Scope of CHN

COMMUNITY HEALTH NURSING

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

Safe and Quality Care, Health Education, and
Communication, Collaboration and Teamwork
6. Family-based Nursing Services(Family
Health Nursing Process)
7. Population Group-based Nursing Services
8. Community-based Nursing
Services/Community Health Nursing
Process
9. Community Organizing
10.Public Health Programs
Research and Quality Improvement
1. Research in the Community
2. National Health Situation
3. Vital Statistics
4. Epidemiology
5. Demography
Management of Resources & Environment and
Records Management
1. Field Health Services And Information
System
2. Target-setting
3. Environmental Sanitation
Ethico-Moral-Legal Responsibility
1. Socio-cultural values, beliefs, and
practices of individuals, families, groups
and communities
2. Code of Ethics for Government Workers
3. WHO, DOH, LGU policies on health
4. Local Government Code
5. Issues
Personal And Professional
Development
1. Self-assessment of CHN competencies,
importance, methods and tools
2. Strategies and methods of updating ones
self, enhancing competence in
community health nursing and related
areas.
HISTORY OF CHN
1901- Act # 157 ( Board of Health of the Philippines);
Act # 309 ( Provincial and Municipal Boards of Health)
were created.

1905- Board of Health was abolished; functions were
transferred to the Bureau of Health.

1912 Act # 2156 or Fajardo Act created the Sanitary
Divisions, the forerunners of present MHOs; male
nurses performs the functions of doctors

1919 Act # 2808 (Nurses Law was created) Carmen
del Rosario, 1
st
Fil. Nurse supervisor under Bureau of
Health


Date Event
Oct. 22, 1922 Filipino Nurses Organization
(Philippine Nurses Organization) was organized.

1923 Zamboanga General Hospital School of Nursing
& Baguio General Hospital were established; other
government schools of nursing were organized
several years after.

1928 - 1
st
Nursing convention was held

1940 Manila Health Department was created.

1941 Dr. Mariano Icasiano became the first city
health officer; Office of Nursing was created through
the effort of Vicenta Ponce (CN) and Rosario Ordiz
(aCN)


Dec. 8, 1941 Victims of World War II were treated by
the nurses of Manila.

July 1942 Nursing Office was created; Dr. Eusebio
Aguilar helped in the release of 31 Filipino nurses in
Bilibid Prison as prisoners of war by the Japanese.

Feb. 1946 Number of nurses decreased from 556
308.

1948 First training center of the Bureau of Health was
organized by the Pasay City Health Department.
Trinidad Gomez, Marcela Gabatin, Costancia Tuazon,
Ms. Bugarin, Ms. Ramos, and Zenaida Nisce composed
the training staff.
1950 Rural Health Demonstration and Training
Center was created.

1953 The first 81 rural health units were
organized.

1957 RA 1891 amended some sections of RA
1082 and created the eight categories of rural
health unit causing an increase in the demand
for the community health personnel.

1958-1965 Division of Nursing was abolished
(RA 977) and Reorganization Act (EO 288)

1961 Annie Sand organized the National League of
Nurses of DOH.

1967 Zenaida Nisce became the nursing program
supervisor and consultant on the six special diseases
(TB, leprosy, V.D., cancer, filariasis, and mental health
illness).

1975 Scope of responsibility of nurses and midwives
became wider due to restructuring of the health care
delivery system.

1976-1986 The need for Rural Health Practice Program
was implemented.

1990- 1992- Local Government Code of 1991 (RA 7160)
1993-1998 Office of Nursing did not
materialize in spite of persistent
recommendation of the officers, board
members, and advisers of the National
League of Nurses Inc.

Jan. 1999 Nelia Hizon was positioned as the
nursing adviser at the Office of Public Health
Services through Department Order # 29.

May 24, 1999 EO # 102, which redirects the
functions and operations of DOH, was signed
by former President Joseph Estrada.
Laws Affecting Public
Health and Practice of
Community Health
Nursing
R.A. 7160 - or the Local Government Code. This
involves the devolution of powers, functions and
responsibilities to the local government both
rural & urban.The Code aims to transform local
government units into self-reliant communities
and active partners in the attainment of
national goals thru a more responsive and
accountable local government structure
instituted thru a system of decentralization.
Hence, each province, city and municipality has
a LOCAL HEALTH BOARD ( LHB ) which is
mandated to propose annual budgetary
allocations for the operation and maintenance
of their own health facilities.

Composition of LHB
Provincial Level
1. Governor- chair
2. Provincial Health
Officer vice chair
3. Chair , Committee on
Health of Sangguniang
Panlalawigan
4. DOH rep.
5. NGO rep.
City and Municipal Level
1. Mayor chair
2. MHO vice chair
3. Chair, Committee on
Health of Sangguniang
Bayan
4. DOH rep
5. NGO rep

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

P.D. No. 965 requires applicants for marriage license to
receive instructions on family planning and responsible
parenthood.

P.D. NO. 79 defines , objectives, duties and functions of
POPCOM

RA 4073 advocates home treatment for leprosy

Letter of Instruction No. 949 legal basis of PHC dated OCT.
19, 1979
promotes development of health programs on the
community level

RA 3573 requires reporting of all cases of communicable
diseases and administration of prophylaxis

Ministry Circular No. 2 of 1986 includes AIDS as notifiable
disease



R.A. 7875 National Health Insurance Act

R.A. 7432 Senior Citizens Act

R.A. 7719 National Blood Services Act

R.A. 8172 Salt Iodization Act ( ASIN LAW)

R.A. 7277 Magna Carta for PWDs, provides
their rehabilitation, self-development and self-
reliance and integration into the mainstream of
society
A. O. No. 2005-0014- National Policies on
Infant and Young Child Feeding:

1. All newborns be breastfeed within 1 hr after
birth
2. Infants be exclusively breastfeed for 6 mos.
3. Infants be given timely, adequate and safe
complementary foods
4. Breastfeeding be continued up to 2 years and
beyond


E.O. 51- Phil. Code of Marketing of Breastmilk
Substitutes

R.A. 7600 Rooming In and Breastfeeding Act
of 1992

R.A. 8976 Food Fortification Law

R.A. 8980 promulgates a comprehensive
policy and a national system for ECCD
A..O. No. 2006- 0015- defines the Implementing
guidelines on Hepatitis B Immunization for
Infants

R.A. 7846- mandates Compulsory Hepatitis B
Immunization among infants and children less
than 8 yrs old

R.A. 2029- mandates Liver Cancer and Hepatitis
B Awareness Month Act ( February)

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

Public Health
science and art of
preventing disease,
prolonging life,
promoting health and
efficiency thru
organized community effort for the sanitation of
the environment,
control of communicable diseases,
the education of individuals in personal hygiene,
the organization of medical and nursing services
for the early diagnosis and preventive treatment
of diseases and
the development of social machinery to ensure
everyone a standard of living adequate for the
maintenance of health,
so organizing these benefits as to enable every
citizen to realize his birthright off birth and longevity

( DR. C.E. Winslow)
Community Health Nursing
special field of nursing that combines
skills of nursing,
public health and
some phases of social assistance and functions
as part of the total public health program for the
promotion of health, the improvement of the
conditions in the social and physical environment,
rehabilitation of illness and disability
(WHO Expert Committee of Nursing)
CHN
learned practice discipline with the ultimate goal of
contributing as individuals and in collaboration with
others to the promotion of the clients optimum level of
functioning thru teaching and delivery of care ( Jacobson
)

a service rendered by a professional nurse to IFCs,
population groups in health centers, clinics, schools ,
workplace for the promotion of health, prevention of
illness, care of the sick at home and rehabilitation (DR.
Ruth B. Freeman)
Concepts
The primary focus of community health nursing is
health promotion.

Community health nurses provide care necessary to
meet the requirements of an individual all throughout
the life cycle.

Knowledge on different fields (biological and social
sciences, clinical nursing, and community health
organizations) is used.

Nursing process in community health nursing changes
based on the needs of the community.
GOAL
To elevate the level of health of the multitude.

PHILOSOPHY
Worth and dignity of man.



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

PRINCIPLES
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
Collaborates with other members of the
health team, professionals and community
representatives in assessing, planning,
implementing and evaluating programs for
community health
Standards
IX. Research
Indulges in research to contribute to theory
and practice in community health nursing

LEVELS OF CARE/ PREVENTION
1. PRIMARY

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

2. SECONDARY LEVEL FACILITIES

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

THE DEPARTMENT OF HEALTH
VISION: Health for all Filipinos

MISSION: Ensure accessibility & quality of
health care to improve the quality of life of all
Filipinos, especially the poor.

NATIONAL OBJECTIVES
1. Improve the general health status of the population
(reduce infant mortality rate, reduce child morality rate,
reduce maternal mortality rate, reduce total fertility rate,
increase life expectancy & the quality of life years).

2. Reduce morbidity, mortality, disability &
complications
Diarrheas, Pneumonias, Tuberculosis, Dengue, Intestinal
Parasitism, Sexually Transmitted Diseases, Hepatitis B,
Accident & Injuries, Dental Caries & Periodontal Diseases,
Cardiovascular Diseases, Cancer, Diabetes, Asthma & Chronic
Obstructive Pulmonary Diseases, Nephritis & Chronic Kidney
Diseases, Mental Disorders, Protein Energy Malnutrition, Iron
Deficiency Anemia & Obesity.
3.Eliminate the ff. diseases as public health
problems:
Schistosomiasis
Malaria
Filariasis
Leprosy
Rabies
Measles
Tetanus
Diphtheria & Pertussis
Vitamin A Deficiency & Iodine Deficiency
Disorders
4. Eradicate Poliomyelitis
5. Promote healthy lifestyle through
healthy diet & nutrition, physical activity & fitness,
personal hygiene, mental health & less stressful
life & prevent violent & risk-taking behaviors.
6. Promote the health & nutrition of families &
special populations through
child, adolescent & youth, adult health, womens
health, health of older persons, health of
indigenous people, health of migrant workers and
health of different disabled persons and of the
rural & urban poor.
7. Promote environmental health and
sustainable development through the
promotion and maintenance of healthy
homes, schools, workplaces, establishments
and communities towns and cities.
Basic Principles to Achieve
Improvement in Health
1. Universal access to basic health services
must be ensured.
2. The health and nutrition of vulnerable
groups must be prioritized.
3. The epidemiological shift from infection to
degenerative diseases must be managed.
4. The performance of the health sector must
be enhanced.
Primary Strategies to Achieve Goals
1. Increasing investment for Primary Health
Care.
2. Development of national standards and
objectives for health.
3. Assurance of health care.
4. Support to the local system development.
5. Support for frontline health workers.
PHC as a Strategy
PRIMARY HEALTH CARE (PHC)
May 1977- 30
th
World Health Assembly decided
that the main health target of the government
and WHO is the attainment of a level of health
that would permit them to lead a socially and
economically productive life by the year 2000.

September 6-12, 1978 - First International
Conference on PHC in Alma Ata, Russia (USSR)
The Alma Ata Declaration stated that PHC was the
key to attain the health for all goal
October 19, 1979 - Letter of Instruction (LOI)
949), the legal basis of PHC was signed by
Pres. Ferdinand E. Marcos, which adopted PHC
as an approach towards the design,
development and implementation of
programs focusing on health development at
community level.

