CHAPTER 14: NONCOMMUNICABLE DISEASE 


Smoking
Sedentary lifestyle
PREVENTION AND CARE OF AGEING POPULATION  Alcohol consumption

Notes by: Fritz Daisy B. Bonganciso For Cerebrovascular disease

 Hypertension
 Smoking
According to the WHO
 High cholesterol
 NCDs are the leading cause of mortality.
 History of ischemic attacks
 71% of the total deaths worldwide were due to NCDs.
 Age
 Deaths of NCDs occur between ages 30-69 years
PREVENTION OF CVD AND CVA
Reports of PSA (2018)
1. Screening – is the identification of an unrecognized
 Top leading causes of mortality are
disease by the application of test, examination, or other
- Ischemic heart disease (rank 1)
procedures that can be applied rapidly to help identify and
- Neoplasms or cancer (rank 2)
individual’s chances of becoming ill.
- Cerebrovascular disease or stroke (rank 4)
- Example: for hypertension, monitoring of blood
- Hypertensive disease (rank 5)
pressure with the use of sphygmomanometers.
- Diabetes (rank 6)
- Example: for elevated cholesterol in the blood,
- Other heart disease (rank 7)
taking a blood sample to determine the total
serum cholesterol, low density lipoprotein, and
NONCOMMUNICABLE DISEASES
high density lipoprotein
 A medical condition that is noninfectious and
BLOOD PRESSURE CATEGORY
nontransmissable.
 Are referred as “chronic diseases” due to their long CATEGORY SYSTOLIC DIASTOLIC
duration. Normal <120 <80
 Also referred as “lifestyle-related diseases” due to common Elevated 120-129 <80
risk factors such as: Hypertension Stage 1 130-139 80-89
- Lifestyle of the individual Hypertension Stage 2 >140 >90
 It is estimated that 75% of the total deaths can be Hypertensive crisis >180 >120
attributed to NCDs (Ulep, 2012)
 Causes of mortality in the country were caused by chronic
lifestyle-related noncommunicable diseases (LRNCDs) CLASSIFICATION OF LDL, HDL, AND TOTAL CHOL.
such as cardiovascular, cerebrovascular disease, cancer,
COPD, and diabetes (DOH, 2005) VALUES INTERPRETATION
LDL
CARDIOVASCULAR AND CEREBROVASCULAR DISEASE <100 Optimal
100-129 Above optimal
 Cardiovascular death is the most common cause of NCDs
130-159 Borderline
mortality worldwide 160-189 High
 The most common cause of these two diseases are >190 Very high
ATHEROSCLEROSIS and HYPERTENSION.
TOTAL CHOLESTEROL
 CARDIOVASCULAR DISEASE
- “heart disease” <200 Desirable
- Is the general term used to refer to diseases that 200-239 Borderline
involve the heart or blood vessels. >240 High

 CEREBROVASCULAR DISEASE HDL

- “stroke”
<40 Low
- Is a group of brain dysfunction related to disease
>60 High
of the blood vessels supplying the brain.

 HYPERTENSION
- “high blood pressure”
- A systolic blood pressure equal to or above 140 CANCER (MALIGNANT NEOPLASM)
mm Hg or a diastolic blood pressure equal or
above 90 mm Hg  Is the second most common cause of death worldwide
 In the Philippines, lung cancer was the leading cancer
 ATHEROSCLEROSIS killer in both men and women in 2015.
- Is a disease of the blood vessels characterized by  While breast cancer ranked first among women.
the deposition of fats and cholesterol within the  Liver cancer was the second cause of cancer deaths for
walls of the artery. both sexes combined in 2015.
 Is a group of various diseases involving unregulated cell
RISK FACTORS growth.

For Cardiovascular disease

 Unhealthy diet
 LIFESTYLE RELATED FACTORS FOR CANCER
PACKAGE OF ESSENTIAL NCD INTERVENTIONS
 Cigarette smoking
 Unhealthy diet  The PEN is “a prioritized set of cost-effective interventions
 Alcohol drinking that can be delivered to an acceptable quality of care even
 Physical inactivity in resource poor settings”
 Overweight/obesity  It enables early detection and management of
cardiovascular diseases diabetes, chronic respiratory
PREVENTION OF CANCER diseases, and cancer to prevent life threatening
complications
 Screening for cancer involves early detection of the
warning signals of cancer developed by the American
GOALS:
Cancer Society.
1. To achieve universal access to high-quality
WARNING SIGNALS (Mnemonic: CAUTION US) diagnosis and patient-centered treatment
2. To reduce the suffering and socioeconomic
C – change in bowel or bladder habits burden associated with major NCDs
A – a sore throat that does not heal 3. To protect poor and vulnerable populations from
U – unusual bleeding or discharge NCDs
T – thickening or lump in breast 4. To provide effective and affordable prevention
I – indigestion or difficulty of swallowing and treatment through primary care.
O – obvious change in a wart or mole 5. To support early detection, community
N – nagging cough or hoarseness engagement, and self-care
U – unexplained anemia
S – sudden weight loss CVD  Primary prevention of heart attacks and
strokes
 Accute Myocardial infarction
CHRONIC OBSTRUCTIVE PULMONARY DISEASE  Secondary prevention (post MI)
 Secondary prevention (post stroke)
 Is a condition affecting the lungs in which the airways  Secondary prevention (rheumatic heart
narrow overtime. disease)
 It includes chronic bronchitis, chronic asthma, and DIABETES  Type 1
emphysema. MELLITUS  Type 2
 Prevention of foot complications through
RISK FACTORS
examination and monitoring
 Prevention of onset and delay in
 Smoking is a strong risk factor – 15% of cigarette smokers
progression of:
develop COPD.  Chronic kidney disease
 Second hand smoke  Diabetic retinopathy
 Pollution  Prevention of onset progression of
neuropathy

DIABETES MELLITUS COPD 


Bronchial asthma
Prevent exacerbation of COPD and
disease neuropathy
 Is a serious chronic, metabolic disease characterized by CANCER  Early diagnosis
high levels of blood sugar due to inability of insulin, or
inability of the body to effectively use the insulin it


produces.
Common effect of diabetes is hyperglycemia MENTAL HEALTH
SYMPTOMS  Is an integral part of every individual
 It is a state of social well-being in which every individual
- Polyuria realizes his or her own potential (self-image), can cope
- Polydipsia with the normal stresses of life (resiliency), can work
- Polyphagia productively and fruitfully (productivity and creativity),
- Weight loss and is able to make a contribution to her or his community
- Vision change (sense of purpose). (WHO, 2001)
- Fatigue  It is determined by the interplay of different factors that
affect the mental state and well-being of an individual.
COMPLICATIONS ASSOCIATED
FACTORS AFFECTING MENTAL HEALTH
- Heart disease
- Neuropathies  Socioeconomic factors such as:
- Amputations  Poverty
- Kidney disease  Low levels of education
 Poor living conditions
 Hopelessness
 Genetics
 Chemical imbalance in the brain due to trauma
 Infectious diseases
 Toxic substances
 Behavioral problems 3. Less economic participation
 Health problems (e.g. HIV/AIDS) 4. Higher rates of poverty
5. Increased dependency
FOUR FACETS OF MENTAL HEALTH PROBLEMS 6. Restricted participation

As a public health burden: BARRIERS IDENTIFIED:

