CONTENTS OUTLINE Bag Technique Breastfeeding or Lactation Management Education Training Communicable Disease !ector !ector Borne" Communicable Diseases Chronic" Control of #cute $es%irator& Infections C#$I" Control of Diarrheal Diseases CDD" E'%anded (rogram for Immuni)ation E(I" *erbal Medicine (lants #%%ro+ed b& the DO* Integrated Management of Childhood Illnesses IMCI" Management of a Child ,ith an Ear (roblem Maternal and Child *ealth Nursing (rogram Non-Communicable Diseases and $ehabilitation .amil& (lanning (rogram
Bag Technique Definition
Bag technique-a technique- a tool making use of 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.
(ublic health bag – bag – is an essential and indispensable equipment equipment of the public public health nurse which which he/she has to carry along when he/she goes out home visiting. It contains basic medications and articles which are necessary for giving care.
$ationale
To render effective nursing care to clients and /or members of the family during home visit.
1. 2. 3. !.
1. 2. 3.
!. &. (.
(rinci%les The The use use of the the bag bag tech techni niqu que e sho shoul uld d min minim imiz ize e if if not not tot total ally ly prev preven entt the the spr spread ead of of infe infect ctio ion n from from individuals to families, hence, to the community. Bag Bag tec techn hniq ique ue shou should ld save save time time and and eo eort rt on the the par partt of of the the nurs nurse e in in the the perf perfor orma manc nce e of of nur nursi sing ng procedures. Bag Bag tech techni niqu que e shou should ld not not ove overs rsha hado do conc concer ern n for for the the pati patien entt rat rathe herr shou should ld sho sho the the eec eecti tive vene ness ss of total care given to an individual or family. Bag Bag tec techn hniq ique ue can can b be e perf perfor orme med d in in a var varie iety ty of ay ays s depe depend ndin ing g upon upon age agenc ncy y pol polic icie ies, s, actu actual al home home situation, etc., as long as principles of avoiding transfer of infection is carried out. S%ecial Considerations in the Use of the Bag The The bag bag shou should ld cont contai ain n all all nece necess ssar ary y art artic icle les, s, supp suppli lies es and and equ equip ipme ment nt hi hich ch may may be be use used d to to anser emergency needs. The The bag bag and and its its cont conten ents ts shou should ld be clea cleane ned d as as oft often en as poss possib ible le,, sup suppl plie ies s rep repla lace ced d and and ready eady for for use at any time. The The bag bag and and its its cont conten ents ts shou should ld be be el elll pr protec otecte ted d fr from con conta tact ct it ith h any any artic rticle le in the the hom home e of of the the patients. "onsider the bag and it#s contents clean and $or sterile hile any article belonging to the patient as dirty and contaminated. The The ar arrang rangem emen entt of of the the cont conten ents ts of the the bag bag shou should ld be the the one one most most conv conven enie ient nt to the the use userr to to facilitate the e%ciency and avoid confusion. 'and 'and ash ashin ing g is is d don one e as as fr freque equent ntly ly as the the sit situa uati tion on cal calls ls for, for, help helps s in in min minim imiz izin ing g or or avo avoid idin ing g contamination of the bag and its contents. The The bag bag hen hen use used d for for a com commu muni nica cabl ble e cas case shou should ld be be thor thorou ough ghly ly clea cleane ned d and and disi disinf nfec ecte ted d befo beforre )eeping and re*using. Contents of the Bag +aper lining -tra paper for ma)ing bag for aste materials paper bag/ +lastic linen$lining 0pron 'and toel in plastic bag oap in soap dish Thermometers Thermometers in case one oral and and rectal rectal 2 pairs of scissors 1 surgical and 1 bandage 2 pairs of forceps curved and straight yringes & ml and 2 ml
'ypodermic 'ypodermic needles g. 14, 22, 23, 2& terile dressings 5, ".B terile "ord Tie 0dhesive +laster 6ressing 6ressing 5, cotton ball 0lcohol lamp Tape Tape 7easure 7easure Baby#s scale 1 pair of rubber gloves 2 test tubes Test Test tube holder 7edicines betadine 89: alcohol ophthalmic ointment antibiotic/ zephiran solution hydrogen pero-ide spirit of ammonia acetic acid benedict#s solution
Note: Blood Pressure Pressure Apparatus and Stethoscope Stethoscope are carried separately.
Ste%s/(rocedures
Actions
Rationale
1. ;pon arriving at the client#s home, place the bag on the table or any
To protect the bag from contamination.
2. 0s) for a basin of ater and a glass of ater if faucet is not available. +lace these outside the or) area.
To To be used for handashing. handashing. To To protect the the or) =eld from being et.
3. 5pen the bag, ta)e the linen$plastic lining and spread over or) =eld or area. The paper lining, clean side out folded part out/.
To ma)e a non*contaminated or) =eld or area.
!. Ta)e out hand toel, soap dish and apron and the place them at one corner of the or) area it ithi hin n the the con= con=ne nes s of the the lin linen en$p $pla last stic ic lin linin ing/ g/..
To prep prepar are e for for hand handa ash shin ing. g.
&. 6o handashing. >ipe, dry ith toel. ?eave the plastic rappers of the toel in a soap dish in the bag.
'andashing prevents possible infection from one care provi to the client.
(. +ut on apron right side out and rong side ith crease touching the body, sliding the head into
To To protect the the nurses# uniform. @eeping @eeping the crease crease creates creates
the the nec) nec) str strap ap.. Aeat Aeatly ly tie tie the the str strap aps s at the the bac) bac)..
aest aesthe heti tic c appe appear aran ance ce..
8. +ut out things most needed for the speci=c case e.g./ thermometer, )idney basin, cotton ball, aste paper bag/ and place at one corner of the or) area.
To ma)e them readily accessible.
. +lac +lace e as aste te pap paper er bag bag outs outsid ide e of or) or) area area..
To prev preven entt cont contam amin inat ation ion of cle clean an area area..
4. "lose the bag.
To To give comfort and security, security, maintain personal hygiene hygiene and hasten recovery. recovery.
19. +roceed to the speci=c nursing care or treatment.
To prevent contamination of bag and contents.
11. 0fter completing nursing care or treatment, clean and alcoholize th the th things us used.
To pr protect ca caregiver an and pr prevent sp spread of of in infection to to ot others
12. 6o handashing handashing again. 13. 5pen the bag and put bac) all articles in their proper places. 1!. Cemove apron folding aay from the body, ith soiled sidefolded inards, and the clean side out. +lace it in the bag. 1&. Dold the linen$plastic lining, cleanE place it in the bag and close the bag. 1(. 7a)e post*visit conference on matters relevant to health care, ta)ing anecdotal notes preparatory to =nal reporting.
To be used as reference for future visit.
18. 7a)e appointment for the ne-t visit either home or clinic/, ta)ing note of the date, time and purpose.
Dor follo*up care.
#fter Care
1. 2.
Befo Beforre )eeping ping all artic ticles in the the bag, bag, clea lean and alcoh lcohol oliz ize e them them.. Fet Fet the the bag bag fr from the the tabl table, e, fold fold the the pape paperr lin linin ing g and and inse insert rt/, /, and and pla place ce in bet betee een n the the
1.
Cecor ecord d all all relev eleva ant =ndi ndings ngs ab about out th the cli clien entt and and memb embers ers of of th the fa family mily.
2. 3. !.
