COMMUNITY HEALTH

NURSING
Mrs. Laarne Estenzo-Pontillas
BSN , R.N., MSN
 (Mark 10:45)

Discipleship is a lifestyle
Not just a biblical truth
Nor a Christian ideal but a way of life
For the Son of Man also came not to be served
But to serve and to give His life as a ransom for
many.
COVERAGE FOR LOCAL
BOARD EXAM : CHN
I. Safe and Quality Care, Health
Education, and Communication,
Collaboration and Teamwork
1. Principles and Standard of CHN
2. Levels of care
3. Types of Clientele
4. Health Care Delivery System
5. PHC as a Strategy
1. Family-based Nursing
Services(Family Health Nursing
Process)
2. Population Group-based Nursing
Services
3. Community-based Nursing
Services/Community Health Nursing
Process
4. Community Organizing
5. Public Health Programs
I. Research and Quality
Improvement

3. Research in the Community

4. National Health Situation
5. Vital Statistics
6. Epidemiology
7. Demography
I. Management of Resources &
Environment and Records
Management
2. Field Health Services And
Information System
3. Target-setting
4. Environmental Sanitation
I. Ethico-Moral-Legal Responsibility
2. Socio-cultural values, beliefs, and
practices of individuals, families,
groups and communities
3. Code of Ethics for Government
Workers
4. WHO, DOH, LGU policies on health
5. Local Government Code
6. Issues
 Personal And Professional
Development
1. Self-assessment of CHN
competencies, importance, methods
and tools
2. Strategies and methods of updating
one’s self, enhancing competence in
community health nursing and
related areas.
 HISTORY OF CHN
Date Event
1901 - Act # 157 ( Board of Health of the Philippines) ;
Act # 309 ( Provincial and Municipal Boards of
Health) were created.
1905 - Board of Health was abolished; functions were
transferred to the Bureau of Health.
1912 – Act # 2156 or Fajardo Act created the Sanitary
Divisions, the forerunners of present MHOs; male
nurses performs the functions of doctors
1919 – Act # 2808 (Nurses Law was created)
- Carmen del Rosario , 1st Fil. Nurse supervisor
under Bureau of Health
Oct. 22, 1922 – Filipino Nurses Organization
(Philippine Nurses’ Organization) was organized.
 1923 – Zamboanga General Hospital School of
Nursing & Baguio General Hospital were
established; other government schools of nursing
were organized several years after.
 1928- 1st Nursing convention was held
 1940 – Manila Health Department was created.
 1941 – Dr. Mariano Icasiano became the first
city health officer; Office of Nursing was
created through the effort of Vicenta Ponce
(chief nurse) and Rosario Ordiz (assistant chief
nurse)
 Dec. 8, 1941 – Victims of World War II were
treated by the nurses of Manila.
 July 1942 – Nursing Office was created; Dr.
Eusebio Aguilar helped in the release of 31 Filipino
nurses in Bilibid Prison as prisoners of war by
the Japanese.
 Feb. 1946 – Number of nurses decreased from 556 – 308.
 1948 – First training center of the Bureau of Health
was organized by the Pasay City Health
Department. Trinidad Gomez, Marcela Gabatin,
Costancia Tuazon, Ms. Bugarin, Ms. Ramos, and
Zenaida Nisce composed the training staff.
 1950 – Rural Health Demonstration and
Training Center was created.
 1953 – The first 81 rural health units were
organized.
 1957 – RA 1891 amended some sections of RA
1082 and created the eight categories of rural
health unit causing an increase in the demand
for the community health personnel.
 1958-1965 – Division of Nursing was abolished
(RA 977) and Reorganization Act (EO 288)
 1961 – Annie Sand organized the National League of
Nurses of DOH.
 1967 – Zenaida Nisce became the nursing program
supervisor and consultant on the six special
diseases (TB, leprosy, V.D., cancer, filariasis, and
mental health illness).
 1975 – Scope of responsibility of nurses and midwives
became wider due to restructuring of the health
care delivery system.
 1976-1986 – The need for Rural Health Practice
Program was implemented.
 1990- 1992- Local Government Code of 1991 (RA 7160)
 1993-1998 – Office of Nursing did not
materialize in spite of persistent
recommendation of the officers, board
members, and advisers of the National League
of Nurses Inc.
 Jan. 1999 – Nelia Hizon was positioned as the
nursing adviser at the Office of Public
Health Services through Department Order #
29.
 May 24, 1999 – EO # 102, which redirects the
functions and operations of DOH, was
signed by former President Joseph Estrada.
LAWS AFFECTING
PUBLIC HEALTH
AND PRACTICE
OF COMMUNITY
HEALTH NURSING
R.A. 7160 - or the Local Government Code. This
involves the devolution of powers, functions and
responsibilities to the local government both rural
& urban.The Code aims to transform local
government units into self-reliant communities and
active partners in the attainment of national goals
thru’ a more responsive and accountable local
government structure instituted thru’ a system of
decentralization. Hence, each province, city and
municipality has a LOCAL HEALTH BOARD
( LHB ) which is mandated to propose annual
budgetary allocations for the operation and
maintenance of their own health facilities.
 Composition of LHB
Provincial Level
1.Governor- chair
2. Provincial Health Officer – vice chair
3. Chair , Committee on Health of Sangguniang
Panlalawigan
4. DOH rep.
5. NGO rep.
 Composition of LHB
City and Municipal Level
2. Mayor – chair
2. MHO – vice chair
3. Chair, Committee on Health of Sangguniang
Bayan
4. DOH rep
5. NGO rep
 EFFECTIVE LHS DEPENDS
ON:

1. the LGU’s financial capability

2. a dynamic and responsive political leadership
3. community empowerment
R.A. 2382 – Philippine Medical Act. This act defines the
practice of medicine in the country.

R.A. 1082 – Rural Health Act. It created the 1st 81 Rural

Health Units.
-amended by RA 1891 ; more physicians, dentists,
nurses, midwives and sanitary inspectors will live in the
rural areas where they are assigned in order to raise the
health conditions of barrio people ,hence help decrease the
high incidence of preventable diseases
R.A. 6425 – Dangerous Drugs Act. It stipulates
that the sale, administration, delivery,
distribution and transportation of prohibited
drugs is punishable by law.
R.A. 9165 – the new Dangerous Drug Act of 2002

P.D. No. 651 – requires that all health workers

shall identify and encourage the registration of
all births within 30 days following delivery.
P.D. No. 996 – requires the compulsory
immunization of all children below 8 yrs. of age
against the 6 childhood immunizable diseases.
P.D. No. 825 – provides penalty for improper
disposal of garbage.
R.A. 8749 – Clean Air Act of 2000
P.D. No. 856 – Code on Sanitation. It provides for
the control of all factors in man’s environment that
affect health including the quality of water, food,
milk, insects, animal carriers, transmitters of
disease, sanitary and recreation facilities, noise,
pollution and control of nuisance.
R.A. 6758 – standardizes the salary of government
employees including the nursing personnel.
R.A. 6675 – Generics Act of 1988 which promotes, requires
and ensures the production of an adequate supply,
distribution, use and acceptance of drugs and medicines
identified by their generic name.
R.A. 6713 – Code of Conduct and Ethical Standards of
Public Officials and Employees. It is the policy of the
state to promote high standards of ethics in public office.
Public officials and employees shall at all times be
accountable to the people and shall discharges their duties
with utmost responsibility, integrity, competence and
loyalty, act with patriotism and justice, lead modest lives
uphold public interest over personal interest.
R.A. 7305 – Magna Carta for Public Health Workers.
This act aims: to promote and improve the social
and economic well-being of health workers, their
living and working conditions and terms of
employment; to develop their skills and capabilities
in order that they will be more responsive and better
equipped to deliver health projects and programs;
and to encourage those with proper qualifications
and excellent abilities to join and remain in
government service.
R.A. 8423 – created the Philippine Institute of
Traditional and Alternative Health Care.
P.D. No. 965 – requires applicants for marriage license to
receive instructions on family planning and responsible
parenthood.

P.D. NO. 79 – defines , objectives, duties and functions of

POPCOM
 RA 4073 – advocates home treatment for
leprosy

 Letter of Instruction No. 949 – legal basis of

PHC dated OCT. 19, 1979
 - promotes development of health programs on the
community level
 RA 3573 – requires reporting of all cases of
communicable diseases and administration of
prophylaxis

 Ministry Circular No. 2 of 1986 – includes

AIDS as notifiable disease
R.A. 7875 – National Health Insurance Act
R.A. 7432 – Senior Citizens Act
R. A. 7719 - National Blood Services Act
R.A. 8172 – Salt Iodization Act ( ASIN LAW)
R.A. 7277- Magna Carta for PWD’s, provides
their rehabilitation, self-development and self-
reliance and integration into the mainstream of
society
 A. O. No. 2005-0014- National Policies on
Infant and Young Child Feeding:
1.All newborns be breastfeed within 1 hr after
birth
2. Infants be exclusively breastfeed for 6 mos.
3. Infants be given timely, adequate and safe
complementary foods
4. Breastfeeding be continued up to 2 years and
beyond
 EO 51- Phil. Code of Marketing of Breastmilk
Substitutes
 R.A.- 7600 – Rooming In and Breastfeeding
Act of 1992
 R.A. 8976- Food Fortification Law
 R.A. 8980- prolmulgates a comprehensive
policy and a national system for ECCD
 A..O. No. 2006- 0015- defines the
Implementing guidelines on Hepatitis B
Immunization for Infants
 R.A. 7846- mandates Compulsory Hepatitis B
Immunization among infants and children less
than 8 yrs old
 R.A. 2029- madates Liver Cancer and
Hepatitis B Awareness Month Act ( February)
 A.O. No. 2006-0012- specifies the Revised
Implementing Rules and Regulations of E.O.
51 or Milk Code, Relevant International
Agreements, Penalizing Violations thereof and
for other purposes
 Public Health
 -” science and art of preventing diasease,
prolonging life, promoting health and efficiency thru’
organized community effort for the sanitation of the
environment, control of communicable diseases, the
education of individuals in personal hygiene, the
organization of medical and nursing services for the
early diagnosis and preventive treatment of diseases
and the development of social machinery to ensure
everyone a standard of living adequate for the
maintenance of health, so organizing these benefits as
to enable every citizen to realize his birthright off
birth and longevity” ( DR. C.E. Winslow)
 Community Health Nursing
 - special field of nursing that combines the
skills of nursing, public health and some
phases of social assistance and functions as
part of the total public health program for the
promotion of health, the improvement of the
conditions in the social and physical
environment, rehabilitation of illness and
disability ( WHO Expert Committee of
Nursing )
 CHN
 - a learned practice discipline with the ultimate goal
of contributing as individuals and in collaboration
with others to the promotion of the client’s optimum
level of functioning thru’ teaching and delivery of
care ( Jacobson )
 - a service rendered by a professional nurse to IFCs,
population groups in health centers, clinics, schools ,
workplace for the promtion of health, preventionof
illness, care of the sick at home and rehabilitation
(DR. Ruth B. Freeman)
 Concepts
 The primary focus of community health nursing
is health promotion.
 Community health nurses provide care necessary
to meet the requirements of an individual all
throughout the life cycle.
 Knowledge on different fields (biological and
social sciences, clinical nursing, and community
health organizations) is used.
 Nursing process in community health nursing
changes based on the needs of the community.
 Goal
 To elevate the level health of the multitude.
Philosophy
 Worth and dignity of man.
Principles
1.The need of the community is the basis of
community health nursing.
2.The community health nurse must
understand fully the objectives and policies
of the agency she represents.
3. The family is the unit of service.
4. CHN must be available to all regardless of
race,creed and socioeconomic status
5. The CHN works as a member of the health team
6. There must be provision for periodic evaluation
of community health nursing services
7. Opportunities for continuing staff education
programs for nurses must be provided by the
community health nursing agency and the CHN
as well
8. The CHN makes use of available community
health resources
9. The CHN taps the already existing
active organized groups in the
community
10. There must be provision for educative
supervision in community health nursing
11. There should be accurate recording
and reporting in community health
nursing
12. Health teaching is the primary
responsibility of the community health
nurse
 Standards in CHN
I. Theory
Applies theoretical concepts as basis for
decisions in practice
II. Data Collection
Gathers comprehensive , accurate data
systematically
 Standards
III. Diagnosis
Analyzes collected data to determine the needs/
health problems of IFC
IV. Planning
At each level of prevention, develops plans that
specify nursing actions unique to needs of
clients
 Standards
V. Intervention
Guided by the plan, intervenes to promote,
maintain or restore health, prevent illness and
institute rehabilitation
VI. Evaluation
Evaluates responses of clients to interventions to
note progress toward goal achievement, revise
data base, diagnoses and plan
 Standards
VII. Quality Assurance and Professional
Development
Participates in peer review and other means of
evaluation to assure quality of nursing practice
Assumes professional development
Contributes to development of others
 Standards
VIII. Interdisciplinary Collaboration

