PHC

Overview 

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

Rationale for Adopting Primary Health Care 

 Magnitude of Health Problems

 Inadequate and unequal distribution of health resources
 Increasing cost of medical care
 Isolation of health care activities from other development activities

Definition of Primary Health Care 

 essential health care made universally accessible to individuals and families in the community by means acceptable to them,
through their full participation and at cost that the community can afford at every stage of development.
 a practical approach to making health benefits within the reach of all people.
 an approach to health development, which is carried out through a set of activities and whose ultimate aim is the continuous
improvement and maintenance of health status

Goal of Primary Health Care 

 HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE HANDS OF THE PEOPLE by the year 2020.
 An improved state of health and quality of life for all people attained through SELF RELIANCE.
    Key Strategy to Achieve the Goal: 

 Partnership with and Empowerment of the people - permeate as the core strategy in the effective provision of essential health
services that are community based, accessible, acceptable, and sustainable, at a cost, which the community and the
government can afford.

Objectives of Primary Health Care 

 Improvement in the level of health care of the community

 Favorable population growth structure
 Reduction in the prevalence of preventable, communicable and other disease.
 Reduction in morbidity and mortality rates especially among infants and children.
 Extension of essential health services with priority given to the underserved sectors.
 Improvement in Basic Sanitation
 Development of the capability of the community aimed at self- reliance.
 Maximizing the contribution of the other sectors for the social and economic development of the community.

Mission 

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

Two Levels of Primary Health Care Workers 

1. Barangay Health Workers - trained community health workers or health auxiliary volunteers or traditional birth attendants
or healers.
2. Intermediate level health workers- include the Public Health Nurse, Rural Sanitary Inspector and midwives.

Principles of Primary Health Care 

    1. 4 A's = Accessibility, Availability, Affordability & Acceptability, Appropriateness of health services. 

 The health services should be present where the supposed recipients are. They should make use of the available resources
within the community, wherein the focus would be more on health promotion and prevention of illness.
    2. Community Participation 

 heart and soul of PHC

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

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

o Lack of motivation
o Attitude
o Resistance to change
o Dependence on the part of community people
o Lack of managerial skills
    4. Self-reliance 

 Through community participation and cohesiveness of people’s organization they can generate support for health care through
social mobilization, networking and mobilization of local resources. Leadership and management skills should be develop among
these people. Existence of sustained health care facilities managed by the people is some of the major indicators that the
community is leading to 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 nongovernment organization and people’s organization.
    6. Recognition of interrelationship between the health and development 

 Health- Is not merely the absence of disease. Neither is it only a state of physical and mental well-being. Health being a social
phenomenon recognizes the interplay of political, socio-cultural and economic factors as its determinant. Good Health therefore,
is manifested by the progressive improvements in the living conditions and quality of life enjoyed by the community residents
(PCF,
 Development- is the quest for an improved quality of life for all. Development is multidimensional. It has 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 

 This ensures empowerment and that empowerment can only be facilitated if the administrative structure provides local level
political structures with more substantive responsibilities for development initiators. This also facilities proper allocation of
budgetary resources.

Elements of Primary Health Care 

    1. 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.
    2. Locally Endemic Disease Control 

 The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate. Example Malaria Control
and Schistosomiasis Control
    3. Expanded Program on Immunization 

 This program exists to control the occurrence of preventable illnesses especially of children below 6 years old. Immunizations
on poliomyelitis, measles, tetanus, diphtheria and other preventable disease are given for free by the government and ongoing
program of the DOH
    4. 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.
    5. Environmental Sanitation and Promotion of Safe Water Supply 

 Environmental Sanitation is defined as the study of all factors in the man’s 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 man’s environment. Water is
necessary for the maintenance of healthy lifestyle. Safe Water and Sanitation is necessary for basic promotion of health.
    6. Nutrition and Promotion of Adequate Food Supply 

 One basic need of the family is food. And if food is properly prepared then one may be assured healthy family. There are many
food resources found in the communities but because of faulty preparation and lack of knowledge regarding proper food
planning, Malnutrition is one of the problems that we have in the country.
    7. Treatment of Communicable Diseases and Common Illness 

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

 This focuses on the information campaign on the utilization and acquisition of drugs.
 In response to this campaign, the GENERIC ACT of the Philippines is enacted. It includes the following drugs: Cotrimoxazole,
Paracetamol, Amoxycillin, Oresol, Nifedipine, Rifampicin, INH (isoniazid) and Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine

Major Strategies of Primary Health Care 

    1. Elevating Health to a Comprehensive and Sustained National Effort. 

 Attaining Health for all Filipino will require expanding participation in health and health related programs whether as service
provider or beneficiary. Empowerment to parents, families and communities to make decisions of their health is really the
desired outcome.
 Advocacy must be directed to National and Local policy making to elicit support and commitment to major health concerns
through legislations, budgetary and logistical considerations.
    2. Promoting and Supporting Community Managed Health Care 

 The health in the hands of the people brings the government closest to the people. It necessitates a process of capacity building
of communities and organization to plan, implement and evaluate health programs at their levels.
    3. Increasing Efficiencies in the Health Sector 

 Using appropriate technology will make services and resources required for their delivery, effective, affordable, accessible and
culturally acceptable. The development of human resources must correspond to the actual needs of the nation and the policies
it upholds such as PHC. The DOH will continue to support and assist both public and private institutions particularly in faculty
development, enhancement of relevant curricula and development of standard teaching materials.
    4. 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 and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. Support mechanism made available
Department of Health (DOH)

Vision
 Health for all Filipinos

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

National Objectives
1. Improve the general health status of the population (reduce infant mortality rate, reduce child morality rate, reduce maternal
mortality rate, reduce total fertility rate, increase life expectancy & the quality of life years).
2. Reduce morbidity, mortality, disability & complications from Diarrheas, Pneumonias, Tuberculosis, Dengue, Intestinal
Parasitism, Sexually Transmitted Diseases, Hepatitis B, Accident & Injuries, Dental Caries & Periodontal Diseases,
Cardiovascular Diseases, Cancer, Diabetes, Asthma & Chronic Obstructive Pulmonary Diseases, Nephritis & Chronic Kidney
Diseases, Mental Disorders, Protein Energy Malnutrition, and Iron Deficiency Anemia & Obesity.
3. Eliminate the ff. diseases as public health problems:
1. Schistosomiasis
2. Malaria
3. Filariasis
4. Leprosy
5. Rabies
6. Measles
7. Tetanus
8. Diphtheria & Pertussis
9. Vitamin A Deficiency & Iodine Deficiency Disorders
4. Eradicate Poliomyelitis
5. Promote healthy lifestyle through healthy diet & nutrition, physical activity & fitness, personal hygiene, mental health & less
stressful life & prevent violent & risk-taking behaviors.
6. Promote the health & nutrition of families & special populations through child, adolescent & youth, adult health, women’s
health, health of older persons, health of indigenous people, health of migrant workers and health of different disabled
persons and of the rural & urban poor.
7. Promote environmental health and sustainable development through the promotion and maintenance of healthy homes,
schools, workplaces, establishments and communities’ towns and cities.

Basic Principles to Achieve Improvement in Health

1. Universal access to basic health services must be ensured.

2. The health and nutrition of vulnerable groups must be prioritized.
3. The epidemiological shift from infection to degenerative diseases must be managed.
4. The performance of the health sector must be enhanced.

Primary Strategies to Achieve Goals 

1. Increasing investment for Primary Health Care.

2. Development of national standards and objectives for health.
3. Assurance of health care.
4. Support to the local system development.
5. Support for frontline health workers. 

DOH Programs
Dental Health Program 
 To improve the quality of life of the people through the attainment of the highest possible oral health.
 Objective: To prevent and control dental diseases and conditions like dental caries and periodontal diseases thus reducing
their prevalence.

Osteoporosis Program
  It is characterized by a decrease in bone mass and density that progresses without a symptom or pain until a fracture occurs
generally in the hip, spine or wrist.
 Objectives:
o To increase awareness on the prevention and control of osteoporosis as a chronic debilitating condition;
o To increase awareness by physicians and other health professionals on the screening, treatment and rehabilitation of
osteoporosis;
o To empower people with knowledge and skills to adopt healthy lifestyle in preventing the occurrence of osteoporosis.

Health Education & CO 

 Accepted activity at all levels of public health used as a means of improving the health of the people through techniques which
may influence peoples thought motivation, judgment and action.
Three aspects of health education: 
 Information
 Communication

Education
Sequence of steps in health education: 
 Creating awareness
 Creating motivation
 Decision making action

Reproductive Health 
1. Family Planning
2. MCH & Nutrition
3. Prevention / treatment of Reproductive Tract Infection & STD
4. Prevention of abortion & its complication
5. Education & counseling on sexuality & sexual health
6. Adolescent sexual reproductive health
7. Violence against women
8. Men’s reproductive health (Male sexual disorder )
9. Breast CA & other gyne problem
10. Prevention / treatment of infertility

Older Persons Health Services 

 Participation in the celebration of Healthy National Elderly Week (Oct 1-7)
o Lecture on healthy lifestyle for the elderly
 Provision of drugs for the elderly (20% discount)

Guidelines for Good Nutrition 

 Nutritional Guidelines are primary recommendations to promote good health through proper nutrition.
Activities: 

    1. Malnutrition Rehabilitation Program 

 Targeted Food Task Force Assistance Program (TFAP)
 Nutrition Rehabilitation Ward
 Akbayan sa Kalusugan sa Kabataan (ASK Project)
    2. Micronutrient Supplementation Program 
 “23 in ‘93”
 Fortified Vitamin Rice
 “Health for More in ‘94”
 “Buwan ng Kabataan, Pag-asa ng Bayan”
 National Focus: National Micronutrient Day or “Araw ng Sangkap Pinoy”
Protein Energy Malnutrition 
1. Marasmus – looks like an old worried man
o Less subcutaneous fats
2. Kwashiorkor - a moon face child
o With flag sign (hair changes)
Vitamin A Deficiency 

Respiratory Infection Control 

 Provision of medicines
 Consultative meetings with CARI coordinators
 Monitoring of health facilities on the implementation of the program
Alternative Medicine
 RA 8423
 23 IN 93
Herbal Medicine (LUBBY SANTA) 
 Herbal Medicine  USES
 Lagundi ( Vitex Negundo) Skin diseases 
 SHARED Headache, 
Asthma,fever,cough&colds 
Rheumatism 
Eczema 
Dysentery

 Ulasimang Bato (Peperonia Pellucida) Lowers uric acid

 Bawang ( Allium Sativum) HAT Headache and Tootache

 Bayabas ( Psidium Guajava) Anti septic, Anti-diarrheal, Astringent
 Yerba Buena (Mentha Cordifolia) Rheumatism and other body aches, analgesics

