COMMUNITY HEALTH NURSING

C - Community — client communities (Ruth Freeman & Janet

H - Health — goal Heinrich, 191)
N - Nursing — means
Public Health (Winslow)
Levels of Clientele ● Philosophy – health and longevity
● Individual as birthrights
● Family –Basic Unit ● Objectives
● Community – group of families ○ Prevents disease
● Population Groups ○ Prolong life
○ Promote health and
Health efficiency
➔ complete physical, mental and social ● Through – organized community
well-being and not merely the efforts
absence of disease or infirmity
(WHO,1958) Health Facilities
➔ Dynamic state fluctuating from
patterns of death or OLOF (Dunn,
1961)

Health as a RIGHT
➔ Art. 25, Sec. 1, Universal Declaration
of Human Rights (GA RES. 217 AIII,
1948)
➔ Art. 2, Sec. 15 of the Phil.
Constitution – state to protect and
promote right to health
➔ Art. 13, Sec. 11 of the Phil.
Constitution – comprehensive and
integrated approach

General Philosophy of CHN – community

health nursing is based on the worth and
dignity of man (Margaret Shetland)
Nursing – assisting sick or well individual
to help him gain independence (Virginia
Henderson, 1964)
COMMUNITY HEALTH NURSING
➔ Direct, goal-oriented and adaptable
to the needs of the individual, family
and community during health and
illness (ANA, 1973)
➔ An area of human services directed
toward developing and enhancing
the health capabilities of people –
either singly, as individual, or
collectively as groups and
RA 7160 – Devolution Code , Local
Government Code of 1991
Aim : to transfer local government units into
● Self-reliant communities
● Active partnership with the people
● Responsive to the needs of the
people
● Accountable government
representatives
● Decentralization system of health
decision making
 COMMUNITY HEALTH NURSING
HERBAL PLANTS

LAGUNDI Asthma, cough,

dysentery, analgesic

ULASIMANG BATO Uric Acid

(rheumatism and
gout)

BAWANG lower cholesterol

Primary Health Care – essential health care blood level,
made universally Accessible, Available, hypertension,
Appropriate and Affordable to individuals & toothache
families in the community by means
Acceptable to them BAYABAS Antiseptic wash,
relief of diarrhea,
● Goal: Health for all Filipinos & Health toothache
in the Hands of the People by the
YERBA BUENA Analgesic, cough and
year 2020
colds, swollen gums,
● Mission: to strengthen health care
toothache, nausea
system by increasing opportunities
and fainting
& supporting the conditions wherein
people will manage their own health SAMBONG Diuretic, anti edema
care
AMPALAYA Diabetes Mellitus
PHC Cornerstones/ Pillars
● Active community participation NIYOG-NIYOGAN Anti-Helminitic
● Intra & Intersectoral Linkages
● Use of appropriate technology TSAANG GUBAT Diarrhea, with high
(focus on indigenous resources) fluoride content,
● Support mechanisms made used as a
available mouthwash to
prevent dental caries
Use of Alternative Medicine
➔ RA 8423 – Traditional and AKAPULKO Anti-fungal
Alternative Medicine Act of 1997
➔ Promotes usd of indigenous Determinant of Success of PHC (Atsana
resources Declaration)
➔ Traditional medicine – sum total of 1. Knowledge and capacity building -
knowledge, skill, practices based on health education
theories, beliefs and experiences 2. Human resources for health -
indigenous to different culture multidisciplinary approach
➔ Complementary Medicine – 3. Financing - universal health coverage
combination of both traditional and 4. Technology - effective, safe,
conventional methods affordable, sustainable, acceptable
 COMMUNITY HEALTH NURSING
SUSTAINABLE DEVELOPMENT GOALS delineation of roles of key agencies
2030 and stakeholders towards better
performance in the health system
● Ensure that all filipinos are
guaranteed equitable access to
quality and affordable health care
goods and services, and protected
against financial risk

Pantawid, Pamilyang, Pilipino, Program –

MILLENNIUM DEVELOPMENT GOALS 2015
rights-based and social development
program of the national government to
reduce poverty by providing Conditional
Cash Transfer (CCT) grants to extremely
poor households to improve their health,
nutrition and education particularly of their
children aged 0-18 y/o

