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COMMUNITY HEALTH NURSING: AN OVERVIEW

What is a community?
      § a group of people with common
         characteristics or interests living together
         within a territory or geographical
         boundary
      § place where people under usual
         conditions are found
What is health?
  § Health-illness continuum
  § High-level wellness
  § Agent-host-environment
  § Health belief
  § Evolutionary-based
  § Health promotion
  § WHO definition
§ What is community health?
 
        § part of paramedical and medical intervention/
           approach which is concerned on the health of
           the whole population
        § aims:
1. health promotion
2. disease prevention
3. management of factors affecting health
§ What is nursing?
- assisting sick individuals to become healthy
    and healthy individuals achieve optimum
    wellness
Public Health Nursing: the term used before for
  Community Health Nursing

According to Dr. C.E. Winslow, Public Health is a
    science & art of 3 P’s
§ Prevention of Disease
§ Prolonging life
§ Promotion of health and efficiency through organized
  community effort
§ What is Community Health Nursing?
 
  “The utilization of the nursing process in the different
    levels of clientele-individuals, families, population
    groups and communities, concerned with the
    promotion of health, prevention of disease and
    disability and rehabilitation.”
    - Maglaya, et al
 
COMMUNITY HEALTH NURSING (CHN):

§  a specialized field of nursing practice
§  a science of Public Health combined with
    Public Health Nursing Skills and Social
    Assistance with the goal of raising the level of
    health of the citizenry, to raise optimum level
    of functioning of the citizenry (Characteristic
    of CHN)
BASIC PRINCIPLES OF CHN

ü  The community is the patient in CHN, the family is the
    unit of care and there are four levels of clientele:
    individual, family, population group (those who share
    common characteristics, developmental stages and
    common exposure to health problems – e.g. children,
    elderly), and the community.

ü  In CHN, the client is considered as an ACTIVE partner
    NOT PASSIVE recipient of care
BASIC PRINCIPLES OF CHN

ü  CHN practice is affected by developments in health
    technology, in particular, changes in society, in
    general
ü  The goal of CHN is achieved through multi-sectoral
    efforts
ü  CHN is a part of health care system and the larger
    human services system.
ROLES OF THE PUBLIC HEALTH NURSE

Clinician, who is a health care provider, taking care of the sick people
   at home or in the RHU
Health Educator, who aims towards health promotion and illness
  prevention through dissemination of correct information; educating
  people
Facilitator, who establishes multi-sectoral linkages by referral system
Supervisor, who monitors and supervises the performance of
  midwives
TARGET POPULATION (IFC) ARE:

1. I ndividual
2. F amily
3. C ommunity
3 Elements considered in CHN:

v  Science of Public Health (core foundation in CHN),

v  Public Health Nursing Skills and

v  Social Assistance Functions
OBJECTIVES OF PUBLIC HEALTH: CODES

C ontrol of Communicable Diseases
O rganization of Medical and Nursing Services
D evelopment of Social Machineries
E ducation of IFC on personal Hygiene→ Health Education
  is the essential task of every health worker
S anitation of the environment
3 ELEMENTS IN HEALTH EDUCATION: IEC

§ I nformation: to share ideas to keep population group
  knowledgeable and aware
§ E ducation: change within the individual
   3 Key Elements of Education:
      K nowledge
      A ttitude
      S kills
3 ELEMENTS IN HEALTH EDUCATION: IEC

§ C ommunication: interaction involving 2 or more
  persons or agencies

 3 Elements of Communication:
     Message
     Sender
     Receiver
PUBLIC HEALTH WORKERS (PHW)
PHW’s: are members of the health team who are
    professionals namely
§ Medical Officer (MO)-Physician
§ Public Health Nurse (PHN)-Registered Nurse
§ Rural Health Midwife (RHM)-Registered Midwife-
§ Dentist
§ Nutritionist
§ Medical Technologist
§ Pharmacist
§ Rural Sanitary Inspector (RSI)-must be a sanitary engineer
5 MAJOR FUNCTIONS:
1.  Ensure equal access to basic health services
2.  Ensure formulation of national policies for proper division of
    labor and proper coordination of operations among the
    government agency jurisdictions
3.  Ensure a minimum level of implementation nationwide of
    services regarded as public health goods
4.  Plan and establish arrangements for the public health systems to
    achieve economies of scale
5.  Maintain a medium of regulations and standards to protect
    consumers and guide providers

 
BASIC HEALTH SERVICES UNDER OPHS OF DOH
E ducation regarding Health
L ocal Endemic Diseases
E xpanded Program on Immunization
M aternal & Child Health Services
E ssential drugs and Herbal plants
N utritional Health Services (PD 491): Creation of Nutrition Council of the Phils.
T reatment of Communicable & Non communicable Diseases
S anitation of the environment (PD 856): Sanitary Code of the Philippines

D ental Health Promotion
A ccess to and use of hospitals as Centers of Wellness
M ental Health Promotion
VISION BY 2030 (DREAM OF DOH)

A Global Leader for attaining
 better health outcomes,
 competitive and responsive
 health care systems, and
 equitable health financing
MISSION

  To guarantee EQUITABLE,
  SUSTAINABLE and QUALITY
     health for all Filipinos,
   especially the poor and to
       lead the quest for
      excellence in health
Principles to attain the vision of DOH

§ Equity: equal health services for all-no
   discrimination
§ Quality: DOH is after the quality of service not the
   quantity
   Philosophy of DOH: “Quality is above quantity”
§ Accessibility: DOH utilize strategies for delivery of
   health services
HEALTH CARE DELIVERY SYSTEM


“the totality of all policies, facilities, equipment,
   products, human resources and services
   which address the health needs, problems
   and concerns of the people. It is large,
   complex, multi-level and multi-disciplinary.”
THREE STRATEGIES IN DELIVERING HEALTH
     SERVICES (ELEMENTS)
ü  Creation of Restructured Health Care Delivery System
    (RHCDS) regulated by PD 568 (1976)
ü  Management Information Systems regulated by R.A.
    3753: Vital Health Statistics Law
ü  Primary Health Care (PHC) regulated by LOI 949 (1984):
    Legalization of Implementation of PHC in the Philippines
CREATION OF RHCDS

RHO (National Health Agency)
  or existing national agencies like PGH
  or specialized agencies like Heart Center for Asia, NKI

MHO & PHO (Municipal/Provincial Health Office)
 
BHS & RHU (Barangay Health Station/Rural Health Unit)
3 LEVELS OF HEALTH CARE

1.  Primary-prevention of illness or promotion of
    health
2.  Secondary-curative
3.  Tertiary-rehabilitative
According to Increasing Complexity of                         According to the Type of Service
                    the Services Provided


Type                      Service                              Type                       Example


                          Health Promotion, Preventive Care,   Health Promotion and       Information Dissemination
                          Continuing Care for common           illness Prevention
Primary                   health problems, attention to
                          psychological and social care,
                          referrals

                          Surgery, Medical services by         Diagnosis and Treatment    Screening
Secondary                 Specialists

                          Advanced, specialized, diagnostic,
Tertiary                  therapeutic & rehabilitative care    Rehabilitation             PT/OT
LEVELS OF PREVENTION
      PRIMARY LEVEL                     SECONDARY LEVEL                       TERTIARY LEVEL
  Health Promotion and Illness   Prevention of Complications thru Early    Prevention of Disability, etc.
          Prevention                           Dx and Tx

Provided at –                  ! When hospitalization is     deemed ! When highly-specialized medical
! Health care/RHU                  necessary and referral is made to   care is necessary
! Brgy. Health Stations            emergency (now district), ! referrals are made to hospitals and
!Main Health Center                provincial or regional or private   medical center such as PGH,
!Community Hospital and Health     hospitals                           PHC, POC, National Center for
   Center                                                              Mental Health, and other gov’t
!Private and Semi-private                                              private hospitals at the municipal
   agencies                                                            level
Referral System in Levels of the Health Care:

ü  Barangay Health Station (BHS) is under the
    management of Rural Health Midwife (RHM)
ü  Rural Health Unit (RHU) is under the management or
    supervision of PHN
ü  Public Health Nurse (PHN) caters to 1:10,000
    population, acts as managers in the implementation of
    the policies and activities of RHU, directly under the
    supervision of MHO (who acts as administrator)
REFERRAL SYSTEM:


BHS→ RHU→ MHO→ PHO→
 RHO→ National Agencies→
 Specialized Agencies
CHARACTERISTICS OF PHC

Acceptable
Accessible
Affordable
Available
Sustainable
Attainable
 
UTILIZES APPROPRIATE TECHNOLOGIES USED
  BY PHC: ACCEFS

A ffordable, accessible, acceptable, available
C ost wise=economical in nature
C omplex procedures which provide a simple
   outcome
E ffective
F easibility of use=possibility of use at all times
S cope of technology is safe & secure
SENTRONG SIGLA MOVEMENT (SSM)
was established by DOH with LGUs having a logo of
  a Sun with 8 Rays and composed of 4 Pillars:

1.    Health Promotion
2.    Granted Facilities
3.    Technical Assistance
4.    Awards: Cash, plaque, certificate
4 CONTRIBUTIONS OF PHC TO DOH &
ECONOMY:

  § Training of Health Workers
  § Creation of Botika sa Baryo & Botika
    sa Health Center
  § Herbal Plants
  § Oresol
A. TRAINING OF HEALTH WORKERS
3 Levels of Training:
Grassroot/Village
  § Includes Barangay Health Volunteers (BHV) and Barangay Health
     Workers (BHW)
  § Non professionals, didn’t undergo formal training, receive no
     salary but are given incentive in the form of honorarium from the
     local government since 1993
Intermediate - these are professionals including the 8 members of the
   PHWs
First Line Personnel - the specialist
B. CREATION OF “BOTIKA SA BARYO &
                 BOTIKA SA HEALTH CENTER”
RA 6675: Generics Act of 1988: Implementing
“Oplan Walang Reseta Program”-solution to the absence of a
  medical officer who prescribed the medicines so PHN are
  given the responsibility to prescribe generic medicines and
“Walong Wastong Gamot Program”- available generics in “Botika
  sa Baryo” & Health Center

§ Father of Generics Act: Dr. Alfredo Bengzon
8 COMMONLY AVAILABLE GENERICS (CARIPPON)

Co-Trimoxazole:
 § it’s a combination of 2 generics of drugs which is antibacterial
     Trimethoprim(TMP)
     § Has a bacteriostatic action that stops/inhibits multiplication
        of bacteria
     § For GUT, GIT & URTI (TMP combined with SMX)
     Sulfamethoxazole (SMX)
     § Has bactericidal action that kills bacteria
     § For GUT, GIT, URTI & Skin Infections
8 COMMONLY AVAILABLE GENERICS (CARIPPON)

Amoxicillin/Ampicillin
§ An antibacterial drug that comes from the Penicillin
  family
§ Effect is generally bacteriostatic (when source of
  infection is bacterial)
§ These 2 drugs provide the least sensitivity reaction
  (rashes & GI) and the adverse effect of other antibiotics
  is anaphylactic shock
8 COMMONLY AVAILABLE GENERICS (CARIPPON)

TB DRUGS:
Rifampicin (RIF)
Isoniazid (INH)
Pyrazinamide (PZA)
8 COMMONLY AVAILABLE GENERICS (CARIPPON)

Paracetamol
Has an analgesic & anti-pyretic effect

Acetyl Salicylic Acid (ASA) or Aspirin is never kept in the
  “Botika” because of its effects:
   § Anticoagulant-highly dangerous to Dengue patients
      that’s why it’s not available in “Botika” & Health Center
8 COMMONLY AVAILABLE GENERICS (CARIPPON)

Oresol:
a management for diarrhea to prevent dehydration
  under the Control of Diarrheal Diseases (CDD)
  Program
8 COMMONLY AVAILABLE GENERICS (CARIPPON)

Nifedipine:
         § An anti-hypertensive drug
         § According to DOH, 16% of population
            belonging to 25 years old & above in the
            community are hypertensive
C. HERBAL PLANTS

RA 8423: Alternative Traditional Medicine Law
a program where patient may opt to use herbal plants
    especially for drugs that are not available in dosage
    form or patients has no financial means to buy the
    drug
Traditional Medicine:
§ Use of herbal plants
10 ADVOCATED HERBAL PLANTS BY DOH:
   LUBBY SANTA


Lagundi   Vitex     Asthma,        Leaves   Decoction
          negundo   cough, colds &          Poultice
                    fever (ASCOF)
                    Pain and
                    inflammation
10 ADVOCATED HERBAL PLANTS BY DOH:
   LUBBY SANTA

Ulasimang Peperonia Gout           Leaves Decoction
Bato      pellucida Arthritis             Poultice
                      Rheumatism
10 ADVOCATED HERBAL PLANTS BY DOH:
   LUBBY SANTA

Bayabas   Psidium   Diarrhea Leaves     Decoction
          quajava   Toothache
                    Mouth and
                    wound
                    wash
10 ADVOCATED HERBAL PLANTS BY DOH:
   LUBBY SANTA

Bawang   Allium    HPN       Clove/Bulb Poultice
         sativum   Toothache
10 ADVOCATED HERBAL PLANTS BY DOH:
  LUBBY SANTA

Yerta   Mentha     Same as   Leaves   Decoction
Buena   cordifelia Lagundi            Poultice
                   except
                   asthma
10 ADVOCATED HERBAL PLANTS BY DOH:
  LUBBY SANTA

Sambong Blumea      Edema Leaves   Decoction
        balsanifera Diuretic
10 ADVOCATED HERBAL PLANTS BY DOH:
   LUBBY SANTA
Akapulko Cassia   All forms   Leaves   Decoction
         alata    of skin              Poultice
                  diseases             Cream
10 ADVOCATED HERBAL PLANTS BY DOH:
   LUBBY SANTA

Niyog   Quisqualis Intestinal  Seeds   Decoction
niyogan indica     Parasitism          Poultice
                   (Nematodes)         Juice
10 ADVOCATED HERBAL PLANTS BY DOH:
   LUBBY SANTA
Tsaang   Carmona   Diarrhea    Leaves   Decoction
Gubat    resuta    Infantile            Poultice
                   colic
                   (Kabag)
                   Dental
                   caries
10 ADVOCATED HERBAL PLANTS BY DOH:
   LUBBY SANTA
Ampalaya Mamordica Type II    Leaves Decoction
         charantia Diabetes
                   (NIDDM)
POLICIES TO ABIDE:

Know indications
Know parts of plants with therapeutic value: roots,
  fruits, leaves
Know official procedure/preparation
Procedures/Preparations:

    Decoction
Ø  Gather leaves & wash thoroughly, place in a
    container the washed leaves & add water
Ø  Let it boil without cover to vaporize/steam to
    release toxic substance & undesirable taste
Ø  Use extracts for washing
PROCEDURES/PREPARATIONS:

    Poultice
Ø  Done by pounding or chewing leaves used by
    herbolaryo
Ø  Example: Akapulko leaves-when pounded, it releases
    extracts coming out from the leaves contains enzyme
    (serves as anti-inflammatory) then apply on affected
    skin or spewed it over skin
Ø  For treatment of skin diseases
PROCEDURES/PREPARATIONS:

Infusion

To prepare a tea (use lipton bag), keep standing
for 15 minutes in a cup of warm water where a
brown solution is collected, pectin which serves
as an adsorbent and astringent
PROCEDURES/PREPARATIONS:
   Juice/Syrup

To prepare a papaya juice, use ripe papaya &
mechanically mashed then put inside a blender
& add water

To produce it into a syrup, add sugar then heat to
dissolve sugar & mix it
PROCEDURES/PREPARATIONS:
Cream/Ointment

