1.CD control program Communicable diseases

National Tuberculosis Control Program – key policies Case finding – direct Sputum Microscopy and

X-ray examination of TB symptomatics who are negative after 2 or more sputum exams

Treatment – shall be given free and on an ambulatory basis, except those with acute complications and emergencies

Direct Observed Treatment Short Course – comprehensive strategy to detect and cure TB patients.

Category and Treatment Regimen Category 1- new TB patients whose sputum is positive; seriously ill

patients with severe forms of smear-negative PTB with extensive parenchymal involvement (moderately- or far- advanced) and extra-pulmonary TB (meningitis, pleurisy, etc.)

Category 2-previously-treated patients with relapses or failures. Category 3 – new TB patients whose sputum is smear-negative for

3 times and chest x-ray result of PTB minimalCategory 1-

new TB patients whose sputum is positive; seriously ill patients with severe forms of smear-negative PTB with extensive parenchymal involvement (moderately- or far- advanced) and extra-pulmonary TB (meningitis, pleurisy, etc.)

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

Intensive Phase (daily for 2 months) – Isioniazid + rifampicin + pyrazinamide

Maintenance Phase (daily for the next 2 months) - Isioniazid + rifampicin

Stop TB ; Do it with DOTS Advocacy is a planned and continuous effort to inform people

about issue and instigate change. Advocacy usually takes place over an extended period of time and includes a variety of strategies to communicate a specific message.

TB is the number one infectious killer in the world. One TB suspect can infect another 10 healthy persons

Leprosy Control Program WHO Classification – basis of multi-drug therapy

▪ Paucibacillary/PB – non-infectious types. 6-9 months of treatment.

▪ Multibacillary/MB – infectious types. 24-30 months of treatment.

Multi-drug therapy – use of 2 or more drugs renders patients non-infectious a week after starting treatment

▪ Patients w/ single skin lesion and a negative slit skin smear are treated w/ a single dose of ROM regimen

▪ For PB leprosy cases- Rifampicin+Dapsone on Day 1 then Dapsone from Day 2-28. 6 blister packs taken monthly within a max. period of 9 mos.

All patients who have complied w/ MDT are considered cured and no longer regarded as a case of leprosy, even if some sequelae of leprosy remain.

Responsibilities of the nurse

▪ Prevention – health education, healthful living through proper nutrition, adequate rest, sleep and good personal hygiene;

▪ Casefinding ▪ Management and treatment – prevention of

secondary injuries, handling of utensils; special shoes w/ padded soles; importance of sustained therapy, correct dosage, effects of drugs and the need for medical check-up from time to time; mental & emotional support

▪ Rehabilitation-makes patients capable, active and self-respecting member of society.

Control of Schistosomiasis – a tropical disease caused by a blood fluke, Schistosoma Japonicum ; transmitted by a tiny snail Oncomelania quadrasi

Preventive measures – health education regarding mode of transmission and methods of protection; proper disposal of feces and urine; improvement of irrigation and agriculture practices

Control of patient, contacts and the immediate environment Specific treatment- Praziquantel – drug of choice

Programs on Filariasis, Malaria and Dengue Hemorrhagic Fever Filariasis- a chronic prasitic infection caused by a nematode,

Wuchereria bancrofti. Young and adult worms live in the lymphatic vessels and nodes, while the micro filariae are in the blood; transmitted through bites from an infected female mosquito, Aedes poecilius, that bites at night.

▪ Treatment: Diethylcarbamazine citrate or Hetrazan

▪ Elephantiasis and Hydrocoele are handled through surgery, prevention and supportive care

Malaria – infection caused by the bite of the female Anopheles mosquito , Chemoprophylaxis – Chloroquine taken at weekly

intervals, starting from 1-2 weeks before entering the endemic area.

Anti-malarial drugs – sulfadoxine, quiinine sulfate, tetracycline, quinidine

Insecticide treatment of mosquito nets, house spraying, stream seeding and clearing, sustainable preventive and vector control meas

Dengue H-fever 4 o’clock habit

Programs on Measles. Chickenpox, Mumps, Diphtheria, Pertusis, Tetanus –focused on health information campaigns and intensive immunization of children in barangays.

Prevention and Control Program on Parasitic Infestations ( STH e.g. Ascaris, Trichuris, Hookworm) and Paragonimiasis in communities where eating of fresh or inadequately cooked crab is a practiceManagement:1. Deworming 2. Health Education re:

▪ Good personal hygiene▪ Use of footwear▪ Washing fruits and vegetables well▪ Use of sanitary toilets▪ Sanitary disposal of garbage▪ Boiling drinking water at least 2-3 min. from

boiling point or chlorinationPrevention and Control on Leptospirosis/ Weil’s Disease/ Mud fever/Flood fever/ Spirochetal Jaundice thru contact with the skin/ open wound with water or moist soil contaminated with urine of infected rat

And RabiesMgt. of Rabies

Wash wound with soap and water, betadine or alcohol may be applied

If dog is healthy observe for 14 days. If nothing happens- no need for ttt.If it dies or shows rabies, kill then bring head for lab. Exam & consult doctor.

Active immunization – body develops Ab against rabies up to 3 yrs.

Passive I – giving Ab to persons with head and neck bites, multiple single deep bites, contamination of mucous membranes or thin covering of the eyes, lips or mouth to provide immediate protection

RPO – immunization of pets at 3 mos. of age and yearly thereafterPrevention and Control on STIs

- Gonorrhea, Syphilis, HIV/AIDS, Trichomoniasis,Chlamydia, Hep B ( the most serious type ‘cause of severe cx. Eg. Massive liver damage and hepatocarcinoma

- 4 C’s in the Syndromic Mgt - 1. Compliance- 2. Counseling/ Education- 3. Contact tracing to treat partner- 4. Condom use- Hep B vaccination- Universal precautions- Safe sex

2. Community Needs Assessment/ Community Diagnosis 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

Done to come up with a profile of local health situation Will serve as a basis of health programs and services to be delivered

to the community Starts with determining the health status of the community

2 Types of Community Diagnosis 1. Comprehensive Community Diagnosis

aims to obtain general information about the community

2. Problem-Oriented Community Diagnosis type of assessment responds to a particular need

ELEMENTS OF COMPREHENSIVE COMMUNITY DIAGNOSIS

1. DEMOGRAPHIC VARIABLES i. Total population & Geographical distribution including

Urban-Rural index & Population Densityii. Age & Sex composition

iii. Selected vital indicators e.q. Growth rate, CBR, CDR & Life expectancy rate

iv. Patterns of migrationv. Population projection

Note: Population groups that need special attentions:

▪ Indigenous people▪ Socially dislocated groups as a result of

disasters, calamities & development programs

2. Socio-economic & Cultural variables i. Social indicators

Communication network Transportation system Educational level Housing conditions

ii. Economic indicators Poverty level income Employment rate Types of industry present in the community Occupation common in the community

iii. Environmental indicators Physical/geographical/topographical characteristics Water supply Waste disposal Air, Water and Land pollution

iv. Cultural factors Variables that may break up people into groups within

the community e.q.▪ Ethnicity▪ Social class▪ Language▪ Religion▪ Race▪ Political orientation

Cultural beliefs and practices that affect health Concepts about Health and Illness

3. Health & illness patterns Leading cause of mortality

Leading cause of morbidity Leading cause of infant mortality Leading cause of maternal mortality Leading cause of hospital admission

4. Health resources Manpower resources Material resources

5. Political/Leadership patterns Reflects the action potential of the state and its people

to address the health needs and problems of the community

Mirrors the sensitivity of the government to the people’s struggle for better lives

PROCESS OF COMMUNITY DIAGNOSIS Consists of;

1. Collecting, organizing & synthesizing data In order to identify the different factors that may

directly or indirectly influence the health of the population

2. Analyzing & interpreting health data Seek explanations for the occurrence of health needs

and problems of the community3. Formulation of Community Health Nursing Diagnoses

Will become the bases for developing and implementing community health nursing interventions and strategies

STEPS IN CONDUCTING COMMUNITYDIAGNOSIS

1. DETERMINING THE OBJECTIVES – the nurse decides on the depth and scope of the data she needs to gather.

2. DEFINING THE STUDY POPULATION – the nurse identifies the population group to be included in the study.

3. DETERMINING THE DATA TO BE COLLECTED – the objectives will guide the nurse in identifying the specific data she will collect, and will also decide on the sources of these data.

