Doh programs

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Doh programs

  1. 1. “HindiLahatngNakatalikod, Di nakikinig”<br />RandelDalauta,RN<br />
  2. 2. Q: WHAT ARE SETS OF INTERVENTIONS PUT TOGETHER TO OPERATIONALIZE POLICIES AND STANDRDS DIRECTED TOWARDS THE PREVENTION OF CERTAIN SOCIETAL PROBLEMS?<br />
  3. 3. DOH / PUBLIC HEALTH PROGRAMS<br />
  4. 4. DOH Health Calendar 2010<br />JANUARY<br /> STI / Condom Week January 7, 2010<br /> World Leprosy Day January 31, 2010<br />FEBRUARY<br /> World Cancer Day February 4, 2010<br /> Pregnancy Awareness Week February 7-14, 2010<br /> Healthy Lifestyles Awareness Day February 19, 2010<br />
  5. 5. DOH Health Calendar 2010<br />MARCH<br />International Women’s Day March 8, 2010<br /> World Kidney Day March 11, 2010<br /> World Head Injury Awareness Day March 20, 2010<br /> Human Rights Day March 21-24,2010<br /> World Down Syndrome Day March 21, 2010<br /> World TB Day March 24, 2010<br />
  6. 6. DOH Health Calendar 2010<br /> APRIL <br />World Autism Awareness Day April 2-4, 2010<br /> National Polio Eradication Awareness Week April 4, 2010<br /> World Health Day April 7, 2010<br /> World Hemophilia Day April 17, 2010<br />
  7. 7. DOH Health Calendar 2010<br />MAY<br />World Red Cross Day May 8, 2010<br /> World Move for Health Day May 10, 2010<br /> World Chronic Fatigue and <br /> Immune Dysfunction Syndrome May 12, 2010<br /> International Nurses Day May 12, 2010<br /> International Day of Action for <br /> Women’s Health May 28, 2010<br /> World No Tobacco Day May 31, 2010<br />
  8. 8. DOH Health Calendar 2010<br />JUNE<br />International Children’s Day June 1, 2010<br /> International Day of Innocent Children <br /> Victims of Aggression June 4, 2010 <br /> World Environment Day June 5, 2010<br /> World Blood Donor Day June 14, 2010<br /> World Elder Abuse Awareness Day June 15, 2010<br /> Youth Day June 16, 2010<br /> National Epilepsy Day June 21, 2010<br />International Day against Drug Abuse <br /> and Illicit Drug Trafficking June 26, 2010<br />
  9. 9. DOH Health Calendar 2010<br />JULY<br /> World Population Day July 11, 2010<br />AUGUST<br /> World Breastfeeding Week August 1-7, 2010 <br /> National Immunization Awareness Week August 2-8, 2010<br /> Rheumatic Fever Week August 2-8, 2010<br /> National Women’s Day August 9, 2010<br /> International Youth Day August 12, 2010<br /> Deaf Awareness Week August 30, 2010<br />
  10. 10. DOH Health Calendar 2010<br />SEPTEMBER<br /> Pharmacy Week September 6-12, 2010<br /> Kidney Awareness Week September 6-9, 2010<br /> World Rabies Day September 8, 2010<br /> World Oral Health Day September 12, 2010<br /> Attention Deficit Hyperactivity<br /> Disorder Day (ADHD) September 14, 2010<br /> Stroke Week September 14-17, 2010<br /> World Alzheimer’s Day September 21, 2010<br /> World Heart Day September 21, 2010<br />
  11. 11. DOH Health Calendar 2010<br />OCTOBER <br /> International Day for Older Persons October 1, 2010<br /> National Nutrition Week October 1, 2010<br /> World Mental Health Day October 10, 2010<br /> World Arthritis Day October 12, 2010<br /> World Food Day October 16, 2010<br /> International Day for the Eradication of<br /> Poverty October 17, 2010<br /> National Down Syndrome Day October 20, 2010<br /> National Iodine Deficiency Disorder Day October 23, 2010<br /> World Polio Day October 24, 2010<br />
  12. 12. DOH Health Calendar 2010<br />NOVEMBER<br /> National Children’s Day November 6, 2010<br /> Malaria Day November 12, 2010<br /> International Day for the Elimination of <br /> Violence against Women November 25, 2010<br />DECEMBER<br /> World AIDS Day December 1, 2010<br /> International Day of Disabled Persons December 3, 2010<br /> International Volunteers Day December 5, 2010<br /> World Patient Safety Day December 9, 2010<br /> International Human Rights Day December 10, 2010<br />
  13. 13. D – Dental Health Program<br />O – Osteoporosis Prevention<br />H – Health Educ. & Community Org.<br />P – Primary Health Care<br />R – Reproductive Health<br />O – Order Person Health Services<br />G – Guidelines for Good Nutrition<br />R – Respiratory Infection Control<br />A – Acupressures<br />M – Maternal and Child Care<br />S – Sentrong Sigla Movement<br />
  14. 14. Eradicate extreme poverty & hunger<br />Achieve universal primary education<br />Promote gender equality& empower women<br />Reduce child mortality<br />Improve maternal health<br />Combat HIV/AIDS, malaria & other diseases<br />Ensure environmental sustainability<br />Develop a global partnership for development<br />
  15. 15. I. FAMILY HEALTH /SERVICES<br />Reduce morbidity and mortality rates for children, adolescents, adults and older people.<br />
  16. 16. THE MATERNAL AND CHILD HEALTH PROGRAM<br />Facts:<br />-Maternal and pediatric population group comprise 60% of population of most communities<br />-Decrease women having prenatal ( 1998-77% to 2003-70.4%)<br />-Decrease women receiving @least 2 doses of TT(1998-38% to 2003-37.3%)<br />-Only 76.8% of pregnant received supplementation during pregnancy <br />
  17. 17. 6 COMPONENTS:<br />PRE - NATAL<br />POST – NATAL<br />EPI<br />FAMILY PLANNING<br />NUTRITION<br />UFC<br />
  18. 18. 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. <br /> Total no. of deaths from maternal causes registered for a given year <br />MMR = ----------------------------------------------------- X 1000<br /> Total no. of live births registered of same year<br />
  19. 19. Current MMR<br />170/100,000<br />Rank number 49th of the 136 countries<br />