Start with poultice (pound leaves) to turn it semi-solid

Add flour to keep preparation pasty & make it adhere to skin
lesions

To make it into an ointment: add oil (mineral, baby or any oil-
serves as moisturizer) to the prepared cream to keep it
lubricated while being massage on the affected area
D. ORESOL
Glucose                  20 grams    1° Significance:
                                     For re-absorption of Na
                                     Facilitates assimilation of
                                     Na
                                     2° Significance:
                                     Provides heat & energy
Sodium Chloride/NaCl     3.5 grams   For retention of water/fluid
Sodium                   2.5 grams   Buffer content of solution
Bicarbonate/NaHCO3                   Neutralizer content of
                                     solution
Potassium Chloride/KCl   1.5 grams   Stimulates smooth muscle
                                     contractility especially the
                                     heart & GIT
PREPARATION OF PROPER HOMEMADE
   ORESOL

A volume or one liter homemade oresol   Smaller volume or a glass homemade
                                        oresol
Water 1000 ml. or 1 liter               250 ml.
Sugar 8 teaspoon                        2 teaspoon
Salt 1 teaspoon                         ! teaspoon or a pinch of salt=10-12
                                        granules of rock salt: iodized salt=tips of
                                        thumb & index finger are penetrated with
                                        salt
UNIVERSAL HEALTH CARE (UHC), ALSO
  REFERRED TO AS KALUSUGAN
  PANGKALAHATAN (KP)

is the “provision to every Filipino of the highest
   possible quality of health care that is accessible,
   efficient, equitably distributed, adequately funded,
   fairly financed, and appropriately used by an
   informed and empowered public”
UNIVERSAL HEALTH CARE (UHC), ALSO
     REFERRED TO AS KALUSUGAN
     PANGKALAHATAN (KP
The Aquino administration puts it as the availability
    and accessibility of health services and
    necessities for all Filipinos.
It is a government mandate aiming to ensure that
    every Filipino shall receive affordable and quality
    health benefits.This involves providing adequate
    resources – health human resources, health
    facilities, and health financing.
UHC’S THREE THRUSTS

1)  Financial risk protection through expansion in
    enrollment and benefit delivery of the
    National Health Insurance Program (NHIP);
2)  2) Improved access to quality hospitals and
    health care facilities; and
3)  3) Attainment of health-related Millennium
    Development Goals (MDGs).
FINANCIAL RISK PROTECTION


Protection from the financial impacts of health care is
  attained by making any Filipino eligible to enroll, to
  know their entitlements and responsibilities, to avail
  of health services, and to be reimbursed by
  PhilHealth with regard to health care expenditures.
MPROVED ACCESS TO QUALITY HOSPITALS AND
    HEALTH CARE FACILITIES
Improved access to quality hospitals and health facilities
  shall be achieved in a number of creative approaches.
  First, the quality of government-owned and operated
  hospitals and health facilities is to be upgraded to
  accommodate larger capacity, to attend to all types of
  emergencies, and to handle non- communicable
  diseases.
The Health Facility Enhancement Program
  (HFEP) shall provide funds to improve facility
  preparedness for trauma and other
  emergencies. The aim of HFEP was to upgrade
  20% of DOH- retained hospitals, 46% of
  provincial hospitals, 46% of district hospitals,
  and 51% of rural health units(RHUs) by end of
  2011.
ATTAINMENT OF HEALTH-RELATED MDGS
Further efforts and additional resources are to be applied on
  public health programs to reduce maternal and child mortality,
  morbidity and mortality from Tuberculosis and Malaria, and
  incidence of HIV/AIDS. Localities shall be prepared for the
  emerging disease trends, as well as the prevention and control
  of non- communicable diseases.
The organization of Community Health Teams (CHTs) in each
  priority population area is one way to achieve health-related
  MDGs. CHTs are groups of volunteers, who will assist families
  with their health needs, provide health information, and
ATTAINMENT OF HEALTH-RELATED MDGS
RNheals nurses will be trained to become trainers and supervisors to
  coordinate with community-level workers and CHTs. By the end of
  2011, it is targeted that there will be 20,000 CHTs and 10,000
  RNheals.
Another effort will be the provision of necessary services using the life
  cycle approach. These services include family planning, ante-natal
  care, delivery in health facilities, newborn care, and the
  Garantisadong Pambata package.
Better coordination among government agencies, such as DOH,
  DepEd, DSWD, and DILG, would also be essential for the
  achievement of these MDGs.
GOAL 1: ERADICATE EXTREME POVERTY AND
   HUNGER

Target :    Halve, between 1990 and 2015, the
  proportion of people whose income is less than one
  dollar a day

Target :    Halve, between 1990 and 2015, the
  proportion of people who suffer from hunger
GOAL 2:   ACHIEVE UNIVERSAL PRIMARY
EDUCATION


Target :   Ensure that, by 2015, children
  everywhere, boys and girls alike, will be able to
  complete a full course of primary schooling
GOAL 3: PROMOTE GENDER EQUALITY AND
  EMPOWER WOMEN

Target :     Eliminate gender disparity in primary and
  secondary education preferably by 2005 and to all
  levels of education no later than 2015
GOAL 4:    REDUCE CHILD MORTALITY


Target :  Reduce by two-thirds, between 1990
  and 2015, the under-five mortality rate
GOAL 5:    IMPROVE MATERNAL HEALTH


Target :  Reduce by three-quarters, between
  1990 and 2015, the maternal mortality ratio
GOAL 6:   COMBAT HIV/AIDS, MALARIA AND
  OTHER DISEASES

Target :    Have halted by 2015 and begun to
  reverse the spread of HIV/AIDS

Target :    Have halted by 2015 and begun to
  reverse the incidence of malaria and other major
  diseases
GOAL 7:   ENSURE ENVIRONMENTAL
     SUSTAINABILITY
Target :    Integrate the principles of sustainable
  development into country policies and programmes and
  reverse the loss of environmental resources
Target :   Halve, by 2015, the proportion of people
  without sustainable access to safe drinking water
Target:     By 2020, to have achieved a significant
  improvement in the lives of at least 100 million slum
  dwellers
GOAL 8:   DEVELOP A GLOBAL PARTNERSHIP
      FOR DEVELOPMENT
Target : Develop further an open, rule-based, predictable, non-
   discriminatory trading and financial system
Target: Address the special needs of the least developed countries
Target: Address the special needs of landlocked countries and small
   island developing States
Target: Deal comprehensively with the debt problems of developing
   countries through national and international measures in order to
   make debt sustainable in the long term
FIELD HEALTH SERVICE INFORMATION SYSTEM
      (FHSIS)
• It is a network of information

• It is intended to address the short term needs of DOH and LGU
   staff with

managerial or supervisory functions in facilities and program
 areas.

• It monitors health service delivery nationwide.
OBJECTIVES OF FHSIS
To provide summary data on health service delivery and selected
   program accomplishment indicators at the barangay, municipality/
   city, and district, provincial, regional and national levels.
To provide data which when combined with data from other sources,
   can be used for program monitoring and evaluation purposes.
To provide a standardized, facility-level data base that can be accessed
   for more in-depth studies.
To minimize the recording and reporting burden at the service delivery
   level in order to allow more time for patient care and promote
   activities.
IMPORTANCE OF FHSIS
• Helps local government determine public health priorities.
• Basis for monitoring and evaluating health program implementation.
• Basis for planning, budgeting, logistics and decision making at all
levels.
• Source of data to detect unusual occurrence of a disease.
• Needed to monitor health status of the community.
• Helps midwives in following up clients.
• Documentation of RHM/PHN day to day activities.
COMPONENTS OF FHSIS

1.    Individual Treatment Record (ITR)
2.    Target Client List (TCL)
3.    Summary Table
4.    The Monthly Consolidation Table (MCT)
INDIVIDUAL TREATMENT RECORD (ITR)
The fundamental building block or foundation of the Field
  Health Service Information System is the INDIVIDUAL
  TREATMENT RECORD.
This is a document, form or piece of paper upon which is
  recorded the date, name, address of patient, presenting
  symptoms or complaint of the patient on consultation
  and the diagnosis (if available), treatment and date of
  treatment.
TARGET CLIENT LIST (TCL)
The Target Client Lists constitute the second “building block”
  of the FHSIS and are intended to serve several purposes

First is to plan and carry out patient care and service
   delivery. Such lists will be of considerable value to
   midwives/nurses in monitoring service delivery to clients
   in general and in particular to groups of patients
   identified as “targets” or “eligibles” for one or another
   program of the Department
TARGET CLIENT LIST (TCL)

The second purpose of Target Client Lists is to facilitate
  the monitoring and supervision of service delivery
  activities.
The third purpose is to report services delivered.


The fourth purpose of the Target Client Lists is to
  provide a clinic-level data base which can be
  accessed for further studies
TARGET CLIENT LISTS TO BE MAINTAINED IN
     THE FHSIS
1.  Target Client List for Prenatal Care
2.  Target Client List for Post-Partum Care
3.  Target Client List of Under 1 Year Old Children
4.  Target Client List for Family Planning
5.  Target Client List for Sick Children
6.  NTP TB Register
7.  National Leprosy Control Program Form 2-Central Registration
    Form
SUMMARY TABLE
The Summary Tables is a form with 12-month columns retained at
  the facility (BHS) where the midwife records monthly all
  relevant data. The Summary Table is composed of:
(1)  Health Program Accomplishment this can serve as proof of
     accomplishments to show LGU officials whenever they visit
     the facility.
(2)  Morbidity Diseases the source of ten leading causes of
     morbidity for the municipality/city. This summary table will
     help the nurse and MHO to get the monthly trend of diseases.
THE MONTHLY CONSOLIDATION TABLE (MCT)

ü  The Consolidation Table is an essential form in the
    FHSIS where the nurse at the RHU records the
    reported data per indicator by each BHS or midwife.
ü  This is the source document of the nurse for the
    Quarterly Form.
ü  The Consolidation Table shall serve as the Output
    Table of the RHU as it already contains listing of BHS
    per indicator.
FHSIS REPORTING

These are summary data that are transmitted or
  submitted on a monthly, quarterly and on annual
  basis to higher level. The source of data for this
  component is dependent on the records.
THE MONTHLY FORM
Program Report (M1)
The Monthly Form contains selected indicators categorized as
  maternal care, child care, family planning and disease
  control.
Morbidity Report (M2)
The Monthly Morbidity Disease Report contains a list of all
  diseases by age and sex. The Midwife uses the form for
  the monthly consolidation report of Morbidity Diseases and
  is submitted to the PHN for quarterly consolidation.
THE QUARTERLY FORM
Program Report (Q1)
The Quarterly Form is the municipality/city health report and
  contains the three-month total of indicators categorized as
  maternal care, family planning, child care, dental health and
  disease control
Morbidity Report (Q2)
The PHN uses the form for the Quarterly Consolidation Report of
  Morbidity Diseases to consolidate the Monthly Morbidity
  Diseases taken from the Summary Table.
THE ANNUAL FORMS (A-BHS, A1, A2 & A3)
ABHS Form is the report of midwife which contains data on demographic,
environmental and natality.


The report of nurse at the RHU/MHC are the Annual Form 1 which is the report
   on vital statistics: demographic, environmental, natality and mortality.


Annual Form 2 is the report that lists all diseases and their occurrence in the
   municipality/city. The report is broken down by age and sex.


Annual Form 3 is the report of all deaths occurred in the municipality/city. The
report is also broken down by age and sex.
FLOW OF REPORT
OFFICE    PERSON    RECORDING   FORMS          FREQUENCY   SCHEDULE OF
                    TOOLS                                  SUBMISION

BHS       Midwife   -  ITR      Monthly Form Monthly       Every 2nd week of the
                    -  TCL      (M1 & M2)                  succeeding month
                    -  ST
                                A-BHS Form     Annually    Every 2nd week of
                                                           January



RHU       PHN       -  ST       Quarterly      Quarterly   Every 3rd week of the 1st
                    -  MCT      Form                       month of succeeding
                                (Q1 & Q2)                  quarter

                                Annual Forms               Every 3rd week of
                                -  A1                      January
                                -  A2
                                -  A3
Fertility
§ Crude Birth Rate (CBR) - Overall total reported births

Morbidity-Illnesses affecting the population group
§ Incidence Rate (IR)-reported new cases affecting the
  population group
§ Prevalence Rate (PR)-determine sum total of new + old
  cases of diseases per percent population
Mortality-Reports causes of deaths
§ Crude Death Rate (CDR)-overall total reported death
§ Maternal Mortality Rate (MMR)-maternal deaths due to
  maternal causes
§ Infant Mortality Rate (IMR)-# of infant deaths (0-12
  months) or less than 1 year old
§ Neonatal Mortality Rate (NMR)-# of deaths among
  neonates (newborn 0-28 days, < 1 month)
§ Swaroops Index (SI)-deaths among individual in the age
  group of 50 and above
CRUDE BIRTH RATE (CBR)


CBR= Overall total reported births                   x   1000
      --------------------------------------------
                  Population
INCIDENCE RATE (IR)



IR= new cases of disease                   x   100
    ------------------------------------
             Population
PREVALENCE RATE (PR):


PR= new cases + old cases x                  100
    --------------------------------------
            Population
CRUDE DEATH RATE (CDR)


CDR = overall total deaths x               1000
      ----------------------------------
                Population
MATERNAL MORTALITY RATE (MMR)


MMR= # of maternal deaths x               1000
     ----------------------------------
                   RLB
INFANT MORTALITY RATE (IMR)


IMR = # of infant deaths                 x   1000
     ---------------------------------
                 RLB
NEONATAL MORTALITY RATE (NMR)


NMR = # of neonatal deaths x                   1000
     ---------------------------------------
                RLB
SWAROOP’S INDEX (SI)


SI= # of deaths (individual >50 years old)                         x   100
    ------------------------------------------------------------
                    Total Deaths
FAMILY HEALTH NURSING PROCESS

a systematic approach of solving an existing
   problem/meeting the needs of family
R apport
A ssessment
P lanning
I ntervention
E valuation
I. RAPPORT


ü  Trust building
ü  Knowing your client
ü  Adjusting to the situation and environment
ü  RESPECT
II. ASSESSMENT
Data Gathering: tools or instruments used during
survey:
ü Interview
ü Observation
ü Questionnaires-mostly patronized & used in CHN
ü Records & Reports available

Consolidation or Collation: collecting back the
 questionnaires, tabulate and summarize
Validation: uses statistical approaches

Statistical Approaches:
1. Central Tendencies: 3 M’s
Mean=average
Median=range (Highest – Lowest Score)
Mode=frequency of occurrence of a variable, used if
   there’s too many variable occur
2. Standard Deviation: used if there are too many
   variables available to be treated which is seldom
   used in CHN
 
SD=√ ∑ (x-x)        ∑=summation of
      n-1           x=variables available
                   x=mean (given special attention)
                   n=# of existing variables
3. Percentile (%) Method:
most commonly used in CHN by adding all cores
   then multiply by 100
Presentation of Data
                                            Sales
                                  Series
1. Table/Chart      Categ         1                1st Qtr
                    Categ
                                 Series
2. Graph:           Categ
                                 2
                                                   2nd Qtr
                    Categ
Pie                              Series
                        0 20     3      6
Bar-2 variables only                    4            Series
                                        2            1
Line                                    0
                                                     Series




                                           Catego
                                           Catego
                                           Catego
                                           Catego
                                                     2
Polygon-connecting the results
Histograph-2 or more variables & appear adjacent to
   each other
TYPOLOGY OF NURSING PROBLEMS

A. First Level Assessment: to determine problems of
   family
Sources of Problems using IDB
Family: use of Initial Data Base (IDB)
Nature: Health Deficit (HD), Health Threat (HT),
   Foreseeable Crisis (FC)
USE OF INITIAL DATA BASE (IDB):
   1. Family Chart Structure:
Nuclear -Father, mother, children
Extended (3rd generation)-Relatives staying with the family
Multi-generational extended-“apo sa tuhod” or “apo sa talampakan”
Dyad -Husband & wife only (childless couple)
Blended -widow married another widow & have children
Gay -Same sex living together
Matriarchal -Mother is the decision maker
Patriarchal -Father is the decision maker
Communal -different families forming a community
2. Socio-economic: poverty level, educational
attainment & nature of occupation of members
of the family (sources of income)

3. Socio-cultural: different nature of religion

4. Home environment: assessment according to
ES, treatment of garbage, preparation of food,
availability of toilet, water & food sanitation,
sources of diseases
4. Medical history: history of certain disease, family
  member with disease

   5. Resources available in community for use by the
   family:
5 Generalized M’s in resources available in community:
     § Man/Manpower
     § Money
     § Machine
     § Materials
     § Methods
DEFINE THE PROBLEM AFTER IDENTIFYING IT
ACCORDING TO NATURE

Health Deficit (HD)
- if identified problem is an abnormality, illness
    or disease, there’s a gap/difference between
    normal status (ideal, desirable, expected) &
    actual status (the outcome/result/problem
    encountered on that actual day)
Health Threat (HT)
-any condition or situation which will be conducive
  to health alteration, health interference & health
  disturbance.


