Public Health Program FAMILY HEALTH

Family Health
Health is the right of every human being. Healthy people is a prerequisite to national development. The DOH uses the life span approach to design program and assist in the delivery of health to specific age group. Specific Aims of Family Health: 1. Improve the survival, health and well being of mothers and the unborn through a package of services for the pre-pregnanacy, prenatal, natal and postnatal stages. 2. Reduce the mortality and morbidity rates for children 0-9 years 3. Reduce mortality from preventable causes among adolescents and young people. 4. Reduce morbidity and mortality among Filipino adults and improve their quality of life 5. Reduce the morbidity and mortality of older persons and improve their quality of life

Family Health
The family Health Program includes: Maternal Health Program The Family Planning Program The Child Health Programs (Newborns, Infants and Children)
Infant and Young Child Feeding Newborn Screening Expanded Program on Immunization Management of Childhood Illnesses Micronutrients Supplementation Dental Health Early Childhood Development Child Health Injuries

The Adolescent Health Program The Adult Men The Adult Women The Older Person The Philippine Reproductive Health

The Maternal Health Progman

The Maternal Health Program The Philippines is tasked to reduce the MMR by three quaters by 2015 to achieve its millenium development goal. The 2000 Philippine Health Statistics revealed that 25% of all maternal deaths are due to hypertension, 20.30% to postpartum hemorrhage, 9% pregnanacy abortive outvomes which are neither preventable and non predictable. What are the cause of maternal death? Delay in taking critical actions Delay in seeking care Delay in making referals Delay in providing appropriate medical management

The Maternal Health Progman

What are the other factors that contributes to maternal death? Death including cosely spaced births Frequent pregnanacy Poor detection and management of high risk pregnanacies Poor access to health facilities brought about by geographic distance Lack of health staff and competence of the health staff

What has the Government done to address this promblem? BEMOC strategy Improve the quality of prenatal and postnatal visit Reduce womens exposure to health risk through institutionalization of responsible parenthood LGUs and NGOs and other stakeholder must advocate for health through resource generation

The Maternal Health Progman

Essential Health Services Packages Available in Health Care Facilities A. Antenatal Registration Visit 1st Visit 2nd Visit 3rd Visit Every 2 weeks B. C. D. E. Period of Pregnancy As early in pregnancy as possible before four months or during the first trimester During 2nd Trimester During 3rd Trimester After 8th month of pregnancy till term

Tetanus Toxoid Immunization Micronutrients Supplementation Treatment of Disease and Other Condition Clean and Safe Delivery

The Maternal Health Progman

Clean and Safe Delivery Do a quick check upon admission for emergency signs: Unconcious/ convulsion Vaginal bleeding Severe abdominal pain Looks very ill Secere headache with visual disturbance Severe breathing difficulty Fever Severe vomiting Make the woman comfortbale Assess the woman in labor Determine the stage of labor Decide if the woman can deliver safely Give supportive care throughout labor Encourage to take a bath Encourage to drink Encourage to empty the bladder Encourage to do breathing techniques Monitor and manage labor Monitor closely within one hour after delivery and give supportive care Continue care after one hour postpartum Educate and counsel on FP and provide FP method Inform , teach and counsel the women on important MCH message
Birth registration Importnace of BF NBS Schedule of visit for postpartum visit

Priority Program of DOH:

MCH - maternal and child health.

DOHs mission for creating the MCH program:

1. For the reduction in maternal, prenatal, infant and young child mortality and morbidity. 2. For safe pregnancy, delivery and monitoring of exclusive breastfeeding. Q. What is the tool that is utilized to ensure a safe pregnancy? A. HBMR home based maternal record. Q. What is a quality of ante partum check up? A. At least one check up on the 1st, 2nd, 3rd trimester. However, it is ideal to have a monthly check up and upon nearing the final term, check ups should be done every two weeks.

Supplements given to the pregnant woman:

1. Iron with Folic Acid - to be given on the 5 month of pregnancy up to 2 months after post partum. Q. How many iron tablets does the pregnant woman will consume ? A. 210 tablets.

2. Tetanus Toxoid and dental check-up controversial issue------has some abortive property, thus giving it to pregnant women was discouraged. However, an Administrative Order (AO 15) - reinstitution of the tetanus toxoid, but it should de given to women who are on there 5th month of pregnancy to avoid abortion.
Administration of Tetanus toxoid on pregnant women: TT1 - 5th month of pregnancy TT tetanus toxoid TT2 - after 4 weeks TT1 no protection yet TT3 - 6 months after TT2 3 years protection TT4 - 1 year after Tt3 TT3 5 years protection TT5 - 1 year after Tt4 TT4 10 years protection TT5 lifetime protection

Update:(FIC)

TT3 5th ( month of pregnancy) TT4 - after 4 weeks TT5 5th or 6th month of the new pregnancy (ex. 2nd pregnancy)

Situation: 21 year old woman, pregnant, fully immunized child. What TT will you give to the pregnant woman?

Three cleans to be practiced in delivery:

1. Clean hands 2. Clean delivery surface 3. Clean cutting and delivery and care of the umbilical cord.

*Syntocinon rather than Methergin After the baby has been born Syntocinon may be given to stimulate contractions that help push out the placenta and prevent heavy bleeding.also something to do with the first flow of milk. 3. Vitamin A for pregnant woman. dosage - 10 000 IU (3 times a week up to term starting on the 4th or 5th month) If taking multivitamins do not give vitamin A. Vitamin A enhances the absorption of iron towards the bone marrow. 4. Iodized salt and iodized oil - iodized oil to be given once only, considered to be therapeutic if the patient is with iodine deficiency.

5. Chloroquine - although not routinely given to pregnant women, it is used to treat malaria. Can be given to women in endemic areas, 2 tablets per week quickly up to the duration of the pregnancy.
Treatment: Chloroquine (safe for pregnant women) - Before going to a place where malaria is prevalent. * Chloroquine - 1 tablet a week for two (2) weeks - When already in the place: * Chloroquine - 1 tablet a week for four (4) weeks - When you arrived at your place: * Chloroquine - 1 tablet a week for two (2) weeks 6. Calcium - given anytime, 500mg once a day, for bone resorption, because the baby gets the calcium of the mother.

Bone resorption is the process by which osteoclasts break down bone and release the minerals resulting in a transfer of calcium from bone fluid to the blood.

7. Folic Acid dosage: 500mg once a day for iron absorption prevents neural tube defects (Defect in the spinal cord - SPINA BIFIDA) * In the developing vertebrate, the neural tube is the embryos precursor to the central nervous system which comprises the brain and spinal cord. *Spina bifida (Latin: split spine) is a developmental birth defect involving the neural tube incomplete closure of the embryonic neural tube results in an incompletely formed spinal cord. In addition the vertebrae overlying the open portion of the spinal cord do not fully and remain unfused and open. This allows the abnormal portion of the spinal cord to protrude through the opening in the bones.

TBA - traditional birth attendant (also known as hilot) Under Presidential Decree 651. - Hilot are allowed to do delivery provided they will report the deliveries they performed to the nearest health care unit. PD. #651 - mandates that whoever performs the delivery must register the birth within 30 days.
A quality ante natal check-up is where a pregnant woman gets to have at least one check-up every trimester.

Republic Act No. 7600 - AN ACT PROVIDING INCENTIVES TO ALL GOVERNMENT AND PRIVATE HEALTH INSTITUTIONS WITH ROOMING-IN AND BREAST-FEEDING PRACTICES AND FOR OTHER PURPOSES. SECTION 1. Title. - This Act shall be known as The Rooming-In and BreastFeeding Act of 1992.

SECTION 2 Declaration of Policy - The State adopts rooming-in as a national policy to encourage, protect and support the practice of breastfeeding. It shall create an environment where the basic physical, emotional and psychological needs of mothers and infants are fulfilled through the practice of rooming-in and breastfeeding
Breastfeeding has distinct advantages which benefit the infant and the mother including the hospital and the country that adopt its practice It is the first preventive health measures that can give to the child at birth It also enhances mother-infant relationship Furthermore the practice of Breastfeeding could save the country valuable foreign exchange that may otherwise be used for milk importation.

Breast milk is the best because it contains Fats,CHON,CHO suitable for the infants needs. It also serve as first immunization, enabling the infant to fight potential serious infection; it contains growth factors that enhance the maturization of an infants organ systems.

RA 7600 - ROOMING-IN AND BREASTFEEDING ACT. EMPHASIZES THE 3-ES 1. As Early as possible. Colostrums is rich in immunoglobulin. *Latch-on - provides bonding between mother and child and promotes uterine contraction. 2. Exclusive for 4 to 6 months 3. Extended up to 2 years to ensure adequate nutrition.
Do home visit to know post - partum complications and to know if the mother is breastfeeding. Do the home visit within a month and advise the mother to take vitamin A. (Teratogenic - possible birth defects or malformations)

ADVANTAGES OF BREASTFEEDING
F B R E A S T Bonding Family planning (LAM)

E
Resistance in infection

Energy giving Error free formula Digestible

Inexhaustible supply

E
Economic

D
Allergy free I Safe

N
Time bounded

No vitamins needed Guaranteed

What is LAM?
By feeding a new baby only with breast milk, a new mother can prevent pregnancy for up to six months if her period has not returned. When used as a family planning method, this pattern of exclusive breastfeeding is called the lactational amenorrhea method, or LAM.

Three (3) Maternal Reflexes in Breastfeeding:

1. Milk secreting reflex - during pregnancy there is a decrease in prolactin because there is an increase in progesterone. 2. Let-down - oxytocin is release by the posterior pituitary gland. 3. Milk ejecting reflex - brought by oxytocin.

Breastfeeding releases the hormones oxytocin and prolactin. These relax the mother and make her feel more nurturing toward her baby. Breastfeeding soar after giving birth increases oxytocin levels in the mother. This makes her uterus contract more quickly and reduces bleeding Oxtocin is similar to pitacin a synthetic hormone used to make the uterus contract.

Composition of breast milk

s 1. Colostrum first milk after the delivery very rich in immunoglobulin A.

* Calostrum (also known as beestings or first milk) is a form of milk produced by the mammary glands in late pregnancy and the few day after giving birth. Colostrum is high in carbohydrates high in protein, high in antibodies and low in fat. 2. Mature milk blue watery in color. 3. Fore milk - rich in vitamins, proteins and minerals and has enough water. (blue watery in color) *Foremilk, the milk released at the beginning of a feed is watery, low in fat and high in carbohydrates relative to the creamier hind milk which is released as the feed progresses. 4. Hind milk - end feeding color is whitish because it is rich in fats. (Fat gives energy to the baby)

EBM expressed breast milk (for working mother)

Storage Room temperature

Full term baby 8 to 10 hours

Pre term baby 4 hours

Refrigerator
Freezer Deep freezer

2 days
3 months 6 months

24 hours
3 months Never

Goal: Improvement of the nutritional status productivity and quality of life.

(Because if one is undernourished, one cant be productive)

Department of Health PD. 491 - declaring July as the nutritional month.

NBS
What is newborn screening? Newborn screening (NBS) is a simple procedure to find out if your baby has a congenital metabolic disorder that may lead to mental retardation and even death if left untreated. Why is it important to have newborn screening? Most babies with metabolic disorders look normal at birth. One will never know that the baby has the disorder until the onset of signs and symptoms and more often ill effects are already irreversible. When is newborn screening done? Newborn screening is ideally done on the 48th hour or at least 24 hours from birth. Some disorders are not detected if the test is done earlier than 24 hours. The baby must be screened again after 2 weeks for more accurate results.

NBS
How is newborn screening done? Newborn screening is a simple procedure. Using the heel prick method, a few drops of blood are taken from the baby's heel and blotted on a special absorbent filter card. The blood is dried for 4 hours and sent to the Newborn Screening Laboratory (NBS Lab).
How much is the fee for newborn screening? P550. The DOH Advisory Committee on Newborn Screening has approved a maximum allowable fee of P50 for the collection of the sample. When are newborn screening results available? Newborn screening results are available within seven working days to three weeks after the NBS Lab receives and tests the samples sent by the institutions. Results are released by NBS Lab to the institutions and are released to your attending birth attendants or physicians. Parents may seek the results from the institutions where samples are collected. A negative screen mean that the result of the test is normal and the baby is not suffering from any of the disorders being screened. In case of a positive screen, the NBS nurse coordinator will immediately inform the coordinator of the institution where the sample was collected for recall of patients for confirmatory testing.

1. Congenital Hypothyroidism (CH) CH results from lack or absence of thyroid hormone, which is essential to growth of the brain and the body. If the disorder is not detected and hormone replacement is not initiated within (4) weeks, the baby's physical growth will be stunted and she/he may suffer from mental retardation. 2. Congenital Adrenal Hyperplasia (CAH) CAH is an endocrine disorder that causes severe salt lose, dehydration and abnormally high levels of male sex hormones in both boys and girls. If not detected and treated early, babies may die within 7-14 days. 3. Galactosemia (GAL) GAL is a condition in which the body is unable to process galactose, the sugar present in milk. Accumulation of excessive galactose in the body can cause many problems, including liver damage, brain damage and cataracts. 4. Phenylketonuria (PKU) PKU is a metabolic disorder in which the body cannot properly use one of the building blocks of protein called phenylalanine. Excessive accumulation of phenylalanine in the body causes brain damage. 5. Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD Def) G6PD deficiency is a condition where the body lacks the enzyme called G6PD. Babies with this deficiency may have hemolytic anemia resulting from exposure to certain drugs, foods and chemicals.

