Community Health nursing Board Exam

The College of Maasin Nisi Dominus Frustra College of Nursing Maasin City, Southern Leyte

SUPPLEMENTAL REVIEW KEY POINTS IN COMMUNITY HEALTH NURSING (Prepared by Rhenier S. Ilado RN) Some test taking techniques: A-ssimilate A-ssimi late essential essentia l principles in the care of patients in the community These principles may include: 1. have a purpose or objective when conducting c onducting home visit 2. plan ahead 3. priority should be given to the recognized needs of the family 4. there is no definite rule as to the frequency of a home visit 5. freq freque uenc ncyy of home home visi visitt shou should ld take take into into acco accoun unt, t, the the phys physic ical al,, psychological and educational needs of the individual and family 6. the initial step in conducting a home visit is to GREET the client and introduce yourself 7. soiled articles with discharge should be boiled in water 30 minutes before laundering B- ag Techni Tec hnique que - steps which are carried out by the nurse to facilitate the performance of nursing procedures with ease and deafness Remember the : Bag and its contents must be protected from any possible contamination Always wash your hands to prevent the spread of infection Gather all necessary articles and supplies to answer emergency needs blood d pres pressu sure re appa appara ratu tuss and and stet stetho hosc scop ope e are are carr carrie ied d Note: bloo separately

Consider the following principles: 1. prevention of contamination Note: place waste paper bag outside the work areas 2. protection of the caregiver Note: clean and alcoholize all articles after use 3. make articles readily accessible Note: place the articles in one corner of the work area 4. make follow-up care Note: set the date and time for the next visit

C- ommunity Based Rehabilitation Program the the goal goal of this this prog progra ram m is the the impr improv ovem emen entt of quali quality ty of life life and and productivity of disabled persons R.A 7277, Magna Carta for Disabled Persons, serves as the legal basis of the program The compon component entss of the progra program m includ include: e: social social prepar preparati ations ons,, servic services es prepar preparati ation, on, traini training, ng, informa informatio tion, n, educat education ion and commun communicat ication ion and monitoring, supervision and evaluation The VISION of the Department of Health is: health for all Filipinos The MISSION of the Department of Health is: Ensure accessibility of health care to improve the quality of life of all Filipinos especially the poor The basic principles to achieve improvement in health include: E – nsure universal access to basic health services E – pidemiological shift from infectious to degenerative disease must be managed E – nhance the performance of health sector E – nsure the priotization of health and an d nutrition of vulnerable groups The primary strategies to achieve health goals include: S – uppo upport rt for front rontlline ine he heaalth lth worke orkers rs and and to loca locall syste ystem m development A – ssurance of health care I – ncreasing investment for primary health care c are D – evelopment of national standard and objectives for health Primary health Care (PHC), according to the World Health organization  is an essential health care made universally accessible to individuals and  families in the community by means acceptable to them through their full  participation and at a cost that the community and country can afford at  every stage of development  The goal of PHC is health for all Filipinos and Health in the hands of the people by the year 2020 Letter of instruction (LOI) 949 (October 19, 1979) is the legal basis of PHC The first international conference on primary health care was held in Alma, Ata, USSR on September 6-12, 1978 sponsored by the WHO and UNICEF The Th e fram frame ewo work rk for for mee eeti ting ng the the goal goal of prima rimary ry he heal alth th car care is orga organi niza zati tion onal al stra strate tegy gy,, it calls calls for for amon amongg commu communit nitie ies, s, priv privat ate e and government agencies with the end view of health development The four cornerstone/pillars in primary health care includes: care includes: 1. active community participation 2. intra and inter sectoral linkages 3. use of appropriate technology 4. support mechanism made available The expanded program on immunization aims to reduce the morbidity and mortality among infants and children caused by the six childhood immunizable diseases. It was launched in July Jul y 1976. •

