Primary Health Care Hand Outs for Students

Perpetual Help Paramedical College Happy Homes Subdivision Tagas, Tabaco City

Note-Taking Guide Guide for MIDWIFE Licensure Examination Examination PRIMARY HEALTH CARE Lecture by: Eduard E. Gandul Jr. RM, RN, EMT-B ------------------------------------------------------------------------------------------------------------------------------I.DOH PROGRAM AND HEALTH CONCEPT Department of Health (DOH) Vision : Mission:

National Objectives:

• • • • •

•

Improve Improve the general general health health status status of the popula population tion (reduc (reducee mortality mortality and and morbidity morbidity rates rates etc.) etc.)

Promote Promote healthy healthy lifestyle lifestyle through through healthy healthy diet diet and nutritio nutrition, n, physical physical activit activity y and fitness, fitness, personal personal hygiene, hygiene, mental health and less stressful life violent and risk-taking behaviour. Promote Promote health health nutritio nutrition n of families families and especi especial al populatio population n through child child adolescen adolescent, t, and youth, youth, adult adult health, health, women’s health, elder’s people health, health of indigenous people, health of migrant workers, and health of the rural and urban poor Promote Promote Environme Environment nt health health and sustaina sustainable ble develop development ment through through the promoti promotion on of healthy healthy homes, homes, school school workplaces, establishment and community.

8 Millennium Development Goals are as Follows:

• • • • • • •

DOH GOAL:

•

Heal Health th Sect Sector or Refo Reform rm Agen Agenda da

Framework: FORMULA ONE Health Financing-looking in resources Health Service Development – ensure the accessibility and equitability of basic essentials health care Health regulation – quality and affordability of health goods goods and services Good governance – enhance health performance ex. Reduce corruption

Four mula mula One for Health Goals and Objectives Over-all Goals:

NOTES IN PRIMARY HEALTH CARE

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•

• • •

The implementation of FOUR of FOURmula mula ONE for Health is directed towards achieving the following end goals, in conson consonanc ancee with with the health health system system goals goals ident identifi ified ed by the World World Health Health Organi Organizat zation ion,, the Millen Millenniu nium m Development Goals, and the Medium Term Philippine Development Plan: Better health outcomes More responsive health system More equitable healthcare financing.

General Objective:

FOURmula FOURmula ONE for Health is aimed at achieving achieving critical critical reforms reforms with speed, speed, precision precision and effective effective coordinatio coordination n directed at improving the quality, efficiency, effectiveness and equity of the Philippine health system in a manner that is felt and appreciated by Filipinos, especially the poor. Specific Fourmula One for Health will strive, within the medium term, to: Secure more, better and sustained financing for health • Assure the quality and affordability of health goods and services • Ensure access to and availability of essential and basic health packages • Improve performance of the health system • Basic Principles to Achieve Important in Health: • • • •

Universal access to basic health services must be ensured. The Health and Nutrition of the vulnerable groups must be prioritized The epidemiological shift from infection to degenerative disease must be managed. The performance of the health sector must be enhanced.

Strategic THRUST 2005-2010

1. Launch and implement the Basic Emergency Obstetric Care or BEMOC strategy in coordination with the DOH – 2. Improve Improve the the Quali Quality ty of prenatal prenatal and Post Natal Care Pregnant woman should at least have 4 prenatal Visits: 1. 2. 3. 4.

3. Reduces Reduces woman exposu exposure re to health health risks through through parent parenthood hood and and healthcare healthcare packages packages Essentials Health Services Packages Available in the Health Care Facilities (every woman has to receive before and after pregnancy and or delivery of a baby. 4. LGUs, LGUs, NGOs and other stakeholder stakeholderss must advocate advocate for health through through resources resources generation generation and allocation allocation for health health services. DOH PROGRAM STRATEGIES

Reaching Every Barangay (REB) Strategy for Immunization” • • • •

Wednesday is the Immunization Day RHU – every Wednesday BHS – Every first Wednesday, every months Farflung Area – Once every Quarter or every 4 months

Infant and Young Child Feeding Goal: Reduce Child Mortality by 2/3 by 2015. • •

Objectives: to improve the health and nutritional of the infant and young children

•

Strategies: Promotion of Breast Feeding

•

Promotion of exclusive BF for 6 months”- even water is given.


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•

• • •

The implementation of FOUR of FOURmula mula ONE for Health is directed towards achieving the following end goals, in conson consonanc ancee with with the health health system system goals goals ident identifi ified ed by the World World Health Health Organi Organizat zation ion,, the Millen Millenniu nium m Development Goals, and the Medium Term Philippine Development Plan: Better health outcomes More responsive health system More equitable healthcare financing.

General Objective:

FOURmula FOURmula ONE for Health is aimed at achieving achieving critical critical reforms reforms with speed, speed, precision precision and effective effective coordinatio coordination n directed at improving the quality, efficiency, effectiveness and equity of the Philippine health system in a manner that is felt and appreciated by Filipinos, especially the poor. Specific Fourmula One for Health will strive, within the medium term, to: Secure more, better and sustained financing for health • Assure the quality and affordability of health goods and services • Ensure access to and availability of essential and basic health packages • Improve performance of the health system • Basic Principles to Achieve Important in Health: • • • •

Universal access to basic health services must be ensured. The Health and Nutrition of the vulnerable groups must be prioritized The epidemiological shift from infection to degenerative disease must be managed. The performance of the health sector must be enhanced.

Strategic THRUST 2005-2010

1. Launch and implement the Basic Emergency Obstetric Care or BEMOC strategy in coordination with the DOH – 2. Improve Improve the the Quali Quality ty of prenatal prenatal and Post Natal Care Pregnant woman should at least have 4 prenatal Visits: 1. 2. 3. 4.

3. Reduces Reduces woman exposu exposure re to health health risks through through parent parenthood hood and and healthcare healthcare packages packages Essentials Health Services Packages Available in the Health Care Facilities (every woman has to receive before and after pregnancy and or delivery of a baby. 4. LGUs, LGUs, NGOs and other stakeholder stakeholderss must advocate advocate for health through through resources resources generation generation and allocation allocation for health health services. DOH PROGRAM STRATEGIES

Reaching Every Barangay (REB) Strategy for Immunization” • • • •

Wednesday is the Immunization Day RHU – every Wednesday BHS – Every first Wednesday, every months Farflung Area – Once every Quarter or every 4 months

Infant and Young Child Feeding Goal: Reduce Child Mortality by 2/3 by 2015. • •

Objectives: to improve the health and nutritional of the infant and young children

•

Strategies: Promotion of Breast Feeding

•

Promotion of exclusive BF for 6 months”- even water is given.


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Key messages on IYCF 1. Initiate Initiate breastfeed breastfeeding ing within within 1 hour after birth birth 2. Exclus Exclusive ive for for the the first first 6 months months of life life 3. Complement Complemented ed at 6 months, months, excluding excluding milk supplemen supplements ts 4. Extend Extend brea breastf stfeed eeding ing up up to 2 years years and and beyond beyond National IYCF strategy 1. Heal Health th Faci Facili liti ties es a. Mothe Mother-b r-baby aby friend friendly ly hospit hospitals als b. Health workers i. Advocates ii. Pro Protect tector orss iii. iii. Promo Promote ters rs of IYCF IYCF iv. iv. Enforc Enforcers ers of of laws, laws, not not violat violators ors 2. Fami Family ly/C /Com ommu muni nity ty a. Supp Suppor orti tive ve fami family ly b. Milk Code “vigilantes” “vigilantes” c. Lay/ Lay/Pe Peer er cou couns nsel elor orss d. IYCF IYCF “ba “baya yani niha han” n” spir spirit it e. Mothe Mother-b r-baby aby friend friendly ly pub public lic places places 3. Worki orking ng plac places es a. Mat Matern ernity leave eave b. Lactation/Breastfeeding Lactation/Breastfeeding room c. Brea Breast stfe feed edin ing g brea breaks ks 4. Industry a. Comp Comply ly with with the the “Co “Code de”” 5. Schools a. Introd Introduci ucing ng the the “breas “breastfe tfeedi eding ng cultu culture” re” Laws that protects IYCF 1. EO 51, 51, Mil Milk Cod Codee 2. Roomin Rooming-i g-in n and Breas Breastfe tfeedi eding ng Act of of 1992 1992 3. RA 8976, 8976, Food Food Forti Fortific ficati ation on Law Law of 2000 2000 CONCEPTS HEALTH- state of complete physical, mental and social well being, not merely the absence of disease or infirmity (WHO) PUBLIC HEALTH

The science and art _________________________ ______________________________________ _________________________ _________________________ __________________________ ___________________ ______ ________________________ _____________________________________ __________________________ _________________________ _________________________ __________________________ _______________________ __________ ________________________ _____________________________________ __________________________ _______________________ensu __________ensure re everyone a standard of living living adequate for the maintenance of health, so organize to enable every citizen to realize his birthright of health and longevity (WINSLOW). Science & art of: Preventing disease • •

Prolonging life

•

Promoting health and efficiency through organized community effort.

