CHN Lec - Midterm Transes

Community Health Nursing 1: LECTURE
Professor: Ms. Anne Jo Ruiz

Compiled by: Justine Angelique Zabala 1st Semester Midterms BSN 2B
LESSON 1: FAMILY NURSING performance of functions to attain, sustain maintain

ASSESSMENT
and regain individual and family health.
FAMILY NURSING PRACTICE

STEPS IN NURSING ASSESSMENT
Family nursing practice emphasizes the need to
1. Data Collection
understand the behavior of the family as a dynamic,
2. Data Analysis
functioning unit which affects its capability to help
3. Formulation of Diagnosis
itself and maintain system integrity, or its readiness
to work with the nurse in enhancing wellness or DATA COLLECTION
addressing problems on health and illness.
FIRST LEVEL ASSESSMENT
FAMILY SYSTEMS THEORY
Family Systems Theory views the family as a living

5 TYPES OF DATA
social system within a context in which multiple
A. Family Structure, characteristics, and dynamics
environmental actions or factors occur over the life
course. B. Socio-economic and cultural characteristics
THE INTERACTIONAL APPROACH OR C. Home and environment

SYMBOLIC INTERACTIONAL FRAMEWORK
D. Health status of each member
The Interactional Approach or Symbolic
Interactional Framework views the family as a unity E. Values and practices on health
of interacting personalities whose actions are based promotion/maintenance and disease prevention.
on meanings they derived from interactions and
taken in an ever-changing process of new
interactions, new interpretations, and new meanings. SECOND LEVEL ASSESSMENT
THE DEVELOPMENTAL APPROACH Data include those that specify or describe the
The Developmental Approach views family family’s realities, perception and attitudes related to
development throughout its generational life cycle, the assumption or performance of family health tasks
highlighting critical periods of family growth and on health condition or problem identified during the
development across the life course. first level assessment.
STRUCTURAL-FUNCTIONAL PERSPECTIVE DATA GATHERING METHODS AND TOOLS
Structural-Functional perspective specifies family 1. Observation

characteristics such as member roles, family forms,
2. Physical Examination
power structure, communication processes and
value systems which provide order to family 3. Interview
interactions and interdependent relationships and
4. Record Review
serve to organize performance of roles and
functions. 5. Laboratory/Diagnostic Tests
FAMILY HEALTH TASKS PERSPECTIVE
Family Health Tasks Perspective integrates the

application of theoretical perspectives which
converge particularly at the critical role of family
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DATA ANALYSIS
❑ Sort data
❑ Cluster/group related data
❑ Distinguish relevant to irrelevant data
❑ Identify patterns
❑ Relate family data to relevant clinical data and

research findings
FRAMEWORK ❑ Compare patterns with norms or standards
Use an organized and comprehensive approach to ❑ Interpret results

assessment.
❑ Make inferences/draw conclusions
• FIRST LEVEL- Data on status:

HEALTH CONDITION/PROBLEMS AND
✓ Family/household members FAMILY NURSING DIAGNOSIS
✓ Home and enviroment
FIRST LEVEL ASSESSMENT
• Second Level- Data on family’s assumption of ❑ Define the health condition/problems (categorize
health tasks on each health condition/problem as: wellness state, health deficits, health threats,
identified in first level assessment foreseeable crisis or stress points
SECOND LEVEL ASSESSMENT

DATA COLLECTION (METHODS/SOURCES)
FIRST LEVEL ASSESSMENT ❑ Define the family nursing problems/diagnosis as
Family/household members statement
❑ Health assessment ❑ Family’s inability to perform health tasks on each

❑ Laboratory/diagnostic test results health condition/problem specifying the barriers to
❑ Records performance or reasons for non-performance of

family health tasks.
Home and environment
❑ Observation/ocular survey THE ASSESSMENT DATABASE (ADB)

❑ Interview Supported and complemented by other family
❑ Laboratory/diagnostic test results assessment tools to elicit generational information

about family structure and processes (genogram),
❑ Records
factual data about family relationship with the
SECOND LEVEL ASSESSMENT external environment and its resources (ecomap),
❑ In-depth interview on realities/perceptions about and interactive processes and family relationship
and attitudes towards assumptions/performance of problems/difficulties and strengths (family life
health tasks chronology).
❑ Observation: Relate verbal with Non-verbal cues
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GENOGRAMS 2.Clustering of related cues to determine

relationships between and among data
3. Distinguish relevant from irrelevant data
4. Identifying patterns such as physiologic function,

developmental, nutritional/dietary, lifestyle.
5. Relating family data to relevant clinical/research

findings and comparing patterns with standards of
health
6. Interpreting results based on how family

FAMILY SYSTEMS THEORY OF MURRAY characteristics, values, attitudes, perceptions
BOWEN (1978)
lifestyle are associated with specific health
Conceptual framework for constructing and conditions or problems identified
analyzing genogram patterns.
7. Making inferences or drawing conclusions about
ECOMAP the reasons for the existence of the health condition

or problem and risk factor related to non-
maintenance of wellness state can be attributed to
non-performance of family health task.
STANDARDS IN DETERMINING THE STATUS

OF THE FAMILY
1.) Normal Health of individual members.
2.) Home and Environmental Conditions conducive

to health development.
FAMILY LIFE CHRONOLOGY
3.) Family Characteristics, dynamics and level of

functioning conducive to family growth and
development.
FAMILY HEALTH TASKS
● Recognize the presence of wellness state or health

condition problem
● Make decisions about taking appropriate health

action to maintain wellness or manage the health
DATA ANALYSIS
problem
SUB-STEPS ● Provide nursing care to the sick, disabled, or at-risk

members
1. Sorting data for broad categories
● Maintain home environment conducive to health
maintenance and personal development
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● Utilize community resources for health care

