INTEGRATED COMMUNITY HEALTH NURSING

By: LEONARD

IVAN T. MELANA, RN

NURSES are created to GIVE a GREAT EFFECT on the LIVES of the PEOPLE

Deliberate attention to the needs of millions of poor Filipino families which comprise the majority of our population

Public health by C. E. Winslow

A science and art of PROMOTING

health,

PREVENTING

disease

and

PROLONGING life through organized

community efforts.

Ecosystem influencing optimum level of functioning include:

Political Behaviorchange the behavior of people

Hereditary Health Care Delivery Systemaccessible, availble

Economic Factors Social Factor-

appropriate technology

culture-->adopt with the culture

Core business of public health:

DISEASE CONTROL

INJURY PREVENTION
HEALTH PROTECTION HEALTHY PUBLIC POLICY PROMOTION OF HEALTH

Public health nursing:

A special field of nursing that combines

skills of nursing, public health and some phases of social assistance.

Lilian Wald coined the term public health nursing to denote a service available to all people.

DEPARTMENT OF HEALTH
LEader
DOH is the lead agency in health.

ADvocate
MOdel

VISION: Health for all Filipinos

NEW VISION: DOH is the LEader staunch

ADvocate and MOdel in promoting Health for all in the Philippines

DEPARTMENT OF HEALTH
MISSION: To ensure an effective and efficient

devolved health care delivery system which is ccessible, vailable, cceptable and

A A A Affordable at all times

NEW MISSION: Guarantee

Equitable, Sustainable

and uality health for all Filipinos, especially the poor and shall lead the quest for excellence in health.

DEPARTMENT OF HEALTH
Role of DOH

Leader Enabler and capacity builder Aadministrator

GOAL: PARTNERSHIP---

HSRA

Health Sector Reform Agende

The Health Reform Agenda (HSRA)

overriding GOAL of the DOH

FRAMEWORK for Implementation:

FOURmula ONE for HEALTH Better Health outcome

More responsive health System Equitable Health Care Financing Decrease mortality Rate

Four elements of the strategy are:

1. Health Financing----Investments

2. Health Regulation----Control
3. Health Service Delivery----Accessible,

Availability 4. Good Governance---performance

UN Millennium Development Goals

Source: MDG Monitor: Quick Facts (accessed 10/11/2010)

PRIMARY HEALTH CARE

When: SEPTEMBER 12, 1978

Where: ALMA ATA, RUSSIA

Leader: DOH

Legal Bais: LOI 949 ( October 19, 1979)

Goal: Health for all by the year 2000

and Health in the hands of the people by the year 2020 SELF-RELIANCE

Criteria: 4 As
Elements:
Educator- basic service of a nurse Localy and Endemic disease- filariasis, malaria E xpanded Program of Immunization Maternal and Birth E ssential Drugs- BnB Botika ng Barangay N utrition T reatment- EMONC Emergency Obstetric in Neonate Child Save Water and Sanitation Dental Health Access to Sentrong Sigla Mental Health

4 PILLARS:
1. 2. 3. 4.

Active Community Participation Appropriate Technology Multisectoral linkages Support Mechanism made available

STRATEGIES:

Reorganization and Reorientation Enabling and Effective Preparation of the People Mobilizzation Opportunity for Community Participation Technology Encourage Self-reliance Linkages Opportunity for Community Participation

The Philippine HEALTH CARE DELIVERY SYSTEM

A

Public Health Nurse does not function in a vacuum. She is a member of a team working within a system

MAJOR PLAYERS: 1.PUBLIC SECTOR

2.PRIVATE SECTOR

The TWO LEVELS of PHC WORKERS

Village

or Barangay Health Workers (V/BHWs). This refers to trained community health workers or health auxiliary volunteer or a traditional birth attendant or healer.

Intermediate level health workers. General

medical practitioners or their assistants. Public Health Nurse, Rural Sanitary Inspectors and Midwives may compose these groups.

For every forty years after independence, the Philippine Health care system was administered by a central agency based in Manila. However, with the passage of the Local Government Code, LGUs facilitate health service delivery. This law is known as: a. RA 7610 b. RA 7160 c. RA 7600 d. RA 9173

Pillars of primary health care include all of the ff, except: a.Active community participation. b.Provision of medical care and emergency treatment c.Support mechanism made available d.Intra and inter-sectoral linkages

The concept of Primary Health Care is characterized by partnership and empowerment of the people that shall permeate as the core strategy in the provision of health services. Which of the following is a strategy of PHC?
a.Provision of essential drugs b.Health education c.Effective preparation and enabling process for health action at all levels d.All of the above

The DOH, in its new role as the national authority on health has several functions. Which one is specific to the role of the DOH as the enabler and capacity builder? a.Serve as the national policy and regulatory institution b.Innovate new strategies in health to improve effectiveness of programs c.Administer direct services for emergent health concerns that require new technologies. d.Serve as advocate in adoption of health policies.

