Chn Quick Notes

8/3/2019 Chn Quick Notes

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SAINT JOSEPH INSTITUTE OF TECHNOLOGY

COLLEGE OF NURSING

EPI (EXPANDED PROGRAM ON IMMUNIZATION)

TARGET SETTING:INFANTS 0-12 MONTHS

PREGNANT AND POST PARTUM WOMENSCHOOL ENTRANTS/ GRADE 1 / 7 YEARS OLD

OBJECTIVES OF EPI:TO REDUCE MORBIDITY AND MORTALITY RATES AMONG INFANTS AND CHILDREN from SIX

CHILDHOOD IMMUNIZABLE DISEASE

ELEMENTS OF EPI:TARGET SETTINGCOLDCHAIN LOGISTIC MANAGEMENT- Vaccine distribution through cold chain is designed to ensure

that the vaccine were maintained under proper environmental condition until the time of

administration.IECAssessment and evaluation of Over-all performance of the programSurveillance and research studies

EXPANDED PROGRAM FOR IMMUNIZATION (EPI)Principles of EPI include:

1. Epidemiological situation2. Mass approach3. Basic Health Service

The 7 immunizable diseases are:

1. Tuberculosis2. Diptheria3. Pertussis4. Measles5. Poliomyelitis6. Tetanus7. Hepatitis B


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ADMINISTRATION OF VACCINES:

VACCINE CONTENT FORM &DOSAGE

# OF DOSES ROUTE

BCG Live attenuatedbacteria

Freeze driedinfant- 0.05mlPreschool-0.1ml

1 ID

DPT DT- weakenedtoxinP-killed bacteria

liquid-0.5ml 3 IM

OPV weakened virus liquid-2drops 3 Oral

Hepa B Plasma derivative Liquid-0.5ml 3 IM

Measles Weakened virus Freeze dried-0.5ml

1 Subcutaneous

SCHEDULE OF VACCINES:

VACCINE AGE AT 1st dose IINTERVALBETWEEN DOSE

PROTECTION

BCG At birth TB

DPT 6 weeks 4 weeks DPT

OPV 6weeks 4weeks Poliomyelitis

Hepa B @ birth @birth,6th week,14th

weekHepaB

Measles 9m0s.-11m0s. measles

6 months earliest dose of measles given in case of outbreak9months-11months- regular schedule of measles vaccine15 months- latest dose of measles given4-5 years old- catch up dose

FULLY IMMUNIZED CHILD (FIC)- less than 12 months old child with completeimmunizations of DPT, OPV, BCG, Anti Hepatitis, Anti measles.

Vaccine Minimum ageinterval

% protected Duration of Protection

TT1 As early as possible 0% 0

TT2 4 weeks later 80% 3 yearsTT3 6 months later 95% 5 years

TT4 1year later/duringnext pregnany

99% 10 years

TT5 1 year later/thirdpregnancy

99% Lifetime

There is no contraindication to immunization except when the child isimmunosuppressed or is very, very ill (but not slight fever or cold). Or if the


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child experienced convulsions after a DPT or measles vaccine, report such tothe doctor immediately.

Malnutrition is not a contraindication for immunizing children rather, it is anindication for immunization since common childhood diseases are oftensevere to malnourished children.

COLD CHANIN UNDER EPI: Cold Chain is a system used to maintain potency of a vaccine from that of

manufacture to the time it is given to child or pregnant woman.The allowable timeframes for the storage of vaccines at different levels are:

6months- Regional Level

3months- Provincial Level/District Level 1month-main health centers-with ref. Not more than 5days- Health centers using transport boxes.

MOST SENSITIVE TO HEAT: Freezer (-15 to -25 degrees C)

OPV

Measles

SENSITIVE TO HEAT AND FREEZING (body of ref. +2 to +8 degrees Celcius)

BCG DPT Hepa B TT

Use those that will expire first, mark X/ exposure, 3rd- discard,Transport-use cold bags, let it stand in room temperature for a while before storing DPT.Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B.

FEFO (first expiry and first out) - vaccine is practiced to assure that all vaccines areutilized before the expiry date.Proper arrangement of vaccines and/or labeling of vaccines expiry date are done toidentify those near to expire vaccines.