Foreseeable Crisis (FC)
-stress points, anything which is anticipated/
   expected to become a problem
Jobless Father
Suffering from TB
                          th
Wife is pregnant for the 8 time
2 y/o youngest child lacks immunization
                       rd
9 y/o eldest child is 3 degree
malnourished
Poor environmental sanitation
III. PLANNING

     Four (4) Standard Steps:
Prioritization -start if there are multiple identified
  problems
Formulation of objectives -planning a procedure will
  start here if there is only one problem
Developing strategies of action
Formulation of evaluation tools for the identified
  strategy developed
CRITERIA IN IDENTIFYING THE PROBLEM
Criteria                      Score   Weight
I. Nature: assess by PHW
   Health deficit (HD)        3       1
   Health threat (HT)         2
   Foreseeable Crisis (FC)    1
II. Modifiability
   Easily                     2       2
   Intermediate (moderate)    1
   Not modifiable             0
III. Preventive Potential
     Highly                   3       1
     Moderate                 2
     Low                      1
IV. Salience of the Problem
     Problem needing urgent   2       1
     attention
     Problem not needing      1
     urgent attention
     Not a felt problem       0
§ Steps:
a. Decide on a score
b.  Score              x     weight
   -----------------
 Highest Score
b.  Get the sum total of all the scores
§ Interpretation:
Perfect score=5, if score nearing 5 then prioritize the problem
Criteria 1, 2 & 3 has to be assessed objectively by the health
   worker
Criteria 4 has to be assessed by the perception of the family
Compute for 3rd Degree Malnutrition
IV. INTERVENTION

ü Is the capacity to provide management
ü Is the professional phase of nursing process
ü Is the time when the PHN executes the standard
 function of an RN
ü Three (3) Standard Functions of RN:
  § Dependent-giving of medicines
  § Independent-monitor, assess, provide, educate
  § Interdependent-referrals
V. EVALUATION
Three (3) Things to be evaluated: SPO
1.  Structure of program & activity -what articles, equipments, supplies are
    utilized
2.  Process utilized -steps used
3.  Outcome of activity -results can be:
§ Desirable -to be implemented, advocated, strengthen
§ Undesirable -to be avoided
Two (2) Aspects to be evaluated in the Outcome:
§ Quality -characteristic or kind of outcome; no numerical value, not measurable
§ Quantity -from the word “quantum”, with numerical value, measurable
OBJECTIVES OF COPAR
Patterns to be followed:
1.  Organize people
2.  Mobilize people
3.  Work with people
4.  Educate people
ü  Knowledge
ü  Attitude
ü  Skills
PHASES OF COPAR

1. Preparatory
2. Organizing
3. Mobilizing
4. Educating
5. Collaborating
6. Phase Out
1. PREPARATORY PHASE
A. Area of Selection
    § It should be DOPE Community: Depressed,
       Oppressed, Poor & Exploited, a new criteria for
       community organization
    § “Old Criteria”→ it must be a virgin
       community=meaning no agency has gone there.
    § This is a dangerous situation that’s why RA 7305:
       Magna Carta for Public Workers was provided-a PHN
       is to receive a hazard pay of 20-25% of monthly
       salary
1. PREPARATORY PHASE

B. Entry: the 1st thing to do upon entering the
  community is to have a courtesy call with the
  Barangay
1. PREPARATORY PHASE

C. Integration/Immersion
    § Immersion is imbibing the life situation/
       condition of the community by living, eating &
       sleeping with the family to be able to
       understand their situation
    § It requires 2 Qualities of PHN:
        § Empathy
        § Sympathy (Integration)
1. PREPARATORY PHASE

D. Community Study: Diagnosis of Community-COPAR
   § Makes use of the Nursing Process/Problem
      Solving Approach
   § Prioritized which among the problems identified
      is to be attended 1st like in nature, magnitude,
      modifiability, preventive potential, salience
PRIORITIZATION OF COMMUNITY PROBLEMS
NATURE
Health Status (HS)               3
Health Resource(s)               2
Health Related                   1

Indicators of Health Status/Condition:
Fertility: ↑ CBR=community is overpopulated=HS
Morbidity: IR (new cases) & PR (old cases)=HS
Mortality: Deaths like children dying of pneumonia=HS
PRIORITIZATION OF COMMUNITY PROBLEMS
NATURE
Health Status (HS)                 3
Health Resource(s)                 2
Health Related                     1

Health Resource(s):
5 M’s-Manpower/Man, money, machinery, material & methods
(+) available facilities-Hospital/Clinic, mode of transportation,
    market, school & movie houses for recreation
PRIORITIZATION OF COMMUNITY PROBLEMS
   NATURE
   Health Status (HS)                  3
   Health Resource(s)                  2
   Health Related                      1

Health Related: Categories according to 5 Aspects of Man=PEMSS
P hysical, P hysiological, P sychological
E motional
M ental
S ocial
S piritual
MAGNITUDE OF THE PROBLEM: % of population affected by the identified
problem
75-100%                    4
50-74 %                    3
25-49 %                    2
<25 % of the population    1
MODIFIABILITY
Easily                     3
Intermediate               2
Low                        1
Not modifiable             0
PREVENTIVE POTENTIAL
Highly                     3
Moderate                   2
Low                        1
SALIENCE
2. ORGANIZING PHASE
Choosing Potential Community Leaders
Core Group Formation
Community Assembly: Community Organizing Participatory Action
  Research (COPAR)
   § Attend the assembly of the family/families
   § Families in the community should be represented, any
      family members can represent his/her family as long as he/
      she is a RESPONSIBLE (one who also can comprehend)
      member of that family.
   § Barangay Captain/Chairman need not necessary be the
      leader. He can recommend
3. MOBILIZATION PHASE

Mobilization
- let the members of the community do the work.
   PHN should only SUPERVISE
4. HEALTH EDUCATION

ü Adjust on the level of understanding of the
   community
ü Return demonstration is the best way of
   teaching
ü Focus on the KSA
ü Respect of the custom and tradition
5. COLLABORATING



6. PHASE OUT
EPIDEMIOLOGY
is the pattern of occurrences & distribution of diseases, defects &
    deaths
                                      2 Population in Distribution
Patterns               Susceptible                   Immune
                       (at risk to develop, acquire (those      that     did not
                       or experience the disease)    experience the disease,
                                                     usually individuals develop
                                                     resistance      against the
                                                     disease)
Epidemic               80% (more than 50%)           20%
Endemic                50%                           50%
Sporadic               20%                           80%
Pandemic               -----                         -----
EPIDEMIC
§ Greater than 50% of populations are susceptible or less immune
   individual
§ Greater % of the population is affected by the occurring disease

Example: Health worker reports that Community Lanting has an
epidemic of measles affecting children less than 7 years old
Total susceptible population: 3000
Children affected by measles: 1750
1750
ENDEMIC
The disease occurs regularly, habitually, constantly affecting the
  population group
2 Local Endemic Diseases: where causative agent is available on
     those places
§ Schistosomiasis: Samar, Leyte, Mindoro, Davao
§ Malaria: Palawan & Mindanao-reasons why it’s prevalent
   § Forested areas
   § Surrounded by bodies of water
SPORADIC

§ The pattern of occurrence is on & off where:
      On=available causative agent
      Off=no available causative agent
§ It’s intermittent (unpredictable) in occurrence
§ Disease occurs only if there’s a susceptible host
   like in rabies
PANDEMIC

Worldwide, international, universal, global in
 occurrence like in AIDS, Hepatitis B, PTB, measles,
 mumps, diphtheria, pneumonia

§ SARS is categorized by WHO as an OUTBREAK only
  because out of 191 nations, 33 countries are
  reported to have it.
HOME VISIT

ü  Is a PROFESSIONAL contact between PHN &
    the family

ü  The services provided is an extension of the
    Health Service Agency (Health Center)
OBJECTIVES OF HOME VISIT

 § Assessment
 § Nursing Care
 § Treatment
 § Health Education
 § Referral (if care fails)
PRIORITIES (IN THE CARE): TO PREVENT CROSS
   CONTAMINATION
1.  Newborn
2.  Post partum
3.  Pregnant mothers
4.  Morbid cases
The families need the assistance of the health center that’s why
  home visit was done to the family
The person who makes the home visit is rendering services on
  behalf of the health center
PHASES OF HOME VISIT:

1. Planning
ü Starts at the health center
ü Makes a study on the status of the family
ü Statement of the problem
ü Formation of objective
2. Socialization –first activity is to establish rapport
   & to gain the trust of the family
PHASES OF HOME VISIT:
3. Activity
ü  Intervention/Professional Phase
ü  Opportunity to provide or extend health services
ü  Standard Role of the Nurse: Independent, Dependent and
    Interdependent
ü  To be effective, come in complete uniform (also bring a long
    umbrella with pointed end which serve as protection)
4. Summarization - ability to put into record & report
   (orally) about the outcome of the activity
PUBLIC HEALTH BAG:


Indispensable tool that should be organize to
  save time & effort and to prevent cross
  infection & contamination
GUIDING PRINCIPLES IN THE USE OF PUBLIC
    HEALTH BAG:

§ Content -should be prepared by the one who will
   make home visit
   Note: BP Apparatus is kept separately from PHN bag

§ Cleaning
   ü The inner part of the bag should be clean & sterile
   ü Should be done every after home visit
   ü Never endorse the bag
GUIDING PRINCIPLES IN THE USE OF PUBLIC
HEALTH BAG:
 § Contamination
    § The less one opens the bag, the lesser
       chance of contamination
    § In general, the bag is open 3x:
        ü Putting out materials for hand washing
        ü Putting out materials used for nursing
         care
        ü Returning all what have been used
GUIDING PRINCIPLES IN THE USE OF PUBLIC
HEALTH BAG:


Care of Communicable Case(s)
- should be disinfected with the use of 70%
   isopropyl alcohol or Lysol which should be
   done at the health center and not at home
POLICIES FOR SCHISTOSOMIASIS CONTROL
PROGRAM (SCP): CHES

C ase Finding
H ealth Education
E nvironmental Sanitation
S nail Eradication
CASE FINDING:
6 Aspects or Thing to Know
§ Disease: Schistosomiasis
§ Other name: Bilhariasis or Snail Fever
§ Causative agent: Schistosoma-a blood fluke (parasite)
   3 Types of Species:
     ü Schistosoma japonicum-endemic in the Philippines &
      affecting Indonesia, China, Japan, Korea Vector: Oncomelania
      quadrasi
     ü Schistosoma mansoni
     ü Schistosoma haematobium
§ Laboratory Procedures to rule out Schistosomiasis:
    Blood Examination: ↑ eosinophil level indicates parasitism
    Fecalysis: Kato Katz (plain stool exam that uses a special
                 apparatus resembling a feeding bottle sterilizer)
       Procedure:
         ü Collect specimen
         ü Have the test tube undergo centrifugation for 20
          minutes
         ü Get specimen from precipitate & swab it on glass slide
         ü Observe it on microscope
§ Signs & Symptoms

ü CNS: High grade fever→ cerebral convulsion
ü GIT: Nausea & vomiting, Diarrhea→ Chronic dysentery
 (prolonged diarrhea of more than 2 weeks & consistency is
 mucoid & bloody (with streaks of blood)
ü Liver: Presence of infection manifested by jaundice &
 hepatomegaly
ü Spleen: Infection of spleen→ inflammation→ enlargement of
 organ (Splenomegaly)→ abdominal distension→ abdominal
 pain on the right upper quadrant
ü Blood: Anemia & weakness
§ Treatment: Drug of Choice-Praziquantel (Biltricide)
                 60 mg/KBW/day
   ü Example: If patient is 50 kg, 50 kg x 60 mg/KBW/day=3000
     mg/day
   ü Initial treatment: 1st 2 weeks=3000 mg/day, then do stool
     exam after 2 weeks→ if still (+), extend treatment for another
     2 weeks. Repeat stool exam, if still (+) after the extended
     week, continue treatment for 2 weeks again. No adverse
     effect or over dosage even if extended for a year.
   ü Length of Treatment: takes months to a year
Health Education: It affects mostly farmers so educate them to
  wear rubber boots
Environmental Sanitation:
          Snail is the 1st concern
          Water where snail thrives is the 2nd concern
          Toilet=3rd concern
           Food
           Garbage
Snail Eradication: Use molluscicides treat the entire suspected
  soil with chemical solution that kills snails
CASE FINDING:
§ Disease: Malaria
§ Other name: Ague
§ Causative Agent: Plasmodium-a protozoa
    4 Types of Species:
     ü Plasmodium falciparum-more fatal that affects the Philippine
           Vector: Female Anopheles Mosquito (FAM)
     ü Plasmodium vivax
     ü Plasmodium ovale
     ü Plasmodium malariae
§ Laboratory Procedure: Malarial smear-extract blood at the
   height of fever because plasmodium is very active & ruptures
   at this period.

