fish, milk, cheese , anchovies, salmon,

NP1 sardines
 Primary Health Care and CHN  VIT C prevents SCURVY
 MDG target- reduction of maternal mortality  Solutions like alcohol must be must be
by 80/100,000 live births (mdg5) placed in the center of the Public health
 2/3- reduction of child mortality rate (mdg4) Bag
 Mdg 5- TARGET 2015  IRON- 60 mg per tablet once a day and 400
 SDG 3– HEALTH and WELL being mcg of folic acid for 6 months
Centered ( disease focus : HIV/AIDS ,  Vitamin A for postpartum – 200,00 IU one
Malaria) dose
 SDG 6 – SANITATION centered  Vitamin A for pregnant– 10,00 IU 2x a
Transforming our world: the 2030 Agenda for week starts at 4 months
Sustainable Development.  Vitamin A for Children 12 months and
above – 200,00 IU dose every 6 months
17 goals target is 2030  Vitamin capsule colors: RED
 Goal 1: No Poverty  Vitamin A treatment of Xeropthalmia
 Goal 2: Zero Hunger and Measles
 Goal 3: Good Health and Well-  Beta-carotene in vegetables such as carrots
and sweet potatoes is the most common
being (health centered related) provitamin A.
 Goal 4: Quality Education
 Goal 5: Gender Equality  Dairy products (such as cheese and fortified
 Goal 6: Clean Water and milk), eggs, cod, liver oil and halibut are
rich sources of preformed vitamin A.
Sanitation(sanitation centered)
 Goal 7: Affordable and Clean Energy  Plant-based sources of provitamin vitamin A
 Goal 8: Decent Work and Economic Growth include pumpkin, broccoli, and dark green,
 Goal 9: Industry, Innovation and leafy vegetables.
Infrastructure  Signs of long-term vitamin A toxicity are
 Goal 10: Reduced Inequalities coarse hair, thinning eyebrows, dry skin,
 Goal 11: Sustainable Cities and cracked lips, weakness, and severe
Communities headache.
 Goal 12: Responsible Consumption and  One major sign of vitamin A toxicity is
Production carotenosis, a condition in which the palms
 Goal 13: Climate Action of the hands and soles of the feet appear a
 Goal 14: Life Below Water deep yellow or orange color.
 Goal 15: Life on Land
 Goal 16: Peace, Justice and Strong  BP cuff , Paper lining must be OUT of
Institutions the PHN bag
 Goal 17: Partnerships for the Goals
 Tuberculosis / PTB- a highly infectious
 chronic disease that usually affects the
 SDG- 17 GOALS – 2030 lungs.
 Spacing of pregnancy - 3-5 years Causative Agent: Mycobacterium
 iron- prevent anemia of pregnancy- liver Tuberculosis (acid fast bacteria)
products, red meat and internal organs,
munggo, green leafy vegetables
 Vit.D for calcium absorption prevents  Robert Koch- German physician and
RICKETS in children and osteomalasia in scientist, presented his discovery of
adult- sources dairy products ,cod liver oil, Mycobacterium tuberculosis, the
 bacterium that causes tuberculosis (TB),  Direct Observed Treatment Short Course
on the evening of March 24, 1882 – comprehensive strategy to detect and cure
TB patients.
 Sign/Symptoms:  DOTS (Direct Observed Treatment Short
 cough for more than 2 weeks Course)
 afternoon fever  Category I - 6 months treatment
o Swelling lyphnodes o -new smear (+) PTB
 weight loss -new smear (-) PTB with extensive
 night sweat lesions on CXR
 blood stain sputum - hemoptysis - -EPTB
***late sign -Severe concominant HIV disease 2
Preventing Tuberculosis  BCG o -DOTS: 2months RIPE
vaccination maintenance: 4months RI
 Case finding – Direct Sputum Smear  II -treatment failure
Microscopy and X-ray examination of TB -relapse
symptomatics who are negative after 2 or -return after default
more sputum exams -intensive: 2 months RIPES/1 month RIPE
 Sputum smear and culture or DSSM - Maintenance: 5 months RIE
confirms the diagnosis
 Tuberculin test (Mantoux test- detects the  III -new smear (-) PTB with minimal lesion
presence of antibodies on CXR
(Results read within 48-72 hours from skin o -DOTS: 2months RIPE
testing, posistive if within duration of 10mm maintenance: 4months RI
or more.
Below 5 y/o - > or = 10 mm is positive,  IV -chronic Refer to specialized facility or
Older than 5 y/o > or = to 5 mm is positive) DOTS Plus Center
 Mantoux test- A positive reaction means Refer to Provincial/City NTP Coordinator
that the client has been
exposed to TB  Rifampicin causes urine discoloration.
 DOTS- declared in 1996 Isoniazid give Vit. B6 or pyridoxine to
 Inhale or deep breath then cough up 3-5ml prevent peripheral neuropathy
sputum proper way to collect Pyrazinamide - causes G.I upset.
Ethambutol causes-
 Hemoptysis is contraindication of sputum
-not given to children under 6 years or
collection
younger because they cannot reliably
 3x in a month – collection of sputum for
monitor vision –
case finding
 Bcg – do not give to immunosuppressed
baby- with leukemia and hiv  Streptomycin causes- tinnitus and auditory
impairment/ OTOTOXICITY.
 A positive reaction consists of palpable
swelling and induration of
- 10mm and above for normal  FDC – Fixed Dose Combination
- 5mm and above for immunocompromised.  4 FDC or 4 drugs combined in a blister pack
 Chest x-ray - determines the presence and – R.I.P.E
extent of disease  3 FDC or 3 drugs combined i a blister
 the primary diagnostic tool in TB case packs – R.I.P or the new drug R.I.E.
finding is DSSM  2 FDC or 2 drugs combined i a blister packs
 The only contraindication for sputum – I.E or the new drug R.I.
collection is hemoptysis  Streptomycin – only TB drug in Vial

 Leprosy
 RA 4073- Liberization and Treatment of water contaminated with Vibrio cholerae
Leprosy (February as Leprosy Month)
• Hansen's disease - BACTERIA from other cholera patients
• •Multi-Drug-Therapy (MDT)
• LEPROMATOUS TYPE is the most
 Where is the major reservoir for cholera?
disfiguring type of LEPROSY
 Answer: The major reservoir for cholera
CHOLERA was long assumed to be humans themselves,
 In August of 1854 Soho, a suburb of but considerable evidence exists that aquatic
London, was hit hard by a terrible outbreak
environments can serve as reservoirs of the
of cholera. Dr. Snows himself lived near
Soho, and immediately went to work to bacteria.
prove his theory that contaminated water
was the cause of the outbreak.
 In 1883 a German physician, Robert Koch,  In its most severe form what effect does
took the search for the cause of cholera a Cholera have?
step further when he isolated the  Answer: Severe drop in blood pressure
bacterium Vibrio cholerae, the “poison”
Snow contended caused cholera. Infected patients may die within three hours
 Dr. Koch determined that cholera is not if medical treatment is not provided
contagious from person to person, but is It colonize in the intestine and produce
spread only through unsanitary water or
food supply sources, a major victory for toxin, it makes intestinal cell secrete water,
Snow’s theory. The cholera epidemics in you die from shock.
Europe and the United States in the
19th century ended after cities finally
improved water supply sanitation.  What is the most common scenario for

 John Snow to be the pioneer of Cholera?

public health research in a field known  Answer: In a common scenario, the disease
as father of MODERN progresses from the first liquid stool to
EPIDEMIOLOGY in part because of his
work in tracing the source of a cholera shock in 4 to 12 hours, with death following
outbreak in Soho, London, in 1854 in 18 hours to several days, unless oral (or,
 Cholera is an acute diarrhoeal infection in more serious cases, intravenous)
caused by the bacterium Vibrio cholera of rehydration therapy is provided.
serogroups O1 or O139.
 Humans are the only relevant reservoir,  What is the major symptom of Cholera?

 What is Cholera?  Answer: Massive, rice-water diarrhea

(Contains mucus) (up to 10 liters per day!)
 Answer: It is an opportunistic infection,
caused by enterotoxin - producing strains of Fluid & electrolyte loss -> K+ depletion ->
the bacterium Vibrio cholera death

 VERY common in RAINY SEASON

 What is the treatment for Cholera?

