July 2012 nle tips chn and cd

WHAT YOU SHOULD KNOW BEFORE THE PNLE JULY 2012 PNLE PEARLS OF SUCCESS

PART 3: COMMUNITY HEALTH NURSING

POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING JULY 2012 PNLE *Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE students on the possible topics that might be part of the upcoming July 2012 PNLE

A. DOH Vision 2030

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

equitable health financing. B. DOH Mission

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

quest for excellence in health. C. Levels of Prevention

PRIMARY LEVEL

Health Promotion and

Illness Prevention

SECONDARY LEVEL

Prevention of Complications thru Early Dx

and Tx

TERTIARY LEVEL

Prevention of Disability, etc.

Provided at –

Health care/RHU

Brgy. Health Stations

Main Health Center

Community Hospital and Health Center

Private and Semi-‐private agencies

When hospitalization is deemed necessary and referral is made to emergency (now district), provincial or regional or private hospitals

When highly-‐specialized medical care is necessary referrals are made to hospitals and medical center such as PGH, PHC, POC, National Center for Mental Health, and other gov’t private hospitals at the municipal level

D. 8 Common Generic Drugs (Botika sa Baranggay)

1. Co-‐Trimoxazole : GUT/GIT/URT Infection 2. Amoxicillin / Ampicillin 3. Rifampicin 4. Isoniazid 5. Pyrazinamide 6. Paracetamol 7. Oresol 8. Nifidipine: HPN

E. Herbal Plants

Plant Name Scientific Name Indications Lagundi Vitex negundo Asthma, cough,

colds & fever Pain and inflammation

Ulasimang Bato Peperonia pellucida

Gout Arthritis Rheumatism

Bayabas Psidium quajava Diarrhea Toothache Mouth and wound wash

Bawang Allium sativum HPN Toothache

Yerta Buena Mentha cordifelia Same as Lagundi except asthma

Sambong Blumea balsanifera

Edema Diuretic

Akapulko Cassia alata All forms of skin diseases

Niyog niyogan Quisqualis indica Intestinal Parasitism (Nematodes)

Tsaang Gubat Carmona resuta Diarrhea Infantile colic (Kabag) Dental caries

Ampalaya Mamordica charantia

Type II Diabetes (NIDDM)

F. Homemade Oresol A volume or one liter homemade oresol

Smaller volume or a glass homemade oresol

Water 1000 ml. or 1 liter 250 ml. Sugar 8 teaspoon 2 teaspoon Salt 1 teaspoon ¼ teaspoon or a pinch of

salt=10-‐12 granules of rock salt: iodized salt=tips of thumb & index finger are penetrated with salt

G. Millennium Goal Development (MDG)

1. ERADICATE EXTREME POVERTY AND HUNGER 2. ACHIEVE UNIVERSAL PRIMARY EDUCATION 3. PROMOTE GENDER EQUALITY AND EMPOWER

WOMEN 4. REDUCE CHILD MORTALITY (Phil. focus) 5. IMPROVE MATERNAL HEALTH (Phil. focus) 6. COMBAT HIV/AIDS, MALARIA AND OTHER

DISEASES 7. ENSURE ENVIRONMENTAL SUSTAINABILITY 8. DEVELOP A GLOBAL PARTNERSHIP FOR

DEVELOPMENT H. Field Health Service Information System ( FHSIS)

Ø Individual Treatment Record (ITR) ü Fundamental building block or foundation

FHSIS. Ø Target Client List (TCL)

ü Such lists will be of considerable value to midwives/nurses in monitoring service delivery to clients in general and in particular to groups of patients identified as “targets” or “eligibles” for one or another program of the Department




Ø Summary Table ü Composed of Health Program Accomplish

and Morbidity Diseases Ø The Monthly Consolidation Table (MCT) FHSIS Reporting Ø Monthly Form

1. Program report (M1) 2. Morbidity report (M2)

ü Prepare by Midwife ü Every 2nd week of the month is the

submission Ø Quarterly Form

1. Program report (Q1) 2. Morbidity report (Q2)

ü Prepared by Nurse ü Every 3rd week of the succeeding quarter

month is the submission Ø Annual Form

1. ABHS report ü Contains data on demographic,

environmental and natality. ü Prepare by Midwife ü Every 2nd week of January is the

submission 2. A1: Report on vital statistics: demographic,

environmental, natality and mortality. 3. A2: Lists all diseases and their occurrence in

the municipality/city. The report is broken down by age and sex.

