Phc Compre

COMMUNITY HEALTH NURSING: AN OVERVIEW What is a community?

§ a group of people with common characteristics or interests living together within a territory or geographical boundary § place where people under usual conditions are found

What is health? § Health-illness continuum § High-level wellness § Agent-host-environment § Health belief § Evolutionary-based § Health promotion § WHO definition

§ What is community health?

§ part of paramedical and medical intervention/approach which is concerned on the health of the whole population

§ aims: 1. health promotion 2. disease prevention 3. management of factors affecting health

§ What is nursing? - assisting sick individuals to become healthy

and healthy individuals achieve optimum wellness

Public Health Nursing: the term used before for Community Health Nursing

According to Dr. C.E. Winslow, Public Health is a

science & art of 3 P’s § Prevention of Disease § Prolonging life § Promotion of health and efficiency through organized community effort

§ What is Community Health Nursing? “The utilization of the nursing process in the different

levels of clientele-individuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation.” - Maglaya, et al

COMMUNITY HEALTH NURSING (CHN): §  a specialized field of nursing practice §  a science of Public Health combined with

Public Health Nursing Skills and Social Assistance with the goal of raising the level of health of the citizenry, to raise optimum level of functioning of the citizenry (Characteristic of CHN)

BASIC PRINCIPLES OF CHN ü  The community is the patient in CHN, the family is the

unit of care and there are four levels of clientele: individual, family, population group (those who share common characteristics, developmental stages and common exposure to health problems – e.g. children, elderly), and the community.

ü  In CHN, the client is considered as an ACTIVE partner

NOT PASSIVE recipient of care

BASIC PRINCIPLES OF CHN

ü  CHN practice is affected by developments in health technology, in particular, changes in society, in general

ü  The goal of CHN is achieved through multi-sectoral efforts

ü  CHN is a part of health care system and the larger human services system.

ROLES OF THE PUBLIC HEALTH NURSE

Clinician, who is a health care provider, taking care of the sick people at home or in the RHU

Health Educator, who aims towards health promotion and illness prevention through dissemination of correct information; educating people

Facilitator, who establishes multi-sectoral linkages by referral system Supervisor, who monitors and supervises the performance of

midwives

TARGET POPULATION (IFC) ARE:

1. I ndividual 2. F amily 3. C ommunity

3 Elements considered in CHN: v  Science of Public Health (core foundation in CHN), v  Public Health Nursing Skills and v  Social Assistance Functions

OBJECTIVES OF PUBLIC HEALTH: CODES

C ontrol of Communicable Diseases O rganization of Medical and Nursing Services D evelopment of Social Machineries E ducation of IFC on personal Hygiene→ Health Education

is the essential task of every health worker S anitation of the environment

3 ELEMENTS IN HEALTH EDUCATION: IEC

§ I nformation: to share ideas to keep population group knowledgeable and aware § E ducation: change within the individual 3 Key Elements of Education:

K nowledge A ttitude S kills

3 ELEMENTS IN HEALTH EDUCATION: IEC

§ C ommunication: interaction involving 2 or more persons or agencies

3 Elements of Communication: Message Sender Receiver

PUBLIC HEALTH WORKERS (PHW) PHW’s: are members of the health team who are

professionals namely § Medical Officer (MO)-Physician § Public Health Nurse (PHN)-Registered Nurse § Rural Health Midwife (RHM)-Registered Midwife- § Dentist § Nutritionist § Medical Technologist § Pharmacist § Rural Sanitary Inspector (RSI)-must be a sanitary engineer

5 MAJOR FUNCTIONS:

1.  Ensure equal access to basic health services 2.  Ensure formulation of national policies for proper division of

labor and proper coordination of operations among the government agency jurisdictions

3.  Ensure a minimum level of implementation nationwide of services regarded as public health goods

4.  Plan and establish arrangements for the public health systems to achieve economies of scale

5.  Maintain a medium of regulations and standards to protect consumers and guide providers

BASIC HEALTH SERVICES UNDER OPHS OF DOH E ducation regarding Health L ocal Endemic Diseases E xpanded Program on Immunization M aternal & Child Health Services E ssential drugs and Herbal plants N utritional Health Services (PD 491): Creation of Nutrition Council of the Phils. T reatment of Communicable & Non communicable Diseases S anitation of the environment (PD 856): Sanitary Code of the Philippines D ental Health Promotion A ccess to and use of hospitals as Centers of Wellness M ental Health Promotion

VISION BY 2030 (DREAM OF DOH)

A Global Leader for attaining better health outcomes, competitive and responsive health care systems, and equitable health financing

MISSION

To guarantee EQUITABLE, SUSTAINABLE and QUALITY

health for all Filipinos, especially the poor and to

lead the quest for excellence in health

Principles to attain the vision of DOH

§ Equity: equal health services for all-no discrimination § Quality: DOH is after the quality of service not the quantity Philosophy of DOH: “Quality is above quantity”

§ Accessibility: DOH utilize strategies for delivery of health services

HEALTH CARE DELIVERY SYSTEM

“the totality of all policies, facilities, equipment, products, human resources and services which address the health needs, problems and concerns of the people. It is large, complex, multi-level and multi-disciplinary.”

THREE STRATEGIES IN DELIVERING HEALTH SERVICES (ELEMENTS)

ü  Creation of Restructured Health Care Delivery System (RHCDS) regulated by PD 568 (1976)

ü  Management Information Systems regulated by R.A. 3753: Vital Health Statistics Law

ü  Primary Health Care (PHC) regulated by LOI 949 (1984): Legalization of Implementation of PHC in the Philippines

CREATION OF RHCDS

RHO (National Health Agency) or existing national agencies like PGH or specialized agencies like Heart Center for Asia, NKI MHO & PHO (Municipal/Provincial Health Office) BHS & RHU (Barangay Health Station/Rural Health Unit)

3 LEVELS OF HEALTH CARE

1.  Primary-prevention of illness or promotion of health

2.  Secondary-curative 3.  Tertiary-rehabilitative

According to Increasing Complexity of

the Services Provided

According to the Type of Service

Type

Service

Type

Example

Primary

Health Promotion, Preventive Care, Continuing Care for common health problems, attention to psychological and social care, referrals

Health Promotion and illness Prevention

Information Dissemination

Secondary

Surgery, Medical services by Specialists

Diagnosis and Treatment Screening

Tertiary

Advanced, specialized, diagnostic, therapeutic & rehabilitative care

Rehabilitation

PT/OT

LEVELS OF PREVENTION

PRIMARY LEVEL Health Promotion and Illness

Prevention

SECONDARY LEVEL Prevention of Complications thru Early

Dx and Tx

TERTIARY LEVEL Prevention of Disability, etc.