COMMUNITY HEALTH NURSING (WHO) -a special field nursing that combines the skills of nursing, public health and some phases of social assistance and function as part of the total public health program ________________________________ _____________________________________________ _____________________ ________ ________________________ _____________________________________ __________________________ ____________________ _______

According to Anderson Gaylord: CHN _________________________ _____________________________________ _________________________ __________________________ __________________________ __________________________ _______________ __ ________________________ _____________________________________ __________________________ _______________and __and it is the duty of the health department as an agent of the people or the community to prevent unnecessary illness;


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The primary focus of community health nursing is health promotion. Community health nurses provide care necessary to meet the requirements of an individual all throughout the life cycle. Knowledge on different fields (biological and social sciences, clinical nursing, and community health organizations) is used. Nursing process in community health nursing changes based on the needs of the community. Abilities of a CHN 1. 2. 3. HANLON

Public Health is “dedicated to the highest levels of physical, mental and social well-being and longetivity consist with available knowledge and resources at given time and place.” It holds this goal as its contribution the most effective total development and life of the individual and hi level of f unctioning through teaching s society. JACOBSON states that CHN is a learned practise discipline with the ultimate goal __________________________ __________________________________________________________________________________________________ ________________________________________________________________________________________________ RUTH FREEMAN Special field of nursing that combines skills in of work Public health Nursing and some phases of social assistance to further community health. Is a “service rendered by a Professional nurse with community, groups, families and individuals at homes, in health centers, in clinics, in school, in places for the promotion of health, prevention of illness, care of the sick and rehabilitation. EC0-SYSTEMS INFLUENCES ON OPTIMUM LEVEL OF FUNCTIONING (OLOF)

Political Safety Oppression Socio Economics Empolyment Education

Environment Air Water Urban/rural Noise Radiation


OLOF INDIVIDAUL FAMILY/GRO UP POPULATION COMMUNITIE S Health Care Delivery System Preventive Curative rehabilitative

Behavior Culture Habits Mores Ethnic Costumes

Heredity Generic Endowment -Defects -strengths -Risks: Familial Ethnic Racial

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Public Health is a core of government’s attempts to improve and promote the health and welfare of their citizens.

It further presented the core business of Public Health as: 1. Disease control 2. Injury prevention 3. Health Protection – immunize occupational precaution. 4. Health Public Policy it includes environment hazards in workplace, housing, food, water, etc, 5. It requires everyone to do its ex, public places has a smoking area free, sanitary permit. 6. Promotion of health and equitable health gain. COMMUNITY HEALTH NURSING Goal: To elevate the level health of the multitude. Philosophy: Worth and Dignity of Man Principles of CHN: 1. __________________________________________________________________________________________ 2. __________________________________________________________________________________________ 3. __________________________________________________________________________________________ 4. ___________________________________________________________________________________________ 5. __________________________________________________________________________________________ 6. CHN nurse works as a member of the health team 7. Periodic evaluation of CHN services is an integral professional growth and CHN must provide for opportunities for continuing staff education program. 8. The CH nurse is responsible for his own professional growth and CHN must provide opportunities for continuing staff education program. 9. The CH nurse make use of used of community available resources 10. The CH nurse utilize existing active organizing community group 11. There must be provision for educative supervision in CHN 12. There should be accurate recording and reporting in CHN

Other related concepts: • Focus of CHN• Clients• Types of service• Contacts• Process-

POVERTY - ILLNESS CYCLE

Poverty

Poor Education Poor Nutrition Poor env. Sanitation

Reduce Productivity

Prone to illness/ disability NOTES IN PRIMARY HEALTH CARE

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INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (pls refer to supplemental notes) S TRATEGIES TO A DDRESS S PECIFIC H EALTH P ROBLEMS Communicable Disease Prevention and Control

Communicable Diseases

Chronic Communicable ►

Tuberculosis

►

Leprosy (LCP)

Vector-borne Communicable Diseases ► Malaria (MCP) Schistosomiasis (SCP) ► Filariasis (FCP) ► H-Fever (Dengue)

1. National Tuberculosis Control Program (NTBCP)

“Tuberculosis is a highly infectious, chronic respiratory disease caused by TB Bacilli. It is one of the 10 leading causes of morbidity and mortality in the Philippines, which is also known as “Koch’s Disease.” Objective of the Program: To control TB by reducing the annual risk of infection (prevalence and mortality rates) Key Policies: Prevention ○ BCG vaccination under the EPI Program ○ Annual identification of at least 45% of its prevalence ○ Public health education re: PTB mode of transmission, methods of control, and importance of early diagnosis ○ Provide outreach services for home supervision of patients in Multi-Drug Therapy and also for preventive treatment of contacts Case Finding ○ Direct sputum microscopy for identified TB symptomatics ○ X-ray exam of TB symptomatics who are (-) after 2 or more sputum exam ○ Establishment of passive and active collection points for sputum samples of all identified TB symptomatics, as well as validation centers to ensure the standard and quality of sputum exam ○ Case finding and treatment services shall be made available in the BHS/RHUs Treatment ○ ○ ○

All TB cases must be treated for free, on ambulatory and domiciliary (home) basis, except those with acute complications and emergencies All sputum positive and cavitary cases shall be given priority for short course chemotherapy or SCC for 6 mos. Standard Regimen or SR for a year or intermittent SCC for 6 mos. shall be given to all infiltrative but sputum negative.

SR: isoniazid and streptomycin sulfate SCC: Combo pack, Multi Drug Therapy

DOTS (Direct Observed Treatment Short Course) Regimen Regimen I 2RIPE / 4RI

Regimen II 2RIPES/ 1RIPE / 5RIE

Regimen III 2RIP / 4RI


Type of TB Patient New pulmonary smear (+) cases · New seriously ill pulmonary smear (-) cases w/ extensive lung lesions · New severely ill extra-pulmo TB · New pulmonary smear (+) case · New seriously ill pulmonary smear (-) cases w/ extensive lung lesions · New severely ill extra-pulmo TB · New smear(-) but with minimal pulmonary TB on radiography as confirmed by a medical officer · New extra-pulmo TB (not serious)

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PTB TREATMENT REGIMEN Categories: 6 SCC Patient will be:

Rifampicin Isoniazid Pyrazinamide

2 mos. on

Rifampicin + 4 mos. Isoniazid

Indicated for patients who are (+) sputum smear seriously ill --(-) sputum smear, (+) extensive lung lesion (+) radiographic lung lesion extrapulmonary cases 8 SCC Patient will be:

2 mos. on

Rifampicin Isoniazid Pyrazinamide Ethambulol Streptomycin

+ 4 mos.

Rifampicin Isoniazid Ethabutol

+ 5 mos

Rifampicin Isoniazid Ethambulol

Indicated for those with relapse failures others 4 SCC Patient will be:

2 mos. on


Rifampicin + 2 mos. Isoniazid

Indicated for PTB minimal (-) sputum smear

3 Phases of Treating a PTB patient:

2 mos. on

1 - Intensive Phase


Diagnostic: Sputum Exam if (+), proceed to Rifampicin 2 - Maintenance Phase

+ 4 mos. on Isoniazid

if still (+) TB Colonies proceed to Rifampicin 3 - Extensive Phase

up to 12 mos. on Isoniazid

What is the purpose of SCC-MDT? prevent developing resistance against the three drug combinations shorten duration of treatment usually treatment lasts from 5-10 years. With SCC-MDT. tx can be reduced to a minimum of 6 mos. eradicate and completely prevent the relapse of the disease


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Direct Observation Treatment of Short-Course Chemotherapy (DOTS) “Tutok-Gamutan”

DOH Activities on NTBCP: Part of the “23 in ‘93” is the integrated disease control of TB together with schistosomiasis and malaria through the formulation of a strategic plan for infectious disease control by specific DOH units. “Health for More in ‘94” had “Malakas na Baga, Malinaw na Mata” as its strategy National Focus: TB Control Month ► laboratory and drug supplies were available to local governments in 1994 aimed to accelerate case finding and treatment Strategies done: Ensure that every microscopy and treatment center has the ff: Exnal microscope  Microscopist trained within the last 3 years   A 90% agreement rate in microscopy reading between the microscopist and validator Available NTP manual of procedures  Drugs for at least 6 months supply  Reagents, sputum cups for at least 6 months  Utilization of an itinerant team composing of at least 2 microscopists, nurse, midwife,  and a medical officer who will stay for 2 – 3 days in far flung communities to identify TB and start treatment