4. COLLECTING THE DATA – the nurse decides on the specific methods depending on the type of data to be generated.

Ocular survey, interview, and records review, 5. DEVELOPING THE INSTRUMENT instruments/tools facilitate the

nurse’s data-gathering activities. Most common instruments :

survey questionnaire interview guide observation checklist

6. ACTUAL DATA GATHERING – the nurse supervises the data collectors by checking the filled-up instruments in terms of completeness, accuracy and reliability of the information collected.

7. DATA COLLATION – the nurse is now ready to put together all the information.

Numerical data Descriptive data

8. DATA PRESENTATION – will depend largely on the type of data obtained.

Descriptive- narrative reports numerical data- table or graphs

9. DATA ANALYSIS – aims to establish trends and patterns in terms of health needs and problems of the community.

10. Identifying Community Health Nursing Problems a. Health Status Problems

Increased/decreased morbidity, mortality fertility or reduced capability for wellness

b. Health Resources Problems Lack of or absence of manpower, money, materials or

institutions necessary to solve health problemsc. Health Related Problems

Existence of social, economic, environmental and political factors that aggravate the illness-inducing situations in the community

11. Priority-setting a. Nature of the condition/problem presented

Classified as health status, health resources or health related problems

b. Magnitude of the problem

Severity of the problem which can be measured in terms of the proportion of the population affected by the problem

c. Modifiability of the problem Probability of reducing, controlling or eradicating the

problemd. Preventive potential

Probability of controlling or reducing the effects posed by the problem

e. Social concern Perception of the population or the community as they

are affected by the problem and their readiness to act on the problem

PLANNING WHAT IS PLANNING?

is a process that entails formulation of steps to be undertaken in the future in order to achieve a desired end.

Concepts of Planning: Planning is futuristic. Planning is change-oriented. Planning is a continuous and dynamic process. Planning is flexible. Planning is a systematic process.

THE PLANNING CYCLE: 1. Situational Analysis

gather health data tabulate, analyze and interpret data identify health problems set priority

2. Goal and Objective Setting define program goals and objectives assign priorities among objectives

3. Strategy/Activity Setting Design CHN Program Ascertain resources Analyze constraints and limitations

4. Evaluation determines outcomes specify criteria and standards

Application of Public Health Tools (discuss in separate slide)Three important tools

The health disciplines of 1. Demography 2. Vital statistics 3. Epidemiology

3. COMMUNITY ORGANIZING A process whereby the community members develop the

capability to assess their health needs and problems, plan and implement actions to solve these problems, put up sustain organizational structures which will support and monitor implementation of health initiatives by the people

maglaya COMMUNITY ORGANIZING

Purpose: Empowerment or building the capability of people for

future community action Approaches to community development

a. Social changes Building up social organizations (relationships, structure

and resources)b. Change in ideology

Knowledge, beliefs and attitudec. Change agents

Capacity to influence others by setting a good example.Principles of CO:

1. Welfare approach People esp. the oppressed, exploited and deprived sectors are

most open to change, have the capacity to change and are able to bring about change. Hence , CO is based on the ff:

a. Power must reside in the peopleb. Development. is from the people to the peoplec. People participation

2. Technological approach

must be based on the poorest sectors of society. The solutions of problems commonly shared by these sectors must be focused on collective organizations, planning and action

3. Transformatory approah should lead to self-reliant communities

Five stages 1. Community analysis 2. Design and initiation 3. Implementation 4. Program maintenance – consolidation 5. Dissemination – reassessment 1.Community analysis The process of assessing and defining needs, opportunities and

resources involved in initiating community health action . Maybe referred to as community diagnosis, community needs

assessment, health education planning and mapping5 components of community analysis

1. Demographic, social and economic profile of the community derived from secondary data.

2. Health risk profile (social, behavioural and environmental risks) Behavioural- dietary habits and other life style concerns

like alcohol, tobacco and drugs Social indicators- exposure to long term unemployment,

low education and isolation.3. Health/wellness out comes profile (morbidity/mortality data)4. Survey of current health promotion programs.5. Studies conducted in certain target groups Steps in community analysis

Steps in community analysisi. Defining the community

1. Determining the geographic boundaries of the target community

ii. Collecting dataiii. Assessing community capacity

1. Entails an evaluation of the driving forces which may facilitate or impede the advocated change

iv. Assessing community barriersv. Assessing readiness to change

1. Community interest2. Perception on the importance of the problem

vi. Synthesis data and set priorities1. Provide a community profile of the needs and resources

and will become the Basis for designing prospective community interventions for health promotion

2.Design and initiation STEPS:

1. Establish a core planning group and select a local organizer. Requirements: Select 5-8 member in charge for core planning and

management of the program With management skills, good listener and conflict

resolution skills.2. Choose an organizational structure.

This activate the community participation. Types:

a. Leadership board council- existing local leaders working for a common cause

b. Coalition- linking organizations and groups to work on community issues.

c. “lead” or official agency- a single agency takes the primary responsibility of a liaison for health promotion activities in the community.

d. Grass-roots- informal structures in the community like the neighbourhood residents.

e. Citizens panels- a group of citizens (5-10) emerge to form a partnership with the government agency.

f. Networks and consortia- network develop because of a certain concerns

3. Identify, select and recruit organizational members. As much as possible different groups, organizations

sectors should be represented. Chosen representative have power for the group they

represents4. Define the organization mission and goals.

This will specify the what, who, where, when and extent of the organizational objectives.

5. Clarify roles and responsibilities of people involved in the organization.

This is done to establish a smooth working relationship and avoid overlapping of responsibilities.

6. Provide training and recognition. Active involvement in planning and management of

programs may require skills development training. Recognition of the programs accomplishment and

individuals contribution to the success of the program and boost morale of the members.

3.Implementation-put the design plan into action.

a. Generate broad citizen participation How?

▪ Organizing task force, who, with appropriate guidance can provide the necessary support.

b. Develop a sequential work plan Activities should be planned sequentially. Often, times

has to be modified as events unfold. Community members may have to constantly monitor implementation steps.

c. Use comprehensive, integrated strategies Generally the program utilize more than one strategies

that must complement each other.d. Integrate community values into the programs, materials and

messages. The community language, values and norms have to be

incorporated into the program. 4.Program maintenance – consolidation

The program a this point has experienced some degree of success and has weathered through implementation problems, the organization and program is gaining acceptance in the community.

Maintenance:a. Integrate intervention activities into community networks

This can be affected through implementation problems. The organization and program is gaining acceptance in

the community.b. Establish a positive organizational culture.

A positive environment is a critical element in maintaining cooperation and preventing fast turnover of members.

This is a result of good group process based on trust, respect, and openness.

c. Establish an ongoing recruitment plan. It should be expected that volunteers may leave the

organization. This requires a built in mechanisms for continuous

recruitment and training of new members.d. Disseminate results.

Continuous feedback to the community on results of activities enhances visibility and acceptance of the organization.

