PHC modules
● Robert Koch- discovered of
Primary Health Care and CHN
● MDG5 target- reduction of maternal
mortality by 80/100,000 live births (mdg5)
● 2/3- reduction of child mortality rate (mdg4)
● Mdg 5- TARGET of three quarters
reduction by 2015
● 11 mothers die everyday due to childbirth
and delivery
● SDG 3– HEALTH and WELL being
Centered ( disease focus : HIV/AIDS ,
Malaria)
● SDG 6 – SANITATION centered
● Sustainable Development Goals 2030
Agenda : “Transforming our world”
17 goals target is 2030
● SDG- 17 GOALS by 2030
● Goal 1: No Poverty
● Goal 2: Zero Hunger
● Goal 3: Good Health and
Well-being (health centered
related)
● Goal 4: Quality Education
● Goal 5: Gender Equality
● Goal 6: Clean Water and
Sanitation(sanitation centered)
● Goal 7: Affordable and Clean Energy
● Goal 8: Decent Work and Economic Growth
● Goal 9: Industry, Innovation and
Infrastructure
● Goal 10: Reduced Inequalities
● Goal 11: Sustainable Cities and
Communities
● Goal 12: Responsible Consumption and
Production
● Goal 13: Climate Action
● Goal 14: Life Below Water
● Goal 15: Life on Land
● Goal 16: Peace, Justice and Strong
Institutions
● Goal 17: Partnerships for the Goals
Tuberculosis / PTB- a highly infectious
chronic disease that usually affects the lungs.
Causative Agent: Mycobacterium Tubercles (acid
fast BACTERIA)
Mycobacterium tuberculosis, the
bacterium that causes tuberculosis (TB),
on the evening of March 24, 1882
● Sign/Symptoms:
⎫ cough for more than 2 weeks
⎫ afternoon fever
o Swelling lyphnodes
⎫ weight loss
⎫ night sweat
⎫ blood stain sputum - hemoptysis -
***late sign
● Primary Prevention for Tuberculosis -
BCG vaccination
● Case finding – Direct Sputum Smear
Microscopy (DSSM) and X-ray
examination of TB symptomatics who are
negative after 2 or more sputum exams
● Sputum smear and culture or DSSM –
CONFIRMATORY test
● Tuberculin test (Mantoux test- detects the
presence of antibodies to CONFIRM
EXPOSURE
(Results read after 48-72 hours from skin
testing.
● Needs gauge 26 needle syringe (ID route
bevel up)
● positive if within duration of 10mm or more.
Below 5 y/o and HIV + pt. - > or = 5mm
is positive
Older than 5 y/o > or = to 10 mm is positive)
● Mantoux test- A positive reaction means
that the client has been
exposed to TB
● DOTS- was declared in 1996
● proper way to collect sample: Inhale or
deep breath then cough up 3-5ml
sputum
● Hemoptysis is CONTRAINDICATION of
sputum collection
● 3x in a month – collection of sputum
for case finding
● BCG – DO NOT GIVE to
immunosuppressed baby- with
LEUKEMIA AND HIV
● Chest x-ray - determines the presence and
extent of disease
● the primary diagnostic tool in TB case
finding is DSSM
● Direct Observed Treatment Short Course
– comprehensive strategy to detect and cure
TB patients.
● DOTS (Direct Observed Treatment Short
Course)
● Category I - 6 months treatment
o -new smear (+) PTB
-new smear (-) PTB with extensive
lesions on CXR
-EPTB
-Severe concominant HIV disease 2
o -DOTS: intensive for 2months of
RIPE
o maintenance: 4months of RI
● Category II-treatment failure
-relapse
-return after default
-intensive: 2 months RIPES/1 month RIPE
● Maintenance: 5 months RIE
● Category III -new smear (-) PTB with
minimal lesion on CXR
o -DOTS: 2months RIPE
o maintenance: 4months RI
● Category IV –chronic MDR pt.
● Refer to specialized facility or DOTS
Plus Center
Refer to Provincial/City NTP
Coordinator
● Rifampicin causes urine discoloration.
Isoniazid give Vit. B6 or pyridoxine to
prevent peripheral neuropathy
Pyrazinamide - causes G.I upset.
Ethambutol causes optic neuritis-
-not given to children under 6 years or
younger because they cannot reliably
monitor vision –
● Streptomycin causes- tinnitus and auditory
impairment/ OTOTOXICITY.
● FDC – Fixed Dose Combination
● 4 FDC or 4 drugs combined in a blister pack
– R.I.P.E
● 3 FDC or 3 drugs combined in a blister
packs – R.I.P
● 2 FDC or 2 drugs combined i a blister packs
– I.E or the new drug R.I.
● Streptomycin – only TB drug in Vial
- causes hearing loss and damage to cranial
nerve 8
- contraindicated in pregnancy
● DOTS therapy is recommended for the
treatment of ACTIVE TB
● The minimum duration of treatment for
culture-positive TB is 6 months
● For the treatment of TB in pregnant women, the
initial regimen should be INH(Isoniazid),
RIF(Rifampicn), and EMB(ethambutol) (RIPE)
for at least 9 months
● X-rays must be done at diagnosis and then
every after 2 months of treatment.