RATIONALE FOR ADOPTING PRIMARY
HEALTH CARE:
Magnitude of Health Problems
Inadequate and unequal distribution of health
resources
Increasing cost of medical care
Isolation of health care activities from other
development activities
DEFINITION OF PRIMARY HEALTH CARE
essential health care made universally accessible to
individuals and families in the community by means
acceptable to them, through their full participation and at
cost that the community can afford at every stage of
development.

a practical approach to making health benefits within the
reach of all people.

an approach to health development, which is carried out
through a set of activities and whose ultimate aim is the
continuous improvement and maintenance of health status
of the community.

GOAL OF PRIMARY HEALTH CARE:
HEALTH FOR ALL FILIPINOS by the year 2000
AND HEALTH IN THE HANDS OF THE PEOPLE by the year 2020.

An improved state of health and quality of life
for all people attained through SELF-RELIANCE.
` KEY STRATEGY TO ACHIEVE THE GOAL:

Partnership with and Empowerment of the people -
permeate as the core strategy in the effective
provision of essential health services that are
community based, accessible, acceptable, and
sustainable, at a cost, which the community and the
government can afford.
OBJECTIVES OF PRIMARY HEALTH CARE
Improvement in the level of health care of the community
Favorable population growth structure
Reduction in the prevalence of preventable, communicable and
other disease.
Reduction in morbidity and mortality rates especially among infants
and children.
Extension of essential health services with priority given to the
underserved sectors.
Improvement in Basic Sanitation
Development of the capability of the community aimed at self-
reliance.
Maximizing the contribution of the other sectors for the social and
economic development of the community.

MISSION:
To strengthen the health care system by
increasing opportunities and supporting
the conditions wherein people will manage
their own health care.

TWO LEVELS OF PRIMARY HEALTH CARE WORKERS
1. Barangay Health Workers - trained community health workers
or health auxiliary volunteers or traditional birth attendants or
healers.
2. Intermediate level health workers include the Public Health
Nurse, Rural Sanitary Inspector and midwives.
PRINCIPLES OF PRIMARY HEALTH CARE
1. 4 A's = Accessibility, Availability, Affordability &
Acceptability, Appropriateness of health services. The
health services should be present where the supposed
recipients are. They should make use of the available
resources within the community, wherein the focus
would be more on health promotion and prevention of
illness.

2. COMMUNITY PARTICIPATION =heart and soul of PHC

3. People are the center, object and subject of
development.

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

DEVELOPMENT
is the quest for an improved quality of life for all.
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
The health in the hands of the people
brings the government closest to the
people. It necessitates a process of capacity
building of communities and organization to
plan, implement and evaluate health
programs at their levels.

C. INCREASING EFFICIENCIES IN THE HEALTH
SECTOR
Using appropriate technology will make services
and resources required for their delivery, effective,
affordable, accessible and culturally acceptable.
The development of human resources must
correspond to the actual needs of the nation and
the policies it upholds such as PHC. The DOH will
continue to support and assist both public and
private institutions particularly in faculty
development, enhancement of relevant curricula
and development of standard teaching materials.
D. ADVANCING ESSENTIAL NATIONAL HEALTH
RESEARCH
Essential National Health Research
(ENHR) is an integrated strategy for
organizing and managing research
using intersectoral, multi-disciplinary
and scientific approach to health
programming and delivery.
4 CORNERSTONES/ PILLARS IN
PRIMARY HEALTH CARE
1. Active Community Participation
2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. Support mechanism made available

HERBAL MEDICINES ENDORSED BY THE
DEPARTMENT OF HEALTH
Naime Indications Dosage
Five-leaf
Chaste tree
(Lagundi)
1. Asthma
2. Cough
3. Body Pain
4. Fever
Divide the decoction
into 3 parts:
For asthma and cough,
drink 1 part 3 times a
day.
For fever and body
pains, drink 1 part
every 4 hrs.
Marsh-Mint;
Peppermint
(Yerba Buena)
1. Body pain Divide
decoction into
2 parts and
drink 1 part
every 3 hours.
Sambong 1. Swelling
2. Inducing
diuresis
(anti-
urolithiasis)

Divide
decoction into
3 parts and
drink 1 part 3
times a day.
Tsaang
Gubat
1. Stomachache Drink the warm
decoction. If it
persists, or if there
is no improvement
an hour after
drinking the
decoction, consult a
doctor.
Ulasimang
Bato/Pansit-
Pansitan
1. Gouty Arthritis Divide the
decoction into 3
parts and drink 1
part 3 times a day
after meals.
Garlic 1. Hypertension
2. Hyperlipidemia
Eat 6 cloves of
garlic together
with meals
Niyog-
Niyogan
1. Ascariasis Chew and
swallow only
dried seeds 2
hours after
dinner according
to the following:
ADULTS = 8-10 seeds
9-12 y/o = 6-7 seeds
6-8 y/o = 5-6 seeds
4-5 y/o = 4-5 seeds
Guava 1. Cleaning
wounds
2. Mouth wash
for mouth
infection,
sore gums &
tooth decay
For wound cleaning, use
decoction for washing
the wound 2 times a day
For tooth decay and
swelling of gums, gargle
with warm decoction 3
times a day
Akapulko
1. Ring
worm
2. Athletes
foot
3. Scabies
Apply the juice on the affected
area 1 to 2 times a day
If the person develops an allergy
while using the above preparation,
prepare the following:
oPut 1 cup of chopped fresh leaves
in an earthen jar. Pour in 2 glasses
of water and cover it.
oBoil the mixture until the 2 glasses
of water originally poured have
been reduced to 1 glass of water
oStrain the mixture. Use it while it
is warm.
oApply the warm decoction on the
affected area 1 to 2 times a day.
Bitter Gourd/
Melon
(Ampalaya)
1. Mild Non-
Insulin
Dependent
Diabetes
Mellitus
Drink cup
of cooled or
warm
decoction 3
times a day
after meals.
Ginger
(Zingiber
officinale)
1. Motion
sickness,
sore throat,
nausea &
vomiting,
migraine
headaches,
arthritis
An abortifacient if taken
in large amounts; should
not be used by persons
with cholelithiasis unless
directed by the physician;
may increase the risk of
bleeding when used
concurrently with
anticoagulants &
antiplatelets.
Chop and Mash a piece of ginger
root, and mix in a glass of water
Boil the mixture
Drink the cooled or warm decoction
as needed.
ELEMENTS OF PRIMARY HEALTH CARE:
Education For Health
Is one of the potent methodologies
for information dissemination. It
promotes the partnership of both
the family members and health
workers in the promotion of health
as well as prevention of illness.

Locally Endemic Disease Control
The control of endemic disease
focuses on the prevention of its
occurrence to reduce morbidity rate.
Example Malaria Control and
Schistosomiasis Control

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

Maternal and Child Health and
Family Planning
The mother and child are the most delicate
members of the community. So the
protection of the mother and child to
illness and other risks would ensure good
health for the community. The goal of
Family Planning includes spacing of
children and responsible parenthood.
Environmental Sanitation and
Promotion of Safe Water Supply
Environmental Sanitation is defined as the study of
all factors in the mans environment, which
exercise or may exercise deleterious effect on his
well-being and survival.

Water is a basic need for life and one factor in
mans environment. Water is necessary for the
maintenance of healthy lifestyle.

Safe Water and Sanitation is necessary for basic
promotion of health.

Nutrition and Promotion of
Adequate Food Supply
One basic need of the family is food. And if food
is properly prepared then one may be assured
healthy family. There are many food
resources found in the communities but
because of faulty preparation and lack of
knowledge regarding proper food planning,
Malnutrition is one of the problems that we
have in the country.

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


Supply of Essential Drugs
This focuses on the information campaign on the
utilization and acquisition of drugs.

In response to this campaign, the GENERIC ACT of the
Philippines is enacted . It includes the following
drugs: Cotrimoxazole, Paracetamol, Amoxicillin,
Oresol, Nifedipine, Rifampicin, INH(isoniazid) and
Pyrazinamide, Ethambutol, Streptomycin,
Albendazole, Quinine
FAMILY HEALTH NURSING
that level of CHN practice directed to the FAMILY
as the unit of care with HEALTH as the goal and
NURSING as the medium, channel or provider of
care
Family Case Load
the no. and kind of families a nurse handles at
any given time

variable for cases are added or dropped based
on the need for nursing care and supervision
Types of Families
1. Nuclear
2. Extended
3. Three generational
4. Dyad
5. Single-Parent
6. Step-Parent
7. Blended or reconstituted
8. Single adult living alone
9. Cohabiting/Livingin
10. No-kin
11. Compound
12. Gay
13. Commune

Stages of Family Life Cycle
1. Newly married couple
2. Childbearing
3. Preschool age
4. School-age
5. Teenage
6. Launching
7. Middle-aged ( empty nest retirement)
8. Period from retirement to Death of both spouses
HEALTH TASKS OF THE FAMILY
(Freeman, 1981)
1. recognizing interruptions of health or development
2. seeking health care
3. managing health and non-health crises
4. providing nursing care to the sick, disabled and
dependent member of the family
5. maintaining a home environment conducive to
good health and personal development
6. maintaining a reciprocal relationship with the
community and health institutions
Family Nursing Problem
Arises when the family cannot effectively
perform its health tasks
Nurses Roles in Family Health Nursing
1. HEALTH MONITOR
2. PROVIDER OF CARE TO A SICK FAMILY
MEMBER
3. COORDINATOR OF FAMILY SERVICES
4. FACILITATOR
5. TEACHER
6. COUNSELOR
INITIAL DATA BASE FOR FAMILY NURSING
PRACTICE
Family structure, Characteristics, an
Dynamics
1. Members of the household and relationship
to the head of the family
2. Demographic data age, sex, civil status,
position in the family
3. Place of residence of each member whether
living with the family or elsewhere

4. Type of family structure e.g. matriarchal or
patriarchal, nuclear or extended
5. Dominant family members in terms of
decision-making, especially in matters of
health care
6. General family relationship/dynamics
presence of any readily observable conflict
between members; characteristics
communication patterns among members
Socio-economic and Cultural
Characteristics
1. Income and Expenses
Occupation, place of work and income of
each working members
Adequacy to meet basic necessities
Who makes decisions about money and how
it is spent
2. Educational attainment of each other
3. Ethnic background and religious affiliation
4. Significant Others role(s) they play in
familys life
5. Relationship of the family to larger
community Nature and extent of
participation of the family in
community activities
Home and Environment
1. Housing
Adequacy of living peace
Sleeping arrangement
Presence of breeding or resting sites of vectors of
diseases
Presence of accidents hazards
Food storage and cooking facilities
Water supply source, ownership, portability
Toilet facility type, ownership, sanitary condition
Drainage system type, sanitary condition
2. Kind of neighborhood, e.g. congested,
slum, etc.
3. Social and health facilities available
4. Communication and transportation
facilities available
Health Status of each Family Member

1. Medical and nursing history indicating current or
past significant illnesses or beliefs and practices
conducive to health illness

2. Nutritional assessment
Anthropometric data: Measures of nutritional status of
children, weight, height, mid-upper arm circumference:
Risk assessment measures of obesity: body mass index,
waist circumference, waist hip ratio
Dietary history specifying quality and quantity of
food/nutrient intake per day
Eating/ feeding habits/ practices
Developmental assessments of infants, toddlers, and
preschoolers e.g., Metro Manila

Risk factor assessment indicating presence of major
and contributing modifiable risk factors for specific
lifestyles, cigarette smoking, elevated blood lipids,
obesity, diabetes mellitus, inadequate fiber intake,
stress, alcohol drinking and other substance abuse

Physical assessment indicating presence of illness
state/s

Results of laboratory/ diagnostic and other screening
procedures supportive of assessment findings

Values, Habits, Practices on Health
Promotion, Maintenance and Disease
Prevention.

