1.CD control program Communicable diseases National Tuberculosis Control Program – key policies Case finding – direct Sputum Microscopy and X-ray examination of TB symptomatics who are negative after 2 or more sputum exams Treatment – shall be given free and on an ambulatory ambulatory basis, except those with acute complications and emergencies Direct Observed Treatment Short Course – comprehensive strategy to detect and cure TB patients. Category and Treatment Regimen Category 1- new TB patients whose sputum is positive; seriously ill patients with severe forms of smear-negative PTB with extensive parenchymal involvement (moderately- or faradvanced) and extra-pulmonary TB (meningitis, pleurisy, etc.) Category 2-previously-treated patients with relapses or failures. Category 3 – new TB patients whose sputum is smear-negative for 3 times and chest x -ray result of PTB minimal Category 1-
new TB patients whose sputum is positive; seriously ill patients with severe forms of smearnegative PTB with extensive parenchymal involvement (moderately- or far- advanced) and extra-pulmonary TB (meningitis, pleurisy, etc.) Intensive Phase (given daily for the first 2 months)Rifampicin + Isioniazid + pyrazinamide + ethambutol. If 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 examined for culture and drug sensitivity. The patient resumes taking the 4 drugs for another month and then another smear exam is done at the end of the 3rd month. Maintenance Phase (after 3rd month, regardless of the result of the s putum exam)-INH + rifampicin daily Category 2-previously-treated patients with relapses or failures. Intensive Phase (daily for 3 months, month 1,2 & 3)Isioniazid+ rifampicin+ pyrazinamide+ ethambutol+ streptomycin for the first 2 months Streptomycin+ rifampicin pyrazinamide+ ethambutol on the 3rd month. If sputum is still positive after 3 months, the intensive phase is continued for 1 more month and then another sputum exam is done. If still positive after 4 months, intensive phase is continued for the next 5 months. Maintenance Phase (daily for 5 months, month 4,5,6,7,& 8)-Isionazid+ rifampicin+ ethambutol Category 3 – new TB patients whose sputum is smearnegative for 3 times and chest x-ray result of PTB minimal Intensive Phase (daily for 2 months) – Isioniazid + rifampicin + pyrazinamide Maintenance Phase (daily for the next 2 months) - Isioniazid + rifampicin Stop TB ; Do it with DOTS
Advocacy is a planned and continuo us effort to inform people about issue and instigate change. Advocacy usually takes place over an extended period of time and includes a variety of strategies to communicate a specific message.
TB is the number one infectious killer in the world. One TB suspect can infect another 10 healthy persons Leprosy Control Program WHO Classification – basis of multi-drug therapy
Paucibacillary/PB – noninfectious types. 6-9 months of treatment. Multibacillary/MB – infectious types. 24-30 months of treatment. Multi-drug therapy – use of 2 or more drugs renders patients non-infectious a week after starting treatment Patients w/ single skin lesion and a negative slit skin smear are treated w/ a single dose of ROM regimen For PB leprosy casesRifampicin+Dapsone on Day 1 then Dapsone from Day 2-28. 6 blister packs taken monthly within a max. period of 9 mos. All patients who have complied w/ MDT are considered cured and no longer regarded as a case of leprosy, even if some sequelae of leprosy remain. Responsibilities of the nurse Prevention – health education, healthful living through proper nutrition, adequate rest, sleep and good personal hygiene; Casefinding Management and treatment – prevention of secondary injuries, handling of utensils; special shoes w/ padded soles; importance of sustained therapy, correct dosage, effects of drugs and the need for medical checkup from time to time; mental & emotional support Rehabilitation-makes patients capable, active and selfrespecting member of society. Control of Schistosomiasis – a tropical disease caused by a blood fluke, Schistosoma Japonicum Schistosoma Japonicum ; transmitted by a tiny snail Oncomelania quadrasi Preventive measures – health education regarding mode of transmission and methods of protection; proper disposal of feces and urine; improvement of irrigation and agriculture practices Control of patient, contacts and the immediate environment Specific treatment- Praziquantel – drug of choice Programs on Filariasis, Malaria and Dengue Hemorrhagic Fever ▪
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Filariasis- a chronic prasitic infection caused by a nematode, Wuchereria bancrofti. Young bancrofti. Young and adult worms live in the lymphatic vessels and nodes, while the micro filariae are in the blood; transmitted through bites from an infected female mosquito, Aedes poecilius, Aedes poecilius, that bites at night. Treatment: Diethylcarbamazine citrate or Hetrazan Elephantiasis and Hydrocoele are handled through surgery, prevention and supportive care Malaria – infection caused by the bite of the female Anopheles mosquito, mosquito, Chemoprophylaxis – Chloroquine taken at weekly intervals, starting from 1-2 weeks before entering the endemic area. Anti-malarial drugs – sulfadoxine, quiinine sulfate, tetracycline, quinidine Insecticide treatment of mosquito nets, house spraying, stream seeding and clearing, sustainable preventive and vector control meas Dengue H-fever ▪
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4 o’clock habit
Programs on Measles. Chickenpox, Mumps, Diphtheria, Pertusis, Tetanus – focused on health information campaigns and intensive immunization of children in barangays. Prevention and Control Program on Parasitic Infestations ( STH e.g. Ascaris, Trichuris, Hookworm) and Paragonimiasis in communities where eating of fresh or inadequately cooked crab is a practice Management: 1. Deworming 2. Health Education re: Good personal hygiene Use of footwear Washing fruits and vegetables well Use of sanitary toilets Sanitary disposal of garbage Boiling drinking water at least 23 min. from boiling point or chlorination Prevention and Control on Leptospirosis/ Leptospirosis/ Weil’s Disease/ Mud fever/Flood fever/ Spirochetal Jaundice thru contact with the skin/ open wound with water or moist soil contaminated with urine of infected rat And Rabies Mgt. of Rabies Wash wound with soap and water, betadine or alcohol may be applied If dog is healthy observe for 14 days. days. If nothing happens- no need for ttt.If it dies or shows rabies, kill then bring head for lab. Exam & consult doctor. Active immunization – body develops Ab against rabies up to 3 yrs. Passive I – giving Ab to persons with head and neck bites, multiple single deep bites, contamination of mucous membranes or thin covering of the eyes, lips or mouth to provide immediate protection RPO – immunization of pets at 3 mos. of age and yearly thereafter Prevention and Control on STIs Gonorrhea, Syphilis, HIV/AIDS, Trichomoniasis,Chlamydia, Trichomoniasis,Chlamyd ia, Hep B ( the most most serious type ‘cause of severe cx. Eg. Massive liver damage and hepatocarcinoma 4 C’s in the Syndromic Syndromic Mgt 1. Compliance 2. Counseling/ Education 3. Contact tracing to treat partner 4. Condom use Hep B vaccination Universal precautions Safe sex 2. Community Needs Assessment/ Community Diagnosis Community Diagnosis A process by which the nurse collects data about the community in order to identify factors which may influence the deaths and illnesses of the population to formulate a community health nursing diagnosis and develop and implement community health nursing interventions and strategies Done to come up with a profile of local health situation Will serve as a basis of health programs and services to be delivered to the community Starts with determining the health status of the community 2 Types of Community Diagnosis 1. Compre Comprehen hensiv sive e Commun Community ity Diag Diagnos nosis is aims to obtain general information about the community 2. Proble Problem-O m-Orie riente nted d Communi Community ty Diagno Diagnosis sis
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type of assessment responds to a particular need
ELEMENTS OF COMPREHENSIVE COMPREHENSIVE COMMUNITY DIAGNOSIS 1. DEMO DEMOGR GRAP APHI HIC C VARI VARIAB ABLE LES S i. Tota Totall popu popula lati tion on & Geog Geogra raph phic ical al distribution including Urban-Rural index & Population Density ii. Age & Sex composit iio on iii. iii. Sele Select cted ed vit vital al ind indic icat ator ors s e.q. e.q. Gro Growt wth h rate, CBR, CDR & Life expectancy rate iv. Patterns of migrat iio on v. Population project iio on Note: Population groups that need special attentions: Indigenous people Socially dislocated groups as a result of disasters, calamities & development programs 2. SocioSocio-eco econom nomic ic & Cultu Cultural ral vari variabl ables es i. Social in indicators Communication network Transportation system Educational level Housing conditions ii. Economic indicators Poverty level income Employment rate Types of industry present in the community Occupation common in the community iii. iii. Env Enviro ironme nmental ntal ind indicat icato ors Physical/geographical/topographical characteristics Water supply Waste disposal Air, Water and Land pollution iv. Cultural fa factors Variables that may break up people into groups within the community e.q. Ethnicity Social class Language Religion Race Political orientation Cultural beliefs and practices that affect health Concepts about Health and Illness 3. Heal Health th & illn illnes ess s patt patter erns ns Leading cause of mortality Leading cause of morbidity Leading cause of infant mortality Leading cause of maternal mortality Leading cause of hospital admission 4. Heal Health th reso resour urce ces s Manpower resources Material resources 5. Politi Political cal/Le /Leade adershi rship p patte patterns rns Reflects the action potential of the state and its people to address the health needs and problems of the community Mirrors the sensitivity of the government to the people’s struggle for better lives PROCESS OF COMMUNITY DIAGNOSIS Consists of; 1. Collec Collectin ting, g, organi organizin zing g & synthesi synthesizin zing g data data In order to identify the different factors that may directly or indirectly influence the health of the population 2. Analyz Analyzing ing & inter interpre preting ting health health data data Seek explanations for the occurrence of health needs and problems of the community ▪
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Formul Formulati ation on of Comm Communi unity ty Healt Health h Nursing Nursing Diagnoses Will become the bases for developing and implementing community health nursing interventions and strategies STEPS IN CONDUCTING COMMUNITY DIAGNOSIS
Perception of the population or the community as they are affected by the problem and their readiness to act on the problem PLANNING WHAT IS PLANNING?
is a process that entails formulation of steps to be undertaken in the future in order to achieve a desired end. Concepts of Planning:
1.
