Chn review march 1 2011 complete


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Chn review march 1 2011 complete

  2. 2. <ul><li>CHN ??? </li></ul><ul><li>Boring?? </li></ul><ul><li>Verbose?? </li></ul><ul><li>Confusing?? </li></ul><ul><li>Repetitive?? </li></ul>
  4. 4. Promotion of OLOF thru health teaching and delivery of care 1 Primary GOAL
  5. 5. Health Teaching 2 Primary DUTY
  6. 6. 3 Health care for the ENTIRE community Primary PRINCIPLE
  7. 7. Health Promotion 4 Primary FOCUS
  8. 8. Nursing Process 5 Primary METHODOLOGY
  9. 9. Population-focused care (MASS – BASED) 6 Primary TYPE of CARE DELIVERY
  10. 10. Recognized Needs of Clients 7 Primary BASIS
  11. 11. Family 8 Primary UNIT of SERVICE
  12. 12. 9 Primary CLIENT & SETTING Community
  13. 13. <ul><li>Linguistic Origin </li></ul><ul><li>[L. communitas, fellowship] </li></ul><ul><li>[MOSBY] a group of species who reside in a designated geographic area and who share common interests or bonds </li></ul><ul><li>[STEDMAN] a group of persons united by some common feature or shared interest </li></ul>COMMUNITY
  14. 14. Qualities of a Healthy Community 4) Awareness  community health status 5) Independence  people & leaders 6) Role Models  parents & guardians 7) Active Concern  health threats 8) Sustainability  environment & needs 9) Accessibilty  health services 1) Resources  open & controlled 2) Empowerment  active participation 3) People  healthy citizenry 10) Politics  mass-based & respected (REPAIR ASAP)
  15. 15. Classification of a Community
  16. 16. <ul><li>Rural or Open lands </li></ul><ul><li>Agricultural / fishing </li></ul><ul><li>less dense </li></ul><ul><li>more spacious </li></ul>1
  17. 17. <ul><li>Urban or the City </li></ul><ul><li>non-agricultural </li></ul><ul><li>dense & highly populated </li></ul><ul><li>highly industrialized </li></ul>2
  18. 18. Rurban or the Capitals - mixed type of rural & urban 3
  19. 19. COMPONENTS OF A COMMUNITY <ul><li>THE CORE </li></ul><ul><li>People  demographics, values & beliefs </li></ul>
  20. 20. B. 8 subsystems of the community 4) Economics  livelihood projects 5) Recreation  community activities 6) Fire and safety  bldg. & house check 7) Politics & gov’t  selection of leaders 8) Health  health services & programs 1) Communication  open all channels 2) Housing  adequate shelter & security 3) Education  health teachings, seminar (CHEER for public health)
  21. 21. APPROACHES TO COMMUNITY DEVELOPMENT <ul><li>A. Welfare approach </li></ul><ul><ul><li>the immediate & spontaneous response to ameliorate poverty </li></ul></ul><ul><ul><li>assumes that poverty is God-given </li></ul></ul><ul><ul><li>poverty is destiny  must accept fate </li></ul></ul><ul><ul><li>just reward in heaven </li></ul></ul>
  22. 22. <ul><li>B. Modernization approach </li></ul><ul><ul><li>aka “project development approach” </li></ul></ul><ul><ul><li>introduces lacking resources </li></ul></ul><ul><li>C. Transformatory/participatory approach </li></ul><ul><ul><li>involves people empowerment & transformation of the poor </li></ul></ul><ul><ul><li>assumes that poverty is not God-given </li></ul></ul><ul><ul><li>poverty  historical past  existence of oppressive structures in society </li></ul></ul>
  23. 23. <ul><li>State of complete physical, mental and social well-being, not merely the absence of disease or infirmity </li></ul><ul><li>WORLD HEALTH ORGANIZATION </li></ul><ul><li>OLOF of individuals, families & communities being influenced by several factors in the eco-system </li></ul><ul><li>MODERN CONCEPT OF HEALTH </li></ul><ul><li>[NLPGN, CHN committee, 2000] </li></ul>HEALTH
  25. 25. <ul><li>This factor pertains to the power and authority to regulate the environment </li></ul><ul><li>EXAMPLES: </li></ul><ul><li>Safety </li></ul><ul><li>Oppression </li></ul><ul><li>People empowerment </li></ul>P O L I T I C A L
  26. 26. <ul><li>One component of this factor is the primary health care which is a partnership approach </li></ul><ul><li>GOAL: effective provision of health services that are community-based and accessible </li></ul><ul><li>COMPONENTS: </li></ul><ul><li>Promotive, Preventive, Curative & Rehabilitative </li></ul>HEALTH CARE DELIVERY SYSTEM
  27. 27. <ul><li>COMPONENTS </li></ul><ul><li>Culture </li></ul><ul><li>Habits </li></ul><ul><li>Ethnic customs </li></ul><ul><li>EXAMPLES </li></ul><ul><li>Smoking </li></ul><ul><li>Intake of alcoholic drinks </li></ul><ul><li>Substance abuse </li></ul><ul><li>Lack of exercise </li></ul>B E H A V I O R A L
  28. 28. <ul><li>COMPONENTS </li></ul><ul><li>Employment </li></ul><ul><li>Education </li></ul><ul><li>Housing </li></ul>SOCIO ECONOMIC INFLUENCES
  29. 29. <ul><li>COMPONENTS </li></ul><ul><li>Air </li></ul><ul><li>Food </li></ul><ul><li>Water waste </li></ul><ul><li>Urban/rural noise </li></ul><ul><li>Radiation </li></ul><ul><li>Pollution </li></ul>ENVIRONMENTAL INFLUENCES
  30. 30. <ul><li>COMPONENTS </li></ul><ul><li>Genetic endowment </li></ul><ul><li>Defects </li></ul><ul><li>Strengths </li></ul><ul><li>Risks: </li></ul><ul><ul><li>Familial </li></ul></ul><ul><ul><li>Ethnic </li></ul></ul><ul><ul><li>Racial </li></ul></ul>H E R E D I T Y
  31. 31. 4) Environment  air, food, water, noise 5) Behavior  culture, habits, customs 6) Health care delivery system  promotive, preventive, curative, rehab 1) Political  safety, oppression, gov’t. 2 ) Socio-economic  employment, educ. 3) Heredity  genetics, race, ancestry ECO-SYSTEM FACTORS THAT AFFECT CH Physician Sometimes Heals Everyone But Himself
  32. 32. <ul><li>Public health as the science and art of preventing disease, prolonging life and efficiency to enable every citizen to realize his birthright of health and longevity. </li></ul>DEFINITIONS W I N S L O W
  33. 33. <ul><li>Public health is dedicated to the common attainment of the highest level of physical, mental and social well-being and longevity </li></ul><ul><li>GOAL: contribute to the most effective total development and life of the individual and his society </li></ul>H A N L O N
  34. 34. <ul><li>Community health nursing is a learned practice discipline </li></ul><ul><li>Ultimate goal : contribute to the promotion of client’s optimum level of functioning </li></ul><ul><li>Through teaching and delivery of care </li></ul>J A C O B S O N
  35. 35. <ul><li>CHN is a service rendered by a professional nurse with the community, groups, families and individuals </li></ul><ul><li>GOAL: promotion of health, prevention of illness, care of the sick at home and rehabilitation </li></ul>F R E E M A N
  36. 36. <ul><li>Philosophy of community health nursing is based on the worth and dignity of man </li></ul>S H E T L A N D
  37. 37. 5 Core Business of Public Health <ul><li>Disease control </li></ul><ul><li>Injury prevention </li></ul><ul><li>Health protection </li></ul><ul><li>Health public policy </li></ul><ul><li>Promotion of health and equitable health gain </li></ul>
  39. 39. <ul><li>[MOSBY] the practice in which a nurse assists the individual, sick or well, in the performance of those activities contributing to health or its recovery ( or to a peaceful death)… </li></ul><ul><li>- adaptation from Virginia Henderson </li></ul>NURSING
  40. 40. PUBLIC HEALTH NURSING <ul><li>Lillian Wald coined the term “public </li></ul><ul><li>health nursing” to denote “ a service </li></ul><ul><li>that was available to all people” </li></ul><ul><li>PHN  Public/gov’t agency </li></ul><ul><li>  care of poor people </li></ul><ul><li>CHN -> nursing for the health of the </li></ul><ul><li>ENTIRE public/community, NOT ONLY for the </li></ul><ul><li>public who are poor </li></ul><ul><li>PHN & CHN have been used interchangeably in the Philippines by both foreign and local authors </li></ul>
  41. 41. <ul><li>Public Health Nurses (PHNs) – refer to nurses in the local /national health dept or public schools whether their official position title is Public Health Nurse or Nurse or School Nurse </li></ul>PHN ACCORDING TO NLPGN, 2005
  42. 42. PHN ACCORDING TO NLPGN, 2005 <ul><li>Public Health Nursing – refers to the practice of nursing in national and local govt health dept. and public schools. IT IS CHN PRACTICED IN THE PUBLIC SECTOR. </li></ul>
  43. 43. FIVE FOLD MISSION OF CHN / PHN: 4) Disease Prevention – avoid consequences Primary prevention  immunizations Secondary prevention  screenings Tertiary Prevention  rehabilitation 5) Social Justice – right to “basics of life” 1) Health Promotion – lifestyles / choices 2) Health Protection – alter community dses 3) Health Balance – biopsychosocial homeo Holding Hands, Hugs, Don’t Smack
  44. 44. 8 Millenium Dev’t Goals (2015) 4) Gender equality and women empowerment 5) Environmental sustainability 6) Universal primary education 7) Combat HIV/AIDS, malaria & other dses 8) Global partnership for development 1) Extreme poverty and hunger eradication 2) Maternal health improvement 3) Child mortality reduction Every Married Cool Guy Eyeballs Underage Cool Girls
  45. 45. <ul><li>APIE over-all community health plan </li></ul><ul><li>Provide quality nursing services </li></ul><ul><li>Coordinate the health team, NGO’s & gov’t. agencies </li></ul><ul><li>Researches relevant to PHN services </li></ul><ul><li>Continuing education & professional growth </li></ul>OBJECTIVES OF CHN: ALL PUBLIC COMFORT ROOMS CONTAMINATED
  46. 46. <ul><li>SPECIALIZED FIELDS OF CHN: </li></ul><ul><li>COMMUNITY MENTAL HEALTH NURSING </li></ul><ul><ul><li>A unique clinical process which includes an integration of concepts from nursing, mental health, social psychology, community networks & the basic sciences </li></ul></ul><ul><ul><li>FOCUS: mental health promotion </li></ul></ul>
  47. 47. <ul><li>OCCUPATIONAL HEALTH NURSING </li></ul><ul><ul><li>The application of nursing principles & procedures in conserving the health of workers in all occupations </li></ul></ul><ul><ul><li>AIMS: </li></ul></ul><ul><ul><ul><li>Health promotion </li></ul></ul></ul><ul><ul><ul><li>Prevention of diseases </li></ul></ul></ul><ul><ul><ul><li>Risk reduction </li></ul></ul></ul><ul><ul><ul><li>Safe workplace </li></ul></ul></ul>
  48. 48. <ul><li>SCHOOL HEALTH NURSING </li></ul><ul><ul><li>Application of nursing theories & principles in the care of the school population </li></ul></ul><ul><ul><li>COMPONENTS: </li></ul></ul><ul><ul><ul><li>School Health services </li></ul></ul></ul><ul><ul><ul><li>Health instruction </li></ul></ul></ul><ul><ul><ul><li>Healthful school living </li></ul></ul></ul><ul><ul><ul><li>School-community linkage </li></ul></ul></ul>
  49. 49. LEADING AILMENTS/DEFECTS AMONG SCHOOL CHILDREN <ul><li>Dental Caries </li></ul><ul><li>Intestinal Helminthiasis </li></ul><ul><li>Colds </li></ul><ul><li>Pediculosis </li></ul><ul><li>Upper respiratory tract infection </li></ul>
  50. 50. <ul><li>1) Individual - Not the main client in CHN, but receives CHN care through the family </li></ul><ul><li>Family - the basic unit of care </li></ul><ul><li>Population group </li></ul><ul><li>Community </li></ul><ul><li>The ultimate patient is the COMMUNITY . </li></ul>4 Levels of Clients / patients