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(Septe temb mber er 16, 16, 1976 1976)) prov provid ides es for for comp compul ulso sory ry basi basicc P.D. P.D. 996 996 (Sep immu immuniz nizat atio ionn for for infa infants nts and child childre renn belo below w 8 year yearss of age. age. Th The e EPI EPI program is based on epidemiological situations. Presidential proclamation no. 147 (March 3, 1993) declares April 21 and May 19, 1993 and every third Wednesday of January and February thereafter for two years as National Immunization Days. R.A. 7846 (December 30, 1994) requires compulsory immunization against hepatitis B for infants and children below 8 years old the ultimate goal of promotion of reproductive health is “ QUALITY OF The e focu focuss of the the Phil Philip ippi pine ne fram frame ewo work rk of the the pro program gram is LIFE”. Th Reproductive Health status in terms of, its elements. The ten elements of Reproductive Health includes: 1. maternal and child health and nutrition 2. family planning 3. prevention and management of abortion complications 4. prevention and treatment of reproductive tract infection (RTI’s) including STD’s, HIV and AIDS 5. education and counseling on sexuality and sexual health 6. breast breast and reprod reproducti uctive ve tract tract cancers cancers and other other gyneco gynecolog logical ical conditions 7. men’s reproductive health 8. violence against women 9. prevention and treatment of infertility and sexual disorders 10. adolescent reproductive the the goal goal of the the 2000 2000 Nut Nutriti rition onal al Guid Guidan ance ce for for Fil Filipin ipinoos is the the improvement of nutritional status, productivity and quality of life of the population through adoption of desirable dietary practices and healthy lifest lifestyle yle.. An exampl example e is the exclus exclusive ive breas breastfe tfeedi eding ng of infants infants from birth to 4-6 months and the use of iodized salt. The use of fluoride in the prevention of tooth decay is carried out by making four application of fluoride about a week apart among children who are aged 3, 7, 10 and 13 because at these ages new teeth have erupted The goal for health care and services for older persons is to provide a longer disability-free life. This is carried out through a holistic care approach To reduce the blindness prevalence rate in the Philippines, the prevention of blindness program was conceived. It is subdivided into four programs namely, cataract program, primary eye care, c are, vitamin A deficiency program and other eye care program The goals of the mental health program include: promotion of mental health, decreased health-related effects of stressful lifestyle and reduct reduction ion of prevale prevalence nce of mental mental ill health health and disord disorders ers in the Philippines The Sentrong sigla movement aims to promote availability of quality heal he alth th serv service icess in he heal alth th cent center erss and and hosp hospit ital alss and and to make make thes these e services accessible to every Filipino •

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“Sang Milyong Sepilyo ” is a strategy for social mobilization of Dental health program. It aims to emphasize the importance of oral health in rela relati tion on to tota totall body body he heal alth th to incr increa ease se publ public ic awar awaren enes esss on the the prevention of common dental diseases D- OH PROGRAMS DOH-

ental health Program steoporosis prevention ealth education and Community Organization

PROGRAMS-

rimary Health Care eproductive health lder Persons health lth Services uidelines nes for Good Nutrition espir piratory Infection cont contrrol ccupressures aternal and Child care entrong Sigla Movement

E- pidemiology

System Systemati aticc and scient scientifi ificc study study of the distri distribut bution ion patter patterns ns and determ determinan inants ts of health, health, diseas disease e and conditi condition on for the purpos purpose e of promoting wellness and preventing disease conditions Basic concepts that guide epidemiological study include: biostatistics, aggregate at risk, the natural life history of a disease, levels of prevention, host-agent-environment relationships, multiple causation, person-place-time-relationships When monitoring incidence of infectious disease, the term used to distinguish relative frequency in time and space include the following: Sporadic – presence of occasional cases of the disease Endemic – constant long-term presence of the disease Epidemic – presence of the disease at a much higher frequency over a short period of time Pandemic – presence of a disease in many countries in a relatively short period of time Effective implementation of the epidemiological process requires a multi disciplinary approach A community health nurse must apply the principles of epidemiology in order to provide preventive services to the community Community Community health health nurses nurses participate participate in may epidemiolo epidemiological gical activities like: case finding, health teaching, counseling and follow up essential to the prevention of diseases and other conditions •