Which element of FOURmula One aims to improve and ensure accessibility and availability of basic and essential health care? a.Health financing b.Health regulation c.Health service delivery d.Good governance

Framework for COMMUNITY HEALTH NURSING

Community Health Nursing is the totality or

its philosophy and beliefs, principles and processes.

CLIENTS:

INDIVIDUAL FAMILY POPULATION GROUP COMMUNITY

FAMILY HEALTH NURSING

6 FAMILY HEALTH TASK

1.Manage Health and non-health crises

2.Provide care to : SDDs 3.Seek Health Care 4.Recognize interruptions in health 5.Maintains Health Environment

6.Maintains

Relationship

FNCP (Family Nursing Care Plan)

1. FIRST Level of Assessment

What are the problems of the family? What are the health situation/ condition/ experience?
2. SECOND Level of Assessment

Why does the family have those problems?

4 CRITERIA FOR PRIORITIZATION

1.

2.
3. 4.

NATURE OF THE PROBLEM MODIFIABILITY PREVENTIVE POTENTIAL SALIENCE

GOAL:

HEALTH PROMOTION

COMMUNITY HEALTH NURSING

CHN PROCESS:

1. ASSESSMENT What is the problem 2. PLANNING What problems should I attend to first? 3. INTERVENTION What is the solution? 4. EVALUATION Did the solution work?

COMMUNITY DIAGNOSIS

Both a PROFILE and a PROCESS

Types:
1. COMPREHENSIVE

2. PROBLEM ORIENTED

CRITERIA FOR PRIORITIZATION

1. 2. 3. 4. 5.

NATURE OF THE PROBLEM--- H StaRR

Health Status, Health Related, Health Ressources

MODIFIABILITY PREVENTIVE POTENTIAL SOCIAL CONCERNS MAGNITUDE OF THE PROBLEM

GOAL:

SELF-RELIANCE

COPAR
Community Organizing Participatory Action Research
- Continuous and sustained process of educating the
people to understand and develop their critical

awareness of their existing conditions, working with

people collectively & efficiently on their immediate and long-term problems, and mobilizing people to develop

their capability and readiness to respond & take action on

their immediate needs towards solving their long-term problem

COPAR- (Maglaya)
1. Preparatory Phase

2. Community Profile
3. Entry and Integration

4. Organizational Phase
5. Education and Training

6. Collaboration
7. Phase Out

COPAR-(DOH)
1. Community Analysis/ Needs 2.

3.
4. 5.

Assessment/Dx Design/Initiation Implementation Program Maintenance + Consolidation Dissemination/ Reassessment

The family nursing care plan is the blueprint of the care that the nurse designs to systematically minimize or eliminate the health and family nursing problems. All of the following are features of the FNCP, except: a.The FNCP is based upon identified health and nursing problems. b.The FNCP relates to the future. c.The FNCP is an end in itself. d.The FNCP focuses on actions designed to solve a problem.

Developing a family care plan involves many steps. These steps are done in which sequence? 1. Develop the intervention plan 2. Define goals and objectives of care 3. Prioritize the health conditions 4. Develop the evaluation plan a.2,1,3,4 b.3,2,1,4 c.2,3,1,4 d.3,1,2,4

Nurse Monica is conducting the nursing assessment of the Lopez family. Mr. Lopez is security guard in a public school and Mrs. Lopez recently lost her job. They have 5 children, ages 9,7,5,3 and 1. They live in a small house by the railroad tracks. Their house has only 1 room for sleeping with poor ventilation. The eldest child has chickenpox which he got from a neighbor while the youngest child has not received any immunizations yet.

