NURSING PRACTICE 1 4) ACCEPTABILITY

● Health services offered area to

COMMUNITY HEALTH NURSING
be in accordance to the
(PART 1)
prevailing beliefs and
practices of the intended
PRIMARY HEALTH CARE
clients of care.
ALMA ATA DECLARATION
COMMUNITY PARTICIPATION
September 6-12, 1978
⮚ Citizens and communities have a
● First International Conference on PHC
right and responsibility to be active
● PHC goal: HEALTH FOR ALL BY THE
partners in making decisions about
YEAR 2000
their own health and the health of
● ALMA-ATA, Kazakhstan, RUSSIA
their communities.
(USSR)
⮚ Heart and Soul of PHC
● Sponsored by WHO and UNICEF
⮚ The ideal word for COMMUNITY
PARTICIPATION is “The nurse is
ASTANA DECLARATION
working WITH THE PEOPLE”
● October 25-26, 2018
● Marks by 40 years since the first
HEALTH PROMOTION
Global Conference on PHC
⮚ Focus or enabling citizens to increase
● Declaration of Astana took place in
control over and improve their
Astana, Kazakhstan
health and well-being
● Hosted by WHO, UNICEF and the
⮚ BASIC PRINCIPLE: PREVENTION IS
Government of Kazakhstan
BETTER THAN CURE
LETTER OF INSTRUCTION (LOI) 949
APPROPIRATE TECHNOLOGY
● Philippines First Asian country to
⮚ The people, procedures, equipment,
have adopted PHC as a national
drugs, and resources used are
strategy
EFFECTIVE and CULTURALLY
● The legal basis of PHC was signed by
ACCEPTABLE to individuals and the
Pres. Ferdinand Marcos
community
● Signed by October 19, 1979
⮚ Use of cheaper, scientifically valid
● HEALTH FOR ALL FILIPINOS (by the
tools and methods that are all
year 2000) AND HEALTH IN THE
suitable and acceptable to the
HANDS OF THE PEOPLE (by the
families and communities
year 2020)
⮚ E.g. use of herbal medicines,
● END GOAL of PHC approach is for
acupuncture, acupressure
people to be SELF-RELIANT
INTERSECTORAL COLLABORATION
PRINCIPLES OF PHC: 4 A’s of PHC
⮚ Partnership between community and
1) ACCESSIBILITY
health agencies
● Essential and appropriate
⮚ E.g.
health services are available to
a) Referral system among the RHU
citizens within a reasonable
b) NGOs
geographical distance by an
c) Local social welfare and
appropriate provider and within
Development Office
a time frame that is appropriate
(Not more than 5 km away
SOCIAL MOBILIZATION
and 30 minutes to travel)
⮚ Enhancing people participation
2) AVAILABILITY
⮚ Process of BRINGING TOGETHER
● Care can be obtained
ALL SOCIETAL AD PERSONAL
whenever people need it (24/7)
INFLUENCES TO RAISE
3) AFFORDABILITY
AWARENESS of and demand for
● The cost should be within the
healthcare, assist in the delivery of
means and resources of the
resource and services, and cultivate
individual and the country (not
sustainable individual and community
totally free SERVICES)
involvement.
 CONTACT TRACERS 1:800
DECENTRALIZATION
⮚ Transfer of authority, functions LEVELS OF PHC WORKERS
and/or resources from the center to the 1) GRASSROOTS/VILLAGERS
periphery within a specific sector ⮚ First contact of the community
⮚ The Philippines decentralized ⮚ Initial link to healthcare
government health services in 1992 ⮚ Renders simple
through devolution with the curative/preventive health
Implementation of the Local measures
Government Code (RA 7160) ⮚ Serves as the foundation of
4 MAJOR PILLARS OF PHC healthcare
(CORNERSTONES) ⮚ Trained local individuals in the
1) INTERSECTORAL LINKAGES community provides
(Multisectoral) ⮚ BATA:
2) USE OF APPROPRIATE a) BHWs
TECHNOLOGY b) Auxiliary Volunteers
3) SUPPORT MECHANISM MADE c) Traditional Birth
AVAILABLE Attendants/ TBA
4) ACTIVE COMMUNITY (Trained hilots)
PARTICIPATION (sustained by social d) Albularyos
mobilization)
2) INTERMEDIATE LEVEL
COMPONENTS OF PHC: “MAD ⮚ First source of professional
ELEMENTS” OF PHC health care
1) Mental Health ⮚ Attends health problems
2) Access to Sentrong Sigla beyond the competence of
3) Dental Health grassroots workers
4) Education In Concerning Prevailing a) Rural Sanitary
Health Problems Inspectors
5) Locally Endemic Disease Preventions b) Medical Practitioners
And Control and their Assistants
6) Expanded Program Of Immunization c) Registered Midwives
Against Major Infectious Diseases (RA d) Nurse in Public Health
10152) (PHN)
7) Maternal And Child Healthcare 3) FIRST LINE HOSPITAL PERSONNEL
Including Family Planning ⮚ Provide backup health services
8) Essential Drugs Arrangement for cases that needs
9) Nutritional Food Supplement, And hospitalization
Adequate Supply Of Safe And Basic a) Doctors with
Nutrition Specialties:
10) Treatment Of Communicable And 1. OB
Non-Communicable Diseases And 2. Pediatrician
Promotion Of Mental Health 3. Cardiologist
11) Safe Water And Sanitation 4. Dentist
b) Other Healthcare
DOH STANDARD RATIO OF HEALTHCARE Professionals
WORKERS c) Nurse Specialist
d) Anesthesiologist and
BARANGAY HEALTH 1:20 HOUSEHOLDS Surgeon
WORKERS
MIDWIFE 1:5,000 LEVELS OF HEALTHCARE DELIVERY
NURSE 1:20,000 SYSTEM
MD/PHYSICIAN 1:20,000 1) PRIMARY
SANITARY 1:20,000 ⮚ Basic health procedures
INSPECTOR ⮚ 25-75 beds capacity
DENTIST 1:50,000
 ⮚ Puericulture centers/Birthing in c) Hygiene
or Lying in (HANDWASHING)
⮚ Rural Health Unit (RHU) (RA d) Immunization/Inoculatio
1082) n
⮚ Community Health Centers Or e) Isolation of the
Barangay Health Station (BHS) diagnosed sick child to
2) SECONDARY pregnant mother
⮚ Referral system of primary f) Intake or use of
level Prophylactic drugs
⮚ Minor operations and 1. Antiretroviral drugs
laboratory examinations 2. Chloroquine tablets
⮚ 100-200 beds capacity (Prophylaxis of
⮚ Outpatient Department malaria)
Hospitals 3. Doxycycline
⮚ Provincial Hospitals (Prophylaxis of
⮚ District Hospitals/Emergency leptospirosis)
District Hospital 4. Crede’s
3) TERTIARY Prophylaxis
⮚ Referral system of secondary (prevent
level gonorrheal/chlamydi
⮚ Highly specialized staff and al eye infection)
technical equipment g) Vector Control
⮚ Complex medical and surgical 1. Destroy breeding
interventions sites (for Dengue,
⮚ Major operations and invasive Zika prevention)
procedures 2. Clear hanging trees
⮚ Medical Centers & National in the riverbanks (for
Hospitals Malaria prevention)
⮚ Regional Hospitals 2) SECONDARY LEVEL
⮚ Training and Teaching ⮚ Target: Sick or at risk
Hospitals individuals
⮚ GOAL: SCREENS clients for
3 LEVELS OF PREVENTION early detection and prompt
1) PRIMARY LEVEL treatment of the disease
⮚ Target: HEALTHY individuals ⮚ INTERVENTION: Early
⮚ GOAL: To prevent/delay the diagnosis and treatment
actual occurrence of disease ⮚ ACTIVITIES:
⮚ INTERVENTION: Health a) Case finding tools
Promotion and Disease 1. Skin Slit Smears
Prevention for leprosy
⮚ HEALTH EDUCATION 2. Sputum smear
✔ Basic health service for TB
that aims to modify 3. Swab Test for
harmful practices of COVID-19
people and their b) Blood tests
unscientific knowledge 1. CBC for blood
and attitude disorders
⮚ ACTIVITIES: (Pancytopenia)
a) Health Education 2. ELISA
1. Family Planning (Confirmatory for
2. Genetic Counseling Dengue)
b) Healthy Lifestyle Habits 3. Western Blot for
1. Health Diet HIV
2. Rest (Confirmatory)
3. Exercise 4. CD4 T cell
4. Not Smoking Count
 (Confirmatory for g) Use of
AIDS) chemotherapeutic drugs
c) Contact tracing and radiation for cancer
d) Quarantine (separation h) Provide family therapy
of contact to well for abusive families;
individuals) remove children from
e) Disease surveillance home
f) Diagnostic Tests
1. Ultrasound
2. CXR
3. MRI DEPARTMENT OF HEALTH
4. CT Scan ⮚ Dr. Francisco Duque III (DOH
5. Mammography Secretary)
g) Treatment/Cure of ⮚ VISION: Filipinos are among the
disease healthiest people in Southeast Asia by
h) Examination of breast 2022, and Asia by 2040
(BSE) ⮚ MISSION: To lead country in the
i) Examination of Testes development of a productive, resilient,
(TSE) equitable and people centered health
j) OPLAN Timbang system
k) Screening Test &
Selective Examinations ROLES AND FUNCTIONS OF DOH
1. Newborn 3 BASIC FUNCTIONS “LEA”
Screening 1) LEADERSHIP IN HEALTH
2. Screening for ✔ Serve as the national policy and
hypertension regulatory institution
l) Trauma & CRISIS ✔ Provide leadership in formulation,
PREVENTION (stress monitoring and evaluation of
debriefing) national health policies
3) TERTIARY LEVEL ✔ Serve as advocate in the adoption
⮚ Target: Individuals with of health policies, plans and
diagnosed illness and advance programs to address national and
disease sectoral concerns
⮚ GOAL: Reduce impact/limit ✔ FORMULATE
disability, prevent sequelae and ❒ Creates the policies, protocols,
prevent death rules and regulations of health
⮚ INTERVENTION: Rehabilitation in the Philippines.
⮚ ACTIVITIES: ✔ ADVOCATE
a) Therapies ❒ Protect the right of the people
1. Physical therapy ✔ REGULATE
2. Occupation ❒ All hospitals must have
therapy certification of cooperation from
(Prostheses DOH
use) ❒ Make sure affordable and safe
b) Health care and health services in the country
treatment for those 2) ENABLER & CAPACITY BUILDER
infected by COVID-19 “IME”
c) Use of assistive devices ✔ INNOVATE
d) Maintenance drugs ❒ Update of health practices in
among patient with the country.