LEPROSY CONTROL PROGRAM LEPROSY is a chronic disease of the skin and peripheral nerves caused by Myobacterium Leprae WHO CLASSIFICATION OF LEPROSY:

Paucibacillary (tuberculoid and indeterminate) – non-infectious Duration of Treatment: 6-9 months Multibacillary (lepromatous and borderline) – infectious Duration of treatment: 24-30 months Objectives of the Program: - provide MDT to all leprosy cases within 3 years and complete the treatment of 90% of all cases out on MDT within the prescribed period identify all correctible deformities and institution of appropriate intervention reduce the stigma attached to the disease thru IEC formulate research proposals on topics associated with leprosy Key Policies: Strategies: Prevention Treatment -

MDT as the core strategy for the National Leprosy Control Program Procurement and supply of MDT Drugs, IEC and Training Materials by CDCS Health education Supervision and Control of leprosy Control Activities

Health Education BCG vaccination Case Finding Validate old registered cases Early referral of suspected leprosy patients Epidemiologic investigation Ambulatory Domiciliary chemotherapy through the use of MDT as embodied in RA 4073 which advocates home treatment

MDT Treatment Regimen Paucibacillary Supervised dose: 1. Rifampicin 600 mg 2. Dapsone 100 mg Taken once/month in the clinic Self-administered


Multibacillary Supervised dose: 1. Rifampicin 600 mg 2. Lamprene 300 mg 3. Dapsone 100 mg Taken once/month in the clinic

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1. Dapsone 100 mg Taken OD, daily by the patient at home

• •

• •

Self-administered dose 1. Lamprene 50 mg 2. Dapsone 100 mg Take OD, daily at home

Leprosy Patients must be taught ways to prevent secondary injury caused by burns and rough sharp objects Emphasize importance of sustained therapy, correct dosage, effects of drugs and the need for medical check-up from time to time Provide mental and emotional support to the families of leprosy patients Refer patients as needed

Rehabilitation: Imbibe patient’s participation in occupational activities Family and community health (PD 304) non-segregation of leprosy patients o counseling and guidance o • •

Locally-endemic Disease Prevention and Control

Leptospirosis · an infectious disease that affects humans and animal s, is considered the most common zoonosis in the world Causative Agent: S/S: -high fever -severe headache -chills -muscle aches -vomiting -may include jaundice (yellow skin and eyes) -red eyes -abdominal pain -diarrhea Treatment: PET - > MALARIA · Malaria (from Medieval Italian: mala aria - "bad air"; formerly called ague or marsh fever) is an infectious disease that is widespread in many tropical and subtropical regions. Causative Agent: Anopheles female mosquito Signs & Symptoms: Treatment: Chemoprophylaxis: Preventive Measures: (CLEAN) C L E A N Detection and Early Treatment of Cases ●

Early Recognition, Prevention, and Control of Malaria epidemics a system which will recognize impending malaria epidemics ● Early diagnosis and prompt Treatment identification of a patient with malaria as soon as he is examined. This may be done thru: ► Clinical ► Microscopic - Signs and symptoms - Mass Blood Smear Exam - history of visit to an endemic area In the event that an imminent epidemic occurs, the following should be done: Mass Blood Smear Collection Immediate confirmation and follow-up of cases Insecticide-treatment of mosquito nets •

• •

• • •

FILIARIASIS name for a group of tropical diseases caused by various thread-like parasitic round worms (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 


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S/S: Asymptomatic Stage Characterized by the presence of microfilariae in the peripheral blood  No clinical signs and symptoms of the disease  Some remain asymptomatic for years and in some instances for life 

Acute Stage Lymphadenitis (inflammation of lymph nodes)  Lymphangitis (inflammation of lymph vessels)  In some cases the male genitalia is affected leading to orchitis (redness, painful and tender scrotum  Chronic Stage Hydrocoele (swelling of the scrotum)  Lyphedema (temporary swelling of the upper and lower extremities  ·Elephantiasis (enlargement and thickening of the skin of the lower and / or upper extremities, scrotum, breast)  Management: No treatment can reverse elephantiasis 

SCHISTOSOMIASIS · parasitic disease caused by a larvae Causative Agent: Signs & Symptoms: (BALLIPS) B A L L I P S Treatment: DENGUE is a mosquito-borne infection which in recent years has become a major international public health concern.. · It is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas. Causative Agent: Dengue fever virus (DENV) Mode of Transmission: Vector Borne Disease (Mosquito Bite) Aedes aegypti typically Day biting (Early morning and evening) Aedes albopictus Known as Asian Tiger Mosquito

S/S: (VLINOSPARD) V Low platelet I N Onset of fever Severe headache Pain of the muscle and joint A bdominal pain R ashes D TREATMENT: 

The mainstay of treatment is supportive therapy.

  


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

CONTROL OF CARDIOVASCULAR DISEASE – should be controlled on the 1st trimester, last trimester only premature delivery NON COMMUNICABLE DISEASE Birth: CHD (Congenital heart Disease)

Adult: HPN – HYPERTENSION Type: 1 Type: 2 Middle age: CAD (Coronary Artery Disease) and IHD (Ischemic Heart Disease) Elderly: CVA (Cerebro Vascular Accident) Major Factors to Consider in CAD: 1. Hypertension 2. Diabetes Mellitus – affect all organs 3. Serum Lipid Concentration (Inc. Cholesterol) 4. Cigarette smoking – tar (causes cancer) a. Nicotine – causes spasm Effects: Coronary Artery Spasm Myocardial irritability Blood coagulation Minor Factors: increases HPN 1. Stress 2. Obesity 3. Family history and hereditary 4. Sex-more common to men at age 60 y.o Prevention and Control: CHN Functions: - Health Education on:

CANCER CONTROL Types: - Carcinoma - Leukemia - Lymphoma - Sarcoma

Warning Signs of Cancer: C A U T I O N U S

RH – Reproductive Health


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A state of complete physical, mental and social well being merely the absences of disease or infirmity in all matters relating the reproductive system and its functioning process. Concepts • Married couple has the capacity to procreate • RH is the exercise of reproductive rights with responsibility, • RH includes sexual health for the purpose of enhancement of the life and personal relationship. • RH includes protection from unwanted pregnancy by access to safe and acceptable F.P method • RH includes protection from harmful procedure practices and violation • RH assures accesses to information on sexual to achieve sexual enjoyment. Goals: • To archive healthy sexual development and maturation. • To achieve their reproductive intention. • To avoid illness, injury, disability, related to sexual and reproduction • To receive appropriate counselling and care of RH problem Strategies: • Used of modern and more effective way of contraceptives • Provision of RH services in clinics and hospitals • RH cares focus on adolescent, unmarried, men, etc. Concerned high risk • Strengthen outreach and referrals • Prevent specific RH problems Ten Elements of RH

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

MCH and nutrition Family planning Prevention and management of abortion complication Prevention and treatment of reproductive tract infection and disease Education and counselling on sexuality and sexual health Breast and reproductive tract cancers and other gyne condition Men’s reproductive health Adolescent reproductive health Violence against women (VAW) Prevention and treatment of infertility and sexual disorder

MATERNAL CARE Prenatal Care I-Physical Exam Wt. Gain - should not exceed 2 lbs. For the first trimester and 11 lbs for the 2 nd trimester and 11 lbs on the 3 rd trimester. BP - should not exceed 30 mm Hg of baseline BP Heart Rates of Fetus Respiratory Rates of Mothers II – Prenatal Check – Up First Trimester (1-3rd month)

Services: 1. 2. 3. 4.

_______________________________ _______________________________ _______________________________ _______________________________

Cervical Smear – for high risk women with multiple partner – to prevent STD Health Teaching – personal hygiene, mental health, Nutrition, exercise, avoids sick individuals, avoid taking medication without prescription. II- Prenatal check-up

Second Trimester (4-6 th month) Services:


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• • • • • • •

Third Trimester (7-9th month)

Services: 1. 2. 3. 4. Maternal High Risk Factors 1. Age---------------------2. Parity-------------------3. Weight------------------4. Height------------------5. Hemoglobin-----------5 High Risk Pregnancy: 1. 2. 3. 4. 5.

To many Too soon Too sickly – Too Young – Too Old –

Danger signs – refer

Frequent Visit - 1-7 months – once a month - 8th month – 2x month - 9th – weekly until delivery Minimum number of Visit

-

Once / trimester with 2 prenatal visit on the 3 rd trimester

Immediate Postpartum Care Check the following:

Mother 1. 2. 3. 4.

