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COMMUNITY

HEALTH NURSING
By: MS. CAROLINA D. BARROT, MAN,RN /
MR. JARVIN G. RENOMERON, MAN, MHS, RN

(Mark 10:45)
Discipleship is a lifestyle
Not just a biblical truth
Nor a Christian ideal but a way of life
For the Son of Man also came not to be
served
But to serve and to give His life as a
ransom for many.

COVERAGE FOR LOCAL
BOARD EXAM : CHN

I.

Safe and Quality Care, Health
Education, and Communication,
Collaboration and Teamwork
1. Principles and Standard of CHN
2. Levels of care
3. Types of Clientele
4. Health Care Delivery System
5. PHC as a Strategy

6. Family-based Nursing
Services(Family Health Nursing
Process)
7. Population Group-based Nursing
Services
8. Community-based Nursing
Services/Community Health Nursing
Process
9. Community Organizing
10.Public Health Programs

Research and Quality Improvement 1.II. 3. 2. 5. Research in the Community National Health Situation Vital Statistics Epidemiology Demography . 4.

III. Management of Resources
& Environment and Records
Management

1. Field Health Services And
Information System
2. Target-setting
3. Environmental Sanitation

IV.

Ethico-Moral-Legal Responsibility

1.

Socio-cultural values, beliefs, and
practices of individuals, families,
groups and communities
Code of Ethics for Government
Workers
WHO, DOH, LGU policies on health
Local Government Code
Issues

2.
3.
4.
5.

V.

Personal And Professional
Development
1. Self-assessment of CHN
competencies, importance,
methods and tools
2. Strategies and methods of
updating one’s self, enhancing
competence in community health
nursing and related areas.

HISTORY OF CHN

Date Event
1901 - Act # 157 ( Board of Health of the
Philippines) ; Act # 309 ( Provincial and Municipal
Boards of Health) were created.
1905 - Board of Health was abolished;
functions
were transferred to the Bureau of Health.
1912 – Act # 2156 or Fajardo Act created the Sanitary
Divisions, the forerunners of present MHOs; male
nurses performs the functions of doctors
1919 – Act # 2808 (Nurses Law was created)
- Carmen del Rosario , 1st Fil. Nurse supervisor
under Bureau of Health
Oct. 22, 1922 – Filipino Nurses Organization
(Philippine Nurses’ Organization) was
organized.

 1923 – Zamboanga General Hospital School
of Nursing & Baguio General Hospital were
established; other government schools of
nursing were organized several years after.
 1928- 1st Nursing convention was held
 1940 – Manila Health Department was
created.
 1941
– Dr. Mariano Icasiano became the
first
city health officer; Office of Nursing
was
created through the effort of Vicenta
Ponce (chief nurse) and Rosario Ordiz
(assistant chief nurse)

 Dec. 8, 1941 – Victims of World War II were
treated by the nurses of Manila.
 July 1942 – Nursing Office was created; Dr.
Eusebio Aguilar helped in the release of 31
Filipino nurses in Bilibid Prison as prisoners of
war
by the Japanese.
 Feb. 1946 – Number of nurses decreased from 556
– 308.
 1948 – First training center of the Bureau of Health
was organized by the Pasay City Health
Department. Trinidad Gomez, Marcela Gabatin,
Costancia Tuazon, Ms. Bugarin, Ms. Ramos, and
Zenaida Nisce composed the training staff.

 1950 – Rural Health Demonstration and
Training Center was created.
 1953 – The first 81 rural health units were
organized.
 1957 – RA 1891 amended some sections of
RA 1082 and created the eight categories
of rural health unit causing an increase in
the demand for the community health
personnel.
 1958-1965 – Division of Nursing was
abolished (RA 977) and Reorganization Act
(EO 288)

 1961 – Annie Sand organized the National
League of
Nurses of DOH.
 1967 – Zenaida Nisce became the nursing
program
supervisor and consultant on the six
special diseases (TB, leprosy, V.D., cancer,
filariasis, and mental health illness).
 1975 – Scope of responsibility of nurses and
midwives became wider due to restructuring of
the health care delivery system.
 1976-1986 – The need for Rural Health
Practice
Program was implemented.
 1990- 1992- Local Government Code of 1991 (RA
7160)

 1993-1998 – Office of Nursing did not
materialize in spite of persistent
recommendation of the officers, board
members, and advisers of the National
League of Nurses Inc.
 Jan. 1999 – Nelia Hizon was positioned as
the
nursing adviser at the Office of
Public Health Services through Department
Order # 29.
 May 24, 1999 – EO # 102, which redirects the
functions and operations of DOH, was
signed by former President Joseph Estrada.

LAWS AFFECTING PUBLIC HEALTH AND PRACTICE OF COMMUNITY HEALTH NURSING .

. 7160 .R.The Code aims to transform local government units into selfreliant communities and active partners in the attainment of national goals thru’ a more responsive and accountable local government structure instituted thru’ a system of decentralization. Hence.A.or the Local Government Code. each province. city and municipality has a LOCAL HEALTH BOARD ( LHB ) which is mandated to propose annual budgetary allocations for the operation and maintenance of their own health facilities. This involves the devolution of powers. functions and responsibilities to the local government both rural & urban.

. 5.Composition of LHB Provincial Level 1.chair 2. DOH rep. Provincial Health Officer – vice chair 3. Chair . Committee on Health of Sangguniang Panlalawigan 4.Governor. NGO rep.

NGO rep . MHO – vice chair 3. Chair. Mayor – chair 2. DOH rep 5. Committee on Health of Sangguniang Bayan 4.Composition of LHB City and Municipal Level 1.

EFFECTIVE LHS DEPENDS ON: 1. the LGU’s financial capability 2. community empowerment . a dynamic and responsive political leadership 3.

dentists. It created the 1 st 81 Rural Health Units. 2382 – Philippine Medical Act. R. 1082 – Rural Health Act.hence help decrease the high incidence of preventable diseases .A.R. more physicians. This act defines the practice of medicine in the country. -amended by RA 1891 . midwives and sanitary inspectors will live in the rural areas where they are assigned in order to raise the health conditions of barrio people .A. nurses.

distribution and transportation of prohibited drugs is punishable by law. R. No.A. 9165 – the new Dangerous Drug Act of 2002 P.A. . delivery.R. It stipulates that the sale.D. 651 – requires that all health workers shall identify and encourage the registration of all births within 30 days following delivery. administration. 6425 – Dangerous Drugs Act.

P. milk. of age against the 6 childhood immunizable diseases. . insects. transmitters of disease. food. 856 – Code on Sanitation. It provides for the control of all factors in man’s environment that affect health including the quality of water. No. R. No. noise. sanitary and recreation facilities.D. P. animal carriers.A. 8749 – Clean Air Act of 2000 P. pollution and control of nuisance. 996 – requires the compulsory immunization of all children below 8 yrs.D.D. No. 825 – provides penalty for improper disposal of garbage.

distribution.A. Public officials and employees shall at all times be accountable to the people and shall discharges their duties with utmost responsibility. competence and loyalty. 6758 – standardizes the salary of government employees including the nursing personnel. integrity.R. use and acceptance of drugs and medicines identified by their generic name.A. R. act with patriotism and justice. 6713 – Code of Conduct and Ethical Standards of Public Officials and Employees. R. 6675 – Generics Act of 1988 which promotes. It is the policy of the state to promote high standards of ethics in public office.A. requires and ensures the production of an adequate supply. . lead modest lives uphold public interest over personal interest.

to develop their skills and capabilities in order that they will be more responsive and better equipped to deliver health projects and programs.R. and to encourage those with proper qualifications and excellent abilities to join and remain in government service. R. 7305 – Magna Carta for Public Health Workers.A. .A. their living and working conditions and terms of employment. 8423 – created the Philippine Institute of Traditional and Alternative Health Care. This act aims: to promote and improve the social and economic well-being of health workers.

duties and functions of POPCOM . No. P. NO. 79 – defines . objectives.P.D.D. 965 – requires applicants for marriage license to receive instructions on family planning and responsible parenthood.

19. RA 4073 – advocates home treatment for leprosy  Letter of Instruction No.promotes development of health programs on the community level . 949 – legal basis of PHC dated OCT. 1979  .

 RA 3573 – requires reporting of all cases of communicable diseases and administration of prophylaxis  Ministry Circular No. 2 of 1986 – includes AIDS as notifiable disease .

8172 – Salt Iodization Act ( ASIN LAW) R.A.Magna Carta for PWD’s.A. 7277.A. 7432 – Senior Citizens Act R. 7719 . 7875 – National Health Insurance Act R. selfdevelopment and self-reliance and integration into the mainstream of society .National Blood Services Act R. A.R. provides their rehabilitation.A.

3. O. 2005-0014. No. Infants be exclusively breastfeed for 6 mos. Infants be given timely. Breastfeeding be continued up to 2 years and beyond  .A.All newborns be breastfeed within 1 hr after birth 2. adequate and safe complementary foods 4.National Policies on Infant and Young Child Feeding: 1.

A. 8976. 8980.Phil..A.prolmulgates a comprehensive policy and a national system for ECCD . Code of Marketing of Breastmilk Substitutes  R.Food Fortification Law  R.7600 – Rooming In and Breastfeeding Act of 1992  R. EO 51.A.

defines the Implementing guidelines on Hepatitis B Immunization for Infants  R.madates Liver Cancer and Hepatitis B Awareness Month Act ( February) . 7846.A. 2029.mandates Compulsory Hepatitis B Immunization among infants and children less than 8 yrs old  R.A.O.0015. 2006. No.. A.