hypertension ✔ MONITOR
e) Blood pressure and ❒ All hospitals in the country
Blood sugar monitoring have license from DOH
f) Self-Management ❒ All hospitals in the country are
Education for patient checked by the DOH
with diabetes ✔ ENSURE
 ❒ Must have safe and quality
health services
3) Administrator of specific services
✔ EMERGENCY SERVICES “EMA”
❒ In case of emergencies, the
DOH must ensure safe and
quality healthcare services
✔ MANAGE SELECTED HOSPITAL
❒ Specific hospitals are funded
are from DOH
❒ E.g. Philippine General
Hospital
❒ Specialized Hospitals = infectious cause of death in
Specific cases (e.g. National
Kidney Institute, Philippine
Heart Centre)
✔ ADMINISTER BASIC SERVICES
− To provide basic health
services
UNIVERSAL HEALTH CARE (RA 11223)
⮚ KALUSUGAN PANGKALAHATAN (KP)
⮚ Highest possible quality of healthcare
for EVERY Filipino
⮚ Care that is accessible, efficient,
equitably distributed, adequately
funded, fairly financed, and
appropriately used by an informed and
empowered public
UHC’S 3 THRUSTS
⮚ KEY PLAYERS IN UHC: DOH, LGU &
PhilHealth
1) FINANCIAL RISK PROTECTION
✔ Through expansion in enrollment
and benefit delivery of the National
Health Insurance Program (NHIP)
or PhilHealth
2) IMPORVED ACCESS TO QUALITY
HOSPITALS AND HEALTHCARE
FACILITIES
✔ Upgrading government-owned and
operated hospitals and health
facilities
✔ Rehabilitation and Construction of
Critical Health Facilities
✔ Treatment Packs for HTN and DM
✔ Obtained and distributed to RHUs
3) ATTAINMENT OF HEALTH-REALTED
MDGs
✔ MDG signed: September 2000
✔ Target: 2015
✔ Goals: 8 MDGs
✔ To reduce maternal and child
mortality
✔ TO reduce morbidity and mortality
from TB, Malaria and incidence of
HIV/AIDS
⮚ 8 MDGs
1) Eliminate Extreme Poverty And
Hunger
2) Achieve Global Primary Education
3) Promote Gender Equality And
Empower Women
4) Reduce Child Mortality (reduce the
under-five mortally rate by 2/3 in
year 2015)
✔ Pneumonia = single largest
children worldwide
(under-five)
✔ Diarrhea =
✔ Asphyxia = Common cause
of newborn deaths
5) Improve Maternal Health (reduce
maternal mortality by 3 quarters
(3/4) in 2015)
✔ Direct Maternal Deaths
(HOUSE)
a) Hemorrhage
b) Obstructed Labor
c) Unsafe Abortion
d) Sepsis
e) Eclampsia
6) Combat Malaria, HIV/AIDS, And
Other Diseases (Including
neglected tropical diseases)
7) Ensure Environmental
Sustainability
8) Develop A Universal/Global
Partnership For Development
SUSTAINABLE DEVELOPMENT GOALS
1) No Poverty
2) 0 (Zero) Hunger
3) Good Health & Well-Being
4) Education (Quality)
5) Equality (Gender)
6) Clean Water And Sanitation
7) Affordable And Clean Energy
8) Decent Work And Economic Growth
9) Industry, Integration And Infrastructure
10) Reduced Inequalities
11) Cities And Communities (Sustainable)
12) Consumption And Production
13) Climate Change Action
14) Life Below Water
15) Life On Land
16) Peace, Justice & Strong Institution
17) Partnership For Goals
IMPORTANT NOTES:
 a) MDGs 4 & 5 is the priority of the a) TCL for Prenatal
DOH b) TCL for Postpartum
b) Reduce Child Mortality And Improve Care
Maternal Health are 2 goals which are c) TCL for Family Planning
VERY specific to Maternal Child Health d) TCL for Under One year
(MCH) old children
✔ Infant Mortality Rate = most e) TCL for Sick Children
sensitive indicator that reflects f) NTP TB Register
the health of the community (National Leprosy
c) Reduction of maternal mortality of 75% Control Program)
by year 2015 3) TALLY/REPORTING FORMS
d) NATIONAL PRIORITY: MDG 1 ⮚ Reporting forms is the ONLY
(Eradicate Extreme Poverty) mechanism through which
date are routinely transmitted
FILED HEALTH SERVICE INFORMATION from one facility to another
SYSTEM (FHSIS) ⮚ Reports are submitted directly
⮚ Provides a summary of data on health to the PROVINCIAL HEALTH
service delivery and selected programs OFFICE (PHO)
from the barangay level up to the ⮚ E-2 is the Maternal Death Form
national level ⮚ Reporting forms from BHU
Facility to the PHO
⮚ Output Reports are solely
⮚ FHSIS Importance: produced by the PHO
a) Facilitates information for ⮚ Data submitted to the PHO is
monitoring and evaluating health processed using
program implementation MICROCOMPUTER
b) Help local government determine ⮚ The recommended frequency
public health priorities in tallying activities and
c) Service delivery monitoring services using tally sheets is
d) It monitors health status of the DAILY
community ⮚ Counting of the tally sheet is
e) Source of data to detect any done at the END OF THE
unusual occurrence of a disease MONTH

COMPONENTS OF FHSIS RA 7160 (Devolution Code or Local

1) INDIVIDUAL TREATMENT RECORD Government Code)
(ITR) ⮚ Aims to transform local government
⮚ Use to record patient units into self-reliant communities
address, full name, age, and active partners
symptoms and diagnosis
(piece of paper/patient LOCAL HEALTH BOARD (LHB)
consultation record) 1) PROVINCIAL HEALTH BOARD
⮚ Individual treatment record or a) Chairman: GOVERNOR
FAMILY TREATMENT b) Vice Chairman: Provincial Health
RECORD is the fundamental Officer
block or foundation of FHSIS c) MEMBERS:
2) TARGET CLIENT LIST (TCL) 1. Chairman, Committee on
⮚ Primary Advantage: Lets Health of Sangguniang
nurses and midwives save Panlalawigan
time and effort in monitoring 2. DOH Representative
treatment and services to (PHN)
beneficiaries 3. NGO Representative
⮚ TCL will be transmitted to the (Private Sector)
next facility in the form form of 2) CITY & MUNICIPAL HEALTH BOARD
REPORTING FORMS a) Chairman: MAYOR
⮚ TCLS TO BE MAINTAINED b) Vice Chairman: Municipal Health
ARE: Officer
 c) MEMBERS: a) Fried, roasted soaked in
1. Chairman, Committee on vinegar for 30 minutes
Health of Sangguniang b) Blanched in boiled water
Panlungsod for 15 minutes
2. DOH Representative c) Take 2 pieces 3x a day
(PHN) AFTER MEALS
3. NGO Representative 4) BAYABAS (Psidium Guajava)
(Private Sector) a) Stomach Flu/Diarrhea
❒ TAKE NOTE: b) Use for Wound Washing
a) MIDWIFE is NOT a member of c) Gets rid of fungi, amoeba, and
the Health Board bacteria
b) Midwives are the FRONTLINE d) Antiseptic activity
WORKERS in COMMUNITY e) Toothache
and RHU ✔ PREPARATION:
c) Midwives links the community a) Young leaves can be
to RHU boiled taken 3-4x a day for
diarrhea
RA 8423 – TRADITIONAL AND b) Warm decoction for gargle
ALTERNATIVE MEDICINAL ACT (TAMA) of in toothache
1997 5) YERBA BUENA (Mentha Cordifolia)
⮚ By Juan Flavier a) ANALGESIC
1) LAGUNDI (Vitex Negundo) b) Pruritus or itchiness
a) Sprain and Skin Diseases c) Arthritis/Rheumatism
b) Headache & Fever d) Insect bites and swollen gums
c) Rheumatism e) Nausea & Vomiting
d) Eczema f) Flatulence or Gas pain
e) Dysentery g) Loss of consciousness
✔ PREPARATION: temporarily (syncope) –
a) Decoction: Boil ½ cup of alternative of spirit of ammonia
chopped fresh or dried h) Menstrual pain
leaves in 2 cups of water ✔ PREPARATION:
for 10-15 minutes a) For PAIN: boil leaves in 2
b) Drink half cup 3 times a glasses for 15 minutes
day b) Divide
c) Pounded leaves for c) Decoction in 2 parts and
headache and rheumatism drink one
2) ULASIMANG 6) SAMBONG (Blumea Balsamifera)
BATO/PANSIT-PANSITAN (Peperonia a) Antiurolithiasis
Pellucida) b) Diuretic
a) Gouty arthritis (Great Toe pain) c) Anti-edema
b) Others: Boils and abscesses d) NOT used for kidney infections
c) Uric Acid lowering Agent ✔ PREPARATION:
d) Tophi prevention a) Decoction of leaves – boil
e) YES you can boil it or eat like a chopped leaves in a glass
salad of water
✔ PREPARATION: b) Divide into 3 parts
a) ½ cup of leaves boiled in a c) Drink one part every 3
glasses for water hours
b) Divide into 3 parts and 7) AKAPULKO (Cassia Alata L.)
drink one part 3x a day a) Antifungal parasites herb
3) BAWANG (Allium Sativum) b) Ringworm (Fungal)
a) Hypertension c) Athlete’s Foot
b) Toothache d) Tinea flava
c) Neutralize free radicals & lowers e) Scabies (Parasite)
cholesterol level ✔ PREPARATION:
✔ PREPARATION: a) Pounded fresh matured
leaves
 b) Can be made into a soap,
cream or paste applied to
affected area 1-2x a day
c) Apply cream all over the
body for scabies
8) NIYOG NIYOGAN (Quisqualis Indica)
a) Anti-helminthic
b) Expel worms or parasite like
roundworms, tapeworms,
hookworms.
✔ PREPARATION:
a) Take seeds 2 hours
AFTER dinner
b) CHILDREN: at least 4-7
seeds
c) ADULTS: at least 8-10
seeds
d) CONTRAINDICATED
less than 4 years old
9) TSAANG GUBAT (Carmona Retusa)=
Wild Tea
a) Antispasmodic (Cramps)
b) Body cleanser/wash
c) Diarrhea
d) Oral Hygiene or canker sores
e) Mouth wash used in “SAGIPIN:
UNANG NGIPIN” (fluoridation of
teeth)
f) Eczema
g) Natural remedy for biliary colic
10) AMPALAYA (Momordica Charantia)
a) DM Type 2
✔ PREPARATION:
a) Chopped leaves
b) Boil in a glass of water for
15 minutes
c) Take 1/3 cup 3x a day
AFTER MEALS
of community people to affordable
medicines
⮚ VENDOR: At least 2 BHW
⮚ MANAGED BY: legitimate community
organization. NGOs and/or LGUs
DRUGS SOLD IN BnB
1) RIPES (TB drugs)
2) NIFEDIPINE
3) AMOXICILLIN (1st line antibiotic of
pneumonia)
4) ALBENDAZOLE
5) PARACETAMOL
6) COTRIMOXAZOLE (2nd line antibiotic
of pneumonia)
7) ORS (Oresol)
8) QUININE
to ❒ ASPIRIN is NOT BEING SOLD in BnB
IMMUNIZATION PROGRAM
⮚ VACCINE HISTORY:
1) EDWARD JENNER
✔ Founder of Vaccinology in the
West (1796)
✔ After he inoculated a 13 y/o
boy with vaccinia virus
(cowpox) which demonstrated
immunity to smallpox
✔ In 1798, the FIRST smallpox
vaccine was developed
✔ Smallpox vaccine was the
FIRST SUCCESSFUL
VACCINE to be developed
✔ WHO declares GLOBAL
eradication of Smallpox (May
1980)
✔ LAST WILD CASE of small pox
– Somalia (1977)

REMINDERS ON THE USE OF HERBAL EXPANDED PROGRAM ON IMMUNZATION

MEDICINE (established in 1976)
1) Boil using a clay pot and remove ⮚ IMMUNIZATION
cover while boiling at low heat ✔ Process of introducing
2) Only one kind of herbal plant for each vaccine into the body before
type of symptoms infection sets in providing
3) No use of insecticides as these may ARTIFICIAL ACTIVE
leave poison on plants IMMUNITY
4) Use only part of the plant being ⮚ WHO stated that as many as 2-3
advocated million deaths among children per year
5) Symptoms persist after 2-3 doses – could have been prevented by
CONSULT physician ACCESS TO IMMUNIZATION
⮚ SCHEDULE: WEDNESDAY
BOTIKA NG BARANGAY/BOTIKA NG BAYAN ✔ Designated NATIONAL
(BnB) IMMUNIZATION DAY or
⮚ Botika ng Barangay (BnB), a “Patak Day”
government-initiated poverty ⮚ WEEKLY: Rural Health Units
alleviation program to increase access ⮚ MONTHLY: Barangay Health Stations
 ⮚ QUARTERLY: Remote areas ⮚ ONLY OPV doses can lead to
(Far-flung) polio eradication
⮚ OPV given simultaneously to
VACCINE PREVENTABLE DISEASES all children younger than 5 y/o
1) Tuberculosis – BCG 2) PROCLAMATION NO. 135, s. 2001
2) Diphtheria & Pertussis – ⮚ POLIO-FREE MAINTENANCE
DPT/Pentavalent IMMUNIZATION CAMPAIGN
3) Measles – Measles Vaccine ⮚ Last wild Poliomyelitis case in
4) Poliomyelitis – OPV and IPV the Philippines was in 1993
a) OPV – Albert Sabin ⮚ Philippines was certified
b) IPV – Jonas Salk POLIO-FREE country on
5) Tetanus October 29,2000 in Kyoto,
a) CHILDREN = DPT Japan
b) Mothers = Tetanus Toxoid ⮚ 19 years after, On September
6) Hepatitis B – HepB vaccine 19,2019, a new polio outbreak
7) Diarrhea caused by Rotavirus – was reported by POLIO VIRUS
Rotavirus vaccine 2
8) Meningitis – PentaHIB vaccine ⮚ 3 Viral Strains of Polio
a) Brunhilde Type 1
FALSE TRUE/ABSOLUTE b) Lansing type 2
CONTRAINDICATIO CONTRAINDICATIO c) Leon type 3
NS NS 3) PROCLAMATION NO. 4, s. 1998
Fever NOT more than Convulsions within 7 ⮚ LIGTAS TIGDAS MONTH
38.5 degrees C days after DPT ⮚ September 16 – October 14,
vaccine 1998
Seizures 4 days ⮚ Free measles vaccines
before DPT 1 between the ages of 9 months
Vomiting Anaphylaxis to any – less than 15 years
components of 4) PRESIDENTIAL DECREE 996
vaccine ⮚ COMPULSORY basic
Respiratory HIV/AIDS with signs immunization for infants and
Conditions (Cough & and symptoms children below 8 years of age
Colds) 5) REPUBLIC ACT NO. 7846
Like BROMA ⮚ COMPULSORY Hepatitis B
vaccines immunization among infants &
a) BCG children less than 8 years old
⮚ Newborn infants of women with
b) Rotavirus
Hepatitis B shall be given
c) OPV immunization against Hepatitis
d) Measles B within 24 hours after birth
e) 6) RA No. 10152
⮚ MANDATORY infants and
Malnutrition Children Health Immunization
Act of 2011
Anaphylaxis after a ⮚ TAKE NOTE:
Diarrhea previous dose a) If the infant is sick, and
Hepatitis the parent strongly
Neural Problems objects for the
immunization, DO NOT
REGULATORY LAWS GIVE IT
1) PROCLAMATION NO. 773, s. 1996 b) Ask the mother to
⮚ Declaring April 17 and May 15, comeback when child is
1996 and every third well
Wednesday of April and May
from 1996 to 2000 as FULLY IMMUNIZED CHILD (FIC)
“KNOCKOUT POLIO DAYS” 1) Before 12 months
 2) Before 1st birthday of child he/she must ⮚ School based immunization program
have completed: provides free measles and rubella
a) 1 dose of BCG vaccines including booster doses of
b) 3 doses of DPT tetanus-diphtheria vaccines to public
c) 3 doses of OPV school children from kindergarten to
d) 3 doses of HepB Grade 7 (ages 5-13 y/o)
e) 1 dose of Measles ⮚ For Grade 4 females: HPV
immunization, a protection against
FREEZE DRIED: cervical cancer
1) BCG
2) Others: Yellow Fever and HIB GENERAL PRINCIPLES IN VACCINATING
CHILDREN
MOST SENSITIVE TO HEAT/SUNLIGHT: 1) Give doses less than 4 weeks interval
1) OPV may lessen the antibody response
2) Measles 2) Lengthening the interval between
3) MMR doses of vaccine leads to a higher
antibody levels
MOST SENSITIVE TO COLD/FREEZING 3) Avoid using the same arm or leg for
1) DPT more than 1 injection
2) DT 4) Do not give more than 1 dose of the
3) TT SAME VACCINE to a child in one
4) HepB session
5) Pentavalent Vaccine 5) If the vaccination schedule is
6) PCV vaccine interrupted, it is NOT NECESSARY to
RESTART.
