HANDOUT IN BHW
REFRESHER TRAINING
COURSE
Volume I
PART I: Roles of Community Health
Worker
1. An ADVOCATE of current health programs, projects and activities to improve access
and use of health services.
Examples :
BHWs are expected to know:
1. The basic concepts on the priority programs of DOH:
a. MNCHN
b. RPRH
c. IYCF
d. GP
e. Communicable and Non-communicable diseases.
f. Healthy lifestyle
2. An EDUCATOR who will advise and counsel the community.
Providing basic information and education campaigns on the priority programs of the
DOH (e.g., importance of immunization, pre/post natal visits or preventive methods) to
either minimize or control the spread of infectious diseases (e.g., TB or dengue
3. A DISSEMINATOR to maintain regular communication between local professional
health workers and their catchment household.
Acts as a distributor of IEC materials (e.g., pamphlets and brochures) if available, while
conducting household education campaign or counselling.
4. A LINKER to facilitate access or association of the community between local professional
health workers and their catchment household.
a. Knowledgeable of when and where to refer clients for their specific needs or health
facilities that provide specific services needed by members of their household
catchment areas.
b. Constantly update their household catchment areas on the latest ordinances for
health programs or health related activities supported by local officials or NGOs.
5. A RECORD KEEPER to maintain updated lists/records of health data, health
activities/events in the community.
a. Regularly update family profile of household catchment areas
b. Regularly record important information regarding compliance of members of the
household catchment areas with the needed medications (e.g, NTP, HPN or DM)
What are the Qualities of a Good
Barangay Health Worker:
Three C’s
Compassionate (kind)
Other Qualities
Committed
Patient
Creative ( Resourceful)
The all around “handyman” for
health
Two V’s
Voluntary spirit
Visionary leadership
Healthy
Team worker (good
model/approachable)
PART II: Vital Signs Assessment
The Vital
Signs
or Cardinal
Signs are:
 Body Temperature
 Pulse
 Respirations
 Blood Pressure
Vital Signs
 Necessary to monitor the functions of the body.
 Necessary to know the changes in function that otherwise might
not be observed.
 When these values are not zero, they indicate that a person is
alive.
When Monitoring Vital Signs...
 All persons should be made comfortable and reassured that
recording vital signs is normal part of health checks, and that it is
necessary to ensure that the state of their health is being monitored
correctly.
 Any abnormalities in vital signs should be reported to the health
care professional in charge of care (midwife, nurse or doctor).
Times to Assess Vital Signs
 On admission to a health care agency to obtain baseline data (or during
home visits)
 When a client has a change in health status.
 According to a nursing or medical order.
 Before and after surgery.
 Before and after administration of a medication that could aggravate
changes.
Body Temperature
Normal body temperature can range from 36.5 degrees Celsius to 37.2
degrees Celcius for a healthy adult.
 The normal body temperature of a person varies depending on gender,
recent activity, food and fluid consumption, time of day, and, in
women, the stage of the menstrual cycle.
A person's body temperature can be taken in any of the
following ways:
 Rectally
 Orally
 Axillary
 By ear
 By the skin
Procedures for Assessing Body Temperature
For an Axillary Temperature
1. Expose the client’s axilla. If the axilla is moist, dry it with the towel
in a patting motion.
2. Check the equipment.
3. Assist the client to place the arm tightly across the chest to keep the
thermometer in place.
4. Leave the thermometer in place until it beeps.
5. Remain with the client, and hold the thermometer in place if the
client is irrational or very young.
6. Read the temperature reading.
7. Document the temperature.
8. Clean the thermometer.
Pulse Rate
 The pulse rate is a measurement of the heart rate, or the number of
times the heart beats per minute
 As the heart pushes blood through the arteries, the arteries expand
and contract with the flow of the blood
Pulse Sites
1. Temporal. The site is above and away from the midline of the eye.
2. Carotid. At the side of the neck below the lobe of the ear.
3. Apical. Located at the left side of the chest.
4. Radial. Thumb side of the inner aspect of the wrist.
5. Brachial.
 The radial site is the most commonly used. It is found in most people
and is readily accessible.