No. Penalizing Violations thereof and for other purposes . Relevant International Agreements.O.specifies the Revised Implementing Rules and Regulations of E. 2006-0012.O. A. 51 or Milk Code.

prolonging life. control of communicable diseases.Public Health  -” science and art of preventing diasease. Winslow) . the organization of medical and nursing services for the early diagnosis and preventive treatment of diseases and the development of social machinery to ensure everyone a standard of living adequate for the maintenance of health. the education of individuals in personal hygiene.E. so organizing these benefits as to enable every citizen to realize his birthright off birth and longevity” ( DR. C. promoting health and efficiency thru’ organized community effort for the sanitation of the environment.

special field of nursing that combines the skills of nursing. public health and some phases of social assistance and functions as part of the total public health program for the promotion of health. rehabilitation of illness and disability ( WHO Expert Committee of Nursing ) .Community Health Nursing  . the improvement of the conditions in the social and physical environment.

preventionof illness. workplace for the promtion of health. clinics. care of the sick at home and rehabilitation (DR.a learned practice discipline with the ultimate goal of contributing as individuals and in collaboration with others to the promotion of the client’s optimum level of functioning thru’ teaching and delivery of care ( Jacobson )  .CHN  . Ruth B.a service rendered by a professional nurse to IFCs. Freeman) . schools . population groups in health centers.

 Community health nurses provide care necessary to meet the requirements of an individual all throughout the life cycle. .  Knowledge on different fields (biological and social sciences. clinical nursing. and community health organizations) is used.  Nursing process in community health nursing changes based on the needs of the community.Concepts  The primary focus of community health nursing is health promotion.

Goal  To elevate the level health of the multitude. Philosophy Principles 1.The need of the community is the basis of community health nursing. 2. .The community health nurse must understand fully the objectives and policies of the agency she represents.  Worth and dignity of man.

4. CHN must be available to all regardless of race. The family is the unit of service. There must be provision for periodic evaluation of community health nursing services 7. Opportunities for continuing staff education programs for nurses must be provided by the community health nursing agency and the CHN as well 8. The CHN works as a member of the health team 6.3.creed and socioeconomic status 5. The CHN makes use of available community health resources .

There should be accurate recording and reporting in community health nursing 12.9. There must be provision for educative supervision in community health nursing 11. The CHN taps the already existing active organized groups in the community 10. Health teaching is the primary responsibility of the community health nurse .

Data Collection Gathers comprehensive . accurate data systematically . Theory Applies theoretical concepts as basis for decisions in practice II.Standards in CHN I.

Diagnosis Analyzes collected data to determine the needs/ health problems of IFC IV. develops plans that specify nursing actions unique to needs of clients . Planning At each level of prevention.Standards III.

revise data base. maintain or restore health. diagnoses and plan . prevent illness and institute rehabilitation VI. intervenes to promote. Intervention Guided by the plan. Evaluation Evaluates responses of clients to interventions to note progress toward goal achievement.Standards V.

Quality Assurance and Professional Development Participates in peer review and other means of evaluation to assure quality of nursing practice Assumes professional development Contributes to development of others .Standards VII.

Interdisciplinary Collaboration Collaborates with other members of the health team. professionals and community representatives in assessing. implementing and evaluating programs for community health . planning.Standards VIII.

Research Indulges in research to contribute to theory and practice in community health nursing .Standards IX.

TERTIARY .LEVELS OF CARE/ PREVENTION  1. SECONDARY  3. PRIMARY  2.

g.Aggregate of people who share common characteristics. elderly.     . workers etc. FAMILIES 3. POPULATION GROUPS . children .Types of Clientele 1. COMMUNITIES 4. 1995:5) e. INDIVIDUALS 2. women. developmental stage or common exposure to particular environmental factors thus resulting in common health problems ( Clark.

SECONDARY LEVEL FACILITIES  3.Phil.Health Care Delivery System  1. TERTIARY LEVEL FACILITIES .PRIMARY LEVEL FACILITIES  2.

belong        1. City Health Services 3. Puericulture Centers 7. RHU . Heart Institutes 6.Classify as to what level the ff. Private Practitioners 5. Emergency and District Hospitals 4. Teaching and Training Hospitals 2.

especially the poor. .THE DEPARTMENT OF HEALTH VISION: Health for all Filipinos MISSION: Ensure accessibility & quality of health care to improve the quality of life of all Filipinos.

Mental Disorders. Hepatitis B. Pneumonias. reduce child morality rate. reduce total fertility rate. . Accident & Injuries. Iron Deficiency Anemia & Obesity. Reduce morbidity. Asthma & Chronic Obstructive Pulmonary Diseases. 2. Improve the general health status of the population (reduce infant mortality rate. Protein Energy Malnutrition. Sexually Transmitted Diseases. Nephritis & Chronic Kidney Diseases.NATIONAL OBJECTIVES 1. Intestinal Parasitism. Cancer. Dengue. Dental Caries & Periodontal Diseases. disability & complications from Diarrheas. reduce maternal mortality rate. Cardiovascular Diseases. Diabetes. increase life expectancy & the quality of life years). Tuberculosis. mortality.

3.Eliminate the ff. diseases as public health
problems:
 Schistosomiasis
 Malaria
 Filariasis
 Leprosy
 Rabies
 Measles
 Tetanus
 Diphtheria & Pertussis
 Vitamin A Deficiency & Iodine Deficiency
Disorders

4. Eradicate Poliomyelitis
5. Promote healthy lifestyle through healthy diet
& nutrition, physical activity & fitness, personal
hygiene, mental health & less stressful life &
prevent violent & risk-taking behaviors.
6. Promote the health & nutrition of families &
special populations through child, adolescent
& youth, adult health, women’s health, health
of older persons, health of indigenous people,
health of migrant workers and health of
different disabled persons and of the rural &
urban poor.

7. Promote environmental health and
sustainable development through the
promotion and maintenance of healthy
homes, schools, workplaces,
establishments and communities towns
and cities.

Basic Principles to
Achieve Improvement in
Health
1. Universal access to basic health services
2.
3.
4.

must be ensured.
The health and nutrition of vulnerable
groups must be prioritized.
The epidemiological shift from infection to
degenerative diseases must be managed.
The performance of the health sector
must be enhanced.

Primary Strategies to
Achieve Goals
1. Increasing investment for Primary Health
Care.
2. Development of national standards and
objectives for health.
3. Assurance of health care.
4. Support to the local system development.
5. Support for frontline health workers.

PHC as a Strategy .

1978 . Russia (USSR) The Alma Ata Declaration stated that PHC was the key to attain the “health for all” goal .First International Conference on PHC in Alma Ata.  September 6-12.PRIMARY HEALTH CARE (PHC)  May 1977 -30th World Health Assembly decided that the main health target of the government and WHO is the attainment of a level of health that would permit them to lead a socially and economically productive life by the year 2000.

1979 .Letter of Instruction (LOI) 949).October 19. Ferdinand E. development and implementation of programs focusing on health development at . Marcos. which adopted PHC as an approach towards the design. the legal basis of PHC was signed by Pres.

 RATIONALE FOR ADOPTING PRIMARY HEALTH CARE:  Magnitude of Health Problems  Inadequate and unequal distribution of health resources  Increasing cost of medical care  Isolation of health care activities from other development activities .

an approach to health development.DEFINITION OF PRIMARY HEALTH CARE  essential health care made universally accessible to individuals and families in the community by means acceptable to them. through their full participation and at cost that the community can afford at every stage of development. a practical approach to making health benefits within the reach of all people. which is carried out through a set of activities and whose ultimate aim is the continuous improvement and maintenance of health status of the community. .

and sustainable. at a cost. An improved state of health and quality of life for all people attained through SELF-RELIANCE. .permeate as the core strategy in the effective provision of essential health services that are community based. accessible. acceptable.GOAL OF PRIMARY HEALTH CARE: HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE HANDS OF THE PEOPLE by the year 2020. which the community and the government can afford.  KEY STRATEGY TO ACHIEVE THE GOAL: Partnership with and Empowerment of the people .

 Reduction in morbidity and mortality rates especially among infants and children.   Improvement in Basic Sanitation   Development of the capability of the community aimed at selfreliance.OBJECTIVES OF PRIMARY HEALTH CARE   Improvement in the level of health care of the community   Favorable population growth structure   Reduction in the prevalence of preventable. . communicable and other disease.   Maximizing the contribution of the other sectors for the social and economic development of the community.   Extension of essential health services with priority given to the underserved sectors.

MISSION:  To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care. TWO LEVELS OF PRIMARY HEALTH CARE WORKERS 1.trained community health workers or health auxiliary volunteers or traditional birth attendants or healers. Rural Sanitary Inspector and midwives. Barangay Health Workers . Intermediate level health workers include the Public Health Nurse. . 2.

Affordability & Acceptability.PRINCIPLES OF PRIMARY HEALTH CARE   4 A's = Accessibility. They should make use of the available resources within the community. Appropriateness of health services. wherein the focus would be more on health promotion and prevention of illness. The health services should be present where the supposed recipients are. Availability.   COMMUNITY PARTICIPATION =heart and soul of PHC .

monitoring and evaluating. Example: Scheduling of Barangay Health Workers in the health center . implementing.  Thus.  In general. People are the center. the success of any undertaking that aims at serving the people is dependent on people’s participation at all levels of decision-making. health work should start from where the people are and building on what they have. social mobilization and decentralization. object and subject of development. 3. 1990)  Part of the people’s participation is the partnership between the community and the agencies found in the community. Any undertaking must also be based on the people’s needs and problems (PCF. planning.

