CHN Enhancement

 

By: Merly Marantan-Alcabedos, RN, MSN

 

PUBLIC HEALTH Overview of Public Health Definition by: 1. Winslow

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PH is the science and art of; Preventing disease Prolonging life Promoting health and efficiency through organized community effort for the; Sanitation Sanitati on of the environment Control of communicable infection Education of individual in personal hygiene Orgaization of medical and nursing services for the early diagnosis and prevention preven tion and treatment of diseases Establishment of a social machinery  1st approach- preve  preventive ntive not curative

Focus-care of the well and non hospitalized sick

 

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PH is to ensure everyone a standard of living adequate for the maintenance of health *Increase quality of life PH is to enable every citizen to realize his birth right of  health and longevity  *Health services servi ces should be readily available available and accessible

 

PUBLIC HEALTH NURSING 

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Definition by: 1. WHO PHN is a special field of nursing which combines PH, nursing skills,social functions for the; Promotion of health Prevention of disease Rehabilitation of the sick Philosophy  The family is the basic unit of service Focus of PHN is community  Goal To raise the level of health of the citizenry  Objective To actively participate in the promotion of health of individual, family and community  *Geared towards the attainment of Optimum Level of functioning ( OLOF)

 

  QUALIFICATIONS, ROLES AND FUNCTIONS OF A COMMUNITY HEALTH NURSE QUALIFICATIONS OF PUBLIC HEALTH NURSE:    

ROLES     A.MANAGER   A.MANA GER   FUNCTIONS *Plans and organize the nursing service plan

of the health unit

* Participates in the preparation and implementation of municipal health plan   

Monitors theabsence implementation of theHealth nurs ingPhysician nursing service plan Managesand the evaluates RHU in the of the Rural    Allocates and distribut distributes es materials materials and equipments at local levels

 

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SUPERVISOR   * Formulates and implements a supervisory plan Monitors and evaluates midwives in the implementation of public health programs  Maintains records and reports

 

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TRAINOR   Identifies and interprets training needs of  Midwives, BHW and Hilots  Formulates training program for midwives, BHW and Hilots Evaluates effects of training on work performanc performancee

 

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CLINICIAN OR PROVIDER OF NURSING CARE

* Provides direct nursing care to the sick, disabled disabled in the home, clinic cl inic and place of wor work k HEALTH EDUCATOR  

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Conducts health education activites ( mothers class, IEc) COUNSELOR   Conducts pre-marital counselling

 

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COMMUNITY ORGANIZER   Responsible for motivating and enhancing community  participation COORDINATOR/FACILITATOR   Coordinates nursing programs with other health

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programs Multi-sectoral linkage 

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HEALTH MONITOR   HEALTH Detects deviation from health of individuals, families, and communities communities through follow-up care ROLE MODEL  Provides good good example of healt healthful hful livin living g to the public CHANGE AGENT  Motivates changes in heal health th behaviour

 

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RECORDER/REPORTER   Maintains and submit submitss ac accurate curate and complete data RESEARCHER   Participates, assists assists or conducts researches on nursing and health related subjects

 

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NATIONAL HEALTH PLAN  It is the blueprint, which is followed by the DOH. It defines theand country’s country’ s health problems, policy thrusts, strategies targets - A long-term directional plan ffor or health. This is the blueprint defining the country’s health: 

PROBLEMS POLICIES STRATEGIES THRUSTS

 

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GOAL; Healthy citizenry-National development To improve health indicators through access To enable the Filipino population to achieve a level of  health w/c will allow Filipinos to lead a socially & economically-productive life, withlow longer life expectancy, low infant mortality, maternal mortality,, & less disability through measures mortality measures that will guarantee access access of everyone everyone to essent essential ial HC

 

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Broad Objectives:  

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Promote equity in health status among all segments of  society   Address  Addr ess specific health problems of the population Upgrade the status & transform the HCDS into a responsive, dynamic & highly hi ghly efficient eff icient & effective one in the provision of solutions to changing the health needs of the population Promote active active & sustai sustained ned people’s participation in HC.  HC. 

 

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STRATEGIES: Health service service delivery system Thrust program/Priority program Restructured health Care delivery system ( RHCDS) Concept of the expanded roles of PHN Management Information System

 

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MAJOR HEALTH HEALTH PLANS PL ANS TOW TOWARDS ARDS “HEAL “HEALTH TH IIN N THE HANDS OF THE PEOPLE IN THE YEAR 2020”   “23 IN 1993” Refers to the 23 programs, projects, activities of the DOH for the  year 1993, w which hich marks marks the the beginning of its journey to towards wards DOG vision. “ Health for more in ‘94”   Activities in 1994 focused focused on on Cancer Cancer prevention, prevention, rreproducti eproductive ve health, mental health, and maintenance maintenance of a safe env’t env’t..

 

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“ Health Focus in 1995” –  – “ Think Health, Health Link”    A A national national & multi-sectoral multi-sectoral health prom promotion otion strat strategy  egy  aimed at conveying conveying health health mess messages ages to people  wherever  wherev er they are aimed at building supportiv supportivee environments through advocacy, advocacy, community action & networking.  

 

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“Health Sector Sector Reform Agenda Agenda””   Emphasizing on improvements improvements in he health alth care delivery  by maximizing people’s participation in health “Sentrong Sigla Sigla Mov Movement ement  Pertains to development & implementa implementation tion of  standards to provide provide quality health heal th services ser vices to the people.

 

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HEALTH SERVICE DELIVERY SYSTEM Is the totality of all policies, infrastructures infrastructures,, facilities, equipments, products, human resources and services that address the health needs, problems and concerns conc erns of all people. 

 

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CONCEPT: Partnershi CONCEPT: Partnership p 1.Government sectors (GO’s)  RHU representatives Health Centers RA 7160 – local gov government ernment code -devolution –transfer of powers to the LG 2. Private Sector ( NGO’s)  3. Mixed Sector

 

4. Community  * Local L ocal go government vernment ccode(RA ode(RA 77160) 160) The code aims to: a. Transform Transform local government unit iinto nto self reliant communities 

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b. And active partners in the attainment attainment of national goals through a more responsive and accountable local government government structu structure re instituted th through rough a system of decentralization 

 

*Inter local health system:  1. in order to ensure quality health healthcare care services at the local level 

23.. each clustering into “interlocal “interlocal health zone”  zone”  ILHZ municipalities has a defined population within a geographical area 4. partnership is the basic framework   Composition: People Boundaries Health facilities Health workers

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THRUST PROGRAMS  I.CMCH ( Comprehensive Maternal and Child Health) IMCH ( Integrated Maternal and Child Health) Components: a. Maternal Care – Safe motherhood Program a.1 Prenatal Care a.2 Natal Care a.3 Post-natal Care *To *T o reach al pregnant women, to give sufficien sufficientt care, ensure a healthy pregnancy and the birth of a full term healthy baby  

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History taking Compute EDC (Naegel’s rule) 1st get the (LMP) nd

2Example: use the following: -3+7+1 (constant)  August 13, 2010 8 13 2010 -3 +7 + 1 5 20 2011 EDC *to compute the AOG 1st get LMP Ex: Jan 24, 2011 2nd get the latest consultation date Ex: July 20, 2011 Ex: Jan 31-24 = 7  Jan 7 Feb 28 Mar - 31  Apr - 30 May 31  June - 30  July 20 177/7 = 25 weeks and 2 days AOG  