DETERMINING THE OBJECTIVES – the nurse decides on the depth and scope of the of the data she needs to gather.
2.
DEFINING THE STUDY POPULATION – the nurse identifies the population group to be included in the study.
Planning is futuristic.
Planning is change-oriented.
DETERMINING THE DATA TO BE COLLECTED – the objectives will guide the nurse in identifying the specific data she will collect, and will also decide on the sources of these data.
Planning is a continuous and dynamic process.
Planning is flexible.
3.
4.
COLLECTING COLLECTING THE DATA – the nurse decides on the specific methods depending on the type of data to be generated. Ocular survey, survey, interview, and records records review,
Planning is a systematic process. THE PLANNING CYCLE:
1.
Situational Analysis
5.
DEVELOPING THE INSTRUMENT instruments/tools facilitate the nurse’s data-gathering activities. Most common instrume in struments nts :
survey questionnaire
interview guide observation checklist
6.
ACTUAL DATA GATHERING – the nurse supervises the data collectors by checking the filled-up instruments in terms of completeness, accuracy and reliability of the information collected.
7.
DATA COLLATION – the nurse is now ready to put together all the information. Numerical data
8.
DATA PRESENTATION – will depend largely on the type of data obtained. Descriptive- narrative reports
9.
Descriptive data
numerical data- table or graphs
DATA ANALYSIS – aims to establish trends and patterns in terms of health needs and problems of the community. 10. Identifying Community Health Nursing Problems a. Heal Health th Stat Status us Prob Proble lems ms Increased/decreased morbidity, mortality fertility or reduced capability for wellness b. Heal Health th Reso Resour urce ces s Probl Problem ems s Lack of or absence of manpower, money, materials or institutions necessary to solve health problems c. Heal Health th Rela Relate ted d Pro Probl blem ems s Existence of social, economic, environmental and political factors that aggravate the illness-inducing situations in the community 11. Priority-se Priority-setting tting a. Nature Nature of the the conditi condition/ on/pro proble blem m present presented ed Classified as health status, health resources or health related problems b. Magn Magnit itud ude e of the the pro probl blem em Severity of the problem which can be measured in terms of the proportion of the population affected by the problem c. Modi Modifi fiab abil ilit ity y of the the prob proble lem m Probability of reducing, controlling or eradicating the problem d. Prev Preven enti tive ve pote potent ntia iall Probability of controlling or reducing the effects posed by the problem e. Soci Socia al con conce cern rn
2.
gather health data
tabulate, analyze and interpret data
identify health problems
set priority
Goal and Objective Setting
define program goals and objectives
assign priorities among objectives Stra Strate tegy gy/A /Act ctiv ivit ity y Sett Settin ing g Design CHN Program Ascertain resources Analyze constraints and limitations 4. Evaluation determines outcomes specify criteria and standards Application of Public Health Tools (discuss ( discuss in separate slide) Three important tools The health disciplines of 3.
1. 2. 3.
Demography Vital statistics
Epidemiology 3. COMMUNITY ORGANIZING A process whereby the community members develop the capability to assess their health needs and problems, plan and implement actions to solve these problems, put up sustain organizational structures which will support and monitor implementation of health initiatives by the people maglaya
COMMUNITY ORGANIZING Purpose:
Empowerment or building the capability of people for future community action Approaches to community development a. Soci Social al chan chang ges Building up social organizations (relationships, structure and resources) b. Chan Change ge in ide ideol olog ogy y Knowledge, beliefs and attitude c. Chan Chang ge agen agents ts Capacity to influence others by setting a good example. Principles of CO: 1. Welf Welfar are e app appro roac ach h People esp. the oppressed, exploited and deprived sectors are most open to change, have the capacity to change and are able to bring about change. Hence , CO is based on the ff: a. Power Power must must resi reside de in the the peop people le
b.
Develo Developm pment. ent. is from from the the peopl people e to the the people c. Peop People le part partic icip ipat atio ion n 2. Tech Techno nolo logi gica call appr approa oach ch must be based on the poorest sectors of society. The solutions of problems commonly shared by these sectors must be focused on collective organizations, planning and action 3. Tran Transf sfor orma mato tory ry app appro roah ah should lead to self-reliant communities Five stages
1. 2. 3. 4. 5.
2.
CoalitionCoaliti on- linking organizations organiza tions and groups to work on community issues.
c.
“lead” or official agency- a single agency takes the primary responsibility of a liaison for health promotion activities in the community.
d.
Grass-roots- informal structures in the community like the neighbourhood residents.
e.
Citizens panels- a group of citizens (510) emerge to form a partnership with the government agency.
Community analysis Design and initiation
f.
Implementation Program maintenance – consolidation
Dissemination – reassessment 1.Community analysis The process of assessing and defining needs, opportunities and resources involved in initiating community health action . Maybe referred to as community diagnosis, community needs assessment, health education planning and mapping 5 components of community analysis 1. Demograp Demographic, hic, social and economic economic profile profile of the community derived from secondary data. 2. Health Health risk risk profi profile le (socia (social, l, behav behaviou ioural ral and and environmental risks) Behavioural- dietary habits and other life style concerns like alcohol, tobacco and drugs Social indicators- exposure to long term unemployment, low education and isolation. 3. Health Health/we /wellne llness ss out out come comes s profi profile le (morbidity/mortality data) 4. Survey Survey of curre current nt health health promot promotion ion progr programs ams.. 5. Studie Studies s conduct conducted ed in certa certain in targe targett groups groups Steps in community analysis Steps in community analysis i. Defining the community 1. Dete Determ rmin inin ing g the the geog geogra raph phic ic bou bound ndar arie ies s of the target community ii. Collecting data iii. iii. Asse Assess ssin ing g comm commun unit ity y capa capaci city ty 1. Enta Entail ils s an an eva evalu luat atio ion n of of the the driv drivin ing g forces which may facilitate or impede the advocated change iv. iv. Asses ssessi sing ng com comm munit unity y bar barrier riers s v. Asses ssessi sing ng read eadines iness s to to cha chang nge e 1. Community interest 2. Perc Percep epti tion on on the the imp impor orta tanc nce e of of the the problem vi. vi. Synt Synthe hesi sis s dat data a and and set set pri prior orit itie ies s 1. Prov Provid ide e a com commu muni nity ty pro profi file le of of the the nee needs ds and resources and will become the Basis for designing prospective community interventions for health promotion 2.Design and initiation STEPS:
1.
b.
Establish a core planning group and select a local organizer. Requirements: Select 5-8 member in charge for core planning and management of the program With management skills, good listener and conflict resolution skills. Choose Choose an org organi anizat zation ional al struc structur ture. e. This activate the community participation. Types:
a.
Leadership Leadersh ip board councilcouncil - existing local leaders working for a common cause
3.
4.
5.
6.
Networks and consortia- network develop because of a certain concerns Identi Identify, fy, selec selectt and recruit recruit orga organiz nizati ationa onall members. As much as possible different groups, organizations sectors should be represented. Chosen representative have power for the group they represents Define Define the organi organizat zation ion missio mission n and and goals goals.. This will specify the what, who, where, when and extent of the organizational objectives. Clarif Clarify y roles roles and respo responsib nsibili ilitie ties s of people people involved in the organization. This is done to establish a smooth working relationship and avoid overlapping of responsibilities. Provid Provide e train training ing and recog recogniti nition. on. Active involvement in planning and management of programs may require skills development training.
