CHNI – Definition of Terms

Community- derived from a latin word “comunicas” which means

                       a group of people.

a group of people with common characteristics or interests

living together within a territory or geographical boundary

place where people under usual conditions are found

Health – is the OLOF (Optimum Level of Functioning)

Community Health – part of paramedical and medical intervention/approach which is concerned on the health of the whole population

Aims:

1. health promotion

2. disease prevention

3. management of factors affecting health

Nursing – both profession & a vocation. Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness

II – Community Health Nursing

The utilization of the nursing process in the different levels of clientele-individuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation.

Goal: “To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats to health in such a way as to maximize their potential for high-level wellness”

MISSION OF CHN

· Health Promotion

· Health Protection

· Health Balance

· Disease prevention

· Social Justice

PHILOSOPHY OF CHN

The philosophy of CHN is based on the worth and dignity on the worth and dignity of man.

Principles of Community Health:

1. The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual, family, population group (those who share common characteristics, developmental stages and common exposure to health problems – e.g. children, elderly), and the community.

2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care

3. CHN practice is affected by developments in health technology, in particular, changes in society, in general

4. The goal of CHN is achieved through multi-sectoral efforts

5. CHN is a part of health care system and the larger human services system.

Role of CH Nurse:

Clinician –  who is a health care provider, taking care of the sick people at home or in the RHU

Health Advocator – speaks on behalf of the client

Advocator – act on behalf of the client

Supervisor – who monitors and supervises the performance of midwives

Facilitator – who establishes multi-sectoral linkages by referral system

Collaborator – working with other health team member

COMMON PROCEDURE IN CHN:

· HOME VISIT

· BAG TECHNIQUE

· STERILIZATION

· SPECIMEN COLLECTION

- URINE

- FECES

- SPUTUM

Levels of Client in CHN:

1. Application of Nursing Process to:

1.a Family

      1.a.1 Family Coping Index

Physical Independence - ability of the family to move in & out of bed & performed activities of daily living

Therapeutic Independence - ability of the family to comply with the therapeutic regimen (diet, medication & usage of appliances)

Knowledge of Health Condition- wisdom of the family to understand the disease process

Application of General &Personal Hygiene- ability of the family to perform hygiene & maintain environment conducive for living

Emotional Competence – ability of the family to make decision maturely & appropriately (facing the reality of life)

Family Living Pattern- the relationship of the family towards each other with love, respect & trust

Utilization of Community Resources – ability of the family to know the function & existence of resources within the vicinity

Health Care Attitude – relationship of the family with the health care provider

Physical Environment – ability of the family to maintain environment conducive for living

1.a.2 Family Life Cycle

Stage I – Beginning Family (newly wed couples)

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

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

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

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

TASK: learn the concept of responsible parenthood

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

TASK: Reinforce the concept of responsible parenthood

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

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

Stage VI – Launching Center (1st child will get married up to the last child)

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

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

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

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

TASK: learn the concept of death positively

1.b Community

COMMUNITY ASSESSMENT:

Status

Structure

Process

TYPES OF COMMUNITY ASSESSMENT:

1. COMMUNITY DIAGNOSIS

A process by which the nurse collects data about the community in order to identify factors which may influence the deaths and illnesses of the population, to formulate a community health nursing diagnosis and develop and implement community health nursing interventions and strategies.

2 Types:

 Comprehensive Community Diagnosis  Problem-Oriented Community Diagnosis

 - aims to obtain general information about the community

 - type of assessment responds to a particular need

STEPS:

Preparatory Phase

1. site selection

2. preparation of the community

3. statement of the objectives

4. determine the data to be collected

5. identify methods and instruments for data collection

6. finalize sampling design and methods

7. make a timetable

Implementation Phase

1. data collection

2. data organization/collation

3. data presentation

4. data analysis

5. identification of health problems

6. priority zation of health problems

7. development of a health plan

8. validation and feedback

Evaluation Phase

BIOSTATISTICS

2.1 DEMOGRAPHY - study of population size, composition and spatial distribution as affected by births, deaths and migration.

Sources : Census – complete enumeration of the population

2 Ways of Assigning People:

1. De Jure – People were assigned to the place where assigned to the place they usually live regardless of where they are at the time of census.

2.De Facto – People were assigned to the place where they are physically present at are at the time of census regardless, of their usual place of residence.

Components:

1. Population size

2. Population composition

* Age Distribution

* Sex Ratio

* Population Pyramid

* Median age – age below which 50% of the population fall and above

which 50% of the population fall. The lower the median

age, the younger the population (high fertility, high death rates).

* Age – Dependency Ratio – used as an index of age-induced economic drain on human resources

* Other characteristics:

- occupational groups

- economic groups

- educational attainment

- ethnic group

3. Population Distribution

* Urban-Rural – shows the proportion of people living in urban compared to the rural areas

* Crowding Index – indicates the ease by which a communicable disease can be transmitted from 1 host to another susceptible host.

* Population Density – determines congestion of the place

VITAL STATISTICS

the application of statistical measures to vital events (births, deaths and common illnesses) that is utilized to gauge the levels of health, illness and health services of a community.

TYPES:

Fertility Rate

1. A.    CRUDE BIRTH RATE

total # of livebirths in a given calendar year X 1000

estimated population as of July 1 of the same given year

1. B.    GENERAL FERTILITY RATE

total # of livebirths in a given calendar year X 1000

Total number of reproductive age

Mortality Rate

A. CRUDE DEATH RATE

Total # of death in a given calendar year X 1000

Estimated population as of July 1 of the same calendar year

B. INFANT MORTALITY RATE

Total # of death below 1 yr in a given calendar year X 1000

Estimated population as of July 1 of the same calendar year

C. MATERNAL MORTALITY RATE

Total # of death among all maternal cases in a given calendar year X 1000

Estimated population as of July 1 of the same calendar year

Morbidity Rate

A. PREVALENCE RATE

Total # of new & old cases in a given calendar year X 100

Estimated population as of July 1 of the same calendar year

B. INCIDENCE RATE

Total # of new cases in a given calendar year X 100

Estimated population as of July 1 of the same calendar year

C. ATTACK RATE

Total # of person who are exposed to the disease X 100

Estimated population as of July 1 of the same calendar year

III – Epidemiology

The study of distribution of disease or physiologic condition among human population s and the factors affecting such distribution

the study of the occurrence and distribution of health conditions such as disease, death, deformities or disabilities on human populations

1. a.     Patterns of disease occurrence

 Epidemic        

- a situation when there is a high incidence of new cases of a specific disease in excess of the expected.

- when the proportion of the susceptibles are high compared to the proportion of the immunes

Epidemic potential

- an area becomes vulnerable to a disease upsurge due to causal factors such as climatic changes, ecologic changes, or socio-economic changes

Endemic

- habitual presence of a disease in a given geographic location accounting for the low number of both immunes and susceptibles

e.g. Malaria is a disease endemic at Palawan.

- the causative factor of the disease is constantly available or present to the area.

Sporadic 

- disease occurs every now and then affecting only a small number of people relative to the total population

- intermittent

Pandemic

- global occurrence of a disease

Steps in EPIDEMIOLOGICAL IVESTIGATION:

1. Establish fact of presence of epidemic

2. Establish time and space relationship of the disease

3. Relate to characteristics of the group in the community

4. Correlate all data obtained

1. b.    Role of the Nurse

Case Finding

Health Teaching

Counseling

Follow up visit

IV. Health Situation of the Philippines

Philippine Scenario:

· In the past 20 years some infectious degenerative diseases are on the rise.

· Many Filipinos are still living in remote and hard to reach areas where it is difficult to deliver the health services they need

· The scarcity of doctors, nurses and midwives add to the poor health delivery system to the poor

VITAL HEALTH STATISTICS 2005

• PROJECTED POPULATION :

MALE – 42,874,766

FEMALE – 42,362,147

BOTH SEXES - 85,236,913

• LIFE EXPECTANCY

FEMALE - 70 yrs. old

MALE - 64 yrs. Old

LEADING CAUSES OF MORBIDITY

· Most of the top ten leading causes of morbidity are communicable disease

· These include the diarrhea, pneumonia, bronchitis, influenza, TB, malaria and varicella

· Leading non CD are heart problem, HPN, accidents and malignant neoplasm

LEADING CAUSES OF MORTALITY

· The top 10 leading causes of mortality are due to non CD

· Diseases of the heart and vascular system are the 2 most common causes of deaths.

· Pneumonia, PTB and diarrheal diseases consistently remain the 10 leading causes of deaths.

