ABC’S OF Primary Health Care Comprehensive Comprehensive review on ABC’S of PHC (created by RSI) A. PRIMAR PR IMARY Y HEALTH HEA LTH CARE C ARE - As defined by the World Health Organization (WHO), Primary health care is essential health health care care based based on practi practical cal,, scient scientifi ifica cally lly sound sound and and social socially ly accept acceptabl able e method methods s 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. - 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 - Framewo Framework rk : People’s People’s empowerment empowerment and partnership partnership is the Key Strategy Strategy to achieve achieve the GOAL, “Health for all Filipinos by the year 2000 and Health in the Hands of the People by the year 2020”. B. Missio Mis sion n of PHC - PH PHC C aims aims to stre streng ngth then en the the heal health th care care syst system em by incr increa easi sing ng oppo opport rtun unit itie ies s and and supporting the conditions wherein people will manage their own health care. C. Principles of PHC 1. Partnership and empowerment as the core strategy. 2. Focuses responsibility responsibility for health on the the individual, his family family and the community. community. 3. Full participation and active involvement of the community towards towards the development of self-reliant people. 4. Interrelationship between health and the overall political, socio-cultural and economic development of society 4 As of Primary health care A – ccessibility A – vailability A – cceptability A – ffordability D. Objectives of PHC 1. improvement in the level of health care of the community. 2. favorable population growth structure. 3. reduction in the prevalence of preventable, communicable communicable and other diseases. 4. reduction in morbidity and mortality rates especially among infants and children. 5. extens extension ion of essent essential ial health health care care servic services es with with priori priority ty given given to the under underser served ved sectors. 6. improvement in basic sanitation 7. development of the capability of the community aimed to the underserved sectors. 8. development of the capability of the community aimed at self-reliance. 9. maxi maximi mizi zing ng the the cont contri ribu buti tion on of the the othe otherr sect sector ors s for for the the soci social al and and econ econom omic ic development of the community. E. Four Cornerstone/P Cornerstone/Pillars illars in PHC 1. active community participation participation 2. intra and inter –sectoral linkages 3. use of appropriate technology 4. support mechanism made available F. Strategies 1. Reorientation and reorganization of the national health care system in support of the mandate of devolution under the Local Government Code of 1991.
2. Effective preparation and enabling process for health action at all levels. 3. Mobilization of the people to know their communities and identifying their basic health needs. 4. Development and utilization of appropriate technology focusing on local indigenous resources available. 5. Organization of communities arising from their expressed needs. 6. Increase opportunities for community participation in local level planning, management, monitoring and evaluation within the context of regional national objectives. 7. Development of intra-sectoral intra-sectoral linkages with other government and private agencies. 8. Emphasizing Emphasizing partnership.
G. Elements of Primary Health Care (Elements Dam) E – ducation on prevailing health problems L – ocally endemic Disease Prevention and Control E – xpanded Program of immunization immunization M – aternal and Child Health and Family Planning E – nvironmental Sanitation and Safe Water Supply N – nutrition and Food Supply T – reatment of Communicable Communicable & Non-communicable Non-communicable Diseases S – supply and proper use of Essential Drugs and Herbal Medicine D – ental Health Promotion A – ccess to and use of hospitals as centers of wellness M – ental health promotion H. Primary health Care Workers - Various categories of health care workers make up the primary health care team. The types vary in different communit communities ies depending upon: a. Available health manpower resources b. Local health needs and problems c. Political and financial feasibility - In general, the PHC team may consist of physician, nurses, midwives, nurse auxiliaries, locally trained community health workers, traditional birth attendants and healers. - types: 1. Village or Barangay Health Workers (V/ BHWs) - This This refe refers rs to trai traine ned d comm commun unit ity y heal health th work worker ers s or heal health th auxi auxili liar ary y volunteer or a traditional birth attendant or healer 2. Intermediate Level Health Workers - General medical practioners or their assistants, Public Health Nurse, Rural Sanitary Inspectors and Midwives. I. Levels of Health Care Services - Health problems that are beyond the capability of PHC units and beyond the competence of the PHC workers are referred to an intermediate health facility or Rural health Units (RHU) - The RHU team generally consists of the physician, dentist, public health nurse, midwife, sanitarian and other health workers. - The higher the level the more qualified the health personnel and the more sophisticated the health equipment. 3 levels: 1. Primary Primary level - Baran Barangay gay Health Health statio station, n, Privat Private e practi practitio tioner ners s ,Comm ,Communi unity ty Hospitals, Health Centers and Rural Health Unit 2. Secondary Level - Emergenc Emergency/ y/ District District Hospitals Hospitals,, Provincia Provincial/ l/ City Hospitals Hospitals and Provincial/ City Health Services 3. Tertiary Level - Teaching Teaching and Training Training Hospitals, Hospitals, Medical Medical Centers Centers and National National Health Services J. Philippine health Care Delivery System The Health Care Delivery System (Major players)
–
Com Compos posed of 2 sec secto torrs 1. PUBLIC SECTOR – financed with a tax based – budgeting system at both national and local levels and where health care is generally given for free at the point of service - Consists Consists of the national and local local government government agencies agencies providing providing health health services - The DOH –the national level lead agency in health - has regional field office in every region - maintains specialty hospitals, regional hospitals and medical centers - LGU’s LGU’s – it now run the local local health health system system becaus because e of the devolu devolutio tion n of health care services a. Provincial government: manages provincial and district hospitals b. City/Municipal Government: manages health centers, RHU and BHSs - every province, city or municipality municipality has a local health health board chaired chaired by local chief executive 2. PRIVATE PRIVATE SECTOR SECTOR (for (for profit profit and nonpro nonprofit fit provi provider ders) s) – marke markett orient oriented ed and where health care is paid through user fees at the point of service - Incl Includ udes es prov provid idin ing g heal health th serv servic ices es in the the clin clinic ics s and and hosp hospit ital als, s, heal health th insur ins uranc ance, e, manuf manufac actur ture e of medici medicines nes,, vaccin vaccines, es, medica medicall suppli supplies, es, equipm equipment ent,, nutrition products and other health related services
K . Philippine Department of Health - Has the new role as the national national authorit authority y on health health providin providing g techni technical cal and other other resources assistance to concerned groups as mandated by EO 102. EO 102 102 – manda mandates tes the DOH to provi provide de assist assistanc ance e to local local govern governme ment nt units units,, people people’s ’s organization and other members of civic society in effectively implementing programs, projects and services that will promote the health and well being of every Filipino; prevent and control diseases among population at risks; protect individuals, families and communities exposed to hazards and risk that could affect their health; and treat, manage and rehabilitative individuals affected by diseases and disability Roles and Functions: 1. Leader Leadershi ship p in health health a. Serve as as the nationa nationall policy policy and regulat regulatory ory institut institution ion b. Provides Provides leadershi leadership p in the formulatio formulation, n, monitoring monitoring and evaluatio evaluation n of national national health policies, plans and programs c. Serve as advoca advocate te in the adoption adoption of health health policies policies,, plans and and programs programs 1. Enable Enablerr and Capa Capacit city y build builder er a. Innovate Innovate new strategies strategies in health health b. Exercise oversight functions functions and monitoring monitoring and and evaluation evaluation of national health plans, programs and policies c. Ensu Ensure re the the high highes estt achi achiev evab able le stan standa dard rds s of qual qualit ity y heal health th care care,, heal health th promotion and health protection 1. Adminis Administrato tratorr of of Specif Specific ic Services Services a. Manage Manage selected selected national national health health facili facilitie ties s and hospita hospitals ls with with moder modern n and and advanced facilities b. Administ Administer er direct services services for emergent emergent health health concerns concerns that require require newly complicated technologies c. Administ Administer er health health emerge emergency ncy respon response se servic services es VISION - The DOH is the leader, staunch advocate and model in promoting health for all in the Philippines MISSION – Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor and shall lead the quest for excellence in health GOAL – Health Sector Reform Agenda (HSRA) Rationale for Health Sector reform: 1. Slowing down down in the reduction reduction in the infant mortality mortality rate rate (IMR) and the maternal maternal mortality rate (MMR)
2. Persis Persisten tence ce of large large variat variation ions s in health health status status acros across s popula populatio tion n groups groups and geographic areas 3. High burden burden form form infectiou infectious s disease diseases s 4. Rising Rising burden burden from chroni chronic c and degenera degenerative tive diseases diseases 5. Unattended emerging health risk risk from environmental environmental and work work related related factors factors 6. Burden Burden of diseas disease e is heavie heaviest st on the poor poor The reasons why the above conditions are still seen among the population can be explained by the following factors 1. Inapprop Inappropriate riate health health care care delivery delivery system system 2. Inadequa Inadequate te regulator regulatory y mechanisms mechanisms for for health servic services es 3. Poor Poor health health care financ financing ing and ineffi inefficie cient nt sourc sourcing ing or genera generatio tion n of funds funds for health care The following are the implications of the above situation: 1. There There is poor coverag coverage e of public health health and and primary primary care care services services 2. There There is inequ inequita itable ble access access (physi (physical cal and financ financial ial)) to person personal al health health care services 3. There is low quality and high cost of both both public and personal personal health care care Framework Framework for Implementation Implementation of HSRA: FOURmula ONE for health Goals of FOURmula ONE for health: 1. Better Better health health outco outcomes mes 2. More More respons responsive ive healt health h system systems s 3. Equitable Equitable health health care care finan financing cing The four elements of the strategy are: 1. Health financ financing ing – the goal of this health health reform reform area area is to foster greater, greater, better better and sustained investments in health 2. Health regulat regulation ion – the goal is to ensure the quality quality and affordabi affordability lity of health goods goods and services 3. Healt Health h serv servic ice e deli delive very ry – the the goal goal is to impr improv ove e and and ensu ensure re the the acce access ssib ibil ilit ity y and and availability of basic and essential health care 4. Good governan governance ce – the goal is to enhance health health system system performanc performance e at the national national and local levels Natio National nal Health Health Insura Insurance nce Progr Program am (NHIP (NHIP)) – the main main lever lever to effect effect desire desire chang changes es and outcomes of the four elements implementation components in terms of financing, governance, regulation, service delivery.
