CHN-1-ILG

MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Alimannao Hills, Peñablanca Cagayan
INSTRUCTIONAL
LEARNING GUIDE
COMMUNITY
HEALTH NURSING 1
(LECTURE)
FIRST SEMESTER F.Y. 2020-2021
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NAME OF STUDENT:___________________________YEAR AND SECTION:__________
NAME OF TEACHER:______________________________________________________
AUTHOR
AMIEL F. REYES, RN, MSN, LPT

Lecturer/Two-Year Courses Coordinator
College of Nursing
Medical Colleges of Northern Philippines
REVIEWERS
REYNALDO M. ADDUCUL, RN, RM, MSN, JD

Dean
College of Nursing and Two-Year Courses
Medical Colleges of Northern Philippines
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PREFACE
This instructional learning guide provides an introduction to Community Health Nursing for
students of Bachelor of Science in Nursing Level 2 of Medical Colleges of Northern Philippines.
This material has been prepared to address the needs of the students in the distance learning
mode of instruction. This resource material will provide an introduction and a clear picture of
public health and community health especially in the Philippines. This will also provide a good
foundation in knowledge, practice and even values in the practice of community health nursing
and public health nursing. Moreover, may this material also spark an interest to the student to
practice community health nursing in his or her undergraduate studies and on the chosen
career path. Nursing is not only in the hospitals. Over the years, community health nursing and
public health nursing was given more emphasis as the government put efforts on reaching the
public even in far-flung areas. It may also include other community settings such as schools,
government institutions, workplaces, churches, industries and business establishments. The
contents of this guide have been carefully planned and reviewed to ensure accuracy of the
information and to present generally accepted practices.
Community Health Nursing 1 focuses on the nursing practice focused to individual and family.
Community organizing and community health care process is delivered on Community Health
Nursing 2. This material is a collection of lectures from different credible-authored local and
foreign Community Health Nursing authors and their publish works. However, with the ongoing
pursuit of knowledge that brings significant changes in the nursing profession and related
programs, the user is urged to be updated from time to time.
The term community health nurse will be used interchangeably with public health nurse to clear
that the professional does not only work in the community, but also is equipped with nursing
science and public health that provides nursing practice.
Guidelines on the use of the instructional learning guide
• These guidelines were developed to facilitate the use of this instructional learning guide
by students with diverse backgrounds, learning style and internet connectivity.
• It is required that the students will accomplish the learning guide and the course in a
specific period of time specified by the institution.
• It is assumed that students have passed the pre-requisite subjects prior to the
enrolment of this course.
• Concise, readable styles were included to facilitate the student acquire a professional
vocabulary skills and appropriate communication skills. Efforts have been made to avoid
overwhelming the student to further enhance the learning process.
• Government, private and non-government organization programs are discussed on this

material. This information also increases student’s awareness of public health and
community health programs and the expected roles and responsibilities of that of a
nurse.
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• Every effort has been made to discuss current and up-to-date information and concepts
from references.
• Italics and bold words are used for emphasis of significant word or phrase. These words
are usually defined when initially used.
• Chapter activities are presented every end of a section of this material. The student is
expected to accomplish the tasks in a given period of time. The student may use
properly labeled and numbered bond papers as answer sheets.
• While using this learning material, the student may prepare textbooks or references that
may further supplement his/her learning. The student will also prepare materials (pens,
art materials, papers, etc.), as some chapter activities may require so.
Features of the instructional learning guide

The learning guide is simple and direct to the point. Several materials have been included to
improve the information and facilitate comprehension. The features of the learning guide:
• Chapter intended learning outcomes are included in the beginning. These are expected
to be accomplished after studying the chapters. The objectives may be modified or
added throughout the course
• Key terms are listed at the beginning of the chapter. These are words usually
encountered initially within the learning guide. Key terms are not repeated in
subsequent chapters. This is also represented by the symbol ..
• Lecture/Discussions are presented from introduction to specific applications or situations

of that same topic. The contents of this section are from different references which were
consolidated by the instructor.
• Exercises within the discussions are presented. These will stimulate the minds of the
user. This will further gauge his/her knowledge and understanding of the topics. This
section is presented by . Such exercises are required to be accomplished.
• Teacher’s insights are presented as well every end of the chapter. This is represented by
the image .
• Illustrations, tables, diagrams and images are also included to reinforce learning.
• Relate to practice/Case studies (Application) with questions are incorporated at the end
of the chapters to provide a basis for discussion and as an assessment to the student’s
understanding. This is represented by the image .
• Self-reflection ( ) activities are provided to assess the understanding of the student

on the topics and contents presented. These activities will also gauge the appreciation of
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the user. The instructor may include this as part of the portfolio or to entice the student
to share his or her idea to the group.
• Appendices contain the rubrics that will be used to grade or score the student’s required
outputs.
• References section contains the materials which were used to create this learning
guide. The user is also encouraged to explore and use additional references other than
this material.
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TABLE OF CONTENTS
PRELIMINARIES – COURSE DETAILS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PRELIMS COVERAGE
CHAPTER 1: FAMILY HEALTH NURSING PROCESS
LESSON 1: Concept of Family as a Basic Unit of Society
A. Concept of Family
B. Types of Family
C. Stages of Family Development
D. Roles and Responsibilities of Family Members
E. Rights of Family Members
LESSON 2: Levels of Prevention in Family Health
LESSON 3: Family Nursing Care Process
A. Conducting Family Assessment
B. Typology of Nursing Problems in Family Nursing Practice
C. Family Nursing Care Plan
D. Implementing Family Nursing Care Plan
E. Evaluating Family Nursing Care
LESSON 4: Nurse-Family Contacts
MIDTERMS COVERAGE
CHAPTER 2: CONCEPT OF PUBLIC HEALTH AND COMMUNITY HEALTH NURSING
LESSON 1: Concept of Public Health
LESSON 2: Concept of Community Health Nursing
LESSON 3: Historical Background of Community Health Nursing in the Philippines
LESSON 4: Specialized Field in Community and Public Health Nursing
CHAPTER 3: THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM
LESSON 1: World Health Organization, Millennium Development Goals And Sustainable
Development Goals
LESSON 2: Components of the Phil. Health Care Delivery System
LESSON 3: Restructured Health Care Delivery System and Devolution Code of the Philippines
LESSON 4: Levels of Health Care Facilities
LESSON 5: Two-way Referral System
LESSON 6: Multi-Sector Approach to Health
SEMIFINALS COVERAGE
CHAPTER 4: PRIMARY HEALTH CARE AS AN APPROACH TOWARDS HEALTHY FILIPINOS
LESSON 1: Definition and Concepts Related
LESSON 2: Principles and Strategies
LESSON 3: ELEMENTS/Health Programs of PHC
FINALS COVERAGE
CHAPTER 5: TREATMENT OF COMMUNICABLE AND NON-COMMUNICABLE DISEASES
Introduction:
Lesson 1: Cardiovascular diseases
Lesson 2: Cancer
Lesson 3: Diabetes Mellitus
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Lesson 4: Chronic Obstructive Pulmonary Disease
Lesson 5: Risk Assessment and Screening Procedures
Lesson 6: Promotion of Healthy Lifestyle
Lesson 7: Blindness Program
Lesson 8: Mental Health Program
CHAPTER 6: CONTROL OF COMMUNICABLE DISEASES
Lesson 1: Chain of Infection and Related Concepts
Lesson 2: Blood/Vector-Borne Diseases
Lesson 3: Central Nervous System Diseases
Lesson 4: Hepato-enteric Diseases
Lesson 5: Eruptive Diseases
Lesson 6: Respiratory System Diseases
Lesson 7: Gastrointestinal System Diseases
Lesson 8: Contact Transmission
Lesson 9: Sexually-Transmitted Diseases
CHAPTER 7: ENVIRONMENTAL DISEASES
Lesson 1: Environmental Health Records Management
Lesson 2: Solid Waste Management
Lesson 3: Water Sanitation and Air Purity
Lesson 4: Food Safety
Lesson 5: Sanitation
Lesson 6: Vermin and Vector Control
APPENDICES
A. Family Nursing Care Plan (FNCP) Template
B. Rubrics for Case Analysis
C. Rubrics for Teaching Plan/Session Design
D. Rubrics for Short Essay
E. Rubrics for Video Analysis
REFERENCES
Textbooks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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PRELIMINARIES – COURSE DETAILS
Subject: Community Health Nursing 1– Lecture Units: 2 Class hours: 3 lecture hours/week
Course: BSN____________ Year level: __2___ Section: ____________________________
Subject Teacher: _______________________________ Contact number:______________
Class schedule and consultation time: __________________________________________
COURSE DESCRIPTION:
This course covers the concepts and principles in the provision of basic care in terms of
health promotion, health maintenance and disease prevention at the individual and
family level - recognized as the basic unit of the larger community. It includes the study
of the Philippine Health Care Delivery System and global context of public health. It
describes what community/public health nursing is in the context of the Philippine
Health Care Delivery System, and in community development.
COURSE OUTCOMES:
At the end of the course the student will be able to:

1. Apply concepts and principles of community health nursing in the care of individuals
and families.
2. Utilizes the nursing process in the care of families.
a. Assess the health status of communities through families to identify existing and
potential problems.
b. Plans relevant and comprehensive interventions and programs based on identified
priority problems.
c. Implements appropriate plan of care to improve the health status of the families
in the community.
d. Evaluates the progress and outcomes of community health nursing interventions
and programs.
3. Ensure a well-organized recording and reporting system.
4. Share leadership/relate effectively with others in work situations related to nursing
and health.
5. Recognize the roles and responsibilities of a nurse in nation-building.
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METHODOLOGY OF IMPLEMENTATION:
This is a distance learning strategy wherein the students will be provided with a copy of the
Instructional Learning Guide (ILG) or be enrolled in the Learning Management System (LMS) to
acquire the necessary knowledge, skills, and attitude offered by the course. This is in response
to the new mode of delivering instruction without requiring the students to report to school.
The teacher shall conduct an orientation to the students via online platforms or call and/or text
message regarding the utilization of this material for them to be guided throughout the duration
of the course.
Topics shall be assigned based on the syllabus of the subject. Specific instructions on how
complete the activities per chapter will be given to the students. Activities are given at pre-
determined time to be completed by the students. At the completion of each topic, students are
required to take the evaluative examinations which shall be given by the teacher based on the
intended learning outcomes.
During the duration of the course, students can consult their teachers at a specified time to
address their difficulties or challenges they may encounter along the way.
The subjects are structured in sequential order. Course materials and references shall be
provided by the teacher in advance to facilitate teaching and learning process.
Delivery Mode:
1. Hard/soft copy of the Instructional Learning Guide (Offline)
2. Learning Management System (Online)
3. Audio / video materials
4. Downloaded links
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PRELIM COVERAGE
Specific Instructions in the completion of each Chapter:

1. Set your learning goals. Read and understand the Intended Learning Outcomes of each
chapter. This shall serve as your checklist of acquired knowledge and skills after
completing the entire chapter, likewise, the basis of the teacher in the formulation of the
summative evaluation given at the end of each chapter.
2. Lecture notes are provided for you. BE SURE NOT TO SKIP the lecture. Read and
understand before answering the activities. You can take note those concepts that are
not clear to you and refer to your subject teacher during the specified consultation
hours.
3. Read the teacher’s insight and watch the downloaded videos saved in the flash drive to
supplement the lecture notes.
4. As you go on, you will encounter exercises that will test your knowledge and
understanding as well as your critical thinking. Read the instructions carefully, and write
your answers to the space provided at the end of Midterm coverage.
5. Compile your outputs in your Learning Portfolio to be submitted on the date set by your
teacher.
6. Should you have any queries or clarifications with the topics, please contact your subject
teacher during consultation hours (please refer to the preliminaries of this material).
CHAPTER 1
FAMILY HEALTH NURSING PROCESS
Intended Learning Outcomes:

After studying this chapter, the student is expected to:
1. Describe the tools used for family assessment.
2. Differentiate areas of family coping index.
3. Identify the family health tasks.
4. Categorize family nursing problem utilizing various family assessment tools.
5. Develop family nursing care plan based on steps given.
6. Differentiate various methods of family nurse contacts.
7. Apply essential principles in home visit and bag technique.
8. Utilize public health nurse tools in providing family nursing care.
9. Evaluate nursing care given to family
10. Create a family health tree from their three-generation family.
KEY TERMS:
bag technique extended family
blended family evaluation
cohabitation family
compound family family coping index
dyad family health assessment
ecomap family health tree
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family-nurse contacts home visit
family nursing care interview
genogram nuclear
LESSON 1: CONCEPT OF FAMILY AS A BASIC UNIT OF SOCIETY
A. Concepts of Family
FAMILY
-U.S census Bureau: a group of people related by blood, marriage, or adoption living together
-Allender and Spradley (2004): two or more people who live in the same household (usually) share a
common emotional bond, and perform certain interrelated social tasks
=better definition for HCP’s because it addresses the broad range of types of families that they
encounter
-primary institution in society that preserves and transmits culture
-MAGLAYA: a very important social institution that performs 2 major functions- reproduction and
socialization
-performs health promoting, health maintaining, and disease preventing activities
-family is the locus of decision making on health matters.
-it is the source of the most solid support and care to its members, particularly to
the young, the elderly, the disabled, and the chronically ill.
-FRIEDMAN: two or more persons who are joined together by bonds of sharing and emotional closeness
and who identify themselves as being part of the family
- PHC -family is the basic social institution and the primary group in society
-a social group characterized by common residence, economic cooperation and reproduction
-includes both sexes, at least two of who maintain a socially approved sexual relationship, and one
or two children
B. Types of Family
2 BASIC FAMILY TYPES:

1. FAMILY OF ORIENTATION
-the family one is born into; or oneself, mother, father, and siblings, if any
2. FAMILY OF PROCREATION
-a family one establishes; or oneself, spouse or significant other, and children
▪ THE DYAD FAMILY

-consists of 2 people living together, usually a woman and a man, without children
-generally viewed as temporary arrangements, but if the couple chooses child-free living, this can
also be a lifetime arrangement
▪ THE NUCLEAR FAMILY

-composed of a husband, wife, and children
-most common structure
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-advantage: ability to provide support to family members, because with its small size, people feel
with genuine affection for each other
▪ THE COHABITATION FAMILY

-are composed of heterosexual couples who live together like a nuclear family but remain
unmarried
-may be temporary, may also be a long-lasting and as meaningful as a more traditional alliance and
therefore offer as much psychological comfort and financial security as marriage
▪ THE EXTENDED (MULTIGENERATIONAL) FAMILY

-includes not only one nuclear family but also other family members such as grandmothers,
grandfathers, aunts, uncles, cousins and grandchildren
-advantage: contains more people to serve as resources during crises and provides more role
models for behaviour and values
-disadvantage: family resources such as, financial and psychological, must be stretched to
accommodate all members.
▪ THE SINGLE-PARENT FAMILY

-increase is a result of both the high rate of divorce and the increasingly common practice of
women raising children outside marriage
-PROBLEMS:
>if the parent is ill, there is no back-up person for child care. If child is ill,
there is no close support person to give reassurance or second opinion on
whether the child ‘s health is worsening or improving.
>low-income: because the parent is most often women, and women’s
income are lower than men’s
>they may also have difficulty with role modelling or clearly identifying
their role in the family.( mentally and physically exhausting)
>single-parent fathers: may have difficulty with home management or child
care if they had little experience with these roles before the separation
▪ THE BLENDED FAMILY

-or remarriage, or reconstituted family, a divorced or a widowed person with children marries
someone who also has children
-advantages:
>increased security and resources for the new family
>children of blended family are exposed to different ways of life and may
become more adaptable to new situations
-problems:
>childrearing problems may arise- rivalry among the children for the
attention of a parent or from competition with the stepparent for the love of
the biologic parent.
>children may not welcome stepparent because they have not yet resolved their feelings of
separation of their biologic parents
-roles of nurses: offer emotional support to members of a remarriage family until the adjustments for
mutual living have been made
▪ THE COMMUNAL FAMILY

▪ THE GAY OR LESBIAN FAMILY
-individuals of the same sex live together as partners of companionship, financial security, and sexual
fulfilments
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-offers support in times of crisis comparable to that offered by nuclear or cohabitation family
-include children from previous heterosexual marriages through the use of artificial insemination, adoption
or surrogate motherhood
▪ THE FOSTER FAMILY

-children whose parents can no longer care for them may be placed in a foster or substitute home by a
child protection agency
-foster parents may or may not have children of their own
-they receive remuneration for their care and concern for the foster child
-foster home placement is temporary until children can be returned to their own parents
-if not possible, children may be raised to adulthood in foster care
-when caring for children from foster homes, it is important to determine who has legal responsibility to
determine who has legal responsibility to sign for health care (a foster parent may or may not have this
responsibility)
▪ THE ADOPTIVE FAMILY

-methods of adoption:
1. agency adoption
-a couple contacts an agency by first attending an informational meeting
-if they decide to apply to the agency, they are then put on a waiting list for processing
-the process includes extensive interviewing and a home visit by an agency social worker to determine
whether the couple can be relied on to provide a safe and nurturing environment for an adopted child.
-once approved, the couple is placed on a second waiting list
-when a child has been located for them. The agency notifies the parent
C. Stages of Family Development
FAMILY STAGES
1. BEGINNING FAMILY
▪ TASKS:
-establishing a mutually satisfying marriage
-planning to have or not to have children
2. CHILD-BEARING FAMILY
▪ TASKS:
-having and adjusting to infant
-supporting the needs of all three members
-renegotiating marital relationships
3. FAMILY WITH PRE-SCHOOL CHILDREN

▪ TASKS:
-adjusting to costs of family life
-Adapting to the needs of pre-school
-coping with parental loss of energy and privacy
4. FAMILY WITH SCHOOL-AGE CHILDREN

▪ TASKS:
-adjusting to the activity of the growing children
-promoting joint decisions between children and parents
-encouraging and supporting children’s educational achievements
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5. FAMILY WITH TEEN-AGERS AND YOUNG ADULTS
▪ TASKS:
-maintaining open communication among members
-supporting ethical and moral values within the family
-balancing freedom with responsibility of teen-agers
-releasing young adults with appropriate rituals and assistance
6. POST-PARENTAL FAMILY
▪ TASKS:
-strengthening marital relationships
-Maintaining supportive home base
-preparing for retirement
-maintaining ties with younger and older generations
7. AGING FAMILY
▪ TASKS:
-adjusting to retirement
-Adjusting to loss of spouse
-Closing family house
D. Family Structures and Functions
FAMILY STRUCTURES
BASED ON INTERNAL ORGANIZATION AND MEMBERSHIP

1. NUCLEAR
-also known as primary or elementary family
-composed of the father, mother, and children
2. EXTENDED
-composed of two or more nuclear families related to each other economically or socially
-extensions may be through the parent-child relationships , when the unmarried children and
the married children with their families live with the parents
-another extension is through the husband-wife relationship, as in polygamous marriage
BASED ON PLACE OF RESIDENCE

1. Patrilocal
-requires the newly-wed couple to live with the family of the bridegroom or near the residence
of the parents of the bridegroom
2. Matrilocal
-requires the newly-wed couple to live with or near the residence of the bride’s parents
3. Bilocal
-provides the newly-wed couple the choice of staying with either the groom’s parents or the
bride’s parents, depending on factors like the relative wealth of the families or their status, the
wishes of their parents, or certain personal preferences of the bride or the groom
4. Neolocal
-permits the couple to reside independently of their parents
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-they can decide on their own as far as their residence is concerned
5. Avunculocal
-prescribes the newly-wed couple to reside with or near the maternal uncle of the groom
BASED ON DESCENT
1. Patrilineal
-affiliates a person with a group of relatives through his or her father
2. Matrilineal
-affiliates a person with a group of relatives through his or her mother
3. Bilateral
-affiliates a person with a group of relatives related through both his or her parents
BASED ON AUTHORITY
1. Patriarchal
-authority is vested in the oldest male in the family, often the father
2. Matriarchal
-authority is vested in the mother or mother’s kin
3. Egalitarian
-the husband and wife exercises a more or less equal amount of authority
4. Matricentric
-prolonged absence of the father gives the mother a dominant position in the family, although
the father may also share with the mother in desicion-making
E. Functions of Family
-defined as the ability of the family to meet the needs of its members through developmental
transitions
-indicators:
1. Regulates sexual behavior and reproduction.
2. Biological maintenance function.
3. Socialization function.
4. The family gives its members a status.
5. Social control function.
6. Economic functions.
- Indicators:
1. Socialization of new family members.
2. Regulation of members' behaviours with performance of expected roles.
3. Adaptation to developmental transitions and unexpected crises.
4. Creation of an environment for free expression by members.
5. Support and assistance for one another.
6. Expression of loyalty to family.
7. Participation in community activities.
8. Involvement in problem solving and conflict resolution.
Acceptance of diversity among members.
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F. Characteristics of Family
CHARACTERISTICS OF FAMILY:
1. The family as a social group is universal and is significant element in man’s social life.
2. It is the first social group to which the individual is exposed.
3. Family contact and relationships are repetitive and continuous.
4. The family is very close and intimate group.
5. It is the setting of the most intense emotional experiences during the life time of individual.
6. The family affects the individual’s social values, disposition, and outlook in life.
7. The family has the unique position of serving as a link between the individual and the larger
society.
8. The family is also unique in providing continuity of social life.
EXERCISE 1.1:
Describe your family according to type, stage, and the different structures. You may also write something
for your family. You may include a picture of your family.
LESSON 2: LEVELS OF PREVENTION IN FAMILY HEALTH
Primary Prevention
Providing specific protection against disease to prevent its occurrence is the most desirable form of
prevention. Primary preventive efforts spare the client the cost, discomfort and the threat to the quality of
life that illness poses or at least delay the onset of illness. Preventive measures consist of counseling,
education and adoption of specific health practices or changes in lifestyle.
Examples:
a. Mandatory immunization of children belonging to the age range of 0 – 50 months old to
control acute infection diseases.
b. Minimizing contamination of the work or general environment by asbestos dust, silicone
dust, smoke, chemical pollutants and excessive noise.
c. Proper nutrition, proper attitude towards sickness, proper and prompt utilization of
available health and medical facilities, handwashing
Secondary Prevention
It consists of organized, direct screening efforts or education of the public to promote early case finding of
an individual with disease so that prompt intervention can be instituted to halt pathologic processes and
limit disability. Early diagnosis of a health problem can decrease the catastrophic effects that might
otherwise result for the individual and the family from advanced illness and its many complications.
Examples:
a. Public education to promote breast self-examination, use of home kits for detection of occult
blood in stool specimens and familiarity with the seven cancer danger signals.
b. Screening programs for hypertension, diabetes. Uterine cancer (pap smear), breast cancer
(examination and mammography), glaucoma and sexually transmitted disease.
Tertiary Prevention
It begins early in the period of recovery from illness and consists of such activities as consistent and
appropriate administration of medications to optimize therapeutic effects, moving and positioning to
prevent complications of immobility and passive and active exercise to prevent disability. Continuing health
supervision during rehabilitation to restore an individual to an optimal level of functioning. Minimizing
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residual disability and helping the client learn to live productively with limitations are the goals of tertiary
prevention. (Pender, 1987)
Examples:
a. Rehabilitation therapy and physical therapy after stroke
b. Speech therapy after a laryngectomy
c. Insulin therapy for Diabetics
LESSON 3: THE FAMILY HEALTH NURSING PROCESS
FAMILY HEALTH NURSING
- Level of community health nursing practice directed or focused on the family as the unit of care
with health as the goal and nursing as the medium and the nurse as the channel or provider of
care.
3. A. Conducting Family Health Assessment
Assessment of the family helps nurses identify the health status of individual members of the family
and aspects of family composition, function and process. The nurse as much information about a familyas
is possible and practical. The process of family health assessment does not stop and requires objectivity
and professional judgment to attach practical meaning to the information being acquired.
The nurse may use a tool called Family Health Assessment Form (Appendix A). or the initial
database to be a guide in data collection. Over time and depending on the guidelines of the agency, the
tool can be modified or updated.
STEPS IN FAMILY NURSING ASSESSMENT

1. Data Collection
- Gathering of five types of data which will generate the categories of health
conditions or problems of the family.
2. Data Analysis
- Sort data
- Cluster/group related date
- Distinguish relevant from irrelevant data
- Identify patterns
- Compare patterns with norms or standards
- Interpret results
- Make inferences/draw conclusions
3. Formulation of Nursing Diagnoses
- Identification of Family Nursing Problems.
INITIAL DATA BASE FOR FAMILY NURSING PRACTICE
A. Family Structure, Characteristics and Dynamics

1. Members of the household and relationship to the head of the family
2. Demographic data – age, sex, civil status, position in the family
3. Place of residence of each member – whether living with the family or elsewhere
4. Type of family structure – e.g. matriarchal or patriarchal, nuclear or extended
5. Dominant family members in terms of decision – making, especially in matters of health care
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6. General family relationship/dynamics – presence of any obvious/readily observable conflict between
members; characteristic communication/interaction patterns among members
B. Socio – economic and Cultural Characteristics

1. Income and Expenses
a. Occupation, place of work and income of each working member
b. Adequacy to meet basic necessities (food, clothing, shelter)
c. Who makes decisions about money and how it is spent
2. Educational attainment of each member
3. Ethnic background and religious affiliation
4. Significant Others – role(s) they play in family’s life
5. Relationship of the family to larger community – nature and extent of participation of the family in
community activities
C. Home and Environment

1. Housing
a. Adequacy of living space
b. Sleeping arrangement
c. Presence of breeding or resting sites of vectors of diseases (e.g. mosquitoes, roaches, flies,
rodents, etc.)
d. Presence of accident hazards
e. Food storage and cooking facilities
f. Water supply – source, ownership, potability
g. Toilet facility – type, ownership, sanitary condition
h. Garbage/refuse dispossi – type, sanitary condition
i. Drainage system – type, sanitary condition
2. Kind of neighborhood, e.g. congested, slum, ect.
3. Social and health facilities available
4. Communication and transportation facilities available
D. Health Status of each Family Member

1. Medical and nursing history indicating current or past significant illnesses or beliefs and practices
conducive to health and illness
2. Nutritional assessment (specially for vulnerable or at – risk members)
a. Anthropometric data
➢ Measures of nutritional status of children – weight, height, mid – upper arm
circumference
➢ Risk assessment measures for Obesity – body mass index (BMI = weight in kgs.
divided by height in meters), waist circumference (WC: greater than 90 cm in men
and greater than 80 cm in women), waist hip ratio (WHR = waist circumference in
cm divided by hip circumference in cm). Central obesity: WHR equal to or greater
than 1 cm in men and 0.85 cm in women.
b. Dietary history specifying quality and quantity of food/nutrient intake per day
c. Eating/feeding habits/practices
3. Developmental assessment of infants, toddlers, and preschoolers – e.g. Metro Manila
Developmental Screening Test (MMDST).
4. Risk factor assessment indicating presence of major and contributing modifiable risk factors for
specific lifestyle diseases – e.g. hypertension, physical inactivity, sedentary lifestyle,
cigarette/tobacco smoking, elevated blood lipids/cholesterol, obesity, diabetes mellitus, inadequate
fiber intake, stress, alcohol drinking and other substance abuse
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5. Physical assessment indicating presence of illness state/s (diagnosed o undiagnosed by medical
practitioners)
6. Results of laboratory/diagnostic and other screening procedures supportive of assessment findings
E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention.
Examples include:
1. Immunization status of family members
2. Healthy lifestyle practices, Specify
3. Adequacy of
a. rest and sleep
b. exercise/activities
c. use of protective measures – e.g. adequate footwear in parasite infected areas, use of
bednets and protective clothing in malaria endemic areas
d. relaxation and other stress management activities
4. Use of promotive – preventive health services
METHODS OF DATA GATHERING
1. Observation
- Method of data collection through the use of sensory capacities (sight, hearing, smell and
touch).
- Data gathered through this method have the advantage of being subjected to validation and
reliability testing by other observers.
2. Physical Examination
- Done through inspection, palpation, percussion, auscultation, measurement of specific body
parts and reviewing the body systems.
3. Interview
- Completing the health history of each family member. The health history determines current
health status based on significant past health history.
- The second type of interview is collecting data by personally asking significant family members
or relatives questions regarding health, family life experiences and home environment to
generate data on what wellness condition and health problems exist in the family.
- Productivity of the interview process depends upon the use of effective communication
techniques to elicit the needed responses.
4. Record Review
- Reviewing existing records and reports pertinent to the client. (individual clinical records of the
family members; laboratory & diagnostic reports; immunization records; reports about the
home & environmental conditions).
5. Laboratory/Diagnostic Tests
- performing laboratory tests, diagnostic procedures or other tests of integrity and functions
carried out by the nurse herself and/or other health workers.
TOOLS USED IN FAMILY ASSESSMENT
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GENOGRAM
- A genogram is a pictorial, multi-generational representation of familial relationships and
patterns of behavior.
Purpose:
- To engage the family in pictorially summarizing and illustrating familial relationships and
patterns of behavior within a family system in support of family assessment and intervention
planning.
ECOMAP
- A pictorial representation of a family’s connection to the persons and systems in their
environment. It illustrates three separate dimensions for each connection:
1. the strength of the connection- (weak, tenuous/uncertain, strong);
2. the impact of the connection- (no impact, draining resources/energy, providing
resources/energy);
3. the quality of the connection (stressful).
Purpose:
- To support classification of family needs and decision-making about potential interventions.
Further, it is to create a shared awareness (between a family and their social worker) of the
family’s significant connections, and the constructive and destructive influences those
connections may be having.
FAMILY HEALTH TREE

- Provides a mechanism for recording the family’s medical and health histories.
Purpose:
- To plan positive familial influences on factors on risk factors such as diet, exercise, coping with
stress, or pressure to have physical examination
EXERCISES 1.2:
1. Complete a personal genogram What are the high-risk factors in your family history? What are the
current risk factors? Categorize current risk factors as physical, interpersonal, and environmental.
2. Create a family health tree of your own. Make it creative.
4. B. Typology of Nursing Problems in Family Nursing Practice
FIRST LEVEL ASSESSMENT
I. Presence of Wellness Condition – stated as Potential or Readiness – a clinical or nursing

judgment about a client in transition from a specific level of wellness or capability to a higher
level.
Wellness potential
➢ Nursing judgment on wellness state or condition based on client’s performance, current
competencies or clinical data but no explicit expression of client desire.
Readiness for enhanced wellness state

➢ Nursing judgment on wellness state or condition based on client’s current competencies or
performance, clinical data and explicit expression of desire to achieve a higher level of state or
function in a specific area on health promotion and maintenance.
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Examples
A. Potential for Enhanced Capability for:
1. Healthy lifestyle – e.g nutrition/diet, exercise/activity
2. Health Maintenance/Health Management
3. Parenting
4. Breastfeeding
5. Spiritual Well – being – process of a client’s developing/unfolding of mystery through
harmonious interconnectedness that comes from inner strength/sacred source/God
6. Others, specify
B. Readiness for Enhanced Capability for:

1. Healthy lifestyle – e.g nutrition/diet, exercise/activity
2. Health Maintenance/Health Management
3. Parenting
4. Breastfeeding
5. Spiritual Well – being – process of a client’s developing/unfolding of mystery through
harmonious interconnectedness that comes from inner strength/sacred source/God
6. Others, specify
II. Presence of health threats – conditions that are conducive to disease, accident or failure to
realize one’s health potential. Examples:
A. Family history of hereditary condition/disease, e.g diabetes
B. Threat of cross infection from a communicable disease case
C. Family size beyond what family resources can adequately provide
D. Accident hazards, specify
1. broken stairs
2. pointed/sharp objects, poisons, and medicines improperly kept
3. fire hazards
4. fall hazards
5. others, specify
E. Faulty/unhealthful nutrition/eating habits or feeding techniques/practices, specify
1. inadequate food intake both in quality and quantity
2. excessive intake of certain nutrients
3. faulty eating habits
4. ineffective breastfeeding
5. faulty feeding techniques
F. Stress – provoking factors, specify
1. strained marital relationship
2. strained parent – sibling relationship
3. interpersonal conflicts between family members
4. care – giving burden
G. Poor home/environmental condition/sanitation, specify
1. inadequate living spaces
2. lack of food storage facilities
3. polluted water supply
4. presence of breeding or resting sites of vectors of diseases (e.g. mosquitoes,
roaches, flies, rodents, etc.)
5. improper garbage disposal
6. unsanitary waste disposal
7. improper drainage system
8. poor lighting and ventilation
9. noise pollution
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10. air pollution
H. Unsanitary food handling and preparation
I. Unhealthy lifestyle and personal habits/practices, specify
1. alcohol drinking
2. cigarette/tobacco smoking
3. walking barefooted or inadequate footwear
4. eating raw meat or fish
5. poor personal hygiene
6. self – medication/substance abuse
7. sexual promiscuity
8. engaging in dangerous sports
9. inadequate rest or sleep
10. lack of/inadequate exercise/physical activity
11. lack of/inadequate relaxation activities
12. non – use of self – protection measures (e.g non use of bed nets in malaria and
filariasis endemic areas)
J. Inherent personal characteristics – e.g poor impulse control
K. Health history which may participate/induce the occurrence of a health deficit, e.g previous
history of difficult labor
L. Inappropriate role assumption – e.g., child assuming mother’s role, father not assuming his
role
M. Lack of immunization/inadequate immunization status specially of children
N. Family disunity – e.g.
1. self – oriented behavior of members
2. unresolved conflicts of members
3. intolerable disagreement
O. Others, specify
III. Presence of health deficits – instances of failure in health maintenance. Examples include:
A. Illness states, regardless of whether it is diagnosed or undiagnosed by medical practitioner
B. Failure to thrive/develop according to normal rate
C. Disability – whether congenital or arising from illness; transient/temporary (e.g. aphasia or
temporary paralysis after a CVA) or permanent (e.g. leg amputation secondary to diabetes,
blindness from measles lameness from polio)
IV. Presence of stress points/foreseeable crisis situation – anticipated periods of unusual demand
on the individual or family in terms of adjustment/family resources. Examples include:
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Addition member – e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of job
K. Hospitalization of a family member
L. Death of a member
M. Resettlement in a new community
N. Illegitimacy
O. Others, specify
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SECOND LEVEL ASSESSMENT
I. Inability to recognize the presence of the condition or problem due to:

A. Lack of or inadequate knowledge
B. Denial about its existence or severity as a result of fear of consequences of diagnosis of
problem, specifically:
1. social stigma, loss of respect of peer/significant others
2. economic/cost implications
3. physical consequences
4. emotional/psychological issues/concerns
C. Attitude/philosophy in life which hinders recognition/acceptance of a problem
D. Others, specify
II. Inability to make decisions with respect to taking appropriate health action due to:
A. Failure to comprehend the nature/magnitude of the problem/condition
B. Low salience of the problem/condition
C. Feeling of confusion, helplessness and/or resignation brought about by perceived
magnitude/severity of the situation or problem, i.e. failure to break down problems into
manageable units of attack
D. Lack of/inadequate knowledge/insight as to alternative courses of action open to them.
E. Inability to decide which action to take from among a list of alternatives.
F. Conflicting opinions among family members/significant others regarding action to take.
G. Lack of/inadequate knowledge of community resources for care.
H. Fear of consequences of action, specifically:
1. social consequences
2. economic consequences
3. physical consequences
4. emotional/psychological consequences
I. Negative attitude towards the health condition of problem –by negative attitude is meant
one that interferes with rational decision making.
J. Inaccessibility of appropriate resources of care, specifically:
1. physical inaccessibility
2. cost constraints of economic/financial inaccessibility
K. Lack of trust/confidence in the health personnel/agency

L. Misconceptions or erroneous information about proposed course(s) of action.
M. Others, specify
III. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at-risk
member of the family due to:
A. Lack of/inadequate knowledge about the disease/health condition (nature, severity,
complications, prognosis and management).
B. Lack of/inadequate knowledge about child development and care
C. Lack of/inadequate knowledge of the nature and extent nursing care needed
D. Lack of the necessary facilities, equipment and supplies for care
E. Lack of or inadequate knowledge and skill in carrying out the necessary
interventions/treatment/procedure/care (e.g., complex therapeutic regimen of healthy
lifestyle program)
F. Inadequate family resources for care, specially:
1. absence of responsible member
2. financial constraints
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3. limitations/lack of physical resources – e.g., isolation room
G. Significant person’s unexpressed feelings (e.g., hostility/anger, guilt, ear/anxiety, despair,
rejection) which disable his/her capacities to provide care.
H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent,
vulnerable/at-risk member
I. Member’s preoccupation with own concerns/interests
J. Prolonged disease or disability progression which exhausts supportive capacity of family
members
K. Altered role performance – specify:
1) Role denial or ambivalence
2) Role strain
3) Role dissatisfaction
4) Role conflict
5) Role confusion
6) Role overload
L. others, specify
IV. Inability to provide a home environment conductive to health maintenance and personal
development due to:
A. Inadequate family resources, specifically
1. financial constraints/limited financial resources
2. limited physical resources – e.g., lack of space to construct a family
B. Failure to see benefits (specifically long-term ones) of investment in home environment
improvement
C. Lack of/inadequate knowledge of importance of hygiene and sanitation
D. Lack of/inadequate knowledge of preventive measures
E. Lack of skill in carrying out measures to improve home environment
F. Ineffective communication patterns within the family
G. Lack of supportive relationship among family members
H. Negative attitude/philosophy in life which is not conductive to health maintenance and
personal development
I. Lack of/inadequate competencies in relating to each other for mutual growth and
maturation (e.g., reduced ability to meet the physical and psychological needs of other
members as a result of family’s preoccupation with current problem or condition)
J. Others, specify
V. Failure to utilize community resources for health care due to:

A. Lack of/inadequate knowledge of community resources for health care
B. Failure to perceive the benefits of health care/services
C. Lack of trust/confidence in the agency/personnel
D. Previous unpleasant experience with health worker
E. Fear of consequences of action (preventive, diagnostic, therapeutic rehabilitative),
specifically:
1. physical/psychological consequences
2. financial consequences
3. social consequences –e.g., loss of esteem of peer/significant others
F. Unavailability of required care/service
G. Inaccessibility of required care/service due to:
1. cost constraints
2. physical inaccessibility, i.e. location of facility
H. Lack of or inadequate family resources, specifically:
1. manpower resources –e.g., baby sitter
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2. financial resources –e.g., cost of medicine prescribed
I. Feeling of alienation to/lack of support from the community, e.g., stigma due to mental
illness, AIDS, etc.
J. Negative attitude/philosophy in life which hinders effective/maximum utilization of
community resources for health care
K. Others, specify
STATEMENT OF FAMILY NURSING PROBLEM
TWO PARTS:
 Statement of unhealthful response
 Statement of factors which are maintaining the undesirable response and preventing the desired
change
Example
 Inability to make decisions with respect to taking appropriate health action due to lack of
knowledge as to alternative courses of action open to the family
3. C. Family Nursing Care Plan
THE FAMILY CARE PLAN

- Is the blueprint of the care that the nurse designs to systematically minimize or eliminate the
identified health and family nursing problems through explicitly formulated outcomes of care (
goals and objectives) and deliberately chosen of interventions, resources and evaluation criteria,
standards, methods and tools.
DESIRABLE QUALITIES OF A NURSING CARE PLAN
1. It should be based on clear, explicit definition of the problems. A good nursing plan is based on a
comprehensive analysis of the problem situation.
2. A good plan is realistic.
3. The nursing care plan is prepared jointly with the family. The nurse involves the family in
determining health needs and problems, in establishing priorities, in selecting appropriate courses
of action, implementing them and evaluating outcomes.
4. The nursing care plan is most useful in written form.
THE IMPORTANCE OF PLANNING CARE
1. They individualize care to clients.