 

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b. Under five Clinic ( UFC) b .1 G-rowth Monitoring b. 2 O-resol (ORT) b. 3 B-reatfeeding b. 4 I-mmunization

 

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Growth Monitoring Monitors wasting and stunting stunting  Anthropometric  Anthrop ometric measurement Height for ageage- measures only stunting  Weight  W eight for height –measures only wasting  Arm circumferenc circumferencee least reliable measurement ( decrease 13 cm diameter – child under 4y/o= wasting)

 

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BREASTFEEDING Exclusive BF for the 1st 4-6 months of life 3 E’s  E’s  E-arly ( 30 minutes m inutes after delivery) E-xclusive ( pure breatmilk) E-xtended ( up to 2 years) years) EO 51- Milk Code ( law which prohibit the commercialization comm ercialization of artificial feeding) Senate Bill No. 1044- bill seeking for the implementation of  “ RoomingRooming-In In””  RA No. 7600- Mother Baby Friendly Hospital Initiative

 

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ORT  fluid replacement therapy  3F’s    Increase f luid Increase feeding Increase fast referrals Composition: 3.5 gram NaCl 2.5 gram NaHCO3 2.9 gram g ram Na citrate 1.5 gram KCl 20 grams glucose 1 pack:1L of Water (clean water) Homemade oresol; 1 tsp salt:8 tsp sugar + 1L water or; 1 heaped tsp salt to 4 heaped tsp sugar + 1L water

 

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B-est for babies up to 6 months to 2 years R -apid -apid involution is promoted E-conomical  A -lways -lways available S-atisfies infant’s needs  needs  T-emperature is always right F-eeding promotes bonding E-asy to digest E-ffortless D-ecrease incidence of cancer I-llness prevention N-ormally contains antibodies G-astroenteri -astroenterities ties is less llikely ikely to occur

 

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*10 Steps to Successful Breastfeeding:    

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Make it a policy in all hospitals T raining of alldissemination heaslth workers on BF Information disseminatio n on BF Teach mothers how to breastfeed properly 

Right breast-Left breast 10 minutes ( hunger) 10 minutes( pleasure)

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Only small portion of the areola is seen Chin closed to the breast Pain felt at 1st , painless afterwards Slow deep sucking Exclusive BDF for 4-6 months of life

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Rooming-in BF on demand BF 30 minutes after delivery (NSD), 1 hour for bonding, 3-4 ho hours urs after CS delivery  No pacifiers BF support groups

 

 

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Launched in July 1976 Objective: To To reduce the morbidity and mortality mort ality among infants in fants and children caused by the six childhood immunizable diseases   Laws; PD# 996 –compulsary basic immunization for children below 8 years old PD# 6 –Universal child immunization PD # 46- Universal child and mother immunization

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PD# immunization days PD# 147773- National Knock out PD# 1066- neonatal tetanus elimination ccampaign ampaign PD# 7846- compulsary immunization against hepatitis

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Strategies: 1. PEI –Polio Eradication Eradication IInitiative nitiative OPV to children less than 4 years 2. Case Containment ( saturation s aturation of a barangay with a reported case 

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3. NID –National Immunization Day ( 1 patak center every 1000 population) *FIC- Fully Immunized Child

 

 V  Vaccine accine

 Age to be Doses

Dosage

Route

Interval

Site

0.05ml

ID

R deltoid

0.1ml

ID

Ldeltoid

given BCG

Infants 1  Anytime at birth School 1 entrance

4 wks DPT

6 weeks

 3

0.5ml

OPV 

6 weeks

 3

2-3 drops PO

4wks

HEpB

6 weeks

 3

0.5ml

4wks

measles

9 months

1

0.5ml

IM

IM SC

 Vastus  Vastus lateralis Mouth  Vastus  Vastus lateralis deltoid

 

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 VIAL/AMPULE  VIAL/AMP ULE C COMPUT OMPUTA ATION  Vaccine Computation: For infants, target –setting should be based on the 3% of the total population,whi population,whiler ler for pregnant women, it must be based on thec 3.5% of the total polulation + 25% buffer/reserved stock Eligible population=total population x 0.03 (infants/school entrants) Eligible population=total population x 0.035( pregnant women)

 

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Example: How How Many ampule of B BC CG and vial of DPT

and TT will you request for a population of 50 5000 00 per  year? 1. Compare eligible population: Formula: Eligible Eligib le population= total population x cconstant onstant percentage a. infants -3%=.03 b. school entrance-3%=.0 entrance-3%=.033 c. pregnant mother-35%=.035 Infants: 5000 x .03 = 150 infants Pregnant mother: 5000 x .035 = 175 pregnant

 

2. Compute doses needed nee ded per year: Formula: Doses needed ne eded per year = eligible population populat ion x constant doses Constant doses: BCG-1 dose HEPB- 3 doses MEASLES- 1 doses TT- 2 doses DPT- 3 doses OPV- 3 doses BCG: 150 x 1 dose = 150 doses of BCG DPT: 150 x 3 doses = 450 doses of DPT T T 175 x 2 doses = 350 doses of TT

 

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3. Compute Compute doses with wastage allowance: allowance: Formula: Doses with wastage allowance = doses needed n eeded per year year x constant wastage allowanc all owancee per pe r vaccine vaccine Infant BCG------------------2. BCG------------------2. 50 SE BCG --------------------- 1.67 DPT,OPV,TT---DPT,OPV ,TT--------------------------------- 1.67 HepB------------------------- 1.20 Measles --------------------- 2.0 BCG= 150 dose x 2.50 = 375 doses of BCG DPT = 450 doses x 1.67 = 752 doses of DPT

 

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4. Compute Comp ute ampule and vial reque request st per year: Formula:  Ampule and  vial request request = doses with wastage wastage allowance allowance per year constant stocks doses per ampule or per vial Constant stock doses per ampule or per vial BCG,OP BCG,OPV V.,TT ---------------------20 --------------------20 doses do ses DPT, Measles, HepB ------------ 10 doses BCG : 375 doses 20 doses/ampule = 19 ampules/year ampules/year DPT : 752 doses 10 doses/vial = 38 vials/year

 

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COLD CHAIN SYSTEM

-System to maintain potency of vaccines Refrigerators: a. Freeze Freezerr = -15 to -25C OPV = and b. Body +2 Measles to +8 C BCG, DPT, TT, Hepa B OPV- most sensitive sensitive to heat TT – least sensitive sensitive to heat

 

2-4 hours open ( BCG.Measles) 8 hours open (OPV, DPt, TT, Hepa B) 2. Vaccine Vaccine Carri Carriers ers > 4 icepack frozen ( white) > 5 icepack frozen ( black)

 

 Vaccine  Vacc ine composition: composition: BCG, OPV OPV,, Measl Measles es - live attenu attenuated ated organi organism sm DT, TT- toxoid Pertussis – killed bactreri bactreriaa Hepa B – plasma derivative

 

Drill questions : 1.The 1st approach and focus of public health is:

 

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Ist approach =preventive not curative Focus-care of the well and non hospitalized sick

 

2. The basic unit of service in PHN PHN is:_________ 3.Focus of PHN is ____________.

 

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The family is the basic unit of service in PHN The family is:_________ Focus of PHN is community community  

 

4. The goal and objective object ive of PHN is geared towards the attainment of _______________.

 

The goal and objective of PHN is geared towards the attainment of Optimum Level of functioning ( OLOF)

 

5. It is the blueprint, which is followed by the DOH. It defines the country’s country’s health problems, policy thrusts, strategies and targets

 

National Health Plan

 

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It is the totality of all policies, infrastructures, facilities, equipments, products, human resources and services that address the health needs, problems and concerns concerns of all people 

 

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HEALTH SERVICE DELIVERY SYSTEM

 

If the PHN rovides direct nursing care to the sick, disabled disable d in the home home,, clinic and place of work, she is performing the role as ________.