 Sambong (Blumea Balsamifera) Edema, diuretics

 Akapulko Fungal infection, skin diseases

 Niog Niogan (Quisqualis Indica) Anti-helminthic

 Tsaang Gubat (Carmona Retusa) Diarrhea

 Ampalaya (Momordica Charantia) DM

Maternal- Child Care

I. Maternal Care 

    1. Family Planning 

        A. Spacing / Artificial Method 

a. Hormonal 
b. Mechanical & Barrier 
c. Biologic 
d. Natural 

        B. Permanent (surgical/irreversible) 

a. Tubal Ligation 
b. Vasectomy 

        C. Behavioral Method 

    2. Breastfeeding

II. Child Care 

    1. Under Five Care Program 

o A package of child health-related services focused to the 0-59 months old children to assure their wellness and
survival
        Growth Monitoring Chart (GMC) 
o A standard tool used in health centers to record vital information related to child growth and development, to assess
signs of malnutrition.
    2. Expanded Program on Immunization 

        Legal Basis:

 PD #996 – Compulsory basic
 PP #147 – National Immunization Day
 PP #773 – Knock out Polio Days
 PP # 1064 – polio eradication campaign
 PP #4 - Ligtas Tigdas month

Mental Health
 A state of well-being where a person can realize his or her own abilities, to cope with the normal stresses of life and work
productively
Components of Mental Health Program
 Stress Management and Crisis Intervention
 Drugs and Alcohol Abuse Rehabilitation
 Treatment and Rehabilitation of Mentally-Ill Patients
 Special Project for Vulnerable Groups

Sentrong Sigla Movement

Aim: to promote availability of quality health services 

4 pillars: 
 Quality assurance
 Grants & technical assistance
  Health promotion
 Award

Community Organizing Participatory Action Research

Community Organizing 
 A continuous and sustained process of;
o EDUCATING THE PEOPLE,
o CRITICAL AWARENESS
o MOBILIZING
Participatory Action Research 
 A combination of education, research and action.
 The purpose is the EMPOWERMENT of people
4 Phases: 
 Pre entry
 Entry
 Organizational Building
 Sustenance and Strengthening

Laws Affecting CHN Implementation 

 RA 8749 - Clean Air Act (2000)
 RA 6425 – Dangerous Drug Act: sale, administration and distribution of prohibited drugs is punishable by law
 RA 9173
 RA 2382 – Philippines Medical Act: define the practice of medicine in the Philippines
 RA 1082 – Rural Health Act: employment of more physicians, nurses, midwives who will live in the rural areas to help raise
the health condition.
 RA 3573 - Reporting of Communicable Disease
 RA 6675 – Generic Act: promotes, requires and ensures the production of an adequate supply, distribution, and use of drugs
identified by their generic names.
 RA 6365
 RA 6758
 RA 4703
 RA 7305 – Magna Carta for Public Health Workers (approved by Pres. Corazon C. Aquino): aims to promote and improve the
social and economic well being of health workers, their living and conditions.
 RA 7160 – Local Government Code: responsibility for the delivery of basic services of the national government
History of Community Health Nursing

Date Event 

1901 

 Act # 157 (Board of Health of the Philippines); Act # 309 (Provincial and Municipal Boards of Health) were created.
1905 

 Board of Health was abolished; functions were transferred to the Bureau of Health.
1912 

 Act # 2156 or Fajardo Act created the Sanitary Divisions, the forerunners of present MHOs; male nurses performs the
functions of doctors
1919 

 Act # 2808 (Nurses Law was created) - Carmen del Rosario, 1st Filipino Nurse supervisor under Bureau of Health
Oct. 22, 1922

 Filipino Nurses Organization (Philippine Nurses’ Organization) was organized.

1923 

 Zamboanga General Hospital School of Nursing & Baguio General Hospital were established; other government schools of
nursing were organized several years after.
1928 

 1st Nursing convention was held

1940 

 Manila Health Department was created.

1941 

 Dr. Mariano Icasiano became the first city health officer; Office of Nursing was created through the effort of Vicenta Ponce
(chief nurse) and Rosario Ordiz (assistant chief nurse)
Dec. 8, 1941 

 Victims of World War II were treated by the nurses of Manila.

July 1942 

 Nursing Office was created; Dr. Eusebio Aguilar helped in the release of 31 Filipino nurses in Bilibid Prison as prisoners of war
by the Japanese.
Feb. 1946 

 Number of nurses decreased from 556 – 308.

1948 

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

 Rural Health Demonstration and Training Center was created.

1953 

 The first 81 rural health units were organized.

1957 

 RA 1891 amended some sections of RA 1082 and created the eight categories of rural health unit causing an increase in the
demand for the community health personnel.
1958-1965 

 Division of Nursing was abolished (RA 977) and Reorganization Act (EO 288)
1961 

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

1967 

 Zenaida Nisce became the nursing program supervisor and consultant on the six special diseases (TB, leprosy, V.D., cancer,
filariasis, and mental health illness).
1975 

 Scope of responsibility of nurses and midwives became wider due to restructuring of the health care delivery system.
1976-1986 

 The need for Rural Health Practice Program was implemented.

1990- 1992 

 Local Government Code of 1991 (RA 7160)

1993-1998 

 Office of Nursing did not materialize in spite of persistent recommendation of the officers, board members, and advisers of the
National League of Nurses Inc.
Jan. 1999 

 Nelia Hizon was positioned as the nursing adviser at the Office of Public Health Services through Department Order # 29.
May 24, 1999 

 EO # 102, which redirects the functions and operations of DOH, was signed by former President Joseph Estrada.
Health Care Delivery System
Definition

 The totality of all policies, facilities, equipments, products, human resources and services which address the health needs
problems and concerns of the people. It is large, complex, multi-level and multi-disciplinary. 

Health Sectors 

 Government Sectors 
 Non Government Sectors 
 Private Sectors 

Department of Health 

 Vision: Health for all by year 2000 ands Health in the Hands of the People by 2020 
 Mission: In partnership with the people, provide equity, quality and access to health care esp. the marginalized 
    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 
5. Maintain a medium of regulations and standards to protect consumers and guide providers 

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 Delivery System 

 RA 1082 - RHU Act 

 RA 1891 - Strengthen Health Services 
 PD 568 - Restructuring HCDS 
 RA 7160 - LGU Code 
Community Health Nursing: An Overview
Definition of Terms 

Community 

 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
 Derived from a latin word “comunicas” which means a group of people.
Health 

 OLOF (Optimum Level of Functioning)

 Health-illness continuum
 High-level wellness
 Agent-host-environment
 Health belief
 Evolutionary-based
 Health promotion
WHO definition
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
Nursing

 Both profession & a vocation. Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness
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.” ( Maglaya, et
al)
 Goal: “To raise the level of citizenry by helping communities 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)
 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 ( WHO Expert Committee of Nursing)
 A learned practice discipline with the ultimate goal of contributing as individuals and in collaboration with others to the
promotion of the client’s optimum level of functioning thru’ teaching and delivery of care (Jacobson)
 A service rendered by a professional nurse to IFCs, population groups in health centers, clinics, schools , workplace for the
promotion of health, prevention of illness, care of the sick at home and rehabilitation (DR. Ruth B. Freeman)
Public Health 

 “Public Health is directed towards assisting every citizen to realize his birth rights and longevity.”“The science and art of
preventing disease, prolonging life and efficiency through organized community effort for:
1. The sanitation of the environment
2. The control of communicable infections
3. The education of the individual in personal hygiene
4. The organization of medical and nursing services for the early diagnosis and preventive treatment of disease
5. The development of a social machinery to ensure every one a standard of living, adequate for maintenance of health to enable
every citizen to realize his birth right of health and longevity (Dr. C.E Winslow)

Mission of CHN 

 Health Promotion
 Health Protection
 Health Balance
 Disease prevention
 Social Justice

Philosophy of CHN 

 “The philosophy of CHN is based on the worth and dignity on the worth and dignity of man.”(Dr. M. Shetland)

Basic Principles of CHN 

 1. The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual,
family, population group (those who share common characteristics, developmental stages and common exposure to health
problems – e.g. children, elderly), and the community.
2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care
3. CHN practice is affected by developments in health technology, in particular, changes in society, in general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is a part of health care system and the larger human services system.

Roles of the PUBLIC HEALTH NURSE 

 Clinician, who is a health care provider, taking care of the sick people at home or in the RHU
 Health Educator, who aims towards health promotion and illness prevention through dissemination of correct information;
educating people
 Facilitator, who establishes multi-sectoral linkages by referral system
 Supervisor, who monitors and supervises the performance of midwives
 Health Advocator, who speaks on behalf of the client
 Advocator, who act on behalf of the client
 Collaborator, who 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 MHO’s responsibilities. 

Other Specific 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 physician
 Provision 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

 Case finding and epidemiological investigation
 Program planning, implementation and evaluation
 Influencing executive and legislative individuals or bodies concerning health and development

Responsibilities of CHN 

 be a part in developing an overall health plan, its 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 opportunities for professional growth and continuing education for staff development

Standards in CHN 

1. Theory
o Applies theoretical concepts as basis for decisions in practice
2. Data Collection
o Gathers comprehensive, accurate data systematically
3. Diagnosis
o Analyzes collected data to determine the needs/ health problems of IFC
4. Planning
o At each level of prevention, develops plans that specify nursing actions unique to needs of clients
5. Intervention
o Guided by the plan, intervenes to promote, maintain or restore health, prevent illness and institute rehabilitation
6. Evaluation
o Evaluates responses of clients to interventions to note progress toward goal achievement, revise data base,
diagnoses and plan
7. Quality Assurance and Professional Development
o Participates in peer review and other means of evaluation to assure quality of nursing practice
o Assumes professional development
o Contributes to development of others
8. Interdisciplinary Collaboration
o Collaborates with other members of the health team, professionals and community representatives in assessing,
planning, implementing and evaluating programs for community health
9. Research
o Indulges in research to contribute to theory and practice in community health nursing
Definitions of COPAR

 A social development approach that aims to transform the apathetic, individualistic and voiceless poor into dynamic,
participatory and politically responsive community.
 A collective, participatory, transformative, liberative, sustained and systematic process of building people’s organizations by
mobilizing and enhancing the capabilities and resources of the people for the resolution of their issues and concerns towards
effecting change in their existing oppressive and exploitative conditions (1994 National Rural Conference)
 A process by which a community identifies its needs and objectives, develops confidence to take action in respect to them and
in doing so, extends and develops cooperative and collaborative attitudes and practices in the community (Ross 1967)
 A continuous and sustained process of educating the people to understand and develop their critical awareness of their
existing condition, working with the people collectively and efficiently on their immediate and long-term problems, and
mobilizing the people to develop their capability and readiness to respond and take action on their immediate needs towards
solving their long-term problems (CO: A manual of experience, PCPD)

Importance of COPAR 

1. COPAR is an important tool for community development and people empowerment as this helps the community workers to
generate community participation in development activities.
2. COPAR prepares people/clients to eventually take over the management of a development programs in the future.
3. COPAR maximizes community participation and involvement; community resources are mobilized for community services.