NEW MANDATED VACCINES 6) Minimal intervals between doses to
1) ROTAVIRUS catch up as quickly as possible if it is
✔ Prevents diarrhea interrupted
2) PNEUMOCOCCAL CONJUGATE 7) Immunity provided by vaccines is
VACCINES ( PCV13) ARTIFICIAL ACTIVE:
✔ Prevents pneumonia a) More than 1 vaccine is to be
3) INACTIVATED POLIO VACCINE (IPV) administered, inject it at different
✔ Given to infant at 3 ½ sites of body
months (14 weeks) b) Mild asthma, stable cerebral
❒ TAKE NOTE: palsy or down syndrome is NOT
a) Give PCV to infants as a series a contraindication
of 3 doses, 1 dose at each of c) Use single syringe (1 syringe
these ages: per vaccine) when giving more
o 1 ½ months (6 weeks) than 1 vaccine
o 2 ½ months (10 weeks) d) NEVER reconstitute freeze dried
o 3 ½ months (14 weeks) vaccine anything other than the
b) Children who miss their shots or diluent supplied with them
start the series later should still e) Effective and still safe if more
get the vaccine than 1 vaccine is given on the
same day
PENTALENT VACCINE f) DO NOT ADMINSTER live
⮚ Vaccine (5 in 1) that contains Five vaccines to persons who are
antigens: significantly immune
1) Diphtheria compromised
2) Pertussis
3) Tetanus COLD CHAIN
4) HepB ⮚ SYSTEM of storing and transporting
5) Haemophilus influenzae type vaccines at recommended
B temperatures from the point of
manufacture to the point of use
“BACK TO BAKUNA” Program ⮚ Primary PURPOSE: MAINTAIN
POTENCY of vaccine

VACCINE STORAGE
1) Store VARICELLA at freezing
temperatures
2) Temperature should be checked
TWICE A DAY
3) One in the morning and one in the late
afternoon
4) Refrigerator: Stand-alone refrigerator REFRIGERATOR
and freezer
5) Avoid direct contact of vaccine to ice
6) Goodies, foods and drinks should
NEVER be stored
7) Ensure to keep refrigerator away from
sunlight and at least (10cm) distance
from the wall
COLD CHAIN REMINDERS:
1) NEVER store any vaccine in a
dormitory style or bar style combined
unit 2 COMPARTMENTS:
2) NEVER place vaccines and diluents in
the DOOR shelves (Temperature is not
stable)
3) AVOID frequent opening and closing of
doors
4) Place vaccines and diluents in the
center of the unit 2 or 3 inches away
from walls, ceiling, floor. And door
5) AVOID freezing of diluents as the vial
may burst when frozen
6) DO NOT STORE vaccines in deli, fruit
or vegetable drawers or in the door
7) Place vaccines and diluents with the
earliest expiration dates in front of
those with later expiration dates
8) Do not return reconstituted vaccines
(BCG, Measles) or opened PCV 10
vials to the refrigerator. They should be
discarded at the end of the
immunization session or after 6 hours,
whichever comes first, STORING:
9) The refrigerator should not be packed
too full (to allow air to circulate)
10) Vaccines should be stored carefully
between +2 degrees C and +8
degrees C at all times
11) Freeze-sensitive vaccines
(Pentavalent, PCV10, TT & HepB)
should be kept away from the freezing
compartment, refrigeration plates, side
linings or bottom lining of refrigerators
and frozen ice packs
WATER BOTTLES
STORAGE TIME FRAMES
1) Place water bottles on the top shelf,
floor and in the door racks
2) Putting water bottles in the unit can
help maintain stable temperatures
cause by frequently opening and
closing unit doors or a power failure
3) Label all water bottles DO NOT DRINK
1) NO foods, drinks or other drugs are to
be kept in a refrigerator
2) Check and record temperature 2x a
day in temperature log for 2-7 days
3) DEFROST the refrigerator when ice
becomes more than 0,5 cm thick, or
once a month, whichever comes first
4) Record temperature, date, time and
initials of the person in monitoring log
sheet
1) REFRIGERATOR (Main Compartment)
⮚ Kept between +2 degrees C
and +8 degrees C
⮚ Used for storing vaccines and
diluents
⮚ E.g.
a) BCG
b) DPT
c) HepB
d) TT
2) FREEZER
⮚ Kept between -15 degrees C to
-25 degrees C
⮚ Average of 20 degrees C
⮚ Used for freezing ice packs
⮚ For heat sensitive vaccines
(OPV & Measles)
⮚ OPV is the MOST sensitive to
heat and fragile vaccine
1) FREEZING COMPARTMENTS
a) Ice cubes
b) Ice packs
2) MAIN COMPARTMENT
a) TOP
1. OPV
2. Measles
b) MIDDLE
1. DPT
2. TT
3. Diluent
c) LOWER
1. Water bottles
 1) 6 MONTHS – Regional Level 6) MEASLES
2) 3 MONTHS – Provincial Level/District ⮚ CONTENT: Live Attenuated Virus
Level (weakened)
3) 1 MONTH – Main Health Centers with ⮚ TYPE: Freeze dried
refrigerator ⮚ DOSAGE: 0.5 mL
4) NOT MORE THAN 5 DAYS – Health ⮚ NUMBER OF DOSES: 1 dose
centers using transport boxes ⮚ ROUTE: SQ

ESSENTIAL ELEMENTS: BCG

1) Personnel to manage vaccine ⮚ At birth or Any time after birth
distribution ⮚ NORMAL SIDE EFFECTS
2) Equipment for vaccine storage & a) KOCH’S PHENOMENON
transport ✔ Acute inflammatory process
3) Maintenance of equipment starting 24 hours after
4) Monitoring injection and may last 2-4
5) COLD CHAIN MANAGER: PHN days
✔ Wheal formation (small
VACCINES: raised lump of 10 mm of
1) BCG (Bacillus Chalmette Guerin) diameter)
⮚ CONTENT: Live Attenuated ✔ Disappears within 30
Bacteria minutes
⮚ TYPE: Freeze Dried b) ULCER/RED SORE FORMATION
⮚ DOSAGE: ✔ May appear 2 weeks after
a) Infant/birth: 0.05 mL injection and may persist for
b) Preschool: 0.1 mL another 2 weeks to heal
⮚ NUMBER OF DOSES: 1dose ✔ Keep dry and clean (Do not
⮚ ROUTE: ID using 26G needle put any ointment on the sore
syringe or give the child any
2) Hepatitis B medicine)
⮚ CONTENT: Plasma Derivative
(HbsAg)/ RNA Recombinant c) SCAR FORMATION
⮚ TYPE: Liquid ✔ About 5 mm
⮚ DOSAGE: ✔ Scar at 12 weeks after
a) Infant/birth: 0.5 mL injection (2-5 months)
⮚ NUMBER OF DOSES:3 doses ✔ Sign that the child has
⮚ ROUTE: IM been effectively
3) DPT (Diphtheria-Pertussis-Tetanus) immunized
⮚ CONTENT: DT weakened toxin/ ⮚ ABNORMAL ADVERSE EFFECTS
P-killed bacteria a) INDOLENT ULCERATION
⮚ TYPE: Liquid ✔ WATCH OUT FOR: Signs
⮚ DOSAGE: 0.5 mL of Infection
⮚ NUMBER OF DOSES: 3 doses ✔ Abscess formation and
⮚ ROUTE: IM swelling of glands in
4) OPV (Oral Polio Virus) armpits
⮚ CONTENT: Live Attenuated Virus (lymphadenopathy)
(weakened) ✔ Abscess may be due to:
⮚ TYPE: Liquid 1. UNSTERILE
⮚ DOSAGE: 2 drops (0.1 mL) needle/syringe was
⮚ NUMBER OF DOSES: 3 doses used (#1 cause)
⮚ ROUTE: PO 2. Too much vaccine
5) Rotavirus Vaccine was injected
⮚ CONTENT: Live Attenuated Virus 3. Wrong technique of
(weakened) administration
⮚ TYPE: Liquid ✔ MANAGEMENT:
⮚ DOSAGE: 5 drops (0.5 mL) 1. Do not incise and
⮚ NUMBER OF DOSES: 5 doses Drain
⮚ ROUTE: PO
 2. Use warm water
compresses over the
injection site or
suppurating lymph
node/s 4-5 times a
day
HEPATITIS B
⮚ Transmission at birth is possible give:
a) HepB 1 – At Birth
b) HepB 2 – 6 weeks
c) HepB 3 – 14 weeks
⮚ When transmission at birth is less
likely, the recommended schedule is:
a) HepB 1 – 6 weeks
b) HepB 2 – 10 weeks
c) HepB 3 – 14 weeks
⮚ COMMON SIDE EFFECTS:
a) MILD FEVER (1-2 days)
✔ Teach mother to perform
TSB
✔ Advise to give
Paracetamol every 4 hours
if temperature is above
38.5 degrees C
✔ REFER if fever last for 4
days
b) SORENESS, REDNESS OR
SWELLING IN THE INJECTION
SITE
✔ Teach mother to perform
COLD compress FIRST
before HOT compress
DPT
⮚ The recommended schedule is: 4
weeks interval between doses
a) DPT 1 – 6 weeks
b) DPT 2 – 10 weeks
c) DPT 3 – 14 weeks
⮚ MILD REACTIONS:
a) FEVER
✔ Child may have fever in
the evening AFTER
receiving DPT vaccine
✔ Fever should disappear
within a day
✔ NOTE: FEVER that begins
more than 25 hours after a
DPT injection is UNLIKELY
to be a reaction to the
vaccine
b) SORENESS
c) PAIN
d) REDNESS OR SWELLING AT
INJECTION SITE
⮚ WATCH OUT FOR: ABSCESS
FORMATION
✔ An abscess may develop a
week or more after a DPT
infection due to:
1. Unsterile needle or
syringe was used
2. Wrong technique
3. Vaccine was note
injected into the muscle
⮚ DPT vaccine should NOT be given:
a) Children over 5 years of age
b) Children who have suffered a
severe reaction to a previous
dose of DPT vaccine
⮚ Instead, a COMBINATION OF
DIPHTHERIA AND TETANUS
TOXOIDS (DT) should be given
OPV
⮚ The recommended schedule is: 4
weeks interval between doses
a) OPV 1 – 6 weeks
b) OPV 2 – 10 weeks
c) OPV 3 – 14 weeks
⮚ NO SIDE EFFECT
ROTAVAC
⮚ The recommended schedule is:
d) ROTAVAC 1 – 6 weeks
e) ROTAVAC 2 – 10 weeks to a
maximum of 32 weeks
⮚ Rare and mild side effects
⮚ Fussiness, mild diarrhea, and vomiting
MEASLES
⮚ Regular schedule: 9 months
⮚ NOTE: if the child aged 6-9 months
when hospitalized should receive
measles vaccine apart from the
scheduled vaccine at 9 months
⮚ In case of outbreak: may be given at 6
months (EARLIEST dose)
⮚ LATE dose: 15 months
⮚ Catch up dose: 4-5 y/o
IMPORTANT NOTES:
1) It is safe to vaccinate a sick child who
is suffering from a minor illness
2) When handling vaccines, the FIRST
step is to CHECK the vial for
EXPIRATION DATE
3) Use standard refrigerator with
separate freezer door and seal for
vaccines
4) Vaccines can be mixed in a single
syringe when:
 a) Vaccines are licenses and a) Date of administration
labeled to be mixed b) Vaccine manufacturer
5) BCG vaccine protects against TB in c) Vaccine lot number
infants d) Name and title of the person who
6) BCG vaccine amber glass ampules is administered the vaccine
to protect from ultraviolet and
fluorescent light to MAINTAIN
POTENCY HERD IMMUNITY
7) BCG also should be discarded AFTER ⮚ Occurs when a high percentage of the
6 HOURS of reconstitution because of community is immune to a disease
risk of contamination d/t lack of (through a vaccination and/or prior
preservative and loss of potency illness) making the spread of the
8) BCG vaccine is NOT damaged by disease from person to person is
freezing unlikely.