Examples include:
1. Immunization status of family members
2. Healthy lifestyle practices. Specify.
3. Adequacy of:
rest and sleep
exercise
use of protective measures- e.g. adequate footwear in
parasite-infested areas;
relaxation and other stress management activities
4. Use of promotive-preventive health services
A TYPOLOGY OF NURSING PROBLEMS IN
FAMILY NURSING PRACTICE
FIRST-LEVEL ASSESSMENT
I. Presence of Wellness Condition stated as Potential or
Readiness is a clinical or nursing judgment about a client in
transition from a specific level of wellness or capability to a
higher level.

Wellness potential is a nursing judgment on wellness state
or condition based on clients performance, current
competencies or clinical data but no explicit expression of
client desire.

Readiness for enhanced wellness state is a nursing
judgment on wellness state or condition based on clients
current competencies or performance, clinical data explicit
expression of desire to achieve a higher level of state or
function in specific area on health promotion and
maintenance.
Examples of these are the following:
1. Potential for Enhanced Capability for:
Healthy lifestyle e.g. nutrition/diet, exercise/
activity
Health Maintenance
Parenting
Breastfeeding
Spiritual Well-being process of a clients
unfolding of mystery through harmonious
interconnectedness that comes from inner
strength/sacred source/GOD (NANDA 2001)
Others,
2. Readiness for Enhanced Capability for:
Healthy Lifestyle
Health Maintenance
Parenting
Breastfeeding
Spiritual Well-being
Others,
II. Presence of Health Threats conditions that
are conducive to disease, accident or failure
top realize ones health potential.

Examples of these are the following:
1. Family history of hereditary condition, e.g.
diabetes
2. Threat of cross infection from a
communicable disease case
3. Family size beyond what family
resources can adequately provide
4. Accidental hazards
Broken stairs
Sharp objects, poison, and medicines
improperly kept
Fire hazards
5. Faulty nutritional habits or feeding
practices.
Inadequate food intake both in quality
& quantity
Excessive intake of certain nutrients
Faulty eating habits
Ineffective breastfeeding
Faulty feeding practices
6. Stress-provoking factors
Strained marital relationship
Strained parent-sibling relationship
Interpersonal conflicts between family
members
Care-giving burden
7. Poor home condition
O Inadequate living
space
O Lack of food storage
facilities
O Polluted water supply
O Presence of breeding
sites of vectors of
disease
O Improper garbage
O Unsanitary waste
disposal
O Improper drainage
system
O Poor ventilation
O Noise pollution
G Air pollution

8. Unsanitary food handling and preparation
9. Unhealthful lifestyles and personal habits-
Alcohol drinking
Cigarette smoking
Inadequate footwear
Eating raw meat
Poor personal hygiene
Self-medication
Sexual promiscuity
Engaging in dangerous sports
Inadequate rest
Lack of inadequate exercise
Lack of relaxation activities
Non-use of self protection measures
10. Inherent personal characteristics e.g. poor
impulse control
11. Health history which induce the occurrence of
a health deficit, e.g. previous history of difficult
labor
12. Inappropriate role assumption e.g. child
assuming mother's role, father not assuming
his role
13. Lack of immunization/ inadequate
immunization status specially of children
14.Family disunity
Self-oriented behavior of
member(s)
Unresolved conflicts of member(s)
Intolerable disagreement
Other
15.Other
III. Presence of Health Deficits instances of
failure in health maintenance.
Examples include:
1. Illness states, regardless of whether it is
diagnosed or by medical practitioner
2. Failure to thrive/ develop according to
normal rate
3. Disability whether congenital or arising
from illness; temporary
IV. Presence of stress Points/ Foreseeable Crisis Situations
anticipated periods of unusual demand of the individual
or family in terms of family resources.

1. Marriage
2. Pregnancy
3. Parenthood
4. Additional member
5. Abortion
6. Entrance at school
7. Adolescence
8. Divorce


9. Menopause
10. Loss of job
11. Hospitalization of a family
member
12. Death of a member
13. Resettlement in a new
community
14. illegitimacy
Second Level Assessment
Focus on determining familys capacity to perform the
health tasks
Statements on family health nursing problem:
1. Inability to recognize the presence of the condition or problem
2. Inability to make decisions with respect to taking appropriate health
action
3. Inability to provide adequate nursing care to the sick, disabled ,
dependent or vulnerable member of the family
4. Inability to provide a home environment conducive to health
maintenance or personal development
5. Failure to utilize community resources for health care
Scale for Ranking Health Conditions and
Problems according to priorities
Criteria:
1. Nature of the condition or problem presented (wellness
state, health deficit, health threat, foreseeable crisis)
2. b. Modifiability of the condition or problem (easily,
partially, not modifiable)
3. c. Preventive Potential (high, moderate , low)
4. d. Salience ( needs immediate attention, not immediate,
not perceived as a problem)
COMMUNITY HEALTH CARE PROCESS
Assessment
Purpose : To identify the health needs of the people
Planning of nursing actions
Purpose : To act on the determined needs of the
community people
Implementation
Purpose : To achieve the optimum level of health of
the community people
Evaluation
Purpose : To determine the effectiveness of health
care programs

NURSING PROCEDURES
CLINIC VISIT
process of checking the clients health condition in a
medical clinic
HOME VISIT
a professional face to face contact made by the nurse with
a patient or the family to provide necessary health care
activities and to further attain the objectives of the agency
BAG TECHNIQUE
a tool making of the public health bag through which the
nurse during the home visit can perform nursing
procedures with ease and deftness saving time and effort
with the end in view of rendering effective nursing care

THERMOMETER TECHNIQUE
to assess the clients health condition through
body temperature reading
NURSING CARE IN THE HOME
giving to the individual patient the nursing care
required by his/her specific illness or trauma to
help him/her reach a level of functioning at which
he/she can maintain himself/herself or die
peacefully in dignity

ISOLATION TECHNIQUE IN THE HOME
-done by :
1. separating the articles used by a client with
communicable disease to prevent the spread of
infection:
2. frequent washing and airing of beddings and other
articles and disinfections of room
3. wearing a protective gown , to be used only within
the room of the sick member
4. discarding properly all nasal and throat discharges
of any member sick with communicable disease


5. burning all soiled articles if could be or
contaminated articles be boiled first in
water 30 minutes before laundering

INTRAVENOUS THERAPY
insertion of a needle or catheter into a vein to
provide medication and fluids based on
physicians written prescription
can be done only by nurses accredited by ANSAP
PRINCIPLES OF HEALTH EDUCATION
It considers the health status of the people,
which is determined by the economic and
social conscience of the country.
It is a process whereby people learn to
improve their personal habits and attitudes,
to work responsibly for the improvement of
health conditions of the family, community,
and nation.
It involves motivation, experience, and
change in conduct and thinking, while
stimulating active interest. It develops and
provides experience for change in peoples
attitudes, customs, and habits in relation to
health and everyday living.
It should be recognized as the basic function
of all health workers.
It takes place in the home, in the
school, and in the community.
It is a cooperative effort requiring
all categories of health personnel to
work together in close teamwork
with families, groups, and the
community.
It meets the needs, interests, and problems
of the people affected.
It finds means and ways of carrying out plans
by encouraging individual and community
participation.
It is a slow, continuous process that involves
constant changes and revisions until
objectives are achieved.
Makes use of supplementary aids and
devices to help with the verbal instructions.
It utilizes community resources by careful
evaluation of the different services and
resources found in the community.
It is a creative process requiring methods
and techniques with various characteristics,
not following a rigid and flexible pattern.
It aims to help people make use of their own
efforts and education to improve their
conditions of living,
It makes careful evaluation of the planning,
organization, and implementation of all
health education programs and activities.
THE COMMUNITY HEALTH NURSE
Qualifications
1. Bachelor of Science in Nursing
2. Registered Nurse of the Philippines
Planner/Programmer
1. Identifies needs, priorities, and problems
of individuals, families, and communities
2. Formulates municipal health plan in the
absence of a medical doctor
3. Interprets and implements nursing plan,
program policies, memoranda, and circular
for the concerned staff personnel
4. Provides technical assistance to rural
health midwives in health matters
Provider of Nursing Care
1. Provides direct nursing care to sick or
disabled in the home, clinic, school, or
workplace
2. Develops the familys capability to take
care of the sick, disabled, or dependent
member
Manager/Supervisor
1. Formulates individual, family, group, and
community-centered plan
2. Interprets and implements programs, policies,
memoranda, and circulars
3. Organizes work force, resources, equipments, and
supplies at local level
4. Provides technical and administrative support to
Rural Health Midwives (RHM)
5. Conducts regular supervisory visits and meetings
to different RHMs and gives feedback on
accomplishments
Community Organizer
1. Motivates and enhances community
participation in terms of planning,
organizing, implementing, and evaluating
health services
2. Initiates and participates in community
development activities
Coordinator of Services
1. Coordinates with individuals, families,
and groups for health related services
provided by various members of the
health team
2. Coordinates nursing program with other
health programs like environmental
sanitation, health education, dental
health, and mental health
Trainer/Health Educator
1. Identifies and interprets training needs of the
RHMs, Barangay Health Workers (BHW), and
hilots
2. Conducts training for RHMs and hilots on
promotion and disease prevention
3. Conducts pre and post-consultation conferences
for clinic clients; acts as a resource speaker on
health and health-related services
4. Initiates the use of tri-media (radio/TV, cinema
plugs, and print ads) for health education
purposes
5. Conducts pre-marital counseling
Health Monitor
1. Detects deviation from health of
individuals, families, groups, and
communities through contacts/visits with
them
Role Model
1. Provides good example of healthful living
to the members of the community
Change Agent
1. Motivates changes in health behavior in
individuals, families, groups, and
communities that also include lifestyle in
order to promote and maintain health
Recorder/Reporter/Statistician
1. Prepares and submits required reports
and records
2. Maintain adequate, accurate, and
complete recording and reporting
3. Reviews, validates, consolidates, analyzes,
and interprets all records and reports
4. Prepares statistical data/chart and other data
presentation
Researcher
1. Participates in the conduct of survey
studies and researches on nursing and
health-related subjects
2. Coordinates with government and non-
government organization in the
implementation of studies/research
Community Organizing
Approaches to community devt.:
a. Welfare approach
b. Technological approach
c. Transformatory approach
Community Organizing
Principles of CO:
1. People esp. the oppressed, exploited and
deprived sectors are most open to change, have
the capacity to change and are able to bring
about change. Hence , CO is based on the ff:
Power must reside in the people
Devt. is from the people to the people
People participation
Principles of CO
2. must be based on the poorest sectors of society.
The solutions of problems commonly shared by
these sectors must be focused on collective
organizations, planning and action