Dissemination of information is vital to gain and maintain community support.

5.Dissemination-Reassessment Continuous assessment is part of the monitoring aspect in the

management of the programa. Update the community analysis.

Is there a change in leadership, resources and participation?

This may necessitate reorganization and new collaboration with other organizations.

b. Assess effectiveness of interventions/programs. Quantitative and qualitative methods of evaluation can

be used to determine participation, support and behavior change level of decision making and other factors deemed important to the program.

c. Chart future directories and modifications. This may mean revision of goals and objectives and

development of new strategies. Revitalization of collaboration and networking may be

vital in support of new ventures.d. Summarize and disseminate results.

Some organization die because of the lack of visibility. Thus, a dissemination plan may be helpful in diffusion

of information to further boost support to the organization’s endeavour.

The Health Resource Development Program Community Health Organizing Utilizing COPAR HRDP Was developed and sponsored by the Philippine Center for

Population and Development (PCPD) To make health services available and accessible to depressed and

underserved communities in the Philippines PCPD is a non-stock, non-profit institution, which serves as a

resource center assisting institutions and agencies through programs and projects geared toward the social human development of rural and urban communities

Formerly known as The Population Center FoundationHISTORY OF HRDP

HRDP I Trained the faculty, medical/nursing students to

provide health care services to the far flung barrios because of lack of man power for health services at the same time that similar activities fulfilled the curricular requirements of the students for public health

The PCPD provides seed money for the income generating projects

The CO uses his/her own strategy or method in developing the community

Short-term serviceHISTORY OF HRDP

HRDP II The 2nd cycle uses the same strategy but the program

could not be sustained by the schools or hospitals and the income-generating projects eventually become the hindrance to the goal of achieving the health program because the people tend to be more interested in the income generated by the projects

Both HRDP I and HRDP II have brought about some changes in the community life of the people

Established basic health infrastructure; basic health services were increased; there were trained workers and organized health groups to take care of the needs of the community

HISTORY OF HRDP HRDP III

PCPD refined the program and resulted to what is now called HRDP III, which has these unique features:

▪ Comprehensive training of the staff and faculty of the participating agency in which the community work was initiated

▪ Periodic training program and regular assistance to the participating agency were provided to strengthen the health outreach program to become community oriented

▪ PHC as the approach with which all nursing/medical students, their CI’s and indigenous health workers are trained for community health work and around which all other project inputs will revolve

HISTORY OF HRDP Community organizing as the main strategy to be

employed in preparing the communities to develop their community health care systems and the establishment of community health organization to manage the community health programs

Organizing work in the communities were done in 3 phases

PAR as fascinating strategy for maximum community involvement through collective identification and analysis of community health problems and collective health action

Available funds to finance community initiated projectsCOPAR?

Since Management Leadership and Jurisprudence are courses taught in the classroom members of this group of students were

trained to manage and acts as leaders of the different levels of the students who were involved in COPAR

Principles of management were applied in carrying out primary health care

The community members, CHW’s and leaders were empowered to manage their own health projects

Conducted seminars and trainings as well as health education and services needed by community(exposure and immersion 6-8 weeks)

THE HRDP-COPAR PROCESS1. PRE-ENTRY PHASE2. ENTRY PHASE3. COMMUNITY STUDY/DIAGNOSIS PHASE/RESEARCH PHASE4. COMMUNITY ORGANIZATION AND CAPABILITY-BUILDING PHASE5. COMMUNITY ACTION PHASE6. SUSTENANCE AND STRENGTHENING PHASE1. Pre-Entry Phase Preparation of the Institution Train faculty and students in COPAR. Formulate plans for institutionalizing COPAR. Revise/enrich curriculum and immersion program. Coordinate participants of other departments. Site Selection Initial networking with local government. Conduct preliminary special investigation. Make long/short list of potential communities. Do ocular survey of listed communities. Criteria for Initial Site Selection o Must have a population of 100-200 families. o Economically depressed. o No strong resistance from the community. o No serious peace and order problem. o No similar group or organization holding the same program. Identifying Potential Barangay o Do the same process as in selecting municipality. o Consult key informants and residents. o Coordinate with local government and NGOs for future activities. Choosing Final Barangay o Conduct informal interviews with community residents and key

informants. o Determine the need of the program in the community. o Take note of political development. o Develop community profiles for secondary data. o Develop survey tools. o Pay courtesy call to community leaders. o Choose foster families based on guidelines. Identifying Host Family o House is strategically located in the community. o Should not belong to the rich segment. o Respected by both formal and informal leaders. o Neighbours are not hesitant to enter the house. o No member of the host family should be moving out in the

community.2. Entry Phase Guidelines for Entry o Recognize the role of local authorities by paying them visits to

inform their presence and activities. o Her appearance, speech, behavior and lifestyle should be in

keeping with those of the community residents without disregard of their being role model.

o Avoid raising the consciousness of the community residents; adopt a low-key profile.

Activities in the Entry Phase Integration - establishing rapport with the people in continuing

effort to imbibe community life. § living with the community § seek out to converse with people where they usually

congregate § lend a hand in household chores § avoid gambling and drinking

Deepening social investigation/community study verification and enrichment of data collected from initial survey

conduct baseline survey by students, results relayed through community assembly

Leader Spotting Through Sociogram.

Key persons - approached by most people Opinion leader - approach by key persons Isolates - never or hardly consulted 4.NCD prevention and control program 1. Prevention and Control of Cardiovascular Diseases2. Cancer Prevention and Early Detection3. Nat’l Diabetes Prevention and Control Program4. Prevention and Control of Kidney Disease5. Program on Mental Health and Mental Disorders6. Program on Drug Dependence/

Substance Abuse7. Community-Based Rehabilitation Program8. Program on the Elderly/Geriatric Nursing Services9. Programs on Blindness, Deafness and Osteoporosis

1. Prevention and Control of Cardiovascular Diseases heart – 1st leading cause of death blood vessels - 2nd

Types:

1. Congenital Heart Disease (CHD):

2. Rheumatic Fever or Rheumatic Heart Disease

3. Hypertension4. primary or essential5. Ischemic Heart Disease/ Atherosclerosis 1.Congenital Heart Disease (CHD): Result of the abnormal development of the heart that exhibits septal defect, patent ductus arteriosus, aortic and pulmonary stenosis, and cyanosis; most prevalent in children

Causes: environmental factors, maternal diseases or genetic aberrations2. Rheumatic Fever or Rheumatic Heart Disease: Systematic

inflammatory disease that may develop as a delayed reaction to repeated and an inadequately treated infection of the upper respiratory tract by group A beta-hemolytic streptococci.

3. Hypertension: Persistent elevation of the arterial blood pressure.4. primary or essential) ;frequent among females but

severe,malignant form is more common among males5. Ischemic Heart Disease/ Atherosclerosis: Condition usually caused

by the occlusion of the coronary arteries by thrombus or clot formation.

higher among males than females for the latter are protected by estrogen before menopause

PF: HPN, DM, Smoking Minor RF: stress, strong family history, obesity CVD CVD Primary Prevention: CVD Primary Prevention thru health education is the main focus of the

program:1. maintenance of ideal body wt.2. diet - low fat3. alcohol/smoking avoidance4. Exercise5. regular BP check up

2. Cancer Prevention and Early Detection Any malignant tumor arising from the abnormal and uncontrolled

division of cells causing the destruction in the surrounding tissues. Common Cancer: Lung cancer, cervical cancer, colon cancer, cancer

of the mouth, breast cancer, skin cancer, prostate cancer. 3rd leading cause of illness and death ( Phil.) Incidence can only be reduced thru prevention and early detectionNINE WARNING SIGNS OF CANCER: Change in blood bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty in swallowing Obvious change in wart or mole Nagging cough or hoarseness Unexplained anemia Sudden unexplained weight loss

Prevention & Early DetectionPRINCIPLES OF TREATMENT OF MALIGNANT DISEASES

One third of all cancers are curable if detected early and treated properly.

