Refresher Notes ♡

COMMUNITY HEALTH NURSING

- outside the hospital; more relatively healthy clients
- mainly heald education
- Focus:
HEALTH PROMOTION
ILLNESS PREVENTION

Health Promotion
a. Diet
➢ Aim ideal body weight
○ ↓ 10 years old: growth chart
○ ↑ 10 years old: BMI
The Philippines uses Asia Pacific Obesity Guidelines (APOG) over WHO guidelines

WHO APOG

UNDERWEIGHT < 18.5 < 18.5

NORMAL 18.5 - 24.9 18.5 - 22.9

OVERWEIGHT 25 - 29.9 23 - 24.9

PRE-OBESE —- 25 - 29.9

OBESE ≥ 30 ≥ 30

OBESE 1 (obese) 30 - 40 30 - 40

OBESE 2 (morbid) 40.1 - 50 40.1 - 50

OBESE 3 (super) > 50 > 50

➢ Build healthy nutrition practices

➢ Choose food wisely

B. Exercise
➢ Moderate intensity: everyday
➢ Vigorous exercise: 3x per week
C. Rest
D. Stop Smoking
➢ Education
○ ask, advice, assist, arrange
 ➢ Legislation
○ Tobacco Regulation Act RA 9211 (2003)
○ No smoking in public spaces
➢ Ottawa Charter - first health promotion convention in Canada
➢ Illness prevention
○ specific protection (e.g condom, facemask, gloves)

PHN
- public; government-bounded
- Magna Carta for public health workers → RA 7305
➔ Night Differential (10%)
➔ Tenure (5%)
- Nurses are under salary grade 15
- Department of Health
➔ National authority for health
➔ Functions delineated by EO 102
a. Leadership in Health: making policies
b. Enabler and Capacity builders: making new strategies and training
c. Administrative Function: manage tertiary hospitals
➔ Vision: Filipinos are among the healthiest people in Southeast Asia by 2022, and
Asia by 2040
➔ Mission: To lead the country in the development of a productive, resilient,
equitable and people-centered health system

Philippines Healthcare Delivery System

1 - Primary: Basic Health Care Services

2 - Secondary: Common Medical/ Surgical Cases, Labs
3 - Tertiary: Advanced Health Services
 PRIMARY
Barangay Health Station (BHS) Rural Health Unit / Health Center

Satellite Station Complete Health care team

Managed by Public health midwife (PHM) Public health midwife: frontliner

Public health nurse: supervisor
Rural Health Physician / Health officer:
manager
Sanitary inspector
Medtech
Dentist

Primary services should be accessible

● within 3-5 km
● within 30 mins travel

RA 7160: Local Government code

- in 1991
- created decentralization and devolution – transfer of power
- DOH formulates; LGU implements

Four Levels of Clientele

1. Individuals
2. Family (basic unit of service)
3. Groups / Population Aggregate (share common characteristics)
4. Community (Primary client)

Primary Health Care

- WHO in 1978
- Alma Ata Conference in USSR, Kazakhstan
● Ferdinand marcos was the president at this time, he sign the LOI 949

Letter of Instruction 949: legal basis of PHC; sign in Oct 1979

- Underlying Theme:
➔ “Health in the hands of the people by 2020”
- 2 Core Principles
1. Partnership (with the people)
2. Empowerment
- Transfer of knowledge, skills and attitudes
- Mission:
 ➔ self-reliance

4 Pillars / Cornerstones of PHC (AIUS)

1. Active community participation
2. Intra and intersectoral linkages
3. Use of Appropriate technology (Local indigenous resources)
➔ TB: sputum microscopy, ↑ OFU
4. Support mechanism made available

Provincial Government Municipal / City Government

Chairman: Governor Chairman: Mayor

Vice Chairman: PHO Vice Chairman: MHO / CHO
manages secondary manages primary

intra linkages interlinkages

- within healthcare delivery systems - outside healthcare delivery systems

- two-way referrals - between GO and NGOs

Characteristics of PHC (CASASA)

❖ Community-based
❖ Accessible
❖ Sustainable
❖ Affordable (not Free)
❖ Self-Reliance
❖ Available
Elements of PHC
❖ Education for health
❖ Locally endemic and communicable disease control and treatment
❖ Expanded Program on Immunization
❖ Maternal and Child Health and Family Planning
❖ Essential Drugs
❖ Nutrition
❖ Treatment (Medical and Emergency care, Non-communicable diseases and Mental
Health)
❖ Sanitation of the environment
 Levels of Prevention
Primary Secondary Tertiary

WHO? Healthy High-Risk Post-Treatment

ACTIVITY Health promotion Early Diagnosis and Rehab

Illness prevention screening Palliative
Early Treatment - quality of life
- pain
- supportive
- hospice

Examples
Primary - immunization, diet, exercise
Secondary - BSE, AFB test, Cancer s/s,
Tertiary - mental health, crutch walking, physical therapy

Answer the following:

1. BSE
2. Chloroquine 1 week before palawan
3. DOTS
4. Determine if the area is in granular lockdown
5. Use of mask when going outdoors
6. Oxygen in patient with dyspnea
7. Oxygen humidification
8. ET tube intubation in patient with stridor
9. Salbutamol in asthma
10. Water in patient with asthma (candidiasis)
11. Tracheostomy care
12. Cholystectomy in cholelithiass
13. LF diet post cholecystectomy

