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  • hi sir, can u please send me a copy of ur presentation? my email add is min_zephyr@yahoo.com thank u sir.. Godbless
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  • sir, your presentation will surely be of great help to school nurse like me..please send me a copy of this presentation..my email add is khakiregoroso@yahoo.com.thank you very much
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    Doh programs Doh programs Presentation Transcript

    • “HindiLahatngNakatalikod, Di nakikinig”
      RandelDalauta,RN
    • Q: WHAT ARE SETS OF INTERVENTIONS PUT TOGETHER TO OPERATIONALIZE POLICIES AND STANDRDS DIRECTED TOWARDS THE PREVENTION OF CERTAIN SOCIETAL PROBLEMS?
    • DOH / PUBLIC HEALTH PROGRAMS
    • DOH Health Calendar 2010
      JANUARY
      STI / Condom Week January 7, 2010
      World Leprosy Day January 31, 2010
      FEBRUARY
      World Cancer Day February 4, 2010
      Pregnancy Awareness Week February 7-14, 2010
      Healthy Lifestyles Awareness Day February 19, 2010
    • DOH Health Calendar 2010
      MARCH
      International Women’s Day March 8, 2010
      World Kidney Day March 11, 2010
      World Head Injury Awareness Day March 20, 2010
      Human Rights Day March 21-24,2010
      World Down Syndrome Day March 21, 2010
      World TB Day March 24, 2010
    • DOH Health Calendar 2010
      APRIL
      World Autism Awareness Day April 2-4, 2010
      National Polio Eradication Awareness Week April 4, 2010
      World Health Day April 7, 2010
      World Hemophilia Day April 17, 2010
    • DOH Health Calendar 2010
      MAY
      World Red Cross Day May 8, 2010
      World Move for Health Day May 10, 2010
      World Chronic Fatigue and
      Immune Dysfunction Syndrome May 12, 2010
      International Nurses Day May 12, 2010
      International Day of Action for
      Women’s Health May 28, 2010
      World No Tobacco Day May 31, 2010
    • DOH Health Calendar 2010
      JUNE
      International Children’s Day June 1, 2010
      International Day of Innocent Children
      Victims of Aggression June 4, 2010
      World Environment Day June 5, 2010
      World Blood Donor Day June 14, 2010
      World Elder Abuse Awareness Day June 15, 2010
      Youth Day June 16, 2010
      National Epilepsy Day June 21, 2010
      International Day against Drug Abuse
      and Illicit Drug Trafficking June 26, 2010
    • DOH Health Calendar 2010
      JULY
      World Population Day July 11, 2010
      AUGUST
      World Breastfeeding Week August 1-7, 2010
      National Immunization Awareness Week August 2-8, 2010
      Rheumatic Fever Week August 2-8, 2010
      National Women’s Day August 9, 2010
      International Youth Day August 12, 2010
      Deaf Awareness Week August 30, 2010
    • DOH Health Calendar 2010
      SEPTEMBER
      Pharmacy Week September 6-12, 2010
      Kidney Awareness Week September 6-9, 2010
      World Rabies Day September 8, 2010
      World Oral Health Day September 12, 2010
      Attention Deficit Hyperactivity
      Disorder Day (ADHD) September 14, 2010
      Stroke Week September 14-17, 2010
      World Alzheimer’s Day September 21, 2010
      World Heart Day September 21, 2010
    • DOH Health Calendar 2010
      OCTOBER
      International Day for Older Persons October 1, 2010
      National Nutrition Week October 1, 2010
      World Mental Health Day October 10, 2010
      World Arthritis Day October 12, 2010
      World Food Day October 16, 2010
      International Day for the Eradication of
      Poverty October 17, 2010
      National Down Syndrome Day October 20, 2010
      National Iodine Deficiency Disorder Day October 23, 2010
      World Polio Day October 24, 2010
    • DOH Health Calendar 2010
      NOVEMBER
      National Children’s Day November 6, 2010
      Malaria Day November 12, 2010
      International Day for the Elimination of
      Violence against Women November 25, 2010
      DECEMBER
      World AIDS Day December 1, 2010
      International Day of Disabled Persons December 3, 2010
      International Volunteers Day December 5, 2010
      World Patient Safety Day December 9, 2010
      International Human Rights Day December 10, 2010
    • D – Dental Health Program
      O – Osteoporosis Prevention
      H – Health Educ. & Community Org.
      P – Primary Health Care
      R – Reproductive Health
      O – Order Person Health Services
      G – Guidelines for Good Nutrition
      R – Respiratory Infection Control
      A – Acupressures
      M – Maternal and Child Care
      S – Sentrong Sigla Movement
    • Eradicate extreme poverty & hunger
      Achieve universal primary education
      Promote gender equality& empower women
      Reduce child mortality
      Improve maternal health
      Combat HIV/AIDS, malaria & other diseases
      Ensure environmental sustainability
      Develop a global partnership for development
    • I. FAMILY HEALTH /SERVICES
      Reduce morbidity and mortality rates for children, adolescents, adults and older people.
    • THE MATERNAL AND CHILD HEALTH PROGRAM
      Facts:
      -Maternal and pediatric population group comprise 60% of population of most communities
      -Decrease women having prenatal ( 1998-77% to 2003-70.4%)
      -Decrease women receiving @least 2 doses of TT(1998-38% to 2003-37.3%)
      -Only 76.8% of pregnant received supplementation during pregnancy
    • 6 COMPONENTS:
      PRE - NATAL
      POST – NATAL
      EPI
      FAMILY PLANNING
      NUTRITION
      UFC
    • Reduce the maternal mortality ratio (MMR) by three quarters by 2015 to achieve its millennium developmental goal. This means a MMR of 112/100,000 live births in 2010 & 80/100,000 live births by 2015.
