TRANSES

CA I – COMPETENCY APPRAISAL I
Concept: Community Health Nursing

Instructor: Jocyl Darrel B. Abinal, MAN
BSN IV: 1st Semester SY 2023-2024
COMMUNITY HEALTH NURSING - The nurse monitors and supervises the

COMMUNITY performance of midwives and other auxiliary
Established when more than two people share the same health workers;
values, this personal connection evolves into a - The nurse also initiates the formulation of staff
fellowship governed by rituals, traditions, and a developments and training programs for
particular form of communication that when taken midwives and other auxiliary health workers as
together makes a group of individuals. part of their training function as supervisor.
COMMUNITY HEALTH 5. LEADER AND CHANGE AGENT
Medical specialty that focuses on the physical and - The nurse influences people to participate in the
mental well-being of the people in a specific geographic overall process of community development.
region. 6. MANAGER
NURSING IN COMMUNITY HEALTH - The nurse organizes the nursing service
 Provide Health Education component of the local health agency or local
 Promote Healthy practices government unit;
 Provide Medical treatment - Also, as program manager, the PHN is
 Guiding patients and their families responsible for delivery of the package of
 Provide referrals for other services, resources and services provided by the health program to
classes. target clientele
 Collaboration with other healthcare workers and 7. RESEARCHER
with government agencies - The nurse participates in the conducts of
 Research research and utilizes research findings in
 Rehabilitation practice.
COMMUNITY HEALTH NURSING (CHN) FIVEFOLD MISSION OF CHN
Synthesis of nursing and public health practice, applied 1. Health promotion
to promote and protect the health of the population It 2. Health protection
combines all the basic elements of professional, clinical 3. Health balance
nursing with public health and community practice. 4. Disease prevention
BASIC PRINCIPLES OF CHN 5. Social justice
ROLES OF PUBLIC HEALTH NURSE CHN Process (ADPIE)
1. CLINICIAN OR HEALTH CARE PROVIDER Community Health Nursing Process
- The nurse utilizes the nursing process in the care ASSESSMENT
of the client in the home setting through home  initiate contact
visits and in public health care facilities  collect data
- The nurse conducts referral of patients to  identify health problems
appropriate levels of care when necessary  assess coping ability
2. HEALTH EDUCATOR  analyze and interpret data
- The nurse utilizes teaching skills to improve the 2 LEVELS OF FAMILY ASSESSMENT
health knowledge, skills and attitude of the 1. First level – determine actual and potential health
individual, family and the community problems. Answers ‘what’ questions.
- The nurse conducts health information 2. Second level – determine barriers to family’s
campaigns to various groups for the purpose of performance of tasks. Answers ‘why’ questions.
health promotion and disease prevention CATEGORIES OF HEALTH PROBLEMS
3. COORDINATOR AND COLLABORATION (according to priority)
- The nurse establishes linkages and collaborative 1. Wellness state – readiness to achieve higher level or
relationships with other health professionals, state of health
government agencies, the private sector, non- Health deficit – presence of illness; gap between actual
government organization and people’s and ideal health
organizations to address health problems *both are equally considered as priority #1
4. SUPERVISOR 2. Health threat – condition that promote disease or
injury
3. Stress point/foreseeable crisis – anticipated periods 2. Community diagnosis enables the nurse/program
of unusual demands coordinator to set priorities for planning and
INITIAL DATA BASE developing programs of health care for the
1. Family structure and characteristics community. The data gathered through the process
2. Socio-economic and cultural factors serves as the material for analysis.
3. Environmental factors TYPES OF COMMUNITY DX
4. Health assessment of each member 1. Comprehensive Community Dx
5. Value placed on prevention of disease - general view
2. Problem-oriented Community Dx
FAMILY DIAGNOSIS
- specific problem
POINT COMPONENTS OF COMMUNITY DX
GIVE COMPONENT 1. Demographic variables
N 2. Socio-economic and cultural variables
Nature of the problem 3. Health and illness patterns
(1) Deficit/wellness 4. Health resources
X1
(2) threat 5. Political and leadership patterns
(3) stress point Components of Community Dx
Modifiability possibility of success 1. Primary Data - source would be the community
Highly people through survey, interview, focused group
X2
Partially discussions, observation and through the actual
Non-modifiable minutes.of community meetings
Preventive potential 2. Secondary Data - source would be organizational
X1 Magnitude of future problems that can be records of the program, health center records and
minimized by solving this other public records through review of records
Salience PLANNING
X1
Family’s perception of the problem  goal setting
 constructing plan of action and operational plan
COMMUNITY DIAGNOSIS
IMPLEMENTATION
POINT  put nursing plan to action
COMPONENT
GIVEN  coordinate care/services
Nature  utilize community resources
Health status (illness, stats), health  delegate and supervise
X1 resource (material, manpower), Health-  provide health education
related (social, economic, political,  document responses
environmental) 2 LEVELS OF NURSING INTERVENTION IN CHN
Modifiability possibility of success 1. Anticipatory – primary level of prevention
X4
(highly, partially, or non-modifiable) 2. Participatory – secondary & tertiary levels
Preventive potential EVALUATION
X1 Magnitude of future problems that can  nursing audit
be minimized by solving this  evaluate care outcomes
Salience  performance appraisal for workers
X1
Family’s perception of the problem  estimate cost-benefit ratio (determine efficiency)
Magnitude of the problem  identify necessary alterations
X3 Severity: proportion of population  revise plans
affected by problem FRAMEWORK FOR EVALUATION
Total=10 1. Structural elements - physical: manpower,
equipment, infrastructure
WHY UNDERTAKE COMMUNITY DX?
2. Process elements - actions, procedures, protocols
1. To have a clear picture of the problems of the
3. Outcome elements - changes in clients’ health
community and to identify the resources available
status, objectives and goals of care outcome
to the community people.
NATIONAL IMMUNIZATION PROGRAM AND  OPV given simultaneously to all children younger
COLD CHAIN MANAGEMENT (ALL VACCINES) than 5 y/o
IMMUNIZATION PROGRAM 2. PROCLAMATION NO. 135, s. 2001
VACCINE HISTORY:  POLIO-FREE MAINTENANCE IMMUNIZATION
 EDWARD JENNER CAMPAIGN
 Founder of Vaccinology in the West (1796)  Last wild Poliomyelitis case in the Philippines was
 After he inoculated a 13 y/o boy with vaccinia in 1993
virus (cowpox) which demonstrated immunity  Philippines was certified POLIO-FREE country on
to smallpox October 29,2000 in Kyoto, Japan
 In 1798, the FIRST smallpox vaccine was  19 years after, On September 19,2019, a new
developed polio outbreak was reported by POLIO VIRUS 2
 Smallpox vaccine was the FIRST SUCCESSFUL  3 Viral Strains of Polio
VACCINE to be developed a. Brunhilde Type 1
 WHO declares GLOBAL eradication of Smallpox b. Lansing type 2
(May 1980) c. Leon type 3
 LAST WILD CASE of small pox – Somalia (1977) 3. PROCLAMATION NO. 4, s. 1998
EXPANDED PROGRAM ON IMMUNZATION  LIGTAS TIGDAS MONTH
(established in 1976)  September 16 – October 14, 1998
 IMMUNIZATION  Free measles vaccines between the ages of 9
- Process of introducing vaccine into the body months – less than 15 years
before infection sets in providing ARTIFICIAL 4. PRESIDENTIAL DECREE 996
ACTIVE IMMUNITY  COMPULSORY basic immunization for infants and
 WHO stated that as many as 2-3 million deaths children below 8 years of age
among children per year could have been prevented 5. REPUBLIC ACT NO. 7846
by ACCESS TO IMMUNIZATION  COMPULSORY Hepatitis B immunization among
 SCHEDULE: WEDNESDAY infants & children less than 8 years old
- Designated NATIONAL IMMUNIZATION DAY or  Newborn infants of women with Hepatitis B shall
“Patak Day” be given immunization against Hepatitis B within
 WEEKLY: Rural Health Units 24 hours after birth
 MONTHLY: Barangay Health Stations 6. RA No. 10152
 QUARTERLY: Remote areas (Far-flung)  MANDATORY infants and Children Health
VACCINE PREVENTABLE DISEASES Immunization Act of 2011
1. Tuberculosis – BCG  TAKE NOTE:
2. Diphtheria & Pertussis – DPT/Pentavalent a. If the infant is sick, and the parent strongly
3. Measles – Measles Vaccine objects for the immunization, DO NOT GIVE IT
4. Poliomyelitis – OPV and IPV b. Ask the mother to comeback when child is well
a. OPV – Albert Sabin FULLY IMMUNIZED CHILD (FIC)
b. IPV – Jonas Salk 1. Before 12 months
5. Tetanus 2. Before 1st birthday of child he/she must have
a. CHILDREN = DPT completed:
b. Mothers = Tetanus Toxoid  1 dose of BCG
6. Hepatitis B – HepB vaccine  3 doses of DPT
7. Diarrhea caused by Rotavirus – Rotavirus vaccine  3 doses of OPV
8. Meningitis – PentaHIB vaccine  3 doses of HepB
REGULATORY LAWS  1 dose of Measles
1. PROCLAMATION NO. 773, s. 1996 FREEZE DRIED:
 Declaring April 17 and May 15, 1996 and every 1. BCG
third Wednesday of April and May from 1996 to 2. Others: Yellow Fever and HIB
2000 as “KNOCKOUT POLIO DAYS” MOST SENSITIVE TO HEAT/SUNLIGHT:
 ONLY OPV doses can lead to polio eradication 1. OPV
2. Measles 6. Minimal intervals between doses to catch up as

3. MMR quickly as possible if it is interrupted
MOST SENSITIVE TO COLD/FREEZING 7. Immunity provided by vaccines is ARTIFICIAL
1. DPT ACTIVE:
2. DT a. More than 1 vaccine is to be administered, inject
3. TT it at different sites of body
4. HepB b. Mild asthma, stable cerebral palsy or down
5. Pentavalent Vaccine syndrome is NOT a contraindication
6. PCV vaccine c. Use single syringe (1 syringe per vaccine) when
NEW MANDATED VACCINES giving more than 1 vaccine
1. ROTAVIRUS d. NEVER reconstitute freeze dried vaccine
- Prevents diarrhea anything other than the diluent supplied with
2. PNEUMOCOCCAL CONJUGATE VACCINES ( PCV13) them
- Prevents pneumonia e. Effective and still safe if more than 1 vaccine is
3. INACTIVATED POLIO VACCINE (IPV) given on the same day
- Given to infant at 3 ½ months (14 weeks) f. DO NOT ADMINSTER live vaccines to persons
 TAKE NOTE: who are significantly immune compromised
a. Give PCV to infants as a series of 3 doses, 1 dose at COLD CHAIN
each of these ages:  SYSTEM of storing and transporting vaccines at
 1 ½ months (6 weeks) recommended temperatures from the point of
 2 ½ months (10 weeks) manufacture to the point of use
 3 ½ months (14 weeks)  Primary PURPOSE: MAINTAIN POTENCY of vaccine
b. Children who miss their shots or start the series VACCINE STORAGE
later should still get the vaccine 1. Store VARICELLA at freezing temperatures
PENTALENT VACCINE 2. Temperature should be checked TWICE A DAY
 Vaccine (5 in 1) that contains Five antigens: 3. One in the morning and one in the late afternoon
1. Diphtheria 4. Refrigerator: Stand-alone refrigerator and freezer
2. Pertussis 5. Avoid direct contact of vaccine to ice
3. Tetanus 6. Goodies, foods and drinks should NEVER be stored
4. HepB 7. Ensure to keep refrigerator away from sunlight and
5. Haemophilus influenzae type B at least (10cm) distance from the wall
“BACK TO BAKUNA” Program COLD CHAIN MANAGEMENT:
 School based immunization program provides free 1. NEVER store any vaccine in a dormitory style or bar
measles and rubella vaccines including booster style combined unit
doses of tetanus-diphtheria vaccines to public 2. NEVER place vaccines and diluents in the DOOR
school children from kindergarten to Grade 7 (ages shelves (Temperature is not stable)
5-13 y/o) 3. AVOID frequent opening and closing of doors
 For Grade 4 females: HPV immunization, a 4. Place vaccines and diluents in the center of the unit
protection against cervical cancer 2 or 3 inches away from walls, ceiling, floor. And
GENERAL PRINCIPLES IN VACCINATING CHILDREN door
1. Give doses less than 4 weeks interval may lessen 5. AVOID freezing of diluents as the vial may burst
the antibody response when frozen
2. Lengthening the interval between doses of vaccine 6. DO NOT STORE vaccines in deli, fruit or vegetable
leads to a higher antibody levels drawers or in the door
3. Avoid using the same arm or leg for more than 1 7. Place vaccines and diluents with the earliest
injection expiration dates in front of those with later
4. Do not give more than 1 dose of the SAME expiration dates
VACCINE to a child in one session 8. Do not return reconstituted vaccines (BCG,
5. If the vaccination schedule is interrupted, it is NOT Measles) or opened PCV 10 vials to the refrigerator.
NECESSARY to RESTART. They should be discarded at the end of the
immunization session or after 6 hours, whichever a. TOP