RA 11310 – Pantawid Pamilyang Pilipino

Program Act
● The government will provide
MDGs to SDGs conditional cash transfers to
qualified poor households for a
maximum period of 7 years.
● The national advisory council,
however, may recommend a longer
period under exceptional
circumstabnces.
● Qualified for the programs are
farmers, fishermen, homeless
families, indigenous people, informal
sectors, living in isolated and
disadvantaged areas including
places without electricity.
Department of Health
● Vision: Filipinos are among the
Beneficiary Amount Duration
healthiest people in Southeast Asia
by 2022, and Asia by 2040 Php 300 or Max of 10
● Mission: To lead the country in the Elementary
higher mos
development of a productive,
resilient, equitable and people Php 700 or Max of 10
centered health system Senior HS
higher mos

RA 11223 – Universal Health Care Act Php 750

Health & Max of 12
Month or
Nutrition mos
Objectives: higher
● Progressively realize universal health
care in the country through a
systemic approach and clear
 COMMUNITY HEALTH NURSING
The cash grants shall be received by the
FAMILY COMMUNITY
mother through Landbank cash card, OTC,
G-cash remit, Rural Banks. Health
Wellness task
Program Conditions - Family Development Condition (increase
3 modules well being)
1. Paglalatag ng pundasyon ng
programang pantawid pamilya Morbidity,
Existence Health
2. Paghahanda at pangangalaga ng mortality or
of actual Status
pamilyang pilipino fertility
health
3. Partisipasyon ng pamilyang pilipino Health
problems
sa gaping pang komunidad Deficit
to any
● Parents must attend Family member of
development sessions (FDS) on the family
effective parenting, husband and
wife relationships, child Conditions Man power/
development, laws affecting the to develop facilities.
Health
Filipino family, gender and Health Financial
Resourc
development and home Threat resources in
es
management. the
● Livelihood programs and community
employment assistance may also be
available by eligible beneficiaries at Increased political/
the department of Social Welfare demand to environmen
Foreseea
and Development cope up Health tal/ social
ble Crisis
● Persons who will be found of the Related problems in
or Stress
falsifying their information in the problem the
registry for a CCT may be community
imprisoned for a month or up to a
year, and may be fined with not less Department of Health Programs
than Php 10,000 but not more than
Php 100,000.. 7 Priority Areas
● Pregnant must avail pre/post-natal 1. Diet and exercise
care and be attended by a trained 2. Environmental health
health professional 3. Vaccines and immunization
● 0-5 y/o children must receive regular 4. Substance abuse
preventive health check-ups and 5. Sexual and reproductive health
vaccines. 6. Mental health
● 6-14 y/o must receive deworming 7. Violence and injury prevention
pills 2x a year
● 3-5 y/o must attend day care or Maternal Health Program
pre-school classes and must attend
at least 85% of the time Paradigm Shift
● 6-8 y/o must enroll in elementary or
highschool classes and must attend
at least 85% of the time

Family and Community Health Nursing

 COMMUNITY HEALTH NURSING
● A document prepared during the
prenatal care which states the
woman's condition during
pregnancy;
● Her preferences for her place of
delivery
● Choice of birth attendant
● Her available resources for her
Basic Emergency Obstetric and Newborn childbirth and newborn baby
Care (Bemonc) Services ● Preparations needed should an
● Administer parenteral antibiotics emergency situation arise during
● Parenteral uterotonic drugs pregnancy, childbirth and
(oxytocin) to prevent or treat postpartum
postpartum hemorrhage
● Parenteral anticonvulsants for PERINATAL CARE
preeclampsia and eclampsia (e.g PRENATAL/ ANTENATAL VISITS
MgSO4) ➢ Home-based mother’s record
● Manual removal of placenta ➢ Encourage all women to deliver in
● Removal of retained placental the health facility
products (vacuum/dnc)
● Perform assisted vaginal delivery WHO/UNICEF/
(vacuum/forceps) No. of PHN 2007
DOH CPG
● Perform basic neonatal Visits BOOK
2005/2006
resuscitation (with bag/mask)
1st Before the 4th 1st trimester
Comprehensive Emergency Obstetric and month of
Newborn Care (CEmonc) Services pregnancy
● 7 functions of BEmOC facility +
● Perform surgery (CS or 2nd Between 6th - 7th 2nd trimester
hysterectomy) month of
● Give safe blood transfusion pregnancy

