SCOPE OF NURSING LICENSURE EXAMINATION (NLE)

Nursing Board Exam/Nursing Licensure Exam Coverage (Nursing Practice I)

NURSING BOARD EXAM SCOPE/COVERAGE
NURSING PRACTICE I
TEST DESCRIPTION: Theories, concepts, principles and processes basic to the
practice of nursing with emphasis on health promotion and health maintenance. It
includes basic nursing skills in the care of clients across age groups in any setting.
Moreover, it encompasses the varied roles, functions and responsibilities of the
professional nurse in varied health care settings.
TEST SCOPE:
I. Personal and Professional Growth and Development

A. Historical Perspective in Nursing

HISTORICAL FOUNDATION OF NURSING

The Four Great Periods of Nursing

1. INTUITIVE NURSING
*This untaught nursing was instinctive.
*Dated from pre-historic times.
*Practice among primitive tribes and lasted through Christian era.
*Performed out of feeling of compassion to others.
*Out of wish to do good- HELPING

2. APPRENTICE NURSING
*Extends from the founding of religious orders in the 6 th century through the
crusades which began in the 11th century to 1836.
*The Deacons School of Nursing at Kaisserwerth, Germany established by
pastor Fliedner and his wife.
*Period of on the job training- desired of person to be trained

3. EDUCATED NURSING
*Began in 1860.
*Florence Nightingale School of Nursing opened at St. Thomas in London.
First program of formal education for nurses started.

4. CONTEMPORARY NURSING
*Began at the end of World War II (1945)
*Scientific and Technological developments of many social changes occurs.

INTUITIVE NURSING
*Cause of illness was believed to be the invasion of the victims body by an evil
spirit.
*Uses black magic or voodoo to harm or driven out by using supernatural power.
*Believed in medicine man (shaman or witch doctor) that had the power to heal
by using white magic.
They made use of hypnosis, charms, dances, incantations, purgatives,
massage,fire, water, herbs or other vegetations and even animals.
*Performing a trephine
Drilling a hole in the skull with a rock or stone without benefit of anesthesia.
Goal of this therapy is to drive the evil spirit from the victims body.
*Nurses role was instinctive directive toward comforting, practicing midwifery
and being wet nurse to a child.
*Act performed without training and direction.

Babylonia
*Practice of medicine is far advanced.
*Code of Hammurabi.
-Legal and Civil measures is establish
-Regulate the practice of physicians
-Greater safety of patient provided
*No mention of Nurses or nursing this time

Egypt
*Art of embalming enhance their knowledge of human anatomy
*Developed the ability to make keen clinical observations and left a record of 250
recognized diseases.
*Control of health was in the hands of Gods. The first acknowledged physicians
was Imhotep.
*Made great progress in the field of hygiene and sanitation.
*Reference to nurses in Moses 5th book is a midwife and wet nurse.

Palestine
*The Hebrews book of genesis emphazised the teachings of Judaism regarding
hospitality to the stranger and acts of charity.
*Implementation of laws like
-controlling the spread of communicable disease
-cleanliness
-preparation of food
-purification of man (bathing and his food.
*The ritual of circumcision of the male child on the 8th day
*The established of the High Priest Aaron as the physician of people.

China
*Culture was imbued with the belief in spirits and demons.
*Gave the world the knowledge of material medica (pharmacology); method of
treating wounds, infection and muscular afflictions.
*Chan Chun Ching Chinese Hippocrates.
*Emperor Shen Nung said to be the father of Chinese medicine and the
inventor of acupuncture technique.
*No mention of nursing in Chinese writings so it is assumed that care of the sick
will fall to the female members of the household.

India
*First recorded reference to the nurses taking care of patients on the writings of
shushurutu.
*Functions and Qualifications of nurse includes:
- Knowledge in drug preparation and administration.
- Cleverness.
- Devotedness to the patient.
- Purity of both mind and body.
*King Asoke, a Buddhist, published an edict to established hospitals throughout
India where nurses were employed.

Greece
*Made contribution in the area aesthetic arts and clinical medicine, but nursing
was the task of the untrained slave.
*Aesculapius, The Father of Medicine in Greek mythology to whom we associate
the Caduceus, (known insignia of medical profession today)
*Hippocrates, the Father of Medicine insisted that magic and philosophical
theories had no place in medicine.
*The work of women was restricted to the household. Where mistress of the
mansion gave nursing care to the sick slaves.

Rome
*Acquired their knowledge of medicine from the Greeks.
*Emperor Vespasian opened schools to teach medicine.
*Developed military medicine First aid, field ambulance service and hospitals for
wounded soldiers.
*Translated Greek medical terminologies into Latin terms which has been used in
medicine ever since.

APPRENTICE NURSING
*Religious orders of Christian Church played a major role in this kind of nursing.

The Crusades (11th Century)

*Series of holy wars were conducted by Christian in an attempt to recapture the
Holy land from the Turks.
*Military religious orders founded during the crusades established hospitals and
staffed them with men who served as nurses. Among these were:
 - The knights of St. John of Jerusalem served both as warriors in battle and
nurses in the hospital and was called Knights Hospitallers.
- The Teutonic Knights built hospitals cared for sick and denfended the faith.
- The Knights of St. Lazarus established primarily for the nursing of lepers,
forerunners of our now known communicable diseases hospital (also called
lazarettos).

The Rise of Religious Nursing Orders

* The Regular Orders established monasteries to house travelers, paupers and
patient under one roof. Later as society became better organized hospitals
tended to become separate institutions apart from monsteries.
*The Secular Orders developed for the primary purpose of nursing; were similar
to the regular orders by their temporary vows, uniformity in dress and religious
observation.
*The Nursing Orders definitely organized. The sisters advanced the stage of
probationer to wearing the white robe to receiving the hood; They were all under
the superintendent of nurses or director of nursing; later adopted a uniform dress
that eventually became entirely standardized.

Nursing Saints
* St. Hildegarde a Benedictine abbess in Germany, actually prescribed cures in
her 2 books on medicine and natural history.
* St. Francis and Clara took vows of poverty, obedience, service and chastity
and took care of the sick and the afflicted; founders of the Franciscan Order and
the Order of the Poor Clares respectively.
* St. Elizabeth of Hungary the patroness of nurses; built a hospital for the sick
and the needy.
* St. Catherine of Siena the 1st lady with a lamp; became a tertiary of St.
Dominic and engaged in works of mercy among the sick and of the Church.

The Reformation
* St. Vincent de Paul set up the first program of social service in France and
organized the Community of the Sisters of Charity. His 1st superior and co-
founder was Louise de Gras (nee de Marillac).

The Intellectual Revolution (17th Century)

Characterized by the development of natural science, medicine, arts and as
well as interest in human beings and their welfare. Among the leaders for reform
were:
* St. John of God founder of the Brother Hospitallers and declared the patron
of all hospitals and sick folk by Pope Leo XIII in 1930.
* George Fox founder of the sect known as the Soicety of Friends (Quakers)
who advocated equality of men and women, thus making it easier for women to
become active in Nursing.
* John Howard introduced prison reforms (fresh air and plenty of water).
* Philippe Pinel introduced his modern open-door treatment of the mentally ill.
* Elizabeth Fry greatly improved prison conditions by developing work fo the
prisoners and the segregations of sexes, later established the Insitute of Nursing
sisters, the first organization of women to be trained as private duty nurse.
* Mother Mary Catherine MccAuley founder of the Order of the Sisters of
Mercy, 2nd largest of the Roman Catholic Orders.
* Theodor Fliedner and his wife Friederike Mumster established the Institute of
Kaisserwerth on the Rhine for the practical training of Deaconesses (1836), which
is considered as the 1st Organized training school for nurses. It was here where
Florence Nightingale received some of her training and the inspiration for the
establishment of her school of nursing. Some of its features includes:
1. A rotating 3 year experience in cooking and housekeeping, laundry and linen
and nursing care in the womens and mens wards; and
2. A preliminary and probationary 3 months period of trial and error for both
school and student.

The Dark Period of Nursing (17th 19th Century)

* Many hospitals were closed; the wealth took care of their sick at home; the
indigent sick were taken care of by uneducated, illiterate women who had no
background for nursing.
* Charles Dickens in his book entitled Martin Chuzzleswit published the selfish and
cruel conduct of 2 private duty nurses namely Sairey Gamp and Betsy Prig.

THE PERIOD OF EDUCATED NURSING

England
* June 15, 1860 marked the day when 15 probationers entered St. Thomas
Hospital in London to establish the Nightingale system of Nursing, founded
by Florence Nightingale (May 12, 1820). Among the highlights in her life are the
following:
- At age of 31, obtained parental consent to enter the Deaconess School at
Kaisserwerth.
- Had 3 months training at Kaisserwerth; later superintendent of the
Establishment for Gentlewomen During Illness (1853) during which time she
initiated the policy of admitting and visiting the patients of all faiths.
- In 1854 a Volunteered for Crimean war service together with 38 women at
Scutari in the Crimea upon the request of Sir Sidney Herbert, Minister of War in
England. At first their work is not accepted because it consisted of cleaning the
area, thus reducing the infections, clothing for the men, writing letters to their
families; their work served as inspiration for the Red Cross later on.
- In 1860 started the Nightingale System of Nursing at the St. Thomas Hospital
in London believed that schools should be self-supporting; that schools of nursing
should have decent living quarters for their student; that they should have paid
nurse instructors; that the school should correlate theory to practice and these
students should be taught the why not just how in nursing.
- 2 books written Note on Nursing and Notes on Hospital, contain many
timely portions applicable in the 1970s as they were in 1859.

United States
* At the time that Florence Nightingale was opening her school in London; the U.S
was on the brink of the civil war. However though the country was in a condition of
chaos, nursing had many supporters and the needs to train nurses were
recognized.
- Linda Richards is the first graduate nurse in the U.S completed her training at
the New England Hospital for Women and Children in Boston, Massachusetts,
patterned after the DeaconessesSchool of Kaisserwerth.
- In 1873 3 schools of nursing opened, patterned after the Nightingale plan
the Bellevue Training School for Nurse in the New York City , the Connecticut
training. School in New Haven and the Massachusetts General Hospital in Boston.
- In 1881 founding of American Red Cross by Clara Barton.
- In 1889 John Hopkins hospital opened a school of Nursing with Isabel
Hampton Robb as its 1st principal and the person most influential in directing the
development of nursing in the U.S.
- In 1893 the groundwork for the estimate of the 2 new nursing organization
was lad:
1. The Associated Alumnae, later known as the American Nurses Association
was begun at the Chicago Worlds fair and
2. The American Society of Superintendent of Training Schools for Nurses, later
known as the National League for Nursing Education, also began.
- During the Spanish American War (1898 1899) nurse were concerned with
the care of the wounded as well as care of those inflected with malaria and yellow
fever.
Nurse Clara Louise Maas gave her life for the advancement of medical science in
the search for control yellow fever.

The 20th Century

*In 1900 1912
- advancement in hospital nursing, private duty nursing, public health nursing,
school nursing, government service and pre-maternal nursing;
- there was a growing awareness for the preventive measures that could be
uses to maintaing the heath of the nation;
- There was beginning specialization in medicine.

* 1913 1937
- a standard curriculum for schools of nursing was prepared by the National
League for Nursing Education.
- the practice of nursing was gradually infiltrated with educational objectives.
* Worl War I (1917 1918)
- Private duty nurses were now nursing in the hospitals rather than in homes.
- Opening of more nursing schools as a result of the construction of more
hospitals.
- Increase demand for public health nurse for preventice aspects of care.
- Awareness of the need for military ranking among nurses for which a bill was
later introduced and passed.
Julia Stimson was the first woman to hold rank of major.

* World War II (1942 1945)

- the start of Aero-medical nursing (flight nursing)
- Creation of the U.S Cadet Nurses Corps with Mrs. Lucille Ptery Leone as
director and later the 1st woman to serve as assistant surgeon of the U.S public
Health Service.
- granting of permanent commissioned rank for both army and navy nurses.
- the concept of family centered care as methods to help patient help
themselves.
- concept of psychosomatic medicine and early ambulation.
- consept of creative nursing, which has necessitated the need for laundering
definitive studies of all aspects of nursing thus helping to raise the standards to a
professional level.

CONTEMPORARY NURSING
* Creation of United Nations in San Francisco California in 1945.
2 folds purpose are:
- International peace and international security with provisions for equal justice,
Machinery for peaceful disputes and provisions.
- Provisions for assuring human rights, social justice and economic progress.

World Health Organization (WHO)

- Special agency of U.N, established in Geneva, Switzerland in 1948
- providing health information in fighting diseases and improving the nutrition,
living standards and environmental conditions of all people.
- Scientific and Technical Research used in disease prevention and health
care.
- Social Force affecting Nursing Legislation, prepared health care, technology
efficiency and nursing involvement with minority groups.
 NURSING IN THE PHILIPPINES

Early Care of the Sick

* Early life of Filipinos had been more or less mixed with superstitious belief.
- believed in the powers of witch.
- belief in the powers of herbolarios (albularyo)
* Hospitals existed as early as 15th Century, which were established by the
religious and also by Spanish administration.
* Franciscan Order is more than any other religious group. Among their early
hospitals are:

The Earliest Hospitals Established were the following:

HOSPITAL REAL de MANILA (1577) established primarily for kings soldiers
and Spanish civilians. Founded by Gov. Francisco de Sande.
SAN LAZARO HOSPITAL (1578) exclusively for the service of leprous patients.
Named after San Lazaro, patron saint of lepers. Founded by Brother Juan
Clemente.
HOSPITAL de INDIOS (1586) established by the Franciscan Order: offered
general services, supported purely by alms and contributions from charitable
persons.
HOSPITAL de AGUAS SANTAS (1590) convalescent hospital in Pansol,
Laguna; this was near medicinal spring, which cured several patients. Founded by
Brother J. Bautista of the Franciscan Order.
SAN JUAN de DIOS HOSPITAL (1596) founded by brotherhood of misericordia;
administered by the hospitallers of San Juan de Dios.
HOSPITAL de DULAC (1602 1603) located in Paco and existed only for 1
year.
HOSPITAL de NUEVA CACERES (1655) general hospital located in Bicol.
HOSPITAL de CONVALENSCECIA (1656) estimated by the Brotherhood of San
Juan de Dios on the little island on the Pasig River, where the Hospicio de San
Jose now stands; patients of San Juan de Dios Hospital who were in the
convalescent stage were sent there for their complete recovery.
HOSPITAL de ZAMBOANGA (1842) this is a governement military hospital run
and finance by Spanish governement.
HOSPITAL de CAVITE (1842) a general hospital estimated and managed by
Brotherhood of San Juan de Dios.
HOSPITAL de SAN GABRIEL (1866) exclusively for Chinese patients .

*Fray Juan Clemente was one of the 1st members of the Mission of the Order of
St. Francis in the Philippines in 1578.
- Collected native herbs for medicine later set a little pharmacy which he filled
with various medical remedies.
- Performed both the function of a physician and those of a nurse.
*Persons who really did nursing care of the sick were religious group (called
hospitallers) but they were assisted by Filipino attendants.
*In the early development of nursing, the work of the nurse and those of the
physician were not clearly defined.

Nursing Service during the Philippine Revolution

* The women during the Philippine revolutions took active part in nursing the
wounded soldier. They dress wounds, alleviate pains, prepared food and gave
comfort even without previous trainings.
* These were the prominent women who volunteered and gave nursing service.
Josephine Bracken wife of Jose Rizal Installed a field hospital in an estate
house in tejeros, Provided nursing care to the wounded night and day.
Mrs. Rosa Sevilla de Alvaro volunteered her service for the wounded soldier at
age of 18; he work hand in hand with Dona Hilaria de Aguinaldo and they led other
Filipino women to form the Filipino Red Cross in 1899.
converted their house into quarters for the Filipino soldier, during the Philippine
American war that broke out in 1899.
Dona Hilaria de Aguinaldo wife of Emilio Aguinaldo; Organized the Filipino
Red Cross under the inspiration of Apolinario Mabini.
Dona Maria de Aguinaldo second wife of Emilio Aguinaldo. Provided nursing
care for the Filipino soldier during the revolution. President of the Filipino Red
Cross branch in Batangas.
Melchora Aquino (Tandang Sora) Nurse the wounded Filipino soldiers and
gave them shelter and food.
Captain Salome A revolutionary leader in Nueva Ecija; provided nursing care to
the wounded when not in combat.
Agueda Kahabagan Revolutionary leader in Laguna, also provided nursing
services to her troop.
Trinidad Tecson Ina ng Biac na Bato, stayed in the hospital at Biac na Bato
to care for the wounded soldier.

* The Filipino Red Cross had its own constitution approved by the revolutionary
government. This was founded on February 17, 1899 with Dona Hilaria
Aguinaldo as president and Dona Sabina Herrera as secretary.

The Rise of Hospital and Nursing Schools

*The need for hospitals, dispensaries and laboratories led to the establishement of
the Board of Health in July 1901;
*A small dispensary in Manila opened for civil officers and employees, called Civil
Hospital.
*The need for doctors and nurses to help eradicate the epidemics of cholera and
smallpox led to the employment of U.S physicians and graduate nurses.
*In 1906 the idea of training Filipino girls to become nurses intiated the growth of
nursing schools.
1. Iloilo Mission Hospital School of Nursing (Iloilo City, 1906)
- It was ran by the Baptist Foreign Mission Society of America.
- Miss Rose Nicolet, a graduate of New England Hospital for woman and
children in Boston, Massachusetts, was the first superintendent.
- Miss Flora Ernst, an American nurse, took charge of the school in 1942.

2. St. Pauls Hospital School of Nursing (Manila, 1907)

- The hospital was established by the Archbishop of Manila, The Most
Reverend Jeremiah Harty, under the supervision of the Sisters of St. Paul
de Chartres.
- It was located in Intramuros and it provided general hospital services.
-First trained nursing student graduated after 3 years.
-No standard requirements for admission except willingness to work.

3. Philippine General Hospital School of Nursing (1907)

- In 1907, with the support of the Governor General Forbes and the Director
of Health and among others, she opened classes in nursing under the
auspices of the Bureau of Education.
- Anastacia Giron-Tupas, was the first Filipino to occupy the position of
chief nurse and superintendent in the Philippines, succeeded her.

4. St. Lukes Hospital School of Nursing (Quezon City, 1907)

- The Hospital is an Episcopalian Institution. It began as a small dispensary
in 1903. In 1907, the school opened with three Filipino girls admitted.
- Mrs. Vitiliana Beltran was the first Filipino superintendent of nurses.

5. Mary Johnston Hospital and School of Nursing (Manila, 1907)

- It started as a small dispensary on Calle Cervantes (now Avenida)
- It was called Bethany Dispensary and was founded by the Methodist
Mission.
- Miss Librada Javelera was the first Filipino director of the school.

6. Philippine Christian Mission Institute School of Nursing.

- The United Christian Missionary of Indianapolis, operated Three schools
of Nursing:
1. Sallie Long Read Memorial Hospital School of Nursing (Laoag,
Ilocos Norte,1903)
2. Mary Chiles Hospital School of Nursing (Manila, 1911)
3. Frank Dunn Memorial Hospital

7. San Juan de Dios Hospital School of Nursing (Intramuros, Manila, 1913)

- Was destroyed during the war with a new hospital built along Dewey
Boulevard.

8. Emmanuel Hospital School of Nursing (Capiz, 1913)

9. Southern Island Hospital School of Nursing (Cebu, 1918)
- The hospital was established under the Bureau of Health with Anastacia
Giron-Tupas as the organizer.

10. Zamboanga general Hospital School of Nursing (1921)

11. Chinese General Hospital School of Nursing (1921)

12. Baguio General Hospital School of Nursing (1923)

13. Manila Sanitarium and Hospital School of Nursing (1930)

14. Quezon Memorial Hospital School of Nursing (1957)

15. North General Hospital School of Nursing (1946)

16. Siliman University School of Nursing (Dumaguete, 1947)

17. Occidental Negros Provincial Hospital School of Nursing (1946)

18. Cebu (Velez) General Hospital School of Nursing (1951)

19. Brokenshire School of Nursing (Nueva Ecija, 1960)

20. De Ocampo Memorial School of Nursing (1954)

21. Marian School of Nursing (1960)

22. St. Rita Hospital and School of Midwifery (1956) and Nursing (1960)

Advantages of University Hospitals over Hospital Schools of Nursing:

1. students are treated as students and not as employees.
2. adequate financial support.
3. The head of the school is responsible only for the education of students in
nursing and;
4. The environment for the university school of nursing school education.

The First Colleges of Nursing in the Philippines

a. University of Santo Tomas .College of Nursing (1946)
- The first basic collegiate school for Nursing in the Philippines.
b. Manila Central University College of Nursing (1948)
c. University of the Philippines College of Nursing (1948). Ms.Julita Sotejo
was its first Dean
d. Southwestern College College School of Nursing (Cebu, 1947)
e. Philippine Union College of Nursing (1947)
f. Central Philippine College of Nursing (1947)
 g. Siliman University College of Nursing (1947)
h. Philippine Womens University College of Nursing (1951)
i. FEU Institute of Nursing (1955)
j. UE College of Nursing (1958)
k. Saint Paul College of Nursing (Manila, 1958)

Nursing Leaders in the Philippines

*Anastacia Giron-Tupaz First Filipino nurse to hold the position of Chief Nurse
Superintendent; Founder of PNA (Philippine Nurses Association)
*Cesaria Tan First Filipino to receive a masters degree abroad.
*Socorro Sirilan Pioneered in Hospital Social Service in San Lazaro Hospital
where she was the Chief Nurse.
*Rosa Militar Pioneered in School Health Education.
*Sor Ricarda Mendoza Pioneer in Nursing Education.
*Socorro Diaz First Editor of the PNA magazine called The Message
*Conchita Ruiz First full-time editor of the PNA magazine called The Filipino
Nurse.
*Loreta Tupaz Dean of the Philippine Nursing, regarded as the Florence
Nightingale of Iloilo.

Some Highlights in the History of Nursing in the Philippines

*1906 at the Union Mission Hospital (now Iloilo Mission Hospital) in Iloilo City, 4
women started training in nursing; 3 female graduated in 1909 as Qualified
Surgical and Medical Nurses.
*1907 19 students admitted to a preliminary course in nursing as the Philippine
Normal College.
*1909 A nursing school was established under the Bureau of Education by
Authority of Act No. 1931.
*1910 Act No. 1975 recognized the school under the Bureau of Health. The
school continued as one of the activities of the newly opened Philippine General
Hospital and became known as the Philippine General Hospital School of Nursing.
*1915 Act No. 2468 authorized the granting of the titles of graduate in nursing
and graduate in midwifery to nursing midwifery students of the PGHSN.
- Public Health Nursing in the Bureau of Health began in accordance with Act
No. 2468.
*1919 Act No. 2808 (Nurses Law) was passed, enacted regulating the practice
of the nursing profession in the Philippines Islands.It also provided the holding of
exam for the practice of nursing on the 2nd Monday of June and December of each
year. This act was later amended in 1922, 1933 and 1950.
*1920 1st Board Examination for Nurse was conducted by the Board of
Examiners, 93 candidates took the exam, 68 passed with the highest rating of
93.5% - Anna Dahlgren.
- theoretical exam was held at the UP Amphitheater of the College of
Medicine and Surgery. Practical Exam at the PGH Library.
*1922 Filipino Nurses Association was established (now PNA) as the National
Organization of Filipino Nurses.
First President Rosario Delgado
Founder Anastacia Giron-Tupas
*1924 A standard curriculum for school of Nursing was published by the PNA.
*1948 UP College of Nursing was established.
- First attempt to offer a 4 year basic nursing course leading to a B.S
Nursing Degree
- The 1st attempt to elevate nursing as profession by enriching and
broadening the preparation of nurses and by educating them in a University
Setting.
- The idea was conceived by Julita V. Sotejo, a Nurse and Lawyer, who later
became the 1st Dean of the School.
- A program was opened for graduate of the 3 year hospital nursing course
to obtain a B.S Nursing Degree at the U.P College of Nursing. This program ended
in 1975.
*1951 Republic Act 649 provided for the standardization of nurses salaries both
in institution and in public health.
*1953 Republic Act No. 877 (Nursing Practice Law) was approved. Minor
revisions were incorporated in 1957, 1966 1970 and 1972.
*1955 The UPCN offered a Master of Arts in (Nursing) Degree program to
prepare BSN holders of demonstrated competence and scholarship for senior
positions in nursing and to encourage nursing research.
- A one-year course leading to a certificate of Public Health Nursing was
opened at the UPCN. This program ended in 1969.
*1965 The Academy of Nursing of the Philippines (ANPHI) approved its
constitution.
- Among its objectives are initiate, promote, sponsor, encourage, and/or
conduct nursing studies and research, and to serve as a medium of exchange
through conference, seminar, institute and workshops.
*1966 R.A 4704, amending R.A 877 was approved.
*1968 A movement toward accreditation of Nursing Schools in the Philippines
was started.
*1970 WHO started an ongoing project in nursing education on family planning
to prepare faculty members to introduce family planning in basic nursing curricula.
- R.A 6136 amending R.A 877 and 4704 was approved.
*1972 A national seminar on Public Health Nursing Education was held with
WHO technical assistance.
*1975 A national seminar on Public Health Nursing Education was held with
WHO technical assistance.
*1975 A National Health Plan was formulated.
- It redefined the functions and responsibilities of nurses and other health
workers with implication for Nursing Education and Community Health Nursing.
- The Psychiatric-Nursing Specialists, Inc. (PNSI), the 1 st independent Nurse
Practitioners groups, was established.
*1976 A National Workshop on the Proposed Nurse-Midwife Curriculum of
Schools of Nursing in the Ministry of Health was sponsored by the Ministry. The
Workshop drafted an experimental 4-year Nurse-Midwifery curriculum.
*1977 ILO convention 149 and recommendations 157, concerning the
employment of Nursing Personnel and the conditions of their life and work, were
adopted in Geneva.
*1978 The Declaration of the Economic and School Welfare of Filipino Nurses
was passed by the PNA.
*1979 The 1st National Nurse Congress was held, its theme Nursing Issues in
the 80s.
- The 1st National Tripartite Conference on employment and conditions of life
and work of Nursing and other Health Personnel was held.
- Labor, management and government were involved.
*2002 Philippine Nursing Act of 2002 (R.A 9173)

1. Nursing Leaders
Florence Nightingale (1820-1910)
-recognized as nursings first scientist-theorist for her work, Notes on
Nursing: What It is, and What It is Not
-considered the founder of modern nursing.
-developed the Nightingale Training School of Nurses, which operated in
1860. The scchool served as a model for other training schools. Its
graduates traveled to other countries to manage hospitals and institute
nurse-training programs.
-Nightingales vision of nursing, which include public health and healt
promotion roles for nurses, was only partially addressed in the early days of
nursing. The focus tended to be on developing the profession within
hospitals.
Clara Barton (1812-1921)
-organized the American Red Cross, which linked with the International
Red Cross when the U.S Congress ratified the Geneva Convention in 1882.
Lilian Wald (1867-1941)
-considered the founder of Public Health Nursing.
Lavinia L. Dock (1858-1956)
-active in the protest movement for womens right that resulted in the U.S
Constitution amendment in 1920, allowing women to vote.
Margaret Sanger (1879-1966)
-a nurse activist; considered the founder of planned Parenthood, was
imprisoned for opening the first birth control information clinic in Baltimore in
1916.
Lydia Hall
-developed the Care, Core, and Cure Theory
-Goal: To Care, and Cure Cores disease.
-Care for the patients BODY. Cure the DISEASE. Treat the PERSON ( or
patient) as the Core.

B. Nursing as a Profession
NURSING AS A PROFESSION

Profession is a calling that requires special knowledge, skill and preparation.

An occupation that requires advanced knowledge and skills and that it grows out
societys needs for special services.

Criteria of Profession:
1. To provide a needed service to the society.
2. To advance knowledge in its field.
3. To protect its memebers and make it possible to practice effectively.

Characteristics of a Profession:
1. A basic profession requires an extended education of its members, as well as a
basic liberal foundation.
2. A profession has a theoretical body of knowledge leaing to defined skills,
abilities and norms.
3. A profession provides a specific service.
4. Members of a profession have autonomy in decision-making and practice.
5. The profesion has a code of ethics for practice.

NURSING
- is a desciplined involved in the delivery of health care to the society.
- is a helping profession.
- is service-oriented to maintain health and well-being of people.
- is an art and science.

NURSE originated from a Latin word NUTRIX, to nourish.

Characteristics of Nursing:
1. Nursing is caring.
2. Nursing involves close personal contact with the recipient of care.
3. Nursing is concerned with services that take humans into account as
physiological, psychological, and sociological organism.
4. Nursing is committed to promoting individual, family, community, and national
health goals in its best manner possible.
5. Nursing is committed to personalized services for all persons without regard to
color, creed, social or economic status.
6. Nursing is committed to involvement in ethical, legal, and political issues in the
delivery of health care.

Personal Qualities of a Nurse:

1. Must have a Bachelor of Science degree in Nursing.
2. Must be physically and mentally fit.
3. Must have a license to prac tice nursing in the country.
- A professional nurse therefore, is a person who has completed a basic nursing
education program and is licensed in his country to practice professional nursing.

Roles of a Professional

1. Caregiver/Care provider
- the traditional and most essential role.
- functions as nurturer, comforter, provider.
- mothering actions of the nurse.
- provides direct care and promotes comfort of client.
- activities involves knowledge and sensitivity to what matters and what is
important to clients.
- show concern for client welfare and acceptance of the client as a person.

2. Teacher
- provides information and helps the client to learn or acquire new knowledge and
technical skills.
- encourages compliance with prescribed therapy.
Promotes healthy lifestyle.
- interprets information to the client.

3. Counselor
- helps client to recognize and cope with stressful psychologic or social problems;
to develop an improve interpersonal relationships and to promote personal growth.
- Encourages the client to look at alternative behaviors recognize the choices and
develop a sense of control.

4. Change agent
- initiate changes or assist clients to make modifications in themselves or in the
system of care.

5. Client advocate
- involves concern for and actions in behalf of the client to bring about a change.
- promotes what is best for the client, ensuring that the clients needs are met and
protecting the clients right.
- provides explanation in clients ;anguage and support clients decisions.

6. Manager
- makes decisions, coordinates activities of others, allocate resource evaluate care
and personnel.
- plans, give direction, develop staff, monitor operations, give the reward fairly and
represent both staff and administrations as needed.
7. Researcher
- participates in identifying significant researchable problems.
- participates in scientific investigation and must be a consumer of research
findings.
-must be aware of the research process, language of research, a sensitive to
issues related to protecting the rights of human subjects.

Expanded role as of the Nurse

1. Clinical Specialists
- is a nurse who has completed a masters degree in specialty and has
considerable clinical expertise in that specialty. She provides expert care to
individuals, participates in education health care professionals and ancillary, acts
as a clinical consultant and participates in research.

2. Nurse Practitioner
-is a nurse who has completed either as a certificate program or a masters degree
in a specialty and is also cerified by the appropriate specialty organization. She is
skilled at making nursing assessments, performing P.E., counselling, teaching and
treating minor and self-limiting illness.

3. Nurse-Midwife
- a nurse who has completed a program in midwifery; provides prenatal and
postnatal care and delivers babies to woman with uncomplicated pregnancies.

4. Nurse Anesthetist
- a nurse who completed the course of study in an anesthesia school and carries
out pre-operative status of clients.

5. Nurse Educator
- a nurse usually with advanced degree, who beaches in clinical or educational
settings, teaches theoretical knowledge, clinical skills and conduct research.

6. Nurse Entrepreneur -
- a nurse who has an advanced degree, and manages health-related business.

7. Nurse Administrator
- a nurse who functions at various levels of management in health settings;
responsible for the management and administration of resources and personnel
involved in giving patient care.

Fields and Opportunities in Nursing

1. Hospital/Institutional Nursing a nurse working in an institution with patients.

Example: rehabilitation, lying-in, etc.

2. Public Health Nursing/Community Health Nursing usually deals with

families and communities. ( no confinement, OPD only ).
Example: brgy, Health Center.

3. Private Duty/Special Duty Nurse privatey hired.

4. Industrial/Occupational Nursing a nurse working in factories, office,

companies.

5. Nursing Education nurses working in school, review center and hospital as a

C.I.

6. Military Nurse nurses working in a military base.

7. Clinic Nurse nurses working in a private and public clinic.

8. Independent Nursing Practice private practice, BP monitoring, home

service.
- Independent Nurse Practtioner.

Nursing Theory and Theorists

4 Essential concepts common among nursing theories:

- Individual
- Health
- Environment
- Nursing

FLORENCE NIGHTINGALES ENVIRONMENTAL THEORY

- Defined Nursing: The act of utilizing the environment of the patient to assist
him in his recovery.
- Focuses on changing and manipulating the environment in order to put the
patient in the best possible conditions for nature to act.
- Identified 5 environmental factors: fresh air, pure water, efficient drainage,
cleanliness/sanitation and light/direct sunlight.
- Considered a clean, well-ventilated, quiet environment essential for recovery.
- Deficiencies in these 5 factors produce illness or luch of health but with a
nurturing environment, the body could repair itself.

DOROTHEA OREMS SELF-CARE THEORY

- Defined Nursing: The act of assisting others in the provision and
management of self-care to maintain/improve human functioning at home
level of effectiveness.
- Focuses on activities that adult individuals perform on their own behalf to
maintain life, health and well-being.
-Has a strong health promotion and maintainance focus.

C. Theoretical Foundation of Nursing Applied in Health Care Situations

THEORETICAL FOUNDATION OF NURSING
I. Philosophy
Specifies the definition of the metaparadigm concepts (person, environment,
health, and nursing) in each of
the conceptual models of nursing.
Sets forth meaning through analysis, reasoning, and logical argument. It provides
a broad understanding and
direction.

Florence Nightingale - Modern Nursing; Environmental Theory

*Disease is a reparative process, and that the manipulation of the environment -
ventilation, warmth, light, diet, cleanliness, and noise - would contribute to the
process and health of the patient.
*Did not agree with the germ theory of disease although she accepted the ill
effects of contamination from organic materials from the patients and the
environment hence found sanitation as important.
*Also renowned for pioneering statistical analysis of healthcare.

Ernestine Wiedenbach - Helping Art of Clinical Nursing

* nursing is nurturing or caring for someone in a motherly fashion.
*Proposed that nurses identify patients need-for-help by:
o Observing behaviors regarding comfort.
o Exploring meanings of the behavior.
o Knowing the cause of discomfort.
o Knowing if they can solve on their own or need help.

Virginia Henderson - Definition of Nursing; 14 Basic Needs

*The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or to recovery (or to a
peaceful death) that he would perform unaided if he had the necessary strength,
will, or knowledge and to do this in such a way as to help him gain independence
as rapidly as possible

*14 Basic Needs:

1. Breathe 8. Clean body and intact integument
2. Eat and drink 9. Safe environment
3. Eliminate 10. Communicate
4. Motion and position 11. Worship
5. Rest and sleep 12.Work
6. Clothing 13.Play
7. Temperature 14.Learn

Faye Glenn Abdellah - 21 Nursing Problems

*Problem solving was seen as the way of presenting nursing(patient) problems as
the patient moved towards health.
*Contributed to nursing theory development through the systematic analysis of
research reports to formulate the 21 nursing problems that served as an early
guide for comprehensive nursing care.

Lydia Hall - Care, Core, and Cure

*The theory consists of 3 major tenets:
o The nurse functions differently in the 3 interlocking aspects of the patient:
-Cure (Disease) shared with doctors
-Core (Person) addressed by therapeutic use of self; shared with
psychiatry/psychology, religious ministry, etc.
-Care (Body) exclusive to nurses; involves intimate bodily care like feeding,
bathing and toileting
o As the patient needs less medical care, he needs more professional nursing care
o Wholly professional nursing care will hasten recovery

Jean Watson - Philosophy and Science of Caring; Carative Factors

*Caring is a universal social phenomenon that is only effective when practiced
interpersonally. Nurses should be sensitized to humanistic aspects of caring
*10 Carative Factors
1. Form humanistic-altruistic values 6. Scientific problem-solving method for
decisions
2. Instill faith-hope 7. Promote interpersonal teaching-learning
3. Cultivate sensitivity 8. Provide supportive, protective, or
corrective environemnt
4. Develop helping-trust relationship 9. Assist gratifying human needs
5. Promote and accept expression
of positive and negative 10. Allowance for existential-phenomeno-
logical forces

Patricia Benner - Novice to Expert

*Validated the Dreyfus Model of Skill Acquisition in nursing practice with the
systematic description of the 5 stages (Novice, Advanced beginner, Competent,
Proficient, and Expert).
BENNERS STAGES OF NURSING EXPERTISE
STAGE I, Novice
*Has no experience (e.g., Nursing Student)
*Performance is limited inflexible, and governed by context-free rules and
regulations rather than experience.
*Novices have no life experience in the application of rules.
*Just tell me what I need to do and I do it.
STAGE II, Advanced Beginner
*Demonstrate marginally acceptable performance.
* Recognizes the meaningful aspect of a real situation.
*Has experienced enough real situations to make judgement about them.
*Principles to guide actions begin to be formulated and are focused on experience.
STAGE III, Competent
*Has 2 to 3 years of experience.
*Demonstrates organizational and planning abilities.
*Differentiates important factors from less inportant aspects of care.
*Coordinates multiple complex care demands.
*Develops when the nurse begins to see his or her actions in terms of long-range
goals or plans which he or she is consciously aware of.
STAGE IV, Proficient
*Has 3 to 5 years of experience.
*Perceives situations as a whole rather than in terms of parts as in Stage II.
*Uses maxims as guides for what to consider in a situation.
*Has holistic understanding of the client, which improves decision making.
*Focuses on long-terms goals.
STAGE V, Expert
*Performance is fluid, flexible, and highly proficient; no longer requires rules
guidelines, or maxims to connect an understanding of the situation to appropriate
action.
*Demonstrates highly-skilled intuitive and analytical ability in new situations.
*Is inclined to take a certain action because it felt right.

II. Conceptual Models

*Frameworks or paradigms that give a broad frame of reference for systematic
approaches to the concerned phenomena.
*Concepts that specify their interrelationship to form an organized perspective for
viewing the phenomena
Grand Theories
*Derived from models but as theories, they propose testable truths or outcomes
based on use of the model in Practice.
 Dorothea Orem - Self- Care Deficit Theory
*Composed of 3 Theories:
o Theory of Self Care
o Theory of Self-Care Deficit
o Theory of Nursing Systems - 3 Types:
Wholly Compensatory - do for the patient.
Partly Compensatory - help the patient do for himself.
Supportive Educative - help the patient learn to do for himself; nurse has
important
role in designing nursing care.

Myra Estrin Levine - Conservation Model

*Major Concepts:
o Wholism (Holism)
o Adaptation - process whereby patients retain integrity; establish body economy
to safeguard stability:
Environment
Organismic Response - (1)Fight or flight, (2)inflammatory response,
(3)response to stress, (4)perceptual awareness
Trophicogenesis - alternative to nursing diagnosis
o Conservation - 4 principles of conservation - Nursing intervention is based on
the conservation of the patients:
Energy
Structural Integrity
Personal Integrity
Social Integrity
*Composed of 3 Theories- (1) conservation (2) redundancy (3) therapeutic
intention.

