I.

COMMUNICABLE DISEASES

A. Tuberculosis – a highly infectious chronic diseases caused by the TB bacilli. It is

primarily a respiratory disease common among malnourished individuals living in
crowded areas. It often occurs among children in underdeveloped and developing
countries.

The Strengthened National Tuberculosis Control Program

General Objective – To control tuberculosis, which is a public health problem, by the

year 2000 through the reduction of:

 Annual Risk of Infection from 2.5% to 1.0%

 Prevalence Rate from 6.6 to 1.9 per 1000 population
 Mortality Rate due to Tuberculosis from 39.4 to 19.2 per 100,000 population

Specific Objectives:

1. To vaccinate with BCG the eligible population under the Expanded Program
for Immunization scheme in towns, schools, clinics and hospitals with at least
90% coverage.

2. To identify at least 45%, the prevalence of infectious cases annually.

3. To treat effectively and adequately all sputum positive cases including those
with moderate and far advanced radiographic abnormalities with cavitary lung
lesion for a period of 6 months with the use of the short course chemotherapy.

Nursing Responsibilities:

1. BCG vaccination of newborn, infants and grade I/school entrants.

2. Educate the public in mode of spread and methods of control and the importance
of early diagnosis.

3. Improve social conditions, which increase the risk of becoming infected, such as
overcrowding.

4. Make available medical, laboratory and x-ray facilities for examination of

patients, contacts and suspects and facilities for early treatment of cases and
persons at high risk of infection and beds for those needing hospitalization.

5. Provide public health nursing and outreach services for home supervision of
patients to supervise therapy directly and to arrange for examination and
preventive treatment of contacts.
B. Pneumonias – an acute infectious disease of the lings usually caused by the
pneumococcus resulting in the consolidation of one or more lobes of either one or both
lungs.

Control of Acute Respiratory Infections (CARI)

 Acute Respiratory Infections (ARI) especially pneumonia remains to be the

leading cause of illness and death among Filipino children. In 1989, which was the
launching year of the Program for the Control of Acute Respiratory Infections (CARI),
almost 25,000 children aged under five died de to pneumonia alone.

General Objective – The CARI program is mandated to reduce mortality due to

pneumonia among under fives by 25% from baseline levels by year 2000. It hopes to
accomplish this through the following strategies:

1. Training government and private health workers in the standard management

of ARI.

2. Enabling BHWs to identify pneumonia cases, refer cases for treatment and
educating patients and caretakers.

3. Assuring the adequate supply of antibiotics and other essential drugs.

4. Teaching parents and communities on how to recognize symptoms of

pneumonia and other ARI.

5. Mobilizing non-government organizations and field workers to communicate

with parents and communities.

6. Advocacy and social mobilization to gain the support of local government

officials, NGOs, private and educational institutions.

Nursing Responsibilities

1. Bedrest
2. Adequate salt, calorie and vitamin intake. Water requirement increases
because of fever, sweating and increased respiratory rate. Plasma chlorides
tend to fall in pneumonia, hence sodium chloride should be given by mouth or
by vein if necessary.
3. Adequate urine output is essential for excretions of toxins and for avoidance
of serious urinary complications due to medications.
4. Adequate caloric and vitamin (Vitamin C).
5. Tepid sponge for fever
6. Frequent turning from side to side
7. Antibiotics based on CARI of DOH.
C. Diarrheal Diseases - a major cause of mortality in the Philippines. Over the past 20
years, it has ranked 1st to 4th leading cause of morbidity and mortality. Among children
under the age of five, it is a major cause of illness and death.

Control of Diarrheal Diseases (CDD)

 Diarrheal disease in general and in particular among children under five is a

serious public health and development problem. In view of this, the DOH launched a
national program to control diarrheal disease (CDD) in 1980.

Objectives:

To reduce mortality from diarrhea particularly among children under five through
extensive case management utilizing oral rehydration therapy (ORT), environmental
sanitation, maternal and child health, nutrition and health education activities.