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F- ormulas for Mortality and Morbidity Statistics CRUDE BIRTH RATE (CBR) – a measure of one characteristics of the natural growth or increase of a population

CBR= total number of live births registered in a given calendar year x 1000 Estimated population as July 1 of same year CRUDE DEATH RATE (CDR) – a measure of one mortality from all causes which may result in a decrease of population

CDR= total number of deaths registered in a given calendar year x 1000 Estimated population as of July 1 of same year INFANT MORTALITY RATE (IMR) –measure the risk of dying during the 1st year if life

IMR= total number of deaths under 1 year of age registered in a given calendar calend ar year x 1000 total number of registered live births of same calendar year

MATERNAL MORTALITY RATE (MMR) – it measures the risk of dying from causes related to pregnancy, childbirth and puerperum

MMR= total number of deaths from maternal causes c auses registered For a given give n year yea r x 1000 100 0 total number of live births registered of same year INCIDENCE INCIDENCE RATE (IR) –measures the frequency of occurrence of the phenomenon during a given period of time. Deals only with new cases

IR= no of new cases of a particular disease registered During a specified specif ied period of time Estimated population as of July of same year

x 100, 000

PREVALENCE RATE (PR) –measures the proportion of the population which exhibits a particular disease at a particular time. Deals with total (old and new) number cases

PR= no of new and old cases of a certain disease registered At a given give n time x 100 Total no of persons examined at same year given time

K- ey Points to EPI •

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A fully immunized immunized child should have received one (1) dose of BCG, three (3) doses of DPT, three (3) doses of OP, three (3) doses of hepatitis B and one (1) dose of measles, before the child’s birthday Modera Moderate te fever, fever, malnut malnutrit rition ion,, mild mild respir respirato atory ry infect infection ion,, cough, cough, diarrhea and vomiting are not contraindications to vaccination vacc ination DPT2 or DPT3 is not given to a child who has had convulsion or shock within 3 days of the pervious dose BCG vaccine is not given to a child with clinical AIDS Measles and polio vaccines are most sensitive to heat

Vaccine

ADMNISTRATION OF VACCINES Dose Route of Site of Administration administration

BCG

Infant-

DPT, HEPATITIS B POLIO

MEASLES TETANUS TOXOID

School entrance0.5 ML

Intradermal

Right deltoid region of the arm

age Intradermal

Left deltoid region of the arm Upper, outer portion of the thigh Mouth

Intramuscular

2 drops, or Oral depending on manufacturer’s instructions 0.5 ml Subcutaneous 0.5 ml

Deep Intramuscular

Outer Part of the Upper arm Deltoid region of the upper arm

K- ey Points in Vaccine Administration •

BCG- lay the syringe and needle almost flat along the child’s arm - if the vaccine is injected correctly into the skin, a flat wheal with the surface pitted like an orange peer will appear at the injection site

OPV – if necessary open the child’s mouth by squeezing the cheeks gently between your fingers to make lips point upwards - put drops of vaccine straight from the dropper onto the child’s tongue but do not let the dropper touch the child’s tongue - if the child spit out the vaccine, give another dose

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HEPA and DPT  – the best injection site is the outer part of the child’s midthigh - ask the mother of the child to hold the child’s legs MEASLES –the best injection site is on the outer side of the upper arm TETANUS TOXOID –the best injection site for a woman is the outer side of the left upper arm

Vaccine Dose TT1 TT2 TT3 TT4 TT5

Timing of Vaccination 5-6 months of pregnancy 1 month/ 4 weeks after TT1 at least 6 months later at least 1 year later at least 1 year later