Principles of COPAR 

1. People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change and
are able to bring about change.
2. COPAR should be based on the interest of the poorest sectors of society
3. COPAR should lead to a self-reliant community and society.

COPAR Process 

 A progressive cycle of action-reflection action which begins with small, local and concrete issues identified by the people
and the evaluation and the reflection of and on the action taken by them.
 Consciousness through experimental learning central to the COPAR process because it places emphasis on learning that
emerges from concrete action and which enriches succeeding action.
 COPAR is participatory and mass-based because it is primarily directed towards and biased in favor of the poor, the powerless
and oppressed.
 COPAR is group-centered and not leader-oriented. Leaders are identified, emerge and are tested through action rather than
appointed or selected by some external force or entity.

COPAR Phases of Process 

1. Pre-entry Phase 

 Is the initial phase of the organizing process where the community/organizer looks for communities to serve/help.
 It is considered the simplest phase in terms of actual outputs, activities and strategies and time spent for it
        Activities include: 

o  Designing a plan for community development including all its activities and strategies for care development.
o Designing criteria for the selection of site
o Actually selecting the site for community care
2. Entry Phase 

 Sometimes called the social preparation phase as to the activities done here includes the sensitization of the people on the
critical events in their life, innovating them to share their dreams and ideas on how to manage their concerns and eventually
mobilizing them to take collective action on these.
 This phase signals the actual entry of the community worker/organizer into the community. She must be guided by the
following guidelines however.
 o Recognizes the role of local authorities by paying them visits to inform them of their presence and activities.
o The appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without
disregard of their being role models.
o Avoid raising the consciousness of the community residents; adopt a low-key profile.
3. Organization Building Phase 

 Entails the formation of more formal structures and the inclusion of more formal procedures of planning, implementation, and
evaluating community-wide activities. It is at this phase where the organized leaders or groups are being given trainings
(formal, informal, OJT) to develop their skills and in managing their own concerns/programs.
4. Sustenance and Strengthening Phase 

 Occurs when the community organization has already been established and the community members are already actively
participating in community-wide undertakings. At this point, the different communities setup in the organization building
phase are already expected to be functioning by way of planning, implementing and evaluating their own programs with the
overall guidance from the community-wide organization.
        Strategies used may include: 

o  Education and training

o Networking and linkaging
o Conduct of mobilization on health and development concerns
o Implementing of livelihood projects
o Developing secondary leaders

Levels of Clientele in CHN

Individual 

Basic approaches in looking at the individual: 

1. Atomistic
2. Holistic
Perspectives in understanding the individual: 

1. Biological
o unified whole
o holon
o dimorphism
2. Anthropological
o essentialism
o social constructionism
o culture
3. Psychological
o psychosexual
o psychosocial
o behaviorism
o social learning
4. Sociological
o family and kinship
o social groups

Family 

Models: 

1.Developmental 

    Stages of Family Development 

    Stage I – Beginning Family (newly wed couples) 

    TASK: compliance with the PD 965 & acceptance of the new member of the family 

    Stage II – Early Child Bearing Family (0-30 months old) 

    TASK: emphasize the importance of pregnancy & immunization & learn the concept of parenting 

    Stage III –Family with Pre- school Children (3-6yrs old) 

    TASK: learn the concept of responsible parenthood 

    Stage IV – Family with School age Children (6-12yrs old) 

    TASK: Reinforce the concept of responsible parenthood 

    Stage V - Family with Teen Agers (13-25yrs old) 

    TASK: Parents to learn the concept of “let go system” and understands the “generation gap” 

    Stage VI – Launching Center (1st child will get married up to the last child) 
    TASK: compliance with the PD 965 & acceptance of the new member of the family 

    Stage VII -Family with Middle Adult parents (36-60yrs old) 

    TASK: provide a healthy environment, adjust with a new lifestyle and adjust with the financial aspect 

    Stage VIII – Aging Family (61yrs old up to death) 

    TASK: learn the concept of death positively 

2.Structural-Functional 
    Initial Data Base 

 Family structure and Characteristics

 Socio-economic and Cultural Factors
 Environmental Factors
 Health Assessment of Each Member
 Value Placed on Prevention of Disease
    First Level Assessment 

    Health threats: 

o conditions that are conducive to disease, accident or failure to realize one’s health potential
    Health deficits: 

o instances of failure in health maintenance (disease, disability, developmental lag)

    Stress points/ Foreseeable crisis situation: 

o anticipated periods of unusual demand on the individual or family in terms of adjustment or family resources
    Second Level Assessment: 

 Recognition of the problem

 Decision on appropriate health action
 Care to affected family member
 Provision of healthy home environment
 Utilization of community resources for health care
    Problem Prioritization: 

        Nature of the problem 

 Health deficit
 Health threat
 Foreseeable Crisis
        Preventive potential 

 High
 Moderate
 Low
        Modifiability 

 Easily modifiable
 Partially modifiable
 Not modifiable
        Salience 

 High
 Moderate
 Low
    Family Service and Progress Record 

Population Group 

Vulnerable Groups: 

 Infants and Young Children

 School age
 Adolescents
 Mothers
 Males
Old People
Specialized Fields: 

Community Mental Health Nursing 


A unique clinical process which includes an integration of concepts from nursing, mental health, social psychology, psychology,
community networks, and the basic sciences
Occupational Health Nursing 

 The application of nursing principles and procedures in conserving the health of workers in all occupations
School Health Nursing 

 The application of nursing theories and principles in the care of the school population

Expanded Program for Immunization (EPI)

Principles of EPI

1. Epidemiological situation
2. Mass approach
3. Basic Health Service

The 7 immunizable diseases

1. Tuberculosis
2. Diptheria
3. Pertussis
4. Measles
5. Poliomyelitis
6. Tetanus
7. Hepatitis B

Target Setting 

 Infants 0-12 months

 Pregnant and Post Partum Women
 School Entrants/ Grade 1 / 7 years old

Objectives of EPI 

 To reduce morbidity and mortality rates among infants and children from six childhood immunizable disease

Elements of EPI 

 Target Setting
 Cold chain Logistic Management- Vaccine distribution through cold chain is designed to ensure that the vaccines were
maintained under proper environmental condition until the time of administration.
 Information, Education and Communication (IEC)
 Assessment and evaluation of Over-all performance of the program
 Surveillance and research studies

Administration of vaccines 
 Vaccine  Content  Form & Dosage  # of Doses  Route

 BCG (Bacillus Calmette Guerin)  Live attenuated bacteria Freeze dried   1  ID
Infant- 0.05ml 

Preschool-0.1ml
 DPT (Diphtheria Pertussis Tetanus) DT- weakened toxin   liquid-0.5ml  3  IM

P-killed bacteria

 OPV (Oral Polio Vaccine)  weakened virus  liquid-2drops  3  Oral

 Hepatitis B  Plasma derivative  Liquid-0.5ml  3  IM

 Measles  Weakened virus  Freeze dried- 0.5ml  1  Subcutaneous

Schedule of Vaccines 
 Vaccine  Age at 1st dose  Interval between dose  Protection

 BCG  At birth  BCG is given at the earliest possible age protects
against the possibility of TB infection from the
other family members

 DPT  6 weeks  4 weeks  An early start with DPT reduces the chance of
severe pertussis
 OPV  6weeks  4weeks  The extent of protection against polio is increased
the earlier OPV is given.

 Hepa B  @ birth  @birth,6th week,14th  An early start of Hepatitis B reduces 

week
the chance of being infected and becoming a
carrier.

 Measles  9m0s.-11m0s.  At least 85% of measles can be prevented by

immunization at this age.

 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.
 a polio vaccine that is taken by mouth and contains the three serotypes of poliovirus in a weakened live state—called
also Sabin oral vaccine

Tetanus Toxiod Immunization 

Schedule for Women 

 Vaccine  Minimum age interval  % protected  Duration of
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 next  99%  10 years
pregnancy

 TT5  1 year later/third pregnancy  99%  Lifetime

 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 Celsius)
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.
 These are the list of the ten (10) medicinal plants that the Philippine Department of Health (DOH) through its "Traditional
Health Program" has endorsed. All ten (10) herbs have been thoroughly tested and have been clinically proven to have
medicinal value in the relief and treatment of various aliments:
Herbal Medicine Plants Approved by the 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:
         Lagundi             (Vitex
negundo)

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
Plant Name: Menstrual & gas pain - Soak a handful of leaves in a lass of boiling water.
Yerba (Hierba ) Buena  (Mentha Drink infusion.
cordifelia) 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.

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:
            Sambong               (Blumea
balsamifera)

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:
        Tsaang Gubat         (Carmona
retusa)

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:
Niyug-niyogan   (Quisqualis indica
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:
Bayabas/Guava   (Psidium
guajava 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:
         Akapulko                 (Cassia
alata L.)