2. The nursing care plan helps in setting priorities by providing information about the client as well as
the nature of his problems.
3. The nursing care plan promotes systematic communication among those involved in the health care
effort.
4. Continuity of care is facilitated through the use of nursing care plans. Gaps and duplications in the
services provided are minimized, if not totally eliminated.
5. Nursing care plans, facilitate the coordination of care by making known to other members of the
health team what the nurse is doing.
STEPS IN DEVELOPING A FAMILY NURSING CARE PLAN

1. The prioritized condition/s or problems based on:
a. NATURE OF CONDITION/ PROBLEM PRESENTED
- Categorized as wellness state/potential, health threat, health deficit, foreseeable crisis.
b. MODIFIABILITY OF THE CONDITION/PROBLEM
- Probability of success in enhancing the wellness state, improving the condition, minimizing,
alleviating or totally eradicating the problem through intervention.
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c. PREVENTIVE POTENTIAL
- Nature and magnitude of future problems that can be minimized or totally prevented if
intervention is done on the problem under consideration.
d. SALIENCE
- Family’s perception and evaluation of the problem in terms of seriousness and urgency of
attention needed or family readiness
Scoring – this process will help the nurse in determining which among the family problems or needs be
prioritized
1. Decide a score for each of the criteria

2. Divide the score by the highest possible score in that item and multiply by the weight
▪ Score x weight
Highest score
3. Sum up the scores of all criteria. The highest score is 5 which is equivalent to the total weight.
4. The highest score is given the priority, and so on with depending on the next highest score
CRITERIA SCALE WEIGHT

Nature of the problems Presented
Health deficit / Wellness 3 1
Health threat 2
Foreseeable crisis 1
Modifiability of the problem
Easily modifiable 2 2
Partially modifiable 1
Not modifiable 0
Preventive potential
High 3 1
Moderate 2
Low 1
Salience
A condition / problem needing Immediate attention 2 1
A condition / problem not needing Immediate attention 1
Not perceived as a problem or condition needing change 0
Factors affecting priority setting:
The nurse considers the availability of the following factors in determining the modifiability of a health
condition or problem.
1. Current Knowledge, technology and interventions

2. Resources of the family - physical, financial & manpower
3. Resources of the nurse - knowledge, skills and time
4. Resources of the community - facilities and community organization or support
Factors in Deciding Appropriate Score for Preventive Potential

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1. Gravity or severity of the problem - Refers to the progress of the disease/ problem indicating
extent of damage on the patient / family. Also indicates the prognosis, reversibility of the problem
2. Duration of the problem - refers to the length of time the problem has been existing
3. Current Management - refers to the presence and appropriateness of intervention
4. Exposure of any high-risk group
Family Nursing Care Plan

• It is the blueprint of care that the nurse designs to systematically minimize or eliminate the
identified family health problem through explicitly formulated outcomes of care (goal and
objectives) and deliberately chosen set of interventions/resources and evaluation criteria,
standards, methods and tools.
Characteristics of Family Nursing Care Plan

1. It focuses on actions w/c are designed to solve or alleviate & existing problem.
2. It is a product of deliberate systematic process.
3. The FNCP as with other plans relates to the future.
4. It revolves around identified health problems.
5. It is a mean to an end and not a end to itself.
6. It is a continuous process, not one shot deal.
Desirable Qualities of Family Nursing Care Plan

1. It should be based on a clear definition of the problem.
2. A good plan is realistic, meaning it can be implemented w/ reasonable chance of success
3. It should be consistent w/ the goals & philosophy of the health agency.
4. It’s drawn w/ the family.
5. It’s best kept in written form.
Setting/ Formulating Goals & Objectives

• This will set direction of the plan.
• This should be stated in terms of client outcomes whether at the individual, family or community
level.
• The mutual setting of goals w/c is the cornerstone of effective planning consists of:
1. Identifying possible resources.
2. Delineating alternative approaches to meet goals.
3. Selecting specific interventions.
4. Operationalizing the plan - setting of priorities.
Goal
• It is a general statement of the condition or state to be brought about by specific courses of action.
Cardinal Principle in goal-setting

• It must be set jointly with the family. This ensures family commitment to their realization.
• Basic to the establishment of mutually acceptable goal in the family’s recognition and acceptance of
existing health needs and problems.
Barriers to Joint Goal Setting

1. Failure in the part of the family to perceive the existence of the problem.
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Sometimes the family perceives the existence of the problem but does not see it as serious enough to
warrant attention
Characteristics of Goals/ Objectives

1. Specific
2. Measurable
3. Attainable
4. Realistic
5. Time bound
Objective
• Refers to a more specific statement of desired outcome of care.
• They specify the criteria by which the degree of effectiveness of care is to be measured.
Types of Objective
1. Short term or Immediate Objective
• Formulated for problem situation w/c require immediate attention & results can be observed in a
relatively short period of time.
• They are accomplished w/ few HCP-family contacts & relatively less resources.
2. Medium or Intermediate objective
• Objectives w/c is not immediately achieved & is required to attain the long ones.
3. Long Term or Ultimate Objective
• This requires several HCP-family contacts & an investment of more resources.
Plan of Actions/ Interventions

• Its aim is to minimize all the possible reasons for causes of the family’s inability to do certain
tasks.
It is highly dependent on 2 Major Variables:

1. nature of the problem
2. the resources available to solve the problem
Typology of Interventions
1. Supplemental - the HCP is the direct provider of care.
2. Facilitative - HCP removes barriers to needed services.
3. Developmental - improves client’s capacity.
3. D. Implementation
• Actual doing of interventions to solve health problems.
• Determined by mutually agreed goals and objectives
• It can be: direct nursing care, assisting the family to meet health needs and problems and
referrals to proper agencies
Barriers to Implementation
A. Family-related: indecision, apathy
B. Nurse-related: imposing ideas, negative labeling, overlooking family strengths and neglecting
cultural and gender implications
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3. E. Evaluation
• Determination whether goals / objectives are met.
• Determination whether nursing care rendered to the family are effective.
• Determines the resolution of the problem or the need to reassess, and re-plan and re-
implement nursing interventions.
According to Alfaro-LeFevre:
Evaluation is being applied through the steps of the nursing process:
• Assessment – changes in health status.
• Diagnosis – if identified family nursing problems were resolved, improved or controlled.
• Planning – are the interventions appropriate & adequate enough to resolve identified
problems.
• Implementation – determine how the plan was implemented, what factors aid in the success
and determine barriers to the care.
Types of Evaluation:
• Ongoing Evaluation – analysis during the implementation of the activity, its relevance, efficiency
and effectiveness.
• Terminal Evaluation – undertaken 6-12 months after the care was completed.
• Ex-post Evaluation – undertaken years after the care was provided
Steps in Evaluation:
1. Decide what to evaluate.
• Determine relevance, progress, effectiveness, impact and efficiency
2. Design the evaluation plan
• Quantitative – a quantifiable means of evaluation which can be done through numerical
counting of the evaluation source.
• Qualitative – descriptive transcription of the outcome conducted through interview to
acquire an in-depth understanding of the outcome.
3. Collect Relevant Data that will support the outcome
4. Analyze Data - What does the data mean?
5. Make Decisions
• If interventions are effective, interventions done can be applied to other client / group with
the similar circumstances
• If ineffective, give recommendations
6. Report / Give Feedbacks
Dimensions of Evaluation
1. Effectiveness – focused on the attainment of the objectives.
2. Efficiency – related to cost whether in terms on money, effort or materials.
3. Appropriateness – refer its ability to solve or correct the existing problem, a question which
involves professional judgment.
4. Adequacy – pertains to its comprehensiveness.
Tools Being used during Evaluation

Instruments are tools are being used to evaluate the outcome of the nursing interventions:
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• Thermometer
• Tape measure
• Ruler
• BP apparatus
• Weighing scale
• Checklist
• Key Guide Questionnaires
• Return Demonstrations
Methods of Evaluation
1. Direct observation
2. Records review
3. Review of questionnaire
4. Simulation exercises
The goals and objectives of nursing care.

FORMULATE:
EXPECTED OUTCOMES
- Conditions to be observed to show problem is prevented, controlled, resolved or eliminated.
- Client response/s or behavior
- Specific, Measurable, Client-centered Statements/Competencies
GOAL
- general statement of the condition; state to be brought about by specific courses of action
- E.g. after nursing intervention, the family will be able to take care of the disabled child
competently
Cardinal Principle in goal-setting:

- Goals must be set jointly with the family
Barriers to nurse - patient joint goal setting:
- Failure on the part of the family to perceive existence of the problem
- The family may realize the existence of a health condition or problem but too busy at the moment
with other concerns and preoccupations
- Family perceives the existence of problem but does not see it as serious to warrant attention
- Family may perceive the presence of the problem and the need to take action
- Failure to develop working relationship
Reasons:
- Fear of consequence
- Respect for tradition
- Failure to perceive the benefits of action proposed
- Failure to relate the proposed action to the family’s goals
OBJECTIVES
- Best stated in terms of client outcomes
- Refer more specific statements of the desired results or outcomes of care
Categories of Objectives:
 LONG TERM/ULTIMATE – require several nurse – family encounters and an investment of more
resources
 SHORT TERM / IMMEDIATE – require immediate attention and results can be observed in a
relatively short period of time
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 MEDIUM TERM / INTERMEDIATE – not immediately achieved and are required to attain long – term
ones
2. The plan of interventions.

➢Decide on:
• Measures to help family eliminate:
✓ Barriers to performance of health tasks
✓ Underlying cause/s of non-performance of health tasks
• Family-centered alternatives to recognize/detect, monitor, control or manage health
condition or problems
• Determine Methods of Nurse-Family Contact
• Specify Resources Needed
3. The plan for evaluating.
• Criteria/Outcomes Based on Objectives of Care
• Methods/Tools
Categories of health care strategies and intervention

1. Preventive
2. Curative
3. Rehabilitative
4. Facilitative
5. Facilitation
6. Direct
FAMILY-NURSE CONTACTS
CLINIC VISIT
Pre-Consultation Conference
1. Take clinical history after greeting and making client at ease.
2. Take temperature, blood pressure, height and weight.
3. Perform a thorough physical assessment.
4. Do selective laboratory examinations such as urinalysis for sugar and albumin as necessary, sputum
exam, stool examination for parasites, vaginal smear for SID screening after taking the necessary training.
5. Write findings on client's record.
Medical Examination
1. Assist client before, during and after examination by physician.
2. Inform physician of relevant findings gathered in pre-conference.
3. Work with the physician during the examination.
4. Ensure privacy, safety and comfort of patient throughout procedure.
5. Observe confidentiality of examination results.
Nursing Intervention
1. Carry out physician's orders as giving medication or injection.
2. Explain and reinforce physician's orders and advises.
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3. Teach patient/client measures designed to promote and maintain health as proper diet, exercise and
personal hygiene.
4. Seek information regarding health status of other family members.
Example: immunization status of children, health and problems of elderly if any, health of husband.
4. Counseling
Post Consultation Conference

1. Explain findings and needed care or intervention.
2. Refer patient/client to other health of related staff/agency if necessary.
3. Make appointment for next clinic/home visit.
4. Referral as needed.
New: Standard procedures performed during clinic visits
1. registration/Admission
2. waiting time (1st come, 1st serve except for emergency)
3. triaging
a. manage program-based cases
b. refer all non-program based cases to the physician
c. provide 1st aid treatment to emergency cases
4. clinical evaluation
5. lab/ diagnostic exam
6. referral system
7. prescription/dispensing: give proper instructions on drug intake
8. health education
Blood Pressure Measurement

1. Preparatory: 5min rested, no cigar nor caffeine within 30 min prior to BP taking
2. Applying BP cuff & steth: 2-3 cm above brachial artery
3. Obtaining BP: use bell (diaphragm for obese); column reaches 30 mmHg above palpated BP;
deflate at 2-3mm Hg/beat; [pulse sound (korotkoff sounds): 1st clear sound as korotkoff phase I,
softening/muffling sound as korotkoff phase IV, disappearance of sound as Korotkoff phase V)
4. Recording BP: mean of 2 reading 2 min apart, if 5 min difference, do 3 rd reading
Home Visit
- is a professional face to face contact made by a nurse to the client or the family to provide
necessary health care activities and to further attain an objective of e agency. It is made to the
client or to a responsible member of the family.
Principles in Preparing for Home Visit

Planning for a home visit is an essential tool in achieving best results.
1. A home visit should have a purpose or objective.
2. Planning for a home visit should make use of all available information about the patient and his/her
family through family health records; knowledge of the health center personnel, including those from other
agencies that may have rendered services to this particular patient or family.
3. Planning should revolve around the essential needs of the individual and his/her family but priority
should be given to those needs recognized by the family itself.
4. Planning of a continuing care should involve the individual and his/her family.
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5. Planning should be flexible and practical.
Factors to be Consider in Determining the Frequency of Home Visit

▪ Acceptance of the family for the services offered; the willingness and interest to cooperate.
▪ Physical, psychological and educational needs of individual/ family.
▪ Take into account other health agencies and the number of health personnel already involved in the
care of a specific family
▪ Policy of a given agency and the emphasis placed on a given health program.
▪ Careful evaluation of past services given to a family and how this family made use of such nursing
services.
▪ Ability of the patient and his/her family to recognize their own needs, their knowledge of available
resources and their abilities to use these resources on their own accord.
Advantages Disadvantages
First hand assessment of the home situation Cost of time and effort
Nurse is able to seek out previously unidentified Environmental distractions
needs Nurse’s safety may be a concern
Opportunity to adapt interventions according to
family resources
Promotes family participation
Focused on the family
Easier family health education
Increased sense of confidence to the family and to
the agency
Phases of Home Visit

Home visit is consisting of three phases: pre-visit, in-home visit, and post-visit phases.
A. Pre-visit phase
Activities:
- Nurse contacts the family for home visit
- Determines willingness for visit
- Appointment-setting
- Planning phase
Principles:
- The home visit should have a purpose.
- Use information about the family collected from all possible sources. This is to analyze the family’s
situation.
- Focused on identified family needs, particularly needs recognized by the family.
- The family or the client should actively participate in the plan and implementation of care.
- Plan should be practical and adaptable.
Before leaving the health facility:
- The nurse must ensure the completeness of materials or resources he/she needs.
- The nurse must comply to safety protocols.
- Buddy system and a spot map is suggested.
B. In-home visit phase

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- Begins as the nurse seeks permission to enter the house and lasts until he/she leaves.
Activities:
B.1. Initiation:
- Knock or ring the doorbell while introducing self to the family.
- Acknowledge the family members
- Introduce self and the agency represented
- Observe the environment
- Establish rapport
B.2. Implementation:
- Assessment can be done. Depending on the type of assessment: physical examination, interview
and/or simple diagnostic procedures. Family Assessment form is suggested to facilitate the
assessment (Appendix A)
- Direct nursing care as needed. Direct and/or basic nursing care, health teachings and counselling
may be implemented. Interventions beyond the nurse’s capability or due to limited resources may
be referred.
- Observation and evaluation of health practices and family dynamics
B.3. Termination:
- Summarizing what transpired within the visit
- Setting a subsequent home visit
- Record findings
C. Post-visit phase
- Takes place when the nurse already returned to the health facility
- Documentation of the visit
- Referrals can be made
- Planning for the next visit
Steps in Home Visit

1. Greet client or household member and introduce yourself.
2. Explain purpose of home visit.
3. Inquire about health and welfare of client/patient and other family members. Ask about any
health and health-related problems.
4. Place bag in a convenient place before doing bag technique.
5. Wash hands and wear apron and put out needed articles and/or medicines, dressings from bag
6. Perform physical assessment and nursing care needed. If more than one member of the family is for
health supervision and care, start with the well member to avoid transfer of infection.
7. Give the necessary health teaching and advice based on client's patient's need and condition.
8. Wash hands and close bag.
9. Record findings and nursing care given.
10. Make appointment either for a clinic or home visit.
11. On succeeding home visit and when nurse has gained the family's trust and confidence, she/he may
look into more detailed aspects of the household and surroundings and other health problems/concerns.
34
The Nursing Bag
- Also called PHN bag, is a tool used by the nurse during home and community visits to provide care
efficiently and safely.
- Handwashing always a must
- It supports the idea that the nurse must be prepared for different situations while in the community
or in a visit.
Bag Technique
Bag technique - a tool making use of a public health bag through which the nurse, during his/her home
visit, can perform nursing procedures with ease and deftness, saving time and effort with the end in view
of rendering effective nursing care.
Public health bag - is an essential and indispensable equipment of the public health nurse which he/she
has to carry along when he/she goes out home visiting. It contains basic medications and articles which
arc necessary for giving care.
Rationale: To render effective nursing care to clients and/or members of the family during home visit.
Principles in the use of bag technique

1. should minimize if not totally prevent the spread of infection from individuals to families, hence, to
the community.
2. should save time and effort on the part of the nurse in the performance of nursing procedures.
3. should not overshadow concern for the patient rather should show the effectiveness of total care
given to an individual or family.
4. can be performed in a variety of ways depending upon agency policies, actual home situation, etc., as
long as principles of avoiding transfer of infection is carried out.
Special Considerations in the Use of the Bag

1. contain all necessary articles, supplies and equipment used to answer emergency needs.
2. be cleaned as often as possible, supplies replaced and ready for use at any time.
3. well protected from contact with any article in the home of the patients. Consider the bag and its
contents clean and/or sterile while any article belonging to the patient as dirty and
contaminated.
4. arrangement of the contents of the bag should be the one most convenient to the user to facilitate
efficiency and avoid confusion.
5. Hand washing is done as frequently as the situation calls for
6. bag when used for a communicable case should be thoroughly cleaned and disinfected before keeping
and re-using.
Contents of the bag

1. Paper lining 7. Thermometers in case [one oral and rectal]
2. Extra paper for making bag for waste 8. 2 pairs of scissors [1 surgical and 1 bandage]
materials (paper bag). 9. 2 pairs of forceps [curved and straight]
3. Plastic/linen lining 10. Syringes [5 ml and 2ml]
4. Apron 11. Hypodermic needles g19,22,23,25
5. Hand towel in plastic bag 12. Sterile dressings [OS, C.B]
6. Soap in soap dish 13. Sterile Cord Tie
35
14. Adhesive Plaster 18. Baby's scale
15. Dressing [OS, cotton ball] 19. 1 pair of rubber gloves
16. Alcohollamp 20. 2 test tubes
17. Tape measure 21. Test tube holder
22. Medicines:
a. Betadine e. hydrogen peroxide
b. 70% alcohol f. spirit of ammonia
c. ophthalmic ointment (antibiotic) g. acetic acid
d. zephiran solution h. benedict's solution
Note: Blood Pressure Apparatus and Stethoscope are carried separately.
TEACHER’S INSIGHTS:
Community health nurses do not only work with individuals, but work hand in hand at least with
a family. Dealing with families is likewise challenging due to its nature, dynamics and traditions
within and in the community, they live in. The family remains to be the basic unit of a society
and also the unit of care. With this reason, the health status of the families will also dictate the
health status of the community. Caring for a family also cares for the community. This section
of the learning material provided the different accepts and tools for the application of the
nursing care process on the family level.
Community health nurses provides nursing care to individual and family which the result will be
the health of the community and the larger society.
SELF-REFLECTION:
Put yourself in the situation of a community health nurse assigned to families in a slum area or
far-flung areas, how will you help the families to attain
CHAPTER 1 ACTIVITIES:
CASE ANALYSIS
Application of the family nursing process:
SCENARIO:
Jennifer Reyes is a public health nurse at the Rural Health Unit of Bagumbayan. She met 28-
year-old Pinky Dela Cruz, married, 6 months pregnant with her first child, in a Garantisadong
Pambata (outreach health services) visit at an ambulatory clinic in the barangay where the Dela
Cruz family was residing.
Jennifer found out that Pinky never had a prenatal consultation. She also noted that Pinky was
underweight, with a weight of only 48kg and a height of 155 cm. when Jenny asked her where
she plans to deliver her baby, she replied that she woulf probably have a home delivery under
the care of the local “hilot” because professional attendance would be too expensive for them.
Pinky explained that she came to the ambulatory clinic upon the prodding of her husband who
heard about the health worker’s visit to the barangay. To assess the Dela Cruz’s home situation
and to teach Pinky health practices related to her pregnancy, Jennifer asked Pinky if she could
make a home visit. Seemingly pleased with Jennifer’s attention, Pinky agreed with Jennifer on a
home visit schedule, stating that she wanted to learn more from Jennifer to prevent problems
with her pregnancy and delivery.
when Jennifer made the home visit, she noted that Rina lived with her 32-year-old husband
Ryan, who has work at the time of the visit. He was the sole breadwinner of his family – a
36
construction worker earning the daily minimum wage. Pinky described her husband as
hardworking. They lived in a rented shack of mixed materials with a bedroom, a bathroom and
toilet, and a small multipurpose room (living, dining room and kitchen). Pinky’s activities
consisted mainly of household chores. Sometimes, Pinky would spend time at the homes of
some friends and relatives in the barangay.
During the interview, Jennifer found out that Pinky had inadequate knowledge about
community health services, prenatal nutrition, preparation for childbirth, and infant care. Pinky
said that she and her friends and relatives sometimes talk about such matter, but the given
information was confusing and conflicting. Aside from palmar pallor and underweight, other
finding during physical examination were normal. When asked about her diet, Pinky told Jenny
that she limited her food intake because she did not want to have a caesarian section, which
may be needed if the baby grew too big.
a. Identify the concerns or issues of Dela Cruz family. Prioritize the problems
b. According to the prioritization you have, construct a family nursing care plan (based on the
template on Appendix A) that bears the health problem, diagnosis, planning (goal and
objectives), interventions and evaluations. This will be considered a working family nursing care
plan
REFERENCES:
Famorca (2013). Nursing Care of the Community: A Comprehensive Text on Community

and Public Health 1st edition
Rector (2018). Community & Public Health Nursing: Promoting the Public’s Health 9 th
edition
Gesmundo (2010). The Basics of Community Health Nursing
Maglaya, A. (2004). Nursing Practice in the Community, 4th edition
37
MIDTERM COVERAGE
Specific Instructions in the completion of each chapter:

hours.
teacher.
CHAPTER 2
CONCEPT OF PUBLIC HEALTH AND COMMUNITY HEALTH NURSING

1. Define public health, its principles and concepts.
2. Trace the history of public health nursing in the Philippines.
3. Identify the core functions of public health.
4. Define community health nursing.
5. Demonstrate the basic roles and functions of a public health nurse.
6. Comprehend the definition and philosophy of community health nursing.
7. Distinguish the different specialized fileds in community and public health nursing.
8. Compare the different fields in nursing.
9. Lists the different roles and responsibilities of a specialized community health nurse.
KEY TERMS:
clinician health promotion
community mental health nursing
community health occupational health nursing
community health nursing public health
disease prevention public health nursing
health educator school nursing
38
LESSON 1: CONCEPT OF PUBLIC HEALTH
PUBLIC HEALTH
- science and art of preventing disease, prolonging life, promoting health and efficiency
through organized community effort for the sanitation of the environment, control of
communicable diseases, the education of individuals in personal hygiene, the
organization of medical and nursing services for the early diagnosis and preventive
treatment of disease, and the development of social machinery to ensure everyone a
standard of living adequate for the maintenance of health, so organizing these benefits
as to enable every citizen to realize his birthright of health and longevity.
▪ Dr. C.E. Winslow
- art of applying science in the context of politics so as to reduce inadequalities in health
while ensuring the best health for the greatest number
▪ WHO
PUBLIC HEALTH NURSING

- special field of nursing that combines the skills of nursing, public health and some
phases of social assistance and functions as part of the total public health program for
the promotion of health, the improvement of the conditions in the social and physical
environment, rehabilitation of illness and disability
- nursing practice in the public sector
CORE FUNCTIONS OF PUBLIC HEALTH

1. Disease control
2. Injury prevention
3. Health protection
4. Healthy public policy
5. Promotion of health and equitable health gain
PUBLIC HEALTH NURSE

- nurses in the local/national health departments or public schools whether their official
position title is PHN or nurse or school nurse
Roles and Functions of the Public Health Nurse

- health promotion and education function; training function; research function
▪ Clinician - health care provider, taking care of the sick people at home or in the RHU
▪ Health Educator - aims towards health promotion and illness prevention through
dissemination of correct information; educating people
▪ Facilitator - establishes multi-sectoral linkages by referral system
▪ Supervisor- monitors and supervises the performance of midwives
*In the event that the Municipal Health Officer (MHO) is unable to perform his duties/functions
or is not available, the Public Health Nurse will take charge of the MHO’s responsibilities.
39
Other Specific Responsibilities of a Nurse, spelled by the implementing Rules and Regulations of
RA 7164 (Philippine `Nursing Act of 1991) includes:
• Supervision and care of women during pregnancy, labor and puerperium
• Performance of internal examination and delivery of babies
• Suturing lacerations in the absence of a physician
• Provision of first aid measures and emergency care
• Recommending herbal and symptomatic meds…etc.
➢ In the care of the families:
• Provision of primary health care services
• Developmental/Utilization of family nursing care plan in the provision of
• care
➢ In the care of the communities:
• Community organizing mobilization, community development and people empowerment
• Case finding and epidemiological investigation
• Program planning, implementation and evaluation
• Influencing executive and legislative individuals or bodies concerning health and
development
LESSON 2: CONCEPT OF COMMUNITY HEALTH NURSING
COMMUNITY
- a group of people with common characteristics or interests living together within a territory or
geographical boundary
- place where people under usual conditions are found
COMMUNITY HEALTH
- part of paramedical and medical intervention/approach which is concerned on the health of
the whole population
- aims:
1. health promotion
2. disease prevention
3. management of factors affecting health
NURSING
- assisting sick individuals to become healthy and healthy individuals achieve optimum wellness
COMMUNITY HEALTH NURSING

-“The utilization of the nursing process in the different levels of clientele-individuals, families,
population groups and communities, concerned with the promotion of health, prevention of
disease and disability and rehabilitation.”
- Maglaya, et al
GOAL
“To raise the level of citizenry by helping communities and families to cope with the
discontinuities in and threats to health in such a way as to maximize their potential for high-
level wellness”
- Nisce, et al
40
OBJECTIVES:
1. To participate in development of an over-all health plan for the community
2. To provide quality nursing services
3. To coordinate nursing services with various membranes of the health team
4. To participate in and/or conduct researches relevant
5. To provide community health nursing personnel for continuing education and
professional growth
BASIC PRINCIPLES OF CHN

1. The community- the patient in CHN
the family is the unit of care and there
four levels of clientele: individual, family, population group (those who share common
characteristics, developmental stages and common exposure to health problems – e.g.
children, elderly), and the community.
2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care
3. CHN practice is affected by developments in health technology, in particular, changes in
society, in general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is a part of health care system and the larger human services system.
6. Based on the needs of the clients
7. CHN must be available to all
8. Health teaching is a primary responsibility
9. Use available community health resources
CONCEPTS
1. The focus is on health promotion
2. Contact with client may continue over long period of time
3. The dynamic nursing care process is implicit in the practice of CHN
4. To benefit the whole family, not only the individual
5. CHNurses are generalists
ROLES AND RESPONSIBILITIES OF COMMUNITY HEALTH NURSE
1. Planner/ Programmer- identifies needs, priorities & problems if individual, family, &
comm.
- Formulates nursing component of health plans
- In doctorless areas, she is responsible for the formulation of the municipal health
plan
- Provides technical assistance to rural health midwives in health matters like target
setting.
2. Provider of nursing care- provides direct nsg care to the sick, disabled in the homes,
clinics, schools, or places of work
- provide continuity of patient care
3. Manager/ Supervisor- formulates care plan for the 4 Clientele:
a. Requisitions, allocates, distributes materials (meds & medical supplies & records &
reports equips
b. Interprets and implements programs, policies, memoranda, & circulars
41
c. Conducts regular supervisory visits & meetings to diff RHMs & gives feedbacks on
accomplishments
4. Community Organizer- motivates & enhance community participation in terms of

planning, org, implementing and evaluating health programs/ services.
5. Coordinator of Health Services- coordination with other health team & other gov’t org
(GOs & NGOs) to other health programs as environment, sanitation health education, dental
health & mental health.
Other related functions:

1. Trainer/ Health educator/ counselor- conducts training for rural health midwives (RHMs),
barangay health workers (BHWs), hilots who aim towards H promo & illness prevention
through dissemination of correct information;
- educating people
2. Researcher- coordinates with government and non-government organizations NGOs in
the implementation of studies/researches
- participates in the conduct of surveys studies & researches on nursing and health
related subjects.
3. Health Monitor-evaluating what deviates from normal
4. Manager/supervisor – supervises team and subordinates such as public health midwives
5. Change Agent
6. Client Advocate
RESPONSIBILITIES OF COMMUNITY HEALTH NURSE

1. Be a part in delivering an overall health plan; its implementation & evaluation for comm.
2. Provide quality nursing services to 4 levels of clientele
3. Maintain coordination/ linkages of nsg service with other health team members NGO/GO
in the provision of PH services- multisectoral app
4. Conduct research relevant to CHN services to improve provision of health service-
research—to improve HC
5. Provide opportunities for professional growth and continuing education for staff
development
LESSON 3: HISTORICAL BACKGROUND OF COMMUNITY HEALTH NURSING
The following events, laws and activities make up the history of CHN in the Philippines:
Note: The student may read other references as others may present different timelines and
events of the history of CHN in the Philippines
1901 Act # 157 of the Philippine Commission created a Board of Health of the Philippines
Subsequently, Act # 309 created Provincial and Municipal Boards of Health
1905 Act # 1407 (Reorganization Act) abolished the Board of Health and its activities
were taken over by the Bureau of Health under the Department of the Interior.
1912 • The Philippine General Hospital, then under the Bureau of Health, sent 4 nurses
to Cebu to take care of mothers and their babies.
42
• The St. Paul’s Hospital School of Nursing in Intramuros, also assigned 2 nurses to
do home visiting in Manila and gave nursing care to mothers and newborns from
the outpatient obstetrical service of the PGH.
1914 School Nursing was rendered by a Filipino nurse employed by the Bureau of Health
1915 The Bureau of Health was renamed Philippine Health Service with a Director of
Health as its head.
• In the same year, Reorganization Act # 2462 created the Office of General
Inspection under which the Office of District Nursing was organized.
• The Office was created due to increasing demands of nurses to work outside the
hospital, in the homes, and the need for direction, supervision, and guidance of
public health nurses.
1916- Ms. Perlita Clark took charge of the public health nursing work
1918
1919 The first Filipino nurse supervisor under the Bureau of Health, Ms. Carmen del
Rosario was appointed. She had a staff of 84 public health nurses assigned in 5
health stations
1923 Establishment of 6 government Schools of Nursing:
• Zamboanga General Hospital School of Nursing, Mindanao
• Baguio General Hospital, Northern Luzon
• Quezon Province, Southern Luzon
• Cebu, Bohol, and Leyte – Visayas
These schools were primarily intended to train non-Christian women and prepare
them to render service among their people.
1927 Office of District Nursing under the Office of General Inspection, Philippine Health
Service was abolished and supplanted by the Section of Public Health Nursing
1930 Section of Public Health Nursing was converted into Section of Nursing due to
pressing need for guidance not only in public nursing services, but also in hospital
nursing and nursing education
Dec At the outbreak of WWII, public health nurses in Manila were assigned to
8,1941 devastated areas to attend to the sick and the wounded.
June A group of public health nurses with physicians went to the internment camp in
1942 Capas, Tarlac to receive sick POWs released by the Japanese army.
July Many public health nurses joined the guerillas or went to hide in the mountains
1942 during WWII
Oct 7, E.O. #94 reorganized government offices and created the Division of Nursing
1947 under the Office of the Secretary of Health
• The Nursing Division was placed directly under the Secretary of Health so that
nursing services can be availed of by the different Bureau and units to help carry
out their health programs.
1953 Philippine Congress approved R.A. # 1082 or the Rural Health Law
• Each unit had a physician, a public health nurse, a midwife, a sanitary inspector,
and a clerk driver
43
1957 Approval of R.A. 1891 or the Second Rural Health Act created 8 categories of rural
health units based on population.
• This resulted in additional number of positions for health workers including public
health nurses and midwives.
1958- The Department of Health National League of Nurse, Inc., was founded
1965
1967 Mrs. Zenaida Panlilio-Nisce was appointed as Nursing Program Supervisor and
served as consultant on the nursing aspects of the 6 special diseases/condition :
TB, leprosy, VD, cancer, Filariasis, and Mental Health
• She was involved in program of planning, monitoring, evaluation, and research.
1976- The Nursing Consultant and Nursing Program graduates to serve for 2 months in
1986 the rural areas of the country before their license were issued by the PRC.
1987 - E.O. #119 reorganized the DOH and created several offices and services within the
1989 department.
1990- The number of positions of Nursing Program Supervisors (Nurse VI) were increased
1992 as there were 3 or more appointed in each service: Maternal and Child Health
Service, Expanded Program on Immunization, Control of Diarrheal Diseases, and
Control of Acute Respiratory Infections.
1990- The Local Government Code of 1991 (RA#7160) was passed into law.
1992 • This resulted in devolution, which transferred the power and authority from the
National Government to the Local Government Units (LGUs).
• It was aimed to build their capabilities for self-government and develop them as
self-reliant communities.
May EO#102 was signed. Most of the nursing positions of the Central Office were
24,1999 either transferred or devolved to other offices and services.
LESSON 4: SPECIALIZED FIELD IN COMMUNITY AND PUBLIC HEALTH NURSING
1. SCHOOL HEALTH NURSING

• Type of PHN that focuses on the promotion of health and wellness OF THE
pupils/students, teaching and non-teaching personnel of the schools.
▪ OBJECTIVES:
o GENERAL: to promote and maintain the health of the school populace by
providing comprehensive and quality nursing care
o SPECIFIC:
1. Provide quality nursing service to the school population
2. Create awareness on the importance of promotive and preventive aspects of
health through health education
3. Encourage the provision of standard functional facilities
44
4. Provide nursing personnel with opportunities for continuing education and
training
5. Conduct and participate in researches related to nursing care
6. Establish/strengthen linkages with government and NGO for school
community health work
▪ DUTIES AND RESPONSIBILITIES OF THE SCHOOL NURSE

1. Health advocacy
2. Health and nutrition assessment including other screening procedures
3. Supervision of the health and safety of the school
4. Treatment of the common ailments and attending to emergency cases
5. Referrals and follow-up of pupils and personnel
6. Home visits
7. Community outreach
8. Recording and reporting of accomplishments
9. Monitoring and evaluation of accomplishments
▪ FUNCTIONS OF SCHOOL NURSE

1. SCHOOL HEALTH AND NUTRITION SURVEY
- Provide data for evaluation and planning purposes
- Current health and nutritional status, situation on facilities, health education,
survey
2. FUNCTIONAL SCHOOL CLINIC

- RA 124 -> mandates creation of such
3. HEALTH ASSESSMENT
- Aims to discover the signs of illness and physical defects
- Thorough examination; give also advice on problems of the pupils/personnel
o Health assessment includes:

- Interviewing for information gathering
- Nutritional assessment (ht and wt)
- Vision acuity/hearing test
- Methods of physical examination
- Vital signs
- Appraisal of physical and mental condition
- Recording of findings
o Preparation
- Well-lighted, ventilated screened room or corner of room
- Chairs, wastebasket, handwashing facilities, tongue depressor, penlight,
stethoscope and sphygmomanometer, forms and records
o Frequency
- Once a year
o Procedure
45
- Conduct classroom health lecture and inform the pupils on what to do
- 3-5 students should be waiting
- Assess one by one
- Cephalocaudal -> cleanliness, skin conditions and abnormalities
- Steth -> heart and lung assessment
- Record findings
o Steps:
a. Arms, hand, nails: roll sleeves, extend arms, show hands and fingers
b. Eyes: put down lower lid and look up
c. Nose: place 2nd finger on the tip of the nose and pull up his nose and
extend his head backward
d. Teeth: open mouth, inspect also for the throat
e. Ears: push back hair behind ear and pull outer ear up (down and back)
f. Neck and chest: inspect neck; chest and back auscultate
g. Hair: run fingers on hair; inspect nape
h. Feet and legs; inspect
i. General appearance: observe
IMPORTANT REMINDERS:
a. If the personnel is opposite sex, it must be done with the
presence of a personnel preferably with the same sex
b. Treat cases needing treatment
c. Refer cases
d. Inform parents
4. STANDARD VISION TESTING