 

Clinician or provider of nursing care

 

If a PHN monitors monitors and evaluates midwives in the implementation of public health programs, she is acting the role as:___________ 

 

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SUPERVISOR 

 

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Milk Code ( law which prohibit the commercialization of artificial feeding)

 

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Eo 51

 

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compulsary basic immunization immunization for children below below 8  years old

 

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PD# 996

 

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Vaccines that is : most sensitive to heat _________least sensitive to heat___________

 

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OPV- most most sensitive to heat TT – least sensitive sensit ive tto o heat

 

DRILL QUESTIONS: Direction: If the DOH- prescribed schedule was followed, what vaccines vaccines would hav havee bee been n received by  these children? Indicate the number of doses receiv received: ed: Linda – 2 -months- old  Amado,, 6- months –old  Amado Lauro, - 1-year -old

 

   Answer::  Answer Linda- BCG 1 dose, DPT DPT,, OPV and Hepatitis B, 1st dose, Hepatitis B, 2nd dose  Amado – BCG 1st dose and DPT DPT,, doseOPV and Hepatitis B ,3rd dose Lauro- BCG 1st dose dose,, DP DPT T, O OPV PV,, Hep HepaB aB 3 rd dose and st

Measles 1 dose

 

2.. A child is said to be fully immunized if he has received which set of immunizations?  A. 1 dose of BC BCG, G, 2 doses of OPV and 3 doses of DPT B. 2 doses of BC B CG, 3 doses of OPV and 1 dose of MMR MMR,1 ,1 Measle C. 1 dose dose of BCG, 3 doses of OPV and 3 d doses oses of DPT DPT,3 ,3 dose of Hepa B and measle D. 1 dose of BCG BCG,, 2 doses of DPT and 3 doses of MMR 

 

3. interval? .D DPT PT vaccines vaccines are given in mult multiple iple doses at w which hich  A. one week B. one month C. six months D. on onee yea

 

II. NA NATIONAL TIONAL TUBERCULOSIS PROGRAM  A.BC  A.BCG G Immunization Immuniz B. Case Finding (ation TB symptomatic) screening: a. chest chest x-ra x-ray  y  b. sputum microscopy / smear sme ar exam c. tubercullin/ mantoux test

 

Tuberculosis     

Other names: Koch’s Dise Koch’s Disease ase  Consumption Phthisis  Weak  W eak lungs

 

Causative Agent     

Mycobacterium tube Mycobacterium tuberculosis rculosis TB bacillus Koch’ss bacil Koch’ bacillus lus  Mycobacterium Myc obacterium bovis (rod-shaped)

 

Mode of Transmission  Airborne-droplet  Airborne-droplet Direct invasion through mucous membranes and breaks in the skin (very rare)

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Incubation period : 4 – 6 weeks

 

PATHO THOGNO GNOMON MONIC IC SI SIGN GN       

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1. Usually asymptomatic 2. Low-grade afternoon fever 3. Night sweating 4. Loss of appetite 5. Weight loss 6. Easy fatigability – fatigability – due to increased oxygen demand 7. Temporary Temporary amenorrhea ame norrhea 8. Productive dry cough cough

9. Hemoptysis  

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PERIOD OF COMMUNICABILITY OF TUBERCULOSIS: as long as bacillus is contained in the sputum Primary complex in children is NOT contagious Good compliance to regimen regimen renders person not not contagious contagious 22-4 4 weeks after initiation of treatment

 

C. Chemotherapy ( Case Holding) 1. Standard regimen ( SR )-1 year > streptomycin streptomycin Sulfate inject injection ion > Isoniazid ( INH) 2. Short Short Course chemotherapy ( SCC) – 6 months a. Intensive Phase b. Maintenance Phase

 

1. CATEGORY I- Treatm reatment entss for clients clients who are: New

pulmonaryy cases, pulmonar sputum (-) but with severe severe pulmonary condition., secondary ill clients Intensive Phase : ( 2 months) _ RIPE > Rifampicin > INH > Pyrazinamide ( PZA) > Ethambutol

 

Maintenance Phase: ( 4 months)_ RI > INH > Rifampicin 2. CATEGORY II. Treatment Treatment for clients client s who are: on relapse, relapse , treatment failures, returning after default Intensive Phase: 3 months _ RIPES > Rifampicin > INH > PZA  > Ethambutol > Streptomycin

 

Maintenance Phase: ( 5 months) _ RIPE > Rifampicin > INH > Ethambutol > PZA  3. CA CATEGORY III – Treatment for clients with : (-) sputum smear, smear, min minimal imal PTB, extrapulmonary  extrapulmonar y  Intensive Phase – (2 months) _ RIP > Rifampicin > INH

> PZA   

Maintenance Phase : ( 4 months) _ RI > Rifampicin > INH 4. CA CATEGORY TEGORY IV – IV – Treatment for clients who are: Chronic (+) smear after supervised re-treatment > refer to specialized facility or DOTS Pl Plus us Center Center,, or Provincial or City NTP Coordinator

 

Side Effects:      

Rifampicin · body fluid discoloration · hepatoto hepatotoxic xic · permanent permanent discoloration of  contact lenses

 

Isoniazid · Peripheral neuropathy  (Give Vit B6/Pyridoxine) Pyrazinamide hyperuricemia /gouty arthritis 

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(increase fluid intake)

 

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Ethambutol · Optic neuritis · Blurring of vision (Not to be given to children chil dren b below elow 6 yy.o. .o. due to inability to complain blurring of vision) · Inability Inability to rec recognize ognize green from blue Streptomycin · Damage to 8th CN · Ototoxic · Tinnitus

· nephroto nephrotoxic xic  

MANAGEMENT/TREATMENT Diagnostic test: · Sputum examination or the Acid-fast bacilli (AFB) / sputum microscopy  1. Confirmatory test 2. Early E arly morning sputum about 3-5 cc 3. Maintain NPO before collecting sputum 

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4. Give oral care after the procedure 5. Label and immediately send to laboratory  6. If the time of the collection of the sputum is

unknown, discard  

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Chest X-ray is used to: 1. Determine Determine the clinical activity of TB, whether it is inactive (in control) or activ activee (ongoing) 2. To To determine the size of the lesion: lesion: a. Minimal – very small b. Moderately advance – lesion is < 4 cm c. Far advance – lesion is > 4 cm · Tuberculin Test – purpose is to determine the history of exposure to tuberculosis Other names:  names: 

