MULTI-EDUCATIONAL REVIEW GROUP EXPERTS, INC.

*BAGUIO CITY*ILOILO CITY * DAVAO CITY *CABANATUAN CITY*

MAKATI CITY*METRO CEBU*VIGAN CITY*GEN SANTOS CITY *PAMPANGA*
MANILA HEAD OFFICE
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COMMUNITY HEALTH NURSING
NATIONAL HEALTH SITUATION
Demographic profile:
a. Leading Causes of Mortality among Filipinos in 2002
1. Diseases of the Heart
2. Diseases of the Vascular System
3. Malignant Neoplasm
4. Pneumonias
5. Accidents
6. Tuberculosis
b. Leading Causes of Infant Mortality in 2002
1. Respiratory conditions of the fetus and newborns -2002 -2008
2. Pneumonias- 1995-2001
3. Bacterial sepsis of newborn
4. Diarrhea and Gastroenteritis
5. Congenital malformation of the heart
c. Leading Causes of Maternal Mortality in 2002
1. Other complications related to pregnancy
occurring in the course of labor and delivery
2. Hypertension complicating pregnancy and childbirth
3. Postpartum Hemorrhage
4. Pregnancy with abortive outcome
5. Hemorrhage related to pregnancy
d. Leading Causes of Morbidity in 2002
1. Pneumonias 2002-2008
2. Diarrheas 1998-2001
3. Bronchitis
4. Influenza
5. Hypertension
6. Tuberculosis
DEPARTMENT OF HEALTH
Lead agency in the health sector and sets the goals for the nations health.
Roles and Functions of DOH
Leadership in Health
Enabler and Capacity Builder
Administrator of specific services
VISION of DOH:
The Leader of Health For All in the Philippines
MISSION of DOH:
Guarantee equitable, sustainable and quality health for all
Filipinos, especially the poor and to lead the quest for excellence
in health
OBJECTIVES of DOH:
General health status of the population must be improved.
Reduce morbidity, mortality, disability and complications from the different
diseases and disorders.
Eliminate the following diseases as public health problems
(Schistosomiasis, Malaria, Filariasis, Leprosy, Rabies, Vaccine preventable
diseases, Vit. A and Iodine deficiency)
Eradicate poliomyelitis
Promote Healthy Lifestyle
Promote the health and nutrition of families
Promote Environmental Health
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GOAL of DOH:
HEALTH SECTOR REFORM AGENDA ( HSRA)

FRAMEWORK FOR IMPLEMENTATION OF HSRA: FOURmula 1 for Health
FOURmula 1 for Health
speed, precision, and effective coordination towards improving the efficiency, effectiveness & equity of
health care delivery.
FOURmula 1 COMPONENTS or ELEMENTS
1. HEALTH REGULATION
2. HEALTH FINANCING
3. HEALTH SERVICE DELIVERY
4. GOOD GOVERNANCE IN HEALTH
NATIONAL HEALTH PLAN:
It is the blue print, which is followed by the Department of Health. It defines the
countrys health problems, policy thrusts, strategies and targets.
HEALTH CARE DELIVERY SYSTEM:
Is the totality of all policies, infrastructures, facilities, equipment, products, human
resources and services that address the health needs, problems and concerns of all
people.
HEALTH CARE SERVICES:
Promotive and Preventive:
Curative and Rehabilitative:
Local Government Code (RA 7160)

The Code aims to:
a. transform local government units into self reliant communities
b. and active partners in the attainment of national goals through
a more responsive and accountable local government structure
instituted through a system of decentralization.
Inter Local Health System
In order to ensure quality health care services at the local level
Clustering municipalities into
Inter Local Health Zone
Each ILHZ has a defined population within a defined geographical area
Partnership as the basic framework
Composition of ILHZ:
1. People
2. Boundaries
3. Health Facilities
4. Health Workers
PRIMARY HEALTH CARE: (WHO)
Is essential health care based on practical and socially acceptable methods and technology made
universally accessible to I-F-C
GOAL: Health for All Filipinos and Health in the Hands of the People by the year 2020.
MISSION: To strengthen the health care system by increasing opportunities and supporting the
conditions wherein people will manage their own health care.