Recognition of the programs accomplishment and individuals contribution to the success of the program and boost morale of the members. 3.Implementation -put the design plan into action. a. Genera Generate te broad broad citi citizen zen part partici icipat pation ion How? Organizing task force, who, with appropriate guidance can provide the necessary support. b. Develo Develop p a sequen sequentia tiall work work plan plan Activities should be planned sequentially. Often, times has to be modified as events unfold. Community members may have to constantly monitor implementation steps. c. Use compre comprehen hensiv sive, e, integr integrate ated d strateg strategies ies Generally the program utilize more than one strategies that must complement each other. d. Integrate Integrate community community values values into into the the programs, programs, materials and messages. The community language, values and norms have to be incorporated into the program. 4.Program maintenance – consolidation The program a this point has experienced s ome degree of success and has weathered through implementation problems, the organization and program is gaining acceptance in the community. Maintenance: a. Integr Integrate ate interve interventi ntion on activiti activities es into commun community ity networks This can be affected through implementation problems. The organization and program is gaining acceptance in the community. b. Establish Establish a positive positive organizat organizational ional culture. culture. ▪
A positive environment is a critical element in maintaining cooperation and preventing fast turnover of members. This is a result of good group process based on trust, respect, and openness. c. Establ Establish ish an an ongoi ongoing ng recr recruit uitmen mentt plan. plan. It should be expected that volunteers may leave the organization. This requires a built in mechanisms for continuous recruitment and training of new members. d. Disse Dissemi mina nate te resul results ts.. Continuous feedback to the community on results of activities enhances visibility and acceptance of the organization. Dissemination of information is vital to gain and maintain community support. 5.Dissemination-Reassessment 5.Dissemination-Reassessment Continuous assessment is part of the monitoring aspect in the management of the program a. Update Update the commun community ity analys analysis. is. Is there a change in leadership, resources and participation? This may necessitate reorganization and new collaboration with other organizations. b. Assess effectiven effectiveness ess of interventio interventions/pr ns/program ograms. s. Quantitative and qualitative methods of evaluation can be used to determine participation, support and behavior change level of decision making and other factors deemed important to the program. c. Chart Chart futur future e direct directori ories es and mod modific ificati ations ons.. This may mean revision of goals and objectives and development of new strategies. Revitalization of collaboration and networking may be vital in support of new ventures. d. Summar Summarize ize and and diss dissemi eminat nate e result results. s. Some organization die because of the lack of visibility.
Thus, a dissemination plan may be helpful in diffusion of information to further boost support to the organization’s endeavour. The Health Resource Development Program Community Health Organizing Utilizing COPAR HRDP Was developed and sponsored by the Philippine Center for Population and Development (PCPD) To make health services available and accessible to depressed and underserved communities in the Philippines PCPD is a non-stock, non-profit institution, which serves as a resource center assisting institutions and agencies through programs and projects geared toward the social human development of rural and urban communities Formerly known as The Population Center Foundation HISTORY OF HRDP HRDP I Trained the faculty, medical/nursing students to provide health care services to the far flung barrios because of lack of man power for health services at the same time that similar activities fulfilled the curricular requirements of the students for public health The PCPD provides seed money money for the income generating projects The CO uses his/her own strategy or method in developing the community
Short-term service HISTORY OF HRDP HRDP II
The 2nd cycle uses the same strategy but the program could not be sustained by the schools or hospitals and the incomegenerating projects eventually become the hindrance to the goal of achieving the health program because the people tend to be more interested in the income generated by the projects Both HRDP I and HRDP II have brought about some changes in the community life of the people Established basic health infrastructure; basic health services were increased; there were trained workers and organized health groups to take care of the needs of the community HISTORY OF HRDP HRDP III PCPD refined the program and resulted to what is now called HRDP III, which has these unique features: Comprehensive training of the staff and faculty of the participating agency in which the community work was initiated Periodic training program and regular assistance to the participating agency were provided to strengthen the health outreach program to become community oriented PHC as the approach with which all nursing/medical students, their CI’s and indigenous health workers are trained for community health work and around which all other project inputs will revolve HISTORY OF HRDP Community organizing as the main strategy to be employed in preparing the communities to develop their community health care systems and the establishment of community health organization to manage the community health programs Organizing work in the communities were done in 3 phases PAR as fascinating strategy for maximum community involvement through collective identification and analysis of community health problems and collective health action Available funds to finance community initiated projects COPAR? Since Management Leadership and Jurisprudence are courses taught in the classroom members of this group of students were trained to manage and acts as leaders of the different levels of the students who were involved in COPAR Principles of management were applied in carrying out primary health care The community members, members, CHW’s CHW’s and leaders were empowered to manage their own health projects Conducted seminars and trainings as well as health education and services needed by community(exposure and immersion 6-8 weeks) THE HRDP-COPAR PROCESS 1. PREPRE-EN ENT TRY PHAS PHASE E 2. ENTRY PH PHASE ▪
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COMMU COMMUNI NITY TY STUDY/ STUDY/DIA DIAGNO GNOSIS SIS PHASE/RESEARCH PHASE 4. COMMUNIT COMMUNITY Y ORGANIZAT ORGANIZATION ION AND CAPABILIT CAPABILITYYBUILDING PHASE 5. COMM COMMUN UNIT ITY Y ACTI ACTION ON PHA PHASE SE 6. SUSTEN SUSTENAN ANCE CE AND STRE STRENG NGTHE THENIN NING G PHASE PHASE 1. Pre-Entry Phase
Preparation of the Institution Train faculty and students in COPAR. Formulate plans for institutionalizing COPAR. Revise/enrich curriculum and immersion program. Coordinate participants of other departments. Site Selection Initial networking with local government. Conduct preliminary special investigation. Make long/short list of potential communities. Do ocular survey of listed communities. Criteria for Initial Site Selection o Must have a population of 100-200 families. o Economically depressed. o No strong resistance from the community. o No serious peace and order problem. o No similar group or organization holding the same program. Identifying Potential Barangay o Do the same process as in selecting municipality. o Consult key informants and residents. o Coordinate with local government and NGOs for future activities. Choosing Final Barangay o Conduct informal interviews with community residents and key informants. o Determine the need of the program in the community. o Take note of political development. o Develop community profiles for secondary data. o Develop survey tools. o Pay courtesy call to community leaders. o Choose foster families based on guidelines.
Identifying Host Family o House is strategically located in the community. o Should not belong to the rich segment. o Respected by both formal and informal leaders. o Neighbours are not hesitant to enter the house. o No member of the host family s hould be moving out in the community. 2. Entry Phase
Guidelines for Entry o Recognize the role of local authorities by paying them visits to inform their presence and activities. o Her appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of their being role model. o Avoid raising the consciousness of the community residents; adopt a low-key profile.
Activities in the Entry Phase Integration - establishing rapport with the people in continuing effort to imbibe community life.
§ living with the community
§ seek out to converse with people where they usually congregate
§ lend a hand in household chores
§ avoid gambling and drinking Deepening social investigation/community study verification and enrichment of data collected from initial survey
conduct baseline survey by students, results relayed through community assembly
Leader Spotting Through Sociogram. Key persons - approached by most people Opinion leader - approach by key persons Isolates - never or hardly consulted 4.NCD prevention and control program 1. Preven Preventio tion n and Contr Control ol of Cardi Cardiova ovascul scular ar Diseases 2. Cancer Cancer Prev Prevent ention ion and and Earl Early y Detec Detectio tion n 3. Nat’l Nat’l Diabete Diabetes s Prevent Prevention ion and Control Control Progra Program m 4. Preven Preventio tion n and Cont Control rol of of Kidney Kidney Dise Disease ase 5. Progra Program m on Mental Mental Healt Health h and Mental Mental Disor Disorder ders s 6. Prog Progra ram m on Drug Drug Depe Depend nden ence/ ce/ Substance Abuse 7. Commun Community ity-Ba -Based sed Rehabi Rehabilit litati ation on Program Program 8. Progra Program m on the Elder Elderly/ ly/Ger Geriat iatric ric Nursi Nursing ng Services 9. Progra Programs ms on on Blindn Blindness ess,, Deafn Deafness ess and and Osteoporosis 1. Prevention and Control of Cardiovascular Diseases
heart – 1st leading cause of
blood vessels -
death
2nd
Types: 1.
Cong Congen enit ital al Hea Heart rt Dis Disea ease se (CH (CHD) D)::
2.