Ta)e a)e note note of envi envirronme onment ntal al fact factor ors s hic hich h aec aectt the the cli clien ents ts$f $fam amil ily y heal health th.. Gnclude quality of nurse*patient relationship. 0ssess eectiveness of nursing care provided.
reastfeeding or !actation "anagement #ducation Training Introduction
reastfeeding practices has been proved to be very beneficial to both mother and baby thus the creation of the following laws support the full implementation of this program$
-ecutive 5rder &1 Cepublic 0ct 8(99 The Cooming*Gn Cooming*Gn and Breastfeeding Breastfeeding 0ct 0ct of 1442 (rogram Ob0ecti+es and 1oals +rotection and promotion of breastfeeding and lactation management education training #cti+ities and Strategies
%. .ull %. .ull Im%lementation of La,s Su%%orting the (rogram
a. EO 23 T*E MIL4 CODE – CODE – protection and promotion promotion of breastfeeding breastfeeding to ensure the safe safe and adequate nutrition nutrition of infants through regulation of marketing of infant foods and related products. &e.g. breast milk milk substitutes, infant formulas, feeding bottles, teats etc. '
b. $# 5677 T*E $OOMIN1 8IN and B$E#ST.EEDIN1 #CT of 399:
0n act providing incentives to government and private health institutions promoting and practicing rooming*in and breast*feeding. +rovision for human mil) ban). Gnformation, education and re*education drive anction and Cegulation
(. Conduct Orientation/#d+ocac& Meetings to *os%ital/ Communit&
Advantages of of Breastfeeding: Breastfeeding:
Mother
5-ytocin help the uterus contracts ;terine involution Ceduce incidence of Breast "ancer +romote 7aternal*Gnfant Bonding Dorm of Damily planning 7ethod ?actational 0menorrhea/
Baby
+rovides 0ntibodies "ontains ?actoferin binds ith Gron/ ?eu)ocytes "ontains Bi=dus factorpromotes groth of the ?actobacillusinhibits ?actobacillusinhibits the groth of pathogenic bacilli
Positions in Breastfeeding of the baby:
1. 2. 3.
"radle 'old H head and nec) are supported Dootball 'old ide ?ying +osition B#)T *+ -I#) R#D# I0ID#0# +* -!!#1#0) E+0+"I-! A0TI+DI#) 2#)#0T ST++! I0+**#0)I3# &1+!D#0 4#!!+5' T#"2#-T# -!5-4) ID#-! F#)6 "I!7 0#3# 1+#) +** E"+TI+0-!!4 +0DI01 E -)4 +0# +0# #)T-!I) #)T-!I)6#D 6#D DI1#)T#D #-)I!4 ""#DI -T#!4 -3-3-I!-! I!-!# # I""#DI-T#!4
NTITI+0-!!4 +2TI"-! 1 -)T+#0T#ITI) -)T+#0T#ITI) 1#-T! 1#-T!4 4 #D#D
ommunicable Disease &3ector orne' Le%tos%irosis ;eil
0n infectious disease that aects humans and animals, is considered the most common zoonosis in the orld Causative Agent:
!eptospira interrogans
Sign/Symptoms: 'igh fever "hills Iomiting Ced eyes 6iarrhea evere headache muscle aches may include Jaundice yello s)in and eyes/ abdominal pain
Treatment:
PET – > Penicillins, Erythromycin, Tetracycline Tetracycline
Malaria
7alaria from 7edieval GtalianK mala aria L Mbad airNE formerly called ague or marsh fever/ is an infectious disease that is idespread in many tropical and subtropical regions. Causative Agent:
-nopheles female mosquito
Signs & Symptoms: Chills to convulsion Hepatomegaly Anemia Seats profusely Elevated temperature Treatment: "hemoprophyla-is L chloroquine ta)en at ee)ly interval, starting from 1*2 ee)s before entering the endemic area. 0nti*malarial drugs L sulfado-ine, quinine sulfate, tetracycline, quinidine Gnsecticide treatment treatment of mosquito nets, house spraying, stream stream seeding and clearing, sustainable preventive and vector control meas Preventive Measures: (CLA!" Chemically treated mosquito nets Larvae eating =sh Environmental clean up Anti mosquito soap$lotion Neem trees$eucalyptus tree .ilariasis
name for a group of tropical diseases caused by various thread*li)e parasitic round orms nematodes/ and their larvae larvae transmit the disease to humans through a mosquito bite can progress to include gross enlargement of the limbs and genitalia in a condition called elephantiasis Sign/Symptoms:
Asymptomatic Stage
"haracterized by the presence of micro=lariae in the peripheral blood Ao clinical signs and symptoms of the disease ome remain asymptomatic for years and in some instances for life
Acute Stage
?ymphadenitis in
Chronic Stage
'ydrocoele selling of the scrotum/ ?yphedema temporary selling of the upper and loer e-tremities lephantiasis enlargement and thic)ening of the s)in of the loer and $ or upper e-tremities, scrotum, breast/ Management: 6iethylcarbamazine citrate or 'etrazan Gvermectin, 0lbendazolethe Ao treatment can reverse elephantiasis Schistosomiasis
parasitic disease caused by a larvae Causative Agent:
)chistosoma intercalatum, )chistosoma 8aponicum, )chistosoma mansoni
Signs & Symptoms: (BALL#PS" Bulging abdomen Abdominal pain Loose boel movement Lo grade fever In
Preventive measures health education regarding regarding mode of transmission and methods of protectionE proper disposal of feces and urineE improvement of irrigation and agriculture practices "ontrol of patient, contacts and the immediate environment environment
Treatment: 6iethylcarbamazepine 6iethylcarbamazepine citrate 6"/ or +raziquantel +raziquantel drug of choice/
Dengue
6AF; is a mosquito*borne infection hich in recent years has become a maJor international public health concern.. Gt is found in tropical and sub*tropical regions around the orld, predominantly in urban and semi* urban areas. Sign/Symptoms: ($L#!%SPA'" omiting Lo platelet Nausea !nset of fever
Severe headache Pain of the muscle and Joint Abdominal pain Rashes Diarrhea
Treatment: The mainstay mainstay of treatment treatment is supportive supportive therapy. Gntravenous
ommunicable ommunicable Diseases &hronic'
Tuberculosis TB is a highly highly infectious chronic disease disease that that usually aects aects the lungs. lungs. Causative Agent:
"ycobacterium Tuberculosis Tuberculosis
Sign/Symptoms: cough afternoon fever eight loss night seat blood stain sputum Prevaen)e/#n)iden)e: ran)s si-th in the leading causes of morbidity ith 11!,221 cases/ in the +hilippines i-th leading cause of mortality ith 2&98 cases/ in the +hilippines. +hilippines. !ursing and Medi)a Management Ientilation systems ;ltraviolet lighting Iaccines, such as the bacillus "almette Fuerin B"F/ vaccine drug therapy Preventing Tuber)uosis B"F vaccination 0dequate rest Balanced diet Dresh air 0dequate e-ercise Food personal 'ygiene !ationa Tuber)uosis Contro Program * +ey poi)ies Case "n#in$ L direct putum 7icroscopy and P*ray e-amination of TB symptomatics ho are negative after 2 or more sputum e-ams Treatment L Treatment L shall be given free and on an ambulatory basis, e-cept those ith acute complications and emergencies Direct !%ser&e# Treatment Short Co'rse L comprehensive strategy to detect and cure TB patients.
