THE FAMILY HEALTH NURSING PROCESS PART 2.

*Focuses on ways and means

6. NCP IS A CONTINUOUS PROCESS NOT A
Planning Phase
ONE SHOT DEAL
DEVELOPING FAMILY NURSING CARE PLAN *The result of the evaluation will trigger
another cycle of the planning process
THE FAMILY CARE PLAN

The blueprint of care that the nurse DESIRABLE QUALITIES OF NCP

1. It should be based on the clear, explicit
designs to systematically eliminate or
definition of problem/s.
minimize the identified health & family *comprehensive analysis of the problem.
*identify factors related to the problem
nursing problems
2. Realistic
through: * Activities are done with reasonable chance of
Success
Formulated outcomes (goals & objectives);
*Related to the quantity & quality of resources
deliberate interventions; resources; & required
3. Prepared jointly with the family.
evaluation criteria, standards, methods & tools
*The nurse works with the family & not for the
family
FEATURES OF NURSING CARE PLAN
*Participatory planning makes the family feel
1. ACTION FOCUSED-to solve/ lessen existing
that the health of its members is a family
problems.
responsibility & commitment.
*Plan is blueprint for action
4. NCP is most useful in written form
*Approaches, strategies, activities, methods, &
*means of communication
materials needed to solve the problem.
*useful administrative device for evaluating
2. PRODUCT OF DELIBERATE AND SYSTEMATIC
staff performance & the quality of care
PROCESS
provided to clients
*Logical analyses of data to arrive at
IMPORTANCE OF PLANNING CARE
rational decisions
1. NCP individualize care to clients
3. RELATES TO THE FUTURE
-Consider the uniqueness of the client
*Use events of the past & what is happening in
2. NCP sets priorities.
the present to determine patterns
-from the available data, the nurse sets
*Predict future scenario if current situation is
priorities
not corrected
3. NCP promotes systematic
4. NCP IS BASED UPON IDENTIFIED NEEDS &
communication
PROBLEMS
-Clearly defines problems, outcomes &
*Problems are the starting point for the plan,
intervention measures
the objectives, & intervention measures
4. NCP facilitates continuity of care.
5. NCP IS A MEANS TO AN END & NOT AN END
-Gaps & duplications are prevented -least weight to foreseeable crisis due to
5. NCP facilitates coordination of care culturally linked support given to families in
-NCP as communication tool, prevents need.
fragmentation of care & increases efficiency of B. MODIFIABILITY OF HEALTH CONDITION
health service delivery ORPROBLEM
STEPS IN DEVELOPING FNCP 1. Current knowledge, technology &
1.A list of prioritized health condition or intervention to enhance wellness state or
problems manage the problem.
according to: 2. Family resources - physical, financial &
a. Nature manpower.
b. Modifiability 3. Nurse resources - knowledge, skills & time
c. Preventive potential 4. Community resources-facilities, community
d. salience organization or support
C. PREVENTIVE POTENTIAL OF THE PROBLEM
Scale for Ranking Health Conditions and 1. Gravity or severity of the problem.
Problems according to priorities -refers to the progress of the disease indicating
Criteria: the extent of damage on the client.
A. Nature of the condition or problem -also indicates prognosis, reversibility, or
presented modifiability of the problem.
(wellness state, health deficit, health threat, -the more severe or advanced the problem is,
foreseeable crisis) the lower is the preventive potential of the
B. Modifiability of the condition or problem problem.
(easily, partially, not modifiable) 2. Duration of the problem.
C. Preventive Potential (high, moderate, low) -the length of time the problem has been
D. Salience (needs immediate attention, not existing.
immediate, not perceived as a problem) -duration of the problem has direct relationship
to gravity.
FACTORS AFFECTING PRIORITY SETTING Because of this relationship to gravity of the
A. NATURE & CONDITION OF THE PRESENTED problem, duration has also a direct relationship
PROBLEM to preventive potential.
-highest weight given to wellness state due to 3. Current management
the credit for the client's desire/effort to -refers to the presence & appropriateness of
sustain/ maintain high level of wellness. intervention measures to enhance wellness
-same highest weight to health deficit due to state or remedy the problem.
clinical urgency w/c require immediate -the presence increases the preventive
intervention. potential.
4. Exposure of any vulnerable or high-risk group
-increases the preventive potential of a -specify physical, psychosocial states or family
condition or problem behavior (competencies).
5. Effective health management / health
maintenance pattern and desire for or GOALS = tell where the family is going
engagement in healthy lifestyle activities destination
increases the preventivepotential of a wellness OBJECTIVES= are the milestones to reach the
state or condition destination
D. SALIENCE
-The family's perception of the condition or BARRIERS TO JOINT GOAL SETTING
problem. 1. Failure of the family to recognize the
-The nurse evaluates the family's perception of existence of the need/problem.
the condition or problem. (problem is part of their lives, comfortable with
-The family's felt needs and or readiness its presence)
increase the score on salience. 2. The family may realize the existence of the
health need/ problem but is too busy at the
FORMULATING OF GOALS & moment with other concerns & preoccupations.