Martha Rogers - Unitary Human Beings

*Principles of Homeodynamics
Helicy - spiral development in continuous, non-repeating, and innovative
patterning.
Resonancy - patterning changes with development from lower to higher
frequency(intensity).
Integrality - continuous mutual process of person and environment.
*Theoretical Assertions
Energy - Man as a whole is more than the sum of his parts.
Openness - Man and environment continuously exchange matter and energy.
Helicy - Life evolves irreversibly and unidirectionally along space and time.
Pattern and organization identify man and reflect his innovative wholeness.
Sentient, thinking being - man has capacity for abstraction and imagery,
language and thought, sensation and emotion.
Dorothy Johnson - Behavioral Systems Model
*Considered attachment or affiliative subsystem as cornerstone of social
organizations
*Nursing problems arise because there are disturbances in the structure or
function of the subsystems:
Dependency
Achievement
Aggressive
Ingestive
Eliminative
Sexual

Sister Callista Roy - Adaptation Model

*Proposed that humans are biophychosocial beings who exist within an
environment
*Environment and self provides 3 types of stimuli: (1) focal (2) residual (3)
contextual
*Human stimuli create needs in adaptation modes, such as physiological self-
concept, role function, and interdependence
*Through adaptive mechanisms, regulator and cognator, a person shows adaptive
or ineffective response that need nursing intervention.

Imogene King - Interacting Systems Framework; Goal Attainment Theory

*Nursing is a process of human interaction between nurses and patients who
communicate to set goals, explore means of attaining goals, and agree on what
means to use
*Perceptions, judgement and actions of nurse and patient lead to reaction,
interaction and transaction
*Interacting systems:
Personal System - perception, self, body image, growth and development
Interpersonal System - role, interaction, communication, transaction, and stress
Social System - organization, power-authority status, decision making.

Roper, Logan, and Tierney - Model for Nursing Based on a Model of Living
Conceptual Components
o 12 Activities of Living (AL) - complex process of living in the view of an amalgam
of activities
1. Maintain safe environment 7. Temperature
2. Communicate 8. Mobility
3. Breathe 9. Work and play
4. Eat and drink 10. Express sexuality
5. Eliminate 11. Sleep
6. Personal cleansing and dressing 12. Dying
 Life span - concept of continuous change from birth to death
Dependence-independence continuum
5 factors influencing AL: Biological, Psychological, Socio-cultural,
Environmental,
Politicoeconomic.
*The individuality of living is the way in which the individual attends to ALs in
regard to place on life span and dependence-independence continuum and as
influenced by the 5 factors.

III. Theories
*Group of related concepts that proposes actions that guide practice. May be
broad but limited only to particular aspects
Middle-range Theories
*The least abstract level because they include specific details in nursing practice
like population, condition and location.

Hildegard Peplau - Psychodynamic Nursing; Mother of Psychiatric Nursing

*Stressed the importance of the nurses ability to understand ones own behavior
to help others identify felt difficulties.
*4 Phases of Nurse-Patient Relationship
Orientation
Identification
Exploitation
Resolution
*6 Nursing Roles
1. Stranger 4. Leader
2.Resource Person 5. Surrogate
3. Teacher 6. Counselor
*4 Psychobiological Experiences that compel destructive or constructive
responses
Needs
Frustrations
Conflicts
Anxieties

Ida Jean Orlando - Nursing Process; Dynamic Nurse-Patient Relationship

*Focused on patients verbal and nonverbal expressions of need and the nurses
reactions to the behavior
*3 Elements of a Nursing Situation
Patient behaviors
Nurse reactions
Nurse actions
*Used the nursing process to meet patients needs through deliberate action;
advanced nursing beyond automatic response to disciplined and professional
response.

Joyce Travelbee - Human-to-Human Relationship Model

*Nursing was accomplished through human-to-human relationship:
1. Original encounter
2. Emerging identities
3. Developing empathy
4. Developing sympathy
5. Rapport

Katherine Kolcaba - Theory of Comfort

*Defined healthcare needs as those needs for comfort including physical, psycho-
spiritual, social, andenvironmental needs
*Intervening factors influence clients perception of comfort: age, attitude,
emotional support, experience, finance, prognosis
*Types of comfort:
1. Relief when specific need is fulfilled
2. Sense of ease, calm, and contentment
3. Transcendence or rising above the problems of pain

Erikson, Tomlin and Swain - Modeling and Role-Modeling

*Synthesis of multiple theories related to basic needs, developmental tasks, object
attachment, and adaptive coping potential
*Views nursing as self-care based on the persons perception of the world and
adaptation to stressors
*Promotes growth and development while recognizing individual differences
according to worldview and inherent endowment.

Ramona Mercer - Maternal Role Attainment

*Focused on parenting and maternal role attainment in diverse populations.
*Developed a complex theory to explain the factors impacting the maternal role
over time.

Kathryn Barnard - Parent-Child Interaction; Child Health Assessment Interaction

Theory
*Individual characteristics of each member influence the parent-infant system and
that adaptive behavior modifies those characteristics to meet the needs of
the system
*The theory is based on scales developed to measure feeding, teaching, and
environment.

Madeleine Leininger - Transcultural Care Theory; Ethnonursing

*Some of the major concepts are care, caring, culture, cultural values, and cultural
variations
*Caring is seen as the central theme in nursing care, knowledge and practice.
*Caring includes assistive, supportive, facilitative acts towards people with actual
or anticipated needs
*3 types of Nursing Actions
Cultural Care Preservation or Maintenance - retention of relevant care values
unique to culture
Cultural Care Accommodation or Negotiation - adapting culture with
professional care providers
Cultural Care Repatterning or Restructuring - changing life-ways while still
respecting culture for a healthier outcome.

Rosemarie Rizzo Parse - Human Becoming

*A unique, humanistic approach instead of a physiological basis for nursing
*Nursing is a human science that is not dependent on medicine or any discipline
for its practice
*Major concepts include:
Imaging Connecting-separating
Valuing Powering
Languaging Originating
Revealing-concealing Transforming
Enabling-limiting

Merle Mishel - Uncertainty in Illness

*Researched into experiences with uncertainty as it relates to chronic and life-
threatening illness.
*Later reconceptualized to accommodate the responses to uncertainty over time in
people with chronic conditions who may not resolve the uncertainty.

Margaret Newman - Model of Health

*Major concepts are movement, time, space and consciousness. Movement is a
reflection of consciousness.
Time is a function of movement. Time is a measure of consciousness.
*The goal of nursing is not to promote wellness or to prevent illness, but to help
people use the power within them as they evolve toward a higher level of
consciousness.

Evelyn Adam - Conceptual Model for Nursing

*Used a model from Dorothy Johnson and definition of nursing from Virginia
Henderson
*Identified assumptions, beliefs, and values, and major units
*Included goal of the profession, beneficiary of the professional service, role of the
professional, source of the beneficiarys difficulty, the intervention of the
professional, and the consequence.

Nola Pender - Health Promotion Model

*The goal of nursing care is the optimal health of the individual
*Developed the idea that promoting optimal health supersedes disease prevention
*Identifies cognitive-perceptual factors of a person, like importance of health-
promotion behavior and its perceived barriers, and these factors are modified by
demographics, biology, interpersonal influences, and situational and behavioral
factors.

D. Continuing Professional Education

E. Professional Organizations in Nursing

F. The Nurse in Health Care

1. Eleven Key Areas of Responsibility

ELEVEN KEY AREAS OF RESPONSIBILITY

A. SAFE AND QUALITY NURSING CARE

1. Demonstrate knowledge based on the health/Illness status of indiidual groups.
2. Provides sound decision making in the care of individuals/groups.
3. Promote wholeness and well-being including safety and comfort of patients.
4. Sets priorities in nursing care based on patients need.
5. Ensures continuity of care..
6. Administersmedications and other health therapeutics.
7. Utilizes the nursing process as framework for nursing.
8. Formulates a plan of care in collaboration with patients and other members of
the health team.
9. Implements planned nursing care to achieve identified outcomes.
10. Evaluates progress toward expected outcomes.
11. Responds to the urgency of the patients condition.

B. MANAGEMENT OF RESOURCES AND ENVIRONMENT

1. Organizes work load to facilitate patient care.
2. Utilizes resources to support Patient care.
3. Ensures availability of human resorces.
4. Checks proper functioning of equipment/facilities.
5. Maintains a safe and therapeutic environment.
6. Practices stewardship in the management of resources.

C. HEALTH EDUCATION
1. Assess the learning needs of the patient and family.
2. Develops health education plan based on assessed and anticipated needs.
3. Develops learning materials for health education.
4. Implements the healtheducation plan.
5. Evaluates the outcome of health education.

D. LEGAL RESPONSIBILITY
1. Adheres to practice in accordance with the nursing law and other relevant
legislation including contracts, informed consent.
2. Adheres to organizational policies and procedures, local and national.
3. Documents care rendered to patients.

E. Ethico-Moral Responsibility
1. Respects the rights of individuals/groups.
2.Accepts responsibility and accountability for own decisions and actions.
3. Adheres to the national and international code pf ethics for nurses.

F. Personal and Professional Development

1. Identifies own learning needs.
2. Pursues continuing education.
3. Gets involved in professional organizations and civic activities.
4. Projects a professional image of the nurse.
5. Possesses positive attitude towards change and criticism.
6. Performs function according to professional standards.

G. Quality Improvement
1. Utilizes data for quality improvement
2. Participtaes in nursing audits and rounds.
3. Identifies and reports variances.
4. Recommends solutions to identified causes of the problems.
5. Recommends improvement of systems and processes.

H. Reasearch
1. Utilizes varied methods of inquiry in solving problems.
2. Recommends actions for implementation.
3. Disseminates results of research findings.
4. Applies research findings in nursing practice.

I. Record Management
1. Maintains accurate and updated documentation of patient care.
2. Records outcome of patient care.
3. Observes legal imperatives in record keeping.
4. Maintains an effective recording and reporing system.
J. Communication
1. Utilizes effective communication in relating with clients, members with the team
and the public in general.
2. Utilizes effective communicationin therapeutic use of self to meet the needs of
clients.
3. Utilizes formal and informal channels.
4. Responds to needs of individuals, families, groups and communities.
5. Uses appropriate information technology to facilitate communication.

K. Collaboration and Teamwork

1. Establishes collaborative relationship with colleagues and other members of the
health team for the health plan.
2. Functions effectively as a team player.

2. Fields of Nursing
3. Roles and Functions

II. Safe and Quality Care

A. The Nursing Process
NURSING PROCESS
Definition
- It is a systematic, client-centered method for structuring the delivery of nursing
care.

B. Basic Nursing Skills

1. Vital Signs
2. Physical Examination and Health Assessment
3. Administration of Medications
4. Asepsis and Infection Control
5. First Aid Measures
6. Wound Care
7. Perioperative Care
8. Post-operative Care
9. Post-mortem Care
C. Measures to meet physiological needs
1. Oxygenation
2. Nutrition
3. Activity, Rest and Sleep
4. Fluid and Electrolyte Balance
5. Urinary Elimination
6. Bowel Elimination
7. Safety, Comfort and Hygiene
8. Mobility and Immobility
III. Health Education
A. Teaching and Learning Principles in the Care of Client
B. Health Education in All Levels of Care
C. Discharge Planning

IV. Ethico-Moral Responsibility

A. Bioethical Principles
1. Beneficence
2. Non-maleficence
3. Justice
4. Autonomy
5. Stewardship
6. Truth Telling
7. Confidentiality
8. Privacy
9. Informed Consent
B. Patients Bill of Rights
C. Code of Ethics in Nursing

V. Legal Responsibility
A. Legal Aspects in the Practice of Nursing
B. The Philippine Nursing Law of 2002 (R.A 9173)
C. Related Laws Affecting the Practice of Nursing

VI. Management of Environment and Resources

A. Theories and Principles of Management
B. Nursing Administration and Management
C. Theories, Principles and Styles of Leadership
D. Concepts and Principles of Organization
E. Patient Care Classification
F. Nursing Care Systems
G. Delegation and Accountability

VII. Records Management

A. Anecdotal Report
B. Incident Report
C. Memorandum
D. Hospital Manual
E. Documentation
F. Endorsement and End of Shift Report
G. Referral

VIII. Quality Improvement

A. Standards of Nursing Practice
B. Nursing Audit
C. Accreditation/Certification in Nursing Practice
D. Quality Assurance

IX. Research
A. Problem Identification
B. Ethics and Science of Research
C. The Scientific Approach
D. Research Process
E. Research Designs and Methodology
1. Qualitative
2. Quantitative
F. Utilization and Dissemination of Research Findings

X. Communication
A. Dynamics of Communication
B. Nurse-Client Relationship
C. Professional-Professional Relationship
D. Therapeutic Use of Self
E. Use of Information Technology

XI. Collaboration and Teamwork

A. Networking
B. Inter-agency Partnership
C. Teamwork Strategies
D. Nursing and Partnership with Other Profession and Agencies

Nursing Board Exam/Nursing Licensure Exam Coverage (Nursing Practice II)

NURSING BOARD EXAM SCOPE/COVERAGE
NURSING PRACTICE II
TEST DESCRIPTION: Theories, concepts, principle and processes in the care of
individuals, families, groups and communities to promote health and prevent
illness, and alleviate pain and discomfort, utilizing the nursing process as
framework. This includes care of high risk and at-risk mothers, children and
families during the various stages of life cycle.
TEST SCOPE:
Part I: CHN

I. Safe and Quality Care, Health Education and Communication, Collaboration and
Team work
COMMUNITY HEALTH NURSING
HISTORY OF CHN
Date
1901 Act # 157 (Board of Health of the Philippines) ;
Act # 309 (Provincial and Municipal Boards of Health) were created.
1095 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, 1st Filipino Nurse supervisor under Bureau of Health.
October 22, 1922 Filipino Nurses Organization (Philippines Nurses
Organization) was organized.
1923 Zamboanga General Hospital School of Nursing and Baguio General
Hospital were established; other government schools of nursing were organized
several years after.
1928 1st Nursing convention was held
1940 Manila Health Department was created.
1941 Dr. Mariano Icasiano became the first ciy health officer; Office of Nursing
was created through the effort of Vicenta Ponce (Chief Nurse) and Rosario Ordiz
(assistant chief nurse)
December 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.
February 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, Constancia 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 Ammended 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 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.
January 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 andPractice 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 and
urban. The Code aims to transform local government unit 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 Local Health Board ( LHB )

Provincial Level
1. Governor Chair
2. Provincial Health Officer vice chair
3. Chair, Committee on Health of Sangguniang Panlalawigan.
4. DOH Representative.
5. NGO Respresentative.
City and Municipal Level
1. Mayor Chair
2. MHO vise chair
3. Chair, Committee on Health of Sangguniang Bayan.
4. DOH Representative
5. NGO Representative
Effective LHS Depends on:
1. The LGUs financial capability.
2. A dynamic and responsive political leadership
3. Community Empowerment

R.A 2382 Philippine Medical Act. This act defines the practice of medicine in the
country.
R.A 1082 Rural Health Act. It created the 1st 81 Rural Health Units.
- amended by R.A 1891; more physicians, dentists, nurses, midwives
and sanitary inspectors will live in the rural areas where they are assigned in order
to raise the health conditions of barrio people, hence help decrease the high
incidence of preventable diseases.
R.A 6425 Dangerous Drugs Act. It stipulates that the sale, administration,
delivery, distribution and transportation of prohibited drugs is punishable by law.
R.A 9165 The New Dangerous Draug Act of 2002.
P.D No. 651 requires that all Health Workers shall identify and encourage the
registration of all births within 30 days following delivery.
P.D No. 996 requires the compulsary immunization of all children below 8 years
of age against the 6 childhood immunizable diseases.
P.D No. 825 provides pernalty for improper disposal of garbage.
R.A 8749 Clean Air Act of 2000
P.D No. 856 Code of Sanitation. It provides for the control of all factors in mans
environment that affect health including the quality of water, food, milk, insects,
animal carriers, transmitters of disease, sanitary and recreation facilities, nilse,
pollution and control of nuisance.
R.A 6758 Standardizes the salary of government employees including the
nursing personnel.
R.A 6675 Generics Act of 1988 which promotes, requires and ensures the
production of an adequate supply, distribution, use and acceptance of drugs and
medicines identified by their generic name.
R.A 6713 Code of Conduct and Ethical Standards of Public Officials and
Employees. It is thepolicy of the state to promote high standards of ethics in public
office. Public officials and employeesshall at all times be accountable to the people
and shall discharges their duties with utmost responsibility, integrity, competence
and loyalty, act with patriotism and justice, lead modest lives uphold public interest
over personal interest.
R.A 7305 Magna Carta for Public Health Workers. This act aims: To promote and
improve the social and economic well-being of health workers, their living and
working conditions and terms of employment; to develop their skills and
capabilities in order that they will be more responsive and better equipped to
deliver health projects and programs; and to encouragethose with proper
qualifications and excellent abilities to join and remain in government service.
R.A 8423 Created the philippine Institute of Traditional and Alternative Health
Care.
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.
R.A 4073 advocates home treatment for lepsrosy.
Letter of Instruction No. 949 legal basis of PHC dated october 19, 1979.
-- promotes development of health programs on the
community level.
R.A 3573 requires reporing of all cases of communicable diseases and
administration of prophylaxis.
Misnistry 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 hour after birth.
2. Infants be exclusively breastfeed for 6 months.
3. Infants be given timely, adequate and safe complementary foods
4. Breastfeeding be continued up to 2 years and beyond.

E.O 51 Philippine 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 Compulsary Hepatitis B Immunization among infants and
children less than 8 years 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.

I. Definition of Terms
Community derived from a latin word communicas which means a group of
people.
- a group of people with common characteristics or interests living together within
a territory or geographical boundary.
- place where people under usual conditions are found.

HEALTH is the OLOF (Optimum level of Functioning).

(WHO)- state of complete physical, mental and social well being, not merely the
absence of disease or infirmity.
-It primarily affects the physical well-being of people in a society.
-Health is a fundamental human right.
-A personal and social responsibility.
-A multifactorial approach.

1. HEALTH ILLNESS CONTINUUM

- A predictive grid that displays the Likelihood of a person to participate in
preventive health care.
 - A Degree of client wellness ranging from optimum wellness to death.
- Dynamic state, matters as a person adopts to change in internal and a
holistic well being.

HIGH-LEVEL GOOD NORMAL ILLNESS DEATH

WELLNES HEALTH HEALTH

HEALTH ILLNESS CONTINUUM, as shown here, represents the

process of achieving HIGH LEVEL OF WELLNESS or the consequences of
unhealthy lifestyle. In this figure, there are three parameters on how to
achieve high level of wellness.
These are: (A) Awareness, (E) Education, and (G) Growth.
Otherwise, an individual who continuously live an unhealthy lifestyle, will be
on the other side of the grid, and would develop the following: (S) Signs
and Symptoms (S) Syndrome, and (D) Disorder or disability which may
lead disease or premature death.

2. AGENT HOST ENVIRONMENT MODEL

- Primarily used to predict an illness
AGENT Any environmental factor or stressor, chemical,
mechanical, physical, psychosocial, that by its presence or absence can
lead to illness or disease.
- Causative etiologic factor
HOST Persons who may or may not be at risk of acquiring the
disease.
- with intrinsic factor
ENVIRONMENT All factors external to the host that may or may not
predispose the person to the development of the disease.

-Requires the individual to maintain a continuum of balance and purposeful

direction with environment.
Ex: Etiologic factor of Dengue? --- Virus
AGENT HOST

A. Etiologic Factors: B. Intrinsic Factors &

1. Biological infections----virus, Environmental Factors
bacteria 1. Age
- fungi, protozoa, 2. Sex (m or f)
helminthes, ectoparasites F - Weak emotional; morbidity:
2. Chemical- carcinogens, poisons, common diseases
allergens M - Mortality ( killer
Ex. GMOs carcinogen diseases)
MSG- poison 3. Behavior
4. Educational attainment-
 3. Mechanical- car accidents, etc occupation
4. Environmental/physical- 5. Prior immunologic- response
heatstroke
5. Nutritive- excess or deficiency C. Extrinsic Factors
6. Psychological 1. Natural boundaries- physical,
geography
2. Biological environment
3. Socioeconomic envt.-
political boundary

3. HEALTH BELIEF MODEL

- Helps determine whether an individual is likely to participate in disease
prevention and promotion activities.
- Usefool tools in developing programs for helping people change to
healthier lifestyles and develop a more positive attitudetoward
preventivehealthier measures.

COMPONENTS:
INDIVIDUAL PERCEPTIONS: Includes perceived susceptivility,seriousness
and threat. Seriousness of an illness.
MODIFYING FACTORS: Includes demographic variables, sociophysiologic
variables, structural variable, and cues to action. Susceptibility to an illness.
LIKELIHOOD TO ACTION: Depends on the perceived benefit versus the
perceived barriers. Benefits of taking actions.

Ex. Male infected w/ STD & female non-infectious----- Increase

susceptibility of transmission
HIV infection (commercial sex farers, sea workers, medical team
Susceptibility, possible MOT--- unprotected sex- occupational hazard

Prevention: Safer Sex Practices

Abstinence
Be faithful
Correct, consistent, continuous use of condom
Do not penetrate (SOP)

HIV infected age groups

Males age 40-49 seafarers ratio: 1: 5 anal sex- wont get pregnant,
common in rural

Vaginal: 1: 1000
 Females 20-29 Anal: 1: 200-----highest risk

Oral lowest risk

4. EVOLUTIONARY BASED MODEL

illness & death serve an evolutionary function- based on Darwins Survival
of the fittest theory
Elements:
a. Life events developmental variables & those associated with changes
b. Lifestyle determinants personal & learned adaptive strategies a
person uses to make lifestyle changes
c. Evolutionary viability within the social context extent to which a
person fx to promote survival
d. Control perceptions
e. Viability emotions affective reactions developed from life events
f. Health determinants

5. HEALTH PROMOTION MODEL

* Directed at increasing clients well being.
* All efforts increasing well being ( no threat ) ex. Sex education
Combating any possible disease ( no existing disease )

Illness Highly subjective feeling of being sick or ill.

PUBLIC HEALTH ( Dr. C.E. Winslow ) the science and art of preventing
disease, prolonging life, promoting health and efficiency through 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 of birth and longevity.( Dr C.E
Winslow ).

COMMUNITY HEALTH part of paramedical and medical intervention/approach

which is concerned on the health of the whole population.

Aims:
1. health promotion
2. disease prevention
3. management of factors affecting health.
INDIVIDUAL CLIENT: APPLIED STUDY: COMMUNITY AS CLIENT:
Anatomy Structure Demographic study of population
Physic Function Sociology
Pathos Malfunction Epidemiology study of disease

NURSING both profession and a vocation. Assisting sick individuals to become

healthy and healthy individuals achieve optimum wellness.

1. Virginia Henderson
- Assisting sick individuals to become healthy and healthy individuals achieve
optimum wellness

2. Dorothea Orem
- Providing assistance to clients to achieve self-care towards optimum wellness.
Early years- fetus- 12 years/ younger adults- 12-24 years
Orem- self care, autonomy----independent patient

3. Florence Nightingale
- Placing an individual in an environment. that will promote optimum capacity for
self-reparative process
- individual capable of self-repair and there is something to repair in an individual.
COMMUNITY HEALTH NURSING
-Synthesis of public and nursing practice.

(WHO Expert Committee of Nursing)

- special field of nursing that combines the 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.

- a specialized field of nursing practice.

1. Utilitarianism: greatest good for the greatest number.
2. Nursing Process.
3. Priority of health-promotive and disease-preventive startegies over curative
interventions.
4. Tools for measuring and analyzing Community Health problems.
5. Application of principles of management and organization in the delivery of
health services to the community.

(Maglaya) The Utilization of the nursing process in the different levels of

clientele individuals, families, population groups and communities, concerned
with the promotion of health, prevention of disease and disability and rehabilitation.
(Jacobson) is a learned practice disciplined with the ultimate goal of contributing
as individual and incollaboration with others, to the promotion of clients optimum
level of functioning through teaching and delivery of care.

(Dr. Ruth B. Freeman)

- 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.
- Technical nursing, interpersonal, analytical and organizational skills are applied to
problems of health as they affect the community.
-Unique blend of nursing & public health practice aimed at developing & enhancing
health capabilities of the people , service rendered by a professional nurse with
the comm., grps, families, and indiv at home, in H centers, in clinics, in school, in
places of work for the ff:
1. Promotion of health
2. Prevention of illness
3. Care of the sick at home and rehab
- self-reliance

Factors affecting Optimum Level of Functioning (OLOF)

1. Political
2. Behavioral
3. Hereditary
4. Health Care Delivery System
5. Environmental Influences
6. Socio economic Influences

Concepts
1. The primary focus of community health nursing practice is on health promotion
and disease prevention.
Primary goal self reliance in health or enhanced capabilities.
Ultimate goal raise level of number of citizenry.
Philosophy of CHN Worth and dignity of man.
2. CHN practices to benefit the individual, family, special groups, and community
*CHN is integrated and comprehensive
3. Community Health Nurses are generalist in terms of their practice through life
but the whole community its full range of health problems and needs.
4. Community Health Nurses are generalist in terms of their practice through life
continuity in its full range of health problems and needs.
5. The nature of CHN practice requires that current knowledge derived from the
biological, social science, ecology, clinical nursing and community health
organizations be utilized.
6. Contact with the client and or family may continue over a long period of time
which includes all ages and all types of health care.
 Levels of Health Care:
Primary Health Care: Management at the level of community
Secondary Health Care: Regional, District, Municipal, and Local Hospital
Tertiary Health Care: Sophisticated Medical Center Heart Center, KI
7. The dynamic process of assessing, planning, implementing and intervening
provide measurements of progress, evaluation and a continuum of the cycle until
the termination of nursing is implicit in the practice of Community Health Nursing.
Nursing Function:
Independent without supervision of MD
Collaborative in collaboration with other Health team
( interdisciplinary, intrasectoral )

II. Community Health Nursing

- The utilization of the nursing process in the different levels of clientele-
individuals, families, population groups and communities, concerned with the
promotion of health, prevention of disease and disability and rehabilitation.

Goal: To raise the level of citizenry by helping and families to cope with the
discontinuities in and threats to health in such a way as to maximize their potential
for high-level wellness. Nisce, et al
To elevate the level health of the multitude.

MISSION OF CHN ( FIVE FOLD MISSION )

*Health Promotion activities related to enhancement of health.
*Health Protection activities designed to protect the people.
*Health Balance activities designed to maintain well being.
*Disease Prevention activities relate to avoid complication = primary, secondary,
tertiary.
*Social Justice activities related to practice practice equity among clients.

PHILOSOPHY OF CHN
*The philosophy of CHN is based on the worth and dignity of man.

Roles of COMMUNITY HEALTH NURSE / PUBLIC HEALTH NURSE

CLINICIANS - who is a health care providers, taking care of the sick people at
home or in the RHU.
HEALTHEDUCATOR who aims towards health promotion and Illness prevention
through dissemination of correctr information; educating people.
ADVOCATOR acts on behalf of the client.
FACILITATOR who establishes multi sectoral linkages by referral system.
SUPERVISOR who monitors and supervises the performance of midwives.
COLLABORATOR working with other health team member.
-In the event that the Municipal Health Officer ( MHO ) is unable to perform his
duties/functions or is not available, the Public Health Nurse will take charge of the
MHOs responsibilites.
-Other Responsibilities of a Nurse, spelled by the implementing rules and
regulations of RA 7164 ( Philippine Nursing Act of 1991 ) includes:
*supervision and care of women during pregnancy, labor, and puerperium.
*Performance of Internal Examination and Delivery of Babies.
*Suturing lacerations in the absence of a Physicians.
*Provisions of First aid measures and Emergency Care.
*Recommending Herbal and Symptomatic Meds... Etc.

In the Care of the Families:

-Provision of Primary Health Care Services.
-Developmental/Utilization of Family Nursing Care Plan in the provision of Care.

In the Care of the Communities:

-Community organizing mobilization, Community development, and People
empowerment.
-Program planning, Implementation, and Evaluation.
-Influencing executive and legislative individuals or bodies concerning health and
develoment.

ROLES OF THE COMMUNITY HEALTH NURSE

1. Planner/ Programmer- identifies needs, priorities & problems if individual, family,

& comm.
- Formulates nursing component of H plans
In doctorless areas, she is responsible for the formulation of the
municipal health plan
Provides technical assistance to rural health midwives in health matters
like target setting.
2. Provider of Nursing care- provides direct nsg care to the sick, disabled in the
homes, clinics, schools,
or places of work
provide continuity of patient care
3. Manager/ Supervisor- formulates care plan for the:
4 Clientele:
a. Requisitions, allocates, distributes materials (meds & medical supplies &
records & reports equips
b. Interprets and implements programs, policies, memoranda, & circulars
c. Conducts regular supervisory visits & meetings to diff RHMs & gives
feedbacks on accomplishments
4. Community Organizer- motivates & enhance community participation in terms
of planning, org, implementing
and evaluating Health programs/ services.
 5. Coordinator of Health Services- coordination with other health team & other
govt org (GOs & NGOs) to other
health programs as envt. sanitation health education, dental health &
mental health.
6. Trainer/ Health educator/ counselor- conducts training for RHMs, BHWs, hilots
who aim towards H promo & illness prevention through dissemination of correct
info;
educating people
7. Researcher- coordinates with govt. & NGOs in the implementation of studies/
researches
participates in the conduct of surveys studies & researches on Nsg and
H related subjs.
8. Health Monitor----evaluating what deviates from normal
9. Manager ---under the nurse---midwives
10. Change Agent
11. Client Advocate

Responsibilities of COMMUNITY HEALTH NURSE

-Be a part in developing an overall health plan, it is implementation and evaluation
for communities.
-Provide quality nursing services to the three levels of clientele.
-Maintain coordination/linkages with other health team members,
NGO/government agencies in the provision of public health services.
-Conduct researches relevant to CHN services to improve provision of health care.
-Provide opprotunities for professional growth and continuing education for staff
development..

PUBLIC HEALTH

1. WINSLOW
- The science & art of preventing disease, prolonging life, promoting health
& efficiency through
organized community effort
To enable each citizen to realize his birth right of health & longevity.
Major concepts:
1. Health promotion
2. Peoples participation towards self-reliance
2. HANLON
- Most effective goal towards total development and life of the individual &
his society

3. PURDOM
- Applies holism in early years of life, young, adults, mid year & later
- Prioritizes the survival of human being
PUBLIC HEALTH NURSING
(Cuevas, 2007)
-In the light of the changing national and global helath situation and the
acknowledgement that nursing is a significant contributor to health, the public
health nurse is strategically positioned to make a difference in the health outcomes
of individuals, families, and communities cared for.

Concepts
1. Science and Art of Preventing diseases, prolonging life, promoting health and
efficiency through organized community effort for the:
a. sanitation of the environment.
b. control of communicable diseases.
c. the education of individuals in personal hygiene.
d. organization of medical and nursing services for early diagnosis and preventive
treatment of disease, 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 of
health and longevity.

Determinants of Health
*Factors that can affect health
a. Income and social status - socioeconomic
b. Education - socioeconomic
c. Physical Environment - Environment
d. Employment and working conditions - socieconomic
e. Social support networks - socioeconomic
f. Culture, Customs and Traditions - Behavior
g. Genetics - Heredity
h. Personal Behavior and coping skills - Behavior
i. Health Services Health Care Delivery System
j. Gender Heredity
-ECOSYSTEM influence on OLOF ( Blum 1974 ).

CORE Busyness of Public Health:

1. Disease control
2. Injury Prevention
3. Health Protection
4. Health public policy including those in relation to environmental hazards such as
in the work place, housing, food, water, etc.,
5. Promotion of health and equitable health gain.
In response to above trends, the global community, represented by the United
Nations General Assembly, decided to adopt a common vision of poberty reduction
and sustainable development in september 2000.
This vision is exemplified by the Millenium Development Goals (MDGs) which
are based on the fundamental values of:
FREEDOM
EQUALITY
SOLIDARITY
TOLERANCE
HEALTH HEALTH: MILLENIUM DEVELOPMENT
GOALS
RESPECT FOR NATURE MDG 1: Eradicate extreme poverty and hunger
Target: Halve, between 1990 and 2015, the
proportion of people whose income is
less than one dollar a day.
Target: Halve, between 1990 and 2015, the
proportion of people who suffer from
hunger.

SHARED RESPONSIBILITY MDG 2: Achieve universal primary education

Target: Ensure that, by 2015, children
everywhere, boys and girls alike, will
be able to complete a full course of
primary schooling.

MDG 3: Promote gender equality and women

empowerment
Target: Eliminate gender disparity in primary
and secondary education preferably
by 2005 and to all levels of education
no later than 2015.

MDG 4: Decreased child mortality

Target: Reduce by 2/3, between 1990 and
2015, the under five mortality rate.

MDG 5: Increased maternal health

Target: Reduce by three quarters, between
1990 and 2015, the maternal mortality
ratio.

MDG 6: Combat HIV/AIDS, Malaria and other

diseases
 Target: Have halted by 2015 and begun to
reverse the spread of HIV / AIDS
Target: Have halted by 2015 and begun to
reverse the incidence of malaria and
other major diseases.

MDG 7: Ensure environmental sustainability

Target : Integrate the principles of sustainable
development into country policies and
programmes and reverse the loss of
environmental resources.
Target : Halve, by 2015, the proportion of
people without sustainable access to
safe drinking water
Target: By 2020, to have achieved a
significant improvement in the lives of
at least 100 million slum dwellers.

MDG 8: Develop a global partnership for

development.
Target : Develop further an open, rule-based,
predictable, non-discriminatory trading
and financial system.
Target: Address the special needs of the least
developed countries.
Target: Address the special needs of
landlocked countries and small
island developing States.
Target: Deal comprehensively with the debt
problems of developing
countries through national and
international measures in order to
make debt sustainable in the long
term.

COMMUNITY HEALTH NURSING PUBLIC HEALTH NURSING

( ART ) and Science ( SCIENCE ) and Art
*Synthesis of nursing practice and *Synthesis of public health and
public health practice applied to nursing practice.
promoting and preserving the health *Specific/subspecialty nursing
of the populations. practice.
*Directs care to individuals, families, *Defined as the practice of
or groups; this care, in turn promoting and protecting health of
contributes to the health of the total populations using knowledge from
 population. nursing social and public health
*knowldge = nursing and PHN sciences.
*More General Specialty area that *CORE FUNCTIONS:
encompasses subspecialties that a. Assessment
include Public Health Nursing and b. Policy development
other developing fields of practice c. Assurance
such as home health, hospice care, *Essential Functions:
and independent nursing practice. -Heart monitoring and analysis.
-Epidemiological
surveillance/disease prevention
and control and all.

A. Principles and Standards of CHN

PRINCIPLES AND STANDARD OF CHN

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
service.
7. Opportunities for continuing staff education programs for nurses must be
provided by the community health nurisng 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
nuraing.
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 basisfor decisions in practice.
II. Data Collection
Gathering comprehensive, accurate data systematically.
III. Diagnosis
Analyzes collected data to determine the needs / health problems of Individual,
Family, Community.
IV. Planning
 At each level of prevention, develops plans that specify nursing actions unique
to needs of clients.
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, diagnose and plan.
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.
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.
IX. Research
Indulges in research to contribute to theory and practice in community health
nursing.

B. Levels of Care
LEVELS OF CARE/PREVENTION

PRIMARY
-Is devolved to the cities and the municipalities. It is health care provided by center
physicians, public health nurses, rural health midwives, barangay health workers,
traditional healers and others at the barangay health stations and rural health
units. The primary health facility is usually the first contact between the community
members and the other levels of health facility.
- activites that prevent a problem before it occurs. Example: Immunization.
SECONDARY
-Secondary care is given by physicians with basic health training. This is usually
given in health facilities and district hospitals and out-patient departments of
provincial hospitals. This serves as a referral center for the primary health facilities.
Secondary facilities are capable of performing minor surgeris and perform some
simple laboratory examinations.
- activities that provide early detection/diagnosis and treatment and Intervention.
Example: Breast self-examination, HIV screening, Operation timbang.
TERTIARY
-Is rendered by specialists in health facilities including medical centers as well as
regional and provincial hospitals, and specialized hospitals such as the Philippine
Heart Center. The tertiary health facility is the referral center for the secondary
care facilities. Complicated cases and intensive care requires tertiary care and all
these can be provided by the tertiary care facility.
- activities that correct a disease state and prevent it from further deteriorating.
Example: Teaching Insulin Administration in the home
C. Types of Clientele
TYPES OF CLIENTELE

INDIVIDUAL
- People who visits the health center.
- People who receives health services.
e.g., Prenatal Supervision
Well Child Follow ups.
Morbidity Service
Teaching Client on Insulin Administration
Basic approaches in looking at the individual:
1. atomistic the basic constituents of an individual, use concepts of biology which
in turn refers to essentialism --- behavior --- psychological --- human behavior is
dictated by experience.
2. holistic suprasystems sociological in nature social constructionism
nurture behavior
SEX --- a biological concept (male / female)
--- a sociological concept --- gender --- musculinity or femininity --- based
on culture.
--- on sexual orientation: attracted to Opposite sex heterosexual
Same sex homosexual
Both bisexual

Perspective in understanding the individual:

1. BIOLOGICAL
a. unified whole
b. holon
c. diporphism
2. ANTHROPOLOGICAL
a. Essentialism
b. Social constructionism
c.Culture
3. PSYCHOLOGICAL
a. Psychosexual
b. Psychosocial
c. Behaviorism
d. Social learning
4. SOCIOLOGICAL
a. Family and kinship
b. Social groups
FAMILY
- 2 or more individuals who commit to live together for an extended period of time
not necessarily with marital affinity or blood relations.
- Considered as the basic unit of care.
a. Nuclear
b. Extended with lolos and lalas, titios and titas
c. Cohabiting live-in, Not married but with kids.
d. Dyad married but without kids.

MODELS:
Stages of Family Development by Evelyn Duvall
STAGE 1 The Beginning Family ( newly wed couples ).
TASK: Compliance with the PD 965 and acceptance of the new member of the
family.

STAGE 2 The Early Child Bearing Family ( 0 30 months ).

TASK: Emphasize the importance of pregnancy and immunization and learn the
concept of parenting

STAGE 3 The Family with Preschool Children ( 3 6 years old ).

TASK: Learn the concept of Responsible Parenthood.

STAGE 4 The Family with School Age Children ( 6 -12 years old).
TASK: Reinforce the concept of Responsible Parenthood.

STAGE 5 The Family with Teenagers (13 25 years old ).

TASK: Parents to learn the concept of let go system and understand the
generation gap.

STAGE 6 Launching Center ( 1st Child will get married upto the last child ).
TASK: Compliance with the PD 965 and acceptance of the new member of the
Family.

STAGE 7 Family with Middle Adult Parents ( 36 60 years old ).

TASK: Provide a Healthy Environment, adjust with a new lifestyle and adjust with
the financial aspect.