'%TS ('ire)t %bserved Treatment Short Course" Cate$ory () ne TB patients hose sputum is positiveE seriously ill patients ith severe forms of smear*negative +TB ith e-tensive parenchymal involvement moderately* or far advanced/ and e-tra* pulmonary TB meningitis, pleurisy, etc./ Intensive Phase given Phase given daily for the =rst 2 months/ L Cifampicin Q Gsioniazid Q pyrazinamide Q ethambutol. Gf sputum result becomes negative after 2 months, maintenance phase starts. But if sputum is still positive in 2 months, all drugs are discontinued from 2*3 days and a sputum specimen is e-amined for culture and drug sensitivity. The patient resumes ta)ing the ! drugs for another month and then another smear e-am is done at the end of the 3rd month. Maintenance Phase after Phase after 3rd month, regardless of the result of the sputum e-am/*GA' Q rifampicin daily Cate$ory *)previously*treated *)previously*treated patients ith relapses or failures. Intensive Phase daily for 3 months, month 1, 2 O 3/*GsioniazidQ rifampicinQ rifampicinQ pyrazinamideQ ethambutolQ streptomycin for the =rst 2 months treptomycinQ rifampicin pyrazinamideQ pyrazinamideQ ethambutol on the 3rd month. Gf sputum is still positive after 3 months, the intensive phase is continued for 1 more month and then another sputum e-am is done. Gf still positive after ! months, intensive phase is continued for the ne-t & months. Maintenance Phase daily for & months, month !, &, (, 8,O /*GsionazidQ rifampicinQ ethambutol Cate$ory + L ne TB patients hose sputum is smear negative for 3 times and chest -*ray result of +TB minimal Intensive Phase daily for 2 months/ L Gsioniazid Q rifampicin Q pyrazinamide pyrazinamide Maintenance Phase daily for the ne-t 2 months/ L Gsioniazid Q rifampicin Le%ros&
ometimes )non as Hansens #isease is an infectious disease caused by , an aerobic, acid fast, rod*shaped mycobacterium mycobacterium Ferhard 0rmauer 'ansen 'istorically, leprosy as an incurable and dis=guring disease Today, Today, leprosy leprosy is easily easily curable by multi*drug antibiotic therapy therapy Signs & Symptoms
Earl& stage CLUM("
Change in skin color Loss in sensation Ulcers that do not heal
Late Stage 1MISC"
1ynocomastia Madarosis&loss of eyebrows' Inability to close eyelids &!agopthalmos'
Muscle weakness
Sinking nosebridge
(ainful nerves
lawing/contractures of fingers 9 nose Clawing/contractures
Prevaen)e ate 7etro 7anila, the prevalence rate ranged from 9.!9 L 3.91 per one thousand population. Management: 6apsone, ?amprene clofazimine and rifampin 7ulti*6rug*Therapy 76T/ si- month course of tablets for the milder form of leprosy and to years for the more severe form
Leprosy Contro Program -H! Classi"cation L basis of multi*drug therapy +aucibacillary$+ +aucibacillary$+B B L non*infectious types. (*4 months of treatment. 7ultibacillary$7B 7ultibacillary$7B L infectious types. 2!*39 months of treatment. treatment. .'lti)#r'$ thera/y L use of 2 or more drugs renders patients non*infectious non*infectious a ee) after starting treatment +atients $ single s)in lesion and a negative slit s)in smear are treated $ a single dose of C57 regimen Dor +B leprosy cases* CifampicinQ6apsone on 6ay 1 then 6apsone from 6ay 2*2. ( blister pac)s ta)en monthly ithin a ma-. period of 4 mos. 0ll patients ho have complied $ 76T are considered cured and no longer regarded as a case of leprosy, even if some sequelae of leprosy remain. Res/onsi%ilities o0 the n'rse1 Pre&ention L health education, healthful living through proper nutrition, adequate rest, sleep and good personal hygieneE Case"n#in$ .ana$ement an# treatment L prevention of secondary inJuries, handling of utensilsE special shoes $ padded solesE importance of sustained therapy, correct correct dosage, eects of drugs and the need for medical chec)*up from time to timeE mental O emotional support Reha%ilitation*ma)es Reha%ilitation*ma)es patients capable, active and self*respecting member of society.
ontrol of -cute espiratory Infections &-I' Classification A, !o Pneumonia: Pneumonia: Cough Cough or or Cod
1. 2.
Ao chest in draing Ao fast fast brea breath thin ing g R2 mos. mos. L R(9 R(9$m $min in,2 ,2*1 *12 2 mos mos.. L less less than than &9 per per min minut uteE eE 12 mos. mos. L & yea years L les less s than !9 per minute/
Treatment=
1. 2. 3. !.
Gf coughing more than 39 days, refer for assessment 0ssess and tre treat ear problems$sore throat if present 0dvise mother to give home care Treat fever$heezing if present
*ome Care=
%. Feed the Child
Deed the child during illness Gncrease feeding after illness "lear the nose if it interferes ith feeding
(. Increase Fluids
oer the child e-tra to drin) Gncrease breastfeeding
:. Soothe the throat and relieve the cough ith a sa!e remedy
;. "atch !or the !olloing signs and symptoms and return #uic$ly i! they occur
Breathing becomes di%cult Breathing becomes fast "hild is not able to drin) "hild becomes sic)er B, Pneumonia
1. 2.
Ao chest in draing Dast ast br breath eathin ing g l less ess tha than n 2 mos mos** (9$ (9$mi min n or or mor more e E 2*12 2*12 mos. mos. L &9$ &9$mi min n or or mor moreE eE 12 mos. mos. L & yea years rs L !9$min or more/
Treatment
1. 2. 3. !.
0dvise mother to give home care Five an antibiotic Treat fever$heezing if present Gf the the chi child ld#s #s cond condit itio ion n get gets s or orst st,, ref refer er urge urgent ntly ly to hosp hospit ital alEE if if imp imprrovin oving, g, =nis =nish h & days days of anti antibi biot otic ic..
#ntibiotics $ecommended b& ;*O
"o*trimo-azole, 0mo-ycillin, 0mpicillin, p.o/ or +rocaine penicillin G.7./ C, Severe Pneumonia
1. 2. 3. !.
"hest indraing Aasal
Treatment
Cefer urgently to hospital
Treat Treat fever fever paracetamol/, paracetamol/, heezing heezing salbutamol/ salbutamol/ ', $ery Severe 'isease
1. 2. 3. !. &.
Aot able to drin) "onvulsions 0bnormally sleepy or di%cult to a)e tridor in calm child evere undernutrition
Treatment
Cefer urgently to hospital
#ssessment of $es%irator& Infection As- the Mother Mother
1. 2. 3. !. &. (.
'o old is the childS Gs the child coughingS Dor ho longS 0ge 0g e les less tha than 2 mon months thsK 'as the the youn young g infa nfant stopp topped ed fee feeding ding el ellS 0ge 2 months up to & yearsK Gs the child able to drin)S 'as the child had feverS Dor ho longS 'as the child had convulsionsS Loo-. Listen
%. ount the breaths in one minute.
A$e
Fast Breathin$
?e ?ess than 2 months
(9$minute or more
2 months* 12 months
&9$minute or more
12 12 months L & years
!9$minute or more
(. !ook for chest in drawing. :. !ook and listen for stridor. )tridor )tridor occurs when there is a narrowing of the laryn<, trachea or epiglottis which interferes with air entering the lungs. ;. !ook and listen for whee=e. 5hee=e is a soft musical noise which shows signs that breathing out &e. )ee if the child is abnormally sleepy or difficult to wake. &)uspect meningitis' ?. *eel for fever or low body temperature. @. heck for severe under nutrition
ontrol of Diarrheal Diseases &DD' Management of the (atient ,ith Diarrhea A, !o 'ehydration 'ehydration "ondition L ell, alert 7outh and Tongue L moist yes L normal Thirst L drin)s drin)s normally, normally, not thirsty Tears Tears L present present )in pinch L goes bac) quic)ly TC0T7AT TC0T7AT +?0A 0* 0* '57 Treatme Treatment. nt.
Three $ules for *ome Treatment
1.
Five the child more
Oresol Treatment
A$e
Amo'nt o0 !RS to $i&e a0ter each loose stool
Amo'nt o0 !RS to /ro&i#e 0or 'se at home
R 2! months
&9*199 ml
&99 ml$day
2* 2*19 years
19 9 * 2 9 9 m l
1999 ml$day
19 19 years up
0s much as anted
2999 ml$day
B, Some 'ehydration "ondition L restless, irritable 7outh and Tongue L dry yes L sun)en Thirst L thirsty, thirsty, drin)s eagerly Tears Tears L absent absent )in pinch L goes bac) sloly >GF' +T, TTT. +?0A B
#%%ro'imate amount of O$S to gi+e in 3st > hours
A$e
-ei$ht 23$4
!RS 2ml4
! months
&
299* !99
!* !* 11 months
&* 8.4
!99* (99
12 12*23 months
* 19.4
(99* 99
2* 2*! yrs.
11* 1&.4
99* 1299
&* &*1! yrs.
1(* 24.4
1299* 2299
1& 1& yrs. up
39 u p
2299* !999
1. 2. 3. !. &. (.
Gf the child ants more 5C than shon, give more "ontinue breastfeeding Dor infa infant nts sb bel elo o ( mos mos.. ho ho are are not not brea breast stfe feed ed,, giv give e 199 199*2 *299 99 ml clea clean n a ater ter dur durin ing g the the per perio iod d Dor a ch child le less th than 2 years gi give a teaspoonful ful ev every 1* 1*2 mi min. Gf the the ch child ild vom vomit its s, a ait for for 19 19 min min,, th then conti ontin nue giv givin ing g 5C 5C, 1 tbs tbsp$2* p$2*3 3 min min Gf the the chi child ld#s #s eyel eyelid ids sb bec ecom ome e pu puy, y, stop stop 5C, 5C, give give plai plain n at ater er or brea breast st mil) mil),, Ces Cesum ume e 5C 5C hen hen pu%ness is gone 8. Gf */ signs of 6'A* shift to +lan 0
Use of Drugs during Diarrhea
1. 2. 3. !.