4. A3: All deaths occurred in the municipality/city. The report is also broken down by age and sex ü Prepared by Nurse ü Every 3rd week of January is the

submission

I. Health Indicators Crude Birth Rate (CBR): Overall total reported births per 1000 population

CBR=overall total reported births x 1000 Population

Incidence Rate (IR): Reported new cases of disease per percent (100/population) population

IR=new cases of disease x 100 Population

Prevalence rate (PR): Reported new cases of disease + old cases of disease per percent of population

PR=new cases + old cases x 100 Population

Crude Death Rate (CDR): Overall total reported deaths per 1000 population

CDR=overall total deaths x 1000 Population

Maternal Mortality Rate (MMR): Reported maternal deaths per 1000 registered live births (RLB)

MMR= # of maternal deaths x 1000

RLB

Infant Mortality Rate (IMR): Reported # of infant (0 to 12 months of age) deaths per 1000 RLB

IMR=# of infant deaths x 1000 RLB

Neonatal Mortality Rate (NMR): Reported # of neonatal (0 to 28 days or <1 month) deaths per 1000 RLB

NMR=# of neonatal deaths x 1000 RLB

Swaroop’s Index (SI): Reported # of deaths among individuals> 50 years old over total deaths SI=# of deaths (individual >50 years old) x 100

Total Deaths J. Nature of the Family Problem

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

Ø Health Threat (HT): any condition or situation

which will be conducive to health alteration, health interference & health disturbance.

Ø Foreseeable Crisis (FC): stress points, anything

which is anticipated/ expected to become a problem.

K. Community Organizing (COPAR) Preparatory Phase 1. Area of Selection

Ø It should be DOPE Community: Depressed, Oppressed, Poor & Exploited, a new criteria for community organization

2. Entry Phase Ø The 1st thing to do upon entering the community is

to have a courtesy call with the Barangay Captain, introduce self & group, purpose, present the project, activities, etc.

3. Integration/Immersion (CIP) Ø Immersion is imbibing the life situation/condition

of the community . 4. Community Study: Diagnosis of Community-‐COPAR

Ø Makes use of the Nursing Process/Problem Solving Approach




Ø Prioritized which among the problems identified is to be attended 1st like in nature, magnitude, modifiability, preventive potential, salience

L. Epidemiology

Ø Epidemic: a situation when there is a high incidence of new cases of a specific disease in excess of the expected.

Ø Endemic : habitual presence of a disease in a given geographic location accounting for the low number of both immunes and susceptibles

Ø Sporadic : disease occurs every now and then affecting only a small number of people relative to the total population

Ø Pandemic: global occurrence of a disease

M . Approve Water Facilities

Level I Point Source

Level II Communal faucet system or stand posts

Level III Waterworks system or individual house connections

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

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

A system with a source, a reservoir, a piped distributor network and household taps that is suited for densely populated urban areas.

N. Approved Toilet Facilities

Level 1 Level 2 Level 3 Non-‐water carriage toilet facility: -‐ Pit latrines -‐ Reed Odorless Earth Closet -‐ Bored-‐hole -‐ Compost -‐ Ventilated improved pit Toilets requiring small amount of water to wash waste into receiving space -‐ Pour flush -‐ Aqua privies

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

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

O. Excreta Disposal

Household Community ○ Burial

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

○ Open burning • Animal feeding • Composting • Grinding and

disposal sewer

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

DOH PROGRAMS

EXPANDED PROGRAM ON IMMUNIZATION v Law: PD 996

Vaccine Dosage # of Doses to complete immunization

BCG 1. I 2. SE

.05 ml .1 ml

1 dose 1 dose

DPT .5 ml 3 doses OPV 2-‐3 gtts 3 doses HBV <10 y/o: .5

>10 y/o: 1 3 doses

MV .5 ml 1 dose v It is safe and immunologically effective to administer all

EPI vaccines on the same day at different sites of the body.

v The vaccination schedule should not be restarted from the beginning even if the interval between doses exceeded the recommended interval by months or year.

v DPT2 or DPT3 is not given to a child who has convulsions or shock within 3 days after DPT1. V

v Do not give live vaccines like BCG to a individuals who are immunosuppressed due to malignant disease (child with AIDS) , going therapy with immunosuppressive agents or radiation.

v Repeat BCG vaccination if the child does not develop a scar after first injection

Type of Vaccine Storage Temp. Hours of Life after

opening OPV -‐15 to -‐25 C Measles At the freezer Hepa B 8 hours DPT 2 to 8 C Tetox Body of BCG refrigerator 4 hours NATIONAL TB PROGRAM




Disease Causative Agent Mode of

Transmission Clinical

Manifestation Reservoir Diagnostic

Exam Treatment Nursing

Implication Tuberculosis “Primary Complex” is less than 3 years old -‐ any child who does not return to normal health after measles or whooping cough. • Most

hazardous period: first 6-‐12 months after infection

• Highest in risk of developing: under 3 years old

Mycobacterium Tuberculosis

Droplet Infection ( inhalation of

bacilli from patient who coughs and

sneeze)

• General

weakness • Loss of

weight, cough and wheeze which does not respond to antibiotic therapy.

• Fever and night sweat

• Abdominal swelling with a hard painless mass and free fluid

• Hemoptysis and chest pain

• Painful firm or soft swelling in a group of superficial lymph nodes.

Man And

Diseased Cattle (Bovine TB)

• Sputum

Exam 3 sample are taken with 24 hrs: -‐ spot sample (1st visit) -‐ early morning specimen -‐ spot sample (2nd visit) Note: at least 2 sample are positive • Chest

Xray • Mantoux

Test -‐ .1 cc injection of PDD and 48-‐72 hours reading * 10 mm + 5 mm + (HIV pt.)