DOH PROGRAMS (Selected) L. Maternal Health Program: Introduction – To reduce reduce the the MMR by three three quarter quarters s by 2015 to achieve achieve its mill millenn ennium ium devel developm opment ent goal. This means a MMR of 112/100,000 live births in 2010 and 80/100,000 live births by 2015 – The percen percentag tage e of pregna pregnant nt women women with at least least four four prenatal prenatal visits visits decrea decreased sed from from 77% in 1998 to 70.4% in 2003 – Women Women who receiv received ed at least least two doses doses of tetanu tetanus s toxoid toxoid also also decrease decreased d from 38% 38% in 1998 to 37.3% in 2003 – The 200 Phili Philippin ppine e health health Statistic Statistics s revealed revealed that that 25% of all all materna maternall death are are due to to hype hypert rten ensi sion on,, 20 20.3 .3% % to post postpa part rtum um hemo hemorr rrha hage ge,, 9% preg pregna nanc ncy y with with abor aborti tive ve outcomes – Underlyin Underlying g causes causes of materna maternall deaths deaths are delays delays in taking taking critica criticall actions actions (the 3 delays delays)) 1. Delay Delay in deciding deciding to seek seek medica medicall care care 2. Delay Delay in identifying identifying and reachin reaching g the appropria appropriate te health facility facility and 3. Delay Delay in receiving receiving appropria appropriate te and adequate adequate care at the health health facility facility Overall GOAL: to imp improv rove e the the survi survival val,, healt health h and and well well bein being g of mothe mothers rs and unborn unborn throug through h a package of services for the pre pregnancy, prenatal, natal and post natal stages The STRATEGIC THRUSTS for 2005-2010 includes: a. Implement Implementatio ation n of the Basic Emergen Emergency cy Obstetric Obstetric Care (BEmOC) (BEmOC) and Comprehensiv Comprehensive e Obstetric Care (CEmOC) strategy in coordination with the DOH.
EmOC – Emergency Obstetric Care - part of essential essential obstetric obstetric care which includes pre and post-natal post-natal care, clean and safe delivery, neonatal care and family planning 2 functions: a. BEmOC BEmOC – entails the establishment of facilities for every 125,000 population, can be reached within 30 minutes from each catchment barangay - it is an RHU or hospital facility facility which: 1. administer parenteral antiobiotics 2. adminster parenteral oxytocin 3. adminster parenteral anticonvulsants for pre-eclampsia/eclampsia pre-eclampsia/eclampsia 4. perform manual removal of placenta 5. perform removal of retained placental products; and 6. perform assisted vaginal delivery b. CEmOC CEmOC – for every 500,000 500,000 popultion, popultion, referring referring facility, facility, reach within within 1 hour from a BEmOC BEmOC facility - a hospital facility which: 1. perform the six functions of a BEmOC facility, plus 2. perform caesarean section and hysterectomy; hysterectomy; and 3. give safe blood transfusion b. improve the quality of prenatal and postnatal care c. reduce women’s exposure to health risk health risk women: 1. All women women of reproduct reproductive ive age especially especially those those who are less than than 18 years old and over 35 years of age 2. low educa educatio tional nal reso resourc urces es 3. low finan financia ciall reso resourc urces es 4. with with unmana unmanaged ged chron chronic ic illnes illness s 5. who just just given given birth birth in the the last last 18 month months s Essential health Service Packages Available in the Health Care facilities: – thes these e are are pack packag ages es of serv servic ices es that that ever every y wome women n has has to recei receive ve befor before e and and afte afterr pregnancy and or delivery of a baby A. Antenatal Antenatal registra registration tion - the standard prenatal visits that a woman has to receive during pregnancy are as follows PRENATAL PERIOD OF PREGNANCY VISITS 1st visit
as ea e arly in i n pr p regnancy as a s po p ossible before four months or during the first trimester
2nd visit
during the 2 nd trimester
3rd visit
during the 3 rd trimester
Every 2 weeks
after 8th month pregnancy till delivery
B. Tetanus Toxoid Immunization - a series of 2 doses of Tetanus Tetanus Toxoid vaccination vaccination must be received by a woman woman one month before delivery to protect baby from neonatal tetanus - the the 3 booste boosterr dose dose shots shots to compl complete ete the five five doses doses that that provi provides des full protec protectio tion n for both mother and child. The mother then is called as a “Fully Immunized Mother” (FIM) Tetanus Toxoid schedule for Women: Vaccine: TT1 – given as early as possible during pregnancy TT2 – at least 4 weeks later, gives 80% protection and 3 years protection for the mother TT3 – at least 6 months later, 95% protection and gives 5 years protection for the mother TT4 – at least one year later, 99% protection and gives 10 years protection for the mother TT5 – at least one year later, 99% protection and gives lifetime protection for the mother
C. Micronutr Micronutrient ient Suppl Supplemen ementatio tation n - these are necessary to prevent anemia, vitamin A deficiency and other nutritional disorders. Vitamins Dose Duration Remarks Vitamin A
1 capsule/tablet Twice a week of 10,000 IU Start from the 4th of pregnancy until delivery
Iron
60mg/400 tablet
ug
Vitamin A should not be given to pregn egnant women before 4 th mont month h of preg pregna nanc ncy. y. It migh mightt caus cause e cong congen enit ital al prob proble lems ms in the baby
1 tablet OD for 6 months or 18 180 0 days days duri during ng the the pregnancy period
Cont Contai ains ns 60 mg elemental iron OR with 400 mcg folic 2 tablets per day if acid prenatal consultations are done done duri during ng the the 2nd and 3rd trimester
D. Treatment of Diseases Diseases and Other Other Conditions Conditions - these conditions may endanger her health and complication could occur Conditions/Diseases What to Do Do not give Difficulty breat breathin hing/o g/obs bstru tructi ction on airway
of of
1. Clea Clearr airw airway ay 2. Place Place in in her her best best posi positio tion n 3. Refe Referr woman woman to hospi hospita tall with with EmOC capabilities
Uncons Unconscio cious us
1. Keep Keep on her back back arms arms at the the side 2. Tilt Tilt head head back backwa ward rds s (unl (unles ess s trauma is suspected) 3. Lift Lift chin chin to open open airwa airway y 4. Clear Clear secr secreti etions ons from from throat throat
a. Do not give Oral Rehydrat Rehydration ion Solution Solution to a woman who is unco uncons nsci ciou ous s or has has convulsions b. Do not not giv give e IVF IVF if you you are not trained to do so
5. Give Give IVF to preve prevent nt or or corr correct ect shock 6. Monito Monitorr blood blood press pressure ure,, pulse pulse and shortness of breath every 15 minutes 7. Monitor fluid given. If diff diffic icul ulty ty of brea breath thin ing g and and puf puffin finess ess devel evelo ops. Stop top infusion 8. Monito Monitorr urine urine output output Post partum bleeding
1. Massage clots
uterus
and
expel
2. If bleedi bleeding ng persis persists: ts: a. Place lace cupped pped palm palmed ed on uterine fundus and feel for sate of contraction