0ntibiotics should only be used for dysentery and suspected cholera 0ntiparasitic drugs should only be used for amoebiasis and giardiasis C, Severe 'ehydration "ondition L lethargic or unconsciousE
$ole of Breastfeeding in the Control of Diarrheal Diseases (rogram To probems in C'' 1. 'igh child mortality due to diarrhea 2. 'igh diarrhea incidence among under =ves 'ighest incidence in age ( L 23 months 'ighest mortality in the =rst 2 years of life 7ain causes of death in diarrhea K Dehy#ration To To prevent dehydration, give home
1. 2. 3. !. &. (. 8.
#nterventions to prevent diarrhea breastfeeding improved eaning practices use of plenty of clean ater hand ashing use of latrines proper disposal of stools of small children measles immunization Breastfeeding %. isk of severe diarrhea %AB:A< higher in bottle fed infants than than in breastfed breastfed infants. infants. (. -dvantages of breastfeeding in relation to DD
a. reast milk is sterile b. 2resence of antibodies protection against diarrhea c. Intestinal *lora in * infants prevents growth of diarrhea causing bacteria.
:. reastfeeding decreases incidence rate by CB(A and mortality by (;B (@ in infants under ? months of age. ;. 5hen to weanE
!*( months L soft mashed foods 2- a day ( months L variety of foods !- a day Summar& of ;*O-CDD recommended strategies to %re+ent diarrhea %. Im%ro+ed Nutrition
-clusive breastfeeding for the =rst !*( months of life and partially for at least one year. Gmproved eaning practices
(. Use of safe ,ater
collecting plenty of ater from the cleanest source protecting ater from contamination contamination at the source and in the home
:. 1ood %ersonal and domestic h&giene
handashing use of latrines proper disposal of stools of young children
;. Measles immuni)ation immuni)ation
#
1. 2. 3.
1. 2. 3. !. &. (. 8.
pidemiological situation 7ass approach Basic 'ealth ervice The 5 immuni)able immuni)able diseases Tuberculosis 6iptheria +ertussis 7easles +oliomyelitis Tetanus 'epatitis B Target Setting
Gnfants 9*12 months +regnant and +ost +artum >omen chool ntrants$ Frade 1 $ 8 years old Ob0ecti+es of E(I
To To reduce morbidity morbidity and mortality mortality rates rates among infants infants and children children from sisi- childhood immunizable immunizable disease Elements of E(I
Target Target etting etting "old chain ?ogistic 7anagement* Iaccine distribution through cold chain is designed to ensure that the vaccines ere maintained under proper environmental condition until the time of administration. administration. Gnformation, ducation and "ommunication G"/ 0ssessment and evaluation of 5ver*all performance of the program urveillance and research studies
#dministration of +accines
accine BC7 2Bacill's Calmette 7'erin4
Content ?ive attenuated bacteria
Form 5 Dosa$e
6 o0 Doses
Ro'te
Dreeze dried
1
G6
Gnfant* 9.9&ml
2reschoolBA.%ml
6T* ea)ened to-in DPT 2Di/htheria Pert'ssis Tetan's4
2Bkilled bacteria
li liquid*9.&ml
3
G7
!P 2!ral Polio accine4 accine4
e ea)ened virus
liquid*2drops
3
5ral
He/atitis B
+lasma derivative
?iquid*9.&ml
3
G7
Dreeze dried* 9.&ml
1
ubcutaneous
>ea)ened virus
.easles
Schedule of !accines
acci ne
A$e at (st #ose
BC7
0t birth
DPT
( ee)s
!P
( ( ee)s
Inter&al %et8een #ose
Protection B"F is given at the earliest possible age protects against the possibility of TB infection from f rom the other family members
! ee)s
0n early start ith 6+T reduces the chance of severe pertussis
!ee)s
The e-tent of protection against polio is increased the earlier 5+I given. 0n early start of 'epatitis B reduces
He/a B
birth
.eas les
4m9s.* 11m9s.
birth,(th ee),1!th ee)
the chance of being infected and becoming a carrier.
0t least &: of measles can be prevented by immunization immunization at thi age.
( months L earliest dose of measles given in case of outbrea) 4months*11months* regular schedule of measles vaccine 1& months* latest dose of measles given !*& years old* catch up dose F'lly Imm'ni9e# Chil# 2FIC4L 2FIC4 L less than 12 months old child ith complete immunizations of 6+T, 5+I, B"F, 0nti 'epatitis, 0nti measles.
Tetanus To'iod Immuni)ation S)hedue for 0omen
.inim'm a$e inter&al
: /rotecte#
D'ration o0 o0 Pr Protection
TT TT1
0s early as possible
9:
9
TT TT2
! ee)s later
9:
3 years
TT TT3
( months later
4&:
& years
44:
19 years
44:
?ifetime
accine
TT! TT TT&
1year later$during ne-t pregnancy 1 year later$third pregnancy
There is no contraindication contraindication to immunization immunization e-cept e-cept hen the child is immunosuppre immunosuppressed ssed or is very, very, very ill but not slight fever or cold/. 5r if the child e-perienced convulsions after a 6+T or measles vaccine, report such to the doctor immediately. 7alnutrition is not a contraindication contraindication for immunizing children ratherE it is an indication for immunization since common childhood diseases are often severe to malnourished children.
Cold Chain under E(I
"old "hain is a system used to maintain potency of a vaccine from that of manufacture to the time it is given to child or pregnant oman. The alloable alloable timeframes timeframes for the storage storage of vaccines vaccines at dierent dierent levels levels areK areK (months* Cegional ?evel 3months* +rovincial ?evel$6istrict ?evel 1month*main health centers*ith ref. Aot more than &days* 'ealth centers using transport bo-es. .ost sensiti&e to heat1 Dreezer heat1 Dreezer *1& to *2& degrees "/ 5+I 7easles Sensiti&e to heat an# 0ree9in$ body of ref. Q2 to Q degrees "elsius/ B"F 6+T 'epa B TT ;se those that ill e-pire =rst, mar) MPN$ e-posure, 3rd* discard, Transport*use Transport*use cold bags let let it stand in room temperature temperature for a hile before storing storing 6+T. 6+T. 'alf life pac)sK !hours*B"F, 6+T, +olio, hours*measles, TT, 'epa B. FEF! M=rst FEF! M=rst e-piry and =rst outN/ L vaccine is practiced to assure that all vaccines are utilized before the e-piry date. +roper arrangement of vaccines and$or labeling of vaccines e-piry date are done to identify those near to e-pire vaccines.
6erbal "edicine 2lants -pproved by the D+6
Lagundi !ite' negundo" Uses ? (re%aration=
Asthma, Co'$h 5 Fe&er L Fe&er L 6ecoction Boil ra fruits or leaves in 2 glasses of ater for 1& minutes/6ysentery, "olds O +ain L 6ecoction Boil a handful of leaves O ash O clean the s)in$ound ith the decoction Hea#ache L Hea#ache L "rush leaves may be applied on the forehead Rhe'matism, s/rain, cont'sions, insect %ites L +ound the leaves and apply on aected area
@erba @erba *ierba " Buena Mentha Mentha cordifelia" cordifelia"
Uses ? (re%aration= Pain 2hea#ache, stomachache4 L Boil chopped leaves in 2 glasses of ater for 1& minutes. 6ivide decoction into 2 parts, drin) one part every 3 hours. Rhe'matism, arthritis an# hea#ache L "rush the fresh leaves and squeeze sap. 7assage sap on painful parts ith eucalyptus Co'$h 5 Col# L Col# L oa) 19 fresh leaves in a glass of hot ater, drin) as tea. e-pectorant/ S8ollen $'ms L $'ms L teep ( g. of fresh plant in a glass of boiling ater for 39 minutes. ;se as a gargle solution Toothache L Toothache L "ut fresh plant and squeeze sap. oa) a piece of cotton in the sap and insert this in aching tooth cavity
.enstr'al 5 $as /ain L /ain L oa) a handful of leaves in a lass of boiling ater. 6rin) infusion. Na'sea 5 Faintin$ L Faintin$ L "rush leaves and apply at nostrils of patients Insect %ites L %ites L "rush leaves and apply Juice on aected area or pound leaves until li)e a paste, rub on aected area Pr'ritis L Pr'ritis L Boil plant alone or ith eucalyptus in ater. ;se decoction as a ash on aected area.