  20. 20. Q: The main causes of maternal deaths according to the National health Statistics?<br />
  21. 21. Main cause of maternal deaths remains to be due to:<br />1. Hypertension (25%)<br /> 2. Post Partum Hemorrhage <br /> – 20.3%<br /> 3. Pregnancy with abortive outcomes – 9%<br />
  22. 22. Q: The underlying causes of maternal deaths are?<br />
  23. 23. <ul><li>Delays in taking critical actions
  24. 24. Delay in seeking care
  25. 25. Delay in making referral
  26. 26. Delay in providing appropriate medical management</li></li></ul><li>Other Factors to Maternal Deaths:<br />Closely Space Births<br />Frequent Pregnancies<br />Poor detection and management of high risk pregnancies<br />Poor Access to health facilities<br />Health Care staff lack the competence in handling obstetrical emergencies<br />
  27. 27. Strategic thrust for 2005-2010<br />BEMOC – Basic Emergency Obstetric Care (entails the establishment of facilities that provide emergency obstetric care for every 125,000 population located strategically.<br />
  28. 28. A. Antenatal Registration:<br /> At least 4 visits till delivery<br />Q: What is the ideal frequency of prenatal visits during the duration of pregnancy?<br />
  29. 29. Standard Prenatal Visits<br />
  30. 30. B. Tetanus Toxoid Immunization<br /> 2 doses one month before delivery plus 3 booster doses for the mother to be called <br />FIM – Fully Immunized Mother<br />
  31. 31. Q:If a woman has had TT2, 80% protection is insured for 3 years. How about the infant?<br />
  32. 32. TETANUS TOXOID VACCINE<br />
  33. 33. Q: If a woman was given DPT immunization in infancy, tetanus toxoid doses can start at?<br />
  34. 34. 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?<br />
  35. 35. C. Micronutrient Supplementation<br />
  36. 36. Facts:<br /> Vitamin A <br /> 1. should start at 4th month of pregnancy until <br /> delivery<br /> 2. should NOT be given to those who are<br /> already taking pre-natal vitamins/multiple<br /> micronutrients containing vit. A<br /> 3. postpartum give 1 dose within 4 weeks after <br /> delivery @ 200,000 IU<br /> 4. pregnant: avoid 200,000IU<br />
  37. 37. XEROPHTHALMIA<br /> - eye disease for pregnant women caused by vit.A deficiency characterized by night blindness<br /> Vitamin A:<br /> 1. give 10,000 IU<br /> 2. 1 capsule/tablet one a day for 4 weeks upon<br /> diagnosis<br /> 3. don’t give if prenatal vitamins has vit A<br /> 4. give regardless of AOG of pregnant woman<br />
  38. 38. Facts:<br /> IRON<br /> Pregnant:<br /> 1. preferably coated tablet<br /> 2. at least 1 tablet once a day for 6 months/ <br /> 180 days during pregnancy period<br /> 3. 2 tablets per day if consults during 2nd<br /> and 3rd trimester<br /> Lactating:<br /> 1. preferably coated tablet<br /> 2. 1 tablet once per day for 3 months.<br />
  39. 39. Q: What is the intervention for post partum bleeding, intestinal parasite, & malaria?<br />
  40. 40. D. Treatment of Diseases and other Conditions<br />
  41. 41.
  42. 42. 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?<br />Clean hands, clean body, clean nails<br />Clean hands, clean cord, clean surface<br />Care, Core, Cure<br />Clean body, clean spirit, clean environment<br />
  43. 43. E. Clean and Safe Delivery<br />Do a quick check upon admission <br />Make the woman comfortable<br />Assess the woman in labor - Danger signs of pregnancy<br />Determine the stage of labor<br />Decide if the woman can safely deliver<br />Give supported care throughout labor<br />
  44. 44. Monitor and manage labor<br />Monitor closely within one hour of delivery and give supportive care<br />Continue care after one hour postpartum. Keep watch closely for at least 2 hours<br />Educate and counsel on FP<br />Teach on the importance of MCH<br /> BF / Newborn Screening – within 48 hours up to 2 weeks after birth<br />
  45. 45. Q:What would include in the counseling of post partum women?<br />
  46. 46. Postpartum counseling:<br />1. Educate and counsel on Family Planning<br />2. Provide method if available <br />note: decision should be made by the woman<br />3. Inform woman on birth registration<br />4. Encourage breastfeeding<br />5. Schedule when to return for postpartum visits<br />6. Counsel on Newborn Screening<br />
  47. 47. Recommended schedule of Post Partum care visit:<br />
  48. 48. Newborn Screening<br />Why important?<br /> -detect congenital metabolic disorders<br /> -most were born asymptomatic<br /> -early diagnosis & prompt treatment <br /> before becoming symptomatic<br /> -prevent mental retardation or death<br />
  49. 49. Newborn Screening<br /> When is the best time?<br /> - 48 hours to 72 hours after birth<br /> - may also be done with in 24 hour after birth<br /> note: result is positive repeat the test 14<br /> days after<br />
  50. 50. Newborn Screening<br /> Who are authorized?<br /> - doctor<br /> - nurse<br /> - medical technologist Trained by <br /> - midwife DOH <br />
  51. 51. Newborn Screening<br /> Why test are repeated?<br /> - children who’s samples taken 24 hours<br /> - contaminated samples<br /> - 1st test the baby was ill<br />
  52. 52. Effects of Newborn Screening<br />
  53. 53. Steps in Implementation<br />Motivating parents & collecting blood samples <br /> Sending the samples to the laboratory and performing the test<br /> Releases result after 14 working days<br /> Recalling patient<br /> Managing and monitoring patient<br />
  54. 54. Q: When did Newborn Screening begun in the Philippines? <br />
  55. 55. Facts: Newborn screening(RA9288)<br /> - Begun in the Philippines in 1996<br /> - Adopted by DOH in the year 2004<br /> - 5 Congenital Metabolic Disorder detected in the Philippines, detects about 50 disorders in the 1st world countries<br />