NBS
What should be done when a baby is tested a positive NBS result?
Babies with positive results should be referred at once to the nearest hospital or specialist for confirmatory testing and further management. Should there be no specialist in the area, the NBS secretariat office will assist its attending physician.

Disorder Screened
CH (Congenital Hypothyroidism CAH (Congenital Adrenal Hyperplasia) GAL (Galactosemia) PKU (Phenylketonuria G6PD

Effects SCREENED
Severe Mental Retardation Death Death of Cataracts Severe Mental Retardation Severe Anemia, Kernicterus

Effect if SCREENED and treated

Normal Alive and Normal Alive and Normal Normal Normal

Food Assistance
Critical period in childs life is 6 months to 2 years old; they are to be given food assistance because the child may acquire nutritional deficiency.

Nutritional Deficiency: I. PEM - Protein Energy Malnutrition

Marasmus- deficiency in carbohydrates Appearance of marasmic child - old man facie Characteristics of a Marasmic child, very irritable skin and bone, psychological and growth failure also have edema, severe wasting. Kwashiorkor - deficiency in protein. Symptoms of kwashiorkor include a swollen abdomen known as a potbelly, as well as reddish discoloration of the hair and depigmented skin.

Best source of protein in the Philippines is fish.

Factors that affects PEM (Protein Energy Malnutrition):

1. Poverty - poor harvest of food. 2. Wrong beliefs and practices. 3. Decreased consumption of oil.

4. Decreased percentage of breastfeeding.

5. Intercurrent infection.

II. VAD - Vitamin A Deficiency

Factors that affects VAD (Vitamin A Deficiency) 1. Low percentage of breastfeeding. 2. Low consumption of oil in the diet.

3. High incidents of measles, pneumonia and diarrhea.

Q. What is the sign that you will notice that a child is Vitamin A deficient? A. Night blindness characterized by frequent blinking of the eyes or when a child frequently falls.

Signs and symptoms of Vitamin A deficiency

1. Xeropthalmia - dryness of the cornea and conjunctiva can also cause thickening and wrinkles. 2. Bitots spot - cheesy, foamy grayish spot forms on the surface of dry patches of the conjunctiva at the side of the eyes. 3. Keratomalacia - softening of the cornea (If the cornea is soft it is prone to infection which then may lead to blindness).

How to treat a Vitamin A deficiency

Age: over 1 year to adult

Age: 6 to 12 months old

Dosage: 200, 000 IU

Therapeutic treatment:
To be given on day 1 Day 2 After 2 weeks

Dosage: 100, 000 IU

Therapeutic treatment:
To be given on day 1 Day 2 After 2 weeks

For high-risk group

To be given on day 1 Day 2 After 2 weeks After 6 months

For high-risk group

To be given on day 1 Day 2 After 2 weeks After 6 months

III. IDA - Iron Deficiency Anemia Factors that affects IDA (Iron Deficiency Anemia)
1. High demand in lactation 2. Poor absorption in the diet 3. Chronic illness
Heme-iron - comes from animal source it is best to cook in oil in order to be absorbed by the body. Non-heme iron - plant source green leafy vegetable Needs vitamin C to be absorbed by the body. (good source of vit. C - orange juice)

IV. lD - Iodine Deficiency

Iodine deficiency is endemic in highly mountainous area, because of soil erosion.

How to prevent iodine deficiency:

1. use of iodized salt 2. use of iodized oil 3. thru health education Q. What is the treatment for iodine deficiency? A. Iodized Oil(200mgs cap/year) Q. What is the first sign that the child is suffering from iodine deficiency? A. Growth retardation or growth failure. Q. What is the tool to know if there is growth retardation? A. Growth monitoring chart.

Indicators of Nutritional Anthropometric Measurement:

1. weight for age (weight is compatible with age) 2. height for age 3. weight for height (assess if there is wasting; org term use for nutritional assessment) 4. arm circumference or triceps fold

Expanded Program on Immunization (EPI) Goal:To reduce the morbidity and mortality of immunizable disease.
*EPI is based on epidemiological approach.

Laws on Expanded Immunization Program (EPI)

P.D 996 - compulsory immunization for all children below 8 years old. Proclamation No. 6 - universal goal in child immunization. Proclamation No. 46 - polio-eradication program. R A. 7846 - compulsory immunization of hepatitis B. Q. What day is the polio patch day? A. Wednesday

REPUBLIC ACT NO. 7846 - AN ACT REQUIRING COMPULSORY IMMUNIZATION AGAINST HEPATITIS-B FOR INFANTS AND CHILDREN BELOW EIGHT (8) YEARS OLD, AMENDING FOR THE PURPOSE PRESIDENTIAL DECREE NO. 996, AND APPROPRIATING FUNDS THEREFORE

SECTION 1. Section 2 of President of Decree No 996 s hereby amended to read us follows

Sec. 2. Scope. - Basic immunization or services shall include: (a) BCG Vaccination against tuberculosis (b) Inoculation against diphtheria, tetanus and pertussis; (a) Oral poliomyelitis immunization, (d) Protection against measles (e) Immunization against rubella; (f) Immunization against HepatitisB; (g) such other basic immunization services for infants and children below eight years of age as determined by the Secretary of Health in a department circular: provided that newborn infants of women with Hepatitis-B shall be given immunization against Hepatitis B w thin twenty four (24) hours after birth.

Elements of Expanded Program on Immunization (EPI)

A. TARGET SETTING - mass approach rather than individual approach. Three priority groups in target setting: 1. Infant comprise of 3% of the total population 2. pregnant women - comprise of 3.5% of the total population 3. school aged group 20% of the total population

B. COLD-CHAIN LOGISTIC MANAGEMENT

Two essential elements of the cold-chain logistic management: 1. people element - maintains the potency of the vaccine 2. equipment element - main storage temperature or the storage ref (15 C to -25 C)

*cold chain monitoring chart - is used to maintain the potency of the vaccine. * FIC (fully immunized child) - all vaccine received before 1 year old * CIC (complete immunized child) - all vaccine received after 1 year old *Most stable vaccine is the BCG *Freeze dried presentation= BCG and AMV needs diluent * Live attenuated bacterial vaccine is BCG * Live attenuated viral vaccine is AMV *After the reconstituted BCG & AMV the life span of the vaccine is only 6 hours freezer +2 to +8 degrees centigrade (ref)

C. IEC - information, education and communication

D. Assessment and evaluation E. Studies, surveillance and research Roles of nurse in Expanded program on Immunization (EPI)
1. Advocate - the nurse motivates 2. Coordinate - the nurse gives proper scheduling 3. Monitoring - monitor the target group to be immunized *all the legal mandates are not included in the essential element of the EPI but serves as a guide in the implementation of the EPI. Q. Who acts as the team leader in EPI? A. PHN (Public Health Nurse)

Q. When do you say that a child is fully immunized? A. When the child has received the following vaccines before the age of 1. 1 dose of BCG 3 dose of DPT 3 dose of HEPA B 3 dose of OPV 1 dose of AMV

Types of Vaccines
Vaccine Complete name
Bacillus Calmette Guerin

When to given
After delivery

Number of times to be given

Once

Route of administration ID intradermal

(Rt deltoid) Wheal indicator that administration is successful

Protection from
Tuberculosis. Also helps the child not to be infected by leprosy (extra pulmonary tb)

BCG .05ml

DPT 0.5 ml

Diphtheria pertussis tetanus toxoid

6 weeks after birth

3 times, 4 weeks interval

IM - intramuscular

Diphtheria pertussis (whooping cough) tetanus

OPV

Oral Polio Vaccine

6 weeks after birth

3 times, 4 weeks interval

Once

Oral 2 drops

Polio

AMV 0.5 ml

Anti Measles Vaccine

9 months

SQ subcutaneous (fats) 45 degree

Measles, protects from acquiring severed diarrhea and pneumonia Hepatitis

Hepa B

Hepatitis B Vaccine

After delivery

3 times, 4 weeks interval

IM - intramuscular

BCG - Bacillus Calmette Guerin

*Booster of BCG - to be given in school-aged child (.10ml)=not done anymore-----no change in titer * Normal side effect of BCG is Kochs phenomenon Bad side effect of BCG: 1. deep abscess 2. glandular enlargement 3. indolent ulceration What causes the deep abscess? Wrong technique Unsterile needle Wrong route (IM rather than ID) How to treat deep abscess and glandular enlargement? Incision and drainage Put INH powder (INH - isoniazid)

How to treat indolent ulceration? Put INH powder (INH - isoniazid)

*Isoniazid is used in the treatment of mycobacterial infection.

DPT- Diphtheria Pertussis Tetanus

*Booster is given 3 years old above but DT only. *Normal side effect of this vaccine is that the child can develop fever, so advise the mother to give the child antipyretic & to do TSB (tepid sponge bath). Q. What component of your DPT will give your client a seizure or convulsion? A. Pertussis (Dont give DPT if the child is 3 years over only DT)

Q. What is the pathognomonic sign of diphtheria? A. Pseudo membrane

OPV Oral Polio Vaccine

*No known side effect *Nursing consideration: do not feed the child 30 minutes before and after the giving the vaccine. Two Types of Oral Polio Vaccine 1. Salk (route is subcutaneous) 2. Sabin (per orem) ** Two polio vaccines are used throughout the world to combat polio.The first was developed by Jonas Salk, first tested in 1952, and announced to the world by Salk on April 12, 1955. It consist of an injected dose of inactivated (dead) poliovirus . The second was an oral vaccine developed by Albert Sabin using attenuated poliovirus. Q.What should the nurse do if the child vomits or spit out OPV?

HEPA B Hepatitis B
* If the pregnant mother is infected with the Hepa B virus, give the baby HEPA B vaccine within 24

AMV Anti Measles Vaccine

* Nobody can die because of measles alone, the child may die because of complications like developing bronchopneumonia. *Vitamin A should be given at 100 000 IU to enhance the effect of AMV.

Control of Acute Respiratory Infection (CARI) Goal: : To reduce mortality case of pneumonia among children 0 to 5 years
old, thru early detection and antibiotic treatment. Do an assessment: Ask, Look and Listen Earliest sign of pneumonia 1. fast breathing 2. chest indrawing

Laws Affecting Community Health

Presidential Decree: PD. 568 - totality of all policies in infrastructure, facilities, equipment, human resources and services that address the health need problems and concerns of all people. RESTRUCTURED HEALTH CARE DELIVERY SYSTEM REPUBLIC ACT NO. 1082 - STRENGTHENING HEALTH AND DENTAL SERVICES IN THE RURAL AREAS, AND PROVIDING FUNDS THEREFOR (rural Health Act) REPUBLIC ACT NO 7160 AN ACT PROVIDING FOR A LOCAL GOVERNMENT CODE OF 1991 Administrative Order (AO 15) - reinstitution of the tetanus toxoid. Administrative Order (AO 3) - Vitamin A. Presidential Decree; P.D. 651. - Hilot are allowed to do delivery provided they will report the deliveries they performed to the nearest health care unit.

Republic Act No. 7600 - AN ACT PROVIDING INCENTIVES TO ALL GOVERNMENT AND PRIVATE HEALTH IN5TITUTION5 WITH ROOMING-IN AND BREAST-FEEDING PRACTICES AND FOR OTHER PURPOSES. Presidential Decree: PD. 491 - Department of Health declaring July as the nutritional month. REPUBLIC ACT NO. 8172 - ASIN LAW REPUBLIC ACT NO. 8972 - AN ACT PROMOTING SALT IODIZATION NATIONWIDE AND FOR RELATED PURPOSES. (Under Senator Juan Flavier)

REPUBLIC ACT NO. 8976 - AN ACT ESTABLISHING THE PHILIPPINE FOOD FORTIFICATION PROGRAM AND FOR OTHER PURPOSES.

Laws on Expanded Immunization Program (EPI)

PD. 996 - compulsory immunization for all children below 8 years old. Proclamation No. 6 universal goal in child immunization. Proclamation No. 46 - polio-eradication program

REPUBLIC ACT NO. 7846 - AN ACT REQUIRING COMPULSORY IMMUNIZATION AGAINST HEPATITIS-B FOR INFANTS AND CHILDREN BELOW EIGHT (8) YEARS OLD, AMENDING FOR THE PURPOSE PRESIDENTIAL DECREE NO. 996 AND APPROPRIATING FUNDS THEREFORE

CDD CONTROL OF DIARRHEAL DISEASES TKO TOILET; KUBETA, ORESOL

Assess - Ilang beses na po dumumi ang bata? - Assess for skin turgor (pinch in abdominal area: normal - comes back easily) Look - Look if lips are dry, scaly; tongue Feel - Feel if the fontanel is sunken Treatment. Give Oresol (Oral Rehydration Solution) In depressed area make homemade oresol Home made Oresol: 1 liter of water 1 tsp of salt 8 tsp of sugar Oresol- chemical composition: 27.9 grams >NaCI - 3 5 grams >Trisodium Citrate dehydrate - 2.9 grams >Glucose - 20 grams (helps absorb sodium) Q. Why glucose is important? A. Glucose enhances the absorption of sodium.