Provided at – ! Health care/RHU ! Brgy. Health Stations !Main Health Center !Community Hospital and Health

Center !Private and Semi-private

agencies

! When hospitalization is deemed necessary and referral is made to emergency (now district), provincial or regional or private hospitals

! When highly-specialized medical care is necessary

! referrals are made to hospitals and medical center such as PGH, PHC, POC, National Center for Mental Health, and other gov’t private hospitals at the municipal level

Referral System in Levels of the Health Care:

ü  Barangay Health Station (BHS) is under the management of Rural Health Midwife (RHM)

ü  Rural Health Unit (RHU) is under the management or supervision of PHN

ü  Public Health Nurse (PHN) caters to 1:10,000 population, acts as managers in the implementation of the policies and activities of RHU, directly under the supervision of MHO (who acts as administrator)

REFERRAL SYSTEM:

BHS→ RHU→ MHO→ PHO→ RHO→ National Agencies→ Specialized Agencies

CHARACTERISTICS OF PHC

Acceptable Accessible Affordable Available Sustainable Attainable

UTILIZES APPROPRIATE TECHNOLOGIES USED BY PHC: ACCEFS

A ffordable, accessible, acceptable, available C ost wise=economical in nature C omplex procedures which provide a simple

outcome E ffective F easibility of use=possibility of use at all times S cope of technology is safe & secure

SENTRONG SIGLA MOVEMENT (SSM)

was established by DOH with LGUs having a logo of a Sun with 8 Rays and composed of 4 Pillars:

1.  Health Promotion 2.  Granted Facilities 3.  Technical Assistance 4.  Awards: Cash, plaque, certificate

4 CONTRIBUTIONS OF PHC TO DOH & ECONOMY:

§ Training of Health Workers § Creation of Botika sa Baryo & Botika sa Health Center § Herbal Plants § Oresol

A. TRAINING OF HEALTH WORKERS 3 Levels of Training: Grassroot/Village § Includes Barangay Health Volunteers (BHV) and Barangay Health

Workers (BHW) § Non professionals, didn’t undergo formal training, receive no

salary but are given incentive in the form of honorarium from the local government since 1993

Intermediate - these are professionals including the 8 members of the PHWs

First Line Personnel - the specialist

B. CREATION OF “BOTIKA SA BARYO & BOTIKA SA HEALTH CENTER”

RA 6675: Generics Act of 1988: Implementing “Oplan Walang Reseta Program”-solution to the absence of a

medical officer who prescribed the medicines so PHN are given the responsibility to prescribe generic medicines and

“Walong Wastong Gamot Program”- available generics in “Botika sa Baryo” & Health Center

§ Father of Generics Act: Dr. Alfredo Bengzon

8 COMMONLY AVAILABLE GENERICS (CARIPPON) Co-Trimoxazole: § it’s a combination of 2 generics of drugs which is antibacterial

Trimethoprim(TMP) § Has a bacteriostatic action that stops/inhibits multiplication

of bacteria § For GUT, GIT & URTI (TMP combined with SMX) Sulfamethoxazole (SMX) § Has bactericidal action that kills bacteria § For GUT, GIT, URTI & Skin Infections

8 COMMONLY AVAILABLE GENERICS (CARIPPON) Amoxicillin/Ampicillin § An antibacterial drug that comes from the Penicillin family § Effect is generally bacteriostatic (when source of infection is bacterial) § These 2 drugs provide the least sensitivity reaction (rashes & GI) and the adverse effect of other antibiotics is anaphylactic shock

8 COMMONLY AVAILABLE GENERICS (CARIPPON) TB DRUGS: Rifampicin (RIF) Isoniazid (INH) Pyrazinamide (PZA)

8 COMMONLY AVAILABLE GENERICS (CARIPPON)

Paracetamol Has an analgesic & anti-pyretic effect Acetyl Salicylic Acid (ASA) or Aspirin is never kept in the

“Botika” because of its effects: § Anticoagulant-highly dangerous to Dengue patients that’s why it’s not available in “Botika” & Health Center

8 COMMONLY AVAILABLE GENERICS (CARIPPON) Oresol: a management for diarrhea to prevent dehydration

under the Control of Diarrheal Diseases (CDD) Program

8 COMMONLY AVAILABLE GENERICS (CARIPPON) Nifedipine:

§ An anti-hypertensive drug § According to DOH, 16% of population belonging to 25 years old & above in the community are hypertensive

C. HERBAL PLANTS

RA 8423: Alternative Traditional Medicine Law a program where patient may opt to use herbal plants

especially for drugs that are not available in dosage form or patients has no financial means to buy the drug

Traditional Medicine: § Use of herbal plants

10 ADVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA

Lagundi Vitex negundo

Asthma, cough, colds & fever (ASCOF) Pain and inflammation

Leaves Decoction Poultice


Ulasimang Bato

Peperonia pellucida

Gout Arthritis Rheumatism



Bayabas Psidium quajava

Diarrhea Toothache Mouth and wound wash

Leaves Decoction


Bawang Allium sativum

HPN Toothache

Clove/Bulb Poultice


Yerta Buena

Mentha cordifelia

Same as Lagundi except asthma



Sambong Blumea balsanifera

Edema Diuretic

Leaves Decoction


Akapulko Cassia alata

All forms of skin diseases

Leaves Decoction Poultice Cream


Niyog niyogan

Quisqualis indica

Intestinal Parasitism (Nematodes)

Seeds Decoction Poultice Juice


Tsaang Gubat

Carmona resuta

Diarrhea Infantile colic (Kabag) Dental caries



Ampalaya Mamordica charantia

Type II Diabetes (NIDDM)

Leaves Decoction

POLICIES TO ABIDE:

Know indications Know parts of plants with therapeutic value: roots,

fruits, leaves Know official procedure/preparation

Procedures/Preparations:

Decoction Ø  Gather leaves & wash thoroughly, place in a

container the washed leaves & add water Ø  Let it boil without cover to vaporize/steam to

release toxic substance & undesirable taste Ø  Use extracts for washing

PROCEDURES/PREPARATIONS:

Poultice Ø  Done by pounding or chewing leaves used by

herbolaryo Ø  Example: Akapulko leaves-when pounded, it releases

extracts coming out from the leaves contains enzyme (serves as anti-inflammatory) then apply on affected skin or spewed it over skin

Ø  For treatment of skin diseases


Infusion To prepare a tea (use lipton bag), keep standing for 15 minutes in a cup of warm water where a brown solution is collected, pectin which serves as an adsorbent and astringent


Juice/Syrup To prepare a papaya juice, use ripe papaya & mechanically mashed then put inside a blender & add water To produce it into a syrup, add sugar then heat to dissolve sugar & mix it


Cream/Ointment Start with poultice (pound leaves) to turn it semi-solid Add flour to keep preparation pasty & make it adhere to skin lesions To make it into an ointment: add oil (mineral, baby or any oil-serves as moisturizer) to the prepared cream to keep it lubricated while being massage on the affected area

D. ORESOL Glucose 20 grams 1° Significance:

For re-absorption of Na Facilitates assimilation of Na 2° Significance: Provides heat & energy

Sodium Chloride/NaCl 3.5 grams For retention of water/fluid Sodium Bicarbonate/NaHCO3

2.5 grams Buffer content of solution Neutralizer content of solution

Potassium Chloride/KCl 1.5 grams Stimulates smooth muscle contractility especially the heart & GIT

PREPARATION OF PROPER HOMEMADE ORESOL

A volume or one liter homemade oresol Smaller volume or a glass homemade oresol

Water 1000 ml. or 1 liter 250 ml. Sugar 8 teaspoon 2 teaspoon Salt 1 teaspoon ! teaspoon or a pinch of salt=10-12

granules of rock salt: iodized salt=tips of thumb & index finger are penetrated with salt

UNIVERSAL HEALTH CARE (UHC), ALSO REFERRED TO AS KALUSUGAN PANGKALAHATAN (KP)

is the “provision to every Filipino of the highest possible quality of health care that is accessible, efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by an informed and empowered public”

UNIVERSAL HEALTH CARE (UHC), ALSO REFERRED TO AS KALUSUGAN PANGKALAHATAN (KP

The Aquino administration puts it as the availability and accessibility of health services and necessities for all Filipinos.