3. should lead to self-reliant communities
THE HRDP-COPAR PROCESS
1. PRE-ENTRY PHASE
2. ENNTRY PHASE
3. COMMUNITY STUDY/DIAGNOSIS
PHASE/RESEARCH PHASE
4. COMMUNITY ORGANIZATION AND
CAPABILITY-BUILDING PHASE
5. COMMUNITY ACTION PHASE
6. SUSTENANCE AND STRENGTHENING PHASE
Classify the ff. CO activities as to phase of
COPAR each belong:
1. Conducts community meetings to draw up
guidelines for the organization of CHO
2. Trains BHWs
3. Sets up of linkages/network and referral systems
4. PIME of health services and or community devt.
Projects
5. Provides continuing education to leaders or
residents
6. Trains secondary leaders
7. Selects site for adoption
8. Identifies key leaders
Continued.
9. Develops criteria for site selection
10. Forms the core group
11. Conducts SALT
12. Selects members of the research team
13. Assists the research team in presenting results
during the general assembly
14. Helps the people identifying the community needs
and health problems
15. Facilitates for the formulation and ratification of the
constitution and by-laws of the organization
Public Health Programs
COMPREHENSIVE MATERNAL AND CHILD
HEALTH PROGRAM
1. EPI (Expanded Program on Immunization)
2. CDD (Control of Diarrheal Diseases)
3. CARI (Control of Acute Respiratory
Infections)
4. UFC (Under-Five Clinics)
5. MC (Maternal Care)
6. BF (Breastfeeding)
7. MRP (Malnutrition Rehabilitation Program)
8. VAD ( Vitamin A Deficiency)
9. IDD/IDA (Iodine Deficiency Disorders/ Iron
Deficiency Anemia)
10. FP (Family Planning)
EPI (EXPANDED PROGRAM ON IMMUNIZATION)
TARGET SETTING:
1.INFANTS 0-12 MONTHS
2.PREGNANT AND POST PARTUM WOMEN
3.SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS OLD

OBJECTIVES OF EPI:
TO REDUCE MORBIDITY AND MORTALITY RATES
AMONG INFANTS AND CHILDREN from SIX CHILDHOOD
IMMUNIZABLE DISEASE
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. Information, Education and Communication (IEC)
4. Assessment and evaluation of Over-all
performance of the program
5. Surveillance and research studies
EXPANDED PROGRAM ON IMMUNIZATION
Vaccine Minimum
Age of 1
st

Dose
Number
of Doses
Minimum
Interval
Between
Doses
Reason
1. BCG
(Bacillus
Calmette
Guerin)
Birth or
anytime after
birth
School
entrants
1
BCG is given at
the earliest
possible age
protects against
the possibility of
TB infection
from the other
family members
2. DPT
(Diphtheria
Pertussis
Tetanus)

6 weeks 3 4 weeks An early start with DPT
reduces the chance of
severe pertussis
3. OPV
(Oral Polio
Vaccine)

6 weeks 3 4 weeks The extent of protection
against polio is increased
the earlier OPV is given.
4. Hepatitis
B
6 weeks 3 4 weeks An early start of
Hepatitis B reduces the
chance of being infected
and becoming a carrier.
5. Measles 9 months 1 At least 85% of measles
can be prevented by
immunization at this age.
CDD (CONTROL OF DIARRHEAL DISEASES)
MANAGEMENT OF THE PATIENT WITH DIARRHEA
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 Tx.


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 ORS
to give after each
loose stool
Amount of ORS to
provide for use at
home
< 24
months
50-100 ml. 500 ml./day
2 10
years
100-200 ml. 1000 ml./day
10 years
up
As much as wanted 2000 ml./day
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, Tx. PLAN B
APPROX. AMT. OF ORS- TO GIVE IN 1
ST
4 HRS
AGE WEIGHT
KG
ORS
ML
4 MOS. 5 200-400
4-11MOS 5-7.9 400-600
12-23MOS 8-10.9 600-800
2-4YRS 11-15.9 800-1200
5-14YRS 16-29.9 1200-2200
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 childs 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
Tx PLAN C- Tx. 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
Two problems in CDD
1. High child mortality due to diarrhea
2. High diarrhea incidence among under
fives
Highest incidence in age 6 23 months

Highest mortality in the first 2 years of
life

Main causes of death in diarrhea :
DEHYDRATION
MALNUTRITION

5. To prevent dehydration, give home fluids
am as soon as diarrhea starts and if
dehydration is present, rehydrate early,
correctly and effectively by giving ORS

6. For undernutrition, continue feeding during
diarrhea especially breastfeeding.
5 Interventions to prevent diarrhea
1. Breastfeeding
2. improved weaning practices
3. use of plenty of clean water
4. hand washing
5. proper disposal of stools of small children
Risk of severe diarrhea 10-30x higher in
bottle fed infants than in breastfed
infants.
Advantages of breastfeeding in relation
to CDD
1. Breast milk is sterile
2. Presence of antibodies protection against
diarrhea
3. Intestinal Flora in BF infants prevents
growth of diarrhea causing bacteria.
Breastfeeding decreases incidence rate
by 8-20% and mortality by 24-27% in
infants under 6 months of age.
When to wean?
4-6 months soft mashed foods 2x a day
6 months variety of foods 4x a day
Summary of WHO-CDD recommended
strategies to prevent diarrhea
Improved Nutrition
exclusive breastfeeding for the first 4-6 months
of life and partially for at least one year.
Improved weaning practices

Use of safe water
collecting plenty of water from the cleanest
source
protecting water from contamination at the
source and in the home
Good personal and domestic hygiene
handwashing
proper disposal of stools of young children

CARI (CONTROL OF ACUTE
RESPIRATORY INFECTIONS)
CLASSIFICATION:

A. NO PNEUMONIA: COUGH OR COLD
1. No chest in drawing
2. No fast breathing ( <2 mos- <60/min, 2-12 mos. less
than 50 per minute; 12 mos. 5 years less than
40 per minute)

TREATMENT:
1. If coughing more than 30 days, refer for assessment
2. Assess and treat ear problems/sore throat if present
3. Advise mother to give home care
4. Treat fever/wheezing if present
HOME CARE:
1. FEED THE CHILD
Feed the child during illness
Increase feeding after illness
Clear the nose if it interferes with feeding
2. INCREASE FLUIDS
offer the child extra to drink
Increase breastfeeding
3. SOOTHE THE THROAT AND RELIEVE
THE COUGH WITH A SAFE REMEDY

4. WATCH FOR THE FOLLOWING
SIGNS AND SYMPTOMS AND
RETURN QUICKLY IF THEY
OCCUR
Breathing becomes difficult
Breathing becomes fast
Child is not able to drink
Child becomes sicker

B. PNEUMONIA

1. No chest in drawing
2. Fast breathing ( less than 2 mos- 60/min or
more ; 2-12 mos. 50/min or more; 12 mos.
5 years 40/min or more)

TREATMENT
1. Advise mother to give home care
2. Give an antibiotic
3. Treat fever/wheezing if present
4. If the childs condition gets worst, refer urgently
to hospital; if improving, finish 5 days of
antibiotic.

ANTIBIOTICS RECOMMENDED BY
WHO
Cotrimoxazole,
Amoxycillin, Ampicillin, (p.o.) or
Procaine penicillin (I.M.)
C. Severe Pneumonia
Chest indrawing
Nasal flaring
Grunting ( short sounds made with the
voice)
Cyanosis
Tx.
1. Refer urgently to hospital
2. Treat fever ( paracetamol), wheezing
(salbutamol)
D. Very Severe Disease
Not able to drink
Convulsions
Abnormally sleepy or difficult to wake
Stridor in calm child
Severe undernutrition
Tx.
Refer urgently to hospital
ASSESSMENT OF RESPIRATORY INFECTION
ASK THE MOTHER:
1. How old is the child?
2. Is the child coughing? For how long?
3. Age 2 months up to 5 years: Is the child
able to drink?
Age less than 2 months: Has the young
infant stopped feeding well?
4. Has the child had fever? For how long?
5. Has the child had convulsions?
LOOK, LISTEN:
1. Count the breaths in one minute.





2. Look for chest in drawing.
3. Look and listen for stridor.
Stridor occurs when there is a narrowing
of the larynx, trachea or epiglottis which
interferes with air entering the lungs.
Age 0 Fast Breathing
Less than 2 months 60/minute or more
2 months 12 months 50/minute or more
12 months 5 years 40/minute or more
4. Look and listen for wheeze
Wheeze is a soft musical noise which
shows signs that breathing out (exhale) is
difficult.
5. See if the child is abnormally sleepy or
difficult to wake. (Suspect meningitis)
6. Feel for fever or low body temperature.
7. Check for severe under nutrition
MANAGEMENT OF A CHILD
WITH AN EAR PROBLEM
Classification of Ear Infection
A. MASTOIDITIS tender swelling behind the
ear (in infants, swelling may be above the
ear)
TREATMENT
1. Antibiotics
2.Surgical intervention
B. ACUTE EAR INFECTION pus draining from
the ear for less than 2 weeks, ear pain, red,
immobile ear drum (Acute Otitis Media)
TREATMENT
1.Cotrimoxazole,Amoxycillin,or Ampicillin
2.Dry the ear by wicking
C. CHRONIC EAR INFECTION pus draining from the
ear for more than 2 weeks (Chronic Otitis Media)
TREATMENT
Most important & effective treatment: Keep the ear
dry by wicking.
Paracetamol maybe given for pain or high fever.
Precautions for a child with a draining ear:
1. Do not leave anything in the ear such as cotton, wool
between wicking treatments.
2. Do not put oil or any other fluid into the ear.
3. Do not let the child go swimming or get water in the ear.
Maternal Care

Philosophy
Pregnancy, labor and delivery and puerperium
are part of the continuum of the total life cycle
Personal, cultural and religious attitudes and
beliefs influence the meaning of pregnancy for
individuals and make each experience unique
MCN is FAMILY CENTERED- the father is as
important as the mother
Goals
To ensure that expectant mother and nursing
mother maintain good health, learn the art of
child care, has a normal delivery and bear
healthy children

That every child lives and grows up in a family
unit with love and security, in healthy
surroundings, receives adequate nourishment,
health supervision and efficient medical
attention and is taught the elements of
healthy living
Classification of pregnant women
Normal healthy pregnancy
With mild complications- frequent home visits
With serious or potentially serious cx
referred to most skilled source of medical and
hospital care
Home Based Mothers Record (HBMR )
Tool used when rendering prenatal care
containing risk factors and danger signs
*Risk Factors
145 cm tall (4 ft & 9 inches)
Below 18 yrs old, above 35 yrs old
Have had 4 pregnancies
With TB, goiter, heart disease, DM, bronchial
asthma, severe anemia
Last baby born was less than 2 years ago
Previous cesarean section delivery
History of 2 or more abortions, difficult delivery,
given birth to twins , 2 or more babies born before
EDD, stillbirth
Weighs less than 45 kgs. or more than 80 kgs.


