CA1-MIDTERM-TRANSES-Complete.pdf

Transcribed by: Jhas, Kri, Shei, & Prince ♡
1

2
CHN DAY 1
The 10 Herbal Plants Approved by the
Department of Health (DOH)
Tips on Handling Medicinal Plants / Herbs:
• Buy herbs that are grown organically without
pesticides.
• Medicinal parts of plants are best harvested on
sunny mornings. Avoid picking leaves, fruits or nuts
during and after heavy rainfall.
• Leaves, fruits, flowers or nuts must be mature
before harvesting. Less medicinal substances are
found on young parts.
• If drying is required, it is advisable to dry the plant
parts either in the oven or air-dried on screens
above ground and never on concrete floors.
• Store plant parts in sealed plastic bags or brown
bottles in a cool dry place without sunlight
preferably with a moisture absorbent material like
charcoal.
• Use only half the dosage prescribed for fresh parts
like leaves when using dried parts.
• Do not use stainless steel utensils when boiling
decoctions. Only use earthen, enameled, glass or
alike utensils.
• As a rule of thumb, when boiling leaves and other
plant parts, do not cover the pot, and boil in low
flame.
• Decoctions loose potency after some time. Dispose
of decoctions after one day. To keep fresh during
the day, keep lukewarm in a flask or thermos.
• Always consult with a doctor if symptoms persist or
if any sign of allergic reaction develop
• Decoction – involves first mashing the plant
material to allow for maximum dissolution, and
then boiling in water to extract oils, volatile organic
compounds and other various chemical substances
• Infusion – Steeping herb leaves in hot water,
• Blanching – is a cooking process in which a food,
usually a vegetable or fruit, is scalded in boiling
water, removed after a brief, timed interval, and
finally plunged into iced water or placed under cold
running water to halt the cooking process
1. LAGUNDI (VITEX NEGUNDO L.)
• Indication:
Leaves and flowering tops decoction, syrup, tablets and
capsules for coughs, colds, fever and asthma.
• Uses & Preparation:
o Asthma, Cough & Fever – Decoction (Boil raw
fruits or leaves in 2 glasses of water for 15
minutes)
o Dysentery, Colds & Pain – Decoction (Boil a
handful of leaves & flowers in water to
produce a glass, three times a day)
o Skin diseases (dermatitis, scabies, ulcer,
eczema) – Wash & clean the skin/wound with
the decoction
o Headache – Crush leaves may be applied on
the forehead
o Rheumatism, sprain, contusions, insect bites –
Pound the leaves and apply on affected area
2. ULASIMANG BATO (PEPERONIA PELLUCIDA)
• Indications:
Infusion, decoction or salad for gout and rheumatic
pains; pounded plant warm poultice for boils and
abscesses
o Lowers uric acid (rheumatism and gout) –
One a half cup leaves are boiled in two glass of
water over low fire. Do not cover pot. Divide
into 3 parts and drink one part 3 times a day
3. GUAVA (PSIDIUM GUAJAVA L.)
• Indications:
antidiarrheal and antiseptic
o For washing wounds – Maybe use twice a day
o Diarrhea – May be taken 3-4 times a day
o As gargle and for toothache – Warm decoction
is used for gargle. Freshly pounded leaves are
used for toothache. Boil chopped leaves for 15
minutes at low fire. Do not cover and then let
it cool and strain
4. BAWANG (ALIUM SATIVUM L.)
• Indications:
Fresh cloves, capsules for lowering blood cholesterol
levels antiseptic.
o Hypertension – Maybe fried, roasted, soaked
in vinegar for 30 minutes, or blanched in boiled
water for 15 minutes. Take 2 pieces 3 times a
day after meals.
o Toothache – Pound a small piece and apply to
affected area

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5. YERBA BUENA (CLINOPODIUM DOUGLASII)
• Indications and preparations:
For muscle pain, arthritis, rheumatism, cough, colds,
nausea, dizziness.
Crush the fresh leaves and squeeze sap. Massage sap
on painful part.
Uses & Preparation:
o Pain (headache, stomachache) – Boil chopped
leaves in 2 glasses of water for 15 minutes.
Divide decoction into 2 parts, drink one part
every 3 hours.
o Rheumatism, arthritis and headache – Crush
the fresh leaves and squeeze sap. Massage sap
on painful parts with eucalyptus
o Cough & Cold – Soak 10 fresh leaves in a glass
of hot water, drink as tea.(expectorant)
6. SAMBONG (BLUMEA BALSAMIFERA L. DC)
• Indications:
Diuretic in hypertension; dissolves kidney stones
o Anti-edema, diuretic, anti-urolithiasis – Boil
chopped leaves in a glass of water for 15
minutes until one glassful remains. Divide
decoction into 3 parts, drink one part 3 times a
day.
o Diarrhea – Chopped leaves and boil in a glass
of water for 15 minutes. Drink one part every 3
hours.
7. AKAPULKO (CASSIA ALATA L.)
• Indications:
Anti-fungal (tinea flava, ringworm, athlete's foot and
scabies)
o Anti-fungal (tinea flava, ringworm, athlete's
foot and scabies) – Fresh, matured leaves are
pounded. Apply soap to the affected area 1-2
times a day
8. NIYOG- NIYOGAN (QUISQUALIS INDICA L.)
• Indications:
Anti-helmintic
o Anti-helmintic – The seeds are taken 2 hours
after supper. If no worms are expelled, the
dose may be repeated after one week.
(Caution: Not to be given to children below 4
years old)
9. TSAANG GUBAT (CARMONA RETUSA (VAHL)
MASAM.)
• Indications:
Diaarhea
o Diarrhea – Boil chopped leaves into 2 glasses
of water for 15 minutes. Divide decoction into
4 parts. Drink 1 part every 3 hours
o Stomachache – Boil chopped leaves in 1 glass
of water for 15 minutes. Cool and strain.
10. AMPALAYA (MOMORDICA CHARANTIA (L.) DC)
• Indications:
Diabetes
o Diabetes Mellitus (Mild non-insulin
dépendent) – Chopped leaves then boil in - a
glass of water for 15 minutes. Do not cover.
Cool and strain. Take 1/3 cup 3 times a day
after meals

4
CHN DAY 1
Essential Intrapartum Newborn Care
(Unang Yakap)
EINC is a simple cost-effective newborn care
intervention that can improve neonatal as well as
maternal care.
It is an evidence-based intervention that:
• emphasizes a core sequence of actions, performed
methodically (step by-step);
• is organized so that essential time bound
interventions are not interrupted; and
• fills a gap for a package of bundled interventions in
a guideline format
The EINC Practices During Intrapartum Period
• Continuous maternal support, by a companion of
her choice, during labor and delivery
• Mobility during labor-the mother is still mobile,
within reason, during this stage
• Position of choice during labor and delivery
• Non-drug pain relief, before offering labor
anesthesia
• Spontaneous pushing in a semi-upright position
• Episiotomy will not be done, unless necessary
• Monitoring the progress of labor with the use of
pantograph
Four Core Steps of Essential Newborn Care
1. Immediate and thorough drying of the newborn
2. Early skin-to-skin contact between mother and the
newborn
3. Properly timed cord clamping and cutting
4. Unang Yakap (First Embrace) of the mother and her
newborn for early breastfeeding initiation
Unang Yakap (First Embrace) Time Band: At Perineal
Bulging, With Presenting Part Visible
• Prepare for the Delivery
o Check temperature of the delivery room (25-28
°C)
o Notify appropriate staff
o Arrange needed supplies in linear sequence
o Check resuscitation equipment 5. Double gloves
just before delivery
1. Time Band: Within 1st 30 seconds Immediate
Thorough Drying
o Dry the newborn thoroughly for at least 30
seconds.
o Wipe the eyes, face, head, front and back,
arms and legs.
o Remove the wet cloth
o Do a quick check of breathing while drying
• Notes:
o Do not wipe off vernix, bathe the newborn
o Do not do foot printing
o No hanging upside-down, no slapping
o No squeezing of chest
2. Time Band: After 30 seconds of drying
Early Skin-to-Skin Contact
• Immediate and thorough drying
• Early skin-to-skin contact
o Position the newborn prone on the mother's
abdomen or chest
o Cover the newborn's back with dry blanket.
o Cover the newborn's head with bonnet
o Place identification band on ankle
3. Time Band: Properly-Timed Cord Clamping
o Remove the first set of gloves
o After umbilical pulsations stopped, clamp the
cord at 2 cm. from the umbilical base, clamp
again at 5 cm. from the base.
o Cut the cord close to the plastic clamp
4. Time Band: Within 90 minutes
Non-separation of newborn from Mother Early
Breastfeeding
o Leave the newborn in skin-to skin contact
o Observe for feeding cues (opening of the
mouth, tonguing, licking, rooting)
o Encourage the mother to nudge the newborn
towards the breast
o Counsel on attachment and sucking
- Mouth wide open, lower lip turned
outwards
- Baby's chin touching breast
- Baby's chin touching the breast
- Suckling is slow, deep with some pauses
- If the attachment or suckling is not good,
try again and reassess.
o Weighing, bathing, eye care, examinations,
injections (hepatitis B, BCG, Vit. K) should be
done after the first full breastfeed is completed
o Postpone washing until 6 hours
Take Anthropometric Measurements:
• Length = 47 cm to 54 cm
• Head circumference. - 33-35 cm
• Chest circumference = 31 to 33 cm
• Abdominal circumference 31 to 33 cm
• Weight=3000 grams to 4000 grams
Reminder
• Health worker should not tap the NB unless there
is a medical indication.
• Do not give sugar water, formula or other
prelacteals.
• Do not give bottles or pacifiers
• Do not thro away colostrum

5
CHN DAY 1
National Immunization Program (NIP)
EPI was established in 1976 to ensure that
infants/children and mothers have access to routinely
recommended infant/childhood vaccines
Objective
Reducing the morbidity and mortality among children
against the most common vaccine-preventable diseases
Supporting Legislation:
• R.A. 10152, also known as Mandatory Infants and
Children Health Immunization Act of 2011
• R.A. 7846 provided for compulsory immunization
against hepatitis B for infants and children below 8
years old
Specific Goals of NIP/ EPI
• To immunize all infants/children against the most
common vaccine-preventable diseases.
• To sustain the polio-free status of the Philippines.
• To eliminate measles infection. Presidential
Proclamation No. 4, s. 1998 launched the Philippine
Measles Elimination Campaign (Office of the
President, 1998).
• To eliminate maternal and neonatal tetanus.
Presidential Proclamation No. 1066, s. 1997
declared a national neonatal tetanus elimination
campaign starting 1997 (Office of the President,
1997).
• To control diphtheria, pertussis, hepatitis B and
German measles.
• To prevent extra pulmonary tuberculosis among
children.
Six Vaccine Preventable Diseases
1. Tuberculosis
2. Poliomyelitis
3. Diptheria
4. Tetanus
5. Pertussis
6. Measles
Immunization Schedule
ANTIGEN AGE DOSE ROUTE SITE
BCG
vaccine
At
birth
0.05
mL
ID Right
deltoid
(arm)
Hepatitis
B vaccine
At
birth
0.5 mL IM Antero -
lateral thigh
muscle
DPT-
HepB-Hib
(Pentaval
ent
vaccine)
6
weeks,
10
weeks,
14
weeks
0.74
mL
IM Antero-
lateral thigh
muscle
Anti-
measles
vaccine
(AMV1)
9-11
moths
0.5 mL SC Outer part
of the upper
arm
Measles-
mumps-
rubella
vaccine
(AMV2)
12-15
month
s
0.5 mL SC Outer part
of the upper
arm
Rotavirus
vaccine
6
weeks,
10
weeks
1.5 mL Oral Mouth
Target Setting and Vaccine Requirement
• Vaccine requirement is calculated based on target
population size.
• The nurse uses the following formulas to estimate
target population size:
o Estimated number of infants
= total population x 2.7%
o Estimated number of 12-59 month-old
children
= total population x 10.8%
o Estimated number of pregnant women
= total population x 3.5%.
Maintaining the Potency of EPI Vaccines
- To be potent, vaccines must be properly stored,
handled and transported
• Maintain the Cold Chain
o The cold chain is a system for ensuring the
potency of a vaccine from the time of
manufacture to the time it is given to an
eligible client
o In RHU, PHN is the Cold Chain Officer
• Observe the first expiry-first out (FEFO) policy
• Comply with recommended duration of storage
and transport

