COMMUNITY HEALTH
NURSING
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LEVELS OF HEALTH CARE SERVICES
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3
THE PUBLIC
HEALTH NURSE
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Qualifications and Functions
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Must be professionally qualified
and licensed to practice in the
arena of public health nursing
Consistent with the nursing law
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 Management function
Inherent
in the practice of PHN
Performs Program Manager
Organizes the nursing service of the local
health agency
 Supervisory function
Supervisor of the midwives and other
health workers
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 Nursing care function
 Inherent function of the nurse
 Based on the science of art and caring
 Caring for all levels of clientele toward health promotion and
disease prevention
 Collaborating and coordinating function
 Care coordinators for communities and their members
 Establishes linkages and collaborative relationships with other
health professionals, government agencies, private sectors,
NGO’s people’s organizations to address health problems
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 Health promotion and education function
Activities
goes beyond health teachings
and health information campaigns
 Training function
Initiates the formulation of staff
development and training programs for
midwives and other auxiliary workers
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Research function
 Participates
in the conduct of research and
utilizes research findings in her practice
Disease surveillance
Measure the magnitude of the problem
Measure the effect of the control program
NURSING PROCEDURES
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 Clinic visit
 Patient visits the health center

Most common is BP measurement
 Home visit
 Family-nurse contact
 The PHN visits the patient
 Bag technique
 Tool by which the nurse during her visit will enable her to perform a
nursing procedure with ease and deftness, save time and effort
 Most important principle


Minimize if not prevent the spread of any infection
Important points to consider in the use of the bag




Contain all necessary articles
Cleaned very often
Well protected
Arrangement-most convenient
PUBLIC HEALTH PROGRAMS
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PUBLIC HEALTH PROGRAMS
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 Sets of interventions put together to operationalize
policies and standards directed towards the
prevention of certain public health problems
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
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
FAMILY HEALTH
NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL
COMMUNICABLE DISEASE PREVENTION AND CONTROL
ENVIRONMENTAL HEALTH AND SANITATION
OTHER PRIORITY HEALTH PROGRAMS


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Sentrong Sigla
Herbal Medicine
Health Emergency Preparedness and Response Program
National Voluntary Blood Services Program
Botika ng Barangay
FAMILY HEALTH
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BASIC UNIT OF THE COMMUNITY
CONCERNED WITH THE HEALTH OF THE
MOTHER, UNBORN, NEWBORN, INFANT,
CHILD, ADOLESCENT AND YOUTH, ADULT
MEN AND WOMEN AND OLDER PERSONS
FAMILY HEALTH
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 Maternal Health Program
 Family Planning Program
 Child Health Programs
 EPI
 Management of Childhood Illnesses
 Nutrition Program
 Oral Health Program
 Adolescent Health Program
 Adult Men, Women
 Older Person
 Philippine Reproductive Health
FAMILY HEALTH…..
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 Aims to:
 Improve the survival, health and well being of mothers
and the unborn




Pre-pregnancy
Prenatal
Natal
Postnatal stages
 Reduce morbidity and mortality rates:



Children 0-9 years old
Among Filipino adults and older persons and improve quality life
Mortality from preventable causes among adolescents and young
people
1. MATERNAL HEALTH PROGRAM
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Tasked to reduce MMR by three quarters by
2015 to achieve MDG
a. Antenatal Registration
b. Tetanus Toxoid Immunization
c. Micronutrient Supplementation
d. Treatment of Diseases
e. Clean and Safe Delivery
Micronutrient supplementation
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Vitamins
Vitamin A
Iron
Dose
10,000 IU
Schedule
2x a week
starting on
the 4th
month of
pregnancy
60mg/400 ug Daily
tablet
Remarks
Do not give Vitamin A
before 4th month of
pregnancy. It might
cause congenital
problems in the baby
Recommended Schedule for Post Partum Care Visits
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1st visit
1st week post partum
preferably 3-5 days
2nd visit
6 weeks post partum
2. FAMILY PLANNING PROGRAM
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 Annual Population Growth

2.36%
 Population expected to double in 29 years
 Total fertility rate



3.5 children/woman
3 to 4 million getting pregnant/year
85% expected to progress full term
 National Demographic and Health Survey (2003)


