(Mark 10:45)

Discipleship is a lifestyle
Not just a biblical truth
Nor a Christian ideal but a way of life
For the Son of Man also came not to be
served
But to serve and to give His life as a
ransom for many.
I. Safe and Quality Care, Health
Education, and Communication,
Collaboration and Teamwork
1. Principles and Standard of CHN
2. Levels of care
3. Types of Clientele
4. Health Care Delivery System
5. PHC as a Strategy
6. Family-based Nursing
Services(Family Health Nursing
Process)
7. Population Group-based Nursing
Services
8. Community-based Nursing
Services/Community Health
Nursing Process
9. Community Organizing
10.Public Health Programs
II. Research and Quality
Improvement

1. Research in the Community

2. National Health Situation
3. Vital Statistics
4. Epidemiology
5. Demography
III. Management of Resources
& Environment and Records
Management
1. Field Health Services And
Information System
2. Target-setting
3. Environmental Sanitation
IV. Ethico-Moral-Legal Responsibility
1. Socio-cultural values, beliefs, and
practices of individuals, families,
groups and communities
2. Code of Ethics for Government
Workers
3. WHO, DOH, LGU policies on health
4. Local Government Code
5. Issues
V. Personal And Professional
Development
1. Self-assessment of CHN
competencies, importance,
methods and tools
2. Strategies and methods of
updating ones self, enhancing
competence in community
health nursing and related areas.
Date Event
1901 - Act # 157 ( Board of Health of the Philippines) ; Act
# 309 ( Provincial and Municipal Boards of Health)
were created.
1905 - Board of Health was abolished; functions were
transferred to the Bureau of Health.
1912 Act # 2156 or Fajardo Act created the Sanitary
Divisions, the forerunners of present MHOs; male nurses
performs the functions of doctors
1919 Act # 2808 (Nurses Law was created)
- Carmen del Rosario , 1st Fil. Nurse supervisor under
Bureau of Health
Oct. 22, 1922 Filipino Nurses Organization (Philippine
Nurses Organization) was organized.
 1923 Zamboanga General Hospital School
of Nursing & Baguio General Hospital
were established; other government
schools of nursing were organized several
years after.
1928- 1st Nursing convention was held
1940 Manila Health Department was
created.
1941 Dr. Mariano Icasiano became the
first city health officer; Office of Nursing
was created through the effort of Vicenta
Ponce (chief nurse) and Rosario Ordiz
(assistant chief nurse)
 Dec. 8, 1941 Victims of World War II were
treated by the nurses of Manila.
July 1942 Nursing Office was created; Dr.
Eusebio Aguilar helped in the release of 31 Filipino
nurses in Bilibid Prison as prisoners of war by
the Japanese.
Feb. 1946 Number of nurses decreased from 556 308.
1948 First training center of the Bureau of Health was
organized by the Pasay City Health Department.
Trinidad Gomez, Marcela Gabatin, Costancia
Tuazon, Ms. Bugarin, Ms. Ramos, and Zenaida Nisce
composed the training staff.
 1950 Rural Health Demonstration and
Training Center was created.
1953 The first 81 rural health units were
organized.
1957 RA 1891 amended some sections of
RA 1082 and created the eight categories
of rural health unit causing an increase in
the demand for the community health
personnel.
1958-1965 Division of Nursing was abolished
(RA 977) and Reorganization Act (EO 288)
 1961 Annie Sand organized the National League of
Nurses of DOH.
1967 Zenaida Nisce became the nursing program
supervisor and consultant on the six special
diseases (TB, leprosy, V.D., cancer, filariasis, and
mental health illness).
1975 Scope of responsibility of nurses and midwives
became wider due to restructuring of the health
care delivery system.
1976-1986 The need for Rural Health Practice
Program was implemented.
1990- 1992- Local Government Code of 1991 (RA 7160)
 1993-1998 Office of Nursing did not
materialize in spite of persistent
recommendation of the officers, board
members, and advisers of the National
League of Nurses Inc.
Jan. 1999 Nelia Hizon was positioned as the
nursing adviser at the Office of Public
Health Services through Department
Order # 29.
May 24, 1999 EO # 102, which redirects the
functions and operations of DOH, was
signed by former President Joseph Estrada.
R.A. 7160 - or the Local Government Code. This
involves the devolution of powers, functions
and responsibilities to the local government
both rural & urban.The Code aims to
transform local government units into self-
reliant communities and active partners in
the attainment of national goals thru a more
responsive and accountable local
government structure instituted thru a
system of decentralization. Hence, each
province, city and municipality has a LOCAL
HEALTH BOARD ( LHB ) which is mandated to
propose annual budgetary allocations for the
operation and maintenance of their own
health facilities.
Provincial Level
1.Governor- chair
2. Provincial Health Officer vice chair
3. Chair , Committee on Health of
Sangguniang
Panlalawigan
4. DOH rep.
5. NGO rep.
City and Municipal Level
1. Mayor chair
2. MHO vice chair
3. Chair, Committee on Health of
Sangguniang
Bayan
4. DOH rep
5. NGO rep
1. the LGUs financial capability
2. a dynamic and responsive political
leadership
3. community empowerment
R.A. 2382 Philippine Medical Act. This act defines the
practice of medicine in the country.

R.A. 1082 Rural Health Act. It created the 1st 81 Rural

Health Units.
-amended by RA 1891 ; more physicians, dentists,
nurses, midwives and sanitary inspectors will live in the
rural areas where they are assigned in order to raise the
health conditions of barrio people ,hence help decrease
the high incidence of preventable diseases
R.A. 6425 Dangerous Drugs Act. It
stipulates that the sale, administration,
delivery, distribution and transportation of
prohibited drugs is punishable by law.
R.A. 9165 the new Dangerous Drug Act of
2002

P.D. No. 651 requires that all health workers

shall identify and encourage the
registration of all births within 30 days
following delivery.
P.D. No. 996 requires the compulsory
immunization of all children below 8 yrs. of
age against the 6 childhood immunizable
diseases.
P.D. No. 825 provides penalty for improper
disposal of garbage.
R.A. 8749 Clean Air Act of 2000
P.D. No. 856 Code on Sanitation. It provides
for the control of all factors in mans
environment that affect health including the
quality of water, food, milk, insects, animal
carriers, transmitters of disease, sanitary and
recreation facilities, noise, pollution and
control of nuisance.
R.A. 6758 standardizes the salary of government
employees including the nursing personnel.
R.A. 6675 Generics Act of 1988 which promotes, requires
and ensures the production of an adequate supply,
distribution, use and acceptance of drugs and
medicines identified by their generic name.
R.A. 6713 Code of Conduct and Ethical Standards of
Public Officials and Employees. It is the policy of the
state to promote high standards of ethics in public
office. Public officials and employees shall at all times
be accountable to the people and shall discharges
their duties with utmost responsibility, integrity,
competence and loyalty, act with patriotism and
justice, lead modest lives uphold public interest over
personal interest.
R.A. 7305 Magna Carta for Public Health Workers. This act
aims: to promote and improve the social and economic
well-being of health workers, their living and working
conditions and terms of employment; to develop their
skills and capabilities in order that they will be more
responsive and better equipped to deliver health
projects and programs; and to encourage those with
proper qualifications and excellent abilities to join and
remain in government service.
R.A. 8423 created the Philippine Institute of Traditional and
Alternative Health Care.
P.D. No. 965 requires applicants for marriage license to
receive instructions on family planning and responsible
parenthood.

P.D. NO. 79 defines , objectives, duties and functions of

POPCOM
 RA 4073 advocates home treatment
for leprosy

Letter of Instruction No. 949 legal basis

of PHC dated OCT. 19, 1979
- promotes development of health programs
on the community level
 RA 3573 requires reporting of all cases
of communicable diseases and
administration of prophylaxis

Ministry Circular No. 2 of 1986 includes

AIDS as notifiable disease
R.A. 7875 National Health Insurance Act
R.A. 7432 Senior Citizens Act
R. A. 7719 - National Blood Services Act
R.A. 8172 Salt Iodization Act ( ASIN LAW)
R.A. 7277- Magna Carta for PWDs,
provides their rehabilitation, self-
development and self-reliance and
integration into the mainstream of
society
 A. O. No. 2005-0014- National Policies
on Infant and Young Child Feeding:
1.All newborns be breastfeed within 1 hr
after birth
2. Infants be exclusively breastfeed for 6
mos.
3. Infants be given timely, adequate and
safe complementary foods
4. Breastfeeding be continued up to 2
years and beyond
 EO 51- Phil. Code of Marketing of
Breastmilk Substitutes
R.A.- 7600 Rooming In and
Breastfeeding Act of 1992
R.A. 8976- Food Fortification Law
R.A. 8980- prolmulgates a
comprehensive policy and a national
system for ECCD
 A..O. No. 2006- 0015- defines the
Implementing guidelines on Hepatitis B
Immunization for Infants
R.A. 7846- mandates Compulsory
Hepatitis B Immunization among infants
and children less than 8 yrs old
R.A. 2029- madates Liver Cancer and
Hepatitis B Awareness Month Act (
February)
 A.O. No. 2006-0012- specifies the Revised
Implementing Rules and Regulations of
E.O. 51 or Milk Code, Relevant
International Agreements, Penalizing
Violations thereof and for other purposes
 - science and art of preventing diasease,
prolonging life, promoting health and efficiency
thru organized community effort for the sanitation
of the environment, control of communicable
diseases, the education of individuals in personal
hygiene, the organization of medical and nursing
services for the early diagnosis and preventive
treatment of diseases and the development of
social machinery to ensure everyone a standard of
living adequate for the maintenance of health, so
organizing these benefits as to enable every citizen
to realize his birthright off birth and longevity ( DR.
C.E. Winslow)
 - special field of nursing that combines
the skills of nursing, public health and
some phases of social assistance and
functions as part of the total public
health program for the promotion of
health, the improvement of the
conditions in the social and physical
environment, rehabilitation of illness and
disability ( WHO Expert Committee of
Nursing )
 - a learned practice discipline with the ultimate
goal of contributing as individuals and in
collaboration with others to the promotion of the
clients optimum level of functioning thru teaching
and delivery of care ( Jacobson )
- a service rendered by a professional nurse to IFCs,
population groups in health centers, clinics, schools
, workplace for the promtion of health,
preventionof illness, care of the sick at home and
rehabilitation (DR. Ruth B. Freeman)
 The primary focus of community health
nursing is health promotion.
Community health nurses provide care
necessary to meet the requirements of an
individual all throughout the life cycle.
Knowledge on different fields (biological and
social sciences, clinical nursing, and
community health organizations) is used.
Nursing process in community health nursing
changes based on the needs of the
community.
 To elevate the level health of the multitude.

Philosophy
Worth and dignity of man.

