COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

COMMUNITY ORGANIZING PARTICIPATORY  Consciousness-raising

ACTION RESEARCH (COPAR) (Day 2) a. Through experiential learning is central to the
COPAR process because it places emphasis on
 is a social development approach that aims to learning that emerges from concrete action and
transform the apathetic, poor into dynamic, which encircles succeeding action.
participatory and politically responsive community?
 COPAR is participatory and mass based
 a collective, participatory, transformative, liberative, a. Because it is primarily directed towards and
sustained and systematic process of building people's biased in favor of the poor, the powerless and the
organizations by mobilizing and enhancing the oppressed.
capabilities and resources of the people for the
 COPAR is group centered
resolution of their exploitative conditions (1994
a. And not leader centered. Leaders are identified,
National Rural CO Conference).
emerge and are tested through action rather than
 A process by which a community identifies its needs appointed or selected by some external force or
and objectives, develops confidence to take action in entity.
respect to them and in doing so, extends and develops
cooperative and collaborative attitudes and practices PHASES OF COPAR
in the community (Rose 1967).
 A continuous and sustained process of educating the  PRE-ENTRY PHASE
people to understand and develop their critical a. The initial phase of the organizing process where
awareness of their existing conditions, working with the community organizer looks for communities
the people collectively and efficiently on their to serve or help. It is the most complex phase in
immediate needs toward solving their long-term terms of actual outputs, activities, and strategies
problems. and time spent for it.
b. Recommended activities:
IMPORTANCE OF COPAR - Laying out the site criteria.
- Site selection.
 OPAR is an important tool for community - Meeting and courtesy call to the local
development and people empowerment as this helps government unit of the selected site.
the community workers to generate community - Courtesy call to the barangay level.
participation in development activities. - Meeting w/ the “will be” foster parents of
 COPAR prepares people to eventually take over the the health care students.
management of a development program in the future. c. Criteria for site selection:
COPAR maximizes community participation and - Is the community in need of assistance?
involvement; community resources are mobilized for - Do the community members feel need to
health development services. work together to overcome a specific health
PRINCIPLES OF COPAR problem?
- Are there concerned groups and
 People, especially the oppressed, exploited and organizations that the nurse can possibly
deprived sectors are open to change, have the work with?
capacity to change and are able to bring about - What will be the counterpart of the
change. community in terms of community support,
 COPAR should be based on the interests of the commitment and human resources?
poorest sectors of the society. d. Entry in the community and integration with
 COPAR should lead to a self-reliant community and the people
society. - Before actual entry into the community,
basic information about the area in relation
PROCESS/METHODS USED IN COPAR to the cultural practices and lifestyles of the
people must be known.
 A progressive cycle of action-reflectional-action
- establishing rapport and integrating with
a. Which begins in small, local and concrete issues
them will be much easier if one is able to
identified by the people and the evaluation and
understand, accept or imbibe their
reflection of and on the action taken by them.
community life.

CRYSTAL JADE S. RESURRECCION | OLFU BSN 1

 COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

- Living with the people, undergoing their - spreading awareness and soliciting solution
hardships and problems and sharing their or suggestion.
hopes and aspirations help build mutual trust - analysis of the presented solution.
and cooperation. - Planning of the activities.
e. Some guidelines in conducting Integration - organizing the people to build their own
work. organization.
- Recognize the role and position of local - registration of the organization.
authorities. - implementing of the said activities.
- Adapt a lifestyle in keeping w/ that of the - evaluation.
community.
- Choose a modest dwelling which the people, SUSTENANCE AND STRENGHTHENING PHASE
especially the economically disadvantaged a. Occur when the community organization has already
will not hesitate to enter. been established and the community-wide
- Avoid raising expectations of the people. Be undertakings. At this point, the different committee’s
clear w/ your objectives and limitations. set-up in the organization-building phase is already
- Participate directly in production process. expected to be functioning by way of planning,
- Make house calls and seek out people where implementing and evaluating their own programs, w/
they usually gather. the overall guidance from the community-wide
- Participate in some social activities. organization.
 ENTRY PHASE b. Recommended activities:
a. Sometimes called the immersion phase as it the - Meeting with the organizational leaders.
activities done here includes the sensitization of - evaluation of the programs.
the people on the critical events in their life, - >re-implementing of the programs. (for
motivating them to share their dreams and ideas unmet goals)
on how to manage their concerns and eventually - education and training.
mobilizing them to make collective action on - networking and linking.
these. - implementation of livelihood projects.
b. Recommended activities: - developing secondary leaders.
- Courtesy call to mayor, or the local  PHASE OUT
government leader of the selected site. a. The phase when the health care workers leave
- Courtesy call to the barangay level. the community to stand-alone. This phase should
- Meeting with the foster parents. be stated during the entry phase so that the
- Appreciating the environment. people will be ready to for this phase. The
- Meeting with community officials and organizations built should be ready to sustain the
residents. test of the community itself because the real
- general assembly. evaluation will be done by the residents of the
- preparation of survey forms. community itself.
- actual survey. b. Recommended activities:
- analysis of the data gathered. - Leaving the immersion site.
 ORGANIZATIONAL-BUILDING PHASE - documentation.
a. The formation of more formal structures and the
inclusion of more formal procedures of planning, THE COMMUNITY HEALTH WORKERS AS A
implementing and evaluating community-wide DOCUMENTER/REPORTER
activities. It is at this phase where the organized
 The community health worker keeps a written
leaders or groups are being given trainings to
account of services rendered, observations, condition,
develop their ask (attitude, knowledge and skills)
needs, problems and attitude of the client in
in managing their own concerns/programs.
community activities, accomplishments made and,
b. Recommended activities
etc.
- Meeting with the officials.
- identifying problems.  Community workers takes responsibility to
disseminate pertinent information to appropriate
authorities, agencies, and most especially to the
CRYSTAL JADE S. RESURRECCION | OLFU BSN 2
 COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

