IMPLEMENTING FAMILY

CARE PLAN
CATEGORIES OF INTERVENTION
1.PROMOTIVE
2.PREVENTIVE
3.CURATIVE
4.REHABILITATIVE
THREE TYPES OF NURSING INTERVENTION
(FREEMAN AND HEINRICH)
1.SUPPLEMENTAL INTERVENTIONS
- Actions that the nurse performs on behalf of the
family when unable to do things for itself
e.g. direct nursing care to a sick /disabled family
member
THREE TYPES OF NURSING INTERVENTION
(FREEMAN AND HEINRICH)

2. FACILITATIVE INTERVENTIONS
- Actions that remove barriers to
appropriate health action
e.g. assisting the family to avail
maternal and early child care services
THREE TYPES OF NURSING INTERVENTION
(FREEMAN AND HEINRICH)

3. DEVELOPMENTAL INTERVENTIONS
- Aim to improve the capacity of the
family to provide for its own health needs
e.g. guiding the family to make
responsible health decisions
- Directed toward family empowerment
TYPES FAMILY-NURSE CONTACTS
1. CLINIC VISIT
-takes place in a PRIVATE CLINIC, HEALTH CENTER, BHS, or IN
AN AMBULATORY CLINIC
STRENGTH
 the family member takes initiative of visiting the prof’l health workers
 Allows the nurse to maximize the resources available(time, material
resources,referral to other hcp)
 Distractions is lessened since the nurse has greater control in the
environment
WEAKNESS
 Obvious hardship of the family like transporting sick family member
 The family member feel less confident to discuss family health concern
due to lesser environment control
TYPES FAMILY-NURSE CONTACTS
2. GROUP CONFERENCE
-takes place in a HEALTH FACILITY OR COMMUNITY
-appropriate in developing COOPERATION, LEADERSHIP, SELF-RELIANCE,
AND COMMUNITY AWARENESS AMONG GROUP MEMBERS
-E.G. conference of mothers in the neighbourhood
STRENGTH:
 opportunity to share experiences and practical solutions to common health
concerns.
WEAKNESS:
 Attendance requires motivation and availability of target family members
the nurse may not be able to reach the families in greatest need of
help
TYPES FAMILY-NURSE CONTACTS
3. TELEPHONE CALLS
-takes place through TELEPHONE OR MOBILE PHONE
-Provides easy access between the nurse/health worker and
the family
 Encouragingthe family to communicate with the clinic or
health center when they feel the need for it CULTIVATES
FAMILY CONFIDENCE IN THE HEALTH AGENCY
WEAKNESS:
 Information transmitted is limited
 Accurate assessment of family conditions requires face-to-
face contact
TYPES FAMILY-NURSE CONTACTS
4. WRITTEN COMMUNICATION
-Used to give specific information to families
Ex: instructions given to parents through school children
STRENGTH:
 Potential for reaching many families
WEAKNESS:
 Requires literacy and interest, the nurse cannot
certain that the information will reach the intended
recipient
TYPES FAMILY-NURSE CONTACTS
5. HOME VISIT
-A professional, purposeful interaction that takes
place in the family’s residence
-aimed at promoting, maintaining, or restoring the
health of the family or its members.
- a set up where in the nurse goes to the family
 The nurse makes home visit when:
1. Upon the family’s request
2. As a result of case finding
3. In response to referral
4. To follow up clients
 ADVANTAGES OF HOME VISIT
1. It allows firsthand assessment of the home situation: family
dynamics, environmental factors affecting health and
resources within the home
2. The nurse is able to seek out previously unidentified needs
3. It gives the nurse an opportunity to adapt interventions
according to family resources
4. It promotes family participation and focuses on the family
as a unit
5. Teaching family members in the home is made easier by the
familiar environment and the recognition of the need to
learn as they are faced by the actual home situation
6. The personalized nature of home visit gives the family the
sense of confidence in themselves and in agency.
 WEAKNESS OF HOME VISIT
RELATES TO EFFICIENCY :
The cost in terms of time and effort
The nurse unable to control the
environment more distractions
Nurse’s safety may also be a concern
 PHASES OF HOME VISIT
1.PREVISIT PHASE
-nurse contacts the family

