CLINICAL TEACHING PLAN

LEVEL II

OBJECTIVES:

Within two weeks of clinical exposure to rural health units, the students will be able to:

1. Be oriented to the clinical set-up, the nursing personnel, the medical staff, and existing rules and regulations of the area.
2. Gain more skills, knowledge and accuracy in providing health care to patients.
3. Apply midwifery and health care theories learned in the actual situations in the clinical area.
4. Promote and provide a competent standard quality health care to all patients by ensuring themselves to adhere to the ethical standards prescribed
in the midwifery code.
5. Promote and adhere to the health care process specifically and correctly, to achieve the specific goals for the patients.
6. Acquire skills, knowledge and acceptable attitude in the care of the family and community.
DELIVERY ROOM AND NURSERY

WEEK 1
ACTIVITIES COURSE CONTENT
DAY 1 The Female Reproductive System
6:30- 7:00 am PRE CONFERENCE
 Attendance, uniform and
paraphernalia check
 Orientation to DR/NICU set-up,
equipments, personnel
 Discussion of activities for the day
 Discussion of daily and weekly
requirements
 Assigning of students to a particular
DR/NICU areas.
7:00-10:15 am
Supervision of students in the implementation
of:
 Health Care Measures
 Hand Washing
 Physical Assessment
 Observing and assisting during
doctor’s rounds
 Assisting in delivery and nursery
activities
 Establishing of NPI
 Taking of vital signs
Assisting students in implementing DOH programs
such as:
o Essential Intrapartum and Newborn Care
10:15- 10:30 am
 Break for the 1st batch (endorsing
their patients to the second half of the
group for continuity of care)
10:30- 10:45 am
  Break for the 2nd batch (endorsing
their patients for continuity of care)
10:45am- 12:00 pm
 Supervise students in DR/NICU
routines
 Assisting students in anticipating the
patient’s needs, problems and
concerns
 Individual conference with students
regarding their patient’s condition
12:00-12:30 pm
 Lunch break for the 1st half of the
group
12:30-1:00 pm
 Lunch break for the 2nd half of the
group
1:00-3:00 pm
 Continue supervising the students in
their assigned area
 Vital signs taking and plotting in the
monitoring sheet
THE FEMALE REPRODUCTIVE ORGAN
 Observe/supervise the implementation
I. External Genitalia (External Reproductive Organs)
of EINC
A. Vulva (pudenda)- collective name of all the structures visible externally from the pubis to
- Topic for Discussion:
the perineum
 Reproductive System 1. Mons veneris (mount of Venus, mons pubis)
 Antepartum, Intrapartum and Postpartum Care - fat filled cushion over the anterios surface of the symphysis pubis
- after puberty, its skin is covered by curly hair that forms the estutchion
- Giving of assignments for the 2nd day 2. Labia Majora
- 2 folds of adipose tissue covered by the skin
- Homologue of the scrotum in the male
3. Labia Minora
- 2 then flat folds of tissue lying between the inner surface of the labia majora
4. Clitoris
- Small erectile body located near the superior extremity of the vulva
- Homologue of the penis
5. Vestibule (openings)
- almond shape area enclosed within the labia minora and extended from the clitoris
to the fourchette
- it is perforated by such orifices as urethral meatus, vaginal orifice, opening of the
duct of the bartholin’s glands
B. Vagina- tubular structure which extends from the vaginal opening in the vestibule of the
uterus
Functions:
1. excretory duct through which secretion and menstrual flow escape\
2. organ of copulation
3. forms part of the birth canala allowing for the passafe of the baby during delivery
II. Internal Genitalia ( internal reproductive organs)
1. Uterus – a hollow, muscular canal resembling an inverted pear which is situated in the
true pelvis.
 Organ of reproduction
 Organ of menstruation
 Fetal expulsion during labor

Layers of the uterus:

 Perimetrium - outermost
 Myometrium – middle, responsible for contraction
 Endometrium – innermost layer

Parts of the uterus:

 Fundus – uppermost convex portion, most contractile portion
 Cornua – the portion at which the fallopian tubes are attached
 Isthmus – upper third of cervix, very thin
 Corpus – body of the uterus makes up of 2/3, it houses the fetus

2. Cervix – the neck of the uterus, about 2.5 cm long, 2.5 cm diameter
Parts of the cervix:
 Internal OS – opens the corpus
 Cervical canal – spindle-shaped area
  External OS – opens to vagina

3. Fallopian Tubes (Oviducts) – pair of tube-like structures about 4 inches (10 cm) long, ¼
inch in diameter
 Transport ovum from ovary to the uterus
 Site of fertilization
 Provides nourishment to the ovum during its journey

Parts:
 Interstitial – thick walled, located inside the uterus and is about 1 cm long
 Isthmus – narrowest portion of the uterus, the site of tubal ligation
 Ampulla – middle portion and the widest part, the site of fertilization
 Infundibulum – most distal portion. It has fingerlike projection called fimbria

4. Ovaries – almond-shape glandular organ

 Oogenesis – development and maturation of ovum
 Ovulation – release of ovum from the ovary
 Hormone production

Layers:
 Tunica albuginea – outermost
 Cortex – functional layer, site of ovum formation
 Medulla – layer which contains blood vessels, lymphatics, nerves and muscle fibers
 THE BONY PELVIS