 

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Mantoux Test Mantoux Test – used for single screening, result interpreted after 72 hours Tine test – used for mass screening read after 48 hours Interpretation: 0 - 4 mm induration – not significant 5 mm or more – significant in individuals who are considered at risk; positive pos itive for patients who are HIV-positive HIV-positive or have have HIV risk factors fac tors and are of u nknown unknown status,case, those t hose who are close contacts withHIV an active and those who have chest x-ray results consistent consistent with tuberculosis. tu berculosis. 10 mm m m or greater – significant in individuals

 who have have normal normal or mildly impaired immunity   

Prevention  

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Respiratory precautions · Cover the mouth and nose when sneezing to avoid mode of transmission · Give BCG BCG is ideally ideally giv given en at birth, then th en at school entrance. If given at 12 months, perform tuberculin testing (PPD), give give BC BCG G if negative. · Improve social conditions

 

Drill questions: 

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. Tuberculosi Tuberculosiss is an infect infection ion that primarily affect the lungs and is caused by a: A. virus B. bacteria C. fungus D. paras parasite ite

 

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The nurse assesses for a manifestation of tuberculosis which includes

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A. severe sharp B. weight gain chest pain C. hematemesis D. hemoptysis

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  The most definitive diagnostic test for pulmonary tuberculosis is A. sputum culture B. blood culture C. chest x-ray  D. pulmonary function test

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.tuberculosis Vitamin B6 therapy is given for among patients multi-drug antiwhich of the on following reasons? A. To To prevent peripheral neuropathy from takin taking g Isoniazid B. To To minimize tinnitus tinni tus caused by Streptomycin sulfate C. To To prevent the development of drug resistance res istance D. To To potentiate the th e effects of other anti-tubercular anti-t ubercular drugs

   

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  The nurse should assess for a common side-effect of Rifampicin (Rifampin)which is: A. Photosensitivity  Photosensitivity  B. Orange discoloration of the urine C. Ringing in the ears D. Renal Rena l damage   . A patient is in a Respiratory Isolation room and is taking multidrug therapy  for tuberculosis. Which of the following statements made by the patient suggests that he is exhibiting adverse effect of Streptomycin?    A. “I am having having numbness numbness in my hands.” hands.”    B. “I have some trouble hearing.”  hearing.”    C. “I noticed my urine turned orange.” orange.”    D. “My hands seem to be more swollen today.”  today.”  

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Some anti-TB drugs can potentially damage the auditory or vestibular branch of cranial nerve VIII. Damage to this nerve branch can lead to: A. ootoxicity, ootoxicity, tinnitus and hear hearing ing loss B. visual loss, blurred vision, photosensitivity  C. nausea, vomiting, diarrhea D. hypersensitivity, organ toxicity, GI upset   The patient with PTB is placed pl aced on the short course chemotherapy  (SCC). The nurse explains to the patient that th at he needs to take the prescribed medicines medi cines for a minimum of  A. 1 month B. 6 weeks C. 6 months

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D. 12 months

 

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To monitor the effectiveness of the anti-TB drug drugs, s, the patien patientt has to go go for return return visits to the clinic for monitoring mon itoring of results from

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A. sputum culture B. chest x-ray  C. CT scan of the chest D. bronchoscopy 

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  . A patient with PTB is considered non-communicable if the patient is in continuous treatment for at least A. 2-3 weeks B. 4-6 weeks C. 6-8 months

D. 1-2 years



 

 

  . Which of these medications are the first line antitubercular drugs? (Sele (Select ct all that apply apply.) .)



A. Isonicotinic acid hydrazide (INH) B. Streptomy Streptomycin cin C. Ethambutol

  

D. Pyrazinamide (PZA) E. Rifampicin

 

 

 

III. CONTROL OF DIARRHEAL DISEASES Trends: 1. No antidiarrheals, no antibiotics 2. 3. 4. 5.

Oresol Exclusive BF for 4-6 months of life Continue other feeding Handwashing

6. Treatment plan- ssee ee IMCI

 

IV.. CHOLE IV CHOLERA RA CONTROL PROGRAM

 A. Suspect Cholera 1. Patient more than 5 y/o develops severe dehydration dehydration

during an acute diarrheal episode 2. Patient more than 2 y/o develops acute diarrhea iin n an area where there is an epidemic of cholera cholera B. Cholera Management Program See CDD chart

 

What is Leprosy?

   

It is a disease  World's oldest recorded disease Stigmatized disease Gerhard Henrick Armauer Hansen

Every year January 27 is World Leprosy Day   

What causes it?

 Mycobacterium leprare Rod Shaped First bacterium disease in humans Humans and Armadillos are only known natural hosts 

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

http://www.aaas.org/news/releases/2005/images/0512 http://www.worldproutassembly.org/leprosy%20patien leprosy.jpg t%20holding%20flower.jpg

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http://genomenewsnetwork.org/articles/02_01/Leprosy.shtml

 

Types of Leprosy 

Depending on clinical features, leprosy is classified as: 1. 2. 3. 4. 5. 6.

Indeterminate Leprosy (IL) Paucibacillary Leprosy (PB)  (PB)  Borderline Tuberculoid Leprosy (BT) Borderline borderline Leprosy (BB) Borderline lepromatous Leprosy (BL) Multibacillary Leprosy (MB) 

 

What are the symptoms? 

Paucibacillary (PB) Leprosy symptoms are: 



 Well defined skin lesions that are numb

Multibacillary (MB) Leprosy symptoms are: –

Chronically stuffy nose and many skin lesions and nodules on both sides of the body 

  Mycobacterium Mycobacterium leprare multiplies very slowly  Symptoms can take as long as 20 years to appear

•

•

 

Who is at risk? •

It can affect all ages and both sexes

•

95% of people who are exposed do not develop 

Mainly affects: 







Skin Eyes The peripheral nerves Mucosa of the upper respiratory tract

 

Who is at risk?

bp2.blogger.com/.../s320/lepromatous_lep rosy.jpg

http://www.leprosymission.o rg/web/pages/leprosy/image s/girlwithleprosypatch.jpg

http://microbes.historique.net/images/lep3.jpg

http://www.leprosymission.org/web/pages/le prosy/leprosy.html

 

Pharmaceutical Treatment 

Multiple Drug Treatment (MDT) •

There agents:are several effective chemotherapeutic Dapsone (diaphenylsulfone, DDS), Rifampicin (RFP), Clofazimine (CLF), Ofloxacin (OFLX), and Minocycline (MINO) constitute the  backbone of the multidrug therapy (MDT) (MDT) regimen.

 

Side Effects 

Dapsone (DDS)





Rifampicin (RFP)







Clofazimine (CLF)

Occasional cutaneous eruptions  A slight reddish coloration of  urine, sweat, and tears Brownish Black discoloration and dryness of skin

 

 V. LEPROSY  V. LEPROSY CONTR ONTROL OL PR PROGRAM OGRAM RA4073- liberalizes treatment of leprosy ( MD MDT) T) - Chronic diseases affecting the skin and peripheral peripheral nerves 1. Pauci-bacillary  - Few bacilli - tuberculoid MDT > Rifampicin > Dapsone

* for a period of 6-9 months  

2. Clients with single skin lesion > Rifampicin > Ofloxacine > Minocycline 3. Multi –bacillary  - plenty of bacilli - lepromatous > rifampicin > dapsone > clofazimine

* for a period of 2 years  

Drill questions:  A single case of leprosy is detect detected ed in the community where you you work as the CHN and the the people are concerned about about its spread. spread. You You allay  their fears by telling them that that the client has already started multi-drug therapy (MDT). When is the client considered non-infectious after starting treatment?