*Danger Signs

1. any type of vaginal bleeding
2. headache, dizziness, blurred vision
3. puffiness of face and hands
4. pallor

Prenatal Care
Schedule of Visits
1
st
as early as pregnancy, 1
st
trimester
2
nd
- 2
nd
trimester
3
rd
& subsequent visits - 3
rd
trimester

More frequent visits for those at risk with cx
TETANUS TOXOID IMMUNIZATION SCHEDULE
FOR WOMEN
Vaccine Minimum Age
Interval
Percent
Protected
Duration of
Protection
TT1 As early as
possible during
pregnancy
80%
TT2 At least 4
weeks later
80% Infants born to
the mother will
be protected
from neonatal
tetanus.
Gives 3 years
protection for
the mother from
tetanus.
TT3 At least 6
months
later
90% Infants born to the mother
will be protected
from neonatal
tetanus.
Gives 5 years protection for
the mother.

TT4

At least 1 year
later

99%

Gives 10
protection for
the mother
TT5 At least 1 year
later
99% Gives lifetime
protection for
the mother.
All infants
born to that
mother
will be
protected.
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 infection
Dental exam
Wt. Ht. BP taking
Exam of conjunctiva and palms for pallor
Abdominal exam - fundic ht, Leopolds
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 5
th
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
The first five years of life form the
foundations of the childs physical and mental
growth and development. Studies have
shown the mortality and morbidity are high
among this age group. The Department of
Health established the Under Five Clinic
Program to address this problem.
PROGRAM OBJECTIVES AND
GOALS:
Monitor growth and development of the
child until 5 years of age.

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

BREASTFEEDING/ LACTATION
MANAGEMENT EDUCATION TRAINING
Breastfeeding practices has been proved to be very
beneficial to both mother and baby thus the
creation of the following laws support the full
implementation of this program:
Executive Order 51
Republic Act 7600
The Rooming-In and Breastfeeding Act of 1992

PROGRAM OBJECTIVES AND
GOALS:
Protection and promotion of breastfeeding
and lactation management education training
ACTIVITIES AND STRATEGIES:
1.FULL IMPLEMENTATION OF LAWS
SUPPORTING THE PROGRAM
A. EO 51 THE MILK CODE protection and
promotion of breastfeeding to ensure the safe
and adequate nutrition of infants through
regulation of marketing of infant foods and
related products. (e.g. breast milk substitutes,
infant formulas, feeding bottles, teats etc. )
B. RA 7600 THE ROOMING IN and
BREASTFEEDING ACT of 1992
An act providing incentives to government and
private health institutions promoting and
practicing rooming-in and breast-feeding.
Provision for human milk bank.
Information, education and re-education drive
Sanction and Regulation

2. CONDUCT ORIENTATION/ADVOCACY
MEETINGS TO HOSPITAL/ COMMUNITY.
ADVANTAGES OF BREASTFEEDING:
MOTHER
Oxytocin help the uterus contracts
Uterine involution
Reduce incidence of Breast Cancer
Promote Maternal-Infant Bonding
Form of Family planning Method (Lactational
Amenorrhea)
BABY
Provides Antibodies
Contains Lactoferin (binds with Iron)
Leukocytes
Contains Bifidus factor-promotes growth of
the Lactobacillus-inhibits the growth of
pathogenic bacilli

POSITIONS IN BF THE BABY:
Cradle Hold = head and neck are supported
Football Hold
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.


HEALTH SERVICES OFFERED IN GP
AND WHO ARE THE TARGETS
Health
Service
Dosage Route of
Administra
tion
Target
Population
Vitamin A
capsule
200,000 IU or
1 capsule
100,000 IU or
cap or 3
drops
Orally by
drops
12-59
months old,
nationwide
9-12 month
old infants
receiving
AMV
nationwide
Ferrous
Sulfate
(25 mg.
Elemental
Iron per ml;
30 ml.
Bottle as
taken home
medicine
with
instructions)


0.3ml(2-6
mos)
once a day

0.6ml(6-
11mos) once
a day


Orally
by
drops


2-11 months old
infants in
Mindanao area,
including
evacuation centers
in armed conflict
areas.

Routine
Immuniza
tion
-BCG*

-DPT*

-OPV*

-AMV*
-Hepa B (if
available)




0.05ml

0.5ml

2 drops
0.5ml

0.5ml



Intradermal on right
deltoid
Intramuscularly on
anterior thigh
Orally
Subcutaneously on
deltoid
Intramuscularly
Nationwide


0-11 mos


0-11 mos

0-11 mos
9-11 mos

0-11 mos
Dewormin
g drug
(if
available)




1 tablet
as single
dose




Orally



36-59 mos,
nationwide
Weighing 0-59 mos,
nationwide
The child should not have received
megadose of Vit. A above the
recommended dosage within the past 4
weeks except if the child has measles or
signs and symptoms of Vit A. deficiency.
For any child between 12-23 months,
who missed any of his routine
immunization, the health worker should
give the child the necessary antigen to
complete FIC and shall be recorded as
such.
GARANTISADONG PAMBATA
Sangkap Pinoy
Vitamin A, Iron and Iodine
-Sources: green leafy and yellow vegetables,
fruits, liver, seafoods, iodized salt, pan de
bida and other fortified foods.
These micronutrients are not produced by
the body, and must be taken in the food we
eat; essential in the normal process of
growth and development:
a) Helps the body to regulate itself
b) Necessary in energy metabolism
c) Vital in brain cell formation and mental
development
d) Necessary in the body immune system to protect
the body from severe infection.
e) Eating Sangkap Pinoy-rich foods can prevent and
control:
1. Protein Energy Malnutrition
2. Vitamin A Deficiency
3. Iron Deficiency Anemia
4. Iodine Deficiency Disorder

BREASTFEEDING
Breast milk is best for babies up to 2 years
old. Exclusive breastfeeding is recommended
for the first six months of life. At about six
months, give carefully selected nutritious
foods as supplements.
Breastfeeding provides physical and
psychological benefits for children and
mothers as well as economic benefits for
families and societies.
BENEFITS :
For infants
a. Provides a nutritional complete food for the
young infant.
b.Strengthens the infants immune system,
preventing many infections.
c. Safely rehydrates and provides essential
nutrients to a sick child, especially to those
suffering from diarrheal diseases.
d.Reduces the infants exposure to infection.
For the Mother
e. Reduces a womans risk of excessive blood loss after
birth
f. Provides a natural method of delaying pregnancies.
g. Reduces the risk of ovarian and breast cancers and
osteoporosis.

For the Family and Community
h. Conserves funds that otherwise would be spent on
breast milk substitute, supplies and fuel to prepare
them.
i. Saves medical costs to families and governments by
preventing illnesses and by providing immediate
postpartum contraception.
COMPLEMENTARY FEEDING FOR
BABIES 6-11 MONTHS OLD
What are Complementary Foods?
foods introduced to the child at the age
6 months to supplement breastmilk
given progressively until the child is used to three
meals and in-between feedings at the age of one
year.
Why is there a Need to Give Complementary Foods?
breastmilk can be a single source of nourishment
from birth up to six months of life.
c. The childs demands for food increases as he
grows older and breastmilk alone is not
enough to meet his increased nutritional
needs for rapid growth and development
d. Breastmilk should be supplemented with
other foods so that the child can get
additional nutrients
e. Introduction of complementary foods will
accustom him to new foods that will also
provide additional nutrients to make him
grow well
f. Breastfeeding, however, should continue for
as long as the mother is able and has milk
which could be as long as two years

How to Give Complementary Foods for
Babies 6-11 Months Old?
a.Prepare mixture of thick lugaw/ cooked rice, soft
cooked vegetables. Egg yolk, mashed beans,
flaked fish/chicken/ground meat and oil.
b.Give mixture by teaspoons 2-4 times daily,
increasing the amount of teaspoons and number
of feeding until the full recommended amount is
consumed
c. Give bite-sized fruit separately
d.Give egg alone or combine with above food
mixture

FAMILY PLANNING
The Philippine Family Planning Program is a national program
that systematically provides information and services needed
by women of reproductive age to plan their families according
to their own beliefs and circumstances.

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

MISSION:
To provide the means and opportunities by which married
couples of reproductive age desirous of spacing and limiting
their pregnancies can realize their reproductive goals.

TYPES OF METHODS:
A. NATURAL METHODS
1. Calendar or Rhythm Method
2. Basal Body Temperature Method
3. Cervical Mucus Method
4. Sympto-Thermal Method
5. Lactational Amenorrhea
B. ARTIFICIAL METHODS
I. CHEMICAL METHODS
1. Ovulation suppressant such as PILLS
2. Depo-Provera
3. Spermicidal
4. Implant
II. MECHANICAL METHODS
1. Male and Female Condom
2. Intrauterine Device
3. Cervical Cap/Diaphragm
III. SURGICAL METHODS
1. Vasectomy
2. Tubal Ligation
WARNING SIGNS
Pills
Abdominal pain (severe)
Chest pain (severe)
Headache (severe)
Eye problems (blurred vision, flashing lights,
blindness)
Severe leg pain (calf or thigh )
Others: depression, jaundice, breast lumps
WARNING SIGNS
IUD
Period late, no symptoms of pregnancy,
abnormal bleeding or spotting
Abdominal pain during intercourse
Infection or abnormal vaginal discharge
Not feeling well, has fever or chills
String is missing or has become shorter or
longer
WARNING SIGNS
INJECTABLES
Dizziness
Severe headache
Heavy bleeding
WARNING SIGNS
BTL
Fever
Weakness
Rapid pulse
Persistent abdominal pain
Vomiting
Dizziness
Pus or tenderness at incision site
Amenorrhea


WARNING SIGNS
Vasectomy
Fever
Scrotal blood clots or excessive swelling

Nutrition
Goal
To improve the nutritional status,
productivity and quality of life of the
population thru adoption of desirable
dietary practices and healthy lifestyle
Objectives
Increase food and dietary energy intake of
the average Filipino
Prevent nutritional deficiency diseases and
nutrition-related chronic degenerative
diseases
Promote a healthy well-balanced diet
Promote food safety
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 childs 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. Bodybuilding 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- its 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.
Niacin Help release energy from
nutrients; support skin, nervous
and digestive system, prevents
pellagra.
Biotin Help energy and amino acid
metabolism; help in the
synthesis of fat glycogen.
Pantothenic Help in energy metabolism.
Folic acid Help in the formation of DNA
and new blood cells including
red blood cells; prevent
anemia and some amino
acids.
Vitamin B 12 Help in the formation of the
new cells; maintain nerve
cells, assist in the metabolism
of fatty acids and amino
acids.
Vitamin C Help in the formation of protein,
collagen, bone, teeth cartilage,
skin and scar tissue; facilitate
in the absorption of iron from
the gastrointestinal tract;
involve in amino acid
metabolism; increase
resistance to infection, prevent
scurvy.
Food sources:
Guava; pomelo; lemon; orange;
calamansi; tomato; cashew