1. Defined or direct burden – burden affecting persons
with mental disorders such as cost of treatment, quality of
life, and disability.
2. Undefined or indirect burden – burden relating to the
impact of mental health problems to others such as family
members or the community who care for the patient.
3. Hidden burden – stigma and violations of human rights
to persons affected with mental health problems.
4. Future or health burden – burden resulting from the
aging population or increasing social problems such as the
development of complications or other medical illnesses or
death.
DEINSTITUTIONALIZATION OF MENTAL HEALTH CARE
 Where home care management for mentally ill patients is
advocated.
 To apply the promotive and preventive levels of health
rather than pursue the curative and rehabilative care.
NATIONAL MENTAL HEALTH PROGRAM
VISION A society that promotes the well-being of
all Filipinos, supported by transformative
multi-sectoral partnerships,
comprehensive mental health policies and
programs, and a responsive service
delivery network.
MISSION To promote over-all wellness of all
Filipinos, prevent mental, psychosocial,
and neurological disorders, and reduce
burden of disease by improving quality
care and recovery.
OBJECTIVES 1. To promote participatory governance
and leadership in mental health.
2. To strengthen coverage of mental
health services.
3. To harness capacities of LGUs and
organized groups
4. To leverage quality data and research
evidence for mental health.
5. To set standards for compliance in
different aspects of services.
MENTAL HEALTH LAW (RA 11036)
 Is an act establishing the national mental health policy for
the purpose of enhancing the delivery of integrated mental
health services, promoting and protecting the rights of
persons utilizing psychiatric, neurologic, and psychosocial
health services in the Philippines.
DISABILITY
 Defined as a general term for impairments, activity
limitations, and participation restrictions
 Refers to the negative aspects of the interaction between
individuals with a health condition, personal, and
environmental factors.
 According to studies, people with disabilities
experience the ff than people without disabilities:
1. Poorer health outcomes
2. Lower educational achievements
1. Inadequate policies and standards for people with
disability
2. Negative attitudes of people
3. Lack of provision of services for PWDs
4. Poor service delivery
5. Inadequate funding
6. Lack of accessibility
7. Lack of involvement
8. Lack of data and evidence on disability
National Health Program for Persons with Disabilities
and RA 7277 (Magna Carta for Disabled Persons
- This law particularly requires
 a national health program for PWDs
 establishment of medical rehabilitation centers in
provincial hospitals
 an integrated and comprehensive program for the
health development of PWDs
- Rule IV, Sec 4 of RA 7277 stipulates the health concerns
of PWDs in 7 categories of disability that include:
1. Psychosocial and behavioral disabilities
2. Chronic illness with disabilities
3. Learning disabilities
4. Mental disabilities
5. Visual disabilities
6. Orthopedic or moving
7. Communication deficits
IMPAIRMENT
 Is a body problem in body function or structure
VISUAL IMPAIRMENT – is a worldwide health problem.
 Major causes of blindness:
 39% cataract
 18% uncorrected defective errors
 10% glaucoma
 7% age-related macular degeneration
 4% corneal opacities
 4% diabetic retinopathy
 3% eye diseases in children
 3% trachoma
 0.7% onchocerciasis
 WHO launched in 1999 “Vision 2020: The Right to Sight”
- Which aims to develop a sustainable comprehensive health
care system that will ensure the best possible vision for all.
 International Agency for the Prevention of Blindness
- 3 essential components are:
1. Cost effective disease control interventions
2. Human resource development
3. Infrastructure development
 National Prevention of Blindness Program developed by the
DOH is the program that addresses visual impairment in
the Philippines. The organizations involved are as follows:
 National Committee for Sight Preservation
 Philippine Academy of Opthalmology
 Philippine Information Agency
 Optometric Association of the Philippines
  Rotary Internation organizing, creative expression, and
 Integrated Philippine Association of Optometrists improvement of self.
 Foundation for Sight 2. After care and follow-up services for senior
 Helen Keller Internation citizens discharged from home/institutions for the
 Lions Club International aged for reintegration with their family and
 Tanggal Katarata Foundation community.
 UP Institute of Opthalmology 3. Neighborhood support services that provide care
 Christian Blind Mission giving services to frail, sick, or bedridden senior
 Resources for the Blind citizens
 Sentro Ofthalmologico Jose Rizal 4. Substitute family care in the form of residential
care/group homes for the abandoned, neglected,
ACTIVITY LIMITATION unattached or homeless senior citizens who are
incapable of self-care.
 Is a difficulty encountered by an individual in executing a
task or action.
Review Questions:

PARTICIPATION RESTRICTION 1. Which of the following are considered for the development of NCDs?
1. Smoking
2. Physical inactivity
 Is a problem experienced by an individual with regard to
3. Unhealthy diet
the involvement in life situations. 4. Excessive alcohol drinking

2. What is the second leading cause of mortality in the Philippines based

AGING IN THE PHILIPPINES on the 2016 statistics?
A. Ischemic heart disease
B. Cancer
 According to UN, a society is considered to be aging if 7% C. Cerebrovascular diseases
D. Diabetes mellitus
of the total population comprises of 60 years old or older.
 Older adults are more at risk for developing disabilities, 3. In promoting and designing physical activity programs in the
chronic diseases, and communicable diseases due to community, which of the following conditions should be considered by
the community health nurse?
aging. 1. The activity should be based on the interests, preferences, and
readiness of the individual
COMMON DISABILITIES AMONG OLDER ADULTS 2. The activity must be enjoyable
3. The community leaders should be present in the activity
4. The activity should include a variety of activities to encourage
1. Low vision (54%) participation
2. Difficulty hearing (9.7%) 5. The physical environment should promote physical activity
behaviors.
3. Partial blindness (8.43%)
4. Partial deafness (6.44%) 4. In the management of NCDs in low resource setting like the Philippines,
5. Total blindness (4.52%) the WHO developed a PEN disease intervention. Which of the following
diseases is not included in the PEN?
A. Cardiovascular diseases
COMMON CAUSES OF MORBIDITY AND MORTALITY B. Pneumonia
C. Diabetes mellitus
D. COPD
1. Hypertension E. Cancer
2. Degenerative osteoarthritis
3. Diabetes mellitus 5. The members of the primary health team works collaboratively in the
implementation of PEN in the health center. What are the responsibilities
4. Pulmonary tuberculosis of the public health nurse?
5. Osteoporosis 1. Counsel individuals about health lifestyle
6. Stroke 2. Receive NCD referrals for medical management
3. Physically examines the individual
7. Dyslipidemia 4. Conduct risk assessment and screening
8. COPD 5. Measure height, weight, and VS

6. All but one is included in the strategies to reduce population’s risk in

RA 7432 OF 1992 developing NCDs
A. Promote a smoke free environment
 Was the initial legislative document that aims to protect B. Read food labels and nurture healthy eating habits
C. Be present during appointments and consultations with mental
the welfare of older persons in the country. health professionals or workers
 Amended by RA 9257 “Expanded Senior Citizen Act of D. Engage in physical activity and exercise at least once a week for
2003” ten minutes.

 Under this law, the senior citizen may render his
or her services to the community.
 The law entitles senior citizens 20% discount from
all establishments
RA 7876 “Senior Citizens Center Act of the Phil”
 The law upholds and recognizes the senior citizen’s right
to have access to vital facilities in the community
7. What are the mental health services that should be provided to
communities as stipulated under the Mental Health Act?
1. Support services for families and co-workers of mental health
services
2. Dissemination of mental health awareness in the community
3. Community resilience and psychosocial well-being training in all
barangays
4. Training and capacity-building programs for local mental health
workers
5. Availability of mental health and psychosocial support services
during and after disasters.