 After one day   After one week



 After month month  After one one year

 

An Occasional cutaneous eruptions is a side effect of   which of the following MDT drug? a. dapsone  b. rifampicin c. clofazimine

 

 Which of the following following statements statements is TRUE TRUE about





multibacillary approach for lepromatous and borderline leprosy?   







Dapsone should be taken twice a day. Duration of of treatment is 12-20 months. Lamprene should be taken once a month. Rifampicin Rifampic in should be taken once a month.



 

 

 You  Y ou are giving health education to a famil familyy who





has a member afflicted with leprosy. Which of the following teachings is inappropriate?   







Encourage the use of padded padde d shoes. Teach the th e value of good personal hygiene. Teach the t he importance impo rtance of sustained su stained therapy. therapy. Instruct on the use of kitchen utensils made of 

stainless steel.  

 VI. PHILIPP PHILIPPINE INE CAN CANCER CER CONTR CONTROL OL PR PROGRAM OGRAM > January- CA Awareness month  A. Strategies; 1. Primary prevention- elimination of risk factors 2. Secondary prevention – early diagnosis and prompt

treatment 3. Definitive treatment and management 4. Supportive care 5. Research

 

 VII. NATIONAL NATIONAL CVD P PREVENTI REVENTION ON AN AND D CONTR CONTROL OL PROGRAM > target: ta rget: 15 y/o and above . February – Cardiology month Strategies: a. Primordial preventionprevention- reduces the chance of the targeted population from adopting the risk factors f actors for HCVD

b. Primary prevention – high risk strategy   

> focused focused on the population with any of the th e risk factors for heart disease: a. hereditary  b. smoking c. increase cholesterol/ diet d. obesity  e. stress c. Secondary prevention - clinical care and management of CVD d. Tertiary prevention – management of complications

 

 VIII.NATIONAL AIDS CONTROL PROGRAM

> Health Education/ Counselling * 1st level counseling – given to people whose behavior are at risk * 2nd level counseling- given to (+) HIV   World’ orld’ss AIDS Day   > December 1 - W MOT: a. Sexual transm transmission ission  Abstinence  Abstinence b. Mu Mutually tually faithful sexual relationship

a.

c.

Use of condom

 

2. blood a. asepsis b. screening of blood donors 3. Perinatal a. health education during AP clinic

 

IX. HERBAL AND PHIL. TRADITIONAL MEDICINE 10 HERBAL PLANTS RA No. 8423- Phil. Institute of Traditional and alternative Health Care ( PITACHC)  Mnemonics : BUBLY SANTA   BAWANG…………………….. Hypertension, Lowers Cholesterol Level. L evel. T Toothac oothache he  

 





ULASIMANG UL ASIMANG BA BATO TO (P (PANSIT-PANSITAN)….. ANSIT-PANSITAN)….. Lowers Uric Acid, Rheumatism   BAYABAS…………………….. Diarrhea, Wounds, Toothache 



LAGUNDI ……………………. Cough, Asthma, Fever 

 





 

 

 YERBA BUENA ……………... M Muscle uscle pain, Ar Arthritis, thritis, Rheumatism, Cough, Headache  SAMBONG …………………… Anti-edema, Anti-edema, Diuretic,  Anti- Urolithiasis Urolithiasis   AMPALA  AMP ALAY YA …………………. Diab Diabetes etes Mellitus  NIOG-NIOGAN………………. NIOGNIOGAN………………. Parasitism, Ascariasis, Parasitism, Ascariasis,  Anti-helmintic  TSAANG GUBAT …………… Stomachache, Diarrhea   AKAPULKO  AKAPULK O …………………. Scabies, A Anti nti-fungal, -fungal,  Athletes foot 



 

 

 X. PHILIPP PHILIPPINE INE NUTRI NUTRITION TION P PRO ROGRAM GRAM  A. Micronutrient supplementation component >> ( Vit. A. Iron, Iodine) > VADAG Program  Vit. A Deficiency, Deficiency, Anemia , goiter goiter  Vit A Deficiency – Deficiency – Retinol cap Iron deficiency deficiency ccontrol ontrol Prog.- FeSO4 Iodine deficiency Control Prog – Iodized salt (FIDEL)

 

B. Growth Monitoring > UFC > OPT ( Operation Timbang)- (0-5y/o) •

•

•

•

Normal – weight is between 91-100% 91-100% of ideal bod body  y   weight  weig ht ( IBW) IBW) 1st degree malnourished -76-90% of IBW  2nd degree malnourished – 61-76% of IBW  3rd degree malnourished -60% below of IBW  * 2nd and 3rd degree malnourishe mal nourished d are enrolled to TPAF TPAF ( Targeted Food Assistance Program)

 

XI. CARI/ ARI ( ACUTE ACUTE RESPIRATOR RESPIRATORY Y INFECTION)  A. Pneumonia mortality reduction B. Target group: Under five less than 2 months old ( young infants) 2 months to 5 years ( older children)

c. trends; 1. no cough preparation exemption: allergic allergic cough cough

pertussoid cough  

2. home h ome car caree 3. soothing throat rremedy emedy MCI)

 



 XII. NATIONAL NATIONAL FAMILY AMILY P PLANNING LANNING PROG PROGRAM RAM

 A. Goal : fertilityhealth reduction = family welfare= reproductive

> proper spacing > proper timing > fewer pregnancy  > special spec ial concern for those at risk b. Target : Married couples of Reproductive Age (

MCRA’s)   

c. Policies: > non- coercion > integration > need need for a multi- sectoral appr approach oach > need need for support of bot both h public and private sector > unacceptability of abortion d. FP Contrac Contraceptives eptives

 

Types of Birth Control      

Hormonal Barrier IUD Methods based on information Permanent sterilization

 

Hormonal Methods 

 

Oral Contraceptives Contraceptives (Birth Control Pill) Injections (Depo-Provera) Implants (Norplant I & II)

 

Birth Control Pills    

Pills can be be taken to prevent prevent pregnancy  Pills are safe and effective when taken properly  Pills are over 99% effective ef fective  Women  W omen must must hav havee a pap smear to get a prescrip prescription tion for birth control pills

 

How does the pill work?   

Stops ovulation Thins uterine lining Thickens cervical mucus mucus  

 

  Positive Benefits of Birth Control Pills  Prevents

pregnancy   Eases menstrual cramps  Shortens period  Regulates period

 Decreases

incidence inciden ce of  ovarian cysts  Prevents ovarian and uterine cancer  Decreases acne

 

Side-effects   

Breast tenderness Nausea Increase in headaches

  

Moodiness  Weight  W eight chang changee Spotting

 

Depo-Provera 

 

Birth control shot given once every three months mo nths to prevent pregnanc pregnancy  y  99.7% effective preventing pregnancy  No daily pills to remember

 

How does the shot work?   