Health conditions identified by nurse Monica in the Lopez family include: 1. Wellness state 2. Health threats 3. Health deficits 4. Foreseeable crises a.2 and 3 b.2,3,4 c.1,2,3 d.All of the above

In the above conditions, which of the following is considered a health deficit?

a.Youngest child with no immunizations b.Eldest child with chickenpox c.House with poor ventilation d.Mother who recently lost her job

Which of the following criteria would receive the most weight when prioritizing health problems?

a.Nature of the problem b.Modifiability of the problem c.Preventive potential d.Salience

Nursing Procedures in Community:

Clinic visits Home Visits BP measurement Bag Technique

HOME VISIT
Purpose:

Care Assessment Relationship Educate Service

Principles

Has a purpose Use Available Informotion Involve Family Priority Needs

Factors affecting FREQUENCY:

Needs Acceptance Policy Other health care workers Past services Ability to determine Health Needs

BAG TECHNIQUE (PHN BAG) POINTS: 4 Cs PRINCIPLES: basics

> Hand Washing > Same Time and Effort > Done in different way dependes on the bag

Clean Contact Complete Convinient CONTENTS?

Which of the following is considered an important principle of bag technique? a.The bag should contain all necessary articles. b.The bag technique can be performed in a variety of ways. c.The arrangement of the bags contents should be what is convenient to the nurse d.The bag should be cleaned very often.

Among the following types of family nurse contacts, which one will reflect the familys initiative for health care?

a.Home visit b.Telephone conference c.Clinic visit d.All of the above

There is no definite rule to be followed on the frequency of home visits. The schedule of visit may vary. Which of the following factors is considered the most important determinant of the frequency of home visits? a.Acceptance of the family b.Needs of the family c.Policy of a specific agency d.Other health care workers involved in the care of the family.

The Philippine Health Situation

Analysis of the nations state of health

Forces that impinge on the countries state of

health Health Policies and Programs * Improvement of HCDS HEALTH CARE DELIVERY SYSTEM - network of health facilities and personnel, which carry out the tasks of rendering health

LEVELS OF CARE and REFERRAL SYSTEM

1. PRIMARY

VS
LEVELS OF PREVENTION
1. PRIMARY

heath promotion and prevent brgy. Health station/ clinic disease 1. SECONDARY

1. SECONDARY
early screening

district hospital/ provincial hospital

1. TERTIARY
rehabilitation and prevention of further complication

1. TERTIARY
regional hospital/ medical center

EXPANDED PROGRAM FOR IMMUNIZATION

Launched July 1976 OBJECTIVE: To reduce the MORBIDITY and MORTALITY

among infants and children caused by the 6 childhood immunization disease. PDD 996 ELEMENTS: 1. Target Setting 2. Cold Chain logistics mgmt 3. IEC 4. Surveillance, Stud/Res 5. Assess/ evaluate

COLD CHAIN
Temperature-controlled supply chain designed to maintain

potency of vaccines when being transported from manufacturer to the clients. TARGET: Infants, School Entrants, Pregnant Woman FIFO (First Inn First Out) Temperature Monitoring * 2 times/ day 7x a week * ice packs- not to be refilled every used-take 24 hrs to freeze an ice pack * DO NOT OPEN ref- power cuts * Domestic Ref and Special designed Ref

Timeframe for storage of vaccines:

Regional level Provincial level District level Health Centers (with refrigerator) Using transport boxes
6 months

BCG and AMV 6 hours after reconstitution

Other vaccines at the end of the working day Open vial policy- OPV, DPT, TT, Hepa B can be used in the next immunization session up to max. Of 4 weeks if: NOT- Expired/ contaminated

3 months
3 months 1 month

5 days

General Considerations:
1. Maintenance and Potency a. Avoid break in the Cold Chain b. Discard Unused c. Maximum duration of storage/ transport

2. Contraindications * False Contraindications REMEMBER:

Oh My Dudung Have Big Titi

OPV Measles DPT Hepatitis B TT

ADMINISTRATION OF VACCINES
Vaccine Minimum age at 1st dose 3 of Doses Minimum interval between doses Route (R), Dosage(D), Site(S)
ID 0.05 ml Right Upper Arm IM 0.5 ml Vastus Lateralis Oral 2 drops Mouth IM 0.5ml Vastus Lateralis SQ 0.5 m Right Upper Arm

