Primary Health Nursing

COPYRIGHT: JONAS MARVIN MERCURIO ANAQUE, RM, RN
PRIMARY HEALTH CARE

▪ Essential health care based on practical, scientifically sound and socially acceptable methods and technology made
universally accessible to individuals and families in the community through their full participation and at a cost that
community and the country can afford (Alma-Ata, 1978) – (CBQ)
September 6-12, 1978

▪ First International Conference on PHC
▪ Alma Ata Declaration
▪ PHC goal: “health for all by the year 2000”
▪ Alma-Ata, Kazakhstan Russia (USSR) – (CBQ)
PHILIPPINES claims to be the FIRST country to have adopted PHC as a national strategy for health care and, since 1981. –
(CBQ)
Letter of Instruction (LOI) 949– (CBQ)

▪ the legal basis of PHC was signed by Pres. Ferdinand E. Marcos
▪ Signed October 19, 1979
▪ HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE HANDS OF THE PEOPLE by the year 2020
▪ Dr. Jesus Azurin – Father of PHC
TAKE NOTE: The END GOAL of PHC approach is for people to be SELF RELIANT – (CBQ)
Principles of Primary Health Care
4 A's of PHC
▪ Accessibility – essential and appropriate health services are available to citizens within a reasonable geographic
distance by an appropriate provider and within a time frame that is appropriate.
▪ Availability – care can be obtained whenever people need it.
▪ Affordability – The cost should be within the means and resources of the individual and the country.
▪ Acceptability – health services offered area to be in accordance to the prevailing beliefs and practices of the intended
clients of care. – (CBQ)
Community participation or public participation

▪ Community is active partners in making decisions about their own health and the health of their communities (CBQ)
▪ Heart and soul of PHC
Health promotion
▪ focus on enabling citizens to increase control over and improve their health and well-being.
Appropriate technology
▪ procedures, equipment, drugs, and resources used are effective and culturally acceptable to individuals and the
community. – (CBQ)
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▪ Example is the use of Herbal meds
Intersectoral collaboration
▪ Partnership between community and health agencies.
▪ Example: referral system among the RHU, non-government organization, and local social welfare and development
office– (CBQ)
Social Mobilization
▪ midwife organizes the community into groups to encourage active participation in health
programs/activities (CBQ)
Decentralization
▪ Transfer of authority, functions, and/or resources from the center to the periphery within a specific sector.
▪ Local Government Code or Devolution Code or Local Autonomy Code (RA 7160) (CBQ)
Four Major Pillars of Primary Health Car
1. Intersectoral linkages
▪ Linkages between the government and the nongovernment organization and people’s organization.
2. Use of appropriate technology

▪ Use of cheaper, scientifically valid tools and methods that are all suitable and acceptable to the families
and communities(CBQ)
3. Support mechanism made available

▪ DOH is the primary support of PHC in the Philippines
▪ PHC depends adequate distribution of health workers.
4. Active community participation

▪ involvements of the community people, the responsibility of health rests not only with government but also
with individuals, families and communities themselves.
Components of PHC: There are 8 elements of primary-health care (PHC). (CBQ)

E– Education concerning prevailing health problems.
L– Locally endemic disease prevention and control.
E– Expanded program of immunization against major infectious diseases.
M– Maternal and child health care including family planning.
E– Essential drugs arrangement.
N– Nutritional food supplement, an adequate supply of safe and basic nutrition.
T– Treatment of communicable and non-communicable disease and promotion of mental health.
S– Safe water and sanitation.
DOH STANDARD RATIO OF HEALH WORKERS:

Barangay health worker to household ratio 1:20 households
Midwife to population ratio 1:5,000– (CBQ)
Nurse to population ratio 1:20,000
Physician to population ratio 1:20,000
Sanitation inspector to population ratio 1:20,000
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Levels of Primary Health Care Workers

Grassroots/Villagers
Primary level
▪ First contact of the community
▪ Initial link to health care (CBQ)
▪ Renders simple curative/preventive health measures
▪ Serves as the foundation of health care
▪ Trained local individuals in the community Provides
B arangay Health workers (BHW)

A uxiliary volunteers
T raditional birth attendants/TBA (Trained hilots) (CBQ)
A lbularyo
Intermediate level
▪ First source of professional health care
▪ Attends health problems beyond the competence of grassroots workers
R ural sanitary inspectors R egistered midwives

M edical practitioners and their assistants N urse in public health (PHN)
First line hospital personnel
▪ Provide back-up health services for cases that needs hospitalization
D octors with specialty: OB, Pedia,Cardiologist, Dentist etc.

O ther health professionals
N urse specialist
A nesthesiologist and surgeon
Three levels of referral:

Primary Secondary Tertiary
▪ Basic health procedures ▪ Referral system of primary level ▪ Referral system of secondary level
▪ highly specialized staff and technical

Puericulture centers equipment
▪ Minor operations and laboratory
Rural health unit (RHU)
Community health centers or barangay examinations(CBQ) ▪ Complex medical and surgical
health station (BHS) interventions
District hospitals ▪ Major operations and invasive procedures
Outpatient department hosp.
Provincial hospital
Emergency/District Hospital Medical centers & National hosp.
Regional hospitals (CBQ)
Training and teaching hospital
THREE LEVELS OF PREVENTION

Primary level
Target: HEALTHY individuals

Goal: To prevent/delay the actual occurrence of disease.
Intervention: heath promotion and disease prevention
Activities: 3H,I,V
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Health education - family planning counseling (CBQ)

Healthy lifestyle habits – healthy diet, rest and exercise, not smoking(CBQ)
Hygiene (HANDWASHING) (CBQ)
Immunizations– (CBQ)
Isolation of the diagnosed case(CBQ)
Intake or use of prophylactic drugs
Vector control
HEALTH EDUCATION is a basic health service that aims to modify harmful practices of people and their unscientific
knowledge and attitude. (CBQ)
Secondary level
Target: Sick or at risk individual

Goal: SCREENS clients for early detection and prompt treatment of the disease
Intervention: Early DIAGNOSIS and treatment(CBQ)
Activities:
Case finding tools like skin smears for leprosy, sputum smear for TB, swab test for COVID-19
Blood test (CBC for blood disorders, ELISA and western blot for HIV) (CBQ)
Contact tracing, quarantine, disease surveillance
Diagnostic test like ultrasound, X-ray, MRI, CT-Scan, Mammography(CBQ)
Treatment/cure of disease – (CBQ)

Examination of the breast (BSE), testes(TSE), “ OPLAN timbang ” (CBQ)
Screening test and selective examinations (Newborn screening, screening for hypertension )
Traumma care
Tertiary level
Target: individuals with diagnosed illness and advance disease.
Goal: reduce impact/limit disability, prevent sequelae and prevent death
Intervention: REHABILITATION – (CBQ)
Activities:
Therapies like physical and occupational therapy

Health care and treatment for those infected by COVID-19
Use of assistive devices – (CBQ)
Maintenance drugs among patient with hypertension
Blood pressure and blood sugar monitoring
Self management education for patient with diabetes.
Use of chemotherapeutic drugs and radiation for cancer

Provide family therapy for abusive families; remove children from the home.
Present Health Secretary

DR. FRANCISCO DUQUE III
ROLES AND FUNCTIONS OF DOH
Leadership in Health Enabler and Capacity Builder Administrator of Specific Services
▪ Serve as the national policy ▪ Innovation of new strategies ▪ Act as administrator of

and regulatory institution in health to improve the selected national and
effectiveness of health sub-national health facilities
▪ Provide leadership in the programs. and hospitals;
formulation, monitoring and
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evaluation of national health

policies. ▪ Exercise oversight functions ▪ Administer direct services for
and monitoring. emergent health concerns;
▪ Serve as advocate in the
adoption of health policies, ▪ Ensure the highest achievable ▪ Administer health emergency
plans and programs to address standards of quality health response services.
national and sectoral concerns. care, health promotion and
health protection
UNIVERSAL HEALTH CARE (RA 11223)
Universal Health Care (UHC) or Kalusugan Pangkalahatan (KP)