Vitamin D Help in the
mineralization of bones
by enhancing
absorption of calcium.
Vitamin E Strong anti-oxidant; help
prevent arteriosclerosis; protect
neuro-muscular system;
important for normal immune
function.
Vitamin K Involve in the synthesis of
blood clotting proteins and a
bone protein that regulates
blood calcium level.
MINERALS FUNCTIONS
Calcium Mineralization of bones and
teeth, regulator of many of the
bodys biochemical processes,
involve in blood clotting,
muscle contraction and
relaxation, nerve functioning,
blood pressure and immune
defenses.
Chloride Maintain normal fluid and
electrolyte balance.
Chromium Work with insulin and is
required for release of energy
from glucose.
Copper Necessary for absorption and
use of iron in the formation of
hemoglobin.
Fluoride Involve in the formation of bones and
teeth; prevents tooth decay.
Iodine As part of the two thyroid hormones,
iodine regulates growth, physical
and mental development and
metabolic rate.
Aids in the development of the brain
and body especially in unborn
babies
Food sources:
Seaweeds; squids; shrimps; crabs;
fermented shrimp; mussels; snails;
dried dilis; fish
Iron
Essential in the formation of
blood. It is involved in the
transport and storage of
oxygen in the blood and is a
co-factor bound to several
non-hemo enzymes required
for the proper functioning of
cells.
Food sources:
Pork; beef; chicken; liver and
other internal organs; dried
dilis; shrimp; eggs; pechay;
saluyot; alugbati
Magnesium Mineralization of
bones and teeth,
building of proteins,
normal muscle
contraction, nerve
impulse
transmission,
maintenance of teeth
and functioning of
immune system.
Manganese Facilitate many cell
processes.
Molybdenum Facilitate many cell
processes.
Phosphorus Mineralization of bones and
teeth; part of every Cell;
used in energy transfer and
maintenance of acid-base
balance.
Selenium Work with vitamin E to
protect body compound
from oxidation.
Selenium Work with vitamin E to protect
body compound from
oxidation.
Sodium Maintain normal fluid and
electrolyte balance, assists
nerve impulse insulin.
Sulfur Integral part of vitamins,
biotin and thiamine as well as
the hormone.
Zinc Essential for normal growth,
development reproduction and
immunity.
MALNUTRITION
An abnormal condition of the body
resulting from the lack or excess
of one or more nutrients like
protein, carbohydrates, fats,
vitamins and minerals.
PRIMARY CAUSE: POVERTY
1. Lack of money to buy food
Majority of the victims of malnutrition comes
from families of farmers, fisherfolk, and laborers
who cannot afford to buy nutritious foods.
2. Lack of food supply
3. Lack of information on proper nutrition and
food values

SECONDARY CAUSES
1. Early weaning of child and improper
introduction of supplementary food
2. Incomplete immunization of babies and
children
3. Bad eating habits
4. Poor hygiene and environmental sanitation:
a. lack of potable water
b. lack of sanitary toilet
c. poor waste disposal
FORMS OF MALNUTRTION
1. Protein-Energy Malnutrition (PEM) is a
nutritional problem resulting from a
prolonged inadequate intake of body-
building and/or energy-giving food in
the diet.
Kinds:
1. MARASMUS
2. KWASHIORKOR
1. MARASMUS
This child does not get the right amount and
kind of energy food. She/He:
is always hungry
has the face of an old man
is very thin
easily gets sick
looks weak
THIS CHILD IS JUST SKIN AND BONES!

2. KWASHIORKOR
This child does not get enough body-building food,
although she/he may be getting enough energy.
She/He:
has swollen face, hands, and feet
easily gets sick
has dry, thin, pale hair
has sores on the skin
has thin upper arms
looks sad
has dry skin
is underweight
THIS CHILD IS SKIN, BONES, AND WATER!
2. VITAMIN A DEFICIENCY (VAD)
a condition in which the level of Vit A in the
body is low.
Causes:
not eating enough foods rich in vitamin A e.g.
yellow vegetables and yellow fruits
lack of fat or oil in the diet which help the
body absorb Vitamin A.
poor absorption or rapid utilization of Vitamin
A during illness

Eye Signs
night blindness (early stage); total blindness (later
stage)
bitots spot (foamy soapsuds-like spots on white
part of the eye)
dry, hazy and rough appearing cornea
crater-like defect on cornea
softened cornea; sometimes bulging
Other Manifestations
increased cases of childhood sickness, and death
and decreased resistance to infection
susceptibility to childhood malnutrition and
infection (measles, diarrhea and pneumonia)
Prevention
eating foods rich in Vitamin A, such as liver, eggs,
milk, crab meat, cheese, dilis, malunggay, gabi
leaves, kamote tops, kangkong, alugbati, saluyot,
carrots, squash, ripe mango, including fats and oils
breastfeeding the child
immunizing the child
taking correct dose of Vitamin A capsules as
prescribed
VAD is most common in children suffering
from PEM and other infectious diseases.
Bottle-fed infants are also at risk of VAD
especially if the milk formula used is not
fortified with Vitamin A.
Common among preschoolers and infants
(FNRI)

SCHEDULE FOR RECEIVING VITAMIN A SUPPLEMENT TO INFANTS
PRESCHOOLERS AND MOTHERS
Schedule Infants(6-11
mos)
Preschoolers(
12-83 mos)
Post Partum
Mother
Give 1 Dose 100,000 IU 200,000 IU 200,000 IU
Within one
month
Give after 6
months High
risk
Condition
Present
100,000 IU 200,000 IU After delivery
of each child
only
SCHEDULE FOR TREATMENT OF VITAMIN A DEFICIENCY
Schedule Infants (6-11 mos.) Preschoolers (12-83
mos.)
Give Today 100,000 IU 200,000 IU
Give Tomorrow 100,000 IU 200,000 IU
Give After 2 Weeks 100,000 IU 200,000 IU
3. ANEMIA
- a condition characterized by the lack of iron in the
body resulting in paleness.
S/S: paleness of the eyelids, inner cheeks, palms and
nailbeds; frequent dizziness and easy fatigability
Common cause: inadequate intake of food rich in iron ;
can also be caused by blood loss during menstruation,
pregnancy and parasitic infections.
Prevention:
Eating iron-rich food such as liver and other internal
organs; green leafy vegetables; and foods rich in
Vitamin C

Prevention of Iron Deficiency
Recommended Iron
Requirements
Dosage
Infants ( 6-12 months) 0.7 mg. Daily
Children ( 12-59 months) 1 mg daily
Treatment of Iron Deficiency
Dosage
Children 0-59 month 3-6 mg./kg. Body wt./day
4.GOITER
enlargement of thyroid gland due to lack
of iodine in the body.

common in areas where the iodine
content in the soil, water and food are
deficient.


Effect of Iodine deficiency to fetus: may
be born mentally and physically retarded.
Goiter can be prevented by:
daily intake of food rich in iodine
use of iodized salt
Iodine Supplementation
Dosage
Children 0-59 months
( in endemic areas)
Iodine capsules (200mg)
potassium iodate in oil
orally once a year.
CHECKING THE NUTRITIONAL STATUS
WEIGHT
1.1 Weight is a very important indicator of a
persons nutritional status. It is measured in relation
to either AGE or HEIGHT. Normally, a well-nourished
child gains weight as she/he grows older.
1.2 On the other hand, a malnourished child
either decreases in weight or maintains his/her
previous weight.
1.3 The nutritional status of a person can also be
checked by looking for specific signs and symptoms
of the different forms of nutritional deficiencies.
IMPORTANT:
1.1Weigh the child in minimal clothing, with
no shoes, clogs or slippers on; and hands and
pockets free of objects.
1.2The same type of scale should be used for
subsequent weighing.
1.3Observe the proper maintenance of the
weighing scale.
1.4Do not use a bathroom scale to avoid
inaccurate readings of weight.
BRING THE MALNOURISHED CHILD TOGETHER WITH
THE PARENTS TO THE HEALTH CENTER FOR PROPER
NUTRITIONAL ADVICE AND TREATMENT.

VISIT THE MALNOURISHED CHILD REGULARLY AND
MONITOR HIS/HER WEIGHT.

ADVISE PARENTS AND THE WHOLE COMMUNITY
ABOUT BETTER NUTRITION AND PROPER FEEDING
ESPECIALLY OF INFANTS, CHILDREN AND SICK
PERSONS.
NUTRITIONAL GUIDELINES
1. Eat a variety of food everyday.
2. Breastfeed infants exclusively from birth to 4-6
months, and then, give appropriate foods while
continuing breastfeeding.
3. Maintain childrens normal growth through
proper diet and monitor their growth regularly.
4. Consume fish, lean meat, poultry or dried
beans.
5. Eat more vegetables, fruits, and root crops.
6. Eat foods cooked in edible/cooking oil daily.
7. Consume milk, milk products or other
calcium-rich foods such as small fish and
dark green leafy vegetables everyday. Use
iodized salt, but avoid excessive intake of
salty foods.
8. Use iodized salt, avoid excessive intake of
salty foods
9. Eat clean and safe food.
10. For a healthy lifestyle and good nutrition,
exercise regularly, do not smoke, avoid
drinking alcoholic beverages.

AIMS AND RATIONALE OF EACH OF
THE GUIDELINES
Guideline No. 1

is intended to give the message that no single
food provides all the nutrients the body
needs. Choosing different kinds of foods from
all food groups is the first step to obtain a
well-balanced diet. This will help correct the
common practice of confining of choice to a
few kinds of foods, resulting in an unbalanced
diet.
Guidelines No.2
is entitled to promote exclusive breastfeeding from
birth to 4-6 months and to encourage the
continuance of breastfeeding for as long as two years
or longer. This is to ensure a complete and safe food
for the newborn and the growing infant besides
imparting the other benefits of breastfeeding. The
guideline also strongly advocates the giving of
appropriate complementary food in addition to
breast milk once the infant is ready for solid foods at
6 months. Malnutrition most commonly occurs
between the age of 6 months to 2 years, therefore
there is a need to pay close attention to feeding the
child properly during this very critical period.

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

Guidelines No. 4,5,6 and 7
are intended to correct the deficiencies in the current dietary
pattern of Filipinos. Including fish, lean meat, poultry and
dried beans, which will provide good quality protein and
dietary energy, as well as iron and zinc, key nutrients lacking
in the diet of Filipinos as a whole. Eating more vegetables,
fruits and root crops will supply the much needed vitamins,
minerals and dietary fiber that are deficient in our diet. In
addition, they provide defense against chronic degenerative
diseases. Including foods cooked in edible oils will provide
additional dietary energy as a partial remedy serve to supply
not only calcium for healthy bones but to provide high quality
protein and other nutrients for growth. to calorie deficiency
of the average Filipino. Including milk and other calcium-rich
foods in the diet will
Guideline No. 8
promotes the use of iodized salt to prevent
iodine deficiency, which is a major cause of
mental and physical underdevelopment in the
country. At the same time, the guideline
warns against excessive intake of salty foods
as a hedge against hypertension, particularly
among high-risk individuals.
Guideline No.9
is intended to prevent food-borne diseases. It
explains the various sources of contamination
of our food and simple ways to prevent it from
occurring.
Guideline No. 10
promotes a healthy lifestyle through regular
exercise, abstinence from smoking and avoiding
consumption. If alcohol is consumed, it must be
done in moderation. All these lifestyle practices
are directly or indirectly related to good nutrition.

