RATIONALE _ CHN _

PREBOARDS
Prioritizing Family Nursing
Problems
●
Wellness, HD
Nature of the problem ●
HT, FC

●
the probability of success in minimizing, alleviating or
Modifiability of the Problem totally eradicating the problem

Preventive Potential the nature and magnitude of future problems that can be minimized or totally
●

prevented if intervention is done on the problem under consideration

Salience the family’s perception and evaluation of the problem in terms

●

of seriousness and urgency of attention needed

#1… Factors Affecting MODIFIABILITY OF THE
PROBLEM

Current knowledge,
technology and Resources of
interventions to
manage the problem the family

Resources Resources of
of the nurse the community
# 2… Factors in Considering the Preventive
Potential

Gravity and
severity
●
Progress and extent

Duration ●
Length of time
Current
Presence and appropriateness
●
management

Exposure to any
high risk group
●
Increases the PP
# 3… Nature of the Problem
1. WELLNESS
2. HEALTH DEFICIT
3. HEALTH THREAT
4. FORESEEABLE CRISIS / STRESS POINT
# 5 … HOME VISIT Guidelines
1) Greet and introduce self. 7. Perform PA  well to
2) Explain the purpose. infectious member.
3) Ask about health status. 8. Provide health
4) Inquire about health and teachings / counselling.
welfare of the ct and 9. Make appropriate
other family members. referral.
5) Place PHN bag in a 10. Do cleansing of
convenient place. equipment.
11. Make an appointment.
12. Record.
 #7… TOILET FACILITIES
LEVEL 1 LEVEL 2 LEVEL 3
A. Non – water carriage On site toilet facilities Water carriage types of
toilet facility of the water carriage toilets
type
-NO WATER IS USED Connected to sewerage
TO FLUSH!!! With water sealed and system to plant for tx
flush type
-EX: PIT LATRINES
With septic tank
B. Small amount of disposal system
water required to flush
the waste

-EX: POOR FLUSH

TOILET, AQUA PRIVIES
 #8… WATER FACILITIES (from PD 856)
LEVEL 1 (Point Source) LEVEL 2 (Communal LEVEL 3 (Waterworks
Faucet System / System or Individual
Standpost) House Connection)
Protected well or a Composed of a With source, reservoir,
developed spring with an source/reservoir, piped piped distribution
outlet but without a distribution network and network and household
distribution system communal faucets, taps
located not more than 25
Rural areas m from the farthest Quality water
house
15 – 25 households,
outreach must not be Rural area
more than 250m from
farthest user 40 – 80 L/ head / day :
1faucet: 4-6household
40 – 140 L/min
RA 9275
 CLEAN WATER ACT 2004
 Unapproved type of water facilities:
 Open dug wells
 Unimproved springs and wells
 Examination of drinking H2O: performed only by LABS acc.
By DOH
 Certification of Potability of wells as source: granted/issued by
Sec. of DOH/representative
 Construction of WELLS: comply with standards of DOH
 No booster pump shall be allowed to boost water from
distribution pipe
 LEVEL 3: preferred
#9… Solid Waste Management RA 9003

 Sec. 21.
 Mandatory Segregation of Solid Wastes. - The LGUs
shall evaluate alternative roles for the public and
private sectors in providing collection services, type of
collection system, or combination of systems, that best
meet their needs: Provided, That segregation of wastes
shall primarily be conducted at the source, to include
household, institutional, industrial, commercial and
agricultural sources: Provided, further; That wastes
shall be segregated into the categories provided in Sec.
22 of this Act.
 (a) provide for the residents a designated area and
containers in which to accumulate source separated
recyclable materials to be collected by the
municipality or private center; and
 (b) notify the occupants of each buildings of the
requirements of this Act and the regulations
promulgated pursuant thereto.
• Sec. 22. Requirements for the Segregation and Storage
of Solid Waste. - The following shall be the minimum
standards and requirements for segregation and storage
of solid waste pending collection:
• (a) There shall be a separate container for each type of
waste from all sources: Provided, That in the case of
bulky waste, it will suffice that the same be collected
and placed in a separate designated area; and
• (b) The solid waste container depending on its use shall
be properly marked or identified for on-site collection
as “compostable”, “non-recyclable”, “recyclable” or
“special waste”, or any other classification as may be
determined by the Commission.
 GREEN BLACK YELLOW ORANGE