Note: TT1 gives initial protection, TT2 provides 3 years protection for the mother, TT3 provides 5 years protection, TT4 provides 10 years protection and TT5 provides lifetime protection of the mother

M- edicinal Plants Herbal Plant

Use/s

Akapulko

Anti-fungal

Ampalaya

Diabetes Mellitus

Bawang

H ypertension (to lower cholesterol levels in the blood)

oothache T oothache Remember: BawHaT (Bawang for Hypertension, toothache) Bayabas/ Guavas Diarrhea Washing of wounds Gargle to relieve toothache Lagundi S-kin diseases H-eadache A-sthma, cough and fever R-heumatism, sprain, insect bites E-czema D ysentery

Niyug-niyogan Sambong Diuretic Anti-urolithiasis

Anti helminthic Anti-edema

Tsaang Gubat Stomach ache saang gubat T saang Diarrhea

Remember:

Yerba Buena S-wollen gums P-ain I-nsect bites -oothache T -oothache M-enstrual and gas pain A-rthritis N-ausea and fainting D-iarrhea Ulasimang bato Uric acid excretion (pansit pansitan) Remember: Ulasimang bato, uric acid REVIEW BULLETS FOR CHN •

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Acupressure - traditional Chinese medicine believes that life is the result of QI or life energy - when there is an imbalance of YIN and YANG forces, there is illness - YIN is the yielding negative negative and feminine force: YIN principle: give Chinese cold deserts after surgery - Yang is the dominating, positive and an d masculine force - posture: lying down or sitting up -foods to avoid; iced food/drinks, sour food, alcohol drink, pepper and spices, seafood, peanuts, salty foods - TSUN measurement- method of locating points in the body using the patient’s own hands or fingers as a base for measurement - contraindications: pregnancy, full stomach and cardiac illness Acupuncture - stimulating specific anatomic points called HSUEH - goal: manipulation of energy flow throughout the body following as thorough assessment by a practitioner - indication: acute and chronic pain and motion disabilities - contraindications: pregnancy, hemophlia, acute CVD Aromatherapy

- based on olfactory stimuli used to help balance the DOSHAS, the mediators between physiologic and psychologic process - done often at night to induce sleep - use of essential oils of plants p lants to treat symptoms Bag Technique - a tool tool making making use of the publi publicc health health bag throug through h which the nurse nurse during the visit can perform nursing procedures with ease and deftness, saving time and effort at the end in view of rendering effective nursing care - PUBLIC HEALTH BAG –essential and indispensable equipment of the public health nurse - principles : shou should ld mini minimi mize ze if not not tota totall llyy prev preven entt the the spre spread ad of infection: should save time and effort - special consideration : hand washing - cont appara ratu tuss and and stet stetho hosc scop ope e are are carr carrie ied d conten entt of the the bag: bag: Bp appa separately; medicines also include – betadine, 70% alcohol, benedict’s solution - place waste paper bag outside of work area to prevent contamination of clean area •

Sample Questions: 1. this is the tool trough which the nurse, during home visit can perform nursing procedures with ease and deftness, saving time and effort with the end of view of rendering effective nursing care: a. public health bag b. bag technique c. home visit d. all of the above 2 the public health bag contains basic medications and articles which are nece necess ssar aryy for for givi giving ng care care duri during ng home home visi visits ts.. Its Its cont conten ents ts are are he following EXCEPT: a. soap, adhesive plaster and tape measure b. betadine, acetic acid and benedict’s solution c. surgical scissors and forceps d. stethoscope and sphygmomanometer

CARE OF THE OLDER PERSON - first cause of morbidity among the 50+ years old: influenza - top cause of mortality among the 60+ years old: Diseases of the heart - common health problems: difficulty in walking, difficulty in chewing, impaired vision in at least one eye, hearing problem - goal: “A longer disability free life’ - Resolution 46: the UN principle for older persons to add life to years that have been added to life