Principles
1.The need of the community is the basis of
community health nursing.
2.The community health nurse must understand
fully the objectives and policies of the agency
she represents.
3. The family is the unit of service.
4. CHN must be available to all regardless of
race,creed and socioeconomic status
5. The CHN works as a member of the health
team
6. There must be provision for periodic
evaluation of community health nursing
services
7. Opportunities for continuing staff education
programs for nurses must be provided by the
community health nursing agency and the
CHN as well
8. The CHN makes use of available community
health resources
I. Theory
Applies theoretical concepts as basis for
decisions in practice
II. Data Collection
Gathers comprehensive , accurate
data systematically
III. Diagnosis
Analyzes collected data to determine the
needs/ health problems of IFC
IV. Planning
At each level of prevention, develops
plans that specify nursing actions unique
to needs of clients
V. Intervention
Guided by the plan, intervenes to
promote, maintain or restore health,
prevent illness and institute rehabilitation
VI. Evaluation
Evaluates responses of clients to
interventions to note progress toward
goal achievement, revise data base,
diagnoses and plan
VII. Quality Assurance and Professional
Development
Participates in peer review and other
means of evaluation to assure quality of
nursing practice
Assumes professional development
Contributes to development of others
VIII. Interdisciplinary Collaboration

Collaborates with other members of the

health team, professionals and
community representatives in assessing,
planning, implementing and evaluating
programs for community health
IX. Research
Indulges in research to contribute to theory
and practice in community health
nursing
 1. PRIMARY

2. SECONDARY

3. TERTIARY
 1. INDIVIDUALS
2. FAMILIES
3. COMMUNITIES
4. POPULATION GROUPS
- Aggregate of people who share common
characteristics, developmental stage or common
exposure to particular environmental factors thus
resulting in common health problems ( Clark,
1995:5) e.g. children . elderly, women, workers etc.
 1.PRIMARY LEVEL FACILITIES

2. SECONDARY LEVEL FACILITIES

3. TERTIARY LEVEL FACILITIES

 1. Teaching and Training Hospitals
2. City Health Services
3. Emergency and District Hospitals
4. Private Practitioners
5. Heart Institutes
6. Puericulture Centers
7. RHU
1. Improve the general health status of the population (reduce infant
mortality rate, reduce child morality rate, reduce maternal mortality
rate, reduce total fertility rate, increase life expectancy & the
quality of life years).
2. Reduce morbidity, mortality, disability & complications from
Diarrheas, Pneumonias, Tuberculosis, Dengue, Intestinal Parasitism,
Sexually Transmitted Diseases, Hepatitis B, Accident & Injuries,
Dental Caries & Periodontal Diseases, Cardiovascular Diseases,
Cancer, Diabetes, Asthma & Chronic Obstructive Pulmonary
Diseases, Nephritis & Chronic Kidney Diseases, Mental Disorders,
Protein Energy Malnutrition, Iron Deficiency Anemia & Obesity.
3.Eliminate the ff. diseases as public health
problems:
Schistosomiasis
Malaria
Filariasis
Leprosy
Rabies
Measles
Tetanus
Diphtheria & Pertussis
Vitamin A Deficiency & Iodine Deficiency
Disorders
4. Eradicate Poliomyelitis
5. Promote healthy lifestyle through healthy diet &
nutrition, physical activity & fitness, personal hygiene,
mental health & less stressful life & prevent violent & risk-
taking behaviors.
6. Promote the health & nutrition of families & special
populations through child, adolescent & youth, adult
health, womens health, health of older persons, health
of indigenous people, health of migrant workers and
health of different disabled persons and of the rural &
urban poor.
7. Promote environmental health and
sustainable development through the
promotion and maintenance of healthy
homes, schools, workplaces,
establishments and communities towns
and cities.
1. Universal access to basic health services
must be ensured.
2. The health and nutrition of vulnerable
groups must be prioritized.
3. The epidemiological shift from infection
to degenerative diseases must be
managed.
4. The performance of the health sector
must be enhanced.
1. Increasing investment for Primary Health
Care.
2. Development of national standards and
objectives for health.
3. Assurance of health care.
4. Support to the local system
development.
5. Support for frontline health workers.
 May 1977 -30th World Health Assembly
decided that the main health target of the
government and WHO is the attainment of a
level of health that would permit them to lead
a socially and economically productive life
by the year 2000.
September 6-12, 1978 - First International
Conference on PHC in Alma Ata, Russia
(USSR) The Alma Ata Declaration stated that
PHC was the key to attain the health for all
goal
RATIONALE FOR ADOPTING PRIMARY HEALTH CARE:

Magnitude of Health Problems

Inadequate and unequal distribution
of health resources
Increasing cost of medical care
Isolation of health care activities from
other development activities
 essential health care made universally
accessible to individuals and families in the
community by means acceptable to them,
through their full participation and at cost that
the community can afford at every stage of
development.
a practical approach to making health
benefits within the reach of all people.
an approach to health development, which is
carried out through a set of activities and
whose ultimate aim is the continuous
improvement and maintenance of health
status of the community.
An improved state of health and quality of life
for all people attained through SELF-RELIANCE.
KEY STRATEGY TO ACHIEVE THE GOAL:
Partnership with and Empowerment of the people -
permeate as the core strategy in the effective provision
of essential health services that are community based,
accessible, acceptable, and sustainable, at a cost,
which the community and the government can afford.
 Improvement in the level of health care of the community
Favorable population growth structure
Reduction in the prevalence of preventable, communicable and
other disease.
Reduction in morbidity and mortality rates especially among infants
and children.
Extension of essential health services with priority given to the
underserved sectors.
Improvement in Basic Sanitation
Development of the capability of the community aimed at self-
reliance.
Maximizing the contribution of the other sectors for the social and
economic development of the community.
 To strengthen the health care system by
increasing opportunities and supporting the
conditions wherein people will manage their
own health care.
TWO LEVELS OF PRIMARY HEALTH CARE WORKERS
1. Barangay Health Workers - trained community health
workers or health auxiliary volunteers or traditional birth
attendants or healers.
2. Intermediate level health workers include the Public
Health Nurse, Rural Sanitary Inspector and midwives.
 1. 4 A's = Accessibility, Availability,
Affordability & Acceptability,
Appropriateness of health services. The
health services should be present where the
supposed recipients are. They should make
use of the available resources within the
community, wherein the focus would be
more on health promotion and prevention of
illness.
2. COMMUNITY PARTICIPATION =heart
and soul of PHC
 3. People are the center, object and subject
of development.
Thus, the success of any undertaking that aims at serving
the people is dependent on peoples participation at all
levels of decision-making; planning, implementing,
monitoring and evaluating. Any undertaking must also
be based on the peoples needs and problems (PCF,
1990)
Part of the peoples participation is the partnership
between the community and the agencies found in the
community; social mobilization and decentralization.
In general, health work should start from where the
people are and building on what they have. Example:
Scheduling of Barangay Health Workers in the health
center
 Lack of motivation
Attitude
Resistance to change
Dependence on the part of community
people
Lack of managerial skills
4.SELF-RELIANCE
5.Partnership between the community and
the health agencies in the provision of
quality of life.
Providing linkages between the
government and the non-
government organization and peoples
organization.
HEALTH
is not merely the absence of disease. Neither it is only a
state of physical and mental well-being. Health being a
social phenomenon recognizes the interplay of political,
socio-cultural and economic factors as its determinant.
Good Health therefore, is manifested by the progressive
improvements in the living conditions and quality of life
enjoyed by the community residents (PCF, DEVELOPMENT
is the quest for an improved quality of life for all.
Development is multi-dimensional. It has a political,
social, cultural, institutional and environmental
dimensions(Gonzales 1994). Therefore, it is measured by
the ability of people to satisfy their basic needs.
It enhances people participation or
governance, support system provided by the
Government, networking and developing
secondary leaders.

8. DECENTRALIZATION
 Attaining Health for all Filipino will require expanding
participation in health and health related programs
whether as service provider or beneficiary.
Empowerment to parents, families and communities to
make decisions of their health is really the desired
outcome.
Advocacy must be directed to National and Local
policy making to elicit support and commitment to major
health concerns through legislations, budgetary and
logistical considerations.
 The health in the hands of the
people brings the government closest
to the people. It necessitates a
process of capacity building of
communities and organization to plan,
implement and evaluate health
programs at their levels.
 Using appropriate technology will make
services and resources required for their
delivery, effective, affordable, accessible and
culturally acceptable. The development of
human resources must correspond to the
actual needs of the nation and the policies it
upholds such as PHC. The DOH will continue
to support and assist both public and private
institutions particularly in faculty
development, enhancement of relevant
curricula and development of standard
teaching materials.
 Essential National Health
Research (ENHR) is an integrated
strategy for organizing and
managing research using
intersectoral, multi-disciplinary and
scientific approach to health
programming and delivery.
 FOUR CORNERSTONES/ PILLARS IN PRIMARY
HEALTH CARE
1. Active Community Participation
2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. Support mechanism made available
 HERBAL MEDICINES ENDORSED BY THE DEPARTMENT OF
HEALTH

Name Indication Dosage

s
1.Five- 1. Asthma Divide the
leaf 2. Cough decoction into 3
Chaste 3. Body Pain parts:
tree 4. Fever For asthma and
(Lagundi) cough, drink 1 part
3 times a day.
For fever and body
pains, drink 1 part
every 4 hrs.
2. Marsh- 1. Body pain Divide
Mint; decoction
Peppermint into 2 parts
(Yerba and drink 1
Buena) part every 3
hours.

3. Sambong 1. Swelling Divide

2. Inducing decoction
diuresis into 3 parts
( and drink 1
anti- part 3 times
urolithia a day.
sis)
4. Tsaang 1. Stomachache Drink the warm
Gubat decoction. If
it persists, or
if there is no
improvement an
hour after
drinking the
decoction,
consult a
doctor.
5. 1. Gouty Divide the
Ulasimang Arthritis decoction into 3
Bato/Pansi parts and drink
t- 1 part 3 times a
Pansitan day after meals.
6. Garlic 1. Hypertension Eat 6 cloves
2. Htperlipidemia of garlic
together with
meals
7. Niyog- 1. Ascariasis Chew and
Niyogan swallow only
dried seeds 2
hours after
dinner
according to
the following:
ADULTS = 8-10
seeds
9-12 y/o = 6-7
seeds 6-8 y/o =
5-6 seeds
4-5 y/o = 4-5
seeds
8. Guava 1. Cleaning For wound cleaning,
wounds use decoction for
2. Mouth wash washing the wound 2
for mouth times a day
infection, For tooth decay and
sore gums & swelling of gums,
tooth decay gargle with warm
decoction 3 times a
day
9. 1. Ring worm Apply the juice on the
Akapulko 2. Athletes affected area 1 to 2 times a
foot day
3. Scabies If the person develops an
allergy while using the above
preparation, prepare the
following:
oPut 1 cup of chopped fresh
leaves in an earthen jar. Pour
in 2 glasses of water and cover
it.
oBoil the mixture until the 2
glasses of water originally
poured have been reduced to 1
glass of water
oStrain the mixture. Use it
while it is warm.
oApply the warm decoction on
the affected area 1 to 2 times
a day.
10. 1. Mild Drink
Bitter Non- cup of
Gourd/ Insulin cooled or
Melon Dependen warm
(Ampalaya) t decoction
Diabetes 3 times a
Mellitus day after
meals.
11. 1. Motion An abortifacient if
Ginger sickness, taken in large
(Zingibe sore amounts; should not be
r throat, used by persons with
officina nausea & cholelithiasis unless
le) vomiting, directed by the
migraine physician; may
headaches, increase the risk of
arthritis bleeding when used
concurrently with
anticoagulants &
antiplatelets.
Chop and Mash a piece of
ginger root, and mix in a
glass of water
Boil the mixture
Drink the cooled or warm
decoction as needed.
Education For Health
Is one of the potent methodologies
for information dissemination. It
promotes the partnership of both the
family members and health workers in
the promotion of health as well as
prevention of illness.
Locally Endemic Disease Control