Leprosy
● RA 4073- Liberization and Treatment of
Leprosy (February as Leprosy Month)
• Hansen's disease - BACTERIA
• •Multi-Drug-Therapy (MDT)
• LEPROMATOUS TYPE is the most
disfiguring type of LEPROSY
CHOLERA or EL TOR (BLUE DEATH)
● Epidemic outbreak on August of 1854 Soho,
a suburb of London
● John Snow - FATHER OF MODERN
EPIDEMIOLOGY in part because of his work in
tracing the source of a cholera outbreak in
Soho, London, in 1854
● Cholera is an acute diarrhoeal infection
● Humans are the only relevant reservoir,
● What is Cholera?
● VERY common in RAINY SEASON
● How is Cholera transmitted?
● Answer: Transmission to humans occurs
through eating food (seafood) or drinking
water contaminated with Vibrio cholerae
from other cholera patients
● Mode of transmission: WATERBORNE
and foodborne disease.
● Where is the major reservoir for cholera?
● Answer: HUMANS
● In its most severe form what effect does
Cholera have?
● Answer: Severe drop in blood pressure
● What is the major symptom of Cholera?
● Answer: Massive, rice-water diarrhea
(Contains mucus) (up to 10 liters per day!)
● What is the treatment for Cholera?
Answer: oral rehydration therapy
● How is Cholera prevented?
Answer: Prevention - Modern
plumbing/sanitation and clean drinking
water
● Who was John Snow?
Answer: One of the fathers of
epidemiology,
Founded that Cholera came from
contaminated drinking water.
● What is the causative agent of Cholera?
Answer: Vibrio Cholerae
BUBONIC PLAQUE – BLACK DEATH
● In what century did the Black Death Occur?
- 14th
● Describe the definition of the Black Death- A
widespread epidemic of the Bubonic
Plague the occurred in the 14th century,
killing millions of people.
● What type of flea carried the Disease?- The
oriental rat flea
● What was the most common strain of the
Black Death?- The Bubonic Plague
● What bought the Black Death from Asia to
Europe?- Rats and their FLEAS traveling
on trade routes
● Where did the Black Death Originate?- Asia,
predominantly China
● Where did the Black Death first arrive in
Europe?- Messina, Italy
● What is another name for the Black
Death?- the Bubonic Plague
Helminths or PARASITES -
● Helminths - most common is ascariasis ,
hookworm ,trichuris (whipworm)
● **** EXCEPT = Taeniasis
● Beef tapeworm - Taenia saginata- ingestion
of undercooked beef
● Ancylostomiasis/Hookworm – causes
anemia - penetration of skin - walking
barefooted
● Pinworms/ enterobiasis .- causes perianal
itchiness at night best way to diagnose this
infection is through a tape test.
HEPATITIS
● Hepatitis A , E or Infectious Hepatitis:
oral-fecal route
● Hepatitis B ,C,D or Serum Hepatitis:
blood-borne, Sex
BULLETS
● Red tide poisoning- first aid Drinking pure
coconut milk
Rabies/ Lysa
 ● Cause by RHABDO VIRUS BY
DOGS ,CATS AND BATS
CONTAMINATED SALIVA
ϒ observe the dog for 14 days. If it dies
or shows signs suggestive of rabies,
consult a physician.
● Rabies - hydrophobia, a morbid fear of
water
● DOG BITE FIRST AID ACTION WASH
WITH SOAP AND RUNNING WATER
● Category 1
∝ Licking of intact skin
∝ Observe the dog for 14 days
● CATEGORY II
∝ Abrasion, laceration, punctured wound
on the lower extremities
∝ Give active vaccine
- Observe dog for 14 day
● CATEGORY III
∝ Abrasion, laceration on upper
extremities, head and neck.
∝ Dog is killed, lost died, stray
∝ Give active vaccine plus Passive vaccine
● Varicella (Chicken Pox)
- Varicella Virus
Communicable 1 DAY BEFORE
ERUPTION OF VESICLES to 6 days
after first crop of vesicles have formed
• Antiviral agents – TREATED WITH
ACYCLOVIR(ZOVIRAX)
● Fifth’s Disease
● Symptoms
¬ Classic rash of erythema on face (cheeks),
“slapped face appearance”
IMMUNIZATION:
● Rubeola (measles)
• Viral infection
• Communicable 4 DAYS just before the
rash appears
● Pre-Eruptive Stage:
• fever, coughing, sneezing, and running of
nose and redness of eyes.
• Koplik spots—bluish-gray specks or
“grains of sand” on a red base—develop
on the buccal mucosa
● Mumps - PAROTITIS
• Viral infection
• Transmitted by direct contact of saliva and
respiratory droplet
• Communicable immediately before
swelling begins
● Rubella(German measles)
• Viral Infection
• Communicable 7 days before to 5 days
after rash
**Pregnant people must avoid infected
child=fetal death
● Pertussis (whooping cough)
• Bacterial infection
● Diptheria- bacterial cause-
corynebacterium diphtheria-
pseudomembrane
● Zika virus
• a virus transmitted by Aedes mosquitoes.
● Causes microcephaly baby in pregnancy
● IPV – IM
● PCV VACCINE – IM
● IPV- killed bacteria
● Measles route – SQ
● Measles insertion 40-50 degree
● Give every child a dose of Vitamin A every
6 months from the age of 6 months.