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• Take note if the vaccine container has a vaccine
vial monitor (VVM) and act accordingly.
o The VVM is a round disc of heat-sensitive
material placed on a vaccine vial to register
cumulative heat exposure
• Abide by the open-vial policy of the DOH
• Reconstitute freeze-dried vaccines ONLY with the
diluents supplied with them
• Discard reconstituted freeze-dried vaccines six
hours after reconstitution or at the end of the
immunization session, whichever comes sooner
• Protect BCG vaccine from sunlight
Side Effects and Adverse Reactions of Immunization
VACCINES SIDE EFFECTS MANAGEMENT
BCG • Koch's
phenomenon
: an acute
inflammatory
reaction
within 2 to 4
days after
vaccination;
usually
indicates
previous
exposure to
tuberculosis.
• Deep abscess
at vaccination
site
• No
managemen
t is needed.
• Refer to the
physician for
incision and
drainage.
Hepatitis B
vaccine
• Local
soreness at
the injection
site.
• No
treatment is
necessary
DPT – HepB
– Hib
(Pentavalen
t vaccine)
• Local
soreness at
the injection
site.
• Abscess after
a week or
more usually
indicates that
the injection
was not deep
enough or
the needle
• Reassure
mother that
soreness will
disappear
after 3 to 4
days.
• Incision and
drainage
may be
necessary.
was not
sterile.
• Convulsions:
although very
rare, may
occur in
children older
than 3
months;
caused by
pertussis
vaccine.
• Proper
managemen
t of
convulsions;
pertussis
vaccine
should not
be given
anymore.
OPV none
Anti-
measles
vaccine
• Fever 5 to 7
days after
vaccination in
some
children.
Sometimes,
there is a
mild rash.
• Reassure the
mother and
instruct her
to give
antipyretic
to the child.
MMR • Local
soreness,
fever,
irritability,
and malaise
in some
children.
• Reassure the
mother and
instruct her
to give
antipyretic
to the child.
Rotavirus
vaccine
• Some
children
develop mild
vomiting and
diarrhea,
fever and
irritability.
• Reassure the
mother and
instruct her
to give
antipyretic
and Oresol
to the child.
Tetanus
toxoid
• Local
soreness at
the injection
site.
• Apply cold
compress at
the site. No
other
treatment is
needed.
Cold Chain Requirements
• OPV stored in freezer at the temperature of (-15°C
to -25°C)
• All other vaccines, including measles vaccine, MMR
have to stored in the refrigerator at a temperature
of(+2°C to +8°C)
• Keep diluents cold by storing them in the
refrigerator in the lower or door shelves

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Contraindications To Immunization
In general, there are no contraindications to
immunization of a sick child if the child is well enough
to go home
Absolute contraindications - DO NOT GIVE:
• Pentavalent vaccine/DPT to
o children over 5 years of age
o a child with recurrent convulsions or another
active neurological disease of the central
nervous system
• Pentavalent vaccine 2 or 3/DPT 2 or DPT 3 to a
child who has had convulsions or shock within 3
days of the most recent dose
• Rotavirus vaccine when the child has a history of
hypersensitivity to a previous dose of the vaccine,
intussusceptions or intestinal malformation, or
acute gastroenteritis (DOH, 2012b)
• BCG to a child who has signs and symptoms of AIDS
or other immune deficiency conditions or who are
immunosuppressed (DOH, 2003a).
EPI Recording and Reporting
Accomplished using the Field Health Service
Information System (FHSIS)
1. Fully immunized children (FIC)
o BCG
o 3 doses of OPV
o d 3 doses of DPT
o hepatitis B vaccine or 3 doses of Pentavalent
vaccine
o one dose of anti-measles vaccine before
reaching one year of age
2. Completely immunized children
- completed their immunization schedule at the age
of 12 to 23 months
3. Child protected at birth (CPAB)
- is a term used to describe a child whose mother
has received
o 2 doses of tetanus toxoid during this
pregnancy, provided that the second dose was
given at least a month prior to delivery, OR
o at least 3 doses of tetanus toxoid anytime prior
to pregnancy with this child
Important Considerations related to the
Administration of Vaccines
• Use only one sterile syringe and needle per client
• There is no need to restart a vaccination series
regardless of the time and has elapsed between
doses
• All EPI antigens are safe and effective when
administered simultaneously, that is, during the
same immunization session but different sites.
• Only monovalent hepatitis B vaccine must be used
for the birth dose.
• Children who have not received AMV1 as
scheduled and children whose parents or
caregivers do not know whether they have
received AMV1 shall be given AMV1 as soon as
possible, then AMV2 months after AMV1. one
• All children entering day care centers/ preschool
and Grade 1 shall be screened for measles
immunization.

8
CHN DAY 2
Community Organizing Participatory
Action Research (COPAR)
Community
• Group of people sharing common geographic
boundaries, common values and interest
Community Organizing Participatory Action Research
(COPAR)
• a social development approach that aims to
transform the apathetic, individualistic and
voiceless poor into dynamic, participatory and
politically community.
• People empowerment
Process of COPAR
• A sequence of steps whereby members of a
community come together to critically assess to
evaluate community conditions and work together
to improve their conditions.
Structure of COPAR
• particular group of community members that work
together for a common health and health related
goals.
Emphasis of COPAR
• Community solve its own problem
• Direction is established internally and externally
• Develop the capacity of the community to
establish their own project
• Consciousness raising involves perceiving health
and medical care within the total structure of
society
Importance of COPAR
• important tool for community development and
people empowerment
• prepares people to eventually take over the
management of a development programs in the
future.
• maximizes community participation and
involvement;
Principles of COPAR
• People, especially the most oppressed, exploited
and deprived sectors are
o open to change.
o have the capacity to change and
o are able to bring about change.
• based on the interest of the poorest sectors of
society
• lead to a self-reliant community and society.
5 Stages of Organizing "Community Health Promotion
Model"
1. Analysis (Community Analysis)
• Process of assessing and defining needs for
community health action plan.
• Also known as (M.E.N.D)
Mapping
Education Planning
Needs Assessment
Diagnosis
5 Components: (P.H.O.S.T)
Profile: eg. Economic, Demographic, Social
Health risk
Outcome Profile (Mortality/ Morbidity Data)
Survey (health promotion programs)
Target group studies
Steps of COMMUNITY ANALYSIS
• Define community
• Data Collection
• Capacity Assessment
• Barriers, assessment
• Change Readiness
• Set Priorities
2. Design & Initiation
• Core Group Planning and select a local organizer. –
5-8 committed members
• Choose an organizational structure
• Identify, select and recruit organizational
members.
• Define the organization mission (WHO, WHEN
WHERE, WHAT) and goals
• Clarify roles and responsibilities of people involved
in the organization.
• Provide training and recognition.
These include the following:
o Leadership board or council – existing local
leaders working for a common cause
o "Lead" or official agency – a single agency
takes the primary responsibility of a liaison for
health promotion activities in the community.
o Grass-roots – informal structures in the
community like the neighborhood residents.
o Citizen panels – a group of citizens (5-10)
emerge to form a partnership with a
government agency

9
3. Implementation
• Implementation put design phase into action.
To do so, the following must be done:
o Generate broad citizen participation.
o Develop a sequential Work Plan
o Use comprehensive, integrated Strategies that
is unified
o Values of the community integrated in the
programs, materials and messages.
4. Consolidation / Program Maintenance
• To maintain and consolidate gains of the program,
the following are essential:
o Integrate activities into community networks
o Establish a positive organizational culture
o Establish an ongoing recruitment plan
o Disseminate results
5. Dissemination-Reassessment
• Before any programs reach its final step, evaluation
is done for future direction.
o Update the community analysis
o Assess effectiveness of interventions
/programs.
o Chart future directories and modifications.
o Summarize and disseminate results.
COPAR Process
• A progressive cycle of action-reflection action.
• Consciousness through experimental learning
• COPAR is participatory and mass-based
• COPAR is group-centered and not leader oriented.
Phases/Process of COPAR:
1. Pre-entry / preparatory Phase
Preparation of the Institution
o Train faculty and students in COPAR
o Formulate plan for institutionalizing COPAR
o Revise curriculum and immersion program
o Coordinate participants to other departments
Site Selection
o Initial Networking with Local Government
o Conduct Preliminary Investigation
o Make long / short list of potential communities
o Do ocular survey of listed communities
Criteria Selection for Initial Site Selection
o Must have a population of 100-200 families
o Economically depressed. (No strong resistance
from the community)
o No serious peace and order problem
o No similar group holding the same program
Identifying Potential Community
o Consult key informants and residents
o Coordinate with local government and NGO's
for future activities.
Choosing Final Community
o Interview the community residents and key
infromants.
o Determine the need of the program in the
community
o Take note of political development
o Develop community profiles for secondary
data.
o Develop survey tools
o Pay courtesy call to community leaders
o Choose foster families based on guidelines
Identifying Host Family
o House strategically located in the community
o Should not belong to the rich segment
o Respected by both formal and informal
leaders.
2. Entry / Social Preparation Phase
Guidelines for Entry
o Recognize the role of local authorities by
paying them visits to inform their presence and
activities.
o avoid raising the consciousness of the
community residents; adopt a low-key profile.
Activities In The Entry Phase
o Integration (establishing rapport)
o Deepening social investigation
CORE GROUP FORMATION
Leader spotting through sociogram
o Key Persons. Approached by most people.
o Opinion Leader. Approached by key persons.
o Isolates. Never or hardly consulted.
3. Organization Building Phase / Community
Organizing & Capability-Building Phase
Key Activities
o Community Health Organizations
o Research Team Committee
o Planning Committee
o Health Committee Organization

10
4. Sustenance and Strengthening
Key Activities
o Training of CHO for monitoring and
Implementing of community health program
o Identification of secondary leaders.
o Linkaging and networking
o Conduct of mobilization on health and
development concerns
o implementation of livelihood programs
5. Turn-over /Termination
• Endorsement -PHASE
• Turn over -PHASE
o Gradual process
o Development of self-reliance
o People empowerment