COMMUNITY HEALTH NURSING : - Goal: promotion of the client’s optimum level of functioning through teaching and delivery of care - Philosophy: based on the worth and dignity of man - the primary focus of CHN practice is HEALTH PROMOTION - community health nurse are generalists in terms of their practice - family is the unit of service - HEALTH TEACHING is the primary responsibility of the community health nurse Sample Question: 1. the the key role role for for the the com communi munity ty he heal alth th nur nurse in deali ealing ng with ith communities is to: a. make sure that people in the community are empowered and able to participate b. provide incentives for community members to follow the protocols of any study or drug trial c. establish project teams that will collect and analyze data d. closely direct community members so that the community assessments are done appropriately CHN ROLES OF THE NURSE: - Clinician: focus on the health of individuals in the larger context of the community - Advocate: advocates self-care, people’s ability to be active participants in their own health, and self-determination, the right to make their own decisions - Collaborator: brin brings gs toge togeth ther er stre streng ngth thss and reso resour urces ces of pe peop ople le involved toward a common goal - Counselor; ke keyy task taskss inclu include de list listen enin ingg and prov provid iding ing feed feedba back ck and and information - Educator: provides skills, knowledge and attitudes that the people need to make appropriate choices or decisions  _  Hospice care: providing care skills in a home or other setting and balancing the client’s needs Sample questions: 1. the the comm commun unit ityy he heal alth th nurse nurse acting acting in the the role role of clini clinicia ciann wo woul uld d be more likely to: a. work to participate the special needs of a population such as homeless people b. focus on reducing the incidence of disease in a population c. addr addres esss the the spir spirit itua uall need needss of a grou groupp with withou outt pe perf rfor ormi ming ng any any screening or treatment d. coordinate the various components of care to different areas of thr health system

2. the CHN acting in the role of advocate would be most likely to promote; a. self-care and self-determination for the population b. telling the people in a community that the medical experts know what is best for them c. smoking cessation d. that health care options should be pursued without the influence of friends or families 3. which of the following is not a role for the community health nurse providing hospice or end of life care? a. providing resources for caregivers to prevent burnout b. ensuring that the client is given every reasonable chance to extend life and is encouraged not to give up too easily c. working as part of a multidisciplinary team to meet client’s, family and community needs d. promoting and coordinating palliative care and an d services COMMUNITY ASSESSMENT: ASSESSMENT: - process of examining the community in collaboration with the community members to develop strategies that improve health and quality of life for the community - community competence refers to the community’s ability to identify needs, achieve working consequence and agree and work together to meet goals - three dimensions include: status, structure and process p rocess - status status-- inform informati ation on about about morbid morbidity ity and mortal mortality ity,, life life exp expect ectancy ancy,, crime rates and education - structure – socioeconomic, age, gender, resources - process – how the community operates and functions as a whole Sample questions: 1. a community is best described as: a. people living in the same place b. organizations, family groups and friend groups that interact c. groups that have common c ommon interest or needs d. all of the above 2. a community that is described as having community competence has which of the following characteristics? a. the ability to perform their own cross-sectional epidemiological studies b. the ability to delegate any community processes to an outside expert such as community health nurse c. the ability to identify their own needs, achieve consensus, plan and implement goals d. the ability to predict morbidity and mortality rates for the population 3. all of the following are part of the community assessment process, EXCEPT: a. identifying available resources such as time, money and team skills

b. collecting and analyzing information c. withholdi withholding ng results results from the community until they can be statisticall statisticallyy confirmed, to avoid alarming people d. setting action priorities based on the needs of the community and available resources 4. a valid way to collect data for a community assessment is: a. using a library database for literative review b. reading government documents to find out about previous data c. usin usingg surv survey eyss or ques questi tion onna nair ires es to gath gather er info inform rmat atio ionn from from the the community members d. all of the above CHN CLINIC VISIT: - PRE-CONSUATION VISIT : clinical history taking, vital sings, physical assessments, laboratory exams and documentation - MEDICAL EXAMINATION : ensure privacy, safety and comfort of the patient throughout procedure - POST-CONSULATION : ex expl plai ainn find finding ingss and need needed ed care, care, refe referr as needed, make appointment for nest clinic/ home visit

