3. Then it is blotched on a special absorbent card and
dried for at least 4 hours.
4. The procedure may be done by the physician, nurse,
midwife, or medical technologist.
5. If a screening test suggests a problem, the baby's
doctor will follow up with further testing. If those
tests confirm a problem, the doctor may refer the
baby to a specialist for treatment. Following doctor's
treatment plan can save the baby from lifelong health-
related and developmental problems.
Heel Prick Method
1. Prepare the materials
2. Warm the baby's heel.
3. Clean the puncture site
4. Dry the puncture site
5. Prick the heel.
Site: DO NOT PUNCTURE:
1. Wipe the first drop of blood.
2. Apply intermittent pressure to the area
surrounding the puncture site.
3. Place the blood onto the filer card.
4. Dry the samples.
EXPANDED NEWBORN SCREENING
DOH is the lead agency
• "Expanded Newborn Screening (NBS)" is now
being promoted which aimed to increase the
screening panel of disorders from six to 28 as
introduced by the Department of Health (DOH).
• If you are a Philhealth member, and opt to have
your baby undergo expanded newborn screening,
you will pay the remaining cost which is P950.
Anu ano ang mga kondisyon screening test? na
sinusuri sa newborn?
Congenital Adrenal Hyperplasia (CAH)
• Ang CAH ay isang kondisyon na nagdudulot
ng kawalan ng asin sa katawan, pagkatuyot at
mataas na antas ng male sex hormones sa
mga babae at lalaki. Kung di agad masuri at di
mabigyan ng angkop na gamot, ang sanggol
na may CAH ay maaaring mamatay sa loob ng
7-14 araw mula ng ipinanganak.
Congenital Hypothyroidism (CH)
• Ang CH ay resulta ng kakulangan o kawalan
ng Thyroid Hormone na mahalaga sa pisikal
at mental na paglaki ng bata. Kung sa loob ng
2 linggo ay di kaagad masuri at di ma- bigyan
ng hormone ang batang may CH, maari syang
maging bansot at magkaroon ng mental
retardation.
Galactosemia
• Ang GAL ay isang kondisyon kung saan ang
sanggol ay di makapagproseso ng galactose
o isang uri ng asukal na makikita sa gatas.
Ang pagdami ng galactose sa katawan ng tao
ay makapagdudulot ng maraming problema
tulad ng pagkasira ng atay at utak, at
pagkakaroon ng katarata sa murang edad.
Glucose-6-phosphate-Dehydroge- nase Deficiency
(G6PD Deficiency)
• Ang katawan ay kulang sa enzyme na G6PD.
Ang mga sanggol na kulang sa G6PD ay
maaring magka- roon ng Hemolytic Anemia
na na- kukuha sa pagkalantad sa oxidative
substances na matatagpuan sa mga gamot,
kemikal at pagkain.
Maple Syrup Urine Disease
• Ang MSUD ay isang genetic metabolic
disorder na resulta ng abnormal na gawain ng
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enzyme branched-chain alpha-keto acid
dehydrogenase (BKCD). Ang pagdami ng
BKCD ay maaaring magdulot ng matinding
sakit sa utak na maaaring humantong sa
pagkamatay.
Phenylketonuria (PKU)
• Ang PKU ay isang kondisyon kung saan ang
sanggol ay walang kakaya- hang iproseso ang
phenylalanine, isang importanteng sangkap
sa paggawa ng protina sa katawan. Ang
sobrang pagdami ng phenylala- nine sa
katawan ay nakakapagdulot ng mental
retardation.
DOH is the lead agency
• Expanded Newborn Screening (NBS)" is now
being promoted which aimed to increase the
screening panel of disorders from six to 28 as
introduced by the Department of Health
(DOH).
• If you are a Philhealth member, and opt to
have your baby undergo expanded newborn
screening, you will pay the remaining cost
which is P950.
INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES
(IMCI)
Key Points
• Pneumonia, diarrhea, dengue hemorrhagic fever,
malaria, measles and malnutrition cause more
than 70% of deaths in children under 5 years of
age.
• There are feasible and effective ways that health
workers in health centers can care for children
with these illnesses and prevent most of these
deaths.
• WHO and UNICEF used updated technical findings
to describe management of these illnesses in a
set of integrated guidelines, instead of separate
guidelines for each illness?
o Nurse, Midwife and doctor should know
how to assess IMCI.
How IMCI Started?
• 1995-IMCI developed by WHO-UNICEF to all
developing countries. (Including Philippines)
• 1997-IMCI was brought to the Philippines thru
the Department of Health-Region I, III, X. XI
(funded by United States Agency for International
Development (USAID)
• 2001-Integration of IMCI to Nursing & Midwifery
Curriculum (attended by the Academe from
different Nursing & Midwifery schools)
Participating Agencies
• DOH-Lead Agency
• Commission on Higher Education Department
(CHED)
• Association of Deans of Philippines College of
Nursing (ADPCN)
• Association of Philippine School of Midwifery
(APSOM)
• Philippine Regulation Commission (PRC)
What is IMCI
• It is an integrated approach to child's health that
focuses on the well-being of the whole child. It is
a case management process and strategy for a
first-level facility such as a health center to
achieve a significant reduction in the number of
deaths from communicable diseases in children
under five
o Ang IMCI ay available lang sa mga health
center pag kasi sa hospital iba na yung
management nun di na kasi nag IMCI sa
hospital.
• aims to reduce death, illness and disability, and
to promote improved growth and development
among children under (5) five years of age
• it includes preventive and curative elements that
are implemented by families and communities as
well as by health facilities.
o Yung sa IMCI hindi na nila kailangan ng
order ng doctor para ibigay yung gamut
na yun.
• Rationale for an integrated approach in the
management of sick children
o Majority of these deaths are caused by 5
preventable and treatable condition
namely: pneumonia, diarrhea, malaria,
measles and malnutrition.
o Three (3) out of four (4) episodes of
childhood illness are caused by these
five-condition. Most children have more
than one illness at one time. This overlap
means that single diagnosis may not be
possible or appropriate.
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IMCI Components of Strategy ▪ It’s moderate. Di mo kailangan na
• Improving case management skills of health dalhin sa hospital kaya ng
workers gamutin sa health center but
o Lahat ng health worker nag undergo sa continues yung pag monitor pag
training. pinauwi yung bata sa bahaya
• Improving the health systems to deliver IMCI then advice mo yung mother
• Improving family and community practices kung kelan sila babalik.
Who are the children covered by the IMCI protocol? o GREEN- indicates supportive home care
• Sick children birth up to 2 months (Sick Young ▪ Mild. Yung bata and mother
Infant) papauwi mo lang but dapat I
• Sick children 2 months up to 5 years old (Sick counsel mo sila bago umuwi.
child) Tinuruan mo kung paanong
Strategies Principles of IMCI gawin like pano mag linis ng
• The children and infants are then assessed for sugat, pano ang tamang pag
main symptoms. For sick children main papasuso and kung pano ibigay
symptoms include cough or difficulty breathing, yung gamut. ORESOL
diarrhea, fever and ear infection. For sick young
infants, local bacterial infection, diarrhea and
jaundice.
• All sick children are routinely assessed for
nutritional, immunization and deworming status
and for other problems
• Only a limited number of clinical signs are used
• A combination of individual signs leads to a
child's classification within one or more
symptom groups rather than a diagnosis.
• IMCI management procedures use limited
number of essential drugs and encourage active
participation of caretakers in the treatment of
children
• Counseling of caretakers on home care, correct
feeding and giving of fluids, and when to return to
clinic is an essential component of IMCI
BASIS FOR CLASSIFYING THE CHILD'S ILLNESS
• The child's illness is classified based on a color-
coded triage system:
o PINK- indicates urgent hospital referral or o Kung ang bata hindi na kakausap at di mo
admission mapapainom yung gamut usually ibibigay mo na
▪ Sever, automatic the child should through IM
refer to the hospital kasi di na o Unang dose ng antibiotic ibibigay
kaya I manage sa health center Chloramphenicol. Kung hindi agad madadala yung
and bahay. Yung IMICI bata sa hospital 2 beses sa isang araw ka mag
piniprevent nila na umabot sa inject.
pink yung sitwasyon ng bata. Dito o Then mag change ka na to appropriate oral
din ibibigay natin yung 1st dose of antibiotic to complete 10 days of treatment
antibiotics. Dito din inutilize yung o Sa mga dosage see mo na lang picture sa taas
plan C monitor the dehydration.
o YELLOW-indicates initiation of specific
Outpatient Treatment
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o First line antibiotic is cotrimoxazole bibigay mo to