Sambong Blumea balsamifera"
Uses ? (re%aration= #nti-edemaA diureticA anti-urolithiasis anti-urolithiasis – – oil chopped leaves in a glass of water for %> minutes until one glassful remains. Divide decoction into : parts, drink one part : times a day. Diarrhea – Diarrhea – hopped leaves and boil in a glass of water for %> minutes. Drink one part every : hours.
Tsaang 1ubat Carmona retusa"
Uses ? (re%aration= Diarrhea – Diarrhea – oil chopped leaves into ( glasses of water for %> minutes. Divide decoction into ; parts. Drink % part every : hours Stomachache – Stomachache – oil chopped leaves in % glass of water for %> minutes. ool and strain.
Ni&ug-ni&ogan uisqualis indica L"
Uses ? (re%aration= #nti-helmintic – The seeds are taken ( hours after supper. If If no worms are e
Ba&abas/1ua+a (sidium gua0a+a L"
Uses ? (re%aration= .or ,ashing ,ounds – ,ounds – "aybe use twice a day Diarrhea – Diarrhea – "ay be taken :B; times a day -s gargle and for toothache – 5arm 5arm decoction is used used for gargle. *reshly *reshly pounded leaves are are used for toothache. toothache. oil chopped leaves for %> minutes at low fire. Do not cover and then let it cool and strain
#a%ulo Cassia alata L"
Uses ? (re%aration= #nti-fungal tinea fla+aA ring,ormA athlete
Ulasimang Bato (e%eronica %ellucida"
Uses ? (re%aration= Lo,ers uric acid rheumatism and gout" – gout" – +ne a half cup leaves are boiled in two glass of water over low fire. Do not cover pot. Divide into : parts and drink one part : times a day
Ba,ang #llium sati+um"
Uses ? (re%aration= *&%ertension – *&%ertension – "aybe fried, roasted, soaked in vinegar for :A minutes, or blanched in boiled water for %> minutes. Take Take ( pieces : times a day after meals. Toothache – Toothache – 2ound a small piece and apply to affected area #m%ala&a Mamordica Charantia"
%. (. :. ;. >. ?. @.
Uses ? (re%aration= Diabetes Mellitus Mild non-insulin de%endent" – hopped leaves then boil in a glass of water for %> minutes. Do not cover. ool and strain. Take %/: cup : times a day after meals $eminders on the Use of *erbal Medicine -void oid th the us use of of in insecticide as as th these ma may le leave ave po poison on on pl plants. In the the pre prepa para rati tion on of herb herbal al medi medici cine ne,, use use a cla clay y pot pot and and rem remov ove e cov cover er whil while e boi boili ling ng at low low hea heat. t. se only part of the plant being advocated. *ollow accurate do dose of of suggested pr preparation. se only only one one kind kind of her herbal bal plan plantt for for eac each type type of symp sympttoms oms or sick sickn ness. ess. )top )top givi giving ng the the herb herbal al medi medica cati tion on in case case unto untow ward ard rea react ctio ion n suc such h as as all aller ergy gy occu occurs rs.. If sign signs s and and symp sympto toms ms are are not not reli reliev eved ed afte afterr ( to : dos doses es of herb herbal al medi medica cati tion on,, con consu sult lt a doc docto torr.
Integrated "anagement of hildhood Illnesses &I"I'
De"nition G7"G is an integrated approach to child health that focuses on the ell*being of the hole child. G7"G strategy is the main intervention proposed to achieve a signi=cant reduction in the number of deaths from communicable diseases in children under =ve 7oal
By 2919, to reduce the infant and under =ve mortality rate at least one third, in pursuit of the goal of reducing it by to thirds by 291&. Aim
To To reduce death, death, illness illness and disability, disability, and to promote improved improved groth and development development among children under & years of age. G7"G includes both preventive and curative elements that are implemented by families and communities as ell as by health facilities. I.CI !%;ecti&es To To reduce signi=cantly signi=cantly global mortality mortality and morbidity morbidity associated associated ith the maJor maJor causes of disease in children To To contribute to the the healthy groth groth O development development of children children
I.CI Com/onents o0 Strate$y Gmproving case management s)ills of health or)ers U Gmproving the health systems to deliver G7"G Gmproving family and community practices
VVDor many sic) children a single diagnosis may not be apparent or appropriate
Presentin$ com/laint1 "ough and$or fast breathing ?ethargy$;nconsciousness 7easles rash MIery sic)N young infant
Possi%le co'rse< associate# con#ition1 +neumonia, evere anemia, +. falciparum malaria "erebral malaria, meningitis, severe dehydration +neumonia, 6iarrhea, ar infection +neumonia, 7eningitis, epsis
Fi&e Disease Foc's o0 I.CI1 0cute Cespiratory Gnfection 6iarrhea Dever 7alaria 7easles 6engue Dever ar Gnfection 7alnutrition
The I.CI Case .ana$ement Process 0ssess and classify Gdentify appropriate treatment Treat$r Treat$refer efer "ounsel Dollo*up
The Inte$rate# Case .ana$ement Process
Check for General Danger Signs: 0 general danger sign is present ifK The child is not able to drin) drin) or breastfeed breastfeed The child vomits vomits everything The child has has had convulsions convulsions The child is lethargic lethargic or unconscious unconscious Assess Main Symptoms "ough$65B 6iarrhea Dever ar problems Assess and Classify Cough of Diculty of Breathing
Cespiratory infections can occur in any part of the respiratory tract such as the nose, throat, laryn-, trachea, air passages or lungs.
Assess and classify PN!M"N#A "ough or di%cult breathing 0n infection of the lungs Both bacteria and viruses can cause pneumonia "hildren ith bacterial pneumonia may die from hypo-ia too little o-ygen/ or sepsis generalized infection/.
VV 0 child ith cough or di%cult breathing is assessed forK 'o long the child has had cough or di%cult breathing Dast breathing breathi ng "hest indraing tridor in a calm child.
Remem%er1 VV Gf the child is 2 months up to 12 months the child has fast breathing breathing if you count &9 breaths per minute or more VV Gf the child is 12 months up to & years the child has fast breathing if you count !9 breaths per minute or more.
Color Coding
PIN= 2R7ENT REFERRAL4
5;T+0TGAT '0?T'
D0"G? D0"G?GTW GTW
+re*referral treatments 0dvise parents Cefer child
?ELL!2Treatment 2Treatment at o't/atient health 0acility4
7REEN 2Home mana$ement4
5;T+0TGAT '0?T' D0"G?GTW
'57
Treat Treat local local infection infection Five oral drugs 0dvise and teach careta)er Dollo*up
CDCC0? D0"G?GTW
mergency Triage and Treatment Treatment T0 T0T/ 6iagnosis, Treatment 7onitoring, follo*up
IC +A;75AG0 5C ICW IC 6G0
"areta)er is counseled onK 'ome treatment$s Deeding and hen to return immediately Dollo*up
Five =rst dose of an appropriate antibiotic Five Iitamin 0 Treat Treat the the child to prevent prevent lo blo sugar Cefer urgently to the hospital Five paracetamol for fever X 3. Five an appropriate appropriate antibiotic for
days
0ny general danger sign
or
"hest indraing or tridor in calm child
+A;75AG0
oothe the throat and relieve cou ith a safe remedy 0dvise mother hen to return immediately Dollo up in 2 days Five +aracetamol for fever X 3.
A5 +A;75AG0 K "5;F' 5C
"5?6
Dast breathing b reathing
Gf coughing more than more than days, refer for assessment oothe the throat and relieve the cough ith a safe remedy 0dvise mother hen to return immediately Dollo up in & days if not improvi
Ao signs of pneumonia or very severe disease Assess and classify D#A$$%A A chil# 8ith #iarrhea is assesse# 0or1 'o long the child has had diarrhoea Blood in the stool to determine if the child has dysentery igns of dehydration.