BARRIERS OF COMMUNITY INVOLVEMENT  Lack of motivation  Attitude  Resistance to change  Dependence on the part of community people  Lack of managerial skills .

Providing linkages between the government and the nongovernment organization and people’s organization.Partnership between the community and the health agencies in the provision of quality of life.SELF-RELIANCE 5.4. .

social. Recognition of interrelationship between the health and HEALTH development  is not merely the absence of disease. cultural. Health being a social phenomenon recognizes the interplay of political. is manifested by the progressive improvements in the living conditions and quality of life enjoyed by the community residents (PCF.6. Neither it is only a state of physical and mental well-being. Therefore. DEVELOPMENT is the quest for an improved quality of life for all. . socio-cultural and economic factors as its determinant. Development is multi-dimensional. Good Health therefore. it is measured by the ability of people to satisfy their basic needs. institutional and environmental dimensions (Gonzales 1994). It has a political.

DECENTRALIZATION . networking and developing secondary leaders.7. SOCIAL MOBILIZATION It enhances people participation or governance. support system provided by the Government. 8.

budgetary and logistical considerations.MAJOR STRATEGIES OF PRIMARY HEALTH CARE A.  Advocacy must be directed to National and Local policy making to elicit support and commitment to major health concerns through legislations. expanding participation in health and health related programs whether as service provider or beneficiary. . ELEVATING HEALTH TO A COMPREHENSIVE AND SUSTAINED  Attaining Health for all Filipino will require NATIONAL EFFORTS. families and communities to make decisions of their health is really the desired outcome. Empowerment to parents.

B. implement and evaluate health programs at their levels. PROMOTING AND SUPPORTING COMMUNITY MANAGED HEALTH CARE The health in the hands of the people brings the government closest to the people. It necessitates a process of capacity building of communities and organization to plan. .

accessible and culturally acceptable.C. . The DOH will continue to support and assist both public and private institutions particularly in faculty development. INCREASING EFFICIENCIES IN THE HEALTH SECTOR  Using appropriate technology will make services and resources required for their delivery. effective. enhancement of relevant curricula and development of standard teaching materials. affordable. The development of human resources must correspond to the actual needs of the nation and the policies it upholds such as PHC.

multi-disciplinary and scientific approach to health programming and delivery. ADVANCING ESSENTIAL NATIONAL HEALTH RESEARCH Essential National Health Research (ENHR) is an integrated strategy for organizing and managing research using intersectoral.D. .

 FOUR CORNERSTONES/ PILLARS IN PRIMARY HEALTH CARE 1. Intra and Inter-sectoral Linkages 3. Support mechanism made available . Active Community Participation 2. Use of Appropriate Technology 4.

It promotes the partnership of both the family members and health workers in the promotion of health as well as prevention of illness. .ELEMENTS OF PRIMARY HEALTH CARE: Education For Health Is one of the potent methodologies for information dissemination.

Example Malaria Control and Schistosomiasis Control .Locally Endemic Disease Control The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate.

diphtheria and other preventable disease are given for free by the government and ongoing program of the DOH . tetanus. measles.Expanded Program on Immunization This program exists to control the occurrence of preventable illnesses especially of children below 6 years old. Immunizations on poliomyelitis.

The goal of Family Planning includes spacing of children and responsible parenthood. .Maternal and Child Health and Family Planning The mother and child are the most delicate members of the community. So the protection of the mother and child to illness and other risks would ensure good health for the community.

Environmental Sanitation and Promotion of Safe Water Supply Environmental Sanitation is defined as the study of all factors in the man’s environment. Water is necessary for the maintenance of healthy lifestyle. . Water is a basic need for life and one factor in man’s environment. Safe Water and Sanitation is necessary for basic promotion of health. which exercise or may exercise deleterious effect on his well-being and survival.

. And if food is properly prepared then one may be assured healthy family. There are many food resources found in the communities but because of faulty preparation and lack of knowledge regarding proper food planning.Nutrition and Promotion of Adequate Food Supply One basic need of the family is food. Malnutrition is one of the problems that we have in the country.

. control and treatment of these illnesses.Treatment of Communicable Diseases and Common Illness The diseases spread through direct contact pose a great risk to those who can be infected. Tuberculosis is one of the communicable diseases continuously occupies the top ten causes of death. The Government focuses on the prevention. Most communicable diseases are also preventable.

INH(isoniazid) and Pyrazinamide. Amoxycillin. the GENERIC ACT of the Philippines is enacted .Albendazole. Paracetamol.Ethambutol. Streptomycin.Quinine . In response to this campaign. Nifedipine.Supply of Essential Drugs This focuses on the information campaign on the utilization and acquisition of drugs. Oresol. Rifampicin. It includes the following drugs: Cotrimoxazole.

that level of CHN practice directed to the FAMILY as the unit of care with HEALTH as the goal and NURSING as the medium. channel or provider of care .FAMILY HEALTH NURSING  .

the no. and kind of families a nurse handles at any given time  .Family Case Load  .variable for cases are added or dropped based on the need for nursing care and supervision .

Single. Blended or reconstituted .Parent 6.Types of Families        1. Nuclear 2. Step.Parent 7. Dyad 5. Extended 3. Three generational 4.

Single adult living alone 9.kin 11. Gay 14. Cohabiting/ Living –in 10.Types of Families       8. Compound 12. Commune . No.

Teenage 6. Middle-aged ( empty nest –retirement) 8. Newly married couple 2. Preschool age 4. Schoolage 5.Stages of Family Life Cycle         1. Launching 7. Period from retirement to Death of both spouses . Childbearing 3.

maintaining a home environment conducive to good health and personal development  6. seeking health care 3. providing nursing care to the sick. recognizing interruptions of health or development 2. 1981) 1. maintaining a reciprocal relationship with the community and health institutions     . managing health and non-health crises 4.HEALTH FAMILY( TASKS OF THE Freeman. disabled and dependent member of the family  5.

Family Nursing Problem  Arises when the family cannot effectively perform its health tasks .

COUNSELOR . FACILITATOR  5. COORDINATOR OF FAMILY SERVICES  4. PROVIDER OF CARE TO A SICK FAMILY MEMBER  3. TEACHER  6.Nurse’s Roles in Family Health Nursing  1. HEALTH MONITOR  2.

Place of residence of each member – whether living with the family or elsewhere . position in the family 3.INITIAL DATA BASE FOR FAMILY NURSING PRACTICE Family structure. sex. Characteristics. Members of the household and relationship to the head of the family 2. civil status. Demographic data – age. and Dynamics 1.

g. nuclear or extended 5. Type of family structure – e. matriarchal or patriarchal. characteristics communication patterns among members .4. especially in matters of health care 6. Dominant family members in terms of decision-making. General family relationship/dynamics – presence of any readily observable conflict between members.

Educational attainment of each other 3. Ethnic background and religious affiliation . Income and Expenses  Occupation. Socio-economic and Cultural Characteristics 1. place of work and income of each working members  Adequacy to meet basic necessities  Who makes decisions about money and how it is spent 2.

Significant Others – role(s) they play in family’s life 5. Relationship of the family to larger community – Nature and extent of participation of the family in community activities .4.

sanitary condition Drainage system – type. Housing         Adequacy of living peace Sleeping arrangement Presence of breeding or resting sites of vectors of diseases Presence of accidents hazards Food storage and cooking facilities Water supply – source. Home and Environment 1. sanitary condition . portability Toilet facility – type. ownership. ownership.

e. Social and health facilities available 4. slum. Kind of neighborhood. 3. Communication and transportation facilities available .2. etc. congested.g.

weight. height. Nutritional assessment    Anthropometric data: Measures of nutritional status of children. waist hip ratio Dietary history specifying quality and quantity of food/nutrient intake per day Eating/ feeding habits/ practices . mid-upper arm circumference: Risk assessment measures of obesity: body mass index. Medical and nursing history indicating current or past significant illnesses or beliefs and practices conducive to health illness 2. waist circumference. Health Status of each Family Member 1.

Metro Manila 4. elevated blood lipids. stress. obesity.g..3. Developmental assessments of infants. Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific lifestyles. alcohol drinking and other substance abuse . toddlers. inadequate fiber intake. and preschoolers – e. diabetes mellitus. cigarette smoking.

Results of laboratory/ diagnostic and other screening procedures supportive of assessment findings .5. Physical assessment indicating presence of illness state/s 6.

Use of promotive-preventive health services . Practices on Health Promotion. Examples include: 1. relaxation and other stress management activities 4. Values. Maintenance and Disease Prevention. 2. Specify.g. Immunization status of family members Healthy lifestyle practices. adequate footwear in parasite-infested areas. 3. Habits.e. Adequacy of:     rest and sleep exercise use of protective measures.

A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE .

Readiness for enhanced wellness state is a nursing judgment on wellness state or condition based on client’s current competencies or performance. Presence of Wellness Condition – stated as Potential or Readiness. clinical data explicit expression of desire to achieve a higher level of state or function in specific area on health promotion and maintenance.a clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher level.FIRST-LEVEL ASSESSMENT I. Wellness potential is a nursing judgment on wellness state or condition based on client’s performance. current competencies or clinical data but no explicit expression of client desire. .

g. Examples of these are the following: 1. Potential for Enhanced Capability for:  Healthy lifestyle – e. . nutrition/diet. exercise/ activity  Health Maintenance  Parenting  Breastfeeding  Spiritual Well-being – process of a client’s unfolding of mystery through harmonious interconnectedness that comes from inner strength/sacred source/GOD (NANDA 2001)  Others.

