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By: LEONARD IVAN T.

MELANA, RN

INTEGRATED COMMUNITYHEALTH NURSING

NURSES are created to GIVE a GREAT EFFECT on

the LIVES of the PEOPLE

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Deliberate atten tion

to the needs of

m i ll ions of poorFi lip ino fam il ies

which compr ise the

major i ty of ou r

populat ion

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Public health by C. E.WinslowA science and art of PROMOTING

health, PREVENTING disease and

PROLONGING life through organized

community efforts.

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Ecosystem influencing optimum

level of functioning include:

Political

Behavior-change the behavior of people

Hereditary

Health Care Delivery System-accessible, availble

Economic Factors-appropriate technology

Social Factor-culture-->adopt with the culture

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Core business of public health: DISEASE CONTROL

INJURY PREVENTION

HEALTH PROTECTION

HEALTHY PUBLIC POLICY PROMOTION OF HEALTH

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Public health nursing:

A special field of nursing that combines

skills of nursing, public health and

some phases of social assistance.

Lilian Wald coined the term public

health nursing to denote a service

available to all people.

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DEPARTMENT OF HEALTH

DOH is the lead agency in health.

VISION: Health for all Filipinos

NEW VISION: DOH is the LEader staunch

ADvocate and MOdel in promoting Health for

all in the Philippines

LEader

ADvocate

MOdel

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MISSION: To ensure an effective and efficientdevolved health care delivery system which is

Accessible, Available, AcceptableandAffordableat all times

NEW MISSION: Guarantee Equitable, Sustainableand Qualityhealth for all Filipinos, especially thepoor and shall lead the quest for excellence in health.

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Role of DOH

Leader

Enabler and capacity builder

Aadministrator

GOAL: PARTNERSHIP---HSRAHealth Sector Reform Agende

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The Health Reform AgendaHSRA) overriding GOAL of the DOH

FRAMEWORK for Implementation:FOURmula ONE for HEALTH

Better Health outcome

More responsive health System

Equitable Health Care Financing

Decrease mortality Rate

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Four elements of the strategy

are:

1. Health Financing----Investments

2. Health Regulation----Control3. Health Service Delivery----Accessible,

Availability

4. Good Governance---performance

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UN Millennium Development Goals

Source: MDG Monitor: Quick Facts

(accessed 10/11/2010)
http://www.mdgmonitor.org/country_progress.cfm?c=PHL&cd=608http://www.mdgmonitor.org/country_progress.cfm?c=PHL&cd=608

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PRIMARY HEALTH CARE

When: SEPTEMBER 12, 1978

Where: ALMA ATA, RUSSIA

Leader: DOHLegal Bais: LOI 949 ( October 19, 1979)

Goal: Health for all by the year 2000

and Health in the hands of the peopleby the year 2020

SELF-RELIANCE

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Criteria: AsElements:Educator- basic service of a nurseLocaly and Endemic disease- filariasis, malariaE xpanded Program of ImmunizationMaternal and BirthE ssential Drugs- BnB Botika ng BarangayNutritionT reatment-EMONC Emergency Obstetric in Neonate ChildSave Water and SanitationDental HealthAccess to Sentrong SiglaMental Health

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4 PILLARS:1. Active Community Participation

2. Appropriate Technology3. Multisectoral linkages

4. Support Mechanism made available

STRATEGIES:Reorganization and ReorientationEnabling and Effective Preparation of the PeopleMobilizzationOpportunity for Community ParticipationTechnologyEncourage Self-relianceLinkagesOpportunity for Community Participation

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The Philippine HEALTH CARE

DELIVERY SYSTEM

A Public Health Nurse does notfunction in a vacuum. She is a member

of a team working within a system

MAJOR PLAYERS:

1.PUBLIC SECTOR2.PRIVATE SECTOR

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The TWO LEVELS of PHC WORKERS

Village or Barangay Health Workers(V/BHWs). This refers to trained communityhealth workers or health auxiliary volunteeror a traditional birth attendant orhealer.

Intermediate level health workers. Generalmedical practitioners or their assistants.

Public Health Nurse, Rural Sanitary Inspectorsand Midwivesmay compose these groups.

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For every forty years after independence, the

Philippine Health care system was

administered by a central agency based in

Manila. However, with the passage of the Local

Government Code, LGUs facilitate healthservice delivery. This law is known as:

a. RA 7610 c. RA 7600b. RA 7160 d. RA 9173

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Pillars of primary health care include all of theff, except:

a.Active community participation.b.Provision of medical care and emergency

treatment

c.Support mechanism made available

d.Intra and inter-sectoral linkages

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The concept of Primary Health Care is

characterized by partnership and

empowerment of the people that shallpermeate as the core strategy in the provision

of health services. Which of the following is a

strategy of PHC?

a.Provision of essential drugs

b.Health education

c.Effective preparation and enabling process for

health action at all levels

d.All of the above

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The DOH, in its new role as the national authority on

health has several functions. Which one is specific tothe role of the DOH as the enabler and capacity

builder?

a.Serve as the national policy and regulatory institutionb.Innovate new strategies in health to improve

effectiveness of programs

c.Administer direct services for emergent health

concerns that require new technologies.

d.Serve as advocate in adoption of health policies.