Collaborates with other members of the health

team, professionals and community
representatives in assessing, planning,
implementing and evaluating programs for
community health
 Standards
I. Research
Indulges in research to contribute to theory and
practice in community health nursing
LEVELS OF CARE/ PREVENTION
 1. PRIMARY

 2. SECONDARY

 3. TERTIARY
 Types of Clientele
 1. INDIVIDUALS
 2. FAMILIES

 3. COMMUNITIES

 4. POPULATION GROUPS

- Aggregate of people who share common

characteristics, developmental stage or common
exposure to particular environmental factors thus
resulting in common health problems ( Clark, 1995:5)
e.g. children . elderly, women, workers etc.
Phil.Health Care Delivery System
 1.PRIMARY LEVEL FACILITIES

 2. SECONDARY LEVEL FACILITIES

 3. TERTIARY LEVEL FACILITIES

 Classify as to what level the ff.
belong
 1. Teaching and Training Hospitals
 2. City Health Services
 3. Emergency and District Hospitals
 4. Private Practitioners
 5. Heart Institutes
 6. Puericulture Centers
 7. RHU
THE DEPARTMENT OF
HEALTH
VISION: Health for all Filipinos
MISSION: Ensure accessibility & quality of
health care to improve the quality of life of
all Filipinos, especially the poor.
 NATIONAL OBJECTIVES
1. Improve the general health status of the population
(reduce infant mortality rate, reduce child morality rate,
reduce maternal mortality rate, reduce total fertility rate,
increase life expectancy & the quality of life years).
2. Reduce morbidity, mortality, disability & complications
from Diarrheas, Pneumonias, Tuberculosis, Dengue,
Intestinal Parasitism, Sexually Transmitted Diseases,
Hepatitis B, Accident & Injuries, Dental Caries &
Periodontal Diseases, Cardiovascular Diseases, Cancer,
Diabetes, Asthma & Chronic Obstructive Pulmonary
Diseases, Nephritis & Chronic Kidney Diseases, Mental
Disorders, Protein Energy Malnutrition, Iron Deficiency
Anemia & Obesity.
3.Eliminate the ff. diseases as public health problems:
 Schistosomiasis
 Malaria
 Filariasis
 Leprosy
 Rabies
 Measles
 Tetanus
 Diphtheria & Pertussis
 Vitamin A Deficiency & Iodine Deficiency
Disorders
4. Eradicate Poliomyelitis
5. Promote healthy lifestyle through healthy diet &
nutrition, physical activity & fitness, personal
hygiene, mental health & less stressful life &
prevent violent & risk-taking behaviors.
6. Promote the health & nutrition of families &
special populations through child, adolescent &
youth, adult health, women’s health, health of
older persons, health of indigenous people, health
of migrant workers and health of different disabled
persons and of the rural & urban poor.
7. Promote environmental health and sustainable
development through the promotion and
maintenance of healthy homes, schools,
workplaces, establishments and communities
towns and cities.
 Basic Principles to Achieve
Improvement in Health
1. Universal access to basic health services
must be ensured.
2. The health and nutrition of vulnerable groups
must be prioritized.
3. The epidemiological shift from infection to
degenerative diseases must be managed.
4. The performance of the health sector must be
enhanced.
 Primary Strategies to Achieve
Goals
1. Increasing investment for Primary Health
Care.
2. Development of national standards and
objectives for health.
3. Assurance of health care.
4. Support to the local system development.
5. Support for frontline health workers.
PHC as a Strategy
 PRIMARY HEALTH CARE (PHC)

 May 1977 -30th World Health Assembly decided

that the main health target of the government and
WHO is the attainment of a level of health that
would permit them to lead a socially and
economically productive life by the year 2000.
 September 6-12, 1978 - First International
Conference on PHC in Alma Ata, Russia (USSR)
The Alma Ata Declaration stated that PHC was the
key to attain the “health for all” goal
October 19, 1979 - Letter of Instruction (LOI)
949), the legal basis of PHC was signed by Pres.
Ferdinand E. Marcos,
which adopted PHC as an approach towards the
design, development and implementation of
programs focusing on health development at
community level.
☛ RATIONALE FOR ADOPTING PRIMARY HEALTH CARE:

• Magnitude of Health Problems

• Inadequate and unequal distribution of
health resources
• Increasing cost of medical care
• Isolation of health care activities from other
development activities
 ☛DEFINITION OF PRIMARY HEALTH CARE
 essential health care made universally accessible to
individuals and families in the community by means
acceptable to them, through their full participation
and at cost that the community can afford at every
stage of development.
 a practical approach to making health benefits

within the reach of all people.

 an approach to health development, which is carried

out through a set of activities and whose ultimate

aim is the continuous improvement and maintenance
of health status of the community.
 GOAL OF PRIMARY HEALTH CARE:
HEALTH FOR ALL FILIPINOS by the year 2000
AND HEALTH IN THE HANDS OF THE PEOPLE by
the year 2020.

An improved state of health and quality of life for all

people attained through SELF-RELIANCE.
 KEY STRATEGY TO ACHIEVE THE GOAL:
Partnership with and Empowerment of the people -
permeate as the core strategy in the effective provision of
essential health services that are community based,
accessible, acceptable, and sustainable, at a cost, which the
community and the government can afford.
 OBJECTIVES OF PRIMARY HEALTH CARE
 • Improvement in the level of health care of the community
 • Favorable population growth structure
 • Reduction in the prevalence of preventable, communicable and
other disease.
 • Reduction in morbidity and mortality rates especially among infants
and children.
 • Extension of essential health services with priority given to the
underserved sectors.
 • Improvement in Basic Sanitation
 • Development of the capability of the community aimed at self-
reliance.
 • Maximizing the contribution of the other sectors for the social and
economic development of the community.
 MISSION:
 To strengthen the health care system by
increasing opportunities and supporting the
conditions wherein people will manage their
own health care.
TWO LEVELS OF PRIMARY HEALTH CARE
WORKERS
3. Barangay Health Workers - trained community health
workers or health auxiliary volunteers or traditional birth
attendants or healers.
4. Intermediate level health workers include the Public
Health Nurse, Rural Sanitary Inspector and midwives.
 PRINCIPLES OF PRIMARY HEALTH CARE
 1. 4 A's = Accessibility, Availability,
Affordability & Acceptability, Appropriateness
of health services. The health services should be
present where the supposed recipients are.
They should make use of the available resources
within the community, wherein the focus would
be more on health promotion and prevention of
illness.
 2. COMMUNITY PARTICIPATION
=heart and soul of PHC
 3. People are the center, object and subject of
development.
 Thus, the success of any undertaking that aims at serving
the people is dependent on people’s participation at all
levels of decision-making; planning, implementing,
monitoring and evaluating. Any undertaking must also be
based on the people’s needs and problems (PCF, 1990)
 Part of the people’s participation is the partnership between
the community and the agencies found in the community;
social mobilization and decentralization.
 In general, health work should start from where the people
are and building on what they have. Example: Scheduling of
Barangay Health Workers in the health center
BARRIERS OF COMMUNITY INVOLVEMENT

 Lack of motivation
 Attitude

 Resistance to change

 Dependence on the part of community

people
 Lack of managerial skills
4.SELF-RELIANCE
5.Partnership between the community
and the health agencies in the provision
of quality of life.
Providing linkages between the
government and the non-government
organization and people’s organization.
 6. Recognition of interrelationship between the
health and development
HEALTH
 is not merely the absence of disease. Neither it is only a
state of physical and mental well-being. Health being a
social phenomenon recognizes the interplay of political,
socio-cultural and economic factors as its determinant.
Good Health therefore, is manifested by the progressive
improvements in the living conditions and quality of life
enjoyed by the community residents (PCF,
DEVELOPMENT is the quest for an improved quality of
life for all. Development is multi-dimensional. It has a
political, social, cultural, institutional and environmental
dimensions(Gonzales 1994). Therefore, it is measured by
the ability of people to satisfy their basic needs.
 7. SOCIAL MOBILIZATION
It enhances people participation or governance,
support system provided by the Government,
networking and developing secondary
leaders.

8. DECENTRALIZATION
 MAJOR STRATEGIES OF PRIMARY
HEALTH CARE
A. ELEVATING HEALTH TO A COMPREHENSIVE AND
SUSTAINED NATIONAL EFFORTS.
 Attaining Health for all Filipino will require expanding
participation in health and health related programs whether
as service provider or beneficiary. Empowerment to
parents, families and communities to make decisions of
their health is really the desired outcome.
 Advocacy must be directed to National and Local policy
making to elicit support and commitment to major health
concerns through legislations, budgetary and logistical
considerations.
B. PROMOTING AND SUPPORTING COMMUNITY
MANAGED HEALTH CARE

The health in the hands of the

people brings the government closest
to the people. It necessitates a process
of capacity building of communities
and organization to plan, implement
and evaluate health programs at their
levels.
 C. INCREASING EFFICIENCIES IN THE
HEALTH SECTOR
 Using appropriate technology will make services
and resources required for their delivery, effective,
affordable, accessible and culturally acceptable. The
development of human resources must correspond
to the actual needs of the nation and the policies it
upholds such as PHC. The DOH will continue to
support and assist both public and private
institutions particularly in faculty development,
enhancement of relevant curricula and development
of standard teaching materials.
D. ADVANCING ESSENTIAL NATIONAL
HEALTH RESEARCH
Essential National Health Research
(ENHR) is an integrated strategy for
organizing and managing research
using intersectoral, multi-disciplinary
and scientific approach to health
programming and delivery.
 FOUR CORNERSTONES/ PILLARS IN
PRIMARY HEALTH CARE
1. Active Community Participation
2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. Support mechanism made available
 HERBAL MEDICINES ENDORSED BY THE
DEPARTMENT OF HEALTH

Name Indications Dosage

1.Five-leaf 1. Asthma Divide the decoction into
Chaste tree 2. Cough 3 parts:
For asthma and cough,
(Lagundi) 3. Body Pain
4. Fever drink 1 part 3 times a day.
For fever and body

pains, drink 1 part every 4

hrs.
2. Marsh-Mint; 1. Body pain Divide
Peppermint decoction into
(Yerba Buena) 2 parts and
drink 1 part
every 3 hours.