      Total no. of deaths from maternal causes registered for a given year
      MMR = ----------------------------------------------------- X 1000
      Total no. of live births registered of same year
    • Current MMR
      170/100,000
      Rank number 49th of the 136 countries
    • Q: The main causes of maternal deaths according to the National health Statistics?
    • Main cause of maternal deaths remains to be due to:
      1. Hypertension (25%)
      2. Post Partum Hemorrhage
      – 20.3%
      3. Pregnancy with abortive outcomes – 9%
    • Q: The underlying causes of maternal deaths are?
      • Delays in taking critical actions
      • Delay in seeking care
      • Delay in making referral
      • Delay in providing appropriate medical management
    • Other Factors to Maternal Deaths:
      Closely Space Births
      Frequent Pregnancies
      Poor detection and management of high risk pregnancies
      Poor Access to health facilities
      Health Care staff lack the competence in handling obstetrical emergencies
    • Strategic thrust for 2005-2010
      BEMOC – Basic Emergency Obstetric Care (entails the establishment of facilities that provide emergency obstetric care for every 125,000 population located strategically.
    • A. Antenatal Registration:
      At least 4 visits till delivery
      Q: What is the ideal frequency of prenatal visits during the duration of pregnancy?
    • Standard Prenatal Visits
    • B. Tetanus Toxoid Immunization
      2 doses one month before delivery plus 3 booster doses for the mother to be called
      FIM – Fully Immunized Mother
    • Q:If a woman has had TT2, 80% protection is insured for 3 years. How about the infant?
    • TETANUS TOXOID VACCINE
    • Q: If a woman was given DPT immunization in infancy, tetanus toxoid doses can start at?
    • Q: AlingDionisia went to the health center for a prenatal check up. Upon interview it was found out that its her 5th pregnancy and currently still on the 1st trimester . She requested to be given supplements. What are we going to give AlingDionisia?
    • C. Micronutrient Supplementation
    • Facts:
      Vitamin A
      1. should start at 4th month of pregnancy until
      delivery
      2. should NOT be given to those who are
      already taking pre-natal vitamins/multiple
      micronutrients containing vit. A
      3. postpartum give 1 dose within 4 weeks after
      delivery @ 200,000 IU
      4. pregnant: avoid 200,000IU
    • XEROPHTHALMIA
      - eye disease for pregnant women caused by vit.A deficiency characterized by night blindness
      Vitamin A:
      1. give 10,000 IU
      2. 1 capsule/tablet one a day for 4 weeks upon
      diagnosis
      3. don’t give if prenatal vitamins has vit A
      4. give regardless of AOG of pregnant woman
    • Facts:
      IRON
      Pregnant:
      1. preferably coated tablet
      2. at least 1 tablet once a day for 6 months/
      180 days during pregnancy period
      3. 2 tablets per day if consults during 2nd
      and 3rd trimester
      Lactating:
      1. preferably coated tablet
      2. 1 tablet once per day for 3 months.
    • Q: What is the intervention for post partum bleeding, intestinal parasite, & malaria?
    • D. Treatment of Diseases and other Conditions
    • Q: Nurse Jenny PHN advocate of the DOH’s clean and safe delivery program for pregnant women, she emphasized the 3 C’s to the Brgy. Health Midwives?
      Clean hands, clean body, clean nails
      Clean hands, clean cord, clean surface
      Care, Core, Cure
      Clean body, clean spirit, clean environment
    • E. Clean and Safe Delivery
      Do a quick check upon admission
      Make the woman comfortable
      Assess the woman in labor - Danger signs of pregnancy
      Determine the stage of labor
      Decide if the woman can safely deliver
      Give supported care throughout labor
    • Monitor and manage labor
      Monitor closely within one hour of delivery and give supportive care
      Continue care after one hour postpartum. Keep watch closely for at least 2 hours
      Educate and counsel on FP
      Teach on the importance of MCH
      BF / Newborn Screening – within 48 hours up to 2 weeks after birth
    • Q:What would include in the counseling of post partum women?
    • Postpartum counseling:
      1. Educate and counsel on Family Planning
      2. Provide method if available
      note: decision should be made by the woman
      3. Inform woman on birth registration
      4. Encourage breastfeeding
      5. Schedule when to return for postpartum visits
      6. Counsel on Newborn Screening
    • Recommended schedule of Post Partum care visit:
    • Newborn Screening
      Why important?
      -detect congenital metabolic disorders
      -most were born asymptomatic
      -early diagnosis & prompt treatment
      before becoming symptomatic
      -prevent mental retardation or death
    • Newborn Screening
      When is the best time?
      - 48 hours to 72 hours after birth
      - may also be done with in 24 hour after birth
      note: result is positive repeat the test 14
      days after
    • Newborn Screening
      Who are authorized?
      - doctor
      - nurse
      - medical technologist Trained by
      - midwife DOH
    • Newborn Screening
      Why test are repeated?
      - children who’s samples taken 24 hours
      - contaminated samples
      - 1st test the baby was ill
    • Effects of Newborn Screening
    • Steps in Implementation
      Motivating parents & collecting blood samples
      Sending the samples to the laboratory and performing the test
      Releases result after 14 working days
      Recalling patient
      Managing and monitoring patient
    • Q: When did Newborn Screening begun in the Philippines?
