Community Health Nursing
najarrieta, rn, rm, ctn, manc drdmc
Community Health Nursing
Definitions
• “Public Health is the science and art of
preventing disease, promoting life, and
promoting health…”
Dr. C.E. Winslow
• “Public Health Nursing is the practice of nursing
in national and local government health
departments. …community health nursing
practiced in the public sector.”
- Standards of Public Health Nursing in the
Philippines, 2005
Community Health Nursing
• Community Health Nursing is “the utilization of
the nursing process in the different levels of
clientele-individual, families, population groups
and communities… promotion of health,
prevention of disease and disability, and
rehabilitation”
- Dr. Araceli Maglaya, et. al.
Community Health Nursing
Need to Remember
• Individual, Family, Population Groups, and
Community are the four LEVELS of clientele
• Community is the patient in CHN
• Family is the unit of care
• Goal of CHN is achieved through multisectoral
efforts
• CHN is part of Health Care System and the
Larger Human Services System
Community Health Nursing
Special Note:
• The Public Health Nurse will take charge of the
Municipal Health Officer’s responsibilities in the
event that the MHO is unable to perform his
duties or is not available
Community Health Nursing
Role of Public Health Nurse
•
•
•
•
•
•
•
Clinician
Health Educator
Coordinator and collaborator
Supervisor
Leader and Change Agent
Manager
Researcher
Community Health Nursing
Health Care Delivery System
• The Public Sector
• Department of Health
– Vision: The DOH is the leader, staunch advocate, and
model in promoting health for all in the Philippines.
– Mission: Guarantee equitable, sustainable, and quality
health for all Filipinos, especially the poor and lead the
quest for excellence in health.
– Goal: Health Sector Reform Agenda
• EO 102 identifies the DOH as the national
health authority
Community Health Nursing
• FOURmula ONE for Health
– Framework for the implementation of the Health Sector
Reform Agenda
• Four Elements
– Good Governance
– Health Financing
– Health Regulation
– Health Service Delivery
Community Health Nursing
Local Government Units
• RA 7160 or Local Government Code of 1991
– Devolution of powers, functions and responsibilities
– Provincial and municipal level
• District Health System – smallest manageable
unit in areas which are small enough to be
managed without being bogged down by
bureaucracy, yet large enough to be feasible
Community Health Nursing
Primary Health Care
“Essential health care made universally
accessible to individuals and families in
the community by means acceptable to
them through their full participation and
at a cost that the community can afford
at every stage of development.”
World Health Organization
Community Health Nursing
Things to Remember:
• PHC Goal: HEALTH FOR ALL BY THE YEAR
2000
– Alma Ata, USSR, First International Conference on
PHC, September 1978
• Legal Basis: LETTER OF INSTRUCTION 949
signed by Pres. F. Marcos
• Underlying Theme: HEALTH IN THE HANDS
OF THE PEOPLE BY 2020
Community Health Nursing
Primary Health Care
• Four Pillars of PHC
Support mechanism made available
Active community participation
Intra- and inter-sectoral linkage
Use of appropriate technology
Community Health Nursing
Levels of Health Care
• Two Levels of Primary Health Care Workers
– Village or Barangay Health Workers
• Trained CHW
• Health auxiliary volunteers
• Traditional birth attendants
– Intermediate Level Health Workers
• General medical practitioner
• Public health nurses
• Rural sanitary inspectors
• Midwives
Community Health Nursing
Three Levels of Health Care
Services
Primary
Secondary
Tertiary
Barangay Health
Station
Rural Health Units
Community
Hospitals
Emergency or
District Hospitals
Provincial or City
Hospitals
Regional Health
Services
Regional Medical
Centers and
Training Hospitals
National Health
Services Medical
Centers
Community Health Nursing
Levels of Disease Prevention
• Primary Level Disease Prevention
– Directed at individuals at risk; specific protection against
risks
– Immunizations
– Food supplementation
– Malaria chemoprophylaxis
Community Health Nursing
• Secondary Level of Prevention
– Directed for individuals in the subclinical asymptomatic
and symptomatic stage; aims to diagnose and treat
existing health problems
– Screening
– Casefinding
– Surveillance
– Treatment of communicable disease
Community Health Nursing
• Tertiary Level Disease Prevention
– Directed towards individual in the pathogenic stage of
disease; deals with the reduction of the magnitude and
severity of the residual effects of communicable and
non-communicable diseases
– Rehabilitation
– Control of measles during an epidemic
Community Health Nursing
Primary Health Care
• Education for Health
• Locally Endemic and
Communicable
Disease Control
• Expanded Program on
Immunization
• Maternal and Child
Health
• Essential Drugs
• Nutrition
• Treatment
• Safe Water and
Sanitation
• Dental Health
• Access to Sentrong
Sigla
• Mental Health
Community Health Nursing
Family Health Nursing