Three major forms of treatment of cancer: Surgery Radiation Therapy

Chemotherapy3.Nat’l Diabetes Prevention and Control Program

Aim: Controlling and assimilating healthy lifestyle in the Filipino culture

( 2005-2010) thru IEC Main Concern: modifiable risk factors( diet, body wt., smoking,

alcohol, stress, sedentary living, birth wt. ,migration4.Prevention and Control of Kidney Disease

Acute or Rapidly Progressive Renal Failure : A sudden decline in renal function resulting from the failure of the renal circulation or by glomerular or tubular damage causing the accumulation of substances that is normally eliminated in the urine in the body fluids leading to disruption in homeostatic, endocrine, and metabolic functions.

Acute Nephritis: A severe inflammation of the kidney caused by infection, degenerative disease, or disease of the blood vessels.

Chronic Renal Failure: A progressive deterioration of renal function that ends as uremia and its complications unless dialysis or kidney transplant is performed.

Neprolithiasis: A disorder characterized by the presence of calculi in the kidney.

Nephrotic Syndrome: A clinical disorder of excessive leakage of plasma proteins into the urine because of increased permeability of the glomerular capillary membrane

Urinary Tract Infection: A disease caused by the presence of pathogenic microorganisms in the urinary tract with or without signs and symptoms.

Renal Tubular Defects: An abnormal condition in the reabsorption of selected materials back into the blood and secretion, collection, and conduction of urine.

Urinary Tract Obstruction: A condition wherein the urine flow is blocked or clogged.

5. Program on Mental Health and Mental Disorders6. Program on Drug Dependence/ Substance Abuse 7.Community-Based Rehabilitation Program

A creative application of the primary health care approach in rehabilitation services, which involves measures taken at the community level to use and build on the resources of the community with the community people, including impaired, disabled and handicapped persons as well.

Goal: To improve the quality of life and increase productivity of disabled, handicapped persons.

Aim: To reduce the prevalence of disability through prevention, early detection and provision of rehabilitation services at the community level.

8. Program on the Elderly/Geriatric Nursing Services 7 humanitarian issues: family, health, income, security,

employment and labor, social welfare, education, recreation, culltural activities and housing

Leading causes of illness:elderly Influenza, HPN, diarrhea, bronchitis, TB, diseases. of the heart, pneumonia, malaria, malignant neoplasm, chickenpox Leading causes of death:elderly Diseases of heart and vascular system Pneumonia, TB, CCOPD Malignant neoplasms Diabetes Nephritis Accidents

9.Programs on Blindness, Deafness and Osteoporosis Cataract- main causes of blindness VAD- main cause of childhood blindness; most serious eye problem

of Fil. children below 6 yrs. old Osteoporosis special problem in women, highest bet. 50—79 yrs.

old, MENOPAUSE- main cause Prevention of NCD/Role of Nursing in Health Promotion And

Advocacy Yosi Kadiri- anti smoking Edi Exercise/Hataw-regular physical activity Tiya Kulit/ Iwas Sakit Diet-low salt, low fat, high fiber diet Mag HL – exercise, no smoking, avoidance of alcohol, healthy diet,

iwas stress, watch wt.

Sentrong Sigla Movement ( SSM)-a certification recognition program which develops and promotes standards for health facilities

- Joint effort bet.:1.DOH – provides technical and financial assistance packages for health care2. LGUs – direct implementers of health programs & prime developers of health centers and hospitals making services accessible to every Filipino

Pillars of SSM1. Quality Assurance2. Grant and Technical Assistance3. Health Promotion4. Awards Expected Outcome: SSM Empowered individuals adopting healthy lifestyle, improved

health-seeking behavior and well-being & increased demand for quality health services

Institutions will develop policies, provide quality services , institute system for surveillance/ merits and advocate for laws

Programs: SSM EPI Disease Surveillance CARI CDD Nutrition/ Micronutrient Supplementation-

*Food Fortification :Rice –iron; Oil and sugar – Vit. A; Flour-Vit. A & iron; Salt- iodine

Integrated Management of Childhood Illness ( IMCI) Integrates management of most common childhood problems

( diarrhea, pneumonia, measles, malnutrition, DHF, malaria) Involves family members and community in the health care

process for physical growth and mental development & disease prevention

IV. The Public Health Nurse Definition and terms:

Public Health Nursing refers to the practice of nursing in local/national health departments (which includes health centers and rural health units) and schools. It is a community health nursing practice in the public sector

Public Health Nurses Refers to the nurses in the local/national health departments or public schools whether their official position title is public health nurse or nurse or school nurse

Leaders in providing quality health services to the communitiesFirst level of health workers to be knowledgeable about new public health technologies and methodologiesUsually the first ones to be trained to implement new programs and apply new technologies

Qualifications Must be professionally qualified and licensed to practice in the arena of public health nursing Consistent with the nursing law of 2002 (RA 9173)

7 Roles and Functions 1. Management function

Inherent in the practice of PHN Organizes the nursing service of the local health agency Applications of 5 management Functions “POSDC” in

organizing the nursing service and the local health agency.

2. Supervisory function Supervisor of the midwives and other health workers

3. Nursing care function Inherent function of the nurse Based on the science of art and caring Caring for all levels of clientele toward health

promotion and disease prevention4. Collaborating and coordinating function

Care coordinators for communities and their members Establishes linkages and collaborative relationships with

other health professionals, government agencies, private sectors, NGO’s people’s organizations to address health problems

5. Health promotion and education function

Activities goes beyond health teachings and health information campaigns

6. Training function Initiates the formulation of staff development and

training programs for midwives and other auxiliary workers

7. Research function Participates in the conduct of research and utilizes

research findings in her practice Disease surveillance

▪ Measure the magnitude of the problem▪ Measure the effect of the control program

Competencies and skills 1. Community health nursing process2. Nursing procedures during clinic and home visits3. Community organizing4. Health promotion and education5. Surveillance6. Recording and reporting7. epidemiology

IV. SPECIAL FIELDS IN COMMUNITY HEALTH NURSING School nursing and occupational health nursing School nursing

A type of public health nursing that focuses on the promotion of health and wellness of the pupils/students, teaching and non teaching personnel of the schools.

The primary role is to support the student learning and ensure that educational potential is not hampered by unmet health needs

Assist the students in making choices for a healthy life style, reduce risk taking behaviour and focus on issues such as prevention of drug and substance abuse, teenage pregnancy, STD,Malnutrition, CD and NCD

founded by: Lillian Wald (1902) a member of the professional educational employed to aid

students in developing their full health potential in health and education

HNC (health and Nutrition Center) of the DepEd Mandated to safeguard the health and nutritional well-

being of the total school population. 2 division1. health

4 sections Medical Dental Nursing Health education

2. nutrition division Objectives of School Nursing

General : To promote and maintain the health of the school populace by proving comprehensive and quality nursing care.

6 Specific :1. Provide quality nursing service to the school population2. Create awareness among children, personnel and administrators

on the importance of the promotive and preventive aspects of health through health education.

3. Encourage the provision of standard functional facilities4. Providing nursing personnel with opportunities for continuing

education and training.5. Conduct and participate in researches related to nursing care.6. Establish/ strengthen linkages with government and non-

government organization/agencies ▪ for school community health work.