It is a government mandate aiming to ensure that every Filipino shall receive affordable and quality health benefits.This involves providing adequate resources – health human resources, health facilities, and health financing.

UHC’S THREE THRUSTS

1)  Financial risk protection through expansion in enrollment and benefit delivery of the National Health Insurance Program (NHIP);

2)  2) Improved access to quality hospitals and health care facilities; and

3)  3) Attainment of health-related Millennium Development Goals (MDGs).

FINANCIAL RISK PROTECTION

Protection from the financial impacts of health care is attained by making any Filipino eligible to enroll, to know their entitlements and responsibilities, to avail of health services, and to be reimbursed by PhilHealth with regard to health care expenditures.

MPROVED ACCESS TO QUALITY HOSPITALS AND HEALTH CARE FACILITIES

Improved access to quality hospitals and health facilities shall be achieved in a number of creative approaches. First, the quality of government-owned and operated hospitals and health facilities is to be upgraded to accommodate larger capacity, to attend to all types of emergencies, and to handle non- communicable diseases.

The Health Facility Enhancement Program (HFEP) shall provide funds to improve facility preparedness for trauma and other emergencies. The aim of HFEP was to upgrade 20% of DOH- retained hospitals, 46% of provincial hospitals, 46% of district hospitals, and 51% of rural health units(RHUs) by end of 2011.

ATTAINMENT OF HEALTH-RELATED MDGS

Further efforts and additional resources are to be applied on public health programs to reduce maternal and child mortality, morbidity and mortality from Tuberculosis and Malaria, and incidence of HIV/AIDS. Localities shall be prepared for the emerging disease trends, as well as the prevention and control of non- communicable diseases.

The organization of Community Health Teams (CHTs) in each priority population area is one way to achieve health-related MDGs. CHTs are groups of volunteers, who will assist families with their health needs, provide health information, and

ATTAINMENT OF HEALTH-RELATED MDGS RNheals nurses will be trained to become trainers and supervisors to

coordinate with community-level workers and CHTs. By the end of 2011, it is targeted that there will be 20,000 CHTs and 10,000 RNheals.

Another effort will be the provision of necessary services using the life cycle approach. These services include family planning, ante-natal care, delivery in health facilities, newborn care, and the Garantisadong Pambata package.

Better coordination among government agencies, such as DOH, DepEd, DSWD, and DILG, would also be essential for the achievement of these MDGs.

GOAL 1: ERADICATE EXTREME POVERTY AND HUNGER

Target : Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day

Target : Halve, between 1990 and 2015, the

proportion of people who suffer from hunger

GOAL 2: ACHIEVE UNIVERSAL PRIMARY EDUCATION

Target : Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling

GOAL 3: PROMOTE GENDER EQUALITY AND EMPOWER WOMEN

Target : Eliminate gender disparity in primary and secondary education preferably by 2005 and to all levels of education no later than 2015

GOAL 4: REDUCE CHILD MORTALITY

Target : Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

GOAL 5: IMPROVE MATERNAL HEALTH

Target : Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio

GOAL 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES

Target : Have halted by 2015 and begun to reverse the spread of HIV/AIDS

Target : Have halted by 2015 and begun to

reverse the incidence of malaria and other major diseases

GOAL 7: ENSURE ENVIRONMENTAL SUSTAINABILITY

Target : Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources

Target : Halve, by 2015, the proportion of people without sustainable access to safe drinking water

Target: By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers

GOAL 8: DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT

Target : Develop further an open, rule-based, predictable, non-discriminatory trading and financial system

Target: Address the special needs of the least developed countries Target: Address the special needs of landlocked countries and small

island developing States Target: Deal comprehensively with the debt problems of developing

countries through national and international measures in order to make debt sustainable in the long term

FIELD HEALTH SERVICE INFORMATION SYSTEM (FHSIS)

• It is a network of information • It is intended to address the short term needs of DOH and LGU

staff with managerial or supervisory functions in facilities and program

areas. • It monitors health service delivery nationwide.

OBJECTIVES OF FHSIS To provide summary data on health service delivery and selected

program accomplishment indicators at the barangay, municipality/city, and district, provincial, regional and national levels.

To provide data which when combined with data from other sources, can be used for program monitoring and evaluation purposes.

To provide a standardized, facility-level data base that can be accessed for more in-depth studies.

To minimize the recording and reporting burden at the service delivery level in order to allow more time for patient care and promote activities.

IMPORTANCE OF FHSIS

• Helps local government determine public health priorities. • Basis for monitoring and evaluating health program implementation. • Basis for planning, budgeting, logistics and decision making at all

levels. • Source of data to detect unusual occurrence of a disease. • Needed to monitor health status of the community. • Helps midwives in following up clients. • Documentation of RHM/PHN day to day activities.

COMPONENTS OF FHSIS

1.  Individual Treatment Record (ITR) 2.  Target Client List (TCL) 3.  Summary Table 4.  The Monthly Consolidation Table (MCT)

INDIVIDUAL TREATMENT RECORD (ITR)

The fundamental building block or foundation of the Field Health Service Information System is the INDIVIDUAL TREATMENT RECORD.

This is a document, form or piece of paper upon which is recorded the date, name, address of patient, presenting symptoms or complaint of the patient on consultation and the diagnosis (if available), treatment and date of treatment.

TARGET CLIENT LIST (TCL)

The Target Client Lists constitute the second “building block” of the FHSIS and are intended to serve several purposes

First is to plan and carry out patient care and service

delivery. Such lists will be of considerable value to midwives/nurses in monitoring service delivery to clients in general and in particular to groups of patients identified as “targets” or “eligibles” for one or another program of the Department

TARGET CLIENT LIST (TCL)

The second purpose of Target Client Lists is to facilitate the monitoring and supervision of service delivery activities.

The third purpose is to report services delivered. The fourth purpose of the Target Client Lists is to

provide a clinic-level data base which can be accessed for further studies

TARGET CLIENT LISTS TO BE MAINTAINED IN THE FHSIS

1.  Target Client List for Prenatal Care 2.   Target Client List for Post-Partum Care 3.   Target Client List of Under 1 Year Old Children 4.   Target Client List for Family Planning 5.   Target Client List for Sick Children 6.   NTP TB Register 7.  National Leprosy Control Program Form 2-Central Registration

Form

SUMMARY TABLE The Summary Tables is a form with 12-month columns retained at

the facility (BHS) where the midwife records monthly all relevant data. The Summary Table is composed of:

(1)   Health Program Accomplishment this can serve as proof of accomplishments to show LGU officials whenever they visit the facility.

(2)  Morbidity Diseases the source of ten leading causes of morbidity for the municipality/city. This summary table will help the nurse and MHO to get the monthly trend of diseases.

THE MONTHLY CONSOLIDATION TABLE (MCT)

ü  The Consolidation Table is an essential form in the FHSIS where the nurse at the RHU records the reported data per indicator by each BHS or midwife.

ü  This is the source document of the nurse for the Quarterly Form.

ü  The Consolidation Table shall serve as the Output Table of the RHU as it already contains listing of BHS per indicator.

FHSIS REPORTING

These are summary data that are transmitted or submitted on a monthly, quarterly and on annual basis to higher level. The source of data for this component is dependent on the records.

