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36254824 Community Health Nursing Reviewer

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    COMMUNITY HEALTH NURSINGI - Definition of TermsCommunity- derived from a latin word comunicas which meansa group of people.

    ya group of people with common characteristics or interestsliving together within a territory or geographical boundary

    yplace where people under usual conditions are foundHealth - is the OLOF (Optimum Level of Functioning)Community Health - part of paramedical and medical intervention/approach which is concernedon the health of the whole populationAims:1. health promotion2. disease prevention3. management of factors affecting healthNursing - both profession & a vocation. Assisting sick individuals to become healthy and healthyindividuals achieve optimum wellness

    II - Community Health NursingyThe utilization of the nursing process in the different levels of clientele-individuals,families, population groups and communities, concerned with the promotion of health,

    prevention of disease and disability and rehabilitation.Goal: To raise the level of citizenry by helping communities and families to cope with thediscontinuities in and threats to health in such a way as to maximize their potential forhigh-level wellnessMISSION OF CHN

    yHealth Promotion

    yHealth Protection

    yHealth Balance

    yDisease prevention

    ySocial JusticePHILOSOPHY OF CHN

    yThe philosophy of CHN is based on the worth and dignity on the worth and dignity ofman.

    Principles of Community Health:1. The community is the patient in CHN, the family is the unit of care and there are four levels ofclientele: individual, family, population group (those who share common characteristics,developmental stages and common exposure to health problems e.g. children, elderly), andthe community.2. In CHN, the client is considered as an ACTIVE partnerNOT PASSIVE recipient of care3. CHN practice is affected by developments in health technology, in particular, changes insociety, in general4. The goal of CHN is achieved through multi-sectoral efforts5. CHN is a part of health care system and the larger human services system.Role of CH Nurse:

    yClinician - who is a health care provider, taking care of the sick people at home or inthe RHU

    y

    Health Advocator speaks on behalf of the clientyAdvocator act on behalf of the client

    ySupervisor - who monitors and supervises the performance of midwives

    yFacilitator - who establishes multi-sectoral linkages by referral system

    yCollaborator working with other health team member

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    COMMON PROCEDURE IN CHN:

    yHOME VISIT

    yBAG TECHNIQUE

    ySTERILIZATION

    ySPECIMEN COLLECTION- URINE

    - FECES- SPUTUMLevels of Client in CHN:1. Application ofNursing Process to:1.a Family1.a.1 Family Coping Index

    yPhysical Independence - ability of the family to move in & out of bed &performed activities of daily living

    yTherapeutic Independence - ability of the family to comply with the therapeuticregimen (diet, medication & usage of appliances)

    yKnowledge ofHealth Condition- wisdom of the family to understand the diseaseprocess

    yApplication of General &Personal Hygiene- ability of the family to perform

    hygiene & maintain environment conducive for livingyEmotional Competence ability of the family to make decision maturely &appropriately (facing the reality of life)

    yFamily Living Pattern- the relationship of the family towards each other with love,respect & trust

    yUtilization of Community Resources ability of the family to know the function &existence of resources within the vicinity

    yHealth Care Attitude relationship of the family with the health care provider

    yPhysical Environment ability of the family to maintain environment conducivefor living

    1.a.2 Family Life Cycle

    yStage I Beginning Family (newly wed couples)TASK: compliance with the PD 965 & acceptance of the new member of the family

    yStage II Early Child Bearing Family(0-30 months old)TASK: emphasize the importance of pregnancy & immunization & learn the conceptof parenting

    yStage III Family with Pre- school Children (3-6yrs old)TASK: learn the concept of responsible parenthood

    yStage IV Family with School age Children (6-12yrs old)TASK: Reinforce the concept of responsible parenthood

    yStage V - Family with Teen Agers (13-25yrs old)TASK: Parents to learn the concept of let go system and understands thegeneration gap

    yStage VI Launching Center (1st child will get married up to the last child)TASK: compliance with the PD 965 & acceptance of the new member of the family

    yStage VII -Family with Middle Adult parents (36-60yrs old)

    TASK: provide a healthy environment, adjust with a new lifestyle and adjust with thefinancial aspect

    yStage VIII Aging Family (61yrs old up to death)TASK: learn the concept of death positively

    1.b CommunityCOMMUNITY ASSESSMENT:

    yStatus

    yStructure

    yProcess

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    TYPES OF COMMUNITY ASSESSMENT:1. COMMUNITY DIAGNOSIS

    yA process by which the nurse collects data about the community in order toidentify factors which may influence the deaths and illnesses of the population, toformulate a community health nursing diagnosis and develop and implementcommunity health nursing interventions and strategies.