DOTS

-‐ patient is required to take the Ant-‐Tb drugs in the presence of a health care provider to ensure

compliance to treatment regimen

Anti-‐TB drugs: (RIPES) • Rifampicin • Isoniazid • Pyrazinamide • Ethambutol • Streptomycin

Pointers for teaching on Anti-‐TB drugs: Rifampicin: taken befor meals, causes red urine urine Isoniazide: causes peripheral neuritis, given with Vit.B6 Pyrazinamide: cause hyperurucemia Ethambutol: causes optic neuritis/ blurring of vision Streptomycin: cause tinnitus, loss of hearing balance, damage to 8th cranial nerve Note: After 2-‐4 weeks of treatment, patient is no longer contagious

RECOMMENDED CATEGORY OF TREATMENT REGIMEN

Category Type of TB Patient Treatment Regimen Intensive Phase Continuation

Phase Total Period

I

• New smear positive PTB • New smear positive PTB with extensive parenchymal lesion

• EPTB and Severe concomitant HIV disease

2 RIPE

4 RI

6 mos.

II

• Treatment Failure • Relapse • Return after default

2 RIPES /1 RIPE

5 RIE

8 mos.

III

• New smear-‐negative PTB • With minimal parenchymal lession

2 RIP

4 RI

6

mos. IV

• Chronic ( still smear-‐positive after supervised re-‐treatment )

Refer to or DOTS to City

Specialized Plus Center Provincial Coordinator

facility refer NTP




INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) Danger Sign

MAIN SYMPTOM: Cough and Difficulty Breathing

Pneumonia Classification

MAIN SYMPTOM: Diarrhea

Dehydration Classification

A child who has had diarrhea for 14 days or more and who has no signs of dehydration is classified as having PERSISTENT DIARRHOEA

Classify a child with diarrhea and blood in the stool as having DYSENTERY. A child with dysentery should be treated for dehydration

MAIN SYMPTOM: Fever




High Malaria Risk Classification

Low Malaria Risk Classification

No Malaria Risk Classification

MAIN SYMPTOM: Ear Problem

Ear Problem Classifications




MAIN SYMPTOM: Malnutrition and Anemia

Malnutrition and Anemia Classification

COMMUNICABLE DISEASES

Ø Cholera

ü Other names:El tor ü Fecal-oral route 5 Fs ü Incubation Period: Few hours to 5 days; Usually 3

days ü Pathognomonic Sign: Rice watery stool ü Diagnostic Test: Stool culture ü Treatment:Oral rehydration solution (ORESOL) IVF ü Drug-of-Choice: tetracycline (use straw; can cause

staining of teeth). Oral tetracycline should be administered with meals or after milk.

Ø Shistosomiasis

ü Other Names: Snail Fever Bilharziasis ü Endemic in 10 regions and 24 provinces High

prevalence: Regions 5, 8, 11 ü Contact with the infected freshwater with cercaria and

penetrates the skin

ü Diarrhea Bloody stools (on and off dysentery) Enlargement of abdomen Splenomegaly Hepatomegaly Anemia / pallor weakness

ü Diagnostic Test: COPT or cercum ova precipitin test (stool exam)

ü Drug-of-Choice: PRAZIQUANTEL (Biltracide) Oxamniquine for S. mansoni Metrifonate for S. haematobium *Death is often due to hepatic complication

ü Dispose the feces properly not reaching body of water Use molluscides Prevent exposure to contaminated water (e.g. use rubber boots)

ü Apply 70% alcohol immediately to skin to kill surface cercariae

ü Allow water to stand 48-72 hours before use Ø Malaria

ü Plasmodium Parasites: Vivax Falciparum (most fatal; most common in the Philippines)

ü Bite of infected anopheles mosquito Night time biting High-flying

ü Rural areas Clear running water ü Malarial Smear – best time to get the specimen is at

height of fever because the microorganisms are very active and easily identified

ü Chemoprophylaxis: only chloroquine should be given (taken at weekly intervals starting from 1-2 weeks before entering the endemic area). In pregnant women, it is given throughout the duration of pregnancy.

ü Treatment: 1. QUININE – oldest drug used to treat malaria; from the bark of Cinchona tree; ALERT: Cinchonism – quinine toxicity 2. CHLOROQUINE 3. PRIMAQUINE – sometimes can also be given as chemoprophylaxis 4. FANSIDAR – combination of pyrimethamine and sulfadoxine

ü CLEAN Technique *Insecticide – treatment of mosquito net *House Spraying (night time fumigation) *On Stream Seeding – construction of bio-ponds for fish propagation (2-4 fishes/m2 for immediate impact; 200-400/ha. for a delayed effect) *On Stream Clearing – cutting of vegetation overhanging along stream banks *Avoid outdoor night activities (9pm – 3am) *Wearing of clothing that covers arms and legs in the evening*Use mosquito repellents *Zooprophylaxis – typing of domestic animals like the carabao, cow, etc near human dwellings to deviate mosquito bites from man to these animals Intensive IEC campaign

July 2012 nle tips chn and cd

Health & Medicine

previous board exams

smear positive ptb

community health nursing

total deaths

tb drugs

guide students

program report

2nd week