Community Health Nursing Overview

COMMUNITY HEALTH NURSING: AN OVERVIEW

What is a community?
§ a group of people with common
characteristics or interests living together
within a territory or geographical
boundary
§ place where people under usual
conditions are found

What is health?
§ Health-illness continuum
§ High-level wellness
§ Agent-host-environment
§ Health belief
§ Evolutionary-based
§ Health promotion
§ WHO definition

§ What is community health?

§ part of paramedical and medical intervention/
approach which is concerned on the health of
the whole population
§ aims:
1. health promotion
2. disease prevention
3. management of factors affecting health

§ What is nursing?
- assisting sick individuals to become healthy
and healthy individuals achieve optimum
wellness

Public Health Nursing: the term used before for
Community Health Nursing

According to Dr. C.E. Winslow, Public Health is a
science & art of 3 P’s
§ Prevention of Disease
§ Prolonging life
§ Promotion of health and efficiency through organized
community effort

§ What is Community Health Nursing?

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

COMMUNITY HEALTH NURSING (CHN):

§  a specialized field of nursing practice
§  a science of Public Health combined with
Public Health Nursing Skills and Social
Assistance with the goal of raising the level of
health of the citizenry, to raise optimum level
of functioning of the citizenry (Characteristic
of CHN)

BASIC PRINCIPLES OF CHN

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

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

BASIC PRINCIPLES OF CHN

ü  CHN practice is affected by developments in health
technology, in particular, changes in society, in
general
ü  The goal of CHN is achieved through multi-sectoral
efforts
ü  CHN is a part of health care system and the larger
human services system.

ROLES OF THE PUBLIC HEALTH NURSE

Clinician, who is a health care provider, taking care of the sick people
at home or in the RHU
Health Educator, who aims towards health promotion and illness
prevention through dissemination of correct information; educating
people
Facilitator, who establishes multi-sectoral linkages by referral system
Supervisor, who monitors and supervises the performance of
midwives

TARGET POPULATION (IFC) ARE:

1. I ndividual
2. F amily
3. C ommunity

3 Elements considered in CHN:

v  Science of Public Health (core foundation in CHN),

v  Public Health Nursing Skills and

v  Social Assistance Functions

OBJECTIVES OF PUBLIC HEALTH: CODES

C ontrol of Communicable Diseases
O rganization of Medical and Nursing Services
D evelopment of Social Machineries
E ducation of IFC on personal Hygiene→ Health Education
is the essential task of every health worker
S anitation of the environment

3 ELEMENTS IN HEALTH EDUCATION: IEC

§ I nformation: to share ideas to keep population group
knowledgeable and aware
§ E ducation: change within the individual
3 Key Elements of Education:
K nowledge
A ttitude
S kills

3 ELEMENTS IN HEALTH EDUCATION: IEC

§ C ommunication: interaction involving 2 or more
persons or agencies

3 Elements of Communication:
Message
Sender
Receiver

PUBLIC HEALTH WORKERS (PHW)
PHW’s: are members of the health team who are
professionals namely
§ Medical Officer (MO)-Physician
§ Public Health Nurse (PHN)-Registered Nurse
§ Rural Health Midwife (RHM)-Registered Midwife-
§ Dentist
§ Nutritionist
§ Medical Technologist
§ Pharmacist
§ Rural Sanitary Inspector (RSI)-must be a sanitary engineer

5 MAJOR FUNCTIONS:
1.  Ensure equal access to basic health services
2.  Ensure formulation of national policies for proper division of
labor and proper coordination of operations among the
government agency jurisdictions
3.  Ensure a minimum level of implementation nationwide of
services regarded as public health goods
4.  Plan and establish arrangements for the public health systems to
achieve economies of scale
5.  Maintain a medium of regulations and standards to protect
consumers and guide providers

BASIC HEALTH SERVICES UNDER OPHS OF DOH
E ducation regarding Health
L ocal Endemic Diseases
E xpanded Program on Immunization
M aternal & Child Health Services
E ssential drugs and Herbal plants
N utritional Health Services (PD 491): Creation of Nutrition Council of the Phils.
T reatment of Communicable & Non communicable Diseases
S anitation of the environment (PD 856): Sanitary Code of the Philippines

D ental Health Promotion
A ccess to and use of hospitals as Centers of Wellness
M ental Health Promotion

VISION BY 2030 (DREAM OF DOH)

A Global Leader for attaining
better health outcomes,
competitive and responsive
health care systems, and
equitable health financing

MISSION

To guarantee EQUITABLE,
SUSTAINABLE and QUALITY
health for all Filipinos,
especially the poor and to
lead the quest for
excellence in health

Principles to attain the vision of DOH

§ Equity: equal health services for all-no
discrimination
§ Quality: DOH is after the quality of service not the
quantity
Philosophy of DOH: “Quality is above quantity”
§ Accessibility: DOH utilize strategies for delivery of
health services

HEALTH CARE DELIVERY SYSTEM

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

THREE STRATEGIES IN DELIVERING HEALTH
SERVICES (ELEMENTS)
ü  Creation of Restructured Health Care Delivery System
(RHCDS) regulated by PD 568 (1976)
ü  Management Information Systems regulated by R.A.
3753: Vital Health Statistics Law
ü  Primary Health Care (PHC) regulated by LOI 949 (1984):
Legalization of Implementation of PHC in the Philippines

CREATION OF RHCDS

RHO (National Health Agency)
or existing national agencies like PGH
or specialized agencies like Heart Center for Asia, NKI

MHO & PHO (Municipal/Provincial Health Office)

BHS & RHU (Barangay Health Station/Rural Health Unit)

3 LEVELS OF HEALTH CARE

1.  Primary-prevention of illness or promotion of
health
2.  Secondary-curative
3.  Tertiary-rehabilitative

According to Increasing Complexity of According to the Type of Service
the Services Provided

Type Service Type Example

Health Promotion, Preventive Care, Health Promotion and Information Dissemination
Continuing Care for common illness Prevention
Primary health problems, attention to
psychological and social care,
referrals

Surgery, Medical services by Diagnosis and Treatment Screening
Secondary Specialists

Advanced, specialized, diagnostic,
Tertiary therapeutic & rehabilitative care Rehabilitation PT/OT

LEVELS OF PREVENTION
PRIMARY LEVEL SECONDARY LEVEL TERTIARY LEVEL
Health Promotion and Illness Prevention of Complications thru Early Prevention of Disability, etc.
Prevention Dx and Tx

Provided at – ! When hospitalization is deemed ! When highly-specialized medical
! Health care/RHU necessary and referral is made to care is necessary
! Brgy. Health Stations emergency (now district), ! referrals are made to hospitals and
!Main Health Center provincial or regional or private medical center such as PGH,
!Community Hospital and Health hospitals PHC, POC, National Center for
Center Mental Health, and other gov’t
!Private and Semi-private private hospitals at the municipal
agencies level

Referral System in Levels of the Health Care:

ü  Barangay Health Station (BHS) is under the
management of Rural Health Midwife (RHM)
ü  Rural Health Unit (RHU) is under the management or
supervision of PHN
ü  Public Health Nurse (PHN) caters to 1:10,000
population, acts as managers in the implementation of
the policies and activities of RHU, directly under the
supervision of MHO (who acts as administrator)

REFERRAL SYSTEM:

BHS→ RHU→ MHO→ PHO→
RHO→ National Agencies→
Specialized Agencies

CHARACTERISTICS OF PHC

Acceptable
Accessible
Affordable
Available
Sustainable
Attainable

UTILIZES APPROPRIATE TECHNOLOGIES USED
BY PHC: ACCEFS

A ffordable, accessible, acceptable, available
C ost wise=economical in nature
C omplex procedures which provide a simple
outcome
E ffective
F easibility of use=possibility of use at all times
S cope of technology is safe & secure