V. Health Care Delivery System

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

HEALTH SECTORS

· GOVERNMENT SECTORS

Department of Health

Vision: Health for all by year 2000 ands Health in the Hands of the People by 2020

Mission: In partnership with the people, provide equity, quality and access to health care esp. the marginalized

5 Major Functions:

1. Ensure equal access to basic health services

2. Ensure formulation of national policies for proper division of labor and proper coordination of operations among the government agency jurisdictions

3. Ensure a minimum level of implementation nationwide of services regarded as public health goods

4. Plan and establish arrangements for the public health systems to achieve economies of scale

5. maintain a medium of regulations and standards to protect consumers and guide providers

· NON GOVERNMENT SECTORS

· PRIVATE SECTORS

PRIMARY STRATEGIES TO ACHIEVE HEALTH GOALS

· Support for health goal

· Assurance of health care

· Increasing investment for PHC

· Development of National Standard

MILESTONE IN HEALTH CARE DELIVRY SYSTEM

· RA 1082 - RHU Act

· RA 1891 - Strengthen Health Services

· PD 568 - Restructuring HCDS

· RA 7160 - LGU Code

VI – National Health Plan

National Health Plan is a long-term directional plan for health; the blueprint defining the country’s health – PROBLEMS, POLICY THRUSTS STRATEGIES, THRUSTS

GOAL :

to enable the Filipino population to achieve a level of health which will allow Filipino to lead a socially and economically-productive life, with longer life expectancy, low infant mortality, low maternal mortality and less disability through measures that will guarantee access of everyone to essential health care

OBJECTIVES:

promote equity in health status among all segments of society

address specific health problems of the population

upgrade the status and transform the HCDS into a responsive, dynamic and highly efficient, and effective one in the provision of solutions to changing the health needs of the population

promote active and sustained people’s participation in health care

“ MAJOR HEALTH PLANS TOWARDS “HEALTH IN THE HANDS OF THE

PEOPLE IN THE YEAR 2020”

A. MAJOR HEALTH PLAN

· 23 IN 93

· Health for more in 94

· Think health…… Health Link

· 5 in 95

B. PRIORITY PROGRAM IN YEAR 2000

· Plan 50

· Plan 500

· Women’s health

·

Children’s health

· Healthy Lifestyle

· Prevention & Control of Infectious Disease

C. PRIORITY PROGRAM IN THE YEAR 2005

· Ligtas Buntis Campaign

· Mag healthy Lifestlye tayo

· TB Network

· Blood Donation Program (RA 7719)

· DTOMIS

· Ligtas Tigdas Campaign

· Murang Gamot

· Anti Tobacco Signature Campaign

· Doctors to the Barrios Program

· Food Fortification Program

· Sentrong Sigla Movement

D. NATIONAL HEALTH EVENTS FOR 2006

 

JANUARY

· National Cancer Consciousness Week – (16-22)

FEBRUARY

· Heart Month

· Dental Health Month

· Responsible Parenthood Campaign National Health Insurance Program

MARCH

· Women’s Health Month

· Rabies Awareness Month

· Burn Injury Prevention Month

· Responsible Parenthood Campaign

· Colon and Rectal Cancer Awareness Month

· World TB Day – (24)

 APRIL

· Cancer in Children Awareness Month

· World Health Day – (7)

· Bright Child Week Phase I -

· Garantisadong Pambata (11-17)

MAY

· Natural Family Planning Month

· Cervical Cancer Awareness Month

· AIDS Candlelight Memorial Day – (21)

· World No Tobacco Day – (31)

JUNE

· Dengue Awareness Month

· No Smoking Month

· National Kidney Month

· Prostate Cancer Awareness Month

JULY

· Nutrition Month

· National Blood Donation Month

· National Disaster Consciousness Month

AUGUST

· National Lung Month

· National Tuberculosis Awareness Month

· Sight-Saving Month

· Family Planning Month

· Lung Cancer Awareness Month

SEPTEMBER

· Generics Awareness Month

· Liver Cancer Awareness Month

OCTOBER

· National Children’s Month

· Breast Cancer Awareness Month

· National Newborn Screening Week (3-9)

· Bright Child Week Phase II Garantisadong Pambata (10-16)

NOVEMBER

· Filariasis Awareness Month

· Cancer Pain Management Awareness Month

· Traditional and Alternative Health Care Month

· Campaign on Violence Against Women and Children

DECEMBER

· Firecracker Injury Prevention Campaign:

· “OPLAN IWAS PAPUTOK”

VII – INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES  (IMCI)

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

· IMCI is an integrated approach to child health that focuses on the well-being of the whole child.

· IMCI strategy is the main intervention proposed to achieve a significant reduction in the number of deaths from communicable diseases in children under five

Goal:

· By 2010, to reduce the infant and under five mortality rate at least one third, in pursuit of the goal of reducing it by two thirds by 2015.

AIM:

· to reduce death, illness and disability, and to promote improved growth and development among children under 5 years of age.

· IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities.

IMCI OBJECTIVES:

· To reduce significantly global mortality and morbidity associated with the major causes of disease in children

· To contribute to the healthy growth & development of children

IMCI COMPONENTS OF STRATEGY:

· Improving case management skills of health workers

· Improving the health systems to deliver IMCI

· Improving family and community practices

**For many sick children a single diagnosis may not be apparent or appropriate

 

Presenting complaint:

· Cough and/or fast breathing

· Lethargy/Unconsciousness

· Measles rash

· “Very sick” young infant

Possible course/ associated condition:

· Pneumonia, Severe anemia, P. falciparum malaria

· Cerebral malaria, meningitis, severe dehydration

· Pneumonia, Diarrhea, Ear infection

· Pneumonia, Meningitis, Sepsis

Five Disease Focus of IMCI:

· Acute Respiratory Infection

· Diarrhea

· Fever

·

Malaria

· Measles

· Dengue Fever

· Ear Infection

· Malnutrition

THE IMCI CASE MANAGEMENT PROCESS

· Assess and classify

· Identify appropriate treatment

· Treat/refer

· Counsel

· Follow-up

THE INTEGRATED CASE MANAGEMENT PROCESS

Check for General Danger Signs:

· A general danger sign is present if:

- the child is not able to drink or breastfeed

- the child vomits everything

- the child has had convulsions

- the child is lethargic or unconscious

ASSESS MAIN SYMPTOMS

· Cough/DOB

· Diarrhea

· Fever

· Ear problems

ASSESS AND CLASSIFY COUGH OR DIFFICULTY OF BREATHING

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

Assess and classify PNEUMONIA

· cough or difficult breathing

· an infection of the lungs

· Both bacteria and viruses can cause pneumonia

· Children with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis (generalized infection).

** A child with cough or difficult breathing is assessed for:

· How long the child has had cough or difficult breathing

· Fast breathing

· Chest indrawing

· Stridor in a calm child.

REMEMBER:

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

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

IMCI COLOR CODING

PINK(URGENT REFERRAL) YELLOW(Treatment  at outpatient health facility)

GREEN(Home management)

OUTPATIENT HEALTH FACILITY

•Pre-referral treatments

•Advise parents

•Refer child

OUTPATIENT HEALTH FACILITY

•Treat local infection

•Give oral drugs

•Advise and teach caretaker

Follow-up

HOMECaretaker is counseled on:

•Home treatment/s

•Feeding and fluids

•When to return immediately

Follow-up

REFERRAL FACILITY

•Emergency Triage and Treatment ( ETAT)

•Diagnosis, Treatment

•Monitoring, follow-up

SEVERE PNEUMONIA OR VERY SEVERE DISEASE

•Give first dose of an appropriate antobiotic

•Give Vitamin A

•Treat the child to prevent low blood sugar

•Refer urgently to the

hospital

•Give paracetamol for fever > 38.5oC

•Any general danger sign or

•Chest indrawing or

•Stridor in calm child

PNEUMONIA

•Give an appropriate antibiotic for 5 days

•Soothe the throat and relieve cough with a safe remedy

•Advise mother when to return immediately

•Follow up in 2 days

•Give Paracetamol for fever > 38.5oC

Fast breathing NO PNEUMONIA : COUGH OR COLD

•If coughing more than more than 30 days, refer for assessment

•Soothe the throat and relieve the cough with a safe remedy

•Advise mother when to return immediately

Follow up in 5 days if not improving

•No signs of pneumonia or very severe disease

Assess and classify  DIARRHEA

A child with diarrhoea is assessed for:

· how long the child has had diarrhoea

· blood in the stool to determine if the child has dysentery

· signs of dehydration

Classify DYSENTERY

· child with diarrhea and blood in the stool

Two of the following signs ?