Stops ovulation Stops menstrual cycles!! Thickens cervical mucus

 

SIDE EFFECTS 



Extremely irregular menstrual bleeding and spotting for 3-6 months!

NO PERIOD  after 3-6 months

 Weight  W eight change

  

Breast tenderness Mood change

*NOT EVERY EVERY WOMAN WOMAN HAS HAS SIDE-EFFECTS! SIDE-EFFECTS!  

IMPLANTS



Implants are placed in the body filled with hormone that prevents pregnancy  Physically inserted in simple 15 minute outpatient procedure Plastic capsules the size of paper matchsticks



inserted under under the skin in the arm 99.95% effectiveness effectiveness rate





 

Norplant I  

Six capsules Five years

vs.

Norplant II  

Two caps capsule uless Three years

 

Norplant Implant

 

Norplant Considerations   

Should be considered long term birth control Requires no upkeep   Extremely effective in pregnancy prevention > 99% 99 %

 

BARRIER METHODS    

Spermicides Male Condom Female Condom Diaphragm



Cervical Cap

 

BARRIER METHOD 



Prevents pregnancy blocks the egg and sperm from meeting Barrier methods meth ods have higher failure rrates ates than hormonal methods due to design and human error

 

SPERMICIDES Chemicals kill sperm in the vagina 



Different forms: - Jelly  Jelly





-Film -Foam -Suppository  Some work instantly instantly,, others others require preinsertion Only 76% effective (used alone), should be used in combination with another method i.e., condoms

 

MALE CONDOM •

•

Most common common and effective effective barrier method  when used properly  properly  Latex and Polyurethane should only be used in the prevention of pregnancy and spread of  STI’s (including HIV)  HIV) 

 

MALE CONDOM 

Perfect effectiveness rate = 97 97% %

  

T ypical effect effectiveness iveness ratecondoms = 88% are available Latex and polyurethane Combining condoms with spermicides raises effectiveness levels to 99%

 

FEMALE CONDOM  

Made as an alternative to male condoms

Polyurethane Physically inserted in the vagina Perfect rate = 95% Typical rate = 79%  Woman  W oman can use female female condom if partner refuses

   

 

DIAPRAGHM   

  

Perfect Effectiveness Rate = 94% Typical Effectiveness Rate = 80% Latex barrier placed inside vagina during intercourse Fitted by physician Spermicidal jelly before insertion Inserted up to 18 hours before intercourse and can be left in for a total of 24 hours

 

DIAPHRAGM

 

CERVICAL CAP     

 

Latex barrier inserted in vagina before intercourse “Caps” around cervix with suction  suction  Fill with spermicidal jelly prior to use Can be left in body for up to a total of 48 hours Must be left in place six hours after sexual intercourse Perfect effectiveness rate rate = 91% Typical effectiveness rate = 80%

 

INTRAUTERINE DEVICES (IUD) 

T-shaped T-shap ed object placed in the uterus to pr prevent event

pregnancy  Must be on period during insertion  A Natural Natural childbirth required required to use IUD

 





Extremely effective without using hormones > 97 % Must be in monogamous relationship

 

Copper T vs.. Progestasert   



10 years 99.2 % effective Copper on IUD acts as spermicide, IUD blocks egg from implanting Must check string before sex and after shedding of  uterine lining.

  





1 year 98% effective T shaped plastic that releases hormones over a one year time frame Thickens mucus, blocking egg Check string before sex & after shedding shedding of uterine lining.

 

STERILIZATION 

 

Procedure performed on a man or a woman permanently sterilizes Female = Tubal Tubal Ligation Male = Vasectomy 

 

TUBAL LIGATION  

 

Surgical procedure performed on a woman woman Fallopian are cut, tied, cauterized, prevents eggs fromtubes reaching sperm Failure rates vary by procedure, from 0.8 0.8%-3.7 %-3.7% % May experience heavier periods

 

VASECTOMY     

Male sterilization sterilization proc procedure edure Ligation of technique Vas Deferens tub tubee No-scalpel techni que available available Faster and easi easier er reco recovery very than a tubal lligation igation Failure rate rate = 0.1%, more effective than female sterilization

 

VASECTOMY

 

METHODS BASED ON INFORMATION    

 Withdrawal  Withdra wal Natural Family Planning Fertility Awareness Awareness Method  Abstinence

 

WITHDRAWAL 

 



Removal of penis from the vagina before ejaculation occurs NOT a sufficient method of birth control by itself  Effectiveness rate is 80% (very unpredictable in teens, wide variation)

1pregnant of 5 women practicing withdrawal become  Very  V ery difficult for a male to ‘contro control’l’



 

Natural Family Planning & Fertility Awareness Method  Women tak  Women takee a class on the menstrual cycle to calculate more more   fertile fertile times







  

Requires taught special equipment and cannot be selfNFP abstains from sex during the calculated fertile time FAM uses barrier methods during fertile time Perfect effectiveness rate = 91% Typical effectiveness rate = 75%



No 100% safe day-irregular periods

 

Abstinence  



Only 100% method of birth control  Abstinence is when partners do not engage in sexua sexuall intercourse Communication between partners is important for those practicing abstinence abst inence to be suc successful cessful

 

Reasons for abstaining    

Moral Mor al or religio religious us values Personal beliefs Medical reasons Not feeling ready for an emotional, intimate relationship



Future plans

 

SOMETHING TO THINK ABOUT… 

Couples who Couples who use no birth birth ccontrol ontrol havee a 85% chan hav chance ce of a pregnanc pregn ancyy with within in th thee ffirs irstt year. year.

 

 

 

  CLIENTELE IN

CH PRACTICE

FAMILY  1.

Definition group of persons: > united by ties of marriage, blood or adoption > single household unit > communicating with each other > common culture

 

3. Family nurse contact a. home visit b. clinic visit c. group group contact/ conference d. school or industrial contact

 

Homee Visit ( nursing Visit) Hom  A purposeful ,

pr professional ofessional nurse- cclient lient face-t face-to-fac o-facee interaction for the provision of various hea, as define defined d by the client’s needs  riorities:  1. P riorities: > pregnant, post-partum, newborn, morbid 2. Public health bag

> indespensable and essential equipment carried by  the nurse during home visit  

2. Health tasks a. recognizing interaction in health development b. making decisions about seeking health care c. providing nursing nursing care to the sick, disabled or dependent members of the family  d. maintaining maintaining an environment cconducive onducive to health e. maintaining a recripocal relationship with the

community 

 

Bag technique  Tool

by which the PHN performs procedure during home visit Steps involved in conducting a home visit a. The nurse nurse should prepare for a home visit b.  A home home visit is planned and and has a clear purpose and objective

c. The nurse nurse makes appointment for a home visit

 

Upon arrival: a. Extend courtesy through a greeting b. Introduce yourself  c. Perform nursing procedures

1. bag technique 2. health assessment 3. provide health teaching

d. Wash Wash hands thoroughly and arrange the equipmen equipmentt e. Document the findingg and the type of care rendered  

Clinic visit Phases: > pre-consultation ( assessment) > consultation(intervention) > post-consultation(evaluation) Group contact  contact  Types:

a. mother’s class  b. Community assemblt  

FAMIL AMILY Y HEALTH NU NURSI RSING: NG:  Is the level of community health h ealth practice that focuses on: a. family as the unit of care b. health as the goal c. nursing as the channel of care Levels of of FHNP a. Family as the ccontext ontext ( indivi individualdual- focus of nursing

care, family- secondary focus) b. Family as sum of its part – each member member is separate

rather an interacting system c. Family as the client ( focuses on the whole member) member)  

Family models 1. DEVELOPMENTAL MODEL by Evelyn Duvalll  8 Stages of Family Development Stage 1- Beginning family  

  

   



-Concern: -Conc ern: maritaladjustment & sexual adjustment, functional, communication, to roles, pre-natal educ. Stage 2- Early Childbearing Family  -Concern: Changing roles, parenting Stage 3- Families with preschool children -Concern: Child discipline, childbearing, accidents, poisoning, CD Stage 4- Families with school age age children



-Concern: Balancing Balancing time t ime & energy to meet demands of   wor  work, k, children children’ ’s needs & activities, activities, adults social interests, interests, harmony in marital & in-laws relations.

