Professional Documents
Culture Documents
Community Health Nursing Review Edited
Community Health Nursing Review Edited
NURSING
Mrs. Laarne Estenzo-Pontillas
BSN , R.N., MSN
(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
II. Research and Quality
Improvement
Principles
1.The need of the community is the basis of
community health nursing.
2.The community health nurse must
understand fully the objectives and
policies of the agency she represents.
3. The family is the unit of service.
4. CHN must be available to all regardless of
race,creed and socioeconomic status
5. The CHN works as a member of the health team
6. There must be provision for periodic evaluation
of community health nursing services
7. Opportunities for continuing staff education
programs for nurses must be provided by the
community health nursing agency and the CHN
as well
8. The CHN makes use of available community
health resources
9. The CHN taps the already existing active
organized groups in the community
10. There must be provision for educative
supervision in community health nursing
11. There should be accurate recording and
reporting in community health nursing
12. Health teaching is the primary
responsibility of the community health nurse
Standards in CHN
I. Theory
Applies theoretical concepts as basis for
decisions in practice
II. Data Collection
Gathers comprehensive , accurate data
systematically
Standards
III. Diagnosis
Analyzes collected data to determine the
needs/ health problems of IFC
IV. Planning
At each level of prevention, develops plans
that specify nursing actions unique to
needs of clients
Standards
V. Intervention
Guided by the plan, intervenes to promote,
maintain or restore health, prevent illness
and institute rehabilitation
VI. Evaluation
Evaluates responses of clients to interventions
to note progress toward goal achievement,
revise data base, diagnoses and plan
Standards
VII. 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
VIII. Interdisciplinary Collaboration
• 2. SECONDARY
• 3. TERTIARY
Types of Clientele
• 1. INDIVIDUALS
• 2. FAMILIES
• 3. COMMUNITIES
• 4. POPULATION GROUPS
- Aggregate of people who share common
characteristics, developmental stage or common
exposure to particular environmental factors thus
resulting in common health problems ( Clark,
1995:5) e.g. children . elderly, women, workers etc.
Phil.Health Care Delivery
System
• 1.PRIMARY LEVEL FACILITIES
• Lack of motivation
• Attitude
• Resistance to change
• Dependence on the part of community
people
• Lack of managerial skills
4.SELF-RELIANCE
5.Partnership between the community
and the health agencies in the
provision of quality of life.
Providing linkages between the
government and the non-
government organization and people’s
organization.
6. Recognition of interrelationship
between the health and development
HEALTH
• is not merely the absence of disease. Neither it is only
a state of physical and mental well-being. Health
being a social phenomenon recognizes the interplay of
political, socio-cultural and economic factors as its
determinant. Good Health therefore, 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. Development is multi-
dimensional. It has a political, social, cultural,
institutional and environmental dimensions(Gonzales
1994). Therefore, it is measured by the ability of
people to satisfy their basic needs.
7. SOCIAL MOBILIZATION
It enhances people participation or
governance, support system provided by
the Government, networking and
developing secondary leaders.
8. DECENTRALIZATION
MAJOR STRATEGIES OF PRIMARY HEALTH
CARE
A. ELEVATING HEALTH TO A COMPREHENSIVE
AND SUSTAINED NATIONAL EFFORTS.
• Attaining Health for all Filipino will require
expanding participation in health and health related
programs whether as service provider or beneficiary.
Empowerment to parents, families and communities to
make decisions of their health is really the desired
outcome.
• Advocacy must be directed to National and Local
policy making to elicit support and commitment to
major health concerns through legislations, budgetary
and logistical considerations.
B. PROMOTING AND SUPPORTING COMMUNITY
MANAGED HEALTH CARE
• OBJECTIVES OF EPI:
TO REDUCE MORBIDITY AND
MORTALITY RATES AMONG INFANTS AND
CHILDREN from SIX CHILDHOOD
IMMUNIZABLE DISEASE
• ELEMENTS OF EPI:
1. TARGET SETTING
2. 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.
3. IEC
4. Assessment and evaluation of Over-all
performance of the program
5. Surveillance and research studies
EXPANDED PROGRAM ON IMMUNIZATION
Vaccine Minimum Numbe Minimum Reason
Age of 1st r 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
2. DPT 6 weeks 3 4 weeks An early start with
(Diphtheria DPT reduces the
Pertusis
Tetanus) chance of severe
pertussis
A. NO DEHYDRATION
• Condition – well, alert
• Mouth and Tongue – moist
• Eyes – normal
• Thirst – drinks normally, not thirsty
• Tears – present
• Skin pinch – goes back quickly
• TREATMENT PLAN A- HOME TTT.
THREE RULES FOR HOME
TREATMENT
1.Give the child more fluids than
usual
use home fluid such as cereal gruel
give ORESOL, plain water
2. Give the child plenty of food to prevent
undernutrition
continue to breastfeed frequently
if child is not breastfeed, give usual milk
if child is less than 6 months and not yet
taking solid food, dilute milk for 2 days
if child is 6 months or older and already taking
solid food, give cereal or other starchy food mixed
with vegetables, meat or fish; give fresh fruit juice
or mashed banana to provide potassium; feed
child at least 6 times a day. After diarrhea stops,
give an extra meal each day for two weeks.