OBJECTIVES OF CARE (household chores, occupation, etc.)
GOAL 3. Sometimes the family perceives the existence
-a general statement of the condition or state of
to be brought about by specific courses of the problem but does not see it as serious
action. enough to warrant attention.
e.g. After nsg. Intervention the family will be (problems regarded as common & taken for
able to take care of the mentally retarded child granted)
competently. 4. The family may perceive the presence of the
problem need to take action but refuse to face
CARDINAL RULE / PRINCIPLE IN GOAL SETTING & do something due to:
-Goals must be set jointly with the family. 4.1. fear of consequence/s of taking action.
This ensures the family's commitment in the 4.2. respect for tradition
realization of goals. 4.3. failure to perceive the benefits of the
Basic to the establishment of mutually accepted actions proposed. (can be due to unfavorable
goals is experiences)
the family's recognition & acceptance of 4.4. failure to relate the proposed action to
existing health needs & problems. the family's goals. (economic & social goals
generally are favored over health goals)
OBJECTIVES 5. Failure to develop working relationship
-more specific statements of the desired results between the nurse & the family.
or outcomes of care. -nothing will be accomplished.
-elements of mutual trust & confidence are
crucial to the success of family-nurse efforts to TIME BOUND-stating the time period in which
better health. they will each be accomplished
E.g.
CHARACTERISTICS OF GOAL NURSING GOAL - the family will cope
1. Realistic or attainable. effectively with the threat of pulmonary
= set at reasonable levels. Too high goals & tuberculosis
consequent failures can be frustrating. SHORT-TERM OBJECTIVE
2. Best stated in terms of client outcomes. The infant and pre-school members of the
3. Objectives stated as outcomes of care in family will be immunized with BCG.
family nursing practice states family's MEDIUM-TERM OBJECTIVE
competencies. All members of the family will have a complete
4. As with goals, objectives should be realistic & physical check-up to rule out pulmonary
attainable considering the resources of the tuberculosis
nurse, the family, & the community LONG-TERM OBJECTIVE
5. Measurable. All members of the family will participate in the
When objectives are stated in terms of care of the sick members and apply preventive
observable fact/behavior, criteria for evaluation measures against the spread of infection.
becomes clear. DEVELOPING THE INTERVENTION PLAN
6. Specific 1. Involves selection of appropriate nursing
= specific stated objectives make evaluation of interventions based on formulated goals &
their attainment easier. objectives
Objectives define the criteria for evaluation. 2. Specifying the most effective & efficient
7. Objectives vary according to the time spent method of nurse-family contact.
for their realization. 3. The resources required.
*Short-term or immediate objectives FAMILY-NURSE CONTACT
*Medium-term or intermediate objectives -the basic method of delivering public health
*Long-term or ultimate objectives nursing services
CHARACTERISTICS OF GOAL (SMART) -an activity with or on behalf of a particular
SPECIFIC-clear about what, where, when and family or individual
how TYPES OF FAMILY-NURSE CONTACT
the situation will be changed I. Direct methods
MEASURABLE - able to quantify the targets and a. Home visit
benefits b. Office conference (clinic, industrial, or school)
ACHIEVABLE/ATTAINABLE - able to attain the c. Group conference
objectives (knowing the resources and d. Telephone contact
capacities e. Written communication
REALISTIC- able to obtain the level of change
reflected in the objective II. . Indirect methods
when there are many people to be reached nursing interventions should maximize the
=training of instructors in home nursing; competencies of the family as thinker, doer, &
=school groups; feeler.
= providing health teaching materials to As thinker = make info. & knowledge available
other professional workers such as social at once for ease of understanding the situation
workers, personnel workers in industry, or As doer = maximize the skills & communication
community group leaders; to enhance
= providing advertisement in other situations the confidence in carrying out the needed
like clinic, industry, or private practice. interventions for health promotion,
CRITERIA FOR SELECTING maintenance & disease management.
FAMILY-NURSE CONTACT As feeler = the family needs to develop or
•Effectiveness strengthen its affective competencies in order
•Efficiency to acknowledge & understand emotions
•Appropriateness generated by family life, or
RESOURCES REQUIRED health/illness situations.
MATERIALS (supplies, equipment, teaching aids, (e.g. fear, anger, jealousy, guilt, etc.)
visual materials, handouts, etc.) By doing so, such emotions can be transformed
HUMAN (other health team members, into growth-
development workers, community leaders) promoting choices & actions.
7 M'S of Resources 3. Focus on interventions to help the family
1. Manpower perform the health tasks.
2. Money A. Help the family recognize the problem.
3. Management (admin.) a.Increase family knowledge on the nature,
4. Materials magnitude & cause of the problem.
5. Mansion (building, infrastructures) b. Let them see the implication of the problem.
6. Messages (information) c. Relate health needs to the goals of the family.
7. Machine (equipment) d. Encourage positive attitude to the problems
GENERAL DIRECTIONS FOR SELECTING by affirming their capabilities, qualities,
NURSING INTERVENTIONS resources, & informed choices.