THE MONTHLY FORM

Program Report (M1) The Monthly Form contains selected indicators categorized as

maternal care, child care, family planning and disease control.

Morbidity Report (M2) The Monthly Morbidity Disease Report contains a list of all

diseases by age and sex. The Midwife uses the form for the monthly consolidation report of Morbidity Diseases and is submitted to the PHN for quarterly consolidation.

THE QUARTERLY FORM

Program Report (Q1) The Quarterly Form is the municipality/city health report and

contains the three-month total of indicators categorized as maternal care, family planning, child care, dental health and disease control

Morbidity Report (Q2) The PHN uses the form for the Quarterly Consolidation Report of

Morbidity Diseases to consolidate the Monthly Morbidity Diseases taken from the Summary Table.

THE ANNUAL FORMS (A-BHS, A1, A2 & A3)

ABHS Form is the report of midwife which contains data on demographic, environmental and natality. The report of nurse at the RHU/MHC are the Annual Form 1 which is the report

on vital statistics: demographic, environmental, natality and mortality. Annual Form 2 is the report that lists all diseases and their occurrence in the

municipality/city. The report is broken down by age and sex. Annual Form 3 is the report of all deaths occurred in the municipality/city. The report is also broken down by age and sex.

FLOW OF REPORT

OFFICE PERSON RECORDING TOOLS

FORMS FREQUENCY SCHEDULE OF SUBMISION

BHS

Midwife

-  ITR -  TCL -  ST

Monthly Form (M1 & M2) A-BHS Form

Monthly Annually

Every 2nd week of the succeeding month Every 2nd week of January

RHU

PHN

-  ST -  MCT

Quarterly Form (Q1 & Q2) Annual Forms -  A1 -  A2 -  A3

Quarterly

Every 3rd week of the 1st month of succeeding quarter Every 3rd week of January

Fertility § Crude Birth Rate (CBR) - Overall total reported births

Morbidity-Illnesses affecting the population group § Incidence Rate (IR)-reported new cases affecting the population group § Prevalence Rate (PR)-determine sum total of new + old cases of diseases per percent population

Mortality-Reports causes of deaths § Crude Death Rate (CDR)-overall total reported death § Maternal Mortality Rate (MMR)-maternal deaths due to maternal causes § Infant Mortality Rate (IMR)-# of infant deaths (0-12 months) or less than 1 year old § Neonatal Mortality Rate (NMR)-# of deaths among neonates (newborn 0-28 days, < 1 month) § Swaroops Index (SI)-deaths among individual in the age group of 50 and above

CRUDE BIRTH RATE (CBR)

CBR= Overall total reported births x 1000 --------------------------------------------

Population

INCIDENCE RATE (IR)

IR= new cases of disease x 100 ------------------------------------

Population

PREVALENCE RATE (PR):

PR= new cases + old cases x 100 --------------------------------------

Population

CRUDE DEATH RATE (CDR)

CDR = overall total deaths x 1000 ----------------------------------

Population

MATERNAL MORTALITY RATE (MMR)

MMR= # of maternal deaths x 1000 ----------------------------------

RLB

INFANT MORTALITY RATE (IMR)

IMR = # of infant deaths x 1000 ---------------------------------

RLB

NEONATAL MORTALITY RATE (NMR)

NMR = # of neonatal deaths x 1000 ---------------------------------------

RLB

SWAROOP’S INDEX (SI)

SI= # of deaths (individual >50 years old) x 100 ------------------------------------------------------------

Total Deaths

FAMILY HEALTH NURSING PROCESS

a systematic approach of solving an existing problem/meeting the needs of family

R apport A ssessment P lanning I ntervention E valuation

I. RAPPORT

ü  Trust building ü  Knowing your client ü  Adjusting to the situation and environment ü  RESPECT

II. ASSESSMENT

Data Gathering: tools or instruments used during survey: ü Interview ü Observation ü Questionnaires-mostly patronized & used in CHN ü Records & Reports available

Consolidation or Collation: collecting back the questionnaires, tabulate and summarize

Validation: uses statistical approaches

Statistical Approaches:

1. Central Tendencies: 3 M’s Mean=average Median=range (Highest – Lowest Score) Mode=frequency of occurrence of a variable, used if

there’s too many variable occur

2. Standard Deviation: used if there are too many variables available to be treated which is seldom used in CHN SD=√ ∑ (x-x) ∑=summation of

n-1 x=variables available x=mean (given special attention) n=# of existing variables

3. Percentile (%) Method: most commonly used in CHN by adding all cores

then multiply by 100

Presentation of Data 1. Table/Chart 2. Graph: Pie Bar-2 variables only Line Polygon-connecting the results Histograph-2 or more variables & appear adjacent to

each other

Sales

1st Qtr 2nd Qtr

0 2 4 6

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Series 1 Series 2

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Series 1 Series 2 Series 3

TYPOLOGY OF NURSING PROBLEMS

A. First Level Assessment: to determine problems of family

Sources of Problems using IDB Family: use of Initial Data Base (IDB) Nature: Health Deficit (HD), Health Threat (HT),

Foreseeable Crisis (FC)

USE OF INITIAL DATA BASE (IDB): 1. Family Chart Structure:

Nuclear -Father, mother, children Extended (3rd generation)-Relatives staying with the family Multi-generational extended-“apo sa tuhod” or “apo sa talampakan” Dyad -Husband & wife only (childless couple) Blended -widow married another widow & have children Gay -Same sex living together Matriarchal -Mother is the decision maker Patriarchal -Father is the decision maker Communal -different families forming a community

2. Socio-economic: poverty level, educational attainment & nature of occupation of members of the family (sources of income) 3. Socio-cultural: different nature of religion 4. Home environment: assessment according to ES, treatment of garbage, preparation of food, availability of toilet, water & food sanitation, sources of diseases

4. Medical history: history of certain disease, family member with disease 5. Resources available in community for use by the family:

5 Generalized M’s in resources available in community: § Man/Manpower § Money § Machine § Materials § Methods

DEFINE THE PROBLEM AFTER IDENTIFYING IT ACCORDING TO NATURE Health Deficit (HD) - if identified problem is an abnormality, illness

or disease, there’s a gap/difference between normal status (ideal, desirable, expected) & actual status (the outcome/result/problem encountered on that actual day)

Health Threat (HT) -any condition or situation which will be conducive

to health alteration, health interference & health disturbance.