11
CHN DAY 2
Integrated Management of Childhood
Illness (IMCI)
IMCI
• Strategy for reducing mortality and morbidity
associated with major causes of childhood illnesses
• initiated jointly in 1992 by DOH, WHO and UNICEF
Factors associated with mortality:
• poorest households
• rural areas
• Low rates of maternal education
Why IMCI?
Children present with multiple potentially deadly
conditions at once
o lack of diagnostics tools
o providers rely on patient history, signs and
symptoms for diagnosis
o need to refer to a higher level of care for
serious
Who can use IMCI?
• The IMCI process can be used by all doctors,
nurses and other health professionals who see
young infants and children less than five years old
• It is a case management process for a first-level
facility, such as a clinic, health center or an
outpatient department of a hospital.
Objectives of IMCI:
• reduce death, frequency and severity of illness and
disability
• to contribute to healthy growth and development
of children.
Principles of the IMCI Management Guidelines
• All sick children aged up to 5 years are examined
for general danger signs and all sick young infants
are examined for very severe disease.
• The children and infants are then assessed for main
symptoms include: For the older children, the main
symptoms include: cough, or difficulty of
breathing, diarrhea, fever, and ear Infection.
• Only limited number of clinical signs are used.
• A combination of individual signs leads to a child's
classification within one or more symptom groups
rather than a diagnosis.
• IMCI management procedures use limited number
of essential drugs and encourage active
participation of caretakers in the treatment of
children.
Benefits of IMCI Strategy
• Addresses major child health problems because it
systematically address the most important causes
of children illness and death.
• Responds to demands
• Promotes prevention as well as cure because IMCI
emphasizes important preventive as immunization
and interventions such breastfeeding.
• Most cost effective interventions in low and
middle income countries
• Promotes cost saving.
• Improves equity
Three major components of IMCI:
1. Improving case management skills of health
workers
2. Improving the health system to deliver IMCI
3. Improving family and community health practices
Case Management Process: (ACITCF)
1. ASSESS the child or young infant
o Good Communicationwith mother of child
o Screen of general danger signs, which indicate
life-threatening condition
o Specific questions about the most common
conditions affecting a child's health
2. CLASSIFY the illness
• Based on the results of the assessment a health
care provider classifies a child's illnesses using a
specially developed colour-coded triage system.
Urgent pre-referral treatment and referral
Specific medical treatment and advice
Simple advice on home management
3. IDENTIFY treatment
• After classifying all the conditions present, a health
care provider identifies specific treatments for sick
children
Hospital
Health Center Rural Health Unit
Home
4. TREAT the child
• After identifying appropriate treatment, a health
care provider carries necessary procedure relevant
to the child's conditions
o gives pre-referral treatment for sick children
o gives the first dose of relevant drugs
o provides advice on the home management

12
5. COUNSEL the mother
• If the follow up care is indicated the health care
provider teaches the mother when to return to the
clinic, the health worker also teaches the mother
to recognize signs indicating that the child should
be brought back to the clinic immediately.
6. FOLLOW-UP care
• Some children need to be seen more than once for
a current episode of illness. The IMCI case
management process helps to identify those
children who require additional follow-up visits.
THE INTEGREATED CASE MANAGEMENT PROCESS
OUTPATIENT HEALTH FACILITY
CHECK FOR GENERAL DANGER SIGNS
o Convulsions (during illness)
Lethargy/Unconsciousness
o Inability to drink/breastfeed
o Vomiting
ASSESS MAIN SYMPTOMS
o Cough/Difficulty breathing
o Diarrhea
o Fever
o Ear Problems
Check for MALNUTRITION and ANEMIA,
IMMUNIZATION, VITAMIN A and DEWORMING
STATUS and POTENTIAL FEEDING PROBLEM
Check for OTHER PROBLEMS
CLASSIFY CONDITION and IDENTIFY TREATMENT
ACTIONS according to color coded treatment
How to Select the appropriate case Management
Charts
• age, name, address
Decide which age group the child is in:
• Birth up to 2 months
• 2 months up to 5 years
CLASSIFY COUGH or DIFFICULTY OF BREATHING
SIGNS CLASSIFY AS TREATMENT
Fast
Breathing
PNEUMONIA • Give appropriate
antibiotic for 3
days
• If wheezing give an
inhaled
bronchodilator for
5 days
• Soothe the throat
and relieve the
cough with safe
remedy
• If coughing for
more than 3
weeks, or having
recurrent
wheezing, refer for
assessment for TB
or asthma
• Advise the mother
when to return
immediately
Follow up in 2 days
No signs of
pneumonia
or very
severe
disease
NO
PNEUMONIA
/ COUGH OR
COLD
• If wheezing, give
an inhaled
bronchodilator for
5 days
• Soothe the throat
and relieve the
cough with safe
remedy
• If coughing for
more than 30 days
refer for
assessment
• Advise the mother
when to return
immediately
• Follow up in 5 days
if not improving, if
treated for wheeze
follow up in 2 days
CASE MANAGEMENT PROCESS: ASSESS AND CLASSIFY
1. Ask the mother what the child's problem are:
o Know the age (age in months)
o weight, temperature
o using good communication skills, ask the
mother what the child's problems are
o Initial or follow-up visit

13
2. Check for General Danger Signs:
• Ask: Is the child able to drink or breastfeed?
• NOT ABLE TO DRINK or BREASTFEED
o too weak to drink and is not able to suckle
o swallow when offered a drink or breastfeed.
o if you are not sure about the mother's answer,
ask her to offer the child a drink of clean water
or breastmilk.
o if the child's nose is blocked, clear it.
• Ask: Does the child vomit everything?
• VOMITS EVERYTHING not able to hold anything
down at all
• Ask: has the child had convulsions during illness?
o The child's arms and legs stiffen as the muscles
are contracting
o The child may lose consciousness
o Not able to spoken directions or handling, even
if eyes are open.
o Child may shiver when the fever is rising
rapidly
• LOOK: See if the child is abnormally sleepy or
difficult to awaken.
o The child is drowsy and does not show interest
in what is happening around him/her.
o The child may stare blankly and appear not to
notice what is going around him/her.
o A child who is abnormally sleepy or is difficult
to awaken or is lethargic does not respond
when he/she is touched, shaken, or spoken to.

14
CHN DAY 3
Philippine Health Care Delivery System
WHO Core Functions
Objective: the attainment by all people of the highest
possible level of health (WHO, 2006)
1. Provide leadership and engage in partnerships on
matters of health
2. Shape research agenda and promote knowledge
• 5 goals: Capacity, Priorities, Standards, Translation
and Organization
3. Set and monitor standards
4. Provide technical support, catalyze change and
build sustainable capacity
Millennium Development Goals
• Resulted from Millennium Summit - Sept. 6-8, 2000
Collective responsibility to uphold the principles of
human dignity, equality and equity at the global
level
• Reduce extreme poverty and achieve seven other
targets by 2015
Department of Health (DOH)
• National agency mandated to lead the health
sector towards assuring quality health care for all
Filipinos
• VISION: to be a global leader for attaining better
health outcomes, competitive and responsive
health care system, and equitable health financing.
• MISSION: to guarantee equitable, sustainable and
quality health for all Filipinos, especially the poor,
and to lead the quest for excellence in health
DOH Roles and Functions (as mandated by EO 102)
• Leadership In Health. Serves as national policy
maker
• Enabler and Capacity Builder. Innovate new
strategies in health to improve effectiveness of
health programs.
• Administrator of Specific Services. Manages
selected national health facilities and hospitals
with modern and advanced facilities that serves as
national referral centers
Primary Health Care
History of PHC
• Alma Ata Conference of Sept. 6-12, 1978
• Alma Ata Declarations of PHC
o Health as Basic Fundamental Right
o Global Burden of Health inequalities -
Economic and Social Development
o Government responsibility
• LOI 949, PHC adopted in the Philippines
Health defined by the WHO
• In the PHC declaration, the WHO defined health as
"a state of complete physical, mental and social
wellbeing, and not merely the absence of disease
or infirmity"
PHC DEFINED
• Alma Ata Declaration: PHC "is essential health care
based on practical, scientifically sound and socially
acceptable methods and technology made
UNIVERSALLY ACCESSIBLE TO INDIVIDUALS AND
FAMILIES IN THE COMMUNITY through their full
participation and at a cost that the community and
country can afford to maintain at every stage of
their development in the spirit of self-reliance and
self-determination".
HEALTH FOR ALL: Universal Goal of PHC
• Health for all means an acceptable level of health
for all the people of the world through community
and individual self reliance.
• This policy agenda of "health for all by the year
2000" technically, was a global strategy employed
in achieving three main objectives:
(1) promotion of healthy lifestyles,
(2) prevention of diseases, and
(3) therapy for existing conditions.
Key Principles of PHC
• Accessibility, affordability, acceptability, and
availability
• Support mechanisms
• Multisectoral approach
• Community participation
• Equitable distribution of health resources
• Appropriate technology
PHC is not Primary Care
Point of
Comparison
PHC Primary Care
Focus Client Family and
Community
Individual
Focus of Care Promotive /
Preventive
Curative
Decision-
Making Process
Community-
centered /
consultative,
participative
Health Worker
driven
Outcome Self-reliance /
self help
Reliance on
health
professional to

15
restore/ regain
health
Setting of
Services
Rural-based
satellite clinics,
community
health centers
Mostly urban
based clinics
and hospitals
Goal Development
and preventive
care
Absence of
disease
• Sept 6-12, 1978, WHO & UNICEF sponsored the
PHC in Alma Ata, Russia (Alma Ata Conference
[AACD]).
• Goal, Health for All for the Year 2000 & beyond to
develop self-reliance.
• 1993, DOH: Health for All Filipinos by Juan Flavier
• Oct 19, 1979, LOI 949 signed by Pres. Marcos
adopting PHC in the Philippines
Four Cornerstones/ Pillars of Primary Health Care
1. Community participation
2. Inter/intrasectoral cooperation and linkages
3. Use of appropriate technology
4. Support system

16
CHN DAY 3
Bag Technique
Bag Technique
• a tool making use of public health bag through
which the nurse, during his/her home visit, can
perform nursing procedures with ease and
deftness, saving time and effort with the end in
view of rendering effective nursing care.
Public Health Bag
• is an essential and indispensable equipment of the
public health nurse which he/she has to carry along
when he/she goes out goes out home visiting. It
contains basic medications and articles which are
necessary for giving care.
Rationale:
To render effective nursing care to clients and /or
members of the family during home visit.
Principles
• The use of the bag technique should minimize if
not totally prevent the spread of infection from
individuals to families, hence, to the community.
• Bag technique should save time and effort on the
part of the nurse in the performance of nursing
procedures
• Bag technique should not overshadow concern for
the patient rather should show the effectiveness of
total care given to an individual or family.
• Bag technique can be performed in a variety of
ways depending upon agency policies, actual home
situation, etc., as long as principles of avoiding
transfer of infection is carried out.
Special Considerations in the Use of the Bag
• The bag should contain all necessary articles,
supplies and equipment which may be used to
answer emergency needs.
• The bag and its contents should be cleaned as
often as possible, supplies replaced and ready for
use at any time.
• The bag and its contents should be well protected
from contact with any article in the home of the
patients. Consider the bag and its contents clean
and /or sterile while any article belonging to the
patient as dirty and contaminated.
• The arrangement of the contents of the bag should
be the one most convenient to the user to
facilitate the efficiency and avoid confusion
• Hand washing is done as frequently as the situation
calls for, helps in minimizing or avoiding
contamination of the bag and its contents.
• The bag when used for a communicable case
should be thoroughly cleaned and disinfected
before keeping and re-using.
Contents of the Bag
• Paper lining
• Extra paper for making bag for waste materials
(paper bag)
• Plastic linen/lining
• Apron
• Hand towel in plastic bag
• Soap in soap dish
• Thermometers in case (one oral and rectal)
• 2 pairs of scissors (1 surgical and 1 bandage)
• 2 pairs of forceps (curved and straight)
• Syringes (5 ml and 2 ml)
• Hypodermic needles g. 19, 22, 23, 25
• Sterile dressings (OS, C.B)
• Sterile Cord Tie
• Adhesive Plaster
• Dressing [OS, cotton ball]
• Alcohol lamp
• Tape Measure
• Baby's scale
• 1 pair of rubber gloves
• 12 test tubes
• Test tube holder
• Medicines
o betadine
o 70% alcohol
o ophthalmic ointment (antibiotic)
o zephiran solution
o hydrogen peroxide
o spirit of ammonia
o acetic acid
o benedict's solution
Note: Blood Pressure Apparatus and Stethoscope are
carried separately.
Steps / Procedures
ACTIONS RATIONALE
1. Upon arriving at the
client's home, place
the bag on the table
or any flat surface
lined with paper
lining, clean side out
(folded part touching
the table). Put the
bag's handles or
strap beneath the
bag.
• To protect the bag
from contamination.

