Community health nursing

CHN DEFINITION:

WHO: combination of nursing skills, sociology and public health.

ANA: Synthesis of public health practice and nursing practice towards preservation of health

Ruth B. Freeman: It is a service rendered by the professional nurse to the levels of clientele in
different health settings.(Subspecialty)
1. Home setting > PHN
2. Clinic setting >PHN (RA 7305) magna carta for public health workers. [Corazon
Aquino]
3. Work Setting > Occupational HN (RA 1054)
4. School Setting > School HN (RA 124)

Other Subspecialty:
1. Home Health/ Home Care Nursing - Attending in the comfort of the patients home. [Ex.
Compliance to medication administration, wound care, services provided by the hospital]
Sick population
2. Community-Based Nursing- providing hospital care in the community [ex. Oplan Tuli
program]
3. Correctional Nursing- Provided in the prison
● Forensic Nursing-
Trace evidence- Evidence
4. . Parish Nursing/Faith Nursing-

HANLON- attainment of total development (All aspects of individuality) Holistic Care

PURDOM- for "Survival of the human species"

MARGARET JACOBSON- Achievement of optimum level of functioning by teaching and

delivery of care.

OLOF Model:
● Political Factor: Safety, Oppression and People empowerment > SOP
● Behavior- lifestyle of the people
● Heredity- Parts of Genetics already (Genetics, familial disease)
● Socioeconomic- EEH (education, employment, Housing)
● Environment-
● Healthcare Delivery System-
Devolution/Decentralisation (RA 7160) Local Gov. Code of the Philippines- power is in
the LGUs (Focus of the delivery of service)
Unit: Family
RA 7610- Anti child Abuse Law (Do not confuse with!)
Services:
1. Promotive
Primary focus: Health Promotion > through health teaching
Primary Role: EDUCATORS (alert!)

Components of Health Teaching:

 ● Information
● Communication
● Education
Criteria:
● Knowledge- (first)
● Skills
● Attitude
Function of Nurse: Generalist

Other fxn:
"RT PCR MO Nurse"
Role Model
Trainer- train BHW/CHW/village workers/auxiliary workers
Planner- implement program
Coordinator of services-
Recording and Reporting- FHSIS (field health service information system) Alert!
Manager/Supervisor- Midwife
Organizer- COPAR (People does the research) self reliant!
Nurse- Care Provider

Primary Goal of chn: Self reliance for all

Ultimate goal: Raise level of Health of the entire citizenry
Philosophy: Uphold the worth and dignity of man (Margaret shetland)
Goal of PHN: Birth rights and Longevity (Winslow)

2. Preventive
3. Curative
4. Rehabilitation

FHSIS-
Record keeping- BHS/RHU-
Daily >Monthly done by: (Midwife) >PHN (Quarterly report) Rhu level > Provincial Health
officer/City Hx officer> Regional health officer (Quarterly report)

Reporting: Bhs/Rhu > Provincial health office> Regional health office

Annual report of FHSIS- done in 2nd week of March

Cont. Of definition:
Bailon Reyes- A nursing service provided outside a purely curative institution (Hospital)

Maglaya (mother of family health nsg in the phil)

Framework of the Phil: (IDB/initial database)
-Utilization of the Nsg. process to benefit the individual, the family and the community.
>CHN uses APIE according to Maglaya (Diagnosis became part of the Assessment)

End result of Assessment in the community: Problem Identification

LEVELS OF CLIENTELE in Community

1.Individual- Entry point
 In hospital Setting- individualistic (patient centered) Atomistic
In Community- Family/community
>HOLISTIC approach

2. Family- unit of service and the focus of nursing care; main caregiver in the primary level of
care.
-Groups of people sharing common interest binded by law and by blood.
Fxn. Of the family :
● Socialization
● Healthcare (starts at the home) IMCI (integrated management of childhood
management)- A protocol based program
Protocol of IMCI: flip chart
Assess- Classify- Mgt.
first line of drug given at RHU

Dehydration:
Severe Dehy: General Danger Sign, inability to drink and swallow, lethargic, very slow skin
pinch
Plan C (Pink): IV, NGT
Some Dehy: No Gds, eagerly thirsty, restless and irritability, slow skin pinch
Plan B (Yellow)- ORS
ORS Formula: Wt. (Kg) x 75ml
No dehy: no s/s of dehydration
Plan A (green): Continue Breast feeding, give natural juices (Calamansi, Buko Juice, Ginger
juice)

● Affection- (Family)
● Reproduction
● Economic
● Social placement/Status

Types of the family

1. Nuclear- mother, father, child (natural born or adopted)
2. Extended- involves 3 generationsmost common type of the Filipino Family

3. Dyad- Newly married couple without child yet, no child in the house
*Empty Nesters- the child left the household
4. Blended- with child from previous marriages

GENOGRAM- presenting family structure

● Square- female
● Circle- Male

5. Compound type- Multiple spouses (male) MUSLIM community (PD 1083) Code of
muslim personal law
6. Cohabitating- living in arrangement, not legal in the gov.
Common Law Spouse- term for living partners
7. Single parent- Death, Born out of wedlock,
8. Gay or lesbian family-
EO 209- Family Code of the Philippines
- Marriage is a special contract and a permanent union of a man and woman.
8 Stages of the Family Life Cycle (Evelyn Duval)
Basis of choosing is the Oldest Child
1. Beginning of family- married or unmarried without child
2. Childbearing Family- with child 0- 30 mo.
3. Family with preschoolers- 30 mo. -6 yo.
4. Family with schooler- 6yo -13 yo
5. Family with teenager- 13yo - 20yo
6. Launching young adult- 1st child- last leaves the family (building career)
7. Middle age family- empty nesters- retirement
8. Aging Family- retirement- death of both spouse

3.Aggregate- Population groups

Vulnerable groups:
● Infants/children
*Leading cause of infant/children mortality- PNEUMONIA
Region: NCR

Malnutrition:
● Vit. K- night blindedness, xerophthalmia (Xerosis- inability to produce tears)
● Iron- Iron deficiency anemia
● Iodine- Goiter, Mental Retardation

DOH programs:
1. Micronutrients supplementation program
Target: 5 yo & below
Strategy: Garantisadong pambata Gp1- April, Gp2- Oct. (Every 6 months- Vit. A
supplementation sched)

Alert!
Vit. A supplement-
<1yo = 100,000 IUs (6mo-11mo) "once"
>1yo= 200,000 IUs (every 6 months- 5yo)

Mother:
Prenatal- 10,000 IUs (2x a week) (4th mo/2nd trimester)
Postpartum- 200,000 IUs (once) (1st 4 weeks post delivery)

2. Food fortification program= Staple food (RA 8976)

Sangkap Pinoy Seal- for fortified foods (ex.chichirya, hotdog, ketchup)

3. First 1000 days program- RA 11148

"Kalusugan at nutrisyon ng mag nanay Act"
Target: Pregnant, Newborn, Infants until 2 years old

RA 11223- Universal Health Care Law

<Astana Declaration> New declaration (helad at Astana Kazakhstan) adapted by Phil.
<Alma Ata Ussr> October 19,1979 (adapted by Philippines
Updated primary Health Care
RA 11463- Malasakit Center Law
-Open facility for everyone to avail services

RA 11332- Mandatory Reporting of notifiable diseases

*RA- 5 numbers (updated laws) 10,11,12

● Pregnant Women- 2nd month

Cause Maternal mortality- Complications, HPN (pre ec, eclampsia), PIH
Maternal mortality (Worldwide)- Postpartum Hemorrhage (Calabarzon)

● Adolescents-
*STI(No Symptoms/STD (with symptoms)
HIV- STI
-Dormant stage (10years)
STD- Gonorrhea (more severe) [morning drip], Chlamydia

*High Risk for Violence-

*Substance Abuse & Use
*High risk for Suicide (ideology)-
young adults- Success rate
If have plan- Suicide

● Elderly- Aging
Chronological Age- Age by number
Older Adult- 65 yo & above= 4% (PSA)
Population pyramid- Expansive type of pyramid.
-Wider base and narrow top- Younger population (increased Birth Rate, Fetal Rate, Mortality
Rate, decreased life expectancy)
-DOH- projected life expectancy 2020-2025: Female- 75 yo, male 70yo

Functional age- ADL (Assessment basis in the community)

Leading cause of mortality: Heart Disease (1st), Cancer (2nd)

Chronic illness: DM, HPN, Artritis

Disability: low vision, hearing
Visual impairment: cataracts
Safety: Falls
Psychosocial: Anxiety, depression, altered mental process

RA 7432- Senior (60&above)

RA 9994- Expanded Senior citizens act of 2010 (Recent)
RA 7876- Senior citizen center in every barangay
RA 7875- National Health Insurance act of the philippines (Philhealth law) > Ammended version
RA 10606

4. Community- DOH (GIDA- Geographically isolated and disadvantaged area)

elements Of community:
● Social
● Geographical
● Psychocultural
Types of community:
Rural- inc. birth rate, basic health care
Urban- inc.morbidity, mortality, advanced HC
Urbanized- Philippines

Others types:
Rurban- mixed of both
Suburban- Gilid ng urban community
Metropolitan- center

Classification of community (maurer and Smith)

1. Geopolitical- Natural or Man made ex. Brgy, sitios, purok,cities, state
2. Phenomenological- culture, values, interest & goals
ex. LGBTQIA+

Context of CHN- Continuous Change

September 6,2000- United nation conference/ Millennium Summit (United nations HQ, NYC)
-191 countries of the world

8 MDGs (2015) (alert)

"PEG C M.AM.E G"
● Poverty
● Education
● Gender equality
● Child mortality (focus)
● Maternal health (focus)
● Aids, Hiv, malaria and other disease
● Environments sustainability
● Global partnership

Sept. 25, 2015- united nations conference (UN HQ, Nyc- 193 countries)
Title: Transforming our world the 2030 agenda for sustainable development

Result: 17 SDG (ALERT) (Sustainable Dev. Goals/Global Goals)

Target: 2030

"PHHEG CEDII Su.Re CA WaLa peace partnership"

Poverty- possible
Hunger- possible
Health and wellbeing- (alert)
Education
Gender equality- not health related
Clean water and Sanitation- possible
Clean Energy
Decent Work and economic growth- possible (shortage of healthcare workers)
Industry, innovation & Infrastructure
Reduce Inequalities- possible
Sustainable cities
Responsible consumption- possible
Climate Action- possible
Life below water- possible
Life on Land- possible (emerging infectious disease
Peace- possible
Partnership for goals- possible (key in the progress of primary Health care) Multisectoral
approach
Stakeholders- play a role in the success of programs

*Covid 19 treatment- Tocilizumab (clone antibody)

Molnupiravir- antiviral drug (Paxlovid) pfizer

Sanitation-
PD 856 (Sanitation code of Phil)
PD 825 (Garbage Law of the phil)
Garbage Collection: Curbside collection

Water Sanitation:
Sources:
Level 1- point source
(250 meters; 40-140 L/min; 15-25 households)
Ex. Covered well

Level 2- Communal Faucet

(25 m; 40-80L/capita/day; 4-6 households)
Ex: Stand post

Level 3- Water Works system, indiv. House connection; paying the consumption of usage
(Cubic centimeter)
Ex. Household Taps/Faucets

Toilet Sanitation
Level 1- Non water Carriage Toilet; pour flush type
Level 2- Flush type with septic tank
Level3- Flush type with septic tank with treatment facility

Food Sanitation:
Sanitary permit: Sanitary inspectors/engineers issued by Municipal Health/ City Health issued
by (mayor)

Food Handlers: Health Cert.