ng 2 beses kada araw sa loob ng 5 days.
o Second line antibiotic is amoxycillin bininigay to 3
times a day for 5 days.
o Sa mga dosage see mo na lang picture sa taas
The IMCI Case Management Process
1. Assess and classify
o taking a history and doing a physical Link: https://youtu.be/mDw5gMXkc_I
examination b. Diarrhea
o making a decision on the severity of the
illness.
2. Identify appropriate treatment
o the charts recommend appropriate
treatment for each classification.
3. Treat/refer
o giving treatment in health center,
prescribing drugs or other treatments to
be given
The IMCI Case Management Process
1. Ask the mother what is the problem of the child.
2. Check for General Danger Signs (GDS):
o Link: https://youtu.be/CmXNGWzuNCI
• Pag may danger sign matic pink and need I refer
mo sa hospital.
• A general danger sign is present if the child is/has:
o C-onvulsions (May history ng seizure)
o U-nable to feed, drink, or breastfeed
o V-omits everything
o A-bnormally sleepy/ difficult to awaken
(lethargic or unconscious)
• REMEMBER: 1 Danger Sign = Severe Classification
Video Notes:
1. Is the child being able to drink o breast feed?
2. Does the child vomit everything?
3. Has the child HAD convulsion?
4. See if the child is lethargic or unconscious?
3. Assess the main symptoms
a. Cough/DOB
Link: https://youtu.be/5bca1ODrU0A