 A stethoscope is used for assessing apical pulses and fetal heart tones.
 The normal pulse for healthy adults ranges from 60 to 100 beats per
minute
 pulse rate may fluctuate and increase with exercise, illness, injury, and
emotions.
Procedures for Assessing a Peripheral Pulse
1. Prepare the client. Select the pulse point. Let the arm rest along side
of the body, the palm facing downward (for clients in bed).
2. Palpate and count the pulse. Place 2 or 3 finger tips lightly over the
pulse point. Count for 1 minute.
3. Document and report pertinent assessment data. (a. Cool skin
temperature, b. Fast or slow pulse rate, c. Full, bounding or weak pulse
volume, and d. irregular pulse rhythm)
Respiration
 Respiration is an act of breathing.
 usually measured when a person is at rest and simply involves counting
the number of breaths for one minute by counting how many times the
chest rises
 Normal respiration rates for an adult person at rest range from 12
to 16 breaths per minute.
 Normal breathing is silent.
Procedures for Assessing Respirations
1. Determine the client’s activity schedule. Choose a
monitor the respirations.
suitable time to
2. Observe and count the respiratory rate. Place a hand against the client’s
chest to feel the client’s chest movements, while supposedly taking the
radial pulse. An inhalation and an exhalation count as one respiration.
3. Document and Report Data. Report for abnormal breathing or complaints
of dyspnea.
Blood Pressure
 Is the force of the blood pushing against the artery walls
 Each time the heart beats, it pumps blood into the arteries, resulting in
the highest blood pressure as the heart contracts
Pumping Action of the Heart
 When the pumping action of the heart is weak, less blood is pumped
into the arteries, and the blood pressure decreases.
 When the heart's pumping action is strong and the volume of blood
pumped into the circulation increases, the blood pressure increases.
KOROTKOFF’S SOUNDS IN BP-TAKING:
• Systolic Pressure. Considered as the point where the first tapping
sound is heard during the deflation of the cuff.
• Diastolic Pressure. The point where the last audible sound is heard.
• Palpatory Method. Used when Korotkoff’s sounds cannot be heard.
Procedures for Assessing Blood Pressure
1. Prepare and position the client appropriately.
• Make sure that the client has not smoked or ingested caffeine
within 30 minutes prior to measurement.
• Expose the upper arm with the palm of the hand facing up and
forearm supported at the heart level.
2. Wrap the deflated cuff evenly around the upper arm. Apply the center
of the bladder directly over the middle aspect of the arm.
3. Position the stethoscope appropriately.
a. Insert the ear attachments of the stethoscope in your ears so that
they tilt slightly forward.
b. Ensure the stethoscope hangs freely from the ears to the diaphragm.
c. Place the stet over the brachial pulse with your index finger.
Procedures for Assessing Blood Pressure (cont.)
4. Auscultate the client’s blood pressure.
a. Pump up the cuff until tight enough.
b. Release the valve on the cuff carefully so that the pressure
decreases at the rate of 2 to 3 mmHg per second.
c. Identify the manometer reading (Korotkoff’s sounds: systolic
pressure and diastolic pressure).
d. Deflate the cuff rapidly and completely.
5. Remove the cuff from the client’s arm.
6. Repeat the above steps once or twice as necessary to confirm the
accuracy of the reading. Wait for 1 to 2 minutes before making
further determinations. This permits the blood trapped in the veins
to be released.
7. Document and report.
PART III: Basic First Aid
Technique
• Adequately trained BHWs are expected to provide DOH-recognized
first aid techniques while waiting for the health personnel to arrive
or while in transit during actual referral.
• In all emergencies, always call for help or ask a bystander to call
for help before starting the first aid measures.
BENIGN FEBRILE CONVULSION
• Benign febrile convulsion is presented as generalized seizures
secondary to high grade fever common among children ≤ 6 yrs
old.
What to do:
• CALL FOR HELP!
• NEVER wrap a person with fever to avoid further increase
in temperature.
• NEVER stop or control the shaking movements to avoid
injuries.
• Give a sponge bath (alternating wet and dry cloth) until the
temperature goes down to normal.
• Regularly check body temperature.
