COMMUNITY

HEALTH
NURSING in
the
Philippines
 (Mark 10:45)

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

3. Research in the Community

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

Provincial Level
1.Governor- chair
2. Provincial Health Officer – vice
chair
3. Chair , Committee on Health of
Sangguniang
Panlalawigan
4. DOH rep.
5. NGO rep.
 Composition of LHB

City and Municipal Level

2. Mayor – chair
2. MHO – vice chair
3. Chair, Committee on Health of
Sangguniang
Bayan
4. DOH rep
5. NGO rep
 EFFECTIVE LHS DEPENDS ON:

1. the LGU’s financial capability

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

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

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

P.D. No. 651 – requires that all

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

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

functions of POPCOM
• RA 4073 – advocates home treatment
for leprosy

• Letter of Instruction No. 949 –

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

• Ministry Circular No. 2 of 1986 –

includes AIDS as notifiable disease
R.A. 7875 – National Health Insurance
Act
R.A. 7432 – Senior Citizens Act
R. A. 7719 - National Blood Services
Act
R.A. 8172 – Salt Iodization Act
( ASIN LAW)
R.A. 7277- Magna Carta for PWD’s,
provides their rehabilitation, self-
development and self-reliance and
integration into the mainstream of
• A. O. No. 2005-0014- National
Policies on Infant and Young Child
Feeding:
1.All newborns be breastfeed within 1
hr after birth
2. Infants be exclusively breastfeed
for 6 mos.
3. Infants be given timely, adequate
and safe complementary foods
4. Breastfeeding be continued up to 2
years and beyond
• EO 51- Phil. Code of Marketing of
Breastmilk Substitutes
• R.A.- 7600 – Rooming In and
Breastfeeding Act of 1992
• R.A. 8976- Food Fortification Law
• R.A. 8980- prolmulgates a
comprehensive policy and a national
system for ECCD
• A..O. No. 2006- 0015- defines the
Implementing guidelines on Hepatitis
B Immunization for Infants
• R.A. 7846- mandates Compulsory
Hepatitis B Immunization among
infants and children less than 8 yrs
old
• R.A. 2029- madates Liver Cancer and
Hepatitis B Awareness Month Act
( February)
• A.O. No. 2006-0012- specifies the
Revised Implementing Rules and
Regulations of E.O. 51 or Milk Code,
Relevant International Agreements,
Penalizing Violations thereof and
for other purposes
 Public Health
• -” science and art of preventing diasease,
prolonging life, promoting health and
efficiency thru’ organized community
effort for the sanitation of the
environment, control of communicable
diseases, the education of individuals in
personal hygiene, the organization of
medical and nursing services for the
early diagnosis and preventive treatment
of diseases and the development of social
machinery to ensure everyone a standard of
living adequate for the maintenance of
health, so organizing these benefits as to
enable every citizen to realize his
birthright off birth and longevity” ( DR.
C.E. Winslow)
 Community Health Nursing

• - special field of nursing that

combines the skills of nursing,
public health and some phases of
social assistance and functions as
part of the total public health
program for the promotion of health,
the improvement of the conditions in
the social and physical environment,
rehabilitation of illness and
disability ( WHO Expert Committee of
Nursing )
 CHN

• - a learned practice discipline with the

ultimate goal of contributing as
individuals and in collaboration with
others to the promotion of the client’s
optimum level of functioning thru’
teaching and delivery of care ( Jacobson )
• - a service rendered by a professional
nurse to IFCs, population groups in health
centers, clinics, schools , workplace for
the promtion of health, preventionof
illness, care of the sick at home and
rehabilitation (DR. Ruth B. Freeman)
 Concepts
• The primary focus of community health
nursing is health promotion.
• Community health nurses provide care
necessary to meet the requirements of an
individual all throughout the life
cycle.
• Knowledge on different fields
(biological and social sciences,
clinical nursing, and community health
organizations) is used.
• Nursing process in community health
nursing changes based on the needs of
the community.
 Goal
• To elevate the level health of the
multitude.
Philosophy
• Worth and dignity of man.

Principles
1.The need of the community is the basis
of community health nursing.
2.The community health nurse must
understand fully the objectives and
policies of the agency she represents.
3. The family is the unit of service.
4. CHN must be available to all regardless
of race,creed and socioeconomic status
5. The CHN works as a member of the health
team
6. There must be provision for periodic
evaluation of community health nursing
services
7. Opportunities for continuing staff
education programs for nurses must be
provided by the community health
nursing agency and the CHN as well
8. The CHN makes use of available
community health resources
9. The CHN taps the already existing active organized
groups in the community
10. There must be provision for educative supervision in
community health nursing
11. There should be accurate recording and reporting in
community health nursing
12. Health teaching is the primary responsibility of the
community health nurse
 Standards in CHN

I. Theory
Applies theoretical concepts as
basis for decisions in practice
II. Data Collection
Gathers comprehensive , accurate
data systematically
 Standards

III. Diagnosis
Analyzes collected data to determine
the needs/ health problems of IFC
IV. Planning
At each level of prevention, develops
plans that specify nursing actions
unique to needs of clients
 Standards

V. Intervention
Guided by the plan, intervenes to
promote, maintain or restore health,
prevent illness and institute
rehabilitation
VI. Evaluation
Evaluates responses of clients to
interventions to note progress
toward goal achievement, revise data
base, diagnoses and plan
 Standards

VII. Quality Assurance and

Professional Development
Participates in peer review and
other means of evaluation to assure
quality of nursing practice
Assumes professional development
Contributes to development of others
 Standards

VIII. Interdisciplinary Collaboration

Collaborates with other members of

the health team, professionals and
community representatives in
assessing, planning, implementing
and evaluating programs for
community health
 Standards

I. Research
Indulges in research to contribute to
theory and practice in
community health nursing
 LEVELS OF CARE/ PREVENTION

• 1. PRIMARY

• 2. SECONDARY

• 3. TERTIARY
 Types of Clientele

• 1. INDIVIDUALS
• 2. FAMILIES
• 3. COMMUNITIES
• 4. POPULATION GROUPS
- Aggregate of people who share common
characteristics, developmental stage or
common exposure to particular
environmental factors thus resulting in
common health problems ( Clark, 1995:5)
e.g. children . elderly, women, workers
etc.
 Phil.Health Care Delivery
System
• 1.PRIMARY LEVEL FACILITIES

• 2. SECONDARY LEVEL FACILITIES

• 3. TERTIARY LEVEL FACILITIES

Classify as to what level the ff.
belong
• 1. Teaching and Training Hospitals
• 2. City Health Services
• 3. Emergency and District Hospitals
• 4. Private Practitioners
• 5. Heart Institutes
• 6. Puericulture Centers
• 7. RHU
THE DEPARTMENT OF HEALTH

VISION: Health for all Filipinos

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

• May 1977    -30th World Health Assembly

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

• Magnitude of Health Problems

• Inadequate and unequal
distribution of health resources
• Increasing cost of medical care
• Isolation of health care
activities from other development
activities
 ☛DEFINITION OF PRIMARY HEALTH CARE

 essential health care made universally

accessible to individuals and families
in the community by means acceptable to
them, through their full participation
and at cost that the community can
afford at every stage of development.
a practical approach to making health
benefits within the reach of all people.
an approach to health development, which
is carried out through a set of
activities and whose ultimate aim is the
continuous improvement and maintenance
of health status of the community.
 GOAL OF PRIMARY HEALTH CARE:
HEALTH FOR ALL FILIPINOS by the year 2000
AND HEALTH IN THE HANDS OF THE PEOPLE by the year
2020.

An improved state of health and quality of

life for all people attained through
SELF-RELIANCE.
 KEY STRATEGY TO ACHIEVE THE GOAL:
Partnership with and Empowerment of the
people - permeate as the core strategy in the
effective provision of essential health
services that are community based, accessible,
acceptable, and sustainable, at a cost, which
the community and the government can afford.
 OBJECTIVES OF PRIMARY HEALTH CARE
∀ • Improvement in the level of health care of the
community
∀ • Favorable population growth structure
∀ • Reduction in the prevalence of preventable,
communicable and other disease.
∀ • Reduction in morbidity and mortality rates especially
among infants and children.
∀ • Extension of essential health services with priority
given to the underserved sectors.
∀ • Improvement in Basic Sanitation
∀ • Development of the capability of the community aimed
at self-reliance.
∀ • Maximizing the contribution of the other sectors for
the social and economic development of the community.
 MISSION:
• To strengthen the health care
system by increasing opportunities
and supporting the conditions
wherein people will manage their
own health care.
TWO LEVELS OF PRIMARY HEALTH CARE WORKERS
3. Barangay Health Workers - trained community
health workers or health auxiliary volunteers
or traditional birth attendants or healers.
4. Intermediate level health workers include the
Public Health Nurse, Rural Sanitary Inspector
and midwives.
 PRINCIPLES OF PRIMARY HEALTH CARE

∀ 1. 4 A's = Accessibility,

Availability, Affordability &
Acceptability, Appropriateness of
health services. The health services
should be present where the supposed
recipients are. They should make use
of the available resources within the
community, wherein the focus would be
more on health promotion and prevention
of illness.
∀ 2.  COMMUNITY PARTICIPATION
=heart and soul of PHC
• 3. People are the center, object and
subject of development.
• Thus, the success of any undertaking that aims
at serving the people is dependent on people’s
participation at all levels of decision-making;
planning, implementing, monitoring and
evaluating. Any undertaking must also be based
on the people’s needs and problems (PCF, 1990)
• Part of the people’s participation is the
partnership between the community and the
agencies found in the community; social
mobilization and decentralization.
• In general, health work should start from where
the people are and building on what they have.
Example: Scheduling of Barangay Health Workers
in the health center
 BARRIERS OF COMMUNITY INVOLVEMENT

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

It enhances people participation or

governance, support system
provided by the Government,
networking and developing
secondary leaders.

8. DECENTRALIZATION
 MAJOR STRATEGIES OF PRIMARY HEALTH CARE
A. ELEVATING HEALTH TO A COMPREHENSIVE AND SUSTAINED
NATIONAL EFFORTS.

• Attaining Health for all Filipino will

require expanding participation in health and
health related programs whether as service
provider or beneficiary. Empowerment to
parents, families and communities to make
decisions of their health is really the
desired outcome.
• Advocacy must be directed to National and
Local policy making to elicit support and
commitment to major health concerns through
legislations, budgetary and logistical
considerations.
B. PROMOTING AND SUPPORTING COMMUNITY MANAGED HEALTH
CARE

The health in the hands of

the people brings the
government closest to the
people. It necessitates a
process of capacity building
of communities and
organization to plan,
implement and evaluate health
programs at their levels.
C. INCREASING EFFICIENCIES IN THE HEALTH SECTOR

• Using appropriate technology will

make services and resources required for
their delivery, effective, affordable,
accessible and culturally acceptable.
The development of human resources must
correspond to the actual needs of the
nation and the policies it upholds such
as PHC. The DOH will continue to
support and assist both public and
private institutions particularly in
faculty development, enhancement of
relevant curricula and development of
standard teaching materials.
D. ADVANCING ESSENTIAL NATIONAL HEALTH
RESEARCH

Essential National Health

Research (ENHR) is an
integrated strategy for
organizing and managing
research using
intersectoral, multi-
disciplinary and scientific
approach to health
programming and delivery.
• FOUR CORNERSTONES/ PILLARS IN PRIMARY
HEALTH CARE
1.      Active Community Participation
2.      Intra and Inter-sectoral
Linkages
3.      Use of Appropriate Technology
4.      Support mechanism made
available
 HERBAL MEDICINES ENDORSED BY THE DEPARTMENT OF
HEALTH

Name Indication Dosage

s
1.Five-leaf 1. Asthma •Divide the
Chaste tree 2. Cough decoction into 3
parts:
(Lagundi) 3. Body Pain
For asthma and
4. Fever
cough, drink 1 part
3 times a day.
For fever and body
pains, drink 1 part
every 4 hrs.
2. Marsh- 1. Body pain •Divide
Mint; decoction
Peppermint into 2 parts
(Yerba and drink 1
Buena) part every 3
hours.