Storage temperature

Type/ form of vaccine

BCG DPT OPV HEPA B MEASLES

Birth 6 weeks

0 4 weeks

Alive 2-8 degree C Bacteria TB 2-8 degree C

Dipteriameasles Pertusis Tetanus-toxin

6 weeks
Birth 9 months

3
3 1

4 weeks
6 weeks or 8 weeks 0

Freezer
2-8 degree C Freezer

Live atenunted virus RNA Recombine Live atenunted virus

TETANUS TOXOID VACCINE

Vaccine Minimal age in interval Percent protected Duration of Protection

TT1 TT2 TT3 TT4 TT5

Which of the following is not a contraindication to immunization? a.Do not give DPT 2 and DPT 3 to a child who had convulsions within 3 days of DPT 1 b.Do not give BCG if the child has known hepatitis c.Do not give any immunization to a child who needs to be hospitalized because of a serious disease. d.Do not give BCG if the child has known AIDS

The nurse has an important role in immunization because every immunized decreases the susceptibility of the population to the largest diseases. Which of the following is NOT a role of the nurse in the delivery of immunization services in the community?
a.Observe clean technique on immunization and maximize the use of the syringe in order to cut costs. b.Identify cases of EPI target diseases per standard case definition c.Manage vaccines properly by following the recommended storage of vaccines. d.Actively include in the master list the infants eligible for vaccination in the community.

When is the designated immunization day in barangay health stations/ Rural health units?

a.Monday b.Wednesday c.Friday d.Any day

MATERNAL HEALTH PROGRAM

GOAL: To

reduce Maternal Mortality Rate

2000 Philippine Health Statistics revealed the causes of all

maternal death: - 25% HYPERTENSION - 20.3% POSTPARTUM HEMORRHAGE - 9% PREGNANCY WITH ABORTIVE OUTCOMES

Common causes of Maternal Death: 3 DELAYS

Other factors: -Young age at marriage & first pregnancy -Domestic violence and gender inequality -Poor maternal health -Poor hygiene during and after delivery

Three DELAYS

1. DELAY IN DECIDING TO SEEK MEDICAL CARE.

Failure to recognize danger signs Lack of money Unplanned/unwanted pregnancy Lack of companion in going to health facility No person to take care of children/home. Fear of being ill treated in health facility

Three DELAYS

2. DELAY IN IDENTIFYING and REACHING THE APPROPRIATE FACILITY

Distance from a womans home to health facility/provider Lack of/poor condition of roads Lack of emergency transportation Lack of awareness of existing services Lack of community support

Three DELAYS

3. DELAY IN RECEIVING APPROPRIATE and ADEQUATE CARE AT HEALTH FACILITY

Lack of health care providers Shortage of supplies Lack of equipments Lack of competence of health providers Weak referral system

Strategic thrust 2005-2010

The overall goal program is to improve the survival, health

and well being of mothers and unborn through a package of services for the pre pregnancy, prenatal, natal and post natal stages
Health service package before, during and after pregnancy

* Antenatal Registration * TT immunization ( FIM= 5TT) * Micronutrient Supplementation * Treatment of disease and other conditions * Clean and safe delivery * BF * Family planning services and counselling

Recommended Visits
PRENATAL VISITS

Prenatal visits
1st visit

Period of pregnancy

2nd visit
3rd visit

Every 2 weeks

Recommended Visits
POST PARTUM CARE VISITS

1st visit

1st week post partum (3-5 days)

2nd visit

6 weeks post partum

FOR HOME DELIVERY

1st visit 2nd visit 3rd visit WITHIN 24 HOURS 1 WEAK AFTER 2-3 WEAKS AFTER

Micronutrient Supplementations
VITAMINS
Vitamin A

DOSE
10,000 IU

SCHEDULE OF GIVING
2x per week starting 4 months of pregnancy
Daily

REMARKS
Consider congenital problems

IRON+ FA

60mg/400 ug tablet 1 cap

Consider period of prenatal visit Consider Goiter Endemic Areas

IODINE

Every year

CRITERIA of SAFE PREGNANCY

AGE: 20-35 y/o No illness

Has less than 4 children

Has not been pregnant for the past 2-3 years Wants to have a baby
CRITERIA IDEAL AT RISK HIGH RISK

AGE SPACING CHILDREN

20-30 2-3YEARS 3

18/ < 20 2 YEARS 4

< 18 >35 1 YEAR >5

QUALIFIED for HOME DELIVERY

Full term Less than 5 pregnancies Cephalic presentation W/out existing diseases ex.diabetes, hpn No history of complications like hemorrhage during

previous deliveries No history of difficult delivery prolonged labor Adequate pelvis Abdominal enlargement is appropriate for age of gestation