  56. 56. Lets Practice? <br />
  57. 57. Q: Clinical manifestations in a child with Congenital Hypothyroidism:<br />a. dry hair, short neck, generalized obesity, cold, short & fat extremities and scaly skin<br />b. dry hair, short neck, generalized obesity, cold, short and fat extremities, sweaty skin<br />c. dry hair, long neck, generalized obesity, dry scaly skin<br />d. dry hair, short neck, generalized obesity, warm, short & fat extremities and scaly skin<br />
  58. 58. Q: Congenital Adrenal Hyperplasia is due to <br /> a. autosomal recessive disorder<br /> b. x-linked chromosomal disorder<br /> c. autosomal dominant inheritance<br />
  59. 59. Q: The Hormones produced by the adrenal glands<br /> a. cortisol, androgen, astrogen<br /> b. cortisol, androgen, aldosterone<br /> c. hydrocortisone, androgen, aldosterone<br /> d. hydrocortisone, cortisol, androgen<br />
  60. 60. Q: An enzyme essentia for the production of adrenal hormones<br /> a. 17-hydroxyprogesterone<br /> b. 21-a-hydroxylase<br /> c. Phenylalanine hydroxylase<br /> d. 17-a-hydroxylase<br />
  61. 61. Q: A disorder wherein the body cannot process galactose<br /> a. galactosemia<br /> b. gallstones<br /> c. galls disease<br /> d. G6PD<br />
  62. 62. Q: Galactose-1-phosphate uridyetranferase is an enzyme needed for the breakdown of<br /> a. galactose<br /> b. gallstones<br /> c. G6PD<br /> d. PKU<br />
  63. 63. Q: One of the building blocks of protein that cannot be metabolized in a child with PKU.<br /> a. Phenyloxalate<br />b.Phenyketones<br /> c. Phenylalanine<br /> d. Preoxalate<br />
  64. 64. Q: Appropriate diet for the patient with PKU<br /> a. low protein food<br /> b. high protein food<br /> c. low carbohydrate food<br /> d. high cabohydrate<br />
  65. 65. Q: Glucose-6-phosphate dehydogenase<br /> a. an enzyme that can help burst RBC <br /> form bilirubin & oxidate<br /> b. an enzyme that can cause mental <br /> retardation when exposed to oxidate<br /> c. an enzyme that protects RBC from <br /> oxidative substances<br /> d. an enzyme derive from oxidates<br />
  66. 66. Q: The preferred method of collecting blood sample for Newborn screening<br /> a. venous blood extraction<br /> b. umbilical cord blood method<br /> c. heel prick method<br /> d. hell print method<br />
  67. 67. Q: Newborn Screening blood samples can be collected by:<br /> a. any nurse<br /> b. trained midwife<br /> c. senior medtech<br /> d. doctor<br />
  68. 68. Family Planning<br />Counseling<br />
  69. 69. THE FAMILY PLANNING PROGRAM<br />EO 199: Created the PFPP (Phil. Family Planning Program.<br />The goal is to provide universal access to family planning information and services whenever and wherever these are needed.<br />
  70. 70. Q: What are the important things to consider in counseling about Family Planning?<br />
  71. 71. Important things to Consider<br />Personal values<br />Ability to use method correctly<br />How method will affect enjoyment<br />Financial factor<br />Status of couples relationship<br />Prior experience<br />Future plans<br />
  72. 72. Assessment for Contra<br /><ul><li>Poor memory for compliance – Oral contraceptives
  73. 73. Valvular heart Disease - IUD
  74. 74. Cigarette smokers – Oral Contraceptives
  75. 75. Liver Disease – Oral contaceptives
  76. 76. Breast Cancer – NorPlant, OC, Depo
  77. 77. Diabetes – Oral Contraceptive
  78. 78. Irregular shape uterus –IUD, cervical cap
  79. 79. Undiagnosed Vaginal Bleeding – all form
  80. 80. Thrombophlebitis – Oral contraceptive</li></li></ul><li>Steps in Counseling<br />Greet client<br />Ask client about themselves<br />Tell about choices of methods<br />Help client make an informed choice<br />Explain fully how to use of chosen method<br />Return visits should be welcome<br />
  81. 81. Criteria for Ideal Contraceptive<br />Safe<br />Affordable<br />Acceptable <br />Free of effects on future pregnancy <br />Free of side effects<br />Effective 100%<br />Easily obtainable<br />
  82. 82. Q: What is the most effective family planning method?<br />
  83. 83. Sterilization<br />Female Sterilization – 99.5% (BTL)<br /> types:<br /> - cautery - crushing<br /> - clamping - blocking tube <br />
  84. 84. Bilateral Tubal Ligation<br />
  85. 85. Sterilization<br />2. Male Sterilization – 99.9% (Vasectomy – Vas deferens – passage of sperm – is tied and cut)<br /> - post-op 1 week can resume coitus<br /> - birth control should be used until 2 (-) sperm reports have been examined<br />
  86. 86. Vasectomy<br />
  87. 87. Artificial Contraceptive<br />1. Pill – 99.7% (Contains hormone estrogen and progesterone)<br /> - prevent ovulation by inhibiting FSH<br /> - decrease permeability of cervical mucus<br />Side effects:<br />Nausea<br />Weight gain<br />Headache<br />Bleeding<br />Mild hpn<br />Contraindications:<br />Smoking<br />Thromboembolic disease<br />CVA<br />35 yo and above<br />Hypertensvie<br />Liver disease<br />
  88. 88. Pills<br />
  89. 89. 4. Male Condom – Protects against microorganisms causing STI’s and HIV (class of retrovirus – cause of AIDS (acquired Immune Deficiency Syndrome) <br /> - 98 % effective<br />Advantages:<br />- Safe and has no hormonal effect<br /><ul><li> Protects against microorganism for STI
  90. 90. Easily accessible
  91. 91. Used in managing premature ejaculation </li></ul>Disadvantages:<br /><ul><li>May cause allergy such </li></ul> as latex<br /><ul><li> Mar decrease sensation
  92. 92. Interrupts the sexual</li></ul> act<br /><ul><li> require man’s</li></ul> cooperation<br />