Nursing Responsibilities

1. Assist mothers in breastfeeding

2. Improved weaning practices

3. Use plenty of clean water

4. Facilitate Proper Handwashing

5. Use of latrines

6. Proper disposal of babies’ stools

7. Measles immunization

8. Convince and help community members to adopt the practices and to continue
the practice them on an on-going basis.
D. Malaria – continues to be a major health problem in the country having an annual
parasite incidence of 5.1/1000 population, In 1994, it was aimed that there be a 20%
reduction in morbidity annually. The nature of malaria as a public health problem
requires sustained and systematic efforts towards two major strategies, namely prevention
and transmission through vector control and the detection and early treatment of cases to
reduce morbidity and prevent mortality.

Malaria Control Service – Sustainable Preventive and Vector Control Measures

 refer to the adoption of measures for the prevention and control against the
malaria parasite and the mosquito vector. Such measures being affordable, applicable and
appropriate under our local conditions so that these measures can be sustained throughout
the duration of malaria control operations.

Objective: To reduce the source of infection in the human populations-vector contact and
the density of the mosquito vector population.

Nursing Responsibilities:

1. Wearing of clothing that covers arms and legs in the evening.

2. Avoiding outdoor night activities, particularly during vector’s peak biting

hours from 9 pm to 3 am.

3. Using mosquito repellents such as mosquito coils, soap lotion, or other

personal application measures advocated by DOH/MCS

4. Planting of Neem tree which are mosquito repellents.

5. Zooprophylaxis-typing of domestic animals near human dwellings to deviate

mosquito bites from man to these animals.

6. All cases should be given drug treatment and followed-up until clinically
found negative.

7. Continuous surveillance measures should be implemented.

E. Measles – an acute highly communicable infection characterized by fever, rashes and
symptoms referable to upper respiratory tract. Death is due to complication, e.g.
secondary pneumonia usually in children under 2 yrs. old. Measles is severe among
malnourished children with fatality 95-100%.

Expanded Program on Immunization (EPI) – was launched in July 1976 by DOH in

cooperation with WHO and UNICEF.
Presidential Proclamation No.4 (July 29,1998) – “ declaring the period from
September 16 – October 14,1998 as the Ligtas Tigdas Month” and launching the
Philippines Measles Elimination Campaign.

Objective: To reduce the morbidity and mortality among infants and children caused by
the six childhood communicable diseases. (measles, diphtheria, polio, hepatitis, etc.)

Principles :
1. The program is based in epidemiological situation; the schedules are
drawn on the basis of the occurrence and characteristic
epidemiological features of the disease.
2. The whole community rather than just the individual is to be protected,
thus mass approach is utilized.
3. Immunization is a basic health service and such it is integrated in to
the health services being provided for by the RHU.
Elements:
• Target Setting
• Cold chain logistic management
• Information, Education and Communication
• Assessment and Evaluation of the Program’s Overall Performance
• Surveillance, studies and research

Nursing Responsibilities:

1. Emphasize the need for immediate isolation when early catarrhal symptoms
appear.

2. If immune serum globulin is available ( gamma Globulin), explain this to the

family and refer to the physician or clinic giving the service.

3. Observe closely the patient for complications during and after the acute stage.

4. Teach, demonstrate, guide and supervise adequate nursing care indicated.

5. Explain proceedings in proper disposal of nose and throat discharges.

6. Teach concurrent and terminal disinf

 II. NON-COMMUNICABLE DISEASES

A. Cardiovascular Diseases (CVD) – have become the greatest threat to Filipinos today.
CVD have varied and multi causes and risk factors, ranging from infectious agents,
environmental and constitutional causes, some inherited and some acquired.

A.1 Congenital Heart Disease (CHD) – by far the most prevalent type of heart
disease among children. They may involve the heart and its great vessels alone or may
exist together with abnormalities in other systems.
A.2 Rheumatic Fever/Rheumatic Heart Disease (RHD) - an auto-immune
disease, that is, the patient develops antibodies which react to the body’s own antigens in
the connective tissues of the heart, as well as in other systems.
A.3 Hypertension – is a persistent elevation of the arterial blood pressure.
Hypertension is very common chronic condition which affects a significant proportion of
adult population and which makes an important contribution to human mortality.
A.4 Ischemic Heart Disease- usually caused by the occlusion of the coronary
arteries by thrombus formation in areas of narrowing and hardening in these arteries.