Continuous LBM can cause severe diarrhea. In case the child has continuous LBM the nurse should also assess the childs immunization record. **If the child has diarrhea DO NOT STOP FEEDING. 3Fs in diarrhea: Fluid - increase fluid intake Feeding continuous feeding Fast referral Q. What is your nursing consideration when transporting the patient? A. The nurse must give the patient Oresol before transporting him / her. Difference between chronic and acute diarrhea: Chronic - 3 or more LBM per day for more than a month Acute - 3 LBM per day in less than two weeks

Diarrhea
Mode of Transmission Ingestion of contaminated food and water.

Signs and Symptoms Passage of watery stools at least 3x a day. Excess thirst. Sunken eyeballs and fontanel. Immediate Treatment: Give Oral Rehydration Solution (ORESOL), rice soup (am) to replace lost body fluid. Continue feeding. Prevention and Control: Drink water only from safe sources. If unsure, boil water for 5 minutes or do water chlorination. Eat only foods that ore well cooked and properly prepared. Avoid eating street vended food.

Keep the food away from insects and rats by covering them using food cover. Wash fruits and vegetables with clean water before eating or cooking. Use toilet when defecating. Wash your hands before eating and after using the toilet.

If diarrhea does not stop, Consult the nearest health center.

*Rotavirus the leading cause of severe diarrhea among infants and young children, is a genus of double-stranded RNA virus in the family Reoviridae. By the age of five, nearly every child in the world has been infected with rotavirus at least once. However, with each infection, immunity develops and subsequent infections are less severe.

Family Planning: (target group - MACRA)

1. MACRA - marriageable couple of reproductive age (15 to 44/49 years old) 2. Those who have had pregnancy for the past 15 months 3. Those below 20 years old and above 35 years old (because this age group is considered high risk)

4. Those who have more than four (4) children.

5. Those with medical complication that do not necessitate pregnancy. (Like patient with congestive heart failure should be given advise regarding family planning method)

RH - Reproductive Health
Ultimate goal: It is geared toward the quality of life. Objective: Take care of the baby and the mother (from womb to tomb) DOH LAW: House Bill 4110 - reproductive health agenda PD965 - requiring every couple before getting married to undergo marital counseling. Ligtas Buntis - safe pregnancy safe motherhood and responsible parenting.

Characteristic of responsible parenting:

Sincerity (sincere because it comes from the heart) Accountability (accountable for whatever happens)

Role of a nurse in family planning. Act as a facilitator

How to give child care:

B I N G O Breastfeed Immunization Nutrition Growth Monitoring Oresol

IMCI: 6 Childhood Diseases:

1. Malnutrition (Kwashiorkor & Marasmus, where the later is more severe because there is wasting. Anemia is also another form of malnutrition because you can easily get iron from food). 2. Pneumonia - Ask, Look Listen 3 Diarrhea Assess Look Feel

4. Measles 5. Dengue - causative agent: Aedes aegypti (low flying mosquito; 6-8AM and 4-6PM biting time) 6. Malaria causative agent: Anopheles mosquito (high flying)

One important aspect in public health: SANITATION

PD 856 - sanitation & sex worker act or law If patient is positive with gonorrhea - check or monitor every two weeks (gram staining) If patient is positive with syphilis - check or monitor every six weeks (RPR/TPPA) Rapid Plasma Reagin (RPR) / treponema pallidum particle agglutination (TPPA), Close monitoring is done to prevent HIV and AID5 (HIV - semen & blood to be infected; AIDS cant survive in outside environment) R.A. 8504 - prevention and control of HIV and AIDS. HIV / AIDS - window period maybe 6 days/weeks/months/year for the infection to become full blown. *Window period is the time between initial infection and the development of detectable antibodies against the infection. R.A. 9263 - violence against women and children act.

Health Education:
Strategy in health education is peer education. Slogan: unite the children, untie against AIDS. Western blot confirmatory test. Elisa - screening test.

** The ELISA test or the enzyme immunoassay (EIA) was the first screening test commonly employed for HIV It has a high sensitivity In an ELISA test a persons serum is diluted 400-fold and applied to a plate to which HIV antigens have been attached

** In the Western blot procedure cells that may be HI V-infected are opened and the proteins within are placed into a slab of gel to which an electrical current is applied

COMMUNICABLE DISEASES
1. Tuberculosis
Active case finding the health worker is the one going out looking for symptomatic and possible TB suspect. Passive case finding the patient is the one who goes to the health center and subject himself for sputum testing. R.A. 1136 - TB control program

Mycobacterium tuberculosis is the bacterium that causes most cases of tuberculosis It was first described on March 24 1882 by Robert Koch who subsequently received the Nobel Prize in physiology or medicine for this discovery in 1905 the bacterium is also known as Koch's bacillus.

Mycobacterium tuberculosis - also known as Kochs disease - Causative agent Koch's bacilli - RA 1136 - the law that mandates the treatment of TB, DOH aims to eradicate tuberculosis.

- DOTS - Directly Observed Treatment Short-course chemotherapy

- elements of DOTS - 6-8 months treatment - DOTS tutok gamutan - Mode of transmission: airborne or droplets - Symptoms: age 10 years and above with chronic cough (more than 2 weeks), loss of appetite (anorexia) with progressive weight loss, night sweat, low grade fever especially in the afternoon or at night, chest and back pain.

To test for TB:

Adult - sputum microscopy done 3 times for 3 consecutive days - Inhale-exhale then coughs to get the sputum - Acid fast stain (acid fast bacilli) Children - PPD Purified Protein Derivatives or Mantoux Test

Procedure:
A standard dose of Tuberculin units (0.1 mL) is injected intradermally (into the skin) and read 72 hours later. A person who has been exposed to the bacteria is expected to mount an immune response on the skin containing the bacterial proteins. The reaction is read by measuring the diameter of induration (palpable raised hardened area) across the forearm (perpendicular to the long axis) in millimeters. No induration should be recorded as 0 mm Erythema (redness) should not be measured.

Classification of tuberculin reaction.

The results of this test must be interpreted carefully. The persons medical risk factors determine at which increment (5 mm, 10mm, 15mm) of induration the result is considered positive. A positive result indicates TB exposure.

5 mm or more ( immuno comprise) is positive in - HIV positive person - Recent contacts of TB case - Persons with nodular or fibrotic changes on chest x-ray consistent with old healed TB -Patients with organ transplant and other immuno-suppressed patients
10 mm or more (high risk) is positive in - Recent arrivals (less than 5 years) from high-prevalence countries - Injection drug users - Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes hospitals homeless shelters, etc.) - Microbacteriology lab personnel

- Persons with clinical conditions that place them at high risk (e.g diabetes prolonged corticosteroid therapy leukemia end stage renal disease chronic malabsorption syndromes, low body weight, etc) -Children less than 4 years of age or children and adolescents exposed to adults in high-risk categories.

15 mm or more (low risk) is positive in -Persons with known risk factors for TB.
*TB can not be eradicated because of poverty.

Elements of DOTS:
1. Government commitment. Because needs training and financial support. 2. Case detection by sputum microscopy 3. Standardized 6 to 8 months treatment regimen. 4. Regular uninterrupted drug supply to the rural health unit in order to avoid treatment failure or relapse 5. Standardized surveillance monitoring.

Treatment Drugs TB Drugs

R ifampicin (450 mg) I soniazid (400 mg) INH

Side Effects
Reddish discoloration of urine Peripheral Neuritis - inflammation of the nerves (pamanmanhid) Give Vit. B6 pyradoxine to prevent peripheral neuropathy. Hyper Uricemia - high uric acid To counteract - increase fluid intake Optic Neuritis

P yrazinamide (500 mg) PZA E thambutol (500 mg)

S treptomycin

Ototoxicity (nabibingi)

Q. What is the comprehensive strategy to detect and cure TB? A. DOTS Q. What is the anti Tb drug that cant be given to children below 6 years old? A. Ethambutol.

Treatment of TB Cases:
CAT I
1. New TB patient positive on smear 2. New TB patient negative on smear with extensive lung involvement. 3. Extra pulmonary TB (millary TB) Intensive phase Maintenance phase Give RIPE for 2 months Give RI for 4 months

CAT II

1. Treatment failure 2. Relapse 3. Defaulters

Intensive phase

Maintenance phase

Give RIPES for 2 months Give RIPE for 1 month (total of 3 months) Give RIE for 5 months

CAT III

1. New TB patient negative on smear for three (3) consecutive times with minimal lung lesion or PTB minimal

Intensive phase
Maintenance phase

Give RIPE for 2 months Give RI for 4 months

CAT IV

1. MDRTB multiple drug resistant TB

Quinolone, ofloxacine, inoflux

* TB patients after two weeks of taking the drug is no longer contagious.

** Miliary tuberculosis (or disseminated TB) is a form of tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions (1-5 mm). Its name comes from a distinctive pattern seen on a chest X ray of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds thus the term miliary tuberculosis. Miliary TB may infect any number of organs including the liver and spleen. It is a complication of 1-3% of all TB cases. ** Potts disease is a presentation of extra pulmonary tuberculosis that affects the spine, a kind of tuberculous arthritis of the intervertebral joints. More precisely it is called tuberculous spondylitis and the original name was formed after Percivall Pott (1714-1788) a London surgeon. It is most commonly localized in the thoracic portion of the spine.

1. Tuberculosis: (from National Center for Disease Prevention and Control)

A BACTERIAL DISEASE An ill child with: A history of contact with a suspect or confirmed case of pulmonary tuberculosis Any child who does not return to normal health after measles or whooping cough Losses weight, cough and wheeze which does not respond to antibiotic therapy for acute respiratory diseases Abdominal swelling with a hard painless mass and free fluid Painful, firm or soft swelling in a group of superficial lymph nodes Any bone or joint lesion of slow onset Signs suggesting meningitis or disease in the central nervous system Occurrence: Worldwide Morbidity and mortality rates are higher in developing countries Infectious Agent: Myobacterium tuberculosis

Reservoir: Man Diseased cattle

Mode of transmission: droplets infection, that is through inhalation of bacilli from patients dust inhalation of bacilli which have dried on the surface of the ground or floor and become suspended in the air Incubation Period: About 4 to 12 weeks from infection A year or two after infection of pulmonary or extrapulmonary tuberculosis Period at Communicability: A person who excretes tubercle bacilli is communicable. Degree of communicability depends upon: >The number of excreted bacilli in the air >Virulence of the bacilli >Environmental conditions like overcrowding

Susceptibility/Resistance: Susceptibility to infection is general. The risk of developing the disease is highest in the children under 3 years.

2. Leprosy
Mycobacterium leprae - also known as Hansen's bacillus.
- Mode of transmission - thru direct contact, intimate skin to skin contact. - Symptoms are: whitish skin lesion; when pricked, the patient will not feel anything; it is numb since leprosy involves the nerves. When patient is asked to jog in place no sweat can be seen at the lesion. - Incubation period: 1 to 5 years (variable)

Two (2) types OF Leprosy

1. Pauci bacillary (PB) or Tuberculoid type - less than 5 lesions. Treatment: Rifampicine 600 mg given once a month Dapsone 100 mg given daily Initial dose: Rifampicine & Dapsone - Day 1 Day 2 to 28: Dapsone only 2. Multi bacillary (MB) or Lepromatous - more than 5 lesions. Treatment: Rifampicine 600 mg Dapsone 100 mg Lamprene (Clofazimine - generic name) 300 mg Initial dose ay 1: Rifampicine 600 mg Dapsone 100 mg Lamprene (Clofazimine - generic name) 300 mg Day 2 to 28: Dapsone 100 mg Lamprene (Clofazimine) 50 mg Note: Lamprene causes skin discoloration (skin will become darker)

Early signs and symptoms;

C L U M P

Change in color in the skin (red or white) Lesion is hypostatic (state of physical weakness) Ulcers that don't heal Muscle weakness Painful nerve

Late signs and symptoms:

C L I Clawing of the fingers and toes Leonine appearance Inability to close the eye

S
M

Sinking of the nose bridge

Madarosis (loss of eyebrow)

Diagnosis: 3 Ps
1. Presence of the Hansen's bacilli. 2. Peripheral nerve enlargement. 3. Presence of localized area of anesthesia.

Leprosy: (from National Center for Disease Prevention and Control)

Cause
Mycobacterium leprae

Mode of Transmission
Airborne: inhalation of droplet/spray from coughing and sneezing of untreated leprosy patient

Signs and Symptoms

Long standing skin lesions that do not disappear with ordinary treatment Loss of feeling numbness on the skin Loss of sweating and hair growth over the skin lesions Thickened and/or painful nerves in the neck, forearm, near elbow joint and the back of knees

Prevention and Control

Treat all leprosy cases to prevent spread of infection. We should avoid direct contact with untreated patients. Practice personal hygiene. Maintain body resistance by healthful living. Good nutrition Enough rest and exercises. Clean environment Immediate treatment.

