Nurse Deployment Program(ndp) Examination Notes 6s246j

CONTENTS OUTLINE Bag Technique Breastfeeding or Lactation Management Education Training Communicable Disease (Vector Borne) Communicable Diseases (Chronic) Control of Acute Respiratory Infections (CARI) Control of Diarrheal Diseases (CDD) Expanded Program for Immunization (EPI) Herbal Medicine Plants Approved by the DOH Integrated Management of Childhood Illnesses (IMCI) Management of a Child with an Ear Problem Maternal and Child Health Nursing Program Non-Communicable Diseases and Rehabilitation Family Planning Program

Bag Technique Definition Bag technique-a tool making use of public health bag through which the nurse, during his/her home visit, can perform nursing procedures with ease and deftness, saving time and effort with the end in view of rendering effective nursing care. Public health bag – is an essential and indispensable equipment of the public health nurse which he/she has to carry along when he/she goes out home visiting. It contains basic medications and articles which are necessary for giving care.

Rationale To render effective nursing care to clients and /or of the family during home visit.

Principles The use of the bag technique should minimize if not totally prevent the spread of infection from individuals to families, hence, to the community. 2. Bag technique should save time and effort on the part of the nurse in the performance of nursing procedures. 3. Bag technique should not overshadow concern for the patient rather should show the effectiveness of total care given to an individual or family. 4. Bag technique can be performed in a variety of ways depending upon agency policies, actual home situation, etc., as long as principles of avoiding transfer of infection is carried out. 1.

1. 2. 3. 4. 5. 6.

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Special Considerations in the Use of the Bag The bag should contain all necessary articles, supplies and equipment which may be used to answer emergency needs. The bag and its contents should be cleaned as often as possible, supplies replaced and ready for use at any time. The bag and its contents should be well protected from with any article in the home of the patients. Consider the bag and it’s contents clean and /or sterile while any article belonging to the patient as dirty and contaminated. The arrangement of the contents of the bag should be the one most convenient to the to facilitate the efficiency and avoid confusion. Hand washing is done as frequently as the situation calls for, helps in minimizing or avoiding contamination of the bag and its contents. The bag when used for a communicable case should be thoroughly cleaned and disinfected before keeping and re-using. Contents of the Bag Paper lining Extra paper for making bag for waste materials (paper bag) Plastic linen/lining Apron Hand towel in plastic bag Soap in soap dish Thermometers in case [one oral and rectal] 2 pairs of scissors [1 surgical and 1 bandage] 2 pairs of forceps [ curved and straight] Syringes [5 ml and 2 ml]

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Hypodermic needles g. 19, 22, 23, 25 Sterile dressings [OS, C.B] Sterile Cord Tie Adhesive Plaster Dressing [OS, cotton ball] Alcohol lamp Tape Measure Baby’s scale 1 pair of rubber gloves 2 test tubes Test tube holder Medicines betadine 70% alcohol ophthalmic ointment (antibiotic) zephiran solution hydrogen peroxide spirit of ammonia acetic acid benedict’s solution Note: Blood Pressure Apparatus and Stethoscope are carried separately.

Steps/Procedures Actions

Rationale

1. Upon arriving at the client’s home, place the bag on the table or any flat surface lined with paper lining, clean side out (folded part touching the table). Put the bag’s handles or strap beneath the bag.

To protect the bag from contamination.

2. Ask for a basin of water and a glass of water if faucet is not available. Place these outside the work area.

To be used for handwashing. To protect the work field from being wet.

3. Open the bag, take the linen/plastic lining and spread over work field or area. The paper lining, clean side out (folded part out).

To make a non-contaminated work field or area.

4. Take out hand towel, soap dish and apron and the place them at one corner of the work area (within the confines of the linen/plastic lining).

To prepare for handwashing.

5. Do handwashing. Wipe, dry with towel. Leave the plastic wrappers of the towel in a soap dish in the bag.

Handwashing prevents possible infection from one care provid to the client.

6. Put on apron right side out and wrong side with crease touching the body, sliding the head into

To protect the nurses’ uniform. Keeping the crease creates

the neck strap. Neatly tie the straps at the back.

aesthetic appearance.

7. Put out things most needed for the specific case (e.g.) thermometer, kidney basin, cotton ball, waste paper bag) and place at one corner of the work area.

To make them readily accessible.

8. Place waste paper bag outside of work area.

To prevent contamination of clean area.

9. Close the bag.

To give comfort and security, maintain personal hygiene and hasten recovery.

10. Proceed to the specific nursing care or treatment.

To prevent contamination of bag and contents.

11. After completing nursing care or treatment, clean and alcoholize the things used.

To protect caregiver and prevent spread of infection to others

12. Do handwashing again. 13. Open the bag and put back all articles in their proper places. 14. Remove apron folding away from the body, with soiled sidefolded inwards, and the clean side out. Place it in the bag. 15. Fold the linen/plastic lining, clean; place it in the bag and close the bag. 16. Make post-visit conference on matters relevant to health care, taking anecdotal notes preparatory to final reporting.

To be used as reference for future visit.

17. Make appointment for the next visit (either home or clinic), taking note of the date, time and purpose.

For follow-up care.

After Care 1. 2.

Before keeping all articles in the bag, clean and alcoholize them. Get the bag from the table, fold the paper lining ( and insert), and place in between the flaps and cover the bag. Evaluation and Documentation

1.

Record all relevant findings about the client and of the family.

2. 3. 4.

Take note of environmental factors which affect the clients/family health. Include quality of nurse-patient relationship. Assess effectiveness of nursing care provided.

Breastfeeding or Lactation Management Education Training Introduction Breastfeeding practices has been proved to be very beneficial to both mother and baby thus the creation of the following laws the full implementation of this program:   

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Executive Order 51 Republic Act 7600 The Rooming-In and Breastfeeding Act of 1992 Program Objectives and Goals Protection and promotion of breastfeeding and lactation management education training Activities and Strategies 1. Full Implementation of Laws ing the Program

a. EO 51 THE MILK CODE – protection and promotion of breastfeeding to ensure the safe and adequate nutrition of infants through regulation of marketing of infant foods and related products. (e.g. breast milk substitutes, infant formulas, feeding bottles, teats etc. ) b. RA 7600 THE ROOMING –IN and BREASTFEEDING ACT of 1992    

An act providing incentives to government and private health institutions promoting and practicing rooming-in and breast-feeding. Provision for human milk bank. Information, education and re-education drive Sanction and Regulation

2. Conduct Orientation/Advocacy Meetings to Hospital/ Community Advantages of Breastfeeding:

Mother Oxytocin help the uterus contracts Uterine involution Reduce incidence of Breast Cancer Promote Maternal-Infant Bonding Form of Family planning Method (Lactational Amenorrhea)

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Provides Antibodies Contains Lactoferin (binds with Iron) Leukocytes Contains Bifidus factorpromotes growth of the Lactobacillusinhibits the growth of pathogenic bacilli Positions in Breastfeeding of the baby:

1. 2. 3.