● Give every child mebendazole every 6
months from the age of one year.
● 6 weeks give DPT+HIB-1** Hep B1
OPV1 RTV1**** PCV1*****
● 10 weeks DPT+HIB-2 Hep B2 OPV2 RTV2
PCV2
● 14 weeks DPT+HIB-3 Hep B3 OPV3 RTV3
PCV3
● Pneumococcal conjugate vaccine (PCV) –
start to be given at 6 weeks, protect the baby
against pneumonia; safe to mother and baby
● 9 months give Measles ***
● 12 months MMR
● ****Rotavirus Vaccine – 2-3 doses
antidiarrheal
Bullets drug Treatments:
● Cholera- first line antibiotic: tetracycline
Cholera second line- Cotrimoxazole
● Tetracycline: causes permanent green
TEETH STAINING of baby if used by
pregnancy
● Pneumonia, Acute ear infection,
Mastoiditis
● Drug: Amoxicillin – 1st line
● Cotrimoxazole – 2nd line
● in IMCI standard for fever is > 38.5oC or
hot to touch - give Paracetamol every 4-5
hours- analgesic and antipyretic
● Census is for gathering data in mass
population or groups
● COPAR stands for - Community
Organizing Participatory Action Research
● BAWANG – Cholesterol and hypertension
● LAGUNDI – cough , colds fever, and
dysentery
● NIYOG NIYOGAN – traditional medicine
act as ANTIHELMINTHIC, to expel
worms and parasites
● LEVEL 2 WATER FACILITY – STAND
POST and communal faucet
● HBMR – home based mothers record
● HBMR – is a tool used to render prenatal
care consisting the risk factors and danger
signs of pregnancy
● PANEL 2 of HBMR – contains the risk
factor and danger signs of pregnancy
● OPV-- SABIN VACCINE
● ORESOL is administered EVERY 4
HOURS
● PLAN C in dehydration treatment --
insertion of IVF
● IVF – for severe dehydration
● COURTESY CALL is done in -- PRE
ENTRY PHASE of COPAR
● HYDROCEPHALUS and mental
retardation is a form of HEALTH
DEFICIT –
● POSTPARTUM BLUES- common
normal 2-3 days postpartum,
● Oxytocin- uterine contraction, given after
3rd stage of labor
● CATEGORY1 - NO
RESTRICTION....NO CONDITION
WHICH CONTRADICTS THE USE OF
THE METHOD...
● CATEGORY 4--- Method not to be used-
A condition which represents an
unacceptable health risk if the contraceptive
method is used ( may sakit)
● DEPO PROVERA – 3 months injectables,
assess weight gain
● Feso4- 1 gram per singleton pregnancy- start
at 5 months to 2 months postpartum
● SITE OF BBT – AXILLARY
● Hand washing/ hand hygiene – 30 seconds
● Scurvy – Vit C deficiency
● DPT interval. – 4 weeks
● Post Partum homevisit – home delivery is
within 24 hours….. hospital delivery-
within 1st week or between 3-5 days after
delivery
● vitamin A,deficiency –Xeropthalmia and
bitots spot
● BP cuff NOT INCLUDED inside PHN/ OB
bag
● RA 7160 LGU – DEVOLUTION CODE
● Vibrio cholera or El tor – common in rainy
season
● VIT. A IU POSTPARTUM mother –
200,000 IU..
● Sabin – OPV – live attenuated virus
● Defrost freezer if ice build up of refrigerator
is 2-3
cm or 1inch or more
● BCG – 0.05 (.05ml) – ID
● TB - SCC means SHORT COURSE
CHEMOTHERAPY
● Einc protocol - 1st 30 second action :
Drying thoroughly
● Cretinism – iodine deficiency
● Measles – infectious before rashes appear
– 4th day
● TT1 protection – “NO “protection
● 6000 TOTAL POPULATION TARGET
FOR EPI – 180
● Blindness – Vit. A
● Ampalaya – DM type 2
● Endometrial cancer s/s – unusual
discharges or vaginal bleeding
● KOPLIK SPOTS – measles or rubeola
● Unang yakap- dry the baby
● BMI- Obese- ≥30.00
--------Normal range - 18.50 -
24.99--------Overweight - ≥25.00
● Cheesy discharges and pruritus itchy vulva
– candidiasis, moniliasis
● Cauliflower cells – condylomata
– HPV
● Clue cells – BACTERIAL
VAGINOSIS
● STRAWBERRY CERVIX –
TRICHOMINASIS
● Foul fishy discharges – bacterial vaginosis
● FROTHY DISCHARGES –
TRICHOMONIASIS
● PID – CAUSED BY CHLAMYDIA
● Hiv – attacks CD4 cells
● HIV/AIDS .– attacks IMMUNE SYTEM
● VIT.D deficiency- RICKETS
● Family Planning – PD 965 –
signed JULY 20 1976
● RH bill – 10354
● IUD – REVERSESSIBLE LONG
TERM
● T cu 380 – 10 YEARS PROTECTION
● COLD CHAIN – a system that
maintains potency of vaccine
● RABIES – saliva of rabid animal
● Rabies – is known as lysa
● PTB – Koch disease
● BREASTFEEDING – the 3 E (Early,
Exclusive, Extended)
● Aqua privies is level 1
● Breast self exam is a secondary level of
prevention
● Iron must be given with vit. C
● Calcium absorption is with vit D
● IRON is in chicken liver and
MONGO , camote tops and
kangkong
● brown vials of vaccines protects
against sunlight to MAINTAIN
POTENCY
● *Breastmilk stool-mashy,golden yellow –
sweet sour smell- 3 – 4x a day
● *lactalbumin- breastmilk easily digestible
protein
● *Content of colostrum - antibody IgA
(immunoglubolin antibody A)
● *Tetanus neonaturum- cord care
management - ALCOHOL AND HAND
HYGIENE OR HANDWASHING
● -HAND HYGIENE - to break chain of
infection
● *Dosages of immunization- Dpt Opv
,Hep.b- 3 doses
● Vaccines must be exposed only in room
temperature up to 3 x
● 3rd exposure – discard vaccine
● FEFO- First expiry first out
● Cold chain by dictrict level – 3 months
● Half life packs shelve of measles- 6 hours
● Half life packs shelve of Dpt, opv, bcg- 4
hours
● Half life packs shelve of Tt, heap b- 8 hours
– discard if not used up within the end of
your shift
● Dosages- 0.5 ml IM( DPT,HEP.