Rheu Rheumat matic ic Fev Fever er or Rhe Rheuma umatic tic Heart Heart Dise Disease ase
3. Hyp Hyperte ertens nsio ion n 4. prim primar ary y or esse essent ntia iall 5. Ischem Ischemic ic Heart Heart Diseas Disease/ e/ Athero Atheroscl sclero erosis sis 1.Congenital Heart Disease (CHD): Result of the abnormal development of the heart that exhibits septal defect, patent ductus arteriosus, aortic and pulmonary stenosis, and cyanosis; most prevalent in children Causes: environmental factors, maternal diseases or genetic aberrations 2. Rheuma Rheumatic tic Fever Fever or Rheu Rheumat matic ic Heart Heart Diseas Disease: e: Systematic inflammatory disease that may develop as a delayed reaction to repeated and an inadequately treated infection of the upper respiratory tract by group A beta-hemolytic streptococci. 3. Hypert Hypertens ension ion:: Persist Persistent ent eleva elevatio tion n of the arterial blood pressure. 4. primary primary or essential) essential) ;frequent ;frequent among among females females but severe,malignant form is more common among males 5. Ischem Ischemic ic Heart Heart Diseas Disease/ e/ Athero Atheroscl sclero erosis: sis: Condition usually caused by the occlusion of the coronary arteries by thrombus or clot formation. higher among males than females for the latter are protected by estrogen before menopause PF: HPN, DM, Smoking Minor RF: stress, strong family history, obesity CVD CVD Primary Prevention: CVD Primary Prevention thru health education is the main focus of the program: 1. mainte maintenan nance ce of ideal ideal body body wt. 2. diet low fat 3. alcoho alcohol/s l/smok moking ing avoida avoidance nce 4. Exercise 5. regu regula lar r BP BP che check ck up 2. Cancer Cancer Prev Prevent ention ion and and Early Early Detect Detection ion Any malignant tumor arising from the abnormal and uncontrolled division of cells causing the destruction in the surrounding tissues.
Common Cancer: Lung cancer, cervical cancer, colon cancer, cancer of the mouth, breast cancer, skin cancer, prostate cancer.
3rd leading cause of illness and death ( Phil.)
Incidence can only be reduced thru prevention thru prevention and early detection NINE WARNING SIGNS OF CANCER: Change in blood bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty in swallowing Obvious change in wart or mole Nagging cough or hoarseness Unexplained anemia Sudden unexplained weight loss Prevention & Early Detection PRINCIPLES OF TREATMENT OF MALIGNANT DISEASES One third of all cancers are curable if detected early and treated properly. Three major forms of treatment of cancer: Surgery Radiation Therapy Chemotherapy 3.Nat’l Diabetes Prevention and Control Program Aim: Controlling and assimilating healthy lifestyle in the Filipino culture ( 2005-2010) thru IEC Main Concern: modifiable risk factors( diet, body wt., smoking, alcohol, stress, sedentary living, birth wt. ,migration 4.Prevention and Control of Kidney Disease
Acute or Rapidly Progressive Renal Failure : A 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 fluids leading to disruption in homeostatic, endocrine, and metabolic functions.
Acute Nephritis: A severe inflammation of the kidney caused by infection, degenerative disease, or disease of the blood vessels.
Chronic Renal Failure: A progressive deterioration of renal function that ends as uremia and its complications unless dialysis or kidney transplant is performed. Neprolithiasis: A disorder characterized by the presence of calculi in the kidney. Nephrotic Syndrome: A clinical disorder of excessive leakage of plasma proteins into the urine because of increased permeability of the glomerular capillary membrane Urinary Tract Infection: A disease caused by the presence of pathogenic microorganisms in the urinary tract with or without signs and symptoms. Renal Tubular Defects: An abnormal condition in the reabsorption of selected materials back into the blood and secretion, collection, and conduction of urine. Urinary Tract Obstruction: A condition wherein the urine flow is blocked or clogged. 5. Program on Mental Health and Mental Disorders 6. Program on Drug Dependence/ Substance Abuse 7.Community-Based Rehabilitation Program A creative application of the primary health care approach in rehabilitation services, which involves measures taken at the community level to use and build on the resources of the community with the community people, including impaired, disabled and handicapped persons as well.
Goal: To improve the quality of life and increase productivity of disabled, handicapped persons. Aim: To reduce the prevalence of disability through prevention, early detection and provision of rehabilitation services at the community level. 8. Progra Program m on the Elder Elderly/ ly/Ger Geriat iatric ric Nursi Nursing ng Services 7 humanitarian issues: family, health, income, security, employment employment and labor, labor, social welfare, education, recreation, culltural activities and housing Leading causes of illness:elderly Influenza, HPN, diarrhea, bronchitis, TB, diseases. of the heart, pneumonia, malaria, malignant neoplasm, chickenpox Leading causes of death:elderly Diseases of heart and vascular system Pneumonia, TB, CCOPD Malignant neoplasms Diabetes Nephritis Accidents 9.Programs on Blindness, Deafness and Osteoporosis Cataract- main causes of blindness VAD- main cause of childhood blindness; most serious eye problem of Fil. children below 6 yrs. old Osteoporosis special problem in women, highest bet. 50—79 yrs. old, MENOPAUSE- main cause Prevention of NCD/Role of Nursing in Health Promotion And Advocacy Yosi Kadiri- anti smoking Edi Exercise/Hataw-regular physical activity Tiya Kulit/ Iwas Sakit Diet-low salt, low fat, high fiber diet Mag HL – exercise, no smoking, avoidance of alcohol, healthy diet, iwas stress, watch wt. Sentrong Sigla Movement ( SSM) -a certification recognition program which develops and promotes standards for health facilities Joint effort bet.: 1.DOH – provides technical and financial assistance packages for health care 2. LGUs – direct implementers of health programs & prime developers developers of health centers and hospitals making services accessible to every Filipino Pillars of SSM 1. Qual Qualit ity y Ass Assur uran ance ce 2. Grant Grant and Techni Technical cal Assist Assistanc ance e 3. Heal Health th Prom Promot otio ion n 4. Awards Expected Outcome: SSM Empowered individuals adopting healthy lifestyle, improved improved health-seeking behavior and well-being & increased demand for quality health services Institutions will develop policies, provide quality services , institute system for surveillance/ merits and advocate for laws Programs: SSM EPI Disease Surveillance CARI CDD Nutrition/ Micronutrient Supplementation *Food Fortification : Rice –iron; Oil and sugar – Vit. A; Flour-Vit. A & iron; Salt- iodine
Integrated Management of Childhood Illness ( IMCI)
Integrates management of most common childhood problems problems ( diarrhea, pneumonia, measles, malnutrition, DHF, malaria) Involves family members and community in the health care process for physical growth and mental development & disease prevention IV. The Public Health Nurse Definition and terms: Public Health Nursing refers to the practice of nursing in local/national health departments (which includes health centers and rural health units) and schools. It is a community health nursing practice in the public sector Public Health Nurses Refers to the nurses in the local/national health departments or public schools whether their official position title is public health nurse or nurse or school nurse Leaders in providing quality health services to the communities First level of health workers to be knowledgeable about new public health technologies and methodologies Usually the first ones to be trained to implement new programs and apply new technologies Qualifications Must be professionally qualified and licensed to practice in the arena of public health nursing Consistent with the nursing law of 2002 (RA 9173) 7 Roles and Functions 1. Mana Manage geme ment nt func functi tion on Inherent in the practice of PHN Organizes the nursing service of the local health agency Applications of 5 management Functions “POSDC” in organizing the nursing service and the local health agency. 2. Supe Superv rviso isory ry func functi tion on Supervisor of the midwives and other health workers 3. Nurs Nursin ing g car care e func functi tion on Inherent function of the nurse Based on the science of art and caring Caring for all levels of clientele toward health promotion and disease prevention 4. Collab Collabora oratin ting g and coordi coordinat nating ing functi function on Care coordinators for communities and their members Establishes linkages and collaborative relationships with other health professionals, government agencies, private sectors, NGO’s people’s organizations to address health problems 5. Health Health prom promoti otion on and educ educati ation on functi function on Activities goes beyond health teachings and health information campaigns 6. Trai Traini ning ng func functi tion on Initiates the formulation of staff development and training programs for midwives and other auxiliary workers 7. Rese Resear arch ch func functi tion on Participates in the conduct of research and utilizes research findings in her practice Disease surveillance Measure the magnitude of the problem Measure the effect of the control program Competencies and skills 1. Commun Community ity health health nursin nursing g proc process ess 2. Nursing Nursing proced procedures ures during during clinic clinic and home visits 3. Comm Commun unit ity y orga organi nizi zing ng 4. Health Health promot promotion ion and educa educatio tion n
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5. Surv Survei eill lla ance nce 6. Reco Record rdin ing g and and rep repor orti ting ng 7. epid epidem emio iolo log gy IV. SPECIAL FIELDS IN COMMUNITY HEALTH NURSING School nursing and occupational health nursing School nursing A type of public health nursing that focuses on the promotion of health and wellness of the pupils/students, teaching and non teaching personnel of the schools.