HIGH RISK PREGNANCIES

5th pregnancy onwards

Abnormal fetal position/ presentation

Bleeding during pregnancy Previous CS delivery or abdominal surgery 35y/o & above, 17y/o & below Hx of PIH, HPN, PID, DM, goiter, premature

contractions, spontaneous abortions, anemia, malnutrition & TB. Twin pregnancy

Treatment of Disease and other Conditions:

Malaria

- Prophylaxis for pregnant women - Chloroquine 150mg/tab - 2 tabs per week for the whole pregnancy
Intestinal parasite infection

- Mebendazole 500mg/tab single dose anytime of pregnancy if none was given in the past 6 months - DO NOT give Mebendazole in the first 1-3 months of preg

MDG 5: Improve Maternal Health

To accomplish MDG 5: Reduce maternal mortality by 75% by 2015 (for the Philippines the target is to reduce MMR from 209 to 52 deaths per 100,000 live births).

How will we make it happen?

(Current tools to avert maternal death and disability)

A skilled health care professional

attends every childbirth Every woman has access to Emergency Obstetric and Newborn Care (EmONC) Family planning services to help women space their pregnancies
Source: Averting Maternal Death and Disability Program

A SKILLED ATTENDANT is an accredited health professional (a midwife, nurse or doctor) who has been educated and trained to proficiency in the skills needed to manage normal pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns.
*Manage was added in 2000 by the Inter-Agency Group for Safe Motherhood in recognition that some skilled attendants will also have competencies to manage complications. Source: A Joint WHO/UNFPA/UNICEF/World Bank Statement on Reduction of Maternal Mortality, 1999.

EMERGENCY OBSTETRIC and NEWBORN CARE (EmONC)

the elements of obstetric & newborn care

needed for the management of normal and complicated pregnancy, delivery, postpartum periods and the newborn.
Early detection and treatment of problem

pregnancies to prevent progression to an emergency. Management of emergency complications*

Definition

BEmONC CEmONC

Emergency Signs
CONVULSIONS/ UNCONSCIUOSNESS

FEVER
VAGINAL BLEEDING LOOKS VERY ILL SEVERE VOMITING HEADACHE WITH VISUAL DISTURBANCE ABDOMINAL PAIN DOB

EmONC Key Functions

Parenteral (IV or IM) Assisted Vaginal

administration of Delivery Antibiotics Administration of Oxytocin corticosteroid for Anticonvulsants preterm labor Manual Removal of Essential Newborn Placenta Care Removal of Retained Surgery (Cesarean Products of Section) conception Blood Transfusion

Most in the community who died giving birth experienced what experts have classified as the delays. These include all of the following except: a.Delay in deciding to seek medical care b.Delay in reaching appropriate care c.Delay in receiving care at the health facility d.None of the above.

Elena, a housewife who is in her 2nd month of pregnancy has intestinal parasitic infection and comes to the health center for consultation. What is the appropriate management for this?
a.Give Mebendazole as soon as possible to avoid infection of the fetus. b.Give Mebendazole on the fourth month of pregnancy regardless of when the previous dose was given c.Give Mebendazole on the fourth month of pregnancy regardless of when the previous dose was given in the past 6 months. d.Do not give any anti-helminthic as this may cause problems during pregnancy.

Which of the following statements about tetanus toxoid immunization is not true? a.The TT vaccine of 0.5 ml is given to mothers in 5 doses to be considered a FIM b.Infants born by the mother with 5 doses of TT vaccine will be protected from neonatal tetanus c.Mothers who have received 3rd dose of TT vaccine will have 5 years protection from tetanus d.2nd dose of TT is given at least 4 months after the first dose.

FAMILY PLANNING
Overall goal of family planning is to provide

universal access to family planning information and services wherever and whenever they are needed.
FAMILY WELFARE-IMPROVEMENT OF QUALITY OF LIFE

Knowing the high risk factors among women can

prevent maternal mortality. Reprocuctive Health Program.

Advocate

4 PILLARS

BRIP-

TYPES OF FAMILY PLANNING

PERMANENT

TEMPORARY

1. Natural Method 2. Barrier Method 3. Hormonal Method

Fertility Awareness Based (FAB)

methods tell a woman when the fertile period of her menstrual cycle starts and ends.