    • Facts: Newborn screening(RA9288)
      - Begun in the Philippines in 1996
      - Adopted by DOH in the year 2004
      - 5 Congenital Metabolic Disorder detected in the Philippines, detects about 50 disorders in the 1st world countries
    • Lets Practice?
    • Q: Clinical manifestations in a child with Congenital Hypothyroidism:
      a. dry hair, short neck, generalized obesity, cold, short & fat extremities and scaly skin
      b. dry hair, short neck, generalized obesity, cold, short and fat extremities, sweaty skin
      c. dry hair, long neck, generalized obesity, dry scaly skin
      d. dry hair, short neck, generalized obesity, warm, short & fat extremities and scaly skin
    • Q: Congenital Adrenal Hyperplasia is due to
      a. autosomal recessive disorder
      b. x-linked chromosomal disorder
      c. autosomal dominant inheritance
    • Q: The Hormones produced by the adrenal glands
      a. cortisol, androgen, astrogen
      b. cortisol, androgen, aldosterone
      c. hydrocortisone, androgen, aldosterone
      d. hydrocortisone, cortisol, androgen
    • Q: An enzyme essentia for the production of adrenal hormones
      a. 17-hydroxyprogesterone
      b. 21-a-hydroxylase
      c. Phenylalanine hydroxylase
      d. 17-a-hydroxylase
    • Q: A disorder wherein the body cannot process galactose
      a. galactosemia
      b. gallstones
      c. galls disease
      d. G6PD
    • Q: Galactose-1-phosphate uridyetranferase is an enzyme needed for the breakdown of
      a. galactose
      b. gallstones
      c. G6PD
      d. PKU
    • Q: One of the building blocks of protein that cannot be metabolized in a child with PKU.
      a. Phenyloxalate
      b.Phenyketones
      c. Phenylalanine
      d. Preoxalate
    • Q: Appropriate diet for the patient with PKU
      a. low protein food
      b. high protein food
      c. low carbohydrate food
      d. high cabohydrate
    • Q: Glucose-6-phosphate dehydogenase
      a. an enzyme that can help burst RBC
      form bilirubin & oxidate
      b. an enzyme that can cause mental
      retardation when exposed to oxidate
      c. an enzyme that protects RBC from
      oxidative substances
      d. an enzyme derive from oxidates
    • Q: The preferred method of collecting blood sample for Newborn screening
      a. venous blood extraction
      b. umbilical cord blood method
      c. heel prick method
      d. hell print method
    • Q: Newborn Screening blood samples can be collected by:
      a. any nurse
      b. trained midwife
      c. senior medtech
      d. doctor
    • Family Planning
      Counseling
    • THE FAMILY PLANNING PROGRAM
      EO 199: Created the PFPP (Phil. Family Planning Program.
      The goal is to provide universal access to family planning information and services whenever and wherever these are needed.
    • Q: What are the important things to consider in counseling about Family Planning?
    • Important things to Consider
      Personal values
      Ability to use method correctly
      How method will affect enjoyment
      Financial factor
      Status of couples relationship
      Prior experience
      Future plans
    • Assessment for Contra
      • Poor memory for compliance – Oral contraceptives
      • Valvular heart Disease - IUD
      • Cigarette smokers – Oral Contraceptives
      • Liver Disease – Oral contaceptives
      • Breast Cancer – NorPlant, OC, Depo
      • Diabetes – Oral Contraceptive
      • Irregular shape uterus –IUD, cervical cap
      • Undiagnosed Vaginal Bleeding – all form
      • Thrombophlebitis – Oral contraceptive
    • Steps in Counseling
      Greet client
      Ask client about themselves
      Tell about choices of methods
      Help client make an informed choice
      Explain fully how to use of chosen method
      Return visits should be welcome
    • Criteria for Ideal Contraceptive
      Safe
      Affordable
      Acceptable
      Free of effects on future pregnancy
      Free of side effects
      Effective 100%
      Easily obtainable
    • Q: What is the most effective family planning method?
    • Sterilization
      Female Sterilization – 99.5% (BTL)
      types:
      - cautery - crushing
      - clamping - blocking tube
    • Bilateral Tubal Ligation
    • Sterilization
      2. Male Sterilization – 99.9% (Vasectomy – Vas deferens – passage of sperm – is tied and cut)
      - post-op 1 week can resume coitus
      - birth control should be used until 2 (-) sperm reports have been examined
    • Vasectomy
    • Artificial Contraceptive
      1. Pill – 99.7% (Contains hormone estrogen and progesterone)
      - prevent ovulation by inhibiting FSH
      - decrease permeability of cervical mucus
      Side effects:
      Nausea
      Weight gain
      Headache
      Bleeding
      Mild hpn
      Contraindications:
      Smoking
      Thromboembolic disease
      CVA
      35 yo and above
      Hypertensvie
      Liver disease
    • Pills
    • 4. Male Condom – Protects against microorganisms causing STI’s and HIV (class of retrovirus – cause of AIDS (acquired Immune Deficiency Syndrome)
      - 98 % effective
      Advantages:
      - Safe and has no hormonal effect
      • Protects against microorganism for STI
      • Easily accessible
      • Used in managing premature ejaculation
      Disadvantages:
      • May cause allergy such
      as latex
      • Mar decrease sensation
      • Interrupts the sexual
      act
      • require man’s
      cooperation
    • Condoms
    • 5. Injectables – Contain synthetic hormone, PROGESTIN which suppresses ovulation, thickens cervical mucus.