Link: https://youtu.be/fdWSS6H1q8Y
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c. Fever

Link: https://youtu.be/wrIJOJbdaXY

d. Ear problems

Link: https://youtu.be/8Qx3WCAzDaQ
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e. Malnutrition/ anemia Give Iron

GIVE MEBENDAZOLE
• Give 500mg Mebendazole as a single dose in
health center if:
• hookworm / whipworm are a problem in children
in your area, and
• the child is 2 years of age or older, and
• the child has not had a dose in the previous 6
months
Department of health programs: Communicable Disease
control and prevention programs
National Tuberculosis TB Control Program
Link : https://youtu.be/8Qx3WCAzDaQ
• Still very common in Philippines
• This days konti ng lang case ng TB therefore
successful naman kahit papano yung gobyerno pa
tungkol dito.
• TB is an infectious disease caused by the bacter
called Mycobacterium tuberculosis (Acid-fast
bacilli)
• Legal Basis of NTP
o RA 10767: Comprehensive TB Elimination
Plan Act of 2016
• Lungs are commonly affected but it could also
affect other organs such as the kidney, bones,
liver and others
o Pulmonary TB – lungs
o Extrapulmonary TB (Nasa labas ng lungs)
▪ Pott's disease – thoracolumbar
(TB sa bones)
▪ Milliary TB - kidney, liver
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• Incubation Period: 2 to 10 weeks
• Mode of Transmission:
o Direct: Airborne through droplet nuclei
(sneezing, coughing)
▪ Mabilis kumalat. N95 used mask
▪ MTV eto yung mga airborne.
o Indirect: continuous exposure to infected
persons within the family
o Source of Infection: sputum, blood from
hemoptysis (pag umubo may blood na
kasama), nasal discharges and saliva
(active cases those showing signs and
symptoms)
Tuberculosis (TB): Cardinal Signs Time result, 1 hours 45 minutes
• CARDINAL symptoms that are lasting for ≥2
weeks
o Cough (Umuubo tayo kasi yung lungs
natin e in expel nya yung dapat hindi
nanduon)
o unexplained fever
o unexplained weight loss
o night sweats.
• Other Symptoms
o Bloody sputum (hemoptysis)
o Easy fatigability or malaise
o Shortness of breath or difficulty of
breathin

