Clinic Visitation

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MISSION

“MABINI COLLEGES provides quality instruction,

MABINI COLLEGES, INC.


research and extension service programs at all
VISION educational levels as its monumental
“MABINI COLLEGES shall contribution to national and global growth and

cultivate a CULTURE of Daet, Camarines Norte development.


Specifically, it transforms
EXCELLENCE in students into:
Education.” College of Nursing and Midwifery •

God – fearing
Nation – loving
Email: mabinicollege@hotmail.com •

Law abiding
Earth caring
• Productive, and
• Locally and globally competitive persons

CLINIC VISIT
➢ The patient visits the health Center/clinic to avail of the services thereto offered by the
facility primarily for consultation on matters that ailed them physically
➢ Nowadays, patients are becoming aware of the other services that the health Center offer
such as pre-natal and post-partum care, well baby check-up. immunization, free
medicines under DOTS and other health care.
➢ Most often, patient utilized the facility mainly for the said purpose. But with the changing
time, close interaction between health care providers and patient intensified with other
health programs prior to the actual nurse patient contact such as enhanced education
and promotion on health care of the family in totality. The nurse plays a very important role
in building a closer tie with the patient to gain their trust and confidence and particularly in
the implementation and promotion of health care.

PRE-CONSULTATION CONFERENCE:

➢ A pre-clinic lecture is usually conducted prior to the admission of patient. which is one way
providing health education.

STANDARD PROCEDURES PERFORMED DURING CLINIC VISITS

I. REGISTRATION/ADMISSION

1. Greet the patient upon entry and establish rapport.


2. Prepare the family record of new patients or retrieve records of old clients.
3. Elicit and record the client's chief complaint and clinical history.
4. Perform physical examination on the client and record it accordingly.

II. WAITING TIME

1. Give priority numbers to client


2. Implement the "first come, first serve" policy except for emergency/urgent Cases.

III. TRIAGING
1. Manage program-based cases
(Certain programs of the DOH like the IMCI utilize an acceptable decision to Which the nurse has
to follow in the management of a simple cases).

Example- for control of a diarrheal diseases (CDD), assess if the child has diarrhea
❖ If he has, for how long-is there blood in the stool
❖ Assess the child's general condition-sleepy, difficult to awaken, restless and imitable
❖ Observe for sunken eyes – dehydration
❖ Offer fluid. Is he able to drink or is he drinking regularly, thirsty.
❖ Pinch skin of the abdomen does it go back very slowly
2. Refer all non-program-based cases to the physician. For all the cases which has no
potential danger, treatment/management is initiated by the nurse and she decides to do
her own nursing diagnosis and then refer to the physician for medical treatment.
3. . Provide first-aid treatment to emergency cases and refer when the next level of care

IV. CLINICAL EVALUATION


1. Validate clinical history and physical examination 2. The nurse arrives at evidence-based
diagnosis and provides rational treatment based on DOH programs.
a. identifies the patient's problem
b. formulate/write the nursing diagnosis and validate
c. give/perform the nursing intervention
d. evaluate the intervention if it has enabled the patient to achieve the desired outcome
V. LABORATORY AND OTHER DIAGNOSTIC EXAMINATIONS

RHU Lab 1. Identify a designated referral laboratory when needed.

VI. REFERRAL SYSTEM

1. Refer to the patient if he needs further management following the two-wo referral system (BHS
to RHU to RHU. RHU to Hospital) 2. Accompany the patient when an emergency referral is needed

Be there

VII. PRESCRIPTION/DISPENSING

1. Give proper instructions on drug intake

VIII. HEALTH EDUCATION

1. Conduct one-on-one counseling with the patient


2. Reinforce health education and counseling messages
3. Give appointments for the next visit
MISSION
“MABINI COLLEGES provides quality instruction,

MABINI COLLEGES, INC.


research and extension service programs at all
VISION educational levels as its monumental
“MABINI COLLEGES shall contribution to national and global growth and

cultivate a CULTURE of Daet, Camarines Norte development.