Penta, PCV)
● 0.5 ml SQ(Measles)
● 0.05 ml ID(BCG)
● 2 DROPS ORAL ( ROTA & OPV)
● 4 months or a 16 months baby completed the
doses of 1 bcg dpt1-3 opv1-3
hepb1-3
● *Crude birthrate- TOTAL LIVEBIRTHS
÷TOTAL POPULATION x 1000
● *Crude death rate - Total deaths ÷total
population x1000
● Weakest link- mode of transmission
● Benedict's and acid test – performed in
community to pregnant mothers in home
visit to test glycosuria and proteinuria
● Roll over test- SIMS OR SIDELYING
● Severe abdominal pain - 90 degree angle
or Fowler's also
● Feeding in bed - 90 degree or fowlers
● 2nd degree burn - painful and blister
● Syphilis bacteria is in the painless ulcers or
sores
● *Vit A- squash, papaya, yellow camote,
yellow corn, banana
● *Cretinism or mental retardation / Iodine
● *TB - intensive phase category 1&2
● *COPAR - courtesy call at pre entry,
(immersion or integration at ENTRY,)
● IFR* individual funding request.
● *IMCI/ danger signs –
Convusion
Unable to drink or breastfed
Vomits everything
Abnormally sleepy or difficult to awaken
● Stridor/chest indrawing - severe pneumonia
Fast breathing classify pneumonia
0-2 mos= more than 60cpm
2-12 mos = more than 50
12-5 years old = 40
Pneumonia first line antibiotics -
AMOXICILLIN
● Cholera- vibrio eltor and cholerae in
RAINY SEASON- DIRTY WATER
● Salmonellosis – caused by food poisoning
in canned goods Or spoiled proteins
● Measles* cough, runny nose, conjunctivitis
and maculopapular rashes
● Koplik spots also in buccal mucusa
● Airborne transmission - measles
● *Colustrum – rich in maternal antibodies –
thick yellow or dirty white
● *Storage of breastmilk- 8 hours if room
temperature
● *Prolactin - hormone that influences
milk production
● *PRENATAL VISIT- AT LEAST 4
VISITS
● 36 weeks to term is everyweek
● *BSE- 7 DAYS AFTER
MENSTRUATION
● (COPAR) - Community Organizing
Participatory Action Research
Pre-entry /Preparatory Phase
⎫ Profiling of community
⎫ Ocular survey/ Site selection
⎫ PAy courtesy call to community leaders.
● Entry Phase
Integration with the community
} Self Awareness Leadership T raining
} Organization phase
⎫ core group formation
social preparation
spotting & developing potential leaders
} A-R-A-S (Action- Reflection-
Action-Session)
} community diagnosis
● Action Phase
} Organization and training of (BHWs):
} PIME of health services (Project
Implementation Monitoring and Evaluation)
} Setting up of linkages/ network/ referral
systems
● Sustenance and Strengthening Phase
} Formulation of by-laws
} Identification and development of “
secondary” leaders
} Setting up of a financing scheme
● Rates- relationship between a vital
event and those persons exposed to event
● Ratio- relationship between two (2)
numerical quantities
● Infant Mortality Rate- good index of the
general HEALTH CONDITION OF A
COMMUNITY
● Swaroops index- is the proportion of deaths
of people aged 50 years and up.