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Which element of FOURmula One aims to

improve and ensure accessibility andavailability of basic and essential health

care?

a.Health financing

b.Health regulation

c.Health service delivery

d.Good governance

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Framework forCOMMUNITY HEALTH NURSING

Community Health Nursing is the totality orits philosophy and beliefs, principles and

processes.

CLIENTS:

INDIVIDUAL

FAMILYPOPULATION GROUP

COMMUNITY

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FAMILY HEALTH NURSING

6 FAMILY HEALTH TASK

1.Manage Health and non-health crises

2.Provide care to : SDDs

3.Seek Health Care

4.Recognize interruptionsin health

5.Maintains Health Environment6.Maintains Relationship

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FNCP (Family Nursing Care Plan)

1. FIRST Level of Assessment What are the problems of the family?

What are the health situation/ condition/

experience?

2. SECOND Level of Assessment Why does the family have those

problems?

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4 CRITERIA FOR PRIORITIZATION1. NATURE OF THE PROBLEM2. MODIFIABILITY

3. PREVENTIVE POTENTIAL

4. SALIENCE

GOAL: HEALTH PROMOTION

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COMMUNITY HEALTH NURSING

CHN PROCESS:

1. ASSESSMENT

What is the problem

2. PLANNING

What problems should I attend tofirst?

3. INTERVENTION

What is the solution?

4. EVALUATION

Did the solution work?

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COMMUNITY DIAGNOSIS

Both aPROFILE and aPROCESSTypes:1. COMPREHENSIVE2. PROBLEM ORIENTED

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CRITERIA FOR PRIORITIZATION

1. NATURE OF THE PROBLEM--- HStaRRHealth Status, Health Related, Health Ressources

2. MODIFIABILITY

3. PREVENTIVE POTENTIAL4. SOCIAL CONCERNS

5. MAGNITUDE OF THE PROBLEM

GOAL: SELF-RELIANCE

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COPARCommunity Organizing Participatory Action

Research

- Continuous and sustained process of educating the

people to understand and develop their criticalawareness of their existing conditions, working with

people collectively & efficiently on their immediate and

long-term problems, and mobilizing people to developtheir capability and readiness to respond & take action on

their immediate needs towards solving their long-term

problem

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COPAR- (Maglaya)

1. Preparatory Phase

2. Community Profile

3. Entry and Integration4. Organizational Phase

5. Education and Training

6. Collaboration

7. Phase Out

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COPAR-(DOH)

1. Community Analysis/ NeedsAssessment/Dx

2. Design/Initiation3. Implementation

4. Program Maintenance +

Consolidation

5. Dissemination/ Reassessment

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The family nursing care plan is the blueprint of

the care that the nurse designs to systematically

minimize or eliminate the health and familynursing problems. All of the following are

features of the FNCP, except:

a.The FNCP is based upon identified health and

nursing problems.

b.The FNCP relates to the future.

c.The FNCP is an end in itself.

d.The FNCP focuses on actions designed to solve a

problem.

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Developing a family care plan involves many

steps. These steps are done in which sequence?1. Develop the intervention plan

2. Define goals and objectives of care

3. Prioritize the health conditions

4. Develop the evaluation plan

a.2,1,3,4

b.3,2,1,4c.2,3,1,4

d.3,1,2,4

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Nurse Monica is conducting the nursing

assessment of the Lopez family. Mr. Lopez issecurity guard in a public school and Mrs. Lopez

recently lost her job. They have 5 children, ages

9,7,5,3 and 1. They live in a small house by therailroad tracks. Their house has only 1 room for

sleeping with poor ventilation. The eldest child

has chickenpox which he got from a neighbor

while the youngest child has not received any

immunizations yet.

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Health conditions identified by nurse Monica in

the Lopez family include:1. Wellness state

2. Health threats

3. Health deficits

4. Foreseeable crises

a.2 and 3

b.2,3,4c.1,2,3

d.All of the above

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In the above conditions, which of thefollowing is considered a health deficit?

a.Youngest child with no immunizations

b.Eldest child with chickenpox

c.House with poor ventilation

d.Mother who recently lost her job

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Which of the following criteria wouldreceive the most weight when prioritizing

health problems?

a.Nature of the problem

b.Modifiability of the problem

c.Preventive potentiald.Salience

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Nursing Procedures in Community:

Clinic visits

Home Visits

BP measurement

Bag Technique

O

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HOME VISITPurpose: Principles

Care Has a purpose

Assessment Use Available InformotionRelationship Involve FamilyEducate Priority NeedsServiceFactors affecting FREQUENCY:

NeedsAcceptance

PolicyOther health care workersPast services

Ability to determine Health Needs

BAG TECHNIQUE PHN BAG

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BAG TECHNIQUE (PHN BAG)

POINTS: PRINCIPLES:

4 Cs basics

Clean > Hand Washing

Contact > Same Time and Effort

Complete > Done in different way

Convinient dependes on the bag

CONTENTS?