Epidemiology
- John Snow: father of epidemiology
- controlled cholera outbreak
- coined “epidemiological investigation”
- Hippocrates: first epidemiologist
- Distribution of disease
- backbone of preventing diseases

Levels
 a. Sporadic
➔ occasionally / few cases
➔ high immunity; low susceptibility
➔ immunity can be boosted through previous exposure to a disease and through
vaccination
b. Endemic
➔ cases are always present
➔ immune = susceptibility

c. Epidemic
➔ also known as “outbreak”
➔ sudden increase in outbreak in a short period of time

d. Pandemic
➔ worldwide epidemic / several countries

Types of Epidemic
1. Point-source epidemic
● single event
● simultaneous exposure
● e.g food poisoning
2. Propagated epidemic
● person-to-person transmission
● more spread
3. Cyclical epidemic / seasonal epidemic
● rainy: dengue, colds
● summer: sore eyes, heat stroke
4. Secular variation
● change of diseases overtime

Triple burden disease

1. Communicable diseases
2. Non-Communicable diseases (Lifestyle related)
3. Diseases of Rapid Urbanization and Industrialization (Mental Health)

Leading Causes of Death in PH

1. Cardiovascular Diseases
2. Blood Vessel Diseases
 Recording Systems
● Field Health Service info system (FHSIS): pen and paper
● Community Health information Tracking System (CHITS): open source electronic
medical record
● Community-Based Teams (CBTs): first level of delivery model used in the Philippines

Universal Health Care Act (RA 11223)

“ All Filipinos are now automatically enrolled in Philhealth” (2019)

RA 8423 Traditional and Alternative Medicine Act (TAMA) of 1997

- SANTALUBBY
- Research Institute of Tropical Medicine (RITM)
- approved herbal medicines

1. Lagundi
- cephalocaudal
- ASCOF: asthma, cough, fever
✓ fever
✓ dysentery
✓ headache
✓ stomach ache
✓ coryza
✓ arthritis
✓ cough
✓ asthma
✓ body malaise
✓ insect bites
✓ sprain
✓ contusion
2. Ulasimang Bato
✓ lowers uric acid
🅧 no kidney stones → not allowed

3. Bawang
✓ hypertension
✓ toothache

4. Bayabas
 ✓ leaves
✓ antiseptic; baya”wash”

5. Yerba Buena
✓ peppermint
✓ analgesic
✓ cough; colds

6. Sambong
✓ diuretics; edema

7. Akapulko
✓ tinea flava; antifungal
✓ tinea flava; ringworm, athlete’s foot, and scabies

8. Niyog-niyogan
✓ “para sa mga batang nagyuyugyugan” HAHA
✓ anthelmintic, anti worms
✓ seeds are taken 2 hours after supper

9. Tsaang-Gubat
✓ gastroenteritis; gargle to prevent cavities
✓ diarrhea, stomachache

10. Ampalaya
✓ flavonoids leves stimulate pancreas to release insulin
✓ lowers blood sugar
✓ DM Type II

Decotions - should be boiled in a clay pot with low heat. Do not cover while boiling

MATERNAL AND CHILD HEALTH

- to decrease maternal mortality rate
- Prenatal Visit
➔ 4x : Sentrong Sigla Guidelines
➔ 8x: WHO guidelines

Basic Emergency Obstetrical Care (BEMOC)

● considers that all pregnant women are at high risk
● addresses common problems of pregnancy
 ● provides capacity building / trainings

Trainings provided by BEMOC

➢ oxytocin
➢ antibiotic
➢ anticonvulsant (MgSO4)
➢ steroids (preterm-betamethasone)
➢ assisted delivery
○ forceps
○ vacuum
➢ manual removal of placenta and retained products of conception

Comprehensive Emergency Obstetrical Care (CEMOC)

● includes delivery via Caesarean Section includes blood transfusion (includes surgeon)

Essential Intrapartal Newborn Care

- developed by DOH
- evidenced-based from WHO standards

REMOVED interventions
🅧 suctioning
🅧 immediate campling
🅧 milking of the cord
🅧 covering the stamp
🅧 applying antiseptic (alcohol and betadine)
🅧 footprinting
🅧 removing vernix caseosa
🅧 washing newborn immediately

Time-bound (Priority) interventions

drying the newborn within 30 minutes
early skin to skin contact
→ bonnet, blanket
delayed cord clamping (1-3 mins after birth)
breastfeeding

Non-time bounded interventions

erythromycin ointment to prevent opthalmia neonatorum
Vitamin K
BCG and Hepa B
 Weight
anthropometric measurement
physical assessment
wash 6hrs after birth

Expanded Program on Immunization

- now “National Immunization Program”
- PD 995 (EPI) ; all children below 8 years old
- RA 10152: mandatory immunization below 5 years old

Vaccines
➢ Pentavalent (5 in 1 vaccine) “DPTHEHi”
■ DPT
■ Hepa B
■ HIb (Haemophilus influenzae type b)
➢ Rota virus
➢ Inactivated polio vaccine (IPV)
➢ MMR (Measles mump rubella)
➢ Pneumococcal conjugate vaccine (PCV)