3. Sambong 1. Swelling  Divide

2. Inducing decoction into
diuresis 3 parts and
( anti- drink 1 part 3
times a day.
urolithiasis)
4. Tsaang 1. Stomachache  Drink the warm
Gubat decoction. If it
persists, or if there is
no improvement an
hour after drinking
the decoction,
consult a doctor.
5. Ulasimang 1. Gouty Arthritis Divide the

Bato/Pansit- decoction into 3 parts

Pansitan and drink 1 part 3
times a day after
meals.
6. Garlic 1. Hypertension Eat 6 cloves of
2. Htperlipidemia garlic together
with meals
7. Niyog- 1. Ascariasis Chew and
Niyogan swallow only
dried seeds 2
hours after dinner
according to the
following:
 ADULTS = 8-10

seeds
9-12 y/o = 6-7 seeds
6-8 y/o = 5-6 seeds
4-5 y/o = 4-5 seeds
8. Guava 1. Cleaning  For wound cleaning, use
wounds decoction for washing the
2. Mouth wash wound 2 times a day
for mouth For tooth decay and

infection, swelling of gums, gargle

sore gums & with warm decoction 3
tooth decay times a day
9.  Ring worm Apply the juice on the affected area 1
Akapulko  Athlete’s to 2 times a day
foot If the person develops an allergy

 Scabies while using the above preparation,

prepare the following:
oPut 1 cup of chopped fresh leaves in

an earthen jar. Pour in 2 glasses of

water and cover it.
oBoil the mixture until the 2 glasses of

water originally poured have been

reduced to 1 glass of water
oStrain the mixture. Use it while it is

warm.
oApply the warm decoction on the

affected area 1 to 2 times a day.

10. 1. Mild Non-  Drink ½ cup
Bitter Gourd/ Insulin of cooled or
Melon Dependent warm
(Ampalaya) Diabetes decoction 3
Mellitus times a day
after meals.
11. Ginger 1. Motion An abortifacient if taken in
(Zingiber sickness, sore large amounts; should not be
officinale) throat, nausea used by persons with
& vomiting, cholelithiasis unless directed
migraine by the physician; may
headaches, increase the risk of bleeding
arthritis when used concurrently with
anticoagulants &
antiplatelets.
Chop and Mash a piece of
ginger root, and mix in a glass of
water
Boil the mixture

Drink the cooled or warm

decoction as needed.
 ELEMENTS OF PRIMARY HEALTH
CARE:
Education For Health
Is one of the potent methodologies for
information dissemination. It promotes
the partnership of both the family
members and health workers in the
promotion of health as well as prevention
of illness.
Locally Endemic Disease
Control
The control of endemic disease focuses
on the prevention of its occurrence to
reduce morbidity rate. Example
Malaria Control and Schistosomiasis
Control
 Expanded Program on Immunization
This program exists to control the
occurrence of preventable illnesses
especially of children below 6 years old.
Immunizations on poliomyelitis,
measles, tetanus, diphtheria and other
preventable disease are given for free
by the government and ongoing
program of the DOH
 Maternal and Child Health and
Family Planning
The mother and child are the most delicate
members of the community. So the
protection of the mother and child to
illness and other risks would ensure good
health for the community. The goal of
Family Planning includes spacing of
children and responsible parenthood.
 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.
Nutrition and Promotion of Adequate
Food Supply
One basic need of the family is food. And if
food is properly prepared then one may be
assured healthy family. There are many food
resources found in the communities but
because of faulty preparation and lack of
knowledge regarding proper food planning,
Malnutrition is one of the problems that we
have in the country.
Treatment of Communicable Diseases
and Common Illness
The diseases spread through direct contact
pose a great risk to those who can be infected.
Tuberculosis is one of the communicable
diseases continuously occupies the top ten causes
of death. Most communicable diseases are also
preventable. The Government focuses on the
prevention, control and treatment of these
illnesses.
 Supply of Essential Drugs
This focuses on the information campaign
on the utilization and acquisition of drugs.
In response to this campaign, the
GENERIC ACT of the Philippines is
enacted . It includes the following drugs:
Cotrimoxazole, Paracetamol,
Amoxycillin, Oresol, Nifedipine,
Rifampicin, INH(isoniazid) and
Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine
 FAMILY HEALTH NURSING
 - that level of CHN practice directed to the
FAMILY as the unit of care with HEALTH as
the goal and NURSING as the medium,
channel or provider of care
 Family Case Load
 - the no. and kind of families a nurse handles
at any given time
 - variable for cases are added or dropped based
on the need for nursing care and supervision
 Types of Families
 1. Nuclear
 2. Extended
 3. Three generational
 4. Dyad
 5. Single- Parent
 6. Step- Parent
 7. Blended or reconstituted
 Types of Families
 8. Single adult living alone
 9. Cohabiting/ Living –in
 10. No- kin
 11. Compound
 12. Gay
 14. Commune
 Stages of Family Life Cycle
 1. Newly married couple
 2. Childbearing
 3. Preschool age
 4. Schoolage
 5. Teenage
 6. Launching
 7. Middle-aged ( empty nest –retirement)
 8. Period from retirement to Death of both spouses
 HEALTH TASKS OF THE
FAMILY( Freeman, 1981)
 1. recognizing interruptions of health or development
 2. seeking health care
 3. managing health and non-health crises
 4. providing nursing care to the sick, disabled and
dependent member of the family
 5. maintaining a home environment conducive to
good health and personal development
 6. maintaining a reciprocal relationship with the
community and health institutions
 Family Nursing Problem
 Arises when the family cannot effectively
perform its health tasks
Nurse’s Roles in Family Health
Nursing
 1. HEALTH MONITOR
 2. PROVIDER OF CARE TO A SICK
FAMILY MEMBER
 3. COORDINATOR OF FAMILY
SERVICES
 4. FACILITATOR
 5. TEACHER
 6. COUNSELOR
 INITIAL DATA BASE FOR
FAMILY NURSING PRACTICE
 Family structure, Characteristics, and
Dynamics
2. Members of the household and relationship to
the head of the family
3. Demographic data – age, sex, civil status,
position in the family
4. Place of residence of each member – whether
living with the family or elsewhere
4. Type of family structure – e.g. matriarchal
or patriarchal, nuclear or extended
2. Dominant family members in terms of
decision-making, especially in matters of
health care
3. General family relationship/dynamics –
presence of any readily observable conflict
between members; characteristics
communication patterns among members
  Socio-economic and Cultural
Characteristics
2. Income and Expenses
 Occupation, place of work and income of
each working members
 Adequacy to meet basic necessities
 Who makes decisions about money and how
it is spent
3. Educational attainment of each other
4. Ethnic background and religious
affiliation
1. Significant Others – role(s)
they play in family’s life
2. Relationship of the family to
larger community – Nature and
extent of participation of the
family in community activities
  Home and Environment
2. Housing
 Adequacy of living peace
 Sleeping arrangement
 Presence of breeding or resting sites of vectors of
diseases
 Presence of accidents hazards
 Food storage and cooking facilities
 Water supply – source, ownership, portability
 Toilet facility – type, ownership, sanitary condition
 Drainage system – type, sanitary condition
1. Kind of neighborhood, e.g.
congested, slum, etc.
2. Social and health facilities
available
3. Communication and
transportation facilities
available
  Health Status of each Family Member
2. Medical and nursing history indicating current
or past significant illnesses or beliefs and
practices conducive to health illness
3. Nutritional assessment
 Anthropometric data: Measures of nutritional status
of children, weight, height, mid-upper arm
circumference: Risk assessment measures of
obesity: body mass index, waist circumference,
waist hip ratio
 Dietary history specifying quality and quantity of
food/nutrient intake per day
 Eating/ feeding habits/ practices
3. Developmental assessments of infants, toddlers,
and preschoolers – e.g., Metro Manila
4. Risk factor assessment indicating presence of
major and contributing modifiable risk factors
for specific lifestyles, cigarette smoking,
elevated blood lipids, obesity, diabetes mellitus,
inadequate fiber intake, stress, alcohol drinking
and other substance abuse
5. Physical assessment indicating
presence of illness state/s
6. Results of laboratory/
diagnostic and other screening
procedures supportive of
assessment findings
  Values, Habits, Practices on Health
Promotion, Maintenance and Disease
Prevention.
Examples include:
3. Immunization status of family members
4. Healthy lifestyle practices. Specify.
5. Adequacy of:
 rest and sleep
 exercise
 use of protective measures- e.g. adequate footwear
in parasite-infested areas;
 relaxation and other stress management activities
6. Use of promotive-preventive health services
 A TYPOLOGY OF NURSING
PROBLEMS IN FAMILY NURSING
PRACTICE
FIRST-LEVEL ASSESSMENT
 Presence of Wellness Condition – stated as Potential
or Readiness- a clinical or nursing judgment about a
client in transition from a specific level of wellness
or capability to a higher level. Wellness potential is
a nursing judgment on wellness state or condition
based on client’s performance, current competencies
or clinical data but no explicit expression of client
desire. Readiness for enhanced wellness state is a
nursing judgment on wellness state or condition
based on client’s current competencies or
performance, clinical data explicit expression of
desire to achieve a higher level of state or function in
specific area on health promotion and maintenance.
 Examples of these are the following:
1. Potential for Enhanced Capability for:
 Healthy lifestyle – e.g. nutrition/diet, exercise/
activity
 Health Maintenance
 Parenting
 Breastfeeding
 Spiritual Well-being – process of a client’s
unfolding of mystery through harmonious
interconnectedness that comes from inner
strength/sacred source/GOD (NANDA 2001)
 Others,
1. Readiness for Enhanced Capability for:
 Healthy Lifestyle
 Health Maintenance
 Parenting
 Breastfeeding
 Spiritual Well-being
 Others,
I. Presence of Health Threats –
conditions that are conducive to
disease, accident or failure top
realize one’s health potential.
Examples of these are the following:
3. Family history of hereditary
condition, e.g. diabetes
4. Threat of cross infection from a
communicable disease case
1. Family size beyond what family
resources can adequately provide
2. Accidental hazards
 Broken stairs
 Sharp objects, poison, and
medicines improperly kept
 Fire hazards
1. Faulty nutritional habits or
feeding practices.
Inadequate food intake both in
quality & quantity
Excessive intake of certain
nutrients
Faulty eating habits
Ineffective breastfeeding
Faulty feeding practices
1. Stress-provoking factors –
 Strained marital relationship
 Strained parent-sibling
relationship
 Interpersonal conflicts between
family members
 Care-giving burden
1. Poor home condition-
 Inadequate living space
 Lack of food storage
facilities
 Polluted water supply
 Presence of breeding
sites of vectors of
disease
 Improper garbage
 Unsanitary waste
disposal
 Improper
drainage system
 Poor ventilation
 Noise pollution
 Air pollution
1. Unsanitary food handling and preparation
2. Unhealthful lifestyles and personal habits-
Alcohol drinking
Cigarette smoking
Inadequate footwear
Eating raw meat
Poor personal hygiene
Self-medication
Sexual promiscuity
Engaging in dangerous sports
Inadequate rest
Lack of inadequate exercise
Lack of relaxation activities
Non-use of self protection measures
1. Inherent personal characteristics – e.g.
poor impulse control
2. Health history which induce the
occurrence of a health deficit, e.g.
previous history of difficult labor
3. Inappropriate role assumption – e.g. child
assuming mother's role, father not
assuming his role
4. Lack of immunization/ inadequate
immunization status specially of children
1. Family disunity –
Self-oriented behavior of
member(s)
Unresolved conflicts of
member(s)
Intolerable disagreement
Other
2. Other
I. Presence of Health Deficits – instances
of failure in health maintenance.
Examples include:
3. Illness states, regardless of whether it is
diagnosed or by medical practitioner
4. Failure to thrive/ develop according to
normal rate
5. Disability – whether congenital or
arising from illness; temporary
I. Presence of stress Points/ Foreseeable Crisis
Situations – anticipated periods of unusual demand of
the individual or family in terms of family resources.
Examples of these include:
 Marriage 9. Menopause
 Pregnancy 10. Loss of job
 Parenthood 11. Hospitalization of a
 Additional member family member
 Abortion 12. Death of a manner
 Entrance at school 13. Resettlement in a
 Adolescence new community
 Divorce 14. illegitimacy
 Second Level Assessment
 Focus on determining family’s capacity to perform the
health tasks
 Statements on family health nursing problem:
c. Inability to recognize the presence of the condition or
problem
d. Inability to make decisions with respect to taking
appropriate health action
e. Inability to provide adequate nursing care to the sick,
disabled , dependent or vulnerable member of the family
f. Inability to provide a home environment conducive to health
maintenance or personal development
g. Failure to utilize community resources for health care
Scale for Ranking Health Conditions
and Problems according to priorities
 Criteria:
b. Nature of the condition or problem presented
( wellness state, health deficit, health threat, forseeable
crisis)
b. Modifiability of the condition or problem
( easily, partially, not modifiable)
c. Preventive Potential (high, moderate , low)
d. Salience ( needs immediate attention, not immediate,
not perceived as a problem)
 COMMUNITY HEALTH CARE
PROCESS
 Assessment
Purpose : To identify the health needs of the people
 Planning of nursing actions
Purpose : To act on the determined needs of the
community people
 Implementation
Purpose : To achieve the optimum level of health of the
community people
 Evaluation
Purpose : To determine the effectiveness of health care programs
 NURSING PROCEDURES
 CLINIC VISIT
- process of checking the client’s health condition
in a medical clinic
 HOME VISIT