Classify D&SN'$& "hild ith diarrhea and blood in the stool
To of the folloing signsS 0bnormally sleepy or di%cult to aa)en un)en eyes Aot able to drin) or drin)ing poorly )in pinch goes bac) very sloly
IC 6'W6C0TG5A
Gf child has no other severe classi=cationK classi=cationK Five
B/ To of the folloing signs K
Cestless, irritable un)en eyes 6rin)s eagerly, thirsty )in pinch goes bac) sloly
57 6'W6C0TG5A
Aot enough signs to classify as some or severe dehydration
6ehydration present
A5 6'W6C0 6'W 6C0TG5A TG5A
IC +CGTAT 6G0CC'0
Ao dehydration
+CGTAT 6G0CC'0
Gf child also has a severe classi=cation K Cefer ;CFAT?W to hospital ith mot giving frequent sips of 5C on the ay 0dvise mother hen to return immediately Dollo up in & days if not improving 'ome "are Five
Blood in the stool
6WATCW
Treat Treat for & days ith ith an oral antibiotic antibiotic recommended for higella in your area Dollo up in 2 days Five also referral treatment
Does the child ha(e fe(er)
@@Deci#e1 7alaria Cis) Ao 7alaria Cis) 7easles 6engue
Malaria $isk
ICW IC
0ny general danger sign or ti nec)
DBCG? 6G0 $ 70?0CG0
Five =rst dose of quinine under medical supervision if a hospital is not accessible ithin !hrs / Five =rst dose of an appropriate antibiotic Treat Treat the the child to prevent prevent lo blood sugar sugar Five one dose of paracetamol in health center for hig fever 3.& o"/ or above end a blood smear ith the patient Cefer ;CFAT?W to hospital
Blood smear Q
/ Gf blood smear not doneK
A5 runny nose,
and
A5 measles, and A5 other causes of fever
70?0CG0
Blood smear
L /, or
Cunny nose, or 7easles, or 5ther causes of fever
DIC K 70?0CG0 ;A?G@?W
Treat Treat the the child ith an oral antimalaria antimalariall Five one dose of paracetamol in health center for hig fever 3.& o"/ or above 0dvise mother hen to return immediately Dollo up in 2 days if fever persists Gf fever is present everyday for more than 8 days, ref for assessment Five one dose of paracetamol in health center for hig fever 3.& o"/ or above 0dvise mother hen to return immediately Dollo up in 2 days if fever persists Gf fever is present everyday for more than 8 days, ref for assessment
No Malaria $isk
0ny general danger
sign or
ti nec) Ao signs of very severe febrile disease
ICW IC DBCG? 6G0
DIC K A5 70?0CG0
Five =rst dose of an appropriate antibiotic Treat Treat the the child to prevent prevent lo blood blood sugar Five one dose of paracetamol in health center for high fever 3.& o"/ or above Cefer ;CFAT?W to hospital Five one dose of paracetamol in health center for high fever 3.& o"/ or above 0dvise mother hen to return immediately Dollo up in 2 days if fever persists
Gf fever is present everyday for more than 8 days, refer for assessment
Measles
"louding of cornea
or
6eep or e-tensive mouth ulcers
IC "57+?G"0T6 70?
+us draining from the eye or 7outh ulcers
70? >GT' W 5C 75;T' "57+?G"0TG5A
7easles no or ithin the last 3 months
.EASLES
Five Iitamin 0 Five =rst dose of an appropriate antibiotic Gf clouding of the cornea or pus draining fro the eye, apply tetracycline eye ointment Cefer ;CFAT?W to hospital Five Iitamin 0 Gf pus draining from the eye, apply tetracycli eye ointment Gf mouth ulcers, teach the mother to treat i gentian violet Five Iitamin 0
Dengue *e(er
Bleeding from nose or gums or Bleeding in stools or vomitus or Blac) stools or vomitus or )in petechiae or "old clammy e-tremities or "apillary re=ll more than 3 seconds or 0bdominal pain or Iomiting Tourniquet Tourniquet test test Q /
SEERE DEN7E HE.!RRHA7IC FEER
Ao signs of severe dengue hemorrhagic fever
DICK 6AF; '75CC'0FG" ;A?G@? ; A?G@?W W
Gf s)in petechiae or Tourniquet test,are th only positive signs give 5C Gf any other signs are positive, give
Does the child ha(e an ear pro+lem)
Tender Tender selling selling behind the ear +us seen draining from the ear and discharge is reported for less than 1! days or ar pain
70T5G6GTG
0";T 0C GAD"TG5A
Five =rst dose of appropriate antibiotic Five paracetamol fo pain Cefer ;CFAT?W Five antibiotic for &
days Five paracetamol fo
pain
6ry the ear by ic)i Dollo up in & days
"'C5AG" 0C GAD"TG5A
+us seen draining from the ear and discharge is reported for less than 1! days
6ry the ear by ic)i Dollo up in & days
A5 0C GAD"TG5A
Ao ear pain and no pus seen draining from the ear
Ao additional treatment
Check for Malnutrition and Anemia 7i&e an A//ro/riate Anti%iotic1 A, *or *or Pneumonia- Acute Acute ear infection or .ery .ery Se(ere disease
C!TRI.!A!LE
A.!?CILLIN
BG6 D5C & 60W
BG6 D5C & 60W
A#'lt A$e or -ei$ht
Ta%let
Syr'/
ta%let
Syr'/
1$2
& ml
1$2
& ml
1
8.& ml
1
19 m l
2 months up to 12 months ! L R 4 )g /
12 months up to & years 19 L 14)g /
B, *or Dysentery
C!TRI.!A!LE
A.!?CILLIN
BG6 D5C & 60W BG6 D5C & 60W
TABLET
S?RP
S?RP *.7<.L
A7E !R -EI7HT
2 L ! months ! L R ()g /
1.2& ml Z tsp / Y & ml
! L 12 months
Y
( L R 19 )g /
1 L & years old 19 L 14 )g /
2.& ml Y tsp / & ml
1
1 tsp / 8.& ml
C, *or Cholera
TETRAC?CLINE
C!TRI.!A!LE
[G6 D5C 3 60W
BG6 D5C 3 60W
A7 A7E !R -EI7HT
Ca/s'le *m$
Ta%let
Syr'/
2 L ! months ! L R ()g /
Z
1$2
&ml
! L 12 months ( L R 19 )g /
Y
1$2
& ml
1 L & years old 19 L 14 )g/
1
1
8.&ml
Gi(e an "ral Antimalarial
+rimaquine Five single "'5?5C5[;GA
+rimaquine
dose in
Five for 3 days
0F
T0B?T 1&97F /
60W1
60W2
60W3
Y
Y
Y
ulfado-ine Q
health
Five daily
center for +.
for 1! days
Dalciparum
for +. Iiva-
Five single dose
T0B?T T0B?T
T0B?T T0B?T
T0B?T T0B?T
1&7F/
1&7F/
1&7F/
+yrimethamine
2months L &months
& months L 12 months
Y
Y
Y
1
1
Y
G
1Y
1Y
1
3$!