The primary role is to support the student learning and ensure that educational potential is not hampered by unmet health needs Assist the students in making choices for a healthy life style, reduce risk taking behaviour and focus on issues such as prevention of drug and substance abuse, teenage pregnancy, STD,Malnutrition, CD and NCD founded by: Lillian Wald (1902)
a member of the professional educational employed to aid students in developing their full health potential in health and education HNC (health and Nutrition Center) of the DepEd Mandated to safeguard the health and nutritional well-being of the total school population. 2 division 1. health 4 sections Medical Dental Nursing Health education 2. nutr nutrit itio ion n divi divisi sion on Objectives of School Nursing
General: General: To promote promote and maintain maintain the health of the school populace by proving comprehensive and quality nursing care.
1.
6 Specif Spe cific ic : Provid Provide e quality quality nursi nursing ng servic service e to the school school population 2. Create Create awaren awareness ess among among child children ren,, personn personnel el and administrators on the importance of the promotive and preventive aspects of health through health education. 3. Encour Encourage age the the provisi provision on of standar standard d functio functional nal facilities 4. Providing Providing nursing nursing personnel personnel with opportuniti opportunities es for continuing education and training. 5. Conduc Conductt and partic participa ipate te in researc researches hes relate related d to nursing care. 6. Establish/ Establish/ strengthen strengthen linkages linkages with governmen governmentt and non-government organization/agencies for school community health work. 9 Duties and responsibilities of the school nurses 1. Heal Health th advo advoca cacy cy 2. Health Health and nutri nutritio tion n assessme assessment nt includ including ing other other screening procedures such as vision and hearing. 3. Superv Supervisi ision on of the the healt health h and safe safety ty of the school plant. 4. Treatm Treatment ent of comm common on ailmen ailments ts and atten attendin ding g to emergency cases. 5. Referrals Referrals and follow-up follow-up of pupils pupils and personnel personnel 6. Home vi visits 7. Comm Commun unit ity y outre outreac ach h E.g.,: attending community assemblies and organizing school community health councils. 8. Record Recording ing and repo reporti rting ng of accompl accomplish ishmen ments ts ▪
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Monito Monitorin ring g and eval evaluat uation ion of prog program rams s and projects. Skills and competencies 1. Assessm Assessment ent and screen screening ing skills skills 2. Heal Health th cou counse nsell llin ing g skil skills ls 3. Soci Social al mobi mobili liza zati tion on skil skills ls 4. Good Good oral oral and writt written en commun communica icatio tion n skills skills 5. Basi Basic c man manag agem emen entt skil skills ls 6. Life skills 16 function of the school nurse
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7. 8.
School health and nutritional survey (from 1 st visit and Qyr)- for data and planning purposes Survey of the ff: current health situation and nutritional status Facilities Health education activities Puttin Putting g up a school school clinic clinic (R.A (R.A.. 124) 124) Health Health asses assessme sment nt (ever (every y year year or or with with epidemics) Purpose: detect the signs of illness and physical defects for early correction. Health habits Standa Standard rd vision vision testi testing ng for schoo schooll childre children n (20/20) a Purpose: Screen students with poor visual acuity and indentify other ocular problems Refer students with eye disease and errors of refraction for further examination and management. Ear Ear exam examin inat atio ion n Methods: Observation Examination by using penlight or otoscope Screening test (whisper test, conversation voice test, ball pen click.) Height Height and and weight weight measure measuremen mentt and nutriti nutritiona onall status determination Height and weight measurement is a procedure for evaluating the tallness or the shortness and the heaviness of a pupil. DepEd <10 years old=weight for age and height for age >10 years old= BMI Appropriate school feeding programs with rice, milk or fortified noodles are given to children with below normal nutritional status for 120 feeding days Deworming is a pre requite prior to feeding Consent from parent is pre requisite prior to deworming Medi Medica call ref refer erra rals ls Attend Attendanc ance e to to emerge emergency ncy cases cases
Encourage the importance of immunization for prevention 13. Establishm Establishment ent of Data Bank on School Health Health and Nutrition Activities Treatment in the school clinic Record of the school visit Health assessment report of the school health personnel Health and nutritional status of pupils/students Form 86 of teaching and non teaching personnel Teachers health profile Records of attended emergency case Inventory of clinic and equipment supplies Health and nutrition activities in school Record of accomplishment of school health services Records of officers/ officials of the School-Community Health Council and their accomplishment Action plan 14. School School plant inspection inspection for healthy environment environment Others concerns: school site, area, location, space and sanitation, classroom and others rooms, school clinics, water supplies, sanitation, school canteen. Inspect for the size, lighting, ventilation, arrangement of seats. 15. Rapid Classroom Classroom Inspection( Inspection( after holidays and epidemics but not to exceed more than a month except for cases of epidemics) Procedure same as HA Purpose: Detect cases of CD Note the correction that have been made Note if the eyeglasses are correctly adjusted Note the general cleanliness of the students Note new ailments. 16. Home visitation Indication: Pupils whose parents are afraid of some medical procedures Pupils who get re-infected because of home conditions Pupils suffering from CD Pupils who are absent frequently because of sickness Pupils who are malnourished. •Occupational health nursing By American Association of Occupational Health
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Student health counselling( for student who manifest the physical and emotional symptoms) symptoms) (parents, teacher, and student) 10. Health Health and nutrition nutrition education education activities activities Training programs, conferences/workshops for teachers, pupils and parents 11. Organization of school-Community school-Community Health and Nutrition Councils Membership shall come from both school and community This attend to the health related problems and concerns 12. Communicab Communicable le disease control control In participation of both the teachers, parents and students
• The special practice that provides for and delivers health care services to workers and worker populations. The practice focuses on promotion, protection, and restoration of workers’ health within the context of a safe and health work environment. Occupational health nursing is autonomous, and occupational health nurses make independent nursing judgments in providing occupational health services. The foundation of occupational occupati onal health nursing practice is research-based with an emphasis on optimizing health, preventing illness and injury, and reducing health hazards. By PNA – ANSAP, 1982 •Is aimed at assisting workers in all occupations to cope with actual and potential stresses in relation to their work and work environment. It is primarily geared at helping workers attain and maintain optimum level of physical and psychological functioning.
mission
compliance with the sanitation code and its implementing rules and regulations 2. Recommends to Local Health Authority the issuance of license/ business permits and suspensions or revocation of the same for any violations of the conditions upon which said licenses or permits had been issued, pursuant to existing rules and regulation. 3. Coordinates with other governments agencies relative to the implementation of the implementing rules and regulations 4. Attends to complaints of all establishment in the area of assignment related to industrial hygiene and recommends appropriate measures for immediate compliance. 5. Participate to provide, install and maintain in good condition all control facilities and protective barriers for potential and actual hazards. 6. Informs all affected workers regarding the nature hazards and the reasons for the control measures and protective equiptment. 7. Makes a periodic testing for physical examination of the workers and other health examination related to workers exposure to potential or actual hazards in the work place 8. Provide control measures to reduce noise, dust, health and other hazards. 9. Ensure strict compliance on the regular use and proper maintenance of Personal Protective Equipment (PPE) 10. Provide employees employees an occupational occupational health services and facilities 11. Refers or elevate to higher authority all unresolved issues in relation to occupational and environmental; health problems 12. Prepare and submit yearly reports to the local and national Government Application of Public Health Principles to Occupational Health Nursing
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disease trends including morbidity and mortality statistics, and social environmental conditions that will provide pertinent information for the establishment of priorities in planning and implementing occupational health programs B. Work Worker er Asses Assessm smen ent: t: Assessment of the workforce to determine populations at risk for occupationally related injury or illness. Types of Classification: Age, sex, race, type of work, the presence or absence of disability. C. Applic Applicatio ation n of of Epi Epidem demiol iolog ogy y To determine relationship of work and injury or illness Methods use: Toxicology, pathology, ergonomics D. Team Team Appr Approa oach ch Collaboration with occupational health team for the development of comprehensive occupational health program Industrial hygienist, epidemiologist, medical technologist, toxicologist, safety engineer, ergonomist, physician, occupational health nurse, occupational health therapist E. Progra Program m Planni Planning ng and and Implem Implement entati ation on Goal: promotion of wellness and prevention of illness and injury among workers. Application: Primary prevention A program to ensure the health of prospective employees/ workers includes a history and physical examination to assess level of wellness. Maintenance of that level is provided through appropriate job placement. Secondary Prevention Applied once the health problems is not meet by primary prevention methods: Early detection and treatment of both work-and non-work related health problems Tertiary prevention: Rehabilitation toward workers disabled by occupational and non occupational problems Methods: Evaluation of current status Enhancement of employability, and appropriate job placement of employees Services: Physical occupational and speech therapy Vocational training Chronic pain clinics Remedial reading Mathematics program F. Referr Referral al to to Com Commun munity ity Resour Resources ces G. Prog Progra ram m Eva Evalu luat atio ion n Assessment of program to determine benefits in terms of decreasing loss of productivity related to employee health problems is carried out. Issues In Occupational Health Nursing A. A. Phys Physic ical al Haz Hazar ard d ▪