• Encourage and assist family members to the nearest health
facility.
POISONING
What to do:
• CALL FOR HELP!
• In all types of poisoning AND if the patient is conscious, give
lots of water to drink.
• NEVER ask the patient to vomit if the poison is a chemical
substance or when there are burn marks on the lips or mouth.
• Check vital signs.
• Refer.
WOUNDS
• All types of wounds are potential entry points of infection. It is
very important to wash all types of wounds no matter how small
its physical appearance may be to prevent infection.
What to do:
• CALL FOR HELP!
• Wash hands with soap and water.
• Clean the wound with soap and water to remove dirt,
sand or dried blood then apply betadine in a clockwise
motion (inner to outer).
• Cover the wound with clean gauze or cloth.
• Refer .
BLEEDING
Bleeding can be external (wound or open fractures) and
internal (bloody discharge from the nose, ears, vagina, anus).
What to do:
• CALL FOR HELP!
• Check vital signs.
• For active external bleeding, elevate the affected area
and apply direct pressure with a clean cloth until the
bleeding stops.
• REFER!
What to do:
Seek emergency help if you are pregnant and you have:
• Heavy vaginal bleeding
• Severe pain
• Frequent contractions
1. Monitor Bleeding
• Put on a sanitary pad or panty liner to keep track of the
amount of bleeding.
2. Prevent Further Bleeding
• Don’t insert anything into the vagina.
3. Get Help
• Call your health care provider immediately . A health
care provider will examine you for signs of
dangerous blood loss and may do tests to confirm the
health of your pregnancy.
FOOD POISONING
Food poisoning is a common, yet distressing and sometimes
life-threatening problem.
People infected with food-borne organisms may be
symptom-free or may have symptoms ranging from mild
intestinal discomfort to severe dehydration and bloody
diarrhea.
What to do:
1.Control Nausea and Vomiting
• Avoid solid foods until vomiting ends. Then eat light,
bland foods, such as saltine crackers, bananas, rice, or
bread.
• Sipping liquids may help avoid vomiting.
• Don’t take anti-nausea or diarrhea medications without
asking your doctor. Your doctor may give you antinausea medication if you are at risk of being
dehydrated.
• health of your pregnancy.
What to do:
2. Prevent Dehydration
• Drink clear fluids, starting with small sips and gradually
drinking more.
• If vomiting and diarrhea last more than 24 hours, drink
an oral rehydration solution.
3. When to Call a Doctor
• Call a doctor immediately if symptoms last more than 3
days and include:
✓ Severe belly pain
✓ Fever
✓ Bloody diarrhea or dark stools
✓ Vomiting that is prolonged or bloody
✓ Signs of dehydration such as dry mouth,
decreased urination, dizziness, fatigue, or
increased heart rate or breathing rate
DIARRHEA
Take Fluids
• Give an adult plenty of clear fluid, like fruit juices
and clear broth.
• Give a child or infant frequent sips of a rehydration
solution such as hydrite or pedialyte.
• Make sure the person drinks more fluids than they
are losing through diarrhea. If they are unable to
keep up with their losses, call a doctor.
Call a doctor right away if:
• You suspect that you or
• your child is dehydrated.
• An infant 3 months old or younger has vomiting or
diarrhea.
• There is blood or mucus in the stool, or the stool is
black.
• There is fever.
• The person is losing more fluid in his stool than he
can replace by drinking fluids.
BURN (First Degree)
1. Stop Burning Immediately
• Put out fire or stop the person's contact with hot liquid,
steam, or other material.
• Remove hot or burned clothing. If clothing sticks to skin,
cut or tear around it.
2. Remove Constrictive
Clothing Immediately
• Take off jewelry, belts, and tight clothing. Burns can
swell quickly.
4. Cool Burn
• Hold burned skin under cool (not cold) running water or
immerse in cool water until pain subsides.
5. Protect Burn
• Cover with clean, non-adhesive bandage or clean cloth.
• Do not apply butter or ointments, which can cause
infection.
6. Seek medical help if:
• You see signs of infection, like increased pain, redness,
swelling, fever, or oozing discharges.
• Redness and pain last more than a few hours.
• Pain worsens.