a. Do not give ergometrine if woman has ecla eclam mps psia ia,, preeclmapsia oor hypertension
b. Massage fundus circular motion
in
a
c. Apply bimanual uterine compression if ergometrine treatment done and postpartum bleeding still persists d. Give Give ergom ergomet etri rine ne 0.2 mg IM and another dose after 15 minutes Intestinal infection
parasite
1. Give Mebendazole tablet single dose
500mg
2. Give anytime from months of pregnancy
Malaria
4-9
a. Do not give mebendaz mebendazole ole in the fir first 1-3 months nths of pregnancy. This might cause congenital problems in baby
1. Give sulfadoxinpyrim pyrimeth etham amine ine to women women from from mala malari ria a ende endemi mic c area area who are in 1 st or 2nd pregnancy, 500 mg 2. Give Give 25 25 mg mg tab, tab, 3 tabs tabs at the the nd beginning of 2 to 3rd trimesters not less than one month interval
Recommended Schedule of Post Partum Visits: 1st visit 1st week post partum preferable 3-5 days 2nd visit
6 weeks post partum
M. Child Health Programs (newborns, (newborns, infants and children) - Newborns, infants and children are vulnerable age group for common childhood diseases. - to address address problems problems,, child health health programs programs have been created created and available available in all health facilities which includes: 1. Infant and Young Child Feeding - Overall objective: To improve the survival of infants and young children by improving their nutritional status, growth and development through optimal feeding. - The The Nati Nation onal al Plan Plan of Ac Acti tion on for for 20 2005 05-2 -201 010 0 for for Infa Infant nt and and Youn Young g chil child d feeding: Goal: reduce child mortality rate by 2/3 by 2015 Objective: To improve health and nutrition status of infants and young children Outcom Outcome: e: To improv improve e exclus exclusive ive and extend extended ed breas breastfe tfeedi eding ng and complementary complementary feeding - Key Messages on Infant and Young Child Feeding a. initiate breastfeeding within 1 hour after birth b. exclusive for the first 6 months of life (only breastmilk and nothing else) c. Complemented at 6 months with appropriate foods, excluding milk supplements d. Extend breastfeeding up to two years and beyond - Laws that protects Infant and Young Child feeding
a. Milk Code (EO 51) – consists of breast milk substitutes, including infant formula; other milk products, foods and beverages, including bottle-fed complementary foods. b. Rooming In and Breastfeeding Act of 1992 – requires both public and private health institutions to promote rooming in and to encourage, protect and support breastfeeding. - one of the 10 th steps to Mother Baby Friendly Hospitals wherein the mother and the baby should be together for 24 hours and as long as both are in the hospital. c. Foo Food d fortif fortific icati ation on Law – decl declar ares es a poli policy cy to impr improv ove e the the nutrition nutritional al status status of the children children which which is cost cost effective effective and has sustainable sustainable intervention intervention to address micronutrient deficiencies. - requ requir ires es a mand mandat ator ory y food food fort fortif ific icat atio ion n of stap staple le food foods s – flour( with iron and Vit. A), cooking oil, refine sugar (with Vit. A), rice (with Iron) and the voluntary fortification fortification of processed foods through the “Sangkap Pinoy Seal”. 2. Expanded program on immunization a. the the expa expand nded ed prog progra ram m on immu immuni niza zati tion on was was laun launch ch in July July 19 1976 76 by the the department of health in cooperation with the World Health Organization and the UNICEF. b. the original objective was to reduce the morbidity and mortality among infants and children caused by the seven childhood immunizable diseases c. Principles: 1. the program based on the epidemiological epidemiological situation 2. the whole community community rather than just the individual individual is to be protected, 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 d. Elements of EPI 1. target setting 2. cold chain logistic management 3. information, education and communication communication 4. assessment and evaluation of the program’s overall performance 5. surveillance, studies and research e. Legal basis/existing policies 1. Presidential Decree No. 996 - providing for compulsory basic immunization for infants and children below eight years of age 2. presidential proclamation No. 6 - implementing a united nations goal on “Universal Child Immunization” 3. Presidential Proclamation No. 147 - declaring every third Wednesday of January and February thereafter, for two years, as “National Immunization Days” 4. Republic Act 7846 - an act requirin requiring g compulso compulsory ry immuniza immunization tion against Hepaptitis Hepaptitis B for infants and children below eight years old f. 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 g. Concepts of Vaccinations Vaccinations 1. it is safe and immunolo immunologica gically lly effective effective to administer administer all EPI vaccines vaccines on the same day at different sites of the body 2. measle measles s vaccin vaccine e shoul should d be given as soon soon as the child child is 9 month months s old, old, regardless of whether other vaccines will be given on that day. Measles vaccines given at 9 months provide 85% protection against measles infection
3. moderate moderate fever, fever, malnutri malnutrition, tion, mild respirat respiratory ory infectio infection, n, cough, cough, diarrhea diarrhea and vomiting are not contraindications contraindications to vaccination. 4. absolute absolute contraindic contraindication ations s to immuniza immunizations tions are: DPT2 or DPT3 to child child who has had convulsions or shock within 3 days after the previous dose. Live vaccines like BCG vaccine vaccine must must not be given to individu individuals als who are immunosu immunosupres pressed sed due to maligna malignant nt disease disease (e.g. child with AIDS) 5. it is safe safe and effect effective ive with with mild mild sid side e effect effects s after after vaccin vaccinati ation. on. Local Local reaction, fever and systemic symptoms can result as part of the normal immune response 6. false contraindications contraindications to immunizations are children with malnutrition, malnutrition, low grade grade fever, fever, mild respirator respiratory y infectio infections ns and other minor minor illness illness and diarrhea diarrhea should not be considered a contraindication contraindication to OPV vaccination. 7. repeat BCG vaccination if the child does not develop a scar after the first injection 8. use one syringe one needle per child during vaccination h. The EPI Target Diseases 1. vaccination among infants and newborns (0-12 months) against the seven vaccination preventable diseases. 