17
2. Ask for a basin of
water and a glass of
water if faucet is not
available. Place
these outside the
work area.
• To be used for
handwashing.
• To protect the work
field from being wet.
3. Open the bag, take
the linen/plastic
lining and spread
over work field or
area. The paper
lining, clean side out
(folded part out).
• To make a non-
contaminated work
field or area.
4. Take out hand towel,
soap dish and apron
and the place them
at one corner of the
work area (within
the confines of the
linen/plastic lining).
• To prepare for
handwashing.
5. Do handwashing.
Wipe, dry with
towel. Leave the
plastic wrappers of
the towel in a soap
dish in the bag.
• Handwashing
prevents possible
infection from one
care provider to the
client.
6. Put on apron right
side out and wrong
side with crease
touching the body,
sliding the head into
the neck strap.
Neatly tie the straps
at the back.
• To protect the
nurses' uniform.
Keeping the crease
creates aesthetic
appearance.
7. Put out things most
needed for the
specific case (e.g.)
thermometer,
kidney basin, cotton
ball, waste paper
bag) and place at
one corner of the
work area.
• To make them
readily accessible.
8. Place waste paper
bag outside of work
area.
• To prevent
contamination of
clean area.
9. Close the bag. • To give comfort and
security, maintain
personal hygiene
and hasten recovery.
10. Proceed to the
specific nursing care
or treatment.
• To prevent
contamination of
bag and contents.
11. After completing
nursing care or
treatment, clean and
alcoholize the things
used.
• To protect caregiver
and prevent spread
of infection to
others.
12. Do handwashing
again.
13. Open the bag and
put back all articles
in their proper
places.
14. Remove apron
folding away from
the body, with soiled
side folded inwards,
and the clean side
out. Place it in the
bag.
15. Fold the linen/plastic
lining. clean; place it
in the bag and close
the bag.
16. Make post-visit
conference on
matters relevant to
health care, taking
anecdotal notes
preparatory to final
reporting.
• To be used as
reference for future
visit.
17. Make appointment
for the next visit
(either home or
clinic), taking note of
the date, time and
purpose.
• For follow-up care.
After Care
1. Before keeping all articles in the bag, clean and
alcoholize them.
2. Get the bag from the table, fold the paper lining
(and insert), and place in between the flaps and
cover the bag.
Evaluation and Documentation
3. Record all relevant findings about the client and
members of the family.
4. Take note of environmental factors which affect
the clients/family health.
5. Include quality of nurse-patient relationship.
6. Assess effectiveness of nursing care provided.

18
CHN DAY 3
Universal Health Care Law
Universal Health Care and Its Aim
• Universal Health Care (UHC), also referred to as
Kalusugan Pangkalahatan (KP). is the "provision to
every Filipino of the highest possible quality of
health care that is accessible, efficient, equitably
distributed, adequately funded, fairly financed, and
appropriately used by an informed and
empowered public".
• It is a government mandate aiming to ensure that
every Filipino shall receive affordable and quality
health benefits. This involves providing adequate
resources – health human resources, health
facilities, and health financing
UHC's Three Thrusts
1. Financial Risk Protection
• Protection from the financial impacts of health
care is attained by making any Filipino eligible to
enroll, to know their entitlements and
responsibilities, to avail of health services, and to
be reimbursed by PhilHealth with regard to health
care expenditures.
2. Improved Access to Quality Hospitals and Health
Care Facilities
• Improved access to quality hospitals and health
facilities shall be achieved in a number of creative
approaches.
• First, the quality of government-owned and
operated hospitals and health facilities is to be
upgraded to accommodate larger capacity, to
attend to all types of emergencies, and to handle
non-communicable diseases.
• The Health Facility Enhancement Program (HFEP)
shall provide funds to improve facility
preparedness for trauma and other emergencies.
3. Attainment of Health related MDG's
• The public health programs is to reduce maternal
and child mortality, morbidity and mortality from
Tuberculosis and Malaria, and incidence of
HIV/AIDS. Localities shall be prepared for the
emerging disease trends, as well as the prevention
and control of non-communicable diseases.
What are the benefits of Universal Health Care (UHC)?
o All Filipinos automatically
o covered by Philhealth.
o Access to quality primary health services.
o Increase in the number of public health
workers.
Major provisions of the UHC Law
• Leadership and Governance
o The Philippine health system is highly
devolved, with significant responsibilities held
by the country's 1,488 municipalities.
o Relationships between the DOH and municipal,
city, and provincial governments complicate
policy implementation. PhilHealth's role has
grown organically as it purchases a disparate
set of benefit packages from a variety of public
and private agencies
• PhilHealth Membership, Benefits, and Financing
o PhilHealth membership is currently achieved
through a variety of subsidized and
contributory schemes.
o PhilHealth reportedly covers 92% of the
population, but a significant proportion of its
members are unaware of or are unable to
access their benefits.
o Under the UHC Law, all citizens are
automatically entitled to PhilHealth benefits,
including comprehensive outpatient services.
o PhilHealth will be responsible for purchasing all
individual-based services, including supplies,
medicines, and commodities, as well as
maintenance and operating expense of health
facilities.
• Service Delivery Structure
o The delivery of public PHC services is currently
controlled at the barangay and municipality
level. Patients struggle to access a continuum
of care across administrative boundaries.
o To address the fragmentation of service
delivery and move towards providing
comprehensive and integrated care, providers
are encouraged to form province-and city-wide
HCPNS.
o These networks can be composed of public,
private, or a mixed set of providers that will
deliver primary, secondary, and tertiary
services.
• Access To Medical Products
o The Philippine market for medical products
lacks effective government coordination and
control, and its inefficiency has led to uniquely
high drug prices.
o The UHC Law mandates the establishment of a
Health Technology Assessment (HTA) Council
to guide pharmaceutical procurement, which
will ensure that the most cost effective and

19
affordable medicines, supplies, and
commodities will be purchased by the
government,
• Health Information System
o Health information systems have been
challenged by lack of structural and technical
capacities, duplication of efforts, and
unconsolidated and incomplete data. Lack of
interoperable mechanisms to bring together
multiple information systems lead to
inefficiencies and restrict data consolidation.
8 Things To Know
1. ALL Filipinos are covered
• Every single Filipino citizen is automatically
enrolled into the newly created National Health
Insurance Program (NHIP)
The program classified membership into two types:
o Direct contributors – those who pay PhilHealth
premiums, are employed and bound by an
"employer-employee relationship." self-
earning. professional practitioners, and
migrant workers. Members' qualified
dependents and lifetime members are also
included.
o Indirect contributors – those not considered as
direct contributors, along with their qualified
dependents, whose health premiums are
subsidized by the government
• Filipinos will also be enrolled with a primary health
care provider of their choice. The primary care
provider is the health worker they can go and seek
treatment from for health concerns. They will also
serve as the person in charge of referring and
coordinating with other health centers if patients
need further treatment
• Citizens will not need to present any PhilHealth ID
to avail of these benefits. Meanwhile, poor
Filipinos or those who are located in geographically
isolated areas will also be given priority when
ensuring access to health services
2. It is NOT COMPLETELY FREE
• Contrary to what some people may think, UHC
does not mean every single health expense will be
made free.
• The law outlines that basic services
accommodations will be covered by PhilHealth.
• As a patient, that means that if you're admitted in
a hospital you can expect regular meals, a bed in a
shared room with fan ventilation, and a shared
toilet and bath to be covered.
• All are also entitled to an "essential health benefit
package," which includes primary care, medicines,
diagnostic, and laboratory tests.
• It also includes preventive, curative, and
rehabilitative services.
• It will no longer be free when one wants to stay in
a hospital room offering private accommodation,
air conditioning, telephone, television, and meal
choices, among others.
• Meanwhile, public and private hospitals are
expected to allocate a certain portion of their beds
as basic accommodations in the following
amounts:
o Government hospitals - at least 90% of
beds
o Specialty hospitals - at least 70% of beds
o Private hospitals - at least 10% of beds
3. PhilHealth will become the "National Purchaser"
of Health Goods and Services
• This means that PhilHealth will be in charge of
paying health care providers like hospitals and
clinics for services given to Filipinos.
• This is already a job PhilHealth carries out but the
universal health care law wants to pool more funds
so it can cover all Filipinos and eventually, more
services.
• Allocating more funds to PhilHealth will also
strengthen its negotiating power with health care
providers, which will foreseeably improve the
quality of services and lower health costs.
• Funds for PhilHealth will be sourced from the
following:
o Philippine Amusement and Gaming
Corporation – 50% of national government's
share
o Philippine Charity Sweepstakes Office (PCSO)
– 10% of its charity fund, net of document
stamp tax payments, and mandatory PCSO
contributions
o Premium contributions of direct contributory
member
o PhilHealth annual budget