 How is Cholera transmitted?  Answer: Treatment - oral rehydration

therapy
 Answer: Transmission to humans occurs
through eating food (seafood) or drinking
 How is Cholera prevented?  Answer: What are the bacterial
 Answer: Prevention - Modern characteristics of Cholera?
plumbing/sanitation and clean drinking  It is gram negative, motile, curved rod
water Very sensitive to low pH <6

 Where did Cholera originate from?  What is the environmental cycle for
 Answer: Originally came from India from Cholera?
Ganges delta.  Answer: They usually cling to biofilm
It was transported by ships. before heavy rain fall from monsoon
season.
 What does serogroup refer to? They are a aqueous virus.
 Answer: "Serogroup" refers to the structure You can screen out the zooplankton with
of lipopolysaccharide or LPS, and O- using clothes to filter water.
antigens expressed It is only 50% effective, it only filters out
stuck zooplankton
 What is does biotype mean?
 Answer: Biotype - further classification  What are the Cholera virulence factors?
based on phenotypic characteristics  Answer: Cholera Toxin (CT)
Toxin Co-regulated Pilus (TCP)
 Who was John Snow?
 Answer: One of the fathers of  What is Cholera Toxin?
epidemiology, because of his work in  Answer: A-B enterotoxin (1 A & 5 B
tracing the source of a cholera outbreak in subunits)
Soho, England, in 1854. Causes symptoms of disease
Found that Cholera came from contaminated
drinking water.  What is Toxin Co-regulated Pilus ?
 Answer: Involved in colonization of human
 How many cases of Cholera are there in a intestine
year? Bacterial-bacterial interactions
 Answer: Approximately 500,000 cases per Also serves as a receptor for the
year bacteriophage that encodes cholera toxin

 Where is the Cholera endemic present?  What are characteristics of Vibrio Cholerae?
 Answer: Endemic (always present) in  Answer: It is motile because it has a
Africa and SE Asia (Indian subcontinent) flagella.
Not in a host it is does not express Cholera
 What is the causative agent of Cholera? toxin
 Vibrio Cholerae The host is used for amplification.
BUBONIC PLAQUE – BLACK DEATH  Where did the Black Death Originate?- Asia,
predominantly China
 When did the Black Death Occur? - 1347 –
1350 ( 1348)
 Where did the Black Death first arrive in
 In what century did the Black Death Occur?
- 14th Europe?- Messina, Italy

 Describe the definition of the Black Death- A

widespread epidemic of the Bubonic  When did the Black Death reach Southern

Plague the occurred in the 14th century, Italy?- December 1347

killing millions of people.  When did the Black Death reach Marseilles
in Southern France?- January 1348
 What helped the spread of the Black
Death?- Trading routes on both land and  When did the Black Death reach England?-

sea September 1348

 True/False: The rat spread the disease by  when did Egypt become infected with the

biting humans (False) Black Death?- 1347

- It was the flea that bit the human, the rat  By ____ the Black Death had spread

only carried the flea. through Northern Africa- 1348

 What fraction of Europe died during the  In what season were the fleas most active?-

Black Death?- about 1/3 Summer

 What type of flea carried the Disease?- The  What did the Pope do to protect himself

oriental rat flea from the Black Death?- He sat in between

two fires, killing the fleas because of
 What was the most common strain of the
Black Death?- The Bubonic Plague extreme heat.

 How many strains of Plague were there?- 3  What was also happening during the Black
death that caused it to spread even
 Name the strains of the Black Death:-
quicker?- Widespread famine
Bubonic, Pneumonic and Septicaemic
 What is another name for the Black
Death?- the Bubonic Plague
COURSE of INFECTION
1. Flea drinks rat blood that carries the  in what desert is the Black Death thought to
have originated?- The Gobi Desert
bacteria
2. Bacteria multiply in flea's gut  What were some of the symptoms of the

3. Gut clogged with bacteria Black Death?

4. Flea bites human, regurgitates blood  -High fever

into open wound -Extreme fatigue

5. Human is infected -Aching limbs

-Lymph nodes (The smaller black swellings)
-Bubo's
 What bought the Black Death from Asia to
Europe?- Rats and their fleas traveling on  bubo