    322 Types:Comprehensive Community DiagnosisProblem-Oriented Community Diagnosis- aims to obtain general information about thecommunity- type of assessment responds to a particularneedSTEPS:

    yPreparatory Phase1. site selection2. preparation of the community3. statement of the objectives4. determine the data to be collected5. identify methods and instruments for data collection6. finalize sampling design and methods7. make a timetable

    yImplementation Phase1. data collection2. data organization/collation3. data presentation4. data analysis5. identification of health problems6. priority zation of health problems7. development of a health plan8. validation and feedback

    yEvaluation PhaseBIOSTATISTICS

    2.1 DEMOGRAPHY - study of population size, composition and spatial distribution as affected bybirths, deaths and migration.Sources : Census complete enumeration of the population2 Ways of Assigning People:1. De Jure - People were assigned to the place where assigned to the place theyusually live regardless of where they are at the time of census.2.De Facto - People were assigned to the place where they are physically present at areat the time of census regardless, of their usual place of residence.COMPONENTS:1. Population size2. Population composition* Age Distribution* Sex Ratio

    * Population Pyramid* Median age - age below which 50% of the population fall and abovewhich 50% of the population fall. The lower the medianage, the younger the population (high fertility, high death rates).* Age Dependency Ratio - used as an index of age-induced economic drain on humanresources* Other characteristics:- occupational groups- economic groups- educational attainment

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    - ethnic group3. Population Distribution* Urban-Rural - shows the proportion of people living in urban compared to the ruralareas* Crowding Index - indicates the ease by which a communicable disease can betransmitted from 1 host to another susceptible host.* Population Density - determines congestion of the placeVITAL STATISTICS

    ythe application of statistical measures to vital events (births, deaths and commonillnesses) that is utilized to gauge the levels of health, illness and health services of acommunity.TYPES:FERTILITY RATEA. CRUDE BIRTH RATEtotal # of livebirths in a given calendar year X 1000estimated population as of July 1 of the same given yearB. GENERAL FERTILITY RATEtotal # of livebirths in a given calendar year X 1000Total number of reproductive ageMORTALITY RATE

    A. CRUDE DEATH RATE

    Total # of death in a given calendar year X 1000Estimated population as of July 1 of the same calendar yearB. INFANT MORTALITY RATETotal # of death below 1 yr in a given calendar year X 1000Estimated population as of July 1 of the same calendar yearC. MATERNAL MORTALITY RATEC

    D Total # of death among all maternal cases in a given calendar year X 1000Estimated population as of July 1 of the same calendar yearMORBIDITY RATEA. PREVALENCE RATE

    E Total # of new & old cases in a given calendar year X 100Estimated population as of July 1 of the same calendar yearB. INCIDENCE RATEF

    G Total # of new cases in a given calendar year X 100Estimated population as of July 1 of the same calendar yearC. ATTACK RATETotal # of person who are exposed to the disease X 100Estimated population as of July 1 of the same calendar year34

    III - Epidemiologyythe study of distribution of disease or physiologic condition among human population s

    and the factors affecting such distributionythe study of the occurrence and distribution of health conditions such as disease, death,deformities or disabilities on human populationsa. Patterns of disease occurrenceEpidemic

    - a situation when there is a high incidence of new cases of a specific disease inexcess of the expected.- when the proportion of the susceptibles are high compared to the proportion ofthe immunes

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    Epidemic potential

    - an area becomes vulnerable to a disease upsurge due to causal factors such asclimatic changes, ecologic changes, or socio-economic changesEndemic

    - habitual presence of a disease in a given geographic location accounting for thelow number of both immunes and susceptibles

    e.g. Malaria is a disease endemic at Palawan.- the causative factor of the disease is constantly available or present to the area.Sporadic

    - disease occurs every now and then affecting only a small number of peoplerelative to the total population- intermittentPandemic- global occurrence of a diseaseSteps in EPIDEMIOLOGICAL IVESTIGATION:1. Establish fact of presence of epidemic2. Establish time and space relationship of the disease3. Relate to characteristics of the group in the community4. Correlate all data obtained

    b. Role of the NurseyCase Finding

    yHealth Teaching

    yCounseling

    yFollow up visitIV. Health Situation of the PhilippinesPhilippine Scenario:

    yIn the past 20 years some infectious degenerative diseases are on the rise.

    yMany Filipinos are still living in remote and hard to reach areas where it is difficult todeliver the health services they need

    yThe scarcity of doctors, nurses and midwives add to the poor health delivery system to thepoorVITAL HEALTH STATISTICS 2005

    PROJECTED POPULATION :MALE - 42,874,766FEMALE - 42,362,147BOTH SEXES - 85,236,913

    LIFE EXPECTANCYFEMALE - 70 yrs. oldMALE - 64 yrs. OldLEADING CAUSES OF MORBIDITY

    yMost of the top ten leading causes of morbidity are communicable disease

    yThese include the diarrhea, pneumonia, bronchitis, influenza, TB, malaria and varicella35

    yLeading non CD are heart problem, HPN, accidents and malignant neoplasms

    LEADING CAUSES OF MORTALITYyThe top 10 leading causes of mortality are due to non CD

    yDiseases of the heart and vascular system are the 2 most common causes of deaths.

    yPneumonia, PTB and diarrheal diseases consistently remain the 10 leading causes ofdeaths.