Highest possible quality of health care to EVERY Filipino. (CBQ)
Care that is accessible, efficient, equitably distributed
UHC’s Three Thrusts

1) Financial risk protection through expansion in enrollment and benefit delivery of the National Health
Insurance Program (NHIP)
2) Improved access to quality hospitals and health care facilities
3) Attainment of health-related Millennium Development Goals (MDGs)
UNITED NATIONS MILLENNIUM DEVELOPMENT GOALS

Signed: September 2000
Target year: 2015
Goals: Eight (8)
Eliminate extreme poverty and hunger
Achieve global primary education
Promote gender equality and empower women
Reduce child mortality (reduce the under-five mortality rate by 2/3 in year 2015)
Improve maternal health (reduce maternal mortality by three quarters (3/4) in 2015
Combat malaria, HIV/AIDS, and other diseases (including neglected tropical diseases)
Ensure environmental sustainability
Develop a universal/global partnership for development.
TAKE NOTE:
▪ Millennium Development Goals (MDGs) 4 and 5 is the priority of the DOH(CBQ)
▪ Reduce child mortality and improve maternal health are the two goals which are VERY specific to Maternal Child
Health (MCH) (CBQ)
▪ Reduction of maternal mortality of 75% by year 2015(CBQ)
▪ NATIONAL PRIORITY – MDG 1 Eradicate Extreme Poverty (CBQ)
▪ 4 P's – Pantawid Pamilyang Pilipino Program. (CBQ)
UNITED NATIONS SUSTAINABLE DEVELOPMENT GOALS

Target year: 2030(CBQ)
Goals: 17
Mnemonics: (N0 Good E-E-CADIRe-CCCLLPP)
No poverty Cities and communities (sustainable)

0 (zero) Hunger Consumption and production
Good Health and wellbeing Climate change action
Education (quality) Life below water
Equality (gender) Life on land
Clean water and sanitation Peace justice and strong institution
Affordable and clean energy Partnership for the goals
Decent work and economic growth
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Industry, innovation and infrastructure

Reduced inequalities
R.A. 7160 – Devolution Code or Local Government Code.

▪ The Code aims to transform local government units into self-reliant communities and active partners. (CBQ)
LOCAL HEALTH BOARD (LHB)
1. Provincial health board

Chairman: Governor
Vice chairman: Provincial Health Officer
Members:
▪ Chairman, Committee on Health of Sangguniang Panlalawigan
▪ DOH representative (PHN)
▪ NGO representative (private sector)
2. City and Municipal Health Board

Chairman: Mayor (CBQ)
Vice chairman: City or Municipal health officer (CHO/MHO)
Members:
▪ Chairman of the committee on health of the sangguniang panlungsod,
▪ NGO representative
▪ DOH Representative
Alternative Medicine
● RA 8423 – "Traditional and Alternative Medicine Act (TAMA) of 1997"
Herbal Medicine (LUBBY SANTA)

Herbal Medicine USES
Lagundi Sprain and skin diseases
( Vitex Negundo) Headache and fever
Asthma cough and colds (CBQ)
Rheumatism
Eczema
Dysentery
Preparation:
▪ Decoction - Boil half cup of chopped fresh or dried leaves in 2 cups of water for
10 to 15 minutes. Drink half cup 3 times a day
▪ Pounded leaves for headache and rheumatism.

Gouty arthritis (CBQ)
Ulasimang Bato Others: Boils and abscesses
“pansit – pansitan” Uric acid lowering agent
(Peperonia Pellucida) Tophi prevention
Yes you can boil it or eat a like a salad.

Preparation: ½ cup of leaves boiled in 2 glasses of water, divide into 3 parts and drink one
part 3x a day.
Bawang Hypertension(CBQ)
(Allium Sativum) Toothache
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Neutralize free radicals & lowers cholesterol level
Preparation: Fried, roasted, soaked in vinegar for 30 mins. or blanched in boiled water for
15 minutes. Take 2 pieces 3x a day AFTER MEALS
TAKE NOTE: Take it AFTER MEALS (CBQ)
Bayabas Stomach flu /diarrhea
(Psidium Guajava) Use for wound washing (also for postpartum)
Gets rid of fungi, amoeba, and bacteria
Antiseptic activity
Toothache
Preparation:
▪ Young leaves can be boiled taken 3 – 4x a day for diarrhea.(CBQ)
▪ Warm decoction for gargle

Yerba Buena ANALGESIC (pain reliever)
(Mentha Cordifolia)
Pruritus or itchiness
Arthritis/rheumatism
Insect bites and swollen gums.
Nausea and vomiting (CBQ)
Flatulence or gas pain
Use for menstrual pain
Loss of consciousness temmporarily (syncope) – alternative of spirit of ammonia
Preparation:
Pain – boil leaves in 2 glasses for 15 minutes. Divide decoction in 2 parts and drink one
part every 3 hours.
Sap of leaves and crashed leaves for other ailments.
Sambong Antiurolithiasis(CBQ)
(Blumea Balsamifera) Diuretic
Anti-edema
NOT used for kidney infections.
Preparation:
Decoction of leaves – boil chopped leaves in a glass of water and divide into 3 parts then
drink one part every 3 hours.
Akapulko Antifungal parasites herbal medicine (CBQ)
(Cassia Alata L.) Uses: Ringworm Athletes foot Tinea flava Scabies
Preparation: Pounded fresh matured leaves, can be made into a soap, cream or paste
applied to affected area 1 – 2 x a day
Niog Niogan (Quisqualis Indica) Anti-helminthic – (CBQ)
*Vine known as "Chinese honey
▪ to expel worms or parasite like ROUNDWORMS
suckle".
▪ Take seeds 2 hours AFTER supper.
Children: give at least 4 – 7 seeds

Adults: give at least 8 – 10 seeds
Contraindicated to less than 4 years old.
Tsaang Gubat Antispasmodic
(Carmona Retusa) Body cleanser/wash
*Wild tea Diarrhea
Oral hygiene for canker sores
Mouth wash used in “SAGIPIN:UNANG NGIPIN”
Eczema
Natural remedy for biliary colic
TAKE NOTE: Tsaang Gubat has high fluoride content.

Ampalaya DM Type 2 (Non insulin dependent diabetes mellitus. (CBQ)
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(Momordica Charantia) Preparation: chopped leaves then boil in a glass of water for 15 minutes. Take 1/3 cup 3x a
day AFTER MEALS
Reminders on the Use of Herbal Medicine

B – Boil using a clay pot and remove cover while boiling at low heat
O – Only one kind of herbal plant for each type of symptoms.
N – No use of insecticide as these may leave poison on plants.
U – Use only part of the plant being advocated.
S – Symptoms persist after 2 – 3 doses consult doctor.
Botika ng Barangay (BnB) is a drug outlet managed by a legitimate community organization, nongovernment organization
and/or local government unit. It is a government-initiated poverty alleviation program to increase access of community people to
affordable medicines
Vendor: At least 2 BHW
Example of Drugs : R.I.P.E.S, Nifedipine, Amoxicillin, Albendazole, Paracetamol, Cotrimoxazole, ORS, Quinine
IMMUNIZATION PROGRAM
VACCINE HISTORY:
▪ Edward Jenner is considered the founder of vaccinology
▪ Smallpox vaccine, introduced by Edward Jenner in 1796, was the FIRST successful vaccine to be developed.
EXPANDED PROGRAM ON IMMUNIZATION (established in 1976)
Immunization – process of introducing vaccine into the body before infection sets in providing ARTIFICIAL ACTIVE
IMMUNITY(CBQ)
Word Health Organization (WHO) stated that as many as 2 – 3 million deaths among children per year could have been
prevented by ACCESS TO IMMUNIZATION – (CBQ)
SCHEDULE: Wednesday – designated NATIONAL IMMUNIZATION DAY or “Patak Day” (CBQ)

▪ Weekly – Rural Health Units
▪ Monthly – Barangay Health Stations(CBQ)
▪ Quarterly – Remote areas (Far-flung)
Vaccine preventable diseases

▪ Tuberculosis – BCG (CBQ)
▪ Diphtheria and Pertussis – DPT/Pentavalent
▪ Measles – measles vaccine
▪ Poliomyelitis – OPV and IPV (OPV – Albert Sabin , IPV – Jonas Salk)
▪ Tetanus – (children – DPT , mothers- Tetanus toxoid)
▪ Hepatitis B – HepB vaccine
▪ Diarrhea caused by Rotavirus – rotavirus vaccine
▪ Meningitis – pentaHIB vaccine
FALSE AND ABSOLUTE CONTRAINDICATIONS
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FALSE CONTRAINDICATIONS TRUE/ABSOLUTE CONTRAINDICATION.