ELEMENTS OF PHC:
E- Education for Health
L- Locally Endemic Disease Control
E- Expanded Program on Immunization
M-Maternal and Child Health
E- Essential Drugs (Botika sa Baryo or Barangay, Botika sa Paso)
N- Nutrition
T-Treatment of Communicable and Non- Communicable Diseases
S- Safe water and Sanitation
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COMPONENTS OF HEALTH CARE DELIVERY SYSTEM:
A. LEVELS OF CLIENTELE
1. Individual
2. Family
3. Community
4. Population Groups

Infants and Young Children
School age
Adolescents
Mothers
Males
Old People
TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE
FIRST LEVEL ASSESSMENT
Health Threats
Conditions that are conducive to disease, accidents, or failure to realize ones own health potential
Ex. Family history, family size, accident hazards, poor environmental conditions
Health Deficits
Instances of failure in health maintenance (disease, disability, developmental lag, etc.)
Ex. Illness states, Malnutrition, Disability
Stress Point / Foreseeable Crisis
Anticipated periods of unusual demand on the family in terms of adjustment or to family resources
Ex. Unemployment, Death of a family member, Unexpected pregnancy, marriage
Community Health Nursing: An Overview
What is COMMUNITY?
*a social group of people interacting with each other, determined by geographic
boundaries,
*living together to attain certain and common goals and sharing the same interest.
Characteristics of a healthy community
1. The members are aware of their own health and biologic status.
2. Members give credit to the governing authority.
3. The natural and biological resources are open for everybody, but the consumption is controlled to
help in preserving this resources.
4. Has a strong and reliable governing body.
5. The people work together to attain independence.
6. Environmental and physiologic needs are sustained by the community and families.
7. Parents and guardians serves as role models for the children.
8. The people are concerned with their health status.
9. Health needs are accessible and affordable to the public and free for the indigent.
10. Everyone is working to attain Health Citizenry.
What is HEALTH?
Modern Concept:
Health refers to:
(Optimum Level of Functioning-OLOF)
of an I-F-C
Eco- System influence the OLOF
What is NURSING?-
assisting sick or well I-F-C to become healthy and to achieve optimum level of
wellness
QUALIFICATIONS, ROLES AND FUNCTIONS OF A COMMUNITY HEALTH NURSE
A. QUALIFICATIONS OF PUBLIC HEALTH NURSE: a nurse working in the community
BSN
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Registered Nurse

Roles Functions
MANAGER
Plans and organizes the nursing service plan of the health unit
Participates in the preparation and implementation of municipal health
plan
Monitors and evaluates the implementation of the nursing service plan
Manages the RHU in the absence of the Rural Health Physician
Allocates and distributes materials and equipments at local levels
SUPERVISOR
Formulates and implements a supervisory plan
Monitors and evaluates midwives in the implementation of public
health programs
Maintains records and reports
TRAINOR
Identifies and interprets training needs of midwives, BHW and
Hilots.
Formulates Training Program for midwives, BHW and Hilots.
Evaluates effects of training on work performance
CLINICIAN or PROVIDER OF NURSING CARE
Provides direct nursing care to the sick, disabled in the home, clinic and
place of work

HEALTH EDUCATOR
Conducts health education activities ( mothers class, IEC)
COUNSELOR
Conducts pre-marital counseling
COMMUNITY ORGANIZER
Responsible for motivating and enhancing community participation
COORDINATOR or FACILITATOR
Coordinates nursing program with other health programs
Multi-sectoral linkages
HEALTH MONITOR
Detects deviation from health of individuals, families and communities
through follow-up care.
ROLE MODEL
Provides good example of healthful living to the public
CHANGE AGENT
Motivates Changes in health behavior
RECORDER/REPORTER
Maintains and submits accurate and complete data

