Expended program for Immunization (EPI)

 Principles of EPI include:

1.      Epidemiological situation

2.      Mass approach

3.      Basic Health Service

 The 7 immunizable diseases are:

1.      Tuberculosis

2.      Diptheria

3.      Pertussis

4.      Measles

5.      Poliomyelitis

6.      Tetanus

7.      Hepatitis B

Administration of vaccines:

Vaccine Content Form & Dosage # of Doses Route

BCG Live attenuated Freeze dried 1 ID
bacteria infant- 0.05ml

Preschool-0.1ml
DPT DT- weakened liquid-0.5ml 3 IM
toxin

P-killed bacteria
OPV weakened virus liquid-2drops 3 Oral
Hepa B Plasma derivative Liquid-0.5ml 3 IM
Measles Weakened virus Freeze dried- 1 Subcutaneous
0.5ml

 
Schedule of Vaccines:

Vaccine Age at 1st dose Interval between Protection

dose
BCG At birth    
DPT 6 weeks 4 weeks DPT
OPV 6weeks 4weeks Poliomyelitis
Hepa B @ birth @birth,6th week,14th HepaB
week
Measles 9m0s.-11m0s.   measles

6 months – earliest dose of measles given in case of outbreak

9months-11months- regular schedule of measles vaccine

15 months- latest dose of measles given

4-5 years old- catch up dose

Fully Immunized Child (FIC)- less than 12 months old child with complete immunizations of
DPT, OPV, BCG, Anti Hepatitis, Anti measles.

Vaccine Minimum age % protected Duration of

interval Protection
TT1 As early as possible 0% 0
TT2 4 weeks later 80% 3 years
TT3 6 months later 95% 5 years
TT4 1year later/during 99% 10 years
next pregnany
TT5 1 year later/third 99% Lifetime
pregnancy

 There is no contraindication to immunization except when the child is

immunosuppressed  or is very, very ill (but not slight fever or cold). Or if the child
experienced convulsions after a DPT or measles vaccine, report such to the doctor
immediately.
 Malnutrition is not a contraindication for immunizing children rather, it is an indication
for immunization since common childhood diseases are often severe to malnourished
children.
Cold Chain under EPI:

      Cold Chain is a system used to maintain potency of a vaccine from that of manufacture
to the time it is given to child or pregnant woman.

      The allowable timeframes for the storage of vaccines at different levels are:

o       6months- Regional Level

o       3months- Provincial Level/District Level

o       1month-main health centers-with ref.

o       Not more than 5days- Health centers using transport boxes.

      Most sensitive to heat: Freezer (-15 to -25 degrees C)

o       OPV

o       Measles

      Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celcius)

o       BCG

o       DPT

o       Hepa B

o       TT

      Use those that will expire first, mark “X”/ exposure, 3rd- discard,

      Transport-use cold bags, let it stand in room temperature for a while before storing DPT.

      Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B.

FEFO (“first expiry and first out”) – vaccine is practiced to assure that all vaccines are
utilized before the expiry date.

Proper arrangement of vaccines and/or labeling of vaccines expiry date are done to identify
those near to expire vaccines.
Definition

Bag technique – a tool making use of public health bag through which the nurse, during his/her
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 - is an essential and indispensable equipment of the public health nurse which
he/she has to carry along when he/she goes out home visiting. It contains basic medications and
articles which are necessary for giving care.

Rationale

To render effective nursing care to clients and /or members of the family during home visit.

Principles

1. The use of the bag technique should minimize if not totally prevent the spread of
infection from individuals to families, hence, to the community.
2. Bag technique should save time and effort on the part of the nurse in the performance of
nursing procedures.
3. Bag technique should not overshadow concern for the patient rather should show the
effectiveness of total care given to an individual or family.
4. Bag technique can be performed in a variety of ways depending upon agency policies,
actual home situation, etc., as long as principles of avoiding transfer of infection is
carried out.