5 Elements of EPI (SICAT)

1. Surveillance - search for cases for evaluation

2. Information, Education and Communication

● EIC
● National Immunization Day (NID) : every WEDNESDAY
● Every 3 months for Geographically Isolated and Disadvantaged Areas (GIDA)

3. Cold Chain and Logistic Management

● storage and transport of vaccines
● all vaccines are sensitive to heat
● most sensitive to heat vaccines:
➔ freezer (-15 to -25 C)
➔ OPV, AMV, MMR, Varicella (MOVA)
● less sensitive to heat vaccines
➔ body (2 to 8 C)
➔ BCG, pentavalent, Hepa B, PCV, rotavaccine, IPV, TT, or TD

4. Assessment and Evaluation

➔ Bacillus Calmette Guerin (BCG)
◆ live attenuated TB
 ◆ prevents TB meningitis and leprosy
◆ clean site with water (🅧 alcohol)
◆ intradermal injection
◆ scarring after 1 week of injection is a good sign
◆ no scarring after 1 week means reinjection
➔ Pentavalent
◆ don’t give if high-grade fever (>38.5)
◆ give if low grade fever (<38.5)
◆ cold compress for 20 mins for local tenderness

➔ OPV
◆ sabin vaccine; live attenuated
◆ 3 doses
◆ within 30 mins
● give another when the child spits
● give another when the child vomits
◆ after 30 mins
● don’t give another when the child vomits after 30 mins
➔ IPV
◆ inactivated
◆ one dose only

➔ Hepa B Vaccine
◆ Recombinant RNA
◆ allergy to yeast – asses before administering
➔ MMR
◆ live attenuated vaccine
◆ side effect: rashes
● management: keep it dry
◆ Since MMR is teratogenic, one nursing responsibility is to keep the baby
away from the pregnant women.
5. Target Setting
- solves for the eligible population for vaccination
Formula:
Infant Pregnant
Eligible population x 2.7% Eligible population x 3.5%

VACCINE # OF SCHEDULE ROUTE DOSAGE

 DOSES

BCG 1 AT BIRTH ID 0.05

HEPA B 1 AT BIRTH IM 0.5

PENTAVALENT 3 6 WK, 10 WK, 14 WK IM 0.5

OPV 3 6 WK, 10 WK, 14 WK ORAL 2 QTTS

PCV 3 6 WK, 10 WK, 14 WK IM 0.5

ROTA 2 6 WK, 10 WK ORAL 1.5 ML

IPV 2 14 WK, 18WK IM 0.5

MMR 2 9 M, 12 M SQ 0.5

Nutrition
Macronutrient deficiency
- CHO and CHON

Marasmus
● CHO and CHON deficiency
● skin and bones appearance
● prominent ribs
● old man’s face
● apathetic

Kwashiorkor
● CHON deficiency (protein)
● thin extremities
● moon face
● edema, ascites
● thin and brittle hair (zebra sign)

Management
feeding programs
Ready to use therapeutic food (RUTF)

Micronutrient deficiency
- vitamins and minerals
 - since junk food provide empty calories, food fortification programs was established
- RA 8976; Food Fortification Law
➔ provides stickers and staples to foods that pass DOH guidelines
➔ “diamond seal”
➔ Vitamin A, Iron, iodine
- Araw ng Sangkap Pinoy
➔ 2x / year
➔ April and October

Vitamin A deficiency
- AKA Retinol

Signs and symptoms

● bitot's spots
● night blindness
● xerophthalmia (lusterless conjunctiva)

NORMAL VAD

INFANT (6 - 11 months) 100,000 IU 100,000 IU

CHILD (12 - 60 months) 200,000 IU 200,000 IU

Schedule 1st: today 1st: today

2nd: 6 months after 2nd: tomorrow
3rd: 2 weeks after

● Vitamin A is contraindicated to pregnant women (2nd - 3rd trimester)

Treatment (CD, NCD, Emergency)

Non Communicable Disease

- Risk Factors
❖ Physical inactivity
❖ unhealthy diet
❖ smoking

Disasters
Types
a. Man-made
 b. Natural
c. Acute (days - weeks)
d. Chronic (months - years

Principles of disasters
● it is a responsibility of all
● 1st priority: people
● 2nd priority: resources
● capability building before impact of disaster

Sanitation
- PD 825: Garbage Disposal Act
- PD 856: Sanitation Code
- Food Sanitation 4 Rights
1. Right source (“fresh”)
2. Right preparation (“wash”)
3. Right cooking (70 C)
4. Right storage
● cool : ↓ 10 C
● warm: ↑ 60 C
- food establishment owners need to secure sanitary permit
- food handlers need to secure a health certificate
- food in room temperature need to be consumed within 2 hours

Water Facility Approval Levels

a. Level 1
● point source
● developed springs
b. Level 2
● communal faucets / stand post
● 1:45 household
c. Level 3
● individual household connection
● waterworks system

Toilet Facility Approval Levels

a. Level 1
● non- water carriage
● pit latrines
● small amount of water toilet facility
 ● pour flush toilet
b. Level 2
● water-sealed / flush type
● waste goes to septic tank
c. Level 3
● Level 2, but waste and water goes to sewerage system, then treatment plant