  51. 51. 4 Major Functions of the Family <ul><li>Physical Function </li></ul><ul><li>Economic Function </li></ul><ul><li>Reproductive Function </li></ul><ul><li>Socialization Function </li></ul>
  52. 52. KINDS OF FAMILY STRUCTURE <ul><li>A) Traditional Family </li></ul><ul><ul><ul><li>nuclear family </li></ul></ul></ul><ul><ul><ul><li>Extended family </li></ul></ul></ul><ul><li>B) Alternate Family Structure </li></ul><ul><ul><ul><li>Single-Parent Families </li></ul></ul></ul><ul><ul><ul><li>Cohabitating families </li></ul></ul></ul>
  53. 53. <ul><ul><ul><li>The beginning family </li></ul></ul></ul><ul><ul><ul><li>The early child-bearing family </li></ul></ul></ul><ul><ul><ul><li>The family with pre-school children </li></ul></ul></ul><ul><ul><ul><li>The family with school-age children </li></ul></ul></ul><ul><ul><ul><li>The family with teen-agers </li></ul></ul></ul><ul><ul><ul><li>The Family as Launching Center </li></ul></ul></ul><ul><ul><ul><li>The middle-aged family </li></ul></ul></ul><ul><ul><ul><li>The aging family </li></ul></ul></ul>Stages of Family Development
  54. 54. <ul><ul><li>Infants & young children </li></ul></ul><ul><ul><li>School age </li></ul></ul><ul><ul><li>Adolescents </li></ul></ul><ul><ul><li>Mothers </li></ul></ul><ul><ul><li>Elderly </li></ul></ul><ul><ul><li>Males * </li></ul></ul>VULNERABLE POPULATION GROUPS
  55. 55. CHN ROLES OF THE NURSE Facilitate & empower people 3) COLLABORATOR Coordinates community resources 1) CLINICIAN Focus on the health of individuals 2) COMMUNITY ORGANIZER
  56. 56. CHN ROLES OF THE NURSE Gives KSA, better informed choices a) INFORMATION – provision of knowledge b) EDUCATION – change thru KSA 4) COUNSELOR Listening, give feedback & support 5) EDUCATOR c) COMMUNICATION – exchange of info 3 ASPECTS OF HEALTH TEACHING
  57. 57. CHN ROLES OF THE NURSE Shows examples of good behavior 8) CHANGE AGENT Influences & motivate others good behavior 6) RESEARCHER/STATISTICIAN/RECORDER Analyzes data to predict future phenomenon 7) ROLE MODEL 9) HEALTH ADVOCATE Aids people in asserting their rights; promotes self-care and self-determination
  58. 58. CHN ROLES OF THE NURSE providing nursing care skills in a home setting 10) CASE MANAGER oversees all aspects of care to facilitate delivery of cost-efficient care; to individualize and coordinate care 11) HOSPICE CARE
  59. 59. 7 FUNCTIONS OF PHN <ul><li>Management function </li></ul><ul><li>Supervisory function </li></ul><ul><li>Nursing care function </li></ul><ul><li>Collaborating & coordinating function </li></ul><ul><li>Health promotion & education function </li></ul><ul><li>Training function </li></ul><ul><li>Research function </li></ul>
  60. 60. Sample Questions: <ul><li>The community health nurse acting in a role of clinician would be more likely to: </li></ul><ul><ul><li>A) Work to articulate the special needs of a population such as homeless people </li></ul></ul><ul><ul><li>B) Focus on reducing the incidence of disease in a population </li></ul></ul><ul><ul><li>C) Address the spiritual needs of a group without performing any screening or treatment </li></ul></ul><ul><ul><li>D) Coordinate the various components of care in different areas of the health system </li></ul></ul><ul><li>Answer: B </li></ul>
  61. 61. <ul><li>The CHN acting in the role of advocate would be </li></ul><ul><li>most likely to promote: </li></ul><ul><ul><li>Self-care & self-determination for the population </li></ul></ul><ul><ul><li>Telling the people in a community that the medical experts know what is best for them. </li></ul></ul><ul><ul><li>Smoking cessation </li></ul></ul><ul><ul><li>That health care options should be pursued without the influence of friends or families </li></ul></ul><ul><li>Answer: A </li></ul>
  62. 62. <ul><li>Which of the following is not a role for the nurse </li></ul><ul><li>providing hospice or end-of-life care? </li></ul><ul><li>Providing resources for caregivers to prevent burnout </li></ul><ul><li>Ensuring that the client is given every reasonable chance to extend life and is encouraged not to give up too easily </li></ul><ul><li>Working as part of a multidisciplinary team to meet client’s needs. </li></ul><ul><li>Promoting & coordinating palliative care </li></ul><ul><ul><li>Answer: B </li></ul></ul>
  63. 64. Philippine Herbal Medicine
  64. 65. T.A.M.A. OF 1997 <ul><li>REPUBLIC ACT NO. 8423 </li></ul><ul><li>(TRADITIONAL & ALTERNATIVE MEDICINE ACT) </li></ul><ul><li>Created PITAHC (Phil. Institute of Traditional & Alternative Health Care) </li></ul><ul><li>- scientific research & development of traditional & alternative health care system that have impact on public health care. </li></ul>
  65. 66. Phil. Institute of Traditional & Alternative Health Care (PITAHC) <ul><li>BACKGROUND: </li></ul><ul><li>Administrative Order No. 12 (1992)- Traditional Medicine Program, through former Health Secretary / Senator Juan M. Flavier </li></ul><ul><li>This special program was tasked to promote and advocate traditional medicine nationwide. </li></ul>
  66. 67. <ul><li>Vision </li></ul><ul><li>&quot;Traditional and alternative health care in the hands of the people&quot; </li></ul><ul><li>Mission </li></ul><ul><li>&quot;PITAHC upholds the right of every Filipino for better health through the provision of safe, effective and affordable traditional and alternative health care products, services and technologies.&quot; </li></ul>
  67. 68. Products of PITAHC
  68. 69. Handling Tips on Medicinal Plants / Herbs <ul><li>If possible, buy herbs that are grown organically - without pesticides. </li></ul><ul><li>Medicinal parts of plants are best harvested on sunny mornings. Avoid picking leaves, fruits or nuts during and after heavy rainfall. </li></ul><ul><li>Leaves, fruits, flowers or nuts must be mature before harvesting. Less medicinal substances are found on young parts. </li></ul>
  69. 70. Tips on Preparation for Intake of Herbal Medicines: <ul><li>Use only half the dosage prescribed for fresh parts like leaves when using dried parts. </li></ul><ul><li>Do not use stainless steel utensils when boiling decoctions. Only use earthen, enameled, glass or alike utensils. </li></ul><ul><li>As a rule of thumb, when boiling leaves and other plant parts, do not cover the pot, and boil in low flame. </li></ul>
  70. 71. <ul><li>Reminders: </li></ul><ul><li>One kind of plant for each type of s/s </li></ul><ul><li>No insecticides </li></ul><ul><li>Use clay pot and plant part advocated </li></ul><ul><li>Stop in case of untoward reactions; seek consultation if signs/symptoms not relieved after 2-3 doses </li></ul>
  71. 72. QUESTION <ul><li>In preparing herbal medicines, which of the following is incorrect? </li></ul><ul><li>A) When boiling, cover the pot well to preserve the nutrients. </li></ul><ul><li>B) You must boil them in low flame. </li></ul><ul><li>C) One kind of plant for each type of symptom </li></ul><ul><li>D) Use a clay pots. </li></ul><ul><li>ANSWER: A </li></ul>
  72. 73. QUESTION <ul><li>In the use of herbal medicine, one should remember to </li></ul><ul><li>a. use all parts of the plant in making decoction. </li></ul><ul><li>b. boil leaves sprayed with insecticide. </li></ul><ul><li>c. stop giving herbal medicine if allergy occurs. </li></ul><ul><li>d. continue giving decoction even if signs and symptoms persist. </li></ul><ul><li>ANSWER : C </li></ul>
  73. 74. QUESTION <ul><li>Which of the following is a correct statement? </li></ul><ul><li>a) local plants and herbs in the Philippine backyard are all effective in treatment of ailments </li></ul><ul><li>b) since they are readily available at no cost, you may use 2 or more for kinds for faster cure </li></ul><ul><li>c) no side effects or untoward reactions </li></ul><ul><li>d) not recommended for everyone to use herbal medicines </li></ul><ul><li>ANSWER : D </li></ul>
  74. 75. QUESTION <ul><li>The Traditional & Alternative Medicine Act of 1997 is also known as: </li></ul><ul><li>A) PD #8243 </li></ul><ul><li>B) RA # 8342 </li></ul><ul><li>C) PD # 8432 </li></ul><ul><li>D) RA # 8423 </li></ul><ul><li>ANSWER: D </li></ul>
  75. 76. 10 DOH herbal medicines ( AUNTY LABS B ) <ul><li>A AMPALAYA </li></ul><ul><li>U ULASIMANG BATO </li></ul><ul><li>N NIYOG-NIYUGAN </li></ul><ul><li>T TSAANG GUBAT </li></ul><ul><li>Y YERBA BUENA </li></ul><ul><li>L LAGUNDI </li></ul><ul><li>A AKAPULKO </li></ul><ul><li>B BAWANG </li></ul><ul><li>S SAMBONG </li></ul><ul><li>B BAYABAS </li></ul>
  76. 77. Ten (10) Herbal Medicines in the Philippines Approved by the Department of Health (DOH)
  77. 78. 1. Ampalaya (Mamordica charantia) - &quot;bitter gourd&quot; or &quot;bitter melon&quot; in English, - treatment of diabetes (diabetes mellitus), for the non-insulin dependent patients. 
  78. 79. 2. Ulasimang Bato (Peperomia pellucida) - also known as &quot;pansit-pansitan&quot; - for arthritis and gout
  79. 80. 3. Niyog-niyogan (Quisqualis indica L.) -  is a vine known as &quot;Chinese honey suckle“ - for intestinal worms, particularly the Ascaris and Trichina
  80. 81. 4. Tsaang Gubat (Ehretia microphylla Lam.) - enhance intestinal motility - mouth wash (high fluoride content)
  81. 82. 5. Yerba Buena (Clinopodium douglasii) - commonly known as Peppermint - an analgesic to relieve body aches and pain
  82. 83. 6. Lagundi (Vitex negundo) - &quot;5-leaved chaste tree“ - for the relief of cough & asthma
  83. 84. 7. Akapulko (Cassia alata) - also known as &quot;bayabas-bayabasan&quot; and &quot;ringworm bush&quot; in English - Antifungal: Tinea Flava, ringworms, athlete’s foot and scabies
  84. 85. 8. Bawang (Allium sativum) - popularly known as &quot;garlic“ - reduces cholesterol in the blood - helps control blood pressure
  85. 86. 9. Sambong (Blumea balsamifera) - English name: Blumea camphora - A diuretic for excretion of urinary stones - anti-edema
  86. 87. 10. Bayabas (Psidium guajava) - &quot;guava&quot; in English an antiseptic - to disinfect wounds - mouth wash to treat tooth decay and gum infection
  87. 88. QUESTION a. lagundi. b. akapulko. c. niyog-niyogan. d. bawang. ANSWER: D Allium sativum is the scientific name of:
  88. 89. QUESTION a. lagundi. b. bayabas. c. niyog-niyogan. d. tsaang gubat. ANSWER: C A vine which acts as an anti-helminthic is
  89. 90. QUESTION a. lower cholesterol levels. b. wash wounds. c. treat diabetes mellitus. d. lower uric acid. ANSWER: A The use of bawang is advocated in order to
  90. 91. QUESTION a. lagundi. b. bayabas. c. niyog-niyogan. d. tsaang gubat. ANSWER: A WHICH OF THE FF. IS MAINLY USED FOR THE RELIEF OF COUGH AND ASTHMA?
  91. 92. QUESTION A) Clinopodium douglasii B) Allium sativum C) Mamordica charantia D) Shigella bordetella ANSWER: C The scientific name of ampalaya is:
  92. 93. QUESTION a. lower cholesterol levels. b. wash wounds. c. treat diabetes mellitus. d. lower uric acid. ANSWER: C Which of the ff is an indication for ampalaya?