20
4. DOH will still be in charge of "population-based"
health services
• While PhilHealth, along with other private health
insurance companies, is expected to cover services
for individuals, the DOH is still in charge of
delivering health services that cover entire
populations.
• Think of these as programs for disease surveillance,
health promotion campaigns, and mass
immunization campaigns.
• The DOH will do this by contracting public health
care providers in cities and provinces.
5. Health Systems will become City-Wide and
Province-Wide
• Provinces and highly urbanized cities will now be in
charge of overseeing health services in areas as
opposed to the current set-up where municipalities
are tasked with managing their own health
centers.
• The DOH will need to work with the Department of
the Interior and Local Government (DILG) to have
province and city-wide health systems or networks
in about two years after the law takes effect.
6. Return Service in the Public Health Sector
• Graduates of health and health related courses
who received government-funded scholarships will
be required to work in the public health sector for
at least 3 full years. This will address the need for
health workers across the country.
• They will be paid by and under the supervision of
the DOH. Those who serve for an extra two years
will also be given incentives, which will be
determined by the DOH.
• Meanwhile, graduates of health courses in state
universities and colleges and private schools are
encouraged to work in the public sector.
7. A “Health Technology and Assessment Council”
(HTAC) will be Created
• Another important feature of the law is the
creation of the HTAC-a group of health experts
who will be responsible for evaluating latest health
developments and recommending their use to
DOH and PhilHealth.
• The HTAC will be responsible for assessing the
safety and effectiveness of health medicines,
vaccines, health advances developed to
technology, devices, procedures, and other health-
related Solve health problems.
8. Health Information will be Collected
• Both public and private hospitals and health
insurers will be required to maintain a health
information system that will contain electronic
health records, prescription logs, and "human
resource information."
Conclusion
• The Philippine UHC Law addresses the inequities
faced by the country's health system because of
fragmentated service delivery and inefficient
financing systems.
• The government and its stakeholders continue to
work towards a responsive health system that
delivers quality care without the risk of financial
burden to its citizens.
UHC Law Addresses Health System Challenges
• guaranteeing access to appropriate health services
for all Filipinos through functional HCPNS
• ensuring strategic and adequate financing and
purchasing service
• engaging local governments to effectively manage
local health systems
• building capacity in terms of qualified human
resources and seamless information systems

21
CHN DAY 1
Family
National Statistical Coordination Board
- A group of persons usually living together &
composed of the head by blood, marriage &
adoption
Johnson
- Social unit interacting with the larger society.
Allen
- Characterized by people together because of birth,
marriage, adoption or choice
EO 209 Family Code
- Marriage special contract of permanent union bet
man & woman.
Friedman
- 2 or more persons who are joined together by
bonds of sharing & emotional closeness & identify
themselves as part of FAMILY
Family Assessment
The Family Interview
- Effective communication is essential in the 1st step
to establish trusting relationship
- Same principles used in an effective interview with
a client applies.
- Family assessment tools are available. Many
agencies have a standard form
- ex. IDB / Initial Data Base
Initial Data Based
Components:
Family structure, characteristics and dynamics
Socio-economic and cultural characteristics
Home and environment
Health status of each member
Values and practice on health promotion, maintenance
and disease prevention
Family Forms/ Family Structure
- Based on Internal Organization and
Membership/Components
Dyad
- Empty nester
Cohabitating
- Live-in
- Common law spouses & children
Compound family
- Man has more that 1 wife
- PD 1083
Blended
- 1 or both spouses bring in child/children from
previous marriage in their new living arrangement
Nuclear
- Husband, wife, children
- Marriage
- procreation
Extended
- 3 generations
- Married sibling & their F w/ grandparents
Single Parent
- Pregnancy outside of wedlock
- Separation .
- Death of spouse
Gay/Lesbian Family
- Cohabitating couple of same sex
- Not legal
Classification of Family
Based on Authority
• Patriarchial – authority is vested on the oldest
male in the family, often the father.
• Matriarchial – authority is vested in the mother or
mother's kin.
• Matricentric – prolonged absence of the father
gives the mother a dominant position in the family,
although the father may also share with the
mother in decision making.
• Patricentric

22
Based on Pattern of Residence
• Patrilocal: When a married couple lives with or
near the husband's family.
• Matrilocal: When a couple lives with or near the
mother's family.
• Neo-Local: When a married couple sets up a home
separate from either side of their families.
Based on Pattern of Lineage
• Patrilineal Family: This type of family occurs when
property and title inheritance passes down
through the father's side.
• Matrilineal Family: This is where the property and
title inheritance passes through the mother's side.
Based on Amount of Mates
• Monogamous Family: In this instance, a husband
only has one wife. This is the western idea of a
typical marriage
• Polygamous Family: In this case, the husband has
more than one wife at the same time. This type of
family can be found mostly in Saudi Arabia.
• Polyandrous Family: This family consists of a wife
with more than one husband. This can be found in
the Todas of Southern India.
Genogram
- known as McGoldrick-Gerson study, a Lapidus
schematic or a family diagram
- a pictorial display of a person's family relationships
and medical history
Culturagram
- (Congress & Kung, 2005) develop a better
understanding of the sociocultural context of the
family as well as identify appropriate interventions
for the family.
Areas (Congress & Kung, 2005)
Reasons for Relocation
o Legal status
o Time in the community
o Language spoken at home and in the
community
o Health beliefs
o Crisis events
o Holidays and special events
o Contact with cultural and religious institutions
Values about education and work
o Values about family structure (power,
hierarchy, rules, subsystems, and boundaries)
Developmental Stages of Family
- By Duvall & Miller 1985
1. Marriage
• Scope of the Stage: Married couple makes
commitment to one another
• Family Developmental Tasks: Establishing a
mutually satisfying marriage
• Family Developmental Tasks: Fitting into the kin
network
o Formation of identity as a couple

23
o Inclusion of spouse in realignment of
relationship with extended families
o Parenthood decision making
2. Family with Young Children
• Scope of the Stage: Oldest child is infant through
12yo
• Family Developmental Tasks: Adjusting to infants
and their development
Establishing a satisfying family te tor both child and
parent
o Integration of children into F. unit
o Adjustment of tasks: Child rearing, financial &
household
o Accommodation of new parenting &
grandparenting role
3. Family with Adolescents
• Scope of the Stage: with 13ylo to 20 y/o children
• Family Developmental Tasks: Balancing freedom
with responsibility as teens, mature and
emancipate
• Family Developmental Tasks: Establishing outside
interests and career
o Development of increasing autonomy for
children
o Midlife reexam. of marital & career issues
o Initial shift towards concern for older
generation
4. Family as Launching Centers
• Scope of the Stage: First child leaves home to last
chad leaving home
• Family Developmental Tasks: Assisting young
adults to work, attend school, military or mariage
o Est, for diff identities for parents & children
o Renegotiation of marital relationship
o Readjustment of relationship to include in-laws
& grandchildren
o Dealing w/ disabilities & older generation
5. Aging Family
• Scope of the Stage: Retirement to moving out of
Family home
• Family Developmental Tasks: Coping with loss and
living alone
• Family Developmental Tasks: Adapting to
retirement and aging
o Maintaining as couple / individual. while
adapting to aging process
o Support role of middle generation
o Support & autonomy of older generation
o Preparation for own death, deal w/ loss of
spouse, sibling, peers
Characteristics Of A Healthy Family
- By Defrain & Montalvo
• Interact w/ one another.
• Can establish priorities
• Support, respect, affirm one another
• Members has flexible role
• Foster responsibility & value service to others
• Have sense of play
• Ability to cope w/ stress
Functions of Family
• Procreation – Universal accepted institution for
reproductive functioning / child-rearing
• Socialization of Family Members – Family First
teacher of societal rules;
• Status Placement – Family. Confers its social rank
into the society.
• Economic Functioning
o Rural Family – Unit Of Production
o Urban Family – Unit Of Consumption,
Enterprise
• Physical Maintenance – Survival needs of
dependents
• Welfare & Protection
o Partners – companionship, affective, sex,
socioeconomic
o Children – Emotional gratification,
psychological security, motivation, morale
Family as Client
Community health nursing has long viewed the family
as an important unit of health care, with awareness
that the individual can be best understood within the
social context of the family.
Reasons it is important for the nurses to work with
families:
1. Family is a critical resource. The importance of
family is giving care to its members.
2. In a family unit, and dysfunctions (like illness,
injury, separation) - affects 1 or more family
members will affect the members and unit as a
whole. Also known as "ripple effect"
3. "Case finding" - nurse may identify a health
problem that necessitates identifying risks for the
entire family.
4. Improving nursing care. - nurse can provide better
and more holistic care by understanding the family
and its members.

24
Family as a System
General System Theory – It is way to explain how the
family as a unit interacts with larger units outside the
family and with smaller units inside the family.
3 Subsystem of the Family (Parke 2002)
• Parent-Child Subsystem
• Marital Subsystem
• Sibling-sibling Subsystem
Family Health Task
Family Health Tasks first family health task is providing
its members with means for health promotion and
disease prevention. Breastfeeding an infant, a healthy
diet for older family members, bringing a young child
to the health center for immunizations, and teaching a
child about proper handwashing are a few examples of
family health

25
CHN DAY 1
Family Nursing Care Plan
Family Nursing Process
- "the blueprint of the care that the nurse designs to
systematically minimize or eliminate the identified
and family nursing problems through explicitly
formulated outcomes of care and deliberately
chosen set”
Nursing Process
- "a problem-solving approach that enables the
nurse to provide care in an organize and scientific
manner. It is applicable to individuals, families and
community groups at any level of health. It is
adaptable to any practice setting or specialization
and the components may be used sequentially or
concurrently."
Phases of Nursing Process:
1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation
(Relating – Rapie)
NURSING ASSESSMENT PHASE
1. DATA COLLECTION
Three Sources of Data
• First Source – Health status of the family
• Second Source – Family’s status as a functioning
unit
• Third Source – Family’s environment
Methods of Gathering Data
Direct observation
- A method of data collection which is done through
the use of all sensory capacities
- The nurse gathers information about the family's
state of being and behavioral responses
- Presence of S/S
o Physical make up of each member
o Communication or language patterns expected
and tolerated
o Role perception/task assumption by each
member, including decision-making patterns
o Conditions in home and environment
Interviewing
- Productivity of interview process depends upon
the use of effective communication techniques to
elicit needed responses.
- Encourage verbalization of thought and feelings
and offer needed support or reassurance.
Physical Examination
- Done through inspection, palpation, percussion,
auscultation measurement of specific body parts
and reviewing the body systems
Review of Records
- Reviewing existing records and reports pertinent
to the client
Laboratory Diagnostics Tests
- Performing laboratory tests, diagnostic procedures
or other test of integrity and function carried out
by the nurse herself and /or health workers
5 Types of Data use as Initial Data Base for Family
Nursing Practice
Family Structure and Characteristics
o Members of the household; relationship to the
head of the family
o Demographic data- age, sex, civil status,
position in the family
o Place of residence of each member - whether
living w/ or elsewhere.
o Type of family structure-matriarchal
patriarchal nuclear extended
o Dominant family members in terms of decision
making in matters of health care
o General family relationship - presence of
obvious/ready observable conflict between
members; communication patterns among
members
Socio-economic and Cultural Factors
o Income and expense
▪ Occupation, place of work, income of
each working member
▪ Adequacy to meet basic necessities
(food clothing shelter)
▪ Who makes decision about money and
how it is spent
o Educational attainment of its members
o Ethnic background and religious affiliation
o Significant others - roles they play in the family
o Relationship of family to community-what is
the participation of the family in community
activities?
Environmental Factors
o Housing
▪ Adequacy of living space
▪ Sleeping arrangement Presence of
insects and rodents.
▪ Adequacy of the furniture
▪ Food storage and cooking facilities
▪ Presence of accidents hazards
▪ Water supply-source, ownership,
potability