STAGE 8 The Aging Family ( 61 years old upto death ).

TASK: Learn the concept of Death Positively.
8 Family Tasks or Basic Tasks of Developmental Model:
Physical maintenance
Allocation of resources- income given to wife
Division of labor joint parenting
Socialization of family members
Reproduction, recruitment & release
*Maintenance of order- high crime rate
Placement of members in larger society- Indication familys success
Maintenance of motivation & morale
Criticisms: very limited & cannot apply to all situation

STRUCTURAL FUNCTIONAL
Initial Data Base
a. Family Structure and Characteristics
Nuclear basic family
Extended in-law relations, or grandparents relations
*members of household in relation to head
*demographic data ( sex male or female, age, civil status )
Live in = married/ common law WIFE
Male Patriarchal Female Matriarchal
*types and structure of family
*dominant members in health
*general family relationship

Assessment: Family
-Initial data base
-1st level assessment
-2nd level assessment

b. Socio-economic and cultural Factors

*resources and expenses
*educational attainment
*ethnic background
*religious affiliation
*SO ( do not live with the family but influences decision )
*Influences to larger communities

c. Environmental Factors
*housing- number of rooms for sleeping
*kind of neighborhood
*social health facilities available
*comm. And transportatx facilities

d. Health Assessment of Each Member PE

e. Value Placed on Prevention of Disease
*Immunization
*Compliance behavior

First Level Assessment

*Health Threats:
-Conditions that are conducive to disease, accident or failure to realize ones
health potential
-Example:
Family history of illness hereditary like DM, HPN
Nutritional problem eating salty foods
Personal behavior smoking, self medication, sexual practices, drugs,
excessive drinking
Inherent personality characteristics short temperedness, short attention span
Short cross infection
Poor home environment
Lack / Inadequate immunization
Hazards fire, falls, or accidents-
Family size beyond what resources can provide -

*Health Deficits:
-Instances of failure in health maintenance ( disease, disability, developmental
lag )
3 TYPES:
a. Disease / Illness URTI, marasmus, scabies, edema
b. Disabilities blindness, polio, colorblindness, deafness
c. Developmental Problem like mental retardation, gigantism, hormonal, dwarfism

*Stree points / Forseeable Crisis Situation:

-Anticipated periods of unusual demand on the individual or family in terms of
adjustment or family resources ( nature situations )
-Example:
Entrance in school
Adolescents (circumcision, menarche, puberty)
Courtship (falling inlove, breaking up)
Marriage, pregnancy, abortion, puerperium
Death, unemployment, transfer or relocation, graduation, board exam

Second Level Assessment (Family tasks involved)

Family tasks that cant be performed

*Recognition of the problem
*Decision on appropriate health action
*Care to affected family member
*Provision of health home environment
*Utilization of community resources for health care

Problem Prioritization:
*Natur eof the Problem
Health Deficit
Health Threat
Forseeable Crisis
*Preventive Potential
High
Moderate
Low
*Modifiability
Easily modifiable
Partially modifiable
Not modifiable
*Salience
High
Moderate
Low
Family Service and Progress Record

Family Coping Index

Physical Independence ability of the family to move in and out of bed and
performed activities of daily living.
Therapeutic Independence abilty of the family to comply with the therapeutic
regimen ( diet, medication and usage of appliances ).
Knowledge of Health Condition wisdom of the family to understand the disease
process.
Application of General and Personal Hygiene ability of the family to perform
hygiene and maintain environment conducive for living.
Emotional Competence ability of the family to make decision maturely and
appropriately ( facing the reality of life ).
Family Living Pattern the relationship of the family towards each other with love,
respect and trust.
Utilization of Community Resources ability of the family to know the function and
existence of resources within the vicinity.
Health Care Attitude relationship of the family with the health care provider.
Physical Environment ability of the family to maintain environment conducive for
living.
COMMUNITY Patient
- Defined by geographic boundaries with certain identifiable characteristics, with
common values and interests.

POPULATION GROUPS-
-Aggregation of people who share common chaaracteristics, 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.

- Vulnerable Groups: or High Risk Groups ( before )

*Infants and Young Children dependent to caretakers
*School age most negected
*Adolescents identify crisis, HIV
*Mother 1/3 of population health problem ( pregnancy, delivery, puerperium )
*Males too macho to consult
*Old People degenerative disease

- Specialized Fields:
*COMMUNITY MENTAL HEALTH NURSING a unique process which includes
an integration of concepts from nursing, mental health, social psychology,
psychology, community networks, and the basic sciences.
Focus: Mental Health Promotion no need to identify disease, increase mental
wellness of people.
Nursing: Strengthening the support mechanism
Psychiatric Nursing-Focus: Mental Disease Prevention
Focus: Mental Disease Prevention identify disease and shorten disease process

*OCCUPATIONAL HEALTH NURSING the application of nursing principles and

procedures in conserving the health of workers in all occupations.
Aims: Health promotion and prvention of disease and injuries, risk minimization,
ensuring safe work place from industrial to service

*SCHOOL AND HEALTH NURSING the application of nursing theories and

principles in the care of the school population.
Components:
School Health Services- maintain school clinic, screening all children- visual,
hearing, scoliosis

Health Instruction- health education/ counselor direct & undirect

Healthful School Living- health monitor

Mental health- substance abuse, sexual H

 Environmental health- food sanitation, water supply, safe environment,
safe toilet

School community- linkage- comm. Organizer

D. Health Care Delivery System

PHILIPPINE HEALTH CARE DELIVERY SYSTEM

The Philippine health care delivery system is composed of two sectors: (1) the
public sector, which largely financed through a tax-based budgeting system at
both national and local levels and where health care is generally given free at the
point of service and (2) the private sector (for profit and non-profit providers)
which is largely market-oriented and where health care is paid through user fees at
the point of service.

The public sector consists of the national and local government agencies
providing health services. At the national level, the Department of Health (DOH) is
mandated as the lead agency in health. It has a regional field office in every region
and maintains specialty hospitals, regional hospitals and medical centers. It also
maintains provincial health teams made up of DOH representatives to the local
health boards and personnel involved in communicable disease control,
specifically for malaria and schistosomiasis. Other national government agencies
providing health care services such as the Philippine General Hospital are also
part of this sector.
With the devolution of health services, the local health system is now run by Local
Government Units (LGUs). The provincial and district hospitals are under the
provincial government while the city/municipal government manages the health
centers/rural health units (RHUs) and barangay health stations (BHSs). In every
province, city or municipality, there is a local health board chaired by the local chief
executive. Its function is mainly to serve as advisory body to the local executive
and the sanggunian or local legislative council on health-related matters.

The private sector includes for-profit and non-profit health providers. Their
involvement in maintaining the peoples health is enormous. This includes
providing health services in clinics and hospitals, health insurance, manufacture of
medicines, vaccines, medical supplies, equipment, and other health and nutrition
products, research and development, human resource development and other
health-related services.

1. PRIMARY LEVEL FACILITIES

2. SECONDARY LEVEL FACILITIES
3. TERTIARY LEVEL FACILITIES

Classify as to what level the following belong

 1. Teaching and Training Hospitals _______________
2. City Health Services _______________
3. Emergency and District Hospitals _______________
4. Private Practitioners _______________
5. Heart Institutes _______________
6. Puericulture Centers _______________
7. RHU Primary Level Facilities

Primary RHU, Brgy health centers

Secondary District Hospitals
Tertiary Provincial Hospitals, City Hospitals

THE DEPARTMENT OF HEALTH

DEPARTMENT OF HEALTH
-Lead agency in the Health Sector
-Sets the goals for the nations health status
-Establishes PARTNERSHIP

DOH MANDATE
1. Formulation
2. Support
3. Issuance
4. Promulgation
5. Development

Roles of DOH:
1. Leadership in Health
*Serve as the national policy and regulatory institution.
*Provide leadership in the formulation, monitoring and evaluation of the national
health policies, plans and programs.
*Serve as advocate in the adoption of health policies, plans and programs
2. Enabler and Capacity builder
*Innovate new strategies in health.
*Exercise oversight functions and monitoring and evaluation of national health
plans, program and policies.
*Ensure the highest achievable standards of quality health care, promotion and
protection
3. Administrator of specific services
*Manage selected national health facilities and hospitals with modern and
advanced facilities.
*Administer direct services for emergent health concerns that require new
complicated technologies.
Primary Function of of DOH
-Promotion
-Protection
-Preservation
-Restoration

VISION:
Old: Health for all Filipinos
New: The Leader of health for all in the Philippines
New: The DOH is the leader, staunch advocate and model in promoting Health for
all in the Philippines.

New: A global leader for attaining better health outcomes, competetive and
responsive health care system, and equitable health financing by 2030.

MISSION:
-Old: Ensure accessability and quality of health care services to improve the
quality of life of all Filipinos, especially the poor.
-New:To guarantee equitable, sustainable and quality health for all Filipinos,
especially the poor, and to lead the quest for excellence in health.

PHILOSOPHY OF DOH:
-Quality is above Quantity!
PRINCIPLES OF DOH
P Performance of health sector must be enhanced.
U Universal Access to basic health services.
S Shifting from infectious to degenerative diseases must be managed.
H Health, and nutrition of vulnerable group must be prioritized.

STRATEGIES OF DOH
SAID!!!
S support the local health system and front line workers.
A assurance of health care for all.
I increase investment of PHC.
D development of national standards.

GOAL: Heal Sector Reform Agenda ( HSRA ).

Rationale for HSRA:

*Slowing down in the reduction of Infant Mortality and Maternal Mortality Rates.
*Persistence of large variations in health status across population groups and
geographic areas.
*High burden from infectious diseases.
*Rising burden from chronic and degenerative diseases.
*Unattended emerging health risks from environmenmental and work related
factors.
*Burden of disease is heaviest on the poor.

Framework for the Implementation of HSRA: FOURmula One for Health

Goals of FOURmula ONE for Health:

1. Better health outcomes
2. More responsive health systems
3. Equitable health care financing

Elements of the Strategy:

1. Health financing to foster greater, better and sustained investments in health.
2. Health regulation to ensure quality and affordability of health goods and
services.
3. Health service delivery to improve and ensure the accessibility and
availability of basic and essential health care in both public and private facilities
and services.
4. Good governance to enhance health system performance at the national and
local levels.

Roadmap for All Stakeholders in Health: National Objectives for Health 2005
2010.

National Objective for Health: sets the target and the critical indicators, current
strategies based on field experience, and laying down new avenues for improved
interventions.

Goals and Objectives of the Health Sector:

*Improve general health status of the population.
( reduce the infant mortality rate, reduce child mortality rate, reduce maternal
mortality rate, reduce total fertility rate, increase life expectancy and the quality of
life years ).
*Reduce morbidity and mortality from certain diseases.
*Eliminate certain diseases as public health problems.
- Schistosomiasis
- Malaria
- Filariasis
- Leprosy
- Rabies
- Measles
- Tetanus
- Diphtheria and Pertussis
- Vitamin A Deficiency and Iodine deficiency disorders.
*Eradicate Poliomyelitis
*Promote healthy lifestyle and environmental health.
*Protect vulnerable groups with special health and nutrition needs.
*Strenthen national and local health systems to ensure better health service
delivery.
*Pursue public health and hospital reforms.
*Reduce the cost and sure the quality of essential drugs.
*Institute health regulatory reforms.
*Strengthen health governance and management support systems.
*Institute safety nets for the vulnerable and margenalized groups.
*Expand the coverage of social health insurance.
*Mobilize more resources for health
*Improve efficiency in the allocation, production and utilization of resources for
health.

Basic Principles to Achieve Improvement in Health

1. Universal access to basic health servicesmust be ensured.
2. The health and nutrrition 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.

E. PHC as a Strategy
PHC as a Strategy

PRIMARY HEALTH CARE (PHC)

*May 1977 30th 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 InternationalConference 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 President Ferdinand E. Marcos, which adopted PHC as an approacch
toward the design, development and implementation of programs focusing on
health development at community level.
LOI 949 signed by President Marcon with an underlying theme: Health in the
hands of the People by 2020.

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 practice 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.

Concept of PHC
KEY STRATEGY TO ACHIEVE THE GOAL:
- charactterized by partnership and empowerment of the people that shall
permeate as the core strategy in the effective provision of essential health service
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.
*Reductionin 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.

Levels of Health Care and Referral System

1. Primary Level of Care Health care provided by center physicians, PHN, Rural
Health Midwives,Barangay Health Workers and other at the Baragay Heath Station
and Rural Health Units.
2. Secondary Level of Care Given by physicians with Basic Health Training;
given in Health Facilities which are privately owned or government operated such
as infirmaries, municipal and district hospitals and OPD of Provincial Hospitals;
serves as the Referral Center for Primary Health Facilities.
3. Tertiary Level of Care Care rendered by Specialists in Health Facilitis including
Medical Centers as well as Regional and Provincial Hospitals and specialized
Hospitals.

PRINCIPLES OF PRIMARY HEALTH CARE

1. 4 As = Accessibility, Availability, Affordability and Acceptability,
Appropriateness of Health Services. The Health Services should ebe
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 Primary Health Care.
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 Centers.
 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.
- Health being a soical phenomenon recognizes the interplay of political, socio
cultural and economic factors as its determinant.
- Good Health therefore, is manifested by the progressive improvements in the
living conditions and quality of life enjoyed by the community residents (PCF,
DEVELOPMENT is the quest for an improved quality of life for all.
-Development is mulit dimentional. 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

Strategies of PRIMARY HEALTH CARE

1. Reorientation ond reorganization of the national health care system.
2. Effective preparation and enabling process for health action at all levels.
3. Mobilization of the people to know their communities and identifying their basic
health needs.
4. Development and utilization of appropriate technology.
5. Organization of communities.
6. Increase opportunities for community participation.
7. Development of intra intersectoral linkages.
8. Emphasizing partnership.
MAJOR STRATEGIES OF PRIMARY HEALTH CARE
A. ELEVATING HEALTH TO A COMPREHENSIVE AND SUSTAINED NATIONAL
EFFORT
- Attaining Health for aal Filipino will require expanding participation in health and
health related programs whether as service provider oe 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 builiding of communities and
organization to plan, implement and ealuate health prgrams 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,
enhancementof 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.

FOUR CORNERSTONES/PILLARS IN PRIMARY HEALTH CARE

1. Active community participation
2. Intra Intersectoral linkages
3. Use of appropriate technology
4. Support mechanism made available

HERBAL MEDICINES ENDORSED BY THE DEPARTMENT OF HEALTH

NAME INDICATIONS DOSAGE
1. Five leaf Chaste tree 1. Asthma *Divide the decoction into
LAGUNDI (Vitex negundo) 2. Cough 3 parts:
3. Body Pain -For asthma and cough,
4. Fever drink 1 part 3 times a day.
-For fever and body
pains,drink 1 part every 4
hours.
2. Marsh Mint; 1. Body aches and pain, *Divide decoction into 2
Peppermint YERBA e.g., rheumatism, parts and drink 1 part
BUENA (Clinopodium headache, swollen every 3 hours.
douglasii) gums,toothache,
menstrual and gas pain.
3. Blumea camphora 1. Swelling *Divide decoction into 3
SAMBONG (Blumea 2. Inducing diuresis parts and drink 1 parts 3
balsamifera) ( anti urolithiasis ) times a day.
4. TSAANG GUBAT 1. Effective in treating *Drink the warm
(Ehretia microphylla Lam). intestinal motility and decoction. If it persists,
also used as a mouth or if there is no
wash since the leaves of improvement an hour
this shrub has high after drinking the
flouride content. decoction, consult a
doctor.
5. ULASIMANG BATO 1. Effective in fighting *The leaves can be eaten
(Peperomia pellucida). arthritis and gout. fresh (about a cupful) as
-also known as PANSIT- a salad or decocted and
PANSITAN. drunk as tea. For the
Decoction, boil a cup of
clean chopped leaves in 2
cups of water. Boil for 15
to 20 minutes. Strain, let
cool and drink a cup after
meals (3 time a day).
6. Garlic 1. Reduces cholesterol *Eat 6 cloves of garlic
BAWANG (Allium sativum) in the blood and hence, together with meals.
helps control blood
pressure.
(Hypertension,
Hyperlipidemia)
7. Chinese honeysuckle 1. Elimination of *Chew and swallow only
NIYOG NIYOGAN Intestinal worms, dried seeds 2 hours after
(Quisqualis Indica L.) particularly the ascaris dinner according to the
and trichina. following:
ADULTS = 8 -10 seeds
9 12 years old = 6 7
seeds
6 8 years old = 5 6
seeds
4 5 years old = 4 5
seeds
8. Guava 1. ANTISEPTIC (to *For wound cleaning, use
BAYABAS (Psidium clean/disinfect wounds) decoction for washing the
Guajava) 2. Mouth wash infection, wound 2 times a day.
sore gums and tooth *For tooth decay and
decay. swelling of gums, gargle
with warm decoction 3
times a day.
9. Ringworm bush Treatment of ringworms *Apply the juice on the
AKAPULKO also known and skin fungal affected area 1 to 2 times
as bayabas bayabasan infections. a day.
(Cassia alata) 1. Ring worm *If the person develops
2. Athletes foot an allergy while using the
3. Scabies above preparation,
prepare the following:
= Put 1 cup of chopped
fresh leaves in an earthen
jar. Pour in 2 glasses of
water and cover it.
= Boil the mixture until the
2 glasses of water
originally poured have
been reduced to 1 glass
of water.
= Strain the mixture. Use
it while it is warm.
= Apply the warm
decoctionon the affected
area 1 to 2 times a day.
10. Bitter gourd or Bitter 1. Mild Non Insulin *Drink cup of cold or
melon Dependent Diabetes warm decoction 3 times a
AMPALAYA (Momordica Meelitus day after meals.
Charantia) = Lowers Blood Sugar
Levels.

11. Ginger (Zingiber 1. Motion Sickness, sore *An abortifacient if taken

officinale) throat, nausea and in large amounts; should
vomiting, migraine not be used by persons
headaches, arthritis. with cholelithiasis unless
directed by the physician;
may increase the risk of
bleeding when used
concurrently with
anticoagulants and
antiplatelets.
*Chop and Mash a piece
 of ginger root, and mix in
a glass of water.
*Boil the mixture.
*Drink the cold or warm
decoction as needed.

*AC 196 A: Ampalaya was deleted in 10 herbal plants advised by DOH in

October 9, 2003
Reminders on the Use of Herbal Medicine:
1. Avoid the use of insecticides
2. Use a clay pot and remove cover while boiling at low heat.
3. Use only the part being advocated
4. follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each type of symptom or sickness.
6. Stop giving the herbal medication in cases of untoward reactions.
7. If signs and symptoms are not relieved after 2-3 doses, consult a doctor.

Policies to abide:
1. Know indications
2. Know parts of plants with therapeutic value: roots, fruits, leaves
3. Know official procedure/preparation
Procedures/Preparations:
a. Decoction
Gather leaves & wash thoroughly, place in a container the washed
leaves & add water
Let it boil without cover to vaporize/steam to release toxic substance
& undesirable taste
Use extracts for washing
b. Poultice
Done by pounding or chewing leaves used by herbolaryo
Example: Akapulko leaves-when pounded, it releases extracts
coming out from the leaves contains enzyme (serves as anti-
inflammatory) then apply on affected skin or spewed it over skin
For treatment of skin diseases
c. Infusion
To prepare a tea (use lipton bag), keep standing for 15 minutes in a
cup of warm water where a brown solution is collected, pectin which
serves as an adsorbent and astringent
Used for diarrhea and for pneumonia so PHN discourages to buy
commercially prepared cough syrup expectorant: Nature of Cough
1) Dry mucolytic liquefy mucus
Example: Carbocisteine, Guafenesin
2) Productive expectorant irritants to the mucus gland
Example: Bromhexine (Bisolvon)
3) Non stop coughing antitussive
 Example: Dextromethorpan (Robitussin) contains codeine
Robitussin AC contains atropine & codeine

d. Juice/Syrup
To prepare a papaya juice, use ripe papaya & mechanically mashed
then put inside a blender & add water
To produce it into a syrup, add sugar then heat to dissolve sugar &
mix it
For problems of constipation
Example: papaya, mango & caimito
e. Cream/Ointment-for topical use
Cream is water based & used for wet skin lesions
Ointment is oil based & used for dry lesions
Example: Akapulko Leaves
start with poultice (pound leaves) to turn it semi-solid
add flour to keep preparation pasty & make it adhere to skin
lesions
to make it into an ointment: add oil (mineral, baby or any oil-
serves as moisturizer) to the prepared cream to keep it lubricated
while being massage on the affected area

Elements/Components of Primary Health Care: E L E M E N T S D A M

*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 Prevention and 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 of 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 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 illness.
*Supply and Proper Use of Essential Drugs and Herbal Medicine
-This focuses on the information campaign on the utilization and acquisition of
drugs.
-In response to this campaign, the GENERIC ACT of the Phiippines is enacted. It
includes the following drugs: Cotrimoxazole, Paracetamol, Amoxycillin, Oresol,
Nifedipine, Rifampicin, INH (isoniazid) and Pyrazinamide, Ethambutol,
Streptomycin, Albendazole,Quinine.
*Dental Health Promotion
*Acces to and Use of Hospitals as Centers of Wellness
*Mental Health Promotion

Functions of the PRIMARY HEALTH NURSING:

1. Management Function
2.Training Function
3.Supervisory Function
4.Health Care Provider Nursing Care Function
5. Health Promotion and Education Function
6. Collaborating and Coordinating Function
7.Research Function

F. Family-based Nursing Services (Family Health Nursing Process)

FAMILY BASED NURSING SERVICES (FAMILY HEALTH NURING PROCESS)
FAMILY HEALTH NURSING

FAMILY Basic unit of society, a primary entity of health care or institution

responsible for the physical, emotional, and social support of its members.
Two Types:
- Family of Orientation
- Family of Procriation

Family Nurse Contact: Definition

 - An activity with or on behalf of a particular family or individual.
- A crucial approach in delivering community health nursing service for the
family.

Family Nurse Contact: Objectives

- Assess health needs and problems of the family;
- Ensure familys understanding and acceptance of their problems;
- Provide the needed support and assistance to the family;
- Develop the individuals and/or familys competence to cope with their
health problems, and;
- Contribute to the personal and social development of the family through
varied health activities.

FAMILY HEALTH NURSING

*Is a special field in nursing in which the family is the unit of care, health as its goal
and nursing as its medium or channel of care.

Family Case Load

*the number 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.

FAMILY NURSING PROCESS

*It is a means by which the health care provider addresses the health needs and
problems of the client.
*It is a logocal and systematic, way of processing information gathered from
different source and translating into meaningful actions or interventions.

Concept of Family as a Basic Unit of Society

*The Universal Declaration of Human Rights in Article 16 states that the family is
the natural and fundamental unit of society and is entitled to protection both by
society and the State.

STEPS:
1. RELATING
- Establishing a working relationship. Results in positive outcomes such as good
quality of data, partnership in addressing identified health need and problems, and
satisfaction of the nurse and the client.
2. ASSESSMENT
- Data Collection, Data Analysis and Data Interpretation and Problem definition or
Nursing Diagnosis.
TWO TYPES OF ASSESSMENT
a. First Level Assessment Data on status / conditions of family household
members.
 b. Second Level Assessment Data on family assumption of health tasks on
each problem identified in the First Level Assessment.

3. PLANNING
- Determination of how to assist client in resolving concerns related to restoration.
Maintenance or promotion of health.
- Establishment of priorities, set goals / objectives, selects strategies, describe
rationale.
4. IMPLEMENTATION
- The carring out of plan of care by client and nurse, make ongoing assessment,
update / revise plan, document responses.
5. EVALUATION
- A systematic, continuous process of comparing the clients response with written
goal and objective.
-Determines progress and evaluate the implemented intervention as to:
1. Effectiveness
2. Efficiency
3. Adequacy
4. Acceptability
5. Appropriateness

I. NURSING ASSESSMENT
-Involves a set of actions by which the nurse measures the status of the family as
a client, their ability to maintain wellness, prevent and control or resolve problems
in order to achieve health and well being among its members.

Steps in Nursing Assessment

1. Data Collection
- The process of identifying the types or kinds of data needed.
- Specify the methods necessary to collect such data.

Methods of Data Collection

a. Observation is use of all sensory capacities. The familys status can be
inferred from the manifestations of problem areas reflected in the following:
1. Communication and interaction pattern expected, used and tolerated by
family members.
2. Role perceptions / tasks assumptions by each member including
decision making patterns.
3. Conditions in the home and environment
b. Physical Examination is done through inspection, palpation, percussion,
and auscultation.
c. Interview by completing health history for each member. Health history
determines current health status.
 d. Record Review is the review existing records and reports pertinent to the
client / family such as diagnostic reports and immunization records.
e. Laboratory / Diagnostic Tests

5 Types of Date in Family Nursing Assessment (Initial Data Base)

A. Family Structure, Characteristics and 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
Nuclear
Extended
Three generational
Dyad
Single Parent
Step Parent
Blended or Reconstituted
Single adult living alone
Cohabiting / Living in
No kin
Compound
Gay
Commune

Stages of Family Life Cycle

Newly married couple
Childbearing
Preschool age
Teenage
Launching
Middle aged (empty nest retirement)
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

5. Dominant family members in terms of decision-making, especially in

matters of health care.
6. General family relationship / dynamics - presence of any obvious /
readily observable conflict between members; characteristic,
communication / interaction pattern among members.

B. Socio-economic and Cultural Characteristics

1. Income and expenses
a. Occupation, place of work and income of each working member
b. Adequacy to meet basic necessities (food, clothing, shelter)
c. Who makes decisions about money and how it is spent
2. Educational attainment of each member
3. Ethnic background and religious affiliation
4. Significant Others - role(s) they play in family's life
5. Relationship of the family to larger community - Nature and extent of
participation of the family in community activities.

C. Home and Environment

1. Housing
a. Adequacy of living space
b. Sleeping arrangement
c. Presence of breeding or resting sites of vectors of disease (e.g.
mosquitoes, roaches, flies, rodents, etc)
d. Presence of accident hazards
e. Food storage and cooking facilities
f. Water supply - source, ownership, sanitary condition
g. Garbage/ refuse disposal - type, sanitary condition
h. Drainage system - type, sanitary condition
2. Kind of neighborhood, e.g. congested, slum
3. Social and health facilities available
4. Communication and transportation facilities available

D. Health Status of each Family Member

1. Medical and nursing history indicating current or past significant illnesses or
beliefs and practices conducive to health and illness.
2. Nutritional assessment ( specially for vulnerable or risk at-risk
members)
a. Anthropometric data: Measures of nutritional status of children- weight,
height, mid-upper arm circumference.
b. Dietary history specifying quality and quantity of food/ nutrient intake per
day
 c. Eating/feeding habits /practices
3. Developmental assessment of infants, toddlers, and preschoolers -
e.g., Metro Manila Developmental Screening Test (MMDST)
4. Risk factor assessment indicating presence of major and contributing
modifiable risk factors for - e.g. hypertension physical inactivity,
sedentary lifestyle, cigarette/ tobacco smoking, elevated blood lipids/
cholesterol, obesity, diabetes mellitus, inadequate fiber intake, stress,
alcohol drinking and other substance abuse.
5. Physical assessment indicating presence of illness state/s (diagnosed
or undiagnosed by medical practitioners.
6. Results of laboratory / diagnostic and other screening procedures
supportive of assessment findings.

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

Prevention Such as:
1. Immunization status of family members.
2. Healthy lifestyle practices.
3. Adequacy of :
a. rest and sleep
b. exercise / activities
c. Use of protective measures - e.g. adequate footwear in parasite-
infested areas; use of bednets and protective clothing in malaria and
filariasis endemic areas.
d. Use of relaxation and other stress management activities
4. Use of promotive-preventive health services.

2. Data Analysis
Steps:
1. Sorting of data for broad categories (such as those related with health
status or practices about home and environment).
2. Clustering of related cues to determine relationship among data.
3. Distinguishing relevant from irrelevant data. This will help in deciding what
information is pertinent to the situation at hand and what information is
immaterial.
4. Identifying patterns such as physiologic function, developmental,
nutritional/dietary, coping/adaptation or communication patterns.
5. Compare patterns with norms or standards of health, family functioning
and assumption of health tasks.
6. Interpreting results of comparisons to determine signs and symptoms or
cues of specific wellness state/s, health deficit/s, health threat/s,
foreseeable crises/stress point/s and their underlying causes or associated
factors.
 7. Making conclusions about the reasons for the existence of the health
condition or problem, or risk for non-maintenance of wellness state/s which
can be attributed to non-performance of family tasks.

3. Problem Definition/Nursing Diagnosis

End result of 2 major types of assessment.

*Family Nursing Problem - Stated as an inability to perform specific health task

and the reasons / etiology) why the family cannot perform such task.

Consists of 2 parts: main category of problem (coming from unattained

health task) and specific problems (statement of factors contributory for the
existence of the main problem.
Example: (general): Inability to utilize resources for health care due to lack
of adequate family resources, specifically: (specific)
a. financial resources
b. manpower resources
c. time
The more specific the problem definition, the more useful
is the nursing diagnosis in determining the nursing
intervention. Therefore, as many as three or four levels
of problem definition can be stated.

*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, AND 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 / dynamic 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
3. Developmental assessments of infants, toddlers, and preschoolers e.g.,
Metro Manila
4. 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
5. Physical assessment indicating presence of illness state/s
 6. 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

Typology of Nursing Problems in Family Nursing Practice

1. First Level of Assessment process whereby existing potential health

conditions/problems of the family are determined.

a. Presence of Wellness Condition states as potential or readiness

a clinical or nursing judgement about a client in transition from a
specific level of wellness or capability to a higher level.

b. Presence of Health Deficits - Instances of failure in health

maintenance.
A. Illness States, regardless of whether it is diagnosed or undiagnosed by
medical practitioner
B. Failure to thrive/ develop according to normal rate
C. Disability - whether (1) congenital or (2) arising from illness.

c. Presence of Health Threats - Conditions that are conducive to

disease, accident or failure to realize one's health potential.
A. Family history of hereditary condition / disease
B. Threat of cross infection from a communicable disease case
C. Family size beyond what family resources can adequately provide
D. Accident hazards .
1. broken stairs
2. pointed /sharp objects, poisons, & medicines improperly kept
3. fire hazards
4. fall hazards
5. others (specify):________
E. Faulty / unhealthy nutritional / eating habits or feeding techniques /
practices.
 1. inadequate food intake both in quality and quantity
2. excessive intake of certain nutrients
3. faulty eating habits
4. ineffective breastfeeding
5. faulty feeding techniques
F. Stress-provoking factors
1. strained marital relationship
2. strained parent-sibling relationship
3. interpersonal conflicts between family members
4. care-giving burden
G. Poor home / environmental condition/ sanitation
1. inadequate living space
2. lack of food storage facilities
3. polluted water supply
4. presence of breeding or resting sites of vectors of diseases
5. improper garbage / refuse disposal
6. unsanitary waste disposal
7. poor lightning and ventilation
8. noise pollution
9. air pollution
H. Unsanitary food handling and preparation
I. Unhealthy lifestyle and personal habits /practices
1. alcohol drinking
2. cigarette / tobacco smoking
3. walking barefooted or inadequate footwear
4. eating raw meat or fish
5. poor personal hygiene
6. self-medication/ substance abuse
7. sexual promiscuity
8. engaging in dangerous sports
9. inadequate rest or sleep
10. lack of / inadequate exercise / physical activity
11. lack of / inadequate activities
12. non-use of self-protection measures (e.g. non-use of bednets in
Malaria and Filariasis endemic areas)
J. inherent personal characteristics - such as poor impulses control
K. Health history which may precipitate / induce the occurrence of a health
deficit, e.g. previous history of difficult labor.
L. Inappropriate role assumption - e.g. child assuming mother's role, father
not assuming his role
M. Lack of immunization / inadequate immunization status specially of
children
N. Family disunity - e.g. self-oriented behavior of members (s), unresolved
conflicts of members(s), intolerable disagreement
 O. Others, specify : _____________

d. Presence of Stress Points / Foreseeable Crisis - Anticipated periods

of unusual demand on the individual or family in terms of adjustment /
family resources.
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member - e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of Job
K. Hospitalization of a family member
L. Death of a Member
M. Resettlement in a new community
N. Illegitimacy
O. Other, Specify ______________

2. Second Level of Assessment defines the nature or type of nursing

problems that the family encounters in performing health.

I. Inability to recognize the presence of the condition or problem due to:

A. Lack of or inadequate knowledge
B. Denial about its existence or severity as a result of fear of
consequences of diagnosis of problem, specifically :
1. social-stigma, loss of respect of peers / significant others
2. economic / cost implications
3. physical consequences
4. emotional / psychological issues / concerns
C. Attitude / philosophy in life which hinders recognition / acceptance of a
problem.
D. Others, specify __________

II. Inability to make decisions with respect to taking appropriate health

action due to:
A. Failure to comprehend the nature/ magnitude of the problem / condition
B. Low salience of the problem / condition
C. Feeling of confusion, helplessness and / or resignation brought by
perceived magnitudes / severity of the situation or problem, i.e., failure
to break down problems into manageable units of attacks
 D. Lack of / or inadequate knowledge / insight as to alternative courses of
action to take
E. Inability to decide which action to take among the list of alternatives
F. Conflicting opinions among family members / significant others
regarding action to take
G. Lack of / or inadequate knowledge of community resources for care
H. Fear of consequence of action, specially:
social consequences
economic consequences
physical / psychological consequences
I. Negative attitude towards the health problem By negative attitude is
meant one that interferes with rational decision making
J. Inaccessibility of appropriate resources for care, specifically:
1. physical inaccessibility
2. cost constraints or economic / financial inaccessibility
K. Lack of trust / confidence in the health personnel / agency
L. Others, specify______________

III. Inability to provide adequate nursing care to sick, disabled, dependent or

vulnerable / at-risk member of the family due to:
A. Lack of / inadequate knowledge about the disease / health condition
(nature, severity, complications, prognosis and management );
B. Lack of / inadequate knowledge about the child development and care;
Lack of / inadequate knowledge of the nature and extent of nursing care
needed;
C. Lack of the necessary facilities, equipment and supplies for care;
D. Lack of or inadequate knowledge and skill in carrying out the necessary
interventions / treatment / procedure / care (e.g., complex therapeutic
regimen or healthy lifestyle program);
E. Inadequate family resources for care, specifically:
Absence of responsible member
Financial constraints
Limitations / lack of physical resources e.g. isolation room
F. Significant persons unexpressed feelings (e.g. hostility / anger, guilt,
fear / anxiety, despair, rejection) which disable his / her capacities to
provide care.
G. Philosophy in life which negates / hinder caring the sick, disabled,
dependent, vulnerable / At risk member
H. Members preoccupation with own concerns / interests
I. Prolonged disease or disability progression which exhausts supportive
capacity of family members
J. Altered role performance specify :
a. role denial or ambivalence
b. role strain
 c. role dissatisfaction
d. role conflict
e. role confusion
f. role overload
K. Others, specify _________________

IV. Inability to provide a home environment conducive to health maintenance

and personal development due to :
A. Inadequate family resources, specifically:
a. financial constraints / limited financial resources
b. limited physical resources e.g. lack of space to construct facility
B. Failure to see benefits (specifically long-term ones) of investment in
home environment improvement
C. Lack of / inadequate knowledge of importance of hygiene and sanitation
D. Lack of / inadequate knowledge of preventive measures
E. Lack of skill in carrying out measures to improve home environment
F. Ineffective communication patterns within the family
G. Lack of supportive relationship among family members
H. Negative attitude / philosophy in life which is not conducive to health
maintenance and personal development
I. Lack of / inadequate competencies in relating to each other for mutual
growth and maturation (e.g. reduced ability to meet the physical and
psychological needs of other members as a result of
J. familys preoccupation with current problem or condition)
K. Others, specify --------------------------

V. Failure to utilize community resources for health care due to :

A. Lack of / inadequate knowledge of community resources for health care
B. Failure to perceive the benefits of health care / services
C. Lack of trust / confidence in the agency / personnel
D. Previous unpleasant experience with health worker
E. Fear of consequences of action (preventive, diagnostic, therapeutic.
Rehabilitative ), specifically :
a. physical / psychological consequences
b. financial consequences
c. social consequences e.g. , loss of esteem of peer / significant
others
F. Unavailability of required care / service
G. Inaccessibility of required care / service due to:
a. cost constraints
b. physical inaccessibility, i.e. location of facility
H. Lack of or inadequate family resources, specifically ;
a. manpower resources e.g. baby sitter
b. financial resources e.g., cost of medicine prescribed
 I. Feeling of alienation to / lack of support from the community, e.g.,
stigma due to mental illness, AIDS, etc.
J. Negative attitude / philosophy in life which hinders effective / maximum
utilization of community resources for health care
K. Others, specify----------------

II. PLANNING
- The step in the process which answers the following questions:
*What is to be done?
*How is to be done?
*When it is to be done?
-It is actually the phase wherein the health care provider formulates a care plan.

Steps in developing a Family Nursing Care Plan

1. Prioritized problems
2. Goals and Objectives of the Nursing Care
3. Plan of Intervention
4. Plan for Evaluating Care.

Prioritizing Health Problems

1. Nature of the Problem Presented - Categorized into wellness state, health
threat, health deficit and foreseeable crisis.

2. Modifiability of the Problem/Condition - Refers to the probability of

success in enhancing, improving, minimizing, alleviating or totally
eradicating the problem through intervention.

3. Preventive Potentials - Refers to the nature and magnitude of future

problems that can be minimized or totally prevented if intervention is done
on the problem under consideration.

4. Salience - Refers to the family's perception and evaluation of the problem

in terms of seriousness and urgency of attention needed or family
readiness.
Scoring
1. Decide a score for each of the criteria
2. divide the score by the highest possible & multiply by the weight
Score x weight
Highest score
3. Sum up the score of all criteria. The highest score is 5 equivalent to the total
weight.
CRITERIA Weight
1. Nature of the problems Presented 1
Scale:
-Health deficit / Wellness 3
-Health threat 2
-Foreseeable crisis 1
2. Modifiability of the problem 2
Scale:
-Easily modifiable 2
-Partially modifiable 1
-Not modifiable 0
3. Preventive potential 1
Scale:
-High 3
-Moderate 2
-Low 1
4. Salience 1
Salience:
-A condition / problem needing Immediate 2
attention
*A condition / problem not needing 1
Immediate attention
*Not perceived as a problem or condition 0
needing change.

Factors affecting priority setting:

The nurse considers the availability of the following in determining the modifiability
of a health condition or problem.
1. Current Knowledge, Technology and Interventions
2. Resources of the family Physical, Financial and Manpower
3. Resources of the nurse Knowledge, Skills and Time
4. Resources of the Community Facilities and Community organization or
support.

Factors in Deciding Appropriate Score for Preventive Potential

1. Gravity or severity of the problem - Refers to the progress of the disease/
problem indicating extent of damage on the patient / family. Also indicates the
prognosis, reversibility of the problem
2. Duration of the problem - refers to the length of time the problem has been
existing
3. Current Management - refers to the presence and appropriateness of
intervention
4. Exposure of any high risk group
Family Nursing Care Plan
* It is the blueprint of care that the nurse designs to systematically minimize or
eliminate the identified family health problem through explicitly formulated
outcomes of care (goal and objectives) and deliberately chosen set of
interventions/resources and evaluation criteria, standards, methods and tools.