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44% women got pregnant with 1st child ages 20-24
6.1% Ages 15-19
35-39 – highest percentage of using contraceptives
15-19 – lowest percentage
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 Married women
 48.8% - use any form of contraceptive method
 33.4% - modern method
 15.5% - traditional method
 51.1% - do not use any form of contraceptive method
Family Planning Methods
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 Female sterilization
 Cutting or blocking two fallopian tubes (BTL)
 Male sterilization
 Vas deferens is tied and cut or blocked through a small
opening on the scrotal skin (Vasectomy)
 Effective 3 months after the procedure
 Pill
 Hormones – estrogen and progesterone
 Taken daily PO
 Male condom
 Thin sheath of latex
 Dual protection from STIs including HIV
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 Injectables
 Synthetic hormone – progestin which suppresses ovulation,
thickens cervical mucus
 LAM
 Postpartum method of postponing pregnancy based on
physiological infertility experienced by breast feeding women
 Effective only for a maximum of 6 months postpartum
 Mucus/Billings/Ovulation
 Abstaining from SI during fertile days
 Can not be used by woman with unusual disease or condition
that results in extraordinary vaginal discharge that makes
observation difficult
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 BBT
 Identifying the fertile and infertile period by daily taking and
recording rise in BT during and after ovulation
 Temp is taken 3 hours of undisturbed rest (usually morning)
 Sympto-thermal method
 Combination of BBT and Billing/Mucus method
 Two day method
 Simple fertility awareness based method
Cervical secretions as an indicator of fertility
 Checking the presence of secretions daily

 Standard days method
 Users with menstrual cycle between 26 and 32 days are
counseled to abstain from SI on days 8-19 to avoid pregnancy
Misconception about Family Planning Methods
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 Some family planning methods causes abortion
 Abortion is termination of pregnancy; family planning
prevents pregnancy
 Using contraceptives will render the couples sterile
 Only vasectomy and BTL considered permanent methods and
chosen by the couples who have completed desired family size
 Using contraceptive methods will result to loss of
sexual desire

Contraceptives free the couple from unwanted pregnancies,
this enhances couple’s sexual relationship
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 Strategy calls for the:
 Promotion of breastmilk as the ideal food for the healthy
growth and development of infants
 Exclusive breastfeeding for the first 6 months of life
 Overall objective:
 Improve the survival of infants and young children by
improving their nutritional status, G & D through optimal
feeding
4. EXPANDED PROGRAM IMMUNIZATION
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 Plz follow sri lankan one…
General principles which apply in
vaccinating children
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 Safe and immunologically effective to administer all
EPI vaccine on the same day at different sites of the
body
 Measles vaccine should be given as soon as the child is
9 months old


9 months – 85% protection
1 year above – 95% protection
 Vaccination schedule should not be restarted from the
beginning even if the interval between doses exceeded
the recommended interval by months or years
 Moderate fever, malnutrition, mild respiratory
infection, cough, diarrhea and vomiting are not
contraindicated to vaccination; unless the child is so
sick that he needs to be hospitalized
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 Absolute contraindications to immunizations are:
 DPT2 or DPT3 to a child who has had convulsions or shock
within 3 days the previous dose
 Vaccines containing the whole pertussis component should not
be given to children with an evolving neurological disease
 Live vaccines like BCG must not be given to
immunosuppressed due to malignant disease (child with
clinical disease), therapy with immunosuppressive agents or
irradiation
 Safe and effective with mild side effects after
vaccination. Local reaction, fever and systemic
symptoms can result as part of the normal immune
response
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 Giving doses of vaccine at less than the recommended 4
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weeks interval may lessen the antibody response.
Lengthening the interval between doses of vaccines leads
to higher antibody levels
No extra doses must be given to children who missed a
dose of DPT/HB/OPV/TT
Strictly follow the principle of never, ever reconstituting
the freeze dried vaccines in anything other than the
diluents supplied with them
Repeat BCG vaccination if the child does not develop a
scar after the 1st injection
Use one syringe one needle per child during vaccination
6. Nutrition Program
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 Common nutritional deficiencies
 Vitamin A
 Iron
 iodine
Nutrition Programs and Projects
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 Micronutrient Supplementation
 “Araw ng Sangkap Pinoy” (Garantisadong Pambata)

Twice a year distribution of Vit. A capsule to children 6 – 71 mos
 Food Fortification Program (RA 8976)
 Addition of essential nutrients to a widely consumed food
product
 Mandatory fortification of staples namely;
 Flour
with Iron and Vitamin A
 Cooking oil and refined sugar with Vitamin A