2. . Readiness for Enhanced Capability for:       Healthy Lifestyle Health Maintenance Parenting Breastfeeding Spiritual Well-being Others.

I. e. Threat of cross infection from a communicable disease case . diabetes 2.g. Family history of hereditary condition. accident or failure top realize one’s health potential. Examples of these are the following: 1. Presence of Health Threats – conditions that are conducive to disease.

Accidental hazards  Broken stairs  Sharp objects. and medicines improperly kept  Fire hazards . Family size beyond what family resources can adequately provide 4.3. poison.

     Inadequate food intake both in quality & quantity Excessive intake of certain nutrients Faulty eating habits Ineffective breastfeeding Faulty feeding practices .5. Faulty nutritional habits or feeding practices.

Stress-provoking factors – Strained marital relationship Strained parent-sibling relationship Interpersonal conflicts between family members Care-giving burden .6.

Poor home condition Inadequate living space  Lack of food storage facilities  Polluted water supply  Presence of breeding sites of vectors of disease  Improper garbage  Unsanitary waste disposal  Improper drainage system  Poor ventilation  Noise pollution  Air pollution .7.

8. Unsanitary food handling and preparation 9. Unhealthful lifestyles and personal habits            Alcohol drinking Cigarette smoking Inadequate footwear Eating raw meat Poor personal hygiene Self-medication Sexual promiscuity Engaging in dangerous sports Inadequate rest Lack of inadequate exercise Lack of relaxation activities Non-use of self protection measures .

father not assuming his role 13.g.Inherent personal characteristics – e. child assuming mother's role. poor impulse control 11.Lack of immunization/ inadequate immunization status specially of children .Health history which induce the occurrence of a health deficit.g. e. previous history of difficult labor 12.10.Inappropriate role assumption – e.g.

Family disunity –  Self-oriented behavior of member(s)  Unresolved conflicts of member(s)  Intolerable disagreement  Other 15.Other .14.

Examples include: 1. Disability – whether congenital or arising from illness.III. Illness states. Presence of Health Deficits – instances of failure in health maintenance. Failure to thrive/ develop according to normal rate 3. temporary . regardless of whether it is diagnosed or by medical practitioner 2.

3. 11. 10. 5.IV. Marriage Pregnancy Parenthood Additional member Abortion Entrance at school Adolescence Divorce 9. 2. 7. 12. Menopause Loss of job Hospitalization of a family member Death of a manner Resettlement in a new community illegitimacy . Presence of stress Points/ Foreseeable Crisis Situations – anticipated periods of unusual demand of the individual or family in terms of family resources. 13. 6. 8. Examples of these include: 1. 4. 14.

disabled . dependent or vulnerable member of the family Inability to provide a home environment conducive to health maintenance or personal development Failure to utilize community resources for health care . c. d. health tasks Statements on family health nursing problem: Inability to recognize the presence of the condition or problem Inability to make decisions with respect to taking appropriate health action Inability to provide adequate nursing care to the sick. b. e.Second Level Assessment  Focus on determining family’s capacity to perform the  a.

Modifiability of the condition or problem ( easily. moderate . Nature of the condition or problem presented ( wellness state. forseeable crisis) b. health threat. not modifiable) c.Scale for Ranking Health Conditions and Problems according to priorities  Criteria: a. partially. not immediate. not perceived as a problem) . Salience ( needs immediate attention. health deficit. Preventive Potential (high. low) d.

COMMUNITY HEALTH CARE PROCESS  Assessment Purpose : To identify the health needs of the people  Planning of nursing actions Purpose : To act on the determined needs of the community people  Implementation Purpose : To achieve the optimum level of health of the community people  Evaluation Purpose : To determine the effectiveness of health care programs .

NURSING PROCEDURES  CLINIC VISIT .a professional face to face contact made by the nurse with a patient or the family to provide necessary health care activities and to further attain the objectives of the agency .process of checking the client’s health condition in a medical clinic  HOME VISIT .

 BAG TECHNIQUE -a tool making of the public health bag through which the nurse during the home visit can perform nursing procedures with ease and deftness saving time and effort with the end in view of rendering effective nursing care .

 THERMOMETER TECHNIQUE -to assess the client’s health condition through body temperature reading  NURSING CARE IN THE HOME .giving to the individual patient the nursing care required by his/her specific illness or trauma to help him/her reach a level of functioning at which he/she can maintain himself/herself or die peacefully in dignity .

frequent washing and airing of beddings and other articles and disinfections of room 3. discarding properly all nasal and throat discharges of any member sick with communicable disease . separating the articles used by a client with communicable disease to prevent the spread of infection: 2. ISOLATION TECHNIQUE IN THE HOME -done by : 1. to be used only within the room of the sick member 4. wearing a protective gown .

insertion of a needle or catheter into a vein to provide medication and fluids based on physician’s written prescription .can be done only by nurses accredited by ANSAP . burning all soiled articles if could be or contaminated articles be boiled first in water 30 minutes before laundering  INTRAVENOUS THERAPY .5.

PRINCIPLES OF HEALTH EDUCATION   It considers the health status of the people. and nation. which is determined by the economic and social conscience of the country. It is a process whereby people learn to improve their personal habits and attitudes. to work responsibly for the improvement of health conditions of the family. community. .

 It involves motivation. experience. and change in conduct and thinking. and habits in relation to health and everyday living. It develops and provides experience for change in people’s attitudes. while stimulating active interest. customs.  It should be recognized as the basic function of all health workers. .

groups. and in the community. in the school. and the community. .  It is a cooperative effort requiring all categories of health personnel to work together in close teamwork with families. It takes place in the home.

 It finds means and ways of carrying out plans by encouraging individual and community participation. It meets the needs. and problems of the people affected. interests. .

. continuous process that involves constant changes and revisions until objectives are achieved. It is a slow.  Makes use of supplementary aids and devices to help with the verbal instructions.

. It utilizes community resources by careful evaluation of the different services and resources found in the community.  It is a creative process requiring methods and techniques with various characteristics. not following a rigid and flexible pattern.

 It aims to help people make use of their own efforts and education to improve their conditions of living. organization.  It makes careful evaluation of the planning. and implementation of all health education programs and activities. .

Bachelor of Science in Nursing 2.THE COMMUNITY HEALTH NURSE  Qualifications 1. Registered Nurse of the Philippines .

Formulates municipal health plan in the absence of a medical doctor 3. program policies. and problems of individuals. Identifies needs. Planner/Programmer 1. Provides technical assistance to rural health midwives in health matters . memoranda. and communities 2. families. and circular for the concerned staff personnel 4. priorities. Interprets and implements nursing plan.

or workplace 2. Develops the family’s capability to take care of the sick. Provides direct nursing care to sick or disabled in the home. Provider of Nursing Care 1. school. clinic. disabled. or dependent member .

resources. policies. family. Formulates individual. and supplies at local level 4. Organizes work force. and circulars 3. Manager/Supervisor 1. equipments. Conducts regular supervisory visits and meetings to different RHMs and gives feedback on accomplishments . Provides technical and administrative support to Rural Health Midwives (RHM) 5. memoranda. Interprets and implements programs. group. and community-centered plan 2.

and evaluating health services 2. Community Organizer 1. organizing. Motivates and enhances community participation in terms of planning. implementing. Initiates and participates in community development activities .

health education. and groups for health related services provided by various members of the health team 2. families. Coordinates with individuals. Coordinates nursing program with other health programs like environmental sanitation. and mental health . dental health. Coordinator of Services 1.

Conducts pre-marital counseling . Identifies and interprets training needs of the RHMs. Barangay Health Workers (BHW). Trainer/Health Educator 1. acts as a resource speaker on health and healthrelated services 4. and print ads) for health education purposes 5. Conducts pre and post-consultation conferences for clinic clients. cinema plugs. and hilots 2. Conducts training for RHMs and hilots on promotion and disease prevention 3. Initiates the use of tri-media (radio/TV.

and communities through contacts/visits with them . families. groups. Detects deviation from health of individuals. Health Monitor 1.

Provides good example of healthful living to the members of the community . Role Model 1.

and communities that also include lifestyle in order to promote and maintain health . groups. Change Agent 1. families. Motivates changes in health behavior in individuals.

accurate. and interprets all records and reports 4. Prepares statistical data/chart and other data presentation . Prepares and submits required reports and records 2. consolidates. analyzes. Recorder/Reporter/Statistician 1. Maintain adequate. Reviews. and complete recording and reporting 3. validates.

Participates in the conduct of survey studies and researches on nursing and health-related subjects 2. Coordinates with government and non-government organization in the implementation of studies/research . Researcher 1.

c.Community Organizing  a. b.: Welfare approach Technological approach Transformatory approah . Approaches to community devt.

Hence . People esp. Power must reside in the people  B.Community Organizing  Principles of CO:  1. is from the people to the people  C. CO is based on the ff:  A. the oppressed. have the capacity to change and are able to bring about change. exploited and deprived sectors are most open to change. Devt. People participation .

– should lead to self-reliant communities .Principles of CO  2. The solutions of problems commonly shared by these sectors must be focused on collective organizations. planning and action  3.-must be based on the poorest sectors of society.