26
▪ Toilet facility-type, ownership,
sanitary condition
▪ Garbage/refuse disposal-type, sanitary
condition
▪ Drainage system-type and sanitary
condition
o Kind of neighborhood-congested, slum, etc
o Social and health facilities available
o Communication and transportation
Health Assessment of Each Member
o Medical and Nursing History indicating past
significant illness. beliefs and practices
conducive to illness.
o Nutritional assessment (specifically for
vulnerable or at risk members)
▪ Anthropometric data- weight, height.
▪ Dietary history indicating quality and
quantity of food intake per day
▪ Eating/feeding habits and practices
o Current health status indicating presence of
illness states (diagnosed/undiagnosed by
medical practitioner).
Value Placed on Preventive Disease
o lmmunization status of children
o Use of other preventive services
2. DATA ANALYSIS
"Comparison of the gathered DATA to the STANDARDS
OR NORMS"
Three Types of Standards or Norms
• Normal health of individual members
• Home and environment conditions conducive to
family development
• Family characteristics, dynamic and level of
functioning conducive to family development.
• Health Problem
- "Is defined as situation or condition which
interferes with the promotion and/ or
maintenance of health and recovery from illness
and injury."
- "A health problem becomes a nursing problem
when it can be modified through nursing
interventions."
• Health Need
- "Exist when there is a health problem that can be
alleviated with medical or social technology."
• Typology of Nursing Problem
- "the study or systematic classification of types."
- "A tool or classification of a family nursing
problems that reflects the family status and
capabilities as a functioning unit."
I. First Level of Assessment
- Presence of health deficit, health threats, and
foreseeable crisis/ stress points in the family
a) Health Deficits
- Instances of failure in health maintenance and
development
- Occurs when there is a gap between actual and
achievable health status
- Diagnosed/suspected illness states of family
members
- Sudden or premature or untimely death illness or
disability and failures to adapt reality of life
emotional control and stability
- Deviations in growth and development
- Personality disorders
b) Stress Points/ Foreseeable Crisis Situation
- Anticipated periods of unusual demand on the
individual or family in terms of adjustments/family
resources.
Examples:
o Marriage
o Pregnancy, labor, puerperium
o Parenthood
o Additional member-newborn, lodger.
o Abortion
o Entrance at school
o Adolescence
o Loss of job
o Death of a spouse /member
o Resettlement in new community
o Illegitimacy
c) Health Threats
- Condition that are conducive to diseases, accidents
or failure to realize one's health potential.
Examples:
o Health history of specific condition/disease
▪ family history of DM
o Threat of gross infection of CD case
o Family size beyond what resources can
adequately provide
o Accident Hazards
▪ Broken stairs
▪ Pointed sharp objects, poison and
medicine improperly kept
▪ Fire hazards
▪ Fall hazards

27
II. Second Level of Assessment
• Inability to recognize presence of problem
• Inability to make decisions with respect to taking
appropriate: health action
• Inability to provide adequate nursing care to the
sick, disabled. dependent or vulnerable/at risk
member of the family.
• Inability to provide home conducive to health
maintenance, personal development
• Failure to utilize community resources for health
care
NURSING DIAGNOSIS PHASE
Two Parts:
• General (Family Heath Task)
- the statement of the unhealthful response
• Specific (Due to or related to)
- the statement of factors which are maintaining the
undesirable response and preventing the desired
change
NURSING PLANNING PHASE
Family Nursing Care Plan (FNCP)
- "A Family Nursing Care Plan is the set of actions
the nurse decides to implement to be able to
resolve identified family health and nursing
problems."
Characteristics Family Nursing Care Plan
o Nursing care plan focuses on actions which are
designed to solve or minimize existing
problem
o Nursing care plan is a product of deliberate
systematic process
o Nursing care plan, as with all other plans,
relates to the future
o Nursing care plan is based upon identified
health & nursing problems
o Nursing care is a means to an end, not an end
in itself Nursing care plan is a continuous
process not a one-shot deal.
Desirable Qualities a Nursing Care Plan
o Based on clear definition of the problems.
o Good plan is realistic.
o Should be consistent with goals & philosophy
of the health agency.
o Nursing care plan is drawn with the family.
o Nursing care plan is best kept in written form
Importance of Planning Care
o Individualized care to clients
o Nursing care plan helps in setting priorities by
providing information about client as well as
nature if his problem.
o Nursing care plan promotes systematic
communication among those involve in health
care effort
o Continuity of care is facilitated through use of
nursing care
o Nursing care plans facilitate coordination of
care by making known to other members of the
health team what nurse is doing
Four Criteria for Determining Priorities
1. Nature of condition or problem
- Categorized into wellness state/ potential, health
threat, health deficit of foreseeable crisis.
2. Modifiability of the Problem
- Refers to the probability of success in minimizing,
alleviation or totally eradicating the problem
through nursing intervention
3. Preventive Potential
- Refers to the nature and magnitude of future
problems that can be minimized or totally
prevented if intervention is done on the problem
under consideration.
4. Salience
- Refers to the family's perception and evaluation of
the problem in terms of seriousness an urgency
attention needed.

28
Scale for Ranking Family Health Problems according to
Priorities
Formulation of Goal and Objective of Nursing Care
Establishment of Goals
Goals
- Is a general statement of condition or state to be
brought about by specific courses of action.
- It is the end towards which all efforts are directed.
Example:
o After nursing intervention, the family will be
able to take care of the premature infant
competently.
Goals relate to health mater
- Specifically the alleviation of disease conditions.
- And health problems that intertwined with other
problems like socio-economic
Goals
- A cardinal principle in goal setting states that goals
must be set mutually with the family.
- Basic to the establishment of mutually acceptable
goals is the family's recognition and acceptance of
existing health needs and problems.
- Goals set by the nurse and the family should be
realistic or attainable
- Goals are best stated in terms of client's
outcomes, whether at the individual, family, or
community levels.
Barriers to Joint Goal Setting Between Nurse and
Family
o Failure on part of family to perceive existence
of the problem.
o Family may realize existence of health
condition/problem but is too busy at the
moment
o Sometimes, family perceives existence of
problem but does not see it as serious enough
to warrant attention.
o Family may perceive presence of problem &
need to action. However, refuse to face & do
something about the situation.
Reasons to this kind of behavior
▪ Fear of consequences of taking actions
▪ Respect for tradition
▪ Failure to perceive the benefits of action.
▪ Failure to relate the proposed action to
the family's goals
o A big barrier to collaborative goal setting
between nurse & the family is the working
relationship.
"Objectives -refer to more specific statements of the
desired results or outcomes of care."
"Either
a) nurse-oriented based on activities of nurse or
b) client-oriented stated in terms of outcomes."
Nurse Oriented vs. Client Oriented
NURSE – ORIENTED CLIENT – ORIENTED
Nurse-oriented
objectives will not tell if
the nurse's activities
produced some
beneficial results: they
only indicate what the
nurse did and in
qualitative evaluation,
how well she performed
them.
Example:
• during the home
visit, the nurse will
discuss the
importance of
immunization.
• during the second
nurse-family contact,
the nurse will show
the different types of
Stating objectives in
terms of client outcomes
will indicate during the
evaluation phase
whether the desired
changes in the problem
situation resulted from
the nurse's action.
Example:
• after the nursing
intervention, the
malnourished pre-
school member of
the family will
increase their
weights by at least
one pound per
month.

29
fertility-regulating
methods.
• after the nursing
intervention, there
will be improved
relationship among
family members
• after the nurse's
visit, the family will
bring the pre-school
members to the
well-baby clinic the
following day
General vs. Specific Objective
GENERAL OBJECTIVE SPECIFIC OBJECTIVE
After the nursing
intervention, the family
will utilize community
resources for health
care.
After the nursing
will be able to take care
of the mentally
challenged child
competently.
-Recognize
DEcide
Care
H&E
Comm Resources
After the nursing
will bring the pregnant
member to the health
center regularly for
check ups
The family will also
consult the health center
on every episode of
illness among members.
Define the criteria for
evaluation
Example:
• After the nursing
intervention, the
family will be able to
feed the mentally
challenged
prescribed quantity
and quality of food.
• They will be able to
teach the child
simple skills related
to activities of daily
living and
• The family will be
able to apply
measures taught to
prevent infection in
the mentally
challenged child.
Objective Time Frame
SHORT-TERM
OR
IMMEDIATE
OBJECTIVES
MEDIUM-TERM
OR
INTERMMEDIATE
OBJECTIVES
LONG-TERM
OR ULTIMATE
OBJECTIVES
problem
situations
which require
immediate
attention
Are those which
are not
immediately
achieved and are
required to
attain the long-
term ones.
Require
several nurse-
family
encounters
Results can be
observed in a
relatively
short period of
time.
The nature of
the outcomes
sought
requires time
to
demonstrate
They are
accomplished
with few
nurse-family
contacts and
relatively less
resources.
Investment of
more
resources
NURSING IMPLEMENTATION PHASE
Selecting Appropriate Nursing Actions
The choice of nursing intervention is highly dependent
on two major variables:
1. The nature of the problem
- resolve around family's assumption of the health
tasks.
2. Resource available to solve the problem
- aimed at minimizing or eliminating reasons for or
causes of family's inability to do these tasks.
Goals and Objectives
S – Specific
M – Measurable
A – Attainable
R – Realistic
T – Time Bound
Principles of Nursing Actions
• stimulate recognition & acceptance of health
needs/problems
• work on the family's failure to decide on taking
appropriate health actions
• increase family's confidence in providing nursing
care to its sick, disabled and dependent member
through demonstrations on nursing procedures

30
utilizing supplies and equipment's available in the
home.
• involve patient & family in order to motivate them
to assume responsibility for their own care.
• Explain and clarify doubts thus the role of the
nurse shifts direct care giver to that of a teacher
• Explore ways to minimize or prevent threats to
the maintenance of health & personal
development among family members
• Utilize intervention measures involving
environmental manipulations through
improvements on physical facilities in home either
by construction of needed ones or modifying
existing ones.
• Minimize or eliminate psychological threats in
home environment. Nurse can work closely with
family to improve its communication patterns,
role assumptions & relationships & interaction
patterns.
Types of Resources
1. FAMILY RESOURCES
- physical & psycho-social strengths assets of
individual members, financial capabilities,
physical facilities & Support system provided by
relatives and significant others.
2. NURSE RESOURCES
- knowledge about family health, her skills in helping
family manage them. These skills may range from
simple nursing procedure to complicated
behavioral problems such as marital disharmony.
Availability of time & logistical support are also
part of resources of the nurse.
3. COMMUNITY RESOURCES
- include existing agencies, programs or activities
for health and related needs/problems and
community organization for health actions
NURSING EVALUATION PHASE
Dimensions of Evaluation
o Effectiveness – focus is attainment of the
objectives
o Efficiency – relates to cost whether in terms of
money. time, effort, or materials
o Appropriateness – ability to solve or correct
existing problem situation, a question that
involves professional judgement
o Adequacy – pertains to its comprehensiveness
whether all necessary activities were
performed in order to realize the intended
results.
Criteria and Standard
o Standard – once a value judgement is applied
to a criterion it acquires the status of a
standard
▪ It refers to the desired level of
performance corresponding with a
criterion against which actual performance
is compared
▪ It tells us what the acceptable level of
performance or state of affairs should be
for us to say that the intervention was
successful
▪ It refers to the desired level of
performance corresponding with a
criterion against
o Criteria – refer to signs or indicators that tell us
if the objective has been achieved
▪ They are names & description of variables
that are relevant indicators of having
attained the objectives
▪ They are free from any value judgement
and are independent to time frame
▪ They are names & description of variables
that are relevant indicators of having
attained the objectives.
STANDARD CRITERIA
Ex. Infant Nutrition
Breastfeeding
With correct attachment
on demand
in correct position
Activity and Outcome
o Activities – are actions performed to
accomplish an objective. They are the things
the nurse does in order to achieved a desired
result or outcome Activities come time and
resources Examples are health teachings,
demonstration and referrals
o Outcome – is the results produced by activities
Where activity is the cause outcome is the
effect. They can also be immediate, immediate
or ultimate outcomes. Patient care outcomes
can be measured along three broad lines:
▪ Physical Condition – decreased
temperature or weight and change in
clinical manifestations
▪ Psychological or Attitudinal Status –
decreased anxiety and favorable attitude
towards health care personnel
▪ Knowledge on Learning Behavior –
compliance of the patient with instructions
given by the nurse.