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Which of the following is considered an

important principle of bag technique?

a.The bag should contain all necessary articles.

b.The bag technique can be performed in avariety of ways.

c.The arrangement of the bagscontents should

be what is convenient to the nurse

d.The bag should be cleaned very often.

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Among the following types of family nursecontacts, which one will reflect the

familysinitiative for health care?

a.Home visit

b.Telephone conference

c.Clinic visitd.All of the above

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There is no definite rule to be followed on the

frequency of home visits. The schedule of visit

may vary. Which of the following factors is

considered the most important determinant of

the frequency of home visits?

a.Acceptance of the family

b.Needs of the family

c.Policy of a specific agencyd.Other health care workers involved in the care

of the family.

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The Philippine Health Situation

Analysis of the nations state of health Forces that impinge on the countries state of

health

Health Policies and Programs

* Improvement of HCDS

HEALTH CARE DELIVERY SYSTEM

- network of health facilities and personnel,

which carr out the tasks of renderin health

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LEVELS OFPREVENTION

1. PRIMARYheath promotion and preventdisease1. SECONDARYearly screening1. TERTIARYrehabilitation and preventionof further complication

LEVELS OF CAREand REFERRALSYSTEM

VS

1. PRIMARYbrgy. Health station/ clinic1. SECONDARYdistrict hospital/ provincial hospital1. TERTIARYregional hospital/ medical center

EXPANDED PROGRAM FOR

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EXPANDED PROGRAM FORIMMUNIZATION

Launched July 1976 OBJECTIVE: To reduce the MORBIDITY and MORTALITY

among infants and children caused by the 6 childhoodimmunization disease.

PDD 996 ELEMENTS:

1. Target Setting

2. Cold Chain logistics mgmt

3. IEC4. Surveillance, Stud/Res

5. Assess/ evaluate

COLD CHAIN

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COLD CHAIN Temperature-controlled supply chain designed to maintain

potency of vaccines when being transported frommanufacturer to the clients.

TARGET: Infants, School Entrants, Pregnant Woman

FIFO (First Inn First Out)

Temperature Monitoring

* 2 times/ day 7x a week

* ice packs- not to be refilled every used-take 24 hrs

to freeze an ice pack

* DO NOT OPEN ref- power cuts

* Domestic Ref and Special designed Ref

Ti f f t f i

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Timeframe for storage of vaccines:

Regional level 6 monthsProvincial level 3 months

District level 3 months

Health Centers(with

refrigerator)

1 month

Using transport

boxes

5 days

BCG and AMV 6 hours

after reconstitution

Other vaccines at the

end of the working day

Open vial policy- OPV,

DPT, TT, Hepa Bcan be

used in the next

immunization session

up to max. Of 4 weeks

if:

NOT- Expired/

contaminated

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General Considerations:1. Maintenance and Potency

a. Avoid break in the Cold Chain

b. Discard Unused

c. Maximum duration of storage/ transport

2. Contraindications

* False Contraindications

REMEMBER:

Oh My Dudung Have Big TitiOPV Measles DPT Hepatitis B TT

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ADMINISTRATION OF VACCINES

Vaccine Minimum

age at 1st

dose

3 of

Doses

Minimum

interval

between

doses

Route (R),

Dosage(D),

Site(S)

Storage

temperature

Type/ form

of vaccine

BCG Birth 1 0

ID

0.05 mlRight Upper Arm 2-8 degree C

Alive

BacteriaTB

DPT 6 weeks 3 4 weeksIM

0.5 ml

Vastus Lateralis2-8 degree C

Dipteria-

measles

Pertusis

Tetanus-toxin

OPV 6 weeks 3 4 weeksOral

2 drops

Mouth

FreezerLive

atenunted

virus

HEPA B Birth 36 weeks

or

8 weeks

IM

0.5ml

Vastus Lateralis2-8 degree C

RNA

Recombine

MEASLES 9 months 1 0SQ

0.5 m

Right Upper Arm

FreezerLive

atenunted

virus

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TETANUS TOXOID VACCINE

Vaccine Minimal age in

interval

Percent

protected

Duration of

Protection

TT1

TT2

TT3

TT4

TT5

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Which of the following is not a contraindication toimmunization?

a.Do not give DPT 2 and DPT 3 to a child who had

convulsions within 3 days of DPT 1

b.Do not give BCG if the child has known hepatitis

c.Do not give any immunization to a child who needs to

be hospitalized because of a serious disease.

d.Do not give BCG if the child has known AIDS

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The nurse has an important role in immunization

because every immunized decreases the susceptibility

of the population to the largest diseases. Which of the

following is NOT a role of the nurse in the delivery of

immunization services in the community?

a.Observe clean technique on immunization andmaximize the use of the syringe in order to cut costs.

b.Identify cases of EPI target diseases per standard case

definition

c.Manage vaccines properly by following therecommended storage of vaccines.

d.Actively include in the master list the infants eligible for

vaccination in the community.