    V. Health Care Delivery Systemythe totality of all policies, facilities, equipments, products, human resources and serviceswhich address the health needs, problems and concerns of the people. It is large,complex, multi-level and multi-disciplinary.

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    HEALTH SECTORS

    yGOVERNMENT SECTORSDepartment of HealthVision:Health for all by year 2000 ands Health in the Hands of the People by 2020Mission: In partnership with the people, provide equity, quality and access to health care esp. themarginalized5 Major Functions:1. Ensure equal access to basic health services2. Ensure formulation of national policies for proper division of labor and propercoordination of operations among the government agency jurisdictions3. Ensure a minimum level of implementation nationwide of services regarded as publichealth goods4. Plan and establish arrangements for the public health systems to achieve economiesof scale5. maintain a medium of regulations and standards to protect consumers and guideproviders

    yNON GOVERNMENT SECTORS

    yPRIVATE SECTORSPRIMARY STRATEGIES TO ACHIEVE HEALTH GOALS

    ySupport for health goal

    yAssurance of health care

    yIncreasing investment for PHC

    yDevelopment ofNational StandardMILESTONE IN HEALTH CARE DELIVRY SYSTEM

    yRA 1082 - RHU Act

    yRA 1891 - Strengthen Health Services

    yPD 568 - RestructuringHCDS

    yRA 7160 - LGU Code

    VI National Health Plan

    yNational Health Plan is a long-term directional plan for health; the blueprintdefining thecountrys health PROBLEMS, POLICYTHRUSTS STRATEGIES, THRUSTSGOAL :

    yto enable the Filipino population to achieve a level of health which will allow Filipino tolead a socially and economically-productive life, with longer life expectancy, low infantmortality, low maternal mortality and less disability through measures that will guaranteeaccess of everyone to essential health careOBJECTIVES:36

    ypromote equity in health status among all segments of society

    yaddress specific health problems of the population

    yupgrade the status and transform the HCDS into a responsive, dynamic and highlyefficient, and effective one in the provision of solutions to changing the health needs ofthe population

    ypromote active and sustained peoples participation in health care MAJOR HEALTH PLANS TOWARDS HEALTH IN THE HANDS OF THE

    PEOPLE IN THE YEAR 2020A. MAJOR HEALTH PLAN

    y23 IN 93

    yHealth for more in 94

    yThink health Health Link

    y5 in 95B. PRIORITY PROGRAM IN YEAR 2000

    yPlan 50

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    yPlan 500

    yWomens health

    yChildrens health

    yHealthy Lifestyle

    yPrevention & Control of Infectious DiseaseC. PRIORITY PROGRAM IN THE YEAR 2005

    yLigtas Buntis CampaignyMag healthy Lifestlye tayo

    yTB Network

    yBlood Donation Program (RA 7719)

    yDTOMIS

    yLigtas Tigdas Campaign

    yMurang Gamot

    yAnti Tobacco Signature Campaign

    yDoctors to the Barrios Program

    yFood Fortification Program

    ySentrong Sigla MovementD. NATIONAL HEALTH EVENTS FOR 2006JANUARY

    yNational Cancer Consciousness Week - (16-22)FEBRUARY

    yHeart Month

    yDental Health Month

    yResponsible Parenthood Campaign National Health Insurance ProgramMARCH

    yWomen's Health Month

    yRabies Awareness Month

    yBurn Injury Prevention Month

    yResponsible Parenthood Campaign

    yColon and Rectal Cancer Awareness Month

    yWorld TB Day - (24)

    AP

    RILyCancer in Children Awareness Month

    yWorld Health Day - (7)

    yBright Child Week Phase I -

    yGarantisadong Pambata (11-17)

    MAY

    yNatural Family Planning Month37

    yCervical Cancer Awareness Month

    yAIDS Candlelight Memorial Day - (21)

    yWorld No Tobacco Day - (31)JUNE

    y

    Dengue Awareness MonthyNo Smoking Month

    yNational Kidney Month

    yProstate Cancer Awareness MonthJULY

    yNutrition Month

    yNational Blood Donation Month

    yNational Disaster Consciousness MonthAUGUST

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    yNational Lung Month

    yNational Tuberculosis Awareness Month

    ySight-Saving Month

    yFamily Planning Month

    yLung Cancer Awareness MonthSEPTEMBER

    yGenerics Awareness MonthyLiver Cancer Awareness MonthOCTOBER

    yNational Children's Month

    yBreast Cancer Awareness Month

    yNational Newborn Screening Week (3-9)

    yBright Child Week Phase II Garantisadong Pambata (10-16)

    NOVEMBER

    yFilariasis Awareness Month

    yCancer Pain Management Awareness Month

    yTraditional and Alternative Health Care Month

    yCampaign on Violence Against Women and ChildrenDECEMBER

    yFirecracker Injury Prevention Campaign:

    yOPLAN IWAS PAPUTOK

    VII - INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

    yIMCI is an integrated approach to child health that focuses on the well-being of the wholechild.

    yIMCI strategy is the main intervention proposed to achieve a significant reduction in thenumber of deaths from communicable diseases in children under fiveGoal:

    yBy 2010, to reduce the infant and under five mortality rate at least one third, in pursuit ofthe goal of reducing it by two thirds by 2015.