FIRST LEVEL OF ASSESSMENT
FORMULATION OF DIAGNOSIS
I. PRESENCE OF WELLNESS CONDITION
● Nursing Diagnosis (POTENTIAL OR READINESS)
● Wellness state or health condition becomes a • Wellness potential

family nursing problem when its is stated as the Potential for enhanced capability for:
family’s failure to perform adequate health tasks to ■ Healthy lifestyle
enhance the wellness state or manage the health ■ Health maintenance/health management
problem. ■ Parenting
■ Breastfeeding
TYPOLOGY OF NURSING PROBLEMS IN ■ Spiritual wellbeing
FAMILY NURISNG PRACTICE
• Readiness for enhanced wellness

FIRST CATEGORY (FIRST LEVEL OF
Readiness for enhanced capability for:
ASSESSMENT)
■ Healthy lifestyle
✓ Presence of wellness states,
■ Health maintenance/health management
✓ Health threats
■ Parenting
✓ Health deficits , &
■ Breastfeeding
✓ Foreseeable crisis or stress points
■ Spiritual wellbeing
5 CATEGORIES (SECOND LEVEL OF
ASSESSMENT) II. PRESENCE OF HEALTH THREATS
1. Inability to recognize the presence of
condition/problem due to…
■ Presence of risk factors of specific disease case
2. Inability to make decisions with respect to taking
■ Threat of cross infection from a communicable
appropriate health action due to….
disease case
3. Inability to provide nursing care to the sick,
■ Family size beyond what family resources can
disabled, dependent or at-risk member of the family
adequately provide
due to…
■ Accidents./fire hazards
4. Inability to provide home environment which is
conducive to health maintenance and personal ■ Faulty/unhealthful nutritional/eating habits
development due to
■ Stress-provoking factors
5. Failure to utilize community resources for health
■ Poor home/environmental condition/sanitation
care due to….
■ Unsanitary food handling and preparation
2 PARTS
1. Statement of unhealthy response ■ Unhealthful lifestyle and personal habits/practices
2. The statement of factors which are maintaining the ■ Lack of immunization
undesirable response and preventing the desired

change.
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III. PRESENCE OF HEALTH DEFICITS C. Feeling of confusion/helplessness.
D. Lack of/inadequate knowledge as to alternative

■ Illness states, regardless of whether it is diagnosed courses of action open to them
or undiagnosed
E. Inability to decide which action to take from among
■ Failure to thrive/develop according to normal rate a list of alternatives.
■ Disability-whether congenital or arising from F. Conflicting opinions among family members

illness, transient /temporary or permanent
G. Negative attitude towards the health condition or
IV. PRESENCE OF STRESS POINTS/ problem
FORESEEABLE CRISIS
H. Lack of trust/confidence in the health
personnel/agency.
■ Marriage
INABILITY TO PROVIDE ADEQUATE NURSING
■ Pregnancy, labor CARE TO THE SICK, DISABLED, DEPENDENT
OR VULNERABLE/AT RISK MEMBER OF THE
■ Parenthood FAMILY DUE TO:
■ Additional member
■ Entrance school A. Lack of/inadequate knowledge about the

disease/health condition
■ Divorce or separation
B. Lack of/inadequate knowledge about child
■ Loss of job development and care
■ Hospitalization of a family member C. Lack of/inadequate knowledge of the nature and

extent of nursing care needed.
SECOND LEVEL ASSESSMENT
D. Lack of the necessary facilities, equipment and
supplies for care.
INABILITY TO RECOGNIZE THE PRESENCE OF
THE CONDITION OR PROBLEM DUE TO
E. Inadequate family resources for care
A. Lack of or inadequate knowledge
✓ Absence of responsible member
B. Denial about its existence or severity as a result
of fear of consequences of diagnosis of problem ✓ Financial constraints
✓ Limitations/lack of physical resources
✓ Social stigma, loss of respect of peer
✓ Economic cost/implications
F. Member’s preoccupation with own
✓ Physical consequences
✓ Emotional/psychological stress concerns/interest
C. Attitude or philosophy in life which hinders G. Prolonged disease or disability progression which
recognition/acceptance of a problem.
exhaust supportive capacity of family members
INABILITY TO MAKE DECISIONS WITH RESPECT
TO TAKING APPROPRIATE HEALTH ACTION
DUE TO:
A. Failure to comprehend the nature/magnitude of

the problem/condition
B. Low salience of the problem
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INABILITY TO PROVIDE HOME ENVIRONMENT

CONDUCIVE TO HEALTH MAINTENANCE AND
LESSON 2: FAMILY NURISNG CARE
PERSONAL DEVELOPMENT DUE TO: PLAN
FAMILY NURSING CARE PLAN

A. Inadequate family resources
The blueprint of the care that the nurse designs to
✓ Financial constraints/limited financial systematically minimize or eliminate the identified
resources health and family nursing problems through explicitly
✓ Limited physical resources e.g lack of formulated outcomes of care and deliberately chosen
space to construct facility. set of interventions, resources and evaluation of
criteria, standards, methods and tools.
B. Failure to see benefits of investment in home
environment improvement. 01. CHARACTERISTICS
C. Lack of/Inadequate knowledge of importance of 1. It focuses on actions which are designed to

hygiene and sanitation solve or minimize existing problem.
D. Lack of/inadequate knowledge of preventive 2. It is the product of a deliberate systematic

process.
measures
3. It relates to the future.
E. Lack of skill in carrying out measures to improve
home environment. 4. It is based upon identified health and nursing
problems.
F. Ineffective communication patterns within the
5. It is a means to an end, not an end itself.
family
6. It is a continuous process, not a one-shot deal.
G. Lack of supportive relationship among family
members 02. DESIREABLE QUALITIES
FAILURE TO UTILIZE COMMUNITY RESOURCES
1. Clear and explicit definition of the problem.
FOR HEALTH CARE DUE TO:
2. Realistic
A. Lack of/inadequate knowledge of community 3. Prepared jointly with the family
resources for healthcare 4. Useful in written form
B. Failure to perceive the benefits of health