To ensure so far as possible every working man in the country is safe and in healthful working conditions Occupational Health Team 1. Occu Occupa pati tion onal al Heal Health th Nurs Nurses es 2. Occupa Occupatio tional nal phys physici icians ans-- focus focus on the prevention, detection, and treatment of workrelated diseases and injuries. 3. Industrial Industrial hygienistshygienists-recog recognize, nize, evaluate, evaluate, and control toxic exposures and hazards in the work environment. 4. Safety Hazards engineers- focus on the prevention of occupational injuries and the maintenance or creation of safe workplaces and safe work practices. 5. epidemiologists- study and describe the natural history of occupational diseases and injuries in population groups. 6. toxicologists- study and describe the toxic properties of agents used in work application to which workers may be exposed. 7. Indust Industria riall engine engineers ers-- desig design n the tool tools, s, equipment, and machines used in manufacturing and other work applications 8. Ergono Ergonomis miststs- study study desi design, gn, and and promot promote e the healthy interface of humans, their tools, and their work. 9. Enviro Environme nmenta ntall enginee engineersrs- conce concentr ntrate ate on environmental controls to limit environmental pollution and achieve a healthy environment. Function of Public Health Nurse as an Occupational Health Nurse 1. Work Work with with the occu occupat pation ional al healt health h team team to lead the sanitary hygiene of all industrial establishment including hospitals to determine their
Community Assessment Assess ment : Identify the demographic data on
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Are agents within the work environment that may cause tissue damage or other physical harm. Radiation, extreme temperature, noise, electric and magnetic field, lasers, microwaves, and vibration. Acute: acoustic trauma from excessive noise, heat stress or stroke, skin rashes, eye injuries from infrared radiation, skin burns, cuts or contusions. Chronic: NIHL, multiple myeloma and leukaemia's from exposure to ionizing radiation, teratogenic or genetics effects induced by certain types of radiation. B. Chem Chemic ical al Haza Hazard rds: s: Various forms of either synthetic or naturally occurring chemicals in the work environment may be potentially toxic or irritating to the body system through inhalation, skin absorption, ingestion, or accidental injection. Mists, vapors, aerosols, gases, medications, particulate matters (dusts and fumes), solvents, metals, oil synthetic textiles, pesticides, explosives, and pharmaceuticals. Specifically, health care workers are exposed to chemical hazards such as anaesthetic gases, chemotherapeutic and antineoplastic agents, tissue fixative reagents, disinfectant and detergents, sterilizing agents, solvents, latex and mercury. Acute: respiratory irritation due to smoke, poisoning from accidental ingestion, metal-fume fever, chemical burns, contact dermatitis and other dermatoses Chronic: cancers (mesothelioma, bronchogenic and GI carcinomas); pleural diseases; occupational asthma; hypersensitivity pneumonitis, birth defects and neurological disorders. mesothelioma C. Biological Hazards: Biological agents such as viruses, bacteria, fungi, mold, or parasites may cause infection disease via direct contact with infected individuals/ animals, contaminated body fluids, or contaminated objects, surfaces Workers in certain occupations ( health care, biological research and animal handling) have a high incidence of infectious diseases. Acute: self limiting infections such as colds and influenzas, measles, skin and parasitic infections. Chronic: TB, chronic Hepa B, HIV and AIDS D. Mechanical Hazards Mechanical agents may cause stress on the musculoskeletal or other body systems Hazards include inadequate work-station and tool design, frequent repetition of a limited movement, repeated awkward movements with hand-held tools, local vibrations. Acute: neck strain and other muscular fatigue from forceful exertion or awkward positioning, and visual; fatigue. Chronic: Raynaud's syndrome from use of vibrating power tools, carpal tunnel syndrome Raynaud's syndrome E. Psychosocial Hazards: Hazards: Often related to trauma to the nature of the job, the job content, the organizational structure and culture, insufficient training and education regarding job requirements, and the physical condition in the work place, leadership and management styles. Interpersonal conflict, unsafe working conditions, overtime, sexual harassment, racial inequality, role conflict, shift work, limited
autonomy, poorly defines expectations and work instructions, and absent or limited reward. Acute: increased HR, increased BP, sleep disturbances, fatigue, depression, substance abuse, worksite violence. Chronic: HPN, alcoholism, CAD, mental illness, GI f.Occupational injury - is any injury, such as cut, fracture, sprain, or amputation that results from a single incident in the work environment. g.Occupational illnessillness- is any abnormal condition or disorder, other than one resulting from a occupational injury, caused by exposure to environmental factors associated with employment. School Nursing Health assessment METHODS USED: a. Interview b. Nutrit Nutrition ional al Assessm Assessment ent – height height and and weight weight measurements c. Vision Vision Acuity Acuity Test/ Test/ Hearin Hearing g Test Test d. IPPA e. V/S f. Apprai Appraisal sal of of the Gene General ral and and Phys Physica icall and Ment Mental al Condition g. Recording PREPARATION: a. Well, Well, lighte lighted, d, venti ventilat lated, ed, scree screened ned room room or a corner of the classroom b. 2 or 3 chair chairs s accor accordin ding g to need need c. Waste ba basket d. Hand Hand was washi hing ng faci facili liti ties es e. Tong Tongue ue dep. dep.,, pen penli ligh ghtt f. Step/ s ph phygmo g. Form Forms/ s/ rec reco ords rds PROCEDURES OF HEALTH ASSESSMENT 1. Nx condu conduct ct a classr classroom oom lect lecture ure to educ educate ate the the pupils on what to do during the Health Assessment. 2. 3-5 chil childre dren n at a time time should should be be waiting waiting for for the the assessment 3. Wash Wash hand hand by the star startt of heal health th asses assessme sment nt 4. Assess Assess the childr children en one one by one 5. Ins pe pection: a. From From head head to foot foot b. Skin Skin disea isease ses s c. Sign Signs s of abn abnor orma mall cond condit itio ion n d. Stet Stet should should be use use across across the the heart heart// lung lung assessment e. Findin Findings gs shoul should d be reco recorde rded d during during the the assessment STEPS a. ARMS, ARMS, HANDS, HANDS, AND FINGER FINGER NAILS: NAILS: Ask the child to roll their sleeves Extend their arms Show hands one side first, then the other Spread their finger b. EYES Ask the child to pull his lower lid using his index finger and ask him to look up c. TEETH Ask the child to open is mouth and say “ah” to show his throat d. NOSE
Ask the child to place his 2nd finger on the tip of the nose and pull up his nose and extend his head backward
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EARS
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Ask the child to push back his hair behind his ear and pull the outer ear up, slightly backward/ and then forward. NECK and CHEST Examine the neck Chest/ back should be auscultated HAIR
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Ask the pupil to run his fingers through his hair several times Ask to show the nape by the pulling the hair up. h. FEET/LEG Ask the girl to pull up her dress The boy his trousers to their knees Or you can observe while they performed marching i. GENE GENERA RAL L APPE APPEAR ARAN ANCE CE IMPORTANT REMINDERS IN HA: 1. If the the health health perso personne nnell is of the the opposi opposite te sex, sex, performed the procedure in the presence of the same sex. 2. The resu result lt shoul should d be disc discuss uss to to the teac teacher her 3. If 4. Refer Refer case cases s that that canno cannott be handle handle stat stat 5. Inform Inform parent parents s if the findin findings gs
COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH (COPAR) Importance of COPAR COPAR is an important tool for community development and people empowerment as this helps the community workers to generate community participation in development activities. COPAR prepares people/clients to eventually take over the management of a development program(s) in the future. COPAR maximizes community participation and involvement; community resources are mobilized for community services. Principles of COPAR 1. People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change, and are able to bring about change. 2. COPAR should be based on the interest of the poorest sector of society. 3. COPAR should lead to a self-reliant community and society. Phases of the COPAR Process 1. Pre-Entry Phase Preparation of the Institution o Train faculty and students in COPAR. o Formulate plans for institutionalizing COPAR. o Revise/enrich curriculum and immersion program. o Coordinate participants of other departments. Site Selection o Initial networking with local government. o Conduct preliminary special investigation. o Make long/short list of potential communities. o Do ocular survey of listed communities. Criteria for Initial Site Selection o Must have a population of 100-200 families. o Economically depressed. o No strong resistance from the community. o No serious peace and order problem. o No similar group or organization holding the same program. Identifying Potential Municipalities o Make long/short list. Identifying Potential Barangay o Do the same process as in selecting municipality. o Consult key informants and residents. o Coordinate with local government and NGOs for future activities. Choosing Final Barangay o Conduct informal interviews with community residents and key informants. o Determine the need of the program in the community. o Take note of political development. o Develop community profiles for secondary data. o Develop survey tools.