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:
Ulasimang Bato(Peperonica
pellucida)

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:
          Bawang                 (Allium
sativum)

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

Plant Name
   Ampalaya       (Mamordica
Charantia)

Reminders on the Use of Herbal Medicine 

1. Avoid the use of insecticide as these may leave poison on plants.
2. In the preparation of herbal medicine, use a clay pot and remove cover while boiling at low heat.
3. Use only part of the plant being advocated.
4. Follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each type of symptoms or sickness.
6. Stop giving the herbal medication in case untoward reaction such as allergy occurs.
7. If signs and symptoms are not relieved after 2 to 3 doses of herbal medication, consult a doctor.
Nutrition
Definition
 Nutrition is a state of well-being achieved by eating the right food in every meal and the proper utilization of the nutrients by
the body.
 Proper nutrition is important because:
o It helps in the development of the brain, especially during the first years of the child’s life.
o It speeds up the growth and development of the body including the formation of teeth and bones
o It helps fight infection and diseases
o It speeds up the recovery of a sick person
o It makes people happy and productive
o Proper nutrition is eating a balanced diet in every meal
Goal 
 To improve the nutritional status, productivity and quality of life of the population thru adoption of desirable dietary practices
and healthy lifestyle

Objectives 
 Increase food and dietary energy intake of the average Filipino
 Prevent nutritional deficiency diseases and nutrition-related chronic degenerative diseases
 Promote a healthy well-balanced diet
 Promote food safety

Balanced diet 
  Balanced diet is made up of a combination of the 3 basic groups eaten in correct amounts. The grouping serves as a guide in
selecting and planning everyday meals for the family.
    The Three (3) Basic Food Groups are: 

        1. Body –building food which are rich in protein and needed by the body for: 
 normal growth and repair of worn-out body tissues
 supplying additional energy
 fighting infections
 Examples of protein-rich food are: fish; pork; chicken; beef; cheese; butter; kidney beans; mongo; peanuts; bean
curd; shrimp; clams
        2. Energy-giving food which are rich in carbohydrates and fats and needed by the body for: 
 providing enough energy to make the body strong
 Examples of energy-giving food are: rice; corn; bread; cassava; sweet potato; banana; sugar cane; honey; lard;
cooking oil; coconut milk; margarine; butter
        3. Body-regulating food which are rich in Vitamins and minerals and needed by the body for: 
 normal development of the eyes, skin, hair, bones, and teeth
 increased protection against diseases
 Examples of body-regulating food are: tisa; ripe papaya; mango; guava; yellow corn; banana; orange; squash; carrot

Low Fat Tips 

1. Eat at least 3 meals/day
2. Eat more fruits, vegetables, grain and cereals e.g. rice, noodles and potato
3. If you use butter or margarine, pat it on thinly
4. Choose low fat substitute i.e. replace whole milk with skimmed milk, low fat cheese
5. Become a label reader. Look for foods that have less than 5 g /100 g of product 
6. Eat less high fat snacks and take away potato chips, sausage rolls or breaded meats
7. Cut all visible fat from meat; remove skin from chicken fat drippings and cream sauces
8. Aim for thin palm-size serving of lean meat, poultry and fish/ meal
9. Grill, bake, steam, stew, stir –fry and microwave, try not to fry
10. Drink lots of water all day- it’s a food quencher
11. Ambulate:
            a. Start by walking for 10 min. 
            b. Build up to 30-40 min/day 
            c. Go for 3-4 times / week of any exercise you enjoy 

Filipino Food Pyramid 

 Drink lot- water, clear broth
 Eat most – rice, root crops, corn, noodles, bread and cereals
 Eat more – vegetables, green salads, fruits or juices
 Eat some – fish, poultry, dry beans, nuts, eggs, lean meats, low fat dairy
 Eat a little – fats, oils, sugar, salt

Important Vitamins and Minerals

 VITAMINS  FUNCTIONS
 Vitamin A  Maintain normal vision, skin health, bone and tooth growth  reproduction and immune function;
prevents xerophthalmia. 

 Food sources: Breastmilk;poultry;eggs; liver;     meat;carrots;squash; papaya;mango;tiesa;   

malunggay;kangkong; camotetops; ampalaya tops

 Thiamine  Help release energy from nutrients; support normal appetite and nerve function, prevent beri-
beri.
 Riboflavin  Helps release energy from nutrients, support skin health,     prevent deficiency manifested by
cracks and redness at     corners of mouth; inflammation of the tongue and     dermatitis.

 Niacin  Help release energy from nutrients; support skin, nervous     and digestive system, prevents
pellagra.
 Biotin  Help energy and amino acid metabolism; help in the     synthesis of fat glycogen.

 Pantothenic  Help in energy metabolism.

 Folic acid  Help in the formation of DNA and new blood cells including     red blood cells; prevent anemia
and some amino acids.
 Vitamin B12  Help in the formation of the new cells; maintain nerve cells, assist in the metabolism of fatty
acids and amino acids.
 Vitamin C  Help in the formation of protein, collagen, bone, teeth     cartilage, skin and scar tissue;
facilitate in the absorption of iron from the gastrointestinal tract; involve in amino acid    
metabolism; increase resistance to infection, prevent     scurvy. 

 Food sources: 
 Guava;pomelo;lemon;orange; calamansi; tomato; cashew

 Vitamin D  Help in the mineralization of bones by enhancing absorption  of calcium

 Vitamin E  Strong anti-oxidant; help prevent arteriosclerosis; protect  neuromuscular system; important for
normal immune     function.

 Vitamin K  Involve in the synthesis of blood clotting proteins and a     bone protein that regulates blood
calcium level.

 MINERALS  FUNCTIONS
 Calcium  Mineralization of bones and teeth, regulator of many of the body’s biochemical processes,
involve in blood clotting,     muscle contraction and relaxation, nerve functioning, blood pressure
and immune defenses.

 Chloride  Maintain normal fluid and electrolyte balance.

 Chromium  Work with insulin and is required for release of energy from glucose.

 Copper  Necessary for absorption and use of iron in the formation of hemoglobin.

 Fluoride  Involve in the formation of bones and teeth; prevents tooth decay.

 Iodine  As part of the two thyroid hormones, iodine regulates     growth, physical and mental
development and metabolic     rate. Aids in the development of the brain and body     especially
in unborn babies

 Food sources: 
 Seaweeds;squids;shrimps;crabs; fermented     shrimp;mussels;snails; dried dilis; fish

 Iron  Essential in the formation of blood. It is involved in the     transport and storage of oxygen in the
blood and  is a     co-factor bound to several non-hemo enzymes required for the proper
functioning of cells. 

 Food sources: 
 Pork; beef; chicken; liver and other internal organs; dried     dilis; shrimp; eggs; pechay; saluyot;
alugbati

 Magnesium  Mineralization of bones and teeth, building of proteins,      normal muscle contraction, nerve
impulse transmission,     maintenance of teeth and functioning of immune system.

 Manganese  Facilitate many cell processes.

 Molybdenum  Facilitate many cell processes.
 Phosphorus  Mineralization of bones and teeth; part of every Cell; used     in energy transfer and
maintenance of acidbase balance.
 Selenium  Work with vitamin E to protect body compound from     oxidation.

 Sodium  Maintain normal fluid and electrolyte balance, assists nerve impulse insulin.

 Sulfur  Integral part of vitamins, biotin and thiamine as well as the hormone.

 Zinc  Essential for normal growth, development reproduction and immunity.

Malnutrition
 An abnormal condition of the body resulting from the lack or excess of one or more nutrients like protein, carbohydrates, fats,
vitamins and minerals.
    Primary Cause: POVERTY 
1. Lack of money to buy food
o Majority of the victims of malnutrition comes from families of farmers, fisherfolk, and laborers who cannot afford to
buy nutritious foods.
2. Lack of food supply
3. Lack of information on proper nutrition and food values
    Secondary Causes 
1. Early weaning of child and improper introduction of supplementary food
2. Incomplete immunization of babies and children
3. Bad eating habits
4. Poor hygiene and environmental sanitation:
a. lack of potable water 
b. lack of sanitary toilet 
c. poor waste disposal 

Forms of Malnutrition

    Protein-Energy Malnutrition (PEM) 

 Is a nutritional problem resulting from a prolonged inadequate intake of bodybuilding and/or energy-giving food in the diet.
        Kinds: 

            1. Marasmus 

 This child does not get the right amount and kind of energy food.
 She/he:
o is always hungry
o has the face of an old man
o is very thin
o easily gets sick
o looks weak
o THIS CHILD IS JUST SKIN AND BONES!
            2. Kwashiorkor 
 This child does not get enough body-building food, although she/he may be getting enough energy.
 She/he:
o
has swollen face, hands, and feet
o
easily gets sick
o
has dry, thin, pale hair
o
has sores on the skin
o
has thin upper arms
o
looks sad
o
has dry skin
o
is underweight
o
THIS CHILD IS SKIN, BONES, AND WATER!
    Vitamin A Deficiency (VAD) 
 A condition in which the level of Vitamin A in the body is low.
        Causes: 
 Not eating enough foods rich in vitamin A. E.g. yellow vegetables and yellow fruits
 Lack of fat or oil in the diet which help the body absorb Vitamin A.
 poor absorption or rapid utilization of Vitamin A during illness
        Eye Signs 
 night blindness (early stage); total blindness (later stage)
 bitot’s spot (foamy soapsuds-like spots on white part of the eye)
 dry, hazy and rough appearing cornea
 crater-like defect on cornea
 softened cornea; sometimes bulging
        Other Manifestations 
 increased cases of childhood sickness, and death and decreased resistance to infection
 susceptibility to childhood malnutrition and infection (measles, diarrhea and pneumonia)
        Prevention 
 eating foods rich in Vitamin A, such as liver, eggs, milk, crab meat, cheese, dilis, malunggay, gabi leaves, kamote tops,
kangkong, alugbati, saluyot, carrots, squash, ripe mango, including fats and oils
 breastfeeding the child
 immunizing the child
 taking correct dose of Vitamin A capsules as prescribed
        Risk Factors 
 VAD is most common in children suffering from PEM and other infectious diseases. Bottle-fed infants are also at risk of VAD
especially if the milk formula used is not fortified with Vitamin A.
 Common among preschoolers and infants (FNRI)
        Schedule for Receiving Vitamin A Supplement to Infants, Preschoolers and Mothers 
 Schedule  Infants (6-11 mos)  Preschoolers (12-83  Post Partum Mother
mos)
 Give 1 Dose  100,000 IU  200,000 IU  200,000 IU 
 Within one month
 Give after 6 months  100,000 IU  200,000 IU  After delivery of      each child
 High risk Condition   only
 Present

        Schedule for Treatment of Vitamin A Deficiency 

 Schedule  Infants (6-11 mos.)  Preschoolers (12-83 mos.)

 Give Today  100,000 IU  200,000 IU

 Give Tomorrow  100,000 IU  200,000 IU
 Give After 2 Weeks  100,000 IU  200,000 IU

    
    Anemia 
 A condition characterized by the lack of iron in the body resulting in paleness.
        Sign/Symptoms 
 Paleness of the eyelids, inner cheeks, palms and nailbeds; frequent dizziness and easy fatigability
        Common cause 
 Inadequate intake of food rich in iron; can also be caused by blood loss during menstruation, pregnancy and parasitic
infections.
        Prevention 
 Eating iron-rich food such as liver and other internal organs; green leafy vegetables; and foods rich in Vitamin C
        Prevention of Iron Deficiency 
 Recommended Iron Requirements  Dosage
 Infants ( 6-12 months)  0.7 mg. Daily

 Children ( 12-59 months)  1 mg daily

        Treatment of Iron Deficiency 

 Dosage
 Children 0-59 month  3-6 mg. /kg. Body wt./day

    Goiter 
 Enlargement of thyroid gland due to lack of iodine in the body.
 Common in areas where the iodine content in the soil, water and food are deficient.
 Effect of Iodine deficiency to fetus: may be born mentally and physically retarded.
 Goiter can be prevented by:
o daily intake of food rich in iodine
o use of iodized salt
        Iodine Supplementation 
 Dosage
 Children 0-59 months   ( in endemic  Iodine capsules (200mg)      potassium iodate in oil
areas) orally     once a year.