RESEARCHER
Participates, Assists or Conducts researches on nursing and health
related subjects.
LAWS AFFECTING COMMUNITY HEALTH NURSING PRACTICE
1. RA 9173----------------Phil. Nursing Act of 2002
2. RA 7160 ---------------Local Government Code
3. RA 7610 ---------------Child Abuse Law
4. RA 2382 ---------------Phil. Medical Act
5. RA 1082 ---------------Rural Health Act
6. RA 7305 ---------------MagnaCarta for Public Health Workers
7. RA 7277---------------MagnaCarta for Disabled Person
8. RA 3573--------------- Communicable Diseases should be reported
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9. RA 9165--------------- Dangerous Drugs Act
10. RA 9262--------------- Domestic Violence Act
11. RA 9257 ---------------Expanded Senior Citizen Act 2003
12. RA 6758 ---------------Salary Standardization Law
13. RA 8423 -------------- Phil. Institute of Traditional and Alternative Health Care
14. RA 6713 ---------------Code of Conduct and Ethical Standards
15. RA 8749 ---------------Clean Air Act
16. PD No. 856 -------------Sanitation Code of the Phil.
17. PD No. 825 ------------Penalty for Improper Garbage Disposal
18. PD No. 807 ------------Civil Service Rules and Regulations
19. PD.No. 651-------------Registration of all births within 30 days following delivery
20. PD No. 996 ------------Compulsory Basic Immunization for Infants and
Children Below 8 years old
21. EO No. 94--------------Reorganization of Govt. Offices and Created the
Division Of Nursing
22. Act No. 1407 ----------Reorganization Act/ Abolition of the Board of Health


VITAL AND HEALTH STATISTICS
Refers to the systematic study of vital events such as births, illnesses and deaths.
Statistics of disease (morbidity) and death indicate the state of health of a
community and the success or failure of health work.
1. Crude Birth Rate: Total No.of Livebirths registered x 1,000
Estimated population as Jul. 1 of the same year
2. Crude Death Rate: Total No. of Deaths registered x 1,000
Estimated population as Jul. 1 of the same year

3. Infant Mortality Rate: Total No. of Deaths under 1 year of age x 1,000
Total No. of registered livebirths
4. Maternal Mortality Rate: Total No. of Deaths from maternal cause x 1,000
Total No. of registered livebirths
5. Incidence Rate: Number of new cases of a particular disease x 100,000
Estimated population as Jul. 1 of the same year
6. Prevalence Rate: Number of new and old cases of a certain disease x 100
Total No. of persons examined at the same given time
HEALTH PROGRAMS, SERVICES AND STRATEGIES
I. MATERNAL AND CHILD HEALTH CARE PROGRAM
A. MATERNAL CARE Safe Motherhood Program
a. Prenatal Care
To reach all a pregnant women, to give sufficient care, ensure a healthy
pregnancy and the birth of a full term healthy baby
History Taking
To compute the EDC ( Expected Date of Confinement) use the
Naegels Rule:
1
st
get the (LMP) Last Menstruation Period
2
nd
use the following: -3 + 7 +1 ( constant)
Example: LMP- Aug. 13, 2005
8 13 2005
-3 + 7 + 1
5 20 2006 EDC
To compute the AOG ( Age of Gestation)
1
st
get the (LMP) Last Menstruation Period
Example: LMP- Jan. 24, 2005
2
nd
get the latest consultation date
Example: April 7, 2005

Jan 31-24= 7
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Jan - 7
Feb - 28
Mar - 31
Apr - 7
73
73 divide 7 = 10 wks and 3 days AOG
Child Care
UNDER FIVE CLINIC PROGRAM
Breast Feeding
B- est for babies up to 6mons to 2 years
R- apid involution is promoted
E - conomical (money, time)
A- lways available
S- atisfies infants needs
T- emperature is always right
F- eeding promotes bonding
E- asy to digest
E- ffortless
D- ecrease incidence of breast cancer
I llness prevention
N- ormally contains antibodies
G - astroenteritis is less likely to occur