o Pay courtesy call to community leaders. o Choose foster families based on guidelines. Identifying Host Family o House is strategically located in the community. o Should not belong to the rich segment. o Respected by both formal and informal leaders. o Neighbours are not hesitant to enter the house. o No member of the host family should be moving out in the community. 2. Entry Phase Guidelines for Entry o Recognize the role of local authorities by paying them visits to inform their presence and activities. o Her appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of their being role model. o Avoid raising the consciousness of the community residents; adopt a low-key profile. Activities Activities in the Entry Phase o Integration - establishing rapport with the people in continuing effort to imbibe community life. living with the community seek out to converse with people where they usually congregate lend a hand in household chores avoid gambling and drinking o Deepening social investigation/community study verification and enrichment of data collected from initial survey conduct baseline survey by students, results relayed through community assembly
Leader Spotting Through Sociogram. Key persons - approached by most people Opinion leader - approach by key persons Isolates - never or hardly consulted 3. Organization-building Phase Entails the formation of more formal structure and the inclusion of more formal procedure of planning, implementing, and evaluating community-wise activities. It is at this phase where the organized leaders or groups are being given training (formal, informal, OJT) to develop their style in managing their own concerns/programs. Key Activities o Community Health Organization (CHO) preparation of legal requirements guidelines in the organization of the CHO by the core group election of officers o Research Team Committee o Planning Committee o Health Committee Organization o Others o Formation of by-laws by the CHO 4. Sustenance and Strengthening Phase Occurs when the community organization has already been established and the community members are already actively participating in community-wide undertakings. At this point, the different committee’s setup in the organization-building phase is already expected to be functioning by way of planning, implementing and evaluating their own programs, with the overall guidance from the community-wide organization. Key Activities o Training of CHO for monitoring and implementing of community health program. o Identification of secondary leaders. o Linkaging and networking. o Conduct of mobilization on health and development concerns. o Implementation of livelihood projects.
MATERNAL HEALTH PROGRAM Tasked:
to reduce MMR by three quarters by 2015 to achieve ( millennium Development Goal) MDG Maternal Mortality Rate (2003) CAUSE Other Complications related to pregnancy occurring in the course of labor, delivery and puerperium
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Hypertension complicating pregnancy, childbirth and puerperium (25%)
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Postpartum hemorrhage (20.3%)
Pregnancy with abortive outcome (9%) 4. Hemorr Hemorrhag hage e relat related ed to to preg pregnan nancy cy Strategic thrusts for 2005-2010 1. Launch Launch and and imple implemen mentt Basic Basic Emerge Emergency ncy and and Obstetric Care (BEMOC) strategy in coordination with DOH Entails establishment of facilities that provide emergency obstetric care for every 125,000 population and which are located strategically 2. Improve Improve quality quality of of prenata prenatall and postnatal postnatal care Pregnant women should have at least four (4) prenatal visit 3. Reduce Reduce wom women’ en’s s exposu exposure re to health health risk risks s Institutionalization of responsible parenthood 4. Stakeh Stakehold olders ers must must adv advoca ocate te for for health health Resource generation and allocation for health services Essential Health Service Packages A. Ante Antena nata tall Regis Registr trat atio ion n
B. C. D. E. F.
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ORS for both unconscious or with convulsions IVF if not trained to do so. 3. Post Post part partum um blee bleedi ding ng What to do?: Massage uterine and expel clots. If bleeding persist: Place cupped palmed on uterine fundus and feel for state of contraction Massage fundus in a circular motion Apply bimanual uterine compression if mem treatment done and postpartum bleeding still persist. Give ergometrine 0.2mg IM and another dose after 15’ Do not give: Mem to woman with eclampsia, pre eclampsia or HPN 4. Intest Intestina inall para parasit site e infect infection ion What to do? Give mebendazole 500mg tab. Single dose anytime from 4-9mos. Of pregnancy if none was given in the past 6 mos. Do not give:
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5. Malaria What to do?
Tetanus Toxoid Immunization Micronutrient Supplementation Treatment Treatment of Disease Diseases s and Other Condition Conditions s Clea Clean n and and Safe Safe deli delive very ry Recomm Recommend ended ed Schedu Schedule le for Post Post Partu Partum m Care Care Visits
Importance of BF 1. Antenatal Registration 2. Tetanus Toxoid Immunization Dose:0.5ml Route: Intramuscularly Site: Right or Left Deltoid/Buttocks 3. Micronutrient Supplementation 4. Treatment of Diseases and Other Conditions Types: 1. Diffic Difficult ulty y of breathi breathing/ ng/ obstr obstruct uction ion of airway airway 2. Unco Uncons nsci ciou ousn snes ess s 3. Post Post part partum um blee bleedi ding ng 4. Intest Intestina inall parasi parasite te infect infection ion 5. malaria 1.Difficulty of breathing/ obstruction of airway What to do? Clear the airway Place in her best position Refer woman to hospital with EmOC capabilities. Do not give anything PO 2. Unco Uncons nsci ciou ousn snes ess s What to do? Keep on her back arms at the side. Tilt head backwards (unless trauma is suspected) Lift chin to open airway Clear secretions from throat. Give IVF to prevent or correct s hock. Monitor BP and SOB every 15’ Monitor fluid given. If DOB and puffiness develops, stop the infusion. Monitor UO Do not give:
Mebendazole in the 1st 1-3mos. Of pregnancy This might cause congenital problem in the baby
Give sulfadoxin-pyrimethamine to woman from malaria endemic areas who are in 1st or 2nd pregnancy
500mg-25mg tab., 3 tabs. At the beginning of 2 nd to 3rd tri semesters not less than one month interval. E. Clea Clean n and and Saf Safe e del deliv iver ery y Presence of skilled birth attendant Purpose to ensure hygiene during labor and delivery. Provide non-traumatic delivery recognize complications Referred those complicated deliveries to high level of care Steps to follow during labor, childbirth and immediate postpartum Please refer accordingly 1. Do a quick quick check check upon upon admissi admission on for for emergen emergency cy signs: Unconscious/convulsion Vaginal bleeding Severe abdominal pain Looks very ill Severe headache with visual disturbance Severe breathing difficulty Fever Sever vomiting 2. Make the woman comfortable Establish rapport with the client by greeting and interviewing to make her comfortable 3. Assess the woman in labor - to determine the status during labor LMP Number of pregnancy Start of labor pains Age/height Danger signs of pregnancy Taking the history through interview will help determine the client’s condition during delivery of baby 4. Determine the stage of labor
Uterine contractions Bulging vulva Leaking amniotic fluid Vaginal bleeding IE 5. Decide if the woman can safely deliver By assessing the condition of the client and not finding any indication that could harm the delivery of the baby 6. Give supportive care throughout labor. Purpose: To deliver clean, safe and free from fatigue 1. Encour Encourage age to to take take a bath bath at the the onset onset of of labor labor 2. Encour Encourage age to to drink drink but but not not eat as as this this may interfere surgery in case needed 3. Encour Encourage age to to empty empty bladd bladder er and bowe bowels ls to facilitate delivery of the baby. Remind to empty the bladder every 2 hours.
4.
Encourage to do breathing technique to help energy in pushing out the vagina. Panting can be done by breathing with open mouth with 2 short breaths followed by long breaths. This prevent pushing at the end of the 1st stage 7. Monitor and manage the different stage of labour -watch out for any danger signs 1. First First stag stage: e: not not in acti active ve labo labor r Cervix: 3cms Contraction: weak Frequency: < 2 to 10’ What to do? Check Q 1hr. for emergency signs, frequency and duration of contractions and FHT. Check Q 4hrs. For fever, pulse, BP and cervical dilatation. Record time of ROM and color of amniotic fluid Assess progress of labor Refer STAT to hospital with complete facilities for the ff condition: If after 8hrs, contractions are stronger and more frequent but not progress in cervical dilatation, with or without membranes ruptured It is false labor if after 8hrs there is no increase in contractions, membranes are not ruptured and no progress in cervical dilatation. Not to do: IE more frequently than Q 4hrs. First stage: active labor 4cms cervical dilatation What to do? Check Q30’ for emergency signs Check Q4hrs. For fever, pulse, BP and cervical dilatation Record time of ROM and color of amniotic fluid Record finding in partographs/patient record. Not to do: Do not allow woman to push unless delivery is imminent. It will just exhaust the woman Do not give medication to speed of labor. It may cause trauma to mother and the baby Second stage: Cervix: 10 cms. or bulging thin perineum and head visible ▪
▪
What to do:
Check Q 5’ for perineum thinning and bulging, visible descend of the had during contraction, emergency signs, FHR and mood and behavior Continue recording in the partograph.