  93. 93. Condoms<br />
  94. 94. 5. Injectables – Contain synthetic hormone, PROGESTIN which suppresses ovulation, thickens cervical mucus.<br /> ex. DMPA - depomedroxy progesterone Acelate<br />Advantages:<br /><ul><li>Reversible
  95. 95. No need for daily intake
  96. 96. Does interfere
  97. 97. No estrogen related effects
  98. 98. does not affect breastfeeding </li></li></ul><li>6. Lactating Amenorrhea Method (LAM) 99.5%<br /> - temp introductory postpartum method of postponing pregnancy <br /> - not effective if mother will be separated to the baby most of the time<br /> - maximum practice in 6 mos.<br /> note: not dependable because woman still ovulate even if no menstruation<br />
  99. 99. LAM(Lactating Amenorrhea Method)<br />
  100. 100. MUCUS/BILLINGS/OVULATION(97%)<br /> - abstaining from sexual intercourse during fertile (wet) days <br />- billings:senses vaginal wetness; spinnbarkeit:mucus<br /> - advantage: can be used by any woman of repro. Age<br /> - disadvantage: not applicable with medical conditions<br /> - how to use:<br /><ul><li>Recording of menstruation and dry days
  101. 101. Inspecting underwear regularly for presence of mucus
  102. 102. Recording the most fertile observation at the end of the day </li></li></ul><li>8. Basal Body Temperature – 99%<br />(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.<br />Women’s resting body temp (morning or before activity)<br />1 degree higher – time of ovulation<br /> ½ degree higher – day before ovulation<br />Ovulation: a slight dip then sudden rise in temp.<br />
  103. 103. 9. Sympto – thermal Method –<br /> Combination of Cervical Mucus, Basal Temp recording and other signs of ovulation<br />10. Two Days Method – 96%<br /> -cervical mucus as an indicator<br />
  104. 104. STANDARD DAYS Method (95%)<br />The Standard Days Method is most appropriate for women who usually have cycles between 26 and 32 days long. <br />Steps:<br /> 1.Count the first day of your menstrual bleeding as day 1. <br /> 2.Continue counting every day. <br /> 3.On days 1 to 7, you can have unprotected intercourse. <br /> 4.On days 8 to 19, you should use a barrier method or avoid intercourse<br /> 5.From day 20 through the end of your cycle, you can have unpro­tected intercourse.<br />6.The Standard Days Method works best for women who usually have cycles between 26 and 32 days long. <br />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. <br />
  105. 105. Billings/Ovulation<br />Cycle Beads<br />
  106. 106. Q: According to the Philippine Health Statistics, as of 2005 what the current Infant mortality rate?<br />
  107. 107. CHILD HEALTH PROGRAMS: (Newborns, Infants and Children)<br />1. Infant and Young Child Feeding<br />Exclusive BF – 6 months<br /> Global Strategy For IYCF – WHO and UNICEF – consensus 55th World Health Assembly in May 2002 and Exec. Board in Sep. 2002 (UNICEF)<br />Goal – Reduce Child Mortality by 2/3 by 2015<br />Current IMR: 24.24 for every 1,000 child<br />
  108. 108. <ul><li>Infants & Young Child Feeding
  109. 109. Newborn Screening
  110. 110. Expanded Program on Immunization
  111. 111. Management on Childhood Illnesses
  112. 112. Micronutrient Supplementation
  113. 113. Dental Health
  114. 114. Early Child Development
  115. 115. Child Health Injuries
  116. 116. Reduce morbidity and mortality 0-9 </li></li></ul><li>Laws that protects IYCF<br />Milk Code – EO 51<br />Rooming In and Breast Feeding Act of 1992<br />Food Fortification Law – RA<br />
  117. 117. Specific Objectives<br />70% of newborn initiated breastfeeding within 1 hour after birth<br />60% of infants are exclusive breastfeeding up to 6 months<br />90% of infants are started on complementary feeding by 6 months of age.<br />Median duration of breastfeeding is 18 months<br />
  118. 118. Benefits of breastfeeding to <br />Infants:<br />Safely rehydrates and provides essential nutrients to sick child, especially to those suffering diarrheal diseases.<br />Increase IQ points<br />
  119. 119. Mothers:<br />Reduce woman’s risk of excessive blood loss after birth.<br />Reduces the risk of ovarian and breast cancers and osteoporosis<br />
  120. 120. Q: In breast feeding, what are the signs of good positioning, good attachments and sucking effectively?<br />
  121. 121. 4 Signs of Good Positioning<br />with infant’s head and body straight<br />facing her breast, with infant’s nose <br /> opposite her nipples<br />with infant’s body close to her body<br />supporting infant’s whole body, not just neck and shoulders<br />
  122. 122. 4 Sign of Good Attachment:<br /> 1. Chin touching breast<br /> 2. Mouth wide open<br /> 3. Lower lip turned outward<br /> 4. More areola visible above than below the mouth.<br />
  123. 123. SUCKING<br />Suckling effectively – the infant suckles with slow, deep sucks and sometimes pauses.<br /> You may see or hear the infant swallowing.<br />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.<br />Not suckling at all – not able to suck breast milk into his mouth and swallow.<br />
  124. 124. Low birth weight (LBW) babies – BW less than 2,500 grams<br />Includes:<br />Babies born before term<br />Premature<br />Babies who are small for gestational age.<br />
  125. 125. Teas and coffee reduces iron that absorbed from foods. It should not be given with 2 hours before and after food.<br />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.<br />
  126. 126. Laws that protects Infants and Young Child:<br />Milk Code (EO 51) <br />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.<br />
  127. 127.