 

 



Stage 5- Families with teenagers -Concern: Open communication, continuing intimacy in marital relation, peer pressure, sex educ. Stage 6- Family as Launching Center





-Concern: Releasing children adults, interest, re-establishing marital dyad, identifying postas parental grandchildren, divorce/ separation, menopause Stage 7- Middle-Aged Families -Concern: -Conc ern: Rebuilding marriage & maintaining satisfying



relationship with aging children with their families, retirement plans, health,parents new career. Stage 8 – Aging Family ( retirement & old age) age)



Concern: Continuous maintenance of family relations, income changes changes & living livi ng arrangements physiologic aspects of aging, death of spouse.

 



8 Family Tasks Tasks or o r Basic Basi c Tasks Tasks of Developmental Model:      

  

Physical maintenance  Allocation of resour resourcesces- income giv given en to wife Division of labor – joint parenting Socialization of family members Reproduction, recruitment & release *Maintenance of order- high h igh crime rate fa mily’s success  Placement of members in larger society- Indication family’s Maintenance of motivation & morale

 

Criticisms: very limited & cannot apply to all situation  

 



2. STRUCTURAL-FUNCTIONAL MODEL ( Ruth Freeman, Baylon & Maglaya)  -deals with the health tasks of the family  6 health tasks: 1. Recognizing interruption in the health development’  2. Making decisions about seeking health care 3. Providing nursing nursing care to a sick, disabled, or dependent member of the family 

 

4. Maintain Maintain an environment conducive to health maintenance and personal development 5. Maintaining a reciprocal relationship with the community and health institution 6. Dealing effectively with health and non-health related problems

 

CATEGORIES CATEGORIE S OF OF FAMIL FAMILY Y HEALTH PROBLEM: Initial data base a. Family structure and characteristics

 

   

b. Socio- economic & cultural factors c. Environmental factors d. Health assessment of a member- PE e. Value Value placed on prevention of dis disease ease

 

 





First Level Assessment Health ThreatThreat - conditions conducive conducive to disease, accidents or failure to realize one’s one’s health health potential potentia l healthy people Ex. Family hx of illness- hereditary like DM, HPN  

   

nutritional problems- eating salty foods personal behavior- smoking, self-medication, sexual practices, drugs, excessive drinking inherent personality char- short sh ort temperedness, short attn span short cross infectx poor home env't. lack/inadequate immunization

 

hazards- fire, falls, or accidents family size beyond what resources can provide



 



Health Deficits- instances of failure in health

 

   



maintenance ( disease, disability, developmental lag)   3 Types Types:: a. Disease/ illness- URT URTI, I, marasmus, scabies, edema b. Disabilities- blindness, polio, color blindness, deafness c. Developmental Problems like mental retardation,



gigantism, hormonal, dwarfism  

 

3. Stress Points/ Foreseeable Crisis Situations anticipated periods of unusual demand on individual or family in terms of adjustment or 

 

family resources ( nature situations) Ex. Entrance in school 





adolescents (circumcision, menarche, puberty  courtship (falling in love, breaking up) marriage, pregnancy, abortion, puerperium



death, unemployment, transfer or relocation, graduation, board exam

 

mil 

Second Level L evel Assess Assessment ment (Family tasks involved) *Family tasks that can’t can’t be perfor performed med  Recognition of the problem

  



Decision on appropriate health action Care to affected fam family ily member Provision of healthy healthy home environment



Utilization of comm. resources for health care 

Family Health Nursing Diagnosis

 

Combination of health problems and health  

 

FAMILY COPING INDEX; a. Goal: estimate the nursing needs b. Nine coping areas

1. physical independence 2. therapeutic therapeutic competenc competencee 3. knowledge knowledge about health 4. application of principles princ iples on general general hygiene 5. health attitude 6. emotional emotiona l competence competence 7. family living

8. environment 9. physical use of community facilities  

: Drill questions the following are the health problems of the Cruz family, identified by nurse Cathy. Group them into health threat, health deficit and forseeable crisis . a. husband has been caring for his wife with  Alzhemer’s diseas diseasee for 3 yyears ears b. unimmunized 1 y/o c. bulimia d. wandering

 

e. presence of a marble- sized mass in the breast f. a 14y/o boy with pimples g. the whole family migrated from Basilan to Manila h. Ji Jim m is training to become a professional boxer i. alterations in perception

 

 Ans: HT = ABH HD=ACDEFJ FC=FG

 

Maglaya defines def ines second llevel evel assessmen assessmentt as a nursing assessment that looks into the family’s ability to perform its health heal th tasks for the health cconditions onditions// problems identified. Identify the family nursing problems from the cues provided. 1. According According to her daughter daughter,, Mrs. Santilla Santillan, n, 60 y/o has the bad habit of bringing food to the bedroom, and  just putting them under her bed aafterwa fterwards. rds. One time she leftthe left thefridge. faucetThese open placed the h house keys on inside The se and inciden incidents ts when commented couse ommented always led to a fight. The children decided tthat hat to

avoid fights avoid f ights with he herr, th they ey will ju just st let he herr do what she  wants to do do.. An Anyway yway,, they reasoned out, she is still healthy and strong.  

Inability Inabili ty to rrecognized ecognized tthe he presence of a condition/ problem

 

2 . Mrs. Santi Santillan llan husband husba nd who is 15 years senior, senior, had a mild stroke a few months ago.their only daughter who lives with them has a fullful l- time job that keeps h her er aaway  way  from home at least 12 hours from Monday to Saturday. Their two other children are living with with their fami family ly in the city, city, 2 1/2 hour hourss away away.. Left Left with the couple is a newly hired domestic helper in her mid-20’s. 