03. IMPORTANCE
care/services.
C. Lack of trust/confidence in the agency/personnel

1. They individualize care to clients
D. Previous unpleasant experience with health
2. Helps in setting priorities by providing information
worker
about the client as well as the nature of his problems
E. Unavailability of required care/service F. Feeling
3. Promotes systematics communication among
of alienation to/lack of support from the community
those involved in the health care effort
eg. Stigma due to mental illness.
4. Continuity of care is facilitated through the use of
nursing care plans
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5. Facilitate the coordination of care by making • The more specific the objectives, the easier is
known to other members of the health team what the the evaluation of their attainment.
nurse is doing.
o After nursing intervention, the family
# 2 STEPS IN DEVELOPINGFAMILY NURSING will be able to:
CARE PLAN
o Feed the mentally retarded child
1.PRIORITIZE THE HEALTH CONDITIONS AND
according to prescribed quantity and
PROBLEMS
quality of food .
• Nature of the problem
• Modifiability
o Teach the mentally retarded child
• Preventive Potential simple skills related to the activities of
• Salience daily living.
2. DEFINE GOALS AND OBJECTIVES OF
CARE o Apply measures taught to prevent
infection in the mentally retarded
EXPECTED OUTCOMES
member.
Conditions to be observed to show problem is
prevented, controlled, resolved or eliminated. Client SHORT TERM OR IMMEDIATE
OBJECTIVES
responses or behavior
Specific, Measurable, Client-Centered Statements/ o Immediate attention

Competencies o Short period of time
o Few family contacts
GOAL
o Less resources
• It should be realistic or attainable.
Ex: The sick members will take the drugs

• It is best stated in terms of client outcomes, accurately as to dose, frequency, duration
whether at the individua and drug combination
• l, family, or community levels LONG TERM OR ULTIMATE

OBJECTIVES
• Tells where the family is going after the

interventions. o Several nurse-family encounters
o Investment of more resources
• Example: After family nursing interventions, the Ex: All members will carry out mosquito
family will be able to take care of the disabled vector control measures
child competently MEDIUM-TERM OR INTERMEDIATE

OBJECTIVES
OBJECTIVE
• Specify the criteria by which the degree of

o Not immediately achieved
effectiveness of care are to be measured
o Required long-term ones
Ex: All member will have medical check-up
• Milestones to reach the destination or the goal.
and laboratory confirmation to diagnose
malaria
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o Guide the family on how to decide on

BARRIERS TO JOINT GOAL SETTING BETWEEN
appropriate health actions to take
THE NURSE AND THE FAMILY INCLUDE THE
FOLLOWING:
o Develop the family’s ability to provide a
1. Failure on the part of the family to perceive home environment conducive to health
the existence of the problem maintenance personal development
2. The family may realize the existence of a o Facilitate the family’s capability to
health condition or problem but is too busy at the utilize community resources for health
moment with other concerns and pre care
occupations
4. Catalyze behavior change through motivation
and support.
3. Sometimes the family perceives the existence
of a problem but does not see it as serious GUIDE IN SELECTION OF APPROPRIATE
enough to warrant attention NURSING INTERVENTIONS
4. The family may perceive the presence of the • Analyze with the family the current situation and
problem and the need to take action however determine choices and possibilities based on a
refuses to face and do something about the lived experience of meanings and outcomes.
situation
• Develop/enhance family’s competencies as

thinker, doer and feeler.
5. Failure to develop a working relationship
3. DEVELOP INTERVENTION PLAN • Focus on interventions to help perform the

health tasks.
DETERMINE METHODS OF NURSE-FAMILY

CONTACT • Catalyze behavior through motivation and
support.
• Specify resources needed.

• Methods of contact 4. DEVELOP THE EVALUATION PLAN
DEVELOPING THE INTERVENTION PLAN • SPECIFY: Criteria/Outcomes based on

Objectives of Care Methods/Tools.
1. Analyze with the family the current situation and

determine choices and possibilities based on a
lived experience of meetings and concerns
2. Develop /enhance family’s competencies as

thinker, doer and feeler
3. Focus on interventions to help perform the

health tasks.
o Help the family recognize the problem.
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# 3 SCALE FOR RANKING HEALTH

CONDITIONS AND PROBLEMS ACCORDING
TO PRIORITIES
1.NATURE OF THE CONDITIONS OR [PROBLEM

PRESENTED
✓ Wellness State/Potential
✓ Health Threat
✓ Health Deficit
✓ Foreseeable Crisis
2. MODIFIABILITY OF THE CONIDITION OR

PROBLEM
SCORING:
● Decide on a score for each of the criteria

3. PREVENTIVE POTENTIAL
● Divide the score by the highest possible score
and multiply by the weight: (Score/Highest Score) x
4.SALIENCE
Weight
● Sum up the scores for all the criteria. The highest

score is 5, equivalent to the total weight.
LESSON 3: FAMILY HEALTH NURISNG

RECORDS
RECORDS IN FAMILY HEALTH NURSING
An effective health record shows the extent of the

health problems’ needs and other factors that affect
individuals their ability to provide care and what the
family believes. What has been done and what
needs to be done now can also be shown in the
records.
PURPOSES OF RECORDS
● Provides documentation of the services that have

been rendered and supply data that are essential for
program planning and evaluation
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● To provide the practitioner with data required for 2. Provides a basis for analyzing needs in terms of
application of professional services for the what has been done, what is being done, what
improvement of family’s health is to be done and the goal towards which means
are to be directed
● Tools for communication
● Shows the health problem in the family and other 3. Provides a basis for short- and long-term
factors that affect health planning
● Indicates plans for future