2. these include: Tuberculosis, Tuberculosis, Diphtheria, Pertussis, Tetanus, Poliomyelitis, Poliomyelitis, measles and hepatitis i. The EPI Routine Schedule of Immunization 1. every Wednesday is designated as immunization day and is adopted in all parts of the country 2. A child is said to be “Fully Immunized Child” when a child receives one dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of HB and one dose of measles before a child’s first birthday Vaccine Minimum Number of Minimum Reason Age of 1st Doses Interval Dose Between Doses BCG Birth of 1 BCG given at BCG given at anytime anytime after earlie earliest st possib possible le age prote protects cts birth the possibility of TB and other TB infections DPT 6 weeks 3 4 weeks An early start with DPT reduces the chance of severe pertussis OPV 6 weeks 3 4 weeks The extent of protection against polio is increased the earlier the OPV is given Hepa B At birth 3 6 weeks An early start of Hepa B reduces inter interval val from from the the chan chance ce of bein being g infe infect cted ed st 1 dose to and becoming becoming a carrier carrier prevent prevent seco second nd dose dose liver cirrhosis and liver cancer. and and 8 week weeks s inter interval val from from seco second nd dose dose to third dose Measles 9 months At least 85% of measles can be preven prevented ted by immuni immunizat zation ion at this age j. Tetanus Toxoid Immunization Immunization Schedule for Women 1. tetanus tetanus toxoid toxoid vaccinati vaccination on for women is importan importantt to prevent prevent tetanus tetanus in both mother and the baby 2. completing the five doses following the schedule provide lifetime immunity
Vaccine TT1
Minimum Age Percent interval Protected As early as poss possib ible le duri during ng
Duration of protection
the pregnancy At least 4 weeks later
TT2
80%
TT3
At least 6 months later
95%
TT4
At least one year later
99%
TT5
At least one year later
99%
Infants bo born to to th the mo mother wi will protected protected from neonatal neonatal tetanus. tetanus. Give Gives s 5 year years s prot protec ecti tion on for for the the mother Infants born to the mother will be protec protected ted from from neonat neonatal al tetanu tetanus. s. Give Gives s 5 year years s prot protec ecti tion on for for the the mother Infants born to the mother will be protec protected ted from from neonat neonatal al tetanu tetanus. s. Gives Gives 10 years years prote protecti ction on for the mother Gives li lifetime pr protection fo for th the moth mother er.. All All infa infant nts s born born to that that mother will be protected
k. Administration of Vaccines Vaccine Dose Route of Administration BCG Infants 0.05 ml Intradermal DPT 0.5 0.5 ml Intr Intra amus usc cular lar OPV 2 drops or depending on manufacturer’s instructions Measles 0.5 ml Subcutaneous Hepa B 0.5 ml Intramuscular Tetanus Toxoid 0.5 ml Intramuscular
Site of Administration Right deltoid region of the arm Uppe Upperr outer uter por portio tion of the thig thigh h Mouth
Outer part of the upper arm Upper outer portion of the thigh Deltoid region of the upper arm
L. the EPI vaccines and its characteristics - Vaccines Vaccines are substanc substances es very sensitive sensitive at various various temperatu temperatures. res. To avoid spoilage and maintain its potency, vaccines need to be stored at correct temperature. Typ Type/ e/Fo Form rm of vacc vaccin ines es Stor Storag age e temp temper erat atur ure e Most Sensitive to Oral polio (live -15C to -25C (at the freezer) heat attenuated) Meas Measle les s (fr (free eeze ze drie dried) d) -15C -15C to -25C -25C (at (at the the free freeze zer) r)
Least heat
Sensitive
to DPT/Hep B
+2C to +8C (in the body of temperature)
D – toxoi oxoid d which hich is a weakened vaccine P – killed bacteria T – toxo toxoid id which ich is a weakened toxin Hep B +2C to +8C (in the body of temperature) BCG (f (freeze dr dried) +2C to to +8 +8C (in the body of of te temperature) Tetanus Toxoid +2C to +8C (in the body of temperature)
3. Management of Childhood Illnesses - the the Inte Integr grat ated ed Mana Manage geme ment nt of Chil Childh dhoo ood d Illn Illnes esse ses s (IMC (IMCI) I) has has been been established as an approach to strengthen the provision of comprehensive and essential health package to the children. Methods in Managing Childhood Illnesses: 1. Assess the patient – taking the history of the patient is one of getting information about the disease condition. This can be done by asking and observing the patient’s condition to explore the possible causes.
- Check for DANGER SIGNS: convulsions, abnormally sleepy, difficult to awaken, unable to drink/breastfeed, vomits everything SYMPTOMS S: cough/di - As Asse sess ss MAIN SYMPTOM cough/difficu fficulty lty breathin breathing, g, diarrhea diarrhea,, fever, ear problems 2. Classify the disease Color- Presentation Classification of Diseases Level of Management Green
Mild
Yellow
Home Care
Moderate
Pink
Manage at the RHU
Severe
Urgent Referral in Hospital
3. Treat the patient 4. Counsel the patient – providing health education to client to promote health and avoid risk of infection. - Counsel about home treatments, feeding and fluids, when to return immediately, follow up
4. Nutrition Program - Malnutrition continues to be the public health concerns in the country. The common nutritional nutritional deficiencies are: VIT. A, IRON and IODINE. - GOAL: GOAL: “To improv improve e qualit quality y of life life of Filipi Filipinos nos throug through h better better nutri nutritio tion, n, improved and increased productivity. Nutritional Guideline for Micronutrient Supplementation: Supplementation: Supplementation of Vitamin A A. Universal Supplementation Target Preparation Dose/Duration Infants 6-11 months
Children months
21-
71
100,000 IU
1 dose only
200, 000 IU
1 capsule every six months
B. Vit. A supplementation supplementation to High risk children. Target/Illness Preparations Measles Infants (6 months-11 months)
100, 000 IU 200, 000 IU
Remarks One ca capsule is is gi given anytime during the 611 months but usually given at 9 months during measles immunization
Dose/Duration One capsule given upon diagnosi diagnosis, s, regardle regardless ss of when the last dose of VAC was given.
Pre-school children (12 months- 71 months)
One capsule given upon diag diagno nosi sis, s, exce except pt when when the the child was given VAC less than 4 weeks before diagnosis.
Severe pneumonia Persistent Diarrhea Malnutrition Infants (6 months- 11 months) Pre-school children (12 months – 71 months)
100, 000 IU 200, 000 IU
One capsule given upon diag diagno nosi sis, s, exce except pt when when the the child was given VAC less than 4 weeks before diagnosis
Malnutrition School children (6 years to 12 years old)
200, 000 IU
supplementation for pregnant women and post partum women. B. Vit. A supplementation Targets Preparation Dose Duration Remarks Pregnant women
10, 000 IU
1 capsule/ tablet of 10,000 IU twice a week
Start from the 4 th month of preg pregna nanc ncy y unti untill delivery
Post-partum women
200, 000 IU
1 capsule 000 IU
One dose only Vit. A of 200, 000 withi ithin n 4 weeks eeks IU should NOT be after delivery given to pregnant women
200,
D. Iron supplementation for pregnant and lactating women Targets Preparations Dose/Duration Pregnant women
Tablet containing 60 mg elemental iron with 400 mcg folic acid
1 tablet once a day for 6 months 0r 180 days during during the pregnanc pregnancy y period
Vit. A 10, 000 IU should NOT be given to pregnant wome women n who who are are already taking pre-natal vitamins or multiple micronutrient tablet tablets s that that also also contain Vit. A
Remarks A dose of 800 mcg of folic acid is still safe to the pregnant woman.