Cardiovascular Disease Control Program

General Strategies of Disease Control:
1. promote the factors that prevent the occurrence of impede the progression of
the disease, and
2. remove/diminish the factors that cause or contribute to the occurrence and
progression of the disease.
In Cardiovascular Disease Control, efforts should be concentrated on primary
prevention. Prevention of CVD occurrence:
1. Spare the individual from a lifetime of pain, suffering and limited activity,
from unfulfilled dreams, or early death because of the progressive nature of the disease.
2. Spare the family from tremendous expense, abnormal family life and anguish.
3. Spare the community from huge capital and operating expenses for medical
facilities for the chronically ill CVD patients and from unhealthy and unproductive
members who otherwise can contribute to community development.
Specific protection from CVD is also achieved by the removal of the risk factors
or reduction in their levels.

Nursing Responsibilities

1. Maintenance of Ideal Body Weight

Weight control is useful for preventing and correcting high blood pressure and
diabetes. The goal of the body weight should be within 15% of desirable weight.
2. Diet and Modification of Dietary Fats
 Dietary education must be initiated. Dietary changes recommended for obese
individuals with or without hypertension.
3. Smoking/Tobacco Avoidance
 Complete cessation of cigarette smoking should be advised to all individuals, whether
he/she is hypertensive or not and particularly those with special risk of CHD. Nicotine
increases blood pressure activity
4. Exercise
 regular exercise programs, facilitate weight control and increase cardiopulmonary
stamina.
5. Monitor non-pharmacological methods and drug administration.

B. Cancer – ranks third in leading cause of morbidity and mortality in the Philippines. A
disturbance of growth characterized primarily by an excessive proliferation of cells
without apparent relation to the physiological demands of the organ involved.

Cancer Control Program (CCP) – presently the two most important modes recognized
in the reduction of cancer incidence are prevention and early detection.One-third of all
cancers are curable if detected early and treated properly. Treatment of cancer needs a
multi-disciplinary team approach.

There are three major forms of treatment of cancer:

1. Surgery
2. Radiation Therapy
3. Chemotherapy

Cancer that cannot be detected early, which is usually present at an advanced

stage at diagnosis and which can be cured, can be offered supportive or palliative care.
This is the active, holistic care of patients and their families given by a multi-disciplinary
team of physicians, nurses, nutritionists, etc.

The DOH-PCCP has supported the Palliative Care of Filipino Cancer Patients by
providing free morphine tablets to indigent patients, particularly in government hospitals.
The DOH-PCCP also support Philippine Cancer Society, Inc.-Hospice Care Program,
recognizing at as the first and lead agency.

Nursing Responsibilities
 1. Refer immediately any case of suspected disease to physician.
2. Share with patient and family knowledge on available resources for accurate
diagnosis and adequate treatment.
3. Assist and guide families in availing of existing health resources and facilities.
4. Record history of symptoms , which will help physician arrive at an accurate
diagnosis.
5. Assist physician in the performance of examinations and diagnosis test as aids
to diagnosis and treatment.
6. Conduct nursing demonstrations to patient or families on proper nursing care,
particularly on post-operative care of discharged hospital cases and terminal
cancer patients who have to be taken care of at home.
7. Assist the patient and family in making necessary adjustment and developing
proper attitudes towards prescribed treatment.
8. Provide guidance, counseling and supervision in the management of case at
home.
9. Participate in the planning and implementation of rehabilitation program for
post-op and other cases in need of this service.
10. Help patient and family understand the most important facts about cancer.
11. Conduct and participate in health education programs on cancer for allied
health workers and the general public.
C. Kidney Diseases – there are about 6,500 yearly deaths in the country secondary to
various kidney diseases. Renal diseases threaten to be one of the leading causes of death
if there will not be an effective prevention and control programs to address the problem.

Preventive Nephrology Program – reduce the occurrence of kidney diseases and end-
stage renal diseases to 3000 cases a year. Increase awareness and practice of preventing
renal diseases among high risk groups to 80%. Increase awareness on signs and
symptoms of kidney diseases. Improve access and median waiting time for renal
transplantation.

Nursing Responsibilities

1. Increase awareness and practice of preventing renal disease through:

 adequate water intake

 balanced diet
 good personal hygiene
 regular exercise
 regular BP check-up
 complete immunization for infants and children
 proper management of throat and skin infections
 yearly urinalysis
2. Increase awareness of signs and symptoms of kidney disease as edema and
high blood pressure.

3. Routine screening for urinary tract infection, diabetes and kidney diseases.