● 3 CRITERIA FOR LAM use:
ϖ Amenorrhea
ϖ Fully or nearly fully breast feeding her
infant
ϖ BF on demand basis (evey 2-4 hrs during
the day, 4-6 hrs at night
ϖ Infant is less than 6 mos
● Gonorrhea
Male:purulent yellow penile discharge
Females: - Greenish vaginal discharge
● Genital Human Papillomavirus
HPV
 } condylomata, cauliflower-like warts and abscesses in the pelvis. Can be life
} Acetic acid (vinegar) swabbing (will threatening - very serious.
whiten lesion)
● Candidacies
} Condylomata acuminata } Yeast infection
} With white cheesy patches
● Hepatitis B
(moniliasis)(CBQ)
} Spread through infected blood and bodily
} Oral trush in the newborn (CBQ)
fluids such as semen
Medications:
} Nystatin
● HIV – AIDS
} Retrovirus (HIV1 & HIV2)
} Attacks and kills CD4+ lymphocytes ● Trichomoniasis
(T-helper) sTrawberry cervix
} Sexual intercourse (anal and vaginal) FROTHY, foul-smelling ("fishy" smell
) vaginal discharge
● Exposure to contaminated blood, semen, } Trichomona vaginalis, single cell
breast milk protozoan
} Needlestick injuries S/sx: Females: Yellow gray frothy
} HIGH RISK GROUP – BLACK and discharge
HISPANIC (MEN) Dx:
} Homosexual or bisexual – most highest - elevated vaginal pH 5.5+ ( alkaline
cases
} Sexual contact with HIV+
Mgmt: Metronidazole (Flagyl);
} Intravenous drug users
● Bacterial vaginosis
} HIV TEST
foul, fishy smelling, thin gray vaginal
} ELISA – Enzyme Link Immunosorbent
discharge
Assay ( first test conducted)
} presence of CLUE CELLS (CBQ)
} Western Blot - confirmatory test
● θ HIV+
2 consecutive positive ELISA and
1 positive Western Blot Test
PHC
● } Full blown AIDS- CD4 is less than
200/ml LOI 949 - legal basis of PHC
● Goal of PHC:
} Health in the Hands of the People by the
Year 2020
PELVIC INFLAMMATORY Mission of PHC: SELF RELIANCE
DISEASE ● PHC- is universal and it extends even to
● Cause by CHLAMYDIA – primary agent people in the hospital, both sick and well.
● Gonorrhea is also secondary agent -Accessible – not more than 5 km to travel
● MOST COMMON AFFECTED – -Available
OVIDUCTS or Fallopian tube -Affordable
} Chronic pelvic pain, fever, flu-like -Acceptable
symptoms, pain during or after -Appropriateness
intercourse(CBQ), vaginal bleeding, foul
smelling discharge, tenderness in lower ● Four Cornerstones/Pillars in
abdomen, and chills Primary Health Care
} Can cause ectopic pregnancies, infertility Active Community Participation
 Multisectoral - Intra and Inter-sectoral
Linkages
Use of Appropriate Technology ● Schistosomiasis
Support mechanism made available
byDepartment of Health (DOH)
● Primary level- locally trained
● Villagers/Grassroots workers
- BHW - frontline worker in
community
- Traditional birth attendants – traditional
Hilots- traditionally acceptable
to deliver pregnancy in
community
- Arbularyo or healers – uses herbs for
treatment of illnesses
ϒ Elevated temperature
Treatment: chloroquine
Causative Agent: Schistosoma japonicum
Snail : oncomelania quadrasi
Signs & Symptoms: Bulging abdomen,
Abdominal pain, Loose bowel
movement(black tarry), Low grade fever,
Seizure
} Preventive measures
Proper excreta disposal
Agricultural & vegetation improvement
Let water stand 2-3 days before usage
Mollucides use
Educate in Hand hygiene
Rubber boots use
} Treatment: Praziquantel (drug of choice)

● Secondary- Intermediate
workers
Public Health Nurse – ● Expanded Program for
supervisor or immediate Immunization (EPI)
Wednesday - immunization day
superior of the midwife of the } FULLY IMMUNIZED CHILD
midwife in RHU } before the child's first birthday.
Midwives – frontline worker in } fully immunized child must have
RHU level completed
} BCG 1
● Health deficits- TB, DM, } DPT 3
} OPV 3
hydrocephalus, polio,leprosy
} HB 3
● Health Threats – lack of } measles vaccines to complete FIC
immunization, no or lack prenatals
● Foreseeable crisis – Abortion - ● Bacillus Calmette-Guérin - Birth or
Divorce or separation Marriage -Entrance at anytime after birth
school –newborn - Death of a family
member
● Diphtheria-Pertussis-Tetanus Vaccine
● Malaria 6 weeks(DPT 1)
Causative Agent: - PLASMODIUM 10 weeks (DPT 2)
(PROTOZOA) 14 weeks (DPT 3)
● P. Falciparum (most fatal)
Vector
● } Oral Polio Vaccine – SABIN -
ϒ Anopheles female mosquito } 6 weeks(OPV 1)
● Signs & Symptoms: } 10 weeks (OPV2)
ϒ Chills to convulsion,
} 14 weeks (OPV3)

● OPV- Number of doses per vial/amp: 20
● HEPA B , Measles & BCG
Number of doses per vial/amp: 10
● Hepatitis B Vaccine - At birth – RNA
RECUMBINANT, PLASMA
● Upper outer portion of the thigh, Vastus
Lateralis (R-L-R)
● Warm compress for soreness -
Brings more blood to the area where it is
applied.
● Warm - Reduces joint stiffness and muscle
spasm, which makes it useful when muscles
are tight.
● Cold compress for pain relief and swelling
● 85% of measles can be prevented by
immunization at 9 MOS.