 NATURAL

Standard , Calendar and 2 day-method Basal Body Temperature Cervical Mucus Method Sympthothermal Method Lactational Amenorrhea Method
ARTIFICIAL

IUD Diaphragm & Cervical Caps Spermicides Pills ( Progesterone and Estrogen Containing Pills) Injection- Depo Provera Condoms
PERMANENT

Vasectomy Bilateral Tubal Ligation

1.___________________

is

an injectable contraceptive containing progestin that inhibits ovulation and thickens cervical mucus, making it difficult for sperm to pass

2.___________________

after cutting, the male partner would need to ejaculate 20 times to completely empty it of sperm. Is best inserted during menstruation or within 10 minutes after delivery of placenta or up to 48 hours after childbirth by specially trained health professional

3.___________________

4.___________________

After ejaculation, its rim is held at the base so that the sperm will not spill off while pulling the penis off the vagina before losing erection

5.___________________

This procedure is done immediately after chid birth or within 7 days

6.___________________

Can be used immediately after birth while breastfeeding, effective for at least 6 months

7.___________________

Also known as cervical mucus method

8.___________________

This method is a combination of basal body temperature, billings method and calendar method

9.___________________

Vaginal method that blocks sperm from entering the uterus and tubes Kills sperms and make them unable to move towards the ovum

10.__________________

1. DEPO PROVERA

is

an injectable contraceptive containing progestin that inhibits ovulation and thickens cervical mucus, making it difficult for sperm to pass

2. VASECTOMY

after cutting, the male partner would need to ejaculate 20 times to completely empty it of sperm. Is best inserted during menstruation or within 10 minutes after delivery of placenta or up to 48 hours after childbirth by specially trained health professional

3. IUD

4. CONDOM

After ejaculation, its rim is held at the base so that the sperm will not spill off while pulling the penis off the vagina before losing erection

5. BTL

This procedure is done immediately after chid birth or within 7 days

6. LAM

Can be used immediately after birth while breastfeeding, effective for at least 6 months

7. BILLINGS METHOD

Also known as cervical mucus method

8. SYPMTHOTHERMAL METHOD

This method is a combination of basal body temperature, billings method and calendar method

9. DIAPHRAGM / CERVICAL CAPS

Vaginal method that blocks sperm from entering the uterus and tubes Kills sperms and make them unable to move towards the ovum

10. SPERMICIDE

How many tears interval between births is recommended by the Family Planning program?

a.1-2 years b.3-5 years c.2-4 years d.4-6 years

Fertility Awareness-Based (FAB) Methods are contraceptive methods hinged on the awareness of the end of the fertile time of a womans menstrual cycle. Example of FAB methods are the following, except: a.Basal Body Temperature b.Billings Method c.Lactational Amenorrhea method d.Standard Days Method

A 23-year old woman has just given birth to her second child. She asked you for some information regarding the Lactational Amenorrhea Method. Which statement will be excluded from the discussion?
a.This method has no hormonal side effects b.If the baby is more than 6 months old, the chances of getting pregnant increase. c.This can protect her from pregnancy for at least 6 months and as long as 9 to 12 if she continues to breastfeed very often. d.The baby should be fed food other than breast milk at least 30 % of the time.

PHILIPPINE NUTRITION PROGRAM

GOAL: Improve nutritional status, productivity and

quality of life by 2020

Programs/ Projects

1. Micronutrient Supplementation 2. Food Fortification Enrichment ( RA 8976) 3. RA 7600 4. Infant and Young Child Feeding 5. Food/ Livelihood Assistance

Nutritional Guidelines for MS:

Universal Supplementation of VITAMIN A

Infants (6-12 months) = 100,000 IU----w/AMV Children (12-71 months) = 200,000 IU

High Risk Children

Measles
Severe Pneumonia Persistent Diarrhea

1 cap given upon Dx, REGARDLESS of when the last dose of VAC 1 cap given upon Dx, EXCEPT when the child was given VAC <4 weeks before DX

Malnutrition

Pregnant woman/ Post Partum

10,000 IU 200, 000 IU

XEROPHTHALMIA
Infant

Children

__________IU __________IU

Day Morrow Weeks after

Pregnant mother 10,000 IU/ cap for 4 weeks upon Dx

IRON SUPPLEMETATION
Pregnant women

Lactating women= 60/400---1 tab OD for 3 months

LOW BIRTH WEIGTH = 0.3 ml OD x 6 months INFANTS (6-11 months) = 0.6 ml OD x 3 months CHILDREN(1-5 y/0)=30mg/5ml ( 1tbsp OD for 3

months OR 30 mg/wk for 6months) CHILDREN 6-11 y/0= 2 tbsp OD for 6 months

RA 7600

BREASTFEEDING

B bonding R ready to use E economical A always available S safe to use T temperature is right at all times F fosters trust E effective contraceptive E - exposure to diseases is reduced D digestion is okay I immune system is strengthened N nutritious G GIT protected