comes first, 1. OPV
9. The refrigerator should not be packed too full (to 2. Measles
allow air to circulate) b. MIDDLE
10. Vaccines should be stored carefully between +2 1. DPT
degrees C and +8 degrees C at all times 2. TT
11. Freeze-sensitive vaccines (Pentavalent, PCV10, TT & 3. Diluent
HepB) should be kept away from the freezing c. LOWER
compartment, refrigeration plates, side linings or 1. Water bottles
bottom lining of refrigerators and frozen ice packs STORAGE TIME FRAMES
WATER BOTTLES 1. 6 MONTHS – Regional Level
1. Place water bottles on the top shelf, floor and in the 2. 3 MONTHS – Provincial Level/District Level
door racks 3. 1 MONTH – Main Health Centers with refrigerator
2. Putting water bottles in the unit can help maintain 4. NOT MORE THAN 5 DAYS – Health centers using
stable temperatures cause by frequently opening transport boxes
and closing unit doors or a power failure ESSENTIAL ELEMENTS
3. Label all water bottles DO NOT DRINK 1. Personnel to manage vaccine distribution
REFRIGERATOR 2. Equipment for vaccine storage & transport
1. NO foods, drinks or other drugs are to be kept in a 3. Maintenance of equipment
refrigerator 4. Monitoring
2. Check and record temperature 2x a day in 5. COLD CHAIN MANAGER: PHN
temperature log for 2-7 days VACCINES
3. DEFROST the refrigerator when ice becomes more 1. BCG (Bacillus Chalmette Guerin)
than 0,5 cm thick, or once a month, whichever  CONTENT: Live Attenuated Bacteria
comes first  TYPE: Freeze Dried
4. Record temperature, date, time and initials of the  DOSAGE:
person in monitoring log sheet a. Infant/birth: 0.05 mL
2 COMPARTMENTS b. Preschool: 0.1 mL
1. REFRIGERATOR (Main Compartment)  NUMBER OF DOSES: 1dose
 Kept between +2 degrees C and +8 degrees °C  ROUTE: ID using 26G needle syringe
 Used for storing vaccines and diluents 2. Hepatitis B
 E.g.  CONTENT: Plasma Derivative (HbsAg)/ RNA
a. BCG Recombinant
b. DPT  TYPE: Liquid
c. HepB  DOSAGE:
d. TT a. Infant/birth: 0.5 mL
2. FREEZER  NUMBER OF DOSES:3 doses
 Kept between -15 degrees C to -25  ROUTE: IM
degrees C 3. DPT (Diphtheria-Pertussis-Tetanus)
 Average of 20 degrees C  CONTENT: DT weakened toxin/ P-killed bacteria
 Used for freezing ice packs  TYPE: Liquid
 For heat sensitive vaccines (OPV &  DOSAGE: 0.5 mL
Measles)  NUMBER OF DOSES: 3 doses
 OPV is the MOST sensitive to heat and  ROUTE: IM
fragile vaccine 4. OPV (Oral Polio Virus)
STORING  CONTENT: Live Attenuated Virus (weakened)
1. FREEZING COMPARTMENTS  TYPE: Liquid
a. Ice cubes  DOSAGE: 2 drops (0.1 mL)
b. Ice packs  NUMBER OF DOSES: 3 doses
2. MAIN COMPARTMENT  ROUTE: PO
5. Rotavirus Vaccine c. HepB 3 – 14 weeks

 CONTENT: Live Attenuated Virus (weakened)  When transmission at birth is less likely, the
 TYPE: Liquid recommended schedule is:
 DOSAGE: 5 drops (0.5 mL) a. HepB 1 – 6 weeks
 NUMBER OF DOSES: 5 doses b. HepB 2 – 10 weeks
 ROUTE: PO c. HepB 3 – 14 weeks
6. MEASLES  COMMON SIDE EFFECTS:
 CONTENT: Live Attenuated Virus (weakened) a. MILD FEVER (1-2 days)
 TYPE: Freeze dried  Teach mother to perform TSB
 DOSAGE: 0.5 Ml  Advise to give Paracetamol every 4 hours if
 NUMBER OF DOSES: 1 dose temperature is above 38.5 degrees C
 ROUTE: SQ  REFER if fever last for 4 days
BCG b. SORENESS, REDNESS OR SWELLING IN THE
 At birth or Any time after birth INJECTION SITE
 NORMAL SIDE EFFECTS  Teach mother to perform COLD compress
a. KOCH’S PHENOMENON FIRST before HOT compress
 Acute inflammatory process starting 24 hours DPT
after injection and may last 2-4 days  The recommended schedule is: 4 weeks interval
 Wheal formation (small raised lump of 10 between doses
mm of diameter) a. DPT 1 – 6 weeks
 Disappears within 30 minutes b. DPT 2 – 10 weeks
b. ULCER/RED SORE FORMATION c. DPT 3 – 14 weeks
 May appear 2 weeks after injection and may  MILD REACTIONS:
persist for another 2 weeks to heal a. FEVER
 Keep dry and clean (Do not put any ointment  Child may have fever in the evening AFTER
on the sore or give the child any medicine) receiving DPT vaccine
c. SCAR FORMATION  Fever should disappear within a day
 About 5 mm  NOTE: FEVER that begins more than 25 hours
 Scar at 12 weeks after injection (2-5 months) after a DPT injection is UNLIKELY to be a
 Sign that the child has been effectively reaction to the vaccine
immunized b. SORENESS
 ABNORMAL ADVERSE EFFECTS c. PAIN
a. INDOLENT ULCERATION d. REDNESS OR SWELLING AT INJECTION SITE
 WATCH OUT FOR: Signs of Infection  WATCH OUT FOR: ABSCESS FORMATION
 Abscess formation and swelling of glands in  An abscess may develop a week or more after a
armpits (lymphadenopathy) DPT infection due to:
 Abscess may be due to: 1. Unsterile needle or syringe was used
1. UNSTERILE needle/syringe was used (#1 2. Wrong technique
cause) 3. Vaccine was note injected into the muscle
2. Too much vaccine was injected  DPT vaccine should NOT be given:
3. Wrong technique of administration a. Children over 5 years of age
 MANAGEMENT: b. Children who have suffered a severe
1. Do not incise and Drain reaction to a previous dose of DPT vaccine
2. Use warm water compresses over the injection  Instead, a COMBINATION OF DIPHTHERIA AND
site or suppurating lymph node/s 4-5 times a TETANUS TOXOIDS (DT) should be given
day OPV
HEPATITIS B  The recommended schedule is: 4 weeks interval
 Transmission at birth is possible give: between doses
a. HepB 1 – At Birth a. OPV 1 – 6 weeks
b. HepB 2 – 6 weeks b. OPV 2 – 10 weeks
c. OPV 3 – 14 weeks  5th dose, at least 4 weeks after he or she has

 NO SIDE EFFECT received the last dose in the schedule
ROTAVAC 16. Diphtheria and Tetanus toxoid parts re damaged by
 The recommended schedule is: freezing
a. ROTAVAC 1 – 6 weeks 17. For outreach session using vaccine carriers or old
b. ROTAVAC 2 – 10 weeks to a maximum of 32 box:
weeks a. Do not let DPT, TT or HepB vaccine vials touch
 Rare and mild side effects the cold dogs/ice packs.
 Fussiness, mild diarrhea, and vomiting b. Put or wrap newspaper or cardboard around
DPT, TT, or HepB to protect them from
MEASLES freezing.
 Regular schedule: 9 months 18. PERTUSSIS vaccine is damaged by heat
 NOTE: if the child aged 6-9 months when 19. Pertussis causes the fever after DPT shot
hospitalized should receive measles vaccine apart 20. If a child spits out, regurgitates the vaccine drops, or
from the scheduled vaccine at 9 months vomits immediately after a dose of OPV, it is safe to
 In case of outbreak: may be given at 6 months repeat the doe (DO NOT BF immediately)
(EARLIEST dose) VACCINATION CARD
 LATE dose: 15 months a. Date of administration
 Catch up dose: 4-5 y/o b. Vaccine manufacturer
IMPORTANT NOTES c. Vaccine lot number
1. It is safe to vaccinate a sick child who is suffering d. Name and title of the person who administered the
from a minor illness vaccine
2. When handling vaccines, the FIRST step is to CHECK LEVELS OF PREVENTION
the vial for EXPIRATION DATE Contrasting with “medical care,” which focuses on
3. Use standard refrigerator with separate freezer disease management and “cure,” public health efforts
door and seal for vaccines focus on health promotion and disease prevention.
4. Vaccines can be mixed in a single syringe when: Health promotion activities are directed at improving
a. Vaccines are licenses and labeled to be mixed wellbeing, whereas disease prevention activities
5. BCG vaccine protects against TB in infants protect people from disease and the effects of disease.
6. BCG vaccine amber glass ampules is to protect from They are used to:
ultraviolet and fluorescent light to MAINTAIN PREVENT DETECT MANAGE
POTENCY Detect diseases and
Prevent Manage
7. BCG also should be discarded AFTER 6 HOURS of protect the
disease or existing
reconstitution because of risk of contamination d/t community & the
outbreaks illnesses
lack of preservative and loss of potency patients
8. BCG vaccine is NOT damaged by freezing Leavell and Clark (1958) as cited by Nies and McEwen
9. Store BCG Vaccine and its diluent side-by-side in a (2019) identified three levels of prevention commonly
refrigerator or vaccine carrier described in nursing practice:
10. BCG is administered via ID route at (R) deltoid  Primary Prevention or First line of Defense
11. NEVER immunize in buttocks, IM vaccines like HepB,  Secondary Prevention or Second Line of
DPT, IPV, Pentavalent and PCV should be Defense
administered muscle of the upper outer of the thigh  Tertiary Prevention or Third Line of Defense
12. Measles is given ONCE, SQ injection in the OUTER PRIMARY PREVENTION
UPPER (R) arm - relates to activities directed at preventing a
13. The Measles, Mumps, Rubella, Vaccine (MMR) can problem before it occurs by altering susceptibility
be stored either in the freezer or the refrigerator or reducing exposure for susceptible individuals.
14. Protect reconstituted measles vaccine from This consists of two (2) elements:
sunlight. WRAP IT WITH FOIL 1. General Health Promotion
15. If a child has diarrhea, give OPV as usual but 2. Specific Protection
administer an extra dose
GENERAL HEALTH EFFORTS Examples are:

- enhance resiliency and protective factors and  mammograms
target essentially well populations  routine bloodworks
Examples of Primary Prevention under this element:  annual/general check ups
 Promotion of good nutrition This helps to:
 Provision of adequate shelter, and  detect cancer & serious disease
 Encouraging regular exercise  identify diseases or outbreaks in the community
SPECIFIC PROTECTION EFFORTS TERTIARY PREVENTION
- reduce or eliminate risk factors (risk reduction) - targets populations that have experienced disease
and include such measures as immunization, seat or injury and focuses on limitation of disability and
belt use, and water purification. rehabilitation.
In terms of disaster management, activities such as Aims to:
earthquake and fire drills are forms of primary 1. to keep health problems from getting worse
prevention. 2. to reduce the effects of disease and injury, and
SUMMARY NOTES: 3. to restore individuals to their optimal level of
Primary think “P” functioning.
Prevent Problems Prior to their development. Examples are:
 This is important as it limits the potential outbreaks  include teaching how to perform insulin
and diseases injections and disease management to a patient
 Stops potential injuries or accidents before they with diabetes
happen  referral of a patient with spinal cord injury for
 Keep the community safe and healthy occupational and physical therapy, and
Examples are: Vaccines & Use of Seat Belts  leading a support group for cancer patients who
SECONDARY PREVENTION have undergone cancer treatment, such as
- refers to early detection and prompt intervention surgery, chemotherapy, and/or radiation
during the period of early disease pathogenesis. therapy.
- is implemented after a problem has begun but  Palliative treatment for those with chronic
before signs and symptoms appear, and targets the illness
populations that have risk factors. SUMMARY NOTES:
Examples of Secondary Prevention: Tertiary think “T”
 Mammography Treatment of an Existing Disease
 Blood Pressure Screening Another example would be:
 Newborn Screening, and  A patient is diagnosed with hypertension. He may
 Papanicolaou Tests take antihypertensive drugs and follow a low-
- Secondary prevention is also directed toward sodium diet.
prompt intervention to prevent worsening
Much of public health nursing practice is directed
conditions of the affected population.
toward preventing the progression of disease at the
- This includes measures during the early stage of the
earliest period or phase feasible using the appropriate
disease to prevent complications.
levels of prevention.
Examples of this are:
 Teaching a mother how to give Oresol (a salt and For example, when applying “levels of
sugar solution) to her child suffering from prevention”concerning malnutrition among young
diarrhea to prevent dehydration children in a community, a nurse might perform the
 Administering vit. A capsule to children with following interventions:
measles. 1. Educate pregnant women on the benefits of
 Provision of first-aid and emergency care also exclusive breastfeeding on the first six months of
falls under this level. life (primary prevention).
SUMMARY NOTES: 2. Conduct periodic Operation Timbang (secondary
Secondary think “SEC” prevention).
Screen Early to Catch
3. Provide nutrition education to mothers of children d. Infectious agents

with chronic and severe malnutrition (tertiary  Metazoan
prevention).  Protozoa
COMMUNICABLE DISEASES  Bacteria
EPIDEMIOLOGICAL TRIANGLE  Fungi
 Rickettsia
 Viruses
Host
2. Host factors (intrinsic factors) – influences
exposure, susceptibility or response to agents
a. Genetic
b. Age
Environment c. Sex
Agent
d. Ethnic group
e. Physiologic
The Epidemiologic Triangle consists of three component f. Immunologic experience
– host, environment and agent. The model implies that  Active
each must be analyzed and understood for  Passive
comprehensions and prediction of patterns of a disease. g. Inter-current or pre-existing disease
A change in any of the component will alter an existing h. Human behavior
equilibrium to increase or decrease the frequency of 3. Environmental factor (extrinsic factors) –
the disease. influences existence of the agent, exposure, or
1. The host is any organism that harbors and provides susceptibility to agent.
nourishment for another organism. a. Physical environment
2. Agent is the intrinsic property of microorganism to b. Biologic environment
survive and multiply in the environment to produce  Human population
disease.  flora
3. Environment is the sum total of all external c. Socio-economic environment
condition and influences that affects the  Occupation
development of an organism which can be  Urbanization
biological, social and physical. The environment  Disruption
affects both the agents and the host.
Three components of the environment: CHAIN OF INFCTION
a. Physical Environment is composed of the
inanimate surroundings such as the
geophysical conditions of the climate.
b. Biological environment makes up the living
things around us such as plants and animal life.
c. Socio-economic environment which may be in
the form of level of economic development of
the community, presence of social disruptions
and the like.
Classifications of Agents, Host and Environment
1. Agents of disease
a. Nutritive elements
 Excess Agent - These are the pathogens that cause
 Deficiencies communicable disease. Most commonly these are
b. Chemical agents bacteria, virus, fungi or parasites.
 Poisons Reservoir - the reservoir (source) is a host which allows
 Allergens the pathogen to live, and possibly grow, and multiply.
c. Physical agents Human animals and the environment can all be
reservoirs from microorganism.
Portal of exit - this refers the route by which the TYPES OF IMMUNITY
infectious microorganisms escape or leave the
reservoir.
Mode of transmission - since microorganisms cannot
travel on their own, they require a vehicle to carry them
to other persons a place.
Portal of entry - the path for the microorganism to get
into a new host (the reverse of the portal of exit). The
mode of entry refers to the method by which the
pathogens enter the person.
Susceptible host - the future host is the person who is
next exposed to the pathogen. The microorganisms may Immunity is the ability of the body to protect against all
spread to another person but does not develop into an types of foreign bodies like bacteria, virus, toxic
infection if the person’s immune system can fight it off. substances etc. which enter the body.
STAGES OF DISEASE INNATE IMMUNITY
it is called natural or native immunity, consist of
mechanisms that exist before infection and are capable
of rapid responses to microbes. It is comprises four
types of defense barriers:
a. Physical barriers
b. Chemical barriers
c. Cellular defenses
TYPES OF INNATE IMMUNITY
a. Species immunity – is the total immunity shown by
all members of a species against pathogen; e.g.
Infections progress through a common pattern. The birds immune to tetanus.
severity and duration of the steps in the pattern may b. Racial immunity – is that in which various races
vary among pathogens and hosts to some degree, but show marked difference in their resistance to
the overall pattern is similar. Differences in severity and certain infectious disease.
duration of the stages in disease progression are often c. Individual immunity – is very specific for each and
of diagnostic value. every individual despite having same racial
Icubation period is the initial stage of the disease background and opportunity for exposure.
process before symptoms become apparent and the ADAPTIVE/ACQUIRED IMMUNITY
pathogen is actively replicating. There are no signs or is the immunity that is developed by the host in its body
symptoms during the incubation period. after exposure to suitable antigen or after transfer of
Prodromal phase is the stage of the disease process antibodies or lymphocyte from an immune donor.
when symptoms first become apparent. These CHARACTERISTICS OF ACQUIRED IMMUNITY
symptoms are typically unspecific to the pathogen and a. Antigenic specificity
vague; they may include fever, fatigue, and headaches. b. Diversity
Illness period the infected person shows noticeable c. Immunologic memory
symptoms of infectious disease. The symptoms may be d. Self/non-self-recognition
localized or systemic. TYPES OF ACQUIRED IMMUNITY
Decline phase is the stage of disease when symptoms 1. Active Immunity – it is induced by natural exposure
begin to abate and the pathogen population begins to to a pathogen or by vaccination. It can be
decline. Damaged tissues begin to repair, and pathogen categorized into two types:
numbers decrease. a. Naturally Acquired Active Immunity
Convalescence period is the stage of the disease b. Artificially Acquired Active Immunity
process when symptoms disappear. It is considered a 2. Passive Immunity – is achieve by transfer of
recovery period, when host strength is regained. Host immune products, such as antibody or sensitized T-
tissues are repaired to their pre infection health.
cell, from an immune individual to non-immune When you are close to patients or close to handling
one. It has two types: blood, bodily fluid, bodily tissues, mucous membranes,
a. Naturally Acquired Passive Immunity or areas of open skin, you must use personal protective
b. Artificially Acquired Passive Immunity equipment (PPE). Depending on the anticipated
MECHANISM OF ACTIVE IMMUNITY exposure, types of PPE that may be required include:
Primary immune response – takes place when the host  Gloves
is attacked by certain microbes for first time. The  Masks and goggles
antibodies start to generate after certain period as the  Aprons, gowns, and shoe covers
binding of an antigen with its particular antibody is very TRANSMISSION-BASED PRECAUTIONS
specific. Transmission-based precautions are extra steps to
Secondary immune response – occurs when an follow for illnesses that are caused by certain germs.
individual is being attacked by the same antigen Transmission-based precautions are followed in
subsequently. It is a rapid process. addition to standard precautions. Some infections
PATTERN OF DISEASE OCCURANCE require more than one type of transmission-based
The variables of disease as to person, time and place are precaution.
reflected in distinct patterns of occurrence and  Airborne precautions - may be needed for germs
distribution in a given community. that are so small they can float in the air and travel
1. Sporadic occurrence is the intermittent occurrence long distances. Germs that warrant airborne
of a few isolated and unrelated cases in a given precautions include chickenpox, measles, and
locality. The cases are few and scattered, so that tuberculosis (TB) bacteria infecting the lungs or
there is no apparent relationship between them larynx (voicebox).
and they occur on and off, intermittently, through a  Contact precautions - help keep staff and visitors
period of time. from spreading the germs after touching a person
2. Endemic occurrence is the continuous occurrence or an object the person has touched. Some of the
throughout a period of time, of the usual number of germs that contact precautions protect from are C
cases in a given locality. The disease is therefore difficile, norovirus, and COVID-19. These germs can
always occurring in the locality and the level of cause serious infection in the intestines or lungs.
occurrence is more or less constant through a  Droplet precautions - are used to prevent contact
period of time. The level of occurrence maybe low with mucus and other secretions from the nose and
or high, when the given level is continuously sinuses, throat, airways, and lungs. When a person
maintained, then the pattern maybe low endemic talks, sneezes, or coughs, droplets that contain
or high endemic as the case maybe. germs can travel about 3 feet (90 centimeters).
3. Epidemic occurrence is of unusually large number of Illnesses that require droplet precautions include
cases in a relatively short period of time. There is a influenza (flu), pertussis (whooping cough), mumps,
disproportionate relationship between the number and respiratory illnesses, such as those caused by
of cases and the period of occurrence, the more coronavirus infections including COVID-19.
acute is the disproportion, the more urgent and CHICKENPOX
serious is the problem. Other names: Varicella
4. Pandemic is the simultaneous occurrence of
pandemic of the same disease in several countries.
It is another pattern of occurrence from an
international perspective.
TYPES OF ISOLATION
Isolation precautions create barriers between people
and germs. These types of precautions help prevent the
spread of germs in the hospital.
ETIOLOGY
 Human (alpha) herpes virus 3 (varicella-zoster
STANDARD PRECAUTIONS virus), a member of the Herpesvirus group.
SOURCE OF INFECTION
 Secretions of respiratory tract of infected persons  Exclusion from school for 1 week after eruption first
 Lesions (little consequence) appears
 Scabs are not infective  Tell the patient not to scratch the lesions
MODE OF TRANSMISSION  Teach the child and the family how to apply
 Direct contact or droplet spread antipruritic medication correctly
 Indirect through articles freshly soiled by discharges PREVENTIVE MEASURES
of infected person  Vaccine
INCUBATION PERIOD  Varicella - zoster Immune Globulin (VZIG)
 2-3 weeks, commonly 13 to 17 days  given within 10 days of exposure
PERIOD OF COMMUNICABILITY  Cases over 15 years of age should be investigated to
 Cases are infectious for up to 2 days before the eliminate possibility of smallpox
onset of the rash until 5 days after first crop of  Report to local authority
vesicles  Avoid contact with susceptibles
CLINICAL MANIFESTATION MEASLES

Other terms: Rubeola / Morbili / 7 - day Measles
 Vesiculo-pustular rashes
 Centrifugal appearance of rashes
 Pruritus
DIAGNOSTIC PROCEDURE
1. Isolation of the virus from the vesicular fluid within
the first 3 to 4 days of the rash
2. Serum antibodies are present in 7 days after onset
If diagnosis is in doubt, laboratory confirmation can be
done:
 Polymerase Chain Reaction (PCR) Test - to ETIOLOGY
detect VZV in skin lesions (vesicles, scabs, Filterable virus of measles (Paramyxoviridae)
maculopapular lesions) SOURCE OF INFECTION
 Tzanck Smear Test
Secretion of nose and throat of infected persons
 Direct Fluorescent Antibody (DFA) Test
MODE OF TRANSMISSION
 Viral Culture Test
Droplet spread or direct contact with infected persons
TREATMENT MODALITIES
Indirectly through articles freshly soiled with secretions
 Treatment is supportive and symptomatic; infection
of nose and throat
is viral in origin and therefore is self-limiting
In some instances, airborne
 Drug-of-choice: Acyclovir (orally to reduce the
INCUBATION PERIOD
number of lesions; topically to lessen the pruritus)
10 days – fever
COMPLICATIONS
14 days – rashes appear
 Group A Streptococcal Infection
PERIOD OF COMMUNICABILITY
 Pneumonia
4 days before and 5 days after the appearance of rash
 Encephalitis
CLINICAL MANIFESTATION
 Cerebellar Ataxia
 Hemorrhagic Complications Koplik spots - pathognomonic sign
 Sepsis 1. Pre-eruptive Stage
 Dehydration  Fever
 Acute Cerebellar Ataxia  Catarrhal Symptoms ( 3C’s - cough,
 Reye’s Syndrome conjunctivitis, coryza)
NURSING MANAGEMENT  Photophobia
 Strict Isolation until Vesicles Crust  Stimson’s line (red line on the lower
 Concurrent disinfection of throat and nose conjunctiva)
discharges 2. Eruptive Stage
 Maculo-papular rash
 High-grade fever  Galloping Consumption Disease