WET NON – DRY NON - INFECTIOUS / TOXIC /

PATHOLOGIC PATHOLOGIC PATHOLOGIC HAZARDOUS!
WASTES WASTES WASTES
# 10… SENTRONG SIGLA MOVEMENT

 a certification recognition program which develops

and promotes standards for health facilities
 CENTER FOR HEALTH VITALITY

 Joint effort bet.:

1.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
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
Programs: SSM
 EPI
 Disease Surveillance

 CARI

 CDD

 Nutrition/ Micronutrient Supplementation-

*Food Fortification :
Rice –iron; Oil and sugar – Vit. A;
Flour-Vit. A & iron; Salt- iodine
# 13 … Botika ng Barangay
 A.O # 23-a, July 5, 1996
 Outlines the guidelines in establishing the BnB
 BnB – drug outlet managed by legitimate community
organization, NGO and the LGU with a trained
operator and a supervising pharmacist.
 Licensed by BFAD to sell, distribute OTC or generics
 2000 = pharma 50 = cutting the prices into 50%
Goal of BnB
 Promote equity in health by ensuring the
availability and accessibility of AHSE
medicines with priority for marginalized,
underserved, critical and hard to reach
areas.
CBQ tips… CRITERIA
1) Managed by: CO or Cooperative duly recognized by a
judicial body
2) Coverage: 1-more adjacent brgys, far-flung, no licensed
drug stores
3) Source of funds: 1/3 = community funded
4) LGU = 1/3
5) Master list of indigents
6) Commitment from a licensed pharmacist
7) 2 accredited BHWs
8) Available space
# 14… Bag Technique
 a tool making use of public health bag through which
the nurse, during his/her home visit, can perform
nursing procedures with ease and deftness, saving
time and effort with the end in view of rendering
effective nursing care.
 Public health bag
 is an essential and indispensable equipment of the public
health nurse which he/she has to carry along when he/she
goes out home visiting. It contains basic medications and
articles which are necessary for giving care.
 Rationale
 To render effective nursing care to clients and /or
members of the family during home visit.
Principles
1. The use of the bag technique should minimize if not totally
prevent the spread of infection from individuals to families,
hence, to the community.
2. Bag technique should save time and effort on the part of the
nurse in the performance of nursing procedures.
3. Bag technique should not overshadow concern for the patient
rather should show the effectiveness of total care given to an
individual or family.
4. Bag technique can be performed in a variety of ways depending
upon agency policies, actual home situation, etc., as long as
principles of avoiding transfer of infection is carried out.
 STEPS IN BAG TECHNIQUE… CBQs