Child 1. 2. 3. 4.

Succeeding Visits: Mother 1. Check signs of bleeding and infection 2. Check V/s. Breast Feeding practices


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3. P.P counselling – birth Spacing 4. Cord Care 5. Hygiene and Nutrition Child 1. Check sucking reflex and breast feeding practice problem 2. Check umbilical Stump for signs of infection 3. Observes s/s of pathological jaundice

Qualified for Home Delivery 1. 2. 3. 4. Venue of Delivery 1. Home 2. Lying In Centers or Birthing Centers (BEmONC) 3. Hospitals Principles in Home Deliveries

3’C’s C C C Breast Feeding - Iron is only Lacking • • • • • Importance of Breast feeding

BREASTFEEDING-

• • • • • • • • •

Importance of breast Feeding Essential for Child survival Develop bond between mother and child More superior than other milk Promotes self care Contraindication of Breast Feeding Cracked or fissured nipple(wipe nipple w/ luke warm water) Galactosemia O lactose is rich in breast milk Infection like AID’s, hepatitis B, Leprosy, untreated TB Meds that can be transmitted to mothers milk

Difference of breast milk from formula milk BREASTMILK VS FORMULA* CHO > CHO CHON (LACTALBUMIN) < CHON (CASEIN) FATS = FATS Linoleic acid content (3x) > Linoleic acid content MINERALS < MINERALS

* the high CHON and mineral content of cow’s milk may overwhelm the newborn’s kidney, thus it still needs to be diluted. Casein is more difficult to digest Maternal Care DOH policy on maternal Care


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• • • •

All pregnant women shall be given tetanus toxoid immunization Iron Supplemental Shall be given the 5 th month of pregnancy until 2 months post partum (100-200mg daily p.o for 210 days) Iodized oil capsule every year to goiter infested areas Chloroquine (150mg) 2 tablets/week, an anti-malarial drugs prophylaxis given during pregnancy for malarial areas.

Grassroots Worker: • BHW- Barangay Health Workers • TBA – traditional Birth Attendant (HILOT) • Record –HBMR-HOME BASED MOTHERS RECORD FAMILY PLANNING Family Planning Program Objectives: A. Increase the number of mother of reproductive age participating to contribute to improvement of mother and child health and reduction of fertility by: Expanding the program coverage • Quality Service Provision • B. Promote Value of: Responsible sexual behaviour • Delayed marriage • Promote safe motherhood • Child survival • Counteracting trend toward abortions • C. Strengthening Management • Logistics • Research • Training • Important objectives • Reduce High Risk • Reduce total fertility Rate • Components: 1. Service Delivery • • •

2. Information, Education, Communication and Motivation- sustained public awareness on responsible parenthood and health and family welfare. 3. Training – upgrade skills of health workers 4. Research and Development – 5. Monitoring and supervision – FAMILY PLANNING METHOD – couples decision/ whatever fits/suits with the patient. 1.

Permanent A. Female – BTL- Bilateral Tubal Ligation – b. Cutting or blocking two fallopian tubes (BTL) c. 99.5% of effectiveness B. Male (Vasectomy)Effective 3 months after sterilization,

B. Non Permanent A. Pill


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B.

C.

D.

E.

F.

d. Hormones – estrogen and progesterone e. Taken daily PO f. 92.0% to 99.7% effective Male condom a. Thin sheath of latex b. Dual protection from STIs including HIV c. 85% to 98% effective Injectables a. Synthetic hormone – progestin which suppresses ovulation, thickens cervical mucus b. 97.0% to 99.7% effective LAM a. Postpartum method of postponing pregnancy based on physiological infertility experienced by breast feeding women b. Effective only for a maximum of 6 months postpartum c. 99.5% to 98% effective Mucus/Billings/Ovulation a. Abstaining from SI during fertile days b. Can not be used by woman with unusual disease or condition that results in extraordinary vaginal discharge that makes observation difficult c. 80% to 97% effective BBT a. Identifying the fertile and infertile period by daily taking and recording rise in BT during and after ovulation b. Temp is taken 3 hours of undisturbed rest (usually morning) c. 80% to 99% effective

G. Sympto-thermal method a. Combination of BBT and Billing/Mucus method b. 9% to 80% effective H. Two day method a. Simple fertility awareness based method i. Cervical secretions as an indicator of fertility ii. Checking the presence of secretions daily b. 86% to 96.5% effective I. Standard days method a. Users with menstrual cycle between 26 and 32 days are counseled to abstain from SI on days 8-19 to avoid pregnancy b. 88% to 95% effective Factors to Consider in Choosing Methods 1. Safety 2. Effectiveness 3. Convenience 4. Cost 5. Availability Developmental Goals for F.P 1. Sustainable Growth 2. Alleviation of Poverty 3. Better Education 4. Improved Health and Nutritional status at the level of individual household (specially mother and children) Principles Concerning Family Planning Program: “Improvement of family well being through population information and education and F.P methods but giving respect to the couple’s right conviction based on their morale and religious beliefs” EXPANDED PROGRAM OF IMMUNIZATION (EPI) 

Aims to immunize all children against the target Disease:

1. 2. 3. 4. 5. 6. 7.


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PD 996 – compulsory basic immunization to 8 y.o and below Expanded program on Immunization  Fully immunized child is ad child who has received 1 dose of BCG, 3 doses of DPT, OPV and 1 dose of AMV before his first birthday General principles which apply in vaccinating children

• • • • • • • • • • • • • • • •

Safe and immunologically effective to administer all EPI vaccine on the same day at different sites of the body Measles vaccine should be given as soon as the child is 9 months old 9 months – 85% protection 1 year above – 95% protection Vaccination schedule should not be restarted from the beginning even if the interval between doses exceeded the recommended interval by months or years Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindicated to vaccination; unless the child is so sick that he needs to be hospitalized Absolute contraindications to immunizations are: DPT2 or DPT3 to a child who has had convulsions or shock within 3 days the previous dose Vaccines containing the whole pertussis component should not be given to children with an evolving neurological disease Live vaccines like BCG must not be given to immunosuppressed due to malignant disease (child with clinical disease), therapy with immunosuppressive agents or irradiation Safe and effective with mild side effects after vaccination. Local reaction, fever and systemic symptoms can result as part of the normal immune response Giving doses of vaccine at less than the recommended 4 weeks interval may lessen the antibody response. Lengthening the interval between doses of vaccines leads to higher antibody levels No extra doses must be given to children who missed a dose of DPT/HB/OPV/TT Strictly follow the principle of never, ever reconstituting the freeze dried vaccines in anything other than the diluents supplied with them Repeat BCG vaccination if the child does not develop a scar after the 1 st injection Use one syringe one needle per child during vaccination

Immunization Guidelines

• • • • • •

Don’t be burden by the remarks of the mothers on the inconveniences of receiving 3-4 vaccines on the same day. Continue giving immunization according to the # of doses even if the interval exceeded by weeks, months or years. No contraindication in giving immunization moderate fever, cough and colds, diarrhea and malnutrition; not unless the child is assessed by the physician to be serious enough needing hospitalization. No BCG to child born positive to clinical AIDS. No food 30 min. after OPV; if the child vomits after receiving OPV, give additional drop. Contraindication of Vaccination

Acute Illness that needs hospitalization • Fever of 38.5 degree Celsius and above • Hypersensitivity to any of the vaccines Target Eligible population:

• • • •

3 % (0.03 03 3/100) for children 5 % (0.035 03 3.5/100) for pregnant mothers Computation –

Schedule: • • 1 ½ months: • 2 ½ months: • 3 ½ months:

Elements of Immunization: 1. Target setting 2. Cold chains logistic management – ensure that the vaccines will still be potent 3. Information, education and communication (IEC)


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4. Assessment, evaluation of the program 5. Surveillance, studies and research (REB)-reading every barangay Cold Chain System- a system that ensure the potency f the vaccines from the time of manufacture to the time it is given to the child or pregnant.