3. Rabies
RHABDO VIRUS rabies virus (commonly infects humans) causes rabies. Rabies - an acute central nervous system (CNS) infection caused by the direct invasion of the brain by the Rhabdo virus. Rhabdo virus are said to be heat stable. Incubation period is to 1-2 weeks, 1 to 19 years. Mode of transmission: bite, scratch, lick

 Manifestations 1. Invasive stage - fever, numbness, headache, restlessness 2. Excitement stage - hydrophobia, aerophobia, manyakal behavior (nauulol) 3. Paralytic stage- paralysis, unresponsiveness Diagnosis- subject the dog to brain biopsy= NEGRIBODIES. * E.O 84- national rabies prevention and control program
Immunization. 1. Active (single bite/scratch) 2. Passive -ERIG/ HRIG= neck up

Both should be administered for multiple bite or scratch or if bite is at the bock or from neck up

Active: Day 0, intradermal (ID) 0.1ml on both deltoid muscles (muscle on the shoulder) Day 3 (ID) 0.1 cc each on both deltoid Day 7, (ID) 0.1 cc each on both deltoid Day 30, (ID) 0.1 cc on one side, deltoid Day 90, (ID) 0.1 cc on one side, deltoid

* after day 0, if day 3 is not administered, it can still be continued within 7 days. after 7 days, re-start treatment. *good for 3 years of being immunized * Immunity: 0 - 6 months - no booster needed, but the patient should be given antibiotic and anti-tetanus 6 months 3 years= .1 ml booster dose= day 0 and day 3, one side one dose 3 years onwards - repeat immunization, day 0 90 *rabies - no lifetime immunity Passive: administered once only, develops antibodies immediately. *Vaccines: ERIG - equine rabies immuno globulin (do skin test) HRIG - human rabies immuno globulin PVRV - purified verocell rabies vaccine (verorab) PCEC - purified chick embryo cultured (rabipur)

*Rhabdo virus - con travel 3mm per hour and can go to the blood vessel or nerves.

ACTIVE
For single bite on the extremities

PASSIVE
If you want to immediately protect the patient within 24 hours To give within 7 days Give active immunization first before giving the passive.

If animal has been immunized Takes 5 to 14 days before it can develop

Rabies: (from National Center for Disease Prevention and Control)

Cause
Rabies Virus

Mode of Transmission
Through bite of a rabid animal or contamination of any wound/scratch with saliva containing rabies virus

Signs and Symptoms

1. Headache and fever Pain or numbness of bite site Delirium and paralysis Muscle spasms Hydrophobia and aerophobia

Prevention and Control

Be a Responsible Pet Owner Have your pet dog immunized against rabies at 3 months old and every year thereafter. Never allow your pet dog to roam the streets. Take care of your pet dog: bathe, give clean food, and provide clean sleeping quarters.

When Bitten by a Dog

Wash the wound immediately with soap and running water. Observe the dog for 14 days and consult your physician if any of the following occurs: >dog becomes wild and runs aimlessly >drooling of saliva >bites any moving or non-moving object >does not eat or drink >the dog dies within observation period If dog cannot be observed (stray dog) or if suspected to be rabid, consult your physician immediately or go to the nearest Animal bite Treatment Center in your area.

4. Schistosomiasis
Schistosomiasis or bilharzia is a parasitic disease caused by several species of flatworm. The acute form of schistosomiasis is sometimes commonly called swimmers itch. The disease affects many people in developing countries, and in certain African communities and east Asia. Although it has a low rate, schistosomiasis can be very debilitating. Schistosomiasis is known as Bilharzia or bilharziosis in many countries, after Theodor Eilharz, who first described the cause of urinary schistosomiasis in 1851, although the first doctor who described entirely the disease cycle was Piraja da Silva in 1908. An often chronic illness that results from infection of the blood with parasitic flatworm (schistosome), it can cause liver and internal damage. It is most commonly found in Asia, Africa, and South America, especially in areas with water that is contaminated with fresh water snails, which may carry the parasite.

Schistosomiasis
Commonly called swimmers itch. (endemic in Samar and Leyte) There are five species of flatworms that cause schistosomiasis. Each causes a different clinical presentation of the disease. Schistosomiasis may localize in different parts of the body and its localization determines its particular clinical profile. Schistosoma mansoni and Schistosoma intercalatum cause intestinal schistosomiasis Schistosoma haematobium causes urinary schistosomiasis Schistosoma japonicum causes Asian intestinal schistosomiasis

Mode of Transmission. Penetration of the skin with infected cercaria, which are the larvae capable of infecting mammals. Intermediate Host: Tiny fresh water snail (Oncomelania quadrasi).

Diagnostic Method: Stool examination through Kato Katz method Drug of choice: Praziquantel Prevention and Control: Avoid infected area Wear rubber boots Wash with soap and water & 70% alcohol Eradication of the snail

Schistosomiasis: (from National Center for Disease Prevention and Control)

The Disease: It is caused by a blood fIuke (parasite) called Schistosoma japonicum, transmitted through a tiny fresh water snail (Oncomelania quadrasi) It is transmitted to man or animal through skin penetration when they get in contact with schisto infested water. It is closely related to personal habits and livelihood requiring contact with water. Signs and Symptoms: a. Early Stage Abdominal pain Low grade fever Loose bowel movement Bloody stool

b. Late Advance Stage Inflammation of the liver Bulging of the Abdomen Enlargement of the Spleen Sometimes the brain is affected that caused epilepsy
Diagnostic Method: Stool examination through Kato Katz method Prognosis: Curable at the early stage but fatal in the advanced stage Drug of Choice: Praziquantel tablets Prevention and Control: Submit stool for examination to the Schistosomiasis Control Team (SCT) or Health Centers. Construct and use sanitary toilets. Avoid contact or exposing oneself to schisto infested waters. Fencing or tying of stray animals Keep environment clean and participate in community efforts of controlling the disease. Consult SCT or Health Centers for additional information.

5. Filariasis
Lymphatic Filiariasis is a parasitic and infectious tropical disease, caused by three threadlike parasitic filarial worms called nematode worms, Wuchereria bancrofti, Bruqia timori, all transmitted by mosquitoes. It is extremely rare in Western countries. Loa loa is another filarial parasite of humans transmitted by deer fly. Mode of Transmission: Thru the bite of an infected female mosquito (aedes poecilius) Intermediate Host: Wuchereria bancrofti, Brugia malayi, and Brugia timori

Treatment: Diethylcarbamazine citrate or hetragan Amputation

Diagnosis: Nocturnal blood smear taken at patients residence or hospital at around 8pm. Health teaching: Proper hygiene If there is swelling, elevate the affected are to promote circulation

Filiariasis: (from National Center for Disease Prevention and Control)

Commonly known as elephantiasis is a disease caused by a parasite transmitted by mosquito

Signs and Symptoms Pain and swelling of the breast, vagina, scrotum legs and arms Fever Cough Chills Wheezing

Prevention Wear long sleeve shirt and long pants when working in farms or areas endemic of filariasis. Sleep under a mosquito net. Treatment Selective treatment with DEC (Diethylcarbamazine Citrate) is given to people with clinical manifestations of the disease. Mass treatment of the people living in established endemic areas. Medicines (DEC and albendazole) are given once a year for 5 years.

6. Diptheria
1. Genus corynebacterium a. Corynebacterium xerosis normal inhabitant of the human conjunctiva. b. Corynebacterium pseudodiptheriticum - normal inhabitant of the pharynx. c. Corynebacterium diptheriae - causes diphtheria and produces a potent toxin.

* Diptheria - acute highly contagious infection generally affecting the throat but occasionally other mucous membrane and the skin. - the disease s spread through direct contact with a carrier or by contaminated milk. -after incubation period of 2 to 6 days, sore throat, weakness, mild fever develops. Later a soft grey membrane forms across the throat constricting the air passage and can cause difficulty in breathing (DYSPNEA) and swallowing (DYSPHAGIA). - soft grey membrane called Pseudomembrane, is the pathgnomonic sign of Diptheria it is characterized by a whitish grey color in the throat doctors may order a Tracheostomy= surgical procedure performed on the neck to open a direct airway through an incision in the trachea (the windpipe). - bacteria multiply at the site of the infection and release the toxin into the blood stream which damages the heart and the nerves and result in heart failure and general collapse within four (4) days. But administration of antibiotic (PCN) and anti-toxin arrest the disease.

Diptheria: (from National Center for Disease Prevention and Control)

A BACTERIAL (Toxin-Related) DISEASE It is an acute pharyngitis, acute naso pharyngitis or acute laryngitis with a pseudomembrane formation in the throat. Infectious Agent: Q.What instrument is used in cleaning a patient
who underwent a Tracheonomy Forceps

Corynebocterium diphtheria A.

Reservoir: Man

Q. What is the susceptability test for diphtheria? A. SHICKS test.

Incubation Period: Q. What is the sensitivity test for diphtheria? 2 to 5 days or maybe longer A. MALONEYS test. Mode of Transmission: By droplets spread through sneezing coughing and close personal contact.

Period of Communicability: May last for 2 to 3 weeks May be shortened in patients with antibiotic treatment. Diphtheria transmission is increased in schools, hospitals, households and in crowded areas.

Prevention: Immunization of infants with 3 doses of DPT.

7. Pertussis
Whooping cough is an infection of the respiratory system characterized by severe coughing spells that end in a whooping sound when the person breathes in. Causative agent: Bordetella pertussis Incubation Period: 7 to 10 days but not exceeding 21 days Mode of Transmission: airborne or droplet

Stages of Pertusis: 1. Invasive or Catarrhal Stage - 7 to 14 days in which the patient will have fever, watery eyes and nasal discharge sometimes patient becomes restless 2. Spasmodic Stage patient develops forceful cough with whoop, swollen face and neck, protruding eyes, the patient may sometimes develop epistaxis (nose bleeding) 3. Convalescence Stage Recovery Stage

Q. Which stage is the most infectious or

contagious? A. Invasive stage or catarrhal stage, because of the discharge or secretion.

Treatment: Penicillin G or Erythromycin

Nursing Intervention: Oxygenation (to lessen the paroxysm of cough) Give small frequent feeding to avoid aspiration pneumonia (sometimes can he fatal) Ask the patient to have a solid bed rest to avoid coughing Give abdominal support to patient especially children when coughing to avoid umbilical hernia.

Pertusis: (from National Center for Disease Prevention and Control)

A BACTERIAL (Toxin-Related) Disease History of severe cough and history of any of the following: Cough persisting 2 or more weeks; fits of coughing, and cough followed by vomiting.
Occurrence: Worldwide Morbidity higher in developing countries

Infectious Agent: Bordetella pertussis Reservoir: Man

Mode of Transmission: Primarily by direct contact with discharges from respiratory mucus membranes of infected persons Airborne route probably by droplets Indirect contact with articles freshly soiled with the discharges of infected persons
Incubation Period: Usually 7 days but ranges from 5 to 15 days Period of Communicability: Highly communicable in early catarrhal stage before paroxysmal cough Antibiotics may shorten the period of communicability from 7 days after exposure to 3 weeks after onset of typical paroxysms to only 5 to 7 days after onset therapy

Susceptibility/Resistance: Susceptibility is general. One attack confers a prolonged immunity although exposed adults may have another attack. Three doses of DPT confers immunity to pertussis.

8. Tetanus
Characterized by a prolonged contraction of skeletal muscle fibers The primary symptoms are caused by tetonospasmin, a neurotoxin produced by the Gram-positive, obligate anaerobic bacterium tetani. Infection generally occurs through wound contamination and often involves a cut or deep puncture wound. As the infection progresses, muscles spasms in the jaw develop hence the common name, lockjaw. This is followed by difficulty swallowing and general muscle stiffness and spasms in other parts of the body. Infection can be prevented by proper immunization and by postexposure prophylaxis.

Causative Agent: Clostridium tetani Preventive medicine: anti- tetanus serum (nursing consideration ANST because it is a serum) or Tetanus toxoid.

Mode of Transmission: through an open wound (important in the mode of transmission is the presence of open wound) stays in the soil (ex. farmer tiling the soil with open wound can be infected with Tetanus because Clostridium tetani stays in the soil)

Clinical Manifestation: T I TRISMUS or lock jaw Incontinence (inability to control)

R
D R O

Rigidity of muscles abdomen and extremities

Dyspnea Resus Sardonicus (sarcastic face or look) OPITOTONUS (arching of the back)

Pain

First Sign of Tetanus: Rigidity of abdomen, muscles and extremity Pathognomonic Sign: Resus Sardonicus Diagnosis: Based on wound history and wound culture

Management: Neutralize the toxins or bacteria Give ATS (Anti-Tetanus serum 1 500 IU to 3 000 IU ANST) Kill the bacteria - give antibiotic (bactericidal) that will act on the cell wall Patient suffering from spasm control the spasm by sedating the patient Give Valium (Diazepam)/downers 2, 5,10 mg

9. Meningococcemia
Meningococcemia is the presence of Neisseria meningitis (also known as meningococcus), a sever bacterial infection in the blood stream. It is demonstrated by blood culture. The disease is hard to identify as it can appear in several different forms, depending on which part of the body the bacteria invade. There can be meningitis or septicemia, or a combination of both. (SEPTICEMIA is the presence and multiplication of pathogens in blood.) An acute fatal disease, because there is rapid deterioration of the patient within 24 hours. - Common in cold in congested area. Like meningitis but with rashes Causative Agent: Neisseria Meningitidis

Neisseria Meningitidis - first colonizes in the nasapharyngeal mucous membrane. - can go to the blood and can cause blood invasion in the spinal column (CSF (cerebra spinal fluid clear fluid found inside the spinal column) then the brain covering and will cause meningitis.

** Neisseria meningitidis, also simply known as meningococcus, is a gramnegative bacterium best known for its role in meningitis. It only infects human; there is no animal reservoir. It is the only form of bacterial meningitis known to cause epidemics.