COPAR

DEFINITIONS OF COPAR: A social development approach that aims to transform the apathetic,

individualistic and voiceless poor into dynamic, participatory and politicallyresponsive community.

A collective, participatory, transformative, liberative, sustained andsystematic process of building peoples organizations by mobilizing andenhancing the capabilities and resources of the people for the resolutionof their issues and concerns towards effecting change in their existingoppressive and exploitative conditions (1994 National Rural Conference)

A process by which a community identifies its needs and objectives,develops confidence to take action in respect to them and in doing so,extends and develops cooperative and collaborative attitudes andpractices inthe community (Ross 1967)

A continuous and sustained process of educating the people tounderstand and develop their critical awareness of their existing condition,
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working with the people collectively and efficiently on their immediate andlong-term problems, and mobilizing the people to develop their capabilityand readiness to respond and take action on their immediate needstowards solving their long-term problems (CO: A manual of experience,PCPD)

IMPORTANCE OF COPAR:1. COPAR is an important tool for community development and people

empowerment as this helps the community workers to generate communityparticipationin development activities.

2. COPAR prepares people/clients to eventually take over the management of adevelopment programsin the future.

3. COPAR maximizes community participation and involvement; communityresources are mobilized for community services.

PrINCIPLES COPAR:1. People, especially the most oppressed, exploited and deprived sectors are

open to change, have the capacity to change and are able to bring about

change.2. COPAR should be based on the interest of the poorest sectors of society3. COPAR should lead to a self-reliant community and society.

COPAR PROCESS: A progressive cycle ofaction-reflection action which begins with small,

local and concrete issues identified by the people and the evaluation andthe reflection of and on the action taken by them.

Consciousness through experimental learning central to the COPARprocess because it places emphasis on learning that emerges from

concrete action and which enriches succeeding action. COPAR is participatory and mass-based because it is primarily directed

towards and biased in favor of the poor, the powerless and oppressed. COPAR is group-centered and not leader-oriented. Leaders are

identified, emerge and are tested through action rather than appointed orselected by some external force or entity.

PHASES OF COPAR

I. PRE-ENTRY PHASEA. Is the initial phase of the organizing process where the community/organizer looks

for communities to serve/help.

B. It is considered the simplest phase in terms of actual outputs, activities andstrategies and time spent for it.Activities include:1. Designing a plan for community development including all its activities and

strategies for care development.2. Designing criteria for the selection of site3. Actually selecting the site forcommunity care
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II. ENTRY PHASEA. Sometimes called the social preparation phase as to the activities done here

includes the sensitization of the people on the critical events in their life,innovating them to share their dreams and ideas on how to manage theirconcerns and eventually mobilizing them to take collective action on these.

B. This phase signals the actual entry of the community worker/organizer into the

community. She must be guided by the following guidelines however.1. Recognizes the role of local authorities by paying them visits to inform them of

their presence and activities.2. The appearance, speech, behavior and lifestyle should be in keeping with

those of the community residents without disregard of their being role models.3. Avoid raising the consciousness of the community residents; adopt a low-key

profile.

III. ORGANIZATION BUILDING PHASEA. Entails the formation of more formal structures and the inclusion of more formal

procedures of planning, implementation, and evaluating community-wide

activities. It is at this phase where the organized leaders or groups are beinggiven trainings (formal, informal, OJT) to develop their skills and in managing theirown concerns/programs.

IV. SUSTENANCE AND STRENGTHENING PHASEA. Occurs when the community organization has already been established and the

community members are already actively participating in community-wideundertakings. At this point, the different communities setup in the organizationbuilding phase are already expected to be functioning by way of planning,implementing and evaluating their own programs with the overall guidance fromthe community-wide organization.

1. Strategies used may include:a. Education and trainingb. Networking and linkagingc. Conduct of mobilization on health and development concernsd. Implementing of livelihood projectse. Developing secondary leade
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NINE WARNING SIGNS OF CANCER:Change in blood bowel or bladder habitsA sore that does not healUnusual bleeding or dischargeThickening or lump in breast or elsewhereIndigestion or difficulty in swallowing

Obvious change in wart or moleNagging cough or hoarsenessUnexplained anemiaSudden unexplained weight loss