Classes:
A- Excellent- Fine dine
B- very satisfactory- Fast Food chains
C- Satisfactory- Canteen, Karenderya

4 Rights for Food Sanitation:

Source
Preparation
Cooking
Storage
*General rule: If in doubt throw it out
_______//
Chn
OCCUPATIONAL NSG
Setting: Workplace
Goal: Safety
Hazards: safety: Preventing injuries
Health: illness and diseases

Types if Hazards:
Physical: healthy working environment (Temp, ventilation, humidity)
Biological: The presence of bacteria, virus, infectious agents
Chemical: Toxic gas, fumes
Mechanical: Safe machine and using PPE
Psychosocial: Relationship in the working environment, healthy working environment

Guidelines in occupational nsg:

● RA 1054
● 1:100 or more workers
● No RN if 100 below; Has health facility (primary, secondary, tertiary) 1 km away
● Bed ratio: 1:100 workers

OHNAP: Occupational Health Nsg. Association of the philippines

Anita Santos- First president (founded 1964)

The Philippine Labor Code: PD 442

● Duty: 8 hours × 5 days= 40 hours
● Can be 6 days= 48 hours (paid with additional compensation of 30% on an hourly basis)
● Rest periods: min. of 15 min (Article 84
● Meal periods: min of 60 min. ( Art. 85
● Ratio: 100 or more- 1 full time RN
200-300 - 1 full RN, 1PT MD.,1PT dentist
Part time*= minimum of 2 hours
● 300 and above= 1 FT RN,MD, Dentist
*Full Time= 8 hours

● Night Shift Differential- 10pm-6pm (Compensation-min. Of 10% per hour)

● Overtime- anytime beyond 8 hours (Compensation 25% Additional)
● Rest day: min. 24 hours (Determined by employers) except: Religious grounds
● Holiday or Rest day= demand to work (Compensation is 30%)
● Holiday and Rest day= Demand to work (Compensation 50%)

SCHOOL HEALTH NURSING (RA 124)

"ROGARS"
Role: Facilitator Advocate
Asses:
Once a year; School Year: Twice (Beginning and at the end of SY)
Orient: 5 students
One to one interaction; M:M, F:F nurse [opposite sex needs parental consent, With class
adviser]
Gather information > interview parents, guardians, Class advisers

Assessment in the school:

● Nutritional status
Chn book (<10,>10
(who: <5yo, >5yo) [Tool: Ht & Wt by age]
>Bmi: wt in kg / ht in m2 (>10)
>Not Normal: Feeding program (breakfast) 120 days
Prerequisite= Deworming (needs consent)
● Visual Acuity= 20/20 (snellen Chart)
20/40= refer the child > class adviser >observation
● Hearing Screening= Ball Pen Click Test (2- 3 times)
● IPPA- Physical assessment: cephalocaudal (Hospital);
School: pattern (Arms, eyes-visual acuity, nose, Mouth- dental, ears, neck and chest-
chicken pox, hair, lower extrem.- Rash)
Measles: Cephalocaudal-outward progression
Chicken pox- inward progression

Record- Rapid class inspection (Fast- unannounced)

School health program- Focus: Students (also entire school population)

Public health nursing (Alert!)

It is the science and art to prevent disease, promote health and to prolong life.

Settings: Home and Clinic

PHN Hx:
-Babaylan/shaman-
-Introduce health to phil: Spaniards

Spanish Era
● 1st hospital: Hospital Real (The Royal Hospital) caters to Spanish only in Cebu
● 1st hospital for Filipinos- Hospital de los indios naturales (The hospital for the dumb and
the poor) in Intramuros manila [Destroyed by fire]
● Hospital de San Lazaro- donated by the rich chinese man to the filipinos
● 1st university that offered medical course (2 year course, fundamentals of medicine and
dentistry) (graduates are called Cirujanos ministrantes) -male nurse/sanitary inspectors -
UST
● Maternity clinic (puericulture center) high risk pregnancy- 1st (La Gota De Leche) "milk
station" - introduced wet nursing
● Philippine General Hospital 1915- introduced public health nursing
● Board of Health- Americans; 1939- Manuel L. quezon- Commonwealth gov. (Department
of health and public welfare) 1st sec.- Dr. Jose Fabella
Roxas- separate health and welfare- DOH (oct. 4, 1947) EO 94 (kagawaran ng kalusugan) 1st
sec. (Dr. Antonio Villarama)

1978- Marcos changed it to Ministry of Health

1986- Corazon Aquino (Changed it back to DOH) E.O 119

Prime- Fidel V. Ramos- Let's DOH IT! (Dr. Juan Flavier)

-Doctor to the Barrios
-Multiple antigen vaccines with partnership with who and unicef
-RA 7170 (organ donation law)
- RA 7875 (Philhealth)
1st Female Secretary- Carmencita Reodica
● Expanded program of immunization
● IMCI
● BnB (Botika ng Barangay)
● TAMA (traditional alternative medicine act of the Phil.) RA. 8423

Leprosy- non contagious (BCG Vaccine)

Pathognomonic sign: Lionins face
Paget's disease (bone remodeling)

SETTING:
Clinic Visit:
Phase:
1. Pre Consultation Conference- chief complaint (important data)
2. Medical examination phase
3. Nursing intervention phase
4. Post consultation conference- Health Teachings - Health promotion

OTTAWA charter for health promotion- Assembly at Ottawa, Canada (Nov. 17-21, 1986)
WHO
Result: 5 action areas for health promotion
"DR. BSC"
1. Develop personal skills
2. Reorient public health services
3. Building public health policy
4. Strengthening community action
5. Create supportive environment

Activities in the clinic visit:

1. Registration
2. Waiting time
3. Triaging (ALERT!)
a- program based- protocol; DoH program; primary level care
TB DOTS- direct observed treatment short course. RIPES (streptomycin- inj.) Tutok Gamutan
(tagalog) No missed dose

b- non program based- refer the situation beyond the nursing and primary capacity of
care
c- emergency case based- First Aid
● Dog bite: Wash with running water for 15 min. or with antiseptic agent (Rabies is
hydro and aerophobic)
4. Clinical evaluation
5. Laboratory Exam- Screening test
6. Dispensing of drugs- OTC drugs, Rx drugs (with prescription, DOH program) ex. TB
DOTS, HIV (ARV- Antiretroviral drug) 1st line: LTE (Lamivudine. Tenofovir. Efavirenz)
2nd line: TLD: teno. Lami, dolutegravir (milder effects)
Common drugs: CARIPPON
 ● Cotrimoxazole (antibiotic)
(azole- antifungals)
● Amoxicilline (antibiotics)
● Rifampicin
● Isoniazid
● Pyrazinamide
● Paracetamol
● Oresol (lite)
● Nifedipine

7. Referral system- comprehensive two way system

8. Health education

HOME VISIT (ALERT!)

Purpose:
-Provide nursing Care; to Assess living conditions of family; Provide health Teachings

Principles-
Purpose and objectives; Prioritize; Plan of visit (characteristics: Practical, flexible, family) Make
use of all available information from the client

Phases-
Pre-visit phase- purpose and plan
In home phase- 1. Initiation (Knock, non threatening voice, greet, introduce yourself, observe
the environment, establish rapport, state the purpose)
2. Implementation- nsg. process
3. Termination- summarize with the family
set the next visit/clinic visit
Record
Post visit phase- return to the facility, documentation, referral

Factors affecting the frequency of visit: "PAPANO"

Past services rendered
Acceptance of the family - Most important (Alert!)
Policies of specific agency
Ability of the family to recognize needs
Needs of the family- determinant of home visit
Other health services involve

BAG TECHNIQUE: tool (Alert)

Equipment: PHN bag

Home visit- bag put in Lap

Bag technique- Table with lining- plastic (direct the table) paper (bag)

Principles:
● Minimize if not prevent the spread of infection (most important)
● Effectiveness of total care
● Save time and effort
● Avoid contamination
● Handwashing
Contents/Area:
Top- "Ganunin" wave like
Front- Thermometer and Test tube with Holder
Center- ___?____
Rear- chemicals and solutions
*All contents of the bag must be clean or aseptic

NURSING PROCESS (Maglaya)

alert!
Assessment: all "data"
Activities:
Data collection-
Data collation
Data presentation
Data analysis
Data Utilization

Primary- f
Secondary- reports, records, document

Data collection:
>Primary data
1. Interview- First hand, most reliable, Best method.
● Informant interview- head of the family
● Key person interview- key people (leaders of the community> brgy captain,
elderly, parish priest)
2. Observation-
● participant observation
● Rapid observation (windshield observation)- during ocular inspection/survey
3. Surveys/questionnaire- Majority of data
4. Community forum/assembly (pagpupulong-pulong sa barangay)- open meeting of
the heads of the brgy.
5. Focus group- smaller meeting 6-12 participants

>Secondary data-
1. Records review
● Census- official enumeration of the total population
>Demography- characteristics of the population
>Health indicators of the population: births, Morbidity, mortality (Vital
statistics/biostatistics/health statistics)

De Jure- point of origin "taga asa ka?"

De Facto- Factual/actual location at the time of census "asa ka karon?"

PSA- The Philippine Statistics Authority

-Census and Certification (RA 10625) philippine statistical act - Aquino 2013
NSO- RA 3753 (Civil registration law of the philippines)

Type of Census in the Philippines: De Jure (place of birth)

 2. Registrations (alert!)
Births and Death
PD 651 (60 days)
PD 766 (30 days)

Section 2: birth registration (without a fee)

-30 days
In the facility- Hospital- Attending Physician
Lying in- The RN/ if no RN- Midwife
Submitted ito the Local civil registrar

Outside the facility- Home

Report- Parent or any relative (LCR)
Issuing person- the Local health officer (MD)
Local Civil Registrar: place of birth

Section 5: Death registration (without fee) 30 days

-in the facility- Attending physician *who pronounced the death of the patient
-Last attending physician

Report to local civil registrar (48 hours)

outside the facility- home

Reporting (LCR) by anybody who has the knowledge of death. (48 hours)
-Issuing person: local health officer (MD)
-In the absence of the local health officer: Mayor > municipal secretary (will receive only)
Rule: to where you are added, to where u are substracted

PD 856- Sanitation code (death certificate before burial

Post mortem- same precaution when alive, same precaution when died

3. FHSIS (EO 352) official recording and reporting system of the department of health
Components of FHSIS:
1. Treatment record- Fundamental Building block
● Individual- record of each member of the family
● Family- as whole
2. Target client list TCL- secondary building block of FHSIS "Sino -Sino"
● prenatal and postnatal
● Under 1 year
● Sick children
● Family planning
● Cd- TB
3. Tally reporting Forms- monthly report
"ILAN"
a. Hx programs
b. Morbidity report
4. Summary report: 12 columns

Events
E1- death and Birth

Monthly Report- prepared by midwife to PHH

M1- program report
M2- Morbidity report

Quarterly report
Prepared by nurse submitted to the provincial health officer
Q1- 3 month program report
Q2- 3 month Morbidity report

Annual report- prepared by the nurse (RHU)

A1- demographic of the community- births and deaths
A2- yearly morbidity report (age and sex)
A3- yearly mortality (death) (age and sex)

Office Person Report/Schedule

BHU Midwife Monthly Report- every 2nd week of

a month
Annual Report- every 2nd week of
January

RHU PHN Quarterly report- every 3rd week of

each first month of every quarter
Annual report- every 3rd week of
January

PHO/CHO Provincial/city health office/ Quarterly report- every 4th week of

FHSIS coordinator each first month of every quarter
Annual report- every 4th week of
January

Regional Health Office Regional health officer/ Quarterly report- every 2nd week of
FHSIS coordinator each second month
Annual report- every 2nd week of
March

● On every first week- Data Gathering

● Whole February: Data Gathering

In the BHS- monthly (2ndweek) > midwife > Annual (rn/rm)

Rhu- Quarterly report - phn- Annual
3rdweek of January, April, July, Oct.
*first report is 3rd week of april
Last report is 3rd week of january

PhO- quarterly report- pho- annual (pho)

4th week of June,April, July, Oct

Regional-Quarterly report- regional hx office -Annual (Rho)

2nd week of Feb, May, Aug, Nov

NESSS- National epidemic sentinel surveillance system

Hospital based data of disease occurrences; It provides supplemental information for the
department of health

Cases by geographic Location

Demographic Characteristics of the disease
Information
Estimates
Trends

Malaria- parasite (4 types)

Covid 19- philippines (P- point 3)
Typhoid fever- salmonella typhi
Salmonaliosis- salmonella enterica (chicken), salmonalla bongori (lizards and turtles)
Cholera- vibrio cholerae

VITAL STATISTICS

Is the study of measure and proportions of quantitative data about the population
Health indicator of the births, mortality, mobidity
100,000-used in a greater population
100- percentage
1000-common

Formulas:
Group 1:
● Crude Birth Rate
● Crude Death Rate

Denominator : mid year population (July1)

Numerator- hinahanap

Group 2: mother and child

● Maternal mortality Rate

● Infant mortality rate (deaths <1)
● Fetal death rate (death before expulsion)
● Neonatal maternal rate (death <28)
denominator: total live births

Group 3: specific date ratio (age, sex, cause, case)

Specific date ratio = case fatality rate

Case fatality rate

Morbidity

Incidence rate= new cases only /population x100

Prevalence Rate= New +Old case /population x 100

2. Data collation: Categorization

3. Data presentation=

● Descriptive= Narration
● Numerical = numbers, percentage, charts, figures

Examples:
4. Data analysis = standard/norm

5. Data utilization

FAMILY ASSESSMENT- Alert!