      ex. DMPA - depomedroxy progesterone Acelate
      Advantages:
      • Reversible
      • No need for daily intake
      • Does interfere
      • No estrogen related effects
      • does not affect breastfeeding
    • 6. Lactating Amenorrhea Method (LAM) 99.5%
      - temp introductory postpartum method of postponing pregnancy
      - not effective if mother will be separated to the baby most of the time
      - maximum practice in 6 mos.
      note: not dependable because woman still ovulate even if no menstruation
    • LAM(Lactating Amenorrhea Method)
    • MUCUS/BILLINGS/OVULATION(97%)
      - abstaining from sexual intercourse during fertile (wet) days
      - billings:senses vaginal wetness; spinnbarkeit:mucus
      - advantage: can be used by any woman of repro. Age
      - disadvantage: not applicable with medical conditions
      - how to use:
      • Recording of menstruation and dry days
      • Inspecting underwear regularly for presence of mucus
      • Recording the most fertile observation at the end of the day
    • 8. Basal Body Temperature – 99%
      (from day 6-10 of the menstrual cycle to identify thermal shift (the three consecutive temp. above the cover line labeled as days 1,2,3 intercourse is allowed only from 4th day thermal shift until the end of the cycle.
      Women’s resting body temp (morning or before activity)
      1 degree higher – time of ovulation
      ½ degree higher – day before ovulation
      Ovulation: a slight dip then sudden rise in temp.
    • 9. Sympto – thermal Method –
      Combination of Cervical Mucus, Basal Temp recording and other signs of ovulation
      10. Two Days Method – 96%
      -cervical mucus as an indicator
    • STANDARD DAYS Method (95%)
      The Standard Days Method is most appropriate for women who usually have cycles between 26 and 32 days long.
      Steps:
      1.Count the first day of your menstrual bleeding as day 1.
      2.Continue counting every day.
      3.On days 1 to 7, you can have unprotected intercourse.
      4.On days 8 to 19, you should use a barrier method or avoid intercourse
      5.From day 20 through the end of your cycle, you can have unpro­tected intercourse.
      6.The Standard Days Method works best for women who usually have cycles between 26 and 32 days long.
      7.To prevent pregnancy. Unprotected intercourse is permitted on days 1 to 7 and from day 20 until the end of your cycle. On days 8 to 19, use a barrier method or avoid intercourse.
    • Billings/Ovulation
      Cycle Beads
    • Q: According to the Philippine Health Statistics, as of 2005 what the current Infant mortality rate?
    • CHILD HEALTH PROGRAMS: (Newborns, Infants and Children)
      1. Infant and Young Child Feeding
      Exclusive BF – 6 months
      Global Strategy For IYCF – WHO and UNICEF – consensus 55th World Health Assembly in May 2002 and Exec. Board in Sep. 2002 (UNICEF)
      Goal – Reduce Child Mortality by 2/3 by 2015
      Current IMR: 24.24 for every 1,000 child
      • Infants & Young Child Feeding
      • Newborn Screening
      • Expanded Program on Immunization
      • Management on Childhood Illnesses
      • Micronutrient Supplementation
      • Dental Health
      • Early Child Development
      • Child Health Injuries
      • Reduce morbidity and mortality 0-9
    • Laws that protects IYCF
      Milk Code – EO 51
      Rooming In and Breast Feeding Act of 1992
      Food Fortification Law – RA
    • Specific Objectives
      70% of newborn initiated breastfeeding within 1 hour after birth
      60% of infants are exclusive breastfeeding up to 6 months
      90% of infants are started on complementary feeding by 6 months of age.
      Median duration of breastfeeding is 18 months
    • Benefits of breastfeeding to
      Infants:
      Safely rehydrates and provides essential nutrients to sick child, especially to those suffering diarrheal diseases.
      Increase IQ points
    • Mothers:
      Reduce woman’s risk of excessive blood loss after birth.
      Reduces the risk of ovarian and breast cancers and osteoporosis
    • Q: In breast feeding, what are the signs of good positioning, good attachments and sucking effectively?
    • 4 Signs of Good Positioning
      with infant’s head and body straight
      facing her breast, with infant’s nose
      opposite her nipples
      with infant’s body close to her body
      supporting infant’s whole body, not just neck and shoulders
    • 4 Sign of Good Attachment:
      1. Chin touching breast
      2. Mouth wide open
      3. Lower lip turned outward
      4. More areola visible above than below the mouth.
    • SUCKING
      Suckling effectively – the infant suckles with slow, deep sucks and sometimes pauses.
      You may see or hear the infant swallowing.
      Not suckling effectively – he is taking only rapid, shallow sucks. You may see in-drawing of the cheeks. You do not see or hear swallowing.
      Not suckling at all – not able to suck breast milk into his mouth and swallow.
    • Low birth weight (LBW) babies – BW less than 2,500 grams
      Includes:
      Babies born before term
      Premature
      Babies who are small for gestational age.
    • Teas and coffee reduces iron that absorbed from foods. It should not be given with 2 hours before and after food.
      Non – breastfed child aged 6 – 24 months of age needs approx. 2-3 cuts of water in a temperate climate and needs 6 cups of water per day in a hot climate. This water can be incorporated in porridges and stews.
