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

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
2. Code of Ethics for Government
Workers
3. WHO, DOH, LGU policies on health
4. Local Government Code
5. Issues

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 .

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.The Code aims to transform local government units into self-reliant 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.R. . 7160 .A. Hence.or the Local Government Code. each province. functions and responsibilities to the local government both rural & urban.

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

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

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

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

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

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

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

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

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

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

 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 .

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

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

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

O..madates Liver Cancer and Hepatitis B Awareness Month Act ( February) .defines the Implementing guidelines on Hepatitis B Immunization for Infants  R. 2006. No.A. 2029.0015. A.mandates Compulsory Hepatitis B Immunization among infants and children less than 8 yrs old  R. 7846.A.

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

prolonging life. so organizing these benefits as to enable every citizen to realize his birthright off birth and longevity” ( DR. control of communicable diseases.E. promoting health and efficiency thru’ organized community effort for the sanitation of the environment. 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. Winslow) . C.Public Health  -” science and art of preventing diasease.

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

schools .a service rendered by a professional nurse to IFCs.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  . Freeman) . preventionof illness. care of the sick at home and rehabilitation (DR. clinics. workplace for the promtion of health. population groups in health centers. Ruth B.

and community health organizations) is used.  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. Concepts  The primary focus of community health nursing is health promotion. clinical nursing. .  Nursing process in community health nursing changes based on the needs of the community.

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

The family is the unit of service.3. There must be provision for periodic evaluation of community health nursing services 7. CHN must be available to all regardless of race. 4.creed and socioeconomic status 5. 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. The CHN makes use of available community health resources .

There should be accurate recording and reporting in community health nursing 12. There must be provision for educative supervision in community health nursing 11. 9. 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 .Standards in CHN I. Theory Applies theoretical concepts as basis for decisions in practice II.

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

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

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.

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

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

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

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

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

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

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. . especially the poor.

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

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 must be ensured.
2. The health and nutrition of vulnerable
groups must be prioritized.
3. The epidemiological shift from infection
to degenerative diseases must be
managed.
4. 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 .

Russia (USSR) The Alma Ata Declaration stated that PHC was the key to attain the “health for all” goal . 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.  September 6-12. 1978 .First International Conference on PHC in Alma Ata.

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

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 .

a practical approach to making health benefits within the reach of all people. through their full participation and at cost that the community can afford at every stage of development. an approach to health development. 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. . DEFINITION OF PRIMARY HEALTH CARE  essential health care made universally accessible to individuals and families in the community by means acceptable to them.

accessible. which the community and the government can afford. at a cost. 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. and sustainable.permeate as the core strategy in the effective provision of essential health services that are community based.  KEY STRATEGY TO ACHIEVE THE GOAL: Partnership with and Empowerment of the people . An improved state of health and quality of life for all people attained through SELF-RELIANCE. . acceptable.

  Maximizing the contribution of the other sectors for the social and economic development of the community.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. .   Improvement in Basic Sanitation   Development of the capability of the community aimed at self- reliance.   Extension of essential health services with priority given to the underserved sectors.  Reduction in morbidity and mortality rates especially among infants and children.

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

Availability. wherein the focus would be more on health promotion and prevention of illness.  2. Appropriateness of health services. 4 A's = Accessibility. Affordability & Acceptability.PRINCIPLES OF PRIMARY HEALTH CARE  1. The health services should be present where the supposed recipients are. They should make use of the available resources within the community. COMMUNITY PARTICIPATION =heart and soul of PHC .

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

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 non- government organization and people’s organization.4.Partnership between the community and the health agencies in the provision of quality of life.SELF-RELIANCE 5.

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

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

families and communities to make decisions of their health is really the desired outcome.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. ELEVATING HEALTH TO A COMPREHENSIVE AND SUSTAINED NATIONAL EFFORTS. Empowerment to parents.  Attaining Health for all Filipino will require expanding participation in health and health related programs whether as service provider or beneficiary. budgetary and logistical considerations.

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. .B.

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

. 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.

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

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

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.

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

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. . The goal of Family Planning includes spacing of children and responsible parenthood.

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. Safe Water and Sanitation is necessary for basic promotion of health. Water is a basic need for life and one factor in man’s environment. which exercise or may exercise deleterious effect on his well-being and survival.

. There are many food resources found in the communities but because of faulty preparation and lack of knowledge regarding proper food planning. And if food is properly prepared then one may be assured healthy family.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.

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

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

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

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

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

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

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

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

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

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

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

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

Educational attainment of each other 3.  Socio-economic and Cultural Characteristics 1. Ethnic background and religious affiliation . Income and Expenses  Occupation. 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.

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

sanitary condition . ownership.  Home and Environment 1. portability  Toilet facility – 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. sanitary condition  Drainage system – type. ownership.