Note: there must be 5 Emoc facilities (at 3rd 8th month of 3rd trimester
least 1 cemoc) for every 500,000 population pregnancy
(WHO)
4th After 8th
9th month of
Domiciliary Obstetrical Service: month; every
pregnancy
Qualifications 2 weeks
● Full term
● Not a primigravida, with less than 5 Ideal Prenatal Check Up
pregnancies
● Without coexisting disease
AOG INTERVAL NO. OF VISIT
● No history of complications/
abnormalities in present & previous 1st 28
pregnancies & deliveries Every 4 weeks 7 visit
weeks
● Imminent delivery
28-36
What is a Birth Plan? Every 2 weeks 4 visit
weeks
 COMMUNITY HEALTH NURSING
36-40 (+) CHON =
Every week 4 visit If it turns cloudy
weeks proteinuria

Assessment during pregnancy TETANUS TOXOID IMMUNIZATION

1. History taking – protects the mother and baby against
2. Weight & height tetanus
3. Vitals signs
4. Physical examination ● Fully immunized mother – 5 TT
5. Laboratory examinations ● 3 doses of DPT = 2 doses of TT
a. Glucose screening – 24 to 28 ● For determining the amount of TT to
weeks if (+) DM history, be requested: 3.5% of the population
obese, recurrent vaginal
infections, history of Schedule of Tetanus Toxoid and Diphtheria
unexplained fetal death, large as per AO #15
fetus
b. Urinalysis DURATION %
■ Benedict’s test: test OF PROTECTION
DOSE SCHEDULE
for sugar in the urine; PROTECTIO OF THE
test for diabetes N MOTHER

At any
(-) sugar 1st anytime immediate
Blue point
in urine
After 1
Trace of 2nd 3 years 80%
month
Green sugar in +1 +
urine After 6
3rd 5 years 95%
months
Traces
Yellow of sugar +2 ++ After 1
4th 10 years 99%
in urine year

More After 1
5th lifetime 99%
traces of year
Orange +3 +++
sugar in
urine
MICRONUTRIENT SUPPLEMENTATION
Brick Surely
+4 ++++ Iron deficiency - can cause neural tube
Red diabetic
defects
Anemia - presence of pallor, N=11g/dL
● Acetic Acid Test: test
for albumin in urine; Iron supplementation
for pregnancy
induced hypertension
DOSE/
TARGETS PREPARATIONS
DURATION
(-) CHON or
If it remains clear Pregnant Tab w/ 60 mg 1 tab 1x/day
albumin in urine
Woman EI w/ 400 mcg for 6 mos or 2
 COMMUNITY HEALTH NURSING
Folic Acid tabs/day if WHO/UNICEF/
No. of PHN 2007
2nd or 3rd DOH CPG
Visits BOOK
trimester 2005/2006

Tab w/ 60 mg 1 tab 1x/day 1st First 24 to 48 Within 3-5

Lactating
EI w/ 400 mcg for 3 mos or hours after days
Woman
Folic Acid 90 days delivery