  128. 128. 3. Food Fortification Law or An Act Establishing the Philippine Food Fortification Program and for other <br /><ul><li>aims : to address the nutritional deficiency problems in the Philippines, based on the past nutrition surveys
  129. 129. to compensate for the deficiencies in the Filipino diet
  130. 130. 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.
  131. 131. Fortification: addition of nutrients to processed foods or food products at levels above what is naturally present in the food.
  132. 132. based on a typical Filipino's daily needs as measured using the most recent Recommended Dietary Allowances (RDA). </li></li></ul><li>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<br />
  133. 133. Hepa B – Integrated in EPI in 1992. Due to high cost – 40% eligible targets vaccinated.<br />Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindication to vaccination.<br />DPT2 and DPT3 are contraindicated to a child who has had convulsion or shock within 3 days the previous dose<br />Live vaccines like BCG – immuno-suppressed due to malignant disease (child with clinical AIDS)<br />No extra dose for who missed DPT/HB/TT<br />Repeat BCG vaccination if the child does not develop a scar after the first injection.<br />
  134. 134. Measles given at 9 months provides 85% protection, 95% protection when given at 1 year and older.<br />Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindications to vaccination.<br />Use one syringe, one needle per child during vaccination<br />
  135. 135. EXPANDED PROGRAM ON IMMUNIZATION<br />Sustaining high routine FIC coverage of at least 90% in all provinces and cities.<br />Sustaining the polio free country for global certification<br />
  136. 136. 3. Eliminating neonatal tetanus by 2008.<br />4. Measles elimination by 2008<br /> A. Measles Catch – up campaign (reduces cases by 70% in 15 years after 1998.<br /> B. Follow – Up Measles Campaign vaccination of children 9 months to less than 5 years old – 94 % reduction in cases in 2004.<br />
  137. 137. 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?<br />Give DPT, OPV, Hepa B<br />Give DPT2, OPV2<br />Give DPT3, OPV2, HepaB3<br />Do not give DPT<br />
  138. 138. 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:<br />a.1 BCG,3 OPV,3 DPT, 2 HB & 1 measles before 1st birthday<br />b.1 BCG,3 OPV,3 DPT, 3 HB & 1 leasles before 1st birthday<br />c.1BCG, 4 OPV,3 DPT,2 HB & 1 MMR before 1st birthday<br />d.1 BCG, 3 OPV,3 DPT, 3 HB & 1 measles before 5 yrs old<br />
  139. 139. 1. MEASLES<br />Vaccine: freeze dried<br />Generalized blotchy rash, lasting for 3 or more days<br />Cough, runny nose, red eyes / conjunctivitis<br />M.T - 4 days before until 2 days after rash<br />Day 1-3: The child has a cold, cough, and high fever. Eyes are pink, watery, sensitive to light.<br />Days 2-4: The rash spreads over the face and body.<br />
  140. 140. 2. TUBERCULOSIS<br />Vaccine: freeze dried<br />Any child who does not return to normal health after measles or whooping cough. <br />Any child with loss of weight, cough, and wheeze which does not respond to antibiotic therapy for acute respiratory disease.<br />Abnormal swelling with a hard painless mass and free fluid.<br />Painful firm or soft swelling in a group of superficial lympnodes<br />Any bone or joint lesion or slow onset.<br />Signs suggesting meningitis or disease in the central nervous system<br />
  141. 141. 3. DIPHTHERIA<br /> Throat with whitish gray membrane and swollen neck (S.D – It is an acute pharyngitis, acute naso pharyngitis or acute laryngitis with pseudomembrane.<br /><ul><li>Vaccine: weakened toxins
  142. 142. Corynebacterium diphtheria
  143. 143. Respiratory droplet
  144. 144. 2 to 5 days or may longer
  145. 145. Days 1 to 3 - Child complains of mild sore throat, is unwell</li></li></ul><li>Days 4 to 6 – Child is very ill. Neck is swollen<br />After two weeks – Diphtheria toxins may cause heart failure, paralysis of breathing<br />May Last 2 -3 weeks<br />Maybe shortened in patients with antibiotics<br />Transmission is increased in schools, hospitals, households and in crowded places.<br />
  146. 146. 4. PERTUSSIS<br />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.<br /><ul><li>Vaccine: killed bacteria
  147. 147. Hundred Day Cough
  148. 148. Borderline Pertussis</li></li></ul><li>Highly Communicable in early catarrhal stage, before paroxysmal cough<br />First week – symptoms – colds<br />Second week – The child struggles to breath and whoops: cough – whoop – vomit<br />Third week – cough usually subsides<br />
  149. 149. 5. POLIOMYELITIS – Residual Paralysis<br />Below 15 years of age with acute flaccid paralysis (including those diagnosed to have Guillain Barre Syndrome) <br />Poliovirus type 1, 2 and 3<br />M.T – Oral route - pharyngeal secretion<br />I.P – 7 to 12 days but can range from 3 to 21 days<br />P.C – 7 to 16 before the onset of symptoms<br />
  150. 150. 6. NEONETAL TETANUS<br />Vaccine: weakened toxins<br />Sardonic’s smile<br />History of all 3 of the following:<br />Normal suck and cry for the first two days of life<br />Onset of illness bet. 3 & 28 days<br />Inability to suck followed by stiffness of the body & or convulsions<br />
  151. 151. Clostridium Tetani<br />Intestinal canals of animals (esp. horses)<br />I.P – 6 days but ranges from 3 to 21 days<br />P.C – not directly transmitted from man to man<br />5 to 7 days – baby has tight mouth that does not open. Baby stops sucking<br />7 to 10 days – The baby does not suck. The entire body is tight and there are severe fits. Baby dies.<br />
  152. 152. 7. HEPATITIS B<br />A liver infection caused by the B type of Hepatitis Virus<br />Mode of Transmission:<br />From child to child<br />From mother to child during birth<br />
  153. 153. Expanded Program On Immunization<br />
  154. 154.