9) Store BCG Vaccine and its diluent
side-by-side in a refrigerator or vaccine TARGET SETTING
carrier 1) BCG
10) BCG is administered via ID route at ⮚ Number of Doses: 1
(R) deltoid ⮚ Number of Doses per ampule: 20
11) NEVER immunize in buttocks, IM ⮚ Wastage factor: 2.5
vaccines like HepB, DPT, IPV, 2) HepB
Pentavalent and PCV should be ⮚ Number of Doses: 3
administered muscle of the upper ⮚ Number of Doses per ampule: 10
outer of the thigh ⮚ Wastage factor: 1.10
12) Measles is given ONCE, SQ injection 3) DPT
in the OUTER UPPER (R) arm ⮚ Number of Doses: 3
13) The Measles, Mumps, Rubella, ⮚ Number of Doses per ampule: 20
Vaccine (MMR) can be stored either in ⮚ Wastage factor: 1.67
the freezer or the refrigerator 4) OPV
14) Protect reconstituted measles vaccine ⮚ Number of Doses: 3
from sunlight. WRAP IT WITH FOIL ⮚ Number of Doses per ampule: 20
15) If a child has diarrhea, give OPV as ⮚ Wastage factor: 1.67
usual but administer an extra dose 5) MEASLES
✔ 5th dose, at least 4 weeks after ⮚ Number of Doses: 1
he or she has received the last ⮚ Number of Doses per ampule: 10
dose in the schedule ⮚ Wastage factor: 2
16) Diphtheria and Tetanus toxoid parts re 6) TETANUS TOXOID
damaged by freezing ⮚ Number of Doses: 5
17) For outreach session using vaccine ⮚ Number of Doses per ampule: 10
carriers or old box: ⮚ Wastage factor: 1.67
a) Do not let DPT, TT or HepB
vaccine vials touch the cold STEP 1: DETERMINE THE ELIGIBLE
dogs/ice packs. POPULATION OUT OF THE GIVEN TOTAL
b) Put or wrap newspaper or POPULATION
cardboard around DPT, TT, or
HepB to protect them from COMPUTE FOR ELIGIBLE POPULATION
freezing ⮚ FORMULA: TOTAL POPULATION x
18) PERTUSSIS vaccine is damaged by Target Setting = Eligible Population
heat ⮚ For Target Setting of Eligible
19) Pertussis causes the fever after DPT Population:
shot a) Total number of children &
20) If a child spits out, regurgitates the infants for immunization = 3%
vaccine drops, or vomits immediately or 0.03
after a dose of OPV, it is safe to repeat b) Total number of mothers for
the doe (DO NOT BF immediately) immunization = 3.5% or 0.035
⮚ EXAMPLE: Midwife Lorna was
VACCINATION CARD assigned to Bgy. San Roque with 20
 000 population. How many infants are
expected to receive measles injection
✔ TP = 20 000
✔ EP = 3% (Infants)
✔ 20 000 x 0.03 = 600 infants
STEP 2: DETERMINE THE TOTAL VACCINE
REQUIRED (TVR)
⮚ FORMULA: Eligible Population x
Number of doses to complete
immunization = TVR
⮚ 600 infants x 1 dose of measles = 600
TVR
STEP 3: DETERMINE THE ANNUAL
VACCINE DOSES REQUIRED (AVR)
⮚ FORMULA: Total Vaccine dose
Required x Wastage Factor of the
vaccine (refer to table above)
⮚ 600 (TVR) x 2 (constant wastage
factor of measles) = 1200 AVR
EXAMPLE 1: Lorna has an eligible target of
600 (0-1 y/o) for the current year. If she
computes her EPI target on anti-measles.
How many vials of 10 doses will she need?
✔ ANSWER: 120 vials
✔ 600 x1 = 600
✔ 600 x 2 = 1200
✔ 1200/10 = 120 vials
STEP 4: DETERMINE ANNUAL VACCINE
AMPULE OR VIAL (AVA)
⮚ FORMULA: Annual Vaccine Doses
Required (AVR)/number of doses per
ampule
⮚ 1200 (AVR)/ 10 doses per ampule of
measles = 120 ampules of measles
EXAMPLE 2: Nurse Ling Ling has a total
eligible target of 205 (mothers), If she
computes her EPI target on Tetanus Toxoid,
how many vials of 20 doses will she need?
✔ 205 x 5 (doses of TT) = 1025
MATERNAL HEALTH PROGRAM
MCHP
⮚ The Philippines is tasked to reduce the
Maternal Mortality Ratio (MMR) by
three quarters or 75% by 2015 to
achieve its MDG
⮚ This means a MMR of 112/100, 000
live births in 2010
⮚ 80/100,000 live births by 2015
HOME BASED MOTHER’S RECORD
(HBMR)
⮚ Tool used when rendering prenatal
care containing risk factors and danger
signs
⮚ A system for recording risk factors,
early sings of complications, referrals
and treatment of the mother
⮚ PANEL 1: Maternal Information
(demographics)
⮚ PANEL 2: Danger signs/Risk
factors/Present pregnant condition
⮚ PANEL 3: Actions by referral
⮚ PANEL 4: Family planning/Postpartum
Care
RISK FACTORS
a) Height 145 cm tall (4 ft & 9 in)
b) Age below 18 y/o (PIH) ; above 35 y/o
(H-mole, Placental Previa)
c) Recent pregnancy was C/S delivery
d) Multiparity and last baby born was less
than a years ago
e) Family history of DM, Hypertension,
and Heart disease
f) Underlying condition like TB, Goiter,
Bronchial Asthma, Severe Anemia
g) Less than 45 kg or more than 80 kg
weight
DANGER SIGNS
1) Any type of vaginal bleeding
2) Headache, Dizziness, Blurred Vision
(Pre-Eclampsia/Gestational HTN)
3) Puffiness of the face and hands (Facial
Edema/Peripheral Edema)
4) Pale and Anemic
5) Any watery discharges (PROM)
MATERNAL DEATHS
⮚ Maternal Mortality: 10-11 mothers die
each day d/t pregnancy and delivery
complication
⮚ MATERNAL DEATH:
✔ Death of a woman while
pregnant or within 42 days of
termination of pregnancy
DIRECT MATERNAL DEATHS (HOUSE)
a) Hemorrhage
b) Obstructed Labor
c) Unsafe Abortion
d) Sepsis
✔ Endometriosis (most common
puerperal sepsis)
e) Eclampsia and PIH
DAILY IRON & FOLIC ACID
SUPPLEMENTATION DURING PREGNANCY
⮚ WHO & National Guidelines
recommended all pregnant women
should receive a daily Oral Fe and
Folic Acid supplementation dose of
DAILY 60 mg of Fe + 400mcg (0.4 mg)
Folic Acid for 6 months (125 days)
✔ To prevent maternal anemia,
puerperal sepsis, LBWs and
Preterm birth
⮚ Folic Acid is the chief
⮚ TAKE NOTE: Folic acid should be
commenced as early as possible
(ideally before conception) to prevent
NTDs
PRENATAL CONTACT/VISIT
⮚ 8 or more Prenatal contacts for
antenatal care can reduce perinatal
deaths by up to 8 per 1000 births when
compared to 4 visits
⮚ It recommends pregnant women to
have their first contact in the FIRST 12
weeks AOG with subsequent contacts
taking place at:
a) 20 weeks AOG
b) 26 weeks AOG
c) 30 weeks AOG
d) 34 weeks AOG
e) 36 weeks AOG
f) 38 weeks AOG
g) 40 weeks AOG
NUTRITION
⮚ Emphasize the importance of nutrition
during each prenatal contacts
1) Eat nutritious foods like fruits &
vegetables
2) Avoid excessive weight gain
3) Daily oral Fe and Folic Acid (600
mg Fe + 400 mcg Folic Acid)
4) Daily calcium supplementation
(1.5-2 g)
✔ Prevents eclampsia
5) NO SMOKING and NO
DRINKING ALCOHOL
TETANUS TOXOID IMMUNIZATION
⮚ Both mother & child are protected
against tetanus & neonatal tetanus
⮚ A series of 2 doses of TT vaccination
must be received by a women 1month
before delivery to protect baby from
neonatal tetanus
⮚ And the 3 booster dose shots to
complete the 5 doses following the
recommended schedule provide full
protection for both mother & child.
⮚ The mother is then called a “FULY
IMMUNIZED MOTHER” (FIM)
⮚ There are many kinds of vaccines
used to protect against tetanus, all of
which are combined with vaccines for
other diseases: DT, DTaP, TD, Tdap
TETANUS TOXOID
⮚ To protect mother and her baby against
Clostridium-borne infection; injected
TWICE during pregnancy
⮚ Dose: 0.5 mL
⮚ Route: IM
⮚ Site: (R) & (L) Deltoid/Buttocks
⮚ 1st Pregnancy (G1) – give TT1 and TT2
(CBQ)
⮚ 2nd Pregnancy (G2) – give TT3 (1st booster
dose)
⮚ 3rd Pregnancy (G3) – give TT4 (2nd booster
dose)
⮚ 4th Pregnancy (G4) 0 give TT5 (3rd booster
dose)
TAKE NOTE:
1) If a pregnant mother received TT
injection, she is protected from tetanus
infection through ARTIFICIAL ACTIVE
IMMUNITY
2) 2 TT doses (TT2) protects for 1-3 years
although some studies indicate even
longer protection
3) TT is SAFE during pregnancy
4) If a pregnant mother has received 2
doses of TT. The baby is protected from
tetanus neonatorum through NATURAL
PASSIVE IMMUNITY
5) TT3 is administered 6 months after TT2
6) The nurse understands that the client
can be considered fully immunized
against tetanus if she received how
many booster doses of TT? ANSWER:
THREE
7) Which of the following dose of TT is
given to the mother to protect her infant
from neonatal tetanus and likewise
provide 10 years protection for the
mother? ANSWER: TT4
8) Of the mother receives TT4 vaccine:
this will give her protection that lasts up
to 10 years
9) A pregnant woman had just receive 4th
dose of TT, subsequently her baby will
have protection against tetanus for how
long? ANSWER: 1 year
INTRAPARTAL CARE:
⮚ Deliver at the Health Facility
⮚ FOLLOW UNANG YAKAP
PROTOCOL
1) Dry thoroughly (first 30 seconds)
2) Skin to skin contact (after 30
minutes)
3) Properly timed cord clamping
(within 1-3 minutes)
4) Early Breastfeeding and Rooming
In (within 90 minutes)
IMMINENT HOME DELIVERY
⮚ In case of imminent delivery at home,
birth attendants must be aware of the
CLEAN principles of HOME
DELIVERY
⮚ 5 CLEANS:
1) CLEAN hands of attendant
2) CLEAN surface
3) CLEAN cord
4) CLEAN cord tie without dressing
5) CLEAN and dry wrapping of baby
POSTPARTUM CARE
⮚ Delay facility discharge for at least 24
hours
⮚ Visit women and babies with home
births WITHIN THE FIRST 24 hours
⮚ FIRST 24 hours assess for vaginal
bleeding, uterine contractions, vital
signs and voiding within 6 hours
POSTPARTUM VISIT
⮚ Provide every mother and baby a total
of 4 POSTPARTAL VISITS on:
a) 1st visit: 1st day (within first 24
hours)
b) 2nd visit: Day 3 (48-72 hours)
c) 3rd visit: Between 7-14 days
d) 4th visit: 6 weeks
⮚ For a woman who delivered at the
health facility:
a) 1st visit: within FIRST week
preferably 2-3 days after
delivery
b) 2,d visit: end of puerperium or
4-6 weeks after delivery
MICRONUTRIENT DEFICIENCY (IVI)
a) IRON = causing ANEMIA
b) VITAMIN A = causing NIGHT
BLINDNESS
c) IODINE = causing CRETINISM
NUTRITION
⮚ Nutrition LAW: PD 491
⮚ Nutrition month: JULY
⮚ MOST VULNERABLE TO
MALNUTRITION:
a) Children
b) Lactating mothers
c) Infants
d) Pregnant
⮚ RA 8976 – Philippine Food
Fortification Act of 2000
⮚ FOOD FORTIFICATION:
✔ Addition of Sangkap Pinoy or
Micronutrient such as Vitamin
A, Iron and Iodine to food.