    AIM:yto reduce death, illness and disability, and to promote improved growth and developmentamong children under 5 years of age.

    yIMCI includes both preventive and curative elements that are implemented by families and

    communities as well as by health facilities.IMCI OBJECTIVES:

    yTo reduce significantly global mortality and morbidity associated with the major causes ofdisease in children

    yTo contribute to the healthy growth & development of childrenIMCI COMPONENTS OF STRATEGY:

    yImproving case management skills of health workers

    yImproving the health systems to deliver IMCI

    yImproving family and community practices**For many sick children a single diagnosis may not be apparent or appropriate38Presenting complaint:

    yCough and/or fast breathing

    yLethargy/Unconsciousness

    yMeasles rash

    yVery sick young infantPossible course/ associated condition:

    yPneumonia, Severe anemia, P. falciparum malaria

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    yCerebral malaria, meningitis, severe dehydration

    yPneumonia, Diarrhea, Ear infection

    yPneumonia, Meningitis, SepsisFive Disease Focus of IMCI:

    yAcute Respiratory Infection

    yDiarrhea

    yFeveryMalaria

    yMeasles

    yDengue Fever

    yEar Infection

    yMalnutritionTHE IMCI CASE MANAGEMENT PROCESS

    yAssess and classify

    yIdentify appropriate treatment

    yTreat/refer

    yCounsel

    yFollow-upTHE INTEGRATED CASE MANAGEMENT PROCESS

    Check for General Danger Signs:yA general danger sign is present if:- the child is not able to drink or breastfeed- the child vomits everything- the child has had convulsions- the child is lethargic or unconsciousASSESS MAIN SYMPTOMS

    yCough/DOB

    yDiarrhea

    yFever

    yEar problemsASSESS AND CLASSIFY COUGH OR DIFFICULTY OF BREATHING

    - Respiratory infections can occur in any part of the respiratory tract such as the nose, throat,larynx, trachea, air passages or lungs.Assess and classifyPNEUMONIA

    ycough or difficult breathing

    yan infection of the lungs

    yBoth bacteria and viruses can cause pneumonia

    yChildren with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis(generalized infection).** A child with cough or difficult breathing is assessed for:

    yHow long the child has had cough or difficult breathing

    yFast breathing

    yChest indrawing

    yStridor in a calm child.REMEMBER:39** If the child is 2 months up to 12 months the child has fastbreathing if you count 50breaths perminute or more** If the child is 12 months up to 5 years the child has fastbreathing if you count 40breaths perminute or more.IMCI COLOR CODINGPINK(URGENT REFERRAL)

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    YELLOW(Treatment at outpatienthealth facility)GREEN(Home management)OUTPATIENTHEALTHFACILITY

    Pre-referral treatmentsAdvise parentsRefer childOUTPATIENTHEALTHFACILITY

    Treat local infectionGive oral drugsAdvise and teach caretakerFollow-upHOMECaretaker is counseled on:

    Home treatment/sFeeding and fluidsWhen to return immediatelyFollow-upREFERRAL FACILITY

    Emergency Triage andTreatment ( ETAT)

    Diagnosis, TreatmentMonitoring, follow-upSEVERE PNEUMONIA ORVERY SEVERE DISEASE

    Give first dose of anappropriate antobiotic

    Give Vitamin ATreat the child to prevent lowblood sugar

    Refer urgently to the hospital

    Give paracetamol for fever >38.5oC

    Any general danger sign orChest indrawing orStridor in calm child PNEUMONIAGive an appropriate antibioticfor 5 days

    Soothe the throat and relieve

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    cough with a safe remedy

    Advise mother when to returnimmediately

    Follow up in 2 daysGive Paracetamol for fever >38.5oC

    Fast breathing NO PNEUMONIA : COUGHOR COLD

    If coughing more than morethan 30 days, refer for40assessment

    Soothe the throat and relievethe cough with a safe remedy

    Advise mother when toreturn immediatelyFollow up in 5 days if notimproving

    No signs of pneumonia orvery severe diseaseAssess and classify DIARRHEAA child with diarrhoea is assessed for:

    yhow long the child has had diarrhoea

    yblood in the stool to determine if the child has dysentery

    ysigns of dehydration.Classify DYSENTERY

    ychild with diarrhea and blood in the stoolTwo of the following signs ?