Or 2 tablets per day (120 mg) if prenatal consultations consultations are done during the 2 nd and 3rd trimester Lactating women
Tablet containing 60 mg elemental iron with 400 mcg folic acid
1 tablet once a day for 3 months or 90 days
E. Iodine supplementation to specific population groups. Targets Preparation Women 15-45 years old
Iodized oil capsule with 200 mg iodine
Dose/Duration
1 capsule for 1 year
Children of school age
Iodi Iodize zed d oil oil caps capsul ule e with with 20 200 0 mg iodine
Adult males
1 capsule for 1 year
1 capsule for 1 year Iodi Iodize zed d oil oil caps capsul ule e with with 20 200 0 mg iodine
Elements of Primary Health Care
(selected)
N. Health Education - is a process whereby knowledge, attitude attitude and practice of people are changed to improve individual, family and community health. Sequence of STEPS in health education: C – reating awareness M – otivation D – ecision making action Component of Health education: I –nformation E – ducation C – ommunication
Principles: H – ealth E – ducation considers the health status of the people. A – chieved by doing L – earning T – takes the lead in helping people to attain health through their own effort H – uman and natural resources were utilized (community resources) H – ealth workers consider health education as their basic function E – ducation for health is a creative process D – evelopment is slow but continuous and creative process U – se of supplementary supplementary aids and devices C – ooperative effort T – akes place in the home, in the school and the community I – nlvolves motivation O –penly makes us of supplementary aids and devices N – eeds, interests and problems of the people affected must be met Health Education teaching methods: a. Interviewing b. Counseling c. Lecture – discussion d. Open- forum e. Workshop f. Case study g. Role Play h. Symposium i. Community assembly Qualities of a Good HEALTH EDUCATOR E – effective motivator to others D – oes have knowledge or mastery of subject matter U – tilizes the quality of Patience and flexibity
C – redible/creative A – able to emphatize with others T – teaching skills O – organizes and encourage group participation R – ephrase or summarize summarize ability S – ense of humor
O. Treatment of Communicable Diseases (common) Defining terms: Communicable Disease – is an illness illness caused by an infectious infectious agent that is transmitted transmitted directly or indirectly to a well person through a vector or an inanimate object. Carrier – Carrier – is an individual who harbors the organism and is capable of transmitting it to a susceptible host without showing manifestations of the disease. Contagious Disease – is a term given to a disease that is easily transmitted from one person to another through direct or indirect means. Host – Host – is a person, animal or a plant on which parasite depends for its survival Infectious Disease – is trans transmit mitted ted not only only by ordina ordinary ry contac contactt but requir requires es direct direct inoculation of the organism through a break on the skin or mucous membrane. Isolation – is the the sepa separa rati tion on from from othe otherr pers person ons s of an indi indivi vidu dual al suff suffer erin ing g from from a communicable communicable disease. Quarantine – is the limitation of freedom of movement of persons or animals which have been exposed to communicable disease for a period of time equivalent to the longest incubation period of illness. Surveillance – is the act of watching. Sporadic diseases – are diseases that occur occasionally and irregularly with no specific pattern. Epidemic diseases – are diseases that occur in a greater number than what is expected in a specific area over a specific time. Pandemic diseases – is an epidemic that affects several countries or continents. Endemic diseases – are those that are present in a population or community at times involving few people during specific periods. Chain of INFECTION: 1. CAUSATIV CAUSATIVE E agent agent – is any micro microbe be capabl capable e of produc producing ing a disea disease. se. E.g. E.g. bacter bacteria, ia, spirochete, virus, fungi. Etc. 2. RESERVOIR of Infection – refers to the environment and objects on which an organism survives and multiplies. 3. Portal of EXIT – is the path or way in which the organism leaves the reservoir. E.g. RS, GUT, GIT, skin and mm. 4. Mode of TRANSMISSION – is the means by which the infectious agent passes through from the portal of exit of the reservoir to the susceptible host. This is the easiest link to break the chain of infection. Modes: a. Contact Contact Transmissi Transmission on – most common common and can be transmit transmitted ted through through direct and indirect contact and droplet spread. b. Air-bo Air-born rne e transm transmiss ission ion – occur occurs s when when fine fine micro microbia biall partic particles les or dust dust particles containing microbes microbes remain suspended in the air for a prolong period c. Vehicle transmission – is the transmission of the infectious disease through articles or substances that harbor organism until it is ingested or inoculated into the host d. Vect Vector or-b -bor orne ne tran transm smis issi sion on – occu occurs rs when hen carr carrie iers rs,, su such ch as flie flies s intermediate intermediate intermediate and mosquitoes transfers transfers the microbes to another living organism. 5. PORTAL of Entry – Entry – is the venue where the organism gains entrance into the susceptible host. 6. SUSCEPTI SUSCEPTIBLE BLE host – the the huma human n body body has has many many defe defens nses es agai agains nstt the the entr entry y and and multiplication of organism. Preventive Aspect of Care of patients with Communicable Disease: A. Health Education
a. availability and importance importance of prophylactic immunization immunization b. manner in which infectious illness is spread and methods of avoiding the spread c. importance of seeking medical advice for any sign of health problem d. importance of environmental cleanliness and personal hygiene e. means of preventing contamination of food and water supply B. Immunization – is the introduction of specific protective antibodies in a susceptible person or animal, or the production of cellular immunity in such person or animal Immunity – is a condition of being secure against any particular disease. Types: 1. Natural a. Natural Passive – acquired through placental transfer b. Natural Active – acquired through immunization and or recovery from a certain disease 2. Artificial a. Artificial Passive – acquired through the administration of antitoxin, antiserum, and gamma-globulins b. Artificial Active – acquired through the administration of vaccine and toxoid Types of antigen: 1. Inactivated (killed organism) - not long lasting, multiple dose needed and booster dose is needed 2. Attenuated (live organism) - single dose needed and has long lasting immunity C. Environmental Sanitation – the DOH, through the Environmental Health Services (EHS), has the authority to act in all issues and concerns in environmental health including the Code on Sanitation (PD 856 1. Water Supply Sanitation Program a. Approved types of water facilities such as: LEVEL 1 (Point of source) – a protected well or a developed spring with an outlet but without a distribution distribution system generally adoptable to rural areas LEVEL II (Communal Faucet System or Stand Posts) – composed of a source reservoir, a piped distribution network and communal faucet LEVEL III – waterworks system or individual house connection b. Unapproved type of water facility or water coming from doubtful source such as open dug well, unimproved spring and wells are not allowed for drinking unless treated through proper disinfection. c. Water quality and monitoring - examination of drinking water shall be performed only in private and government laboratories laboratories duly accredited by the DOH - certific certificatio ation n of potability potability of an existing water source source is done by the Secretary of health or his duly authorized representative - water supply sources need to be disinfected: (1)newly constructed water water supply supply facilitie facilities, s, (2)water (2)water supply facility facility that has been repaired repaired or improved improved (3)water (3)water supply sources found to be bacteriologically bacteriologically positive through laboratory analysis. 2. Proper Excreta and Sewage Disposal a. Approved types of toilet facilities: LEVEL I – non water carriage toilet facility (pit latrines) - toilet toilet facili facility ty requir requiring ing small small amoun amountt of water water to wash wash the waste into receiving space (aqua privies) LEVE LEVEL L II – Wate Waterr seal sealed ed and and flus flush h type type with with sept septic ic tank tank disp dispos osal al facilities LEVE LEVEL L III III – wate waterr carr carria iage ge toil toilet et conn connec ecte ted d to sept septic ic tank tanks s or to sewerage system to treatment plant 3. Hospital Waste Management a. all newly newly construc constructed/r ted/renova enovated ted governmen governmentt and private private hospitals hospitals shall prepare and implement HWM