4 Criteria of prioritizing Family problem

1. Nature of the problem
2. Modifiability of the problem
3. Preventive potential
4. Salience
Intensive Notes ♡
Community Health Nursing
- outside hospital
- Healthy individuals

Primary: health education

FOCUS OF HEALTH TEACHING

Health promotion
● increase the level of health
● Healthy today —> healthier tomorrow
● Optimum level of functioning (OLOF)

Illness prevention
● Maintain health
● Healthy today healthy tomorrow
● Specific protection
○ E.g: Condom, Kulambo, Off lotion

Goal: Primary health care

● help patients to reach self-reliance in health

Goal of COPAR “CHD”:

● Community Health Department (Social Transformation)

Philippine Health Care Delivery System (PHCDS)

Primary - most accessible, within 3-5 km, within 30 mins
● Barangay Health Station (BHS)
- Smallest unit of primary facility
- Satellite Station
- Manned by public health midwife and barangay health workers

● Rural Health Unit (RHU) / Health Center

- Intermediate Primary
- Main primary center
- Comprised with complete health care team:
 ➢ Midwife: frontline health workers
➢ Public Health Nurse (PHN): Supervisor, coach of midwife
➢ Health Officer / Rural Health Physician: Manager
➢ Medtech: Laboratory
➢ Dentist: Dental Health Program

✓ Services: Basic Health Care Services

Secondary
● District Hospital / Emergency Hospital
● Provincial Hospital

✓ Services: Common medical, surgical, laboratory procedures

Tertiary
● Regional Hospital
● Private: Medical center
● National Hospital; PGH
● National Medical Center; St. Luke's hospital, Makati Med, ASEAN hospital
● Specialty Hospital; Heart Center, Lung Center, Orthopedics, National Children’s Hospital

Two-way referral system

- From primary papadala patient to secondary ipapadala sa tertiary, pag ka okay na
patient ibabalik secondary then, primary then balik sa bahay

Department of Health (DOH)

- considered as national authority for health

Executive Order (E.O) 102

3 Functions of DOH - “LEA”
1. Leadership in health - creates policies for health
2. Enabler and capacity builder - creates new strategies and training for health
3. Administrative Function - manage tertiary facilities

Local Government Code - RA 7160

- transferring control and responsibility of delivering basic services to the hands of local
government units (LGU)

Local Government Unit (LGU):

● Primary → Chairperson: Mayor
 ● Secondary → Chairperson: Governor
● Tertiary → DOH

DOH VISION: Filipinos will be the healthiest in Southeast Asia in 2022. Filipinos will be
healthiest in Asia in 2040

Life expectancy
➢ Southeast asia
● Singapore: 84
● Philippines: 71.53
➢ Asia
● Top 1: Hongkong
● Top 2: Japan

DOH MISSION:
- Develop a Productive, Resilient, Equitable, People-centered Health system

National Objective for Health (NOH) - Goal of DOH

- Every 5 years, ine-evaluate yung Goal every 5 years

Health Sector Report Agenda (HSRA)

- started sa panahon ni Gloria Macapagal Arroyo
- It was called F1 (Formula 1 for health) - but hindi na ginagamit to ngayon

Aquino Health Agenda (AHA)

Theme: Universal Health Care
- This was approved sa reign ni Duterte

*It is now called F1plus: Formula 1 plus

Theme: boosting universal health care

5 Pillars
1. Health Financing
- better investment for health

National Health Insurance Program (NHIP): Philhealth

RA 11223
● Universal Health Care Law
● All filipinos are automatically enrolled in Philhealth
Case Rate Method
● per Diagnosis
○ Dengue : 10k
○ Severe dengue: 16k

2 MEMBERS
➢ Direct Contributor: paying
○ employees with formal employment
○ Kasambahays
○ Self earning individuals: Professional practitioner
○ Overseas filipino workers
○ Filipinos living abroad and those with dual citizen
○ Lifetime members
○ All filipinos 21 years old

➢ Indirect Contributor: nonpaying

○ Indigents identified by the DSWD
○ Beneficiaries of Pantawid Pamilyang Filipino Program (Project of DSWD)
○ Senior citizens
○ Persons with disability
○ Sangguniang kabataan officials
○ Previously identified at point-of service / sponsored LGUs
○ No capacity to pay
○ Filipinos aged 21

2. Health Regulation
● Affordable and quality health care services
● “RAQ” - regulation affordable quality

3. Health Service Delivery

● accessible and available

Nurse Deployment Program (NDP)

- Salary grade 15
- 35,000 / month

SACVAS - service affordable

4. Good Governance
- Stakeholders (DOH; LGU)
✔️ Transparent - Statement of asset liabilities and networth (SALN)
✔️ Accountable
✔️ Efficient
5. Performance Accountability
● Outcome-based approach

“FRS GG PA” - First gerger ni packboy

4 CLIENTS
❖ Individual
❖ Family - basic unit of service
❖ Group / Population
❖ Community - primary client

Family Care Plan

1. Use of nursing process - ADPIE

ASSESSMENT - data collection

1. Interview
2. Observation

2 ASSESSMENT
✔️ First level assessment - “What” are the problem

Acc to Maglaya:
4 Categories of Health problem
1. Wellness state - Healthy
● We can make our clients healthier; regular exercise, balance diet, breastfeeding