 Anorexia and irritability  Phthisis
 Throat is red and extremely sore ETIOLOGY
3. Convalescence Stage  Mycobacterium tuberculosis
 Rashes fade away  M. africanum from humans, but occasionally by M.
 Fever subsides bovis from cattle, or M. canettii
 Desquamation begins SOURCE OF INFECTION
 Symptoms subside and appetite is restored  Sputum
DIAGNOSTIC PROCEDURE  Blood from Hemoptysis
 Tissue culture of nasopharyngeal secretions  Nasal discharge
 Urinalysis  Saliva
 Blood exams (Single raised IgM or rise on IgG) MODE OF TRANSMISSION
 Serological testing  Airborne-droplet
 Direct/indirect contact with infected persons
TREATMENT MODALITIES INCUBATION PERIOD
 Anti-viral drug (Isoprenosine)  4 – 6 weeks
 Antibiotic ( if with complications like pneumonia) PERIOD OF COMMUNICABILITY
 Oxygen Inhalation  As long as the tubercle bacilli are being discharged
 IV Fluids in the sputum
COMPLICATIONS CLINICAL MANIFESTATION
 Bronchopneumonia 1. Low-grade afternoon fever
 Otitis Media 2. Night sweats
 Pneumonia 3. Loss of appetite
 Nephritis 4. Significant weight loss
 Encephalitis 5. Easy fatigability – due to increased oxygen demand
NURSING MANAGEMENT 6. Productive dry cough
 Protect eyes of patient from glare of strong light (be 7. Hemoptysis
inflamed) 8. Sputum positive for AFB
 Keep in adequately ventilated room but free from DIAGNOSTIC PROCEDURE
drafts, and chilling ( prevent pneumonia) 1. Sputum Analysis for AFB
 Teach, guide and supervise correct technique of  Confirmatory
giving sponge baths for comfort of patient  Early morning sputum about -5 cc
 Check for corrections of medication and treatment  Maintain NPO before collecting sputum
prescribed by the physician  Give oram care after the procedure
PREVENTIVE MEASURES  Label and immediately send to laboratory
 Immunization with:  If unknown when was the sputum collected,
o Anti-measles at the age of 9 months as a single discard

dose 2. Chest X-ray is used to:
 Determine the clinical activity of TB, whether it
o MMR vaccine (15 mons.); 2nd dose (11 to 12
is inactive (in control) or active (Ongoing)
years old)
 To determine the size of the lesion:
 Measle Vaccine should not be given to pregnant
 Minimal - very small
women, or persons with active tuberculosis,
 Moderately - lesion is <4 cm
leukemia, lymphoma or depressed immune system
 Far advance - lesion is >4 cm
 Disinfection of soiled articles
3. Tuberculin Testing (for TB exposure)
 Isolation of cases from diagnosis until about 5-7
 Mantoux Test (PPD) - used for single
days after onset of rash
screening, result interpreted after 72 hours
TUBERCULOSIS
 Tine Test - used for mass screening read after
Other names:
48 hours
 Koch’s Disease
 Heaf Test Administer medicines as ordered

TREATMENT MODALITIES  Educate patient all about PTB
 Short-course chemotherapy  Stop smoking
 Six-month treatment ( Rifampicin, Isoniazid,  Cough or sneeze into tissue paper and dispose
Pyrazinamide, Ethambutol and Streptomycin) of secretion properly
1. Rifampicin  Provide the patient with a well-balanced, high-
 Empty stomach calorie diet, preferably in small, frequent meals
 Body fluid discoloration (red-orange) to conserve energy
 Hepatotoxic (metabolism)  Allow rest periods
 Nephrotoxic (elimination)  Caution the patient who is taking an oral
 Permanent discoloration of contact lenses contraceptive that the contraceptive may be
2. Isoniazid less effective while she's taking rifampin.
 Empty stomach Preventive Measures
 Peripheral Neuropathy  Submit all babies for BCG (Bacille Calmette-
 Avoid Alcohol Guerin) immunization
 Hepatotoxic  Avoid overcrowding
 Nephrotoxic  Improve nutritional and health status
 Increase intake of Vit B6  Persons who have been exposed (Receive
3. Pyrazinamide Tuberculin Test)
 Before meals LEPROSY
 Monitor s/sx of liver impairment Other names: Hansen’s Disease
 Anorexia
 Fatigue
 Dark urine
 Photosensitivity
 Liver Function Studies
 Causes hyperuricemia
4. Ethambutol  Is a chronic systemic infectious lesion
 Not affected by food characterized by progressive cutaneous lesions.
 Report visual disturbances  Incubation Period: five-and-a-half months to 8
 Hepatotoxic years.
 Not recommended for children (below 6  Most individuals do not become infected after
years old); can cause optic neuritis exposure. Causes chronic granulomatous disease.
 Inability to recognize green from blue ETIOLOGY
5. Streptomycin ● Mycobacterium leprae
 After meals ● Mycobacterium Lepromatosis
 Report Oliguria - nephrotoxic MODE OF TRANSMISSION
 Timmitus ● Respiratory Droplets
 Damage to 8th CN ● Inoculation through the skin break and mucous
 Direct Observation Treatment Short (DOTS) Course membranes
 Strategy to prevent non-compliance LEPROSY OCCURS IN 3 DISTINCT FORMS
Complications 1. Lepromatous leprosy (Multibacillary)
 Spinal pain  The most serious type and
 Tuberculous arthritis considered to be the most
 Liver or kidney problems infectious.
 Joint damage  6 or more symmetrical
 Heart disorders (rarely occur) lesions,
Nursing Management  Leonine facies (facial nodules, loss of
 Maintain respiratory isolation eyebrows, thickened pinna)

There is a gradual thickening of the skin with  Growth most efficient and fastest at temperature of
the development of a granulomatous 27-33 degree celcius.
condition.  Affects the coolest parts of the body (skin,
 Lesions frequently appear in macules and eyes, nose, mucous membranes of the
become nodular in character (leproma). respiratory tract)
 There is a slow movement of the peripheral RISK FACTORS
nerves, with some degree of anesthesia, loss 1. Close Contact
of sensation, and gradual destruction of the 2. Age: Bimodal effect
nerves.  Between ages 5-15 and older than 30 years
 Atrophy of the skin and muscles and eventual old
melting or absorption of small bones, 3. Genetics
primarily those of the hands and feet.  NOD2 variants
 Natural amputation may occur. 4. Immunosuppression
 Ulceration in the mucous membranes of the  Chemotherapy, HIV positive
nose. DIAGNOSTIC PROCEDURES
 Causes damage to the respiratory tract, eyes, 1. Identification of the signs and symptoms.
and testes, as well as nerves and the skin. 2. Tissue Biopsy
 Lepromin test is negative, but the skin a. AFB (Acid-fast bacilli staining)
lesions contain large amounts of Hansen’s b. PCR
bacillus. 3. Tissue smear
2. Tuberculoid leprosy (Paucibacillary) 4. Blood tests show increase RBC and ESR
 Affects the peripheral nerves (erythrocytes sedimentation rate); decreased serum
and sometimes the calcium, albumin and colesterol levels.
surrounding skin. (face, eyes OTHER MANIFESTATIONS AND COMPLICATIONS
and testes, nerves in the 1. Neuropathy (Amputation, sensory loss)
skin) 2. Opthalmic injury (weakening of the eye
 Lepromin test is positive, but the organism is musculature, drying of the eye, corneal abrasion)
rarely isolated from the lesions. 3. Immunologic Reactions
 Macules are elevated, with clearing at the a. Fatigue, fever, arthritis, neuritis, iritis
center, and are more clearly defined than in b. Type 1
the lepromatous form. i. Occurs in borderline leprosy patients
 Anesthesia is present, and involvement of the c. Type 2
peripheral nerves occurs more rapidly than i. Erythema Nosodum Leprosum
the lepromatous form. ii. Occurs in lepromatous disease
 Well-defined dry lesions. iii. Sudden eruption of multiple painful nodules
3. Borderline (dimorphous) leprosy PATHOPHYSIOLOGY
 Has the characteristics of both lepromatous

and tuberculoid leprosy.
 Skin lesions are diffused and poorly defined.
PATHOGENESIS
 Invades through epithelium and into peripheral
nerves.
 Obligate intracellular parasite that lives within MEDICAL MANAGEMENT
macrophages. 1. Sulfone Therapy
 Slow growing organisms 2. Rehabilitation, recreational and occupational
 Multiplies approximately 12.5 days. therapy.
3. Multiple drug therapy. 2. Social Isolation

3. Ineffective coping
DRUG DESCRIPTION 4. Knowledge deficit
Rifampicin + Treatment for multibacillary leprosy 5. Anxiety
6. Impaired body image.
Clofazimine +  Rifampicin 600mg, OM
Dapsone PREVENTION
 Dapsone 100mg, OD
 Clofazimine 50mg, OD  Report all cases and suspects of leprosy.
For 12 months  Newborn infants should be separated from leprous
 After taking 12 monthly doses of mothers.
MDT, this person is considered  BCG vaccine may be protective if given during the
cured and should be removed first 6 months of life.
from the register.  Health education should be given, with the
emphasis on the mode of transmission.
Rifampin + Treatment for Single lesion SCABIES
Ofloxacin + paucibacillary.  Is an age-old skin
Minocycline infection caused by an
(ROM) itch mite, which
penetrates the skin,
Rifampicin + Treatment for paucibacillary type.
forming burrows.
Dapsone  Rifampicin 600mg, OM
(Burrows are tiny,
 Dapsone, OD
thread-like projections ranging from 2-6mm long
For 6 months
that appear as thin gray, brown or red likes in
 After 6 monthly doses, the person
affected areas).
is considered cured and should be
ETIOLOGIC AGENTS
discharged.
The disease is caused by a mite, Sarcoptes scabiei.
Dapsone Used to treat dermatitis herpetiformis 1. The mite is yellowish-white and can barely be
(a skin condition) and leprosy seen by the unaided eye.
2. The female parasite burrows beneath the
Clofazimine Causes brownish-black discoloration
epidermis to lay her eggs. This causes intense
and dryness of the skin. However, this
irritation.
disappears within a few months after
3. The males are smaller and reside in the surface
stopping the treatment.
of the skin.
This should be explained to the
4. Scabies occurs worldwide and is predisposed by
patient starting MDT (multidrug
overcrowding and poor hygiene.
therapy) regimen for MB leprosy.
5. The parasite does not survive more that 3-4
Rifampicin Most important anti-leprosy drug and days away from the skin.
is therefore included in the treatment INCUBATION PERIOD
in both types of leprosy.  The itch mite may burrow under the skin and lay
ova within 24hrs of the original contact.
NURSING MANAGEMENT
1. If the patient is admitted to the hospital, isolation  The disease is communicable for the entire period
and medical asepsis should be carried out. that the host is infected.
2. Moral support and encouragement are necessary. MODE OF TRANSMISSION
3. Diet should be full, wholesome, and nutritious. 1. Transmission is Direct – through an infected
4. Special attention should be given to personal individual.
hygiene. 2. The disease is also acquired through sleeping on an
5. Terminal disinfection should be carried out. infested bed or wearing infested clothing.
COMMON NURSING DIAGNOSIS 3. Anyone may become infected or re-infected.
1. Impaired skin integrity
4. Infestation with mites may also result from contact MEDICATION DESCRIPTION
with dogs, cats, and other small animals.
5. Mange – scabies on dog. When canine or feline Pediculicide permethrin cream or lindane
mites land on human skin, they fail to thrive and lotion, as a thin layer over the
produce only a mild itch that eventually disappears. entire skin surface, left on forn
6. Human scabies gets worse and worse unless the 10-12 hours.
condition is treated.
Crotamiton cream is applied for 5 consecutive
SIGNS AND SYMPTOMS
nights
1. Itching, characteristically
more pronounced at night, Neosporin is rubbed into the affected skin
when the patient has ointment 4 or 5 times a day.
retired, since the increase
warmth of the skin has a Antihistamine Can be useful in giving relief
stimulating effect on the (Diphenhydramine) from the itching.
parasite.
NURSING MANAGEMENT
2. For the first week, the itch is subtle. It gradually
1. Instruct the patient to apply the cream at bedtime,
becomes intense that after a month or two, sleep
from the neck down to the toes, covering the entire
becomes almost impossible.
body.
3. Secondary lesions like vesicles, papules, pustules,
2. Contaminated clothing or bedclothes should be dry-
excoriations, and crusts may be found on the
cleaned or boiled.
affected site.
3. Advise the patient to report any skin irritation.
4. Bacterial superinfection may result from constant
5. Suggest that family members and other close
excoriation of burrows and papules.
contacts of the patient be checked for possible
symptoms and treated if necessary.
6. If the patient is hospitalized, practice good
handwashing technique or use gloves while
performing nursing procedures.
7. Terminal disinfection should be carried out after the
discharge of the patient.
COMMON NURSING DIAGNOSIS
 Alteration in comfort; itchiness
 Impaired skin integrity
 Altered role performance.
 Knowledge deficit
 Social isolation
 Body image disturbance
PREVENTION
 Good personal hygiene
 Avoid contact with infected persons.
 All members in the household, including close
DIAGNOSTIC PROCEDURES contacts, should be treated.
 A drop of mineral oil placed over the burrow,  After treatment, beddings and clothing worn next to
followed by superficial scraping and examination of the skin should be properly laundered.
expressed material under a low-power microscope, GERMAN MEASLES
may reveal mites, ova or mite feces. Other names: Rubella / three-day measles
MEDICAL MANAGEMENT
 All clothes used before and during treatment period
should be disinfected by dry cleaning or boiling.
 An acute contagious disease characterized by mild days after onset.