- a professional face to face contact made by the

nurse with a patient or the family to provide
necessary health care activities and to further
attain the objectives of the agency
 BAG TECHNIQUE

-a tool making of the public health bag through

which the nurse during the home visit can
perform nursing procedures with ease and
deftness saving time and effort with the end in
view of rendering effective nursing care
 THERMOMETER TECHNIQUE
-to assess the client’s health condition through
body temperature reading
 NURSING CARE IN THE HOME

- giving to the individual patient the nursing care

required by his/her specific illness or trauma
to help him/her reach a level of functioning at
which he/she can maintain himself/herself or
die peacefully in dignity
 ISOLATION TECHNIQUE IN THE HOME
-done by :
1. separating the articles used by a client with
communicable disease to prevent the spread of
infection:
2. frequent washing and airing of beddings and
other articles and disinfections of room
3. wearing a protective gown , to be used only
within the room of the sick member
4. discarding properly all nasal and throat
discharges of any member sick with
communicable disease
5. burning all soiled articles if could be or
contaminated articles be boiled first in water
30 minutes before laundering
 INTRAVENOUS THERAPY

- insertion of a needle or catheter into a vein to

provide medication and fluids based on

physician’s written prescription
- can be done only by nurses accredited by
ANSAP
 PRINCIPLES OF HEALTH
EDUCATION
 It considers the health status of the people,
which is determined by the economic and
social conscience of the country.
 It is a process whereby people learn to
improve their personal habits and attitudes,
to work responsibly for the improvement of
health conditions of the family, community,
and nation.
 It involves motivation, experience, and
change in conduct and thinking, while
stimulating active interest. It develops
and provides experience for change in
people’s attitudes, customs, and habits in
relation to health and everyday living.
 It should be recognized as the basic
function of all health workers.
 It takes place in the home, in the
school, and in the community.
 It is a cooperative effort requiring
all categories of health personnel to
work together in close teamwork
with families, groups, and the
community.
 It meets the needs, interests, and
problems of the people affected.
 It finds means and ways of
carrying out plans by
encouraging individual and
community participation.
 It is a slow, continuous process
that involves constant changes
and revisions until objectives are
achieved.
 Makes use of supplementary
aids and devices to help with the
verbal instructions.
 It utilizes community resources by
careful evaluation of the different
services and resources found in the
community.
 It is a creative process requiring
methods and techniques with various
characteristics, not following a rigid and
flexible pattern.
 It aims to help people make use of their
own efforts and education to improve
their conditions of living,
 It makes careful evaluation of the
planning, organization, and
implementation of all health education
programs and activities.
 THE COMMUNITY HEALTH
NURSE
 Qualifications
2. Bachelor of Science in
Nursing
3. Registered Nurse of the
Philippines
 Planner/Programmer
2. Identifies needs, priorities, and problems
of individuals, families, and communities
3. Formulates municipal health plan in the
absence of a medical doctor
4. Interprets and implements nursing plan,
program policies, memoranda, and circular
for the concerned staff personnel
5. Provides technical assistance to rural
health midwives in health matters
 Provider of Nursing Care
2. Provides direct nursing care to
sick or disabled in the home,
clinic, school, or workplace
3. Develops the family’s
capability to take care of the
sick, disabled, or dependent
member
 Manager/Supervisor
2. Formulates individual, family, group, and
community-centered plan
3. Interprets and implements programs,
policies, memoranda, and circulars
4. Organizes work force, resources, equipments,
and supplies at local level
5. Provides technical and administrative
support to Rural Health Midwives (RHM)
6. Conducts regular supervisory visits and
meetings to different RHMs and gives
feedback on accomplishments
 Community Organizer
2. Motivates and enhances
community participation in terms
of planning, organizing,
implementing, and evaluating
health services
3. Initiates and participates in
community development activities
 Coordinator of Services
2. Coordinates with individuals, families,
and groups for health related services
provided by various members of the
health team
3. Coordinates nursing program with
other health programs like
environmental sanitation, health
education, dental health, and mental
health
 Trainer/Health Educator
2. Identifies and interprets training needs of the
RHMs, Barangay Health Workers (BHW),
and hilots
3. Conducts training for RHMs and hilots on
promotion and disease prevention
4. Conducts pre and post-consultation
conferences for clinic clients; acts as a
resource speaker on health and health-
related services
5. Initiates the use of tri-media (radio/TV,
cinema plugs, and print ads) for health
education purposes
6. Conducts pre-marital counseling
 Health Monitor
2. Detects deviation from health of
individuals, families, groups,
and communities through
contacts/visits with them
 Role Model
2. Provides good example
of healthful living to
the members of the
community
 Change Agent
2. Motivates changes in health
behavior in individuals,
families, groups, and
communities that also include
lifestyle in order to promote and
maintain health
 Recorder/Reporter/Statistician
 Prepares and submits required reports
and records
 Maintain adequate, accurate, and
complete recording and reporting
 Reviews, validates, consolidates,
analyzes, and interprets all records
and reports
 Prepares statistical data/chart and other
data presentation
 Researcher
2. Participates in the conduct of
survey studies and researches on
nursing and health-related subjects
3. Coordinates with government and
non-government organization in
the implementation of
studies/research
 Community Organizing
 Approaches to community devt.:
b. Welfare approach
c. Technological approach
d. Transformatory approah
 Community Organizing
 Principles of CO:
 1. 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 people
 B. Devt. is from the people to the people
 C. People participation
 Principles of CO
 2.-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. – should lead to self-reliant communities
THE HRDP-COPAR PROCESS
 1. PRE-ENTRY PHASE
 2. ENNTRY PHASE
 3. COMMUNITY STUDY/DIAGNOSIS
PHASE/RESEARCH PHASE
 4.COMMUNITY ORGANIZATION AND
CAPABILITY-BUILDING PHASE
 5. COMMUNITY ACTION PHASE
 6. SUSTENANCE AND STRENGTHENING
PHASE
 Classify the ff. CO activities as to
phase of COPAR each belong:
 1.Conducts community meetings to draw up
guidelines for the organization of CHO
 2. Trains BHWs
 3. Sets up of linkages/network and referral systems
 4. PIME of health services and or community devt.
Projects
 5. Provides continuing education to leaders or
residents
 6. Trains secondary leaders
 7. Selects site for adoption
 8. Identifies key leaders
 Continued….
 9. Develops criteria for site selection
 10. Forms the core group
 11.Conducts SALT
 12.Selects members of the research team
 13. Assists the research team in presenting results
during the general assembly
 14. Helps the people identifying the community
needs and health problems
 15. Facilitates for the formulation and ratification of
the constitution and by-laws of the organization
Public Health Programs
COMPREHENSIVE MATERNAL
AND CHILD HEALTH PROGRAM
 EPI (Expanded Program on
Immunization)
 CDD (Control of Diarrheal Diseases)
 CARI (Control of Acute Respiratory
Infections)
 UFC (Under-Five Clinics)
 MC (Maternal Care)
 BF (Breastfeeding)
 MRP (Malnutrition Rehabilitation
Program)
 VAD ( Vitamin A Deficiency)
 IDD/IDA (Iodine Deficiency
Disorders/ Iron Deficiency Anemia)
 FP (Family Planning)
 EPI (EXPANDED PROGRAM ON
IMMUNIZATION)
 TARGET SETTING:
 INFANTS 0-12 MONTHS
 PREGNANT AND POST PARTUM WOMEN
 SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS
OLD

 OBJECTIVES OF EPI:
TO REDUCE MORBIDITY AND
MORTALITY RATES AMONG INFANTS AND
CHILDREN from SIX CHILDHOOD
IMMUNIZABLE DISEASE
 ELEMENTS OF EPI:
 TARGET SETTING
 COLDCHAIN LOGISTIC MANAGEMENT-
Vaccine distribution through cold chain is
designed to ensure that the vaccine were
maintained under proper environmental
condition until the time of administration.
 IEC
 Assessment and evaluation of Over-all
performance of the program
 Surveillance and research studies
 EXPANDED PROGRAM ON IMMUNIZATION
Vaccine Minimum Number Minimum Reason
Age of 1st of Doses Interval
Dose Between
Doses
 BCG Birth or 1 BCG is given
(Bacillus at the earliest
anytime possible age
Calmette after protects against
Guerin)
birth the possibility
of TB infection
School from the other
entrants family
members
 2. DPT 6 weeks 4 weeks An early start with
(Diphtheria 3 DPT reduces the
Pertusis
Tetanus)
chance of severe
pertussis

3. OPV 6 weeks 4 weeks The extent of

(Oral Polio 3 protection against
Vaccine)
polio is increased the
earlier OPV is given.

4. Hepatitis 6 weeks 4 weeks An early start of

B 3 Hepatitis B reduces the
chance of being infected
and becoming a carrier.

5. Measles 9 months At least 85% of measles

1 can be prevented by
immunization at this age.
 CDD (CONTROL OF DIARRHEAL DISEASES)
MANAGEMENT OF THE PATIENT WITH
DIARRHEA

A. NO DEHYDRATION
 Condition – well, alert

 Mouth and Tongue – moist

 Eyes – normal

 Thirst – drinks normally, not thirsty

 Tears – present

 Skin pinch – goes back quickly

 TREATMENT PLAN A- HOME TTT.