    • Laws that protects Infants and Young Child:
      Milk Code (EO 51)
      The Rooming In and breastfeeding Act of 1992 – requires institution adopting rooming. Baby friendly hospital wherein the mother and the baby should be together for 24 and as long as both are in hospital.
    • 3. Food Fortification Law or An Act Establishing the Philippine Food Fortification Program and for other
      • aims : to address the nutritional deficiency problems in the Philippines, based on the past nutrition surveys
      • to compensate for the deficiencies in the Filipino diet
      • Purpose : Food Fortification Law (Republic Act 8976) – it covers all manufacturers, or producers, importers, traders, tollees, retailers, repackers, of food products as well as restaurants and food service establishments where such fortified foods are encourage to be served.
      • Fortification: addition of nutrients to processed foods or food products at levels above what is naturally present in the food.
      • based on a typical Filipino's daily needs as measured using the most recent Recommended Dietary Allowances (RDA).
    • 2. EPIFour Major Strategies: Sustain 90% FICSustain Polio Free Country for Global Cert. In 2000 our country has been certified polio free in Kyoto JapanEliminate Measles by 2008 Given @ 9 months 85% protection Given @ 1 year and older – 95% protectionEliminating Neonatal Tetanus by 2008
    • Hepa B – Integrated in EPI in 1992. Due to high cost – 40% eligible targets vaccinated.
      Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindication to vaccination.
      DPT2 and DPT3 are contraindicated to a child who has had convulsion or shock within 3 days the previous dose
      Live vaccines like BCG – immuno-suppressed due to malignant disease (child with clinical AIDS)
      No extra dose for who missed DPT/HB/TT
      Repeat BCG vaccination if the child does not develop a scar after the first injection.
    • Measles given at 9 months provides 85% protection, 95% protection when given at 1 year and older.
      Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindications to vaccination.
      Use one syringe, one needle per child during vaccination
    • EXPANDED PROGRAM ON IMMUNIZATION
      Sustaining high routine FIC coverage of at least 90% in all provinces and cities.
      Sustaining the polio free country for global certification
    • 3. Eliminating neonatal tetanus by 2008.
      4. Measles elimination by 2008
      A. Measles Catch – up campaign (reduces cases by 70% in 15 years after 1998.
      B. Follow – Up Measles Campaign vaccination of children 9 months to less than 5 years old – 94 % reduction in cases in 2004.
    • Q:Ricky a 2 ½ months old child is brought to the Health Center for vaccination. Upon interview the mother said that a day after the first visit Ricky had a temperature of more than 40C in a convulsive state. As a knowledgeable nurse what would be the appropriate nursing intervention?
      Give DPT, OPV, Hepa B
      Give DPT2, OPV2
      Give DPT3, OPV2, HepaB3
      Do not give DPT
    • Q:Erma brought her two months old infant to the clinic for immunization. She asked you when her child can be considered fully immunized. A child is “fully immunized child” when he receives:
      a.1 BCG,3 OPV,3 DPT, 2 HB & 1 measles before 1st birthday
      b.1 BCG,3 OPV,3 DPT, 3 HB & 1 leasles before 1st birthday
      c.1BCG, 4 OPV,3 DPT,2 HB & 1 MMR before 1st birthday
      d.1 BCG, 3 OPV,3 DPT, 3 HB & 1 measles before 5 yrs old
    • 1. MEASLES
      Vaccine: freeze dried
      Generalized blotchy rash, lasting for 3 or more days
      Cough, runny nose, red eyes / conjunctivitis
      M.T - 4 days before until 2 days after rash
      Day 1-3: The child has a cold, cough, and high fever. Eyes are pink, watery, sensitive to light.
      Days 2-4: The rash spreads over the face and body.
    • 2. TUBERCULOSIS
      Vaccine: freeze dried
      Any child who does not return to normal health after measles or whooping cough.
      Any child with loss of weight, cough, and wheeze which does not respond to antibiotic therapy for acute respiratory disease.
      Abnormal swelling with a hard painless mass and free fluid.
      Painful firm or soft swelling in a group of superficial lympnodes
      Any bone or joint lesion or slow onset.
      Signs suggesting meningitis or disease in the central nervous system
    • 3. DIPHTHERIA
      Throat with whitish gray membrane and swollen neck (S.D – It is an acute pharyngitis, acute naso pharyngitis or acute laryngitis with pseudomembrane.
      • Vaccine: weakened toxins
      • Corynebacterium diphtheria
      • Respiratory droplet
      • 2 to 5 days or may longer
      • Days 1 to 3 - Child complains of mild sore throat, is unwell
    • Days 4 to 6 – Child is very ill. Neck is swollen
      After two weeks – Diphtheria toxins may cause heart failure, paralysis of breathing
      May Last 2 -3 weeks
      Maybe shortened in patients with antibiotics
      Transmission is increased in schools, hospitals, households and in crowded places.
    • 4. PERTUSSIS
      History of severe cough and Hx of any of the following: cough persisting 2 or more weeks; fits of coughing and cough followed by vomiting.