client. At the same time, the community worker c. Family planning – prevention and management
develops the people’s capabilities to keep/maintain of lifestyle. Who has history of diabetes and
their recording and reporting system. cardiovascular disease?
 RECORDS – refer to forms on which information d. Counselling on STI, HIV and personal
pertaining the client is noted. hygiene.
 REPORTS - refers to periodic summaries of the e. Facilitative based record – to be used by the
services/activities of an organization/unit or the health care center or by the nurse.
analysis of certain phases of its work. f. Home based mother’s record (HBMR) –
simplified record of health history of the present
PURPOSE OF RECORDS AND REPORTS and past pregnancy of the mother.
- Uses of HBMR:
 Measure service/program directed to the clients.
1. Promotes continuity of care.
 Provide basis for future planning.
2. Promotes early recognition of women who is at
 Interpret the work to the public and other agencies,
risk of developing conditions such as severe
community.
anemia, hypertension, bleeding, and severe
 Aid in studying the conditions of the community. edema.
 Contributes to client care. 3. Source of health statistics.
MATERNAL NEWBORN AND CHILD HEALTH AND 4. Provide health care workers by health
NUTRITION STARTEGY (Day 3) educational needs.

Key Package PRENATAL PACKAGE

- Ensuring universal access to and utilization of an 1. Prenatal Visits

MNCHN core package. - First and Second trimester: At least once
- Establishment of service delivery network at all level - Third trimester: Twice
of care. 2. Micronutrient Supplements
- Organized used of instrument for health systems - Vitamin A: 10,000 IU twice a week from 4th month
development. of pregnancy.
- Rapid build-up of institutional capacities of DOH and - Iodine: 200mg during pregnancy. (every week or a
phil-health. daily vitamins) or until 60 days.
3. Tetanus toxoid
Note: Schedule for Women

 DOH is the lead national agency in terms of health Vaccine Minimum age % Duration of
care program. Also, the one helps LGU’s and other interval protected protection.
DOH hospital in terms of planning and development TT1 As early as 0% 0 years
of standards and capacity to run the health center or possible.
implement the services offered in community health TT2 4 weeks later 80% 3 years
center. TT3 6 months after. 95% 5 years
 Is there a need for reproductive health age to visit TT4 1 year later 99% 10 years
during next
health center? Or is there a need for women in
pregnancy.
reproductive age to visit health care center? Yes,
TT5 1 year later/ or 99% Lifetime
because they are part of the community and to
third
prevent future complications of pregnancy it is better pregnancy.
at women in reproductive age will visit the center.  The mother must receive 3 shots of TT before
 So, what are the things that pre-pregnancy pregnancy. The newborn will be protected.
packages included?  But if the women got pregnant the mother should
a. Nutritional counselling receive 2 shots when to give (At least 3 months of the
b. Intake of iron and folate (beginning and end of delivery before given to the mother).
pregnancy) (elemental iron the iron must be
 Route/dosage: 0.5 ml IM upper arm deltoid
taken for 3 to 6 months during the pre-pregnancy
state) POST PARTUM PACKAGE

CRYSTAL JADE S. RESURRECCION | OLFU BSN 3

 COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

1. Post-partum visits GOAL: To reduce infant mortality and morbidity through

a. 1st within 72 hours decreasing the prevalence of immunizable disease.
b. 2nd 7th day of post-partum
c. Check for bleeding or infections.  Legal basis of EPI PD 996 – compulsory basic
d. 3 C’s: first is clean hands, clean surface, clean immunization for infants and children below 8 years
cord. of age. Covers infants and school entrants.
2. Micronutrients supplements:  RA 10152 – mandatory infants and children health
a. Iron and folate – 60 mg/400 ug OD for 3 immunization act of 2011, mandates basic
months or 90 tablets. immunization covering the vaccine-preventable
b. Vitamin A – 200,000 IU within 4 weeks after diseases. (rotavirus and hep vaccine)
delivery.  RA 7846 – provide compulsory immunization
3. Counselling on nutrition, child care, FP and other against hep B for infants and children below 8 years
services. of age.

BENEFITS OF THE BREASTFEEDING Principles of EPI

 B EST FOR BABIES 1. Epidemiological situation

 R EDUCED ALLERGIC REACTIONS 2. Mass Approach
 E CONOMICAL 3. Basic Health Service
 A LWAYS AVAILABLE The 7 Immunolabel Disease
 S AFE/MAINTAINS THE STOOL SOFT
 T EMPERATURE ALWAYS RIGHT 1. Tuberculosis
 F RESH 2. Diphtheria
 E MOTIONAL BONDING 3. Pertussis
4. Measles
 E ASILY ESTABLISHED
5. Poliomyelitis
 D IGESTIBLE
6. Tetanus
 I MMUNITY
7. Hepatis B
 N UTRITIOUS
 G IT DISORDERS ARE DECREASED Target settings:

2 LAWS RELATED TO BREASTFEEDING  Infants- 0-12 months

 Pregnant and Post-Partum Women
1. E.O. 51 (Milk code of the Philippine’s)
 School Entrants/Grade 1/7 years old
2. RA 7600 (the mother child friendly hospital or child
rooming-in and breastfeeding Act) Objectives of EPI
NOTE:  To reduce morbidity and mortality rates among
infants and children from six childhood immunizable
 Another reason why breastfeeding is preferred than
disease.
formula we don’t want babies’ kidneys to be
overwhelmed by protein. Content that hard to digest Elements of EPI
in COW’S milk.
 Target setting
EXPANDED PROGRAM ON IMMUNIZATION  Cold chain logistics Management- Vaccine
- Rural health unit team responsible in the vaccine distribution cold chain is designed to ensure that the
allocation public health nurse is responsible for the vaccines were maintained under proper environment
vaccine and overseeing of vaccine. condition until the time of administration.
 Information, Education and Communication (IEC)
LONG TERM VISION OF THE PHILIPPINES  Assessment and Evaluation of Over-all performance
of the program.
AMBISYON 2040
 Surveillance and Research Studies.