 

Inability Inabili ty to pr provide ovide adequate nursing care to the sick, disabled, dependent or vulnerable/ at-r disabled, at-risk isk member member of  the family 

 

3. Six Six months after Mr. Mr. santillan santil lan had his stroke, he still has to have have check-up with his neurologi neurologist. st. He has not consulted at the center which is resi residence. dence. The municipal health officer and the public health nurse are both trained in caring for people with lifestyle related relat ed diseases

 

Failure to utilize community resources for health care

 

NURSING PROCESS IN CH PRACTICE 

STEPS: 1. Relating – establishment of a working relationship with the family, family, establish establ ish rapport. Establishment Establish ment of mutual trust and confidence. a. initiating contact b. two-way communication c. sincerity and concern

2. Assessments – output of a problem - problem identification

 

 A. Collection Collection of data – most important step in assessment

Levels of level assessment 1. First assessment Goal:: To identif Goal identifyy the problem of family (HT, (HT, HD HD,, FC) Tool: Typology ypolog y of nursing problem/ initial database/ database/ family Data base Components:

1. Family Structure and characteristics >demographic data of the family  >rest and sleep pattern >diet and nutrition  

2. Socio-economic and cultural factors of the family  >occupation >income/expenses >educational attainment >religion >customs, beliefs, norms, etc. 3. Environmental factors

>water supply  >excreta disposal >garbage disposal  

  4. Medical and health history  >common illnesses >health resources >preventive measures >perception of the roles of health professionals 2. Second level assessment Goal: – determines the th e extent to which the family is

able to perform the different health task Tool: - family fam ily coping coping index

 

B. Analysis and interpretation of data C. Problem identification 1. Health problem – situation which interferes in the promotion andillness on maintenance heal th and recovery from and injury. of health 2. Nursing problem – when a health problem is modified thru nursing intervention. D. Setting priorities: Criteria: 1. Nature of the problem:

H.D. – 1st priority  nd

H.T. priority  S.P. ––32rd priority   

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2. Modifiab Modifiability ility of the problem – probability of success in minimizing , alleviating al leviating or totally er eradicating adicating th thee problem. 3. Preventive potential – possibilit possibilityy of avoiding the of the problem. 4. Salience – family’s perception of the problem  - urgency of attention needed

 

3. Planning – FNCP

a. problem identification b. setting goals and objectives – set direction for the plan = SMART c. develop plan of action / activities / intervention d. plan of evaluation

> evaluate evaluate effectiv effectiveness, eness, eeffi fficiency ciency,, appropriateness and adequacy 

 

4. Implementation

> process of carrying out plan of action 5. Evaluation > phase which determine whether the objective have have been attained or not

 

Drill questions: The goal of the first level assessment is_______ The tool use in first level assessment is _______

 

goal- to identify identif y health problems of the family ( HT.H HT.H D. FC) tool: typology of nursing problem

 

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The inability inabil ity of the family to perform its heal health th task is _____

 

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Family nursing p problem roblem

 

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Goal of the 2nd level assessment is_________

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Tool use in the 2nd level assessment is ___________

 

goal: determines extent to which the family is able to perform the different health task tool: family coping index ( health problem)

 

COMMUNITY  I. Community Organization ( CO) > stimulating stimulating the people to w work ork together a. gaining entry- gaining acceptance by the community  > courtesy call b. integration- “ immersion “ – living with the community,, and iimbibing community mbibing with the community  lifestyle c. community diagnosis

d. core group formation- selection of key leaders in the community  e. organizational structure  

II. Community Communit y Care  A. Community Assessment > finding f inding out what has been done and what needs to be done * Community survey  a. Definition: > process of gathering information about the population and its environment b. types of survey  sur vey 

> ocular survey  > block survey  > random survey   

B. community community Diagnos Diagnosis is > deep study / analysis of the community  community  1. data collection collection ( su survey) rvey) 2. data collation ( tabulation) 3. data presentation ( tables/ graphs) 4. analysis and interpretation of data C. Program Planning 1. problem identification / prioritization

2. set goals and objectives > general- ultimate or long range goal > specific – immediate or short term goal  

 

 

SICK CLIENTELE I.

Natural history of disease a. definition > course taken by disease from beginning to end b. ecologic triad 1. agent – infectious substance subst ance and its toxic products factors: > type ( bacteria, viruses0

> characteristic ( aerobic, unaerobic) >dose ( number numbe r or amount of living livi ng organism) > virulence ( strenght)

 

  2. host – living body body which harbors and causes the multiplication of infectious substances - source of infection ( reservoir)  A. types: types: a. frank/ typical/ typic al/ severe case - obviously ill

 

b. sub-clinical case - cases with mild mild or with no symptoms at all - missed / abortive cases - ambulatory  c. carrier - harbors the organism but not the

disease - most dangerous sourc sourcee

 

B. factors a. resistance b. immunity  c. environment 3. Stages a. pre-pathogenesis /

> “ no –illness” stage 

> no signs and symptoms * Primary Prevention  

a. health promotion b. specific protection 2. Pathogenesis stage > “ illness stage”  stage”  > with signs and symptoms * Secondary Prevention

a. early diagnosis and prompt treatment * Tertiary prevention a. disability limitation  

 

II . EPIDEMIOLOGY        

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

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 when.    

 

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Basic Concepts:   Epidemiologic Epidemi ologic Triad: Agent- H Hostost- env't Transmissi ransmission on of CD: Common vehicle, sourc sourcee- serial- tr transferansferpropagated from host to host Incubation period: Entry of pathogens w/ enough infections st

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load up to appearance 1 s/sxpop- some indiv are Herd, Immunity Immunity: : %ofofthe immune immune

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 Arthropod

Dengue- aedes – daytime Malaria – anopheles- nighttime

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C L

E As

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Types of Immunit Immunity: y:    1. Passive: Quick to come, quick to go Natural- in water, water, breast feeding feeding

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antitoxin

Artificial- serum globulin, antiserum,

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2. Active: Slow to come, slow to go Natural activeactive- getting the dse its itself  elf  Artificial- tetanus toxoid

 

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Factors Affecting Distribution of Disease:  1. Person- exposure, exposure, susceptibility suscepti bility or rresponse esponse to agents. - Inf luenced by intrinsic characteristic characteristic - Genetic/ family, prior immunologic experience - Age, sex, ethnic grp, physiologic status - Human behavior---most significant---can be modified Some identified increase risk grps. - Mothers, infants, and young children - School children, old people, contacts

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- People far from medical assistance - People in areas with endemic dse - People at certain times  

 

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2. Place - Extrinsic factors, existence of etiologic factors & exposure & susceptibility of human host, influenced inf luenced by extrinsic factors.

3. Time - Temporal Temporal patterns- fluctuations f luctuations of incidence incidence a. Short term- fluctuations - Time of day 

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- Days of the t he week

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b. Cyclic pattern- regular regul ar pattern Seasonal cycli c yclicity  city –– annual cyclicity  Secular cyclicity – cyclicity – every other year year typhoid, measles

 

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Patterns of Disease Occurrence:  

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Epidemic

- A situation when there is a high incidence of new new cases of a specific specif ic dse in excess of the expected. - When the proportion of the susceptible are high compared to the proportion of the immunes.   dis eases that you don’ don’tt know  Ex. 20-30 diseases

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Current number of cases exceeds exceeds the usua usuall expectancy.  

 

Endemic 

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- Habitual Habitual presence of a disease iin n a given geographic geographic location accounting accounting for the low number

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of both immunes & susceptible. - Causative factor is constantly available available or

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present to the area Ex. Malaria, constant 

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Sporadic

- Disease Disease occurs ev every ery now & the then n affecting only a

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small number of people relative to the total pop - Intermittent - On & off 

 

Pandemic 

- Global occurrence of a disease, bigger population