First level assessment- problems of the family
IDB- Family health assessment form (tool of assessment)
1. Family structure
● Surname
● Address/contact
● Source of information- head of fam
● Data gathered by, date
● Household numbers= age, relationship to the head of the fam
Tools:
a. genogram= outline by genealogy; 3 generations; symbols
B. Family health tree- medical history by genogram
C. Ecomap- familys linkages to the suprasystem (represented by circle) (the bigger the circle
the priority)
2. Socioeconomic & culture
3. Home mgt.
4.Health assessment of family
5.Resources

Result: the typology of nursing problems

>Hx deficit (within self)
>Hx threat (around self) (external)
>Foreseeable crisis (problems of the current that leads to a problems of the future)
Diagnostic tool- NANDA (family level)

Second level - Performance of the family hx task

- Recognition of the problem = Salience
Result: "Inability"
Community assessment/ Community diagnosis/community situational analysis
Types:
● Comprehensive community Diagnosis- General > assess > problem
● Problem oriented diagnosis- specific> problem > assess

Family assessment tool in the community: OMAHA SYSTEM

Domains:
1. Environmental domain- sanitation
2. Psychosocial domain-
3. Physiological domain- health functions/process
4. Health-related behaviors domain- nutrition, sleep pattern, exercise, hygiene, family planning
of the community
result: community health problems
1. Health status problem
2. Hx resource
3. Hx related problems
end result assessment: problem Identification

PLANNING PHASE
Activity: prioritization
Criteria:
Family Criteria:
● Nature of the problem
● Modifiability of the problem
● Preventive potential
● Salience

Community criteria:
● Nature- What type of problem
● Modifiability- it has the most weight during prioritization*
● Magnitude- its the unique criterion in the community (population that is affected by
the problem)
● Prev. Potential- The potentiality of it to happen again
● Social concern/ Salience- Recognition of the problem
Family
Has *Not: starts with "0"
No *Not: "1"
Criteria Score Weight

1. Nature
Hx Deficit 3 1
Hx Threats 2
Foreseeable crisis 1

2. Modifiability
Easy 2 2
Intermediate 1
Not modifiable 0

3. Preventive potential
Highly 3 1
Moderate 2
Low 1

4. Salience
Need urgent attention 2 1
Do not need urgent attention 1
Not a felt problem 0

Community prioritization

Nature Score Weight

1. Nature
Hx status 3 1
Hx resource 2
Hx related 1

2. Modifiability
Easily 3 4
Intermediate 2
Low 1
Not Modifiable 0

3. Magnitude
75- 100% 4 3
50-74% 3
25-49% 2
<25% 1

4. Preventive potential
Highly 3 1
Moderate 2
 Low 1

5. Social Concern
Need urgent attention 2 1
Do not need urgent attention 1 1
Not a felt problem 0 1

Formula:
Score/highest score × weight

PHN- use judgment to identify the criterion

Rule: highest score in the family= 5
Highest score in the community- 10
*the higher the score, the more priority it is!

2. Set Goals
Types:
Short term: Attend to the immediate problem; Factors; specific
Ex. Water Sanitation, reflection of intervention (nurse)

Long Term: Address the main problem; General

Ex: Sanitation

3. PLAN
Evaluation parameters:
FNCP- Family Nursing Care Plan
CHP- Community Health Plan

Implementation/ Intervention
Plan- Action (Professional Stage)
Fxn of nurses:
● Independent Function- Chn
● Interdependent Function- Chn, Hospital
● Dependent Function- Hospital

EVALUATION
Types:
1. Qualitative-
2. Quantitative

Components of evaluation:
● Structure- input/resources
🚩
Parameters: adequacy, appropriateness
● Process- procedures performed
Parameters: efficiency, effectiveness
● Outcome- result
Parameters: met, unmet, partially met

CHN (APIE) FUNDA (ADPIE)

 ASSESSMENT

Data: primary, secondary Data: Objectives, subjective

Well population Sick population- thorough assessment

Primary level of care Secondary and tertiary

End result: problem Identification

Focus: Family, community Focus: Individual

DIAGNOSIS

Problem Identification

Prioritization

PLANNING

Prioritization Goal setting

Develop a Plan (FNCP, CHP) Plan- PNCP

IMPLEMENTATION

Independent and Interdependent Dependent and Interdependent

EVALUATION

SPO Outcome based

CO-PAR- Community Organizing Participatory Action Research

Goal for CO: Self Reliance
Goal for PAR: Social transformation
Goal of COPAR: Community Development

Principles of Copar:
P- people centered, participative, process oriented (client: poorest sectors) [oppressed,
depressed, underserved community]
D- democratic, developmental
C- change
S- Self reliance

COPAR team
1. proj. Director- Director of the school
2. Proj. Manager- Dean of the college
3. Coor. for immersion- RLE coordinator: Site selection
4. Hx service coor. - Clinical Instructor
5. Comm. Organizer- Students
6. Training officer- one who plans and implements training
 7. Financial officer- Budgeting
8. Bookkeeper- Auditor; records all financial activities
9. Secretary- Documentation
_____
TAMA- RA 8423
Herbal Meds
Preparations:
● Decoction- boiling the plan material for 20 min.
● Poultice- pounding the plant- direct application
● Infusion- soaking plant in a hot water to release the extract for 10-15 min
● Juice/syrup- juice is more concentrated; juice with syrup (honey)
● Cream and ointment: + starch= cream : starch and oil= ointment

PLANT INDICATION PARTS PREPARATION

Sambong Edema, Diuretics Leaves Decoction, Boil

Akapulko Skin disease (anti Leaves Decoction, poultice,

fungal element) cream

Niyug- niyogan Intestinal parasitism Seeds Decoction, poultice,

Anti helminthic juice
(parasitic worms)

Tsaang Gubat Diarrhea, stomach Leaves Decoction and

ache, infantile colic poultice

Ampalaya Diabetes Leaves Decoction

Lagundi Cough, asthma, Leaves Decoction, poultice

colds, fever

Ulasimang Bato/ Gout, arthritis, Leaves Decoction, poultice

Pansit pansitan rheumatism

Bayabas Wound care, oral Leaves Decoction for 20 min.

and dental care (anti In Clay pot / palayok
microbial, anti (well distributed heat)
bacterial) burns,
chickenpox,
toothache

Bawang Anti Hypertension, Bulb/cloves Poultice- direct

toothache application

Yerba Buena Cough colds, fever, Leaves Decoction, poultice

dysmenorrhoea

Alternative hx practice
1. Massage
 2. Reflexology- (palms and sole)
3. Acupressure- ( acupoints- points of body meridian)
4. Acupuncture- (using fine thin needles)
5. Aroma therapy
6. Chiropractic-proper alignment of spine and pelvis
7. Reiki- power of palms- into the head or face
8. Pranic healing- (Prana- Aura)
9. Meditation- relaxation of mind
10. Yoga- relaxation if mind and body
11. Yin-Yang- promoting balance of bad and good

Phases of COPAR process (Jimenez)

1. Pre-entry phase
🚩🚩
Activities:
● Site selection
● ocular inspection
● community assembly
● Preliminary social investigation- secondary data is obtained
● Network with LGUs
● Identify forster family
● Develop survey tools (basis: ocular survey and preliminary investigation)

2. Entry phase
● Arrival & integration- 🚩
○ R- establish rapport
○ I- Imbibe community life
○ S- Share
○ E- experiences
○ R- respect culture
● Information dissemination
● Identify potential leaders
○ T- Time
🚩
○ O- Oriented for change
○ R- respected by the people
○ P- member of poorest sector
○ E- effective communication skills
● Core group formation
● Deepening social investigation- Primary Data is obtained
● SALT- self awareness and leadership training

3. Community study/community Diagnostic phase- community dx expiration: 6 months

4. Community organizing and capability building phase- Officers
● election of officers
● Management system
● Definition of roles and functions of the officers
● Team building
● Working committees
● Training of CHO/Community Leaders

5. Community action phase

 ● implementation and mobilization
● PIME (project implementation monitoring and evaluation)
● Selection and training of CHWs and BHWs
● Set up linkages

6. Sustainance and strengthening phase

● develop financial scheme
● Constitution ang by laws
● Secondary leaders
● Continuing education
● Develop medium and long term goals

7. Termination phase
● Self reliance
● Transfer of responsibility to the community

LOCAL HX SYSTEM
Inter Local Hx System- concept of district hx system
LGU- RA 7160 > Inter Local hx zone (Tool: LGU hx score card)

Composition of inter local health zone:

1. People- 150k to 500k
2. Boundaries
3. Hx workers- healthcare team- MD (Leader) [MD,RN,Midwife, BHW, San. Inspector]
Nurse fxn: Collaborative
DOH Programs - nurse fxn: Facilitator
4. Health care facility-
● Primary- primary level of care
● Central- Secondary and tertiary level of care

Levels of Care: Alert ⚠️

Primary -Promotion and prevention ○ RHU, BHU, clinics, lying in
-It attends to the pre
pathogenic stage
Well population
Ex:

Secondary -Diagnosis and cure (P) provincial hospital-

-Symptomatic stage pababa
-Early detection and prompt
treatment District hospital
Sick population Provincial hospital
City hospital
Ex: Breast self examination,
operation Timbang, Contact
tracing

Tertiary Rehabilitation O Regional

Terminal stage or critical
 /recovery or convalescent General hospital
stage Specialized institution
Terminally ill or recovering Regional hospital
clients

Ex: diagnosed with HIV,

insulin Dependent diabetes

DEPARTMENT OF HEALTH
-Leading authority for health

Goals of DoH:
● Erap Estrada: HSRA (Health sector reform agenda) 1999-2004
● Gloria Arroyo: Fourmula one for health (F1) 2005-2010
Secretary: Francisco Duque III
● Elements:
1. Hx financing- foster investment for health– health is not a form of
expenditure
2. Hx service delivery- Accessible and Available
3. Hx regulation- Quality and Affordability
4. Good governance- improve Health Sectors
● PNoy- Universal Health Care (Kalusugang pangkalahatan)
Elements:
5. Human Resources for Health-
6. Health information

Deployment programs: Project NARS (nurses assigned in rural services project)

GMA (Started)
● Training program for 6 months <not renewable> (stipend > allowance 8k per mo.)