CRYSTAL JADE S. RESURRECCION | OLFU BSN 4

 COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

SCHEDULE AND MANNER OF ADMINISTRATION  Koch’s phenomenon - Pulmonary TB is caused by

OF INFANT IMMUNIZATIONS the bacterium Mycobacterium tuberculosis (M
tuberculosis). TB is contagious. This means the
bacteria is easily spread from an infected person to
someone else. You can get TB by breathing in air
droplets from a cough or sneeze of an infected
person.
 No treatment for Koch’s phenomenon.
 Acute inflammation lasts 2 to 4 days.
 Deep abscess – incision and drainage at least 10 mm.
Swelling disappear 2 to 3 weeks.
 Indolent ulceration - Scar formation of BCG will
manifest about 12 weeks. If there is scarring will
called it indolent ulceration.
 Treatment for II – INH powder.
 Glandular enlargement – enlargement of the limp
glands.

DPT

 1ST Dose at 6 weeks, interval at 4 weeks it is 3 doses.

 0.5 ml IM upper outer thigh.

NOTE FOR DPT side effects

 Fever
 Local soreness
 Abscess (manifest cause of shallow administration
instead of IM it turns in subcutaneous). Occur after 1
week.
 Convulsion (rare)
 6 months- earlier dose of measles given in case of NOTE FOR OPV side effects
outbreak
 9 months-11 months- regular schedule of measles  None (2 drops)
vaccine  Not allowed to drink or breastfeed for 30 minutes.
 15 months- latest dose of measles given
HEPA B
 4-5 years old- catch up dose
 There is no contraindication to immunization except  1st dose at birth.
when the child is immunosuppressant or is very, very  Interval: 6 weeks 1st to 2nd, 8 weeks 2nd to 3rd.
ill.  Route: 0.5 ml IM upper outer thigh
(but not slight fever or cold.) OR if the child
experienced convulsions after DPT or measles NOTE FOR HEPA B side effects:
vaccine, report such to the Doctor immediately.
 Malnutrition is not a contraindication for immunizing  Local soreness at the site (within 24 hours).
children rather; it is an indication for immunization AMV
since common childhood disease are often severe to
malnourished children.  1ST Dose: 9 to 11 months.
 BCG protection: TB and Meningitis. 0.5 ML right  Dose 1 only
deltoid.  0.5 ml SQ outer upper arm.
NOTE for BCG side effects NOTE FOR AMV 1 and 2 side effects:

CRYSTAL JADE S. RESURRECCION | OLFU BSN 5

 COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

 Fever 7. If AMV 1 not given or doesn’t know give AMV 1

 Rash ASAP, then AMV 2 one month after AMV 1.
 5 to 7 days will present – TSB and Anti-pyretic 8. All children entering day care centers/preschool and
Grade 1 shall be screened for immunization. Those
MEASLES-MUMPS-RUBELLA VACCINCE (AMV2) without immunization shall be referred to the nearest
health facility.
 1ST dose: 12-15 months.
 Doses: 1 COLD CHAIN UNDER EPI COLD CHAIN
 Route: 0.5 ml SQ outer upper arm.
 is a system used to maintain potency of a vaccine
from that of manufacture to the time it is given to
child or pregnant woman?
 Fever and rash (5-7 days)  The Allowable timeframes for the storage of vaccines
at different level are:
ROTA VIRUS VACCINE Side effects
a. 6months- Regional Level
 Infects large intestines causing severe diarrhea given b. 3 months- Provincial Level/District Level
in 6 weeks. c. 1 month- Main Health Center with Ref.
 1st dose: 6 weeks, 2 doses interval 4 weeks route 1.5 d. Not more than 5 days- Health Center using
ml oral Transports Boxes.
 Mild vomiting and diarrhea – mgt. diarrhea  Most Sensitive to heat: Freezer (-15 to -25 degrees
 Fever Celsius)
 Irritability – mgt. reassurance 1. OPV- Oral Polio Vaccine
 Children between 6 to 24 months at risk in rota-virus.
 Rotavirus spreads easily among infants and young  Measles Sensitive to heat and freezing. HEPA B,
children. The virus can cause severe watery pentavalent, vaccine, rotavirus and TT are damaged
diarrhea, vomiting, fever, and abdominal pain. by freezing.
Children who get rotavirus disease can become  (Body of ref +2 to +8 degree Celsius)
dehydrated and may need to be hospitalized. a. BCG
b. DPT
INACTIVATED POLIO VACCINE c. HEPA B
 1ST dose 14th week or 3 ½ months 1 dose 0.5 ml IM 4. TT Use those that will expire first, mark “X”; 3rd
left thigh exposure- discard Transport-use cold bags let it stand in
PNEUMOCOCCAL CONJUGATE VACCINE (PCV) room temperature for a while before storing DPT.

 1ST dose: 1 ½ month, 2nd ½ month, 3 ½ month  Half-life packs:

 Doses: 3 a. 4 hours- BCG, DPT, Polio
b. 8 hours- Measles, TT, HEPA B
 0.5 ml IM left thigh
 FEFO (First Expiry and First out)
 Only available in private clinics, pediatricians.
 Keep the diluents cold by storing them in the lower
IMPORTANT CONSIDERATIONS: or door shelf.
 Responsible for cold chain management is the public
1. Use only one sterile syringe and needle per client. health nurse.
2. No need to restart s vaccination series regardless of
the time that has elapsed between doses. CHARACTERISTICS OF THE VACCINE
3. Safe administer vaccine all at once but different site.
(2.5 to 5 CM apart)  BCG, Rota, AMV and polio – live vaccine bacteria
4. OPV 1st then ROTA virus vaccine. For proper and freeze dried. (BCG) no longer pathogenic but
absorption. still antigenic.
5. Do not let dropper of OPV touched.  D – weakened
6. Only monovalent hep b vaccine must be used for the  P – killed bacteria
birth dose and not pentavalent vaccine.