• First Level Assessment
– Wellness Condition
– Health Deficit are instances of failure in health
maintenance
– Health Threat are conditions that are conducive to
disease, accident, or failure
– Foreseeable crisis or stress points are anticipated
periods of unusual demand on the individual or family in
terms of adjustment
Community Health Nursing
• Second Level Assessment
– Inability to recognize the existence of a health condition
or problem
– Inability to make decisions with respect to taking
appropriate health action
– Inability to provide nursing care to the sick, disable, or
dependent member of the family
– Inability to provide a home environment that is
conducive to health maintenance and personal
development
– Failure to utilize community resources for health care
Community Health Nursing
Scale of Ranking Health
Conditions
Criteria
Score
Weight
Nature of the Condition
Wellness
Health Deficit
Health Threat
Foreseeable crisis
3
3
2
1
Modifiability of the Condition
Easily modifiable
Partially modifiable
Not modifiable
2
1
0
Preventive Potential
High
Moderate
Low
3
2
1
Salience
A condition needing immediate attention
A condition not needing immediate attention
Not perceived as a condition
2
1
0
Community Health Nursing
1
2
1
1
Home Visit
Principles
• Must have a purpose
• Makes use of all available
information about a patient
• Consider and give priority
to needs of clients
• Involve clients
• Should be flexible
•
•
•
•
Need of the client
Acceptance of the family
Policy of a specific agency
Other health agencies
present
• Past services given
• Ability of clients to
recognize own needs
Guidelines to consider about
frequency of visits
Community Health Nursing
Steps in Conducting Home Visits
1.
2.
3.
4.
5.
6.
Greet the client and introduce self
State the purpose of the visit
Assess the health needs
Perform the bag technique
Perform nursing care and give health teachings
Record all data (observation and care
rendered)
Community Health Nursing
Bag Technique
• Is a tool used by the nurse to enable her to
perform a nursing procedure with ease and
deftness
• PHN Bag is an essential and indispensable
equipment of a public health nurse which she
has to carry along during home visits
• The BP Apparatus is part of the PHN Bag
Community Health Nursing
Bag Technique
Principles
•
• Minimize, if not prevent the
spread of infection
•
• Saves time and effort of the
nurse
• Should show effectiveness •
of total care given to an
•
individual or family
• Can be performed in a
variety of ways
Important Points
Should contain all
necessary articles/supplies
Should be cleaned very
often and supplies are
replaced
Should be well-protected
Arranged according to
convenience
Community Health Nursing
Community Diagnosis
• An in-depth process in finding out the profiles, health
status of the community and the factors affecting the
present status
1. Preparation for Community Diagnosis
2. Data gathering (spot map, key informant interview,
community survey, records review)
3. Data presentation
4. Problem identification
5. Preparation of an action plan
Community Health Nursing
Community Organizing
• Is a process by which people, health services
and agencies of the community are brought
together to:
a. Learn about common problems
b. Identify these problems are their own
c. Plan the kind of action to solve problems
d. Act on this basis
Community Health Nursing
Community Organizing
Participatory Action Research
• Principles:
– People have the capacity to change
– COPAR should be based on the interest of the poorest
sectors of society
– COPAR should lead to the development of self-reliance
• Methods:
– Action-Reflection-Action-Session
– Consciousness-Raising
Community Health Nursing
COPAR Phases
• I. Pre-Entry Phase
– Site Selection
•
•
•
•
•
•
Must be DOPE
Health services are inaccessible or inadequate
Poor health status
Area has no serious peace and order problem
No strong resistance
Area is free from relatively similar programs
– Preliminary Social Investigation
– Identification of Potential Barangays
Community Health Nursing
• II. Entry Phase
– Integration
– Conduct of Information Campaign
– Deepening Social Investigation
– Identification of Potential Leaders
– Provision of Health Services
– Core Group Formation
Community Health Nursing
• III. Organization-Building Phase
– Preparing the community for organization-building
– Organizing the CHO
– Training and Education for the CHO
– Setting up the CHO
Community Health Nursing
• IV. Sustenance and Strengthening Phase
– Education and Training
– Networking and Linkages
– Community Mobilization on Health and Development
Concerns
– Development of Secondline Leaders
Community Health Nursing
Expanded Program on
Immunization
Vaccine
Minimum Age Number of
Doses
Amount
Route
BCG
At birth
0.05 mL
ID
1
Interval
Hepatitis B
At birth
3
0.5 mL
IM (thigh)
10th and 14th
week
DPT
6 weeks
3
0.5 mL
IM (thigh)
4 weeks
OPV
6 weeks
3
2 drops
PO
4 weeks
Measles
9 months
1
0.5 mL
IM (arm)
If child has convulsions, Do NOT give DPT
If child is immunocompromised, Do NOT give Polio,
Measles, and BCG!!!