Characteristics of Family Nursing Care Plan

1. It focuses on actions which are designed to solve or alleviate & existing
problem.
2. It is a product of deliberate systematic process.
3. The FNCP as with other plans relates to the future.
4. It revolves around identified health problems.
5. It is a mean to an end and not a end to itself.
6. It is a continuous process, not one shot deal.

Desirable Qualities of Family Nursing Care Plan

1. It should be based on a clear definition of the problem.
2. A good plan is realistic, meaning it can be implemented with reasonable chance
of success
3. It should be consistent with the goals and philosophy of the health agency.
4. Its drawn with the family.
5. Its best kept in written form.

Setting/ Formulating Goals & Objectives

This will set direction of the plan.
This should be stated in terms of client outcomes whether at the individual,
family or community level.
The mutual setting of goals which is the cornerstone of effective planning
consists of:
1. Identifying possible resources.
2. Delineating alternative approaches to meet goals.
3. Selecting specific interventions.
4. Operationalizing the plan - setting of priorities.

Goal
* It is a general statement of the condition or state to be brought about by
specific courses of action.

Cardinal Principle in Goal setting

* It must be set jointly with the family. This ensures family commitment to
their realization.
 * Basic to the establishment of mutually acceptable goal in the familys
recognition and acceptance of existing health needs and problems.

Barriers to Joint Goal Setting

1. Failure in the part of the family to perceive the existence of the problem.
2. Sometimes the family perceives the existence of the problem but does not
see it as serious enough to warrant attention.

Characteristics of Goals/ Objectives

1. Specific
2. Measurable
3. Attainable
4. Realistic
5. Time bound

Objective
Refers to a more specific statement of desired outcome of care.
They specify the criteria by which the degree of effectiveness of care is to
be measured.

Types of Objective
1. Short term or Immediate Objective
Formulated for problem situation which require immediate attention &
results can be observed in a relatively short period of time.
They are accomplished with few HCP-family contacts & relatively less
resources.
2. Medium or Intermediate objective
Objectives which is not immediately achieved & is required to attain the
long ones.
3. Long Term or Ultimate Objective
This requires several HCP-family contacts & an investment of more
resources.

Plan of Actions/ Interventions

Its aim is to minimize all the possible reasons for causes of the familys
inability to do certain tasks.

It is highly dependent on 2 Major Variables:

1. nature of the problem
2. the resources available to solve the problem

Typology of Interventions
1. Supplemental - the HCP is the direct provider of care.
2. Facilitative - HCP removes barriers to needed services.
 3. Developmental - improves clients capacity.

III. Implementation
Actual doing of interventions to solve health problems.

IV. Evaluation
Determination whether goals / objectives are met.
Determination whether nursing care rendered to the family are effective.
Determines the resolution of the problem or the need to reassess, and
re-plan and re-implement nursing interventions.

According to Alfaro-LeFevre:

Evaluation is being applied through the steps of the nursing process:

Assessment changes in health status.

Diagnosis if identified family nursing problems were resolved,
improved or controlled.
Planning are the interventions appropriate & adequate enough to
resolve identified problems.
Implementation determine how the plan was implemented, what
factors aid in the success and determine barriers to the care.

Types of Evaluation:
On-going Evaluation analysis during the implementation of the activity,
its relevance, efficiency and effectiveness.

Terminal Evaluation undertaken 6-12 months after the care was

completed.

Ex-post Evaluation undertaken years after the care was provided

Steps in Evaluation:
1. Decide what to Evaluate.
Determine relevance, progress, effectiveness, impact and efficiency
2. Design the Evaluation Plan
Quantitative a quantifiable means of evaluation which can be done
through numerical counting of the evaluation source.
Qualitative descriptive transcription of the outcome conducted
through interview to acquire an in-depth understanding of the
outcome.
3. Collect Relevant Data that will support the outcome
4. Analyze Data - What does the data mean?
5. Make Decisions
 If interventions are effective, interventions done can be applied to
other client / group with the similar circumstances
If ineffective, give recommendations
6. Report / Give Feedbacks

Dimensions of Evaluation
1. Effectiveness focused on the attainment of the objectives.
2. Efficiency related to cost whether in terms on money, effort or
materials.
3. Appropriateness refer its ability to solve or correct the existing
problem, a question which involves professional judgment.
4. Adequacy pertains to its comprehensiveness.

Tools Being used during Evaluation

Instruments are tools are being used to evaluate the outcome of the
nursing interventions:

Thermometer
Tape measure
Ruler
BP apparatus
Weighing scale
Checklist
Key Guide Questionnaires
Return Demonstrations

Methods of Evaluation
1. Direct observation
2. Records review
3. Review of questionnaire
4. Simulation exercises
1.1 Family Based Nursing Services (Family Health Nursing Process)
Nursing Assessment of Family:
First Level Assessment:
1. Family structure, characteristics and dynamics
2. Socio-economic and cultural characteristics
3. Home and environment
4. Health status of each member
5. Values and practices on health promotion/maintenance
and disease prevention
Second Level Assessment data include those that specify or describe the
familys realities, perceptions about and attitudes related to the assumption or
performance of family health tasks on each health condition or problem
identified during the first level assessment.
Developing the Nursing Care Plan
Steps in developing a family care plan:
1. The prioritized condition/s or problems
2. The goals and objectives of nursing care
3. The plan of interventions
4. The plan for evaluating care
Implementing the Nursing Care Plan
During this phase the nurse encounters the realities in family nursing practice
which can motivate her to try out creative innovations or overwhelm her to
frustration or inaction. As the nurse practitioner works with clients she
experiences varying degrees of demands on her resources. A dynamic attitude
on personal and professional development is, therefore, necessary if she has
to face up to challenges of nursing practice.
Evaluation of Family Health Services.

G. Population Group-based Nursing Services

POPULATION FOCUSED APPROACH
- Concentrates on specific groups of people and focuses on health promotion and
disease prevention, regardless of geographical location (Baldwin et al, 1998).
- In short (Minesota Department of Health, 2003)
*Focuses on the entire population
*Is based on assessment of the population health status.
*Considers broad determinants of health.
*Emphasizes all levels of prevention.
*Intervenes with communities, systems, individuals and families.

GOAL: To promote Healthy Communities

*A population focused involves concern for those who do, and for those who do
not receive health services (social jusctice)
*SCIENTIFIC APPROACH AND POPULATION FOCUS = 1.
Epidemiology 2. Information about the community.

H. Community-based Nursing Services/ Community Health Nursing Process

COMMUNITY HEALTH NURSING PROCESS
1. Assessment/Diagnosis
- assessment: purpose is to identify the health needs of the people.
a. Collection of data ( subjective: expressed by client or;
objective: measurable- interview & observations, senses)
b. Categories of health problems

2. Planning
- purpose is to act on determined needs of the community people.

3. Implementation
- purpose is to achieve the optimum level of health of the community people.

4. Evaluation-
- to determine the effectiveness of health care programs.
3 elements : structural , process & measurable outcome or objective

4 Tools/ Instruments for Data Collection:

1. Nursing history subjective
2. PE- Objective
3. Lab- Objective
4. Process recording- objective (analyzed by RN)

NURSING PROCEDURES
Clinic visit
- patient visits the Health center to avail of the services there to offered by the
facility primarily for consultation on matters that ailed them physically.
-Process of checking the clients health condition in a medical clinic.

PURPOSE: (C.U.R.E)
-Consult about signs and symptoms of illness.
-Utilize service of a health agency.
-Render some treatment procedures.
-Evaluate through some diagnostic procedures

PRE CONSULTATION CONFERENCE (CuTe PaLa We?)

-Take Clinical History after greeting and making client at ease.
-Take Temperature, BP, Height, Weight.
-Perform a through Physical Assessment
-Do Selective Laboratory Exams: Urinalysis, Sputum Exam, Fecalysis.
-Write Findings on clients record.

MEDICAL EXAMINATION (A IWan PO!)

-Assist before, during and after exam by Physician.
-Inform Physician of relevant findings.
-Work with Physician during Exam.
-Ensure Privacy, safety and comfort of patient.
-Observe Confidentiality of Exam result.

POST CONSULTATION CONFERENCE (E..R.A)

-Explain Findings and needed care or intervention.
-Refer patient to other health agency in necessary.
-Make Appointment for next client or home visit.
Standard procedures performed during clinic visits:
I. Registration/ Admission
1. Greet client and establish rapport
2. Prepare the family record or retrieve records of old clients
3. Elicit and record the clients chief complaint and clinical history
4. Perform physical examination on the client and record it accordingly

II. Waiting time

1. Give priority numbers to clients
2. Implement the first come, first served policy except for emergency
cases

III. Triaging
1. Manage program-based cases (like the IMCI)
2. Refer all non-program based cases to the physician
3. Provide first aid treatment to emergency cases and refer to the next
level when necessary

IV. Clinical evaluation

1. Validate clinical history and physical exam
2. Nurse arrives at evidence-based diagnosis and provides rational
treatment based on DOH programs
3. Inform the client on the nature of the illness, appropriate treatment and
prevention and control measures

V. Laboratory and other diagnostic examinations

1. Identify a designated referral laboratory when needed

VI. Referral system

1. Refer patient if he needs further management following the 2-way
referral system
2. Accompany the patient when an emergency referral is needed

VII. Prescription/dispensing
1. Give proper instructions on drug intake

VIII. Health education

1. Conduct one-on-one counseling with the patient
2. Reinforce health education and counseling messages
3. Give appointments for the next visit

Blood pressure measurement

Procedure:
1. Preparatory phase
 Introduce self to client
Make sure client is relaxed and has rested for at least 5 minutes
Explain the procedure
Assist to a seated or supine position

2. Applying the BP cuff and stethoscope

Bare clients arm
Apply cuff around upper arm 2-3 cm above brachial artery
Keep manometer at eye level
Keep arm level with his heart by placing it on a table or a chair arm or by
supporting it
Palpate brachial pulse correctly just below or slightly medial to the
antecubital area

3. Obtaining the BP reading by using palpatory method

While palpating the brachial or radial pulse, close valve or pressure bulb
and inflate cuff until pulse disappears
Note point at which pulse disappeared palpated systolic BP
Deflate cuff fully
Wait 1-2 minutes before inflating cuff again

Obtaining the BP reading by auscultation

Place earpieces of stethoscope in ears and stethoscope head over the
brachial pulse
Use the bell of the stethoscope to auscultate pulse
Watching the manometer, inflate the cuff rapidly by pumping the bulb until
the column reaches 30 mmHg above the palpatd SBP
Deflate the cuff slowly at a rate of 2-3 mmHg per beat
While the cuff is deflating, listen for pulse sounds (Korotkoff sounds) (1 st
clear tapping sound Systolic BP and disappearance of sound Diastolic
BP

4. Recording BP and other guidelines

For every visit, take the mean of 2 reading, obtained at least 2 minutes
apart
If first visit, repeat procedure with other arm. Subsequent BP readings
should be performed on the arm, with a higher BP reading

Home visit
- family nurse contact which allows the health worker to assess the home and
family situations in order to provide the necessary nursing care and health related
activities.
- 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.
-PRIORITY during HOME VISITS: Newborn (First), Post-Partum, Pregnant
Mother, Morbid Individual (Last).

Purpose of Home Visit:

1. To give nursing care to the clients
2. To assess living conditions of the patient and his family and their health
practices
3. To give health teachings regarding prevention and control of diseases
4. To establish close relationships between the health agencies and the public
5. To make use of the inter-referral system and to promote the utilization of
community services

Principles involve in Preparing for a Home visit:

1. Must have a purpose or objective
2. Should make use of all available information about a patient
3. Should consider and give priority to needs of clients
4. Should involve the clients
5. Should be flexible

Guidelines to consider regarding the Frequency of Home Visits

1. Needs of the client (Physical, Psychological, and Educational needs)
2. Acceptance of the family
3. Policy of a specific agency
4. Other health agencies and personnel involved in care of family
5. Past services given to families
6. Ability of clients to recognize own needs

Steps in conducting home visits

1. Greet the patient and introduce yourself
2. State the purpose of the visit
3. Observe the patient and determine the health needs
4. Put the bag in a convenient place then proceed to perform the bag
technique
5. Perform nursing care needed and give health teachings
6. Record all important data, observation and care rendered
7. Make an appointment for a return visit

Bag Technique: tool by which the nurse, during her visit will enable her to perform
a nursing procedure with ease and deftness, to save time and effort
- 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.

*Public Health Bag: an essential and indispensable equipment of a public health

nurse which she has to carry along during her home visits.

Principles of Bag Technique:

 1. Minimize, if not prevent the spread of infection
2. Saves time and effort of the nurse
3. Should show effectiveness of total care given to an individual or family
4. Can be performed in a variety of ways

Important points to consider in the use of the bag technique: HANDWASING

1. The bag should contain all necessary articles, supplies and equipments that
will be used
2. The bag and its contents should be cleaned very often, supplies replaced
and ready for use anytime
3. The bag and its contents should be well-protected from contact with any
article in the patients home.
4. The arrangement of the contents of the bag should be the one most
convenient for the user, to facilitate efficiency and avoid confusion.

-Contents of the BAG:

*BP Apparatus , Stethoscope and umbrella are carried separately
*Medicines include: Betadine, 70% alcohol, Benedicts solution

SOLUTION:
1. Benedicts Solution For sugar detection
2. Acetic Acid For Albumin Detection
3. Zephiram Solution Soaking Solution
4. Alcohol, Betadine
5. Ammonia
-Placed waste paper bag outside of work area to prevent contamination of clean
area.
-RATIONALE IN THE USE OF PHN BAG :
*Technique during home visit
- It helps render effective nursing care.

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.

Principles in Nursing Care:

1. Nursing care utilizes a medical plan of care and treatment
2. Performance of nursing care utilizes skills that would give maximum comfort
and security to the individual
3. Nursing care given at home should be used as a teaching opportunity to the
patient or to any responsible member of the family
4. Performance of nursing care should recognize dangers in the patients over-
prolonged acceptance of support and comfort
 5. Nursing care is a good opportunity for detecting abnormal signs and
symptoms, observing patients attitude towards care given and the progress
of the patient

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(Association of Nursing
Service Administration of the Philippine.)
- INDICATIONS:
*Maintenance /Correction of dehydration in patient unable to tolerate adequate
volume of oral fluid medications
*Parenteral Nutrition
*Administration of Drugs
*Blood Transfusion
- CONTRAINDICATIONS:
*Administration of irritant fluids / drugs through peripheral access (e.g., Sodium
Chloride, Hypertonic Potassium Chloride).

Specimen Collection
-URINE Sterile Bottle, Midstream Collection
-FECES Clean Container, Small amount of feces only.
-SPUTUM NPO midnight first collection early AM then submit at the health
center immediately, then second collection following day early in the AM then
submit at the health center then collect the third sputum; instruct the patient to take
a deep breath four times then cough out.

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 activites.

THE COMMUNITY HEALTH NURSE

QUALIFICATIONS
1. BSN
2. RN 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 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, equipment, 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
resources speaker on health and health related services.
4. Initiates the use of tri media (radio / TV, cinema plug, 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 contracts / 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.

CHN NOTES:
1. Primary Goal in CHN Self-reliance in health
2. Ultimate Goal in CHN Raise the level of health of the citizenry
3. Unit of care - Family
4. Levels of Clientele Individual, Family, Special Population & Community
5. Primary Focus Health Promotion & Disease Prevention
6. Philosophy Of CHN Uphold the worth & dignity of man
7. Theoretical Bases of CHN Practice Theories & Principles of Nursing & Public
Health
8. CHN as : People-oriented, comprehensive & integrated, focus on
health

I. Community Organizing
COMMUNITY ORGANIZING
Maglaya DOH
Preparatory Phase Community Analysis
Organizational Phase Design and Initiation
Education and training Implementation
Collaboration Phase Program Maintenance
Consolidation
Phase Out Dissemination Reassessment

COMMUNITY ORGANIZING a continuous and sustained (i.e. never-ending)

process of awareness-raising, organizing, and mobilizing. Awareness primary
motivation to action
Basic Concepts and Principles
Based on concrete analysis of actual situation
Basic trust on the people
By, for, with, and among the people
Anyone is capable of change
Self-willed changes have more meaning than imposed ones

Context of Community Organizing (CO): Current situation

towards the poor, deprived, oppressed (i.e. not all) but
struggling segments of the society

Goal of Community Organizing (CO): Community Development the creation of

a society that provides equal access to all benefits and opportunities the society
can offer to the people
Application of CO in Health: PRIMARY HEALTH CARE
PRIMARY HEALTH CARE
- Essential care (i.e. not alternative)
- Based on scientifically sound and socially acceptable methods and technology
- Made universally available to individuals, families, and communities
- At a cost they can afford at any given stage of their development
- Through their full participation
- Towards self- reliance and self-determination

Major Pillars of Primary Health Care

a. Multi-sectoral approach (inter- and intra-sectoral linkages)
b. Peoples participation
Partnership or shared leadership; minimum level of peoples participation
c. Appropriate technology underwent experimentation and with high empirical basis;
e.g. herbal medicine and accupressure
d. Support mechanism made available
COMMUNITY ORGANIZING IN HEALTH

Two types of community:

a. Organized community with peoples organization
b. Virgin community without peoples organization

Phases of CO:
1. SOCIAL INVESTIGATION
Preliminary Investigation
- done before entry to community
- secondary data sources are utilized
- baseline information from secondary data sources (e.g. Records
Review)
Deepening Social Investigation
- continuous appraisal of community situation through primary data
sources
2. ENTRY low-key or low-profile approach
Upon entry, start the following:
a. Deepening Social Investigation
b. Social Preparation
c. Community Integration
3. SOCIAL PREPARATION tampering the grounds for setting up health
programs

Target: community leaders

- Establish rapport, develop trust, clarify intentions and
expectations
- Starts upon entry, ends with launching
Methods: courtesy call and attendance to meetings
 4. COMMUNITY INTEGRATION imbibing the community way of life
Target: community
- Deepen rapport, develop mutual trust, draw objectives
Methods: house-to-house, going to places where people are, direct participation
in the production process (best method)
5. SMALL GROUP FORMATION
- cluster of 8-15 households
- manageable units
- data processing of community diagnosis is being done
6. ELECTION OF CHWs
7. LAUNCHING social preparation ends
8. COMMUNITY DIAGNOSIS
Outcome: Problems and needs of the people
9. TRAINING AND SERVICES
Advanced community health workers have the leadership traits
10. CORE GROUP FORMATION
- Group of advanced CHWs
11. PHASE OUT so that people can practice self-reliance
- Provide opportunity for the health workers to stand on their own
Indicator of Phase-out: Advanced CHWs are able to assume staff level
functions

COMMUNITY ORGANIZING PROCESS (COPAR)

PRE-ENTRY
1. Site selection
2. Preliminary Social Investigation
ENTRY
1. Social preparation
2. Community integration
3. Deepening social investigation
ORGANIZATION FORMATION PHASE
1. Small group formation
2. Election of CHW (women; middle-aged; married)
3. Organizational meetings - to clarify matters
TRAINING PHASE
1. Training needs assessment COMMUNITY DIAGNOSIS
2. Curriculum development based on problems identified
3. Actual training
4. Training evaluation
SERVICES PHASE
1. Community clinics
2. Other services
LEADERSHIP FORMATION PHASE
 1. Core group formation
2. Advanced training
CONSOLIDATION PHASE
1. Evaluation session
2. Staff development
SUSTENANCE AND MAINTENANCE PHASE
1. Endorsement to sectoral organizing
2. Formation of regional coordinating bodies

1. Community analysisThe process of assessing and defining needs,

opportunities and resources involved in initiating community health action
program. This process may be referred to as community diagnosis, community
needs assessment, health education planning, and mapping.

5 components
Demographic, social and economic profile of the community
derived from secondary data
Health risk profile
Health/wellness outcome profile
Survey of current health promotion programs
Studies conducted in certain target groups
Steps in community analysis
Define the community - Determine the geographic boundaries of the
target community. This is usually done in consultation with representatives of
the various sectors.
Collect data As earlier mentioned, several types of data have to
be collected and analyzed.
Assess community capacity This entails and evaluation of the
driving forces which may facilitate or impede the advocated
change. Current programs have to be assessed including the
potential of the various types of leaders/influential, organization
and programs.
Assess community barriers Are there features of the new
program which run counter to existing customs and traditions? Is
the community resilient to change?
Assess readiness for change _ Data gathered will help in the
assessment of community interest, their perception on the
importance of the problem.
Synthesis of data and set priorities This will provide a
community profile of the needs and resources, and will become
the basis for designing prospective community interventions for
health promotion.
2. Design and initiation
In designing and initiating interventions the following should be done:
Establish a core planning group and select a local organizer -
Five to eight committed members of the community may be
selected to do the planning and management of the program.
Choose an organizational structure - There are several
organization structures which can be utilized to activate
community participation. These include the following:
Leadership board or council existing local leaders working for
a common cause
Coalition linking organizations and groups to work on
community issues.
Lead or official agency a single agency takes the primary
responsibility of a liaison for health promotion activities in the
community.
Grass-roots informal structures in the community like the
neighborhood residents.
Citizen panels a group of citizens (5-10) emerge to form a
partnership with a government agency
Networks and consortia Network develop because of certain
concerns.
Identify, select and recruit organizational members - As much as
possible, different groups, organizations sectors should be
represented. Chosen representative have power for the groups
they represent.
Define the organization mission and goals - This will specify the
what, who, where, when and extent of the organizational
objectives.
Clarify roles and responsibilities of people involved in the
organization - This is done to establish a smooth working
relationship and avoid overlapping of responsibilities.
Provide trainings and recognition - Active involvement in planning
and management of programs may require skills development
training. Recognition of the programs accomplishment and
individuals contribution to the success of the program and boost
morale of the members.

3. Implementation
Implementation put design phase into action. To do so, the following
must be done:
Generate broad citizen participation - There are several ways to
generate citizen participation. One of them is organizing task
force, who, with appropriate guidance can provide the necessary
 support.
Develop a sequential work plan - Activities should be planned
sequentially. Oftentimes, plan has to be modified as events
unfold. Community members may have to constantly monitor
implementation steps.
Use comprehensive integrated strategies - . Generally the
program utilize more than one strategies that must complement
each other.
Integrate community values into the programs, materials and
messages. The community language, values and norms have to
be incorporated into the program.

4. Program maintenance consolidation

The program at this point has experienced some degree of success and
has weathered through implementation problems. The organization and
program is gaining acceptance in the community.
Integrate intervention activities into community networks - This
can be affected through implementation problems. The
organization and program is gaining acceptance in the
community.
Establish a positive organizational structure - A positive
environment is a critical element in maintaining cooperation and
preventing fast turnover of members. This is the result of good
group based on trust, respect, and openness.
Establish an ongoing recruitment plan- It should be expected that
volunteers may leave the organization. This requires a built in
mechanism for continuous recruitment and training of new
members.
Disseminate results - Continuous feedback to the community on
results of activities enhances visibility and acceptance of the
organization. Dissemination of information is vital to gain and
maintain community support.

5. Dissemination reassessment
Continuous assessment is part of the monitoring aspect in the
management of the program. Formative evaluation is done to provide
timely modification of strategies and activities. However, before any
programs reach its final step, evaluation is done for future direction.
Update the community analysis - Is there a change in leadership,
resources and participation? This may necessitate reorganization
and new collaboration with other organizations.
Assess effectiveness of interventions/programs - Quantitative
and qualitative methods of evaluation can be used to determine
participation, support and behavior change level of decision-
 making and other factors deemed important to the program
Chart future directories and modifications - This may mean
revision of goals and objectives and development of new
strategies. Revitalization of collaboration and networking may be
vital in support of new ventures.
Summarize and disseminate results - . Some organizations die
because of the lack of visibility. Thus, a dissemination plan
maybe helpful in diffusion of information to further boost support
to the organizations endeavor.

GUIDE ON HOW TO DO AN EFFECTIVE COMMUNITY DIAGNOSIS

Community Diagnosis: an in-depth process of finding out the profiles, health

status of the community and the factors affecting the present status

Contents:
1. Introduction
1.1 Rationale accurate, valid, timely and relevant information on the
community profile and health problems are essential so that resources can be
maximized
1.2 Purpose to analyze the data in order to develop responsive
intervention strategies that address the root cause of the problem
1.3 Statement of Objective what are to be accomplished to attain the
study
1.4 Methodology and tool used a description of the adoption,
construction and administration of instruments
1.5 Limitation of the study state any limitations that exist in the
reference or given population or area of assignment

2. Target Community Profile

2.1 Geographical Identifiers historical background, location,
boundaries, population, physical features, climate, spot map
2.2 Population Profile Total estimated population of Barangay,
Population Density,
2.3 Socio-demographic Profile total population of families surveyed,
number of households, age and sex distribution, sex ratio, dependency ratio,
civil status, types of families, religious distribution, place of origin, length of
residency
2.4 Socio-economic indicators educational attainment, literacy rate,
occupation, income, housing, ventilation
2.5 Environmental indicators Water supply, excreta disposal, garbage
disposal, pet ownership, domestic animals
2.6 Health profile food storage, infant feeding practices, immunization,
community facilities, health seeking behaviors, communication resource and
family planning
2.7 Morbidity and mortality data leading cause of morbidity, mortality,
infant mortality and maternal mortality

3. Analysis of Data
3.1 Identification of health problems
3.2 Prioritized problems identified

4. Action plan based from prioritized problem identified

4.1 Intervention strategies

5. Conclusion

6. Recommendation

Community Diagnosis
1. Preparation of Community Diagnosis
a. Identify barangay to survey or required by the health center
b. Ocular survey
c. Community assembly
2. Conduct of survey proper using the format/survey form
a. Random sampling or saturation
b. Guidelines in filling survey form
c. Data collection techniques
3. Make graph or chart of each data gathered
4. Data analysis and interpretation
5. Preparation of action plan /project plan

HRDP CO-PAR
COMMUNITY ORGANIZING
A continuous process of awareness building, organizing and mobilizing
community members towards community development.

PHASES AND ACTIVITIES

I. PRE-ENTRY PHASE
Preparation of the staff
Site selection
II. ENTRY PHASE
integration with the community
Courtesy calls
Information campaigns
 Identification of potential leaders
III. CORE-GROUP FORMATION & MOBILIZING
integration with core group
IV. ORGANIZATION-BUILDING
Organizing Barrio Health committees
Setting up community organization
V. CONSOLATION & EXPANSION PHASE
Networking, linkages
Implementation of livelihood projects
developing secondary leaders

J. Public Health Programs

PUBLIC HEALTH PROGRAMS

FAMILY HEALTH
Aims to:
1. Improve the survival, health and well-being of mothers and the unborn through a
package of services for the pre-pregnancy, prenatal, natal and postnatal packages.
2. Reduce morbidity and mortality rates for children 0-9 years.
3. Reduce mortality from preventable causes among adolescents and young
people.
4. Reduce mortality and morbidity among Filipino adults and improve their quality
of life.
5. Reduce morbidity and mortality of older persons and improve their quality of life.

The Maternal Health Program

Strategic thrusts for 2005-2010

Launch and implement the Basic Emergency Obstetric Care or BEMOC

strategy in coordination with the DOH.
Improve the quality of prenatal and postnatal care
Reduce womens exposure to health risks through the institutionalization of
responsible parenthood and provision of appropriate health care package to
all women of reproductive age
LGUs, NGOs and other stakeholders must advocate for health through
resource generation and allocation for health services to be provided for the
mother and the unborn

a. Antental Registration
Prenatal Visits Period of Pregnancy
1st visit As early as possible before 4 months or during the 1 st
trimester.
2nd visit During the 2nd trimester.
3rd visit During the 3rd trimester.
Every 2 weeks After 8th month until delivery.
 b. Tetanus Toxoid Immunization
*A series of 2 doses of Tetanus Toxoid vaccination must be received by a woman
one month before delivery to protect the baby from neonatal tetanus.
*3 booster dose shots are needed to complete the five doses following the
recommended schedule to provide full protection for both mother and child.
*mother is then called as a fully immunized mother.

c. Micronutrients Supplementation
Vit A: 10,000 IU 2x a week starting on 4th month of pregnancy
Iron: 600mg/400ug tablet daily

d. Treatment of Diseases and other Conditions ????

e. Clean and safety delivery.

1. Do a quick check upon admission for emergency signs.
2. Make the woman comfortable/
3. Assess the woman in labor.
4. Determine the stage of labor.
5. Decide if the woman can safely deliver.
6. Give supportive care throughout labor.
7. Monitor and manage labor.
8. Monitor closely within one hour after delivery and give supportive care.
9. Continue care after one hour postpartum.
10. Educate and counsel on Family Planning and provide Family Planning Method
if available and decisions made by the woman.
11. Inform, teach and counsel the woman on important MCH messages:
*birth registration
*importance of breastfeeding
*Newborn Screening for babies delivered in RHU or at home within 48 hours
up to 2 weeks after birth
*Schedule when to return for consultation for post partum visits
1st visit 1st week post partum preferably 3 - 5
days
2nd vist 6 weeks post partum

The Family Planning Program

FAMILY PLANNING
The concept of enhancing the quality of families which includes:
*Started 1960s
*2 3 years spacing of child
*2 3 years children is ideal
*5 pregnancy is a risk factor
*COUPLES FOR CHRIST DOH Partner
*Regulating and spacing childbirth
*Helping subfertile couples beget children
*Counseling parents and would-be parents
*The privilege and the obligation of the (married) couple exclusively to decide
w/ love when andhow many children provided:
the motive is justified and the means are moral.
*Involves personal decisions based on each individuals background,
experiences andsociocultural beliefs. It involves thorough planning to be
certain that the method chosen isacceptable and can be used effectively.

Function of the Health Professional in Family Planning

*To counsel, reassure, give information and allow an individual/couple
to decide his/her/their course of action according to what he/she think is
appropriate for them and in accordance to their own personal,societal,
religious beliefs & values

Goal: Provide universal access to family planning information and

services wherever and whenever these are needed.
FAMILY PLANNING Aims to contribute to:
- Reduced infant deaths
- Neonatal deaths
- Under five deaths
- Maternal deaths
Objectives:
-Addresses the need to help couples and individuals achieve their
desired family size within the context of responsible parenthood and
improve their reproductive health to attain sustainable development.
-Ensure that quality Family Planning services are available in DOH
retained hospitals, LGU managed health facilities, NGOs and private
sector.
Strategies:
*Focus service delivery to urban and rural poor
*Reestablish the FP outreach program
*Strengthen FP provision in regions with high unmet needs
*Promote frontline participation of hospitals
*Mainstream modern natural family planning
*Promote and implement CSR strategy
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.

FAMILY PLANNING SERVICES

 *Temporary conception control
-Methods used to prevent conception
-Methods used to prevent ovulation
-Methods used to prevent implantation

*Sterilization / Permanent conception control

-Tubal occlusion / Bilateral Tubal Ligation
-Vasectomy or Vas Ligation (never advice a permanent method of
planning).

Family Planning: 4 Pillars

BIRR!!!
B-
I-
R-
R-

Important Concept!!!
COUPLE Decision maker
DOH Regulator
Community Health Nurse Facilitator

Important Concept!!!
High risk Pregnancies
-Too early
-Too late
-Too Frequent
-Too many

The family planning methods:

Natural Family Planning
1. BBT (Basal Body Temperature)
- 91 99% effective
- Observe temperature for six (6) months or more
- Taken per mouth or per axilla
- Take temperature upon waking up
- Graph
- Mark coitus schedule
- Mark time of menstruation
Important Concept!!!
Progesterone CAUSES AN INCREASE IN TEMPERATURE
Estrogen CAUSES A DROP IN TEMPERATURE

2. Cervical Mucus / Billing Method

- Spinbarkeit Test
- 91 99% effective
 - Clear, stretchable and mucus is abundant Fertile
- Cervical mucus is pasty Not Fertile

3. Sympto Thermal method

- 91 -99% effective
- Combination of basal body temperature and billing method

4. Lactational Amenorrhea Method (LAM)

- 98% effective
- Done for six (6) months
- Three Criteria for LAM:
* Child less than six (6) months
* Menses are still absent
* Pure Breast Feeding
- No pacifier, water, supplementary food

Artificial Family Planning

1. Pills
- % effective
- Usually taken at night
- COCs (Combine Oral Contraceptives)
* Not given on breast feeding mother
* With estrogen and progesterone
- POCs (Progestin Only Contraceptives)
* Taken by breastfeeding mothers

2. Intrauterine Device (IUD)

- 98% effective
- Sterile plastic device
- Best time for insertion
- During the second (2nd) day of menses
- You know you are not pregnant
- Cervix is slightly open
- ABSOLUTE CONTRAINDICATION
* When you have abnormal uterine bleeding.
* Nulliparous
* History of Pelvic Inflammatory Disease
* History of Sexually Transmitted Disease

3. Condom
- 97% effective
- Mother is most responsible in inserting the condom.

4. Depo Medroxyl Progesterone Acetate (DMPA)

- 98% effective
- Injectable; every 3 months
 - Fertility after 6 months

Permanent Family Planning

1. Tubal Ligation
- 99% effective
- Best time:
* Post partum
* Within four (4) to six (6) hours after delivery
- Do not engage in coitus three (3) days before and after the procedure
- Restrict lifting of objects heavier than newborn

2. Vasectomy
- 99% effective
- Vas deferens is cut
- Does not give immediate sterility
- There is a waiting time of six (6) months
- Sperm is still stored
- After six months, patient can engage in unprotected coitus.
- Not Popular among Filipinos

Nursing Alert!!!
Methods that are not part of Natural Family Planning: (not accepted by the
DOH)
- Withdrawal
- Calendar Method

Misconception about Family Planning Methods:

*Some family planning methods cause abortion
*Using contraceptives will render couples sterile
*Using contraceptive methods will results to loss of sexual desire

The Child Health Programs (Newborns, Infants and Children)

Newborns, infants and children are vulnerable age group for common
childhood diseases. The risk of infection among children is higher when not
screened for metabolic disorder, not exclusively breastfed, unvaccinated, not
properly managed when sick, not given with vitamin supplementation and many
others. To address problems, child health programs have been created and
available in all health facilities which includes:
Infants and Young Child Feeding
National Plan of Action for 2005 2010 for infant and young Child Feeding
Goal: Reduce child mortality rate by 2/3 by 2015
Objective: To improve health and nutrition status of infants and young children
Outcome: To improve exclusion and extended breastfeeding and complementary
feeding
 Key Messages on infant and young child feeding
* Initiate breastfeeding within 1 hour after birth
* Exclusive for the first 6 months of life
* Complemented at 6 months with appropriate foods, excluding milk
supplements
* Extend breastfeeding up to 2 years and beyond.
Breastfeeding benefits
To Infants:
Provides a nutritional complete food for the young infant
Strengthens infants immune system
Safely rehydrates and provides essential nutrients
Reduces infants exposure to infection
Increase IQ points

To Mother:
Reduces womans risk of excessive blood loss after birth
Provides natural methods of delaying pregnancies
Reduces the risk of ovarian and breast cancers and osteoporosis

To Household and the Community:

Conserve funds that would be spent on breastmilk substitute
Saves medical cost to families

Newborn Screening??????

Expanded Program on Immunization

Goal of EPI: Reduction of morbidity and mortality of immunizable diseases
Not all diseases are immunizable
Principles in Vaccinating Children:
*It is safe and immunologically effective to administer all EPI vaccines on the same
day at different sites of the body.
*Measles vaccine should be given as soon as the child is 9m/o.
*Vaccination schedule should not be restarted from beginning even if interval
exceeds recommended interval.
*Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and
vomiting are not contraindications to vaccination.
*Absolute contraindications: DPT 2 or DPT3 to a child who had convulsions or
shock within 3 days after DPT administration; BCG to immunosuppressed clients
*Giving doses of a vaccine at less than the recommended 4 weeks interval may
lessen antibody response
*False contraindications: malnutrition, low-grade fever, mild respiratory infections,
and other minor illnesses and diarrhea

Vaccine Minimum age # of Minimum Route, Storage Type/ form

at 1st dose Doses interval Dosage, temp of vaccine
between Site
 doses
BCG Birth or anytime 1 ID 2-8 C in Freeze dried,
after birth 0.05 ml body of live
Right ref attenuated
arm bacteria
DPT 6 weeks 3 4 weeks IM 2-8 C in D
0.5 ml body of weakened
Thigh ref toxin
(vastus P killed
lateralis) bacteria
T toxin
OPV 6 weeks 3 4 weeks Oral -15 to Live
2 drops -25C attenuated
Mouth (freezer) virus
Hepa B At birth 3 6 weeks IM 2-8 C in RNA
interval 0.5 ml body of recombinant
from 1st Thigh ref
dose to 2nd (vastus
dose, 8 lateralis)
weeks
interval
from 2nd to
3rd dose
Measles 9 months 1 SQ -15 to Freeze dried,
0.5 ml -25C live attenua-
Outer (freezer) ted virus
part of
upper
arm

Types and Schedule of Vaccines:

AT BIRTH 1 months 2 3 months 9-12
months months
st
1 BCG DPT1 DPT2 DPT3 MEASLES
OPV1 OPV1 OPV3
HEPB 1 HEPB 2 HEPB 3

BCG: Infant 0.05ml ID Will not totally eliminate TB

School entrants 0.1 ml ID (double dose) Will inhibit Leprosy

DPT:
HepB 5 ml IM destroyed by freezing
TT

Measles .5ml. SQ Most sensitive to heat & destroyed by heat

OPV 2 gtts/ P.O. - Trivalent ( 3 types)

SIDE-EFFECTS OF BCG:

a. Kochs Phenomenon (Nisie)

- Inflammation of the site of injection after 2-4 days
- 2 to 3 wks. Abscess will ulcerate then heals leaving a scar (12 wks.)
- Warm complex after vaccination

b. Deep abscess at site even after 12 wks.: Incision & drainage

Treatment: Powedered INH

c. Indolent ulceration- ulcer after 12 weeks

Treatment: Powedered INH

d. Glandular enlargement- abscess (2-3 weeks abscess will leave scar 12 weeks
after)

SIDE-EFFECTS OF DPT:

- Fever for a day (always bring antipyretic)-----------------------Normal

Soreness at site within 3-4 days Treatment: Warm compress-----
Normal
Abscess after a week or more- incision & drainage ------Not normal
Convulsions-----Emergency: post-pone giving of next dose

SIDE-EFFECT OF MEASLES:

- Fever 5-7 days after within 1-4 days------Normal

Mild rashes --------if it does not disappear-----Roseola

Remember the Principles:

* Even if the interval exceeded that of the expected interval, continue to give the
doses of the vaccine.
* Immunization can still be given until the child reaches 6 y/o
* If there has been a reported epidemic of measles, measles vaccine can be given
as early as six months
* BCG booster dose must be given to school entrants regardless of presence of
BCG scar.
* There is no contraindication to immunization, EXCEPT when the child had
convulsions upon giving the 1st dose of DPT.
* MALNUTRITION is not a contraindication, but RATHER AN INDICATION for
immunization since common childhood disease are often severe to malnourished
children.