4. It prevents duplication of services and helps
● Provides baseline data to estimate the long term follow up services effectively
changes related to services
5. Helps the nurse to evaluate the care and the
PRINCIPLES OF RECORD WRITING teaching which she has given
• Nurses should develop their own method of
expression ad form in record writing. 6. It helps the nurse organize her work in an orderly
way and to make an effective use of time
• Records should be written clearly, appropriately,

and legibly. 7. It serves as a guide to professional growth
• Records should contain facts based on 8. It enables the nurse to judge the quality and
observation, conversation, and action. quantity of work done
• Select relevant facts and the recording should 9. Records help them to become aware of and to
be neat, complete, and uniform. recognize their health needs. A record can be
used as a teaching tool as well
• Records are valuable legal documents and so it
should be handled carefully, and accounted for 10. Record serves as a guide for diagnosis,
treatment and evaluation of services
• Records systems are essential for efficiency and
uniformity of services. 11. It indicates progress
• Records should provide for periodic summary to

12. It may be used in research
determine progress and to make future plans.
• Records should be written immediately after an 13. The record helps identify families needing
interview. service and those prepared to accept help
• Records are confidential documents. 14. It enables to draw the nurse’s attention towards
any pertinent observation he/she has made
VALUES AND USES OF RECORDS
1. Records provides basic facts for services. 15. The record helps the supervisor evaluate the
Records show health condition as it is and as the services rendered, teaching done and a
patient and family accepts it person’s actions and reactions
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16. It helps in the guidance of staff and students-

REGISTERS
where planned records are utilized as an
• It provides indication of the total volume of
evaluation tool during conferences
service and type of cases seen.
17. It helps the administrator assess the health

• Clerical assistance may be needed for this.
assets and needs of the village or area
• Registers can be of varied types such as

18. It helps in making studies for research, for
immunization register, clinic attendance
legislative action and for planning budget
register, family planning register, birth
register and death register.
19. It is legal evidence of the services rendered by
each worker
REPORTS
20. It provides a justification for expenditure of funds

• Reports can be compiled daily, weekly, monthly
quarterly and annually.
TYPES OF RECORDS
• Report summarizes the services of the nurse

CUMULATIVE OR CONTINUING RECORDS and/or the agency.
● Time saving, economical, helpful in reviewing the
total history of an individual and evaluate progress of • Reports may be in the form of an analysis of
a long period some aspect of a service. These are based on
records and registers and so it is relevant for the
● One record for home visits/services (blue ink) and
nurses to maintain the records regarding their
clinic visits/services (red ink) which helps coordinate
daily case load, service load and activities
services and saves time
PURPOSES OF WRITING REPORTS
FAMILY RECORDS
● All family records should be placed in a single

family folder • To show the kind and quantity of service
rendered over to a specific period.
● Separate record forms may be needed for different • To show the progress in reaching goals
types of services such as TB, Maternity etc. all such
• As an aid in studying health conditions
individual records which relate to members of one
• As an aid in planning
family should be placed in a single family folder
• To interpret the services to the public and to
other interested agencies
FILING RECORDS
Different systems may be adopted depending on the

purposes of the records and on the merits of a
system. The records should be arranged:
1. Alphabetically
2. Numerically
3. Geographically
4. With index cards
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LESSON 4: CONTROL OF INFECTIVITY

COMMUNICABLE DISEASES
Refers to the ability of an agent to infect large
numbers of people.
LEADING CAUSE OF MORBIDITY
VIRULENCE
1.) Acute Respiratory Infection
Refers to the ability to produce disease in those
2.) Acute Lower Respiratory Tract Infection and
infected.
Pneumonia
3.) Bronchitis/Bronchiolitis ANTIGENECITY
4.) Hypertension Refers to the ability of the agent to stimulate an
5.) Acute Watery Diarrhea immune response.
6.) Influenza
TOXIGENECITY
7.) Urinary Tract Infection
8.) TB Respiratory Refers to the ability of the agent to produce toxin
9.) Injuries that cause infection.
10.) Acute Febrille Illness
FUNCTIONS OF PUBLIC HEALTH NURSE IN
THE CONTROL OF COMMUNICABLE
EPIDEMIOLOGIC TRIANGLE DISEASES
1.) Report to local health authorities (MHO) any

know case of notifiable disease as required by
the law (RA 11332)
2.) Refer any known case of notifiable disease to

the nearest health facility
CHAIN OF INFECTION 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 sign and
symptoms
5.) Conduct epidemiologic investigations together

with the public health team during an outbreak
TUBERCULOSIS
CAUSATIVE AGENT
PATHOGENICITY Mycobacterium tuberculosis, M.africanum from
Refers to the ability of an agent to produce disease humans , but occasionally by M. bovis from cattle, or
in those infected with the agent. M. canettii
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MODE OF TRASMISSION
Airborne droplet through coughing, sneezing, and

spitting. Thus, close contacts with infected.
INCUBATION PERIOD
4-6 Weeks
SIGNS AND SYMPTOMS
Fever: low grade late afternoon, loss of appetite,

easy faigability, night sweats, dry cough, later
productive with hemptysis, chest pain
RISK FACTORS
a. contacts of TB patients;
b. those ever treated for TB (i.e. with history of PHILIPPINE TB CLINICAL PRACTICD
previous TB treatment); GUIDELINES (CPG)
c. people living with HIV (PLHIV); PULMONARY TUBERCULOSIS (PTB)

d. elderly (> 60 years old); • DSSM
e. diabetics; • TB Culture (Gold Standard)
• XpertMTB/RIF
f. smokers; o As initial diagnostic test in adults with
presumptive TB
g. health-care workers;
o As initial diagnostic test in adults with
h. urban and rural poor (indigents); and presumptive drug-resistant TB
o As an ancillary test to smear-
i. those with other immune-suppressive medical negative patients with CXR findings
conditions suggestive of active PTB
EXTRAPULMONARY TB (EP-TB)
• Direct microscopy
• TB culture
• XpertMTB/RIF of a biological specimen
DRUG RESISTANT TB (DR-TB)
• Drug Susceptibility Testing (DST)
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• H: Isoniazid SECOND LINE DRUGS
• R: Rifampicin
• Z: Pyrazinamide
• E: Ethambutol
• S: Streptomycin
ROLES AND RESPONSIBILITY OF THE NURSE