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

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

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

Results of laboratory/ diagnostic and other screening procedures supportive of assessment findings . Physical assessment indicating presence of illness state/s 6.5.

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

A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE .

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. Presence of Wellness Condition – stated as Potential or Readiness. Readiness for enhanced wellness state is a nursing judgment on wellness state or condition based on client’s current competencies or performance. 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. .

Potential for Enhanced Capability for:  Healthy lifestyle – e. 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. Examples of these are the following: 1. nutrition/diet.g. .

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

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

3. and medicines improperly kept  Fire hazards . Family size beyond what family resources can adequately provide 4. poison. Accidental hazards  Broken stairs  Sharp objects.

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

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

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

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 .8.

Lack of immunization/ inadequate immunization status specially of children .10. father not assuming his role 13. previous history of difficult labor 12.Inappropriate role assumption – e. e.g. child assuming mother's role.g.g.Inherent personal characteristics – e.Health history which induce the occurrence of a health deficit. poor impulse control 11.

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

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

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

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

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

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. to be used only within the room of the sick member 4. ISOLATION TECHNIQUE IN THE HOME -done by : 1. 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. wearing a protective gown .

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

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

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

groups. and in 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. in the school. . and the community.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Public Health Programs .

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

6. IDD/IDA (Iodine Deficiency Disorders/ Iron Deficiency Anemia) 10. MRP (Malnutrition Rehabilitation Program) 8. BF (Breastfeeding) 7. VAD ( Vitamin A Deficiency) 9.FP (Family Planning) .

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 .PREGNANT AND POST PARTUM WOMEN 3. EPI (EXPANDED PROGRAM ON IMMUNIZATION)  TARGET SETTING: 1.

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

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

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

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

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

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

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

All infants born to that mother will be protected.5ml Route: Intramuscularly Site: Right or Left Deltoid/Buttocks . Dose:0.TT5 At least 1 year 99% Gives later 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. . Studies have shown the mortality and morbidity are high among this age group. The Department of Health established the Under Five Clinic Program to address this problem.

 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.

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

 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. infant formulas.ACTIVITIES AND STRATEGIES: 1. 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. ) . breast milk substitutes. teats etc. feeding bottles.g.

B. education and re-education drive =Sanction and Regulation . =Information. 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 breast- feeding. =Provision for human milk bank.

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 factor- promotes growth of the Lactobacillus- inhibits the growth of pathogenic bacilli .

Football Hold  3. 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. Cradle Hold = head and neck are supported  2.

 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. WHAT ARE THE HEALTH SERVICES OFFERED IN GP AND WHO ARE THE TARGETS? GP offers the following: 1. 1.1 Routine Health Services: .

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

Ferrous Sulfate (25 mg. medicine with a day instructions) . once a day drops Mindanao area.3ml(2-6 Orally 2-11 months old Elemental mos) by infants in Iron per ml.6ml(6. 30 ml. Bottle including as taken evacuation 0. 0. centers in armed home 11mos) once conflict areas.

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

Deworming drug (if available) 1 tablet 36-59 mos. Orally as nationwide single dose Weighing 0-59 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. 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. deficiency. * The child should not have received megadose of Vit. .

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

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

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

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

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

 Why is there a Need to Give Complementary Foods? c.given progressively until the child is used to three meals and in-between feedings at the age of one year. 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.

c. 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. Breastfeeding. 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. should continue for as long as the mother is able and has milk which could be as long as two years . however.

Give bite-sized fruit separately d.Prepare mixture of thick lugao/ cooked rice. b. Egg yolk. mashed beans. flaked fish/chicken/ground meat and oil.Give mixture by teaspoons 2-4 times daily. How to Give Complementary Foods for Babies 6-11 Months Old? a.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. soft cooked vegetables.

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. education and services. . GOALS AND OBJECTIVES:  Universal access to family planning information. 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.

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

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

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

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

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

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 .

Proper nutrition is important because:  it helps in the development of the brain.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.  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 . especially during the first years of the child’s life.

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.

mongo. bean curd. clams . pork. 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.THE THREE (3) BASIC FOOD GROUPS ARE: 1. peanuts. beef. kidney beans. shrimp. cheese. chicken.

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. banana. cooking oil. cassava. sugar cane. sweet potato. 2. butter . coconut milk. bread. honey. lard. margarine. corn.

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

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

steam. poultry and fish/ meal 9. Aim for thin palm-size serving of lean meat. try not to fry 10. remove skin from chicken fat drippings and cream sauces 8. stew.it’s a food quencher . Grill. sausage rolls or breaded meats 7. Drink lots of water all day.6. Cut all visible fat from meat. bake. Eat less high fat snacks and take away potato chips. stir –fry and microwave.