 Close bag
Place the bag,
linedplace
with itclean
in one
paper
corner
clean
of side
the working
out (foldedareapart
 touching
Perform NSG the table).
Care/txPut the bag’s handles or strap beneath
the bag.
 Clean all things after usage
 Ask for basin of water
 Open bag, return all things
 Open bag, take out soap and towel. Wash hands. Leave the
 Remove apron folding
plastic wrappers of theaway
towelfrom the body,
in a soap dish with
in thesoiled
bag.
sidefolded inwards, and the clean side out. Place it in the
 Put on apron right side out and wrong side with crease touching the
bag.
body, sliding the head into the neck strap. Neatly tie the straps at the
 Fold Put
back. lining,
out place inside the
all necessary bag
articles
 Record
 Set appointment
# 15… OHN
 Based in commercial and industrial establishments
 Concerned with the promotion of health and
prevention of disease among adult workers and
their families in the commercial and industrial
establishments
 CONCENTRATION:
 Health and wellbeing of the employees
ACTIVITIES OF OHN
1) Observation / assessment of worker and working env’t
2) Interpretation and evaluation of the worker’s medical and
occupational hx, PE, industrial hygiene and personal
exposure
3) Interpretation of medical dx
4) Appraisal of working env’t for potential exposures
5) Identification of abnormalities
6) Description of worker’s response to exposures
7) Occupational and non – occupational injuries
8) Documentation
 # 17… 10 ELEMENTS OF RH
1)
6) Breastnutrition
MCH Ca & gyne
2)
7) FP
Men’s RH
3)
8) Abortion complication mgt
VAWC
4)
9) RTI mgt & sexual dse tx
Infertility
5)
10) Sexual
Adolescent
HE Health
# 19… IV
 RA 9173 …
 ARTICLE VI… Nursing Practice
Section 28. Scope of Nursing. - A person shall be deemed to be practicing
nursing within the meaning of this Act when he/she singly or in
collaboration with another, initiates and performs nursing services to
individuals, families and communities in any health care setting. It
includes, but not limited to, nursing care during conception, labor,
delivery, infancy, childhood, toddler, preschool, school age, adolescence,
adulthood, and old age. As independent practitioners, nurses are primarily
responsible for the promotion of health and prevention of illness. A
members of the health team, nurses shall collaborate with other health care
providers for the curative, preventive, and rehabilitative aspects of care,
restoration of health, alleviation of suffering, and when recovery is not
possible, towards a peaceful death. It shall be the duty of the nurse to:
 (a) Provide nursing care through the utilization of the
nursing process. Nursing care includes, but not limited
to, traditional and innovative approaches, therapeutic use
of self, executing health care techniques and procedures,
essential primary health care, comfort measures, health
teachings, and administration of written prescription for
treatment, therapies, oral topical and parenteral
medications, internal examination during labor in the
absence of antenatal bleeding and delivery. In case of
suturing of perineal laceration, special training shall be
provided according to protocol established;
 (b) establish linkages with community resources and coordination
with the health team;
 (c) Provide health education to individuals, families and
communities;
 (d) Teach, guide and supervise students in nursing education
programs including the administration of nursing services in varied
settings such as hospitals and clinics; undertake consultation
services; engage in such activities that require the utilization of
knowledge and decision-making skills of a registered nurse; and
 (e) Undertake nursing and health human resource development
training and research, which shall include, but not limited to, the
development of advance nursing practice;
 # 20… LEPROSY Treatment
Etiology MOT IP Dxc S/Sx
M. leprae Respi Months Tissue EARLY
/ droplet -years biopsy Skin color
Skin-to-skin Blood Loss of hair
HANSEN’S
works Skin lesion
BACILLUS Paresthesia
Ulcers that
does not heal
LATE
Lagopthalmos
Madarosis
Clawing of
fingers
Saddle Nose
Contractures
 WHO CLASSIFICATION OF
LEPROSY
 PAUCIBACILLARY / BORDERLINE
MULTIBACILLARY
 Infectious
Non – infectious
 Tuberculoid
Lepromatous
 6 ––930
24 mosmos

12/07/2021 32
PAUCIBACILLARY 6 – 9 mos.
MEDS ADULT 10 – 14 Y/O < 10 Y/O
Monthly Tx
DAY 1 (SD)
Rifampicin 600 mg 450 mg 300 mg

Dapsone 100 mg 50 mg 25 mg

Daily Tx
DAY 2 – 28
(SAD)
Dapsone 100 mg 20 mg 25 mg

12/07/2021 33
34

MEDS ADULT 10 – 14 Y/O

Rifampicin 600 mg 300 mg

Ofloxacin 400 mg 200 mg

Minocycline 100 mg 50 mg

12/07/2021
 MULTIBACILLARY – 24 – 30 mos
MEDS ADULT 10 – 14 Y/O < 10 Y/O
Monthly Tx
DAY 1 (SD)

Rifampicin 600 mg 450 mg 300 mg

Clofazimine 300 mg 150 100 (1x/mo)

Dapsone 100 mg 50 mg 25 mg
Daily Tx
DAY 2 – 28 (SAD)

Clofazimine 50 mg 50 mg qod 50 mg (2x/mo)