1$2
1
(<*
12months L 3 years old
3 years old L & years old
7IE ITA.IN A A7 A7E
ITA.IN A CAPSLES *, I
( months L 12 months
1$2
12 12 months L & years old
1
7IE IR!N Iron
A7E or -EI7HT
Iron Syr'/ FeSo ( m$<ml 2Jm$ elemental iron /er ml 4
2months*!months ! L R()g /
2.& ml
!months L 12months ( L R19)g /
! ml
12months L 3 years L R1!)g/
19 1$2
& ml
3years L & years years 1! L 14)g /
1$2
8.& ml
7IE PARACETA.!L PARACETA.!L F!R HI7H FEER 2+K oC !R .!RE4 !R EAR PAIN A7 A7E !R -EI7HT 2 months L 3 years 3 years up to & years
TABLET 2 .7 4
S?RP 2 (*.7 < .L 4
! L R1!)g /
Z
& ml
1! L 14 )g /
1$2
19 ml
7IE .EBENDA!LE Five &99mg 7ebendazole as a single dose in health center if K hoo)orm $ hiporm are a problem in children in your area, and the child is 2 years of age or older, and the child has not had a dose in the previous ( months
"anagement of a hild with an #ar 2roblem Classi"cation o0 Ear In0ection .astoi#itis L tender selling behind the ear in infants, selling may be above the ear/ Treatment a. 0ntibiotics b. urgical intervention 2. Ac'te Ear In0ection L pus draining from the ear for less than 2 ee)s, ear pain, red, immobile ear drum 0cute 5titis 7edia/ Treatment a. "otrimo-azole,0mo-ycillin,or 0mpicillin b. 6ry the ear by ic)ing 3. Chronic Ear In0ection L pus draining from the ear for more than 2 ee)s "hronic 5titis 7edia/ Treatment a. .ost im/ortant 5 eMecti&e treatmentK treatment K /eep the ear dry +y 0icking, b. +aracetamol maybe given for pain or high fever. c. +recautions for a child ith a draining earK 6o not leave anything in the ear such as cotton, ool beteen ic)ing treatments. 6o not put oil or any other
"aternal and hild 6ealth 0ursing 2rogram (hiloso%h&
+regnancy, +regnancy, labor and delivery and puerperium are part of the continuum of the total life cycle +ersonal, cultural and religious attitudes and beliefs in
To To ensure that e-pectant e-pectant mother and and nursing mother mother maintain good health, learn learn the art of child care, has a normal delivery and bear healthy children That every child lives and gros gros up in a family family unit ith ith love and security, security, in healthy healthy surroundings surroundings,, receives receives adequate nourishment, health supervision and e%cient medical attention and is taught the elements of healthy living Classi"cation o0 /re$nant 8omen Aormal L healthy pregnancy >ith mild complications* frequent home visits >ith serious or potentially serious complication L referred to most s)illed source of medical and hospital care Home Base# .others Recor# 2HB.R4 Tool Tool used hen rendering rendering prenatal prenatal care care containing ris) ris) factors and danger signs
Ris3 Factors 1!& cm tall ! ft O 4 inches/ Belo 1 yrs old, above 3& yrs old 'ave had ! pregnancies >ith TB, goiter, heart disease, 67, bronchial asthma, severe anemia ?ast baby born as less than 2 years ago +revious cesarian section delivery 'istory of 2 or more abortions, di%cult delivery, given birth to tins, 2 or more babies born before 66, stillbirth >eighs less than !& )gs. or more than 9 )gs.
1. 2. 3. !.
Dan$er Si$ns any type of vaginal bleeding headache, dizziness, blurred vision pu%ness of face and hands pallor
Prenatal Care
Schedule of .isits 1st L as early as pregnancy, 1st trimester 2nd L 2nd trimester 3rd O subsequent visits L 3rd trimester 7ore frequent visits for those at ris) ith complications
'etanus 'o1iod #mmuni2ation Schedule for 3omen
ac cine
.inim'm A$e Inter&al
Per cent Prot ecte #
TT1
0s early as possible during pregnancy
9:
Aone
TT2
0t least ! ee)s later
9:
Gnfants born to the mother ill be protected from neonatal tetanus. Five years protection for the mother from the tetanus.
D'ration o0 Protection
Gnfants born to the mother ill be protected from neonatal tetanus.
TT3
0t least ( months later
49:
Fives & years protection for the mother.
TT!
0t least 1 year later
44:
Fives 19 years protection for the mother
TT&
0t least 1 year later
44:
Fives lifetime protection for the mothers. 0ll Gnfants born to that mother be protected.
Dose1 9.&ml Ro'te1 Gntramuscular Gntramuscular Site1 Cight Site1 Cight or ?eft 6eltoid$Buttoc)s
Components of Prenatal .isits 'istory L ta)ing 6etermination of obstetrical score* F, +, T+0?, 05F, 66 ;$0 for +roteinuria, glycosuria and inf-tn 6ental e-am >t. 't. B+ ta)ing -am of conJunctiva and palms for pallor 0bdominal e-am L fundic ht, ?eopold#s maneuver and D'T -am of breasts, face, hands and feet for edema and nec) for thyroid enlargement 'ealth teachings* nutrition, personal hygiene, common complaints Tetanus Tetanus to-oid to-oid immunization immunization Gron supplementation L from &th mo. 5f pregnancy L 2 mos. +ostpartum Gn goiter endemic areas L iodized capsule once a year Gn malaria infested areas* prophylactic "hloroquine 1&9 mg$tab / 2 tabs$ ) for the hole duration of pregnancy
0onBommunicable Diseases and ehabilitation (re+ention and Control of Cardio+ascular Diseases
heart L 1st leading cause of death E blood vessels L 2nd Con$enital Heart Disease 2CHD4K 2CHD4 K Cesult of the abnormal development of the heart that e-hibits septal defect, patent ductus arteriosus, aortic and pulmonary stenosis, and cyanosisE most prevalent in children "ausesK environmental factors, maternal diseases or genetic aberrations Rhe'matic Fe&er or Rhe'matic Heart Disease1 ystematic in
Ty/e o0 CD
Pre&alence
"ongenital 'eart 6isease
2$ 1999 school children aged &*1& yrs. old/
arly arly to to late late chi child ldho hood od
Cheu Cheuma mati tic c Dev Dever er$$ Cheu Cheuma mati tic c 'ear 'eartt 6ise 6iseas ase e
1$1999 school children aged &*1& old/
arly 0dulthood
6iseases of 'eart 7uscles ssential 'ypertension
19$199 adults
"or "oronar onary y 0rte 0rtery ry 6ise 6iseas ase e "er "erebro ebrova vasc scul ular ar
&$19 &$199 9 adul adults ts
7idd 7iddle le age age to old old age age
0ccident
Cardio(ascular Disease Di D iseases
Ca'ses< Ris3 0actors
"ongenital 'eart 6isease
7aternal Gnfections, 6rug inta)e, 7aternal 6isease, Fenetic
Cheumatic Dever$Cheumatic 'eart 6isease
Drequent treptoccocal ore Throat
ssential 'ypertension
'eredity, 'igh alt Gnta)e
"oronary 0rtery 6isease 'eart 0ttac)/
mo)ing, 5besity, 'ypertension, tress 'yperlipidemia, 6iabetes 7ellitus edentary ?ife tyle
"erebrovascular 0ccident tro)e/
'ypertension, 0rteriosclerosis
Primary Pre(ention: C.D Disease
"ongenital 'eart 6isease
Primor#ial
S/eci"c Protection
+revention of viral infection and inta)e of harmful drugs during pregnancy. 0voidance of marriage beteen blood relatives
Cheumatic 'eart +revention of recurrent sore throat thru adequate environmental environmental sanitationE avoidance of overcrodingE adequate treatment
ssential
Drom early childhood lo salt diet adequate physical e-ercise
'ypertension
+revention +revention of development$ acquisition of ris)
factors
6isease 'eart
0ttac)/
"erebrovascular 0ccident
6isease
"oronary 'eart
cigarette smo)ing high fat inta)e high salt inta)e all measures to prevent hypertension O arteriosclerosis
0dequate treatment of viral infection during pregnanc Fenetic counseling of blood related married couples.
Gdenti=cation of cases o rheumatic fever +rophyla-is ith penicill or erythromycin erythromycin
"ontinued lo salt diet adequate e-ercise
cessation of smo)ing control $treatment of diabetes, hypertension eight reduction change to proper diet 0dJustment of activities all measures to control hypertension O progression of
tro)e/ arteriosclerosis
1. 2. 3. !. &.
Primary Pre(ention thru health education is the main focus of the program: 7aintenance of ideal body t. diet L lo fat alcohol$smo)ing avoidance e-ercise regular B+ chec) up Cancer Pre&ention an# Early Detection 0ny malignant tumor arising from the abnormal abnormal and uncontrolled division of cells causing the destruction in the surrounding surrounding tissues. "ommon "ancerK ?ung cancer, cervical cancer, colon cancer, cancer of the mouth, breast cancer, s)in cancer, prostate cancer. 3rd leading cause of illness and death +hil./ Gncidence can only be reduced thru prevention and early detection Nine 3arning Signs of Cancer: Change in blood boel or bladder habits A sore that does not heal nusual bleeding or discharge Thic)ening or lump in breast or elsehere Indigestion or di%culty in salloing !bvious change in art or mole Nagging cough or hoarseness ne-plained anemia Sudden une-plained eight loss Pre(ention 4 arly Detection CA ty/e
Pre&ention
Detection
?u ?ung
Ao smo)ing
Aone
;terin e
7onogamy, afe se-
+ap#s smear every 1*3 yrs
"ervic al
7onogamy, afe se-
+ap#s smear every 1*3 yrs
?iver
'ep B vaccination, ?ess alcohol inta)e, 0voidance of moldy foods
Aone
"o " olon
'igh =ber diet
Cegular medical chec)up after !9 yrs of age
Cectu m
?o fat inta)e
7outh
Ao smo)ing, betel nut cheing, 5ral hygiene
Decal occult blood test 6C igmoidoscopy
Cegular dental chec)*ups
Br Breast
none
7onthly B, Wearly e-am by doctor, 7ammography f &9 yrs old and above females
) )in
Ao e-cessive sun e-posure
0ssessment of s)in
+rosta te
none
6igital transrectal e-am
Principles of 'reatment 'reatment of Malignant Diseases 5ne third of all cancers are curable if detected early and treated properly.