IN THE NTP AND DOTS STRATEGY
Nurse as
• Administrator
• Health educator
• Case manager and coordinator
• Community organizer
• Treatment partner
• TB advocate
LEPROSY
CAUSATIVE AGENT
Mycobacterium leprae, Hansen's bacillus
FIRST LINE DRUGS MODE OF TRANSMISSION
Prolonged skin contact, droplet
INCUBATION PERIOD
5 months-5 years
SIGNS AND SYMTPOMS
• SKIN
➢ Discolored patches of skin, usually flat, that
may be numb and look faded (lighter than
the skin around)
➢ Growths (nodules) on the skin
➢ Thick, stiff or dry skin
➢ Painless ulcers on the soles of feet
➢ Painless swelling or lumps on the face or
earlobes
➢ Loss of eyebrows or eyelashes
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• NERVES TREATMENT
• Multi Drug Therapy (MDT)

➢ Numbness of affected areas of the skin ➢ dapsone (Aczone)
➢ Muscle weakness or paralysis (especially in ➢ rifampin (Rifadin)
the hands and feet) ➢ clofazimine (Lamprene)
➢ Enlarged nerves (especially those around ➢ minocycline (Minocin)
the elbow and knee and in the sides of the ➢ ofloxacin (Ocuflux)
neck)
➢ Eye problems that may lead to blindness PREVENTION AND CONTROL
(when facial nerves are affected)
• BCG Vaccination
• Avoidance of prolonged skin contact with active
untreated case
• MUCOUS MEMBRANES • Good personal hygiene
• Adequate Nutrition
➢ Stuffy nose • Health Education
➢ Nose bleeds
DENGUE
• ADVANCE/LATE STAGE CAUSATIVE AGENT
Dengue virus (DEN)

➢ Paralysis and crippling of hands and feet
➢ Shortening of toes and fingers due to VECTOR
reabsorption
• Aedes aegypti
➢ Chronic non-healing ulcers on the bottoms
• Aedis albopictus
of the feet
➢ Blindness MODE OF TRANSMISSION
➢ Loss of eyebrows
➢ Nose disfigurement Bite of mosquito
LABORATORY/DIAGNOSTIC TEST INCUBATION PERIOD
• Skin Slit Test (Lepromin Skin Test) 3-14 days, commonly 5-7 days
• Skin biopsy
LABORATORY & DIAGNOSTIC EXAMINATION
• Acid-fast staining
• Torniquet test or rumpel-Leads test
RA 4073
• Capillary refill test or nail blanch test
• Sec. 1058. Persons afflicted with leprosy not to • Platelet count
be segregated. ➢ Platelet: 150,000 to 400,000 cu.mm
• Sec. 1059. Confinement and treatment in ➢ Hematocrit: F= 36-46%, M= 41-53%
sanitarium when necessary • Hemagglutination-inhibition (H1) test
• Dengue NS1 Kit
TYPES
• Paucibacillary: (-) Skin slit test, <5 lesions

• Multibacillary: (+) Skin slit test, >5 lesions
CLASSIFICATION
• Tuberculoid leprosy
• Borderline tuberculoid leprosy
• Mid-borderline leprosy
• Borderline lepromatous leprosy
• Lepromatous leprosy
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• Blood transfusion should be given as soon as

severe bleeding is suspected or recognized
• In case of shock, position patient in dorsal

recumbent
• Monitor laboratory results
PREVENTION CONTROL
4S Strategy for Dengue prevention
DENGUE TIME FRAME MALARIA
CAUSATIVE AGENT
Plasmodium falciparum, vivax, ovale, malariae

(Protozoa)
VECTOR
Female Anopheles mosquito
MODE OF TRANSMISSION
Bite of mosquito
INCUBATION PERIOD
TREATMENT 7 days or longer
• Paracetamol q4-6h LABORATORY & DIAGNOSTIC EXAMINATION

➢ DO NOT GIVE: aspirin, ibuprofen and
NSAIDs • Clinical Diagnosis
• Oral rehydration • Fluorescent Microscopy
➢ ORESOL/ORS • Rapid Diagnostic Tests (RDTs)
➢ IVF • Antigen Detection
• Avoid dark colored foods. • Serology
• Polymerase Chain Reaction
• Strict bed rest and protect from trauma
SIGNS AND SYMTPOMS
• Do not give IM injections • Fever and flu-like illness

➢ Shaking
➢ Chills
• Instruct caregivers that the patient should be ➢ Headache
brought to the hospital immediately if any of the ➢ Muscle aches
following occur: ➢ Faitigue
• Anemia
➢ No clinical improvement, deterioration • Jaundice
around defervescense, severe • Kidney failure
abdmoninal pain, persistent vomiting, • Seizures
cold and clammy extremities, lethargy • Mental confusion
or irritability/restlessness, bleeding, not • Coma
passing urine for more than 4-6 hrs. • Death
• For epistaxis, maintain elevated position and
apply ice compress
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TREATMENT FILARIASIS
• Chloroquine phosphate 250mg (all species CAUSATIVE AGENT

except P. malariae) Wucheria bancrofti, Brugia malayi
• Sulfadoxine 50mg (for resistant P.
VECTOR
falciparum)
Aedes poecilus, Culex quinquefasciatus
• Primaquine (for relapse P. vivax and P. ovale)
• Pyrimethamine 25mg/tab MODE OF TRANSMISSION
• Quinine sulfate 300mg/tab Bite of mosquito
• Tetracycline HCL 250mg/tab
INCUBATION PERIOD
• Quinidine sulfate 200mg/cap
8-16 months
• The Artemether-Lumefantrine (AL) SIGNS AND SYMTPOMS

combination will be the first line medicine in the
treatment of confirmed uncomplicated and • Chills
severe Plasmodium falciparum malaria, • Fever
replacing CQ+SP combination • Myalgia
• Lymphangitis with gradual thickening of the skin
• Quinine (QN) in combination with either (limbs and scrotum)
tetracycline or doxycycline or clindamycin
(QN+T/D/C x 7 days), will be the second-line
treatment. Circulating filarial antigen (CFA)- Finger prick
• Artesunate (AS) suppository for severe TREATMENT

malaria cases Diethycarbamazine citrate (Hetrazan)
• ACT can be used for all Plasmodium species PREVENTION AND CONTROL
and mixed infections
Eradication of vectors
PREVENTION AND CONTROL TYPHOID FEVER
• RA 4832 Malaria Eradication Law