CRYSTAL JADE S. RESURRECCION | OLFU BSN 6

 COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

 T- weakened toxin/inactivated/ altered bacterial  3 PCV

exotoxins.  2 ROTA
 HEPA B – RNA recombinant.  Or even the child’s first birthday.
 AMV1, AMV2, OPV, Rota virus – live attenuated  Completely immunized children completed their
vaccine. immunization schedule at the age of 12-23 months.
 OPV – clear and pinkish liquid.  Child protected at birth (CPAB)
 HEPA B – color cloudy white.  Whose mother receives two doses of TT during
 Use only prescribed diluent. pregnancy provided the 2nd doses was given at least a
month before delivery.
OTHER CONSIDERATIONS IN COLD CHAIN
 Whose mother receives three doses of TT any time
 FEFO prior the pregnancy.
 Duration in the ref must be one month only. INFANT AND YOUNG CHILD FEEDING
 Duration in transport boxes: 5 days.
 Multi-dose liquid vaccines, such as OPV, pentavalent  EO 51 – milk code
vaccine, HEPA B vaccines and TT may be used in  EO 382 – national food fortification day every
the next immunization sessions for up to 4 weeks. If November 7
the ff are met:  RA 7600 – Rooming-in and breastfeeding act
 The expiry date: within 4 weeks, not contaminated,  RA 8172 – ASIN (act for salt iodization nationwide).
reconstitute. Stored properly.  RA 8976 – Philippine food fortification Act.
 Not submerged in water.  RA 10028 – expanded breastfeeding promotion act.
 VVM vial has not reach the point.
MICRONUTRIENT SUPPLEMENTATIONS
 How can you say vaccine is already expired? If the
inner square matches the outer and darker it should Nutrition programs
be discarded but if its lighter it still can be used.
 Discard reconstituted freeze-dried vaccines 6 hours a. Goal – improve quality of life of Filipinos through
after reconstitution or the at the end of the better nutrition, improved health and increased
immunization session. products.
 8 to 12 only time. b. Programs and Project:
 Protect BCG and Rota virus from light.  Araw ng sangkap pinoy (ASAP) – known as
 Take note of vaccine vial monitor. garantisadong pambata or child health week.
 Food fortification through “Sangkap Pinoy Seal”.
GENERAL CONSIDERATIONS:  VITAMIN A SUPPLEMENTATION
- Infants 6 to 11 months: 100, 000 IU once only.
 CONTRAINDICATIONS
- Children 21 to 71 months: 1 cap/ 200,000 IU every 6
a. Pentavalent/DPT to a child with recurrent
months.
convulsions or neurological disease.
- Purpose: to add vitamins and minerals in the usual
b. BCG to a child who is immunocompromised.
intake of our body.
 FALSE ONTRAINDICATIONS:
 IRON SUPPLEMENTATION
a. Moderate fever, malnutrition, mild respiratory,
- Infants 2 to 6 months with low birth weight: 0.3 ml
infection, cough, diarrhea and vomiting.
CD
 99% protection from diseases.
- Anemic children 2-59 months old: 30 mg once a
 Every Wednesday is vaccination day. week.
 Fully immunized child if:  ZINC SUPPLEMENTATION
 1 BCG - Infants less than 6 months: 10 mg/day
 3 OPV - Children 9-59 months: 20 mg/day for 10-14 days.
 3HB
 3 PENTAVALENT VACCINE DEWORMING
 1 AMV 1  Children aged 12-24 months: albendazole 200 mg or
 1 AMV 2 half tablet of mebendazole 500 mg tablet.
 1 IPV

CRYSTAL JADE S. RESURRECCION | OLFU BSN 7

 COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

 Children older than 2 years old: Albendazole 400 mg - The right of children to assistance, including proper
or mebendazole 500 mg tablet. care and nutrition, and special protection from all
 Side effects are allergy, abdominal pain, diarrhea and forms of neglect, abuse, cruelty, exploitation, and
erratic worm migration. other conditions prejudicial to their development;
 Contraindications such as serious illness that need - The right of the family to a family living wage and
hospital, abdominal pain, diarrhea, allergic reaction, income; and
severe malnutrition. - The right of families or family associations to
participate in the planning and implementation of
MALNUTRITION IN CHILDREN policies and programs
b. MCHN
PROTEIN ENERGY MALNUTRITION
c. Prevention and Management of reproductive
 Signs and symptoms: Underweight, stunting, tract infections including STI and HIV/AIDS.
wasting, overweight and baggy pants or edema. d. Adolescent reproductive health.
 Detection: through measurement of height and - Fertility awareness, Adolescent must be aware of
weight. MUAC (male upper arm circumference) is fertility and their human sexuality. As well as they
below 115 mm is already severe malnutrition in should be receiving counselling.
children 6 to 59 months. So, the common disorder e. Prevention and management of abortion and
disease under this kwashiorkor (protein deficiency) its complication.
and marasmus disease (carbohydrates deficiency). - Must be given counselling in family planning.
Unwanted pregnancy.
PHILIPPINE REPRODUCTIVE HEALTH f. Prevention and management of breast and
reproductive tract cancers and other
 Goal is to have a better-quality life among Filipinos.
gynecological conditions.
 10 elements to be considered such as: - Must be awareness about cancer for women/men.
a. Family planning (4 pillars: responsible Health teaching is a must.
parenthood, respect for human life, birth spacing g. Education and counselling on sexuality and
(3-5 years) and informed choice. Magna carta sexual health.
of women RA 9710 laws affecting PRH, h. Violence against women and children.
comprehensive health programs/services. That is i. Prevention and management of infertility and
for the women of the republic. Another law is sexual dysfunction.
RA 10354 responsible parenthood and j. Men’s reproductive health.
reproductive act of 2012. The State recognizes
and guarantees the human rights of all persons Note:
including their right to equality and
nondiscrimination of these rights, the right to - Considered protected the baby if the mother receive
sustainable human development, the right to two doses of TT. At least one month before the
health which includes reproductive health, the delivery.
right to education and information, and the right INTEGRATED MANAGEMENT OF CHILDHOOD
to choose and make decisions for themselves in ILLNESS (Day 4)
accordance with their religious convictions,
ethics, cultural beliefs, and the demands of - Started 1992
responsible parenthood. Moreover, the State - This was created as a response in increasing under 5
recognizes and guarantees the promotion of years old mortality and morbidity.
gender equality, gender equity, women
GENERAL GUIDELINES
empowerment and dignity as a health and human
rights concern and as a social responsibility. The IMCI CASE MANAGEMENT
advancement and protection of women’s human
rights shall be central to the efforts of the State to  Ask (Focused assessment) (history taking and
address reproductive health care. physical examination)
- The right of spouses to found a family in accordance  Ask if this is an initial visit or another.
with their religious convictions and the demands of a. Danger signs (CANS)
responsible parenthood; b. Main symptoms