Determines the family’s willingness for a home

visit
Set an appointment
A plan for home visit is formulated this phase
 ThePLANNING PROCESS for a home visit is
essentially the same as the PLANNING PHASE
OF NURSING PROCESS
 SPECIFIC PRINCIPLES IN PLANNING FOR
HOME VISIT
1. Being a professional contact with the family, the home visit should have a
purpose.
- not for social reason; should be THERAPEUTIC!
PURPOSES:
 To have a more accurate assessment of the family’s living conditions and adapt
interventions accordingly
 To educate the family about measures for health promotion, disease prevention
and control of health problems
 To prevent the spread of infection among family members and within the
community
 To provide supplemental intervention for the sick, disabled or dependent family
member and guide the family on how to give care in the future
 To provide family with greater access to health resources in the community
 SPECIFIC PRINCIPLES IN PLANNING FOR
HOME VISIT
2. Use information about the family collected from all
possible sources (records)
3. The home visit plan focuses on identified family needs,
particularly needs recognized by the family as requiring
urgent attention.
4. Continuing care for a client who needs it will be
provided by the client or family member ( client and
family member should actively participate in planning for
cont. of care )
5. The should be practical and adaptable
 Beforeleaving the health facility, the nurse
should check the contents of the Nursing
bag and other articles
 carry out home visit efficiently and
safety
 The nurse comply with practices and
policies for personnel safety
Informing other personnel of his/her
itinerary
 “BUDDY SYSTEM” Nursing
students/new personnel
PHASES OF HOME VISIT
2. IN-HOME PHASE
-begins as the nurse seeks
permission to enter and lasts until
she/he leaves the family’s home
 IN-HOME PHASE
1. INITIATION
 Acknowledging family members through greetings
and introducing oneself and agency he/she
represents.
 Observe the environment for own safety
 Sits as the family directs him/her to sit.
 ESTABLISH RAPPORT
- NURSE initiates a short social conversation
-states the purpose of the visit and the source
of information
 IN-HOME PHASE
2. IMPLEMENTATION
 Application of nursing process
 ASSESSMENT- Interview/PA/diagnostic exam that can be
done at home
 FAMILY ASSESSMENT FORM is used as a guide for this purpose
 Physical care, health teachings and counselling is provided
to the family
 Nurse observes aseptic practices (handwashing before and
after)
 Opportunity for demonstration of practical methods in
preventing spread of infection
 IN-HOME PHASE
3. TERMINATION
 summarizing with the family the
events during the home visit and
setting subsequent home visit or
another form of family-nurse contact
Use this time to record findings- vital
signs and body weight
AS MUCH AS POSSIBLE , THE NURSE
EVALUATES WITH THE FAMILY
WHAT THEY HAVE ACCOMPLISHED
DURING THE VISIT
 PHASES OF HOME VISIT
3. POST-VISIT PHASE
- Takes place when the nurse has returned to
the health facility
-involves documentation of the visit
-personal observations and feelings
THE NURSING BAG
 THE NURSING BAG
 Also called as PHN BAG
A tool used by the nurse during home and community
visit to be able to provide care safely and efficiently.
 Contents depends on agency policies and type of services
to render
A receptacle for items needed for nursing care
 Serves a reminder for prevention of spread of infection
A nurse is prepared for variety of situation while in the
field
- Indispensable tool that
should be organize to save
time & effort and to prevent
cross infection &
contamination
 Contents :
 1. ARTICLES FOR INFECTION CONTROL: soap in a covered dish and linen or
disposable paper towel for hand washing, apron, bottles for antiseptics and
hand sanitizer
 2. ARTICLES FOR ASSESSMENT OF FAMILY MEMBERS: thermometer,
measuring tape, weighing scale, glucometer, benedict’s test- benedict’s
sol’n, medicine dropper, test tube and holder, alcohol lamp
NOTE: STETHOSCOPE AND SPHYGMOMANOMETER ARE CARRIED SEPARATELY
 3. ARTICLES FOR NURSING CARE:
• STERILE ITEMS: dressings, cotton balls, cotton tip applicator, syringe (2 and 5
cc), surgical gloves, cord clamp, surgical scissors, sterile pack with kidney
basin, 2 pairs of forcep- straight and curved
• CLEAN ARTICLES: adhesive tape, bandage scissors
• PIECES OF PAPER: for lining the soap dish if the home sink is used and for
lining the bag and folded paper to be used as waste receptacle if needed
 PRINCIPLES IN USING NURSING
BAG/ BAG TECHNIQUE
1.Bag technique helps the nurse in infection control.
2. Bag technique allows the nurse to care efficiently.
- saves time and effort
- the nurse check the contents of bag for completeness and for proper functioning
before leaving the health facility for home visit.
-articles/contents must be arranged according to use
3. Bag technique should not take away the nurse’s focus on the patient and the family
- simple a tool in providing care
4. Bag technique may be performed in different ways.
-depends on agency policies and home situation
PRINCIPLES OF ASEPSIS ARE OF THE ESSENCE AND SHOULD BE PRACTICE AT ALL
TIMES
ACTIVITIES THAT SHOULD BE PRACTICED DURING
HOME VISITS AS PART OF BAG TECHNIQUE