1. Explore with family choices/possibilities B. Guide the family on how to decide on
based on lived experience of appropriate health actions to take.
meanings/concerns. a. Identify with the family the courses of action
•Othe nurse needs to explore with the family available & the resources needed.
the possibilities & choices presented by the b. Discussing the consequences of each action
current situation they are experiencing given available.
the meanings, concerns, social relations & c. Analyzing with the family the consequences
resources. of inaction.
2. Develop cognition, volition & emotion
C. Develop the family's ability & commitment to 5. Make directions explicit & accurate
provide nursing care to its members. 6. Personalize the referral whenever possible
-the nurse increase the family's confidence in
providing nursing care through: 4. Catalyze behavior change through motivation
demonstration and practice sessions on & support.
procedure, treatments, techniques utilizing To bring about self-directed change, people
available, low cost materials, equipment & must learn to learn from their experiences.
resources. "allow themselves to experience the needed
D. Enhance the capability of the family to change."
provide a home environment conducive to
health maintenance & personal development. DEVELOPING THE EVALUATION PLAN
•the family can be taught skills to ensure such a ➡The evaluation plan specifies how the nurse
home environment through: will determine:
a. Environmental modification •changes in health status, condition, or
b. Environmental manipulation to minimize or situation
eliminate health problems •achievement of the outcomes of care (goals &
c. Install facilities for nursing care objectives
E. Facilitate the family's capability to utilize • The plan includes: criteria/indicators,
community resources for health care evaluation methods/tools, & sources of
•maximize use of available resources through evaluation data
the coordination, collaboration, & team work
provided by an effective referral system. 2 terms in evaluation that are often confused
•easy access to available health & socio- with each other
economic resources starts with maintaining an 1. Activities = actions performed to accomplish
updated file that lists such resources, addresses, an objective. (cause)
contact numbers, & specific services offered. 2. Outcomes = results produced by activities.
REFERRAL SYSTEM (effect)
Good referral procedures promotes optimum 2 terms associated with evaluation process
use of available community resources. 1. Criterion/criteria = signs or indicators that tell
1. Work with the family members before us if objectives have been attained.
referral to be sure they are ready to accept the 2. Standards=desired level of performance
services of the agency & see the need for care. corresponding with criterion against which
2. Get the right person into the right agency actual performance is compared.
3. Introduce the client to the agency by
sending appropriate information on the referral DEVELOPING THE EVALUATION PLAN
form, making a preliminary telephone call or •Patient Care Outcomes
personal call if indicated. 1. Physical condition
4. Introduce the agency to the client. 2. Psychological / attitudinal
3. Knowledge or learned behavior THE NURSES' ROLE IN FAMILY CARE PRACTICE
•IMPORTANCE OF EVALUATION 1. Health monitor
1. To eliminate the continued performance of 2. Provider of care
useless activities or interventions 3. Coordinator of family services- the nurse has
2. Increase efficiency of nursing interventions the holistic view of the entire spectrum of
3. Documentation family health.
4. Promote professional growth & refinement of 4. Facilitator- making arangement & proper
nursing practice referrals.
•METHODS & SOURCES OF EVALUATIVE DATA 5. Teacher / health educator-frequently used
1. Direct observation intervention by the nurse.
2. Record review 6. Counsellor - one of the concrete evidence
3. Interview / Questionnaire that the family has developed trust &
4. Simulation exercises confidence in the nurse is openness on the part
•STEPS IN EVALUATION of the family.
1. Establish a baseline in terms of health Trust & confidence is manifested by consulting
problem areas. & seeking advice for the most intimate &
2. Define goals & objectives of nursing care. personal problems. All activities are all related
3. Determine the criteria & standards for to the major role of assisting families cope with
evaluation. health problems by increasing their capabilities
4. Decide on methods/techniques of evaluation to perform the health tasks.
& sources of data.
5. Compare the actual situation (after the RECORDS IN FAMILY HEALTH NURSING
nursing care). PRACTICE
6. Identify the causes for less than optimum HEALTH RECORDS AND REPORTS
performance. -Field Health Service Information System (FHSIS)
7. Redefine the objectives •official recording & reporting system of DOH.
•Used to generate health statistics
IMPLEMENTATION •Used to generate health status of people at
*IMPLEMENTING THE FNCP diff. levels
During the implementation phase, the nurse •lt is the basis for:
encounters the realities in family nursing a. Priority setting by local governments.
practice which can: b. Planning & decision - making at diff. levels
•motivate her to try out creative innovations (Brgy.. municipality, dist., provincial, & nat')
•overvwhelm her to frustrations or inactions C. Monitoring & evaluating health program
* A dynamic attitude on personal & professional implementation.
development is necessary if she has to face up HEALTH RECORDS AND REPORTS
to challenges of nursing practice FHSIS - composed of recording & reporting
tools.