      • Vaccine: killed bacteria
      • Hundred Day Cough
      • Borderline Pertussis
    • Highly Communicable in early catarrhal stage, before paroxysmal cough
      First week – symptoms – colds
      Second week – The child struggles to breath and whoops: cough – whoop – vomit
      Third week – cough usually subsides
    • 5. POLIOMYELITIS – Residual Paralysis
      Below 15 years of age with acute flaccid paralysis (including those diagnosed to have Guillain Barre Syndrome)
      Poliovirus type 1, 2 and 3
      M.T – Oral route - pharyngeal secretion
      I.P – 7 to 12 days but can range from 3 to 21 days
      P.C – 7 to 16 before the onset of symptoms
    • 6. NEONETAL TETANUS
      Vaccine: weakened toxins
      Sardonic’s smile
      History of all 3 of the following:
      Normal suck and cry for the first two days of life
      Onset of illness bet. 3 & 28 days
      Inability to suck followed by stiffness of the body & or convulsions
    • Clostridium Tetani
      Intestinal canals of animals (esp. horses)
      I.P – 6 days but ranges from 3 to 21 days
      P.C – not directly transmitted from man to man
      5 to 7 days – baby has tight mouth that does not open. Baby stops sucking
      7 to 10 days – The baby does not suck. The entire body is tight and there are severe fits. Baby dies.
    • 7. HEPATITIS B
      A liver infection caused by the B type of Hepatitis Virus
      Mode of Transmission:
      From child to child
      From mother to child during birth
    • Expanded Program On Immunization
    • NORMAL COURSE
      &
      SIDE EFFECTS OF VACCINATION
    • Q: A grandmother brought her grandson to the health center on a Monday, she said that on Wednesday her grandson was scheduled to have his measles vaccine, but they will be leaving for a vacation to Tagaytay on Wednesday, instead she requested to have it that day, as a competent nurse what will be your appropriate response?
    • NON COMMUNICABLE DISEASES PREVENTION AND CONTROL
    • Q: What is the role of a public health nurse in Non Communicable Programs?
    • Integrated Community Based Non-Communicable Diseases Prevention & Control Program
      Aim at preventing the four major Non-CD/chronic/lifestyle related diseases , cardiovascular diseases , cancers , COPD , DM
      Through promotion of healthy lifestyle
      Healthy Lifestyleis defined as a way of life that promotes & protects health and well-being.
      Includes practices that promote health as:
      Healthy diet & nutrition
      Regular & adequate physical activity & leisure
      Avoidance of substances that can be abused-tobacco, alcohol, addicting substances,
      adequate stress mgt. relaxation
      Safe sex and immunization
    • Role of Public Health Nurse In Non Communicable
      1.Health Advocate -help people towards optimal degree of independence in DM & asserting the right to safer & better community
      2.Health Educator -inform ,motivate & guide the people into action.
      3.Health Care Provider- emphasizing on health promotion & prevention
      4.Community Organizer- community health development and people empowerment
      5.Health Trainer- provide technical assistance
      6.Researcher- community assessment, epidemiological studies & intervention studies
    • NATIONAL PREVENTION OF BLINDNESS PROGRAM
      Vision 20 / 20: The Right to Sight
      Cataract / Refractive Errors / Low Vision causes of childhood blindness
    • KEY POINTS IN COMMUNICABLE DISEASE NURSING
      • AIDS – opportunistic and malignant manifestations – T4 below 200/dl – ELISA / Western Blot / PCT
      • Amoebiasis – bloody mucoid stool – I: bismuth glycoarsenilate combined with chloroquine / proper disposal of excreta
      • Ascariasis – vomiting passing out of worm / Mebendazole. IP: 4-8 weeks
      • Candidiasis – (Moniliasis) cheeselike discharge / I: Nystatine or Imidazole, ketoconazole swab in the oral mucosa of an infant thrush
      Chicken pox – Vesiculopapular lesions / I: Zovirax to lessen lessions / VZ immune G
      Cholera – Rice watery stool / IC: 2-3 days / PC: 7-14 days / tetracyclines and cotrimoxazole
      Dengue – Heman’s sign / Rumpel Lead Test / Hct – decreased / clotting & bleeding time – 3 series in 8 hours
    • Diphthria – Pseudomembrane – caused by Klebs Loeffler / Bullneck appearance / Shick’s Test / Maloney’s Test
      Enterobiasis – Nocturnal itchiness / I: Pyrantel Pamoate
      Filariasis – Elephantiasis / Wuchereria Bancrofti; Brugia Malayi
      German M. – Forscheimer’s spots / 3 day measles
      Gonorrhea – Thick purulent discharges / Opthalmia neonatorum
    • Herpes Z. – Lesions follow peripheral nerve pathway
      Leptospirosis – Weil’ s Dse. / Mud fever / Swine herd’s dse. / Orange Eyes
      Leprosy – Hansenosis / HANSEN’S DSE.
      Malaria – Fever and chills / CQ + SP – 1st line drug.
      Measles – Rubeola 7 day measles / Koplik’s spot / 3 C’s Coryza, Cough , Conjunctivitis
    • Meningitis – Nucchal rigidity / Cerebro spinal fever / lumbar tap – CSF high WBC
      Mannitol (Cerebral Edema) / Seizure/ HW
      Mumps – Swollen parotid glands
      Pertussis – Paroxysmal cough ending with whoop
      Pneumonia – Rusty sputum
      Polio – Flaccid paralysis
      Rabies – Hydrophobia
      Scabies – Weeping itch
    • Scarlet – Raspberry tongue
      Tetanus – Locked jaw / trismus
      Tuberculosis – Initially ASYMPTOMATIC
      Typhoid – 3 Cardinal signs: ladderlike fever. Rose spots, spleenomegaly
      Pattern of a disease:
      Sporadic – intermittent occurrence
      Endemic – constant occurrence certain geographical area
      Epidemic – sudden increase / short period of time / within a given population
      Pandemic - worldwide
    • MANAGEMENT OF CHILDHOOD ILLNESS
    • SentrongSigla
      Definition: SS is a quality improvement initiative through a certification/recognition program. Health facilities are certified based on a set of standards
      Started in 1998 as Quality Assurance Program (QAP)
      Renamed from QAP to SentrongSigla or Centers of Vatality Movement- goal: quality health care, services & facilities
      Expansion of program to the private sector – Phase II (2001)
      Level 1 – Focus on the major functions of RHU/HC
      Level 2 – Directed on Specialty Achivement on strengthening local health programs
    • Botika Ng Barangay (BnB)
      • Refers to the drug outlet managed by a legitimate Community Organization, NGO and LGU as liscence by BFAD to manage.
