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CD control program
TB is the number one infectious killer in the
Communicable diseases
National Tuberculosis Control world.
Program – key policies One TB suspect can infect another 10 healthy
Case finding – direct Sputum persons
Microscopy and X-ray Leprosy Control Program
examination of TB symptomatics WHO Classification – basis of multi-drug therapy
who are negative after 2 or more ▪ Paucibacillary/PB – noninfectious
sputum exams types. 6-9 months of
Treatment – shall be given free treatment.
and on an ambulatory basis, ▪ Multibacillary/MB – infectious
except those with acute types. 24-30 months of
complications and emergencies treatment.
Direct Observed Treatment Short Multi-drug therapy – use of 2 or more drugs
Course – comprehensive strategy renders patients non-infectious a week after
to detect and cure TB patients. starting treatment
Category and Treatment Regimen ▪ Patients w/ single skin lesion and
a negative slit skin smear are
Category 1- new TB patients whose sputum is treated w/ a single dose of ROM
positive; seriously ill patients with severe forms regimen
of smear-negative PTB with extensive ▪ For PB leprosy cases-
parenchymal involvement (moderately- or faradvanced) Rifampicin+Dapsone on Day 1
and extra-pulmonary TB (meningitis, then Dapsone from Day 2-28. 6
pleurisy, etc.) blister packs taken monthly
Category 2-previously-treated patients with within a max. period of 9 mos.
relapses or failures. All patients who have complied w/ MDT are
Category 3 – new TB patients whose sputum is considered cured and no longer regarded as a
case of leprosy, even if some sequelae of leprosy
smear-negative for 3 times and chest x-ray
remain.
result of PTB minimal
Category 1- Responsibilities of the nurse
▪ Prevention – health education,
new TB patients whose sputum is positive;
healthful living through proper
seriously ill patients with severe forms of smearnegative nutrition, adequate rest, sleep
PTB with extensive parenchymal and good personal hygiene;
involvement (moderately- or far- advanced) and ▪ Casefinding
extra-pulmonary TB (meningitis, pleurisy, etc.) ▪ Management and treatment –
Intensive Phase (given daily for the first 2 months)- prevention of secondary injuries,
Rifampicin + Isioniazid + pyrazinamide + ethambutol. handling of utensils; special
If sputum result becomes negative after 2 months, shoes w/ padded soles;
maintenance phase starts. But if sputum is still positive importance of sustained therapy,
in 2 months, all drugs are discontinued from 2-3 days correct dosage, effects of drugs
and a sputum specimen is examined for culture and drug and the need for medical checkup
sensitivity. The patient resumes taking the 4 drugs for from time to time; mental &
another month and then another smear exam is done at emotional support
the end of the 3rd month. ▪ Rehabilitation-makes patients
Maintenance Phase (after 3rd month, regardless of the
capable, active and selfrespecting
result of the sputum exam)-INH + rifampicin daily
member of society.
Category 2-previously-treated patients with relapses or
Control of Schistosomiasis – a tropical disease caused by
failures.
a blood fluke, Schistosoma Japonicum ; transmitted by a
Intensive Phase (daily for 3 months, month 1,2 & 3)-
tiny snail Oncomelania quadrasi
Isioniazid+ rifampicin+ pyrazinamide+ ethambutol+
streptomycin for the first 2 months Streptomycin+ Preventive measures – health education
rifampicin pyrazinamide+ ethambutol on the 3rd month. regarding mode of transmission and methods of
If sputum is still positive after 3 months, the intensive protection; proper disposal of feces and urine;
phase is continued for 1 more month and then another improvement of irrigation and agriculture
sputum exam is done. If still positive after 4 months, practices
intensive phase is continued for the next 5 months. Control of patient, contacts and the immediate
Maintenance Phase (daily for 5 months, month 4,5,6,7,&
environment
8)-Isionazid+ rifampicin+ ethambutol
Category 3 – new TB patients whose sputum is smearnegative Specific treatment- Praziquantel – drug of choice
for 3 times and chest x-ray result of PTB Programs on Filariasis, Malaria and Dengue Hemorrhagic
minimal Fever
Intensive Phase (daily for 2 months) – Isioniazid Filariasis- a chronic prasitic infection caused by
+ rifampicin + pyrazinamide
a nematode, Wuchereria bancrofti. Young and
Maintenance Phase (daily for the next 2 months) adult worms live in the lymphatic vessels and
- Isioniazid + rifampicin nodes, while the micro filariae are in the blood;
Stop TB ; Do it with DOTS transmitted through bites from an infected
female mosquito, Aedes poecilius, that bites at
Advocacy is a planned and continuous effort to night.