Abnormally sleepy or difficult to awaken

Sunken eyes

Not able to drink or drinking poorly

Skin pinch goes back very slowly

SEVERE DEHYDRATION

•If child has no other severe classification:

- Give fluid for severe dehydration ( Plan C ) OR

If child has another severe classification :

- Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way - Advise the mother to continue breastfeeding

If child is 2 years or older and there is cholera in your area, give antibiotic for cholera

Two of the following signs :

Restless, irritable

Sunken eyes

Drinks eagerly, thirsty

Skin pinch goes back slowly

SOME DEHYDRATION

•Give fluid and food for some dehydration ( Plan B )

If child also has a severe classification :

- Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way - Advise mother when to return immediately

Follow up in 5 days if not improving

•Not enough signs to classify as some or severe dehydration

NO DEHYDRATION

•Home Care

Give fluid and food to treat diarrhea at home ( Plan A )

•Advise mother when to return immediately

•Follow up in 5 days if not improving

Dehydration present SEVERE PERSISTENT DIARRHEA

•Treat dehydration before referral unless the child has another severe classification

Give Vitamin a

Refer to hospital

No dehydration PERSISTENT DIARRHEA

•Advise the mother on feeding a child who has persistent diarrhea

Give Vitamin A

Follow up in 5 days

Blood in the stool DYSENTERY

•Treat for 5 days with an oral antibiotic recommended for Shigella in your area

Follow up in 2 days

Give also referral treatment

Does the child have fever?

**Decide :

   -  Malaria Risk

- No Malaria Risk

- Measles

- Dengue

Malaria Risk

•Any general danger sign or

Stiff neck

 VERY SEVERE FEBRILE DISEASE / MALARIA

•Give first dose of quinine ( under medical supervision or if a hospital is not accessible within 4hrs )

Give first dose of an appropriate antibiotic

Treat the child to prevent low blood sugar

Give one dose of paracetamol in health center for high fever

(38.5oC) or above

Send a blood smear with the patient

Refer URGENTLY to hospital

•Blood smear ( + )

If blood smear not done:

NO runny nose, and

NO measles, and

NO other causes of fever

    MALARIA

•Treat the child with an oral antimalarial

Give one dose of paracetamol in health center for high fever (38.5oC) or above

Advise mother when to return immediately

Follow up in 2 days if fever persists

If fever is present everyday for more than 7 days, refer for assessment

•Blood smear ( – ), or

Runny nose, or

Measles, or

Other causes of fever

 FEVER : MALARIA UNLIKELY

•Give one dose of paracetamol in health center for high fever (38.5oC) or above

Advise mother when to return immediately

Follow up in 2 days if fever persists

If fever is present everyday for more than 7 days, refer for assessment

No Malaria Risk

•Any general danger sign or

 

VERY SEVERE FEBRILE DISEASE

•Give first dose of an appropriate antibiotic

Treat the child to prevent low

Stiff neck

blood sugar

Give one dose of paracetamol in health center for high fever (38.5oC) or above

Refer URGENTLY to hospital

•No signs of very severe febrile disease

FEVER : NO MALARIA

•Give one dose of paracetamol in health center for high fever (38.5oC) or above

Advise mother when to return immediately

Follow up in 2 days if fever persists

If fever is present everyday for more than 7 days, refer for assessment

Measles

•Clouding of cornea or

Deep or extensive mouth ulcers

SEVERE COMPLICATED MEASLES

•Give Vitamin A

Give first dose of an appropriate antibiotic

If clouding of the cornea or pus draining from the eye, apply tetracycline eye ointment

Refer URGENTLY to hospital

•Pus draining from the eye or

Mouth ulcers

MEASLES WITH EYE OR MOUTH COMPLICATIONS

•Give Vitamin A

If pus draining from the eye, apply tetracycline eye ointment

If mouth ulcers, teach the mother to treat with gentian

violet

•Measles now or within the last 3 months

 MEASLES •Give Vitamin A

Dengue Fever

•Bleeding from nose or gums or

Bleeding in stools or vomitus or

Black stools or vomitus or

Skin petechiae or

Cold clammy extremities or

Capillary refill more than 3 seconds or

Abdominal pain or

Vomiting

Tourniquet test ( + )

  SEVERE DENGUE HEMORRHAGIC FEVER

•If skin petechiae or Tourniquet test,are the only positive signs give ORS

If any other signs are positive, give fluids rapidly as in Plan C

Treat the child to prevent low blood sugar

DO NOT GIVE ASPIRIN

Refer all children Urgently to hospital

No signs of severe dengue hemorrhagic fever

FEVER: DENGUE HEMORRHAGIC UNLIKELY

•DO NOT GIVE ASPIRIN

Give one dose of paracetamol in health center for high fever (38.5oC) or above

Follow up in 2 days if fever persists or child shows signs of bleeding

Advise mother when to return immediately

 

Does the child have an ear problem?

•Tender swelling MASTOIDITIS •Give first dose of

behind the ear

appropriate antibiotic

Give paracetamol for pain

• Refer URGENTLY

•Pus seen draining from the ear and discharge is reported for less than 14 days or

Ear pain

ACUTE EAR INFECTION

•Give antibiotic for 5 days

Give paracetamol for pain

Dry the ear by wicking

Follow up in 5 days

•Pus seen draining from the ear and discharge is reported for less than 14 days

CHRONIC EAR INFECTION •Dry the ear by wicking

Follow up in 5 days

•No ear pain and no pus seen draining from the ear

NO EAR INFECTION •No additional

treatment

Check for Malnutrition and Anemia

Give an Appropriate Antibiotic:

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

2. COTRIMOXAZOLEBID FOR 5 DAYS AMOXYCILLINBID FOR 5 DAYS

 Age or Weight  Adulttablet  Syrup  Tablet   Syrup 

2 months up to 12 months ( 4 – < 9 kg )

1 / 2 5 ml 1 / 2 5 ml

12 months up to 5 years ( 10 – 19kg )

1 7.5 ml 1 10 ml

B. For Dysentery

  COTRIMOXAZOLEBID FOR 5 DAYS  AMOXYCILLINBID FOR 5 DAYS 

 AGE OR WEIGHT  TABLET  SYRUP  SYRUP 250MG/5ML 

2 – 4 months( 4 – < 6kg ) 

½  5 ml 1.25 ml ( ¼ tsp ) 

4 – 12 months( 6 – < 10 kg )

½  5 ml 2.5 ml ( ½ tsp ) 

1 – 5 years old( 10 – 19 kg )

1  7.5 ml ( 1 tsp ) 

C. For Cholera

 TETRACYCLINEQID FOR 3 DAYS 

COTRIMOXAZOLEBID FOR 3 DAYS  

 AGE OR WEIGHT  Capsule 250mg   Tablet  Syrup

2 – 4 months( 4 – < 6kg ) ¼ 1 / 2 5ml

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

1 – 5 years old( 10 – 19 kg 1 1 7.5m

 

Give an Oral Antimalarial

CHOLOROQUINEGive for 3 days

PrimaquineGive single dose in health center for P. Falciparum

PrimaquineGive daily for 14 days for P. Vivax

Sulfadoxine + PyrimethamineGive single dose

AGE TABLET ( 150MG ) TABLET( 15MG) TABLET( 15MG) TABLET( 15MG)

  DAY1 DAY2 DAY3      

2months –5months

½ ½ ½     ¼

5 months –12 months

½ ½ ½     1/2

12months –3 years old 

1 1 ½ ½ ¼ ¾

3 years old -5 years old

1 ½ 1 ½ 1 3/4 1/2 1

GIVE VITAMIN A

AGE VITAMIN A CAPSULES200,000 IU

6 months – 12 months 1//2

12 months – 5 years old 1

GIVE IRON

 

AGE or WEIGHT Iron/Folate TabletFeSo4 200mg + 250mcg Folate (60mg elemental iron)

Iron SyrupFeSo4 150 mg/5ml( 6mg elemental iron per ml )

2months-4months( 4 – <6kg ) 2.5 ml

4months – 12months( 6 – <10kg )

4 ml

12months – 3 years ( 10 – <14kg )

1/2 5 ml

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

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

AGE OR WEIGHT TABLET ( 500MG ) SYRUP ( 120MG / 5ML )

2 months – 3 years ( 4 – <14kg ) ¼ 5 ml

3 years up to 5 years ( 14 – 19 kg ) 1/2 10 ml

GIVE MEBENDAZOLE

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

> hookworm / whipworm are a problem in children in your area, and

> the child is 2 years of age or older, and

> the child has not had a dose in the previous 6 months

VIII – DOH PROGRAMS

DENTAL HEALTH PROGRAM

• To improve the quality of life of the people through the attainment of the highest possible oral health.

• Objective: To prevent and control dental diseases and conditions like dental caries and periodontal diseases thus reducing their prevalence.

OSTEOPOROSIS PROGRAM

• It is characterized by a decrease in bone mass and density that progresses without a symptom or pain until a fracture occurs generally in the hip, spine or wrist.

• Objectives:

• To increase awareness on the prevention and control of osteoporosis as a chronic debilitating condition;

• To increase awareness by physicians and other health professionals on the screening, treatment and rehabilitation of osteoporosis;

• To empower people with knowledge and skills to adopt healthy lifestyle in preventing the occurrence of osteoporosis.

HEALTH EDUCATION & CO

· Accepted activity at all levels of public health used as a means of improving the health of the people through techniques which may influence peoples thought motivation, judgment and action.