days and leaves no
constitutional symptoms, and a rose-colored pigmentation no
macular eruption which sometimes resembles desquamation.
measles and at other times, scarlet fever. It causes  Testicular pain in young
mild, feverish illness associated with rashes and adults
aches in joints. It has teratogenic effects on the  Transient polyarthralgia
fetus. and polyarthritis may
 It can affect anyone of any age and is generally a occur in adults and
mild disease, rare in infants or those over the age of occasionally with
40 years old. The older person is, the more severe children.
the symptoms are likely to be. Up to one-third of MODALITIES OF TREATMENT
older girls or women experience joint pain or  Very littles treatment is necessary; treatment is
arthritic type of symptoms with rubella. essentially symptomatic.
ETIOLOGIC AGENTS COMPLICATIONS
 Rubella Virus (Family – Togaviridae; Genus - 1. Encephalitis
Rubivirues) 2. Neuritis
INCUBATION PERIOD 3. Arthritis
 From exposure to the appearance of rash, the 4. Arthralgias
incubation period is usually 14 to 21 days. 5. Congenital Rubella Syndrome
PERIOD OF COMMUNICABILITY a. Microcephaly
 One week before and four days after the onset of b. Mental Retardation
the rash, but is at its worst when the rash is at its c. Cataract
peak. d. Deaf mutism
 Highly communicable infants with congenital e. Heart disease.
rubella may shed virus for months after birth. RISK FOR CONGENITAL MALFORMATION
MODE OF TRANSMISSION 1. 100% - when maternal infection occurs on the first
1. Direct contact with nasopharyngeal secretions trimester of pregnancy or first month of gestation.
2. Air droplets 2. 4% - in the second and third trimesters if
3. Transplacental transmission in congenital rubella pregnancy.
4. Infants with congenital rubella shed large quantities 3. 90% - of congenital rubella cases excrete the virus
of the virus through their pharyngeal secretions and at birth and are therefore infectious.
urine, which serves as sources of infection to other 4. 10% - the virus remains contagious until the first
contacts. year of age of the infected child.
CLINICAL MANIFESTATIONS PATHOGENESIS
PRODROMAL
ERUPTIVE PERIOD
PERIOD
 Low-grade fever  Pinkish rash on the soft
 Headache palate. (Forcheimer’s
 Malaise spot), an exanthematous
 Mild coryza rash that appears first on
(common cold) the face, spreading to the
 Conjunctivitis neck, arms, trunk, and
 Post-auricular, legs.
sub-occipital,  Eruption appears after
and posterior the onset of adenopathy.
cervical  Children usually present
lymphadenopath less or no constitutional
y which occurs symptoms.
on the 3rd to 5th  Rash may last for 1-5
CLINICAL MANIFESTATIONS PREVENTION

(Congenital Rubella) • Administration of live attenuated vaccine(MMR)
• Pregnant women should avoid exposure to patients
CLASSIC infected with the rubella virus.
CONGENITAL • Administration of immune serum globulin one week
INTRAUTERINE INFECTION
RUBELLA after exposure to rubella.
SYNDROME • Prevent the spread of infection by minimizing
  May result to
Intrauterine contact with visitors.
growth spontaneous abortion. HERPES ZOSTER
 Multiple birth
retardation Other name: Shingles
 Low birth weight
abnormalities:
 - Cleft palate, hare lip,
Thrombocytopeni
c purpura talipes, and eruption of
(blueberry teeth.
muffin) - Eye defects (glaucoma,
 Lethargy andretinopathy,
hypothermia microphthalmia,
unequal-sized eyeballs)
- Ear defects (deafness ETIOLOGY
usually bilateral, • Varicella-zoster virus (VZV)
abnormally-shaped SOURCE OF INFECTION
ears) • Once a person has chickenpox (also caused by
- Neurologic varicella virus) the virus stays in the body. The virus
(microcephaly, mental can reactivate later in life and cause shingles.
retardation, MODE OF TRANSMISSION
psychomotor
• Transmission occurs through airborne and droplet
retardation, behavioral
transmission, contact with fluid in the blisters of the
disturbances, vasomotor
rash. Disseminated zoster is likely as infectious as
instability)
varicella.
NURSING MANAGEMENT
INCUBATION PERIOD
1. The patient should be isolated.
• 2–3 weeks and usually 14–16 days.
2. Advise the patient to rest in bet until fever subsides.
• prolonged in immunosuppressed people.
3. Darken the patient’s room to avoid photophobia.
4. The patient must take a mild liquid but nourishing
• one to two days before rash onset until all the
diet.
chickenpox lesions have crusted.
5. Eyes should be irrigated with warm normal saline to
CLINICAL MANIFESTATION
relieve irritations.
6. The ears should be taken care of. Do not apply heat • Fever
or cold compress unless ordered. • Headache
8. Good ventilation is necessary. • Malaise
9. Prevent the spread of infection. • Loss of appetite
10. Occurrence of complications must be prevented. • Self-limiting rash on the skin and sometimes
11. Encourage increase fluid intake. mucosa.
COMMON NURSING DIAGNOSIS • Rashes begin as macules, rapidly progressing to
papules, followed by a vesicular stage and crusting
• Impaired skin integrity
of lesions.
• Knowledge deficit
DIAGNOSTIC PROCEDURE
• Impaired physical mobility
• Impaired social interaction • PCR (Polymerase Chain Reaction) laboratory test for
• Pain cases of herpes zoster. PCR testing and genotyping
• High risk for infection distinguish wild-type and vaccine strains of VZV.
Swabs of unroofed vesicular lesions and scabs from MODE OF TRANSMISSION:

lesions are ideal. • Droplet from respiratory tract of an infected person
TREATMENT MODALITIES or carrier directly or indirectly
• Acyclovir, famciclovir, and valacyclovir are used to NURSING ASSESSMENT
reduce acute herpes zoster. These antiviral agents A child with diphtheria usually seeks medical help for
help in reducing pain, promote fast healing, and one of the following complaints (sometimes they are
prevent post-herpetic neuralgia. Treatment with called types)
antivirals should be started within 72 hours of rash 1. Sore throat
onset. • Fever
COMPLICATIONS • Difficulty to swallow
• Chronic pain (postherpetic neuralgia) • Swelling of the neck
• Cranial nerve palsies • Exudate or a yellow-gray membrane on tonsils
• Zoster paresis and may be the pharynx. (Membrane varies
• Meningoencephalitis from thin to thick one)
• Cerebellitis 2. Croup
• Myelopathy • Hoarse or croupy cough and stridor
• Multiple ocular disorders • Noisy respiration, the child may have severe
• Vasculopathy that can mimic giant cell arteritis. respiratory distress.
NURSING MANAGEMENT • The membrane may cover the vocal cord
• Manage acute pain and discomfort. (When examined with laryngoscope)
• Minimize complications and infections. 3. Nasal Discharge
• Promote healing and prevent scarring. • Purulent, bloody nasal discharge
• Educate patients on self-care measures. • The membrane can be seen on the nasal
• Support emotional well-being. septum
• Prevent transmission. 4. Infected skin ulcer
• Provide follow-up care and monitoring. • This skin ulcer can be confused with impetigo
PREVENTIVE MEASURES (skin disease). The membrane is not always
• Shingrix vaccine is recommended for the prevention present in diphtheria
of shingles and its complications. Two doses of 5. Other signs and symptoms:
Shingrix given two (2) to six (6) months apart are That could be present (especially in severe cases):
recommended for healthy adults 50 years of age • Purulent conjunctivitis
and older. • Otitis media
DIPHTHERIA • Ulcerative vulvo-vaginitis
• Toxins from organism produces fever and
malaise
NURSING CONSIDERATION
1. Isolate the child (place him in isolating room, use
medical aseptic techniques). Keep the child in
isolation until 2 consecutive nose and throat culture
are negative (24 hours apart between the two
cultures)
2. Bed rest for about 6 weeks for all types except in
ETIOLOGY nasal diphtheria
• Corynebacterium diphteria (Diphtheria bacillus) 3. For respiratory distress (if present): suction to
INCUBATIONAL PERIOD trachea and larynx to remove secretions and pieces
of membrane, oxygen humidifier.
• 2-5 days
4. For fever: check vital signs, use 2-3-4 hours
COMMUNICABILITY PERIOD
schedule; depending on the degree of fever, degree
• Several hours before onset of the disease until of respiratory embarrassment and change in pulse
organism disappear from the respiratory tract rate. Check blood pressure frequency.
5. For membrane: Oral hygiene (warm mouth wash,  Periorbital edema