 Social services include:

1. Self and social enhancement services that provide
senior citizens opportunities for socializing,
CHAPTER 15: CONTROL OF COMMUNICABLE  Helminths (ascariasis, enterobiasis,
ancyclostomiasis, and schistosomiasis)

DISEASES  Arthropods (sabies)

Notes by: Fritz Daisy B. Bonganciso 2. Host

- Is any organism that harbors and provides nutrition for the
INTRODUCTION agent.
- Most often, humans are the host of an infectious organism.
 Communicable diseases are among the 2016 top 10 - The ability if the host to fight the agent causing the
leading causes of morbidity in the Philippines. infection is influenced by many factors such as:
 Age
Rank Disease  Gender
1 Acute respiratory infection  Socioeconomic status
2 Hypertension  Ethnicity
3 Acute Lower Respiratory Tract Infection & Pneumonia  Nutritional and immune status
4 Urinary Tract Infection  Genetic makeup
5 Influenza  Hygiene
6 Bronchitis  Behavior
7 Acute Watery Diarrhea
8 Tuberculosis (Respiratory) 3. Environment
9 Acute Bloody Diarrhea - Refers to the condition in which the agent may exist,
10 Dengue Fever survive or originate.
- It comprises physical, biological, and socioeconomic
 Leading causes of morbidity for the past six years are: components.
 Acute respiratory tract infection
 Pneumonia PHYSICAL BIOLOGICAL SOCIOECONOMIC
 Influenza  Temperature  Animals  Behavior
 Tuberculosis  Weather  Insects  Personality
 Acute watery diarrhea  Soil  Flora  Attitudes
 Water  Other  Cultural
 Dengue and water-borne disease increases due to the  Food sources human characteristics
impact of climate change beings  Occupation
 The fastest growing epidemic in the country is the number  urbanization
of HIV cases.