Fever NOT more than 38.5°C Convulsion within 7 days after DPT injection.
Vomiting Anaphylaxis to any components of vaccine
Respiratory condition (cough and colds) HIV/AIDS with signs and symptoms
Anaphylaxis after a previous dose
Malnutrition
Diarrhea TAKE NOTE: The ONLY contraindication applicable to all
vaccines is a history of a severe allergic reaction after a prior
dose of vaccine or to a vaccine constituent.
REGULATORY LAWS:
Proclamation No. 773, s. 1996

▪ Declaring April 17 and May 15, 1996 and every third Wednesday of April and May from 1996 to 2000 as “KNOCK OUT
POLIO DAYS”.
▪ ONLY Oral Polio Vaccine (OPV) doses can lead to polio eradication
▪ OPV given simultaneously to all children younger than 5 years old

▪ POLIO-FREE MAINTENANCE IMMUNIZATION CAMPAIGN
▪ LAST wild Poliomyelitis case in the Philippines was in 1993
▪ Philippines was certified POLIO-FREE country on October 29, 2000 in Kyoto, Japan
TAKE NOTE: On September 19, 2019 a new polio outbreak was reported, DOH confirms re-emerging of POLIO in the
Philippines, 19 years AFTER the country was declared polio-free by the WHO in 2000.The polio outbreak in the Philippines is
confirmed to be from a circulating vaccine-derived poliovirus type 2.

▪ “LIGTAS TIGDAS MONTH” (CBQ)
▪ September 16 to October 14, 1998.
▪ Free measles vaccines between the ages of nine (9) months to less than fifteen (15) years.
Presidential decree 996

▪ Compulsory basic immunization for infants and children below 8 years of age.
Republic Act No. 7846

▪ Compulsory Hepatitis B immunization among infants & children less than 8 years old
▪ That newborn infants of women with Hepatitis-B shall be given immunization against Hepatitis-B within twenty-four
(24) hours after birth.
Republic Act No. 10152

▪ Mandatory Infants and Children Health Immunization Act of 2011
TAKE NOTE: If the infant is sick, and the parent strongly objects for the immunization. DO NOT GIVE IT. Ask the mother
to comeback when the child is well.
MUST KNOWS!
1. Fully Immunized Child (FIC)
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▪ BEFORE 12 months
▪ BEFORE 1st birthday of child he/she must have completed:

● 1 dose of BCG , 3 doses of DPT, 3 doses of OPV, 3 doses of Hepatitis B and 1
dose of measles
2. Two vaccines that are

Freeze dried : Measles and BCG (others: Yellow fever and HIB)
Most sensitive to heat/sunlight:OPV, Measles and MMR
Most sensitive to cold/freezing:DPT, DT, TT, HepB, pentavalent and PCV vaccines.
3. New mandated vaccines

Rotavirus – prevents diarrhea
Pneumococcal conjugate vaccines (PCV13) – prevents pneumonia
Inactivated polio vaccine (IPV) – given to infant at 3 ½ months (14weeks)
TAKE NOTE: Give PCV to infants as a series of 3 doses, one dose at each of these ages: 1 ½ months (6
weeks), 2 ½ months (10 weeks), 3 ½ months (14 weeks). Children who miss their shots or start the series
later should still get the vaccine.
4. Pentavalent vaccine
▪ Vaccine (5 in 1) that contains five antigens (diphtheria, pertussis, tetanus, and hepatitis B and
Haemophilus influenzae type b)
5. “Back to Bakuna” program

▪ school-based immunization program provides free measles and rubella vaccines including
booster doses of tetanus-diphtheria vaccines to public school children from kindergarten to Grade
7 (ages 5 to13 years old).
▪ For Grade 4 female kids, there is the Human Papillomavirus (HPV) immunization, a protection
against cervical cancer.
GENERAL PRINCIPLES IN VACCINATING CHILDREN
Giving doses less than 4 weeks interval may lessen the antibody response
Lengthening the interval between doses of vaccine leads to a higher antibody levels.
Avoid using the same arm or leg for more than 1 injection.
Do not give more than one(1) dose of the SAME vaccine to a child in one session. (CBQ)
I If the vaccination schedule is interrupted, it is NOT necessary to restart. (CBQ)

Minimal intervals between doses to catch up as quickly as possible if it is interrupted.
Immunity provided by vaccines is ARTIFICIAL ACTIVE

M ore than 1 vaccine is to be administered, inject it at different sites of body.
M ild asthma, stable cerebral palsy or down syndrome is NOT a contraindication
U se single syringe ( 1 syringe per vaccines) when giving more than 1 vaccine(CBQ)
N EVER reconstitute freeze dried vaccine anything other than the diluent supplied with them
E ffective and still safe if more than 1 vaccine is given on the same day. (CBQ)
Do NOT administer live vaccines to persons who are significantly immunocompromised. (CBQ)
NICE TO KNOW! (CBQ)
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BCG is CONTRAINDICATED in a child exhibiting signs and symptoms of HIV/AIDS

Anaphylaxis is a CONTRAINDICATION applicable to ALL vaccines
Kidney or liver disease, heart or lung disease, are not contraindications to vaccination.
Use one sterile needle, one sterile syringefor each child to prevent Hepa B, Hepa C and HIV
NEVER massage BCG injection site (CBQ)
Any remaining reconstituted vaccine like BCG and measles must be discarded AFTER 6 hours or at the end of
immunization session. (CBQ)
COLD CHAIN (CBQ)

▪ SYSTEM of storing and transporting vaccines at recommended temperatures from the point of
manufacture to the point of use. (CBQ)
▪ Primary purpose is to MAINTAIN THE POTENCY of vaccines.
Essential elements:
▪ Personnel to manage vaccine distribution
▪ Equipment for vaccine storage & transport
▪ Maintenance of equipment
▪ Monitoring
COLD CHAIN MANAGER: PUBLIC HEALTH NURSE
STORAGE TIMEFRAMES
o 6months- Regional Level
o 3months- Provincial Level/District Level
o 1month-main health centers-with refrigerator
o Not more than 5 days- Health centers using transport boxes.
S tore VARICELLA/Chicken pox at freezing temperatures (freezer)(CBQ)

T emperature in the refrigerator and freezer should be checked TWICE A DAY(CBQ)
O ne in the morning and one in the late afternoon before going home
R efrigerator: Stand-alone refrigerator and freezer units are safest for storing vaccines. (CBQ)
A void direct contact of vaccine to ice.
G oodies, foods and drinks should NEVER be stored in a vaccine refrigerator.
E nsure to keep refrigerator away from sunlight and at least (10 cm) distance from the wall. (CBQ)
COLD CHAIN REMINDERS
VACCINE and diluents:

● NEVER store any vaccine in a dormitory-style or bar-style combined unit.
● NEVER place vaccines and diluents in the DOOR shelves (Temp. is not stable.) (CBQ)
● AVOID frequent opening and closing of the doors.
● Place vaccines and diluents in the center of the unit 2 to 3 inches away from walls, ceiling, floor, and door.
● Avoid freezing of diluents as the vial may burst when frozen.
● DO NOT store vaccines in deli, fruit, or vegetable drawers or in the door. Temperatures in these areas are not stable
and can differ from those inside the main part of the unit.
● Arrange vaccines and diluents in rows, allowing space between rows to promote air circulation.
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● Place vaccines and diluents with the earliest expiration dates in front of those with later expiration dates.(FEFO)
(CBQ)
● Do not return reconstituted vaccines (BCG, measles) or opened PCV10 vials to the refrigerator. They should be
discarded at the end of the immunization session or after six (6) hours, whichever comes soonest. (CBQ)
● The refrigerator should not be packed too full. (to allow air to circulate)
● Vaccines should be stored carefully between +2ºC and +8ºC at all times.
● Freeze-sensitive vaccines (pentavalent, PCV10, TT and HepB) should be kept away from the freezing compartment,
refrigeration plates, side linings or bottom linings of refrigerators, and frozen ice-packs.
WATER BOTTLES
● Place water bottles on the top shelf, floor, and in the door racks.
● Putting water bottles in the unit can help maintain stable temperatures caused by frequently opening and closing unit
doors or a power failure.
● Label all water bottles “DO NOT DRINK.”
REFRIGERATOR
● NO foods, drinks or other drugs are to be kept in a refrigerator. (Vaccines ONLY)
● Check and record temperatures TWICE A DAY in temperature log for 2 to 7 days.
● DEFROST the refrigerator when ice becomes more than 0.5 cm thick, or once a month, whichever comes first
● Record temperature, date, time and initials of the person in monitoring log sheet.
Two compartments:
1) Main compartment (the REFRIGERATOR)
▪ kept between +2ºC and +8ºC
▪ used for storing vaccines and diluents.
▪ BCG, DPT, Hepa B, TT
2) Top compartment (the FREEZER)

▪ Kept between –15 °C to –25°C (average of 20°C)
▪ used for freezing ice-packs
▪ For heat sensitive vaccines (OPV and measles)
▪ OPV is the MOST sensitive to heat and fragile vaccine
Vaccine Content Form & Dosage Number of Route

Doses
BCG Freeze dried 1 ID
(Bacillus Calmette Guerin) Live attenuated bacteria Infant /birth- 0.05ml
Preschool-0.1ml
Hepatitis B Plasma derivative Liquid-0.5ml 3 IM

(HbsAg)
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RNA recombinant
DPT (Diphtheria Pertussis DT- weakened toxin liquid-0.5ml 3 IM
Tetanus) P-killed bacteria
OPV (Oral Polio Vaccine) Weakened virus Liquid-2drops 3 Oral
*SABIN vaccine (CBQ) (0.1ml)
Rotavirus vaccine Live attenuated virus Liquid-5 drops 2 Oral

(0.5ml)
Measles Weakened virus Freeze dried- 0.5ml 1 SQ
Vaccine Schedule Side effects
BCG At birth NORMAL SIDE EFFECTS

Anytime after birth
Koch's phenomenon – acute inflammatory process starting 24 hours after
injection and may last 2 – 4 days
Wheal formation
▪ Small raised lump (10mm diameter)
▪ Disappears within 30 minutes

Ulcer/red sore formation
▪ May appear 2 weeks after injection and may persist for
another 2 weeks to heal.
▪ Keep dry and clean (do not put any ointment on the sore or
give the child any medicine)
SCAR formation, about 5 mm(CBQ)

▪ Scar at 12 weeks after injection (2 – 5 months)
▪ Sign that the child has been effectively immunized.
ABNORMAL ADVERSE EFFECT
Indolent ulceration
WOF: SIGNS OF INFECTION
ABSCESS formation and swelling of glands in armpit.
ABSCESS may due to:
▪ UNSTERILE needle/syringed was used (#1 cause)
▪ Too much vaccine was injected.
▪ Wrong technique of administration
Management: (CBQ)
▪ DO NOT INCISE AND DRAIN.
▪ Use WARM water compresses over the injection site

or suppurating lymph node(s) 4–5 times/day.
▪ The doctor may order Antibiotic treatment, such as
isoniazid (INH), but NOT routinely indicated.
Hepa B Transmission at birth is possible Common Side Effects (last 1-2 days.)
give: Mild fever (1 – 2 days)
HepB 1 – At birth
▪ Teach mother to perform TSB
HepB 2 – 6 weeks
HepB 3 – 14 weeks
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▪ Advise to give paracetamol every 4 hours if temperature is

Where transmission at birth is less
likely, the recommended schedule above 38.5°
is: ▪ REFER if fever last for 4 days
HepB 1 – 6 weeks
HepB 2 –10 weeks
HepB3 – 14 weeks Soreness, redness, or swelling in the injection site.
● Teach mother to perform COLD compress FIRST before hot
compress.
DPT DPT 1 – 6 weeks MILD REACTIONS:

DPT 2 –10 weeks Fever: A child may have fever the evening AFTER receiving
DPT 3 – 14 weeks DPT vaccine. The fever should disappear within a day.(CBQ)
NOTE: Fever that begins more than 24 hours after a DPT
*4 weeks interval between doses. injection is unlikely to be a reaction to the vaccine.
(CBQ) Soreness: Pain, redness or swelling at the injection site.
WOF: Abscess formation

▪ An abscess may develop a week or more after a DPT
injection. This can happen because:
▪ unsterile needle or syringe was used
▪ Wrong technique, vaccine was NOT

injected into the muscle.
DPT vaccine should NOT be given to children over 5 years of age or to

children who have suffered a severe reaction to a previous dose of this
vaccine.
Instead, a combination of diphtheria and tetanus toxoids (DT) should be
given.
OPV OPV 1 – 6 weeks NO SIDE EFFECT (CBQ)
OPV 2 –10 weeks
OPV 3 – 14 weeks
*4 weeks interval between doses.
Rotavac 1st dose – 6 weeks Rare and mild side effects

2nd dose – 10 weeks to a maximum Fussiness, mild diarrhea, and vomiting.
of 32 weeks
Measles Regular schedule: Mild fever and rash lasting one to three days may occur approximately a
week after immunization. (CBQ)
▪ 9 months
NOTE: If the child aged 6 to 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) (CBQ)
Late dose
▪ 15 months
Catch up dose
▪ 4-5 years old
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IMPORTANT NOTES:
▪ It is safe to vaccinate a sick child who is suffering from a minor illness (CBQ)
▪ When handling vaccines, the FIRST step is to CHECK the vial for expiration date (CBQ)
▪ Use Standard refrigerator with separate freezer door and seal for vaccines (CBQ)
▪ Vaccines can be mixed in a single syringe when: Vaccines are licensed and labelled to be mixed. – (CBQ)
▪ BCG vaccine protects against TUBERCULOSIS (TB) in infants.
▪ BCG vaccine amber glass ampoules is to protect it from ultraviolet and fluorescent light to MAINTAIN POTENCY. –
(CBQ)
▪ BCG vaccine also should be discarded AFTER 6 hours of reconstitution because of risk of contamination due to lack of
preservative and loss of potency. – (CBQ)
▪ BCG vaccine is NOT damaged by freezing.
▪ Store BCG vaccine and its diluent side-by-side in a refrigerator or vaccine carrier.
▪ BCG is administered via intradermal route at RIGHT DELTOID. (CBQ)
▪ NEVER immunize in the buttocks, IM vaccines like Hepa B, DPT, IPV, Pentavalent and PCV should be administered
Muscle of the upper outer of the thigh
▪ Measles is given ONCE (1dose), SUBCUTANEOUS injection in the OUTER UPPER right arm– (CBQ)
▪ The measles, mumps, rubella vaccine (MMR) can be stored either in the freezer or the refrigerator. (CBQ)
▪ Protect reconstituted measles vaccine from sunlight. WRAP IT WITH FOIL(CBQ)
▪ If a child has diarrhea, give OPV as usual but administer an extra dose, i.e., a
fifth dose, at least four weeks after he or she has received the last dose in the schedule.
▪ Diphtheria and tetanus toxoid parts are damaged by freezing.
▪ For outreach session using vaccine carriers or cold box DO NOT let DPT, TT or hepatitis B vaccine vials touch the cold
dogs/ice packs. Put or wrap newspaper or cardboard around DPT, TT, or Hepa B to protect them from freezing. (CBQ)
▪ Pertussis vaccine is damaged by heat.
▪ Pertussis causes the fever after DPT shot.
▪ If a child spits out, regurgitated the vaccine drops, or vomits immediately after a dose of OPV, it is quite safe

to repeat the dose (Do not breastfeed immediately) (CBQ)
▪ OPV contains an attenuated (weakened) form of the virus, activating an immune response in the body.
▪ When a child is immunized with OPV, the weakened virus replicates in the intestine for a limited period, thereby
developing immunity by building up antibodies. During this time, the virus is also excreted in their feces. In areas
where there is inadequate sanitation and hygiene, the excreted weakened virus can spread in the immediate
community before eventually dying out.
▪ If a population is NOT sufficiently immunized, the weakened virus can continue to circulate and cause vaccine derived
poliovirus infection.
▪ Health care providers are required by law to record certain information in a patient’s medical record. This record can
be in electronic or paper form. Health care providers who administer vaccines covered by the National Childhood
Vaccine Injury Act are required to ensure that the permanent medical record of the recipient indicates:
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o Date of administration
o Vaccine manufacturer
o Vaccine lot number
o Name and title of the person who administered the vaccine and address of the facility where the
permanent record will reside
HERD IMMUNITY (CBQ)