The adult Pelvis is composed of 4 bones

1. 2 innominate bones formed by the fusion of 3 parts
 Ilium- largest of the 3 bones
 Ischium- lowermost portion of the hip bone
 Pubis- fron portion of the hip bone

2. Sacrum- triangular in shape formed by 5 fused vertebrae

3. Coccyx- forms the lowermost portion of the spinal column and which is composed of 4
coccygeal vertebrae fused together
Pelvic joints:
1. Sacroiliac joints
2. sacrococcygeal joints
3. symphysis pubis
Divisions of the Pelvis:
1. False pelvis- portion of the pelvis above the pelvic brim, of little obstetrical significance
Functions
 Supports the uterus during late pregnancy
 Helps direct the fetus towards the pelvic inlet

2. True pelvis- portion of the pelvis below the pelvic brim through which the fetus must pass
during childbirth
a. Pelvic inlet- entry way to the pelvic cavity, among its important diameter are
1. A-P diameter
 True conjugate
 Obstetrical conjugate- 10cm
 Diagonal conjugate- 12cm

2. transverse diameter- 13cm

3. oblique diameter- 12.5 cm
b. Midpelvis- is at the level of the ischial spine and which is of particular importance
following engagement of the fetal head.
 AP diameter- 11.5
 Transverse diameter- 10 cm
 Posterior sagittal diameter- 4.5 cm

c. Pelvic outlet
 AP diameter 11.4 cm
 Transverse diameter- 10cm
 Posterior sagittal diameter- 7.5 cm
Pelvis Classification/Types
 GYNECOID – normal female pelvis, ideal for childbearing; circular
- inlet: slightly ovoid, transversely rounded; depth: moderate; sacrum: deep, well
curved; pubic arch: wide; coccyx: movable; sacrosciatic notch: well-rounded
 ANDROID – wedge or heart-shaped associated with worse pregnancy/labor outcome
usually result to difficult forceps delivery or CS, resembles the male pelvis
  ANTHROPOID – narrow, oval-shaped, with sacrum usually straight making it deeper
than other types, resembles ape pelvis
 PLATYPELLOID – rarest, flat gynecoid shaped with a short AP diameter and a wide
transverse diameter, may still allow vaginal birth

ANTENATAL CARE
Focused antenatal care- is based on the premise that every pregnancy is at risk for
complications. All women should receive the same basic care including identifying
complications. This model of antenatal care involves a minimum of 4 visits in normal or
uncomplicated pregnancies. It stresses quality rather than number of visit and has essential
goal- directed elements including screening for diseases that provides more time to interact
with patients thereby improving quality of care.
Components:
1. General assessment of the pregnant woman
2. Screening for diseases that complicate pregnancy: hypertension, anemia, syphilis
3. preventive measures: tetanus immunization, iron, folic acid supplementation
4. health education: self care, nutrition, and danger signs during pregnancy
5. birthplan
Objectives of Prenatal Care
1. Detection of diseases which may complicate pregnancy
2. Education of woman on the danger and emergency signs and symptoms
3. Preparation of the woman and her family for childbirth

Steps to follow in Prenatal Care

1. Immediate Assessment for emergency signs (quick check)

 Unconscious or convulsing
 Vaginal bleeding
 Severe abdominal pain
 Looks very ill
 Severe headache with visual disturbance
 Sever difficulty in breathing
 Fever
 Severe vomiting
2. Make woman comfortable
  Greet her
 If first visit, register the woman and issue a mother and child book/ home based
maternal record
3. Assess the pregnant woman
 On first visit
- age
- Past medical history
-OB history
-ask or check record of pregnancy
-birthplan
 On all visit
- AOG
-danger signs of pregnancy
-record for previous treatments received during the pregnancy
-ask for other concerns
-give education and counseling on family planning and breastfeeding
 If on 3rd trimester
- leopold’s maneuver and FHT
-education and counseling on family planning

 Do not perform vaginal exam as a routine prenatal care procedure

 Always record findings
 All pregnancies are at risk. Encourage all pregnant woman to deliver in a
health care facility
 Refer patients with abnormal findings to doctor or to a higher facility

4. Get baseline laboratory- CBC and Urinalysis

5. Check for ANEMIA
Check for S/S
- pallor
-easy fatigability
-shortness of breath
-drowsiness
-palpitations
-headaches
 - Hgb should be at least 11g/dl if its lower or equal to 8g/dl refer

6. Check for HYPERTENSION/preeclampsia

Check for S/S
-BP- 140/90 (normal BP is 90/60 to 130/80), if first reading is high repeat after 1
hour rest
- if it’s still high after rest, ask for severe headache, blurred vision and epigastric
pain
-check urine for protein
- if with S/S, refer
7. Check for GESTATIONAL DIABETES
-Ask about family history
-Ask about past medical OB history like difficult labor, large baby, congenital
malformations and unexplained fetal death
-Look for S/S like obesity, polyhydramnios, fetal abnormality or large baby, vaginal
infection especially CANDIDIASIS

-If with S/S, refer for glucose test at 24-28 weeks for low risks or immediately if
high risk
8. Check for presence of STI’s
-ask for fever
-burning sensation on urination
-abnormal vaginal discharge
-itching at the vulva if partner has a urinary problem
9. Give IMMUNIZATION AGAINST TETANUS

TT1 first visit no protection

TT2 4 weeks after TT1 3 years protection
TT3 6 months after TT2 5 years protection
TT4 1 year after TT3 10 years protection
TT5 1 year after TT4 lifetime