31
CHN DAY 1
Infant and Young Child Feeding / IYCF
Legal Basis
1. EO 51
- National Code of Marketing of Breastmilk
Substitutes, Breastmilk Supplement & Other
Related Products.
- “Milk Code”
- Prohibits advertising, promotion, marketing
- Implies bottle milk is superior/equivalent
2. RA 7600
- “Rooming-in & Breastfeeding Act”
- Room-in w/in 30 mins (NSD)
- w/in 3-4 hrs if C/S Delivery
o Rooming-in
▪ place nb in same room as the mother right
after delivery up to discharge
▪ facilitate mother-infant bonding and
initiate breast-feeding
Exemptions:
- Seriously ill mothers - are those who are: w/
o Severe infections;
o in shock;
o in severe cardiac or respiratory distress;
o or dying: -or those with other conditions that
may be determined by the attending physician
as serious
- taking medications contraindicated to breast
feeding:
- whose con
- violent psychotics: or
- whose conditions do not permit breast-feeding and
rooming-in as determined by the attending
physician
RA 7600
- Act providing incentives to all government and
private health institutions with rooming-in and
breastfeeding practice
Right of the Mother to Breast-feed
- child equally has the right to her breastmilk
Bottle-feeding
- allowed only after mo. has been informed health
- personnel of: advantages of bf & proper
techniques of infant formula feeding mo. opted in
writing to adopt infant formula feeding the infant.
3. RA 10028
- “Expanded Breastfeeding Promotion Act"
- An Act Providing Incentives to All Govt & Private
Health Institution w/ Rooming-In and BF Practices
& for other Purposes.
o Lactation Station
o In health/non-facility, institution,
establishment
o Break for BF or expressed feeding
4. RA 8976
- "Philippine Food Fortification Act”
o Rice, Flour, Cooking Oil, Sugar
o Use Of Sangkap Pinoy Seal
- Mandatory fortification of staples
5. RA 8172
- “Asin Law”
- "Act for Salt lodization Nationwide"
- All producer of food-based salt to iodize it.
6. EO 382
- November 7 – National Food Fortification Day
7. AO No. 2011-0303
- "Micronutrient powder supplementation for
children 6-23 months"
8. AO 32, S2010
- “Expanded Garantisadong Pambata”
- Compre/integrated
- Health, nutrition, environment every day in
different settings
9. AO 2005-0014
- National Policy on Infant and Young Child Feeding
- May 23 2005

32
IYCF Feeding Practices
A. Early initiation of BF
- EINC / unang yakap
B. Exclusive BF
- BEST food except if w/ Galactosemia
o DO NOT GIVE plain water sugared water
chewy sticky rice herbals or starved the baby :
- BF day & night (per demand)
- Use breast alternately
Breastmilk
Proteins in Human Milk
- Higher proportion of lactalbumin and lactoglobulin
in breast milk form finer curds and are easily
digested
- Human milk proteins have a suitable quality of
anti-infective protein
- Contains taurine and cysteine necessary for brain
development
Variations of Breastmilk
1. Colostrum-thick/yellowish
- More whey than mature milk - antibodies
- Purgative-meconium
- Growth factors - helps intestine to grow
- Rich in Vit A
2. Mature Milk
- Larger in quantity
o Foremilk – produce early in feeding.
o Hindmilk – produce later. More fat
• Breastmilk is the best food
- contains essential nutrients
- complete nature's first immunization
- growth factors
Techniques of Breastfeeding
Positioning and Attachment
• Positioning
- refers to how you hold the baby at your breasts
during breastfeeding Attachment
- also can describe how the baby latches to the
breast (how the baby's mouth holds the breast)
Correct positioning and attachment is key to successful
breastfeeding.
- protects the mother's milk supply protects the
nipple from getting injuries (engorgement, cracking
and soreness and infection).
- helps the mother bond w/ their child
• Position
- Infant close to mo
- Tummy to tummy * (baby's stomach should touch
your stomach)
- Diff. positions are:
Cradle Hold
▪ Ensure you sit comfortably
▪ Support baby's head in the crook of the
arm inside around the elbow)
▪ The palm of the hand should hold the
baby's bottom
▪ Turn the baby to his/her side such that you
are belly to belly
▪ Raise the baby to the breast
▪ You can use the other arm to support the
baby too
▪ Post CS moms can use this too it's not
causing them a lot of pain or discomfort
Cross Cradle Hold / Cross Over Hold
▪ Use the opposite arm to support the
baby's head from around the back, while

33
supporting the neck, shoulders and the
head.
▪ The other hand can hold the breast
▪ Mother should be belly to belly with the
child.
Side Lying
▪ Lower lying arm should hold the baby or
you can tuck a rolled up blanket behind
the baby for more support
▪ Support the breast with the other hand
▪ PS: DO NOT LEAVE THE BABY ON THE
BREAST WHILE YOU SLEEP TURN THEM
FROM THE BREAST OR RETURN THEM TO
THEIR CRIB
Football / Clutch / Underarm hold
▪ Hold the baby facing the nipple
▪ The hand supports the neck and the baby
closely to the moms side
▪ The baby's feet and the legs are tucked
under the arm
▪ Lift the baby to the breast
*** it is not acceptable to do the koala or upright hold
Concerns about Breast
Small breast
- Different sizes of breast don’t affect the amount of
milk it produce
Flat, inverted nipple
- Shape of nipple- not important
o Position well
o Syringe method (pull plunger)
o Shape breast (c hold) recommended
o U hold
5 Proper Latching (Attachment)
1. FINGERS against chest; below breast, thumb above
2. Stimulate by rooting reflex
3. Wait for infant's mouth to open
4. Move infant to breast quickly
5. lower lips below nipple: chin touch breast
Good Latch
- mouth wide open
- Lower lip turned outward
- Chin touching breast
- More areola visible above
Poor Latch
- Baby’s mouth is barely open
- Baby’s tongue is behind the lower gum
- Baby’s lips are curled in
- Baby’s chin barely touches your breast
Signs that baby is not getting enough milk
• Urinates less than 6 x / day
- Usual: 6-8 x in 24hrs
• Poor wt. gain- less than 500 grms/mon
- Usual: 1st 6 mons- wt gain of 500g in a month
Breast Engorgement
- caused by an imbalance between milk supply and
infant demand.
- BF-both
- MANUAL milk expression
- Breast pump

34
Milk Expression
- collected milk
- Use cup feeding *Nipple confusion
- Upright position
Expressed Breastmilk
- human milk extracted from breast by hand or by
breast pump
- fed using dropper, nasogastric tube, cup & spoon,
or bottle
Breast
- no need to wash before and after feeding
- Regular washing
- No soap
Mother Food intake
- Malunggay (Moringa oleifera)
- Galactagogue - promotes milk flow
Causes uterine pain
Stimulate release of oxytocin

Makes uterus contract

Reduces bleeding
Predominant Breastfeeding,
- BREAST milk
- BEST food
- Wet nurses
- w/ liquid...water-based food, fruit juice ritual fid,
oresol,drops, syrup, vit, mineral
Covid Patient
• Take precautions when breastfeeding, day and
night
Care of the newborn during the prevailing COVID-19
pandemic
1. Non-separation of clinically stable mother
(suspected or confirmed Covid-19 infection) from
her newborn
2. Kangaroo mother care (KMC) for stable premature
& low birth weight newborns
3. Rooming in or co-location of stable mother-infant
dyads with suspected or confirmed COVID-19
infection
4. optimal source of nutrition is direct exclusive BF. If
not feasible assist mother to express her own milk
(MOM), If MOM is not available, pasteurized donor
milk (PDM)
C. Extended BF
- Bf 2yrs & beyond
- Plus Complimentary feeding
D. Complimentary Feeding
- After 6 mons of age, required other foods to
complement BF
- Use of locally, acceptable food
Characteristics
• TIMELY... They are INTRODUCED when the need
for energy & nutrients EXCEEDS what can be
provided by exclusive frequent BF
• ADEQUATE... Provide SUFFICIENT energy...CHON...
Micronutrient to meet nutritional needs
• SAFE... HYGIENICALLY STORED & prepared. Fed w/
clean hands using clean utensils
• PROPERLY FED... Given consistently w/ a CHILD'S
SIGNALS of HUNGER MEAL FREQUENCY &
METHOD...should be SUITABLE for CHILD's age
Bottle Feeding
- Given from bottle w/ nipple, teats
- Interference of bottle feeding
- Increase diarrhea, morbidity, mortality
6 to 9 months (IMCI)
- Breastfeed as often
- Give thick porridge or well mashed foods. Include
animal source foods & vit A-rich fruits & veg.
- Start: Give 2 tbsp – Gradually increase to ½ cups (1
cup = 250 ml)
- Give 2 to 3 meals/day
- Offer 1 to 2 snacks/day bet meals when hungry

35
9 mon-12 mon (IMCI)
- Breastfeed as often
- Give variety of mashed or finely chopped family
food, include animal source foods & VitA rich
fruits/veg.
- Give ½ cup at each meal
- Give 3 to 4 meals /day
- Offer 1 to 2 snacks bet meals when hungry
Replacement Feeding/ Commercial Infant Feeding
Nutritional Assessment of Infant and Young Child
Anthropometry
- measurement of physical dimensions & gross mass
composition of body
Weight-for-Age
- Body weight relative the child's age
- Determines underweight
- Nutritional status can be assessed through
Length/Height for Age
- identifies short or stunted d/t prolonged
undernutrition or repeated illness
- Consider heredity
- Low height for age
- stunted (bansot)
Weight for height
- Low wt for height
- Wasting
Muac-Mid Upper Arm Circumference

36
Circumference
- Rapid screening of malnutrition
- MUAC below 115mm for children 6-59
mons...severe malnutrition
Physical Assessment
- P.E.
- Eye exam - VAD..nightblindness (micronutrient
def.)
Night Blindness – a common result of vitamin A
deficiency which is preventable and reversible
- Marasmus
- Kwashiorkor – protein malnutrition
Biochemical Examination
- Assessment of specific component of bld, urine
sample..measures metabolism