SENTRONG SIGLA MOVEMENT (SSM)
was established by DOH with LGUs having a logo of
a Sun with 8 Rays and composed of 4 Pillars:

1.  Health Promotion
2.  Granted Facilities
3.  Technical Assistance
4.  Awards: Cash, plaque, certificate

4 CONTRIBUTIONS OF PHC TO DOH &
ECONOMY:

§ Training of Health Workers
§ Creation of Botika sa Baryo & Botika
sa Health Center
§ Herbal Plants
§ Oresol

A. TRAINING OF HEALTH WORKERS
3 Levels of Training:
Grassroot/Village
§ Includes Barangay Health Volunteers (BHV) and Barangay Health
Workers (BHW)
§ Non professionals, didn’t undergo formal training, receive no
salary but are given incentive in the form of honorarium from the
local government since 1993
Intermediate - these are professionals including the 8 members of the
PHWs
First Line Personnel - the specialist

B. CREATION OF “BOTIKA SA BARYO &
BOTIKA SA HEALTH CENTER”
RA 6675: Generics Act of 1988: Implementing
“Oplan Walang Reseta Program”-solution to the absence of a
medical officer who prescribed the medicines so PHN are
given the responsibility to prescribe generic medicines and
“Walong Wastong Gamot Program”- available generics in “Botika
sa Baryo” & Health Center

§ Father of Generics Act: Dr. Alfredo Bengzon

8 COMMONLY AVAILABLE GENERICS (CARIPPON)

Co-Trimoxazole:
§ it’s a combination of 2 generics of drugs which is antibacterial
Trimethoprim(TMP)
§ Has a bacteriostatic action that stops/inhibits multiplication
of bacteria
§ For GUT, GIT & URTI (TMP combined with SMX)
Sulfamethoxazole (SMX)
§ Has bactericidal action that kills bacteria
§ For GUT, GIT, URTI & Skin Infections


Amoxicillin/Ampicillin
§ An antibacterial drug that comes from the Penicillin
family
§ Effect is generally bacteriostatic (when source of
infection is bacterial)
§ These 2 drugs provide the least sensitivity reaction
(rashes & GI) and the adverse effect of other antibiotics
is anaphylactic shock


TB DRUGS:
Rifampicin (RIF)
Isoniazid (INH)
Pyrazinamide (PZA)


Paracetamol
Has an analgesic & anti-pyretic effect

Acetyl Salicylic Acid (ASA) or Aspirin is never kept in the
“Botika” because of its effects:
§ Anticoagulant-highly dangerous to Dengue patients
that’s why it’s not available in “Botika” & Health Center


Oresol:
a management for diarrhea to prevent dehydration
under the Control of Diarrheal Diseases (CDD)
Program


Nifedipine:
§ An anti-hypertensive drug
§ According to DOH, 16% of population
belonging to 25 years old & above in the
community are hypertensive

C. HERBAL PLANTS

RA 8423: Alternative Traditional Medicine Law
a program where patient may opt to use herbal plants
especially for drugs that are not available in dosage
form or patients has no financial means to buy the
drug
Traditional Medicine:
§ Use of herbal plants

10 ADVOCATED HERBAL PLANTS BY DOH:
LUBBY SANTA

Lagundi Vitex Asthma, Leaves Decoction
negundo cough, colds & Poultice
fever (ASCOF)
Pain and
inflammation

LUBBY SANTA

Ulasimang Peperonia Gout Leaves Decoction
Bato pellucida Arthritis Poultice
Rheumatism

LUBBY SANTA

Bayabas Psidium Diarrhea Leaves Decoction
quajava Toothache
Mouth and
wound
wash

LUBBY SANTA

Bawang Allium HPN Clove/Bulb Poultice
sativum Toothache

LUBBY SANTA

Yerta Mentha Same as Leaves Decoction
Buena cordifelia Lagundi Poultice
except
asthma

LUBBY SANTA

Sambong Blumea Edema Leaves Decoction
balsanifera Diuretic

LUBBY SANTA
Akapulko Cassia All forms Leaves Decoction
alata of skin Poultice
diseases Cream

LUBBY SANTA

Niyog Quisqualis Intestinal Seeds Decoction
niyogan indica Parasitism Poultice
(Nematodes) Juice

LUBBY SANTA
Tsaang Carmona Diarrhea Leaves Decoction
Gubat resuta Infantile Poultice
colic
(Kabag)
Dental
caries

LUBBY SANTA
Ampalaya Mamordica Type II Leaves Decoction
charantia Diabetes
(NIDDM)

POLICIES TO ABIDE:

Know indications
Know parts of plants with therapeutic value: roots,
fruits, leaves
Know official procedure/preparation

Procedures/Preparations:

Decoction
Ø  Gather leaves & wash thoroughly, place in a
container the washed leaves & add water
Ø  Let it boil without cover to vaporize/steam to
release toxic substance & undesirable taste
Ø  Use extracts for washing

PROCEDURES/PREPARATIONS:

Poultice
Ø  Done by pounding or chewing leaves used by
herbolaryo
Ø  Example: Akapulko leaves-when pounded, it releases
extracts coming out from the leaves contains enzyme
(serves as anti-inflammatory) then apply on affected
skin or spewed it over skin
Ø  For treatment of skin diseases


Infusion

To prepare a tea (use lipton bag), keep standing
for 15 minutes in a cup of warm water where a
brown solution is collected, pectin which serves
as an adsorbent and astringent

Juice/Syrup

To prepare a papaya juice, use ripe papaya &
mechanically mashed then put inside a blender
& add water

To produce it into a syrup, add sugar then heat to
dissolve sugar & mix it

Cream/Ointment

Start with poultice (pound leaves) to turn it semi-solid

Add flour to keep preparation pasty & make it adhere to skin
lesions

To make it into an ointment: add oil (mineral, baby or any oil-
serves as moisturizer) to the prepared cream to keep it
lubricated while being massage on the affected area

D. ORESOL
Glucose 20 grams 1° Significance:
For re-absorption of Na
Facilitates assimilation of
Na
2° Significance:
Provides heat & energy
Sodium Chloride/NaCl 3.5 grams For retention of water/fluid
Sodium 2.5 grams Buffer content of solution
Bicarbonate/NaHCO3 Neutralizer content of
solution
Potassium Chloride/KCl 1.5 grams Stimulates smooth muscle
contractility especially the
heart & GIT

PREPARATION OF PROPER HOMEMADE
ORESOL

A volume or one liter homemade oresol Smaller volume or a glass homemade
oresol
Water 1000 ml. or 1 liter 250 ml.
Sugar 8 teaspoon 2 teaspoon
Salt 1 teaspoon ! teaspoon or a pinch of salt=10-12
granules of rock salt: iodized salt=tips of
thumb & index finger are penetrated with
salt

UNIVERSAL HEALTH CARE (UHC), ALSO
REFERRED TO AS KALUSUGAN
PANGKALAHATAN (KP)

is the “provision to every Filipino of the highest
possible quality of health care that is accessible,
efficient, equitably distributed, adequately funded,
fairly financed, and appropriately used by an
informed and empowered public”

UNIVERSAL HEALTH CARE (UHC), ALSO
REFERRED TO AS KALUSUGAN
PANGKALAHATAN (KP
The Aquino administration puts it as the availability
and accessibility of health services and
necessities for all Filipinos.
It is a government mandate aiming to ensure that
every Filipino shall receive affordable and quality
health benefits.This involves providing adequate
resources – health human resources, health
facilities, and health financing.