3. Sambong 1. Swelling •Divide

2. Inducing decoction
diuresis into 3 parts
and drink 1
( anti- part 3 times
urolithia a day.
sis)
4. Tsaang 1. Stomachache •Drink the warm
Gubat decoction. If
it persists, or
if there is no
improvement an
hour after
drinking the
decoction,
consult a
doctor.
5. 1. Gouty •Divide the
Ulasimang Arthritis decoction into 3
Bato/Pansi parts and drink
t- 1 part 3 times a
Pansitan day after meals.
6. Garlic 1. Hypertension •Eat 6 cloves
2. Htperlipidemia of garlic
together with
meals
7. Niyog- 1. Ascariasis •Chew and
Niyogan
swallow only
dried seeds 2
hours after
dinner
according to
the following:
• ADULTS = 8-10

seeds
9-12 y/o = 6-7
8. Guava 1. Cleaning •For wound cleaning,
wounds use decoction for
2. Mouth wash washing the wound 2
for mouth times a day
infection, •For tooth decay and
sore gums & swelling of gums,
tooth decay gargle with warm
decoction 3 times a
day
9.  Ring worm •Apply the juice on the
Akapulko  Athlete’s affected area 1 to 2 times a
foot
day
 Scabies
•If the person develops an
allergy while using the above
preparation, prepare the
following:
oPut 1 cup of chopped fresh
leaves in an earthen jar. Pour
in 2 glasses of water and cover
it.
oBoil the mixture until the 2
glasses of water originally
poured have been reduced to 1
glass of water
oStrain the mixture. Use it
10. 1. Mild •Drink ½
Bitter Non- cup of
Gourd/ Insulin cooled or
Melon Dependen warm
t decoction
(Ampalaya) Diabetes 3 times a
Mellitus day after
meals.
11. 1. Motion •An abortifacient if
Ginger sickness, taken in large
(Zingibe sore amounts; should not be
r throat, used by persons with
officina nausea & cholelithiasis unless
le) vomiting, directed by the
migraine physician; may
headaches, increase the risk of
arthritis bleeding when used
concurrently with
anticoagulants &
antiplatelets.
•Chop and Mash a piece of
ginger root, and mix in a
glass of water
•Boil the mixture
•Drink the cooled or warm
decoction as needed.
 ELEMENTS OF PRIMARY HEALTH CARE:

Education For Health

Is one of the potent
methodologies for information
dissemination. It promotes the
partnership of both the family
members and health workers in
the promotion of health as well
as prevention of illness.
Loca lly En demic Disea se
Co ntrol
The control of endemic
disease focuses on the
prevention of its occurrence
to reduce morbidity rate.
Example Malaria Control and
Schistosomiasis Control
 Expanded Program on Immunization

This program exists to control the

occurrence of preventable illnesses
especially of children below 6 years old.
Immunizations on poliomyelitis, measles,
tetanus, diphtheria and other preventable
disease are given for free by the government
and ongoing program of the DOH
 Maternal and Child Health and
Family Planning
The mother and child are the most
delicate members of the
community. So the protection
of the mother and child to
illness and other risks would
ensure good health for the
community. The goal of Family
Planning includes spacing of
children and responsible
parenthood.
 Environmental Sanitation and
Promotion of Safe Water Supply
Environmental Sanitation is defined
as the study of all factors in the
man’s environment, which exercise or
may exercise deleterious effect on his
well-being and survival.
Water is a basic need for life and one
factor in man’s environment. Water is
necessary for the maintenance of
healthy lifestyle.
Safe Water and Sanitation is necessary
for basic promotion of health.
Nutrition and Promotion of Adequate
Food Supply
One basic need of the family is
food. And if food is properly
prepared then one may be assured
healthy family. There are many food
resources found in the communities
but because of faulty preparation
and lack of knowledge regarding
proper food planning, Malnutrition
is one of the problems that we have
in the country.
Treatment of Communicable Diseases
and Common Illness
The diseases spread through direct
contact pose a great risk to those
who can be infected. Tuberculosis is
one of the communicable diseases
continuously occupies the top ten
causes of death. Most communicable
diseases are also preventable. The
Government focuses on the prevention,
control and treatment of these
illnesses.
 Supply of Essential Drugs
This focuses on the information campaign on the
utilization and acquisition of drugs.
In response to this campaign, the GENERIC
ACT of the Philippines is enacted . It
includes the following drugs: Cotrimoxazole,
Paracetamol, Amoxycillin, Oresol, Nifedipine,
Rifampicin, INH(isoniazid) and
Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine
 FAMILY HEALTH NURSING

• - that level of CHN practice

directed to the FAMILY as the unit
of care with HEALTH as the goal and
NURSING as the medium, channel or
provider of care
 Family Case Load

• - the no. and kind of families a

nurse handles at any given time
• - variable for cases are added or
dropped based on the need for
nursing care and supervision
 Types of Families

• 1. Nuclear
• 2. Extended
• 3. Three generational
• 4. Dyad
• 5. Single- Parent
• 6. Step- Parent
• 7. Blended or reconstituted
 Types of Families

• 8. Single adult living alone

• 9. Cohabiting/ Living –in
• 10. No- kin
• 11. Compound
• 12. Gay
• 14. Commune
 Stages of Family Life Cycle
• 1. Newly married couple
• 2. Childbearing
• 3. Preschool age
• 4. Schoolage
• 5. Teenage
• 6. Launching
• 7. Middle-aged ( empty nest –retirement)
• 8. Period from retirement to Death of both
spouses
 HEALTH TASKS OF THE FAMILY(
Freeman, 1981)
• 1. recognizing interruptions of health or
development
• 2. seeking health care
• 3. managing health and non-health crises
• 4. providing nursing care to the sick,
disabled and dependent member of the
family
• 5. maintaining a home environment
conducive to good health and personal
development
• 6. maintaining a reciprocal relationship
with the community and health institutions
 Family Nursing Problem

• Arises when the family cannot

effectively perform its health tasks
 Nurse’s Roles in Family
Health Nursing

• 1. HEALTH MONITOR
• 2. PROVIDER OF CARE TO A SICK
FAMILY MEMBER
• 3. COORDINATOR OF FAMILY
SERVICES
• 4. FACILITATOR
• 5. TEACHER
• 6. COUNSELOR
 INITIAL DATA BASE FOR FAMILY
NURSING PRACTICE
• Family structure,
Characteristics, and Dynamics
2. Members of the household and
relationship to the head of the
family
3. Demographic data – age, sex, civil
status, position in the family
4. Place of residence of each member –
whether living with the family or
elsewhere
4. Type of family structure – e.g.
matriarchal or patriarchal,
nuclear or extended
2. Dominant family members in terms
of decision-making, especially in
matters of health care
3. General family
relationship/dynamics – presence
of any readily observable
conflict between members;
characteristics communication
patterns among members
• Socio-economic and Cultural
Characteristics
2. Income and Expenses
– Occupation, place of work and
income of each working members
– Adequacy to meet basic necessities
– Who makes decisions about money
and how it is spent
3. Educational attainment of each
other
4. Ethnic background and religious
affiliation
1.Significant Others –
role(s) they play in
family’s life
2. Relationship of the
family to larger
community – Nature and
extent of participation
of the family in
community activities
 • Home and Environment
2. Housing
– Adequacy of living peace
– Sleeping arrangement
– Presence of breeding or resting sites of
vectors of diseases
– Presence of accidents hazards
– Food storage and cooking facilities
– Water supply – source, ownership,
portability
– Toilet facility – type, ownership,
sanitary condition
– Drainage system – type, sanitary
condition
1.Kind of neighborhood,
e.g. congested, slum,
etc.
2.Social and health
facilities available
3.Communication and
transportation
facilities available
 • Health Status of each Family
Member
2. Medical and nursing history
indicating current or past
significant illnesses or beliefs and
practices conducive to health
illness
3. Nutritional assessment
– Anthropometric data: Measures of
nutritional status of children, weight,
height, mid-upper arm circumference:
Risk assessment measures of obesity:
body mass index, waist circumference,
waist hip ratio
– Dietary history specifying quality and
quantity of food/nutrient intake per day
– Eating/ feeding habits/ practices
3. Developmental assessments of
infants, toddlers, and preschoolers –
e.g., Metro Manila
4. Risk factor assessment indicating
presence of major and contributing
modifiable risk factors for specific
lifestyles, cigarette smoking,
elevated blood lipids, obesity,
diabetes mellitus, inadequate fiber
intake, stress, alcohol drinking and
other substance abuse
5. Physical assessment
indicating presence of
illness state/s
6. Results of laboratory/
diagnostic and other
screening procedures
supportive of assessment
findings
 • Values, Habits, Practices on
Health Promotion, Maintenance
and Disease Prevention.
Examples include:
3. Immunization status of family
members
4. Healthy lifestyle practices.
Specify.
5. Adequacy of:
– rest and sleep
– exercise
– use of protective measures- e.g.
adequate footwear in parasite-infested
areas;
– relaxation and other stress management
activities
6. Use of promotive-preventive health
services
A TYPOLOGY OF NURSING PROBLEMS IN
FAMILY NURSING PRACTICE
FIRST-LEVEL ASSESSMENT
 Presence of Wellness Condition – stated
as Potential or Readiness- a clinical or
nursing judgment about a client in
transition from a specific level of
wellness or capability to a higher level.
Wellness potential is a nursing judgment
on wellness state or condition based on
client’s performance, current
competencies or clinical data but no
explicit expression of client desire.
Readiness for enhanced wellness state is
a nursing judgment on wellness state or
condition based on client’s current
competencies or performance, clinical
data explicit expression of desire to
achieve a higher level of state or
function in specific area on health
promotion and maintenance.
• Examples of these are the following:
1. Potential for Enhanced Capability
for:
 Healthy lifestyle – e.g.
nutrition/diet, exercise/ activity
 Health Maintenance
 Parenting
 Breastfeeding
 Spiritual Well-being – process of a
client’s unfolding of mystery through
harmonious interconnectedness that
comes from inner strength/sacred
source/GOD (NANDA 2001)
 Others,
1. Readiness for Enhanced
Capability for:
 Healthy Lifestyle
 Health Maintenance
 Parenting
 Breastfeeding
 Spiritual Well-being
 Others,
I. Presence of Health Threats – conditions
that are conducive to disease, accident
or failure top realize one’s health
potential.
Examples of these are the following:
3. Family history of hereditary condition,
e.g. diabetes
4. Threat of cross infection from a
communicable disease case
1.Family size beyond what
family resources can
adequately provide
2.Accidental hazards
 Broken stairs
 Sharp objects, poison, and
medicines improperly kept
 Fire hazards
1. Faulty nutritional habits or feeding
practices.
Inadequate food intake both in quality
& quantity
Excessive intake of certain nutrients
Faulty eating habits
Ineffective breastfeeding
Faulty feeding practices
1.Stress-provoking
factors –
 Strained marital
relationship
 Strained parent-sibling
relationship
 Interpersonal conflicts
between family members
 Care-giving burden
1. Poor home
condition-
 Inadequate living  Unsanitary
space waste
 Lack of food disposal
storage facilities  Improper
 Polluted water drainage
supply system
 Presence of  Poor
breeding sites of ventilation
vectors of disease  Noise
 Improper garbage pollution
 Air pollution
1. Unsanitary food handling and
preparation
2. Unhealthful lifestyles and personal
habits-
Alcohol drinking
Cigarette smoking
Inadequate footwear
Eating raw meat
Poor personal hygiene
Self-medication
Sexual promiscuity
Engaging in dangerous sports
Inadequate rest
Lack of inadequate exercise
Lack of relaxation activities
Non-use of self protection measures
1. Inherent personal characteristics – e.g.
poor impulse control
2. Health history which induce the occurrence
of a health deficit, e.g. previous history
of difficult labor
3. Inappropriate role assumption – e.g. child
assuming mother's role, father not assuming
his role
4. Lack of immunization/ inadequate
immunization status specially of children
1.Family disunity –
Self-oriented behavior of
member(s)
Unresolved conflicts of
member(s)
Intolerable disagreement
Other
2.Other
I. Presence of Health Deficits –
instances of failure in health
maintenance.
Examples include:
3. Illness states, regardless of
whether it is diagnosed or by
medical practitioner
4. Failure to thrive/ develop
according to normal rate
5. Disability – whether
congenital or arising from
illness; temporary
I. Presence of stress Points/ Foreseeable Crisis
Situations – anticipated periods of unusual demand
of the individual or family in terms of family
resources.
Examples of these include:
3. Marriage 9. Menopause
4. Pregnancy 10. Loss of job
5. Parenthood 11. Hospitalization of
a
6. Additional member family member
7. Abortion 12. Death of a manner
8. Entrance at school 13. Resettlement in a
9. Adolescence new community
10. Divorce 14. illegitimacy
 Second Level Assessment
• Focus on determining family’s capacity to
perform the health tasks
• Statements on family health nursing problem:
c. Inability to recognize the presence of the
condition or problem
d. Inability to make decisions with respect to
taking appropriate health action
e. Inability to provide adequate nursing care to
the sick, disabled , dependent or vulnerable
member of the family
f. Inability to provide a home environment
conducive to health maintenance or personal
development
g. Failure to utilize community resources for
health care
 Scale for Ranking Health
Conditions and Problems according
to priorities
• Criteria:
b. Nature of the condition or problem
presented
( wellness state, health deficit, health
threat, forseeable crisis)
b. Modifiability of the condition or problem
( easily, partially, not modifiable)
c. Preventive Potential (high, moderate ,
low)
d. Salience ( needs immediate attention, not
immediate, not perceived as a problem)
 COMMUNITY HEALTH CARE PROCESS
• Assessment
Purpose : To identify the health needs of the
people
• Planning of nursing actions
Purpose : To act on the determined needs of the
community people
• Implementation
Purpose : To achieve the optimum level of health
of the community people
• Evaluation
Purpose : To determine the effectiveness of health care
programs
 NURSING PROCEDURES
• CLINIC VISIT
- process of checking the client’s health
condition in a medical clinic
• HOME VISIT
- a professional face to face contact
made by the nurse with a patient or the
family to provide necessary health care
activities and to further attain the
objectives of the agency
• BAG TECHNIQUE
-a tool making of the public health bag
through which the nurse during the home
visit can perform nursing procedures
with ease and deftness saving time and
effort with the end in view of rendering
effective nursing care
• THERMOMETER TECHNIQUE
-to assess the client’s health condition
through body temperature reading
• NURSING CARE IN THE HOME
- giving to the individual patient the
nursing care required by his/her
specific illness or trauma to help
him/her reach a level of functioning
at which he/she can maintain
himself/herself or die peacefully in
dignity
• ISOLATION TECHNIQUE IN THE HOME
-done by :
1. separating the articles used by a
client with communicable disease to
prevent the spread of infection:
2. frequent washing and airing of beddings
and other articles and disinfections of
room
3. wearing a protective gown , to be used
only within the room of the sick member
4. discarding properly all nasal and
throat discharges of any member sick
with communicable disease
5. burning all soiled articles if could
be or contaminated articles be boiled
first in water 30 minutes before
laundering
• INTRAVENOUS THERAPY
- insertion of a needle or catheter into
a vein to provide medication and
fluids based on physician’s written
prescription
- can be done only by nurses accredited
by ANSAP
 PRINCIPLES OF HEALTH EDUCATION