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When is the designated immunization day

in barangay health stations/ Rural healthunits?

a.Mondayb.Wednesday

c.Friday

d.Any day

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MATERNAL HEALTH PROGRAM

GOAL: To reduce Maternal Mortality Rate

2000 Philippine Health Statistics revealed the causes of allmaternal death:

- 25% HYPERTENSION

- 20.3% POSTPARTUM HEMORRHAGE- 9% PREGNANCY WITH ABORTIVE OUTCOMES

Common causes of Maternal Death: 3 DELAYS

Other factors:

-Young age at marriage & first pregnancy

-Domestic violence and gender inequality

-Poor maternal health

-Poor hygiene during and after delivery

Th DELAYS

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Three DELAYS

1. DELAY IN DECIDING TO SEEK MEDICAL

CARE.

Failure to recognize danger signs

Lack of money

Unplanned/unwanted pregnancy Lack of companion in going to health facility

No person to take care of children/home.

Fear of being ill treated in health facility

Three DELAYS

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Three DELAYS

2. DELAY IN IDENTIFYING and REACHING

THE APPROPRIATE FACILITY

Distance from a womans home to health

facility/provider

Lack of/poor condition of roads

Lack of emergency transportation

Lack of awareness of existing services

Lack of community support

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Three DELAYS

3. DELAY IN RECEIVING APPROPRIATE and

ADEQUATE CARE AT HEALTH FACILITY

Lack of health care providers

Shortage of supplies

Lack of equipments

Lack of competence of health providers

Weak referral system

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The overall goal program is to improve the survival, health

and well being of mothers and unborn through a package ofservices for the pre pregnancy, prenatal, natal and post natalstages

Health service package before, during and after pregnancy* Antenatal Registration

* TT immunization ( FIM= 5TT)

* Micronutrient Supplementation

* Treatment of disease and other conditions* Clean and safe delivery

* BF

* Family planning services and counselling

Strategic thrust 2005-2010

Recommended Visits

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Recommended Visits

Prenatal visits Period of pregnancy

1stvisit

2ndvisit

3rdvisit

Every 2 weeks

PRENATAL VISITS

Recommended Visits

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Recommended Visits

1st

visit WITHIN 24 HOURS2ndvisit 1 WEAK AFTER

3rdvisit 2-3 WEAKS AFTER

FOR HOME DELIVERY

POST PARTUM CARE VISITS

1stvisit 1stweek post partum

(3-5 days)

2ndvisit 6 weeks post partum

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Micronutrient Supplementations

VITAMINS DOSE SCHEDULEOF GIVING

REMARKS

Vitamin A 10,000 IU 2x per

week

starting 4

months of

pregnancy

Considercongenitalproblems

IRON+ FA 60mg/400

ug tablet

Daily Considerperiod ofprenatal visit

IODINE 1 cap Every year ConsiderGoiterEndemicAreas

CRITERIA of SAFE PREGNANCY

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CRITERIA of SAFE PREGNANCY

AGE: 20-35 y/o

No illness Has less than 4 children

Has not been pregnant for the past 2-3 years

Wants to have a baby

CRITERIA IDEAL AT RISK HIGH RISK

AGE 20-30 18/ < 20 < 18

>35SPACING 2-3YEARS 2 YEARS 1 YEAR

CHILDREN 3 4 >5

QUALIFIED for HOME DELIVERY

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QUALIFIED for HOME DELIVERY

Full term Less than 5 pregnancies

Cephalic presentation

W/out existing diseasesex.diabetes, hpn

No history of complications like hemorrhage duringprevious deliveries

No history of difficult delivery prolonged labor

Adequate pelvis

Abdominal enlargement is appropriate for age ofgestation

HIGH RISK PREGNANCIES

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HIGH RISK PREGNANCIES

5thpregnancy onwards Abnormal fetal position/ presentation

Bleeding during pregnancy

Previous CS delivery or abdominal surgery

35y/o & above, 17y/o & below

Hx of PIH, HPN, PID, DM, goiter, premature

contractions, spontaneous abortions, anemia,

malnutrition & TB. Twin pregnancy

Treatment of Disease and other

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Treatment of Disease and other

Conditions:

Malaria- Prophylaxis for pregnant women

- Chloroquine 150mg/tab

- 2 tabs per week for the whole pregnancy

Intestinal parasite infection

- Mebendazole 500mg/tab single dose anytime of

pregnancy if none was given in the past 6 months- DO NOT give Mebendazole in the first 1-3 months of

preg

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MDG 5: Improve Maternal Health

To accomplish MDG : Reduce maternalmortality by 75% by 2015

(for the Philippines the target is to reduceMMR from 209 to 52 deaths per 100,000

live births).