Foreseeable Crisis (FC) -stress points, anything which is anticipated/

expected to become a problem

Jobless Father Suffering from TB Wife is pregnant for the 8th time 2 y/o youngest child lacks immunization 9 y/o eldest child is 3rd degree malnourished

Poor environmental sanitation

III. PLANNING

Four (4) Standard Steps: Prioritization -start if there are multiple identified

problems Formulation of objectives -planning a procedure will

start here if there is only one problem Developing strategies of action Formulation of evaluation tools for the identified

strategy developed

CRITERIA IN IDENTIFYING THE PROBLEM Criteria Score Weight

I. Nature: assess by PHW Health deficit (HD) Health threat (HT) Foreseeable Crisis (FC)

3 2 1

1

II. Modifiability Easily Intermediate (moderate) Not modifiable

2 1 0

2

III. Preventive Potential Highly Moderate Low

3 2 1

1

IV. Salience of the Problem Problem needing urgent attention Problem not needing urgent attention Not a felt problem

2 1 0

1

§ Steps: a. Decide on a score b.  Score x weight ----------------- Highest Score b.  Get the sum total of all the scores § Interpretation: Perfect score=5, if score nearing 5 then prioritize the problem Criteria 1, 2 & 3 has to be assessed objectively by the health

worker Criteria 4 has to be assessed by the perception of the family

Compute for 3rd Degree Malnutrition

IV. INTERVENTION

ü Is the capacity to provide management ü Is the professional phase of nursing process ü Is the time when the PHN executes the standard function of an RN ü Three (3) Standard Functions of RN: § Dependent-giving of medicines § Independent-monitor, assess, provide, educate § Interdependent-referrals

V. EVALUATION

Three (3) Things to be evaluated: SPO 1.  Structure of program & activity -what articles, equipments, supplies are

utilized 2.  Process utilized -steps used 3.  Outcome of activity -results can be: § Desirable -to be implemented, advocated, strengthen § Undesirable -to be avoided Two (2) Aspects to be evaluated in the Outcome: § Quality -characteristic or kind of outcome; no numerical value, not measurable § Quantity -from the word “quantum”, with numerical value, measurable

OBJECTIVES OF COPAR

Patterns to be followed: 1.  Organize people 2.  Mobilize people 3.  Work with people 4.  Educate people ü  Knowledge ü  Attitude ü  Skills

PHASES OF COPAR

1. Preparatory 2.  Organizing 3.  Mobilizing 4.  Educating 5.  Collaborating 6.  Phase Out

1. PREPARATORY PHASE

A. Area of Selection § It should be DOPE Community: Depressed, Oppressed, Poor & Exploited, a new criteria for community organization § “Old Criteria”→ it must be a virgin community=meaning no agency has gone there. § This is a dangerous situation that’s why RA 7305: Magna Carta for Public Workers was provided-a PHN is to receive a hazard pay of 20-25% of monthly salary


B. Entry: the 1st thing to do upon entering the community is to have a courtesy call with the Barangay


C. Integration/Immersion § Immersion is imbibing the life situation/condition of the community by living, eating & sleeping with the family to be able to understand their situation § It requires 2 Qualities of PHN: § Empathy § Sympathy (Integration)


D. Community Study: Diagnosis of Community-COPAR § Makes use of the Nursing Process/Problem Solving Approach § Prioritized which among the problems identified is to be attended 1st like in nature, magnitude, modifiability, preventive potential, salience

PRIORITIZATION OF COMMUNITY PROBLEMS

Indicators of Health Status/Condition: Fertility: ↑ CBR=community is overpopulated=HS Morbidity: IR (new cases) & PR (old cases)=HS Mortality: Deaths like children dying of pneumonia=HS

NATURE Health Status (HS) Health Resource(s) Health Related

3 2 1


Health Resource(s): 5 M’s-Manpower/Man, money, machinery, material & methods (+) available facilities-Hospital/Clinic, mode of transportation,

market, school & movie houses for recreation


3 2 1


Health Related: Categories according to 5 Aspects of Man=PEMSS P hysical, P hysiological, P sychological E motional M ental S ocial S piritual


3 2 1

MAGNITUDE OF THE PROBLEM: % of population affected by the identified problem 75-100% 50-74 % 25-49 % <25 % of the population

4 3 2 1

MODIFIABILITY Easily Intermediate Low Not modifiable

3 2 1 0

PREVENTIVE POTENTIAL Highly Moderate Low

3 2 1

SALIENCE

2. ORGANIZING PHASE Choosing Potential Community Leaders Core Group Formation Community Assembly: Community Organizing Participatory Action

Research (COPAR) § Attend the assembly of the family/families § Families in the community should be represented, any

family members can represent his/her family as long as he/she is a RESPONSIBLE (one who also can comprehend) member of that family.

§ Barangay Captain/Chairman need not necessary be the leader. He can recommend

3. MOBILIZATION PHASE

Mobilization - let the members of the community do the work.

PHN should only SUPERVISE

4. HEALTH EDUCATION

ü Adjust on the level of understanding of the community

ü Return demonstration is the best way of teaching

ü Focus on the KSA ü Respect of the custom and tradition

5. COLLABORATING 6. PHASE OUT

EPIDEMIOLOGY is the pattern of occurrences & distribution of diseases, defects &

deaths

2 Population in Distribution Patterns Susceptible

(at risk to develop, acquire or experience the disease)

Immune (those that did not experience the disease, usually individuals develop resistance against the disease)

Epidemic Endemic Sporadic Pandemic

80% (more than 50%) 50% 20% -----

20% 50% 80% -----

EPIDEMIC

§ Greater than 50% of populations are susceptible or less immune individual

§ Greater % of the population is affected by the occurring disease Example: Health worker reports that Community Lanting has an epidemic of measles affecting children less than 7 years old Total susceptible population: 3000 Children affected by measles: 1750 1750

ENDEMIC The disease occurs regularly, habitually, constantly affecting the

population group 2 Local Endemic Diseases: where causative agent is available on

those places § Schistosomiasis: Samar, Leyte, Mindoro, Davao § Malaria: Palawan & Mindanao-reasons why it’s prevalent § Forested areas § Surrounded by bodies of water

SPORADIC

§ The pattern of occurrence is on & off where: On=available causative agent Off=no available causative agent

§ It’s intermittent (unpredictable) in occurrence § Disease occurs only if there’s a susceptible host like in rabies

PANDEMIC

Worldwide, international, universal, global in occurrence like in AIDS, Hepatitis B, PTB, measles, mumps, diphtheria, pneumonia

§ SARS is categorized by WHO as an OUTBREAK only because out of 191 nations, 33 countries are reported to have it.

HOME VISIT

ü  Is a PROFESSIONAL contact between PHN & the family

ü  The services provided is an extension of the Health Service Agency (Health Center)

OBJECTIVES OF HOME VISIT

§ Assessment § Nursing Care § Treatment § Health Education § Referral (if care fails)

PRIORITIES (IN THE CARE): TO PREVENT CROSS CONTAMINATION

1.  Newborn 2.  Post partum 3.  Pregnant mothers 4.  Morbid cases The families need the assistance of the health center that’s why

home visit was done to the family The person who makes the home visit is rendering services on

behalf of the health center

PHASES OF HOME VISIT:

1. Planning ü Starts at the health center ü Makes a study on the status of the family ü Statement of the problem ü Formation of objective 2. Socialization –first activity is to establish rapport

& to gain the trust of the family

PHASES OF HOME VISIT: 3. Activity

ü  Intervention/Professional Phase ü  Opportunity to provide or extend health services ü  Standard Role of the Nurse: Independent, Dependent and

Interdependent ü  To be effective, come in complete uniform (also bring a long

umbrella with pointed end which serve as protection)

4. Summarization - ability to put into record & report (orally) about the outcome of the activity

PUBLIC HEALTH BAG:

Indispensable tool that should be organize to save time & effort and to prevent cross infection & contamination

GUIDING PRINCIPLES IN THE USE OF PUBLIC HEALTH BAG:

§ Content -should be prepared by the one who will make home visit

Note: BP Apparatus is kept separately from PHN bag § Cleaning ü The inner part of the bag should be clean & sterile ü Should be done every after home visit ü Never endorse the bag

GUIDING PRINCIPLES IN THE USE OF PUBLIC HEALTH BAG: § Contamination § The less one opens the bag, the lesser chance of contamination § In general, the bag is open 3x: ü Putting out materials for hand washing ü Putting out materials used for nursing care ü Returning all what have been used