• It considers the health status of

the people, which is determined by
the economic and social conscience
of the country.
• It is a process whereby people
learn to improve their personal
habits and attitudes, to work
responsibly for the improvement of
health conditions of the family,
community, and nation.
• It involves motivation,
experience, and change in
conduct and thinking, while
stimulating active interest.
It develops and provides
experience for change in
people’s attitudes, customs,
and habits in relation to
health and everyday living.
• It should be recognized as the
basic function of all health
workers.
• It takes place in the home,
in the school, and in the
community.
• It is a cooperative effort
requiring all categories of
health personnel to work
together in close teamwork
with families, groups, and
the community.
• It meets the needs,
interests, and problems
of the people affected.
• It finds means and ways
of carrying out plans by
encouraging individual
and community
participation.
• It is a slow, continuous
process that involves
constant changes and
revisions until
objectives are achieved.
• Makes use of
supplementary aids and
devices to help with the
verbal instructions.
• It utilizes community
resources by careful
evaluation of the different
services and resources found
in the community.
• It is a creative process
requiring methods and
techniques with various
characteristics, not following
a rigid and flexible pattern.
• It aims to help people make
use of their own efforts and
education to improve their
conditions of living,
• It makes careful evaluation of
the planning, organization,
and implementation of all
health education programs and
activities.
 THE COMMUNITY HEALTH NURSE

• Qualifications
2.Bachelor of Science
in Nursing
3.Registered Nurse of
the Philippines
• Planner/Programmer
2. Identifies needs, priorities, and problems
of individuals, families, and communities
3. Formulates municipal health plan in the
absence of a medical doctor
4. Interprets and implements nursing plan,
program policies, memoranda, and circular
for the concerned staff personnel
5. Provides technical assistance to rural
health midwives in health matters
• Provider of Nursing
Care
2.Provides direct nursing
care to sick or
disabled in the home,
clinic, school, or
workplace
3.Develops the family’s
capability to take care
• Manager/Supervisor
2. Formulates individual, family, group,
and community-centered plan
3. Interprets and implements programs,
policies, memoranda, and circulars
4. Organizes work force, resources,
equipments, and supplies at local
level
5. Provides technical and administrative
support to Rural Health Midwives
(RHM)
6. Conducts regular supervisory visits
and meetings to different RHMs and
gives feedback on accomplishments
• Community Organizer
2. Motivates and enhances
community participation in
terms of planning,
organizing, implementing,
and evaluating health
services
3. Initiates and participates
in community development
activities
• Coordinator of Services
2. Coordinates with
individuals, families, and
groups for health related
services provided by various
members of the health team
3. Coordinates nursing program
with other health programs
like environmental
sanitation, health
education, dental health,
• Trainer/Health Educator
2. Identifies and interprets training
needs of the RHMs, Barangay Health
Workers (BHW), and hilots
3. Conducts training for RHMs and hilots
on promotion and disease prevention
4. Conducts pre and post-consultation
conferences for clinic clients; acts
as a resource speaker on health and
health-related services
5. Initiates the use of tri-media
(radio/TV, cinema plugs, and print
ads) for health education purposes
6. Conducts pre-marital counseling
• Health Monitor
2.Detects deviation from
health of individuals,
families, groups, and
communities through
contacts/visits with
them
• Role Model
2.Provides good
example of
healthful living
to the members of
the community
• Change Agent
2.Motivates changes in
health behavior in
individuals, families,
groups, and communities
that also include
lifestyle in order to
promote and maintain
health
• Recorder/Reporter/Statistician
2. Prepares and submits required reports and
records
3. Maintain adequate, accurate, and complete
recording and reporting
4. Reviews, validates, consolidates, analyzes,
and interprets all records and reports
5. Prepares statistical data/chart and other
data presentation
• Researcher
2. Participates in the conduct of survey
studies and researches on nursing and
health-related subjects
3. Coordinates with government and non-
government organization in the
implementation of studies/research
 Community Organizing

• Approaches to community devt.:

b. Welfare approach
c. Technological approach
d. Transformatory approah
 Community Organizing

• Principles of CO:
• 1. People esp. the oppressed,
exploited and deprived sectors are
most open to change, have the
capacity to change and are able to
bring about change. Hence , CO is
based on the ff:
• A. Power must reside in the people
• B. Devt. is from the people to the
people
• C. People participation
 Principles of CO

• 2.-must be based on the poorest

sectors of society. The solutions of
problems commonly shared by these
sectors must be focused on
collective organizations, planning
and action
• 3. – should lead to self-reliant
communities
 THE HRDP-COPAR PROCESS

• 1. PRE-ENTRY PHASE
• 2. ENNTRY PHASE
• 3. COMMUNITY STUDY/DIAGNOSIS
PHASE/RESEARCH PHASE
• 4.COMMUNITY ORGANIZATION AND
CAPABILITY-BUILDING PHASE
• 5. COMMUNITY ACTION PHASE
• 6. SUSTENANCE AND STRENGTHENING
PHASE
Classify the ff. CO activities as
to phase of COPAR each belong:
• 1.Conducts community meetings to draw up
guidelines for the organization of CHO
• 2. Trains BHWs
• 3. Sets up of linkages/network and
referral systems
• 4. PIME of health services and or
community devt. Projects
• 5. Provides continuing education to
leaders or residents
• 6. Trains secondary leaders
• 7. Selects site for adoption
• 8. Identifies key leaders
 Continued….
• 9. Develops criteria for site selection
• 10. Forms the core group
• 11.Conducts SALT
• 12.Selects members of the research team
• 13. Assists the research team in
presenting results during the general
assembly
• 14. Helps the people identifying the
community needs and health problems
• 15. Facilitates for the formulation and
ratification of the constitution and by-
laws of the organization
Public Health Programs
COMPREHENSIVE MATERNAL AND CHILD
HEALTH PROGRAM

 EPI (Expanded Program on

Immunization)
 CDD (Control of Diarrheal
Diseases)
 CARI (Control of Acute
Respiratory Infections)
 UFC (Under-Five Clinics)
 MC (Maternal Care)
 BF (Breastfeeding)
 MRP (Malnutrition
Rehabilitation Program)
 VAD ( Vitamin A Deficiency)
 IDD/IDA (Iodine Deficiency
Disorders/ Iron Deficiency
Anemia)
 FP (Family Planning)
 EPI (EXPANDED PROGRAM ON IMMUNIZATION)

• TARGET SETTING:
INFANTS 0-12 MONTHS
PREGNANT AND POST PARTUM WOMEN
SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS OLD
 
• OBJECTIVES OF EPI:
TO REDUCE MORBIDITY AND MORTALITY
RATES AMONG INFANTS AND CHILDREN from
SIX CHILDHOOD IMMUNIZABLE DISEASE
• ELEMENTS OF EPI:
 TARGET SETTING
 COLDCHAIN LOGISTIC MANAGEMENT- Vaccine
distribution through cold chain is
designed to ensure that the vaccine
were maintained under proper
environmental condition until the time
of administration.
 IEC
 Assessment and evaluation of Over-all
performance of the program
 Surveillance and research studies
 EXPANDED PROGRAM ON IMMUNIZATION
Vaccine Minimum Age Number Minimum Reason
of 1st Dose of Doses Interval
Between
Doses

 BCG Birth or 1 BCG is given

(Bacillus anytime at the
after earliest
Calmette
birth possible age
Guerin) protects
School against the
entrants possibility
of TB
infection
from the
other family
members
 2. DPT 6 weeks 3 4 weeks An early start
(Diphthe with DPT reduces
ria the chance of
Pertusis severe pertussis
Tetanus)

3. OPV 6 weeks 3 4 weeks The extent of

(Oral protection against
Polio polio is increased
Vaccine) the earlier OPV is
given.
4. 6 weeks 3 4 weeks An early start of
Hepatiti Hepatitis B
s B reduces the chance
of being infected
and becoming a
carrier.
5. 9 months 1 At least 85% of
Measles measles can be
prevented by
immunization at this
age.
 CDD (CONTROL OF DIARRHEAL DISEASES)
MANAGEMENT OF THE PATIENT WITH DIARRHEA