2. Health deficit
● (+) Disease
- Ex. TB, measles, Pre-eclampsia
● (+) Disability
- Ex. Paralysis, nabulag dahil sa meningitis

3. Health threat - ↑ Risk of Injury or illness

● Ex. Stress, Chemotherapy patients, Vices, Sedentary lifestyle
● Walang panggastos, away away magkakapatid, ineffective breastfeeding
 4. Foreseeable crisis / Stress points

Foreseeable crisis - alam mangyayari

Stress points - hindi dapat mangyari or di alam / biglaan
● Anticipated problem
● Developmental / Social
○ Abortion
○ Marriage
○ Entrance at school
○ Adolescence
○ Divorce / separation
○ Menopause
○ Chronic Illness
○ Loss of job
○ Hospitalization of a family member
○ Death of a member
○ Resettlement in a new community
○ Ilegitimacy
○ First time breastfeeding

✔️ Second level assessment - “Why” there is a problem

- “Inability”

PLANNING - goal setting: SMART

- Construct plan of action
- Choose nursing intervention
- Develop operational plan
● You try to Prioritize

4 Criteria of Operational Plan

“highest score the highest priority”
“lowest score the lowest priority”
*each have corresponding weight
Highest score: 5

1. Nature of the problem SCORE:

- type of nursing problem
● Wellness state - 3
● Health deficit - 3 1
 ● Health threat - 2
● Foreseeable crisis - 1

2. Modifiability of the problem

- solution of the problem

● Easily modifiable - 2 2
● Partially modifiable - 1
● Not modifiable - 0

3. Preventive potential
- Future recurrence of the problem
1
● Highly preventable - 3
● Moderately preventable - 2
● Low preventive - 1

4. Salience
- perception of the client about the
problem
- patient decides 1
● Immediate problem:
● Not that immediate:
● Not a problem at all:

Mneumonic: “Na Mo Pre Sal”

Formula:
Score / Highest score X weight

IMPLEMENTATION
● Dependent
● Independent
● Interdependent

EVALUATION
- Outcome

QUALITY
“QAE”: ASSURANCE
ELEMENTS

SOP:

1. Structural elements
● Physical settings
● manpower
● money
● material/ equipment

*lahat ng pwede mahawakan

2. Outcome elements
● Changes resulting from nursing intervention

3. Process elements
● Steps of nursing process - eto yung tinitignan if tama yung ginagawa sa process
○ Assessment
○ Planning
○ Intervention
○ Evaluation

Epidemiology
- Occurence and distribution of disease
- back bone of preventing disease

First epidemiology: Hippocrates

Father of Epidemiology: John Snow

Classify disease
1. Sporadic
○ Cases occur occasionally
○ Few cases
○ Paminsan minsan lang
○ ↑ Immune
○ ↓ Susceptible
○ Measles vs Covid
Herd Immunity - Herd immunity occurs when a large portion of a community (the herd)
becomes immune to a disease. The spread of disease from person to person becomes
unlikely when herd immunity is achieved. As a result, the whole community becomes
protected - not just those who are immune.

Threshold proportion - Often, a percentage of the population must be capable of getting a

disease in order for it to spread.

If the proportion of the population that is immune to the disease is greater than this
threshold, the spread of the disease will decline. This is known as the herd immunity
threshold.

2. Endemic
○ Disease is always present
○ Immune = Susceptible
○ E.g: TB Dengue

Locally Endemic:
➢ Schistosomiasis: Rice, sorsogon, leyte
➢ Malaria: mountains areas?

Types of Epidemic
❖ Point source epidemic
➢ Single event
➢ Simultaneous exposure
➢ E.g: Food poisoning
❖ Cyclical / Seasonal
➢ Rainy season
➢ Summer
❖ Secular
➢ changes of disease over time

● PD 651 - Registration of birth and death

○ Birth within 30 days
■ Who: Birth attendant
■ Where: Civil Registrar
○ Death: Within 48 hrs

Vital Statistics
- study of vital events
 - birthday, deaths

Health Statistics
- Health related data

TITLE SIGNIFICANCE FORMULA

1. Crude birth rate Measures natural increase in 𝑇𝑜𝑡𝑎𝑙 𝐵𝑖𝑟𝑡ℎ

𝑥 1, 000
𝑇𝑜𝑡𝑎𝑙 𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
population

2. Crude death rate Measures natural decrease in 𝑇𝑜𝑡𝑎𝑙 𝐷𝑒𝑎𝑡ℎ

𝑥 1, 000
𝑇𝑜𝑡𝑎𝑙 𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
population

3. Maternal Mortality Rate Index in prenatal care in the 𝑇𝑜𝑡𝑎𝑙 𝐷𝑒𝑎𝑡ℎ 𝑑𝑢𝑒 𝑡𝑜 𝑝𝑟𝑒𝑔𝑛𝑎𝑛𝑐𝑦
𝑥 1, 000
𝐿𝑖𝑣𝑒 𝐵𝑖𝑟𝑡ℎ
community

4. Neonatal Mortality Rate Index of Postpartum Care 𝑇𝑜𝑡𝑎𝑙 𝐷𝑒𝑎𝑡ℎ 𝑏𝑒𝑙𝑜𝑤 28 𝑑𝑎𝑦𝑠 𝑜𝑙𝑑
𝑥 1, 000
𝐿𝑖𝑣𝑒 𝐵𝑖𝑟𝑡ℎ
Below 28 days (1 month)