GUIDING PRINCIPLES IN THE USE OF PUBLIC HEALTH BAG:

Care of Communicable Case(s) - should be disinfected with the use of 70%

isopropyl alcohol or Lysol which should be done at the health center and not at home

POLICIES FOR SCHISTOSOMIASIS CONTROL PROGRAM (SCP): CHES C ase Finding H ealth Education E nvironmental Sanitation S nail Eradication

CASE FINDING: 6 Aspects or Thing to Know § Disease: Schistosomiasis § Other name: Bilhariasis or Snail Fever § Causative agent: Schistosoma-a blood fluke (parasite)

3 Types of Species: ü Schistosoma japonicum-endemic in the Philippines &

affecting Indonesia, China, Japan, Korea Vector: Oncomelania quadrasi

ü Schistosoma mansoni ü Schistosoma haematobium

§ Laboratory Procedures to rule out Schistosomiasis: Blood Examination: ↑ eosinophil level indicates parasitism Fecalysis: Kato Katz (plain stool exam that uses a special apparatus resembling a feeding bottle sterilizer)

Procedure: ü Collect specimen ü Have the test tube undergo centrifugation for 20

minutes ü Get specimen from precipitate & swab it on glass slide ü Observe it on microscope

§ Signs & Symptoms ü CNS: High grade fever→ cerebral convulsion ü GIT: Nausea & vomiting, Diarrhea→ Chronic dysentery

(prolonged diarrhea of more than 2 weeks & consistency is mucoid & bloody (with streaks of blood)

ü Liver: Presence of infection manifested by jaundice & hepatomegaly

ü Spleen: Infection of spleen→ inflammation→ enlargement of organ (Splenomegaly)→ abdominal distension→ abdominal pain on the right upper quadrant

ü Blood: Anemia & weakness

§ Treatment: Drug of Choice-Praziquantel (Biltricide) 60 mg/KBW/day ü Example: If patient is 50 kg, 50 kg x 60 mg/KBW/day=3000

mg/day ü Initial treatment: 1st 2 weeks=3000 mg/day, then do stool

exam after 2 weeks→ if still (+), extend treatment for another 2 weeks. Repeat stool exam, if still (+) after the extended week, continue treatment for 2 weeks again. No adverse effect or over dosage even if extended for a year.

ü Length of Treatment: takes months to a year

Health Education: It affects mostly farmers so educate them to wear rubber boots

Environmental Sanitation: Snail is the 1st concern Water where snail thrives is the 2nd concern

Toilet=3rd concern Food Garbage

Snail Eradication: Use molluscicides treat the entire suspected soil with chemical solution that kills snails

CASE FINDING:

§ Disease: Malaria § Other name: Ague § Causative Agent: Plasmodium-a protozoa

4 Types of Species: ü Plasmodium falciparum-more fatal that affects the Philippine Vector: Female Anopheles Mosquito (FAM) ü Plasmodium vivax ü Plasmodium ovale ü Plasmodium malariae

§ Laboratory Procedure: Malarial smear-extract blood at the height of fever because plasmodium is very active & ruptures at this period.

§ Signs & Symptoms of Malaria: 1st Stage=Cold: Chilling sensation for 1-2 hours 2nd Stage=Hot: High grade fever lasting for 3-4 hours 3rd Stage=Wet: Diaphoresis (excessive sweating/perspiration)

§ Treatment: Drug of Choice-Quinine 2 Forms: a) Chloroquine (Aralen)

b) Primaquine If Quinine is not available, may use Sulfadoxime-an

antibacterial drug paired with pyrinthamine

PERSONAL PROTECTION:

§ Sleep under a mosquito net § Sleep in a screened room § Sleep with long sleeve attire § Use repellents that contains DET (diethyl toluamide or toluene which has a pungent odor that drives away mosquitoes & an irritant to mucous membrane of respiratory tract when inhaled § Plant a Neem Tree using the leaves

CLEAN: Chemical Method=insecticide spraying at night Larvae eating fish=Tilapia Environmental Sanitation & Health

Education=insect, water, trash Anti-mosquito soap=basil citronelli Neem tree=banana, banaba, gabi, eucalyptus

provide repellent effect

STRATEGIES:

A. Provision of Regular and Quality Maternal Care Services Ø  Regular and quality pre-natal care § hx-taking, utilization of HBMR (Home-Based Mother’s Record) as

a guide in the identification of risk factors § PE: weight, height, BP-taking § Perform head-to-toe assessment, abdominal exam § Tetanus Toxoid Immunization § Fe supplementation: given from 5th mo. of pregnancy to two

months postpartum (100-120 mg orally/day for 210 days) § Laboratory exam: Heat-acetic acid test. Benedict’s test § Oral/Dental exam

Ø  Pre-natal counseling Ø  Provision of safe, delivery care § all birth attendants shall ensure clean and safe

deliveries at the faciltiies (RHUs/hospitals) § at-risk pregnancies and mothers must be immediately

referred to the nearest institution

Ø  Provision of quality postpartum care Ø  Proper schedule of follow-up must be followed: § 1st postpartum visit for home deliveries must be done within 24

hours after delivery § 2nd, done at least 1 week after delivery § 3rd, done 2-4 weeks thereafter Attendants must be aware of the early signs, symptoms and

complications. They should follow the 3 CLEANS: CLEAN Hands CLEAN Surface CLEAN Cord

C. Improvement of the health personnel’s capabilities on newborn care, midwifery thru trainings.

Note: All deliveries should be done in health care facilities ONLY D. Improvement on the quality of care at the First Referral Level Ø  Orientation, training should be done on the use of proper filling-up of HBMR

card Ø  Proper referrals/endorsements must be done for future If-ups E. Prevention of unwanted pregnancies through family planning services F. Prevention and management of STDs

G. Promotion of Appropriate health practices H. Upgrade reporting services I. Mobilize political commitment and community

involvement to provide support to basic health care delivery

GOALS:

A. Safe Pregnancy ü  Right age to be pregnant=20-35 years old,

not less than 20 & not more than 35 ü  Right interval of pregnancy=once in 2 or 3

years ü  Home Base Mother’s Record (HBMR): the

record used for care of mothers in CHN

Laboratory Examinations: Benedict’s Test: test for sugar in the urine; test for diabetes § Heat test tube with 5 cc of Benedict’s Solution (blue) in the

burner then add 3-5 gtts of urine (amber yellow) then heat again. Observe for the change in color:

Blue : (-) sugar in urine Green : trace of sugar in urine +1 + Yellow : traces of sugar in urine +2 ++ Orange : more traces of sugar in urine +3 +++ Brick Red : surely diabetic +4 ++++

Laboratory Examinations: Acetic Acid Test: test for albumin in urine; test for Pregnancy Induced HPN § Collect urine in test tube, heat it in burner then add

3-5 gtts of acetic solution (clear white). Observe for change in color:

If it remains clear: (-) CHON or albumin in urine If it turns cloudy: (+) CHON=proteinuria

POLICIES: 1.  Non coercive (give freedom of choice)

2.  Integration of Family Planning in all Curricular Program: § LOI 47 DECS states that Family Planning is to be integrated in all

school curricular programs, either baccalaureates or non-baccalaureates, enrolled separately as one unit

3. Multi-Sectoral Approach: establish relationship with other agencies which can either be: § Intrasectoral § Intersectoral-Local or International (WHO, Unicef, USAID,