37
CHN DAY 2
Integrated Management of Childhood
Illness
IMCI
- World Health Organization (WHO) & United
Nations Children's Fund (UNICEF)
- Philippines - pilot in 1996
- Implement the strategy at the frontline level
- Elements of prevention as well as curative and
addresses the most common conditions that affect
young children
5 Common Diseases
1. Pneumonia
2. Diarrhea
3. Malaria
4. Measles
5. Dengue hemorrhagic fever
Rationale for an integrated approach in the
management of sick children
• Deaths from pneumonia, diarrhea, malaria,
measles & malnutrition-preventable & treatable
• 3 out of 4 childhood illness are by these
• Most children - more than one illness at one time
Objectives of IMCI
• Reduce death, frequency, severity of illness,
disability
• Contribute to improved growth & development
Components of IMCI
• Improving case management skills of health
workers
• Improving over-all health systems
• Improving family and community health practices
The Case Management Process
The charts describes the following steps;
1. Assess the child or young infant
2. Classify the illness
3. Treatment
4. Counsel the mother
5. Follow up care
SIGNS CLASSIFY AS IDENTIFY
TREATMENT
(Urgent pre-
referral
treatments are in
bold print)
• Any
general
danger
sign or
• Chest
indrawing
or
• Stridor in
calm child
• SEVERE
PNEUMONI
A OR VERY
SEVERE
DISEASE
• Give first
dose of
Cotrimoxazol
e
• Refer
URGENTLY to
hospital
• Fast
breathing
• PNEUMONI
A
• Give
Cotrimoxazol
e for 5 days.
• Soothe the
throat and
relieve the
cough with a
safe remedy.
• Advise
mother
when to
return
immediately.
• Follow-up in
2 days
• No signs
of
pneumoni
a or very
severe
disease.
• NO
PNEUMONI
A COUGH
OR COLD
• If coughing
more than
21 days,
refer for
assessment
• Soothe the
throat and
relieve the
cough with a
safe remedy
• Advise
mother
when to
return
immediately,
• Follow-up in
5 days if not
improving
The CASE MANAGEMENT PROCESS is used to assess
and classify two age groups:
• age birth up to 2 months (0 mon - 2 mons)
• age 2 months up to 5 years (2mons-5y/o)

38
Strategies/Principles of IMCI
1. Sick Children
- 2 months up to 5yrs examined for general danger
signs
• ASSESS the Child:
Check for ANY danger signs:
o Convulsion (now/had)
o Abnormally sleepy,
o Not able to drink/eat
o Severe vomiting
2. Sick Young Infants
- Birth up to 2 months examined for very severe
disease & local bacterial infection
- Indicate: stat referral or admission to hosp.
3. Children & infants
- then assessed for main symptoms.
o Sick children – main symptoms: cough or
difficulty breathing, diarrhea, fever and ear
infection.
o Sick young infants – local bacterial infection,
diarrhea and jaundice.
4. All sick children
- routinely assessed: nutritional, immunization and
deworming status & other problems
5. Limited number of clinical signs are used
6. Combination of individual
- signs-leads to classification w/in 1 or more
symptom groups rather than diagnosis.
7. IMCI management procedures
- limited number of essential drugs, encourage
active participation of caretakers in treatment of
child
8. Counseling of caretakers
- home care, correct feeding, giving of fluids, when
to return to clinic
Summary of the Integrated Case Management Process
ASSESS the Child:
• Danger signs (or possible bacterial infection).
• Main symptoms.
• Check nutrition & immunization status.
• Check for other problems
Ask the mother, what is the problem of the child?
• Initial visit
• Follow-up visit
Check for ANY danger signs:
o Convulsion (now/had)
o Abnormally sleepy,
o Not able to drink/eat
o Severe vomiting
Ask about the 4 main symptoms:
• Cough or difficult breathing
• Diarrhea
• Fever
• Ear problem
Classify the child's illness:
• Use a color-coded triage system
- to classify child's main symptoms & his/her
nutrition or feeding status.
o PINK- refer STAT. except diarrhea
o YELLOW-give meds
o GREEN-home care
A. IMCI – Sick Children: 2months up to 5yrs
ASSESS and CLASSIFY using main SYMPTOM
I. Cough or difficulty of breathing
o How long-cough / DOB
o Fast Breathing
o Chest Indrawing
o Stridor in a calm child
o Wheeze in a calm child
CLASSIFY: SEVERE PNEUMONIA
Any of these (1 sign only)
• Danger sign; or
• Chest Indrawing (lower chest indrawing); or
• Stridor in a calm child (laryngotracheitis)
Treatment:
• Antibiotic - 1st dose of antibiotic
A-C(Amox/Cotri)
• Vit. A
o "IF W/ CHEST INDRAWING & WHEEZE, go
directly to treat wheezing :
o Prevent lowering of bld sugar
• Refer Urgently
w/wheezes....fast breathing/chest indrawing
removed
• Give inhaled bronchodilator for 5 days
• 0.5 ml Salbutamol diluted in 2.0 ml of sterile
water per dose nebulization

39
CLASSIFY: PNEUMONIA
• fast breathing
Age Specific Threshold
• 2mons & below - 60 bpm
• 2mon-12 mons = 50 bpm
• 12mons - 5yrs = 40 bpm
Treatment:
• ANTIBIOTIC: A-C-3 days
o twice a day for 3 days 25mg/kg If HIV
prevalent - first dose is Cotri
o If wheezing-inhaled/oral bronchodilator 5
days
o If <3wks cough - Refer for TB, asthma
• Relieve Safe Remedy
• Advice when to return stat
• FUp: 2days
CLASSIFY: No Pneumonia:
• cough and cold
• No signs of pneumonia or very severe disease
Treatment:
• Cough and Cold
- If wheezing inhaled/oral bronchodilator 5 days
- Safe Remedy
- 30DAYS COUGH -Refer! (TAP)
- Advice when to return stat
- Ffup: 5days
- Ffup 2 days if treated w/ wheezing
• Wheezes
- If continued resp. distress p 30 mins of
bronchodilator.... refer
• Ff up 2 days
- If WORSE: w/ chest indrawing, not able to feed,
has other danger signs - refer
- If the SAME-change antibiotic
- If IMPROVING-continue antibiotic -Breathing
slower, eats better, less fever
II. Treat the Child to Prevent Low Blood Sugar
TREAT HYPOGLYCEMIA
- breastfeed:
- If unable to breastfeed, but able to swallow:
o Give EXPRESSED MILK
o SUGAR WATER: (20gms sugar + 200ml water)
• If unable to swallow:
o 50 ml of milk or sugar water thru NGT
• If unconscious & NGT is not possible:
o Give D10 IV (5ml/kg) or
o Give D50 slow push (1ml/kg)
Diarrhea
- 3more loose or watery stools in a 24-hr. prd
• Assess Diarrhea
o ASK: does the child has diarrhea
o ASK: how long
o ASK: Blood in the stool – for dysentery
o LOOK & FEEL- genera l cond
• Classification of diarrhea
o severe
o some DEHYDRATION
o no
• 14 days or more
o Persistent
• Blood
o Dysentery
There are 3 classification tables for classifying diarrhea
1. All are classified for dehydration
2. classify for persistent diarrhea (14 days or more)
3. Classify for dysentery (bld. In the stool)
Classify Dehydration: Severe Dehydration
Assess: 2 or more of these
• SUNKEN eyes
o look at the eyes
• SKIN PINCHED goes back VERY SLOWLY (Longer
than 2 seconds)
o Use thumb & bended forefinger
o Vertical pinch
o Slowly – 2 secs
o Very Slowly – longer than 2 secs.
• SLEEPY Abnormally
• NOT ABLE to drink
Treatment:
• If child has no other severe classification
- Give food for severe dehydration Plan C) or

40
• If child also has another severe classification:
- Refer URGENTLY to hospital with mother giving
frequent sips of ORS on the way
- Advise the mother to continue breastfeeding
• If child is 2 years or older and there is cholera in
your area
- give antibiotic for cholera
Classify: Some Dehydration
Assess: 2 of these
• Sunken eyes
• Pinched skin goes back SLOWLY – 2 seconds
• Restless irritable
• Thirsty
o Indication that child wants to drink
Treatment:
• Give fluid, zinc supplements, and food for some
dehydration Plan B
How to give ZINC
• Infant – dissolve in expressed milk or ORS in a
spoon
• older child – chewed or dissolve
P4 HRS.
• Reassess... reclassify
• Food
• Zinc (10- 14days)
o less 6 mons 1/2tab - 10mg
o 6mos & above 1 tab
o Zinc – reduce duration & incidence
• If child also has a severe classification:
- Refer URGENTLY to hospital with mother giving
frequent sips of ORS on the way
- Advise the mother to continue breastfeeding
• Advise mother when to return immediately
- Follow-up in 5 days if not improving
Classify: No Dehydration
- not enough s/s
Treatment:
3 RULES OF HOME TREATMENT
- EXTRA FLUID (as much as the child can)
- ZINC SUPPLEMENT
- FOOD ATO TREAT DIARRHEA AT HOME (PLAN A)
• Mo: Flup: 5 DAYS
• BF/Food based flds / rice water
• Plan A: Treat at home
ORS Plan A
Give 2 packets of ORS
o Up to 2 yrs
▪ 50 to 100ml p each loose stool
evacuation (1/4 cup)
o 2 years or more
▪ 100 to 200ml after each loose stool
evacuation (1/2 cup)
Show Mo how to GIVE ORS

41
- Give frequent sips from cup
- Continue breastfeeding whenever child wants to
be breastfed
Taste: tears / salty – mistake in making:Brain
damage
Expiration: 24hrs
Classify: Persistent Diarrhea (14 days or more)
Classify: Persistent Diarrhea
Assessment:
- Dehydration is present
Treatment:
• Treat DEHYDRATION before referral unless the
child has another severe classification.
• Give Vitamin A
• Refer to hospital
Classify: Persistent Diarrhea
Assessment:
- No dehydration
Treatment:
Advise mother on feeding a child who has
PERSISTENT DIARRHEA
• Give VITAMIN A
• FFUP in 5 days
Advise the mother to Return Immediately
Classify: Dysentery
Assessment:
- Blood in the stool
Treatment:
• Give Ciprofloxacin for 3 DAYS
• Ff-up in 3 days
• Advise mo. when to Return stat
III. Assess and Classify Fever
Malaria
- Decide if no malaria risk area or not malaria risk
area
• Malaria Risk Area
3 classifications
1. Very Severe Malaria / Very Severe Febrile Disease
2. Malaria
3. Fever: Malaria Unlikely
Classify: Very Severe Malaria / Very Severe Febrile
Disease
• Any of the Danger signs or
• Stiff neck
• Malaria risk area
Treatment:
Very severe malaria / very sever febrile disease
• Give 1" dose of IM quinine (supervised) or if
hospital is not accessible w/in 4 hrs.
o (SE = drop of BP, dizziness, ringing of ears,
abscess) - flat
• Give 1" dose of antibiotic
• Give 1 dose paracetamol (38.5 or above)
• Treat lowering of blood sugar level
• Send blood smear to referral hospital
• REFER urgently
Classify: Malaria
• Blood Smear (+)
• If bid smear Was not done:
o (-) runny nose, Measles other causes of fever
• If fever is present a day for more than 7 days
o refer for additional assessment

CA1-MIDTERM-TRANSES-Complete.pdf

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