Stocking of Vaccines Refrigerator

Most sensitive to heat Least sensitive to heat

Vaccine Oral Polio (live attenuated) Measles (freeze dried) DPT/Hep B “D” toxoid; wekened toxin “P” killed bacteria “T” weakened toxin Hep B BCG (freeze dried) Tetanus Toxoid

Tetanus Toxoid Immunization Schedule for Women Vaccine Minimum age/interval % protected TT1 Early during pregnancy 80 % TT2 4 weeks later 80% TT3 6 months later 95% TT4 1 year later 99% TT5 1 year later 99%

Storage Temp -15C to -25C (at the freezer) -15C to -25C (at the freezer) +2C to +8C (in the body of the refrigerator)

+2C to +8C (in the body of the refrigerator) +2C to +8C (in the body of the refrigerator)

Duration of protection 3 yrs for the mother 5 yrs for the mother 10 yrs for the mother : INFANT 1 YEAR Lifetime for the mother; All infants born will be protected

NEWBORN SCREENING ACT OF 2004 R.A 9288 When: 48th to 72nd hour of life, the result are available after 7 working days from the sample are received. WHAT METHOD USED: “HEEL PRICK METHOD” Location of Screening: Hospitals, lying-in centers, RHU and Health Centers Disorders to be Screened in the Newborn Screening ACT of 2004 RA 9288 1. CH (congenital hyperthyroidism) 2. CAH (Congenital Adrenal Hyperplasia) 3. GAL (Galactosemia) 4. PKU (Phenylketonuria) 5. G6PD deficiency NUTRITION PROGRAM AND GARANTISADONG PAMBATA PROGRAM Nutrition Program Main Objective: - Aims to promote protect and preserve the nutritional and health status of the Filipino population particularly the vulnerable group such as infants, pre-schoolers, pregnant and lactating mothers.

THREE BASIC GROUPS Go-ENERGY GIVING FOODS – carbohydrates, and Fats Types:


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Source: GROW-BODY BUILDING FOODS – Protein Source: PlantsGROW REGULATING FOODS – vitamins and minerals (fruits)

Nutrition Program: - Garantisadong pambata (Apr. 10-24 2000)

-

Micronutrients malnutrition

1. VAD-VIT. A DEFICEINCY

Prob: Signs and symptoms: •

Night blindness, bitot’s spot in the eyes-foamy white spot in the eyes

•

Dry, hazy rough appearing cornea

•

Crater like defect on cornea (late s/s) decrease result to permanent blindness

•

Softened, sometimes bulging cornea

-

100,000 iu- (6-11 mos in infants) 200,000 iu 12-83 mos. Vitamin A capsule

2. IDD-IODINE DEFFICINCY DISEASE (200,000 iu – post partum)

Problems: S/s:

enlarged thyroid gland Sudden wt. Loss Tremors

Iodine deficiency Disease –

Cause: inadequate intake of iodine Management: ___________________________________________________________________________________________ __________________________________________________________________________________________

3. IDA-IRON DEFICIENCY DISEASE Problems: S/s:


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Causes:

1. 2. Management: -

Forms of Malnutrition Deficiency Diseases

Nutrients

MACRO MALNUTRITION Marasmus Kwashiorkor

-

MICRO MALNUTRITION Xeropthalmia Endemic Goiter Pellagra Beriberi Rickets Scurvy Anemia

-

-

Gross Malnutrition (Protein – Caloric Def.) 1. Marasmus – Balance Nurition s/s: Mgt: 2. Kwashiorkor – s/s: Mgt: Nutrition Program Component: 1. Growth Monitoring A. Operation Timbang – salter, ming scale, bar detecto (instrument used in weight taking) B. UMAC – upper mid arm circumference 1-5 years old – 15 cm cm – susceptible to malnutrition cm – under weight C. Physical Exam D. Clinic Visit if necessary

2. Nutritional Education – Information provide knowledge 3. 4. 5. 6. 7. 8.

Target Food Assistance Food Production – backyard gardening and livestock Income generating project Malnutrition ward for 3 degree Macronutrient supplementation and food fortification – FIDEL (fortification Iodized Deficiency elimination) ASAP – Araw Nang Sangkap Pinoy –

Care of Premature Infant in the HOME I. Establish and maintain good respiration – mouth to nose resuscitation


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II. III. IV. V. VI.

Minimum Handling of Babies Regulation of Body temperature Proper management of Feeding Prevention of Infection Early Detection and Tx of Complication

Go to your Nearest Health facility for the Garantisadong Pambata package of Services: 1. Immunization 2. Vit. A supplement 3. Deworming 4. Health Information on 9 ways to save your child 9 WAYS TO SAVE YOUR CHILD 1. Skilled health Professional during pregnancy, delivery and immediate postpartum 2. Care of the New born 3. Breast feeding and complementary feeding 4. Micronutrient Supplements 5. Immunization of the infant and the mother 6. Integrated management of sick children 7. Child injury prevention control 8. Birth spacing 9. Proper personal hygiene 7 Healthy Lifestyle Habits 1. No smoking 2. Don’t Drink Alcohol 3. No to illegal Drugs 4. Eat low fat, low salt and high fiber diet

5. Prevent hypertension 6. Do Physical activity 7. Manage Stress

Herbal Medicine Lecture Lagundi Ulasimang-Bato Bawang Bayabas Yerba Buena Sambong Akapulko Niyog-niyogan Tsaang-gubat Ampalaya AKAPULKO (CASSIE, ALATA L.) • It is also known as "bayabas-bayabasan" and "ringworm bush" in English, this herbal medicine is used to treat ringworms and skin fungal infections. Parts utilized: • leaves Use: • Anti-fungal: Tinea Flava, ringworm, athlete’s foot and scabies. Preparation: • Fresh, matured leaves pounded. Apply as soap to the affected part 1-2 times a day. AMPALAYA (MAMORDICA CHARANTIA) • Most known as a treatment of diabetes (diabetes mellitus), for the non-insulin dependent patients. Known as "bitter gourd" or "bitter melon" in English, it Parts utilized: • leaves Use: • Lower blood sugar levels Preparation: • Gather and wash young leaves very well. Chop. Boil 6 tablespoons in two glassfuls of water for 15 minutes under low fire. Do not cover pot. Cool and strain. Take one third cup 3 times a day after meals. Remember that young leaves may be blanched/ steamed and eaten ½ glassful 2 times a day. BAWANG (ALLIUM SATIVUM)


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•

Popularly known as "garlic", it mainly reduces cholesterol in the blood and hence, helps control blood pressure. Also a remedy for toothache Parts utilized: • Garlic Bulb • Uses: • For hypertension: Toothache; to lower cholesterol levels in blood. Preparation: • May be fried, roasted, soaked in vinegar for 30 minutes or blanched in boiled Water for 5 minutes. Take 2 pieces three times a day after meals. For toothache: • Pound a small piece and apply to affected part. BAYABAS / GUAVA (PSIDIUM GUAJAVA L.) • A tree about 4- 5 meters high with tiny flowers with round or oval fruits that are eaten raw. Propagated through seeds. Parts utilized: • leaves Uses: • For washing wounds- may be used twice a day. • For diarrhea- may be taken 3-4 twice a day. • As gargle and to relieve toothache. Warm decoction is used for gargle. Freshly pounded leaves are used for toothache. Guava leaves are to be washed well and chopped. Boil for 15 minutes at low fire. Do not cover pot. Cool and strain before use. LAGUNDI (VITEX NEGUNDO) • A shrub known in English as the “5-leaved chase tree” which grows wild in vacant lots and waste land. The flowers are blue and bell-shaped and small fruits turn black when ripe. It is better to collect the leaves where are in bloom. Matured branches are planted. Parts utilized: • Leaves, flower. Uses: • Asthma, cough and fever- boil the chopped raw fruits or leaves in 2 glasses of water left for 15 minutes until the water left in only one glass. Strain. The following dosages of the decoction are given to age group. • Dysentery, colds and pain in any part of the body as influenza – boil a handful of leaves and flowers in water to produce a glass full of decoction 3 times a day.

•

Skin Diseases (dermatitis, scabies, ulcer, eczema) and wounds – prepare a decoction of the leaves. Wash and clean the skin/ wound with the decoction.

•

Headache- crushed leaves may be applied on the forehead.

•

Rheumatism, sprain, contusion insect bites- pound the leaves and apply on affected part.

•

Aromatic bath for sick patients - prepare leaf decoction for use in sick and newly delivered patients.

NIYUG- NIYOGAN (QUISQUALIS INDICA L.) • A vine known as “Chinese honey suckle” which bears tiny fruits and grows wild in backyards. It is effective for the elimination of intestinal worms. The seeds must come from m ature. Dried but newly opened fruits. Propagated through stem cuttings about 20cm in height. Parts utilized: • seeds Uses: • An anti- helmintic used to expel round worms ascariasis. The seeds are taken 2 hours after supper. If no worms are expelled, the dose may be repeated after one week. This is not to be given to children below four years old. • Special precautions: Follow recommended dosage. Overdose causes hiccups. SAMBONG ( BLUMEA BALSAMIFERA) • A plant that reaches 1.5 to 3 meters high with rough hairy leaves. Young plants around mother plant may be separated when they have three or more leaves. • English name: Blumea camphora Parts utilized: • leaves Uses: • Anti- edema, diuretic, anti- urolithiasis -boil chopped leaves in water for 15 minutes until one glassful remains. Cool and strain. Divide decoction into 3 parts. Drink one part 3 times a day. Remember that sambong is not a medicine for kidney infection.