  155. 155.
  156. 156. NORMAL COURSE <br />& <br />SIDE EFFECTS OF VACCINATION<br />
  157. 157.
  158. 158.
  159. 159. 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?<br />
  160. 160. NON COMMUNICABLE DISEASES PREVENTION AND CONTROL<br />
  161. 161. Q: What is the role of a public health nurse in Non Communicable Programs?<br />
  162. 162. Integrated Community Based Non-Communicable Diseases Prevention & Control Program<br />Aim at preventing the four major Non-CD/chronic/lifestyle related diseases , cardiovascular diseases , cancers , COPD , DM<br />Through promotion of healthy lifestyle<br />Healthy Lifestyleis defined as a way of life that promotes & protects health and well-being.<br />Includes practices that promote health as:<br />Healthy diet & nutrition<br />Regular & adequate physical activity & leisure<br />Avoidance of substances that can be abused-tobacco, alcohol, addicting substances,<br /> adequate stress mgt. relaxation<br />Safe sex and immunization<br />
  163. 163. Role of Public Health Nurse In Non Communicable<br />1.Health Advocate -help people towards optimal degree of independence in DM & asserting the right to safer & better community<br />2.Health Educator -inform ,motivate & guide the people into action.<br />3.Health Care Provider- emphasizing on health promotion & prevention<br />4.Community Organizer- community health development and people empowerment<br />5.Health Trainer- provide technical assistance<br />6.Researcher- community assessment, epidemiological studies & intervention studies<br />
  164. 164. NATIONAL PREVENTION OF BLINDNESS PROGRAM<br />Vision 20 / 20: The Right to Sight<br />Cataract / Refractive Errors / Low Vision causes of childhood blindness<br />
  165. 165. KEY POINTS IN COMMUNICABLE DISEASE NURSING<br /><ul><li>AIDS – opportunistic and malignant manifestations – T4 below 200/dl – ELISA / Western Blot / PCT
  166. 166. Amoebiasis – bloody mucoid stool – I: bismuth glycoarsenilate combined with chloroquine / proper disposal of excreta
  167. 167. Ascariasis – vomiting passing out of worm / Mebendazole. IP: 4-8 weeks</li></li></ul><li><ul><li>Candidiasis – (Moniliasis) cheeselike discharge / I: Nystatine or Imidazole, ketoconazole swab in the oral mucosa of an infant thrush</li></ul>Chicken pox – Vesiculopapular lesions / I: Zovirax to lessen lessions / VZ immune G<br />Cholera – Rice watery stool / IC: 2-3 days / PC: 7-14 days / tetracyclines and cotrimoxazole<br />Dengue – Heman’s sign / Rumpel Lead Test / Hct – decreased / clotting & bleeding time – 3 series in 8 hours<br />
  168. 168. Diphthria – Pseudomembrane – caused by Klebs Loeffler / Bullneck appearance / Shick’s Test / Maloney’s Test<br />Enterobiasis – Nocturnal itchiness / I: Pyrantel Pamoate<br />Filariasis – Elephantiasis / Wuchereria Bancrofti; Brugia Malayi<br />German M. – Forscheimer’s spots / 3 day measles<br />Gonorrhea – Thick purulent discharges / Opthalmia neonatorum<br />
  169. 169. Herpes Z. – Lesions follow peripheral nerve pathway<br />Leptospirosis – Weil’ s Dse. / Mud fever / Swine herd’s dse. / Orange Eyes<br />Leprosy – Hansenosis / HANSEN’S DSE.<br />Malaria – Fever and chills / CQ + SP – 1st line drug.<br />Measles – Rubeola 7 day measles / Koplik’s spot / 3 C’s Coryza, Cough , Conjunctivitis<br />
  170. 170. Meningitis – Nucchal rigidity / Cerebro spinal fever / lumbar tap – CSF high WBC<br /> Mannitol (Cerebral Edema) / Seizure/ HW<br />Mumps – Swollen parotid glands<br />Pertussis – Paroxysmal cough ending with whoop<br />Pneumonia – Rusty sputum<br />Polio – Flaccid paralysis<br />Rabies – Hydrophobia<br />Scabies – Weeping itch<br />
  171. 171. Scarlet – Raspberry tongue<br />Tetanus – Locked jaw / trismus<br />Tuberculosis – Initially ASYMPTOMATIC<br />Typhoid – 3 Cardinal signs: ladderlike fever. Rose spots, spleenomegaly<br />Pattern of a disease:<br />Sporadic – intermittent occurrence<br />Endemic – constant occurrence certain geographical area<br />Epidemic – sudden increase / short period of time / within a given population<br />Pandemic - worldwide<br />
  172. 172. MANAGEMENT OF CHILDHOOD ILLNESS<br />
  173. 173. SentrongSigla<br />Definition: SS is a quality improvement initiative through a certification/recognition program. Health facilities are certified based on a set of standards<br />Started in 1998 as Quality Assurance Program (QAP)<br />Renamed from QAP to SentrongSigla or Centers of Vatality Movement- goal: quality health care, services & facilities<br />Expansion of program to the private sector – Phase II (2001)<br />Level 1 – Focus on the major functions of RHU/HC<br />Level 2 – Directed on Specialty Achivement on strengthening local health programs<br />
  174. 174. Botika Ng Barangay (BnB)<br /><ul><li>Refers to the drug outlet managed by a legitimate Community Organization, NGO and LGU as liscence by BFAD to manage.