Three aspects of health education:

Information

Communication

Education

Sequence of steps in health education:

Creating awareness

Creating motivation

Decision making action

REPRODUCTIVE HEALTH

1. Family Planning

2. MCH & Nutrition

3. Prevention / treatment of Reproductive Tract Infection & STD

4. Prevention of abortion & its complication

5. Education & counseling on sexuality & sexual health

6. Adolescent sexual reproductive health

7. Violence against women

8. Men’s reproductive health ( Male sexual disorder )

9. Breast CA & other gyne problem

10. Prevention / treatment of infertility

OLDER PERSONS HEALTH SERVICES

· Participation in the celebration of Healthy National Elderly Week ( Oct 1-7)- Lecture on healthy lifestyle for the elderly

· Provision of drugs for the elderly( 20% discount)

GUIDELINES FOR GOOD NUTRITION

· Nutritional Guidelines are primary recommendations to promote good health through proper nutrition.

ACTIVITIES:

1.Malnutrition Rehabilitation Program

• Targeted Food Task Force Assistance Program (TFAP)

• Nutrition Rehabilitation Ward

• Akbayan sa Kalusugan sa Kabataan (ASK Project)

2.Micronutrient Supplementation Program

· “23 in ‘93”

· Fortified Vitamin Rice

· “Health for More in ‘94”

· “Buwan ng Kabataan, Pag-asa ng Bayan”

· National Focus: National Micronutrient Day or “Araw ng Sangkap Pinoy“

PROTEIN ENERGY MALNUTRITION

1. Marasmus – looks like an old worried man

- less subcutaneous fats

2. Kwashiorkor – a moon face child

- with flag sign (hair changes)

VITAMIN A DEFICIENCY

Early symptoms: Xeropthalmia (Nigtblindess)

Bitot’s spot (silvery foamy spot located @ lateral sclera)

   

Corneal Xerosis (eye lesion)

Conjunctival Xerosis(scar in the eyes)

Keratomalacia ( whitish to grayish sclera)

BLINDNESS

RESPIRATORY INFECTION CONTROL

• Provision of medicines

• Consultative meetings with CARI coordinators

• Monitoring of health facilities on the implementation of the program

ALTERNATIVE MEDICINE

· RA 8423

· 23 IN 93

1. A.    Herbal Medicine(LUBBY SANTA)

 

Herbal Medicine

 

USES

Lagundi ( Vitex Negundo)

SHARED

 

 

Skin diseases

Headache,

Asthma,fever,cough&colds

Rheumatism

Eczema

Dysentery

Ulasimang Bato (Peperonia Pellucida) Lowers uric acid

Bawang ( Allium Sativum) HAT 

Headache and Tootache

Bayabas ( Psidium Guajava) Anti septic, Anti-diarrheal

Yerba Buena (Mentha Cordifolia)Rheumatism and other body aches, analgesics

Sambong (Blumea Balsamifera) Edema, diuretics

Akapulko Fungal infection, skin diseases

Niog Niogan (Quisqualis Indica) Anti-helminthic

Tsaang Gubat (Carmona Retusa) Diarrhea

Ampalaya (Momordica Charantia) DM

MATERNAL- CHILD CARE

I – Maternal Care

A.    FAMILY PLANNING

  I.    Spacing / Artificial Method

A. Hormonal

B. Mechanical & Barrier

C. Biologic

D. Natural

II.   Permanent (surgical/irreversible)

A. Tubal Ligation

B. Vasectomy

III. Behavioral Method

 

B.  BREASTFEEDING

II – CHILD CARE

A.  UNDER FIVE CARE PROGRAM

· A package of child health-related services focused to the 0-59 months old children to assure their wellness and survival

Growth Monitoring Chart (GMC)

· A standard tool used in health centers to record vital information related to child growth and development, to assess signs of malnutrition

B.  EXPANDED PROGRAM ON IMMUNIZATION

· LEGAL BASIS

· PD #996 – Compulsory basic

· PP #147 – National Immunization Day

· PP #773 – Knock out Polio Days

· PP # 1064 – polio eradication campaign

· PP #4 - Ligtas Tigdas month

MENTAL HEALTH

a state of well-being where a person can realize his or her own abilities, to cope with the normal stresses of life and work productively

Components of Mental Health Program

Stress Management and Crisis Intervention

Drugs and Alcohol Abuse Rehabilitation

Treatment and Rehabilitation of Mentally-Ill Patients

Special Project for Vulnerable Groups

 SENTRONG SIGLA MOVEMENT

AIM: to promote availability of quality health services

4 pillars:

Quality assurance

Grants & technical assistance

Health promotion

Award

COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH

Community Organizing

· a continuous and sustained process of

· EDUCATING THE PEOPLE,

· CRITICAL AWARENESS

· MOBILIZING

Participatory Action Research

· A combination of education, research and action.

· The purpose is the EMPOWERMENT of people

4 Phases:

· Pre entry

· Entry

· Organizational Building

· Sustenance and Strengthening

 

Laws Affecting CHN Implementation:

RA 8749 – Clean Air Act (2000)

RA 6425 – Dangerous Drug Act: sale, administration and distribution of prohibited drugs is punishable by law

RA 9173

RA 2382 – Philippines Medical Act: define the practice of medicine in the Philippines

RA 1082 – Rural Health Act: employment of more physicians, nurses, midwives who will live in the rural areas to help raise the health condition.

RA 3573 –   Reporting of Communicable Disease

RA 6675 – Generic Act: promotes, requires and ensures the production of an adequate supply, distribution, use of drugs identified by their generic names.

RA 6365

RA 6758

RA 4703

RA 7305 – Magna Carta for Public Health Workers (approved by Pres. Corazon C. Aquino): aims to promote and improve the social and economic well being of health workers, their living and conditions.

RA 7160 – Local Government Code: responsibility for the delivery of basic services of the national government

IX – CHRONIC COMMUNICABLE DISEASES

I – TUBERCULOSIS

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

Causative Agent: Mycobacterium Tuberculosis

S/S: 

cough

afternoon fever

weight loss

night sweat

blood stain sputum

Prevalence/Incidence:

ranks sixth in the leading causes of morbidity (with 114,221 cases) in the Philippines

sixth leading cause of mortality (with 28507 cases) in the Philippines.

Nursing and Medical Management

Ventilation systems

Ultraviolet lighting

Vaccines, such as the bacillus Calmette Guerin (BCG) vaccine

drug therapy

Preventing Tuberculosis

BCG vaccination

Adequate rest

Balanced diet

Fresh air

Adequate exercise

Good personal Hygiene

DOTS  (Direct Observed Treatment Short Course)

Regimen Type of TB Patient

Regimen I

2RIPE / 4RI

New pulmonary smear (+) cases

New seriously ill pulmonary smear (-)

cases w/ extensive lung lesions

New severely ill extra-pulmo TB

Regimen II

2RIPES/

1RIPE / 5RIE

New pulmonary smear (+) case

New seriously ill pulmonary smear (-) cases w/ extensive lung lesions

New severely ill extra-pulmo TB

Regimen III

 

2RIP / 4RI

New smear(-) but with minimal pulmonary TB on radiography as confirmed by a medical officer

New extra-pulmo TB (not serious)

II – LEPROSY

Sometimes known as Hansen’s disease

is an infectious disease caused by , an aerobic, acid fast, rod-shaped mycobacterium

Gerhard Armauer Hansen

Historically, leprosy was an incurable and disfiguring disease

Today, leprosy is easily curable by multi-drug antibiotic therapy

Signs & Symptoms

Early stage(CLUMP)                                Late Stage(GMISC)

Change in skin color Gynocomastia

Loss in sensation Madarosis(loss of eyebrows)

Ulcers that do not heal Inability to close eyelids (Lagopthalmos)

Muscle weakness Sinking nosebridge

Painful nerves Clawing/contractures of fingers & nose

Prevalence Rate

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

MANAGEMENT:

Dapsone, Lamprene

clofazimine and rifampin

Multi-Drug-Therapy (MDT)

six month course of tablets for the milder form of leprosy and two years for the more severe form

X – Vector Borne Communicable Disease

I – LEPTOSPIROSIS

an infectious disease that affects humans and animals, is considered the most common zoonosis in the world

Causative Agent: Leptospira interrogans

S/S:

-high fever -severe headache

-chills -muscle aches

-vomiting -may include jaundice (yellow skin and eyes)

-red eyes -abdominal pain

-diarrhea

TREATMENT:

PET - > Penicillins , Erythromycin, Tetracycline

 

II – MALARIA

Malaria (from Medieval Italian: mala aria – “bad air”; formerly called ague or marsh fever) is an infectious disease that is widespread in many tropical and subtropical regions.

Causative Agent: Anopheles female mosquito

Signs & Symptoms:

Chills to convulsion

Hepatomegaly

Anemia

Sweats profusely

Elevated temperature

Treatment: Chemoprophylaxis – chloroquine taken at weekly interval, starting from 1-2 weeks before entering the endemic area.