Incubation Period: 2 to 10 days Mode of Transmission: droplet and direct contact

Manifestation: Sign of meningeal irritation like meningitis Usually accompanied by a rash There is nuchal rigidity (Nuchal rigidity is the inability to flex the head
forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present nuchal rigidity is absent)

Characteristic Rash: Petechiae, Ecchymosis usually in the wrist and ankle **A petechiae is a small red or purple spot on the body, caused by a minor hemorrhage (broken capillary blood vessels). **A bruise also called contusion or ecchymosis, is an injury to biological tissue in which the capillaries are damaged allowing blood to sip into the surrounding tissue.

Q. Why do patients with meningo die? A. Because it leads to DIC Disseminated Intravascular Coagulation-> Hypovolomia (decreased in blood volume) -> Hypotension (heart is failing/no pressure) -> Hypovolemic shock (cause of death)

Diagnosis: Blood culture of the CSF (cerebrospinal fluid)

Management: Early administration of Penicillin G or Ceftriaxone (in case you are or duty in the hospital with meningo case) do prophylaxis: Rifampicin or Ceftriaxone or Ciprofloxacin

Meningococcemia: (from National Center for Disease Prevention and Control)

Is a disease brought about by spread of the bacteria (Neisseria Meningitides) to blood stream causing severe signs and symptoms that may lead to death.
Transmission Direct contact with discharges from the nose and throat of an infected person. It can be spread by coughing, sneezing, kissing, sharing of foods, drinks and utensils. Signs and Symptoms Fever Cough, sore throat and other respiratory symptoms Pinpoint rashes which become wider and appear like bruises starting from the legs and arms. Severe skin lesions may lead to gangrene. Unstable vital signs.

May or may not have signs of meningitis such as: stiff neck convulsion (in some cases) delirium altered mental vomiting

Prevention and Control Avoid crowded places. Avoid close contacts with meningococcemia patients. Increased resistance by having healthy diet, regular exercise, adequate rest/ sleep, no alcohol and cigarette smoking. Maintain clean environment/surroundings. Dont share utensils or anything that has been in the mouth of an infected person. Wash hands frequently with soap and water.

Treatment Early recognition of meningococcal infection and prompt treatment with penicillin greatly improves chances of survival.

10. Meningitis
Common Causative Agent: Neisseria meningitis Mode of Transmission: droplet and direct contact Clinical Manifestations: fever, chills, vomiting signs of increase intracranial pressure (headache, projectile vomiting, bulging of the anterior and posterior fontanels) babies with high pitch cry

Signs of meningeal irritation Kernigs sign Brudzinski Nuchal rigidity

Diagnosis: Lumbar tap (getting CSF in the lumbar area) Needs 3 vials ( 1st - bloody due to trauma 2nd and 3rd - clear) Nursing Intervention: Do lumbar tap only with the consent of the patient or family member. Position the patient in fetal position. Let the patient lie flat on bed for 6-8 hours to prevent spinal headache. Hydrate the patient

Treatment: Give Penicillin G and Cephalosporin Mannitol drip - to decrease intracranial pressure

11. Poliomyelitis
Poliomyelitis, often called polio or infant paralysis, is an acute viral infectious disease spread from person to person, primarily via the fecal oral route. Poliomyelitis was first recognized as a distinct condition by Jacob Heine in 1840. Its causative agent, poliovirus, was identified in 1908 by Karl Landsteiner. The polio vaccines developed by Jonas Salk and Albert Sabin in 1962.

Causative Agent. Legio depilitans

Incubation Period 7 to 12 days Mode of Transmission Direct contact or fecal oral route

Signs and Symptoms: Abortive type of poliomyelitis: minimal illness like fever, vomiting, diarrhea Non-paralytic signs & symptoms: signs of meningeal irritation and spasm Paralytic. AFP (Acute Flaccid Paralysis) Diagnosis: Do muscle testing= Range of Motion, EMG (Electromyogram) to know what muscle is paralyzed, stool exam, lumbar tap. Treatment: Prevention of contracture and deformities can be achieved by rehabilitation

Poliomyelitis: (from National Center for Disease Prevention and Control)

A VIRAL DISEASE A suspect case of polio is defined as any patient below 15 years of age with acute flaccid paralysis including those diagnosed to have Guillain - Barre Syndrome for which no other cause can be immediately identified.

Signs and Symptoms: fever severe muscle pain and paralysis difficulty of breathing Inability to move affected arm/leg Mode of Transmission: Fecal - oral route Oral route through pharyngeal secretion Contact with infected persons

Complications: death may occur if respiratory muscles are affected paralyzed limb
Treatment: there is no treatment for polio but only supportive treatment based on the symptoms presented/manifested by the patient

12, Malaria
* Malaria is a vector - borne infectious disease caused by protozoan parasites. It is widespread in tropical and subtropical regions including parts of America, Asia and Africa. * The disease is caused by protozoan parasites of the genus Plasmodium. The most serious form of the disease are caused by Plasmodium falciparum and Plasmodium vivax, but other related species (Plasmodiurn ovale, Plasmodium malariae can also infect humans. This group of human-pathogenic Plasmodium species is usually referred to as malarial parasites.

The disease is caused by protozoan parasites of the genus Plasmodium. Infection of the red blood cells. Malarial parasites are transmitted by female Anopheles mosquitoes. (high-flying mosquitoes)

Mode of transmission: Spread by the bite of an infected mosquito. Spread thru blood transfusion if blood is contaminated. Previously used needle with infection. Vector: Anopheles mosquito (high flying) Blood meal/Biting Time: 9AM to 3PM Plasmodium species: falciparum, ovale, vivax, malariae
Specie that is common in the Philippines and can be fatal: Plasmodium falciparum: because it causes cerebral malaria. Endemic area: Palawan

Incubation Period: 10 to 12 days Life cycle: Begins when female mosquito bites a person with malaria, the mosquito ingests blood containing malaria parasite and once inside the body of the mosquito, it moves to the mosquitos salivary glands. When the infected mosquito bites another person ,the parasite is injected along with the mosquitos saliva. Then the malaria parasite goes to the liver and will stay in the liver and mature for almost one (1) month or 2 to 4 weeks. Then goes to the red blood cell (RBC) and multiplies and as it multiplies the red blood cells will rapture thus causes anemia. * The life span of the RBC is 120 days but when infected with the malarial parasite the life span of RBC is shortened.

Types of malaria: 1. Plasmodium falciparum - causes cerebral malaria, most fatal (incubation period 10-12 days) 2. Plasmodium ovale 3. Plasmodium vivax 4. Plasmodium malariae Clinical manifestations of malaria 1. cold stage - chills 2. hot stage fever, nausea & vomiting, nose bleeding 3. diaphoretic - excessive sweating, general body weakness (malaise), decreased blood pressure, temperature and decreased respiratory rate.

Diagnosis: The most economical, preferred, and reliable diagnosis of malaria is microscopic examination of blood films because each of the four major parasite species has distinguishing characteristics. Two sorts of blood film are traditionally used. Thin films are similar to usual blood films and allow species identification because the parasites appearance is best preserved in this preparation. Thick films allow the microscopist to screen a larger volume of blood and are about eleven times more sensitive than the thin film, so picking up low levels of infection is easier on the thick film, but the appearance of the parasite is much more distorted and therefore distinguishing between the different species can be much more difficult. With the pros and cons of both thick and thin smears taken into consideration, it is imperative to utilize both smears while attempting to make a diagnosis.
TWO (2) TYPES OF SMEAR 1. Thin smear a drop of blood that is spread across a large area of the slide. Thin blood smears helps doctors discover what species of malaria is causing the infection.

2. Thick smear - a drop of blood on a glass slide. Thick blood smears are most useful for detecting the presence of parasites because they examine a larger sample of blood. (Often there are few parasites in the blood at the time the test is done.) Q. When is the right time to do malarial smear? A. Height of fever accompanied by chills. Treatment: Chloraquine or Doxycycline (safe far pregnant women) - Before going to a place where malaria is prevalent: *Chloroquine or Doxycycline - 1 tablet a week for two (2) weeks - When already in the place. *Chloroquine or DoxycycIine - 1 tablet a week for four (4) weeks - When one has left the place: *Chloroquine or Doxycycline - 1 tablet a week for two (2) weeks Mefloquine - chloroquine resistant malaria medicine

Nursing interventions: TSB - tepid sponge bath High caloric diet Correct anemia If hemoglobin level is low - blood transfusion

13. DENGUE
Dengue fever and dengue hemorrhagic fever (DHF) are acute febrile diseases, found in the tropics and Africa, with a geographical spread similar to malaria. One major difference, however, is that malaria is often eradicated in major cities, whereas dengue is often found in urban areas of developed tropical nations, including Singapore, Taiwan, Indonesia and Brazil. Caused by one of four closely related virus serotypes of the genus Flavivirus, family Flaviviridae each serotype is sufficiently different that there is no cross-protection and epidemics caused by multiple serotypes (hyperendemicity) can occur. Dengue is transmitted to humans by the Aedes aegypti (rarely Aedes albopictus) mosquito, which feeds during the day. one of the most important vector-borne diseases acute febrile infection of sudden onset with clinical manifestation Caused by one of four closely related virus serotypes of the genus Flavivirus.

Vector:

Aedes aegypti (low flying mosquito) Biting Time: 6AM to 8AM and 4PM to 6PM Abnormal clotting mechanism Decrease in intravascular volume -> Hypovolemia

Clinical Manifestations: fever, headache, joint pain, retrobulbar pain , bleeding manifestation (epistaxis, gum bleeding, petechiae) Do tourniquet Test = test for capillary fragility; look/count the petechiae per square inch (Positive: more than 20 in 1 square inch)
Diagnosis: Platelet Count (Normal: 150 000 to 400 000) Request for Hematocrit (Hct) - increase of 20 % because of hemo concentration Prothrombin Time (ProTime) Partial Thromboplastin Time

Nursing Intervention: Need to rehydrate the patient If theres loss of blood, do Blood Transfusion NSS - only IV fluid allowed with BT Stages/Grade of Manifestation: Grade I Fever, generalized rash, positive Herman sign (there is flash extremities with pale center) Grade II - Grade I + bleeding manifestation (epistaxis) Grade III - Grade II + sign of circulatory collapse (cold clammy skin, hypotension (heart will compensate by tachycardia), weak pulse Grade IV - Grade III + shock

Nursing Intervention: watch out for bleeding avoid dark colored food Prevention: C L Chemically Treated Mosquito Net Larva eating fish (ex. gold fish)

E A N

Environmental sanitation Anti mosquito soap made of Lanzones Natural mosquito repellant (neem tree, oregano, eucalyptus)

Dengue hemorrhagic fever

(from National Center for Disease Prevention and Control)

is an acute infectious disease manifested initially with fever.

Transmission Aedes aegypti the transmitter of the disease is a day biting mosquito which lays eggs in clear and stagnant water found in flower vases, cans, rain barrels, old rubber tires, etc. The adult mosquitoes rest in dark places of the house.

Signs and Symptoms Sudden onset of high fever which may last 2 to 7 days Joint & muscle pain and pain behind the eyes. Weakness Skin rashes - maculopapular rash or red tiny spots on the skin called petechiae Nose b!eeding when fever starts to subside Abdominal pain Vomiting of coffee-colored matter Dark-colored stools

Prevention and Control Cover water drums and water pales at any times to prevent mosquitoes from breeding Replace water in flower vases once a week Clean all water containers once a week. Scrub the sides well to remove eggs of mosquitoes sticking to the sides. Clean gutters of leaves and debris so that rain water will not collect as breeding places of mosquitoes Old tires used as roof support should be punctured or cut to avoid accumulation of water Collect and dispose all unusable tin cans, jars bottles and other items that can collect and hold water.

14. Sexually Transmitted Disease

Clamydias
Tiny spherical bacteria that invades the host cells where they are protected from immune defense mechanism. Like the Rickettsias, scientist considered it as a virus.

A. Chlamydia trachormatis Varies their pathogenicity, they are pathogenic because it involves many organs. Can cause trachoma (involves the eyes) and inclusion conjunctivitis. Can cause infection of the middle ear - otitis media (luga) Otitis externa - lesions that surround the ears Can go to the urinary system of both male and female and can cause NGU (non - gonococcal urethritis) Treatment - Doxycycline.

Neisseria Gonorrhea
Constitutes a large group of medically important gram negative aerobic cocci. The only cocci that are gram negative. Most neisseria are found or thrives in the mucous membranes of the human urogenital tract and causes venereal disease. Initial symptoms is Dysuria - difficulty in urinating (dys - difficulty) When it becomes severe the urine has unusual discharge (yellow, greenish or greenish yellow)

Causative Agent: Neisserta gonorrhea Signs and Symptoms: Painful Urination (Dysuria) Purulent Urethral Discharge Burning sensation Specimen: Urethral and Cervical Smear Culture

Diagnosis: Gram staining Coffee bean shape

Treatment: GN= Cefixime 100mg(200mgs SD) or Ceftriaxone 500mg(female),1gm(male) SD IM Uncomplicated anogenital infection = NGU (non-gonococcal urethritis) =Doxycycline (DOXIN) 100mg BID (twice a day) for 1 week or 10 to 14 days

Syphilis
Causative Agent: Treponema pallidum

Mode of Transmission: Direct contact Signs and Symptoms: Primary lesion: Painful (chancre) Secondary lesion: presence or rashes > Condyloma - rashes at the palm and sole, copper or reddish in color > Alopecia - patchy hair loss Tertiary lesion: Gumma - necrosis with cardiac involvement and neurological complications.