Specifically, it transforms
EXCELLENCE in students into:
Education.” College of Nursing and Midwifery •

God – fearing
Nation – loving
Email: mabinicollege@hotmail.com •

Law abiding
Earth caring
• Productive, and
• Locally and globally competitive persons

EXPANDED PROGRAM ON IMMUNIZATION


INTRODUCTION:
➢ With the commitment of our country to Universal Child Immunization (UCI) Goal
acceleration of EPI coverage had begun in 1986.

➢ The achievement of the fully immunized child (FIC) coverage of 80% was noted one year
ahead of the target date of UCI in 1990. This was attributed to the strong political will and
support from

➢ international partners, better program management, and improvement in cold chain


facilities for better performance at all levels of health facilities.

➢ The development of the EPI Manual of Operations with its clear guidelines for better
planning, correct targeting, correct immunization procedures. strategies appropriate for
better lineaging /coordination and program implementation had contributed much for the
success of the program:
➢ Hepatitis B immunization has been integrated into the EPI in 1992 among infants 0-1 year of
age.
➢ Due to high cost of vaccines only 40% of eligible targets were prioritized and given with
vaccination.
➢ This was the period of EPI Acceleration (1987-1992) that system has been put in place.
❖ The conceptualization and introduction of the disease reduction initiative in early 90's contributed
to the declined of numerous cases of the immunizable disease

THE FOUR MAJOR STRATEFIES INCLUDES:


a. Sustaining high routine FIC coverage of at least 90% in all provinces and cities.
b. Sustaining the polio free country for global certification.
c. Eliminating measles by 2008,
d. Eliminating neonatal tetanus by 2008

❖ The development of National Plan of Action for Polio Eradication has been done in 1990 which
help a lot in the Implementation of the eradication of polio
❖ Polio Eradication Project has been created in 1992 with the expansion of sentinel sites for AFP
reporting. The high routine coverage of FIC of 92% has been achieved nationwide in the same
year.
❖ This year also marked the Presidential Proclamation #46 with the affirmation of the commitment to
the Universal Child Immunization and the Mother Immunization Goal which has highlighted by the
launching of the Polio Eradication Project.
❖ National Immunization Days were conducted in 1993 to 1996 nationwide and Sub National
Immunization Days in selected areas with cases of polio and with low OPV coverage.
❖ This was the period of excitement from 1993 to 1997 where all concerned agencies public and
private sector participated for the Oplan Alis Disis.
• The challenging period had started in 1998 up to the present wherein our country had embarked
on the Measles Elimination to achieve the goal of eliminating measles by 2008.
• Mass Measles vaccination among children ages 9 months to less than 15 years were given
nationwide regardless of immunization status.
• This was the initial phase called the Measles Catch-Up Campaign vaccinating 28 million children
(96) that resulted to a drastic reduction of measles cases by 70%.
• In 2004, he follow-Up Measles campaign Immunizing Children 9 months to less than five years of
age had achieved 94% in all parts of the country

In 2000 our country has been certified polio free in Kyoto Japan 4 This was the greatest
achievement of the Philippines as one of the certified polio free in Western Pacific Region.
The challenge is difficult to sustain since we are at risk of importing polio from endemic areas.
In 2000, the circulating vaccine derived polio (CVDPV) had occurred in Cagayan de Oro, Laguna
and Cavite.
In response to the CVDPV outbreak a "Balik Polio Patak" has been conducted nationwide
immunizing children o to less than 5 years of age regardless of immunization status with coverage
of 98.5% during the first round and 101% for the second round while the routine coverage of OPV3
remained low for many tears
Many children are susceptible to get polio infection and/or at risk of getting the disease.

o The country's neonatal tetanus (NT) rate is below 1/1000 livebirth.


o There are few cities and provinces remained to have high NT rates.
o The focus of NT elimination was in areas with low TT coverage and poor delivery care of babies
but continuing TT routine vaccination I areas with good coverage and good delivery care
practices to sustain NI elimination.
o A Maternal and Neonatal Tetanus Elimination Plan gas been developed for appropriate sourcing
of funds and implementation for NT elimination.