PREVENTION & EARLY DETECTION

CA type

Lung

Uterine

Cervical

Liver

Prevention

No smoking

Monogamy

Safe sex

Hep B vaccinationLess aalcohol intakeAvoidance of moldyfoods

Detection

Paps smear every 1-3yrs

Colon

Rectum

High fiber diet

Low fat intake

Regular medical check-up after 40 yrs of age

Fecal occult blood testDRESigmoidoscopy


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Mouth No smoking, betel nutchewingOral hygiene

Regular dental check-ups

Breast none Monthly SBEYearly exam by doctorMammography for 50 yrsold and above females

Skin

Prostate

No excessive sunexposure

None

Assessment of skin

Digital trans-rectal exam

PRINCIPLES OF TREATMENT OF MALIGNANT DISEASES One third of all cancers are curable if detected early and treated properly.

THREE MAJOR FORMS OF TREATMENT OF CANCER:

Surgery

Radiation Therapy

Chemotherapy

Natl Diabetes Prevention and Control Program

Aim:

Controlling and assimilating healthy lifestyle in the Filipino culture ( 2005-2010)thru IEC

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


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PREVENTION AND CONTROL OF KIDNEY DISEASES

Acute or Rapidly Progressive Renal Failure : A sudden decline in renalfunction resulting from the failure of the renal circulation or by glomerular ortubular damage causing the accumulation of substances that is normally

eliminated in the urine in the body fluids leading to disruption in homeostatic,endocrine, and metabolic functions.

Acute Nephritis: A severe inflammation of the kidney caused by infection,degenerative disease, or disease of the blood vessels.

Chronic Renal Failure: A progressive deterioration of renal function that ends asuremia and its complications unless dialysis or kidney transplant is performed.

Neprolithiasis: A disorder characterized by the presence of calculi in the kidney. Nephrotic Syndrome: A clinical disorder of excessive leakage of plasma

proteins into the urine because of increased permeability of the glomerularcapillary membrane

Urinary Tract Infection: A disease caused by the presence of pathogenicmicroorganisms in the urinary tract with or without signs and symptoms.

Renal Tubular Defects: An abnormal condition in the reabsorption of selectedmaterials back into the blood and secretion, collection, and conduction of urine.

Urinary Tract Obstruction: A condition wherein the urine flow is blocked orclogged.


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PHN BAGEssential and indispensable equipment which contains basic medication and articles

necessary for giving care.Should observe proper bag technique principle

Prevent spread of microorganismSave time and efforts for nursing procedure

Should show effectiveness of total care given to clients

RESPONSIBILITY OF CHNBe a part in developing and overall health plan, its implementation and evaluation for

communities.Provide quality nursing service to all level of clienteleMaintain coordination/ linkages with other health team members in the provision of public

health serviceConduct researches relevant to CHN services to improve provision of HCProvide opportunities for professional growth and continuing education for staff

development

LEVELS OF CLIENTELE IN CHN

INDIVIDUALSView atomistic and holistically (mind, body and soul)Needs are identified depending on growth and development

TYPOLOGY OF PROBLEMS IN FAMILY

First Level AssessmentI. Presence of health threats, health deficits and foreseeable crisis or stress point inthe family.

Health threats conditions that are conducive to disease, accident or failure torealize ones health potentials.

B. Health Deficits instances of failure in health maintenance. These includeillness states, regardless of whether it is diagnosed or not. Failure to thrive ordevelop according to normal rate.

C. Foreseeable Crisis Situation / stress points anticipated periods of unusualdemands on the individual or family in terms of adjustment or family resources.

Second Level Assessment

Recognition of the problem

Decision on appropriate health action

Care to affected family member

Provision of healthy home environment

Utilization of community resources for health care


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EPIDEMIOLOGY

the study of distribution of disease or physiologic condition among

human population s and the factors affecting such distribution the study of the occurrence and distribution of health conditions

such as disease, death, deformities or disabilities on humanpopulations

PATTERN OF DISEASE OCCURENCE

EPIDEMIC

a situation when there is a high incidence of new cases of a specificdisease in excess of the expected.

when the proportion of the susceptibles are high compared to theproportion of the immunes

EPIDEMIC POTENTIAL

an area becomes vulnerable to a disease upsurge due to causalfactors such as climatic changes, ecologic changes, or socio-economic changes

ENDEMIC

habitual presence of a disease in a given geographic locationaccounting for the low number of both immunes and susceptibles (e.g.Malaria is a disease endemic at Palawan. )

the causative factor of the disease is constantly available or present to

the area.