*COLD CHAIN

A system used to maintain the potency of a vaccine from that of manufacturer to

the time it is given to child or pregnant woman.

Principles:

I. Storage- it should not exceed:

- 6 months @ the regional level

- 3 months @ the provincial/ district level
- 1 month @ main health centers (with refrigerators)
- Not more than 5 days @ health centers (using transport boxes)

Important Points To Remember:

Arranging of stored vaccine according to:

Type
Expiration date
Duration of storage
# of times they have been brought out to the field

The vaccine stored the LONGEST & THOSE THAT WILL EXPIRE
FIRST should be distributed or used 1st.

It is a MUST to mark ampules/vials with an X mark each time they are

carried to the field, because if a VACCINE IS NOT USED on the 3 rd trip,
it must already BE DISCARDED.

II. Transport

Use of cold dogs

III. Handling

Once opened or reconstituted, vaccines must be placed in a special cold

pack during immunization sessions.

Vaccine Half life

BCG 4 hours
DPT
Polio
Measles 8 hours
TT
HepaB

TARGET SETTING:

Involves the calculation of the eligible population.

ELIGIBLE POPULATION consists of any group of people targeted for

specific immunizations due to susceptibility to one or several of the EPI
diseases.

Management of Childhood Illnesses (IMCI)

INTEGRATED MANAGEMENT AND CHILDHOOD ILLNESSES
Definition: The Integrated Management of Childhood Illness (IMCI) is a strategy
to address the most common causes of illness (morbidity) and deaths(mortality)
among children under 5 which was developed and initiated by the World Health
Organization (WHO) in collaboration with UNICEF in 1995.

Goal: By 2010, to reduce the infant and under five mortality rate at least one third,
in pursuit of the goal of reducing it by two thirds by 2015.

AIM: To reduce death, illness and disability, and to promote improved growth and
development among children under 5 years of age.
IMCI includes both prventive and curative elements that are implemented by
families and communities as well as by health facilities.

Objective: Aims to reduce death, illness and disability, and to promote improved
growth and development among children under five years old.
*To reduce SSIGNIFICANTLY global mortality and morbidity
associated with the major causes of disease in children.
*To contribute to healthy gorth and development of children.

IMCI Components of Strategy:

*Improving case management skills of health workers.
*Improving the health systems to deliver IMCI.
*Improving family and community practices.

***For many sick children a single diagnosis may not be apparent or appropriate.

Presenting Complaint:
*Cough and / or fast breathing
*Lethargy / Unconsciousness
*Measles rash
*Very sick young infant

Steps in IMCI Process

-
-
-
-
-
-

Principles of the Integrated Care

o Assess for General Danger Signs
* Vomits everything
* Convulsion / Seizure
* Difficulty drinking / breastfeeding
* Drowsiness / Lethargy / Difficulty to awaken

o Assess for Main Symptoms

* Cough / DOB
* Diarrhea
* Ear Problem
* Fever
*M

Color Classification Classification of Disease Level of Management

*Green - Mild--- Home Care
*Yellow - Moderate--- Managed at the RHU
*Pink --- Sever--- Urgent Referral in Hospital

Assess and Identify Classifications

A. Cough and Difficulty

Micronutrient Supplementation
Dental health Early Child Development
Child Health Injuries

Its main goal is to reduce morbidity and mortality rates for children 0-9
years with the strategies necessary for program implementation.
 Essential Packages of Health Services for Newborn, Infant and Child

The Adolescent Health Program

The Adult Men Health Program

The Adult Women Health Program

The Older Person Health Program

Philippine Reproductive Health

NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL

AIM: Preventing the four major non communicable / Chronic / Lifestyle related
disease, cancer, chronic obstructive pulmonary diseases and diabetes mellitus,
through the promotion of healthy lifestyle aimed at preventing the three
commonly shared major risk factors; unhealthy diet. Physical inactivity and
smoking.

I. Integrated Community Based Non-Communicable Disease

Prevention and Control Program
FOUR MAJOR NON COMMUNICABLE DISEASES
1. Cardiovascular diseases
2. Cancer
3. Chronic Obstructive Pulmonary Diseases
4. Diabetes Mellitus

2005 It was estimated that 35 million deaths would have occurred due to these
diseases, contributing 60% of deaths worldwide. As well as a high death toll,
chronic diseases also caused disability, often for decades of a persons life.
The most widely used summary measure of the burden of disease is the
disability adjusted life year or DAILY, which combines the number of years of
healthy life lost to premature death with time spent in less than full health. One
DAILY can be thought of as one lost healthy year of life. The projected burden
of disease of these diseases is approximately half or 48% of the global burden
of disease.
2020 The diseases are expected to account for 73% of deaths and 60% of the
disease burden.
2002 Life expectancy of Filipinos has gone up to 69.6 years.
 - MORTALITY statistics showed that 7 out of 10 leading causes of
deaths in the country are diseases which are lifestyle related:
diseases of the heart and the vascular system, cancers, chronic
obstructive pulmonary diseases, accidents, diabetes, kidney
problem.
- MORBIDITY statistics also showed that hypertension and
diseases of the heart are among the top 10 leading causes of
illnesses in the country.
2003 The result of the National Nutrition and Health Survey conducted that
recently 90% of Filipinos has one or more risk factors associated with chronic,
non-communicable diseases.

THE RISK FACTORS WITH THE CORRESPONDING PREVALENCE RATES:

a. Physical Inactivity 60.5%
b. Smoking 34.8%
c. Hypertension 22.5% (SBP > 140 or DBP > 90)
d. Hypercholesterolemia 8.5% (TC > 240)
e. Obesity 4.9% (BMI > 30)
f. Diabetes 4.6%

HEALTHY LIFESTYLE defined as a way of life that promotes and protects

health and well-being. This would include practices that promotes healthy such as
healthy diet and nutrition, regular and adequate physical activity and leisure,
avoidance of substances that can be abused such as tobacco, alcohol and other
addicting substances, adequate stress management and relaxation; and practices
that offer protection from health risks such as safe sex and immunization.

GOAL:
Reduce the toll of morbidity, disability and premature deaths due to chronic, non-
communicable lifestyle related disease.

OBJECTIVES:
1. Analyze the social, economic, political and behavioral determinants of NCD that
will serve as bases for:
a. Developing policy guidelines;
b. Setting legislative and political directions, and
c. Providing financial measures to support NCD prevention and control.

2. Reduce exposure of individuals and population to major determinants of NCD

while preventing emergence of preventable common risk factors. To hasten this,
the health sector lobby for a healthy protective environment by:
a. Proposing healthy public policies that encouraged health promoting settings in
school, workplaces and communities.
b. Encouraging government to provide protection against activities by industry and
commerce that promote unhealthy products and lifestyles.
c. Communicating the consequences of major risk factors of NCD, paying
particular attention to the most vulnerable population.

3. Strengthen health care for people with NCD through health sector reforms and
cost effective interventions. In order to contribute health status individuals and
respond to the communitys basic health care needs, there must be enhance
capability to take action to address these major NCD risk factors.

To achieve significant reduction in morbidity and mortality from major NCDs, the
following approaches should characterize the program:
1. Comprehensive Approach Focused on Primary Prevention
2. Community Based Approach
3. Integrated Approach

KEY INTERVENTION STRATEGIES

1. Establishing program direction and infrastructure
2. Changing environments
3. Changing Lifestyle
4. Reorienting health services

THE ROLE OF PUBLIC HEALTH NURSE IN NCD PREVENTION AND

CONTROL

Health Advocate
Public Health Nursing promote active community participation in NCD prevention
and control through advocacy work. As a health advocate, the PHN helps the
people toward optimal degree of independence in decision making and in
asserting their right to their right to a safer and better community. This involves:
1. Informing the people about the rightness of the cause. It is important to convey
the problem, show it affects people in the community and describe possible
actions to take.
2. Thoroughly discussing with the people the nature of the alternatives, their
content and consequences. In this manner, needs demands of the people are
amplified and eventually become the framework for decision making.
3. Supporting peoples right to make a choice and to act on the choice. The people
must be assured that they have the right responsibility to make decisions and that
they do not to change their decisions because of others objections.
4. Influencing public opinion. The advocate affirms the decision made by the
people by getting powerful individuals or groups to listen, support and eventually,
make substantial changes to solve the problem.

Health Educator
Health Education is an essential tool to achieve community health. In non-
communicable disease prevention and control, health education focuses on
establishing or inducing changes in personal and group attitudes and behavior that
promote healthier living. PHNs, as well as educators and media personel, should
conduct healthier education in a variety of settings.

The health educator aims to:

1. Inform the people. Health education creates an awareness of health needs and
problems which consequently make the people become conscious of their own
responsibilities towards their own healthy. Misconceptions and ignorance will be
corrected by disseminating scientific knowledge about causes, factors, prevention
and control of non-communicable diseases.
2. Motivate the people. Telling people about health is not enough. They should be
motivated to make own choices and decisions about habits and practices that are
determined to health, such as cigarette smoking, indulgence in alcohol, physical
inactivity and fat and sugar rich diet.
3. Guide people into action. Oftentimes, people need to supported in their effort to
adopt or maintain healthy practices and lifestyles.

Health Care Provider

The Public Health Nurse is a care provider to individuals, families and
communities rendering primary, secondary and tertiary health care services in any
setting including the community and workplace.

As care provider, emphasis of care is on health promotion and disease

prevention focusing on promotion of rational diet and physical activity and
cessation of smoking and alcohol drinking. In addition, action is directed towards
the reduction of risk factors of non communicable diseases. Primary prevention
must be family oriented because the family members live and eat together and
the roots of chronic diseases are related to personal habits and lifestyle.

Community Organizer
As an organizer, the ultimate goal of the PHN is community health
development and empowerment of the people. This is achieve by:
*Raising the level of awareness of the community regarding non communicable
diseases, its causes, prevention and control;
*Organizing and mobilizing the community in taking action for the reduction of risk
factors;
*Influencing executive and legislative bodies to create and enforce policies that
favor a healthy environment.

Healthy Trainer
The PHN provides technical assistance in the assessment of the skills of
auxiliary health workers in NCD prevention and control; teaching and supervision
on clinical management of non communicable diseases and other community
based services and recording, reporting and utilization of health information
related to non communicable diseases.
Researcher
Research is an integral part of a primary health care approach to non
communicable disease prevention and control program. It is inextricably related to
community health practices since it provides the theoretical bases for developing
appropriate and responsive intervention programs and strategies.

II. Causes and Risk Factors of Major NCDs

A. Diseases of the Heart and Blood Vessels

1. Hypertension
Description
*Hypertension or high blood pressure is defined as a sustained elevation in mean
arterial pressure.
*It is not a single disease state but a disorder with many causes, a variety of
symptoms, and a range of responses to therapy.
*Hypertension is also a major risk factor for the development of others CVDs like
coronary heart disease and stroke.

ETIOLOGY / CAUSE
*In terms of etiology, hypertension is classified into primary and secondary
hypertension.
Primary hypertension has no definite cause. It is also called essential
hypertension. Secondary hypertension is usually the result of some other primary
diseases leading to hypertension such as renal disease. For the rest of these
session, we will be focusing on primary hypertension, which is more common.
*Although exact cause is unknown, primary hypertension is attributed to
atherosclerosis.

RISK FACTORS
*There is no single cause for primary hypertension but several risk factors have
been implicated in its development.
*Risk factors include family health history, advancing age, race and high salt
intake.
*Other lifestyle factors interact with these risk and contribute to the development of
hypertension such as obesity, excess alcohol consumption, intake of potassium
(diet high in sodium is generally low in potassium; increasing potassium in diet
increase elimination of sodium), calcium, and magnesium, stress, and use of
contraceptive drugs.
*FAMILY HISTORY
-People with a positive family history of hypertension are twice at risk than those
with no history.
*AGE
-Older person are at greater risk for hypertension than younger persons.
-The aging processes that increase BP include stiffening of the arteries,
decreased baroreceptor sensitivity, increase peripheral resistance and decreased
renal blood flow.
 -For years, systolic hypertension common in older persons was considered
benign and, therefore, not treated. However, the Framingham study showed that
there was two to five times increased in death from CVD associated with isolated
systolic hypertension.
*HIGH SALTH INTAKE
-Excessive salt intake does not cause hypertension in all people, nor does
reducing salt intake, reduce BP in all hypertensives. Some people are more
susceptible than others to effects of increased salt intake.
*OBESITY
-Risk for hypertension is two times greater among overweight / obese persons
compared to people of normal weight, and three times more than that of
underweight persons.
-Fat distribution is more important risk factor than actual weight as measured by
waist to hip ratio.
-The exact mechanism of how obesity contributes to the development of
hypertension is unknown. Whatever the cause, weight loss is effective in reducing
BP in obese hypertensive patients.
-Weight loss or sodium restriction in hypertensives, controlled for 5 years, more
than doubled the success of withdrawal of drug therapy.
*EXCESSIVE ALCOHOL INTAKE
-As much as 10% of hypertension cases could be related to alcohol consumption.
Regular consumption of 3 or more drinks per day increased risk of hypertension.
Systolic pressures were more markedly affected than diastolic pressure.

KEY AREAS FOR PREVENTION OF HYPERTENSION

*Encouraged proper nutrition reduce salt and fat intake.
*Prevent becoming overweight or obese weight reduction through proper
nutrition and exercise.
*Smoking cessation tobacco use promotes atherosclerosis that may contribute
to hypertension; quitting smoking anytime is beneficial; this refers to both active
and passive smokers.
*Identify people with risk factors and encouraged regular check ups for possible
hypertension and modification of risk factors.

2. Coronary Artery Disease

Description
*Coronary Artery Disease (CAD) is heart disease cause by impaired coronary
blood flow. It is also known as Ischemic Heart Disease.
*When the coronary arteries become narrowed or clogged, supply of blood and
oxygen to the heart muscle is affected.
*When there is decreased oxygen supplied to the heart muscle, chest pain (called
ANGINA) occurs.
*CAD can cause myocardial infarction (heart attack), arrhythmias, heart failure,
and sudden death.
ETIOLOGY / CAUSES
*The most common cause is atherosclerosis. This is the thickening of the inside
wall of arteries due to deposition of a fat like substance. This thickening narrows
the space through which blood can flow, decreasing and sometimes completely
cutting off the supply of oxygen and nutrients to the heart. It affects large and
medium sized arteries like the aorta, coronary arteries and the large vessels that
supply the brain.
*Atherosclerosis usually occurs when a person has high level of cholesterol in the
blood. When the level of cholesterol in the blood is high, there is a greater chance
that it will be deposited onto the artery walls.
*In diabetes mellitus, atherosclerosis is accelerated, often resulting in coronary
artery disease, myocardial infarction and stroke.

RISK FACTORS OF CAD

a. Elevated blood lipids and cholesterol level (hyperlipidemia)
b. Hypertension
c. Smoking
d. Diabetes mellitus
e. Obesity
f. Physical inactivity/ sedentary lifestyle
g. Stress

ELEVATED BLOOD LIPIDS/ CHOLESTEROL

-Increased blood cholesterol is an important risk factor in the development of CAD.
Reports have shown that modest reduction in total cholesterol can significantly
lessen CVD morbidity and mortality.
-High LDL(low- density lipoprotein) level is a risk factor of CAD. It is called the
bad cholesterol because it is the main carrier of cholesterol and contributes to
atherosclerosis. LDL level is increased by saturated fat intake, obesity, sedentary
lifestyle, smoking, androgens and certain drugs.
-Not all cholesterol is bad. HDL (high density lipoprotein) is now acknowledged
as a protective factor against coronary heart disease. HDL facilitates reverse
transport of cholesterol to the liver where it may be excreted and therefore prevent
atherosclerosis. When HDL level is below normal, this becomes a risk factor
for CAD. It is decreased in smoking, obesity and diabetes mellitus. Regular
exercise and moderate alcohol consumption increased HDL levels.

SMOKING/TOBACCO USE
-Risk of death from CAD is 70-200 times greater for men who smoke one or more
packs of cigarettes per day compared to those who do not smoke. This risk is most
seen in young people, particular those younger than 50 years old.
KEY AREAS FOR PREVENTION OF CAD
Promote regular physical activity and exercise; exercise increases HDL, prevent
obesity and improves optimum functioning of the heart.
Encourage proper nutrition particularly by limiting intake of saturated fats that
increased LDL, limiting salt intake and increasing intake of dietary fiber by
eating more vegetables, fruits, unrefined cereals and wheat breads.
Maintain body weight and prevent obesity through proper nutrition and physical
activity/ exercise.
Advise smoking cessation for active smokers and prevent exposures to second-
hand smoke by family members, friends and co-workers of active smokers. In
general, promote a smoke- free environment through advocacy and community
mobilization.
Early diagnosis, from prompt treatment and control of diabetes and
hypertension; these diseases are risk factors and contribute to the development
of coronary artery disease.

3. Cerebrovascular Disease or Stroke

Description
*Stroke is the loss or alteration of bodily function that result from insufficient supply
of blood to some parts of the brain. For human brain to function at emboli. Cocaine
use has been closely related to strokes, heart attacks and a variety of other
cardiovascular complications. Some of them have been fatal even in first time
cocaine users.

KEY AREAS FOR PREVENTION OF STROKE

*Treatment and control of hypertension - many people believe that effective
treatment of high blood pressure is a key reason for the rapid decline in the death
rates for stroke.
*Smoking cessation and promoting a smoke-free environment.
*Prevent thrombus formation in rheumatic heart disease and arrhythmias with
appropriate medications. These medications are usually taken on a daily basis.
Health workers need to remind these persons to take their medications as
prescribed.
*Limit alcohol consumption for women, not more than one drink per day, and for
men, not more than two drinks per day.
*Avoid intravenous drug abuse and cocaine.
*Prevent all other risk factors of atherosclerosis.

B. Cancer
-cancer is not a single disease.
-cancer develops when cell in a part of the body begin to grow out of control.
-they compete with normal cells for the blood supply and nutrients that normal
cells need thus causing weight loss.
-cancer cells often travels to the other part of the body where they begin to grow
and replace normal tissue. This process is called metastasis. It occurs as the
cancer cells get into the bloodstream or lymph vessels of our body.
-the immune system seems to play a role in the development and spread of
cancer. When the immune system is intact, isolated cancer cells will usually be
detected and removed from the body. When the immune system is impaired as in
people with immunodeficiency diseases, people with organ transplant who are
receiving immunosuppressant drugs, or in AIDS, there is usually an increase in
cancer incidence.

CAUSES OF CANCER
-Normal cells transform into cancer cells because of damage to DNA. People can
inherit damage DNA which account for inherited cancers. Many times though, a
persons DNA becomes damaged by exposure to something toxic in the
environment such as chemicals, radiation or viruses.
Carcinogens
*a carcinogen is an agent capable of causing cancer. This maybe a chemical, an
environmental agent, radiation and viruses.
*Effect of carcinogenic agents usually depend on the dose or amount of exposure;
the larger the dose or the longer the exposure, the greater the risk of cancer.
*Many cancers are associated with lifestyle risk factors such as smoking, dietary
factors and alcohol consumption.
Chemicals and Environmental Agents
*Polycyclic hydrocarbons are chemicals found in cigarette smoke, industrial
agent, or in food such as smoke foods. Polycyclic hydrocarbons produced from
animal fat in the process of broiling meats and are present in smoked meats and
fish.
*Aflatoxin is found in peanuts and peanut butter.
*Other includes benzopyrene, nitrosamines, and a lot more.
Benzopyrene
*Produced when meat and fish are charcoal broiled or smoked (e.g tinapa or
smoked fish). Avoid eating burned food and eat smoked foods in moderation.
*Also produced when food is fried in fat that has been reused repeatedly. Avoid
reusing cooking oil.
Nitrosamines
*These are powerful carcinogens use as preservatives in food like tocino,
longganisa, bacon and hotdog.
*Formation of nitrosamines may be inhibited by the presence of antioxidants such
as Vit. c in the stomach. Limit eating preserved food and eat more vegetables and
fruits that are rich in dietary fiber.
Radiation
*Radiation can also cause cancer including ultraviolet rays from sunlight, x-rays,
radioactive chemicals and other forms of radiation.
Viruses
* a virus can enter a host cell and cause cancer. This is found in cervical
cancer(human papilloma virus), liver cancer( hepatitis B virus), certain leukemias,
lymphoma an nasopharyngeal cancer( epstain barr virus).

RISK FACTORS OF CANCER

- risk factors for cancer include a person's age, sex and family medical
history. Other are linked to cancer thus causing factors in the environment. Still
others are related to lifestyle factors such as tobacco and alcohol use, diet and
sun exposure.

CANCER RISK FACTOR

Lung Cancer *Tobacco use, including cigarettes,
cigar, chewing tobacco and snuf.
*Radiation exposure
*Second hand smoke
Oral Cancer *Tobacco use (cigarette, cigar, pipes,
smokeless tobacco)
*Excessive alcohol use
*Chronic Irritation (e.g, Ill fitting
dentures)
*Vitamin A deficiency
Laryngeal Cancer *Tobacco used (cigarette, cigar, pipe,
smokeless tobacco)
*Poor nutrition
*Alcohol
*Weakened immune system
*Occupational exposure to wood dust,
paint, fumes
*Gender: 4 5 times more common in
man
*Age: more than 60 years.
Renal Cancer *Tobacco used (cigarette, cigar, pipe,
smokeless tobacco): increase risk by
40%.
*Obesity
*Diet: well cooked meat
* Occupational exposure: asbestos
organic solvents.
*Age: 50 70 years old.
Cervical Cancer *Tobacco use (cigarette, cigar, pipe
smokeless tobacco).
*Human papillomavirus infection
*Chlamydia infection
*Diet: low in fruits and vegetables.
*Family history of cervical cancer.
Bladder Cancer *Tobacco use (cigarette, cigar, pipe,
smokeless tobacco)
*Occupational exposure: dry solvents,
*Chronic bladder inflammation.
Esophageal Cancer *Tobacco use (cigarette, cigar, pipe,
smokeless tobacco)
*Gender: 3 times more common in man
*Alcohol
*Diet: low in fruits and vegetables.
Breast Cancer *early menarche or late menopause
*Age changes in hormone levels
throughout life, such as age at first
menstration, number of pregnancies,
and age at menopause.
*High fat diet
*Obesity
*Physical inactivity
*Some studies have also shown a
connection between alcohol
consumption and an increase risk of
breast cancer.
Prostate Cancer *While all man are at risk, several
factors can increase the chances of
developing the disease, such as
advancing age, race and diet.
*Race: more common among African
American man than among white man
*High fat diet.
*Man with a father or brother who has
had prostate cancer are more likely to
get prostate cancer themselves.
Liver Cancer *Certain types of viral hepatitis
*Cirrhosis of the liver
*Long term exposure to aflatoxin
(carcinogenic substance produced by a
fungus that often contaminates peanuts,
wheat, soybeans, corn and rice.
Skin Cancer *Unprotected exposure to strong
sunlight.
*Fair complexion.
*Occupational exposure.
Colonic Cancer *Personal or family history of polyps.
*High fat diet or low fiber diet
*History of ulcerative colitis.
*Age: > 50 years.
Uterine endometrial Cancer *Estrogen replacement therapy.
 *Early menarche / late menopause.

KEY AREAS FOR PRIMARY PREVENTION OF CANCER

*Smoking Cessation.
*Encourage Proper Nutrition.
*Drink alcohol beverages in moderation.
*Avoid / control obesity through proper nutrition and exercise.
*The sooner a cancer is diagnosed and treatment begins, the better the chances
of living longer and enjoying a better quality of life.

C. Diabetes Mellitus
Diabetes Mellitus (DM) is one of the leading causes of disability in persons over
45. More than half of diabetic persons will die of coronary heart disease. CAD
tends to occur at an earlier age and with greater severity in persons with diabetes.
It also increases the risk of dying of cardiovascular disease like heart attack or
stroke among women.
Description
*Diabetes mellitus is not a single disease. It is genetically and clinically
heterogeneous group of metabolic disorders characterized by glucose intolerance,
with hyperglycemia present at time of diagnosis.

ETIOLOGY / CAUSES
*Specific cause depends in the type of diabetes, however it is easier to think of
diabetes as an interaction between two factors: Genetic Predisposition
(diabetogenic genes) and Environment / Lifestyle (obesity, poor nutrition, lack of
exercise).

TYPES OF DIABETES
Type 1 Diabetes is insulin dependent diabetes mellitus (IDDM) and Type 2
is noninsulin dependent diabetes mellitus (NIDDM) Gestational Diabetes is
diabetes that develops during pregnancy. It may develop into full blown diabetes.
NIDDM is more common, occurring in about 90 95% of all persons with diabetes.
It is also more preventable because it is associated with obesity and diet.

Type 1 DM
*Characterized by absolute lack of insulin due to damaged pancreas, prone to
develop ketosis, and dependent on insulin injections.
*Genetic, environment, or may be acquired due to viruses (e.g. mumps, congenital
rubella) and chemical toxins (e.g. Nitrosamines).
Type 2 DM
*Characterized by fasting hyperglycemia despite availability of insulin.
*Possible causes include impaired insulin secretion, peripheral insulin resistance
and increased hepatic glucose production.
*Usually occurs in older and overweight persons (about 80%).

Risk Factors of Type 2 DM

*Family history of diabetes (i.e., parents or siblings with diabetes)
*Overweight (BMI 23 kg/m ) and obesity (BMI > 30 kg/m )
*Sedentary lifestyle
*Hypertension
*HDL cholesterol < 35 mg/dl (0.90 mmol/L) and/or triglyceride level > 250 mg/dl
(2.28mmol/L)
*History of Gestational Diabetes Mellitus (GDM) or delivery of a baby weighing 9
Ibs (4.0 Kgs)
*Previously identified to have Impaired Glucose Tolerance (IGT)

Complications
*Acute complications include diabetic ketoacidosis (DKA), hyperosmolar
hyperglycemic nonketotic coma (HHNK) and hypoglycemia especially in type 1
diabetic.
*Chronic complications cause most of the disability associated with disease. These
include chronic renal disease (nephropathy), blindness (retinopathy) coronary
artery disease and stroke, neuropathy and foot ulcers.

KEY AREAS FOR PREVENTION AND CONTROL OF DIABETES

*Maintain body weight and prevent obesity
*Encourage proper nutrition
*Promote regular physical activity and exercise
*Advise smoking cessation for active smokers and prevent exposure to
secondhand smoke.

D. Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic
morbidity and mortality throughout the world. COPD is currently the fourth leading
cause of death in the world, and more cases and deaths due to COPD can be
predicted in the coming decades because of smoking.
Description
*COPD is a disease state characterized by airflow limitation that is not fully
reversible.

CAUSES AND RISK FACTORS

*COPD is usually due to chronic bronchitis and emphysema, both of which are due
to cigarette smoking. Cigarette smoking is the primary cause of COPD.

DIAGNOSIS
*A diagnosis of COPD should be considered in any patient who has symptoms of
cough, sputum production, or dyspnea, and / or a history of exposure to risk
factors for the disease. The diagnosis is confirmed by spirometry.

COMPLICATIONS
-Respiratory failure In advanced COPD, peripheral airways obstruction,
parenchymal destruction, and pulmonary vascular abnormalities reduce the lungs
capacity for gas exchange, producing hypoxemia and, later on, hypercapnea.
-Cardiovascular disease Pulmonary hypertension, which develops late in the
course of severe COPD), is the major cardiovascular complication of COPD), and
is associated with the development of cor pulmonale and a poor prognosis.

E. Bronchial Asthma
Asthma is a chronic disease. It is an inflammatory disorder of the airways in which
many cells and cellular elements play a role. Chronic inflammation causes an
associated increase in airway hyper responsiveness that leads to recurrent
episodes of wheezing, breathlessness, chest tightness and coughing, particularly
at night or in the early morning.

These episodes are usually associated with widespread but variable airflow
obstruction that is often reversible either spontaneously or with treatment.

CAUSES AND RISK FACTORS

Asthma development has both genetic and environment component.
a. Host Factors: predispose individuals to protect them from developing asthma.
*Genetic Predisposition
*Airway hyperresponsiveness
*Gender
*Race / Ethnicity
b. Environmental Factors:
*Indoor allergens
*Outdoor allergens
*Occupational sensitizers
*Tobacco smoke
*Air pollution
*Respiratory infections
*Parasitic infections
*Socioeconomic factors
*Family size
*Diet and drugs
*Obesity

Asthma triggers
Triggers are risk factors for asthma exacerbations. These cannot cause asthma to
develop initially, but can exacerbate established asthma. They induce inflammation
and / or provoke acute bronchoconstriction. It involves further exposure to causal
factors (allergens and occupational agents) that have already sensitized the
airways of the person with asthma.
Other form of triggers are irritant gases and smoke, house dust mite found in
pillows, mattresses, carpets; respiratory infection, inhaled allergens, weather
changes, cold air, exercise, certain foods, additives and drugs.

KEY AREAS FOR PRIMARY PREVENTION AND EXACERBATION OF ASTHMA

*Recognize triggers that exacerbate asthma
*Avoid these triggers if possible, particularly smoking
*Promote exclusive breastfeeding as long as possible; early introduction to cows
milk may predispose baby to allergens and possible asthma.

RISK FACTORS KEY AREAS FOR PREVENTION

*Elevated blood lipid PROMOTE PROPER NUTRITION
(Hyperlipidemia) *Limit intake of fatty, salty and
*High intake of fatty foods preservative foods.
*Inadequate intake of *Increase intake of vegetable and
dietary fiber fruits.
*Avoid high caloric low nutrient
value food like junk food, Instant
noodles, softdrinks.
*Start developing healthy habits in
children.
*Overweight and obesity. ENCOURAGE MORE PHYSICAL
*Sedentary lifestyle ACTIVITY AND EXERCISE
*Moderate physical activity of
atleast 30 minutes for most days.
*Integrate physical activity and
exercise into regular day -to- day
activities.
*Walking is one form of exercise
that is possible for including older
persons with cardiovascular
disease.
*Smoking, both active or PROMOTE SMOKE FREE
passive / second hand ENVIRONMENT
*Smoking cessation for active
smokers to reduce risk.
*Prohibit smoking inside living
areas, houses and closed areas.
*Excessive use of alcohol DISCOURAGE EXCESSIVE
DRINKING OF ALCOHOLIC
BEVERAGES
*Hyperlipidemia, *EARLY DIAGNOSIS AND
Hypertension, Diabetes PROMPT TREATMENT.
Mellitus
III. Risk Assessment and Screening Procedures
The basis of non-communicable disease (NCD) prevention is the identification
of the major common risk factors and their prevention and control. A risk
factors refers to any attribute, characteristics or exposure of an individual,
which increases the likelihood of developing NCD. Assessment of these risk
factors and screening for NCDs in individuals and communities important in
preventing and controlling future diseases.

Risk Factor Assessment:

A. Cigarette Smoking
* Assess smoking status by asking individuals whether they smoke
or not. In order to monitor trends, collect information not only on
smoking status but also on age of onset, amount smoked by current
and former smokers, and quit attempts. Every client should be asked
about tobacco use. Smoking status should be recorded and updated
at regular intervals.

B. Nutrition/Diet
* Diet is a combination of related behaviors, which are often culture
specific. Comprehensive nutritional assessment involves detailed
recall methods (e.g., 24 hours food diary) or extensive food
frequency, questionnaires and estimation of nutrients based on food
composition tables. At the very least, the following questions should
be ask to determine the contribution of the patients nutrition to NCD
development. These include:
*Vegetables Number of servings of vegetables per day and usual
types of vegetables eaten.
*Fruits Number of fruits per day.
*Fat
Number of servings of meat and poultry.
Which part (e.g. skin of chicken)
How often fried foods are eaten
How often fast foods / restaurants are visited.
*Sodium / Salt
How often preserved, canned and instant foods are
eaten per weak.
How much salt is added when cooking food.

GUIDELINES FOR ADEQUATE VEGETABLE AND FRUIT INTAKE

*Eat 2 3 servings of vegetables each day, one serving of which is
green or yellow leafy vegetables. One serving means:
Raw vegetables 1 cup
Cooked vegetables cup
 *Eat at least 2 serving of fruit per day, 1 serving is a vitamin C rich
fruit. One serving of fruit depends on type of fruit.

C. Overweight/Obesity
* Body fat can best be assessed using Body Mass Index (BMI) and
waist circumference. BMI correlates closely with total body fat in
relation to height and weight. However, this does not compensable
for frame size, does not indicate fat distribution, and cannot be
adjusted for age.

Weight In children and adults, regular weighing is the simplest way

of knowing if energy balance is being achieved. The use of weight
for age or weight for height tables will help determines the
desirable weight either according to age (children) or height (adults).

Body Mass Index (BMI) BMI is calculated using the following

formula:
BMI = Weight in kgs / Height in meters.

GUIDELINE
Based on Asia Pacific Obesity Guidelines:
BMI Interpretation
<18.5 Underweight
18.6 22.9 Healthy weight
>23.0 Overweight
23.0 24.9 At risk
25.0 29.9 Obese 1
>30.0 Obese 2

Waist Circumference (WC) This alone is an accurate measure of

the amount of visceral fat. Remember that the central obesity is a
significant risk factor to heart disease and stroke.

ASSESSING DEGREE OF RISK CO MORBID CONDITIONS

BASED ON BMI AND WC
Measuring Waist Circumference
Procedure: Subject should be unclothed at the waist, and standing
with abdomen relaxed, arms at the sides, feet together. Use non
stretchable, measure and do not compress the skin.
Clinical Thresholds:
Men <90 cm (35 inches)
Women <80 cm(31.5 inches)
Greater than these value is not normal and the person is at risk even
if BMI is normal.
 Waist Hip Ratio (WHR) Another useful measures of obesity is the
waist to hip ration by dividing the waist circumference at the
narrowest point by the hip circumference at the widest point.
WHR = Waist circumference (cm) / Hip circumference (cm)
WHR Interpretation:
*Less than 1.0 (men); less than 0.85 (women) = normal WHR
*Equal to or greater than 1.0 (men) and 0.85 (women) = android or
central obesity.
D. Physical Inactivity/Sedentary Lifestyle
*Assessment of physical activity includes on type of work, means of
transportation and leisure time activities like sports and formal
exercise.
Minimum Recommended amount of physical activity needed to
achieve health benefit:
Regular Physical Activity: Minimum 30 minutes per day most days of
the week preferably daily.
If moderate intensity: 5 or more days of the week.
If vigorous intensity: 3 or more days of the week.

Guideline:
At least 30 minutes of cumulative physical activity moderate in
intensity for most days of the week.

E. Excessive Alcohol Drinking

*Assess habitual alcohol intake and risky behavior, such as driving or
operating machinery while intoxicated.

Screening Guidelines and Procedures:

A. Screening for Hypertension

B. Screening for Elevated Cholesterol in the Blood

C. Screening for Diabetes Mellitus
D. Screening for Cancer
E. Screening for COPD
F. Screening for Asthma
IV. Promoting Physical Activity and Exercise
V. Promoting Proper Nutrition
VI. Promoting a Smoke-Free Environment
VII. Promoting Stress Management
VIII. Programs for the Prevention and Control of other non-communicable
diseases
A. National Prevention of Blindness Program
B. Mental Health and Mental Disorders
C. Renal Disease Control Program
D. Community-based Rehabilitation Program
COMMUNICABLE DISEASE PREVENTION AND CONTROL
COMMUNICABLE DISEASE
*It is an illness caused by an infectious agent or its toxic products that are
transmitted directly or indirectly to a well person through an agent, vector
or inanimate object.
TWO TYPES
INFECTIOUS DISEASE
*Not easily transmitted by ordinary contact but require a direct inoculation through
a break in the previously intact skin or mucous membrane
CONTAGIOUS DISEASE
*Easily transmitted from one person to another through direct or indirect means
TERMINOLOGIES
DISINFECTION destruction of pathogenic microorganism outside the body
by directly applying physical or chemical means
Concurrent method of disinfection done immediately after the
infected individual discharges infectious material/secretions. This
method of disinfection is when the patient is still the source of
infection
Terminal applied when the patient is no longer the source of
infection.
Disinfectant -chemical used on non living objects
Antiseptic chemical used on living things.
Bactericidal kills microorganism
Sterilization complete destruction of all microorganism
General Principles
Pathogens move through spaces or air current
Pathogens are transferred from one surface to another whenever objects
touch
Hand washing removes microorganism
Pathogens are released into the air on droplet nuclei when person speaks,
breaths, sneezes
Pathogens are transferred by virtue of gravity
Pathogens move slowly on dry surface but very quickly through moisture
INFECTION
invasion and multiplication of microorganisms on the tissues of the host
resulting to signs and symptoms as well as immunologic response
injures the patient either by:
o competing with the hosts metabolism
o cellular damage produced by the microbes intracellular multiplication
Factors of severity of infection
o disease producing ability
o the number of invading microorganism
o The strength of the hosts defence and some other factors.
Epidemiological triad:
o Agent
o Host
 o Environment

Classification according to incidence:

SPORADIC - disease that occur occasionally and irregularly with no
specific pattern
ENDEMIC those that are present in a population or community at times.
EPIDEMIC diseases that occur in a greater number than what is expected
in a specific area over a specific time.
PANDEMIC is an epidemic that affects several countries or continents

Causes of INFECTION
Some bacteria develop resistance to antibiotics
Some microbes have so many strains that a single vaccine cant protect
against all of them ex. Influenza
Most viruses resist antiviral drugs
Opportunistic organisms can cause infection in immunocompromised
patients
Most people have not received vaccinations
Increased air travel can cause the spread of virulent microorganism to
heavily populated area in hours
Use of immunosupressive drugs and invasive procedures increase the risk
of infection
Problems with the bodys lines of defense

Three Lines of Defense

FIRST LINE OF DEFENSE
o MECHANICAL BARRIERS
o CHEMICAL BARRIERS
o BODYS OWN POP. OF MICROORGANISM - microbial
antagonism principle
SECOND inflammatory response
o Phagocytic cells and WBC to destroy invading microorganism
manifesting the cardinal signs
THIRD immune response - Natural/Acquired: active/passive

RISK FACTORS
Age, sex, and genes
Nutritional status, fitness, environmental factors
General condition, emotional and mental state
Immune system
Underlying disease ( diabetes mellitus, leukemia, transplant)
Treatment with certain antimicrobials (prone to fungal infection), steroids,
immunosuppresive drugs etc.
Mode of Transmission
Contact transmission
Direct contact - person to person
Indirect - thru contaminated object
o Droplet spread - contact with respiratory secretions thru cough,
sneezing, talking. Microbes can travel up to 3 feet.
Airborne Transmission
Vector Borne Transmission
Vehicle Borne Transmission

Emerging problems in infectious diseases

Developing resistance to antibiotics eg: anti tb drugs, MRSA, VRE
Increasing numbers of immunosuppressed patients.
Use of indwelling lines and implanted foreign bodies has increased.