    Abnormally sleepy or difficult toawaken

    Sunken eyes

    Not able to drink or drinkingpoorlySkin pinch goes back very slowlySEVEREDEHYDRATIONIf child has no other severeclassification:- Give fluid for severedehydration ( Plan C ) OR If child has another severeclassification :- ReferURGENTLY to hospitalwith mother giving frequent sips of

    ORS on the way- Advise the mother tocontinue breastfeeding If child is 2 years or older andthere is cholera in your area, giveantibiotic for choleraTwo of the following signs :

    Restless, irritable Sunken eyes

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    Drinks eagerly, thirstySkin pinch goes back slowlySOME DEHYDRATION

    Give fluid and food for somedehydration ( Plan B )

    If child also has a severe

    classification :- ReferURGENTLY to hospitalwith mother giving frequent sips ofORS on the way- Advise mother when to returnimmediately

    Follow up in 5 days if notimproving

    Home Care41

    Not enough signs to classify assome or severe dehydration NO DEHYDRATION

    Give fluid and food to treatdiarrhea at home ( Plan A )Advise mother when to returnimmediately

    Follow up in 5 days if notimprovingDehydration present SEVERE PERSISTENTDIARRHEA

    Treat dehydration before referralunless the child has anothersevere classification

    Give Vitamin a Refer to hospitalNo dehydration PERSISTENTDIARRHEA

    Advise the mother on feeding achild who has persistent diarrhea

    Give Vitamin A Follow up in 5 daysBlood in the stool DYSENTERYTreat for 5 days with an oralantibiotic recommended forShigella in your area

    Follow up in 2 daysGive also referral treatmentDoes the child have fever?

    **Decide :

    - Malaria Risk- No Malaria Risk- Measles- DengueMalaria Risk

    Any general danger sign or

    Stiff neck

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    VERY SEVERE FEBRILEDISEASE / MALARIA

    Give first dose of quinine( under medical supervision orif a hospital is not accessiblewithin 4hrs )

    Give first dose of anappropriate antibiotic Treat the child to preventlow blood sugar

    Give one dose ofparacetamol in health centerfor high fever (38.5oC) orabove

    Send a blood smear with thepatient

    ReferURGENTLY tohospital

    Blood smear ( + )If blood smear not done: NO runny nose, and NO measles, andNO other causes of feverMALARIA

    Treat the child with an oralantimalarial

    Give one dose ofparacetamol in health centerfor high fever (38.5oC) orabove

    Advise mother when toreturn immediately

    Follow up in 2 days if feverpersists42

    If fever is present everydayfor more than 7 days, refer forassessment

    Blood smear ( - ), or Runny nose, or Measles, orOther causes of fever

    FEVER : MALARIA UNLIKELYGive one dose ofparacetamol in health centerfor high fever (38.5oC) orabove

    Advise mother when toreturn immediately

    Follow up in 2 days if feverpersists

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    If fever is present everydayfor more than 7 days, refer forassessmentNo Malaria Risk

    Any general danger sign or

    Stiff neckVERY SEVERE

    FEBRILE DISEASE

    Give first dose of an appropriate

    antibiotic

    Treat the child to prevent low

    blood sugar

    Give one dose of paracetamol in

    health center for high fever (38.5oC)or above

    ReferURGENTLY to hospital

    No signs of very severefebrile disease

    FEVER : NO MALARIA Give one dose of paracetamol in

    health center for high fever (38.5oC)or above

    Advise mother when to return

    immediately

    Follow up in 2 days if fever

    persists

    If fever is present everyday for

    more than 7 days, refer forassessmentMeasles

    Clouding of cornea or

    Deep or extensive mouth

    ulcersSEVERE COMPLICATEDMEASLES

    Give Vitamin A

    Give first dose of an

    appropriate antibiotic

    If clouding of the cornea or

    pus draining from the eye,apply tetracycline eye ointment

    ReferURGENTLY to

    hospital

    Pus draining from the eye or

    Mouth ulcers

    MEASLES WITH EYE ORMOUTH COMPLICATIONS

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    Give Vitamin A

    If pus draining from the eye,

    apply tetracycline eye ointmentIf mouth ulcers, teach themother to treat with gentianviolet43

    Measles now or within the

    last 3 months

    MEASLES Give Vitamin A

    Dengue Fever

    Bleeding from nose or gumsor Bleeding in stools orvomitus or Black stools or vomitus or Skin petechiae or Cold clammy extremities or Capillary refill more than 3seconds orAbdominal pain or Vomiting Tourniquet test ( + )SEVERE DENGUEHEMORRHAGIC FEVER

    If skin petechiae orTourniquet test,are the onlypositive signs give ORS

    If any other signs arepositive, give fluids rapidly as

    in Plan C Treat the child to preventlow blood sugar

    DO NOT GIVE ASPIRIN Refer all children Urgentlyto hospitalNo signs of severe denguehemorrhagic feverFEVER: DENGUEHEMORRHAGIC UNLIKELY

    DO NOT GIVE ASPIRIN

    Give one dose of

    paracetamol in health centerfor high fever (38.5oC) orabove

    Follow up in 2 days if fever

    persists or child shows signsof bleeding

    Advise mother when to

    return immediately

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    Does the child have an ear problem?