EO 51 MILK CODE
COMPLEMENTARY FOODS
TIMELY

ADEQUATE
SAFE PROPERLY FED

Malnutrition continues to be the Health concern in the country. The common nutritional deficiencies are:

a.Vitamin A, iron and folic acid b.Vitamin A, B complex and iodine c.Iodine, iron and folic acid d.Iodine, iron and vitamin A

Supplementation of Vitamin A for pregnant women is starting on the:

a. 1st month of pregnancy b.2nd month of pregnancy c.3rd month of pregnancy d.4th month of pregnancy

A child with visible muscle wasting, an old mans face and is apathetic and quiet has:

a.Protein energy malnutrition b.Kwashiorkor c.Marasmus d.Iodine deficiency

Iron supplementation for low birth infants will start at what age?

a.1 month b.2 months c.4 months d.6 months

All of the following statements are true with regards to breastfeeding, except: a.Mothers with mastitis shall continue to breastfeed their infants. b.Mothers with mild to moderate medical problems such as TB who have been adequately treated for at least 2 days shall continue to breastfeed c.Mothers who are taking anticancer drugs are not allowed to breastfeed. d.Breastmilk shall be given to all infants who are sick but can tolerate oral and tube feeding.

Which of the following are economic benefits of breastfeeding to households and the community? a.Reduces infants exposure to infection b.Saves medical costs to families and governments by preventing illnesses c.Reduces the risk of ovarian and breast cancers and osteoporosis among women d.Provides a nutritional complete food for the young infant.

MDG 4: Reduce Child Mortality

Reduce Under 5-mortality rate from 80.0 to 26.7 (per 1,000 LB)
Reduce Infant mortality rate from 57.0 to 19.0 (per 1,000 LB)

CARE OF THE NEWBORN

Refer on the slides for an UPDATED DOH PROTOCOL

on ESSENTIAL NEWBORN CARE (ENC)

Video/ Film Showing on ENC Protocol by the DOH-

UNANG YAKAP

ENVIRONMENTAL SANITATION
3 preventive strategies for the

epidemiological triad:
Change peoples behaviour Prevent production of disease agents Increase mans resistance or immunity

WATER SUPPLY
Level I water supply facilities: (point source) protected well, developed spring Level II water supply facilities: waterworks system or individual house connections Level III water supply facilities: waterworks system or individual house connections

TOILET FACILITIES
Level I toilet Facilities: pit latrines, bore hole, antipolo type, pour-flush toilet and over hang Level II toilet facilities: water sealed and flush type with septic vault/tank disposal facilities. Level III toilet facilities: water carriages connected to septic tanks and/or sewerage system to treatment plants.

FOOD SANITATION
Four rights in food safety:

Right Source
Right Preparation Right Cooking

Class A Class B

Excellent Very Satisfactory

Right Storage

Class C

Satisfactory

RULE IN FOOD SAFETY:

When in DOUBT, THROW it OUT

LAWS/ DOH POLICIES:

PD 856-SEAWAGE/ EXCRETA/ DRAINAGE RA 8749- AIR RA 9275- WATER RA 9003- SOLID WASTE ( 3 Rs) RA 6969- TOXIC/NUCLEAR SUBSTANCE

An example of approved type water supply under Level I is:

a. b. c. d.

Communal faucet Individual house connections Protected well Water stand post

An example of approved type of toilet facility under level II includes:

a. b. c. d.

Pour flush toilet Pit latrines Reed odorless earth closet Water carriage with water seal

OTHER PRIORITY PROGRAMS

QUALITY ASSURANCE---SS HERBAL MEDICINE VOLUNTARY BLOOD DONATION BOTIKA NG BARANGAY

QUALITY ASSURANCE
Sentrong Sigla Movement is joint project of the DOH

and LGU with the goal of providing quality health care services and facilities.
GOAL: For an active partnership between DOH and

LGUs. The goal is QUALITY health care, services and faculities.

Key Strategies:

1. Certification/ Recognition Program 2. Continuous Quality Improvement

 Guiding principles of SS certification focuses on Public

Health Program such as MCH, FP, Prevention and Control of CD and NCD and promotion of healthy lifestyle.
Level and scope of Certification include: Basic SS

certification, Specialty Awards, Awards for excellence

1. Basic SS certification - minimum input, process and output standards for integrated public health services for 4 core programs, facility system, regulatory functions and basic curative services.