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TSAANG GUBAT (CARMONA RETUSA) • A shrub with small, shiny nice- looking leaves that grows in wild uncultivated areas and forests. Mature stems are used for planting. Parts utilized: • leaves Uses: • Diarrhea – boil the following amount of chopped leaves in 2 glasses of water for 15 minutes or until amount of water goes down to 1 glass. Cool and strain. Divide decoction into 4 parts. Let patient drink 1 part every 3 hours. • Stomachache- washes leaves and chops. Boil chopped leaves in 1 glass of water for 15 minutes. Cool and filter, strain and drink. ULASIMANG- BATO (PEPERONIA PELLUCIDA) • A weed, with heart-shaped leaves also known as "pansit-pansitan", grows in shady parts of the garden and yard. It is effective in fighting arthritis and gout. The leaves can be eaten fresh (about a cupful) as salad or like tea. Parts utilized: • leaves Use: • Lowers uric acid. (Rheumatism and gout) Preparation: • Wash leaves well. One and a half cup leaves are boiled in two glassfuls of water over lower fire. Do not cover pot. Cool and strain. Divide into three parts and drink each part three times a day after meals. • May also be eaten as salad. Wash the leaves well. Prepare one and a half cups of leaves. Divide into 3 parts and take as salad three times s day. YERBA BUENA (CLINOPODIUM DOUGLASII) • A small multi- branching aromatic herb commonly known as Peppermint. The leaves are small, elliptical ands with soothed margin. The stem creeps to ground, and develops roots. May also be propagated through cuttings. Parts utilized: • leaves, sap of plant Uses: For pain in different parts of the body as headache, stomach ache – boil chopped leaves in two glasses of water for 15 minutes. Cool and strain. Divide decoction into two parts and drink one part every three hours. Rheumatism, arthritis and headache – crush the fresh leaves squeeze sap. Massage sap on painful parts with eucalyptus. Cough and colds – get about 10 fresh leaves and soak in a glass of hot water. Drink as tea. Acts as an expectorant. Swollen Gums – steep 6 grams of fresh plant in a glass of boiling water for 30 minutes. Use solution as gargle. Toothaches – cut fresh plant and squeeze sap. Soak a piece of cotton in the sap and insert this in aching tooth cavity. Mouth should be rinsed by gargling salt solution before inserting the cotton. To prepare salt solution add 5 grams of table salt to one glass of water. Menstrual and gas pain – soak a handful of leaves in a glass of boiling water. Drink infusion. It induces menstrual flow and sweating. Nausea and fainting – crush leaves and apply at nostrils of patients. Insect bites – crush leaves and apply juice on affected part or pound leaves until paste-like. Then rub this on affected part. Pruritis- boil plant alone or with eucalyptus in water. Use decoction as wash on affected area. •

•

•

• •

•

• •

•

MENTAL HEALTH/STRESS MANAGEMENT LECTURE Lusog Isip ’97 Program: Stress – a state where one’s coping is not enough to maintain a balance of equilibrium; a state of body disequilibrium. Sources of Stress: 1. 2. 3. 4. Organizational Problems

a. Functionalism b. Lack of communication

c. Low Morale d. Burn out Feeling

ABC OF STRESS MANAGEMENT A – Awareness of being aware of things that makes you stress B - Balance in using Strategies - Change stressor, Physical reaction - Diet, Goal setting, exercise


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C – Control of feeling to cope with stress 12’S

1. Spirituality 2. Siesta – a break 3. 4. 5. 6.

7. 8. 9. 10. 11. 12.

Sounds, Songs Stress debriefing Speak to me Self Awareness Social Sports

Pointers to Mental Health: 1. Maintain Good Physical Health 2. Undergo Annual physical Check-ups 3. Develop and maintain a wholesome lifestyle 4. Avoid smoking and excessive alcohol intake 5. Have realistic goals in life 6. Have a friend whom you can confide and ventilate you problem 7. Don’t live in the past and avoid worrying about the future 8. Live one day at a time 9. Avoid excessive physical, mental and emotional stress 10. Develop and sustain solid spiritual values

BOTIKA NG BARANGAY GOAL: To promote equity in health by insuring the availability and accessibility of affordable safe and effective quality essential drugs to all, with priority for marginalized, underserved, critical and hard to reach areas.

LIST OF OVER THE COUNTER (OTC) DRUG PREPARATION FOR BOTICA NG BARANGAY (BnB) 1. ANALGESICS/ANTIPYRETICS 13. SOLUTION CORRECTION WATER AND 2. ANTACIDS ELECTROLYTE 3. ANTIHELMINTICS 14. LAXATIVE/CATHARTICS 4. ANTI-HISTAMIN 15. ANTI-SCABIES 5. NON-STEROIDAL ANTI-INFLAMATORY 16. ANTI-ANEMIC 6. (NSAIDs) 17. ANTIFUNGAL 7. ANTI-VERTIGO 18. VITAMINS 8. BRONCHODILATORS 19. VITAINS AND MINERALS 9. DIURRETICS 20. MINERALS 10. ANTITUSSIVE 21. ANTI-INFECTIVES 11. NASAL DECONGESTANT 22. MEDICATION FOR CHRONIC DISEASE 12. ANTI MOTILITY 23. TOPICAL NASAL DECONGESTANT 24. DISENFECTANTS *Community Organizing Participatory Action Research (COPAR) Please refer to your supplemental notes

COMMUNITY DIAGNOSING Community Is a group of people sharing common geographical boundaries and common values and interest. It functions within a particular sociocultural environment. A physical environment so coping and behaviour varies. Sign’s of “Healthy Community”


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1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Awareness that we are community Conservation of natural resources Recognition and respect of subgroups Participation in subgroups in community affairs Preparation for crisis management Ability to solve problems Open communication Resources available to all Settling of dispute though legal mechanism Participation of citizens in decision making Wellness in High Degree among the members

COMMUNITY DIAGNOSING

1. Preparation for community diagnosis 2. Data gathering Spot Map • Key information • Interview • Community survey • Records review • 3. Data Presentation 4. Problem Identifications 1st and 2nd level assessment; problem prioritization • 5. Preparation of actions

Community Diagnosis: • • •

• •

Descriptive research Profile general picture of comm., a direct health indicator Process by which the people in the connection & Health team assess the community. Health problems & needs as bases for Health programs development. A learning process for the comm. to identify their own H problems & needs A profile that deposits the Health problems & potentials of the community

2 Types of Community Dx

1. Comprehensive- provides the general health profile of the comm. 2. Specific or problem oriented- yields a comprehensive profile of a particular H problem. Steps: Preparatory Phase

Site selection: Location of 1 st criteria a. Poor community because they are vulnerable to disease, a health problem b. Free from other agency 1. Preparation of the community 2. Statement of obj- dependent of comm. Dx 3. Identify methods & instruments for data collection

1. Method of Survey: Questionnaire • •

Census (100%) : Most ideal, enumeratx of data conducted 6 mos. Sample Survey : Most practical study representative of a comm. Size matters in terms of validity

2. Interview method •

Instrument- interview guide/ schedule a. Records review


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Instrument: checklist b. Ocular inspection/ observation Instrument: checklist • c. Participant observation 3. Finalize sampling design & methods •

a. Probability: Equal chances- random- ( simple, stratified, cluster) b. Non- probability: Everyone will not have equal chances 4. Make a timetable

•

•

Implementation Phase 1. Data collection-uses instruments 2. Data organization/ collation 3. Data Presentation (narrative, tubular, graphical) 4. Data Analysis Median age decrease – young population • Preferred Pop. – older population—longer life span, less people dying • 5. Identification of health problems 6. Prioritization of health problems 7. Development of a health plan 8. Validation and feedback- presentation of results Evaluation Phase 1. Process evaluation 2. Product evaluation

FAMILY NURSING CARE PLAN (NURSING PROCESS) Family

The fundamental units of any society, composed of father, mother and children related by blood or marriage.