      • Started July 5, 1996
      • Should sell low priced generic home remedies
      • OTC Amoxicillin
      • 2 selected publicly known antibiotics Cotrimixazole
      • Maintenance drugs for lifetime use for
      a. asthma
      b. diabetes
      c. hypertension
    • Facts:
      • Training deployment project desinged to mobilize RN in to the poorest municipalities
      • Areas to cover: 2 months hospital, 2 months RHU, 2 months school nursing
      • Program of DOH, DOLE and DOST
      • 3 I’s
      - Initiate Primary health care, school nutrition & MCH
      - Inform public on water sanitation and health surveillance
      - Immunize children and mother
      • In reference to FOURmula One
      • Beneficiaries:
      -10,000 NARS trainees
      -1,000 poorest municipalities
    • Public Health Nursing in Schools
      The primary role of the school nurse is to support student learning & ensure that educational potential is not hampered or unmet health needs.
      Assist the pupils in acquiring health knowledge in developing attitudes & practices conducive to healthful living
      Based on the philosophy that the academic performances of the pupils & the instructional outcomes are also determined by the quality of health of the school population & the community where they come from.
    • Public Health Nursing in Schools
      Objectives of School Nursing: To promote & maintain the health of the school populace by provingcomprehensive& quality nursing care.
    • Home Visit
      Is a family-nurse contact allows the health worker to assess the home & family situations in order to provide the necessary nursing care & health related activities
      Important to have a Plan of Visit-to meet the needs of the client and to achieve the best results
      PURPOSE
      1. Give nursing care to the sick, post partum& her NB.
      2. Assess the living condition of the patient & his family
      3. Give Health Education on prevention & control
      4. Establish close relationship between agencies & public
      5. Make use of the inter-referral system to promote the utilization of community services.
    • Principles: Home Visit
      HV should have a purpose or objective
      Planning for HV should make use of all available information about the patient & his family through family records
      In planning, priority should be given to the essential needs of the individual and his family
      Planning & delivery of care should involve the individual and family
      Planning should be flexible
    • Steps in Home Visit(Greet PapaHaha Baba Wow PHW RAN)
      Greet
      Purpose
      Health Inquiry
      Bag Placement
      Wash Hands
      Physical assessment
      Health teaching
      Wash Hands
      Record
      Appointment set
      Normal Pleasantries- Goodbye
    • ACUTE COMPLICATIONS:
      DIABETIC KETOACIDOSIS – DKA for IDDM
      HYPEROSMOLAR HYPERGLYCEMIC NONKETOTIC COMA – HHNK for NIDDM
      CHRONIC COMPLICATIONS:
      CHONIC RENAL DISEASE (NEPHROPATHY)
      BLINDNESS (RETINOPATHY)
      CORONARY ARTERY DSES. AND STROKE
      NEUROPATHIES AND FOOT ULCERS
    • Any Question?
      www.nursendoutfield.blogspot.com
    • PD568
      Restructuring HCDS to minimize health workers( 1midwife:5,000 population)
      -midwife visits 2 times a month
      - well clients only
      - 1 nurse:10,000/ homevisit once/month
      - client: well and sick
    • Programs
      23 in 93 – 23 programs for 1993
      - more on health promotion and
      disease prevention
      • Health for more in 94
      a. cancer prevention program thru KKK
      (Kayang-kaya and Kanser)
      b. mental health program- teach stress management
      c. environmental health program- clealiness in brgy
      d. reproductive health
      “think health….health link”
      • 5 in 95 – describe a healthy country
    • Priority Program in Year 2000
      Plan 50 – to promote affordable drugs
      - to promote Lagundi tablet available
      @ ate glo’s rolling store
      2. Plan 500 – philhealth plan, all Filipino household can avail free PHIC card
      3. Women’s Health- reduce mortality/morbidity among children
      4. Children’s Health – reduce morbidity/mortality
      5. Healthy Lifestyle
    • Risk Factors for Type 2 DM
      • Family history of diabetes (parents or sib. w/ DM)
      • Overweight (BMI 23 kg./m) Obesity (BMI > 30 kg./m
      • Sedentary Lifestyle
      • Hypertension
      • HDL Cholesterol < 35 mg/dl (0.90 mmol/L) and or triglyceride level > 250 mg./dl. (2.82 mmol/L)
      • Hx of GDM – delivery of baby wt. 9lbs (4 kgs.)