trade routes  the apple-sized, pus-filled lumps that grew

on the armpits and groins of sufferers
 What were the symptons of the pneumonic vesicles have formed
• Antiviral agents – acyclovir
plague? - Coughing up blood
 Fifth’s Disease
 Symptoms
 Classic rash of erythema on face (cheeks),
“slapped face appearance”
 Helminths - most common is ascariasis ,
hookworm ,trichuris (whipworm) ****  Rubeola (measles)
EXCEPT = Taeniasis • Viral infection
• RNA virus of the genus Morbillivirus
within the family Paramyxoviridae
 Beef tapeworm - Taenia saginata- ingestion • Communicable just before the rash
of undercooked beef appears
 Ancylostomiasis/Hookworm – causes  Pre-Eruptive Stage:
anemia - penetration of skin - walking • fever, coughing, sneezing, and running of
barefooted nose and redness of eyes.
 Pinworms/ enterobiasis .- best way to • Koplik spots—bluish-gray specks or
diagnose this infection is through a tape test. “grains of sand” on a red base—develop
 Hepatitis A , E or Infectious Hepatitis: oral- on the buccal mucosa
fecal route  Mumps - PAROTITIS
 Hepatitis B or Serum Hepatitis: blood-borne, • Viral infection
oral-oral • Transmitted by direct contact of saliva and
 Red tide poisoning- first aid Drinking pure respiratory droplet
coconut milk • Communicable immediately before
 Rabies/ Lysa Mgt. swelling begins
 observe the dog for 14 days. If it dies or  Rubella(German measles)
shows signs suggestive of rabies, consult a • Viral Infection
physician. • Communicable 7 days before to 5 days
after rash
 Rabies - hydrophobia, a morbid fear of
water **Pregnant people must avoid infected
child=fetal death
 Licking of intact skin
 Pertussis (whooping cough)
 Observe the dog for 14 days
• Bacterial infection
 CATEGORY II
 Diptheria- bacterial cause-
 Abrasion, laceration, punctured wound on
corynebacterium diphtheria-
the lower extremities
pseudomembrane
 Give active vaccine
 Zika virus
- Observe dog for 14 days • a virus transmitted by Aedes mosquitoes.
 CATEGORY III  Causes microcephaly baby in pregancy
 Abrasion, laceration on upper extremities,
 Census- mass population collection of data
head and neck.
 9 cotton balls – thermometer technique
 Dog is killed, lost died, stray
 IPV – IM
 Give active vaccine plus Passive vaccine
 IPV- killed bacteria
ACTIVE IMMUNIZATION –
 Measles route – SQ
PCEC (Purified Chick Embryo Vaccine),
RABIPUR and the new cheap drug  Measles insertion 40-50 degree
VEROWELL  Give every child a dose of Vitamin A every
 Viral Infection six months from the age of 6 months.
Varicella (Chicken Pox)  Give every child mebendazole every 6
- Varicella Virus months from the age of one year.
Communicable 1 day before eruption of
vesicles to 6 days after first crop of
 6 weeks DPT+HIB-1** Hep B1 OPV1  POSTPARTUM BLUES- common normal
RTV1**** PCV1***** 2-3 days postpartum,
 10 weeks DPT+HIB-2 Hep B2 OPV2 RTV2  Oxytocin- uterine contraction, given after 3rd
PCV2 stage of labor
 14 weeks DPT+HIB-3 Hep B3 OPV3 RTV3  CATEGORY1 - NO RESTRICTION....NO
PCV3 CONDITION WHICH CONTRADICTS
 Pneumococcal conjugate vaccine (PCV) – THE USE OF THE METHOD...
start to be given at 6 weeks  CATEGORY 4--- Method not to be used-
 9 months Measles *** A condition which represents an
 12 months MMR unacceptable health risk if the contraceptive
 ****Rotavirus Vaccine – 2-3 doses method is used ( may sakit)
antidiarrheal  DEPO PROVERA – 3 months injectables,
 Cholera- tetracycline- Cotrimoxazole assess weight gain
 Tetracycline: permanent green teeth  feso4- 1 gram per singleton pregnancy- start
staining of baby if used by pregnancy at 5 months to 2 months postpartum
 Pneumonia, Acute ear infection,  site of bbt – AXILLARY
Mastoiditis (Drug: Amoxicillin – 1st line,  Hand washing/ hand hygiene – 40-60
Cotrimoxazole – 2nd line) seconds
 in IMCI standard for fever is > 38.5oC or  Scurvy – Vit C
hot to touch - give Paracetamol evry 4-5  Dpt interval. – 4 weeks
hours- analgesic and antipyretic  Post Partum homevisit – home delivery is
 Census is for gathering data in mass within 24 hours….. hospital delivery- within
population or groups 1st week or between 3-5 days after delivery
 COPAR - Community Organizing  vitamin A,deficiency –Xeropthalmia and
Participatory Action Research bitots spot
 BAWANG – Cholesterol and hypertension  BP cuff not included inside PHN/ OB bag
 LAGUNDI – cough , colds fever, and  7160 LGU – DEVOLUTION CODE
dysentery  Vibrio cholera or El tor – common in rainy
 NIYOG NIYOGAN – traditional medicine season
act as ANTIHELMINTHIC, to expel worms  vit. A IU postpartum mother – 200,000 IU..
and parasites  Sabin – OPV – live attenuated virus
 LEVEL 2 WATER FACILITY – STAND  Defrost freezer if ice build up of refrigerator
POST and communal faucet is 2-3 cm or 1inch or more
 HBMR – home based mothers record  Bcg – 0.05 (.05ml) – ID
 HBMR – is a tool used to render prenatal  TB - SCC means short course
care consisting the risk factors and danger chemotherapy
signs of pregnancy  Einc protocol 3x- Drying thoroughly
 PANEL 2 of HBMR – contains the risk  Cretinism – iodine deficiency
factor and danger signs of pregnancy  Measles – infectious before rashes appear –
 OPV-- SABIN VACCINE 4th day
 ORESOL is administered EVERY 4  TT1 protection - no protection
HOURS  6000 TOTAL POPULATION TARGET
PLAN C in dehydration treatment -- FOR EPI – 180
insertion of IVF  Sabin - opv
 IVF – for severe dehydration  Blindness – Vit. A
 COURTESY CALL is done in -- PRE  Ampalaya – DM type 2
ENTRY PHASE of COPAR  Endometrial cancer s/s – unusual discharges
 HYDROCEPHALUS and mental retardation or vaginal bleeding
is a form of HEALTH DEFICIT –  CBR Crude birth rate
 koplik spots – measles
 Unang yakap- dry the baby  *Dosages of immunization- Dpt Opv
 BMI- Obese- ≥30.00--------Normal ,Hep.b- 3 doses
range - 18.50 - 24.99--------Overweight -  Vaccines must be exposed only in room
≥25.00 temperature up to 3 x
 3rd exposure – discard vaccine
 Cheesy discharges and pruritus vulva –
candidiasis, moniliasis  FEFO- First expiry first out
 Cauliflower cells – condylomata – HPV  Cold chain by dictrict level – 3 months
 Clue cells – bacterial vaginosis  Half life packs shelve of measles- 6 hours
 Strawberry cervix – trichominasis  Half life packs shelve of Dpt, opv, bcg- 4
hours
 Foul fishy discharges – bacterial vaginosis
 Half life packs shelve of Tt, heap b- 8 hours
 FROTHY DISCHARGES –
– discard if not used up within the end of
TRICHOMONIASIS
your shift
 PID – CAUSED BY GONORRHEA AND
 Dosages- 0.5 ml IM( DPT,HEP. Penta,
CHLAMYDIA
PCV)
 Hiv – attacks CD4 cells
 0.5 ml SQ(Measles)
 And HIV/AIDS .– attacks immune sytem
 0.05 ml ID(BCG)
 Family Planning
 2 DROPS ORAL ( ROTA & OPV)
 VIT.D- RICKETS
 4 months or a 16 months baby completed the
 Family Planning – PD 965 – july 20 1976
doses of 1 bcg dpt1-3 opv1-3 hepb1-3
 RH bill – 10354
 *Crude birthrate- TOTAL LIVEBIRTHS
 IUD – REVERSESSIBLE LONG TERM ÷TOTAL POPULATION x 1000
 T cu 380 – 10 YEARS PROTECTION  *Crude death rate - Total deaths ÷total
 COLD CHAIN – a system that maintains population x1000
potency of vaccine  *Chain of infection- handwashing
 RABIES – saliva of rabid animal  Weakest link- mode of transmission
 Rabies – is known as lysa  Benedict's and acid test – performed in
 PTB – Koch disease community to pregnant mothers in home
 BREASTFEEDING – the 3 E (Early, visit to test glycosuria and proteinuria
Exclusive, Extended)  Roll over test- Sims or sidelying
 Aqua privies is level 1  Severe abdominal pain - 90 degree angle or
Breast self exam is a secondary level of Fowler's also
prevention  Feeding in bed - 90 degree or fowlers
 Cretinism is iodine deficiency  2nd degree burn - painful and blister
 Iron must be with vit. C  Syphilis bacteria is in the painless ulcers or
 Calcium is with vit D sores
 IRON is in chicken liver and MONGO  *Iron- chicken liver, monggo
 brown vials of vaccines protects against  *Vit A- squash, papaya, yellow camote,
sunlight to maintain potency yellow corn, banana
 Thick creamy cheese substance –  *Cretinism or mental retardation / Iodine
candidiasis  *TB - intensive phase category 1&2
 *Breastmilk stool-mashy,golden yellow –  *COPAR - courtesy call at pre entry,
sweet sour smell (immersion or integration at ENTRY,)
 *lactalbumin- breastmilk easily digestible  IFR* individual funding request.
protein
 *IMCI/ danger signs – Convusion, Unable
 *Content of colostrum - antibody IgA to drink or breastfed, Vomits everything,
(immunoglubolin antibody A) Abnormally sleepy or difficult to awaken)
 *Tetanus neonaturum- cord care mangement  Stridor/chest indrawing - severe pneumonia
- alcohol and hand hygiene or handwashin
 Fast breathing (0-2 mos= 60cpm ,, 2-12 mos
 -hand hygiene - to break chain of infection = 50 ,, 12-5 years old = 40 ** pneumonia
 Pneumonia first line antibiotics - amoxicillin  Setting up of linkages/ network/ referral
 Cholera- vibrio eltor and cholerae in rainy systems
season- Dirty water
 Salmonellosis – caused by food poisoning in
canned goods Or spoiled proteins  Sustenance and Strengthening Phase
 HIV attacks CD4 T helper cells in immune  Formulation of by-laws
system  Identification and development of “
 Measles* cough, runny nose, conjunctivitis secondary” leaders
and maculopapular rashes  Setting up of a financing scheme
 Koplik spots also in buccal mucusa
 Airborne transmission - measles
 *Post partum management/ *foul lochial  Rates- relationship between a vital event and
discharge- puerperal sepsis or endometritis those persons exposed to event
 *Cold chain- system to maintain potency of  Ratio- relationship between two (2)
vaccine numerical quantities
 *Colustrum – rich in maternal antibodies –  Infant Mortality Rate- good index of the
thick yellow or dirty white general health condition of a community
 *Storage of breastmilk-4-6hours if room  Swaroops index- is the proportion of deaths
temperature of people aged 50 years and up.
 *Prolactin - hormone that influences  3 CRITERIA FOR LAM use:
milk production  Amenorrhea
 *Prenatal visit- at least 4 visits  Fully or nearly fully breast feeding her
 36 weeks to term is everyweek infant
 Home based mothers record - panel 1-  BF on demand basis (evey 2-4 hrs during
maternal obstetrical history and info the day, 4-6 hrs at night
Panel 2- present pregnancy, danger signs,  Infant is less than 6 mos
TT, FESO4, LAB RESULTS  Gonorrhea
 *BSE- 7 DAYS AFTER MENSTRUATION Male:
 (COPAR) - Community Organizing purulent yellow penile discharge
Participatory Action Research  Females: - Greenish vaginal discharge
Pre-entry /Preparatory Phase  Genital Human Papillomavirus
 Profiling of community HPV
 Ocular survey/ Site selection  condylomata, cauliflower-like warts
 PAy courtesy call to community leaders.  Acetic acid swabbing (will whiten lesion)
 Condylomata acuminata
 Entry Phase  Hepatitis B
Integration with the community  Spread through infected blood and bodily
 Self Awareness Leadership T raining fluids such as semen
 Organization phase  HIV – AIDS