Breast Feeding Positions:
Cradle Position
Side-lying Position
Football Position
EXPANDED PROGRAM ON IMMUNIZATION launched in July 1976
Objective: To reduce the morbidity and mortality among infants and children
caused by the six childhood immunizable diseases.
Legal Basis:
Pres. Decree No. 996 - Compulsory Basic Immunization for Children below 8 years old
Pres. Proclam No. 6 - Universal Child Immunization
Pres. Proclam No. 46 - Universal Child and Mother Immunization
Pres. Proclam No.147 - National Immunization Days
Pres. Proclam.No. 773 - Knock Out
Pres. Proclam No. 1066 - Neonatal Tetanus Elimination Campaign
Rep. Act 7846 - Compulsory Immunization Againts Hep.
IMMUNIZATION SCHEDULE
Vaccine Age to be given Doses Dosage Interval Route Site
1. BCG Infants: 1 0.05 ml ID R Deltoid
anytime at birth
School Entrance: 1 0.1 ml ID L Deltoid
6 yrs old

2. DPT 6 weeks 3 0.5 ml 4 wks IM Thigh-Vastus
Lateralis
3. OPV 6 weeks 3 2-3 drops 4 wks PO Mouth
Salk- parenteral
Sabin- oral ( liquid form)
4. Hep. B 6 weeks 3 0.5 ml 4 wks IM Thigh-Vastus
Lateralis
5. Measles 9 mons 1 0.5 ml SC Deltoid- Thigh
(Ligtas Tigdas Campaign-February 2004)
(PMEC)- the ultimate goal is to interrupt the circulation of measles virus in all communities by 2008
Target Participants: 9 months to less than 8 years old children
VACCINE COMPUTATION:
For infants, target-setting should be based on the 3% of the total population, while for pregnant
women, it must be based on the 3.5% of the total population.
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infants
Eligible Population = total population x 0.03
school entrants
x 0.035 pregnant women
Example: How many amp of BCG and vial of DPT and TT will you request for a
population of 5000 per year.
1. Compute eligible population:
Formula:
Eligible Population= total population x constant percentage
Constant Percentage
a. Infants- 3%=.03
b. School entrance- 3%=.03
c. Pregnant mother- 3.5%=.035
Infants: 5000 x .03 = 150 infants
Pregnant Mother: 5000 x .035 = 175 pregnant
2. Compute Doses needed per year:
Formula:
Doses needed per year= Eligible Population x constant doses
Constant Doses:
BCG-1 dose
DPT- 3 doses
OPV- 3 doses
Hep.B- 3 doses
Measles-1 dose
TT - 2 doses
BCG: 150 x 1 dose 150 doses of BCG
DPT: 150 x 3 dose 450 doses of DPT
TT: 175 X 2 dose 350 doses of TT
3. Compute Doses with Wastage Allowance:
Formula:
Doses with Wastage Allowance= Doses needed per year x constant wastage allowance
Constant Wastage Allowance per vaccine
a. Infant-BCG ---------------- 2.50
b.SE-BCG---------------------- 1.67
c.DPT, OPV--------------------1.67
d Hep. B.------------------------1.20
e.Measles -----------------------2.0
BCG- 150 dose x 2.50 = 375 doses of BCG
DPT 450 doses x 1.67 = 752 doses of DPT
4. Compute Ampule and vial request per year:
Formula:
Ampule and vial request per year= Doses with Wastage Allowance
Constant stock doses per ampule or per vial
Constant stock doses per ampule or per vial
a.BCG, OPV, TT------------ 20 doses
b.DPT, Measles, Hep.B---- 10 doses

BCG: 375 doses
20 doses/ampule
= 19 ampules/ year
DPT : 752 doses
10 doses/vial
= 38 vials/year
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HEALTH EDUCATION AND COMMUNITY ORGANIZATION
HEALTH EDUCATION
Process whereby knowledge, attitude and practice of people are changed to
improve individual, family and community health.
HEALTH EDUCATION TEACHING METHODS AND STRATEGIES:

Interviewing
Counseling
Lecture- Discussion
Work shops
Case study
Role play
QUALITIES OF A GOOD HEALTH EDUCATOR
Knowledgeable
Credible
Patience
Possess teaching skills
Creative
Encourage Group Participation
COMMUNITY ORGANIZATION:
Process by which people, health services and agencies of the community are
brought together.
STEPS IN ORGANIZING A COMMUNITY FOR HEALTH ACTION:
PREPARATORY PHASE:
Area Selection
Courtesy call
Gain Entry in the community
Community Profiling
Community Assembly
ORGANIZATIONAL PHASE:
Social Preparation
Spotting and Developing Potential leaders
Core Group Formation
Setting up community organization
EDUCATION AND TRAINING PHASE:
Conducting community diagnosis
Training of community health workers
Health services and mobilization
Leadership-formation activities
INTERSECTORAL COLLABORATION PHASE:
SUSTENANCE AND STRENGTHENING PHASE:
PHASE- OUT
10 HERBAL MEDICINES:
RA No.- 8423- Phil. Institute of Traditional and Alternative Health Care (PITAHC)
Mnemonic is BUBLY SANTA
B - awang ------------------------------- Hypertension, Lowers Cholesterol, Toothache
U - lisimang Bato (Pansit-pansitan)- Lowers uric acid, Rheumatism
B - ayabas-------------------------------- Diarrhea, Wounds, Toothache
L - agundi--------------------------------- Cough, Asthma, Fever
Y - erba Buena-------------------------- Muscle pain, Arthritis, Rheumatism, Cough,
Headache
S - ambong------------------------------- Anti edema, Diuretic, Anti- urolithiasis
A - mpalaya------------------------------ Diabetes Mellitus
N - iog-niogan---------------------------- Parasitism, Ascariasis, Anti-helmintic
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T - saang Gubat------------------------- Stomachache, Diarrhea
A - kapulko ------------------------------ Scabies, Anti-fungal, and Athletes foot
TEN ELEMENTS OF REPRODUCTIVE HEALTH
Family Planning (FP)
MCH and Nutrition (MCH and N)
Prevention and Management of RTIs and STIs
Adolescents Reproductive Health (ARH)
Prevention and Management of Abortion Complications (PMAC)
Education on breast and RT Cancers
Education and counseling on sexual health
Violence Against Women and Children (VAWC)
Prevention and Management of Infertility and sexual disorders
Mens reproductive health
BOTIKA NG BARANGAY
Drug outlet
Managed by a legitimate CO, NGO and LGU
With a trained operator and a supervising pharmacist
OBJECTIVES OF BNB
Serve as mechanism for the DOH to establish partnership with LGU and CO
Increase the involvement of the BHW to the community
Rationalize the distribution of common drugs and medicines to indigents
LIST OF OTC DRUGS IN BNB
ANALGESICS
ANTACIDS
ANTIHELMINTICS
ANTIHISTAMINIC
NSAIDs
ANTIVERTIGO
ANTICOUGH- lagundi only
DIURETIC- sambong only
ANTITUSSIVE
NASAL DECONGESTANT
ANTIMOTILITY
ORS
LAXATIVE
ANTI-SCABIES
ANTI ANEMIC
ANTIFUNGAL
VITAMINS AND MINERALS
ANTI-INFECTIVES- amox and cotri only
TOPICAL NASAL DECONGESTANT
DISINFECTANTS
Med. For CHRONIC DISEASES like:
Metformin, Glibenclamide,
Metoprolol, Captopril
Salbutamol
Nine Warning Signs of Cancer: CAUTION US
C- hange in blood bowel or bladder habits
A -sore that does not heal
U- nusual bleeding or discharge
T hickening or lump in breast
I- ndigestion or difficulty in swallowing
O-bvious change in wart or mole
N- aging cough or hoarseness

U- nexplained anemia
S- udden weight loss
LIFE IS WHAT WE MAKE IT!
ONLY those who have truly sacrificed can reach the unreachable and can find Gods blessings.
May you be blessed a thousand fold and be a blessing to the least of our brethren.
GOOD LUCK AND GOD BLESS
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