  93. 94. Narra Pterocarpus indicus <ul><li>NARRA </li></ul><ul><li>USES: </li></ul><ul><li>DIARRHEA </li></ul><ul><li>HEADACHE </li></ul><ul><li>PRICKLY HEAT </li></ul>
  94. 95. Lansones Lansium domesticum Correa <ul><li>LANSONES </li></ul><ul><li>USES: </li></ul><ul><li>DIARRHEA </li></ul><ul><li>ABDOMINAL COLIC </li></ul><ul><li>FEVER </li></ul>
  95. 96. Mani Arachis hypogaea Linn. PEANUT <ul><li>MANI </li></ul><ul><li>USES: </li></ul><ul><li>BLADDER INFECTIONS </li></ul><ul><li>OILS & LINIMENTS </li></ul>
  96. 97. Luya Zingiber officinale Rose. GINGER <ul><li>LUYA </li></ul><ul><li>USES: </li></ul><ul><li>ANTISEPTIC </li></ul><ul><li>RHEUMATISM </li></ul><ul><li>SORE THROAT/ HOARSENESS </li></ul><ul><li>COUGH </li></ul><ul><li>HANGOVERS </li></ul><ul><li>HEADACHES </li></ul>
  97. 98. Makahiya Mimosa pudica Linn. BASHFUL MIMOSA, SENSITIVE PLANT <ul><li>MAKAHIYA </li></ul><ul><li>USES: </li></ul><ul><li>ASTHMA </li></ul><ul><li>EXPECTORANT </li></ul><ul><li>SORE THROAT </li></ul><ul><li>WOUNDS </li></ul>
  98. 99. Makopa Syzygium malaccense MALAY APPLE, TERSANA ROSE APPLE <ul><li>MAKOPA </li></ul><ul><li>USES: </li></ul><ul><li>DYSENTERY </li></ul><ul><li>AMENORRHEA </li></ul>
  99. 100. Oregano Coleus aromaticus Benth. <ul><li>OREGANO </li></ul><ul><li>USES: </li></ul><ul><li>ASTHMA </li></ul><ul><li>CHRONIC COUGH </li></ul><ul><li>BRONCHITIS </li></ul>
  100. 101. Kauayan BAMBOO <ul><li>KAWAYAN </li></ul><ul><li>USES: </li></ul><ul><li>INDUCE LOCHIA AFTER C.B. </li></ul><ul><li>ANTIHELMINTHIC </li></ul><ul><li>ANURIA </li></ul>
  101. 102. Mangga Mangifera indica <ul><li>MANGGA </li></ul><ul><li>USES: </li></ul><ul><li>DIURETIC </li></ul><ul><li>ASTRINGENT </li></ul><ul><li>STOMATITIS </li></ul>
  102. 103. Mangostan Garcinia mangostana MANGOSTEEN <ul><li>MANGOSTEEN </li></ul><ul><li>USES: </li></ul><ul><li>ABDOMINAL PAIN </li></ul><ul><li>DIARRHEA </li></ul><ul><li>DYSMENORRHEA </li></ul>
  103. 104. Malunggay Moringa oleifera BEN OIL TREE <ul><li>MALUNGGAY </li></ul><ul><li>USES: </li></ul><ul><li>INTESTINAL PARASITISM </li></ul><ul><li>CONSTIPATION </li></ul><ul><li>WOUNDS & CUTS </li></ul>
  104. 105. Niyog Cocos nucifera COCONUT <ul><li>NIYOG </li></ul><ul><li>USES: </li></ul><ul><li>DANDRUFF </li></ul><ul><li>DRY SKIN </li></ul><ul><li>SCABIES </li></ul>
  105. 106. Okra Abelmoschus escuclentus Linn. Hibiscus esculentis Linn. <ul><li>OKRA </li></ul><ul><li>USES: </li></ul><ul><li>URINARY INFECTIONS </li></ul><ul><li>SORE THROAT </li></ul><ul><li>WOUNDS </li></ul>
  106. 107. Mais Zea mays CORN <ul><li>MAIS </li></ul><ul><li>USES: </li></ul><ul><li>DIURETIC </li></ul><ul><li>DYSURIA </li></ul><ul><li>URINARY TRACT INFECTION </li></ul>
  107. 108. QUESTION <ul><li>It is also known as “ BEAN OIL TREE”. </li></ul><ul><li>NARRA </li></ul><ul><li>NIYOG </li></ul><ul><li>MAKOPA </li></ul><ul><li>MALUNGGAY </li></ul><ul><li>ANSWER: D </li></ul>
  108. 109. QUESTION <ul><li>WHICH OF THE FOLLOWING IS EFFECTIVE FOR DYSMENORRHEA? </li></ul><ul><li>OREGANO </li></ul><ul><li>OKRA </li></ul><ul><li>MAIS </li></ul><ul><li>MANGOSTEEN </li></ul><ul><li>ANSWER: D </li></ul>
  109. 110. QUESTION <ul><li>It is also known as “ MALAY APPLE”. </li></ul><ul><li>LANSONES </li></ul><ul><li>MANGA </li></ul><ul><li>MAKOPA </li></ul><ul><li>OREGANO </li></ul><ul><li>ANSWER: C </li></ul>
  110. 111. QUESTION <ul><li>WHICH OF THE FOLLOWING IS EFFECTIVE </li></ul><ul><li>FOR INDUCING LOCHIA AFTER CHILD BIRTH? </li></ul><ul><li>MAKAHIYA </li></ul><ul><li>KAUAYAN </li></ul><ul><li>NIYOG </li></ul><ul><li>MALUNGGAY </li></ul><ul><li>ANSWER: B </li></ul>
  111. 112. Talong Solanum melogena L. <ul><li>TALONG </li></ul><ul><li>USES: </li></ul><ul><li>SORE THROAT </li></ul><ul><li>ABSCESS </li></ul><ul><li>CRACKED NIPPLES </li></ul>
  112. 113. Sibuyas Allium cepa L. True onion <ul><li>SIBUYAS </li></ul><ul><li>USES: </li></ul><ul><li>STIMULANT </li></ul><ul><li>DIURETIC </li></ul><ul><li>EXPECTORANT </li></ul>
  113. 114. Patatas Solanum tuberosum <ul><li>PATATAS </li></ul><ul><li>USES: </li></ul><ul><li>GENTLE LAXATIVE </li></ul><ul><li>GOUTY ARTHRITIS </li></ul><ul><li>HYPERTENSION </li></ul>
  114. 115. Sabila Aloe vera <ul><li>SABILA </li></ul><ul><li>USES: </li></ul><ul><li>DANDRUFF </li></ul><ul><li>SCALDS AND BURNS </li></ul><ul><li>SPRAINS </li></ul><ul><li>BRUISES </li></ul>
  115. 116. Siling-labuyo Capsicum frutescens CHILE PEPPER, SPANISH PEPPER CAYENNE <ul><li>SILING-LABUYO </li></ul><ul><li>USES: </li></ul><ul><li>ARTHRITIS / RHEUMATISM </li></ul><ul><li>DYSPEPSIA </li></ul><ul><li>FLATULENCE </li></ul>
  116. 117. Sampalok Tamarindus indica Linn. TAMARIND <ul><li>SAMPALOK </li></ul><ul><li>USES: </li></ul><ul><li>FEVER </li></ul><ul><li>LAXATIVE </li></ul><ul><li>ASTHMA </li></ul>
  117. 118. Sampagita Jasminum sambac Linn. JASMINE <ul><li>SAMPAGUITA </li></ul><ul><li>USES: </li></ul><ul><li>FEVER </li></ul><ul><li>COUGH </li></ul><ul><li>DIARRHEA </li></ul>
  118. 119. Tanglad Andropogon citratus Lemon Grass, Ginger grass <ul><li>TANGLAD </li></ul><ul><li>USES: </li></ul><ul><li>DIARRHEA </li></ul><ul><li>FEVER </li></ul>
  119. 120. Papaya Carica papaya MELON TREE <ul><li>PAPAYA </li></ul><ul><li>USES: </li></ul><ul><li>LAXATIVE </li></ul><ul><li>ACNE </li></ul><ul><li>STOMACH ACHE </li></ul>
  120. 121. Saging Musa sapientum Linn. BANANA <ul><li>SAGING </li></ul><ul><li>USES: </li></ul><ul><li>COOL DRESSING </li></ul><ul><li>THINNING HAIR </li></ul><ul><li>HEADACHES </li></ul>
  121. 122. Pito-Pito <ul><li>Pito-Pito is a blend of seven seeds or leaves of seven traditional herbal medicinal plants , usually prepared as a decoction </li></ul><ul><li>It is used in a wide variety of applications: headaches, fever, cough, colds, migraine, asthma, abdominal pains, diarrhea, etc. </li></ul>
  122. 123. Pito-Pito <ul><li>The ingredients vary according to availability and intended use. Seven (pito) is believed to be numerologically essential to the efficacy of the eventual formulation. </li></ul>
  123. 124. <ul><li>A traditional combination is seven leaves of: </li></ul><ul><li>alagaw, </li></ul><ul><li>banaba, </li></ul><ul><li>bayabas, </li></ul><ul><li>pandan, </li></ul><ul><li>mangga, </li></ul><ul><li>with half a teaspoon each of anis and cilantro </li></ul><ul><li>boiled for 30 minutes, strained and drained. </li></ul>
  124. 125. Pito-Pito <ul><li>In the urban and suburban areas, it has become part of alternative new-age menu as a herbal tea blend. Commercial tea preparations substitute one or two ingredients with other herbal medicinal components. </li></ul>
  125. 127. QUESTION <ul><li>It is also known as “ MELON TREE”. </li></ul><ul><li>PATATAS </li></ul><ul><li>NIYOG </li></ul><ul><li>PAPAYA </li></ul><ul><li>PIPINO </li></ul><ul><li>ANSWER: C </li></ul>
  126. 128. QUESTION <ul><li>WHICH OF THE FOLLOWING IS EFFECTIVE FOR CRACKED NIPPLES? </li></ul><ul><li>SILING-LABUYO </li></ul><ul><li>SABILA </li></ul><ul><li>PANDAN </li></ul><ul><li>TALONG </li></ul><ul><li>ANSWER: D </li></ul>
  127. 129. QUESTION <ul><li>It is also known scietifically as “ MUSA SAPIENTUM”. </li></ul><ul><li>SAGING </li></ul><ul><li>PATOLA </li></ul><ul><li>PATATAS </li></ul><ul><li>TANGLAD </li></ul><ul><li>ANSWER: A </li></ul>
  128. 130. QUESTION <ul><li>WHICH OF THE FOLLOWING IS NOT PART OF PITO-PITO? </li></ul><ul><li>BANABA </li></ul><ul><li>BAYABAS </li></ul><ul><li>AMPALAYA </li></ul><ul><li>MANGGA </li></ul><ul><li>ANSWER: C </li></ul>
  130. 132. <ul><li>POPULATION STRUCTURE </li></ul><ul><li>POPULATION SEX RATIO </li></ul><ul><li>= M / F x 100% </li></ul><ul><li>ex: 12,349 M / 12,413 F x 100 = 99% </li></ul><ul><li>( for every 99 males, there are 100 females) </li></ul>
  131. 133. <ul><li>AGE STRUCTURE </li></ul><ul><ul><ul><li>Percentage of a specified age group in comparison to the total number of population </li></ul></ul></ul><ul><ul><ul><li>EXAMPLE: </li></ul></ul></ul><ul><ul><ul><li>total population = 50 </li></ul></ul></ul><ul><ul><ul><li>specified age group=children 1– 4 = 30 </li></ul></ul></ul><ul><li>30 / 50 x 100 = 60% </li></ul>
  132. 134. <ul><li>DEPENDENCY RATIO </li></ul><ul><ul><ul><li>Refers to the very young & old population </li></ul></ul></ul><ul><ul><ul><li>FORMULA: </li></ul></ul></ul><ul><ul><ul><li>Population (0-14) + (65 & above) / (15 – 64) x 100 </li></ul></ul></ul>
  133. 135. <ul><ul><ul><li>EXAMPLE: </li></ul></ul></ul><ul><ul><ul><li>Population 0 – 14 + 65 & above = 500 </li></ul></ul></ul><ul><ul><ul><li>Population 15 – 64 y.o. = 500 </li></ul></ul></ul><ul><ul><ul><li>500 / 500 x 100 = 100 (ratio 1:1) </li></ul></ul></ul>
  134. 136. <ul><li>MEASURES OF DISTRIBUTION </li></ul><ul><li>DENSITY (D) – shows the number of persons dwelling upon a unit area of land </li></ul><ul><li>D = Population / area </li></ul>
  135. 137. <ul><li>EXAMPLE: </li></ul><ul><li>land area = 20,000 square meters </li></ul><ul><li>population = 1000 </li></ul><ul><li>1,000 / 20, 000 sq. m = 0.05 sq. m </li></ul><ul><li>THUS: for every 100 sq. m, there are 5 persons living on it </li></ul>
  136. 138. <ul><li>MEASURES OF MIGRATION </li></ul><ul><ul><ul><li>MIGRATION </li></ul></ul></ul><ul><ul><ul><li>CRUDE IN – MIGRATION RATE (CMIR) </li></ul></ul></ul><ul><ul><ul><li>no. of in – migrants / population x 100 </li></ul></ul></ul>
  137. 139. <ul><ul><ul><li>CRUDE OUT – MIGRATION RATE (CMOR) </li></ul></ul></ul><ul><ul><ul><li>no. of out – migrants / population x 100 </li></ul></ul></ul><ul><ul><ul><li>NET MIGRATION RATE </li></ul></ul></ul><ul><ul><ul><li>CMIR – CMOR = net migration rate </li></ul></ul></ul>
  138. 140. <ul><li>MEASURES OF POPULATION GROWTH </li></ul><ul><li>RATE OF NATURAL INCREASE </li></ul><ul><li>CBR – CDR per 1000 population </li></ul>
  139. 141. <ul><li>AVERAGE ANNUAL PERCENTAGE INCREASE </li></ul><ul><li>Pt / Po – 1 / t x 100 </li></ul><ul><li>Where: Pt – population at a later date </li></ul><ul><li>Po – population at an earlier date </li></ul><ul><li> t – time interval between dates t & o </li></ul>
  140. 142. <ul><li>EXAMPLE: </li></ul><ul><li>Population in 1977 = 5,000 </li></ul><ul><li>Population in 1972 = 1,000 </li></ul><ul><li>5,000 / 1,000 – 1 / 5 x 100 = 80% </li></ul>
  141. 143. <ul><li>ZERO GROWTH RATE </li></ul><ul><li>BIRTH RATE = DEATH RATE </li></ul>
  142. 144. <ul><li>RATIO </li></ul><ul><li>A relative number expressing the magnitude of one occurrence or condition in relation to another </li></ul>
  143. 145. <ul><li>RATE </li></ul><ul><li>Measures the probability of occurrence of some particular events </li></ul><ul><li>A relation indicating the number of times a certain number of exposures to the risks of occurrence is present in a given period of time </li></ul>
  144. 146. <ul><li>MID-YEAR POPULATION </li></ul><ul><li>Population of the area under study as of JULY 1 </li></ul><ul><li>POPULATION AT RISK </li></ul><ul><li>Population capable of acquiring the disease </li></ul>
  145. 147.