CRYSTAL JADE S. RESURRECCION | OLFU BSN 8

 COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

c. Nutritional status Note:

d. Immunization status
e. Other problems.  Ask about the main symptoms
 Classification (severity of the illness, basis for a. Cough or DOB
treatment) b. Diarrhea
a. Need to refer (pink indicates hospital) c. Fever
b. Specific treatment (yellow indicates health d. Ear problem
center) e. Malnutrition and anemia
c. Home management (green indicates home) GUIDELINES
 Treatment
a. Identify treatment treat (what drug will be a. Urgent referral
needed, or fluids) b. Out-patient health facility
 Counsel and follow-up c. Pre-referral treatments
a. Counsel caretaker’s follow-up d. Advise patients
(If there is no mother, talk to companion for need e. Refer child
of counselling. Also give health teaching).
a. Referral facility (slip)
CHECK ALL SICK CHILDREN FOR GENERAL b. Emergency triage and treatment
DANGER SIGNS c. Diagnosis
d. Treatment
C – Convulsions
e. Monitoring and follow-up
 Ask the mother if the child had episodes of
unconsciousness even if eyes open. a. Treatment at out-patient health facility
 Unable to follow or respond with accompanied b. Treat local infections
muscle contracting or arms and legs are stiffening. c. Give oral drugs
 Needs to check convulsion to not mistake for d. Advise and teach caretaker
shivering. e. Follow-up.

A – abnormally sleepy HOME MANAGEMENT

 The mother should know the sleep cycle of the child. a. Home caretaker is counseled on: refer child, home
The child is not awake or alert when he should be. treatments, feeding and fluids, when to return
immediately, follow-up.
 The child is drowsy and does not show interest at all.
 He does not look at his mother or watch your face TARGET GROUPS
when you talk.
 If the child does not respond by shaking him. 1. Sick young infant 1 week up to 2 months.
2. Sick young children 2 months up to 5 years.
N – not able to drink
THE SICK CHILD: 2 months up to 5 years.
 Means that the child cannot suck or swallow any
fluid or breastmilk because the child is too weak. 1. Cough or DOB. Assess
 Ask the mother to describe it. Then if not convince, COMMUNITY HEALTH NURSING PROGRAMS OF
observe by letting the mother offer drinks. DOH (Day 5)
S – sever vomits everything SPECIAL FIELDS IN CHN
 A child is not able to hold anything down at all not  School nursing – Type of public health nursing that
food, fluid or drugs, it means what goes down comes focuses on the promotion of health and wellness of
back up. the pupils and students, teaching and non-teaching
- Need to refer (except in severe dehydration) in personnel of the schools. To see the factors that
hospital. affects student in academic performance in the school
- Child has a severe problem. Do not delay the  Duties and responsible of a school nurse.
treatment. (GDS)