SANGKAP PINOY SEAL PROGRAM (SPSP)
⮚ A strategy to encourage food
manufacturers to fortify processed
foods or food products with essential
nutrients at levels approved by DOH
and use its seal
⮚ The seal is a guide used by
consumers in selecting nutrition’s
foods
MANDATORY FOOD FORTIFICATION
1) RICE – with Iron
2) WHEAT FLOUR – with vitamin A and
Iron
3) REFINED SUGAR – with vitamin A
4) COOKING OIL – with vitamin A
5) Other staple foods:
a) STAR Margarine (1992)
✔ FIRST ever product to
partner with DOH and the
FIRST to reserve the
Sangkap Pinoy Seal
GOVERNMENT SUPPORT PROGRAMS
1) Sustansya Para Sa Masa
2) Pan De Bida (Pandesal with Vitamin A)
3) NUTRI BAN
4) SALT FORTIFICATION
a) RA 8172 (Act for Salt Iodization
Nationwide –ASIN LAW)
b) Use salt with “FIDEL” seal
(Fortification for Iodine
Deficiency Elimination)
IODINE
⮚ For proper functioning of thyroid,
growth and development of the brain
⮚ Iodine deficiency is a leading cause of
preventable brain damage and
reduced IQ among children worldwide
⮚ Iodine Deficiency Disorder (IDD)
during pregnancy may result in
 stillbirth, miscarriage, and congenital a) Hgb levels <12 g/dL in women
abnormalities such as cretinism b) Hgb levels <13 g/dL in men
⮚ For iodine supplementation give ⮚ In children above 2 years old
iodized oil capsule with 200 mg iodine, ⮚ Anemia is worsened by hookworm and
1 cap for 1 year whipworm
⮚ Give Mebendazole + Iron supplement
GOITER ⮚ RISK INDIVIDUALS: WOMEN
⮚ Common in mountainous or inlands or a) Women at childbearing age
uplands areas where iodine content in b) Old age/elderly
the soil, water and food are different c) Menstrual and GI bleeding
⮚ Endemic goiter is more common (heavy)
among girls than boys and among d) Enteric parasitism (hookworm,
women than men. ascaris & trichuris)
⮚ Effect of iodine deficiency to fetus may e) Not enough iron intake
be born mentally and physically ⮚ CLINICAL MANIFESTATIONS:
retarded PALENESS
a) Pallor
OBESITY b) Anorexia
⮚ A risk factor for many chronic diseases c) Lightheadedness
including heart disease, cancer, d) Easy fatigability
hypertension and DM. e) Nail brittleness (koilonychia)
⮚ ABC for healthy nutrition: f) Enlargement of spleen
1) Aim for fitness g) SOB
2) Build a healthy base h) Sore/cramps of muscles
3) Choose sensibly (restless legs syndrome)
⮚ PREVENTION & MANAGEMENT:
3 SOMATOTYPES OR BODY TYPES a) Liver products
1) ECTOMORPH = Skinny; Difficulty in b) Lean & Red meats
gaining weight c) Legumes
✔ Narrow hips and clavicles d) Leafy green vegetables
✔ Small joints (wrist/ankles) 1. Camote (Sweet
✔ Thin build Potatoes)
✔ Stringy muscle bellies 2. Kangkong
✔ Long limbs 3. Malunggay
2) MESOMORPH = Naturally muscular; ⮚ TREATMENT of IDA: FeSO4
easy gain and loses weight a) Mainstay treatment
✔ Wide clavicles b) Continued for about 2 months
✔ Narrow waist after correction of the anemia
✔ Thinner joints c) Ferrous sulfate is the most
✔ Long and round muscle bellies common and CHEAPEST form
3) ENDOMORPH = Round; Difficulty in of iron utilized
losing weight; slower metabolism ⮚ MOST COMMON SIDE EFFECTS OF
✔ Blocky IRON
✔ Thick rib cage a) Constipation
✔ Wide/thicker joints b) Unpleasant taste
✔ Hips as wide (or wider) than c) Nausea & Vomiting
clavicles d) Tarry stool (Dark discolored
✔ Shorter limbs stool)
✔ High body fat (Central Obesity) ⮚ NORMAL side effect
✔ Pear-shaped
✔ High tendency to store body fat VITAMIN A DEFICIENCY (VAD)
⮚ VAD Causes:
IRON DEFICIENCY ANEMIA (IDA) a) Inadequate nutritional intake of
⮚ Normal Hgb Level: Vitamin A rich foods
a) MALES: 14-18 g/dL b) Lack of fats/oils in diet
b) FEMALES: 12-16 g/dL c) Rapid utilization of Vitamin A
⮚ According WHO, anemia is defined as: during course of illness
 d) Liver disorders = 80-90% of VITAMIN A SUPPLEMENTATION FOR
Vitamin A is stored in liver PREGNANT AND POSTPARTUM MOTHERS
e) Long term drinking alcohol (Table at the back)
lowers Vitamin A levels in the
liver TREATMENT SCHEDULE FOR
⮚ VULNERABLE GROUPS XERPOHTHALMIA FOR PREGNANT
a) Infants WOMEN
b) Preschoolers a) Pregnant women with
c) Pregnant night-blindness
⮚ VAD S/Sx: b) 1 capsule of 10,000 IU (Colorless
a) NIGHT BLINDNESS (EARLIST capsule)
SIGN) c) 1 capsule, once a day regardless of
⮚ Impaired dark adaptation d/t lack of the AOG
rhodopsin (NYCTALOPIA)
b) XEROPHTHALMIA PROTEIN ENERGY MALNUTRITION (PEM)
⮚ Dry, thickened conjunctiva and cornea ⮚ TYPES INCLUDE:
c) BITOT’S SPOTS a) KWASHIORKOR
⮚ Foamy soapsuds-like spots on white ⮚ PROTEIN malnutrition predominant
part of the eye b) MARASMUS
⮚ CALORIE deficiency intake
d) KERATOMALACIA c) MARASMIC KWASHIORKOR
⮚ Corneal erosions and ulcerations ⮚ Marked protein deficiency and marked
e) BLINDNESS (END STAGE) calorie insufficiency signs present,
⮚ Irreversible eye blindness sometimes referred to as the MOST
SEVERE FORM OF MALNUTRITION
VITAMIN A SUPPLEMENTATION
⮚ Provides PROTECTION UP TO 6 NUTRITIONAL INDICATORS
MONTHS 1) Arm Circumference (MUAC) – GOLD
Standard
SCHEDULE INFANTS PRESCHOOLERS 2) Low Height for Age (STUNTING)
(6-11 (12-59 months) 3) Low Weight for Age (Underweight)
months) 4) Low Weight for Height (Wasting)
TODAY 100,000 200,000 IU ❒ TAKE NOTE: classical indicator used
IU (Red capsule) by experts to diagnose MARASMUS:
(Blue a) Weight for Height (WFH) Z
capsule) score of less than -3
AFTER 6 100,000 200,000 IU ⮚ BEST INDICATOR OF MORTALITY
MONTHS IU (Red capsule)
(Blue MUAC INDICATORS (Mid-Upper Arm
capsule) Circumference) (Table at the back)
Given 100,000 200,000 IU
immediately IU (Red capsule) SERUM ALBUMIN
upon (Blue ⮚ Found to be a better predictor of
diagnosis capsule) underlying malnutrition than BMI
⮚ Most widely used laboratory measures
(GIVE ONE of nutritional status
CAPSULE) ⮚ Good marker of nutritional status
Given the 100,000 200,000 IU
next day IU (Red capsule) MARASMUS
(Blue ⮚ Wasting/Withering Malnutrition
capsule) ⮚ Cause by TOTAL CALORIC
Given after 100,000 200,000 IU DEFICIENCY
2 weeks IU (Red capsule) ⮚ HALLMARK SIGN:
(Blue a) Visible generalized muscle
capsule) wasting/withering
⮚ CLINICAL MANIFESTATIONS:
CALORIES
 a) Caloric deficiency (deficiency of
ALL NUTRIENTS) COMMUNITY HEALTH NURSING (PART 2)
b) Active & Irritable
c) Liver is NOT enlarged (NO ENVIRONMENTAL SANITATION
FATTY LIVER)
d) Old man look/Chipmunk face or REGULATORY LAWS:
Monkey face with Lanugo 1) PD 825 – Anti Improper Garbage
e) Retarded growth (Severe) Disposal (CBQ)
f) Infants under 1 year old are 2) PD 856 – Code Of Sanitation
commonly affected 3) RA 6969 – Toxic Waste Management
g) Eager or Voracious appetite 4) RA 8749 – Clean Air Act
h) Severe Muscle Wasting 5) RA 9003 – Ecological Solid Waste
⮚ TAKE NOTE: MARASMUS may also Management (CBQ)
have: 6) RA 9211 – Tobacco Regulation Act
a) Baggy pants appearance 7) RA 9275 – Clean Water Act
(REFER IMMEDIATELY!) 8) EO 26 – Smoked Free Environment
b) No hair color changes (appears
normal) GOALS
c) Loose wrinkled skin/Emaciated 1) MDG 7 – Ensure Environmental
look Sustainability By 2015
d) Weight loss 2) SDG 13 – Climate Change Action By
e) Child is like skin & bones (RIBS 2030 (at least decrease of 2° C)
ARE VERY PROMINENT)
f) Child may also have diarrhea & SOLID WASTE MANAGEMENT: 5 R’s
dehydration 1) REDUCE: Minimize amount of waste we
create
KWASHIORKOR 2) REUSE: Using items more than once
⮚ Edematous Malnutrition 3) RECYCLE: Putting a product to a new
⮚ Caused by PROTEIN DEFICIENCY use
⮚ HALLMARK SIGN: Edema of both feet 4) RECOVER: Practice of putting waste
⮚ CLINICAL MANIFESTATIONS: products to use
PROTEINS 5) REFUSE: Refuse wasteful and polluting
a) Pot belly/Large swollen products
protruding belly (ENLARGED
FATTY LIVER) ENVIRONMENTAL SANITATION
b) Ribs are NOT PROMINENT ⮚ Encompasses the control of
c) Occurs in children older than environmental factors that are
18 months to 2 y/o connected to disease transmission
d) Thin muscles & small MUAC ⮚ SDG is for everyone to have an
e) EDEMATOUS “Moon face” ADEQUATE AND EQUITABLE
appearance SANITATION by 2030
f) Increased risk of infection ⮚ Father of Public Hygiene & Sanitation:
g) No or lack of appetite Moses
(anorexia)
h) Sluggish, apathetic, lethargic, GLOBAL WARMING
unresponsive ⮚ Global Warming Potential
✔ The heat absorbed by any
⮚ TAKE NOTE: KWASHIORKOR may greenhouse gas in the
also have: atmosphere, as a multiple of the
a) Dry sparse discolored hair heat that would be absorbed by
(FLAG SIGN) the same mass of carbon dioxide
b) Growth retardation ⮚ CAUSE: Greenhouse gases (Carbon
c) Anemia Dioxide)
d) Skin lesions ⮚ Greenhouse Effect
1. Hyperkeratosis ✔ Ability of certain atmospheric gas
2. Dermatoses to trap the heat in earth surface
3. Dyspigmentation ⮚ Albedo Effect
 ✔ Ability of the earth surface to used N95 masks, used
reflect (bounce back) sunlight PPEs
(heat) back to the atmosphere.
