COMMUNITY HEALTH NURSING
BULLETS Human Resources for Health (HRH) – NDP,
1. DOH Vision – Filipinos are among the healthiest
people in Southeast Asia by 2022 and Asia by
2040
2. DOH Mission – To lead the country in the
development of people-centered, resilient, and
equitable health system
3. FOURmula 1 Plus Strategy – STRATEGIC
FOCUS:
a. Institutionalize a People Centered Service
Delivery Network (SDN)
• Engage the healthy – preventive and
promotive
• Engage the sick – curative, rehabilitative,
palliative
• Engage the affected population –
preparedness and response to conflicts
and disasters
• Engage the special groups
Geographically Isolated and Depressed
Area (GIDA), Indigenous Population &
Migrant Workers
b. LEAD a Whole-of-Society Collaboration AT
ALL LEVELS against TOP RISK FACTORS:
• Diet – Healthy Markets and Produce
• Physical Activity
• Smoking – taxation and smoke free places
• Road Traffic Injuries – helmet and child restraint
4. STRATEGIC PILLARS of FOURmula 1 Plus
1ST PILLAR: FINANCING through:
1. Increased resources for health (sin tax,
sugar sweetened beverage task) and
PhilHealth funding
2. EXPAND Benefits FAIRLY
3. Improve FINANCIAL PROTECTION
and CONTAIN COST through Zero and
fixed payment
2ND PILLAR: SERVICE DELIVERY (demand for
holistic client experience):
1. Enable comprehensive PRIMARY HEALTH
CARE approach
- Invest in HEALTH PROMOTION and DISEASE
PREVENTION
2. Cultivate and engage COMPETENET
HEALTH WORKFORCE
- RETURN of SERVICE for scholars
- Maintain national health workforce pool through
PHA, UHC
3. Capacitate public hospitals to become
MODEL HOSPITALS
- Upgrade governance and management
practices
3rd PILLAR: REGULATION (Shift to a regulatory
regime that reinforces equity and embraces
innovation)
1. Support healthy food, lifestyle, environment
2. Enable PATIENT’S CHOICE – publish prices
of goods and services
3. Increase ability to enforce
4. Ensure EQUITABLE distribution of health
facilities and professionals
4 AREAS of REGULATION:
a. Services
b. Professionals
c. Facilities
d. Products
–
4th PILLAR: GOVERNANCE (Foster a culture of
learning and shared accountability)
1. Drive timely, evidence-informed, data driven
information – build health policy and
research
2. Integrate the public system at a
PROVINCIAL LEVEL – promote province
wide investment plans for health
3. Build succession of health managers and
leaders
4. Upgrade supply chain and logistics
management systems
PLUS +: PERFORMANCE ACCOUNTABILITY
(ADDITIONAL PILLAR)
- Publish SCORECARDS in platform easily
accessed and manners easily understood
- Regular surveys to identify administrative data
gaps
POLIOMYELITIS (POLIO)
• Caused by poliovirus that can be transmitted
through infected food and water (vehicle-
borne transmission)
• Signs and Symptoms:
- Fever
- Sudden onset of lower back and neck pain
- Acute flaccid paralysis (lower extremities, least
common in upper extremities)
- Difficulty of breathing
• Polio is NON-CURABLE
• Best Prevention for Polio: Immunization
 6 weeks – OPV 1 (2 gtts or drops)
10 weeks – OPV 2
14 weeks – OPV 3 + One dose Inactivated Polio
Vaccine (IPV) 0.5 ml IM @ Vastus Lateralis
• The recent Polio outbreak is considered
EPIDEMIC – since Polio has been previously
eradicated in the country
• Herd Immunity against is developed through
wider OPV vaccination coverage
• Health Promotion and Primary Prevention:
a. Proper Handwashing/Hygiene
b. Clean surroundings
c. Zero Open Defecation in APPROVED
TOILET FACILITIES only
d. Drink and consume SAFE food and water
only (boil water for at least 2 minutes or use
Sodium Hypochlorite tablet)
• MOST FATAL COMPLICATION: Paralysis of
Respiratory Muscles
• CHRONIC COMPLICATION: Irreversible
Paralysis of Lower Extremities
LEPTOSPIROSIS (Japanese 7 Days Fever)
• Agent: Leptospira SPIROCHETE BACTERIA
found in infected FECES AND URINE
• Mode of Transmission: Vector-borne – RATS,
RODENTS, VERMIN through:
a. Direct inoculation- contaminated water
comes in contact with broken skin (floods)
and soil
b. Ingestion of infected food and water
• Incubation Period: 7-10 days
• Signs and Symptoms:
a. Fever
b. Calf muscle pain and headache
c. Reddish eye
d. Jaundice, “yellow eyes”, dysuria, oliguria –
renal and liver involvement