The control of endemic disease

focuses on the prevention of its
occurrence to reduce morbidity
rate. Example Malaria Control
and Schistosomiasis Control
 This program exists to control the occurrence of
preventable illnesses especially of children below 6
years old. Immunizations on poliomyelitis, measles,
tetanus, diphtheria and other preventable disease are
given for free by the government and ongoing
program of the DOH
 Maternal and Child Health and
Family Planning
The mother and child are the most
delicate members of the community. So
the protection of the mother and child
to illness and other risks would ensure
good health for the community. The
goal of Family Planning includes spacing
of children and responsible parenthood.
 Environmental Sanitation is defined as the
study of all factors in the mans
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 mans environment. Water is necessary
for the maintenance of healthy lifestyle.
Safe Water and Sanitation is necessary for
basic promotion of health.
Nutrition and Promotion of Adequate
Food Supply
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.
 The diseases spread through direct
contact pose a great risk to those who can
be infected. Tuberculosis is one of the
communicable diseases continuously
occupies the top ten causes of death.
Most communicable diseases are also
preventable. The Government focuses on
the prevention, control and treatment of
these illnesses.
 Supply of Essential Drugs
This focuses on the information campaign on the
utilization and acquisition of drugs.
In response to this campaign, the GENERIC ACT of the
Philippines is enacted . It includes the following drugs:
Cotrimoxazole, Paracetamol, Amoxycillin, Oresol,
Nifedipine, Rifampicin, INH(isoniazid) and
Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine
 - that level of CHN practice directed to
the FAMILY as the unit of care with
HEALTH as the goal and NURSING as the
medium, channel or provider of care
 - the no. and kind of families a nurse
handles at any given time
- variable for cases are added or
dropped based on the need for nursing
care and supervision
 1. Nuclear
2. Extended
3. Three generational
4. Dyad
5. Single- Parent
6. Step- Parent
7. Blended or reconstituted
 8. Single adult living alone
9. Cohabiting/ Living in
10. No- kin
11. Compound
12. Gay
14. Commune
 1. Newly married couple
2. Childbearing
3. Preschool age
4. Schoolage
5. Teenage
6. Launching
7. Middle-aged ( empty nest retirement)
8. Period from retirement to Death of both spouses
 1. recognizing interruptions of health or
development
2. seeking health care
3. managing health and non-health crises
4. providing nursing care to the sick, disabled and
dependent member of the family
5. maintaining a home environment conducive to
good health and personal development
6. maintaining a reciprocal relationship with the
community and health institutions
 Arises when the family cannot effectively
perform its health tasks
 1. HEALTH MONITOR
2. PROVIDER OF CARE TO A SICK
FAMILY MEMBER
3. COORDINATOR OF FAMILY
SERVICES
4. FACILITATOR
5. TEACHER
6. COUNSELOR
 Family structure, Characteristics, and
Dynamics
1. Members of the household and
relationship to the head of the family
2. Demographic data age, sex, civil status,
position in the family
3. Place of residence of each member
whether living with the family or elsewhere
4. Type of family structure e.g. matriarchal or
patriarchal, nuclear or extended
5. Dominant family members in terms of
decision-making, especially in matters of
health care
6. General family relationship/dynamics
presence of any readily observable conflict
between members; characteristics
communication patterns among members
 Socio-economic and Cultural
Characteristics
1. Income and Expenses
Occupation, place of work and income of
each working members
Adequacy to meet basic necessities
Who makes decisions about money and how
it is spent
2. Educational attainment of each other
3. Ethnic background and religious affiliation
4. Significant Others role(s)
they play in familys life
5. Relationship of the family to
larger community Nature
and extent of participation
of the family in community
activities
 Home and Environment
1. Housing
Adequacy of living peace
Sleeping arrangement
Presence of breeding or resting sites of
vectors of diseases
Presence of accidents hazards
Food storage and cooking facilities
Water supply source, ownership, portability
Toilet facility type, ownership, sanitary
condition
Drainage system type, sanitary condition
2. Kind of neighborhood, e.g.
congested, slum, etc.
3. Social and health facilities
available
4. Communication and
transportation facilities
available
 Health Status of each Family Member
1. Medical and nursing history indicating
current or past significant illnesses or
beliefs and practices conducive to health
illness
2. Nutritional assessment
Anthropometric data: Measures of nutritional
status of children, weight, height, mid-upper
arm circumference: Risk assessment measures
of obesity: body mass index, waist
circumference, waist hip ratio
Dietary history specifying quality and quantity
of food/nutrient intake per day
Eating/ feeding habits/ practices
3. Developmental assessments of infants,
toddlers, and preschoolers e.g., Metro
Manila
4. Risk factor assessment indicating presence
of major and contributing modifiable risk
factors for specific lifestyles, cigarette
smoking, elevated blood lipids, obesity,
diabetes mellitus, inadequate fiber intake,
stress, alcohol drinking and other
substance abuse
5. Physical assessment
indicating presence of illness
state/s
6. Results of laboratory/
diagnostic and other
screening procedures
supportive of assessment
findings
 Values, Habits, Practices on Health
Promotion, Maintenance and Disease
Prevention.
Examples include:
1. Immunization status of family members
2. Healthy lifestyle practices. Specify.
3. Adequacy of:
rest and sleep
exercise
use of protective measures- e.g. adequate
footwear in parasite-infested areas;
relaxation and other stress management
activities
4. Use of promotive-preventive health
services
FIRST-LEVEL ASSESSMENT
I. Presence of Wellness Condition stated as
Potential or Readiness- a clinical or nursing
judgment about a client in transition from a specific
level of wellness or capability to a higher level.
Wellness potential is a nursing judgment on wellness
state or condition based on clients performance,
current competencies or clinical data but no
explicit expression of client desire. Readiness for
enhanced wellness state is a nursing judgment on
wellness state or condition based on clients
current competencies or performance, clinical
data explicit expression of desire to achieve a
higher level of state or function in specific area on
health promotion and maintenance.
 Examples of these are the following:
1. Potential for Enhanced Capability for:
Healthy lifestyle e.g. nutrition/diet, exercise/
activity
Health Maintenance
Parenting
Breastfeeding
Spiritual Well-being process of a clients
unfolding of mystery through harmonious
interconnectedness that comes from inner
strength/sacred source/GOD (NANDA 2001)
Others,
2. Readiness for Enhanced Capability for:
Healthy Lifestyle
Health Maintenance
Parenting
Breastfeeding
Spiritual Well-being
Others,
I. Presence of Health Threats conditions that are
conducive to disease, accident or failure top
realize ones health potential.
Examples of these are the following:
1. Family history of hereditary condition, e.g. diabetes
2. Threat of cross infection from a communicable
disease case
3. Family size beyond what family
resources can adequately
provide
4. Accidental hazards
Broken stairs
Sharp objects, poison, and
medicines improperly kept
Fire hazards
5. Faulty nutritional habits or feeding practices.
Inadequate food intake both in quality &
quantity
Excessive intake of certain nutrients
Faulty eating habits
Ineffective breastfeeding
Faulty feeding practices
6. Stress-provoking factors
Strained marital relationship
Strained parent-sibling
relationship
Interpersonal conflicts
between family members
Care-giving burden
7. Poor home
condition-
Inadequate living Unsanitary
space waste
Lack of food storage disposal
facilities Improper
Polluted water supply drainage
system
Presence of breeding
sites of vectors of Poor
ventilation
disease
Noise
Improper garbage
pollution
Air pollution
8. Unsanitary food handling and
preparation
9. Unhealthful lifestyles and personal habits-
Alcohol drinking
Cigarette smoking
Inadequate footwear
Eating raw meat
Poor personal hygiene
Self-medication
Sexual promiscuity
Engaging in dangerous sports
Inadequate rest
Lack of inadequate exercise
Lack of relaxation activities
Non-use of self protection measures
10. Inherent personal characteristics e.g. poor impulse
control
11. Health history which induce the occurrence of a
health deficit, e.g. previous history of difficult labor
12. Inappropriate role assumption e.g. child assuming
mother's role, father not assuming his role
13. Lack of immunization/ inadequate immunization
status specially of children
14. Family disunity
Self-oriented behavior of
member(s)
Unresolved conflicts of
member(s)
Intolerable disagreement
Other
15. Other
 Presence of Health Deficits instances of
III.
failure in health maintenance.
Examples include:
1. Illness states, regardless of whether it is
diagnosed or by medical practitioner
2. Failure to thrive/ develop according to
normal rate
3. Disability whether congenital or arising
from illness; temporary
IV. Presence of stress Points/ Foreseeable Crisis Situations
anticipated periods of unusual demand of the individual or
family in terms of family resources.
Examples of these include:
1. Marriage 9. Menopause
2. Pregnancy 10. Loss of job
3. Parenthood 11. Hospitalization of
a
4. Additional member family member
5. Abortion 12. Death of a manner
6. Entrance at school 13. Resettlement in a
7. Adolescence new community
8. Divorce 14. illegitimacy
 Focus on determining familys capacity to perform the
health tasks
Statements on family health nursing problem:
a. Inability to recognize the presence of the condition or
problem
b. Inability to make decisions with respect to taking
appropriate health action
c. Inability to provide adequate nursing care to the sick,
disabled , dependent or vulnerable member of the family
d. Inability to provide a home environment conducive to
health maintenance or personal development
e. Failure to utilize community resources for health care
 Criteria:
a. Nature of the condition or problem presented
( wellness state, health deficit, health threat,
forseeable crisis)
b. Modifiability of the condition or problem
( easily, partially, not modifiable)
c. Preventive Potential (high, moderate , low)
d. Salience ( needs immediate attention, not
immediate, not perceived as a problem)
 Assessment
Purpose : To identify the health needs of the people
Planning of nursing actions
Purpose : To act on the determined needs of the
community people
Implementation
Purpose : To achieve the optimum level of health of the
community people
Evaluation
Purpose : To determine the effectiveness of health care programs
 CLINIC VISIT
- process of checking the clients health condition
in a medical clinic
HOME VISIT
- a professional face to face contact made by the
nurse with a patient or the family to provide
necessary health care activities and to further
attain the objectives of the agency
BAG TECHNIQUE
-a tool making of the public health bag through
which the nurse during the home visit can
perform nursing procedures with ease and
deftness saving time and effort with the end in
view of rendering effective nursing care
 THERMOMETER TECHNIQUE
-to assess the clients health condition
through body temperature reading
NURSING CARE IN THE HOME
- giving to the individual patient the nursing
care required by his/her specific illness or
trauma to help him/her reach a level of
functioning at which he/she can maintain
himself/herself or die peacefully in dignity
 ISOLATION TECHNIQUE IN THE HOME
-done by :
1. separating the articles used by a client with
communicable disease to prevent the spread
of infection:
2. frequent washing and airing of beddings and
other articles and disinfections of room
3. wearing a protective gown , to be used only
within the room of the sick member
4. discarding properly all nasal and throat
discharges of any member sick with
communicable disease
5. burning all soiled articles if could be or
contaminated articles be boiled first in
water 30 minutes before laundering
INTRAVENOUS THERAPY
- insertion of a needle or catheter into a vein
to provide medication and fluids based on
physicians written prescription
- can be done only by nurses accredited by
ANSAP
 It considers the health status of the
people, which is determined by the
economic and social conscience of the
country.
It is a process whereby people learn to
improve their personal habits and
attitudes, to work responsibly for the
improvement of health conditions of the
family, community, and nation.
 It involves motivation, experience, and
change in conduct and thinking, while
stimulating active interest. It develops
and provides experience for change in
peoples attitudes, customs, and habits
in relation to health and everyday living.
It should be recognized as the basic
function of all health workers.
 It takes place in the home, in the
school, and in the community.
It is a cooperative effort requiring
all categories of health personnel
to work together in close
teamwork with families, groups,
and the community.
 It meets the needs, interests,
and problems of the people
affected.
It finds means and ways of
carrying out plans by
encouraging individual and
community participation.
 It is a slow, continuous process
that involves constant
changes and revisions until
objectives are achieved.
Makes use of supplementary
aids and devices to help with
the verbal instructions.
 It utilizes community resources by
careful evaluation of the different
services and resources found in the
community.
It is a creative process requiring
methods and techniques with various
characteristics, not following a rigid and
flexible pattern.
 It aims to help people make use of their
own efforts and education to improve
their conditions of living,
It makes careful evaluation of the
planning, organization, and
implementation of all health education
programs and activities.
 Qualifications
1. Bachelor of Science in
Nursing
2. Registered Nurse of the
Philippines
 Planner/Programmer
1. Identifies needs, priorities, and problems of
individuals, families, and communities
2. Formulates municipal health plan in the absence of a
medical doctor
3. Interprets and implements nursing plan, program
policies, memoranda, and circular for the concerned
staff personnel
4. Provides technical assistance to rural health midwives
in health matters
 Provider of Nursing Care
1. Provides direct nursing care
to sick or disabled in the
home, clinic, school, or
workplace
2. Develops the familys
capability to take care of
the sick, disabled, or
dependent member
 Manager/Supervisor
1. Formulates individual, family, group, and
community-centered plan
2. Interprets and implements programs,
policies, memoranda, and circulars
3. Organizes work force, resources,
equipments, and supplies at local level
4. Provides technical and administrative
support to Rural Health Midwives (RHM)
5. Conducts regular supervisory visits and
meetings to different RHMs and gives
feedback on accomplishments
 Community Organizer
1. Motivates and enhances
community participation in terms of
planning, organizing,
implementing, and evaluating
health services
2. Initiates and participates in
community development activities
 Coordinator of Services
1. Coordinates with individuals,
families, and groups for health
related services provided by
various members of the health
team
2. Coordinates nursing program with
other health programs like
environmental sanitation, health
education, dental health, and
mental health
 Trainer/Health Educator
1. Identifies and interprets training needs of
the RHMs, Barangay Health Workers (BHW),
and hilots
2. Conducts training for RHMs and hilots on
promotion and disease prevention
3. Conducts pre and post-consultation
conferences for clinic clients; acts as a
resource speaker on health and health-
related services
4. Initiates the use of tri-media (radio/TV,
cinema plugs, and print ads) for health
education purposes
5. Conducts pre-marital counseling
 Health Monitor
1. Detects deviation from
health of individuals, families,
groups, and communities
through contacts/visits with
them
 Role Model
1. Provides good
example of healthful
living to the
members of the
community
 Change Agent
1. Motivates changes in health
behavior in individuals,
families, groups, and
communities that also
include lifestyle in order to
promote and maintain
health
 Recorder/Reporter/Statistician
1. Prepares and submits required reports and records
2. Maintain adequate, accurate, and complete
recording and reporting
3. Reviews, validates, consolidates, analyzes, and
interprets all records and reports
4. Prepares statistical data/chart and other data
presentation
 Researcher
1. Participates in the conduct of survey studies and
researches on nursing and health-related subjects
2. Coordinates with government and non-government
organization in the implementation of
studies/research
 Approaches to community devt.:
a. Welfare approach
b. Technological approach
c. Transformatory approah
 Principles of CO:
1. 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 must reside in the people
B. Devt. is from the people to the people
C. People participation
 2.-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. should lead to self-reliant
communities
 1. PRE-ENTRY PHASE
2. ENNTRY PHASE
3. COMMUNITY STUDY/DIAGNOSIS
PHASE/RESEARCH PHASE
4.COMMUNITY ORGANIZATION AND
CAPABILITY-BUILDING PHASE
5. COMMUNITY ACTION PHASE
6. SUSTENANCE AND STRENGTHENING
PHASE
 1.Conducts community meetings to draw up
guidelines for the organization of CHO
2. Trains BHWs
3. Sets up of linkages/network and referral systems
4. PIME of health services and or community devt.
Projects
5. Provides continuing education to leaders or
residents
6. Trains secondary leaders
7. Selects site for adoption
8. Identifies key leaders
 9. Develops criteria for site selection
10. Forms the core group
11.Conducts SALT
12.Selects members of the research team
13. Assists the research team in presenting results
during the general assembly
14. Helps the people identifying the community
needs and health problems
15. Facilitates for the formulation and ratification of
the constitution and by-laws of the organization
1. EPI (Expanded Program on
Immunization)
2. CDD (Control of Diarrheal Diseases)
3. CARI (Control of Acute Respiratory
Infections)
4. UFC (Under-Five Clinics)
5. MC (Maternal Care)
6. BF (Breastfeeding)
7. MRP (Malnutrition Rehabilitation
Program)
8. VAD ( Vitamin A Deficiency)
9. IDD/IDA (Iodine Deficiency Disorders/
Iron Deficiency Anemia)
10. FP (Family Planning)
 TARGET SETTING:
1. INFANTS 0-12 MONTHS
2. PREGNANT AND POST PARTUM WOMEN
3. SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS OLD