Preventive Measures: (CLEAN)

Chemically treated mosquito nets

Larvae eating fish

Environmental clean up

Anti mosquito soap/lotion

Neem trees/eucalyptus tree

III – FILIARIASIS

name for a group of tropical diseases caused by various thread-like parasitic round worms (nematodes) and their larvae

larvae transmit the disease to humans through a mosquito bite

can progress to include gross enlargement of the limbs and genitalia in a condition called elephantiasis

S/S:

Asymptomatic Stage

Characterized by the presence of microfilariae in the peripheral blood

No clinical signs and symptoms of the disease

Some remain asymptomatic for years and in some instances for life

 Acute Stage

Lymphadenitis (inflammation of lymph nodes)

Lymphangitis (inflammation of lymph vessels)

In some cases the male genitalia is affected leading to orchitis (redness, painful and tender scrotum)

Chronic Stage

Hydrocoele (swelling of the scrotum)

Lyphedema (temporary swelling of the upper and lower extremities

Elephantiasis (enlargement and thickening of the skin of the lower and / or upper extremities, scrotum, breast)

MANAGEMENT:

Diethylcarbamazine

Ivermectin,

Albendazolethe

No treatment can reverse elephantiasis

VI – SCHISTOSOMIASIS

parasitic disease caused by a larvae

Causative Agent: Schistosoma intercalatum, Schistosoma japonicum, Schistosoma mansoni

Signs & Symptoms: (BALLIPS)

Bulging abdomen

Abdominal pain

Loose bowel movement

Low grade fever

Inflammation of liver & spleen

Pallor

Seizure

Treatment: Diethylcarbamazepine citrate (DEC) or Hetrazan (drug of choice)

VII – DENGUE

DENGUE is a mosquito-borne infection which in recent years has become a major international public health concern..

It is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas.

S/S: (VLINOSPARD)

Vomiting

Low platelet

Nausea

Onset of fever

Severe headache

Pain of the muscle and joint

Abdominal pain

Rashes

Diarhhea

TREATMENT:

The mainstay of treatment is supportive therapy.

- intravenous fluids

- A platelet transfusion

Millenium Goals

Posted: September 17, 2011 in CHN

0

Goal 1. Eradicate extreme poverty and hunger

Target 1. Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day

o Poorest quintile’s share in national income or consumption, per cent (WB)

o Population below $1 (PPP) per day consumption, percentage

o Population below national poverty line, rural, percentage

o Population below national poverty line, total, percentage

o Population below national poverty line, urban, percentage

o Poverty gap ratio

o Purchasing power parities (PPP) conversion factor, local currency unit to international dollar

Target 2. Halve, between 1990 and 2015, the proportion of people who suffer from Hunger

o Children under 5 moderately or severely underweight, percentage

o Children under 5 severely underweight, percentage

o Population undernourished, number of people

o Population undernourished, percentage

Goal 2. Achieve universal primary education

Target 3. Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling

o Literacy rates of 15-24 years old, both sexes, percentage

o Literacy rates of 15-24 years old, men, percentage

o Literacy rates of 15-24 years old, women, percentage

o Net enrolment ratio in primary education, both sexes

o Net enrolment ratio in primary education, boys

o Net enrolment ratio in primary education, girls

o Percentage of pupils starting grade 1 reaching grade 5, both sexes

o Percentage of pupils starting grade 1 reaching grade 5, boys

o Percentage of pupils starting grade 1 reaching grade 5, girls

o Primary completion rate, both sexes

o Primary completion rate, boys

o Primary completion rate, girls

Goal 3. Promote gender equality and empower women

Target 4. Eliminate gender disparity in primary and secondary education, preferably by 2005, and to all levels of education no later than 2015

o Gender Parity Index in primary level enrolment

o Gender Parity Index in secondary level enrolment

o Gender Parity Index in tertiary level enrolment

o Seats held by men in national parliament

o Seats held by women in national parliament

o Seats held by women in national parliament, percentage

o Share of women in wage employment in the non-agricultural sector

o Total number of seats in national parliament

o Women to men parity index, as ratio of literacy rates, 15-24 years old

Goal 4. Reduce child mortality

Target 5. Reduce by two thirds, between 1990 and 2015, the under-five mortality rate

o Children 1 year old immunized against measles, percentage

o Children under five mortality rate per 1,000 live births

o Infant mortality rate (0-1 year) per 1,000 live births

Goal 5. Improve maternal health

Target 6. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

o Births attended by skilled health personnel, percentage

o Maternal mortality ratio per 100,000 live births

Goal 6. Combat HIV/AIDS, malaria and other diseases

Target 7. Have halted by 2015 and begun to reverse the spread of HIV/AIDS

o AIDS deaths

o Condom use to overall contraceptive use among currently married women 15-49 years old, percentage

o Contraceptive use among currently married women 15-49 years old, any method, percentage

o Contraceptive use among currently married women 15-49 years old, condom, percentage

o Contraceptive use among currently married women 15-49 years old, modern methods, percentage

o Men 15-24 years old, who know that a person can protect himself from HIV infection by consistent condom use, percentage

o People living with HIV, 15-49 years old, percentage

o Ratio of school attendance rate of orphans to school attendance rate of non orphans

o Women 15-24 years old, who know that a healthy-looking person can transmit HIV, percentage

o Women 15-24 years old, who know that a person can protect himself from HIV infection by consistent condom use, percentage

Target 8. Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

o Tuberculosis death rate per 100,000 population

o Tuberculosis detection rate under DOTS, percentage

o Tuberculosis prevalence rate per 100,000 population

o Tuberculosis treatment success rate under DOTS, percentage

Goal 7. Ensure environmental sustainability

Target 9. Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources

o Carbon dioxide emissions (CO2), metric tons of CO2 per capita (CDIAC)

o Carbon dioxide emissions (CO2), thousand metric tons of CO2 (CDIAC)

o Consumption of all Ozone-Depleting Substances in ODP metric tons

o Consumption of ozone-depleting CFCs in ODP metric tons

o Energy use (Kg oil equivalent) per $1,000 (PPP) GDP

o Land area covered by forest, percentage

o Protected area to total surface area, percentage

o Protected areas, sq. km.

Target 10. Halve by 2015 the proportion of people without sustainable access to safe drinking water

o Proportion of the population using improved drinking water sources, rural

o Proportion of the population using improved drinking water sources, total

o Proportion of the population using improved drinking water sources, urban

o Proportion of the population using improved sanitation facilities, rural

o Proportion of the population using improved sanitation facilities, total

o Proportion of the population using improved sanitation facilities, urban

Target 11. By 2020 to have achieved a significant improvement in the lives of at least 100 million slum dwellers

o Slum population as percentage of urban, percentage

o Slum population in urban areas

Goal 8. Develop a global partnership for development

Target 15. Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term

o Debt service as percentage of exports of goods and services and net income from abroad

Target 16. In cooperation with developing countries, develop and implement strategies for decent and productive work for youth

o Ratio of youth unemployment rate to adult unemployment rate, both sexes

o Ratio of youth unemployment rate to adult unemployment rate, men

o Ratio of youth unemployment rate to adult unemployment rate, women

o Share of youth unemployed to total unemployed, both sexes

o Share of youth unemployed to total unemployed, men

o Share of youth unemployed to total unemployed, women

o Share of youth unemployed to youth population, both sexes

o Share of youth unemployed to youth population, men

o Share of youth unemployed to youth population, women

o Youth unemployment rate, aged 15-24, both sexes

o Youth unemployment rate, aged 15-24, men

o Youth unemployment rate, aged 15-24, women

Target 18. In cooperation with the private sector, make available the benefits of new technologies, especially information and communications

o Internet users

o Internet users per 100 population

o Personal computers

o Personal computers per 100 population

o Telephone lines and cellular subscribers

o Telephone lines and cellular subscribers per 100 population

Components of a Community Health Care: Components of A Community

Posted: September 17, 2011 in CHN

0

1. The CORERepresents the people that make up the community included in the community CORE are the demographic of the population as well as the values, beliefs and history of the people.

2. Eights (8) subsystems of the communitya.Housing – what type of housing facilities are there in the community, are there enough housing facilities available; are there housing laws/regulations governing the people? What are these?

b. Education – these include laws, regulations, facilities, activities affecting education, ratio of health educators to learners, distribution of educational facilities, who utilizes these, what informal educational facilities and activities exist in the community.

c. Fire and Safety – fire protection facilities and fire prevention activities, distribution of these.

d.Politics and government – political structures present in the community, decision-making process/pattern leadership style observed, etc.

e. Health – health facilities and activities: distribution, utilization, ratio of providers to clientele served; priorities in health, programs developed, etc…

f. Communication – systems, types of communication existing, forms of communication, be it formal or informal; etc..

g. Economics – occupation, types of economic activities, income, etc…

h. Recreation – recreational activities/facilities: types, consumers, appropriateness to consumers, etc…

ELEMENTS OF A HEALTH COMMUNITY1. People are partners in health care

2. People work together to attain goals.3. Physical environment promotes health, safety, order and cleanliness.4. Safe water and nutritious food.5. Families provide members with basic needs.6. Available, affordable health care.