UHC’S THREE THRUSTS

1)  Financial risk protection through expansion in
enrollment and benefit delivery of the
National Health Insurance Program (NHIP);
2)  2) Improved access to quality hospitals and
health care facilities; and
3)  3) Attainment of health-related Millennium
Development Goals (MDGs).

FINANCIAL RISK PROTECTION

Protection from the financial impacts of health care is
attained by making any Filipino eligible to enroll, to
know their entitlements and responsibilities, to avail
of health services, and to be reimbursed by
PhilHealth with regard to health care expenditures.

MPROVED ACCESS TO QUALITY HOSPITALS AND
HEALTH CARE FACILITIES
Improved access to quality hospitals and health facilities
shall be achieved in a number of creative approaches.
First, the quality of government-owned and operated
hospitals and health facilities is to be upgraded to
accommodate larger capacity, to attend to all types of
emergencies, and to handle non- communicable
diseases.

The Health Facility Enhancement Program
(HFEP) shall provide funds to improve facility
preparedness for trauma and other
emergencies. The aim of HFEP was to upgrade
20% of DOH- retained hospitals, 46% of
provincial hospitals, 46% of district hospitals,
and 51% of rural health units(RHUs) by end of
2011.

ATTAINMENT OF HEALTH-RELATED MDGS
Further efforts and additional resources are to be applied on
public health programs to reduce maternal and child mortality,
morbidity and mortality from Tuberculosis and Malaria, and
incidence of HIV/AIDS. Localities shall be prepared for the
emerging disease trends, as well as the prevention and control
of non- communicable diseases.
The organization of Community Health Teams (CHTs) in each
priority population area is one way to achieve health-related
MDGs. CHTs are groups of volunteers, who will assist families
with their health needs, provide health information, and

ATTAINMENT OF HEALTH-RELATED MDGS
RNheals nurses will be trained to become trainers and supervisors to
coordinate with community-level workers and CHTs. By the end of
2011, it is targeted that there will be 20,000 CHTs and 10,000
RNheals.
Another effort will be the provision of necessary services using the life
cycle approach. These services include family planning, ante-natal
care, delivery in health facilities, newborn care, and the
Garantisadong Pambata package.
Better coordination among government agencies, such as DOH,
DepEd, DSWD, and DILG, would also be essential for the
achievement of these MDGs.

GOAL 1: ERADICATE EXTREME POVERTY AND
HUNGER

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

Target : Halve, between 1990 and 2015, the
proportion of people who suffer from hunger

GOAL 2: ACHIEVE UNIVERSAL PRIMARY
EDUCATION

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

GOAL 3: PROMOTE GENDER EQUALITY AND
EMPOWER WOMEN

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

GOAL 4: REDUCE CHILD MORTALITY

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

GOAL 5: IMPROVE MATERNAL HEALTH

Target : Reduce by three-quarters, between
1990 and 2015, the maternal mortality ratio

GOAL 6: COMBAT HIV/AIDS, MALARIA AND
OTHER DISEASES

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

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

GOAL 7: ENSURE ENVIRONMENTAL
SUSTAINABILITY
Target : Integrate the principles of sustainable
development into country policies and programmes and
reverse the loss of environmental resources
Target : Halve, by 2015, the proportion of people
without sustainable access to safe drinking water
Target: By 2020, to have achieved a significant
improvement in the lives of at least 100 million slum
dwellers

GOAL 8: DEVELOP A GLOBAL PARTNERSHIP
FOR DEVELOPMENT
Target : Develop further an open, rule-based, predictable, non-
discriminatory trading and financial system
Target: Address the special needs of the least developed countries
Target: Address the special needs of landlocked countries and small
island developing States
Target: Deal comprehensively with the debt problems of developing
countries through national and international measures in order to
make debt sustainable in the long term

FIELD HEALTH SERVICE INFORMATION SYSTEM
(FHSIS)
• It is a network of information

• It is intended to address the short term needs of DOH and LGU
staff with

managerial or supervisory functions in facilities and program
areas.

• It monitors health service delivery nationwide.

OBJECTIVES OF FHSIS
To provide summary data on health service delivery and selected
program accomplishment indicators at the barangay, municipality/
city, and district, provincial, regional and national levels.
To provide data which when combined with data from other sources,
can be used for program monitoring and evaluation purposes.
To provide a standardized, facility-level data base that can be accessed
for more in-depth studies.
To minimize the recording and reporting burden at the service delivery
level in order to allow more time for patient care and promote
activities.

IMPORTANCE OF FHSIS
• Helps local government determine public health priorities.
• Basis for monitoring and evaluating health program implementation.
• Basis for planning, budgeting, logistics and decision making at all
levels.
• Source of data to detect unusual occurrence of a disease.
• Needed to monitor health status of the community.
• Helps midwives in following up clients.
• Documentation of RHM/PHN day to day activities.

COMPONENTS OF FHSIS

1.  Individual Treatment Record (ITR)
2.  Target Client List (TCL)
3.  Summary Table
4.  The Monthly Consolidation Table (MCT)

INDIVIDUAL TREATMENT RECORD (ITR)
The fundamental building block or foundation of the Field
Health Service Information System is the INDIVIDUAL
TREATMENT RECORD.
This is a document, form or piece of paper upon which is
recorded the date, name, address of patient, presenting
symptoms or complaint of the patient on consultation
and the diagnosis (if available), treatment and date of
treatment.

TARGET CLIENT LIST (TCL)
The Target Client Lists constitute the second “building block”
of the FHSIS and are intended to serve several purposes

First is to plan and carry out patient care and service
delivery. Such lists will be of considerable value to
midwives/nurses in monitoring service delivery to clients
in general and in particular to groups of patients
identified as “targets” or “eligibles” for one or another
program of the Department

TARGET CLIENT LIST (TCL)

The second purpose of Target Client Lists is to facilitate
the monitoring and supervision of service delivery
activities.
The third purpose is to report services delivered.

The fourth purpose of the Target Client Lists is to
provide a clinic-level data base which can be
accessed for further studies

TARGET CLIENT LISTS TO BE MAINTAINED IN
THE FHSIS
1.  Target Client List for Prenatal Care
2.  Target Client List for Post-Partum Care
3.  Target Client List of Under 1 Year Old Children
4.  Target Client List for Family Planning
5.  Target Client List for Sick Children
6.  NTP TB Register
7.  National Leprosy Control Program Form 2-Central Registration
Form

SUMMARY TABLE
The Summary Tables is a form with 12-month columns retained at
the facility (BHS) where the midwife records monthly all
relevant data. The Summary Table is composed of:
(1)  Health Program Accomplishment this can serve as proof of
accomplishments to show LGU officials whenever they visit
the facility.
(2)  Morbidity Diseases the source of ten leading causes of
morbidity for the municipality/city. This summary table will
help the nurse and MHO to get the monthly trend of diseases.

THE MONTHLY CONSOLIDATION TABLE (MCT)

ü  The Consolidation Table is an essential form in the
FHSIS where the nurse at the RHU records the
reported data per indicator by each BHS or midwife.
ü  This is the source document of the nurse for the
Quarterly Form.
ü  The Consolidation Table shall serve as the Output
Table of the RHU as it already contains listing of BHS
per indicator.

FHSIS REPORTING

These are summary data that are transmitted or
submitted on a monthly, quarterly and on annual
basis to higher level. The source of data for this
component is dependent on the records.

THE MONTHLY FORM
Program Report (M1)
The Monthly Form contains selected indicators categorized as
maternal care, child care, family planning and disease
control.
Morbidity Report (M2)
The Monthly Morbidity Disease Report contains a list of all
diseases by age and sex. The Midwife uses the form for
the monthly consolidation report of Morbidity Diseases and
is submitted to the PHN for quarterly consolidation.