OBJECTIVES OF EPI:
TO REDUCE MORBIDITY AND MORTALITY
RATES AMONG INFANTS AND CHILDREN from
SIX CHILDHOOD IMMUNIZABLE DISEASE
 ELEMENTS OF EPI:
1. TARGET SETTING
2. COLDCHAIN LOGISTIC MANAGEMENT-
Vaccine distribution through cold chain is
designed to ensure that the vaccine were
maintained under proper environmental
condition until the time of administration.
3. IEC
4. Assessment and evaluation of Over-all
performance of the program
5. Surveillance and research studies
Vaccine Minimum Age Number Minimum Reason
of 1st Dose of Doses Interval
Between
Doses

1. BCG Birth or 1 BCG is given

(Bacillus anytime at the
Calmette after earliest
birth possible age
Guerin) protects
School against the
entrants possibility
of TB
infection
from the
other family
members
 2. DPT 6 weeks 3 4 weeks An early start
(Diphthe with DPT reduces
ria the chance of
Pertusis severe pertussis
Tetanus)

3. OPV 6 weeks 3 4 weeks The extent of

(Oral protection against
Polio polio is increased
Vaccine) the earlier OPV is
given.
4. 6 weeks 3 4 weeks An early start of
Hepatiti Hepatitis B
s B reduces the chance
of being infected
and becoming a
carrier.
5. 9 months 1 At least 85% of
Measles measles can be
prevented by
immunization at this
age.
A. NO DEHYDRATION
Condition well, alert
Mouth and Tongue moist
Eyes normal
Thirst drinks normally, not thirsty
Tears present
Skin pinch goes back quickly
TREATMENT PLAN A- HOME TTT.
1.Give the child more fluids than usual
use home fluid such as cereal gruel
give ORESOL, plain water
2. Give the child plenty of food to prevent undernutrition
continue to breastfeed frequently
if child is not breastfeed, give usual milk
if child is less than 6 months and not yet taking solid
food, dilute milk for 2 days
if child is 6 months or older and already taking solid
food, give cereal or other starchy food mixed with
vegetables, meat or fish; give fresh fruit juice or mashed
banana to provide potassium; feed child at least 6 times
a day. After diarrhea stops, give an extra meal each day
for two weeks.
3. Take the child to the health worker if the
child does not get better in 3 days or
develops any of the following:
many watery stools
repeated vomiting
marked thirst
eating or drinking poorly
fever
blood in the stool
 Age Amount of ORS Amount of ORS to
to give after provide for use
each loose at home
stool
50- 500
< 24 100 ml. ml./day
months
100- 1000
2 10 200 ml. ml./day
years

As much as 2000
10 wanted ml./day
years
up
B. SOME DEHYDRATION
Condition restless, irritable
Mouth and Tongue dry
Eyes sunken
Thirst thirsty, drinks eagerly
Tears absent
Skin pinch goes back slowly
WEIGH PT, TTT. PLAN B
AGE WEIGHT ORS
KG ML

4 MOS. 5 200-400

4-11MOS 5-7.9 400-600

12-23MOS 8-10.9 600-800

2-4YRS 11-15.9 800-1200

5-14YRS 16-29.9 1200-2200

15 YRS UP 30 UP 2200-4000
1. If the child wants more ORS than shown, give more
2. Continue breastfeeding
3. For infants below 6 mos. who are not breastfeed, give
100-200 ml clean water during the period
4. For a child less than 2 years give a teaspoonful every 1-2
min.
5. If the child vomits, wait for 10 min, then continue giving
ORS, 1 tbsp/2-3 min
6. If the childs eyelids become puffy, stop ORS , give plain
water or breast milk, Resume ORS when puffiness is gone
7. If ( -) signs of DHN- shift to Plan A
Use of Drugs during Diarrhea
Antibiotics should only be used for
dysentery and suspected cholera
Antiparasitic drugs should only be
used for amoebiasis and giardiasis
C. SEVERE DEHYDRATION
Condition lethargic or unconscious; floppy
Eyes very sunken and dry
Tears absent
Mouth and tongue very dry
Thirst- drinks poorly or not able to drink
Skin pinch goes back very slowly
TTT PLAN C- ttt. quickly
1.Bring pt. to hospital
2. IVF Lactated Ringers Solution or Normal
Saline
3.Re-assess pt. Every 1-2 hrs
4. Give ORS as soon as the pt. can drink
1.Two problems in CDD
1. High child mortality due to
diarrhea
2. High diarrhea incidence
among under fives
2. Highest incidence in age 6 23 months