A.   NO DEHYDRATION
• Condition – well, alert
• Mouth and Tongue – moist
• Eyes – normal
• Thirst – drinks normally, not
thirsty
• Tears – present
• Skin pinch – goes back quickly
• TREATMENT PLAN A- HOME TTT.
 THREE RULES FOR HOME
TREATMENT
1.Give the child more fluids than
usual
•   use home fluid such as cereal
gruel
•  give ORESOL, plain water
2.     Give the child plenty of food to prevent
undernutrition
•        continue to breastfeed frequently
•        if child is not breastfeed, give usual
milk
•        if child is less than 6 months and not
yet taking solid food, dilute milk for 2 days
•        if child is 6 months or older and
already taking solid food, give cereal or other
starchy food mixed with vegetables, meat or
fish; give fresh fruit juice or mashed banana
to provide potassium; feed child at least 6
times a day. After diarrhea stops, give an
extra meal each day for two weeks.
3.     Take the child to the health
worker if the child does not get
better in 3 days or develops any
of the following:
•        many watery stools
•        repeated vomiting
•        marked thirst
•        eating or drinking poorly
•        fever
•        blood in the stool
 ORESOL TREATMENT
Age Amount of ORS Amount of ORS to
to give after provide for use at
each loose home
stool
50- 500
< 24 100 ml. ml./day
months
100- 1000 ml./day
2 – 10 200 ml.
years

As much as 2000 ml./day

10 wanted
years
up
B.   SOME DEHYDRATION
• Condition – restless, irritable
• Mouth and Tongue – dry
• Eyes – sunken
• Thirst – thirsty, drinks eagerly
• Tears – absent
• Skin pinch – goes back slowly
• WEIGH PT, TTT. PLAN B
 APPROX. AMT. OF ORS- TO GIVE IN 1ST 4 HRS
AGE WEIGHT ORS
KG ML

4 MOS. 5 200-400

4-11MOS 5-7.9 400-600

12-23MOS 8-10.9 600-800

2-4YRS 11-15.9 800-1200

5-14YRS 16-29.9 1200-2200

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

1. Two problems in CDD

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

 Highest mortality in the first 2

years of life

 Main causes of death in

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

3. For undernutrition, continue

feeding during diarrhea especially
breastfeeding.
 Interventions to prevent diarrhea
1.      breastfeeding

2.      improved weaning practices

3.      use of plenty of clean
water
4.      hand washing
5. use of latrines
6. proper disposal of stools of
small children
7. measles immunization
1. Risk of severe diarrhea 10-30x
higher in bottle fed infants than
in breastfed infants.
2. Advantages of breastfeeding in
relation to CDD
1.Breast milk is sterile
2.Presence of antibodies
protection against diarrhea
3.Intestinal Flora in BF infants
prevents growth of diarrhea
causing bacteria.
1. Breastfeeding decreases
incidence rate by 8-20% and
mortality by 24-27% in infants
under 6 months of age.
2. When to wean?
4-6 months – soft mashed foods
2x a day
6 months – variety of foods 4x
a day
1. Summary of WHO-CDD recommended
strategies to prevent diarrhea
1. Improved Nutrition
- exclusive breastfeeding for the first 4-
6 months of life and partially for at
least one year.
- Improved weaning practices
2.Use of safe water
- collecting plenty of water from the
cleanest source
- protecting water from contamination at
the source and in the home
 3.Good personal and domestic
hygiene
- handwashing
- use of latrines
- proper disposal of stools of
young children
4.Measles immunization
CARI (CONTROL OF ACUTE RESPIRATORY INFECTIONS)

CLASSIFICATION:
A.   NO PNEUMONIA: COUGH OR COLD
1.    No chest in drawing
2.    No fast breathing ( <2 mos- <60/min,2-12 mos.
– less than 50 per minute; 12 mos. – 5 years – less than
40 per minute)
TREATMENT:
1. If coughing more than 30 days, refer for assessment
2. Assess and treat ear problems/sore throat if present
3. Advise mother to give home care
4.Treat fever/wheezing if present
HOME CARE:
1. FEED THE CHILD
3. Feed the child during illness
4. Increase feeding after illness
5. Clear the nose if it interferes with feeding
2. INCREASE FLUIDS
2. offer the child extra to drink
3. Increase breastfeeding
3. SOOTHE THE THROAT AND
RELIEVE THE COUGH WITH A SAFE
REMEDY
4. WATCH FOR THE FOLLOWING SIGNS
AND SYMPTOMS AND RETURN
QUICKLY IF THEY OCCUR
2. Breathing becomes difficult
3. Breathing becomes fast
4. Child is not able to drink
5. Child becomes sicker
B.  PNEUMONIA
1. No chest in drawing
2. Fast breathing ( less than 2 mos- 60/min or more
; 2-12 mos. – 50/min or more; 12 mos. – 5 years –
40/min or more)
TREATMENT
1.Advise mother to give home care
2.Give an antibiotic
3.Treat fever/wheezing if present
4.If the child’s condition gets worst,refer urgently to
hospital; if improving, finish 5 days of antibiotic.
ANTIBIOTICS RECOMMENDED BY WHO
*Co-trimoxazole,
*Amoxycillin, Ampicillin, (p.o)
*or Procaine penicillin (I.M.)
 C. Severe Pneumonia

• Chest indrawing
• Nasal flaring
• Grunting ( short sounds made with
the voice)
• Cyanosis
TTT.
6. Refer urgently to hospital
7. Treat fever ( paracetamol),
wheezing ( salbutamol)
 D. Very Severe Disease

• Not able to drink

• Convulsions
• Abnormally sleepy or difficult to
wake
• Stridor in calm child
• Severe undernutrition
TTT.
Refer urgently to hospital
 ASSESSMENT OF RESPIRATORY INFECTION
ASK THE MOTHER:
2. How old is the child?
3. Is the child coughing? For how long?
4. Age 2 months up to 5 years: Is the child able to
drink?
Age less than 2 months: Has the young infant
stopped feeding well?
6. Has the child had fever? For how long?
7. Has the child had convulsions?
• LOOK, LISTEN:
1.    Count the breaths in one minute.

Age0 Fast Breathing

Less than 2 months 60/minute or more
2 months – 12 months 50/minute or more
12 months – 5 years 40/minute or more
2. Look for chest in drawing.
3. Look and listen for stridor.
Stridor occurs when there is a narrowing of the larynx,
trachea or epiglottis which interferes with air entering
the lungs.
4. Look and listen for wheeze
Wheeze is a soft musical noise which
shows signs that breathing out(exhale) is
difficult.
5. See if the child is abnormally sleepy or
difficult to wake. (Suspect meningitis)
6. Feel for fever or low body temperature.
7. Check for severe under nutrition
 MANAGEMENT OF A CHILD WITH
AN EAR PROBLEM
Classification of Ear Infection
A. MASTOIDITIS – tender swelling behind
the ear (in infants, swelling may be
above the ear)
TREATMENT
1. Antibiotics
2.Surgical intervention
B. ACUTE EAR INFECTION – pus draining
from the ear for less than 2 weeks,
ear pain, red, immobile ear drum
(Acute Otitis Media)
TREATMENT
1.Cotrimoxazole,Amoxycillin,or
Ampicillin
2.Dry the ear by wicking
C. CHRONIC EAR INFECTION – pus draining from
the ear for more than 2 weeks (Chronic Otitis
Media)
TREATMENT
Most important & effective treatment: Keep
the ear dry by wicking.
 Paracetamol maybe given for pain or high
fever.
 Precautions for a child with a draining ear:
 Do not leave anything in the ear such as
cotton, wool between wicking treatments.
 Do not put oil or any other fluid into the
ear.
 Do not let the child go swimming or get water
in the ear.
Maternal and Child Health
Nursing
Philosophy
• Pregnancy, labor and delivery and
puerperium are part of the continuum
of the total life cycle
• Personal, cultural and religious
attitudes and beliefs influence the
meaning of pregnancy for individuals
and make each experience unique
• MCN is FAMILY CENTERED- the
father is as important as the mother
• Goals
• To ensure that expectant mother and
nursing mother maintain good health,
learn the art of child care, has a
normal delivery and bear healthy
children

• That every child lives and grows up in

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

• Tool used when rendering prenatal

care
containing risk factors and danger
signs
*Risk Factors
• 145 cm tall ( 4 ft & 9 inches)
• Below 18 yrs old, above 35 yrs old
• Have had 4 pregnancies
• With TB, goiter, heart disease, DM,
bronchial asthma, severe anemia
• Last baby born was less than 2 years ago
• Previous cesarian section delivery
• History of 2 or more abortions, difficult
delivery, given birth to twins , 2 or more
babies born before EDD, stillbirth
• Weighs less than 45 kgs. or more than 80
kgs.
 *Danger Signs

• 1. any type of vaginal bleeding

• 2. headache, dizziness, blurred
vision
• 3. puffiness of face and hands
• 4. pallor
 Prenatal Care

• Schedule of Visits
• 1st – as early as pregnancy, 1st trimester

• 2nd - 2nd trimester

• 3rd & subsequent visits - 3rd trimester

• More frequent visits for those at risk

with cx
 TETANUS TOXOID IMMUNIZATION SCHEDULE FOR WOMEN

Vaccine Minimum Age Percent Duration of

Interval Protecte Protection
d

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

Dose:0.5ml
Route: Intramuscularly
Site: Right or Left Deltoid/Buttocks
 Components of Prenatal
Visits
• History – taking
• Determination of obstetrical score-
G, P, TPAL,AOG,EDD
• U/A for Proteinuria, glycosuria
and infxtn
• Dental exam
• Wt. Ht. BP taking
• Exam of conjunctiva and palms for
pallor
• Abdominal exam - fundic ht,
Leopold’s maneuver and FHT
• Exam of breasts, face, hands and feet
for edema and neck for thyroid
enlargement
• Health teachings- nutrition, personal
hygiene, common complaints
• Tetanus toxoid immunization
• Iron supplementation – from 5th mo. of
pregnancy - 2 mos. Postpartum
• In goiter endemic areas – iodized
capsule once a year
• In malaria infested areas- prophylactic
Chloroquine ( 150 mg/tab ) 2 tabs/ wk
for the whole duration of pregnancy
 • UNDER FIVE CLINIC
 
The first five years of life form
the foundations of the child’s physical
and mental growth and development.
Studies have shown the mortality and
morbidity are high among this age group.
The Department of Health established
the Under Five Clinic Program to address
this problem.
• PROGRAM OBJECTIVES AND GOALS:

•Monitor growth and development of

the child until 5 years of age.

•Identify factors that may hinder

the growth and development of the
child.
• ACTIVITIES AND STRATEGIES:
1. Regular height and weight determination/
monitoring until 5 years old.
0-1 year old=monthly
1 year old and above =quarterly
2. Recording of immunization, vitamins
supplementation,
deworming and feeding.
3. Provision of IEC materials (ex. Posters,
charts, toys) that promote and enhance child’s
proper growth and development.
4. Provision of a safe and learning – oriented
environment for the child.
5. Monitoring and Evaluation.
• BREASTFEEDING/ LACTATION MANAGEMENT EDUCATION
TRAINING
Breastfeeding practices has been proved to
be very beneficial to both mother and baby thus
the creation of the following laws support the
full implementation of this program:
Executive Order 51
Republic Act 7600
The Rooming-In and Breastfeeding Act of
1992 
• PROGRAM OBJECTIVES AND GOALS:
=Protection and promotion of
breastfeeding and lactation
management education training
ACTIVITIES AND STRATEGIES:
1.FULL IMPLEMENTATION OF LAWS
SUPPORTING THE PROGRAM

A. EO 51 THE MILK CODE – protection and

promotion of breastfeeding to ensure
the safe and adequate nutrition of
infants through regulation of
marketing of infant foods and related
products. (e.g. breast milk
substitutes, infant formulas, feeding
bottles, treats etc. )
B. RA 7600 THE ROOMING –IN and BREASTFEEDING
ACT of 1992
=An act providing incentives to government
and private health institutions promoting
and practicing rooming-in and breast-
feeding.
=Provision for human milk bank.
=Information, education and re-education
drive
=Sanction and Regulation
2. CONDUCT ORIENTATION/ADVOCACY MEETINGS
TO HOSPITAL/ COMMUNITY.
ADVANTAGES OF BREASTFEEDING:
 
MOTHER
∀ •      Oxytocin help the uterus
contracts
∀ •      Uterine involution
∀ •      Reduce incidence of Breast Cancer
∀ •      Promote Maternal-Infant Bonding
∀ •     Form of Family planning Method
(Lactational Amenorrhea) 
BABY
∀ •     Provides Antibodies
∀ •     Contains Lactoferin (binds
with Iron)
∀ •     Leukocytes
∀ •    Contains Bifidus factor-
promotes growth of the
Lactobacillus-inhibits the
growth of pathogenic bacilli
• POSITIONS IN BF THE BABY:
• 1.     Cradle Hold = head and neck are supported
• 2.     Football Hold
• 3.     Side Lying Position
BEST FOR BABIES
REDUCE INCIDENCE OF ALLERGENS
ECONOMICAL
ANTIBODIES PRESENT
STOOL INOFFENSIVE (GOLDEN YELLOW)
EMPERATURE ALWAYS IDEAL
FRESH MILK NEVER GOES OFF
  EMOTIONALLY BONDING
EASY ONCE ESTABLISHED
DIGESTED EASILY
IMMEDIATELY AVAILABLE
NUTRITIONALLY OPTIMAL
GASTROENTERITIS GREATLY REDUCED
• GARANTISADONG PAMBATA (GP)
Garantisadong Pambata is a biannual week
long delivery of a package of health services
to children between the ages of 0-59 months old
with the purpose of reducing morbidity and
mortality among under fives through the
promotion of positive Filipino values for
proper child growth and development.
 