**Pregnant women can transmit the disease to the unborn child (congenital syphilis/Hutchington Disease) Diagnosis: RPR -Rapid Plasma Reagin If positive (agglutination), have to confirm via TPPA (Treponema Pallidum Particles AggIutination) ** Rapid Plasma Reagin (RPR) refers to a type of test that looks far specific antibodies in the blood of the patient that indicate that the organism (Treponema pallidum) that causes syphilis is present. The term reagin means that this test does not look for antibodies against the actual bacterium but rather for antibodies against substances released by cells when they are damaged by T. pallidum. Another test after used to screen for syphilis is the Venereal Disease Research Laboratory VDRL slide test, however, the RPR test is generally preferred due to its ease of use. In addition to screening for syphilis, an RPR level (also called a titer ) can be used to track the progress of the disease over time and its response to therapy.

The RPR test is an effective screening test, meaning it is very good in detecting people who are affected by syphilis, however, this comes with the drawback that this test is also known to show that people have syphilis who in reality do not (in other words it will produce false positives). When the RPR test produces a positive result, this result is confirmed with a test that is more specific, This test is called the treporema pallidum particle agglutination (TPPA), and it confirms the diagnosis of syphilis. Treatment: Penicillin Nursing Consideration: ANST (after negative skin test)

HIV/AIDS (Human Immunodeficiency Virus Infection/Acquired Immune Deficiency Syndrome)

Human immunodeficiency virus (HIV) is a retrovirus that can lead to acquired immunodeficiency syndrome (AIDS), a condition in humans in which the immune system begins to fail, leading to life threatening opportunistic infections. Blood and sperm (body fluids such as tears, saliva) The HIV virus cannot survive the outside environment

Incubation Period: Variable - window period 6 days, 6 weeks, 6 months, 6 years Patient with AIDS/HIV have low immune system Signs and Symptoms: Kaposi's sarcoma (skin cancer) PCP (Pneumocystic Carinii Pneumonia)

Initial Manifestation: Oral Thrush (singaw) Diagnosis: ELISA Test (Enzyme Linked Immuno-Sorbent Assay) - screening test Western blot - confirmatory test Polymerase Chain Reaction (PCR) For Kids: request for P24 Antigen Treatment: AZT (Zidovudine) Nursing Consideration: If patient is taking AZT, request weekly blood count because AZT causes Anemia and Agranulocytosis Check for RBC count and Hematocrit and Hemoglobin **Hematocrit / 3 = Hemoglobin Hemoglobin x 3.5 = RBC count

Q. In the Philippines, what is the most common opportunistic infection in patients with AIDS? A. TB (tuberculosis) Transition Period from HIV to AIDS: 2 years to 20 years Development of Detectable Antibodies: 1 to 3 months

15. Cholera
acute enterotoxin gastrointestinal infection Causative Agent: Vibrio El Tor Vibrio cholerae Signs and Symptoms: Voluminous diarrhea Rice watery fishy odor Severe Dehydration Suffer from muscle cramps Hypokalemia (lack of Potassium); give Kalium Durule, eat Banana (Latundan 2OmEq) Replace fluid by giving IV (fast drip) to avoid hypovolemic shock Acid Base Balance: Metabolic acidosis (rectum) Respiratory acidosis (mouth)
Q. Best parameter in your patient to know if dehydrated A. Weight the patient

Cholera:

(from National Center for Disease Prevention and Control)

Causative agent Vibrio cholerae bacteria Mode of Transmission Eating of food or drinking of water contaminated with human waste Signs & Symptoms sudden onset of frequent painless watery stools vomiting rapid dehydration (e.g. sunken eyeballs, wrinkled and dry skin) Immediate Treatment Replace lost body fluid by giving Oral Rehydration Solution (ORESOL) or homemade solution composed of 1 teaspoon of salt 4 teaspoons of sugar mix to Liter of water. If diarrhea persists,. consult your health workers or bring the patient to the nearest hospital

Drink only safe and clean water. If unsure, boil drinking water (Upon reaching boiling point extend boiling for two or more minutes) or Do water chlorination Keep food away from insects and rats by covering it. Wash and cook food properly. Sanitary disposal of human waste. Use toilet properly and clear toilet everyday. Wash hands with soap after using toilet and before eating. Keep surroundings clean to prevent flies and other insects and rodents from breeding.

Prevention and Control In extreme cases cholera is a rapidly fatal disease A healthy individual may die within 2-3 hours if no treatment is provided.

16. Mumps / Parotitis

Causative Agent: - Paramyxo virus

PARAMYXO VIRUS medium size envelope virus that has the affinity for mucous. - they cause mumps, measles, croup, viral pneumonia and bronchitis in children and URTI in young adults. URTI upper respiratory tract infection MUMPS -parotitis (inflammation of the parotid glands) can cause sterility especially with the male since it affect the testicles (orchitis) All viral infection are self - limiting meaning they can be cured by itself.

Incubation Period: 9 days or 1 to 2 weeks Mode of Transmission: Droplet, direct or indirect contact

Treatment: Symptomatic Cold compress Diet: Soft bland Complication: Orchitis - an often very painful condition of the testicles involving inflammation, swelling and frequently infection For younger children: Meningoencephalitis
Nursing Responsibility: Young kids: Advise mother to put supporter or sling and cold compress

17. Hepatitis
RA 7846 - Compulsory Immunization of Hepa B REPUBLIC ACT NO 7846 - AN ACT REQUIRING COMPULSORY IMMUNIZATION AGAINST HEPATITIS-B FOR INFANTS AND CHILDREN BELOW EIGHT (8) YEARS OLD, AMENDING FOR THE PURPOSE PRESIDENTIAL DECREE NO 996, AND APPROPRIATING FUNDS THEREFORE

Incubation Period: 45 to 180 days

Types:

Hepa A - Infectious Hepatitis Hepa B - Serum Hepatitis / Post Transfusion Hepatitis Hepa C - non-A and non-B Hepatitis Hepa D co - infection Hepatitis / co-exists with Hepatitis B Hepa E - transmitted by infected food or drink and can cause acute hepatitis

Mode of Transmission: Hepa A - Fecal - Oral Route Hepa B, C, D - blood blood contact, semen Phases: 1. Pre-icterus - symptoms during this stage includes: jaundice and flu like symptoms such as body malaise, anorexia, pain in right upper quadrant (Pre - icterus is two (2) weeks before icterus phase) 2. Icteric phase - symptoms during this stage includes; jaundice hepatomegaly , pruritus, cholic, dark colored urine 3. Post-icteric phase or resolution phase - symptoms: fatigue Laboratory Diagnosis: marked increase in Serum Glutamic Pyruvic Transaminase (SGPT); SGPT - liver liver - ALT heart - SGOT or AST request for Hepatitis B Surface Antigen (HBSAg) anti - HBSAg

Treatment: Diet: High Caloric Diet (high sugar) Advise patient for bed rest Rationale: to rest the liver

**Liver damage / pathology. Low protein diet

Hepatitis A (from National Center for Disease Prevention and Control)

It is caused by the Hepatitis A virus (HAV)

Mode of Transmission ingestion of food contaminated with human waste and urine of persons who are sick of Hepatitis A
Signs and Symptoms fever Flu - Like symptoms: weakness, muscle and joint aches, loss of appetite, dizziness with or without abdominal discomfort after few days, jaundice may follow

Immediate Treatment No specific medicine to cure the patient or shorten the course of illness. Sick persons should be isolated advised to rest take plenty of fluids and avoid fatty foods. Patient who fail to take fluids or are too weak to eat are sometimes brought for intravenous administration of fluids and vitamins. Prevention and Control Wash hands after using the toilet before preparing food and before eating Dispose human waste properly. Thoroughly cook oysters, clams, and other shellfish for 4 minutes or steamed for 1 minute & 30 seconds. Practice safe handling and storage of food and water. **The disease is self limiting and may last for 1 to 2 weeks. Patient often recovers even without treatment.

Hepatitis B (from National Center for Disease Prevention and Control)

A VIRAL DISEASE. Hepatitis B is liver infection caused by the B type of Hepatitis virus. It attacks the liver often resulting to inflammation.

Signs and Symptoms weakness stomach upset dark urine or very pale stools Jaundice
Mode of transmission - Hepatitis B spreads through the following: from child to child from mother to child during birth through blood transfusion through sharing of unsterilized needles, knives or razors through sexual intercourse Complications chronic hepatitis cirrhosis liver failure liver cancer

Prevention Immunization of infants with 3 doses of Hepatitis B vaccine at ages 6 weeks old, 10 weeks old and 14 weeks old. use of safe/clean injection and equipment/supplies Treatment: NONE

Hepatitis C (from National Center for Disease Prevention and Control)

Hepatitis C is usually spread through contact with blood products, l. Most people who are infected with hepatitis C dont have any symptoms for years The virus Stays in the liver and causes chronic liver inflammation cirrhosis or liver cancer.

Signs and Symptoms Headache, nausea and vomiting, abdominal pain, jaundice, weakness and fatigue. Some people have dark yellow urine, light-colored stools and yellowish eyes.

Treatment Medicines such as interferon and rebavirin dont cure hepatitis C, but they do make people feel better and may prevent future liver problems.
Prevention There is no vaccine for hepatitis C. Use condom during sexual activity to protect yourself and your partner from hepatitis C Dont share needles with anyone. Wear gloves if you have to touch anyones blood. Dont use an infected persons toothbrush, razor, or anything that could have blood on it. Make sure any tattooing or body piercing is done with clean tools.

18. Chicken Pox

Causative Agent: Varicella - zoster virus (VZV) - causes chicken pox, shingles (herpes) Varicella zoster virus (VZV) is one of the eight herpes viruses known to affect humans (and other vertebrates) Incubation Period: 14 to 21 days Mode of Transmission: Droplet and airborne (within 3 feet)

Period of Communicability: 1 to 2 days before the appearance of the rash, up to 6 days after, or when all the lesions had dried or crusted

Signs and Symptoms: Initially: Maculopapular rash (typical chicken pox lesion vesicle) Lesion is said to be CENTRIFUGAL (starts from the center then spreads outward) Diagnosis: Isolation of the virus in 3 to 4 days after the rash Stain with Giemsa stain ** Giemsa stain, named after Gustav Giemsa, an early malariologist, is used for the histopathological diagnosis of malaria and other parasites. It is a mixture of methylene blue and eosin. The stain is usually prepared from commercially available Giemsa powder. **Giemsa stain is also a differential stain. It can be used to study the adherence of pathogenic bacteria to human cells. It differentially stains human and bacterial cells purple and pink respectively. It can be used for histopathotogicol diagnosis of malaria and some other spirochete and protozoan blood parasites.

Treatment: Symptomatic, but if the patient has fever or body pain, DO NOT GIVE ASPIRIN (might cause or lead to Reyes Syndrome) For Pruritus (itch), give antihistamine (caladryl or baking soda solution) Acyclovir - speeds skin healing and controls systemic spread ** Reyes syndrome is a potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver. It is associated with aspirin consumption by children with viral diseases such as chicken pox. ** The disease causes fatty liver with minimal inflammation, and severe encephalopathy (with swelling of the brain). The liver may became slightly enlarged and firm, and there is a change in the appearance of the kidneys. Jaundice is not usually present. **Early diagnosis is vital otherwise death or severe brain damage may follow. Nursing Consideration: Advise patient not to scratch trim the nails

Chicken Pox (from National Center for Disease Prevention and Control)
Causative agent: Varicella zoster virus Mode of transmission person to persons direct contact droplet or air borne spread of fluid or secretions from persons with chicken pox contagion / fore and 5 days after the appearance of blisters

Signs and symptom appearance of reddish skin lesions which later become blisters on the 3rd - 4th day of fever weakness muscle and joint pains sudden onset of fever
Immediate treatment chickenpox rashes will disappear in 1-2 weeks time even without treatment

Prevention and control Avoid crowded areas during epidemics Isolate known cases Vaccine is available as precautionary measure and as per doctors advise.

19. Herpes Zoster

also known as Shingles

Causative Agent: Varicella zoster Reactivation of previous chicken pox infection Universal property of latency (virus hides on the neurons; becomes dormant but can be reactivated and produce shingles) Affects the severely immuno-compromised patients (patients with organic diseases such as HIV, Cancer, Diabetes)

Signs and Symptoms: Vesicular but appear in cluster Lesion is unilateral (limited to one side) Usually follows the nerve pathway Very painful
Q.Is it possible that the patient will still have pain after treating the infection? A. YES. If the virus caused permanent nerve damage (Post Herpetic neuropathy). Treatment: Pain - first priority in the treatment Acyclovir - for pain To dry the lesion give Potassium Manganese (KMnO4) Compress

Herpes zoster (or zoster), commonly known as shingles, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body. It is caused by Varicella Zoster Virus (VZV), which is also the virus that causes chickenpox. After a chickenpox infection the virus can lodge permanently in ganglionic neurons, and less frequently in nonneuronal satellite cells, without causing any symptoms, although the mechanism is not understood. In an immunocompromised individual perhaps years or decades after a chickenpox infection, the virus may break out of nerve cell bodies and travel down nerve axons to cause viral infection of the skin in the region of the nerve. The nerve cell bodies of dorsal root, cranial nerve or autonomic ganglion may contain the latent virus, and the virus may spread from one or more ganglia along nerves of an affected segment and infect the corresponding dermatome causing a rash, often referred to as shingles. Although the rash usually heals within two to four weeks some sufferers experience residual nerve pain for months or years, a condition called postherpetic neuralgia.