1. Remember to proceed from “CLEAN” to

“CONTAMINATED”.
2. The bag and its content should be well protected
from contact with any article in the patient’s home.
Consider the bag and its content as clean or sterile,
while articles that belong to the patients as dirty and
contaminated.
3. Line the table/flat surface with paper or washable
protector on which the bag and all the articles to be
used are placed
ACTIVITIES THAT SHOULD BE PRACTICED DURING
HOME VISITS AS PART OF BAG TECHNIQUE

4. Wash your hands before and after physical assessment

and physical care of each family member
5. Bring out only the articles needed for the care of the
family. Those that will not be used should remain in the
bag. This practice is facilitated when the contents of the
bag are arranged according to the nurse’s convenience
to avoid confusion and promote efficiency.
6. Do not put any family’s articles on your paper
lining/washable protector
ACTIVITIES THAT SHOULD BE PRACTICED DURING
HOME VISITS AS PART OF BAG TECHNIQUE

7. Whenever possible and as necessary, wash your

articles before putting them back into the bag. If this is
not possible, wrap them properly to prevent
contaminating the bag and its contents
8. After using an article such as apron or washable
protector, confine the contaminated surface by folding
the contaminated side inward.
9. Wash the inner cloth lining of the bag as necessary.
 DEPARTMENT OF
HEALTH PROGRAMS
EXPANDED PROGRAM
ON IMMUNIZATION
1. EXPANDED PROGRAM ON
IMMUNIZATION
 Established in 1976 to ensure that infants/children and
mothers have access to routinely recommended
infant/childhood vaccines
 SIX VACCINE-PREVENTABLE DISEASES where initially included:
TB, POLIOMYELITIS, DIPHTHERIA,TETANUS, PERTUSSIS and
MEASLES
 The immunization coverage of children has improved from
2003 to 2008
GOALS OF EXPANDED PROGRAM ON
IMMUNIZATION AND SUPPORTING
LEGISLATION

OVER-ALL GOAL: “REDUCING THE

MORBIDITY AND MORTALITY AMONG
CHILDREN AGAINST THE MOST COMMON
VACCINE-PREVENTABLE DISEASES”
 GOALS OF EXPANDED PROGRAM ON
IMMUNIZATION AND SUPPORTING LEGISLATION
SPECIFIC GOALS:
1. To immunize all infants/children against the most common
vaccine-preventable diseases
2. To sustain the polio-free status of the Philippines
3. To eliminate measles infection. Pres. Proclamation No.4, s. 1998
(MEASLES ELIMINATION CAMPAIGN)
4. To eliminate maternal and neonatal tetanus. Pres. Proclamation
No.1066, s. 1997 (NATIONAL NEONATAL TETANUS ELIMINATION
CAMPAIGN)
5. To control diphtheria, pertussis, hepatitis B and German measles
6. To prevent extrapulmonary TB among children
LAWS MANDATED TO PROTECT CHILDREN THROUGH
IMMUNIZATION TO THE DOH AND LGUS:

1. R.A 10152- MANDATORY INFANTS AND

CHILDREN HEALTH IMMUNIZATION ACT
OF 2011
-mandates basic immunization covering the vaccine-
preventable diseases.
- Added to the previously mentioned are HEPATITIS B,
MUMPS, RUBELLA, DISEASES CAUSED BY HAEMOPHILUS
INFLUENZAE TYPE B (Hib), and other diseases as determined by
Department of Health
R.A 10152- MANDATORY INFANTS AND CHILDREN
HEALTH IMMUNIZATION ACT OF 2011

Itgives the directive to gov’t hospitals

and health centers to provide free
mandatory basic immunization to
infants and children up to 5 years of
age.
This law has repealed PD 996
(Congress of the Philippines,2011)
RA 7846- COMPULSORY
IMMUNIZATION AGAINST HEPATITIS B