How will we make it happen?

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pp(Current tools to avert maternal death and

disability)

A skilled health care professional

attends every childbirth

Every woman has access toEmergency Obstetric and Newborn

Care (EmONC)

Family planning services tohelp

women space their pregnanciesSource: Averting Maternal Death and Disability Program

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A SKILLED ATTENDANT is an

accredited health professional (a

midwife, nurse or doctor) who has been

educated and trained to proficiency in

the skills needed to manage normal

pregnancies, childbirth and theimmediate postnatal period, and in the

identification, management and

referral of complicationsin women

and newborns.*Manage was added in 2000 by the Inter-Agency Group for Safe Motherhood in

recognition that some skilled attendants will also have competencies to manage

complications.

Source: A Joint WHO/UNFPA/UNICEF/World Bank Statement on Reduction of

Maternal Mortality, 1999.

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EMERGENCY OBSTETRIC and NEWBORNCARE (EmONC)

the elements of obstetric & newborn careneeded for the management of normal andcomplicated pregnancy, delivery, postpartumperiods and the newborn.

Early detection and treatment of problempregnancies to prevent progression to anemergency.

Management of emergency complications*

Definition

BEmONC

CEmONC

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Emergency Signs

CONVULSIONS/ UNCONSCIUOSNESS

FEVER

VAGINAL BLEEDING

LOOKS VERY ILL

SEVERE VOMITING

HEADACHE WITH VISUAL DISTURBANCE

ABDOMINAL PAIN

DOB

EmONC Key Functions

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EmONC Key Functions

Parenteral (IV or IM)administration ofAntibiotics OxytocinAnticonvulsants Manual Removal of

Placenta

Removal of RetainedProducts ofconception

Assisted VaginalDelivery

Administration of

corticosteroid forpreterm labor

Essential NewbornCare

Surgery (CesareanSection)

Blood Transfusion

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Most in the community who died giving birth

experienced what experts have classified as the

delays. These include all of the following

except:

a.Delay in deciding to seek medical care

b.Delay in reaching appropriate care

c.Delay in receiving care at the health facilityd.None of the above.

El h if h i i h 2nd th f

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Elena, a housewife who is in her 2nd month of

pregnancy has intestinal parasitic infection and comes

to the health center for consultation. What is the

appropriate management for this?

a.Give Mebendazole as soon as possible to avoid

infection of the fetus.b.Give Mebendazole on the fourth month of pregnancy

regardless of when the previous dose was given

c.Give Mebendazole on the fourth month of pregnancy

regardless of when the previous dose was given in thepast 6 months.

d.Do not give any anti-helminthic as this may cause

problems during pregnancy.

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Which of the following statements about tetanus

toxoid immunization is not true?

a.The TT vaccine of 0.5 ml is given to mothers in 5

doses to be considered a FIM

b.Infants born by the mother with 5 doses of TTvaccine will be protected from neonatal tetanus

c.Mothers who have received 3rd dose of TT

vaccine will have 5 years protection from tetanusd.2nd dose of TT is given at least 4 months after

the first dose.

FAMILY PLANNING

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FAMILY PLANNING

Overall goal of family planning is to provideuniversal access to family planning informationand services wherever and whenever they areneeded.

FAMILYWELFARE-IMPROVEMENT OF QUALITY OF LIFE

Knowing the high risk factors among women can

prevent maternal mortality. AdvocateReprocuctive Health Program.

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4 PILLARSB-

R-I-

P-

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TYPES OF FAMILY PLANNING

PERMANENT TEMPORARY

1. Natural Method

2. Barrier Method

3. Hormonal Method

Fertility Awareness Based (FAB)methods tell a woman when the fertile period ofher menstrual cycle starts and ends.

NATURAL

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Standard , Calendar and 2 day-method

Basal Body Temperature

Cervical Mucus Method

Sympthothermal MethodLactational Amenorrhea Method

ARTIFICIAL

IUD

Diaphragm & Cervical Caps

Spermicides

Pills ( Progesterone and Estrogen Containing Pills)

Injection- Depo Provera

Condoms

PERMANENT

Vasectomy

Bilateral Tubal Ligation

is an injectable contraceptive1

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is an injectable contraceptive

containing progestin that inhibits

ovulation and thickens cervical

mucus, making it difficult for spermto pass

after cutting, the male partner would

need to ejaculate 20 times to

completely empty it of sperm.