PNOY- RN HEALS (RN for health enhancement and local services)

- Training program and an employment opportunity
- 12 months (not renewable 8k salary)

● Duterte-BBM- Nurse Deployment Program (purely employment opportunity)

PHN 2 - 6 Month- renewable - SG 15/16

● Duterte- Philippine Health Agenda 2016- 2022

Goal: All for Health towards health for all (Sec: UBIAL) > (Duque III)
Goal: Fourmula One Plus for Health
1. Hx financing- foster investment for health– health is not a form of expenditure
2. Hx service delivery- Accessible and Available
3. Hx regulation- Quality and Affordability
4. Good governance- improve Health Sectors
5. Performance accountability - FOCUS element

● BBM- health sector strategy 2023-2028 (AO #32 s-2022)

DOH Vision: Filipinos are among the healthiest in southeast asia by 2022 and in Asia by
2040
 Mission: To lead the country in the development of a productive, resilient, equitable, and
people centered health system

The health sector goals:

1. Better health outcomes
2. Responsive health system
3. Financial risk protection

DOH core values: (PRICE)

● Professionalism
● Reliability
● Integrity
● Compassion
● Excellence

NEW DOH secretary: Teddy Herbosa- June 2023

Key feature: Engagement of Philhealth > RA 7875 >> RA 10606

October 2019: Philhealth circular memo #9-2019

Philhealth contribution 3% by 2020 with increment of .5% every yr.
Philhealth members:
1. Self earning
2. Sponsored
3. Indigent. Retiree, abandoned children
4. OFWs
5. Senior Citizens- Lifetime membership
6. PWD- RA 11228 (Mandatory Philhealth coverage to PWD)
7. Dependents- Parents, legitimate spouse, child 21 & below (legitimate or illegitimate) RA
10165 (Foster act of 2012)
8. cancer patients- RA 11215 national integrated cancer control act of the philippines (Feb
14, 2019) Philhealth coverage diagnosed with cancer > access to cancer services and
medicines

Philhealth benefits:
● Inpatient coverage- room, drugs/meds, Labs, OR, PF- confinement >24 hours
45 days of confinement per year - including the Dependents

Roles and Functions of the DOH: EO 102 (Erap Estrada)

—LEA
● Leadership in Health
● Enabler and capacity builder
● Administrator of services

DOH facilities:
Classifications of Hospitals of DOH
1. General hospital
2. Special hospital

Level 1-
a. Consulting specialist= med, OB, Pedia,Surgery
b. Emergency and OPD
 c. Isolation Facility
d. Surgical and maternity facility
e. Dental facility
f. Laboratory
g. Pharmacy

Level 2-
A. Level 1
B. Departmentalized services
C. Respiratory unit
D. ICU
E. NICU

Level 3:
A. Level 1 and 2
B. Residency training for doctors
C. Rehabilitation unit
D. Ambulatory surgical unit
E. Dialysis
F. Blood bank

Categories of health facility

Category A- primary care facility (first contact health facility (Health center, Outpatient clinic,
Dental clinic, lying in clinic)

Category B- Custodial care facility (long term care) includes food and shelter
Ex: psych facility, rehab center, nsg homes

Category C: diagnostic and therapeutic facility

Ex: Lab Facility, Drug testing facility, HIV hubs, blood services facility

Category D: specialized outpatient facility (procedures in outpatient)

Ex: Dialysis facility, chemo facility, ambulatory surgical clinics)

DOH psychiatric: Mariveles mental wellness and general hospital (bataan)

PRIMARY HEALTH CARE- alert ⚠️

Alma Ata Declaration- Sept. 6-12 1978 (first International conference, Alma Ata, USSR
>Almaty, Kazakhstan (new)
Goal: Health for all by 2000

Phil adapted: oct. 19 1979, LOI 949 (Marcod Sr.) First country in southeast asia to adapt

Goal: heath in the hands of the people by the year 2020

40 years after- ASTANA DECLARATION (Global conference- oct. 25-26, 2018)

In Astana, Kazakhstan
Goal: health and wellbeing for all, living no one behind
PH: Feb, 20, 2019 (UHC law RA 11223)
Goal: hx for all, no Filipino must be left behind
Players: DOH and Unicef

Sectors:
Public- under gov.
Private- profitable

Levels of workers:
1.BHW/village/auxiliary workers
2. Intermediate level health workers (healthcare professionals)

I🩷
Pillars/cornerstone of PHC
USA
1. Intra & intersectoral linkages (Multisectoral)
2. Use of appropriate technology (herbal plants as a medicine)
3. Support mechanisms made available
4. Active community participation

Elements of PHC: I see male he comm

1. Immunization
PD 996- against 6 immunizable disease
● Tb- BCG
● Diphtheria
● Pertussis
● Tetanus
● Poliomyelitis - OPv + IPV
● Measles - AMV (anti measle vaccine) >> MMR >>> MMRV (new) 2005
(Measles. Mumps, rubella, varicella

RA 10152
● Other 6
● HEPA B
● Haemophilus influenzae Type B ( HiB) cause of infantile meningitis
● Mumps
● Rubella

Pentavalent: DPT, Hepa B, Hib

2. Sanitation
Waste mgt RA 9003
Healthcare waste mgt, 2011 (DOH)
Black- General waste, non hazardous, non biodegradable

Yellow with ☣️
Green- non hazardous- biodegradable
- pathological waste and anatomical waste
Yellow with black band- pharma drugs, cytotoxic drugs, chemical waste
Yellow bag (autoclave)- infectious waste
Orange bin- Radioactive waste

_____int. standards
White- Sharps
Red- plastics
Blue- breakable
 3. Essential drugs- BnB (RA 6675) generics act of the philippines
4. Emergency care- BEMONC (basic emergency obstetrics and Neonatal care) in RHU,
lying in or birthing home or stand alone facility
DOH- At Least 1RM or RN with a physician on call
WHO ratio:
1 bemonc facility: 125,000 population
6 functions (DoH):
1. Parenteral administration of oxytocin (3rd stage)
2. P admin. Of anticonvulsant
3. P. Admin of initial dose of antibiotics
4. Assisted delivery
5. Removal of retained products of conception
6. Manual removal of retained placenta

3 functions (newborn)
1. Newborn resuscitation
2. Treatment of Neonatal sepsis
3. Oxygen support to the Newborn

5. Maternal and Child health

🚩
Prenatal care - HBMR (home based mothers record)- facility based record
Minimum visits- 4 visits
1st trimester= 1
to allow to deliver in lying in

2nd trimester- 2
3rd trimester- 3
8 mo. Onward - 4,5 of 2 weeks

6. Adequate food and proper nutrition (PD 491) nutrition act of the philippines
7. Local Endemic diseases
Ex. Malaria, dengue, leptospirosis
8. Health Education
9. Communicable Diseases (RA 11332) new!
Communicable Diseases- detectable alteration to normal tissue function
-With signs and symptoms
-Abnormal

Two Classifications of disease

● Non communicable
● Communicable disease - infectious agent involve and transmission

Infection- successful inoculation,implantation, invasion of the organism to a cell or a tissue

where it is not normally found.

Cell- Virus
Tissue- fungal,bacterial

Hiv- cd4 cell

Covid 19- pneumocyte (P.1 - gas exchange, P.2- Surfactant)
Delta- lower respi
Omicron- upper respi

Contagion- "contact" exposure that can lead to a disease

Infectious disease- an infection that leads to a manifestation of signs and symptoms and
immune response

Contagious disease- Contact or exposure that lead to an infection and a disease (person to
person)

All Contagious are all Infection

Infectious are not all contagious

Stages of the disease:

1. Incubation period- exposure > appearance of the first sign
No relation with fatality*
Longer- Hiv/aids- 10 years / rabies- 15-30 years
Shorter- Ebola - 24-48hrs

Virulence- the power of the organism to cause a disease

● The shorter the incubation the higher the virulence

Period of communicability = longer the infection period > higher communicable

2. Prodromal period/catharhal- appearance of first sign> Pathognomonic sign

Six disease (Rashes)- common worldwide

1. Measles
 2. Scarlet fever
3. Rubella
4. Duke's disease (scarlet fever)
5. Erythema infectiosum
6. Roseola infantum (baby Measles)

Forchheimer spots- reddish (rubella and scarlet fever)

3. Stage of illness- all signs and symptoms

Peak of disease- Fastigium sign (apex) of infection

4. Convalescent stage- stage of recovery

Different types of infection:

1. Health Care Associated infections
● Nosocomial infection- infxn. during the client's stay in the facility.
-Not present at the time of admission. -Not related to the diagnosis at the time of
admission
-appearing 48-72 hours after admission even until discharge
-most common- Hospital acquired Pneumonia

● Iatrogenic infection- related to the procedures performed. Can be a therapeutic or

diagnostic procedure.
○ Catheter
○ Surgical site infection

2. Community acquired infection

Most common- Community acquired pneumonia

3. Endogenous infection- internal infection

common: (creutzfeldt jakob disease) a neuro infection <prions> normal protein that is
found in the brain cells (there is misfolding and will cause other to misfold) >cell lysis >
apoptosis> bubbles/plaque > brain tissue = sponge > TSE (transmissible spongiform
encephalopathy)

Or..

Exogenous infection- external infxn.

Eat: Infected meat, unpasteurised milk (contains misfolded prions) > bovine spongiform
encephalopathy (mad cow disease)

4. Opportunistic infection- ⬇️
defense system, immunocompromised
● MAC- Mycobacterium avium complex
- If immune is down can develop tuberculosis
● Mycobacterium Cansa. E and Avium - non tuberculotic bacteria

Concepts
Epidemiology- study of patterns and occurrences of the disease pattern (time, place, person)
-backbone of disease prevention

Spanish flu- Avian flu (ground zero is not identified) carrier (birds)
Ebola virus- Republic of congo in africa
Mers Cov- bats to camel (middle east)
HIV- chimpanzee (hunted for meat) infected blood SIV (simian immunodeficiency virus)

Patterns:

Endemic- constant, consistent, continuous

Ex. Malaria: mindoro, rizal, palawan
Dengue: rainy season
Leptospirosis: rainy season

Epidemic- sudden increase, outbreak

Major outbreak- sudden increase of disease coming from the notifiable disease of the world
Ex. Polio- Mindanao october 2019 (vaccine derived polio outbreak)
Mers Cov- July 2015
Meningococcemia- January 2005
Sars cov- May 2003
Covid 19- January 2020

Sporadic- on and off, intermittent occurrence

Ex. Rabies, tetanus

Pandemic- worldwide occurrence of disease

Pande-igdigan- worldwide
Epidemic can develop to pandemic

Triad: agent,host, environment (epidemiology)

Chain of infection:
Rule: Break the chain of infection

● Causative agent: microorganisms "pathogens" can cause disease

● Reservoir- Habitat of the microorganisms, they will grow, mutate, replicate/multiple
(Humans, animals and insects, non living things= Fomites)
● Portal of exit- secretions
● Mode of transmission: weakest link, also determine the period of communicability,
precaution that you will implement
● Portal of entry- body parts
● Susceptible host- consider age, sex, lifestyle,genetics, comorbidity, immune system.
Carrier and release another agent

Infectious agents:
1. Virus- smallest organism of them all, the most microscopic, intracellular organism
-Always needs a HOST CELL (that's why we isolate so that there will be no other host)
- not asexual,sexual
-self limiting
Replication: V. RNA infect human RNA = more viral rna
V.DNA combine to human DNA
may Transcribe to v. RNA infect human RNA
Dx: RT PCR( Rna), PCR (rna and dna)
Pharma: anti viral- (vir, vudine)

2. Bacteria- most common cause of fatal infectious disease (bacteria does not stop)
Bacterial spores- spore forming bacteria carries Toxins (Ex. DPT) (Anthrax= bacillus
anthracis> lighter than air, carries shiga toxin)

Dx: culture and sensitivity (microscope)

Pharma: Antibiotics (bacteriostatic, bactericidal) mycin, cillin, cycline
Cocci- round in shape (streptococci <line>, staphylococci <bulk forming>
Bacilli- Rod shaped ex. Tuberculosis
Spirilla- twisted or spiral ex. Leptos spira

3. Fungi- least common to cause an infection (it is everywhere)

ex. Tinea capitis (head and scalp)
Tinea corporis (body) pedis (feet) cruris (groin. Rep.area) also called <jock itch>
Cryptococcus- fungi
Pharma: anti fungal (azole) except cotrimoxazole (antibiotic)
Ringworm- fungi

4. Parasite- invades
Protozoa- simplest single cell in the planet (plasmodia) plasmodium malariae- milder,
plasmodium falciparum- strongest (goes up to the brain)

Malarial drugs- "arte, quin"