 core group formation  Retrovirus (HIV1 & HIV2)
social preparation  Attacks and kills CD4+ lymphocytes (T-
spotting & developing potential leaders helper)
 A-R-A-S (Action- Reflection- Action-  Sexual intercourse (anal and vaginal)
Session)  Exposure to contaminated blood, semen,
 community diagnosis breast milk
 Needlestick injuries
 Action Phase  HIGH RISK GROUP – BLACK and
 Organization and training of (BHWs): HISPANIC (MEN)
 PIME of health services (Project  Homosexual or bisexual
Implementation Monitoring and Evaluation)  Sexual contact with HIV+
  Intravenous drug users  PHC- is universal and it extends even to
 HIV TEST people in the hospital, both sick and well.
 Elisa – Enzyme Link Immunosorbent -Accessible
Assay ( first test conducted) -Available
 Western Blot - confirmatory test -Affordable
  HIV+ -Acceptable
2 consecutive positive ELISA and -Appropriatene
1 positive Western Blot Test  Four Cornerstones/Pillars in Primary Health
  Full blown AIDS- CD4 is less than 200/ml Care
 Pelvic Inflammatory Disease  Intra and Inter-sectoral Linkages
 Cause by CHLAMYDIA – primary agent  Use of Appropriate Technology
 Gonorrhea is also secondary agent  Support mechanism made available
 Most common affected – OVIDUCTS or Department of Health (DOH)
Fallopian tube  Active Community Participation
 Chronic pelvic pain, fever, flu-like
symptoms, pain during or after  Primary level- Villagers/Grassroots workers
intercourse(CBQ), vaginal bleeding, foul - BHW - frontline worker in community
smelling discharge, tenderness in lower - Traditional birth attendants – traditional
abdomen, and chills Hilots- traditionally acceptable to deliver
 Can cause ectopic pregnancies, infertility pregnancy in community
and abscesses in the pelvis. Can be life - Arbularyo or healers – uses herbs for
threatening - very serious. treatment of illnesses
 8. Candidacies
 Yeast infection  Secondary- Intermediate workers
Public Health Nurse – supervisor of the
 With white cheesy patches
midwife in RHU
(moniliasis)(CBQ)
Midwives – frontline worker in RHU level
 Oral trush in the newborn (CBQ)
Medications:
 Nystatin  Health deficits- TB, DM, hydrocephalus,
polio,leprosy
 Trichomoniasis
strawberry cervix  Health Threats – lack of immunization, no
frothy, foul-smelling ("fishy" smell or lack prenatals
) vaginal discharge  Foreseeable crisis – Abortion - Divorce or
 Trichomona vaginalis, single cell separation Marriage -Entrance at school –
protozoan newborn - Death of a family member
S/sx: Females: Yellow gray frothy
discharge  Malaria
Dx: Causative Agent: - PLASMODIUM
- elevated vaginal pH 5.5+ ( alkaline (protozoa) P. Falciparum (most fatal)
Mgmt: Metronidazole (Flagyl); Vector
 Bacterial vaginosis  Anopheles female mosquito
foul, fishy smelling, thin gray vaginal  Signs & Symptoms:
discharge  Chills to convulsion,
 presence of CLUE CELLS (CBQ)  Elevated temperature
LOI 949 - legal basis of PHC Treatment: chloroquine
 Goal of PHC:  Schistosomiasis
 Health for ALL Filipinos and Health in the Causative Agent: Schistosoma japonicum
Hands of the People by the Year 2020 Snail : oncomelania quadrasi
Mission of PHC: SELF RELIANCE Signs & Symptoms: Bulging abdomen,
Abdominal pain, Loose bowel
 movement(black tarry), Low grade fever,   VVM or Vaccine vial monitor - a
Seizure thermochromic label put on vials which
 Preventive measures gives a visual indication of vaccine potency
Proper excreta disposal  Cold Chain  is a system used to maintain
Agricultural & vegetation improvement potency of a vaccine from that of
Let water stand 2-3 days before usage manufacture to the time it is given to child
Mollucides use or pregnant woman.
Educate in Hand hygiene   Timeframes for the storage of vaccines
Rubber boots use ◦ 6months- Regional Level
 Treatment: Praziquantel (drug of ◦ Not more than 5days - Health centers using
choice) transport boxes. .
 Expanded Program for Immunization (EPI)   “Eligible population”
Wednesday - immunization day - group of people targeted for specific
 FULLY IMMUNIZED CHILD immunizations susceptible to EPI diseases.”
 before the child's first birthday.  Rotavirus vaccine- 6 WEEKS – ORAL
 fully immunized child must have  -GIVEN BEFORE 8 MOS 2 DOSES
completed  PENTA – 6 WEEKS – IM
 BCG 1  MMR- 12 MOS-SQ
 DPT 3  Maternal and child health
 OPV 3  Home Based Mother’s Record (HBMR)
 HB 3 Tool used when rendering prenatal care
 measles vaccines to complete FIC containing risk factors and danger signs
- guide in the identification of risk factors
 Bacillus Calmette-Guérin - Birth or anytime  Fe supplementation: 60 mg with 400
after birth mcg of Folic Acid once a day
 Diphtheria-Pertussis-Tetanus Vaccine  Postpartum visit- Home deliveries
6 weeks(DPT 1) - 1st visit - 24 hours after delivery
10 weeks (DPT 2)  Health care facility
14 weeks (DPT 3) 1st- within 1 week
  3 C of Home delivery
  Oral Polio Vaccine – SABIN - CLEAN Hands
 6 weeks(OPV 1) CLEAN Surface
 10 weeks (OPV2) CLEAN Cord
 14 weeks (OPV3)   Vitamin A Supplement to Infants,
Preschoolers (6mos – 7 yeas and Mothers
 Pregnant women - 10, 000 IU 2x a week
 OPV- Number of doses per vial/amp: 20 starting on the 4th month of pregnancy
 HEPA B , Measles & BCG  Do not give vit. A supplementation before
Number of doses per vial/amp: 10 the 4th month of pregnancy. It might
 Hepatitis B Vaccine - At birth – RNA congenital problems in the baby.
RECUMBINANT, PLASMA  Postpartum women - 200, 000 IU - 1 cap; 1
 Upper outer portion of the thigh, Vastus dose only within 4 weeks after delivery
Lateralis (R-L-R)  Viamin A Deficiency (CBQ) -
  Measles Vaccine - 9 months old – SQ - XEropthalmia – night blindness
Upper outer portion of the arms, Right  Water Supply
deltoid  Level 1 (Point Source) - protected well or
 85% of measles can be prevented by developed spring
immunization at 9 MOS.  Level II - With a source, reservoir, piped
distribution network and communal faucets
 Level III - Individual House Connections
 or Waterworks System - With a source, - On and off scattered cases –habitual
reservoir, piped distributor network and occurence
household taps  Nosocomial (hospital acquired) - urinary
tract infections.
 Toilet or sewerage  Carriers- “an infected person or animal that
 Level I - pit latrines , pour flush toilet & harbors a specific infectious agent in the
aqua privies absence of discernible (visible) clinical
 Level II - with septic vault/tank disposal - disease and serves as a potential source of
water-sealed and flush type infection to others.
 Level III - connected to septic tanks and/or  Leptospirosis – Vector is Rat
to sewerage system to treatment plant. Causative Agent: - bacteria--- Leptospira
 Bag technique-a tool making use of public interrogans
health bag (open bag 3x only)  Sign/Symptoms: High fever, Chills,
 Public health bag - is an essential and Vomiting, Red/ orange eyes, Diarrhea,
indispensable equipment of the public health Severe headache, muscle aches, may include
nurse jaundice (yellow skin and eyes), abdominal
Removed BP Cuff inside bag pain
 Home visit - is a family-midwife contact Treatment: PET - Penicillins G,
which allows the health worker to assess the Erythromycin, Tetracycline, Doxycycline as
home and family situations in order to prophylactic drug
provide the necessary nursing care and  Dengue - mosquito-borne infection
health related activities  Vector is female aedes aegypti mosquito,
*****cleanest to dirtiest dapat day biting, low flying, satagnant clear
****priority sunod sunod na to – pregnant – water,stripes black white body.
newborn – postpartum – last ang may mga  Agent is a Virus.. dengue virus 1,2,3,4
sakit - female aedes aegypti in stagnant water
 Epidemiology - the study of disease treatment is supportive therapy.
occurrence and distribution  Intravenous fluids
 Infection- entry and development or  A platelet transfusion
multiplication of an infectious agent in the  DENGUE DIAGNOSIS:
body of man or animals. - Tourniquet test (capillary fragility test or
 Contamination- presence of an infectious Rumpel Leads Test), a presumptive test
agent on a body surface, on or in clothes, which is positive in the presence of more
beddings, toys, surgical instruments or than 20 petechiae within an inch square,
dressings, or other articles or substances after 5 minutes of test
including water and food  TOURNIQUET TEST - (BP Cuff):
 4 types of disease distribution o fluids (most important treatment) like
 1. Epidemic- “The unusual occurrence in a oresol and IV
community of disease- sudden outbreak of a o paracetamol ( do not give aspirin)
disease in a short period of time o for nose bleeding, flex the neck lean
2. Endemic- constant presence of a disease forward to prevent aspiration
or infectious agent within a given o avoid unnecessary movement
geographic area or population group. o assist in the management of shock.
3. Pandemic- worlwide Dorsal recumbent to trendelenburg
distribution….geographic area such as a position
section of a nation, the entire nation, a  What is hepatitis?
continent or the world  Hepatitis is an inflammation of the
4. Sporadic- “scattered about”. The cases liver. The condition can be self-limiting
occur irregularly, The cases are few and or can progress to fibrosis (scarring),
separated widely in time and place cirrhosis or liver cancer.
 from family member to infant in early
 Hepatitis viruses are the most common childhood.
cause of hepatitis in the world but other  Transmission may also occur through
infections, toxic substances (e.g. alcohol, transfusions of HBV-contaminated blood
certain drugs), and autoimmune diseases and blood products, contaminated
can also cause hepatitis. injections during medical procedures, and
through injection drug use.
 There are 5 main hepatitis viruses,  HBV also poses a risk to healthcare
referred to as types A, B, C, D and E. workers who sustain accidental needle
stick injuries while caring for infected-
 B and C - most common cause of liver HBV patients. Safe and effective
cirrhosis and cancer. vaccines are available to prevent HBV.
 Hepatitis A and E are typically caused  Hepatitis C virus (HCV) is mostly
by ingestion of contaminated food or transmitted through exposure to
water. infective blood.
 Hepatitis B, C and D usually occur as a  Hepatitis C is the most common blood
result of parenteral contact with borne virus in the USA. It is considered
infected body fluids. to be the most serious of the hepatitis
 Common modes of transmission for viruses
these viruses include receipt of  This may happen through transfusions of
contaminated blood or blood products, HCV-contaminated blood and blood
invasive medical procedures using products, contaminated injections during
contaminated equipment and for hepatitis medical procedures, and through
B transmission from mother to baby at injection drug use.
birth, from family member to child, and  Sexual transmission is also possible, but
also by sexual contact. is much less common.
 There is no vaccine for HCV.