 THREE RULES FOR HOME
TREATMENT
1.Give the child more fluids than usual
• use home fluid such as cereal gruel
• give ORESOL, plain water
2. Give the child plenty of food to prevent
undernutrition
• continue to breastfeed frequently
• if child is not breastfeed, give usual milk
• if child is less than 6 months and not yet taking
solid food, dilute milk for 2 days
• if child is 6 months or older and already taking
solid food, give cereal or other starchy food mixed
with vegetables, meat or fish; give fresh fruit juice
or mashed banana to provide potassium; feed child
at least 6 times a day. After diarrhea stops, give an
extra meal each day for two weeks.
3. Take the child to the health worker if
the child does not get better in 3 days or
develops any of the following:
• many watery stools
• repeated vomiting
• marked thirst
• eating or drinking poorly
• fever
• blood in the stool
 ORESOL TREATMENT
Age Amount of ORS Amount of ORS to
to give after provide for use at
each loose stool home

< 24 50-100 ml. 500 ml./day

months

2– 100-200 ml. 1000 ml./day

10 years

10 As much as 2000 ml./day

years up wanted
B. SOME DEHYDRATION
 Condition – restless, irritable

 Mouth and Tongue – dry

 Eyes – sunken

 Thirst – thirsty, drinks eagerly

 Tears – absent

 Skin pinch – goes back slowly

 WEIGH PT, TTT. PLAN B

 APPROX. AMT. OF ORS- TO GIVE IN 1ST 4
HRS
AGE WEIGHT ORS
KG ML
4 MOS. 5 200-400

4-11MOS 5-7.9 400-600

12-23MOS 8-10.9 600-800

2-4YRS 11-15.9 800-1200

5-14YRS 16-29.9 1200-2200

15 YRS UP 30 UP 2200-4000
1. If the child wants more ORS than shown, give more
2. Continue breastfeeding
3. For infants below 6 mos. who are not breastfeed, give
100-200 ml clean water during the period
4. For a child less than 2 years give a teaspoonful every 1-2
min.
5. If the child vomits, wait for 10 min, then continue giving
ORS, 1 tbsp/2-3 min
6. If the child’s eyelids become puffy, stop ORS , give plain
water or breast milk, Resume ORS when puffiness is gone
7. If ( -) signs of DHN- shift to Plan A
Use of Drugs during Diarrhea
Antibiotics should only be used for
dysentery and suspected cholera
Antiparasitic drugs should only be used
for amoebiasis and giardiasis
C. SEVERE DEHYDRATION
Condition – lethargic or unconscious; floppy
Eyes – very sunken and dry
Tears – absent
Mouth and tongue – very dry
Thirst- drinks poorly or not able to drink
Skin pinch – goes back very slowly
TTT PLAN C- ttt. quickly
1.Bring pt. to hospital
2. IVF – Lactated Ringers Solution or Normal Saline
3.Re-assess pt. Every 1-2 hrs
4. Give ORS as soon as the pt. can drink
 ROLE OF BREASTFEEDING IN THE
CONTROL OF DIARRHEAL DISEASES
PROGRAM

1. Two problems in CDD

 1. High child mortality due to
diarrhea
 2. High diarrhea incidence among
under fives
 Highest incidence in age 6 – 23 months

 Highest mortality in the first 2 years of life

 Main causes of death in diarrhea :

 DEHYDRATION
 MALNUTRITION
1. To prevent dehydration, give home fluids
“am” as soon as diarrhea starts and if
dehydration is present, rehydrate early,
correctly and effectively by giving ORS

3. For undernutrition, continue feeding during

diarrhea especially breastfeeding.
 Interventions to prevent diarrhea
1. breastfeeding
2. improved weaning practices
3. use of plenty of clean water
4. hand washing
5. use of latrines
6. proper disposal of stools of
small children
7. measles immunization
1. Risk of severe diarrhea 10-30x higher in
bottle fed infants than in breastfed infants.
2. Advantages of breastfeeding in relation to
CDD
1.Breast milk is sterile
2.Presence of antibodies protection against
diarrhea
3.Intestinal Flora in BF infants prevents
growth of diarrhea causing bacteria.
1. Breastfeeding decreases incidence rate by
8-20% and mortality by 24-27% in
infants under 6 months of age.
2. When to wean?
4-6 months – soft mashed foods 2x a day
6 months – variety of foods 4x a day
1. Summary of WHO-CDD recommended strategies
to prevent diarrhea
1. Improved Nutrition
- exclusive breastfeeding for the first 4-6 months of
life and partially for at least one year.
- Improved weaning practices
2.Use of safe water
- collecting plenty of water from the cleanest source
- protecting water from contamination at the source
and in the home
 3.Good personal and domestic hygiene
- handwashing
- use of latrines
- proper disposal of stools of young children
4.Measles immunization
CARI (CONTROL OF ACUTE RESPIRATORY
INFECTIONS)
CLASSIFICATION:
A. NO PNEUMONIA: COUGH OR COLD
1. No chest in drawing
2. No fast breathing ( <2 mos- <60/min,2-12
mos. – less than 50 per minute; 12 mos. – 5
years – less than 40 per minute)
TREATMENT:
1. If coughing more than 30 days, refer for
assessment
2. Assess and treat ear problems/sore throat if
present
3. Advise mother to give home care
4.Treat fever/wheezing if present
HOME CARE:
1. FEED THE CHILD
3. Feed the child during illness
4. Increase feeding after illness
5. Clear the nose if it interferes with feeding
2. INCREASE FLUIDS
2. offer the child extra to drink

3. Increase breastfeeding

3. SOOTHE THE THROAT AND

RELIEVE THE COUGH WITH A
SAFE REMEDY
4. WATCH FOR THE FOLLOWING
SIGNS AND SYMPTOMS AND
RETURN QUICKLY IF THEY
OCCUR
2. Breathing becomes difficult

3. Breathing becomes fast

4. Child is not able to drink

5. Child becomes sicker

B. PNEUMONIA
1. No chest in drawing
2. Fast breathing ( less than 2 mos- 60/min
or more ; 2-12 mos. – 50/min or more; 12
mos. – 5 years – 40/min or more)
TREATMENT
1.Advise mother to give home care
2.Give an antibiotic
3.Treat fever/wheezing if present
4.If the child’s condition gets worst,refer
urgently to hospital; if improving, finish 5 days
of antibiotic.
ANTIBIOTICS RECOMMENDED BY
WHO
*Co-trimoxazole,
*Amoxycillin, Ampicillin, (p.o)
*or Procaine penicillin (I.M.)
 C. Severe Pneumonia
 Chest indrawing
 Nasal flaring
 Grunting ( short sounds made with the voice)
 Cyanosis
TTT.
6. Refer urgently to hospital
7. Treat fever ( paracetamol), wheezing
( salbutamol)
 D. Very Severe Disease

 Not able to drink

 Convulsions

 Abnormally sleepy or difficult to wake

 Stridor in calm child

 Severe undernutrition

TTT.
Refer urgently to hospital
 ASSESSMENT OF RESPIRATORY
INFECTION
ASK THE MOTHER:
2. How old is the child?
3. Is the child coughing? For how long?
4. Age 2 months up to 5 years: Is the child able
to drink?
Age less than 2 months: Has the young infant
stopped feeding well?
6. Has the child had fever? For how long?
7. Has the child had convulsions?
 LOOK, LISTEN:
1. Count the breaths in one minute.
Age0 Fast Breathing
Less than 2 months 60/minute or more
2 months – 12 months 50/minute or more
12 months – 5 years 40/minute or more

2.Look for chest in drawing.

3.Look and listen for stridor.
Stridor occurs when there is a narrowing of the
larynx, trachea or epiglottis which interferes
with air entering the lungs.
4. Look and listen for wheeze
Wheeze is a soft musical noise
which shows signs that breathing
out(exhale) is difficult.
5. See if the child is abnormally sleepy
or difficult to wake. (Suspect
meningitis)
6. Feel for fever or low body
temperature.
7. Check for severe under nutrition
 MANAGEMENT OF A CHILD
WITH AN EAR PROBLEM
Classification of Ear Infection
A. MASTOIDITIS – tender swelling behind the ear
(in infants, swelling may be above the ear)
TREATMENT
1. Antibiotics
2.Surgical intervention
B. ACUTE EAR INFECTION – pus draining
from the ear for less than 2 weeks, ear pain,
red, immobile ear drum (Acute Otitis Media)

TREATMENT
1.Cotrimoxazole,Amoxycillin,or Ampicillin
2.Dry the ear by wicking
C. CHRONIC EAR INFECTION – pus draining from the
ear for more than 2 weeks (Chronic Otitis Media)
TREATMENT
Most important & effective treatment: Keep the ear dry
by wicking.
 Paracetamol maybe given for pain or high fever.

 Precautions for a child with a draining ear:

 Do not leave anything in the ear such as cotton, wool

between wicking treatments.

 Do not put oil or any other fluid into the ear.

 Do not let the child go swimming or get water in the

ear.
Maternal and Child Health Nursing
Philosophy
 Pregnancy, labor and delivery and puerperium
are part of the continuum of the total life cycle
 Personal, cultural and religious attitudes and
beliefs influence the meaning of pregnancy for
individuals and make each experience unique
 MCN is FAMILY CENTERED- the father
is as important as the mother
 Goals
 To ensure that expectant mother and nursing
mother maintain good health, learn the art of
child care, has a normal delivery and bear
healthy children

 That every child lives and grows up in a family

unit with love and security, in healthy
surroundings, receives adequate nourishment,
health supervision and efficient medical attention
and is taught the elements of healthy living
 Classification of pregnant
women
 Normal – healthy pregnancy
 With mild complications- frequent home visits
 With serious or potentially serious cx –
referred to most skilled source of medical and
hospital care
 Home Based Mother’s Record
( HBMR )

 Tool used when rendering prenatal care

containing risk factors and danger signs
*Risk Factors
 145 cm tall ( 4 ft & 9 inches)

 Below 18 yrs old, above 35 yrs old

 Have had 4 pregnancies

 With TB, goiter, heart disease, DM, bronchial
asthma, severe anemia
 Last baby born was less than 2 years ago

 Previous cesarian section delivery

 History of 2 or more abortions, difficult delivery,

given birth to twins , 2 or more babies born before

EDD, stillbirth
 Weighs less than 45 kgs. or more than 80 kgs.
 *Danger Signs

 1. any type of vaginal bleeding

 2. headache, dizziness, blurred vision
 3. puffiness of face and hands
 4. pallor
 Prenatal Care
 Schedule of Visits
 1st – as early as pregnancy, 1st trimester

 2nd - 2nd trimester

 3rd & subsequent visits - 3rd trimester

 More frequent visits for those at risk with cx

TETANUS TOXOID IMMUNIZATION SCHEDULE
FOR WOMEN

Vaccine Minimum Age Percent Duration of

Interval Protected Protection

As early as possible
TT1 during pregnancy 80%
TT2 At least 4 80% Infants born to the
weeks later mother will be
protected
from neonatal
tetanus.
Gives 3 years
protection for
the mother from
tetanus.
 At least 6 Infants born to the mother
TT3 months later 90% will be protected
from neonatal
tetanus.
Gives 5 years protection
for the mother.
TT4 At least 1 99% Gives 10
year later protection
for the
mother
TT5 At least 1 year 99% Gives lifetime
later protection for
the mother.
All infants
born to that
mother
will be
protected.

Dose:0.5ml
Route: Intramuscularly
Site: Right or Left Deltoid/Buttocks
 Components of Prenatal Visits
 History – taking
 Determination of obstetrical score- G, P,
TPAL,AOG,EDD
 U/A for Proteinuria, glycosuria and infxtn
 Dental exam
 Wt. Ht. BP taking
 Exam of conjunctiva and palms for pallor
 Abdominal exam - fundic ht, Leopold’s
maneuver and FHT
 Exam of breasts, face, hands and feet for edema and
neck for thyroid enlargement
 Health teachings- nutrition, personal hygiene,
common complaints
 Tetanus toxoid immunization
 Iron supplementation – from 5th mo. of pregnancy -
2 mos. Postpartum
 In goiter endemic areas – iodized capsule once a
year
 In malaria infested areas- prophylactic Chloroquine
( 150 mg/tab ) 2 tabs/ wk for the whole duration of
pregnancy
  UNDER FIVE CLINIC

The first five years of life form the foundations

of the child’s physical and mental growth and
development. Studies have shown the mortality and
morbidity are high among this age group. The
Department of Health established the Under Five
Clinic Program to address this problem.
 PROGRAM OBJECTIVES AND GOALS:

•Monitor growth and development of the child

until 5 years of age.