✔ Asphalt Road = 0% Albedo Effect ❒ Infectious
(absorbs heat from the sun) YELLOW ❒ Chemical Waste/
✔ Ice/Snow/Clouds = 100% Albedo WITH Pharmaceutical Waste
Effect BLACK ❒ Heavy Metal
BAND
GREENHOUSE GASES: ❒ E.g. betadine, acid,
1) WATER VAPOR formaldehydes, expired
✔ most abundant greenhouse gas drugs
✔ acts as a FEEDBACK to the
climate ORANGE ❒ Radioactive Waste
2) CARBON DIOXIDE ❒ Toxic Waste
✔ Main contributor “forcing” climate ❒ E.g. radio isotopes, used
change
x-ray films, any
✔ Produce through burning of
fossil fuels equipment used in
3) METHANE (CH4) radiotherapy
4) NITROUS OXIDE (N20)
5) CHLOROFLUOROCARBONS (CFCs) RED ❒ Sharps
❒ TAKE NOTE: ❒ Toxic Waste
✔ O2 and CO2 are NOT ❒ E.g. needles, syringes,
Greenhouse gases scalpel blades, stylets,
❒ VITAL SIGNS OF THE EARTH: WARM
ampules, blood lancets
a) Warming Global Temperature
b) A Climate Change
BLUE ❒ Recyclable Materials
c) Rising Sea Levels
d) Melting Ice Glaciers (Most Visible
Sign of Global Warming)
APPROVED TYPE OF WATER FACILITIES
1) LEVEL 1 (POINT SOURCE)
SOLID WASTE SEGREGATION:
✔ With an outlet but without a
1) Prevention of Deforestation
distribution system (Rural
2) Promote Reforestation
Areas)
3) Waste Segregation
✔ 250 m away from farthest user
BLACK ❒ DRY ✔ It caters 15-25 households
❒ Non-Infectious Waste ✔ Delivers 40-140 L of water per
❒ E.g. paper products minute
(Most common waste in ✔ Water needs boiling for 3
hospitals), plastic, bottles minutes
✔ E.g. Protected wells,
Developed springs
2) LEVEL 2 (COMMUNAL FAUCET)
GREEN ❒ WET ✔ With a source, reservoir, piped
❒ Non-Infectious Waste distribution network and
❒ E.g. leftover foods, communal faucets
peelings, rotten products, ✔ 25 m away from farthest user
fish bones ✔ It caters 100-125 households
✔ Delivers 40-80 L of water per
minute
YELLOW ❒ Infectious ✔ Water needs boiling for 3
❒ Pathologic Waste minutes
❒ E.g. gauze, wound ✔ E.g. Stand posts (poso/pump),
dressings, diapers, Artesian wells
umbilical cord, placenta, 3) LEVEL 3 (WATERWORKS SYSTEM)
 ✔ With a source, reservoir, piped ✔ Separate raw meat,
distribution network and poultry, seafood and eggs
individual household taps from ready-to-eat foods.
✔ Tilt for densely populated urban ✔ Use separate cutting
communities boards and keep raw
✔ Water does need boiling for 3 meat way from other
minutes foods in shopping cart
✔ E.g. NAWASA ✔ Wipe surfaces and sweep
floor
APPROVED TYPE OF TOILET FACILITIES 3) Cook Thoroughly Reaching 70°
1) LEVEL 1 C (Right Cooking)
a) NON-WATER CARRIAGE Eggs, ground meats 160 °F
1. Pit Latrines Poultry, Fowl & 165° C
2. Pit Privies Leftovers
3. Reed Odorless Earth Fresh pork meat, 145°C
Closet steaks, chops &
4. Bored Hole roasts
b) LESS WATER CARRIAGE
1. Pour Flush Toilets
2. Aqua Privies 4) Keep Food at Safe
2) LEVEL 2 Temperatures (Right Storage)
✔ Water carriage facility with ✔ Keep refrigerator at 40°C
septic tank/vault or below.
✔ E.g. Water sealed & flushed ✔ Refrigerate leftovers
toilets within 2 hours of cooking
3) LEVEL 3 5) Use Safe Water And Raw
✔ Toilet facility with septic tank or Materials (Right Source)
vaults connected to a ✔ Keep boiling for 1-3
sewerage system and minutes
treatment plan ✔ Always check expiration
✔ TAKE NOTE: date of products
− Toilets, septic tank, ✔ AVOID buying canned
garbage MUST be 25 goods with dents and
m/70 ft. away from the deformations
water source ✔ SAFETY RULE: WHEN
IN DOUBT, THROW IT
NOT APPROVED TYPE OF TOILET OUT
FACILITIES:
1) LEVEL 1 HEALTH
a) Bucket Latrine ⮚ Is a state of complete physical, mental
b) Overhung Toilet (Coastal Areas) and social well-being and not merely
c) Cat Hole Latrine the absence of disease or infirmity
d) Flying Saucers (WHO)
⮚ HEALTH TRIANGLE: Physical, Social
FOOD SANITATION PROGRAM & Mental Health
⮚ 4 RIGHTS OF FOOD SAFETY ⮚ 10 DETERMINANTS OF HEALTH:
1) Right Source BIG CHEESE
2) Right Preparation 1) Behavior
3) Right Cooking 2) Income
4) Right Storage 3) Gender & Genetics (Internal
⮚ WHO Five Key Principles Of Food Variable)
Hygiene: 4) Culture
1) Keep Clean (Right Preparation) 5) Health Services
2) Separate Raw And Cooked 6) Education & Literacy
Foods (Right Preparation) 7) Employment
8) Social Support Network
 9) Environment (External Variable) 5) GOAL FO CHN:
a) Through multisectoral efforts
COMMUNITY 6) PRIMARY TOOL
⮚ A group of people with common a) Health Education
characteristics or interest living 7) PURPOSE of CHN
together within a territory or a) To make a change
geographical boundary 8) MOST IMPORTANT ROLE in CHN:
⮚ TAKE NOTE: a) Health Educator
1) COMMUNITY is the PRIMARY 9) The indicator of effective communication
CLIENT in CHN a) Feedback
2) FAMILY is UNIT OF SERVICE in
CHN PUBLIC HEALTH NURSING
3) POPULATION is the FOCUS OF ⮚ The science and art of (Winslow, 1920):
EPIDEMIOLOGY in CHN a) Preventing Disease
⮚ BEST DEFINITION: People with a b) Prolonging Life
sense of belonging or common c) Promoting Physical And Mental
identity Health
⮚ COMMUNITY HEALTH NURSING d) Efficiency Through Organized
✔ Coined CHN: Ruth Freeman Community Effort (Winslow, 1920)
✔ Coined PHN: Lillian Wald ⮚ Nurse is a COMMUNITY LEADER
✔ Utilization of the nursing process in ✔ by Florence Nightingale
the different levels of clienteles ⮚ Lillian Wald
✔ Specific field of nursing that ✔ FIRST PHN
combines the skills of nursing, ✔ FOUNDER of PHN
public health, and some phases of ✔ Coined the term Public Health
social assistance and functions Nursing
✔ Part of paramedical and medical ⮚ GOAL of PHN:
intervention which is concerned on a) For people to attain their
the health of the whole population birthrights of health and longevity
✔ CHN AIMS: ⮚ MOST PROMINENT FEATURE:
a) Health Promotion a) Public health focuses on
b) Disease Prevention PREVENTIVE, NOT CURATIVE
c) Management of Factors services
Affecting Health b) PREVENTION IS BETTER THAN
✔ PRIMARY GOAL: CURE
a) To enhance the capacity of ⮚ Place to apply PHN: Rural Health Unit
individuals, families and ⮚ Person for Requirements Approval:
communities to cope with Municipal Mayor
their health needs ⮚ QUALIFICATIONS: RN in the Philippines
✔ CHN PHILOSOPHY ⮚ TAKE NOTE:
a) Based on the WORTH AND ✔ In the event that the MHO is
DIGNITY of man (by Dr. unable to perform his duties or
Margaret Shetland) functions or is NOT AVAILABLE,
the PHN will take charge of the
MUST KNOW ABOUT CHN: MHO’s responsibilities.
1) Primary focus of CHN ⮚ PHN = SUPERVISOR of midwife
✔ Health Promotion & Disease ⮚ Midwife = first line of service to client’s
Prevention needs
2) PRIMARY GOAL of CHN
✔ Self-reliance in health & enhanced Roles of PUBLIC Health Nurse
capabilities a) CLINICIAN
3) ULTIMATE GOAL ✔ Provide nursing care
✔ Raise level of health of the ✔ Healthcare provider
citizenry ✔ Taking care of the sick
4) In CHN b) HEALTH EDUCATOR
a) Client-Active Participant ✔ Conduct health teachings
b) Full Involvement Recipient Care ✔ Disseminate correct information
 ✔ Educating people 3) DYAD
✔ Make life changes ✔ Husband or wife (must be
✔ MOST IMPORTANT ROLE MARRIED)
c) SUPERVISOR ✔ Early marriage life
✔ Leader of Midwives 4) SINGLE Parent
✔ Monitors and supervises the ✔ One parent and child/ren
performance of midwives ✔ mother and child/father and
d) MANAGER child
✔ Leader of Nurses 5) COHABITATION
e) RESEARCHER ✔ live-in with/without child/ren
✔ Gather data ✔ Not married
✔ E.g. contact tracing 6) BLENDED family
f) FACILITATOR ✔ 2 families mixed together
✔ Provide guidance/assistance to the ✔ Married couple with their
community children from previous
✔ Establish multi-sectoral linkages by marriages
referral system 7) SAME SEX/HOMOSEXUAL
✔ Self-reliance ✔ Family with a Gay and/or
g) COORDINATOR Lesbian partner
✔ Organize activities of the 8) COMMUNAL
community ✔ Live in a single area but not
blood related
Clienteles in CHN ✔ E.g. dorm-mates/board-mates
1) Individual = Entry Point 9) COMPOUND
2) Families = Basic Unit Of Service/Care ✔ Live in a single area but blood
3) Community = Primary Client related
4) Population Group = Point Of Specific ✔ E.g. Neighboring houses are
Care brothers and sisters
a) Children attending Schools 10) FOSTER FAMILY
(Aggregate Population) ✔ Adopted children
b) Pregnant Mothers 11) ALTERNATIVE FAMILY
c) Infants ✔ Relationships include
d) Elderly multi-adult households
e) Religious Groups ✔ Skip generation families
f) Indigenous People ✔ E.g. Grandparents caring for
grandchildren, Communal
FAMILY groups with children,
⮚ Unit of Service in the community “nonfamilies” (adults living
⮚ A small social system (2) or more alone), Cohabitating partners,
people living together who are related Homosexual couples
by blood, marriage, adoption 12) BEANPOLE
✔ Family comprised of 4 or more
CLASSIFICATION OF FAMILIES generations
1) NUCLEAR (TRADITIONAL)
✔ mother, father, children
✔ Must be MARRIED couple
✔ MOST COMMON TYPE of
family
2) EXTENDED/MULTIGENERATIONAL Types of family ACCORDING TO POWER
✔ Relatives live together in one 1) PATRIARCHAL/PATRIFOCAL
household ✔ Males have the POWER in the
✔ mother, father, children, house
grandparents, tito/tita ✔ Father is the decision-maker,
✔ MOST COMMON TYPE of and makes the rules
family IN THE PHILIPPINES 2) MATRIARCHAL/MATRIFOCAL
✔ Females have the POWER in
the house
 ✔ Mother is the decision-maker, achieve higher level of
and makes the rules functioning.