COMMUNICABLE DISEASES
 One of the major health problems in the Philippines.
 Are illnesses caused by an infectious agent or its toxic
products transmitted directly or indirectly to a person,
animal, or intermediary host or inanimate environment.
 Could be contagious or infectious.
 Contagion – a derivative of contact, means
transmitted by direct physical contact.
 Infectious disease – is transmitted indirectly
through contaminated food, body fluids, objects,
airborne inhalation, or through vector organisms.
EPIDEMIOLOGIC TRIANGLE MODEL
 The fundamental public health concept explaining the
development of communicable disease.
THREE MAJOR COMPONENTS
1. Agent
- An organism involved in the development of disease.
- Agents include bacteria, viruses, rickettsial agents, fungi,
protozoa, helminths, and arthropods that act as vectors to
agents from their reservoirs to humans.
 Bacteria (TB, pneumonia, typhoid fever)
 Viruses (polio, hepatitis, herpes simplex,
influenza, and viral meningitis)
 Rickettsial Agents (rocky mountain spotted fevr
and rickettsial pox)
 Fungi (ringworm or tinea capitis, athletes foot or
tinea pedis)
 Protozoa (malaria, amebiasis, and giardiasis)
CHAIN OF INFECTION
 it is a logical sequence of factors that are essential for the
development of communicable disease
ELEMENTS IN THE CHAIN OF INFECTION
1. Causative Agent – an organism capable of producing
disease. The agent interacts with its host through several
wats namely:
a. Pathogenicity – refers to the ability of agent to
produce disease in those infected with the agent.
b. Infectivity – refers to the ability of agent to infect
large numbers of people.
c. Virulence – refers to the ability to produce disease
in those infected.
d. Antigenicity – refers to the ability of the agent to
stimulate an immune response
e. Toxigenicity – refers to the ability of the agent to
produce toxin that cause infection.
2. Reservoir – is the environment or object in which an
organism survives and multiplies.
3. Portal of Exit – the path by which an agent leaves its
reservoir. Common portals of exit includes:
 Respiratory
 Genitourinary
 Skin and mucous membranes
 Gastrointestinal tract
4. Mode of Transmission
- is the means by which the agent passes from the portal of
exit in the reservoir to the susceptible host.
- Is considered the weakest link and is usually the focus in
the prevention and control of infection.
- Different modes of transmission include:
a. Contact – can be direct or indirect.
 Direct contact transmission occurs when disease
causing agents from an infected person enters a
healthy person through physical contact.
 Indirect contact transmission occurs from an
infected individual enters a healthy person
through an inanimate or contaminated surfaces,
objects, or substances.
b. Vector – occurs when living organisms infect health
individuals by transmitting disease causing agents
that grow inside their body.
c. Vehicle – occurs when disease causing agents
present in inanimate objects, substances, or materials
act as transport agents to infect healthy individuals
(e.g. food or water contaminated with feces or
vomitus of infected individuals)
d. Airborne – occurs when disease causing agents
present in small solid or liquid particles spreads more
than 3ft distance through the air and infect healthy
individuals.
e. Droplet – occurs when disease causing agents that is
present in residues of fluid from infected person
travels less than 3ft to healthy individual through
sneezing, coughing, dripping, or exhalation
5. Portal of Entry – is the path by which an agent invades
a susceptible host.
6. Susceptible host – are the various factors of the
individual that increases their chances or risk for acquiring
the infection.
CONTROL, ERADICATION, AND ELIMINATION OF
COMMUNICABLE DISEASES
Goal of communicable disease: elimination and eradication
 Control – activities that reduce morbidity and mortality of
disease at an acceptable level within a locality.
 Eradication – permanent reduction to zero of the
worldwide prevalence of a disease caused by a specific
agent.
 Elimination – is reduction to zero prevalence of a disease
in a single country, continent, or other limited geographical
area. It is also defined as control of the manifestations of
a disease.
INTERNATIONAL TASK FORCE FOR DISEASE
ERADICATION (ITFDE)
 In 1988, it was established to systematically review
potential candidate diseases for eradication and to provide
leadership and advocacy for the concept of eradication
where appropriate and useful.
 For global eradication it identified
 Smallpox
 Poliomyelitis
 Measles
 Rubella
 Lymphatic filariasis
 Dracunculiasis (guinea worm disease)
 Taeniasis tapeworm
 For global elimination it identified
 Hepatitis B
 Malaria
 Neonatal tetanus
 Rabies
 Chagas disease
 Trachomatis
 Onchocerciasis
 Iodine deficiency disorders
 Yaws
 In the Philippines, malaria, filariasis, schistosomiasis,
leprosy, and rabies are the disease targeted for
elimination.
 Rabies is one of the most acute fatal infections.
 The focus of communicable disease control is to eliminate
the burden of disease and its associated mortality.
FUNCTIONS OF THE PUBLIC HEALTH NURSE IN THE
CONTROL OF COMMUNICABLE DISEASES
1. Report to local health authorities any known case of
notifiable disease as required by the law (RA 11332)
2. Refer any known case of notifiable disease to the nearest
health facility.
3. Initiate health education drive directed towards prevention
of outbreaks in communities
4. Assist in the diagnosis of potential cases of communicable
disease based on signs and symptoms
5. Conduct epidemiologic investigations together with public
health team during an outbreak.
COMMUNICABLE DISEASES IN THE PHILIPPINES
TUBERCULOSIS
 Is one of the oldest and deadly diseases worldwide
 Ranks 8 in the Philippines.
 TB incidence is relatively high among the poor sectors of
society specifically those enrolled in the conditional cash
transfer or Pantawid Pamilyang Program.
 Is known to be a perennial disease of poor Filipinos due to
unsanitary living conditions, overcrowding, poor
ventilation, and malnutrition.
Causative Agent: Mycobacterium tuberculosis
Mode of Transmission: airborne droplet through coughing,
sneezing, and spitting
Incubation Period: 4-6 weeks
Signs and Symptoms: Fever: low grade late afternoon, loss
of appetite, easy fatigability, night sweats, dry cough –
hemoptysis, chest pain
Laboratory/Diagnostic Exam:
1. Direct sputum smear microscopy (DSSM)
a. Motivate the patient to undergo DSSM by
explaining the importance of the procedure,
and the need to submit 2 sputum specimen
for collection.
b. Prepare the sputum cups and label the cups
and label the cups indicating patient’s name,
and the order of specimen collection.
c. Demonstrate to the patient how to produce
sputum.
d. Specimens are collected in a well-ventilated
sputum collection area, or outside the
facility.
 First specimen is collected at the
time of the first consultation
 The second specimen is collected
after an hour or the following
morning.
  If the second specimen is not
submitted within 3 days, a new set
of 2 specimens must be collected
unless the first specimen revealed
positive for AFB.
e. After collecting the specimen, wipe off the
external surface of the sputum cup and wash
hands thoroughly with soap and water
2. Xpert MTB/RIF – is rapid diagnostic assay test for TB
and drug resistance. It simultaneously detects
mycobacterium tuberculosis complex and resistance
to rifampicin in less than 2 hours.
3. TB Skin Test (TST) – it is a basic screening tool for TB
infection among children using purified protein
derivative (PPD) tuberculin solution that can stimulate
hypersensitivity reaction for those who had previously
been infected.
4. Chest X-ray – another method used in the diagnosis
of TB is through chest radiography.
MANAGEMENT
 TB can be cured but requires adherence to drug intake for
the prescribed duration.
 The directly observed treatment (DOT) locally known as
“tutok gamutan” is a method developed to ensure
treatment adherence by providing constant supervision to
TB patients.
 Antibiotics taken involved five major drugs, namely:
1. Isoniazid
2. Rifampicin
3. Pyrazinamide
4. Ethambutol
5. Streptomycin
ROLES AND RESPONSIBILITIES OF THE NURSE IN THE
NTP AND DOTS STRATEGY
 Nurse as Administrator
1. Manage the procedures for case-finding activities
with other NTP staff workers.
2. Assign and supervise a treatment partner for
patients who will undergo DOTS.
3. Supervise rural health midwives to ensure proper
implementation of DOTS.
4. Maintain and update the NTP register
5. Facilitate requisition and distribution of drugs and
other NTP supplies
6. Provide continuous health education to all TB
patients placed under treatment and encourage
family and community participation in TB control
7. Conduct training of the health workers in
coordination with the Municipal Health Officer
(MHO)
8. Prepare and submit the quarterly reports to
provincial health office (PHO)
 Nurse as Health Educator
- Patient education is vital to a successful treatment
outcome that patient education will be an on-going process
throughout the duration of treatment period.
 Nurse as Case Manager and Coordinator
1. Managing services for the individually diagnosed
or suspected of having TB from initiation to
completion of treatment and a change in the
diagnosis or death.
2. Scheduling immediately another date if patient is
unable to keep appointments to avoid the patient
being labeled as delinquent.
 Nurse as Community Organzer (CO)
- The nurse can assume the role as CO, and ensures that all
activities related to the TB control program are done in
such a way that the patients and the people in general will
benefit.
- Community Organization Activities are as follows:
1. Generate data on the incidence of TB in the
locality.
2. Conduct home visitation to patients and
treatment partners.
3. Meet the health workers and other key leaders.
4. Determine resources for the treatment regimen.
5. Build the team.
6. Conduct networking and establish linkages with
LGUs, and NGOs.
 Nurse as Treatment Partner
- The nurse may continue to use the nursing process as a
systematic approach in providing individualized care to the
patient.
 Nurse as TB advocate
- Roles of the TB-DOTS advocate:
1. Shares experiences and accomplishments in
terms of cure and referral to TB network.
2. Disseminates right information on TB through
available information, education, and
communication campaign materials.
3. Serves as moral support to TB patients and fellow
advocates.
4. Refers individuals with cough for 2 weeks or more
to the nearest DOTS center for proper
management
5. Conducts health education activities on how TB is
acquired and developed.
6. Promotes the DOTS services of TB partners
including the private sector
7. Advocates DOTS as a strategy for curing TB
8. Participates during NTP activities
9. Encourages other people from different sectors to
be a TB DOTS advocate
10. Assists the treatment partner or ma serve as the
treatment partner.
LEPROSY
Causative agent: Mycobacterium leprae, hansen’s bacillus
Mode of Transmission: prolonged skin contact, droplet
infection
Incubation Period: 5 months – 5 years
Laboratory/Diagnostic Test: skin slit test
Signs and Symptoms:
 Early signs: reddish or which change in skin color, loss of
sensation on the skin lesion, decrease/loss of sweating and
hair growth over the lesion, thickened or painful nerves,
muscle weakness, pain or redness of the eye, nasal
obstruction/bleeding, ulcers that does not heal.
 Late signs: loss of eyebrow (madarosis), inability to close
eyelids (lagopthalmos), clawing of fingers and toes,
contractures, sinking of the nose bridge, enlargement of
the breast in males (gynecomastia), chronic ulcers.
 PATIENT CLASSIFICATION OF LEPROSY
1. PAUCIBACILLARY (PB) – negative skin slit test or five
or less lesions.
2. MULTIBACILLARY (MB) – positive skin slit test and
more than five lesions.
Treatment: Multidrug treatment therapy for leprosy to kill
all viable organisms in a relatively short period of time
rendering the patient noninfectious.
Prevention and Control:
 BCG vaccination
 Avoidance of prolonged skin to skin contact with
active untreated case
 Good personal hygiene
 Adequate nutrition
 Health education
VECTOR BORNE DISEASES
DENGUE
 The disease once associated with the rainy season has
begun to change its pattern in the country.
 The sudden change of pattern may be attributed to climate
change and urbanization since the vector of the disease
proliferates in congested urban areas.
Causative Agent: dengue virus (DEN)
Vector: infected female Aedes mosquitoes. It proliferates in
clean, clear and unpolluted stagnant bodies of water used for
domestic water storage or rain filled habitats like flower vase,
earthen jars, concrete water tanks, etc. which can accumulate
water up to 7 days.
Mode of Transmission: bite of mosquito
Incubation Period: 3-14 days, commonly 5-7 days
Susceptible: all individuals regardless of age, gender, or
geographic location
Laboratory/Diagnostic Exams:
1. Tourniquet test or Rumpel-Leads test – to measure
the coagulability of the blood by applying a tourniquet
on a client’s extremity and observing the amount of
petechiae produced.
2. Capillary refill test o nail blanch test
3. Platelet count and hematocrit count
4. Hemagglutination-inhibition (HI) test
5. Dengue NS1 Kit – Dropping blood samples on a
cartridge similar to a pregnancy test kit.
DENGUE CASE CLASSIFICATION
PROBABLE DENGUE
Live in / travel to dengue endemic area. Fever and 2 of the
following criteria:
1. Nausea, vomiting
2. Rash
3. Aches and pains
4. Tourniquet test (+)
5. Leukopenia – low WBC count
6. Any warning sign
WARNING SIGNS
1. Abdominal pain or tenderness
2. Persistent vomiting
3. Clinical fluid accumulatation
4. Mucosal bleed
5. Lethargy, restlessness
6. Liver enlargement >2cm
7. Increase in HCT concurrent with decrease in
platelet count
SEVERE DENGUE
A. Severe plasma leakage leading to:
1. Shock (DSS)
2. Fluid accumulation with respiratory distress
B. Severe bleeding as evaluated by clinician
C. Severe organ involvement
1. Liver: AST or ALT > or = 1000
2. CNS: impaired consciousness
3. Heart and other organs
PHASES OF ILLNESS
1. Febrile Phase
- Lasts 2-7 days
- High grade fever, facial flushing, skin erythema,
generalized body ache, myalgia, arthralgia, and headache.
2. Clinical Phase
- Lasts 24-48 hours
- Increase in capillary permeability with increasing
hematocrit levels may occur.
- Rapid decrease in platelet count
- Pleural effusion and ascites may be detectable
3. Recovery Phase
- Usually takes place in the following 48-72 hours.
- The general well-being improves, appetite returns,
gastrointestinal symptoms subsides, hemodynamic status
stabilized.
TREATMENT
 Give paracetamol every 4-6 hours. If there is still high
fever, do tepid sponge bath. Do not give acetylsalicylic
acid, ibuprofen, or other NSAIDs as these drugs may
aggravate bleeding.
 Encourage oral intake of oral rehydration solution
 Advise the patient to avoid dark colored foods that can
mask bleeding.
 Ensure strict bed rest
 Do not give IM injections to avoid hematoma
 Patient should be brought to the hospital if any of the ff
occur: no clinical improvement, deterioration around the
time of defervescence, severe abdominal pain, persistent
vomiting, cold and clammy extremities, lethargy or
irritability, bleeding, and not passing urine for more than
4-6 hours.
 For epistaxis, maintain an elevated position and apply ice
compress to promote vasoconstriction.
 Blood transfusion
 In cases of shock, place client in dorsal recumbent position
to promote circulation
 Monitor laboratory results
FOUR “S” STRATEGY FOR DENGUE PREVENTION