Special Considerations in the Use of the Bag

1. The bag should contain all necessary articles, supplies and equipment which may be used
to answer emergency needs.
2. The bag and it’s contents should be cleaned as often as possible, supplies replaced and
ready for use at any time.
3. The bag and it’s contents should be well protected from contact with any article in the
home of the patients. Consider the bag and it’s contents clean and /or sterile while any
article belonging to the patient as dirty and contaminated.
4. The arrangement of the contents of the bag should be the one most convenient to the user
to facilitate the efficiency and avoid confusion.
5. Hand washing is done as frequently as the situation calls for, helps in minimizing or
avoiding contamination of the bag and its contents.
6. The bag when used for a communicable case should be thoroughly cleaned and
disinfected before keeping and re-using.
Contents of the Bag

 Paper lining
 Extra paper for making bag for waste materials (paper bag)
 Plastic linen/lining
 Apron
 Hand towel in plastic bag
 Soap in soap dish
 Thermometers in case [one oral and rectal]
 2 pairs of scissors [1 surgical and 1 bandage]
 2 pairs of forceps [ curved and straight]
 Syringes [5 ml and 2 ml]
 Hypodermic needles g. 19, 22, 23, 25
 Sterile dressings [OS, C.B]
 Sterile Cord Tie
 Adhesive Plaster
 Dressing [OS, cotton ball]
 Alcohol lamp
 Tape Measure
 Baby’s scale
 1 pair of rubber gloves
 2 test tubes
 Test tube holder
 Medicines
o betadine
o 70% alcohol
o ophthalmic ointment (antibiotic)
o zephiran solution
o hydrogen peroxide
o spirit of ammonia
o acetic acid
o benedict’s solution

Note: Blood Pressure Apparatus and Stethoscope are carried separately.

Steps/Procedures

Actions Rationale
1. Upon arriving at the client’s home, To protect the bag from
place the bag on the table or any flat contamination.
surface lined with paper lining, clean
side out (folded part touching the
table). Put the bag’s handles or strap
beneath the bag.
2. Ask for a basin of water and a glass To be used for handwashing.
of water if faucet is not available. To protect the work field from being
Place these outside the work area. wet.
3. Open the bag, take the linen/plastic To make a non-contaminated work
lining and spread over work field or field or area.
area. The paper lining, clean side out
(folded part out).
4. Take out hand towel, soap dish and To prepare for handwashing.
apron and the place them at one
corner of the work area (within the
confines of the linen/plastic lining).
5. Do handwashing. Wipe, dry with Handwashing prevents possible
towel. Leave the plastic wrappers of infection from one care provider to
the towel in a soap dish in the bag. the client.
6. Put on apron right side out and To protect the nurses’ uniform.
wrong side with crease touching the Keeping the crease creates aesthetic
body, sliding the head into the neck appearance.
strap. Neatly tie the straps at the back.
7. Put out things most needed for the To make them readily accessible.
specific case (e.g.) thermometer,
kidney basin, cotton ball, waste paper
bag) and place at one corner of the
work area.
8. Place waste paper bag outside of To prevent contamination of clean
work area. area.
9. Close the bag. To give comfort and security,
maintain personal hygiene and hasten
recovery.
10. Proceed to the specific nursing To prevent contamination of bag and
care or treatment. contents.
11. After completing nursing care or To protect caregiver and prevent
treatment, clean and alcoholize the spread of infection to others.
things used.
12. Do handwashing again.
13. Open the bag and put back all
articles in their proper places.
14. Remove apron folding away from
the body, with soiled sidefolded
inwards, and the clean side out. Place
it in the bag.
15. Fold the linen/plastic lining,
clean; place it in the bag and close the
bag.
16. Make post-visit conference on To be used as reference for future
matters relevant to health care, taking visit.
anecdotal notes preparatory to final
reporting.
17. Make appointment for the next For follow-up care.
visit ( either home or clinic), taking
note of the date, time and purpose.