Sample questions: 1. during clinic visits, all of the following are done in the consultation conference, EXCEPT: a. take clinical history after greeting and making client at ease b. refer client to other related staff or agency if necessary c. take temperature, BP, height and weight d. perform physical assessment and selective laboratory l aboratory examination COMMUNITY ORGANIZING: - a continuous of awareness building, organizing and mobilizing mobilizing community members towards community development - phases of activities: PRE-ENTRY - preparation of the staff - site selection ENTRY PHASE – integration with the community - courtesy calls, information campaigns, identification of potential leaders CORE-GROUP FORMATION AND MOBILIZING  - integration with the core group ORGANIZATIO- BUILDING  - organizing barrio health committee, setting up the community organization CONSOLIDATION AND EXPANSION PHASE  - netw networ orki king ng and and esta establ blis ishi hing ng linka linkage ges, s, imple impleme ment ntat atio ionn of livelihood-projects and developing secondary leaders Sample questions;

1. one of the primary tasks of the community health nurses during the pre-entry phase is the selection of the barangay to become the initial site for their organizing efforts. The following are the steps in the selection of the project site by the team, EXCEPT: a. developing criteria for site selection b. identifying potential barangays and choosing the final project village c. identification of potential leaders d. identification of the host family 2. it is during this period that one member of the team formed was given the ole of a community organizer: a. organizing-building phase b. core stoup formation phase c. consolidation phase d. expansion phase 3. for potential potential leaders leaders to perform perform their roles roles effectively effectively,, they have to possess certain characteristics. Among these are the following, EXCEPT: a. they must belong to the poor sector b. they must be respected members of the community c. preferably informal leaders d. formal leaders with many community responsibilities 4. this phase signals the start of community self-management of any development program: a. consolidation and expansion phase b. core group formation c. entry phase d. organization building phase 5. under this phase of the education and training process, the conduct of training, monitoring and documentation of training are included in: a. implementation phase b. planning phase c. evaluation phase d. post-training phase DENTAL HEALTH PROGRAM: ifetim ime e oral ral he heal alth th and and no toot tooth h decay ecay for for the the nest nest - vision : a lifet generations -objective : to prevent and control dental diseases and conditions - “Sang milyong Sepilyo”- project for social mobilization of dental health program DEPARTMENT OF HEALTH: - Vision: health for all filipinos - mission: enhance accessibility and quality of health care to improve the quality of life of all Filipinos, especially the poor - basic principles to achieve improvement of health  1. ensured universal access to basic health services 2. health and nutrition of vulnerable groups must be prioritized

3. epidemiological shift from infection to degenerative diseases must be managed 4. performance of the health sector must be enhanced enhanc ed - primary strategies:  1. assurance of health care 2. increased investment for primary health care 3. development of national standards and objectives for health 4. support to local health system development and frontline health workers Sample questions: Situat Situation ion:: the dep depart artmen mentt of health health formul formulate ated d plan, plan, progra programs ms and projects with the vision, “health for all Filpinos’ 1. which of the following is the mission of the department of health? a. promote healthy lifestyle b. ensure accessibility and quality of health care c. reduce morbidity and mortality d. improve general health status of the people 2. which of the following is not a basic principle in the achievement of improved health? a. health and nutrition priorities b. universal access to health service c. enhancement of performance of health sector d. investment for primary health care 3. which of the following is not a primary strategies to achieve health goals? a. support of local health system b. development of national standards for health c. assurance of health care for all d. funding from non-government organization