Intestinal parasite- GI (attacks Microvilli) nutrition

Worms except ring worm

External parasite- fleas, lies, ticks, mites

Lymes disease- carries bacteria from ticks

Treatment/mgt of infectious agents: know the causative agents

Mode of transmission:
Contact: the most common mode of transmission
Direct- person to person (std)
Indirect- person to middle point (vehicles) to person
-Vehicle: food, water, fomites
-Vector: animal and insects
-Fecal oral route

Airborne transmission-
airborne (>3 feet)
droplet (within 3 feet)
aerosol- no nebulizer (use MDI metered dose Inhaler)

Covid 19- droplet spread but precaution is airborne

CA > Reservoir
 ● Cleaning
● Decontamination- specific pathogen
● Disinfectant- killing the microbes but not all and except spores
○ Germicidals/germicides
i. Antiseptics- skin
ii. Disinfectant- surface
● Sterilization- killing all forms of microbes
○ Autoclave - 121 degree CelsiuS for 30 minutes
○ Ethylene oxide- (1-6 hours)
○ Liquid chemical sterilants- requires longer exposure (3-12 hours)
○ Boiling
○ Radiation

Precautions:
Tier 1- standard precaution- priority
Tier 2- transmission precaution

Standard precaution- universal precaution

-used to all hospitalized indiv. Regardless of their diagnosis and infection status
-used to all blood and body fluids
Alert: treat all blood and bloody fluids as if it is contaminated

Measures:
1. handwashing- the best and the most effective way of infection control
Who number 1 spreader- Healthcare workers
What is the number 1 spreader- Hands

Components of hand washing:

● Water
● Soap- liquid at least 4-5 ml
● Friction- the most important

5 Moments of hand washing

-Refer to screenshot
At Least- 20 secs

PPE- personal protective equipment

Most used- gloves
Double gloving- increase by .5
Triple gloving- if preventing needle stick injury (ANA)
● Clean
● Sterile- if the size of a fist
Points:
1. Fit
2. Allergy to latex

Gown-
Double gowning- highly infectious patients

Mask-
Simple face mask
Surgical mask
FFP mask- filtering facepiece mask
Class:
FFP1 - 80 -94 % (KN94)
FFP2- 94-95 % (N95, P-2 mask)
FFP3- 99% (N99, EN1499, P-3 mask)

Goggles- protects from splashes

Donning- wearing
Doffing- removal

Needle stick injury

Suggested- Retractable needle system
First- wash with soap and water, antiseptic, encourage the wound to bleed, report, take PEP
(post exposure prophylaxis)

Safe handling of contaminated objects:

Same precaution when alive and at post mortem and strict standard precaution

Tier 2-
Mode of transmission- same precaution

1. Contact precaution
Disease:
Respiratory Infection
Influenzae
Wound infection
enteric Infection- fecal oral (enteric precaution- more specific)
Skin infections (scabies)
Conjunctivitis
All Indirect contact (vector,vehicle)

Measures:
● private room
● Cohorting- placing the pt with another pt. (Place the pt with another pt with the same
infection status (mild to mild, severe to severe) exception: when there is an outbreak or
pandemic
● Gloves and gown (mask is optional if with respi problems)

2. Droplet precaution
1. Adenovirus- common flu (trangkaso)
2. Diphtheria
3. Influenzae
4. Meningitis
5. Mumps- infectious parotitis (Paramyxovirus)
6. Parvovirus B19- fifth disease (erythema infectiosum)
7. Pertussis
8. Pneumonia
9. Rubella
10. Streptococcal pharyngitis
Measures:
Private room
Cohorting
Surgical mask/medical grade mask (colored in)
Airborne precaution
-Measles
-Tuberculosis
-Varicella /herpes zoster painful shingles (peripheral nerves)
-Covid 19

Measures:
Private room: negative air pressure
Air exchange: 6 times per hour / every 10 min.
No Cohort: except pandemic or outbreak

Cases: requires negative air pressure with mtvc

● chronic and severe infections
● Immunocompromised
● Children
● Drug resistant patients

PPE- n95 mask (High efficiency particulate air filter HEPA)

Susceptible host
Primary line of defense- Skin, mucous
Secondary- inflammatory response
Tertiary- immune response

Immunology- study of immune system

2 responses:
● Innate immune response
● Adaptive immune response - needs to be stimulated
○ Cell mediated- T cells (helper cells) normal cd4- 500-1500
○ Antibody mediated- B cells - triggered by an antigen

Antigen- can be seen in pathogens (surface layers and spike proteins)

Antibody- release by the body in response to the antigen (y shaped protein that binds to the
antigens)
To initiate infection, microorganisms should bind ( spike protriens/cellular wall) and should
attach to the cell tissue

-Hiv can't trigger antibody response

Mutation
2 types of mutation:
● Genetic- inward
● Antigenic- outward change (more deadly)

Antibody isotopes
Immunoglobulins
 ● IGg- Gama Immunoglobulin (most common type found in the blood) the only antibody
capable of crossing the placenta (Fetus) natural passive immunity (onsent- 21 days to
even years) (bacteria,fungal,viral)
● IGa- alpha immunoglobulin (seen in mucosal area,saliva, tears, breastmilk) natural
passive immunity
● IGm- Macro immunoglobulin (largest antibody among all) the first antibody to always
respond (onset- 5days or more)
● IgE- epsilon (responsds when there is allergy and parasitic infection)
● IgD- Delta immunoglobulin (antimicrobial- supportive)

Goal: immunity = "immunis"to be exempted

Immunity: to be protected by a disease (to develop a memory)
Immunization- process of achieving immunity through administration of something to the body
(vaccines)

Vaccines contains antigen to trigger antibody response

Types of immunity: ⚠️
Natural- natural active (best immunity)
● Active- exposure and
● Passive-placental and breastmilk
Artificial- introduce/administration
● Active- vaccines and toxoids
● Passive-anti toxin, anti serum

Anti tetano- vaccine (address the bacteria itself) used for prevention [Artificial active]

T. Toxoid- weakened toxin (address the toxin) for prevention [artificial active]

TIG- antibody against the tetanus infection (for management) [artificial passive]

For rabies and burns- Tetanus toxoid

Vaccines
Types: artificial active
1. Live attenuated vaccine- actual infection (best vaccine) that provides long lasting
immunity (single dose)
-mimics The natural active immunity
2. Inactivated- weakened or a killed organism (not long lasting) multiple dose and requires
booster dose (most common in the world)
3. Active component- part or conjugate of the organism
- The most expensive
ex. hepatitis- active recombinant

4. Toxoid- weakened toxin (cannot prevent infection but it prevents the harmful effects of
the toxin)
ex: botulinum toxoid (botulism) bacteria > produces botulin toxin Cause muscle paralysis
(used in botox)

Covid 19 vaccine:
1. Live attenuated vaccine-
 2. Inactivated- sinovac, sinopharma, bharat biotech (indian)
3. Active component-
mRNA- 94-100%
● pfizer- Comirnaty
● moderna-Spikevax

Viral vector-
Adenovirus- injected into it the vaccine for covid (Astrazeneca vaccine, sputnik V (first to
undergo clinical trial), Johnson and Johnson)

Program:
1st and 2nd dose- primary series (to achieve level of
Booster dose:
● Homologous- "same" to the primary series
● Heterologous- "different" vaccine
○ pfizer-store in 60 to 80 degrees
○ Moderna,
○ astrazenica

Immunization in the PH:

PD- 996
⚠️
-against the 6 immunizable disease
● Tb- BCG
● Diphtheria- dpt (pentavalent vaccine new)
● Pertussis
● Tetanus
● Polio- OPV/IPV (Inactivated polio vaccine)
● Measles AMV (anti measles vaccine)

RA 10152
- 10 immunizable disease
- Hepa B- Pentavalent
- Hib- (number cause of infant bacterial meningitis) pentavalent
- Mumps- MMR
- Rubella- MMR (Mmrv new + varicella for chicken pox)

Principles of immunization
-1 needle, syringe, child
-All vaccine is sensitive to heat - requires a storage system
MOSTH- measles, opv, sensitive to heat
-freezer -25 to -15 degrees Celsius
LEAST- all except
-Body (+2-+8)
When exposed to heat- decreased potency
Technology: VVM (Vaccine vial monitoring)
Rule: the darker the vvm the more it was exposed to heat
Not give the vaccine- when the vvm has the same color from the outline

Cold chain- cold chain officer <maintains> (rho to provincial health office to municipal- rhu- bhs
and bhc)
Rule: rho, phd, mho (FDFD) first delivery, first to dispose
Rhu, Bhc (FEFO) first expiry, first out

Continue: malnutrition, anemia, cough and colds, fever <38.5, Diarrhea, (-)Western blot (HIV),

Stop: immunocompromised, seizure, convulsions, >38.6, Diarrhea if vaccine is ROTA virus

(number 1 cause of Diarrheal infxn to children) NB from an HIV mother weather undetectable

Missed dose:
Give the missed dose immediately and proceed with the interval
1- 6weeks
2- 4 weeks
3- 4 weeks

Bcg= koch phenomenon (scar)

Do not repeat bcg if there is no scar formation

OPV- pink colored given orally (drops 2-3 drops) tongue

Rota- given orally (1-2ml) at the back of the tongue

Fully immunized child- immunized before 1 y.o

Completely immunized- received complete

Vaccine preventable disease

2019 childhood immunization > PPS, PIDSP
Target: 0-18yo

BCG= TB and leprosy

● Type: live attenuated
● At birth intradermal 0.05ml
● Brands: BCG vaccine (india)
Pentavalent: D,P, T (Inactivated), Hep B, Hib (active component)
● 0.5ml IM
● 1st- 6 weeks
● 2nd- 4 weeks
● 3rd- 4weeks
Mmr- live attenuated .5ml
● SC
● 1st = 12-15 mo.
● 2nd= 4-6 yo
Hep B- type: active
● 1st= at birth
● <20 yo= .5ml
● >20yo= 1ml
● IM
● Genvac B
● Engerix B

Polio=OPV (2-3 drops)

1st- 6weeks
2nd- 4weeks
3rd -4 weeks + IPV (Inactivated) .5ml IM or SC brand: IPol, IPV

RotaVirus- live attenuated, oral

Brads: Rotarix 1ml (2 doses) [1st: 2 mo. 2nd: 4mo]
Rotateq 2ml ( 3 doses) [1st: 2mo, 2nd: 4mo, 3rd: 6mo.