Is best inserted during menstruation orwithin 10 minutes after delivery of

placenta or up to 48 hours after

childbirth by specially trained health

professional

1.___________________

2.___________________

3.___________________

After ejaculation its rim is held at the4

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After ejaculation, its rim is held at the

base so that the sperm will not spill

off while pulling the penis off the

vagina before losing erection

This procedure is done immediatelyafter chid birth or within 7 days

Can be used immediately after birthwhile breastfeeding, effective for at

least 6 months

4.___________________

5.___________________

6.___________________

Also known as cervical mucus method7

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Also known as cervical mucus method

This method is a combination of basal

body temperature, billings method

and calendar method

Vaginal method that blocks sperm from

entering the uterus and tubes

Kills sperms and make them unable to

move towards the ovum

7.___________________

9.___________________

10.__________________

8.___________________

is an injectable contraceptive1 DEPO

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is an injectable contraceptive

containing progestin that inhibits

ovulation and thickens cervical

mucus, making it difficult for spermto pass

after cutting, the male partner would

need to ejaculate 20 times to

completely empty it of sperm.

Is best inserted during menstruation orwithin 10 minutes after delivery of

placenta or up to 48 hours after

childbirth by specially trained health

professional

1. DEPO

PROVERA

2. VASECTOMY

3. IUD


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base so that the sperm will not spill

off while pulling the penis off the

vagina before losing erection

This procedure is done immediatelyafter chid birth or within 7 days

Can be used immediately after birthwhile breastfeeding, effective for at

least 6 months

4. CONDOM

5. BTL

6. LAM

Also known as cervical mucus method7 BILLINGS

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Also known as cervical mucus method

This method is a combination of basal

body temperature, billings method

and calendar method

Vaginal method that blocks sperm from

entering the uterus and tubes

Kills sperms and make them unable to

move towards the ovum

7. BILLING S

METHOD

8. SYPMTHO-

THERMAL

METHOD

9. DIAPHRAGM /

CERVICAL CAPS

10. SPERMICIDE

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How many tears interval between births is

recommended by the Family Planningprogram?

a.1-2 yearsb.3-5 years

c.2-4 years

d.4-6 years

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Fertility Awareness-Based (FAB) Methods

are contraceptive methods hinged on the

awareness of the end of the fertile time of

a womansmenstrual cycle. Example of FAB

methods are the following, except:

a.Basal Body Temperature

b.BillingsMethodc.Lactational Amenorrhea method

d.Standard Days Method

ld h b h h d

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A 23-year old woman has just given birth to her second

child. She asked you for some information regarding the

Lactational Amenorrhea Method. Which statement willbe excluded from the discussion?

a.This method has no hormonal side effects

b.If the baby is more than 6 months old, the chances ofgetting pregnant increase.

c.This can protect her from pregnancy for at least 6

months and as long as 9 to 12 if she continues to

breastfeed very often.

d.The baby should be fed food other than breast milk at

least 30 % of the time.

PHILIPPINE NUTRITION PROGRAM

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PHILIPPINE NUTRITION PROGRAM

GOAL: Improve nutritional status, productivity andquality of life by 2020

Programs/ Projects

1. Micronutrient

Supplementation

2. Food Fortification

Enrichment ( RA 8976)3. RA 7600

4. Infant and Young Child Feeding

5. Food/ Livelihood Assistance

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Nutritional Guidelines for MS:

Universal Supplementation of VITAMIN AInfants(6-12 months) = 100,000 IU----w/AMV

Children(12-71 months) = 200,000 IU

High Risk Children

Measles

Severe PneumoniaPersistent Diarrhea

Malnutrition

1 cap given upon Dx,EXCEPT when the

child was given VAC

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Pregnant woman/ Post Partum

10,000 IU

200, 000 IU

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XEROPHTHALMIA

Infant __________IU Children __________IU

Pregnant mother 10,000 IU/ cap for 4 weeks upon Dx

DayMorrow

Weeks after2

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IRON SUPPLEMETATION

Pregnantwomen Lactating women= 60/400---1 tab OD for 3 months

LOW BIRTH WEIGTH = 0.3 ml OD x 6 months

INFANTS (6-11 months) = 0.6 ml OD x 3 months

CHILDREN(1-5 y/0)=30mg/5ml ( 1tbsp OD for 3

months OR 30 mg/wk for 6months) CHILDREN 6-11 y/0= 2 tbsp OD for 6 months

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RA 7600

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BREASTFEEDING Bbonding Rready to use E economical A always available S safe to use T temperature is right at all times F fosters trust Eeffective contraceptive E - exposure to diseases is reduced Ddigestion is okay I immune system is strengthened Nnutritious G GIT protected