3. Take the child to the health worker
if the child does not get better in 3
days or develops any of the following:
many watery stools
repeated vomiting
marked thirst
eating or drinking poorly
fever
blood in the stool
ORESOL TREATMENT
Age Amount of Amount of ORS to
ORS to give provide for use at
after each home
loose stool
< 50-100 500 ml./day
24 ml.
months
2– 100-200 1000 ml./day
10 ml.
years
10 As much as 2000 ml./day
years wanted
up
B. SOME DEHYDRATION
• Condition – restless, irritable
• Mouth and Tongue – dry
• Eyes – sunken
• Thirst – thirsty, drinks eagerly
• Tears – absent
• Skin pinch – goes back slowly
• WEIGH PT, TTT. PLAN B
APPROX. AMT. OF ORS- TO GIVE IN 1ST 4 HRS
AGE WEIGHT ORS
KG ML
4 MOS. 5 200-400
15 YRS UP 30 UP 2200-4000
1. If the child wants more ORS than shown, give more
2. Continue breastfeeding
3. For infants below 6 mos. who are not breastfeed,
give 100-200 ml clean water during the period
4. For a child less than 2 years give a teaspoonful
every 1-2 min.
5. If the child vomits, wait for 10 min, then continue
giving ORS, 1 tbsp/2-3 min
6. If the child’s eyelids become puffy, stop ORS , give
plain water or breast milk, Resume ORS when
puffiness is gone
7. If ( -) signs of DHN- shift to Plan A
Use of Drugs during Diarrhea
Antibiotics should only be used for
dysentery and suspected cholera
Antiparasitic drugs should only be
used for amoebiasis and giardiasis
C. SEVERE DEHYDRATION
Condition – lethargic or unconscious; floppy
Eyes – very sunken and dry
Tears – absent
Mouth and tongue – very dry
Thirst- drinks poorly or not able to drink
Skin pinch – goes back very slowly
TTT PLAN C- ttt. quickly
1.Bring pt. to hospital
2. IVF – Lactated Ringers Solution or Normal
Saline
3.Re-assess pt. Every 1-2 hrs
4. Give ORS as soon as the pt. can drink
ROLE OF BREASTFEEDING IN THE
CONTROL OF DIARRHEAL DISEASES
PROGRAM
Dose:0.5ml
Route: Intramuscularly
Site: Right or Left Deltoid/Buttocks
Components of Prenatal Visits
• History – taking
• Determination of obstetrical score- G, P,
TPAL,AOG,EDD
• U/A for Proteinuria, glycosuria and infxtn
• Dental exam
• Wt. Ht. BP taking
• Exam of conjunctiva and palms for pallor
• Abdominal exam - fundic ht, Leopold’s
maneuver and FHT
• Exam of breasts, face, hands and feet for
edema and neck for thyroid enlargement
• Health teachings- nutrition, personal hygiene,
common complaints
• Tetanus toxoid immunization
• Iron supplementation – from 5th mo. of
pregnancy - 2 mos. Postpartum
• In goiter endemic areas – iodized capsule once
a year
• In malaria infested areas- prophylactic
Chloroquine ( 150 mg/tab ) 2 tabs/ wk for the
whole duration of pregnancy
• UNDER FIVE CLINIC
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
• POSITIONS IN BF THE BABY:
• 1. Cradle Hold = head and neck are supported
• 2. 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
• 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.
• 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
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.
Proper nutrition is important because:
it helps in the development of the brain, especially
during the first years of the child’s life.
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
Balanced diet is made up of a
combination of the 3 basic groups
eaten in correct amounts. The
grouping serves as a guide in
selecting and planning everyday
meals for the family.
THE THREE (3) BASIC FOOD GROUPS ARE:
1. 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;
pork; chicken; beef; cheese; butter; kidney
beans; mongo; peanuts; bean curd; shrimp;
clams
• 2. 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;
corn; bread; cassava; sweet potato;
banana; sugar cane; honey; lard; cooking
oil; coconut milk; margarine; butter
• 3. Body-regulating food which are rich in
Vitamins and minerals and needed by the
body for:
• < normal development of the eyes, skin,
hair, bones, and teeth
• < increased protection against diseases
• < Examples of body-regulating food are:
tisa; ripe papaya; mango; guava; yellow
corn; banana; orange; squash; carrot
Low Fat Tips
1. Eat at least 3 meals/day
2. Eat more fruits, vegetables, grain and
cereals e.g. rice, noodles and potato
3. If you use butter or margarine, pat it on
thinly
4. Choose low fat substitute i.e. replace
whole milk with skimmed milk, low fat
cheese
5. Become a label reader. Look for foods that
have less than 5 g /100 g of product
6. Eat less high fat snacks and take away
potato chips, sausage rolls or breaded
meats
7. Cut all visible fat from meat, remove skin
from chicken fat drippings and cream
sauces
8. Aim for thin palm-size serving of lean
meat, poultry and fish/ meal
9. Grill, bake, steam, stew, stir –fry and
microwave, try not to fry
10. Drink lots of water all day- it’s a food
quencher
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
Filipino Food Pyramid
• Drink a lot- water, clear broth
• Eat most – rice, root crops, corn, noodles,
bread and cereals
• Eat more – vegetables, green salads,
fruits or juices
• Eat some – fish, poultry, dry beans, nuts,
eggs, lean meats, low fat dairy
• Eat a little – fats, oils, sugar, salt
IMPORTANT VITAMINS AND
MINERALS
VITAMINS FUNCTIONS
Vitamin A Maintain normal vision, skin
health, bone and tooth
growth reproduction and
immune function; prevents
xerophthalmia.