20. Scabies
Also known as Itch Mite Causative Agent: Sarcoptes scabiei Site: Interdigitals

Clinical Manifestation: Intense Pruritus Pathognomonic Sign: Silvery-White linear streak Mode of Transmission: Direct or Indirect contact Treatment: Kwell Lotion or Lindane

Nursing Intervention: Wash the infected area first then pat dry before applying Lindane (thin application only because it is neurotoxic)) once a meek Nursing Consideration: Apply treatment only once a week Treat the entire household at the same time Kwell lotion is contraindicated to pregnant women and children below 2 years old Scabies is a transmissible ectoparasite skin infection characterized by superficial burrows, intense pruritus (itching) and secondary infection. The word scabies comes from the Latin word for scratch (scabere). Scabies is caused by the mite Sarcoptes scabiei, variety hominis, as shown by the Italian biologist Diacinto Cestoni in the 18th century produces intense, itchy skin rashes when the impregnated female tunnels into the stratum corneum of the skin and deposits eggs in the burrow. The larvae, which hatch in 3-10 days, move about on the skin molt, into a nymphal stage, and then mature into adult mites. The adult mites live 3-4 weeks in the hosts skin.

The action of the mites moving within the skin and on the skin itself produces an intense itch which may resemble an allergic reaction in appearance. The presence of the eggs produces a massive allergic response which in turn produces more itching. Scabies is transmitted readily often throughout an entire household, by skinto-skin contact with an infected person (e.g bed partners school mates daycare) and thus is sometimes classed as a sexually transmitted disease. Spread by clothing bedding or towels is a less significant risk though possible.

21. Pendiculosis (lice)

Causative Agent: Pediculus humanus capitis (head lice) Pediculosis corporis (body lice) Pthirus pubis (pubic lice) **Pediculosis corporis is caused by the louse Pediculus humanus humanus. Unlike the head louse, the body louse deposits eggs on clothing.

Treatment: Kwell Shampoo ( cave it for 5 to 10 minutes and dry it with white towel then comb using a fine-tooth comb (suyod) **Pediculosis is an infestation of lice -- which are parasitic insects -- on the bodies of humans. The condition is more commonly known as head lice body lice or pubic lice. Head lice (Pediculus humanus capitis) infestation is most frequent on children aged 3-10 and their families. Females get head lice more often than males, and infestation in blacks is rare. Head lice are spread through direct head-to-head contact with an infested person. Body lice are spread through direct contact with the body, clothing or other personal items of a person already carrying lice. Pubic lice are most often spread by intimate contact with an infested person. Head lice occur on the head hair, body lice on the clothing, and pubic lice mainly on the hair near the groin. Human lice do not occur on pets or other animals. Lice do not have wings and cannot jump.

From each egg or nit may hatch one nymph that will grow and develop to the adult louse. Full - grown lice are about the size of a sesame seed. Lice feed on blood once or more often each day by piercing the skin with their tiny needle like mouthparts. Lice cannot burrow into the skin. Head lice and body lice (Pediculus humanus) are similar in appearance, although the head louse is often smaller. Pubic lice (Pthirus pubis) on the other hand, are quite distinctive. They have shorter bodies and pincer-like claws making them look like crabs (hence, the nickname for pubic lice: crabs).

Symptoms The most common symptom of lice infestation is itching. Excessive scratching of the infested areas can cause sores, which may become infected. In addition, body lice can be a vector for louse-borne typhus, louseborne relapsing fever or trench fever.

22.Enterobiasis (pinworm)
Causative Agent: Enterobius vermicularis (parasite)

Manifestation: Itchy; Pruritus especially at night (the worm goes down to the anus at night)
Mode of Transmission Direct or indirect contact Diagnosis: put a scotch tape on a tongue depressor and swab it on the anus nocturnal perianal pruritus

Treatment Anti - pinworm drugs such as Albenza (albendazole), Vermox (mebendazole), and Pin - X (pyrantel pamoate) are commonly used to treat pinworms.

** The best known is the human pinworm also known as the threadworms Enterobius vermicularis and the more recently discovered Enterobius gregorii. The adult pinworm male is 1 - 4 mm in length which the adult female is 8 - 13 mm and possesses the long, pin shaped posterior for which the worm is named. The human pinworm is commonly found in children.

Habitat The pinworm lives in the lower part of the small intestine and the upper part of the colon. It is found worldwide and causes the common infection enterobiasis humans. Unlike many other intestinal parasites, the pinworm does not usually enter the bloodstream or any other organs besides the intestines. Only in rare cases disoriented pinworms are found in the vagina and even more rarely in the uterus, fallopian tubes, liver, and peritoneum but the worms cannot survive long in these places.
Reproduction Pinworm eggs are easily seen under the microscope. After mating the male dies. The female migrates to the anus and emerges, usually during the night, to deposit about 10, 000 to 20, 000 eggs in the perianal area (around the anus). She then secretes a substance which causes a very strong itching sensation, inciting the host to scratch the area and thus transfer some of the eggs to the fingers.

Eggs can also be transferred to cloth, toys and the bathtub. Once ingested orally the larvae hatch and migrate back to the intestine, growing to maturity in 30-45 days. The eggs can survive for 2 to 3 weeks on their own outside of the human body. In some cases, the larvae will hatch in the peri - anal area and travel back inside the anus, up the rectum, and back inside to the intestines where they mature.

Effects Except for itching, pinworm infestation does not usually cause any damage to the body. Sleep disturbance may arise from the itching or crawling sensations. Some case reports suggest that severe infestation on may be associated with an increased risk far appendicitis. There s also some evidence of or association between enterobiasis and diminished zinc levels. Diagnosis Diagnosis is often made clinically by observing the female worm (or many worms) in the pen anal region, but can also be made using the scotch- tape test, in which the sticky side of a strip of cellophane tape is pressed against the peri- anal skin, then examined under a microscope for pinworm eggs. The diagnostic characteristics are: size 50-60 um by 20 - 32 um; typical elongated shape, with one convex side and one flattered side and colorless shell.

Treatment Anti-pinworm drugs such as Albenza (albendazole), Vermox (mebendazole), and Pin-X (pyrantel pamote) are commonly used to treat pinworms. It is not a necessity to visit a doctor to get these drugs, as Pin-X is available as an over-the-counter medication (Albenza and Vermox are prescription in the US); ask a pharmacist for medicines to treat pinworms (or threadworms as they are known in the UK). These medicines kill the pinworms 95% of the time, but do not kill the eggs. The person being treated may have to return after a time of two weeks to be re - treated. Another precaution is to wash the hands before eating (to prevent any pinworm eggs under finger nails from being ingested) and to wash any area or clothes which have touched or been in the vicinity of the infected areas. Treating the entire family is after necessary for cure.

23. Ascariasis
Causative Agent: Ascaris lumbricoides Size: 6 inches up to 20 inches long

Mode of Transmission: food contaminated with the parasitic ova will go to the small intestine > lymphatic system -> blood stream -> lungs (s i s for weeks) respiratory tract (where it will be then coughed off) or if swallowed back - goes back to the intestine and copulate -> lays 200,000 ova per day for 1 year after 3 weeks, the eggs/ova are infectious and can stay in the soil for 3 years.
Treatment: Pyrantel Pamoate (Combantrin) Mebendazole - contraindicated to pregnant women Nursing Intervention: Give anti-histamine (ex. Benadryl) for 3 days first before giving Combantrin to prevent erraticity of the worms (might go out through the nose, mouth...)

Nursing Contraindication: do not give to children 2 years and below

Ascariasis

Intestinal roundworm (round - worms are collectively known as nemotoides) An intestinal worm common in warm areas with poor sanitation where it persists largely by indiscriminate defecation of children. The life cycle resemble Trichuris trichiura except that the larvas also migrate to the lungs. When the larva hatches it migrates to the small intestines then it is carried by the lymphatic vessels and bloodstream then into the lungs, where it passes into the air sac, then it ascends to the respiratory tract and it is swallowed. The larva matures in the small intestines where it remains as an adult warm ranging from 6 inches to 20 inches.

Symptoms: if it migrates in the lungs - it can cause fever, cough, constriction of the alveoli thus produces a wheezing sound. if it migrates in the small intestines and there is heavy infection, it can cause intestinal obstruction (too crowded n the intestines) and abdominal bleeding and forms BOLUS ASCARIASIS. Diagnosis: fecalysis (stool exam) look for ova (egg) golden yellow egg to adult worm in stool vomiting larva in the sputum. CBC test - if the eosinophils is high it can mean theres a parasitic infection or allergic reaction. sign of migration to the lungs can be seen through the x-ray Treatment: Mebendazole Pyrantel Pamoate - for pregnant women

* Ascaris lumbricoides, or roundworm, infections in humans occurs when an ingested infective egg releases a worm that penetrates the wall of the duodenum and enters the bloodstream. From here, it is carried to the liver and heart, and enters pulmonary circulation to break free in the alveoli, where it grows and molts. In 3 weeks, the larvae pass from the respiratory system to be coughed up, swallowed, and thus returned to the small intestine, where they mature to adult male and female worms. Fertilization can now occur and the female produces as many as 200,000 eggs per day for a year. These fertilized eggs become infectious after 2 weeks in soil; they can persist n soil for 3 years or more.

24. Trichuris trichiura

causes trichuriasis when it infects a human large intestine. an intestinal worm, the parasite occurs mainly in the subtropics and tropics where poor sanitation and a warm, moist climate provide the conditions needed for the eggs to incubate in the soil. the infection results when a person swallows food that contains egg that has been incubated in the soil for 2 - 3 weeks. the life cycle begins from the time the parasite is swallowed. the larva hatchc5 a small intestines, then migrate to the large intestines and embeds their heads in the intestinal lining. each larva grow to about 4 1/2 inches and then the mature female produces 5,000 eggs per day which are passed in the stool.

Symptoms: Only heavy infection causes severe abdominal pain and diarrhea, may also cause bleeding in the intestines and can cause anemia, weight loss and appendicitis. Occasionally the rectum will pass by the anus and will cause rectal prolapse.

Prevention:

1. Use of sanitary toilet facilities. 2. Avoid unclean vegetables. 3. Maintaining good personal hygiene

Treatment:

Mebendazole (however, should not be given to pregnant women because it can cause harmful effect to the fetus).

**Medical literature shows that the appendix is not generally credited with significant function. The appendix is rich in infection-fighting lymphoid cells, suggesting that it might play a role in the immune system. Whether or not the appendix has a function, it is routinely removed without any notable ill effects or side effects. The human whipworm (Trichuris trichiura or Trichocephalus trichiuris), is a roundworm, which causes trichuriasis when it infects a human large intestine. The name whipworm refers to the shape of the worm; they look like whips with wider handles at the posterior end.

Light infestations are frequently asymptomatic. Heavy infestations may have bloody diarrhea Long-standing blood loss may lead to iron-deficiency anemia. Rectal prolapse is possible in severe cases.
Infection occurs through accidental ingestion of eggs and is more common in warmer areas. The eggs hatch in the small intestine, and then move into the wall of the small intestine and develop. On reaching adulthood, the thinner end (the front of the worm) burrows into the large intestine and the thicker end hangs into the lumen and mates with nearby worms. The females can grow to 50 mm (2 inches) long. Neither the male nor the female has much of a visible tail past the anus. . Whipworm infestation is detectable by stool examination, which can detect eggs and charcot-leyden crystals. Mebendozole is 90% effective in the first dose, and albendazole may also be offered as on anti-parasitic agent. Adding iron to the bloodstream helps solve the iron deficiency and rectal prolapse.

Pathognomic signs
DISEASE Duchenne's Muscular Dystrophy Hypocalcaemia Gowers Sign Trousseau sign and Chvostek sign SIGN

Tetanus
Liver cirrhosis Systemic Lupus Erythematosus Bulimia Nervosa Leprosy Measles Diphtheria Kawasaki Disease Graves disease

Risus sardonicus
Spider angioma Butterfly rash Chipmunk facies (parotid gland swelling) Leonine facies (thickened lion-like facial skin) Kopliks spots Pseudomembrane on tonsils, pharynx, and nasal cavity Strawberry tongue New bilateral Exophthalmos

Pancreatitis
Chronic hemorrhagic pancreatitis Cholera Typhoid fever Meningitis Cholecystitis

Cullens sign (bluish discoloration of umbilicus)

Grey-Turners Sign (ecchymosis in flank area) Rice-watery stool Rose spots in abdomen Kernigs sign and Brudzinskis sign Murphys sign (pain on deep inspiration when inflamed gallbladder is palpated) Levines sign (hand clutching of chest)

Angina pectoris

Patent ductus arteriosus

Parkinsons disease Whipples disease

Machine-like murmur
Pill-rolling tremors Oculo-Masticatory Myorhythmia

NON COMMUNICABLE DISEASES

1. Diabetes
Diabetes mellitus often simply diabetes, is a syndrome characterized by disordered metabolism and inappropriately high blood sugar (hyperglycaemia) resulting from either low levels of the hormone insulin or from abnormal resistance to insulins effects cuopled with inadequate levels of secretion to compensate.