2nd 6 weeks after 6 weeks after

Vitamin A deficiency - can cause delivery delivery
congenital problems
Note: do not give Vit. A if woman is taking
multivitamins Postpartum Care
● Breast
Vitamin A Supplementation ● Uterus
● Bowel
● Bladder
DOSE/
TARGETS PREPARATIONS ● Lochia
DURATION
● Episiotomy
1 cp/tab ● Skin
Pregnant 2x/week (4th ● Homan's sign
10,000 IU ● Emotions
Woman month until
delivery)
4 PILLARS OF FAMILY PLANNING
1 cap 1x PROGRAM
Postpartu (within 4 1. Responsible parenthood
200,000 IU 2. Child spacing
m Woman weeks after
delivery) 3. Respect for life
4. Informed choice
Iodine supplementation
➔ RA 6365 – National policy on
population, POPCOM
TARGETS PREPARATIONS
DOSE/ ➔ PD 69 – limit to 4 children tax
DURATION exemption
➔ LOI 47 – schools to integrate family
Children Iodized oil 1 cap for 1 planning
of School capsule w/ 200 year ➔ PD 965 – family planning before
Age mg iodine marriage license
Woman Iodized oil 1 cap for 1
FAMILY PLANNING PRIORITIES
15-45 y/o capsule w/ 200 year
1. Couples in the reproductive age: 20
mg iodine
to 44 y/o
Adult Iodized oil 1 cap for 1 2. 3 or more children
Males capsule w/ 200 year 3. Close interval pregnancies
mg iodine 4. (+) chronic disease

EARLY CHILDHOOD CARE AND

POSTNATAL VISITS DEVELOPMENT (ECCD) PROGRAMS - RA
8980 – Refers to the full range of health,
 COMMUNITY HEALTH NURSING
nutrition, early education and social service 4. Non-separation of the newborn and
programs that provide for the basic holistic mother for early initiation of
needs of young children from birth to 6 breastfeeding
years of age. To promote their optimum
growth and development Newborn Screening
● RA 9288 "Newborn Screening Act of
1. Center-based programs 2004"
a. Day care service (RA6972) ● AO No. 2018-0025 - National Policy
b. Public and private and Strategic Framework on
pre-schools Expanded NBS for 2017
c. Kindergarten ● 48-72 hrs or 2-3 days of life (ideal),
d. Community or school-based 24 hrs (at least)
early childhood ➔ Trained MD, RN, Midwife, Medical
e. Child-minding centers technologist
f. Health centers and stations ➔ using heel prick method, a few drops
2. Home-based programs of blood are taken from the baby's
a. Neighborhood-based play heel Blotted on a special absorbent
groups filter card
b. Family day care programs ➔ Blood is dried for 4 hrs & sent to the
c. Parent education NBS center
d. Home visiting program ➔ After 7 working days, parents claim
the results from their physician,
nurse, midwife or health worker:
Number/Schedule of Visits
○ If positive (+) screen:
0-11 months Every month ■ Released within 24
hrs for confirmatory
12-23 months Every 2 months testing
■ Referred to a
24-54 months specialist for further
Every 3 months
(3rd year) management