 To be protected, a pregnant woman must receive at least 2 doses of tetanus

toxoid. The last dose should be at least 2 weeks before delivery
10. Give MEBENDAZOLE for areas with cases of parasitism
 - single dose 500mg,once in 6 months after 1st trimester
11. Give IRON AND FOLATE SUPPLEMENTATION
- to avoid anemia and neural tube defects
- ferrous sulfate 320mg (60 mg elemental iron)and 250mcg Folate
- if Hgb is lower that 8g/dl double the dose of iron, then refer to doctor
12. Give preventive intermittent for falciparum malaria (if endemic)
13. Provide health information, advice. Counsel on danger Signs
14. Encourage the woman to come back for return visits
-at least 4 prenatal visits
 1st visit before 4 months
 2nd visit 6 months
 3rd visit 8 months
 4th visit 9 months- return if undelivered within 2 weeks after the EDC
15. Introduce BIRTHPLAN
 A written document prepared during the first visit. Plan may change anytime
pregnancy if an abnormality develops
 Discussed by the patient with the skilled birth attendant
 Contains information on:
 The woman’s condition during pregnancy
 Preferences for her place of delivery and choice of birth attendant. Discuss
why facility vs home delivery with skilled attendant is recommended
 Available resources (transportation, companion, money) for her childbirth
and newborn baby
 Preparations needed (blood donor, referral center) should an emergency
situation arise during pregnancy, childbirth and post partum
EMERGENCY PLAN
 Advise on danger signs, signs of labor
 Where to go?
 How to go?
 What to bring?
 With whom will you go?
 How much will it cost? Who will pay? How will you pay?
 Start saving for these possible cost now
 Who will take care for your home and other children when you are away?
 INTRAPARTAL CARE
Stages of Labor
1. First Stage / Cervical Stage – period from onset of true labor contractions until full
cervical dilation and effacement is achieved.
2. Second Stage / Expulsive Stage – from full cervical dilatation until the birth of the
baby
3. Third Stage / Placental Stage – from delivery of the baby to the expulsion of placenta
4. Fourth Stage / Immediate postpartum period – period from delivery of placenta until
the condition of the woman has stabilized
Steps to Follow in Intrapartal Care
1. Examine the woman for emergency signs
2. Greet the woman and make her comfortable
 Asked informed consent before examination or any procedure
 Respect her privacy
 Inform her of results of examination
 Reassure

3. Assess the woman in labor

 Take the history of labor and record on the labor room
 Review home base maternal record/ mother child book
 Review birthplan
 Assess uterine contractions; intensity, duration and interval
 Observe the woman’s response to contractions
 Perform abdominal exam; Leopold’s maneuver, FHT between contractions
4. Determine the stage of labor
 Explain to the woman that you will perform a vaginal examination and ask for her
consent
 Respect her privacy
 Observe standard precautions (wash hands, wear gloves)
 Inspect the vulva
- Bulging perineum
- Any visible fetal parts
- Vaginal bleeding
 - Leaking amniotic fluid, if yes is it meconium stained, foul smelling?
- Warts, keloid tissue or scars that may interfere with delivery
 Perform gentle vaginal examination (do not start during contraction)
 Explain findings to the woman. Reassure her
 Record the findings in labor or partograph
5. Decide if the woman can safely deliver. If there is indication for referral
6. Give supportive care throughout the labor
 Explain procedures seek permission and discuss findings with the woman and her
family
 Examine the woman in a place where she is not exposed to people other than the
examining person and her choice of companion
 Never leave a woman in labor alone
7. Encourage woman to:
 Wash from her waist down or take a bath at the onset of labor
 Empty the bladder (every 2 hours) and bowels.
 Move freely if BOW is not ruptured
 Respect choice of birthing position
 Drink as she wishes. Contractions will make her thirsty and the sugar will give her
energy for her labor. She is on soft diet during labor
8. Monitor and manage labor.
 FIRST STAGE: NOT ACTIVE LABOR 0-3 CM
- monitor contractions, FHT, mood and behavior every hour
- VS every 4 hours and cervical dilatation
- If contractions are stronger but no progress in cervical dilatation within 8 hours,
REFER
 FIRST STAGE: IN ACTIVE LABOR 4-7 CM
- monitor contractions, FHT, mood and behavior every 30 min
- VS every 4 hours and cervical dilatation
- record time of BOW ruptured

Relief of Pain and Discomfort

 Suggest change of position
 Encourage mobility as comfortable to her
 Encourage proper breathing technique; breathe slowly make a sighing
 noise, make 2 short breaths followed by a long breath out
 Massage her lower back if she finds it helpful