THE QUARTERLY FORM
Program Report (Q1)
The Quarterly Form is the municipality/city health report and
contains the three-month total of indicators categorized as
maternal care, family planning, child care, dental health and
disease control
Morbidity Report (Q2)
The PHN uses the form for the Quarterly Consolidation Report of
Morbidity Diseases to consolidate the Monthly Morbidity
Diseases taken from the Summary Table.

THE ANNUAL FORMS (A-BHS, A1, A2 & A3)
ABHS Form is the report of midwife which contains data on demographic,
environmental and natality.

The report of nurse at the RHU/MHC are the Annual Form 1 which is the report
on vital statistics: demographic, environmental, natality and mortality.

Annual Form 2 is the report that lists all diseases and their occurrence in the
municipality/city. The report is broken down by age and sex.

Annual Form 3 is the report of all deaths occurred in the municipality/city. The
report is also broken down by age and sex.

FLOW OF REPORT
OFFICE PERSON RECORDING FORMS FREQUENCY SCHEDULE OF
TOOLS SUBMISION

BHS Midwife -  ITR Monthly Form Monthly Every 2nd week of the
-  TCL (M1 & M2) succeeding month
-  ST
A-BHS Form Annually Every 2nd week of
January

RHU PHN -  ST Quarterly Quarterly Every 3rd week of the 1st
-  MCT Form month of succeeding
(Q1 & Q2) quarter

Annual Forms Every 3rd week of
-  A1 January
-  A2
-  A3

Fertility
§ Crude Birth Rate (CBR) - Overall total reported births

Morbidity-Illnesses affecting the population group
§ Incidence Rate (IR)-reported new cases affecting the
population group
§ Prevalence Rate (PR)-determine sum total of new + old
cases of diseases per percent population

Mortality-Reports causes of deaths
§ Crude Death Rate (CDR)-overall total reported death
§ Maternal Mortality Rate (MMR)-maternal deaths due to
maternal causes
§ Infant Mortality Rate (IMR)-# of infant deaths (0-12
months) or less than 1 year old
§ Neonatal Mortality Rate (NMR)-# of deaths among
neonates (newborn 0-28 days, < 1 month)
§ Swaroops Index (SI)-deaths among individual in the age
group of 50 and above

CRUDE BIRTH RATE (CBR)

CBR= Overall total reported births x 1000
--------------------------------------------
Population

INCIDENCE RATE (IR)

IR= new cases of disease x 100
------------------------------------
Population

PREVALENCE RATE (PR):

PR= new cases + old cases x 100
--------------------------------------
Population

CRUDE DEATH RATE (CDR)

CDR = overall total deaths x 1000
----------------------------------
Population

MATERNAL MORTALITY RATE (MMR)

MMR= # of maternal deaths x 1000
----------------------------------
RLB

INFANT MORTALITY RATE (IMR)

IMR = # of infant deaths x 1000
---------------------------------
RLB

NEONATAL MORTALITY RATE (NMR)

NMR = # of neonatal deaths x 1000
---------------------------------------
RLB

SWAROOP’S INDEX (SI)

SI= # of deaths (individual >50 years old) x 100
------------------------------------------------------------
Total Deaths

FAMILY HEALTH NURSING PROCESS

a systematic approach of solving an existing
problem/meeting the needs of family
R apport
A ssessment
P lanning
I ntervention
E valuation

I. RAPPORT

ü  Trust building
ü  Knowing your client
ü  Adjusting to the situation and environment
ü  RESPECT

II. ASSESSMENT
Data Gathering: tools or instruments used during
survey:
ü Interview
ü Observation
ü Questionnaires-mostly patronized & used in CHN
ü Records & Reports available

Consolidation or Collation: collecting back the
questionnaires, tabulate and summarize

Validation: uses statistical approaches

Statistical Approaches:
1. Central Tendencies: 3 M’s
Mean=average
Median=range (Highest – Lowest Score)
Mode=frequency of occurrence of a variable, used if
there’s too many variable occur

2. Standard Deviation: used if there are too many
variables available to be treated which is seldom
used in CHN

SD=√ ∑ (x-x) ∑=summation of
n-1 x=variables available
x=mean (given special attention)
n=# of existing variables

3. Percentile (%) Method:
most commonly used in CHN by adding all cores
then multiply by 100

Presentation of Data
Sales
Series
1. Table/Chart Categ 1 1st Qtr
Categ
Series
2. Graph: Categ
2
2nd Qtr
Categ
Pie Series
0 20 3 6
Bar-2 variables only 4 Series
2 1
Line 0
Series

Catego
Catego
Catego
Catego
2
Polygon-connecting the results
Histograph-2 or more variables & appear adjacent to
each other

TYPOLOGY OF NURSING PROBLEMS

A. First Level Assessment: to determine problems of
family
Sources of Problems using IDB
Family: use of Initial Data Base (IDB)
Nature: Health Deficit (HD), Health Threat (HT),
Foreseeable Crisis (FC)

USE OF INITIAL DATA BASE (IDB):
1. Family Chart Structure:
Nuclear -Father, mother, children
Extended (3rd generation)-Relatives staying with the family
Multi-generational extended-“apo sa tuhod” or “apo sa talampakan”
Dyad -Husband & wife only (childless couple)
Blended -widow married another widow & have children
Gay -Same sex living together
Matriarchal -Mother is the decision maker
Patriarchal -Father is the decision maker
Communal -different families forming a community

2. Socio-economic: poverty level, educational
attainment & nature of occupation of members
of the family (sources of income)

3. Socio-cultural: different nature of religion

4. Home environment: assessment according to
ES, treatment of garbage, preparation of food,
availability of toilet, water & food sanitation,
sources of diseases

4. Medical history: history of certain disease, family
member with disease

5. Resources available in community for use by the
family:
5 Generalized M’s in resources available in community:
§ Man/Manpower
§ Money
§ Machine
§ Materials
§ Methods

DEFINE THE PROBLEM AFTER IDENTIFYING IT
ACCORDING TO NATURE

Health Deficit (HD)
- if identified problem is an abnormality, illness
or disease, there’s a gap/difference between
normal status (ideal, desirable, expected) &
actual status (the outcome/result/problem
encountered on that actual day)

Health Threat (HT)
-any condition or situation which will be conducive
to health alteration, health interference & health
disturbance.

Foreseeable Crisis (FC)
-stress points, anything which is anticipated/
expected to become a problem

Jobless Father
Suffering from TB
th
Wife is pregnant for the 8 time
2 y/o youngest child lacks immunization
rd
9 y/o eldest child is 3 degree
malnourished
Poor environmental sanitation

III. PLANNING

Four (4) Standard Steps:
Prioritization -start if there are multiple identified
problems
Formulation of objectives -planning a procedure will
start here if there is only one problem
Developing strategies of action
Formulation of evaluation tools for the identified
strategy developed

CRITERIA IN IDENTIFYING THE PROBLEM
Criteria Score Weight
I. Nature: assess by PHW
Health deficit (HD) 3 1
Health threat (HT) 2
Foreseeable Crisis (FC) 1
II. Modifiability
Easily 2 2
Intermediate (moderate) 1
Not modifiable 0
III. Preventive Potential
Highly 3 1
Moderate 2
Low 1
IV. Salience of the Problem
Problem needing urgent 2 1
attention
Problem not needing 1
urgent attention
Not a felt problem 0

§ Steps:
a. Decide on a score
b.  Score x weight
-----------------
Highest Score
b.  Get the sum total of all the scores
§ Interpretation:
Perfect score=5, if score nearing 5 then prioritize the problem
Criteria 1, 2 & 3 has to be assessed objectively by the health
worker
Criteria 4 has to be assessed by the perception of the family