never use tooth brush or swabs because of danger  Conjuctival hemorrhage
of distracting the membrane leading to bleeding  Diagnostic Procedure:
and rapid spread of toxins into blood system.  Nasopharyngeal swabs
6. Observe: vital signs, secretion and the need for  Sputum culture
suction, observe signs and symptoms of paralysis  CBC (leukocytosis)
7. Tracheostomy and/or intubation trays must be  Chest radiography
ready at bedside table of the child. If tracheostomy TREATMENT MODALITIES
or intubation is done, apply the proper care of • Supportive therapy: Fluid and electrolyte
tracheostomy or intubation replacement, adequate nutrition, oxygen therapy.
 In intubation, the child can expel the tube Antibiotics: Erythromycin and Ampicillin
when he coughs, so watch constantly as he COMPLICATIONS
can’t call for help. Frequent suctioning of the
 Most dangerous: Bronchopneumonia
tube use proper restraints so that he will not
 Convulsion
remove the tube.
 Umbilical hernia
8. If myocarditis appears as a complication, guard the
 Otitis media
child for exhaustion, beside the other nursing care
 Severe malnutrition and starvation
TREATMENT
NURSING MANAGEMENT
 Bedrest
 Isolation and Medical Asepsis
 Antibiotics
 Suction Equipment should be present at bedside
 Anti-toxins
 Provide warm baths
PREVENTION
 Keep the bed dry and free from soiled linens
1. Active immunization: DPT vaccine
 I & O should be closely monitored
2. Passive immunization: injection with anti-toxins
 General care of nose and throat discharges
COMPLICATIONS
 Instruct patuents to cover their mouths when they
 Bronchopneumonia
cough or sneeze and to wash their hands
 Kidney dysfunction
immediately afterwards
 Paralysis PREVENTIVE MEASURES
 Myocarditis
 Any case of pertussis should be reported
 Cardiac failure
 Patient should be isolated for 4 to 6 weeks
PERTUSSIS
 Routine DPT immunization of all infants which can
ETIOLOGY
be started at 1 and ½ months of life and given at
• Hemophilus Pertussis or Bordet Gengou Bacillus or monthly intervals in 3 consecutive months.
Bordetella pertussis
 Keep newborns away from anyone with cold or
SOURCE OF INFECTION
cough symptoms.
• Discharges from the laryngeal and bronchial  Previously immunized children should be given
mucous membrane of infected persons. reinforcing injection
MODE OF TRANSMISSION ANTHRAX
• Direct spread through respiratory and salivary (Malignant pustule, Malignant edema, Woolsorter's
contacts disease, Ragpicker Disease)
INCUBATION PERIOD ETIOLOGY
• 7-10 days but may ocassionally be up to 3 weeks • An acute bacterial disease usually affecting the skin
PERIOD OF COMMUNICABILITY but which may very rarely involve the oropharynx,
• 7 days after exposure to 3 weeks after onset of lower respiratory tract, mediastinum or intestinal
typical paroxysms. tract.
CLINICAL MANIFESTATIONS SOURCE OF INFECTION
 Violent coughing • Bacillus anthracis is a gram positive, encapsulated,
 Nose bleeding spore forming non-motile rod.
 Distended neck veins MODE OF TRANSMISSION
• Cutaneous infection is by contact with tissues of  Stool testing. To diagnose gastrointestinal anthrax,
animals (cattle, sheep, goats, horses, pigs, and your doctor may check a sample of your stool for
other) dying of the disease; possibly by biting flies anthrax bacteria.
that had partially fed on such animals;  Spinal tap (lumbar puncture). In this test, your
contaminated hair, wool, hides or products made doctor inserts a needle into your spinal canal and
from them such as drums or brushed: or contact withdraws a small amount of fluid. A spinal tap is
with the soil associated with the infected animals or recommended any time doctors suspect systemic
contaminated bone meal used in gardening. anthrax — anthrax other than cutaneous — due to
SIGNS AND SYMPTOMS the possibility of meningitis.
Three clinical forms are recognized: TREATMENT MODALITIES
1. Cutaneous form is the most common and is Doctors have several options for treating patients with
contracted by contact with infected animals usually anthrax, including antibiotics and antitoxin. Patients
(carcasses) or contaminated wool, hides and fur. with serious cases of anthrax need to be hospitalized.
The exposed part of the skin begins to itch and a They may require aggressive treatment, such as
papule appears in the inoculation site. This papule continuous fluid drainage and help breathing through
becomes a vesicle and then evolves into depressed mechanical ventilation.
black eschars. The lesion is not painful and often Antibiotics
untreated which will result in septicemia and death  All types of anthrax infection can be treated with
when not treated early. The case fatality rate is 5- antibiotics, including intravenous antibiotics
20%. (medicine given through the vein). If someone has
2. The pulmonary form is contracted by inhalation of symptoms of anthrax, it’s important to get medical
B. anthracis spores. At the onset of illness, the care as quickly as possible to have the best chances
symptoms are mild and resemble that of common of a full recovery. Doctors will select antibiotics that
upper respiratory tract infection. After 3-5 days, the are best for treating anthrax and that are best for
symptoms become acute, with fever, shock and the patient based on their medical history.
death results. The case fatality is high. Antitoxin
3. The gastrointestinal anthrax is contracted by  When anthrax spores get inside the body, they can
ingestion of meat from infected animals and is be “activated.” When they become active, anthrax
manifested as violent gastroenteritis with vomiting bacteria can multiply, spread out in the body, and
and bloody stools. Mortality ranges from 25-75% produce toxins—or poisons. Anthrax toxins in the
(Brachman, 1984). body cause severe illness.
INCUBATION PERIOD  After anthrax toxins have been released in the
A few hours to 7 days most cases occur within 48 hours body, one possible treatment is antitoxin. Antitoxins
of exposure target anthrax toxins in the body. Doctors must use
DIAGNOSTIC PROCEDURE antitoxin together with other treatment options.
You may have a rapid flu test to quickly diagnose a case COMPLICATIONS
of influenza. If other tests are negative, you may have The most serious complications of anthrax include:
further tests to look specifically for anthrax, such as:  Your body being unable to respond to infection
 Skin testing. A sample of fluid from a suspicious normally, leading to damage of multiple organ
lesion on your skin or a small tissue sample (biopsy) systems (sepsis)
may be tested in a lab for signs of cutaneous  Inflammation of the membranes and fluid covering
anthrax. the brain and spinal cord, leading to massive
 Blood tests. You may have a small amount of blood bleeding (hemorrhagic meningitis) and death
drawn that's checked in a lab for anthrax bacteria. NURSING MANAGEMENT
 Chest X-ray or computerized tomography (CT)  Improve airway patency. Auscultate chest for
scan. Your doctor may request a chest X-ray or crackles, indicating the need for better secretion
computed tomography (CT) scan to help diagnose mobilization; monitor oxygen saturation and arterial
inhalation anthrax. blood gases periodically to determine oxygenation
status and acid-base balance; and suction
frequently and provide chest physiotherapy to clear
airways, prevent atelectasis, and maximize oxygen as a public health problem requires sustained and
therapy. systematic efforts toward two major strategies, namely
 Improve breathing pattern. Position for maximum prevention of transmission through vector control and
chest expansion and reposition frequently to the detection and early treatment of cases to reduce
mobilize secretions; and provide supplemental morbidity and prevent mortality.
oxygen or mechanical ventilation, as needed. SIGNS AND SYMPTOMS
 Improve swallowing. Corticosteroids are used to  Recurrent chills
decrease the swelling in the head or neck region.  Fever
 Eliminate diarrhea. Cases of gastrointestinal anthrax  Profuse sweating
can be treated with ciprofloxacin or doxycycline for  Anemia
60 days.  Malaise
 Improve tissue integrity. Patients with isolated  Hepatomegaly
cutaneous anthrax without systemic involvement  Splenomegaly
(ie, without edema, fever, cough, headache, etc) or INFECTIOUS AGENTS
complications may be treated on an outpatient Malaria is produced by intraethrocytic of the genus
basis with antibiotic monotherapy. plasmodium. Four plasmodia produce malaria in
 Diminish hyperthermia. Administer analgesics as humans:
prescribed.  Plasmodium falciparum
PREVENTIVE MEASURES  P. vivax
 Immunize high-risk persons with a cell free vaccine  P. ovale
prepared from a culture filtrate containing the  P. Malariae
protection antigen. LIFE CYCLE OF THE MALARIA PARASITE
 educate employees handling potentially
contaminated articles about modes of anthrax
transmission, care for skin abrasions and personal
cleanliness.
 Control dusts and proper ventilation in hazardous
industries especially those that handle raw animal
materials.
 Thoroughly wash disinfectant or sterilize hair, wool
and bone meal or other feed of animal origin prior
to pressing.
 Do not sell the hides of animal exposed to anthrax 1. Mosquito transmits a motile Sporozoite.
nor use their carcasses as food or feed supplements 2. A sporozoite travels through the blood vessels to
(i.e. bone or blood meal) liver cells.
 If anthrax is suspected, do not necropsy the animal 3. In the liver sporozoite reproduces sexually
but aseptically collect a blood sample for culture. (schizogony), producing thousands of merozoites.
Avoid contamination of the area. 4. The merozoites infect red blood cells, where they
 Control effluents and trade waste of rendering develop into ring forms, trophozoites and
plants handling potentially infected animals and schizonts.
those from factories that manufacture products 5. Other merozoites develop into precursors of male
from hair, wool, bones or hides likely to be and female gametes.
contaminated. 6. When the mosquitos bite an infected person,
 Promptly immunize and annually re-immunize all gametocytes are taken up and mature in the
animals at risk. mosquito gut.
7. The male and female gametocytes fuse and form
MALARIA
an ookinete.
Malaria continues to be a major health problem in the
8. Ookinetes develop into new sporozoites that
country having an annual parasite incidence of 5.1/1000
migrate to the insect’s salivary glands.
pop. In 1994, it was aimed that there be a 20%
EARLY DIAGNOSIS AND PROMPT TREATMENT
reduction in morbidity annually. The nature of malaria
 Early diagnosis is the identification of a patient with responsibility of the LGUs and their
malaria as soon as he/she is seen, through clinical corresponding communities.
and/or microscopic method. d. On Stream Clearing
 Clinical method is based on the signs and symptoms This is the cutting of vegetation overhanging
of the patient and the history of his/her having along stream banks to expose the breeding
visited a malaria endemic area. stream to sunlight, rendering it unsuitable for
 Microscopic method is based on examination of the mosquito vector habituation.
blood smear of the patient through a microscope. RECOMMENDED ANTI-MALARIA DRUGS
 This shall be done by the medical technologist or Blood Schizonticides - drug acting on sexual blood
microscopist at the main health center where there stages of the parasites which are responsible for clinical
are microscopy facilities during regular manifestations.
consultations. She should take smear of patients  Chloroquine phosphate 250mg (150mg
with fever or history of recent fever with one month base/tablet)
and are residing or have stayed in malaria endemic  Sulfadoxine (or Sulfalene) 50mg –
area, of clinically diagnosed patients and of patients pyrimethamine 25 mg/tablet
who did not respond to appropriate anti-malarial  Quinine sulfate 300mg tablet
treatment.  Quinine hydrochloride 300mg/ml, 2ml ampule
Chemoprophylaxis  Tetracycline hydrochloride 250mg/capsule
Only Chloroquine drug should be given. It must be taken  Quinidine sulfate 200mg/durules
at weekly intervals, starting from 1-2 weeks before  Quinidine glucolate 80mg (50mg base) ml, 1 ml
entering the endemic area. In pregnant women, it is vial
given throughout the duration of pregnancy. OTHER PREVENTIVE MEASURES
Sustainable preventive and Vector control measures  Wearing of clothing that covers arms and legs in the
Sustainable preventive and Vector control measures evening.
refer to the adaptation of the measures for the  Avoiding outdoor night activities, particularly during
prevention and control against the malaria parasites the vector’s peak biting hours from 9pm to 3am.
and the mosquito vector. Such measures being  Using mosquito repellents such as mosquito coils,
affordable, applicable and appropriate are under our soap lotion or other personal protection measures
local conditions so that these measures can be advocated by the DOH / MCS – Malaria control
sustained throughout the duration of malaria control service.
operations.  Planting of Neem tree or other herbal plants which
Objectives of this measure is to reduce the source of are (potential) mosquito repellents as advocated by
infection in the human population; man – vector the DOH/MCS _ Malaria Control Service.
contact, and the density of the mosquito vector  Zooprophylaxis – the typing of domestic animals like
population. the carabao, cow, etc., near human dwellings to
a. Insecticide – Treatment of Mosquito Net deviate mosquito bites from man to these animals.
This involves the soaking the mosquito net in an Early Recognition Prevention and Control of
insecticide solution and allowed to dry. Such Malaria Epidemics
trated net is used as protective measure against  Early recognition prevention and control of malaria
the vector mosquito during sleeping time at epidemics refer to the establishment of a system
night. Insecticide – treated contains may be that will immediately recognize an impending
used in areas where they are more culturally malaria epidemic.
acceptable than mosquito nets.  Malaria epidemic is a situation where there is an
b. House Spraying incidence of new malaria cases in excess of the
This is the application if insecticide on the expected. Any transmission in a previously malaria-
indoor surfaces of the house through spraying. free area is obviously in excess of the expected and
c. On Stream Seeding constitutes and epidemic by the above definition,
This involves the construction of bio-ponds for with the premise that, traditionally, small epidemics
fish propagation which shall be the are usually called outbreaks.
 Epidemic potential is a situation wherein an area is f. Use of insecticide aerosols and pyrethroid
vulnerable to malaria case upsurge due to causal mosquito coils
factors such as climatic changes, ecological changes g. Clearing of hanging branches of trees along
or socio-economic changes. the stream
PREVENTION OF THE EPIDEMIC 4. Availability of anti-malarial drugs and
1. The following should be done in the event that an chemoprophylaxis drugs.
imminent epidemic occurs: FILIRIASIS
 Mass blood smear (MBS) collection ETIOLOGY
 Immediate confirmation and follow –  Wuchereria bancrofti
up of cases  Brugia malayi
 Insecticide – treatment of mosquito  Brugia Timori
nets  Loa loa
 Focal spraying SOURCE OF INFECTION
 Stream clearing • Any one of several thread-like parasitic round
 Intensive IEC campaign worms
2. All cases should be given drug treatment and MODE OF TRANSMISSION
followed-up until clinically and/or microscopically
• Mosquito bite (Aedes poecilius)
found negative.
INCUBATION PERIOD
3. Continuous surveillance measures should be
• 8-16 month
implemented for three years.
4. The Local Government Units in collaborating with
the nongovernmental organization and with the • 4 weeks, but most commonly it is 8-16 months.
technical assistance from the provincial malaria CLINICAL MANIFESTATION
coordinator should contribute in terms of IEC  Asymptomatic Stage (No clinical signs and
campaign and logistics support. symptoms of the disease)
PUBLIC HEALTH NURSING RESPONSIBILITIES  Acute Stage (Lymphadenitis, Lymphangitis,
1. Participation in the implementation of the Epididymitis, and Orchitis)
following:  Chronic Stage (Develop 10 to 15 years from the
a. Treatment policies onset of the first attack)
b. Provision of drugs o Chronic Signs and Symptoms (Hydrorecele,
c. Laboratory confirmation of diagnosis Lymphedema, Elephantiasis)
d. Training of barangay health workers and DIAGNOSTIC PROCEDURE
volunteers on the diagnosis and treatment  Nocturnal Blood Examination (NBE)
of malaria. o Blood are taken from the patient’s residence
e. Supervision of malaria control activities of (8pm)
all health personnel in the area  Immunochromatographic Test (ICT)
f. Collection, analysis and submission of o Rapid Assessment Method
required reports o Antigen test can be done at daytime
2. Recognition of early signs and symptoms for TREATMENT MODALITIES
management ad further referrals.
• Diethylcarbamazine citrate (hetrazan)
3. Educate the dividual / families /community of the
COMPLICATIONS
importance of the following:
Vasculopathy that can mimic giant cell arteritis.
a. Taking of chemoprophylaxis
NURSING MANAGEMENT
b. Wearing long-sleeved clothing and trousers
when going out at night  Health Education
c. Application of insect repellant to skin  Environmental Sanitation
d. Use of mosquito net  Psychological and emotional support
e. Use of screen in doors and windows. If no  Personal hygiene
screen, close windows and doors during PREVENTIVE MEASURES
night time.  Mosquito net
 Mosquito repellent  Isolate Pt. & concurrent disinfection of soiled