Cradle Hold = head and neck are ed Football Hold Side Lying Position BEST FOR BABIES REDUCE INCIDENCE OF ALLERGENS ECONOMICAL ANTIBODIES PRESENT STOOL INOFFENSIVE (GOLDEN YELLOW) TEMPERATURE ALWAYS IDEAL FRESH MILK NEVER GOES OFF EMOTIONALLY BONDING EASY ONCE ESTABLISHED DIGESTED EASILY IMMEDIATELY AVAILABLE NUTRITIONALLY OPTIMAL GASTROENTERITIS GREATLY REDUCED

Communicable Disease (Vector Borne) Leptospirosis (Weil’s disease) 

An infectious disease that affects humans and animals, is considered the most common zoonosis in the world Causative Agent: Leptospira interrogans

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Sign/Symptoms: High fever Chills Vomiting Red eyes Diarrhea Severe headache muscle aches may include jaundice (yellow skin and eyes) abdominal pain

Treatment: PET – > Penicillins, Erythromycin, Tetracycline

Malaria 

Malaria (from Medieval Italian: mala aria – “bad air”; formerly called ague or marsh fever) is an infectious disease that is widespread in many tropical and subtropical regions. Causative Agent: Anopheles female mosquito

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Signs & Symptoms: Chills to convulsion Hepatomegaly Anemia Sweats profusely Elevated temperature Treatment: Chemoprophylaxis – chloroquine taken at weekly interval, starting from 1-2 weeks before entering the endemic area. Anti-malarial drugs – sulfadoxine, quinine sulfate, tetracycline, quinidine Insecticide treatment of mosquito nets, house spraying, stream seeding and clearing, sustainable preventive and vector control meas Preventive Measures: (CLEAN) Chemically treated mosquito nets Larvae eating fish Environmental clean up Anti mosquito soap/lotion Neem trees/eucalyptus tree Filariasis

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name for a group of tropical diseases caused by various thread-like parasitic round worms (nematodes) and their larvae larvae transmit the disease to humans through a mosquito bite can progress to include gross enlargement of the limbs and genitalia in a condition called elephantiasis Sign/Symptoms: Asymptomatic Stage

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Characterized by the presence of microfilariae in the peripheral blood No clinical signs and symptoms of the disease Some remain asymptomatic for years and in some instances for life Acute Stage

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Lymphadenitis (inflammation of lymph nodes) Lymphangitis (inflammation of lymph vessels) In some cases the male genitalia is affected leading to orchitis (redness, painful and tender scrotum) Chronic Stage

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Hydrocoele (swelling of the scrotum) Lyphedema (temporary swelling of the upper and lower extremities Elephantiasis (enlargement and thickening of the skin of the lower and / or upper extremities, scrotum, breast) Management: Diethylcarbamazine citrate or Hetrazan Ivermectin, Albendazolethe No treatment can reverse elephantiasis Schistosomiasis

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parasitic disease caused by a larvae Causative Agent: Schistosoma intercalatum, Schistosoma japonicum, Schistosoma mansoni

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Signs & Symptoms: (BALLIPS) Bulging abdomen Abdominal pain Loose bowel movement Low grade fever Inflammation of liver & spleen Pallor Seizure

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Preventive measures health education regarding mode of transmission and methods of protection; proper disposal of feces and urine; improvement of irrigation and agriculture practices Control of patient, s and the immediate environment

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Treatment: Diethylcarbamazepine citrate (DEC) or Praziquantel (drug of choice)

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Dengue  

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DENGUE is a mosquito-borne infection which in recent years has become a major international public health concern.. It is found in tropical and sub-tropical regions around the world, predominantly in urban and semiurban areas. Sign/Symptoms: (VLINOSPARD) Vomiting Low platelet Nausea Onset of fever

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Severe headache Pain of the muscle and t Abdominal pain Rashes Diarrhea Treatment: The mainstay of treatment is ive therapy.  Intravenous fluids  A platelet transfusion

Communicable Diseases (Chronic) 

Tuberculosis TB is a highly infectious chronic disease that usually affects the lungs. Causative Agent: Mycobacterium Tuberculosis

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Sign/Symptoms: cough afternoon fever weight loss night sweat blood stain sputum

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Prevalence/Incidence: ranks sixth in the leading causes of morbidity (with 114,221 cases) in the Philippines Sixth leading cause of mortality (with 28507 cases) in the Philippines.

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Nursing and Medical Management Ventilation systems Ultraviolet lighting Vaccines, such as the bacillus Calmette Guerin (BCG) vaccine drug therapy

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Preventing Tuberculosis BCG vaccination Adequate rest Balanced diet Fresh air Adequate exercise Good personal Hygiene

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National Tuberculosis Control Program – Key policies Case finding – direct Sputum Microscopy and X-ray examination of TB symptomatics who are negative after 2 or more sputum exams Treatment – shall be given free and on an ambulatory basis, except those with acute complications and emergencies Direct Observed Treatment Short Course – comprehensive strategy to detect and cure TB patients.

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DOTS (Direct Observed Treatment Short Course) Category 1- new TB patients whose sputum is positive; seriously ill patients with severe forms of smear-negative PTB with extensive parenchymal involvement (moderately- or far advanced) and extrapulmonary TB (meningitis, pleurisy, etc.) Intensive Phase (given daily for the first 2 months) – Rifampicin + Isioniazid + pyrazinamide + ethambutol. If sputum result becomes negative after 2 months, maintenance phase starts. But if sputum is still positive in 2 months, all drugs are discontinued from 2-3 days and a sputum specimen is examined for culture and drug sensitivity. The patient resumes taking the 4 drugs for another month and then another smear exam is done at the end of the 3rd month. Maintenance Phase (after 3rd month, regardless of the result of the sputum exam)-INH + rifampicin daily Category 2-previously-treated patients with relapses or failures. Intensive Phase (daily for 3 months, month 1, 2 & 3)-Isioniazid+ rifampicin+ pyrazinamide+ ethambutol+ streptomycin for the first 2 months Streptomycin+ rifampicin pyrazinamide+ ethambutol on the 3rd month. If sputum is still positive after 3 months, the intensive phase is continued for 1 more month and then another sputum exam is done. If still positive after 4 months, intensive phase is continued for the next 5 months. Maintenance Phase (daily for 5 months, month 4, 5, 6, 7,& 8)-Isionazid+ rifampicin+ ethambutol Category 3 – new TB patients whose sputum is smear negative for 3 times and chest x-ray result of PTB minimal Intensive Phase (daily for 2 months) – Isioniazid + rifampicin + pyrazinamide Maintenance Phase (daily for the next 2 months) – Isioniazid + rifampicin Leprosy

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Sometimes known as Hansen’s disease is an infectious disease caused by , an aerobic, acid fast, rod-shaped mycobacterium Gerhard Armauer Hansen Historically, leprosy was an incurable and disfiguring disease Today, leprosy is easily curable by multi-drug antibiotic therapy Signs & Symptoms Early stage (CLUMP) Change in skin color

Late Stage (GMISC) Gynocomastia

Loss in sensation

Madarosis(loss of eyebrows)

Ulcers that do not heal

Inability to close eyelids (Lagopthalmos)

Muscle weakness

Sinking nosebridge

Painful nerves

Clawing/contractures of fingers & nose

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Prevalence Rate Metro Manila, the prevalence rate ranged from 0.40 – 3.01 per one thousand population.

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Management: Dapsone, Lamprene clofazimine and rifampin Multi-Drug-Therapy (MDT) six month course of tablets for the milder form of leprosy and two years for the more severe form

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Leprosy Control Program WHO Classification – basis of multi-drug therapy Paucibacillary/PB – non-infectious types. 6-9 months of treatment. Multibacillary/MB – infectious types. 24-30 months of treatment. Multi-drug therapy – use of 2 or more drugs renders patients non-infectious a week after starting treatment Patients w/ single skin lesion and a negative slit skin smear are treated w/ a single dose of ROM regimen For PB leprosy cases- Rifampicin+Dapsone on Day 1 then Dapsone from Day 2-28. 6 blister packs taken monthly within a max. period of 9 mos. All patients who have complied w/ MDT are considered cured and no longer regarded as a case of leprosy, even if some sequelae of leprosy remain. Responsibilities of the nurse: Prevention – health education, healthful living through proper nutrition, adequate rest, sleep and good personal hygiene; Casefinding Management and treatment – prevention of secondary injuries, handling of utensils; special shoes w/ padded soles; importance of sustained therapy, correct dosage, effects of drugs and the need for medical check-up from time to time; mental & emotional Rehabilitation-makes patients capable, active and self-respecting member of society.