Immunize every sick child
Community Health Nursing
Tetanus Toxoid
Vacci
ne
TT1
TT2
TT3
TT4
TT5
Minimum Time
Percent
and Interval
Protection
As early during
pregnancy
4 weeks
6 months
1 year
1 year
Duration of Protection
0
80
3 years; Infants protected
from NT
95
5 years; Infants protected
from NT
99
10 years; Infants protected
from NT
99
Lifetime; ALL Infants
protected from NT
Community Health Nursing
EPI: Cold Chain
• Storage:
– 6 months Regional Level
– 3 months Provincial/District Level
– 1 month Main Health Centers
– 5 days Health Centers
Community Health Nursing
Family Planning
• Principles:
– Responsible Parenthood
– Respect for Life
– Birth Spacing
– Informed Choice
• Mandate: EO 119 and EO 102
Community Health Nursing
Contraceptive Methods
• Natural
– Abstinence
– Calendar Method
– Basal Body Temperature
– Cervical Mucus (Billings)
– Symptothermal method
– Lactation Amenorrhea
Method
– Coitus Interruptus
– Standard Days Method –
Cycle Beads
• Surgical Methods
– Tubal Ligation
– Vasectomy
Community Health Nursing
Contraceptive Methods
• Hormonal
• Barrier
– Progestin-Only Oral
Contraceptives
– Low-Dose Combined
Oral Contraceptives
– Injectables
– Norplant Implants
– Intrauterine Device
– Diaphragm
– Cervical Cap
– Condoms
Community Health Nursing
Malnutrition
• Vitamin A Supplementation
– Infants (6 to 11 months) 100,000 IU – 1 dose
– Children (12 to 72 months) 200,000 IU – 1 capsule
every 6 months
– For Pregnant women given starting 4th Month 10,000 IU
twice a week until delivery
• Iron Supplementation
– For Pregnant women 60 mg Iron and 400 mcg Folic
acid 1 tablet OD for 6 months or 2 tabs per day if
started in the 2nd or 3rd trimester
Community Health Nursing
• Iron Supplementation
– For Low Birth Weight - drops 15 mg Iron/0.6 mL, 0.3 mL
once a day to start 2 months until 6 months
– For 1 to 5 y/o – syrup 30 mg Iron/5 mL, 1 tbsp OD for 3
months or 1 tsp once a week for 6 months
– For 6 to 11 years anemic and underweight – syrup 30
mg/5 mL, 2 tbsp OD for 6 months
• Iodine Supplementation
– Iodized capsule with 200 mg iodine 1 capsule for 1 year
Community Health Nursing
Garantisadong Pambata
• Campaign to support various health programs
that will reduce childhood illnesses
• Vit. A and iron supplementation
• Catch-up immunization
• Done twice a year (one week in April, and one
week in October)
Community Health Nursing
Newborn Screening
Disorder
Effects
Congenital Hypothyroidism
Mental Retardation
Congenital Adrenal Hyperplasia
Death
Galactosemia
Death and cataracts
Phenylketonuria
Mental Retardation
G6PD Deficiency
Anemia and Kernictirus
• Done after 24, 48th to 72nd hour after birth; screened again
after 2 weeks for more accurate results
• Uses heel prick method and an absorbent filter paper and
dried for 4 hours
• Report positive results immediately
Community Health Nursing
DOH Herbal Medicines
• BAYABAS
• ULASIMANG
BATO
• BAWANG
• LAGUNDI
• YERBA BUENA
• SAMBONG
• AKAPULKO
• NIYUG-NIYOGAN
• TSAANG GUBAT
• AMPALAYA
Community Health Nursing
IMCI
• Assess, Clasify, Identify, Treat
• CUVA
Community Health Nursing
Isolation Precautions
• Universal Precautions or Standard Precautions
– Apply to blood, all body fluids, secretions, and
excretions; skin that is not intact; and mucus
membranes
• Hand Hygiene or Handwashing
– Best way to prevent spread of pathogens
– May use alcohol based when hands are not visibly
soiled
– Handwashing is for visibly soiled hands
Community Health Nursing
Transmission Based Precautions
Airborne Precaution
Droplet Precaution
For PTB, measles, For influenza,
varicella
meningitis, diptheria,
Must use a
rubella
particulate filter mask Safe 3 feet and more
Do NOT RECAP NEEDLES!