§ Signs & Symptoms of Malaria:
1st Stage=Cold: Chilling sensation for 1-2 hours
2nd Stage=Hot: High grade fever lasting for 3-4 hours
3rd Stage=Wet: Diaphoresis (excessive sweating/perspiration)
§ Treatment: Drug of Choice-Quinine
    2 Forms:
        a) Chloroquine (Aralen)
        b) Primaquine


If Quinine is not available, may use Sulfadoxime-an
   antibacterial drug paired with pyrinthamine
PERSONAL PROTECTION:

§ Sleep under a mosquito net
§ Sleep in a screened room
§ Sleep with long sleeve attire
§ Use repellents that contains DET (diethyl toluamide or
  toluene which has a pungent odor that drives away
  mosquitoes & an irritant to mucous membrane of
  respiratory tract when inhaled
§ Plant a Neem Tree using the leaves
CLEAN:
  Chemical Method=insecticide spraying at night
  Larvae eating fish=Tilapia
  Environmental Sanitation & Health
  Education=insect, water, trash
  Anti-mosquito soap=basil citronelli
  Neem tree=banana, banaba, gabi, eucalyptus
  provide repellent effect
STRATEGIES:
A. Provision of Regular and Quality Maternal Care Services
Ø  Regular and quality pre-natal care
§ hx-taking, utilization of HBMR (Home-Based Mother’s Record) as
   a guide in the identification of risk factors
§ PE: weight, height, BP-taking
§ Perform head-to-toe assessment, abdominal exam
§ Tetanus Toxoid Immunization
§ Fe supplementation: given from 5th mo. of pregnancy to two
   months postpartum (100-120 mg orally/day for 210 days)
§ Laboratory exam: Heat-acetic acid test. Benedict’s test
§ Oral/Dental exam
Ø  Pre-natal counseling


Ø  Provision of safe, delivery care
§ all birth attendants shall ensure clean and safe
   deliveries at the faciltiies (RHUs/hospitals)
§ at-risk pregnancies and mothers must be immediately
   referred to the nearest institution
Ø  Provision of quality postpartum care
Ø  Proper schedule of follow-up must be followed:
§ 1st postpartum visit for home deliveries must be done within 24
   hours after delivery
§ 2nd, done at least 1 week after delivery
§ 3rd, done 2-4 weeks thereafter
 
Attendants must be aware of the early signs, symptoms and
   complications. They should follow the 3 CLEANS:
    CLEAN Hands
    CLEAN Surface
    CLEAN Cord
C. Improvement of the health personnel’s capabilities on newborn care,
    midwifery thru trainings.
    Note: All deliveries should be done in health care facilities ONLY
 
D. Improvement on the quality of care at the First Referral Level
Ø  Orientation, training should be done on the use of proper filling-up of HBMR
    card
Ø  Proper referrals/endorsements must be done for future If-ups


E. Prevention of unwanted pregnancies through family planning services
 
F. Prevention and management of STDs
G. Promotion of Appropriate health practices
 
H. Upgrade reporting services
 
I. Mobilize political commitment and community
   involvement to provide support to basic health care
   delivery
 
GOALS:

    A. Safe Pregnancy
ü  Right age to be pregnant=20-35 years old,
    not less than 20 & not more than 35
ü  Right interval of pregnancy=once in 2 or 3
    years
ü  Home Base Mother’s Record (HBMR): the
    record used for care of mothers in CHN
Laboratory Examinations:
Benedict’s Test: test for sugar in the urine; test for diabetes
  § Heat test tube with 5 cc of Benedict’s Solution (blue) in the
     burner then add 3-5 gtts of urine (amber yellow) then heat again.
     Observe for the change in color:
Blue    : (-) sugar in urine
Green   : trace of sugar in urine         +1        +
Yellow : traces of sugar in urine          +2       ++
Orange : more traces of sugar in urine     +3       +++
Brick Red : surely diabetic                +4       ++++
Laboratory Examinations:
Acetic Acid Test: test for albumin in urine; test for
Pregnancy Induced HPN
   § Collect urine in test tube, heat it in burner then add
      3-5 gtts of acetic solution (clear white). Observe for
      change in color:
If it remains clear: (-) CHON or albumin in urine
If it turns cloudy:    (+) CHON=proteinuria
POLICIES:
1.  Non coercive (give freedom of choice)
2.  Integration of Family Planning in all Curricular Program:
§ LOI 47 DECS states that Family Planning is to be integrated in all
   school curricular programs, either baccalaureates or non-
   baccalaureates, enrolled separately as one unit
3. Multi-Sectoral Approach: establish relationship with other
agencies which can either be:
   § Intrasectoral
   § Intersectoral-Local or International (WHO, Unicef, USAID,
      Japhiego)
METHODOLOGIES:

 Biological
 A. Basal Body Temperature (BBT)
 § Get the temperature early morning before waking up
    which should be monitored daily at the same time
 § There should be a sudden drop of temperature between
    0.3-0.6°C followed by an increase of temperature by
    0.3-0.6°C which means that the woman is fertile
B. Sympto-thermal
C. Cervical Mucus Test
  Ø Billing’s Method by Dr. Billing
  Ø Spinnbarkheit (came from a German word Spinner which means
    to play with the cervical mucus with the finger) or Wet & Dry
    Method:
     § Wet Cervical Mucus (Fertile): abundant, stretchy & transparent
     § Dry Cervical Mucus (Safe & Not fertile): whitish, pasty &
        adhesive
D. Calendar (Rhythm)
§ Deleted already since 1998 because it’s not recommended for
   irregular cycle of menstruation
§ Menstrual cycle should be regular; obtain 4-6 months cycle
E. Lactation Amenorrhea Method (LAM): RA 7600-Breastfeeding &
     Rooming In Law
§ DOH organized Maternal & Child Family Health Institute (MCFHI)
   with the following members:
    ü All government hospitals
    ü Private hospitals (volunteer)
§ Normal involution (uterus goes back to normal) of the uterus:
   after 45 days or 5-6 weeks or 1 ½ months if not breastfeeding
§ Frozen breast milk is to be put out of the freezer 2 hours before
   feeding ( Body of Ref: 2-3 days / Freezer: 3-4 months)
§ Left over milk should be discarded & should not be re-preserved
   or re-frozen because it is already contaminated
METHODOLOGIES:
Temporary
A. Chemical
§ Oral Pills (Logentrol)-has low dose of estrogen & progesterone that
   inhibits ovulation
§ Parenteral: Depot Medroxyprogesterone Acetate (DMPA)/Depo-
   provera- inhibits ovulation making women amenorrheic;
1991, DMPA was found to be causing cancer of the cervix
1994, DMPA is given IM 4x a year every 3 months (90 days interval)
§ Implants: Norplant-it inhibits ovulation effective for 5 years
   but seldom advocated for use because it is usually
   expensive; the client buys the device (consists of 5
   capsules) & have it implanted at the health center by
   minor surgical incision in:
     ü upper inner arm because it is nearest to the brain
     ü external oblique
     ü thigh
     ü gluteal muscles
B. Mechanical:
§  IUD
ü  Up to 10 years protection
§  Cervical cap & Diaphragm
ü  Prevent the sperm to pass the cervix
ü  Works better with spermicide
ü  Wore 30 minutes before coitus and keep up to 6
    hours after coitus
§  Condom
ü  Most effective way to prevent STD’s / STI’s
METHODOLOGIES:
C. Behavioral
Ø  Abstinence
Ø  Withdrawal

D. Permanent
Ø  Vasectomy (reversible)-since year 2000 in the
    Philippines
Ø  BLT
POLICIES:
I. Nutritional Surveillance (NS): to determine victims of
    malnutrition
A. Anthropometric Measurement: study of measurements of
human dimensions
Ø  Age for Weight-if weight is not appropriate with the age:
     ü Stunting: growth retardation
     ü Wasting: connotes malnutrition
Ø  Age for Height-if height is not appropriate with the age:
    Stunting
Ø  Weight for Height
Rule             Male        Female
Every height of 5 110 lbs.   105 lbs.
ft.
Every increment + 6          +5
of an inch above
5 ft. ADD
Every decrement - 6          -5
of an inch below
5 ft. SUBTRACT
Ø  Skin Folds Test-pinch the external oblique muscle (“bilbil”)
    with your palm
Normal: 1 inch
Overweight: > 1 inch
Ø  Middle Upper Arm Circumference (MUAC)-used in children
    below 5 years old by measuring the middle upper arm with a
    tape measure
Normal: 13 cms. & above
Malnutrition: <13 cms
POLICIES:
I. Nutritional Surveillance (NS): to determine victims of malnutrition
B. Biochemical Method
Ø  Micronutrient Malnutrition -available in small amount in the body VADAG:
Vitamin A Deficiency:
      § Deficiency: Xeropthalmia-opacity of cornea leading to night blindnes
       Infants (6-12 months)                : Give 100,000 i.u.
       Pre-schoolers (12-83 months)         :        200,000 i.u.
       Post partum                          :        200,000 i.u.

      § Never give Vitamin A to infants less than 6 months & pregnant
         women because it is toxic
Anemia: Iron Deficiency Anemia
      § Target age group: 0-59 months (less than 5 years)
      § Give 3-6 mg/kbw/day
      § Always give the maximum

       Example: Child weighs 8 kg
 8 x 6=48 mg/day for the 1st 3 months then monitor
If still anemic, continue giving but compute again 6 mg/kbw
Goiter: Iodine Deficiency Disease (endemic in uphill)
§ Target age group: 0-59 months
§ Give 1 capsule (200 mg) of potassium iodate in oil once a
   year
For a child < 5 years old, empty contents of capsule in a cup
    with warm water because he can’t tolerate it
§ Adverse Effect of Iodine Deficiency Disease that must be
   avoided:
   Ø Mental retardation-intelligence quotient: idiot, moron &
     imbecile
   Ø Growth retardation- cretinism (pedia) & dwarfism (adult)
Ø  Macronutrient Malnutrition - available in large
    amount in the body (Protein Energy
    Malnutrition or PEM)

§ Kwashiorkor-protein deficiency
§ Marasmus-carbohydrate deficiency (energy
  giving food)
 
               Kwashiorkor                        Marasmus
Etiology       Disease experienced by an elder Muscle wasting
               child upon the birth of a new baby

Deficiency    CHON                           CHO
Age           Toddlers (1-3 years old)       All ages
Major Signs & Facial edema, moon facie       Muscle wasting, old man’s facie
Symptoms
Hair Changes (+) color changes from black to (-) hair changes
              brown or from brown to golden
              yellow
              (+) sparse “flag sign”
Skin             Dermatosis:                       (-)
                 dryness, peeling off of the skin,
                 desquamation
Behavior         Irritable                         Apathetic
Management High CHON diet                          High CHO diet
Hospital Setting                         Total Parenteral Nutrition (TPN)
                                         Hyperalimentation process
                                         IV infusion with CHON, CHO regulated by a
                                         machine
POLICIES:
II. Food Production
Fortification-products without any nutrient are added with nutrients
RA 8172 (Asin Law): Fidel Salt (Fortification of Iodine Deficiency Elimination)
=Iodized Salt-“Patak” sa Asin” by Secretary Flavier on December 1-5, 2003
where DOH workers go to market to check if salt sold contains iodine by
placing few drops of reagent:
If salt color turns to blue violet→ fortified with iodine
If salt color show no change→ not fortified with iodine

RA 832 (Rice Fortification): FVR (Fortified Vitamin Rice) by Secretary Flavier
under FVR, Erap Rice under Erap, Gloria Rice or “Bigas ni Gloria” under PGMA
ENVIRONMENTAL SANITATION


Ø refers to all factors available in the
 environment affecting the health of the
 individual or population

Ø  regulated by PD 856: Comprehensive
    Sanitation Code of the Philippines
ENVIRONMENTAL HEALTH SERVICE (EHS) OF
  DOH IS RESPONSIBLE FOR

§ Promotion of healthy environmental conditions &
   prevention of environmental related diseases through
   appropriate sanitation strategies
§ Promotion & implementation of sanitation programs
   through the Department of Health Field Health Units
§ Conceptualization of new programs/projects to
   contend with emerging environmentally related
   health problems
COMPONENTS:

ü  Water Supply Sanitation Program
ü  Proper Excreta and Sewage Disposal
    Program
ü  Insect and Rodent Control
ü  Food and Sanitation Program
ü  Hospital Waste Management Program
1. WATER SUPPLY SANITATION PROGRAM



ü  Potable
ü  Free from any particles that might
    cause illness to an individual
Ways to make Water Potable:

§ Boiling: minimum of 3 minutes to maximum of
   10 minutes for drinking
§ Sterilization: 30 minutes after the water starts
   to boil
§ Filtration: makes use of filter paper or cotton
   cloth to separate solid particle from liquid if
   water comes from river
§ Coagulation/Flocculation: uses aluminum
   crystal (tawas) that collects or absorbs
   particles from liquid part & becomes slimy

 ü In 1 gallon of water, drop tawas (the size of
  magi cubes) & allow to stand for 6-8 hours
 ü Initially, water appears to be cloudy then
  after 6-8 hours of standing, the water
  becomes clear
Chlorination: uses 100% pure concentrated
       chlorine bought from botika or given free by
       health centers
Ø  To prepare stock solution (SS): in 1 liter drinking
    water, add 1 tablespoon of concentrated chlorine
    which is potent for 3-4 months
Ø  To prepare the chlorinated water: in 2 ½ gallons of
    drinking water (10,000 ml=10 liters), add 1
    tablespoon from the prepared stock solution & let it
    stand for 30 minutes to react with water
 
§ Fluoridation: adding fluoride to prevent dental
   caries (primary significance) & whitens
   enamel of teeth ( 2nd significance)

§ Aeration: exposing drinking water in air to
   strengthen taste within 24 hours which is
   usually used in uphill areas where there’s less
   or no pollution
3 TYPES OF APPROVED WATER SUPPLY AND
 FACILITIES

Level I
Point Source


A protected well or a developed spring with an
outlet but without a distribution system for rural
areas where houses are thinly scattered.
3 TYPES OF APPROVED WATER SUPPLY AND
  FACILITIES
Level II
Communal faucet system or stand posts

A system composed of a source, a reservoir, a piped
distribution network and communal faucets, located at
not more than 25 meters from the farthest house in
rural areas where houses are clustered densely.
3 TYPES OF APPROVED WATER SUPPLY AND
 FACILITIES

Level III
Waterworks system or individual house
connections
A system with a source, a reservoir, a piped
distributor network and household taps that is
suited for densely populated urban areas.
2. PROPER EXCRETA AND SEWAGE DISPOSAL
SYSTEM
3 TYPES OF APPROVED TOILET FACILITIES

Level 1
Non-water carriage toilet facility:
- Pit latrines
- Reed Odorless Earth Closet
- Bored-hole
- Compost
 
Toilets requiring small amount of water to wash waste into
receiving space
- Pour flush
- Aqua privies
Pit latrines
Ø  most commonly observed in rural area
Ø  has three components: the pit, a squatting plate and the
    super-structure
Ø  types of pit include
“Antipolo type”, a pit type of toilet provided with concrete floor
  and an elevated seat with a cover
Ventilated Improved Pit or VIP, pit with a vent pipe
Reed Odourless Earth Closet or ROEC, a pit completely displaced
  from the superstructure and connected to the squatting plate
  by a curved chute.
Bored Hole Latrine
ü  consists of relatively deep holes bored into the earth by
    mechanical or manual earth-boring equipment
ü  holes are about 10-18 inches in diameter and usually
    15-35 feet deep. The hole is provided to facilitate
    squatting. Two types of bored-hole latrines are:
Wet Type - when the hole penetrates ground water table or
    other strata.
Dry Type - when he hole does not reach ground water table;
  fills up at a faster rate then than the wet type.
3 TYPES OF APPROVED TOILET FACILITIES


Level 2

On site toilet facilities of the water carriage type with
water sealed and
flushed type with septic vault/tank disposal facilities.
3 TYPES OF APPROVED TOILET FACILITIES

Level 3



Water carriage types of toilet facilities
connected to septic tanks an/or to sewerage
system to treatment plant.
THINGS TO CONSIDER IN CONSTRUCTING A TOILET
FACILITY:


ü  At least 25 meters away from water sources
    at a lower elevation
ü  It should be within your financial capability
ü  It should be approved by the local health
    authorities
CARE AND MAINTENANCE OF YOUR TOILET FACILITY:
ü  Water must be provided at all times.
ü  Use toilet paper
ü  Use lysol once a month for odor removal
ü  Clean the bowl by muriatic acid to remove the stains.
ü  Avoid depositing solid objects on the bowl to prevent clogging
ü  Always check your toilet if it’s clean
ü  Use plunger when clogging occurs. Don’t use sticks or rods to
    avoid the breakage of the trap or the bowl.
3. PROPER SOLID WASTE MANAGEMENT



refers to satisfactory methods of storage,
  collection and final disposal of solid wastes
SOURCES OF SOLID WASTE
Household Waste - these are wastes generated in or discharged
  from household including shops but excluding commercial
  activities
 
Commercial Waste - restaurants, stationery shops, grocery
  shops or any commercial activity are the main sources of
  commercial waste.
 
Market Waste - only refers to waste generated in or discharged
  from markets both for whole sale and retailing
 
SOURCES OF SOLID WASTE
Institutional Waste - these are wastes generated in
   government, state enterprise and private firm office.
 
Street Sweeping Waste - these are wastes generated by the
   street sweeping cleansing service.
 
River Waste - includes all the wastes generated by the river
   and creek cleansing
 
Medical Waste - these are wastes generated in hospitals.
COMPONENTS OF SOLID WASTE
Garbage refers to left over vegetable, animal and fish material
  from kitchen and food establishments. These materials have
  the tendency to decay giving off foul odors and sometimes
  serve as food for flies and rats.
 
Rubbish refers to waste materials such as bottles, broken glass,
  tin can, waste papers, discarded textile materials, porcelain
  wares, pieces of metal and other wrapping materials.
 