inform people about issue and instigate change. ▪ Treatment: Diethylcarbamazine
Advocacy usually takes place over an extended citrate or Hetrazan
period of time and includes a variety of ▪ Elephantiasis and Hydrocoele
strategies to communicate a specific message. are handled through surgery,
prevention and supportive care A process by which the nurse collects data about
Malaria – infection caused by the bite of the female
the community in order to identify factors which
Anopheles mosquito ,
may influence the deaths and illnesses of the
Chemoprophylaxis – Chloroquine taken population
at weekly intervals, starting from 1-2 to formulate a community health nursing
weeks before entering the endemic area.
diagnosis and develop and implement community
Anti-malarial drugs – sulfadoxine, health nursing interventions and strategies
quiinine sulfate, tetracycline, quinidine Done to come up with a profile of local health
Insecticide treatment of mosquito nets, situation
house spraying, stream seeding and Will serve as a basis of health programs and
clearing, sustainable preventive and
services to be delivered to the community
vector control meas
Dengue H-fever Starts with determining the health status of the
4 o‘clock habit community
Programs on Measles. Chickenpox, 2 Types of Community Diagnosis
1. Comprehensive Community Diagnosis
Mumps, Diphtheria, Pertusis, Tetanus –
focused on health information aims to obtain general information about
campaigns and intensive immunization the community
of children in barangays. 2. Problem-Oriented Community Diagnosis
Prevention and Control Program on Parasitic type of assessment responds to a
Infestations ( STH e.g. Ascaris, Trichuris, Hookworm) and
particular need
Paragonimiasis in communities where eating of fresh or
ELEMENTS OF
inadequately cooked crab is a practice
COMPREHENSIVE COMMUNITY DIAGNOSIS
Management:
1. DEMOGRAPHIC VARIABLES
1. Deworming
i. Total population & Geographical
2. Health Education re:
distribution including Urban-Rural index
▪ Good personal hygiene
& Population Density
▪ Use of footwear ii. Age & Sex composition
▪ Washing fruits and vegetables iii. Selected vital indicators e.q. Growth
well rate, CBR, CDR & Life expectancy rate
▪ Use of sanitary toilets iv. Patterns of migration
▪ Sanitary disposal of garbage v. Population projection
▪ Boiling drinking water at least 2- Note:
3 min. from boiling point or
chlorination Population groups that need special
Prevention and Control on Leptospirosis/ Weil’s Disease/ attentions:
Mud fever/Flood fever/ Spirochetal Jaundice thru contact with ▪ Indigenous people
the skin/ open wound with water or moist soil contaminated ▪ Socially dislocated groups as a
with urine of infected rat result of disasters, calamities &
And Rabies development programs
2. Socio-economic & Cultural variables
Mgt. of Rabies
i. Social indicators
Wash wound with soap and water, betadine or
Communication network
alcohol may be applied
Transportation system
If dog is healthy observe for 14 days. If nothing
happens- no need for ttt.If it dies or shows Educational level
rabies, kill then bring head for lab. Exam & Housing conditions
consult doctor.
ii. Economic indicators
Active immunization – body develops Ab against
Poverty level income
rabies up to 3 yrs.