9 Duties and responsibilities of the school nurses 1. Health advocacy2. Health and nutrition assessment including other screening

procedures such as vision and hearing.3. Supervision of the health and safety of the school plant.4. Treatment of common ailments and attending to emergency cases.5. Referrals and follow-up of pupils and personnel6. Home visits7. Community outreach

E.g.,: ▪ attending community assemblies

▪ and organizing school community health councils.

8. Recording and reporting of accomplishments9. Monitoring and evaluation of programs and projects.

Skills and competencies 1. Assessment and screening skills2. Health counselling skills3. Social mobilization skills4. Good oral and written communication skills5. Basic management skills6. Life skills

16 function of the school nurse 1. School health and nutritional survey (from 1st visit and Qyr)- for

data and planning purposes Survey of the ff: current health situation and nutritional status Facilities Health education activities

2. Putting up a school clinic (R.A. 124)3. Health assessment (every year or with epidemics) Purpose:

detect the signs of illness and physical defects for early correction.

Health habits4. Standard vision testing for school children (20/20)

a Purpose:

Screen students with poor visual acuity and indentify other ocular problems

Refer students with eye disease and errors of refraction for further examination and management.

5. Ear examination Methods:

Observation Examination by using penlight or otoscope Screening test (whisper test, conversation voice test,

ball pen click.) 6. Height and weight measurement and nutritional status

determination Height and weight measurement is a procedure for evaluating the

tallness or the shortness and the heaviness of a pupil. DepEd

<10 years old=weight for age and height for age >10 years old= BMI

Appropriate school feeding programs with rice, milk or fortified noodles are given to children with below normal nutritional status for 120 feeding days

Deworming is a pre requite prior to feeding Consent from parent is pre requisite prior to de-worming 7. Medical referrals8. Attendance to emergency cases9. Student health counselling( for student who manifest the physical

and emotional symptoms) (parents, teacher, and student)10. Health and nutrition education activities

Training programs, conferences/workshops for teachers, pupils and parents

11. Organization of school-Community Health and Nutrition Councils Membership shall come from both school and

community This attend to the health related problems and concerns

12. Communicable disease control In participation of both the teachers, parents and

students Encourage the importance of immunization for

prevention13. Establishment of Data Bank on School Health and Nutrition

Activities Treatment in the school clinic Record of the school visit Health assessment report of the school health

personnel Health and nutritional status of pupils/students Form 86 of teaching and non teaching personnel Teachers health profile

Records of attended emergency case Inventory of clinic and equipment supplies Health and nutrition activities in school Record of accomplishment of school health services Records of officers/ officials of the School-Community

Health Council and their accomplishment Action plan

14. School plant inspection for healthy environment Others concerns: school site, area, location, space and

sanitation, classroom and others rooms, school clinics, water supplies, sanitation, school canteen.

Inspect for the size, lighting, ventilation, arrangement of seats.

15. Rapid Classroom Inspection( after holidays and epidemics but not to exceed more than a month except for cases of epidemics)

Procedure same as HA Purpose:

Detect cases of CD Note the correction that have been made Note if the eyeglasses are correctly adjusted Note the general cleanliness of the students Note new ailments.

16. Home visitationIndication:

Pupils whose parents are afraid of some medical procedures

Pupils who get re-infected because of home conditions Pupils suffering from CD Pupils who are absent frequently because of sickness Pupils who are malnourished.

•Occupational health nursing By American Association of Occupational Health • The special practice that provides for and delivers health care

services to workers and worker populations. The practice focuses on promotion, protection, and restoration of

workers’ health within the context of a safe and health work environment.

Occupational health nursing is autonomous, and occupational health nurses make independent nursing judgments in providing occupational health services.

The foundation of occupational health nursing practice is research-based with an emphasis on optimizing health, preventing illness and injury, and reducing health hazards.

By PNA – ANSAP, 1982 •Is aimed at assisting workers in all occupations to cope with

actual and potential stresses in relation to their work and work environment.

It is primarily geared at helping workers attain and maintain optimum level of physical and psychological functioning.

mission To ensure so far as possible every working man in the country is

safe and in healthful working conditions Occupational Health Team

1. Occupational Health Nurses2. Occupational physicians- focus on the prevention, detection, and

treatment of work-related diseases and injuries.3. Industrial hygienists-recognize, evaluate, and control toxic

exposures and hazards in the work environment. 4. Safety Hazards engineers- focus on the prevention of occupational injuries and the maintenance or creation of safe workplaces and safe work practices. 5. epidemiologists- study and describe the natural history of occupational diseases and injuries in population groups. 6. toxicologists- study and describe the toxic properties of agents used in work application to which workers may be exposed.

7. Industrial engineers- design the tools, equipment, and machines used in manufacturing and other work applications

8. Ergonomists- study design, and promote the healthy interface of humans, their tools, and their work.

9. Environmental engineers- concentrate on environmental controls to limit environmental pollution and achieve a healthy environment.

Function of Public Health Nurse as an Occupational Health Nurse 1. Work with the occupational health team

to lead the sanitary hygiene of all industrial establishment including hospitals to determine their

compliance with the sanitation code and its implementing rules and regulations

2. Recommends to Local Health Authority the issuance of license/ business permits and suspensions or revocation of the same for any violations of the conditions upon which said licenses or permits had been issued, pursuant to existing rules and regulation. 3. Coordinates with other governments agencies relative to the implementation of the implementing rules and regulations4. Attends to complaints of all establishment in the area of assignment related to industrial hygiene and recommends appropriate measures for immediate compliance.5. Participate to provide, install and maintain in good condition all control facilities and protective barriers for potential and actual hazards.6. Informs all affected workers regarding the nature hazards and the reasons for the control measures and protective equiptment. 7. Makes a periodic testing for physical examination of the workers and other health examination related to workers exposure to potential or actual hazards in the work place8. Provide control measures to reduce noise, dust, health and other hazards.9. Ensure strict compliance on the regular use and proper maintenance of Personal Protective Equipment (PPE)10. Provide employees an occupational health services and facilities11. Refers or elevate to higher authority all unresolved issues in relation to occupational and environmental; health problems12. Prepare and submit yearly reports to the local and national Government Application of Public Health Principles to Occupational Health Nursing

A. Community Assessment : Identify the demographic data on

▪ disease trends including morbidity and mortality statistics,

▪ and social environmental conditions ▪ that will provide pertinent

information for the establishment of priorities in planning and implementing occupational health programs

B. Worker Assessment: Assessment of the workforce to determine populations

at risk for occupationally related injury or illness.Types of Classification:

Age, sex, race, type of work, the presence or absence of disability.

C. Application of Epidemiology To determine relationship of work and injury or illness

Methods use: Toxicology, pathology, ergonomics

D. Team Approach Collaboration with occupational health team for the

development of comprehensive occupational health program

Industrial hygienist, epidemiologist, medical technologist, toxicologist, safety engineer, ergonomist, physician, occupational health nurse, occupational health therapist

E. Program Planning and Implementation Goal: promotion of wellness and prevention of illness and injury among workers.Application:Primary prevention

A program to ensure the health of prospective employees/ workers includes a history and physical examination to assess level of wellness. Maintenance of that level is provided through appropriate job placement.

Secondary Prevention Applied once the health problems is not meet by

primary prevention methods:

Early detection and treatment of both work-and non-work related health problems

Tertiary prevention: Rehabilitation toward workers disabled by occupational

and non occupational problems

Methods: Evaluation of current status Enhancement of employability, and appropriate job placement of employees

Services: Physical occupational and speech therapy Vocational training Chronic pain clinics Remedial reading Mathematics program

F. Referral to Community ResourcesG. Program Evaluation

Assessment of program to determine benefits in terms of decreasing loss of productivity related to employee health problems is carried out.