 
COMPONENTS OF SOLID WASTE
 Ashes are left over from burning of wood and coal. Ashes may
   become a nuisance because of the dust associated with them.
 
Stable manure is animal manure collected from stables.
 
Dead animals like dead dogs, cats, rats, pigs, and chickens that
  are killed by cars and trucks on streets and public highways.
  They include small and large animals that died from disease.
 
COMPONENTS OF SOLID WASTE

Street sweeping includes dust, manure, leaves, cigarette buts,
   waste papers and other materials that are swept from
   streets.
 
Night soil is human waste normally wrapped and thrown into
  sidewalks and streets. This also includes human waste from
  pail system of toilets.
 
Yard cuttings includes leaves, branches, grass and other
SANITARY WAYS OF TREATING GARBAGE:

Segregation-separating biodegradable from non
  biodegradable
Collection-adherence to the proper collection time→ the
  City of Manila coordinates with Leonel Waste
  Management (a private firm which collects garbage)
  where the truck driver coordinates with the Barangay
  Chairman on the time they will collect garbage so don’t
  bring out garbage before the collection time
WAYS OF DISPOSAL

                  Household
○ Burial
 ► Deposited in 1m x 1m deep pits covered with
 soil, located 25 m. away from water supply
  
○ Open burning
o  Animal feeding
o  Composting
o  Grinding and disposal sewer
WAYS OF DISPOSAL

                           Community
○ Sanitary landfill or controlled tipping
► Excavation of soil deposition of refuse and compacting
with a solid cover of 2 feet
 
○ Incineration
Ecological Solid Waste Management: RA 9003- the use of
incinerator approved in 2000 but was implemented in 2003
because of lack of funding to purchase
4. FOOD SANITATION PROGRAM
POLICIES:
ü  Food establishment are subject to inspection
    (approved of all food sources containers and
    transport vehicles)
ü  Comply with sanitary permit requirement
ü  Comply with updated health certificates for food
    handlers, helpers, cooks
ü  All ambulant vendors must submit a health
    certificate to determine present of intestinal parasite
    and bacterial infection
3 POINTS OF CONTAMINATION

ü Place of production processing and source of
   supply
ü Transportation and storage
ü Retail and distribution points
5. HOSPITAL WASTE MANAGEMENT


RA 4226-Hospital Licensure Act monitors the
  hospital license & proper management of
  wastes as well as renewal of license to
  operate
GOAL:

To prevent the risk of contraction contracting
  nosocomial infection from type disposal of
  infectious, pathological and other wastes from
  hospital
COLOR CODING OF BIN TO KEEP WASTE:

Green:    wet waste
Black :   dry waste
Yellow:   infectious/pathological waste like blood,
          sputum, urine, feces & gauze
Orange:   toxic/hazardous waste

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Community Health Nursing (complete)