▪ Herd immunity (or community immunity) occurs when a high percentage of the community is immune to a disease
(through vaccination and/or prior illness), making the spread of this disease from person to person unlikely. (CBQ)
▪ Even individuals not vaccinated (such as newborns and the immunocompromised) are offered some protection
because the disease has little opportunity to spread within the community if there is Herd immunity.
TARGET SETTING
BEFORE WE START YOU NEED TO MEMORIZE THIS FIRST:
VACCINES Number of doses to complete Number of doses per ampule Wastage factor (constant)
the immunization. or vials
BCG 1 20 (can immunize 20 children) 2.5
HepB 3 1 in single dose vial 1.10
10 for multi-dose vial (can
immunize 10 children) (CBQ)
DPT 3 20 or 10 1.67
OPV 3 20 (can immunize 20 children) 1.67
Measles 1 10 (can immunize 10 children) 2
Tetanus toxoid 5 10 or 20 1.67
STEP 1 – DETERMINE THE ELIGIBLE POPULATION OUT OF THE GIVEN TOTAL POPULATION.
FORMULA: TOTAL POPULATION x target setting = Eligible population
For Target setting of eligible population:

▪ Use 3% or 0.03 to determine total number of children and infants for immunization.
▪ Use 3.5% or 0.035 to determine total number of mothers for immunization.
Example: Nurse Lorna was assigned to Barangay San Roque with 20, 000 population. How many infants are expected to
receive measles injection?
Total population is 20, 000

Eligible population to find is INFANTS so use 3% for target setting.
Formula: 20, 000 total population x 0.03 (3%) = 600 infants

So, the eligible population is 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
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)
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MATERNAL HEALTH PROGRAM

▪ The Philippines is tasked to reduce the maternal mortality ratio (MMR) by three quarters or 75% by 2015 to achieve
its millennium development goal. (CBQ)
▪ This means a MMR of 112/100,000 live births in 2010 and 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
Risk Factors
H – height 145 cm tall (4 ft. & 9 inches)
A – age Below 18 yrs. old, above 35 yrs. old
R – recent pregnancy was cesarean section delivery
M – Multiparity and last baby born was less than 2 years ago
F – family history of DM, Hypertension and heart disease
U – underlying condition like TB, goiter, bronchial asthma, severe anemia
L – less than 45 kgs. or more than 80 kgs. Weight.
Maternal Mortality:10 – 11 mothers die each day due to pregnancy and delivery complication. (CBQ)
MATERNAL DEATH
▪ Death of a woman while pregnant or within 42 days of termination of pregnancy. (CBQ)
Daily iron and folic acid supplementation during pregnancy.
▪ World health organization and National guideline recommend all pregnant women should receive a daily oral iron and
folic acid supplementation dose of DAILY 60 mg iron + 400 μg (0.4 mg) folic acid for 6 monthsTO PREVENT maternal
anemia, puerperal sepsis, low birth weight (LBW) and preterm birth(CBQ)
▪ TAKE NOTE: Folic acid should be commenced as early as possible (ideally before conception) to prevent NEURAL
TUBE DEFECTS. (CBQ)
PRENATAL CONTACT/VISIT: Eight (8) (CBQ)

▪ Eight or more 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’ gestation, with subsequent contacts
taking place at 20, 26, 30, 34, 36, 38- and 40-weeks’ gestation.
NUTRITION – emphasize the importance of nutrition during each prenatal contact. (CBQ)
1. Eat nutritious foods like fruits and vegetables
2. Avoid excessive weight gain
3. Daily oral iron and folic (60mg iron + 400mcg folic acid)
4. Daily calcium supplementation (1.5 to 2 g) – prevents eclampsia
5. NO smoking and drinking alcohol.
Tetanus Toxoid Immunization
▪ Both mother and child are protected against tetanus and neonatal tetanus.
▪ A series of 2 doses of Tetanus Toxoid vaccination must be received by a woman one month before delivery to protect
baby from neonatal tetanus.
▪ And the 3 booster dose shots to complete the five doses following the recommended schedule provides full
protection for both mother and child. The mother is then called as a “fully immunized mother” (FIM). (CBQ)
▪ 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.
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TETANUS TOXOID IMMUNIZATION SCHEDULE FOR WOMEN
TETANUS TOXOID IMMUNIZATION

Tetanus toxoid To PROTECT mother and her baby against CLOSTRIDIUM – BORNE infection, injected twice
during pregnancy.
Doses Schedule % of protection Number of Years protection
Tetanus toxoid 1 As soon as possible. NO PROTECTION Zero protection (CBQ)
Tetanus toxoid 2 At least 4 weeks or 1 month 80% 3 years (CBQ)
after TT1
Tetanus toxoid 3 At least 6 months after 95% 5 years (CBQ)
TT2(CBQ)
Tetanus toxoid 4 At least 1 year after TT3 99% 10 years (CBQ)
Tetanus toxoid 5 At least 1 year after TT4 99% Lifetime
Dose: 0.5ml
Route: Intramuscular
Site: Right or Left 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) – give TT5 (3rd booster dose)
TAKE NOTE:
▪ If a pregnant mother received Tetanus toxoid injection she is protected from tetanus infection thru ARTIFICIAL
ACTIVE IMMUNITY. – (CBQ)
▪ Two doses (TT2) protect for 1–3 years, although some studies indicate even longer protection – (CBQ)
▪ Tetanus toxoid is safe during pregnancy.
▪ If a pregnant mother has received two doses of tetanus toxoid. The baby is protected from tetanus neonatorum thru
NATURAL PASSIVE immunity – (CBQ)
▪ Tetanus toxoid 3 is administered 6 months after TT2 – (CBQ)
▪ The nurse understands that the client can be considered fully immunized against tetanus if she received how many
booster doses of tetanus toxoid? answer: Three (CBQ)
▪ Which of the following dose of tetanus toxoid is given to the mother to protect her infant from neonatal tetanus and
likewise provide 10 years protection for the mother: Tetanus toxoid 4(CBQ)
▪ If the mother received her TT4 vaccine, this will give her protection that lasts up to: 10 years (CBQ)
▪ A pregnant woman had just received her 4th dose of tetanus toxoid. Subsequently, her baby will have protection
against tetanus for how long? Answer: 1 year (CBQ)
INTRAPARTAL CARE:
DELIVER AT THE HEALTH FACILITY:

FOLLOW UNANG YAKAP PROTOCOL. (CBQ)
1st action – Dry thoroughly (1st 30 seconds)
2nd action – Skin to skin contact (after 30 seconds)
3rd action – properly timed cord clamping (within 1 – 3 minutes)
4th action – early breastfeeding and rooming in (within 90 minutes)
IMMINENT HOME DELIVERY