Community Health Nursing
Contact Precaution
Skin to skin contact
or through fomites
Requires gloves, a
mask, gown, and
personal equipment
Tuberculosis
• TUBERCULOSIS
– CA: Mycobacterium tuberculosis
– MOT: Airborne droplet through coughing and sneezing
– Direct Sputum Smear Microscopy is the PRIMARY
diagnostic tool
– PPD: Detects presence of antibodies; Results after 48
to 72 hours
• (+) <5 y/o (+) BCG ≥10 mm is positive
• (+) >5 y/o (-) BCG ≥5 mm is positive
Community Health Nursing
Directly Observed Treatment Shortcourse
Category
Type of TB Patient
Intensive
Phase
Continuation
Phase
I
New smear-positive;
With extensive parenchymal lesion
EPTB
Severe concomitant HIV disease
2 RIPE
4 RI
II
Treatment failure
Relapse
2 RIPES/
1RIPE
5 RIE
New smear-negative PTB with minimal
parenchymal lesions
2 RIPE
4 RI
III
IV
Chronic
Refer
Community Health Nursing
Antimycobacterials
• Rifampicin – take with meals; protect from light
• Isoniazid – take before meals; give 10 to 100
mg of Pyridoxine
• Pyrazinamide – caution for gouty arthritis;
protect from light
• Ethambutol – not given to children below 6
years
• Streptomycin – given IM
Community Health Nursing
Leprosy
• LEPROSY (Hansen Disease)
– CA: Mycobacterium leprae
– MOT: Direct skin contact; prolonged
– Dx: Slit Skin Smear
– Types:
• Paucibacillary: Treat with Rifampicin and Dapsone for
6 to 9 months
• Multibacillary: Treat with Rifampicin, Clofazimine, and
Dapsone for 24 to 30 months
Community Health Nursing
Malaria
• MALARIA
– CA: Plasmodium (vivax, ovale, malariae, falciparum)
– MOT: Bite of anopheles mosquito
– DX: Quantitative Buffy Coat
– Treatment: Quinine, Sulfadoxine, Chloroquine,
Mefloquine
– Prophylaxis: Chloroquine, weekly intervals, start 1 to 2
weeks prior to entering endemic area.