3) PATRICENTRIC
✔ No mother, father gets B. HEALTH THREATS
dominant power ❒ Conductive to disease,
✔ E.g. Father is working (OFW, accidents or failure
policeman) while mother stays ❒ To realize one’s health potential
at house ❒ Examples:
4) MATRICENTRIC 1. Family history of illness
✔ No father, mother gets ● Hereditary like DM,
dominant power HPN)
✔ Mother is working (OFW, 2. Nutritional problems
policewoman) while father ● Eating salty foods
stays at house 3. Personal Behavior
5) EGALITARIAN ● Smoking
✔ Both mother and father are the ● Self-Medication
decision-makers and makes ● Sexual Practices
the rules ● Drugs
✔ EQUAL authority of both ● Excessive Drinking
parents 4. Inherent personality
characteristics
Types of family ACCORDING TO LOCATION ● Short temperedness
1. PATRILOCAL ● Short attention span
✔ Newlyweds reside nearby ● Family size beyond
father’s family side what resources can
2. MATRILOCAL provide
✔ Newlyweds reside nearby 5. Short cross infections
mother’s family side 6. Poor home environment
3. BILOCAL 7. Lack/inadequate
✔ Newlyweds living near both immunization
sides 8. Hazards
❒ Additional Examples:
BASURAS
FAMILY CARE PLAN a) Broken glasses and
⮚ Blueprint of care to family scattered sharp objects
b) Absence or lack of
FAMILY ASSESSMENT prenatal visits or clinic
visits
TYPOLOGY OF NURSING PROBLEMS IN c) Safety hazards: Fires,
FAMILY NURSING PRACTICE Falls, and Accidents
1) FIRST LEVEL ASSESSMENT d) Unhealthy lifestyle:
(Categories of health problems) Faulty eating,
A. WELLNESS CONDITION Sedentary
1. WELLNESS POTENTIAL e) Rodents and Insects
❒ Nursing judgments f) Absence or lacks of
❒ No explicit expression of immunization
client desire g) Sanitation issues and
2. READINESS FOR family history of
ENHANCED WELLNESS diseases
STATE C. HEALTH DEFICITS
❒ Judgment on wellness ❒ Failure in health maintenance
state (disease, disability,
❒ Based on current developmental lag)
competencies and ❒ 3 TYPES:
performance a) DISEASE/ILLNESS
❒ Clinical data and explicit 1. URTI
expression of desire to 2. Marasmus
 3. Scabies 1) NATURE OF THE PROBLEM
4. Edema ✔ Wellness condition, health
b) DISABILITIES deficits, health threats & stress
1. Blindness points.
2. Polio 2) PREVENTIVE POTENTIAL
3. Color Blindness ✔ Nature and magnitude of
4. Deafness future problems
c) DEVELOPMENTAL ✔ Can be minimized or totally
DISORDERS prevented
1. Mental Retardation ✔ Intervention must be done on
2. Gigantism the problem in this part.
3. Hormonal Problems 3) MODIFIABILITY OF THE PROBLEM
4. Dwarfism ✔ Probability in enhancing
5. Trisomy 21 wellness state
✔ Improving condition
D. STRESS POINTS/ ✔ Minimizing, alleviating or totally
FORESEEABLE CRISIS eradicating the problem
❒ Anticipated period of ✔ Intervention must be done
UNUSUAL DEMAND on 4) SALIENCE
individual or family in terms of ✔ FAMILY’S PERCEPTION
adjustment or family resources ✔ Evaluation of problem in terms
❒ Examples: of seriousness and urgency of
a) Entrance In School attention needed.
b) Adolescents NATURE OF THE PROBLEM (Wt: 1)
(Circumcision, Menarche, 1) HEALTH DEFICIT 3
Puberty)
c) Courtship (Falling In 2) HEALTH THREAT 2
Love, Breaking Up)
d) Marriage 3) FORESEEABLE CRISIS 1
e) Pregnancy
f) Abortion PREVENTIVE POTENTIAL (ABILITY)
g) Puerperium (Wt: 1)
h) Death 1) HIGH 3
i) Unemployment
j) Transfer or relocation 2) MODERATE 2
k) Graduation
l) Board exams 3) LOW 1
❒ Additional examples: PAPA IS DEAD
a) Pregnancy MODIFIABILITY OF THE PROBLEM
b) Abortion (loss in safety & (Wt: 2)
security) 1) EASILY MODIFIABLE 2
c) Parenthood
d) Additional family member 2) PARTIALLY MODIFIABLE 1
(newborn)
e) Income loss (loss of job) 3) NOT MODIFIABLE 0
f) Separation or breakups
and courtship SALIENCE (Wt: 1)
g) Divorce & Annulment 1) HIGH (serious - immediate 2
h) Entrance in School
attention)
i) Adolescence
(Circumcision, Menarche,
2) MODERATE (serious – not 1
Puberty)
j) Death of love ones immediate)

CRITERIA FOR RANKING HEALTH 3) LOW (not seen as a problem) 0

CONDITIONS AND PROBLEMS
ACCORDING TO PRIORITIES:
CHN PROCEDURES a) Nature Of The
Illness
CLINIC VISIT b) Appropriate
A. PRE-CONSULTATION CONFERENCE Treatment And
✔ Pre-clinic lecture conducted Prevention
✔ Provide health education c) Control Measures
B. STANDARD PROCEDURES
PERFORMED DURING CLINIC 5) LABORATORY AND OTHER
VISITS DIAGNOSTIC EXAMINATIONS
1) REGISTRATION/ADMISSION ✔ Identify a designated
✔ Greet the client upon referral laboratory when
entry needed.
✔ Establish rapport 6) REFERRAL SYSTEM
✔ Prepare the family ✔ Two-way referral system
treatment record of new (BHS to RHU to hospital)
patients ✔ Accompany the patient
✔ Record client’s chief when an emergency
complaints and clinical referral is needed.
history 7) PRESCRIPTION/DISPENSING
✔ Perform physical ✔ Proper instructions on
examination drug intake
✔ First action in clinic visit 8) HEALTH EDUCATION
2) WAITING TIME ✔ One-on-one counseling
✔ Give priority numbers ✔ Reinforce health
✔ “First come, First served “ education
policy ✔ Give appointments for
✔ Exemptions for next visits
emergency/urgent cases ✔ LAST STEP of clinic visit
3) TRIAGING
✔ Manage program-based HOME VISIT
cases ⮚ Essential to prepare a plan to visit to
✔ Refer all non-program meet their needs of the client which
based cases to physician. assesses the living condition of the
✔ Other cases (no potential patient and health practices
danger), ⮚ ADVANTAGE: provides opportunity to
treatment/management is do FIRST HAND APPRAISAL of the
initiated by the nurse home situation
✔ Nurse decides to do her
own nursing diagnosis
✔ Refer clients to PURPOSES OF HOME VISIT:
physicians for medical a) Health care provider giving nursing
management care to the sick, postpartum, and her
4) CLINICAL EVALUATION newborn
✔ Validate clinical history b) Observation and assessment of living
and physical examination condition and family health practices
✔ Evidenced-based nursing c) May establishes close relationship
diagnosis and rational between health agencies
treatment based on DOH d) Educate family regarding health
programs are provided by promotion and disease prevention
the nurse
✔ Identify patient’s problem PRINCIPLES INVOLVED IN PREPARING
✔ Formulate nursing FOR A HOME VISIT
diagnosis and validate 1) Must have a purpose or objective
✔ Perform the nursing 2) Use of all available information about
intervention patient and the patient’s family
✔ Evaluate the intervention 3) Set and give priority to the essential
✔ Inform client: needs of the family
 4) The planning and delivery must
Involve the individual and family
5) Home visit must be FLEXIBLE
STEPS IN CONDUCTING HOME VISITS
1) Greet the patient and introduce
yourself (ESTABLISH RAPPORT)
(FIRST STEP)
2) State the purpose of your visit
3) Observe patient and Assess the health
needs
4) Put the bag in a convenient place
(stable table) then perform bag
technique
5) Perform physical examination and
nursing care
6) Impart health teachings
7) Record all important data, observation
and care rendered
8) Make appointment for a return visit
PHN BAG
⮚ The public health bag is an essential
and indispensable equipment of a
PHN which she has to carry along
during her home visits.
⮚ LEFT HAND must be the PHN bag in
a 45° angle flexed
⮚ RIGHT HAND must hold the long,
black umbrella
BAG TECHNIQUE
⮚ A tool which the nurse, during her visit
will enable her to perform a nursing
procedure with ease and depth, to
save time and effort, with the end view
of rendering effective nursing care to
clients.
IMPORTANT POINTS TO CONSIDER IN THE
USE OF THE BAG:
a) Should contain all the necessary
articles, supplies and equipment
(COMPLETE)
b) The bag and its contents should be
cleaned very often. (CLEAN)
c) Well protected from contact with any
article in the patient’s home.
d) Consider the bag and its contents
clean and sterile. (CONTAMINATION)
e) The arrangement of the contents of the
bag should be the one most
convenient to the user.
✔ Solution like 70% alcohol,
hydrogen peroxide and
heading are placed at the
BACK OF THE BAG
✔ Oral & Rectal thermometers,
syringes and needles should
be placed AT THE FRONT OF
THE BAG
✔ Thermometers should be
FACING DOWN
f) Hand washing is done frequently as
situation for (HANDWASHING)
✔ Helps minimizing and avoiding
contamination.
PRINCIPLES OF BAG TECHNIQUE
a) Minimize, if not, prevent the spread of
any infection (MOST IMPORTANT)
b) Save time and effort
c) Show effectiveness of total care given
to an individual
d) Performed in a variety of ways
depending on the agency’s policy or as
principles of avoiding transfer of
infection is always observed
COMMON BOARD QUESTIONS:
1) Upon arriving client’s home, place the
bag on the table or any flat surface
lined with paper lining, clean side out
(folded part touching the table)
2) Place the linen/plastic lining spread
over work field or area CLEAN SIDE
OUT
3) LAST item placed in the bag is the
PLASTIC/PAPER LINING
4) Sphygmomanometer (BP Cuff),
Stethoscope & Hypodermic needles
(0.5 in) IS NOT INCLUDED INSIDE
the PHN bag
5) DO NOT USE NEWSPAPERS only
clean papers as linings
6) FIRST thing you get from CHN bag –
SOAP in a SOAP DISH and HAND
TOWEL
7) AVOID FREQUENT opening of the
bag
8) AVOID SHAKING OR SWAYING the
bag when carrying it
9) Bag technique should not
overshadow but rather show the
effectiveness of the total care given to
the individual and family.
COPAR (Community Organizing Participatory
Action Research)
⮚ CONTINUOIS and DYNAMIC
process of encouraging people
⮚ Helps people to understand/develop
their awareness of their existing
conditions by providing the skills,
 capacity training and working with the g) The Actual Site Selection
people (CBQ)
⮚ A social development approach that h) Initial Or Preliminary Social
aims to transform into DYNAMIC. Investigation (PSI)
PARTICIPATORY and POLITICALLY i) Ocular Survey/Windshield
RESPONSIVE community Survey Noting Accessibility,
⮚ Framework of Primary Health Care Geography, Terrain, And
⮚ GOAL: Self-reliance Available Resources
⮚ Role of Nurse in COPAR: j) Networking With LGUs And
FACILITATOR NGOs And Other Department
❒ ACTIVITIES OF PRE-ENTRY:
IMPORTANCE OF COPAR: SAME a) Profiling Of Communities
1) Self-Reliance to manage a (Site Selection)
development program in the future b) Courtesy Call To Mayor
2) Active community participation and c) Trains Students On Baseline
involvement is maximized Survey
3) Mobilized community resources for d) Interview
community services e) Ocular Survey/Windshield
4) Empowerment of the people and Survey
community development f) Networking with other
departments
PRINCIPLES OF COPAR: POWER g) Poster/Host Family
1) People’s participation should always Selection
pe present ❒ CRITERIA FOR SITE SELECTION:
2) Oppressed and exploited sectors are DEPRESSED
most open to change a) Depressed and Exploited
3) With COPAR is lead to self-reliant Rural Community
community b) Ensure acceptance (No
4) Empowerment: power must reside in strong resistance from the
the people people)
5) Remember: COPAR should be for the c) Poor
interest of the poorest sectors of the d) Residents (100-200 families)
society e) Economically depressed
f) Safe (No Serious peace and
PHASES OF COPAR order problem)
1) PRE-ENTRY PHASE (1-2 months) g) Show high morbidity and
⮚ INITIAL PHASE of the infant mortality cases
organizing process h) Ensure no similar agency
⮚ Looking for communities to holding the same programs
serve or help (Area/Site i) Do not have BHS or nearby
Selection) hospital
⮚ SIMPLEST PHASE CRITERIA FOR SITE SELECTION
❒ ACTIONS POOR & a. Majority Below
a) Formulation Of Goals & DEPRESSED Poverty
Objectives b. Lack of Income
b) Institutional Goals
c) Revision Of Curriculum c. Lack of
d) Seek And Coordinate Opportunities
Participation Of Other
Adjustments Within The INACCESSIBLE/ a. No hospital
Institution INADEQUATE within 5 km (30
e) At The Community Level, HEALTH minutes) from
Encourage Dialogues With SERVICES
community
The People b. No health
f) Criteria For Site Selection
centers
Development
 POOR HEALTH a. High Infant c) Converse with people in their
STATUS Mortality Rate visual gatherings/area of
b. High incidence congregation
d) Living with the community
of
e) Information campaign on
Communicable health programs
Diseases f) Participate in livelihood
c. High activities
Malnutrition g) Support and lend a hand in
Rate household chores
d. Lack of h) Ensure to be a ROLE MODEL:
AVIOD gambling and drinking
Sanitation
alcohol
i) Deepening social investigation
NO STRONG RESISTANCE AGAINST
j) Potential Leader spotting
COMMUNITY ORGANIZATION
k) Core Group Formation
NO SERIOUS PEACE AND ORDER l) Self-Awareness & Leadership
PROBLEM Training (SALT)
NO EXISTING COMMUNITY ❒ CRITERIA FOR POTENTIAL
ORGANIZATION/AGENCY LEADER: LEADS
a) Low profile
2) ENTRY PHASE: PASOK b) Education: at least basic
⮚ Phase for Social Preparation primary education
(CBQ) c) Approachable/respected by
⮚ Actual entry of the nurse or both formal & informal sectors
community organizer into the d) Develops good
community (CBQ) communication skills
⮚ Sensitization of the people on e) Serve willfully (CBQ)
the critical events in their life
⮚ Organizer motivates the people 3) COMMUNITY STUDY/DIAGNOSIS
to share their dreams and PHASE (RESEARCH PHASE)
ideas ⮚ Selection o the research team
⮚ Known as the MOST CRUCIAL ⮚ Training of researchers on data
PHASE (CBQ) collection (CBQ)
❒ GUIDELINES FOR ENTRY PHASE: ⮚ Planning for the actual
PLEASE gathering of data
a) Pay courtesy call upon entry ⮚ Data gathering
to the community to the local ⮚ Training on data validation
authorities (Barangay ⮚ Community validation
Officials) ⮚ Presentation of the community
b) Let them know your project study/diagnosis and
objectives recommendation
c) Ensure to be a ROLE MODEL ⮚ Prioritization of community
d) Avoid raising needs/problems for actions
expectations/consciousness of ❒ METHODS OF DATA SELECTION
the community residents a) Survey (MOST PRACTICAL)
e) Speech, behavior and lifestyle − Using questionnaires
should be in keeping with b) Interview (face-to-face)
those of the community − Using interview guide
residents c) Record Review (Checklist)
f) Ensure to adopt a low-key d) Census (MOST IDEAL of
profile data)
❒ OTHER INFORMATION: − Provides biggest bulk of
a) Immersion/Integration/ data
Sensitization with the − Complete enumeration of
community data
b) Establish Rapport e) Observation (Ocular surveys)
❒ 2 types of CENSUS ⮚ Formulation and development
a) DE FACTO of SECONDARY leaders
− ACTUAL phase (CBQ)
− Individuals are recorded ⮚ Setting up of financing scheme
in the geological area in implementation of livelihood
where they were projects
present at a specific ⮚ Training and continuing
time education of BHWs (CBQ)
b) DE JURE ⮚ Formulation/Ratification of
− RESIDENCY by-laws
− Individuals are ⮚ TAKE NOTE:
recorded by their place a) Formalize linkages,
of residence networks and referral
− Usual residence system
− The place where a b) Register organization to
person lives and SEC (Security and
sleeps most of the time Exchange Commission)
7) PHASE OUT PHASE
4) COMMUNITY ORGANIZATION & ⮚ Gradual turnover of works
CAPABILITY BUILDING PHASE ⮚ Transfer of community
⮚ Election of officers and organizing and responsibilities
delineation of roles and tasks and documents to organization
⮚ Leaders or groups are being ⮚ Need for Follow up
given trainings (formal, informal,
OJT) COMMUNICABLE DISEASES
⮚ Entails the information of more ⮚ EPIDEMIOLOGY
formal structure ✔ Study of the occurrences,
⮚ Community meeting s to draw up distribution and determinants of
guidelines effort the organization health related states or events
⮚ Team building Exercises in specified populations
⮚ TAKE NOTE: ✔ Backbone of disease
✔ A-R-A-S prevention
(Action-Reflection-Action ⮚ EPIDEMIOLOGIC TRIAD
Session) a) HOST-AGENT-ENVIRONMEN
T
b) Host
5) COMMUNITY ACTION PHASE ✔ INTRINSIC FACTOR
⮚ Organization and training of ✔ man as primary host
BHWs c) AGENT
⮚ PIME of health services ✔ ETIOLOGIC FACTOR
(Project Implementation, ✔ Virus, bacteria, fungi,
Monitoring and Evaluation) parasites etc.