•Records are facility based. Kept at BHS or RHU. -The FHSIS Manual of Operations lists of
Contain day - to – day account of activities of RECORDING tools:
Health workers & Services delivered to clients. 3. The Summary Table - accomplished by
•Records are basis of Reports midwives. Kept at BHS. Has
•Reports consists of summary data that are 12 columns to correspond the l2 mos. of the
transmitted or submitted monthly, quarterly, or year.
annually to higher level. From BHS to RHU to *2 components:
Provincial Health Office to Regional Health 1. Health Program Accomplishment - a tool for
Office. assessment of accomplishments & a ready
-The FHSIS Manual of Operations lists of source of reports
RECORDING 2. Monthly summary of Morbidity /Diseases -
tools: gives information on monthly trend of diseases
1. The Individual treatment record (ITR)- 1st & source of 10 leading causes of morbidity in
building block of FHSIS. the municipality
Contains the date, patient's name, address, -The Summary Table - is also a source for any
presenting symptoms, diagnosis, date & name survey or research.
of treatment. The FHSIS Manual of Operations lists of
2. Target Client List (TCL) -2nd building block of RECORDING tools:
FHSIS. It serves to: 4. The Monthly Consolidation Table (MCT) -
a. plan & cary out patient care & service doneby the Nurse based on the Summary Table.
delivery to monitor target or eligible population Serves as the source document for the
for particular health service. Quarterly Form & the Output Table of the RHU.
b. facilitate monitoring & supervision of service
delivery activities. -The FHSIS Manual of Operations lists of
C. report delivered services REPORTING tools:
d. provide a clinic – level database for further 1. Monthly Forms -prepared by midwife &
studies. submitted to the Nurse
HEALTH RECORDS AND REPORTS a. Program Report (M1) contains indicators
- TCLs maintained in RHUs & Health Centers categorized as maternal care, child care, family
1. TCL Prenatal Care planning, & disease control. The midwife copies
2. TCL Postpartum Care the data from the Summary Table.
3. TCL Under 1 year old children b. Morbidity Report (M2) contains a list of all
4. TCL Family Planning cases of disease by age & sex.
5. TCL Sick Children
6. National Tuberculosis Program TB Register -The FHSIS Manual of Operations lists of
7. National Leprosy Control Program Central REPORTING tools:
Registration Form 2. Quarterly Forms - prepared by the Nurse.
There should only be one quarterly form for the
municipality or city. Consolidation must be done
if there are more than 1 RHU or center as
directed by the DOH PROGRAMS RELATED TO FAMILY HEALTH
MHO. DEPARTMENT OF HEALTH
Quarterly Forms - are submitted to the
Provincial Health Office EO 102 mandates the DOH
Quarterly Form components: 1. to provide assistance to local government
a. Program Report (Q|) - contains 3 month total units, people's organization, and other
of indicators categorized as maternal care, members of civic Society in effectively
family planning, child care, implement programs, projects and services that
dental health, & disease control. will promote the health and well-being of every
b. Morbidity Report (Q2) -3 month Filipino:
consolidation of Morbidity 2. prevent and control diseases among
Report (M2) population at risks;
3. protect individuals, families and communities
Annual Forms: exposed to hazards and risks; and
a. A-BHS - report done by midwife that contains 4. treat, manage and rehabilitate individuals
demographic, environmental, & natality data. affected by diseases and disability.
c. Annual Form 1 (A- 1) done by the Nurse.
Report of the RHU or health center. Contains ROLES AND FUNCTIONS OF DOH
demographic & environmental 1. LEADERSHIP IN HEALTH- serves as the
data, & data on natality & mortality for the national policy and regulatory institution,
entire year. leads in formulation, monitoring, and
d. Annual Form 2 (A-2) - prepared by the nurse, evaluation of national health policies, plans
the yearly morbidity reporty age and sex. and programs, and to serves as advocate
e. Annual Form 3 (A- 3) - prepared by the nurse, in the adoption of health policies.
the yearly report of all deaths (mortality) by age 2. ENABLER AND CAPACITY BUILDER -innovate
and sex. new strategies in health to improve the
effectiveness of health programs, initiate public
3. Disease Registries - DOH registries for discussions, undertake and disseminate policy
HIV/AIDS & Chronic non - communicable research outputs to ensure public participation
diseases (Ca; DM; COPD; & stroke) in policy decision making.
the Renal Disease Control Program manages the 3. ADMINISTRATOR OF SPECIFIC SERVICES
Philippine Renal Disease Registry by NKTI. - manage selected national health facilities,
- administer direct services for emergent health
concerns,
- administer health emergency response
services.
DEVOLUTION OF HEALTH SERVICES >Barrio Health Stations
>Each province, city and municipality hasa •Location: 3-5 km radius from the main health
LOCAL HEALTH BOARD (LHB) - this body is a center
good venue for making the local health system •Staff: Rural health midwifes
more responsiİve to the needs of the people. serves 24 hrs./day
>It is mandated to propose annual budgetary REFERRAL SYSTEM:
allocations for the operation and maintenance BHS→ RHU→ MHO→ PHO→ RHO→
of health facilities and services within the National Agencies→ Specialized
municipality, city or province. Agencies
>COMPOSITION of LOCAL HEALTH BOARDS:
Provincial level: Chair: Governor: DEPARTMENT OF HEALTH
Vice-Chair: PHO * The leader of health for all in the Philippines.