- Very important sensory skill that affects learning and general development
- Early detection-> childhood blindness and visual disorder
- 20/20 vision-> visual task clearly and comfortably
- Screen students with poor acuity and ocular problems
- Refer diseases and refraction errors
o IMPORTANT
a. School physician should validate
b. Refer visual problems to specialists
c. Parents should be informed
5. EAR EXAMINATION
- Early recognition is very important: achievement, learning process, clear speech
and social skills
- Effective treatment and rehabilitation
- Helps preserve hearing and stimulates language and speech development and
socialization
- Early detection of hearing difficulties
- Tests, observation, examination
6. HEIGHT AND WEIGHT MEASUREMENT/NUTRITIONAL STATUS
46
- Evaluating the tallness and shortness and heaviness
- Most acceptable and simplest way the nutritional status
- Ht for age, wt for age, BMI
- Deworming, feeding program
7. MEDICAL REFERRAL
- For further assessment, management of proper professional/agency
8. ATTENDANCE TO EMERGENCY CASES

- Attend emergency case while in school
- Parents must be informed
9. STUDENT HEALTH COUNSELLING

- Counseling and referral
10. HEALTH AND NUTRITION EDUCATIONACTIVITIES

- Health-related topics on formal and informal settings
- Enhance QOL by:
a. Plans/conducts trainings, programs, conferences
b. Acts as resource person
c. Information dissemination
11. COMMUNICABLE DISEASE PERSONNEL

- Responsibility shared by school, parents, community and DOH
- Refer and send home students until clear
- Vaccination, early detection, parental notification, referrals
12. DATA BANK

- Accurate and up-to-date health records
- For monitoring and evaluation
13. RAPID CLASSROOM INVESTGATION
▪ LEGAL BASES
a. PD 603
- The child is one of the most important assets of the nation. Every effort should
be enacted to promote his welfare and enhance his opportunities for a useful
happy life
b. Article II – Promotion of health

- It should be the responsibility of the health, welfare and education entities to
assists the parents in looking after the child
c. Article III – Rights of the Child

- Every child has the right to balanced diet, adequate clothing, sufficient shelter,
proper medical attention, and the basic physical requirements of a healthy and vigorous
life
47
2. OCCUPATIONAL HEALTH NURSING
▪ Health of people in workplace
▪ Assess the health needs of working population and design healthy working environment
FUNCTIONS OF PHN AS OCCUPATIONAL HEALTH NURSE

1. Lead team in sanitary and industrial hygiene of all industrial establishments
- Compliance with the sanitation code and IRR
2. Recommend to local health authority the issuance of license/permits, suspensions and
revocations
3. Coordinates with other government agencies
4. Attends to complaints of all establishments related to hygiene
5. Participates to provide, install and maintains in good condition all control facilities and
protective barriers for potential and actual hazards
6. Informs all affected workers regarding the nature of hazards and the reasons for the
control measures and protective equipment
7. Makes a periodic testing for physical examination of the workers and other health
examinations related to worker’s exposure to potential or actual hazards in workplace
8. Provides control measures to reduce noise, dust, health and other hazards
9. Ensure strict compliance on the regular use and proper maintenance of PPE
10. Provide employees/workers an occupational health services and facilities
11. Refers or elevates to higher authority all unsolved issues in relation to occupational and
environmental health problems
12. Prepares and submits yearly reports
THE PRIMARY FOCUS

▪ To assure so far as possible every working man and woman in the country is safe and
healthful working conditions
A. Occupational health and safety should be considered an integral part of all health
services
B. Occupational environment is complex and multi-dimensional. It requires an as
appreciation of the social, cultural political and economic context of work
C. Occupational health and safety affect not only the worker, but also the worker’s
family, SO and community
D. It is a population-based practice
PROFESSIONAL GOALS
A. Central mission is to promote and maintain the health and safety of workers through
systematic process of APIE
B. Occupational physicians focus on prevention, detection and treatment of work-
related diseases and injuries
C. Industrial hygienist recognizes, evaluate and control toxic exposures and hazards in
the work environment
48
D. Safety engineers and other safety professionals focus in the prevention of
occupational injuries and the maintenance or creation of safe workplaces and safe
work practices
E. Other professionals:
a. Epidemiologists – study occupational diseases and injuries
b. Toxicologists – study toxic properties of agents
c. Industrial engineers – design tools, equipments and machines
d. Ergonomists – study, design, and promote healthy interface
e. Health educators – promote healthy lifestyle and work practices
THE PRACTICE
A. Nurses focus on “promotion, protection and restoration of workers’ health within
the context of a safe and healthy work environment
B. Autonomy and independent nursing judgments characterize the practice of OHN
C. It is research-based and multidisciplinary
D. Occupational health nurses are advocates and encourage informed decisions
about health
E. Key to coordination to of holistic approach to the delivery of quality,
comprehensive occupational health services
F. Occupational health nurses are professionally accountable to workers and other
matters
3. MENTAL HEALTH NURSING
- A unique process which includes an integration of concepts from nursing, mental health,
social psychology, psychology, community networks & the basic sciences.
FOCUS: Mental Health promotion- no need to identify disease, increase mental wellness
of people
Nursing: Strengthening the support mechanism
Psychiatric Nursing- focus: Mental Disease Prevention
Focus: Mental Disease Prevention- identify disease & shorten disease process
EXERCISES 2.1:
In a table, summarize by comparing and contrasting the three special fields of nursing in terms
of: definition, vision, mission, goals, clients, roles and responsibilities of the nurse.
49
This chapter have presented the different roles and responsibilities of a community health
nurses. A community health nurse should be equipped with the knowledge and skills to deal
with the different areas of the community. Community health nursing is a challenging
profession. He or she should be aware and sensitive with the people’s traditions and respect
their culture and views still with prioritization of their health and safety.
This chapter also presented that the scope of nursing is wide with the different special fields of
the profession. Though school nursing, occupational nursing and mental health nursing is
briefly discussed in this resource material, there are many other fields that a nurse can have
career into. This proves that a nurse should be flexible and at the same time, a generalist in
the chosen career.
SELF-REFLECTION:
If you will pursue a career as a public health nurse, what field or specialization will you take?
Why will you choose this field? How will you perform your roles and responsibilities?
CHAPTER ACTIVITIES
Interview a public health nurse regarding their nature of work, roles and responsibilities. Ask
their educational background and years of service in their work. You may also ask their
opinion/s on the focus of community health nursing or public health nursing.
Document your interview.
REFERENCES:

edition
Department of Health (2010). Public Health Nursing in the Philippines
50
CHAPTER 3
THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM

1. Understand the current national health situation in the country
2. Identify the different components of the health care delivery system
3. Discuss the vision, mission, objectives and strategies of the Department of Health
4. List the different programs of the Department of Health
5. Outline the sustainable development goals (SDG)
6. Differentiate the different levels of health care facilities
7. Explain the two-way referral system
8. Differentiate the levels of health care facilities
KEY TERMS:
Department of Health public health nurse

devolution referral
health care delivery system rural health midwife
interlocal health zone rural health unit
Local Government Code rural sanitary inspector
local health board secondary facility
Millennium Development Goals tertiary facility
Municipal Health Officer Universal Health Care
primary facility
LESSON 1: WORLD HEALTH ORGANIZATION, MILLENNIUM DEVELOPMENT GOALS

AND SUSTAINABLE DEVELOPMENT GOALS
WORLD HEALTH ORGANIZATION
When the diplomats formed the United Nations in 1945, they also decided the creation of a
health organization. It then formed the World Health Organization (WHO). It had its
constitution on April 7, 1948. Since then, Aptil 7 is commemorated as World Health Day. The
headquarters is in Geneva Switzerland. It has 147 country offices and 6 regional offices. The
Philippines is a member of the Western Pacific Region. The country office is in Manila.
OBJECTIVE:
Attainment by all peoples of the highest possible level of health
CORE FUNCTIONS:
Provides leadership on matters critical to health and engaging in partnerships where joint action
is needed.
Shaping the research agenda stimulating the generation, translation, and disseminating
valuable knowledge.
Setting norms and standards and promoting and monitoring their implementation.
51
Articulating ethical and evidence-based policy options.
Providing technical support, catalyzing change and building sustainable institutional capacity.
MILLENNIUM DEVELOPMENTAL GOALS (MDG)
On September 6-8, 2000, world leaders who attended in the UN General assembly
participated in the Millennium Summit. A resolution was crafted during that momentous event
and it was entitled, United Nations Millennium Declaration. Collective responsibility to uphold
the principles of human dignity, equality and equity in the global level was emphasized.
The declaration expressed the commitment of 191 member states, with the inclusion of the
Philippines: to reduce extreme poverty and achieve seven other targets called Millennium
Development Goals (MDGs) by year 2015.
SUSTAINABLE DEVELOPMENT GOALS (SDG)
When the MDG ended in 2015, the Sustainable Development Goals were crafted. The
Sustainable Development Goals are the blueprint to achieve a better and more sustainable
future for all. They address the global challenges we face, including those related to poverty,
inequality, climate change, environmental degradation, peace and justice. The 17 Goals are
all interconnected, and in order to leave no one behind, it is important that we achieve them
all by 2030.
52
LESSON 2: COMPONENTS OF THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM
Related terms and concepts:
HEALTH CARE DELIVERY SYSTEM

- Totality of all policies, facilities, equipment, products, human resources and services
which address the health needs, problems and concerns of the people
SYSTEM
- A set of interrelated and independent parts that form a complex whole, and of these
parts can be viewed as a subsystem with its own set of interrelated and independent
parts
HEALTH SYSTEM
- Interrelated ways in which a country organizes available resources for the maintenance and
improvement of the health of the citizens and communities
HEALTH CARE SYSTEM
- An organize plan of health services
HEALTH CARE DELIVERY
53
- Rendering health care services to the people
HEALTH CARE DELIVERY SYSTEM
- The network of health facilities and personnel which carries out the task of rendering health
care to the people
PHILIPPINE HEALTH CARE SYSTEM
- Is a complex set of organizations interacting to provide an array of health services
FIVE MAJOR FUNCTIONS:

1. Ensure equal access to basic health services
2. Ensure formulation of nat’l policies for proper division of labor & proper coordination of
operations among the government agency jurisdictions.
3. Ensure implementation nationwide of services regarded as public health goods
4. Plan and establish arrangements for the public health systems to achieve economies of scale
5. Maintain a medium of regulations and standards to protect consumers and guide providers
CHARACTERISTICS OF HEALTH CARE DELIVERY SYSTEM

• The system should encompass the entire population on the basis of equality and
responsibility
• It should include components from the health sectors and from the sectors whose
interrelated actions contribute to health
• The essential elements of PHC should be delivered as the first point of contact between
the individuals and the health system
• The other level of system should support the first contact level to permit it to provide
the aforementioned essential elements on a continuing basis
• At intermediate levels, more complex problems should be dealt with more skilled and
specialized care as well as logistic support
• The central level should coordinate all parts of the system and provide planning and
management expertise, highly specialized care, teaching for specialized staff
STRUCTURE OF THE HEALTH SECTOR IN THE PHILIPPINES

➢ MAJOR COMPONENTS
A. PUBLIC SECTOR
- tax-based
A.1. National Level
DEPARTMENT OF HEALTH (DOH)

The Department of Health (DOH) holds the over-all technical authority on health as it is a
national health policy-maker and regulatory institution.
VISION
Filipinos are among the healthiest people in Southest Asia by 2022, and Asia by 2040
MISSION
To lead the country in the development of a people-centered, resilient, and equitable health
system
54
ROLES AND FUNCTIONS OF DOH
1. LEADERSHIP IN HEALTH
Functions:
- LEADER in the formulation, monitoring and evaluation of national health policies, plans
and programs
- ADVOCATE in the adoption of health policies, plans and programs to address national
and sectoral concerns
- NATIONAL POLICY AND REGULATORY INSTITUTION on which members of the health
sector anchor their thrusts and directions for health
2. ADMINISTRATOR OF SPECIFIC SERVICES
Functions:
- MANAGE selected health facilities and hospitals
- ADMINISTER direct services for emergent health concerns that require new complicated
technologies
- PROVIDE emergency health response services
- ADMINISTER special components of specific programs
3. CAPACITY BUILDER AND ENABLER
Functions:
- ENSURE the highest achievable standards of quality health care, promotion and
protection
- INNOVATE new strategies in health to improve the effectiveness of health programs
- INITIATE public discussion on health issues and disseminate policy research outputs
- OVERSEE implementation, monitoring and evaluation of national health plans, programs
and policies
DOH CORE VALUES

• Integrity – The Department believes in upholding truth and pursuing honesty,
accountability, and consistency in performing its functions.
• Excellence – The DOH continuously strive for the best by fostering innovation,
effectiveness and efficiency, pro-action, dynamism, and openness to change.
• Compassion and respect for human dignity – Whilst DOH upholds the quality of life,
respect for human dignity is encouraged by working with sympathy and benevolence
for the people in need.
• Commitment – With all our hearts and minds, the Department commits to achieve its
vision for the health and development of future generations.
• Professionalism – The DOH performs its functions in accordance with the highest
ethical standards, principles of accountability, and full responsibility.
• Teamwork – The DOH employees work together with a result-oriented mindset.
• Stewardship of the health of the people – Being stewards of health for the people, the
Department shall pursue sustainable development and care for the environment since
it impinges on the health of the Filipinos.
Together with its attached agencies, the DOH – constituted of various central bureaus and
services in the Central Office, Centers for Health Development (CHD) in every region, and DOH-
retained hospitals – performs its roles to continuously improve the country’s health care system.
55
Central Office
The central office is composed of the Office of the Secretary and five major function clusters:
Sectoral Management Coordinating Team, Internal Management Support Team, Policy and
Standard Development Team for Regulation, Policy and Standard Development Team for
Service Delivery, and Policy and Standard Development Team for Financing.
DOH Hospitals
Provides hospital-based care; specialized or general services, some conduct research on clinical
priorities and training hospitals for medical specialization.
Attached Agencies
Attached agencies including the Philippine Health Insurance Corporation, Philippine National
AIDS Council, Philippine Institute of Traditional Alternative Health Care, Population Commission,
Dangerous Drugs Board, and National Nutrition Council.
Libraries and Learning Resource Centers

Research and resource centers and offices like the DOH Central Library, the National
Epidemiology Center Library, the DOH-DTTB-Pfizer Training and Learning Center other in-house
resource units.
56
GOAL OF THE DOH:
Implementation of health sector reforms through the HEALTH SECTOR REFORM AGENDA
(HSRA)
• Slowing down in the reduction in the infant mortality rate (IMR) and the maternal
mortality rate (MMR)
• Persistence of large variations in health status across population groups and geographic
areas
• High burden form infectious diseases
• Rising burden from chronic and degenerative diseases
• Unattended emerging health risk from environmental and work related factors
• Burden of disease is heaviest on the poor
> The reasons why the above conditions are still seen among the population can be explained
by the following factors
• Inappropriate health care delivery system
• Inadequate regulatory mechanisms for health services
• Poor health care financing and inefficient sourcing or generation of funds for health care
➢ Framework in the implementation of HSRA: FOURmula ONE for health

a. Good governance – enhance health system performance at all levels
b. Health financing – foster greater, better and sustained investments in health
c. Health regulation – ensure the quality and affordability of health goods and services
d. Health service delivery – improve and ensure the accessibility and availability of basic
essential health care in both public and private facilities
NATIONAL OBJECTIVES FOR HEALTH
- Roadmap for stakeholders in health and health-related sectors

- Sets the targets and critical indicators to guide policymakers and stakeholders in health
- Implementation is defined through FOURmula ONE for health
OBJECTIVES OF THE HEALTH SECTOR
1. Improve the health status of the population

- Improve the general health status of the population
- Reduce mortality and morbidity
- Eliminate certain diseases
- Promote health lifestyle and environmental health
- Protect vulnerable groups
2. Ensure quality service delivery
- Strengthen national and local health systems to ensure better health service delivery
- Pursue public health and hospital reforms
- Reduce cost and ensure the quality of essential drugs
- Institute health regulatory reforms
- Strengthen health governance and management support systems
3. Improve support system for the vulnerable and marginalized groups
4. Implement proper resource management
- Expand the coverage of social health insurance
57
- Mobilize more resources for health
- Improve efficiency in the allocation, production and utilization of resources
Universal Health Care (UHC) to Address Inequity in the Health System
• also referred to as Kalusugan Pangkalahatan (KP)

• “provision to every Filipino of the highest possible quality of health care that is
accessible, efficient, equitably distributed, adequately funded, fairly financed, and
appropriately used by an informed and empowered public”
• The Aquino administration puts it as the availability and accessibility of health services
and necessities for all Filipinos.
• It is a government mandate aiming to ensure that every Filipino shall receive affordable
and quality health benefits. This involves providing adequate resources – health human
resources, health facilities, and health financing.
UHC’s Three Thrusts
1) Financial risk protection through expansion in enrolment and benefit delivery of the
National Health Insurance Program (NHIP)
- Protection from the financial impacts of health care is attained by making any Filipino
eligible to enroll, to know their entitlements and responsibilities, to avail of health
services, and to be reimbursed by PhilHealth with regard to health care expenditures.
- PhilHealth operations are to be redirected towards enhancing national and regional
health insurance system. The NHIP enrollment shall be rapidly expanded to improve
population coverage. The availment of outpatient and inpatient services shall be
intensively promoted. Moreover, the use of information technology shall be maximized
to speed up PhilHealth claims processing.
2) Improved access to quality hospitals and health care facilities; and

- The quality of government-owned and operated hospitals and health facilities is to be
upgraded to accommodate larger capacity, to attend to all types of emergencies, and to
handle non-communicable diseases.
- The Health Facility Enhancement Program (HFEP) shall provide funds to improve facility
preparedness for trauma and other emergencies.
- Financial efforts shall be provided to allow immediate rehabilitation and construction of
critical health facilities. In addition to that, treatment packs for hypertension and
diabetes shall be obtained and distributed to RHUs.
- The DOH licensure and PhilHealth accreditation for hospitals and health facilities shall be
streamlined and unified.
3) Attainment of health-related Millennium Development Goals (MDGs).
- Further efforts and additional resources are to be applied on public health programs to
reduce maternal and child mortality, morbidity and mortality from Tuberculosis and
58
Malaria, and incidence of HIV/AIDS. Localities shall be prepared for the emerging
disease trends, as well as the prevention and control of non-communicable diseases.
- The organization of Community Health Teams (CHTs) in each priority population area
- Another effort will be the provision of necessary services using the life cycle approach.
A.2. LOCAL LEVEL
LOCAL GOVERNMENT UNITS (LGU)
R.A. 7160 – “Local Government Code of 1991”

- Devolution of powers, functions and responsibilities to the local government
* Devolution – refers to the act by which national government confers power and authority
OBJECTIVES FOR LOCAL HEALTH SYSTEM

1. Establish local health systems for effective and efficient delivery of health services
2. Upgrade the health care management and services capabilities of local health care
financing
3. Promote inter LGU linkages
4. Foster participation of the private sector, NGO’s and communities
5. Ensure the quality of health service delivery at the local level
COMPOSITION OF LOCAL HEALTH BOARDS
PROVINCIAL MUNICIPAL
Governor- Chairperson Mayor-Chairperson
PHO- Vice Chairman MHO-Vice Chairman
Chairman of the Committee on Health of the Chairman of the Committee on Health of the
Sangguniang Panlalawigan Sangguniang Bayan
DOH Representative DOH Representative
NGO Representative NGO Representative
THE ORGANIZATIONAL STRUCTURE OF THE DOH AND LGUs AFTER DEVOLUTIION
59
• FUNCTIONS
1. Proposing budgetary allocations – operation and maintenance of health services
2. Advisory committee
3. Creating committees that shall advise local health agencies
B. PRIVATE SECTOR
- market-oriented
TYPE ORIENTATION EXAMPLES

Commercial or Business Profit-oriented Private Practitioners
Non-commercial Service-oriented Socio-civic groups, religious
organizations, foundations
Private sub-sector involvement includes:
1. Inputs provision which covers supplies and equipment/treatment facilities

2. Service delivery which includes a whole range of activities from casefinding/treatment
and follow-up, counseling environmental sanitation, to manufacture and sale of health-
related goods
3. Support activities mostly in the form of research, personnel training, project monitoring
and evaluation, and development of IEC materials
4. Financing through financial assistance that usually comes in the form of grants from
multilateral and bilateral agencies.
C. Non-Government Organizations
NGOs play an important role in national and local development with emphasis on policy
and program reforms and people empowerment. NGOs have consistently assumed the roles of
catalysts, advocates, facilitators and enablers in people development. Heath NGOs are those
that are directly involved in health care and in reforming the present health care delivery
system. Some of them have pioneered alternative approaches in health.
60
The roles played by the NGOs include:
1. Direct delivery of health services

2. Policy and legislative advocacy
3. Organizing to promote and protect economic and democratic rights, interests, and
general welfare of health workers
4. Research and documentation concerning important health issues such as appropriate
health technology and PHC
5. Health resource development to respond to the severe lack of human resources
especially in depressed areas
6. Human rights advocacy to uphold and advance the basic health and human rights of the
people, especially those marginalized by socio-economic factors such as urban poor,
workers on strike, victims of torture, etc.
7. Relief and disaster management which includes activities as recruitment and organizing
volunteers as disaster response teams, regular solicitation and stockpiling of needed
medicine, medical supplies, food and other essentials
8. Networking to enable health NGOs to learn from each other, maximizing their resources,
avoid duplication of work and respond to various issues simultaneously.
LESSON 3: Levels of Health Care Facilities
HEALTH FACILITIES
Health facilities are physical infrastructures that offer health services. These include
hospitals, health centers, health stations, clinics, and laboratories. The government, private
sector and NGO’s today operate health facilities.
A. Hospitals
The Philippine Hospital System is composed of government and privately-owed
hospitals. The hospitals are further subdivided into primary, secondary, and tertiary
categories according to the level of care that is being offered. To ensure quality
hospitals, it should be equipped with functioning physical facilities and equipment,
has an effective organization and procedures/system; high quality managerial
resource, able to adopt and meet changing demands for hospital care.
B. Health Center and Barangay Health Stations

Health Center and barangay health stations (BHS) are government facilities that
are primarily responsible for the delivery of basic health services to communities.
They are the first point of contact between majority of the poor people and the
health system.
C. Private Clinics and Laboratories

These provide service to a significant proportion of the population, particularly
those belonging to the middle- and upper-income classes. Most of these facilities
are concentrated in urban areas where they are highly in demand.
61
• Primary Level of Care
– devolved to the cities and municipalities and is the first contact
– in fair health, patients in early symptomatic stages
- RHU, chest clinics, malaria eradication clinics, private clinics
• Secondary Level of Care

– rendered by physicians with basic health training in district provincial and city hospitals
– capable of basic surgical procedures and simple laboratory exams; serves as the
referral center of primary health facilities
- Patients with symptomatic stages of disease; moderately specialized knowledge and
technical resources
- Emergency, provincial, district
• Tertiary Level of Care – rendered by specialists in medical centers, regional hospitals

and specialized hospitals
- – serves as the referral center of secondary health facilities
- - With diseases w/c seriously threaten their health; require higly technical and
specialized knowledge facilities and personnel
** DOH AO 2012-0012 (RULES AND REGULATIONS GOVERNING THE NEW

CLASSIFICATION OF HOSPITALS AND OTHER HEALTH FACILITIES)
LEVELS OF HEALTH CARE DELIVERY REMAINED, CLASSIFICATION HAS CHANGED
THREE LEVELS OF HEALTH CARE
• CATEGORY A. PRIMARY CARE FACILITY

- First contact; basic services
- Emergency services and normal delivery services
a. Without in-patient beds (health centers, out-patient clinics, dental clinics)
b. With in-patient beds – short stay facilities (infirmaries, lying-in)
62
• CATEGORY B. CUSTODIAL CARE FACILITY
- Long term-care facility, food, shelter
- Chronic conditions requiring ongoing health and nursing care due to impairment and a
reduced degree of independence in ADLs and patients in need of rehabilitation
- Nursing home, leprosaria, rehabilitation
• CATEGORY C. DIAGNOSTIC/THERAPEUTIC FACILITY

- Examination, specimens for diagnosis, treatment, water analysis
• CATEGORY D. SPECIALIZED OUTPATIENT FACILITY
- Performs highly specialized procedures on an out-patient basis
- Dialysis, ambulatory surgical clinic, chemo clinic, radiation facility, rehabilitation clinic
TYPES OF PRIMARY HEALTH WORKERS
LESSON 4: RESTRUCTURED HEALTH CARE DELIVERY SYSTEM (RHCDS)
Rationale for RHCDS
63
• Healthcare system serves only small portion of rural population
• Diseases do not require sophistication
• Some problems can be handled by other postions besides MHO (Municipal Health Officer)
Solutions
• Three levels of health care provided by RHU (rural health unit) staff, with referral and
supervisory system support
• Redefinition of roles and relationships among RHU staff
• Establishment of satellite health centers in selected barangays
Features of DOH reorganization

• 1958- RA 1082
- 1st Rural Health Act
- employment of more physicians, dentists, nurses, midwives and sanitary inspectors
assigned to RHU’s o 1st 81 rural health units
• 1972- RA 5435 o defined authorities of regional directors for more meaningful decentralization
- 13 regional health offices
• 1974 o IBRD- RHCDS implemented RHM were sent to BHS to man BHS o Midwives were
trained and roles expanded
• 1982- EO 851 o integrated public health and hospital systems with emphasis on importance of
putting together promotive, preventive, curative and rehabilitative components of health care o
utilization of BHW o implementation of DOH impact programs
Role of Society in RHCDS

• participation in information drive of HCDS
• identifying problems
• identify sources
Rural Health Unit compositions and ratio to population:

• PHYSICIAN/MHO – 1: 20,000
• PHN – 1: 10,000 – 15,000
• RHM – 1: 5,000
• Rural Sanitary Inspector – 1:20,000
• Dentist – 1:50, 000
• Med tech – 1: 20, 000
• Pharmacist
• Nutritionist
HEALTH CARE FINANCING

- From the government
- WHO recommends 5% of the country’s GNP shall be for health. However, it was
only placed on through the following:
• Government third party schemes:
o Medicare program
o PhilHealth
o Employees Compensation Commission (ECC)
64
• Private sources
o Out-of-pocket
o Health Management Organizations (HMO) payments
• Company-financed health benefits
• Community-generated resources and donations of cash/material and
technical services from donors
• External sources
o WHO
o UNICEF
o USAID
o World Bank
LESSON 5: TWO-WAY REFERRAL SYSTEM
Referral – set of activities undertaken by a health care provider or facility in response to its
inability to provide the necessary health intervention to satisfy a patient’s need.
- A functional referral system is one that ensures the continuity and complementation of
health and medical services
- It encompasses all types of care
- It involves movement of a patient from the health center of first contact and the hospital
at first referral level. When hospital intervention has been completed, the patient is
referred back to the health center – this is the two-way referral system.
Two types of referrals
A. Internal referral – occur within the health facility

B. External referral – movement of a patient or client from one health facility to another.
Inter Local Health System

- clustering municipalities into inter local health zone for holistic delivery of health services. It is
based on the concept of the District Health System, a term used by WHO to describe an
integrated health management and delivery system based on a defined administrative and
geographical area.
- has defined catchment area with a central or core referral hospital and a number of primary
level facilities.
Composition of ILHZ:
1. People (100,000 – 500,000 population / health district)

2. Boundaries to determine accountability & responsibility of health service providers
3. Health facilities
4. Health workers
65
The World Health Organization takes the lead role in health concerns globally, while the
Department of Health provides leadership in the country. In the Philippines, the health system
is divided into: government organizations, non-government organizations and the private
sectors. The Department of Health, which is constitutionally authorized, is headed by the
Department Secretary that is appointed by the Philippine President. Health services are
provided by the three health facilities with the RHU or health center providing primary care at
the municipal/city level. Through this health facilities, the public health nurse serves the
community.
Devolution has made the basic services more reachable for the community. The concerns to
address with this implementation is the fragmentation and segregation of health delivery
system in the country. Since the health care system is multisector, knowing one’s role in the
system enables one to contribute effectively to system.
SELF-REFLECTION:
What are your feelings and insights of the Philippines’ health care system?
CHAPTER ACTIVITIES:
1. Choose one country from the ASEAN and one country each from Europe and from American
region.
2. Have a short description of the countries.
3. In a narrative form, discuss the health care system of these countries in terms of:
a. Health government and regulations
b. Healthcare financing
c. Health service delivery
d. Health information system
e. Health sector reforms and policies
REFERENCES:
Books:

Websites:
www.doh.gov.ph
66
SEMIFINALS COVERAGE
Specific Instructions in the completion of each Chapter:

hours.
teacher.
CHAPTER 4
PRIMARY HEALTH CARE AS AN APPROACH TOWARDS HEALTHY FILIPINOS

1. Define primary health care
2. Outline the historical background of primary health care
3. Enumerate the principles and strategies of primary health care
4. Identify the different health care services under each elements of primary health care
5. Differentiate primary health care and primary care
6. Relate the different programs of the DOH and PHC in the current health situation,
concerns and issues
7. Recognize the roles of the nurses in the different programs of primary health care
KEY TERMS:
acceptability health education
accessibility immunization
affordability kwashiorkor
appropriate technology marasmus
availability primary health care
community participation reproductive health
endemic support mechanism
family planning vaccine
essential drugs
67
LESSON 1: DEFINITION AND CONCEPTS RELATED
PRIMARY HEALTH CARE (PHC)
- essential health care based on practical, scientifically sound and socially acceptable methods
and technology, made universally accessible to individuals and families in the community
through their full participation and at a cost that the community can afford to maintain at every
stage of their development in the spirit of self-reliance and self- determination.
CONCEPTUAL FRAMEWORK
• Health is a fundamental human right
• Health is both an individual and collective responsibility
• Health should be an equal opportunity to all
• Health is an essential element of socio-economic development
FOCUS OF THE PHC APPROACH
• Partnership with the community

• Equitable distribution of health resources
• Organized and appropriate health system infrastructure
• Prevention of disease and promotion of health
• Linked multi-sectoral
• Emphasis on appropriate technology
PHC UNIVERSAL GOAL: “Health for all by the year 2000”
- An acceptable level of health for all people of the world through self-reliance
Framework:
People’s empowerment and partnership is the Key Strategy
- Alma-Ata, USSR
- September 6-12, 1978
First International Conference on PHC; sponsored by WHO and UNICEF

PHC was declared in the Alma-Ata Conference in 1978, as a strategy to community health
development. It is a strategy aimed to provide essential health care that is:
C – ommunity based
A – ccessible
P – art and parcel of the total socio-economic development effort of the nation
A – cceptable
S – ustainable at an affordable cost
LEGAL BASIS OF PHC IN THE PHILIPPINES: Letter of Instruction 949

- Signed by then President Ferdinand Marcos, with underlying theme, “Health in the
Hands of the People by 2020”
68
COMPARISON OF COMMERCIALIZED HEALTH CARE AND PRIMARY HEALTH CARE
DIMENSION COMMERCIALIZED PHC

HEALTH CARE
GOAL Absence of disease Prevention of disease
FOCUS Sick Sick and well
SETTING Hospital-based; urban; few Health centers; rural-based;
all
PEOPLE Passive recipients Active participants
STRUCTURE Health is isolated from other Heath is integrated; linkaging
sectors
PROCESS Decision-making (top- Bottom-top
bottom)
TECHNOLOGY Curative; physician- Promotive and preventive

dominated Appropriate technology for
frontline health care
OUTCOME Reliance on health People empowerment/self-
professionals reliance
LESSON 2: PRINCIPLES AND STRATEGIES
Principles and Strategies of Primary Health Care
PRINCIPLE STRATEGIES
Accessibility, availability, affordability and - Health services must be delivered
acceptability of health services where people are
- use indigenous/resident volunteer
workers as health care providers
(1:20)
- use traditional medicine with
essential drugs
Provision of quality, basic, and essential - Training design and curriculum based
services on community needs and priorities
- KSA on promotive, preventive,
curative and rehabilitative health care
- Regular monitoring and periodic
evaluation of CHW
Community participation - Awareness-building and

consciousness raising
- Planning, implementation, monitoring
and evaluation
- Selection of CHW
69
- Community-building and CO
- Formation of health committees
- Establishment of a community health
worker organization
- Mass health campaign and
mobilization
Self-reliance - Community generates support

- Use of local resources
- Training of community leadership and
management skills
- incorporation of IGP, coops, small-
scale industries
Recognition of interrelationship between - Convergence of health, food,

health and development nutrition, sanitation, etc
- integration of PHC into all level plans
- coordination of activities to different
sectors
Social mobilization - Establishment of effective referral

system
- multisectoral and interdisciplinary
linkages
- IEC using multi-media
- Collaboration between GO and NGO
Decentralization - Re-allocation of budgetary resources

- Re-orientation of health professionals
on PHC
- Advocacy for political will and support,
from the national leadership down to
the barangay
FOUR CORNERSTONES OR PILLARS OF PHC
1. ACTIVE COMMUNITY PARTICIPATION

• Community Involvement
• Participation of the Community in:
- Defining the health and health-related needs
- Identifying realistic solutions
- Organizing, mobilizing its resources for health activities
- Evaluating the results of health actions
2. SUPPORT MECHANISM MADE AVAILABLE

- resources in for essential health services come from three major entities: the people, the
government and the private sector. These three groups should interplay to have better health
outcomes. A multi-sector approach is necessary.
70
Factors to consider:
a. Improvement of the following:
– Working conditions of health personnel such as team building, performance
review and promotion
– Planning and management skills of health personnel at all levels
– Technical skills of health personnel
b. Improvement of the referral system at all levels
c. Formation and use of an information system that will continuously monitor the changing
needs and attitudes of the community.
3. APPROPRIATE TECHNOLOGY
Characteristics of an appropriate technology in PHC are the following:
Acceptability
Complexity
Cost
Effectiveness
Safety
Scope of technology
Feasibility
Examples: ORS for diarrhea, Herbal Medicine, Alternative Health care modalities practiced
4. INTRA- AND INTER-SECTORAL LINKAGE

Intrasectoral linkages – refer to communication, cooperation and collaboration within the health
sector
Intersectoral linkages – refer to communication, cooperation and collaboration between the
health sector and other sectors
Local Governments
Education
Agriculture
Public works
Population control
Social welfare
LESSON 3: ELEMENTS/HEALTH PROGRAMS OF PHC
The Alma Ata Declaration listed eight essential health services in Primary Health Care, using the
acronym ELEMENTS:
Education for health
Locally endemic diseases
Expanded Program on Immunization
Maternal and Child care Program
Essential drugs
Nutrition
Treatment of communicable diseases
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Sanitation
I. EDUCATION FOR HEALTH

- the sum of activities in which health agencies engage to influence the thinking,
motivation, judgment, and action of the people
- consists of techniques that stimulate, arouse, and guide people to live healthfully it is the
process whereby knowledge, attitude, and practice of the people are changed to improve
individual, family, and community.
Steps in Health Education:

• Creating awareness
• Motivation
• Decision-making
Aspects of Health Education

• Information – provision of knowledge
• Communication- exchange of information
• Education – change in knowledge, attitude, and skills
Principles of Health Education

• Health education considers the health status of the people
• Health education is learning
• Health education involves motivation, experience, and change in conduct and thinking
• Health education should be recognized as a basic function of health workers
• Health education takes place in the home, in the school, and the community
• Health education is a cooperative effort
• Health education meets the needs, interests and problems of the people affected
• Health education is achieved by doing.
• Health education is a slow and continuous process
• Health education makes use of supplementary aids and devices
• Health education utilizes community resources
• Health education is a creative process.
• Health education helps people attain health through their own efforts
• Health education makes careful evaluation of the planning, organization, and
implementation of health education program and activities.
General Aims of Health Education

• To persuade people to adopt and sustain healthful life practices
• To use judiciously and wisely the health services available to them
• To make their own decisions, both individually and collectively to improve their health
status and environment.
Factors Affecting the Attainment of Health Education

• Availability and accessibility of health services to which the individual have trust
• The economic feasibility of putting into practice the health measures being advocated
• Acceptability of the proposed health practice in terms of their customs and traditions
that an individual observes.
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Qualities of a Health Educator
• Knowledgeable/mastery of subject matter
• Credible
• Good listener
• Can empathized with others
• Possess teaching skills
• Flexible
• Patience
• Creative and innovative
• Effective motivator
• Able to rephrase and summarize
• Encourages group participation
• Good sense of humor
• Works for the joy of it
II. LOCALLY ENDEMIC DISEASES CONTROL
A. NATIONAL DENGUE PREVENTION AND CONTROL PROGRAM
VISION: A dengue free Philippines
MISSION: Ensure healthy lives and promote well-being for all at all ages
GOAL: To reduce the burden of dengue disease
OBJECTIVES: 1.) To reduce dengue morbidity by atleast 25% by 2022
INDICATORS: Morbidity rate = No. of suspect, probable & confirmed cases x100,000
total population
(baseline: 198.1 per 100,000 population)
(2015 data: 200,145/100,981,437 x 100,000)
2.) To reduce dengue mortality by at least 50% by 2022
Mortality rate = No of dengue (probable & confirmed) deaths x 100,000
total population
(baseline: 0.59 per 100,000 population)
(2015 data: 598/100,981.437 x 100,100)
3.) To maintain Case Fatality Rate (CFR) to < 1% every year.
CFR = no. of dengue (probable & confirmed) deaths x 100
no. of probable & confirmed cases
PROGRAM COMPONENTS
1. Surveillance
• Case Surveillance through Philippine Integrated Disease Surveillance and
Response (PIDSR)
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• Laboratory-based surveillance/ virus surveillance through Research
Institute for Tropical Medicine (RITM) Department of Virology, as national
reference laboratory, and sub-national reference laboratories.
• Vector Surveillance through DOH Regional Offices and RITM Department
of Entomology
2. Case Management and Diagnosis

• Dengue Clinical Management Guidelines training for hospitals.
• Dengue NS1 RDT as forefont diagnosis at the h ealth center/ RHU level.
• PCR as dengue confirmatory test available at the sub-national and
national reference laboratories.
• NAAT-LAMP as one of confirmatory tests will be available at district
hospitals, provincial hospitals and DOH retained hospitals.
3. Integrated Vector Management (IVM)

• Training on Vector Management, Training on Basic Entomology for
Sanitary Inspector, Training on Integrated Vector Management (IVM) for
health workers.
• Insecticide Treated Screens (ITS) as dengue control strategy in schools.
4. Outbreak Response
• Continuous DOH augmentation of insecticides such as adulticides and
larvicides to LGUs for outbreak response.
5. Health Promotion and Advocacy