36-47 months 6 Disorder in the Newborn Screening

Every 6 months
(4th year)
48-59 months
Once a year
(5th year)
ESSENTIAL NEWBORN CARE (UNANG
YAKAP) – DOH ADMINISTRATIVE ORDER
2009-0025
Four Core Steps in Essential Newborn Care
1. Immediate and thorough drying to
prevent hypothermia
2. Early skin-skin contact to reduce
infection and hypoglycemia
3. Properly timed cord clamping to
prevent intraventricular hemorrhage
Package
● Congenital Hypothyroidism
● Congenital Adrenal Hyperplasia
● Galactosemia
● Phenylketonuria
● G6PD Deficiency
● Maple syrup Urine Disease
28 Disorder in the Expanded NBS Package
● Current 6 Disorder (mentioned
above)
● Biotinidase Disease
● Cystic Fibrosis
● Organic Acid Disorders
● Fatty Acid Oxidation Disorders
● Amino Acid Disorders
● Urea Cycle Disorders
 COMMUNITY HEALTH NURSING
● Hemoglobin Disorders obligation to inform the parents or
legal guardian of the newborn of the
Newborn Screening Cost availability, nature and benefits of
hearing loss screening among
newborn or infants 3 months old
BASIC EXPANDED
and below
Price Php 550 Php 1500
Breastfeeding
Facility
Php 50 Php 50 Advantages of Breastfeeding
collection fee
A. Mother
Total: Php 600 Php 1550 a. Oxytocin helps uterus
contracts
Cost per b. Uterine involution
Disorder Php 100 x 6 Php 55 x 28 c. Reduce incidence of breast
Tested cancer
d. Promote maternal-infant
Basic Expanded bonding
Total:
Php 600 Php 1555 e. Form of family planning
method (LAM)
PhilHealth
FREE Php 950 B. Baby
Member
a. Provides antibodies
b. Contains Lactoferrin (binds
Roles of RHU Staff in NBS with iron)
1. Advocacy for NBS of every baby. c. Leukocytes
This starts during pregnancy. The d. Contains bifidus factor
family is advised to save Php 550 promotes growth of the
2. Collection of samples Lactobacillus - inhibits the
3. Assures transport of specimen growth of pathogenic bacilli
within 24 hours following collection
of the sample Promoting Breastfeeding
4. Advise and counsel parents upon ● RA 7600 – Rooming-in &
receiving the screening results Breastfeeding Act of 1992
○ Breastfeeding week: August
Universal Newborn Hearing Screening 1 to 7
Program ● EO 51 – Milk Code
● RA 10028 – Expanded
RA 9709 – Universal Newborn Hearing Breastfeeding Promotion Act –
Screening and Intervention Act of 2009 Lactation stations
● AO 2006-0012 – Revised
● Early detection of congenital Implementing rules and regulations
hearing loss and referral; for early in the EO 51
intervention for infants ● AO 2005-0014 – National Policies
● Newborn hearing screening on Infant and Young Child Feeding
reference center at the national
institutes of health Breastfeeding Practices
● On any healthcare practitioner who ● Exclusive Breastfeeding – allows to
delivers, or assists in the delivery of receive ORS, drops, vitamins,
a baby in the Philippines the medicines
 COMMUNITY HEALTH NURSING
● Predominant Breastfeeding – H20,
fruit juice, ORS, vitamins, medicines
● Complementary Feeding – foods
and liquids with breast milk Kangaroo position
● Bottle Feeding – food or drink (inc
breast milk) from a bottle
● Early Initiation of Breastfeeding –
after birth within 90 mins of life
STEPS TO A GOOD LATCH
Breastfeeding during Trimesters
● 1st trimester - discomfort of
pregnancy
● 2nd trimester - accept pregnancy & The mother holds her
baby breast in a C-hold
● 3rd trimester - birth preparation
(labor & delivery)

Technique for Breastfeeding

Positions for Breastfeeding Stimulate the bay’s

rooting reflex

Cradle hold/
Madonna/Cross-chest
position When the baby’s mouth
opens wide, put the
nipple and as much of
the areola as possible
into his mouth

How to make baby let go of the breast

without hurting the mother
Football Hold/Clutch
1. Press down on the breast near his
position
mouth
2. Pull down on his chin and insert a
small finger in the corner of his
mouth. This will break his seal on
the nipple
3. Then remove him from the breast

Side-lying position Signs that the baby has latched on properly

to the breast
1. The baby’s mouth is wide open
2. The baby and the mother are in
tummy to tummy position
 COMMUNITY HEALTH NURSING
3. Much of the mother’s areola is inside C - Clinical Exam
the baby’s mouth D - Dietary History
4. The mother does not feel nipple pain H - Health History
5. The baby is relaxed and happy
Anthropometry
Breastfeeding Campaign ● Weight for age
● Storage of breastmilk ○ Under 5, Operation Timbang
○ Room temp – 8 hrs every month
○ Refrigerator – 24 hrs ○ Do not use when pt has
○ Frozen – 1 month edema
● Breastfeeding should be fed on ○ Used in dx of
demand at least 8x a day ■ Chronic
● Diet during lactation: (+) 550 undernutrition =
calories, high CHON, high calcium, stunting
sufficient fluids ■ Acute (current)
malnutrition
Nutrition Program ● Overweight –
obesity
Goal: improve quality of life through better ● Underweight –
nutrition, improved health and increased wasting
productivity ○ Gomez classification of
nutritional status
Nutrition Program & Projects
● Nutritional assessment Formula for computation of % of EBW
● Micronutrient supplementation
● Food fortification
● Maternal & child health service
packages
● Nutrition information,
communication, education
● Home, school and community food
production
● Food assistance >100% Overweight
● Livelihood assistance
● Treatment of conditions associated 91-100% Normal
with malnutrition
76-90% 1o undernutrition (mild)
Legislations affecting the Philippine
61-75% 2o undernutrition (moderate)
Nutrition Program
● PD No. 491 – declared July as the <60% 3o undernutrition (severe)
Nutrition month and creation of
national nutrition council
● LOI 441 – integration of Nutrition Management of PEM
Education in the school curriculum ● 1st & 2nd degree malnutrition
○ Home management
Nutritional Assessment Methods ○ Nutrition education
● 3rd degree malnutrition
A - Anthropometry ○ Referral to a hospital
B - Biochemical or lab exams ○ Nutrition education
 COMMUNITY HEALTH NURSING
● Height for Age
Protein energy malnutrition (PEM)
● Weight for Age
○ Adults weight for age < -2 standard
○ Dx of acute malnutrition deviations (SD) of the WHO
○ Body mass index Underweight
Child Growth Standards
Formula: median