SPORAIDC

diseaseoccurs every now and thenaffecting only a small number ofpeople relative to the total population

intermittent

PANDEMIC

global occurrence of a disease

STEPS IN EPIDEMIOLOGICAL INVESTIGATION:

1. Establish fact of presence of epidemic2. Establish time and space relationship of the disease3. Relate to characteristics of the group in the community4. Correlate all data obtained

ROLE OF THE NURSE

Case Finding


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Health Teaching

Counseling

Follow up visit

COMMUNITY HEALTH NURSING

The utilization of the nursing process in the different levels of clientele-individuals, families, population groups and communities, concerned with thepromotion of health, prevention of disease and disability and rehabilitation.

GOAL:

To raise the level of citizenry by helping communities and families to copewith the discontinuities in and threats to health in such a way as to maximizetheir potential for high-level wellness

MISSION OF CHNHealth Promotion activities related to enhancement of healthHealth Protection activities designed to protect the peopleHealth Balance activities designed to maintain well beingDisease prevention activities relate to avoid complicationSocial Justice activities related to practice equity among clients

PHILOSOPHY OF CHN ACCORDING TO DR. MARGARET SHETLAND

The philosophy of CHN is based on the worth and dignity on the worth anddignity of man.

Four levels of clientele: individual, family, population group (those who sharecommon characteristics, developmental stages and common exposure tohealth problems e.g. children, elderly), and the community.

In CHN, the client is considered as an ACTIVE partner NOT PASSIVErecipient of care

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

The goal of CHN is achieved through multi-sectoral efforts

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

ROLES OF CH NURSE:

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

Health Advocator speaks on behalf of the client Advocator act on behalf of the client

Supervisor - who monitors and supervises the performance of midwives

Facilitator - who establishes multi-sectoral linkages by referral system

Collaborator working with other health team member


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LEVELS OF CLIENT IN CHN:

FAMILY

FAMILY COPING INDEX

Physical Independence - ability of the family to move in & out of bed & performedactivities of daily living

Therapeutic Independence - ability of the family to comply with the therapeuticregimen (diet, medication & usage of appliances)

Knowledge of Health Condition- wisdom of the family to understand the diseaseprocess

Application of General &Personal Hygiene- ability of the family to perform hygiene& maintain environment conducive for living

Emotional Competence ability of the family to make decision maturely &appropriately (facing the reality of life)

Family Living Pattern- the relationship of the family towards each other with love,respect & trust

Utilization of Community Resources ability of the family to know the function &existence of resources within the vicinity

Health Care Attitude relationship of the family with the health care provider Physical Environment ability of the family to maintain environment conducivefor living

FAMILY LIFE CYCLE

Stage I Beginning Family (newly wed couples)TASK: compliance with the PD 965 & acceptance of the new member of thefamily

Stage II Early Child Bearing Family(0-30 months old)TASK: emphasize the importance of pregnancy & immunization & learn theconcept of parenting

Stage III Family with Pre- school Children (3-6yrs old)TASK: learn the concept of responsible parenthood

Stage IV Family with School age Children (6-12yrs old)TASK: Reinforce the concept of responsible parenthood

Stage V - Family with Teen Agers (13-25yrs old)TASK: Parents to learn the concept of let go system and understands thegeneration gap

Stage VI Launching Center (1st child will get married up to the last child)TASK: compliance with the PD 965 & acceptance of the new member of thefamily

Stage VII -Family with Middle Adult parents (36-60yrs old)TASK: provide a healthy environment, adjust with a new lifestyle and adjustwith the financial aspect


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Stage VIII Aging Family (61yrs old up to death)TASK: learn the concept of death positively

COMMUNITY

COMMUNITY ASSESSMENT: Status information about morbidity, mortality & life

expectancy Structure information about age, gender and socio economic Process information about how the community function

TYPES OF COMMUNITY ASSESSMENT:

COMMUNITY DIAGNOSISA process by which the nurse collects data about the community in order to identifyfactors which may influence the deaths and illnesses of the population, to formulate acommunity health nursing diagnosis and develop and implement community healthnursing interventions and strategies.