Caution:
 Do not IE more frequently
 Do not allow the woman to push unless delivery is imminent, pushing does
not speed up the labor, mother will become tired and cervix will swell
 Do not give medications to speed up labor, dangerous, may cause trauma to
the mother and baby
 Do not do fundal pressure, may cause uterine rupture, fetal death
 SECOND STAGE OF LABOR (10 CM TO DELIVERY OF THE BABY)
How to tell if the woman is in second stage of labor
 IE, fully dilated
 Woman wants to bear down
 Strong uterine contractions, every 2-3 mins, 4x in 10 mins
 Bulging thin perineum, fetal head visible during contractions
 BOW will rupture
Monitoring the second stage of labor:
 Check uterine contractions, FHT, mood and behavior
 Continue recording in the partograph
 REMINDERS: massaging and stretching the perineum have not been
shown to be beneficial
 Do not apply fundal pressure to help deliver the baby, support the
perineum and the anus with a clean swab to prevent lacerations
 Ensure controlled delivery of the head
- Keep one hand on the head as it advances during
contractions. Keep the head from coming out too quickly
- Support the perineum with other hand
- Discard pad and replace when soiled to prevent infection
- During delivery of the head, encourage woman to stop pushing
and breathe rapidly with mouth open
 Gently feel if the cord is around neck
 Wipe the mouth and nose of the baby with a clean gauze or cloth
 Wait for external rotation within 1-2 minutes head will turn sideways
 bringing one shoulder just below the symphysis pubis and other facing
the perineum
 Apply gentle downward pressure to deliver the top shoulder then lift baby
up to deliver lower shoulder. Gently deliver the rest of the baby. Note the
time of baby out
 Put the baby on mother’s abdomen in prone position. Cover with dry
towel
 Thoroughly dry the baby immediately. Wipe eyes
 Discard wet cloth
 Put baby prone on mother’s abdomen, in skin-skin contact, keep the
baby warm
 Exclude 2nd baby by palpating mother’s abdomen
 Give 10 units of oxytocin IM to mother within 2 minutes after baby out
 Watch out for vaginal bleeding
 Remove first set of gloves
 Clamp the cord after the pulsations are not felt (However, if pulsation is
prolonged, cut the cord within 3 mins) using plastic cord clamp 2 cm
away from the abdomen. Sweep the cord and apply a Kelly forcep 5 cm
from the abdomen then cut in between. Observe stump for oozing blood.
Do not apply anything on the cord.
 THIRD STAGE (delivery of the baby to placental delivery)
 Deliver the placent by controlled cord traction ( with counter traction on
the uterus above the symphysis pubis)
 Massage the uterus over the fundus
 Encourage initiation of breastfeeding. Keep the baby warm on mother’s
abdomen for 60-90 minutes
 Check the placenta and membranes (20 cotyledons), put in a container
for disposal

ACTIVE MANAGEMENT of the third stage of labor (under supervision of doctor)

o Cord is clamped after the cord pulsations have stopped
o Oxytocin is given withing 2 minutes of delivery of the baby
o Placenta is delivered by controlled cord traction with
countercontraction on the uterus above the symphysis pubis
o Massage fundus
9. Monitor closely within 1 hour after delivery (immediate post partum period) and give
supportive care
 Check for vaginal tears and bleeding
 Clean the woman and make her comfortable
 Check BP, PR, emergency signs and uterine contraction every 15
minutes
 Initiate breastfeeding within 1 hour when the baby is ready
10. Continue care after 1 hour postpartum. Keep watch closely for at least 2 hours
 VS every 30 min for 4 hours
 Check emergency signs and hardness of the uterus
 Check bladder for distensions if unable to void
 Advise clean cloth/napkin to collect vaginal blood
 Eat and drink high energy foods that are easily digestible

11. Educate and counsel on family planning and provide the family planning method if
available
 Ask what are the counsel/s plans regarding having more children
 Give relevant information and advice
 Advice that exclusive breastfeeding is the best contraceptive in the 1st
months
 Help her to choose the most appropriate method for her and her partner
12. inform, teach and counsel the woman on important MCH messages
 Talk to the woman when she is rested and comfortable
 Also give important information and advice to her companion
 Take time to explain, use visual aids and demonstrate important lesson
 Encourage them to participate actively in discussions and to ask
questions
13. Discharge the woman and her baby after 24 hours
 The woman and her baby may be discharged 24 hours after delivery
 Ensure that the woman is able to breastfeed successfully before
discharge
 Repeat important health information
 Check understanding and arrange follow up
DAY 2