5. Infant Mortality Rate Index of Health Status in the 𝑇𝑜𝑡𝑎𝑙 𝐷𝑒𝑎𝑡ℎ 𝑏𝑒𝑙𝑜𝑤 1 𝑦𝑒𝑎𝑟
𝑥 1, 000
𝐿𝑖𝑣𝑒 𝐵𝑖𝑟𝑡ℎ
Below 1 year above 28 days whole community

6. Fetal Death Rate Index of Pregnancy wastage 𝑇𝑜𝑡𝑎𝑙 𝐷𝑒𝑎𝑡ℎ 𝑖𝑛 𝑡ℎ𝑒 𝑖𝑛𝑡𝑟𝑎𝑢𝑡𝑒𝑟𝑜
𝑥 1, 000
𝐿𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ

7. Incidence Rate Measure acute disease in the

community 𝑇𝑜𝑡𝑎𝑙 # 𝑜𝑓 𝑁𝑒𝑤 𝑐𝑎𝑠𝑒𝑠
𝑥 1, 000
𝑇𝑜𝑡𝑎𝑙 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
< 6 months

8. Prevalence Rate Measure chronic disease in the

community 𝑇𝑜𝑡𝑎𝑙 # 𝑜𝑓 𝑁𝑒𝑤 𝑎𝑛𝑑 𝑜𝑙𝑑 𝑐𝑎𝑠𝑒𝑠
𝑥 100
𝑇𝑜𝑡𝑎𝑙 𝑝𝑒𝑟𝑠𝑜𝑛𝑠 𝑒𝑥𝑎𝑚𝑖𝑛𝑒𝑑
> 6 month

9. Sex Ratio Balance of Male of Female 𝑇𝑜𝑡𝑎𝑙 𝑀𝑎𝑙𝑒

𝑥 100
𝑇𝑜𝑡𝑎𝑙 𝐹𝑒𝑚𝑎𝑙𝑒

10. Swaroop’s Index Measure longevity of life 𝑇𝑜𝑡𝑎𝑙 𝐷𝑒𝑎𝑡ℎ 50 𝑦𝑒𝑎𝑟𝑠 𝑜𝑙𝑑 𝑎𝑏𝑜𝑣𝑒
𝑥 100%
𝑇𝑜𝑡𝑎𝑙 𝑑𝑒𝑎𝑡ℎ

𝑁𝑢𝑚𝑒𝑟𝑎𝑡𝑜𝑟
𝐷𝑒𝑛𝑜𝑚𝑖𝑛𝑎𝑡𝑜𝑟
𝑥 𝐹𝑎𝑐𝑡𝑜𝑟 - 100 or 1,000 or 10,000 or 100,000

Numerator - Title ng hinahanap

Factor - For every
● 100 - used with few population - if % ; Ratio ang hinahanap
● 1,000 - number 1 - 6 ito gagamitin na factor
● 10,000
● 100,000
Denominator - Total Population
● Total population as of June 30, July 10 or this year
○ Crude birth rate
● Total Live birth
gamitin if it sounds OB subject
○ Maternal, Neonate, Infant, Fetal

Swaroop’s Index
Example:
● Total population: 50,000
● Total death: 500
○ by age:
■ 0-24 y/o: 81
■ 25-49 y/o: 19
81 - 19 = 100
50 above = 400
400
5000
𝑥 100% = 0. 8 𝑜𝑟 80%
= 80% death of 50 above

Maternal Child Health (MCH)

✓ Goal: Reduce maternal mortality rate

Promote prenatal check up

4 Prenatal Visit - Based on DOH Sentrong Sigla
8 Prenatal Visit - Based on WHO

Essential Intrapartal Newborn Care (EINC)

Intrapartal - during labor and delivery

Not required anymore:

🅧 NPO
🅧 Enema
🅧 Shaving of pubic hair
🅧 Lithotomy position

✓ Any position of comfort

✓ Pwede magsama ng companion of choice

🅧 Restrictive episiotomy

Active management of the third stage of labor (AMTSL)

🅧 Methergine → ✓ IM oxytocin (given after delivery of baby)
✓ Controlled Cord Traction - done when there is signs of placental separation, isang kamay
naka support sa fundus then isang kamay naghihila sinasabay sa contraction
✓ Uterine Muscle

Newborn Screening
RA 9288 → Voluntary
Purpose: To detect genetic disorders
● Heel prick

Types of newborn screening

Basic Expanded

Free (Philhealth) P 1,000

Can detect 6 genetic disorders Can detect + 22 genetic disorders

Total of 28

Congenital Hypothyroidism +
Congenital Adrenal hyperplasia Cystic Fibrosis
Galactosemia Organic acid disorders
G6PD deficiency Amino acid disorders
Phenylketonuria Fatty acid disorders
Maple Syrup

“CoCo GG Pa More”

Reproductive Health (RH)