1. Search and destroy breeding places of mosquito

2. Seek early consultation and immediate treatment
3. Self-protection measures
4. Say yes to fogging only during outbreaks
 MALARIA Nursing care: practice enteric precaution
character of stool for signs of bleeding
and observe

Causative Agent: plasmodium falciparum, vivax, ovale,

malariae (protozoa) DYSENTERY
Signs and Symptoms: recurrent fever preceded by chills and
profuse sweating, malaise, anemia Causative Agent: Shigella dysenteriae
Mode of Transmission: Vector (female anopheles mosquito) Mode of Transmission: ingestion of contaminated food or
Incubation Period: 7 days or longer water
Laboratory/Diagnostic Exam: Incubation Period: 3-4 days
1. History. Endemic Area: Palawan and Mindoro Signs and Symptoms:
2. Blood smear  High grade fever
 Colicky abdominal pain with tenderness
PREVENTION AND CONTROL  Diarrhea with straining
 Bloody mucoid stool
1. Mosquito control
2. Chemical methods – use of insecticides Laboratory/Diagnostic Exam: Stool Exam
3. Biological methods – stream seeding Treatment: Co-trimoxazole, Chloramphenicol
4. Zooprophylaxis – larvae-eating fish, farm animals should Prevention and Control: Safe water supply, handwashing
be kept near the house.
5. Environmental methods – cleaning and irrigating canals Nursing care: monitor intake and output and observe for signs
6. Protective screening of windows and doors of houses of dehydration, rehydration by increasing fluid intake or drink
7. Education methods Oresol.
8. Mechanical methods – use of fly swats or traps
9. Universal precaution
10. Screening of blood donors CHOLERA
Causative Agent: Vibro cholera (El Tor)
FILARIASIS Mode of Transmission: ingestion of contaminated food,
water, or milk
Causative Agent: Wuchereiria bancrofti, Brugia malayi Incubation Period: 1-3 days
Mode of Transmission: bite of mosquito Signs and Symptoms: rapid explosive watery stool and
Incubation Period: 8-16 months vomiting
Vector: Aedes poecilus, Culex quinquefasciatus Laboratory/Diagnostic Examination: Stool Exam
Signs and Symptoms: chills, fever, myalgia, lymphangitis Treatment: Tetracycline, Furazolidone
with gradual thickening of the skin Prevention and Control:
Laboratory/Diagnostic Exam: Circulating filarial antigen - Boiling and chlorination of water
(CFA) – finger prick - Sanitary disposal of human waste
Prevention and Control: Eradication of vectors - Administer vaccine per orem with a dosage of 1.5 ml at a
minimum age of 12 months for 2 doses with 2 weeks
WATER-BORNE DISEASES interval

TYPHOID FEVER Nursing care: increase fluid intake, administer oral rehydrating
solutions

Causative Agent: Salmonella typhosa MEASLES, RUBELLA, CHICKEN POX, AND MUMPS
Mode of Transmission: ingestion of contaminated food or
water with feces or urine of infected individuals
Incubation Period: 7-14 days MEASLES
Signs and Symptoms:
1. Prodromal: headache, fever, anorexia, lethargy, Causative Agent: Morbili virus
diarrhea, vomiting, abdominal pain Mode of Transmission: Airborne
2. Fastigial: ladder-like curve of temperature, rose spots Incubation Period: 8-20 days, average of 10 days
on trunks, splenomegaly Signs and Symptoms:
3. Defervescence: fever gradually subsides, onset of - Acute onset of fever
complications such as hemorrhage, peritonitis - Rhinitis
4. Convalescence or Recovery stage - Conjunctivitis
- Bronchitis
Laboratory/Diagnostic Exam: Typhidot test - Excessive lacrimation
Treatment: Chloramphenicol - Koplik’s spots on the buccal mucosa
- Stomatitis
PREVENTION AND CONTROL
Laboratory/Diagnostic Exam: tissue culture of naso-
 Sanitary disposal of feces pharyngeal secretions and serological testing
 Practice hand washing Treatment: supportive care, antibiotic if with complications
 Avoid feces, fomites, flies, food, and fluids (5 Fs) that carry like pneumonia
the infection Prevention and Control: administer measles vaccine at the
age of 9 and 12 months
Nursing care: administer antipyretic, provide eye, nasal and Prevention and Control: immunization for 2 doses at 12-18
oral-care, strict isolation, increase fluid intake months

MUMPS Nursing care: antipyretic for fever,

handwashing, trim fingernails, daily bath
strict isolation,

Causative Agent: Mumps virus from paramyxovirus

Mode of Transmission: airborne or droplets, or direct contact POLIOMYELITIS
with saliva of infected person
Incubation Period: 16-18 days, range of 14-25 days Causative Agent: Polio virus
Communicability Period: 2 days before to 4 days after onset Mode of Transmission: fecal-oral, droplet
of parotitis but range can be 7 days before to 15 days after Incubation Period: 7-21 days
onset.
Signs and Symptoms: TYPES AND SIGNS AND SYMPTOMS
- Acute onset of fever
- Painful swelling of the salivary or parotid glands 1. Abortive – fever, sore throat, low-lumbar
- Headache backache/cervical stiffness on anteflexion of spine
Laboratory/Diagnostic Exam: isolation of virus from oral 2. Non-paralytic – recurrence of fever, poker spine,
and throat spray, urine and cerebrospinal fluid. tightness and spasm of hamstring, hypersensitiveness of
Treatment: Supportive Care the skin, deep reflexes are exaggerated.
Prevention and Control: Mumps vaccine (MMR vaccine) 3. Paralytic – with paralysis depending on part affected.
given at 9 and 12 months.
Laboratory/Diagnostic Exam: blood and throat culture,
Nursing care: apply warm and cold compress for pain and stool exam, lumbar tap
affected area, strict isolation, use of mask when handling Treatment: symptomatic and supportive
patient, terminal disinfection, provide oral care, and provide Prevention and control: proper disposal fecal waste, hand
soft to semi-solid food. washing, proper preparation of food, immunization