Members: Chairman on the Committee A. VISION FOR THE HEALTH SECTOR
on Health of the Sangguniang -Fiipinos are among the healthiest people in
Panlalawigan, Asia by 2040
DOH Representative, and B. DOH MISSION
NGO representative -To promote healthy settings, and steer the
>COMPOSITION of LOCAL HEALTH BOARDS: development of an effective, resilient,
Barangay level: equitable, and people-centered
Chair: Brgy. Chairman health system for Universal Health Care.
Vice-Chair: Brgy. Kagawad Committee on Health
Members: BHW, BNS, DOH representative and Basic Principles of DOH include ensuring the
other leaders of the organizations such as universal access to basic health services and the
DepEd Principal, Day Care worker, prioritization of the health and nutrition of
PWD Pres. Senior Citizen Pres., etc.. vulnerable groups.
RESTRUCTURED HEALTH CARE DELIVERY >Primary Strategies
SYSTEM 1. Support to local health system
*To strengthen and to effect a more efficient 2. Assurance of health care
and effective delivery of health services in the 3. Increased investment for PHC
country by combination of main health center 4. Development of national standards and
and satellite barrio health stations. objectives for health.
>Main Health Center
•Locaton: Municipality MONTHLY DOH PROGRAMS
•Staff: MHO, Rural MD, PHN, >January -Cancer Consciousness Week
Sanitary Inspector, Midwife >February- Dental Health Week, Heart Month,
-In RHU some headed by a Leprosy Control Week
PHN based on RA 1891, an >March-Women's Health Month, Burn Injury
amendment of RA 1082
Prevention Month. Rabies Awareness Month, 1) Financial risk protection through expansion in
World Tuberculosis Day (24) enrolment and benefit delivery of the National
>April- Garantisadong Pambata, World Health Health Insurance Program (NHIP);
Day (7) 2) Improved access to quality hospitals and
>May- National Family Planning Month, Cervical health care facilities; and
Cancer Awareness Month, Safe Motherhood 3) Attainment of health-related Millennium
Week (10-16) Development Goals (MDGs).
>June - Kidney month, No Smoking Month,
Dengue Awareness Month, Prostate cancer 2. IMPROVED ACCESS TO QUALITY HOSPITALS
awareness, World Environment Day (5) AND HEALTH CARE FACILITIES
>July - Nutrition, National Voluntary Blood >The Health Facility Enhancement Program
Donation and National Disaster Preparedness (HFEP) shall provide funds to improve facility
Month preparedness for trauma and other
>August- National Lung & Sight-saving emergencies. The aim of HFEP was to
month, Family Planning Day (), hospital upgrade 20% of DOH-retained hospitals, 46% of
as centers of Wellness week, Asthma provincial hospitals, 46% of district hospitals,
week and 51% of rural health units (RHUS) by end of
> September - Liver Cancer Awareness and 2011.
Generics Awareness Month
>October- Elderly Filipino and National Mental "Maternal and Child Health Nursing"
Health Week, National Newborn Screening Philosophy:
>November- Substance Abuse Prevention week >Pregnancy, labor and delivery and puerperium
>December -Oplan Iwas Paputok, World AIDS are part of the continuum of the total life cycle
(1) >Personal, cultural and religious attitudes and
beliefs influence the meaning of pregnancy for
UNIVERSAL HEALTH CARE (UHC) individuals and make each experience unique
(KALUSUGAN PANGKALAHATAN) >MCN is FAMILY CENTERED- the father is as
>The Aquino administration puts it as the important as the mother
availability and accessibility of health services GOALS:
and necessities for all >To ensure that expectant mother and nursing
Filipinos. mother maintain good health, learn the art of
> It is a government mandate aiming to ensure child Care, has a normal delivery and bear
that every Filipino shall receive affordable and healthy children
quality health benefits. >That every child ives and grows up in a family
>This involves providing adequate resources- unit with love and security, in healthy
health human resources, health facilities, and surroundings, receives adequate nourishment,
health financing. health supervision and efficient medical
THREE THRUSTS
attention and is taught the elements of healthy •History - taking
Iiving •Determination of obstetrical score
►Classification of pregnant women G, P,TPAL, AOG, EDD
•Normal-healthy pregnancy •U/A for Proteinuria, glycosuria and infection
•With mild complications- frequent home visits •Dental exam
•With serious or potentially serious cx- referred •Wt. Ht. BP taking
to most skilled source of medical and hospital •Exam of conjunctiva and palms for pallor
care •Abdominal exam - fundal ht, Leopold's
▶ Home Based Mother's Record (HBMR) maneuver and FHT(average 110 to 160 bpm)
-a Tool used when rendering prenatal care •Exam of breasts, face, hands and feet for
containing risk factors and danger signs edema and neck for thyroid enlargement
•Health teachings- nutrition, personal hygiene,
*Risk Factors common complaints
>145 cm tall (4 ft & 9 inches) •Tetanus toxoid immunization
>Below 18 yrs old, above 35 yrs old •Iron supplementation - from 5th mo. of
>Have had 4 pregnancies pregnancy - 2 mos. Postpartum
>With TB, goiter, heart disease, DM, bronchial •In goiter endemic areas - iodized capsule once
asthma, severe a year
anemia •In malaria infested areas- prophylactic
>Last baby born was less than 2 years ago Chloroquine (150 mg/tab) 2 tabs/wk for the
>Previous cesarean section delivery whole duration of pregnancy
>History of 2 or more abortions, difficult
delivery, given birth to twins, 2 or more babies
born before EDD, stillbirth "REPRODUCTIVE HEALTH"
>Weighs less than 45 kgs. or more than 80 kgs. ▷ a state of complete physical, mental and
* Danger Signs social well-being and not merely the
1. any type of vaginal bleeding absence of disease/ infirmity in all matters
2. headache, dizziness, blurred vision relating to the reproductive system and to
3. puffiness of face and hands its functions and processes.