  146. 148. <ul><li>FERTILITY / NATALITY RATES </li></ul><ul><li>CRUDE BIRTH RATE </li></ul><ul><li>Total live births in a calendar year / MP x 1,000 </li></ul>
  147. 149. <ul><li>GEN. FERTILITY RATE </li></ul><ul><li>Total live births in a calendar year / mid-year population of women of child-bearing age (15 – 44) x 1,000 </li></ul>
  148. 150. <ul><li>MORTALITY RATES </li></ul><ul><li>A. CRUDE DEATH RATE </li></ul><ul><li>Total deaths in a calendar year from all causes / MP x 1,000 </li></ul><ul><li>CAUSE – SPECIFIC DEATH RATE </li></ul><ul><li>Deaths from a particular cause / MP x 100,000 </li></ul>
  149. 151. <ul><li>PROPORTIONAL MORTALITY RATE </li></ul><ul><li>Deaths from a particular cause / deaths from all causes x 100 </li></ul><ul><li>SWAROOP’S INDEX </li></ul><ul><li>Deaths in persons 50 yrs & above / total no. of deaths x 100 = % (no. of persons who died at 50 yrs. & above) </li></ul>
  150. 152. <ul><li>CASE FATALITY RATE </li></ul><ul><li>Deaths from a particular cause / no. of cases from the same cause x 100 </li></ul><ul><li>INFANT MORTALITY RATE </li></ul><ul><li>Deaths in 1 year of age / total live births in same year x 1,000 </li></ul>
  151. 153. <ul><li>NEONATAL MORTALITY RATE </li></ul><ul><li>Deaths below 28 days of age / total no. of live births x 1,000 </li></ul><ul><li>MATERNAL MORTALITY RATE </li></ul><ul><li>Deaths from women directly due to pregnancy, labor or puerperium (90 days after delivery) / total no. of live births x 1,000 </li></ul>
  152. 154. <ul><li>MORBIDITY RATES </li></ul><ul><ul><ul><li>Measures the frequency of illness or disability </li></ul></ul></ul><ul><ul><ul><li>For groups of allied illnesses within specific populations </li></ul></ul></ul>
  153. 155. <ul><li>GENERAL MORBIDITY RATE </li></ul><ul><li>Total no. of sick persons / MP x 100,000 </li></ul><ul><li>INCIDENCE RATE </li></ul><ul><ul><li>It answers how frequently the disease occur within a given period of time </li></ul></ul><ul><li>No. of new cases of a specified disease during a given time / population at risk in the area during that time x 100,000 </li></ul>
  154. 156. <ul><li>ATTACK RATE </li></ul><ul><ul><li>A measure of incidence during outbreaks or epidemics </li></ul></ul><ul><li>No. of new cases of a disease in a time period / population at risk during that time x 100 </li></ul>
  155. 157. <ul><li>PREVALENCE RATE </li></ul><ul><ul><li>Measure of the status of a particular disease within a given point or interval in time </li></ul></ul><ul><ul><li>It answers what proportion of the population or group of persons are actually ill with the particular disease or are infected with a particular agent at a given point in time </li></ul></ul>
  156. 158. <ul><ul><ul><li> no. of new and old cases of a certain diseases </li></ul></ul></ul><ul><ul><ul><li>registered at a given time </li></ul></ul></ul><ul><ul><ul><li>PR = ___________________________________ x 100 </li></ul></ul></ul><ul><ul><ul><li> total number of person examined </li></ul></ul></ul><ul><ul><ul><li>at same given time </li></ul></ul></ul>
  158. 160. COPAR
  159. 161. COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH <ul><li>DEFINITIONS: </li></ul><ul><ul><li>a social development approach that aims to transform the apathetic , individualistic, and voiceless poor into dynamic, participatory and politically responsive community </li></ul></ul>
  160. 162. IMPORTANCE OF COPAR <ul><ul><li>COPAR helps the community workers </li></ul></ul><ul><ul><li>to generate community participation </li></ul></ul><ul><ul><li>in development activities. </li></ul></ul><ul><ul><li>COPAR prepares people/clients to </li></ul></ul><ul><ul><li>eventually take over the management </li></ul></ul><ul><ul><li>of a development program in the </li></ul></ul><ul><ul><li>future. </li></ul></ul>
  161. 163. <ul><ul><li>COPAR maximizes community participation </li></ul></ul><ul><ul><li>and involvement; community resources </li></ul></ul><ul><ul><li>are mobilized for community services </li></ul></ul>
  162. 164. PRINCIPLES OF COPAR <ul><ul><li>People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change, and are able to bring about change </li></ul></ul><ul><ul><li>COPAR should be based on the interests of the poorest sectors of society </li></ul></ul><ul><ul><li>COPAR should lead to a self-reliant community and society </li></ul></ul>
  163. 165. PROCESSES / METHODS USED <ul><li>PROGRESSIVE CYCLE OF ACTION-REFLECTION- ACTION </li></ul><ul><li>– begins with small, local and concrete issues identified by the people and the evaluation and reflection of and on the action taken by them </li></ul>
  164. 166. <ul><li>CONSCIOUSNESS-RAISING THROUGH EXPERIENTIAL LEARNING </li></ul><ul><li>- placing an emphasis on learning that emerges from concrete action and which enriches succeeding action </li></ul>
  165. 167. <ul><li>C. PARTICIPATORY & MASS-BASED – it is primarily directed towards and biased in favor of the poor, the powerless and the oppressed </li></ul>
  166. 168. <ul><li>D. GROUP-CENTERED and NOT LEADER ORIENTED </li></ul><ul><li>– leaders are identified, emerge and are tested through action rather than appointed or selected by some external force or entity. </li></ul>
  167. 169. PHASES OF THE COPAR PROCESS <ul><li>1. Pre-entry phase </li></ul><ul><li>- is the initial phase of the organizing process where the community organizer looks for communities to serve or help </li></ul><ul><li>- it is considered the simplest in terms of actual outputs, activities, and strategies and time spent for it </li></ul>
  168. 170. <ul><li>Activities include: </li></ul><ul><li>designing a plan for community development, including all its activities and strategies for care/development </li></ul><ul><li>designing criteria for the selection of site </li></ul><ul><li>Methods for site selection: </li></ul><ul><ul><ul><li>Coordination with community leaders </li></ul></ul></ul><ul><ul><ul><li>Ocular observation </li></ul></ul></ul><ul><ul><ul><li>Data collection </li></ul></ul></ul><ul><ul><ul><li>Informal interviews </li></ul></ul></ul><ul><li>actually selecting the site for community care </li></ul>
  169. 171. <ul><li>2. ENTRY PHASE </li></ul><ul><li>- called the social preparation phase </li></ul><ul><li>- activities are the following: </li></ul><ul><li>a) sensitization of the people on the critical events in their life </li></ul><ul><li>b) motivating them to share their dreams and ideas on how to manage their concerns </li></ul><ul><li>c) mobilizing them to take collective action </li></ul>
  170. 172. <ul><li>signals the actual entry of the community worker/organizer into the community. </li></ul><ul><li>Guidelines for entry: </li></ul><ul><li>“ courtesy call” - recognize the role of local authorities by paying them visits to inform them of your presence & activities </li></ul><ul><li>“ when in Rome, be a Roman” appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of being role the model </li></ul><ul><li>adopt a low-key profile </li></ul>
  171. 173. <ul><li>- look for potential leaders & core-group members </li></ul><ul><ul><li>Criteria for potential leaders: </li></ul></ul><ul><ul><ul><li>Mass based or from poor sector </li></ul></ul></ul><ul><ul><ul><li>Directly engaged in production </li></ul></ul></ul><ul><ul><ul><li>Respectable & trustworthy </li></ul></ul></ul><ul><ul><ul><li>Charismatic </li></ul></ul></ul><ul><ul><ul><li>Pro - active & change agent </li></ul></ul></ul><ul><ul><ul><li>Conscientious & resourceful </li></ul></ul></ul><ul><ul><ul><li>Effective communication skills </li></ul></ul></ul>
  172. 174. <ul><li>3. Organization-building phase </li></ul><ul><li>- entails the formation of more formal structures </li></ul><ul><li>- It is at this phase where the organized leaders or groups are being given trainings ( OJT, formal or informal ) </li></ul><ul><li>- wider participation & collective community action </li></ul>
  173. 175. <ul><li>4. Sustenance and strengthening phase </li></ul><ul><li>- occurs when the community organization has already been established and the community members are already actively participating in community-wide undertakings. </li></ul>
  174. 176. <ul><li>- strategies used may include: </li></ul><ul><li>a) education & training </li></ul><ul><li>b) networking and linkaging </li></ul><ul><li>c) conduct of mobilization on health and development concerns </li></ul><ul><li>d) implementation of livelihood projects </li></ul><ul><li>e) developing secondary leaders </li></ul>
  175. 177. RECORDS & REPORTS <ul><li>Records </li></ul><ul><li>– refer to forms on which information pertaining the client is noted </li></ul><ul><li>Reports </li></ul><ul><li>– refers to periodic summaries of services /activities of an organization/ unit or the analysis of certain phases of its work </li></ul>
  176. 178. <ul><li>Purposes of records and reports: </li></ul><ul><li>a) measure service / program directed to the clients </li></ul><ul><li>b) provide basis for future planning </li></ul><ul><li>c) interpret the work to the public and other agencies </li></ul><ul><li>d) aid in studying the conditions of the community </li></ul><ul><li>e) contribute to client care </li></ul>
  177. 179. <ul><li>Sample Questions </li></ul><ul><li>One of the primary tasks of the community health nurses during the pre-entry phase is the selection of the Barangay to become the initial site for their organizing efforts. The following are the steps in the selection of the project site by the team, except: </li></ul><ul><li>Developing criteria for site selection </li></ul><ul><li>Identifying potential barangays and choosing the final project village </li></ul><ul><li>Identification of potential leaders </li></ul><ul><li>Identification of the host family </li></ul><ul><li>Answer: C (under entry phase) </li></ul>
  178. 180. <ul><li>2. It is considered the simplest in terms of actual outputs, activities, and strategies and time spent for it. </li></ul><ul><li>Organizing-building phase </li></ul><ul><li>Pre-entry phase </li></ul><ul><li>Sustenance phase </li></ul><ul><li>Strengthening phase </li></ul><ul><li>Answer: B </li></ul>
  179. 181. <ul><li>3. For potential leaders to perform their roles effectively, they have to possess certain characteristics. Among these are the following, except: </li></ul><ul><li>They must belong to the poor sector </li></ul><ul><li>They must be respected members of the community </li></ul><ul><li>Preferably informal leaders </li></ul><ul><li>Formal leaders with many community responsibilities </li></ul><ul><li>Answer: D (They do not have time to perform additional duties) </li></ul>
  180. 182. <ul><li>4. This phase signals the start of community self-management of any development program. </li></ul><ul><li>Pre-entry phase </li></ul><ul><li>Integration phase </li></ul><ul><li>Entry phase </li></ul><ul><li>Organization-building phase </li></ul><ul><li>Answer: D (a community organization facilitates in the participation in health and other development activities) </li></ul>
  182. 184. <ul><li>NURSING PROCESS </li></ul><ul><li>A systematic, scientific, dynamic, on-going interpersonal process </li></ul><ul><li>The nurses & the clients are viewed as a system, with each affecting the other & both being affected by the factors within the behavior </li></ul>
  183. 185. <ul><li>4 STEPS IN CHN PROCESS: </li></ul><ul><li>A ssessment </li></ul><ul><li>P lanning </li></ul><ul><li>I mplementation </li></ul><ul><li>E valuation </li></ul>
  184. 186. Community competence <ul><li>refers to the community’s ability to: </li></ul><ul><li>- identify needs </li></ul><ul><li>- achieve working consensus </li></ul><ul><li>- agree and work together to meet goals </li></ul>
  185. 187. COMMUNITY ASSESSMENT <ul><li>Process of examining the community </li></ul><ul><li>strategies that improve health and quality of life for the community </li></ul><ul><li>Systematic & continuous </li></ul>
  186. 188. <ul><li>Identifies specific deficiencies or guidance needed </li></ul><ul><li>Estimates possible effects of the nursing interventions </li></ul><ul><li>getting to know the community client </li></ul><ul><li>- this includes: </li></ul><ul><li>a) decide what data to be gathered </li></ul><ul><li>b) plan the process of data gathering </li></ul>
  187. 189. <ul><ul><ul><ul><li>DATA TO BE COLLECTED </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Demographic data </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Vital health statistics </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Community dynamics </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Education, socio-cultural, religious & occupational background </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Family dynamics </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Environment & patterns of coping </li></ul></ul></ul></ul>
  188. 190. THREE DIMENSIONS OF COMMUNITY ASSESMENT <ul><li>Status - information about morbidity and mortality, life expectancy, crime rates and education. </li></ul><ul><ul><li>Structure – socioeconomic, age, gender, resources </li></ul></ul><ul><ul><li>Process – how the community operates and functions as a whole </li></ul></ul>
  189. 191. <ul><li>Planning for a Program of Action </li></ul><ul><li>a) determining objectives for care / action </li></ul><ul><li>- identify what is to be done and what outcomes might be expected from the program/project/services implemented </li></ul>
  190. 192. <ul><li>Criteria for setting objectives: </li></ul><ul><li>they should be realistically be achievable </li></ul><ul><li>should be specifically stated </li></ul><ul><li>should be flexible enough to allow for change </li></ul><ul><li>should be closely related to the problems and needs identified and felt by the client </li></ul><ul><li>should be closely coordinated with those of the entire health care team </li></ul>
  191. 193. <ul><li>b) select activities and methods / </li></ul><ul><li>strategies for achieving the objectives </li></ul><ul><li>a. home visits </li></ul><ul><li>b. conferences / demonstrations </li></ul><ul><li>c. health service delivery </li></ul><ul><li>d. group discussion </li></ul><ul><li>e. information dissemination </li></ul>
  192. 194. <ul><li>Factors in selecting activities: </li></ul><ul><li>a. need / capabilities of the client </li></ul><ul><li>b. identify target clientele </li></ul><ul><li>c. review traditional activities and select only those not detrimental to health, life and limb </li></ul><ul><li>d. bear in mind that a balanced program is far more effective than in those which are unbalanced or biased </li></ul>