 Acute infection may occur with limited or  Hepatitis D virus (HDV) infections
no symptoms, or may include symptoms occur only in those who are infected with
such as jaundice (yellowing of the skin HBV.
and eyes), dark urine, extreme fatigue,  The dual infection of HDV and HBV can
nausea, vomiting and abdominal pain. result in a more serious disease and worse
 Hepatitis A virus (HAV) is present in outcome.
the feces of infected persons and is most  Hepatitis B vaccines provide protection
often transmitted through consumption from HDV infection.
of contaminated water or food.
 transmitted mainly through the fecal oral  Hepatitis E virus (HEV) is mostly
route. (foodborne) transmitted through consumption of
 Certain sex practices can also spread contaminated water or food.
HAV.  HEV is a common cause of hepatitis
 symptoms often include nausea, pain in outbreaks in developing parts of the
upper right quadrant of the abdomen, world and is increasingly recognized as
fever, joint pain, loss of appetite and an important cause of disease in
jaundice developed countries.
 Hepatitis B virus (HBV) is transmitted  transmitted mainly through the fecal oral
through exposure to infective blood, route. (foodborne)
semen, and other body fluids.
 HBV can be transmitted from infected
mothers to infants at the time of birth or  FHSIS/Record & Report:
Objective:
 1.Provide summary of data on health service  ❖ Health educator, who aims towards
delivery & selective program.
health promo & illness prevention thru
2. Provides data w/c combined w/data from
dissemination of correct info; educating
other sources.
people
3. to provide standardized facility level data
base  ❖ Facilitator, who establishes multi-sectoral
4. to ensure data reported is useful & linkages by referral system
accurate;timely & easy to use fashion.  ❖ Supervisor, who monitors & supervises
5. minimize recording & reporting
the performance of midwives
burdens;to
allow more time for patient care and
promotive activities.  ROLES OF THE PHN
 Components:  ❖ Clinician who is a health care provider,
1. Family tx record = Daily taking care of the sick people at home or in
2. Target Client list = weekly the RHU.
3. Reporting forms = monthly  ❖ Health educator, who aims towards
4. Output reports = quarterly;annually
health promo & illness prevention thru
 *Family tx record - fundamental building dissemination of correct info; educating
block; foundation of FHSIS
people
*Target client list - 2nd building block
 The Primary focus of CHN is Health  ❖ Facilitator, who establishes multi-sectoral
Promotion & Disease Prevention linkages by referral system
 Primary goal - self reliance in health or  ❖ Supervisor, who monitors & supervises
enhanced capabilities the performance of midwives
 Ultimate goal - raise level of # of citizenry
 Philosophy of CHN- Worth and dignity of  Community Diagnosis:
man - by the nature of her work has the o Descriptive research
opportunity & responsibility for evaluating o Profile general picture of comm., a
the health status of people & groups & direct health indicator
relating them to practice. o Process by which the people in the
 CHN practices -to benefit the individual, conn & H team assess the comm. H
family, special groups & community • CHN problems & needs as bases for H
is integrated and comprehensive programs devt.
 1. The comm. is the patient in CHN, o A learning process for the comm. to
 the family is the unit of care and the identify their own H problems &
 4 levels of clientele are: needs
 a. Individual o A profile that deposits the H
 b. Pop. group ( those who share common problems & potentials of the comm.
char, dev stages & common exposure to the  2 Types of Community Dx
problems ex. Children, elderly) • Comprehensive- provides the
 c. Family general health profile of the
 In CHN, the client is considered as an comm.
ACTIVE partner NOT PASSIVE recipient • Specific or problem oriented-
of care-participatory approach Client- active yields a comprehensive
participant, full involvement recipient care profile of a particular H
problem.
 ROLES OF THE PHN  Method of Survey: Questionnaire
• Census (100%) : Most ideal,
 ❖ Clinician who is a health care provider,
enumeratx of data conducted
taking care of the sick people at home or in 6 mos.
the RHU.
 • Sample Survey : Most  Quantitative- numerical • Can be measured •
practical study representative Discrete- whole number or integral values •
of a comm. Size matters in Continuous- fractions, decimals, can attain
terms of validity any decimal
• Interview method
• Instrument- interview guide/
schedule  Common Epidemiologic Studies:
 Records review •  Retrospective (Past)
Instrument: checklist  Cross- Sectional (Present)
 Ocular inspection/  Prospective Cohort (future)
observation •  *Independent variable (Cause) - The one to
Instrument: checklist be manipulated ( symbol is “y”)
 Participant  *Dependent (Effect) - Will always be the
observation interest of the researcher ( symbol is “X”)
• Finalize sampling design &  . Primary Level Of Disease Prevention -
methods Keep people healthy - Prevention of disease
 Probability: Equal - Risk factors & threats present
chances- random- (  Through People Ex.
simple, stratified, o Immunization: Method of health
cluster) promotion
 Non- probability: o Chemoprophylaxis: Intake of drugs
Everyone will not Ex. Vit C to avoid URTI
have equal chances o Reproduction & Sexual Health
 STATISTICS Statistics: A science- o Responsible Parenthood
collection, organization, analysis,  Through Environmental Control
interpretation of numerical data. o Safe Water Supply - Physical
Biostatistics: refers to the application of characteristics - Chemical
statistical method to the life science like characteristics-with minerals in
biology, medicine. H2O- hard water (better - Biological
 Demography: Study of pop size, (-) for e.coli Common household
composition & spatial distribution as water function = Boil H2O Boil with
affected by births, deaths & migration. low fire, wait 5 mins after boiling
 Phenomenon of Variation - Tendency of a Filtration- from ascariasis due to
measurable character to change from 1 airborne solid block Water supply-
individual or 1 setting to another or from 1 25 meters away from toilet, pig pen,
instant of time to another within the same poultry refuse disposal system
individual or setting o Food Sanitation/ Good Food
 Types of Data: Hygiene Ensure the Health of the FF:
• Constant- value remains the  Sources of raw food- without pesticides
same from person to person,  Food handlers
time to time, place to place  Environmental sanitation
Ex. Minutes/ hour, speed  Safe excretal disposal (toilets)
• Variable- Ex. Temperature  Water No water Needs Transplant Cistern
Qualitative- categories are flush with sewage system
simply used to label to
 Flying saucer-pail system (bucket latrine)
distinguish & group to
 No Transplant Cistern flush with septic tank
another, rather than a basis
for saying that 1 group is  PIT- privy > Antipolice, bore hole, compost,
twin > Ventilate 1 improved pit- less smell >
greater, higher than the other.
Reed odorless earth closet (ROEC)
Ex. Sex, Religion, Color
 Overhung latrine (batalan) – bangin
 Cat-hole latrine 1. Sensitivity:
 Reuse Management: True positive rate or strength of association
- Solid & semi-solid waste excluding human bet. presence of disease & Sx
excretal 2. Specificity
Garbage- fruit peelings, left over food-  Tertiary Level Of Disease Prevention -
biodegradable Applied in symptomatic phase & defects or
Rubbish- broken glass, plastic- non- disability is present already.
biodegradable  Starts when the individual seeks medical
Acceptance of Reuse Management: help - Rehabilitation is the goal, resting to
1. Open burning an optimum level of functioning within the
2. Composting constraints of disability
3. Burial • Diagnosis During
Community Level symptomatic phase
a. Sanitary Landfill • Treatment
Problem: Prone to scavenging • Management
b. Incinerator- no residue, pure smoke • Rehabilitation – starts when
4. Vector animal reservoir control the individual enters the
5. Disinfestations & Sterilization facility
6. Good living & working condition  Bag technique-a tool making use of public
7. Health education -Health promotion best health bag (open bag 3x only)
source of prevention  Public health bag - is an essential and
2. Secondary Level Of Disease Prevention indispensable equipment of the public health
- Early diagnosis & prompt intervention to nurse
halt pathological process to shorten duration, Removed BP Cuff inside bag
severity &  Home visit - is a family-midwife contact
return to normal functioning at earliest which allows the health worker to assess the
possible time. home and family situations in order to
a. Screening Methods provide the necessary nursing care and
• Mass Screening: Should be simple & health related activities
inexpensive *****cleanest to dirtiest dapat
• Case Finding: Positive cases of leading ****priority sunod sunod na to – pregnant –
causes of morbidity newborn – postpartum – last ang may mga
Gold Standard for TB test: Culture and sakit
Sensitivity  Epidemiology - the study of disease
Sputum smear microscopy- TB test occurrence and distribution
• Contact Tracing: Pt. with disease & check  Infection- entry and development or
source of infection from family • Multiple multiplication of an infectious agent in the
Screening: HIV test • Surveillance body of man or animals.
1. Pre-Test Counseling- risk appraisal for  Contamination- presence of an infectious
disease prevention agent on a body surface, on or in clothes,
Risk situation, Risk behavior beddings, toys, surgical instruments or
2. ELISA I dressings, or other articles or substances
3. Post Test Counseling including water and food
Behavioral modification- IMPT  4 types of disease distribution
Uniqueness of individual  1. Epidemic- “The unusual occurrence in
Risk factor: increase probability of a community of disease- sudden outbreak