4. pallor >BASIC RH RIGHT
*Prenatal Care •Right to RH information and health care
Schedule of Visits services for safe pregnancy and childbirth
► 1st - as early as pregnancy, 1st trimester •Right to know different means of regulating
► 2nd 2nd trimester fertility to preserve health and where to obtain
► 3rd & subsequent visits - 3rd trimester them
► More frequent visits for those at risk with cx •Freedom to decide the number and timing of
birth of children
*Components of Prenatal Visits •Right to exercise satisfying sex life
>Factors/ determinants of RH •lt includes protection from harmful
•Socioeconomic conditions - education, reproductive practices and violence
employment, poverty, nutrition, living •it ensure sexual health for the purpose of
condition/ environment, family environment enhancement of life and personal relations and
•Status of women - equal right in education and assures access to information on sexuality to
in making decisions about her own RH; right to achieve sexual enjoyment
be free from torture and ill treatment and to >Goal
participate in politics •To achieve healthy sexual development and
•Social and Gender Issues maturation
•Biological (individual knowledge of •To achieve their reproductive intention
reproductive organs and their functions), •To avoid diseases, injuries and disabilities
cultural (country's norms, RH practices) and related to sexuality and reproduction
psychosocial factors' •To receive appropriate counseling and care
>Elements of RH problems
•Maternal and Child Health Nutrition >Strategies
•Family Planning •Increase and improve the use of more
•Prevention and Management of Abortion effective or modern contraceptive methods
Complications •Provision of care, treatment and rehabilitation
•Prevention and Treatment of Reproductive for RH
Tract Infections, including STDS, HIV and AIDS •RH care provision should be focused on
•Education and Counseling on Sexuality and adolescents, men and unmarried and other
Sexual Health displaced people with RH problems
•Breast and Reproductive Tract Cancers and •Strengthen outreach activities and referral
other Gynecological Conditions system
•Men's Reproductive Health •Prevent specific RH problems through
•Adolescent Reproductive Health information dissemination and counseling of
•Violence Against Women clients
•Prevention and Treatment of Infertility and
Sexual Disorders "FAMILY PLANNING"
>Selected Concepts The Philippine Family Planning Program is
•RH is the exercise of reproductive right with a national program that systematically
responsibility provides information and services needed
•lt means safe pregnancy and delivery, the right by women of reproductive age to plan
of access to appropriate health information and their families according to their own
services beliefs and circumstances.
•it includes protection from acceptable
methods of having access to safe, and GOALS AND OBJECTIVES:
family planning of their choice
•Universal access to family planning
information, education and services. "FP WARNING SIGNS"
MISSION: >Pills
•To provide the means and opportunities by •Abdominal pain (severe)
which married couples of reproductive age •Chest pain (severe)
desirous of spacing and limiting their •Headache (severe)
pregnancies can realizetheir reproductive goals. •Eye problems (blurred vision, flashing lights,
FAMILY PLANNING PROGRAM blindness)
► Created by EO 199 and augmented by the •Severe leg pain (calf or thigh )
National Family Planning Policy of AO 50A •Others: depression, jaundice, breast lumps
s2001. Hisense
► Focus as a health intervention to promote >IUD
health all •Period late, no symptoms of pregnancy,
Filipinos but with special attention to women abnormal bleeding or spotting
and children. •Abdominal pain during intercourse
► It is important not only for the physical •Infection or abnormal vaginal discharge
health of the mother but also her psychological •Not feeling well, has fever or chills
and emotional health. •String is missing or has become shorter or
"FP TYPES OF METHODS" longer
A. NATURAL METHODS
1. Calendar or Rhythm Method
2. Basal Body Temperature Method
3.Cervical Mucus Method >INJECTABLES
4. Sympto-Thermal Method •Dizziness
5. Lactational Amenorrhea •Severe headache
B. ARTIFICIAL METHODS •Heavy bleeding
1. Chemical Method >BTL
a. Ovulation suppressant such as PILLS •Fever
b. Depo-Provera •Weakness
c. Spermicidal •Rapid pulse
d. Implant •Persistent abdominal pain
2. MECHANICAL METHODS •Vomiting
a. Male and Female Condom •Dizziness
b. Intrauterine Device •Pus or tenderness at incision site
c. Cervical Cap/Diaphragm •Amenorrhea
3. SURGICAL METHODS >Vasectomy
a. Vasectomy •Fever
b. Tubal Ligation •Scrotal blood clots or excessive swelling
 1992
CHILD HEALTH CARE PROGRAM OBJECTIVES AND GOALS:
>UNDER FIVE CLINIC = Protection and promotion of
The first five years of life form the foundations breastfeeding and lactation
of the child's physical and mental growth and management education training
development. Studies have shown the mortality ACTIVITIES AND STRATEGIES:
and mọrbidity are high among this age group. 1.FULL IMPLEMENTATION OF LAWS
The Department of Health established the SUPPORTING THE PROGRAM
Under Five Clinic Program to address this A. EO 51 THE MILK CODE - protection and
problem. promotion of breastfeeding to ensure the. safe
PROGRAM OBJECTIVES AND GOALS: and adequate nutrition of infants through
•Monitor growth and development of regulation of marketing of infant foods and
the child until 5 years of age. related products. (e.g. breast milk
•ldentify factors that may hinder the Substitutes, infant formulas, feeding bottles,
growth and development of the teats ete. )
child. B. RA 7600 THE ROOMING -IN and
>ACTIVITIES AND STRATEGIES: BREASTFEEDING ACT of 1992
1. Regular height and weight determination/ = An act providing incentives to government
monitoring until 5 years old. and private health institutions promoting and
*0-1 year old=monthly practicing rooming-in
*1 year old and above =quarterly and breast-feeding.