PRE-ENTRY PHASE 2. SUSTENANCE AND STRENGTHENING PHASE    . COMMUNITY STUDY/DIAGNOSIS PHASE/RESEARCH PHASE  4. COMMUNITY ACTION PHASE  6.COMMUNITY ORGANIZATION AND CAPABILITY-BUILDING PHASE  5.THE HRDP-COPAR PROCESS 1. ENNTRY PHASE 3.

Selects site for adoption 8. Trains BHWs 3. Identifies key leaders . CO activities as to phase of COPAR each belong:  1. PIME of health services and or community devt.Classify the ff.Conducts community meetings to draw up        guidelines for the organization of CHO 2. Provides continuing education to leaders or residents 6. Projects 5. Sets up of linkages/network and referral systems 4. Trains secondary leaders 7.

Assists the research team in presenting results during the general assembly  14. Facilitates for the formulation and ratification of the constitution and by-laws of the organization      .Selects members of the research team 13. 9. Helps the people identifying the community needs and health problems  15. Develops criteria for site selection 10. Forms the core group 11.Conducts SALT 12.Continued….

Public Health Programs .

CDD (Control of Diarrheal Diseases) 3. EPI (Expanded Program on Immunization) 2. CARI (Control of Acute Respiratory Infections) 4. UFC (Under-Five Clinics) 5.COMPREHENSIVE MATERNAL AND CHILD HEALTH PROGRAM 1. MC (Maternal Care) .

MRP (Malnutrition Rehabilitation Program) 8. BF (Breastfeeding) 7. IDD/IDA (Iodine Deficiency Disorders/ Iron Deficiency Anemia) 10.6.FP (Family Planning) . VAD ( Vitamin A Deficiency) 9.

EPI (EXPANDED PROGRAM ON IMMUNIZATION)  TARGET SETTING: 1.PREGNANT AND POST PARTUM WOMEN 3.INFANTS 0-12 MONTHS 2.SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS OLD  OBJECTIVES OF EPI: TO REDUCE MORBIDITY AND MORTALITY RATES AMONG INFANTS AND CHILDREN from SIX CHILDHOOD IMMUNIZABLE DISEASE .

TARGET SETTING 2. 3. IEC 4. Assessment and evaluation of Over-all performance of the program 5. COLDCHAIN LOGISTIC MANAGEMENTVaccine distribution through cold chain is designed to ensure that the vaccine were maintained under proper environmental condition until the time of administration. Surveillance and research studies . ELEMENTS OF EPI: 1.

BCG (Bacillus Calmette Guerin) Birth or anytime after birth School entrants Number of Doses 1 Minimum Reason Interval Between Doses BCG is given at the earliest possible age protects against the possibility of TB infection from the other family members .EXPANDED PROGRAM ON IMMUNIZATION Vaccine Minimum Age of 1st Dose 1.

An early start of Hepatitis B reduces the chance of being infected and becoming a carrier. At least 85% of measles can be prevented by immunization at this age. .2. Hepatitis B 6 weeks 3 4 weeks 5. OPV (Oral Polio Vaccine) 6 weeks 3 4 weeks The extent of 4. DPT (Diphtheria Pertusis Tetanus) 6 weeks 3 4 weeks An early start with 3. Measles 9 months 1 DPT reduces the chance of severe pertussis protection against polio is increased the earlier OPV is given.

TETANUS TOXOID IMMUNIZATION SCHEDULE FOR WOMEN Vaccin e TT1 Minimum Age Interval As early as possible during pregnancy Percent Protecte d 80% Duration of Protection .

Gives 3 years protection for the mother from tetanus. .TT2 At least 4 weeks later 80% Infants born to the mother will be protected from neonatal tetanus.

. Gives 5 years protection for the mother.TT3 At least 6 months later 90% Infants born to the mother will be protected from neonatal tetanus.

TT4 At least year later 1 99% Gives 10 protection for the mother .

TT5 At least 1 year later 99% Dose:0. All infants born to that mother will be protected. .5ml Route: Intramuscularly Site: Right or Left Gives lifetime protection for the mother.

 UNDER FIVE CLINIC The first five years of life form the foundations of the child’s physical and mental growth and development. The Department of Health established the Under Five Clinic Program to address this problem. . Studies have shown the mortality and morbidity are high among this age group.

 PROGRAM OBJECTIVES AND GOALS: Monitor growth and development of the child until 5 years of age. . Identify factors that may hinder the growth and development of the child.

5. ACTIVITIES AND STRATEGIES: Regular height and weight determination/ monitoring until 5 years old. Provision of a safe and learning – oriented environment for the child. 0-1 year old=monthly 1 year old and above =quarterly 2. toys) that promote and enhance child’s proper growth and development. charts. Posters. Recording of immunization. 1. 4. Provision of IEC materials (ex. Monitoring and Evaluation. . vitamins supplementation. deworming and feeding. 3.

 BREASTFEEDING/ LACTATION MANAGEMENT EDUCATION TRAINING Breastfeeding practices has been proved to be very beneficial to both mother and baby thus the creation of the following laws support the full implementation of this program: Executive Order 51 Republic Act 7600 The Rooming-In and Breastfeeding Act of 1992 .

 PROGRAM OBJECTIVES AND GOALS: =Protection and promotion of breastfeeding and lactation management education training .

(e.FULL IMPLEMENTATION OF LAWS SUPPORTING THE PROGRAM A. ) .ACTIVITIES AND STRATEGIES: 1. feeding bottles. teats etc. breast milk substitutes. infant formulas. EO 51 THE MILK CODE – protection and promotion of breastfeeding to ensure the safe and adequate nutrition of infants through regulation of marketing of infant foods and related products.g.

=Information. education and re-education drive =Sanction and Regulation . =Provision for human milk bank.B. RA 7600 THE ROOMING –IN and BREASTFEEDING ACT of 1992 =An act providing incentives to government and private health institutions promoting and practicing rooming-in and breastfeeding.

2. CONDUCT ORIENTATION/ADVOCACY MEETINGS TO HOSPITAL/ COMMUNITY. ADVANTAGES OF BREASTFEEDING: MOTHER  Oxytocin help the uterus contracts  Uterine involution  Reduce incidence of Breast Cancer  Promote Maternal-Infant Bonding  Form of Family planning Method (Lactational Amenorrhea) .

BABY   Provides Antibodies   Contains Lactoferin (binds with Iron)   Leukocytes  Contains Bifidus factorpromotes growth of the Lactobacillusinhibits the growth of pathogenic bacilli .

Cradle Hold = head and neck are supported 2. Side Lying Position BEST FOR BABIES REDUCE INCIDENCE OF ALLERGENS ECONOMICAL ANTIBODIES PRESENT STOOL INOFFENSIVE (GOLDEN YELLOW) EMPERATURE ALWAYS IDEAL FRESH MILK NEVER GOES OFF EMOTIONALLY BONDING EASY ONCE ESTABLISHED DIGESTED EASILY IMMEDIATELY AVAILABLE NUTRITIONALLY OPTIMAL GASTROENTERITIS GREATLY REDUCED .    POSITIONS IN BF THE BABY: 1. Football Hold 3.

1 Routine Health Services: . WHAT ARE THE HEALTH SERVICES OFFERED IN GP AND WHO ARE THE TARGETS? GP offers the following: 1. GARANTISADONG PAMBATA (GP) Garantisadong Pambata is a biannual week long delivery of a package of health services to children between the ages of 0-59 months old with the purpose of reducing morbidity and mortality among under fives through the promotion of positive Filipino values for proper child growth and development. 1.

000 IU Orally by or 1 capsule drops capsule 100.Health Service Dosage Route of Target Administr Population ation Vitamin A 200.000 IU or ½ cap or 3 drops 12-59 months old. nationwide 9-12 month old infants receiving AMV nationwide .

.6ml(611mos) once a day Orally by drops 2-11 months old infants in Mindanao area. Elemental Iron per ml. Bottle as taken home medicine with instructions) 0.3ml(2-6 mos) once a day 0. including evacuation centers in armed conflict areas. 30 ml.Ferrous Sulfate (25 mg.

5ml 0.5ml Intradermal on right deltoid Intramuscularly on anterior thigh Orally Subcutaneously on deltoid Intramuscularly 0-11 mos 0-11 mos 0-11 mos 9-11 mos 0-11 mos .05ml 0.Routine Immunizat ion -BCG* -DPT* -OPV* -AMV* -Hepa B (if available) Nationwide 0.5ml 2 drops 0.

nationwide 0-59 mos.Deworming drug (if available) 1 tablet Orally as single dose Weighing 36-59 mos. nationwide .

 ** For any child between 12-23 months. . A above the recommended dosage within the past 4 weeks except if the child has measles or signs and symptoms of Vit A. deficiency. * The child should not have received megadose of Vit. who missed any of his routine immunization. the health worker should give the child the necessary antigen to complete FIC and shall be recorded as such.

Vitamin A.GARANTISADONG PAMBATA Sangkap Pinoy . liver. and must be taken in the food we eat. fruits. iodized salt. seafoods. pan de bida and other fortified foods. essential in the normal process of growth and development: . These micronutrients are not produced by the body. Iron and Iodine -Sources: green leafy and yellow vegetables.

Vitamin A Deficiency 3. Iron Deficiency Anemia 4. Iodine Deficiency Disorder . e) Eating Sangkap Pinoy-rich foods can prevent and control: 1.a) b) c) Helps the body to regulate itself Necessary in energy metabolism Vital in brain cell formation and mental development d) Necessary in the body immune system to protect the body from severe infection. Protein Energy Malnutrition 2.