disease of a disease – IN A SHORT PERIOD OF
4. ELISA II TIME
5. Western Block Test- (-) or (+) result with
post counseling (Confirmatory DX)  Nosocomial (hospital acquired) - urinary
Characteristics Of An Ideal Screening Test: tract infections.
 Carriers- “an infected person or animal that ✔
harbors a specific infectious agent in the
5. Cervix Uteri 4812cases 6 %
absence of discernible (visible) clinical
disease and serves as a potential source of
 lung cancer was the most common cancer
infection to others.
in men
 Leptospirosis – Vector is Rat
 In Females, breast cancer was the most
Causative Agent: - bacteria--- Leptospira
common
interrogans
****Smoking (including passive smoking)
 Sign/Symptoms: High fever, Chills, is the most important factor.
Vomiting, Red/ orange eyes, Diarrhea,
 The Philippine Health Agenda Framework
Severe headache, muscle aches, may include
2016-2022
jaundice (yellow skin and eyes), abdominal
pain  Financial Protection: Filipinos, especially
Treatment: PET - Penicillins G, the poor are protected from high cost of
Erythromycin, Tetracycline, Doxycycline as health care.
prophylactic drug  Better Health Outcomes: Filipinos attain the
best possible health outcome with no
 Dengue - mosquito-borne infection
disparity.
 Vector is female aedes aegypti mosquito,
 Responsiveness: Filipinos feel respected,
day biting, low flying, satagnant clear
valued and empowered in all of their
water,stripes black white body.
interaction with the health system.
 Agent is a Virus.. dengue virus 1,2,3,4
- female aedes aegypti in stagnant water  new health agenda framework will be
attainable through the ACHIEVE strategy:
treatment is supportive therapy.
 Intravenous fluids  Advance health promotion,
 A
 A platelet transfusion primary care and quality
 DENGUE DIAGNOSIS:
 Cover all Filipinos against
- Tourniquet test (capillary fragility test or  C
Rumpel Leads Test), a presumptive test financial health risk
which is positive in the presence of more  Harness the power of
than 20 petechiae within an inch square,  H
strategic HRH
after 5 minutes of test
 DENGUE ns1 – ANTIGEN CAPTURE -  Invest in eHealth and data for
 I
CONFIRMATORY decision-making
 TOURNIQUET TEST - (BP Cuff):
o fluids (most important treatment) like  Enforce standards,
oresol and IV  E accountability and
o paracetamol ( do not give aspirin) transparency
o for nose bleeding, flex the neck lean
 V  Value clients and patients
forward to prevent aspiration
o avoid unnecessary movement  Elicit multi-stakeholder
o assist in the management of shock.  E
support for health
Dorsal recumbent to trendelenburg
position  RH Law, otherwise known as Republic
 Leading New Cancer Cases in 2010, Both Act 10354 or the Responsible Parenthood
Sexes, Philippines (GLOBOCAN 2008). and Reproductive Health Act
 Cancer Sites Number Percentage
1. Breast 12262 cases 15 %  10-point Socioeconomic Agenda of the
2. Lung 11458 cases 14 % Duterte Administration:
3. Liver 7331cases 9 %  Macroeconomic policies
 Tax reform
4. Colon/Rectum 5787cases 7 % ✔ ✔ ✔
 Increase competitiveness and the ease of  Wait for the dog to pass or slowly back
doing business. away.
 Accelerate annual infrastructure spending to  Remain motionless (e.g., "be still like a
account for 5% of GDP, with Public-Private tree") when approached by an unfamiliar
Partnerships playing a key role. dog or attempt to sit.
 Promote rural and value chain development  Avoid retrieving objects from the dog's
toward increasing agricultural and rural mouth
enterprise productivity and rural tourism.  Do not disturb the dog while the animal is
 Ensure security of land tenure to encourage eating.
investments, and address bottlenecks in land  Curl into a ball with your head tucked and
management and titling agencies. your hands over your ears and neck if a dog
 Invest in human capital development, knocks you over.
including health and education systems, and  Immediately let an adult know about stray
match skills and training to meet the dogs or dogs that are behaving strangely.
demand of businesses and the private sector.  *Head (NERVOUS SYSTEM)- most
 Promote science, technology, and the affected part and most fatal or dangerous
creative arts to enhance innovation and site for dog bite
creative capacity towards self-sustaining,
inclusive development.  Post-exposure prophylaxis (PEP)
 Improve social protection programs, 
including the government’s Conditional  Categories of  Post-
Cash Transfer program, to protect the contact with exposure
poor against instability and economic suspect rabid prophylaxis
shocks. animal measures 
 Strengthen implementation of the
Responsible Parenthood and  Category I –
Reproductive Health Law to enable touching or
especially poor couples to make informed feeding
choices on financial and family planning. animals, licks
 RABIES PREVENTION AND CONTROL on intact skin  None 
PROGRAM  Category II –
 RA 9482 or “The Rabies Act of 2007”, nibbling of
rabies control ordinances shall be strictly uncovered
implemented. skin, minor  Immediate
 March as the Rabies Awareness Month scratches or vaccination
 September 28 as the World Rabies Day. abrasions and local
 Stop walking or moving. without treatment of
 Stay still and be calm. bleeding the wound 
 Do not panic or make loud noises.
 Category III –
 Avoid direct eye contact with the dog. single or
 Say "No" or "Go Home" in a firm, deep multiple
voice. transdermal  Immediate
 Stand with the side of your body facing the bites or vaccination
dog. scratches, and
 Avoid facing a dog directly since it can 
licks on administratio
appear aggressive to the dog. broken skin; n of rabies
 keep your body turned partially or contamination immunoglob
completely to the side. of mucous ulin; local
 Slowly raise your hands to your neck, with membrane treatment of
your elbows in. with saliva the wound
 from licks,
 Examples of active vaccines are PCEC
contacts with
(Purified Chick Embryo Vaccine),
bats.
RABIPUR and the new cheap drug
 Head is the most fatal site for dog bite VEROWELL
 Legs are the most common site for dog  - It will give 2 years immunity against rabies
bite if the dose is completed
 Rabies vaccine is an artificial active  Postexposure Prophylaxis for Non-
 given on days 0, 3, 7, 14, 30, and 90, immunized Individuals
 avoid gluteal area
 Rabies vaccine should be administered in  Treatment  Regimen
the deltoid muscle
 In both pre-exposure and post-exposure any remaining
immunization, the full 1.0 mL dose should volume should be
be given 9 intramuscularly administered IM
 Sanofi Pasteur created both antirabies and at an anatomical
antidengue vaccine site distant from
 antirabies horse serum vaccine
 HRIG is from human serum administration.
Also, RIG should
 Examples of active vaccines are PCEC
not be
(Purified Chick Embryo Vaccine),
administered in
RABIPUR and the new cheap drug
the same syringe
VEROWELL
as vaccine.
 - It will give 2 years immunity against rabies Because RIG
if the dose is completed might partially
 Postexposure Prophylaxis for Non- suppress active
immunized Individuals production of
antibody, no more
 Treatment  Regimen than the
recommended
 Wound  All postexposure dose should be
cleansing prophylaxis should given.
begin with
immediate  Vaccine  HDCV or
thorough cleansing PCECV 1.0 mL,
of all wounds with IM (deltoid area
soap and water. If ), one each on
available, a days 0 , 3, 7, and
virucidal agent 14. – AVOID
such as povidine- GLUTEAL
iodine solution INJECTIONS
should be used to  A 5th dose on day 28 may be recommended
irrigate the for immunocompromised persons.
wounds.
 Postexposure Prophylaxis for Previously
 RIG  If possible, the full Immunized Individuals
dose should be
infiltrated around  Treatment  Regimen
any wound(s) and
  EBOZ or ebola ZAIRRE strain is the
 Postexposure Prophylaxis for Previously most deadliest strain
Immunized Individuals
 RESTV or EBOR (ebola reston) species,
found in Philippines and the People's
 Treatment  Regimen Republic of China, have been found to
infect humans but they do not cause illness
 Wound  All postexposure or death
cleansing prophylaxis should  Diagnosis
begin with
 ***antibody-capture enzyme-linked
immediate
immunosorbent assay (ELISA)
thorough cleansing
of all wounds with
soap and water. If
available, a
virucidal agent  Herbal Medicine  USES
such as povidine-  Niog Niogan  Anti-helminthic
iodine solution (Quisqualis Indica) every 6 months
should be used to 2 hours p
irrigate the supper
wounds.  No to less than 4
y/o
 RIG  RIG should not be  Tsaang Gubat  Diarrhea
administered. (Carmona Retusa)
 Ampalaya  DM Type 2-
 Vaccine  HDCV or PCECV (Momordica obesity
1.0 mL, IM Charantia)
(deltoid area), one
each on days 0 and  FOR PROPHYLAXIS IN HIV
3. CONFIRMED OR EXPOSED CHILD:
 Ebola: Mapping the outbreak  ANTIBIOTIC FOR PROPHYLAXIS: Oral
From the section of WEST Africa Cotrimoxazole
Ebola crisis
The hunters breaking an Ebola ban on  OPV (Oral Polio Vaccine)
bushmeat- FRUIT BATS  “Sabin vaccine”
 Primary source = fruit bats or flying foxes ,  polio vaccine that is taken by mouth and
old world bats contains the three serotypes of poliovirus in
 Other sources: a weakened live state—called also Sabin
o Chimpanzees oral vaccine
o Gorillas  Measles- Subcutaneous
o fruit bats  Cold Chain under EPI
o monkeys o 6months- Regional Level
o antelope o Not more than 5days- Health
o porcupines centers using transport boxes.
o symptomatic humans  Most sensitive to heat: Freezer (-15 to -25
 Ebola largest outbreak in West Africa degrees C)
was first reported in March 2014, o OPV
 discovery in 1976. o Measles
The total number of reported cases is more 
than 28,607. Rubeola (measles)
 Virus is named after the ebola river
 There are 5 strains of EBOLA virus
 Communicable just before the rash isolated in an Aedes mosquito from the same
appears to 4-5 days after rash region.
appears=highly contagious  The first human cases appeared in 1952