b. the use of appropriate technology and indigenous materials for HWM shall be adopted c. training of hospital personnel involved in waste management shall be an essential part of hospital training program 4. Food Sanitation Program a. food food esta establ blis ishm hmen ents ts shal shalll be appr apprai aise sed d as to the the foll follow owin ing g sani sanita tary ry conditions: - inspection/approval of all food sources, containers, transport vehicles - compliance to sanitary permit requirements for all food establishments - provision of updated health certificates for food handlers, cook and cook helpers - training food handlers and operators on food sanitation
Common Communicable Diseases: AMOEBIASIS (Amoebic Dysentery) - a protozoal infection of human beings initially involves the colon, but may spread to soft tissues, most commonly to the liver by lymphatic dissemination. dissemination. - Etiologic Agent: Entamoeba Histolytica - Source: Human excreta - Incubation period: in svere infection is 3 days. - Period of communicability: communicable communicable for the entire duration of illness - Mode Mode of of tran transm smis issi sion on:: 1. Fec Fecal al ora orall rou route te 2. can be trans transmit mitted ted throug through h direc directt contac contactt and throug through h sexual sexual contact ie. Orogenital, oroanal 3. Through indirect contact, the disease can infect human by ingestion of food food espec especial ially ly uncoo uncooked ked leafy leafy vegeta vegetable bles s or foods foods contam contamina inated ted with with fecal fecal mater material ials s containing E. hystolitica - Sign Sign and sympto symptoms ms:: 1. Sligh Slightt attack attack of of diarrh diarrhea, ea, alter altered ed with with perio periods ds of cons constip tipati ation on and often accompanied by tenesmus 2. diarrh diarrhea, ea, watery watery and foul foul smell smelling ing stool stool often often conta containi ining ng blood blood streaked mucus. 3. nausea nausea,, flatul flatulenc ence, e, abdom abdomina inall dis disten tensio sion n and and tender tendernes ness s in the right iliac region over the colon - Diagnostic exam: stool exam - Treatment: Metronidazole (Flagyl) - Nursin Nursing g manag managemen ement: t: 1. Obser Observe ve isolat isolation ion and enteric enteric precautio precaution n 2. Provide health education such as boiling of water for drinking; avoid washing of food from open drum or pail, food preparation preparation and food handling. BACILLARY DYSENTERY (Shigellosis) - is an acute acute bacter bacterial ial infect infection ion of the intes intestin tine e charac character terize ized d by diarr diarrhea hea and fever fever associated with the passing out of bloody mucoid stool with tenesmus. - Etiologic Agent: Shigella (flesneri, boydii, connei and dysenteriae) - Incubation period: 7 hours to7 days, average 3 to 5 days - Period of communicability: capable of transmitting the microorganism during the acute infection until the feces are negative of the organism. - Mod Mode of tra trans nsm mission ion: 1. thro throu ugh inge inges stio tion of contam ntamiinate nated d food ood or drin rinking king contaminated contaminated water 2. transmitted by flies or through other objects contaminated by feces of the patient 3. fecal- oral transmission transmission - Sig Signs ns and symp ymptom toms: 1. Feve Feverr 2. tenesmus, tenesmus, nausea and vomiting vomiting 3. colicky colicky or cramping cramping abdominal abdominal pain associated associated with anorexia anorexia and body weakness 4. diarrhea with bloody-mucoid stool that is watery at first 5. dehydration and loss of weight
- Diagnostic exam: Fecalysis - Treatment: Ampicillin, Tetracycline and Cotrimoxazole - Nursin Nursing g manag managemen ement: t: 1. Maintenan Maintenance ce of fluid fluid and and electrolyt electrolytes es 2. restriction of food until nausea and vomiting subsides 3. proper disposal of excreta
CHICKENPOX (Varicella) - is an acute and highly contagious disease of viral etiology characterized by vesicular eruptions on the skin and mucous membrane - Etiologic agent: Herpesvirus varicellae - Incubation period: 10-21 days - Mode of transmi transmissio ssion: n: 1. Transmitted Transmitted through direct direct contact contact with patients patients who shed the virus from the vesicles 2. Indirectly through linens or fomites 3. Droplet infection - Period of Communicability: about a day before the eruption of the first lesion up to about 5 days after the appearance of the last crop - Signs Signs and sympto symptoms ms:: 1. P Prere-eru erupti ptive: ve: mild mild feve feverr and and mala malaise ise 2. erup erupti tive ve:: rash rashes es star starts ts from from the the trun trunk k (une (unexp xpos osed ed area area), ), then then spread to other parts, parts, very pruritic vesicular vesicular lesion, lesions are characterized characterized by different different stages such as Macule-Papule-Vesicle-Pustule-Crust Macule-Papule-Vesicle-Pustule-Crust - Diagnostic exam: based on the clinical symptoms - Treatment: Zoveraz, Acyclovir - Nurs Nursing ing manag manageme ement: nt: 1. Resp Respira irator tory y isolat isolation ion 2. proper personal hygiene 3. cut finger nails short hand washing to minimize spread of bacterial infections CHOLERA (El Tor) - is an acute acute bacter bacterial ial enteri enteric c dis diseas ease e of the GIT charac character terize ized d by profu profuse se diarr diarrhea hea,, vomiting, massive loss of fluid and electrolytes that could result to hypovolemic shock and death. - Etiologic agent: Vibrio Cholerae/Coma - Pathognomonic sign: Rice watery stool - Incubation period: 1-3 days - Period of communicability: communicable during stool positive stage, usually a few days after recovery - Mode Mode of of tran transm smis issi sion on:: 1. Fec Fecal al-- oral oral rou route te 2. Transmitted through ingestion of food or water contaminated with stool 3. Flies, soiled hands and utensils serve to transmit infection infection - Diagnostic exam: Rectal swab/ Stool exam - Treatment: Treatment: 1. IVF treatment treatment 2. Oral Rehydration Therapy by oral route such Oresol and Hydrites 3. ATBC – Tetracycline - Nurs Nursin ing g mana manage geme ment nt:: 1. Han Hand d wash washin ing g 2. enteric isolation 3. VS, I/O 4. proper personal hygiene 5. proper disposal of excreta 6. health health educat education ion – food/w food/wate aterr suppl supply, y, boili boiling ng of water, water, sanita sanitary ry disposal of human excreta DIPTHERIA (Pseudo-membrane) - is an acute bacterial disease that can infect the body in two areas; the throat (respiratory diphtheria) and the skin (cutaneous diphtheria) diphtheria) - Etiologic agent: Corynbacterium Corynbacterium Diptheria (Klebs leoffler Bacillus) - Incubation period: 2-5 days
- Source Source of infect infection ion:: infec infectio tion n comes comes from from disch discharg arges es of the nose, nose, phary pharynx, nx, eyes eyes or lesions on other parts of the body - Mode Mode of transm transmis issio sion: n: transm transmitt itted ed through through contac contactt with with a patient patient or a carri carrier, er, or with articles with discharges of infected persons -Typ -Types es:: 1. Nasa Nasall – wit with h fou foull-sm smel elli lin ng ser seros osan angu guin inou ous ss sec ecre reti tion ons s 2. Tonsilar 3. Nasophar Nasopharyngea yngeall (more (more severe severe type) – cervical cervical lymph adenopat adenopathy, hy, Bull’s Bull’s neck appearance 4. Wound or Cutaneous diphtheria –affects mucus membrane and any break on the skin - Sign Sign and and sym sympt ptom oms; s; 1. Fat Fatig igue ue,, mala malais ise, e, sli sligh ghtt sore sore thr throa oatt and and feve feverr 2. Cervical adenitis 3. Bull’s neck appearance due to swelling of the neck - Diagnostic exam: Nose and Throat swab, Schick test and Molony test - Treatment: Treatment: 1. ATBC – Penicillin Penicillin 2. Antitoxin – requires skin testing, given in combination with penicillin penicillin - Nursing Nursing managemen management: t: 1. Absol Absolute ute CBR CBR for for 2 weeks to conse conserve rve energy energy 2. soft food diet/ small frequent feeding 3. encourage to drink fruit juice rich in Vit. C to increase resistance resistance 4. Ice collar for the neck