Control of Acute Respiratory Infections (CARI) Classification A. No Pneumonia: Cough or Cold 1. 2.

No chest in drawing No fast breathing ( <2 mos. – <60/min,2-12 mos. – less than 50 per minute; 12 mos. – 5 years – less than 40 per minute) Treatment:

1. 2. 3. 4.

If coughing more than 30 days, refer for assessment Assess and treat ear problems/sore throat if present Advise mother to give home care Treat fever/wheezing if present

Home Care: 1. Feed the Child   

Feed the child during illness Increase feeding after illness Clear the nose if it interferes with feeding 2. Increase Fluids

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offer the child extra to drink Increase breastfeeding 3. Soothe the throat and relieve the cough with a safe remedy 4. Watch for the following signs and symptoms and return quickly if they occur

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Breathing becomes difficult Breathing becomes fast Child is not able to drink Child becomes sicker B. Pneumonia

1. 2.

No chest in drawing Fast breathing (less than 2 mos- 60/min or more ; 2-12 mos. – 50/min or more; 12 mos. – 5 years – 40/min or more) Treatment

1. 2. 3. 4.

Advise mother to give home care Give an antibiotic Treat fever/wheezing if present If the child’s condition gets worst, refer urgently to hospital; if improving, finish 5 days of antibiotic. Antibiotics Recommended by WHO

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Co-trimoxazole, Amoxycillin, Ampicillin, (p.o) or Procaine penicillin (I.M.) C. Severe Pneumonia

1. 2. 3. 4.

Chest indrawing Nasal flaring Grunting ( short sounds made with the voice) Cyanosis Treatment

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Refer urgently to hospital

Treat fever ( paracetamol), wheezing ( salbutamol)

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D. Very Severe Disease 1. 2. 3. 4. 5.

Not able to drink Convulsions Abnormally sleepy or difficult to wake Stridor in calm child Severe undernutrition Treatment Refer urgently to hospital

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Assessment of Respiratory Infection Ask the Mother 1. 2. 3. 4. 5. 6.

How old is the child? Is the child coughing? For how long? Age less than 2 months: Has the young infant stopped feeding well? Age 2 months up to 5 years: Is the child able to drink? Has the child had fever? For how long? Has the child had convulsions? Look, Listen 1. Count the breaths in one minute. Age

Fast Breathing

Less than 2 months

60/minute or more

2 months- 12 months

50/minute or more

12 months – 5 years

40/minute or more

2. Look for chest in drawing. 3. Look and listen for stridor. Stridor occurs when there is a narrowing of the larynx, trachea or epiglottis which interferes with air entering the lungs. 4. Look and listen for wheeze. Wheeze is a soft musical noise which shows signs that breathing out (exhale) is difficult. 5. See if the child is abnormally sleepy or difficult to wake. (Suspect meningitis) 6. Feel for fever or low body temperature. 7. Check for severe under nutrition

Control of Diarrheal Diseases (CDD) Management of the Patient with Diarrhea A. No Dehydration Condition – well, alert Mouth and Tongue – moist Eyes – normal Thirst – drinks normally, not thirsty Tears – present Skin pinch – goes back quickly TREATMENT PLAN A- HOME Treatment.

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Three Rules for Home Treatment 1.   2.     3.      

Give the child more fluids than usual use home fluid such as cereal gruel give ORESOL, plain water Give the child plenty of food to prevent under nutrition continue to breastfeed frequently if child is not breastfeed, give usual milk if child is less than 6 months and not yet taking solid food, dilute milk for 2 days if child is 6 months or older and already taking solid food, give cereal or other starchy food mixed with vegetables, meat or fish; give fresh fruit juice or mashed banana to provide potassium; feed child at least 6 times a day. After diarrhea stops, give an extra meal each day for two weeks. Take the child to the health worker if the child does not get better in 3 days or develops any of the following: many watery stools repeated vomiting marked thirst eating or drinking poorly fever blood in the stool Oresol Treatment

Age

Amount of ORS to give after each loose stool

Amount of ORS to provide for use at home

< 24 months

50-100 ml

500 ml/day

2-10 years

100- 200 ml

1000 ml/day

10 years up

As much as wanted

2000 ml/day

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B. Some Dehydration Condition – restless, irritable Mouth and Tongue – dry Eyes – sunken Thirst – thirsty, drinks eagerly Tears – absent Skin pinch – goes back slowly WEIGH PT, TTT. PLAN B Approximate amount of ORS to give in 1st 4 hours Age

Weight (kg)

ORS (ml)

4 months

5

200- 400

4- 11 months

5- 7.9

400- 600

12-23 months

8- 10.9

600- 800

2-4 yrs.

11- 15.9

800- 1200

5-14 yrs.

16- 29.9

1200- 2200

15 yrs. up

30 up

2200- 4000

1. 2. 3. 4. 5. 6.

If the child wants more ORS than shown, give more Continue breastfeeding For infants below 6 mos. who are not breastfeed, give 100-200 ml clean water during the period For a child less than 2 years give a teaspoonful every 1-2 min. If the child vomits, wait for 10 min, then continue giving ORS, 1 tbsp/2-3 min If the child’s eyelids become puffy, stop ORS, give plain water or breast milk, Resume ORS when puffiness is gone 7. If ( -) signs of DHN- shift to Plan A Use of Drugs during Diarrhea          1. 2. 3. 4.

Antibiotics should only be used for dysentery and suspected cholera Antiparasitic drugs should only be used for amoebiasis and giardiasis C. Severe Dehydration Condition – lethargic or unconscious; floppy Eyes – very sunken and dry Tears – absent Mouth and tongue – very dry Thirst- drinks poorly or not able to drink Skin pinch – goes back very slowly Treatment PLAN C- treat quickly Bring pt. to hospital IVF – Lactated Ringers Solution or Normal Saline Re-assess pt. Every 1-2 hrs Give ORS as soon as the pt. can drink

Role of Breastfeeding in the Control of Diarrheal Diseases Program Two problems in CDD High child mortality due to diarrhea High diarrhea incidence among under fives Highest incidence in age 6 – 23 months Highest mortality in the first 2 years of life Main causes of death in diarrhea : Dehydration  To prevent dehydration, give home fluids “am” as soon as diarrhea starts and if dehydration is present, rehydrate early, correctly and effectively by giving ORS  Malnutrition  For under nutrition, continue feeding during diarrhea especially breastfeeding.

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1. 2. 3. 4. 5. 6. 7.

Interventions to prevent diarrhea breastfeeding improved weaning practices use of plenty of clean water hand washing use of latrines proper disposal of stools of small children measles immunization Breastfeeding 1. Risk of severe diarrhea 10-30x higher in bottle fed infants than in breastfed infants. 2. Advantages of breastfeeding in relation to CDD a. Breast milk is sterile b. Presence of antibodies protection against diarrhea c. Intestinal Flora in BF infants prevents growth of diarrhea causing bacteria. 3. Breastfeeding decreases incidence rate by 8-20% and mortality by 24- 27% in infants under 6 months of age. 4. When to wean?