 The first sign of measles is usually a high

fever (often >104o F [40o C]) that typically Anthrax
lasts 4-7 days.  (Splenic fever, Siberian ulcer, Charbon,
 Koplik spots—bluish-gray specks or “grains Milzbrand)
of sand” on a red base—develop on the  Bacillus anthracis.
buccal mucosa opposite the second molars  most common in wild and domestic
 First 24 hours herbivores (eg, cattle, sheep, goats, camels,
o Fever, malaise, cough, coryza, antelopes)
conjunctivitis  B anthracis spores can remain viable in
 In 48 hours soil for many years.
o “Koplik spots” (small, irregular,  Raw or poorly cooked contaminated meat is
red spots with minute bluish-white a source of infection for zoo carnivores and
center) first seen on buccal mucosa omnivores; anthrax resulting from
 Diphtheria contaminated meat consumption has been
 Diphtheria is an acute infection caused by reported in pigs, dogs, cats, mink, wild
 bacteria Corynebacterium diphtheriae. carnivores, and people
 The throat infection causes a gray to black,
tough, fiber-like covering, which can  Specific diagnostic tests include bacterial
block your airways culture, PCR tests, and fluorescent antibody
 Shick test for susceptibility to diphtheria: stains to demonstrate the agent in blood
A + shicks means no immunity or films or tissues
suceptible; (antigen test)  Treatment
 Moloney test – for sensitivity of diptheria  Oxytetracycline given daily in divided doses
 Tetanus also is effective.
 caused by the bacterium Clostridium tetani,  Ciprofloxacin,Amoxicillin, Gentamicin,
the spores of which are widespread in the ,Erythromycin Doxycycline, Streptomycin,
environment
 present with trismus (“lockjaw”), which is
 Middle East respiratory syndrome
the inability to open the mouth secondary to
coronavirus (MERS-CoV)
masseter muscle spasm.
- CAMEL FLU or SARS of MIDDLE
 Nuchal rigidity and dysphagia are also early
complaints that cause risus sardonicus, the EAST
scornful smile of tetanus, resulting from  a viral respiratory disease caused by a novel
facial muscle involvement coronavirus (MERS‐CoV) that was first
 generalized muscle rigidity with intermittent identified in Saudi Arabia in 2012.
reflex spasms in response to stimuli (eg,  1st case - april 2012
noise, touch). 2nd case - sept. 2012
 Tonic contractions cause opisthotonos (ie,
flexion and adduction of the arms, clenching  1st Outbreak
of the fists, and extension of the lower - SAUDI ARABIAN PENINSULA
extremities).  MERS COV IS A CLADES "B" VIRUS
 ZIKA-
 Republic of South Korea is the largest
 The Zika virus was detected for the first
outbreak outside of the Middle East year
time in a rhesus monkey
2015
 Virus was named after a forest
in Uganda in 1947. A year later, it was
 Source of the virus  2012 outbreak in Saudi Arabia. Bat ->
originated in bats and was transmitted to
camels sometime in the distant past. Camel -> Human. Man consumed milk/meat
 camels - major reservoir host for MERS- of infected camel.
CoV and an animal source of MERS
infection in humans  Signs and symptoms
A- airway problems
B- breathing difficulty
 Where is the virus thought to have come C- cough and colds
from? D- diarrhea
 Thought to have originated from bats, due to E- elevated temperature