height for age < -2 SD of the

WHO Child Growth Standards
Stunting
median

BMI of 20-25 is desirable (WHO)

BMI of 18.5-22.9 is desirable (Asian Criteria) weight for height < -2 SD of
● Mid upper arm circumference the WHO Child Growth
(MUAC) Standards median; "baggy
○ 1-4 y/o pants"
○ Rapid screening for
malnutrition Wasting
Procedure:
➢ Determine midpoint between
acromion & olecranon
➢ Measure circumference at midpoint
➢ Interpretation
○ >115 mm = normal
nutritional status weight for height > +2 SD of
○ <115 mm = acute the WHO Child Growth
undernutrition (wasting) Standards median;
Overweight associated with a higher
probability of obesity in
adulthood

Severe Acute Malnutrition (SAM)

In children 6-9 months of age

● weight -for-height less than (-) 3 SD
of the WHO child growth standards
median
● Skin fold thickness ● Presence of edema of both feet
○ Thickness of subcutaneous ● MUAC less than 115 mm
tissue For infants less than 6 months old
■ Femoral ● Presence of visible severe wasting
■ Abdominal and edema together with difficulties
■ Triceps in breastfeeding
○ Harpenden caliper
○ Adults – acute malnutrition Macronutrient Deciencies
● Kwashiorkor
Malnutrition in Children ● Marasmus
 COMMUNITY HEALTH NURSING
Iron deficiency
● Susceptible population: 1-4 y/o;
occurs together with PEM
● Food rich in iron
○ Rich source: Plant sources
○ Best source: Animal sources

Iron Supplement

60 Iron with 400 mcg

10 to 19 yrs old
folic acid
girls
= 1 tab/day

Micronutrient – a substance found in very 60 Iron with 400 mcg

small amounts in the body (<0.005% of body Folic Acid
weight) Pregnant = 1 tab 1x/day for 6
months or 2 tab/day
Major Micronutrient Deficiency 2nd or 3rd trimester
● Vitamin A Deficiency
● iron-deficiency anemia 60 mg Iron with 400
● Iodine deficiency disorders Lactating/Post mcg Folic
Partum = 1 tab 1x/day for 3
Vitamin A Deficiency (Xerophthalmia) months
● susceptible population: 1-4 y/o;
usually occurs together with PEM 60 mg Iron with 400
● Foods rich in vitamin A Older Persons mcg Folic Acid
○ Rich source: animal sources = 1 tab 1x/day
(retinol) – liver, egg yolk &
milk
○ Best source: Plant sources Iodine Supplementation
(carotene) – dark green leafy
vegetables, yellow fruits & Targets Preparations Dose/Duration
vegetables; considering the
Iodized oil
socioeconomic status of Children of 1 cap for 1
capsule w/
family School Age year
200 mg iodine

Vitamin A Supplementation
Fortification - addition of a nutrient to food
6-12 months 100,000 IU during processing
● Sangkap Pinoy seal - placed on label
12 months & 200,000 IU
of fortified foods
above
● RA 8976 - Philippine Food
Fortification Act of 2000.
This provides for mandatory
Prevention: Every 6 months or 2x a year fortification of the following
Treatment: give now, after 2 weeks and products:
every 5 months ➔ Rice with iron
➔ Wheat flour with vitamin A & iron
 COMMUNITY HEALTH NURSING
➔ Refined sugar with vitamin A ➔ X awaken or unconscious - IVF
➔ Cooking oil with vitamin A ◆ 5 ml/kg of 10% of Dextrose
● E.O. 382: November 7 declared as for a few minutes,
National Food Fortification Day ◆ 1 ml/kg of 5% of Dextrose in
50cc by slow IV push