In cases of imminent delivery at home, birth attendants must be aware of the CLEAN principles of Home delivery.
They should follow the 5 CLEANS:
▪ CLEAN hands of attendant
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▪ CLEAN surface
▪ CLEAN cord
▪ CLEAN cord tie without dressing
▪ CLEAN and Dry wrapping of the baby
POSTPARTUM CARE
▪ Delay facility discharge for at least 24 hours (CBQ)
▪ Visit women and babies with home births WITHIN THE FIRST 24 hours.
▪ FIRST 24 hours assess for vaginal bleeding, uterine contraction, Vital signs and voiding within 6 hours. (CBQ)
POSTPARTUM VISIT
Provide every mother and baby a total of FOUR postpartum visit on
▪ 1st visit: First day (within first 24 hours) (CBQ)
▪ 2nd visit: Day 3 (48 – 72 hours)
▪ 3rd visit: Between 7 – 14 days
▪ 4th visit: Six weeks
▪
For a woman who delivered at the health facility
▪ 1st visit: within the FIRST week preferably 2 – 3 days after delivery (CBQ)
▪ 2nd visit: end of puerperium or 4 – 6 weeks after delivery. (CBQ)
National Deworming Program

▪ DOH launched “Oplan Goodbye Bulate (Worm),” a program designed to deworm 16 million public elementary school
students TWICE a year.
▪ STH infections are transmitted by eggs present in human feces, which in turn contaminate soil in areas where water,
sanitation and hygiene are poor.
OPLAN: “Goodbye Bulate, Hello Healthy Body”

National Deworming Month: January and July (EVERY 6 MONTHS) – (CBQ)
Target: Young children: 12–23 months old

Preschool children: 2–4 years old
School-age children: 5–14 years of age
Undernutrition and Helminthiasis is a common problem among UNDER-FIVE years old children
Soil Transmitted Helminths (STH)
▪ The three major causes of intestinal parasitic infections in the Philippines are the following:
1. Ascaris/Round worms (Ascaris lumbricoides)

2. Whipworm (Trichuris trichiura)
3. Hookworm (Anclostoma duodenale and Necator americanus)
TAKE NOTE: Taeniasis/Tapeworm is NOT included. (CBQ)
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1. ASCARIASIS – caused by Ascaris lumbricoides roundworms.

2. Hookworm | Ancyclostomiasis – MAINLY acquired by walking barefoot on contaminated soil. Hookworm can also be
acquired by ingesting soil or sand through dirty hands or unwashed fruits and vegetables. (CBQ)
3. Trichuriasis: Whipworm – It can cause RECTAL PROLAPSE. (CBQ)
STH Treatment: Anthelminthic – deworming every 6 months (TWICE A YEAR) (CBQ)

1. Albendazole tablet – 400mg per tablet
1 year old to 23 months – give 1/2 tab. or 200mg
2 yrs. old to 14 yrs. old – give 1 tablet or 400 mg
2. Mebendazole tablet – 500mg per tablet (CBQ)

1-14 yrs. old – give 1 (500mg tablet) every 6 mos.
NOTE: anthelminthic drugs should NOT BE TAKEN with empty stomach. (Take with full stomach)
Precautionary measures (CBQ)
Albendazole and Mebendazole are NOT recommended to: Hypersensitivity to the drug and
S eriously ill child.
A bdominal pain.
D iarrhea.
S everely malnourished.
ENVIRONMENTAL SANITATION
Regulatory Laws:
PD 825 – Anti Improper garbage disposal
PD 856 – Code of Sanitation (CBQ)
RA 6969 – Toxic waste management
RA 8749 – Clean Air Act
RA 9003 – Ecological Solid Waste Management
RA 9211 – Tobacco Regulation Act
RA 9275 – Clean Water Act
EO 26 – Smoked free Environment
Solid waste Segregation:
B – black: Non-Infectious “DRY WASTE” (paper products, admin papers, office papers, cardboard, plastic, bottles)
G – green: Non-Infectious “WET WASTE”- (left over foods, peelings and rotten products) (CBQ)
Y – yellow: infectious pathological – gauze, wound dressing, diapers umbilical cord and placenta (CBQ)
Y – yellow with black band: infectious chemicals – betadine, acid, formaldehydes and expired drugs
O – orange: radioactive wastes, radio isotopes, used x-ray films (CBQ)
R – red: sharps - Needles, syringes, scalpel blades, stylet, ampules, blood lancets
Water Supply Sanitation Program
Approved type of water facilities:

Level 1 – POINT SOURCE
▪ with an outlet but without a distribution system (rural area)
▪ 250 meters away from farthest user
▪ caters 15-25 households
▪ Delivers 40 to 140 L of water per minute
▪ protected well, developed springs
Level 2 – Communal faucet

▪ With a source, reservoir, piped distribution network and communal faucets
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▪ 25 meters away from farthest user
▪ Caters 100 to 125 households
▪ Delivers 40-80 L of water per minute
▪ Stand post and artesian well. (CBQ)
Level 3 – Waterworks system

▪ With a source, reservoir, piped distributor network and household taps
▪ Fit for densely populated urban communities
▪ with pipe distribution and INDIVIDUAL HOUSEHOLD TAPS
▪ NAWASA.
TAKE NOTE: OPEN DUG WELL is unapproved source of water supply.

Proper Excreta and Sewage Disposal Program
Approved types of Toilet facilities.
Level 1 (CBQ)
A. Non-water carriage
▪ pit latrines, pit privies, Reed odorless earth closet, bored hole
B. less water carriage

▪ pour flush toilets, aqua privies
Level 2
▪ water carriage facility with septic tank/vault
▪ water sealed and flushed toilets
Level 3
▪ toilet facility with septic tank or vaults connected to a sewerage system and treatment plan
TAKE NOTE: Toilets, septic tank, garbage MUST be 25meters/ 70 feet away from the water source
Epidemiology
▪ study of the occurrences, distribution and determinants of health-related states or events in specified populations,
and the application of this study to the control of health problems.
▪ backbone of the prevention of the disease
Epidemiologic Triad: HOST – AGENT – ENVIRONMENT(CBQ)

▪ Host – intrinsic factor (man as primary host)
▪ Agent – etiologic factor (virus, bacteria, fungi, parasites etc.)
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▪ Environment – extrinsic factor
TAKE NOTE: Viruses are the SMALLEST of all the microbes. Some microbiologist classifies this as microorganisms, but
others consider these as non-living. (CBQ)
John Snow — “FATHER OF EPIDEMIOLOGY” (CBQ)

▪ In 1800's - Snow conducted one of his famous studies in 1854 when an epidemic of CHOLERA erupted in the Golden
Square of Soho district London.
CHOLERA is an infectious disease that became a major threat to health during the 1800s(CBQ)
▪ Cholera is caused by a bacteria known as Vibrio El tor, vibrio coma and vibrio cholerae.
▪ Cholera or El Tor is MOST COMMON DURING RAINY SEASONS (CBQ)
REMEMBER:
C – called as “Blue Death”
H – Hands and feet are wrinkled known as “washer woman hands” (CBQ)
O – Oral rehydrating solution “Tubig Kubeta Oresol” campaign (hydration is the priority) (CBQ)
L – Loose and fishy odor stool
E – Evident signs of dehydration
R – “RICE watery” stool is the pathognomonic sign (CBQ)
A – Antibiotic drug of choice – Tetracycline. (CBQ
Descriptive vs. Analytic epidemiology

▪ Descriptive epidemiology can identify patterns among cases and in populations by time, place and person. Survey
are used to find out the nature of the population affected by a particular disease noting the age, sex and occupation.
(CBQ)
▪ Analytic epidemiology is concerned with the search for causes and effects, or the why and the how. The key feature
of analytic epidemiology is the presence of comparison group.
Patterns of Occurrence and Distribution:
1. Sporadic – intermittent occurrence of a few isolated (scattered) and unrelated cases (CBQ)
2. Endemic – continuous occurrence throughout a period of time of the usual number of cases in a given LOCALITY(CBQ)
▪ Endemic refers to the constant presence and/or usual prevalence of a disease or infectious agent in a population
within a geographic area (CBQ)
▪ Hyperendemic refers to persistent, high levels of disease occurrence.
3. Epidemic – unusual large number of cases in a relatively SHORT period of time (CBQ)
▪ Outbreak carries the same definition of epidemic, but is often used for a more limited geographic area.
4. Pandemic – simultaneous occurrence of epidemic on the same disease in SEVERAL COUNTRIES affecting large number
of population (CBQ)
Pandemic diseases:
MERS CoV, Asian Flu, Spanish flu, Antonine plague, Meningococcemia, A H1N1
B lack death / Bubonic plague by Yersinia pestis (CBQ)

H IV/AIDS
E bola
COVID – 19 by SARS-CoV-2
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Sources of Data on Health
1. Vital Registration Records
RA 3753 (Civil Registry Law) registration of births, deaths to local registrars (city health officer or municipal treasurer) (CBQ)
Registration and Certification of Birth.