3. Highest mortality in the first 2 years of life

4. Main causes of death in diarrhea :

DEHYDRATION
MALNUTRITION
5. To prevent dehydration, give home
fluids am as soon as diarrhea starts
and if dehydration is present, rehydrate
early, correctly and effectively by giving
ORS

6. For undernutrition, continue feeding

during diarrhea especially
breastfeeding.
7. Interventions to prevent diarrhea
1. breastfeeding
2. improved weaning practices
3. use of plenty of clean water
4. hand washing
5. use of latrines
6. proper disposal of stools of
small children
7. measles immunization
8. Risk of severe diarrhea 10-30x higher in bottle
fed infants than in breastfed infants.
9. Advantages of breastfeeding in relation to
CDD
1.Breast milk is sterile
2.Presence of antibodies protection against
diarrhea
3.Intestinal Flora in BF infants prevents growth
of diarrhea causing bacteria.
10. Breastfeeding decreases incidence rate
by 8-20% and mortality by 24-27% in
infants under 6 months of age.
11. When to wean?
4-6 months soft mashed foods 2x a day
6 months variety of foods 4x a day
12. Summary of WHO-CDD recommended
strategies to prevent diarrhea
1. Improved Nutrition
- exclusive breastfeeding for the first 4-6 months
of life and partially for at least one year.
- Improved weaning practices
2.Use of safe water
- collecting plenty of water from the cleanest
source
- protecting water from contamination at the
source and in the home
 3.Good personal and domestic hygiene
- handwashing
- use of latrines
- proper disposal of stools of young children
4.Measles immunization
CLASSIFICATION:
A. NO PNEUMONIA: COUGH OR COLD
1. No chest in drawing
2. No fast breathing ( <2 mos- <60/min,2-12 mos.
less than 50 per minute; 12 mos. 5 years less than
40 per minute)
TREATMENT:
1. If coughing more than 30 days, refer for assessment
2. Assess and treat ear problems/sore throat if present
3. Advise mother to give home care
4.Treat fever/wheezing if present
HOME CARE:
1. FEED THE CHILD
1. Feed the child during illness
2. Increase feeding after illness
3. Clear the nose if it interferes with
feeding
2. INCREASE FLUIDS
1. offer the child extra to drink
2. Increase breastfeeding
3. SOOTHE THE THROAT AND RELIEVE
THE COUGH WITH A SAFE REMEDY
4. WATCH FOR THE FOLLOWING SIGNS AND
SYMPTOMS AND RETURN QUICKLY IF
THEY OCCUR
1. Breathing becomes difficult
2. Breathing becomes fast
3. Child is not able to drink
4. Child becomes sicker
B. PNEUMONIA
1. No chest in drawing
2. Fast breathing ( less than 2 mos- 60/min or
more ; 2-12 mos. 50/min or more; 12 mos.
5 years 40/min or more)
TREATMENT
1.Advise mother to give home care
2.Give an antibiotic
3.Treat fever/wheezing if present
4.If the childs condition gets worst,refer
urgently to hospital; if improving, finish 5 days
of antibiotic.
ANTIBIOTICS RECOMMENDED BY WHO
*Co-trimoxazole,
*Amoxycillin, Ampicillin, (p.o)
*or Procaine penicillin (I.M.)
 Chest indrawing
Nasal flaring
Grunting ( short sounds made with the
voice)
Cyanosis
TTT.
1. Refer urgently to hospital
2. Treat fever ( paracetamol), wheezing (
salbutamol)
 Not able to drink
Convulsions
Abnormally sleepy or difficult to wake
Stridor in calm child
Severe undernutrition
TTT.
Refer urgently to hospital
ASK THE MOTHER:
1. How old is the child?
2. Is the child coughing? For how long?
3. Age 2 months up to 5 years: Is the child able
to drink?
Age less than 2 months: Has the young
infant stopped feeding well?
4. Has the child had fever? For how long?
5. Has the child had convulsions?
 LOOK, LISTEN:
1. Count the breaths in one minute.

Age0 Fast Breathing

Less than 2 months 60/minute or more
2 months 12 months 50/minute or more
12 months 5 years 40/minute or more

2. Look for chest in drawing.

3. Look and listen for stridor.
Stridor occurs when there is a narrowing of
the larynx, trachea or epiglottis which
interferes with air entering the lungs.
4. Look and listen for wheeze
Wheeze is a soft musical noise which
shows signs that breathing out(exhale) is
difficult.
5. See if the child is abnormally sleepy or
difficult to wake. (Suspect meningitis)
6. Feel for fever or low body temperature.
7. Check for severe under nutrition
Classification of Ear Infection
A. MASTOIDITIS tender swelling behind the ear
(in infants, swelling may be above the ear)
TREATMENT
1. Antibiotics
2.Surgical intervention
B. ACUTE EAR INFECTION pus draining
from the ear for less than 2 weeks, ear
pain, red, immobile ear drum (Acute
Otitis Media)
TREATMENT
1.Cotrimoxazole,Amoxycillin,or
Ampicillin
2.Dry the ear by wicking
C. CHRONIC EAR INFECTION pus draining from the ear
for more than 2 weeks (Chronic Otitis Media)
TREATMENT
Most important & effective treatment: Keep the ear dry
by wicking.
Paracetamol maybe given for pain or high fever.
Precautions for a child with a draining ear:
1. Do not leave anything in the ear such as cotton, wool
between wicking treatments.
2. Do not put oil or any other fluid into the ear.
3. Do not let the child go swimming or get water in the
ear.
Maternal and Child Health
Nursing
Philosophy
Pregnancy, labor and delivery and
puerperium are part of the continuum of
the total life cycle
Personal, cultural and religious attitudes
and beliefs influence the meaning of
pregnancy for individuals and make each
experience unique
MCN is FAMILY CENTERED- the father is
as important as the mother
 Goals
To ensure that expectant mother and
nursing mother maintain good health,
learn the art of child care, has a normal
delivery and bear healthy children

That every child lives and grows up in a

family unit with love and security, in healthy
surroundings, receives adequate
nourishment, health supervision and
efficient medical attention and is taught
the elements of healthy living
 Normal healthy pregnancy
With mild complications- frequent home
visits
With serious or potentially serious cx
referred to most skilled source of medical
and hospital care
 Tool used when rendering prenatal
care
containing risk factors and danger signs
*Risk Factors
145 cm tall ( 4 ft & 9 inches)
Below 18 yrs old, above 35 yrs old
Have had 4 pregnancies
With TB, goiter, heart disease, DM, bronchial
asthma, severe anemia
Last baby born was less than 2 years ago
Previous cesarian section delivery
History of 2 or more abortions, difficult delivery, given
birth to twins , 2 or more babies born before EDD,
stillbirth
Weighs less than 45 kgs. or more than 80 kgs.
 1. any type of vaginal bleeding
2. headache, dizziness, blurred vision
3. puffiness of face and hands
4. pallor
 Schedule of Visits
1st as early as pregnancy, 1st trimester

2nd - 2nd trimester

3rd & subsequent visits - 3rd trimester

More frequent visits for those at risk with cx

Vaccine Minimum Age Percent Duration of
Interval Protecte Protection
d

As early as
TT1 possible during 80%
pregnancy
 At least 4 Infants born
TT2 weeks later to the mother
80%
will be
protected
from neonatal
tetanus.
Gives 3 years
protection for
the mother
from tetanus.
 At least 6 Infants born to the
TT3 months 90%
later mother will be
protected
from neonatal
tetanus.
Gives 5 years
protection for the
mother.
TT4 At least 1 99% Gives 10
year later protectio
n for the
mother
TT5 At least 1 99% Gives
year later lifetime
protection
for
the mother.
All infants
born to
that mother
will be
protected.
 History taking
Determination of obstetrical score- G,
P, TPAL,AOG,EDD
U/A for Proteinuria, glycosuria and
infxtn
Dental exam
Wt. Ht. BP taking
Exam of conjunctiva and palms for
pallor
Abdominal exam - fundic ht, Leopolds
maneuver and FHT
 Exam of breasts, face, hands and feet for
edema and neck for thyroid enlargement
Health teachings- nutrition, personal hygiene,
common complaints
Tetanus toxoid immunization
Iron supplementation from 5th mo. of
pregnancy - 2 mos. Postpartum
In goiter endemic areas iodized capsule
once a year
In malaria infested areas- prophylactic
Chloroquine ( 150 mg/tab ) 2 tabs/ wk for the
whole duration of pregnancy
 UNDER FIVE CLINIC

The first five years of life form the

foundations of the childs physical and
mental growth and development. Studies
have shown the mortality and morbidity are
high among this age group. The Department
of Health established the Under Five Clinic
Program to address this problem.
 PROGRAM OBJECTIVES AND GOALS:

Monitor growth and development of the child

until 5 years of age.

Identify factors that may hinder the growth

and development of the child.
 ACTIVITIES AND STRATEGIES:
1. Regular height and weight determination/ monitoring until
5 years old.
0-1 year old=monthly
1 year old and above =quarterly
2. Recording of immunization, vitamins supplementation,
deworming and feeding.
3. Provision of IEC materials (ex. Posters, charts, toys) that
promote and enhance childs proper growth and
development.
4. Provision of a safe and learning oriented environment
for the child.
5. Monitoring and Evaluation.
 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:
Executive Order 51
Republic Act 7600
The Rooming-In and Breastfeeding Act of 1992
 PROGRAM OBJECTIVES AND GOALS:
=Protection and promotion of
breastfeeding and lactation
management education training
ACTIVITIES AND STRATEGIES:
1.FULL IMPLEMENTATION OF LAWS
SUPPORTING THE PROGRAM

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
2. CONDUCT ORIENTATION/ADVOCACY
MEETINGS TO HOSPITAL/ COMMUNITY.
ADVANTAGES OF BREASTFEEDING:

MOTHER
Oxytocin help the uterus contracts
Uterine involution
Reduce incidence of Breast Cancer
Promote Maternal-Infant Bonding
Form of Family planning Method
(Lactational Amenorrhea)
BABY
Provides Antibodies
Contains Lactoferin (binds with Iron)
Leukocytes
Contains Bifidus factor-promotes
growth of the Lactobacillus-inhibits the
growth of pathogenic bacilli
 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 OPTIMAL
GASTROENTERITIS GREATLY REDUCED
 GARANTISADONG PAMBATA (GP)
Garantisadong Pambata is a biannual week long
delivery of a package of health services to children
between the ages of 0-59 months old with the purpose of
reducing morbidity and mortality among under fives
through the promotion of positive Filipino values for
proper child growth and development.