INFECTION CONTROL MEASURES

UNIVERSAL PRECAUTION All blood, blood products and secretions from
patients are considered as infected.
WORK PRACTICE CONTROL
Handwashing
o Before and after using gloves, after hand contact with patients,
patients blood and other potentially infected materials.
Protective Equipment shall be removed immediately upon leaving the work
area. Like apron, mask, gloves etc.
o Place in designated area.
Used needles and sharps shall not be bent, broken, recapped. Used
needles must not be removed from disposable syringes.
 Eating, drinking, smoking, applying cosmetics or handling contact lenses
are prohibited in work areas.
Foods and drinks shall not be stored in refrigerators, freezers where blood
or other infectious materials are stored.
All procedures involving blood or other potentially infectious materials shall
be performed in such a manner as to minimize splashing, or spraying.

Control Measures
Masking Wear mask if needed. Patient with infectious respiratory
diseases should wear mask.
Handwashing Practice it with soap and water.
Gloving Wear gloves for all direct contact with patients. Change gloves
and wash hands every after each patient.
Gowning - Wear gown during procedures which are likely to generate
splashes of blood or sprays of blood and body fluids, secretions or excretions.
Eye protection (goggles) wear it to prevent splashes.
Environmental disinfection Clean surfaces with disnfectant 70%
alcohol,diluted bleach)
Ex. Normal clean clean the room post discharge, final clean- MRSA and
infectious pts.

ISOLATION PRECAUTIONS
Separation of patients with communicable diseases from others so as to
reduce or prevent transmission of infectious agents.
7 Categories Recommended in isolation
Strict isolation prevent spread of infection from patient to patient/staff.-
handwashing, infectous materials must be discarded, use of single room,
use of mask, gloves and gowns and (-) pressure if possible
Contact isolation prevent spread by close or direct contact
Respiratory isolation prevent transmission thru air.
TB isolation for (+) TB or CXR suggesting active PTB.
Enteric Isolation direct contact with feces
Drainage/secretion precaution- prevents infection thru contact with
materials or drainage from infected person.
Universal Precaution for handling blood and body fluids. (Bloods, pleural
fluid, peritoneal fluid etc.)
PREVENTION
Health Education educate the family about
Immunization
MOT
Environmental sanitation breeding places of mosquito, disposal of feces
Importance of seeking medical advice for any health problem
Preventing contamination of food and water.
Environmental Sanitation
o Water Supply Sanitation Program DOH thru EHS (Environmental Health
Services)
o Policies on Food Sanitation Program
o Policies on Hospital Waste Management
The Community Health Nurse is in the best position to do health education
such as
o > development of materials for environmental sanitation
o > providing group counselling, holding community assemblies and
conferences.
o > create programs for sanitation
o > be a role model
Immunization introduction of specific antibody to produce immunity to certain
disease.
o Natural passive (from placenta), active (thru immunization & recovery
from diseases)
o Artificial passive (antitoxins), active (vaccine, toxoid)
Maintain vaccine potency by preventing:
o Heat and sunlight
o Freezing
Antiseptic/ disinfectants/ detergents lessen the potency of vaccine. Use
water only when cleaning fridge/ref.
COLD CHAIN SYSTEM maintenance of correct temperature of vaccines,
starting from the manufacturer, to regional store, to district hospital, to the health
center to the immunizing staff and to the client.

Disease Acquired Thru the Respiratory tract

TUBERCULOSIS
Chronic respiratory disease affecting the lungs characterized by formation
of tubercles in the tissues---> caseation --> necrosis ---> calcification.
AKA: Phthisis, Consumption, Kochs, Immigrants disease
Etiologic agent: Mycobacterium tuberculosis
Incubation period: 2 10 wks.
Period of communicability: all throughout the life if not treated
MOT: Droplet
Sources of infection sputum, blood, nasal discharge, saliva

Classification
1. Inactive asymptomatic, sputum is (-), no cavity on chest X ray
2. Active (+) CXR, S/S are present, sputum (+) smear
Classification 0-5
A. Minimal slight lesion confined to small part of the lung
B. Moderately advanced one or both lungs are involved, volume affected
should not extend to one lobe, cavity not more than 4 cm.
C. Far advance more extensive than B

MANIFESTATIONS
Primary Complex: TB in children: non contagious, children swallow phlegm,
fever, cough, anorexia, weight loss, easy fatigability
 Adult TB
o afternoon rise in temperature
o night sweats
o weight loss
o cough dry to productive
o Hemoptysis
o sputum AFB (+)
Milliary TB - very ill, with exogenous TB like Potts disease
Primary Infection
o Asymptomatic
o No manifestations even at CXR, Sputum AFB
Primary Complex
o Minimal manifestations
o Lymphadenopathy

DX
Tuberculin testing
CXR
Sputum AFB

Prevention
BCG
Avoid overcrowding
Improve nutritional status

TX
DOTS
6 months of RIPE
Respiratory isolation,
Take medicines religiously prevent resistance
Stop smoking
 Plenty of rest
Nutritious and balance meals, increase CHON, Vit. A, C

MENINGITIS
Inflammation of the meninges usually some combination of headache,
fever, stiff neck, and delirium
Meningococcemia: cerebrospinal fever
o Etiologic agent: Neisseria meningitidis
o Incubation: 2-10 days
o MOT: droplet
Acute meningococcemia - with or without meningitis
o Waterhouse Friederichsen Syndrome

Diagnostic exams:
o Lumbar tap, CSF - high WBC and CHON, low glucose
Manifestations:
o Sudden onset of fever x 24h
o Petechiae, Purpuric rashes
o Meningeal irritation
Stiff neck
Opisthotonus
Kernigs sign
Brudzinski sign
o ALOC (Altered level of consciousness)
o S/S of Increase ICP

Nursing Mgt:
Administer prophylactic antibiotics: Rifampicin - drug of choice
Aquaeous Pen
Mannitol
Dexamethasone
Priority: AIRWAY, SAFETY
 Maintain seizure precaution
Respiratory precaution
Handwashing
Suction secretions

DIPTHERIA
Acute contagious disease characterized by generalized toxemia coming from
localized inflammatory process
Etiologic agent: Corynebacterium Diptheria (Klebs loffer bacillus)
Incubation period: 2-5 days
Period of communicability: variable, ave:2-4 weeks
MOT Droplet, direct or intimate contact, fomites, discharge from nose, skin,
eyes

Manifestation
PSEUDOMEMBRANE - grayish white, smooth, leathery and spider web
like structure that bleeds when detached
Types of Respiratory Diptheria
NASAL
o serous to serosanginous purulent discharge
o Pseudomebrane on septum
o Dryness/ excoriation on the upper lip and nares
PHARYNGEAL
o pharyngeal pseudomembrane
o bull neck ( cervical adenitis)
o Difficulty swallowing
LARYNGEAL
o Sorethroat, pseudomembrane
o Barking, dry metallic cough

Complications
o Due to TOXEMIA
Toxic endocarditis
Neuritis
Toxic nephritis
o Due to Intercurrent Infection
Bronchopneumonia
Respiratory failure

DX
Nose and throat swabs - culture of specimen form beneath membrane
Virulence test
SHICKs TEST: test for susceptibility to diptheria
MOLONEYs TEST: test for hypersensitivity to diphtheria
MANAGEMENT
1. Penicillin, Erythromycin
2. Diptheria Antitoxin after skin test if (+), fractional dose
3. Supportive
O2, if laryngeal obstruction tracheostomy
CBR for 2 weeks
Increase fluids, adequate nutrition- soft food, rich in Vit C
Ice collar
4. Isolation till 3 NEGATIVE cultures

Prevention
DPT

PERTUSSIS (whooping cough)

Repeated attacks of spasmodic coughing with series of explosive expirations
ending in long drawn force inspiration
Etiologic agent: Bordetella pertusis or Haemiphilus pertussis
Incubation period: 7-14 days
Period of communicability: 7 days post exposure to 3 wks post disease onset
MOT Droplet

Manifestation
o rapid cough 5-10x in one inspiration ending a high pitched
whoop.
Catarrhal slight fever in PM, colds, watery nasal discharge, teary
eyes, nocturnal coughing, 1-2 weeks
Paroxysmal Spasmodic stage; 5-10 successive forceful coughing
ending with inspiratory whoop, involuntary micturition and defecation,
choking spells, cyanosis
Convalescent 4th- 6th week; diminish in severity, frequency
Complications:
Otitis media
Acute bronchopneumonia
Atelectasis or emphysema
Rectal prolapse, umbilical hernia
Convulsions (brain damage - asphyxia, hemorrhage)

Dx:
Elevated WBC
Nasopharyngeal swab
Nursing Management
Prevention:
o DPT
Parenteral fluids
Erythromycin - drug of choice
Prone position during attack
Abdominal binder
Adequate ventilation, avoid dust, smoke
Isolation
Gentle aspiration of secretions

MEASLES
Acute viral disease with prodromal fever, conjunctivitis, coryza, cough
and Kopliks spots
AKA: Rubeola, 7-day measles
Etiologic agent: Morbilli Paramyxoviridae virus
Incubation period: 10-12 days
Period of communicability: 3 days before and 5 days after the
appearance of rashes. Most communicable during the height of rash.
MOT: Airborne
Sources of infection secretions from eyes, nose and throat

Pathognomonic sign: Kopliks spots

Manifestations
1.Pre eruptive stage / Prodromal (10-11 days)
o Coryza, Cough, Conjunctivitis
o Kopliks Spots, whitish spot at the inner cheek
o Fever, photophobia
2. Eruptive stage
o Maculopapular rashes
o Rash is fully developed by 2nd day
o High grade fever on and off
o Anorexia, throat is sore
3. Convalescence (7-10 days)
o Desquamation of the skin

Diagnostics
Nose and throat swab

Treatment
1. Antiviral drugs- Isoprenosine
2. Antibiotics if with complications
3. Supportive O2, IVF
Complications bronchopneumonia, otitis media, encephalitis

Nursing Management
Preventive measles vaccine at 9 months, MMR 15 months and
then 11-12; defer if with fever, illness
Isolation - contact/respiratory
TSB , Skin care daily cleansing wash
Oral and nasal care
Plenty of fluids
Avoid direct glare of the sun- due to photophobia
GERMAN MEASLES
Mild viral illness caused by rubella virus.
AKA: Rubella; 3-Day Measles
Incubation period from exposure to rash 14 -21d
Period of communicability one week before and and 4 days after onset
of rashes. Worst when rash is at its peak.
MOT: Droplet, nasal ceretions, transplacental in congenital
Manifestations
1. Prodromal low grade fever, headache , malaise, colds, lymph node
involvement on 3rd to 5th day
2. Eruptive FORSCHEIMERS SPOTS: pinkish rash on soft palate, rash
on face, spreading to the neck, arms and trunk
o lasts1-5 days with no pigmentation or desquamation
o muscle pain
Treatment
o symptomatic treatment
Complications
1. Encephalitis, neuritis
2. Rubella syndrome microcephaly, mental retardation, deaf mutism,
congenital heart disease

RISK for congenital malformation

1. 100% when maternal infection happens on first trimester of pregnancy.
2. 4% - second/third trimester

Nursing Management
1. Isolation. Bed rest
2. Room darkened photophobia
3. Encourage fluid
4. Like measles tx

PREVENTION;
MMR, Pregnant women should avoid exposure to rubella patients
Administration of Immune serum globulin one week after exposure to rubella.

CHICKEN POX
Acute and highly contagious viral disease characterized by vesicular eruptions
on the skin
Infectious agent Herpes zoster virus or Varicella zoster
Incubation period 10 -21 days
Period of communicability: 1 day before eruption up to 5 days after the
appearance of the last crop
MOT: airborne, direct, indirect
o Direct contact thru shedding vesicles,
o Indirect thru linens or fomites
Manifestations
Pre eruptive: Mild fever and malaise
Eruptive: rash starts from trunk
Lesions - red papules then becomes milky and pus like within 4 days,
Pruritis

Stages of skin affectations

o Macule flat
o Papule elevated above the skin diameter about 3 cm
o Vesicle
o Pustule
o Crust scab , drying on the skin
Complications
o pneumonia, sepsis
Treatment
Zovirax 500mg tablet 1 tab BID X 7 days
Acyclovir
Oral antihistamine
Calamine lotion
Antipyretics

NURSING MANAGEMENT
Strict isolation until all vesicles scabs disappear
Hygiene of patient
Cut finger nails short
Baking soda - pruritus
PREVENTION: Live attenuated varicella vaccine
VZIG - effective if given 96h post exposure

Herpes Zoster
Acute inflammatory disease known to be caused by herpes virus varicellae or
VZ virus
Infection of the sensory nerve charac by extremely painful infection along the
sensory nerve pathway
Occurs as reinfection of VZ virus
MOT
o Direct
o Indirect airborne
Incubation: 1-2 weeks
Diagnostic procedure
o Hx of chickenpox
o Pain and burning sensation over lesions of vesicles along nerve
pathway
o Smear of vesicle fluid- giant cells
o Viral cultures of vesicle fluid
o Electron microscopy
o Giemsa-stained scraping multinucleate giant epithelial cells
S/S
o Burning, itching, pain then erythematous patches followed by crops
of vesicles
o Eruptions are unilateral
o Lesions may last 1-2 weeks
o Fever, regional lymphadenopathy
o Paralysis of cranial nerve, vesicles at external auditory canal
o Paralytic ileus, bladder paralysis, encephalitis

Complications
o Opthalmia herpes blindness because of damage of gasserian
ganglion
o Geniculate herpes deafness because of infection of 7 th CN (AKA:
Ramsay Hunt Syndrome)

Nursing Intervention
o Compress of NSS or alluminum acetate over lesions
o Analgesics, sedatives weeks to mos
o Steroids
o Keep blister covered with sterile powder esp after break
o Prevent bacterial invasion
o Encourage proper disposal of secretions and usage of gown and
mask
MUMPS
Acute viral disease manifested by swelling of one or both of the parotid
glands, with occasional involvement of other glandular
structures,particularly testes in male.
Etiologic agent filterable virus of paramyxovirus group usually found in
saliva of infected person.
AKA: Epidemic/ infectious parotitis
Incubation period: 14 -25 days.
Period of communicability 6d before and 9d post onset of parotid gland
swelling.
o 48 hrs immediately preceding the onset of swelling is the highest
communicability.
MOT: direct, indirect - droplet, airborne

CLINICAL MANIFESTATIONS
1. Sudden headache, earache, loss of appetite
2. Swelling of the parotid gland
3. Pain is related to extent of the swelling of the gland which reaches its peak in 2
days and continues for 7-10 days.
4. Fever may reach 40 C during acute stage,
5. One gland may be affected first and 2 days later the other side is involved

COMPLICATIONS
1. Orchitis testes are swollen and tender to palpation.
2. Oophoritis- pain and tendeness of the abdomen
3. Mastitis
4. Deafness may happen
5. Meningo-encephalitis -possible

DIAGNOSTIC PROCEDURES
 1. Viral culture
2. WBC Count

PREVENTION: MMR Vaccine

TREATMENT MODALITIES
1. Antiviral drugs
2. NSAIDS - Acetaminophen
Nursing Interventions
o Symptomatic
o Application of warm/ cold compress
o Oral care, warm salt water gargle
o Diet semi solid, soft food easy to chew
Acid foods/fluids fruit juices may increase discomfort

Diseases Acquired thru GIT

Diseases caused by Bacteria
o Typhoid Fever
o Cholera
o Dysentery
Diseases caused by Virus
o Poliomyelitis
o Infectious Hepatitis A
Diseases caused by Parasites
o Amoebiasis
o Ascariasis

TYPHOID FEVER
Infection of the GIT affecting the lymphoid tissues(ulceration of Peyers
patches) of the small intestine
Etiologic Agent: Salmonella typhosa and typhi, Typhoid bacillus
Incubation period: 1-2 weeks
Period of communicability: as long as the patient is excreting the
microorganism,
MOT: fecal-oral route, contaminated water, milk or other food
Sources of Infection
o A person who recovered from the disease can be potential carrier.
o Ingestion of shellfish taken from waters contaminated by sewage
disposal
o Stool and vomitus of infected person are sources of infection.
CLINICAL MANIFESTATIONS
ONSET
Ladderlike fever
Nausea, vomiting and diarrhea
RR is fast, skin is dry and hot, abdomen is distended
Head-ache, aching all over the body
Worsening of symptoms on the 4th and 5th day
Rose spots
TYPHOID STATE
Tongue protrudes- dry and brown
sordes
(coma vigil)
(subsultus tendinus)
(Carphologia)
Always slip down to the foot part of the bed,
Severe case - delirum sets in often ending in death

Complications
o Hemorrhage, Peritonitis, Pneumonia, Heart failure, Sepsis

DIAGNOSTIC PROCEDURES
1. WBC elevated
2. Blood Culture (+) S. typhosa
3. Stool Culture (+)
4. Widal test blood serum agglutination test
O antigen active typhoid
 H antigen- previously infected or vaccinated
Vi antigen - carrier

TREATMENT
1. Chloramphenicol drug of choice
2.Paracetamol

NURSING MANAGEMENT
1. Restore FE balance
2. Bedrest
3. Enteric precaution
4. Prevent falls/ safety prec
5. Oral/personal hygiene
6. WOF intestinal bleeding-bloody stool, sweating, pallor
7. NPO, BT

CHOLERA
An acute bacterial disease of the GIT characterized by profuse diarrhea,
vomiting, loss of fluid.
Etiologic agent: Vibrio cholerae, V. comma
Pathognomonic sign: rice watery stool
Incubation period: 2-3 days
Period of Communicability: entire illness, 7-14d
MOT: fecal oral route

Clinical manifestations
o Acute, profuse, watery diarrhea.
o Initial stool is brown and contains fecal material becomes rice water
o Nausea/ Vomiting
Signs and symptoms of Dehydration
o poor tissue turgor, eyes are sunken
o Pulse is low or difficult to obtain, BP is low and later unobtainable.
o RR rapid and deep
o Cyanosis later
 o Voice becomes hoarse speaks in whisper
Oliguria or anuria
Conscious, later drowsy
Deep shock
Death may occur as short as four hours after onset.
Usually first or 2nd day if not treated.

Principal deficits
1. Severe dehydration - circulatory collapse
2. Metabolic acidosis loss of large volume of bicarbonate rich stool. RR rapid
and deep
3. Hypokalemia massive loss of K. abdominal distention paralytic ileus

DIAGNOSTIC EXAMS
Fecal microscopy
1. Rectal swab
2. Stool exam

Treatment
1. IVF- rapid replacement
2. Oral rehydration
3. Strict I and O
4. Antibiotics Tetracycline, Cotrimoxazole.

NURSING MANAGEMENT
1. Medical Asepsis
2. Enteric precaution
3. VS monitoring
4. Intake and Output
5. Good personal hygiene
6. Proper excreta disposal
7. Concurrent disinfection.
8. Environmental sanitation

PREVENTION
1. Protection of food and water supply from fecal contamination.
2. Water should be boiled/ chlorinated.
3. Milk should be pasteurized.
4. Sanitary disposal of human excreta
5. Environmental sanitation.

DYSENTERY
Acute bacterial infection of the intestine characterized by diarrhea and
fever
 Etiologic Agent: Shigella group
o Shigella flesneri - commmon in the Philippines
o Shigella boydii, S. connei,
o S. dysenteria most infectious, habitat exclusively in man, they
develop resistance to antibiotics
Incubation period 7 hrs. to 7 days
Period of communicability during acute infection until the feces are (-)
MOT fecal-oral route, contaminated water/ milk/ food.

Clinical manifestations
Fever esp. in children
Nausea, vomiting and headache
Anorexia, body weakness
Cramping abdominal pain (colicky)
Diarrhea bloody and mucoid
Tenesmus
Weight loss

DIAGNOSTICS
Fecalysis
Rectal Swab/culture
Bloods WBC elevated
Blood culture

TREATMENT
Antibiotics- Ampicillin, Cotrimoxazole, Tetracycline
IVF
Anti diarrheal are Contraindicated

NURSING MANAGEMENT
1. Maintain fluid and electrolyte balance
2. Restrict food until nausea and vomiting subsides.
3. Enteric precaution
4. Excreta must be disposed properly.
 5. Prevention- food preparation, safe washing facilities, fly control.

POLIOMYELITIS
An acute infectious disease caused by any of the 3 types of poliomyelitis virus
which affects mainly the anterior born cells of the spinal cord and the medulla,
cerebellum and the midbrain
AKA: Acute anterior poliomyelitis, heinmedin disease, infantile paralysis
Etiologic Agent: Poliovirus (Legio Debilitans)
3 Types of Poliovirus
Type I - most paralytogenic, most frequent
Type II - next most frequent
Type III - least frequent associated with paralytic disease

3 Strains
o Brunhilde
o Laasing
o Leon
MOT: Fecal-Oral
Incubation period: 7-14 days ave (3-21 days)
Period of communicability:
o 7-16 days before and few days after onset of s/s
Signs and Symptoms:
o Febrile episodes with varying degrees of muscle weakness
o Occasionally progressive Flaccid Paralysis

3 Types of Paralysis
Spinal Paralytic
o Flaccid paralysis
o Autonomic involvement
 o Respiratory difficulty
Bulbar Form
o Rapid & serious
o Vagus and glossopharyngeal nerves affected
o Cardiac and respiratory reflexes altered
o Pulmo edema
o Hypertension, impaired temp regulation
o Encephalitic s/s
Bulbospinal
o Combination
Minor Polio
o Inapparent / subclinical
o Abortive: recover within 72 hours; flulike; backache; vomiting
Major Polio
o Paralytic: asymmetrical weakness, paresthesia, urinary
retention, constipation
o Non paralytic: slight involvement of the CNS; stiffness and
rigidity of the spine, spasms of hamstring muscles, with paresis
o Tripod position: extend his arms behind him for support when
upright
o Hoynes sign: head falls back when he is in supine position with
the shoulder elevated
o Meningeal irritation: (+) Brudzinski, Kernigs sign

Diagnostic tests:
Throat swab, stool exam, LP

Nursing Interventions:
Supportive, Preventive Salk and Sabin Vaccine
NO morphine
Moist heat application for spasms
AIRWAY: tracheotomy
Footboard to prevent foot drop
Fluids, NTN, Bedrest
Enteric and strict precautions

HEPATITIS A
Inflammation of the liver caused by hepatitis A virus
AKA: infectious hepatitis
Incubation period: 2-6weeks
MOT: oral-fecal/ enteric transmission
Diagnostic test: liver function (SGOT/SGPT)
Clinical manifestations
Prodromal/ pre icteric
S/S of URTI
Weight loss
Anorexia
RUQ pain
Malaise
Icteric
Jaundice
Acholic stool
Bile-colored urine

Diagnostic tests: HaV Ag, Ab, SGOT, SGPT

Nursing Interventions:
o Provide rest periods
o Increase CHO, mod Fat, low CHON
o Intake of vits/minerals
o Proper food preparation/handling
o Handwashing to prevent transmission

AMOEBIASIS
Involves the colon in general but may involve the liver or lungs as well
Etiologic agent: Entamoeba histolytica
Incubation: 3-4 weeks
Period of communicability: duration of illness
MOT: fecal oral route
 Indirect - Ingestion of food contaminated with E.Histolytica cysts,
polluted water supply, exposure to flies, unhygienic food handlers.
Direct contact sexual, oral, or anal, proctogenital

Clinical manifestations
Intermittent fever
Nausea, vomiting, weakness
Later : anorexia, weight loss, jaundice
Diarrhea watery and foul smelling stool often containing blood streaked
mucus.
Colic and abdominal distention
Intestinal perforation bleeding

DIAGNOSTIC EXAM
Stool Exam ( cyst, amoeba+++)
WBC elevated

TREATMENT
o Amoebacides Metronidazole(Flagyl) 800mg TID X 7days
o Bismuth gylcoarsenilate combined with Chloroquine
o Antibiotic Ampicillin, Tetracycline, Chloramphenicol
o Fluid replacement IVF, oral

NUSING MANAGEMENT
Enteric precaution
Health education- boil drinking water (20-30 mins), Use mineral water.
Cover leftover food.
Avoid washing food from open drum/pail.
Wash hands after defecating and before eating.
Observe good food preparations.
Fly control

ASCARIASIS
 Helminthic infection of the small intestine caused by ASCARIS
LUMBRECOIDES
MOT: fecal-oral
Incubation period: 4-8 weeks
Communicability: as long as mature fertilized female worms live in intestine

Diagnostic exams: Microscopic identification of eggs in stool, CBC, Hx of passing

out of worms (oral or anal), X-ray.

Signs and Symptoms

o Stomachache
o Vomiting
o Passing out of worms
o Complications
o Energy / Protein malnutrition, Anemia
o Intestinal obstruction

Treatment:
o Pyrantel Pamoate
o Piperazine Citrate
o Mebendazole, Tetramizole
o Dicyclomine Hcl, NSAIDS for abdominal pain
o For intestinal obstruction
Decompression
Fluid and electrolyte therapy
If persistent, laparotomy
o Follow-up stool exam 1-2 weeks after treatment

Nursing Intervention:
o Isolation- not needed
o Enteric precaution
o Handwashing
o Proper nutrition
o Maintenance of hydration / fluid balance / boil of water
o Improve personal hygiene
o Proper food prep/handling
o Administer meds (NSAIDS, MEBENDAZOLE).

Diseases Acquired thru the Skin

Diseases caused by Trauma and Inoculation
o Tetanus
o Rabies
o Malaria
o DHF
 o Leptospirosis
o Schistosomiasis
Diseases acquired thru contact
o Leprosy

TETANUS
An acute, often fatal, disease characterized by generalized rigidity and
convulsive spasms of skeletal muscles caused by the endotoxin released by
C. Tetani
AKA: Lockjaw

Etiologic Agent: Clostridium Tetani

o Anerobic
o Spore forming, gram positive rod

Sources:
o Animal and human feces
o Soil and dust
o Plaster, unsterile sutures, rusty scissors, nails and pins

MOT:
o Direct or indirect contact to wounds
o Traumatic wounds and burns
o Umbilical stump of the newborn
o Dirty and rusty hair pins
o GIT- port of entry rare
o Circumcision/ ear pearcing

Incubation period: 3d-3week (ave:10days).

Signs and symptoms:
persistent contraction of muscles in the same anatomic area as the
injury
Local tetanus
Cephalic tetanus - rare form
o otitis media (ear infections)
Generalized tetanus
o trismus or lockjaw
o stiffness of the neck
o difficulty in swallowing
o rigidity of abdominal muscles
o elevated temperature
o sweating
o elevated blood pressure episodic rapid heart rate
Neonatal tetanus - a form of generalized tetanus that occurs in
newborn infants

Complications:
o Laryngospasm
Hypostatic pneumonia
Hypoxia
Atelectasis

o Trauma
Fractures
o Septicemia
Nosocomial infections
o Death

Diagnostic procedure:
entirely clinical
CSF normal
WBC - normal or slight elevation

Treatment:
Wounds should be cleaned
Necrotic tissue and foreign material should be removed
Tetanic spasms - supportive therapy and maintenance of an adequate
airway
Tetanus immune globulin (TIG)
o help remove unbound tetanus toxin
o cannot affect toxin bound to nerve endings
o single intramuscular dose of 3,000 to 5,000 units
 o Contains tetanus antitoxin.
Oxygen
NGT feeding
Tracheostomy
Adequate fluid, electrolyte, caloric intake
During convalescence
o Determine vertebral injury
o Attend to residual pulmonary disability
o Physiotherapy
o Tetanus Toxoid
Nursing Interventions:
Prevention
DPT
o Adverse Reactions
o Local reactions (erythema, induration)
o Fever and systemic symptoms not common
o Exagerated local reactions

Nursing interventions:
Prevention of CV and respiratory complications
o Adequate airway
o ICU ET- MV
Provide cardiac monitoring
KVO
Wound care (TIG, Debridement, TT)
Administer antibiotics as ordered
o Penicillin
Care during tetanic spasm/ convulsion
o Administer Diazepam muscle rigidity/spasm
o Administer neuromuscular blocking agents (metocurin iodide) relax
spasms and prevent seizure
Keep on seizure precaution
Parenteral nutrition
Avoid complications of immobility (contractures, pressure sores)
WOF urinary retention, fractures

RABIES
A viral zoonotic neuroinvasive disease that causes acute encephalitis
Etiologic agent: Rhabdovirus
AKA: Hydrophobia, Lyssa
Negri bodies in the infected neurons pathognomonic
Incubation period: 4-8 weeks; 10d-1yr
Period of communicability: 3-5 days before the onset of s/s until the
entire course of disease
MOT: contamination of a bite of infected animals
 Diagnostic procedures
O History of exposure
O PE/ assessment of s/s
O Microscopic examination of Negri bodies using Sellers May-Grunwald
and Mann Strains
O Fluorescent Rabies Antibody technique / Direct Immunofluorescent test.

Clinical Manifestations
Prodromal Phase / Stage of Invasion
Fever, anorexia, malaise, sorethroat, copious salivation, lacrimation,
perspiration, irritability, hyperexcitability, restlessness, drowsiness, mental
depression, marked insomia
Sensitive to light, sound, and changes in temp
Myalgia, numbness, tingling, burning or cold sensation along nerve
pathway; dilation of pupils
Stage of Excitement
Marked excitation, apprehension
Delirium, nuchal stiffness, involuntary twitching
Painful spasms of muscles of mouth, pharynx, and larynx on
attempting to swallow food or water or the mere sight of them
hydrophobia
Aerophobia
Precipitated by mild stimuli touch or noise
Death spasm from or from cardiac / respiratory failure
Terminal Phase or Paralytic Stage
Quiet and unconscious
Loss of bowel and bladder control
Tachycardia, labored irregular respiration, steady rising temp
Spasm, progressively increasing paralysis
Death due to respiratory paralysis
TREATMENT:
No cure
No specific symptomatic/ supportive directed toward alleviation of
spasm
Employ continuing cardiac and pulmonary monitoring
Assess the extent and location of the bite biting incident/ status of
the animal
o Severe exposure
o Mild exposure
Wound treatment (local care)
o Cleanse thoroughly with soap and water (or ammonium
compounds, betadine, or benzalkonium cl)
o Anti - rabies serum
o Tetanus prophylaxis
o Antibiotics
o Suturing should be avoided
Antirabies sera
o Heterologous serum obtained by hyperimmunization of
different animal species i.e. horses
o HRIG Homologous reabies immunoglobulin human origin
Rabies Vaccine
Active immunization
o Administered 3 years duration
o Used for lower extremity bites
o Lyssavac (purified protein embryo), Imovax, Anti-rabies
vaccine
Passive immunization
o 3 months
o Rabuman, Hyper Rab, Imogam

Nursing Intervention:
o Isolation of patient
o Provide comfort for the patient by:
Place padding of bedside or use restraints
Clean and dress wound with the use of gloves
Do not bathe the patient, wipe saliva or provide sputum
jar
o Provide restful environment
Quiet, dark environment
Close windows, no faucets or running water should be
heard
IVF should be covered
No sight of water or electric fans

MALARIA
 Acute and chronic disease transmitted by mosquito bite confined mainly to
tropical areas.
Etiologic agent Protozoa of genus Plasmodia
Plasmodium Falciparum (malignant tertian)
o most serious, high parasitic densities in RBC with tendency to agglutinate
and form into microemboli. Most common in the Philippines
P. Vivax - non life threatening except for the very young and old.
o Manifests chills every 48 hrs on the 3rd day onward if not treated,
P. malarie (Quartan) less frequent, non life threatening, fever and chills occur
every 72 hrs on the 4th day of onset
P. ovale - rare
Incubation period:
o 12days P. falciparum, 14 days P vivax and ovale, 30 days P. malariae
Period of communicability:
o If not treated /inadequate more than 3 yrs. P malariae, 1-2 yrs. P. vivax, 1
yr- P. falciparum
Mode of transmission
o Mosquito bite

VECTOR female Anopheles mosquito

DIAGNOSTICS
Malarial smear film of blood is placed on a slide, stained and examined.
Rapid diagnostic test (RDT) done in field. 10 -15 mins result blood test.

Clinical Manifestions:
Rapidly rising fever with severe headache
Shaking chills
Diaphoresis, muscular pain
Splenomegaly, hepatomegaly
Hypotension
 o May lasts for 12 hours daily or every 2 days.
Complicated Malaria
GIT
o Bleeding from GUT, N/V, Diarrhea, abdominal pain, gastric, tyhoid, choleric,
dysenteric
CNS or Cerebral Malaria
o Changes in sensorium
o Severe headache
o N/V
Hemolytic
Blackwater fever
o Reddish to mahogany colored urine due to hemoglobinuria
o Anuria death
Malarial lung disease

MANAGEMENTS:
Antimalarial drugs Chloroquine (all but P. Malarie), quinine, Sulfadoxine
(resistant P falciparum) Primaquine (relapse P vivax/ovale)
RBC replacement/ erythrocyte exchange transfusion

Nursing management:
Isolation of patient
Use mosquito nets
Eradicate mosquitos
Care of exposed persons case finding
I and O
BUN & creatinine dialysis could be life saving
ABG
TSB, ice cap on head
Hot drinks during chilling, lots of fluid
Monitoring of serum bilirubin
Keep clothes dry, watch for signs of bleeding
PREVENTION
o Mosquito breeding places should be destroyed
o Insecticides, insect repellant
o Blood donor screening.

DENGUE FEVER
Is an acute febrile disease cause by infection with one of the serotypes of
dengue virus which is transmitted by mosquito (Aedes aegypti).
Dengue hemorrhagic fever fatal characterized by bleeding and
hypovolemic shock
Etiologic agent Arbovirus group B
AKA: Chikungunya, O nyong nyong, west nile fever
Mode of Transmission: Bite of infected mosquito AEDES AEGYPTI
Incubation period 3-14 days
 Period of communicability mosquito all throughout life
Sources of infection
Infected person- virus is present in the blood and will be the reservoir
when sucked by mosquitoes
Stagnant water = any

Diagnostic Tests:
Torniquet test
Platelet Count
Hematocrit

Manifestations
PRODROMAL symptoms
o malaise and anorexia up to 12 hrs.
o Fever and chills, head-ache, muscle pain
o N &V
FEBRILE Phase
o Fever persists (39-40 C)
o Rash - more prominent on the extremities and trunk
o (+) torniquet test- petechia more than 10.
o Skin appears purple with blanched areas with varied sizes (
Hermans sign)
o Generalized or abdominal pain
o Hemorrhagic manifestations epistaxis, gum bleeding
CIRCULATORY Phase
o Fall of temp on 3rd to 5th day
o Restless, cool clammy skin
o Profound thrombocytopenia
o Bleeding and shock
o Pulse - rapid and weak
o Untreated shock --- coma death
 o Treated recovery in 2 days
CLASSIFICATION
Grade 1
Grade 2
Grade 3
Grade 4

Treatment:
No specific antiviral therapy for dengue
Analgesic not aspirin for relief of pain
IV fluid
BT as necessary
O2 therapy

NURSING MANAGEMENT
1. Kept in mosquito free environment
2. Keep pt. at rest
3. VS monitoring
4. Ice bag on the bridge of nose and forehead.
5. Observe for signs of shock VS (BP low), cold clammy skin

PREVENTION:
Mosquito net
Eradication of breeding places of mosquito-
o house spraying
o change water of vases
o scrubbing vases once a week
o cleaning the surroundings
o keep water containers covered
o avoid too many hanging clothes inside the house

LEPTOSPIROSIS
Infectious bacterial disease carried by animals whose urine contaminates water
or food which is ingested or inoculated thru the skin.
Etiologic agent: spirochete Leptospira interrogans
o found in river, sewerage, floods
AKA: Weils disease, mud fever, Swineherds disease
Incubation Period: 6 -15 days
Period of Communicability found in urine between 10-20 days
MOT contact with skin of infected urine or feces of wild/domestic animals;
ingestion, inoculation
Diagnostic tests:
o Clinical manifestations
o Culture
SOURCE OF INFECTION
o Rats, dogs, mice

MANIFESTATIONS
o Septic Stage
Early
Fever (40 C), tachycardia, skin flushed, warm, petechiae
Severe
Multiorgan
Conjunctival affectation, jaundice, purpura, ARF, Hemoptysis,
head-ache, abdominal pain, jaundice
o Toxic stage with or w/o jaundice, meningeal irritation, oliguria
shock, coma , CHF
o Convalescence recovery

MANAGEMENT
1. IV antibiotic
Pen G Na
Tetracycline
Doxycycline
2. Dialysis peritoneal
3. IVF
4. Supportive
5. Symptomatic

Nursing Interventions
o Isolation of patient urine must properly disposed
o Care of exposed persons keep under close surveillance
o Control measures
Cleaning of the environment/ stagnant water
Eradicate rats
Avoid bathing or wading in contaminated pool of water
vaccination of animals (cattles,dogs,cats,pigs)
SCHISTOSOMIASIS
Parasitic disease caused by Schistosomiasis japonicum, Schistosomiasis
mansoni, Schistosomiasis Hematobium.
AKA: Bilharziasis, Snail fever.
Incubation Period: 2 6 weeks
MOT: Bathing, swimming, wading in water.
Vector: Oncomelania quadrasi
o Cercariae: most effective stage
Diagnostic test: Ova seen in fecalysis
Diagnostic procedures:
Fecalysis
Identification of eggs
Liver and rectal biosy
Immunodiagnostic tests / circumoval precipitin test and cercarial envelope
reactions.

Signs and symptoms:

o Swimmers itch
Itchiness
Redness and pustule formation at site of entry of cercariae
Diarrhea
Abdominal pain
hepatosplenomegaly
CLINICAL MANIFESTATIONS:
Abdominal pain
Cough
Diarrhea
Eosinophilia - extremely high eosinophil granulocyte count.
Fever
Fatigue
Hepatosplenomegaly - the enlargement of both the liver and the spleen.
Colonic polyposis with bloody diarrhea (Schistosoma mansoni mostly)
Portal hypertension with hematemesis and splenomegaly (S. mansoni, S.
japonicum);
Cystitis and ureteritis with hematuria bladder cancer;
Pulmonary hypertension (S. mansoni, S. japonicum, more rarely S.
haematobium);
Glomerulonephritis; and central nervous system lesions.
Complications:
O Pulmonary hypertension
O Cor pulmonale
O Myocardial damage
O Portal cirrhosis

Treatment:
Trivalent antimony
o Tartar emetic administered thru vein
o Stibophen (FUADIN) given per IM
PRAZIQUANTEL per orem
Niridazole

Nursing Interventions:
o Administer prescribed drugs as ordered
o Prevent contact with cercaria-laden waters in endemic areas like streams
o Proper sanitation or disposal of feces
o Creation of a program on snail control chemical or changing snail
environment

LEPROSY
Chronic systemic infection characterized by progressive cutaneous lesions
Etiologic agent: Mycobacterium leprae
o Acid fast bacilli that attack cutaneous tissues, peripheral nerves producing
skin lesions, anesthesia, infection and deformities.
Incubation period 5 1/2 mo - eight years.
MOT respiratory droplet, inoculation thru break in skin and mucous
membrane.