Others:
Influenza= flu vaccine, type: inactivated
● Cdc- yearly (as early as 6 months) .5ml
● Route: IM
● Brands: fluarix, flulaval, fluzone

HPV= type: active recombinant

● 11 or 12 yo: 2 doses = 6-12 mo interval
● 15 months= 3 doses (6 months interval)
● .5ml IM
● brand: gardasil, cervarix

Meningococcal vaccine: type: Inactivated .5ml IM

1st: 11-12 yrs 2nd: 16 yo
Streptococcus Pneumoniae- common in adolescents (pneumonia)
Nececeria meningitides ( meningococcal)
6 types: vaccine
A MenACWY (menectra, menveo, menquadfi)
B. MenB ( TruMenBa, Bexsero)
C
W
X- no vaccine
Y

Pneumococcal-
Types:
● PCV 13- 13 valent vaccine (given to child) pneumococcal conjugate vaccine 13 [prevnar
13]
● Type: Inactivated
● .5ml IM
● 1st dose: 2 mo, 2nd: 4mo, 3rd: 6mo, 4th: 12-15 mo
● Alert: needs to be completed before 2 years old
PPSV 23- 23 valent vaccine- pneumococcal polysaccharide vaccine 23 [pneumovax 23] for
adult
● 19 yo and above
● IM .5ml
● 1st dose: 19-64 yo; 2nd dose: 65 and above (singke dose)
● Interval: atleast 5 years apart
● If pcv 13 but not complete-
● 1st= pvc 13 = less that 19 years
● 2nd= ppsv 23= 19-64 yo
● Interval of 1st and 2nd is 8 weeks apart
● 3rd dose: ppsv 23= 19-64 yo
 ● 2nd and 3rd dose interval: 5 years apart
● 4th dose: final dose= ppsv =65 years and above
● 3rd and 4th interval: 5 years apart

Given to smokers, HIV pt., (given pneumovax)

Chicken pox= varicella vaccine ( live attenuated)

● .5ml SC
● 1st dose: 12-15, mo, 2nd dose: 4-6 yo (common age of having chicken pox)
● Brand names: varivax, proquad (mmrv)

Hepatitis A = Inactivated type of vaccine

1st dose= 12-23 mo
2nd dose: 6 mo. After
● .5ml IM
● Brand: Havrix, Vaqta

Tips:
Inactivated- common type
Route: IM
Dose: .5ml
Schedule: 644 mo
Side effect: fever (2-3 days only) if more than this in not assoc to the vaccine except measle
vaccine: fever can last up to 7 days
Side effects: if what vaccine side effects will be the same but milder

Immunizable diseases of the philippines: ⚠️

● Tuberculosis- Koch's disease/phthisis/consumption disease/the great white plague
○ common In asia and africa- 80%
○ Causative agent: mycobacterium tuberculosis (aerobic)
○ Mycobacterium africanum (common in west african countries) s/s are the same
with M.T
○ Mycobacterium Bovis (TB in cattles) drinking unpasteurised milk
○ Mycobacterium cannettii (common in horn of africa - ethiopia and somalia
[Associated with farm animals]
○ Mycobacterium microti (rodents)
○ Myco. Avium- non tb
○ Myco Kansa.ii- non tb

incubation period: 2-12 weeks

MOT: airborne/ Droplet
Signs and symptoms: low grade afternoon fever, cough (2weeks), chest pain, signs of infection
(malaise, fatigue), night sweats, hemoptysis

Extra PTB- tuberculosis outside of the lungs (common in child and immunocompromised)
Site: common in the organs close to the lungs: bone, GI, GU, pleura, lymphatic sys., may
develop TB meningitis (common to pt. have chronic TB)
Mycobacterium-aerobic (aerobic) > inhale> pulmonary alveoli > signs and symptoms > lung
tissue > replicate > fibrosis of the lung tissue> parenchymal lesions called (lung opacities) in the
Xray

Diagnostic test:
Primary: screening
● Mantoux test /tuberculin test/ Ppd (ID .1ml site: lower inner aspect
● result (48-72 hours)
● False positive: BCG
● > 5mm- positive
● >10 mm- postive to heathcare, children <4yo, prisoners, travelers
● >15mm - general population

Igra Test- interferon gama release assay / TB gold / quantiferon tb test (uses blood) (not
sensitive to BCG)

Chest Xray- to show the effect to lungs

Confirmatory- DSSM (diresct sputum smear microscopy in NP1) local

Np3- Culture and sensitivity (international)
Fluorence acid fast microscopy staining = AFB
Method: 3 sputum specimen (time : morning ×3) 5ml and deep cough
Positive: 2 to 3 samples (smear positive)
(+)= repeat 3 sampling
(-)= 3 consecutive samles no AFB
Contraindication: hemoptysis

Culture and sensitivity

(-) no afb in 100 fields in microscope
(+) 1-9 afb in 100 f
1+- 10-99 afb in 100
2+- 1-10 afb in 50 field
3+- >10 afb in 20f

Prevention: BCG vax

● Airborne precaution
● Ppe- mask- n95
● Drug resistant > neg. Pressure room
● Isolation- smear (+) - 2 weeks from the start of treatment

DOH program: National TB control program

Strategy: TB dots (short term 6-9 months)
● Multidrug course (inorder to not develop drug resistance)

Treatment: HRZES
H-isoniazid (INH drug class)
● S/e: neurotoxic (isip)
Rifampicin
● Red-orange body secretions
Z-pyrazinamide
● Hepatotoxic
Ethambutol (only bacteriostatic)
● Eyes (optic neuritis)
Streptomycin
● Ototoxic, nephrotoxic

Leprosy
-"Lepos" skin
-Leperos (the scaly man)
Other names: Hansen's disease; Hansenosis; the lepers disease
Pathognomonic sign: Lionin' face /leontiasis
Leprosy attacks the skin
Leontiasis ossea- the bone is involved
Paget's disease- there is completely bond remodeling
Causative agent: myco. Leprae (loves cold environment)- it has lower body temperature
Reservoir - Armadillos
Mot: direct contact (droplet) requires prolonged contact with an untreated person with leprosy
Incubation: 9mo-20 years; cdc: 5 years
Pathog: cutaneous skin lesions, neuropathies (hands and toes), sensory loss in the limbs

Who Classifications:
1. Paucibacillary- low quantity ( tubercular type) 5 or fewer skin (2-5) lessions
a. Single paucibacillary- 1 skin lesion
2. Multibacillary- lepromatous type, 6 or more lesions

Patho:
M leprae> replicate in cooler temperature > enters through droplet > skin [s/s: skin nodules, skin
lesions (non healing lesions), loss of sensation of the areas of lesions, anhidrosis (inability to
produce sweat), dry skin, loss of hair (eyebrows, eyelash), lesions turn to plaques and has
enlarged nodules in the earlobes, nose, eyebrows,forehead

Peripheral nerves [s/s: nerve damage> atrophy of hands and toes, claw hand, claw toes, foot
drop] [ muscle weakness, paresthesia, ] [facial nerve paralysis> Lagophthalmos (inability to
close the eyelids completely)> corneal ulceration > scaring > blindness]

[Respiratory mucosa, upper respi > nasa perforation, saddle nose (collapse of nasal bridge),
epistaxis, ulceration in the uvula and tonsils,]

Diagnostic test":
Confirmatory:skin/biopsy disease (cdc)
Skin smear/ skin slit smear -who
Method:tiny skin sample of tissue (8mm in size) microscopy staining = 1% acid alcohol or 5%
sulfuric acid > 100 fields
Site for sample: tissue of the active lesions

Prevention: BCG
Treatment: multi drug therapy
Who tx protocol:
● Paucibacillary- negative skin smear
○ Rifampicin (600 mg/once a month)
○ Dapsone (100mg/ od)
 ○ Treatment course: 6 mo.
○ Acquired in who (blister pack) 6 blister packs
● Multibacillary- positive skin Smear
○ Rifampicin (600 mg/once a month)
○ Clofazimine (300 mg once a month) 50 mg od.
○ Dapsone (100mg/ od)
○ Tx course: 12 months
○ Day 1= R,C 300, D
○ Day 2-28= C 50, D
○ 12 blister backs

● Single lesion= single dose : rifampicin 600 mg, ofloxacin 400mg, minocycline 100mg

Diphtheria- bull neck disease, klef -loafler, pseudomembrane

Ca: corynebacterium Diphtheriae
Mot: direct contact
Pathognomonic: pseudomembrane (whitish to grayish membrane attached to the palate)
Site of infxn: Upper respi. Most common: tonsillopharyngeal
Bull neck- larynx is affected

Pseudomembranous colitis- yellowish in the lining of colon (clostridium difficile) diarrheal

infection of the GI related to antibiotic Therapy (broad spectrum)

Dgx: naso pharyngeal culture - 2 swab (24 hours interval)

Stop antibiotic intake if you swab
Vaccine: pentavalent (philippines) dtap(us) booster (tdap
Treatment: erythromycin, Penicillin G for 14 days
● Horse serum based antitoxin (equine antitoxin) ( contains antibody) (IV 10,000 IU
ampule
● Needs allergy test- skin scratch test (2mm-4mm - 27 gauge needle) Patakan ng:
■ Normal saline- negative
■ Histamine phosphate-
positive control
■ DAT (Diphtheria antitoxin)

If (+) desensitize with epinephrine HCL

Pertussis- whooping cough, 100 days cough (highly contagious)

Ca: Bordetella pertussis (direct contact via droplet spread) (can also be indirect contact of
fomites)
Incubation: 4-21 days, average of 5-10 days
Pathognomonic: whooping cough (nocturnal coughing ff. by sudden inspiration of whoop or
crowing sound) for 100 days

Stages of Pertussis:
1. Catarrhal/prodromal- 7-10 days, mild cough, low grade fever
2. Paroxysmal- episodic attacks (usually at night) whooping cough for 1-6 weeks - 10
weeks (maximum 70 days)
 3. Convalescent stage = gradual recovery 7-10 days max. 21days

Diagnostic test: nasopharyngeal swab- 2 weeks pcr= 4 weeks

Isolation: 3 weeks - 6 weeks
Treatment: azithromycin, erythromycin
Complications: seizures, pneumonia

Tetanus
Other names: lockjaw, sardonic smile disease, trismus
Ca: clostridium tetani (anaerobic bacteria) can be seen in soil, manure
Produce a toxin called tetanospasmin cause muscle spasm
Mot: direct contact /indirect (spore enters to the wound/skin abrasion)
Incubation: 3-21 days, ave. 10 days
Pathognomonic: lockjaw/trismus, sardonic smile (risus sardonicus), opisthotonus

Patho:
C. Tetani> enters the wound > release toxin - tetanospasmin > affects neuromuscular fuction>
spasm start on the face [trismus and sardonic smile] > descending pattern spread >
opisthotonus > muscle tearing/bone fracture

Spasm: sudden, powerful, lasting, painful

Wof: laryngospasm

Types of tetanus:
1. Generalized tetanus- most common form of tetanus, triad sign, 10-20% mortality
2. Localized tetanus- mild form, happens in partially immunized pt, low mortality
3. Neonatal tetanus - highest mortality, site: umbilicus, poor feeding, can lead to full blown
tetanus
4. Cephalic tetanus- rarest form, incubation period: 1-2 days, a result of head or neck i
jury, unilateral face palsy

Dgx: Clinical presentation, spatula test (touch posterior pharyngeal wall) gag- (-), spasm (+)
Vax: pentavalent
Tx: Antibiotics (penicillin), TIG (IM) 500 IU single dose, muscle relaxant (benzodiazepine) pain
meds, intubate if laryngo spasm,

Complication:
Fractures

Meningitis: Alert ⚠️
- Inflammation of meninges (membrane that is covering the brain and spine)
- Leptomeninges (2 layers of meningitis) arachnoid and pia

Meningitis Meningococcal Meningococcemia

Any cause (bacteria, virus, Bacteria (n. Meningitides) Meningococcal + septicaemia

fungi, parasite)

Other name: cerebrospinal

fever (csf in infected)

Causative agent- Common:

bacteria
● Nb: Hib,
strep.pneumoniae,
e.coli, listeria
monocytogenes
● Children:
n.meningitidis, strep
pneumonia (most
common)
● Adults/elders:
Pneumoniae, listeria,
tb meningitis
Viral: enteroviruses, herpes,
HIV

Fungi: cryptococcus
Parasite: plasmodium
falciparum (can cause
cerebral malaria)

Mot: droplet spread (droplet

prec.) Via anatomical defect,
skull fracture/head injury

Hematogenous spread:
(Meningococcemia)

Incubation: depends on the

CA (2 days - 2 weeks)

Triad sign: Fever ,

headache, nuchal rigidity

Photophobia
Phonophobia
Meningoencephalitis> altered
mental thought process,
seizure

Patho: multiply in the csf >

inflammatory response >
meningitis > increase wbc (>5
wbc) (normal: 5 cells/m) ex.
Bacteria: >100, viral:
10-100mL, fungi 10-500ml >>
s/s: fever, headache,nuchal
rigidity, Phonophobia,
photophobia >>
Meningoencephalitis >>>
altered mental process>
seizures> coma> death

Diagnostic: kernings (knee)

Flexed 90 deg., hip 90 deg.
Extension> pain & (+)
resistance

brudzinski (batok)- flexion of

the neck > flexion of the
knees and the hip > this is
positive for (nuchal rigidity)

Confirmatory: CSF analysis

through lumbar puncture (3
samples)
Per sample: 1 ml of csf per
tube

Vaccine: MenACWY, MenB

Bacterial meningitis:
isolate: 24 hrs from the start
of the treatment

Treatment:
● corticosteroids( 1st to
give to prevent further
inflammation)