Passive I – giving Ab to persons with head and Employment rate
neck bites, multiple single deep bites, Types of industry present in the
contamination of mucous membranes or thin community
covering of the eyes, lips or mouth to provide Occupation common in the community
immediate protection
iii. Environmental indicators
RPO – immunization of pets at 3 mos. of age and
Physical/geographical/topographical
yearly thereafter
Prevention and Control on STIs characteristics
- Gonorrhea, Syphilis, HIV/AIDS, Water supply
Trichomoniasis,Chlamydia, Hep B ( the most Waste disposal
serious type ‗cause of severe cx. Eg. Massive
liver damage and hepatocarcinoma Air, Water and Land pollution
- 4 C‘s in the Syndromic Mgt iv. Cultural factors
- 1. Compliance
Variables that may break up people into
- 2. Counseling/ Education
- 3. Contact tracing to treat partner groups within the community e.q.
- 4. Condom use ▪ Ethnicity
- Hep B vaccination ▪ Social class
- Universal precautions ▪ Language
- Safe sex ▪ Religion
2. Community Needs Assessment/ Community Diagnosis ▪ Race
Community Diagnosis ▪ Political orientation
Cultural beliefs and practices that affect Descriptive data
health
Concepts about Health and Illness 8. DATA PRESENTATION – will depend largely on
the type of data obtained.
3. Health & illness patterns
Descriptive- narrative reports
Leading cause of mortality
Leading cause of morbidity numerical data- table or graphs
Leading cause of infant mortality 9. DATA ANALYSIS – aims to establish trends and
patterns in terms of health needs and problems
Leading cause of maternal mortality
of the community.
Leading cause of hospital admission 10. Identifying Community Health Nursing Problems
4. Health resources a. Health Status Problems
Manpower resources Increased/decreased morbidity,
mortality fertility or reduced capability
Material resources
for wellness
5. Political/Leadership patterns b. Health Resources Problems
Reflects the action potential of the state Lack of or absence of manpower, money,
and its people to address the health materials or institutions necessary to
needs and problems of the community solve health problems
Mirrors the sensitivity of the c. Health Related Problems
government to the people‘s struggle for Existence of social, economic,
better lives environmental and political factors that
PROCESS OF COMMUNITY DIAGNOSIS aggravate the illness-inducing situations
Consists of; in the community
1. Collecting, organizing & synthesizing data 11. Priority-setting
In order to identify the different factors a. Nature of the condition/problem presented
that may directly or indirectly influence Classified as health status, health
the health of the population resources or health related problems
2. Analyzing & interpreting health data b. Magnitude of the problem
Seek explanations for the occurrence of Severity of the problem which can be
health needs and problems of the measured in terms of the proportion of
community the population affected by the problem
3. Formulation of Community Health Nursing c. Modifiability of the problem
Diagnoses
Probability of reducing, controlling or
Will become the bases for developing
eradicating the problem
and implementing community health d. Preventive potential
nursing interventions and strategies
STEPS IN CONDUCTING COMMUNITY Probability of controlling or reducing the
DIAGNOSIS effects posed by the problem
e. Social concern
1. DETERMINING THE OBJECTIVES – the nurse
decides on the depth and scope of the data she Perception of the population or the
needs to gather. community as they are affected by the
2. DEFINING THE STUDY POPULATION – the nurse problem and their readiness to act on
identifies the population group to be included in the problem
the study. PLANNING
3. DETERMINING THE DATA TO BE COLLECTED – the WHAT IS PLANNING?
objectives will guide the nurse in identifying the
specific data she will collect, and will also decide is a process that entails formulation of
on the sources of these data. steps to be undertaken in the future in
4. COLLECTING THE DATA – the nurse decides on order to achieve a desired end.
the specific methods depending on the type of Concepts of Planning:
data to be generated.
Planning is futuristic.
Ocular survey, interview, and records
review, Planning is change-oriented.
5. DEVELOPING THE INSTRUMENT instruments/tools
facilitate the nurse‘s data-gathering activities. Planning is a continuous and dynamic
Most common instruments : process.
survey questionnaire Planning is flexible.