Types of Family by Structure: 1. NUCLEAR2. EXTENDED3. SINGLE PARENT4. BLENDED/RECONSTITUTED-a combination of two families with children from both families and sometimes children of the newly married couple. It is also a remarriage with children from previous marriage. 5. COMPOUND-one man/woman with several spouses 6. COMMUNAL-more than one monogamous couple sharing resources 7. COHABITING/LIVE-IN-unmarried couple living together 8. DYAD— husband and wife or other couple living alone without children 9. GAY/LESBIAN-homosexual couple living together with or without children 10. NO-KIN- a group of at least two people sharing a relationship and exchange support who have no legal or blood tie to each other 11. FOSTER- substitute family for children whose parents are unable to care for them Types of Family by Structure 1. 2.

PATRIARCHAL – full authority on the father or any male member of the family e.g. eldest son, grandfather MATRIARCHAL – full authority of the mother or any female member of the family, e.g. eldest sister, grandmother

3.

EGALITARIAN- husband and wife exercise a more or less amount of authority, father and mother decides

4.

DEMOCRATIC – everybody is involve in decision making

5.

AUTHOCRATIC- only the father or the mother has the power with complete control over the family(Strict policey)

6.

LAISSEZ-FAIRE- “full autonomy”

7.

MATRICENTRIC- the mother decides/takes charge in absence of the father (e.g. father is working overseas)

8.

PATRICENTIC- the father decides/ takes charge in absence of the mother


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CHN PROCESS I. Assessment 1. Data gathering- first level of assessment 2. initial data(Health Threat, Health Deficit, Foreseeable Crisis, Wellness Deficit) a.

Health Threat- conditions conducive to disease, accidents or failure to realize one’s health potential healthy people Ex. Family hx of illness- hereditary like DM, HPN nutritional problems- eating salty foods personal behavior- smoking, self-medication, sexual practices, drugs, excessive drinking inherent personality char- short temperedness, short attn span short cross infectx poor home env't. lack/inadequate immunization hazards- fire, falls, or accidents family size beyond what resources can provide Health Deficits- instances of failure in health maintenance ( disease, disability, dev’tl lag) • • • • • • • •

b.

3 Types: a. Disease/ illness- URTI, marasmus, scabies, edema b. Disabilities- blindness, polio, colorblindness, deafness c. Developmental Problems like mental retardatx, gigantism, hormonal, dwarfism c.

Stress Points/ Foreseeable Crisis Situations - anticipated periods of unusual demand on individual or family in terms of adjustment or family resources

( nature situations) Ex. Entrance in school • adolescents (circumcision, menarche, puberty • courtship (falling in love, breaking up) • marriage, pregnancy, abortion, puerperium • death, unemployment, transfer or relocation, graduation, board exam 3. Collect data and analyze 4. Identity of health needs II. PLANNING 1. Prioritize the problem a. Nature of conditions-wellness state, health treat, health deficits and foreseable crisis b. Modifiability of the problem-probability of success in improving conditions c. Preventive potentials-refers to probability of minimizing/preventive future problem Salience -refers to family perception and evaluation of the problem in terms of serious and urgency of attention needed. Modifiability: - Current knowledge, technology and intervention - Resources of the family - Resources of the nurse Preventive Potentials - Gravity and severity - Duration of the problem - Current management - Exposure to any risk group

2. Statement of goals and objectives (smart) III. IMPLEMENTATION Guide in the selection of nursing intervention: 1. Analyze with the family current situation and determine choices and possibilities based on lived experiences of meanings and concerns 2. Development / enhance family’s competencies as thinker, doer and feeler 3. Focus on the interventions to help perform the health tasks 4. Catalyst behaviour changes through motivation and support Types of nursing interventions: Supplemental – doing things for the patient Facilitative- removing barriers for care Developmental-improving family capabilities IV. EVALUATION


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HOME VISIT / BAG TECHNIQUE Home Visit Definition: a professional face to face contact made by PHN or RHM to the patient or the family to provide necessary health care to further the objective of the agency. Phases of Home visit I. Socialization Phase 1. introducing your name 2.Greetings 3. your purpose of home visit

II. Working Phase 1. Teaching 2. Return demonstration of the mother

III. Evaluation Phase 1. Record Data Findings 2. Schedule another Visit 3. Final Instruction

Principles of Home Visit 1. Home visit should have a purpose and objective 2. Planning a home visit make use of available information about the client from records and other professional providing care 3. Planning a home visit takes into consideration identified needs and clients taking into priority recognized needs the family itself. 4. Planning continuing care should involve the clients family Planning should be flexible and practical

Principles of Home Visit: should be “” from the cleanest to the dirtiest case” eg Newborn, Postpartum to morbid case. Advantage of Home Visit 1. The PHN or RHM see the family in their natural setting 2. The PHN or RHM can identify the presence of CD in the community 3. H.V establish a working and social relationship between the family and the health center staff. Disadvantages of Home Visit 1. Time consuming in the party of the health Personnel. 2. H.V disrupt the family activities for the day 3. Some family are not comfortable of the health personnel’s presence at their home

Clinic Visit Patient visits the Health Center to avail of the services thereto offered by the primarily for the consultation on matters that allied them physically. Phases Phase I: Pre Consultation/ Conference 1. Pt. Records 2. V/S 3. Assessment 4. Record findings

Phase II: Consultation / Conference 1. Rx is Given 2. Treatment and Prevention

Phase III: Post Conference 1. Schedule of the next visit 2. referral

Advantages of Clinic Visit: 1. Make the health Personnel Available to more patient 2. Save time and effort of the health personnel 3. Materials and equipment needed for care are readily available 4. Record are available Community Assembly Phase I: Planning and Preparation 1. 2.

Setting Objectives Organizing Community leaders and Community


Phase II: Assembly 1. 2.

Presentation of Data and Survey Program Presentation

Phase III: Evaluation 1. 2. 3.

Assessment and result Referral/coordination/networking Follow-up

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3. 4.

Program Planning Giving of Assignments and Task 5. Invitations (Brgy. Captain, principal, etc)

3. 4.

Open forum/ consultation socialization

Bag Technique

-steps which are carried out by the nurse to facilitate the performance of nursing procedures with ease and deftness -a tool making use of the public health bag through which the nurse during the visit can perform nursing procedures with ease and deftness, saving time and effort at the end in view of rendering effective nursing care. Public Health Bag- essential and indispensable equipment of the Public Health Nurse    

Principles: Should minimize if not totally prevent the spread of infection; should save time and effort Special Consideration: HAND WASHING Contents of the Bag: BP apparatus and stethoscope are carried separately; medicines also includeBetadine, 70% alcohol, Benedict’s solution Place waste paper bag outside the work area to prevent contamination of the work area

Remember the : Bag -and its contents must be protected from any possible contamination Always wash your hands to prevent the spread of infection Gather all necessary articles and supplies to answer emergency needs. Note: Blood Pressure apparatus and stethoscope are carried separately. Consider the following principles:

1. prevention of contamination - place waste paper bag outside the work areas 2. protection of the caregiver - clean and alcoholize all articles after use 3. make articles readily accessible - place the articles in one corner of the work area 4. make follow-up care - set the date and the time for the next visit VITAL STATISTICS LECTURES Vital Statistics - refers to birth, deaths, population, illness, marriages, divorce The application of statistical measures to vital events (births, deaths and common illnesses) that is utilized to gauge the levels of health, illness and health services of a community. Source of Data: - Municipal Treasurer - Civil Register General - City Health Officer Types of Record: - Birth record - record of live birth and fetal death - Mortality Record – records of deaths, date and causes - Morbidity Record – CD and important Chronic Disease - Reportable Disease 6 Quarentinable Diseases:

1. 2. 3. 4. 5.

Small Pox Cholera Plague Yellow Fever Typhoid


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6. Relapsing fever TYPES OF VITAL STATISTICS FERTILITY RATE 1. Crude Birth Rate

Total # of livebirths in a given calendar year Estimated population as of July 1 of the same given year

X 1000

2. General Fertility Rate

Total # of livebirths in a given calendar year Total number of reproductive age

X 1000

MORTALITY RATE 1. Crude Death Rate

_Total # of death in a given calendar year _ X 1000 Estimated population as of July 1 of the same calendar year 2. Infant Mortality Rate X 1000 Total # of death below 1 yr in a given calendar year Estimated population as of July 1 of the same calendar year 3. Maternal Mortality Rate

Total # of death among all maternal cases in a given calendar year Estimated population as of July 1 of the same calendar year

X 1000

EPIDEMIOLOGY

• • •

Study of frequency of disease Study of distribution of disease or physiologic condition among human pop & the factors affecting such distribution. Distribution means the frequency of diseases & physiologic condition in terms of who gets sick where & when.