Japhiego)

METHODOLOGIES:

Biological A. Basal Body Temperature (BBT) § Get the temperature early morning before waking up

which should be monitored daily at the same time § There should be a sudden drop of temperature between

0.3-0.6°C followed by an increase of temperature by 0.3-0.6°C which means that the woman is fertile

B. Sympto-thermal C. Cervical Mucus Test Ø Billing’s Method by Dr. Billing Ø Spinnbarkheit (came from a German word Spinner which means

to play with the cervical mucus with the finger) or Wet & Dry Method: § Wet Cervical Mucus (Fertile): abundant, stretchy & transparent § Dry Cervical Mucus (Safe & Not fertile): whitish, pasty &

adhesive D. Calendar (Rhythm) § Deleted already since 1998 because it’s not recommended for

irregular cycle of menstruation § Menstrual cycle should be regular; obtain 4-6 months cycle

E. Lactation Amenorrhea Method (LAM): RA 7600-Breastfeeding & Rooming In Law

§ DOH organized Maternal & Child Family Health Institute (MCFHI) with the following members: ü All government hospitals ü Private hospitals (volunteer)

§ Normal involution (uterus goes back to normal) of the uterus: after 45 days or 5-6 weeks or 1 ½ months if not breastfeeding

§ Frozen breast milk is to be put out of the freezer 2 hours before feeding ( Body of Ref: 2-3 days / Freezer: 3-4 months)

§ Left over milk should be discarded & should not be re-preserved or re-frozen because it is already contaminated

METHODOLOGIES:

Temporary A. Chemical § Oral Pills (Logentrol)-has low dose of estrogen & progesterone that

inhibits ovulation § Parenteral: Depot Medroxyprogesterone Acetate (DMPA)/Depo-

provera- inhibits ovulation making women amenorrheic; 1991, DMPA was found to be causing cancer of the cervix 1994, DMPA is given IM 4x a year every 3 months (90 days interval)

§ Implants: Norplant-it inhibits ovulation effective for 5 years but seldom advocated for use because it is usually expensive; the client buys the device (consists of 5 capsules) & have it implanted at the health center by minor surgical incision in: ü upper inner arm because it is nearest to the brain ü external oblique ü thigh ü gluteal muscles

B. Mechanical: §  IUD ü  Up to 10 years protection §  Cervical cap & Diaphragm ü  Prevent the sperm to pass the cervix ü Works better with spermicide ü Wore 30 minutes before coitus and keep up to 6

hours after coitus §  Condom ü Most effective way to prevent STD’s / STI’s

METHODOLOGIES:

C. Behavioral Ø  Abstinence Ø Withdrawal D. Permanent Ø  Vasectomy (reversible)-since year 2000 in the

Philippines Ø  BLT

POLICIES:

I. Nutritional Surveillance (NS): to determine victims of malnutrition

A. Anthropometric Measurement: study of measurements of human dimensions Ø  Age for Weight-if weight is not appropriate with the age:

ü Stunting: growth retardation ü Wasting: connotes malnutrition

Ø  Age for Height-if height is not appropriate with the age: Stunting

Ø Weight for Height

Rule Male Female

Every height of 5 ft.

110 lbs. 105 lbs.

Every increment of an inch above 5 ft. ADD

+ 6 + 5

Every decrement of an inch below 5 ft. SUBTRACT

- 6 - 5

Ø  Skin Folds Test-pinch the external oblique muscle (“bilbil”) with your palm

Normal: 1 inch Overweight: > 1 inch Ø Middle Upper Arm Circumference (MUAC)-used in children

below 5 years old by measuring the middle upper arm with a tape measure

Normal: 13 cms. & above Malnutrition: <13 cms

POLICIES: I. Nutritional Surveillance (NS): to determine victims of malnutrition

B. Biochemical Method Ø  Micronutrient Malnutrition -available in small amount in the body VADAG: Vitamin A Deficiency:

§ Deficiency: Xeropthalmia-opacity of cornea leading to night blindnes Infants (6-12 months) : Give 100,000 i.u.

Pre-schoolers (12-83 months) : 200,000 i.u. Post partum : 200,000 i.u.

§ Never give Vitamin A to infants less than 6 months & pregnant women because it is toxic

Anemia: Iron Deficiency Anemia § Target age group: 0-59 months (less than 5 years) § Give 3-6 mg/kbw/day § Always give the maximum Example: Child weighs 8 kg

8 x 6=48 mg/day for the 1st 3 months then monitor If still anemic, continue giving but compute again 6 mg/kbw

Goiter: Iodine Deficiency Disease (endemic in uphill) § Target age group: 0-59 months § Give 1 capsule (200 mg) of potassium iodate in oil once a

year For a child < 5 years old, empty contents of capsule in a cup

with warm water because he can’t tolerate it § Adverse Effect of Iodine Deficiency Disease that must be

avoided: Ø Mental retardation-intelligence quotient: idiot, moron &

imbecile Ø Growth retardation- cretinism (pedia) & dwarfism (adult)

Ø  Macronutrient Malnutrition - available in large amount in the body (Protein Energy Malnutrition or PEM)

§ Kwashiorkor-protein deficiency § Marasmus-carbohydrate deficiency (energy giving food)

Kwashiorkor Marasmus Etiology Disease experienced by an elder

child upon the birth of a new baby Muscle wasting

Deficiency CHON CHO Age Toddlers (1-3 years old) All ages Major Signs & Symptoms

Facial edema, moon facie Muscle wasting, old man’s facie

Hair Changes (+) color changes from black to brown or from brown to golden yellow (+) sparse “flag sign”

(-) hair changes

Skin Dermatosis: dryness, peeling off of the skin, desquamation

(-)

Behavior Irritable Apathetic Management High CHON diet High CHO diet Hospital Setting Total Parenteral Nutrition (TPN)

Hyperalimentation process IV infusion with CHON, CHO regulated by a machine

POLICIES: II. Food Production

Fortification-products without any nutrient are added with nutrients RA 8172 (Asin Law): Fidel Salt (Fortification of Iodine Deficiency Elimination)=Iodized Salt-“Patak” sa Asin” by Secretary Flavier on December 1-5, 2003 where DOH workers go to market to check if salt sold contains iodine by placing few drops of reagent: If salt color turns to blue violet→ fortified with iodine If salt color show no change→ not fortified with iodine RA 832 (Rice Fortification): FVR (Fortified Vitamin Rice) by Secretary Flavier under FVR, Erap Rice under Erap, Gloria Rice or “Bigas ni Gloria” under PGMA

ENVIRONMENTAL SANITATION

Ø refers to all factors available in the environment affecting the health of the individual or population

Ø  regulated by PD 856: Comprehensive Sanitation Code of the Philippines

ENVIRONMENTAL HEALTH SERVICE (EHS) OF DOH IS RESPONSIBLE FOR

§ Promotion of healthy environmental conditions & prevention of environmental related diseases through appropriate sanitation strategies § Promotion & implementation of sanitation programs through the Department of Health Field Health Units § Conceptualization of new programs/projects to contend with emerging environmentally related health problems

COMPONENTS:

ü Water Supply Sanitation Program ü  Proper Excreta and Sewage Disposal

Program ü  Insect and Rodent Control ü  Food and Sanitation Program ü  Hospital Waste Management Program