● } VVM or Vaccine vial monitor - a
thermochromic label put on vials which
gives a visual indication of vaccine
potency
● body of man or animals.
● } “Eligible population”
- group of people targeted for specific
immunizations susceptible to EPI diseases.”
● PENTA – 6 WEEKS – IM
● MMR- 12 MOS-SQ
● Fe supplementation: 60 mg with 400 mcg
of Folic Acid once a day
● } 3 C of Home delivery
CLEAN Hands
CLEAN Surface
CLEAN Cord
● } Vitamin A Supplement to Infants,
Preschoolers (6mos – 7 yeas and Mothers
● Pregnant women - 10, 000 IU 2x a week
starting on the 4th month of pregnancy
} Do not give vit. A supplementation before
the 4th month of pregnancy. It might
congenital problems in the baby.
● Postpartum women - 200, 000 IU - 1
cap; 1 dose only within 4 weeks after
delivery
● Viamin A Deficiency (CBQ) -
XEropthalmia – night blindness
● Water Supply
● Level 1 (Point Source) - protected well or
developed spring
} Level II - With a source, reservoir, piped
distribution network and communal
faucets or stand post
} Level III - Individual House Connections
or Waterworks System - With a source,
reservoir, piped distributor network and
household taps
Toilet or sewerage
● Level I - pit latrines , pour flush toilet &
aqua privies
● Level II - with septic vault/tank
disposal - WATER-SEALED AND
FLUSH TYPE
● Level III - connected to septic tanks and/or
to sewerage system to treatment plant.
● Epidemiology - the study of disease
occurrence and distribution
● Infection- entry and development or
multiplication of an infectious agent in the
● 4 types of disease distribution
● 1. EPIDEMIC- “The unusual occurrence
in a community of disease- sudden outbreak
of a disease in a short period of time
2. Endemic- constant presence of a
disease or infectious agent within a given
geographic area or population group.
3. Pandemic- worlwide
distribution….geographic area such as a
section of a nation, the entire nation, a
continent or the world
4. Sporadic- “scattered about”. The cases
occur irregularly, The cases are few and
separated widely in time and place
- On and off scattered cases –habitual
occurence
● Nosocomial (hospital acquired) - urinary
tract infections are the most common.
● CARRIERS- “an infected person or
animal that harbors a specific infectious
agent in the absence of discernible (visible)
clinical disease and serves as a potential
source of infection to others

Leptospirosis – Vector is Rat
Causative Agent: - bacteria--- Leptospira
interrogans
● Sign/Symptoms: High fever, Chills,
Vomiting, Red/ orange eyes, Diarrhea,
Severe headache, muscle aches, may
include jaundice (yellow skin and eyes),
abdominal pain
Treatment: PET - Penicillins G,
Erythromycin, Tetracycline,
● Doxycycline as prophylactic drug
Dengue - mosquito-borne infection
● Vector is female aedes aegypti mosquito,
day biting, low flying, STAGNANT
CLEAR WATER,stripes black white
body.
● Agent is a Virus.. dengue virus 1,2,3,4
treatment is supportive therapy.
∝ Intravenous fluids
∝ A platelet transfusion
● DENGUE DIAGNOSIS:
- Tourniquet test (capillary fragility test or
Rumpel Leads Test), a presumptive test
which is positive in the presence of more
than 20 petechiae within an inch square,
after 5 minutes of test
● TOURNIQUET TEST - (BP Cuff):
o fluids (most important treatment) like
oresol and IV
o paracetamol ( do not give aspirin)
o for nose bleeding or EPISTAXIS, flex
the neck lean forward to prevent
aspiration
o avoid unnecessary movement
● assist in the management of shock.
Dorsal recumbent to
TRENDELENBURG POSITION
Hepatitis
What is hepatitis?
● Hepatitis is an inflammation of the liver.
The condition can be self-limiting or can
progress to fibrosis (scarring), cirrhosis or
liver cancer.
● Hepatitis viruses are the most common
cause of hepatitis
● There are 5 main hepatitis viruses,
referred to as types A, B, C, D and E.
● B and C - most common cause of liver
cirrhosis and cancer.
● Hepatitis A and E are typically caused
by ingestion of contaminated food or
water.
● Hepatitis B, C and D usually occur as a
result of parenteral BLOOD contact
with infected body fluids.
● Common modes of transmission for
these viruses include receipt of
contaminated blood or blood products,
invasive medical procedures using
contaminated equipment and for hepatitis
B transmission from mother to baby at
birth, from family member to child, and
also by sexual contact.
● Hepatitis A virus (HAV) transmitted
through consumption of contaminated
water or food.
● transmitted mainly through the fecal oral
route. (foodborne)
● Hepatitis B virus (HBV) is transmitted
through exposure to infective blood,
semen, and other body fluids.
● HBV can be transmitted from infected
mothers to infants at the time of birth
or from family member to infant in early
childhood
● Hepatitis C virus (HCV) is mostly
transmitted through exposure to
infective blood.
● It is considered to be the most serious
of the hepatitis viruses
 ● Hepatitis D virus (HDV) infections
occur only in those who are infected with
HBV.
● Hepatitis E virus (HEV) is mostly
transmitted through consumption of
contaminated water or food.