✓ Goal: To achieve better quality life

International Framework → Focus: Women

Local Framework → Focus: Men and Women

10 Elements of Reproductive Health (RH)

● 4 Priority “FAMS”
1. Family Planning - Primary intervention
■ Right Timing
■ Right Size of the family
● 2 children
■ Right Interval
● 3 - 5 years gap /Average of 4 years
2. Adolescent Reproductive Health
■ Prevent Teenage Pregnancy
■ Sex education initiated by the parents
 ● if walang alam ang parents, tuturo ang nurse, then ituturo padin
ng parents sa child
● At School, sex education is integrated starting at
Grade 5
3. Maternal Child Health (MCH)
4. Sexually transmitted infection (STI)

● 6 other elements “SIMVAR” (Simva roar haha)

1. Sexuality
2. Infertility - 1 year of unprotected sex, wala pa din nabubuo
3. Men’s reproductive health
4. Violence against women and children (VAWC)
■ RA 9262
■ “Si 9nay inun2og 6ually abuse I2”
Types:
➢ Physical violence
➢ Psychological violence
➢ Sexual violence
➢ Economic abuse

5. Prevention of abortion and it’s complication

6. Reproductive Drug Cancer
■ HPV Vaccine - Bardasil → can prevent cervical cancer

Expanded Program on Immunization (EPI)

1976 (old)
❖ PD 996: All children below 8 years old, libreng vaccine
❖ 2 BCG doses

2011 (new)
❖ RA 10152: Mandatory immunization
❖ Target: Below 5 years old
❖ 1 BCG dose
❖ Updated vaccines
➢ Pentavalent (5 in 1 vaccine)
■ DPT
■ Hepa B
■ HIb (Haemophilus influenzae type b)
➢ Rota virus
➢ Inactivated polio vaccine (IPV)
➢ MMR (Measles mump rubella)
➢ Pneumococcal conjugate vaccine (PCV)

5 Elements of immunization “ SICA”

➢ Surveillance - search for cases for evaluation if effective ang vaccine

 ➢ Information, education, communication
○ National immunization day (NID): Wednesday
■ if walang ref ang health center : Monthly
○ Goal: reaching every barangay (REB)
○ Far flung: Geographically Isolated and Disadvantaged area (GIDA) → Scheduled
quarterly (every 3 months)

➢ Cold chain and logistics management

○ Proper storage and transport of vaccines
○ All vaccines are sensitive to heat

Varicella (chicken pox)

Oral Polio Vaccine (OPV) FREEZER
Most sensitive to heat MMR -15 to -25 C

“VOM Panis”

All other vaccines

Pentavalent
BCG
Less sensitive to heat Hepa B BODY
IPV +2 to +8 C
PCV
RotaV
Tetanus toxoid + diphtheria
toxoid (TD)

● Bawal ilagay vaccine sa door → mga diluent nilalagay

○ pag ka binuksan kasi maeexpose sa room temperature
BCG, MMR → Freeze Dried
“BM” → basain muna

★ How many times a day do you check the temperature for the vaccine? 2 times a day
➢ Assessment and evaluation
 VACCINE # OF SCHEDULE ROUTE DOSAGE
DOSES

BCG 1 AT BIRTH ID 0.05

HEPA B 1 AT BIRTH IM 0.5

PENTAVALENT 3 6 WK, 10 WK, 14 WK IM 0.5

OPV 3 6 WK, 10 WK, 14 WK ORAL 2 QTTS

PCV 3 6 WK, 10 WK, 14 WK IM 0.5

ROTA 2 6 WK, 10 WK ORAL 1.5 ML

IPV 2 14 WK, 18WK IM 0.5

MMR 2 9 M, 12 M SQ 0.5

“ Boarding House POP RIM”

Pwede magbgay ng vaccine ng sabay basta magkaibang site
ROTA una before ORAL since sabay sila binibigay
ALL IM → VASTUS LATERALIS → OUTER THIGH → 0.5
SQ → ARM → 0.5
ID → 0.05
Target Setting
- Primary element of EPI

Eligible population: Target population

Infant Pregnant
Eligible population x 2.7% Eligible population x 3.5%

Annual Vaccine Required:

Eligible population x Dose x Wastage Factor (WF)

“EDI WOW”

Wastage Factor
1
1 − 𝑊%
 Wastage % of

5% 15% 25% 60%

Pentavalent “Pive percent” Hepa B MMR BCG

PCV “Pive percent” IPV MR (measles, rubella)
Rota V TD Japanese Encephalitis
FLU vaccine Oral Polio Vaccine

1.05 1.18 1.33 2.5

15% - ano meron sa kinsenas? Sweldo! kaya lang di ka naka shopping kasi you’ve been HIT
by Fa LU

25 % - percent ng bugaw! sinong bugaw? si mama jo!