 Infants and children below 8 years old

 Within
24 hours after birth for babies of
women with hepatitis B
In 2012, TWO NEW VACCINES WERE INTRODUCED
AS PART OF EPI:
 ROTAVIRUS VACCINE
- rotavirus infects the large intestine;most common
cause of severe diarrhea in infants and children.
-Ages 6 and 24 months are at greatest risk for
developing severe rotavirus infection.
 Hib VACCINE
- Hib is a bacterium responsible for serious illnesses, such
as MENINGITIS AND PNEUMONIA with almost all cases younger
than 5 yrs, with those between 4 and 18 months of age.
 IMMUNIZATION SCHEDULE and MANNER OF
ADMINISTRATION FOR INFANTS
ANTIGEN AGE DOSE ROUTE SITE
Right Deltoid Region
BCG vaccine At birth 0.05ml Intradermal
(ARM)
Anterolateral thigh
Hepatitis B vaccine At birth 0.5ml Intramuscular
muscle
DPT-HepB-
6 weeks, 10 Anterolateral thigh
Hib(PENTAVALENT 0.5ml Intramuscular
weeks, 14 weeks muscle
VACCINE)
6 weeks, 10
Oral Polio Vaccine 2 drops Oral Mouth
weeks, 14 weeks
Anti-measles Outer part of the
9-11 months 0.5ml Subcutaneous
vaccine (AMV1) upper arm
Measles-Mumps-
Outer part of the
Rubella vaccine 12-15 months 0.5ml Subcutaneous
upper arm
(AMV2)
Rotavirus vaccine 6 weeks, 10 weeks 1.5 ml Oral Mouth
IMPORTANT CONSIDERATIONS RELATED
TO THE SCHEDULE AND MANNER OF
ADMINISTERING INFANT IMMUNIZATION :
1. Use only one sterile syringe and needle per client (DOH, 2003a)
2. There is no need to restart a vaccination series regardless of the time
that has elapsed between doses (DOH, 2006a)
3. All the EPI antigens are safe and effective when administered
simultaneously , that is, during the same immunization session but at
different sites. It is NOT RECOMMENDED to mix different vaccines in
one syringe before injection, or to use a fluid vaccine for
reconstitution of a freeze-dried vaccine (DOH, 2003a)
When vaccine is administered to an infant at same time with another
injectable vaccine, the vaccines should be administered on different
sites.
IF MORE THAN ONE VACCINE GIVEN TO SAME LIMB, THE INJECTION SITE
SHOULD BE 2.5-5 CM APART TO PREVENT OVERLAPPING OF LOCAL
REACTIONS (DOH, 2006a)
IMPORTANT CONSIDERATIONS RELATED TO THE
SCHEDULE AND MANNER OF ADMINISTERING INFANT
IMMUNIZATION :
4. The recommended sequence of the coadministration of vaccines is
OPV FIRST followed by rotavirus vaccine, then other appropriate
vaccines (DOH,2012b)
5. OPV is administered by putting drops of the vaccine straight from
the dropper onto the child’s tongue. Do not let the dropper touch
the tongue (DOH, 1995)
6. Only monovalent hepatitis B vaccine must be used for the birth
dose. Pentavalent vaccine must not be used for the birth dose
because DPT and Hib should not be given at birth.
Pentavalent vaccine contains antigens against five diseases:
diphtheria, pertusses, tetanus, hepatitis B and Hemophilus influenza
B
IMPORTANT CONSIDERATIONS RELATED TO THE
SCHEDULE AND MANNER OF ADMINISTERING INFANT
IMMUNIZATION :
7. Children who have not received AMV1 as scheduled and children
whose parents or caregivers do not know whether they have
received AMV1 shall be given AMV1 as soon as possible, then AMV2
one month after AMV1 dose (DOH, 2010Dd)

8. All children entering day care centers/ pre-schoolers and grade 1

shall be screened for measles immunization. Rthose without the
immunization shall be referred to the nearest health facility for
immunizlation (DOH,2010d)