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4-6 months – soft mashed foods 2x a day 6 months – variety of foods 4x a day Summary of WHO-CDD recommended strategies to prevent diarrhea 1. Improved Nutrition

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Exclusive breastfeeding for the first 4-6 months of life and partially for at least one year. Improved weaning practices 2. Use of safe water

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collecting plenty of water from the cleanest source protecting water from contamination at the source and in the home 3. Good personal and domestic hygiene

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handwashing use of latrines proper disposal of stools of young children

4. Measles immunization

Expanded Program for Immunization (EPI) Principles of EPI 1. 2. 3. 1. 2. 3. 4. 5. 6. 7.

Epidemiological situation Mass approach Basic Health Service The 7 immunizable diseases Tuberculosis Diptheria Pertussis Measles Poliomyelitis Tetanus Hepatitis B Target Setting

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Infants 0-12 months Pregnant and Post Partum Women School Entrants/ Grade 1 / 7 years old Objectives of EPI

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To reduce morbidity and mortality rates among infants and children from six childhood immunizable disease Elements of EPI

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Target Setting Cold chain Logistic Management- Vaccine distribution through cold chain is designed to ensure that the vaccines were maintained under proper environmental condition until the time of istration. Information, Education and Communication (IEC) Assessment and evaluation of Over-all performance of the program Surveillance and research studies

istration of vaccines

Vaccine BCG (Bacillus Calmette Guerin)

Content Live attenuated bacteria

Form & Dosage Freeze dried

# of Doses 1

Route ID

Infant- 0.05ml Preschool-0.1ml DT- weakened toxin DPT (Diphtheria Pertussis Tetanus) OPV (Oral Polio Vaccine)

P-killed bacteria weakened virus Plasma derivative

Hepatitis B

Measles

Weakened virus

liquid-0.5ml

3

IM

liquid-2drops

3

Oral

Liquid-0.5ml

3

IM

Freeze dried0.5ml

1

Subcutaneous

Schedule of Vaccines

Vacci ne

Age at 1st dose

Interval between dose

BCG

At birth

DPT

6 weeks

4 weeks

OPV

6weeks

4weeks

Protection BCG is given at the earliest possible age protects against the possibility of TB infection from the other family An early start with DPT reduces the chance of severe pertussis

The extent of protection against polio is increased the earlier OPV given. An early start of Hepatitis B reduces

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Hepa B

@ birth

Meas les

9m0s.11m0s.

@birth,6th week,14th week

the chance of being infected and becoming a carrier.

At least 85% of measles can be prevented by immunization at this age.

6 months – earliest dose of measles given in case of outbreak 9months-11months- regular schedule of measles vaccine 15 months- latest dose of measles given 4-5 years old- catch up dose Fully Immunized Child (FIC)– less than 12 months old child with complete immunizations of DPT, OPV, BCG, Anti Hepatitis, Anti measles.

Tetanus Toxiod Immunization Schedule for Women % protected

Vaccine

Minimum age interval

TT1

As early as possible

0%

0

TT2

4 weeks later

80%

3 years

TT3

6 months later

95%

5 years

99%

10 years

99%

Lifetime

TT4 TT5

1year later/during next pregnancy 1 year later/third pregnancy

Duration of Protection

There is no contraindication to immunization except when the child is immunosuppressed or is very, very ill (but not slight fever or cold). Or if the child experienced convulsions after a DPT or measles vaccine, report such to the doctor immediately. Malnutrition is not a contraindication for immunizing children rather; it is an indication for immunization since common childhood diseases are often severe to malnourished children.

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Cold Chain under EPI                  

Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to the time it is given to child or pregnant woman. The allowable timeframes for the storage of vaccines at different levels are: 6months- Regional Level 3months- Provincial Level/District Level 1month-main health centers-with ref. Not more than 5days- Health centers using transport boxes. Most sensitive to heat: Freezer (-15 to -25 degrees C) OPV Measles Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius) BCG DPT Hepa B TT Use those that will expire first, mark “X”/ exposure, 3rd- discard, Transport-use cold bags let it stand in room temperature for a while before storing DPT. Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B. FEFO (“first expiry and first out”) – vaccine is practiced to assure that all vaccines are utilized before the expiry date. Proper arrangement of vaccines and/or labeling of vaccines expiry date are done to identify those near to expire vaccines.

Herbal Medicine Plants Approved by the DOH Lagundi (Vitex negundo) Uses & Preparation: 

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Asthma, Cough & Fever – Decoction ( Boil raw fruits or leaves in 2 glasses of water for 15 minutes)Dysentery, Colds & Pain – Decoction ( Boil a handful of leaves & flowers in water to produce a glass, three times a day) Skin diseases (dermatitis, scabies, ulcer, eczema) -Wash & clean the skin/wound with the decoction Headache – Crush leaves may be applied on the forehead Rheumatism, sprain, contusions, insect bites – Pound the leaves and apply on affected area Yerba (Hierba ) Buena (Mentha cordifelia)

    

Uses & Preparation: Pain (headache, stomachache) – Boil chopped leaves in 2 glasses of water for 15 minutes. Divide decoction into 2 parts, drink one part every 3 hours. Rheumatism, arthritis and headache – Crush the fresh leaves and squeeze sap. Massage sap on painful parts with eucalyptus Cough & Cold – Soak 10 fresh leaves in a glass of hot water, drink as tea. (expectorant) Swollen gums – Steep 6 g. of fresh plant in a glass of boiling water for 30 minutes. Use as a gargle solution Toothache – Cut fresh plant and squeeze sap. Soak a piece of cotton in the sap and insert this in aching tooth cavity

   

Menstrual & gas pain – Soak a handful of leaves in a lass of boiling water. Drink infusion. Nausea & Fainting – Crush leaves and apply at nostrils of patients Insect bites – Crush leaves and apply juice on affected area or pound leaves until like a paste, rub on affected area Pruritis – Boil plant alone or with eucalyptus in water. Use decoction as a wash on affected area. Sambong (Blumea balsamifera)

 

Uses & Preparation: Anti-edema, diuretic, anti-urolithiasis – Boil chopped leaves in a glass of water for 15 minutes until one glassful remains. Divide decoction into 3 parts, drink one part 3 times a day. Diarrhea – Chopped leaves and boil in a glass of water for 15 minutes. Drink one part every 3 hours. Tsaang Gubat (Carmona retusa)

 

Uses & Preparation: Diarrhea – Boil chopped leaves into 2 glasses of water for 15 minutes. Divide decoction into 4 parts. Drink 1 part every 3 hours Stomachache – Boil chopped leaves in 1 glass of water for 15 minutes. Cool and strain. Niyug-niyogan (Quisqualis indica L.)



Uses & Preparation: Anti-helmintic – The seeds are taken 2 hours after supper. If no worms are expelled, the dose may be repeated after one week. (Caution: Not to be given to children below 4 years old) Bayabas/Guava (Psidium guajava L.)

 

Uses & Preparation: For washing wounds – Maybe use twice a day Diarrhea – May be taken 3-4 times a day As gargle and for toothache – Warm decoction is used for gargle. Freshly pounded leaves are used for toothache. Boil chopped leaves for 15 minutes at low fire. Do not cover and then let it cool and strain Akapulko (Cassia alata L.)