60 % - BonGO%→ parang 60%
- paka sensitive
- 4 hours lang sira agad
- half day lang binibigay tong vaccine na to

Example, solve for the following

1. Pentavalent = 1.05
2. Hepa B = 1.18
3. MMR = 1.33
4. BCG = 2.5

Solve:
Annual vaccine required
Pentavalent
total pop: 55,000

55, 000 x 2.7% = 1485

1485 x 3 x 1.05 = 4677.75 / 4,678 doses per year

Hepa B
Target pop 3,000

3000 x 1 x 1.18 = 3540 doses per year

Monthly Vaccine Required

MMR
Total Pop; 80,000

first solve for AVQ

80,000 x 2.7%= 2160 x 2 x 1.33 = 5746 doses per year
5746 / 12 = 478.8 / 479 doses per month
Sentro Sigla
QAP
● Quality
● Assurance
● Program
Certification Program
DOH → LGU

3 Levels
● Level 1 - Basic Sentro Sigla certification; minimum standard
● Level 2 - Specialty Award
● Level 3 - Award for excellence ; highest award that you can get

Community Diagnosis
- analyzing the collected data from the community

Steps
1. Determine objectives
● Comprehensive community diagnosis; general
● Problem-oriented community diagnosis; specific
2. Define study population
3. Determine the data to be collected
4. Collect the data
5. Develop an instrument (questionnaire)
6. Actual data gathering (c/o people)
7. Data collation (tallying)
8. Data presentation
Line graph: distribution over time (trend)
Pie graph / area diagram: few variables
Bar graph: several variables

9. Data Analysis (with the people; identifying problem)

10. Identify community health problems
● Health status: morbidity / mortality
● Health resources: 3 M (manpower, money, material)
● Health-related: political, socio-economic, cultural, environmental
11. Prioritize problems

COPAR
- community organizing and participatory action research
- approach: Primary Health Care
- people must have active participation
 NURSE PEOPLE

● Facilitators ● Leaders
● only assists ● co-researchers/partner
● teaches ● plan, assess
● change-agent ● implement
● evaluate

Goal: Community health development or social transformation

COPAR PHASES (PE COAST Mnemonic)

● Pre-entry
● Entry / Social preparation
● Community Study/ Assessment /Diagnosis / or Situational Analysis
● Organizational
● Action
● Sustenance and Strengthening
● Turn-over / Phase-out

- PROMOTES SELF RELIANCE

1. Pre-Entry
Preliminary Social Investigation (PSI): gathering data from different barangays
Site selection
○ Depressed
○ Oppressed
○ Poor
○ Exploited
Baseline ocular or windshield survey
○ Information dissemination
○ Networking thru linkages

2. Entry → Continuous appraisal

Courtesy call: leaders → respect
Deepening Social Investigation: identify people’s pressing needs
Immersion / Integration
○ imbibing the life of the community people
Identifying potential leaders → CORE GROUP FORMATION
○ Poor
○ Respected
○ Communicator
○ Desire for change
○ Open-minded
○ Charismatic
SALT: Self Awareness Leadership Training
 ➔ teaching what is DOH and Primary Health Care (PHC)
➔ teaching how to become leaders → Leadership Seminar

3. Community Study / Community assessment / Community Diagnosis /

Situational Analysis
Profling of com
Research Team - bubuo
➔ Ad hoc committee (temporary)
Community Diagnosis (by the people)
★ People will assess the community
★ people are the co-researchers

4. Organizational Phase
● Plan solution for community problems
Build a formal community health organization
Election of officers
Training of officers
Team building of officers

5. Action Phase
Mobilization - exercise of people’s power
Project management
PIME:
○ Program
○ Implementation
○ Monitoring
○ Evaluation
Recruit and train barangay health workers / community health workers - they
will be the one to implement (BHW)

6. Sustenance and Strengthening Phase

Continue education and training of officers and barangay health workers
- important kasi kapag umalis na mga unang leaders merong papalit
Develop medium and long term goals

7. Turn over / Phase out

Aalis kana
To promote Self-Reliance
Empowered people
PRE-TEST
1. C - korik
2. B - korik
3. D - korik
4. D -ligwak
5. D - korik
6. B - ligwak
7. A - ligwak
8. A - korik
9. A -ligwak
10. B - korik
OTHER NOTES:

Republic Act 7305 or Magna Carta of Public Health workers was passed into law last 1991.
“Public health workers”

Republic Act 9173 of 2002

→ SALARY GRADE 15
sets the entry level position for nurses at what salary grade?

Proportionate mortality
deaths due to a specific cause / total deaths x 100%

In scheduling several cases for community home visit, dirty cases should be the last priority

Alzheimer’s home core = protect client from possible injury in his environment

Client with cataract: instruct family not to change furniture arrangement at home

The Filipino Food Guide Pyramid includes drinking 6 - 8 glasses of water

Primary prevention of cancer is focused on elimination of conditions causing cancer

PD 651 : mandate of the immediate registration of birth and deaths

Only doctors can proclaim death or sign death certificate

Crowding index : health indicator that refers to the transmissibility of the disease from one
host to another

Vaccines can only be stored in transport box for 5 days

BCG has only 6 hrs of life after opening

DPT vaccine is cold sensitive

Enterobius vermicularis → may lead to the child’s frequent scratching of his perineal area
→ Diagnosis : Scotch tape method

Paragonimus westermani infection is similar to TB symptoms

RHU is the health arm of LGU

FIFO: food ; FEFO: vaccine

EO 51 - Milk Code
RA 7600 - Rooming-in and Breastfeeding Act
- Lactation stations

Contaminated instruments during delivery:

➔ wash with soap and water, soak in 0.5% chlorine solution for 10 minutes