A HEALTH COMMUNITY…

1. … prompts its members to have a high degree of awareness that “we are community”2. … uses its natural resources while taking steps to conserve them for future generations.3. … openly recognizes the existence of sub-groups and welcomes their participation in community affairs.4. … is prepared to meet crises.5. … is a problem-solving community; it identifies, analyzes & organizes organizes to meet its own needs.6. … has open channels of communication that allows information to flow among all subgroups of its citizens in all directions7. … seeks to make each of its system’s resources available to all members of the community.8. … has legitimate and effective ways to settle disputes and meet needs that arise within the community.9. … encourages maximum citizen participation in decision-making.10. … promotes a high level wellness among all its members.

CHN Complete

Posted: September 17, 2011 in CHN

0

Community Health Nursing

CHW – group of people with common chrematistics or interest within a territory or geographical boundary

Community

1. Patient/Client

2. Setting - outside curative institutions

home – family HNSg

school – SHSg

places of work – occupational HNSg

World Views:

1. Community integral part of society compose of families

Eg. – poor community

under nutrition

poor food supply

level of knowledge – poor

o intrapersonal conflict – choosing what to wear

o intrapersonal family

o intrapersonal community (interfamilial) regionalism – parochial

o intra sociedad (inter societal)

2. Conflicts/contradiction – always present in the community

Note: Should be positive in dealing with conflict.

3. Condition in the family is always changing

Health

1. Wellness – Illness continuum

Optimum – internal ————- death

Wellness - external

External

Macro system

political

economic

socio cultural – education, customs, beliefs, practices, tradition, mass media

o maintain continuum balance and purpose direction with environment

o progress toward a high level of FXU, lice to the fullest potential

o Epidemiologic model

2. High Level Wellness

3. Agent Host Environmental Model

Agent (Etiologic Facts)

1. Infections/biological factor

2. Mechanical

3. Physical

4. Carcinogenetics – pringels, tobleron (GMO’s – chemical

5. Poison – eg. MSG

6. Allergies

7. Nutritive elements

8. Psychological

Host – intrinsic factor – age, sex

exposure

response – susceptibility

- resistance

environment – extrinsic factor

4. Health Belief Model

relationship bet a person’s belief and his behavior in health

3 components

1. Susceptibility to illness

2. Seriousness of an illness

3. Benefits taking the action

 AN/AIDS

Common in

1. Commercial Sex Worker – unprotactive penetrated sex

2. Sea farers

3. Religious Nums

Vaginal – male and female 1:000

Oral – male to male also common in male to female 1:200

Felacio – mouth to penis

Oral – cumaningus – mount to vagina

Aningus – mouth to amus

Preventive :

1. abstinence – sex (safe)

2. Be Faithful – Mutual/Monogamy

3. Correct continous consistent use of condom

4. Do no penetrate

5. Evolutionary Based Model

illness and death sometimes serves an evolutionary function

Elements:

life events

life style determinants

control perception

viability emotions

health out comes

o client’s won being

o health is not merely the absence of DSE illness of infirmity

o state of complete physical mental, and social wen being

6. Health Promotion Model

7. WHO – Definition 1978 – Alma Ata

Health

1. Social phenomenon – Health outcome is interplay of different societal factors

outcome with interplay of different factors and society:

biological

physical

ecologic multiple causation Theory

political (Holistic)

economic

socio-cultural

Community Health

Part of medical paramedical intrapersonal which is concerned and the heath of the whole population.

Major Concept

1-health promotion & DSE prevention

2- people participation

Individual    Applied   Community

Client Study As Client

- Anatomy - structure - demography

- Physio - functions - Sociology

- Patho - malfunction - epidemiology

Public Health & Longetirity (CBQ)

WINSLOW – contribution to the most effective total development and life on the

Individual and the society.

HANLON – priority the survival of the species the prevention of condition which

lead to the structure destruction or retardation of human function and

potential in early year of life.

Communication Health Nursing

- special field of nursing that combines the skills of nursing public health, and some phases of social assistance and FXUS as part of the total health project and promotion of health.

JACOBSON – is a learned practice discipline with the ultimate goal of contributing as individual and in collaboration with others, promotions of clients’ optimum level of fractioning through teaching and delivery care.

Jacobson Major Roles

1. Health Educator

2. Provider of Nursing Care

FREEMAN – aimed developing and enhancing health capability of people,

Individual, families and communities.

Community

People Organization (PO)

Agency

1. Ngo

2. GO – DOH – National – Regional – Province – Municipal – BHW

RA – 7305 – Magna Corta of PHWorker

RA – 7160 – Local Government Code

Devolution of Health Services

CHN CONCEPTS:

1. 10 Focus on CHN is an heath promotion

2. CHN practice is extended to benefit not only individual but whole & family

3. CHN are generalist in terms of their practice throughout life’s continuum – its full range of Health problems and need.

4. Contact with client may continue over a long period of time which includes all ages and types of HC

Levels

Primary HC – community

20 HC – Regimal, Provincial, Municipal & District

Tertiary – sophisticated medical center

Assessment:

Community Dx

health problems and needs

sources of solve to problem

Principle of Community Health Nursing

1. Recognize needs of individual

2. Knowledge and understanding of agency and policies facilitates goal achievement

3. The family is the unit of service

Planning

1. Prioritization

2. Goal setting

3. Objectives

4. Actions/Intervention

5. Evaluation out come:

- criteria

- standard

Health Education and Counseling

common goal – behavior change or modification

Basic Different

Health Education – dive advice

Counseling – provide all option

Implementation:

Community – family focus of /unit of care

4. Respect values, customs and beliefs of clients – as nurse we should not be judgmental

5. Health education and counseling are vital parts of CHN

6. Collaborative working relationship with the health team facilitates goals achievement.

7. Continuing staff education ensures quality client care and upgrade nursing practice.

8. Indigenous and communication resources

appropriate tech – methods and tech both scientifically sound and socially

and acceptable

9. Individual families and communities must actively participate in decision making

10. Supervising of nursing services be qualified personnel provides guidance and direction to work.

11. Accurate recording and reporting serve as bases for evaluation and guide for future actions.

12. Periodic and continuing education

board quest

how would you evaluate – objective – if both present answer this

criteria

HEALTH SITUATION

1. Health Indices

A. Basic Indicators Anemia

1. Nutrition 48% of Filipinos

2. DSE Pattern 58% of pregnant women

- morbidity

- mortality

infant mortality rate according to DOH – 18.7

life expectancy: Female 69.2

Male 63.7

HEALTH PROMOTION

Consist of activities directed towards increasing the fever of well being and actualizing the health potential of individuals families communication and societies.

Different with prevention

not desl dysixy or health problem financial

“approach “ behavior not

avoidance behavior

seeks to expand (+) potential for health

Multidimensional Nature of Health Promotion

1. Individual – lifestyle

- personal habits & practices affecting health

-lifestyle

- lifestyle responsibility

2. Family – health behavior and belief

3. Community – norms

4. Environment – harmony and bal bet human and surroundings

5. Society – basic human needs

 

HEALTH PROMOTION METHODS

health education

Good standard nutrition adjusted to development phases of life

Attention to personality development

Provision of adequate housing

Recreation and agreeable working condition

Genetics counseling

Periodic selective examination – self breast examination (SBE)

SCREENING METHOD

Presumptive identification of unorganized dse or defect by the application of test, examination or other procedures that can be applied rapidly and inexpensively population.

mass screening

case finding

contact tracing

multi phasic screening eg HIV antibody testing

surveillance

RA 7305 – Jon reporting of communicable dse

Tertiary Prevention

methods

Dx

Tx

Mx

Rehabilitation

Community Organizing

Awareness raising

Organizing

Mobilizing / responsible action

Key Concepts and Principles

1. Objective analysis of objective condition – scientific

2. Basic trust among people

3. By the people from the people, for the people

4. People want and can change

5. Self-willed changes will have move meaning and performance than imposed changes.

Primary Health Care

- Essential care based on scientifically – sound and socially acceptable methods and technology made universally available to individuals families and communities at the cost they can afford at any given stage development than their full participation towards self-reliance and self determination.