Uses & Preparation: Anti-fungal (tinea flava, ringworm, athlete’s foot and scabies) – Fresh, matured leaves are pounded. Apply soap to the affected area 1-2 times a day Ulasimang Bato (Peperonica pellucida)



Uses & Preparation: Lowers uric acid (rheumatism and gout) – One a half cup leaves are boiled in two glass of water over low fire. Do not cover pot. Divide into 3 parts and drink one part 3 times a day Bawang (Allium sativum)

 

Uses & Preparation: Hypertension – Maybe fried, roasted, soaked in vinegar for 30 minutes, or blanched in boiled water for 15 minutes. Take 2 pieces 3 times a day after meals. Toothache – Pound a small piece and apply to affected area Ampalaya (Mamordica Charantia)



1. 2. 3. 4. 5. 6. 7.

Uses & Preparation: Diabetes Mellitus (Mild non-insulin dependent) – Chopped leaves then boil in a glass of water for 15 minutes. Do not cover. Cool and strain. Take 1/3 cup 3 times a day after meals Reminders on the Use of Herbal Medicine Avoid the use of insecticide as these may leave poison on plants. In the preparation of herbal medicine, use a clay pot and remove cover while boiling at low heat. Use only part of the plant being advocated. Follow accurate dose of suggested preparation. Use only one kind of herbal plant for each type of symptoms or sickness. Stop giving the herbal medication in case untoward reaction such as allergy occurs. If signs and symptoms are not relieved after 2 to 3 doses of herbal medication, consult a doctor.

Integrated Management of Childhood Illnesses (IMCI)  

Definition IMCI is an integrated approach to child health that focuses on the well-being of the whole child. IMCI strategy is the main intervention proposed to achieve a significant reduction in the number of deaths from communicable diseases in children under five Goal



By 2010, to reduce the infant and under five mortality rate at least one third, in pursuit of the goal of reducing it by two thirds by 2015. Aim

 

 

To reduce death, illness and disability, and to promote improved growth and development among children under 5 years of age. IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities. IMCI Objectives To reduce significantly global mortality and morbidity associated with the major causes of disease in children To contribute to the healthy growth & development of children

IMCI Components of Strategy Improving case management skills of health workers § Improving the health systems to deliver IMCI Improving family and community practices

  

**For many sick children a single diagnosis may not be apparent or appropriate

   

Presenting complaint: Cough and/or fast breathing Lethargy/Unconsciousness Measles rash “Very sick” young infant

   

Possible course/ associated condition: Pneumonia, Severe anemia, P. falciparum malaria Cerebral malaria, meningitis, severe dehydration Pneumonia, Diarrhea, Ear infection Pneumonia, Meningitis, Sepsis

       

Five Disease Focus of IMCI: Acute Respiratory Infection Diarrhea Fever Malaria Measles Dengue Fever Ear Infection Malnutrition

    

The IMCI Case Management Process Assess and classify Identify appropriate treatment Treat/refer Counsel Follow-up The Integrated Case Management Process

        

Check for General Danger Signs: A general danger sign is present if: The child is not able to drink or breastfeed The child vomits everything The child has had convulsions The child is lethargic or unconscious Assess Main Symptoms Cough/DOB Diarrhea Fever Ear problems Assess and Classify Cough of Difficulty of Breathing



Respiratory infections can occur in any part of the respiratory tract such as the nose, throat, larynx, trachea, air ages or lungs.

Assess and classify PNEUMONIA Cough or difficult breathing An infection of the lungs Both bacteria and viruses can cause pneumonia Children with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis (generalized infection).

   

** A child with cough or difficult breathing is assessed for: How long the child has had cough or difficult breathing Fast breathing Chest indrawing Stridor in a calm child.

   

: ** If the child is 2 months up to 12 months the child has fast breathing if you count 50 breaths per minute or more ** If the child is 12 months up to 5 years the child has fast breathing if you count 40 breaths per minute or more.

 

Color Coding

PINK (URGENT REFERRAL)

YELLOW (Treatment at outpatient health facility)

GREEN (Home management) HOME

OUTPATIENT HEALTH FACILITY OUTPATIENT HEALTH

FACILITY   Pre-referral treatments  Advise parents Refer child 

  

Treat local infection Give oral drugs Advise and teach caretaker Follow-up

    

Caretaker is counseled on: Home treatment/s Feeding and fluids When to return immediately Follow-up



Give first dose of an appropriate antibiotic Give Vitamin A Treat the child to prevent low bloo sugar Refer urgently to the hospital Give paracetamol for fever > 38.5

REFERRAL FACILITY   

Emergency Triage and Treatment ( ETAT) Diagnosis, Treatment Monitoring, follow-up

 SEVERE PNEUMONIA OR VERY  SEVERE DISEASE

 

Give an appropriate antibiotic for

 days  Any general danger sign

 or  

Chest indrawing or Stridor in calm child

 PNEUMONIA

 

Soothe the throat and relieve coug with a safe remedy Advise mother when to return immediately Follow up in 2 days Give Paracetamol for fever > 38.5

  NO PNEUMONIA : COUGH OR COLD  

Fast breathing

 

If coughing more than more than days, refer for assessment Soothe the throat and relieve the cough with a safe remedy Advise mother when to return immediately Follow up in 5 days if not improvin

No signs of pneumonia or very severe disease Assess and classify DIARRHEA A child with diarrhea is assessed for: How long the child has had diarrhoea Blood in the stool to determine if the child has dysentery Signs of dehydration.

  

Classify DYSENTERY Child with diarrhea and blood in the stool



If child has no other severe classification: Give fluid for severe dehydration ( Pla C ) OR  If child has another severe classification :  Refer URGENTLY to hospital with moth giving frequent sips of ORS on the way  Advise the mother to continue breastfeeding  If child is 2 years or older and there is choler in your area, give antibiotic for cholera 

   

Two of the following signs? Abnormally sleepy or difficult to awaken Sunken eyes Not able to drink or drinking poorly Skin pinch goes back very slowly



SEVERE DEHYDRATION

Give fluid and food for some dehydration ( P

 B)

Two of the following signs :    

Restless, irritable Sunken eyes Drinks eagerly, thirsty Skin pinch goes back slowly

  SOME DEHYDRATION

   





Not enough signs to classify as some or severe dehydration

Dehydration present

NO DEHYDRATION   SEVERE PERSISTENT DIARRHEA

   



No dehydration

PERSISTENT DIARRHEA

 

If child also has a severe classification : Refer URGENTLY to hospital with moth giving frequent sips of ORS on the way Advise mother when to return immediately Follow up in 5 days if not improving

Home Care Give fluid and food to treat diarrhea at home ( Plan A ) Advise mother when to return immediately Follow up in 5 days if not improving Treat dehydration before referral unless the child has another severe classification Give Vitamin a Refer to hospital

Advise the mother on feeding a child who ha persistent diarrhea Give Vitamin A Follow up in 5 days

  

DYSENTERY

Blood in the stool



Treat for 5 days with an oral antibiotic recommended for Shigella in your area Follow up in 2 days Give also referral treatment

Does the child have fever? **Decide: Malaria Risk No Malaria Risk Measles Dengue

   

Malaria Risk  VERY SEVERE  

Any general danger sign or Stiff neck

FEBRILE DISEASE / MALARIA

    

Give first dose of quinine ( under medical supervision if a hospital is not accessible within 4hrs ) Give first dose of an appropriate antibiotic Treat the child to prevent low blood sugar Give one dose of paracetamol in health center for hig fever (38.5oC) or above Send a blood smear with the patient Refer URGENTLY to hospital

Blood smear ( +

 )

If blood smear not done:

  NO runny nose,

 and  

NO measles, and NO other causes of fever

MALARIA

   

Blood smear

 ( – ), or  

Runny nose, or Measles, or Other causes of fever

FEVER : MALARIA UNLIKELY

  