 Yearly dose of medicine articles.
LEPTOSPIROSIS  Health Teaching
Other names: Mud Fever, Flood Fever, Canicola Fever, PREVENTIVE MEASURES
Swamp Fever, Pre-tibial Fever, Ictero- hemorrhagica  Improved education of people at particular risk
Disease, Weil’s Disease, Swineherd’s Disease, Spiroketal (farmers, miners, etc. )
Jaundice, Japanese Seven Days Fever  Use of protective barriers like boots and gloves
ETIOLOGY especially by workers with occupational hazards.
• Leptospira interrogans (Spirochete)  Stringent community- wide rat eradication program.
SOURCE OF INFECTION Remove rubbish from work and the domestic
• Infected animals (eg. Rats, Pigs, Rabbits) and/or environment to reduce rodent population.
contaminated soil or water  Segregate domestic animals potentially infected
MODE OF TRANSMISSION from man’s living, working, and recreation areas.
• Skin penetration (e.g contaminated urine or water  Report all cases of leptospirosis.
getting in open wounds) & ingesting contaminated  Investigation of contacts and source of infection
food/water  Chemoprophylaxis can be done in a group of high-
INCUBATION PERIOD risk infected hosts.
• Ranges from 7-19 days, with average of 10 days MUMPS
PERIOD OF COMMUNICABILITY Other name: Epidemic Parotitis
• 1–3 months or longer
CLINICAL MANIFESTATIONS
• Clinical manifestations are variable with different
degrees of severity. It has two phases.
• Leptospiremic phase- leptospires are present in the
blood & CSF.
SIGNS AND SYMPTOMS
• abrupt with fever, headache, myalgia, nausea,
vomiting, cough, & chest pain. • An acute contagious disease, the characteristic
• Immune phase- correlates with the appearance of feature of which is the swelling of one or both of
circulating IgM the parotid glands, usually occurring in epidemic
DIAGNOSTIC PROCEDURE form.
• Microscopic Agglutination Test (MAT) ETIOLOGIC AGENT
• Enzyme Linked Immunosorbent Assay (ELISA) • Mumps virus, a member of the family
TREATMENT MODALITIES Paramyxomviridae, genus Paramyxovirus, is
Antibiotics antigenically related to the parainfluenza viruses.
 Penicillins and other B- lactam antibiotics(PCN at SOURCE OF INFECTION
2M units q6H IM/IV) • Secretion of the mouth and nose.
 Teracycline (Doxycycline at 100mg q12H PO) MODE OF TRANSMISSION
 Erythromycin (500mg q12H PO)- if allergic to
• It is spread by direct contact with a person who has
Penicillin
the disease or by contact with articles in his/ her
Prophylaxis - 200 mg twice a day for 3 days
immediate environment which have become freshly
COMPLICATIONS
soiled with secretion from the nasopharynx.
Affects striated muscles, Liver, Kidneys INCUBATION PERIOD
Myocardial Involvement and Pulmonary Haemorrhage
• The incubation period is from 12- 26 days, usually
Cause of death: Kidney failure
18 days.
NURSING MANAGEMENT
 Supportive PERIOD OF COMMUNICABILITY
 UO – consistency, frequency and amount (Refer if
with changes)
• The period of communicability begins before the  Encourage control of scratching to prevent local
glands are swollen and remains for an unknown infections and scars.
length of time, but it is presumed to last as long as  Assist and direct family in carrying out concurrent
any localized glandular swelling remains. and terminal disinfections.
CLINICAL MANIFESTATIONS PREVENTIVE MEASURES
 Painful swelling in front of ear, angle of jaws and • You can protect your child against mumps by
down the neck making sure they're given the combined MMR
 Fever vaccine for mumps, measles and rubella.
 Malaise  The MMR vaccine is part of the routine NHS
 Loss of appetite childhood immunization schedule.
 Swelling of one or both testicles (orchitis) in some  Your child should be given 1 dose when they're
boys around 12 to 13 months and a second booster
DIAGNOSTIC PROCEDURE dose at 3 years and 4 months.
• A test of a sample from the mouth.  Once both doses are given, the vaccine provides
• A blood test that may show an immune system around 88% protection against mumps.
reaction to the virus.  Anyone who did not have both doses of the
• A test of a sample of urine, but this is less common. MMR vaccine as a child can contact a GP to
TREATMENT MODALITIES arrange to be vaccinated.
VITAL STATISTICS
a. Prophylactic. A vaccine exists for the active
Statistics : referes to a systematic approach of
immunization of patient against mumps. However,
obtaining, organizing, and analyzing numerical facts so
it is of no avail after a non-immune patient has been
that conclusion may be drawn from them.
actively exposed to the diseases. The immunity
Vital Statistics: refers to the systematic study of vital
granted by inoculation with mumps vaccine is of
events such as births, illnesses, marriages, divorce,
relatively short duration for passive immunization
separation and deaths.
against the disease.
HEALTH INDICATORS
b. Active Treatment. The average case before the age
1. A list of information which would determine the
puberty requires little attention
health of a particular community
c. After the Age of Puberty. All patients, particularly
2. information that help anybody in describing or in
adults, should remain quiet in bed until all fever and
maintaining surveillane over the health status of the
swelling have been absent for at least four days
people or population
because of the danger of glandular complications.
3. serve as basis for developing, implementing and
d. The diet should be soft or liquid as tolerated. Sour
evaluating public health programs and intervention
foods or fruit juices are dislikes because of the
strategies.
burning or stinging sensation they elicit.
THE DIFFERENT HEALTH INDICATORS
COMPLICATIONS
1. Marriage
• It does not seem to be generally known that
2. Morbidity
meningitis to some degree is a part of the mumps
3. Migration or social mobility
syndrome and not a complication. Orchitis is the
4. Life expectancy
commonest complication in the male adult. After
5. Mortality
puberty, in all males with mumps the scrotum
MARRIAGE
should be supported by a suspensory from the start.
1. considered as healthy indicator of the health status
• Encephalitis may complicate mumps. Sudden rise in
of the community if
temperature, stiff neck, headache, malaise, nausea
a. intact and its exist for its own real purpose
and vomiting, delirium and double vision should be
b. it is planned marriage- right time, right person
watched for since they are the symptoms of this
marrying each other
complication. These symptoms usually subside
2. considered unhealthy community when it ends up
spontaneously within 10 to 14 days.
in divorce or separation
NURSING MANAGEMENT
MORBIDITY
- the lesser the occurence of illnesses in a dealing with births, deaths and all reportable
particular locality, the healthier this locality is diseases.
considered • Office of the Local Civil Registrar of the
Migration or social mobility: the faster the migration, Municipality or City Health Department:
the faster the ff effects on the health status of the registration of births and deaths and correction of
community would occur errors in names, dates, etc. are done in...
a. more congestion to the place where people will • NSO National Statistics Office or PSA Philippine
transfer Ptatistics Authority: statistics on population and
b. more depletion or utilization of health its characteristics like age, sex and distribution can
resources intended for the expected population be obtained from the...
living in that community • RA 3753: Civil Registry Law -registration of births,
c. more chances of transfer or spread of death to local registrar
communicable diseases PROBLEMS IN REGISTRATION:
FERTILITY/BIRTH 1. under registration and de facto registration
- bearing or coming into being of a new spring 2. unreported birth - unreported death
MORBIDITY 2 WAYS OF ASSESSING PEOPLE DURING CENSUS
- refers to being sick or diseased 1. De Jure: people are assigned according to the places
MIGRATION/SOCIAL MOBILITY where they usually libe regardless of where they are
- act of transfer of a person/s from one locality to during the time of census
another 2. De facto: people are assigned to where they are
LIFE EXPECTANCY physically present during the time of census
- it is the average number of years that a person lives regardless of where they usually live.
MORTALITY/FATALITY RA 3573: law on the reporting of notifiable diseases like
- cessation of physical and chemical processes that dengue, rabies, leptospirosis, and HIV/AIDS to local and
occur in all living things, of people national authorities.
RATE REPORT FROM FIELD HEALTH PERSONNEL:
- shows the relationship between a vital event and a. report to provincial and duty health office
those person exposed to the occurence of said b. midwife reports - under supervision of nurse
event, within a given area and during a specified c. report within 24h- measles or polio
unit of time. d. report within a week- tetanus neonatorum, severe
CRUDE OR GENERAL RATES and acute diarrhea, HIV/AIDS
- referred to the total living population. it must POPULATION CENSUS
presumed that the total population was exposed to accurate estimation
the risk of the occurence of the event Individual health records/family records:
SPECIFIC RATE a. birth certificate, deatb certificate, school clinic
the relationship is for a specific population or class or records
group. it limits the occurence of the event to the b. employment records
portion of the population definitely exposed to it. c. health center records, hospital records, healthy
CRUDE BIRTH RATE facility logbooks
a measure of one characteristics of the natural growth Community Organizing Participatory Action Research
or increase of a population (COPAR)
USES OF VITAL AND HEALTH STATISTICS  A social development approach that aims to
1. Vital and health statistics are used as indicators of transform the apathetic, individualistic and
the health status for a group or a whole community. voiceless poor into a dynamic, participatory and
2. Serves as bases for planning, implementing, politically responsive community.
monitoring anf evaluating community health  A collective, participatory, transformative,
programs and services. liberative, sustained and systematic process of
• Rural Health Units (RHUs): are responsible for building people’s organizations by mobilizing and
collecting and reporting data of vital statistics enhancing the capabilities and resources of the
people for the resolution of their issues and
concerns towards effecting change in their existing  Organization

oppressive and exploitative conditions (1994 PHASES OF COPAR
National Rural Conference). COPAR has four phases namely: Pre-Entry Phase, Entry
PROCESS Phase, Organization-Building Phase, and Sustenance
The sequence of steps whereby members of a and Strengthening Phase.
community come together to critically assess to 1. PRE-ENTRY PHASE
evaluate community conditions and work together to -Is the initial phase of the organizing process where the
improve those conditions. community/organizer looks for communities to
STRUCTURE serve/help.
Refers to a particular group of community members -It is considered the simplest phase in terms of actual
that work together for a common health and health outputs, activities and strategies and time spent for it.
related goals. Activities include:
EMPHASIS  Designing a plan for community development
1. Community working to solve its own problem. including all its activities and strategies for care
2. Direction is established internally and externally. development.
3. Development and implementation of a specific  Designing criteria for the selection of site
project less important than the development of the  Actually selecting the site for community care
capacity of the community to establish the project. 2. ENTRY PHASE
4. Consciousness raising involves perceiving health  AKA social preparation phase as to the activities
and medical care within the total structure of done here includes the sensitization of the people
society. on the critical events in their life, innovating them
IMPORTANCE to share their dreams and ideas on how to manage
 Tool for community development and people their concerns and eventually mobilizing them to
empowerment as this helps the community workers take collective action on these.
to generate community participation in  This phase signals the actual entry of the
development activities. community worker/organizer into the community.
 Prepares clients to eventually take over the She must be guided by the following guidelines
management of a development programs in the however;
future.  Recognizes the role of local authorities by paying
 Maximizes community participation and them visits to inform them of their presence and
involvement; community resources are mobilized activities.
for community services.  The appearance, speech, behavior and lifestyle
PRINCIPLES OF COPAR should be in keeping with those of the community
 People, especially the most oppressed, exploited residents without disregard of their being role
and deprived sectors are open to change, have the models.
capacity to change and are able to bring about  Avoid raising the consciousness of the community
change. residents; adopt a low-key profile.
 Should be based on the interest of the poorest 3. ORGANIZATION-BUILDING PHASE
sectors of society Entails the formation of more formal structure and the
 Should lead to a self-reliant community and society. inclusion of more formal procedure of planning,
CRITICAL STEPS implementing, and evaluating community-wise
 Integration activities. It is at this phase where the organized leaders
 Social Investigation or groups are being given training (formal, informal,
 Tentative program planning OJT) to develop their style in managing their own
 Groundwork concerns/programs.
 Meeting Key Activities
 Role Play  Community Health Organization (CHO)
 Mobilization or action  preparation of legal requirements
 Evaluation  guidelines in the organization of the CHO by
 Reflection the core group
 election of officers minutes)Dysentery, Colds & Pain – Decoction ( Boil