the high degree of adaptive evolution within  Treatment: No specific treatment

their DPP4 gene.  No vaccine or specific treatment is currently

available.
 avoid contact with camels, drinking raw
 Host- humans, camels, maybe bats camel milk or camel urine, or eating meat
that has not been properly cooked.
 Distribution- Middle East, esp. Saudi  Avoid contact to camel droplets
Arabia.  Cover your nose and mouth with a tissue
when you cough or sneeze, then throw the
tissue in the trash.
Transmission- human-to-human contact
 Avoid touching your eyes, nose and mouth
 Highest Risk : IMMUNOSUPRESSION with unwashed hands.
(CANCER)  Avoid personal contact, such as kissing, or
 Symptoms- Mild-severe respiratory illness sharing cups or eating utensils, with sick
people.
Gastrointestinal symptoms
 Severe Acute Respiratory Syndrome
Complications-pneumonia, kidney failure (SARS) is an acute respiratory illness
caused by infection with the SARS virus.
 Fever followed by a rapidly progressive
 Is person to person transmission possible? respiratory compromise is the key
complex of signs and symptoms, which also
include chills, muscular aches, headache and
- Only if in close personal contact. loss of appetite.
 greater than 50% in persons aged 65
years and older (WHO Update ). – mostly
 What is a 'Silent Mers CoV' case? How
affected
frequent are these cases?  The etiologic agent of SARS is a
 An asymptomatic sufferer who carries Mers coronavirus which was identified in
March 2003. The initial clusters of cases
CoV antibodies within their bloodstream. It in hotel and apartment buildings in Hong
is estimated to occur in 20% of cases. Kong
 Attack rates in excess of 50% have been
reported.
 Timeline of current outbreak?
 virus is predominantly spread by droplets
or by direct and indirect contact.  Among which is not a gas produce by green
Shedding in feces and urine also occurs. houses
 Medical personnel, physicians, nurses, and Answer: oxygen and Carbon monoxide
hospital workers are among those commonly
infected.  What can we do to stop climate change?
 NO drugs or a vaccine for SARS, Answer:
 control of this disease relies on the rapid 1.Turn off the lights when you leave a room.
identification of cases and their appropriate 2.Turn off your computer and other
management, including the isolation of electronic devices when you're not using
suspect and probable cases and the them.
management of their close contacts. 4.Drive less. Instead, walk, ride your bike,
 Supportive care is of primary importance. or use public transportation if you can.
Immunomodulation by steroid treatment 6.Use less water.
may be important 7.Create less waste.
 The SARS outbreak of 2003 8. Recycle used paper, cans, bottles, and
 According to the World Health Organization other materials
(WHO), a total of 8,098 people worldwide 9. Plant more trees and prevent
became sick with SARS during the 2003 deforestations.
outbreak. Of these, 774 died. In the United  What are the disease commonly seen
States, only eight people had laboratory because of climate change
evidence of SARS-CoV infection. All of Answer: mosquito borne, vector borne and
these people had traveled to other parts of food borne diseases
the world with SARS. SARS did not spread
more widely in the community in the United  What are the most visible signs and
States. synptoms of climate change?
 Symptoms of SARS Answer:
 SARS begins with a high fever 1. average sea level around the world has
(temperature greater than 100.4°F risen by nearly 7 inches in the last 100 years
[>38.0°C]). 2.glaciers all over the world are shrinking
 headache, an overall feeling of discomfort, 4. many bird species are shifting northward.
and body aches. 5. most obvious changes are happening in
the Arctic, where the amount of ice in the
 Some people also have mild respiratory
ocean has decreased dramatically.
symptoms at the outset. About 10 percent to
20 percent of patients have diarrhea.
 The most abundant greenhouse gas, but
 After 2 to 7 days, SARS patients may
importantly, it acts as a feedback to the
develop a dry cough. Most patients
climate.
develop pneumonia.
Answer: Water vapor
 Examples of close contact include kissing or
hugging, sharing eating or drinking utensils,
 What are the important actions in the fight
talking to someone within 3 feet, and
against global warming.
touching someone directly. Close contact
does not include activities like walking by a  Answer: Preventing deforestation as well as
person or briefly sitting across a waiting planting trees, through reforestation and
room or office. afforestation
 The principal forcing greenhouse gases are:
 The most important greenhouse gas which is  Carbon dioxide (CO2)
released whenever people burn fossil fuels Methane (CH4)
to do everyday activities like driving cars, Nitrous oxide (N2O)
heating buildings, and making electricity. Fluorinated gases
Answer: Carbon dioxide
 The main feedback greenhouse gas is: Water 24,000
vapor
* Note: For SURGERIES, the Case Rates
o Top 10 green house gases payment will apply only to cases managed
 1. WATER VAPOR
in Levels 2 to 4 hospitals, with certain
2. CARBON DIOXIDE
3. METHANE exceptions.
4. NITROUS OXIDE  to avail of your PhilHealth benefits
5. OZONE  Payment of at least 3 months’ worth of
6. TRIFLUOROMETHANE premiums within the immediate 6 months of
7. HEXAFLUOROETHANE confinement.
8. SULFUR HEXAFLUORIDE
9. TRICHLOROFLUOROMETHANE  And 9 months’ worth of contributions in the
10. SULFURYL FLUORIDE last 12 months is needed for pregnancies,
 Climate forcing refers to availing of the newborn care package,
processes that disrupt Earth's heat balance dialysis, chemotherapy, radiotherapy and
forcing the climate to change selected surgical procedures, .
 Confinement in an accredited hospital for 24
 Greenhouse effect refers to hours due to illness or disease requiring
B ability of certain atmospheric gases to trap
hospitalization.
heat and keep the planet relatively warm
 Attending physician(s) must also be
 These are the surgical and medical cases, PhilHealth accredited.
and the corresponding fixed rates or  Claim is within the 45 days allowance for
payments/reimbursements by Philhealth. room and board.

Medical Cases: HOME VISIT is a family-nurse contact which allows the

Dengue Fever and DHF Grades 1 and 2 — health worker to assess the home and family situations in
8,000 pesos order to provide the necessary nursing care and health
DHF Grades 3 and 4 — 16,000 related activities.
Asthma — 9,000
Newborn care package (NCP) — 1,000 —
increased to 1,750 Purposes

 Surgical Cases: 1. To give care to the sick, to

1. Radiotherapy — 3,000 pesos a postpartum mother and her newborn with the
2. Hemodialysis — 4,000 view teach a responsible family member to
3. Normal delivery or maternity care give the subsequent care.
package (MCP) in maternity or lying-in 2. To assess the living condition of the patient
clinics — 8,000 and his family and their health practices in
order to provide the appropriate health
Normal spontaneous delivery (NSD) in
teaching.
Level 1 hospitals — 8,000
Normal spontaneous delivery (NSD) Levels 3. To give health teachings regarding the
2 to 4 hospitals — 6,500 prevention and control of diseases.
Delivery by caesarian section (CS) —
15,000 — increased to 19,000
Appendectomy — 26,000 — decreased to
 4. To establish close relationship between the BAG TECHNIQUE is a tool by which the nurse,
health agencies and the public for the during her visit will enable her to perform a
promotion of health. nursing procedure with ease and deftness, to save
5. To make use of the inter-referral system and time and effort with the end view of rendering
to promote the utilization of community effective nursing care to clients.
services
PUBLIC HEALTH BAG is an essential and
Principles indispensable equipment of a public health nurse
which she has to carry along during her home visits.
The following principles are involved when performing a
home visit:
Principles

1. A home visit must have a purpose or  will minimize, if not, prevent the
objective. spread of any infection.- most important
2. Planning for a home visit should make use of central feature
all available information about the patient  It saves time and effort in the
and his family through family records. performance of nursing procedures.
3. In planning for a home visit, we should  The bag technique can be performed in a
consider and give priority to the essential variety of ways depending on the
needs of the individual and his family. agency’s policy, the home situation, or as
4. Planning and delivery of care should involve long as principles of avoiding transfer
the individual and family. of infection is always observed.
5. The plan should be FLEXIBLE.

Contents
Steps
 Extra paper for making waste bag
1. Greet the patient and introduce yourself.
 Plastic/linen lining
2. State the purpose of the visit (Question after
 Apron
Greeting the patient and introducing
 Hand towel
yourself what is your next action? = State the
 Soap in a soap dish
purpose of the visit)
 Thermometers (oral and rectal)
3. Assess or Observe the patient and determine
 2 pairs of scissors (surgical and bandage)
the health needs.
 2 pairs of forceps (curved and straight)
4. Put the bag in a convenient place and then
 Disposable syringes with needles (g. 23
proceed to perform the bag technique.
& 25)
5. Perform the nursing care needed and give
 Hypodermic needles (g. 19, 22, 23, 25
health teachings.
ONLY)
6. Record all important date, observation and care
 Sterile dressing
rendered.
 Cotton balls
7. Make appointment for a return visit.
 Cord clamp
  Micropore plaster
 Tape measure
 1 pair of sterile gloves
 Baby’s scale
 Alcohol lamp
 2 test tubes
 Test tube holders
 Solutions of:
o Betadine
o 70% alcohol
o Zephiran solution
o Hydrogen peroxide
o Spirit of ammnonia
o Ophthalmic ointment
o Acetic acid
o Benedict’s solution

*BP apparatus and stethoscope are carried

separately and are never placed in the bag.

4 C Points to consider
COMPLETE- contain all the necessary
articles, supplies and equipment that will
be used to answer the emergency needs
CLEAN - contents should be cleaned
very often, the supplies replaced and
ready for use anytime.
CONTENT protection- contents should
be well protected from contact with any
article in the patient’s home.
*Consider the bag and its contents clean and
sterile, while articles that belong to the
patients as dirty and contaminated.
CONVENIENT- arrangement of the
contents of the bag should be the one
most convenient to the user, to facilitate
efficiency and avoid confusion.

Initial step in bag technique : Upon arrival at the

patient’s home, place the bag on the table lined
with a clean paper. The clean side must be out and
the folder part, touching the table Steps