1.     WHAT ARE THE HEALTH SERVICES OFFERED IN GP
AND WHO ARE THE TARGETS?
GP offers the following:
1.1     Routine Health Services:
 Health Dosage Route of Target
Service Administr Populatio
ation n
Vitamin A 200,000 IU Orally 12-59
capsule or 1 by drops months
capsule old,
100,000 IU nationwid
or ½ cap e
or 3 drops 9-12
month old
infants
receiving
AMV
nationwid
Ferrous
Sulfate
(25 mg. 0.3ml(2-6 Orally 2-11 months old
Elemental mos) by infants in
Iron per once a day drops Mindanao area,
ml; 30 ml.   including
Bottle as evacuation
0.6ml(6- centers in armed
taken home
11mos) once conflict areas.
medicine
with a day
instruction
s)
Routine Nationwide

Immunizat
ion 0-11 mos
-BCG* 0.05ml Intradermal on
right deltoid
-DPT* 0.5ml  Intramuscularly 0-11 mos
on anterior thigh
 -OPV* 2 drops Orally 0-11 mos
0.5ml Subcutaneously on 9-11 mos
-AMV*
-Hepa B (if deltoid
available) 0.5ml Intramuscularly 0-11 mos
Deworming
drug
(if
available 1 36-59 mos,
) Orally
tablet nationwide
as
single
dose

Weighing 0-59 mos,

nationwide
•* The child should not have
received megadose of Vit. A above
the recommended dosage within the
past 4 weeks except if the child
has measles or signs and symptoms
of Vit A. deficiency.
• ** For any child between 12-23
months, who missed any of his
routine immunization, the health
worker should give the child the
necessary antigen to complete FIC
and shall be recorded as such.
 GARANTISADONG PAMBATA
Sangkap Pinoy

- Vitamin A, Iron and Iodine

-Sources: green leafy and yellow
vegetables, fruits, liver,
seafoods, iodized salt, pan de
bida and other fortified foods. 
These micronutrients are not
produced by the body, and must be
taken in the food we eat;
essential in the normal process of
growth and development:
a) Helps the body to regulate itself
b) Necessary in energy metabolism
c) Vital in brain cell formation and mental
development
d) Necessary in the body immune system to
protect the body from severe infection. 
e) Eating Sangkap Pinoy-rich foods can prevent
and control:
1. Protein Energy Malnutrition
2. Vitamin A Deficiency
3. Iron Deficiency Anemia
4. Iodine Deficiency Disorder
 • BREASTFEEDING
Breast milk is best for babies up
to 2 years old. Exclusive
breastfeeding is recommended for the
first six months of life. At about
six months, give carefully selected
nutritious foods as supplements.
Breastfeeding provides physical
and psychological benefits for
children and mothers as well as
economic benefits for families and
societies.
 BENEFITS :
For infants
c.Provides a nutritional complete
food for the young infant.
d.Strengthens the infant’s immune
system, preventing many infections.
e.Safely rehydrates and provides
essential nutrients to a sick
child, especially to those
suffering from diarrheal diseases.
f.Reduces the infant’s exposure to
infection.
 – For the Mother
a. Reduces a woman’s risk of excessive
blood loss after birth
b. Provides a natural method of delaying
pregnancies.
c. Reduces the risk of ovarian and breast
cancers and osteoporosis.
– For the Family and Community
d. Conserves funds that otherwise would be
spent on breast milk substitute,
supplies and fuel to prepare them.
e. Saves medical costs to families and
governments by preventing illnesses and
by providing immediate postpartum
contraception.
COMPLEMENTARY FEEDING FOR BABIES 6-11 MONTHS OLD 
• What are Complementary Foods?
c.foods introduced to the child at the age
6 months to supplement breastmilk
e.given progressively until the child is
used to three meals and in-between
feedings at the age of one year.
• Why is there a Need to Give Complementary
Foods?
g.breastmilk can be a single source of
nourishment from birth up to six months
of life.
a. The child’s demands for food increases
as he grows older and breastmilk alone
is not enough to meet his increased
nutritional needs for rapid growth and
development
b. Breastmilk should be supplemented with
other foods so that the child can get
additional nutrients
c. Introduction of complementary foods
will accustom him to new foods that
will also provide additional nutrients
to make him grow well
d. Breastfeeding, however, should continue
for as long as the mother is able and
has milk which could be as long as two
years
• How to Give Complementary Foods for
Babies 6-11 Months Old?
b.Prepare mixture of thick lugao/ cooked
rice, soft cooked vegetables. Egg yolk,
mashed beans, flaked fish/chicken/ground
meat and oil.
c.Give mixture by teaspoons 2-4 times
daily, increasing the amount of
teaspoons and number of feeding until
the full recommended amount is consumed
d.Give bite-sized fruit separately
e.Give egg alone or combine with above
food mixture
 FAMILY PLANNING
The Philippine Family Planning Program is a
national program that systematically provides
information and services needed by women of
reproductive age to plan their families
according to their own beliefs and
circumstances.
GOALS AND OBJECTIVES:
• Universal access to family planning
information, education and services. 
MISSION:
• To provide the means and opportunities by which
married couples of reproductive age desirous of
spacing and limiting their pregnancies can
realize their reproductive goals.
 TYPES OF METHODS:
A. NATURAL METHODS
1.     Calendar or Rhythm Method
2.     Basal Body Temperature Method
3.     Cervical Mucus Method
4.     Sympto-Thermal Method
5.     Lactational Amennorhea
B. ARTIFICIAL METHODS
I. CHEMICAL METHODS
1.Ovulation suppressant such as PILLS
2. Depo-Provera
3. Spermicidals
4. Implant
II. MECHANICAL METHODS
1.     Male and Female Condom
2.     Intrauterine Device
3.     Cervical Cap/Diaphragm
III. SURGICAL METHODS
1.     Vasectomy
• 2.     Tubal Ligation
 WARNING SIGNS

Pills
• Abdominal pain ( severe)
• Chest pain ( severe)
• Headache ( severe)
• Eye problems ( blurred vision,
flashing lights, blindness)
• Severe leg pain ( calf or thigh )
• Others: depression, jaundice, brest
lumps
 WARNING SIGNS

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

• INJECTABLES
• Dizziness
• Severe headache
• Heavy bleeding
 WARNING SIGNS
BTL
• Fever
• Weakness
• Rapid pulse
• Persistent abdominal pain
• Vomiting
• Dizziness
• Pus or tenderness at incision site
• Amenorrhea
 WARNING SIGNS

Vasectomy

• Fever
• Scrotal blood clots or excessive
swelling
 Nutrition

• Goal
To improve the nutritional
status, productivity and
quality of life of the
population thru adoption of
desirable dietary practices
and healthy lifestyle
• Objectives
• Increase food and dietary
energy intake of the average
Filipino
• Prevent nutritional
deficiency diseases and
nutrition-related chronic
degenerative diseases
• Promote a healthy well-
balanced diet
• Promote food safety
Nutrition is a state of well-being
achieved by eating the right food in
every meal and the proper utilization of
the nutrients by the body.
Proper nutrition is important because:
•  it helps in the development of the brain,
especially during the first years of the
child’s life.
•  It speeds up the growth and development of the
body including the formation of teeth and bones
•  It helps fight infection and diseases
•  It speeds up the recovery of a sick person
•  It makes people happy and productive
•  Proper nutrition is eating a balanced diet in
every meal
Balanced diet is made up of a
combination of the 3 basic
groups eaten in correct
amounts. The grouping
serves as a guide in
selecting and planning
everyday meals for the
family.
THE THREE (3) BASIC FOOD GROUPS ARE:
1.     Body –building food which are rich
in protein and needed by the body for:
< normal growth and repair of worn-out
body tissues
< supplying additional energy
< fighting infections
< Examples of protein-rich food are:
fish; pork; chicken; beef; cheese;
butter; kidney beans; mongo; peanuts;
bean curd; shrimp; clams
• 2. Energy-giving food which are rich in
carbohydrates and fats and needed by the
body for:
•< providing enough energy to make the
body strong
•< Examples of energy-giving food are:
rice; corn; bread; cassava; sweet
potato; banana; sugar cane; honey; lard;
cooking oil; coconut milk; margarine;
butter
• 3. Body-regulating food which are
rich in Vitamins and minerals and
needed by the body for:
•< normal development of the eyes,
skin, hair, bones, and teeth
•< increased protection against
diseases
•< Examples of body-regulating food
are: tisa; ripe papaya; mango; guava;
yellow corn; banana; orange; squash;
carrot
 Low Fat Tips
1. Eat at least 3 meals/day
2. Eat more fruits, vegetables, grain
and cereals e.g. rice, noodles and
potato
3. If you use butter or margarine, pat
it on thinly
4. Choose low fat substitute i.e.
replace whole milk with skimmed
milk, low fat cheese
5. Become a label reader. Look for
foods that have less than 5 g /100
g of product
1. Eat less high fat snacks and take
away potato chips, sausage rolls
or breaded meats
2. Cut all visible fat from meat,
remove skin from chicken fat
drippings and cream sauces
3. Aim for thin palm-size serving of
lean meat, poultry and fish/ meal
4. Grill, bake, steam, stew, stir –fry
and microwave, try not to fry
5. Drink lots of water all day-
it’s a food quencher
 Ambulate

• Start by walking for 10 min.

• Build up to 30-40 min/day
• Go for 3-4 times / week of any
exercise you enjoy
 Filipino Food Pyramid

• Drink a lot- water, clear broth

• Eat most – rice, root crops, corn,
noodles, bread and cereals
• Eat more – vegetables, green
salads, fruits or juices
• Eat some – fish, poultry, dry beans,
nuts, eggs, lean meats, low fat
dairy
• Eat a little – fats, oils, sugar,
salt
IMPORTANT VITAMINS AND MINERALS
VITAMINS FUNCTIONS
Vitamin A Maintain normal vision,
skin health, bone
and tooth growth
reproduction and
immune function;
prevents
xerophthalmia.
Food sources:
Breastmilk;poultry;eggs
; liver;
meat;carrots;squash;
papaya;mango;tiesa;
malunggay;kangkong;
Thiamine Help release
energy from
nutrients;
support normal
appetite and
nerve function,
prevent beri-
beri.
Riboflavi Helps release energy from
nutrients, support skin
n health, prevent deficiency
manifested by cracks and
redness at corners of mouth;
inflammation of the tongue and
dermatitis.

Niacin Help release energy from

nutrients; support skin,
nervous and digestive system,
prevents pellagra.
Biotin Help energy and
amino acid
metabolism; help
in the synthesis
of fat glycogen.

Pantothen Help in energy

ic metabolism.
Folic acid Help in the formation of DNA
and new blood cells
including red blood cells;
prevent anemia and some
amino acids.