NUTRIENTS IN FOOD
Nutrients are chemical substances present in the
foods that keep the body healthy, supply
materials for growth and repair of tissues, and
provide energy for work and physical activities.

The major nutrients include the macronutrients,
namely; proteins, carbohydrates and fats; the
micronutrients, namely vitamins such as A, D, E
and K, the B complex vitamins and C and minerals
such as calcium, iron, iodine, zinc, fluoride and
water.
Reproductive Health
a state of complete physical, mental and social
well-being and not merely the absence of
disease/ infirmity in all matters relating to the
reproductive system and to its functions and
processes.
Basic RH Rights
Right to RH information and health care
services for safe pregnancy and childbirth
Right to know different means of regulating
fertility to preserve health and where to
obtain them
Freedom to decide the number and timing
of birth of children
Right to exercise satisfying sex life
Factors/ determinants of RH

Socioeconomic conditions education,
employment, poverty, nutrition, living
condition/ environment, family environment
Status of women equal right in education
and in making decisions about her own RH;
right to be free from torture and ill treatment
and to participate in politics
Social and Gender Issues
Biological (individual knowledge of
reproductive organs and their functions),
cultural (countrys norms, RH practices) and
psychosocial factors
Elements
Maternal and Child Health Nutrition
Family Planning
Prevention and Management of Abortion
Complications
Prevention and Treatment of Reproductive
Tract Infections, including STDs, HIV and
AIDS
Education and Counseling on Sexuality and
Sexual Health
Elements
Breast and Reproductive Tract Cancers and
other Gynecological Conditions
Mens Reproductive Health
Adolescent Reproductive Health
Violence Against Women
Prevention and Treatment of Infertility and
Sexual Disorders
Selected Concepts
RH is the exercise of reproductive right with
responsibility
It means safe pregnancy and delivery, the right of
access to appropriate health information and services
It includes protection from unwanted pregnancy by
having access to safe and acceptable methods of
family planning of their choice
It includes protection from harmful reproductive
practices and violence
It ensure sexual health for the purpose of
enhancement of life and personal relations and
assures access to information on sexuality to achieve
sexual enjoyment
Goal
To achieve healthy sexual development
and maturation
To achieve their reproductive intention
To avoid diseases, injuries and
disabilities related to sexuality and
reproduction
To receive appropriate counseling and
care of RH problems
Strategies
Increase and improve the use of more effective or
modern contraceptive methods
Provision of care, treatment and rehabilitation for
RH
RH care provision should be focused on
adolescents, men and unmarried and other
displaced people with RH problems
Strengthen outreach activities and referral system
Prevent specific RH problems through information
dissemination and counseling of clients
HEALTH AND SANITATION
Environmental Sanitation is still a health
problem in the country.
Diarrheal diseases ranked second in the
leading causes of morbidity among the
general population.
Other sanitation related diseases :
tuberculosis, intestinal parasitism,
schistossomiasis, malaria, infectious hepatitis,
filariasis and dengue hemorrhagic fever
DOH thru Environmental Health Services (EHS)
unit is authorized to act on all issues and
concerns n environment and health including
the very comprehensive Sanitation Code of
the Philippines (PD 856, 1978).
WATER SUPPLY SANITATION
PROGRAM
EHS sets policies on:
Approved types of water facilities
Unapproved type of water facility
Access to safe and potable drinking water
Water quality and monitoring surveillance
Waterworks/Water system and well
construction
Approved type of water facilities
Level 1 (Point Source)- a protected well or a
developed spring with an outlet but without a
distribution system
indicated for rural areas;
serves 15-25 households; its outreach is not
more than 250 m from the farthest user
yields 40-140 L/ min
Level II ( Communal Faucet or Stand Posts)
With a source, reservoir, piped distribution
network and communal faucets
Located at not more than 25 m from the
farthest house
Delivers 40-80 L of water per capital per day to
an average of 100 households
Fit for rural areas where houses are densely
clustered
Level III ( Individual House Connections or
Waterworks System)
With a source, reservoir, piped distributor
network and household taps
Fit for densely populated urban communities
Requires minimum treatment or disinfection
ENVIRONMENTAL SANITATION
the study of all factors in mans physical
environment, which may exercise a
deleterious effect on his health, well-being
and survival.

Includes:
1. Water sanitation
2. Food sanitation
3. Refuse and garbage disposal
4. Excreta disposal
5. Insect vector and rodent control
6. Housing
7. Air pollution
8. Noise
9. Radiological Protection
10. Institutional sanitation
11. Stream pollution
PROPER EXCRETA AND SEWAGE
DISPOSAL PROGRAM
EHS sets policies on:
Approved types of toilet facilities :
LEVEL I
Non-water carriage toilet facility no water
necessary to wash the waste into receiving space
e.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
sets policy and practical programs to prevent
and control food-borne diseases to alleviate
the living conditions of the population
HOSPITAL WASTE MANAGEMENT
PROGRAM
Disposal of infectious, pathological and other
wastes from hospital which combine them
with the municipal or domestic wastes pose
health hazards to the people.

Hospitals shall dispose their hazardous wastes
thru incinerators or disinfectants to prevent
transmission of nosocomial diseases
PROGRAM ON HEALTH RISK MINIMIZATION
DUE TO ENVIRONMENTAL POLLUTION
Foci:
1. Prevention of serious environmental hazards
resulting from urban growth and industrialization
2. policies on health protection measures
3. researches on effects of GLOBAL WARMING to
health (depletion of the stratosphere ozone layer
which increases ultraviolet radiation, climate
change and other conditions)
NURSING RESPONSIBILITIES AND
ACTIVITIES
Health Education IEC by conducting
community assemblies and bench conferences.
The Occupational Health Nurse, School Health
Nurse and other Nursing staff shall impart the
need for an effective and efficient
environmental sanitation in their places of
work and in school.
Actively participate in the training component of
the service like in Food Handlers Class, and attend
training/workshops related to environmental health.
Assist in the deworming activities for the school
children and targeted groups.
Effectively and efficiently coordinate
programs/projects/activities with other government and
non-government agencies.
Act as an advocate or facilitator to families in the
community in matters of
program/projects/activities on environmental
health in coordination with other members of Rural
Health Unit (RHU) especially the Rural Sanitary
Inspectors.
Actively participate in environmental
sanitation campaigns and projects in the
community. Ex. Sanitary toilet campaign
drive for proper garbage disposal,
beautification of home garden, parks drainage
and other projects.
Be a role model for others in the community
to emulate terms of cleanliness in the home
and surrounding.

Non-Communicable Diseases and
Rehabilitation
1. Prevention and Control of
Cardiovascular Diseases
heart 1
st leading cause of death
; bld vessels - 2
nd

Congenital Heart Disease (CHD): Result of the abnormal
development of the heart that exhibits septal defect, patent
ductus arteriosus, aortic and pulmonary stenosis, and
cyanosis; most prevalent in children
Causes: envtl factors, maternal diseases or genetic aberrations

Rheumatic Fever or Rheumatic Heart Disease: Systematic
inflammatory disease that may develop as a delayed reaction
to repeated and an inadequately treated infection of the
upper respiratory tract by group A beta-hemolytic
streptococci.

Hypertension: Persistent elevation of the arterial
blood pressure.
( primary or essential) ;frequent among females
but severe,malignat form is more common among
males

Ischemic Heart Disease/ Atherosclerosis: Condition
usually caused by the occlusion of the coronary
arteries by thrombus or clot formation.
higher among males than females for the latter
are protected by estrogen before menopause
PF: HPN, DM, Smoking
Minor RF: stress, strong family history, obesity

CVD
PERIOD OF LIFE TYPE OF CVD PREVALENCE
At birth to early
childhood
Congenital Heart
Disease
2 / 1000 school children
(aged 5 15 y.o.)
Early to late childhood Rheumatic Fever /
Rheumatic Heart
Disease
1 / 1000 school children
(aged 5 15 y.o.)
Early Adulthood Diseases of Heart
Muscles
Essential Hypertension
10 / 100 adults
Middle age to old age Coronary Artery Disease
Cerebrovascular
Accident
5 / 100 adults
CVD
Diseases Causes / Risk factors
Congenital Heart Disease Maternal Infections, Drug intake,
Maternal Disease, Genetic
Rheumatic Fever/Rheumatic Heart
Disease
Frequent Streptoccocal Sore Throat
Essential Hypertension Heredity, High Salt Intake
Coronary Artery Disease (Heart
Attack)
Smoking, Obesity, Hypertension,
Stress Hyperlipidemia, Diabetes
Mellitus Sedentary Life Style
Cerebrovascular Accident (Stroke) Hypertension, Arteriosclerosis
Primary Prevention: CVD
Disease Primordial Specific Protection
Congenit
al Heart
Disease
- Prevention of
viral infection
and intake of
harmful drugs
during pregnancy.
- Avoidance of
marriage between
blood relatives
- Adequate treatment of
viral infection during
pregnancy.
- Genetic counseling of
blood related married
couples.
Rheumatic Heart
Disease
- Prevention of
recurrent sore
throat thru
adequate
environmental
sanitation;
avoidance of
overcrowding;
adequate
treatment
- Identification of
cases of
rheumatic fever
- Prophylaxis
with penicillin or
erythromycin
Essential
Hypertension
- From early
childhood
> low salt diet
> adequate
physical exercise
- Continued low
salt diet and
adequate exercise
Coronary Heart
Disease(Heart
Attack)
- Prevention of
development/
acquisition of
risk factors
> cigarette
smoking
> high fat intake
> high salt intake
- cessation of
smoking
- control
/treatment of
diabetes,
hypertension
-weight reduction
-change to proper
diet
-Adjustment of
activities
Cerebrovascular
Accident (Stroke)

- all measures to
prevent
hypertension &
arteriosclerosis
- all measures to
control
hypertension &
progression of
arteriosclerosis
1. Primary Prevention thru health education is
the main focus of the program:
maintenance of ideal body wt.
diet - low fat
alcohol/smoking avoidance
exercise
regular BP check up

2. Cancer Prevention and Early Detection
Any malignant tumor arising from the abnormal
and uncontrolled division of cells causing the
destruction in the surrounding tissues.
Common Cancer: Lung cancer, cervical cancer,
colon cancer, cancer of the mouth, breast cancer,
skin cancer, prostate cancer.
3
rd
leading cause of illness and death ( Phil.)
Incidence can only be reduced thru prevention
and early detection
NINE WARNING SIGNS OF CANCER:
Change in blood bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty in swallowing
Obvious change in wart or mole
Nagging cough or hoarseness

Unexplained anemia
Sudden unexplained weight loss
Prevention & Early Detection
CA type
Lung
Uterine
Cervical
Liver
Prevention
No smoking
Monogamy
Safe sex
Hep B
vaccination
Less aalcohol
intake
Avoidance of
moldy foods
Detection
None
Paps smear
every 1-3 yrs
None
Colon
Rectum

High fiber diet
Low fat intake
Regular medical
check-up after 40
yrs of age
Fecal occult
blood test
DRE
Sigmoidoscopy

Mouth

No smoking,
betel nut chewing
Oral hygiene
Regular dental
check-ups
Breast

none Monthly SBE
Yearly exam by
doctor
Mammography
for 50 yrs old and
above females
Skin

Prostate

No excessive sun
exposure
none
Assessment of
skin
Digital trans-
rectal exam
PRINCIPLES OF TREATMENT OF MALIGNANT
DISEASES
One third of all cancers are curable if detected
early and treated properly.
Three major forms of treatment of cancer:
Surgery
Radiation Therapy
Chemotherapy

3. Natl Diabetes Prevention and Control
Program
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
A creative application of the primary health care approach in
rehabilitation services, which involves measures taken at the
community level to use and build on the resources of the
community with the community people, including impaired,
disabled and handicapped persons as well.