▪ The declaration of the physician or midwife in attendance at the birth or the parent of the newborn shall be sufficient
for the registration of a birth in the civil register.
▪ Register the birth within 30 days after the birth (CBQ)
▪ Who can register the birth: physician, midwife, parent, nurse or any of the birth attendant.
2. Weekly reports from field health personnel RA 3573 (Law on reporting of Notifiable Diseases) (CBQ)
▪ Report to provincial and duty health office
▪ Midwife reports – under supervision of the nurse
▪ REPORT Measles Polio within 24 hours (CBQ)
▪ Tetanus Neonatorum, Severe and acute diarrhea, HIV within a WEEK
Vital Statistics
▪ The study of vital events like births, deaths, fetal deaths, marriages and divorces.
▪ The most common way of collecting information on these events is through civil registration.
MUST KNOWS:
▪ National Statistics Office (NSO) / Philippine Statistics Authority (PSA) the office charged with registering vital facts in
the country.
▪ Birth and deaths are registered in the Office of the Local Civil Registrar of the municipality or city.
▪ The Local Civil Registrar of municipality is usually the Municipal Treasurer or the Municipal Health Officer.
▪ In cities, births and deaths are registered at the City Health Department.
▪ To CORRECT errors in birth certificate. The petition shall be filed with the local civil registry office of the city or
municipality where the birth is registered. (CBQ)
Health Indicators
1. BIRTH – the act or process of being born.
2. DEATH – the cessation of all physical and chemical processes that invariably occurs in all living things.
Rates and Ratios

▪ Rates – relationship between a vital event and those persons exposed to the occurrence of said event (CBQ)
▪ Ratio – relationship between two numerical quantities or measures of events without taking particular considerations
to the time or place. (CBQ)
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Crude or General Rates – referred to the total living population. (CBQ)
1. Crude Birth Rate – measures the natural growth or increase of a population. (CBQ)
Total No. of live births registered in a given calendar year x 1000

Estimated population as July 1 of same year
Answer: CBR = _________ per 1000 population
2. Crude Death Rate – measures mortality from all causes, causing decrease in population
Total No. of deaths registered in a given calendar yearx 1000

Estimated population as July 1 of same year
Answer: CDR = _________ per 1000 population
3. Infant Mortality Rate – Measures the risk of dying during the 1st year of life.
TAKE NOTE: It is a good index of the general health condition of a community since it reflects the changes in the
environmental and medical conditions of a community. (CBQ)
Total No. of deaths under 1 year of age registered in a given calendar year x 1000
Total No. of registered live births of same calendar year
Answer: IMR = _________ per 1000 live births
4. Maternal Mortality Rate – It measures the risk of dying from causes related to pregnancy, childbirth, and puerperium.
TAKE NOTE: It is an index of the obstetrical care needed and received by the women in a community.
Total No. of deaths maternal causes registered in a given yearx 1000

Total No. of live births registered of same year
Answer: MMR = _________ per 1000 live births
5. Fetal Death Rate – Measures pregnancy wastage, death of the product of conception occurs prior to its complete expulsion,
irrespective of duration of pregnancy.
Total No. of Fetal deaths registered in a given calendar year x1000

Total No. of live births registered of same year
Answer: FDR = _________ per 1000 live births
6. Neonatal Death Rate – Measures the risk of dying the 1st month of life.
▪ index of the effects of prenatal care and obstetrical management on the newborn.
▪
No. of deaths under 28 days of age registered in a given calendar year x 1000
Total No. of live births registered of same year.
Answer: NDR = _________ per 1000 live births
7. Incidence Rate – Measures the frequency of occurrence of the phenomenon during a given period of time. NEW CASES
ONLY(CBQ)
No. of NEW CASES of a disease registered in a specified period of time x 100, 000
Estimated population as July 1 in same year
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8. Prevalence Rate – Measures proportion of the population which EXHIBITS a particular disease at a particular time. Total
number cases. (OLD and NEW CASES) (CBQ)
No. of NEW and OLD cases of a certain disease registered at a given time x 100
Total no. of person examined at same given time
9. Attack Rate – More ACCURATE measure of the RISK OF EXPOSURE. Useful in epidemiological investigations.
(CBQ)
No. of persons acquiring a disease registered in a given year x 100

No. exposed to same disease in same year
10. Proportionate Mortality (Death Ratios) – Shows the numerical relationship between deaths from a cause (a groups of
causes), age (or groups of age), etc. and the total no. of deaths from all causes in all ages taken together. Not a measure of risk of
dying.
No. of registered deaths from a specific cause or age for a given calendar year x 100
No. of registered deaths from all causes, all ages in same year
11. Case Fatality Ratio – Index of the KILLING POWER of a disease.
No. of registered deaths from a specific disease for given calendar year x 100
No. of registered cases from same specific disease in same year
12. Swaroop's Index – measure of longevity of Life

Formula: Total death above 50years old ÷ Total Death from all causes X 100
FAMILY
▪ The UNIT OF SERVICE in the community (CBQ)
CLASSIFICATION OF FAMILIES
1. Nuclear family – TRADITIONAL type, consists of husband and wife (and perhaps one or more children).
2. Extended family – includes relatives (aunts, uncles, grandparents, and cousins)
3. Single-parent family – consist of one parent and children
4. Blended family- married couple, their children and their children from previous marriages
5. Alternative family – Relationships include multi-adult households, "skip-generation" families (grandparents caring for
grandchildren), communal groups with children, "nonfamilies" (adults living alone), cohabitating partners, and homosexual
couples.
6. Beanpole - Family comprised of 4 or more generations
7. Same Sex/Homosexual – Family comprised of Gay/Lesbian partner w/ adopted/biological child
8. Communal – Unrelated individual/family in one roof
AUTHORITY:
▪ Patri focal/Patriarchal – Father has main authority
▪ Matrifocal/Matriarchal – Mother has main authority
▪ Egalitarian – Equal authority of both parents
▪ Matricentric - Prolonged absence of father (OFW), Mother gets the dominant power
LOCALITY:
▪ Patrilocal – Newlywed living nearby father's side
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▪ Matrilocal – Newlywed living near mother's side
▪ Bilocal – Newlywed living near both side
FAMILY CARE PLAN

▪ blueprint of the care to the family
First Level Assessment
1. Health Deficits – FAILURE in health maintenance (disease, disorders and disability)

Score: 3
Disease/ illness – hypertension, DM, heart diseases, URTI, marasmus, scabies (CBQ)
Disabilities – deaf, mute, blind, polio, stroked patient with paralysis.
Disorders – problems like mental retardation, down syndrome (CBQ)
2. Health Threat – conditions conducive to disease, accidents or failure to realize one’s health potential. (Score:2)
B roken glasses and scattered sharp objects
A bsence or lack of prenatal visits or clinic visits (CBQ)
S afety hazards: fires, falls and accident
U nhealthy lifestyle – faulty eating, sedentary
R odents and insects
A bsence or lack of immunization
S anitation issues and family history of diseases.
3. Stress Points/ Foreseeable Crisis (CBQ)

▪ anticipated periods of UNUSUAL DEMAND on individual or family in terms of adjustment or family resources (SCORE:
1)
Pregnancy
Abortion
Parenthood
Additional family member (Newborn) (CBQ)
Income loss (loss of job) (CBQ)