• Celebration of ASEAN Dengue Day every June 15
• Quad media advertisement
• IEC materials
6. Research
STRATEGIES
• Enhanced 4S Strategy
S - earch and Destroy
S - eek Early Consultation
S - elf Protection Measures
S - ay yes to fogging only during outbreaks
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B. MALARIA CONTROL PROGRAM
• Vision: Malaria-free Philippines by 2030
• Mission: To empower health workers, the population at risk and all others concerned to
eliminate malaria in the country.
• Goal: To significantly reduce malaria burden so that it will no longer affect the socio-
economic development of individuals and families in endemic areas.
• Objectives:
1. Ensure universal access to reliable diagnosis, highly effective, and appropriate treatment and
preventive measures;
2. Capacitate local government units (LGUs) to own, manage, and sustain the Malaria Program
in their respective localities;
3. Sustain financing of anti-malaria efforts at all levels of operation; and
4. Ensure a functioning quality assurance system for malaria operations
Beneficiaries:
• meager-resourced municipalities in endemic provinces
• rural poor residing near breeding areas
• farmers relying on forest products
• indigenous people with limited access to quality health care services
• communities affected by armed conflicts
• pregnant women
• children aged five years old and below.
Program Strategies:
1. Early diagnosis and prompt treatment
• Diagnostic Centers were established and strengthened to achieve this strategy.
The utilization of these diagnostic centers is promoted to sustain its functionality.
2. Vector control
• The use of insecticide-treated mosquito nets, complemented with indoor residual
spraying, prevents malaria transmission.
3. Enhancement of local capacity
• LGUs are capacitated to manage and implement community-based malaria
control through social mobilization.
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C. NATIONAL FILARIASIS ELIMINATION PROGRAM
A major strategy of the Elimination Plan was the Mass Annual Treatment using the
combination drug, Diethylcarbamazine Citrate and Albendazole for a minimum of 2 years
& above living in established endemic areas after the issuance from WHO of the safety
data on the use of the drugs
• Vision: Healthy and productive individuals and families for Filariasis-free Philippines
• Mission: Elimination of Filariasis as a public health problem thru a comprehensive
approach and universal access to quality health services
• Goal: To eliminate Lymphatic Filariasis as a public health problem in the Philippines by
year 2017
• Specific Objectives:
The National Filariasis Elimination Program specifically aims to:
1. Reduce the Prevalence Rate to elimination level of <1%;
2. Perform Mass treatment in all established endemic areas;
3. Develop a Filariasis disability prevention program in established endemic
areas;
4. Continue surveillance of established endemic areas 5 years after mass
treatment.
Target Population/Clients/Beneficiaries:
• individuals, families and communities living in endemic municipalities in 44 provinces in
12 regions (30 million targeted for mass treatment or 1/3 of the total population of the
country).
• However, 9 provinces have reached elimination level namely: Southern Leyte; Sorsogon;
Biliran; Bukidnon; Romblon; Agusan Sur; Dinagat Islands; Cotabato Province; and
COMVAL.
Management Being Used:

A. Selective Treatment – treating individuals found to be positive for microfilariae in
nocturnal blood examination.
• Drug: Diethylcarbamazine Citrate
• Dosage: 6 mg/kg body weight in 3 divided doses for 12 consecutive days (usually given
after meals)
B. Mass Treatment – giving the drugs to all population from aged 2 years and above in
all established endemic areas.
• Drug: Diethlcarbamazine Citrate (single dose based on 6 mg/kg body wt)
plus Albendazole 400mg given single dose given once annually to people 2 yrs & above
living in established endemic areas
C. Disability Prevention thru home-based or community-based care for lymphedema &
elephantiasis cases.
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D. SCHISTOSOMIASIS CONTROL PROGRAM:
Goal: To reduce the disease prevalence by 50% with a vision of eliminating the disease
eventually in all endemic areas
Objectives:
The Schistosomiasis control Program has the following objectives:
1. Reduce the Prevalence Rate by 50% in endemic provinces; and
2. Increase the coverage of mass treatment of population in endemic provinces.
Program Strategies:
The Schistosomiasis Control Program employs the following key interventions:
a. Morbidity control: Mass Treatment
b. Infection control: Active Surveillance
c. Surveillance of School Children
d. Transmission Control
e. Advocacy and Promotion
E. LEPROSY CONTROL PROGRAM:

Vision: Empowered primary stakeholders in leprosy and eliminated leprosy as a public
health problem by 2020
Mission: To ensure the provision of a comprehensive, integrated quality leprosy services
at all levels of health care
Goal: To maintain and sustain the elimination status
Objectives:
The National Leprosy Control Program aims to:
• Ensure the availability of adequate anti-leprosy drugs or multiple drug therapy (MDT).
• Prevent and reduce disabilities from leprosy by 35% through Rehabilitation and
Prevention of Impairments and Disabilities (RPIOD) and SelfCare.
• Improve case detection and post-elimination surveillance system using the WHO
protocol in selected LGUs.
• Integration of leprosy control with other health services at the local level.
• Active participation of person affected by leprosy in leprosy control and human dignity
program in collaboration with the National Program for Persons with Disability.
• Strengthen the collaboration with partners and other stakeholders in the provision of
quality leprosy services for socio-economic mobilization and advocacy activities for
leprosy.
Beneficiaries:
The NLCP targets individuals, families, and communities living in hyperendemic areas
and those with history of previous cases.
III. EXPANDED PROGRAM ON IMMUNIZATION
The expanded program on immunization was launch in July 1976 by the department
of health in cooperation with the World Health Organization and the UNICEF.
Goal: To achieve the overall EPI goal of reducing the morbidity and mortality among
children against the most common vaccine-preventable diseases.
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Laws related to Expanded Program on Immunization:
Presidential Decree 996 – the first law on Expanded Program on Immunization. It has
the original objective of reducing the morbidity and mortality among infants and children
caused by the seven childhood immunizable diseases.
Republic Act 10152 – also known as Mandatory Infants and Children Health
Immunization Act of 2011. It mandates basic immunization covering the vaccine
preventable diseases. It added the vaccines for mumps, hepatitis B, rubella, diseases
caused by Haemophilus influenza type B (Hib) and other diseases determined by the
Department of Health (DOH) Secretary. This law repealed PD 996.
Republic Act 7846 - compulsory immunization against hepatitis B for infants and
children below 8 years old. It also stated that Hepatitis B vaccine within 24 hours after
birth of babies from mothers with hepatitis B.
Specific goals:
a. To immunize all infants/children against the most common vaccine-preventable diseases
b. To sustain the polio-free status of the Philippines
c. To eliminate measles infection
d. To eliminate maternal and neonatal tetanus
e. To control diphtheria, pertussis, hepatitis B and German measles
f. To prevent extrapulmonary TB among children
Principles:
1. The program based on the epidemiological situation
2. The whole community rather than just the individual is to be protected, thus mass approach
is utilized
3. Immunization is a basic health service and such it is integrated in to the health services being
provided for by the Rural health Unit
Elements:
1. Target setting
2. Cold chain logistic management
3. Information, education and communication
4. Assessment and evaluation of the program’s overall performance
5. Surveillance, studies and research
Importance of vaccination:
1. Immunization is the process by which vaccines are introduced into the body before infection
sets in.
2. Vaccines are administered to promote immunity and to protect the children from disease-
causing agents
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Schedule and manner of administration of infant immunization (EPI, Philippines)
ANTIGEN AGE DOSE ROUTE SITE
BCG At birth 0.05 ml ID RIGHT deltoid
Hepa B At birth 0.5 ml IM Vastus lateralis
DPT-HepB-HiB 6 weeks, 10 0.5 ml IM Vastus lateralis
weeks, 14 weeks
OPV 6 weeks, 10 2 gtts Oral Mouth
weeks, 14 weeks
AMV 9-11 months 0.5 ml SQ Outer part of
upper arm
MMR 12-15 months 0.5 ml SQ Outer part of
upper arm
Rotavirus 6 weeks, 10 1.5 ml Oral Mouth
weeks
Schedule and protection of administration of tetanus toxoid immunization (EPI,

Philippines)
VACCINE MINIMUM TIME PERCENT DURATION OF
INTERVAL PROTECTION PROTECTION
TT1 As early as
pregnancy
TT2 At least 4 weeks 80 Infant: Neonatal
tetanus
Mother: 3 years
TT3 At least 6 months 95 Infant: Neonatal
tetanus
Mother: 5 years
TT4 At least 1 year 99 Infant: Neonatal
tetanus
Mother: 10 years
TT5 At least 1 year 99 All infants born will
be protected
Mother: lifetme
Side effect of vaccination and their management (EPI, Philippines)

Vaccines Side effects Management
BCG KOCH’S PHENOMENON No management
- Acute inflammatory reaction
DEEP ABSCESS AT VACCINATION SITE OR I and D
LYMPH NODES
INDOLENT ULCERATIONS INH powder
- Persists after 12 weeks
Ulcer more than 10 mm
GLANDULAR ENLARGEMENT Treat as deep abscess
HEPATITIS B LOCAL SORENESS No treatment is necessary
Within 24 hours
DPT-HepB-Hib FEVER Antipyretic
(Pentavalent) -usually one day TSB
LOCAL SORENESS No treatment
- At injection site 3-4 days
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ABSCESS I and D
- An abscess that appear a week or more
after is due to wrong technique
CONVULSIONS Proper management
-very rare; 3 months of age Do not continue normal
course
OPV Usually none
AMV FEVER AND RASH Antipyretics
5-7 days after (1 week) TSB
MMR Local soreness, fever, irritability, malaise Antipyretics
Rotavirus Some children develop mild vomiting and Antipyretics
diarrhea, fever and irritability Oresol
Tetanus toxoid Local soreness at the injection site Apply cold compress on site
No other treatment
Important considerations:
• Use only one sterile syringe per client.

• No need to restart a series of vaccination regardless of time or doses that have been
missed in between.
• All the EPI antigens are safe and effective when administered simultaneously, that is,
during the same immunization schedule but at different sites. However, it is not
recommended to mix vaccines in a single syringe. Moreover, if the site is of the same
limb, the sites should be at least 2.5-5 cm apart.
• OPV followed by Rotavirus vaccine and then other appropriate vaccines.
OPV is administered with a dropper. Do not let the dropper touch the child’s tongue.
• Only monovalent hepatitis B vaccine must be used for birth dose. Pentavalent vaccine
must not be used because DPT and Hib vaccine should not be administered at birth.
• In case, children who did not receive AMV1 or if the parent/caregiver forgets if the child
received such, AMV1 shall be given as soon as possible, followed by AMV2 one month
after.
• All children entering day care centers/pre-school and Grade 1 shall be screened for
measles immunization. Children without vaccines shall be referred to nearest health
facility.
• The first dose of Rotavirus vaccine is administered only to infants aged 6 weeks to 15
weeks. Second dose is given only to infants aged 10 weeks up to a maximum of 32
weeks.
Vaccines, contents, form, exposure to heat and storage temperature

VACCINE CONTENTS FORM CONDITIONS STORAGE
WHEN TEMPERATURE
EXPOSED TO
HEAT
BCG Live, attenuated, Freeze dried, Destroyed 0
2 to 8 C
bacteria reconstituted
with special
diluent
Hepatitis B RNA- Cloudy, liquid, in Damaged by 0
2 to 8 C
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vaccine recombinant, an auto-disable heat or freezing
using Hepatitis B injection syringe
surface antigen if available
(HBs Ag)
DPT-HepB-Hib D-weakened Liquid, in an D-by heat/freeze 0
2 to 8 C
(Pentavalent toxin auto-disable
vaccine) P-inactivated injection syringe
bacteria
T-weakened
toxin
Recombinant
DNA surface
antigen
Synthetic
conjugate of HiB
bacilli
OPV Live, attenuated Liquid Easily destroyed 0C
-15 to -25
virus by heat, not by
freezing
AMV (AMV1) Live, attenuated Freeze dried, Easily destroyed 0C
-15 to -25
virus reconstituted by heat, not by
freezing
MMR (AMV2) Live, attenuated Freeze dried, Destroyed 0
2 to 8 C
virus reconstituted
Rotavirus Live, attenuated Liquid Destroyed 0
2 to 8 C
virus
TT Liquid Damaged by 0
2 to 8 C
heat or freezing
COLD CHAIN
- System used to maintain the potency of a vaccine from the time of manufacture to time
it is given
COLD CHAIN OFFICER

- Person directly responsible for cold chain management at each level is called Cold Chain
officer. At the RHU/health center, the public health nurse acts as the Cold Chain Officer.
- The officer is in charge of maintaining the cold chain equipment and supplies
** Please refer to the table above for the specific temperatures to maintain the potency of the
vaccines
Considerations to maintain potency:

1. Storage of vaccines should NOT exceed:
▪ 6 months at regional
▪ 3 months at provincial
▪ 1 month at main health centers*
▪ Not more than 5 days at health centers
2. Use of boxes/carriers in transport
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3. Observe the first expiry-first out (FEFO) policy
4. Reconstitute freeze-dried vaccines such as BCG, AMV, and MMR only with the diluents
supplied with them
5. Discard reconstituted freeze-dried vaccines 6 hours after reconstitution or at the end of
the immunization session, whichever comes sooner.
6. Protect BCG from sunlight and Rotavirus from light.
Contraindications to immunization:
There are no general contraindications to immunization of a sick child if the child is well enough
to be sent home.
Few absolute contraindications:

Do not give:
• Pentavalent vaccine/DPT to children over 5 years of age
Pentavalent vaccine/DPT to a child with recurrent convulsions or another active
neurological disease of the central nervous system
Pentavalent 2 or 3/DPT 2 or 3 to a child who has had convulsions or shock within 3 days
of the most recent dose.
• Rotavirus vaccine when the child has a history of hypersensitivity to a previous dose of
the vaccine, intussusceptions or intestinal malformation or acute gastroenteritis.
• BCG to a child who has signs and symptoms of AIDS or other immune deficiency
conditions or who are immunosuppressed.
False contraindications:
• Malnutrition: it is in fact, an indication
• Low-grade fever
Mild respiratory infection
• Diarrhea: Children with diarrhea and is scheduled for OPV, should receive one – but is
not counted. The child should return when the next dose of OPV is due.
EPI recording and reporting

• Fully immunized child (FIC) - who were given one dose of BCG, three doses of OPV,
three doses DPT and hepatitis B vaccine or three doses Pentavalent vaccine, and one
dose anti-measles vaccine before reaching one year old
• Completely immunized child (CIC) – refer to children who completed their immunization
schedule at the age of 12-23 months
• Child protected at birth (CPAB) – a term used to describe a child whose mother has
received: two doses of TT during this pregnancy, provided that the second dose was
given at least a month prior to the delivery; or at least three doses of TT anytime prior
to pregnancy with this child
IV. MATERNAL, NEWBORN AND CHILD HEALTH NUTRITION PROGRAM
In response to the maternal and child health situation, the DOH takes into
consideration the interrelatedness of (a) direct threats to life of mothers and children
that necessitate immediate health care and managing risks that tend to increase
maternal and child deaths and (b) underlying socio-economic conditions that hinder
the provision and utilization of MNCHN core packages of services.
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FOUR KEY STRATEGIES OF MNCHN:
1. Ensuring universal access to and utilization of an MNCHN Core Package of services and
interventions directed not only to individual women of reproductive age and newborns at
different stages of the life cycle, but also to the community.
2. Establishment of a Service Delivery Network at all levels of care to provide the package
of services and interventions.
3. Organized use of instruments for health systems development to bring all localities to
create and sustain their service delivery networks, which are crucial for the provision of
health services to all.
4. Rapid build-up of institutional capacities of DOH and PhilHealth, being the lead national
agencies that will provide support to local planning and development through
appropriate standards, capacity build-up of implementers, and financing mechanisms.
AIMS:
1. Every pregnancy is wanted, planned and supported
2. Every pregnancy is adequately managed throughout its course
3. Every delivery ia facility-based and managed by skilled birth attendants or skilled health
professionals
4. Every mother-newborn pair secures proper postpartum and newborn care with smooth
transition to the women’s health care package for the mother and child survival package
for the newborn
MNCHN CORE PACKAGE OF SERVICES:
A. PRE-PREGNANCY PACKAGE
1. Nutrition: counselling, use of iodized salt, micronutrient supplements (Iron and folate: 60mg
elemental iron/400mcg folic acid, 1 tablet daily for 3-6 months; Vitamin A: at least 5, 0000 IU
every week or a daily multivitamin supplement may be taken as an option when the required
vitamin A is not available)
2. Promotion of healthy lifestyle
3. Advice on family planning and provision of family planning services
4. Prevention and management of life-style related diseases
5. Prevention and management of infection including deworming
6. Counselling on STI/HIV/AIDS, nutrition, personal hygiene and consequences of abortion
7. Adolescent health services
8. Provision of oral health services
B. PRE-NATAL OACKAGE
1. Prenatal visits:
a. at least four times throughout the course of pregnancy
b. pre-natal assessments
2. Micronutrient supplementation:
a. Iron and folate (60mg/400mcg) once a day for 6 moths or 180 tablets
b. Vitamin A: 10, 000 IU twice a week from the fourth month of pregnancy
c. Elemental iodine 200 mg given once during the pregnancy
3. Tetanus toxoid
a. 0.5 ml of TT, IM, deltoid muscle
b. Adequate immunization of women prevents tetanus in both the mother and the newborn
3. Promotion of exclusive breastfeeding, newborn screening and infant immunization
4. Counselling on healthy lifestyle
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5. Early detection and management of pregnancy complications
6. Prevention and management of other conditions such as hypertension, anemia,
diabetes, TB, malaria, STI/HIV/AIDS
C. DELIVERY PACKAGE
1. Skilled birth attendance/skilled health professional-assisted delivery and facility-based
deliveries including the use of partographs
2. Proper management of pregnancy and delivery complications Essential intrapartum and
newborn care practices is applied in hospitals and birthing centers/facilities
D. POSTPARTUM PACKAGE
1. Postpartum visits: within 72 hours and on the 7th day postpartum check for complications like
bleeding and infections
2. Micronutrient supplementation:
a. Iron and folate (60mg/400mcg) once a day for 3 months or 90 tablets
b. Vitamin A: 10, 000 IU twice a week from the fourth month of pregnancy
3. Counseling on nutrition, child care, family planning and other available services
E. NEWBORN PACKAGE
1. Interventions within the first 90 minutes ( Essential Intrapartum and Newborn
Care/EINC)
2. Essential newborn care after 90 minutes to 6 hours
3. Care prior to discharge
F. CHILD CARE PACKAGE

1. Immunization
2. Nutrition
3. Integrated management of childhood illnesses
4. Injury prevention
5. Oral health
6. Insecticide-treated nets for mothers and children in malaria-endemic areas
MNCHN SERVICE DELIVERY NETWORK:
No single facility or unit can provide the entire MNCHN Core Package of Services. It is important
that different health care providers within the locality are organized into a well-coordinated
MNCHN service delivery network to meet the varying needs of populations and ensure the
continuum of care. This is the reason for establishing the province as the basic unit for planning
and implementation of the MNCHN Strategy.
The MNCHN SDN can be a province or city-wide network of public and private health care
facilities and providers capable of giving MNCHN services, including basic and comprehensive
emergency obstetric and essential newborn care. It also includes the communication and
transportation system supporting this network.
1. Community level providers give primary health care services. These may include outpatient
clinics such as Rural Health Units (RHUs), Barangay Health Stations (BHS), and private clinics as
well as their health staff (i.e., doctor, nurse and midwife) and volunteer health workers (i.e.,
barangay health workers, traditional birth attendants).
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The CHTs provide both navigation and basic service delivery functions. Navigation functions
include informing families of their health risks, assisting families in health risks and needs
assessment; assisting families develop health use plans such as birthing plans and facilitating
access by families to critical health services (e.g. emergency transport and communication as
well as outreach) and financing sources (e.g. PhilHealth).
Their basic service delivery functions include advocating for birth spacing and counselling on
family planning services; tracking and master listing of pregnant women, women of
reproductive age, children below 1 year of age; early detection and referral of high-risk
pregnancies; and reporting maternal and neonatal deaths. The team shall also facilitate
discussions of relevant community health issues especially those affecting women and children.
CHTs should be present in each priority population area to improve utilization of services,
ensure provision of services as well as follow-up care for postpartum mothers and their
newborn.
2. Basic Emergency Obstetric and Newborn Care (BEmONC)-capable network of facilities and
providers can be based in hospitals, RHUs, BHS, lying-in clinics or birthing homes. If the
BEmONC is hospital based, blood transfusion services which may or may not include blood
collection and screening will be provided. These facilities operate on a 24-hour basis with staff
complement of skilled health professionals such as doctors, nurses, midwives and medical
technologists.
A BEmONC based in RHUs, BHS, lying-in clinics, or birthing homes can either be a stand-alone
facility or composed of a network of facilities and skilled health professionals capable of
delivering the six signal functions. A standalone BEmONC-capable facility is typically an RHU
which has the complement of skilled health professionals such as doctors, nurses, midwives and
medical technologists. BEmONCs operating as a network of facilities and providers can consist
of RHUs, BHS, lying-in clinics, or birthing homes operated by skilled health professionals. At the
minimum, this can be operated by a midwife who is either under supervision by the rural health
physician or has referral arrangements with a hospital or doctor trained in the management of
maternal and newborn emergencies. Under this arrangement, a midwife can provide lifesaving
interventions within the intent of A. O. 2010-0014.
BEmONCs shall be supported by emergency transport and communication facilities. The

provision of blood transfusion services in non-hospital BEmONCs shall be dependent on
presence of qualified personnel and required equipment and supplies.
3. Comprehensive Emergency Obstetric and Newborn Care (CEmONC)- capable facility or

network of facilities are end-referral facilities capable of managing complicated deliveries and
newborn emergencies. It should be able to perform the six signal obstetric functions, as well as
provide caesarean delivery services, blood banking and transfusion services, and other highly
specialized obstetric interventions. It is also capable of providing newborn emergency
interventions, which include, at the minimum, the following: (a) newborn resuscitation; (b)
treatment of neonatal sepsis/infection; (c) oxygen support for neonates; (d) management of
low birth weight or preterm newborn; and (e) other specialized newborn services.
The CEmONC-capable facility or network of facilities can be private or public secondary or

tertiary hospital/s capable of performing caesarean operations and emergency newborn care.
Ideally, a CEmONC-capable facility is less than 2 hours from the residence of priority
populations or the referring facility.
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These facilities can also serve as high volume providers for IUD and VSC services, especially
tubal ligations and no-scalpel vasectomy.
A typical CEmONC-capable facility has the following health human resource complement: 3
doctors preferably obstetrician/surgeon or General Practitioner (GP) trained in CEmONC (1 per
shift), at least 1 anesthesiologist or GP trained in CEmONC (on call), at least 1 pediatrician (on
call), 3 Operating Room nurses (1 per shift), maternity ward nurses (2 per shift), and 1 medical
technologist per shift.
Alternatively, the SDN can also designate a CEMONC-capable network of facilities that has the
necessary staff, equipment and resources coming from a network in order to provide the full
range of CEmONC services. For example, a designated facility capable of doing caesarean
sections may not have incubators within its physical facility but can secure this equipment either
from other providers or assign care of premature neonates to another facility within the
network.
The CEmONC capable facility or network of facilities should organize an itinerant team that will
conduct out-reach services to remote communities. A typical itinerant team is composed of at
least 1 doctor (surgeon), 1 nurse and 1 midwife.
REPRODUCTIVE HEALTH
Definition:
A state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity in all matters relating to the reproductive system and its functions and
process.
Concepts:
• A married couple has the capability to reproduce/ procreate
• Reproductive health is the exercise of reproductive right with responsibility
• RH includes sexual health for the purpose of enhancement of life and personal relations
• RH means safe pregnancy and delivery
• RH includes protection from unwanted pregnancy by having access to safe and
acceptable methods of family planning of their choice.
• RH includes protection from harmful reproductive practices and violence
• RH assures access to information on sexuality to achieve sexual enjoyment
Vision
Reproductive health practice as a way of life for every man and woman throughout life.
Goals
• To achieve healthy sexual development and maturation
• To achieve their reproductive intention
• To avoid illness diseases, injuries disabilities related to sexuality and reproduction
• To receive appropriate counselling and care of RH problems
Strategies
• Increase in improve the use of more effective or modern contraceptive methods
• Provision of care, treatment and rehabilitation for RH, if possible in all facilities
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• RH care provision should be focused on adolescent, men and unmarried and other
displaced people with RH problems
• Strengthen outreach activities and the referral system
• Prevent specific RH problems
Ten Elements of Reproductive Health

1. Maternal and Child Health and Nutrition
2. Family Planning
3. Prevention and Management of abortion complications
4. Prevention and treatment of Reproductive Tract Infections including STDs, HIV and
AIDS
5. Education and counselling on sexuality and sexual health
6. Breast and Reproductive Tract Cancers and other Gynecological conditions
7. Men’s reproductive Health
8. Adolescent Reproductive Health
9. Violence against Women (VAW)
10. Prevention and Treatment of infertility and sexual disorder
Factors/ Determinants of RH
1.Socio- Economic conditions
• Education
• Employment
• Poverty
• Nutrition
• Living Condition/ Environment
• Family Environment
2. Status of women
3. Social and Gender Issues
4. Biological, cultural and Psycho- Social Factors
NATIONAL FAMILY PLANNING PROGRAM
VISION:
For Filipino women and men achieve their desired family size and fulfill the reproductive health
and rights for all through universal access to quality family planning information and services.
MISSION
In line with the Department of Health FOURmula One Plus strategy and Universal Health Care
framework, the National Family Planning Program is committed to provide responsive policy
direction and ensure access of Filipinos to medically safe, legal, non-abortifacient, effective, and
culturally acceptable modern family planning (FP) methods.
OBJECTIVES:
To increase modern Contraceptive Prevalence Rate (mCPR) among all women from 24.9% in
2017 to 30% by 2022
To reduce the unmet need for modern family planning from 10.8% in 2017 to 8% by 2022
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PROGRAM COMPONENTS:
Component A: Provision of free FP Commodities that are medically safe, legal, non-
abortifacient, effective and culturally acceptable to all in need of the FP service:
Forecasting of FP commodity requirements for the country
Procurement of FP commodities and its ancillary supplies
Strengthening of the supply chain management in FP and ensuring of adequate FP supply at
the service delivery points
Component B: Demand Generation through Community-based Management Information

System:
Identification and profiling of current FP users and identification of potential FP clients and
those with unmet need for FP (permanent or temporary methods)
Mainstreaming FP in the regions with high unmet need for FP
Development and dissemination of Information, Education Communication materials
Advocacy and social mobilization for FP
Component C: Family Planning in Hospitals and other Health Facilities

Establishment of FP service package in hospitals
Organization of FP Itinerant team for outreach missions
Delivery of FP services by hospitals to the poor communities especially Geographically Isolated
and Disadvantaged Areas (GIDAs):
Provision of budget support to operations by the itinerant teams including logistics and medical
supplies needed for voluntary surgical sterilization services
FP services as part of medical and surgical missions of the hospital
Partnership with LGU hospitals for the FP outreach missions
Component D: Financial Security in FP

Strengthening PhilHealth benefit packages for F
Expansion of PhilHealth coverage to include health centers providing No Scalpel Vasectomy and
FP Itinerant Teams
Expansion of Philhealth benefit package to include pills, injectables and IUD
Social Marketing of contraceptives and FP services by the partner NGOs
National Funding/Subsidy
Partner Institutions
Local Government Units
Civil Society Organizations
Non-Government Organizations
Private Sector
Faith-based Organizations
Development Partners
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HIGH-RISK PRENACY CONDITIONS:
1. Being too young (less than 18 years old) or too old (over 34 years old)
2. Having had too many (4 or more) pregnancies
3. Having closely spaced (too close) pregnancies (less than 36 months)
4. Being too ill or unhealthy/too sick or having an existing disease or disorder
FOUR PILLARS OF FAMILY PLANNING PROGRAM

1. RESPONSIBLE PARENTHOOD
This refers to the will and ability to respond to the needs and aspirations of the family. It
promotes the freedom of responsible parents to decide on the timing and size of their families
in pursuit for a better life
2. RESPECT FOR LIFE
The 1987 Constitution protects the life of the unborn from the moment of conception. FP aims
to prevent abortions, thereby saving lives of both women and children
3. BIRTH SPACING
Proper spacing of 3-5 years from a recent pregnancy enables a woman to recover from
pregnancy and to improve her well-being, the health of the child, and the relationship between
husband and wife and between parents and children
4. INFORMED CHOICE
Couples and individuals are fully informed on the different modern FP methods. Couples and
individuals decide and may choose the methods that they will used based on informed choice
and to exercise responsible parenthood in accordance with their religious and ethical values and
cultural background, subject to conformity with universally recognized international human
rights
BENEFITS OF FAMILY PLANNING
Benefits to mothers
1. Enables her to regain her health after delivery
2. Gives enough time and opportunity to love and provide attention to husband and children
3. Gives more time for her family and own personal advancement
4. When suffering from an illness, gives enough time for treatment and recovery
Benefits to children
1. Healthy mothers produce healthy children
2. Will get all attention, security, love and care they deserve
Benefits to fathers
1. Lightens the burdens and responsibility in supporting his family
2. Enables him to give his children their basic needs
3. Gives time for his family and own personal advancement
4. When suffering from an illness, gives enough time for treatment and recovery
FAMILY PLANNING METHODS
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Advantages Disadvantages
1. Female sterilization (bilateral tubal lagation) cutting/blocking 2 fallopian tube

(effectiveness: 99.5%
a. permanent a. uncommon complications:

b. no effect on breastfeeding infection/bleeding
c. minilaparotomy can be performed after a
b. ectopic pregnancy if ever
woman gives birth c. reversal is difficult
d. not protective against STD
e. limitation of work only after surgery
2. Male sterilization (vasectomy): cutting vas deferense thru scrotal opening
(effectiveness: 99.9%)
a. very effective after 3 mos. of procedure a. slight pain & swelling 2-3 days after
b. permanent and safe not lose sexual ability procedure
and ejaculation b. reversibility difficult
c. not affect male hormonal function, erection c. bleeding may result in hematoma in the
& ejaculation scrotum
d. not protective against STD
3. Pill (Estrogen & Progesteron) (effectiveness: 99.7%)
a. safe a. S/E: nausea, dizziness, breast tenderness

b. menstrual cycle more regular & predictable (not really harmful)
c. reduce painful menses and endometriosis b. Decrease effectiviness with: Rifampicin &
d. reduce ovarian & endometrial CA anti-convulsants
e. reversible c. Suppress lactation
4. Male condom (effectiveness: 98%) use in erected penis
a. Safe a. allergy to latex or lubricant

b. protect against STD b. decrease sensation
c. encourage male participation in FP c. interrupts the sexual act
d. easily accessible d. requires a man’s cooperation for its use
e. manage premature ejaculation
5. Injectables (synthetic hormone, progestin) (effectiveness: 99.7%)
a. suppressing ovulation
b. thickens cervical mucus
a. reversible (no estrogen related S/E:
nausea, dizziness, nor serious
complications such as thromboplebitis or
pulmonary embolism)
b. not affect breast feeding
6. Lactation Amenorrhea Method (LAM): temporary introductory postpartum
method of postponing pregnancy based on physiological infertility experienced by
breast feeding women (effectiveness = 9.5%)
a. universally available a. maximum effectiveness of 6 months

b. protection from an unplanned pregnancy postpartum (short)
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begins immediately postpartum b. effectiveness decrease with separation of
c. no FP commodities are required mother & child
d. improve maternal & child health & nutrition
c. difficult to maointain BF for 6 months
d. disadvantage to women who do not pass
any of the three criteria to practice
lactation amenorrhea
7. Mucus/Billing/Ovulation: abstaining from sexual intercourse during fertile (wet)
days prevents pregnancy
By: 1. recording of menstruation and dry days (effectiveness = 97%)
2. inspecting underwear regularly for presence of mucus
3. recording the most fertile observation/characterics at the end of the day
a. can be used by any women of reproductive a. not for women making pregnancy
age provided not suffering from unusual dangerous
condition resulting to extraordinary vaginal
discharge
8. Basal Body Temperature: daily taking and recording of the rise in the body
temperature during & after ovulation
Effectiveness: 99%
Thermometer is placed in axilla or under the tongue at least 3 hours of undisturbed rest during
(upon waking up and before any activity) throughout the menstrual cycle.
Cover line is being determined to identify the highest temp. from day 6-10 of the
menstrual cycle to identify thermal shift (the three consecutive temp above the cover line
labeled as days 1,2,3)
Intercourse is allowed from the 4th day of thermal shift until the end of the cycle (absolute
infertile phase days)
a. Very effective a. take BBT everyday and time to record

temperature. b. may practice abstinence
during fertile periods
9. Sympto-thermal method: identifying the fertile and infertile days of the

menstrual cycle as determined through a combination of observations made on the
cervical mucus, basal body temp recording and other signs of ovulation
Effectiveness: 90%
10. Two Day Method: cervical secretions as an indicator of fertility
Effectiveness: 96.5%; women checking the presence of secretions everyday
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a. Can be used by women with any cycle a. Needs the cooperation of the husband
length b. Can become unreliable for women who
b. enhances self discipline mutual respect have conditions that cause abnormal
cooperation communication, and shared cervical secretions
responsibility of the couple for the FP c. Does not protect the client from HIV/AIDS
c. Acceptable to couples regardless of
culture, religion, socioeconomic status, and
education
11. Standard Days Method: new method of natural family planning in which all
users with menstrual cycles between 26 and 32 days are counseled to abstain from
sexual intercourse on days 8-19 to avoid pregnancy; use color coded cycle beads to
mark the fertile and infertile days of the menstrual cycle
Abstain from sexual intercourse during fertile period

Use color coded beads to mark the fertile and infertile periods
Effectiveness: 95%
a. Increases self awareness and knowledge a. Cannot be used by women who usually
of human reproduction and can lead to a have menstrual cycle between 26 and 32 days
diagnosis of some gynecologic problems long
b. No need for counting or charting since the
standard days method makes use of beads
for tracking the cycle days
c. used either to avoid or achieve
pregnancy
d. Acceptable to couples regardless of
culture, religion, socioeconomic status, and
education
INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS: AN OVERVIEW
In the Philippines, pneumonia was one of the leading causes of infant deaths while diarrhea and
gastroenteritis presumed infectious origin ranked in the top ten. Pneumonia and diarrhea were
two of the top three causes of childhood mortality. Worldwide, more than 50 countries have
high childhood mortalities. More than ten million children die from developing countries before
reaching five years old. Seven of the ten deaths are due to: acute respiratory infections (mostly
pneumonia), diarrhea, measles, malaria or malnutrition – or combination of these illnesses.
The WHO/UNICEF initiated the Integrated Management of Childhood Illness (IMCI) strategies
which offer simple and effective methods for child survival, healthy growth and development
and is based on the combined delivery of essential interventions at community, health facility
and health system levels. The IMCI process includes preventive as well as curative measures to
address the most common conditions that affect young children
The IMCI strategy includes three main components:

a. Improvements in case management skills of health care staff
b. Improvements in the health system needed fir effective management of childhood illness
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c. Improvement in family and community practices
IMCI case management
IMCI clinical guidelines are meant to be used by health worker in the management of sick
children from age 1 week up to 5 years. The IMCI guides the health worker in:
a. Assessing signs that indicate severe diseases
c. Assessing a child’s nutrition, immunization and feeding
d. Teaching parents how to care for a child at home
e. Counselling parents to solve feeding problems
f. Advising parents about when to return to a health facility
IMCI case management processes:
1. ASSESS a child by checking first for danger signs (or possible bacterial infection in a young
infant), asking questions about common conditions, examining the child, and checking
nutrition and immunization status. Assessment includes checking the child for other health
problems.
2. CLASSIFY a child’s illnesses using a color-coded triage system. Many children have more
than one condition. Each illness is classified according to whether it requires:
a. Urgent prereferral treatment and urgent referral (pink)
b. Specific medical treatment and advice (yellow)
c. Simple advice on home management (green)
3. After classifying all conditions, IDENTIFY specific treatments for the child. If a child requires
urgent referral, give essential treatment before transferring. If a child is to be treated at
home, make a treatment plan and give first dose of drugs in the clinic. Give immunizations if
needed or scheduled
4. Provide practical TREATMENT instructions, including teaching the mother or caretaker on
how to give oral drugs, how to feed and give fluids during illness, and how to treat local
infections at home. Ask the mother or caretaker to return for follow-up on a specific
schedule. Teach her to identify untoward signs and symptoms and when to return
immediately.
5. Assess feeding, including breastfeeding practices and COUNSEL to solve any feeding
problems. Counsel the mother with her own health conditions.
6. When a child is brought back to the clinic as requested, GIVE FOLLOW-UP CARE and, if
necessary, reassess the child for possible new problems.
The case management is for two age groups: (a) children aged 2 months to 5 years and (b) 1
week to 2 months. The health worker would ask the age of the child first. If the age is “up to 5
years” the chart is “sick child”. If the age is younger than 2 months, the chart would be “young
infant”. These two age brackets have different case managements. Then, the HCW will ask
what is the problem of the child and if it is an initial visit or follow-up. From there, the
management continues
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V. ESSENTIAL DRUGS
- are medicinal preparations necessary to fill the basic health needs of the population.
- Also are those drugs that satisfy the health care needs of the majority of the population;
they should therefore be available at all times in adequate amounts and in appropriate
dosage forms, at a price the community can afford
The 10 Medicinal plants endorsed by DOH

MEDICINAL PLANTS USE/INDICATION PREPARATION
(with scientific name)
LAGUNDI Asthma. cough and fever; Decoction
Vitex negundo Dysentery, colds and pain in Wash affected site
any part of the body as in
influenza; Skin diseases
(dermatitis, scabies, ulcer,
eczema) and wounds;
Headache, Rheumatism,
sprain, contusion, insect
bites; Aromatic bath for sick
patient
OLASIMANG BATO Lowers uric acid Decoction or
Peperomia pellucida eaten raw
BAYABAS Washing wounds, diarrhea, Decoction
Psidium guajava as gargle and to relieve
toothache.
BAWANG Hypertension; toothache; Eaten raw/fried or

Allium sativum lower cholesterol levels in Apply on part
blood
YERBA BUENA Rheumatism, arthritis and Decoction
Clinopodium douglasii headache; cough & cold, Infusion
swollen gums, Toothache, Massage sap
menstrual and gas pain,
nausea and fainting, insect
bites
SAMBONG Anti-edema, diuretic, anti- Decoction