⮚ Resource mobilization d) Environment
⮚ Setting up of ✔ EXTRINSIC FACTOR
linkages/networks/ referral JOHN SNOW
system ⮚ Anesthesiologist known as FATHER
6) SUSTENANCE AND OF EPIDEMIOLOGY
STRENGTHENING PHASE (7-8 ⮚ In 1800s: He studies epidemic of
months) CHOLERA erupted in Golden Square
⮚ Occurs when the community of Soho District, London (1854)
organization has already been
established 2 TYPES OF EPIDEMIOLOGY
⮚ Community members already 8) DESCRIPTIVE EPIDEMIOLOGY
actively participating in ⮚ DISTRIBUTION
community wide undertaking ⮚ It answers the questions
(CBQ) WHEN, WHERE, and WHO
⮚ The time, place and person
 ⮚ Identify patterns among cases ⮚ Several countries (Worldwide)
and in populations by time, ⮚ PANDEMIC DISEASES:
place and person a) MERS COV
⮚ Surveys are used to find out b) Asian Flu
the nature of the population c) Spanish Flu (1918-1919)
affected by a particular disease d) Antonine Plague
noting the age, sex and e) Meningococcemia
occupation f) AH1N1
9) ANALYTIC EPIDEMIOLOGY g) Black Death/Bubonic
⮚ DETERMINANTS Plague (Yersinia pestis)
⮚ Discovers causes, risk factors, h) HIV/AIDS (Man Sex Man
modes of transmission Relationship)
⮚ It answers WHY and HOW i) Ebola
⮚ Includes the causes (including j) COVID-19 (SARS COV-2)
agents) and risk factors ✔ March 11, 2020 –
(including exposure of sources) COVID 19 is now
⮚ HALLMARK: Presence of global pandemic
comparison group
⮚ Concerned with the search for RA 3573 (LAW ON REPORTING OF
cause and effects NOTIFIABLE DISEASES)
⮚ Report to provincial and duty health
EPIDEMIOLOGIC PATTERNS office
1) SPORADIC ⮚ MIDWIFE REPORTS (under
⮚ Intermittent Occurrence supervision of the nurse)
⮚ Irregular interval ⮚ REPORT MEASLES & POLIO within
⮚ Random locations 24 hours
⮚ Scattered cases ⮚ Tetanus Neonatorum, Severe and
⮚ E.g. rabies Acute Diarrhea, HIV must be reported
2) ENDEMIC within a WEEK
⮚ Constant presence
⮚ Usual prevalence of a disease in CHAIN OF INFECTION
a population within geographical 1) INFECTIOUS AGENT
area ❒ Bacteria, Virus, Fungi, Protozoa
⮚ Continuous occurrence ❒ How to break the CHAIN?
⮚ Steady frequency a) Rapid organism
⮚ Over a period of time identification (DIAGNOSIS)
⮚ Inherent in a given locality b) Prompt treatment
⮚ E.g. Schistosomiasis in Leyte, c) Decontamination
Malaria in Palawan, Filariasis
3) EPIDEMIC VIRULENCE ✔ Ability to cause a
⮚ Outbreak disease
⮚ Greater than usual ✔ Overall strength to
⮚ Short period of time usually in
cause a disease
weeks
⮚ TYPES OF EPIDEMIC
INFECTIVITY ✔ Capacity of agent to
a) POINT SOURCE – food
poisonings enter and multiply in a
b) CYCLICAL PATTERN – susceptible host
Dengue fever
c) SECULAR trend – Influenza, INVASIVENE ✔ Ability to penetrate an
Measles SS intact skin
d) PROPAGATED – HIV/AIDS
4) PANDEMIC PATHOGENIC ✔ Capacity if agent to
⮚ Simultaneous occurrence of ITY cause a clinical disease
epidemic in the infected host
⮚ Concurrent occurrence
⮚ Same disease
TOXIGENICIT ✔ Capacity of agent to ❒ Cholera exits in feces
Y produce a toxin or ❒ How to break the CHAIN?
poison a) Control of secretions
b) Hand hygiene
ANTIGENICIT ✔ Ability to combine c) Proper waste disposal
Y d) Avoid taking, coughing or
specifically with the final
sneezing over open
products of the mention wounds/sterile fields
responses (i.e. e) Cover mouth and nose
antibodies and/or when coughing/sneezing
cell-surface receptors)
4) MODE OF TRANSMISSION (means
❒ KILLING MICROORGANISMS BY: by which the agent passes through
a) DISINFECTION: killing of from the portal of exit of the reservoir
microorganisms but NOT their to the host)
spores DIRECT CONTACT INDIRECT CONTACT
b) STERILIZATION: killing of all − Reservoir to a
microorganisms including host by
spores suspended air
c) AUTOCLAVING: 15 lbs. particles,
pressure, moist heat and 250
vehicles and
°F
d) Blacks trips suggest successful vectors
autoclave
2) RESERVOIR (any site where the CONTACT VEHICLE (inanimate
pathogen can multiply or merely objects)
survive until it is transferred to a host) Skin to skin contact,
❒ Human Reservoirs (Measles, kissing, sexual Indirectly transmit an
Mumps, HIV, STI) contact, contact with infectious agent
❒ Animal Reservoirs soil or vegetation
(Anthrax–Sheep, Rabies-Dogs) 5 F’s:
❒ Environmental Reservoirs (plants, infectious Feces, Food, Fluids,
soil and water) - Histoplasmosis mononucleosis Fingers, Flies,
❒ CARRIER (kissing disease) Fomites
⮚ a person that harbors a
specific infectious agent Hookworm (spread NO DEVELOPMENT
without discernible disease by contaminated soil) of agent
⮚ serves as a potential
source of infection Examples: Examples:
❒ How to break the CHAIN? a) Multidrug a) Milk and Dairy
a) Environmental sanitation resistant foods carrying
b) Good health & hygiene organism LISTERIOSIS
c) Decontamination/ (Methicillin) ( L.
Sterilization b) Respiratory monocytogene
d) Dressing change
Infections s)
e) Appropriate linen disposal
f) Proper feces and urine c) Skin infections b) Food carrying
disposal (Wound, Salmonella
3) PORTAL OF EXIT (path by which the tetanus, c) Water carrying
organism leaves the reservoir) ringworm, Legionella
❒ Mouth (vomit, saliva) scabies) d) Blood can
❒ Cuts in the skin (blood) d) Wound carry Hepatitis
❒ During diapering and toileting
Infections e) Drugs can
(stool)
❒ Influenza & TB exits in respiratory carry bacteria
tract from
 e) Enteric contaminated d) Group A Strep
Infections (GI infusion e) Neisseria
diseases) supplies meningitis
f) Eye infections f) Contaminated
(Conjunctivitis blood, food,
DROPLET
) water,
PRECAUTIONS:
inanimate a) Streptococcal
objects are Infection and
vehicles of Scarlet Fever
transmission b) Pertussis,
Pneumonia,
AIRBORNE
VECTOR (animal Parvovirus
Less than 5 microns intermediaries) R-19
in size c) Influenza
Animals/insects that d) Diphtheria
Suspended longer can transmit the e) Epiglottitis
disease f) Rubella
Travels more than 3
g) Mumps,
ft. DEVELOPMENT of
agent Measles,
Examples: Mycoplasma,
a) Measles e.g. Mosquitoes, Meningitis
b) TB Fleas, Ticks h) Adenovirus
c) Varicella Infection
i) Novel
Coronavirus
(COVID-19)
DROPLETS (Body
fluids)
AEROSOL
Spray with relatively
large, short-range
Tuberculosis,
aerosol
Measles, Chickenpox
More than 5 microns
DROPLET OF
in size
SALIVA
Do not remain
Mumps, Rabies,
suspended in air for
Infectious
very long
mononucleosis
Seldom travel more
❒ Considered as the WEAKEST
than 3 feet
LINK
❒ Can be easily break by hand
Small pox and SARS
washing
could reach persons
❒ Hand washing is the number one
located 6 feet or more
way to stop transmission of
from source
infections
❒ HAND HYGIENE is the single most
Examples:
effective and important technique
a) Flu
to use in and controlling
b) Rhinovirus transmission of infection
c) SARS
 ⮚ 3 elements of Hand
washing:
a) Soap (1-3 mL)
b) Water (running clean
water)
c) Friction (Most important
element)
⮚ Hand washing is 40-60
seconds
⮚ Minimum time each hands:
15 seconds
⮚ Average time: 20 seconds
each hands
⮚ BEST time: 30 seconds
⮚ Minimum percentage of
ethanol: 60% ethanol
❒ How to break the CHAIN?
a) Hand Hygiene
b) Isolation Precautions
c) Disinfection/Sterilization
d) Use Of PPE
e) Aseptic Technique
5) PORTAL OF ENTRY
❒ Mouth, Cuts in the skin, Eyes
❒ How to break the CHAIN?
a) Hand Hygiene
b) Aseptic Technique
c) Wound Care
d) Puncture-Resistant
Containers
6) SUSCEPTIBLE HOST
❒ How to break the CHAIN?
a) Recognize High-Risk
Patients
b) Prompt Treatment
c) Maintain Skin Integrity
d) Balanced Diet
e) Immunization
❒ RISK FACTORS OF A
SUSCEPTIBLE HOST
a) Children
b) Elderly
c) People with a weakened
immune system
d) Unimmunized people