 Research Team Committee a handful of leaves & flowers in water to produce a
 Planning Committee glass, three times a day)
 Health Committee Organization The following dosages of the decoction are given
 Others according to age group:
 Formation of by-laws by the CHO Dried leaves Fresh leaves
4. SUSTENANCE AND STRENGTHENING PHASE Adult 4 tbsp 6 tbsp
Occurs when the community organization has already 7-12 yrs 2 tbsp
been established and the community members are 3 tbsp 2-6 yrs
already actively participating in community-wide 1 tbsp 1 ½ tbsp
undertakings. At this point, the different committees  Skin diseases (dermatitis, scabies, ulcer, eczema) -
setup in the organization-building phase are already Wash & clean the skin/wound with the decoction
expected to be functioning by way of planning,  Headache – Crush leaves may be applied on the
implementing and evaluating their own programs, with forehead
the overall guidance from the community-wide  Rheumatism, sprain, contusions, insect bites –
organization. Pound the leaves and apply on affected area
Key Activities YERBA (HIERBA) BUENA (MENTHA CORDIFELIA)
 Training of CHO for monitoring and implementing of Herba Buena (most dialects)
community health program. Opiz Ablebana (If.)
 Identification of secondary leaders. Hierba/ Yerba Buena (Spanish)
 Linkaging and networking. Malipuen (Als.)
 Conduct of mobilization on health and development Hilbas (Dav, Ley
concerns. Peppermint mint (Eng.)
 Implementation of livelihood projects. - A small multi- branching aromatic herb. The leaves
HERBAL MEDICINE are small, elliptical and with toothed margin. The
As a part of primary health care and because of the stem creeps to the ground, and develops roots. May
increasing cost of drugs, the use of locally available also be propagated through cutting.
medicinal plants has been advocated by the USES & PREPARATION
Department of Health. Many local plants and herbs in  Pain (headache, stomachache) – Boil chopped
the Philippine backyard and field are effective in the leaves in 2 glasses of water for 15 minutes.
treatment of common ailments as attested to by the Dried leaves Fresh leaves
National Science Development Board, other Adult 6 tbsp 4 tbsp
government and private agencies/ persons engaged in 7-12 yrs ½ tbsp of adult dose
research. Divide decoction into two parts and drink one part every
The Department of Health is advocating the use of the three hours.
following ten (10) herbal plants.  Rheumatism, arthritis and headache – Crush the
LAGUNDI (VITEX NEGUNDO) fresh leaves and squeeze sap. Massage sap on
Kamalan (Tag.) painful parts with eucalyptus
Dabtan (If)  Cough & Cold – Soak 10 fresh leaves in a glass of hot
Limo- limo (IIk.) water, drink as tea. (expectorant)
Molave aso (Sul)  Swollen gums – Steep 6 g. of fresh plant in a glass of
Tugas (Ceb) boiling water for 30 minutes. Use as a gargle
5 leaveschaste tree (Eng.) solution
- A shrub growing wild in vacant lots of waste land.  Toothache – Cut fresh plant and squeeze sap. Soak
Matured branches are planted. The flowers are bell- a piece of cotton in the sap and insert this in aching
shaped. The small fruits turn black when ripe. It is tooth cavity
better to collect the leaves when are in bloom.  Menstrual & gas pain – Soak a handful of leaves in a
USES & PREPARATION glass of boiling water. Drink infusion.
 Asthma, Cough & Fever – Decoction ( Boil raw fruits Nausea & Fainting – Crush leaves and apply at nostrils
or leaves in 2 glasses of water for 15 of patients
Insect bites – Crush leaves and apply juice on affected NIYUG-NIYOGAN (QUISQUALIS INDICA L.)
area or pound leaves until like a paste, rub on affected Balitadham, Phones. Pinio, Bonor (Bis.)
area Bawe-bawe (Pamp.)
Pruritis – Boil plant alone or with eucalyptus in water. Kassumbal, Talolong (Bik.)
Use decoction as a wash on affected area. Tagrau, Tagulo Totoraok (Tag.)
Tartarau (IIk.)
SAMBONG (BLUMEA BALSAMIFERA) Burma creeper, Chinese honey suckle (Eng.)
Alibhon, ALimon (p. Vis.) - A vine which bears tiny fruits and grows wild in
Kambihon, Lakadbulan (Vis.) backyards. The seeds must come from mature,
Ayohan, Bulaklak Ga buen, Kaliban (Tag.) dried but newly opened fruits. Propagated through
Gintin- gintin (Haliban/ Campho (Eng.) stem cuttings about 20 cm in height
- A plant that reaches 1 ½ to 3 meters in height with USES & PREPARATION
rough hairy leaves. Yung plants around mother  Anti-helmintic – The seeds are taken 2 hours after
plant may be separated when they have three or supper. If no worms are expelled, the dose may be
more leaves. repeated after one week.
USES & PREPARATION Dried leaves Fresh leaves
 Anti-edema, diuretic, anti-urolithiasis – Boil Adult 8-10 seeds
chopped leaves in a glass of water for 15 minutes 7-12 yrs 6-7
until one glassful remains. 6-8 years 5-6
Dried leaves Fresh leaves 4-5 years 4-5
Adult 6 tbsp 4 tbsp Caution: Not to be given to children below 4 years
7-12 yrs ½ tbsp of adult dose old
Divide decoction into 3 parts, drink one part 3 times a BAYABAS/GUAVA (PSIDIUM GUAJAVA L.)
day. Guyanas. Kalimbahin. Tayabas (Tag.)
Note: Sambong is not a medicine for kidney infection. Bagabas (Ig.) Bayabo (lbm.)
 Diarrhea – Chopped leaves and boil in a glass of Bayawas (Bik., Pang.) Biabas (Sul.)
water for 15 minutes. Drink one part every 3 hours. Guyabas (Ilk.)
TSAANG GUBAT (CARMONA RETUSA) - A tree abput 4-5 meters high with tiny white flowers
Alibungog (Vis.) with round or oval fruits that are eaten raw.
Kalabonog. (Maragued (IIk.) Propagated through seeds.
Kalimunog, Taglokot, Talibunoh, Tsa (Tag.) USES & PREPARATION
Malatadian (Gad.)  For washing wounds – Maybe use twice a day
- A shrub with small, shiny nice- looking leaves that  Diarrhea – May be taken 3-4 times a day
grows in wild uncultivated areas are forests. Mature  As gargle and for toothache – Warm decoction is
stems are used for planting. used for gargle. Freshly pounded leaves are used for
USES & PREPARATION toothache. Boil chopped leaves for 15 minutes at
 Diarrhea – Boil chopped leaves into 2 glasses of low fire. Do not cover and then let it cool and strain
water for 15 minutes. AKAPULKO (CASSIA ALATA L.)
Dried leaves Fresh leaves Bayabas- bayabasan. Kapurko. Kantada. Katandang Aso.
Adult 10 tbsp 12 tbsp Pakagonkon. Sonting (tag.);
7-12 yrs 5 tbsp Andadasi. Andadasi-a dakdako\. Andadasi-bugbugton
6 tbsp 2-6 yrs (Ilk.); Andadasi (Ting.);
2 ½ tbsp 3 tbsp Ancharasi (Ig,);
Divide decoction into 4 parts. Let patient drink 1 part Andalan (Sul.);
every 3 hours Bayabasin. Bibs-bibs (Bik.. Tag.. Bis.);
 Stomachache – Boil chopped leaves in 1 glass of Kasitas (Bik.. Bis.);
water for 15 minutes. Cool and strain. Sunting, Palo china (Bis.);
Dried leaves Fresh leaves Pakayomkom Kastila (Pamp.);
Adult 2 tbsp 3 tbsp Ringworm bush or shrub (Eng.)
7-12 yrs 1 tbsp
½ tbsp
USES & PREPARATION  Stop giving the herbal medication in case untoward
 Anti-fungal (tinea flava, ringworm, athlete’s foot reaction such as allergy occurs.
and scabies) – Fresh, matured leaves are pounded.  If signs and symptoms are not relieved after 2 to 3
Apply soap to the affected area 1-2 times a day doses of herbal medication, consult a doctor
ULASIMANG BATO (PEPERONICA PELLUCIDA)
Pansit-pansitan (Tag.)
- A weed, with heart-shaped leaves
that grow in shady parts of the
garden and yard.
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
BAWANG (ALLIUM SATIVUM)
Ajos (Span., Bis.); Garlic (Eng.)
USES & PREPARATION
 Hypertension – May be 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.
Caution: Take on a full stomach to prevent stomach and
intestinal ulcers.
 Toothache – Pound a small piece and apply to
affected area
AMPALAYA (MAMORDICA CHARANTIA)
Amorgoso (Sp.);
Margoso, Ampalaya (Tag.);
Apalia (Pamp); Apape (Lbn.);
Apapet (Itn.);
Palia (Bis., Ban., If., Ilk.);
Pubia (Sub.); Suligum (sul);
Balsam Apple, Balsam Pear, Bitter Gourd (Eng.)
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
Note: Young leaves may be banched/steamed and eaten
½ glassful 2 times a day.
REMINDERS ON THE USE OF HERBAL MEDICINE
 Avoid the use of insecticide as these may leave
poison on plants.
 In the preparation of herbal medicine, use a clay pot
and remove cover while boiling at low heat.
 Use only part of the plant being advocated.
 Follow accurate dose of suggested preparation.
 Use only one kind of herbal plant for each type of
symptoms or sickness.

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CA I – COMPETENCY APPRAISAL I

Concept: Community Health Nursing

COMMUNITY HEALTH NURSING - The nurse monitors and supervises the

2. Measles 6. Minimal intervals between doses to catch up as

immunization session or after 6 hours, whichever a. TOP

5. Rotavirus Vaccine c. HepB 3 – 14 weeks

c. OPV 3 – 14 weeks  5th dose, at least 4 weeks after he or she has

GENERAL HEALTH EFFORTS Examples are:

3. Provide nutrition education to mothers of children d. Infectious agents

vesicles  Avoid contact with susceptibles

CLINICAL MANIFESTATION MEASLES

 High-grade fever  Galloping Consumption Disease

 Immunization with:  If unknown when was the sputum collected,

o Anti-measles at the age of 9 months as a single discard

 Heaf Test Administer medicines as ordered

 Has the characteristics of both lepromatous

3. Multiple drug therapy. 2. Social Isolation

 An acute contagious disease characterized by mild days after onset.

CLINICAL MANIFESTATIONS PREVENTION

Swabs of unroofed vesicular lesions and scabs from MODE OF TRANSMISSION:

5. For membrane: Oral hygiene (warm mouth wash,  Periorbital edema

 Mosquito repellent  Isolate Pt. & concurrent disinfection of soiled

concerns towards effecting change in their existing  Organization

 election of officers minutes)Dysentery, Colds & Pain – Decoction ( Boil

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