  193. 195. Program Implementation <ul><li>refers to the actual carrying out of the plan </li></ul><ul><li>refers to the mobilization of resources to meet objectives </li></ul><ul><li>must include active participation of the people </li></ul>
  194. 196. Program Monitoring & Evaluation <ul><li>Monitoring </li></ul><ul><li>– is an internal project/intervention/ care activity concerned to assess whether resources are being used as intended and whether they are producing the intended outputs </li></ul>
  195. 197. <ul><li>Evaluation </li></ul><ul><ul><li>is a process that is designed to show the relationship between services rendered and the objectives or purposes of the service / unit / care provider </li></ul></ul><ul><ul><li>not a record nor count of what was done but of what DIFFERENCE the doing made </li></ul></ul>
  197. 199. <ul><li>A gap between actual and achievable health status </li></ul><ul><li>Instances of failure in health maintenance </li></ul><ul><li>Possible precursors of health deficit: </li></ul><ul><ul><li>History of repeated infections or miscarriages </li></ul></ul><ul><ul><li>No regular health check-up </li></ul></ul>HEALTH DEFICIT
  198. 200. <ul><li>EXAMPLES </li></ul><ul><li>ILLNESS states, diagnosed or undiagnosed </li></ul><ul><li>Failure to thrive/develop </li></ul><ul><li>Disability </li></ul><ul><ul><li>Transient (aphasia or temporary paralysis after a CVA) </li></ul></ul><ul><ul><li>Permanent (leg amputation secondary to diabetes, blindness from measles, lameness from polio) </li></ul></ul>
  199. 201. <ul><li>Conditions that are conducive to disease, accident or failure to realize one’s potential </li></ul><ul><li>EXAMPLES: </li></ul><ul><li>Family history of hereditary disease </li></ul><ul><li>Threat of cross infection </li></ul><ul><li>Accident hazards </li></ul><ul><li>Faulty eating habits </li></ul><ul><li>Poor environmental sanitation </li></ul><ul><li>Unhealthy lifestyle/personal habits </li></ul>HEALTH THREAT
  200. 202. <ul><li>Anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources </li></ul><ul><li>EXAMPLES: </li></ul><ul><li>Marriage </li></ul><ul><li>Pregnancy </li></ul><ul><li>Parenthood </li></ul><ul><li>Divorce or separation </li></ul><ul><li>Loss of job </li></ul><ul><li>Menopause </li></ul><ul><li>Death </li></ul>FORESEEABLE CRISIS
  201. 203. <ul><li>NATURE OF THE PROBLEM – categorized into health deficit, health threat and foreseeable crisis </li></ul><ul><li>Health deficit 3 </li></ul><ul><li>Health threat 2 </li></ul><ul><li>Foreseeable crisis 1 </li></ul>PRIORITIZING HEALTH PROBLEMS
  202. 204. <ul><li>MODIFIABILITY OF THE PROBLEM – refers to the probability of success in minimizing, alleviating or totally eradicating the problem through intervention </li></ul><ul><li>Easily modifiable 2 </li></ul><ul><li>Partially modifiable 1 </li></ul><ul><li>Not modifiable 0 </li></ul>
  203. 205. <ul><li>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 </li></ul><ul><li>High 3 </li></ul><ul><li>Moderate 2 </li></ul><ul><li>Low 1 </li></ul>
  204. 206. <ul><li>SALIENCE – refers to the family’s perception and evaluation of the problem in terms of seriousness and urgency of attention needed </li></ul><ul><li>A serious problem, immediate attention needed 2 </li></ul><ul><li>A problem, but not needing immediate attention 1 </li></ul><ul><li>Not a felt need / problem 0 </li></ul>
  206. 208. <ul><li>____ Take clinical history </li></ul><ul><li>___ Write findings on client records </li></ul><ul><li>___ Perform physical assessment </li></ul><ul><li>___ Greet and make client at ease </li></ul><ul><li>___ Do laboratory examinations </li></ul><ul><li>___ Take temperature, blood pressure, height and weight </li></ul>PRE-CONSULTATION CONFERENCE 1 2 3 4 5 6
  207. 209. <ul><li>___ Inform physician of relevant findings gathered in pre-conference </li></ul><ul><li>___ Observe confidentiality of examination results </li></ul><ul><li>___ Ensure privacy, safety and comfort of patient throughout procedure </li></ul><ul><li>___ Work with the physician during the examination </li></ul><ul><li>___ Assist client before, during and after examination by physician </li></ul>MEDICAL EXAMINATION 1 2 3 4 5
  208. 210. <ul><li>___ Counseling </li></ul><ul><li>___ Seek information regarding health status of other family members </li></ul><ul><li>___ Explain and reinforce physician’s orders and advises </li></ul><ul><li>___ Teach patient measures to promote and maintain health as proper diet, exercise and personal hygiene </li></ul><ul><li>___ Carry out physician’s orders as giving medication or injection </li></ul>NURSING INTERVENTION 1 2 3 4 5
  209. 211. <ul><li>____ Make appointment for next clinic/home visit </li></ul><ul><li>____ Refer patient to other health worker/agency </li></ul><ul><li>____ Explain findings and needed care or intervention </li></ul>POST-CONSULTATION CONFERENCE 1 2 3
  211. 213. <ul><li>Made to a client or a responsible member of the family </li></ul><ul><li>GOAL : provide necessary health care activities and further attain an objective of the agency </li></ul><ul><li>A professional face-to-face contact made by a nurse to the patient or the family </li></ul>H O M E V I S I T
  212. 214. PHASES OF A HOME VISIT <ul><li>PREPARATORY PHASE </li></ul><ul><ul><li>Review existing records or referral data </li></ul></ul><ul><ul><li>Notifies family of intention </li></ul></ul><ul><ul><li>Introduce self and explains purpose </li></ul></ul><ul><li>HOME VISIT PHASE </li></ul><ul><ul><li>Actual visit to the patient </li></ul></ul><ul><ul><li>Assessment, planning, and health teaching </li></ul></ul><ul><li>POST-VISIT PHASE </li></ul><ul><ul><li>Records data in the chart </li></ul></ul><ul><ul><li>Plan for next visit </li></ul></ul><ul><ul><li>Referral to other health professionals </li></ul></ul>
  213. 215. STEPS IN A HOME VISIT <ul><li>1.Greet client and introduce self. </li></ul><ul><li>2. Explain purpose. </li></ul><ul><li>3. Inquire about health and welfare. </li></ul><ul><li>4. Place bag in a convenient place. </li></ul><ul><li>5. Wash hands and wear apron. </li></ul><ul><li>6. Perform physical assessment & nursing care. </li></ul><ul><li>7. Give necessary health teaching. </li></ul><ul><li>8. Wash hands and close bag. </li></ul><ul><li>9. Record findings. </li></ul><ul><li>10. Make appointment for clinic or home visit. </li></ul>
  214. 216.
  215. 217. <ul><li>A tool using a public health bag done during a home visit </li></ul><ul><li>The nurse can perform nursing procedures with ease and deftness </li></ul><ul><li>Saving time and effort in view of rendering effective nursing care </li></ul>B A G T E C H N I Q U E
  216. 218. <ul><li>Use of bag technique should minimize, if not totally prevent, the spread of infection </li></ul><ul><li>Should save time and effort in the performance of nursing procedures </li></ul><ul><li>Should not overshadow concern for the patient </li></ul><ul><li>Show the effectiveness of total care given to individual or family </li></ul>PRINCIPLES OF BAG TECHNIQUE
  217. 219. <ul><li>Should contain all necessary articles and equipments </li></ul><ul><li>Bag and contents should be cleaned as often as possible </li></ul><ul><li>Should be protected from contact with any article in the home of the patient </li></ul><ul><li>Arrangement of the contents should be convenient </li></ul><ul><li>Handwashing should be done frequently </li></ul><ul><li>When used in a communicable case, should be thoroughly cleaned and disinfected before keeping and re-using </li></ul>SPECIAL CONSIDERATIONS
  218. 220. <ul><li>thermometers in case (1 oral & 1 rectal) </li></ul><ul><li>syringes </li></ul><ul><li>alcohol lamp </li></ul><ul><li>sputum cup </li></ul><ul><li>medicine dropper </li></ul><ul><li>zephiran solution </li></ul><ul><li>benedict solution </li></ul><ul><li>tape measure </li></ul><ul><li>hypodermic needles </li></ul>CONTENTS OF THE PHN BAG
  219. 222. <ul><li>Essential health care made universally acceptable to individuals and families in the community </li></ul><ul><li>By means acceptable to them and through their full participation </li></ul><ul><li>At a cost that the community and country can afford at every stage of development </li></ul>P R I M A R Y H E A L T H C A R E
  220. 223. <ul><li>GOAL : Health for all Filipinos and Health in the Hands of the People by the year 2020 </li></ul><ul><li>MISSION : To strengthen the health care system wherein people will manage their own health care </li></ul><ul><li>CONCEPT : partnership and empowerment of the people </li></ul><ul><li>LEGAL BASIS: </li></ul><ul><ul><li>Letter of Instruction 949 </li></ul></ul><ul><ul><li>President Ferdinand Marcos </li></ul></ul><ul><ul><li>October 19, 1979 </li></ul></ul>
  221. 224. <ul><li>First International Conference on Primary Health care </li></ul><ul><ul><li>Alma Ata, USSR </li></ul></ul><ul><ul><li>September 6-12, 1978 </li></ul></ul><ul><ul><li>Sponsored by the World Health Organization and UNICEF </li></ul></ul>
  222. 225. ELEMENTS/COMPONENTS of PHC <ul><li>Education for Health </li></ul><ul><li>Locally Endemic Disease Control </li></ul><ul><li>Expanded Program on Immunization </li></ul><ul><li>Maternal and Child Health </li></ul><ul><li>Essential Drugs and Elderly Care </li></ul><ul><li>Nutrition </li></ul><ul><li>Treatment of CD and Non-CD </li></ul><ul><li>Sanitation: Water & Environment </li></ul>ELEMENTS
  223. 226. <ul><li>Framework for meeting the goal of primary health care </li></ul><ul><li>Calls for active and continuing partnership among the communities, private and government agencies in health development </li></ul>O R G A N I Z A T I O N A L S T R A T E G Y
  224. 227. LEVELS OF HEALTH CARE SERVICES <ul><li>PRIMARY </li></ul><ul><ul><li>Barangay Health Station </li></ul></ul><ul><ul><li>Private Practitioners </li></ul></ul><ul><ul><li>Community Hospitals </li></ul></ul><ul><ul><li>Rural Health Unit </li></ul></ul><ul><li>SECONDARY </li></ul><ul><ul><li>Emergency/District Hospitals </li></ul></ul><ul><ul><li>Provincial/City Hospitals </li></ul></ul>
  225. 228. LEVELS OF HEALTH CARE SERVICES <ul><li>TERTIARY </li></ul><ul><ul><li>Regional Medical Centers and Training Hospitals </li></ul></ul><ul><ul><li>National Medical Centers </li></ul></ul><ul><ul><li>Teaching and Training Hospital </li></ul></ul>
  226. 229. <ul><li>VILLAGE / BARANGAY HEALTH WORKERS (V/BHWs) </li></ul><ul><li>- Trained community health workers </li></ul><ul><li>- Health auxiliary volunteer </li></ul><ul><li>- Traditional birth attendant or healer </li></ul><ul><li>INTERMEDIATE LEVEL HEALTH WORKERS </li></ul><ul><ul><li>- General medical practitioner </li></ul></ul><ul><ul><li>- Public health nurse </li></ul></ul><ul><ul><li>- Rural sanitary inspector </li></ul></ul><ul><ul><li>- Midwives </li></ul></ul>TWO LEVELS OF PHC WORKERS
  227. 230. <ul><li>DOH PROGRAMS </li></ul>
  228. 231. <ul><li>ental health program </li></ul><ul><li>steoporosis prevention </li></ul><ul><li>ealth education & community organizing </li></ul><ul><li>rimary health care </li></ul><ul><li>eproductive health </li></ul><ul><li>lder persons health service </li></ul><ul><li>uidelines for good nutrition </li></ul><ul><li>espiratory Infection Control </li></ul><ul><li>lternative health care </li></ul><ul><li>aternal and child care </li></ul><ul><li>entrong Sigla Movement </li></ul>DOH PROGRAMS
  229. 232. <ul><li>DENTAL HEALTH PROGRAM </li></ul>
  230. 233. <ul><li>VISION: A lifetime of oral health & no tooth decay for the next generation </li></ul><ul><li>STRATEGIES </li></ul><ul><ul><li>Social mobilization </li></ul></ul><ul><ul><li>Coordination and partnership with sectoral groups </li></ul></ul><ul><ul><li>Networking </li></ul></ul><ul><ul><li>Capacity building and work value formation </li></ul></ul>DENTAL HEALTH PROGRAM
  231. 234. <ul><li>Project for Social Mobilization </li></ul><ul><li>AIM: </li></ul><ul><ul><li>Emphasize the importance of oral health in relation to total body health </li></ul></ul><ul><ul><li>Increase public awareness on the prevention of common dental diseases </li></ul></ul><ul><ul><li>Solicit one million new toothbrushes from concerned citizens </li></ul></ul>&quot;Sang Milyong Sepilyo&quot;
  233. 236. <ul><li>EXPANDED PROGRAM ON IMMUNIZATION </li></ul><ul><li>A program implemented under PD no. 996 signed on September 16, 1976 which provides for compulsory basic immunization for infants & children below 8 years old </li></ul>
  234. 237. ELEMENTS OF EPI (SACIT) <ul><li>Surveillance, studies & research </li></ul><ul><li>Assessment & evaluation of the program’s overall performance </li></ul><ul><li>Cold chain logistic management </li></ul><ul><li>Information, Education & Communication </li></ul><ul><li>Target setting </li></ul>
  235. 238. Principles & Legal Basis <ul><li>Based on EPIDEMIOLOGICAL SITUATION </li></ul><ul><li>Mass Approach </li></ul><ul><li>basic health service (it is integrated into the health system) </li></ul><ul><li>P.D. 996 – compulsory basic immunization for infants and children below 8 years old </li></ul><ul><li>R.A. 7846 – compulsory Hep B immunization for infants and children below 8 years old </li></ul>
  236. 239. <ul><li>2 IMPORTANT GOALS OF THE PROGRAM: </li></ul><ul><li>To reduce the morbidity & mortality rates of the 7 EPI diseases </li></ul><ul><li>To reduce the incidence of neonatal tetanus by providing pregnant women with TT immunization </li></ul>
  237. 240. <ul><li>APRIL 6, 1986 – PP no. 6 – enjoin all gov’t. as well as NGOs to achieve the goal of immunizing every Filipino against the 6 EPI diseases: </li></ul><ul><li>Poliomyelitis </li></ul><ul><li>Measles </li></ul><ul><li>Diptheria </li></ul><ul><li>Pertussis </li></ul><ul><li>Tetanus </li></ul><ul><li>Tuberculosis </li></ul><ul><li>Hepatitis B – added recently </li></ul>
  238. 241. The seven target EPI Diseases <ul><li>1) Tuberculosis </li></ul><ul><li>A specific, chronic, infectious disease caused by Mycobacterium tuberculosis, characterized by the formation of tubercles in the tissues. </li></ul>
  239. 242. <ul><li>2) Diphtheria </li></ul><ul><li>An acute, specific, highly infectious, epidemic and endemic disease caused by Corynebacterium diphtheria; transmitted by direct and indirect contact and carrier. </li></ul>
  240. 243. <ul><li>3) Pertussis </li></ul><ul><li>Whooping cough. A highly communicable infectious disease of children with paroxysms of coughing that reach a peak of violence ending in a long-drawn inspiration that produces a characteristic “whoop”. </li></ul>