Treat the child with an oral antimalarial Give one dose of paracetamol in health center for hig fever (38.5oC) or above Advise mother when to return immediately Follow up in 2 days if fever persists If fever is present everyday for more than 7 days, refe for assessment

Give one dose of paracetamol in health center for hig fever (38.5oC) or above Advise mother when to return immediately Follow up in 2 days if fever persists If fever is present everyday for more than 7 days, refe for assessment

No Malaria Risk

Any general danger

 sign or 

Stiff neck



No signs of very severe febrile disease

VERY SEVERE FEBRILE DISEASE FEVER : NO MALARIA

      

Give first dose of an appropriate antibiotic Treat the child to prevent low blood sugar Give one dose of paracetamol in health center for high fever (38.5oC) or above Refer URGENTLY to hospital Give one dose of paracetamol in health center for high fever (38.5oC) or above Advise mother when to return immediately Follow up in 2 days if fever persists



If fever is present everyday for more than 7 days, refer for assessment

Measles

Clouding of cornea

 or 

Deep or extensive mouth ulcers

SEVERE COMPLICATED MEASLES

     

  

Pus draining from the eye or Mouth ulcers

MEASLES WITH EYE OR MOUTH COMPLICATIONS

Measles now or within the last 3 months

MEASLES



Give Vitamin A Give first dose of an appropriate antibiotic If clouding of the cornea or pus draining from the eye, apply tetracycline eye ointment Refer URGENTLY to hospital

Give Vitamin A If pus draining from the eye, apply tetracycli eye ointment If mouth ulcers, teach the mother to treat wi gentian violet Give Vitamin A



Dengue Fever         

Bleeding from nose or gums or Bleeding in stools or vomitus or Black stools or vomitus or Skin petechiae or Cold clammy extremities or Capillary refill more than 3 seconds or Abdominal pain or Vomiting Tourniquet test ( + )

   SEVERE DENGUE HEMORRHAGIC FEVER    



No signs of severe dengue hemorrhagic fever

 FEVER: DENGUE HEMORRHAGIC UNLIKELY 

If skin petechiae or Tourniquet test,are the only positive signs give ORS If any other signs are positive, give fluids rapidly as in Plan C Treat the child to prevent low blood sugar DO NOT GIVE ASPIRIN Refer all children Urgently to hospital

DO NOT GIVE ASPIRIN Give one dose of paracetamol in health center for high fever (38.5oC) or above Follow up in 2 days if fever persists or chil shows signs of bleeding Advise mother when to return immediatel

Does the child have an ear problem?

    

Tender swelling behind the ear Pus seen draining from the ear and discharge is reported for less than 14 days or Ear pain

MASTOIDITIS ACUTE EAR INFECTION



Give first dose of appropriate antibiotic Give paracetamol for pain Refer URGENTLY Give antibiotic for 5

 days

Give paracetamol for

 pain





CHRONIC EAR INFECTION

Pus seen draining from the ear and discharge is reported for less than 14 days

NO EAR INFECTION

No ear pain and no pus seen draining from the ear

 

Dry the ear by wickin Follow up in 5 days

 

Dry the ear by wickin Follow up in 5 days No additional treatment



Check for Malnutrition and Anemia Give an Appropriate Antibiotic: A. For Pneumonia, Acute ear infection or Very Severe disease

COTRIMOXAZOLE

AMOXYCILLIN

BID FOR 5 DAYS

BID FOR 5 DAYS

Adult Age or Weight

Tablet

Syrup

tablet

Syrup

1/2

5 ml

1/2

5 ml

1

7.5 ml

1

10 ml

2 months up to 12 months ( 4 – < 9 kg )

12 months up to 5 years ( 10 – 19kg )

B. For Dysentery

COTRIMOXAZOLE

AMOXYCILLIN

BID FOR 5 DAYS BID FOR 5 DAYS

TABLET

SYRUP

SYRUP 250MG/5ML

AGE OR WEIGHT

2 – 4 months ( 4 – < 6kg )

1.25 ml ( ¼ tsp ) ½ 5 ml

4 – 12 months

½

( 6 – < 10 kg )

1 – 5 years old ( 10 – 19 kg )

2.5 ml ( ½ tsp ) 5 ml

1

( 1 tsp ) 7.5 ml

C. For Cholera

TETRACYCLINE

COTRIMOXAZOLE

QID FOR 3 DAYS

BID FOR 3 DAYS

AGE OR WEIGHT

Capsule 250mg

Tablet

Syrup

2 – 4 months ( 4 – < 6kg )

¼

1/2

5ml

4 – 12 months ( 6 – < 10 kg )

½

1/2

5 ml

1 – 5 years old ( 10 – 19 kg)

1

1

7.5ml

Give an Oral Antimalarial

Primaquine Give single CHOLOROQUINE

Primaquine

dose in

Give for 3 days

AGE

TABLET ( 150MG )

DAY1

DAY2

DAY3

½

½

½

Sulfadoxine +

health

Give daily

center for P.

for 14 days

Falciparum

for P. Vivax

Give single dose

TABLET

TABLET

TABLET

( 15MG)

( 15MG)

( 15MG)

Pyrimethamine

2months – 5months

¼

5 months – 12 months

½

½

½

1/2

1

1

½

½

¼

¾

1½

1½

1

3/4

1/2

1

12months – 3 years old

3 years old – 5 years old

GIVE VITAMIN A AGE

VITAMIN A CAPSULES 200,000 IU

6 months – 12 months

1/2

12 months – 5 years old

1

GIVE IRON Iron/Folate Tablet FeSo4 200mg + 250mcg Folate (60mg elemental iron)

AGE or WEIGHT

Iron Syrup FeSo4 150 mg/5ml (6mg elemental iron per ml )

2months-4months (4 – <6kg )

2.5 ml

4months – 12months (6 – <10kg )

4 ml

12months – 3 years – <14kg)

(10 1/2

5 ml

3years – 5 years ( 14 – 19kg )

1/2

7.5 ml

GIVE PARACETAMOL FOR HIGH FEVER (38.5oC OR MORE) OR EAR PAIN AGE OR WEIGHT

TABLET ( 500MG )

SYRUP ( 120MG / 5ML )

2 months – 3 years

( 4 – <14kg )

¼

5 ml

3 years up to 5 years

(14 – 19 kg )

1/2

10 ml

GIVE MEBENDAZOLE    

Give 500mg Mebendazole as a single dose in health center if : hookworm / whipworm are a problem in children in your area, and the child is 2 years of age or older, and the child has not had a dose in the previous 6 months

Management of a Child with an Ear Problem 1.  2.  3. 

Classification of Ear Infection Mastoiditis – tender swelling behind the ear (in infants, swelling may be above the ear) Treatment a. Antibiotics b. Surgical intervention Acute Ear Infection – pus draining from the ear for less than 2 weeks, ear pain, red, immobile ear drum (Acute Otitis Media) Treatment a. Cotrimoxazole,Amoxycillin,or Ampicillin b. Dry the ear by wicking Chronic Ear Infection – pus draining from the ear for more than 2 weeks (Chronic Otitis Media) Treatment a. Most important & effective treatment: Keep the ear dry by wicking. b. Paracetamol maybe given for pain or high fever. c. Precautions for a child with a draining ear:  Do not leave anything in the ear such as cotton, wool between wicking treatments.  Do not put oil or any other fluid into the ear.  Do not let the child go swimming or get water in the ear.