Separation or break ups and courtship
Divorce and annulment

Entrance in school (CBQ)
Adolescence (circumcision, menarche, puberty.)
Death of love ones.
PRIORITIZING HEALTH PROBLEMS
NATURE OF THE PROBLEM – health deficit, health threat and foreseeable crisis
▪ Health deficit 3
▪ Health threat 2
▪ Foreseeable crisis 1
MODIFIABILITY OF THE PROBLEM –the PROBABILITY OF SUCCESS of success in minimizing, alleviating or

totally eradicating the problem through intervention (CBQ)
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▪ Easily modifiable 2
▪ Partially modifiable 1
▪ Not modifiable 0
PREVENTIVE POTENTIAL –refers to the nature and MAGNITUDE of future problems that can be minimized or totally
prevented if intervention is done on the problem under consideration
▪ High 3
▪ Moderate 2
▪ Low 1
SALIENCE – refers to the family’s PERCEPTION and evaluation of the problem in terms of
seriousness and urgency of attention needed (CBQ)
▪ A serious problem, immediate attention needed – 2
▪ A problem, not needing immediate attention – 1
▪ NOT seen as a problem – 0

CHN PROCEDURES
CLINIC VISIT steps - patient or family visits the health center

I. Admission/Registration – initial and FIRST ACTION in clinic visit. (CBQ)
▪ Greet and welcome clients (CBQ)
▪ Prepare the individual or family treatment record
II. Waiting time – 1st come, 1st serve basis

III. Triaging
IV. Clinical evaluation
V. Laboratory test and other Diagnostic examinations
VI. Referral-2-way referral system
VII. Prescription and Dispensing
VIII. Health education – LAST step of clinic visit (CBQ)
HOME VISIT
▪ a nurse –family contact which allows the health worker to assess the home and family situations in
order to provide the necessary nursing care and health related activities
ADVANTAGE OF HOME VISIT: provides opportunity to do FIRST HAND APPRAISAL of the home situation (CBQ)
PURPOSES OF A HOME VISIT:

H – health care provider gives nursing care to the sick, postpartum and her newborn.
O – observation and assessment of living condition and family health practices.
M – may establish relationship between agencies and the public for health promotion.
E – educate the family regarding health promotion and disease prevention.
PRINCIPLES OF A HOME VISIT

M – must “HAVE”a purpose or objective
U – use all available information about the patient and his family
S – set and give priority TO the essential needs of the FAMILY
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T – the planning and deliveryMUST INVOLVEthe individual and his family.
TAKE NOTE: Home visit must be FLEXIBLE
STEPS IN CONDUCTING HOME VISIT

1. Greet client and introduce self and ESTABLISH RAPPORT (FIRST STEP) (CBQ)
2. State the purpose and objective of the visit
3. Assess health needs
4. Perform bag technique (Bag placement)
5. Physical examination and nursing care
6. Impart Health teaching
7. Record all data and observations
8. Appointment
PHN BAG- essential and indispensable equipment of a PHN
IMPORTANT POINTS TO REMEMBER: 4 C’s + H

COMPLETE – contains all the necessary articles, supplies and equipment.
CLEAN – Cleaned very often, supplies replaced and ready for use anytime.
CONTAMINATION – bag contents are clean and sterile, while articles belonging to
the patient as dirty and contaminated. (CBQ)
CONVENIENCE - collection of articles should be convenient to the user.
▪ Solutions like 70% alcohol, hydrogen peroxide and betadine are placed at the BACK of the bag (CBQ)
▪ Oral and rectal thermometers, syringes and needles should be placed at the FRONT of the bag
(Thermometers should be facing DOWN.)
Handwashing is done as frequently as situation for, helps minimizing and

avoiding contamination of the bag and its contents. (CBQ)
BAG TECHNIQUE
▪ A “TOOL” making use of a public health bag through which the nurse, during his/her visit, can perform nursing
procedures with ease and deftness, saving time and effort with the end in view of rendering effective nursing care
PRINCIPLES OF BAG TECHNIQUE:

1. MINIMIZE, if NOT prevent the spread of any infections. (Most important) (CBQ)
2. Saves time and effort in the performance of nursing procedure.
3. Show the effectiveness of total care of the individual and the family.
4. Variety of ways should be performed depending on the agency’s policy.
COMMON BOARD QUESTIONS:

▪ Upon arriving at the 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).
▪ Place the linen/plastic lining spread over work field or area CLEAN SIDE OUT
▪ What is the purpose of paper lining: the purpose is TO PREVENT CONTAMINATION OF BAG
▪ LAST item place back in bag is the PLASTIC/PAPER LINING (CBQ)
Page 28 of 29
▪ Sphygmomanometer (BP cuff) and stethoscope is NOT included inside the bag (CBQ)
▪ DO NOT USE NEWSPAPERS only clean papers as linings.
▪ FIRST thing you get from the CHN bag – soap in a soap dish and hand towel
▪ AVOID frequent opening of the bag. (CBQ)
▪ Avoid shaking or swaying the bag when carrying it.
▪ Bag technique shouldn't overshadow but rather show the effectiveness of the total care given to the individual and
family.
Page 29 of 29

Primary Health Nursing

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Primary Health Nursing

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COPYRIGHT: JONAS MARVIN MERCURIO ANAQUE, RM, RN

PRIMARY HEALTH CARE

September 6-12, 1978

▪ Alma Ata Declaration

▪ PHC goal: “health for all by the year 2000”

▪ Alma-Ata, Kazakhstan Russia (USSR) – (CBQ)

Letter of Instruction (LOI) 949– (CBQ)

▪ Signed October 19, 1979

▪ Dr. Jesus Azurin – Father of PHC

Principles of Primary Health Care

Community participation or public participation

▪ Heart and soul of PHC

▪ Example is the use of Herbal meds

Four Major Pillars of Primary Health Car

2. Use of appropriate technology

3. Support mechanism made available

▪ PHC depends adequate distribution of health workers.

4. Active community participation

Components of PHC: There are 8 elements of primary-health care (PHC). (CBQ)

DOH STANDARD RATIO OF HEALH WORKERS:

Levels of Primary Health Care Workers

▪ Initial link to health care (CBQ)

▪ Renders simple curative/preventive health measures

▪ Serves as the foundation of health care

▪ Trained local individuals in the community Provides

B arangay Health workers (BHW)

▪ Attends health problems beyond the competence of grassroots workers

R ural sanitary inspectors R egistered midwives

D octors with specialty: OB, Pedia,Cardiologist, Dentist etc.

Three levels of referral:

▪ highly specialized staff and technical

THREE LEVELS OF PREVENTION

Target: HEALTHY individuals

Health education - family planning counseling (CBQ)

Target: Sick or at risk individual

Diagnostic test like ultrasound, X-ray, MRI, CT-Scan, Mammography(CBQ)

Treatment/cure of disease – (CBQ)

Therapies like physical and occupational therapy

Use of chemotherapeutic drugs and radiation for cancer

Present Health Secretary

▪ Serve as the national policy ▪ Innovation of new strategies ▪ Act as administrator of

evaluation of national health

UNIVERSAL HEALTH CARE (RA 11223)

Universal Health Care (UHC) or Kalusugan Pangkalahatan (KP)

UHC’s Three Thrusts

UNITED NATIONS MILLENNIUM DEVELOPMENT GOALS

▪ NATIONAL PRIORITY – MDG 1 Eradicate Extreme Poverty (CBQ)

▪ 4 P's – Pantawid Pamilyang Pilipino Program. (CBQ)

UNITED NATIONS SUSTAINABLE DEVELOPMENT GOALS

No poverty Cities and communities (sustainable)

Industry, innovation and infrastructure

R.A. 7160 – Devolution Code or Local Government Code.

LOCAL HEALTH BOARD (LHB)

1. Provincial health board

▪ DOH representative (PHN)

▪ NGO representative (private sector)

2. City and Municipal Health Board

Herbal Medicine (LUBBY SANTA)

Yes you can boil it or eat a like a salad.

Neutralize free radicals & lowers cholesterol level

▪ Warm decoction for gargle

Children: give at least 4 – 7 seeds

TAKE NOTE: Tsaang Gubat has high fluoride content.