  241. 244. <ul><li>4) Tetanus </li></ul><ul><li>An acute infectious disease induced by the toxin of Clostridium tetani, an anaerobic organism growing at the site of injury to body tissue. Is characterized by painful muscular contractions, chiefly of the face and neck, hence the appellation “lockjaw”. </li></ul>
  242. 245. <ul><li>5) Poliomyelitis </li></ul><ul><li>Inflammation of the grey matter of the spinal cord; an acute epidemic viral disease </li></ul><ul><li>most commonly affecting children; marked by fever, headache, sore throat, stiff neck, gastrointestinal symptoms. </li></ul>
  243. 246. <ul><li>6) Measles </li></ul><ul><li>Rubeola. An acute, highly contagious, febrile, exanthematous viral disease; spread by droplets; characterized by fever, blotchy rash, and catarrhal inflammation of the mucous membranes; associated with high rate of complications. </li></ul>
  244. 247. <ul><li>7) Hepatitis B </li></ul><ul><li>May be transmitted by contaminated needles, blood mucous membranes (sexual intercourse), or ingestion of contaminated food; characterized by increase in aspartate transaminase and alanine transaminase level and increased bilirubin in the blood. </li></ul>
  245. 248. Fully immunized Child (Revised in 1996) <ul><li>A child who has received the following vaccines </li></ul><ul><li>1 BCG, 3 DPT, 3 OPV, 3 Hep B, 1 MV </li></ul><ul><li>At the right intervals </li></ul><ul><li>Before reaching 12 months of age </li></ul>
  246. 249. Dosage, route & site of administration Deltoid region, upper arm Intramuscular 0.5 ml TT Outer part of the upper arm Subcutaneous 0.5 ml Measles Upper outer portion thigh Deep IM 0.5 ml DPT Upper outer portion thigh Intramuscular 0.5 ml Hep B Mouth Oral 2 drops OPV Deltoid region right arm Intradermal Infants 0.05 ml BCG Site of Adm. Route of Adm. Dose Vaccine
  247. 250. Routine Immunization Schedule for Infants Vaccine Min Age, 1st Dose No. of Doses Min Interval Bet. Doses Reason BCG Birth, anytime after birth 1 - BCG given early protects infants against TB meningitis infection from family members
  248. 251. Routine Immunization Schedule for Infants Vaccine Min Age, 1st Dose No. of Doses Min Interval Bet. Doses Reason OPV 6 weeks 3 4 weeks When given early increases extent of protection against polio
  249. 252. Routine Immunization Schedule for Infants Vaccine Min Age, 1st Dose No. of Doses Minimum Interval Bet. Doses Reason Hep B w/in 24 hrs of birth 3 6 weeks from 1 st dose to 2 nd dose, and; 8 weeks interval from 2 nd dose to 3 rd dose - Early start reduces chance of infection & becoming a carrier - Eliminate HB before 2012 ( a western regional goal)
  250. 253. Routine Immunization Schedule for Infants Vaccine Min Age, 1st Dose No. of Doses Min Interval Bet. Doses Reason DPT 6 weeks 3 4 weeks Early start reduces chance of severe pertussis
  251. 254. Routine Immunization Schedule for Infants Vaccine Min Age, 1st Dose No. of Doses Min Interval Bet. Doses Reason Measles 9 months 1 - <ul><li>At least 85% of measles cases can be prevented by immunizing at this age </li></ul><ul><li>- Eliminate measles by 2008 </li></ul>
  252. 255. Immunization schedule for mothers Vaccine Minimum interval Percent protection Duration of Protection TT 1 As early as possible during pregnancy
  253. 256. Immunization schedule for mothers Vaccine Minimum interval Percent protection Duration of Protection TT 2 At least 4 weeks after TT 1 80 % Infants protected from neonatal tetanus, 3 years protection for the mother against tetanus
  254. 257. Immunization schedule for mothers Vaccine Minimum interval Percent protection Duration of Protection TT 3 At least 6 months after TT 2 95% Infants protected from neonatal tetanus, 5 years protection for the mother against tetanus
  255. 258. Immunization schedule for mothers Vaccine Minimum interval Percent protection Duration of Protection TT 4 At least 1 year after TT 3 99% Infants protected from neonatal tetanus, 10 years protection for the mother against tetanus
  256. 259. Immunization schedule for mothers Vaccine Minimum interval Percent protection Duration of Protection TT 5 At least 1 year after TT 4 99% Infants protected from neonatal tetanus, lifetime protection for the mother against tetanus
  257. 260. <ul><li>QUESTION: </li></ul><ul><li>If a woman received 3 doses of DPT during infancy, what will be her current TT immunization schedule? </li></ul><ul><li>A) TT1, previous 3 DPT doses not significant </li></ul><ul><li>B) TT2, 3 doses of DPT equals TT1 </li></ul><ul><li>C) TT3, 3 doses of DPT considered TT1 & TT2 </li></ul><ul><li>D) TT4, 3 doses of DPT equals 3 TT shots </li></ul><ul><li>ANSWER: C </li></ul>
  258. 261. Discard point of OPV using the VVM Constant Temperature, Day and Night Length of Time VVM Reaches “Discard Point” At room temperature + 25 ˚C 8 days At room temperature + 20 ˚C 20 days At room temperature + 4 ˚C 180 days At room temperature - 20 ˚C Over 2 years
  259. 262. Proper stocking of Vaccines (refrigerator) <ul><li>Neatly arrange the vaccines (segregated by type) </li></ul><ul><li>Domestic refrigerator </li></ul><ul><li>- freezer compartment -OPV, AMV </li></ul><ul><li>- body - BCG, DPT, Hep B, TT, Diluent </li></ul><ul><li>Modified refrigerator </li></ul><ul><li>- freezer compartment - ice packs </li></ul><ul><li>- Body </li></ul><ul><ul><li>Top - OPV, AMV </li></ul></ul><ul><ul><li>Middle - BCG, DPT, Hep B, TT, Diluent </li></ul></ul><ul><ul><li>Lower - Bottles/ ice packs with water </li></ul></ul>
  260. 263. How to Maintain Cold Chain <ul><li>Stocking of Vaccines in the Transport Box Vaccine Carrier </li></ul><ul><li>Make sure you have enough ice packs </li></ul><ul><li>transport box – 24 pcs </li></ul><ul><li>Vaccine carrier – 4 pcs </li></ul><ul><li>Place OPV, AMV in contact with frozen ice packs </li></ul><ul><li>Wrap DPT, Hep B, TT with paper </li></ul><ul><li>Place BCG in between AMV, OPV and wrapped vaccines </li></ul>
  261. 264. What to do with Opened vials of Vaccines? <ul><li>I. Continue to use opened vials in the subsequent sessions if all these conditions are met: </li></ul><ul><ul><li>Expiry date has not passed </li></ul></ul><ul><ul><li>Vaccines are stored appropriately (+2 to +8 ˚C) </li></ul></ul><ul><ul><li>Sterile procedures have been fully observed </li></ul></ul><ul><ul><li>Opened vial has not been contaminated </li></ul></ul>
  262. 265. <ul><li>NOTE: </li></ul><ul><li>Discard opened BCG and MV after 6 hours of reconstitution. </li></ul><ul><li>Opened vials of DPT, Hep B, TT can still be used for 4 weeks provided condition 1-4 in the previous slide are met. </li></ul>
  263. 266. <ul><li>II. Discard an opened vial immediately if any of the following conditions apply: </li></ul><ul><li>Sterile procedures have not been fully observed </li></ul><ul><li>+ Suspicion of contamination of the opened vial </li></ul><ul><li>+ Visible evidence of contamination (e.g. change in appearance or presence of floating particles) </li></ul>
  264. 267. <ul><li>If the label has come off, or </li></ul><ul><li>If the VVM has reached discard point </li></ul><ul><ul><li>the inner square matches, or </li></ul></ul><ul><ul><li>is darker than the circle </li></ul></ul><ul><li>Reconstituted vaccines (BCG, AMV) after 6 hours of reconstitution </li></ul>
  265. 268. <ul><li> What is reconstitution? </li></ul><ul><li>To restore to the original state by adding water; To build up again by putting back together the original pieces. </li></ul><ul><li>What is a diluent? </li></ul><ul><li> An inert substance that dilutes the strength of a solution or mixture. </li></ul>
  266. 269. What is thermal shock? <ul><li>It is the process of damage to the vaccine resulting from the use of diluent that is at too high a temperature (above +8°C). </li></ul><ul><li>It results in the death of some or all of the essential live organisms in the vaccine. </li></ul>
  267. 270.
  268. 271. How to read a vaccine vial monitor The inner square is lighter than the outer circle. If the expiry date has not passed, USE the vaccine. As time passes the inner square is still lighter than the outer circle. If the expiry date has not passed, USE the vaccine. Discard point: the colour of the inner square matches that of the outer circle. DO NOT USE the vaccine. Beyond the discard point: inner square is darker than the outer circle. DO NOT USE the vaccine.
  269. 272. POINTS to REMEMBER: <ul><li>Only diluent supplied by the manufacturer, specific for the vaccine, should be used. No other diluent may be used. </li></ul><ul><li>Distilled water for injection should NOT be used as a vaccine diluent. </li></ul>
  270. 273. <ul><li>Oral vaccine diluents should never be injected. </li></ul><ul><li>To ensure the correct quantities are available, diluents must be shipped and distributed together with the vaccine vials that it will be used to reconstitute. </li></ul>
  271. 274. During the Reconstitution process: <ul><li>Only the diluent supplied by the manufacturer should be used to reconstitute a freeze-dried vaccine. </li></ul><ul><li>A sterile needle and sterile syringe must be used for each vial for adding the diluent to the powder in a single vial or ampoule of freeze dried vaccine. </li></ul><ul><li>Special care must be taken in opening ampules to avoid loss of the dry vaccine. </li></ul>
  272. 275. Vaccinators and store keepers should always: <ul><li>Include diluents in stock control and ensure adequate supplies. </li></ul><ul><li>Check that the vaccines have been supplied with the right diluent. If any error is noted, the vaccine should not be used and the supervisor must be notified immeditely. </li></ul><ul><li>Use only the diluent that is indicated for each type of vaccine and manufacturer. </li></ul>
  273. 276. <ul><ul><li>Ensure the volume of diluent used is correct so that the proper number of doses per vial is obtained. </li></ul></ul><ul><ul><li>Ensure that no other medication or substance which might be confused with the vaccine or its diluent is stored in the refrigerator of the immunization centre. </li></ul></ul><ul><ul><li>Reconstituted vaccine should be kept on ice to preserve its potency (by maintaining the maximum possible number of live organisms in each dose). </li></ul></ul>
  274. 277. <ul><ul><li>A sterile needle and sterile syringe must be used for each separate dose of reconstituted vaccine drawn from the vial. </li></ul></ul><ul><ul><li>The reconstituted vaccine must be kept cool and any remaining liquid must be discarded after 6 hours. </li></ul></ul>
  275. 278. Sizes of syringe and Needle to use During Vaccination DPT, MV and TT - use 2-3 ml syringe with 25 or 30 mm 23 or 25 gauge needle BCG - use 1 ml tuberculin syringe with 10 mm 26 gauge needle In mixing vaccines - use 5 or 10 ml syringe with 18 gauge needle
  276. 279. Proper ways of handling syringes and needles <ul><li>Disposal of used syringes and needles </li></ul><ul><li>Immediately after use </li></ul><ul><ul><li>Do not recap the needle </li></ul></ul><ul><ul><li>Place them in a safety collector box </li></ul></ul><ul><li>Disposal options </li></ul><ul><ul><li>Burn in pit, bury </li></ul></ul><ul><ul><li>Collect and incinerate </li></ul></ul>
  277. 280. <ul><li>Absolute Contraindications to Immunization: </li></ul><ul><li>BCG to a baby born from a mother with AIDS </li></ul><ul><li>DPT2 and DPT3 to a child who develops convulsion within 3 days of giving DPT </li></ul><ul><li>Infants and children with active neurologic disease </li></ul><ul><li>Relative contraindication </li></ul><ul><li>Any illness which warrants admission to the hospital. </li></ul>
  278. 281. &quot;first expiry and first out&quot; (FEFO) <ul><li>A &quot;first expiry and first out&quot; (FEFO) vaccine system is practiced to assure that all vaccines are utilized before its expiry date. Proper arrangement of vaccines and/or labeling of expiry dates are done to identify those close to expiring. </li></ul><ul><li>Vaccine temperature is monitored twice a day (early in the morning and in the afternoon) in all health facilities and plotted to monitor break in the cold chain. </li></ul>
  280. 283. <ul><li>Implementing guidelines on Hepatitis B Immunization for Infants </li></ul>
  281. 284. <ul><li>Rationale </li></ul><ul><ul><li>hepatitis B is the major health problem in the Philippines </li></ul></ul><ul><ul><li>10-12 % of the total population are chronically infected </li></ul></ul><ul><ul><li>No affordable and effective drug treatment are currently available </li></ul></ul><ul><ul><li>90% of chronic carriers of infection acquire their infection at birth or in early childhood </li></ul></ul>
  282. 285. Objectives <ul><li>General: </li></ul><ul><li>To improve effectiveness of management in the provision of 3 doses of routine Hepatitis B vaccine among infants including a birth dose. </li></ul><ul><li>Specific: </li></ul><ul><li>To provide new guidelines & procedures for Hepatitis B vaccination for infants at all types of health facilities. </li></ul><ul><li>To provide instructions for administration of birth dose Hepatitis B vaccine accdg to the settings where the birth takes place. </li></ul>
  283. 286. New Schedule of Hep. B, DPT & OPV Note: Hep B1 was 6 weeks (old DOH book ); now AT BIRTH (p. 149 new DOH book) Age Hep B DPT OPV At Birth (within 24 hours) Hep B 1 6 weeks Hep B 2 DPT 1 OPV 1 10 weeks DPT 2 OPV 2 14 weeks Hep B 3 DPT 3 OPV 3
  284. 287. <ul><li>Type of Vaccine </li></ul><ul><li>- Recombinant or genetically engineered vaccine using HBsAg (10mg dose) </li></ul><ul><li>- Synthesized in yeast or mammalion cells into which HBsAg gene has been inserted. </li></ul><ul><li>Formulation </li></ul><ul><li>- Monovalent Hepatitis B vaccine/ univalent </li></ul><ul><li>Protects only against Hepatitis B </li></ul><ul><li>Single antigen formulation </li></ul><ul><li>Used for birth dose </li></ul><ul><li>- Combination vaccines (multivalent) </li></ul><ul><li>Protects against Hepatitis B & other dse </li></ul><ul><li>(DPT-Hep B, DPT-Hep B +HiB, Hib-Hep B) </li></ul><ul><li>Combination with other vaccine </li></ul><ul><li>Used for subsequent doses </li></ul>
  285. 288. <ul><li>Dosage </li></ul><ul><li>Standard pediatric dose is 0.5 ml </li></ul><ul><li>Sites of administration </li></ul><ul><li>- Recommended series of 3 doses of hepatitis B vaccine shall be given intramuscularly only in the anterolateral thigh muscle . </li></ul><ul><li>- Hepatitis B vaccine </li></ul><ul><li>Shouldn’t be given in the buttocks </li></ul><ul><li>Risk of injury to the sciatic nerve </li></ul><ul><li>Shouldn’t be given intradermal </li></ul><ul><li>It doesn’t produce adequate antibody response to children </li></ul><ul><li>Shouldn’t be mixed in the same syringe with other vaccine </li></ul>