  • 1.
  • 2. COMMUNITY HEALTH NURSING: AN OVERVIEW What is a community? § a group of people with common characteristics or interests living together within a territory or geographical boundary § place where people under usual conditions are found
  • 3. What is health? § Health-illness continuum § High-level wellness § Agent-host-environment § Health belief § Evolutionary-based § Health promotion § WHO definition
  • 4. § What is community health?   § part of paramedical and medical intervention/ approach which is concerned on the health of the whole population § aims: 1. health promotion 2. disease prevention 3. management of factors affecting health
  • 5. § What is nursing? - assisting sick individuals to become healthy and healthy individuals achieve optimum wellness
  • 6. Public Health Nursing: the term used before for Community Health Nursing According to Dr. C.E. Winslow, Public Health is a science & art of 3 P’s § Prevention of Disease § Prolonging life § Promotion of health and efficiency through organized community effort
  • 7. § What is Community Health Nursing?   “The utilization of the nursing process in the different levels of clientele-individuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation.” - Maglaya, et al  
  • 8. COMMUNITY HEALTH NURSING (CHN): §  a specialized field of nursing practice §  a science of Public Health combined with Public Health Nursing Skills and Social Assistance with the goal of raising the level of health of the citizenry, to raise optimum level of functioning of the citizenry (Characteristic of CHN)
  • 9. BASIC PRINCIPLES OF CHN ü  The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual, family, population group (those who share common characteristics, developmental stages and common exposure to health problems – e.g. children, elderly), and the community. ü  In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care
  • 10. BASIC PRINCIPLES OF CHN ü  CHN practice is affected by developments in health technology, in particular, changes in society, in general ü  The goal of CHN is achieved through multi-sectoral efforts ü  CHN is a part of health care system and the larger human services system.
  • 11. ROLES OF THE PUBLIC HEALTH NURSE Clinician, who is a health care provider, taking care of the sick people at home or in the RHU Health Educator, who aims towards health promotion and illness prevention through dissemination of correct information; educating people Facilitator, who establishes multi-sectoral linkages by referral system Supervisor, who monitors and supervises the performance of midwives
  • 12. TARGET POPULATION (IFC) ARE: 1. I ndividual 2. F amily 3. C ommunity
  • 13. 3 Elements considered in CHN: v  Science of Public Health (core foundation in CHN), v  Public Health Nursing Skills and v  Social Assistance Functions
  • 14. OBJECTIVES OF PUBLIC HEALTH: CODES C ontrol of Communicable Diseases O rganization of Medical and Nursing Services D evelopment of Social Machineries E ducation of IFC on personal Hygiene→ Health Education is the essential task of every health worker S anitation of the environment
  • 15. 3 ELEMENTS IN HEALTH EDUCATION: IEC § I nformation: to share ideas to keep population group knowledgeable and aware § E ducation: change within the individual 3 Key Elements of Education: K nowledge A ttitude S kills
  • 16. 3 ELEMENTS IN HEALTH EDUCATION: IEC § C ommunication: interaction involving 2 or more persons or agencies 3 Elements of Communication: Message Sender Receiver
  • 17. PUBLIC HEALTH WORKERS (PHW) PHW’s: are members of the health team who are professionals namely § Medical Officer (MO)-Physician § Public Health Nurse (PHN)-Registered Nurse § Rural Health Midwife (RHM)-Registered Midwife- § Dentist § Nutritionist § Medical Technologist § Pharmacist § Rural Sanitary Inspector (RSI)-must be a sanitary engineer
  • 18.
  • 19. 5 MAJOR FUNCTIONS: 1.  Ensure equal access to basic health services 2.  Ensure formulation of national policies for proper division of labor and proper coordination of operations among the government agency jurisdictions 3.  Ensure a minimum level of implementation nationwide of services regarded as public health goods 4.  Plan and establish arrangements for the public health systems to achieve economies of scale 5.  Maintain a medium of regulations and standards to protect consumers and guide providers  
  • 20. BASIC HEALTH SERVICES UNDER OPHS OF DOH E ducation regarding Health L ocal Endemic Diseases E xpanded Program on Immunization M aternal & Child Health Services E ssential drugs and Herbal plants N utritional Health Services (PD 491): Creation of Nutrition Council of the Phils. T reatment of Communicable & Non communicable Diseases S anitation of the environment (PD 856): Sanitary Code of the Philippines D ental Health Promotion A ccess to and use of hospitals as Centers of Wellness M ental Health Promotion
  • 21. VISION BY 2030 (DREAM OF DOH) A Global Leader for attaining better health outcomes, competitive and responsive health care systems, and equitable health financing
  • 22. MISSION To guarantee EQUITABLE, SUSTAINABLE and QUALITY health for all Filipinos, especially the poor and to lead the quest for excellence in health
  • 23. Principles to attain the vision of DOH § Equity: equal health services for all-no discrimination § Quality: DOH is after the quality of service not the quantity Philosophy of DOH: “Quality is above quantity” § Accessibility: DOH utilize strategies for delivery of health services
  • 24. HEALTH CARE DELIVERY SYSTEM “the totality of all policies, facilities, equipment, products, human resources and services which address the health needs, problems and concerns of the people. It is large, complex, multi-level and multi-disciplinary.”
  • 25. THREE STRATEGIES IN DELIVERING HEALTH SERVICES (ELEMENTS) ü  Creation of Restructured Health Care Delivery System (RHCDS) regulated by PD 568 (1976) ü  Management Information Systems regulated by R.A. 3753: Vital Health Statistics Law ü  Primary Health Care (PHC) regulated by LOI 949 (1984): Legalization of Implementation of PHC in the Philippines
  • 26. CREATION OF RHCDS RHO (National Health Agency) or existing national agencies like PGH or specialized agencies like Heart Center for Asia, NKI MHO & PHO (Municipal/Provincial Health Office)   BHS & RHU (Barangay Health Station/Rural Health Unit)
  • 27. 3 LEVELS OF HEALTH CARE 1.  Primary-prevention of illness or promotion of health 2.  Secondary-curative 3.  Tertiary-rehabilitative
  • 28. According to Increasing Complexity of According to the Type of Service the Services Provided Type Service Type Example Health Promotion, Preventive Care, Health Promotion and Information Dissemination Continuing Care for common illness Prevention Primary health problems, attention to psychological and social care, referrals Surgery, Medical services by Diagnosis and Treatment Screening Secondary Specialists Advanced, specialized, diagnostic, Tertiary therapeutic & rehabilitative care Rehabilitation PT/OT
  • 29. LEVELS OF PREVENTION PRIMARY LEVEL SECONDARY LEVEL TERTIARY LEVEL Health Promotion and Illness Prevention of Complications thru Early Prevention of Disability, etc. Prevention Dx and Tx Provided at – ! When hospitalization is deemed ! When highly-specialized medical ! Health care/RHU necessary and referral is made to care is necessary ! Brgy. Health Stations emergency (now district), ! referrals are made to hospitals and !Main Health Center provincial or regional or private medical center such as PGH, !Community Hospital and Health hospitals PHC, POC, National Center for Center Mental Health, and other gov’t !Private and Semi-private private hospitals at the municipal agencies level
  • 30. Referral System in Levels of the Health Care: ü  Barangay Health Station (BHS) is under the management of Rural Health Midwife (RHM) ü  Rural Health Unit (RHU) is under the management or supervision of PHN ü  Public Health Nurse (PHN) caters to 1:10,000 population, acts as managers in the implementation of the policies and activities of RHU, directly under the supervision of MHO (who acts as administrator)
  • 31. REFERRAL SYSTEM: BHS→ RHU→ MHO→ PHO→ RHO→ National Agencies→ Specialized Agencies
  • 33. UTILIZES APPROPRIATE TECHNOLOGIES USED BY PHC: ACCEFS A ffordable, accessible, acceptable, available C ost wise=economical in nature C omplex procedures which provide a simple outcome E ffective F easibility of use=possibility of use at all times S cope of technology is safe & secure
  • 34. SENTRONG SIGLA MOVEMENT (SSM) was established by DOH with LGUs having a logo of a Sun with 8 Rays and composed of 4 Pillars: 1.  Health Promotion 2.  Granted Facilities 3.  Technical Assistance 4.  Awards: Cash, plaque, certificate
  • 35. 4 CONTRIBUTIONS OF PHC TO DOH & ECONOMY: § Training of Health Workers § Creation of Botika sa Baryo & Botika sa Health Center § Herbal Plants § Oresol
  • 36. A. TRAINING OF HEALTH WORKERS 3 Levels of Training: Grassroot/Village § Includes Barangay Health Volunteers (BHV) and Barangay Health Workers (BHW) § Non professionals, didn’t undergo formal training, receive no salary but are given incentive in the form of honorarium from the local government since 1993 Intermediate - these are professionals including the 8 members of the PHWs First Line Personnel - the specialist
  • 37. B. CREATION OF “BOTIKA SA BARYO & BOTIKA SA HEALTH CENTER” RA 6675: Generics Act of 1988: Implementing “Oplan Walang Reseta Program”-solution to the absence of a medical officer who prescribed the medicines so PHN are given the responsibility to prescribe generic medicines and “Walong Wastong Gamot Program”- available generics in “Botika sa Baryo” & Health Center § Father of Generics Act: Dr. Alfredo Bengzon
  • 38. 8 COMMONLY AVAILABLE GENERICS (CARIPPON) Co-Trimoxazole: § it’s a combination of 2 generics of drugs which is antibacterial Trimethoprim(TMP) § Has a bacteriostatic action that stops/inhibits multiplication of bacteria § For GUT, GIT & URTI (TMP combined with SMX) Sulfamethoxazole (SMX) § Has bactericidal action that kills bacteria § For GUT, GIT, URTI & Skin Infections
  • 39. 8 COMMONLY AVAILABLE GENERICS (CARIPPON) Amoxicillin/Ampicillin § An antibacterial drug that comes from the Penicillin family § Effect is generally bacteriostatic (when source of infection is bacterial) § These 2 drugs provide the least sensitivity reaction (rashes & GI) and the adverse effect of other antibiotics is anaphylactic shock
  • 40. 8 COMMONLY AVAILABLE GENERICS (CARIPPON) TB DRUGS: Rifampicin (RIF) Isoniazid (INH) Pyrazinamide (PZA)
  • 41. 8 COMMONLY AVAILABLE GENERICS (CARIPPON) Paracetamol Has an analgesic & anti-pyretic effect Acetyl Salicylic Acid (ASA) or Aspirin is never kept in the “Botika” because of its effects: § Anticoagulant-highly dangerous to Dengue patients that’s why it’s not available in “Botika” & Health Center
  • 42. 8 COMMONLY AVAILABLE GENERICS (CARIPPON) Oresol: a management for diarrhea to prevent dehydration under the Control of Diarrheal Diseases (CDD) Program
  • 43. 8 COMMONLY AVAILABLE GENERICS (CARIPPON) Nifedipine: § An anti-hypertensive drug § According to DOH, 16% of population belonging to 25 years old & above in the community are hypertensive
  • 44. C. HERBAL PLANTS RA 8423: Alternative Traditional Medicine Law a program where patient may opt to use herbal plants especially for drugs that are not available in dosage form or patients has no financial means to buy the drug Traditional Medicine: § Use of herbal plants
  • 45. 10 ADVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA Lagundi Vitex Asthma, Leaves Decoction negundo cough, colds & Poultice fever (ASCOF) Pain and inflammation
  • 46. 10 ADVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA Ulasimang Peperonia Gout Leaves Decoction Bato pellucida Arthritis Poultice Rheumatism
  • 47. 10 ADVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA Bayabas Psidium Diarrhea Leaves Decoction quajava Toothache Mouth and wound wash
  • 48. 10 ADVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA Bawang Allium HPN Clove/Bulb Poultice sativum Toothache
  • 49. 10 ADVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA Yerta Mentha Same as Leaves Decoction Buena cordifelia Lagundi Poultice except asthma
  • 50. 10 ADVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA Sambong Blumea Edema Leaves Decoction balsanifera Diuretic
  • 51. 10 ADVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA Akapulko Cassia All forms Leaves Decoction alata of skin Poultice diseases Cream
  • 52. 10 ADVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA Niyog Quisqualis Intestinal Seeds Decoction niyogan indica Parasitism Poultice (Nematodes) Juice
  • 53. 10 ADVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA Tsaang Carmona Diarrhea Leaves Decoction Gubat resuta Infantile Poultice colic (Kabag) Dental caries
  • 54. 10 ADVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA Ampalaya Mamordica Type II Leaves Decoction charantia Diabetes (NIDDM)
  • 55. POLICIES TO ABIDE: Know indications Know parts of plants with therapeutic value: roots, fruits, leaves Know official procedure/preparation
  • 56. Procedures/Preparations: Decoction Ø  Gather leaves & wash thoroughly, place in a container the washed leaves & add water Ø  Let it boil without cover to vaporize/steam to release toxic substance & undesirable taste Ø  Use extracts for washing
  • 57. PROCEDURES/PREPARATIONS: Poultice Ø  Done by pounding or chewing leaves used by herbolaryo Ø  Example: Akapulko leaves-when pounded, it releases extracts coming out from the leaves contains enzyme (serves as anti-inflammatory) then apply on affected skin or spewed it over skin Ø  For treatment of skin diseases
  • 58. PROCEDURES/PREPARATIONS: Infusion To prepare a tea (use lipton bag), keep standing for 15 minutes in a cup of warm water where a brown solution is collected, pectin which serves as an adsorbent and astringent
  • 59. PROCEDURES/PREPARATIONS: Juice/Syrup To prepare a papaya juice, use ripe papaya & mechanically mashed then put inside a blender & add water To produce it into a syrup, add sugar then heat to dissolve sugar & mix it
  • 60. PROCEDURES/PREPARATIONS: Cream/Ointment Start with poultice (pound leaves) to turn it semi-solid Add flour to keep preparation pasty & make it adhere to skin lesions To make it into an ointment: add oil (mineral, baby or any oil- serves as moisturizer) to the prepared cream to keep it lubricated while being massage on the affected area
  • 61. D. ORESOL Glucose 20 grams 1° Significance: For re-absorption of Na Facilitates assimilation of Na 2° Significance: Provides heat & energy Sodium Chloride/NaCl 3.5 grams For retention of water/fluid Sodium 2.5 grams Buffer content of solution Bicarbonate/NaHCO3 Neutralizer content of solution Potassium Chloride/KCl 1.5 grams Stimulates smooth muscle contractility especially the heart & GIT
  • 62. PREPARATION OF PROPER HOMEMADE ORESOL A volume or one liter homemade oresol Smaller volume or a glass homemade oresol Water 1000 ml. or 1 liter 250 ml. Sugar 8 teaspoon 2 teaspoon Salt 1 teaspoon ! teaspoon or a pinch of salt=10-12 granules of rock salt: iodized salt=tips of thumb & index finger are penetrated with salt
  • 63.
  • 64. UNIVERSAL HEALTH CARE (UHC), ALSO REFERRED TO AS KALUSUGAN PANGKALAHATAN (KP) is the “provision to every Filipino of the highest possible quality of health care that is accessible, efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by an informed and empowered public”
  • 65. UNIVERSAL HEALTH CARE (UHC), ALSO REFERRED TO AS KALUSUGAN PANGKALAHATAN (KP The Aquino administration puts it as the availability and accessibility of health services and necessities for all Filipinos. It is a government mandate aiming to ensure that every Filipino shall receive affordable and quality health benefits.This involves providing adequate resources – health human resources, health facilities, and health financing.
  • 66. UHC’S THREE THRUSTS 1)  Financial risk protection through expansion in enrollment and benefit delivery of the National Health Insurance Program (NHIP); 2)  2) Improved access to quality hospitals and health care facilities; and 3)  3) Attainment of health-related Millennium Development Goals (MDGs).
  • 67. FINANCIAL RISK PROTECTION Protection from the financial impacts of health care is attained by making any Filipino eligible to enroll, to know their entitlements and responsibilities, to avail of health services, and to be reimbursed by PhilHealth with regard to health care expenditures.
  • 68. MPROVED ACCESS TO QUALITY HOSPITALS AND HEALTH CARE FACILITIES Improved access to quality hospitals and health facilities shall be achieved in a number of creative approaches. First, the quality of government-owned and operated hospitals and health facilities is to be upgraded to accommodate larger capacity, to attend to all types of emergencies, and to handle non- communicable diseases.
  • 69. The Health Facility Enhancement Program (HFEP) shall provide funds to improve facility preparedness for trauma and other emergencies. The aim of HFEP was to upgrade 20% of DOH- retained hospitals, 46% of provincial hospitals, 46% of district hospitals, and 51% of rural health units(RHUs) by end of 2011.
  • 70. ATTAINMENT OF HEALTH-RELATED MDGS Further efforts and additional resources are to be applied on public health programs to reduce maternal and child mortality, morbidity and mortality from Tuberculosis and Malaria, and incidence of HIV/AIDS. Localities shall be prepared for the emerging disease trends, as well as the prevention and control of non- communicable diseases. The organization of Community Health Teams (CHTs) in each priority population area is one way to achieve health-related MDGs. CHTs are groups of volunteers, who will assist families with their health needs, provide health information, and
  • 71. ATTAINMENT OF HEALTH-RELATED MDGS RNheals nurses will be trained to become trainers and supervisors to coordinate with community-level workers and CHTs. By the end of 2011, it is targeted that there will be 20,000 CHTs and 10,000 RNheals. Another effort will be the provision of necessary services using the life cycle approach. These services include family planning, ante-natal care, delivery in health facilities, newborn care, and the Garantisadong Pambata package. Better coordination among government agencies, such as DOH, DepEd, DSWD, and DILG, would also be essential for the achievement of these MDGs.
  • 72.
  • 73. GOAL 1: ERADICATE EXTREME POVERTY AND HUNGER Target : Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day Target : Halve, between 1990 and 2015, the proportion of people who suffer from hunger
  • 74. GOAL 2: ACHIEVE UNIVERSAL PRIMARY EDUCATION Target : Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling
  • 75. GOAL 3: PROMOTE GENDER EQUALITY AND EMPOWER WOMEN Target : Eliminate gender disparity in primary and secondary education preferably by 2005 and to all levels of education no later than 2015
  • 76. GOAL 4: REDUCE CHILD MORTALITY Target : Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate
  • 77. GOAL 5: IMPROVE MATERNAL HEALTH Target : Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio
  • 78. GOAL 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES Target : Have halted by 2015 and begun to reverse the spread of HIV/AIDS Target : Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases
  • 79. GOAL 7: ENSURE ENVIRONMENTAL SUSTAINABILITY Target : Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources Target : Halve, by 2015, the proportion of people without sustainable access to safe drinking water Target: By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers
  • 80. GOAL 8: DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT Target : Develop further an open, rule-based, predictable, non- discriminatory trading and financial system Target: Address the special needs of the least developed countries Target: Address the special needs of landlocked countries and small island developing States Target: Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term
  • 81.
  • 82. FIELD HEALTH SERVICE INFORMATION SYSTEM (FHSIS) • It is a network of information • It is intended to address the short term needs of DOH and LGU staff with managerial or supervisory functions in facilities and program areas. • It monitors health service delivery nationwide.
  • 83. OBJECTIVES OF FHSIS To provide summary data on health service delivery and selected program accomplishment indicators at the barangay, municipality/ city, and district, provincial, regional and national levels. To provide data which when combined with data from other sources, can be used for program monitoring and evaluation purposes. To provide a standardized, facility-level data base that can be accessed for more in-depth studies. To minimize the recording and reporting burden at the service delivery level in order to allow more time for patient care and promote activities.