RUBELLA OR GERMAN MEASLES Nursing care: enteric isolation, bed rest, passive range of
motion exercises

Causative Agent: Rubella virus family togaviridae PARASITIC INFECTIONS

Mode of Transmission: Droplet and direct contact with
nasopharyngeal secretions of infected person
Incubation Period: 10-21 days ASCARIASIS
Signs and Symptoms:
- Fever Causative Agent: Ascaris lumbricoides (round worm)
- Headache Mode of Transmission: fecal-oral
- Malaise Incubation Period: 8 weeks
- Maculopapular rash Laboratory/Diagnostic Exam: Stool Exam
- Enlarge post auricular occipital and posterior cervical Signs and Symptoms:
lymphadenopathy - Abdominal pain
- Bronchitis - Passing out of worms

Laboratory/Diagnostic Exam: serological testing Treatment: Mebendazole or Albendazole

Treatment: supportive care but for exposed pregnant woman Prevention and Control: Proper disposal of feces, avoid using
in 1st or 2nd trimester, serum immune globulin is administered feces as fertilizer, handwashing, and proper washing of
to protect the fetus. vegetables before consumption.
Prevention and Control: Rubella vaccine at the age of 9 and
12 months
ENTEROBIASIS
Nursing care: administer antipyretic, increase fluid intake, bed
rest Causative Agent: Enterobius vermicularis or the human
pinworm or seatworm
Mode of Transmission: Vehicle-ingestion of contaminated
CHICKEN POX food
Incubation Period: 4-6 hours
Causative Agent: Varicella Zoster Virus Signs and Symptoms:
Mode of Transmission: direct and indirect contact with - Perianal itching-disturbed sleep and nervousness
droplets from respiratory passages or vesicle fluid - Irritability
Signs and Symptoms: Laboratory/Diagnostic Exam: scotch tape swab test in the
- Body malaise perianal region
- Fever Treatment: Mebendazole single dose repeated at 2nd week for
- Itchy vesiculo-pustular lesions first appearing on the chest effectivity
and trunk spreading to extremities Prevention and Control: personal hygiene, handwashing,
keeping fingernails short
Incubation Period: 14-16 days, range 2-3 weeks
Treatment: supportive care, anti-viral drugs
 ANCYLOSTOSOMIASIS c. Paralytic – flaccid ascending symmetric
paralysis, coma, death.
Laboratory/Diagnostic Exam: post-mortem direct
Causative Agent: Ancylostoma duodenale fluorescent antibody staining test
Mode of Transmission: contact Nursing Management:
Incubation Period: 4-6 weeks  Isolate patient
Signs and Symptom:  Encourage family to provide care and company
- Dermatitis  Darken room and observe silence
- Abdominal pain  Give food if patient is hungry
- Anemia  Keep water out of sight
- Mentally and physically underdeveloped  Observe universal precaution, which are essentially
Laboratory/Diagnostic Exam: stool exam wearing gloves
Treatment: Mebendazole  Wash hands frequently
Prevention and Control: avoid walking barefooted, and  Remove oral and nasal secretions
practice personal hygiene  Dispose contaminated materials
 Perform terminal disinfection

SCHISTOMIASIS
LEPTOSPIROSIS
Causative Agent: Schistosoma japonicum, S. mansoni, S.
haemotobium Causative Agent: Leptospira interrogans
Vector: snail Mode of Transmission: inoculation into broken skin, mucous
Incubation Period: 2 months membrane or ingestion of contaminated food and water with
Mode of Transmission: indirect contact urine of animals.
Signs and Symptoms: Source of Infection: urine of rodents, pet animals, and farm
- Rash at site of inoculation animals
- Enlargement of the abdomen Incubation Period: 7-13 days
- Diarrhea Signs and Symptoms:
- Body weakness 1. Sepsis Stage
Laboratory/Diagnostic Exam: stool exam  High fever, 4-7 days, calf pain, abdominal pain
Prevention and Control: 2. Immune/Toxic Stage
1. Proper disposal of feces and urine a. Anicteric Stage – disorientation
2. Proper irrigation of all stagnant bodies of water b. Icteric Stage – jaundice
3. Prevent exposure to contaminated water (wearing of
rubber boots) 3. Convalescence
4. Eradication of breeding places of snails  Symptoms will disappear but relapse may occur
5. Use of molluscides. 4th-5th weeks

ZOONOSES Laboratory/Diagnostic Exam: blood urine culture (1st week)

 Diseases and infections that are naturally transmitted
between vertebrae animals and humans.
 A zoonotic agent may be a bacterium, virus, fungus, or
other communicable disease agent.
and Leptospira Agglutination test (LAT) done on (2nd-3rd week)
Prevention and Control: eradication of rodents, avoid wading
in flood water
Nursing care: symptomatic care, increase fluid intake

RABIES
Causative Agent: Rhabdovirus
Mode of Transmission: bite of rabid animal
Source: saliva of infected animal or human
Incubation Period: 20-90 days for humans. 1 week to 7.5
months for dogs
Signs and Symptoms:
A. DOG – at first withdrawn, change in mood, shows
nervousness, and apprehension, unusual salivation,
paralysis starts on hind legs spreading towards entire
body, death
B. HUMAN –
1. Incubation Period – flu-like symptoms
2. Prodromal Stage – headache, pain and
numbness sensation at the site of bite,
depression, penile erection or spontaneous
ejaculation for males.
3. Acute neurologic phase
a. Spastic – anxiety, confusion, insomnia
b. Dementia – intense excitement, difficulty in
breathing, swallowing, drooling, hydrophobia
SCABIES
Causative Agents: itch mite
Mode of Transmission: prolong skin to skin contact with
infected humans or indirect contact with infested linens or
clothing
Incubation Period: 4-8 weeks
Signs and Symptoms:
- Itchy papulo-vesicular eruptions on warm folds and areas
of friction of the body
Laboratory/Diagnostic Exam: scraping the skin off burrow,
ink test, mineral oil or fluorescence tetracycline test
Prevention and Control: laundry and iron soiled clothes,
practice personal hygiene, terminal disinfection
Nursing care: contact isolation
ANTHRAX
Causative Agent: Bacillus anthracis
Mode of Transmission and Signs and Symptoms:
1.
-
Cutaneous (skin) anthrax
Handling sick animals or contaminated animal wool, hair, GENITAL HERPES
hides, or bone meal products
2. Inhalational anthrax Causative Agent: Herpes simplex virus (HSV) types 1 and 2
- Breathing anthrax spores into the lungs/woolsorter’s Mode of Transmission: direct contact with infected skin and
disease mucous membranes, childbirth
3. Gastrointestinal anthrax Incubation Period: 2-12 days
- Meat products that contain anthrax Signs and Symptoms: localized vesicular lesions at area of
contact but may spread to surrounding tissues or disseminated
Laboratory/Diagnostic Exam: gram staining (+) in body

SEXUALLY TRANSMITTED INFECTIONS (STI)

4Cs in Syndromic Case Management for STI:
 Compliance of clients in the treatment, prevention, and
successful recommendation
 Counseling and education on the nature of the disease,
signs and symptoms, management, and prevention
 Contact tracing facilitates the process of partner treatment
to prevent the spread of the disease.
 Condom use and promoting them to risk individuals to
reduce the change of acquiring the disease.
GONORRHEA
GENITAL WARTS
Causative Agent: Human Papilloma Virus with 100 types
Mode of Transmission: direct contact with infected skin and
mucous membranes, childbirth
Incubation Period: 2-3 months, range 1-20 months
Signs and Symptoms: circumcised lesions in cervix, vulva,
anus, penis, vagina, oropharynx that may be varying in sizes
Laboratory/Diagnostic Exam: visualization of lesion,
excision and histological exam of lesion
Treatment: removal of warts by freezing with liquid nitrogen
Prevention and Control: HPV vaccine for individuals 11-12
years old, and safe sexual practices.