1. WATER SUPPLY SANITATION PROGRAM

ü  Potable ü  Free from any particles that might

cause illness to an individual

Ways to make Water Potable: § Boiling: minimum of 3 minutes to maximum of 10 minutes for drinking § Sterilization: 30 minutes after the water starts to boil § Filtration: makes use of filter paper or cotton cloth to separate solid particle from liquid if water comes from river

§ Coagulation/Flocculation: uses aluminum crystal (tawas) that collects or absorbs particles from liquid part & becomes slimy

ü In 1 gallon of water, drop tawas (the size of magi cubes) & allow to stand for 6-8 hours ü Initially, water appears to be cloudy then after 6-8 hours of standing, the water becomes clear

Chlorination: uses 100% pure concentrated chlorine bought from botika or given free by health centers

Ø  To prepare stock solution (SS): in 1 liter drinking water, add 1 tablespoon of concentrated chlorine which is potent for 3-4 months

Ø  To prepare the chlorinated water: in 2 ½ gallons of drinking water (10,000 ml=10 liters), add 1 tablespoon from the prepared stock solution & let it stand for 30 minutes to react with water

§ Fluoridation: adding fluoride to prevent dental caries (primary significance) & whitens enamel of teeth ( 2nd significance)

§ Aeration: exposing drinking water in air to strengthen taste within 24 hours which is usually used in uphill areas where there’s less or no pollution

3 TYPES OF APPROVED WATER SUPPLY AND FACILITIES

Level I Point Source

A protected well or a developed spring with an outlet but without a distribution system for rural areas where houses are thinly scattered.


Level II Communal faucet system or stand posts

A system composed of a source, a reservoir, a piped distribution network and communal faucets, located at not more than 25 meters from the farthest house in rural areas where houses are clustered densely.


Level III Waterworks system or individual house connections

A system with a source, a reservoir, a piped distributor network and household taps that is suited for densely populated urban areas.

2. PROPER EXCRETA AND SEWAGE DISPOSAL SYSTEM

3 TYPES OF APPROVED TOILET FACILITIES

Level 1 Non-water carriage toilet facility: - Pit latrines - Reed Odorless Earth Closet - Bored-hole - Compost Toilets requiring small amount of water to wash waste into receiving space - Pour flush - Aqua privies

Pit latrines Ø most commonly observed in rural area Ø  has three components: the pit, a squatting plate and the

super-structure Ø  types of pit include “Antipolo type”, a pit type of toilet provided with concrete floor

and an elevated seat with a cover Ventilated Improved Pit or VIP, pit with a vent pipe Reed Odourless Earth Closet or ROEC, a pit completely displaced

from the superstructure and connected to the squatting plate by a curved chute.

Bored Hole Latrine ü  consists of relatively deep holes bored into the earth by

mechanical or manual earth-boring equipment ü  holes are about 10-18 inches in diameter and usually

15-35 feet deep. The hole is provided to facilitate squatting. Two types of bored-hole latrines are:

Wet Type - when the hole penetrates ground water table or other strata.

Dry Type - when he hole does not reach ground water table; fills up at a faster rate then than the wet type.


Level 2

On site toilet facilities of the water carriage type with water sealed and flushed type with septic vault/tank disposal facilities.


Level 3

Water carriage types of toilet facilities connected to septic tanks an/or to sewerage system to treatment plant.

THINGS TO CONSIDER IN CONSTRUCTING A TOILET FACILITY:

ü  At least 25 meters away from water sources at a lower elevation

ü  It should be within your financial capability ü  It should be approved by the local health

authorities

CARE AND MAINTENANCE OF YOUR TOILET FACILITY:

ü Water must be provided at all times. ü  Use toilet paper ü  Use lysol once a month for odor removal ü  Clean the bowl by muriatic acid to remove the stains. ü  Avoid depositing solid objects on the bowl to prevent clogging ü  Always check your toilet if it’s clean ü  Use plunger when clogging occurs. Don’t use sticks or rods to

avoid the breakage of the trap or the bowl.

3. PROPER SOLID WASTE MANAGEMENT

refers to satisfactory methods of storage, collection and final disposal of solid wastes

SOURCES OF SOLID WASTE Household Waste - these are wastes generated in or discharged

from household including shops but excluding commercial activities

Commercial Waste - restaurants, stationery shops, grocery

shops or any commercial activity are the main sources of commercial waste.

Market Waste - only refers to waste generated in or discharged

from markets both for whole sale and retailing

SOURCES OF SOLID WASTE Institutional Waste - these are wastes generated in

government, state enterprise and private firm office. Street Sweeping Waste - these are wastes generated by the

street sweeping cleansing service. River Waste - includes all the wastes generated by the river

and creek cleansing Medical Waste - these are wastes generated in hospitals.

COMPONENTS OF SOLID WASTE

Garbage refers to left over vegetable, animal and fish material from kitchen and food establishments. These materials have the tendency to decay giving off foul odors and sometimes serve as food for flies and rats.

Rubbish refers to waste materials such as bottles, broken glass,

tin can, waste papers, discarded textile materials, porcelain wares, pieces of metal and other wrapping materials.


Ashes are left over from burning of wood and coal. Ashes may become a nuisance because of the dust associated with them.

Stable manure is animal manure collected from stables. Dead animals like dead dogs, cats, rats, pigs, and chickens that

are killed by cars and trucks on streets and public highways. They include small and large animals that died from disease.


Street sweeping includes dust, manure, leaves, cigarette buts, waste papers and other materials that are swept from streets.

Night soil is human waste normally wrapped and thrown into

sidewalks and streets. This also includes human waste from pail system of toilets.

Yard cuttings includes leaves, branches, grass and other

SANITARY WAYS OF TREATING GARBAGE:

Segregation-separating biodegradable from non biodegradable

Collection-adherence to the proper collection time→ the City of Manila coordinates with Leonel Waste Management (a private firm which collects garbage) where the truck driver coordinates with the Barangay Chairman on the time they will collect garbage so don’t bring out garbage before the collection time

WAYS OF DISPOSAL

Household ○ Burial ► Deposited in 1m x 1m deep pits covered with soil, located 25 m. away from water supply ○ Open burning o  Animal feeding o  Composting o  Grinding and disposal sewer

WAYS OF DISPOSAL

Community ○ Sanitary landfill or controlled tipping ► Excavation of soil deposition of refuse and compacting with a solid cover of 2 feet ○ Incineration Ecological Solid Waste Management: RA 9003- the use of incinerator approved in 2000 but was implemented in 2003 because of lack of funding to purchase

4. FOOD SANITATION PROGRAM

POLICIES: ü  Food establishment are subject to inspection

(approved of all food sources containers and transport vehicles)

ü  Comply with sanitary permit requirement ü  Comply with updated health certificates for food

handlers, helpers, cooks ü  All ambulant vendors must submit a health

certificate to determine present of intestinal parasite and bacterial infection

3 POINTS OF CONTAMINATION ü Place of production processing and source of

supply ü Transportation and storage ü Retail and distribution points

5. HOSPITAL WASTE MANAGEMENT

RA 4226-Hospital Licensure Act monitors the hospital license & proper management of wastes as well as renewal of license to operate

GOAL: To prevent the risk of contraction contracting

nosocomial infection from type disposal of infectious, pathological and other wastes from hospital

COLOR CODING OF BIN TO KEEP WASTE:

Green : wet waste Black : dry waste Yellow: infectious/pathological waste like blood, sputum, urine, feces & gauze Orange: toxic/hazardous waste

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