8 Primary Health Care

1. Health Education

2. Food Supply and Nutrition

3. Immunization

4. Hw and Basic Sanitation

5. Prevent & control of common dse

6. Tx of endemic dse

7. MCH including FP

Individual

1. Assessment

a. Data collection

2 types data – subject & objective

2 methods – interview & observation

4 Instruments

1. Nursing History (subjective)

2. Physical Examination

3. Laboratory Exam

4. Process Recording

b. Data Analysis

2. Nsg. Dx

Health Care V/E Etiology

3. Planning

a. Prioritization

b. Goal

c. Objective

d. Nsg. Intervention

e. Evaluation Outcomes - Criteria , standard

4. Implementation

- health educator

- provider of HC

- supervisor Client /Patient Advocate

- researcher

- health organizer

- CH, Monitor

 

8 Basic Tasks:

1. Physical Maintenance

2. Allocation of Resources

3. Division of Labor

4. Socialization of Family Members

5. Reproduction, recruitment and releases

6. Maintenance of order

7. Placement of members in larger society – production of good member

8. Maintenance of motivation and morale

Nuclear Family – Mother, Father, son & daughter

Extended – grandparent relation or daughter in law.

First Level Assessment

Health Threats

Health Deficits

Forcible Crisis/Stresspoints

Family Tasks

1. Ability to recognize the presence of the problem

2. Ability to make decisions.

3. Ability to perform nursing care to sick

4. Ability to provide home environment

5. Ability to utilize community resources

Incubation Pd- entry of Pathogen to appearance of 1st SK

 IMMUNITY

Passive – quick to come/to go active – slow to come / to go

1. natural – utero, breast feeding 1. Natural – getting the dse

2. Artificial – sevum prob. Antitoxin 2. Artificial – utanus toxoid

Pregnant

TT1 – 4th month

TT2 – 8th month

Pregnancy 2

TT3 – booster 1st

Pregnancy 3

TT4 – booster 2nd

Pregnancy 4

TT5 – booster – lifelong immunization

Community Mental Health Nursing

1. A unique process which includes an integration of concepts from nursing mental health, social psychology community network.

Occupational Health Nursing

- Application of Nursing principles and procedure conserving health of the healthworkers.

School Health Nursing

Components

1. School Health Services

2. Health Instruction

a. direct – nurse doing the school teaching

b. indirect

3. Health School Living

4. School – Community Linkage

Median age of Filipinos is 20 yrs old

50 % – 20 years old

50% – above 20 years old

Vital Statistics – application of statiscal measure to vital events fertility , mortality, morbidity

RA 3753 – Civil Registry Law

Requires the registration of births and deaths to local registrars

RA 3573 – Law on reporting notifiable disease

Family Planning Program

Goal Improve material & child through:

proper timing of pregnancy

proper spacing of pregnancy

number of pregnancies

Pregnancy :

Ideal age: 30-30- yrs.

20 -18 - 30 – 35 with risk

18 – 35 – high risk

Ideal interval – 3 years

2 years – with risk

4 years – high risk

ideal No – 3

4 – with risk

4 – risk

 

COMMUNICABLE DISEASE NURSING COMMUNICABLE DISEASE

Posted: September 17, 2011 in CHN

0

Infectious Agent or its toxic products – AGENTDirectly or Indirectly – MODE OF TRANSMISSIONPerson, Animal or Intermediate Vector – HOSTEnvironment – ENVIRONMENTECOLOGIC TRIAD OF DISEASEAgent – element, substance, animate or inanimate that may serve as stimulus to initiate a disease processHost – organism that provides nourishment for another organismEnvironment – physical (climate), biological (plants & animals)CONTAGIOUS VS. INFECTIOUSContagiousDiseases that are easily spread directly transmitted from person to person (direct contact) through an intermediary hostInfectiousDiseases that caused by a pathogen not transmitted by ordinary contact but require a direct inoculation through a break in the skin or mucous membrane.NOTE: ALL CONTAGIOUS DISEASE ARE INFECTIOUS BUT INFECTIOUS DISEASE IS NOT ALWAYS CONTAGIOUS

What is Infection?INFECTION – “the state or condition in which the body or part of the body is invaded by a pathogenic agent ( bacteria, virus, parasites etc.) which under favorable conditions multiplies and produces effects which are injurious…”

Infectious AgentA. RESIDENT ORGANISMSdeeply seated in the epidermis, not easily removed by simple handwashing,Ex: Staphylococci

B. TRANSIENT ORGANISMrepresent recent contamination,survive for a limited period of time, acquired during contact with the infected colonized patient or environment,easily removed by good handwashing

Ex: ( Klebsiella & Pseudomonas)

Infectious AgentBacteria – heama organism, systemicVirus – nuero organism, systemicFungi – skin organism, localProtozoa – GI organism, localInfectious Agent

FACTORS THAT AFFECTS THE AGENT TO DEVELOP A DISEASEPathogenicity – ability to cause a diseaseInfective dose – no of organism to initiate infectionVirulence – ability to enter or move through tissuesSpecificity – ability of the organism to develop antigens

STAGES OF INFECTIOUS PROCESSMeans of Transmission1. CONTACT – most common means of transmitting microorganisms from one person to another.A. Direct Contact (person to person)occurs when one person touches anotherbest vehicle is the Hands especially those of the Health Care workersB. Indirect Contact (inanimate object)- occurs when a person touches an inanimate object contaminated by an infected patient2. AIRBORNE- droplet, dust, organisms in env.3. VECTOR – insects or animals4. VEHICLE- food (salmonella), water (shigellosis), blood (Hepa B), medication ( contaminated infusion)

PREVENTION OF COMMUNICABLE DISEASEHealth Education – primary role of the nurse

Specific Protection- handwashing, use of protective devicesEnvironmental Sanitation – clean and conducive for health

Definition of Prevention“Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability. The concept of prevention is best defined in the context of levels, traditionally called primary, secondary, and tertiary prevention”

Prevention of Needlestick InjuriesDispose Used Needles in Puncture Proof Needle ContainersDon’t Recap Needles (Unless using the One-handed Technique)Use Gloves When Handling Needles (Won’t Prevent Injuries but May Lessen Chance of Transmitting Diseases)

CONTROL OF C0MMUNICABLE DIESEASE1. Notification2. Epidemiological Investigation3. Case finding; early dx and prompt treatment4. Isolation and Quarantine5. Disinfection; disinfestation6. Medical Asepsisa. Handwashingb. Concurrent disinfectionc. Personal protective equipments (PPEs)d. Barrier Cards/Placarding

Objectives of CCDRestoration of health, reduce deaths and disabilityInterpretation of control measures to IFC for practice to prevent spread of CD.Promotion of health and prevention of spread of CD

Diseases that require weekly monitoring:1. Acute flaccid paralysis (AFP) polio2. Measles3. Severe acute diarrhea (SAD)4. Neonatal tetanus5. AIDS

Diseases that require reporting w/in 24 hrs1. Acute flaccid paralysis (AFP) polio2. Measles

Diseases targeted for eradication1. Acute flaccid paralysis polio2. Neonatal tetanus3. Measles4. Rabies

EpidemiologyStudy of the occurrence and distribution of diseases in the population

Patterns of occurrence of disease –frequency of disease occurrenceSporadicOn and off occurrence of the diseaseMost of the time it is not found in the communityOne or two cases that occur are not relatedEndemicPersistently present in the community all year roundEx: malaria in PalawanEpidemicAn unexpected increase in the number of cases of diseasePandemicEpidemic of a worldwide proportionsTime Related Patterns of Occurrencecyclical variationa periodic increase in the number of cases of a diseasea seasonal disease, an increase is expected or there is usual increase- dengue fever during rainy seasons are increased but it is not considered an epidemic because it is expected to rise at this particular timehot spot-a rising increase that may lead to an epidemic

Time Related Patterns of OccurrenceShort time fluctuationA change in the frequency of occurrence of a disease over a short period of timeMaybe (+) or (-)Secular variationA change in the frequency of occurrence of a diseae taking place over a long period of timeEx: a.) the change in the pattern of occurrence of polio after being eradicated in 2000, then sudden repport of cases in 2001 due to mutant restraints.b.) small pox virus-eradicated in 1979 (last case reported) and no another incidence as of todayTypes of EpidemiologyDescriptive Epidemiology – concerned with disease frequency & distributionAnalytic EpidemiologyIs a study of the factors affecting occurrence and distribution of the disease.Ex. Epidemiologic investigationTherapeutic/ClinicalStudy of the efficacy of a treatment of a particular diseaseEx. Clinical trial of a newly proposed therapeutic regimenEvaluation EpidemiologyStudy of the over-all effectiveness of a total/ comprehensive public health program.Ex. Evaluation of the under five clinic

Note: We make use of the epidemiology in CHN in order to come up a community diagnosis and also to determine the effectiveness of a particular treatmentTypes of Epidemiologic Data

Demographic dataDemography is the study of population groupsEx. Population size and distributionVital StatisticsEnvironmental dataHealth services dataEx. Ratio between nurse and the population being servedEx. Degree of utilization of health facility/ serviceEpidemiologic Investigation

1st step- Statement of the problem2nd step- Appraisal of facts – describing the epidemic in terms of time, place, person.3rd step- formulation of hypothesis4th step-Testing the hypothesis5th step- Conclusion and recommendation

TERMSDisinfection – pathogens but not spores are destroyed

Disinfectant – substance use on inanimate objects

Concurrent disinfection – ongoing practices in the care of the patient to limit or control the spread of microorganisms.