Causative Agent: Neisseria gonorrhoeae

Mode of Transmission: sexual contact Review Questions:
Incubation Period: 2-7 days
Signs and Symptoms: 1. In order to prevent and control communicable diseases, which of the following
information will be highly significant for the nurse?
- Thick purulent urethral discharge
A. Expertise of the physician
- Frequency of urination among females B. Nature of the disease
- Burning urination among males/females C. Availability of drugs and vaccines
D. Development of new technologies
Laboratory/Diagnostic Exam: culture of specimen in cervix
(female), gram-stain (male) 2. Feces, urine, blood, ad other body fluids are considered as:
A. Vehicles of transmission
B. Portal of entry
SYPHILIS C.
D.
Reservoir of agent
Portal of exit

3. Which of the following mosquitoes is known to carry Dengue infection?

Causative Agent: Treponema pallidum
A. Dengue virus
Mode of Transmission: sexual contact B. Aedes aegypti
Incubation Period: 10-90 days C. Plasmodium vivax
D. Plasmodium falciparum
Types and Signs and Symptoms:
1. Primary – chancre that appears within 3 weeks 4. In the Philippines, which of the following groups are commonly affected by
at area of contact Dengue?
A. Infants
2. Secondary – condylomata, sore throat, mucous
B. Children
patches of the mouth, macupapular C. Teenagers
3. Tertiary – gumma formation, cardiovascular and D. Elderly
nervous system involvement
5. Which of the following measures is not contraindicated in Dengue?
A. Use aspirin for fever
Laboratory/Diagnostic Exam: darkfield illumination test, B. Give dark colored food to check for GI bleeding
C. Apply calamine lotion for rashes
venereal disease research laboratory test
D. Administer ORS or hydrite solution for rehydration
Prevention and Control: practice monogamy, sex education
6. Which of the following infectious agent is the cause of schistosomiasis?
A. Schistosoma Japonicum
CHLAMYDIA B.
C.
Enterobius vermicularis
Ascaris lumbricoides
D. Ancylosytoma duodenale
Causative Agent: Chlamydia trachomatis
7. What is the intermediary host for schistosomiasis?
Mode of Transmission: sexual contact or contact with A. Anopheles mosquito
exudates from mucous membranes, childbirth B. Oncomelamia quadrasi
Incubation Period: 7-14 days C. Infected humans
D. Sarcoptes scabei
Signs and Symptoms:
- Urethritis with purulent discharge from anterior urethra 8. You know that typhoid fever is caused by which of the following organism?
(males) A. Shigella
B. Paramyxovirus
- Mucopurulent cervicitis often asymptomatic (females) C. Salmonella
D. Spirochete
 CHAPTER 16: ENVIRONMENTAL HEALTH  Social capital refers to networks and the associated
norms and expected collective benefits derived from
Notes by: Fritz Daisy B. Bonganciso cooperation between individuals and groups.
 This includes homes, schools, workplaces,
BASIC CONCEPTS OF ENVIRONMENTAL HEALTH parks/recreation areas, greenways, business areas, and
transportation systems.
 WHO defines environmental health as all physical,  Problems: drunk driving, secondhand smoke, noise
chemical, and biological factors external to a person and exposure, urban crowding, technological hazards
all related behavior, but excluding those natural
environments that cannot be reasonably modified. Urban sprawl has been defined as the conversion of land to
 The purpose of environmental health is to assure the nonagricultural or non-natural uses. It is characterized by four
conditions of human health and provide healthy dimensions:
environments for people to live, work, and play. 1. Low residential density
2. Rigidly separated homes, shops, and workplaces
CONCEPT RELATED TO ENVIRONMENTAL HEALTH: 3. Roads with large blocks and poor access
- Environmental Sanitation 4. Lack of well-defined activity centers
a. The promotion of hygiene
b. The prevention of disease and other consequences of  Consequences of sprawl includes:
ill-health, relating to environmental factors  Air and water pollution
 Floods
MAJOR LAWS REGULATING SANITATION IN THE PH  Infrastructure expenses
 Decrease in natural areas and forests
PD 865 Sanitation Code of the Philippines
PD 825 Anti-Littering Law WORK-RELATED EXPOSURES
RA 9003 Solid Waste Management Act
RA 8749 Clean Air Act  Can happen as a result of poor working conditions and can
RA 9275 Clean Water Act lead to potential injury or illness.
National Environmental Awareness and  Issues such as occupational toxic poisoning, machine-
RA 9512
Education Act
operation hazards, electrical hazards, repetitive motion
EO 26 Nationwide Smoking Ban
injuries, carcinogenic particulate inhalation
RA 10611 Food Safety Act
 Problem: asbestos exposure, agricultural accidents,
Provision of Clean Toilets in Public
RA 11311 excessive exposure to x-rays
Transportation Terminals

OUTDOOR AIR QUALITY

AREAS OF ENVIRONMENTAL HEALTH
 Refers to the purity of the air and the presence of air
THE BUILT ENVIRONMNT pollution.
 The 13th leading cause of mortality worldwide (WHO)
 Consists of the connections among people, communities,  Problem: gaseous pollutants, greenhouse effect,
and their surrounding environments that affect health destruction of the ozone layer, aerial spraying of herbicides
behaviors and habits, interpersonal relationships, cultural and pesticides, acid raid, nuclear facility emissions.
values, and customs.
 There is a growing evidence that the built environment OZONE
directly and indirectly affects health outcomes. - Is a common pollutant and is the primary component of
smog.
THE BUILT ENVIRONMENT (UNDERLYING CONTEXT)
 Land use patterns - Is formed when nitrogen oxides react with oxygen and
 Transportation networks sunlight.
 Infrastructure systems - Ozone, along with other hazardous atmospheric pollutants,
 Public facilities causes and/or contributes to asthma, allergic reactions,
 Buildings bronchitis, lung cancer, chronic respiratory disease, and
MEDIATING FACTORS (EXPOSURE MEDIA) death.
 Environmental toxins
 Local climate SULFUR DIOXIDE
 Noise level - A by-product of burning coal and other fossil fuels,
 Crime level contributes to acid rain, which affects terrestrial
 Disasters and accidents ecosystems by increasing soil acidity, reducing nutrient
 Access to services availability, mobilizing toxic metals, leaching soil
DOWNSTREAM PATHWAYS (HUMAN RESPONSE) chemicals, and altering species composition.
 Behavioral (physical activity, diet behavior, smoking,
drinking, taking drugs)
MAJOR AIR POLLUTANTS
 Psychosocial (satisfaction, depression/distress, social
cohesion)
 Physiological (infection, immune system activation, A. Ozone – a colorless gas that is the major constituent of
hormonal response) smog at the earth’s surface.\
 Sources: vehicles, factories, landfills, lawn
HEALTH STATUS (OUTCOME INDICATORS)
equipment, and industrial solvents.
 Individual level (BMI, perceived health status, well-
 Effects: can irritate the respiratory tract
being)
 Population level (cause-specific mortality rates,
morbidity rates)
B. Carbon monoxide – a colorless and odorless gas that is 3.Radiological quality – tested through
emitted in the exhaust of motor vehicles and other kinds parameters of gross alpha activity, gross beta,
of engines during combustion of fossil fuels. and radon.
 Sources: emitted from the engines and from LEVELS OF WATER SUPPLY IN THE PHILIPPINES
industrial processes.
 Effects: reduces the ability of the blood to deliver  Regular testing schedules of water supply
oxygen to vital tissues.  Level I – every 3 months
 Level II – every other month
C. Nitrogen dioxides – a light-brown gas at lower  Level III – frequent sampling for every 5,000
concentrations, high concentrations; brown urban haze population
 Sources: forms from the burning of fuels in LEVEL I LEVEL II LEVEL III
utilities, industrial boilers, and the engine of cars (Point Source) (Communal (Waterworks/Water
and trucks. Faucet) Districts)
 Effects: is a major component of smog and acid  A protected  Communal  Household
rain; high concentrations increase respiratory well or a faucets taps
illness developed  Once faucet  For populated
spring with serves 4-6 urban areas.
an outlet but households.
D. Sulfur dioxide – a colorless gas, odorless at low
without a  Suitable for
concentrations but pungent at very high concentrations.
distribution rural and
 Sources: emitted from industrial, institutional, system. urban areas
utility, and apartment-house furnaces and  For rural where
boilers. areas where houses are
 Effects: one of the major components of smog houses are clustered
thinly
E. Particulate matter – droplets from smoke, dust, ash, scattered
and condensing vapors  Average of
 Sources: are emitted from industrial processes, 15
vehicles, wood smoke, dust from paved and households
unpaved roads, construction, and agriculture.
 Effects: affect breathing and elicit respiratory PROHIBITIONS OF THE CODE OF SANITATION ON
symptoms WATER SAFETY
 Washing and bathing within a radius of 25 meters from
any well or other source of drinking water
F. Lead – a metal found in nature as well as a by-product of
 Construction of artesians, deep, or shallow well with 25
industry than can be directly inhaled
meters from any source of pollution
 Sources: found near lead smelters, waste
 Drilling a well within 50-meter distance from a
incinerators, utilities, and lead-acid battery cemetery.
manufacturers.  Construction of dwellings within the catchment area of
 Effects: affect mental development and a protected spring water source
performance, kidney function, and blood
chemistry. FOOD SAFETY