CHEST X-RAY

• A chest X-ray posteroanterior (PA) upright view

should be requested
Rifampicin = TB antibiotic • For pregnant women, a written consent shall be
Drug Resistance (yung bacteria nag develop ng immunity taken and abdominal protective shield shall be
laban duon sa drug) used by the X- ray facility.
• Screening by chest X-ray may be done once a
year.
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If resources are limited, you have the option to prioritize
those with TB risk factors as primary clients for chest X-
ray screening. Risk factors¹-8 include:
a. contacts of TB patients;
b. those ever treated for TB (i.e., with history of
previous TB treatment);
c. people living with HIV (PLHIV);
d. elderly (> 60 years old);
e. diabetics;
f. smokers;
g. health-care workers;
h. urban and rural poor (indigents); and
i. those with other immune-suppressive medical
conditions (silicosis, solid organ transplant,
connective tissue or autoimmune disorder,
end-stage renal disease, chronic corticosteroid
use, alcohol or substance abuse, chemotherapy
or other forms of medical treatment for
cancer).
2.2 Ask if the child is a close contact of a known TB
case. If the child is a contact the presence of fatigue,
reduced playfulness, decreased activity, not eating
well or anorexia that lasted for two weeks or more
should also be considered and identify them as a
presumptive TB.
2.3 If the child already has a chest X-ray, review the
results. If chest X-ray findings are suggestive of PTB,
identify as presumptive TB.
Screening by chest X-ray is not routinely
recommended for children, except for TB
household contacts who are 5 years old and
above. 1, 35
2.4 For all PTB identified ask about previous history of
treatment and exposure to TB

TB IN CHILDREN (< 15 years old) Primary Complex

2.1 Ask if the child has TB signs and symptoms.
Identify as presumptive TB if the child has at least
one of the three main signs and symptoms
suggestive of TB:13,14
a. coughing/wheezing of two weeks or more,
especially if unexplained (e.g. not responding
to antibiotic or bronchodilator treatment);
Collection of Specimen
b. unexplained fever of two weeks or more after
common causes such as malaria or • Prepare a sputum cup or 50 ml conical tube 4
pneumonia have been excluded; and • Instruct patient to expectorate one sputum
c. unexplained weight loss or failure to thrive not sample on the spot for diagnostic testing with
responding to nutrition therap Xpert.
• Collect 1ml for Xpert MTB/RIF and TB LAMP and
3-5 ml for SM.
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• Instruct the patient on how to expectorate: o Localized reaction - detected in 48 to
o clean mouth by thoroughly rinsing with 72hours (e.g. if tested on Monday, patient
water will return on Thursday)
o breathe deeply, hold breath for a second o (+) Mantoux test = induration of 10mm or
or two, and then exhale slowly. Repeat above
the entire sequence two more times; o For immunocompromised =>5mm
o cough strongly after inhaling deeply for
the third time and try to bring up sputum
from deep within the lungs; and
o expectorate the sputum in the sputum
cup or conical tube.