GERMAN MEASLES (Rubella/Three day Measles) - is a mild viral illness caused by rubella virus. It causes mild feverish illness associated with rashes and aches in joints. It has teratogenic in fetus. - Etiologic agent: Rubella virus - Incubation Period: 14-21 days - Period of communicability: one week before and four days after the onset of rashes, but worst when the rash is at its peak - Mode Mode of transmi transmissio ssion: n: 1. direc directt contact contact with nasophar nasopharyngea yngeall secret secretions ions 2. air droplets 3. transplacental transmission - Sign Signs s and and symp sympto toms ms:: 1. Prod Prodro roma mall peri period od:: low low grad grade e feve fever, r, head headac ache he,, mala malais ise, e, conjunct conjunctivitis ivitis,, mild coryza, coryza, post-auric post-auricular ular,, occipita occipital, l, posterio posteriorr cervical cervical lymphade lymphadenopa nopathy thy (3-5 days after the onset) 2. Erupti Eruptive ve period period:: Forchh Forchheim eimer’ er’s s spot spot – a pinkis pinkish h rash rash on the the soft soft palate, eruption of rashes that may last for 1-5 days - Treatment: symptomatic - Risk of Congenital malformation: 100% - when maternal infection occurs on the first trimester of pregnancy, 4% - second and third trimesters and 90% of congenital rubella cases will excrete the virus at birth and are therefore infectious. - Nurs Nursing ing manag manageme ement: nt: 1. Iso Isolat lation ion of pati patient ent 2. Bed rest until fever subsides 3. Darkened room to avoid photophobia 4. Irrigation of eyes with normal saline to prevent irritation 5. Health education – administration of MMR, pregnant mothers should avoid exposure to patients infected with rubella virus, administration of Immune Serum Globulin one week after exposure to Rubella HERPES SIMPLEX - is a viral disease characterized by the appearance of sores and blisters anywhere on the skin. - Etiologic agent: Herpes simplex virus (HSV) – Type 1: 1: can cause cold sores characterized by tiny, clear fluid-filled blisters most commonly affects the lips, mouth, nose, chin or cheeks last for 7-10 days, can be transmitted through kissing, sharing or kitchen utensils or towels; Type 2: 2: causes genital sores, affecting the buttocks, penis, vagina or cervix 2 – 20 days after contact, usually usually get through sexual contact, contact, skin contact and is character characterized ized by minor minor rash, rash, painful painful sores, fever, muscular pain and burning sensation on urination - Trea Treatme tment/ nt/Nur Nursin sing g mana managem gement ent:: 1. Oral Oral anti anti-vi -viral ral drugs drugs such such as as Acyc Acyclov lovir ir
2. Personal hygiene
HERPES ZOSTER (Shingles) - is an acute viral infection of the sensory nerve caused by a variety of chickenpox virus. - Etiol Etiologi ogic c agent: agent: Varice Varicella lla-zo -zoste sterr (foun (found d to cause cause two disea diseases ses,, varice varicella lla and herpes herpes zoster) - Incubation period: communicable a day before the appearance of the first rash until to six days after the last crust - Mode of transmi transmissio ssion: n: 1. Transmi Transmitted tted through through direct direct contact, contact, droplet droplet infection infection and airborne 2. Indi Indire rect ctly ly thro throug ugh h arti articl cles es fres freshl hly y soil soiled ed by secr secret etio ions ns and and discharges from the infected person - Signs Signs and sympto symptoms ms:: 1. Eryth Erythema ematou tous s base base of the skin skin lesion lesion appea appears rs first first and followed by the appearance of the vesicles within 24 hours usually affects the thoracic segment including the extremities. (Last for 1-2 weeks) 2. Paroxysmal burning burning and stabbing stabbing pain that occurs occurs 1-5 days prior prior to the development of rash (worst at night and is intensified by movement) 3. Fever, malaise, anorexia, headache and lymphadenopathy - Diagnostic exam: based on the clinical manifestations manifestations - Treatment: Symptomatic, Symptomatic, anti-viral drugs, analgesics, anti-inflammatory - Nursin Nursing g manag manageme ement: nt: 1. stric strictt isolat isolation ion of of patien patient. t. 2. Apply cool, wet dressings with NSS to pruritic lesions 3. Prevention of secondary infections INFLUENZA (La Grippe) - is an acute viral infectious disease affecting the respiratory system - Etiologic agent: RNA containing myxoviruses, Type A, B and C - Incubation period: 24 – 48 hours - Period of communicability: communicability: communicable until the 5 th day of illness and up to seven days in children - Mode Mode of transmi transmissio ssion: n: 1. airbo airborne rne trans transmis mission sion among among crowded crowded populatio population n 2. droplet transmission - Signs Signs and sympto symptoms ms:: 1. Chilly Chilly sensa sensatio tion, n, hyperpyr hyperpyrexi exia, a, malai malaise, se, sore sore throat throat,, coryz coryza, a, myalgia, vomiting and headache - Nurs Nursin ing g man manag agem emen ent: t: 1. Sta Stay y at home home 2. drink plenty of fluids 3. symptomatic treatment 4. TSB 5. isola isolate te patien patientt to decrea decrease se risk risk of infect infecting ing others others (resp (respira irator tory y isolation) 6. Health Health educat education ion – immu immuniz nizati ation, on, avoida avoidanc nce e of crowd crowded ed place places, s, personal hygiene LEPTOSPIROSIS (Weil’s disease/ Hemorrhagic Jaundice) - is a zoonotic infectious bacterial disease carried by animals whose urine contaminates water or food which is ingested or inoculated through the skin. - Etiologic agent: Leptospira Interrogans Interrogans - Incubation period: 6 – 15 days - Period of communicability: leptospira is found in the urine between 10 – 20 days after the onset - Source of infection: Domestic animals such as Rats, Mice and Dogs - Mode Mode of tran transm smis issi sion on:: 1. thro throug ugh h inge ingest stio ion n or cont contac actt with ith the the skin skin and and muco mucous us membrane of the infected urine 2. Transmitted through the mucous membrane of the eyes, nose and mouth and through a break on the skin - Signs and symptoms: Stages: 1. Septic Septic stage stage – marke marked d with with fever fever lastin lasting g 4-7 days. Chills, headache, anorexia, abdominal pain and severe prostration
2. Immune or Toxic stage – can be with or without jaundice and last for 4-30 days. Headache, meningeal manifestation like disorientation, convulsion, with CSF findings of aseptic meningitis, oliguria and anuria with progressive renal failure, shock and coma in severe cases. Death may occur between 9 to the 16 th day 3. Convalescence – at this stage, relapse may occur during the th th 4 to 5 week - Treatment: Penicillin G Na - Nursing Nursing management: 1. Isolate Isolate patient patient with proper disposal of urine urine 2. keep patient on close surveillance 3. healt health h educa educatio tion n – sanita sanitatio tion n in homes, homes, workpl workplac aces es and farm, farm, eradication of rats and rodents
MEASLES (Rubeola/Morbilli) - is an acute, contagious disease that usually affects children which are susceptible to Uppe Upperr Resp Respir irat ator ory y Trac Tractt Infe Infect ctio ion n (URT (URTI) I).. The The most most comm common on and and seri seriou ous s of all all chil childh dhoo ood d diseases. - Etiologic agent: Filterable virus/ Morbilli virus - Incubation period: 10 – 12 days - Period Period of commun communica icabil bility ity:: Commu Communic nicabl able e four four days days before before and five five days days after after the appearance of rashes - Sources of infection: Virus has been found in the patient’s blood, as well as in the secretions from the eyes, nose and throat - Mode Mode of transm transmis issio sion: n: 1. through through direct direct contac contactt with with the drople droplets ts spread spread by coughi coughing ng and sneezing 2. Indire Indirectl ctly y throug through h articl articles es or fomite fomites s fresh freshly ly contam contamina inated ted with with respiratory respiratory secretions of infected patients - Signs and symptoms: symptoms: Stages: 1. Pre-eruptive Pre-eruptive stage stage – fever, fever, catarrhal catarrhal symptoms symptoms (rhinitis, (rhinitis, conjunctivitis, conjunctivitis, photophpbia and coryza), Koplik’s spot 2. Eruptive stage – macula-papular rash appears first on the cheeks, bridge of the nose, along the hairline, at the ear lobe on the 4 th day, on and off high grade fever, anorexia and irritability 3. Convalescence stage – rashes fade away, fever subsides - Diagnostic exam: Nose and throat swab - Treatment: anti-viral drugs, ATBC if with complication such as Bronchopneumonia, otitis media - Nur Nursin sing g Mana Managem gement ent:: 1. Isolat Isolation ion of patien patientt 2. TSB to control high fever with daily cleansing bed bath 3. Oral Oral and and nasa nasall hygi hygien ene e and and prov provis isio ion n of eye/ eye/ea earr care care free free of secretions 4. Patient’s position should be changed every 3-4 hours 4. Health education: measles vaccine, MMR vaccine
MUMPS (Infectious Parotitis) - is an acute viral disease manifested by the swelling of one or both parotid glands, with occasional involvement of other glandular structures, particularly the testes in male - Etiologic agent: Paramyxovirus found in the saliva of the infected person - Incubation period: 14 – 25 days - Period of communicability: 6 days before and nine days after the onset of parotid gland swelling - Mode of transmission: Droplet infection - Signs Signs and sympto symptoms ms:: 1. sudden sudden headac headache, he, earac earache, he, loss loss of appeti appetite te and swellin swelling g of the parotid gland located in front and below the ear 2. Pain reaches its peak in about and continues for about seven to ten days 3. moderately elevated fever 4. one gland maybe affected at first, and one to three days later, the other side may become involved
- Complication: Most notorious complication is Orchitis (occurs several days after the onset of parotid swelling) - Treatment: Treatment: 1. Anti-viral Anti-viral drugs drugs 2. hot and cold application for relief of pain - Nursin Nursing g manage managemen ment: t: 1. Medica Medicall asepti aseptic c protec protectiv tive e care care 2. bed rest to avoid complication 3. diversional activities 4. offer soft and solid foods and avoid acid foods