9. The first dose of rotavirus vaccine is administered only to infants

aged 6 weeks to 15 weeks. The second dose is given only to infants
aged 10 weeks up to a maximum of 32 weeks (DOH, 2012b
IMPORTANT CONSIDERATIONS RELATED TO THE
SCHEDULE AND MANNER OF ADMINISTERING INFANT
IMMUNIZATION :
10. Administer the entire dose of the Rotavirus vaccine
slowly down one side of the mouth (between cheeks and
gum) with the tip of the applicator directed toward the
back of the infant’s mouth.
To prevent spitting, or failed swallowing, stimulate the
rooting and sucking reflex of the young infant. For infants
aged 5 months or older, lightly stroke the throat
downward motion to stimulate swallowing ( DOH, 2012b)
EPI VACCINES CONTENTS AND FORM
VACCINE CONTENTS FORM
BCG (Bacillus Calmette Guerin) Freeze-dried, reconstituted with a
Live, attenuated bacteria
vaccine special diluent
RNA-recombinant, using hepatitis B Cloudy, liquid, in an auto-disable
Hepatitis B vaccine
surface antigen ( HBs Ag) injection syringe if available
Diphtheria toxoid, inactivated pertussis
bacteria, tetanus toxoid, recombinant
DPT-HepB-Hib(PENTAVALENT Liquid, in an auto-disable injection
DNA surface antigen, and synthetic
VACCINE) syringe
conjugate of Haemophilus influenza B
bacilli
Oral Polio Vaccine Live, attenuated virus (trivalent) Clear, pinkish liquid
Freeze-dried, reconstituted with a
Anti-measles vaccine (AMV1) Live, attenuated virus
special diluent
Measles-Mumps- Rubella vaccine Freeze-dried, reconstituted with a
Live, attenuated viruses
(AMV2) special diluent
Clear, colorless liquid, in a container
Rotavirus vaccine Live, attenuated virus
with an oral applicator
Sometimes slightly turbid in appearance;
Tetanus toxoid Weakened toxin
clear , colorless liquid;
MAINTAINING THE POTENCY OF EPI
VACCINES
 MAINTAIN THE COLD CHAIN
- The cold chain is a system for ensuring the potency
of the vaccine from the time of manufacture to the time it is
given to an eligible client.
 COLD CHAIN OFFICER- person directly responsible for cold
chain management at each level
 In RHU, the PUBLIC HEALTH NURSE is the C.C.O
 MAINTAINING THE POTENCY OF EPI VACCINES
COLD CHAIN EQUIPMENT AND SUPPLIES
 FREEZER/REFRIGERATOR
 TRANSPORT BOX
 VACCINE BAGS/CARRIERS
 COLD CHAIN MONITORS
 THERMOMETER
 COLD PACKS
 The nurse implements an emergency plan in the event of
an electrical breakdown or power failure
EPI VACCINES AND THE SPECIAL DILUENTS
HAVE THE FOLLOWING REQUIREMENTS
 OPV : -15 to -25◦C. OPV has to be stored in the freezer. In vaccine
bag, OPV is placed in contact with cold packs.
 ALL other vaccines, including measles vaccine, MMR, and Rotavirus
vaccine have to be stored in the refrigerator at the temperature of
+2 to +8◦c. these vaccines should be stocked neatly on the shelves of
refrigerator. Do not stock vaccines at the refrigerator shelves
 Hepatitis B vaccine, Pentavalent vaccine, Rotavirus vaccine, and TT
are damaged by freezing, so they should not be stored in the
freezer. Wrap the containers of these vaccines with paper before
putting them in the vaccine bag with cold packs
 Keep diluents cold by storing them in the refrigerator in the lower or
door shelves.
Other considerations to maintain potency
 Observe the FIRST EXPIRY-FIRST OUT (FEFO)
 Comply with the recommended duration of storage and transport.
 RHU with ref storage should not exceed 1 month
 Transport boxes kept only up to maximum of 5 days
 Take note if the vaccine container has a VACCINE VIAL MONITOR
(VVM) and act accordingly
 Reconstitute freeze dried vaccines only with the diluents supplied
with them
 Discard Reconstituted freeze dried vaccines 6 hours after
reconstituted or at the end of immunization session, whichever
comes first
 Protect BCG from sunlight and rotavirus vaccine from light
 Abide by the open vial policy of the DOH
VACCINE VIAL MONITOR
 A round disc of heat sensitive material placed on a vaccine vial to register
cumulative heat exposure
 The lower the temp, the slower the color change: The higher the temp, the
faster the color change

INNER SQUARE LIGHTER THAN OUTER RING.

If the expiry date has not been passed, USE THE
VACCINE!

AT A LATER TIME :
INNER SQUARE STILL LIGHTER THAN OUTER RING.
If the expiry date has not been passed, USE THE
VACCINE!

DISCARD POINT:
INNER SQUARE MATCHES COLOUR OF OUTER RING.
DO NOT USE THE VACCINE!

BEYOND THE DISCARD POINT:

INNER SQUARE DARKER THAN OUTER RING.
DO NOT USE THE VACCINE!
OPEN VIAL POLICY
 MULTIDOSE VIAL MAY BE opened for one or two clients if the health
worker feels that a client cannot come back for the scheduled
immunization session .
 MUTIDOSE LIQUID VACCINE from which one or more doses have been
taken following standard sterile procedures, may be used in the next
immunization session for up to maximum of 4 weeks, provided the
following conditions are met:
 The expiry date has not passed
 The vaccine has not been contaminated
 The vials has been stored under appropriate cold chain conditions
 The vaccine vial septum has not been submerged in water
 The VVM on the vial, if attached, has not reached discard point
SIDE EFFECTS:

BCG injection site- formation of wheal that disappears

within 30 mins.
- after 2 weeksa small red tender swelling
appears at the site which may develop into a small abscess
which ulcerates heals and scar (12 weeks)
- expected outcome and dso not require any
management
 SIDE EFFECTS AND MANAGEMENT
VACCINES SIDE EFFECTS MANAGEMENT
KOCH’S PHENOMENON: an acute No management is needed
inflammatory reaction within 2-4
days after vaccination; usually
indicates previous exposure to
tuberculosis
Deep abscess at vaccination Refer to the physician for incision

BCG site;atmost invariably due to and drainage

subcutaneous or deeper injection
Indolent ulceration: an ulcer Treat with INH powder
which persist after 12 weeks from
vaccination date
Glandular enlargement: If suppuration occurs, treat as
enlargement of the lymph glands deep abcess
draining the injection site