2 TYPES:

Comprehensive Community Diagnosis Problem-Oriented Community Diagnosis- aims to obtain general information aboutthe community

- type of assessment responds to aparticular need

STEPS:Preparatory Phase

1. site selection2. preparation of the community3. statement of the objectives4. determine the data to be collected5. identify methods and instruments for data collection

6. finalize sampling design and methods7. make a timetable

Implementation Phase1. data utilization2. data collection3. data organization/collation4. data presentation5. data analysis

Evaluation Phase

2. BIOSTATISTICS

DEMOGRAPHY - study of population size, composition and spatial distribution asaffected by births, deaths and migration.SOURCES : Census complete enumeration of the population

2 WAYS OF ASSIGNING PEOPLE:1. De Jure - People were assigned to the place where assigned to the place they usuallylive regardless of where they are at the time of census.2.De Facto - People were assigned to the place where they are physically present at areat the time of census regardless, of their usual place of residence.


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COMPONENTS:1. Population size2. Population composition * Age Distribution * Sex Ratio * Population Pyramid * Median

age - age below which 50% of the population fall and above which 50% of the populationfall. The lower the median age, the younger the population (high fertility, high deathrates). * Age Dependency Ratio - used as an index of age-induced economic drain onhuman resources * Other characteristics: - occupational groups - economic groups -educational attainment - ethnic group3. Population Distribution * Urban-Rural - shows the proportion of people living in urbancompared to the rural areas * Crowding Index - indicates the ease by which acommunicable disease can be transmitted from 1 host to another susceptible host. *Population Density - determines congestion of the place

3. VITAL STATISTICS the application of statistical measures to vital events (births, deaths and common

illnesses) that is utilized to gauge the levels of health, illness and health servicesof a community.

CLINIC VISIT-process of checking the clients health condition in a medical clinic

HOME VISITa professional face to face contact made by the nurse with a patient or the family to

provide necessary health care activities and to further attain the objectives of theagency

BAG TECHNIQUE

a tool making of the public health bag through which the nurse during the home visit canperform nursing procedures with ease and deftness saving time and effort with theend in view of rendering effective nursing care

THERMOMETER TECHNIQUEto assess the clients health condition through body temperature reading

NURSING CARE IN THE HOMEgiving to the individual patient the nursing care required by his/her specific illness or

trauma to help him/her reach a level of functioning at which he/she can maintainhimself/herself or die peacefully in dignity

ISOLATION TECHNIQUE IN THE HOMEdone by :separating the articles used by a client with communicable disease to prevent the spread

of infection:frequent washing and airing of beddings and other articles and disinfections of roomwearing a protective gown , to be used only within the room of the sick memberdiscarding properly all nasal and throat discharges of any member sick with

communicable disease


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burning all soiled articles if could be or contaminated articles be boiled first in water 30minutes before laundering

INTRAVENOUS THERAPYinsertion of a needle or catheter into a vein to provide medication and fluids based on

physicians written prescription

can be done only by nurses accredited by ANSAP

COMMUNITY ORGANIZING

PRINCIPLES OF CO:1. People esp. the oppressed, exploited and deprived sectors are most open tochange, have the capacity to change and are able to bring about change. Hence ,CO is based on the ff:A. Power must reside in the peopleB. Devt. is from the people to the peopleC. People participation

2.-must be based on the poorest sectors of society. The solutions of problemscommonly shared by these sectors must be focused on collective organizations,planning and action3. should lead to self-reliant communities

VITAL HEALTH STATISTICS 2005

LIFE EXPECTANCYFEMALE - 70 yrs. old

MALE - 64 yrs. Old

LEADING CAUSES OF MORBIDITYMost of the top ten leading causes of morbidity are communicable diseaseThese include

the diarrhea, pneumonia, bronchitis, influenza, TB, malaria and varicellaLeading non CD are heart problem, HPN, accidents and malignant neoplasms

LEADING CAUSES OF MORTALITYThe top 10 leading causes of mortality are due to non CDDiseases of the heart and vascular system are the 2 most common causes of deaths.Pneumonia, PTB and diarrheal diseases consistently remain the 10 leading causes of

deaths.

HEALTH CARE DELIEVERY SYSTEM

the totality of all policies, facilities, equipments, products, humanresources and services which address the health needs, problems


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and concerns of the people. It is large, complex, multi-level andmulti-disciplinary.