    Tender swelling behind the

    ear MASTOIDITIS

    Give first dose of appropriate

    antibiotic

    Give paracetamol for pain

    ReferURGENTLY

    44

    Pus seen draining from the

    ear and discharge is reportedfor less than 14 days or

    Ear pain

    ACUTE EAR INFECTION

    Give antibiotic for 5 days

    Give paracetamol for pain

    Dry the ear by wicking

    Follow up in 5 days

    Pus seen draining from the

    ear and discharge is reportedfor less than 14 daysCHRONIC EAR INFECTION

    Dry the ear by wicking

    Follow up in 5 days

    No ear pain and no pus seen

    draining from the earNO EAR INFECTION

    No additional treatment

    45Check for Malnutrition and AnemiaGive an Appropriate Antibiotic:A. ForPneumonia, Acute ear infection orVery Severe diseaseCOTRIMOXAZOLEBID FOR 5 DAYSAMOXYCILLINBID FOR 5 DAYSAge or Weight AdulttabletSyrup Tablet Syrup2 months up to 12 months ( 4- < 9 kg )

    1 / 2 5 ml 1 / 2 5 ml12 months up to 5 years ( 10

    19kg )1 7.5 ml 1 10 mlB. For DysenteryCOTRIMOXAZOLEBID FOR 5 DAYSAMOXYCILLINBID FOR 5 DAYSAGE OR WEIGHT TABLET SYRUP SYRUP 250MG/5ML

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    2 4 months( 4 - < 6kg ) 5 ml 1.25 ml ( tsp )4 12 months( 6 - < 10 kg ) 5 ml 2.5 ml ( tsp )1 5 years old( 10 19 kg )1 7.5 ml ( 1 tsp )46C. For CholeraTETRACYCLINEQID FOR 3 DAYSCOTRIMOXAZOLEBID FOR 3 DAYSAGE OR WEIGHT Capsule 250mg Tablet Syrup2 4 months( 4 - < 6kg ) 1 / 2 5ml4 12 months

    ( 6 - < 10 kg ) 1 / 2 5 ml1 5 years old( 10 19 kg1 1 7.5mlGive an Oral AntimalarialCHOLOROQUINEGive for 3 daysPrimaquineGive single dose inhealth center for P.FalciparumPrimaquine

    Give daily for 14 days for P.VivaxSulfadoxine +PyrimethamineGive single dose

    AGE TABLET ( 150MG ) TABLET( 15MG)TABLET( 15MG)TABLET( 15MG)DAY1 DAY2 DAY32months

    5months 5 months 12 months 1/212months 3 years old1 1 3 years old -5 years old

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    1 1 1 3/4 1/2 1GIVE VITAMIN A47

    AGE VITAMIN A CAPSULES200,000 IU6 months 12 months 1//212 months 5 years old 1GIVE IRON

    AGE or WEIGHT Iron/Folate TabletFeSo4 200mg + 250mcg Folate (60mg elementaliron)Iron SyrupFeSo4 150 mg/5ml( 6mg elemental iron per ml )2months-4months( 4 -

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    yEducationSequence of steps in health education:

    yCreating awareness

    yCreating motivation

    yDecision making actionREPRODUCTIVE HEALTH

    1. Family Planning2. MCH & Nutrition3. Prevention / treatment of Reproductive Tract Infection & STD4. Prevention of abortion & its complication5. Education & counseling on sexuality & sexual health6. Adolescent sexual reproductive health7. Violence against women8. Mens reproductive health ( Male sexual disorder )9. Breast CA & other gyne problem10. Prevention / treatment of infertilityOLDER PERSONS HEALTH SERVICES

    yParticipation in the celebration ofHealthy National Elderly Week ( Oct 1-7)- Lecture on healthy lifestyle for the elderly

    y

    Provision of drugs for the elderly( 20% discount)GUIDELINES FOR GOOD NUTRITION

    yNutritional Guidelines are primary recommendations to promote good health through propernutrition.ACTIVITIES:1.Malnutrition Rehabilitation ProgramTargeted Food Task Force Assistance Program (TFAP)Nutrition Rehabilitation WardAkbayan sa Kalusugan sa Kabataan (ASK Project)2.Micronutrient Supplementation Program

    y23 in 93

    yFortified Vitamin Rice

    yHealth for More in 94

    yBuwan ng Kabataan, Pag-asa ngBayan49

    yNational Focus: National Micronutrient Day or Araw ng Sangkap Pinoy

    PROTEIN ENERGY MALNUTRITION1. Marasmus looks like an old worried man- less subcutaneous fats2. Kwashiorkor - a moon face child- with flag sign (hair changes)VITAMIN A DEFICIENCYEarly symptoms: Xeropthalmia (Nigtblindess)Bitots spot (silvery foamy spot located @ lateral sclera)Corneal Xerosis (eye lesion)