1. WHAT ARE THE HEALTH SERVICES OFFERED IN GP AND

WHO ARE THE TARGETS?
GP offers the following:
1.1 Routine Health Services:
 Health Dosage Route of Target
Service Administr Populatio
ation n
Vitamin A 200,000 IU Orally 12-59
capsule or 1 by drops months
capsule old,
100,000 IU nationwid
or cap e
or 3 drops 9-12
month old
infants
receiving
AMV
nationwid
Ferrous
Sulfate
(25 mg. 0.3ml(2-6 Orally 2-11 months old
Elemental mos) by infants in
Iron per once a day drops Mindanao area,
ml; 30 ml. including
Bottle as evacuation
0.6ml(6- centers in
taken home
11mos) once armed conflict
medicine
with a day areas.
instruction
s)
Routine Nationwide

Immuniza
tion 0-11 mos
-BCG* 0.05ml Intradermal on
right deltoid
-DPT* 0.5ml Intramuscularly 0-11 mos
on anterior thigh
-OPV* 2 drops Orally 0-11 mos
0.5ml Subcutaneously on 9-11 mos
-AMV*
-Hepa B (if deltoid
available) 0.5ml Intramuscularly 0-11 mos
Deworming
drug
(if
available 1 36-59 mos,
) Orally
tablet nationwide
as
single
dose

Weighing 0-59 mos,

nationwide
 * The child should not have received
megadose of Vit. A above the
recommended dosage within the past 4
weeks except if the child has measles or signs
and symptoms of Vit A. deficiency.
** For any child between 12-23 months, who
missed any of his routine immunization, the
health worker should give the child the
necessary antigen to complete FIC and shall
be recorded as such.
- Vitamin A, Iron and Iodine
-Sources: green leafy and yellow vegetables,
fruits, liver, seafoods, iodized salt, pan de
bida and other fortified foods.
These micronutrients are not produced by
the body, and must be taken in the food we
eat; essential in the normal process of growth
and development:
a) Helps the body to regulate itself
b) Necessary in energy metabolism
c) Vital in brain cell formation and mental development
d) Necessary in the body immune system to protect the
body from severe infection.
e) Eating Sangkap Pinoy-rich foods can prevent and
control:
1. Protein Energy Malnutrition
2. Vitamin A Deficiency
3. Iron Deficiency Anemia
4. Iodine Deficiency Disorder
 BREASTFEEDING
Breast milk is best for babies up to 2
years old. Exclusive breastfeeding is
recommended for the first six months of
life. At 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.
 BENEFITS :
For infants
a. Provides a nutritional complete food for the
young infant.
b. Strengthens the infants immune system,
preventing many infections.
c. Safely rehydrates and provides essential
nutrients to a sick child, especially to those
suffering from diarrheal diseases.
d. Reduces the infants exposure to infection.
 For the Mother
e. Reduces a womans risk of excessive blood
loss after birth
f. Provides a natural method of delaying
pregnancies.
g. Reduces the risk of ovarian and breast
cancers and osteoporosis.
For the Family and Community
h. Conserves funds that otherwise would be
spent on breast milk substitute, supplies and
fuel to prepare them.
i. Saves medical costs to families and
governments by preventing illnesses and by
providing immediate postpartum
contraception.
 COMPLEMENTARY FEEDING FOR BABIES 6-11 MONTHS OLD
What are Complementary Foods?

a. foods introduced to the child at the age

6 months to supplement breastmilk
a. given progressively until the child is used to
three meals and in-between feedings at the
age of one year.
Why is there a Need to Give Complementary Foods?
c. breastmilk can be a single source of
nourishment from birth up to six months of life.
c. The childs demands for food increases as he
grows older and breastmilk alone is not
enough to meet his increased nutritional
needs for rapid growth and development
d. Breastmilk should be supplemented with
other foods so that the child can get
additional nutrients
e. Introduction of complementary foods will
accustom him to new foods that will also
provide additional nutrients to make him
grow well
f. Breastfeeding, however, should continue for
as long as the mother is able and has milk
which could be as long as two years
 How to Give Complementary Foods for Babies
6-11 Months Old?
a. Prepare mixture of thick lugao/ cooked rice,
soft cooked vegetables. Egg yolk, mashed
beans, flaked fish/chicken/ground meat and
oil.
b. Give mixture by teaspoons 2-4 times daily,
increasing the amount of teaspoons and
number of feeding until the full
recommended amount is consumed
c. Give bite-sized fruit separately
d. Give egg alone or combine with above food
mixture
 The Philippine Family Planning Program is a national
program that systematically provides information and
services needed by women of reproductive age to plan
their families according to their own beliefs and
circumstances.
GOALS AND OBJECTIVES:
Universal access to family planning information, education
and services.
MISSION:
To provide the means and opportunities by which married
couples of reproductive age desirous of spacing and
limiting their pregnancies can realize their reproductive
goals.
 TYPES OF METHODS:

A. NATURAL METHODS
1. Calendar or Rhythm Method
2. Basal Body Temperature Method
3. Cervical Mucus Method
4. Sympto-Thermal Method
5. Lactational Amennorhea
B. ARTIFICIAL METHODS
I. CHEMICAL METHODS
1.Ovulation suppressant such as PILLS
2. Depo-Provera
3. Spermicidals
4. Implant
II. MECHANICAL METHODS
1. Male and Female Condom
2. Intrauterine Device
3. Cervical Cap/Diaphragm
III. SURGICAL METHODS
1. Vasectomy
2. Tubal Ligation
Pills
Abdominal pain ( severe)
Chest pain ( severe)
Headache ( severe)
Eye problems ( blurred vision, flashing
lights, blindness)
Severe leg pain ( calf or thigh )
Others: depression, jaundice, brest lumps
IUD
*Period late, no symptoms of pregnancy,
abnormal bleeding or spotting
*Abdominal pain during intercourse
*Infection or abnormal vaginal discharge
*Not feeling well, has fever or chills
*String is missing or has become shorter or
longer
 INJECTABLES
Dizziness
Severe headache
Heavy bleeding
BTL
Fever
Weakness
Rapid pulse
Persistent abdominal pain
Vomiting
Dizziness
Pus or tenderness at incision site
Amenorrhea
Vasectomy

Fever
Scrotal blood clots or excessive swelling
 Goal
To improve the nutritional status,
productivity and quality of life of
the population thru adoption of
desirable dietary practices and
healthy lifestyle
 Objectives
Increase food and dietary energy
intake of the average Filipino
Prevent nutritional deficiency
diseases and nutrition-related
chronic degenerative diseases
Promote a healthy well-balanced
diet
Promote food safety
Nutrition is a state of well-being achieved by
eating the right food in every meal and the
proper utilization of the nutrients by the body.
Proper nutrition is important because:
it helps in the development of the brain, especially during
the first years of the childs life.
It speeds up the growth and development of the body
including the formation of teeth and bones
It helps fight infection and diseases
It speeds up the recovery of a sick person
It makes people happy and productive
Proper nutrition is eating a balanced diet in every meal
Balanced diet is made up of a
combination of the 3 basic
groups eaten in correct amounts.
The grouping serves as a guide in
selecting and planning everyday
meals for the family.
THE THREE (3) BASIC FOOD GROUPS ARE:
1. Body building food which are rich in
protein and needed by the body for:
< normal growth and repair of worn-out body
tissues
< supplying additional energy
< fighting infections
< Examples of protein-rich food are: fish;
pork; chicken; beef; cheese; butter; kidney
beans; mongo; peanuts; bean curd; shrimp;
clams
 2. Energy-giving food which are rich in
carbohydrates and fats and needed by the
body for:
< providing enough energy to make the
body strong
< Examples of energy-giving food are: rice;
corn; bread; cassava; sweet potato; banana;
sugar cane; honey; lard; cooking oil; coconut
milk; margarine; butter
 3. Body-regulating food which are rich in
Vitamins and minerals and needed by the
body for:
< normal development of the eyes, skin,
hair, bones, and teeth
< increased protection against diseases
< Examples of body-regulating food are:
tisa; ripe papaya; mango; guava; yellow
corn; banana; orange; squash; carrot
1. Eat at least 3 meals/day
2. Eat more fruits, vegetables, grain and
cereals e.g. rice, noodles and potato
3. If you use butter or margarine, pat it on
thinly
4. Choose low fat substitute i.e. replace
whole milk with skimmed milk, low fat
cheese
5. Become a label reader. Look for foods
that have less than 5 g /100 g of product
6. Eat less high fat snacks and take away
potato chips, sausage rolls or breaded
meats
7. Cut all visible fat from meat, remove skin
from chicken fat drippings and cream
sauces
8. Aim for thin palm-size serving of lean
meat, poultry and fish/ meal
9. Grill, bake, steam, stew, stir fry and
microwave, try not to fry
10. Drink lots of water all day- its a food
quencher
 Start by walking for 10 min.
Build up to 30-40 min/day
Go for 3-4 times / week of any exercise
you enjoy
 Drink a lot- water, clear broth
Eat most rice, root crops, corn, noodles,
bread and cereals
Eat more vegetables, green salads,
fruits or juices
Eat some fish, poultry, dry beans, nuts,
eggs, lean meats, low fat dairy
Eat a little fats, oils, sugar, salt
VITAMINS FUNCTIONS
Vitamin A Maintain normal vision,
skin health, bone
and tooth growth
reproduction and
immune function;
prevents
xerophthalmia.
Food sources:
Breastmilk;poultry;eggs
; liver;
meat;carrots;squash;
papaya;mango;tiesa;
malunggay;kangkong;
Thiamine Help release
energy from
nutrients;
support normal
appetite and
nerve function,
prevent beri-
beri.
Riboflavi Helps release energy from
nutrients, support skin
n health, prevent deficiency
manifested by cracks and
redness at corners of mouth;
inflammation of the tongue and
dermatitis.

Niacin Help release energy from

nutrients; support skin,
nervous and digestive system,
prevents pellagra.
Biotin Help energy and
amino acid
metabolism; help
in the synthesis
of fat glycogen.

Pantothen Help in energy

ic metabolism.
 Help in the formation of
Folic acid DNA and new blood cells
including red blood cells;
prevent anemia and some
amino acids.

Help in the formation of

Vitamin B the new cells; maintain
12 nerve cells, assist in the
metabolism of fatty acids
and amino acids.
 Help in the formation of
Vitamin C protein, collagen, bone,
teeth cartilage, skin and
scar tissue; facilitate in
the absorption of iron from
the gastrointestinal tract;
involve in amino acid
metabolism; increase
resistance to infection,
prevent scurvy.
Food sources:
Guava;pomelo;lemon;orange;
calamansi; tomato; cashew
Vitamin D Help in the
mineralization of
bones by enhancing
absorption of
calcium.
 Strong anti-oxidant; help
Vitamin E prevent arteriosclerosis;
protect neuro-muscular
system; important for normal
immune function.

Involve in the synthesis of

Vitamin K blood clotting proteins and a
bone protein that regulates
blood calcium level.
 MINERALS FUNCTIONS
Mineralization of bones and
Calcium teeth, regulator of many of the
bodys biochemical processes,
involve in blood clotting,
muscle contraction and
relaxation, nerve functioning,
blood pressure and immune
defenses.
Maintain normal fluid and
Chloride electrolyte balance.
Chromium Work with insulin and is
required for release of
energy from glucose.