● antibiotics (2nd)-
broad spectrum
(cephalosporins) doc
for meningococcal
disease

INFLUENZA
Other name: The Flu
CA: Influenza virus
Type: A- HN (affects both humans and animals) , B- seasonal flu ( yamagata and victoria
lineage) humans only, C- mild flu, children, D- animals only ex. Cattles
MOT: droplet, fomites
Incubation period: 1-4 days average of 2 days (compared to Omicron)

Pathophysiology:
Type A- causes outbreak
H N- surface proteins,
H(hemagglutinin)- used to enter, attach (18 kinds)
N(neuraminidase)- use to exit (11 kinds)
Site: upper respi > bind to endothelial cell> H protein> release viral protein>replicate> bud/exit (
N protein) > new virus > infect other endothelial cells

S/s: fever, sore throat, cough (non productive)

Diagnostic: Rapid Influenza diagnostic test (RITD) 15-30 mins
PCR- RNA protein

Vax: Flulaval/fluarix - quadrivalent (2 type A, 2 type B)

Isolation: Private room, wear mask
Treatment:
severe- neuraminidase inhibitors (prevents the exit of the agent)
● Oseltamivir- tamiflu
● Peramivir- newest
M2 proton inhibitors- prevents H from atttaching to prevent Replication
● Amantadine
● Rimantadine

Mumps
Other name: infectious parotitis
CA: mumps virus, paramyxovirus (target: glands of the body)
MOT: droplet
Incubation: 12- 25 days (ave. 16-18 days)
Pathognomonic: painful swelling of one or both parotid glands
Pathophysiology: mumps virus> droplet >1st gland exposed (salivary glands)

> parotid >parotitis> common: bilateral> s/s: low grade fever, headache,
malaise

Complications if not controlled: Orchitis (testicular gland), Oophoritis ( ovarian gland), mastitis
(mammary gland)
Diagnosis: clinical presentation
Vaccine: MMRV Proquad- 2005
- Droplet precaution
—-----
Viral exanthem- Rash disease
-Outside
Enanthem- internal (first to show before going outside)

Measles- also known as Rubeola

- 7 day measles
- English measles
- Hard measles
- Brown/black measles
- Rubeola virus
- Airborne
- Indirect
- Incubation: 10-20 days
- Pathognomonic: Koplik spots (white spots with reddish surroundings) site: buccal
mucosa (also the initial sign of measles)
- Rashes: 7 days (cephalocaudal- outward progression) Non pruritic rash
(maculopapular rash) change in the color and slight elevation, no fluid (usually reddish
rash) fine flaking only, no crusting
- High fever
- Target: Respiratory
- Severity: life threatening
- Conjunctivitis, coryza, cough

German measles- also known as Rubella

- 3 day measles
- Mild not seeking medical attention
- Rubella virus
- Droplet
- Danger for pregnant women ( might lead to congenital rubella syndrome) cross placenta
> deafness, cardiac abnormalities and others
- Incubation: 14- 21 days
- Sign: Forchheimer spots (reddish spot, palate) can also be seen in scarlet fever
- Rashes: 3 days (pinkish rash)
- Low grade fever
- Target: lymph nodes
- Severity: milder
- Other: conjunc, coryza, cough,lymphadenopathy
- Stimson's sign- sensitivity to light ( dim the light)

Diagnostic of both: PCR, elevated, IgM and IgG (if Igm first- german measle; if both elevated-
measles
Vaccine: MMRV (quadrivalent)
Treatment: Symptomatic, antiviral (isoprinosine) (for measles)

______
Chicken pox - highly contagious
Other names: varicella, child pox, itching pox
CA: varicella Virus
MOT: Airborne, fomites
Incubation: 10-21 days; ave. 14-16
Manifestation: Rash
- Centripetal Rash- inward (more in the Trunk)
- Highly pruritic rash (Macule- there is change in color)
- Papule- <1cm
- Vesicle- fluid filled
- Pustule- pus filled
- Crusting-
-
- Diagnostic: PCr

Chicken pox Measles/g. Measles

Centripetal- inward more in the trunk Outward- cephalocaudal

Highly pruritic Non pruritic- mild
Crusting Fine flaking

Chicken pox Herpes zoster

Childhood Adulthood

Maculopapular > crusting Vesicles> painful - areas that follows the

nerve pathway

Chickenpox Smallpox

Fever appears at the time of the rash Fever for 2-4 days> Rash

Rapid progression of rash Slow- 3 weeks

Pruritic Non pruritic
Deeper

Centripetal Centrifugal
Inward Outward
More: trunk More: extrem.
Less: extremities Less: trunk

Pathognomonic: dent on the rash

Precaution: airborne precaution- negative pressure

Ppe: mask, gloves, apron
Vaccine: varicella vaccine - chicken pox
Smallpox- ACAM 2000 (also given to monkeypox) a live vaccine (contains vaccinia virus- has
the memory of the pox virus)
Treatment: antiviral (acyclovir), bayabas (bacterial skin infection)
Pruritus = calamine/cocoa based lotion
- Wear loose fitting clothes
- Cool baking soda bath

Complications: bacterial skin infection, encephalitis

________
VIRAL HEPATITIS
Came from the word: Hepar= liver (one of the largest part of the body)
Itis- inflammation

Causes:
1. drugs or meds
2. Excessive alcohol
3. Infection- virus (hepatitis virus)
4. Hepatitis X- hepatitis from an unknown cause

Liver fxn:
1. Bile production
2. Bilirubin - brown (clay colored stool if affected ang liver)
3. Blood clot- Vit. K - Bile is essential for the vit. K to be absorbed
4. Carbohydrates
5. Vitamins & mineral storage- ADEK & B12
6. breakdown of proteins
7. Filters blood

Hepatitis A
Other names- infectious hepatitis (Catarrhal jaundice)
Infection: acute- <6mo.
Ca: HEP. A VIRUS- SS Rna
Mot: fecal oral
Incubation: 15-50 days ave. 28 days
Dgx: increase ALT & AST
IGM- inc. Acute infxn
IgG- inc. Convalescent
Treatment: supportive, Bed rest
Vaccine: H.A Vax
Contact precaution / enteric precaution
Proper waste management

Hepatitis B
Other name: serum hepatitis
Infection: acute and leads to chronic
CA; Hep. B Virus (double strand DNA)
Mot: blood, sex, perinatal
Incubation: 60-150 days ave. 90 days
Dgx: lab- specific serum markers
1. HBsAg- hep. B surface antigen - first serum marker to appear ( peaks at 12 weeks) (and
undetectable after 6 mo.
- Can also be used to confirm immunity- Heb. b vaccine ( ) ⬇️
 2. HBeAg- hepa. E ANTIGEN
- Viral Replication
- 6-14 weeks
- Vload- ⬆️
HBeAg
- Placental cross

4. HBeAb- antibody - E antigen ⬆️

HBeAB= ⬇️
3. HBcAB- hep. B virus core antibody (first antibody to be detected)
viral load = convalescent

PCR- quantitative
- Viral count

Fibroscan- damage ( 1,2,3,4 (total liver damage) )

Treatment-
chronic- Pegasys- pegylated interferon
Antivirals- lamivudine, entecavir, tenofovir (either)

Vaccine: Hepatitis B vaccine

Precaution: blood borne
- safe sex

Hepatitis C
Other names: Non A, Non B Hepatitis, inoculation hepatitis
Infection- acute > chronic
Ca: Hep. C virus (single strand RNA)
Mot: sex, blood, perinatal
Incubation: 14-180 days (ave. 45 day)

Diagnostic: liver enzymes (normal)

Hepa C. Antibody test
PCR

Treatment: pegasys + ribavirin

Direct acting antivirals- elbasvir/grazoprevir
Ledipasvir/sofosbuvir

Vaccine: Hep. A/hep. B

Prec.- bloodborne prec. (Contact)
Safe sex
Common Complication: cirrhosis, liver cancer

Hepa D- needs hepa. B

Other Name: con infection hepatitis
Types:
co- infection- "sabay"
Superinfection- Hepa B 1st > Hep. D

Infection: chronic infection

Ca: Hepa. D virus- SS rna
Mot: blood and blood products
IP: co- infection- 45- 160 days; ave. 90 days
Superinfection- 2-8 weeks

Dgx test: PCR- Detect Viral Load

Hepa B - lab serum markers

Treatment: pegasys
Vaccine: hep B vaccine
Precaution: blood borne prec.

Hepatitis E
Other Name: perinatal hepatitis
At risk > pregnant women
Infection- acute <6mo.
CA: Hep. E virus - SS rna
Mot: fecal oral
Ip: 15-60 days (ave. 40 days)
Dgx- pcr
Tx: ribavirin
Prec. Contact prec/ enteric prec.
Health teaching- proper waste mgt.
Complication: fulminant liver failure (too much hepatocytes died)

Pathophysiology of hepatitis:
Release ss rna + rna = more viral rna > replication/ release > exit> invading other hepatocytes>
cell lysis> apoptosis> necrosis> deterioration of liver fxn

Hep B> release DS DNA> + dna = more viral dna > other will transcribe= viral RNA (will go to
RNA)

Stages of Hepatitis
Prodromal- viremia -virus in the blood, fever, headache, fatigue
Icteric- liver damage, jaundice, urine is tea colored, gray or clay stool, yellowish sclera,
hepatomegaly
Convalescent- liver returns to normal size, improved appetite, jaundice decrease, stool and
urine is going back to normal color

_______
Zoonotic Disease - non human animals to humans
Reverse zoonosis

Leptospirosis-
Lepto-thin
Spira-coiled
Spiral aerobic bacteria

Other names: weil's disease ( if sever leptospirosis), canincola fever, Hemorrhagic jaundice, the
japanese 7 day fever, mud fever
CA: Leptospira specie, most common: L. Interrogans
Reservoir: rodents, small mammals, domestic animals
Mot:
1. Direct contact with urine or reproductive fluids from infected animals
2. Contact with urine contaminated water (Flood, streams, sewage, wet soil,) wound, skin
abrasions
3. Rare- ingestion of food and water contaminated by urine or urine contaminated water

Ip: 4-14 days

Common: tropical countries- peak is rainy season
Signs: mild disease-90%
1. Fever
2. Chills
3. Headache
4. Myalgia
5. Nausea and vomiting
6. Diarrhea
7. Conjunctivitis
Severe 10%
● Renal failure
● Hepatic failure
● Jaundice
● Meningitis
● Myocarditis
● Pneumonia

Pathophysiology:
Leptospira(aerobic)> mot: skin breaks/ wounds> bloodstream (multiply)> organs (kidneys, liver,
brain heart, lungs)

Kidneys- renal failure, low uop, fluid retention

Liver: hepatic, jaundice,
Brain- meninggo, encephalitis
Heart- myocarditis

Diagnostic: elisa- detect antigen

Confirmatory- MIcroscopic agglutination test (dark field microscope, detect bacterial dna)
Treatment: mild- Doxycycline 100 mg bid and Amoxicillin 500 mg q6 oral
Severe: PenG or ceftriaxone (IV)
Prevention: chemoprophylaxis- oral doxy =200 mg a week
Proper Sanitation

Mgt: respi support- mech vent> intubation

Blood transfusion> dialysis

______
RABIES
Other Names: hydrophobia, lyssa, mad dog disease
Ca: rhabdovirus/lyssavirus > neurotropic virus - target nerve cells, sensitive to light and
hydrophobic
Mot: contact saliva- biting behaviour, scratching or licking
Reservoir: Dogs- Ph, bats, Raccoons, skunks, foxes
IP: 1-3 months can be up to 15 years
Depends on the ff:
● the distance of the bite to the brain
● The expensiveness of the bite
● Animal specie
● Nerve supply in the area of the bite
Manifestation:
3 phases:
1. Prodromal - invasion phase
● Fever,anorexia, malaise, sore throat, nausea and vomiting, copious salivation,
lacrimation,perspiration, restless and irritable, pain at the site of the bite,
sensitivity- light,sound, temp
2. Neurologic- furious or excitement phase
● Excitation and apprehension> fear
● Delirium with nuchal rigidity and invol. Twitching
● Maniacal behavior= eyes are fixed and glossy skin is cold and clammy
● Profuse drooling
● Aerophobic
● Severe and painful spasm = month,pharynx, larynx= attempt to
● Death= spasm > respi & cardiac failure
3. Paralytic phase- terminal
○ quiet and unconscious
○ Loss of bowel and urinary control
○ Progressive paralysis
○ Death- respi paralysis, heart collapse