  286. 289. <ul><li>Vaccine storage and handling Hep B vaccine </li></ul><ul><li>Stored in refrigerators provided solely for vaccine storage at +2 to +8 ˚C </li></ul><ul><li>Transported properly in once-packed containers with cold chain monitors or thermometer </li></ul><ul><li>Should never be frozen or allowed to come into direct contact with ice because it will be inactivated and will no longer be potent. </li></ul><ul><li>Shake test used to determine if the vaccine has been damaged by freezing. </li></ul>
  287. 290. <ul><li>Indication and Contraindication </li></ul><ul><li>No contraindication for the administration of Hep B vaccine to a newborn within 24 hours of birth. Used to protect against Hepatitis B virus. </li></ul><ul><li>Vaccine side effects and adverse Reaction </li></ul><ul><li>Hep B vaccine is one of the safest vaccines. </li></ul><ul><li>Mild reaction include: </li></ul><ul><li>Soreness & fever at the injection site </li></ul><ul><li>Serious reaction: Anaphylaxis </li></ul><ul><li>– risk for anaphylaxis is estimated at 1/600,000 doses </li></ul>
  288. 291. <ul><li>Administration of Hep B vaccine birth dose </li></ul><ul><li>While 2nd dose and 3rd dose of Hep b vaccine shall be administered along with 1st and 3rd dose of DPT and OPV, administration of the 1st dose within 24 hour of birth. </li></ul><ul><li>Hospitals and lying-in Clinics </li></ul><ul><li>A) No mother/child should be discharged from the hospital without providing the birth dose of Hepatitis b vaccine to the newborn. </li></ul><ul><li>B) Provision of birth dose of Hep B vaccine as part of the standing order for the routine care of medically stable infants weighing equal to or more than 2000 grams at birth. </li></ul>
  289. 292. <ul><li>Health centers & Barangay Health Stations </li></ul><ul><li>All infants attended at birth by midwives from the health center/BHS shall be given the monovalent Hepatitis B vaccine within 24 hours after birth . </li></ul>
  290. 293. <ul><li>Birth taking place outside health facilities </li></ul><ul><li>attended by traditional birth attendants or </li></ul><ul><li>other non-trained providers </li></ul><ul><li>A) TBA or mother should be advised to inform the nearest health facility either by phone or by personal visit for the provision of the Hep B and BCG </li></ul><ul><li>B) Or bring the newborn to the health facility for vaccination </li></ul><ul><li>C) Or the midwife will give immunization during house visit within 7 days after delivery </li></ul>
  291. 294. <ul><li>Calculation of Hepatitis B Vaccine Needs </li></ul><ul><li>(Steps for Calculating Hep B requirement) </li></ul><ul><li>1) Identify the important data for computation: </li></ul><ul><ul><li>Eligible Population (EP) of infants </li></ul></ul><ul><li>EP= Total Population (TP) x 3% </li></ul><ul><ul><li>Wastage Multiplier : 1.2 </li></ul></ul><ul><li>National: </li></ul><ul><li>Reserve stock :25% </li></ul><ul><li>Reserve stock multiplier: 1.25 </li></ul><ul><li>Region/ province/city: </li></ul><ul><li>Reserve stock: 12.5% </li></ul><ul><li>Reserve Stock Multiplier : 1.125 </li></ul><ul><li>Municipality </li></ul><ul><li>Reserve Stock: 12.5% </li></ul><ul><li>Reserve Stock multiplier: 1.1 </li></ul>
  292. 295. <ul><li>2) Formula </li></ul><ul><li>Hep B requirements of National/Provincial/city level </li></ul><ul><li>=EPx no. of doses x wastage multiplier x reserve stock multiplier </li></ul><ul><li>Hep B requirements of lower level </li></ul><ul><li>= EP x no. of doses x wastage multiplier x reserve stock multiplier </li></ul>
  293. 296. <ul><li>SEATWORK: </li></ul><ul><li>Given: Province A with a total population of 2,000,000 for 2006.Compute for the annual requirements for hepatitis B </li></ul><ul><li>Compute for the eligible population infants for Province A </li></ul><ul><li>Calculate for the annual needs (in doses) for Province A </li></ul><ul><li>Calculate for annual needs (in vials) for Province A. </li></ul>
  294. 297. <ul><li>Sample Computation </li></ul><ul><li>Given: Province A with a total population of 2,000,000 for 2006.Compute for the annual requirements for hepatitis B </li></ul><ul><li>Compute for the eligible population infants for Province A </li></ul><ul><li>2,000,000 x 0.03 = 60,000 infants </li></ul><ul><li>Calculate for the annual needs (in doses) for Province A </li></ul><ul><li>60,000 x 3 doses x 1.2 x 1.125= 243,000 doses </li></ul><ul><li>Calculate for annual needs (in vials) for Province A. </li></ul><ul><li>243,000 doses / 10 doses per vial = 24,300 vials </li></ul>
  295. 298. <ul><li>QUESTION: </li></ul><ul><li>1) It refers to a protein which can stimulate the production of antibodies and react specifically with those antibodies. </li></ul><ul><li>A) glycoprotein </li></ul><ul><li>B) vaccines </li></ul><ul><li>C) toxoids </li></ul><ul><li>D) antigen </li></ul><ul><li>ANSWER: D </li></ul>
  296. 299. <ul><li>QUESTION: </li></ul><ul><li>It is a class of specific protein substances in the blood that destroy or render inactive certain foreign substances, particularly bacteria. </li></ul><ul><li>A) antigen </li></ul><ul><li>B) anti-toxin </li></ul><ul><li>C) toxoids </li></ul><ul><li>D) antibody </li></ul><ul><li>ANSWER: D </li></ul>
  297. 300. <ul><li>QUESTION: </li></ul><ul><li>Which of the following is NOT an element of EPI? </li></ul><ul><li>A) Information, Education & Communication </li></ul><ul><li>B) Surveillance, studies & research </li></ul><ul><li>C) Target setting </li></ul><ul><li>D) Vaccine safety </li></ul><ul><li>ANSWER: D </li></ul>
  298. 301. <ul><li>QUESTION: </li></ul><ul><li>The law which requires compulsory basic immunization for infants and children below 8 years old. </li></ul><ul><li>A) R.A.7846 </li></ul><ul><li>B) P.D. 996 </li></ul><ul><li>C) R.A. 8746 </li></ul><ul><li>D) P.D. 966 </li></ul><ul><li>ANSWER: B </li></ul>
  299. 302. <ul><li>QUESTION: </li></ul><ul><li>Which of the following does not belong to the 7 target EPI diseases? </li></ul><ul><li>A) diphtheria </li></ul><ul><li>B) tuberculosis </li></ul><ul><li>C) diabetes </li></ul><ul><li>D) tetanus </li></ul><ul><li>ANSWER: C </li></ul>
  300. 303. <ul><li>QUESTION: </li></ul><ul><li>It is a highly communicable infectious disease of children with paroxysms of coughing that reach a peak of violence ending in a long-drawn inspiration that produces a characteristic “whoop”. </li></ul><ul><li>A) emphysema </li></ul><ul><li>B) pertussis </li></ul><ul><li>C) tuberculosis </li></ul><ul><li>D) bronchial asthma </li></ul><ul><li>ANSWER: B </li></ul>
  301. 304. <ul><li>QUESTION: </li></ul><ul><li>Which of the following is a fully immunized child? </li></ul><ul><li>A) a 7 month old child who has received 1 MV, 1 BCG, 1 Hep B, 3 DPT and 3 OPV </li></ul><ul><li>B) an 18 month old child who had just completed his 1 BCG, 1 Hep B, 1MV, 3 DPT and 3 OPV </li></ul><ul><li>C) a 1 yr old child who had just completed his 1 BCG, 1MV, 3 Hep B, 3 DPT and 3 OPV </li></ul><ul><li>D) none of the above </li></ul><ul><li>ANSWER: C </li></ul>
  302. 305. <ul><li>QUESTION: </li></ul><ul><li>When is the recommended schedule for Hep B2? </li></ul><ul><li>A) within 24 hours </li></ul><ul><li>B) together with DPT1 </li></ul><ul><li>C) together with DPT2 </li></ul><ul><li>D) 14 weeks </li></ul><ul><li>ANSWER: B </li></ul>
  303. 306. <ul><li>QUESTION: </li></ul><ul><li>Hepatitis B vaccine should not be given in the buttocks because of: </li></ul><ul><li>A) gluteal muscle irritation and pain </li></ul><ul><li>B) inadequate antibody production response to children in that area </li></ul><ul><li>C) risk of hematoma formation </li></ul><ul><li>D) potential injury to the sciatic nerve </li></ul><ul><li>ANSWER: D </li></ul>
  304. 307. <ul><li>QUESTION: </li></ul><ul><li>Which of the following is an inappropriate nursing intervention about Hepatitis B vaccine? </li></ul><ul><li>A) Shouldn’t be given intradermal </li></ul><ul><li>B) Should be given in the anterolateral thigh muscle </li></ul><ul><li>C) Should do shake test to determine if the vaccine has been damaged by heat </li></ul><ul><li>D) Shouldn’t be frozen to preserve its potency </li></ul><ul><li>ANSWER: C </li></ul>
  305. 308. <ul><li>QUESTION: </li></ul><ul><li>Which of the following is appropriate? </li></ul><ul><li>A) No mother/child should be discharged from the hospital without providing the mother the required Hepatitis b vaccine. </li></ul><ul><li>B) Provision of birth dose of Hepatitis B vaccine to infants weighing equal to or more than 1000 grams at birth. </li></ul><ul><li>C) Infants attended at birth by midwives shall be given the combination Hepatitis B vaccine within 24 hours after birth. </li></ul><ul><li>D) If birth is attended by TBA outside regular health facilities, the midwife will give immunization during house visit within 7 days after delivery </li></ul><ul><li>ANSWER: D </li></ul>
  306. 309. <ul><li>QUESTION: </li></ul><ul><li> It assure that all vaccines are utilized before its expiry date ? </li></ul><ul><li>A) vaccine vial monitoring </li></ul><ul><li>B) FEFO system </li></ul><ul><li>C) cold chain management </li></ul><ul><li>D) ECCD monitoring </li></ul><ul><li>ANSWER: B </li></ul>
  307. 310. <ul><li>QUESTION: </li></ul><ul><li>Which of the following is an example of relative contraindication to immunization? </li></ul><ul><li>A) Melena, a newborn baby of a mother with AIDS, about to be given BCG </li></ul><ul><li>B) Shigella, a eurasian child who develops convulsion within 3 days of giving DPT, & is due to receive DPT2 </li></ul><ul><li>C) Bordatella , a 6 wk infant-relative of the nurse, who has active neurologic disease </li></ul><ul><li>D) Rubella, a 14 wk infant, admitted to the hospital due to fever and chills. </li></ul><ul><li>ANSWER: D </li></ul>
  308. 311. <ul><li>QUESTION: </li></ul><ul><li>Which of the following follows the standard protocol on immunization? </li></ul><ul><li>A) Open a vial of vaccine even if only one eligible child or pregnant woman is present for immunization. </li></ul><ul><li>B) Distribute health information materials on family planning </li></ul><ul><li>C) Conduct health education among mothers with high risk infants only </li></ul><ul><li>D) Use one sterile needle & one syringe for each type of vaccine for all patients. </li></ul><ul><li>ANSWER: A </li></ul>
  309. 312. <ul><li>QUESTION: </li></ul><ul><li>It means t o restore to the original state by adding water or to build up again by putting back together the original pieces. </li></ul><ul><li>A) dilution </li></ul><ul><li>B) reconstitution </li></ul><ul><li>C) discard point </li></ul><ul><li>D) cold chain </li></ul><ul><li>ANSWER: B </li></ul>
  310. 313. <ul><li>QUESTION: </li></ul><ul><li>During administration of DPT, MV and TT, what syringe size is appropriate ? </li></ul><ul><li>A) 1 ml syringe </li></ul><ul><li>B) 5 ml syringe </li></ul><ul><li>C) 2-3 ml syringe </li></ul><ul><li>D) none of the above </li></ul><ul><li>ANSWER: C </li></ul>
  311. 314. <ul><li>QUESTION: </li></ul><ul><li>When injecting BCG to your inafnts, which of the following needle sizes is most appropriate? </li></ul><ul><li>A) 26 gauge needle </li></ul><ul><li>B) 23 gauge needle </li></ul><ul><li>C) 19 gauge needle </li></ul><ul><li>D) 18 gauge needle </li></ul><ul><li>ANSWER: A </li></ul>
  312. 315. <ul><li>QUESTION: </li></ul><ul><li>Upon inspection of the vaccine vial monitor, you noticed that the inner square is darker than the outer circle. Which of the following is correct? </li></ul><ul><li>A) it has reached the discard point, do not use </li></ul><ul><li>B) it is already expired, do not use </li></ul><ul><li>C) it is already beyond discard point, do not use </li></ul><ul><li>D) it is already expired, do not use if already opened </li></ul><ul><li>ANSWER: C </li></ul>
  313. 316. <ul><li>QUESTION: </li></ul><ul><li>In storing OPV, which of the following is appropriate? </li></ul><ul><li>A) middle portion of the body of a modified refrigerator </li></ul><ul><li>B) lower body of a domestic refrigerator </li></ul><ul><li>C) freezer compartment of both the domestic or modified refrigerator </li></ul><ul><li>D) top body of a modified refrigerator </li></ul><ul><li>ANSWER: D </li></ul>
  314. 317. <ul><li>QUESTION: </li></ul><ul><li>In storing diluents, which of the following is appropriate? </li></ul><ul><li>A) middle portion of the body of a modified refrigerator </li></ul><ul><li>B) lower body of a domestic refrigerator </li></ul><ul><li>C) freezer compartment of both the domestic or modified refrigerator </li></ul><ul><li>D) top body of a modified refrigerator </li></ul><ul><li>ANSWER: A </li></ul>
  315. 318. <ul><li>QUESTION: </li></ul><ul><li>In storing AMV, which of the following is appropriate? </li></ul><ul><li>A) middle portion of the body of a modified refrigerator </li></ul><ul><li>B) lower body of a domestic refrigerator </li></ul><ul><li>C) freezer compartment of both the domestic or modified refrigerator </li></ul><ul><li>D) top body of a modified refrigerator </li></ul><ul><li>ANSWER: D </li></ul>
  316. 319. <ul><li>Sample Computation Problem </li></ul><ul><li>Given: Tagbilaran city, with a total population of 1,000,000 for 2007.Compute for the annual requirements for hepatitis B </li></ul><ul><li>Compute for the eligible population (infants) </li></ul><ul><li>Calculate for the annual needs (in doses) </li></ul><ul><li>Calculate for annual needs (in vials) </li></ul>
  317. 320. <ul><li>Problem Solution </li></ul><ul><li>Given: Tagbilaran city with a total population of 1,000,000 for 2007.Compute for the annual requirements for hepatitis B </li></ul><ul><li>Compute for the eligible population (infants) </li></ul><ul><li>1,000,000 x 0.03 </li></ul><ul><li>= 30,000 infants </li></ul><ul><li>Calculate for the annual needs (in doses) </li></ul><ul><li>30,000 x 3 doses x 1.2 (WM) x 1.125 (RSM) </li></ul><ul><li>= 121,500 doses </li></ul><ul><li>Calculate for annual needs (in vials) </li></ul><ul><li>121,500 doses / 10 doses per vial </li></ul><ul><li>= 12,150 vials </li></ul>
  318. 321. Supply the missing diagram: The inner square is lighter than the outer circle. If the expiry date has not passed, USE the vaccine. As time passes the inner square is still lighter than the outer circle. If the expiry date has not passed, USE the vaccine. Discard point: the colour of the inner square matches that of the outer circle. DO NOT USE the vaccine. Beyond the discard point: inner square is darker than the outer circle. DO NOT USE the vaccine.