EO 51 MILK CODE

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COMPLEMENTARY FOODS

TIMELY

ADEQUATE

SAFE

PROPERLY FED

EO 51MILK CODE

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Malnutrition continues to be the Health

concern in the country. The common

nutritional deficiencies are:

a.Vitamin A, iron and folic acid

b.Vitamin A, B complex and iodine

c.Iodine, iron and folic acidd.Iodine, iron and vitamin A

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Supplementation of Vitamin A for pregnantwomen is starting on the:

a. 1stmonth of pregnancyb.2ndmonth of pregnancy

c.3rdmonth of pregnancy

d.4thmonth of pregnancy

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A child with visible muscle wasting, an oldmans face and is apathetic and quiet has:

a.Protein energy malnutritionb.Kwashiorkor

c.Marasmus

d.Iodine deficiency

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Iron supplementation for low birth infantswill start at what age?

a.1 monthb.2 months

c.4 months

d.6 months

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All of the following statements are true with regards to

breastfeeding, except:

a.Mothers with mastitis shall continue to breastfeed

their infants.

b.Mothers with mild to moderate medical problems suchas TB who have been adequately treated for at least 2

days shall continue to breastfeed

c.Mothers who are taking anticancer drugs are not

allowed to breastfeed.d.Breastmilk shall be given to all infants who are sick but

can tolerate oral and tube feeding.

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Which of the following are economic benefits of

breastfeeding to households and the

community?

a.Reduces infants exposure to infection

b.Saves medical costs to families andgovernments by preventing illnesses

c.Reduces the risk of ovarian and breast cancers

and osteoporosis among womend.Provides a nutritional complete food for the

young infant.

MDG 4

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MDG 4:

Reduce Child Mortality

Reduce Under 5-mortality rate

from 80.0 to 26.7 (per 1,000 LB)

Reduce Infant mortality ratefrom 57.0 to 19.0 (per 1,000 LB)

CARE OF THE NEWBORN

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CARE OF THE NEWBORN

Refer on the slides for an UPDATED DOH PROTOCOL

on ESSENTIAL NEWBORN CARE (ENC)

Video/ Film Showing on ENC Protocol by the DOH-

UNANG YAKAP

ENVIRONMENTAL SANITATION

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ENVIRONMENTAL SANITATION

3 preventive strategies for the

epidemiological triad:Change peoples behaviour

Prevent production of disease agents

Increase mans resistance or immunity

WATER SUPPLY

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WATER SUPPLY

Level I water supply facilities: (point source)protected well, developed spring

Level II water supply facilities: waterworkssystem or individual house connections

Level III water supply facilities: waterworkssystem or individual house connections

TOILET FACILITIES

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TOILET FACILITIES

Level I toilet Facilities: pit latrines, bore hole,antipolo type, pour-flush toilet and over hang

Level II toilet facilities: water sealed and flushtype with septic vault/tank disposal facilities.

Level III toilet facilities: water carriagesconnected to septic tanks and/or sewerage system

to treatment plants.

FOOD SANITATION

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FOOD SANITATION

Four rights in food safety:Right Source

Right Preparation

Right CookingRight Storage

RULE IN FOOD SAFETY:

When in DOUBT, THROW it OUT

Class A Excellent

Class B Very Satisfactory

Class C Satisfactory

LAWS DOH POLICIES

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LAWS/ DOH POLICIES:

PD 856-SEAWAGE/ EXCRETA/ DRAINAGE

RA 8749- AIR

RA 9275- WATER

RA 9003- SOLID WASTE ( 3 Rs)

RA 6969- TOXIC/NUCLEAR SUBSTANCE

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An example of approved type water supplyunder Level I is:

a. Communal faucetb. Individual house connections

c. Protected well

d. Water stand post

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An example of approved type of toiletfacility under level II includes:

a. Pour flush toiletb. Pit latrines

c. Reed odorless earth closet

d. Water carriage with water seal

OTHER PRIORITY PROGRAMS

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OTHER PRIORITY PROGRAMS

QUALITY ASSURANCE---SS

HERBAL MEDICINE

VOLUNTARY BLOOD DONATION

BOTIKA NG BARANGAY

QUALITY ASSURANCE

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QUALITY ASSURANCE

Sentrong Sigla Movement isjoint project of the DOHand LGUwith the goal of providing quality health care

services and facilities.

GOAL: For an active partnership between DOH andLGUs. The goal is QUALITY health care, services and

faculities.

Key Strategies:

1. Certification/ Recognition Program

2. Continuous Quality Improvement

Guiding principles of SS certification focuses on Public

Health Program such as MCH FP Prevention and Control

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Health Program such as MCH, FP, Prevention and Control

of CD and NCD and promotion of healthy lifestyle.