  175. 175. Started July 5, 1996
  176. 176. Should sell low priced generic home remedies
  177. 177. OTC Amoxicillin
  178. 178. 2 selected publicly known antibiotics Cotrimixazole
  179. 179. Maintenance drugs for lifetime use for</li></ul> a. asthma<br /> b. diabetes<br /> c. hypertension<br />
  180. 180.
  181. 181. Facts:<br /><ul><li>Training deployment project desinged to mobilize RN in to the poorest municipalities
  182. 182. Areas to cover: 2 months hospital, 2 months RHU, 2 months school nursing
  183. 183. Program of DOH, DOLE and DOST
  184. 184. 3 I’s</li></ul> - Initiate Primary health care, school nutrition & MCH<br /> - Inform public on water sanitation and health surveillance<br /> - Immunize children and mother<br /><ul><li>In reference to FOURmula One
  185. 185. Beneficiaries:</li></ul> -10,000 NARS trainees<br /> -1,000 poorest municipalities<br />
  186. 186. Public Health Nursing in Schools<br />The primary role of the school nurse is to support student learning & ensure that educational potential is not hampered or unmet health needs.<br />Assist the pupils in acquiring health knowledge in developing attitudes & practices conducive to healthful living<br />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.<br />
  187. 187. Public Health Nursing in Schools<br />Objectives of School Nursing: To promote & maintain the health of the school populace by provingcomprehensive& quality nursing care.<br />
  188. 188. Home Visit<br />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<br />Important to have a Plan of Visit-to meet the needs of the client and to achieve the best results<br />PURPOSE<br />1. Give nursing care to the sick, post partum& her NB.<br />2. Assess the living condition of the patient & his family<br />3. Give Health Education on prevention & control<br />4. Establish close relationship between agencies & public<br />5. Make use of the inter-referral system to promote the utilization of community services.<br />
  189. 189. Principles: Home Visit<br />HV should have a purpose or objective<br />Planning for HV should make use of all available information about the patient & his family through family records<br />In planning, priority should be given to the essential needs of the individual and his family<br />Planning & delivery of care should involve the individual and family<br />Planning should be flexible<br />
  190. 190. Steps in Home Visit(Greet PapaHaha Baba Wow PHW RAN)<br />Greet<br />Purpose<br />Health Inquiry<br />Bag Placement<br />Wash Hands<br />Physical assessment<br />Health teaching<br />Wash Hands<br />Record<br />Appointment set<br />Normal Pleasantries- Goodbye<br />
  191. 191. ACUTE COMPLICATIONS:<br />DIABETIC KETOACIDOSIS – DKA for IDDM<br />HYPEROSMOLAR HYPERGLYCEMIC NONKETOTIC COMA – HHNK for NIDDM<br />CHRONIC COMPLICATIONS:<br />CHONIC RENAL DISEASE (NEPHROPATHY)<br />BLINDNESS (RETINOPATHY)<br />CORONARY ARTERY DSES. AND STROKE<br />NEUROPATHIES AND FOOT ULCERS<br />
  192. 192. Any Question?<br />www.nursendoutfield.blogspot.com<br />
  193. 193. PD568<br />Restructuring HCDS to minimize health workers( 1midwife:5,000 population)<br /> -midwife visits 2 times a month<br />- well clients only<br /> - 1 nurse:10,000/ homevisit once/month<br /> - client: well and sick<br />
  194. 194. Programs<br />23 in 93 – 23 programs for 1993<br /> - more on health promotion and<br /> disease prevention<br /><ul><li>Health for more in 94</li></ul>a. cancer prevention program thru KKK<br /> (Kayang-kaya and Kanser)<br /> b. mental health program- teach stress management<br /> c. environmental health program- clealiness in brgy<br /> d. reproductive health<br />“think health….health link”<br /><ul><li>5 in 95 – describe a healthy country</li></li></ul><li>Priority Program in Year 2000<br />Plan 50 – to promote affordable drugs<br /> - to promote Lagundi tablet available<br /> @ ate glo’s rolling store<br />2. Plan 500 – philhealth plan, all Filipino household can avail free PHIC card<br />3. Women’s Health- reduce mortality/morbidity among children<br />4. Children’s Health – reduce morbidity/mortality<br />5. Healthy Lifestyle<br />
  195. 195.
  196. 196. Risk Factors for Type 2 DM<br /><ul><li>Family history of diabetes (parents or sib. w/ DM)
  197. 197. Overweight (BMI 23 kg./m) Obesity (BMI > 30 kg./m
  198. 198. Sedentary Lifestyle
  199. 199. Hypertension
  200. 200. HDL Cholesterol < 35 mg/dl (0.90 mmol/L) and or triglyceride level > 250 mg./dl. (2.82 mmol/L)
  201. 201. Hx of GDM – delivery of baby wt. 9lbs (4 kgs.)