Blumea balsamifera urolithiasis
AKAPULKO Anti-fungal: Tinea Flava, Poultice

Cassia alata ringworm, athlete’s foot, and
scabies
NIYOG-NIYOGAN Anthelminthic Seeds are used
Quisqualis indica L.
TSAANG GUBAT Diarrhea Decoction
Ehretia microphylla Lam.
AMPALAYA Lower blood sugar levels Decoction
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Momordica charantia Diabetes Mellitus (Mild non- Steamed
insulin dependent)
Medicinal plant preparations
Preparation Procedure
Decoction Boil the recommended part of the plant
material in water (20 minutes)
Infusion Plant material is soaked in water.
Recommended soaking period is 10-15
minutes or longer
Poultice Directly apply recommended plant material
on the part affected
Tincture Mix the plant material in alcohol
Others:
Oil
Ointment
Cataplasm
Syrup
GUIDELINES
1. Avoid the use of insecticides as these may leave poison on plants.
2. In the preparation of herbal medicine, use a clay pot and remove cover while boiling at low
heat.
3. Use only the part of the plant being advocated.
4. Follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each type of symptoms or sickness.
6. Stop giving the herbal medication in case untoward reaction such as allergy occurs.
7. If signs and symptoms are not relieved after 2 or 3 doses of herbal medication, consult a
doctor.
LAWS RELATED:
LAW DESCRIPTION
Generics Act of 1988 “Formally proclaims the state of promoting
R.A. # 6675 the use of generic terminology in the
importation, manufacture, distribution,
marketing, promotion & advertising, labeling,
prescribing & dispensing of drugs.”
“Reinforces the NDP with regards to the

assurance of the high-quality & rational drug
use.”
Dangerous Drugs Act “ The safe administration & transportation of
R.A. 6425 prohibited drugs is punishable by law.”
2 Types of Drugs:
Prohibited Regulated
Republic Act 9165 Comprehensive Dangerous Drugs Act of 2002
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VI. NUTRITION PROGRAM
GOAL:
The improvement of nutritional status, productivity and quality of life of the
population through the adoption of desirable dietary practices and healthy lifestyle
OBJECTIVES:
To decrease the morbidity and mortality rates secondary to avitaminoses and other
nutritional deficiencies among the population mostly composed of infants and
children
COVERAGE:
• Protein Energy Malnutrition (PEM)
• Vitamin A deficiency (VAD)
• Iron Deficiency Anemia (IDA)
• Iodine Deficiency Disorder (IDD)
• Philippine Food & Nutrition Programs
• Directed to the provision of nutrition services to the DOH’s identified priority
vulnerable groups
1. MALNUTRITION REHABILITATION PROGRAM

Targeted Food Task Force Nutrition Rehabilitation Akbayan sa Kalusugan
Assistance Program Ward (ASK Project)
Provision of food rations of Every hospital must have a Aimed to provide rice & corn
bulgur wheat & green peas Nurse ward, where an soya blend supplemented
adequately trained with local foods.
Target population: nutritionist were assigned
Pre-schoolers (RA 422) Target pop:
Pregnant women 6 mos- 2 years
Lactating mothers Moderately & severely
underweight
Pre-schoolers not served by
the DSWD and DA in Regions
2,8,9,10,11,12
2. MICRONUTRIENT SUPPLEMENTATION PROGRAM
“23 in 93” FORTIFIED VITAMIN RICE “Health for More in ‘94”

“Buwan ng Kabataan, Pag-asa ng
Bayan’
National Focus: National Micronutrient
Day or “Araw ng Sangkap Pinoy”
-Aimed to distribute vitamin A supplements,
-A free enrichment program aimed to prevent iodized oil for & seedlings of plants rich in Fe
96
deficiencies in vitamin A (blindness); iron & other minerals.
(anemia); iodine (goiter, mental retardation
& delayed development)
(1 cavan of rice + fistful processed, binilid

enriched with essential micronutrients)
3. FOOD FORTIFICATION PROGRAM

- Is the government’s response to the growing micronutrient malnutrition that has been
prevalent in the Philippines for the past several years
- Vitamin A, Iron, Iodine
- Sangkap Pinoy
- FIDEL salt
*whether or not they are normally contained in the food for the prevention or correction of
deficiency
*Sangkap Pinoy micronutrients required by the body in very small quantities
4. NUTRITION SURVEILLANCE SYSTEM

- A system of keeping close watch on the state of nutrition & the causes of malnutrition
w/n a locality, w/ involves periodic collection of data & analysis & dissemination of
analyzed information
- Tools utilized are Anthropometric measurements:
A. Weight for Age
B. Height for Age
C. Weight for Height
D. BMI
Weight for Age:

Measures degree & presence of wasting or stunting
Height for Age:

Measures the presence of stunting
< 90% of standard→ stunting or past chronic malnutrition
Weight for Height:

Determines the presence of muscle wasting:
Ideal body wt,: 135

Body mass index(BMI)= wt in kgs
Ht in meters
IBW: +6 for every increment of an inch above 5 ft +5 (males)
105-110 lbs for a height of 5 feet 100-105 lbs
-6 for every decrement of an inch below 5 ft -5
DEGREE OF MALNUTRITION INTERPRETATIONS:

110% and above – obese
90-109% - normal
75-89 % - 1st degree
60-75% - 2nd degree
59 and below – 3rd degree
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TYPES OF NUTRITIONAL DEFICIENCIES
A. PROTEIN ENERGY MALNUTRITION (PEM)
1. MARASMUS
- Child lacks food rich in CHON & energy
- Usually the child is < 1 year old when malnutrition starts
MANIFESTATIONS:
• Very thin, no fat, muscle wasting
• Prominent ribs
• Very poor wt gain
• Loose & wrinkled skin
• Enlarged abdomen
• Anxious, always hungry
• “Old Man’s Face”
2. KWASHIORKOR
- Disease of older children when the next baby is born.
- Usually when the child is 1-3 y/o
MANIFESTATIONS:
- Very thin, fails to grow
- Light colored, weak hair
- Moon-shaped, Unhappy face
- Enlarged abdomen
- Muscle wasting
- Swollen legs, feet, arms & hands
- Doesn’t want to eat
- Dark spots on skin
- Skin sores & skin is peeling
- Apathetic
TREATMENT:
Food
B. VITAMIN A DEFICIENCY
CAUSES:
-Low intake of Vitamin A rich food
- Low intake of protein
- Illnesses like measles, diarrhea
CONSEQUENCES:
Blindness
1. Night blindness
2. Nutritional blindness
SOURCES:
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-Breast milk, animal sources, whole milk, eggs, liver, meat
-Yellow/orange fruits (papaya, mango)
- Plant sources yellow/orange vegetables (carrots & squash)
- Green leafy vegetables (malunggay, kangkong), Vit. A capsule
UNIVERSAL SUPPLEMENTATION OF VITAMIN A
INFANTS PRESCHOOLERS PREGNANT POSTPARTUM
WOMEN MOTHERS
100,000 IU 200,000 IU 10,000 IU twice a 200, 000 IU within
One dose only One capsule every 6 week starting at four weeks after
months th
delivery
the 4 month of
pregnancy*
Vitamin A supplementation to High risk children.
Measles 100, 000 IU One capsule given upon

Infants (6 months-11 200, 000 IU diagnosis, regardless of when
months) the last dose of VAC was
Pre-school children given
(12 months- 71 months)
Severe pneumonia 100, 000 IU One capsule given upon
Persistent Diarrhea 200, 000 IU diagnosis, except when the
Malnutrition child was given VAC less than
Infants (6 months- 11 4 weeks before diagnosis
months)
Pre-school children
(12 months – 71 months)
Malnutrition 200, 000 IU One capsule given upon
School children (6 diagnosis, except when the
years to 12 years old) child was given VAC less than
4 weeks before diagnosis
C. IRON DEFICIENCY ANEMIA (IDA)

- Not enough hemoglobin in the RBC because of lack of Fe
CAUSES:
- Low intake of iron-rich foods
- Blood loss
- Poor absorption
- Increased demands
Sources:
a. best animal sources: liver, internal organs, meat, blood, fish, shellfish.
b. best plant sources: green leafy vegetables, dried beans
TREATMENT AND PREVENTION:

-provision of iron with folic acid
- pregnant: Once a day for 180 days
Lactating women: once a day for 90 days
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IRON SUPPLEMENTATION FOR PREGNANT AND LACTATING WOMEN
TARGETS PREPARATIONS DOSE/DURATION
Pregnant women Tablet containing 60 mg 1 tablet once a day for 6
elemental iron with 400 mcg months 0r 180 days during the
folic acid pregnancy period
Or
2 tablets per day (120 mg) if
prenatal consultations are done
nd rd
during the 2 and 3 trimester
Lactating women Tablet containing 60 mg 1 tablet once a day for 3
elemental iron with 400 mcg months or 90 days
folic acid
D. IODINE DEFICIENCY DISORDERS (IDD)

- Abnormalities d/t low iodine intake.
CAUSES:
- Low intake of iodine-rich foods
- Goitrogens and other environmental factors
CONSEQUENCES:
Fetus – abortion/miscarriage/abnormalities/still
Infants – cretinism/delayed walking/motor activities
Children – poor academic performance
Adults – mental impairment/poor working capacity
TREATMENT:
- Women 15-45 y/o, School age children, adult males:
to take one iodized capsule with 200mg iodine every year
SOURCES:
a. 90%-food
b. 10% water
TERMS TO DESCRIBE DIFFERENT FEEDING PATTERNS
Exclusive breastfeeding – the infant receives breastmilk and allows the infant to receive oral
rehydration salt (ORS), drops, syrups, nothing else
Predominant breastfeeding – the infant’s predominant source of nourishment has been breast
milk, including milk expressed from the mother or wet nurse as sources. However, the infant
may also have received liquids – water, water-based drinks, fruit juice, vitamins, minerals and
oresol
Complementary feeding – process of giving the infant foods and liquids, along with breast milk,
when breast milk is no longer sufficient to meet the infant’s nutritional requirements
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Bottle feeding – the child is given food or drinl from a bottle with nipple/teat. Information on
bottle feeding is useful because of the potential interference of bottle feeding with optimal
breastfeeding practices and the association between bottle feeding and increased diarrheal
mortality and morbidity cases
Early initiation of breastfeeding – initiating breastfeeding of the newborn after birth within 90
minutes of lifein accordance to the essential newborn care protocol
BREASTFEEDING
Unique characteristics of Breast milk:
B est for babies F resh

R educed allergic reaction E motional bonding
E conomical E asily established
A lways available D igestible
S afe/ maintains the stool soft I mmunity
T emperature always right N nutritious
G IT disorders are decreased
Difference of breast milk from formula milk:
Breastmilk vs. Formula

CHO > CHO
CHON (LACTALBUMIN) < CHON
(CASEIN)
Fats = Fats
Linoleic acid content (3x) > Linoleic acid
content
Minerals < minerals
LAWS RELATED:
LAW DESCRIPTION
Executive Order 51 The Milk Code. Prohibits advertising,
promotion, or other marketing materials that
shall imply or create a belief that bottle
feeding is equivalent or superior to
breastfeeding
Executive Order 382 Provided for the observance of the National
Food Fortification Day every November 7
Republic Act 7600 Rooming-In and Breastfeeding Act. States
that the newborn be put to the breast of the
mother immediately after birth and be
roomed-in 30 minutes after normal
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spontaneous delivery and within 3-4 hours
after Caesarian section delivery
Republic Act 8172 ASIN (Act for Salt Iodization Nationwide)
Law. Requires all producers of food-grade
salt to iodize the salt that they produce,
import, trade or distribute
Republic Act 8976 Philippine Food Fortification Act. Mandates
the fortification of rice with iron, wheat flour
with vitamin A and iron, refined sugar with
vitamin A, cooking oil with vitamin A;
promotes fortification of food products
through the Sangkap Pinoy seal Program
Republic Act 10028 Expanded Breastfeeding Promotion Act.
Mandates the setting up of lactation stations
in all health and nonhealthy facilities,
establishments, or institutions. It also grant
breaks for nursing employees to breastfeed
or express milk
Administrative Order 36, series 2010 Expanded Garantisadong Pambata. A
comprehensive and integrated package of
services on health, nutrition and environment
for children available everyday at various
settings such as homes, schools, health
facilities and community by government, non-
government organizations, private groups
and civic groups
TEACHER’S INSIGHTS
Primary Health Care is both a philosophy and a strategy. It is an all-encompassing strategy for
all the health services or programs. All the programs are abbreviated as ELEMENTS and all is
anchored to the pillars, principles and strategies of PHC. The programs are to correct the
inequities in the nation and to prioritize the most vulnerable communities. The success of these
programs is based on the partnership among the government, private groups and other sectors.
One of the focuses of the MDGs and SDGs is the improvement of the maternal and child health.
The MNCHN, EPI and Nutrition programs of the Philippines should continue to yield positive
results. In the long run, this is an indicator of a healthy individual, family and the community.
SELF-REFLECTION:
With all these (some) programs you learned, what can you say and feel of becoming a public
health nurse implementing all of these programs. What program/s is/are you most interested?
How are you going to implement it ensuring success of the program?
CHAPTER ACTIVITIES:
1. From the presented programs (ELEMENTS) of PHC, choose one program. Relate it to your
community.
2. What is the situation in your community? What are the related factors or data from your
community that led you to choose the program?
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3. What are the roles of the public health nurse in your community in the implementation of the
program/s?
4. As a nursing student, how can you contribute in the implementation of the program?
REFERENCES:
Books:
Famorca (2013). Nursing Care of the Community: A Comprehensive Text on Community and
Public Health 1st edition
WHO and UNICEF (2015). Integrated Management of Childhood Illness (IMCI) Workbook and
Resource Manual
Websites:
www.doh.gov.ph
www.who.int
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FINALS COVERAGE
Specific Instructions in the completion of each chapter:

hours.
teacher.
CHAPTER 5
TREATMENT OF NON-COMMUNICABLE DISEASES

1. Define non-communicable diseases
2. Identify lifestyle-related diseases
3. List the different risk factors of lifestyle-related diseases
4. Enumerate ways to prevent non-communicable diseases
5. State the different laws affecting implementation of control of non-communicable diseases
6. Conduct health education sessions on the different communicable and non-communicable
diseases
7. Create IEC materials related to the planned health education session topic/s.
KEY TERMS:
blindness
cancer
cardiovascular disease
chronic diseases
chronic obstructive pulmonary disease
diabetes
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hypertension
mental health
INTRODUCTION:
NON-COMMUNICABLE DISEASES (NCD)
NCD is a medical condition that is noninfectious and non-transmissible. On the other hand,
communicable diseases are caused by an infectious agent and is transmissible from one person
to another. NCDs are referred as “chronic diseases” due to their long duration. It is also
interfering in the day-to-day life of the individual for more than 6 months. These are also
considered “lifestyle-related diseases” because an unhealthy lifestyle is a common risk factor.
4 MAJOR NON-COMMUNICABLE DISEASES (CHRONIC DISEASES/LIFESTYLE

RELATED DISEASES):
1. CARDIOVASCULAR DISEASES
2. CANCER
3. CHRONIC OBSTRUCTIVE PULMONARY DISEASES
4. DIABETES MELLITUS
Disability adjusted life year or DALY = most widely used summary measure of the
burden of disease is the, which combines the number of years of healthy life lost to
premature death with time spent in less than full health.
Diseases are linked by three major risk factors: tobacco smoking, physical inactivity
and an unhealthy diet. Below are the risk factors with the corresponding prevalence rates:
a. Physical inactivity 60.5%
b. Smoking... 34.8%
c. Hypertension 22.5% (SBP> 140 or DBP>90)
d. Hypercholesterolemia 8.5% (TC>240)
e. Obesity 4.9% (BMI>30)
f. Diabetes... 4.6%
GOAL
Reduce the toll of morbidity, disability and premature deaths due to chronic, noncommunicable
lifestyle related disease.
To achieve significant reduction in morbidity and mortality from major NCDs, the following
approaches should characterize the program:
1. Comprehensive Approach Focused on Primary Prevention
2. Community-based Approach: people as the center of any health and development effort.
3. Integrated Approach
KEY INTERVENTION STRATEGIES
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1. Establishing program direction and infrastructure.
2. Changing environments.
3. Changing lifestyle.
4. Reorienting health services.
THE ROLE OF PUBLIC HEALTH NURSE IN NCD PREVENTION AND CONTROL

a. Health Advocate: promote active community d. Community Organizer
participation e. Health Trainer
b. Health Educator f. Researcher
c. Health Care Provider
LESSON 1: CARDIOVASCULAR DISEASES
1. HYPERTENSION
A. Primary hypertension (essential/ idiopathic hypertension) (90%): no definite cause
(attributed to atherosclerosis)
B. Secondary hypertension: result of some other primary diseases leading to hypertension
such as renal disease.
RISK FACTORS:
Family history, age, high salt intake, obesity
- Fat distribution is more important risk factor than actual weight as measured by waist-
to-hip ratio. Increased waist-to-hip ratio is more associated with hypertension),
excessive alcohol intake
KEY AREAS FOR PREVENTION OF HYPERTENSION:

• Encourage Proper Nutrition
• Prevent overweight or obesity
• Weight reduction through proper nutrition and exercise
• Smoking cessation
• Identify people with risk factors and encourage regular check-ups for possible
hypertension and modification of risk factors.
2. CORONARY ARTERY DISEASE (CAD)/ISCHEMIC HEART DISEASE

→ decreased O2 to the heart muscle → chest pain (angina) →myocardial infarction (heart
attack), arrhythmias, heart failure, and sudden death.
- most common cause is atherosclerosis, thickening of the inside walls of arteries due
to deposition of a fat-like substance. It affects large and medium-sized arteries like the
aorta, coronary arteries and the large vessels that supply the brain.
- Atherosclerosis usually occurs when a person has high levels of cholesterol in the blood.
In diabetes mellitus, atherosclerosis is accelerated, often resulting in coronary artery
disease, myocardial infarction and stroke.
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RISK FACTORS
Elevated blood lipids/cholesterol: High LDL (low-density lipoprotein) level is a risk factor of CAD
Smoking/Tobacco Use
3. CEREBROVASCULAR DISEASE OR STROKE

- Loss or alteration of bodily function that results from an insufficient supply of blood to
some parts of the brain.
TYPES: thrombotic stroke, embolic stroke and hemorrhagic stroke (most fatal)
KEY AREAS FOR PREVENTION OF STROKE:

• Treatment and control of hypertension
• Smoking cessation and promoting a smoke-free environment
• Prevent thrombus formation in rheumatic heart disease and arrhythmias with
appropriate medications.
• Limit alcohol consumption for women, not more than one drink per day, and for men,
not more than two drinks per day.
LESSON 2: CANCER
CANCER: a part of the body begin to grow out of control.
Metastasis - travel to other parts of the body where they begin to grow and replace normal
tissue.
*Cause of cancer is unknown though it is attributed to several factors
RISK FACTORS:
1. Heredity/Family History,
2. Carcinogens,
3. Chemicals & Environmental Agents (Polycyclic hydrocarbons: chemicals found in
cigarette smoke, industrial agents, or in food such as smoked foods. Polycyclic
hydrocarbons are also produced from animal fat in the process of broiling meats and are
present in smoked meats and fish; Aflatoxin is found in peanuts and peanut butter;
Others include benzopyrene, nitrosamines),
4. Benzopyrene (Produced when meat and fish are charcoal broiled or smoked (e.g.tinapa
or smoked fish). Also produced when food is fried in fat that has been reused
repeatedly.Avoid reusing cooking oil,
5. Nitrosamines (powerful carcinogens used as preservatives in foods like tocino,
longganisa, bacon and hotdog; inhibited by the presence of antioxidants such as
Vitamin C in the stomach)
6. Radiation,
7. Viruses: cervical cancer (human papilloma virus), liver cancer (hepatitis B virus), certain
leukemias, lymphoma and nasopharyngeal cancer (Epstein-Barr virus).
Some of the major risk factors associated with particular types of cancer include the following:
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CANCER RISK FACTORS
Lung cancer Tobacco, Radiation Exposure, Second-hand smoke
Oral cancer Tobacco use, Excessive alcohol use, Chronic irritation (e.g. ill-fitting dentures),
Vit. A def
Laryngeal cancer Tobacco use, Poor nutrition, Alcohol, Weakened immune system, Occupational
exposure to wood dust, paint fumes, Gender: 4-5 times more common in men.
Age: more than 60 years
Bladder cancer Tobacco use, Occupational exposure: dyes, solvents, Chronic bladder
inflammation
Renal cancer Tobacco use (increase risk by 40%), Obesity, Diet: well-cooked meat,
Occupational exposure: asbestos, organic solvents, Age: 50-70 years old
Cervical cancer Tobacco use, Human papilloma virus (HPV) infection, Chlamydia infection, Diet:
low in fruits and vegetables, Family history of cervical cancer
Esophageal cancer Tobacco use, Gender: 3 times more common in men, Alcohol, Diet: low in fruits
& veg.
Breast cancer Early menarche/late menopause, High fat diet, Obesity, Physical inactivity,
alcohol, Hx
Prostate cancer Advancing age, race (African American) and high fat diet, HX
Liver cancer Certain types of viral hepatitis, Cirrhosis of the liver, Long-term exposure to
aflatoxin by a fungus that often contaminates peanuts, wheat, soybeans, corn
and rice)
Skin cancer Unprotected exposure to strong sunlight, Fair complexion, Occupational
exposure
Colonic cancer Personal/family history of polyps, High fat diet and/or low fiber diet, History of
ulcerative colitis, Age: >50 years
Uterine/endometrial Estrogen replacement therapy, Early menarche/late menopause
cancer
KEY AREAS FOR PRIMARY PREVENTION OF CANCERS:

Smoking cessation
Proper Nutrition (Beta-carotene, vitamins A, C, E and dietary fiber)
LESSON 3: DIABETES MELLITUS (DM)
The individual may die of coronary heart disease as a complication, if the disease is
uncontrolled or mismanaged.
Hyperglycemia present at time of diagnosis.
SPECIFIC CAUSE:
Genetic Predisposition (diabetogenic genes)
Environment/Lifestyle (obesity, poor nutrition, lack of exercise)
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TYPES:
a. Type I (insulin-dependent diabetes mellitus (IDDM)
- absolute lack of insulin due to damaged pancreas
- prone to develop ketosis
- dependent on insulin injections
b. Type II (noninsulin dependent diabetes mellitus)

- more common
c. Gestational Diabetes
- is diabetes that develops during pregnancy
- It may develop into full-blown diabetes.
Characterized by fasting hyperglycemia despite availability of insulin.
POSSIBLE CAUSES:
a. impaired insulin secretion,
b. peripheral insulin resistance and
c. increased hepatic glucose production.
*Usually occurs in older and overweight persons
RISK FACTORS OF TYPE 2 DM

1. Family history of diabetes
2. Overweight (BMI 23 kg/m ) and obesity (BMI >30 kg/m )
3. Sedentary lifestyle
4. Hypertension
5. HDL cholesterol < 35 mg/dl (0.90 mmoVL) and/or triglyceride level >250 mg/dl
(2.82mmol/L)
6. History of Gestational Diabetes Mellitus (GDM) or delivery of a baby weighing 9 Ibs (4.0
Kgs)
7. Previously identified to have Impaired Glucose Tolerance (IGT)
COMPLICATIONS:
• Acute complications: DKA, hyperosmolar hyperglycemic non ketotic coma (HHNK) and
hypoglycemia especially type I
• Chronic complications: chronic renal disease (nephropathy), blindness (retinopathy),
CAD & CVA, neuropathies & foot ulcers
LESSON 4. CHRONIC OBSTRUCTIVE PULMONARY DISEASE

- airflow limitation that is not fully reversible → hypoxemia and hypercapnea.
- Emphysema, bronchitis, bronchial asthma
CAUSES AND RISK FACTORS:

Cigarette smoking.
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DIAGNOSIS: cough, sputum production, or dyspnea, and/or a history of exposure to risk
factors.
DIAGNOSTICS: Spirometry
COMPLICATIONS:
• Respiratory failure
• Cardiovascular disease - the major cardiovascular cx of COPD, ass. w/ cor pulmonale
and a poor prognosis.
BRONCHIAL ASTHMA: inflammatory disorder of the airways (bronchoconstriction)
CAUSES AND RISK FACTORS:

a. Host factors: Genetic predisposition, Atopy or allergy, Airway hyperresponsiveness, Gender,
Race/Ethnicity
b. Environmental factors: allergens, Tobacco smoke, Air pollution, Respiratory infections,
Parasitic infections, Socioeconomic factors, Family size, Diet and drugs, Obesity
LESSON 5: RISK ASSESSMENT AND SCREENING PROCEDURES
RISK FACTOR ASSESSMENT
A. CIGARETTE SMOKING
B. NUTRITION/DIET
- detailed recall methods (e.g. 24-hour food diary) or extensive food frequency questionnaires
and estimation of nutrients based on food composition tables
Guideline for adequate vegetable and fruit intake

o Eat 2-3 servings of vegetables each day, one serving of which is green or yellow leafy
vegetables. One serving means: Raw vegetables 1 cup / Cooked vegetables V2 cup
o Eat at least 2 servings of fruit per day, 1 serving is a vitamin C rich fruit. One serving of fruit
depends on type of fruit.
C. OVERWEIGHT/OBESITY: best be assessed using Body Mass Index (BMI) and waist
circumference
BMI = Weight in Kgs / Height in meters
BMI Interpretation
< 18.5 Underweight
18.6-22.9 Healthy weight
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> 23.0 Overweight
23.0-24.9 At risk
25.0-29.9 Obese I
> 30.0 Obese II
Waist Circumference (WC): Subject should be unclothed at the waist, and standing with
relaxed, arms at the sides, feet together. Use non-stretchable tape measure and do not
compress the skin.
Clinical Thresholds: Men < 90 cm (35 inches), Women < 80 cm (31.5 inches)
Greater than these value is not normal and person is at risk even if BMI is normal.
Degree of Risk Based on Body Mass Index and Waist Circumference
Classification BMI Waist Circumference

Men <90
>90
Women <80
>80
Underweight <18.5 Low but increased risk Average
of other clinical
problems
Normal 18.6 – Average Increased
22.9
Overweight >23 Increased Moderate
At risk 23.0 – Moderate Severe
Obese I 24.9 Severe Very
Obese II 25.0 – severe
29.9
>30.0
Waist Hip Ratio (WHR): waist circumference at the narrowest point by the hip circumference at
the widest point.
WHR = Waist circumference (cm)
Hip circumference (cm)
WHR Interpretation:
. Less than 1.0 (men); less than 0.85 (women) = normal WHR
. Equal to or greater than 1.0 (men) and 0.85 (women) = android or central obesity
PHYSICAL INACTIVITY / SEDENTARY LIFESTYLE

Minimum recommended amount of physical activity needed to achieve heart benefit:
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Regular Physical Activity: minimum 30 min/day, preferably daily
If noderate intensity: 5 or more days of the week
If vigorous intensity: 3 or more days of the week
Guideline: At least 30 minutes of cumulative physical activity moderate in intensity for most
days of the week.
EXCESSIVE ALCOHOL DRINKING

Type of Amount % Amount of
Alcoholic Ethanol Ethanol
Beverage Content
Beer 1 glass/can/bottle 3% 10gms
(350ml)
Wine 1 glass (100ml) 10% 10gms
Distilled spirit 1 glass (40ml) 25% 10gms
SCREENING GUIDELINES AND PROCEDURES
Screening: "presumptive identification of unrecognized disease or defect by the application of

tests, examination or other procedures which can be applied rapidly
A. SCREENING FOR HYPERTENSION
Hypertension: sustained systolic BP of 140 mm Hg or more and sustained DBP of 90 mmHg

or more based on measurements done during at least 2 visits taken at least 1 week apart.
: suspect possible hypertension when BP is greater than or equal to 140/90 mmHg.
CLASSIFICATION OF BLOOD PRESSURE (BP)* (JNC 7 Report)

CATEGORY SBP MMHG DBP MMHG
Normal < 120 And <80
Prehypertension 120-139 Or 80-89
Hypertension, Stage 1 140-159 Or 90-99
Hypertension Stage 2 >160 Or > 1 00
Guidelines for Accurate Measurement of BP:

The most accurate and reliable technique for indirect BP measurement is the auscultatory
method using a sphygmomanometer. If you use an aneroid BP apparatus, (recalibrate at least
every six months).
B. SCREENING FOR ELEVATED CHOLESTEROL IN THE BLOOD: (FASTING)

Recommended Guidelines
Cholesterol Level Interpretation Frequency of tests
< 200 mg/100 ml Normal q5yrs
200-239 mg/100 ml Elevated (may be at risk) Repeat tests, take average of both
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tests
Further tests (lipid profile and
> 240 mg/100 ml Elevated(at risk)
treatment)
C. SCREENING FOR DIABETES MELLITUS

- hallmark of diagnosis of diabetes mellitus is the presence of hyperglycemia.
ASK: For adults 20 years and older: FHx,
Symptoms of DM: 1. Polyuria (increased frequency and amount of urination)
2. Polydipsia increased thirst
3. Unexplained weight loss
If special risk for diabetes: Hypertensive, Overweight, Women who have delivered a baby
weighing >9 Ibs
Women who have been diagnosed with gestational diabetes
Fasting blood sugar (FBS)-no caloric intake for at least eight hours (only water is
allowed)
Two-hour blood sugar test - Performed two hours after using 75g glucose dissolved in
water or after a good meal
Oral Glucose Tolerance Test (OGTT) is not recommended for routine clinical use nor screening
purposes.
Fasting Blood Sugar Values:

109 mg% - Normal
110-125 mg% - Impaired Glucose Tolerance (IGT)
126 mg% - Possible Diabetes Mellitus
Criteria for diagnosis of Diabetes Mellitus

Anyone of the following:
1. S/Sx of DM + RBS > 200 mg/dl (11.1 mmol/L)
2. FBS> 126 mg/dL (7.0 mmoVL)
3. Two-hour blood sugar> 200 mg/dL (11.1 mmoVL) during an OGTT or oral glucose tolerance
test
D. SCREENING FOR CANCER

Early detection and prompt treatment are keys to curing
The acronym "CAUTION US"
C = Change in bowel or bladder habits.
A = A sore that does not heal.
U = Unusual bleeding or discharge.
T = Thickening or lump in the breast or elsewhere.
I = Indigestion and difficulty in swallowing
O = Obvious change in wart or mole.
N = Nagging cough or hoarseness in voice.
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U = Unexplained anemia
S = Sudden weight loss.
Specific Guidelines for Early Detection of Common Cancers
Breast Cancer
Warning Signs
Skin changes: Edema, Dimpling or inflammation "peau de orange" - orange peel like skin,
Ulceration, Prominent venous pattern
Nipple abnormalities: Retraction, Rashes or discharge
Abnormal Contours: Variation in size and shape of breasts
Early Detection:
1. Breast self-examination: cheapest and most affordable screening procedure for breast
cancer. The best time to do BSE is 1wk after menstrual period while taking a shower, facing the
mirror standing up or lying down
2. Yearly breast examination:
3. Breast mammography usually confirms it. Baseline mammogram for ages of 35-39, and
yearly after age 40.
If with family history of breast cancer, mammogram should be started at age 30.
Cervical Cancer
Warning Signs:
Often asymptomatic; Abnormal vaginal bleeding (e.g. post-coital bleeding)
Early Detection:
Pap's smear: primary screening tool for women over age 18; done between menses (2wks
after menses).
A woman should not douche, have intravaginal medications nor have sexual intercourse 24
hours prior to test.
Should be done annually for two consecutive years and at least every three years until age 65
for those with normal findings.
For persons at high risk, it should be done yearly
For: Sexually active, Have multiple partners, Commercial sex workers
Colon Rectal Cancer

Warning Signs:
Change in stool, Rectal bleeding, Pressure on the rectum, Abdominal pain
Early Detection:
Annual digital rectal exam starting at age 40
Annual stool blood test starting at age 50
Annual inspection of colon
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Prostate Cancer
Warning Signs: Symptoms of urethral outflow obstruction: Urinary frequency, Nocturia,
Decrease in stream, Post-void dribbling
Early Detection:
Digital rectal exam for men
Prostate specific antigen (PSA) determination a blood test, confirms diagnosis.
Lung Cancer
Early Warning Signs:
Persons with a long history of smoking and/or smoking two or more packs of cigarette/ day
Chronic cough or nagging cough, Dull intermittent, localized pain, History of weight loss
Early Detection:
Chest x-ray every six months for patients who have history of smoking 2 packs per day
Sputum cytology
E. SCREENING FOR COPD

Signs and symptoms: cough, sputum production, and dyspnea upon exertion.
Spirometry = confirmatory, determine degree of obstruction, categorize px as having
restrictive, obstructive or mixed pattern of ventilatory defect.
Suspect COPD in persons with the following: 50 years old, Smoking for many years, progressive
and increasing shortness of breath on exertion, and/or Chronic productive cough
F. SCREENING FOR ASTHMA

Hallmark of asthma: reversibility of airway obstruction.
DIAGNOSTICS:
Spirometry & peak expiratory flow rate (PEFR) using a peak flow meter before and after
using a bronchodilator. Obstruction is reversed if improvement is 15% or > 200 ml.
Suspect asthma in persons with the following: cardinal symptoms (dyspnea, cough,
wheezing, chest discomfort), Temporal waxing and waning and/or nocturnal occurrence of
symptoms, A history of any of the following: symptoms triggered by exogenous factors, a family
history of asthma or allergy, a personal history of asthma, allergic rhinitis or atopy, an
improvement of symptoms with bronchodilator use
LESSON 6: PROMOTION OF HEALTHY LIFETYLE
PROMOTING PHYSICAL ACTIVITY AND EXERCISE

Health Benefits of Regular Physical Activity *
The minimum amount of physical activity required for health benefits can be achieved through:
. at least 30 minutes, cumulative, of moderate intensity, most days of the week,
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. at least 30 minutes, cumulative, of vigorous intensity, 3 or more days of the week
PROMOTING PROPER NUTRITION

Strategies to Promote Healthy Nutrition-related Practices
3 main strategies to address the nutrition problems and practices of Filipinos:
1. Aim for ideal body weight
2. Build healthy nutrition-related practices
3. Choose foods wisely
overweight if he gains >10% of his IBW. (obesity: >20%)
NUTRITION ASSESSMENT
Direct measurements: BMI, waist circumference and waist-hip ratio.
Indirect measurement: 24-hour food recall method.
PROMOTING A SMOKE-FREE ENVIRONMENT

Of all the major factors that lead to the development of NCDs, smoking is the most common
and poses significant danger to the health of most people. ,
Three compounds are known to be harmful to health: tar, nicotine and CO.
Tar: particulate matter left when water and nicotine are removed from cigarette smoke,
contains hydrocarbons and other carcinogenic substances; paralyzes the cleaning mechanisms
(cilia) and damages the air sacs (alveoli).
Nicotine: a particulate, release of epinephrine and norepinephrine, resulting in arrhythmia,
increased heart rate, blood pressure, cardiac output, stroke volume, contractility, oxygen
consumption, and coronary blood flow. It also exerts a toxic effect on the endothelium. It is
also an addicting substance.
Carbon monoxide may produce hypoxia of the intima and increase endothelial permeability;
reduces the oxygen-carrying capacity of the blood because it competes with oxygen and has a
greater affinity for hemoglobin.
Tobacco contains more than 4000 chemicals, 43 of which have been proven to be carcinogenic.
Some of these toxic chemicals and gases include the following:
Acetone – used in nail polish remover
Acetic Acid - used in vinegar
Ammonia - used in food and toilet cleaners
Arsenic - used to make rat poison
Butane - used in cigarette lighter
Cadmium - used in rechargeable batteries
Carbon monoxide - found in exhaust fumes
DDT/Dieldrin – used in insecticides
Ethanol - alcohol
Formaldehyde – used to preserve dead bodies
Hexamine - used in lighter fluid
Hydrogen cyanide - used in gas chambers
Methane - used like gasoline
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Naphthalene - used to make moth balls fluid
Nicotine - used in insecticide
Nitrobenzene - used as gasoline, additive
Nitrous Oxide - used as disinfectant
Strearic acid – used in candle wax
Toluene - used as industrial solvent
Vinyl chloride - used to make PVC pipe
What Happens to Your Body When You Stop Smoking?