6:30- 7:00 am PRE CONFERENCE

 Attendance, uniform and
paraphernalia check
 Orientation to DR/NICU set-up,
equipments, personnel
 Discussion of activities for the day
 Discussion of daily and weekly THE PARTOGRAPH: MONITORING WOMAN IN LABOR (WHO)
requirements Monitoring: VS, progress of labor, contractions, bladder/urine, FHT, perineum-show, rupture
 Assigning of students to a particular of BOW, presenting part, bulging, cord prolapsed, bleeding, ability to manage pain
DR/NICU areas.
PARTOGRAPH – a tool advocated by WHO to be used by the nurse-midwife, midwife, and
7:00-10:15 am medical doctor to assess the progress of labor and to identify when intervention is
Supervision of students in the implementation necessary
of: - started only when the woman is in the active phase labor with cervical dilation of
 Health Care Measures more than 3 cm
 Hand Washing - plotting starts at 4 cm and uterine contractions of two or more within 10 minutes,
 Physical Assessment each lasting 20 seconds or more
 Observing and assisting during - 3 Components of the Partograph
doctor’s rounds o PROGRESS OF LABOR – monitoring uses parameters cervical dilatation,
 Assisting in delivery and nursery descent of head, and uterine contractions
activities o FETA CONDITION – monitoring uses parameters FHT, amniotic membranes
 Establishing of NPI and liquor, and molding of fetal skull
 Taking of vital signs o MATERNAL CONDITION – monitoring uses parameters, pulse, BP, temp,
Assisting students in implementing DOH programs urine, drugs, IVF, oxytocin
such as: - Some Principles in the Use of Partograph
 Maternal health program o The active phase of labor commences at 3 cm cervical dilation. Plotting in the
o Intrapartum care partograph is started when the cervix is 4 cm dilated
o Post partum care o the latent phase of labor should not last longer than 8 hours in primigravida,
o Essential Intrapartum and Newborn Care when the cervix dilates at a rate of 1 cm per hour
10:15- 10:30 am o In multigravida, the latent phase lasts for about 4 hours, when the cervix
 Break for the 1st batch (endorsing dilates at the rate of 1.5 cm per hour
their patients to the second half of the o during active labor, the rate of cervical dilatation should not be slower than 1
group for continuity of care) cm per hour
10:30- 10:45 am o A lag of 4 hours between a slowing in labor and the need for intervention is
 Break for the 2nd batch (endorsing unlikely to compromise the fetus or the mother and avoids unnecessary
their patients for continuity of care) intervention
10:45am- 12:00 pm o vaginal examination should be performed as infrequently as is compatible with
 Supervise students in DR/NICU safe practice, once every 4 hours is recommended
routines o the partograph shows graphically the rate of progress of labor
 Assisting students in anticipating the  the rate or cervical dilation
patient’s needs, problems and  the rate of fetal head descent
concerns  the duration and frequency of uterine contractions
 Individual conference with students  monitoring VS
regarding their patient’s condition o palpation of uterine contractions is done every half hour in the active phase (q
12:00-12:30 pm 1 hour in the latent phase)
 Lunch break for the 1st half of the o with the partograph, there are only two observations made, FREQUENCY and
group DURATION of uterine contractions
12:30-1:00 pm o in uterine contraction monitoring, the number of contractions in 10 minutes is
 Lunch break for the 2nd half of the recorded. In the active phase, the partograph should be started when
group contractions last more than 20 seconds and with two or more contractions in
1:00-3:00 pm 10 minutes
 Continue supervising the students in o With the partograph, listening to the FHT is done immediately after a
their assigned area contraction with the woman in lateral position. FHT is recorded every half hour
 Vital signs taking and plotting in the in the first stage of labor.
monitoring sheet o The partograph should be enlarged to full size before use
 Observe/supervise the implementation - Values of the Partograph
of EINC o prevention of prolong or augmented labor
o reduced risk of postpartum hemorrhage, sepsis, obstructed labor, and uterine
- Topic for Discussion: rupture
 Partograph o improvement in maternal outcomes: reduced number of augmented labor and
 Family Planning Methods operative interventions like CS
 Evaluation and Brainstorming o Improvement in the neonatal outcomes: reduced intrapartum fetal deaths and
neonatal morbidity

Antenatal/prenatal visits
Prenatal Visit Period of Pregnancy
st
1 Visit As early in pregnancy as possible before four months or during
the first trimester
 2nd Visit During 2nd trimester
3rd Visit During 3rd trimester
Every 2 weeks After 8th month of pregnancy till delivery

Recommended Schedule of Post Partum Care Visits

1st visit Ist week post partum preferably 3-5 days
nd
2 visit 6 weeks post partum