WATER QUALITY  Refers to availability, accessibility, and relative cost of

 Refers to the water supply’s availability, volume, mineral
content levels toxic chemical pollution, and pathogenic
microorganism levels.
 Consists of the balance between water contaminants and
the existing community capabilities to purify water for
human use and plant and wildlife sustenance.
 Problems: droughts, contamination of drinking supply by
human waste, oil spills in the world’s waterways, pesticide
or herbicide infiltration of groundwater, aquifer
contamination by industrial pollutants, heavy metal
poisoning of fish.
 DOH issued Administrative Order 2017-0010 also known
as Philippine National Standards for Drinking Water
(PNSDW). It requires that the following must be checked
to determine whether water is safe for human
consumption:
1. Microbial quality – tested through parameters
of total coliform, fecal coliform, and heterotrophic
plate count.
2. Chemical and physical quality – tested
through parameters of pH, chemical-specific
levels, color, odor, turbidity, hardness, and total
dissolved solids.
healthy food free of contamination by harmful herbicides,
pesticides, and bacteria.
 Problems: malnutrition, bacterial food poisoning, food
adulteration, disruption of food chains by ecosystem
destruction, carcinogenic chemical food additives.
RA 10611 (FOOD SAFETY ACT OF 2013)
- Aims to strengthen the food safety regulatory system in
the country.
- Objectives of this law are:
a. Protect the public from food-borne and water
borne illnesses and unsanitary, unwholesome,
misbranded or adulterated foods
b. Enhance industry and consumer confidence in the
food regulatory system
c. Achieve economic growth and development by
promoting fair trade practices
WASTE MANAGEMENT
 Entails the handling of waste materials resulting from
industry, municipal processes, and human consumption as
well as efforts to minimize waste production.
 Problem: use of non-biodegradable plastics, poorly
designed solid-waste dumps, inadequate sewage systems,
 transport and storage of hazardous waste, illegal industrial COLOR CODING FOR HEALTHCARE WASTE
dumping, radioactive hazardous waste.
 Black or colorless: nonhazardous and non-biodegradable
RA 9003 (ECOLOGICAL SOLID WASTE MANAGEMENT ACT OF wastes
2000)  Green: nonhazardous biodegradable wastes
- Through this law, the three Rs of reduce, reuse, and  Yellow with biohazard symbol: pathological/anatomical
recycle methods of solid waste management was wastes
mainstreamed in communities  Yellow with black band: pharmaceutical, cytotoxic, or
chemical wastes (labeled separately)
PROHIBITED ACTS OF SOLIC WASTE MANAGEMENT ACT  Yellow bag that can be autoclaved: infectious wastes
 Orange with radioactive symbol: radioactive waste
 Open burning of solid wastes
 Open dumping
 Burying in flood-prone areas Review Questions:
 Squatting in landfills
 Operation of landfills on any aquifer, groundwater 1. Environmental health issues include:
A. Climate change and global warming
reservoir or watershed
B. Air pollution
 Construction of any establishment within 200 meters from C. Overcrowding and poor waste management
a dump of landfill D. Water contamination and pollution

2. The Sanitation Code of the Philippines is embodied in which of the following

CLASSIFICATION OF SOLID WASTE state declaration?
ACCORDING TO RA 9003 A. RA 9003
B. PD 856
C. PD 825
1. Municipal waste D. RA 8749
- Refers to all discarded nonhazardous household
3. Which of the following diseases can result from poor environmental condition?
commercial and institutional waste, street sweepings, and
A. Hepatitis A
construction debris. B. Hypertension
C. Diabetes Mellitus
D. Anemia
2. Industrial waste
- Refers to the refuse that arise from production and from 4. Color coded bins are important in segregating healthcare waste, all but one
agricultural and mining industries. are included:
A. Pink
B. Yellow
3. Hazardous waste C. Red
- Are substances that post either an immediate or long-term D. Orange
substantial danger to humans because of possessing any
5. Type of water supply recommended for urbanized communities with the
of the following properties: advantage of having a pipeline distribution that reduces contamination:
a. Toxic A. Stand posts
B. Communal faucets
b. Corrosive (acids of pH <2, and bases of pH >12
C. Waterworks
c. Flammable D. Point source
d. Reactive
6. Which of the following are considered as a characteristic of an acceptable
e. Genetoxic
excreta disposal facility?
A. Easy to maintain and safe
4. Health care waste B. Provides privacy
C. Simple, cheap, and easy to construct
- Refers to the refuse that is generated in the diagnosis,
D. Provides protection from elements
treatment, or immunization of human beings or animals.
It is subdivided as follows:
a. Infectious wastes – contain bacterial, viral,
parasitic, or fungal pathogens in sufficient
concentration so as to cause a disease in
susceptible host.
b. Pathological wastes – refers to tissues, organs,
body parts, human fetuses, animal carcasses,
and blood and body fluids.
c. Pharmaceutical wastes – such as drugs, vaccines,
and sera that are no longer required and need to
be disposed of appropriately for any reason.
d. Chemical wastes – include the varied state of
chemical matter from clinical or laboratory
activities, environmental work, housekeeping,
and disinfecting procedures.
e. Sharps – include biomedical wastes that could
cause cuts or puncture wounds.
f. Radioactive wastes – include sealed radiation
sources typically used in cancer treatments,
liquid, and gaseous materials contaminated with
radioactivity.