Within 20 minutes: Blood pressure normalizes, Pulse rate normalizes, Body temperature of
hands and feet normalizes.
Within 8 hours: Carbon monoxide level in the body normalizes.
Within 24 hours: Heart attack chances to decrease.
Within 48 hours: Nerve endings regrow, Blood circulation improves on hands and feet, Ability
to taste and smell changes
Within 72 hours: Breathing is easier, Lung capacity starts to increase.
Within 2-1/2 weeks: Lung function improves by 30%, Risk of heart attack significantly
reduces, Circulation will continue improving.
Within 1 to 9 months: Incidence of coughing, sinus congestion, fatigue and shortness of
breath decreases; Oxygen level in the body normalizes, Cilia (hair-like structures) in lungs,
regrows, increasing the ability tohandle mucus, clean start the lungs reduce infections, Body's
overall energy level increases.
After 5 years: Cancer chances greatly decreases, Risk of heart disease is significantly reduced.
After 10 years: Lung cancer chances are kept to minimum, Pre-cancerous cells are replaced,
Chances of other cigarette-related cancers decreases.
ROLE OF THE PUBLIC HEALTH NURSE
1. Assisting smokers to quit

Strategies in helping smokers to quit: four "As" in helping smokers to quit.
A – ASK
Step 1 - Assess smoking status. Identify all tobacco users at every visit.
A - ADVISE TO STOP SMOKING AND THAT SMOKING CAN CAUSE DISEASE, EVEN DEATH
Step 2 - Target clients' motivation to quit.
Step 3 - Encourage complete cessation.
Step 4 - Discuss alternatives and substitutes to smoking.
A - ASSIST
Step 5 - Develop a quit plan with the smoker. Set a QUIT DATE
Step 6 -. Provide supplementary materials to assist the smoker.
Step 7 - Develop a plan to prevent relapse.
A- ARRANGE FOLLOW-UP
Step 8 - Set follow-up sessions to monitor progress and prevent relapses.
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2. Promoting a smoke-free environment
Four pillars for successful anti-tobacco programs: categorized into education and
legislation.
1. Aggressive health information dissemination combined with comprehensive advertising bans
on tobacco products;
2. Government-supported and multisectoral programs to encourage and help smokers break
free of their addiction to smoking;
3. Building anti-tobacco coalitions to help governments, individuals, and sectors to rid tobacco
from their systems; and
4. The taxation of tobacco products to create an economic disincentive for the buying of higher
priced cigarettes.
Tobacco Regulations Act in 2003 is a landmark legislation in the country against tobacco
use. It declared enclosed places and public utilities as no smoking area, limiting access of
children and youths to cigarettes (prohibiting sale of cigarettes to minors and selling of
cigarettes within 50 meters of schools), prominent labeling of cigarettes warning users of
the danger of smoking, and limiting/banning tobacco advertisements and sponsorships of
activities directed to children and youths.
PROMOTING STRESS MANAGEMENT

12 Stress Management Techniques
1. Spirituality (Meditation) 7. Sports
2. Self Awareness 8. Socials
3. Scheduling: Time Management 9. Sounds and Songs
4. Siesta 10. Speak to Me
5. Stretching 11. Stress Debriefing
6. Sensation Techniques 12. Smile
Critical Incident Stress Debriefing means to assist crisis workers / team member to deal
positively with the emotional impact of a severe event / disaster and to provide education about
current and anticipated stress responses, as well as information about stress management.
LESSON 7: BLINDNESS PROGRAM
VISION 2020: The Right to Sight,
Five priority preventable/treatable conditions:

a. Cataract
b. Refractive errors and low vision
c. Trachoma
d. Onchocerciasis
e. Childhood blindness
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Errors of refraction is the leading cause of visual impairment and of bilateral or monocular
low vision.
Cataract is still the leading cause of bilateral (62%) and monocular blindness.
Interventions by Eye Disorder:

1. Cataract = the opacification of the normally clear lens of the eye, is the most common cause
of blindness worldwide.The only cure for cataract blindness is surgery.
2. Errors of Refraction = the most common cause of visual impairment in the,corrected either
with spectacle glasses, contact lenses or surgery
3. Childhood Blindness.
VISION:
All Filipinos enjoy the right to sight by year 2020
MISSION:
The DOH, local health units, partners and stakeholders commit to:
1. Strengthen partnership among and with stakeholders to eliminate avoidable blindness in the
Philippines
2. Empower communities to take proactive roles in the promotion of eye health and prevention
of blindness
3. Provide access to quality eye care services for all
4. Work toward poverty alleviation through preservation and restoration of sight to indigent
Filipinos
OBJECTIVES:
1. Increase Cataract Surgical Rate from 730 to 2,500 by the year 2010
2. Reduce visual impairment due to refractive errors by 10% by the year 2010
3. Reduce the prevalence of visual disability in children from 0.43% to 0.20% by the year 2010
THREE STRATEGIES:
a. Ensuring that cataract surgery is available, acessible, and affordable to everyone
b. Reduction of the prevalence of cataract, blinding error of refraction and vitamin A deficiency
thru enhanced services
c. Pooling of resources of government and non-government agencies to address the problem of
cataract, blinding error or refraction, and Vitamin A deficiency.
LESSON 8: MENTAL HEALTH PROGRAM
Mental Health
- state of well-being where a person can realize his or her own abilities to cope with normal
stresses of life and work productively.
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FOUR FACETS AS A PUBLIC HEALTH BURDEN
1. Defined burden: burden currently affecting persons with mental disorders and is measured
in terms of prevalence and other indicators such as the quality of life indicators and disability
adjusted life years (DALY).
2. Undefined burden: the portion of the burden relating to the impact of mental health
problems to persons other than the individual directly affected.
3. Hidden burden of mental illness: refers to the stigma and violations of human rights .
Stigma is a mark of shame, disgrace or disapproval that results in a person being shunned or
rejected by others
4. Future burden: refers to the burden in the future resulting from the aging of the
population, increasing social problems and unrest inherited from the existing burden.
NATIONAL MENTAL HEALTH PROGRAM
VISION:
Better quality of life through total health care for all Filipinos
MISSION:
A rational and unified response to mental health
GOAL:
Quality mental health care
Mental Health Sub-Programs

A. Wellness of Daily Living
B. Extreme Life Experiences
C. Mental Disorder: Obj: Promotion of mental health and prevention of mental illness across the
lifespan and across sectors
D. Substance Abuse & Other Forms of Addiction
Pointers for Having Mental Health

. Maintain good physical health
. Undergo annual medical examination or more often as needed
. Develop and maintain a wholesome lifestyle (balanced diet, Adequate rest, exercise, sleep,
recreation).
. Avoid smoking, substance abuse and excessive alcohol.
. Have a realistic goal in life.
. Have a friend in whom you can confide and ventilate your problems.
. Don't live in the past and avoid worrying about the future.
. Live one day at a time.
. Avoid excessive physical, mental and emotional stress.
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. Develop and sustain solid spiritual values.
LAWS RELATED
LAW DESCRIPTION
Executive order 958 National Healthy Lifestyle Advocacy
Campaign. Declaring the years 2005-2013 as
the decade of healthy lifestyle
Republic act 1054 Free emergency medical and dental
treatment for employees
Republic act 9211 Tobacco Regulation Act of 2003. Regulates
the packaging, use, sale distribution and
advertisement of tobacco products
Republic Act 6425 Penalties for the violations of Dangerous
Drugs Act of 1972
Republic Act 9165 Comprehensive Dangerous Drugs Act of 2002
Republic Act 8423 Traditional and Alternative Medicine Act of
1997
Administrative Order No. 179 series 2004 Guidelines for the implementation of the
National Prevention of Blindness Program
Proclamation No. 40 Declaring the month of August every year as
“Sight Saving Month”
TEACHER’S INSIGHTS
Community health nurses are considered front liners and has been considered to have most
time with the clients or patients. With this, the nurse should be knowledgeable with the non-
communicable diseases, not only to treat – but more importantly, to prevent these diseases
from happening. Healthy lifestyle should be promoted since most of non-communicable
diseases are related to poor lifestyle.
SELF-REFLECTION:
As a public health nurse in the future/nursing student, how will you promote healthy lifestyle in
your community?
CHAPTER ACTIVITIES:
1. In a table format: summarize the non-communicable diseases discussed here. Present the
risk factors, manifestations, diagnosis, signs and symptoms, treatment and ways to prevent.
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2. Formulate a teaching design or session design indicating the complete components of it.
Choose one disease and what concerns or problems will it bring to the community. The
solutions will be reflected in your session design.
3. Create IEC materials related to your topic of choice.
REFERENCES:
Books:
Websites:
www.doh.gov.ph
CHAPTER 6
CONTROL OF COMMUNICABLE DISEASES

1. Define communicable diseases
2. Differentiate between infectious and contagious diseases
3. Identify the different communicable and diseases in terms of:
a. Definition
b. Risk factors
c. Modes of transmission
d. Manifestations
e. Diagnostics
f. Medical and/or Surgical management
g. Nursing management
h. Complications
i. Preventions
KEY TERMS:
asepsis infectious disease
communicable diseases isolation
contagious disease mode of transmission
endemic pandemic
epidemic portal of entry
etiologic agent portal of exit
immunity reservoir
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sporadic susceptible host
COMMUNICABLE DISEASES
Goal of WHO
1. Prevention of disease
2. Prevention of disability and death from infection
3.Prevention through immunization
LESSON 1: CHAIN OF INFECTION AND RELATED CONCEPTS
1. Pathogen, etiologic agent or causative agent

biologic agent (organism) capable of causing disease
Eliminate organism by:
• Sterilizing surgical instruments and anything that touches sterile spaces of the body
• Using good food safety methods
• Providing safe drinking water
• Vaccinating people so they do not become reservoirs of illness
• Treating people who are ill
2. Reservoir
Any person, animal, arthropod, plant, soil, or substance (or combination of these) in which an
causative agent normally lives and multiplies, on which it depends primarily for survival, and
where it reproduces in such numbers that it can be transmitted to a susceptible host
Eliminate reservoirs by:
• Treating people who are ill
• Vaccinating people
• Handling and disposing of body fluids responsibly
• Handling food safely
• Monitoring soil and contaminated water in sensitive areas of the hospital and washing
hands carefully after contact with either
3. Portal of exit
the way the causative agent gets out of the reservoir (body fluid or skin)
Reduce risk from portals of exit by:
• Covering coughs and sneezes with a tissue
• Handling body fluids with gloves, then doing hand hygiene
• Keeping draining wounds covered with a dressing
• Not working when you have exudative (wet) lesions or weeping dermatitis
4. Mode of transmission
any mechanism by which a pathogen is spread from a source or reservoir to a person
unwashed hands, things which are not cleaned between patients, droplets, or, for a few
diseases, the air
Eliminate the mode of transmission by:
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• Hand hygiene
• Wearing gloves to minimize contamination of hands and discarding them after each
patient
• Cleaning, disinfection, or sterilization of equipment used by more than one patient
• Cleaning of the environment, especially high-touch surfaces
5. Portal of entry
hole in the skin that allows the infectious agent to get into the body (mouth, nose, eyes,
rashes, cuts, needlestick injuries, surgical wounds and IV sites)
Protect portals of entry (our own and our patients) by:
• Dressings on surgical wounds
• IV site dressings and care
• Elimination of tubes as soon as possible
• Masks, goggles and face shields
• Keeping unwashed hands and objects away from the mouth
• Actions and devices to prevent needlesticks
• Food and water safety
6. Susceptible host
a person or animal lacking effective resistance to a particular infectious agent
Minimize risk to susceptible hosts by:
• Vaccinating people against illnesses to which they may be exposed
• Preventing new exposure to infection in people who are already ill, are receiving
immunocompromising treatment, or are infected with HIV
• Maintaining good nutrition
• Maintaining good skin condition
• Covering skin breaks
• Encouraging rest and balance in our lives
Related terms:
Symptoms
evidence of disease that is experienced or perceived (subjective)
subjective changes in body function noted by patient but not apparent to an observer
Signs
objective evidence of a disease the physician can observe and measure
Syndrome
a specific group of signs and symptoms that accompany a particular disease
Incidence
the number of people in a population who develop a disease during a particular time
period
Prevalence
the number of people in a population who develop a disease, regardless of when it
appeared refers to both old and new cases
Classification of Infectious Disease
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Based on Behavior within host
Infectious Disease
- Any disease caused by invasion and multiplication of microorganisms
Contagious Disease
disease that easily spreads from one person to another
Based on Occurrence of Disease

Sporadic Disease
disease occurs only occasionally
i.e. botulism, tetanus
Endemic Disease
constantly present in a population, country or community
i.e. Pulmonary Tuberculosis
Epidemic Disease
acquire disease in a relatively short period greater than normal number of cases in an area
within a short period of time
Pandemic Disease
epidemic disease that occurs worldwide
i.e. HIV infection
Based on Severity or Duration of Disease

Acute Disease
develops rapidly (rapid onset) but lasts only a short time
i.e. measles, mumps, influenza
Chronic Disease
Develops slowly, milder but longer lasting clinical manifestation
Based on State of Host Resistance

Primary Infection
acute infection that causes the initial illness
Secondary Infection
one caused by an opportunistic pathogen after primary infection has weakened the body’s
defenses
Stages of Disease
Incubation Period
time interval between the initial infection and the first appearance of any s/sx
Prodromal Period
early, mild symptoms of disease
Period of Illness
overt s/sx of disease
WBC may increase or decrease
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can result to death if immune response or medical intervention fails
Period of Decline
s/sx subside
vulnerable to secondary infection
Period of Convalescence
regains strength and the body returns to its pre diseased state
recovery has occurred
Modes of Transmission
The process of the infectious agent moving from the reservoir to the susceptible host
CONTACT TRANSMISSION
- the most important and frequent mode of transmission
Type of Contact Transmission

a. Direct Contact Transmission
• Person to person transmission of an agent by
• physical contact between its source and
• susceptible host
• No intermediate object involved
• i.e. kissing, touching, sexual contact
• Source → Susceptible Host
b. Indirect Contact Transmission
• reservoir to a susceptible host by means of a
• non living object (fomites)
• Source → Non Living Object → Susceptible Host
Susceptible Host
Recognition of high-risk patients
• Immunocompromised
• DM
• Surgery
• Burns
• Elderly
Percentage Nosocomial Infection
• 17% Surgical
• 34% UTI
• 13% LRI
• 14% Bacteremia
• 22% Other (incldng skin infection)
Factors for Nosocomial Infection
Microorganism/Hospital Environment
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Most common cause
• Staph aureus, Coag Neg Staph Enterococci
• E. coli, Pseudomonas, Enterobacter, Klebsiella
• Clostridium Difficile
• Fungi ( C. Albicans)
• Other ( Gram (-) bacteria)
• 70% are drug resistant bacteria
Compromised Host
One whose resistance to infection is impaired by broken skin, mucous membranes and a
suppressed immune system
Skin and Mucous Membrane

physical barrier
i.e. burns, surgical wounds, trauma, IV site, invasive procedures
Suppressed Immune System
i.e. drugs, radiation, steroids, DM, AIDS
IMMUNITY
The human body has the ability to resist almost all types of organisms or toxins that tend to
damage the tissues and organs. This is called immunity
Functions of Immune System
1. Protects the body from internal threats
2. Maintains the internal environment by removing dead or damaged cells.
3. Provides protection against invasion from outside the body.
THE IMMUNE SYSTEM

The major components of the immune system include the bone marrow which produces the
white blood cells (WBC), the lymphoid tissues which includes the thymus, spleen, lymph nodes,
tonsils and adenoids.
Natural Immunity
Non-specific immunity present at birth. This includes;
a. Phagocytosis of bacteria and other invaders by white blood cells and cells of the tissue
macrophage system
b. Destruction by the acid secretions of the stomach and by the digestive enzymes on
organisms swallowed into the stomach.
c. Resistance of the skin invasion by organisms
d. Presence in the blood of certain chemical compounds that attach to foreign organism or
toxins and destroy them like lysozyme, natural killer cells and complement complex.
Acquired Immunity
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The human body has the ability to develop extremely powerful specific immunity against
individual invading agents. It usually develops as a result of prior exposure to an antigen
through immunization or by contracting a disease.
Active Acquired Immunity - immune defense are developed by the person’s own body. This
immunity last many years or a lifetime.
Passive Acquired Immunity - temporary immunity from another source that has developed
immunity through previous disease or immunization. It is used in emergencies to provide
immediate, short acting immunity when the risk is high.
ANTIBODIES
Agglutination - clumping effect of antibodies between two antigen. It helps to clear the body
of invading organisms by facilitating phagocytosis.
Opsonization – in this process, the antigen-antibody molecule is coated with a sticky
substance that facilitates phagocytosis.
1. IgG (75%)
• Appears in serum and tissues
• Assumes a major role in bloodborne and tissue infections
• Activates the complement system
• Enhances phagocytosis
• Crosses placenta
2. IgA (15%)
• Appears in body fluids (blood,saliva, tears, breat milk)
• Protects against respiratory, GIT and GUT
• Prevents absorption of antigens from food
• Passes to neonate in breast milk for protection
3. IgM (10%)
• Appears mostly in intravascular serum
• First immunoglobulin produced in response to bacterial or viral infection
• Activates complement systems
4. IgD (.2%)
Appears in small amount in serum
5. IgE (.004%)
Allergic and hypersensitivity reactions
Combats parasitic infections
IMMUNIZATION AND VACCINES
IMMUNIZATION
Process inducing immunity artificially by either vaccination (active) or administration of antibody
(passive)
Active : stimulates the immune system to produce antibodies, cellular immune responses to
protect against infectious agent
Passive : provides temporary protection through administration of exogenous antibody
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IMMUNIZING AGENTS
Vaccines : a preparation of proteins, polysaccharides or nucleic acids of pathogens that are
administered inducing specific responses that inactivate or destroy or suppress the pathogen
Toxoid : a modified bacterial toxin that has been made nontoxic but retains the capacity to
stimulate the formation of antitoxin
Immune globulin : an antibody containing solution derived from human blood obtained by cold
ethanol fractionation of large pools of plasma and used primarily for immunodeficient persons
or for passive immunization
Antitoxin : an antibody derived from serum of human or animals after stimulation with specific
antigens used for passive immunity
INFECTION CONTROL PROCEDURE

Medical Asepsis
- CLEAN Technique
- Involves procedures and practices that reduce the number and transfer of pathogens
- Will exclude pathogens ONLY
Attain by:
- Frequent and thorough hand washing
- Personal grooming
- Proper cleaning of supplies and equipment
- Disinfection
- Proper disposal of needles, contaminated materials and infectious waste
- Sterilization
Surgical Asepsis
STERILE technique
- Practices used to render and keep objects and areas sterile
- Exclude ALL microorganism
Attain by:
- Use strict aseptic precautions for invasive procedures
- Scrub hands and fingernails before entering O.R.
- Use sterile gloves, masks, gowns and shoe covers
- Use sterile solutions and dressings
- Use sterile drapes and create an sterile field
- Heat –sterilized surgical instruments
Universal Precautions
Universal Precautions
- Infection control guidelines designed to protect workers from exposure to diseases
spread by blood and certain body fluids.
- For prevention of transmission of blood-borne pathogens in health care settings to
prevent contact with patient blood and body fluids
- Stress that all patients should be assumed to be infectious for blood-borne diseases such
as AIDS and hepatitis B.
- Universal Precautions
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Followed when workers are exposed to blood and certain other body fluids, including:
- semen
- vaginal secretions
- synovial fluid
- cerebrospinal fluid
- pleural fluid
- peritoneal fluid
- pericardial fluid
- amniotic fluid
- Universal Precautions
do not apply to:
- feces
- nasal secretions
- sputum
- sweat
- tears
- urine
- vomitus
- saliva (except in the dental setting, where saliva is likely to be contaminated with blood)
Standard Precautions
Replaced universal precautions

Apply to all patients
Stipulate that gloves should be worn to touch any of the following:
- blood
- all body fluids
- secretions and excretions, except sweat, regardless of whether they are visibly bloody
- non-intact skin
- mucous membranes
Gloves
- Prevent contamination of the hands with microorganisms
- Prevent exposure of the HCW to blood-borne pathogens
- Reduce the risk of transmission of microorganisms from the hands of HCWs to the
patient
- Do not replace the need for hand hygiene
Hands washed immediately after gloves are removed and between patient contacts
- For procedures that are likely to generate splashes or sprays of body fluid, a mask with
eye protection or a face shield and a gown should be worn
- Disposable gowns should be constructed of an impervious material to prevent
penetration and subsequent contamination of the skin or clothing
- Needles should not be recapped, bent, or broken but should be disposed of in puncture-
resistant containers
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Hand Hygiene
- Single most important means to prevent transmission of nosocomial pathogens
- Removes the transient flora recently acquired by contact with patients or environmental
surfaces
- Alcohol-based hand rubs are recommended (if hands are visibly soiled, washing with
soap and water is recommended)
- Ring removal prior to patient care
Transmission-Based Precautions
Transmission-Based Precautions
Apply to selected patients based on a suspected or confirmed clinical syndrome, a specific
diagnosis, or colonization or infection with epidemiologically important organisms
Always implemented in conjunction with standard precautions
3 types:
- Airborne
- Droplet
- Contact
Airborne Precautions
Prevent transmission of diseases by droplet nuclei (particles smaller than 5 µm) or dust particles
containing the infectious agent
- Airborne Precautions
- All persons entering the room of these patients must wear a personal respirator that
filters 1 µm particles with a n efficiency of at least 95% (N95 mask)
- Gowns and gloves are used as dictated by standard precautions
1. Disseminated zoster
2. Measles
3. Smallpox
4. SARS
5. Tuberculosis (pulmonary or laryngeal)
6. Varicella
- Patient placed in a private room with monitored negative air pressure in relation to
surrounding areas, and the room air must undergo at least 6 exchanges per hour
- Door to the isolation room must remain closed
- Air from the isolation room should be exhausted directly to the outside, away from air
intakes, and not recirculated (high efficiency filters may be used also)
- Cough etiquette
- Patients should be instructed to cover his/her mouth and nose with tissue when
coughing or sneezing
Droplet Precautions
Prevent transmission by large-particle (droplet) aerosols
(unlike droplet nuclei, droplets are larger, do not remain suspended in the air, and do not
travel long distances)
Droplets are produced when the infected patient talks, coughs, or sneezes and during some
procedures (e.g., suctioning, bronchoscopy)
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A susceptible host may become infected if the infectious droplets land on the mucosal surfaces
of the nose, mouth, or eye.
- Require patients to be placed in a private room, but no special air handling is necessary
(patients with same disease can be placed in the same room if private rooms are not
available)
- Droplets do not travel long distances (generally no more than 3 feet), the door to the
room may remain open
- HCW should wear a standard surgical mask when working within 3 feet of the patient
- Gowns and gloves should be worn by HCWs when dictated by standard precautions
1. Diphtheria, pharyngeal
2. H. influenzae meningitis, epiglottitis, pneumonia
3. Influenza
4. Meningococcal infections
5. Multi-drug resistant pneumococcal disease
6. Mumps
7. Mycoplasma pneumonia
8. Parvovirus B19 infections
9. Pertussis
10. Plague, pneumonic
11. Rubella
12. Streptococcal pharyngitis
Contact Precautions
- Prevent the transmission of epidemiologically important organisms from an infected or
colonized patient through direct contact (touching the patient) or indirect contact
(touching contaminated objects or surfaces in the patient’s environment)
- Patients are placed in a private room or patients infected with same organism may be
placed in the same roo
- Barrier precautions to prevent contamination should be employed
- Gloves and Hand hygiene
- Gowns – worn if the HCW anticipates substantial contact of his or her clothing with the
patient or surfaces in the patient’s environment or there is an increased risk of contact
with potentially infective material
- Noncritical patient care equipment should remain in the room and not used for other
patients, if items must be shared, they should be cleaned and disinfected before reuse
-
1. Acute diarrheal illnesses likely to be infectious in origin
2. Acute viral conjunctivitis
3. Clostridium difficile diarrhea
4. Ectoparasistic infections (lies and scabies)
5. HSV/Varicella/Disseminated zoster
6. MDR bacteria (MRSA, VRE, VISA, VRSA) infection or colonization
7. SARS
8. Smallpox
9. Streptococcal (group A) major skin, burn or wound infection
10. Viral hemorrhagic fevers
ISOLATION OF PATIENTS
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Source Isolation
Reverse Isolation
- Protective or neutropenic isolation
- Used for patients with severe burns, leukemia, transplant, immuno deficient persons,
receiving radiation treatment, leukopenic patients
- Those that enter the room must wear masks and sterile gowns to prevent from
introducing microorganisms to the room
AFB ISOLATION
- VISITORS - report to nurses’ station before entering the room
- MASKS – worn in patient’s room
- GOWNS – prevent clothing contamination
- GLOVES – for body fluids and non-intact skin
- HANDWASHING - after touching patient or potentially contaminated articles and after
removing gloves
- articles discarded, cleaned or sent for decontamination and reprocessing
- room remains closed
- patients wear masks during transport
Personal Protective Equipment

- mask
- gloves
- gown
- shoe cover
- goggles
LESSON 2: BLOOD/VECTOR BORNE DISEASES
Prevention
Eradicate the source DOH CLEAN
- C – chemically treated mosquito net
- L - larvae eating fish
- E – environmental sanitation
- A – anti-mosquito
- N – neem tree (oregano, eucalyptus)
A. Dengue Hemorrhagic Fever

- caused by dengue virus (Flaviviridae) with 4 serotypes
- transmitted to a bite of female aedes aegypti mosquito
- incubation period 2-7 days
Vectors: (day biting)
- Aedes aegypti (breeds in water stored in houses)
- Aedes albopictus
- Culex fatigans
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Clinical manifestations:
> First 4 days – Febrile or Invasive stage – high grade fever, headache, body malaise,
conjuctival injection, vomitting, epistaxis or gum bleeding, positive tornique test.
> 4th – 7th day – Toxic or Hemorrhagic Stage – After the lyze of the fever, this is were the
complication of dengue is expected to come out as manifested by abdominal pain, melena,
indicating bleeding in the upper gastrointestinal tract, Unstable BP, narrow pulse pressure and
shock.
> 7th – 10th day – Convalescent or recovery stage – after 3 days of afebrile stage and the
patient was properly hydrated and monitored BP will become stable and laboratory values of
platelet count and bleeding parameters will begin to normalize.
Classification of Dengue Fever according to severity

1. Grade I – Dengue fever, saddleback fever plus constitutional signs and symptoms plus
positive tornique test
2. Grade II – Stage I plus spontaneous bleeding, epistaxis, GI, cutaneous bleeding
3. Grade III – Dengue Shock Syndrome, all of the following signs and symptoms plus
evidence of circulatory failure
4. Grade IV – Grade III plus irreversible shock and massive bleeding
Diagnostics
Tournique test or Rumpel Leede Test – presumptive test for capillary fragility
- keep cuff inflated for 6-10 mins (child), 10-15 min (adults)
- count the petechiae formation 1 sq inch (>10-15 petechiae/sq inch)
Laboratory Procedures
- CBC
- Bleeding Parameters
- Serologic test
- Dengue blot, Dengue Igm
- Other :
- PT (Prothrombin Time)
- APTT (Activated Partial Thromboplastin Time)
- Bleeding time
- Coagulation time
Management: symptomatic and supportive
- Specific Therapy – none

- Symptomatic/Supportive therapy
- Intravenous Fluids (IVF) f
- with hemoconcentration, 5-7 ml/kg/hr
- with shock, 10-30ml/kg in <20mins
- Use of Blood/Blood Products
- Platelet concentrate 1 unit/5-7kg
- Cryoprecipitate, 1unit/5kg
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- FFP, 15ml/kg x 2-4hrs
- given in patient in impending shock and unresponsive to isotonic or colloid transfusion.
- Prolonged PT
- FWB 20cc/kg
- active bleeding
- check serum calcium
- PRBC 10cc/kg
- Paracetamol (no aspirin)
- Giving of cytoprotectors
- Gastric Lavage
- Trendelenberg position for shock
- Nasal packing with epinephrine
- No intramuscular injections
- manage anxiety of patient and family
Preventive measures
Department of Health program for the control of Dengue Hemorrhagic Fever
Seek and destroy breeding places
Say no to indiscriminate fogging
Seek early consultation
B. Filariasis
- The disease often progresses to become chronic, debilitating and disfiguring disease
since it’s symptoms are unnoticed or unfamiliar to health workers.
- High rates in region 5(bicol), 8 (samar and leyte, II (davao)
- Wuchereria bancrofti and Bulgaria malayi
- Transmitted to the bite of infected female mosquito (Aedes, Anopheles, Mansonia)
- The larvae are carried in the blood stream and lodged in lymphatic vessels and lymph
glands where they mature in adult form
Two biological type

>Nocturnal - microfilaria circulate in peripheral blood at night (10pm – 2am)
> Diurnal - microfilaria circulate in greater concentration at daytime
Clinical Manifestation
Acute stage
- filarial fever and lymphatic inflammation that occurs frequently as 10 times per year and
usually abates spontaneously after 7 days
- Lymphadenitis (Inflammation of the lymphnodes)
- Lymphangitis (Inflammation of the lymph vessels)
Chronic Stage (10-15 years from the onset of the first attack)
- Hydrocele (Swelling of the scotum)
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- Lymphedema (Temporary swelling of the upper and lower extremities)
- Elephantiasis (enlargement and thickening of the skin of the lower or upper extremities)
Laboratory Diagnosis
- Blood smear – presence of microfilaria
- Immunochromatographic Test (ICT)
- Eosinophil count
Management:
- Specific Therapy
- Dietylcarbamazine (DEC) 6mg/KBW in divided doses for 12 consecutive days - Drug of
Choice
- Ivermectine (Mectican)
- Supportive Therapy
- Paracetamol
- Antihistamine for allergic reaction due to DEC
- Vitamin B complex
- Elevation of infected limb, elastic stocking
DEC should be taken immediately after meals

It may cause loss of vision, night blindness, or tunnel vision with prolonged used.
Ivermectin is best taken as single dose with a full glass of water in en empty stomach.
Cannot be used in patient with asthma
Preventive Measures
Health teachings
Environmental Sanitation
C. Leptosiprosis (Weil’s disease)

- a zoonotic systemic infection caused by Leptospires, that penetrate intact and abraded
skin through exposure to water, wet soil contaminated with urine of infected animals.
Types:
Anicteric Type (without jaundice)
- manifested by fever, conjunctival injection; signs of meningeal irritation
Icteric Type (Weil Syndrome)

- Hepatic and renal manifestation: Jaundice, hepatomegaly,
- Oliguria, anuria which progress to renal failure
- Shock, coma, CHF
- Convalescent Period
Diagnosis:
Clinical history and manifestation
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Culture
Blood: during the 1st week
CSF: from the 5th to the 12th day
Urine: after the 1st week until convalescent period
LAAT (Leptospira Agglutination Test)
other laboratory
BUN,CREA, liver enzymes
Treatment:
Specific:
- Penicillin 50000 units/kg/day
- Tetracycline 20-40mg/kg/day
Non-specific
- Supportive and symptomatic
- Administration of fluids
- Peritoneal dialysis for renal failure
- Educate public regarding the mode of transmission, avoid swimming or wadding in
potentially contaminated waters and use proper protective equipment.
Nursing Responsibilities
1. Dispose and isolate urine of patient.
2. Environmental sanitation like cleaning the esteros or dirty places with stagnant water,
eradication of rats and avoidance of wading or bathing in contaminated pools of water.
3. Give supportive and asymptomatic therapy
4. Administration of fluids and electrolytes.
5. Assist in peritoneal dialysis for renal failure patient (The most important sign of renal failure
is presence of oliguria.)
D. MALARIA
- “King of the Tropical Disease”

- an acute and chronic infection caused by protozoa plasmodia
- Infectious but not contagious
- transmitted through the bite of female anopheles mosquito
- Malaria Exacts Heavy Toll in Africa
Vector: (night biting)

- Female: anopheles mosquito
- or minimus flavire
Life cycle:
- Sexual cycle/sporogony (mosquito)
- sporozoites injected into humans
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- Asexual cycle/schizogony (human)
- gametes is the infective stage taken up by biting mosquito
Strains:
Plasmodium Vivax
- more widely distributed
- causes benign tertian malaria
- chills and fever every 48 hours in 3 days
Plasmodium Falciparum
- common in the Philippines
- Causes the most serious type of malaria because of high parasitic densities in blood.
- Causes malignant tertian malaria
Plasmodium malaria
- much less frequent
- causes quartan malaria, fever and chills every 72 hrs in 4 days
- Plasmodium Ovale
- rarely seen.
Plasmodium ovale
Pathology
- the most characteristic pathology of malaria is destruction of red blood cells,
hypertrophy of the spleen and liver and pigmentation of organs.
- The pigmentation is due to the phagocytocis of malarial pigments released into the
blood stream upon rupture of red cells
Clinical Manifestations:
Uncomplicated
- fever, chills, sweating every 24 – 36 hrs
Complicated
- sporulation or segmentation and rupture of erythrocytes occurs in the brain and visceral
organs.
- Cerebral malaria
- changes of sensorium, severe headache and vomiting
- seizures
Stages:
1. Cold stage – 10-15 mins, chills, shakes
2. hot stage – 4-6 hours, recurring high grade fever, severe headache, vomitting,
abdominal pain, face is blue
3. Diaphoretic Stage – excessive sweating
Diagnosis:
- Malarial smear
- Quantitative Buffy Coat (QBC)
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Travel in endemic areas
Treatment:
Determine the species of parasite
Objectives of treatment
1. Destroy all sexual forms of parasite to cure the clinical attack
2. Destroy the excerythrocytes (EE) to prevent relapse
3. Destroy gametocytes to prevent mosquito infections
Treatment for P. Falciparum

1. chloroquine tablet (150mg/base/tab) Day 1,2,3 (4,4,2)
2. Sulfadoxine/Pyrimethamine 500mg/25mg/tab, 3tab single dose
3. Primaquine (15mg/tab) 3 tabs single dose
Treatment for P. Vivax
1. Choloroquine, Day 1,2,3 (4,4,2)
2. Primaquine 1 tab OD for 14 days
Treatment for mixed
- chloroquine (4,4,2)
- Sulfadoxine/Pyrimethamine 3 tabs once
- Primaquine 1 tab for 14 days
*Multi-drug resistant P. Falciparum:

quinine plus doxycycline, or tetracycline and primaquine
Complications:
- severe anemia
- cerebral malaria
- hypoglycemia
Prevention and Control:

- Eliminate anopheles mosquito vectors
- Advise travelers
- limit dusk to dawn outdoor exposure
- insect repellant, nets
Nursing Care
1. Consider a patient with cerebral malaria to be an emergency
- Administer IV quinine as IV infusion
- Watch for neurologic toxicity from quinine transfusion like delirium, confusion, convulsion and
coma
2. Watch for jaundice – this is related to the density of the falciparum parasitemia,
3. Evaluate degree of anemia
4. Watch for abnormal bleeding that are may be due to decrease production of clotting factors
by damage liver.
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Chemoprophylaxis:
- doxycycline 100mg/tab, 2-3 days prior to travel, continue up to 4 weeks upon leaving
the area
- Mefloquine 250mg/tab, 1 week before travel, continue up to four weeks upon leaving
the area
- Pregnant, 1st trimester, chloroquine, 2 tabs weekly, 2 weeks before travel, during stay
and until 4 weeks after leaving
- 2nd and 3rd trimester, Pyrimethamine-sulfadoxine
LESSON 3: CENTRAL NERVOUS SYSTEM DISEASES
A. Inflammation of the meniges

Caused by bacterial pathogen, N. menigitidis, H. Influenza, Strep. Pneumoniae, Mycobacterium
Tuberculosis
Pathology:
Primary – spread of bacteria from the bloodstream to the meniges
Secondary – results from direct spread of infection from other sources or focus of infection.
The disease usually begins as an infection by normal body flora, of:

1. The ear (otitis media) - Haemophilus influenzae
2. The lung (lobar pneumoniae) - Streptococcus pneumoniae
3. The upper respiratory tract (rhinopharyngitis) - Neisseria meningitidis, Haemophilus
influenzae, Streptococcus, Group B
4 The skin and subcutaneous tissue (furunculosis) S. aureus
5. The bone (osteomyelitis) - S. aureus
6. The intestine - E. coli
Clinical manifestation:
- Fever
- Rapid pulse, respiratory arrythmia
- Soreness of skin and muscles
- Convulsion/seizures
- headache
- irritability
- fever
- neck stiffness
- pathologic reflexes: kernig’s, Babinski, Brudzinski
Diagnosis:
- Lumbar puncture
- Blood C/S
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- other laboratories
a. Lumbar Puncture
- To obtain specimen of CSF
- To reduce ICP
- To Introduce medication
- To inject anesthetic
b. CSF Examination
- Fluid is turbid/purulent >1000cc/mm cells
- WBC count increase
- Sugar content markedly reduced
- CHON increased
- Presence of microorganism
Treatment:
Bacterial meningitis
- TB meningitis
- Intensive Phase
- Maintainance Phase
- Fungal meningitis
- cryptococcal meningitis – fluconazole or amphotericin B
2. Supportive/Symptomatic
a. Antipyretic
b. treat signs of increased ICP
c. Control of seizures
d. adequate nutrition
Nursing care:
Prevent occurrence of further complication
- Maintain strict aseptic technique when doing dressing or lumbar puncture.
- Early symptom should be recognize
- Vital signs monitoring
- Observe signs of increase ICP
- Protect eyes from light and noises
Maintain normal amount of fluid and electrolyte balance
- Note and record the amount of vomitus
- Check signs of dehydration
Prevent Spread of the disease
- Having proper disposal of secretions
- Emphasize the importance of masking
- Explain the importance of isolation
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Ensure patient’s full recovery
- Maintain side rails up in episodes of siezures
- Prevent sudden jar of bed
- Keep patient in a dark room and complete physical rest
- Diversional activities and passive exercises
B. Meningococcemia
- caused by Neisseria meningitides, a gram negative diplococcus
- transmitted through airborne or close contact
- incubation is 1-3 days
- natural reservoir is human nasopharynx
Clinical Manifestation
sudden onset of high grade fever, rash and rapid deterioration of clinical condition within 24
hours
S/sx:
1. Meningococcemia – spiking fever, chills, arthralgia, sudden appearance of hemorrhagic
rash
2. Fulminant Meningococcemia (Waterhouse Friderichsen) – septic shock; hypotension,
tachycardia, enlarging petecchial rash, adrenal insufficiency
Diagnostics:
- Blood Culture
- Gram stain of peripheral smear, CSF and skin lesions
- CBC
-
Treatment:
antimicrobial
- Benzyl Penicillin 250-400000 u/kg/day
- Chloramphenicol 100mg/kg/day
Symptomatic and supportive
- fever
- seizures
- hydration
- respiratory function
Chemoprophylaxis
1. Rifampicin 300-600mg q 12hrs x 4 doses
2. Ofloxacin 400mg single dose
3. Ceftriaxone 125-250mg IM single dose
- Provide strict isolation
- Wearing of PPE
- Health teaching
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- Contact tracing
- Prophylaxis
- Meninggococcal vaccine for high risk patient
C. Rabies
- acute viral encephalomyelitis
- incubation period is 4 days up to 19 years
- risk of developing rabies, face bite 60%, upper extremities 15-40%, lower extremities
10%
- 100% fatal
- pain or numbness at the site of bite
- fear of water
- fear of air
4 STAGES
1. prodrome - fever, headache, paresthesia,
2. encephalitic – excessive motor activity, hypersensitivity to bright light, loud noise,
hypersalivation, dilated pupils
3. brainstem dysfunction – dysphagia, hydrophobia, apnea
4. death
Diagnosis:
- FAT (fluorescent antibody test)
- Clinical history and signs and symptoms
Management:
- No treatment for clinical rabies
- Prophylaxis
Postexposure prophylaxis
A. Active vaccine (PDEV,PCEC,PVRV)