    Conjunctival Xerosis(scar in the eyes)Keratomalacia ( whitish to grayish sclera)BLINDNESSRESPIRATORY INFECTION CONTROL

    Provision of medicines

    Consultative meetings with CARI coordinators

    Monitoring of health facilities on the implementation of the program

    ALTERNATIVE MEDICINE

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    yRA 8423

    y23 IN 93A. Herbal Medicine(LUBBY SANTA)Herbal Medicine USESLagundi ( Vitex Negundo)SHARED

    Skin diseasesHeadache,Asthma,fever,cough&coldsRheumatismEczemaDysentery

    Ulasimang Bato (Peperonia Pellucida) Lowers uric acidBawang ( Allium Sativum) HAT Headache and TootacheBayabas ( Psidium Guajava) Anti septic, Anti-diarrhealYerba Buena (Mentha Cordifolia) Rheumatism and other body aches,analgesicsSambong (Blumea Balsamifera) Edema, diuretics

    Akapulko Fungal infection, skin diseasesNiog Niogan (Quisqualis Indica) Anti-helminthicTsaang Gubat (Carmona Retusa) Diarrhea50

    Ampalaya (Momordica Charantia) DMMATERNAL- CHILD CAREI - Maternal CareA. FAMILY PLANNINGI. Spacing / Artificial Method

    A. HormonalB. Mechanical & BarrierC. BiologicD. NaturalII. Permanent (surgical/irreversible)H A. Tubal Ligation

    I B. VasectomyIII. Behavioral MethodB. BREASTFEEDINGII - CHILD CAREA. UNDER FIVE CARE PROGRAM

    yA package of child health-related services focused to the 0-59 months old children to assure theirwellness and survivalGrowth Monitoring Chart (GMC)

    yA standard tool used in health centers to record vital information related to child growth anddevelopment, to assess signs of malnutrition.B. EXPANDED PROGRAM ON IMMUNIZATION

    yLEGAL BASIS

    yPD #996 Compulsory basic

    yPP #147 National Immunization DayyPP #773 Knock out Polio Days

    yPP # 1064 polio eradication campaign

    yPP #4 - Ligtas Tigdas monthMENTAL HEALTH

    ya state of well-being where a person can realize his or her own abilities, to cope with the normalstresses of life and work productivelyComponents of Mental HealthProgram

    yStress Management and Crisis Intervention

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    yDrugs and Alcohol Abuse Rehabilitation

    yTreatment and Rehabilitation of Mentally-Ill Patients

    ySpecial Project for Vulnerable GroupsSENTRONG SIGLA MOVEMENTAIM: to promote availability of quality health services4 pillars:

    y

    Quality assuranceyGrants & technical assistance

    yHealth promotion

    yAwardCOMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCHCommunity Organizing

    ya continuous and sustained process of

    yEDUCATING THE PEOPLE,

    yCRITICAL AWARENESS

    yMOBILIZING51Participatory Action Research

    yA combination of education, research and action.

    yThe purpose is the EMPOWERMENT of people4 Phases:

    yPre entry

    yEntry

    yOrganizational Building

    ySustenance and StrengtheningLaws Affecting CHN Implementation:RA 8749 - Clean Air Act (2000)RA 6425 Dangerous Drug Act: sale, administration and distribution of prohibited drugs is punishableby lawRA 9173RA 2382 Philippines Medical Act: define the practice of medicine in the PhilippinesRA 1082 Rural Health Act: employment of more physicians, nurses, midwives who will live in the

    rural areas to help raise the health condition.RA 3573 - Reporting of Communicable DiseaseRA 6675 Generic Act: promotes, requires and ensures the production of an adequate supply,distribution, use of drugs identified by their generic names.RA 6365RA 6758RA 4703RA 7305 Magna Carta for Public Health Workers (approved by Pres. Corazon C. Aquino): aims topromote and improve the social and economic well being of health workers, their livingand conditions.RA 7160 Local Government Code: responsibility for the delivery of basic services of the nationalgovernment

    IX - CHRONIC COMMUNICABLE DISEASES

    I - TUBERCULOSISyTB is a highly infectious chronic disease that usually affects the lungs.Causative Agent: Mycobacterium TuberculosisS/S:

    ycough

    yafternoon fever

    yweight loss

    ynight sweat

    yblood stain sputum

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    Prevalence/Incidence:

    yranks sixth in the leading causes of morbidity (with 114,221 cases) in the Philippines

    ysixth leading cause of mortality (with 28507 cases) in the Philippines.Nursing and Medical Management

    yVentilation systems

    yUltraviolet lighting

    yVaccines, such as the bacillus Calmette Guerin (BCG) vaccineydrug therapyPreventing Tuberculosis

    yBCG vaccination

    yAdequate rest

    yBalanced diet

    yFresh air

    yAdequate exercise

    yGood personal HygieneDOTS (Direct Observed Treatment Short Course)Regimen Type of TBPatient52Regimen I