Diagnosis:
1. Identification of S/s
 2. Tissue biopsy
3. Tissue smear
4. Bloods inc. ESR
5. Lepromin skin test
6. Mitsuda reaction

MANIFESTATIONS
Corneal ulceration, photophobia blindness
Lesions are multiple, symmetrical and erythematous macules and papules
Later lesions enlarge and form plaques on nodules on earlobes, nose
eyebrows and forehead
Foot drop
Raised large erythemathous plaques appear on skin with clearly defined
borders. rough hairless and hypopigmented leaves an anesthetic scar.
Loss of eyebrows/eyelashes
Loss of function of sweat and sebaceous glands
Epistaxis

TREATMENT
multiple drug therapy
sulfone
rehab
occupational Health
isolation
moral support

PREVENTION
1. Report cases and suspects of leprosy
2. BCG vaccine may be protective if given during the first 6 months.
3. Nursing Interventions:
1. Isolation of patient until causative agent is still present
2. Care of exposed persons
1. Household contact Diaminodiphenylsulfone for 2 years
2. Observe carefully for symptoms of the disease.
Disease Acquired Thru Sexual Contact

HIV /AIDS
Chronic disease that depresses immune function
Characterized by opportunistic infections when T4/CD4 count drops <200
MOT sexual contact with infected unprotected, injection of blood/products,
placental transmission.

History of HIV / AIDS

1959 - African man
1981- 5 homosexual men
1982-Designated as disease by CDC
1983- HIV 1 discovered
1987- 1.5 million HIV-infected in USA
1994- WHO reports 8-10 mil. Worldwide & protease inhibitors introduced
1999-First clinical trials for HIV vaccine
The immune system
o Macrophages
Humoral response
Cell-mediated response

The HIV
RNA virus
Retrovirus
Reverse transcriptase
Protease
 Diagnostic Tests
ELISA
Western Blot
CD4 count
Viral load testing
Home test kits

Manifestations
o Minor signs cough for one month, general pruritus, recurrent herpes zoster,
oral candidiasis, generalized lymphadenopathy
o Major signs loss of weight 10% BW, chronic diarrhea 1month up, prolonged
fever one month up.
Persistent lymphadenopathy
Cytopenias (low)
PCP
Kaposis sarcoma
Localized candida
Bacterial infections
TB
STD
Neurologic symptoms

Criteria for Diagnosis of AIDS

CD4 counts of 200 or less
Evidence of HIV infection and any of
o Thrush
o Bacillary angiomatosis
o Oral hairy leukoplakia
o Peripheral neuropathy
o Vulvovaginal candidiasis
o Shingles
o Idiopathic thrombocytopenia
 o Fatigue, night sweats, weight loss.
o Cervical dysplasia, carcinoma in situ.
Evidence of HIV infection and any one of the following:
O Bronchial candidiasis
O Esophageal candidiasis
O CMV disease
O CMV retinitis
O HIV encephalopathy
O Histoplasmosis
O Kaposis Sarcoma
O Herpes simplex ulcers, bronchitis, pneumonia
O Primary brain lymphoma
O Pneumocystis Carinii Pneumonia
O Recurrent pneumonia
O Mycobacterium infection
O Progressive multifocal leukoencepalopathy
O Salmonella septicemia
O Toxoplasmosis
O Wasting syndromes

Treatment
Started in CD4 counts of <200
Viral load >10,000 copies
All symptomatic regardless of counts
Note: CD4 reflects immune system destruction. Viral load- degree of viral
activity
Nucleoside Reverse Transcriptase Inhibitors
Blocks reverse transcriptase
NRT
Acts by binding directly to the reverse transcriptase enzyme
Not used alone
Rapid development of resistance
Acts by binding directly to the reverse transcriptase enzyme
Not used alone
Rapid development of resistance

Generic Trade Dose Notes

Zidovudine AZT, ZDV, 300 mg. Taken with food

Retrovir Bid

Didanosine ddI, Videx 200 mg Peripheral

bid neuropathy

Zalcitibine ddC,Hivid .75 mg No antacids

TID

Stavudine d4T, Zerit 400 mg Peripheral

bid neuropathy
 Lamivudine 3TC, Epivir 150 mg Used as
bid resistance
develops

Lamiduvine/Zido Combivir 150/300 Bone marrow

vudine mg toxicity

Protease Inhibitors
Introduced in 1995
Acts by blocking protease enzyme
Indinavir (Crixivan)

CDC Guidelines
o Combination of 2 NRTI + PI
Nursing Management
o Administer Antiviral meds as ordered
o Universal precaution
o Reverse isolation
gloves, needle stick injury prevention
o Assist in early diagnosis and management of complications
4 Cs
o Compliance info, + drugs
o Counselling education
o Contact tracing tracing out and tx for partners
o Condoms safe sex

GONORRHEA
A curable infection caused by the bacteria Neisseria gonorrhoea
AKA: Clap, Drip, G. vulvovaginitis
MOT: transmitted during vaginal, anal, and oral sex
Incubation period: 3-10 days initial manifestations
Period of communicability: considered infectious from the time of
exposure until treatment is successful
Manifestations:
Urethritis both male and female
Signs and Symptoms: dysuria and purulent discharge
Cervicitis
Upper Genital Tract females (PID)
Endometritis, Salpingitis,
Pelvic Abscess
Complications :
PID
Infertility

Complications:
 Upper Genital Tract male
o Epididymitis, Prostatitis, Seminal Vesiculitis
Disseminated Gonococcal Infection (DGI)
o Tenosynovitis or Polyarthritis, skin lesions and fever
Anorectal Infection
Pharyngeal Infection
Gonococcal Conjuctivitis
o Opthalmia Neonatorum
Meningitis, Endocarditis

Diagnosis:
Culture & Sensitivity
Blood tests for N. gonorrhoeae antibodies

Treatment:
ANTIBIOTICS
Penicillin
Single dose Ceftriaxone IM + doxycycline PO BID for 1 week
Prophylaxis: Silver nitrate, Tetracycline, Erythromycin

Nursing Interventions:
o Case finding
o Health teaching on importance of monogamous sexual relationship
o Treatment should be both partners to prevent reinfection
o Instruct possible complications like infertility
o Educate about s/s and importance of taking antibiotic for the entire
therapy
SYPHILIS
a curable, bacterial infection, that left untreated will progress through four
stages with increasingly serious symptoms.
Etiologic agent: Treponema pallidum
AKA: Lues, The pox, Bad blood
Type of Infection: Bacterial
Modes of transmission :
o Through sexual contact/ intercourse, kissing
o abrasions
o Can be passed from infected mother to unborn child (transplacental)
Symptoms:
o Primary syphilis (10 90 days after infection)
Chancre a firm, painless skin ulceration localized at the
point of initial exposure to the bacterium appear on the
genitals
can also appear on the lips, tongue, and other body
parts.
o Secondary syphilis (last 2 6 weeks)
 syphilis rash - an infectious brown skin rash that typically
occurs on the bottom of the feet and the palms of the hand
condylomata lata - flat broad whitish lesions
Fever, sore throat, swollen glands, and hair loss can also be
experienced
Third stage
o Will manifest 1 10 years after the infection
o characterised by gummas - soft, tumor-like growths
seen in the skin and mucous membranes occurs in bones
o joint and bone damage
o increasing blindness
o Numbness in the extremities, or difficulty in coordinating movements.

Neurosyphilis
generalized paresis of the insane which results in personality
changes, changes in emotional affect, hyperactive reflexes
cardiovascular syphilis
aortitis, aortic aneurysm, Aneurysm of sinus of valsalva and aortic
regurgitation, - death

Consequences in Infants
Congenital syphilis
extremely dangerous
Deformities
Seizures
Blindness
Damage to the brain, bones, teeth, and ears.

Test and diagnosis

Venereal Disease Research Laboratory (VDRL) test
Flourescent treponemal antibody absorption (FTA Abs)
Micro hemagglutination test (MHA - TP)
CSF examination
Treatment
Syphilis is easily treatable when early detected
Penicillin & other antibiotics

Prevention:
Abstinence
Mutual monogamy
Latex condoms for vaginal and anal sex
Nursing interventions
o Case finding
o Health teaching and guidance along preventive measures
o Utilization of community health facilities
o Assist in interpretation and diagnosis
 o Reinforce ff up treatment
o VD control program participation
o Medical examination of patients contacts

HEPATITIS B
serious disease caused by a virus that attacks the liver
Etiologic agent: hepatitis B virus (HBV)
Source of infections: Blood and body secretions

Risk factors
multiple sex partners or diagnosis of a sexually transmitted disease
Sex contacts of infected persons
Injection-drug users
Household contacts of chronically infected persons
Infants born to infected mothers
Infants/children of immigrants from areas with high rates of HBV infection
Health-care and public safety workerr
Hemodialysis patients

Complications:
Lifelong infection
Liver cirrhosis
Liver cancer
Liver failure
Death

Signs and symptoms:

Jaundice
Pruritus
Fatigue
RUQ - Abdominal pain
Loss of appetite
Nausea, vomiting
Joint pain

Prevention:
Hepatitis B vaccine has been available since 1982.
o Routine vaccination of 0-18 year olds
o Vaccination of risk groups of all ages
Immune globulin if exposed

MEDICAL MANAGEMENT:
Interferon alfa-2b
Lamivudine
 Telbivudine
Entecavir
Adefovir dipivoxil

Nursing Interventions:
o Blood and body secretions precautions
o Prevention- Hepa B vaccine
o Proper rest periods
o Prevent stress physio/psychological
o Proper NTN, increase in CHO, high in CHON, low fats, Vit. K rich
foods and minerals
o Assistance to prevent injury, promote safety AAT
o WOF signs and symptoms bleeding, edema
o Health education on safe sex.

SEVERE OF ACUTE RESPIRATORY SYNDROME

An acute and highly contagious respiratory disease in humans
Etiologic agent: SARS coronavirus
November 2002 and July 2003, with 8,096 known infected cases and 774
deaths
Incubation period: 2-3days
MOT: Airborne

Signs and symptoms:

o flu like: fever, myalgia, lethargy, gastrointestinal symptoms, cough,
sore throat
o fever above 38 C (100.4 F)
o Shortness of breath
o Symptoms usually appear 210 days following exposure
o require mechanical ventilation

Diagnostic Test:
Chest X-ray (CXR)- abnormal with patchy infiltrates
WBC and PLT CT. - LOW
ELISA test detects antibodies to SARS
o but only 21 days after the onset of symptoms
Immunofluorescence assay, can detect antibodies 10 days after the onset
of the disease.
o labour and time intensive test
Polymerase chain reaction (PCR) test that can detect genetic material of
the SARS virus in specimens ranging from blood, sputum, tissue samples
and stools
CXR - increased opacity in both lungs, indicative of pneumonia
SARS may be suspected
fever of 38 C (100.4 F) or more AND
 Either a history of:
o Contact (sexual or casual) with someone with a diagnosis of SARS
within the last 10 days OR
o Travel to any of the regions identified by the WHO as areas with
recent local transmission of SARS (affected regions as of 10 May
2003 were parts of China, Hong Kong, Singapore and the province
of Ontario, Canada).
probable case of SARS has the above findings plus positive chest x-ray
findings of atypical pneumonia or respiratory distress syndrome

Treatment
Supportive with antipyretics, supplemental oxygen and ventilatory support
as needed.
Suspected cases of SARS must be isolated, preferably in negative pressure
rooms, with full barrier nursing precautions taken for any necessary contact
with these patients
steroids
antiviral drug
SARS vaccine
 Tuberculosis*
Leprosy*
Schistosomiasis*
Filariasis
Malaria*
Dengue Hemorrhagic Fever (H-Fever)*
Measles*
Chicken Pox (Varicella)
Mumps (Epidemic Parotitis)*
Diptheria
Whooping Cough (Pertussis)
Tetanus Neonatorum and Tetanus among older age groups*
Influenza
Pneumonias
Cholera (El Tor)*
Typhoid Fever*
Bacillary Dysentery (Shigellosis)*
Soil Transmitted Helminthiases
Paragonimiasis
Hepatitis A*
Paralytic Shellfish Poisoning (PSP I RED TIDE POISONING)
Leptospirosis*
Rabies*
Scabies
Anthrax
Sexually Transmitted Infections
i. Gonorrhea*
ii. Syphilis*
iii. Chlamydia
iv. Gardianella Vaginitis
v. Trichomoniasis
vi. Hepatitis B*
HIV/AIDS*
Meningococcemia
Bird Flu or Avian influenza
SARS Severe Acute Respiratory Syndrome*
Comprehensive Maternal and Child Health Program
*EPI ( EXPANDED PROGRAM ON IMMUNIZATION )
*CDD ( CONTROL OF DIARRHEAL DISEASES )
*CARI (CONTROL OF ACUTE RESPIRATORY INFECTIONS )
*UFC (UNDER FIVE CLINICS )
*MC ( MATERNAL CARE )
*BF ( BREAST FEEDING )
*MRP ( MALNUTRITION REHABILITATION PROGRAM )
*VAD (VITAMIN A DEFICIENCY )
*IDD / IDA ( IODINE DEFICIENCY DISORDERS / IRON DEFICIENCY ANEMIA )
*FP ( FAMILY PLANNING )

*EPI (EXPANDED PROGRAM ON IMMUNIZATION )

PD 996 Compulsory Basic Immunization to all
children before reaching 8 years old
Started in 1976 by MOH
Target Population:
A. Infants (0-12 months):
BCG, DPT, OPV& Measles
HBV (1996)
B. School Entrants:
MECS: Grade 1=7 years old
DECS: Grade 1=6 yrs. old (1993)
Booster of BCG

RA 7846 Compulsory HBV before 8 years

old:1996
PP 4 Measles Elimination Program
(September & October) 1994-
1997-Ligtas Tigdas (6 months-8
years)

PP 6 Universal Mother & Child Immunization

Law advocated by WHO from 1996 and
onwards: 5 vaccines + Tetanus Toxoid
Strengthens the EPI Program
1. Pregnant mothers-Tetanus Toxoid
2. Children:
Infants-5 vaccines
School entrants-BCG booster dose
3. Before EPI total immunization-5
After EPI total immunization-6
 (Tetanus
toxoid was included)
4. OPV was given to all children under
5 years old irregardless of the # of
doses & the time OPV was given

PP 147 Declaring the National Immunization

Day Plus (NIDs Plus) initiated by
former Sec. Flavier in 1993-95
Initially every 3rd Wednesday of
January & February (1993-1995)
1996 to present: Still being practiced
but not every 3rd Wednesday of
January & February
2002: 2nd Tuesday of March & April
At present: depends on the Secretary
PP 773 Launched the Polio Elimination
Program (PEP) 1995-2000: Zero Polio
Philippines, 1. Knock Out Polio (KOP)
2. Zero Polio Philippines (1996-2000)
3. Patak Polio (< 5 years old)
PP 1064 AFP (Acute Flaccid Paralysis)
Elimination Program-an adverse effect
of Polio
PP 1066 Neonatal Tetanus Elimination
Morbidity
Mortality
*RSI locates a venue for immunization called Patak Center and composed of 1
organizer, 1 runner, 1 vaccinator, 1 recorder and 1 health educator catering to a
population of 1,000

Policies of EPI:
I. Coverage--------------------------------------
A. Target Setting
B. FIC ( Full Immunized Child )
C. Wastage Allowance
OBJECTIVES OF EPI: To reduce morbidity and mortality rates among infants and
children from 6 or 7 immunizable disease
II. Cold Chain
III. Immunization Technical Responsibilities of PHN
IV. Surveillance--------------------------------
Planning, Supervision, and Training---
Mobilization, Monitoring and Health Education Administrative and
Supportive Role of PHN
 Referral, Research and Evaluation ---

I. Coverage
A. Target Setting:
1. Target Population is the population group meant to be benefited by the EPI
Programs where DOH is responsible.
a. Infants ( 0 12 ) get the 3% of population
b. School Entrants get the 3% of population ( dictum of DOH ) = 6 years
c. Pregnant Women get the 3.5 % of population ( MWKA ) = 15 49 years
2. Eligible Population ( EP ) rae those qualified to receive specific immunizations
where PHW is responsible PHN, RHM, MO
*3 Population Groups to benefit
a. Infants (I) BCG, DPT, OPV, HBV, MV
b. School Entrants (S.E) Booster of BCG
c. Pregnant Women (PW) Tetanus Toxoid
*To determine Eligible Population:
EP = Population of the Community x 0.03 (Infants and School Entrants) or
X 0.035 (Pregnant Women)
*Example: Lanting Community with a population of 7000
a.) DPT = for infants
EP = 7000 X 0.03 = 210 to receive DPT
b.) Tetanus Toxiod = for pregnant women
EP = 7000 X .035 = 245 to receive TT
c.) Booster BCG = for school entrants
EP = 7000 X 0.03 = 210 to receive booster BCG

B. Fully Immunized Child ( FIC ) is a child who receives the 5 sets of

vaccines (BCG, DPT, OPV, Hepa B and Measles and who receives 11
doses of vaccines.

Vaccine (# of Doses) Infants (0-12 months) School Entrants

Right age to receive the
vaccine
BCG-1 dose 0 age (at birth)-12 1 booster dose (6 years
months old)
DPT-3 doses 1st Dose-6 wks./1 mos.
OPV-3 doses 2nd Dose-10 wks./2
HBV-3 doses mos.
3rd Dose-14 wks./3
mos.
MV-1 dose 9-12 months

*MV may be given 6 months if there is an epidemic.

c. Wastage Allowance
- DOH doesnt ptoduce vaccines biologically and therefore dependent on suppliers
abroad: Germany and Switzerland to economize:
1. Be aware of the availability of vaccines:
Example: BCG
CHN: vial Private Practice: ampule
Frozen powder with a diluent
( 1 ml per content )

2. How many receipients = ?????

-Follow DOH Dictum: On the day of immunization, if 50% and above of computed
recipents arrive in the health center, open a vial but if less than 50%, dont open.
Example: In 20 recipients, 10 arrive = open a vial
-Half life of Vaccines is the duration of potency:
a. Vaccine with 4 hours half life: BCG, MV ( need to mix )
*If open at 8:00 am, its good till 12:00 noon
At 12:30 pm, dont give anymore because its not potent anymore.
b. Vaccine with 8 hours half life: DPT, OPV, HBV, TT (already in solution / liquid
form ready to administer)

Table of Reference for Requesting Vaccines from DOH

Vaccine Availability Dosage # of Doses to Wastage Number of
complete Allowance Recipients per
immunization Multiplier Vaccines
Factor (MF)
BCG Vial:
1. I Frozen .05 ml 1 dose 60% 2.5 20
2. SE Powder .1 ml 1 dose 40% 1.67 10
with
1ml diluent
DPT Vial: 10 ml .5 ml 3 doses 40% 1.67 20
liquid
OPV Plastic 2-3 gtts 3 doses 40% 1.67 25(1ml=15gtts)
(Sabin) bottle: 5 ml
slightly
pink
Liquid
HBV Vial: .5, 1, <10 y/o: .5 3 doses 10% 1.2 .5 ml=1
10 ml >10 y/o: 1 .5 ml
MV Vial: .5 ml 1 dose 50% 2 10
Frozen
Powder
with
 Diluent
Soln=5ml
per content
TT Vial: 10 ml .5 ml 5 doses 40% 1.67 20
liquid
*Parenteral = Salk vaccine ( sinasaksak ) has 5 ml per content
*Oral Polio Vaccine (OPV) = Sabin (sa bibig)
For OPV: 5 ml (availability) 1 ml = 15 gtts 1 ml = 15 gtts = 5 recipients
3 gtts (dosage) 2 ml = 30 gtts = 10 recipients
3 ml = 45 gtts = 15 recipients
4 ml = 60 gtts = 20 recipients
5 ml = 75 gtts = 25 recipients

Right Time for Pregnant Women to receive Tetanus Toxoid

Primary Dose TT1 Anytime during ? Immunity
th th
Pregnancy (5 -6
months)
Primary Dose TT2 4 weeks after TT1 3 years immunity
1st Booster TT3 6 months after 5 years immunity
TT2
2nd Booster TT4 1 year after TT3 10 years immunity
rd
3 Booster TT5 1 year after TT4 Lifetime immunity

Examples:
1. Mrs Dela Cruz received the 1st booster dose (TT3) on November 20, 2004.
When is the 2nd booster? November 20, 2005
2. As a child, you have 3 doses of DPT. Now you become pregnant. What you
need to receive are the 3 booster doses only-TT3, TT4 & TT5 respectively.
3. If as a child, only 1 dose of DPT was given, is there a definite immunity?
Theres no definite # of years of immunity. If until 3 years she failed to receive
vaccine, she got to start with the 1st dose.

Wastage Allowances of DOH Multiplier Factors

BCG (I) 60% 2.5
MV 50% 2.0
BCG (SE) 40% 1.67
DPT
OPV
TT
HBV 10% 1.2

Steps to Compute the Number of Vaccine to be Requested from DOH

1. Determine the Eligible Population (EP)
EP=Population of the Community x 0.03 (I & SE) or 0.035 (PW)
2. Determine the Annual Dose (AD)
 AD=EP x # of doses of the vaccine
3. Determine the Wastage Allowance (WA)
WA=computed AD x MF of the vaccine
4. Determine the Complete Coverage (CC)
CC=WA # of recipients per vaccine
5. Determine the Overall Total in Allowance (OT)
OT=CC x 1.25 (constant), DOH usually grants an allowance of 25% of the CC

Example: Determine the # of vaccines to be requested from DOH of DPT for

Lanting Community with a population of 4000
1. EP=4000 x 0.03=120
2. AD=120 x 3 doses=360
3. WA=360 x 1.67=601
4. CC=601 20=30
5. 30 x 1.25=37.5 or 38 vials to be given by DOH (or 8 vials allowance)

II. Cold Chain

-Tools or Procedures to follow to keep vaccine potent ( expected desired
effect ).
Policies:
1. Proper Storage: store vaccines in refrigerators

RHO 3 Given 6 months to store vaccines

MHO PHO 2 Given 3 months to store vaccines

BHS RHU 1 Given 1 month to store vaccines

RHCDS

- Freezer OPV: most sensitive to heat

-15 C to -20 C MV

Body of Refrigerator BCG

2 C to 8 C DPT
HBV
TT: least sensitive to heat
OPV & MV: highly sensitive to heat
OPV, MV & BCG: Not damage by freezing
DPT, HBV & TT: Damaged by freezing so not placed in the freezer

2. Proper Transport
- Vaccines are to be transported from the health center to the area of
immunization (community: focused, based & oriented)
- Tools provided by DOH: Vaccine Carrier which maybe
a. Black: use by staff of HC during epidemic & needs 5 cold dogs
 b. White: use by student affiliates & needs 4 cold dogs
- Cold Dogs: 4 plastic containers filled with water which is placed in the
freezer a day before immunization which is used as freezant to keep
vaccine potent

3. Proper Handling of Vaccine (After Care of Vaccine): Dictum of DOH

a. Vaccines which are opened, though not consumed, should be discarded
Reasons: cant be used for future program because vaccines have half -
life (duration of potency of vaccine)
BCG -4 hours half life
MV
Other vaccines -8 hours half life

BCG, OPV & MV are composed of live attenuated bacteria & virus so
before discarding them, disinfect 1 st with 1% Hcl or any disinfectant like
zonrox, chlorox or dumex
BCG (Bacilli Calmette-Guerin Vaccine): live attenuated bacteria
OPV & Measles Vaccine: live attenuated virus

DPT, HBV & TT can be readily discarded if not consumed

DPT:
Diphtheria-weakened toxoid treated with chemical solution to weaken
microorganism
Pertussis-killed bacteria
Tetanus-weakened toxoid
HBV: plasma derived, identified to be RNA & DNA recombinant from
blood
TT: weakened toxoid
b. Vaccines which are taken out from Health Center for 3x or more are
considered overly exposed & not potent anymore therefore it should be
discarded
Put notation (state the date) on the unopened vaccine as to when it was
taken out from health center May 19, 2006
Jun. 19, 2006
Jul. 19, 2006-cant be used anymore after this

I. Immunization
Guiding Principles for HW in Administering Vaccines & Screening of Children
for Immunizations:
1. No BCG for a child born clinically positive to AIDS because they have a
damage immune system & introducing bacteria will further aggravate their
condition
2. There are no contraindications such as slight fever, LBM, cough & colds
and malnutrition, in giving the immunization unless upon assessment of the
practitioner that the child has serious medical problems that warrants
hospitalization
 3. In giving immunization with multiple doses such as DPT, OPV & HBV,
continue counting in giving the doses. Never count back even though the
interval exceeds weeks, months or years. As long as the child is on the
eligible age
Example: DPT, OPV & HBV
1st dose: At 6 weeks (1 months), the child was given vaccination
2nd dose: The mother brought back the child when he was 8 months old
instead at 10 weeks (2 months). PHN should still give the 2 nd dose
3rd dose: The mother brought back the child at 2 years old. PHN should still
give the vaccine because child is still at the eligible age (0-59 months or 4
years & 11 months or 5 years old) to receive vaccine

4. DPT: it is a normal reaction for a child to develop high grade fever because
of the pertussis component (killed bacteria)
SOP Management:
Paracetamol q 4 hours RTC for the 1st 2 days (or 3, 4 days if still febrile)
If after 1st dose of DPT, the child develops high grade fever with convulsion,
DPT 2 & 3 are not given anymore because convulsion affects the brain cells
resulting to brain damage
DPT vaccine is only for prophylactic/ preventive use

5. Things to consider in administering vaccines:

a. Vaccine
b. Dosage
c. SOA (Site of Administration)
d. ROA (Route of Administration)
e. Side Effect: patterns of reaction that is considered normal

Vaccines Dosage SOA ROA Conferred

Immunity
BCG I=.05 ml I=R deltoid Intradermal Artificial Active
SE=.1 ml SE=L deltoid (needle is
parallel to
site=10-15
angle
Side Effects: Wheal=10 mm that disappears after 30 minutes
1st week : develops soreness and inflammation
nd th
2 -11 week : develops abscess and ulceration
12th week (3 months): heals and develops permanent scar

Age of Consultation BCG Site of Injection

Right Age (0-12 months) Right Deltoid
Wrong Age but still eligible Left Deltoid
Example: 4 years old
Booster Dose at Age 6 Left Deltoid
*If after BCG, there is no soreness & inflammation, no abscess & ulceration
and no scar developed, there is wrong preparation of site where PHW used
alcohol that kills the microorganism contained in the BCG vaccine. Thus,
repeat the dose on same site but a little lower.
*Site preparation: Use clean cotton ball & wet with sterile water only
*For non-healing abscess & ulceration:
BCG was wrongly administered by IM or SQ by PHW so incision & drainage
should be done by MD only and INH tablet, an anti-bacterial, pounded,
pulverized & applied on the site. Then repeat the dose again but not on the
same site.

Vaccine Dosage SOA ROA Conferred

Immunity
DPT .5 ml Thigh (vastus Intramuscular Artificial
lateralis) (Z tract) Active
where muscle
is grasped
and squeezed
Side Effects:
1. High grade fever due to Pertussis Component which contains killed bacteria
2. Soreness and inflammation
SOP Management:
Paracetamol (anti-pyretic & analgesic) q 4 hours RTC for 1 st 3 days or till with
fever
Nursing Care: 1st Day=apply cold compress on site
2nd , 3rd & 4th Day=apply alternating cold & warm compress
Adverse Effect: If convulsion occurs on 1 st dose, discontinue DPT 2 & DPT 3
because of the sensitivity to DPT Component but private MD gives DT which is
not available in DOH

Vaccine Dosage SOA ROA Conferred

Immunity
OPV 2-3 gtts Mouth Oral: Artificial Active
Sabin by Dr.
Albert Sabin
Salk
(parenteral
polio vaccine)
by Dr. Jones
Salk
Side Effect: None
Nursing Care:
1. NPO for 1st 20-30 minutes after receiving vaccine to prevent nausea &
vomiting
2. In case the child vomits after vaccination, repeat giving the vaccine because it
requires 30 minutes to absorb the OPV
HBV .5 ml Thigh (vastus Intramuscular Artificial Active
lateralis)
Side Effects: Soreness and inflammation on site
SOP Management: Paracetamol q 4 hours RTC for 1 st 2 days or till with fever
HBV & DPT are given together but never administer these 2 vaccines in one site:
DPT HBV
st
1 Dose Right Left
2nd Dose Left Right
3rd Dose Right Left
MV .5 ml Posterior Subcutaneous Artificial Active
aspect of (45 angle)
Deltoid
Side Effect: High grade fever
SOP Management: Paracetamol q 4 hours RTC for 1 st 2 days
MV given on same site with BCG but MV is given at 9 months while BCG at birth
In case, rashes develop after vaccination which makes the child irritable due to
itchiness,
give anti-histamines: Diphenydramine (Benadryl) syrup or
Apply Caladryl or Calamine Lotion which has anti-histamine
and cooling effect to relieve itchiness
TT .5 ml Deltoid or Intramuscular Artificial Active
Gluteal
muscle
Side Effect: Soreness and inflammation on the site which is tolerable by pregnant
woman so no need to take medicines. Just apply cold compress on site to relieve
discomfort

2 Forms of Immunization Conferring Immunity:

1. Natural
a. Active
b. Passive
2. Artificial

IMMUNITY
Natural Artificial
Provided by nature Accepts vaccine
No vaccine was given
Duration is longer/even for a lifetime Duration is shorter period
Example:
BCG-vaccine for protection from TB
gives 7-10 years immunity so booster
is needed
HBV-after 3 doses booster is needed
 after 1 year
Active=person himself is involved in Active=person himself has no
the production of antibodies participation and done by another
1. Carrier (person harbors the disease person
but asymptomatic) of the disease Upon receiving vaccine (antigen) for
2. Constant exposure to disease immunizable diseases such as BCG,
3. Acquired or experienced the disease DPT, OPV, MV and HBV

Passive Passive
1. Breastfeeding IgA (present in 1. Serum (Blood):
colostrums) HBV
2. Perinatal immunity is acquired ATS (Anti-Tetanus Serum)
during the term of pregnancy ADS (Anti-Diptheria Serum)
2. Antitoxin: poison or causes infection
TAT (Tetanus Antitoxin)
DAT (Diptheria Antitoxin)
3. Immunoglobulins: IgA, IgD, IgE, IgG
& IgM where IgG is most predominant

IV. Surveillance--------------- To be discussed unde r Communicable Diseases.

Planning, Supervision and Training
Mobilization, Monitoring, and Health Education
Referral, Research and Evaluation

*CDD ( CONTROL OF DIARRHEAL DISEASES )

Policies to implement CDD:
1. Health Education on Personal Hygiene
- washing of hands before eating and after use of toilet
2. Breastfeeding ( BF )
- Two ( 2 ) Beneficiaries of BF Program:
a. Mother regulated by R.A. 7600: Breastfeeding and Rooming In Act.
*Beastfeeding is an effective contraceptive method because it stimulates the
anterior pituitary gland to produce prolactin hormone putting the female in an
anovulatory stage theres amenorrhea for 6 months form the time she gave
birth.
*Rooming in ( RI ) is putting together of mother and the newborn and it
stimulates the posterior pituitary gland to release oxytocin hormone stimulates
the uterine muscle contraction that inhibits the implantation of fertilized zygote in
the endometrium no pregnancy occurs.
b. Children regulated by EO 51: Milk Code of the Philippines
Dictum of Milk Code: Never commercialized a brand name of milk.
- 3 Principles to make breastfeeding effective: 3 Es
a. Early: start Breastfeeding as early as possible
Normal Spontaneous Delivery (NSD): after 30 minutes
CS: after 3 4 hours
 b. Exclusive: for the 1st six months; never alternate Breastfeeding with any
supplementary feeding.
c. Extensive: Breastfeeding can be extended to 2 years.
- Advantages of Breastfeeding:
Breast milk: EO 51 best for babies
Reduced allergy
Easily established
Always available
Safe making stool soft
Temperature: right teemperature 24C body reference if to be frozen,
preservation is minimum of 3 months and maximum of 6 months

Fresh always
Emotional bonding
Economical
Digestible: contains lactalbumin, a protein substance
Immunity: colostrum contains Ig A that protects baby for the 1st 3 months
Nutritious ( optional )
GIT diseases such as diarrhea is minimize / lessen because its sterile
3. Measles: immunization preventive and prophylactic
4. Oresol: a management for diarrhea to prevent dehydration
2 Concepts of Diarrhea:
a. Frequency of passing out stool = 3x/day
b. Consistency of the stool = watery
ROLE OF BREASTFEEDING IN THE
CONTROL OF DIARRHEAL DISEASES
PROGRAM
1. Two problems in CDD
1. High child mortality due to
diarrhea
2. High diarrhea incidence among under fives
2. Highest incidence in age 6 23 months
3. Highest mortality in the first 2 years of
life
4. 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.
7. Interventions to prevent diarrhea
 1. breastfeeding
2. improved weaning practices
3. use of plenty of clean water
4. hand washing
5. use of latrines
6. proper disposal of stools of
small children
7. measles immunization
8. Risk of severe diarrhea 10-30x higher in
bottle fed infants than in breastfed
infants.
9. 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.
10. Breastfeeding decreases incidence
rate by 8-20% and mortality by 24-27% in
infants under 6 months of age.
11. When to wean?
4-6 months soft mashed foods 2x a day
6 months variety of
foods 4x a day
12. Summary of WHO-CDD recommended
strategies to prevent diarrhea
1. Improved Nutrition
- exclusive breastfeeding for the first 4-6 months
of life and partially for at least one year.
- Improved weaning practices
2.Use of safe water
- collecting plenty of water from the cleanest
source
- protecting water from contamination at the
source and in the home
3.Good personal and domestic hygiene
- handwashing
- use of latrines
- proper disposal of stools of young children
4.Measles immunization.

Contents of One Pack Oresol Dissolved in One Liter drinking Water

Glucose 20 grams 1 Significance:
For re-absorption of Na
Facilitates assimilation of
Na
2 Significance:
Provides heat & energy
Sodium Chloride/NaCl 3.5 grams For retention of
water/fluid
Sodium 2.5 grams Buffer content of solution
Bicarbonate/NaHCO3 Neutralizer content of
solution
Potassium Chloride/KCl 1.5 grams Stimulates smooth
muscle contractility
especially the heart &
GIT
*Never advice mother to buy brandnames like pedialyte or gatorade

Preparation of Proper Homemade Oresol

A volume or one liter homemade oresol Smaller volume or a glass homemade
oresol
Water 1000 ml. or 1 liter 250 ml.
Sugar 8 teaspoon 2 teaspoon
Salt 1 teaspoon teaspoon or a pinch of salt=10-12
granules of rock salt: iodized salt=tips
of thumb & index finger are penetrated
with salt
*For making solutions = use 250 ml of water
*For drinking medicines = a glass is 240 ml of water.

3 Categories of Dehydration:
a. No dehydration-uses oresol
b. Some dehydration-uses oresol
c. Severe dehydration-uses IVF
Objectives/Plan/Policies of the Use of the following Program:
a. Plan A: for prevention of dehydration
b. Plan B: for treatment of dehydration-mild & moderate
c. Plan C: for treatment of dehydration-severe

CDD MANAGEMENT CHART

Assessment Category Treatment

1. Condition No dehydration Plan A-prevention of

a. Normal DHN
 b. Well
c. Alert 3 Principles/3 Fs:
2. Fontanel-normal 1. Increase fluid: Tea-
3. Eyeballs-normal Tears- lipton tea bag left
present standing in a cup of
4. Mouth, Tongue & Lips: water for 15 minutes &
moist or wet Thirst: there is brownish
drinks normally discoloration
5. Skin Turgor-returns =pectin, a diuretic & has
back quickly which is an absorbent effect
done at forearm Fruit Juices-not from
highly fibrous fruits like
pineapple, mango,
guyabano.

Oresol-am or buko where

3 electrolytes are
present: Na, K & Ca
which are lost in diarrhea

Oresol is given/LBM or
every time stool is
passed out:
< 2 years old: 50-100ml.
always give the
maximum amount
2-10 years old: 100-200
ml.
10 years old & above: as
much as tolerated &
desired

2. Increase feeding:
3. Fast referral
1. Condition Some dehydration Plan B-Treatment of mild
a. Restless & Moderate DHN using
b. Irritable oresol
2. Sunken fontanel
3. Sunken eyeballs & If less than 2 years old:
absent tears use age in months
4. Dry mouth, tongue & If < 4 months: 200-400
lips ml.
Eagerness to drink 5-11 months: 400-600 ml.
5. Skin returns back 12-23 months: 600-800
slowly ml.
2-4 y/o: 800-1200 ml.
5-14 y/o: 1200-2200 ml.
15 & above: 2200-4000
ml.

Treatment Plan: 1st 4

hours always give the
maximum
1. Condition Severe dehydration Plan C-treatment of
a. Unconsciousness severe DHN using IVF
b. Lethargic Priority-choice of IVF:
c. Floppy-apathetic or 1. D5LRS-best or 1st
passive choice if available for
2. Very sunken fontanel severe DHN since
3. Very sunken eyeballs dextrose gives additional
& absent tears source of
4. Very dry mouth, energy & improves
tongue & lips appetite D5-is glucose
Refuses to drink orally LRS-has 3 chlorides
5. Skin returns back very, 2. LRS-Lactate Ringers
very slowly best done at or Hartman solution is
the abdomen the most appropriate
choice if no D5LRS
3. Plain NSS or 0.9 NaCl
4. D5W
5. D10W

2 Victims of Severe Dehydration:

a. Child: give 100 mg/kg body weight in the 1st 4 hours
Example: 8 kg=800 ml. IVF to be infused on the 1 st 4 hours for patient with severe
dehydration (8 am-12 noon)
b. Adult: give 3-4 liters of IVF in 1st 4 hours
Example: 9am-1pm=4 liters=1 liter/hour
If still severe dehydration, 2-6pm=infuse 4 liters IVF
Fruits for Diarrhea:
Apple: has pectin & tarum which has an absorbent property, eat the skin
Banana: has K+
Caimito: eat the flesh in cases of constipation but in diarrheal cases, eat the
extracts, milky substances (dagta) found on the inside of the skin
Duhat: wash first the fruit then sprinkle with rock salt & shake, notice extracts to
come out of the fruit, eat both skin & flesh
Fruits to avoid during diarrhea: Papaya flesh, pineapple flesh, mango,
guyabano & kaimito flesh
BRAT Diet: Banana, Rice, Apple, Tea, toasted bread or toasted rice beads which
has activated charcoal that acts as absorbent
Direction: In a cup of warm water, add 1 tablespoon of toasted rice or bread &
allow to stand for 20-30 minutes produces a blackish discoloration which is
pectin

TYPES OF DIARRHEA
o ACUTE : < 14DAYS
o PERSISTENT: 14 DAYS or more
o DYSENTERY: Blood in the stool; with or without mucus *CARI
CLASSIFY DEHYDRATION
SEVERE DEHYDRATION
Two of the following:
Abnormally sleepy
Sunken eyes
Drinks poorly
Skin pinch goes very slowly
Treat PLAN C: Referral to hospital for IVF!!!