Maternal and Child Health Nursing Program Philosophy   

Pregnancy, labor and delivery and puerperium are part of the continuum of the total life cycle Personal, cultural and religious attitudes and beliefs influence the meaning of pregnancy for individuals and make each experience unique MCN is FAMILY CENTERED- the father is as important as the mother Goals



To ensure that expectant mother and nursing mother maintain good health, learn the art of child care, has a normal delivery and bear healthy children That every child lives and grows up in a family unit with love and security, in healthy surroundings, receives adequate nourishment, health supervision and efficient medical attention and is taught the elements of healthy living

  

Classification of pregnant women Normal – healthy pregnancy With mild complications- frequent home visits With serious or potentially serious complication – referred to most skilled source of medical and hospital care





Home Based Mother’s Record (HBMR) Tool used when rendering prenatal care containing risk factors and danger signs



Risk Factors 145 cm tall (4 ft & 9 inches) Below 18 yrs old, above 35 yrs old Have had 4 pregnancies With TB, goiter, heart disease, DM, bronchial asthma, severe anemia Last baby born was less than 2 years ago Previous cesarian section delivery History of 2 or more abortions, difficult delivery, given birth to twins, 2 or more babies born before EDD, stillbirth Weighs less than 45 kgs. or more than 80 kgs.

1. 2. 3. 4.

Danger Signs any type of vaginal bleeding headache, dizziness, blurred vision puffiness of face and hands pallor

      

Prenatal Care    

Schedule of Visits 1st – as early as pregnancy, 1st trimester 2nd – 2nd trimester 3rd & subsequent visits – 3rd trimester More frequent visits for those at risk with complications

Tetanus Toxiod Immunization Schedule for Women

Vac cine

Minimum Age Interval

Per cent Prot ecte d

TT1

As early as possible during pregnancy

0%

None

TT2

At least 4 weeks later

80%

Infants born to the mother will be protected from neonatal tetanus. Gives years protection for the mother from the tetanus.

Duration of Protection

Infants born to the mother will be protected from neonatal tetanus.

TT3

At least 6 months later

90%

Gives 5 years protection for the mother.

TT4

At least 1 year later

99%

Gives 10 years protection for the mother

TT5

At least 1 year later

99%

Gives lifetime protection for the mothers. All Infants born to that mother w be protected.

Dose: 0.5ml Route: Intramuscular Site: Right or Left Deltoid/Buttocks

            

Components of Prenatal Visits History – taking Determination of obstetrical score- G, P, TPAL, AOG, EDD U/A for Proteinuria, glycosuria and infxtn Dental exam Wt. Ht. BP taking Exam of conjunctiva and palms for pallor Abdominal exam – fundic ht, Leopold’s maneuver and FHT Exam of breasts, face, hands and feet for edema and neck for thyroid enlargement Health teachings- nutrition, personal hygiene, common complaints Tetanus toxoid immunization Iron supplementation – from 5th mo. Of pregnancy – 2 mos. Postpartum In goiter endemic areas – iodized capsule once a year In malaria infested areas- prophylactic Chloroquine (150 mg/tab ) 2 tabs/ wk for the whole duration of pregnancy

Non-Communicable Diseases and Rehabilitation Prevention and Control of Cardiovascular Diseases  

 

    

heart – 1st leading cause of death ; blood vessels – 2nd Congenital Heart Disease (CHD): Result of the abnormal development of the heart that exhibits septal defect, patent ductus arteriosus, aortic and pulmonary stenosis, and cyanosis; most prevalent in children Causes: environmental factors, maternal diseases or genetic aberrations Rheumatic Fever or Rheumatic Heart Disease: Systematic inflammatory disease that may develop as a delayed reaction to repeated and an inadequately treated infection of the upper respiratory tract by group A beta-hemolytic streptococci. Hypertension: Persistent elevation of the arterial blood pressure.(primary or essential) ;frequent among females but severe, malignat form is more common among males Ischemic Heart Disease/ Atherosclerosis: Condition usually caused by the occlusion of the coronary arteries by thrombus or clot formation. higher among males than females for the latter are protected by estrogen before menopause Predisposing Factor: Hypertension (HPN),Diabetes Mellitus (DM), Smoking Minor Risk Factor: stress, strong family history, obesity Cardiovascular Disease Period of Life At birth to early childhood

Type of CVD

Prevalence

Congenital Heart Disease

2/ 1000 school children (aged 5-15 yrs. old)

Early to late childhood

Rheumatic Fever/ Rheumatic Heart Disease

1/1000 school children (aged 5-15 y old)

Early Adulthood

Diseases of Heart Muscles Essential Hypertension

10/100 adults

Middle age to old age

Coronary Artery Disease Cerebrovascular

5/100 adults

Accident

Cardiovascular Disease Diseases

Causes/ Risk factors

Congenital Heart Disease

Maternal Infections, Drug intake, Maternal Disease, Genetic

Rheumatic Fever/Rheumatic Heart Disease

Frequent Streptoccocal Sore Throat

Essential Hypertension

Heredity, High Salt Intake

Coronary Artery Disease (Heart Attack)

Smoking, Obesity, Hypertension, Stress Hyperlipidemia, Diabetes Mellitus Sedentary Life Style

Cerebrovascular Accident (Stroke)

Hypertension, Arteriosclerosis

Primary Prevention: CVD Disease

Primordial

Congenital Heart



Disease



Rheumatic Heart Disease

Essential

 

 Prevention of recurrent sore throat thru adequate environmental sanitation; avoidance of overcrowding; adequate treatment



From early childhood low salt diet adequate physical exercise



  

 Prevention of development/ acquisition of risk 

 factors

Disease (Heart

  

Attack) Cerebrovascular Accident

Prevention of viral infection and intake of harmful drugs during pregnancy. Avoidance of marriage between blood relatives



Hypertension

Coronary Heart

Specific Protection



cigarette smoking high fat intake high salt intake

  

all measures to prevent hypertension & arteriosclerosis



Adequate treatment of viral infection during pregnancy Genetic counseling of blood related married couples.

Identification of cases of rheumatic fever Prophylaxis with penicilli or erythromycin

Continued low salt diet a adequate exercise

cessation of smoking control /treatment of diabetes, hypertension weight reduction change to proper diet Adjustment of activities all measures to control hypertension & progression of

(Stroke)

1. 2. 3. 4. 5.

arteriosclerosis

Primary Prevention thru health education is the main focus of the program: Maintenance of ideal body wt. diet – low fat alcohol/smoking avoidance exercise regular BP check up

 

Cancer Prevention and Early Detection Any malignant tumor arising from the abnormal and uncontrolled division of cells causing the destruction in the surrounding tissues. Common Cancer: Lung cancer, cervical cancer, colon cancer, cancer of the mouth, breast cancer, skin cancer, prostate cancer. 3rd leading cause of illness and death (Phil.) Incidence can only be reduced thru prevention and early detection

        

Nine Warning Signs of Cancer: Change in blood bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty in swallowing Obvious change in wart or mole Nagging cough or hoarseness Unexplained anemia Sudden unexplained weight loss

 

Prevention & Early Detection CA type Lung

Prevention

Detection

No smoking

None

Uterin e

Monogamy, Safe sex

Pap’s smear every 1-3 yrs

Cervic al

Monogamy, Safe sex

Pap’s smear every 1-3 yrs

Liver

Hep B vaccination, Less alcohol intake, Avoidance of moldy foods

None

Colon

High fiber diet

Regular medical checkup after 40 yrs of age

Rectu m

Low fat intake

Mouth

No smoking, betel nut chewing, Oral hygiene

Fecal occult blood test DRE Sigmoidoscopy

Regular dental check-ups

Breast

none

Monthly SBE, Yearly exam by doctor, Mammography fo 50 yrs old and above females

Skin

No excessive sun exposure

Assessment of skin

none

Digital transrectal exam

Prosta te

Principles of Treatment of Malignant Diseases One third of all cancers are curable if detected early and treated properly.