Voluntary fortification of processed foods through “sangkap
pinoy seal”
Nutrition Programs and Projects…
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 Essential Maternal and Child Health Service Package
 Breast feeding
 Complementary feeding
 Micronutrient Supplementation
 Nutrition information, communication and
education
 Home, School and Community Food Production
 Food Assistance
 Livelihood Assistance
Nutritional guidelines for
micronutrient supplementation
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TARGET
PREP
DOSE
Infants 6 – 11
months
100,000 IU
1 dose only
Children 12 – 71
months
200,000 IU
1 cap every 6
months
REMARKS
1 cap given anytime during 611 mos but usually given 1t 9
mos during the measles
immunixation
Universal Supplementation of Vitamin A
Supplementation for
pregnant and post partum women
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TARGETS
PREP
DOSE
DURATION
REMARKS
Pregnant
10,000 IU
1 cap 2x
week
4th month till
delivery
Should not be given
who are already
taking pre-natal
vitamins that also
contain Vit. A
Post-partum
200,000 IU
1 cap
One dose only
within 4 weeks
after delivery
Vit. A of 200,000 IU
should not be given
to pregnant women
6. Oral Health Program
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 Classifications of oral intervention



PREVENTIVE
 Oral examination
 Oral hygiene
 Pit and fissure sealant
 Flouride utilization program
CURATIVE
 Permanent filling
 Gum treatment
 Atraumatic restorative treatment
 Temporary filling
 Extraction
 Drainage of localized oral abscess
PROMOTIVE SERVICES
 Health education
REPRODUCTIVE HEALTH
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 A state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity in all matters relating to the reproductive
system and to its functions and processes.
CONCEPTS
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1.
2.
3.
4.
5.
6.
7.
A married couple has the capability to reproduce/procreate.
RH is the exercise of reproductive right with responsibility (e.q. it
is the freedom to when and how to do so)
Includes sexual health for the purpose of enhancement of life
and personal relations (sexual health means protection from STD,
from harmful reproductive practices and violence, control and
freedom over sexual relations.
Means safe pregnancy and delivery. The right of access to
appropriate health information and services to enable woman to
go through pregnancy and childbirth safely.
Includes protection from unwanted pregnancy by having access
to safe and acceptable methods of family planning of their
choice.
Includes protection from harmful reproductive practices and
violence.
Assures access to information on sexuality to achieve sexual
enjoyment.
VISION
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 Reproductive health practice as a way of life for
every man and woman throughout life.
GOALS
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 To achieve healthy sexual development and
maturation
 Achieve their reproductive intention
 Avoid illness/diseases, injuries, disabilities related
to sexuality and reproduction
 Receive appropriate counseling and care of RH
problems
Every pregnancy should be intended
 Every birth should be healthy
 Every sex act should be free of coercion and infection
 Achieve a desired family size

STRATEGIES
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Increase and improve the use of more effective or
modern contraceptive methods. Increase the type of
methods’ offered available in the program
Provision of care; treatment and rehabilitation for RH,
if possible in all facilities (clinic & hospital)
RH care provision should be focused on adolescent,
men and unmarried and other displaced people with
RH problems.
Strengthen outreach activities and the referral system
Prevent specific RH problems through information
dissemination and counseling of clients with RH
problems.
TEN ELEMENTS OF RH
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Maternal and Child Health Nutrition
Family planning
Prevention and Management of Abortion Complications
Prevention and Treatment of RTI including STDs, HIV
and AIDS
Education and Counseling on Sexuality and Sexual Health
Breast and Reproductive Tract Cancers and other
Gynecological conditions
Men’s Reproductive Health
Adolescent Reproductive Health
Violence against Women (VAW)
Prevention and Treatment of Infertility and Sexual
Disorder
Factors/Determinants of Reproductive Health
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Socio-economic conditions
1.
Poverty
Nutrition
Living condition
Family environment
1.
2.
3.
4.



Family surroundings influence the family’s knowledge,
attitudes and practices (KAP)
Many still adhere to superstitious beliefs in terms of health
practices among the elders and tend to pass it on to the
next generation.
Decision of other members may prevail even against the
will of the concerned individual.
Status of women
2.
Destined to bear and raise children

Reducing their mobility and access to education, employment
and other activities related to personal development.

Number and short spacing of pregnancies can
contribute to health or mental/physical burden or
deterioration.
Women should be given equal right in;


Education
Making decision






3.
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to have or not to have children for their health and well-being
Health protection
Right to be free from torture and ill treatment
Right to participate in the political arena.
Social and Gender Issues
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Biological, Cultural and Psycho-Social Factors
4.
Biological


Refers to the individual (knowledge of his her
reproductive organ and its functions)
Culture



Country’s norms, practices of RH.
Care provider need to know the cultural values and
orientation of their clients.