FAMILY PLANNING PROGRAM

The overall goal of Family Planning is to provide universal access to family
planning information and services wherever and whenever these are needed.
Family Planning aims to contribute:
 Reduce infant deaths
 Neonatal deaths
 Under-five deaths
 Maternal deaths
It has the following 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 the quality FP services are available in DOH retained hospitals,
LGU managed health facilities, NGOs, and private sector
Family Planning Methods
Types Advantages Disadvantages
Female Sterilization o Permanent method of o Uncommon
- Safe and simple surgical contraception complications of surgery:
procedure which provides o Nothing to remember infection, bleeding, injury
permanent contraception for o Does not interfere with to internal organs
women who do not want sex o In rare cases, when
more child. o Results in increased pregnancy occurs, it is
- Effectiveness: sexual enjoyment more likely to be ectopic
o Perfect Use: 99.5% o No effect on o Requires physical
o Typical Use: 99.5% breastfeeding quantity examination and minor
and quality surgery by trained
o No known long term side service provider
 effects o Requires an operating
o Minilaparotomy can be set up
performed after a o Reversal surgery is
woman gives birth difficult
o Do not protect against
STDs
o Limitations in physical
activities immediately
after surgery
Male Sterilization o Very effective 3months o Uncomfortable due to
- Permanent method wherein after the procedure slight pain and swelling
the vas deferens is tied and o Permanent, safe, simple, 2-3 days after the
cut or blocked through a and easy to perform procedure
small opening on the scrotal o Can be perform in a o Reversibility is difficult
skin. clinic, office or at a and expensive
-Effectiveness: primary care center o Bleeding may result in
o Perfect Use: 99.9% o No re-supplies or hematoma in the
o Typical Use: 99.8% repeated clinic visits scrotum
o No apparent long term
health risks
o An option to a couple
whose female partner
could not undergo
permanent contraception
o A man who had
vasectomy will not lose
his sexual ability and
ejaculation
o Does not affect male
hormonal function
o Increase the couple’s
sexual drive and
enjoyment
Pill o Safe as proven o Often not used correctly
-contains hormones – o Convenient and easy to and consistently,
estrogen and progesterone use lowering its
taken daily to prevent o Makes menstrual cycle effectiveness
contraception occur regularly and is o Has side effects such as
- How it is used: drug are predictable nausea, dizziness
taken daily per orem o Reduces gynecologic o May pose health risk for
- Effectiveness: symptoms such as a small number of
o Perfect Use: 99.7% painful menses and women
o Typical Use: 92.0% endometriosis o Offers no protection
o Reduces the risk of against STDs
ovarian and endometrial o Can suppress lactation
cancer o Requires regular re-
o Reversible, rapid return supply
to fertility
o Does not interfere with
sexual intercourse
Male Condom o Safe and has no o May cause allergy for
-thin sheath of latex rubber hormonal effect people who are sensitive
made to fit on a man’s erect o Protects against to latex or lubricant
penis to prevent the passage microorganisms causing o Ay decrease sensation,
of sperm cells and STD STIs/HIV making sex less
organisms into the vagina. o Encourages male enjoyable for othe
- How it is used: condom is participation in family partner
inserted into the erected planning o Interrupts the sexual act
penis preventing the sperm o Easily accessible o Requires a mans
from getting in contact with o Is used in managing cooperation for its use
the egg cell premature ejaculation
- Effectiveness:
o Perfect Use: 98%
o Typical Use: 85%
Injectables o Reversible o Offers no protection
-contain synthetic hormone, o No need for daily intake against STDs
progestin which suppresses o Does not interfere with
ovulation, thickens cervical sexual intercourse
mucus, making it difficult for o Culturally acceptable by
sperm to pass through and some women
changes uterine lining o Has no estrogen related
-How it is used: drug side effects
containing progestin is o Does not affect
injected into the body to breastfeeding quality
suppress ovulation making and quantity
sperm difficult to pass
through uterine lining
- Effectiveness:
o Perfect Use: 99.7%
o Typical Use: 97.0%
Lactating Amenorrhea o Universally available to o Short term FP method
Method or LAM all postpartum which is effective only
-temporary introductory breastfeeding women for a maximum of 6
postpartum method of o Protection from an months postpartum
postponing pregnancy based unplanned pregnancy o Effectiveness may
on physiological infertility begins immediately decrease if a mother
experienced by postpartum and child are separated
breastfeeding women o No other FP for extended periods of
-How it is used: amenorrhea, commodities are time
fully or nearly fully required o Full or nearly full BF may
breastfeeding her child, o Contributes to improve be difficult to maintain
infant is less than 6 months maternal and child for up to 6 months due
- Effectiveness: health and nutrition to a variety of social
o Perfect Use: 99.5% circumstances
o Typical Use: 98.0% o Disadvantage to women
who do not pass any of
the three criteria to
practice lactation
amenorrhea
Mucus/Billings/Ovulation Can be used by any woman Cannot be used by woman
-abstaining from sexual of reproductive age as long with medical conditions that
intercourse during fertile as she is not suffering from would make pregnancy
(wet) days prevents an unusual disease or especially dangerous
pregnancy condition that results in
-How it is Used: recording of extraordinary vaginal
menstruation and dry days discharge that makes
Inspecting underwear observation difficult
regularly for presence of
mucus
Recording the most fertile
observation/characteristics at
the end of the day
- Effectiveness:
o Perfect Use: 97%
o Typical Use: 80%
Basal Body Temperature Very effective Requires taking BBT
-identifying the fertile and everyday and time to record
infertile period of a woman’s temperature. Couples may
cycle by daily taking and practice abstinence during
recording of the rise in body fertile periods
temperature during and after
ovulation
-How it is used: thermometer
is placed in axilla or under
the tongue to get the
temperature at least 3 hours
of undisturbed rest during
throughout the menstrual
cycle
- Effectiveness:
o Perfect Use: 99%
o Typical Use: 80%
Sympto-Thermal Method
- identifying the fertile and
infertile days of the menstrual
cycle as determined through
a combination of
observations made on the
cervical mucus, BBT
recording and other signs of
ovulation
- Effectiveness:
o Perfect Use: 99%
o Typical Use: 80%
Two Day Method o Can be used by women o Needs the cooperation of
-a simple fertility awareness with any cycle length the husband
based method of FP that o No health related side o Can become unreliable
involves cervical secretions effects associated for women who have
as an indicator of fertility, o Incurs very little or no conditions that cause
women checking the cost abnormal cervical
presence of secretions o Immediately reversible secretions
everyday o Promoted male partner o Does not protect the
- Effectiveness: involvement in FP client from HIV/AIDS
o Perfect Use: 96.5% o Enhances self discipline,
o Typical Use: 86% mutual respect,
cooperation,
communication, and
shared responsibility of
the couple for the FP
o Provides opportunities
for enhancing the
couples sexual life
o Can be integrated in
health and FP services
o Acceptable to couples
regardless of culture,
religion, socioeconomic
status and education
o Not dependent on
medically qualifies
personnel
Standard Days Method o No health related side Cannot be used by women
-a new method of natural FP effects associated with who usually have menstrual
in which all users with its use cycle between 26 and 32
menstrual cycles between 26 o Increases self days long
and 32 days are counseled awareness and
to abstain from sexual knowledge of human
intercourse on days 8-19 to reproduction and can
avoid pregnancy lead to a diagnosis of
-How it is used: abstain from some gynecologic
sexual intercourse during problems
fertile period, use color o No need for counting
coded beads to mark the o Can be used either to
fertile and infertile periods avoid or achieve
-- Effectiveness: pregnancy
o Perfect Use: 95% o Very little cost and
o Typical Use: 88% promotes male partner
involvement in FP
o Enhances self discipline,
mutual respect, couples
sexual life
o Acceptable to couples
regardless of culture,
religion, socioeconomic
status and education
o Can be integrated in
health and FP services
o Not dependent on
medically qualifies
personnel
 WEEK 2