Vitamin B Help in the formation of the

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

Vitamin K Involve in the synthesis of

blood clotting proteins and a
bone protein that regulates
blood calcium level.
MINERALS FUNCTIONS
Calcium Mineralization of bones and
teeth, regulator of many of the
body’s biochemical processes,
involve in blood clotting,
muscle contraction and
relaxation, nerve functioning,
blood pressure and immune
defenses.

Chloride Maintain normal fluid and

electrolyte balance.
Chromium Work with insulin and is
required for release of
energy from glucose.

Copper Necessary for absorption

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

Iodine As part of the two thyroid

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

Molybdenum Facilitate many

cell processes.
Phosphoru Mineralization of
s bones and teeth;
part of every Cell;
used in energy
transfer and
maintenance of acid-
base balance.
Selenium Work with vitamin E
to protect body
compound from
oxidation.
Selenium Work with vitamin E
to protect body
compound from
oxidation.

Sodium Maintain normal fluid

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

Zinc Essential for normal

growth, development
reproduction and
immunity.
 MALNUTRITION
MALNUTRITION
An abnormal condition of the
body resulting from the lack
or excess of one or more
nutrients like protein,
carbohydrates, fats,
vitamins and minerals.
 PRIMARY CAUSE: POVERTY

1. Lack of money to buy food

Majority of the victims of malnutrition
comes from families of farmers,
fisherfolk, and laborers who cannot
afford to buy nutritious foods.
3. Lack of food supply
4. Lack of information on proper
nutrition and food values
 SECONDARY CAUSES
1. Early weaning of child and improper
introduction of supplementary food
2. Incomplete immunization of babies and
children
3. Bad eating habits
4. Poor hygiene and environmental
sanitation:
a. lack of potable water
b. lack of sanitary toilet
c. poor waste disposal
 FORMS OF MALNUTRTION

 Protein-Energy Malnutrition (PEM)

is a nutritional problem
resulting from a prolonged
inadequate intake of body-
building and/or energy-giving
food in the diet.
Kinds:
a.)MARASMUS
b.) KWASHIORKOR
a) MARASMUS
This child does not get the right
amount and kind of energy food.
She/He:
< is always hungry
< has the face of an old man
< is very thin
< easily gets sick
< looks weak
THIS CHILD IS JUST SKIN AND BONES!
a) KWASHIORKOR
This child does not get enough body-building
food, although she/he may be getting enough
energy. She/He:
< has swollen face, hands, and feet
< easily gets sick
< has dry, thin, pale hair
< has sores on the skin
< has thin upper arms
< looks sad
< has dry skin
< is underweight
THIS CHILD IS SKIN, BONES, AND WATER!
 2. VITAMIN A DEFICIENCY (VAD)
a condition in which the level of
Vitamin A in the body is low.
Causes:
• not eating enough foods rich in
vitamin A e.g. yellow vegetables and
yellow fruits
• lack of fat or oil in the diet
which help the body absorb Vitamin
A.
• poor absorption or rapid
utilization of Vitamin A during
Eye Signs
• night blindness (early stage); total
blindness (later stage)
• bitot’s spot (foamy soapsuds-like
spots on white part of the eye)
• dry, hazy and rough appearing cornea
• crater-like defect on cornea
• softened cornea; sometimes bulging
Other Manifestations
• increased cases of childhood sickness,
and death and decreased resistance to
infection
• susceptibility to childhood
malnutrition and infection (measles,
diarrhea and pneumonia)
Prevention
• eating foods rich in Vitamin A, such
as liver, eggs, milk, crab meat,
cheese, dilis, malunggay, gabi
leaves, kamote tops, kangkong,
alugbati, saluyot, carrots, squash,
ripe mango, including fats and oils
• breastfeeding the child
• immunizing the child
• taking correct dose of Vitamin A
capsules as prescribed
VAD is most common in children
suffering from PEM and other
infectious diseases. Bottle-
fed infants are also at risk of
VAD especially if the milk
formula used is not fortified
with Vitamin A.
• Common among preschoolers and
infants
( FNRI)
 SCHEDULE FOR RECEIVING VITAMIN A SUPPLEMENT TO INFANTS
PRESCHOOLERS AND MOTHERS

Schedule Infants(6- Preschoole Post

11 mos) rs(12-83 Partum
mos) Mother

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

Dose Within one
month

Give after 100,000 IU 200,000 IU After

6 months delivery
High risk of each
Condition child only
Present
 SCHEDULE FOR TREATMENT OF VITAMIN A DEFICIENCY

Schedule Infants (6-11 Preschoolers

mos.) (12-83 mos.)

Give Today 100,000 IU 200,000 IU

Give Tomorrow 100,000 IU 200,000 IU

Give After 2 100,000 IU 200,000 IU

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

Eating iron-rich food such as liver and

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

Infants ( 6-12 months) 0.7 mg. Daily

Children ( 12-59 1 mg daily

months)
 Treatment of Iron Deficiency
Dosage

Children 0-59 month 3-6 mg./kg. Body

wt./day
 4.GOITER
- enlargement of thyroid gland
due to lack of iodine in the
body. 

-common in areas where the

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

Dosage

Children 0-59 months Iodine capsules

( in endemic areas) (200mg) potassium
iodate in oil orally
once a year.
CHECKING THE NUTRITIONAL STATUS
WEIGHT
• 1.1      Weight is a very important indicator
of a person’s nutritional status. It is
measured in relation to either AGE or HEIGHT.
Normally, a well-nourished child gains
weight as she/he grows older.
• 1.2      On the other hand, a malnourished
child either decreases in weight or maintains
his/her previous weight.
• 1.3      The nutritional status of a person
can also be checked by looking for specific
signs and symptoms of the different forms of
nutritional deficiencies.
• IMPORTANT:
• 1.1Weigh the child in minimal
clothing, with no shoes, clogs or
slippers on; and hands and pockets
free of objects.
• 1.2The same type of scale should be
used for subsequent weighing.
• 1.3Observe the proper maintenance of
the weighing scale.
• 1.4Do not use a bathroom scale to
avoid inaccurate readings of weight.
< BRING THE MALNOURISHED CHILD TOGETHER WITH
THE PARENTS TO THE HEALTH CENTER FOR
PROPER NUTRITIONAL ADVICE AND TREATMENT.
< VISIT THE MALNOURISHED CHILD REGULARLY
AND MONITOR HIS/HER WEIGHT.
< ADVISE PARENTS AND THE WHOLE COMMUNITY
ABOUT BETTER NUTRITION AND PROPER FEEDING
ESPECIALLY OF INFANTS, CHILDREN AND SICK
PERSONS.
NUTRITIONAL GUIDELINES
2. Eat a variety of food everyday.
3. Breastfeed infants exclusively from
birth to 4-6 months, and then, give
appropriate foods while continuing
breastfeeding.
4. Maintain children’s normal growth
through proper diet and monitor their
growth regularly.
5. Consume fish, lean meat, poultry or
dried beans.
6. Eat more vegetables, fruits, and root
crops.
7. Eat foods cooked in edible/cooking oil
 Consume milk, milk products or other
calcium-rich foods such as small fish
and dark green leafy vegetables
everyday. Use iodized salt, but avoid
excessive intake of salty foods.
 Use iodized salt, avoid excessive
intake of salty foods
9. Eat clean and safe food.
10. For a healthy lifestyle and good
nutrition, exercise regularly, do not
smoke, avoid drinking alcoholic
beverages.
 AIMS AND RATIONALE OF EACH OF THE
GUIDELINES
 
Guideline No. 1 is intended to give
the message that no single food
provides all the nutrients the
body needs. Choosing different
kinds of foods from all food
groups is the first step to obtain
a well-balanced diet. This will
help correct the common practice
of confining of choice to a few
kinds of foods, resulting in an
unbalanced diet.
Guidelines No.2 is entitled to promote
exclusive breastfeeding from birth to 4-6
months and to encourage the continuance of
breastfeeding for as long as two years or
longer. This is to ensure a complete and
safe food for the newborn and the growing
infant besides imparting the other benefits
of breastfeeding. The guideline also
strongly advocates the giving of appropriate
complementary food in addition to breast
milk once the infant is ready for solid
foods at 6 months. Malnutrition most
commonly occurs between the age of 6 months
to 2 years, therefore there is a need to pay
close attention to feeding the child
properly during this very critical period.
Guideline No. 3 gives advise on
proper feeding of children. In
addition, the guideline promotes
regular weighing to monitor the
growth of children, as it is a
simple way to assess nutritional
status.
Guidelines No. 4,5,6 and 7 are intended to
correct the deficiencies in the current dietary
pattern of Filipinos. Including fish, lean
meat, poultry and dried beans, which will
provide good quality protein and dietary
energy, as well as iron and zinc, key nutrients
lacking in the diet of Filipinos as a whole.
Eating more vegetables, fruits and root crops
will supply the much needed vitamins, minerals
and dietary fiber that are deficient in our
diet. In addition, they provide defense
against chronic degenerative diseases.
Including foods cooked in edible oils will
provide additional dietary energy as a partial
remedy to calorie deficiency of the average
Filipino. Including milk and other calcium-
rich foods in the diet will serve to supply not
only calcium for healthy bones but to provide
high quality protein and other nutrients for
growth.
Guideline No. 8 promotes the
use of iodized salt to prevent
iodine deficiency, which is a
major cause of mental and
physical underdevelopment in
the country. At the same time,
the guideline warns against
excessive intake of salty foods
as a hedge against
hypertension, particularly
among high-risk individuals.
Guideline No.9 is
intended to prevent
food-borne diseases.
It explains the various
sources of
contamination of our
food and simple ways to
prevent it from
occurring.
Finally, Guideline No. 10
promotes a healthy lifestyle
through regular exercise,
abstinence from smoking and
avoiding consumption. If
alcohol is consumed, it must
be done in moderation. All
these lifestyle practices are
directly or indirectly related
to good nutrition.
NUTRIENTS IN FOOD
 
Nutrients are chemical substances
present in the foods that keep the
body healthy, supply materials for
growth and repair of tissues, and
provide energy for work and physical
activities.
The major nutrients include the
macronutrients, namely; proteins,
carbohydrates and fats; the
micronutrients, namely vitamins such
as A, D, E and K, the B complex
vitamins and C and minerals such as
calcium, iron, iodine, zinc, fluoride
and water.
 Reproductive Health

• - a state of complete physical,

mental and social well-being
and not merely the absence of
disease/ infirmity in all
matters relating to the
reproductive system and to its
functions and processes.
• Basic RH Rights

– Right to RH information and health

care services for safe pregnancy
and childbirth
– Right to know different means of
regulating fertility to preserve
health and where to obtain them
– Freedom to decide the number and
timing of birth of children
– Right to exercise satisfying sex
life
• Factors/ determinants of RH
– Socioeconomic conditions –
education, employment, poverty,
nutrition, living condition/
environment, family environment
– Status of women – equal right in
education and in making decisions
about her own RH; right to be free
from torture and ill treatment and
to participate in politics
– Social and Gender Issues
– Biological (individual knowledge of
reproductive organs and their
functions), cultural (country’s
norms, RH practices) and
• Elements
– Maternal and Child Health Nutrition
– Family Planning
– Prevention and Management of
Abortion Complications
– Prevention and Treatment of
Reproductive Tract Infections,
including STDs, HIV and AIDS
– Education and Counseling on
Sexuality and Sexual Health
• Elements
– Breast and Reproductive Tract
Cancers and other Gynecological
Conditions
– Men’s Reproductive Health
– Adolescent Reproductive Health
– Violence Against Women
– Prevention and Treatment of
Infertility and Sexual Disorders
• Selected Concepts
– RH is the exercise of reproductive right
with responsibility
– It means safe pregnancy and delivery, the
right of access to appropriate health
information and services
– It includes protection from unwanted
pregnancy by having access to safe and
acceptable methods of family planning of
their choice
– It includes protection from harmful
reproductive practices and violence
– It ensure sexual health for the purpose of
enhancement of life and personal relations
and assures access to information on
sexuality to achieve sexual enjoyment
• Goal
– To achieve healthy sexual
development and maturation
– To achieve their reproductive
intention
– To avoid diseases, injuries and
disabilities related to
sexuality and reproduction
– To receive appropriate
counseling and care of RH
problems
• Strategies