•Identify factors that may hinder the growth and

development of the child.
 ACTIVITIES AND STRATEGIES:
1. Regular height and weight determination/ monitoring
until 5 years old.
0-1 year old=monthly
1 year old and above =quarterly
2. Recording of immunization, vitamins supplementation,
deworming and feeding.
3. Provision of IEC materials (ex. Posters, charts, toys)
that promote and enhance child’s proper growth and
development.
4. Provision of a safe and learning – oriented environment
for the child.
5. Monitoring and Evaluation.
 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:
Executive Order 51
Republic Act 7600
The Rooming-In and Breastfeeding Act of 1992
 PROGRAM OBJECTIVES AND GOALS:
=Protection and promotion of breastfeeding
and lactation management education
training
ACTIVITIES AND STRATEGIES:
1.FULL IMPLEMENTATION OF LAWS
SUPPORTING THE PROGRAM

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
2. CONDUCT ORIENTATION/ADVOCACY
MEETINGS TO HOSPITAL/ COMMUNITY.
ADVANTAGES OF BREASTFEEDING:

MOTHER
 • Oxytocin help the uterus contracts
 • Uterine involution
 • Reduce incidence of Breast Cancer
 • Promote Maternal-Infant Bonding
 • Form of Family planning Method (Lactational
Amenorrhea)
BABY
 • Provides Antibodies
 • Contains Lactoferin (binds with Iron)
 • Leukocytes
 • Contains Bifidus factor-promotes
growth of the Lactobacillus-inhibits the
growth of pathogenic bacilli
 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 IDEAL
FRESH MILK NEVER GOES OFF
EMOTIONALLY BONDING
EASY ONCE ESTABLISHED
DIGESTED EASILY
IMMEDIATELY AVAILABLE
NUTRITIONALLY OPTIMAL
GASTROENTERITIS GREATLY REDUCED
 GARANTISADONG PAMBATA (GP)
Garantisadong Pambata is a biannual week long
delivery of a package of health services to children between
the ages of 0-59 months old with the purpose of reducing
morbidity and mortality among under fives through the
promotion of positive Filipino values for proper child
growth and development.

1. WHAT ARE THE HEALTH SERVICES OFFERED

IN GP AND WHO ARE THE TARGETS?
GP offers the following:
1.1 Routine Health Services:
 Health Dosage Route of Target
Service Administra Population
tion
Vitamin A 200,000 IU Orally by 12-59
capsule or 1 capsule drops months old,
100,000 IU nationwide
or ½ cap or 3 9-12 month
drops old infants
receiving
AMV
nationwide
Ferrous
Sulfate
(25 mg. 0.3ml(2-6 Orally 2-11 months old
Elemental mos) by drops infants in Mindanao
Iron per ml; once a day area, including
30 ml. Bottle evacuation centers
as taken in armed conflict
home 0.6ml(6- areas.
medicine with 11mos) once a
instructions) day
Routine Nationwide
Immunizati
on 0-11 mos
-BCG*
0.05ml
Intradermal on right
deltoid
-DPT* Intramuscularly on
0.5ml 0-11 mos
anterior thigh
-OPV* Orally
2 drops 0-11 mos
0.5ml Subcutaneously on 9-11 mos
-AMV*
deltoid
-Hepa B (if
available) 0.5ml Intramuscularly 0-11 mos
Dewormin
g drug
(if
available) 1 tablet 36-59 mos,
Orally
as single nationwide
dose

Weighing 0-59 mos,

nationwide
 * The child should not have received
megadose of Vit. A above the recommended
dosage within the past 4 weeks except if the
child has measles or signs and symptoms of
Vit A. deficiency.
 ** For any child between 12-23 months, who

missed any of his routine immunization, the

health worker should give the child the
necessary antigen to complete FIC and shall be
recorded as such.
 GARANTISADONG PAMBATA
Sangkap Pinoy

- Vitamin A, Iron and Iodine

-Sources: green leafy and yellow vegetables,
fruits, liver, seafoods, iodized salt, pan de
bida and other fortified foods.
These micronutrients are not produced by
the body, and must be taken in the food we
eat; essential in the normal process of growth
and development:
a) Helps the body to regulate itself
b) Necessary in energy metabolism
c) Vital in brain cell formation and mental development
d) Necessary in the body immune system to protect the
body from severe infection.
e) Eating Sangkap Pinoy-rich foods can prevent and
control:
1. Protein Energy Malnutrition
2. Vitamin A Deficiency
3. Iron Deficiency Anemia
4. Iodine Deficiency Disorder
  BREASTFEEDING
Breast 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 infants
c. Provides a nutritional complete food for the
young infant.
d. Strengthens the infant’s immune system,
preventing many infections.
e. Safely rehydrates and provides essential
nutrients to a sick child, especially to those
suffering from diarrheal diseases.
f. Reduces the infant’s exposure to infection.
  For the Mother
a. Reduces a woman’s risk of excessive blood loss
after birth
b. Provides a natural method of delaying
pregnancies.
c. Reduces the risk of ovarian and breast cancers and
osteoporosis.
 For the Family and Community

d. Conserves funds that otherwise would be spent on

breast milk substitute, supplies and fuel to prepare
them.
e. Saves medical costs to families and governments
by preventing illnesses and by providing
immediate postpartum contraception.
 COMPLEMENTARY FEEDING FOR BABIES 6-11
MONTHS OLD
 What are Complementary Foods?
c. foods introduced to the child at the age
6 months to supplement breastmilk
e. given progressively until the child is used to three

meals and in-between feedings at the age of one

year.
 Why is there a Need to Give Complementary Foods?
g. breastmilk can be a single source of nourishment
from birth up to six months of life.
a. The child’s demands for food increases as he
grows older and breastmilk alone is not enough to
meet his increased nutritional needs for rapid
growth and development
b. Breastmilk should be supplemented with other
foods so that the child can get additional nutrients
c. Introduction of complementary foods will
accustom him to new foods that will also provide
additional nutrients to make him grow well
d. Breastfeeding, however, should continue for as
long as the mother is able and has milk which
could be as long as two years
 How to Give Complementary Foods for
Babies 6-11 Months Old?
b. Prepare mixture of thick lugao/ cooked rice, soft
cooked vegetables. Egg yolk, mashed beans, flaked
fish/chicken/ground meat and oil.
c. Give mixture by teaspoons 2-4 times daily,
increasing the amount of teaspoons and number of
feeding until the full recommended amount is
consumed
d. Give bite-sized fruit separately
e. Give egg alone or combine with above food mixture
 FAMILY PLANNING
The Philippine Family Planning Program is a national
program that systematically provides information and
services needed by women of reproductive age to plan their
families according to their own beliefs and circumstances.
GOALS AND OBJECTIVES:
• Universal access to family planning information, education
and services.
MISSION:
• To provide the means and opportunities by which married
couples of reproductive age desirous of spacing and limiting
their pregnancies can realize their reproductive goals.
 TYPES OF METHODS:
A. NATURAL METHODS
1. Calendar or Rhythm Method
2. Basal Body Temperature Method
3. Cervical Mucus Method
4. Sympto-Thermal Method
5. Lactational Amennorhea
B. ARTIFICIAL METHODS
I. CHEMICAL METHODS
1.Ovulation suppressant such as PILLS
2. Depo-Provera
3. Spermicidals
4. Implant
II. MECHANICAL METHODS
1. Male and Female Condom
2. Intrauterine Device
3. Cervical Cap/Diaphragm
III. SURGICAL METHODS
1. Vasectomy
 2. Tubal Ligation
 WARNING SIGNS
Pills
 Abdominal pain ( severe)

 Chest pain ( severe)

 Headache ( severe)

 Eye problems ( blurred vision, flashing lights,

blindness)
 Severe leg pain ( calf or thigh )

 Others: depression, jaundice, brest lumps

 WARNING SIGNS
IUD
*Period late, no symptoms of pregnancy,
abnormal bleeding or spotting
*Abdominal pain during intercourse
*Infection or abnormal vaginal discharge
*Not feeling well, has fever or chills
*String is missing or has become shorter or
longer
 WARNING SIGNS
 INJECTABLES
 Dizziness
 Severe headache
 Heavy bleeding
 WARNING SIGNS
BTL
 Fever

 Weakness

 Rapid pulse

 Persistent abdominal pain

 Vomiting

 Dizziness

 Pus or tenderness at incision site

 Amenorrhea
 WARNING SIGNS
Vasectomy

 Fever
 Scrotal blood clots or excessive swelling
 Nutrition

 Goal
To improve the nutritional status,
productivity and quality of life of
the population thru adoption of
desirable dietary practices and
healthy lifestyle
 Objectives
 Increase food and dietary energy

intake of the average Filipino

 Prevent nutritional deficiency

diseases and nutrition-related chronic

degenerative diseases
 Promote a healthy well-balanced diet

 Promote food safety

Nutrition is a state of well-being achieved by eating
the right food in every meal and the proper
utilization of the nutrients by the body.
Proper nutrition is important because:
• it helps in the development of the brain, especially during
the first years of the child’s life.
• It speeds up the growth and development of the body
including the formation of teeth and bones
• It helps fight infection and diseases
• It speeds up the recovery of a sick person
• It makes people happy and productive
• Proper nutrition is eating a balanced diet in every meal
Balanced diet is made up of a
combination of the 3 basic groups
eaten in correct amounts. The
grouping serves as a guide in
selecting and planning everyday
meals for the family.
THE THREE (3) BASIC FOOD GROUPS ARE:
1. Body –building food which are rich in protein
and needed by the body for:
< normal growth and repair of worn-out body tissues
< supplying additional energy
< fighting infections
< Examples of protein-rich food are: fish; pork;
chicken; beef; cheese; butter; kidney beans;
mongo; peanuts; bean curd; shrimp; clams
 2. Energy-giving food which are rich in
carbohydrates and fats and needed by the body for:
 < providing enough energy to make the body strong
 < Examples of energy-giving food are: rice; corn;
bread; cassava; sweet potato; banana; sugar
cane; honey; lard; cooking oil; coconut milk;
margarine; butter
 3. Body-regulating food which are rich in
Vitamins and minerals and needed by the body
for:
 < normal development of the eyes, skin, hair,
bones, and teeth
 < increased protection against diseases
 < Examples of body-regulating food are: tisa;
ripe papaya; mango; guava; yellow corn;
banana; orange; squash; carrot
 Low Fat Tips
1. Eat at least 3 meals/day
2. Eat more fruits, vegetables, grain and cereals
e.g. rice, noodles and potato
3. If you use butter or margarine, pat it on thinly
4. Choose low fat substitute i.e. replace whole
milk with skimmed milk, low fat cheese
5. Become a label reader. Look for foods that
have less than 5 g /100 g of product
1. Eat less high fat snacks and take away potato
chips, sausage rolls or breaded meats
2. Cut all visible fat from meat, remove skin
from chicken fat drippings and cream sauces
3. Aim for thin palm-size serving of lean meat,
poultry and fish/ meal
4. Grill, bake, steam, stew, stir –fry and
microwave, try not to fry
5. Drink lots of water all day- it’s a food
quencher
 Ambulate
 Start by walking for 10 min.
 Build up to 30-40 min/day
 Go for 3-4 times / week of any exercise you
enjoy
 Filipino Food Pyramid
 Drink a lot- water, clear broth
 Eat most – rice, root crops, corn, noodles,
bread and cereals
 Eat more – vegetables, green salads, fruits or
juices
 Eat some – fish, poultry, dry beans, nuts,
eggs, lean meats, low fat dairy
 Eat a little – fats, oils, sugar, salt
IMPORTANT VITAMINS AND
MINERALS
VITAMINS FUNCTIONS
Vitamin A Maintain normal vision, skin
health, bone and tooth
growth reproduction and
immune function; prevents
xerophthalmia.
Food sources:
Breastmilk;poultry;eggs; liver;
meat;carrots;squash;
papaya;mango;tiesa;
malunggay;kangkong;
camotetops; ampalaya tops
Thiamine Help release energy
from nutrients;
support normal
appetite and nerve
function, prevent
beri-beri.
Riboflavin Helps release energy from nutrients,
support skin health, prevent deficiency
manifested by cracks and redness at
corners of mouth; inflammation of the
tongue and dermatitis.