• Drug of Choice: Doxycycline
• Prevention and Control:
a. Avoid swimming and wading in flood water
b. Use boots and gloves
c. Vermin control (rat traps, pesticides)
• Complications:
a. Kidney Failure
b. Hepatic Failure
c. Abortion and Premature Labor
RESPONSIBLE PARENTHOOD AND
REPRODUCTIVE HEALTH ACT (RA 10354)
• It was APPROVED in 2012
• Reproductive Health is defined as a state of
complete physical, mental, and social well-being
and not merely the absence of disease or
infirmity in matters relating to reproductive
system and its processes
• Principles:
1. Marriage is inviolable and is the foundation of
a family
2. Family is the foundation of nation/society
3. DOES NOT promote abortion as a form of
contraception
4. DOES NOT prevent the implantation of fertilized
ovum
• According to this Bill, the Filipino family has the
ff. rights:
A. Spouse finds a family in accordance with his
religious conviction and demand for
parenthood
B. Children has the right to assistance
C. Right to minimum living wage and income
D. Right to PARTICIPATE in planning and
implementation of policies
• Couple has the right to make FREE AND
INFORMED DECISIONS (Nurses must provide
options, the couples will decide what method to
be used) – with NO COERCION
• INFORMED CHOICE AND VOLUNTARISM –
shall be promoted in all public and private
institutions
• NO DISCRIMINATION or deprivation of services
for both MARRIED and UNMARRIED
• RA 10354 strengthens provision of BASIC
EMERGENCY OBSTETRIC AND NEWBORN
CARE (BEMONC) – must be available 24/7
• BEMONC – MATERNAL SERVICES include:
a. Administration of the ff.:
1. Parenteral oxytocic drug
2. Loading dose of parenteral
anticonvulsants (MgS04, Diazepam)
3. Parenteral Antibiotics
4. Antenatal administration of Steroids
(Dexamethasone) for threatened
premature delivery
b. Assisted (forcep) vaginal delivery
c. Removal of retained placenta (D and C)
d. Manual (by hand) removal of placenta
• BEMONC – MATERNAL SERVICES include:
a. MINIMUM newborn resuscitation
b. Provision of warmth
• COMPREHENSIVE EMONC can deliver the ff.
LIFE-SAVING MEASURES:
a. Surgical deliveries (CS)
b. Blood bank services
c. Highly specialized obstetric services
d. Specialized Newborn resuscitation
e. Treatment of neonatal sepsis
f. Oxygen support
 g. Antenatal administration of Steroids Basis:
(Dexamethasone) for threatened • Universal Declaration of Human Rights
premature delivery • First INTERNATIONAL CONFERENCE and
DECLARATION of PHC – ALMA ATA, USSR
• Gender equality (equal rights for men and (September 6-12, 1978) sponsored by:
women); Gender equity (favors women as a. WHO
disadvantage or needs preferential treatment) b. UNICEF
• Philippine Basis – Letter of Instruction (LOI
949) – signed by Ferdinand Marcos (October
• RA 10354 prioritizes BASIC SECTORS or the 19,1979) – aims to achieve Health in the Hands
Disadvantaged Sector which includes: of People by 2020
a. Farmer – peasant
b. Artisanal Fisherfolk • Central Theme of PHC – Partnership and
c. Formal, Informal and Migrant Workers Empowerment
d. Indigenous people
e. Women • Essential Requisites to PHC
f. Differently-abled persons a. Focus – health promotion and illness
g. Senior citizens prevention
h. Victims of calamities and disasters b. Content – from treatment of episodic illness
i. Youth and children to continuous, comprehensive promotive
j. Students care
k. Urban poor c. Organization – from specialist to generalist
practice
• Maternal Death/Mortality – refers to death of a d. Responsibility – from passive to active
woman while pregnant or within 42 days after community involvement
termination of pregnancy (postpartum) of factors
related to pregnancy (DIRECT CAUSES only) • Aspects:
a. Promotive:
• Maternal Death – DIRECT CAUSES 1. Health Education
(Example): 2. Promotion of Food and Water Supply
a. Hemorrhage and Shock 3. Proper Nutrition
b. COPD and Cardiac Problem aggravated by 4. Basic Sanitation
pregnancy
c. Abortion b. Preventive:
d. Puerperial sepsis 1. Maternal and Child Care Services
e. Gestational DM 2. Family Planning
f. Pre-eclampsia and Eclampsia 3. Immunization
g. Abruptio and Previa 4. Prevention and Control of Endemic
h. Dehydration related to Hyperemesis Disease (Prophylaxis)