ACTIVITIES COURSE CONTENT

DAY 1 EXPANDED PROGRAM ON IMMUNIZATION
The concept and importance of vaccination:
6:30- 7:00 am PRE CONFERENCE 1. It is safe and immunologically effective to administer all EPI vaccines on the same day at
 Attendance, uniform and different sites of the body.
paraphernalia check 2. Measles vaccine should be given as soon as the child is 9 months old, regardless of whether
 Discussion of activities for the day other vaccines will be given on that day. Measles vaccines given at 9 months provide 85%
 Discussion of daily and weekly protection against measles infection. When given at 1 year and older provides 95% protection.
requirements 3. The vaccination schedule should not be restarted from the beginning even if the interval
 Assigning of students to a particular between doses exceeded the recommended interval by months or years.
DR/NICU areas. 4. Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea, and vomiting are not
contraindications to vaccination. Generally, one should immunize unless the child is so sick
7:00-10:15 am that he needs to be hospitalized.
Supervision of students in the implementation 5. The absolute contraindications to immunization are:
of: a) DPT2 or DPT3 to a child who has had convulsions or shock within 3 days the previous
 Health Care Measures dose. Vaccines containing the whole cell pertussis component should not be given to
 Hand Washing children with an evolving neurological disease.
 Physical Assessment b) Live vaccines like BCG vaccine must not be given to individuals who are
 Observing and assisting during immunosuppressed due to malignant disease, therapy with immunosuppressive agents,
doctor’s rounds or irradiation.
 Assist in Delivery/ Nursery Cases
 Establishing of NPI 6. It is safe and effective with mild side effects after vaccination. Local reaction, fever and
 Taking of vital signs systemic symptoms can result as part of the normal immune response.
Assisting students in implementing DOH programs 7. Giving doses of a vaccine at less than the recommended 4 weeks interval may lessen the
such as: antibody response. Lengthening the interval between doses of vaccines leads to higher
o Essential Intrapartum and Newborn Care antibody levels.
 Family planning program 8. No extra doses must be given to children/mother who missed a dose of DPT, HB, OPV, TT.
 Child health programs The vaccination must be continued as if no time had elapsed between doses.
 Expanded program on immunization 9. Strictly follow the principle of never ever reconstituting the freeze dried vaccines in anything
 Nutrition program other than the diluent supplied with them.
10. False contraindications to immunizations are children with malnutrition, low grade fever, mild
10:15- 10:30 am respiratory infection and other minor illnesses and diarrhea should not be considered a
 Break for the 1st batch (endorsing contraindication to OPV vaccination. Repeat BCG vaccination if the child does develop a scar
 their patients to the second half of the after the first injection.
group for continuity of care) 11. Use one syringe one needle per child per vaccination.
10:30- 10:45 am Routine Immunization Schedule for Infants
 Break for the 2nd batch (endorsing Minimum Age at Minimum Interval
Vaccine Number of doses Reason
their patients for continuity of care) First Dose Between Doses
10:45am- 12:00 pm BCG Birth or any time 1 BCG given at
 Supervise students in DR/NICU after birth earliest possible
routines protects the
 Assisting students in anticipating the possibility od TB
patient’s needs, problems and meningitis and
concerns other TB
 Individual conference with students infections in
regarding their patient’s condition which infants are
prone.
12:00-12:30 pm DPT 6 Weeks 3 4 weeks An early start with
 Lunch break for the 1st half of the DPT reduces the
group chance of severe
12:30-1:00 pm pertussis
 Lunch break for the 2nd half of the OPV 6 Weeks 3 4 weeks The extent of
group protection against
1:00-3:00 pm polio is increased
 Continue supervising the students in the earlier the
their assigned area OPV is given.
 Vital signs taking and plotting in the Keeps the
monitoring sheet Philippine polio
 DR/NICU cases completion free.
 Post conference HepB At birth 3 6 Weeks interval An early start of
- Topic for Discussion: from first dose to HepB reduces the
second dose, and chance of being
 Expanded program on immunization 8 weeks interval infected and
- Giving of assignments for the 2nd day from second dose becoming a
to third dose carrier. Prevent
liver cirrhosis and
liver cancer.
About 9000 die of
 complications of
HepB. 10% of
Filipinos have
chronic HepB
infection.
Eliminate HepB
before 2012, a
western regional
goal
Measles 9 Months 1 At least 85% of
measles can be
prevented by
immunization at
this age.