THE CONCEPT AND IMPORTANCE OF VACCINATION


• Immunization is the process by which vaccines are introduced into the body before injection sets
in.
• Vaccines are administered to induce immunity thereby causing the recipient's immune system to
react to the vaccine that produces antibodies to fight infection.
• Vaccination promotes health and protect children from disease-causing agents.
• Infants and newborns need to be vaccinated at an early age since they belong to vulnerable
age group. They are susceptible to childhood diseases.

THERE ARE SEVERAL GENERAL PRINCIPLES WHICH APPLY IN VACCINATING CHILDREN:


• It is safe and immunologically effective to administer all EPI vaccines on the
• same day at different sites of the body. Measles vaccine should be given as soon as the child is 9
months old, regardless of whether other vaccines will be given on that day. Measles vaccines
given at 9 months provide 85% protection against measles infection. When given at one year and
older provides 90% protection.
• The vaccination schedule should not be restarted from the beginning even if the interval
between doses exceeded the recommended interval by months or years.
• Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea, and vomiting are not
contraindications to vaccination.
• Generally. One should immunize unless the child is so sick that he needs to be hospitalized.
• The absolute contraindications to immunization are:
o DPT2 or DPT3 to a child who has had convulsions or shock within 3 days the previous dose.
Vaccines containing the whole cell pertussis component should not be given to children
with an evolving neurological disease (uncontrolled epilepsy of progressive
encephalopathy)
o Live vaccines like BCG vaccine must not be given to individuals who are
immunosuppresses due to malignant disease (child with clinical AIDS). therapy with
immunosuppressive agents, or irradiation.
o It is safe and effective with mild side effects after vaccination. Local reaction, fever and
systematic symptoms can result as part of the normal immune response.
o Giving doses of a vaccine at less than the recommended 4 weeks interval may lessen the
antibody response. Lengthening interval between doses of vaccines leads to higher
antibody levels.
o No extra doses must be given to children/mother who missed a dose of DPT/HB/OPV/TT.
The vaccination must be continued as if no time had elapsed between doses. Strictly
follow the principle of never, ever reconstituting the freeze-dried vaccines in anything other
than the diluent supplied with them.
o False contraindications to immunizations are children with malnutrition. low grade fever,
mild respiratory infections and other minor illnesses and diarrhea should not be considered
a contraindication to OPV vaccination. Repeat BCG vaccination fi the child does not
develop a scar after the 1st injection.
o Use one syringe one needle per child during vaccination.

THE EPI TARGET DISEASES

• Vaccination among infants and newborn (0-12 months) against the seven vaccine preventable
diseases.
o These include: Tuberculosis, diphtheria, pertussis, tetanus. poliomyelitis, measles and
hepatitis (see list of EPI diseases with the corresponding WHO standard case definition.

THE EPI ROUTINE SCHEDULE OF IMMUNIZATION


o Every Wednesday is designated as immunization day and is adopted in all parts of the
country.
o In a barangay health station immunization is done monthly while in far flung areas it is done
quarterly.
o However, some areas adopted local practices to provide everyday vaccination in their
areas to cover all targets.

ROUTINE IMMUNIZATION SCHEDULE FOR INFANTS

• The standard routine immunization schedule for infants is adopted to provide maximum
immunity against the seven preventable diseases before a child's first birthday.
• A child is said to "Fully Immunized Child" when a child receives one dose of BCG. 3 doses of
OPV, 3 doses of DPT. 3 doses of HB and one dose of measles before a child's first birthday.
VACCINE MINIMUM AGE NUMBER MINIMUM REASON
AT 1ST DOSE OF DOSES INTERVAL
BETWEEN DOSES
BGC Birth or any 1 BCG is given at earliest possible
time after age protects the possibility of TB
birth meningitis and other TB infectious
in which infants are prone
DPT 6 weeks 3 4 weeks An early start with DPT reduces
the chance of severe pertussis
OPV 6 weeks 3 4 weeks The extent of protection against
polio is increased the earlier the
OPV is given. Keeps the Philippine
polio free
HEP B At birth 3 6 week interval An early start of Hep B reduces
from 1st to 2nd the chance of being infected
dose, and 8 and becoming a carrier. Prevent
weeks interval liver cirrhosis and liver cancer.
from 2nd dose About 9000 die of complication
to third dose of HB. 10% of Filipinos have
chronic HB infection. Eliminate HB
before 2012 (a Western Regional
Goal)
Measles 9 months 1 1 month At least 85% of measles can be
prevented by immunization at this
Age. Prevents deaths (2% die),
malnutrition, pneumonia,
diarrhea (at least 20%) get these
complications from measles) etc.
Eliminate measles by 2008.