MAIN SYMPTOMS
● Pneumonia - cough or difficult
breathing
● Dehydration - diarrhea
● Malnutrition - weight/age
● Anemia - palmar pallor
● Malaria, Measles, Dengue - fever
○ Fever - Feels hot, Temp
(Axilla - 37.5)
● (Rectal-38)
● Ear problem - ear pain or ear
INTEGRATED MANAGEMENT FOR discharge
CHILDHOOD ILLNESSES (IMCI)
Color Codes Classification and MGT
Basic Steps
➔ Assess PINK Severe Referral to
◆ Childs problem classification hospital +
◆ Check for general danger Pharma (1st
signs dose)
◆ Then ask for main symptoms
➔ Classify YELLOW Some/Disease RHU + Pharma
◆ Severe, some/disease, No condition Follow up: 3
➔ Treat days
➔ Follow up
GREEN No Home MGT
Treatment for Danger Signs classification Follow upL 5
➔ Diazepam if convulsing now days
➔ Complete assessment
➔ Give pre-referral treatment
Intramuscular Antibiotic for children being
➔ Treat to prevent low blood sugar
referred urgently
➔ Keep the child warm
● Gentamicin (7.5 mg/kg)
➔ Refer urgently
● Benzylpenicillin (50,000 units/kg)
Dysentery – ciprofloxacin 3 days, BID (15
Management
mg/kg)
Prevent low blood sugar
Cholera – cotrimoxazole or furazolidone BID
➔ Can breastfeed - breastfeed the child
for 3 days
➔ X breastfeed but can swallow -give
Pneumonia – amoxicillin or cotrimoxazole
expressed breast milk
Anemia – FeSO4
◆ 30-50ml milk or sugar H2o
Intestinal Parasitism – mebendazole or
◆ 200 ml of H20 + 4 tsp of
albendazole
sugar
➔ X swallow - 50 ml of milk/sugarH2o
by NGT
 COMMUNITY HEALTH NURSING
VIOLENCE AGAINST WOMEN AND RA 11036 Mental Health Act – An Act
CHILDREN (VAWC) Establishing a National Mental Health Policy
for the Purpose of Enhancing the Delivery of
RA 9262 – anti-violence against women Integrated Mental Health Services,
and their children act of 2004 Promoting and Protecting the rights of
persons utilizing psychiatric, neurologic and
psychosocial health services
● June 21, 2018