– Update: Artemeter-Lumefantrine
Community Health Nursing
Dengue Hemorrhagic Fever
• DENGUE HEMORRHAGIC FEVER
– CA: Dengue virus (I, II, III, IV) and Chikungunya virus
– MOT: Bite of Aedes aegypti virus
– Dx: Tourniquet test (capillary fragility or Rumpel Leads
test)
– Treat:
• Fluids
• Paracetamol
• WOF bleeding
Community Health Nursing
Filariasis
• FILARIASIS
– CA: Wuchereria brancrofti, Brugia malayi, Brugia timor
– MOT: Bite of Aedes poecilius
– Dx: symptomatology: obvious lymphadenitis,
lymphangitis, lymphedema, elephantiasis, orchitis
– Treat:
• Diethylcarbamazine citrate (Hetrazan)
Community Health Nursing
Schistosomiasis
• SCHISTOSOMIASIS (Bilhariasis, Snail Fever)
– CA: Schistosoma japonicum, Schistosoma mansoni,
Schistosoma haematobium
– Intermediate Host: Oncomelania quadrasi
– MOT: Skin contact to contaminated water
– Treat:
• Praziquantel (Biltricide)
Community Health Nursing
Measles
• MEASLES
– CA: Paramyxovirus
– MOT: Airborne droplet (1 to 2 days before onset of s/s;
4 to 5 days after disappearance of rash)
– Pathognomonic Sign: Koplik’s spots
– PVT: Measles vaccine
– Mgt:
• Vitamina A Supplementation
• Ibuprofen or Paracetamol
• Supportive
Community Health Nursing
Chicken Pox
• CHICKEN POX
– CA: Varicella-Zoster Virus
– MOT: Direct contact (1 to 2 days prior to appearance of
rashes; 5 to 6 days onset of vesicular crusting)
– S/S: Vesicular rash starts from the trunk to peripheries
– Mgt:
• Acyclovir 800mg TID
• Paracetamol
• Keeping fingernails short
• Oatmeal bath
Community Health Nursing
Mumps / Parotitis
• MUMPS / PAROTITIS
– CA: Mumps Virus
– MOT: Airborne droplet (1 to 2 days before onset of
parotitis; 5 days after onset of swelling)
– Compli: orchitis, oophoritis, infertility,
meningoencephalitis
– PVT: MMR at 12 to 15 M; Booster at 4 to 6 years
– Mgt:
• Bedrest
• Antipyretics
Community Health Nursing
Diphtheria
• DIPHTHERIA
– CA: Corynebacterium diphtheria (Klebs-Loeffler
bacillus)
– MOT: Contact with ill or contaminated articles
– Pathognomonic Sign: Pseudomembrane on throat and
tonsils
– Dx: Culture of membrane
– PVT: DPT vaccine
– Mgt:
• Diphtheria antitoxin, penicillin, erythromycin
Community Health Nursing
Tetanus
• NEONATAL TETANUS and TETANUS OF
OLDER AGE GROUPS
– CA: Clostridium tetani
– MOT: Contamination of unhealed cord stump
– Treat:
• Penicillin I.V.
• Tetanus antiserum or tetanus immunoglobulin
–PVT:
• Tetanus vaccine
Community Health Nursing
Influenza
• INFLUENZA
– CA: Influenza virus (A, B, C)
– MOT: Droplet
– PVT: Inactivated (IM) for 6 months and older; Live,
attenuated (Nasal Spray) for 2 to 49 years
– Mgt:
• Supportive
Community Health Nursing
Pneumonia
• PNEUMONIA
– CA: a lot!
– MOT: mainly respiratory droplet
– Treat:
• Anti-infectives (Antibiotics, Antivirals, Antifungals)
• Antipyretics
– Mgt:
• Supportive
Community Health Nursing
Cholera
• CHOLERA (EL TOR)
– CA: Vibrio cholerae
– MOT: Fecal-oral route
– S/S: Rice-water stool
– Treat:
• Tetracycline
– Mgt:
• OReSol, coconut water, “am”, soap, cereals, BF
Community Health Nursing
Typhoid Fever
• TYPHOID FEVER
– CA: Salmonella typhi
– MOT: Fecal-oral route
– Note: Rose spots on abdomen or chest
– Treat:
• Chloramphenicol
– Mgt:
• Rehydration
• Proper food preparation
Community Health Nursing
Shigellosis
• SHIGELLOSIS (Bacillary dysentery)
– CA: Shigella (dysenterae, flexneri, boydii, soneii)
– MOT: Fecal-oral route
– Treat:
• Trimethoprim-sulfamethoxazole
– Mgt:
• Rehydration
• Proper food preparation
Community Health Nursing
Amebiasis
• AMEBIASIS (Amebic dysentery)
– CA: Entamoeba histolytica
– MOT: Fecal-oral route
– Treat:
• Metronidazole
– Mgt:
• Rehydration
• Proper food preparation
Community Health Nursing
Soil-Transmitted Helminthiasis
• SOIL-TRANSMITTED HELMINTHIASIS
– CA: Ascaris lumbricoides, Trichuris trichiura,
Ancylostoma duodenale & Necator americanus
(Hookworn)
– MOT: Contact with contaminated soil
– Treat:
• Mebendazole
• Albendazole
Community Health Nursing
Paragonimiasis
• PARAGONIMIASIS
– CA: Paragonimus westermani (subsp. philippinensis),
Paragonimus siamenses
– MOT: ingestion of raw crab (Sundathelpusa philippina,
Varona litterata)
– Treat:
• Praziquantel
• Bithionol
– Mgt:
• Proper food preparation
Community Health Nursing
Hepatitis A
• HEPATITIS A (Infectious Hepatitis, Epidemic
Hepatitis, Catarrhal Jaundice)
– CA: Hepatitis A virus
– MOT: Fecal-oral route, parenteral
– Treat:
• IM injection of gamma globulin
– Mgt:
• Environmental sanitation
• Proper food preparation
Community Health Nursing
Paralytic Shellfish Poisoning
• PARALYTIC SHELLFISH POISONING (Red
Tide Poisoning)
– CA: Dinoflagellates (Pyromidium bahamense var.