  • 84. IMPORTANCE OF FHSIS • Helps local government determine public health priorities. • Basis for monitoring and evaluating health program implementation. • Basis for planning, budgeting, logistics and decision making at all levels. • Source of data to detect unusual occurrence of a disease. • Needed to monitor health status of the community. • Helps midwives in following up clients. • Documentation of RHM/PHN day to day activities.
  • 85. COMPONENTS OF FHSIS 1.  Individual Treatment Record (ITR) 2.  Target Client List (TCL) 3.  Summary Table 4.  The Monthly Consolidation Table (MCT)
  • 86. INDIVIDUAL TREATMENT RECORD (ITR) The fundamental building block or foundation of the Field Health Service Information System is the INDIVIDUAL TREATMENT RECORD. This is a document, form or piece of paper upon which is recorded the date, name, address of patient, presenting symptoms or complaint of the patient on consultation and the diagnosis (if available), treatment and date of treatment.
  • 87. TARGET CLIENT LIST (TCL) The Target Client Lists constitute the second “building block” of the FHSIS and are intended to serve several purposes First is to plan and carry out patient care and service delivery. Such lists will be of considerable value to midwives/nurses in monitoring service delivery to clients in general and in particular to groups of patients identified as “targets” or “eligibles” for one or another program of the Department
  • 88. TARGET CLIENT LIST (TCL) The second purpose of Target Client Lists is to facilitate the monitoring and supervision of service delivery activities. The third purpose is to report services delivered. The fourth purpose of the Target Client Lists is to provide a clinic-level data base which can be accessed for further studies
  • 89. TARGET CLIENT LISTS TO BE MAINTAINED IN THE FHSIS 1.  Target Client List for Prenatal Care 2.  Target Client List for Post-Partum Care 3.  Target Client List of Under 1 Year Old Children 4.  Target Client List for Family Planning 5.  Target Client List for Sick Children 6.  NTP TB Register 7.  National Leprosy Control Program Form 2-Central Registration Form
  • 90. SUMMARY TABLE The Summary Tables is a form with 12-month columns retained at the facility (BHS) where the midwife records monthly all relevant data. The Summary Table is composed of: (1)  Health Program Accomplishment this can serve as proof of accomplishments to show LGU officials whenever they visit the facility. (2)  Morbidity Diseases the source of ten leading causes of morbidity for the municipality/city. This summary table will help the nurse and MHO to get the monthly trend of diseases.
  • 91. THE MONTHLY CONSOLIDATION TABLE (MCT) ü  The Consolidation Table is an essential form in the FHSIS where the nurse at the RHU records the reported data per indicator by each BHS or midwife. ü  This is the source document of the nurse for the Quarterly Form. ü  The Consolidation Table shall serve as the Output Table of the RHU as it already contains listing of BHS per indicator.
  • 92. FHSIS REPORTING These are summary data that are transmitted or submitted on a monthly, quarterly and on annual basis to higher level. The source of data for this component is dependent on the records.
  • 93. THE MONTHLY FORM Program Report (M1) The Monthly Form contains selected indicators categorized as maternal care, child care, family planning and disease control. Morbidity Report (M2) The Monthly Morbidity Disease Report contains a list of all diseases by age and sex. The Midwife uses the form for the monthly consolidation report of Morbidity Diseases and is submitted to the PHN for quarterly consolidation.
  • 94. THE QUARTERLY FORM Program Report (Q1) The Quarterly Form is the municipality/city health report and contains the three-month total of indicators categorized as maternal care, family planning, child care, dental health and disease control Morbidity Report (Q2) The PHN uses the form for the Quarterly Consolidation Report of Morbidity Diseases to consolidate the Monthly Morbidity Diseases taken from the Summary Table.
  • 95. THE ANNUAL FORMS (A-BHS, A1, A2 & A3) ABHS Form is the report of midwife which contains data on demographic, environmental and natality. The report of nurse at the RHU/MHC are the Annual Form 1 which is the report on vital statistics: demographic, environmental, natality and mortality. Annual Form 2 is the report that lists all diseases and their occurrence in the municipality/city. The report is broken down by age and sex. Annual Form 3 is the report of all deaths occurred in the municipality/city. The report is also broken down by age and sex.
  • 96. FLOW OF REPORT OFFICE PERSON RECORDING FORMS FREQUENCY SCHEDULE OF TOOLS SUBMISION BHS Midwife -  ITR Monthly Form Monthly Every 2nd week of the -  TCL (M1 & M2) succeeding month -  ST A-BHS Form Annually Every 2nd week of January RHU PHN -  ST Quarterly Quarterly Every 3rd week of the 1st -  MCT Form month of succeeding (Q1 & Q2) quarter Annual Forms Every 3rd week of -  A1 January -  A2 -  A3
  • 97.
  • 98. Fertility § Crude Birth Rate (CBR) - Overall total reported births Morbidity-Illnesses affecting the population group § Incidence Rate (IR)-reported new cases affecting the population group § Prevalence Rate (PR)-determine sum total of new + old cases of diseases per percent population
  • 99. Mortality-Reports causes of deaths § Crude Death Rate (CDR)-overall total reported death § Maternal Mortality Rate (MMR)-maternal deaths due to maternal causes § Infant Mortality Rate (IMR)-# of infant deaths (0-12 months) or less than 1 year old § Neonatal Mortality Rate (NMR)-# of deaths among neonates (newborn 0-28 days, < 1 month) § Swaroops Index (SI)-deaths among individual in the age group of 50 and above
  • 100. CRUDE BIRTH RATE (CBR) CBR= Overall total reported births x 1000 -------------------------------------------- Population
  • 101. INCIDENCE RATE (IR) IR= new cases of disease x 100 ------------------------------------ Population
  • 102. PREVALENCE RATE (PR): PR= new cases + old cases x 100 -------------------------------------- Population
  • 103. CRUDE DEATH RATE (CDR) CDR = overall total deaths x 1000 ---------------------------------- Population
  • 104. MATERNAL MORTALITY RATE (MMR) MMR= # of maternal deaths x 1000 ---------------------------------- RLB
  • 105. INFANT MORTALITY RATE (IMR) IMR = # of infant deaths x 1000 --------------------------------- RLB
  • 106. NEONATAL MORTALITY RATE (NMR) NMR = # of neonatal deaths x 1000 --------------------------------------- RLB
  • 107. SWAROOP’S INDEX (SI) SI= # of deaths (individual >50 years old) x 100 ------------------------------------------------------------ Total Deaths
  • 108.
  • 109. FAMILY HEALTH NURSING PROCESS a systematic approach of solving an existing problem/meeting the needs of family R apport A ssessment P lanning I ntervention E valuation
  • 110. I. RAPPORT ü  Trust building ü  Knowing your client ü  Adjusting to the situation and environment ü  RESPECT
  • 111. II. ASSESSMENT Data Gathering: tools or instruments used during survey: ü Interview ü Observation ü Questionnaires-mostly patronized & used in CHN ü Records & Reports available Consolidation or Collation: collecting back the questionnaires, tabulate and summarize
  • 112. Validation: uses statistical approaches Statistical Approaches: 1. Central Tendencies: 3 M’s Mean=average Median=range (Highest – Lowest Score) Mode=frequency of occurrence of a variable, used if there’s too many variable occur
  • 113. 2. Standard Deviation: used if there are too many variables available to be treated which is seldom used in CHN   SD=√ ∑ (x-x) ∑=summation of n-1 x=variables available x=mean (given special attention) n=# of existing variables
  • 114. 3. Percentile (%) Method: most commonly used in CHN by adding all cores then multiply by 100
  • 115. Presentation of Data Sales Series 1. Table/Chart Categ 1 1st Qtr Categ Series 2. Graph: Categ 2 2nd Qtr Categ Pie Series 0 20 3 6 Bar-2 variables only 4 Series 2 1 Line 0 Series Catego Catego Catego Catego 2 Polygon-connecting the results Histograph-2 or more variables & appear adjacent to each other
  • 116. TYPOLOGY OF NURSING PROBLEMS A. First Level Assessment: to determine problems of family Sources of Problems using IDB Family: use of Initial Data Base (IDB) Nature: Health Deficit (HD), Health Threat (HT), Foreseeable Crisis (FC)
  • 117. USE OF INITIAL DATA BASE (IDB): 1. Family Chart Structure: Nuclear -Father, mother, children Extended (3rd generation)-Relatives staying with the family Multi-generational extended-“apo sa tuhod” or “apo sa talampakan” Dyad -Husband & wife only (childless couple) Blended -widow married another widow & have children Gay -Same sex living together Matriarchal -Mother is the decision maker Patriarchal -Father is the decision maker Communal -different families forming a community
  • 118. 2. Socio-economic: poverty level, educational attainment & nature of occupation of members of the family (sources of income) 3. Socio-cultural: different nature of religion 4. Home environment: assessment according to ES, treatment of garbage, preparation of food, availability of toilet, water & food sanitation, sources of diseases
  • 119. 4. Medical history: history of certain disease, family member with disease 5. Resources available in community for use by the family: 5 Generalized M’s in resources available in community: § Man/Manpower § Money § Machine § Materials § Methods
  • 120. DEFINE THE PROBLEM AFTER IDENTIFYING IT ACCORDING TO NATURE Health Deficit (HD) - if identified problem is an abnormality, illness or disease, there’s a gap/difference between normal status (ideal, desirable, expected) & actual status (the outcome/result/problem encountered on that actual day)
  • 121. Health Threat (HT) -any condition or situation which will be conducive to health alteration, health interference & health disturbance. Foreseeable Crisis (FC) -stress points, anything which is anticipated/ expected to become a problem
  • 122. Jobless Father Suffering from TB th Wife is pregnant for the 8 time 2 y/o youngest child lacks immunization rd 9 y/o eldest child is 3 degree malnourished Poor environmental sanitation
  • 123. III. PLANNING Four (4) Standard Steps: Prioritization -start if there are multiple identified problems Formulation of objectives -planning a procedure will start here if there is only one problem Developing strategies of action Formulation of evaluation tools for the identified strategy developed
  • 124. CRITERIA IN IDENTIFYING THE PROBLEM Criteria Score Weight I. Nature: assess by PHW Health deficit (HD) 3 1 Health threat (HT) 2 Foreseeable Crisis (FC) 1 II. Modifiability Easily 2 2 Intermediate (moderate) 1 Not modifiable 0 III. Preventive Potential Highly 3 1 Moderate 2 Low 1 IV. Salience of the Problem Problem needing urgent 2 1 attention Problem not needing 1 urgent attention Not a felt problem 0
  • 125. § Steps: a. Decide on a score b.  Score x weight ----------------- Highest Score b.  Get the sum total of all the scores § Interpretation: Perfect score=5, if score nearing 5 then prioritize the problem Criteria 1, 2 & 3 has to be assessed objectively by the health worker Criteria 4 has to be assessed by the perception of the family
  • 126. Compute for 3rd Degree Malnutrition
  • 127. IV. INTERVENTION ü Is the capacity to provide management ü Is the professional phase of nursing process ü Is the time when the PHN executes the standard function of an RN ü Three (3) Standard Functions of RN: § Dependent-giving of medicines § Independent-monitor, assess, provide, educate § Interdependent-referrals
  • 128. V. EVALUATION Three (3) Things to be evaluated: SPO 1.  Structure of program & activity -what articles, equipments, supplies are utilized 2.  Process utilized -steps used 3.  Outcome of activity -results can be: § Desirable -to be implemented, advocated, strengthen § Undesirable -to be avoided Two (2) Aspects to be evaluated in the Outcome: § Quality -characteristic or kind of outcome; no numerical value, not measurable § Quantity -from the word “quantum”, with numerical value, measurable
  • 129.
  • 130. OBJECTIVES OF COPAR Patterns to be followed: 1.  Organize people 2.  Mobilize people 3.  Work with people 4.  Educate people ü  Knowledge ü  Attitude ü  Skills
  • 132. 1. PREPARATORY PHASE A. Area of Selection § It should be DOPE Community: Depressed, Oppressed, Poor & Exploited, a new criteria for community organization § “Old Criteria”→ it must be a virgin community=meaning no agency has gone there. § This is a dangerous situation that’s why RA 7305: Magna Carta for Public Workers was provided-a PHN is to receive a hazard pay of 20-25% of monthly salary
  • 133. 1. PREPARATORY PHASE B. Entry: the 1st thing to do upon entering the community is to have a courtesy call with the Barangay
  • 134. 1. PREPARATORY PHASE C. Integration/Immersion § Immersion is imbibing the life situation/ condition of the community by living, eating & sleeping with the family to be able to understand their situation § It requires 2 Qualities of PHN: § Empathy § Sympathy (Integration)
  • 135. 1. PREPARATORY PHASE D. Community Study: Diagnosis of Community-COPAR § Makes use of the Nursing Process/Problem Solving Approach § Prioritized which among the problems identified is to be attended 1st like in nature, magnitude, modifiability, preventive potential, salience
  • 136. PRIORITIZATION OF COMMUNITY PROBLEMS NATURE Health Status (HS) 3 Health Resource(s) 2 Health Related 1 Indicators of Health Status/Condition: Fertility: ↑ CBR=community is overpopulated=HS Morbidity: IR (new cases) & PR (old cases)=HS Mortality: Deaths like children dying of pneumonia=HS
  • 137. PRIORITIZATION OF COMMUNITY PROBLEMS NATURE Health Status (HS) 3 Health Resource(s) 2 Health Related 1 Health Resource(s): 5 M’s-Manpower/Man, money, machinery, material & methods (+) available facilities-Hospital/Clinic, mode of transportation, market, school & movie houses for recreation
  • 138. PRIORITIZATION OF COMMUNITY PROBLEMS NATURE Health Status (HS) 3 Health Resource(s) 2 Health Related 1 Health Related: Categories according to 5 Aspects of Man=PEMSS P hysical, P hysiological, P sychological E motional M ental S ocial S piritual
  • 139. MAGNITUDE OF THE PROBLEM: % of population affected by the identified problem 75-100% 4 50-74 % 3 25-49 % 2 <25 % of the population 1 MODIFIABILITY Easily 3 Intermediate 2 Low 1 Not modifiable 0 PREVENTIVE POTENTIAL Highly 3 Moderate 2 Low 1 SALIENCE
  • 140. 2. ORGANIZING PHASE Choosing Potential Community Leaders Core Group Formation Community Assembly: Community Organizing Participatory Action Research (COPAR) § Attend the assembly of the family/families § Families in the community should be represented, any family members can represent his/her family as long as he/ she is a RESPONSIBLE (one who also can comprehend) member of that family. § Barangay Captain/Chairman need not necessary be the leader. He can recommend
  • 141. 3. MOBILIZATION PHASE Mobilization - let the members of the community do the work. PHN should only SUPERVISE
  • 142. 4. HEALTH EDUCATION ü Adjust on the level of understanding of the community ü Return demonstration is the best way of teaching ü Focus on the KSA ü Respect of the custom and tradition
  • 144.
  • 145. EPIDEMIOLOGY is the pattern of occurrences & distribution of diseases, defects & deaths 2 Population in Distribution Patterns Susceptible Immune (at risk to develop, acquire (those that did not or experience the disease) experience the disease, usually individuals develop resistance against the disease) Epidemic 80% (more than 50%) 20% Endemic 50% 50% Sporadic 20% 80% Pandemic ----- -----
  • 146. EPIDEMIC § Greater than 50% of populations are susceptible or less immune individual § Greater % of the population is affected by the occurring disease Example: Health worker reports that Community Lanting has an epidemic of measles affecting children less than 7 years old Total susceptible population: 3000 Children affected by measles: 1750 1750
  • 147. ENDEMIC The disease occurs regularly, habitually, constantly affecting the population group 2 Local Endemic Diseases: where causative agent is available on those places § Schistosomiasis: Samar, Leyte, Mindoro, Davao § Malaria: Palawan & Mindanao-reasons why it’s prevalent § Forested areas § Surrounded by bodies of water
  • 148. SPORADIC § The pattern of occurrence is on & off where: On=available causative agent Off=no available causative agent § It’s intermittent (unpredictable) in occurrence § Disease occurs only if there’s a susceptible host like in rabies
  • 149. PANDEMIC Worldwide, international, universal, global in occurrence like in AIDS, Hepatitis B, PTB, measles, mumps, diphtheria, pneumonia § SARS is categorized by WHO as an OUTBREAK only because out of 191 nations, 33 countries are reported to have it.
  • 150.
  • 151. HOME VISIT ü  Is a PROFESSIONAL contact between PHN & the family ü  The services provided is an extension of the Health Service Agency (Health Center)
  • 152. OBJECTIVES OF HOME VISIT § Assessment § Nursing Care § Treatment § Health Education § Referral (if care fails)
  • 153. PRIORITIES (IN THE CARE): TO PREVENT CROSS CONTAMINATION 1.  Newborn 2.  Post partum 3.  Pregnant mothers 4.  Morbid cases The families need the assistance of the health center that’s why home visit was done to the family The person who makes the home visit is rendering services on behalf of the health center
  • 154. PHASES OF HOME VISIT: 1. Planning ü Starts at the health center ü Makes a study on the status of the family ü Statement of the problem ü Formation of objective 2. Socialization –first activity is to establish rapport & to gain the trust of the family
  • 155. PHASES OF HOME VISIT: 3. Activity ü  Intervention/Professional Phase ü  Opportunity to provide or extend health services ü  Standard Role of the Nurse: Independent, Dependent and Interdependent ü  To be effective, come in complete uniform (also bring a long umbrella with pointed end which serve as protection) 4. Summarization - ability to put into record & report (orally) about the outcome of the activity
  • 156. PUBLIC HEALTH BAG: Indispensable tool that should be organize to save time & effort and to prevent cross infection & contamination
  • 157. GUIDING PRINCIPLES IN THE USE OF PUBLIC HEALTH BAG: § Content -should be prepared by the one who will make home visit Note: BP Apparatus is kept separately from PHN bag § Cleaning ü The inner part of the bag should be clean & sterile ü Should be done every after home visit ü Never endorse the bag
  • 158. GUIDING PRINCIPLES IN THE USE OF PUBLIC HEALTH BAG: § Contamination § The less one opens the bag, the lesser chance of contamination § In general, the bag is open 3x: ü Putting out materials for hand washing ü Putting out materials used for nursing care ü Returning all what have been used
  • 159. GUIDING PRINCIPLES IN THE USE OF PUBLIC HEALTH BAG: Care of Communicable Case(s) - should be disinfected with the use of 70% isopropyl alcohol or Lysol which should be done at the health center and not at home
  • 160.
  • 161.
  • 162.
  • 163. POLICIES FOR SCHISTOSOMIASIS CONTROL PROGRAM (SCP): CHES C ase Finding H ealth Education E nvironmental Sanitation S nail Eradication
  • 164. CASE FINDING: 6 Aspects or Thing to Know § Disease: Schistosomiasis § Other name: Bilhariasis or Snail Fever § Causative agent: Schistosoma-a blood fluke (parasite) 3 Types of Species: ü Schistosoma japonicum-endemic in the Philippines & affecting Indonesia, China, Japan, Korea Vector: Oncomelania quadrasi ü Schistosoma mansoni ü Schistosoma haematobium
  • 165. § Laboratory Procedures to rule out Schistosomiasis: Blood Examination: ↑ eosinophil level indicates parasitism Fecalysis: Kato Katz (plain stool exam that uses a special apparatus resembling a feeding bottle sterilizer) Procedure: ü Collect specimen ü Have the test tube undergo centrifugation for 20 minutes ü Get specimen from precipitate & swab it on glass slide ü Observe it on microscope
  • 166. § Signs & Symptoms ü CNS: High grade fever→ cerebral convulsion ü GIT: Nausea & vomiting, Diarrhea→ Chronic dysentery (prolonged diarrhea of more than 2 weeks & consistency is mucoid & bloody (with streaks of blood) ü Liver: Presence of infection manifested by jaundice & hepatomegaly ü Spleen: Infection of spleen→ inflammation→ enlargement of organ (Splenomegaly)→ abdominal distension→ abdominal pain on the right upper quadrant ü Blood: Anemia & weakness
  • 167. § Treatment: Drug of Choice-Praziquantel (Biltricide) 60 mg/KBW/day ü Example: If patient is 50 kg, 50 kg x 60 mg/KBW/day=3000 mg/day ü Initial treatment: 1st 2 weeks=3000 mg/day, then do stool exam after 2 weeks→ if still (+), extend treatment for another 2 weeks. Repeat stool exam, if still (+) after the extended week, continue treatment for 2 weeks again. No adverse effect or over dosage even if extended for a year. ü Length of Treatment: takes months to a year