Goal: To improve the quality of life and increase productivity
of disabled, handicapped persons.

Aim: To reduce the prevalence of disability through
prevention, early detection and provision of rehabilitation
services at the community level.
8. Program on the Elderly/Geriatric Nursing
Services

7. Humanitarian issues: family, health, income,
security, employment and labor, social
welfare, education, recreation, culltural
activities and housing
Leading causes of illness:elderly
Influenza, HPN, diarrhea,
bronchitis, TB, diseases. of the heart,
pneumonia, malaria,
malignant neoplasm, chickenpox
Leading causes of death:elderly
Diseases of heart and vascular system
Pneumonia, TB, CCOPD
Malignant neoplasms
Diabetes
Nephritis
Accidents

9. Programs on Blindness, Deafness and
Osteoporosis
Cataract- main causes of blindness
VAD- main cause of childhood blindness; most
serious eye problem of Fil. children below 6 yrs. old
Osteoporosis special problem in women, highest
bet. 5079 yrs. old, MENOPAUSE- main cause
Prevention of NCD/Role of Nursing in
Health Promotion And Advocacy
Yosi Kadiri- anti smoking
Edi Exercise/Hataw-regular physical activity
Tiya Kulit/ Iwas Sakit Diet-low salt, low fat,
high fiber diet
Mag HL exercise, no smoking, avoidance of
alcohol, healthy diet, iwas stress, watch wt.

Sentrong Sigla Movement ( SSM)
a certification recognition program which
develops and promotes standards for health
facilities
- 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
Quality Assurance
Grant and Technical Assistance
Health Promotion
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
Integrated Management of Childhood
Illness ( IMCI)
Integrates management of most common
childhood problems ( diarrhea, pneumonia,
measles, malnutrition, DHF, malaria)
Involves family members and community in
the health care process for physical growth
and mental development & disease
prevention
IMCI: Case Mgt. Process
1. Assessing the child or young infant- History taking,
PE
2. Classifying the Illness- severity of illness
3. Identifying Tx.- classification chart
4. Treating the child- giving Tx. in health centers,
prescribed drugs & teaching mothers how to carry
out Tx.
5. Counseling the mother- child feeding,foods and
fluids to give & when to bring the child back to the
health center
6. Giving of follow-up care
Communicable diseases
National Tuberculosis Control Program key
policies
Case finding direct Sputum Microscopy and X-ray
examination of TB symptomatics who are negative
after 2 or more sputum exams
Treatment shall be given free and on an
ambulatory basis, except those with acute
complications and emergencies
Direct Observed Treatment Short Course
comprehensive strategy to detect and cure TB
patients.

Category and Treatment Regimen
Category 1- new TB patients whose sputum is
positive; seriously ill patients with severe forms of
smear-negative PTB with extensive parenchymal
involvement (moderately- or far- advanced) and
extra-pulmonary TB (meningitis, pleurisy, etc.)

Category 2-previously-treated patients with relapses
or failures.

Category 3 new TB patients whose sputum is
smear-negative for 3 times and chest x-ray result of
PTB minimal

Category 1- new TB patients whose sputum is positive; seriously ill patients with severe
forms of smear-negative PTB with extensive parenchymal involvement (moderately- or
far- advanced) and extra-pulmonary TB (meningitis, pleurisy, etc.)
Intensive Phase (given daily for the first 2 months)- Rifampicin
+ Isioniazid + pyrazinamide + ethambutol.

If sputum result becomes negative after 2 months,
maintenance phase starts. But if sputum is still positive in 2
months, all drugs are discontinued from 2-3 days and a
sputum specimen is examined for culture and drug sensitivity.
The patient resumes taking the 4 drugs for another month
and then another smear exam is done at the end of the 3
rd

month.

Maintenance Phase (after 3
rd
month, regardless of the result
of the sputum exam)-INH + rifampicin daily
Category 2-previously-treated patients with
relapses or failures.
Intensive Phase (daily for 3 months, month 1,2 & 3)-
Isioniazid+ rifampicin+ pyrazinamide+ ethambutol+
streptomycin for the first 2 months Streptomycin+
rifampicin pyrazinamide+ ethambutol on the 3
rd
month. If
sputum is still positive after 3 months, the intensive phase
is continued for 1 more month and then another sputum
exam is done. If still positive after 4 months, intensive
phase is continued for the next 5 months.

Maintenance Phase (daily for 5 months, month 4,5,6,7,&
8)-Isionazid+ rifampicin+ ethambutol

Category 3 new TB patients whose sputum is smear-negative
for 3 times and chest x-ray result of PTB minimal
Intensive Phase (daily for 2 months)
Isioniazid + rifampicin + pyrazinamide

Maintenance Phase (daily for the next 2
months) - Isioniazid + rifampicin
Stop TB ; Do it with DOTS
Advocacy is a planned and continuous effort to
inform people about issue and instigate change.
Advocacy usually takes place over an extended
period of time and includes a variety of strategies
to communicate a specific message.

TB is the number one infectious killer in the world.
One TB suspect can infect another 10 healthy
persons
Leprosy Control Program
WHO Classification basis of multi-drug therapy
Paucibacillary/PB non-infectious types. 6-9 months of
treatment.
Multibacillary/MB infectious types. 24-30 months of
treatment.
Multi-drug therapy use of 2 or more drugs renders patients
non-infectious a week after starting treatment
Patients w/ single skin lesion and a negative slit skin smear
are treated w/ a single dose of ROM regimen
For PB leprosy cases- Rifampicin+Dapsone on Day 1 then
Dapsone from Day 2-28. 6 blister packs taken monthly
within a max. period of 9 mos.
All patients who have complied w/ MDT are considered cured
and no longer regarded as a case of leprosy, even if some
sequelae of leprosy remain.
Responsibilities of the nurse
Prevention health education, healthful living through
proper nutrition, adequate rest, sleep and good personal
hygiene;
Casefinding
Management and treatment prevention of secondary
injuries, handling of utensils; special shoes w/ padded
soles; importance of sustained therapy, correct dosage,
effects of drugs and the need for medical check-up from
time to time; mental & emotional support
Rehabilitation-makes patients capable, active and self-
respecting member of society.
Control of Schistosomiasis a tropical disease
caused by a blood fluke, Schistosoma Japonicum ;
transmitted by a tiny snail Oncomelania quadrasi
Preventive measures health education
regarding mode of transmission and methods of
protection; proper disposal of feces and urine;
improvement of irrigation and agriculture
practices
Control of patient, contacts and the immediate
environment
Specific treatment- Praziquantel drug of choice
Programs on Filariasis, Malaria and Dengue
Hemorrhagic Fever
Filariasis- a chronic prasitic infection caused
by a nematode, Wuchereria bancrofti. Young
and adult worms live in the lymphatic vessels
and nodes, while the micro filariae are in the
blood; transmitted through bites from an
infected female mosquito, Aedes poecilius,
that bites at night.
Treatment: Diethylcarbamazine citrate or
Hetrazan
Elephantiasis and Hydrocoele are handled
through surgery, prevention and supportive care
Malaria infection caused by the bite of the
female Anopheles mosquito,
Chemoprophylaxis Chloroquine taken at weekly
intervals, starting from 1-2 weeks before
entering the endemic area.
Anti-malarial drugs sulfadoxine, quiinine
sulfate, tetracycline, quinidine
Insecticide treatment of mosquito nets, house
spraying, stream seeding and clearing,
sustainable preventive and vector control meas

Dengue H-fever
4 oclock 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/
Weils 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
Wash wound with soap and water, betadine or alcohol may be
applied
If dog is healthy observe for 14 days. If nothing happens- no need
for Tx.If it dies or shows rabies, kill then bring head for lab. Exam
& consult doctor.
Active immunization body develops Ab against rabies up to 3
yrs.
Passive I giving Ab to persons with head and neck bites,
multiple single deep bites, contamination of mucous membranes
or thin covering of the eyes, lips or mouth to provide immediate
protection
RPO immunization of pets at 3 mos. of age and yearly thereafter

Prevention and Control on STIs
- Gonorrhea, Syphilis, HIV/AIDS,
Trichomoniasis,Chlamydia, Hep B ( the most serious
type cause of severe cx. Eg. Massive liver damage
and hepatocarcinoma
- 4 Cs in the Syndromic Mgt
- 1. Compliance
- 2. Counseling/ Education
- 3. Contact tracing to treat partner
- 4. Condom use
- Hep B vaccination
- Universal precautions
- Safe sex
Other CHN Practice Settings
I. Occupational Health
the application of public health, medical and engineering
practice for the purpose of conserving, restoring the
health and effectiveness of workers thru their places of
employment
A. Occupational Health Nursing
the application of nursing principles and procedures in
providing health service to employees in their place of work
by means of:
1. prompt and efficient nursing care of the ill and
impaired
2. participation in teaching health and safety
practices on the job
3. cooperation with plant department
administrators
4. keeping the health clinic and staff ready to
handle emergencies
5. advising workers in the utilization of community
and welfare services

Objectives of OHN
To assist, maintain and promote positive
health of laborers and employees thru early
detection and prevention of occupational
diseases and hazards of industrial processes
and by coordinating and cooperating with
activities of other community health and
welfare services
Nurses Role in OHN
1. Assists/participates in developing an adequate health
program for workers and laborers including sound
health education activities
2. Encourages periodic P.E.
3. Cooperates with occupational medical programs in the
prevention of accidents as well as in the promotion
of good working atmosphere and relationships in the
place of work
4. Helps in teaching others in giving good nursing care to
the sick or handicapped in their own homes
Prevention and Control on STIs
- Gonorrhea, Syphilis, HIV/AIDS,
Trichomoniasis,Chlamydia, Hep B ( the most serious
type cause of severe cx. Eg. Massive liver damage
and hepatocarcinoma
4 Cs in the Syndromic Mgt
1. Compliance
2. Counseling/ Education
3. Contact tracing to treat partner
4. Condom use
Hep B vaccination
Universal precautions
Safe sex
II. School Health Nursing
School Health Triad :
1. SERVICE
2. EDUCATION
3. ENVIRONMENT
Mission of School Health Program:
To maximize potential for learning and
participation in the educational process by
promoting optimum health of school-age
children and adolescents
School Health Team:
Psychologist/ Counselor
Teacher
Nutritionist
Nurse
Social Workers
Maintenance Personnel

Targets in SHN
Family
Students
Teachers
Supportive Personnel
Community
School Health Nurses 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, Its the nature
of the scorpion to sting. Its my nature to love,
why should I give up my nature to love just
because its the nature of the scorpion to
sting?
Dont give up
loving, dont give
up your goodness
even if people
around you sting
THE
END