'hree ma5or forms of treatment of cancer: 1. 2. 3.
urgery Cadiation Therapy "hemotherapy Natl Dia%etes Pre&ention an# Control Pro$ram Aim: "ontrolling and assimilating healthy lifestyle in the Dilipino culture 299&* 2919/ thru G"
Main Concern: modi=able ris) factors diet, body t., smo)ing, alcohol, stress, sedentary sedentary living, birth t. ,migration
Pre&ention an# Control o0 =i#ney Disease
1.
2. 3. !. &. (. 8. .
Ac'te or Ra/i#ly Pro$ressi&e Renal Fail're 1 0 sudden decline in renal function resulting from the failure of the renal circulation or by glomerular or tubular damage causing the accumulation of substances that is normally eliminated in the urine in the body
Mental %ealth 7ental health is not merely the absence of mental illness. 0ccording to the >orld 'ealth 5rganization 5rganization >'5/ 7anual on 7ental 'ealth, a person is in a state of sound mental health hen, o 'e feels physically ell o 'is thought are organized o 'is feelings are modulated o 'is behaviors are coordinated and appropriate (*note: behaviors considered “normal” may vary according to cultural norms)
0ny person may develop mental illness regardless regardless of race, nationality, age, se- civil status and socio*economic bac)ground may develop mental illness.
Causes of Mental #llness A Com%ination or !ne o0 These1 1.
2.
3.
!.
Biological factors ?i)e hereditary predisposition, poor nutrition +hysical Dactors +hysical inJuries, into-ication +sychological Dactors Dailure to adJust to the di%culties in life. ocio*economic Dactors ;nemployment, housing problems
Ho8 is .ental Illness Detecte# 1. 2. 3.
Gntervie an and as assessment by by th the "l "linical o ocial >o >or)er. +sychological testing and evaluation. +sychiatric intervie and mental status e-amination. on. Is .ental Illness C'ra%le
1. 2. 3. !. &. (.
Wes. Wes. 7ental illness illness is curable if detected early early and prompt prompt and adequate adequate treatment treatment is given. given. Treatment Treatment depends on severity severity of illness illness and includesK +harmacotherapy +harmacotherapy use of medicines/ Iarious therapies physical, recreational, occupational, environmental/ +sychotherapy +sychotherapy and others Pre(ention of Mental #llness 7aintain good physical health. "hoose orthhile activities and develop a hobby olve probl oblems as as they come an and av avoid e-cessive orrying. "ultivate friendships and choose a friend to con=de in. tri)e a happy medium beteen or) and play. Cecognize early signs and symptoms. Some arly Signs of Symptoms Mental #llness +ersistent disturbance in sleep and appetite 5ver sensitiveness and e-cessive irritability ?oss of interest in activities or responsibilities of previous concern "onstant complaint of headaches, ea)ness of hands and feet and other bodily complaints. +ersistent seclusion of oneself from other people. Drequent attac)s of palpitations usually e-pressed as MnerbiyosN O associated ith une-plained fears. Drequent attac)s of dizziness O fainting. -aggerated -aggerated and $or unfounded suspicions +ersistent orrying, forgetfulness O absentmindedness. Pro$ram on Dr'$ De/en#ence< S'%stance A%'se
Community6Based $eha+ilitation Program 0 creative application of the primary health care approach in rehabilitation services, hich involves measures measures ta)en at the community level to use and build on the resources resources of the community ith the community people, including impaired, disabled and handicapped persons as ell.
Goal To To improve the quality of life and increase increase productivity productivity of disabled, disabled, handicapped handicapped persons. persons.
Aim:
To To reduce the the prevalence prevalence of disability disability through through prevention, prevention, early detection and and provision of rehabilitation services at the community level. Pro$ram on the El#erly<7eriatric N'rsin$ Ser&ices
7eading causes of illness: elderly Gn
"ataract* main causes of blindness I06* main cause of childhood blindnessE most serious eye problem of Dilipino children belo ( yrs.
old
5steoporosis special problem in omen, highest bet. &9\84 yrs. old, 7A5+0; main cause
0ursing 2rocedures in the ommunity
Clinic isit process of chec)ing the client#s health condition in a medical clinic Home isit
a professional face to face contact made by the nurse ith a patient or the family to provide necessary necessary health care activities and to further attain the obJectives of the agency Ba$ TechniO'e
a tool ma)ing of the public health bag through hich the nurse during the home visit can perform nursing procedures ith ease and deftness saving time and eort ith the end in vie of rendering eective Thermometer TechniO'e
to assess the client#s health condition through body temperature reading N'rsin$ Care in the Home
giving to the individual patient the nursing care required by his$her speci=c illness or trauma to help him$her reach a level of functioning at hich he$she can maintain himself$herself or die peacefully in dignity Isolation TechniO'e in the Home
1. 2. 3. !. &.
epa epara rati ting ng the the art artic icle les s use used d by by a cli clien entt it ith h com commu muni nica cabl ble e dis disea ease se to prev preven entt the the spr spread ead of of infectionK Dreque equent nt ash ashin ing g and and airi airing ng of bedd beddin ings gs and and oth other er arti articl cles es and disi disinf nfec ecti tion ons s of of roo room m >ear earing ing a prot protec ecti tiv ve go gon n, to to be be us used onl only i ithin thin the room oom of of the the sic) ic) mem membe berr 6isc 6iscar ardi ding ng prop proper erly ly all all nasa nasall and and thr throat oat dis disch char arge ges s of of any any memb member er sic) sic) ith ith comm commun unic icab able le dise diseas ase e Burn Bu rnin ing g all all soil soiled ed arti articl cles es if coul could d be be or or con conta tami mina nate ted d art artic icle les s be be boi boile led d =rst =rst in ate aterr 39 minu minute tes s before laundering Intra&eno's Thera/y
Gnsertion of a needle or catheter into a vein to provide medication medication and
*amily 2lanning 2rogram
!&er&ie8 The +hilippine +hilippine Damily Damily +lanning +lanning +rogram +rogram is a national program program that systematically systematically provides information and services needed by omen of reproductive age to plan their families according to their on beliefs and circumstances. 7oals an# !%;ecti&es ;niversal access to family planning information, education and services. .ission To To provide the means and and opportunities by hich married married couples couples of reproductive reproductive age desirous desirous of spacing and limiting their pregnancies can realize their reproductive goals. Ty/es o0 .etho#s
a. b. c. d. e. a. i. ii. iii. iv. b. i. ii. iii. c. i. ii.
NA'!$A7 M'%"DS "alendar or Chythm 7ethod Basal Body Temperature 7ethod "ervical 7ucus 7ethod ympto*Thermal 7ethod ?actational 0m 0mennorhea A$'#*#C#A7 M'%"DS "hemical 7ethods 5vulation suppressant such as +G?? 6epo*+rovera permicidals Gmplant 7echanical 7ethods 7ale and Demale "ondom Gntrauterine 6evice "ervical "ap$6iaphragm urgical 7ethods Iasectomy Tubal ?igation -arnin$ Si$ns Pills Abdominal pain severe/ Chest pain severe/ Headache severe/ Eye problems blurred vision,
#!D
Period late, no symptoms of pregnancy, abnormal bleeding or spotting Abdominal pain during intercourse
Infection or abnormal vaginal discharge Not feeling ell, has fever or chills String is missing or has become shorter or longer
#n5ecta+les Dizziness Severe headache Heavy bleeding B'7
Dever >ea)ness Capid pulse +ersistent abdominal pain Iomiting 6izziness +us or tenderness at incision site 0menorrhea .asectomy Dever crotal blood clots or e-cessive selling