Pathophysiology:

Dgx: Fluorescent antibody test (use saliva or skin)

Pcr of saliva/skin
Alert: look for negri bodies > rabies
Confirmatory- done Postpartum- brain biopsy, neck skin biopsy (fat) (negri bodies)
Animal: observe animal changes in behavior (14 days) - do not kill the animal
- If the animal dies - ask for assistance to decapitate the dog and submit the specimen
wrapped in plastic or rubber and placed in a cooler and bring to the nearest
communicable disease institution.
- Search for NEGRI BODIES!!
Prevention: Mass dog vaccine
Dog population management (impounding)
Vaccine: Prep & Pep (pre exposure prophylaxis and post exposure prophylaxis) (give prep to
high risk) and Pep for those who were bitten
WHO
PVRV- PURIFIED vero rabies vax ( imorav, verorab, abhahyrab)
PCECV- purified chick embryo cell vax (RabAvert

PREP- given in 1 mo.= 0,1,21, or 28 days

Route: ID or IM

PVRV:

Pep: who: ID/IM

Schedule: 0,3,7,14,28
PVRV=.5ml
PCECV= 1m

Who tx protocol: ⚠️
Category 1 - feeding, touching an animal , licking- intact skin, casual contact with rabies pt.
Action: wash with soap and water, no vaccine or RIG needle

Cat. 2: nibbling (small bite), minor scatches, abrasion and bleeding

Action: wash with soap and water, start the vaccine ( antirabies) complete, RIG is not indicated

Category 3- single or multiple transdermal bites, broken skin with saliva from animal licks,
exposure or direct contact with bats
Action: wash the wound with soap and water, start and complete the rabies vaccine and RIG

(2018) who update

Category 2 and 3
1.wash for 15 minutes
2. Alcohol, povidone iodine or any antiseptic
3. Avoid suturing, if required delay for 2 hours after RIG administration then suture loosely

Nsg. Management:
1. Isolate the pt.- contact precaution
2. Comfort > hyperactive episodes
3. Provide a quiet and darken room
4. Pt should not be bathed. Shouldnt be running water with hearing distance
 5. IV- wrap
6. Disinfection

MOSQUITO-BORNE

Aedes Anopheles Culex

Dengue, zika, chikungunya, Malaria Japanese encephalitis, west

yellow fever nile

Aggressive day biter Dawn and dusk Dawn and dusk

At night At night

Characteristics: Black and Dark legs, dark thorax, dark Tan colored thorax, striped
White striped legs, lyre wings dark legs, dark wings
shaped thorax

Habitat: stagnant water Ponds, lakes Polluted water

Position: parallel 45 degrees Parallel to the surface

Dengue
Other names: dengue hemo fever, breakbone fever, dandy fever, infectious thrombocytopenic
purpura
CA: flavivirus- RNA virus
4 types:
1. DENV 1
2. DENV 2
3. DENV 3
4. DENV 4
5. DENV 5
Vector: (female aedes mosquito)
● Aedes aegypti- the yellow fever mosquito, tiger mosquito
- Before sunset, dawn
- After sunrise- indoor

Aedes albopictus- asian tiger mosquito, outdoor- daylight

Aedes polynesiensis- other countries
Aedes scutellaris

Reservoir: humans, monkeys- west africa, S.E Asia

Incubation: 3-14 days with an average of 5-7 days
Mot: vector borne via mosquito bite
Phases:
1. Febrile phase- 1-3 days
● Fever 39 degrees
● Febrile convulsions
● (+) Tornique test
● Anorexia, vomiting, Myalgia
 ● Petechial rashes
● Abdominal pain
2. Toxic- 4-7 days
○ Fall of temp
○ Restless with cold ans clammy skin
○ Hypovolemic shock - coma, metabolic acidosis, death
3. Recovery- 8-10 days

Grading for dengue and s/s

T. Test- to test capillary fragility

1 inch square to measure petechiae
>20 petechiae (positive)

Bleeding - epistaxis, abdominal bleeding, gingival bleeding

Hypovolemic Shock

Pathophysiology:
Diagnostic: rumpel leads test- screening
Dengue rapid test- IgM and IgG
Vaccine: Dengvaxia- 2019 revoked license
Prevention and mgt:
Low fat, low fiber, non spicy, non carbonated
Analgesic
Monitor for signs and symptoms of shock and Hemorrhage
ORS (NP1) IV (other NPs)

Culombo; chemically treated mosquito nets (pyrroles/pyrethroids)

Larvae eating fishes; mosquito fish (gold fish, gambusia, koi, tilapia)
Environmental Sanitation
Anti mosquito repellent > Deet (Diethyl
Neem trees

DOH Program: dengue preve. And control program

4s- search and destroy
Secure/self protection
Seek early consultation
Spraying indoor/outdoor,

Malaria
Other names:
● marsh/jungle fever (common in forest)
● Ague
● Periodic fever (Paroxysmal- episodic)
● Swamp fever (palawan, mindoro, rizal province)
Ca: plasmodium- tropical protozoa
Types:
● P. Falciparum- most common in ph and the most deadly of all (considered as a
malignant tertian
● P. Vivax- second most common (tertian malaria)
● P.ovale- tertian malaria
● P. Malariae- quartan malaria (rare) mildest
● P. Knowlesi- monkeys in SE asia

Tertian- every 3rd day; 1,3,5; fever interval- 2 days

Quartan- every 4th day; 1, 4, 7; fever interval- 3 days
Incubation: CDC: 7-30 days
Falci: 6-7 days up to 14 days
Vivax- 12-18 days
Ovale- 18- 40 days
Malaria- 24- 40 days
Mot: vector borne- female Anopheles mosquito
Classic signs of malaria
1st- cold = chills 1-2 hours
2nd- hot= fever 3-4 hours
3rd- wet= diaphoresis
Rationale: bec. That is the cycle of the protozoa

Pathophysiology:

Malaria can also be transmitted blood transfusion

Dg: NP1 - MBS
NP3- QBC
Preventive- malaria prophylaxis

Cdc/who:
Atovaquone- proquanil
Doxycycline
Mefloquine
Mgt: CLEAN (same with dengue)
DOC: "arte" "quine"
Artemether-
Artesunate
For pregnant:
If falciparum - quinine
If vivax- chloroquine

Severe malaria- give IV (quinidine gluconate and doxycyclin or clindamycin

Zika fever
Other names: zika virus disease
CA: zika virus
Vector: aedes aegypti, A albopictus
IP: 3-12 days
Mot: Vector borne
The only mosquito disease that is transmitted sexually-anal, vaginal , oral, sex toys
-it can live in the semen up to 6 months and in vaginal fluids with atleast min. Of 8 weeks
-Can be transmitted via blood transfusion, perinatal transmission
Signs/symp: commonly asymptomatic (80%)
If symptomatic: last for 3-7 days
Low grade fever
Arthralgia
Conjunctivitis
Rash (maculopapular rash) pruritic rash (makati)
Diagnosis: Zika virus RNA NAT - nucleic acid amplification test (CONFIRMATORY TEST OF
ZIKA)
Sample: urine, serum
- IgM serology test
Prevention: safe sex (condom) for 6 months
Abstinence
Treatment: supportive care
No nsaids- not unless dengue is ruled out

Syphilis no. 1
Gonorrhea- highest
Herpes simplex- viral in ph

HIV/AIDS

HIV- is a disease; it will lead to the immuneless state (AIDS)

Aids- is not a disease, it is acquired immunodeficiency syndrome (immuneless state of the body)
(pt will only die because of the opportunistic infection)
CA: human immunodeficiency virus - Retrovirus (it replicates backward: RNA to DNA)

Types of HIV:
HIV 1- common world wide; a stronger, more virulent strain
● Group M- more common - 90 percent cases
● Group O
HIV 2- largely confined- west africa and southern asia
- Rare,weaker, less virulent strain
 - Pt will likely die with HIV 2 because HIV 1 has more treatment and HIV 2 has less of it
and few

MOT: Blood, Semen, pre- seminal fluid, vaginal fluids, rectal fluids, breast milk

Incidence rate: 84 percent, male to male sex; 11 percent male to female sex; 4 percent sharing
of infected needles, 1% is vertical transmission, blood transfusion

(+) hiv and undetectable and (-) hiv - Serodiscordant relationship

Common: African americans, males, homosexual, 20-40 yo

HIV replication cycle

1. Binding- attachment of the virus to the surface attacking the CD4 cells
2. Fusion- HIV release RNA protein to the CD4
3. Reverse transcription- HIV RNA> HIv DNA
4. Integration- HIV dna will inject itself to the human dna
5. Replication- producing more HIV proteins
6. Assembly- HIV proteins assemble to the surface wall of the CD4
7. Budding- Pushed out of the CD4 and will infect other cd4 cells

If HIV infects cd4 cells - it will lead to:

Pyroptosis- will have Inflammation and will lead to self destruction
Apoptosis- self Suicide of the cd4 cells that are not infected

- This two will lead to the decrease of the CD4 cell count (Helper T cells that helps
infection in the body)
- Will lead to higher risk for infection
- <200 cd4 cells ( immuneless state)AIDS + Opportunistic infection can only be
classified as aids if both is present
- 0 cd4 > leads to opportunity infections ( infections that affect multi organs of the body
which causes death of HIV)

Stages of HIV
stage 1-
1A- primary infection- Acute HIV Syndrome
-2-4 weeks last to 1-3 weeks
-CD4 lower than the normal (<1500 cells/ml) gradual decrease
S/S: flu like symptoms, night sweats, fatigue, headache, persistent generalized
lymphadenopathy

2. 1B- HIV asymptomatic (dormant stage of HIV)

- 2-10 years
- CD4- 500 above
- Asymptomatic
- Persistent generalized lymphadenopathy (HIV is staying at the lymph nodes)
- No major manifestations - 8-10 years

Stage 2- Symptomatic, CD4 200-499 cells/mL

- Bacillary angiomatosis
- Candidiasis
 - Cervical dysplasia
- Fever- 38. 5 deg.
- Diarrhea- 1mo. Or more
- Hair leukoplasia (oral thrush)
- Shingles (herpes zoster)
- Pelvic inflam. Disease
- Peripheral neuropathy

Stage 3- AIDS
- Cd4 200 cells/mL + Opportunistic infxn present

Opportunistic Infections:
Any CD4 count:
● TB
● Oral Candidiasis- 200-500 cd4 (tx: oral fluconazole)
● Kaposi Sarcoma- an Aids defining illness (more common with cd4 count below 250)
caused by Human herpesvirus 8 HHV8 ( red, purple, brown or black papular lesions on
the skin)
CD4 <=250:
● Coccidioidomycosis- Tx (fluconazole oral until >250 cd4 count

CD4 <200
● Bacterial pneumonia- tx PPSV 23 (pneumovax) polysaccharide pneumococcal vaccine
(Given every 5 years)
● Pneumocystis pneumonia- CA: pneumocystis Jiroveci (fungal infx)
- treatment: trimethoprim, sulfamethoxazole (cotrimoxazole)
3. Isosporiasis/cystoisosporiasis
- Watery, non bleeding, diarrheal disease
- Protozoa- CA: cystoisospora belli (tx: cotrimoxazole)
4. <=150
● Histoplasmosis- tx: Itraconazole, amphotericin- B
5. <or= 100
● Esophageal Candidiasis- s/s: odynophagia (painful swallowing) manifested by
retrosternal chest pain
- treatment: fluconazole or itraconazole

● Toxoplasmosis- toxoplasma gondii > encephalitis (<50) tx: cotrimoxazole lead to

toxoplasmosis encephalitis tx: pyrimethamine & sulfadiazine + leucovorin