Breastfeeding provides physical and psychological benefits for children and mothers as well as economic benefits for families and societies. BREASTFEEDING Breast milk is best for babies up to 2 years old. give carefully selected nutritious foods as supplements. . Exclusive breastfeeding is recommended for the first six months of life. At about six months.

Provides a nutritional complete food for the young infant.Strengthens the infant’s immune system.Safely rehydrates and provides essential nutrients to a sick child. especially to those suffering from diarrheal diseases. d. . c. b.Reduces the infant’s exposure to infection.BENEFITS : For infants a. preventing many infections.

Saves medical costs to families and governments by preventing illnesses and by providing immediate postpartum contraception. . For the Mother e. Reduces a woman’s risk of excessive blood loss after birth f. Reduces the risk of ovarian and breast cancers and osteoporosis. Conserves funds that otherwise would be spent on breast milk substitute. g. i.  For the Family and Community h. Provides a natural method of delaying pregnancies. supplies and fuel to prepare them.

COMPLEMENTARY FEEDING FOR BABIES 6-11 MONTHS OLD  What are Complementary Foods? a. . breastmilk can be a single source of nourishment from birth up to six months of life.foods introduced to the child at the age 6 months to supplement breastmilk a.given progressively until the child is used to three meals and in-between feedings at the age of one year.  Why is there a Need to Give Complementary Foods? c.

c. however. Breastfeeding. The child’s demands for food increases as he grows older and breastmilk alone is not enough to meet his increased nutritional needs for rapid growth and development d. should continue for as long as the mother is able and has milk which could be as long as two years . Breastmilk should be supplemented with other foods so that the child can get additional nutrients e. Introduction of complementary foods will accustom him to new foods that will also provide additional nutrients to make him grow well f.

flaked fish/chicken/ground meat and oil. b.Give egg alone or combine with above food mixture . increasing the amount of teaspoons and number of feeding until the full recommended amount is consumed c. mashed beans.Prepare mixture of thick lugao/ cooked rice. How to Give Complementary Foods for Babies 6-11 Months Old? a. soft cooked vegetables.Give mixture by teaspoons 2-4 times daily. Egg yolk. Give bite-sized fruit separately d.

MISSION:  To provide the means and opportunities by which married couples of reproductive age desirous of spacing and limiting their pregnancies can realize their reproductive goals. education and services. .FAMILY PLANNING The Philippine Family Planning Program is a national program that systematically provides information and services needed by women of reproductive age to plan their families according to their own beliefs and circumstances. GOALS AND OBJECTIVES:  Universal access to family planning information.

3. 5. NATURAL METHODS 1. 4. Basal Body Temperature Method Cervical Mucus Method Sympto-Thermal Method Lactational Amennorhea .TYPES OF METHODS: A. Calendar or Rhythm Method 2.

ARTIFICIAL METHODS I.Ovulation suppressant such as PILLS 2. Spermicidals 4. CHEMICAL METHODS 1. Depo-Provera 3.B. Implant .

Vasectomy  2. MECHANICAL METHODS 1.II. Male and Female Condom Intrauterine Device Cervical Cap/Diaphragm III. 3. Tubal Ligation . SURGICAL METHODS 1. 2.

jaundice.WARNING SIGNS Pills  Abdominal pain ( severe)  Chest pain ( severe)  Headache ( severe)  Eye problems ( blurred vision. breast lumps . blindness)  Severe leg pain ( calf or thigh )  Others: depression. flashing lights.

WARNING SIGNS IUD *Period late. no symptoms of pregnancy. has fever or chills *String is missing or has become shorter or longer . abnormal bleeding or spotting *Abdominal pain during intercourse *Infection or abnormal vaginal discharge *Not feeling well.

WARNING SIGNS     INJECTABLES Dizziness Severe headache Heavy bleeding .

WARNING SIGNS BTL  Fever  Weakness  Rapid pulse  Persistent abdominal pain  Vomiting  Dizziness  Pus or tenderness at incision site  Amenorrhea .

WARNING SIGNS Vasectomy  Fever  Scrotal blood clots or excessive swelling .

Nutrition  Goal To improve the nutritional status. productivity and quality of life of the population thru adoption of desirable dietary practices and healthy lifestyle .

 Objectives  Increase food and dietary energy intake of the average Filipino  Prevent nutritional deficiency diseases and nutrition-related chronic degenerative diseases  Promote a healthy well-balanced diet  Promote food safety .

 It speeds up the growth and development of the body including the formation of teeth and bones  It helps fight infection and diseases  It speeds up the recovery of a sick person  It makes people happy and productive  Proper nutrition is eating a balanced diet in every meal .Nutrition is a state of well-being achieved by eating the right food in every meal and the proper utilization of the nutrients by the body. especially during the first years of the child’s life. Proper nutrition is important because :  it helps in the development of the brain.

The grouping serves as a guide in selecting and planning everyday meals for the family. .Balanced diet is made up of a combination of the 3 basic groups eaten in correct amounts.

chicken. bean curd. pork.THE THREE (3) BASIC FOOD GROUPS ARE: 1. beef. kidney beans. butter. Body –building food which are rich in protein and needed by the body for: < normal growth and repair of worn-out body tissues < supplying additional energy < fighting infections < Examples of protein-rich food are: fish. peanuts. mongo. shrimp. cheese. clams .

honey. lard. bread. cassava. 2. corn. coconut milk. margarine. butter . banana. Energy-giving food which are rich in carbohydrates and fats and needed by the body for:  < providing enough energy to make the body strong  < Examples of energy-giving food are: rice. cooking oil. sugar cane. sweet potato.

mango. banana. 3. squash. yellow corn. skin. guava. carrot . Body-regulating food which are rich in Vitamins and minerals and needed by the body for:  < normal development of the eyes. hair. bones. orange. and teeth  < increased protection against diseases  < Examples of body-regulating food are: tisa. ripe papaya.

pat it on thinly 4. replace whole milk with skimmed milk.Low Fat Tips 1. Become a label reader. If you use butter or margarine. grain and cereals e.e. low fat cheese 5. rice.g. Eat at least 3 meals/day 2. Look for foods that have less than 5 g /100 g of product . vegetables. noodles and potato 3. Choose low fat substitute i. Eat more fruits.

Eat less high fat snacks and take away potato chips. remove skin from chicken fat drippings and cream sauces 8. sausage rolls or breaded meats 7.6. stew.it’s a food quencher . Aim for thin palm-size serving of lean meat. bake. steam. poultry and fish/ meal 9. Cut all visible fat from meat. stir –fry and microwave. Drink lots of water all day. Grill. try not to fry 10.

Build up to 30-40 min/day Go for 3-4 times / week of any exercise you enjoy .Ambulate    Start by walking for 10 min.

eggs. salt . root crops. green salads. dry beans. fruits or juices  Eat some – fish. bread and cereals  Eat more – vegetables. lean meats.Filipino Food Pyramid  Drink a lot. corn. clear broth  Eat most – rice. noodles. sugar. low fat dairy  Eat a little – fats.water. nuts. poultry. oils.

IMPORTANT VITAMINS AND MINERALS .

camotetops. liver. ampalaya tops .poultry. Food sources: Breastmilk. skin health. papaya.kangkong.VITAMINS Vitamin A FUNCTIONS Maintain normal vision.squash.eggs. meat.carrots. bone and tooth growth reproduction and immune function. prevents xerophthalmia.mango.tiesa. malunggay.

prevent beri-beri. .Thiamine Help release energy from nutrients. support normal appetite and nerve function.

support skin health. prevent deficiency manifested by cracks and redness at corners of mouth. Niacin Help release energy from nutrients. inflammation of the tongue and dermatitis. support skin. nervous and digestive system.Riboflavin Helps release energy from nutrients. prevents pellagra. .

help in the synthesis of fat glycogen. .Biotin Help energy and amino acid metabolism. Pantothenic Help in energy metabolism.

assist in the metabolism of fatty acids and amino acids. prevent anemia and some amino acids.Folic acid Help in the formation of DNA and new blood cells including red blood cells. . Vitamin B 12 Help in the formation of the new cells. maintain nerve cells.

collagen. cashew .lemon. involve in amino acid metabolism.pomelo. Food sources: Guava. bone. tomato. prevent scurvy. facilitate in the absorption of iron from the gastrointestinal tract.Vitamin C Help in the formation of protein. teeth cartilage. increase resistance to infection. skin and scar tissue. calamansi.orange.

Vitamin D Help in the mineralization of bones by enhancing absorption of calcium. .

help prevent arteriosclerosis. . Vitamin K Involve in the synthesis of blood clotting proteins and a bone protein that regulates blood calcium level.Vitamin E Strong anti-oxidant. important for normal immune function. protect neuromuscular system.

regulator of many of the body’s biochemical processes.MINERALS FUNCTIONS Calcium Mineralization of bones and teeth. muscle contraction and relaxation. Chloride Maintain normal fluid and electrolyte balance. involve in blood clotting. nerve functioning. . blood pressure and immune defenses.

. Copper Necessary for absorption and use of iron in the formation of hemoglobin.Chromium Work with insulin and is required for release of energy from glucose.

mussels.squids. physical and mental development and metabolic rate.snails. fish .Fluoride Involve in the formation of bones and teeth. dried dilis. prevents tooth decay. Iodine As part of the two thyroid hormones. Aids in the development of the brain and body especially in unborn babies Food sources: Seaweeds. iodine regulates growth.shrimps.crabs. fermented shrimp.

chicken. It is involved in the transport and storage of oxygen in the blood and is a co-factor bound to several non-hemo enzymes required for the proper functioning of cells. Food sources: Pork.Iron Essential in the formation of blood. liver and other internal organs. pechay. alugbati . beef. eggs. shrimp. saluyot. dried dilis.

maintenance of teeth and functioning of immune system. building of proteins. normal muscle contraction. .Magnesium Mineralization of bones and teeth. nerve impulse transmission.