Dapsone 100 mg 50 mg 25 mg

12/07/2021 35
# 21-23… MINORITY FAMILY
 Transcultural Nursing - A humanistic and
scientific area of formal study and practice in
nursing which is focused upon differences and
similarities among cultures with respect to human
care, health, and illness based upon the people's
cultural values, beliefs, and practices, and to use
this knowledge to provide cultural specific or
culturally congruent nursing care to
people ... Leininger
Culture
 Culture is made up of the values, beliefs,
underlying assumptions, attitudes, and
behaviors shared by a group of people. Culture is
the behavior that results when a group arrives at a
set of - generally unspoken and unwritten - rules
for working together.
Seven (7) characteristics of culture… Ken Thompson
& Fred Luthans

1. Culture = Behavior.
2. Culture is Learned.
3. Culture is Learned Through Interaction. 
4. Sub-cultures Form Through Rewards - People Shape the
Culture, Culture is Negotiated, Culture is Difficult to Change. 
5. Your work culture is often interpreted differently by
diverse people.
6. Your culture may be strong or weak.
7. Ideally, organizational culture supports a positive,
productive, environment.
 Boyle and Andrews’ proposed measures
in assessing cultural variations
1. History of the origins of the patients' culture. 
2. Value orientations, including view of the world, ethics, and norms and
standards of behavior as well as attitudes about time, work, money,
education, beauty, strength, and change. 
3. Interpersonal relationships, including family patterns, demeanor, and roles
and relationships. 
4. Communication patterns and forms.
5. Religion and magic.
6. Social systems, including economic values, political systems, and
educational patterns.
7. Diet and food habits.
8. Health and illness belief systems, including behaviors, decision making,
and use of healthcare providers. 
Consider the ff in working with MINORITIES

 Familiarize your self with the customs, values, laws and health of the
country you will work in.
 Try the food, listen to the music and if possible talk with people of
that culture before leaving home.
 Learn the language, you can't provide adequate care if you can not
communicate with your patients.
 Learn about the organization under who you will work - purpose,
goals, philosophy, policies
 Remember you will be under other's rules, laws, value system,
customs.
 Can you cope with lack of structure, boredom, change and danger ?
 The right experience may enrich your life immeasurably.
Most important factor to consider in working with
minorities

 Communication
 Space
 Social organizations
 Time
 Environmental control
 Biological variation
# 28… COMPLEMENTARY FEEDING Readiness
to feed

 good rule of thumb is to "Watch the Baby - Not the Calendar

 beginning to awaken more often at night or eat more often
than "usual"
 Loss of extrusion reflex
 32 oz of formula a day or 960 ml and does not seem satisfied
 nursing q 3-4 hrs and does not seem satisfied

 always consult your baby’s pediatrician before introducing

new foods
 WHO recommends that infants start receiving
complementary foods at 6 months of age in
addition to breastmilk, initially 2-3 times a day
between 6-8 months, increasing to 3-4 times daily
between 9-11 months and 12-24 months with
additional nutritious snacks offered 1-2 times per
day, as desired
Guidelines
 Start out slowly - tablespoon sized portion, one
food at a time – 5-7 days b/w items
 using their (clean and washed) finger as a spoon
 eat 1/2 of the tablespoon sized portion the very first
times you begin solids
 Introduce when hungry
 Salt and sugar?
FOODS TO INTRODUCE
 1ST CEREALS (5-  Prevents IDA, less
6MOS), Fe-fortified allergenic, easily
cereal mixed with digested
breast milk, orange
juice, or formula
 VIT.A
 2nd VEGETABLES
(7MOS), FRUITS
 VIT. C, A
(8MOS)  CHON, Fe and B
 3RD MEAT (9MOS)  Fe
 4TH EGGS (10MOS)
 CEREALS
 Rice and Oatmeal cereals are the least of the
allergenic grains and thus most babies are started
out with those cereals. 