After Care

1. Before keeping all articles in the bag, clean and alcoholize them.

2. Get the bag from the table, fold the paper lining ( and insert), and place in between the flaps
and cover the bag.

Evaluation and Documentation

3. Record all relevant findings about the client and members of the family.

4. Take note of environmental factors which affect the clients/family health.

5. Include quality of nurse-patient relationship.

6. Assess effectiveness of nursing care provided.

Reference:
Community Health Nursing Services in the Philippines, DOH
 Uses & Preparation:
Asthma, Cough & Fever - Decoction ( Boil raw
fruits or leaves in 2 glasses of water for 15
minutes)Dysentery, Colds & Pain - Decoction
( Boil a handful of leaves & flowers in water to
produce a glass, three times a day)

Skin diseases (dermatitis, scabies, ulcer, eczema)

- Wash & clean the skin/wound with the decoction

Headache - Crush leaves may be applied on the

forehead

Rheumatism, sprain, contusions, insect bites -

Pound the leaves and apply on affected area

Plant Name: Yerba (Hierba) Buena ( Mentha cordifelia)

Uses & Preparation:

Pain (headache, stomachache) – Boil chopped
leaves in 2 glasses of water for 15 minutes. Divide
decoction into 2 parts, drink one part every 3
hours.
Rheumatism, arthritis and headache – Crush
the fresh leaves and squeeze sap. Massage sap on
painful parts with eucalyptus
Cough & Cold – Soak 10 fresh leaves in a glass
of hot water, drink as tea. (expectorant)
Swollen gums – Steep 6 g. of fresh plant in a
glass of boiling water for 30 minutes. Use as a
gargle solution
Toothache – Cut fresh plant and squeeze sap.
Soak a piece of cotton in the sap and insert this in
aching tooth cavity
Menstrual & gas pain – Soak a handful of leaves
in a lass of boiling water. Drink infusion.
Nausea & Fainting – Crush leaves and apply at
nostrils of patients
Insect bites – Crush leaves and apply juice on
affected area or pound leaves until like a paste, rub
 on affected area
Pruritis – Boil plant alone or with eucalyptus in
water. Use decoction as a wash on affected area.

Plant Name: Sambong ( Blumea balsamifera)

Uses & Preparation:

Anti-edema, diuretic, anti-urolithiasis – Boil
chopped leaves in a glass of water for 15 minutes
until one glassful remains. Divide decoction into 3
parts, drink one part 3 times a day.
Diarrhea – Chopped leaves and boil in a glass of
water for 15 minutes. Drink one part every 3 hours.

Plant Name: Tsaang Gubat ( Carmona retusa)

Uses & Preparation:

Diarrhea - Boil chopped leaves into 2 glasses of
water for 15 minutes. Divide decoction into 4 parts.
Drink 1 part every 3 hours
Stomachache – Boil chopped leaves in 1 glass of
water for 15 minutes. Cool and strain.

Plant Name: Niyug-Niyogan ( Quisqualis indica L.)

Uses & Preparation:

Anti-helmintic - The seeds are taken 2 hours after
supper. If no worms are expelled, the dose may be
repeated after one week. (Caution: Not to be given
to children below 4 years old)

Plant Name: Bayabas/Guava( Psidium guajava L.)

Uses & Preparation:

For washing wounds - Maybe use twice a day
Diarrhea - May be taken 3-4 times a day
As gargle and for toothache - Warm decoction is
used for gargle. Freshly pounded leaves are used
for toothache. Boil chopped leaves for 15 minutes
at low fire. Do not cover and then let it cool and
strain

Plant Name: Akapulko( Cassia, alata L.)

 Uses & Preparation:
Anti-fungal (tinea flava, ringworm, athlete’s foot
and scabies) - Fresh, matured leaves are pounded.
Apply soap to the affected area 1-2 times a day

Plant Name: Ulasimang Bato( Peperonica pellucida

Uses & Preparation:

Lowers uric acid (rheumatism and gout) – One a
half cup leaves are boiled in two glass of water
over low fire. Do not cover pot. Divide into 3 parts
and drink one part 3 times a day

Plant Name: Bawang/Garlic

Uses & Preparation:

Hypertension - Maybe fried, roasted, soaked in
vinegar for 30 minutes, or blanched in boiled water
for 15 minutes. Take 2 pieces 3 times a day after
meals.
Toothache - Pound a small piece and apply to
affected area

Plant Name: Ampalaya

Uses & Preparation:

Diabetes Mellitus (Mild non-insulin dependent)
- Chopped leaves then boil in a glass of water for
15 minutes. Do not cover. Cool and strain. Take
1/3 cup 3 times a day after meals