Molybdenum Facilitate many cell processes.Manganese Facilitate many cell processes. .

Phosphorus Mineralization of bones and teeth. . Selenium Work with vitamin E to protect body compound from oxidation. part of every Cell. used in energy transfer and maintenance of acidbase balance.

Selenium Work with vitamin E to protect body compound from oxidation. assists nerve impulse insulin. . Sodium Maintain normal fluid and electrolyte balance.

biotin and thiamine as well as the hormone.Sulfur Integral part of vitamins. development reproduction and immunity. Zinc Essential for normal growth. .

vitamins and minerals. . carbohydrates. fats.MALNUTRITION MALNUTRITION An abnormal condition of the body resulting from the lack or excess of one or more nutrients like protein.

Lack of money to buy food Majority of the victims of malnutrition comes from families of farmers. fisherfolk. 2. Lack of information on proper nutrition and food values . Lack of food supply 3.PRIMARY CAUSE: POVERTY 1. and laborers who cannot afford to buy nutritious foods.

b. Bad eating habits 4. Early weaning of child and improper introduction of supplementary food 2. c. lack of potable water lack of sanitary toilet poor waste disposal . Poor hygiene and environmental sanitation: a.SECONDARY CAUSES 1. Incomplete immunization of babies and children 3.

FORMS OF MALNUTRTION 1. Kinds: a.)MARASMUS b. Protein-Energy Malnutrition (PEM) is a nutritional problem resulting from a prolonged inadequate intake of bodybuilding and/or energy-giving food in the diet.) KWASHIORKOR .

She/He: < is always hungry < has the face of an old man < is very thin < easily gets sick < looks weak THIS CHILD IS JUST SKIN AND BONES! .a) MARASMUS This child does not get the right amount and kind of energy food.

AND WATER! . and feet < easily gets sick < has dry. hands. BONES. pale hair < has sores on the skin < has thin upper arms < looks sad < has dry skin < is underweight THIS CHILD IS SKIN. thin. She/He: < has swollen face.b) KWASHIORKOR This child does not get enough body-building food. although she/he may be getting enough energy.

1 Weight is a very important indicator of a person’s nutritional status. . Normally. a malnourished child either decreases in weight or maintains his/her previous weight.  1. It is measured in relation to either AGE or HEIGHT.  1.3 The nutritional status of a person can also be checked by looking for specific signs and symptoms of the different forms of nutritional deficiencies.CHECKING THE NUTRITIONAL STATUS WEIGHT  1. a wellnourished child gains weight as she/he grows older.2 On the other hand.

 1. and hands and pockets free of objects.2The same type of scale should be used for subsequent weighing. with no shoes.3Observe the proper maintenance of the weighing scale.  1. IMPORTANT:  1. clogs or slippers on.4Do not use a bathroom scale to avoid inaccurate readings of weight.  1.1Weigh the child in minimal clothing. .

< ADVISE PARENTS AND THE WHOLE COMMUNITY ABOUT BETTER NUTRITION AND PROPER FEEDING ESPECIALLY OF INFANTS. < VISIT THE MALNOURISHED CHILD REGULARLY AND MONITOR HIS/HER WEIGHT. CHILDREN AND SICK PERSONS. .< BRING THE MALNOURISHED CHILD TOGETHER WITH THE PARENTS TO THE HEALTH CENTER FOR PROPER NUTRITIONAL ADVICE AND TREATMENT.

4. lean meat. 6. 3. and root crops. 5. Maintain children’s normal growth through proper diet and monitor their growth regularly. give appropriate foods while continuing breastfeeding. fruits. 2. . Eat more vegetables. Eat foods cooked in edible/cooking oil daily. and then.NUTRITIONAL GUIDELINES 1. Eat a variety of food everyday. poultry or dried beans. Breastfeed infants exclusively from birth to 46 months. Consume fish.

Use iodized salt. Eat clean and safe food.7. do not smoke. avoid excessive intake of salty foods 9. exercise regularly. For a healthy lifestyle and good nutrition. 8. Use iodized salt. milk products or other calcium-rich foods such as small fish and dark green leafy vegetables everyday. 10. . avoid drinking alcoholic beverages. Consume milk. but avoid excessive intake of salty foods.

This will help correct the common practice of confining of choice to a few kinds of foods. 1 is intended to give the message that no single food provides all the nutrients the body needs. Choosing different kinds of foods from all food groups is the first step to obtain a wellbalanced diet. .AIMS AND RATIONALE OF EACH OF THE GUIDELINES Guideline No. resulting in an unbalanced diet.

Guidelines No. Malnutrition most commonly occurs between the age of 6 months to 2 years.2 is entitled to promote exclusive breastfeeding from birth to 4-6 months and to encourage the continuance of breastfeeding for as long as two years or longer. This is to ensure a complete and safe food for the newborn and the growing infant besides imparting the other benefits of breastfeeding. . therefore there is a need to pay close attention to feeding the child properly during this very critical period. The guideline also strongly advocates the giving of appropriate complementary food in addition to breast milk once the infant is ready for solid foods at 6 months.

3 gives advise on proper feeding of children.Guideline No. as it is a simple way to assess nutritional status. . the guideline promotes regular weighing to monitor the growth of children. In addition.

5. Eating more vegetables. minerals and dietary fiber that are deficient in our diet. key nutrients lacking in the diet of Filipinos as a whole.6 and 7 are intended to correct the deficiencies in the current dietary pattern of Filipinos. In addition. . as well as iron and zinc. which will provide good quality protein and dietary energy. poultry and dried beans. lean meat.Guidelines No. 4. fruits and root crops will supply the much needed vitamins. Including fish. Including foods cooked in edible oils will provide additional dietary energy as a partial remedy to calorie deficiency of the average Filipino. they provide defense against chronic degenerative diseases. Including milk and other calcium-rich foods in the diet will serve to supply not only calcium for healthy bones but to provide high quality protein and other nutrients for growth.

. 8 promotes the use of iodized salt to prevent iodine deficiency. which is a major cause of mental and physical underdevelopment in the country. At the same time. the guideline warns against excessive intake of salty foods as a hedge against hypertension. particularly among high-risk individuals.Guideline No.

9 is intended to prevent food-borne diseases.Guideline No. . It explains the various sources of contamination of our food and simple ways to prevent it from occurring.

Guideline No. 10 promotes a healthy lifestyle through regular exercise. it must be done in moderation. . All these lifestyle practices are directly or indirectly related to good nutrition. If alcohol is consumed. abstinence from smoking and avoiding consumption.Finally.

E and K. iron.NUTRIENTS IN FOOD Nutrients are chemical substances present in the foods that keep the body healthy. zinc. carbohydrates and fats. . namely. and provide energy for work and physical activities. The major nutrients include the macronutrients. the micronutrients. iodine. the B complex vitamins and C and minerals such as calcium. supply materials for growth and repair of tissues. namely vitamins such as A. proteins. fluoride and water. D.

. mental and social well-being and not merely the absence of disease/ infirmity in all matters relating to the reproductive system and to its functions and processes.a state of complete physical.Reproductive Health  .

 Basic RH Rights  Right to RH information and health care services for safe pregnancy and childbirth  Right to know different means of regulating fertility to preserve health and where to obtain them  Freedom to decide the number and timing of birth of children  Right to exercise satisfying sex life .

poverty. living condition/ environment. employment. right to be free from torture and ill treatment and to participate in politics  Social and Gender Issues  Biological (individual knowledge of reproductive organs and their functions). RH practices) and psychosocial factors . nutrition. Factors/ determinants of RH  Socioeconomic conditions – education. cultural (country’s norms. family environment  Status of women – equal right in education and in making decisions about her own RH.

HIV and AIDS  Education and Counseling on Sexuality and Sexual Health . Elements  Maternal and Child Health Nutrition  Family Planning  Prevention and Management of Abortion Complications  Prevention and Treatment of Reproductive Tract Infections. including STDs.

 Elements  Breast and Reproductive Tract Cancers and other Gynecological Conditions  Men’s Reproductive Health  Adolescent Reproductive Health  Violence Against Women  Prevention and Treatment of Infertility and Sexual Disorders .

 Selected Concepts  RH is the exercise of reproductive right with responsibility  It means safe pregnancy and delivery. the right of access to appropriate health information and services  It includes protection from unwanted pregnancy by having access to safe and acceptable methods of family planning of their choice  It includes protection from harmful reproductive practices and violence  It ensure sexual health for the purpose of enhancement of life and personal relations and assures access to information on sexuality to achieve sexual enjoyment .

injuries and disabilities related to sexuality and reproduction  To receive appropriate counseling and care of RH problems . Goal  To achieve healthy sexual development and maturation  To achieve their reproductive intention  To avoid diseases.

 Strategies  Increase and improve the use of more effective or modern contraceptive methods  Provision of care. men and unmarried and other displaced people with RH problems  Strengthen outreach activities and referral system  Prevent specific RH problems through information dissemination and counseling of clients . treatment and rehabilitation for RH  RH care provision should be focused on adolescents.

schistossomiasis. malaria. Other sanitation related diseases : tuberculosis. Diarrheal diseases ranked second in the leading causes of morbidity among the general population.HEALTH AND SANITATION Environmental Sanitation is still a health problem in the country. infectious hepatitis. intestinal parasitism. filariasis and dengue hemorrhagic fever .