DEPARTMENT OF HEALTH

VISION: Health for all by year 2000 ands Health in the Hands of the People by 2020MISSION: In partnership with the people, provide equity, quality and access to health

care esp. the marginalized

5 MAJOR FUNCTIONS:1. Ensure equal access to basic health services2. Ensure formulation of national policies for proper division of labor

and proper coordination of operations among the governmentagency jurisdictions

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

4. Plan and establish arrangements for the public health systems to

achieve economies of scale5. maintain a medium of regulations and standards to protect

consumers and guide providers

PRIMARY STRATEGIES TO ACHIEVE HEALTH GOALSSupport for health goalAssurance of health careIncreasing investment for PHCDevelopment of National Standard

MILESTONE IN HEALTH CARE DELIVRY SYSTEMRA 1082 - RHU Act

RA 1891 - Strengthen Health ServicesPD 568 - Restructuring HCDSRA 7160 - LGU Code

NATIONAL HEALTH PLAN

National Health Plan is a long-term directional plan for health; the blueprintdefiningthe countrys health PROBLEMS, POLICY THRUSTS STRATEGIES, THRUSTS

GOAL :

To enable the Filipino population to achieve a level of health which will allow Filipinoto lead a socially and economically-productive life, with longer life expectancy, lowinfant mortality, low maternal mortality and less disability through measures that willguarantee access of everyone to essential health care

OBJECTIVES:

promote equity in health status among all segments of society


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address specific health problems of the population

upgrade the status and transform the HCDS into a responsive,dynamic and highly efficient, and effective one in the provision ofsolutions to changing the health needs of the population

promote active and sustained peoples participation in health care

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)IMCI is an integrated approach to child health that focuses on the well-being of the whole

child.IMCI strategy is the main intervention proposed to achieve a significant reduction in the

number of deaths from communicable diseases in children under five

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

AIM:to reduce death, illness and disability, and to promote improved growth anddevelopment among children under 5 years of age.IMCI includes both preventive and curative elements that are implemented by families

and communities as well as by health facilities.

IMCI OBJECTIVES:To reduce significantly global mortality and morbidity associated with the major causes of

disease in childrenTo contribute to the healthy growth & development of children

IMCI COMPONENTS OF STRATEGY:Improving case management skills of health workersImproving the health systems to deliver IMCIImproving family and community practices

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

PRESENTING COMPLAINT:Cough and/or fast breathingLethargy/UnconsciousnessMeasles rash

Very sick young infant

POSSIBLE COURSE/ASSOCIATED CONDITION:Pneumonia, Severe anemia, P. falciparum malariaCerebral malaria, meningitis, severe dehydrationPneumonia, Diarrhea, Ear infectionPneumonia, Meningitis, Sepsis


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DISEASE FOCUS OF IMCII:Acute Respiratory InfectionDiarrheAFeverMalariaMeasles

Dengue FeverEar InfectionMalnutrition

THE IMCI CASE MANAGEMENT PROCESSAssess and classifyIdentify appropriate treatmentTreat/referCounselFollow-up

THE INTEGRATED CASE MANAGEMENT PROCESS

Check for General Danger Signs:A general danger sign is present if:

- the child is not able to drink or breastfeed- the child vomits everything- the child has had convulsions- the child is lethargic or unconscious

ASSESS MAIN SYMPTOMSCough/DOBDiarrheaFeverEar problems

ASSESS AND CLASSIFY COUGH OR DIFFICULTY OF BREATHING

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

ASSESS AND CLASSIFY PNEUMONIAcough or difficult breathingan infection of the lungsBoth bacteria and viruses can cause pneumoniaChildren with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis

(generalized infection).

** A child with cough or difficult breathing is assessed for:How long the child has had cough or difficult breathingFast breathingChest indrawingStridor in a calm child.