Level and scope of Certification include: Basic SS

certification, Specialty Awards, Awards for excellence

1. Basic SS certification

- minimum input, process and output

standards for integrated public health services for

4 core programs, facility system, regulatoryfunctions and basic curative services.

2 Specialty awards

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2. Specialty awards

- second level health quality standards for

selected 4 core public health programs and level 2facility system for at least 3 consecutive years.

3. Award for Excellence

- highest level quality standards for maintaining

Level 2 standards for the 4 core public health

programs and level 2 facility systems for at least 3

consecutive years.

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Which of the following quality assuranceprogram of DOH?

a. Sangkap Pinoyb. Sentrong Sigla

c. Kilatis Kutis

d. Botika ng Barangay

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The objective of this program is for the better

and more effective collaboration between DOHand LGUs. Which of the following statement is

not correct?

a. DOH provides technical and financial

assistance packages for health care

b. LGU is the prime developer of health system

c. DOH provides only technical assistance

d. LGU is the direct implement of health

programs

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The guiding principles of Sentrong Sigla

certification focus on Public HealthProgram such as:

a. MCH, FP, Prevention and Control of

Communicable Disease andPromotion of Healthy lifestyle

b. Water sanitation

c. Treatment of waste waterd. Investigation of disease occurrence

HERBAL MEDICINE RA8423- TRADITIONAL AND ALTERNATIVE ACT

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___________________- asthma, cough, fever

___________________- Lowers uric acid, rheumatism and gout___________________- Washing of wounds, diarrhea and toothache

___________________- Lowers cholesterol, HPN, toothache

___________________- Pain, rheumatism, cough and colds, toothache

___________________- Anti-edema, diuretic, anti urolithiasis___________________- Diabetes mellitus, mild noninsulin dependent

___________________- Antihelminthic

___________________- For diarrhea and stomachache

___________________ - Anti-fungal

Remember: LUBBY SANTA

BOTIKA NG BARANGAY

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BOTIKA NG BARANGAY

Botika ng Barangay(BnB) will promoteequity in health by ensuring availability and

accesibility of affordable safe medicines.

The priority beneficiaries are:

marginalized

undeservedcritical and hard to reach areas.

Botika ng Barangay refers to a drug

outlet maganged by :

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outlet maganged by :

Legitimate Community Organization, NGO and LGU

with a trained operator and a supervising pharmacist

and specifically licensed by the Bureau of Food and

Drugsto sell, distribute and make available low-priced

generic OTC drugs, and recently, selected medication

for chronic diseases such as DM, HPN and Asthma.

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BOTIKA NG Barangay refers to a drug outletmanaged by:

a. Barangay Chairmanb. Community Organization (CO)

c. Legitimate CO,NGO and LGU

d. Trained Barangay Helath Workers

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Priority beneficiaries are:

a. Marginalized, underserved

b. Urban populationc. Rural areas

d. NCR especially QC and Manila

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Botika ng Barangay sells essential drugssuch as, except:

a. Genetic home remedies

b. Over the counter drugs (OTC)c. Two selected, public known antibiotic

drugs

d. Third generation antibiotics


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RA 7719- Blood Services act of 1994

Blood are no longer for free voluntary blood

donations are done in hospital Red Cross stations

and some designated places.

Walking blood donors: potential donors who will

be on a list with their blood types and are on callwhen needed.

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Gone are days when private clinics conduct

bloodletting activities for free. Now this is donein the hospitals, Red Cross Offices and some

designated places. Walking Blood Donors means:

a. A donor who walk-in and donate blood.

b. Healthy individual able to donate blood

c. Individual registered in the list of possible

blood donorsd. Individual qualified to donate blood

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To ensure the safety of blood supply, donors

must meet certain requirements before

donating. The donor is not eligible if:

a. Weight more than 45 kg for 250 ml ofdonated blood

b. Be aged 16-65 years of age

c. BP range 90-160 mmHg/60-100 mmHgd. Hemoglobin of 10 g/dL

NEWBORN SCREENING

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NEWBORN SCREENING

WHEN?HOW?

WHERE?RESULTS?

REMARKS?

ROLES OF RHU STAFF?

DISORDERS SCREENED

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CAH G6PDDefieciency

GAL PKU

CH

DISORDERS SCREENED

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Child care program have packages of

very essential care to cite New BornScreening (NBS). NBS must be done:

a. 24 hours after birth

b. 72 hours birth

c. Within 72 hoursd. Within a week after birth

Newborn screening is performed

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by getting a blood sample using the

heel prick method. Who is allowed

to perform this method?

a.Midwife

b. Physicianc.Nurse

d.d. Any of these

Whi h f th f ll i di

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Which of the following diseases

screened could lead to death ifnot detected?

a.G6PDb.PKU

c.Congenital adrenal hyperplasiad.Congenital hypothyroidism

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Documents

CHN-REV