. 1978).DOH thru’ Environmental Health Services (EHS) unit is authorized to act on all issues and concerns in environment and health including the very comprehensive Sanitation Code of the Philippines (PD 856.

WATER SUPPLY SANITATION PROGRAM EHS sets policies on:  Approved types of water facilities  Unapproved type of water facility  Access to safe and potable drinking water  Water quality and monitoring surveillance  Waterworks/Water system and well construction .

Approved type of water facilities  Level 1 (Point Source).  serves 15-25 households.a protected well or a developed spring with an outlet but without a distribution system  indicated for rural areas. its outreach is not more than 250 m from the farthest user  yields 40-140 L/ min .

Level II ( Communal Faucet or Stand Posts)  With a source. piped distribution network and communal faucets  Located at not more than 25 m from the farthest house  Delivers 40-80 L of water per capital per day to an average of 100 households  Fit for rural areas where houses are densely clustered . reservoir.

Level III ( Individual House Connections or Waterworks System)  With a source. reservoir. piped distributor network and household taps  Fit for densely populated urban communities  Requires minimum treatment or disinfection .

which may exercise a deleterious effect on his health. well-being and survival.ENVIRONMENTAL SANITATION . .the study of all factors in man’s physical environment.

11 Stream pollution .7 Air pollution 1.2 Food sanitation 1.3 Refuse and garbage disposal 1.Includes: 1.1 Water sanitation 1.4 Excreta disposal 1.5 Insect vector and rodent control 1.6 Housing 1.10 Institutional sanitation 1.9 Radiological Protection 1.8 Noise 1.

g. pour flush toilet & aqua privies . reed odorless earth closet.g.pit latrines.PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM EHS sets policies on: Approved types of toilet facilities : LEVEL I ◙ Non-water carriage toilet facility – no water necessary to wash the waste into receiving space e. ◙ Toilet facilities requiring small amount of water to wash the waste into the receiving space e.

.LEVEL II – on site toilet facilities of the water carriage type with water-sealed and flush type with septic vault/tank disposal.

LEVEL III – water carriage types of toilet facilities connected to septic tanks and/or to sewerage system to treatment plant. .

FOOD SANITATION PROGRAM -sets policy and practical programs to prevent and control food-borne diseases to alleviate the living conditions of the population .

Hospitals shall dispose their hazardous wastes thru incinerators or disinfectants to prevent transmission of nosocomial diseases .HOSPITAL WASTE MANAGEMENT PROGRAM Disposal of infectious. pathological and other wastes from hospital which combine them with the municipal or domestic wastes pose health hazards to the people.

climate change and other conditions) . Prevention of serious environmental hazards resulting from urban growth and industrialization 2.PROGRAM ON HEALTH RISK MINIMIZATION DUE TO ENVIRONMENTAL POLLUTION Foci: 1. policies on health protection measures 3. researches on effects of GLOBAL WARMING to health (depletion of the stratosphere ozone layer which increases ultraviolet radiation.

.  The Occupational Health Nurse. School Health Nurse and other Nursing staff shall impart the need for an effective and efficient environmental sanitation in their places of work and in school.NURSING RESPONSIBILITIES AND ACTIVITIES  Health Education – IEC by conducting community assemblies and bench conferences.

.  Effectively and efficiently coordinate programs/projects/activities with other government and non-government agencies.  Act as an advocate or facilitator to families in the community in matters of program/projects/activities on environmental health in coordination with other members of Rural Health Unit (RHU) especially the Rural Sanitary Inspectors. Actively participate in the training component of the service like in Food Handler’s Class. and attend training/workshops related to environmental health.  Assist in the deworming activities for the school children and targeted groups.

Ex. parks drainage and other projects. beautification of home garden. .  Be a role model for others in the community to emulate terms of cleanliness in the home and surrounding. Actively participate in environmental sanitation campaigns and projects in the community. Sanitary toilet campaign drive for proper garbage disposal.

Prevention and Control of Kidney Disease  5. 4. Program on Drug Dependence/ Substance Abuse . Program on Mental Health and Mental Disorders  6.

 7. handicapped persons.  Goal: To improve the quality of life and increase productivity of disabled. . which involves measures taken at the community level to use and build on the resources of the community with the community people. disabled and handicapped persons as well.  Aim: To reduce the prevalence of disability through prevention.Community-Based Rehabilitation Program  A creative application of the primary health care approach in rehabilitation services. early detection and provision of rehabilitation services at the community level. including impaired.

income. Program on the Elderly/Geriatric Nursing Services  7 humanitarian issues: family. education. culltural activities and housing . 8. social welfare. recreation. health. employment and labor. security.

of the heart. malaria. TB. diseases. pneumonia. chickenpox .Leading causes of illness:elderly     Influenza. malignant neoplasm. diarrhea. HPN. bronchitis.

TB. CCOPD Malignant neoplasms Diabetes Nephritis Accidents .Leading causes of death:elderly       Diseases of heart and vascular system Pneumonia.

 9. Deafness and Osteoporosis  Cataract. highest bet.main cause of childhood blindness. most serious eye problem of Fil. old. old  Osteoporosis special problem in women. children below 6 yrs. 50—79 yrs. MENOPAUSEmain cause .main causes of blindness  VAD. Programs on Blindness.

. iwas stress. watch wt. avoidance of alcohol. high fiber diet  Mag HL – exercise. low fat.Prevention of NCD/Role of Nursing in Health Promotion And Advocacy  Yosi Kadiri. no smoking.anti smoking  Edi Exercise/Hataw-regular physical activity  Tiya Kulit/ Iwas Sakit Diet-low salt. healthy diet.

LGUs – direct implementers of health programs & prime developers of health centers and hospitals making services accessible to every Filipino .: 1.Sentrong Sigla Movement ( SSM) -a certification recognition program which develops and promotes standards for health facilities .DOH – provides technical and financial assistance packages for health care 2.Joint effort bet.

Health Promotion 4. Grant and Technical Assistance 3.Pillars of SSM     1. Awards . Quality Assurance 2.

Expected Outcome: SSM  Empowered individuals adopting healthy lifestyle. institute system for surveillance/ merits and advocate for laws . provide quality services . improved health-seeking behavior and well-being & increased demand for quality health services  Institutions will develop policies.

iodine      . Oil and sugar – Vit. A.Programs: SSM EPI Disease Surveillance CARI CDD Nutrition/ Micronutrient Supplementation*Food Fortification : Rice –iron. Flour-Vit. Salt. A & iron.

DHF.Integrated Management of Childhood Illness ( IMCI)  Integrates management of most common childhood problems ( diarrhea. malaria)  Involves family members and community in the health care process for physical growth and mental development & disease prevention . measles. malnutrition. pneumonia.

 Programs on Measles.
Chickenpox, Mumps,
Diphtheria, Pertusis, Tetanus
–focused on health
information campaigns and
intensive immunization of
children in barangays.

Other CHN Practice
Settings
 I. Occupational Health
 - the application of public health, medical and
engineering practice for the purpose of
conserving, restoring the health and
effectiveness of workers thru their places of
employment
 A. Occupational Health Nursing
 - the application of nursing principles and
procedures in providing health service to
employees in their place of work by means of:

 1. prompt and efficient nursing care of the
ill and impaired
 2. participation in teaching health and
safety practices on the job
 3. cooperation with plant department
administrators
 4.keeping the health clinic and staff ready
to handle emergencies
 5. advising workers in the utilization of
community and welfare services

Objectives of OHN
 To assist, maintain and promote positive
health of laborers and employees thru
early detection and prevention of
occupational diseases and hazards of
industrial processes and by coordinating
and cooperating with activities of other
community health and welfare services

Nurse’s Role in OHN
 1. Assists/participates in developing an adequate
health program for workers and laborers including
sound health education activities
 2. Encourages periodic P.E.
 3. Cooperates with occupational medical
programs in the prevention of accidents
as
well as in the promotion of good working
atmosphere and relationships in the place of work
 4. Helps in teaching others in giving good nursing
care to the sick or handicapped in their own
homes

EDUCATION  3. ENVIRONMENT . II. SERVICE  2. School Health Nursing  School Health Triad :  1.

 Mission of School Health Program: To maximize potential for learning and participation in the educational process by promoting optimum health of school-age children and adolescents .

 School Health Team:       Psychologist/ Counselor Teacher Nutritionist Nurse Social Workers Maintenance Personnel .

 Targets in SHN      Family Students Teachers Supportive Personnel Community .

FAMILY AND STAFF ADVOCATE/CHANGE AGENT  HEALTH SCREENER  HEALTH CARE PROVIDER    . School Health Nurse’s Roles: EDUCATOR CONSULTANT /RESEARCHER STUDENT.

pimples/acne. allergies 6. Teenage Pregnancies 4. fungal infections. Respiratory Conditions. Dental Health . URTI 7. Nutrition 8. STDs/STIs 3.asthma. Dermatological Disorders.Drug and Alcohol Abuse 2. Mental Health 5. Common Health Concerns of Schoolchildren: 1.

why should I give up my nature to love just because it’s the nature of the scorpion to sting?” . It’s my nature to love.  The man still tried to get the scorpion out of the water but the scorpion stung him again. There was a man who saw a scorpion floundering around in the water.  He decided to save it by stretching out his finger but the scorpion stung him.  Another man nearby told him to stop saving the scorpion but the man said. “It’s the nature of the scorpion to sting.