Compute for 3rd Degree Malnutrition

IV. INTERVENTION

ü Is the capacity to provide management
ü Is the professional phase of nursing process
ü Is the time when the PHN executes the standard
function of an RN
ü Three (3) Standard Functions of RN:
§ Dependent-giving of medicines
§ Independent-monitor, assess, provide, educate
§ Interdependent-referrals

V. EVALUATION
Three (3) Things to be evaluated: SPO
1.  Structure of program & activity -what articles, equipments, supplies are
utilized
2.  Process utilized -steps used
3.  Outcome of activity -results can be:
§ Desirable -to be implemented, advocated, strengthen
§ Undesirable -to be avoided
Two (2) Aspects to be evaluated in the Outcome:
§ Quality -characteristic or kind of outcome; no numerical value, not measurable
§ Quantity -from the word “quantum”, with numerical value, measurable

OBJECTIVES OF COPAR
Patterns to be followed:
1.  Organize people
2.  Mobilize people
3.  Work with people
4.  Educate people
ü  Knowledge
ü  Attitude
ü  Skills

PHASES OF COPAR

1. Preparatory
2. Organizing
3. Mobilizing
4. Educating
5. Collaborating
6. Phase Out

1. PREPARATORY PHASE
A. Area of Selection
§ It should be DOPE Community: Depressed,
Oppressed, Poor & Exploited, a new criteria for
community organization
§ “Old Criteria”→ it must be a virgin
community=meaning no agency has gone there.
§ This is a dangerous situation that’s why RA 7305:
Magna Carta for Public Workers was provided-a PHN
is to receive a hazard pay of 20-25% of monthly
salary


B. Entry: the 1st thing to do upon entering the
community is to have a courtesy call with the
Barangay


C. Integration/Immersion
§ Immersion is imbibing the life situation/
condition of the community by living, eating &
sleeping with the family to be able to
understand their situation
§ It requires 2 Qualities of PHN:
§ Empathy
§ Sympathy (Integration)


D. Community Study: Diagnosis of Community-COPAR
§ Makes use of the Nursing Process/Problem
Solving Approach
§ Prioritized which among the problems identified
is to be attended 1st like in nature, magnitude,
modifiability, preventive potential, salience

PRIORITIZATION OF COMMUNITY PROBLEMS
NATURE
Health Status (HS) 3
Health Resource(s) 2
Health Related 1

Indicators of Health Status/Condition:
Fertility: ↑ CBR=community is overpopulated=HS
Morbidity: IR (new cases) & PR (old cases)=HS
Mortality: Deaths like children dying of pneumonia=HS

NATURE
Health Related 1

Health Resource(s):
5 M’s-Manpower/Man, money, machinery, material & methods
(+) available facilities-Hospital/Clinic, mode of transportation,
market, school & movie houses for recreation

NATURE
Health Related 1

Health Related: Categories according to 5 Aspects of Man=PEMSS
P hysical, P hysiological, P sychological
E motional
M ental
S ocial
S piritual

MAGNITUDE OF THE PROBLEM: % of population affected by the identified
problem
75-100% 4
50-74 % 3
25-49 % 2
<25 % of the population 1
MODIFIABILITY
Easily 3
Intermediate 2
Low 1
Not modifiable 0
PREVENTIVE POTENTIAL
Highly 3
Moderate 2
Low 1
SALIENCE

2. ORGANIZING PHASE
Choosing Potential Community Leaders
Core Group Formation
Community Assembly: Community Organizing Participatory Action
Research (COPAR)
§ Attend the assembly of the family/families
§ Families in the community should be represented, any
family members can represent his/her family as long as he/
she is a RESPONSIBLE (one who also can comprehend)
member of that family.
§ Barangay Captain/Chairman need not necessary be the
leader. He can recommend

3. MOBILIZATION PHASE

Mobilization
- let the members of the community do the work.
PHN should only SUPERVISE

4. HEALTH EDUCATION

ü Adjust on the level of understanding of the
community
ü Return demonstration is the best way of
teaching
ü Focus on the KSA
ü Respect of the custom and tradition

5. COLLABORATING

6. PHASE OUT

EPIDEMIOLOGY
is the pattern of occurrences & distribution of diseases, defects &
deaths
2 Population in Distribution
Patterns Susceptible Immune
(at risk to develop, acquire (those that did not
or experience the disease) experience the disease,
usually individuals develop
resistance against the
disease)
Epidemic 80% (more than 50%) 20%
Endemic 50% 50%
Sporadic 20% 80%
Pandemic ----- -----

EPIDEMIC
§ Greater than 50% of populations are susceptible or less immune
individual
§ Greater % of the population is affected by the occurring disease

Example: Health worker reports that Community Lanting has an
epidemic of measles affecting children less than 7 years old
Total susceptible population: 3000
Children affected by measles: 1750
1750

ENDEMIC
The disease occurs regularly, habitually, constantly affecting the
population group
2 Local Endemic Diseases: where causative agent is available on
those places
§ Schistosomiasis: Samar, Leyte, Mindoro, Davao
§ Malaria: Palawan & Mindanao-reasons why it’s prevalent
§ Forested areas
§ Surrounded by bodies of water

SPORADIC

§ The pattern of occurrence is on & off where:
On=available causative agent
Off=no available causative agent
§ It’s intermittent (unpredictable) in occurrence
§ Disease occurs only if there’s a susceptible host
like in rabies

PANDEMIC

Worldwide, international, universal, global in
occurrence like in AIDS, Hepatitis B, PTB, measles,
mumps, diphtheria, pneumonia

§ SARS is categorized by WHO as an OUTBREAK only
because out of 191 nations, 33 countries are
reported to have it.

HOME VISIT

ü  Is a PROFESSIONAL contact between PHN &
the family

ü  The services provided is an extension of the
Health Service Agency (Health Center)

OBJECTIVES OF HOME VISIT

§ Assessment
§ Nursing Care
§ Treatment
§ Health Education
§ Referral (if care fails)

PRIORITIES (IN THE CARE): TO PREVENT CROSS
CONTAMINATION
1.  Newborn
2.  Post partum
3.  Pregnant mothers
4.  Morbid cases
The families need the assistance of the health center that’s why
home visit was done to the family
The person who makes the home visit is rendering services on
behalf of the health center

PHASES OF HOME VISIT:

1. Planning
ü Starts at the health center
ü Makes a study on the status of the family
ü Statement of the problem
ü Formation of objective
2. Socialization –first activity is to establish rapport
& to gain the trust of the family

PHASES OF HOME VISIT:
3. Activity
ü  Intervention/Professional Phase
ü  Opportunity to provide or extend health services
ü  Standard Role of the Nurse: Independent, Dependent and
Interdependent
ü  To be effective, come in complete uniform (also bring a long
umbrella with pointed end which serve as protection)
4. Summarization - ability to put into record & report
(orally) about the outcome of the activity

PUBLIC HEALTH BAG:

Indispensable tool that should be organize to
save time & effort and to prevent cross
infection & contamination

GUIDING PRINCIPLES IN THE USE OF PUBLIC
HEALTH BAG:

§ Content -should be prepared by the one who will
make home visit
Note: BP Apparatus is kept separately from PHN bag

§ Cleaning
ü The inner part of the bag should be clean & sterile
ü Should be done every after home visit
ü Never endorse the bag

HEALTH BAG:
§ Contamination
§ The less one opens the bag, the lesser
chance of contamination
§ In general, the bag is open 3x:
ü Putting out materials for hand washing
ü Putting out materials used for nursing
care
ü Returning all what have been used

HEALTH BAG:

Care of Communicable Case(s)
- should be disinfected with the use of 70%
isopropyl alcohol or Lysol which should be
done at the health center and not at home

POLICIES FOR SCHISTOSOMIASIS CONTROL
PROGRAM (SCP): CHES

C ase Finding
H ealth Education
E nvironmental Sanitation
S nail Eradication

CASE FINDING:
6 Aspects or Thing to Know
§ Disease: Schistosomiasis
§ Other name: Bilhariasis or Snail Fever
§ Causative agent: Schistosoma-a blood fluke (parasite)
3 Types of Species:
ü Schistosoma japonicum-endemic in the Philippines &
affecting Indonesia, China, Japan, Korea Vector: Oncomelania
quadrasi
ü Schistosoma mansoni
ü Schistosoma haematobium

§ Laboratory Procedures to rule out Schistosomiasis:
Blood Examination: ↑ eosinophil level indicates parasitism
Fecalysis: Kato Katz (plain stool exam that uses a special
apparatus resembling a feeding bottle sterilizer)
Procedure:
ü Collect specimen
ü Have the test tube undergo centrifugation for 20
minutes
ü Get specimen from precipitate & swab it on glass slide
ü Observe it on microscope

§ Signs & Symptoms

ü CNS: High grade fever→ cerebral convulsion
ü GIT: Nausea & vomiting, Diarrhea→ Chronic dysentery
(prolonged diarrhea of more than 2 weeks & consistency is
mucoid & bloody (with streaks of blood)
ü Liver: Presence of infection manifested by jaundice &
hepatomegaly
ü Spleen: Infection of spleen→ inflammation→ enlargement of
organ (Splenomegaly)→ abdominal distension→ abdominal
pain on the right upper quadrant
ü Blood: Anemia & weakness

§ Treatment: Drug of Choice-Praziquantel (Biltricide)
60 mg/KBW/day
ü Example: If patient is 50 kg, 50 kg x 60 mg/KBW/day=3000
mg/day
ü Initial treatment: 1st 2 weeks=3000 mg/day, then do stool
exam after 2 weeks→ if still (+), extend treatment for another
2 weeks. Repeat stool exam, if still (+) after the extended
week, continue treatment for 2 weeks again. No adverse
effect or over dosage even if extended for a year.
ü Length of Treatment: takes months to a year

Health Education: It affects mostly farmers so educate them to
wear rubber boots
Environmental Sanitation:
Snail is the 1st concern
Water where snail thrives is the 2nd concern
Toilet=3rd concern
Food
Garbage
Snail Eradication: Use molluscicides treat the entire suspected
soil with chemical solution that kills snails

CASE FINDING:
§ Disease: Malaria
§ Other name: Ague
§ Causative Agent: Plasmodium-a protozoa
4 Types of Species:
ü Plasmodium falciparum-more fatal that affects the Philippine
Vector: Female Anopheles Mosquito (FAM)
ü Plasmodium vivax
ü Plasmodium ovale
ü Plasmodium malariae

§ Laboratory Procedure: Malarial smear-extract blood at the
height of fever because plasmodium is very active & ruptures
at this period.

§ Signs & Symptoms of Malaria:
1st Stage=Cold: Chilling sensation for 1-2 hours
2nd Stage=Hot: High grade fever lasting for 3-4 hours
3rd Stage=Wet: Diaphoresis (excessive sweating/perspiration)

§ Treatment: Drug of Choice-Quinine
2 Forms:
a) Chloroquine (Aralen)
b) Primaquine

If Quinine is not available, may use Sulfadoxime-an
antibacterial drug paired with pyrinthamine

PERSONAL PROTECTION:

§ Sleep under a mosquito net
§ Sleep in a screened room
§ Sleep with long sleeve attire
§ Use repellents that contains DET (diethyl toluamide or
toluene which has a pungent odor that drives away
mosquitoes & an irritant to mucous membrane of
respiratory tract when inhaled
§ Plant a Neem Tree using the leaves

CLEAN:
Chemical Method=insecticide spraying at night
Larvae eating fish=Tilapia
Environmental Sanitation & Health
Education=insect, water, trash
Anti-mosquito soap=basil citronelli
Neem tree=banana, banaba, gabi, eucalyptus
provide repellent effect

STRATEGIES:
A. Provision of Regular and Quality Maternal Care Services
Ø  Regular and quality pre-natal care
§ hx-taking, utilization of HBMR (Home-Based Mother’s Record) as
a guide in the identification of risk factors
§ PE: weight, height, BP-taking
§ Perform head-to-toe assessment, abdominal exam
§ Tetanus Toxoid Immunization
§ Fe supplementation: given from 5th mo. of pregnancy to two
months postpartum (100-120 mg orally/day for 210 days)
§ Laboratory exam: Heat-acetic acid test. Benedict’s test
§ Oral/Dental exam

Ø  Pre-natal counseling

Ø  Provision of safe, delivery care
§ all birth attendants shall ensure clean and safe
deliveries at the faciltiies (RHUs/hospitals)
§ at-risk pregnancies and mothers must be immediately
referred to the nearest institution

Ø  Provision of quality postpartum care
Ø  Proper schedule of follow-up must be followed:
§ 1st postpartum visit for home deliveries must be done within 24
hours after delivery
§ 2nd, done at least 1 week after delivery
§ 3rd, done 2-4 weeks thereafter

Attendants must be aware of the early signs, symptoms and
complications. They should follow the 3 CLEANS:
CLEAN Hands
CLEAN Surface
CLEAN Cord

C. Improvement of the health personnel’s capabilities on newborn care,
midwifery thru trainings.
Note: All deliveries should be done in health care facilities ONLY

D. Improvement on the quality of care at the First Referral Level
Ø  Orientation, training should be done on the use of proper filling-up of HBMR
card
Ø  Proper referrals/endorsements must be done for future If-ups

E. Prevention of unwanted pregnancies through family planning services

F. Prevention and management of STDs

G. Promotion of Appropriate health practices

H. Upgrade reporting services

I. Mobilize political commitment and community
involvement to provide support to basic health care
delivery

GOALS:

A. Safe Pregnancy
ü  Right age to be pregnant=20-35 years old,
not less than 20 & not more than 35
ü  Right interval of pregnancy=once in 2 or 3
years
ü  Home Base Mother’s Record (HBMR): the
record used for care of mothers in CHN

Laboratory Examinations:
Benedict’s Test: test for sugar in the urine; test for diabetes
§ Heat test tube with 5 cc of Benedict’s Solution (blue) in the
burner then add 3-5 gtts of urine (amber yellow) then heat again.
Observe for the change in color:
Blue : (-) sugar in urine
Green : trace of sugar in urine +1 +
Yellow : traces of sugar in urine +2 ++
Orange : more traces of sugar in urine +3 +++
Brick Red : surely diabetic +4 ++++

Laboratory Examinations:
Acetic Acid Test: test for albumin in urine; test for
Pregnancy Induced HPN
§ Collect urine in test tube, heat it in burner then add
3-5 gtts of acetic solution (clear white). Observe for
change in color:
If it remains clear: (-) CHON or albumin in urine
If it turns cloudy: (+) CHON=proteinuria

POLICIES:
1.  Non coercive (give freedom of choice)
2.  Integration of Family Planning in all Curricular Program:
§ LOI 47 DECS states that Family Planning is to be integrated in all
school curricular programs, either baccalaureates or non-
baccalaureates, enrolled separately as one unit
3. Multi-Sectoral Approach: establish relationship with other
agencies which can either be:
§ Intrasectoral
§ Intersectoral-Local or International (WHO, Unicef, USAID,
Japhiego)

METHODOLOGIES:

Biological
A. Basal Body Temperature (BBT)
§ Get the temperature early morning before waking up
which should be monitored daily at the same time
§ There should be a sudden drop of temperature between
0.3-0.6°C followed by an increase of temperature by
0.3-0.6°C which means that the woman is fertile

B. Sympto-thermal
C. Cervical Mucus Test
Ø Billing’s Method by Dr. Billing
Ø Spinnbarkheit (came from a German word Spinner which means
to play with the cervical mucus with the finger) or Wet & Dry
Method:
§ Wet Cervical Mucus (Fertile): abundant, stretchy & transparent
§ Dry Cervical Mucus (Safe & Not fertile): whitish, pasty &
adhesive
D. Calendar (Rhythm)
§ Deleted already since 1998 because it’s not recommended for
irregular cycle of menstruation
§ Menstrual cycle should be regular; obtain 4-6 months cycle

E. Lactation Amenorrhea Method (LAM): RA 7600-Breastfeeding &
Rooming In Law
§ DOH organized Maternal & Child Family Health Institute (MCFHI)
with the following members:
ü All government hospitals
ü Private hospitals (volunteer)
§ Normal involution (uterus goes back to normal) of the uterus:
after 45 days or 5-6 weeks or 1 ½ months if not breastfeeding
§ Frozen breast milk is to be put out of the freezer 2 hours before
feeding ( Body of Ref: 2-3 days / Freezer: 3-4 months)
§ Left over milk should be discarded & should not be re-preserved
or re-frozen because it is already contaminated

METHODOLOGIES:
Temporary
A. Chemical
§ Oral Pills (Logentrol)-has low dose of estrogen & progesterone that
inhibits ovulation
§ Parenteral: Depot Medroxyprogesterone Acetate (DMPA)/Depo-
provera- inhibits ovulation making women amenorrheic;
1991, DMPA was found to be causing cancer of the cervix
1994, DMPA is given IM 4x a year every 3 months (90 days interval)

§ Implants: Norplant-it inhibits ovulation effective for 5 years
but seldom advocated for use because it is usually
expensive; the client buys the device (consists of 5
capsules) & have it implanted at the health center by
minor surgical incision in:
ü upper inner arm because it is nearest to the brain
ü external oblique
ü thigh
ü gluteal muscles

B. Mechanical:
§  IUD
ü  Up to 10 years protection
§  Cervical cap & Diaphragm
ü  Prevent the sperm to pass the cervix
ü  Works better with spermicide
ü  Wore 30 minutes before coitus and keep up to 6
hours after coitus
§  Condom
ü  Most effective way to prevent STD’s / STI’s

METHODOLOGIES:
C. Behavioral
Ø  Abstinence
Ø  Withdrawal

D. Permanent
Ø  Vasectomy (reversible)-since year 2000 in the
Philippines
Ø  BLT

POLICIES:
I. Nutritional Surveillance (NS): to determine victims of
malnutrition
A. Anthropometric Measurement: study of measurements of
human dimensions
Ø  Age for Weight-if weight is not appropriate with the age:
ü Stunting: growth retardation
ü Wasting: connotes malnutrition
Ø  Age for Height-if height is not appropriate with the age:
Stunting
Ø  Weight for Height

Rule Male Female
Every height of 5 110 lbs. 105 lbs.
ft.
Every increment + 6 +5
of an inch above
5 ft. ADD
Every decrement - 6 -5
of an inch below
5 ft. SUBTRACT

Ø  Skin Folds Test-pinch the external oblique muscle (“bilbil”)
with your palm
Normal: 1 inch
Overweight: > 1 inch
Ø  Middle Upper Arm Circumference (MUAC)-used in children
below 5 years old by measuring the middle upper arm with a
tape measure
Normal: 13 cms. & above
Malnutrition: <13 cms

POLICIES:
I. Nutritional Surveillance (NS): to determine victims of malnutrition
B. Biochemical Method
Ø  Micronutrient Malnutrition -available in small amount in the body VADAG:
Vitamin A Deficiency:
§ Deficiency: Xeropthalmia-opacity of cornea leading to night blindnes
Infants (6-12 months) : Give 100,000 i.u.
Pre-schoolers (12-83 months) : 200,000 i.u.
Post partum : 200,000 i.u.

§ Never give Vitamin A to infants less than 6 months & pregnant
women because it is toxic

Anemia: Iron Deficiency Anemia
§ Target age group: 0-59 months (less than 5 years)
§ Give 3-6 mg/kbw/day
§ Always give the maximum

Example: Child weighs 8 kg
8 x 6=48 mg/day for the 1st 3 months then monitor
If still anemic, continue giving but compute again 6 mg/kbw

Goiter: Iodine Deficiency Disease (endemic in uphill)
§ Target age group: 0-59 months
§ Give 1 capsule (200 mg) of potassium iodate in oil once a
year
For a child < 5 years old, empty contents of capsule in a cup
with warm water because he can’t tolerate it
§ Adverse Effect of Iodine Deficiency Disease that must be
avoided:
Ø Mental retardation-intelligence quotient: idiot, moron &
imbecile
Ø Growth retardation- cretinism (pedia) & dwarfism (adult)

Ø  Macronutrient Malnutrition - available in large
amount in the body (Protein Energy
Malnutrition or PEM)

§ Kwashiorkor-protein deficiency
§ Marasmus-carbohydrate deficiency (energy
giving food)

Kwashiorkor Marasmus
Etiology Disease experienced by an elder Muscle wasting
child upon the birth of a new baby

Deficiency CHON CHO
Age Toddlers (1-3 years old) All ages
Major Signs & Facial edema, moon facie Muscle wasting, old man’s facie
Symptoms
Hair Changes (+) color changes from black to (-) hair changes
brown or from brown to golden
yellow
(+) sparse “flag sign”
Skin Dermatosis: (-)
dryness, peeling off of the skin,
desquamation
Behavior Irritable Apathetic
Management High CHON diet High CHO diet
Hospital Setting Total Parenteral Nutrition (TPN)
Hyperalimentation process
IV infusion with CHON, CHO regulated by a
machine

POLICIES:
II. Food Production
Fortification-products without any nutrient are added with nutrients
RA 8172 (Asin Law): Fidel Salt (Fortification of Iodine Deficiency Elimination)
=Iodized Salt-“Patak” sa Asin” by Secretary Flavier on December 1-5, 2003
where DOH workers go to market to check if salt sold contains iodine by
placing few drops of reagent:
If salt color turns to blue violet→ fortified with iodine
If salt color show no change→ not fortified with iodine

RA 832 (Rice Fortification): FVR (Fortified Vitamin Rice) by Secretary Flavier
under FVR, Erap Rice under Erap, Gloria Rice or “Bigas ni Gloria” under PGMA

ENVIRONMENTAL SANITATION

Ø refers to all factors available in the
environment affecting the health of the
individual or population

Ø  regulated by PD 856: Comprehensive
Sanitation Code of the Philippines

ENVIRONMENTAL HEALTH SERVICE (EHS) OF
DOH IS RESPONSIBLE FOR

§ Promotion of healthy environmental conditions &
prevention of environmental related diseases through
appropriate sanitation strategies
§ Promotion & implementation of sanitation programs
through the Department of Health Field Health Units
§ Conceptualization of new programs/projects to
contend with emerging environmentally related
health problems

COMPONENTS:

ü  Water Supply Sanitation Program
ü  Proper Excreta and Sewage Disposal
Program
ü  Insect and Rodent Control
ü  Food and Sanitation Program
ü  Hospital Waste Management Program

1. WATER SUPPLY SANITATION PROGRAM

ü  Potable
ü  Free from any particles that might
cause illness to an individual

Ways to make Water Potable:

§ Boiling: minimum of 3 minutes to maximum of
10 minutes for drinking
§ Sterilization: 30 minutes after the water starts
to boil
§ Filtration: makes use of filter paper or cotton
cloth to separate solid particle from liquid if
water comes from river

§ Coagulation/Flocculation: uses aluminum
crystal (tawas) that collects or absorbs
particles from liquid part & becomes slimy

ü In 1 gallon of water, drop tawas (the size of
magi cubes) & allow to stand for 6-8 hours
ü Initially, water appears to be cloudy then
after 6-8 hours of standing, the water
becomes clear

Chlorination: uses 100% pure concentrated
chlorine bought from botika or given free by
health centers
Ø  To prepare stock solution (SS): in 1 liter drinking
water, add 1 tablespoon of concentrated chlorine
which is potent for 3-4 months
Ø  To prepare the chlorinated water: in 2 ½ gallons of
drinking water (10,000 ml=10 liters), add 1
tablespoon from the prepared stock solution & let it
stand for 30 minutes to react with water

§ Fluoridation: adding fluoride to prevent dental
caries (primary significance) & whitens
enamel of teeth ( 2nd significance)

§ Aeration: exposing drinking water in air to
strengthen taste within 24 hours which is
usually used in uphill areas where there’s less
or no pollution

3 TYPES OF APPROVED WATER SUPPLY AND
FACILITIES

Level I
Point Source

A protected well or a developed spring with an
outlet but without a distribution system for rural
areas where houses are thinly scattered.

FACILITIES
Level II
Communal faucet system or stand posts

A system composed of a source, a reservoir, a piped
distribution network and communal faucets, located at
not more than 25 meters from the farthest house in
rural areas where houses are clustered densely.

FACILITIES

Level III
Waterworks system or individual house
connections
A system with a source, a reservoir, a piped
distributor network and household taps that is
suited for densely populated urban areas.

2. PROPER EXCRETA AND SEWAGE DISPOSAL
SYSTEM

3 TYPES OF APPROVED TOILET FACILITIES

Level 1
Non-water carriage toilet facility:
- Pit latrines
- Reed Odorless Earth Closet
- Bored-hole
- Compost

Toilets requiring small amount of water to wash waste into
receiving space
- Pour flush
- Aqua privies

Pit latrines
Ø  most commonly observed in rural area
Ø  has three components: the pit, a squatting plate and the
super-structure
Ø  types of pit include
“Antipolo type”, a pit type of toilet provided with concrete floor
and an elevated seat with a cover
Ventilated Improved Pit or VIP, pit with a vent pipe
Reed Odourless Earth Closet or ROEC, a pit completely displaced
from the superstructure and connected to the squatting plate
by a curved chute.

Bored Hole Latrine
ü  consists of relatively deep holes bored into the earth by
mechanical or manual earth-boring equipment
ü  holes are about 10-18 inches in diameter and usually
15-35 feet deep. The hole is provided to facilitate
squatting. Two types of bored-hole latrines are:
Wet Type - when the hole penetrates ground water table or
other strata.
Dry Type - when he hole does not reach ground water table;
fills up at a faster rate then than the wet type.


Level 2

On site toilet facilities of the water carriage type with
water sealed and
flushed type with septic vault/tank disposal facilities.


Level 3

Water carriage types of toilet facilities
connected to septic tanks an/or to sewerage
system to treatment plant.

THINGS TO CONSIDER IN CONSTRUCTING A TOILET
FACILITY:

ü  At least 25 meters away from water sources
at a lower elevation
ü  It should be within your financial capability
ü  It should be approved by the local health
authorities

CARE AND MAINTENANCE OF YOUR TOILET FACILITY:
ü  Water must be provided at all times.
ü  Use toilet paper
ü  Use lysol once a month for odor removal
ü  Clean the bowl by muriatic acid to remove the stains.
ü  Avoid depositing solid objects on the bowl to prevent clogging
ü  Always check your toilet if it’s clean
ü  Use plunger when clogging occurs. Don’t use sticks or rods to
avoid the breakage of the trap or the bowl.

3. PROPER SOLID WASTE MANAGEMENT

refers to satisfactory methods of storage,
collection and final disposal of solid wastes

SOURCES OF SOLID WASTE
Household Waste - these are wastes generated in or discharged
from household including shops but excluding commercial
activities

Commercial Waste - restaurants, stationery shops, grocery
shops or any commercial activity are the main sources of
commercial waste.

Market Waste - only refers to waste generated in or discharged
from markets both for whole sale and retailing

SOURCES OF SOLID WASTE
Institutional Waste - these are wastes generated in
government, state enterprise and private firm office.

Street Sweeping Waste - these are wastes generated by the
street sweeping cleansing service.

River Waste - includes all the wastes generated by the river
and creek cleansing

Medical Waste - these are wastes generated in hospitals.

COMPONENTS OF SOLID WASTE
Garbage refers to left over vegetable, animal and fish material
from kitchen and food establishments. These materials have
the tendency to decay giving off foul odors and sometimes
serve as food for flies and rats.

Rubbish refers to waste materials such as bottles, broken glass,
tin can, waste papers, discarded textile materials, porcelain
wares, pieces of metal and other wrapping materials.

Ashes are left over from burning of wood and coal. Ashes may
become a nuisance because of the dust associated with them.

Stable manure is animal manure collected from stables.

Dead animals like dead dogs, cats, rats, pigs, and chickens that
are killed by cars and trucks on streets and public highways.
They include small and large animals that died from disease.


Street sweeping includes dust, manure, leaves, cigarette buts,
waste papers and other materials that are swept from
streets.

Night soil is human waste normally wrapped and thrown into
sidewalks and streets. This also includes human waste from
pail system of toilets.

Yard cuttings includes leaves, branches, grass and other

SANITARY WAYS OF TREATING GARBAGE:

Segregation-separating biodegradable from non
biodegradable
Collection-adherence to the proper collection time→ the
City of Manila coordinates with Leonel Waste
Management (a private firm which collects garbage)
where the truck driver coordinates with the Barangay
Chairman on the time they will collect garbage so don’t
bring out garbage before the collection time

WAYS OF DISPOSAL

Household
○ Burial
► Deposited in 1m x 1m deep pits covered with
soil, located 25 m. away from water supply

○ Open burning
o  Animal feeding
o  Composting
o  Grinding and disposal sewer

WAYS OF DISPOSAL

Community
○ Sanitary landfill or controlled tipping
► Excavation of soil deposition of refuse and compacting
with a solid cover of 2 feet

○ Incineration
Ecological Solid Waste Management: RA 9003- the use of
incinerator approved in 2000 but was implemented in 2003
because of lack of funding to purchase

POLICIES:
ü  Food establishment are subject to inspection
(approved of all food sources containers and
transport vehicles)
ü  Comply with sanitary permit requirement
ü  Comply with updated health certificates for food
handlers, helpers, cooks
ü  All ambulant vendors must submit a health
certificate to determine present of intestinal parasite
and bacterial infection

3 POINTS OF CONTAMINATION

ü Place of production processing and source of
supply
ü Transportation and storage
ü Retail and distribution points

5. HOSPITAL WASTE MANAGEMENT

RA 4226-Hospital Licensure Act monitors the
hospital license & proper management of
wastes as well as renewal of license to
operate

GOAL:

To prevent the risk of contraction contracting
nosocomial infection from type disposal of
infectious, pathological and other wastes from
hospital

COLOR CODING OF BIN TO KEEP WASTE:

Green: wet waste
Black : dry waste
Yellow: infectious/pathological waste like blood,
sputum, urine, feces & gauze
Orange: toxic/hazardous waste

Community Health Nursing Overview

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