CRYSTAL JADE S. RESURRECCION | OLFU BSN 9

 COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

1. Health advocacy Infusion – soaked in water, like tea for 10 to 15

2. Health and nutrition assessment. minutes.
3. Treatment of common ailments and attending Poultice – directly apply on affected part.
emergency causes. Tincture – mix the plant in alcohol.
4. Referrals and follow-up of pupils and personnel.
5. Home visits. Sambong Real Name:
6. Community outreach. Blumea balsamifera
Uses:
7. Recording and reporting of accomplishments.
Anti-edema, diuretics, anti-urolithiasis.
8. Monitoring and evaluation of programs and projects. Preparation:
9. Supervision of the health and safety of the school. Decoction
 Occupational health nursing – specialty practice Akapulko Real name:
that provides for and delivers health care services to Cassia alata
workers and worker population. Uses:
 Duties and responsible of an occupational nurse. Anti-fungal: Tinea flava, Ringworm,
- Lead sanitary and industrial hygiene. Athlete’s foot and scabies.
- Informs all affected workers regarding the nature of Preparation:
hazards and the reasons for the control measures and Poultice
protective equipment. Niyug-niyogan Real name:
- Physical examination. Quisqualis indica
Uses:
- Ensures strict compliance on the regular use of PPE.
Anti-helminthic. Take not it is not
- Referrals.
given to a child whose below 4 years
 Community health mental nursing - are specialized old. Risk for aspiration and abdominal
Nurses who provide wholistic nursing services for pain, erratic of worms.
people with mental health issues, in a community Preparation:
setting. We provide caring and confidential supports Seeds are used.
for our clients, using the recovery model for care. Tsaang gubat Real name:
Why Is Community Important to Mental Health? Carmona retusa
We're social beings, and we are not meant to live in Uses:
isolation. Community is critical for us to thrive, Diarrhea, stomachache
especially for someone with mental illness who is Preparation:
already experiencing the common symptoms of Decoction
loneliness and isolation. Ampalaya Real name:
Mamordica charantia
 Duties and responsible of a community health
Uses:
mental nurse. Lowers blood sugar levels
- Treatment Planning For FM (mild-non insulin dependent)
- Medication Management Preparation:
- Assessment Decoction and steamed.
- Counseling Lagundi Real name:
- Family Support Vitex negundo
- Education Uses:
- Group Support Asthma, cough and fever. Also, other
- Facilitate services with visiting Psychiatrists uses are skin diseases (dermatitis,
scabies, ulcer, eczema and wounds).
DOH HEALTH PROGRAMS Headache ad aromatic bath for sick
patients.
 10 HERBAL MEDICINES Preparation:
RA 8423 – Philippine institute of traditional and Decoction and wash affected side with
alternative health care. (PITAHC) advocates the use decoction
of traditional and alternative health care modalities. Ulasimang bato Real name:
So, it started by the senator. Peperonia pellucia
Decoction – boil the recommended part of the plant Uses:
in water for 20 minutes. Lowers uric acid (Rheumatism and

CRYSTAL JADE S. RESURRECCION | OLFU BSN 10

 COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

gout). 1. Promote and encourage voluntary blood donation and

Preparation: to instill that blood donation is a humanitarian act.
Decoction and eaten raw 2. To provide, adequate, safe and affordable and
Bayabas Real name: equitable distribution of blood supply. Philippine red
Psidium guajava cross, when runout of blood supply you can go to red
Uses: cross.
Washing of wounds and diarrhea. 3. To mobilize all sectors of the community to
Preparation:
participate for voluntary and non-profit collection of
Decoction, wash the affected site.
blood.
Bawang Real name:
Garlic in english  REQUIREMENTS FOR DONATING BLOOD
Uses: 1. Weigh more than 45 kilograms or 100 lbs. for 250 ml
Hypertension, toothache and to lower and 50 kilograms or 110 llbs. For 450 ml.
cholesterol level. 2. Good health.
Preparation: 3. Aged 16-65 years of age. (consent)
Eaten raw and fried and apply on the 4. BP of 90-160 mmHg systolic and 60-100 mmHg
affected site. diastolic.
Yerba buena Real name: 5. Hemoglobin of 125 g/l.
Mentha cordifelia  CONTRAINDICATIONS I DONATING BLOOD
Uses: 1. DM
Rheumatism, arthritis and headache. 2. CA
Swollen gums, toothache, menstrual
3. Heart Diseases
and gas pain, nausea and fainting,
insect bites and pruritis. 4. STI’S
Preparation: 5. TB
Decoction, infusion ad massage site of 6. Hyperthyroidism
affected area. 7. Severe Psychiatric disorder
 REMINDERS IN THE USE OF THE HERBAL 8. Prolong bleeding
MEDICINE. 9. Malaria
10. Kidney and liver disease.
1. Avoid use of insecticide. 11. Use of prohibited drugs.
2. Use clay and pot and remove cover while boiling  SENTRONG SIGLA/QUALITY ASSURANCE
low heat. PROGRAM/ CENTERS OF VITALITY
3. Use only the part of plant advocated. MOVEMENT
4. Follow accurate dosage.
 Health ang una
5. Use only one kind of herbal plant for each type of
 4 pillars of SSM – Quality assurance, Grants and
symptoms.
6. Stop giving herbal medication when untoward Technical assistance, Health Promotion and Awards.
effects such as allergy occurs.  Levels and scope of certification
7. If signs and symptoms are not relieved after 2-3 a. Level 1: Basic SS certification includes
doses consult a doctor. minimum input, process and output for standards
 ALTERATIVE AND HEALTHCARE for integrated public health services for 4 core
MODALITIES PRACTICED programs, facility systems, regulatory function
and basic curative services.
Acupressure Uses of application of measure on - Integrated public health programs.
acupuncture points. - Facility and system standards – manpower,
Acupuncture Using special needles to puncture and organized procedures and basic curative services.
stimulate specific anatomical points of - Integrated public health function standards –
body. promotion of the core public health programs. Safe
 NATIONAL VOLUNTARY BLOOD SERVICES motherhood and family planning, child care,
PROGRAMS (NVBSP) prevention and control of infectious diseases,
 RA 7719 – Blood services act of 1994. promotion of healthy lifestyle.
 Main objectives: - Basic curative function standards