Checking the Nutritional Status Weight 

1. Weight is a very important indicator of a person’s nutritional status. It is measured in relation to either AGE or HEIGHT.
Normally, a well nourished child gains weight as she/he grows older.
2. On the other hand, a malnourished child either decreases in weight or maintains his/her previous weight.
3. The nutritional status of a person can also be checked by looking for specific signs and symptoms of the different forms of
nutritional deficiencies.
    Important 
1. Weigh the child in minimal clothing, with no shoes, clogs or slippers on; and hands and pockets free of objects.
2. The same type of scale should be used for subsequent weighing.
3. Observe the proper maintenance of the weighing scale.
4. Do not use a bathroom scale to avoid inaccurate readings of weight.
 *bring the malnourished child together with the parents to the health center for proper nutritional advice and treatment.
 *visit the malnourished child regularly and monitor his/her weight.
 *advise parents and the whole community about better nutrition and proper feeding especially of infants, children and sick
persons.

Nutritional Guidelines 
1. Eat a variety of food everyday.
2. Breastfeed infants exclusively from birth to 4-6 months, and then, give appropriate foods while continuing breastfeeding.
3. Maintain children’s normal growth through proper diet and monitor their growth regularly.
4. Consume fish, lean meat, poultry or dried beans.
5. Eat more vegetables, fruits, and root crops.
6. Eat foods cooked in edible/cooking oil daily.
7. Consume milk, milk products or other calcium-rich foods such as small fish and dark green leafy vegetables everyday. Use
iodized salt, but avoid excessive intake of salty foods.
8. Use iodized salt, avoid excessive intake of salty foods
9. Eat clean and safe food.
10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke, avoid drinking alcoholic beverages.
    Aims and Rationale of Each of the Guidelines 
 Guideline No. 1 is intended to give the message that no single food provides all the nutrients the body needs. Choosing
different kinds of foods from all food groups is the first step to obtain a well balanced diet. This will help correct the common
practice of confining of choice to a few kinds of foods, resulting in an unbalanced diet.
 Guidelines No.2 is entitled to promote exclusive breastfeeding from birth to 4-6 months and to encourage the continuance of
breastfeeding for as long as two years or longer. This is to ensure a complete and safe food for the newborn and the growing
infant besides imparting the other benefits of breastfeeding. The guideline also strongly advocates the giving of appropriate
complementary food in addition to breast milk once the infant is ready for solid foods at 6 months. Malnutrition most
commonly occurs between the ages of 6 months to 2 years, therefore there is a need to pay close attention to feeding the
child properly during this very critical period.
 Guideline No. 3 gives advise on proper feeding of children. In addition, the guideline promotes regular weighing to monitor
the growth of children, as it is a simple way to assess nutritional status.
 Guidelines No. 4, 5, 6 and 7 are intended to correct the deficiencies in the current dietary pattern of Filipinos. Including
fish, lean meat, poultry and dried beans, which will provide good quality protein and dietary energy, as well as iron and zinc,
key nutrients lacking in the diet of Filipinos as a whole. Eating more vegetables, fruits and root crops will supply the much
needed vitamins, minerals and dietary fiber that are deficient in our diet. In addition, they provide defense against chronic
degenerative diseases. Including foods cooked in edible oils will provide additional dietary energy as a partial remedy to
calorie deficiency of the average Filipino. Including milk and other calcium-rich foods in the diet will serve to supply not only
calcium for healthy bones but to provide high quality protein and other nutrients for growth.
 Guideline No. 8 promotes the use of iodized salt to prevent iodine deficiency, which is a major cause of mental and physical
underdevelopment in the country. At the same time, the guideline warns against excessive intake of salty foods as a hedge
against hypertension, particularly among high-risk individuals.
 Guideline No.9 is intended to prevent food-borne diseases. It explains the various sources of contamination of our food and
simple ways to prevent it from occurring.
 Finally, Guideline No. 10 promotes a healthy lifestyle through regular exercise, abstinence from smoking and avoiding
consumption. If alcohol is consumed, it must be done in moderation. All these lifestyle practices are directly or indirectly
related to good nutrition.

Nutrients in Food
 Nutrients are chemical substances present in the foods that keep the body healthy, supply materials for growth and repair of
tissues, and provide energy for work and physical activities.
  The major nutrients include the macronutrients, namely; proteins, carbohydrates and fats; the micronutrients, namely
vitamins such as A, D, E and K, the B complex vitamins and C and minerals such as calcium, iron, iodine, zinc, fluoride and
water.
Integrated Management of Childhood Illnesses (IMCI)
Definition 

 IMCI is an integrated approach to child health that focuses on the well-being of the whole child.
 IMCI strategy is the main intervention proposed to achieve a significant reduction in the number of deaths from communicable
diseases in children under five

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 preventive and curative elements that are implemented by families and communities as well as by health
facilities.

IMCI Objectives 

 To reduce significantly global mortality and morbidity associated with the major causes of disease in children
 To contribute to the healthy growth & 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
    Possible course/ associated condition: 

 Pneumonia, Severe anemia, P. falciparum malaria

 Cerebral malaria, meningitis, severe dehydration
 Pneumonia, Diarrhea, Ear infection
 Pneumonia, Meningitis, Sepsis
    Five Disease Focus of IMCI: 

 Acute Respiratory Infection

 Diarrhea
 Fever
 Malaria
 Measles
 Dengue Fever
 Ear Infection
 Malnutrition

The IMCI Case Management Process 

 Assess and classify

 Identify appropriate treatment
 Treat/refer
 Counsel
 Follow-up

The Integrated Case Management Process

Check for General Danger Signs: 

 A general danger sign is present if:

o The child is not able to drink or breastfeed
o The child vomits everything
o The child has had convulsions
o The child is lethargic or unconscious
Assess Main Symptoms 

 Cough/DOB
 Diarrhea
 Fever
 Ear problems

Assess and Classify Cough of Difficulty of Breathing

 Respiratory infections can occur in any part of the respiratory tract such as the nose, throat, larynx, trachea, air passages or
lungs.

Assess and classify PNEUMONIA 

 Cough or difficult breathing

 An infection of the lungs
 Both bacteria and viruses can cause pneumonia
 Children with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis (generalized infection).
    ** A child with cough or difficult breathing is assessed for: 

 How long the child has had cough or difficult breathing

 Fast breathing
 Chest indrawing
 Stridor in a calm child.
        Remember: 

o ** If the child is 2 months up to 12 months the child has fast breathing if you count 50 breaths per minute or more
o ** If the child is 12 months up to 5 years the child has fast breathing if you count 40 breaths per minute or more.

Color Coding 
 PINK   YELLOW   GREEN 
(URGENT REFERRAL) (Treatment at outpatient health facility) (Home management)

 OUTPATIENT HEALTH        OUTPATIENT HEALTH FACILITY  HOME

FACILITY  Treat local infection  Caretaker is counseled on:
 Pre-referral treatments  Give oral drugs  Home treatment/s
 Advise parents  Advise and teach caretaker  Feeding and fluids
 Refer child   Follow-up  When to return immediately
 Follow-up

 REFERRAL FACILITY    Give first dose of an appropriate

 Emergency Triage and antibiotic
Treatment ( ETAT)  Give Vitamin A
SEVERE PNEUMONIA OR VERY SEVERE DISEASE
 Diagnosis, Treatment  Treat the child to prevent low
 Monitoring, follow-up blood sugar
 Refer urgently to the hospital
 Give paracetamol for fever >
38.5oC

  Any general danger sign or   Give an appropriate antibiotic for

 Chest indrawing or 5 days
 Stridor in calm child  PNEUMONIA  Soothe the throat and relieve cough
with a safe remedy
 Advise mother when to return
immediately
 Follow up in 2 days
 Give Paracetamol for fever >
38.5oC
  Fast breathing     If coughing more than more than
30 days, refer for assessment
 Soothe the throat and relieve the
NO PNEUMONIA : COUGH OR COLD cough with a safe remedy
 Advise mother when to return
immediately
 Follow up in 5 days if not
improving

  No signs of pneumonia or

very severe disease

Assess and classify DIARRHEA 

    A child with diarrhea is assessed for:

 How long the child has had diarrhoea
 Blood in the stool to determine if the child has dysentery
 Signs of dehydration.
    Classify DYSENTERY 

o Child with diarrhea and blood in the stool

 Two of the following signs?    If child has no other severe classification:
 Abnormally sleepy or difficult to awaken SEVERE o Give fluid for severe dehydration ( Plan C ) OR
DEHYDRATION
 Sunken eyes  If child has another severe classification :
 Not able to drink or drinking poorly o Refer URGENTLY to hospital with mother giving frequent
 Skin pinch goes back very slowly sips of ORS on the way
o Advise the mother to continue breastfeeding
 If child is 2 years or older and there is cholera in your area, give antibiotic
for cholera

 Two of the following signs :  Give fluid and food for some dehydration ( Plan B )
 Restless, irritable  SOME
DEHYDRATION  If child also has a severe classification :
 Sunken eyes o Refer URGENTLY to hospital with mother giving frequent
 Drinks eagerly, thirsty sips of ORS on the way
 Skin pinch goes back slowly o Advise mother when to return immediately
 Follow up in 5 days if not improving

  Not enough signs to classify as some or  Home Care

severe dehydration NO DEHYDRATION
 Give fluid and food to treat diarrhea at home ( Plan A )
 Advise mother when to return immediately
 Follow up in 5 days if not improving

  Dehydration present    Treat dehydration before referral unless the child has another severe
SEVERE classification
PERSISTENT
DIARRHEA  Give Vitamin a
 Refer to hospital
  No dehydration    Advise the mother on feeding a child who has persistent diarrhea
PERSISTENT
DIARRHEA  Give Vitamin A
 Follow up in 5 days

  Blood in the stool    Treat for 5 days with an oral antibiotic recommended for Shigella in your
DYSENTERY area
 Follow up in 2 days
 Give also referral treatment

Does the child have fever? 

