“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
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 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
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
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
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
Expanded Program on Immunization
Management on Childhood Illnesses
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
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
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
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
2 selected publicly known antibiotics Cotrimixazole
Maintenance drugs for lifetime use for
a. asthma b. diabetes c. hypertension
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
- Initiate Primary health care, school nutrition & MCH - Inform public on water sanitation and health surveillance - Immunize children and mother
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
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