● transmitted mainly through the fecal oral
route. (foodborne)
● FHSIS/Record & Report:
Components:
1. Family tx record = Daily
2. Target Client list = weekly
3. Reporting forms = monthly
4. Output reports = quarterly;annually
● *Family tx record - fundamental building
block; foundation of FHSIS
*Target client list - 2nd building block
CHN
The Primary focus of CHN is Health
Promotion & Disease Prevention
● Primary goal - self reliance in health or
enhanced capabilities
● Ultimate goal - raise level of health of
citizenry
● Philosophy of CHN- Worth and dignity of
man - by the nature of her work has the
opportunity & responsibility for evaluating
the health status of people & groups &
relating them to practice.
● The COMMUNITY. is the patient in CHN,
● the family is the unit of care and the
● ROLES OF THE PHN
● ❖ Clinician - taking care of the sick
people at home or in the RHU.
● ❖ Health educator- dissemination of
correct info; educating people
● ❖ Facilitator, who establishes multi-sectoral
linkages by referral system
● ❖ Supervisor- monitors & supervises the
performance of midwives
o Census (100%) : Most ideal,
enumeratx of data conducted 6 mos.
Level Of Disease Prevention
● PRIMARY – health promotion and disease
prevention
o Health education
o Immunization: Method of health
promotion
o Chemoprophylaxis: Intake of drugs
Ex. Vit C to avoid URTI
o Reproduction & Sexual Health
o Responsible Parenthood
● Through Environmental Control
o Safe Water Supply -
o Food Sanitation/ Good Food
o Hygiene
o Environmental sanitation
● Secondary Level Of Disease Prevention
- Early diagnosis & prompt intervention
to halt pathological process to shorten
a. Screening Methods
• Mass Screening: Should be simple &
inexpensive
• Case Finding: Positive cases of leading
causes of morbidity
Gold Standard for TB test: Culture and
Sensitivity
Sputum smear microscopy- TB test
• Contact Tracing and Surveillance
● Tertiary Level Of Disease
Prevention -
● Rehabilitation is the goal
● Leading New Cancer Cases
● lung cancer was the most common cancer
in MEN
● In Females, breast cancer was the most
common
****Smoking (including passive smoking)
is the most important factor.
Ebola: Mapping the
outbreak
From the section of WEST Africa
Ebola crisis
The hunters breaking an Ebola ban on
bushmeat- FRUIT BATS
● Primary source = fruit bats or flying foxes ,
old world bats
● Other sources:
o Chimpanzees
 o Gorillas
o fruit bats
o monkeys
o antelope
o porcupines
o symptomatic humans
● Ebola largest outbreak in West Africa
was first reported in March 2014,
● discovery in 1976.
Virus is named after the ebola river
● There are 5 strains of EBOLA virus
● EBOZ or ebola ZAIRRE strain is the
most deadliest strain
● RESTV or EBOR (ebola reston) species,
found in Philippines and the People's
Republic of China, have been found to
infect humans but they do not cause illness
or death
● Diphtheria- bacteria Corynebacterium
diphtheriae.
● throat infection causes a gray to black,
tough, fiber-like covering
● Shick test for Susceptibility to
diphtheria: A + shicks means no
immunity or suceptible; (antigen test)
● Moloney test – for sensitivity of diptheria
Tetanus
● caused by the bacterium Clostridium tetani,
● present with trismus (“lockjaw”),
● give TETANUS TOXOID TO PREVENT
Clostridium INFECTION
● L. monocytogenes CAUSES Listeriosis
- BACTERIA Listeria monocytogenes.
- listeriosis after eating contaminated food.
- primarily affects pregnant women, newborns,
older adults, and people with weakened immune
systems.
Foods associated with listeria?
Non-pasteurized milk & milk products (soft
cheeses, ice cream), hot dogs, deli meats, caramel
apples
● Middle East respiratory syndrome
coronavirus (MERS-CoV)
- CAMEL FLU or SARS of MIDDLE
EAST
● a VIRAL respiratory disease caused by a
novel coronavirus (MERS‐CoV) that was
first identified in Saudi Arabia in 2012.
● 1st case - april 2012
2nd case - sept. 2012
● CAMELS - major reservoir host for
MERS-CoV and an animal source of MERS
infection in humans
● Transmission- human-to-human contact
● Highest Risk : IMMUNOSUPRESSION
(CANCER)
● Symptoms- Mild-severe respiratory illness
Gastrointestinal symptoms
Complications-pneumonia, kidney failure
● Treatment: No specific treatment
● No vaccine or specific treatment is
currently available.
● Philhealth.
Medical Cases:
Newborn care package (NCP) — 1,000 —
increased to 1,750
● Surgical Cases:
Normal spontaneous delivery (NSD) in
Level 1 hospitals — 8,000
Normal spontaneous delivery (NSD) Levels
2 to 4 hospitals — 6,500
Delivery by caesarian section (CS) —
15,000 — increased to 19,000
to avail of your PhilHealth benefits
● Payment of at least 3 months’ worth of
premiums within the immediate 6 months of
confinement.
HOME VISIT is a family-nurse contact which allows
the health worker to assess the home and family situations
in order to provide the necessary nursing care and health
related activities.