Issues In Occupational Health Nursing A. Physical Hazard

Are agents within the work environment that may cause tissue damage or other physical harm.

Radiation, extreme temperature, noise, electric and magnetic field, lasers, microwaves, and vibration.

Acute: acoustic trauma from excessive noise, heat stress or stroke, skin rashes, eye injuries from infrared radiation, skin burns, cuts or contusions.

Chronic: NIHL, multiple myeloma and leukaemia's from exposure to ionizing radiation, teratogenic or genetics effects induced by certain types of radiation.

B. Chemical Hazards: Various forms of either synthetic or naturally occurring chemicals

in the work environment may be potentially toxic or irritating to the body system through inhalation, skin absorption, ingestion, or accidental injection.

Mists, vapors, aerosols, gases, medications, particulate matters (dusts and fumes), solvents, metals, oil synthetic textiles, pesticides, explosives, and pharmaceuticals. Specifically, health care workers are exposed to chemical hazards such as anaesthetic gases, chemotherapeutic and antineoplastic agents, tissue fixative reagents, disinfectant and detergents, sterilizing agents, solvents, latex and mercury.

Acute: respiratory irritation due to smoke, poisoning from accidental ingestion, metal-fume fever, chemical burns, contact dermatitis and other dermatoses

Chronic: cancers (mesothelioma, bronchogenic and GI carcinomas); pleural diseases; occupational asthma; hypersensitivity pneumonitis, birth defects and neurological disorders.

mesothelioma C. Biological Hazards:

Biological agents such as viruses, bacteria, fungi, mold, or parasites may cause infection disease via direct contact with infected individuals/ animals, contaminated body fluids, or contaminated objects, surfaces

Workers in certain occupations ( health care, biological research and animal handling) have a high incidence of infectious diseases.

Acute: self limiting infections such as colds and influenzas, measles, skin and parasitic infections.

Chronic: TB, chronic Hepa B, HIV and AIDSD. Mechanical Hazards

Mechanical agents may cause stress on the musculoskeletal or other body systems

Hazards include inadequate work-station and tool design, frequent repetition of a limited movement, repeated awkward movements with hand-held tools, local vibrations.

Acute: neck strain and other muscular fatigue from forceful exertion or awkward positioning, and visual; fatigue.

Chronic: Raynaud's syndrome from use of vibrating power tools, carpal tunnel syndrome

Raynaud's syndrome E. Psychosocial Hazards:

Often related to trauma to the nature of the job, the job content, the organizational structure and culture, insufficient training and education regarding job requirements, and the physical condition in the work place, leadership and management styles.

Interpersonal conflict, unsafe working conditions, overtime, sexual harassment, racial inequality, role conflict, shift work, limited

autonomy, poorly defines expectations and work instructions, and absent or limited reward.

Acute: increased HR, increased BP, sleep disturbances, fatigue, depression, substance abuse, worksite violence.

Chronic: HPN, alcoholism, CAD, mental illness, GIf.Occupational injury- is any injury, such as cut, fracture, sprain, or amputation that results from a single incident in the work environment.g.Occupational illness- is any abnormal condition or disorder, other than one resulting from a occupational injury, caused by exposure to environmental factors associated with employment.

School Nursing Health assessment

METHODS USED: a. Interviewb. Nutritional Assessment – height and weight measurementsc. Vision Acuity Test/ Hearing Testd. IPPAe. V/Sf. Appraisal of the General and Physical and Mental Conditiong. Recording

PREPARATION: a. Well, lighted, ventilated, screened room or a corner of the

classroom b. 2 or 3 chairs according to need c. Waste basket d. Hand washing facilities e. Tongue dep., penlight f. Step/ sphygmo g. Forms/ records

PROCEDURES OF HEALTH ASSESSMENT 1. Nx conduct a classroom lecture to educate the pupils on what to

do during the Health Assessment. 2. 3-5 children at a time should be waiting for the assessment 3. Wash hand by the start of health assessment 4. Assess the children one by one 5. Inspection:

a. From head to foot b. Skin diseases c. Signs of abnormal condition d. Stet should be use across the heart/ lung assessment e. Findings should be recorded during the assessment

STEPS a. ARMS, HANDS, AND FINGER NAILS:

Ask the child to roll their sleeves Extend their arms Show hands one side first, then the other Spread their finger

b. EYES Ask the child to pull his lower lid using his index finger

and ask him to look up c. TEETH

Ask the child to open is mouth and say “ah” to show his throat

d. NOSE Ask the child to place his 2nd finger on the tip of the

nose and pull up his nose and extend his head backward e. EARS

Ask the child to push back his hair behind his ear and pull the outer ear up, slightly backward/ and then forward.

f. NECK and CHEST Examine the neck Chest/ back should be auscultated

g. HAIR Ask the pupil to run his fingers through his hair several

times Ask to show the nape by the pulling the hair up.

h. FEET/LEG Ask the girl to pull up her dress The boy his trousers to their knees Or you can observe while they performed marching

i. GENERAL APPEARANCE IMPORTANT REMINDERS IN HA:

1. If the health personnel is of the opposite sex, performed the procedure in the presence of the same sex.

2. The result should be discuss to the teacher 3. If 4. Refer cases that cannot be handle stat 5. Inform parents if the findings

COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH (COPAR)Importance of COPARCOPAR is an important tool for community development and people empowerment as this helps the community workers to generate community participation in development activities. COPAR prepares people/clients to eventually take over the management of a development program(s) in the future. COPAR maximizes community participation and involvement; community resources are mobilized for community services.Principles of COPAR

1. People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change, and are able to bring about change.

2. COPAR should be based on the interest of the poorest sector of society.

3. COPAR should lead to a self-reliant community and society.

Phases of the COPAR Process1. Pre-Entry PhasePreparation of the Institution

o Train faculty and students in COPAR.o Formulate plans for institutionalizing

COPAR.o Revise/enrich curriculum and immersion

program.o Coordinate participants of other

departments.Site Selection

o Initial networking with local government.o Conduct preliminary special investigation.o Make long/short list of potential communities.o Do ocular survey of listed communities.

Criteria for Initial Site Selectiono Must have a population of 100-200 families.o Economically depressed.o No strong resistance from the community.o No serious peace and order problem.o No similar group or organization holding the same program.Identifying Potential Municipalitieso Make long/short list.

Identifying Potential Barangayo Do the same process as in selecting municipality.o Consult key informants and residents.o Coordinate with local government and NGOs for future activities.

Choosing Final Barangayo Conduct informal interviews with community residents and key informants.o Determine the need of the program in the community.o Take note of political development.o Develop community profiles for secondary data.o Develop survey tools.o Pay courtesy call to community leaders.o Choose foster families based on guidelines.

Identifying Host Familyo House is strategically located in the community.o Should not belong to the rich segment.o Respected by both formal and informal leaders.o Neighbours are not hesitant to enter the house.o No member of the host family should be moving out in the community.

2. Entry Phase

Guidelines for Entryo Recognize the role of local authorities by paying them visits to inform their presence and activities.o Her appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of their being role model.o Avoid raising the consciousness of the community residents; adopt a low-key profile.