    **Decide: 

 Malaria Risk
  No Malaria Risk
 Measles
 Dengue
    Malaria Risk

  Any general danger sign or    Give first dose of quinine ( under medical
 Stiff neck supervision or if a hospital is not accessible within
VERY SEVERE FEBRILE DISEASE / 4hrs )
MALARIA
 Give first dose of an appropriate antibiotic
 Treat the child to prevent low blood sugar
 Give one dose of paracetamol in health center for
high fever (38.5oC) or above
 Send a blood smear with the patient
 Refer URGENTLY to hospital

  Blood smear ( + )    Treat the child with an oral antimalarial

 If blood smear not done: MALARIA
 Give one dose of paracetamol in health center for
 NO runny nose, and high fever (38.5oC) or above
 NO measles, and  Advise mother when to return immediately
 NO other causes of fever  Follow up in 2 days if fever persists
 If fever is present everyday for more than 7 days,
refer for assessment

 Blood smear ( - ), or  Give one dose of paracetamol in health center for

FEVER : MALARIA UNLIKELY high fever (38.5oC) or above
 Runny nose, or
 Measles, or Other causes of fever  Advise mother when to return immediately
 Follow up in 2 days if fever persists
 If fever is present everyday for more than 7 days,
refer for assessment

    No Malaria Risk 

 Any general danger sign or    Give first dose of an appropriate antibiotic
VERY SEVERE FEBRILE DISEASE
 Stiff neck  Treat the child to prevent low blood sugar
 Give one dose of paracetamol in health center for
high fever (38.5oC) or above
 Refer URGENTLY to hospital
 No signs of very severe febrile disease    Give one dose of paracetamol in health center for
FEVER : NO MALARIA high fever (38.5oC) or above
 Advise mother when to return immediately
 Follow up in 2 days if fever persists
 If fever is present everyday for more than 7 days,
refer for assessment

Measles 
 Clouding of cornea or  Give Vitamin A
SEVERE COMPLICATED MEASLES
 Deep or extensive mouth ulcers  Give first dose of an appropriate antibiotic
 If clouding of the cornea or pus draining from
the eye, apply tetracycline eye ointment
 Refer URGENTLY to hospital
 Pus draining from the eye or    Give Vitamin A
MEASLES WITH EYE OR MOUTH
 Mouth ulcers COMPLICATIONS  If pus draining from the eye, apply tetracycline
eye ointment
 If mouth ulcers, teach the mother to treat with
gentian violet
 Measles now or within the last 3 months    Give Vitamin A
MEASLES

Dengue Fever 
  Bleeding from nose or gums or    If skin petechiae or Tourniquet test,are the
SEVERE DENGUE only positive signs give ORS
 Bleeding in stools or vomitus or HEMORRHAGIC FEVER
 Black stools or vomitus or  If any other signs are positive, give fluids
rapidly as in Plan C
 Skin petechiae or
 Treat the child to prevent low blood sugar
 Cold clammy extremities or
 DO NOT GIVE ASPIRIN
 Capillary refill more than 3 seconds or
 Refer all children Urgently to hospital
 Abdominal pain or
 Vomiting
 Tourniquet test ( + )
 No signs of severe dengue hemorrhagic    DO NOT GIVE ASPIRIN
fever FEVER: DENGUE HEMORRHAGIC
UNLIKELY  Give one dose of paracetamol in health center
for high fever (38.5oC) or above
 Follow up in 2 days if fever persists or child
shows signs of bleeding
 Advise mother when to return immediately

Does the child have an ear problem? 

 Tender swelling behind the ear    Give first dose of appropriate antibiotic
MASTOIDITIS
 Give paracetamol for pain
 Refer URGENTLY
 Pus seen draining from the ear and discharge is    Give antibiotic for 5 days
reported for less than 14 days or ACUTE EAR INFECTION
 Give paracetamol for pain
 Ear pain  Dry the ear by wicking
 Follow up in 5 days
  Pus seen draining from the ear and discharge is  Dry the ear by wicking
reported for less than 14 days CHRONIC EAR INFECTION
 Follow up in 5 days
  No ear pain and no pus seen draining from the ear     No additional treatment
NO EAR INFECTION

Check for Malnutrition and Anemia 

    Give an Appropriate Antibiotic: 

        A. For Pneumonia, Acute ear infection or Very Severe disease 

COTRIMOXAZOLE AMOXYCILLIN
BID FOR 5 DAYS BID FOR 5 DAYS

Age or Weight Adult Syrup Tablet Syrup

tablet

2 months up to 12 months ( 4 - 1/2 5 ml 1/2 5 ml

< 9 kg )

12 months up to 5 years ( 10 – 1 7.5 ml 1 10 ml

19kg )

           B. For Dysentery 

COTRIMOXAZOLE AMOXYCILLIN
BID FOR 5 DAYS BID FOR 5 DAYS

AGE OR WEIGHT TABLET SYRUP SYRUP 250MG/5ML

2 – 4 months ½ 5 ml 1.25 ml ( ¼ tsp )

( 4  - < 6kg )

4 – 12 months ½ 5 ml 2.5 ml ( ½ tsp )

( 6 - < 10 kg )
1 – 5 years old 1 7.5 ml ( 1 tsp )
( 10 – 19 kg )

            C. For Cholera 

TETRACYCLINE COTRIMOXAZOLE
QID FOR 3 DAYS BID FOR 3 DAYS
  AGE OR WEIGHT Capsule 250mg Tablet  Syrup

2 – 4 months ( 4  - < 6kg ) ¼ 1/2 5ml

4 – 12 months ( 6 - < 10 kg ) ½  1 / 2 5 ml

1 – 5 years old ( 10 – 19 kg) 1 1 7.5ml

        Give an Oral Antimalarial 

Primaquine Primaquine Sulfadoxine +

CHOLOROQUINE Give single dose in Give daily for 14 Pyrimethamine
Give for 3 days health center for P. days for P. Vivax Give single dose
Falciparum

AGE TABLET ( 150MG ) TABLET TABLET TABLET

( 15MG) ( 15MG) ( 15MG)
DAY1 DAY2 DAY3
2months – ½ ½ ½ ¼
5months
5 months – ½ ½ ½ 1/2
12 months
12months – 1 1 ½ ½ ¼ ¾
3 years old

3 years old  - 1½ 1½ 1 3/4 1/2 1

5 years old

    GIVE VITAMIN A 
 AGE  VITAMIN A CAPSULES  200,000 IU

 6 months – 12 months  1/2

 12 months – 5 years old  1

    GIVE IRON 
 AGE or WEIGHT  Iron/Folate Tablet   Iron Syrup 
 FeSo4 200mg + 250mcg Folate (60mg elemental iron)  FeSo4 150 mg/5ml 
 (6mg elemental iron per ml )

 2months-4months   2.5 ml
 (4 - <6kg )

 4months – 12months   4 ml
 (6 - <10kg )

 12months – 3 years        (10 - <14kg)  1/2  5 ml

 3years – 5 years ( 14 –  19kg )  1/2  7.5 ml

    GIVE PARACETAMOL FOR HIGH FEVER (38.5oC OR MORE) OR EAR PAIN 

 AGE OR WEIGHT  TABLET ( 500MG )  SYRUP ( 120MG / 5ML )
 2 months – 3 years        ( 4 - <14kg )  ¼  5 ml
 3 years up to 5 years     (14 – 19 kg )  1/2  10 ml

    GIVE MEBENDAZOLE 

 Give 500mg Mebendazole as a single dose in health center if :

o hookworm / whipworm are a problem in children in your area, and
o the child is 2 years of age or older, and
o the child has not had a dose in the previous 6 months
Family Planning Program
Overview 

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

Goals and Objectives 

 Universal access to family planning information, education and services. 

Mission 

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

Types of Methods 

1. NATURAL METHODS 

a. Calendar or Rhythm Method 

b. Basal Body Temperature Method 
c. Cervical Mucus Method 
d. Sympto-Thermal Method 
e. Lactational Amennorhea 

2. ARTIFICIAL METHODS 

a. Chemical Methods 
i. Ovulation suppressant such as PILLS 
ii. Depo-Provera 
iii. Spermicidals 
iv. Implant 

b. Mechanical Methods 
i. Male and Female Condom 
ii. Intrauterine Device 
iii. Cervical Cap/Diaphragm 

c. Surgical Methods 
i. Vasectomy 
ii. Tubal Ligation 

Warning Signs 

Pills 

 Abdominal pain (severe) 

 Chest pain (severe) 
 Headache (severe) 
 Eye problems (blurred vision, flashing lights, blindness) 
 Severe leg pain (calf or thigh) 
 Others: depression, jaundice, breast lumps 
IUD 

 Period late, no symptoms of pregnancy, abnormal bleeding or spotting 

 Abdominal pain during intercourse 
 Infection or abnormal vaginal discharge 
 Not feeling well, has fever or chills 
 String is missing or has become shorter or longer 
Injectables 
 Dizziness 
 Severe headache 
 Heavy bleeding 
BTL 
 Fever 
 Weakness 
 Rapid pulse 
 Persistent abdominal pain 
 Vomiting 
 Dizziness 
 Pus or tenderness at incision site 
 Amenorrhea 
Vasectomy 
 Fever 
 Scrotal blood clots or excessive swelling 
Health and Sanitation
Overview 

 Environmental Sanitation is still a health problem in the country. 

 Diarrheal diseases ranked second in the leading causes of morbidity among the general population. 
 Other sanitation related diseases : tuberculosis, intestinal parasitism, schistossomiasis, malaria, infectious hepatitis, filariasis
and dengue hemorrhagic fever 
  DOH thru’ Environmental Health Services (EHS) unit is authorized to act on all issues and concerns in environment and health
including the very comprehensive Sanitation Code of the Philippines (PD 856, 1978). 

Water Supply Sanitation Program 

EHS sets policies on: 

 Approved types of water facilities 
 Unapproved type of water facility 
 Access to safe and potable drinking water 
 Water quality and monitoring surveillance 
 Waterworks/Water system and well construction 
Approved type of water facilities 
Level 1 (Point Source) 
 a protected well or a developed spring with an outlet but without a distribution system 
 indicated for rural areas 
 serves 15-25 households; its outreach is not more than 250 m from the farthest user 
 yields 40-140 L/ min 
Level II (Communal Faucet or Stand Posts) 
 With a source, reservoir, piped distribution network and communal faucets 
 Located at not more than 25 m from the farthest house 
 Delivers 40-80 L of water per capital per day to an average of 100 households 
 Fit for rural areas where houses are densely clustered 
Level III (Individual House Connections or Waterworks System) 
 With a source, reservoir, piped distributor network and household taps 
 Fit for densely populated urban communities 
 Requires minimum treatment or disinfection 

Environmental Sanitation 
 The study of all factors in man’s physical environment, which may exercise a deleterious effect on his health, well-being and
survival. 
Includes: 
 Water sanitation 
 Food sanitation 
 Refuse and garbage disposal 
 Excreta disposal 
 Insect vector and rodent control 
 Housing 
 Air pollution 
 Noise 
 Radiological Protection 
 Institutional sanitation 
 Stream pollution 
Proper Excreta and Sewage Disposal Program 
EHS sets policies on approved types of toilet facilities: 