Niacin Help release energy from nutrients;

support skin, nervous and digestive
system, prevents pellagra.
Biotin Help energy and
amino acid
metabolism; help in
the synthesis of fat
glycogen.
Pantothenic Help in energy
metabolism.
 Help in the formation of DNA and
Folic acid new blood cells including red blood
cells; prevent anemia and some
amino acids.

Help in the formation of the new

Vitamin B 12 cells; maintain nerve cells, assist in
the metabolism of fatty acids and
amino acids.
 Help in the formation of protein,
Vitamin C collagen, bone, teeth cartilage, skin
and scar tissue; facilitate in the
absorption of iron from the
gastrointestinal tract; involve in
amino acid metabolism; increase
resistance to infection, prevent
scurvy.
Food sources:
Guava;pomelo;lemon;orange;
calamansi; tomato; cashew
Vitamin D Help in the
mineralization of bones
by enhancing
absorption of calcium.
 Strong anti-oxidant; help prevent
Vitamin E arteriosclerosis; protect neuro-
muscular system; important for
normal immune function.

Involve in the synthesis of blood

Vitamin K clotting proteins and a bone protein
that regulates blood calcium level.
MINERALS FUNCTIONS
Mineralization of bones and teeth,
Calcium regulator of many of the body’s
biochemical processes, involve in blood
clotting, muscle contraction and
relaxation, nerve functioning, blood
pressure and immune defenses.
Maintain normal fluid and electrolyte
Chloride balance.
Chromium Work with insulin and is
required for release of energy
from glucose.

Copper Necessary for absorption and use

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

As part of the two thyroid hormones,

Iodine iodine regulates growth, physical
and mental development and
metabolic rate.
Aids in the development of the brain
and body especially in unborn
babies
Food sources:
Seaweeds;squids;shrimps;crabs;
fermented shrimp;mussels;snails;
dried dilis; fish
 Essential in the formation of
Iron blood. It is involved in the
transport and storage of
oxygen in the blood and is a
co-factor bound to several
non-hemo enzymes required
for the proper functioning of
cells.
Food sources:
Pork; beef; chicken; liver and
other internal organs; dried
dilis; shrimp; eggs; pechay;
saluyot; alugbati
Magnesium Mineralization of bones
and teeth, building of
proteins, normal muscle
contraction, nerve
impulse transmission,
maintenance of teeth
and functioning of
immune system.
Manganese Facilitate many cell
processes.

Molybdenum Facilitate many cell

processes.
Phosphorus Mineralization of bones
and teeth; part of every
Cell; used in energy
transfer and maintenance
of acid-base balance.

Selenium Work with vitamin E to

protect body compound
from oxidation.
Selenium Work with vitamin E to
protect body compound from
oxidation.

Sodium Maintain normal fluid and

electrolyte balance, assists
nerve impulse insulin.
Sulfur Integral part of vitamins,
biotin and thiamine as well
as the hormone.

Zinc Essential for normal growth,

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

 Protein-Energy Malnutrition (PEM) is a

nutritional problem resulting from a
prolonged inadequate intake of body-
building and/or energy-giving food in the
diet.
Kinds:
a.)MARASMUS
b.) KWASHIORKOR
a) MARASMUS
This child does not get the right amount and
kind of energy food. She/He:
< is always hungry
< has the face of an old man
< is very thin
< easily gets sick
< looks weak
THIS CHILD IS JUST SKIN AND BONES!
a) KWASHIORKOR
This child does not get enough body-building food,
although she/he may be getting enough energy. She/He:
< has swollen face, hands, and feet
< easily gets sick
< has dry, thin, pale hair
< has sores on the skin
< has thin upper arms
< looks sad
< has dry skin
< is underweight
THIS CHILD IS SKIN, BONES, AND WATER!
 2. VITAMIN A DEFICIENCY (VAD)
a condition in which the level of Vitamin A in
the body is low.
Causes:
 not eating enough foods rich in vitamin A

e.g. yellow vegetables and yellow fruits

 lack of fat or oil in the diet which help the

body absorb Vitamin A.

 poor absorption or rapid utilization of

Vitamin A during illness

Eye Signs
 night blindness (early stage); total blindness

(later stage)
 bitot’s spot (foamy soapsuds-like spots on

white part of the eye)

 dry, hazy and rough appearing cornea

 crater-like defect on cornea

 softened cornea; sometimes bulging

Other Manifestations
 increased cases of childhood sickness, and death

and decreased resistance to infection

 susceptibility to childhood malnutrition and

infection (measles, diarrhea and pneumonia)

Prevention
 eating foods rich in Vitamin A, such as liver,

eggs, milk, crab meat, cheese, dilis, malunggay,

gabi leaves, kamote tops, kangkong, alugbati,
saluyot, carrots, squash, ripe mango, including
fats and oils
 breastfeeding the child

 immunizing the child

 taking correct dose of Vitamin A capsules as

prescribed
VAD is most common in children suffering
from PEM and other infectious diseases.
Bottle-fed infants are also at risk of VAD
especially if the milk formula used is not
fortified with Vitamin A.
• Common among preschoolers and infants

( FNRI)
SCHEDULE FOR RECEIVING VITAMIN A SUPPLEMENT TO
INFANTS PRESCHOOLERS AND MOTHERS
Schedule Infants(6-11 Preschoolers Post Partum
mos) (12-83 mos) Mother

Give 1 Dose 100,000 IU 200,000 IU 200,000 IU

Within one
month

Give after 6 100,000 IU 200,000 IU After delivery

months High of each child
risk only
Condition
Present
 SCHEDULE FOR TREATMENT OF VITAMIN A
DEFICIENCY
Schedule Infants (6-11 Preschoolers (12-
mos.) 83 mos.)

Give Today 100,000 IU 200,000 IU

Give Tomorrow 100,000 IU 200,000 IU

Give After 2 100,000 IU 200,000 IU

Weeks
3. ANEMIA - a condition characterized by the lack of
iron in the body resulting in paleness.
 S/S: paleness of the eyelids, inner cheeks, palms and
nailbeds; frequent dizziness and easy fatigability
 Common cause: inadequate intake of food rich in
iron ; can also be caused by blood loss during
menstruation, pregnancy and parasitic infections.
 Prevention:

Eating iron-rich food such as liver and other internal

organs; green leafy vegetables; and foods rich in
Vitamin C
 Prevention of Iron Deficiency
Recommended Iron Dosage
Requirements

Infants ( 6-12 months) 0.7 mg. Daily

Children ( 12-59 months) 1 mg daily

 Treatment of Iron Deficiency
Dosage
Children 0-59 month 3-6 mg./kg. Body wt./day
 4.GOITER
- enlargement of thyroid gland due to lack
of iodine in the body.

-common in areas where the iodine content

in the soil, water and food are deficient.
- Effect of Iodine deficiency to fetus:
may be born mentally and physically
retarded.
- Goiter can be prevented by:
< daily intake of food rich in iodine
< use of iodized salt
 Iodine Supplementation

Dosage
Children 0-59 months Iodine capsules (200mg)
( in endemic areas) potassium iodate in oil
orally once a year.
CHECKING THE NUTRITIONAL STATUS
WEIGHT
 1.1 Weight is a very important indicator of a person’s
nutritional status. It is measured in relation to either
AGE or HEIGHT. Normally, a well-nourished child
gains weight as she/he grows older.
 1.2 On the other hand, a malnourished child either
decreases in weight or maintains his/her previous weight.
 1.3 The nutritional status of a person can also be
checked by looking for specific signs and symptoms of
the different forms of nutritional deficiencies.
 IMPORTANT:
 1.1Weigh the child in minimal clothing, with no
shoes, clogs or slippers on; and hands and
pockets free of objects.
 1.2The same type of scale should be used for
subsequent weighing.
 1.3Observe the proper maintenance of the
weighing scale.
 1.4Do not use a bathroom scale to avoid
inaccurate readings of weight.
< BRING THE MALNOURISHED CHILD
TOGETHER WITH THE PARENTS TO THE
HEALTH CENTER FOR PROPER
NUTRITIONAL ADVICE AND TREATMENT.
< VISIT THE MALNOURISHED CHILD
REGULARLY AND MONITOR HIS/HER
WEIGHT.
< ADVISE PARENTS AND THE WHOLE
COMMUNITY ABOUT BETTER NUTRITION
AND PROPER FEEDING ESPECIALLY OF
INFANTS, CHILDREN AND SICK PERSONS.
NUTRITIONAL GUIDELINES
2. Eat a variety of food everyday.
3. Breastfeed infants exclusively from birth to 4-6
months, and then, give appropriate foods while
continuing breastfeeding.
4. Maintain children’s normal growth through proper
diet and monitor their growth regularly.
5. Consume fish, lean meat, poultry or dried beans.
6. Eat more vegetables, fruits, and root crops.
7. Eat foods cooked in edible/cooking oil daily.
 Consume milk, milk products or other calcium-
rich foods such as small fish and dark green leafy
vegetables everyday. Use iodized salt, but avoid
excessive intake of salty foods.
 Use iodized salt, avoid excessive intake of salty
foods
9. Eat clean and safe food.
10. For a healthy lifestyle and good nutrition, exercise
regularly, do not smoke, avoid drinking alcoholic
beverages.
 AIMS AND RATIONALE OF EACH OF
THE GUIDELINES

Guideline No. 1 is intended to give the

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

Nutrients are chemical substances present in

the foods that keep the body healthy, supply
materials for growth and repair of tissues, and
provide energy for work and physical activities.
The major nutrients include the
macronutrients, namely; proteins, carbohydrates
and fats; the micronutrients, namely vitamins
such as A, D, E and K, the B complex vitamins
and C and minerals such as calcium, iron, iodine,
zinc, fluoride and water.
 Reproductive Health
 - a state of complete physical, mental and
social well-being and not merely the
absence of disease/ infirmity in all
matters relating to the reproductive
system and to its functions and processes.
 Basic RH Rights

 Right to RH information and health care

services for safe pregnancy and childbirth
 Right to know different means of regulating

fertility to preserve health and where to obtain

them
 Freedom to decide the number and timing of

birth of children
 Right to exercise satisfying sex life
 Factors/ determinants of RH
 Socioeconomic conditions – education,
employment, poverty, nutrition, living
condition/ environment, family environment
 Status of women – equal right in education and

in making decisions about her own RH; right

to be free from torture and ill treatment and to
participate in politics
 Social and Gender Issues

 Biological (individual knowledge of

reproductive organs and their functions),

cultural (country’s norms, RH practices) and
psychosocial factors
 Elements
 Maternal and Child Health Nutrition
 Family Planning

 Prevention and Management of Abortion

Complications
 Prevention and Treatment of Reproductive

Tract Infections, including STDs, HIV and

AIDS
 Education and Counseling on Sexuality and

Sexual Health
 Elements
 Breast and Reproductive Tract Cancers and
other Gynecological Conditions
 Men’s Reproductive Health

 Adolescent Reproductive Health

 Violence Against Women

 Prevention and Treatment of Infertility and

Sexual Disorders
 Selected Concepts
 RH is the exercise of reproductive right with
responsibility
 It means safe pregnancy and delivery, the right of
access to appropriate health information and services
 It includes protection from unwanted pregnancy by
having access to safe and acceptable methods of family
planning of their choice
 It includes protection from harmful reproductive
practices and violence
 It ensure sexual health for the purpose of enhancement
of life and personal relations and assures access to
information on sexuality to achieve sexual enjoyment
 Goal
 To achieve healthy sexual development
and maturation
 To achieve their reproductive intention