CRYSTAL JADE S. RESURRECCION | OLFU BSN 11

 COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

- Regulatory function standards – promote Other Purposes' Granting Additional Privileges and
environment that prevents, reduce and control risks Incentives and Prohibitions on Verbal, Non-verbal
and hazards to the community. Ridicule and Vilification Against Persons with
b. Level 2: Disability.
 Specialty awards – second level quality standards - Psychosocial and behavioral disability.
for selected 4 core public health programs. - Chronic illness with disability.
 Award for excellency – 3 consecutive years quality - Learning disability
standards for 4 core public health programs. - Mental disability
 BOTIKA NG BARANGAY - Visual disability
- The DOH issued administrative order No. 23-A that - Orthopedic/ amputations disability
outlines the establishment of the BOTIKA NG - Communication impairment
BARANGAY.  VISUAL IMPAIRMENT – The right to sight
- GOAL: To promote equity in health by ensuring proclamation #40: Declaring the month of august
availability and accessibility or affordable, safe and every year as “sight saving month”. Cataract,
effective quality essential drugs to all, with a priority Refractive errors, Glaucoma.
for un-marginalized, undeserved, critical and hard to  Administrative order 179 series of 2004 – provide
reach areas. guidelines for implementation of national prevention
- OBJECTIVES: To rationalize the distribution of of blindness program.
common drugs and medicines among beneficiaries.  Environmental health – is a branch of public health
To serve as mechanisms for DOH and community that deals with the study of preventing illness by
organizations. Optimize involvement of BHW in managing the environment and changing people’s
addressing needs of the community. To sell, behavior to reduce exposure to biological and non-
distribute and make low-priced generics home biological agents.
remedies OTC drugs. a. PD 856 of 1978 – the DOH through the EOHO
- LIST OF OTC DRUGS: (environmental and occupational health office),
Analgesics/Anti-pyretic has the authority to act on all issue and concerns
Antacid in environment and health and implement
Anti-helminthics sanitation code of the Philippines.
Anti-histaminic b. Factors included are:
NSAIDS - Water sanitation
Anti-vertigo - Food sanitation
Bronchodilator/Anti-cough - Refuse and garbage disposal
Diuretics - Excrete disposal
Anti-tussive - Insect vector and rodent control
Nasal decongestants - Housing
Anti-motility - Air pollution
Oresol - Noise
Laxative/cathartics - Radiological protection
Anti-scabies, anti-lice, anti-fungal - Institutional sanitation
Anti-anemic - Stream pollution
Anti-fungal
Vitamins WATER SUPPLY SANITATION PROGRAM
Mineral  Level 1 (Point Source)
Anti-infectives (amoxicillin and cotrimoxazole) a. Protected well or developed spring adequate for
Medications for Chronic diseases – DM, HPN and rural areas.
asthma. b. Serves 15 to 25 households.
Topical nasal decongestants c. 250 meters from the farthest user.
Disinfectants d. Yield or discharge of 140 liters per minute.
 DISABILITY – General term for impairments,  Level 2 (Communal faucet system or stand post)
activity limitations and participation, restrictions. RA a. Pipe distribution network and communal faucets.
7277 Magna Carta for disabled persons and For

CRYSTAL JADE S. RESURRECCION | OLFU BSN 12

 COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

b. Located not more than 25 meters from the FOUR RIGHTS IN FOOD SAFETY
farthest user.
c. Designed to deliver 40 to 80 liters per capital per  Right source
day.  Right preparation
d. Supply 100 households with 4 to 6 faucets.  Right cooking
 Level 3 (Waterworks system or individual house  Right storage
connection)
Note:
a. A system with a source, reservoir, piped
distribution network and household taps.  Rule in food safety: Always remember “When in
b. Suited for populated urban areas. doubt, Throw it out”. Consider it unsterile.
c. Requires minimum treatment and disinfection.
THREE POINTS OF CONTAMINATION
Note:
 Place of production processing and source supply.
The city health office can check if its safe, level 1 and 2  Transportation and storage, from the factory to the
always test for the benefit of community members. warehouse. Because of the rodents or insects.
PROPER EXCRETA AND WASTE DISPOSAL  Retail and distribution points. Reflected in groceries,
convenience store or department of health.
 Level 1
a. Non-water carriage facility, (Pit latrines, Reed EPIDEMIOLOGY
odorless closet).  Study of distribution and determinants of health-
b. Toilet water requiring small amount of water. related states or events in specified population and
 Level 2 the application of this study to the prevention and
a. On site toilet facilities of the water carriage type control of health programs.
of water sealed and flush type with septic vault  It Use to describe the health status of the population
or tank. through the estimation of health indicators.
 Level 3 (mortality, morbidity and population growth rate,
a. Water carriage types of toilet facilities and prevention of care).
connect to a septic tanks sewerage system to  Other definition in terms of:
treatment plant. Example bigger like hotels, a. Study – is defined as surveillance, hypothesis
malls, establishments. testing and observation.
FOOD SANITATION PROGRAM b. Distribution – analysis in time, place and classes
of people affected.
 POLICIES (Food establishment shall be to the c. Determinants – biological, chemical, physical,
following sanitary conditions) socio-cultural, economic and behavioral factors
a. Inspection and approval of all food sources, affecting health.
containers and transport vehicles. d. Health related states of events – diseases, cause
b. Compliance of sanitary permit. of death and behavior such as use of tobacco.
c. Destruction and banning of food unfit to human e. Specified populations – identifiable
consumption. characteristics such as occupational groups. Who
d. Training of food handlers and operator on is affected?
sanitation. f. Applications to prevention and control – to
e. The establishment should be rated. promote, protect and restore health.
 Applications of Epidemiology:
NOTE:
a. Assessment of health status
The establishment itself will secure the certification of the b. Elucidation of mutual history of disease
program. Food handlers will have also certificate of their food c. Determination of disease causation
handling, not just for restaurants, cafeteria but for food d. Prevention and control of disease
vendors they shall provide also health certificate in comply of e. Monitoring and evaluation of health
food sanitation. So, that they are safe to sell their foods. To interventions
prevent also communicable diseases. f. Provision of evidence for policy formulation

CRYSTAL JADE S. RESURRECCION | OLFU BSN 13

 COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

VITAL STATISTICS  Incidence density rate – Measures the frequency of

occurrence of the phenomenon during a given period
 Statistics refers to a systemic approach of obtaining, of time.
organizing and analyzing numerical facts so that
conclusion may draw from them.
 Utilized to gauge the levels of health, illness and
health services of a community and the country.

MORBIDITY INDICATORS

 is a value describing the presence of disease in the

population, or the degree of risk of an event? The
incidence rate, prevalence, and attack rate (AR) are  Example: The highest number of cases reported for
common applications of this concept in influenza was 9,887 occurring on the 33rd week. If the
epidemiology. population was 77,926,000, What would be the
incidence rate for week 33 be?
PREVALENCE PROPORTION

 Prevalence rate – Measures the total number of
existing cases of a disease at a particular point in time
divided by the number of people at that point in time.