 FRUITS
 May be served raw after 8 months old – bananas
and avocados do NOT need to be cooked ever
 VEGGIES
 Always serve cooked until after 12 months old or
when baby can chew well enough so that no
choking hazard is present

 PROTEIN
 Always serve cooked with no pink areas – NEVER
give a small baby/child raw meat or fish
 DAIRY
 NEVER replace breast milk or formula until after
12 months of age – serious health risks are
possible. 
 Never give a child under the age of 2yrs
old low fat or skim milk products; whole milk is
necessary.
Suggested Daily "Milk" Intakes
 0-3 Months of age:
Breastfeed every 1-3 hours or Formula 18-40 ounces
 4-5 Months of age:
Breastfeed every 2-4 hours or Formula 24-45 ounces
 6-8 Months of age:
Breastfeed every 3-4 hours or Formula 24-37 ounces
 9-12 Months of age:
Breastfeed every 4-5 hours or Formula 24-31 ounces
 Whole Cow Milk, as a drink, should not be introduced
until 12 months of age!
# 29: IMCI General Danger Signs
1. Not able to drink or breastfeed
2. Vomits everything
3. Convulsions (during this illness)
4. Abnormally sleepy or difficult to
awaken
51

MAIN SYMPTOMS

 Cough / DOB
 Diarrhea
 Fever
 Ear Problems

12/07/2021
 SELECTING THE APPROPRIATE CASE
MANAGEMENT
52

 Ask the child’s name and  Ask the mother about the
age child’s problem
 Decide which age group the  Check GENERAL
child is in DANGER SIGNS
 Child is 2 mos - 5 yrs:  Ask for FOUR MAIN
“ASSESS AND CLASSIFY SYMPTOMS
THE SICK CHILD AGE 2  When the main symptom is
MONTHS UP TO 5 present
YEARS”  Assess the child further
 Child is not yet 2 mos, (main sx)
“ASSESS, CLASSIFY AND  Classify according to the
TREAT THE SICK illness
YOUNG INFANT”
12/07/2021
53

 Check for the signs of malnutrition and anemia and

classifying
 Check for child’s immunization status and decide
 Check for the child’s Vit. A status
 Assess any other problems

12/07/2021
# 34… IMCI FEVER
 Fever is a very common condition and is often the
main reason for bringing children to the health
center
 Minor infections, life – threatening disease
 Children are considered to have fever if their body
temperature is above 37.5°C axillary (38°C rectal).
Assess for:
 Stiffed neck
 Risk of malaria and other endemic diseases
 Runny nose
 Duration of fever
 Measles
 Classifications of fever
All children with fever and any general danger
sign or stiff neck are classified as having Any danger sign or very severe febrile
disease
VERY SEVERE FEBRILE DISEASE and Stiff neck

should be urgently referred to a hospital after

pre-referral treatment with antibiotics (the same
REFER
choice as for severe pneumonia or very severe
disease).
In a high malaria risk area or season, children Fever (by history or feels hot
with fever and no general danger sign or stiff or temperature 37.5°C or
above)
malaria

neck should be classified as having

MALARIA.
In a low malarial risk area or season, children
with fever (or history of fever) and no general
danger sign or stiff neck are classified as NO runny nose and NO measles
and NO other causes of fever
malaria

having MALARIA and given an antimalarial

only if they have no runny nose (a sign of
ARI), no measles, and no other obvious cause
of fever (pneumonia, sore throat, etc.).
. Ina low malaria risk area or season,
children with runny nose, measles or
clinical signs of other possible
infection are classified as having
FEVER — MALARIA UNLIKELY. Runny nose PRESENT or
These children need follow-up. If their Measles PRESENT or
Other causes of fever
fever – malaria
unlikely
fever lasts more than five days, they PRESENT

should be referred for further

assessment to determine causes of
prolonged pyrexia. If possible, in low
malaria risk settings, a simple malaria
laboratory test is highly advisable.

In a no malaria risk area or season an attempt

should be made to distinguish cases of possible
possible bacterial
bacterial infection, which require antibiotic Obvious causes of fever
infection
treatment, from cases of non-complicated viral
infection. Presence of a runny nose in such
situations has no or very little diagnostic value.
 In a no malaria risk area or season, if no
clinical signs of obvious infection are found,
the working classification becomes
UNCOMPLICATED FEVER.

NO obvious causes of fever uncomplicated fever

# 44… Does not have ear problem

Communicating- History Taking

General Danger Signs

Main Symptoms

Cough or Difficult Breathing

Diarrhoea

Fever

Ear Problems

Nutritional Status

Immunization Status

Other Problems