HEPATITIS B VACCINE Local soreness at the injection site No treatment is necessary

 SIDE EFFECTS AND MANAGEMENT
VACCINES SIDE EFFECTS MANAGEMENT
Fever that usually lasts for only 1 Advise parent to give antipyretic
day. Fever beyond 24 hours is not
due to the vaccine but to other
causes
Local soreness at the injection site Reassure parents that soreness will
DPT-HepB-Hib disappear after 3-4 days

(PENTAVALENT Abscess after a week or more

usually indicates that the injection
Incision and drainage maybe
necessary
VACCINE) was not deep enough or the
needle was not sterile
Convulsions: although very rare, Propr management of convulsions;
may occur in children older than 3 pertussis vaccine should not be
months;caused by pertussis given anymore
vaccine

Oral polio vaccine None

(OPV)
 SIDE EFFECTS AND MANAGEMENT
VACCINES SIDE EFFECTS MANAGEMENT
Fever 5-7 days after vaccination in Reassure parent and instruct them
ANTI-MEASLES some children; sometimes ther is a to give antipyretic to the child
mild rash
VACCINE
Local soreness, fever, irritability, Reassure parent and instruct them
MMR and malaise in some children to give antipyretic to the child

Some children develop mild Reassure parent and instruct them

Rotavirus vaccine vomiting and diarrhea, fever,
iriitability
to give antipyretic and oresol to
the child
Local soreness at the injection site Apply cold compress at the site.
Tetanus toxoid No other treatment needed
 CONTRAINDICATIONS TO IMMUNIZATION
 In general, there are no contraindications to immunization of a sick
child if the child is well enough to go home to prevent delay of
immunization
 ABSOLUTE CONTRAINDICATIONS/DO NOT GIVE:
1. PENTAVALENT VACCINE/DPT to children over 5 years of age
2. PENTAVALENT VACCINE/DPT to a child with recurrent
convulsions or another active neurological disease of CNS
3. PENTAVALENT VACCINE 2 or3 /DPT 2 or 3 to a child who has had
convulsions or shock within 3 days of the most recent dose
4. Rotavirus vaccine when the child has a history of
hypersensitivity to previous dose of the vaccine, intussusceptions or
intestinal malabsorption or acute gastroenteritis
5. BCG to a child who has signs and symptoms of AIDS or other
immune deficiency conditions or are immunosuppressed
False contraindications and if seen in
children the health worker may continue
with appropriate immunization :
 MALNUTRITON
 Low grade fever
 Mild respiratory infection
 Diarrhea
 Children with diarrhea who are due for OPV
should receive a dose of OPV during the visit.
However THE DOSE IS NOT COUNTED. The child
should return when the next dose of OPV Is due.
EPI RECORDING AND REPORTING
 Accomplished using the FHIS