Copper Necessary for absorption

and use of iron in the
formation of hemoglobin.
 Involve in the formation of
Fluoride bones and teeth; prevents tooth
decay.
As part of the two thyroid
Iodine hormones, iodine regulates
growth, physical and mental
development and metabolic
rate.
Aids in the development of the
brain and body especially in
unborn babies
Food sources:
Seaweeds;squids;shrimps;crabs;
fermented
shrimp;mussels;snails; dried
dilis; fish
 Essential in the
Iron formation of blood.
It is involved in the
transport and storage
of oxygen in the
blood and is a co-
factor bound to
several non-hemo
enzymes required for
the proper
functioning of cells.
Food sources:
Pork; beef; chicken;
liver and other
internal organs;
Magnesium Mineralization of
bones and teeth,
building of
proteins, normal
muscle
contraction, nerve
impulse
transmission,
maintenance of
teeth and
functioning of
immune system.
Manganese Facilitate many
cell processes.

Molybdenum Facilitate many

cell processes.
Phosphoru Mineralization of
s bones and teeth;
part of every Cell;
used in energy
transfer and
maintenance of acid-
base balance.
Selenium Work with vitamin E
to protect body
compound from
oxidation.
Selenium Work with vitamin E
to protect body
compound from
oxidation.

Sodium Maintain normal fluid

and electrolyte
balance, assists
nerve impulse
insulin.
Sulfur Integral part of
vitamins, biotin and
thiamine as well as
the hormone.

Zinc Essential for normal

growth, development
reproduction and
immunity.
 MALNUTRITION
MALNUTRITION
An abnormal condition of the body
resulting from the lack or excess of
one or more nutrients like protein,
carbohydrates, fats, vitamins and
minerals.
1. Lack of money to buy food
Majority of the victims of malnutrition comes
from families of farmers, fisherfolk, and
laborers who cannot afford to buy
nutritious foods.
2. Lack of food supply
3. Lack of information on proper nutrition
and food values
1. Early weaning of child and improper
introduction of supplementary food
2. Incomplete immunization of babies and
children
3. Bad eating habits
4. Poor hygiene and environmental
sanitation:
a. lack of potable water
b. lack of sanitary toilet
c. poor waste disposal
 FORMS OF MALNUTRTION

1. Protein-Energy Malnutrition (PEM) is a

nutritional problem resulting from a
prolonged inadequate intake of body-
building and/or energy-giving food in the
diet.
Kinds:
a.)MARASMUS
b.) KWASHIORKOR
a) MARASMUS
This child does not get the right amount
and kind of energy food. She/He:
< is always hungry
< has the face of an old man
< is very thin
< easily gets sick
< looks weak
THIS CHILD IS JUST SKIN AND BONES!
b) KWASHIORKOR
This child does not get enough body-building food,
although she/he may be getting enough energy.
She/He:
< has swollen face, hands, and feet
< easily gets sick
< has dry, thin, pale hair
< has sores on the skin
< has thin upper arms
< looks sad
< has dry skin
< is underweight
THIS CHILD IS SKIN, BONES, AND WATER!
2. VITAMIN A DEFICIENCY (VAD)
a condition in which the level of Vitamin A in
the body is low.
Causes:
not eating enough foods rich in vitamin A
e.g. yellow vegetables and yellow fruits
lack of fat or oil in the diet which help the
body absorb Vitamin A.
poor absorption or rapid utilization of Vitamin
A during illness
Eye Signs
night blindness (early stage); total
blindness (later stage)
bitots spot (foamy soapsuds-like spots on
white part of the eye)
dry, hazy and rough appearing cornea
crater-like defect on cornea
softened cornea; sometimes bulging
Other Manifestations
increased cases of childhood sickness, and
death and decreased resistance to
infection
susceptibility to childhood malnutrition and
infection (measles, diarrhea and
pneumonia)
Prevention
eating foods rich in Vitamin A, such as
liver, eggs, milk, crab meat, cheese, dilis,
malunggay, gabi leaves, kamote tops,
kangkong, alugbati, saluyot, carrots,
squash, ripe mango, including fats and oils
breastfeeding the child
immunizing the child
taking correct dose of Vitamin A capsules
as prescribed
VAD is most common in children suffering
from PEM and other infectious diseases.
Bottle-fed infants are also at risk of VAD
especially if the milk formula used is not
fortified with Vitamin A.
Common among preschoolers and
infants
( FNRI)
 Schedule Infants(6- Preschoole Post
11 mos) rs(12-83 Partum
mos) Mother

Give 1 100,000 IU 200,000 IU 200,000 IU

Dose Within one
month

Give after 100,000 IU 200,000 IU After

6 months delivery
High risk of each
Condition child only
Present
 Schedule Infants (6-11 Preschoolers
mos.) (12-83 mos.)

Give Today 100,000 IU 200,000 IU

Give Tomorrow 100,000 IU 200,000 IU

Give After 2 100,000 IU 200,000 IU

Weeks
3. ANEMIA - a condition characterized by the lack of
iron in the body resulting in paleness.
S/S: paleness of the eyelids, inner cheeks, palms
and nailbeds; frequent dizziness and easy
fatigability
Common cause: inadequate intake of food rich in
iron ; can also be caused by blood loss during
menstruation, pregnancy and parasitic infections.
Prevention:

Eating iron-rich food such as liver and other internal

organs; green leafy vegetables; and foods rich in
Vitamin C
Recommended Iron Dosage
Requirements

Infants ( 6-12 months) 0.7 mg. Daily

Children ( 12-59 1 mg daily

months)
 Dosage

Children 0-59 month 3-6 mg./kg. Body

wt./day
 4.GOITER
- enlargement of thyroid gland due to
lack of iodine in the body.

-common in areas where the iodine

content in the soil, water and food
are deficient.
- Effect of Iodine deficiency to fetus:
may be born mentally and physically
retarded.
- Goiter can be prevented by:
< daily intake of food rich in iodine
< use of iodized salt
 Dosage

Children 0-59 months Iodine capsules

( in endemic areas) (200mg) potassium
iodate in oil orally
once a year.
CHECKING THE NUTRITIONAL STATUS
WEIGHT
1.1 Weight is a very important indicator of a
persons nutritional status. It is measured in relation to
either AGE or HEIGHT. Normally, a well-nourished child
gains weight as she/he grows older.
1.2 On the other hand, a malnourished child either
decreases in weight or maintains his/her previous
weight.
1.3 The nutritional status of a person can also be
checked by looking for specific signs and symptoms of
the different forms of nutritional deficiencies.
 IMPORTANT:
1.1Weigh the child in minimal clothing,
with no shoes, clogs or slippers on; and
hands and pockets free of objects.
1.2The same type of scale should be used
for subsequent weighing.
1.3Observe the proper maintenance of
the weighing scale.
1.4Do not use a bathroom scale to avoid
inaccurate readings of weight.
< BRING THE MALNOURISHED CHILD TOGETHER WITH THE
PARENTS TO THE HEALTH CENTER FOR PROPER
NUTRITIONAL ADVICE AND TREATMENT.
< VISIT THE MALNOURISHED CHILD REGULARLY AND
MONITOR HIS/HER WEIGHT.
< ADVISE PARENTS AND THE WHOLE COMMUNITY
ABOUT BETTER NUTRITION AND PROPER FEEDING
ESPECIALLY OF INFANTS, CHILDREN AND SICK
PERSONS.
NUTRITIONAL GUIDELINES

1. Eat a variety of food everyday.

2. Breastfeed infants exclusively from birth to 4-6
months, and then, give appropriate foods
while continuing breastfeeding.
3. Maintain childrens normal growth through
proper diet and monitor their growth
regularly.
4. Consume fish, lean meat, poultry or dried
beans.
5. Eat more vegetables, fruits, and root crops.
6. Eat foods cooked in edible/cooking oil daily.
7. Consume milk, milk products or other
calcium-rich foods such as small fish and
dark green leafy vegetables everyday. Use
iodized salt, but avoid excessive intake of
salty foods.
8. Use iodized salt, avoid excessive intake of
salty foods
9. Eat clean and safe food.
10. For a healthy lifestyle and good nutrition,
exercise regularly, do not smoke, avoid
drinking alcoholic beverages.
 AIMS AND RATIONALE OF EACH OF THE
GUIDELINES

Guideline No. 1 is intended to give the

message that no single food provides all the
nutrients the body needs. Choosing
different kinds of foods from all food groups
is the first step to obtain a well-balanced
diet. This will help correct the common
practice of confining of choice to a few
kinds of foods, resulting in an unbalanced
diet.
Guidelines No.2 is entitled to promote exclusive
breastfeeding from birth to 4-6 months and to
encourage the continuance of breastfeeding for as
long as two years or longer. This is to ensure a
complete and safe food for the newborn and the
growing infant besides imparting the other benefits of
breastfeeding. The guideline also strongly advocates
the giving of appropriate complementary food in
addition to breast milk once the infant is ready for
solid foods at 6 months. Malnutrition most commonly
occurs between the age of 6 months to 2 years,
therefore there is a need to pay close attention to
feeding the child properly during this very critical
period.
Guideline No. 3 gives advise on proper
feeding of children. In addition, the
guideline promotes regular weighing to
monitor the growth of children, as it is a
simple way to assess nutritional status.
Guidelines No. 4,5,6 and 7 are intended to correct
the deficiencies in the current dietary pattern of Filipinos.
Including fish, lean meat, poultry and dried beans, which
will provide good quality protein and dietary energy, as
well as iron and zinc, key nutrients lacking in the diet of
Filipinos as a whole. Eating more vegetables, fruits and
root crops will supply the much needed vitamins, minerals
and dietary fiber that are deficient in our diet. In
addition, they provide defense against chronic
degenerative diseases. Including foods cooked in
edible oils will provide additional dietary energy as a
partial remedy to calorie deficiency of the average
Filipino. Including milk and other calcium-rich foods in the
diet will serve to supply not only calcium for healthy
bones but to provide high quality protein and other
nutrients for growth.
Guideline No. 8 promotes the use of
iodized salt to prevent iodine
deficiency, which is a major cause of
mental and physical
underdevelopment in the country. At
the same time, the guideline warns
against excessive intake of salty foods
as a hedge against hypertension,
particularly among high-risk
individuals.
Guideline No.9 is intended
to prevent food-borne
diseases. It explains the
various sources of
contamination of our food
and simple ways to prevent
it from occurring.
Finally, Guideline No. 10 promotes a
healthy lifestyle through regular
exercise, abstinence from smoking
and avoiding consumption. If
alcohol is consumed, it must be
done in moderation. All these
lifestyle practices are directly or
indirectly related to good nutrition.
NUTRIENTS IN FOOD

Nutrients are chemical substances

present in the foods that keep the body
healthy, supply materials for growth and
repair of tissues, and provide energy for
work and physical activities.
The major nutrients include the
macronutrients, namely; proteins,
carbohydrates and fats; the micronutrients,
namely vitamins such as A, D, E and K, the
B complex vitamins and C and minerals
such as calcium, iron, iodine, zinc, fluoride
and water.
 - a state of complete physical, mental
and social well-being and not merely the
absence of disease/ infirmity in all
matters relating to the reproductive
system and to its functions and
processes.
 Basic RH Rights