CAUSATIVE AGENT
• Vector Control:
➢ insecticide-treated nets (ITNs) Salmonella typhosa
➢ indoor residual spraying (IRS)
➢ Zooprophylaxis- larvae eating fish
Ingestion of contaminated food or water with feces or
• Preventive Chemotherapies urine of infected individuals
➢ intermittent preventive treatment of
infants (IPTi) INCUBATION PERIOD
➢ pregnant women (IPTp) 7-14 days
➢ seasonal malaria chemoprevention
(SMC) SIGNS AND SYMTPOMS
➢ mass drug administration (MDA)
• Prodromal
➢ headache, fever, anorexia, lethargy,
• Vaccine
diarrhea, vomiting, abdominal pain
➢ RTS,S/AS01
• Screening of blood donors
Page | 17
• Fastigial SIGNS AND SYMTPOMS

➢ ladder-like curve of temperature,
• high grade fever
rose spots on trunks, spleenomegaly
• colicky abdominal pain with tenderness
• Defervescense • diarrhea with straining, bloody mucoid stool
➢ fever gradually subsides, onset of LABORATORY & DIAGNOSTIC EXAMINATION
complication such as hemorrhage,
peritonitis Fecalysis
TREATMENT
• Convalescence or recovery stage
Co-trimoxazole, Chloramphenicol
PREVENTION AND CONTROL
Thypidot test
Safe water supply, handwashing
TREATMENT
NURSING CARE
Chloramphenicol
I & O monitoring, increase OFI, prevent dehydration
• MEASURES DIRECTED TO RESERVOIR CHOLERA

➢ Case detection and treatment
➢ Isolation
➢ Disinfection of stools and urine CAUSATIVE AGENT
➢ Detection & treatment of carriers
Vibrio cholerae (El Tor)
• MEASURES AT ROUTES OF TRANSMISSION MODE OF TRANSMISSION

➢ Water s
➢ anitation Ingestion of contaminated food or water or milk
➢ Food sanitation INCUBATION PERIOD
➢ Excreta disposal
➢ Fly control 1-3 days
SIGNS AND SYMTPOMS

• MEASURES FOR SUSCEPTIBLES
➢ immunoprophylaxis Rapid explosive diarrhea and vomiting
➢ health education
NURSING CARE
Fecalysis
Practice enteric precaution and observe character of
stool for signs of bleeding. TREATMENT
Tetracycline, Fuazolidone
DYSENTERY
CAUSATIVE AGENT Safe water supply, handwashing, sanitary disposal of

human waste
Shigella dysenteriae
NURSING CARE
I & O monitoring, increase OFI, prevent dehydration
Ingestion of contaminated food or water
INCUBATION PERIOD
3-4 days
Page | 18
MEASLES COMMUNICABILITY PERIOD
CAUSATIVE AGENT 2-4 days before onset of parotitis but range can be 7
days before to 15 days after onset.
Morbili virus (family paramyxoviridae)
SIGNS AND SYMTPOMS
• Fever
Airborne
• Headache
INCUBATION PERIOD • Swollen glands under the ears or jaw
• Muscle aches
8-20 days, ave. of 10 days • Tiredness
SIGNS AND SYMTPOMS • Complications (meningoencephalitis,
permanent hearing impairment, orchitis in post
• Dry Cough & Runny Nose pubescent males, but rarely sterility)
• Body Pains & Headache
• Sore Throat LABORATORY & DIAGNOSTIC EXAMINATION
• Watering & Swelling in Eyes Isolation of virus from oral and throat spray; urine and
• Discomfort & Fatigue cerebrospinal fluid.
• Loss of Appetite
• Diarrhea TREATMENT
• Light Sensitivity Supportive care
• Inflammation in Lymph Nodes
• Koplik's Spots (blue & red spots in the mouth) PREVENTION AND CONTROL
LABORATORY & DIAGNOSTIC EXAMINATION MMR vaccine (9 mos and 12 mos)
Tissue culture of naso-pharhygeal secretions and NURSING CARE

serological testing
Apply warm and cold compress for pain on affected
TREATMENT area, strict isolation, use of mask when handling
patient, terminal disinfection, provide oral care and
Supportive care, antibiotic if with pneumonia soft to semi -solid food.

RUBELLA OR GERMAN MEASLES
MMR vaccine (9 mos and 12 mos)
NURSING CARE CAUSATIVE AGENT

Antipyretic, provide eye, nasal and oral care, strict Rubella virus family togoviridae
isolation, increase OFI
MUMPS Droplet or direct contact with nasopharyngeal
secretions of infected person
CAUSATIVE AGENT INCUBATION PERIOD

Mumps virus (family paramyxoviridae) 10-21 days
MODE OF TRANSMISSION SIGNS AND SYMTPOMS