The characteristic symptoms: excessive urine production (polyuria) excessive thirst and increased flu d intake (polydipsia), and blurred vision. ** These symptoms are likely to be absent if the blood sugar is only mildly elevated.

The World Health Organization recognize three main forms of diabetes mellitus: type 1, type 2, and gestational diabetes (occurring during pregnancy), which have different causes and population distributions. While, ultimately, all forms are due to the beta cells of the pancreas being unable to produce sufficient insulin to prevent hyperglycemia, the causes are different. Type 1 diabetes is usually due to autoimmune destruction of the pancreatic beta cells. Type 2 diabetes is characterized by insulin resistance in target tissues. This causes a need for abnormally high amounts of insulin and diabetes develops when the beta cells cannot meet this demand Gestational diabetes is similar to type 2 diabetes in that it involves insulin resistance; the hormones of pregnancy can cause insulin resistance in women genetically predisposed to developing this condition. Gestational diabetes typically resolves with delivery of the child, however types 1 and 2 diabetes are chronic conditions.

All types have been treatable since insulin became medically available in 1921. Type 1 diabetes, in which insulin is not secreted by the pancreas, is directly treatable only with injected or inhaled insulin, although dietary and other lifestyle adjustments are part of management. Type 2 may be managed with a combination of dietary treatment, tablets and injections and, frequently, insulin supplementation. While insulin was originally produced from natural sources such as porcine pancreas, most insulin used today is produced through genetic engineering, either as a direct copy of human insulin, or human insulin with modified molecules that provide different onset and duration of action. Insulin can also be delivered continuously by a specialized pump which subcutaneously provides insulin through a changeable catheter.

Diabetes can cause many complications: Acute complications (hypoglycemia, ketoacidosis coma) may occur if the disease is not adequately controlled.

Serious long-term complications include cardiovascular disease (doubled risk), chronic renal failure, retinal damage (which can lead to blindness) nerve damage (of several kinds), and microvascular damage which may cause impotence and poor healing. Poor healing of wounds, particularly of the feet, can lead to gangrene, which may require amputation.
Adequate treatment of diabetes, as well as increased emphasis on blood pressure control and lifestyle factors (such as not smoking and keeping a healthy body weight) may improve the risk profile of most aforementioned complications.

2. Hypertension
A SILENT KILLER Most common among the diseases of the heart Most common cause of stroke Highly preventable

MOSTLY AFFECTED BY HIGH BLOOD PRESSURE Smokers Overweight Older age group above 40 years old for males menopausal age for female With family history like, heart diseases, diabetes and kidney disease Under chronic stress Heavy alcohol drinker With high serum cholesterol level

Prevention
Dont smoke Maintain ideal body weight Exercise regularly (at least 20 minutes, continuous & 3x a week) Avoid fatty and salty foods Have adequate relaxation Drink moderately Have a regular blood pressure check-up

Cardio Vascular Disease (CVD)

no. 1 killer in the country Every hour, 9 Filipinos die of CVD 1 out of 4 deaths in the country is due to CVD 1 out of 10 Filipinos aged 15 years old and above has hypertension/high blood pressure 80% - 85% of all primary high blood pressure are mild and thus can be managed by lifestyle modification

Facts
Take good care of your heart, have a healthy lifestyle Pathology of hypertensive Left ventricle atrophy Hypertension in isolation usually produces no symptoms although some people report headaches, fatigue, dizziness, blurred vision, facial flushing or tinnitus. ** Tinnitus can be perceived in one or both ears or the head. It is usually described as a ringing noise, but in some patients it takes the form of a high pitched whining, buzzing, hissing, humming, or whistling sound or as ticking, clicking, roaring, crickets or tree frogs or locusts, tunes, songs, or beeping. It has also been described as a whooshing sound as of wind or waves.

3. Cardiovascular Disease
Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins) While the term technically refers to any disease that affects the cardiovascular system, its usually used to refer to those related to atherosclerosis (arterial disease). These conditions have similar causes, mechanisms, and treatments. In practice, cardiovascular disease is treated by cardiologists, thoracic surgeons, vascular surgeons, neurologists and interventional radiologists, depending on the organ system that is being treated.

4. Cancer
Cancer is a group of diseases in which cells are aggressive (grow and divide without respect to normal limits,) invasive (invade and destroy adjacent tissues), and sometimes metastatic (spread to other locations in the body). These three malignant properties of cancers differentiate them from benign tumors, which are self-limited in their growth and dont invade or metastasize (although some benign tumor types are capable of becoming malignant). Cancer may affect people at all ages even fetuses, but risk for the more common varieties tends to increase with age. Cancer causes about 13% of all deaths Apart from humans, forms of cancer may affect other animals and plants. Most cancers can be treated and some cured, depending on the specific type, location, and stage. Once diagnosed, cancer is usually treated with a combination of surgery, chemotherapy and radiotherapy.

5. Mental Health
Mental health is a term used to describe either a level of cognitive or emotional wellbeing or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individuals ability to enjoy life and procure a balance between life activities and efforts to achieve psychological resilience. The World Health Organization states that there is no one official definition of mental health. Cultural differences, subjective assessments, and competing professional theories all affect how mental health is defined.

Healthy Lifestyle Program

Health and Wealth is a way of life The goal of the Healthy lifestyle program of the DOH: Reduce prevalence of lifestyle diseases particularly cardiovascular diseases, cancers, diabetes and chronic obstructive pulmonary diseases. Maximize the health potential of the individual. As nurses we have to continue educating the family, the welfare of the family and solidarity and responsible parenthood to prevent drug addiction. REPUBLIC ACT NO. 9165 - THE COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002 AN ACT INSTITUTING THE COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002, REPEALING REPUBLIC ACT NO. 6425 OTHERWISE KNOWN AS THE DANGEROUS DRUGS ACT OF 1972, AS AMENDED, PROVIDING FUNDS THEREFOR, AND FOR OTHER PURPOSES.

Section 1. Short Title - This Act shall be known and cited as the Comprehensive Dangerous Drugs Act of 2002. chanrobles virtual law library. Sec 2. Declaration of Policy - It is the policy of the State to safeguard the integrity of its territory and the well being of its citizenry particularly the youth from the harmful effects of dangerous drugs on their physical and mental well being and to defend the same against acts or omissions detrimental to their development and preservation. In view of the foregoing the State needs to enhance further the efficacy of the law against dangerous drugs, it being one of today's more serious social ills chanrobles virtual law library. Toward this end the government shall pursue an intensive and unrelenting campaign against the trafficking and use of dangerous drugs and other similar or substances through or integrated system of planning, implementation and enforcement of anti-drug abuse policies, programs and projects. The government shall however aim to achieve a balance in the national drug control program so that people with legitimate medical needs are not prevented from being treated with adequate amounts of appropriate medication, which include the use of dangerous drug.

It is further declared the policy of the State to provide effective mechanisms or measures to re integrate into society individuals who have fallen victims to drug abuse or dangerous drug dependence through sustainable programs of treatment and rehabilitation.
REPUBLIC ACT NO. 7875 - PHILIPPINE HEALTH INSURANCE ACT AN ACT INSTITUTING A NATIONAL HEALTH INSURANCE PROGRAM FOR ALL FILIPINOS AND ESTABLISHING THE PHILIPPINE HEALTH INSURANCE CORPORATION FOR THE PURPOSE SECTION 1. Short Title This Act shall be known as the National Health Insurance Act of 1995. SECTION 2, Declaration of Principles and Policies Sect or 11 Art c e XIII of the 1987 Constitution of the Republic of the Philippines declares that the Stare shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goads health and other social services available to all the people at affordable cost. Priority for the needs of the underprivileged sick elderly disabled women and children shall be recognized. Likewise it shall be the policy of the State to provide free medical care to paupers.

GMA 50 - gamot na mabisa at abot kayang halaga Objective: to lower the price of medicine and make good quality health service affordable. REPUBLIC ACT NO 6675 - GENERIC ACT LAW

AN ACT TO PROMOTE, REQUIRE AND ENSURE THE PRODUCTION OF AN ADEQUATE SUPPLY, DISTRIBUTION, USE AND ACCEPTANCE OF DRUGS AND MEDICINES IDENTIFIED BY THEIR GENERIC NAMES.
Section 1. Title - This Act shall be known Serer as the Generic Act of 1988. (September 1988) Sec. 2. Statement of Policy It hereby declared the policy of the State: To promote, encourage and require the use of generic terminology in the importation, manufacture, distribution, marketing, advertising and promotion prescription and dispensing of drugs; To ensure the adequate supply of drugs with generic names at the lowest possible cast and endeavor to make them available free for indigent patients;

To encourage the extensive use of drugs with generic names through a national system of procurement and distribution. To emphasize the scientific basis for the use of drugs in order that health professionals may became more aware and cognisant of the therapeutic effectiveness; and To promote drug safety by minimizing duplication in medications and/or use of drugs with potentially adverse drug interactions. REPUBLIC ACT NO 8423 Traditional and Alternative Medicine Act (TAMA) of 1997. REPUBLIC ACT NO. 8423 - AN ACT CREATING THE PHILIPPINE INSTITUTE OF TRADITIONAL AND ALTERNATIVE HEALTH CARE (PITAHC) TO ACCELERATE THE DEVELOPMENT OF TRADITIONAL AND ALTERNATIVE HEALTH CARE IN THE PHILIPPINES, PROVIDING FOR A TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND AND FOR OTHER PURPOSES Section 1. Short Title This Act shall be known as the Traditional and Alternative Medicine Act (TAMA) of 1997.

Section 2. Declaration of Policy It is hereby declared the policy of the State to improve the quality and delivery of health care services to the Filipino people through the development of traditional and alternative health care and its integration into the national health care delivery system.

It shall also be the policy of the State to seek a legally workable basis by which indigenous societies would own their knowledge of traditional medicine. When such knowledge is used by outsiders, the indigenous societies can require the permitted users to acknowledge its source and can demand a share of any financial return that may come from its authorized commercial use.
In promoting herbal medicines: Encourage client to backyard gardening. When using herbal medicines, advise the client never to use insecticides or pesticides Use one herbal medicine at a time When cooking the herb, use clay pat and remove the cover to prevent over cook. If there is a reaction to the herbal medicine, advice client to go to the nearest health center.

DOHs program oral and dental hygiene - isang milyong sipilyo Elderly care - R.A. 7432 - senior citizens act (20% discount) Range of Aging: 55-64 - older population 65-74 - elder population 75-85 - aged population 86 over - extremely age population 60-74 - young old 75-84 - middle old 85- 100 - old old 101 above - elite old

Family
The Family is the unit of care in public health core (PHC)
During home visitation, the distance of the PHN bag to the patient should be at least 6 feet. Q. How many times you should open your PHN bag? A. Three times 1. 2. 3. When you do your hand washing Get all the things inside the bag When returning all the things after the nursing procedure.

Two major function of the family 1. reproduction 2. socialization

Sub specialty Nursing

1. Occupational Health Nursing (RA 1054) To Elements: a. Health promotion b. Health protection *RA 1054 - free dental and medical services for all the employees

2. School Health Nursing

Four (4) Phases in School Nurse: a. Health Instruction - give health education to the student (ex. Proper hygiene) b. Health promotion - by education them to proper nutrition (ex. don't eat junk food) c. Health service - give booster dose of antigen (ex. BCG, DT, deworming) d. School and community coordination

Demography
Demography is the statistical study of all populations. It can be a very general science that can be applied to any kind of dynamic population, that is, one that changes over time or space. It encompasses the study of the size, structure and distribution of populations, and spatial and/or temporal changes in them response to birth death, migration and aging.

Nature and scope of demography

a. Population size number of people given at a certain place and time. (Population size may vary between daytime and night time) b. Population composition - arrangement of people according to group (ex. how many male, female, infant, elder in a certain area) c. Population distribution - this pertains to the allocation of resources. d. Population dynamic - pertains how congested the community is.

Three significance of demography

1. Anticipate health problem 2. Determine availability and needs for resources 3. Serves as a basis for evaluation (ex. survey)
Q. What are the signs and symptoms when an elderly has infection? A. Decrease the breath sound and chuckle.

Morbidity - leading cause of death in elderly is pneumonia Mortality - leading cause of death in elderly is CV (cardio vascular disease)
R.A. 9288 - new born screening (should be taken 24 hours after birth)

Level of Water Supply:

1. Level 1 - source (protected well or spring) should only serve 15 to 25 households and not more than 250 meters away from the farthest user. 2. Level 2 - communal faucet or stand past stand post must not be near the septic tank. 3. Level 3 - individual house connection of water work system pipe distribution and serving densely populated areas.
Boil water for at least 5 mins. when it starts to boil. Deep well: 1 tsp. Of chlorine for every one liter of water (stock solution) Stock solution is good for only a week.

Three Levels of Toilet Facility: 1. Level 1 - non-water carriage toilet (PIT-LATRIN) 2. Level 2 - on site toilet facility (with water seal and septic tank) 3. Level 3 - water carriage facility connected to a septic tank, connected to a sewerage system to final treatment plant. *distance from the rubbish pr toilet facilities must be 25 meters away.