• INDIRECT CAUSE – ** not to be considered as c. Curative:

Maternal Mortality: 1. Treatment of common diseases and
a. Road Accidents injuries through provision of essential
b. Physical Abuse leading to trauma or bleeding drugs

• MODERN Family Planning Methods refer to FOUR CORNERSTONES/PILLARS (AIUS)

BOTH NATURAL AND ARTIFICIAL means of
contraception
• Natural Family Planning – tracks woman’s
fertility cycle and signs of ovulation
• PRO BONO SERVICE – 48 hours FREE
EDUCATION/COUNSELLING SERVICES of
Doctors for INDIGENT clients (required by PHIC)
PRIMARY HEALTH CARE
- Essential health care made universally
accessible and acceptable
1. Active Community Participation – main
indicator of empowerment
2. Intra- and Intersectoral Linkages
3. Use of Appropriate Technology
4. Support Mechanism made Available – refers
to equity in access to health
CHARACTERISTICS of PHC
A. COMMUNITY BASED – health services
should be delivered where the people are
B. ACCESSIBLE – can be reached by majority
of the population and in far-flung areas,
visited by health workers (30 minutes
from main roads)
 C. ACCEPTABLE – people agree and satisfied • Focus:
with health services, low income should be a. Promotion, protection and restoration OF
served MOSTLY worker’s health
D. SUSTAINABLE – for continued and b. Preventing injury in the workplace
maintained health services, community c. Reducing workplace hazards
members must be involved, self-
confidence, self-efficient and self-reliant RA 1054 stipulates:
E. AFFORDABLE – usage of traditional a. For business with less than 30 employees –
herbal plants and alternative forms of occupational health service is rendered by
healing together with generic essential PHN
drugs b. For business with 30-100 employees
located within 1km from RHU – OHN
services will be rendered by PHN, if beyond
NON-COMMUNICABLE DISEASE CONTROL 1 km – NEED TO HIRE an OHN/Company
(NCD) Nurse
c. 101 – 200 – needs to have OHN, supplies
*NCD/LIFESTYLE Related Illnesses are the and equipments
leading causes of death among adults in the d. 201 – 300 – OHN, supplies, equipments,
Philippines dentist, resident physician are needed
e. >301 employees - OHN, supplies,
• FOUR MAJOR NCD: equipments, dentist, resident physician,
A. Cardiovascular Disease (Disease of the permanent clinic, hospital within 2km are
Heart/Ischemic Heart Disease, HPN) needed
B. Cancer/Neoplasm
C. Asthma EPIDEMIOLOGIC STUDY DESIGNS
D. Diabetes Mellitus
Ecological
• Primary Focus : PROMOTION of health lifestyle - Bridges analytical and descriptive epidemiology
and Prevention of NCD - Looks at variations in disease rate
Example:
• Levels of PREVENTION: “Comparison of rates of cervical and breast
A. PRIMARY – health education on exercise, cancers.”
diet, smoking and alcoholism, immunization
(Cervical Cancer) COHORT Studies
- A type of analytical epidemiology
B. SECONDARY – screening tests and early - A cohort (people with similar characteristic of
treatment such as: interest) is followed over time
- Useful for determining prevalence (old and new)
HPN – PhilPEN HPN screening tool for and incidence (new cases only)
adults aged 20 and above - Useful for estimating risk for diseases

DM – FBS is more accurate TYPES:

Cancers – use “9 Warning Signs of Cancer”, A. PROSPECTIVE COHORT (CONCURRENT

BSE for breast cancer, DRE for prostate and COHORT, LONGITUDINAL, FOLLOW-UP)
rectal, VIA for Cervical Cancer, Biopsies for - BEST estimate of INCIDENCE RATE
confirmation - BEST estimate of DISEASE RISK
** Early Diagnosis and Treatment – KEY to - Exposed person (COHORT) are followed
successful cancer management whether they will develop a disease over time
Disadvantage: Expensive and Time-consuming
Asthma – Peak Flow Meter (PFM),
Spirometry for screening Example:
“Will a group of smokers develop lung cancer over
time?”
OCCUPATIONAL HEALTH NURSING
• LEGAL BASIS: B. RESTROSPECTIVE COHORT (NONCONCURENT
COHORT, HISTORICAL COHORT)
- BEST For Occupational Epidemiology
A. PD 856 – Sanitation Code of the
- Relies on EXISTING RECORDS (review of
Philippines
history, health records, insurance)
B. Occupational Health Act – RA 1054
C. RA 9173
- Cohort is followed over time (in the past based
on records) to see if outcome occurred
Example:

Records of patients with lung cancer were reviewed

to see if they have smoking history.

CASE CONTROL STUDY

- Participants are enrolled because they have the
outcome of interest, or do not have the outcome
of interest for comparison

Example:
“Do persons with outcome of interest have the same
exposure as with those who do not have.”

CROSS-SECTIONAL STUDY
- Provides a snapshot or cross section of a
population or group all AT ONCE
- BEST for PREVALENCE ESTIMATES
- Can identify current health status

Example:
Prevalence of Cardiovascular Disease is Lower in
Active Person than in Sedentary People

• WEB OF CAUSALITY/MULTIFACTORIAL
THEORY of DISEASE OCCURRENCE – states
that there is NO SINGLE CAUSE of a disease