MORTALITY INDICATORS

 The various measures of mortality published under

SRS are Crude Death Rate (CDR), Under-five
Mortality Rate (U5MR), Infant Mortality Rate (IMR)
and its components, Age Specific Mortality Rates
 the population of sitio BIGLANG PUTOK, is 30,000 (ASMR), Still Birth Rate (SBR) and Peri-Natal
composed mostly of farmers and their families. The Mortality Rate (PMR). its inception.
number of people visited the health center is 2000.  Crude death rate – is the total number of deaths to
Among them 65 are newly diagnosed with residents in a specified geographic area (country,
schistosomiasis and 655 are old cases. state, county, etc.) divided by the total population for
 Attack rate – a more accurate measure of the risk of the same geographic area (for a specified time period,
exposure. usually a calendar year) and multiplied by 100,000.
The rate which mortality occurs in a given
population.
 CDR = number of deaths in a calendar year/midyear
population x 1,000.
 Example: A total of 396,331 deaths were registered
in the Philippines when it had population of
81,081,000 in 2003 compute CDR.

CRYSTAL JADE S. RESURRECCION | OLFU BSN 14

 COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

deaths is 308,904, what was the SWAROOPS index

in 1977?

SOURCES OF DATA FOR CALCULATION OF

HEALTH INDICATORS
 Cause of death rate = number of deaths from a certain SOURCES OF DATA
cause in a calendar year/midyear population x 1000.
 IMR = deaths under 1 year of age in a calendar  Disease notification – per region they have satellite
year/number of live births in the same year x 1,000. pf DOH.
 Neonatal mortality rate = number of deaths among  Disease registry – this is the compilation of
those under 28 days of age in a calendar year/number information about in a particular disease.
of live births in the same year x 1000.  Public health surveillance system – Every 5 years,
 Post Neonatal mortality rate = number of deaths they have survey number of per family in a
among those under 28 days of age to less than 1 year community.
of age in a calendar year/number of live births in the
EPIDEMIOLOGIC TRIAD
same year x 1000.
 Maternal death = number of deaths due to pregnancy,  Agent
delivery, pueperium in a calendar year/number of live  Host
borths in the same year x 1000.  Environment
 Example is maternal deaths for the Philippines
totaled 1,698 in 2000. Using the total number of live FACTORS AFFECTING DISTRIBUTION OF DISEASE
births for that year, which is 1,766,440, compute for
the MMR.  Person - exposure, susceptibility or response to
agents.
 Case fatality ratio = number of deaths from a
specified cause/number of cases of the same disease  Place – Extrinsic factors, existence of etiologic
x 1000. factors & exposure and susceptibility of human host,
influenced by extrinsic factors.
 Example is if there were 450 cases of diarrhea
reported in NAVOTAS for a six-month period of 277  Time – Temporal patterns – fluctuations of
of there cases subsequently led to death what would incidence.
be the CFR? PATTERNS OF DISEASE OCCURENCE
POPULATION INDICATORS/FERTILITY RATES  Epidemic- a situation where there is a high incidence
 Crude birth rate – number of registered live births in of new case of specific disease in excess when he
a year/midyear population x 1000. proportions of the susceptible are high compared to
the proportion of the immunes.
 Example is the Philippines registered a total of
1,669,442 livebirths in 2003. If it’s 2003 population  Epidemic potential- an area becomes vulnerable to a
was 81,081,000, what was the CBR? disease upsurge due to casual factors such as climatic
changes, ecologic changes, or socio-economic
 General fertility rate = number of registered live
changes
births in a year/midyear population of women 15-44
years of age x 1000.  Endemic- habitual presence of a disease in a given
geographic location accounting for the low number of
 Example in 1977, the Philippines female population
both immunes and susceptible.
of 15-44 years of age group numbered 9,670,200,
while the total live births registered 1,344,836. What  Malaria is a disease endemic at Palawan. Causative
was its GFR? factor of the disease is constantly available ore
present in the area.
 Swaroop’s index = number of deaths among those 50
years and over in a calendar year/ Total deaths same  Sporadic - disease occurs every now and then
year x 1000. affecting only a small number of people of people
relative to the total population. It is Intermittent.
 Example is if the number of deaths in the Philippines
in 1977 for the age group and the total number of  Pandemic- global occurrence of disease

Steps in Epidemiological Investigation

CRYSTAL JADE S. RESURRECCION | OLFU BSN 15

 COMMUNITY HEALTH NURSING LECTURE (MIDTERMS)

 Establish fact of presence of epidemic

 Establish time and space relationship of the disease
 Relate to characteristics of the group in the
community
 Correlate all data obtained.

COMMON EPIDEMIOLOGIC STUDIES

 Retrospective (Past) – Case control study, shows an

association between the risk factor and disease.
 Cross-Sectional (Present) – Prevalence study old and
new cases get the prevalence of disease lung cancer
get the prevalence of risk factor tobacco smoking
 Prospective Cohort (Future) – incidence or new
cases.

OUTBREAK INVESTIGATION

 Occurrence of cases of disease in excess of what

would normally be expected in a defined community,
geographical area or season.

BASIC STEPS IN OUTBREAK INVESTIGATION

 Define what constitutes a case.

 Identify a case
 Base on the number of cases, verify the existence of
outbreak
 Establish the descriptive epidemiologic features of
cases.
 Record signs and symptoms.
 Base on signs and symptoms, formulate hypothesis
RE: etiologic agent, sources of infection, mode of
transmission and best approach to control the disease.
 Test hypothesis by collecting specimens from patient.
 Base on the result, implement and control outbreak.
 Disseminate the findings.

CRYSTAL JADE S. RESURRECCION | OLFU BSN 16