Airborne or droplets, or direct contact • fever
• headache
INCUBATION PERIOD
• malaise
16-18 days, range of 14-25 days • maculopapular rash
• enlarged post auricular occipital and posterior
cervical lymphadenopathy
• sorethroat
• rhinitis
Page | 19
• conjunctivitis
• bronchitis
NURSING CARE
• forchheimer's spot on soft palate
Antipyretic, strict isolation, handwashing, trim
fingernails, daily bath
Serological testing
POLIOMYELITIS
TREATMENT
CAUSATIVE AGENT
Supportive care but for exposed pregnant woman in
Legio debilitans or poilio virus
1st and 2nd trimester, serum immunoglobulin is
administered to protect the fetus. MODE OF TRANSMISSION
PREVENTION AND CONTROL Oral, droplet
MMR vaccine (9 mos and 12 mos) INCUBATION PERIOD
NURSING CARE 7-21 days
Antipyretic, increase OFI, bed rest TYPES AND SIGNS AND SYMTPOMS
• Abortive- fever, sore throat, low lumbar

backache/cervical stiffness on anteflexion of
spine
• Non-Paralytic- recurrence of fever, poker

spine, tightness and spasm of hamstring,
hypersensitiveness of the skin, deep reflexes
are exagerrated
• Paralytic- with paralysis depending on part

affected.
CHICKEN POX

CAUSATIVE AGENT
Blood and throat culture, fecalysis, lumbar tap
Varicella Zoster Virus
TREATMENT
Supportive and symptomatic care
Droplet or indirect contact with droplets from
respiratory passages or vesicle fluid PREVENTION AND CONTROL
INCUBATION PERIOD Proper disposal of fecal waste, handwashing, proper

preparation of food and immunization of OPV (3
14-16 days, range of 2-3 weeks doses)
SIGNS AND SYMTPOMS NURSING CARE

• body malaise Enteric isolation, bed rest passive ROM exercises
• fever
• itchy vesiculo-pustular lesions first appearing on
the chest and trunk spreading to extremities.
TREATMENT
Supportive care, anti-viral drugs
Immmunization (Varivax) for 2 doses at 12 to 18

mos.
Page | 20
PARASITIC INFECTIONS
RABIES
CAUSATIVE AGENT
Rhabdovirus
Bite of rabid animal (Saliva)
INCUBATION PERIOD
20-90 days (humans) 1 week to 7.5 mos. (dogs)
Post-Mortem direct fluorescent antibody staining

test.
SIGNS AND SYMTPOMS
• DOGS
➢ Changes in attitude and behavior
➢ Changes in bark
➢ Dropped jaw
➢ Excessive salivation
➢ Extreme excitability
➢ Fever
➢ Uncoordinated
PREVENTION AND CONTROL ➢ Paralysis
➢ Pica (appetite for non-nutritious
• Proper disposal of feces, handwashing, proper substances)
washing of vegetables before consumption, ➢ Seizures
personal hygiene, proper food preparation, ➢ Shyness or aggression
avoid walking barefooted ➢ Unable to swallow
• For schistosomiasis
• HUMANS
➢ proper irrigation of all stagnant bodies of
water
➢ prevent exposure to contaminated water
➢ eradication of breeding sites (snails)
➢ use of molluscides
NURSING CARE
• Isolate
• encourage family to provide care and company
• Darken room and observe silence
• Give food if patient is hungry
• Keep water out of sight
• Observe universal precaution, which are
essentially wearing gloves
• Wash hands frequently
• Remove oral and nasal secretions
Page | 21
• Dispose contaminated materials

• Perform terminal disinfections LEPTOSPIROSIS
CAUSATIVE AGENT
Leptospira interrogans (bacteria)
Inoculation into broken skin, mucous membrane or

ingestion of contaminated food and water with urine
of animals
INCUBATION PERIOD
POST-EXPOSURE TREATMENT (FOR DOG 7-13 days
BITES)
• Blood/Urine culture done on the 1st weeks

• Wash wound with soap and water and seek
• Leptospira Agglutination Test (LAT) done on
consultation.
2nd to 3rd week.
• Administer ATS/TT; suturing for severe wounds.
• Observe dog for 10 days. SIGNS AND SYMTPOMS
• Recommended vaccines (active) • Sepsis stage (4-7 days)- High fever, calf and
➢ PVCV (purified vero cell vaccine)- abdominal pain
0.1ml
➢ PDEV (purified duck embryo vaccine)- • Immune/Toxic Stage
0.2ml ➢ Anicteric stage- Disorientation
➢ Icteric stage- Jaundice
• Multi-site IM Schedule (2-1-1)
➢ Day 0- 2 doses • Convalesence- symptoms will disappear but
➢ Day 7, 21- 1 dose relapse may occur at 4th-5th weeks.
TREATMENT
• 2 Site ID Regimen (2 doses each)
Doxycycline, Penicillin or Tetracycline
➢ Day 0, 3,7,30
➢ Deltoid, ID
Eradication of rodents, avoid wading in flood water.
• Recommended immunoglobulins NURSING CARE
(passive) IM
Symptomatic/Supportive, increase OFI
➢ Given at day 0
➢ Equine rabies= KBW x 2.0ml
➢ Human rabies= KBW x 0.133 ml
SCABIES
CAUSATIVE AGENT
• Pre-exposure prophylactic treatment for high
risk individuals Itch mite, Sarcoptes scabiei
• Vaccination of dogs/pets
Prolonged skin contact with infected human or
indirect contact with infested linens or clothing
INCUBATION PERIOD
4-8 weeks
Page | 22
Scraping of skin off burrow, ink test, mineral oil or SEXUALLY TRANSMITTED INFECTIONS (STI)
fluorescence tetracycline test.
4CS IN SYNDROME CASE MANAGEMENT FOR
SIGNS AND SYMTPOMS STI
Itchy papulo-vesicular eruptions on warm fold and 1.) Compliance

areas of friction of the body. 2.) Counseling and education
3.) Contact tracing
TREATMENT 4.) Condom use
Permethin cream or scabicide lotion applied to all
areas of the body from the neck down to the feet and
toes.
Laundry and iron soiled clothes, practice personal

hygiene, terminal disinfection
NURSING CARE
Contact isolation
ANTHRAX
CAUSATIVE AGENT
Bacillus anthracis
• Cutaneous (skin) anthrax