    2RIPE / 4RIyNew pulmonary smear (+) cases

    yNew seriously ill pulmonary smear (-) casesw/ extensive lung lesions

    yNew severely ill extra-pulmo TBRegimen II2RIPES/1RIPE / 5RIE

    yNew pulmonary smear (+) case

    yNew seriously ill pulmonary smear (-) casesw/ extensive lung lesions

    yNew severely ill extra-pulmo TBRegimen III

    2RIP / 4RIyNew smear(-) but with minimal pulmonary TBon radiography as confirmed by a medicalofficer

    yNew extra-pulmo TB (not serious)II - LEPROSY

    ySometimes known as Hansen's disease

    yis an infectious disease caused by , an aerobic, acid fast, rod-shaped mycobacterium

    yGerhard ArmauerHansen

    yHistorically, leprosy was an incurable and disfiguring disease

    yToday, leprosy is easily curable by multi-drug antibiotic therapySigns & SymptomsEarly stage(CLUMP) Late Stage(GMISC)

    Change in skin colorGynocomastiaLoss in sensation Madarosis(loss of eyebrows)Ulcers that do not heal Inability to close eyelids (Lagopthalmos)Muscle weakness Sinking nosebridgePainful nerves Clawing/contractures of fingers & nosePrevalence Rate

    yMetro Manila, the prevalence rate ranged from 0.40 3.01 per one thousand population.MANAGEMENT:

    yDapsone, Lamprene

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    yclofazimine and rifampin

    yMulti-Drug-Therapy (MDT)

    ysix month course of tablets for the milder form of leprosy and two years for the more severe formX - VectorBorne Communicable DiseaseI LEPTOSPIROSIS

    yan infectious disease that affects humans and animals, is considered the most common zoonosis

    in the worldCausative Agent: Leptospira interrogansS/S:-high fever -severe headache-chills -muscle aches-vomiting -may include jaundice (yellow skin and eyes)-red eyes -abdominal pain-diarrheaTREATMENT:PET - > Penicillins , Erythromycin, TetracyclineII - MALARIA53

    yMalaria (from Medieval Italian: mala aria - "bad air"; formerly called ague or marsh fever) is aninfectious disease that is widespread in many tropical and subtropical regions.Causative Agent:Anopheles female mosquitoSigns & Symptoms:Chills to convulsionHepatomegalyAnemiaSweats profuselyElevated temperatureTreatment: Chemoprophylaxis chloroquine taken at weekly interval, starting from 1-2 weeks beforeentering the endemic area.Preventive Measures: (CLEAN)Chemically treated mosquito netsLarvae eating fishEnvironmental clean up

    Anti mosquito soap/lotionNeem trees/eucalyptus treeIII - FILIARIASIS

    yname for a group of tropical diseases caused by various thread-like parasitic round worms(nematodes) and their larvae

    ylarvae transmit the disease to humans through a mosquito bite

    ycan progress to include gross enlargement of the limbs and genitalia in a condition calledelephantiasisS/S:Asymptomatic Stage

    yCharacterized by the presence of microfilariae in the peripheral blood

    yNo clinical signs and symptoms of the disease

    ySome remain asymptomatic for years and in some instances for lifeAcute Stage

    yLymphadenitis (inflammation of lymph nodes)

    yLymphangitis (inflammation of lymph vessels)

    yIn some cases the male genitalia is affected leading to orchitis (redness, painful and tenderscrotum)Chronic Stage

    yHydrocoele (swelling of the scrotum)

    yLyphedema (temporary swelling of the upper and lower extremities

    yElephantiasis (enlargement and thickening of the skin of the lower and / or upper extremities,

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    scrotum, breast)MANAGEMENT:

    yDiethylcarbamazine

    yIvermectin,

    yAlbendazolethe

    yNo treatment can reverse elephantiasis

    VI SCHISTOSOMIASISyparasitic disease caused by a larvaeCausative Agent: Schistosoma intercalatum, Schistosoma japonicum, Schistosoma mansoniSigns & Symptoms: (BALLIPS)Bulging abdomenAbdominal painLoose bowel movementLow grade feverInflammation of liver & spleenPallorSeizureTreatment: Diethylcarbamazepine citrate (DEC) orHetrazan (drug of choice)54VII DENGUE

    yDENGUEis a mosquito-borne infection which in recent years has become a major internationalpublic health concern..

    yIt is found in tropical and sub-tropical regions around the world, predominantly in urban and semiurbanareas.S/S: (VLINOSPARD)

    yVomiting

    yLow platelet

    yNausea

    yOnset of fever

    ySevere headache

    yPain of the muscle and joint

    yAbdominal pain

    yRashesyDiarhheaTREATMENT:

    yThe mainstay of treatment is supportive therapy.- intravenous fluids- A platelet transfusion