  319. 322. Supply the missing blanks: New Schedule of Hep. B, DPT & OPV AGE HEP B DPT none Birth (within 24 hours) Hep B1 Hep B3 Hep B2 6 weeks 10 weeks 14 weeks DPT 1 DPT2 DPT3 OPV1 OPV2 OPV3 OPV none none
  321. 325. WHAT IS MATERNAL & CHILD HEALTH NURSING? Mother & child relation-ship to one another & of the entire family
  322. 326. <ul><li>GOALS: </li></ul><ul><li>To ensure that every expectant & nursing mother maintains good health </li></ul><ul><li>Learns the art of child care </li></ul><ul><li>Has a normal delivery & bears healthy children </li></ul>
  323. 327. ESSENTIAL HEALTH SERVICE PACKAGES <ul><li>Antenatal registration </li></ul><ul><li>Tetanus toxoid immunization </li></ul><ul><li>Micronutrient supplementation </li></ul><ul><li>Treatment of diseases & other conditions </li></ul><ul><li>Clean and safe delivery </li></ul><ul><li>Support to Breastfeeding </li></ul><ul><li>Family planning counselling </li></ul>
  324. 328. <ul><li>Attendants must be aware of the early signs, symptoms and complications. They should follow the 3 CLEANS: </li></ul><ul><li>CLEAN Hands </li></ul><ul><li>CLEAN Surface </li></ul><ul><li>CLEAN Cord </li></ul>
  325. 329. <ul><li>Situations wherein “trained hilots” are allowed to attend to home deliveries: </li></ul><ul><li>A) Time of delivery </li></ul><ul><li> no licensed health personnel trained on maternal care, is available </li></ul><ul><li>B) Area of domicile of pregnant mother </li></ul><ul><li> there is no licensed health personnel trained on maternal care </li></ul>
  326. 330. BREASTFEEDING <ul><li>MILK PRODUCTION HORMONES: </li></ul><ul><li>PROLACTIN </li></ul><ul><ul><li>Milk – secreting hormone </li></ul></ul><ul><ul><li>MILK SECRETION REFLEX </li></ul></ul><ul><ul><li>Secreted at the base of the anterior pituitary gland </li></ul></ul><ul><ul><li>Delays ovulation & protect against subsequent pregnancy </li></ul></ul><ul><ul><li>Sensory stimulation through sucking </li></ul></ul>
  327. 331. <ul><li>OXYTOCIN </li></ul><ul><ul><li>For milk “letdown” </li></ul></ul><ul><ul><li>MILK EJECTION REFLEX </li></ul></ul><ul><ul><li>HELP REFLEX </li></ul></ul><ul><ul><ul><li>Site of baby </li></ul></ul></ul><ul><ul><ul><li>Sound of baby’s voice </li></ul></ul></ul><ul><ul><ul><li>Sensory impulses from nipples </li></ul></ul></ul><ul><ul><li>Anxiety, pain or doubts STOP reflex </li></ul></ul>
  328. 332. <ul><li>LEGAL MILESTONES: </li></ul><ul><li>EO 51 MILK CODE OF THE PHILIPPINES </li></ul><ul><li>- protection and promotion of breastfeeding </li></ul><ul><li>- to ensure the safe and adequate nutrition of infants through regulation of marketing of infant foods and related products. (e.g. breast milk substitutes, infant formulas, feeding bottles, teats etc. ) </li></ul>
  329. 333. <ul><li>POSITIONS IN BF THE BABY: </li></ul><ul><li>1. Cradle Hold - head & neck are supported </li></ul><ul><li>2. Football Hold </li></ul><ul><li>3. Side Lying Position </li></ul>
  331. 335. <ul><li>RA 7600 </li></ul><ul><li>THE ROOMING–IN & BREASTFEEDING ACT of 1992 </li></ul><ul><li>- An act providing incentives to government and private health institutions promoting and practicing rooming-in & breastfeeding. </li></ul><ul><li>- Provision for human milk bank. </li></ul><ul><li>- Information, education and re-education drive </li></ul><ul><li>- Sanction and Regulation </li></ul>
  333. 337. <ul><li>Fortification </li></ul><ul><li>is the addition of a micronutrient deficient in the diet to a commonly and widely consumed food or seasoning. </li></ul>
  334. 338. <ul><li>Example: </li></ul><ul><li>The use of FIDEL salt </li></ul><ul><li>F ortification for </li></ul><ul><li>I odine </li></ul><ul><li>D eficiency </li></ul><ul><li>EL imination </li></ul>
  335. 339. <ul><li>REPUBLIC ACT NO. 8976 </li></ul><ul><li>Philippine Food Fortification Act of 2000 </li></ul><ul><li>a) Voluntary Food Fortification </li></ul><ul><li>- Sangkap Pinoy Seal Program (SPSP) </li></ul><ul><li>a strategy to encourage food manufacturers to fortify processed foods or food products with essential nutrients at levels approved by the DOH. The fundamental concept of the program is to authorize food manufacturers to use the DOH seal of acceptance for processed foods or food products, after these products passed a set of defined criteria. The seal is a guide used by consumers in selecting nutritious foods. </li></ul><ul><li>b) Mandatory Food Fortification </li></ul><ul><li>The fortification of staple foods: </li></ul><ul><li>•  Rice – with iron; </li></ul><ul><li>•  Wheat flour – with vitamin A and Iron; </li></ul><ul><li>•  Refined sugar – with vitamin A; </li></ul><ul><li>•  Cooking oil – with vitamin A; and </li></ul><ul><li>•  Other staple foods with nutrients as may later be required by the NNC. </li></ul><ul><li>RA 832 – Rice Enrichment Law </li></ul><ul><li>“ All milled rice has to be enriched with premix Rice” </li></ul><ul><li>Government’s nutrition program </li></ul><ul><li>RA 8172 – FIDEL Salt </li></ul>
  336. 340. SANGKAP PINOY <ul><li>or micronutrients </li></ul><ul><li>are vitamins and minerals required by the body in very small quantities. These are essential in maintaining a strong, healthy and active body; sharp mind; and for women to bear healthy children. </li></ul><ul><li>vitamin A, iron and iodine, which cannot be synthesized by the human body, and therefore must be provided through the diet. </li></ul>
  337. 341. <ul><li>MARASMUS </li></ul><ul><li>Protein & energy malnutrition </li></ul><ul><li>Usually less than 1 year old when malnutrition started </li></ul><ul><li>Very thin </li></ul><ul><li>Very poor weight gain </li></ul>
  338. 342. <ul><li>Old man’s face </li></ul><ul><li>Enlarged abdomen </li></ul><ul><li>Prominent ribs </li></ul><ul><li>Loose & wrinkled skin </li></ul><ul><li>Anxious </li></ul><ul><li>Always hungry </li></ul>
  339. 343. <ul><li>KWASHIORKOR </li></ul><ul><li>Disease of the older child (1-3 y.o.) </li></ul><ul><li>Very thin </li></ul><ul><li>Fails to grow </li></ul><ul><li>Light-colored weak hair </li></ul><ul><li>Moon-shaped, unhappy face </li></ul>
  340. 344. <ul><li>Enlarged abdomen </li></ul><ul><li>Muscle wasting </li></ul><ul><li>Swollen lower & upper extremities </li></ul><ul><li>Apathetic </li></ul>
  341. 345. <ul><li>Skin sores & skin peeling </li></ul><ul><li>dark spots on the skin </li></ul><ul><li>Does not want to eat </li></ul>
  342. 346. <ul><li>TREATMENT: </li></ul><ul><li>Food is the only cure </li></ul><ul><li>Increase: </li></ul><ul><ul><li>CHON & energy concentration of food prepared </li></ul></ul><ul><ul><li>Frequency of feeding </li></ul></ul><ul><ul><li>Variety of food offered </li></ul></ul>
  343. 347. <ul><li>IRON-DEFICIENCY ANEMIA </li></ul><ul><li>Causes: </li></ul><ul><ul><li>Low intake of iron-rich food </li></ul></ul><ul><ul><li>Blood loss </li></ul></ul><ul><ul><li>Poor absorption of iron </li></ul></ul><ul><ul><li>Increased demands </li></ul></ul>
  344. 348. <ul><li>VITAMIN A DEFICIENCY </li></ul><ul><li>Causes: </li></ul><ul><ul><li>Low intake of vitamin A rich food </li></ul></ul><ul><ul><li>Low intake of oil & protein </li></ul></ul><ul><ul><li>Illness like measles, diarrhea & pneumonia </li></ul></ul><ul><li>Consequences: </li></ul><ul><ul><li>Blindness </li></ul></ul><ul><ul><li>Low resistance to infection </li></ul></ul>
  345. 349. <ul><li>IODINE DEFICIENCY </li></ul><ul><li>Causes </li></ul><ul><ul><li>Low intake of iodine </li></ul></ul><ul><li>Consequences </li></ul><ul><li>FETUS </li></ul><ul><ul><ul><li>Abortion </li></ul></ul></ul><ul><ul><ul><li>Congenital abnormalities </li></ul></ul></ul><ul><ul><ul><li>Stillbirth </li></ul></ul></ul>
  346. 350. Review is Over ... Have a nice day ! Good Bye ! Good Luck and God Bless you !
  348. 355. National Voluntary Blood Service Program (NVBSP)
  349. 356. <ul><li>The project is the development and implementation of the computer-based Drug Test Operations and Management Information System (DTOMIS). </li></ul>
  350. 357. The Doctors to the Barrios Program is the deployment of doctors as Rural Health Physicians to doctorless municipalities, usually hard to reach, economically underdeveloped areas
  351. 358. Four Rights in Food Safety <ul><li>Rule in Food Safety: </li></ul><ul><li>“ When in doubt, throw it out!” </li></ul><ul><li>Right Source: </li></ul><ul><li>• Always buy fresh meat, fish, fruits & vegetables. </li></ul><ul><li>• Always look for the expiry dates of processed foods and avoid buying the expired ones. </li></ul><ul><li>• Avoid buying canned foods with dents, bulges, deformation , broken seals and improperly seams. </li></ul><ul><li>• Use water only from clean and safe sources . </li></ul><ul><li>• When in doubt of the water source, boil water