Terminal disinfection – practices to remove pathogens from the patient’s environment after his illness is no longer communicable

FACTORS AFFECTING ISOLATIONMode of TransmissionSourceStatus of the client’s defense mechanismAbility of client to implement precautionsISOLATIONEPILaunched by DOH in cooperation with WHO and UNICEF last July 1976Objective – reduce morbidity and mortality among infants and children caused by the six childhood immunizable diseasesPD No. 996 (Sept. 16, 1076) – “ Providing for compulsary basic immunization for infants and children below 8 y/oPP No. 6 (April 3, 1996) – “ Implementing a United Nations goal on Universal Child Immunization by 1990”RA 7846 (Dec. 30, 1994) – immunization hepa BPD No. 4 (July 29, 1998) – “Declaring the period of September 16 to October 14, 1998 as Ligtas Tigdas Month and launching the Phil Measles Elimination Campaign”

Legislation, Laws affecting EPI

Proclamation No. 46 – “polio eradication project”Proclamation No. 1064 – AFP surveillanceProclamation No. 1066 – National Neonatal Tetanus Elimination Campaign

EPIBCG – TBDPT – Diptheria, Pertussis, TetanuOPV – PoliomyletisHepatitis BMeaslesImmunizationContraindications-conditions that require hospitalizationFor DPT 2 and 3 – history of seizures/ convulsions within 3 days after the first immunization with DPTNursing responsibility: ask how the child reacts to the first doseFor infant BCG – clinical AIDSThe following conditions are NOT contraindications:Fever up to 38.5 ºCSimple or mild acute respiratory infectionSimple diarrhea without dehydrationMalnutrition (it is indication for immunization)

Schedule of immunizationInfant BCG0 to 11 months or 0 to 1 yearat birth0.05 ml (dose) – ID, right armSchool entrance BCGWhen the child enters Grade 1 with or without scar on the right arm then still go on with the vaccination except if he is repeating Grade 1

Schedule of immunizationDPT3 doses, 4 weeks or 1 month intervalTarget age: 1 ½ to 11 months but child is eligible up to 6 yearsIf 7 years old and above DT only not P0.5 ml, IM, vastus lateralis

Schedule of immunizationOPV3 doses, 4 weeks/1 monthTarget population: same as above, eligibility until Grade 62-3 drops, oral route*Feb 8-March 8: Oplan Polio Revival DriveNo side effect, but advise the mother to avoid feeding the child for 30 minutes after the vaccine, if vomits within the 30 minute period, repeat the vaccination

Schedule of immunizationHepa B3 doses, 4 weeksCan be given at birthTarget age 1 ½ to 11 months0.5 ml, IM, vastus lateralisPatient may experience local tendernessSchedule of immunizationMeasles9 to 11 monthsMost babies have protection because of maternal antibodies thus this vaccine is given at 9 months because the time where the maternal antibodies wear off, other virus if it still active it will kill the vaccine0.5 ml, subcutaneous, any armMeaslesFever and measles rash lasting for 1 to 3 days within 2 weeks after immunization (modified measles)

ImmunizationFully Immunized Child – when he received all the antigens that should be given in the first year of life (1 dose BCG, MV; 3 doses DPT, OPV, HB)Completely Immunized Child – All vaccines given but went beyond 0ne year of age

CHN 1

Posted: September 17, 2011 in CHN

0

History

Act No. 157- Creation of Board of Health of the Philippine (BON)

Act No. 1407- Abolish BOH to DILG

1919 Mrs. Carmen Del Rosario – 1st Filipino Nurse Supervisor

1990-1992 – Local Revolutionary Code of 1991, RA 7160 Revolution Code National to local

Definition

Health – (WHO) state of complete physical, mental and social well being, not merely the absence of disease or infirmity

Public health – (Dr. C.E. Winslow) the science and art of preventing disease, prolonging life, promoting health and efficiency through organized community effeort.

Community Health Nursing (Jacobson)- is a learned practice discipline with the ultimate goal of contributing as individual and in collaboration with others to the promotion of clients optimum level of function through teaching and delivery of care.

Factors affecting Optimum Level of Function (OLOF)

1. 1.     Political

2. 2.     Behavioral

3. 3.     hereditary

4. 4.     Health Care Delivery System

5. 5.     Environmental Influences

6. 6.     Socio economic Influences

Concepts

1. 1.     The primary focus of community health nursing practice is on health promotion.

2. 2.     Community health nurses are generalist in term of their practice through life but the whole community.

3. 3.     Community health nurses are generalist in terms of their practice through life continuity in its full range of health problems and needs.

4. 4.     The nature of CHN practice requires that current knowledge derived from the biological, social science, ecology, clinical nursing and community health organizations be utilized

5. 5.     Contact with the client and or family may continue over a long period of time which includes all ages and all types of health care.

6. 6.     The dynamic process of assessing, planning, implementing and intervening provide measurements of progress, evaluation and a continuum of the cycle until the termination of nursing is implicit in the practice of community health nursing.

Principles

1. 1.     CHN is based on recognized needs of communities, families, groups and individuals.

2. 2.     The community health nurse must understand fully the objectives and policies of the agency she represents.

3. 3.     In CHN, the family is the Unit of services.

4. 4.     CHN must be available to all regardless of race, creed and socioeconomic status

5. 5.     Health teaching is a primary responsibility of the CHN.

6. 6.     The community health nurse works as a member of the health team.

7. 7.     There must be a provision for period’s evaluation of community health team.

8. 8.     Opportunities for continuation staff education programs nurses must be provided by the CHN agency. The community health nurse also has a responsibility for his/her own professional growth.

9. 9.     The community health nurse makes use of available community health resources.

10. 10.   The community health nurse utilizes the already existing active organized groups in the community.

11. 11.   There must be provision for educative supervision CHN

12. 12.   There should be accurate recording and reporting in CHN.

Public Health Nurse

1. 1.     Planner/programmer

2. 2.     Provide of Nursing Care/Caregiver

3. 3.     Manager/Supervisor

4. 4.     Community Organizer

5. 5.     Coordinator of Service

6. 6.     Trainer/ Health Educator/ Counselor

7. 7.     Health monitor

8. 8.     Role Model

9. 9.     Change Agent

10. 10.   Recorder/ Reporter/ Statistician

11. 11.   Researcher

Community Health Process

Assessment

Collection of data, collected from family, groups and community.

Examples: Demographic Data

Vital Health Statistics

Community Dynamics

Health Status

Education

Methods: Community Survey

Interview

Statistics

Epidemiological studies

Common indicators of health status

Ø Morbidity

Ø Mortality

Categories of Health Problems

Ø Health Deficit (HD)

Ø Health Treat (HT)

Ø Foreseeable Crisis (FC)

Ex: Active TB- HD

45 yr, old male smoke- HT

Sedimentary health style- Ht

Early pregnancy- FC

Father of family losses his job FC

Death in the family- FC

Patient is sick due to pneumonia- HD

Children who are not immunized- HT

Lack of prenatal check – up- HT

Eclampsia- HD

Working hazard- HT

Hypertensive- HD

With measles “child”- HD

Family members has liprosy (microbactria liporea)- HD

Marriage- FC

Community diagnosis

1. A.     Physical Characteristics

2. B.    Population Characteristics

3. C.    Environmental factors

4. D.    Knowledge, attitude, practices of the people

5. E.     Community resources and facilities

Planning: Based on the actual and potential problems that were identified and prioritized

Goal: Declaration of purpose or intent, gives essential direction to action

Specific objectives: Made in terms of activities of daily living

Implementation:

Ø Carries out nursing procedures which are consistent with nursing with nursing care plans.

Ø Involve the patient with his/her family

Ø Utilized support system

Evaluation

Frame works

1. a.     Structural elements

2. b.     Process elements

3. c.     Outcome elements

Nursing Procedures

Clinic Visit

1. 1.     Pre-consultation conference

2. 2.     Medical examination

3. 3.     Nursing intervention

4. 4.     Post consultation conference

Home Visit- face to face contact with the client

Principles

1. 1.     A home visit should have a purpose or objective

2. 2.     Planning for a home visit should use every available information about the family, and individual

3. 3.     Planning should revolve around the essential needs of the individual

4. 4.     Planning of a continuing care involve the individual or family

5. 5.     Planning should be flexible and practical

Bag technique- Tool

Public health bag- is an indispensable equipment of the public health nurse

Principles

1. 1.     Prevent the spread of infection

2. 2.     Save time and effort

3. 3.     should not shadow the concern for the patient

4. 4.     Can be performer in a variety of ways

Zippiram solution- disinfectant