Intradermal (0,3,7,30,90)
Intramuscular (0,3,7,14,28)
(0,7,21)
B. Passive Vaccine
a. ERIG wt in kg x .2 = cc to be injected im (ANST)
b. HRIG wt in Kg x .1333
Pre-exposure Prophylaxis
Intradermal/Intramuscular (0,7,21)
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Infection control
- Patient is isolated to prevent exposure of hospital personnel, watchers and visitors
- PPE
- Preventive Measures
- Education
- Post-exposure and Pre-exposure Prophylaxis
D. Poliomyelitis
- RNA, Polio virus
- Fecal oral route/droplets
- IP 7-12 days
- Disease of the lower motor neurin involving the anterior horn cells
- Infantile paralysis; Helne-Medin disease
Predisposing Factors
- Children below 10 years old
- Male more often affected
- Poor environmental and hygienic conditions
Causative Agent:
- Legio debilitans
- Brunhilde (permanent)
- Lansing and Leon (temporary)
- May exist in contaminated water, sewage and milk
1. mild febrile illness – fever, malaise, sore throat (abortive stage)
2. Pre-paralytic stage - flaccid asymetrical ascending paralysis (Landry’s sign), Hayne’s sign
(head drop), Pofer’s sign (opisthotonus)
3. Paralytic stage
bulbar or spinal
Mode of Transmission
- Droplet infection – in early infection
- Body secretions – nasopharyngeal
- Fecal oral – during late stage
- Flies may act as mechanical vectors
B. I – Abortive or inapparent
C. II – Meningitis (non-paralytic)
D. III – Paralytic (anterior horn of spinal cord)
E. IV – Bulbar (encephalitis)
Diagnostics:
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Pandy’s test - CSF (increased CHON)
Management:
Active – OPV (Sabin) and IPV (Salk)
Immunity is acquired for 3 strains

A. Legio brunhilde (fatal)
B. Legio lansing
C. Legio leon
Respiratory distress
A. Respirator
B. Tracheostomy – life saving procedure when respiratory failure and inability to
swallow are not corrected
C. Oxygen therapy
D. Rehabilitation (Physical)
E. Tetanus
- caused by Clostridium tetani, grows anaeronically
- Tetanus spores are introduced into the wound contaminated with soil.
- Incubation period 4-21 days
Clinical manifestation:
- Difficulty of opening the mouth (trismus or lockjaw)
- Risus sardonicus
- Abdominal rigidity
- Localized or generalized muscle spasm
Treatment:
1. Neutralize the toxin
2. Kill the microorganism
3. Prevent and control the spasm
- muscle relaxants
- Sedatives
- Tranquilizers
4. Tracheostomy
Anti-toxin:
Tetanus Anti-Toxin (TAT)
- Adult,children,infant 40,000 IU ½ IM,1/2 IV
- Neonatal Tetanus 20000 IU, 1/2IM, ½ IV
TIG
- Neonates 1000 IU, IV drip or IM
- Adult, infant, children 3000 IU, IV drip or IM
Antimicrobial Therapy
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Penicillin (drug of choice) -3 mil units q 4hours
Pedia 500000 – 2mil units q 4 hrs
Neonatal 200000 units IVP q 12hrs or q8hrs
Control of spasms
- diazepam
- chlorpromazine
Nursing care
- Patient should be in a quiet, darkened room, well ventilated.
- Minimal/gentle handling of patient
- Liquid diet via NGT
- Prevent Injury
- Preventive Measures
- Treatment of wounds
- Tetanus toxoid (0,1,6,1,1)
LESSON 4: HEPATO-ENTERIC DISEASES
A. Schistosomiasis
- caused by blood flukes, Schistosoma
- has 3 species, S. haematobium, S. Mansoni, S. japonicum
- S. japonicum is endemic in the Philippines (leyte, Samar, Sorsogon, Mindoro,Bohol)
- Intermediate host, Oncomelania Quadrasi
Diagnosis:
- Schistosoma eggs in stool
- Rectal bipsy
- Kato Katz
- Ultrasound of HBT
- severe jaundice
- edema
- ascites
- 146epatosplenomegaly
- S/S of portal hypertention
Management:
- Praziquantrel 60mg/kg Once dosing
- Supportive and sympromatic
Methods of Control:
- Educate the public regarding the mode of transmission and methods of protection.
- Proper disposal of feces and urine
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- Prevent exposure to contaminated water. To minimize penetration after accidental water
exposure, towel dry and apply 70% alcohol.
- The organism is pathogenic only in man
B. Typhoid Fever
- Spread chiefly by carriers, ingestion of infected foods

- Endemic particularly in areas of low sanitation levels
- Occurs more common in may to august
Mode of Transmission: oral fecal route
Rose spot (abdominal rashes), more than 7days Step ladder fever 40-41 deg, headache,
abdominal pain, constipation (adults), mild diarrhea (children)
Diagnosis:
Blood examination WBC usually leukopenia with lymphocytosis
Isolation
- Blood culture 1st week\
- Urine culture 2nd week
- Stool culture 3rd week
- Widal test O or H
- 1st week step ladder fever (BLOOD)
- 2nd week rose spot and fastidial
- typhoid psychosis (URINE & STOOL)
Management: Chloramphenicol (drug of choice), Amoxicillin, Sulfonamides, Ciprofloxacin,

Ceftriaxone
Watch for complication

a. Perforation – symptoms of sharp abdominal pain, abdominal rigidity and absent of
bowel sounds.
- prepare for intestinal decompression or surgical intervention
b. Intestinal hemorrhage - withold food and give blood transfusion
Nursing Interventions:
- Environmental Sanitation
- Food handlers sanitation permit
- Supportive therapy
- Assessment of complication (occuring on the 2nd to 3rd week of infection ):
Typhoid psychosis, typhoid meningitis, typhoid ileitis
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C. Hepatitis
- Hepa A – fecal oral route
- Hepa B – body fluids
- Hepa C – non A non B, BT, body fluids
- Hepa D – hypodermic, body fluids
- Hepa E – fecal oral route, fatal and common among pregnant women
- Hepa G – BT, parenteral
Hepatitis A
- Infectious hepatitis, epidemic hepatitis
- Young people especially school children are most commonly affected.
- Predisposing factors:
- Poor sanitation, contaminated water supply, unsanitary preparation of food,
malnutrition, disaster conditions
Incubation Period: 15-50 days

- Influenza
- Malaise and easy fatigability
- Anorexia and abdominal discomfort
- Nausea and vomiting
- Fever, CLAD
- jaundice
Diagnostics: Anti HAV IgM – active infection; Anti HAV IgG – old infection; no active disease
Management:
- Prophylaxis
- Complete bed rest
- Low fat diet but high sugar
- Ensure safe water for drinking
- Sanitary method in preparing handling and serving of food.
- Proper disposal of feces and urine.
- Washing hands before eating and after toilet use.
- Separate and proper cleaning of articles used by patient
Hepatitis B
- DNA, Hepa B virus
- Serum hepa
- Worldwide distribution
- Main cause of liver cirrhosis and liver cancer
Incubation Period: 2-5 months
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Mode of Transmission:
- From person to person through
- contact with infected blood through broken skin and mucous membrane
- sexual contact
- sharing of personal items
- Parenteral transmission through
- blood and blood products
- use of contaminated materials
- Perinatal transmission
High Risk group:

- Newborns and infants of infected mothers
- Health workers exposed to handling blood
- Persons requiring frequent transfusions
- Sexually promiscuous individuals
- Commercial sex workers
- Drug addicts
Possible Outcome:
- Most get well completely and develop life long immunity.
- Some become carriers of the virus and transmit disease to others.
- Almost 90% of infected newborns become carriers
Hepatitis C
- Post transfusion Hepatitis
- Mode of transmission – percutaneous, BT
- Predisposing factors – paramedical teams and blood recepients
- Incubation period – 2weeks – 6 months
Hepatitis D
- Dormant type
- Can be acquired only if with hepatitis B
Hepatitis E
- If hepatitis E recurs at age 20-30, it can lead to cancer of the liver
- Enteric hepatitis
- Fecal-oral route
Diagnostics:
- Elevated AST or SGPT (specific) and ALT or SGOT
- Increased IgM during acute phase
- (+) or REACTIVE HBsAg = INFECTED, may be acute, chronic or carrier
- (+) HBeAg = highly infectious
- ALT – 1st to increase in liver damage
o HBcAg = found only in the liver cells
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- (+) Anti-HBc = acute infection
- (+) Anti-HBe = reduced infectiousness
- (+) Anti-HBs = with antibodies (FROM vaccine or disease)
- Blood Chem. Analysis (to monitor progression)
- Liver biopsy (to detect progression to CA)
Management:
- Prevention of spread – Immunization and Health Education
- Enteric and Universal precautions
- Assess LOC
- Bed rest
- ADEK deficiency intervention
- High CHO, Moderate CHON, Low fat
- FVE prevention
Complications:
1. Fulminant Hepatitis – s/sx of encephalopathy
2. Chronic Hepatitis - lack of complete resolution of clinical sx and persistence of hepatomegaly
3. HBsAg carrier
LESSON 5: ERUPTIVE FEVER
A. Measles
- Extremely contagious
- Breastfed babies of mothers have 3 months immunity for measles
- The most common complication is otitis media
- The most serious complications are bronchopneumonia and encephalitis
Measles, Rubeola, 7 Day Fever, Hard Red Measles

- RNA, Paramyxoviridae
- Active MMR and Measles vaccine
- Passive Measles immune globulin
- Lifetime Immunity
- IP: 7-14 days
Mode of transmission: droplets, airborne

- *Contagious 4 days before rash and 4 days after rash
a. Pre eruptive stage
- Patient is highly communicable
- 4 characteristic features
A. Coryza
B. Conjunctivitis
C. Photophobia
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D. Cough
- Koplik’s spots
- Stmsons line
b. Eruptive stage
- Maculopapular rashes appears first on the hairline, forehead, post auricular area the
spread to the extremities (cephalocaudal)
- Rashes are too hot to touch and dry
- High grade fever and increases steadily at the height of the rashes
c. Stage of convalescence
- Rashes fade in the same manner leaving a dirty brownish pigmentation (desquamation)
- Black measles – severe form of measles with hemorrhagic rashes, epistaxis and melena
Rashes: maculopapaular, cephalocaudal (hairline and behind the ears to trunk and limbs),
confluent, desquamation, pruritus
Complications:
- Bronchopneumonia
- Secondary infections
- Encephalitis
- Increase predisposition to TB
Managements:
1. Supportive
2. Hydration
3. Proper nutrition
4. Vitamin A
5. Antibiotics
6. Vaccine
Nursing Care:
- Respiratory precautions
- Restrict to quite environment
- Dim light if photophobia is present
- Administer antipyretic
- Use cool mist vaporizer for cough
B. German Measles (Rubella)

- Acute infection caused by rubella virus characterized by fever, exanthem and
retroauricular adenopathy.
- Has a teratogenic potential on the fetuse of women in the 1st trimester
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- forschheimer’s (petecchial lesion on buccal cavity or soft palate),
- cervical lymphadenopathy, low grade fever
- “ Oval, rose red papules about the size of pinhead
Diagnostics: clinical
Complications: rare; pneumonia, meningoencephalitis
Complications to pregnant women:
- 1st tri-congenital anomalies
- 2nd tri-abortion
- 3rd tri-pre mature delivery
Rashes: Maculopapular, Diffuse/not confluent, No desquamation, spreads from the face
downwards
C. Roseola Infantum,
Exanthem Subitum, Sixth disease
- Human herpes virus 6
- 3mos-4 yo, peak 6-24 mos
- MOT: probably respiratory secretions
Spiking fever w/c subsides 2-3 days, Face and trunk rashes appear after fever subsides, Mild
pharyngitis and lymph node enlargement
D. Chicken Pox, Varicella

- Herpes zoster virus (shingles),
varicella zoster virus(chocken pox)
- Active : Varicella vaccine
- Passive: VZIG, ZIG – given 72-96 hrs
w/n exposure
- Lifetime Immunity
- IP: 14-21 days
Mode of transmission: Respiratory route

* Contagious 1 day before rash and 6 days after first crop of vesicles
- S/sx:
fever, malaise, headache
- Rashes: Maculopapulovesicular (covered areas), Centrifugal, starts on face and trunk
and spreads to entire body
- Leaves a pitted scar (pockmark)
- CX furunculosis, erysipelas, meningoencephalitis
- Dormant: remain at the dorsal root ganglion and may recur as shingles (VZV)
Management:
a. oral acyclovir
b. Tepid water and wet compresses for pruritus
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c. Aluminum acetate soak for VZV
d. Potassium Permanganate (ABO)
a. Astringent effect
b. Bactericidal effect
c. Oxidizing effect (deodorize the rash)
E. Small Pox, Variola

- DNA, Pox virus
- Last case 1977
- spreads from man-to-man only
- Active: Vaccinia pox virus
- IP: 1-3 weeks
- Rashes:
- Maculopapulovesiculopustular
- Centripetal
- contagious until all crusts disappeared
Diagnostics:
- Paul’s test - instilling of vesicular fluid w/ small pox into the cornea; if keratitis develops,
small pox
- Cx: same with chicken pox
F. Kawasaki Disease
- Mucocutaneous lymph node syndrome
- Children younger than 5 years old are primarily affected.
- Associated with large coronary blood vessel vasculitits
- A febrile, exanthematous, multisystem illness characterized by
o Acute febrile phase manifested by high spiking fever, rash, adenopathy,
peripheral edema, conjunctivitis and exanthem
o sub acute phase, thrombocytosis, desquamation and resolution of fever.
o Convalescent stage
Manifestations:
- bilateral, non purulent conjuctivitis
- congested oropharynx, strawberry tongue, erythematous lymphs
- erythematous palms/soles, edematous hands/feet
- periungal desquamation, truncal rash
- CLADP ( 1node >1.5cm)
Diagnosis
- CBC: leukocytosis
- Platelet count >400000
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- 2D echo (if coronary artery involvement is highly suggestive
- ESR and CRP elevated
Management
- IV Gamma globulin – 2g/kg as single dose for 10-12 hours. Effective to prevent coronary
vascular damage if given within 10 days of onset.
- Salicylates: 80-100mg/kg/24 hours in 4 divided doses
- Symptomatic and supportive therapy
LESSON 6: RESPIRATORY SYSTEM DISEASES
A. Mumps
Etiologic agent: RNA, Mumps virus
- Mumps vaccine - > 1yo
- MMR – 15 mos
- Lifetime Immunity
Mode of transmission: Droplet, saliva, fomites
Clinical Manifestations: Unilateral or bilateral

- parotitis, Orchitis - sterility if bilateral,
- Oophoritis, Stimulating food cause severe pain, aseptic meningitis
- Dx: serologic testing, ELISA
Management: supportive
Nursing care:
- Respiratory precautions
- Bed rest until the parotid gland swelling subsides
- Avoid foods that require Chewing
- Apply hot or cold compress
- To relieve orchitis, apply warmth and local support with tight fitting underpants
B. Diptheria
- Acute contagious disease
- Characterized by generalized systemic toxemia from a localized inflammatory focus
- Infants immune for 6 months of life
- Produces exotoxin
- Capable of damaging muscles especially cardiac, nerve, kidney and liver
- Increase incidence prevalence during cooler months
- Mainly a disease of childhood with peak at 2-5 years, uncommon in >6months
Etiologic agent: Corynebacterium diphtheriae, gram (+), slender, curved clubbed organism
“Klebs-Loeffler Bacillus”
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Mode of transmission: direct or indirect contact

1. Nasal – invades nose by extension from pharynx
2. Pharygeal
- sorethroat causing dysphagia
- Pseudomembrane in uvula, tonsils, soft palate
- Bullneck – inflammation of cervical LN
3. Laryngeal
- increasing hoarseness until aphonia
- wheezing on expiration
- dyspnea
Diagnosis:
- Nose and throat swab using loeffler’s medium
- Schick test – determine susceptibility or immunity in diptheria
- Maloney test – determines hypersensitivity to diptheria toxoid
Complications:
Toxic myocarditis – due to action of toxin in the heart muscles (1st 10-14 days)
Neuritis caused by absorption of toxin in the nerve
- Palate paralysis (2nd week)
- Ocular palsy (5th week)
- Diapgram paralysis (6-10wk causing GBS)
- Motor and skeletal muscle paralysis
Treatment:
A. Neutralize the toxins – antidiptheria serum
B. Kill the microorganism – penicillin
C. Prevent respiratory obstruction – tracheostomy, intubation
Serum therapy (Diptheria antitoxin)

- early administration aimed at neutralizing the toxin present in the general circulation
Antibiotics
- Penicillin G 100000mg/kg.day (drug of choice)
- Erythromycin 40mg/kg
- Rest.
- Patient should be confined to bed for at least 2 weeks
- Prevent straining on defecation
- vomiting is very exhausting, do not do procedures that may cause nausea
- Care for the nose and throat
- Ice collar to reduce the pain of sorethroat
- Soft and liquid diet
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C. Whooping Cough, 100 day fever
Etiologic agent: Bordetella pertussis, B. parapertussis, B. bronchiseptica, gram (-)
Mode of transmission: airborne/droplet
- Invasion or catarrhal stage (7-14days) starts with ordinary cough
- Spasmodic or paroxysmal
- 5-10 spasms of explosive cough (no time to catch breath. A peculiar inspiratory crowing
sound followed by prolonged expiration and a sudden noisy inspiration with a long high
pitched “whoop”
- During attack the child becomes cyanotic and the eyes appear to bulge or popping out
of the eyeball and tongue protrudes
Diagnosis:
- WBC count 20000-50000
- Culture with Bordet Gengou Agar
Treatment:
- Erythromycin shorten the period of communicability
- Ampicillin if with allergy to erythromycin
- Heperimmune pertusis gamma globulin in <2 years old (1.25ml IM)
- Control of cough with sedatives
Diagnostics:
WHO - >21 days cough + close contact w/ pertussis px + (+) culture OR rise in Ab to FHA or
pertussis toxin
* throat culture w/ Bordet gengou agar
Management:
- CBR to conserve energy
- Prevent aspiration
- High calorie, bland diet
- Omit milk and milk product because it increases the mucous
- Refeeding of infants 20 min after vomitting
- Milk should be given at room temperature
Complications:
- Bronchopneumonia
- Abdominal hernia
- Severe malnutrition
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- TB, asthma
- encephalitis
Pre exposure prophylaxis for Diphtheria, Pertussis, Tetanus

DPT- 0.5 ml IM
- 1 - 1 ½ months old
2 - after 4 weeks
3 - after 4 weeks
- 1st booster – 18 mos
- 2nd booster – 4-6 yo
- subsequent booster – every 10 yrs thereafter
D. Pulmonary Tuberculosis
- The world’s deadliest disease and remains as a major public health problem.
- Badly nourished, neglected and fatigued individuals are more prone
- Susceptibility is highest in children under 3 years
- AKA: Koch’s disease: Galloping consumption
- Wt loss
- night sweats
- low fever,
- non productive to productive cough
- anorexia,
- Pleural effusion and hypoxemia
- cervical lymphadenopathy
PPD – ID
- macrophages in skin take up Ag and deliver it to T cells
- T cells move to skin site, release lymphokines
- activate macrophages and in 48-72 hrs, skin becomes indurated
- > 10 mm is (+)
Dx:
- Chest xray - cavitary lesion
- Sputum exam
- sputum culture
The National Tuberculosis Control Program

- Vision: A country where TB is no longer a public health problem.
- Mission: Ensure that TB DOTS services are available to the communities.
- Goal: To reduce the prevalence and mortality from TB by half by the year 2015
Targets:
1. To cure at least 85% of the sputum smear positive TB patient discovered.
2. Detect at least 70% of the estimated new sputum smear positive TB cases.
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Management:
short course – 6-9 months
long course – 9-12 months
Follow-up
• 2 weeks after medications – non communicable
o 3 successive (-) sputum - non communicable
o rifampicin - prophylactic
Recommended Treatment Regimen for Adults and Children

Category of Treatment Classification and Treatment Regimen
Registration Group
Category I Pulmonary TB, new (whether
bacteriologicallyconfi rmed or
clinically-diagnosed) Extra- 2HRZE/4HR
pulmonary TB, new (whether
bacteriologically-confi rmed or
clinically-diagnosed) except
CNS/ bones or joints
Category Ia Extra-pulmonary TB, new 2HRZE/10HR
(CNS/bones or joints)
Category II Pulmonary or extra-pulmonary, 2HRZES/1HRZE /5HRE
previously treated drug-
susceptible TB (whether
bacteriologically-confirmed or
clinically diagnosed)
• Relapse
• Treatment After Failure
• Treatment After Lost to
Follow-up (TALF)
• Previous Treatment Outcome
Unknown
• Other
Category IIa Extra-pulmonary, Previously 2HRZES/1HRZE /9HRE
treated drugsusceptible TB
(whether
bacteriologicallyconfirmed or
clinically-diagnosed - CNS/bones
or joints)
Standard Regimen Drug- Rifampicin-resistant TB or ZKmLfxPtoCs
resistant (SRDR) Multidrug-resistant TB • Individualized once DST
result is available
• Treatment duration for at
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least 18 months
XDR-TB Regimen Extensively drug-resistant TB Individualized based on DST
result and history of previous
treatment
Legend: R - Rifampicin, I - Isoniazid, E - Ethambutol, Z - Pyrazinamide, S - Streptomycin, Km - Kanamycin.
Lfx - Levofloxacin, Pto - Prothionamide. C - Cycloserine
Guide in Managing Adverse Reactions to Anti-TB Drugs

Adverse Reactions Drug(s) probably Management
responsible
Minor
1. Gastro-intestinal Rifampicin/Isoniazid/ Give drugs at bedtime or with
intolerance Pyrazinamide small meals.
2. Mild or localized skin Any kind of drugs Give anti-histamines.
reactions
3. Orange/red colored urine Rifampicin Reassure the patient
4. Pain at the injection site Streptomycin Apply warm compress. Rotate
sites of injection.
5. Burning sensation in the Isoniazid Give Pyridoxine (Vitamin B6):
feet due to peripheral 50-100 mg daily for
neuropathy treatment, 10 mg daily for
prevention.
6. Arthralgia due to Pyrazinamide Give aspirin or NSAID. If
hyperuricemia symptoms persist, consider
gout and request for blood
chemistry (uric acid
determination) and manage
accordingly
7. Flu-like symptoms (fever, Rifampicin Give antipyretics
muscle pains, inflammation of
the respiratory tract)
Major
1. Severe skin rash due to Any kind of drugs (especially Discontinue anti-TB drugs and
hypersensitivity Streptomycin) refer to appropriate specialist.
2. Jaundice due to hepatitis Any kind of drugs (especially Discontinue anti-TB drugs and
Isoniazid, Rifampicin, and refer to appropriate specialist.
Pyrazinamide) If symptoms subside, resume
treatment and monitor
clinically
3. Impairment of visual acuity Ethambutol Discontinue Ethambutol and
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and color vision due to optic refer to an ophthalmologist.
neuritis
4. Hearing impairment, Streptomycin Discontinue Streptomycin and
ringing of the ear, and refer to appropriate specialist
dizziness due to damage of .
the eighth cranial nerve
5. Oliguria or albuminuria due Streptomycin/ Rifampicin Discontinue anti-TB drugs and
to renal disorder refer to appropriate specialist
6. Psychosis and convulsion Isoniazid Discontinue Isoniazid and
refer to appropriate specialist.
7. Discontinue Isoniazid and Rifampicin Discontinue anti-TB drugs and
refer to appropriate specialist. refer to appropriate specialist
Methods of Control:
• Prompt treatment and diagnosis
• BCG vaccination
• Educate the public in mode of transmission and importance of early diagnosid
• Improve social condition
E. Pneumonia
1. Community acquired
Typical– Strep. Pneumoniae, H. Influenzae type B
Atypical Pneumonia – S. Aureus, M. Pneumoniae, L. Pneumophila, P. Cariini
2. Nosocomial – Pseudomonas, S. Aureus
Mode of transmission: aspiration, inhalation, hematogenous, direct inoculation, contiguous

spread
CHILDHOOD PNEUMONIA
1. No pneumonia
- infant, 60/min and no chest indrawing
2. Pneumonia
- young infant >60/min, fast breathing without chest indrawing
3. Severe pneumonia
- fast breathing, severe chest indrawing, with one of danger signs
4. Very severe pneumonia
- below 2 mos old, fast breathing, chest indrawing, with danger signs
4 Danger Signs
1. Vomits
2. Convulsion
3. Drowsiness/lethargy
4. Difficulty of swallowing or feeding
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1. Typical – sudden onset Fever of > 38 x 7-10 days, productive cough, pleuritic chest
pain, dullness, inc fremitus, rales
2. Atypical – gradual onset, dry cough, headache, myalgia, sore throat
Watch out for complications; In 24 hours death will occur from respiratory failure
Nursing Diagnosis:
• Ineffective airway clearance
• Ineffective breathing pattern
• Impaired gas exchange
• Risk for activity intolerance
Management:
• Antibiotics, hydration, nutrition, nebulization
• CARI-health teaching
• Nursing Interventions
• Respiratory support
- oxygen supplementation
- mechanical ventilation
• Positioning
• Rest
• Suctioning of secretions
• Antipyretic and TSB
• Nutrition
LESSON 7: GASTROINTESTINAL SYSTEM DISEASES

A. Amoebiasis
Etiologic agent: Entamoeba Hystolitica, protozoa
- IP: few days to months to years,
- usually 2- 4 weeks
- MOT: Ingestion of cysts from fecally contaminated sources (Oral fecal route)
oral and anal sexual practices
- Extraintestinal amoebiasis- genitalia, spleen, liver, anal, lungs and meninges
- Blood streaked, watery mucoid diarrhea, foul smelling,
- abdominal cramps
- Pain on defecation (tenesmus)
- Hyperactive bowel sounds
Diagnostic tests:
- Stool culture of 3 stool specimens
- Sigmoidoscopy
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- Recto-sigmoidoscopy and coloscopy for intestinal amoebiasis
Medical treatment:
- Metronidazole – trichomonocide and amoebicide for intestinal and extra intestinal sites
(monitor liver function test)
- Diloxanide furoate – luminal amoebicide
- Paromomycin – eradicate cyst of histolytica
- Tinidazole – hepatic amebic abscess
B. Bacillary Dysentery
Shigellosis
- Shiga bacillus: dysenteriae (fatal), flexneri (Philippines), boydii, sonnei; gram (-)
- Shiga toxin destroys intestinal mucosa
- Humans are the only hosts
- Not part of normal intestinal flora
- IP: 1-7 days
- MOT : oral fecal route
Clinical manifestations: fever, severe abdominal pain, diarrhea is watery to bloody with pus,
tenesmus
Diagnostics: stool culture
Management: Oresol, Ampicillin, Trimethoprim-Sulfamethoxazole, Chloramphenicol,

Tetracycline, Ciprofloxacin
C. Cholera
- Etiologic agent: Vibrio coma (inaba, ogawa, hikojima), vibrio cholerae, vibrio el tor;
gram (-)
- Choleragen toxin induces active secretion of NaCl
- Active Immunization
- Incubation Period: few hours to 5 days
- Mode of transmission: oral fecal route
Clinical manifestations: Rice watery stool with flecks of mucus, s/sx of severe dehydration ie
Washerwoman’s skin, poor skin turgor
Diagnostics: stool culture
Management: IV fluids, Tetracycline (drug of choice), Doxycycline, Erythromycin, Quinolones,

Furazolidone and Sulfonamides (children)
D. Paragonimiasis
- Chronic parasitic infection
- Closely resembles PTB
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- Endemic areas: 163orsogo, camarines sur, norte, samar, 163orsogon, leyte, albay,
basilan
- Paragonimiasis
- AKA: Lung fluke disease
- causative agent: paragonimus westermani; Trematode
- Eating raw or partially cooked fish or fresh water crabs
Signs and symptoms

- Cough of long duration
- Hemoptysis
- Chest/back pain
- PTB not responding to anti-koch’s meds
Diagnosis:
- sputum examination – eggs in brown spots
Treatment:
1. Praziquantrel (biltrizide) (drug of choice)
2. Bithionol
E. Parasitic worms
Ascariasis
- Common worldwide with greatest frequency in tropical countries.
- Has an infection rate of 70-90% in rural areas
- MOT: ingestion of embryonated egss (fecal-oral)
- Worms reach maturity 2 months after ingestion of eggs.
- Adult worms live less than 10 months(18 months max.)
- Female can produce up to 200000 eggs per day
- Eggs may be viable in soils for months or years
- Worms can reach 10-30cm in length
- loss of appetite
- Worms in the stool
- Fever
- Wheezing
- Vomiting
- Abdominal distention
- Diarhea
- dehydration
Medical Management:
A. Mebendazole (antihelmintic) effect occurs by blocking the glucose uptake of the
organisms, reducing the energy until death
B. Pyrantel pamoate: neuromuscular blocking effect which paralyze the helminth, allowing
it to be expelled in the feces
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C. Pierazine citrate: paralyze muscles of parasite, this dislodges the parasites promoting
their elimination
Nursing care:
- Environmental sanitation
- Health teachings
- Assessment of hydration status
- Use of ORS
- Proper waste disposal
- Enteric precautions
Complications:
- Migration of the worm to different parts of the body Ears, mouth,nose
- Loefflers Pneumonia
- Energy protein malnutrition
- Intestinal obstruction
Tapeworm (Flatworms)
- Etiologic agent: Taenia Saginata (cattle), Taenia Solium (pigs)
- Mode of transmission: fecal oral route (ingestion of food contaminated by the agent)
- Clinical manifestations: neurocysticercosis – seizures, hydrocephalus
- Diagnostics: Stool Exam
- Management: Praziquantel, Niclosamide
Pinworm
- Etiologic agent:Enterobius Vermicularis
- Mode of transmission: fecal oral route
- Clinical manifestations: Itchiness at the anal area d/t eggs of the agent
- Diagnostics: tape test at night time (agents release their eggs during night time); use
flashlight
- Management: Pyrantel Pamoate, Mebendazole
Hookworm
- Etiologic agent: Necator Americanus, Ancylostoma Duodenale
- Leads to iron deficiency and hypochromic microcytic anemia
- Gain entry via the skin
- Diagnostics: microscopic exam (stool exam)
- Management: Pyrantel Pamoate and Mebendazole
- don’t give drug without (+) stool exam
- members of the family must be examined and treated also
Nursing Intervention:
- Promote hygiene
- Environmental Sanitation
- Proper waste and sewage disposal
- Antihelmintic medications repeated after 2 weeks (entire family)
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E. PARALYTIC SHELLFISH POISONING
- A syndrome of characteristic symptoms predominantly neurologic which occurs within
minutes or several hours after ingestion of poisonous shellfish
- Single celled dinoflagellates (red planktons) become poisonous after heavy rain fall
preceded by prolonged summer
- Common in seas around Manila bay, Samar, Bataan and Zambales
-
Mode of transmission: Ingestion of contaminated bi-valve shellfish
Incubation period: within 30 minutes
- numbness of the face especially around the mouth
- vomiting, dizziness, headache
- tingling sensation, weakness
- rapid pulse, difficulty of speech (ataxia), dysphagia, respi paralysis, death.
Management and control measures:

- no definite medications
- induce vomiting (early intervention)
- drinking pure coconut milk (weakens toxic effect) don’t give during late stage it may
worsen the condition.
- nahco3 solution (25 grams in ½ glass of water)
- respiratory support
- avoid using vinegar in cooking shellfish affected by red tide (15x virulence)
- toxin of red tide is not totally destroyed in cooking.
- avoid tahong, talaba, halaan, kabiya, abaniko. when red tide is on the rise.
F. BOTULISM
- A True poison known to be one of the deadliest substance and usually released into the
food shortly after it has been canned
- Botulism
- Etiologic agent: Clostridium Botulinum, gram (+), spore forming
- Ingestion of contaminated foods (canned foods), wound contamination, infant botulism
(most common; ingestion of honey)
- Neurotoxins block AcH
- Incubation period: 12-36H (canned food)
- Incubation period: 4-14 days (wound)
- Active and passive immunization
Clinical manifestations: Diplopia, dysphagia, symmetric descending flaccid paralysis, ptosis,

depressed gag reflex, nausea, vomiting, dry mouth, respiratory paralysis
Diagnostics: gastric siphoning, wound culture, serum bioassay (food borne)

Management: respiratory support, antitoxin
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LESSON 8: CONTACT TRANSMISSION
A. Pediculosis
Blood sucking lice/Pediculus humanus
p. capitis-scalp
p. palpebrarum-eyelids and eyelashes
p. pubis-pubic hair
p. corporis-body
Mode of transmission: skin contact, sharing of grooming implements
Clinical manifestations: nits in hair/clothing, irritating maculopapular or urticarial rash
Management: disinfect implements, Lindane (Kwell) topical, Permethrin (Nix) topical
B. Scabies
- Sarcoptes scabiei
- Pruritus (excreta of mites)
- Mites come-out from burrows to mate at night
- Mode of transmission: skin contact
Clinical manifestations:: itching worse at night and after hot shower; rash; burrows (dark wavy
lines that end in a bleb w/ female mite) in between fingers, volar wrists, elbow, penis; papules
and vesicles in navel, axillae, belt line, buttocks, upper thighs and scrotum
Diagnostics: biopsies/scrapings of lesions
Management: Permethrin (Nix) cream, crotamiton cream, Sulfur soap, antihistamines and
calamine for pruritus, wash linens with hot water, single dose of Ivermectin, treat close contacts
Nursing Care:
A. Administer antihistamines or topical steroids to relieve itching.
B. Apply topical antiscabies creams or lotion like lindasne(kwell), Crotamiton (Eurax),
permithrin
C. d. Lindane (kwell) not used in <2 years old, causes neurotoxicity and seizures
D. e. Apply thinly from the neck down and leave for 12-14hrs then rinse
E. f. Apply to dry skin, moist skin increases absorption
F. g. All family members and close contacts
G. h. Beddings and clothings should be washed in very hot water and dried on hot dryer
C. Leprosy
- Chronic infectious and communicable disease
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- No new case arises without previous contact
- Majority are contracted in childhood, manifestation arises by 15 yrs old and will
definitely diagnose at 20
- it is no hereditary
- Does not cross placenta
Cardinal Sign:
A. Presence of Hansen’s bacilli in stained smear or dried biopsy material.
B. Presence of localized areas of anesthesia
* Lepromatous or malignant
- many microorganisms
- open or infectious cases
- negative lepromin test
* Tuberculoid or benign
- few organism
- noninfectious
- positive reaction to lepromin test
• Early/Indeterminate – hypopigmented / hyperpigmented anesthetic macules/plaques
• Tuberculoid – solitary hypopigmened hypesthetic macule, neuritic pain, contractures of
hand and foot, ulcers, eye involvement ie keratitis
• Lepromatous – multiple lesions, Loss of lateral portion of eyebrows (madarosis),
corugated skin (leonine facies), septal collapse (saddlenose)
Diagnosis:
- Skin smear test
- Skin lesion biopsy
- Lepromin test -
Management:
Multidrug Therapy and home treatment-RA 4073 (home meds)
Paucibacillary - 6-9 months

1. Dapsone
2. Rifampicin
Multibacillary- 12-24 months

1. Dapsone – mainstay; hemolysis, agranulocytosis
2. Clofazimine – reddish skin pimentation, intestinal toxicity
3. Rifampicin – bactericidal; renal and liver toxicity
Nursing Intervention:
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- Health teachings
- Counseling involving the family members and even the community
- Prevention of transmission ( use of mask )
LESSON 9: SEXUALLY-TRANSMITTED DISEASES
A. Gonorrhea, Morning drop, Clap, Jack

o Etiologic agent: Neisseria gonorrheae, gram (+)
o Incubation period: 3-7 days
- Females: usually asymptomatic or minimal urethral discharge w/ lower abdominal pain
sterility or ectopic pregnancy
- Male: Mucopurulent discharge, Painful urination
decreased sperm count
Diagnostics:
- gram stain and culture of cervical secretions on Thayer Martin VCN medium
Management: single dose only

- Ceftriaxone (Rocephin) 125 mg IM
- Ofloxacin (Floxin) 400 mg orally
- treat concurrently with Doxycycline or Azithromycin for 50% infected w/ Clamydia
Complications:
PID, ectopic pregnancy and infertility, peritonitis, perihepatitis, Ophthalmia neonatorum, sepsis
and arthritis
B. Syphilis
Etiologic agent: Treponema pallidum, spirochete
“ Beautiful” fast moving but delicate spiral thread
Incubation period: 10-90 days
• Primary (3-6 wks after contact) – nontender lymphadenopathy and chancre; most
infectious; resolves 4-6 wks
Chancre – painless ulcer with heaped up firm edges appears at the site where the
treponema enters. Related to pattern of sexual behavior (genitalia, rectal, oral, lips);
BUBO – swelling of the regional lymphnode
• Secondary – systemic; generalized macular papular rash including palms and soles and
painless wartlike lesions in vulva or scrotum (condylomata lata) and lymphadenopathy
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• Tertiary – (6-40 years) - neurosyphilis/permanent damage (insanity); gumma (necrotic
granulomatous lesions), aortic aneurysm
Diagnostics:
Dark-field examination of lesion- 1st and 2nd stage
Non specific VDRL and RPR
FTA-ABS
Management:
- Primary and secondary - Pen G
- Tertiary - IV Pen G
C. Chlamydia
- Etiologic agent: Chlamydia trachomatis, gram (-)
- Incubation period: 2-10 days
- Maybe asymptomatic
- Gray white discharge, Burning and itchiness at the urethral opening
Diagnostics:
- Gram stain
- Antigen detection test on cervical smear
- Urinalysis
Management:
- Doxycycline or Azithromycin
- Erythromycin and Ofloxacin
Complications:
- PID
- Ectopic pregnancy
- Fetus transmittal (vaginal birth)
D. Herpes Genitalis
Etiologic agent: Herpes Simplex Virus 2
Clinical manifestations: Painful sexual intercourse, Painful vesicles (cervix, vagina, perineum,
glans penis)
Diagnostics:
- Viral culture
- Pap smear (shows cellular changes)
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- Tzanck smear (scraping of ulcer for staining)
Management:
Anti viral - acyclovir (zovirax)
Complications:
- Meningitis
- Neonatal infection (vaginal birth)
E. Genital Warts, Condyloma Acuminatum