Three major forms of treatment of cancer: 1. 2. 3.

Surgery Radiation Therapy Chemotherapy Nat’l Diabetes Prevention and Control Program Aim: Controlling and assimilating healthy lifestyle in the Filipino culture (2005- 2010) thru IEC



Main Concern: modifiable risk factors ( diet, body wt., smoking, alcohol, stress, sedentary living, birth wt. ,migration



Prevention and Control of Kidney Disease 1.

2. 3. 4. 5. 6. 7. 8.

Acute or Rapidly Progressive Renal Failure : A sudden decline in renal function resulting from the failure of the renal circulation or by glomerular or tubular damage causing the accumulation of substances that is normally eliminated in the urine in the body fluids leading to disruption in homeostatic, endocrine, and metabolic functions. Acute Nephritis: A severe inflammation of the kidney caused by infection, degenerative disease, or disease of the blood vessels. Chronic Renal Failure: A progressive deterioration of renal function that ends as uremia and its complications unless dialysis or kidney transplant is performed. Neprolithiasis: A disorder characterized by the presence of calculi in the kidney. Nephrotic Syndrome: A clinical disorder of excessive leakage of plasma proteins into the urine because of increased permeability of the glomerular capillary membrane Urinary Tract Infection: A disease caused by the presence of pathogenic microorganisms in the urinary tract with or without signs and symptoms. Renal Tubular Defects: An abnormal condition in the reabsorption of selected materials back into the blood and secretion, collection, and conduction of urine. Urinary Tract Obstruction: A condition wherein the urine flow is blocked or clogged. Program on Mental Health and Mental Disorders

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Mental Health Mental health is not merely the absence of mental illness. According to the World Health Organization (WHO) Manual on Mental Health, a person is in a state of sound mental health when, o He feels physically well o His thought are organized o His feelings are modulated o His behaviors are coordinated and appropriate (*note: behaviors considered “normal” may vary according to cultural norms)

Any person may develop mental illness regardless of race, nationality, age, sex civil status and socio-economic background may develop mental illness.

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Causes of Mental Illness A Combination or One of These: 1.  2.  3.  4. 

Biological factors Like hereditary predisposition, poor nutrition Physical Factors Physical injuries, intoxication Psychological Factors Failure to adjust to the difficulties in life. Socio-economic Factors Unemployment, housing problems How is Mental Illness Detected?

1. 2. 3.

Interview and assessment by the Clinical Social Worker. Psychological testing and evaluation. Psychiatric interview and mental status examination. Is Mental Illness Curable?

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Yes. Mental illness is curable if detected early and prompt and adequate treatment is given. Treatment depends on severity of illness and includes:  Pharmacotherapy (use of medicines)  Various therapies (physical, recreational, occupational, environmental)  Psychotherapy and others

1. 2. 3. 4. 5. 6.         

Prevention of Mental Illness Maintain good physical health. Choose worthwhile activities and develop a hobby Solve problems as they come and avoid excessive worrying. Cultivate friendships and choose a friend to confide in. Strike a happy medium between work and play. Recognize early signs and symptoms. Some Early Signs of Symptoms Mental Illness Persistent disturbance in sleep and appetite Over sensitiveness and excessive irritability Loss of interest in activities or responsibilities of previous concern Constant complaint of headaches, weakness of hands and feet and other bodily complaints. Persistent seclusion of oneself from other people. Frequent attacks of palpitations usually expressed as “nerbiyos” & associated with unexplained fears. Frequent attacks of dizziness & fainting. Exaggerated and /or unfounded suspicions Persistent worrying, forgetfulness & absentmindedness. Program on Drug Dependence/ Substance Abuse

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Community-Based Rehabilitation Program A creative application of the primary health care approach in rehabilitation services, which involves measures taken at the community level to use and build on the resources of the community with the community people, including impaired, disabled and handicapped persons as well.

Goal To improve the quality of life and increase productivity of disabled, handicapped persons.

 Aim: 

To reduce the prevalence of disability through prevention, early detection and provision of rehabilitation services at the community level. Program on the Elderly/Geriatric Nursing Services

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Leading causes of illness: elderly Influenza, HPN, diarrhea, bronchitis, TB, diseases. of the heart, pneumonia, malaria, malignant neoplasm, chickenpox

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Leading causes of death: elderly Diseases of heart and vascular system Pneumonia, TB, CCOPD Malignant neoplasms Diabetes Nephritis Accidents Programs on Blindness, Deafness and Osteoporosis Cataract- main causes of blindness VAD- main cause of childhood blindness; most serious eye problem of Filipino children below 6 yrs.

  old 

Osteoporosis special problem in women, highest bet. 50—79 yrs. old, MENOPAUSE main cause

Nursing Procedures in the Community

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Clinic Visit process of checking the client’s health condition in a medical clinic Home Visit

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a professional face to face made by the nurse with a patient or the family to provide necessary health care activities and to further attain the objectives of the agency Bag Technique

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a tool making of the public health bag through which the nurse during the home visit can perform nursing procedures with ease and deftness saving time and effort with the end in view of rendering effective Thermometer Technique

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to assess the client’s health condition through body temperature reading Nursing Care in the Home

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giving to the individual patient the nursing care required by his/her specific illness or trauma to help him/her reach a level of functioning at which he/she can maintain himself/herself or die peacefully in dignity Isolation Technique in the Home

1. 2. 3. 4. 5.

Separating the articles used by a client with communicable disease to prevent the spread of infection: Frequent washing and airing of beddings and other articles and disinfections of room Wearing a protective gown, to be used only within the room of the sick member Discarding properly all nasal and throat discharges of any member sick with communicable disease Burning all soiled articles if could be or contaminated articles be boiled first in water 30 minutes before laundering Intravenous Therapy

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Insertion of a needle or catheter into a vein to provide medication and fluids based on physician’s written prescription can be done only by nurses accredited by ANSAP

Family Planning Program 

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Overview The Philippine Family Planning Program is a national program that systematically provides information and services needed by women of reproductive age to plan their families according to their own beliefs and circumstances. Goals and Objectives Universal access to family planning information, education and services. Mission To provide the means and opportunities by which married couples of reproductive age desirous of spacing and limiting their pregnancies can realize their reproductive goals. Types of Methods

a. b. c. d. e. a. i. ii. iii. iv. b. i. ii. iii. c. i. ii.

NATURAL METHODS Calendar or Rhythm Method Basal Body Temperature Method Cervical Mucus Method Sympto-Thermal Method Lactational Amennorhea ARTIFICIAL METHODS Chemical Methods Ovulation suppressant such as PILLS Depo-Provera Spermicidals Implant Mechanical Methods Male and Female Condom Intrauterine Device Cervical Cap/Diaphragm Surgical Methods Vasectomy Tubal Ligation Warning Signs Pills Abdominal pain (severe) Chest pain (severe) Headache (severe) Eye problems (blurred vision, flashing lights, blindness) Severe leg pain (calf or thigh) Others: depression, jaundice, breast lumps

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Period late, no symptoms of pregnancy, abnormal bleeding or spotting Abdominal pain during intercourse

Infection or abnormal vaginal discharge Not feeling well, has fever or chills String is missing or has become shorter or longer

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Injectables Dizziness Severe headache Heavy bleeding BTL

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Fever Weakness Rapid pulse Persistent abdominal pain Vomiting Dizziness Pus or tenderness at incision site Amenorrhea

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Vasectomy Fever Scrotal blood clots or excessive swelling