  202. 202. Previously identified to have IGT</li></li></ul><li>Screening for Diabetes Mellitus<br />Hallmark – presence of hyperglycemia<br />For those with Hx of DM<br />FBS – 109mg% --------- Normal <br /> 110 – 125mg% -- Impaired Glucose Tolerance (IGT) <br /> 126mg% ------------ Possible DM<br />
  203. 203. CRITERIA FOR DIAGNOSIS OF DM<br />Symptoms of DM plus RBS > 200mg/dl (11.1mmol/L)<br />FBS >126mg/dl (7.0 mmol/dl)<br />Two – hour – blood sugar > 200mg/dl (11.1mmol/L) during an OGTT<br />
  204. 204. C. DIABETES MELLITUS<br /> - one of the leading causes of disability in persons over 45.<br /> - Chronic disorder of carbo. / protein / fats metabolism. – char. By imbalance bet. Insulin & demand. Normal blood sugar 70-100 mg/dl<br /> - More than half of Diabetic patients will die of coronary heart disease.<br />
  205. 205. D. CHRONIC OBSTRUCTIVE PULMONARY DSE.<br /><ul><li>Characterized by airflow limitation
  206. 206. Major cause of chronic morbidity and mortality and the 4th leading cause throughout the world.
  207. 207. Usually due to chronic bronchitis & emphysema
  208. 208. Cigarette smoking is the primary cause – COPD
  209. 209. Cough, sputum production, or dyspnea
  210. 210. Diagnoses is confirmed by SPIROMETRY.
  211. 211. Oxygen at 1 to 3 L even if hypoxia is severe.
  212. 212. Phlebotomy to reduce blood volume if hematocrit (PCV – M: 40-54% F: 36-47%) is more than 60%; also to reduce cardiac workload.</li></li></ul><li>E. Bronchial Asthma<br /><ul><li>Inflammatory disorder of the airways – airway hyperresponsiveness.
  213. 213. Intrinsic and extrensic
  214. 214. 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.
  215. 215. Promote exclusive BF as long as possible; early introduction to cow’s milk may predispose baby to allergies and predispose asthma.</li></li></ul><li>Through blood transfusion<br />Through sharing of unsterilized needles<br />Through sexual Intercourse<br />R.Fx – HBeAg + Mother, Multiple partners<br />Eliminate HB before 2012 (a western Regional Goal)<br />
  216. 216. A. Diseases of the Heart and Blood Vessels (Cardiovascular Diseases)<br />Hypertension<br /> - sustained elevation in mean arterial blood pressure<br /> - a major risk factor for development of CVD’s like coronary heart disease and stroke.<br /> - classified into primary and secondary<br />
  217. 217. Primary HPN – It has no definite cause: essential HPN or Idiopathic HPN – 90% of all hypertensives have primary HPN<br />Secondary HPN – the result of some other primary diseases leading to HPN: such renal dses. <br />P. HPN – more common. Cause is unknown, HPN is attributed to Atherosclerosis.<br />
  218. 218. RISK FACTORS:<br />Obesity <br /> - 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.<br /> - Increased waist to hip ratio is more associated with hypertension<br />
  219. 219. 2. Coronary Artery Disease (CAD)<br />- caused by impaired coronary blood flow, known as Ischemic Heart Disease.<br /> - when there is a decreased oxygen supply to the heart muscles, chest pain (called angina) occurs.<br /> - CAD can cause M.I (Heart Attack) arrhythmias, heart failure, and sudden death.<br /> - Atherosclerosis – high levels of cholesterol in the blood. (low density lipoproteins / LDL – bad cholesterol)<br />
  220. 220. Smoking Tobacco – Risk of CAD is 70 – 200 times greater for men who smoke.<br />
  221. 221. 3. Cerebrovascular Disease or Stroke<br />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.<br />Most fatal stroke is due to Intracerebral Hemorrhage – rupture of IC B.vessel.<br />
  222. 222. Risk Factors of Stroke<br />Increasing age<br />Sex<br />Hereditary<br />Hypertension<br />Cigarette Smoking<br />Diabetes Mellitus<br />Heart Diseases<br />High Red Blood Cell Count<br />
  223. 223. The use of oral contraceptives combined with cigarette smoking (nicotine and carbon monoxide) greatly increase stroke risk.<br />People with diabetes often also high cholesterol and overweight.<br />
  224. 224. B. CANCER<br /> - it is not a single disease.<br /> - the immune system seems to play a role in development and spread of cancer.<br />
  225. 225. Chemicals and Environmental Agents:<br />Polycyclic Hydrocarbons<br />Aflatoxin – Peanuts and peanut butter<br />Benzopyrene – charcoaled broiled or smoked, reusing cooking oil<br />Nitrosamines – from food preservatives; like tocino, longganisa, bacon and hotdogs<br />Virus – cervical (human papilloma virus) liver cancer (hepatitis B virus) certain leukemias, lymphomas and nasopharyngeal cancer (Epstein – Barr Virus)<br />
  226. 226. Lung Cancer<br />Oral Cancer<br />Laryngeal Cancer<br />Bladder Cancer<br />Renal Cancer<br />Cervical Cancer<br />Esophageal Cancer<br />8. Breast Cancer<br />9. Prostate Cancer<br />10. Liver Cancer<br />11. Skin Cancer<br />12. Colonic Cancer<br />13. Uterine / Endometrial Cancer<br />
  227. 227. 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.<br />Prevent thrombus formation in RHD and arrhythmias with appropriate medications.<br />
  228. 228. Seasons and Climate<br />Socio Economic Factors<br />Excessive Alcohol Intake<br />Certain kind of drug abuse<br />
  229. 229. Thrombotic Stroke – Thrombi<br />Embolic Stroke – Emboli (a moving blood clot usually from a thrombus in the left heart that becomes lodged in a small artery.<br />Hemorrhagic Stroke<br />

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