 FULLY IMMUNIZED CHILDREN (FIC)-who were given BCG, 3 doses of

OPV, 3 doses of DPT and hepatitis B vaccine or 3 doses of
Pentavalent vaccine and one dose of anti measles vaccine before
reaching one year of age
 COMPLETELY IMMUNIZED CHILDREN – children who completed their
immunization schedule at the age of 12-23 months
 CHILD PROTECTED AT BIRTH( CPAB) – used to describe a child
whose mother has received (a) two doses of TT during her
pregnancy, provided that the second dose was given at least a
month prior to delivery or (b) at least 3 doses of TT anytime prior to
pregnancy with this child
 NEWBORN
SCREENING
Republic Act no. 9288 otherwise
known as Newborn Screening Act
of 2004. 
NEWBORN SCREENING (NBS)
A simple procedure to find out if a baby has
a congenital metabolic disorder that may
lead to mental retardation or even death if
left untreated.
It is ideally done on the 48th hour or at least
24 hours from birth. .
NEWBORN SCREENING (NBS)
It is important because most babies with
metabolic disorders look “normal” at birth
May be detected even before clinical signs
and symptoms are present
Treatment can then be given early to
prevent serious consequences of untreated
metabolic conditions
Newborn screening program in the
Philippines currently includes screening of
six disorders:
 Congenital Hypothyroidism (CH),
 Congenital Adrenal Hyperplasia (CAH),
 Phenylketonuria (PKU),
 Glucose-6- Phosphate Dehydrogenase (G6PD)
Deficiency,
 Galactosemia (GAL) and
 Maple Syrup Urine Disease (MSUD).
The expanded screening will include
22 more disorders such as
hemoglobinopathies and additional
metabolic disorders, namely, organic
acid, fatty acid oxidation, and amino
acid disorders. The latter are included
in the standard care across the globe.
 DISORDERS INCLUDED IN
NEWBORN SCREENING (NBS)
1. CONGENITAL HYPOTHYROIDISM (CH)
- results from lack of/absence of thyroid
hormone, which is essential to the growth of
brain and body.\
- If not detected or hormone replacement is
not initiated within 4 weeks, the baby’s
physical growth will be stunded and may suffer
mental retardation
 DISORDERS INCLUDED IN
NEWBORN SCREENING (NBS)
2. CONGENITAL ADRENAL HYPERPLASIA (CAH)
 An endocrine disorder that causes severe salt
loss, dehydration and abnormally high levels
of male sex hormone in both boys and girls.
 If not detected or treated early, babies may
die within 7-14 days
 DISORDERS INCLUDED IN
NEWBORN SCREENING (NBS)
3. GALACTOSEMIA
- A condition in which the body is unable to
process galactose, the sugar present in milk.
- Accumulation of excessive galactose in the
body can cause many problems including liver
damage, brain damage, and cataracts.
 DISORDERS INCLUDED IN
NEWBORN SCREENING (NBS)
4. PHENYLKETONURIA (PKU)
- A metabolic disorder in which the body
cannot properly use one of the building blocks
of protein called phenylalanine.
- Excessive accumulation of phenylalanine in
the body causes brain damage
 DISORDERS INCLUDED IN
NEWBORN SCREENING (NBS)
5. GLUCOSE-6-PHOSPHATE DEHYDROGENASE
(G6PD deficiency )
-A condition where the body lacks G6PD
enzyme.
- Babies with this deficiency may have
hemolytic anemia resulting from exposure to
certain drugs, foods, and chemicals.
 DISORDERS INCLUDED IN
NEWBORN SCREENING (NBS)
5. MAPLE SYRUP URINE DISEASE (MSUD).
-A condition where there is an absence of a group of
enzymes called “branched-chain ketoacid
dehydrogenase” (BCKAD).
The job of this enzyme group is to break down three
different amino acids called leucine, isoleucine and 
valine. When they cannot be broken down, these
amino acids build up in the blood and cause problems. 
It is named for the sweet maple syrup smell of the
urine in untreated babies
Classic MSUD
Symptoms start as soon as a baby is fed protein, usually shortly after birth. 
Some of the first symptoms are:
 poor appetite
 weak suck
 weight loss
 high pitched cry
 urine that smells like maple syrup or burnt sugar
Babies with MSUD have episodes of illness called metabolic crisis. Some of the
first symptoms of a metabolic crisis are:
 extreme sleepiness
 sluggishness
 irritable mood
 vomiting
If not treated, other symptoms can follow: 
 episodes where muscles tone alternates between being rigid and floppy
 swelling of the brain
 seizures
 high levels of acidic substances in the blood, called metabolic acidosis
 coma, sometimes leading to death
 Symptoms of a metabolic crisis often happen:
 after going too long without food
 during illness or infection
 during stressful events such as surgery

Without treatment, brain damage can occur. This can

cause intellectual disabilities or spasticity. Some babies
become blind. If not treated, most babies die within a
few months. 
HOW IS NBS IS DONE?
A few drops of blood are taken from the
baby’s heel, blotted on a special absorbent
filter card and then sent to Newborn
Screening Center (NSC).
Who will collect the sample for ENBS?

 The blood sample for ENBS may be

collected by any of the following:
 Physician
 Nurse
 Medical technologist
 trained midwife.
Where is ENBS available?

ENBS is available in hospitals,

lying-ins, rural health units, health
centers and some private clinics.
How much is ENBS?
 

 Expanded newborn screening costs

₱1750 and is included in the Newborn Care
Package (NCP) for PhilHealth members.

What is Newborn Care Package?

 NCP is a PhilHealth benefit package for
essential health services of the newborn
during the first few days of life. It covers
essential newborn care, expanded newborn
screening, and hearing screening tests.
What are the eligibility conditions for newborn to
avail of the NCP?

 Newborns are eligible for NCP if ALL of the

following are met:
• Either of the parents are eligible to avail
of the benefits,
• Born in accredited facilities that perform
deliveries, such as hospitals and birthing
homes; and
• Services were availed of upon delivery.
 How can results be claimed?
 Results can be claimed from the health
facility where ENBS was availed. Normal
ENBS results are available by 7 - 14 working
days from the time samples are received at the
NSC.
 Positive
ENBS results are relayed to the parents
immediately by the health facility.
 Please ensure that the address and phone
number you will provide to the health facility
are correct.
What is the meaning of the newborn 
screening result?
 A NEGATIVE SCREEN means that the ENBS result is
 normal.
A POSITIVE SCREEN means that the newborn must
be brought back to his/her health practitioner for
further testing.
What must be done when a baby has a positive ENBS
 result?
 

 Babies with positive results must be

referred at once to a specialist for
confirmatory testing and further
management.
What happens to the dried blood samples after scre
ening?