SOME DEHYDRATION
Two of the following:
Restless, irritable
Sunken eyes
THIRSTY: drinks eagerly
Skin pinch goes back
Treat PLAN B
O.R.S: first 4hours after assessment
200-400ml 0-4mos
400-700ml 4-12mos
700-900ml 1-2 yrs
900ml-1L 2-5yrs
NO DEHYDRATION
Not enough signs to classify some or severe
Treat PLAN A
Give extra fluids
50-100ml after each watery stool (0-2y/o)
100-200ml (2 y/o & above)
as tolerated (10y/o & above)
Continue feeding
Return if with danger sign/s.
(CONTROL OF ACUTE RESPIRATORY INFECTIONS )
Goal: Morality and Morbidity reduction of Pnuemonia.
Target groups: very young: <2 months
Older child: 2 months 5 years old
Child with cough and colds
Program:
1. Assessment:
History: Subjective
Age
Cough and Duration
Able to Drink or stop feeding
Fever ---- duration
Convulsion

Physical Examination: Objective

Weight, Height
Respiratory Rate one whole minute
Fast Breathing
*Less than 2 months 60/min or >
*2 months 1 year 50/min or >
*1- 5 years old 40/min or >
Observe for :
- Chest in drawing
- Stridor during inhalation
- LOC
- Wheeze during exhalation
- Fever
- Malnutrition
- Level of Consciousness

2. STANDARD CLASSIFICATION OF ILLNESS:

I. Infants 2 months to 5 years old

1. VERY SEVERE DISEASE:
If any 3 of the 5 Danger signs are present
Signs and Symptoms:
f. Not able to drink
g. Convulsion
h. Sleepy
i. Stridor
j. Severe Malnutrition

Treatment:
1. Refer urgently to hospital
2. 1st dose of antibiotics
3. Treatment of Fever ( TSB ) * Wheeze (NEBULIZE)
4. Antimalarial

2. PNEUMONIA:
 Signs and Symptoms:
a. Chest in drawing
b. Nasal flaring
c. Grunting
d. Cyanosis

2 Types:
a. Severe Pneumonia
Symptoms: Chest indrawing, cyanosis, nasal flaring, grunting.
Treatment: Same with very severe but anti malarial is not given.

b. Not Severe Pneumonia

Symptoms: No chest in drawing and fast breathing.
Treatment: 1. Home care TSB, Nutrition, Steam inhalation
2. Antibiotics for 2 days and follow up after 2 days.
a. If it improves, consume all meds finish the course of
the treatment.
b. If worse, refer.

3. NO PNEUMONIA
Assess for other problems and provide home care.
No Chest indrawing, No fever
If with sore throat in children: Mild, warm tea with syrup.
If chronic, refer.

II. Infants lessthan 2 months

1. VERY SEVERE DISEASE
Symptoms: Stopped feeding well
Convulsions
Abnormally sleepy
Stridor
Wheeze
Severe malnutrition and Fever of 38C or Hypothermia
(<35.5C)
Treatment: Refer urgently to hospital
Keep warm
Give first doses of antibiotic

2. PNEUMONIA
Symptoms: Severe Chest indrawing and Fast Breathing
Treatment: Same as severe.

*UFC (UNDER FIVE CLINICS )

 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 chiild 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 sagfe and learning oriented environment for the child.
5. Monitoring and Evaluation.

**BREASTFEEDING / LACTATION MANAGEMENT EDUCATION TRAINING**

-Breastfeeding practices has been proven 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 substitute, infant formulas, feeding
bottles, teats etc.)
B. RA 7600 THE ROOMING IN AND BREASTFEEDING AC T 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.
3. Conduct Orientation / Advocacy meetings to Hospital / Community.
ADVANTAGES OF BREASTFEEDING:
MOTHER:
*Oxytocin helps the uterus contracts
*Uterine involution
*Reduce incidence of Breast Cancer
*Promote Maternal Infant Bonding
*Form of Family planning method ( Lactational Amenorrhea )

BABY:
*Provide Antibodies.
*Contains Lactoferin ( Binds with Iron )
*Leukocytes
*Contains Bifidus factor
Promotes growth of the Lactobacillus inhibits the growth of
pathogenic bacilli.

Positions in BF THE BABY:

1. Cradle Hold head and neck are supported
2. Football Hold
3. Side Lying Position
Best for Babies
Reduce Incidence of Allergens
Economical
Antibodies Present
Stool Inoffensive ( Golden Yellow )
Temperature 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 children growth and development.

1. WHAT ARE THE HEALTH SERVICES OFFERED IN GP AND WHO ARE THE
TARGETS?
GP offers the following:
1.1 Routine Health Services:

Health Service Dosage Route of Target

Administration Population
Vitamin A 200,000 IU or Orally by drops 12 59 months
Capule capsule 100,000 old, nationwide
IU or cap or 3 9 -12 months old
drops infants receiving
AMV nationwide.
Ferrous Sulfate 0.3 ml ( 2 6 Orally by drops. 2 -11 months old
( 25 mg elemental months ) once a infants in
Iron per ml; 30 ml day Mindanao area,
Bottle as taken including
home medicine 0.6ml ( 6- 11 evacuation
with instructions ) months) centers in armed
conflict areas.
Routine
Immunization
-BCG 0.05 ml Intradermal on 0 11 months
right deltoid.
-DPT 0.5 ml Intramuscularly 0 11 months
on anterior thigh
-OPV 2 drops Orally 0 11 months

-AMV 0.5 ml Subcutaneously

on deltoid
-Hepa B ( If 0.5 ml Intramuscularly 0 11 months
available )
Deworming drug 1 tablet as single Orally 36 59 months,
( If available ) dose nationwide
Weighing 0 59 months
nationwide

-*The child should not have received megadose of Vitamin A above the
recommended dosage within the past 4 weeks except if the child has measles or
signs and symptoms of Vitamin A deficiency.
-**For any 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 ( GP )
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.) Necesary in energy metabolism
c.) Vital in brain cell formation and mental developmet
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. Vital 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 minths 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 womens 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 moths old

*What are Complementary Foods?
a. foods introduced to the child at the age 6 months to supplement breast milk
b. 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?

c. Breast milk can be a single source of nourishment from birth up to six months of
life.
d. 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.
e. Breastmilk should be supplemented with other foods so that the child can get
additional nutrients.
f. Introuction of complementary foods will accustom him to new foods that will also
provide additional nutrients to make him grow well.
g. 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 lugao / cooked rice, soft cooked vegetable. 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 amounts is
consumed.
c. Give bite sized fruit separately
d. Give egg alone or combine with above food mixture.

*FP ( 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.
Goal and Objective:
* 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 Amennorhea
B. ARTIFICIAL METHODS
I. CHEMICAL METHODS
1. Ovulation suppressant such as PILLS
2. Depo Provera
3. Spermicidals
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
*MC ( MATERNAL CARE )
*BF ( BREAST FEEDING )
*MRP ( MALNUTRITION REHABILITATION PROGRAM )
*VAD (VITAMIN A DEFICIENCY )
*IDD / IDA ( IODINE DEFICIENCY DISORDERS / IRON DEFICIENCY ANEMIA )
*FP ( FAMILY PLANNING )

II. Research and Quality Improvement

A. Research in the Community
RESEARCH IN THE COMMUNITY
Research is an important activity in public health but it is misconceived to be primarily
an activity of professional researchers and academicians. Although it is not commonly
included in the PHNs statement of duties and responsibilities, research is nonetheless
included in the scope of functions of the nurse as defined by the Nursing Law.

Research in community health serves a number of purposes, among which are: (1)
improve our understanding of clients and their specific contexts;
(2) provide data needed for program and policy development and evaluation;
(3) improve the delivery of health services and implementation of existing programs;
(4) improve cost-effectiveness of programs; and (5) project a good image of nurses.

The PHN can initiate small researches on the major concerns in health service
delivery and in the management of the health facility. Research topics that could be
studied by the PHN by himself/herself include, among others, socio-demographic
profile of those who utilize health services, client waiting time, referral from and to the
health center, perception of clients on the delivery of health services, response of
clients to different health or nursing interventions, supply management and effects of
specific health education activities.

Research also contributes to what is called evidence-based practice. The practices

that were passed on and were considered as gospel truth in the past should be
examined and tested through research. The challenge, not only PHNs but to major
decision makers in the local health system is to integrate research into the
management and operation of the health facility.

B. National Health Situation

NATIONAL HEALTH SITUATION
Philippine Scenario:
*In the past 20 years some infectious degenerative diseases are on the rise.
*Many Filipinos are still living in remote and hard to reach areas where it is difficult
to deliver the health services they need.
*The scarcity of doctors, nurses and midwives add to the poor health delivery
system to the poor.

VITAL HEALTH STATISTICS 2005

PROJECTED POPULATION :
MALE - 42,874,766
FEMALE - 42,362,147
BOTH SEXES - 85,236,913
LIFE EXPECTANCY
FEMALE - 70 yrs. Old
MALE - 64 yrs. Old

LEADING CAUSES OF MORBIDITY

*Most of the top ten leading causes of morbidity are communicable disease
*These include the diarrhea, pneumonia, bronchitis, influenza, TB, malaria and
varicella
*Leading non CD are heart problem, HPN, accidents and malignant neoplasms

LEADING CAUSES OF MORTALITY

*The top 10 leading causes of mortality are due to non CD
*Diseases of the heart and vascular system are the 2 most common causes of
deaths.
*Pneumonia, PTB and diarrheal diseases consistently remain the 10 leading
causes of deaths.

-HEALTH INDICES
I. Basic Health Indicators
2 Indicators to assess a national health situation
A. Nutrition
B. Disease Patterns
Context of CHN: Health Situation
**Leading Causes of Morbidity**
10 Leading Causes of Morbidity
1. Pneumonia -- Bacterial
2. Diarrhea
3. Bronchitis
4. Influenza -- Respiratory
5. Hypertension
6. TB Respiratory
7. Diseases of the Heart
8. Malaria
9. Chickenpox
10. Measles

**Leading Causes of Mortality**

10 Leading Causes of Mortality
1. Disease of the Heart
2. Diseases of the Vascular System
3. Malignant neoplasm
4. Pneumonia
5. Accidents
6.TB all forms
7. COPD
8. Conditions originating in perinatal
period
9. Diabetes Mellitus
10. Nephritis, Nephrotic Syndrome

III. Other Indicators

A. Infant Mortality Rate
*2002 --- 21/1000 rated based on WHO global indicator >50 high
Increase IMR decrease MCHS ( poor nutrition and child health service )

INFANT MORTALITY RATE

Total # of death below 1 yr in a given calendar year X 1000
Estimated population as of July 1 of the same calendar year

10 Leading Causes of Infants Deaths

1. Other perinatal conditions
2. Pneumonia
3. Bacterial Sepsis of Newborn
4. Diarrhea & Gastroenteritis of presumed infectious origin
5. Congenital Pneumonia
7. Other congenital malformations
8. Disorders r/t short gestation & LBW
9. Septicemia
10. Measles
*Increase IMR = decrease MCHS
*Poor maternal childs service

B. Maternal Mortality Rate

 MMR= # of maternal deaths x 1000
RLB

Leading Causes Of Maternal Deaths:

1. Normal delivery and other complications r/t pregnancy occurring in the course of
labor, delivery & puerperium
2. HPN complicating pregnancy, childbirth & puerperium
3. Postpartum hemorrhage
4. Pregnancy with abortive outcome
5. Hemorrhage related to pregnancy

*Life expectancy at birthlife span either: age specific or sex specific

*Median Age- 20.1 years
*The Philippines is an agricultural country- 55%

C. Life Expectancy at Birth

D. Median Age
E. Crude Rates
1. Crude Birth Rate
2. Crude Death Rate

-Health Care Delivery System the totality of all policies, equipment, products,
human resources and services whichaddress the health needs, problems and
concerns of the people. It is large, complex, multi level and multi disciplinary.

Categories:
According to Increasing According to the Type of Service
Complexity of the Services
Provided
Type Service Type Service
Primary Health Promotion, Health Information
Preventive Care, Promotion Dissemination
Continuing Care for and illness
common health prevention
problems, attention
to psychological and
social care, referrals
Secondar Surgery, Medical Diagnosis Screening
y services by and
specialists Treatment
Tertiary Advanced, Rehabilitation PT/OT
specialized,
diagnostic,
therapeutic and
rehabilitative care
- The Health Sector

GOVERNMENT SECTORS
DEPARTMENT OF HEALTH (DOH)
VISION:
-Health for all by year 2000 and Health in the Hands of the People by 2020(OLD).
-A global leader for attaining better health outcomes, competitive and responsive
health care system, and equitable health financing(NEW VISION by 2030).

MISSION:
-In partnership with the people, provide equity, quality and access to health care
especially the marginalized.(OLD)
-To guarantee equitable, sustainable and quality health for all Filipinos, especially
the poor, and to lead the quest for excellence in health.(NEW)

5 Major Functions:
1. Ensure equal access to basic health services
2. Ensure formulation of national policies for proper division of labor and proper
coordination of operations among the government agency jurisdictions
3. Ensure a minimum level of implementation nationwide of services regarded as
public health goods
4. Plan and establish arrangements for the public health systems to achieve
economies of scale Phil Health.
5. Maintain a medium of regulations and standards to protect consumers and
guide providers Sentrong Sigla = Training and infrastructure

-LOCAL GOVERNMENT UNIT / NON GOVERNMENT SECTORS

R.A. 7160 Local Govt Code Local health board- Governor
Municipal health officer- mayor
Assistant - municipal
Provincial health officer

Health Promotion- no threats, no risk- approach behavior

Health Prevention- identified health problem- avoidance behavior

-Private Sector
-Composed of both commercial and business organization, non
business organizations
 Commercial/Business Non-commercial
Profit-oriented Orientation to social development, relief
and rehabilitation, community
organizing
Manufacturing Socio-civic groups
companies Religious organizations/foundations
Advertising agencies
Private practitioners
Private institutions

NGOs assumes the following roles:

Policy and Legislative Advocates
Organizers, Human Rights Advocates
Research and Documentation
Health Resource Development Personnel
Relief and Disaster Management
Networking

PRIMARY STRATEGIES TO ACHIEVE HEALTH GOALS

*Support for health goal
*Assurance of health care
*Increasing investment for PHC
*Development of National Standard

MILESTONE IN HEALTH CARE DELIVRY SYSTEM

*RA 1082 - RHU Act
*RA 1891 - Strengthen Health Services
*PD 568 - Restructuring HCDS
*RA 7160 - LGU Code

NATIONAL HEALTH PLAN

*National Health Plan is a long-term directional plan for health; the blueprint
defining the countrys health PROBLEMS, POLICY, STRATEGIES, THRUSTS

GOAL:
*To improve health indicators through access.
*To enable the Filipino population to achieve a level of health which will allow
Filipino to lead socially and economically productive life, with longer life
expectancy, low infant mortality, low maternal mortality and less disability through
measures that will guarantee access of everyone to essential health care.

BROAD OBJECTIVES:
*promote equity in health status among all segments of society
*address specific health problems of the population
*upgrade the status and transform the HCDS into a responsive, dynamic and
highly efficient, and effective one in the provision of solutions to changing the
health needs of the population
*promote active and sustained peoples participation in health care

MAJOR HEALTH PLANS TOWARDS HEALTH IN THE HANDS OF THE

PEOPLE IN THE YEAR 2020

23 IN 1993
Refers to the 23 programs, projects, activities of the
DOH for the year 1993, which marks the beginning
of its journey towards DOG vision.

Health for more in 94

Activities in 1994 focused on Cancer prevention,
reproductive health, mental health, and
maintenance of a safe envt.

Health Focus in 1995 Think Health, Health Link

A national & multi-sectoral health promotion

strategy aimed at conveying health messages to
people wherever they are aimed at building
supportive environments through advocacy,
community action & networking.

Health Sector Reform Agenda

Emphasizing on improvements in health care

delivery by maximizing peoples participation in
health

Sentrong Sigla Movement

 Pertains to development & implementation of
standards to provide quality health services to the
people.

C. Vital Statistics
VITAL STATISTICS
Statistics refers to a systematic approach of obtaining, organizing and analyzing
numerical facts so that conclusion may be drawn from them.
Vital Statistics refers to the systematic study of vital events such as births,
illnesses, marriages, divorce, separation and deaths.
Statistics of disease (morbidity) and death (mortality) indicate the state of
health of a community and the success or failure of health work.

Use of Vital Statistics:

*Indices of the health and illness status of a community
*Serves as bases for planning, implementing, monitoring and evaluating
community health nursing programs and services.

Sources of Data:
*Population census
*Registration of Vital Data
*Health Survey
*Studies and researches

Rates and Ratios:

Rate shows the relationship between a vital event and those persons exposed to
the occurrence of said event, within a given area and during a specified unit of
time, it is evedent that the person experiencing the event (Numerator) nust come
from the total population exposed to the risk of same event (Denominator).

Ratio is used to describe the relationship between two (2) numerical quanitities
or measures of events without taking particular considerations to the time or place.
These quantities need not necessarily represent the same entities; although the
unit of measure must be the same for both numerator and denominator of the
ratio.

Crude or General Rates referred to the total living population. It must be

presumed that the total population was exposed to the risk of the occurrence of
the event.
Specified Rate - the relationship is for a specific population class or group. It
limits the occurrence of the event to the portion of the population definitely
exposed to it.

Crude Birth Rate a measure of one characteristic of the natural growth or

increase of a population.

Crude Death Rate a measure of one mortality from all causes which may result
in a decrease of population.

Infant Mortality Rate measure the risk of dying during 1st year of like. It is a
good index of the general health condition of a community since it reflects the
changes in environment and medical condition of a community.

Maternal Mortality Rate measures the risk of dying from causes related to
pregnancy, childbirth, and puerperium. It is an index of the obstetrical care needed
and received by women in a community.

Fetal Death Rate measures pregnancy wastage. Death of the product of

conception occurs prior to its complete expulsion, irrespective of duration of
pregnancy.

Neonatal Death Rate measures the risk of dying the 1st month of life. It serves
as an index of the effects of prenatal care and obstetrical management of the
newborn.

Specific Death Rate describes more accurately the risk of exposure of certain
classes of groups to particular diseases. To understand the forces of mortality, the
rates should be made specific provided the data are available for both the
population and the event in their specifications. Specific rates render more
comparable and thus reveal the problem of public health.

Incidence Rate measures the frequency of occurrence of the phenomenon

during a given period of time.

Prevalence Rate measures the proportion of the population which exhibits a

particular disease at a particular time. This can only be detremined following a
survey of the population concerned, deals with the total (new and old) number of
cases.

Proportionate Mortality (Death Ratios) - shows the numerical relationship

between deaths from all causes (or group of causes), age (or group of age) etc.
and the total no. of deaths from all causes in all ages taken together.
Adjusted or Standardized Rate to render the rates of 2 communities
comparable, adjustment for the differences in age, sex, and any other factors
which influence vital events have to be made.

Methods:
*By applying observed specific rates to some standard population.
*By applying specific rates of standard population to corresponding classes or
groups of the local population.

Presentation of Data
The following are most commonly used graphs in presenting data:
Line or Curved graphs shows peaks, valleys and seasonal trends. Also
used to show the trends of birth and death rates over a period of time.
Bar graphs each bar represents or expresses a quantity in terms of rates or
percentages of a particular observation like causes of illness and deaths.
Area diagram (Pie Charts) shows the relative importance of parts of the
whole.

Functions of the Nurse:

*Collects data
*Tabulates data
* Analyzes and interprets data
*Evaluates data
*Recommends redirection and / or strengthening of specific areas of health
programs as needed.

D. Epidemiology
E. Demography

III. Management of Resources and Environment and Records Management

A. Field Health Services and Information System ( FHSIS )
FIELD HEALTH SERVICES AND INFORMATION SYSTEM (Cuevas, 2007)

Objectives:
- To provide summary of data on health services delivery and selected program
accomplished indicators at the barangay municipality / city, district, provincial,
regional and national events.
-To provide data which when combined with data from other sources, ca be used
for program monitoring and evaluation purposes.
-To provide a standardized, facility level data base which can be assessed for a
more in depth study /studies.
-To ensure that the data reported to the FHSIS are useful and accurate and are
disseminated in a timely and easy to use fashion.
-To minimize the recording and reporting burden at the service delivery level in
order to allow more time for patient care and promotive activities.

Importance of FHSIS
- Helps local government determine public health priorities.
- Basis for monitoring and evaluatinghealth program implementation.
- Basis for planning, budgeting, logistics and decision making at all levels.
- Source of data to detect unusual occurrence of a disease.
- Needed to monitor health status of the community.
- Helps midwives in following up clients.
- Documentation of RHM / PHN day to day activities.

Components:
*FAMILY TREATMENT RECORD (Cuevas, 2007) /
INDIVIDUAL RECORD (Famorca, 2013) / *INDIVIDUAL TREATMENT RECORD
*TARGET CLIENT LIST
*REPORTING FORMS / SUMMARY TABLE
*OUTPUT REPORTS /MONTHLY CONSOLIDATION TABLE (MCT)

Concept:
*TREATMENT RECORD Fundamental building block or foundation of FHSIS.
This is the document, form or pieces of paper upon which the presenting
symptoms or complaints of the patient on consultation and the diagnosis,
treatment and date of treatment if recorded.
*CLIENT LIST Second building block of the FHSIS and are intended to serve
several purposes.
First is to plan and carry out patient care and service delivery. Such lists
will be of considerable value to midwives / nurses in monitoring service delivery to
clients in general and in particular to groups of patients identified as targets or
eligibles for one or another program of the Department.
The second purpose of Target Client Lists is to facilitate the monitoring
and supervision of service delivery activities.
The Third purpose is to report services delivered.
The fourt purpose of the Target Client Lists is to provided a clinic level
data base which can be accessed for further studies.
TARGET CLIENT LISTS TO BE MAINTAINED IN
THE FHSIS
1. Target Client List for Prenatal Care
2. Target Client List for Post-Partum Care
3. Target Client List of Under 1 Year Old Children
4. Target Client List for Family Planning
5. Target Client List for Sick Children
6. NTP TB Register
7. National Leprosy Control Program Form 2-Central Registration
Form

*TALLY / REPORTING FORMS Submitted monthly or quarterly (majority).

One report is prepared weekly several
annually, and in some instances, every few
minutes as relevant events occur, e.g., maternal
and neonatal deaths.

FHSIS Manual of Operations has the following

RECORDING TOOLS:
1. INDIVIDUAL TREATMENT RECORD (ITR)
- Date, Home address of patient
- Presenting symptoms or complaint of the patient on consultation.
- Diagnosis (if available)
- Treatment and Date of treatment.

2. TARGET CLIENT LIST (TCL)

- To carry / plan out care for patient.
- Facilitate monitoring / supervision of service delivery activities.
- To report services delivered.
- To provide clinic level data base.
e.g., TCL for prenatal care; TCL for postpartum care.

3. SUMMARY TABLE
- Accomplished by Midwife
- 12 column table = 12 months of calendar year
- monthly summary of morbidity / monthly trends of disease
- serves as a source for the 10 leading causes of morbidity.

4. MONTHLY CONSOLIDATION TABLE

- Accomplished by the Nurse
- Source document for the Quarterly form and the Output Table of the RHU or
Health Center.
- Based on the Summary Table.
 (Famorca, 2013)

FHSIS Manual of Operations

REPORTING FORMS:
- These are summary data that are transmitted or submitted on a monthly,
quarterly and on annual basis to higher level. The source of data for this
components is dependent on the records.
1. MONTHLY FORMS
- Prepared by the Midwife
- Submitted to the Nurse
a. Program Report (M1)
- Maternal Care
- Child Care
- Family Planning
- Disease Control
- Summary Table Data are copied into this report; program report.
b. Morbidity Report (M2)
- Contains list of all cases of disease by age and sex.
2. QUARTERLY FORMS
- Prepared by the Nurse
- Only one quarterly form for every Municipality / City
- If there are 2 RHU / Centers for the Municipal Health Officer / Mayor.
- Quartely Forms are submitted to the provincial health officr / Office.
a. Program Report (Q1)
- 3 months total indicators: Maternal Care, Family Planning, Child Care,
Dental Health and Disease Control.
(Famorca, 2013)
b. Morbidity Report (Q2)
- 3 months consolidation of Morbidity Report (M2)
3. ANNUAL FORMS
a. A BHS
*Report by the Midwife Demographic
- Environmental
- Natality Data
b. Annual Form 1 (A-1)
- Prepared by the Nurse
 - Report of the RHU / Health Center
- Demographic, Environmental,Natality and Mortality for the entire year.
c. Annual Form 2 (A-2)
- Prepared by the Nurse
- Yearly Report for morbidity by age / sex
d. Annual Form 3 (A-3)
- Prepared by the Nurse
- Yearly Report of all deaths (mortality) by age and sex.

FLOW OF REPORT
OFFIC PERSO RECORDING FORMS FREQUENCY SCHEDULE OF
E N TOOLS SUBMISSION
BHS Midwife -ITR Monthly Monthly Every 2nd week
-TCL Form (M1 of the
-ST AND M2 ) succeeding
month
A-BHS Annually
Form Every 2nd week
of january
RHU PHN -ST Quarterly Quarterly Every 3rd week
-MCT Form (Q1 of the 1st month
AND Q2) of succeeding
quarter
Annual Every 3rd week
Forms of January
-A1
-A2
-A3

B. Target-setting
C. Environmental Sanitation

IV. Ethico-Moral-Legal Responsibility

A. Socio-cultural Values, Beliefs and Practices of Individuals, Families, Groups and
Communities
B. Code of Ethics for Government Workers
C. WHO, DOH, LGU Policies on Health
D. Local Government Code
E. Issues

V. Personal and Professional Development

A. Self-assessment of CHN Competencies, Importance, Methods, Tools
B. Strategies and Methods of Updating Ones Self, Enhancing Competence in
Community Health Nursing and Related Areas.

VI. Part II: MCN

VII. Safe and Quality Care, Health Education, and Communication, Collaboration
and Teamwork
A. Principles and Theories of Growth and Development (Pediatric Nursing)
PRINCIPLES OF GROWTH AND DEVELOPMENT
PRINCIPLES EXAMPLES
Growth and development are Although there are highs and lows in
continuous processes from conception terms of the rate at which growth and
until death development proceed, a child grows
new cells and learns new skills at all
times. An example of how the rate of
growth changes is a comparison
between that of the first year and later
in life. An infants triples birthweights and
increases height by 50% during the first
year of life. If this tremendous growth
rate were to continue, the 5 ye-old
child, when ready to begin school,
would weigh 1,600 Ib. And be 12 ft. 6 in.
Tall.
Growth and development proceed in an Growth in height occurs in only one
orderly sequence. sequence from smaller to larger.
Development also proceeds in a
predictable order. For example, the
majority of children sit before they
creep, creep before they stand, stand
 before they walk, and walk before they
run. Some children may skip a stage
( or pass through it so quickly that the
parents do not observe the stage) or
progress in a different order, but most
children follow a predictable sequence
of growth and development.
Different children pass through the All stages of development have a range
predictable stages at different rates. of time rather than a certain point at
which they are usually accomplished.
Two children may pass through the
motor sequence at different rates. For
example, one child begins walking at 9
months while another at 14 months.
Both are developing normally. They are
both following the predictable
sequence; they are merely developing
at different rates.
All body systems do not develop at the Certain body tissues mature more
same rate. rapidly than others. For example,
neurologic tissue experiences its peak
growth during the first year of life,
whereas genital tissues grows little until
puberty.
Development is cephalocaudal. Cephalo is a Greek word meaning
head; Caudal means tail.
Development proceeds from head to
tail. A newborn can lift only his or her
head off the bed when he or she lies in
a prone position. By age 2 months., the
infant can lift his or her head and chest
off the bed; by 4 months., he or she can
lift his or her head, chest, and part of
the abdomen; by 5 months., the infant
has enough control to turn over ; by 9
months., he or she can control the legs
enough to crawl; and by 1 year., the
child can stand upright and perhaps
walk. Motor development has
proceeded in a cephalocaudal order
from the head to the lower extremities.
Development proceeds from proximal to This principle is closely related to
distal body part. cephalocaudal development. It can be
 illustrated by tracing the progress of
upper extremity development. A
newborn makes ;ittle use of the arms or
hands. Any movement, except to put a
thumb in the mouth, is a flailing motin.
By age 3 or 4 months., the infant has
enough arm control to support the
upper body weight on the forearms, and
the infant can coordinate the hand to
sccop up objects. By 10 months., the
infant can coordinate the arm, thumb,
and index fingers, sufficiently well to use
a pincer-like grasp or be able to pick up
an object as fine as a piece of breakfast
cereal on a high-chair train.
Development proceeds from gross to This principle parallels the proceeding
refined skills. one. Because the child is able to control
distal body parts such as fingers, he or
she is able to perform fine motor skills
( a 3-year- old colors best with a large
crayon; a 12 yr-old can write with a fine
pen).
There is an optimum time for initiation of A child cannot learn a task until his or
experiences or learning. her nervous system is mature enogh to
allow that particular learning. A child
cannot learn to sit, for example, no
matter how much thechilds
parentshave him or her practice, until
the nervous system has matured
enough to allow back control. A child
who is not given the opportunity to learn
developmental tasks at the appropriate
or targert times for such tasks may
have ,ore difficulty than the usual child
learning the tasks later on. A child who
is confined to a body cast at 12
months., which is the time he or she
would normally learn to walk, may take
a long time to learn this skill once free
of the cast at, say, age 2 years old. The
child has passed the time of optimal
learning fo that particular skill.
Neonatal reflexes must be lost before An infant cannot grasp with skill until the
development can proceed. grasp reflex has faded nor stand
steadily until the walking reflex has
faded. Neonatal reflexes are replaced
by purposeful movements.
A great deal of skill and behavior is An infants practices taking a first step
learned by practice. over and over before he or she
accomplishes this securely. If a child
falls behind the normal growth and
development rate because of illness, he
or she is capable of catch-up growth
to bring him or her on equal footing
again with his or her age group.

THEORIES OF DEVELOPMENT

1. Definition of Theories
Theory a systematic statement of principles that provides a framework for
explaining some phenomenon. Developmental theories provide road maps for
explaining human development.
Developmental Task a skill or a growth responsibility arising at a particular time
in an individuals life, the achievement of which will provide a foundation for the
accomplishment of future tasks. It is not so much chronological as the completion
of developmental tasks that defines whether a child has passed from one
developmental stage of childhood to another. For example, a child is not a toddler
just because he or she is 1 year plus 1 day old; he or she becomes a toddler when
he or she has passed through the development stage of infancy.

2. Basic Division of Childhood

Stage Age Period
Neonate From 28 days of life
Infant 1 month 1 year
Toddler 1 3 years
Preschooler 3 5 year
School-age child 6 12 years
Adolescent 13 20 years

3. Freuds Stages of Childhood (Psychosexual Development)

Stage Psychosexual Stage Nursing Implications
Infant ORAL STAGE: Child explores the Provide oral stimulation
world by using his or her mouth, by giving pacifiers; do not
especially the tongue. discourage thumb
sucking. Breastfeeding
may provide more
stimulation than formula
feeding because it
requires the infant to
expend more energy.
Toddler ANAL STAGE: Child learns to Help children achieve
control urination and defecation. bowel and bladder control
without undue emphasis
on its importance. If at all
possible, continue bowel
and bladder training while
child is hospitalized.
Preschooler PHALLIC STAGE: Child learns Accept childs sexual
sexual identity through awareness interest,such as fonding
of genital area. his or her own genitals,
as a normal area of
exploration. Helps
parents answer the childs
questions about birth or
sexual differences.
School-age child LATENT STAGE: Childs Help the child have
personality development appears positive experiences as
to be non-active or dormant. his or her self-esteem
continues to grow and as
he or she prepares for the
conflicts of adolescence.
Adolescent GENITAL STAGE: Adolescent Provide appropriate
develops sexual maturity and opportunities for the child
learns to establish satisfactory to relate with opposite
relationships with the opposite sex. sex; allow the child to
verbalize feelings about
new relationships.

Eriksons Stages of Childhood (Psychosocial Development)

Stage Developmental Task Nursing Implications
Infant Developmental task is to Provide a primary
form a sense of trust caregiver.Provide
versus mistrust. Child experiences that add to
learns to love and be security such as soft
 loved. sounds and touch.
Provide visual stimulation
for active child
involvement.
Toddler Developmental task is to Provide opportunities for
form a sense of autonomy decision makingsuch as
versus shame. Child offering choicesof clothes
learns to be independent to wear or toys to play
and make decisions for with. Praise ability to
himself or herself. make decisions rather
than judge or correct the
childs decision.
Preschooler Developmental task is to Provide opportunities for
form a sense of initiative exploring new places or
versus guilt. Child learns activities. Allow play to
how to do things (basic include activities involving
problem solving) and that water, clay (for modeling),
doing things is desirable. or finger paints.
School-age child Developmental task is to Provide opportunities
form a sense of industry such as allowing child to
versus inferiority. Child assemble and complete a
learns how to do things short project so that the
well. child feels rewarded for
the accomplishement.
Adolescent Developmental task is to Provide opportunites for
form a sense of identity the adolescent to discuss
versus role confusion. feelings about events
Adolescent learns who he important to him or her.
or she is and what kind of Offer support and praise
person he or she will be for decision making.
by adjusting to a new
body image, seeking
emancipation from
parents, choosing a
vocation, and determining
a value system.

Piagets Stages of Cognitive Development

Stage of Development Age Span Nursing Implication

Sensorimotor neonatal 1 month Stimuli are assimilated
reflexes into beginning mental
images.Behavior is
 entirely reflexive.
Primary circular reaction 1 4 months Hand mouth and ear
eye coordination develop.
Infant spends much time
looking at objects and
separating self from them.
Beginning intention of
behavior is present ( the
infant brings thumb to
mouth for a purpose: to
suck it ). An enjoyable
activity for the period: a
rattle or a tape of parents
voice.
Secondary circular 4 8 months Infant learns to initiate,
reaction recognize, and
repeatpleasurable
experiences from
environment. Memory
traces are present; infants
anticipates familiar events
( a parent coming near
him will pick him up ).
Good toy for this period:
mirror; good game: peek
a boo.
Coordination of 8 12 months Infant can plan activities to
secondary reaction attain specific goals; can
perceive that others can
cause activity and that
activities of own body are
separate from activity of
objects; can search for
and retrieve toy that
disappears from view; and
can recognize shapes and
sizes of familiar objects.
Because of increased
sense of separateness,
infant experiences
separation anxiety when
primary caregiver leaves.
Good toy for this period:
 nesting toys ( e.g., colored
boxes ).
Tertiary circular reaction 12 18 months Child is able to experiment
Invention of new means 18 24 months
through mental
combination
Pre operational thought 2 7 years
Concrete operational 7 12 years
thought
Formal operational 12 years
thought

B. Nursing Care in the Different stages of Growth and Development including

1. Nutrition
2. Safety
3. Language Development
4. Discipline
5. Play
6. Immunization
7. Anticipatory guidance
8. Values formation
C. Human Sexuality and Reproduction including Family Planning
D. Nursing Care of Women during Normal Labor, Delivery and Postpartum
E. Nursing Care of the Newborn
1. APGAR Scoring
2. Newborn Scoring
3. Maintenance of Body Processes (oxygenation, temperature)
F. Nursing Care of Women with Complications of Pregnancy, Labor, Delivery and
Postpartum Period (High-risk conditions)
G. Nursing Care of High-risk Newborn
1. Prematurity
2. Congenital defects
3. Infections
H. Nursing Care of Women with Disturbances in Reproduction and
Gynecology

VIII. Research and Quality Improvement

A. Fertility Statistics
B. Infant Morbidity and Mortality
C. Maternal Mortality
D. Standards of Maternal and Child Nursing Practice
IX. Ethico-Moral-Legal Responsibility
A. Socio-Cultural Values, Belief, and Practices of Individuals, Families related to
MCN.
B. WHO, DOH, LGU Policies on Health of Women and Children
C. Family Code
D. Child and Youth Welfare Code
E. Issues related to MCN

X. Personal and Professional Development

A. Self-assessment of MCN Competencies, Importance, Methods, Tools
B. Strategies and Methods of Updating Ones self, Enhancing Competence in
MCN and Related Areas.

Nursing Board Exam/Nursing Licensure Exam Coverage (Nursing Practice

III, IV and V)
NURSING BOARD EXAM SCOPE/COVERAGE
NURSING PRACTICE III, IV, V
TEST DESCRIPTION: Theories, concepts, principles and processes in the care of
clients with altred health patterns, utilizing the nursing process and integrating the
key areas of nursing competencies.
TEST SCOPE:
I. Safe & Quality Care, Health Education, Management of Environment &
Resources, and Quality Improvement.

A. TEST III
1. Client in Pain
CLIENT IN PAIN
Pain- the fifth vital sign American Pain Society 2003.
-Identifying pain as the fifth vital sign suggests that the assessment of pain should
be as automatic as taking a clients BP abd Pulse.
-Whatever the person says it is, existing whenever the experiencing person says
it does McCaffery and Pasero, 1999
-Emphasizes the highly subjective nature of pain.
-Pain is the most common reason client seek medical advice.
-Pain is protective mechanism or a warning to prevent further injury.
- an unpleasant sensory and emotional experience associated with actual or
potential

THE PATHOPHYSIOLOGY OF PAIN

Basic Categories of Pain:

1. Acute Pain- sudden pain which is usually relieved in seconds or after
a few weeks.
2. Chronic Pain (Non-Malignant)- constant, intermittent pain which
usually persists even after healing of the injured tissue
3. Cancer-Related Pain- May be acute or chronic; may or may not be
relieved by medications.

Pain Transmission:
1. Nociceptors are called pain receptors. These are the free nerve endings in the
skin that respond to intense, potentially damaging stimuli.
2. Peripheral Nervous System
3. Central Nervous System
4. Descending Control System

2. Peri-operative Care
3. Alterations in Human Functioning
a Disturbance in Oxygenation
b Disturbance in Metabolic and Endocrine Functioning
c Disturbance in Elimination

B. TEST IV
1. Alterations in Human Functioning
a. Disturbances in Fluids and Electrolytes
b. Inflammatory and Infectious Disturbances
c. Disturbances in Immunologic functioning
d. Disturbances in Cellular functioning
2. Client Biologic Crisis
3. Emergency and Disaster Nursing

C. TEST V
 1. Disturbances in Perception and Coordination
a. Neurologic Disorders
b. Sensory Disorders
c. Musculo-skeletal Disorders
d. Degenerative Disorders
2. Maladaptive Patterns of Behavior
a. Anxiety Response and Anxiety Related Disorders
b. Psycho-physiologic Responses, Somatoform, and Sleep Disorders
c. Abuse and Violence
d. Emotional Responses and Mood Disorders
e. Schizophrenia and Other Psychotic and Mood Disorders
f. Social Responses and Personality Disorders
g. Substance related Disorders
h. Eating Disorders
i. Sexual Disorders
j. Emotional Disorders of Infants, Children and Adolescents.

II. Personal and Professional Development

A. Nurse-Client Relationship
B. Continuing Education

III. Communication, Collaboration and Teamwork

A. Team approach
B. Referral
C. Network/linkage
D. Therapeutic communication

IV. Ethico-Moral-Legal Responsibility

A. confidentiality
B. Clients Rights
1. Informed Consent
2. Refusal to take medications, Treatment and Admission Procedures
C. Nursing Accountability
D. Documentation/charting
E. Culture Sensitivity