Level I 
 Non-water carriage toilet facility – no water necessary to wash the waste into receiving space e.g. pit latrines, reed odorless
earth closet. 
 Toilet facilities requiring small amount of water to wash the waste into the receiving space e.g. pour flush toilet & aqua privies 
Level II 
 On site toilet facilities of the water carriage type with water-sealed and flush type with septic vault/tank disposal. 
Level III 
 Water carriage types of toilet facilities connected to septic tanks and/or to sewerage system to treatment plant. 
Food Sanitation Program 
 sets policy and practical programs to prevent and control food-borne diseases to alleviate the living conditions of the
population 
Hospital Waste Management Program 
 Disposal of infectious, pathological and other wastes from hospital which combine them with the municipal or domestic wastes
pose health hazards to the people. 
 Hospitals shall dispose their hazardous wastes thru incinerators or disinfectants to prevent transmission of nosocomial
diseases 
Program on Health Risk Minimization due to Environmental Pollution 
1. Prevention of serious environmental hazards resulting from urban growth and industrialization 
2. Policies on health protection measures 
3. Researches on effects of GLOBAL WARMING to health (depletion of the stratosphere ozone layer which increases ultraviolet
radiation, climate change and other conditions) 

Nursing Responsibilities and Activities 

 Health Education – IEC by conducting community assemblies and bench conferences. 
 The Occupational Health Nurse, School Health Nurse and other Nursing staff shall impart the need for an effective and efficient
environmental sanitation in their places of work and in school. 
 Actively participate in the training component of the service like in Food Handler’s Class, and attend training/workshops
related to environmental health. 
 Assist in the deworming activities for the school children and targeted groups. 
 Effectively and efficiently coordinate programs/projects/activities with other government and non-government agencies. 
 Act as an advocate or facilitator to families in the community in matters of program/projects/activities on environmental
health in coordination with other members of Rural Health Unit (RHU) especially the Rural Sanitary Inspectors. 
  Actively participate in environmental sanitation campaigns and projects in the community. Ex. Sanitary toilet campaign drive
for proper garbage disposal, beautification of home garden, parks drainage and other projects. 
 Be a role model for others in the community to emulate terms of cleanliness in the home and surrounding. 
Communicable Disease (Vector Borne)
Leptospirosis (Weil’s disease) 

 An infectious disease that affects humans and animals, is considered the most common zoonosis in the world
Causative Agent: Leptospira interrogans 

Sign/Symptoms: 

 High fever
 Chills
 Vomiting
 Red eyes
 Diarrhea
 Severe headache
 muscle aches
 may include jaundice (yellow skin and eyes)
 abdominal pain
Treatment: 

PET - > Penicillins, Erythromycin, Tetracycline 

Malaria 

 Malaria (from Medieval Italian: mala aria - "bad air"; formerly called ague or marsh fever) is an infectious disease that is
widespread in many tropical and subtropical regions.
Causative Agent: Anopheles female mosquito 

Signs & Symptoms:

 Chills to convulsion
 Hepatomegaly
 Anemia
 Sweats profusely
 Elevated temperature
Treatment: 

 Chemoprophylaxis – chloroquine taken at weekly interval, starting from 1-2 weeks before entering the endemic area.
 Anti-malarial drugs – sulfadoxine, quinine sulfate, tetracycline, quinidine
 Insecticide treatment of mosquito nets, house spraying, stream seeding and clearing, sustainable preventive and vector
control meas
Preventive Measures: (CLEAN) 

 Chemically treated mosquito nets

 Larvae eating fish
 Environmental clean up
 Anti mosquito soap/lotion
 Neem trees/eucalyptus tree

Filariasis 

 name for a group of tropical diseases caused by various thread-like parasitic round worms (nematodes) and their larvae
 larvae transmit the disease to humans through a mosquito bite
 can progress to include gross enlargement of the limbs and genitalia in a condition called elephantiasis
Sign/Symptoms: 

Asymptomatic Stage 

 Characterized by the presence of microfilariae in the peripheral blood

 No clinical signs and symptoms of the disease
 Some remain asymptomatic for years and in some instances for life
Acute Stage 

 Lymphadenitis (inflammation of lymph nodes)

 Lymphangitis (inflammation of lymph vessels)
 In some cases the male genitalia is affected leading to orchitis (redness, painful and tender scrotum)
Chronic Stage 

 Hydrocoele (swelling of the scrotum)

 Lyphedema (temporary swelling of the upper and lower extremities
 Elephantiasis (enlargement and thickening of the skin of the lower and / or upper extremities, scrotum, breast)
Management: 
  Diethylcarbamazine citrate or Hetrazan
 Ivermectin,
 Albendazolethe
 No treatment can reverse elephantiasis

Schistosomiasis 

 parasitic disease caused by a larvae

Causative Agent: Schistosoma intercalatum, Schistosoma japonicum, Schistosoma mansoni 

Signs & Symptoms: (BALLIPS) 

 Bulging abdomen
 Abdominal pain
 Loose bowel movement
 Low grade fever
 Inflammation of liver & spleen
 Pallor
 Seizure
Preventive measures 

 health education regarding mode of transmission and methods of protection; proper disposal of feces and urine; improvement
of irrigation and agriculture practices
 Control of patient, contacts and the immediate environment
Treatment: 

 Diethylcarbamazepine citrate (DEC) or Praziquantel (drug of choice)

Dengue 

 DENGUE is a mosquito-borne infection which in recent years has become a major international public health concern..
 It is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas.
Sign/Symptoms: (VLINOSPARD) 

 Vomiting
 Low platelet
 Nausea
 Onset of fever
 Severe headache
 Pain of the muscle and joint
 Abdominal pain
 Rashes
 Diarrhea
Treatment: 

 The mainstay of treatment is supportive therapy.

o Intravenous fluids
o A platelet transfusion
Communicable Diseases (Chronic)
Chronic 

1. Tuberculosis 

 TB is a highly infectious chronic disease that usually affects the lungs.

Causative Agent: Mycobacterium Tuberculosis 

Sign/Symptoms: 

 cough
 afternoon fever
 weight loss
 night sweat
 blood stain sputum
Prevalence/Incidence: 

 ranks sixth in the leading causes of morbidity (with 114,221 cases) in the Philippines
 Sixth leading cause of mortality (with 28507 cases) in the Philippines.
Nursing and Medical Management 

 Ventilation systems
 Ultraviolet lighting
 Vaccines, such as the bacillus Calmette Guerin (BCG) vaccine
 drug therapy
Preventing Tuberculosis 
  BCG vaccination
 Adequate rest
 Balanced diet
 Fresh air
 Adequate exercise
 Good personal Hygiene
National Tuberculosis Control Program – key policies 

 Case finding – direct Sputum Microscopy and X-ray examination of TB symptomatics who are negative after 2 or more
sputum exams
 Treatment – shall be given free and on an ambulatory basis, except those with acute complications and emergencies
 Direct Observed Treatment Short Course – comprehensive strategy to detect and cure TB patients.
DOTS (Direct Observed Treatment Short Course) 

 Category 1- new TB patients whose sputum is positive; seriously ill patients with severe forms of smear-negative PTB with
extensive parenchymal involvement (moderately- or far advanced) and extra-pulmonary TB (meningitis, pleurisy, etc.)
o Intensive Phase (given daily for the first 2 months) - Rifampicin + Isioniazid + pyrazinamide + ethambutol.
o If sputum result becomes negative after 2 months, maintenance phase starts. But if sputum is still positive in 2
months, all drugs are discontinued from 2-3 days and a sputum specimen is examined for culture and drug
sensitivity. The patient resumes taking the 4 drugs for another month and then another smear exam is done at the
end of the 3rd month.
o Maintenance Phase (after 3rd month, regardless of the result of the sputum exam)-INH + rifampicin daily
 Category 2-previously-treated patients with relapses or failures.
o Intensive Phase (daily for 3 months, month 1, 2 & 3)-Isioniazid+ rifampicin+ pyrazinamide+ ethambutol+
streptomycin for the first 2 months Streptomycin+ rifampicin pyrazinamide+ ethambutol on the 3rd month. If
sputum is still positive after 3 months, the intensive phase is continued for 1 more month and then another sputum
exam is done. If still positive after 4 months, intensive phase is continued for the next 5 months.
o Maintenance Phase (daily for 5 months, month 4, 5, 6, 7,& 8)-Isionazid+ rifampicin+ ethambutol
 Category 3 – new TB patients whose sputum is smear negative for 3 times and chest x-ray result of PTB minimal
o Intensive Phase (daily for 2 months) – Isioniazid + rifampicin + pyrazinamide
o Maintenance Phase (daily for the next 2 months) - Isioniazid + rifampicin

2. Leprosy 

 Sometimes known as Hansen's disease

 is an infectious disease caused by , an aerobic, acid fast, rod-shaped mycobacterium
 Gerhard Armauer Hansen
 Historically, leprosy was an incurable and disfiguring disease
 Today, leprosy is easily curable by multi-drug antibiotic therapy
Signs & Symptoms 

Early stage (CLUMP)                                              Late Stage (GMISC) 

Change in skin color                                        Gynocomastia 
Loss in sensation                                            Madarosis(loss of eyebrows) 
Ulcers that do not heal                                    Inability to close eyelids (Lagopthalmos) 
Muscle weakness                                            Sinking nosebridge 
Painful nerves                                                Clawing/contractures of fingers & nose 

Prevalence Rate 

 Metro Manila, the prevalence rate ranged from 0.40 – 3.01 per one thousand population.
Management: 

 Dapsone, Lamprene
 clofazimine and rifampin
 Multi-Drug-Therapy (MDT)
 six month course of tablets for the milder form of leprosy and two years for the more severe form
Leprosy Control Program 

 WHO Classification – basis of multi-drug therapy

o Paucibacillary/PB – non-infectious types. 6-9 months of treatment.
o Multibacillary/MB – infectious types. 24-30 months of treatment.
 Multi-drug therapy – use of 2 or more drugs renders patients non-infectious a week after starting treatment
o Patients w/ single skin lesion and a negative slit skin smear are treated w/ a single dose of ROM regimen
o For PB leprosy cases- Rifampicin+Dapsone on Day 1 then Dapsone from Day 2-28. 6 blister packs taken monthly
within a max. period of 9 mos.
 All patients who have complied w/ MDT are considered cured and no longer regarded as a case of leprosy, even if some
sequelae of leprosy remain.
 Responsibilities of the nurse:
o Prevention – health education, healthful living through proper nutrition, adequate rest, sleep and good personal
hygiene;
o Casefinding
o Management and treatment – prevention of secondary injuries, handling of utensils; special shoes w/ padded
soles; importance of sustained therapy, correct dosage, effects of drugs and the need for medical check-up from time
to time; mental & emotional support
o Rehabilitation-makes patients capable, active and self-respecting member of society.
Bag Technique