Mental Health Services at Community Level

1. Basic mental health services at all
LGUs down to the barangay
2. Community resilience and
psychosocial well-being training in
all barangays including the
availability of mental health and
psychosocial support services
during and after natural disasters
and other calamities
3. Training and capacity-building
programs for local mental health
workers in coordination with mental
health facilities and departments of
psychiatry in general or university
MENTAL HEALTH hospitals;
4. Support services for families and
4 facets of mental health problems as a co-workers of mental health services
public health problem: 5. Dissemination of mental health
1. Defined Burden – burden of information and promotion of
currently affecting person with mental health awareness among the
mental disorders general population.
a. Quality life indicators,
disability adjusted life years INTEGRATED COMMUNITY-BASED NON -
(DALY) COMMUNICABLE DISEASE PREVENTION &
2. Undefined Burden – portion of the CONTROL PROGRAM
burden relating to impact of mental
health problems to persons other Strategies for the Control & Prevention of
than the individual directly affected Non-Communicable
a. Felt by families and relatives ● Promote Physical Activity &
od mentally ill Exercise
3. Hidden burden - stigma and ○ Physical Activity = body
violations of human rights. movement that results in
a. Rejection, shame - suffered expenditure of energy
by mentally ill. (occupational, leisure-time,
4. Future burden - burden in the future routine daily activities)
resulting from the aging of the ○ Exercise = planned,
population, increasing social structured, repetitive aimed
problems and unrest inherited from at improving or maintaining
the existing burden physical fitness (performed
 COMMUNITY HEALTH NURSING
activities with vigor &
alertness without undue
fatigue).
○ Moderate intensity for 30
mins for 5 days
● Promote proper nutrition (ABC)
○ A – aim for physical fitness
(ideal body weight)
○ B – build healthy
nutrition-related practices
○ C – choose foods sensibly
● Promote Smoke Free Environment
○ Five A's - quitting smoking
Ask = smoking status
Advice = to stop smoking,
can cause death NCD Care
Assess = willingness to quit ● Package essential
Assist = quitting non-communicable (PEN) disease
Arrange follow up = monitor intervention for Primary Health Care
progress in low-resource settings
○ RA 10352 = Excise tax on ○ Prevention
alcohol and Tobacco for 5 ○ Treatment
years for the Universal Health ○ Rehabilitation
Care program of the ○ Palliative care
government. PHILPEN – Philippine Package of Essential
● Stress Management Techniques Noncommunicable Disease Intervention
12s
1. Spirituality
2. Self - Awareness
3. Scheduling activities
4. Siesta
5. Stretching
6. Sensation Techniques
7. Sports
8. Socials
9. Sounds and songs ● shall be used in all primary health
10. Speak to me care facilities in the country, ie,
11. Stress Debriefing barangay health stations, rural health
12. Smile centers, community health centers,
and the like
WHO Package of Essential ● (WHO PEN and Phil PEN) - tool to
Non-Communicable Disease Interventions improve access of cost effective
– Enable early detection and management interventions to the poor even in
of cardiovascular diseases, diabetes, resource constrained settings
chronic respiratory diseases and cancer to Target Population
prevent life threatening complications (e.g. ● All individuals aged 25 years old and
heart attacks, stroke, kidney failure, above with no established
amputations, blindness) cardiovascular disease angina
pectoris, coronary heart disease,
 COMMUNITY HEALTH NURSING
myocardial infarction and transient ● Yellow with biohazard symbol -
ischemic attacks), cerebrovascular pathological/ anatomical wastes
disease (CeVD) or peripheral ● Yellow with black band -
vascular disease (PVD) or have not pharmaceutical, cytotoxic, or
undergone coronary chemical wastes (labeled
revascularization or carotid separately).
endarterectomy will undergo Risk ● Yellow bag that can be autoclaved -
Factor Assessment. (WHO 2007) infectious wastes.
● Orange with radioactive symbol -
Primary Health Center Staff Team and their radioactive wastes.
Roles
● Physician - Receives NCD referrals Food Sanitation (4Rs in Food Safety)
from the nurse, Plusienly examines 1. Right source
patient Prescribed medications and 2. Right preparation
promotes adherence 3. Right cooking
● Nurse - Conducts risk assessment 4. Right storage
and screening, Measures weight
height VS, Performs urinalysis and Rule: When in doubt, throw it out!
blood sugar testing, I needed,
Healthy Lifestyle counseling FORMULAS
● Others - Dietician, Smoking FERTILITY RATES
cessation specialist, Health educator Crude Birth Rate

ENVIRONMENTAL SANITATION

Is the control of factors in man’s physical

environment that maybe deleterious to General/Total Fertility Rate
man's well-being

The program covers the following areas:

● Water sanitation
● Food sanitation MORTALITY RATES
● Waste management Crude Death Rates

Legislations on Environmental Sanitation

● PD 825 – Anti-littering Act
● PD 856 – Code on Sanitation
● RA 9003 – Ecological Solid Waste Age-specific Death Rate
management Act
● RA 8749 – Clean Air Act
● RA 9275 – Clean Water Act
● PP 1101 – November as Clean Air
Month Sex-specific Death Rate

Waste Segregation
● Black or colorless- non-hazardous,
non-biodegradable wastes
● Green- non-hazardous
biodegradable wastes
 COMMUNITY HEALTH NURSING
Cause-specific Mortality Rate

Proportionate Mortality Rate

Case Fatality Rate

Swaroop’s Index

Maternal Mortality Rate

Infant Mortality Rate

Neonatal Mortality Rate