  • 168. Health Education: It affects mostly farmers so educate them to wear rubber boots Environmental Sanitation: Snail is the 1st concern Water where snail thrives is the 2nd concern Toilet=3rd concern Food Garbage Snail Eradication: Use molluscicides treat the entire suspected soil with chemical solution that kills snails
  • 169.
  • 170. CASE FINDING: § Disease: Malaria § Other name: Ague § Causative Agent: Plasmodium-a protozoa 4 Types of Species: ü Plasmodium falciparum-more fatal that affects the Philippine Vector: Female Anopheles Mosquito (FAM) ü Plasmodium vivax ü Plasmodium ovale ü Plasmodium malariae
  • 171. § Laboratory Procedure: Malarial smear-extract blood at the height of fever because plasmodium is very active & ruptures at this period. § Signs & Symptoms of Malaria: 1st Stage=Cold: Chilling sensation for 1-2 hours 2nd Stage=Hot: High grade fever lasting for 3-4 hours 3rd Stage=Wet: Diaphoresis (excessive sweating/perspiration)
  • 172. § Treatment: Drug of Choice-Quinine 2 Forms: a) Chloroquine (Aralen) b) Primaquine If Quinine is not available, may use Sulfadoxime-an antibacterial drug paired with pyrinthamine
  • 173. PERSONAL PROTECTION: § Sleep under a mosquito net § Sleep in a screened room § Sleep with long sleeve attire § Use repellents that contains DET (diethyl toluamide or toluene which has a pungent odor that drives away mosquitoes & an irritant to mucous membrane of respiratory tract when inhaled § Plant a Neem Tree using the leaves
  • 174. CLEAN: Chemical Method=insecticide spraying at night Larvae eating fish=Tilapia Environmental Sanitation & Health Education=insect, water, trash Anti-mosquito soap=basil citronelli Neem tree=banana, banaba, gabi, eucalyptus provide repellent effect
  • 175.
  • 176. STRATEGIES: A. Provision of Regular and Quality Maternal Care Services Ø  Regular and quality pre-natal care § hx-taking, utilization of HBMR (Home-Based Mother’s Record) as a guide in the identification of risk factors § PE: weight, height, BP-taking § Perform head-to-toe assessment, abdominal exam § Tetanus Toxoid Immunization § Fe supplementation: given from 5th mo. of pregnancy to two months postpartum (100-120 mg orally/day for 210 days) § Laboratory exam: Heat-acetic acid test. Benedict’s test § Oral/Dental exam
  • 177. Ø  Pre-natal counseling Ø  Provision of safe, delivery care § all birth attendants shall ensure clean and safe deliveries at the faciltiies (RHUs/hospitals) § at-risk pregnancies and mothers must be immediately referred to the nearest institution
  • 178. Ø  Provision of quality postpartum care Ø  Proper schedule of follow-up must be followed: § 1st postpartum visit for home deliveries must be done within 24 hours after delivery § 2nd, done at least 1 week after delivery § 3rd, done 2-4 weeks thereafter   Attendants must be aware of the early signs, symptoms and complications. They should follow the 3 CLEANS: CLEAN Hands CLEAN Surface CLEAN Cord
  • 179. C. Improvement of the health personnel’s capabilities on newborn care, midwifery thru trainings. Note: All deliveries should be done in health care facilities ONLY   D. Improvement on the quality of care at the First Referral Level Ø  Orientation, training should be done on the use of proper filling-up of HBMR card Ø  Proper referrals/endorsements must be done for future If-ups E. Prevention of unwanted pregnancies through family planning services   F. Prevention and management of STDs
  • 180. G. Promotion of Appropriate health practices   H. Upgrade reporting services   I. Mobilize political commitment and community involvement to provide support to basic health care delivery  
  • 181.
  • 182. GOALS: A. Safe Pregnancy ü  Right age to be pregnant=20-35 years old, not less than 20 & not more than 35 ü  Right interval of pregnancy=once in 2 or 3 years ü  Home Base Mother’s Record (HBMR): the record used for care of mothers in CHN
  • 183. Laboratory Examinations: Benedict’s Test: test for sugar in the urine; test for diabetes § Heat test tube with 5 cc of Benedict’s Solution (blue) in the burner then add 3-5 gtts of urine (amber yellow) then heat again. Observe for the change in color: Blue : (-) sugar in urine Green : trace of sugar in urine +1 + Yellow : traces of sugar in urine +2 ++ Orange : more traces of sugar in urine +3 +++ Brick Red : surely diabetic +4 ++++
  • 184. Laboratory Examinations: Acetic Acid Test: test for albumin in urine; test for Pregnancy Induced HPN § Collect urine in test tube, heat it in burner then add 3-5 gtts of acetic solution (clear white). Observe for change in color: If it remains clear: (-) CHON or albumin in urine If it turns cloudy: (+) CHON=proteinuria
  • 185. POLICIES: 1.  Non coercive (give freedom of choice) 2.  Integration of Family Planning in all Curricular Program: § LOI 47 DECS states that Family Planning is to be integrated in all school curricular programs, either baccalaureates or non- baccalaureates, enrolled separately as one unit 3. Multi-Sectoral Approach: establish relationship with other agencies which can either be: § Intrasectoral § Intersectoral-Local or International (WHO, Unicef, USAID, Japhiego)
  • 186. METHODOLOGIES: Biological A. Basal Body Temperature (BBT) § Get the temperature early morning before waking up which should be monitored daily at the same time § There should be a sudden drop of temperature between 0.3-0.6°C followed by an increase of temperature by 0.3-0.6°C which means that the woman is fertile
  • 187. B. Sympto-thermal C. Cervical Mucus Test Ø Billing’s Method by Dr. Billing Ø Spinnbarkheit (came from a German word Spinner which means to play with the cervical mucus with the finger) or Wet & Dry Method: § Wet Cervical Mucus (Fertile): abundant, stretchy & transparent § Dry Cervical Mucus (Safe & Not fertile): whitish, pasty & adhesive D. Calendar (Rhythm) § Deleted already since 1998 because it’s not recommended for irregular cycle of menstruation § Menstrual cycle should be regular; obtain 4-6 months cycle
  • 188. E. Lactation Amenorrhea Method (LAM): RA 7600-Breastfeeding & Rooming In Law § DOH organized Maternal & Child Family Health Institute (MCFHI) with the following members: ü All government hospitals ü Private hospitals (volunteer) § Normal involution (uterus goes back to normal) of the uterus: after 45 days or 5-6 weeks or 1 ½ months if not breastfeeding § Frozen breast milk is to be put out of the freezer 2 hours before feeding ( Body of Ref: 2-3 days / Freezer: 3-4 months) § Left over milk should be discarded & should not be re-preserved or re-frozen because it is already contaminated
  • 189. METHODOLOGIES: Temporary A. Chemical § Oral Pills (Logentrol)-has low dose of estrogen & progesterone that inhibits ovulation § Parenteral: Depot Medroxyprogesterone Acetate (DMPA)/Depo- provera- inhibits ovulation making women amenorrheic; 1991, DMPA was found to be causing cancer of the cervix 1994, DMPA is given IM 4x a year every 3 months (90 days interval)
  • 190. § Implants: Norplant-it inhibits ovulation effective for 5 years but seldom advocated for use because it is usually expensive; the client buys the device (consists of 5 capsules) & have it implanted at the health center by minor surgical incision in: ü upper inner arm because it is nearest to the brain ü external oblique ü thigh ü gluteal muscles
  • 191. B. Mechanical: §  IUD ü  Up to 10 years protection §  Cervical cap & Diaphragm ü  Prevent the sperm to pass the cervix ü  Works better with spermicide ü  Wore 30 minutes before coitus and keep up to 6 hours after coitus §  Condom ü  Most effective way to prevent STD’s / STI’s
  • 192. METHODOLOGIES: C. Behavioral Ø  Abstinence Ø  Withdrawal D. Permanent Ø  Vasectomy (reversible)-since year 2000 in the Philippines Ø  BLT
  • 193.
  • 194. POLICIES: I. Nutritional Surveillance (NS): to determine victims of malnutrition A. Anthropometric Measurement: study of measurements of human dimensions Ø  Age for Weight-if weight is not appropriate with the age: ü Stunting: growth retardation ü Wasting: connotes malnutrition Ø  Age for Height-if height is not appropriate with the age: Stunting Ø  Weight for Height
  • 195. Rule Male Female Every height of 5 110 lbs. 105 lbs. ft. Every increment + 6 +5 of an inch above 5 ft. ADD Every decrement - 6 -5 of an inch below 5 ft. SUBTRACT
  • 196. Ø  Skin Folds Test-pinch the external oblique muscle (“bilbil”) with your palm Normal: 1 inch Overweight: > 1 inch Ø  Middle Upper Arm Circumference (MUAC)-used in children below 5 years old by measuring the middle upper arm with a tape measure Normal: 13 cms. & above Malnutrition: <13 cms
  • 197. POLICIES: I. Nutritional Surveillance (NS): to determine victims of malnutrition B. Biochemical Method Ø  Micronutrient Malnutrition -available in small amount in the body VADAG: Vitamin A Deficiency: § Deficiency: Xeropthalmia-opacity of cornea leading to night blindnes Infants (6-12 months) : Give 100,000 i.u. Pre-schoolers (12-83 months) : 200,000 i.u. Post partum : 200,000 i.u. § Never give Vitamin A to infants less than 6 months & pregnant women because it is toxic
  • 198. Anemia: Iron Deficiency Anemia § Target age group: 0-59 months (less than 5 years) § Give 3-6 mg/kbw/day § Always give the maximum Example: Child weighs 8 kg 8 x 6=48 mg/day for the 1st 3 months then monitor If still anemic, continue giving but compute again 6 mg/kbw
  • 199. Goiter: Iodine Deficiency Disease (endemic in uphill) § Target age group: 0-59 months § Give 1 capsule (200 mg) of potassium iodate in oil once a year For a child < 5 years old, empty contents of capsule in a cup with warm water because he can’t tolerate it § Adverse Effect of Iodine Deficiency Disease that must be avoided: Ø Mental retardation-intelligence quotient: idiot, moron & imbecile Ø Growth retardation- cretinism (pedia) & dwarfism (adult)
  • 200. Ø  Macronutrient Malnutrition - available in large amount in the body (Protein Energy Malnutrition or PEM) § Kwashiorkor-protein deficiency § Marasmus-carbohydrate deficiency (energy giving food)  
  • 201.   Kwashiorkor Marasmus Etiology Disease experienced by an elder Muscle wasting child upon the birth of a new baby Deficiency CHON CHO Age Toddlers (1-3 years old) All ages Major Signs & Facial edema, moon facie Muscle wasting, old man’s facie Symptoms Hair Changes (+) color changes from black to (-) hair changes brown or from brown to golden yellow (+) sparse “flag sign” Skin Dermatosis: (-) dryness, peeling off of the skin, desquamation Behavior Irritable Apathetic Management High CHON diet High CHO diet Hospital Setting Total Parenteral Nutrition (TPN) Hyperalimentation process IV infusion with CHON, CHO regulated by a machine
  • 202. POLICIES: II. Food Production Fortification-products without any nutrient are added with nutrients RA 8172 (Asin Law): Fidel Salt (Fortification of Iodine Deficiency Elimination) =Iodized Salt-“Patak” sa Asin” by Secretary Flavier on December 1-5, 2003 where DOH workers go to market to check if salt sold contains iodine by placing few drops of reagent: If salt color turns to blue violet→ fortified with iodine If salt color show no change→ not fortified with iodine RA 832 (Rice Fortification): FVR (Fortified Vitamin Rice) by Secretary Flavier under FVR, Erap Rice under Erap, Gloria Rice or “Bigas ni Gloria” under PGMA
  • 203.
  • 204. ENVIRONMENTAL SANITATION Ø refers to all factors available in the environment affecting the health of the individual or population Ø  regulated by PD 856: Comprehensive Sanitation Code of the Philippines
  • 205. ENVIRONMENTAL HEALTH SERVICE (EHS) OF DOH IS RESPONSIBLE FOR § Promotion of healthy environmental conditions & prevention of environmental related diseases through appropriate sanitation strategies § Promotion & implementation of sanitation programs through the Department of Health Field Health Units § Conceptualization of new programs/projects to contend with emerging environmentally related health problems
  • 206. COMPONENTS: ü  Water Supply Sanitation Program ü  Proper Excreta and Sewage Disposal Program ü  Insect and Rodent Control ü  Food and Sanitation Program ü  Hospital Waste Management Program
  • 207. 1. WATER SUPPLY SANITATION PROGRAM ü  Potable ü  Free from any particles that might cause illness to an individual
  • 208. Ways to make Water Potable: § Boiling: minimum of 3 minutes to maximum of 10 minutes for drinking § Sterilization: 30 minutes after the water starts to boil § Filtration: makes use of filter paper or cotton cloth to separate solid particle from liquid if water comes from river
  • 209. § Coagulation/Flocculation: uses aluminum crystal (tawas) that collects or absorbs particles from liquid part & becomes slimy ü In 1 gallon of water, drop tawas (the size of magi cubes) & allow to stand for 6-8 hours ü Initially, water appears to be cloudy then after 6-8 hours of standing, the water becomes clear
  • 210. Chlorination: uses 100% pure concentrated chlorine bought from botika or given free by health centers Ø  To prepare stock solution (SS): in 1 liter drinking water, add 1 tablespoon of concentrated chlorine which is potent for 3-4 months Ø  To prepare the chlorinated water: in 2 ½ gallons of drinking water (10,000 ml=10 liters), add 1 tablespoon from the prepared stock solution & let it stand for 30 minutes to react with water  
  • 211. § Fluoridation: adding fluoride to prevent dental caries (primary significance) & whitens enamel of teeth ( 2nd significance) § Aeration: exposing drinking water in air to strengthen taste within 24 hours which is usually used in uphill areas where there’s less or no pollution
  • 212. 3 TYPES OF APPROVED WATER SUPPLY AND FACILITIES Level I Point Source A protected well or a developed spring with an outlet but without a distribution system for rural areas where houses are thinly scattered.
  • 213. 3 TYPES OF APPROVED WATER SUPPLY AND FACILITIES Level II Communal faucet system or stand posts A system composed of a source, a reservoir, a piped distribution network and communal faucets, located at not more than 25 meters from the farthest house in rural areas where houses are clustered densely.
  • 214. 3 TYPES OF APPROVED WATER SUPPLY AND FACILITIES Level III Waterworks system or individual house connections A system with a source, a reservoir, a piped distributor network and household taps that is suited for densely populated urban areas.
  • 215. 2. PROPER EXCRETA AND SEWAGE DISPOSAL SYSTEM
  • 216. 3 TYPES OF APPROVED TOILET FACILITIES Level 1 Non-water carriage toilet facility: - Pit latrines - Reed Odorless Earth Closet - Bored-hole - Compost   Toilets requiring small amount of water to wash waste into receiving space - Pour flush - Aqua privies
  • 217. Pit latrines Ø  most commonly observed in rural area Ø  has three components: the pit, a squatting plate and the super-structure Ø  types of pit include “Antipolo type”, a pit type of toilet provided with concrete floor and an elevated seat with a cover Ventilated Improved Pit or VIP, pit with a vent pipe Reed Odourless Earth Closet or ROEC, a pit completely displaced from the superstructure and connected to the squatting plate by a curved chute.
  • 218. Bored Hole Latrine ü  consists of relatively deep holes bored into the earth by mechanical or manual earth-boring equipment ü  holes are about 10-18 inches in diameter and usually 15-35 feet deep. The hole is provided to facilitate squatting. Two types of bored-hole latrines are: Wet Type - when the hole penetrates ground water table or other strata. Dry Type - when he hole does not reach ground water table; fills up at a faster rate then than the wet type.
  • 219. 3 TYPES OF APPROVED TOILET FACILITIES Level 2 On site toilet facilities of the water carriage type with water sealed and flushed type with septic vault/tank disposal facilities.
  • 220. 3 TYPES OF APPROVED TOILET FACILITIES Level 3 Water carriage types of toilet facilities connected to septic tanks an/or to sewerage system to treatment plant.
  • 221. THINGS TO CONSIDER IN CONSTRUCTING A TOILET FACILITY: ü  At least 25 meters away from water sources at a lower elevation ü  It should be within your financial capability ü  It should be approved by the local health authorities
  • 222. CARE AND MAINTENANCE OF YOUR TOILET FACILITY: ü  Water must be provided at all times. ü  Use toilet paper ü  Use lysol once a month for odor removal ü  Clean the bowl by muriatic acid to remove the stains. ü  Avoid depositing solid objects on the bowl to prevent clogging ü  Always check your toilet if it’s clean ü  Use plunger when clogging occurs. Don’t use sticks or rods to avoid the breakage of the trap or the bowl.
  • 223. 3. PROPER SOLID WASTE MANAGEMENT refers to satisfactory methods of storage, collection and final disposal of solid wastes
  • 224. SOURCES OF SOLID WASTE Household Waste - these are wastes generated in or discharged from household including shops but excluding commercial activities   Commercial Waste - restaurants, stationery shops, grocery shops or any commercial activity are the main sources of commercial waste.   Market Waste - only refers to waste generated in or discharged from markets both for whole sale and retailing  
  • 225. SOURCES OF SOLID WASTE Institutional Waste - these are wastes generated in government, state enterprise and private firm office.   Street Sweeping Waste - these are wastes generated by the street sweeping cleansing service.   River Waste - includes all the wastes generated by the river and creek cleansing   Medical Waste - these are wastes generated in hospitals.
  • 226. COMPONENTS OF SOLID WASTE Garbage refers to left over vegetable, animal and fish material from kitchen and food establishments. These materials have the tendency to decay giving off foul odors and sometimes serve as food for flies and rats.   Rubbish refers to waste materials such as bottles, broken glass, tin can, waste papers, discarded textile materials, porcelain wares, pieces of metal and other wrapping materials.    
  • 227. COMPONENTS OF SOLID WASTE  Ashes are left over from burning of wood and coal. Ashes may become a nuisance because of the dust associated with them.   Stable manure is animal manure collected from stables.   Dead animals like dead dogs, cats, rats, pigs, and chickens that are killed by cars and trucks on streets and public highways. They include small and large animals that died from disease.  
  • 228. COMPONENTS OF SOLID WASTE Street sweeping includes dust, manure, leaves, cigarette buts, waste papers and other materials that are swept from streets.   Night soil is human waste normally wrapped and thrown into sidewalks and streets. This also includes human waste from pail system of toilets.   Yard cuttings includes leaves, branches, grass and other
  • 229. SANITARY WAYS OF TREATING GARBAGE: Segregation-separating biodegradable from non biodegradable Collection-adherence to the proper collection time→ the City of Manila coordinates with Leonel Waste Management (a private firm which collects garbage) where the truck driver coordinates with the Barangay Chairman on the time they will collect garbage so don’t bring out garbage before the collection time
  • 230. WAYS OF DISPOSAL Household ○ Burial ► Deposited in 1m x 1m deep pits covered with soil, located 25 m. away from water supply   ○ Open burning o  Animal feeding o  Composting o  Grinding and disposal sewer
  • 231. WAYS OF DISPOSAL Community ○ Sanitary landfill or controlled tipping ► Excavation of soil deposition of refuse and compacting with a solid cover of 2 feet   ○ Incineration Ecological Solid Waste Management: RA 9003- the use of incinerator approved in 2000 but was implemented in 2003 because of lack of funding to purchase
  • 232. 4. FOOD SANITATION PROGRAM
  • 233. POLICIES: ü  Food establishment are subject to inspection (approved of all food sources containers and transport vehicles) ü  Comply with sanitary permit requirement ü  Comply with updated health certificates for food handlers, helpers, cooks ü  All ambulant vendors must submit a health certificate to determine present of intestinal parasite and bacterial infection
  • 234. 3 POINTS OF CONTAMINATION ü Place of production processing and source of supply ü Transportation and storage ü Retail and distribution points
  • 235. 5. HOSPITAL WASTE MANAGEMENT RA 4226-Hospital Licensure Act monitors the hospital license & proper management of wastes as well as renewal of license to operate
  • 236. GOAL: To prevent the risk of contraction contracting nosocomial infection from type disposal of infectious, pathological and other wastes from hospital
  • 237. COLOR CODING OF BIN TO KEEP WASTE: Green: wet waste Black : dry waste Yellow: infectious/pathological waste like blood, sputum, urine, feces & gauze Orange: toxic/hazardous waste