Basic Concepts:

1. Epidemiologic Triad: Agent- Host- env't 2. Transmission of CD: Common vehicle, source- serial- transfer- propagated from host to host 3. Incubation period:

Entry of pathogens w/ enough infections load , up to appearance of the 1 st s/sx

4. Herb Immunity: % of immune pop- some indiv are immune Dengue- aedes – daytime C Arthropod Malaria – anopheles- nighttime L E A Neem tree Types of Immunity: 1. Passive:

Quick to come, quick to go Natural- in water, breast feeding Artificial- serum globulin, antiserum, antitoxin


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2. Active:

Slow to come, slow to go Natural active- getting the dse itself Artificial- tetanus toxoid

Preg 1 --- 4th month --------------------------TT1 --- 8th month (before delivery) ---- TT2 Preg 2 --------------------------------------------- TT3 ( 1st booster dose) Preg 3 -------------------------------------------- TT4 (2 nd booster dose) Preg 4 -----------------------------------------------TT5 (3 rd booster dose) Factors Affecting Distribution of Disease:

1. Person- exposure, susceptibility or response to agents. - Influenced by intrinsic characteristic - Genetic/ family, prior immunologic experience - Age, sex, ethnic grp, physiologic status - Human behavior---most significant---can be modified Some identified increase risk grps. - Mothers, infants, and young children - School children, old people, contacts - People far from medical assistance - People in areas with endemic dse - People at certain times Attack Rate- incidence of illness among exposed pop Number of cases x 100 Pop at Risk 2. Place - Extrinsic factors, existence of etiologic factors & exposure & susceptibility of human host, influenced by extrinsic factors. 3. Time

- Temporal patterns- fluctuations of incidence a. Short term- fluctuations - Time of day - Days of the week b. Cyclic pattern- regular pattern Seasonal cyclicity – annual cyclicity Secular cyclicity – every other year typhoid, measles

Patterns of Disease Occurrence: Epidemic • A situation when there is a high incidence of new cases of a specific dse in excess of the expected. When the proportion of the susceptible are high compared to the proportion of the immunes.

Ex. 20-30 diseases that you don’t know Current number of cases exceeds the usual expectancy. Endemic • Habitual presence of a disease in a given geographic location accounting for the low number of both immunes & susceptible. • Causative factor is constantly available or present to the area Ex. Malaria, constant Sporadic

• •

Disease occurs every now & then affecting only a small number of people relative to the total pop Intermittent


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•

On & off

Pandemic • Global occurrence of a disease, bigger population - Patient epidemic- easily the person can identify the cause Common Epidemiologic Studies:

Retrospective (Past) Case Control study -Show an association bet. the risk factor & disease

Cross- Sectional (Present) Prevalence study- old & new cases - Get prevalence of disease (Lung CA) - Get prevalence of risk factor (smoking)

Prospective Cohort (future) - Incidence or new cases

*Independent variable (Cause)

- The one to be manipulated

*Dependent

- Will always be the interest of the researcher

(Effect)

MORBIDITY RATE 1. Prevalence Rate

Total # of new & old cases in a given calendar year Estimated population as of July 1 of the same calendar year

X 100

2. Incidence Rate

Total # of new cases in a given calendar year_ Estimated population as of July 1 of the same calendar year 3. Attack Rate Total # of person who are exposed to the disease Estimated population as of July 1 of the same calendar year

X 100

X 100

PRIMARY Health Care/Rural Health Care Delivery System (RHCD) Primary Health Care (PHC) An essential health care based on practical, scientifically sound and social acceptable methods and technology made universally accessible and families in the community through their full participation 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 (WHO/UNICEF 78)  Primary health care was declared during the First International Conference on PHC held in Alma Ata USSR on September 6 – 12, 1978 by WHO with a goal of “Health for All by the year 2000” 

Primary Health Care was adopted in the Philippines through LOI 949 signed by Pres. Marcos on October 19, 1979 and has an underlying theme of “Health in the hands of the People by 2020”

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: Community-based Accessible Part and parcel of the total socio-economic development effort of the nation Acceptable Sustainable at an affordable cost. Framework

People’s Empowerment and Partnership is the Key Strategy to achieve the goal, “Health For all Filipinos by the year 2000 And Health in the Hands of the People by the year 2020” Levels of Care WHAT DOES ESSENTIAL HEALTH CARE IN PHC MEANS? 2-way referral It stands for:


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Education of prevailing Health Problems system Goal Locally-endemic Disease Prevention and Control Tertiary Level Rehab Expanded Program of Immunization -National Health services Maternal and Child Health and Family Planning Medical and Training centers Environmental Sanitation and Safe Water Supply -Regional Medical Centers Secondary Nutrition and Food Supply Treatment of Communicable & Non-communicable Diseases/ Conditions Level Supply and Proper use of Essential Drugs and Herbal Medicine Goal: Curative -Provincial / City Hospital Dental Health Promotion -Provincial / City Health Services -Emergency / District Hospital Primary Access to and use of hospitals as Centers of Wellness Mental Health Promotion Level

Acronym: ELEMENTS + DAM Pillars (major elements): A. Multi-sectoral approach Intersectoral linkages • Intrasectoral linkages • B. Community C. Appropriate Technology - method used to provide a socially and environmentally acceptable level of service or quality product at the least economic cost.

Goal: Promotion of Health and Prevention Of Illness -Rural Health Unit, Barangay Health Station -Community Hospital and Health Center -Private Practitioner, Puericulture Center

Levels of Health Care Providers Feasible Acceptable, Affordable Complex Effective Safe Scope-wise

Criteria:

Tertiary Level

MHO Secondary

PHN RHM BHM SI

Primary

Concept of PHC is characterized by; 

Partnership and empowerment of the people 

PHC is a strategy 



PHC includes full participation and active involvement of the community 



which focuses responsibility for health on the individual, his family and the community

towards the development of self-reliant people, capable of achieving an acceptable level of health and well being

PHC recognizes the interrelationship between health and the overall political, socio-cultural and economic development of society

Four cornerstones/Pillars in PHC

1. Active community participation 2. Intra and Inter-sectoral linkages 3. Use of appropriate technology


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4. Support mechanisms made available Two levels of PHC workers

1. Village or Barangay Health Workers 2. Intermediate Level Health Workers a.

General medical practitioners

b. PHN c.

RSI

d. RHM Supervisory Function of the PHN 3. The PHN supervises midwifes within her catchment area 4. The PHN formulates a supervisory plan 5. Identifies the factors that affect the midwives performances and job satisfaction 6. Defines standards of the performances 7. Set achievable performance targets and defines criteria for evaluation 8. Formulates objectives and strategies to meet the midwives needs for supervision. 9. Conduct supervisory visits. 10. Monitor and evaluates midwives and nursing auxiliary performances in the implementation of public health programs. 11. Utilize public health monitoring and evaluation tools. 12. Reviews clinic records and reports, validates their accuracy and completeness and compares actual performances. 13. Utilize results of monitoring and evaluation strengthens supervisory. 14. Documents Findings during monitoring and evaluation RURAL HEALTH MIDWIVE QUALIFICATION OF A RURAL HEALTH MIDWIFE (RHM) Graduate of an accredited School of Midwifery and Passed the Midwifery Board Examination • ROLES OF RURAL HEALTH MIDWIFE IN COMMUNITY WORK • Guide – help the people achieve their goal • Enabler- facilitates the community organization process • Expert – provides technical skills and advice • Therapist – clarifies issues and bring diverse group together DUTIES AND RESPONSIBILTY OF AN RHM 1. Works with the PHN in Planning and Evaluating Health Services at the barangay level - Participates in determining health needs of the community - Assists in planning and organizing the clinic in his/her barangay station - Prepares monthly scheduled of activities in coordination with the physicians, nurse, sanitary inspectors and other health workers 2. Plans for activities in the clinic Barangay Health Station (BHS) follow-ups in homes and clinic visits in the community. - Participate in the periodic evaluation of health services in the barangay. 3. Provides midwifery services in the barangay. - Gives direct care to normal childbearing woman as well as normal infants - Refer to physicians and / or nurse and appropriate agencies any postpartum women and newborn infant with suspected abnormalities and problems. 4. Carries out medical nursing functions as authorize by the department of health 5. Conduct clinics which includes: - Obtaining clinical history - Performing simple routines physical and laboratory examinations - Administering emergency and therapeutic measures based on the standing procedures. 6. Refer cases needing further diagnostics and management by the nurse or the physicians and other agencies. 7. Keeps accurate record f medical and nursing care rendered in the clinic homes and community 8. Mobilizes community for health actions 9. Carries out health education and information education communication activities. - Conduct individuals and group teachings utilizes IEC materials - Request and distributes IEC materials to other government and non-government units


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Primary Health Care Hand Outs for Students

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