Activities in the Entry Phaseo Integration - establishing rapport with the people in continuing effort to imbibe community life. living with the community seek out to converse with people where they usually congregate lend a hand in household chores avoid gambling and drinkingo Deepening social investigation/community study verification and enrichment of data collected from initial survey conduct baseline survey by students, results relayed through community assembly

Leader Spotting Through Sociogram.Key persons - approached by most peopleOpinion leader - approach by key personsIsolates - never or hardly consulted

3. Organization-building PhaseEntails the formation of more formal structure and the inclusion of more formal procedure of planning, implementing, and evaluating community-wise activities. It is at this phase where the organized leaders or groups are being given training (formal, informal, OJT) to develop their style in managing their own concerns/programs.Key Activities

o Community Health Organization (CHO) preparation of legal requirements guidelines in the organization of the CHO by the core group election of officers

o Research Team Committeeo Planning Committeeo Health Committee Organizationo Otherso Formation of by-laws by the CHO

4. Sustenance and Strengthening PhaseOccurs when the community organization has already been established and the community members are already actively participating in community-wide undertakings. At this point, the different committee’s setup in the organization-building phase is already expected to be functioning by way of planning, implementing and evaluating their own programs, with the overall guidance from the community-wide organization.Key Activities

o Training of CHO for monitoring and implementing of community health program.o Identification of secondary leaders.o Linkaging and networking.o Conduct of mobilization on health and development concerns.o Implementation of livelihood projects.

MATERNAL HEALTH PROGRAM Tasked:

to reduce MMR by three quarters by 2015 to achieve ( millennium Development Goal) MDG

Maternal Mortality Rate (2003) CAUSE Other Complications related to pregnancy occurring in the course of labor, delivery and puerperium

1. Hypertension complicating pregnancy, childbirth and puerperium (25%)

2. Postpartum hemorrhage (20.3%) 3. Pregnancy with abortive outcome (9%) 4. Hemorrhage related to pregnancy

Strategic thrusts for 2005-2010

1. Launch and implement Basic Emergency and Obstetric Care (BEMOC) strategy in coordination with DOH

Entails establishment of facilities that provide emergency obstetric care for every 125,000 population and which are located strategically

2. Improve quality of prenatal and postnatal care Pregnant women should have at least four (4) prenatal

visit3. Reduce women’s exposure to health risks

Institutionalization of responsible parenthood4. Stakeholders must advocate for health

Resource generation and allocation for health servicesEssential Health Service Packages

A. Antenatal RegistrationB. Tetanus Toxoid Immunization C. Micronutrient Supplementation D. Treatment of Diseases and Other ConditionsE. Clean and Safe deliveryF. Recommended Schedule for Post Partum Care VisitsG. Importance of BF 1. Antenatal Registration

2. Tetanus Toxoid Immunization Dose:0.5ml

Route: IntramuscularlySite: Right or Left Deltoid/Buttocks

3. Micronutrient Supplementation 4. Treatment of Diseases and Other Conditions Types:

1. Difficulty of breathing/ obstruction of airway2. Unconsciousness3. Post partum bleeding4. Intestinal parasite infection5. malaria 1.Difficulty of breathing/ obstruction of airway

What to do? Clear the airway Place in her best position Refer woman to hospital with EmOC capabilities.

Do not give anything PO 2. Unconsciousness

What to do? Keep on her back arms at the side. Tilt head backwards (unless trauma is suspected) Lift chin to open airway Clear secretions from throat. Give IVF to prevent or correct shock. Monitor BP and SOB every 15’ Monitor fluid given. If DOB and puffiness develops, stop

the infusion. Monitor UO

Do not give: ORS for both unconscious or with convulsions IVF if not trained to do so.

3. Post partum bleeding What to do?:

Massage uterine and expel clots. If bleeding persist:

▪ Place cupped palmed on uterine fundus and feel for state of contraction

▪ Massage fundus in a circular motion▪ Apply bimanual uterine compression if mem

treatment done and postpartum bleeding still persist.

▪ Give ergometrine 0.2mg IM and another dose after 15’

Do not give: Mem to woman with eclampsia, pre-eclampsia or HPN

4. Intestinal parasite infectionWhat to do?

Give mebendazole 500mg tab. Single dose anytime from 4-9mos. Of pregnancy if none was given in the past 6 mos.

Do not give: Mebendazole in the 1st 1-3mos. Of pregnancy

▪ This might cause congenital problem in the baby

5. Malaria What to do?

Give sulfadoxin-pyrimethamine to woman from malaria endemic areas who are in 1st or 2nd pregnancy

500mg-25mg tab., 3 tabs. At the beginning of 2nd to 3rd tri semesters not less than one month interval.

E. Clean and Safe delivery Presence of skilled birth attendant Purpose

to ensure hygiene during labor and delivery. Provide non-traumatic delivery recognize complications Referred those complicated deliveries to high level of

care Steps to follow during labor, childbirth and immediate postpartum

Please refer accordingly1. Do a quick check upon admission for emergency signs:

Unconscious/convulsion Vaginal bleeding Severe abdominal pain Looks very ill Severe headache with visual disturbance Severe breathing difficulty Fever Sever vomiting

2. Make the woman comfortable Establish rapport with the client by greeting and interviewing to

make her comfortable 3. Assess the woman in labor- to determine the status during labor

LMP Number of pregnancy Start of labor pains Age/height Danger signs of pregnancy Taking the history through interview will help determine the

client’s condition during delivery of baby 4. Determine the stage of labor

Uterine contractions Bulging vulva Leaking amniotic fluid Vaginal bleeding

IE 5. Decide if the woman can safely deliver

By assessing the condition of the client and not finding any indication that could harm the

delivery of the baby 6. Give supportive care throughout labor. Purpose:

To deliver clean, safe and free from fatigue1. Encourage to take a bath at the onset of labor2. Encourage to drink but not eat as this may interfere surgery in case

needed3. Encourage to empty bladder and bowels to facilitate delivery of

the baby. Remind to empty the bladder every 2 hours.4. Encourage to do breathing technique to help energy in pushing out

the vagina. Panting can be done by breathing with open mouth with 2 short breaths followed by long breaths. This prevent pushing at the end of the 1st stage

7. Monitor and manage the different stage of labour-watch out for any danger signs

1. First stage: not in active labor Cervix: 3cms Contraction: weak Frequency: < 2 to 10’

What to do? Check Q 1hr. for emergency signs, frequency and

duration of contractions and FHT. Check Q 4hrs. For fever, pulse, BP and cervical

dilatation. Record time of ROM and color of amniotic fluid Assess progress of labor

▪ Refer STAT to hospital with complete facilities for the ff condition:

▪ If after 8hrs, contractions are stronger and more frequent but not progress in cervical dilatation, with or without membranes ruptured

It is false labor if after 8hrs there is no increase in contractions, membranes are not ruptured and no progress in cervical dilatation.

Not to do: IE more frequently than Q 4hrs.

First stage: active labor 4cms cervical dilatation

What to do? Check Q30’ for emergency signs Check Q4hrs. For fever, pulse, BP and cervical dilatation Record time of ROM and color of amniotic fluid Record finding in partographs/patient record.

Not to do: Do not allow woman to push unless delivery is

imminent. It will just exhaust the woman Do not give medication to speed of labor. It may cause

trauma to mother and the babySecond stage:

Cervix: 10 cms. or bulging thin perineum and head visible

What to do: Check Q 5’ for perineum thinning and bulging, visible

descend of the had during contraction, emergency signs, FHR and mood and behavior

Continue recording in the partograph.Not to do:

Do not apply fundal pressure to help deliver the baby Third stage:

Between birth of the baby and delivery of the placentaWhat to do:

Deliver the placenta Check the completeness of placenta and membranes

Not to do: Do not squeeze or massage the abdomen to deliver the

placenta 8. Monitor closely within 1hr. After delivery and give supportive

care.9. Continue care after 1hr. Postpartum. Keep watch closely for at

least 2hrs.10. Educate and counsel on FP and provide FP method if available and

decision was made by a woman.11. Informs, teach and counsel the woman on important MCH

messages: Birth registration Importance of BF Newborn Screening for babies delivered in RHU or at

home within 48hrs up to 2 weeks after birth. Scheduled when to return for consultation for

postpartum visit F. Recommended Schedule for Post Partum Care Visits G. Importance of BF

BREASTFEEDINGBreast milk is best for babies up to 2 years old.