      • Previously identified to have IGT
    • Screening for Diabetes Mellitus
      Hallmark – presence of hyperglycemia
      For those with Hx of DM
      FBS – 109mg% --------- Normal
      110 – 125mg% -- Impaired Glucose Tolerance (IGT)
      126mg% ------------ Possible DM
    • CRITERIA FOR DIAGNOSIS OF DM
      Symptoms of DM plus RBS > 200mg/dl (11.1mmol/L)
      FBS >126mg/dl (7.0 mmol/dl)
      Two – hour – blood sugar > 200mg/dl (11.1mmol/L) during an OGTT
    • C. DIABETES MELLITUS
      - one of the leading causes of disability in persons over 45.
      - Chronic disorder of carbo. / protein / fats metabolism. – char. By imbalance bet. Insulin & demand. Normal blood sugar 70-100 mg/dl
      - More than half of Diabetic patients will die of coronary heart disease.
    • D. CHRONIC OBSTRUCTIVE PULMONARY DSE.
      • Characterized by airflow limitation
      • Major cause of chronic morbidity and mortality and the 4th leading cause throughout the world.
      • Usually due to chronic bronchitis & emphysema
      • Cigarette smoking is the primary cause – COPD
      • Cough, sputum production, or dyspnea
      • Diagnoses is confirmed by SPIROMETRY.
      • Oxygen at 1 to 3 L even if hypoxia is severe.
      • Phlebotomy to reduce blood volume if hematocrit (PCV – M: 40-54% F: 36-47%) is more than 60%; also to reduce cardiac workload.
    • E. Bronchial Asthma
      • Inflammatory disorder of the airways – airway hyperresponsiveness.
      • Intrinsic and extrensic
      • Other forms triggers are irritant gases & smoke house dust-mite found in pillows, mattresses, carpets; respiratory infection, inhaled allergens, weather changes, cold air, exercise, certain foods, additives and drugs.
      • Promote exclusive BF as long as possible; early introduction to cow’s milk may predispose baby to allergies and predispose asthma.
    • Through blood transfusion
      Through sharing of unsterilized needles
      Through sexual Intercourse
      R.Fx – HBeAg + Mother, Multiple partners
      Eliminate HB before 2012 (a western Regional Goal)
    • A. Diseases of the Heart and Blood Vessels (Cardiovascular Diseases)
      Hypertension
      - sustained elevation in mean arterial blood pressure
      - a major risk factor for development of CVD’s like coronary heart disease and stroke.
      - classified into primary and secondary
    • Primary HPN – It has no definite cause: essential HPN or Idiopathic HPN – 90% of all hypertensives have primary HPN
      Secondary HPN – the result of some other primary diseases leading to HPN: such renal dses.
      P. HPN – more common. Cause is unknown, HPN is attributed to Atherosclerosis.
    • RISK FACTORS:
      Obesity
      - Risk for hypertension is two times greater among overweight / obese persons compared to people of normal weight, and three times more than that of underweight persons.
      - Increased waist to hip ratio is more associated with hypertension
    • 2. Coronary Artery Disease (CAD)
      - caused by impaired coronary blood flow, known as Ischemic Heart Disease.
      - when there is a decreased oxygen supply to the heart muscles, chest pain (called angina) occurs.
      - CAD can cause M.I (Heart Attack) arrhythmias, heart failure, and sudden death.
      - Atherosclerosis – high levels of cholesterol in the blood. (low density lipoproteins / LDL – bad cholesterol)
    • Smoking Tobacco – Risk of CAD is 70 – 200 times greater for men who smoke.
    • 3. Cerebrovascular Disease or Stroke
      Stroke – results from insufficient supply of blood to the brain. If blood is obstructed for more than several minutes, injury to brain cells becomes permanent and tissue dies in the affected region resulting in cerebral infarction.
      Most fatal stroke is due to Intracerebral Hemorrhage – rupture of IC B.vessel.
    • Risk Factors of Stroke
      Increasing age
      Sex
      Hereditary
      Hypertension
      Cigarette Smoking
      Diabetes Mellitus
      Heart Diseases
      High Red Blood Cell Count
    • The use of oral contraceptives combined with cigarette smoking (nicotine and carbon monoxide) greatly increase stroke risk.
      People with diabetes often also high cholesterol and overweight.
    • B. CANCER
      - it is not a single disease.
      - the immune system seems to play a role in development and spread of cancer.
    • Chemicals and Environmental Agents:
      Polycyclic Hydrocarbons
      Aflatoxin – Peanuts and peanut butter
      Benzopyrene – charcoaled broiled or smoked, reusing cooking oil
      Nitrosamines – from food preservatives; like tocino, longganisa, bacon and hotdogs
      Virus – cervical (human papilloma virus) liver cancer (hepatitis B virus) certain leukemias, lymphomas and nasopharyngeal cancer (Epstein – Barr Virus)
    • Lung Cancer
      Oral Cancer
      Laryngeal Cancer
      Bladder Cancer
      Renal Cancer
      Cervical Cancer
      Esophageal Cancer
      8. Breast Cancer
      9. Prostate Cancer
      10. Liver Cancer
      11. Skin Cancer
      12. Colonic Cancer
      13. Uterine / Endometrial Cancer
    • A moderate or marked increase in RBC count is a risk factor for stroke. The reason is that more RBC thicken the blood and make clots more likely. This present in persons with CHD.
      Prevent thrombus formation in RHD and arrhythmias with appropriate medications.
    • Seasons and Climate
      Socio Economic Factors
      Excessive Alcohol Intake
      Certain kind of drug abuse
    • Thrombotic Stroke – Thrombi
      Embolic Stroke – Emboli (a moving blood clot usually from a thrombus in the left heart that becomes lodged in a small artery.
      Hemorrhagic Stroke