2. Recording of immunization, vitamins = Provision for human milk bank.
supplementation, deworming and feeding. = Information, edUcation and re-education
3. Provision of IEC materials (ex. Posters, charts, drive
toys) that promote and enhance child's proper = Sanction and Regulation
growth and development. 2. CONDUCT ORIENTATION/ADVOCACY
4. Provision of a safe and learning oriented MEETINGS TO HOSPITAL/COMMUNITY.
environment for the child. ADVANTAGES OF BREASTFEEDING:
5. Monitoring and Evaluation. MOTHER
BREASTFEEDING/ LACTATION -Oxytocin help the uterus contracts
MANAGEMENT EDUCATION TRAINING -Uterine involution
•Breastfeeding practices has been proved to -Reduce incidence of Breast Cancer
be very beneficial to both mother and baby -Promote Maternal-Infant Bonding
thus the creation of the following laws support -Form of Family planning Method (Lactational
the full implementation of this program: Amenorrhea)
Executive Order 51 BABY
Republic Act 7600 -Provides Antibodies
The Rooming-In and Breastfeeding Act of -Contains Lactoferin (binds with lIron)
 -Leukocytes NUTRITIONALLY OPTIMAL
-Contains Bifidus factor-promotes growth of the GASTROENTERITIS GREATLY REDUCED
Lactobacillus
(inhibits the growth of pathogenic bacilI) GARANTISADONG PAMBATA (GP)
POSITIONS IN BF THE BABY: Garantisadong Pambata is a biannual week long
1.Cradle Hold=head and neck are supported delivery of a package of health services to
2.Footbal Hold children between the ages of 0-59 months old
3.Side Lying Position with the purpose of reducing morbidity and
ADVANTAGES OF BREASTFEEDING: mortality among under fives through the
BEST FOR BABIES promotion of positive Filipino values for proper
REDUCE INCIDENCE OF ALLERGENS child growth and development.
ECONOMICAL 1. WHAT ARE THE HEALTH SERVICES OFFERED
ANTIBODIES PRESENT IN GP AND WHO ARE THE TARGETS?
STOOL INOFFENSIVE (GOLDEN YELLOW) GP offers the following:
TEMPERATURE ALWAYS IDEAL 1.1 Routine Health Services:
FRESH MILK NEVER GOES OFF
EMOTIONALLY BONDING Deworming 1 tablet Orally 36-59 mos
EASY ONCE ESTABLISHED drug (if as nationwide
DIGESTED EASILY available) single
IMMEDIATELY AVAILABLE dose
Weighing 0-59 mos
Health Dosage Route of Target Nationwide
Service administration Population
Vitamin A 200,000 Orally by drops 12-59 Take Note:
Calsule IU or 1 months old, •The child should not have received megadose
Capsule nationwide of Vit. A above the recommended dosage within
100,000 9-12 month the past 4 weeks except if the child has measles
IU or old infants or signs and symptoms of Vit A. deficiency.
1/2 cap receiving •For any child between 12-23 months, who
o3 AMV missed any of his routine inmmunization, the
drops nationwide health worker should give the child the
Ferouse 0.3ml Orally by drops 2-11 mos necessary antigen to complete FlC and shall be
Sulfate (2-6 old infant recorded as such.