Purposes
1. To give care to the sick,
2. To assess the living condition
3. To give health teachings
 4. To establish close relationship
5. To make use of the inter-referral system
Principles
1. A home visit must have a purpose or
objective.
2. Planning and delivery of care should involve
the individual and family.
3. The plan should be FLEXIBLE.
Steps
1. Greet the patient and introduce yourself.
2. State the purpose of the visit (Question after
Greeting the patient and introducing
yourself what is your next action? = State the
purpose of the visit)
3. Assess or Observe the patient and determine
the health needs.
4. Put the bag in a convenient place and then
proceed to perform the bag technique.
5. Perform the nursing care needed and give
health teachings.
6. Record all important date, observation and care
rendered.
7. Make appointment for a return visit.
BAG TECHNIQUE is a tool by which the nurse,
during her visit will enable her to perform a
nursing procedure with ease and deftness, to save
time and effort with the end view of rendering
effective nursing care to clients.
PUBLIC HEALTH BAG is an essential and
indispensable equipment of a public health nurse
which she has to carry along during her home visits.
Principles
● will minimize, if not, prevent the
spread of any infection.- most important
central feature
● It saves time and effort in the
performance of nursing procedures.
● The bag technique can be performed in a
variety of ways depending on the
agency’s policy, the home situation, or as
long as principles of avoiding transfer
of infection is always observed.
*BP apparatus and stethoscope are carried
separately and are never placed in the bag.
4 C Points to consider
COMPLETE- contain all the necessary
articles, supplies and equipment that will
be used to answer the emergency needs
CLEAN - contents should be cleaned
very often, the supplies replaced and
ready for use anytime.
CONTENT protection- contents should
be well protected from contact with any
article in the patient’s home.
*Consider the bag and its contents clean and
sterile, while articles that belong to the
patients as dirty and contaminated.
CONVENIENT- arrangement of the
contents of the bag should be the one
most convenient to the user, to facilitate
efficiency and avoid confusion.
Initial step in bag technique : Upon arrival at the
patient’s home, place the bag on the table lined
with a clean paper. The clean side must be out and
the folder part, touching the table Steps
BULLETS
● Spacing of pregnancy - 3-5 years
● Vit.D for calcium absorption prevents
RICKETS in children and osteomalasia in
adult- sources dairy products ,cod liver oil,
fish, milk, cheese , anchovies, salmon,
sardines
● VIT C prevents SCURVY
● Solutions like alcohol must be must be
placed in the center of the Public health
Bag
● IRON- 60 mg per tablet once a day and 400
mcg of folic acid for 6 months
● Vitamin A for postpartum – 200,00 IU one
dose
● Vitamin A for pregnant– 10,00 IU 2x a week
starts at 4 months
 ● Vitamin A for Children 12 months and
above – 200,00 IU dose every 6 months
● Vitamin capsule colors: RED
● Vitamin A treatment of Xeropthalmia
and Measles
● Beta-carotene in vegetables such as carrots
and sweet potatoes is the most common
provitamin A.
● Dairy products (such as cheese and fortified
milk), eggs, cod, liver oil and halibut are
rich sources of preformed vitamin A.
● Plant-based sources of provitamin vitamin A
include pumpkin, broccoli, and dark green,
leafy vegetables.
NEWBORN CORD CARE
- keep skin clean and dry, no tub baths, wash
around area with water, ALWAYS AIR DRY
THE CORD
- monitor for bleeding, redness, drainage,
foul odor
- fold diapers below cord stump, clean
area around cord after each diaper
change, allow cord to fall off on its own
- Hemorrhage(keep cord clamped
securely for 24 hours after birth)
- Infection(keep cord clean and dry, do
not use creams or lotions near the cord),
necessary, the penis needs to be
pointed down for boys).
- The cord will fall off at about 2-weeks of
age (7-10 DAYS).
- WATCH FOR Signs and symptoms of
infection include a red ring around the
umbilical area, foul smell, moist oozing
cord, drainage at the site, and either a
high or very low core temperature in the
newborn.
- Allow the client/family to watch the
MIDWIFE perform cord care correctly,
and ask them to repeat for return
demonstration.
RETURN DEMONSTRATION – THE BEST
EVALUATION TECHNIQUE FOR
TEACHING
SOLID WASTE MANAGEMENT
Color coded trash bins
Black - Non-infectious dry waste
Green - Non-infectious wet waste (kitchen,
dietary etc.)
Yellow -- Infectious and Pathological waste
Yellow with black band ---Chemical waste
including those w/ heavy metals
💥 💥Orange--- Radioactive waste
💥 💥Red---- Sharps and pressurized

- umbilical clamp can be removed after 24 containers

hrs if cord is dried and occluded and is
not bleeding
- keep cord clean and dry ~~> soap and
water ONLY WHEN SOILED
- NEVER APPLY COVER- REMOVE
COVER IF PRESENT
- keep the diaper from covering the cord
~~> fold diaper below cord
- assess cord for odor, swelling, or
discharge
- the newborn is washed via a sponge
bath until the cord falls off (within 2 wks)
- The cord needs to be kept dry to
promote its "falling off" without risk of
infection.
- Tub baths will have to wait until the cord
falls off.
- Diapers will need to be rolled down
so that the cord stays dry (and, if