- Etiologic agents: HPV type 6 & 11, papilloma virus
- Clinical manifestations: Single or multiple soft, fleshy painless growth of the vulva,
vagina, cervix, urethra, or anal area, Vaginal bleeding, discharge, odor and dyspareunia
Diagnostics:
- Pap smear-shows cellular changes (koilocytosis)
- Acetic acid swabbing (will whiten lesion)
- Cauliflower or hyperkeratotic papular lesions
Treatment:
- liquid nitrogen
- podophylin resin
Management:
Laser treatment is more effective
Complications:
- Neoplasia
- Neonatal laryngeal papillomatosis (vaginal birth)
F. Candidiasis, Moniliasis
- Etiologic agent: Candida Albicans, Yeast or fungus
- Clinical manifestations: cheesy white discharge, extreme itchiness
Diagnostics:
KOH (wet smear indicates positive result)
Management:
Imidazole, Monistat, Diflucan
Complications:
Oral thrush to baby (vaginal birth)
G. Trichomoniasis
170
- Etiologic agent: Trichomona vaginalis, parasite
- Clinical manifestations: Females: itching, burning on urination, yellow gray frothy

malodorous vaginal discharge, foul smelling; Males: usually asymptomatic
- Diagnostics: microscopic exam of vaginal discharge
- Management: Metronidazole (Flagyl); include partners
- Complications: Premature rupture of membranes (PROM)
H. HIV and AIDS

- Retrovirus (HIV1 & HIV2)
- Attacks and kills CD4+ lymphocytes (T-helper)
- Capable of replicating in the lymphocytes undetected by the immune system
- Immunity declines and opportunistic microbes set in
- No known cure
- HIV/AIDS Reverses Development and Poses Serious Threat to Future Generations
- Since 1980s, 60m have been infected and 25m have died
- About 40m live with HIV/AIDS – 38m in developing countries and 28m in Africa
alone
- The spread is accelerating in India, Russia, the Caribbean and China
- AIDS is stretching health care systems beyond their limits
- There are 12m AIDS orphans – they are estimated to rise to 40m by 2010
- In Sub-Saharan Africa, 58% of HIV/AIDS infected adults are women. More than two-
thirds of newly infected teenagers are female.
- Life expectancy has declined by more than 10 years in South Africa and Botswana –
Swaziland faces the risk of extinction
- Most HIV/AIDS Infected Live in Africa and South Asia
Health
Health care workers often have rates of infection as high or higher than adults in general
Illness and death of skilled personnel further weakens the sector
Education
Education faces decimation of skilled teachers
Children of families struck by AIDS often have to leave school to help generate income or
undertake basic household tasks
Mode of transmission:
- Sexual intercourse (oral, vaginal and anal)
- Exposure to contaminated blood, semen, breast milk and other body fluids
- Blood Transfusion
- IV drug use
- Transplacental
- Needlestick injuries
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High risk group:
• Homosexual or bisexual
• Intravenous drug users
• BT recipients before 1985
• Sexual contact with HIV+
• Babies of mothers who are HIV+
1. Acute viral illness (1 month after initial exposure) – fever, malaise, lymphadenopathy
2. Clinical latency – 8 years w/ no manifestations; towards end, bacterial and skin
infections and constitutional signs – AIDS related complex; CD4 counts 400-200
3. AIDS – 2 years; CD4 T lymphocyte < 200 w/ (+) ELISA or Western Blot and
opportunistic infections
HIV CLASSIFICATION
CATEGORY 1 – CD4+ 500 OR MORE
CATEGORY 2 – CD4+ 200-499
CATEGORY 3 – CD4+ LESS THAN 200
HIV test/Diagnostics:
- Elisa
- Western Blot
- Rapid HIV test
How to Diagnose
• HIV+
2 consecutive positive ELISA and
1 positive Western Blot Test
• AIDS+
HIV+
CD4+ count below 500/ml
Exhibits one or more of the ff: (next slide)
• Full blown AIDS
CD4 is less than 200/ml
Exhibits one or more of the ff:

- Extreme fatigue
- Intermittent fever
- Night sweats
- Chills
- Lymphadenopathy
- Enlarged spleen
- Anorexia
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- Weight loss
- Severe diarrhea
- Apathy and depression
- PTB
- Kaposis sarcoma
- Pneumocystis carinii
- AIDS dementia
Treatment
Anti-retroviral Therapy (ART) – ziduvirine (AZT)
a. Prolong life
b. Reduce risk of opportunistic infection
c. Prolong incubation period
Prevention:
• A – ABSTINENCE
• B – BE FAITHFUL
• C – CONDOMS
• D – DON’T USE DRUGS
LAWS RELATED
Laws Description
Republic Act 3573 Reporting of Communicable diseases
Requires all individuals and health facilities to
report notifiable diseases to local and
national public health authorities. Refer to
Section 3 of the Act for the list of diseases
covered.
Republic Act 4073 An Act Liberalizing the Treatment of Leprosy
No persons afflicted with leprosy shall be
confined in a leprosarium provided that such
person shall be treated in any government
skin clinic, rural health unit or duly licensed
physician
Republic Act 8504 Philippine AIDS Prevention and Control Act of
1998
An act promulgating policies and prescribing
measures for the prevention and control of
HIV AIDS in the Philippines, instituting a
nationwide HIV AIDS information and
educational program, establishing a
comprehensive HIV AIDS monitoring system,
strengthening the Philippine National AIDS
173
Council and for other purposes.
Republic Act 9482 The Rabies Act of 2007
Rabies control ordinances shall be strictly
implemented and the public shall be informed
on the proper management of animal bites
and/or rabies exposures.
Republic Act 1136 Tuberculosis Law of 1954
Creation of Division of Tuberculosis under an
appointed Director of the National
Tuberculosis of the Philippines (NTCP)
established at the DOH compound
Despite of the efforts of the government and other sectors in the Philippines, communicable
diseases still are one of the major problems in the country. As a future public health nurse, it is
a must to have knowledge on the different communicable diseases, providing emphasis on the
control and prevention aspect. It is the responsibility of a public health nurse to educate and
lead the public in response to the occurring phenomena. Moreover, the public should be
updated on the new strains of the aforementioned diseases as well the emerging diseases. If
left unmanaged or mismanaged, these concerns do not only affect an individual or a family, but
that of a society.
CHAPTER ACTIVITIES:
1. In a table format: summarize the common communicable diseases discussed here. Choose
the system affected. The columns should indicate the name, other name, causative agent,
mode of transmission, incubation period and significant/pathognomonic signs, diagnostics and
significant treatment/management
2. Formulate a teaching design or session design indicating the complete components of it.
Choose one disease and what concerns or problems will it bring to the community. The
solutions will be reflected in your session design
3. Create IEC materials related to your topic of choice.
REFERENCES:
Books:
174
Websites:
www.doh.gov.ph
CHAPTER 7
ENVIRONMENTAL HEALTH

1. Define environmental health
2. Differentiate the different water and toilet facilities
3. State the different laws covering environmental health in the Philippines
KEY TERMS:
Clean Air Act
Clean Water Act
Code of Sanitation
Field Health Service Information System
Health certificate
sanitation
solid waste
toxic waste
LESSON 1: ENVIRONEMTAL HEALTH RECORDS MANAGEMENT
In the Philippines, the maintenance of environmental health records is one of the

responsibilities which is given to city, municipality, and provincial health nurses. The data
management system used by DOH is Field Health Service Information System (FHSIS).
Data collection begins with the midwife and the barangay health workers. The midwife is tasked
to maintain monthly environmental health program accomplishments in the Summary Table
form. The following are the indicators to be monitored:
1. Households with access to improved or safe water – stratified to Levels 1, 2,
3
2. Households with sanitary toilets
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3. Households with satisfactory disposal of solid waste
4. Households with complete basic sanitation facilities
5. Food establishments
6. Food establishments with sanitary permits
7. Food handlers
8. Food handlers with health certificates
a. The form should be finished within the year. The midwife submits the reports (A-
BHS) to the city/municipal health nurse.
b. The nurse then consolidates all A-BHS forms into an annual report of the
city/municipality using A1 form.
c. The provincial health nurse performs the same tasks and submits a consolidated
“A1” report from all municipalities and cities in a province to the Regional FHSIS
Coordinator
d. The consolidated regional annual reports are submitted to the DOH National
Office
Related definitions:
Household with access to improved or safe water supply – refers to the covered by or
have access to any of the three levels of safe water sources that conforms to the
national standards for drinking water.
POINT SOURCE COMMUNAL WATERWORKS

FAUCET SYSTEM OR
SYSTEM/STAND INDIVIDUAL
POSTS HOUSE
Description Protected well or A system composed of A system with

developed spring a source, a reservoir, source, a reservoir, a
with an outlet but a piped distribution piped distribution
without a network and network and
distribution system communal faucets household taps
Suitable area Rural areas Rural areas where Urban areas

houses are clustered
Number of 15-25 Average of 100 More than 100
households
served
Distance from not greater than Not more than 25 m
farthest 250 m
Water yield or 40-140 lpm 40-80 liters, 1 faucet 1 faucet/houshold
discharge per 4-6 households
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Household with sanitary toilets – refer to households with their own flush toilets
connected to septic tanks and/or sewerage system or any other approved treatment
system, sanitary pit latrine, or ventilated improved pit latrine
Households with complete basic sanitation facilities – refers to those that satisfy the
presence of the following basic sanitation elements, namely: access to safe water,
availability of a sanitary toilet, and satisfactory system of garbage disposal
Food establishments – refer to those where food or drinks are manufactured, processed,
stored, sold, or served, including those that are located in the vessels
Sanitary permit – written certification that the establishment complies with the minimum
sanitation requirements upon inspection.
Food handlers – persons who handle, store, prepare, or serve any food item, drink, or
ice who come in contact in any cooking or eating utensil or food vending machine
Health certificate – written certification to a person after passing the required physical
and medical examinations and immunizations
LESSON 2: SOLID WASTE MANAGEMENT
To reduce the contamination of land supports the work of the public health nurse in enabling
the community to increase its level of wellness, as it is necessary to protect some of the health-
supporting functions of land:
1. Platform for human activities
2. Agricultural production
3. Habitat of members of the food chain
4. Filter for surface water
Through the definitions used by Republic Act 9003 known as “Ecological Solid Waste
Management Act of 2000”, solid wastes may be classified as follows:
Municipal waste – discarded nonhazardous household commercial and institutional waste, street
sweepings, and construction debris
Health care waste – refuse that is generated from medical interventions to humans and animals
and also research endeavors
Industrial waste - refuse that arise from production and from agricultural and mining industries.
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Hazardous waste – substances that post either an immediate or long term substantial danger to
human because of possessing such properties
RA 9003 defined solid waste management as the discipline associated with the control of
generation, storage, collection transfer and transport processing and disposal of solid wastes in
a manner that is in accordance with the best principles of public health, economics,
engineering, conservation, aesthetics, and other environmental consideration, and that is also
responsive to public attitudes. Materials that cannot be used should be segregated in trash bins
color-coded and labeled lining, so that each form of waste item could be managed accordingly.
Color coding for hospital wastes are as follows:
- Black or colorless: nonhazardous and nonbiodegradable

- Green: Nonhazardous biodegradable
- Yellow with biohazard biohazard symbol
- Yellow with black band: pharmaceutical cytotoxic or chemical wastes
- Yellow bag that can be autoclaved: infectious wastes
- Orange with radioactive symbol: radioactive wastes
Moreover, the Act also declares that these are prohibited actions:
- Open burning of solid wastes
- Open dumping
- Burying in flood-prone areas
-Squatting landfills
- Operation of landfills on any aquifer, groundwater reservoir, or watershed
- Construction of establishment within 200 meters from a dump or landfill
LESSON 3: WATER SANITATION AND AIR PURITY
A. WATER SANITATION
The DOH identified three levels of access to safe water supply and had set the standards of
quality of drinking water:
POINT SOURCE COMMUNAL WATERWORKS

FAUCET SYSTEM OR
SYSTEM/STAND INDIVIDUAL
POSTS HOUSE
Description Protected well or A system composed of A system with source,

developed spring a source, a reservoir, a reservoir, a piped
with an outlet but a piped distribution distribution network
without a network and and household taps
178
distribution system communal faucets
Suitable area Rural areas Rural areas where Urban areas
houses are clustered
Number of 15-25 Average of 100 More than 100
households
served
Distance from not greater than Not more than 25 m
farthest 250 m
Water yield or 40-140 lpm 40-80 liters, 1 faucet 1 faucet/household
discharge per 4-6 households
The general requirements of safe drinking water cover the following:
1. Microbial quality tested through the parameters of total coliform, fecal coliform and
heterotrophic plate count
2. Chemical and physical quality tested through parameters of pH, chemical-specific levels,
color, odor, turbidity, hardness and dissolved solids
3. Radiological quality tested through the parameters of gross alpha activity, gross beta and
radon
The three key components of water safety plans:

1. System assessment
2. Operational monitoring
3. Management plans
Some provisions of the Sanitation Code of the Philippines for water sanitation include:
1. Washing and bathing within a radius of 25 meters from any well or other source of drinking
water is prohibited
2. No artesians, deep or shallow wells shall be constructed within 25 meters from any source of
pollution.
3. No radioactive source or material shall be stored within 25 meters from any well or source of
drinking water unless the radioactive source is adequately and safely enclosed by proper
shielding.
4. No dwellings shall be constructed within the catchment area of protected spring water
source, and it shall be off limits to people and animals.
Emergency water treatment
179
Pretreatment processes:
• Aeration – to remove volatile substances, reduce carbon dioxide, and oxidized dissolve
minerals for preparation for sedimentation and filtration
• Settlement – allowing water to stand undisturbed in the dark for a while
• Filtration – done by utilizing filters to block particles while allowing water to pass
through
Disinfection process:
Boiling – considered to be a very effective method of water disinfection
Chemical disinfection – can be done using various chemicals but the most widely used remains
to be chlorine as it can kill all viruses and bacteria.
Solar disinfection – ultraviolet rays from the sun destroy the harmful organism in water
AIR PURITY
Under the Clean Air Act of the Philippines, there are two sources of air pollution:
1. Mobile source – refers to machine propelled by or through oxidation or reduction reactions,
including combustion of carbon-based or other fuel, constructed and operated principally for the
conveyance of persons or the transportation of property or goods, that emit air pollutants as a
reaction production.
2. Stationary source – refers to any building or fixed structure, facility or installation that emits
or may emit any air pollutant.
Other than the air pollutants, The American Conference of Governmental Industrial Hygienists
has defined a criteria depending on the efficiency of various particle sizes in entering the
respiratory tract as:
a. inhalable particulate matter starting at 100 micrometer diameter
b. thoracic particulate matter starting at 10 micrometer diameter
c. respirable particulate matter at 4 micrometer diameter
Public health nurses serve as an expert resource not only for the mayors and governors of their
respective localities but also for the “Airshed” to whom the city or municipality belongs. An
airshed refers to an area with a common weather or meteorological condition and a common
source of air pollution.
In the Philippines, the Air Quality Management Section of the DENR Environmental Management
Bureau monitors air quality. It maintains 42 air quality-monitoring stations nationwide, which
measure the total suspended particles.
180
People’s right to clean air has been clearly defined by the Republic Act 8749, known as
Philippine Clean Air Act of 1999. The following rights of the citizens stipulated there are as
follows:
1. The right to breath clean air.
2. The right to utilize and enjoy all natural resources according to the principle of sustainable
development.
3. The right to participate in the formulation, planning, implementation and monitoring of

environmental policies and programs and in the decision-making process.
4. The right to participate in decision-making process concerning development policies, plans

and programs projects or activities that may have adverse impact on the environment and
public health.
5. The right to be informed of the nature and extent of the potential hazard of any activity,
undertaking and project and to be served timely notice of any significant rise in the level of
pollution and the accidental or deliberate release into the atmosphere of harmful or hazardous
substances.
6. The right of access to public records which a citizen may need to exercise his or her rights
effectively under his Act.
7. The right to bring action in court or quasijudicial bodies to enjoin all activities in violation of
environmental laws and regulations, to compel the rehabilitation and clean-up of affected areas,
and to seek the imposition of penal sanctions against violators of environmental laws.
8. The right to bring to court for compensation of personal damages resulting from the adverse
environmental and public health impact of a project or activity.
LESSON 4: FOOD SAFETY
The NEHAP defined food safety as the assurance the food will not cause any harm to the
consumer when it is prepared and eaten according to its intended use.
Republic Act 9711 - known as Food and Drug Administration Act
- Strengthened the FDA in safeguarding the safety and quality of processed

foods, drugs, diagnostic reagents, medical devices, cosmetics, and household
substances
Presidential Decree 856 – Sanitation code of the Philippines
- Define the sanitation requirements for the operation of food establishments

- Food establishments must have a sanitary permit to operate
181
- Permit must be posted in a conspicuous place in the establishment
- No person shall be employed in any food establishment without health
certificate
- No person shall be allowed to work on food handling if afflicted with
communicable diseases
- Food preparation and storage rooms should never be used or directly
connected to a sleeping area or toilet.
- Any live area in the food area is strictly prohibited.
- Adequate lighting, ventilation and minimum space requirements.
- Handwashing areas with equipment and supplies must be present.
- Utensils must be washed in warm water (49oC) and soap
- It shall be the duty of the Sanitation Inspector of the city/municipality or
province to perform an inspection and evaluation of the compliance of food
establishments to the set standards at a at a frequency specified by the
implementing rules and regulations (IRR).
- Ambulant food vendors shall sell only bottled drinks and prepacked food.
They are prohibited from selling food that requires the use of utensils
LESSON 5: SANITATION
Sanitation - hygienic and proper management, collection, disposal or reuse of human excreta
(feces and urine) and community liquid waste to safeguard the health of individuals and
communities (Philippines Sanitation Sourcebook and Decision Aid, 2005).
Presidential Decree 856 – Sanitation Code of the Philippines of 1976
DOH – chair of sanitation sector in the country
DILG – vice chair of sanitation in the Philippines
F-Diagram – proposed the 6 Fs that form part of the means to transmit microoganisms in fecal
materials to a new host. These are: feces, fingers, fluids, flies, fields/floors and food.
Two barriers to prevent transmission of the pathogens:
1. Primary barriers are the structures and facilities that prevent the fecal contamination of
fingers, fluids, flies, and fields/floors
2. Secondary barriers are practices that prevent contaminated fingers, fluids, flies, fields/floors
from coming in contact with food or the new host. It includes, but not limited to: handwashing,
insect and vermin control, water treatment, and proper food handling.
182
SANITATION FACILITIES COMMONLY FOUND IN THE COMMUNITY:
Box-and-can privy (bucket latrine) – Fecal matter is collected in a can or bucket, which is
periodically removed for emptying and cleaning
Pit latrine (or pit privy) – fecal matter is eliminated into a hole in the ground and leads to a dug
pit
Antipolo toilet - it is made up of an elevated pit privy that has a covered latrine
Septic privy – fecal matter is collected in a built septic tank that is not connected to a sewerage
system.
Aqua privy – Fecal matter is eliminated into a water-sealed drop pipe that leads from the latrine
to a small water-filled septic tank directly below the squatting plate
Overhung latrine – fecal material is directly eliminated into a body of water such as a flowing
river that is underneath the facility
Ventilated-improved pit (VIP) latrine – a pit latrine with screened air vent installed directly over
the pit. The ambient air enters the pit hole pushes the foul air onto the air vent
Concrete vault privy – fecal matter is collected in a pit privy lined with concrete in such a
manner so as to make it water tight.
Chemical privy – fecal matter is collected into a tank that contains a caustic chemical solution,
which in turn controls and facilitates the waste decomposition
Compost privy – fecal matter is collected into a pit with urine and anal cleansing materials with
the addition of organic garbage such as leaves and grass to allow biological decomposition and
production of agricultural or fishpond compost
Pour-flush latrine – it has a bowl with a water-seal trap similar to the conventional tank-flush
toilet except it requires only a small volume of water for flushing .
Tank-flush toilet – feces are excreted into a bowl with a water-sealed trap. The water tank that
receives a limited amount of water empties into the bowl for flushing of fecal materials through
the water-sealed trap and into the sewerage system.
Urine diversion dehydration toilet (UDDT) – it is a waterless toilet system that allows the
separate collection and on-site storage or treatment of urine and feces.
Three sanitation facilities considered sanitary:
Level I Level II Level III
183
Non- water carriage toilet On site toilet facilities of Water carriage types of
facility: the water carriage type toilet facilities connected
Pit Latrines with water sealed and to septic tanks an/or to
Reed Odorless Earth Closet flushed type with septic sewerage system to
Bored-Hole vault/tank disposal treatment plant.
Compost facilities. Rural.
Ventilated improved pit
Toilets requiring small amount

of water to wash waste into
receiving space
-Pour flush, Aqua Privies
Unsanitary facilities:
1. Water-sealed toilet connected to a sewer or septic tank, shared with other households
2. Water-sealed toilet connected to other depository type, shared with other households
3. Closed pit, shared with other households
4. Open pit
5. Hanging toilet
6. Other unsanitary types of practice
7. Open defecation
LESSON 6: VERMIN AND VECTOR CONTROL
The Sanitation Code of the Philippines also presented the Implementing Rules and Regulations
on Vermin Control. The following were presented:
Vermin – A group of insects or small animals such as flies, mosquitoes, cockroaches, fleas, lice,
bedbugs, mice, rats, which are vectors of diseases
Insects – Flies, mosquitoes and cockroaches, bed =bugs, fleas, lice, ticks, ants and other
arthropods
Pest – Any destructive or unwanted insect or other small animals (rats, mice, etc.) that cause
annoyance, discomfort, nuisance, or transmission of disease to humans and damage to
structures
Rodent – Small mammals such as rats and mice, characterized by constantly growing incisor
teeth used for gnawing or nibbling
184
Vector – Any organism that transmits infection by inoculation into the skin or mucous
membrane by biting; or by deposit of infective materials on skin, food, or other objects; or
other objects; or by biological reproduction within the organism
Vermin abatement program as identified by DOH:
1. It mut be community-wide and community-participated
2. It must be technically coordinated
3. It must be continuing
4. It must be basically a partnership between the government and private sectors
5. It should preferably utilize indigenous technology and resources that will lead to self-reliance
Vermin control and disinfection methods:

Environmental sanitation control
Naturalistic control
Biologic and genetic control
Mechanical and physical control
Chemical control
Integrated control
As a generalist nurse, he or she must be aware of the interplay between the health and the
environment. This was introduced also by the Agent-Host-Environment Theory. Moreover, the
nurse is aware of the effects of the environment to human health. The public whether in the
government sector, private group or in the community should work collaboratively to achieve
the goals of these sanitation programs. The nurse can be a coordinator or a leader in the
implementations of these programs. He or she needs to be guided by the different laws, rules
and regulations.
SELF-REFLECTION:
How did you contribute to environment health? If you have not yet, how do you plan? Are you
in favor of the passed law requiring all graduating students to plant trees?
185
CHAPTER ACTIVITIES
Create a program proposal to prevent pollution or to preserve the natural resources in your
community and promote the health of the community people. Present one as if you are the
head of the rural health unit seeking approval from the local government unit. Present the
problems you observe in the community as the background of your program proposal. You may
include a letter addressed to your local government.
REFERENCES:

edition
Websites:
www.doh.gov.ph
186
187
APPENDIX:
APPENDIX A:
FAMILY NURSING CARE PLAN TEMPLATE
Note: This will be used in data gathering. Data will be presented in a textual format. Family nursing care plan and
prioritization will be supported by the template in a table form.
FAMILY
HEALTH GOAL OF OBJECTIVE OF
NURSING INTERVENTION PLAN
PROBLEM CARE CARE
PROBLEM
METHOD OF
NURSING NURSE – RESOURCES
INTERVENTIONS FAMILY REQUIRED
CONTACT
PRIORITIZATION
CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

1. Nature of problem
2. Modifiability of the
problem
188
3. Preventive potential
4. Salience of the problem
FAMILY PROFILE
Barangay:
Zone:
Household number:
FAMILY CIVIL EDUCATIONAL

GENDER AGE BIRTHDAY BIRTHPLACE OCCUPATION
MEMBER STATUS ATTAINMENT
FATHER
MOTHER
CHILDREN
189
INITIAL DATA BASE FOR FAMILY NURSING CARE PRACTICE
I. FAMILY STRUCTURE AND CHARACTERISTICS
A. HEAD OF THE FAMILY

Name:
Age:
Sex:
Birthday:
Civil status:
Address:
Religion:
Position in the family:
Educational attainment:
Occupation:
B. DEMOGRAPHIC DATA
NAME
POSITION
OF CIVIL EDUCATIONAL
IN THE AGE BIRTHDAY RELIGION OCCUPATION
FAMILY STATUS ATTAINMENT
FAMILY
MEMBER
C. COMMUNITY ORGANIZATION
D. TYPE OF FAMILY
[ ] Nuclear [ ] Blended
[ ] Extended [ ] Gay/Lesbian
[ ] Cohabitation [ ] Foster
E. WHO MAKES THE DECISION IN THE FAMILY?

[ ] Father [ ] Mother [ ] Both
F. WHO WORKS FOR THE FAMILY?

[ ] Father [ ] Mother [ ] Both [ ] Other, specify: ____________
II. SOCIO – ECONOMIC
190
A. NUMBER OF FAMILY MEMBER/S WHO ARE WORKING: ____________________
B. FAMILY MONTHLY NET INCOME
[ ] 1, 000 – 2, 000 [ ] 7, 000 – 8, 000
[ ] 2, 000 – 3, 000 [ ] 8, 000 – 9,000
[ ] 3, 000 – 4, 000 [ ] 9, 000 – 10, 000
[ ] 4, 000 – 5, 000 [ ] 10, 000 – 11, 000
[ ] 5, 000 – 6, 000 [ ] 11, 000 – above
[ ] 6, 000 – 7, 000
C. HOW DO YOU PRIORITIZE THE FOLLOWING? (Rate from 1 – 3)

[ ] Food
[ ] Education
[ ] Health care (check – up, consultation, hospitalization)
III. HOME AND ENVIRONMENT
A. HOME
1. Ownership: [ ] Owned [ ] Rented
2. House structure: [ ] Concrete [ ] Semi – concrete [ ] Nipa
3. Type: [ ] Bungalow [ ] 2 storey [ ] Others, specify:
____
4. Number of rooms: ___________________
5. Light facility: [ ] Electricity [ ] Methane gas lamp [ ] Candle
[ ] Kerosene: ( ) Hasag ( ) Lamp
6. Floor area (square meters): ___________________
B. WATER SUPPLY
1. Source [ ] Open dig well [ ] Pump well [ ] NAWASA
[ ] River [ ] Rain [ ] Others,
specify:____
2. Ownership: [ ] Owned [ ] Shared/Communal
3. Distance from the house (meters): _______________
4. Storage of drinking water: [ ] Jar with faucet [ ] Jar without faucet [ ] Plastic
bottle [ ] None
5. Source of drinking water: [ ] Faucet [ ] Commercialized
C. WASTE DISPOSAL
1. Garbage
Ownership: [ ] Owned [ ] Communal [ ] None
Container: [ ] Covered [ ] Open
Method of disposal: [ ] Open dumping [ ] Compost pit []
Burning
2. Drainage [ ] With [ ] Without
D. TOILET
Ownership [ ] Owned [ ] Communal [ ] None
Type [ ] Pit – privy [ ] Water sealed [ ] Flush type
191
Distance of toilet from source of drinking water (meters): _______________
IV. HEALTH PRACTICE AND MEDICAL HISTORY
A. PAST ILLNESS OF THE FAMILY DURING CHILDHOOD [specify]

Father
Mother
Children (specify)
B. PRESENT ILLNESS OF THE FAMILY [specify]

Father
Mother
Children (specify)
C. IMMUNIZATION
NAME OF
TETANUS
FAMILY BCG OPV DPT MEASLES HEPA B
TOXOID
MEMBER
D. HOME REMEDIES BEFORE CONSULTING HEALTH PRACTITIONER

[ ] Use of herbal medicines
[ ] Use of over the counter drugs
[ ] Neglects the disease
[ ] Others, specify____________________
E. HEALTH PRACTICES OBSERVED

[ ] Offering (atang) [ ] Consulting a doctor [ ] Consulting a quack
doctor
F. FAMILY RECREATIONAL ACTIVITIES [check all applicable]

[ ] Listening to radio [ ] Watching TV [ ] Others,
specify_______
[ ] Reading books, magazines, comics [ ] Sports
G. RECREATIONAL MATERIALS AVAILABLE IN THE HOME [check all applicable]

[ ] Radio [ ] Reading materials (books, magazines, comics)
[ ] TV [ ] Cellphones [ ] Others, specify_______
V. VALUE – BELIEF SYSTEM
A. SOURCE OF STRENGTH [rate from 1 – 4]

[ ] God
[ ] Husband/Wife
[ ] Children
[ ] Parents
192
B. RELIGIOUS PRACTICES USUALLY OBSERVED
[ ] Going to mass
[ ] Attending prayer meetings
[ ] Others, specify ______________
C. DOES IT HELP YOU IN YOUR DIFFICULTIES? [ ] Yes [ ] No

VI. LIVESTOCK/PET
WITHOUT
LIVESTOCK/PET WITH LEASH WITH OWN HOUSE
LEASH/ASTRAY
193
APPENDIX B: RUBRICS FOR CASE ANALYSIS
DESCRIPTORS Excellent Very good Good Fair Poor
SCORES 5 4 3 2 1
AREAS
ISSUES Recognizes Recognizes Recognizes Mentions Does not

one or more multiple one valid problems recognize the
key problems in problems that lack main problem
problems in the case significance or mentions
the case. problems that
Indicates are not based
some issues on the facts
are more of the case
important
than others
and explains
why
CONTENT AND Best and Important Some Failed to Applicable

ANALYSIS applicable points are important make any points are not
points are presented points are important presented
presented, while addressed, points and and paper is
no unnecessary but not fully analyze the full of
unnecessary contents covered. case unnecessary
contents. are left out. scenario contents
Considers with it
Discusses Discusses facts in the issues. Does not
facts in the facts in the case and have a clear
case and case and understands Accurately understanding
cites related cites related relevance of lists facts in of the facts in
knowledge knowledge these facts the case but the case
from from does not
research research understand
and adds the
knowledge relevance of
from
194
personal these facts
experience
ACTIONS Proposed More than Action Action No actions

actions best one proposed is proposed is proposed
deal with reasonable feasible not feasible
issue/s action
ORGANIZATION Points are Made a Made some Failed to Points are not
AND LOGIC logical and point, but points but make the logical and
well- could not logical; point, do not are not
supported, present not related use the supported by
organized more to the case concepts, the materials
and logically and itself. theories and
presented more principles
by organized;
evidence. supported
by
evidences
GRAMMAR AND Proper Few or no Overlooked Overlooked Many errors,

PUNCTUATION sentence errors, but errors in several poorly
structure, sentence sentences, errors in written.
punctuation, structure structure, spelling,
and could punctuation punctuation,
spelling, no improve. and and/or
revision spelling. sentence
required. structure
manifesting
carelessness.
TOTAL: 50
195
APPENDIX B: RUBRICS FOR TEACHING PLAN/SESSION DESIGN
DESCRIPTORS Very good Fair Poor
SCORES 5 3 1
CRITERIA
TARGET CLIENT Target client is listed Target client is listed Target client is not
and appropriate for but may not be listed.
teaching appropriate for
teaching.
TOPIC Topic is listed and Topic is listed but Topic is not listed.
appropriate for client may not be
appropriate for client.
GENERAL A general objective is A general objective is No general objective

OBJECTIVE listed and is listed but is not is listed.
appropriate appropriate for clien
OBJECTIVES Specific objectives are Multiple objectives are Multiple objectives are
listed and appropriate listed but not all are not listed.
(SMART) appropriate for client.
CONTENT Content is listed and Content is listed but Content is not listed.
includes all significant may be lacking
topics for the client. significant topics for
the client.
METHODOLOGY Teaching strategies Teaching-learning Teaching-learning

are listed and all are strategies are listed strategies are not
appropriate for client. but some may be listed.
inappropriate for
client.
TIME ALLOTMENT Time allotment is Time allotment is Time allotment is not

listed and is realistic listed but times listed.
for client allowed may be
unrealistic for client
RESOURCES Resources are listed Resources are listed Resources are not
and all are but may not be listed.
196
appropriate for client. appropriate for client.
EVALUATION Evaluation of teaching Evaluation of teaching Evaluation of teaching

is listed and is is listed but evaluation is not listed.
appropriate for client. may not be
appropriate for client.
REFERENCES References are listed References are listed References are not
in correct APA format but not all are from listed.
and all are from nursing resources.
nursing resources References may not
be in correct APA
format.
TOTAL: 50
197
APPENDIX C: RUBRICS FOR SHORT ESSAY
DESCRIPTORS EXCELLENT VERY GOOD FAIR POOR NON-

GOOD COMPLIA
NT
SCORES 5 4 3 2 1 0
CORRECTNES Correct Answer Answer Answer Answer No

S OF ANSWER answer is provide provided is provided given is answers
given (right d is similar is not incorrect, provided
terminology correct concept clear has no
or concept) but with correct relation
incompl answer to the
ete topic or
question
being
asked
CONCISE Explanation is Explana Explanation Explanati Explanati No

EXPLANATION supported tion is is correct on is on is explanatio
with correct but is not missing incorrect ns
appropriate but supported significan provided
concepts with t
appropriate informati
concepts on
GRAMMAR Proper Few or Overlooked Overlook Many No

AND sentence no errors in ed errors, answers
PUNCTUATIO structure, errors, sentences, several poorly provided
N punctuation, but structure, errors in written.
and spelling, sentenc punctuation spelling,
no revision e and punctuati
required. structur spelling. on,
e could and/or
improv sentence
e. structure
manifesti
ng
carelessn
ess.
TOTAL: 15
198
APPENDIX D: RUBRICS FOR VIDEO ANALYSIS
DESCRIPTORS Excellent Very good Good Fair Poor
SCORES 5 4 3 2 1
AREAS
CONTENT AND Best and Important Some Failed to Applicable

ANALYSIS applicable points are important make any points are not
points are presented points are important presented and
presented, while addressed, points and paper is full of
no unnecessary but not fully analyze the unnecessary
unnecessary contents are covered. case contents
contents. left out. scenario
Considers with it Does not have
Discusses Discusses facts in the issues. a clear
facts in the facts in the case and understanding
case and case and understands Accurately of the facts in
cites related cites related relevance of lists facts in the case
knowledge knowledge these facts the case but
from from does not
research and research understand
adds the
knowledge relevance of
from these facts
personal
experience
ORGANIZATION Points are Made a Made some Failed to Points are not
AND LOGIC logical and point, but points but make the logical and are
well- could not logical; point, do not not supported
supported, present not related use the by the
organized more to the case concepts, materials
and logically and itself. theories and
presented by more principles
evidence. organized;
supported
by evidences
GRAMMAR AND Proper Few or no Overlooked Overlooked Many errors,

PUNCTUATION sentence errors, but errors in several poorly written.
199
structure, sentence sentences, errors in
punctuation, structure structure, spelling,
and spelling, could punctuation punctuation,
no revision improve. and spelling. and/or
required. sentence
structure
manifesting
carelessness.
TOTAL: 15
REFERENCES
Textbooks
Nursing Care of the Community: A Comprehensive Text on Community and

Public Health (Philippines, 1st ed, Famorca, 2013)
200
Community/ Public Health Nursing Practice: Health for Families (IE), Gail, 2014
Maglaya, A. Nursing Practice in the Community, 4th ed, Marikina City:Argonauta
Corporation. 2005
Integrated Management of Childhood Illness (IMCI) Workbook and Resource
Manual, ADCPN, 2008
Integrated Management of Childhood Illness (IMCI), Chart Booklet, 2008
Websites
www.doh.gov.ph
www.who.int
201

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES

Alimannao Hills, Peñablanca Cagayan

AMIEL F. REYES, RN, MSN, LPT

REYNALDO M. ADDUCUL, RN, RM, MSN, JD

Guidelines on the use of the instructional learning guide

• Government, private and non-government organization programs are discussed on this

Features of the instructional learning guide

• Lecture/Discussions are presented from introduction to specific applications or situations

• Self-reflection ( ) activities are provided to assess the understanding of the student

PRELIMINARIES – COURSE DETAILS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

At the end of the course the student will be able to:

Specific Instructions in the completion of each Chapter:

Intended Learning Outcomes:

LESSON 1: CONCEPT OF FAMILY AS A BASIC UNIT OF SOCIETY

2 BASIC FAMILY TYPES:

▪ THE DYAD FAMILY

▪ THE NUCLEAR FAMILY

▪ THE COHABITATION FAMILY

▪ THE EXTENDED (MULTIGENERATIONAL) FAMILY

▪ THE SINGLE-PARENT FAMILY

▪ THE BLENDED FAMILY

▪ THE COMMUNAL FAMILY

▪ THE FOSTER FAMILY

▪ THE ADOPTIVE FAMILY

C. Stages of Family Development

3. FAMILY WITH PRE-SCHOOL CHILDREN

4. FAMILY WITH SCHOOL-AGE CHILDREN

D. Family Structures and Functions

BASED ON INTERNAL ORGANIZATION AND MEMBERSHIP

BASED ON PLACE OF RESIDENCE

LESSON 2: LEVELS OF PREVENTION IN FAMILY HEALTH

FAMILY HEALTH NURSING

3. A. Conducting Family Health Assessment

STEPS IN FAMILY NURSING ASSESSMENT

INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

A. Family Structure, Characteristics and Dynamics

B. Socio – economic and Cultural Characteristics

C. Home and Environment

D. Health Status of each Family Member

E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention.

METHODS OF DATA GATHERING

TOOLS USED IN FAMILY ASSESSMENT

FAMILY HEALTH TREE

4. B. Typology of Nursing Problems in Family Nursing Practice

FIRST LEVEL ASSESSMENT

I. Presence of Wellness Condition – stated as Potential or Readiness – a clinical or nursing

Readiness for enhanced wellness state

B. Readiness for Enhanced Capability for:

I. Inability to recognize the presence of the condition or problem due to:

K. Lack of trust/confidence in the health personnel/agency

V. Failure to utilize community resources for health care due to:

STATEMENT OF FAMILY NURSING PROBLEM

THE FAMILY CARE PLAN

THE IMPORTANCE OF PLANNING CARE

1. They individualize care to clients.

STEPS IN DEVELOPING A FAMILY NURSING CARE PLAN

1. Decide a score for each of the criteria

CRITERIA SCALE WEIGHT

Factors affecting priority setting:

1. Current Knowledge, technology and interventions