Food sources:
Breastmilk;poultry;eggs; liver;
meat;carrots;squash;
papaya;mango;tiesa;
malunggay;kangkong;
camotetops; ampalaya tops
Thiamine Help release
energy from
nutrients; support
normal appetite
and nerve function,
prevent beri-beri.
Riboflavin Helps release energy from
nutrients, support skin health,
prevent deficiency manifested by
cracks and redness at corners of
mouth; inflammation of the tongue
and dermatitis.
LEVEL I
◙ Non-water carriage toilet facility – no water necessary
to wash the waste into receiving space e.g.pit latrines, reed
odorless earth closet.
◙ Toilet facilities requiring small amount of water to
wash the waste into the receiving space e.g. pour flush toilet &
aqua privies
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
• Unexplained anemia
• Sudden unexplained weight loss
Prevention & Early Detection
CA type Prevention Detection
Lung No smoking None
Uterine Monogamy Pap’s smear
Cervical Safe sex every 1-3 yrs
Liver Hep B None
vaccination
Less aalcohol
intake
Avoidance of
moldy foods
Colon High fiber diet Regular
Rectum Low fat intake medical check-
up after 40 yrs
of age
Fecal occult
blood test
DRE
Sigmoidoscopy
• Aim:
• Controlling and assimilating healthy
lifestyle in the Filipino culture ( 2005-2010)
thru IEC
• Main Concern: modifiable risk
factors( diet, body wt., smoking, alcohol,
stress, sedentary living, birth wt. ,migration
• 4. Prevention and Control of Kidney Disease
• Acute or Rapidly Progressive Renal Failure : A
sudden decline in renal function resulting from the
failure of the renal circulation or by glomerular or
tubular damage causing the accumulation of
substances that is normally eliminated in the urine in
the body fluids leading to disruption in homeostatic,
endocrine, and metabolic functions.
• Acute Nephritis: A severe inflammation of the kidney
caused by infection, degenerative disease, or disease
of the blood vessels.
• Chronic Renal Failure: A progressive deterioration of
renal function that ends as uremia and its
complications unless dialysis or kidney transplant is
performed.
• Neprolithiasis: A disorder characterized by the
presence of calculi in the kidney.
• Nephrotic Syndrome: A clinical disorder of
excessive leakage of plasma proteins into the urine
because of increased permeability of the
glomerular capillary membrane
• Urinary Tract Infection: A disease caused by the
presence of pathogenic microorganisms in the
urinary tract with or without signs and symptoms.
• Renal Tubular Defects: An abnormal condition in
the reabsorption of selected materials back into the
blood and secretion, collection, and conduction of
urine.
• Urinary Tract Obstruction: A condition wherein
the urine flow is blocked or clogged.
• 5. Program on Mental Health and
Mental Disorders
• 6. Program on Drug Dependence/
Substance Abuse
• 7.Community-Based Rehabilitation Program
Dengue H-fever
4 o’clock habit
• Programs on Measles.
Chickenpox, Mumps,
Diphtheria, Pertusis, Tetanus
–focused on health
information campaigns and
intensive immunization of
children in barangays.
• Prevention and Control Program on Parasitic
Infestations ( STH e.g. Ascaris, Trichuris,
Hookworm) and Paragonimiasis in communities
where eating of fresh or inadequately cooked crab
is a practice
Management:
1. Deworming
2. Health Education re:
• Good personal hygiene
• Use of footwear
• Washing fruits and vegetables well
• Use of sanitary toilets
• Sanitary disposal of garbage
• Boiling drinking water at least 2-3 min. from
boiling point or chlorination
• Prevention and Control on Leptospirosis/
Weil’s Disease/ Mud fever/Flood fever/
Spirochetal Jaundice thru contact with the
skin/ open wound with water or moist soil
contaminated with urine of infected rat
• And Rabies
• Mgt. of Rabies
• 1. SERVICE
• 2. EDUCATION
• 3. ENVIRONMENT
• Mission of School Health Program:
• 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
• Common Health Concerns of
Schoolchildren:
1.Drug and Alcohol Abuse
2. STDs/STIs
3. Teenage Pregnancies
4. Mental Health
5. Dermatological Disorders- pimples/acne,
fungal infections, allergies
6. Respiratory Conditions- asthma, URTI
7. Nutrition
8. Dental Health
• 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.
• 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. It’s my nature to love,
why should I give up my nature to love just
because it’s the nature of the scorpion to
sting?”