 After the dried blood spot has been tested,

it will be stored in a secure locked area.
The stored sample is retained to allow for
normal quality assurance and may be used
for ethics committee approved researches
for the benefit of the public.
INTEGRATED MANAGEMENT
OF CHILDHOOD ILLNESSES
 Facts:
 Everyyear almost 11 million children under the
age of five in third world countries die from
preventable and treatable illnesses such as
dehydration, acute respiratoy infections,
measles, and malaria. Malnutrition complicates
half of theses cases.
Many of these children have never
even been seen at a health facility
for several reasons:
Services do not exist
Families lack access to these
services
Families and other caregivers do not
recognize the warning signs of life
threatening diseases
WITH THIS , IMCI WAS BORN
 INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESSES
 Simply the umbrella program through which all
community health interventions can be delivered
to children under 5 years of age .
 Firstdeveloped in 1992 by the United Nations Children
Emergency Fund (UNICEF) and the WORLD HEALTH
ORGANIZATION (WHO) with the aim of prevention or
early detection and treatment of the leading cause of
childhood deaths.
 Also emphasizes prevention of illness, through
education on the importance of immunization,
micronutrient supplementation, and improved
nutrition.
 IMCI seeks to reduce childhood mortality and
morbidity by improving family and community
practices for the home management of illness and
improving case management of skills of health workers
in the bigger health system.
WHY AN INTEGRATED APPROACH?

 Ten million children die each year and majority

of these deaths are caused by
5 preventable and treatable conditions
namely: pneumonia, diarrhea, malaria,
measles and malnutrition. Three (3) out of four
(4) episodes of childhood illness are caused by
these five conditions
Most children have more than one illness at one
time. This overlap means that a single diagnosis
may not be possible or appropriate.
WHAT ARE THE STEPS IN THE IMCI CASE MANAGEMENT PROCESS?

 ASSESS THE CHILDS ILLNESS

 CLASSIFY THE ILLNESS BASED ON SIGNS
 IDENTIFY TREATMENT
 TREAT THE CHILD
 COUNSEL THE CARETAKER
 FOLLOW-UP
WHAT ARE THE FOCUS OF IMCI?

 Improving case management skills of health

workers
 Improving over-all health systems
 Improving family and community health practices
WHAT ARE THE BENEFITS OF THE IMCI STRATEGY?

 Addresses major child health problems because it

systematically address the most important causes of
children illness and death.
 Responds to demands.
 Promotes prevention as well as cure because IMCI
emphasizes important preventive interventions such as
immunization and breastfeeding.
 Is cost-effective- most cost-effective interventions in low
and middle income countries (World Bank).
 Promotes cost-saving.
 Improves equity – IMCI improves inequity in global health
care.
What is the disease focus of IMCI in the
Philippines?
 PNEUMONIA
 DENGUE
 DIARRHEA
 MALARIA
 MEASLES
 MALNUTRITION
 PRINCIPLES OF THE IMCI CASE
MANAGEMENT GUIDELINES
 All sick children aged up to 5 years are examined for general
danger signs and all sick young infants are examined for very
severe disease. These signs indicate immediate referral or
admission to hospital
 The children and infants are then assessed for main symptoms.
For older children, the main symptoms include: cough or
difficulty breathing, diarrhea, fever and ear infection. For
young children, local bacterial infection, diarrhea and
jaundice. All sick children are routinely assessed for
nutritional and immunization and deworming status and
other problems
 Only a limited number of clinical signs are used
 A combination of individual signs leads to a child’s classification within one
or more symptom groups rather than a diagnosis.
 IMCI management procedures use limited number of essential drugs and
encourage active participation of  caretakers in the treatment of children
 Counseling of caretakers on home care, correct feeding and giving of fluids,
and when to return to clinic is an essential component of IMCI
  
WHAT IS THE EXTENT OF IMCI
IMPLEMENTATION?
 IMCI is implemented in 70% of all health facilities
nationwide.  IMCI is also integrated in the Nursing,
Midwifery and Medical Pre- Service Education. The
attached lists/addresses of DOH Centers for
Development (CHDs) in 17 regions can provide
technical assistance in IMCI training. The list also
includes the Nursing and Midwifery Schools
designated as Training Institution for IMCI Pre-
Service.
IMCI
Read advance on the following topics :
PRETEST NEXT WEEK
1. Principles/activities to be practice during home visit for infection control
(bag technique
2. DOH PROGRAMS:
- EXPANDED PROGRAM OF IMMUNIZATION
-INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES
-EARLY ESSENTIAL INTRAPARTAL AND NEWBORN CARE
-NEWBORN SCREENING
-BEmONC/CEmONC
-NUTRITION
-MhGAP