• Inhalational anthrax
• Gastrointestinal anthrax
Gram staining (+)
TREATMENT
Formaldehyde, Fluoroquinolones, ciprofloxacin
BioThrax, although it is commonly called Anthrax

Vaccince Absorbed (AVA)
SIGNS AND SYMTPOMS
• Fever and chills

• Chest Discomfort
HIV/AIDS
• Shortness of breath
• Confusion or dizziness
• Cough CAUSATIVE AGENT
• Nausea, vomiting, or stomach pains
• Headache HIV 1 and HIV 2
• Sweats (often drenching)
• Extreme tiredness
• Body aches
Page | 23
MODE OF TRANSMISSION treatment and support to services

during pregnancy, labor and delivery,
• Sexual contact, blood transfusion, contaminated and postpartum.
syringes, needles, nipper, blades, etc.
• PrEP or Pre Exposure Prophylaxis for peopleat
• Direct contact of open wounds/mucous high risk by taking drug Truvada
membranes with contaminated blood, body
fluid, semen and vaginal discharges. RA 11166 of 2018
An Act Strengthening the Philippine Comprehensive

INCUBATION PERIOD Policy on Human Immunodeficiency Virus (HIV) and
Acquired Immune Deficiency Syndrome (AIDS)
Varies from 3-6 mos to many years (8-10 years)
Prevention, Treatment, Care, and Support, and,
SIGNS AND SYMTPOMS Reconstituting the Philippine National Aids Council
(PNAC), Repealing for the Purpose Republic Act No.
8504, Otherwise Known as The "Philippine Aids
Prevention and Control Act of 1998", and
Appropriating Funds Therefor.
EMERGING INFECTIOUS DISEASES
• Enzyme Linked Immuno Sorbent Assay (ELISA)

test- Presumptive test
• Western Blot- Confirmatory test
TREATMENT
Antiretroviral drugs that suppress the virus
• Blood and Blood products
➢ Screen blood donors

➢ Observe Universal Precaution
➢ Refrain from using contaminated
needles and syringes.
• Sexual transmission
➢ Abstain from promiscuous sexual

contact
➢ Be faithful to your partner
➢ Follow correct and consistent use of
condoms.
• Mother to child
➢ For HIV (+) mothers, consult with
health workers to have access to care,
Page | 24
DEPARTMENT MEMORANDUM NO. 2022-0501:

INTERIM REVISED CASE DEFINITIONS FOR
COVID-19
Page | 25

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Community Health Nursing 1: LECTURE

Professor: Ms. Anne Jo Ruiz

LESSON 1: FAMILY NURSING performance of functions to attain, sustain maintain

FAMILY NURSING PRACTICE

Family Systems Theory views the family as a living

THE INTERACTIONAL APPROACH OR C. Home and environment

STRUCTURAL-FUNCTIONAL PERSPECTIVE DATA GATHERING METHODS AND TOOLS

Structural-Functional perspective specifies family 1. Observation

FAMILY HEALTH TASKS PERSPECTIVE

Family Health Tasks Perspective integrates the

❑ Cluster/group related data

❑ Distinguish relevant to irrelevant data

❑ Relate family data to relevant clinical data and

FRAMEWORK ❑ Compare patterns with norms or standards

Use an organized and comprehensive approach to ❑ Interpret results

• FIRST LEVEL- Data on status:

SECOND LEVEL ASSESSMENT

FIRST LEVEL ASSESSMENT ❑ Define the family nursing problems/diagnosis as

Family/household members statement

❑ Health assessment ❑ Family’s inability to perform health tasks on each

❑ Records performance or reasons for non-performance of

❑ Observation/ocular survey THE ASSESSMENT DATABASE (ADB)

❑ Laboratory/diagnostic test results assessment tools to elicit generational information

❑ Observation: Relate verbal with Non-verbal cues

GENOGRAMS 2.Clustering of related cues to determine

3. Distinguish relevant from irrelevant data

4. Identifying patterns such as physiologic function,

5. Relating family data to relevant clinical/research

6. Interpreting results based on how family

ECOMAP the reasons for the existence of the health condition

STANDARDS IN DETERMINING THE STATUS

1.) Normal Health of individual members.

2.) Home and Environmental Conditions conducive

3.) Family Characteristics, dynamics and level of

FAMILY HEALTH TASKS

● Recognize the presence of wellness state or health

● Make decisions about taking appropriate health

SUB-STEPS ● Provide nursing care to the sick, disabled, or at-risk

● Utilize community resources for health care

● Wellness state or health condition becomes a • Wellness potential

• Readiness for enhanced wellness

1. Statement of unhealthy response ■ Unhealthful lifestyle and personal habits/practices

2. The statement of factors which are maintaining the ■ Lack of immunization

undesirable response and preventing the desired

III. PRESENCE OF HEALTH DEFICITS C. Feeling of confusion/helplessness.

D. Lack of/inadequate knowledge as to alternative

■ Disability-whether congenital or arising from F. Conflicting opinions among family members

■ Entrance school A. Lack of/inadequate knowledge about the

■ Hospitalization of a family member C. Lack of/inadequate knowledge of the nature and

A. Failure to comprehend the nature/magnitude of

B. Low salience of the problem

INABILITY TO PROVIDE HOME ENVIRONMENT

FAMILY NURSING CARE PLAN

C. Lack of/Inadequate knowledge of importance of 1. It focuses on actions which are designed to

D. Lack of/inadequate knowledge of preventive 2. It is the product of a deliberate systematic

B. Failure to perceive the benefits of health

C. Lack of trust/confidence in the agency/personnel

Specific, Measurable, Client-Centered Statements/ o Immediate attention

Ex: The sick members will take the drugs

• l, family, or community levels LONG TERM OR ULTIMATE

• Tells where the family is going after the

child competently MEDIUM-TERM OR INTERMEDIATE