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

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

IMPORTANT VITAMINS AND MINERALS .

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

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

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

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

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

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

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

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

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

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

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

saluyot. eggs. alugbati . Food sources: Pork. dried dilis. shrimp. liver and other internal organs. pechay. chicken. It Iron 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. Essential in the formation of blood. beef.

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

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

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

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

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

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

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

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

FORMS OF MALNUTRTION 1.)MARASMUS b. Kinds: a. Protein-Energy Malnutrition (PEM) is a nutritional problem resulting from a prolonged inadequate intake of body- building 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! . pale hair < has sores on the skin < has thin upper arms < looks sad < has dry skin < is underweight THIS CHILD IS SKIN. although she/he may be getting enough energy. hands.b) KWASHIORKOR This child does not get enough body-building food. BONES. She/He: < has swollen face. thin. and feet < easily gets sick < has dry.

. a well- nourished child gains weight as she/he grows older. a malnourished child either decreases in weight or maintains his/her previous weight.  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.  1.1 Weight is a very important indicator of a person’s nutritional status. Normally.2 On the other hand. It is measured in relation to either AGE or HEIGHT.CHECKING THE NUTRITIONAL STATUS WEIGHT  1.

 1. with no shoes.2The same type of scale should be used for subsequent weighing.  1. . clogs or slippers on.  1.1Weigh the child in minimal clothing. and hands and pockets free of objects. IMPORTANT:  1.3Observe the proper maintenance of the weighing scale.4Do not use a bathroom scale to avoid inaccurate readings of weight.

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

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

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

. AIMS AND RATIONALE OF EACH OF THE GUIDELINES Guideline No. This will help correct the common practice of confining of choice to a few kinds of foods. resulting in an unbalanced diet. 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 well- balanced diet.

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. .Guidelines No.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. Malnutrition most commonly occurs between the age of 6 months to 2 years. therefore there is a need to pay close attention to feeding the child properly during this very critical period.

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

which will provide good quality protein and dietary energy. In addition. . they provide defense against chronic degenerative diseases. poultry and dried beans. lean meat. Eating more vegetables. Including fish. 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.Guidelines No.6 and 7 are intended to correct the deficiencies in the current dietary pattern of Filipinos. Including foods cooked in edible oils will provide additional dietary energy as a partial remedy to calorie deficiency of the average Filipino. key nutrients lacking in the diet of Filipinos as a whole. 4.5. minerals and dietary fiber that are deficient in our diet. fruits and root crops will supply the much needed vitamins. as well as iron and zinc.

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

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.

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

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

Reproductive Health  . 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. .

 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 .

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). nutrition. employment. cultural (country’s norms. Factors/ determinants of RH  Socioeconomic conditions – education. RH practices) and psychosocial factors . poverty. family environment  Status of women – equal right in education and in making decisions about her own RH. living condition/ environment.

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

 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 .

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 . Selected Concepts  RH is the exercise of reproductive right with responsibility  It means safe pregnancy and delivery.

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.

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

.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. 1978).

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 .

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

reservoir. 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 .Level II ( Communal Faucet or Stand Posts)  With a source.

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

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

9 Radiological Protection 1.11 Stream pollution . Includes: 1.5 Insect vector and rodent control 1.10 Institutional sanitation 1.4 Excreta disposal 1.3 Refuse and garbage disposal 1.1 Water sanitation 1.8 Noise 1.7 Air pollution 1.2 Food sanitation 1.6 Housing 1.

g.g. reed odorless earth closet. ◙ Toilet facilities requiring small amount of water to wash the waste into the receiving space e. pour flush toilet & aqua privies .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.pit latrines.

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 .

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. Hospitals shall dispose their hazardous wastes thru incinerators or disinfectants to prevent transmission of nosocomial diseases .

Prevention of serious environmental hazards resulting from urban growth and industrialization 2. climate change and other conditions) . 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.

. NURSING RESPONSIBILITIES AND ACTIVITIES  Health Education – IEC by conducting community assemblies and bench conferences. 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.  The Occupational Health Nurse.

 Assist in the deworming activities for the school children and targeted groups. Actively participate in the training component of the service like in Food Handler’s Class.  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.  Effectively and efficiently coordinate programs/projects/activities with other government and non-government agencies. and attend training/workshops related to environmental health. .

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

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

handicapped persons. disabled and handicapped persons as well.  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. .  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. 7.

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

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

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

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

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

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

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

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

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

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

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

 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 .

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

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

 The man still tried to get the scorpion out of the water but the scorpion stung him again.  Another man nearby told him to stop saving the scorpion but the man said. “It’s the nature of the scorpion to sting. why should I give up my nature to love just because it’s the nature of the scorpion to sting?” . 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. It’s my nature to love.