Tuberculosis (TB): Diagnosis

Diagnosis
• Sputum Culture and Sensitivity (confirmatory)
• Chest X-ray - (extent of damage)
• Tuberculin Test
o PPD - Purified Protein Derivative -
Mantoux Test
o Intradermal injection into the inner aspect
of forearm to detect exposure to TB
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Tuberculosis (TB): Registration Groups
• New-has never had treatment for TB or has taken anti-
TB drugs for less than one month
• Retreatment has been treated before with anti-TB
drugs for at least one month.) This includes the
following:
I. Relapse - previously treated for TB and declared
cured or treatment completed, but is presently
diagnosed with active TB disease
II. Treatment after failure - previously treated for TB
Tuberculosis (TB): Treatment but failed most recent course based on a positive
Treatment/medications SM follow-up at five months or later, or a clinically
• R-ifampicin (R) diagnosed TB patient who does not show clinical
o Side-effects- orange colored urine improvement anytime during treatment
(reassure patient it's normal), Gl upset, III. Treatment after lost to follow-up - previously
jaundice & thrombocytopenia Multidrug treated for TB but did not complete treatment and
lost to follow-up for at least two months in the
(discontinue drug)
most recent course Previous treatment outcome
• Yung Patient yung skin nya
nagiging yellow or orange unknown- previously treated for TB but whose
o Rifampicin decreases effectiveness of outcome IV.
IV. in the most recent course is unknown
oral contraceptives (pills)
V. Patients with unknown previous TB treatment
o Can be used prophylactically
history - patients who do not fit any of the
• I-soniazid (H)
categories listed above or previous treatment
o Used prophylactically to patient (+) of
history is unknown (this group will be considered
PPD
as previously treated also)
o Side-effects -peripheral neuritis (give
Bago
Vitamin B6[Pyridoxine]) 50-100mg,
rashes (give anti-histamines), jaundice
(hepatotoxicity -discontinue drug)
• P - yrazinamide (Z)
o Side-effect - hyperuricemia (increased
uric acid), arthalgia (give NSAIDs)
o Management - increase fluid intake
• Ethambutol (E)
o Side-effect - optic neuritis (decreased
visual acuity)
o Give Vitamin B6 (pyridoxine)
• Streptomycin (S) (No longer used)
• Side-effect - Ototoxicity (8th cranial nerve
damage) - tinnitus, dizziness, nausea & vomiting
- (discontinue drug)
 CHN
FINALS
Drug resistant cases - three or more consecutive
cultures taken at least thirty (30) days apart are
negative
Tuberculosis (TB): Prevention
• Submit all babies for BCG immunization
• Avoid overcrowding
• Improve nutritional and health status
• Advise persons who have been exposed
to infected persons to receive tuberculin
test if necessary CXR and prophylactic
isoniazid.

Direct Observed Treatment Short Course Strategy

(DOTS)
• DOTS (directly-observed therapy, short-course)
means that the patient taking the medicine
should be observed by a nominated person, and
the taking of the medicine should be recorded.
• The patient will meet with a health care worker
every day or several times a week. This can be at
the TB clinic, your home or work, or any other
convenient location. You will take your medicines
at this place while the health care worker
observes.
Tuberculosis (TB): Management
MAINTAIN REPIRATORY ISOLATION
• Administer medicine as ordered
• Always check sputum for blood or purulent
expectoration
• Encourage questions and conversation so that the
patient can air his or her feelings
• Teach or educate the patient all about PTB
• Encourage patient to stop smoking
• Teach how to dispose secretion properly
(cough/sneeze into tissue paper, then dispose
properly)
• Advised to have plenty of rest and eat balanced
diet
• Be alert of drug reaction
• Emphasize the importance of follow-up
Tuberculosis (TB): REMEMBER
• no longer infectious after two (2) weeks of
appropriate and adequate therapy for as long as
treatment compliance
• when to say a patient is CURED
• Drug-Susceptible TB cases - culture-negative in
the last month of tx