PERTUSSIS (Whooping Cough) - is an infectious disease characterized by repeated attacks of spasmodic coughing which consists of a series of explosive expirations, typically ending in a long drawn forced inspiration which produces a crowing sound, the “whoop” and usually followed by vomiting. - Etiologic agent: Bordatella Pertussis - Incubation period: 7 – 14 days - Period of communicability: starts from 7 days after exposure to three weeks after typical symptoms - Mode Mode of of trans transmi miss ssion ion:: 1. d dire irect ct contac contactt and and dropl droplet et 2. indirectly through soiled linens and other articles contaminated by respiratory respiratory secretions - Sourc Sources es of of inf infect ection ion:: secret secretion ions s from from the nose nose and throat throat of infect infected ed pers person ons s - Signs and symptoms: Stages: 1. Catarrhal stage – coryza. Sneezing, lacrimation and dry cough. It is the most communicable communicable stage and last for 1-2 weeks 2. Paroxysmal stage – occurs on the 7 to the 14 th day, cough becomes spasmodic and recurrent with excessive explosive outburst in series of rapid 5 to 10 rapid coughs in one expiration, each cough ends in loud, crowing inspiratory inspiratory whoop and choking on mucus that causes vomiting. Last from 4-6 weeks. 3. Convalescence stage – marked by decrease in paroxysms of coughing, both in frequency and severity, the attack subsides after about six weeks. - Diagnostic exam: Nasopharyngeal Nasopharyngeal swabs - Treatmetn: Treatmetn: 1. Supportive Supportive therapy therapy 2. ATBC such as Erythromycin and Ampicillin - Nursin Nursing g manag manageme ement: nt: 1. Isola Isolatio tion n and medi medical cal asep asepsis sis 2. Suctio Suctionin ning g equipm equipment ent must must be readil readily y availa available ble at all time time for emergency 3. Decrease environmental stimuli 4. Provide warm baths and keep bed dry 5. Health education – immunization, immunization, patient isolation, case reporting RABIES (Hydrophobia/Lyssa) - is a specific, acute, viral infection communicated to man by the saliva of an infected animal - Etiologic agent: Rhabdovirus - Incubation period: 1-7 ½ months in dogs, 10 days to 15 years in human depending on the following: a. distance of the site b. extensiveness of the bite c. specie of the animal d. richness of the blood supply in the area of the bite e. resistance of the host - Period of communicability: communicable from 3-5 days before onset of symptoms until the entire course of illness - Signs and symptoms: Stages: 1. Prodr Prodroma omal/In l/Invas vasion ion phase phase – charac character terize ized d by fever, fever, anor anorex exia ia,, mala malais ise, e, sore sore thro throat at,, copi copiou ous s sali saliva vati tion on,, lacr lacrim imat atio ion, n, pers perspi pira rati tion on,, irri irrita tabi bili lity ty,, restlessness, restlessness, sometimes drowsy, mental depression and insomnia. Pain at the original site of the bite, sensitive sensitive to lig light, ht, sound sound and temperature, temperature, numbness numbness and tingling sensation sensation along along the peripheral nerves and site of the bite
2. Exciteme Excitement nt or Neurolog Neurological ical phase – characte characterized rized by mark mark excitation. There is delirium with nuchal rigidity, severe and painful spasm of the muscles of the mouth, pharynx and larynx on attempt to swallow water or food. Patient may exhibit maniacal behavior and profuse drooling of saliva. 3. Terminal phase – patient becomes unconscious and spasm ceases ceases with progressive progressive paralysis paralysis.. Death Death occurs occurs due to respirat respiratory ory paralysi paralysis s and circulat circulatory ory collapse. - Diagnost Diagnostic ic exam: exam: Fluoresc Fluorescent ent rabies rabies anti-body anti-body (FRA), (FRA), presence presence of negri negri bodies bodies in the dog’s brain - Treatm Treatment ent:: 1. Washin Washing g of wounds wounds from the bite bite and scratch scratches es of dog with soap soap and running water for at least 3 minutes 2. give ATS and anti-rabies vaccine - Nursing management: 1. Isolate the patient 2. give emotional, spiritual support and optimum comfort 3. patien patientt should should not be bath bath and there there should should not be any running running water in the room or within the hearing distance of the patient 4. IVF should be wrapped and needle should be properly anchored 5. Health education – vaccination of all dogs, confinement of any dog that has bitten a person for 10 – 14 days
TETANUS (Lockjaw) - is an infectio infectious us disease disease caused by Clostrid Clostridium ium tetani which which produces produces potent exotoxin with with prom promin inen entt syst system emic ic neur neurom omus uscu cula larr effo effort rts s mani manife fest sted ed by gene genera rali lize zed d spas spasmo modi dic c contractions contractions of the skeletal muscles. - Incubation period: 3 days to 3 weeks in adult, 3 – 30 days in Tetanus neonatorum - Etiologic agent: Clostridium tetani - Sources of infection: animal and human feces, soil and dust and plaster of paris, unsterile sutures, pins, rusty materials, scissors - Mode of transmission: transmission: 1. through punctured wound and and burns that is contaminated by dust, soil or animal excreta 2. Umbilical stump in newborn especially for babies delivered at home with faulty cord dressing 3. Circumcision and ear piercing - Sig Signs ns and symp ymptom toms: Neon eonate: ate: - have feeding and sucking difficulties difficulties - Excessive and voiceless crying -Tonic and rigid muscular contractions - Cyanosis, pallor Adult: - Musc Muscle le spas spasm m and and incr increa ease se musc muscle le tone tone near near the the woun wound d (localized) - if systemic systemic or generali generalized: zed: - Hypertoni Hypertonicity, city, hyperactive hyperactive deep tendon reflexes and painful involuntary muscle contractions - neck and facial muscle rigidity (Trismus) (Trismus) - Grinning expression (Risus Sardonicus) - Opisthotonus - Intermittent tonic convulsions lasting for several minutes which may result in cyanosis and sudden death due to asphyxiation - Laryngos Laryngospasm pasm followed followed by accumula accumulation tion of secretion secretions s in the lower airway resulting in respiratory distress - Tre Treat atme ment nt:: Spe Speci cifi fic; c; 1. Pati Patien entt shoul should d recei receive ve ATS ATS withi within n 72 hours hours afte afterr a punc punctu ture red d wound 2. tetanus toxoid IM given in standard schedule schedule 3. Pen G to control infection 4. Musle relaxant to decrease muscle rigidity and spasm NonNon- sp spec ecif ific ic;; 1. Main Mainta tain inan ance ce of adeq adequa uate te airw airway ay// Tra Trach ches esto tomy my 2. feeding through NGT 3. adequate fluid, electrolyte and caloric intake
4. lower environmental stimuli 5. close monitoring of VS and muscle tone 6. health education – active immunization with TT and DPT for babies and children
TYPHOID FEVER - is a bacterial infection transmitted transmitted by contaminated water, milk, shellfish or other food. It is an infection of the GIT affecting the lymphoid tissues (payer’s patches) of the small intestines. - Etiologic agent: Salmonella typhosa/typhi - Incubation period: 5 – 40 days with a mean of 10- 20 days - Period of communicability: as long as the patient is excreting the microorganism, he is still capable of infecting others - Sour Source ces s of infe infect ctio ion: n: 1. A perso person n who recov recover ered ed from from the the disea disease se or one one who took took care of a patient with with typhoid and and was infected infected 2. ingestio ingestion n of shellfis shellfish h (oysters (oysters)) taken from waters waters contamin contaminated ated by sewage disposal 3. stool and vomits of infected individual - Mode Mode of of trans transmi miss ssion ion:: 1. Feca Fecall oral oral tra transm nsmiss ission ion 2. Through 5 F’s 3. ingestion of contaminated food, water and milk - Signs igns and symp ymptom toms: Ons Onset: et: - hea headac dache, he, chil chilly ly se sens nsa atio tion, bo body pai pains ns,, nau nausea and vomiting and diarrhea - symptoms worst at 4-5th day - fever is higher in the morning that afternoon - red spots on the abdominal wall on the 7-9 th day Typ Typh hoid state: ate: - sym symp ptom toms dec decli line ne in sever everiity - Accumulation of dirty brown collection of dried mucus and bacteria (Sordes) - Coma vigil (blank stare) - twitching of the tendon in the wrist - Patient mutters deliriously and picks up aimlessly at bed clothes with his fingers in continuous fashion (Carphologia) (Carphologia) - Delirium and death in severe cases - Diagnostic exam: Typhidot - Treatment: Chloramphenicol Chloramphenicol – drug of choice - Nursing Nursing management: 1. Maintain Maintain or restore fluid and electrolyte balance 2. Monitoring patient’s VS 3. Prevent further injury (fall) of patient with typhoid psychosis 4. Maintain good personal hygiene and mouth care 5. Cooling measures are necessary during febrile state 6. Watch for signs of intestinal bleeding 7. Health education – sanitary disposal of excreta, proper supervision of food handlers, enteric isolation, adequate protection or provision of safe drinking water supply