– Increase and improve the use of more

effective or modern contraceptive methods
– Provision of care, treatment and
rehabilitation for RH
– RH care provision should be focused on
adolescents, men and unmarried and other
displaced people with RH problems
– Strengthen outreach activities and
referral system
– Prevent specific RH problems through
information dissemination and counseling
of clients
HEALTH AND SANITATION
Environmental Sanitation is still a
health problem in the country.
Diarrheal diseases ranked second in
the leading causes of morbidity among
the general population.
Other sanitation related diseases :
tuberculosis, intestinal parasitism,
schistossomiasis, malaria, infectious
hepatitis, filariasis and dengue
hemorrhagic fever
DOH thru’ Environmental Health
Services (EHS)
unit is authorized to act on all
issues and concerns
in environment and health including
the very
comprehensive Sanitation Code of the
Philippines (PD 856, 1978).
 WATER SUPPLY SANITATION
PROGRAM
EHS sets policies on:
• Approved types of water facilities
• Unapproved type of water facility
• Access to safe and potable
drinking water
• Water quality and monitoring
surveillance
• Waterworks/Water system and well
construction
 Approved type of water
facilities
• Level 1 (Point Source)- a protected
well or a developed spring with an
outlet but without a distribution
system
• indicated for rural areas;
• serves 15-25 households; its
outreach is not more than 250 m from
the farthest user
• yields 40-140 L/ min
 Level II ( Communal Faucet or
Stand Posts)

• With a source, reservoir, piped

distribution network and communal
faucets
• Located at not more than 25 m from
the farthest house
• Delivers 40-80 L of water per
capital per day to an average of 100
households
• Fit for rural areas where houses are
densely clustered
 Level III ( Individual House
Connections or Waterworks System)

• With a source, reservoir, piped

distributor network and household
taps
• Fit for densely populated urban
communities
• Requires minimum treatment or
disinfection
ENVIRONMENTAL SANITATION
- the study of all factors
in man’s physical
environment, which may
exercise a deleterious effect
on his health, well-being and
survival. 
 Includes:
1.1     Water sanitation
1.2     Food sanitation
1.3     Refuse and garbage disposal
1.4     Excreta disposal
1.5     Insect vector and rodent control
1.6     Housing
1.7     Air pollution
1.8     Noise
1.9     Radiological Protection
1.10   Institutional sanitation
1.11   Stream pollution
PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM
 
EHS sets policies on:
Approved types of toilet facilities :

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

-sets policy and practical programs

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

Hospitals shall dispose their hazardous

wastes thru incinerators or disinfectants to
prevent transmission of nosocomial diseases
 PROGRAM ON HEALTH RISK MINIMIZATION DUE TO
ENVIRONMENTAL POLLUTION
Foci:
1. Prevention of serious environmental hazards
resulting from urban growth and
industrialization
2. policies on health protection measures
3. researches on effects of GLOBAL WARMING to
health (depletion of the stratosphere ozone
layer which increases ultraviolet radiation,
climate change and other conditions)
 NURSING RESPONSIBILITIES AND ACTIVITIES
• Health Education – IEC by conducting
community assemblies and bench
conferences.
• The Occupational Health Nurse, School
Health Nurse and other Nursing staff
shall impart the need for an effective
and efficient environmental sanitation
in their places of work and in school.
• Actively participate in the training
component of the service like in Food
Handler’s Class, and attend training/workshops
related to environmental health.
• Assist in the deworming activities for
the school children and targeted groups.
• Effectively and efficiently coordinate
programs/projects/activities with other
government and non-government agencies.
• Act as an advocate or facilitator to families
in the community in matters of
program/projects/activities on
environmental health in coordination with
other members of Rural Health Unit (RHU)
especially the Rural Sanitary Inspectors.
• Actively participate in
environmental sanitation campaigns
and projects in the community. Ex.
Sanitary toilet campaign drive for
proper garbage disposal,
beautification of home garden, parks
drainage and other projects.
• Be a role model for others in the
community to emulate terms of
cleanliness in the home and
surrounding.
Non-Communicable Diseases and
Rehabilitation
• 1. Prevention and Control of Cardiovascular
Diseases
• - heart – 1st leading cause of death
; bld vessels -
2nd
• Congenital Heart Disease (CHD): Result of the
abnormal development of the heart that
exhibits septal defect, patent ductus
arteriosus, aortic and pulmonary stenosis,
and cyanosis; most prevalent in children
• Causes: envt’l factors, maternal diseases or
genetic aberrations
• Rheumatic Fever or Rheumatic Heart Disease:
Systematic inflammatory disease that may
develop as a delayed reaction to repeated and
an inadequately treated infection of the
upper respiratory tract by group A beta-
hemolytic streptococci.
• Hypertension: Persistent elevation of the
arterial blood pressure.
• ( primary or essential) ;frequent among
females but severe,malignat form is more
Ischemic Heart Disease/
Atherosclerosis: Condition usually
caused by the occlusion of the
coronary arteries by thrombus or
clot formation.
• higher among males than females for
the latter are protected by
estrogen before menopause
• PF: HPN, DM, Smoking
• Minor RF: stress, strong family
history, obesity
 CVD
PERIOD OF LIFE TYPE OF CVD PREVALENCE

At birth to early Congenital Heart 2 / 1000 school

childhood Disease children (aged 5
– 15 y.o.)
Early to late Rheumatic Fever / 1 / 1000 school
childhood Rheumatic Heart children (aged 5
Disease – 15 y.o.)
Early Adulthood Diseases of Heart 10 / 100 adults
Muscles
Essential
Hypertension
Middle age to old Coronary Artery 5 / 100 adults
age Disease
Cerebrovascular
Accident
 CVD
Diseases Causes / Risk factors

Congenital Heart Disease Maternal Infections, Drug

intake, Maternal
Disease, Genetic
Rheumatic Fever/Rheumatic Frequent Streptoccocal
Heart Disease Sore Throat

Essential Hypertension Heredity, High Salt

Intake
Coronary Artery Disease Smoking, Obesity,
(Heart Attack) Hypertension, Stress
Hyperlipidemia, Diabetes
Mellitus Sedentary Life
Style
Cerebrovascular Accident Hypertension,
(Stroke) Arteriosclerosis
 Primary Prevention: CVD
Disease Primordial Specific Protection

Congenit - Prevention of - Adequate treatment

al Heart viral infection of viral infection
Disease and intake of during pregnancy.
harmful drugs - Genetic counseling
during of blood related
pregnancy. married couples.
- Avoidance of
marriage
between blood
relatives
Rheumatic - Prevention -
Heart Disease of recurrent Identification
sore throat of cases of
thru adequate rheumatic
environmental fever
sanitation; - Prophylaxis
avoidance of with
overcrowding; penicillin or
adequate erythromycin
treatment
Essential - From early - Continued
Hypertension childhood low salt diet
> low salt and adequate
diet exercise
> adequate
physical
exercise
Coronary Heart - Prevention - cessation of
Disease(Heart of smoking
Attack) development/ - control
acquisition of /treatment of
risk factors diabetes,
> cigarette hypertension
smoking -weight
> high fat reduction
intake -change to
> high salt proper diet
intake -Adjustment of
activities
Cerebrovascula - all measures - all measures
r Accident to prevent to control
(Stroke) hypertension & hypertension &
arterioscleros progression of
is arterioscleros
is
• Primary Prevention thru health
education is the main focus of the
program:
• 1. maintenance of ideal body wt.
• 2. diet - low fat
• 3. alcohol/smoking avoidance
• 4. exercise
• 5. regular BP check up
2. Cancer Prevention and Early
Detection
• Any malignant tumor arising from the
abnormal and uncontrolled division of
cells causing the destruction in the
surrounding tissues.
• Common Cancer: Lung cancer, cervical
cancer, colon cancer, cancer of the
mouth, breast cancer, skin cancer,
prostate cancer.
• 3rd leading cause of illness and death
( Phil.)
• Incidence can only be reduced thru
prevention and early detection
 NINE WARNING SIGNS OF CANCER:

• Change in blood bowel or bladder habits

• A sore that does not heal
• Unusual bleeding or discharge
• Thickening or lump in breast or
elsewhere
• Indigestion or difficulty in swallowing
• Obvious change in wart or mole
• Nagging cough or hoarseness

• Unexplained anemia
• Sudden unexplained weight loss
Prevention & Early Detection

CA type Prevention Detection

Lung No smoking None
Uterine Monogamy Pap’s smear
Cervical Safe sex every 1-3 yrs
Liver Hep B None
vaccination
Less aalcohol
intake
Avoidance of
moldy foods
Colon High fiber Regular
Rectum diet medical check-
Low fat intake up after 40
yrs of age
Fecal occult
blood test
DRE
Sigmoidoscopy

Mouth No smoking, Regular dental

betel nut check-ups
chewing
Oral hygiene
Breast none Monthly SBE
Yearly exam by
doctor
Mammography
for 50 yrs old
and above
females
Skin No excessive Assessment of
sun exposure skin
Prostate none Digital trans-
rectal exam
• PRINCIPLES OF TREATMENT OF MALIGNANT
DISEASES
• One third of all cancers are
curable if detected early and
treated properly.
Three major forms of treatment of
cancer:
• Surgery
• Radiation Therapy
• Chemotherapy
• 3. Nat’l Diabetes Prevention and
Control Program

• Aim:
• Controlling and assimilating
healthy lifestyle in the Filipino
culture ( 2005-2010) thru IEC
• Main Concern: modifiable risk
factors( diet, body wt., smoking,
alcohol, stress, sedentary living,
birth wt. ,migration
• 4. Prevention and Control of Kidney
Disease
• Acute or Rapidly Progressive Renal
Failure : A sudden decline in renal
function resulting from the failure of
the renal circulation or by glomerular
or tubular damage causing the
accumulation of substances that is
normally eliminated in the urine in the
body fluids leading to disruption in
homeostatic, endocrine, and metabolic
functions.
• Acute Nephritis: A severe inflammation
of the kidney caused by infection,
degenerative disease, or disease of the
blood vessels.
• Chronic Renal Failure: A progressive
deterioration of renal function that
• Neprolithiasis: A disorder characterized by
the presence of calculi in the kidney.
• Nephrotic Syndrome: A clinical disorder of
excessive leakage of plasma proteins into
the urine because of increased permeability
of the glomerular capillary membrane
• Urinary Tract Infection: A disease caused
by the presence of pathogenic
microorganisms in the urinary tract with or
without signs and symptoms.
• Renal Tubular Defects: An abnormal
condition in the reabsorption of selected
materials back into the blood and
secretion, collection, and conduction of
urine.
• Urinary Tract Obstruction: A condition
wherein the urine flow is blocked or
clogged.
• 5. Program on Mental Health and
Mental Disorders
• 6. Program on Drug Dependence/
Substance Abuse
• 7.Community-Based Rehabilitation Program

• A creative application of the primary health

care approach in rehabilitation services,
which involves measures taken at the
community level to use and build on the
resources of the community with the
community people, including impaired,
disabled and handicapped persons as well.
• Goal: To improve the quality of life and
increase productivity of disabled,
handicapped persons.
• Aim: To reduce the prevalence of disability
through prevention, early detection and
provision of rehabilitation services at the
community level.
• 8. Program on the Elderly/Geriatric
Nursing Services