Not to do:
Do not apply fundal pressure to help deliver the baby
Third stage:
Between birth of the baby and delivery of the placenta
Deliver the placenta Check the completeness of placenta and membranes
What to do:
Not to do: Do not squeeze or massage the abdomen to deliver the placenta 8. Monito Monitor r close closely ly within within 1hr. 1hr. After After delive delivery ry and and give supportive care. 9. Continue Continue care care after 1hr. Postpartum Postpartum.. Keep Keep watch watch closely for at least 2hrs. 10. Educate Educate and counsel counsel on FP and provid provide e FP method if available and decision was made by a woman. 11. Informs, Informs, teach teach and counsel counsel the woman on important MCH messages: Birth registration Importance of BF Newborn Screening for babies delivered in RHU or at home within 48hrs up to 2 weeks after birth. Scheduled when to return for consultation for postpartum visit
F.
Recommended Schedule for Post Partum Care Visits G. Impo Import rtan ance ce of BF BREASTFEEDING Breast milk is best for babies up to 2 years old. Exclusive breastfeeding is recommended for for the first six months of life. At about about six months, give carefully selected nutritious foods as supplements. Breastfeeding provides physical and psychological benefits for children and mothers as well as economic benefits for families and societies. societies. BENEFITS : For infants a. Provid Provides es a nutrit nutrition ional al comp complete lete food food for the the young infant. b. Streng Strengthe thens ns the infan infant’s t’s immu immune ne syste system, m, preventing many infections. c. Safely Safely rehyd rehydrate rates s and prov provide ides s essenti essential al nutrients to a sick child, especially to those suffering from diarrheal diseases. d. Reduce Reduces s the infant infant’s ’s exposu exposure re to infect infection ion.. BREASTFEEDING/ BREASTFEEDING/ LACTATION MANAGEMENT EDUCATION TRAINING Breastfeeding 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: A. Executive Order 51 B. Republic Act 7600 C. The Rooming-In and Breastfeeding Act of 1992 A. EO 51 THE MILK CODE – protection and promotion of breastfeeding to ensure the safe and adequate nutrition of infants through regulation of marketing of infant foods and related products. (e.g. breast milk substitutes, infant formulas, feeding bottles, teats etc. ) B. RA 7600 THE ROOMING –IN and BREASTFEEDING ACT of 1992 =An act providing incentives to government and private health institutions promoting and practicing rooming-in and breast-feeding. =Provision for human milk bank.
=Information, education and re-education drive =Sanction and Regulation BABY Provides Antibodies Contains Lactoferin (binds with Iron) Leukocytes Contains Bifidus factor-promotes growth of the Lactobacillus-inhibits the growth of pathogenic bacilli For the Mother e. Reduce Reduces s a woman’ woman’s s risk of of excessi excessive ve blood blood loss loss after birth f. Provid Provides es a natura naturall meth method od of delayi delaying ng pregnancies. g. Reduce Reduces s the risk risk of ovaria ovarian n and breas breastt cancers cancers and osteoporosis. For the Family and Community h. Conser Conserves ves funds funds that that other otherwis wise e would would be spent spent on breast milk substitute, supplies and fuel to prepare them. i. Save Saves s medi medica call cost costs s to fami famili lies es and and governments by preventing illnesses and by providing immediate postpartum contraception.
POSITIONS IN BF THE BABY:
1.
Cradle Hold = head and neck are supported
2.
Football Hold
3.
Side Lying Position BEST FOR BABIES REDUCE INCIDENCE OF ALLERGENS ECONOMICAL ANTIBODIES PRESENT STOOL INOFFENSIVE (GOLDEN YELLOW) EMPERATURE ALWAYS IDEAL FRESH MILK NEVER GOES OFF EMOTIONALLY BONDING EASY ONCE ESTABLISHED DIGESTED EASILY IMMEDIATELY AVAILABLE NUTRITIONALLY NUTRITIONALLY OPTIMAL GASTROENTERITIS GREATLY REDUCED Environmental Health Program Environmental Sanitation and Promotion of Safe Water Supply Environmental Sanitation is defined as the study of all factors in the man’s environment, which exercise or may exercise deleterious effect on his well-being and survival. -Water is a basic need for life and one factor in man’s environment. Water is necessary for the maintenance of healthy lifestyle. Safe Water and Sanitation is necessary for basic promotion of health. health. -One basic need of the family is food. And if food is properly prepared then one may be assured healthy family. There are many food resources found in the communities but because of faulty preparation and lack of knowledge regarding proper food planning, Malnutrition is one of the problems that we have in the country. HEALTH AND SANITATION -Environmental Sanitation is still a health problem in the country. -Diarrheal diseases ranked second in the leading causes of morbidity among the general population. -Other sanitation related diseases : tuberculosis, intestinal parasitism, schistossomiasis, malaria, infectious hepatitis, filariasis and dengue hemorrhagic fever DOH thru’ Environmental Health Services (EHS)unit (EHS)unit is authorized to act on all issues and concernsin environment and health including the verycomprehensive Sanitation Code of the Philippines (PD 856, 1978). WATER SUPPLY SANITATION PROGRAM EHS sets policies on:
Approved types of water facilities Unapproved type of water facility Access to safe and potable drinking water Water quality and monitoring surveillance Waterworks/Water system and well construction Approved type of water facilities Level 1 (Point Source)- a protected well or a developed spring with an outlet but without a distribution system indicated for rural areas; serves 15-25 households; its outreach is not more than 250 m from the farthest user yields 40-140 L/ min
Level II ( Communal Faucet or Stand Posts) Posts ) With a source, reservoir, piped distribution network and communal faucets Located at not more than 25 m from the farthest house Delivers 40-80 L of water per capital per day to an average of 100 households Fit for rural areas where houses are densely clustered Level III ( Individual House Connections or Waterworks System) With a source, reservoir, piped distributor network and household taps Fit for densely densely populated populated urban communities Requires minimum minimum treatment or disinfection disinfection ENVIRONMENTAL SANITATION - the study of all factors in man’s physical environment, which may exercise a deleterious effect on his health, well-being and survival. Includes: 1.1 Water sanitation 1.2 Food sanitation 1.3 Refuse and garbage disposal 1.4 Excreta disposal 1.5 Insect vector and rodent control 1.6 Housing 1.7 Air pollution 1.8 Noise 1.9 Radiological Protection 1.10 Institutional sanitation 1.11 Stream pollution PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM EHS sets policies on: Approved types of toilet facilities : LEVEL II – on site toilet facilities of the water carriage type with water-sealed and flush type with septic vault/tank disposal. LEVEL III – water carriage types of toilet facilities connected to septic tanks and/or to sewerage system to treatment plant. FOOD SANITATION PROGRAM -sets policy and practical programs to prevent and control food-borne diseases to alleviate the living conditions of the population HOSPITAL WASTE MANAGEMENT PROGRAM Disposal of infectious, pathological and other wastes from hospital which combine them with the municipal or domestic wastes pose health hazards to the people. Hospitals shall dispose their hazardous wastes thru incinerators or disinfectants to prevent transmission of nosocomial diseases PROGRAM ON HEALTH RISK MINIMIZATION DUE TO ENVIRONMENTAL POLLUTION Foci: 1. Prevention of serious environmental hazards resulting from urban growth and industrialization 2. policies on health protection measures 3. researches on effects of GLOBAL WARMING to health (depletion of the stratosphere ozone layer which increases ultraviolet radiation, climate change and other conditions) NURSING RESPONSIBILITIES AND ACTIVITIES Health Education – IEC by conducting community assemblies and bench conferences.
The Occupational Health Nurse, School Health Nurse and other Nursing staff shall impart the need for an effective and efficient environmental sanitation in their places of work and in school. Actively participate in the training component of the service like in Food Handler’s Class, and attend training/workshops related to environmental health. Assist in the deworming activities for the school children and targeted groups. Effectively and efficiently coordinate programs/projects/activities with other government and non-government agencies. Act as an advocate or facilitator to families in the community in matters of program/projects/activities program/projects/ac tivities on environmental health in coordination with other members of Rural Health Unit (RHU) especially the Rural Sanitary Inspectors. Actively participate in environmental sanitation campaigns and projects in the community. community. Ex. Sanitary toilet campaign drive for proper garbage disposal, beautification of home garden, parks drainage and other projects. Be a role model for others in the community to emulate terms of cleanliness in the home and surrounding. There was a man who saw a scorpion floundering around in the water. He decided to save it by stretching out his finger but the scorpion stung him. The man still tried to get the scorpion out of the water but the scorpion stung him again. Another man nearby told him to stop s aving the scorpion but the man said, “It’s the nature of the scorpion to sting. It’s my nature to love, why should I give up my nature to love just because it’s the nature of the scorpion to sting?” Don’t give up loving, don’t give up your goodness even if people around you sting… THE END See u next sem.