NUTRITIONAL PROGRAM
DAY 2 Goal: To provide quality of life of Filipinos through better nutrition, improve health and increase
productivity.
6:30- 7:00 am PRE CONFERENCE Objectives:
 Attendance, uniform and 1. Reduction in the proportion of Filipino households with intake below 100% below the dietary
paraphernalia check energy requirement from 53.2% to 44%.
 Discussion of activities for the day 2. Reduction in:
 Discussion of daily and weekly a. Underweight among preschool children
requirements b. Stunting among preschool children
 Assigning of students to a particular c. Chronic energy deficiency among pregnant women
DR/NICU areas. d. Iron deficiency among children 6 months to 5 years old, pregnant and lactating
mothers.
7:00- 10:15 am e. Elimination of moderate and severe iron deficiency disorder among school children and
Supervision of students in the implementation pregnant women.
of: f. Reduction in the prevalence of iron deficiency disorder among lactating mothers
 Health Care Measures g. Reduction in the prevalence of low birth weight
 Hand Washing Strategies:
 Physical Assessment 1. Food based interventions for sustained improvements in nutritional status.
 Observing and assisting during 2. Life cycle approach with strategic attention to 0-3 year old children, adolescent females and
 doctor’s rounds pregnant lactating mother.
 Getting NICU/DR cases 3. Effective complementation of nutrition interventions with other services.
 Establishing of NPI 4. Geographical focus to needier areas
 Taking of vital signs Programs and Projects:
Assisting students in implementing DOH programs 1. Micronutrients supplementation
such as: 2. Food fortification
 Maternal health program 3. Essential maternal and child health service package
o Essential Intrapartum and Newborn Care 4. Nutrition information, communication, and education
 Family planning program 5. Home, School, and community food production
 Child health programs 6. Food assistance includes center based complimentary feeding for wasted, stunted children
 Expanded program on immunization and pregnant women with delivering low birth weight
 Nutrition program 7. Livelihood assistance
 Oral health program Nutritional Guidelines for Micronutrient Supplementation
10:15- 10:30 am Universal Supplementation of Vit. A
 Break for the 1st batch (endorsing Target Preparation Dose Duration Remarks
their patients to the second half of the Infants 6-11 months 100,000 IU 1 dose only 1 capsule is given
group for continuity of care) anytime during the 6-
10:30- 10:45 am 11 months but usually
 Break for the 2nd batch (endorsing given at 9 months
their patients for continuity of care) during the measles
10:45am- 12:00 pm immunization
 Supervise students in DR/NICU Children 12-71 months 200,000 IU 1 capsule every 6
routines months
 Assisting students in anticipating the
patient’s needs, problems and Supplementation to High Risk Children
concerns Target Illness Preparations Dose Duration
 Individual conference with students Measles
regarding their patient’s condition Infants 6-11 months 100,000 IU One capsule upon diagnosis
Preschool children 12-71 200,000 IU regardless of when the last
12:00-12:30 pm dose of VAC was given
 Lunch break for the 1st half of the
group Severe Pneumonia
12:30-1:00 pm Persistent Diarrhea
 Lunch break for the 2nd half of the Malnutrition
group Infants 6-11 months 100,000 IU One capsule given upon
1:00-3:00 pm
  Continue supervising the students in Preschool children 12-71 200,000 IU diagnosis, except when the
their assigned area Children 6-12 years old 200,000 IU child was given VAC less than
 Vital signs taking and plotting in the 4 weeks upon diagnosis
monitoring sheet
 Getting DR/NICU cases Supplementation for Pregnant and Post-Partum Women
 Post conference Targets Preparation Dose Duration Remarks
- Topic for Discussion: Pregnant women 10,000 IU 1 capsule/tablet th
Start from the 4 Should not be
 Nutrition program of 10,000 IU twicemonth of given to pregnant
 Oral health program a week pregnancy until women who are
 Evaluation and Brainstorming delivery already taking
prenatal vitamins
or multiple
micronutrient
tablets that also
contain vit. A
Post-partum 200,000 IU 1 capsule 1 dose only within Should not be
women 200,000 IU 4 weeks after given to pregnant
delivery women

ORAL HEALTH PROGRAM

Goal: Reduce the prevalence rate of dental carries and periodontal diseases from 92% in 1998 to
85% and from 78% in 1998 to 60% by end of 2010 among general population.
Objectives:
1. To increase the proportion of orally fit children under 6 years old to 80% by 2010.
2. To control oral health risks among young young people
3. To improve the health conditions of pregnant women by 20% and older persons by 10% every
year until 2010.
Basic Package of Oral Health Care:
Stages of Life Types of Oral Services
Mother (pregnant) o Oral examination
o Oral prophylaxis
o Permanent fillings
o Gum treatment
o Health education
Neonatal and infants under o Dental check up as soon as the first tooth erupts
1 year old o Health instructions on infant oral health care and advice on
exclusive breastfeeding
Children 12-71 months o Dental check up as soon as the first tooth appears and every
6 months thereafter
o Supervised tooth brushing drills
o Oral urgent treatment
o Removal of unsavable teeth
o Referral of complicated cases
o Treatment of post extraction complications
o Application of atraumatic restorative treatment
School children 6-12 years o Oral examination
o Supervised tooth brushing drills
o Topical fluoride therapy
o Pits and fissure sealant application
o Oral prophylaxis
o Permanent fillings
Adolescent and youth 10- o Oral examination
12 years old o Health promotion and education, adverse effects of
consumption of sweets and sugary beverages, tobacco and
alcohol
Other adults 25-59 years o Oral examination
old o Emergency dental treatment
o Health instruction and advice
o Referrals
Older persons o Oral examination
o Extraction of unsavable tooth
o Gum treatment
o Relief of pain
o Health instruction and advice
References:
1. EPI Manual, 1995
2. Philippine Clinical Standard Manual on Family Planning 2006
3. AO # 39 Series 2003, Policy on Nationwide Implementation of Expanded Program on Immunization
4. Public health Nursing in the Philippines 10th Edition, Copyright 2007
5. Integrated Management for Childhood Illnesses Manual 2004
6. www.dohprograms.com
7. www.mchnfamilyplanning.com
8. www.phn.com