•7 humanitarian issues: family,

health, income, security, employment
and labor, social welfare,
education, recreation, culltural
activities and housing
 Leading causes of
illness:elderly
• Influenza, HPN, diarrhea,
• bronchitis, TB, diseases. of the
heart,
• pneumonia, malaria,
• malignant neoplasm, chickenpox
 Leading causes of
death:elderly
• Diseases of heart and vascular
system
• Pneumonia, TB, CCOPD
• Malignant neoplasms
• Diabetes
• Nephritis
• Accidents
• 9. Programs on Blindness, Deafness
and Osteoporosis
• Cataract- main causes of blindness
• VAD- main cause of childhood
blindness; most serious eye problem
of Fil. children below 6 yrs. old
• Osteoporosis special problem in
women, highest bet. 50—79 yrs.
old, MENOPAUSE- main cause
Prevention of NCD/Role of Nursing
in Health Promotion And Advocacy
• Yosi Kadiri- anti smoking
• Edi Exercise/Hataw-regular physical
activity
• Tiya Kulit/ Iwas Sakit Diet-low
salt, low fat, high fiber diet
• Mag HL – exercise, no smoking,
avoidance of alcohol, healthy diet,
iwas stress, watch wt.
 Sentrong Sigla Movement ( SSM)
-a certification recognition program
which develops and promotes
standards for health facilities
- Joint effort bet.:
1.DOH – provides technical and
financial assistance packages for
health care
2. LGUs – direct implementers of
health programs & prime developers
of health centers and hospitals
making services accessible to every
Filipino
 Pillars of SSM

• 1. Quality Assurance
• 2. Grant and Technical Assistance
• 3. Health Promotion
• 4. Awards
 Expected Outcome: SSM

• Empowered individuals adopting

healthy lifestyle, improved health-
seeking behavior and well-being &
increased demand for quality health
services
• Institutions will develop policies,
provide quality services , institute
system for surveillance/ merits and
advocate for laws
 Programs: SSM

• EPI
• Disease Surveillance
• CARI
• CDD
• Nutrition/ Micronutrient
Supplementation-
*Food Fortification :
Rice –iron; Oil and sugar – Vit. A;
Flour-Vit. A & iron; Salt- iodine
 Integrated Management of
Childhood Illness ( IMCI)
• Integrates management of most common
childhood problems ( diarrhea,
pneumonia, measles, malnutrition,
DHF, malaria)
• Involves family members and
community in the health care process
for physical growth and mental
development & disease prevention
 IMCI: Case Mgt. Process
• 1. Assessing the child or young infant-
History taking, PE
• 2. Classifying the Illness- severity of
illness
• 3. Identifying ttt.- classification chart
• 4. Treating the child- giving ttt. in
health centers, prescribed drugs &
teaching mothers how to carry out ttt.
• 5. Counseling the mother- child
feeding,foods and fluids to give & when to
bring the child back to the health center
• 6. Giving of follow-up care
• Communicable diseases
– National Tuberculosis Control
Program – key policies
Case finding – direct Sputum Microscopy
and X-ray examination of TB
symptomatics who are negative after 2 or
more sputum exams
Treatment – shall be given free and on
an ambulatory basis, except those with
acute complications and emergencies
Direct Observed Treatment Short Course –
comprehensive strategy to detect and
cure TB patients.
 Category and Treatment
Regimen
• Category 1- new TB patients whose sputum
is positive; seriously ill patients with
severe forms of smear-negative PTB with
extensive parenchymal involvement
(moderately- or far- advanced) and extra-
pulmonary TB (meningitis, pleurisy, etc.)

• Category 2-previously-treated patients

with relapses or failures.

• Category 3 – new TB patients whose sputum is

smear-negative for 3 times and chest x-ray result
of PTB minimal
 – Category 1- new TB patients whose sputum is positive;
seriously ill patients with severe forms of smear-
negative PTB with extensive parenchymal involvement
(moderately- or far- advanced) and extra-pulmonary TB
(meningitis, pleurisy, etc.)

Intensive Phase (given daily for the first 2

months)- Rifampicin + Isioniazid +
pyrazinamide + ethambutol.
If sputum result becomes negative after 2
months, maintenance phase starts. But if
sputum is still positive in 2 months, all
drugs are discontinued from 2-3 days and a
sputum specimen is examined for culture and
drug sensitivity. The patient resumes taking
the 4 drugs for another month and then
another smear exam is done at the end of the
3rd month.
Maintenance Phase (after 3rd month, regardless
of the result of the sputum exam)-INH +
• Category 2-previously-treated patients with relapses or
failures.

Intensive Phase (daily for 3 months,

month 1,2 & 3)-Isioniazid+ rifampicin+
pyrazinamide+ ethambutol+ streptomycin
for the first 2 months Streptomycin+
rifampicin pyrazinamide+ ethambutol on
the 3rd month. If sputum is still
positive after 3 months, the intensive
phase is continued for 1 more month
and then another sputum exam is done.
If still positive after 4 months,
intensive phase is continued for the
next 5 months.
Maintenance Phase (daily for 5 months,
month 4,5,6,7,& 8)-Isionazid+
• Category 3 – new TB patients whose sputum is smear-
negative for 3 times and chest x-ray result of PTB
minimal

• Intensive Phase (daily for 2 months)

– Isioniazid + rifampicin +
pyrazinamide
• Maintenance Phase (daily for the
next 2 months) - Isioniazid +
rifampicin
• Stop TB ; Do it with DOTS
– Advocacy is a planned and continuous effort
to inform people about issue and instigate
change. Advocacy usually takes place over an
extended period of time and includes a
variety of strategies to communicate a
specific message.

– TB is the number one infectious killer in

the world.
– One TB suspect can infect another 10 healthy
persons
• Leprosy Control Program
– WHO Classification – basis of multi-drug
therapy
• Paucibacillary/PB – non-infectious types. 6-9
months of treatment.
• Multibacillary/MB – infectious types. 24-30 months
of treatment.
– Multi-drug therapy – use of 2 or more drugs
renders patients non-infectious a week after
starting treatment
• Patients w/ single skin lesion and a negative slit
skin smear are treated w/ a single dose of ROM
regimen
• For PB leprosy cases- Rifampicin+Dapsone on Day 1
then Dapsone from Day 2-28. 6 blister packs taken
monthly within a max. period of 9 mos.
– All patients who have complied w/ MDT are
considered cured and no longer regarded as a case
of leprosy, even if some sequelae of leprosy
remain.
– Responsibilities of the nurse
• Prevention – health education, healthful living
through proper nutrition, adequate rest, sleep
and good personal hygiene;
• Casefinding
• Management and treatment – prevention of
secondary injuries, handling of utensils;
special shoes w/ padded soles; importance of
sustained therapy, correct dosage, effects of
drugs and the need for medical check-up from
time to time; mental & emotional support
• Rehabilitation-makes patients capable, active
and self-respecting member of society.
• Control of Schistosomiasis – a tropical
disease caused by a blood fluke, Schistosoma
Japonicum ; transmitted by a tiny snail
Oncomelania quadrasi
– Preventive measures – health education
regarding mode of transmission and methods
of protection; proper disposal of feces and
urine; improvement of irrigation and
agriculture practices
– Control of patient, contacts and the
immediate environment
– Specific treatment- Praziquantel – drug of
choice
• Programs on Filariasis, Malaria
and Dengue Hemorrhagic Fever
– Filariasis- a chronic prasitic
infection caused by a nematode,
Wuchereria bancrofti. Young and
adult worms live in the lymphatic
vessels and nodes, while the micro
filariae are in the blood;
transmitted through bites from an
infected female mosquito, Aedes
poecilius, that bites at night.
• Treatment: Diethylcarbamazine citrate or
Hetrazan
• Elephantiasis and Hydrocoele are handled
through surgery, prevention and
supportive care
Malaria – infection caused by the
bite of the female Anopheles
mosquito,
– Chemoprophylaxis – Chloroquine taken at
weekly intervals, starting from 1-2 weeks
before entering the endemic area.
– Anti-malarial drugs – sulfadoxine,
quiinine sulfate, tetracycline, quinidine
– Insecticide treatment of mosquito nets,
house spraying, stream seeding and
clearing, sustainable preventive and
vector control meas

Dengue H-fever
4 o’clock habit
•Programs on Measles.
Chickenpox, Mumps,
Diphtheria, Pertusis,
Tetanus –focused on
health information
campaigns and intensive
immunization of children
in barangays.
• Prevention and Control Program on Parasitic
Infestations ( STH e.g. Ascaris,
Trichuris, Hookworm) and Paragonimiasis in
communities where eating of fresh or
inadequately cooked crab is a practice

Management:
1. Deworming
2. Health Education re:
• Good personal hygiene
• Use of footwear
• Washing fruits and vegetables well
• Use of sanitary toilets
• Sanitary disposal of garbage
• Boiling drinking water at least 2-3 min. from
boiling point or chlorination
• Prevention and Control on
Leptospirosis/ Weil’s Disease/ Mud
fever/Flood fever/ Spirochetal
Jaundice thru contact with the
skin/ open wound with water or moist
soil contaminated with urine of
infected rat
• And Rabies
• Mgt. of Rabies

• Wash wound with soap and water, betadine or

alcohol may be applied
• If dog is healthy observe for 14 days. If nothing
happens- no need for ttt.If it dies or shows
rabies, kill then bring head for lab. Exam &
consult doctor.
• Active immunization – body develops Ab against
rabies up to 3 yrs.
• Passive I – giving Ab to persons with head and
neck bites, multiple single deep bites,
contamination of mucous membranes or thin covering
of the eyes, lips or mouth to provide immediate
protection
• RPO – immunization of pets at 3 mos. of age and
yearly thereafter
• Prevention and Control on STIs
- Gonorrhea, Syphilis, HIV/AIDS,
Trichomoniasis,Chlamydia, Hep B ( the
most serious type ‘cause of severe cx. Eg.
Massive liver damage and hepatocarcinoma
- 4 C’s in the Syndromic Mgt
- 1. Compliance
- 2. Counseling/ Education
- 3. Contact tracing to treat partner
- 4. Condom use
- Hep B vaccination
- Universal precautions
- Safe sex
 Other CHN Practice Settings
• I. Occupational Health
• - the application of public health,
medical and engineering practice for the
purpose of conserving, restoring the
health and effectiveness of workers thru
their places of employment
• A. Occupational Health Nursing
• - the application of nursing principles
and procedures in providing health service
to employees in their place of work by
means of:
• 1. prompt and efficient nursing
care of the ill and impaired
• 2. participation in teaching health
and safety practices on the job
• 3. cooperation with plant department
administrators
• 4.keeping the health clinic and
staff ready to handle emergencies
• 5. advising workers in the
utilization of community and welfare
services
 Objectives of OHN

• To assist, maintain and promote

positive health of laborers and
employees thru early detection and
prevention of occupational diseases
and hazards of industrial processes
and by coordinating and cooperating
with activities of other community
health and welfare services
 Nurse’s Role in OHN
• 1. Assists/participates in developing an
adequate health program for workers and
laborers including sound health education
activities
• 2. Encourages periodic P.E.
• 3. Cooperates with occupational medical
programs in the prevention of accidents
as well as in the promotion of good
working atmosphere and relationships in the
place of work
• 4. Helps in teaching others in giving good
nursing care to the sick or handicapped in
their own homes
• II. School Health Nursing
• School Health Triad :

• 1. SERVICE

• 2. EDUCATION

• 3. ENVIRONMENT
• Mission of School Health Program:

To maximize potential for learning and

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

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

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

• EDUCATOR
• CONSULTANT /RESEARCHER
• STUDENT, FAMILY AND STAFF
ADVOCATE/CHANGE AGENT
• HEALTH SCREENER
• HEALTH CARE PROVIDER
• Common Health Concerns of
Schoolchildren:
1.Drug and Alcohol Abuse
2. STDs/STIs
3. Teenage Pregnancies
4. Mental Health
5. Dermatological Disorders-
pimples/acne, fungal infections,
allergies
6. Respiratory Conditions- asthma,
URTI
7. Nutrition
8. Dental Health
• There was a man who saw a scorpion
floundering around in the water.
• He decided to save it by stretching
out his finger but the scorpion stung
him.
• The man still tried to get the
scorpion out of the water but the
scorpion stung him again.
• Another man nearby told him to stop
saving the scorpion but the man said,
“It’s the nature of the scorpion to
sting. It’s my nature to love, why
should I give up my nature to love
just because it’s the nature of the
•Don’t give up
loving, don’t
give up your
goodness even
if people
around you
Thank
you
very