Right to RH information and health care

services for safe pregnancy and childbirth
Right to know different means of regulating
fertility to preserve health and where to obtain
them
Freedom to decide the number and timing of
birth of children
Right to exercise satisfying sex life
 Factors/ determinants of RH
Socioeconomic conditions education,
employment, poverty, nutrition, living condition/
environment, family environment
Status of women equal right in education and
in making decisions about her own RH; right to
be free from torture and ill treatment and to
participate in politics
Social and Gender Issues
Biological (individual knowledge of
reproductive organs and their functions),
cultural (countrys norms, RH practices) and
psychosocial factors
 Elements
Maternal and Child Health Nutrition
Family Planning
Prevention and Management of Abortion
Complications
Prevention and Treatment of Reproductive
Tract Infections, including STDs, HIV and AIDS
Education and Counseling on Sexuality and
Sexual Health
 Elements

Breast and Reproductive Tract Cancers and

other Gynecological Conditions
Mens Reproductive Health
Adolescent Reproductive Health
Violence Against Women
Prevention and Treatment of Infertility and
Sexual Disorders
 Selected Concepts
RH is the exercise of reproductive right with
responsibility
It means safe pregnancy and delivery, the right
of access to appropriate health information and
services
It includes protection from unwanted pregnancy
by having access to safe and acceptable
methods of family planning of their choice
It includes protection from harmful reproductive
practices and violence
It ensure sexual health for the purpose of
enhancement of life and personal relations and
assures access to information on sexuality to
achieve sexual enjoyment
 Goal

To achieve healthy sexual

development and maturation
To achieve their reproductive
intention
To avoid diseases, injuries and
disabilities related to sexuality and
reproduction
To receive appropriate counseling
and care of RH problems
 Strategies

Increase and improve the use of more

effective or modern contraceptive methods
Provision of care, treatment and rehabilitation
for RH
RH care provision should be focused on
adolescents, men and unmarried and other
displaced people with RH problems
Strengthen outreach activities and referral
system
Prevent specific RH problems through
information dissemination and counseling of
clients
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 is authorized to act on all issues and
concerns
in environment and health including the
very
comprehensive 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
 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
 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
 With a source, reservoir, piped distributor
network and household taps
Fit for densely populated urban
communities
Requires minimum treatment or
disinfection
ENVIRONMENTAL SANITATION
- the study of all factors in mans
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 I
Non-water carriage toilet facility no water necessary
to wash the waste into receiving space e.g.pit latrines, reed
odorless earth closet.
Toilet facilities requiring small amount of water to
wash the waste into the receiving space e.g. pour flush toilet &
aqua privies
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 Handlers 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 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. 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.
 1. Prevention and Control of Cardiovascular Diseases
- heart 1st leading cause of death ; bld vessels - 2nd
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: envtl factors, maternal diseases or genetic
aberrations
Rheumatic Fever or Rheumatic Heart Disease:
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.
Hypertension: Persistent elevation of the arterial blood
pressure.
( primary or essential) ;frequent among females but
severe,malignat form is more common among males
Ischemic Heart Disease/ Atherosclerosis:
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
PERIOD OF LIFE TYPE OF CVD PREVALENCE

At birth to early Congenital Heart 2 / 1000 school

childhood Disease children (aged 5
15 y.o.)
Early to late Rheumatic Fever / 1 / 1000 school
childhood Rheumatic Heart children (aged 5
Disease 15 y.o.)
Early Adulthood Diseases of Heart 10 / 100 adults
Muscles
Essential
Hypertension
Middle age to old Coronary Artery 5 / 100 adults
age Disease
Cerebrovascular
Accident
Diseases Causes / Risk factors

Congenital Heart Disease Maternal Infections, Drug

intake, Maternal
Disease, Genetic
Rheumatic Fever/Rheumatic Frequent Streptoccocal
Heart Disease Sore Throat

Essential Hypertension Heredity, High Salt

Intake
Coronary Artery Disease Smoking, Obesity,
(Heart Attack) Hypertension, Stress
Hyperlipidemia, Diabetes
Mellitus Sedentary Life
Style
Cerebrovascular Accident Hypertension,
(Stroke) Arteriosclerosis
Disease Primordial Specific Protection

Congenit - Prevention of - Adequate treatment

al Heart viral infection of viral infection
Disease and intake of during pregnancy.
harmful drugs - Genetic counseling
during of blood related
pregnancy. married couples.
- Avoidance of
marriage
between blood
relatives
Rheumatic - Prevention -
Heart Disease of recurrent Identificatio
sore throat n of cases of
thru adequate rheumatic
environmental fever
sanitation; - Prophylaxis
avoidance of with
overcrowding; penicillin or
adequate erythromycin
treatment
Essential - From early - Continued
Hypertension childhood low salt diet
> low salt and adequate
diet exercise
> adequate
physical
exercise
Coronary - Prevention - cessation
Heart of of smoking
Disease(Heart development/ - control
Attack) acquisition /treatment of
of risk diabetes,
factors hypertension
> cigarette -weight
smoking reduction
> high fat -change to
intake proper diet
> high salt -Adjustment
intake of activities
Cerebrovascul - all - all
ar Accident measures to measures to
(Stroke) prevent control
hypertension hypertension
& & progression
arteriosclero of
sis arteriosclero
sis
 Primary Prevention thru health education
is the main focus of the program:
1. maintenance of ideal body wt.
2. diet - low fat
3. alcohol/smoking avoidance
4. exercise
5. regular BP check up
2. Cancer Prevention and Early Detection
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 and early detection
 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
CA type Prevention Detection
Lung No smoking None
Uterine Monogamy Paps smear
Cervical Safe sex every 1-3 yrs
Liver Hep B None
vaccination
Less aalcohol
intake
Avoidance of
moldy foods
Colon High fiber Regular
Rectum diet medical
Low fat check-up
intake after 40 yrs
of age
Fecal occult
blood test
DRE
Sigmoidoscopy

Mouth No smoking, Regular

betel nut dental check-
chewing ups
Oral hygiene
Breast none Monthly SBE
Yearly exam
by doctor
Mammography
for 50 yrs
old and above
females
Skin No excessive Assessment of
sun exposure skin
Prostate none Digital
trans-rectal
exam
 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. Natl 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. Program on the Elderly/Geriatric
Nursing Services

7 humanitarian issues: family, health,

income, security, employment and
labor, social welfare, education,
recreation, culltural activities and
housing
 Influenza, HPN, diarrhea,
bronchitis, TB, diseases. of the heart,
pneumonia, malaria,
malignant neoplasm, chickenpox
 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. 5079 yrs. old,
MENOPAUSE- main cause
 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 of health
centers and hospitals making services
accessible to every Filipino
 1. Quality Assurance
2. Grant and Technical Assistance
3. Health Promotion
4. Awards
 Empowered individuals adopting
healthy lifestyle, 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
 EPI
Disease Surveillance
CARI
CDD
Nutrition/ Micronutrient
Supplementation-
*Food Fortification :
Rice iron; Oil and sugar Vit. A;
Flour-Vit. A & iron; Salt- iodine
 Integrates management of most
common childhood 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
 1. Assessing the child or young infant- History
taking, PE
2. Classifying the Illness- severity of illness
3. Identifying ttt.- classification chart
4. Treating the child- giving ttt. in health centers,
prescribed drugs & teaching mothers how to carry
out ttt.
5. Counseling the mother- child feeding,foods and
fluids to give & when to bring the child back to the
health center
6. Giving of follow-up care
 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 basis, except those with acute
complications and emergencies
Direct Observed Treatment Short Course
comprehensive strategy to detect and cure TB
patients.
 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 far- advanced) 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 smear-negative 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 sputum 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 smear-negative 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 continuous 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 non-infectious 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 cases- Rifampicin+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 check-up from time to time;
mental & emotional support
Rehabilitation-makes patients capable, active
and self-respecting member of society.
 Control of Schistosomiasis a tropical disease caused by
a blood fluke, 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
Filariasis- a chronic prasitic infection caused by
a nematode, Wuchereria 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, 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,
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
4 oclock 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 2-3 min. from
boiling point or chlorination
 Prevention and Control on Leptospirosis/
Weils 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. 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, Hep B ( the most serious
type cause of severe cx. Eg. Massive liver damage
and hepatocarcinoma
- 4 Cs in the Syndromic Mgt
- 1. Compliance
- 2. Counseling/ Education
- 3. Contact tracing to treat partner
- 4. Condom use
- Hep B vaccination
- Universal precautions
- Safe sex
 I. Occupational Health
- the application of public health, medical and
engineering practice for the purpose of
conserving, restoring the health and effectiveness
of workers thru their places of employment
A. Occupational Health Nursing
- the application of nursing principles and
procedures in providing health service to
employees in their place of work by means of:
 1. prompt and efficient nursing care of
the ill and impaired
2. participation in teaching health and
safety practices on the job
3. cooperation with plant department
administrators
4.keeping the health clinic and staff
ready to handle emergencies
5. advising workers in the utilization of
community and welfare services
 To assist, maintain and promote positive
health of laborers and employees thru
early detection and prevention of
occupational diseases and hazards of
industrial processes and by coordinating
and cooperating with activities of other
community health and welfare services
 1. Assists/participates in developing an adequate
health program for workers and laborers including
sound health education activities
2. Encourages periodic P.E.
3. Cooperates with occupational medical programs
in the prevention of accidents as well as in the
promotion of good working atmosphere and
relationships in the place of work
4. Helps in teaching others in giving good nursing
care to the sick or handicapped in their own homes
 II. School Health Nursing
School Health Triad :

1. SERVICE

2. EDUCATION

3. ENVIRONMENT
 Mission of School Health Program:

To maximize potential for learning and

participation in the educational process
by promoting optimum health of school-
age children and adolescents
 School Health Team:

Psychologist/ Counselor
Teacher
Nutritionist
Nurse
Social Workers
Maintenance Personnel
 Targets in SHN

Family
Students
Teachers
Supportive Personnel
Community
 School Health Nurses Roles:

EDUCATOR
CONSULTANT /RESEARCHER
STUDENT, FAMILY AND STAFF
ADVOCATE/CHANGE AGENT
HEALTH SCREENER
HEALTH CARE PROVIDER
 Common Health Concerns of
Schoolchildren:
1.Drug and Alcohol Abuse
2. STDs/STIs
3. Teenage Pregnancies
4. Mental Health
5. Dermatological Disorders-
pimples/acne, fungal infections,
allergies
6. Respiratory Conditions- asthma, URTI
7. Nutrition
8. Dental Health
 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
saving the scorpion but the man said, Its
the nature of the scorpion to sting. Its my
nature to love, why should I give up my
nature to love just because its the nature
of the scorpion to sting?
Dont give up
loving, dont give
up your goodness
even if people
around you
sting
 Thank
you very
much!!!