2. Specialty awards - second level health quality standards for selected 4 core public health programs and level 2 facility system for at least 3 consecutive years. 3. Award for Excellence - highest level quality standards for maintaining Level 2 standards for the 4 core public health programs and level 2 facility systems for at least 3 consecutive years.

Which of the following quality assurance program of DOH?

a. b. c. d.

Sangkap Pinoy Sentrong Sigla Kilatis Kutis Botika ng Barangay

The objective of this program is for the better and more effective collaboration between DOH and LGUs. Which of the following statement is not correct? a. DOH provides technical and financial assistance packages for health care b. LGU is the prime developer of health system c. DOH provides only technical assistance d. LGU is the direct implement of health programs

The guiding principles of Sentrong Sigla certification focus on Public Health Program such as: a. MCH, FP, Prevention and Control of Communicable Disease and Promotion of Healthy lifestyle b. Water sanitation c. Treatment of waste water d. Investigation of disease occurrence

HERBAL MEDICINE
RA8423- TRADITIONAL AND ALTERNATIVE ACT

___________________- asthma, cough, fever ___________________- Lowers uric acid, rheumatism and gout ___________________- Washing of wounds, diarrhea and toothache ___________________- Lowers cholesterol, HPN, toothache ___________________- Pain, rheumatism, cough and colds, toothache ___________________- Anti-edema, diuretic, anti urolithiasis ___________________- Diabetes mellitus, mild non insulin dependent ___________________- Antihelminthic ___________________- For diarrhea and stomachache ___________________ - Anti-fungal Remember: LUBBY

SANTA

BOTIKA NG BARANGAY
Botika ng Barangay(BnB) will promote

equity in health by ensuring availability and accesibility of affordable safe medicines.

The priority beneficiaries are:

marginalized undeserved critical and hard to reach areas.

Botika ng Barangay refers to a drug outlet maganged by :

Legitimate Community Organization, NGO and LGU

with a trained operator and a supervising pharmacist

and specifically licensed by the Bureau of Food and

Drugs to sell, distribute and make available low-priced

generic OTC drugs, and recently, selected medication for chronic diseases such as DM, HPN and Asthma.

BOTIKA NG Barangay refers to a drug outlet managed by:

a. b. c. d.

Barangay Chairman Community Organization (CO) Legitimate CO,NGO and LGU Trained Barangay Helath Workers

Priority beneficiaries are: a. Marginalized, underserved b. Urban population c. Rural areas d. NCR especially QC and Manila

Botika ng Barangay sells essential drugs such as, except: a. Genetic home remedies b. Over the counter drugs (OTC) c. Two selected, public known antibiotic drugs d. Third generation antibiotics

VOLUNTARY BLOOD DONATION

RA 7719- Blood Services act of 1994 Blood are no longer for free voluntary blood

donations are done in hospital Red Cross stations and some designated places.
Walking blood donors: potential donors who will

be on a list with their blood types and are on call when needed.

Gone are days when private clinics conduct bloodletting activities for free. Now this is done in the hospitals, Red Cross Offices and some designated places. Walking Blood Donors means:

a. A donor who walk-in and donate blood. b. Healthy individual able to donate blood c. Individual registered in the list of possible blood donors d. Individual qualified to donate blood

To ensure the safety of blood supply, donors must meet certain requirements before donating. The donor is not eligible if:

a. Weight more than 45 kg for 250 ml of donated blood b. Be aged 16-65 years of age c. BP range 90-160 mmHg/60-100 mmHg d. Hemoglobin of 10 g/dL

NEWBORN SCREENING
WHEN? HOW? WHERE?

RESULTS?
REMARKS?

ROLES OF RHU STAFF?

DISORDERS SCREENED
CAH GAL G6PD Defieciency PKU

CH

Child care program have packages of very essential care to cite New Born Screening (NBS). NBS must be done:

a. b. c. d.

24 hours after birth 72 hours birth Within 72 hours Within a week after birth

Newborn screening is performed by getting a blood sample using the heel prick method. Who is allowed to perform this method?
a.Midwife b. Physician c.Nurse d.d. Any of these

Which of the following diseases screened could lead to death if not detected? a.G6PD b.PKU c.Congenital adrenal hyperplasia d.Congenital hypothyroidism