compressum in Manila Bay, Samar, Bataan, Zambales)
– MOT: Eating contaminated bivalve shellfish
– Treat/Mgt:
• Induce vomiting
• Pure coconut milk and sodium bicarbonate
Community Health Nursing
Leptospirosis
• LEPTOSPIROSIS (Weil’s Disease, Trench
Fever, Mud Fever, Flood Fever, Japanese
Seven Days Fever, Spiroketal Jaundice)
– CA: Leptospira interrogans
– MOT: Skin contact to contaminated water or moist water
– Treat:
• Penicillin
• Tetracycline
• Erythromycin
Community Health Nursing
Rabies
• RABIES (Hydrophobia)
– CA: Rabies virus
– MOT: Bite of a rabid animal, or through scratches on the
skin
– Treat/Mgt:
• Wash area with soap and water
• Rabies immunoglobulin and active immunization
Community Health Nursing
Scabies
• SCABIES
– CA: Sarcoptes scabiei
– MOT: Direct contact with infected person or through
fomites
– Treat:
• Benzyl benzoate
• Permethrin (Kwell)
– Mgt:
• Personal hygiene
• Environmental sanitation
Community Health Nursing
Anthrax
• ANTHRAX (Woolsorter Disease, Ragpicker
Disease)
– CA: Bacillus anthracis
– MOT: Ingestion, inhalation or cutaneous contact with
spore
– Treat:
• Penicillin
• Erythromycin
• Tetracycline
Community Health Nursing
Sexually Transmitted
• GONORRHEA (GC, Clap, Drip)
– CA: Neisseria gonorrheae
– MOT: Sex, Mother to child during delivery
– Treat:
•Ceftriaxone
•Azithromycin
•Doxycycline
Community Health Nursing
• SYPHILIS
– CA: Treponema pallidum
– MOT: Sex
– 4 Stages (First, Second, Latent, Late)
– Complications:
• Neurosyphilis
• Cardiovascular syphilis
– Treat:
• Penicillin, Tetracycline, Doxycycline
Community Health Nursing
• TRICHOMONIASIS (Trich)
– CA: Trichomonas vaginalis
– MOT: Sex
– Treat:
• Metronidazole
Community Health Nursing
• Hepatitis B
– CA: Hepatitis B virus
– MOT: Sex and blood, mother to child
– PVT:
• Hepatitis B vaccine
• Safe sex practice
–Treat:
• Hepatitis B immunoglobulin
Community Health Nursing
• HIV/AIDS
– CA: Human Immunodeficiency Virus
– MOT: Sex and blood and body fluids
– Dx: EIA and Western Blot
– Note: 6 months window period
– Treat: Highly Actice AntiRetroviral Therapy (HAART)
• Reverse Transcriptase Inhibitors, Protease Inhibitors,
Nucleosides, Fusion Inhibitors
Community Health Nursing
Meningococcemia
• MENINGOCOCCEMIA
– CA: Neisseria meningitidis
– MOT: Droplet spread
– Treat: Ciprofloxacin
Community Health Nursing
Severe Acute Respiratory
Syndrome
• SARS
– CA: Coronavirus
– MOT: Droplet spread
– Note: Isolation!
Community Health Nursing