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 its contents should be cleaned as often as possible, supplies replaced and ready for use at any time.
3. The bag and its 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, place To protect the bag from contamination.
the bag on the table or any flat 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 of To be used for handwashing.
water if faucet is not available. Place these To protect the work field from being wet.
outside the work area.
 3. Open the bag, take the linen/plastic lining To make a non-contaminated work field or area.
and spread over work field or area. The paper
lining, clean side out (folded part out).
4. Take out hand towel, soap dish and apron To prepare for handwashing.
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 towel. Handwashing prevents possible infection from one care
Leave the plastic wrappers of the towel in a provider to the client.
soap dish in the bag.
6. Put on apron right side out and wrong side To protect the nurses’ uniform. Keeping the crease
with crease touching the body, sliding the creates aesthetic appearance.
head into the neck strap. Neatly tie the straps
at the back.
7. Put out things most needed for the specific To make them readily accessible.
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 work To prevent contamination of clean area.
area.
9. Close the bag. To give comfort and security, maintain personal hygiene
and hasten recovery.
10. Proceed to the specific nursing care or To prevent contamination of bag and contents.
treatment.
11. After completing nursing care or To protect caregiver and prevent spread of infection to
treatment, clean and alcoholize the things others.
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 matters To be used as reference for future visit.
relevant to health care, taking anecdotal
notes preparatory to final reporting.
17. Make appointment for the next visit For follow-up care.
(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 

1. Record all relevant findings about the client and members of the family.
2. Take note of environmental factors which affect the clients/family health.
3. Include quality of nurse-patient relationship.
4. Assess effectiveness of nursing care provided.
A Typology of Problems in Family Practice
First Level Assessment 

I. Presence of Wellness Condition-stated as potential or Readiness-a clinical or nursing judgment about a client in transition from a
specific level of wellness or capability to a higher level. Wellness potential is a nursing judgment on wellness state or condition based
on client’s performance, current competencies, or performance, clinical data or explicit expression of desire to achieve a higher level of
state or function in a specific area on health promotion and maintenance. Examples of this are the following 

A. Potential for Enhanced Capability for: 

1. Healthy lifestyle-e.g. nutrition/diet, exercise/activity

2. Healthy maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being-process of client’s developing/unfolding of mystery through harmonious interconnectedness that comes
from inner strength/sacred source/God (NANDA 2001)
6. Others. Specify.
B. Readiness for Enhanced Capability for: 

1. Healthy lifestyle
2. Health maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being
6. Others. Specify.
II. Presence of Health Threats-conditions that are conducive to disease and accident, or may result to failure to maintain wellness or
realize health potential. Examples of this are the following: 

A. Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic syndrome) 

B. Threat of cross infection from communicable disease case 

C. Family size beyond what family resources can adequately provide 

D. Accident hazards specify. 

1. Broken chairs
2. Pointed /sharp objects, poisons and medicines improperly kept
3. Fire hazards
4. Fall hazards
5. Others specify.
E. Faulty/unhealthful nutritional/eating habits or feeding techniques/practices. Specify. 

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. Specify. 

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. Specify. 

1. Inadequate living space

2. Lack of food storage facilities
3. Polluted water supply
4. Presence of breeding or resting sights of vectors of diseases
5. Improper garbage/refuse disposal
6. Unsanitary waste disposal
7. Improper drainage system
8. Poor lightning and ventilation
9. Noise pollution
10. Air pollution
H. Unsanitary Food Handling and Preparation 

I. Unhealthy Lifestyle and Personal Habits/Practices. Specify. 

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/relaxation activities
12. Non use of self-protection measures (e.g. non use of bed nets in malaria and filariasis endemic areas).
J. Inherent Personal Characteristics-e.g. poor impulse control 

K. Health History, which may Participate/Induce the Occurrence of 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. 

1. Self-oriented behavior of member(s)

2. Unresolved conflicts of member(s)
3. Intolerable disagreement
O. Others. Specify._________ 

III. Presence of health deficits-instances of failure in health maintenance. 

Examples include: 

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 congenital or arising from illness; transient/temporary (e.g. aphasia or temporary paralysis after a CVA) or
permanent (e.g. leg amputation secondary to diabetes, blindness from measles, lameness from     polio) 

IV. Presence of stress points/foreseeable crisis situations-anticipated periods of unusual demand on the   individual or family in
terms of adjustment/family resources. Examples of this include: 

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. Others, specify.___________ 

Second-Level Assessment 

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 peer/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 about by perceive magnitude/severity of the  situation or problem, i.e.
failure to breakdown problems into manageable units of attack. 

D. Lack of/inadequate knowledge/insight as to alternative courses of action open to them 

E. Inability to decide which action to take from among a list of alternatives 

F. Conflicting opinions among family members/significant others regarding action to take. 

G. Lack of/inadequate knowledge of community resources for care 

H. Fear of consequences of action, specifically: 

1. Social consequences
2. Economic consequences
3. Physical consequences
4. Emotional/psychological consequences
I. Negative attitude towards the health condition or problem-by negative attitude is meant one that interferes with  rational decision-
making. 

J. In accessibility of appropriate resources for care, specifically: 

1. Physical Inaccessibility
2. Costs constraints or economic/financial inaccessibility
K. Lack of trust/confidence in the health personnel/agency 

L. Misconceptions or erroneous information about proposed course(s) of action 

M. Others specify._________ 

III. Inability to provide adequate nursing care to the 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 child development and care 

C. Lack of/inadequate knowledge of the nature or extent of nursing care needed 

D. Lack of the necessary facilities, equipment and supplies of care 

E. Lack of/inadequate knowledge or skill in carrying out the necessary intervention or treatment/procedure of care  (i.e. complex
therapeutic regimen or healthy lifestyle program). 
F. Inadequate family resources of care specifically: 

1. Absence of responsible member

2. Financial constraints
3. Limitation of luck/lack of physical resources
G. Significant persons unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety, despair, rejection) which his/her capacities to
provide care. 

H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at risk member 

I. Member’s preoccupation with on concerns/interests 

J. Prolonged disease or disabilities, which exhaust supportive capacity of family members. 

K. Altered role performance, specify. 

1. Role denials or ambivalence

2. Role strain
3. Role dissatisfaction
4. Role conflict
5. Role confusion
6. Role overload
L. Others. Specify._________ 

IV. Inability to provide a home environment conducive to health maintenance and personal development due to: 

A. Inadequate family resources specifically: 

1. Financial constraints/limited financial resources

2. Limited physical resources-e.i. lack of space to construct facility
B. Failure to see benefits (specifically long term ones) of investments 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 pattern within the family 

G. Lack of supportive relationship among family members 

H. Negative attitudes/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 family’s preoccupation with    current problem or condition. 

J. 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 : 

1. Physical/psychological consequences
2. Financial consequences
3. Social consequences
F. Unavailability of required care/services 

G. Inaccessibility of required services due to: 

1. Cost constrains
2. Physical inaccessibility
H. Lack of or inadequate family resources, specifically 

1. Manpower resources, e.g. baby sitter

2. Financial resources, cost of medicines prescribe
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 __________ 

Maternal and Child Health Nursing Program
Philosophy 
 Pregnancy, labor and delivery and puerperium are part of the continuum of the total life cycle
 Personal, cultural and religious attitudes and beliefs influence the meaning of pregnancy for individuals and make each
experience unique
 MCN is FAMILY CENTERED- the father is as important as the mother
Goals 
 To ensure that expectant mother and nursing mother maintain good health, learn the art of child care, has a normal delivery
and bear healthy children
 That every child lives and grows up in a family unit with love and security, in healthy surroundings, receives adequate
nourishment, health supervision and efficient medical attention and is taught the elements of healthy living

Classification of pregnant women 

 Normal – healthy pregnancy
 With mild complications- frequent home visits
 With serious or potentially serious complication – referred to most skilled source of medical and hospital care

Home Based Mother’s Record (HBMR) 

 Tool used when rendering prenatal care containing risk factors and danger signs

Risk Factors 
 145 cm tall (4 ft & 9 inches)
 Below 18 yrs old, above 35 yrs old
 Have had 4 pregnancies
 With TB, goiter, heart disease, DM, bronchial asthma, severe anemia
 Last baby born was less than 2 years ago
 Previous cesarian section delivery
 History of 2 or more abortions, difficult delivery, given birth to twins, 2 or more babies born before EDD, stillbirth
 Weighs less than 45 kgs. or more than 80 kgs.

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

Prenatal Care 

    Schedule of Visits 
 1st – as early as pregnancy, 1st trimester
 2nd - 2nd trimester
 3rd & subsequent visits - 3rd trimester
 More frequent visits for those at risk with complications
    Tetanus Toxiod Immunization Schedule for Women 
 Vaccine  Minimum Age Interval  Percent Protected  Duration of Protection

 TT1 As early as possible during  0% None

pregnancy
 TT2 At least 4 weeks later  80% Infants born to the mother will be protected from neonatal
tetanus. Gives 3 years protection for the mother from the
tetanus.

 TT3 At least 6 months later  90%  Infants born to the mother will be protected from neonatal
tetanus. 

Gives 5 years protection for the mother.

 TT4 At least 1 year later  99% Gives 10 years protection for the mother

 TT5 At least 1 year later  99% Gives lifetime protection for the mothers. All Infants born to
that mother will be protected.

Dose: 0.5ml 
Route: Intramuscular 
Site: Right or Left Deltoid/Buttocks 

    Components of Prenatal Visits 

 History – taking
 Determination of obstetrical score- G, P, TPAL, AOG, EDD
 U/A for Proteinuria, glycosuria and infxtn
 Dental exam
 Wt. Ht. BP taking
 Exam of conjunctiva and palms for pallor
 Abdominal exam - fundic ht, Leopold’s maneuver and FHT
 Exam of breasts, face, hands and feet for edema and neck for thyroid enlargement
 Health teachings- nutrition, personal hygiene, common complaints
 Tetanus toxoid immunization
 Iron supplementation – from 5th mo. Of pregnancy - 2 mos. Postpartum
 In goiter endemic areas – iodized capsule once a year
 In malaria infested areas- prophylactic Chloroquine (150 mg/tab ) 2 tabs/ wk for the whole duration of pregnancy
Cancer Prevention and Early Detection 

 Any malignant tumor arising from the abnormal and uncontrolled division of cells causing the destruction in the surrounding
tissues.
 Common Cancer: Lung cancer, cervical cancer, colon cancer, cancer of the mouth, breast cancer, skin cancer, prostate cancer.
 3rd leading cause of illness and death (Phil.)
 Incidence can only be reduced thru prevention and early detection
    Nine Warning Signs of Cancer: 

 Change in blood bowel or bladder habits

 A sore that does not heal
 Unusual bleeding or discharge
 Thickening or lump in breast or elsewhere
 Indigestion or difficulty in swallowing
 Obvious change in wart or mole
 Nagging cough or hoarseness
 Unexplained anemia
 Sudden unexplained weight loss