Exclusive breastfeeding is recommended for the first six months of life. At about six months, give carefully selected nutritious foods as supplements.

Breastfeeding provides physical and psychological benefits for children and mothers as well as economic benefits for families and societies. BENEFITS :

For infantsa. Provides a nutritional complete food for the young infant.b. Strengthens the infant’s immune system, preventing many

infections.c. Safely rehydrates and provides essential nutrients to a sick child,

especially to those suffering from diarrheal diseases.d. Reduces the infant’s exposure to infection.

BREASTFEEDING/ LACTATION MANAGEMENT EDUCATION TRAINING

Breastfeeding practices has been proved to be very beneficial to both mother and baby thus the creation of the following laws support the full implementation of this program:

A. Executive Order 51 B. Republic Act 7600 C. The Rooming-In and Breastfeeding Act of 1992

A. EO 51 THE MILK CODE – protection and promotion of breastfeeding to ensure the safe and adequate nutrition of infants through regulation of marketing of infant foods and related products. (e.g. breast milk substitutes, infant formulas, feeding bottles, teats etc. )B. RA 7600 THE ROOMING –IN and BREASTFEEDING ACT of 1992 =An act providing incentives to government and private health institutions promoting and practicing rooming-in and breast-feeding.=Provision for human milk bank.=Information, education and re-education drive=Sanction and Regulation BABY

Provides Antibodies Contains Lactoferin (binds with Iron) Leukocytes Contains Bifidus factor-promotes growth of the Lactobacillus-

inhibits the growth of pathogenic bacilli For the Mother

e. Reduces a woman’s risk of excessive blood loss after birthf. Provides a natural method of delaying pregnancies.g. Reduces the risk of ovarian and breast cancers and osteoporosis.

For the Family and Communityh. Conserves funds that otherwise would be spent on breast milk

substitute, supplies and fuel to prepare them.i. Saves medical costs to families and governments by preventing

illnesses and by providing immediate postpartum contraception. POSITIONS IN BF THE BABY: 1. Cradle Hold = head and neck are supported 2. Football Hold 3. Side Lying Position

BEST FOR BABIES REDUCE INCIDENCE OF ALLERGENS ECONOMICAL ANTIBODIES PRESENT STOOL INOFFENSIVE (GOLDEN YELLOW) EMPERATURE ALWAYS IDEALFRESH MILK NEVER GOES OFF

EMOTIONALLY BONDING EASY ONCE ESTABLISHED DIGESTED EASILY IMMEDIATELY AVAILABLE NUTRITIONALLY OPTIMAL GASTROENTERITIS GREATLY REDUCED

Environmental Health Program Environmental Sanitation and Promotion of Safe Water Supply

Environmental Sanitation is defined as the study of all factors in the man’s environment, which exercise or may exercise deleterious effect on his well-being and survival.

-Water is a basic need for life and one factor in man’s environment. Water is necessary for the maintenance of healthy lifestyle.

Safe Water and Sanitation is necessary for basic promotion of health.

-One basic need of the family is food. And if food is properly prepared then one may be assured healthy family. There are many food resources found in the communities but because of faulty preparation and lack of knowledge regarding proper food planning, Malnutrition is one of the problems that we have in the country. HEALTH AND SANITATION

-Environmental Sanitation is still a health problem in the country. -Diarrheal diseases ranked second in the leading causes of morbidity among the general population. -Other sanitation related diseases : tuberculosis, intestinal parasitism, schistossomiasis, malaria, infectious hepatitis, filariasis and dengue hemorrhagic fever DOH thru’ Environmental Health Services (EHS)unit is authorized to act on all issues and concernsin environment and health including the verycomprehensive Sanitation Code of the Philippines (PD 856, 1978). WATER SUPPLY SANITATION PROGRAMEHS sets policies on:

Approved types of water facilities

Unapproved type of water facility Access to safe and potable drinking water Water quality and monitoring surveillance Waterworks/Water system and well construction

Approved type of water facilitiesLevel 1 (Point Source)- a protected well or a developed spring with an outlet but without a distribution system

indicated for rural areas; serves 15-25 households; its outreach is not more than 250 m from

the farthest user yields 40-140 L/ min Level II ( Communal Faucet or Stand Posts) With a source, reservoir, piped distribution network and

communal faucets Located at not more than 25 m from the farthest house Delivers 40-80 L of water per capital per day to an average of 100

households Fit for rural areas where houses are densely clustered

Level III ( Individual House Connections or Waterworks System) With a source, reservoir, piped distributor network and household

taps Fit for densely populated urban communities Requires minimum treatment or disinfection

ENVIRONMENTAL SANITATION- the study of all factors in man’s physical environment,

which may exercise a deleterious effect on his health, well-being and survival.Includes:1.1 Water sanitation1.2 Food sanitation1.3 Refuse and garbage disposal1.4 Excreta disposal1.5 Insect vector and rodent control1.6 Housing1.7 Air pollution1.8 Noise1.9 Radiological Protection1.10 Institutional sanitation1.11 Stream pollution PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM

EHS sets policies on:Approved types of toilet facilities : LEVEL II – on site toilet facilities of the water carriage type with water-sealed and flush type with septic vault/tank disposal. LEVEL III – water carriage types of toilet facilities connected to septic tanks and/or to sewerage system to treatment plant. FOOD SANITATION PROGRAM

-sets policy and practical programs to prevent and control food-borne diseases to alleviate the living conditions of the population HOSPITAL WASTE MANAGEMENT PROGRAM

Disposal of infectious, pathological and other wastes from hospital which combine them with the municipal or domestic wastes pose health hazards to the people. Hospitals shall dispose their hazardous wastes thru incinerators or disinfectants to prevent transmission of nosocomial diseasesPROGRAM ON HEALTH RISK MINIMIZATION DUE TO ENVIRONMENTAL POLLUTION

Foci: 1. Prevention of serious environmental hazards resulting from urban growth and industrialization2. policies on health protection measures3. researches on effects of GLOBAL WARMING to health (depletion of the stratosphere ozone layer which increases ultraviolet radiation, climate change and other conditions)NURSING RESPONSIBILITIES AND ACTIVITIES

Health Education – IEC by conducting community assemblies and bench conferences.

The Occupational Health Nurse, School Health Nurse and other Nursing staff shall impart the need for an effective and efficient environmental sanitation in their places of work and in school.

Actively participate in the training component of the service like in Food Handler’s Class, and attend training/workshops related to environmental health.

Assist in the deworming activities for the school children and targeted groups.

Effectively and efficiently coordinate programs/projects/activities with other government and non-government agencies.

Act as an advocate or facilitator to families in the community in matters of program/projects/activities on environmental health in coordination with other members of Rural Health Unit (RHU) especially the Rural Sanitary Inspectors.

Actively participate in environmental sanitation campaigns and projects in the community. Ex. Sanitary toilet campaign drive for proper garbage disposal, beautification of home garden, parks drainage and other projects.

Be a role model for others in the community to emulate terms of cleanliness in the home and surrounding.

There was a man who saw a scorpion floundering around in the water.

He decided to save it by stretching out his finger but the scorpion stung him.

The man still tried to get the scorpion out of the water but the scorpion stung him again.

Another man nearby told him to stop saving the scorpion but the man said, “It’s the nature of the scorpion to sting. It’s my nature to love, why should I give up my nature to love just because it’s the nature of the scorpion to sting?”

Don’t give up loving, don’t give up your goodness even if people around you sting…

THE END See u next sem.