 To avoid diseases, injuries and

disabilities related to sexuality and

reproduction
 To receive appropriate counseling and

care of RH problems
 Strategies
 Increase and improve the use of more effective or
modern contraceptive methods
 Provision of care, treatment and rehabilitation for
RH
 RH care provision should be focused on adolescents,
men and unmarried and other displaced people with
RH problems
 Strengthen outreach activities and referral system
 Prevent specific RH problems through information
dissemination and counseling of clients
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 concerns
in environment and health including the very
comprehensive Sanitation Code of the Philippines
(PD 856, 1978).
 WATER SUPPLY SANITATION
PROGRAM
EHS sets policies on:
 Approved types of water facilities

 Unapproved type of water facility

 Access to safe and potable drinking water

 Water quality and monitoring surveillance

 Waterworks/Water system and well

construction
Approved type of water facilities
 Level 1 (Point Source)- a protected well or a
developed spring with an outlet but without a
distribution system
 indicated for rural areas;
 serves 15-25 households; its outreach is not
more than 250 m from the farthest user
 yields 40-140 L/ min
 Level II ( Communal Faucet or
Stand Posts)
 With a source, reservoir, piped distribution
network and communal faucets
 Located at not more than 25 m from the
farthest house
 Delivers 40-80 L of water per capital per day
to an average of 100 households
 Fit for rural areas where houses are densely
clustered
 Level III ( Individual House
Connections or Waterworks System)
 With a source, reservoir, piped distributor
network and household taps
 Fit for densely populated urban communities
 Requires minimum treatment or disinfection
ENVIRONMENTAL SANITATION
- the study of all factors in man’s
physical environment, which may
exercise a deleterious effect on his
health, well-being and survival.
 Includes:
1.1 Water sanitation
1.2 Food sanitation
1.3 Refuse and garbage disposal
1.4 Excreta disposal
1.5 Insect vector and rodent control
1.6 Housing
1.7 Air pollution
1.8 Noise
1.9 Radiological Protection
1.10 Institutional sanitation
1.11 Stream pollution
PROPER EXCRETA AND SEWAGE DISPOSAL
PROGRAM

EHS sets policies on:

Approved types of toilet facilities :

LEVEL I
◙ Non-water carriage toilet facility – no water
necessary to wash the waste into receiving space e.g.pit
latrines, reed odorless earth closet.
◙ Toilet facilities requiring small amount of water to
wash the waste into the receiving space e.g. pour flush toilet &
aqua privies
LEVEL II – on site toilet facilities
of the water carriage type with
water-sealed and flush type with
septic vault/tank disposal.
LEVEL III – water carriage types of toilet facilities
connected to septic tanks and/or to sewerage system
to treatment plant.
FOOD SANITATION PROGRAM

-sets policy and practical programs to prevent

and control food-borne diseases to alleviate the
living conditions of the population
HOSPITAL WASTE MANAGEMENT PROGRAM
Disposal of infectious, pathological and other wastes
from hospital which combine them with the
municipal or domestic wastes pose health hazards to
the people.

Hospitals shall dispose their hazardous wastes thru

incinerators or disinfectants to prevent transmission of
nosocomial diseases
 PROGRAM ON HEALTH RISK MINIMIZATION
DUE TO ENVIRONMENTAL POLLUTION
Foci:
1. Prevention of serious environmental hazards resulting
from urban growth and industrialization
2. policies on health protection measures
3. researches on effects of GLOBAL WARMING to health
(depletion of the stratosphere ozone layer which
increases ultraviolet radiation, climate change and other
conditions)
 NURSING RESPONSIBILITIES AND ACTIVITIES
 Health Education – IEC by conducting community
assemblies and bench conferences.
 The Occupational Health Nurse, School Health Nurse
and other Nursing staff shall impart the need for an
effective and efficient environmental sanitation in
their places of work and in school.
 Actively participate in the training component of the
service like in Food Handler’s Class, and attend
training/workshops related to environmental health.
 Assist in the deworming activities for the school
children and targeted groups.
 Effectively and efficiently coordinate
programs/projects/activities with other government and non-
government agencies.
 Act as an advocate or facilitator to families in the
community in matters of program/projects/activities
on environmental health in coordination with other
members of Rural Health Unit (RHU) especially the Rural
Sanitary Inspectors.
 Actively participate in environmental
sanitation campaigns and projects in the
community. Ex. Sanitary toilet campaign
drive for proper garbage disposal,
beautification of home garden, parks drainage
and other projects.
 Be a role model for others in the community to
emulate terms of cleanliness in the home and
surrounding.
Non-Communicable Diseases and
Rehabilitation
 1. Prevention and Control of Cardiovascular Diseases
 - heart – 1st leading cause of death ; bld vessels - 2nd
 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: envt’l factors, maternal diseases or genetic
aberrations
 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.
 Hypertension: Persistent elevation of the arterial blood
pressure.
 ( primary or essential) ;frequent among females but
severe,malignat form is more common among males
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
PERIOD OF LIFE TYPE OF CVD PREVALENCE

At birth to early Congenital Heart 2 / 1000 school children

childhood Disease (aged 5 – 15 y.o.)

Early to late childhood Rheumatic Fever / 1 / 1000 school children

Rheumatic Heart (aged 5 – 15 y.o.)
Disease
Early Adulthood Diseases of Heart 10 / 100 adults
Muscles
Essential Hypertension
Middle age to old age Coronary Artery Disease 5 / 100 adults
Cerebrovascular
Accident
 CVD
Diseases Causes / Risk factors
Congenital Heart Disease Maternal Infections, Drug
intake, Maternal Disease,
Genetic
Rheumatic Fever/Rheumatic Frequent Streptoccocal Sore
Heart Disease Throat
Essential Hypertension Heredity, High Salt Intake
Coronary Artery Disease (Heart Smoking, Obesity,
Attack) Hypertension, Stress
Hyperlipidemia, Diabetes
Mellitus Sedentary Life Style
Cerebrovascular Accident Hypertension, Arteriosclerosis
(Stroke)
 Primary Prevention: CVD
Disease Primordial Specific Protection

Congenital - Prevention of - Adequate treatment of

Heart viral infection and viral infection during
Disease intake of harmful pregnancy.
drugs during - Genetic counseling of
pregnancy. blood related married
- Avoidance of couples.
marriage between
blood relatives
Rheumatic Heart - Prevention of - Identification of
Disease recurrent sore cases of
throat thru rheumatic fever
adequate - Prophylaxis
environmental with penicillin or
sanitation; erythromycin
avoidance of
overcrowding;
adequate
treatment
Essential - From early - Continued low
Hypertension childhood salt diet and
> low salt diet adequate exercise
> adequate
physical exercise
Coronary Heart - Prevention of - cessation of
Disease(Heart development/ smoking
Attack) acquisition of - control
risk factors /treatment of
> cigarette diabetes,
smoking hypertension
> high fat intake -weight reduction
> high salt intake -change to proper
diet
-Adjustment of
activities
Cerebrovascular - all measures to - all measures to
Accident (Stroke) prevent control
hypertension & hypertension &
arteriosclerosis progression of
arteriosclerosis
 Primary Prevention thru health education is the
main focus of the program:
 1. maintenance of ideal body wt.
 2. diet - low fat
 3. alcohol/smoking avoidance
 4. exercise
 5. 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 detection

 NINE WARNING SIGNS OF
CANCER:
 Change in blood bowel or bladder habits
 A sore that does not heal
 Unusual bleeding or discharge
 Thickening or lump in breast or elsewhere
 Indigestion or difficulty in swallowing
 Obvious change in wart or mole
 Nagging cough or hoarseness

 Unexplained anemia
 Sudden unexplained weight loss
 Prevention & Early Detection
CA type Prevention Detection
Lung No smoking None
Uterine Monogamy Pap’s smear
Cervical Safe sex every 1-3 yrs
Liver Hep B None
vaccination
Less aalcohol
intake
Avoidance of
moldy foods
Colon High fiber diet Regular medical
Rectum Low fat intake check-up after 40
yrs of age
Fecal occult
blood test
DRE
Sigmoidoscopy

Mouth No smoking, Regular dental

betel nut chewing check-ups
Oral hygiene
Breast none Monthly SBE
Yearly exam by
doctor
Mammography
for 50 yrs old and
above females
Skin No excessive sun Assessment of
exposure skin
Prostate none Digital trans-
rectal exam
 PRINCIPLES 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

 Chemotherapy
 3. 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. ,migration
 4. 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
Disorders
 6. 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 care
2. LGUs – direct implementers of health
programs & prime developers of health centers
and hospitals making services accessible to
every Filipino
 Pillars of SSM
 1. Quality Assurance
 2. Grant and Technical Assistance
 3. Health Promotion
 4. 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
 IMCI: Case Mgt. Process
 1. Assessing the child or young infant- History
taking, PE
 2. Classifying the Illness- severity of illness
 3. Identifying ttt.- classification chart
 4. Treating the child- giving ttt. in health centers,
prescribed drugs & teaching mothers how to carry out
ttt.
 5. Counseling the mother- child feeding,foods and
fluids to give & when to bring the child back to the
health center
 6. Giving of follow-up care
 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 minimal
  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.)

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 daily
 Category 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+ ethambutol
 Category 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
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 practice

Management:
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 chlorination
 Prevention 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 Rabies
 Mgt. 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
thereafter
 Prevention 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
 Other CHN Practice Settings
 I. Occupational Health
 - the application of public health, medical and
engineering practice for the purpose of conserving,
restoring the health and effectiveness of workers thru
their places of employment
 A. Occupational Health Nursing
 - the application of nursing principles and procedures
in providing health service to employees in their
place of work by means of:
 1. prompt and efficient nursing care of the ill
and impaired
 2. participation in teaching health and safety
practices on the job
 3. cooperation with plant department
administrators
 4.keeping the health clinic and staff ready to
handle emergencies
 5. advising workers in the utilization of
community and welfare services
 Objectives of OHN
 To assist, maintain and promote positive
health of laborers and employees thru early
detection and prevention of occupational
diseases and hazards of industrial processes
and by coordinating and cooperating with
activities of other community health and
welfare services
 Nurse’s Role in OHN
 1. Assists/participates in developing an adequate health
program for workers and laborers including sound
health education activities
 2. Encourages periodic P.E.
 3. Cooperates with occupational medical programs in
the prevention of accidents as well as in the
promotion of good working atmosphere and
relationships in the place of work
 4. Helps in teaching others in giving good nursing care
to the sick or handicapped in their own homes
 II. School Health Nursing
 School Health Triad :

 1. SERVICE

 2. EDUCATION

 3. ENVIRONMENT
 Mission of School Health Program:

To maximize potential for learning and

participation in the educational process by
promoting optimum health of school-age
children and adolescents
 School Health Team:

 Psychologist/ Counselor
 Teacher
 Nutritionist
 Nurse
 Social Workers
 Maintenance Personnel
 Targets in SHN

 Family
 Students
 Teachers
 Supportive Personnel
 Community
 School Health Nurse’s Roles:

 EDUCATOR
 CONSULTANT /RESEARCHER
 STUDENT, FAMILY AND STAFF
ADVOCATE/CHANGE AGENT
 HEALTH SCREENER
 HEALTH CARE PROVIDER
 Common Health Concerns of Schoolchildren:
1.Drug and Alcohol Abuse
2. STDs/STIs
3. Teenage Pregnancies
4. Mental Health
5. Dermatological Disorders- pimples/acne,
fungal infections, allergies
6. Respiratory Conditions- asthma, URTI
7. Nutrition
8. Dental Health
 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…
T HE
END