TETANUS TOXOID IMMUNIZATION SCHEDULE FOR WOMEN


o Tetanus toxoid vaccination for women is important to prevent tetanus in both 1 math.
o When two doses of IT injection given at one month interval between each dose mother
and baby. during pregnancy or even before pregnancy period the baby is protected
against neonatal tetanus.
o Completing the five doses following the schedule provide lifetime immunity (see
vaccination schedule below.

VACCINE MINIMUM % DURATION OF PROTECTION


INTERVAL PROTECTED
TT1 As early as
possible during
pregnancy
TT2 At least 4 weeks 80% • Infants born to the mother will be
later protected from neonatal tetanus
• Gives 3 years protection for the mother

TT3 At least 6 months 95% • Infants born to the mother will be


later protected from neonatal tetanus
• Gives 5 years protection for the mother

TT4 At least one year 99% • Infants born to the mother will be
later protected from neonatal tetanus
• Gives 10 years protection for the mother

TT5 At least one year 99% • Gives lifetime protection to the mother
later • All infants born to that mother will be
protected

THE EPI VACCINES AND ITS CHARACTERISTICS

• Vaccines are substances very sensitive at various temperature


• To avoid spoilage and maintain its potency, vaccines need to be stored at correct
temperature.
• 4 Below are recommended storage temperatures of EPI vaccines

Most sensitive to heat • Oral Polio (live attenuated) -15 c to -20 c


• Measles (freeze dried)
Least sensitive to heat • DPT/ Hep B +2 TO +8 c (body of
» D-toxoid which is refrigirator)
weakened toxin
» P- killed bacteria
• Hep b
• BCG (Freeze dried)
• Tetanus toxoid

• When handling, transporting and storing vaccines, special care must be given to provide
quality potent vaccines among the targets.

• A "first expiry and first out" (FEFO) vaccine is practices to assure that all vaccines are utilized
before its expiry date, Proper arrangement of vaccines and/or labelling of vaccines expiry
date are done to identify those near to expire vaccines. monitor
• Temperature monitoring of vaccines is done in all levels of health facilities to Temp monitor
vaccine temperature. This is done twice a day early in the morning and in the afternoon
before going home. Temperature is plotted every day in a temperature monitoring chart to
monitor break in the cold chain.
• Each level of health facilities has cold chain equipment for use in the storage of vaccines.
These are: cold room, freezer, refrigerator, transport box, vaccine carrier. Other cold chain
logistics supplies include: thermometers, cold chain monitor, ice packs, temperature
monitoring chart, safety collector box etc. these are essentials in proper management of
vaccines and other EPI logistics.
Administration of vaccines
VACCINE Dose Route of Site of administration
administration
BGC Infants 0.05 ml Intradermal Right deltoid region of the
5- 15O angle arm
DPT 0.5 ml Intramuscular Upper outer portion of the
90O thigh
OPV 2 drops oral Mouth
HEP B 0.5 ml Intramuscular Upper outer portion of the
90O thigh
Measles 0.5 ml Subcutaneous Upper outer portion of the
45O arm
Tetanus 0.5 ml Intramuscular deltoid region of the arm
toxoid 90O
PROCEDURE IN THE GIVING OF VACCINES:

RECONSTITUTING THE FREEZE-DRIED BCG VACCINE

a) always keep the diluent cold by sustaining with BCG vaccine ampules in refrigerator or
vaccine carrier.
b) using a 5 ml syringe fitted with a long needle, aspirate 2 ml of saline solution from the opened
ampule of diluent,
c) Inject the 2 ml saline into the ampule of freeze-dried BCG.
d) Thoroughly mix the diluent and vaccine by drawing the mixture back into the syringe and
expel it slowly into the ampule several times. e. Return the reconstituted vaccine on the slit of
the foam provided in the vaccine carrier.
GIVING BCG VACCINE:
a) clean the skin with cotton ball moistened with water and let skin dry.
b) Hold the child's arm with your left hand so that: your hand is under the arm, and your thumb
and fingers come around the arm and stretch the skin.
c) Hold the syringe in your right hand with the bevel and the scale pointing up towards you.
d) Lay the syringe and needle almost flat along the child's arm,
e) Insert the tip of the needle into the skin-just the bevel and a little bit more. Keep the needle flat
along the skin and the bevel facing upwards, so that the vaccine only goes into the upper
layers of the skin.
f) Put your left thumb over the needle end of the syringe to hold it in position. Hold the
plunger end of the syringe between the index and middle fingers of your right hand and press
the plunger in with your right thumb.
g) If the vaccine is injected correctly into the skin, a flat wheal with the surface pitted like an
orange peel will appear at the injection site.
h) Withdraw the needle gently.
GIVING ORAL POLIO VACCINE:
a) Read the manufacturer's instructions to determine number of drops to be given. Use the
dropper provided for.
b) Let the hold the child lying firmly on his back.
c) If necessary open the child's mouth by squeezing the cheeks gently between your fingers
to make his lip point upwards.
d) Put drops of vaccine straight from the dropper onto the child's tongue but do not let the
dropper touch the child's tongue.
e) Make sure that the child swallows the vaccine. If he spits, give another dose.
HEPATITIS B AND DPT- GIVING HEPATITIS B AND DPT
a) Ask mother to hold the child across her knees so that his thigh is facing upwards. Ask her to
hold child's legs.
b) Clean the skin with a cotton ball, moistened with water and let the skin dry.
c) Place your thumb and index finger on each side of the injection site and grasp the muscles
slightly. The best injection site is outer part of the child's mid-thigh.
d) Quickly push the needle into the space between your fingers, going deep in the
e) muscle.
f) Slightly pull the plunger back before injecting to be sure that vaccine is not injected into
the vein (if using disposable syringe and needles).
g) Inject the vaccine. Withdraw the needle and press the injection spot quickly with a piece
of cotton.
MEASLES

RECONSTITUTING THE FREEZE DRIED MEASLES VACCINE


a) Using a 10 ml syringe fitted with a long needle, aspirate 5 ml of special diluent, from
b) the ampule.
c) Empty the diluent from the syringe into the vial with the vaccine.
d) Thoroughly mix the diluent and vaccine by drawing the mixture back into the syringe and
expelling it slowly into the vial several times. Do not shake the vial.
e) Protect reconstituted measles vaccine from sunlight. Wrap vial in foil.
f) Place the reconstituted vaccine in the slit of the foam provided in the vaccine carrier.

GIVING MEASLES VACCINE


a) Ask the mother to hold the child firmly.
b) Clean the skin with cotton ball, moistened with water and let the skin dry.
c) With the fingers of one hand, pinch up the skin on the outer side of the upper arm.
d) Without touching the needle, push the needle into the pinched-up skin so that it is not
pointing.
e) Slightly pull the plunger back to make sure that the vaccine is not injected into a vein (if
using disposable syringe and needles).
f) f. Press the plunger gently and inject.

TETANUS TOXOID- GIVING TETANUS TOXOID


a) Shake the vial
b) Clean the skin with cotton ball, moistened with water and let the skin dry.
c) Place your thumb and index finger on each side of the injection site and grasp the muscle.
slightly. The best injection site for a woman is outer side of the left upper arm.
d) Slightly pull the plunger back before injecting to be sure that vaccine is not injected into
the vein.
e) Quickly push the needle into the space between your finger, going deep in the muscle.
f) Inject the vaccine. Withdraw the needle and press the injection spot quickly with piece of
cotton.

NOTE: Shake the vial before every injection

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