(25 mg. mos) in
Elemental Once a Mindanao GARANTISADONG PAMBATA
Iron per ml. day area Sangkap Pinoy
Bottle as including Vitamin A, Iron and lodine
taken home 0.6ml evacuation
medicine (6-11 center in
with mos) armed
instructions Once a conflict
day areas
Sources: green leaty and yellow vegetables, d.Reduces the infant's exposUre to infection.
fruits, liver, seafoods, iodized salt, pan de bida •For the Mother
and other fortified foods. e. Reduces a Woman's risk of excessive blood
These micronutrients are not produced by the loss after birth
body, and must be taken in the food we eat; f. Provides a natural method of delaying
essential in the normal process of growth and pregnancies.
development: g.Reduces the risk of ovarian and breast cancers
a) Helps the body to regulate itself and osteoporosis.
b) Necessary in energy metabolism -For the Family and Community
c) Vital in brain cell formation and mental h.Conserves funds that otherwise would be
development spent on breast milk substitute, supplies and
d) Necessary in the body immune system to fuel to prepare them.
protect the body from severe infection. i. Saves medical costs to families and
e) Eating Sangkap Pinoy-rich foods can prevent governments by preventing illnesses gnd by
and control: providing immediate postpartum
1. Protein Energy Malnutrition contraception.
2. Vitamin A Deficiency
3. Iron Deficiency Anemia COMPLEMENTARY FEEDING FOR BABIES 6-11
4. lodine Deficiency Disorder MONTHS OLD
>BREASTFEEDING What are Complementary Foods?
Breast milk is best for babies up to 2 years old. a.foods introduced to the child at the age
Exclusive breastfeeding is recommended for the 6 months to supplement breastmilk
first six months of life, At about six months, give b. given progressively until the child is used to
carefully selected nutritious foods as three meals and in-between feedings at the age
supplements. of one year.
Breastfeeding provides physical and
psychological benefits for children and mothers Why Is there a Need to Give Complementary
as well as economic benefits for families and Foods?
societies. a. breast milk can be a single source of
BENEFITS: nourishment from birth up to six months of life.
•For infants b. The child's demands for food increases as he
a.Provides a nutritional complete food for the grows older and breast milk alone is not enough
young infant. to meet his increased nutritional needs for
b.Strengthens the infant's immune system, rapid growth and development
preventing many infections. c. Breast Milk should be supplemented with
C.Safely rehydrates and provides essential other foods so that the child can get additional
nutrients to a sick child, especially to those nutrients
suffering from diarheal diseases.
d. Introduction of complementary foods will Garantisadong Pambata-given to children
accustom him to new foods that will also below 6 years old
provide additional nutrients to make him grow •Hghlights health-promoting behaviors that
well parents, and other leaders can do in their
e. Breastfeeding, however, should continue for respective spheres of influence.
as long as the mother is able and has milk which •E.g. breastfeeding, completion of
could be as long as two years. immunization, regular vit A supplementation,
deworming, handwashing, toothbrushing,
How to Give Complementary Foods for Babies proper toillet use, and prevention smoking at
6-11 Months Old? home.
a. Prepare mixture of thick lugao/ cooked rice, Newborn Screening- is a simple procedure to
soft cooked vegetables. Egg yolk, mashed find out if the newborn has a congenital
beans, flaked fish/chicken/ground meat and oil. metabolic disorder that may lead to mental
b. Give mixture by teaspoons 2-4 times daily, retardation.
increasing the amount of teaspoons and •lt is done on the 48th hour or at least 24 hrs
number of feeding until the full recommended from birth. It Uses the heel prick method. The
amount is consumed blood is dried for 4 hours and sent to the
c. Give bite-sized fruit separately Newborn Screening Laboratory.
d. Give egg alone or combine with above food •The fee is P550-750.
mixture. Newborn Screening Package
1. Congenital Hypothyroidism -results from lack
Child Health Programs or absence of thyroid hormone
>Other relevant laws: 2. Congenital Adrenal Hyperplasia-is an
•RA 7610– anti-child abuse act endocrine disorder that causes severe salt loss,
•RA 768- an act prohibiting the employment dehydration, and abnormally, high levels of
of children below 15 years of age male sex hormone in both boys and girls.
•RA 6809-emancipation low lowered at 3. Galactosemia -a condition in which the body
majority age from 21 to 18 years old. is unable to process galactose, the sugar in milk.
4. Phenylketonuria -a metabolic disorder in
Goal: Every child grows up in a family with love which the body cannot properly use one of the
and security, Iives in healthy surroundings, building blocks of protein called phenylalanine.
receives adequate nourishment, health 5. Glucose 6 Phosphate Dehydrogenase
Supervision and medical attention, and is taught Deficiency- Condition where the lacks the
the elements of healthy living. enzyme called G6PD
Objectives: To reduce children mortality and (babies may haye hemolytic anemia resulting
morbidity and contribute to healthy growth and from exposure to certain drugs, foods and
development of children chemicals.
Other Relevant Child Health Programs
•intensify health education and information
campaigns at the ground level
•enhance medical, nursing and midwifery
education with cost-effective saving strategies
such as the IMCI & BEMOC.
•pursue the implementation of laws and
policies for protection of newborns, infants &
children
-Early Childhood Development Act of 2000
-Newborn Screening Act of 2004
-EO 286 for the Bright Child Program
-EO 51 known as the Milk Code
-The rooming-in and breastfeeding Act, etc.
-Food Fortification Law