REMEMBER:


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

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

IMCI COLOR CODING

PINK(URGENT REFERRAL)

YELLOW(Treatment at outpatienthealth facility)

GREEN(Home management)

OUTPATIENT HEALTHFACILITY

Pre-referral

treatments

Advise parents

Refer child

OUTPATIENT HEALTHFACILITY

Treat local infection

Give oral drugs

Advise and teach

caretakerFollow-up

HOMECaretaker is counseled on:

Home treatment/s

Feeding and fluids

When to return

immediatelyFollow-up

REFERRAL FACILITY

Emergency Triage

and Treatment ( ETAT)

Diagnosis,

Treatment

Monitoring, follow-

up

SEVERE PNEUMONIA ORVERY SEVERE DISEASE

Give first dose of anappropriate antobiotic

Give Vitamin A Treat the child to

prevent low blood sugar

Refer urgently to thehospital

Give paracetamol forfever > 38.5oC

Any general dangersign or

Chest indrawing or Stridor in calm child

PNEUMONIA

Give an appropriateantibiotic for 5 days

Soothe the throat andrelieve cough with asafe remedy

Advise mother when to

return immediately Follow up in 2 days Give Paracetamol for

fever > 38.5oC

Fast breathing NO PNEUMONIA : COUGH If coughing more than


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OR COLD more than 30 days,refer for assessment

Soothe the throat andrelieve the cough with asafe remedy

Advise mother when toreturn immediately

Follow up in 5 days if notimproving

No signs of pneumoniaor very severe disease

ASSESS AND CLASSIFY DIARRHEA

A CHILD WITH DIARRHEA IS ASSESSED FOR:

how long the child has had diarrhoeablood in the stool to determine if the child has dysenterysigns of dehydration.

CLASSIFY DYSENTERYchild with diarrhea and blood in the stool

Two of the following signs ?

Abnormally sleepy ordifficult to awaken

Sunken eyes

Not able to drink or drinkingpoorly

Skin pinch goes back veryslowly

SEVEREDEHYDRATION

If child has no other severeclassification:- Give fluid for severe

dehydration ( Plan C ) OR If child has another severe

classification :- Refer URGENTLY to

hospital with mother givingfrequent sips of ORS on theway

- Advise the mother tocontinue breastfeeding If child is 2 years or older

and there is cholera in yourarea, give antibiotic forcholera

Two of the following signs :

Restless, irritable

Sunken eyes

Drinks eagerly, thirstySkin pinch goes back slowly SOME

DEHYDRATION

Give fluid and food for somedehydration ( Plan B )

If child also has a severeclassification :- Refer URGENTLY to

hospital with mother giving


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frequent sips of ORS on theway

- Advise mother when toreturn immediately


Not enough signs to classifyas some or severedehydration NO DEHYDRATION

Home Care Give fluid and food to treat

diarrhea at home ( Plan A )



Dehydration present SEVEREPERSISTENTDIARRHEA

Treat dehydration beforereferral unless the child hasanother severeclassification

Give Vitamin a Refer to hospital

No dehydration PERSISTENTDIARRHEA

Advise the mother onfeeding a child who haspersistent diarrhea

Give Vitamin A

Follow up in 5 days

Blood in the stool DYSENTERY Treat for 5 days with an oralantibiotic recommended forShigella in your area

Follow up in 2 daysGive also referral treatment

DOES THE CHILD HAVE FEVER??

**DECIDE :- Malaria Risk- No Malaria Risk- Measles- Dengue

MALARIA RISK


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Any general danger

sign or

Stiff neck

VERY SEVERE FEBRILE

DISEASE / MALARIA

Give first dose ofquinine ( under medicalsupervision or if ahospital is notaccessible within 4hrs )

Give first dose of anappropriate antibiotic

Treat the child toprevent low blood sugar

Give one dose ofparacetamol in healthcenter for high fever(38.5oC) or above

Send a blood smearwith the patient

Refer URGENTLY to

hospital

Blood smear ( + )

If blood smear not done:

NO runny nose, and

NO measles, and

NO other causes of fever

MALARIA

Treat the child with anoral antimalarial



Follow up in 2 days if

fever persists If fever is present

everyday for more than7 days, refer forassessment

Blood smear ( - ), or

Runny nose, or

Measles, or

Other causes of fever

FEVER : MALARIAUNLIKELY



return immediately Follow up in 2 days if

fever persists

If fever is presenteveryday for more than7 days, refer forassessment


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NO MALARIA RISK

Any general danger

sign or

Stiff neck

VERY SEVEREFEBRILE DISEASE

Give first dose of an

appropriate antibiotic

Treat the child to prevent

low blood sugar

Give one dose of

paracetamol in health centerfor high fever (38.5oC) orabove

Refer URGENTLY to

hospital

No signs of very severe

febrile disease

FEVER : NOMALARIA

Give one dose of paracetamol

in health center for high fever(38.5oC) or above


return immediately

Follow up in 2 days if fever

persists

If fever is present everyday

for more than 7 days, refer for

assessment

MEASLES

Clouding of cornea or

Deep or extensive

mouth ulcers

SEVERE COMPLICATEDMEASLES

Give Vitamin A

Give first dose of an


If clouding of the

cornea or pus drainingfrom the eye, applytetracycline eyeointment

Refer URGENTLY to

hospital


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Pus draining from the

eye or

Mouth ulcers

MEASLES WITH EYE ORMOUTH COMPLICATIONS

Give Vitamin A

If pus draining from the

eye, apply tetracyclineeye ointment

If mouth ulcers, teach themother to treat with gentianviolet

Measles now or within

the last 3 months

MEASLES Give Vitamin A

DENGUE FEVER

Bleeding from nose orgums or

Bleeding in stools orvomitus or

Black stools or vomitusor

Skin petechiae or Cold clammy

extremities or Capillary refill more

than 3 seconds or Abdominal pain or Vomiting Tourniquet test ( + )

SEVERE DENGUEHEMORRHAGIC FEVER

If skin petechiae or

Tourniquet test,are theonly positive signs giveORS

If any other signs are

positive, give fluidsrapidly as in Plan C

Treat the child to

prevent low blood sugar

DO NOT GIVE

ASPIRIN

Refer all children

Urgently to hospital

No signs of severe denguehemorrhagic fever

FEVER: DENGUEHEMORRHAGICUNLIKELY

DO NOT GIVE ASPIRIN

Give one dose of

paracetamol in healthcenter for high fever(38.5oC) or above

Follow up in 2 days if

fever persists or childshows signs of bleeding


return immediately


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DOES THE CHILD HAVE AN EAR PROBLEM?

Tender swelling behind

the ear MASTOIDITIS Give first dose of


Give paracetamol for

pain Refer URGENTLY

Pus seen draining from

the ear and discharge isreported for less than14 days or

Ear pain

ACUTE EAR INFECTION Give antibiotic for 5

days

Give paracetamol for

pain

Dry the ear by wicking

Follow up in 5 days

Pus seen draining fromthe ear and discharge isreported for less than14 days

CHRONIC EARINFECTION

Dry the ear by wicking

Follow up in 5 days

No ear pain and no pus

seen draining from theear

NO EAR INFECTION No additional treatment

PROTEIN ENERGY MALNUTRITION

1. Marasmus looks like an old worried man- less subcutaneous fats

2. Kwashiorkor - a moon face child- with flag sign (hair changes)

VITAMIN A DEFICIENCY

Early symptoms: Xeropthalmia (Nigtblindess)

Bitots spot (silvery foamy spot located @ lateral sclera)


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Corneal Xerosis (eye lesion)

Conjunctival Xerosis(scar in the eyes)

Keratomalacia ( whitish to grayish sclera)

BLINDNESS

RESPIRATORY INFECTION CONTROLProvision of medicinesConsultative meetings with CARI coordinatorsMonitoring of health facilities on the implementation of the program

ALTERNATIVE MEDICINERA 8423

23 IN 93

A. HERBAL MEDICINE (LUBBY SANTA)

Herbal Medicine USES

Lagundi ( Vitex Negundo) SHARED

Skin diseasesHeadache,Asthma,fever,cough&coldsRheumatismEczema

Dysentery

Ulasimang Bato (PeperoniaPellucida)

Lowers uric acid

Bawang ( Allium Sativum) HAT Headache and Tootache

Bayabas ( Psidium Guajava) Anti septic, Anti-diarrheal

Yerba Buena (Mentha Cordifolia) Rheumatism and other body aches,analgesics

Sambong (Blumea Balsamifera) Edema, diuretics

Akapulko Fungal infection, skin diseases

Niog Niogan (Quisqualis Indica) Anti-helminthic

Tsaang Gubat (Carmona Retusa) Diarrhea


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Ampalaya (Momordica Charantia) DM

MATERNAL- CHILD CARE

I MATERNAL CARE

FAMILY PLANNING

I. Spacing / Artificial MethodA. HormonalB. Mechanical & BarrierC. BiologicD. Natural

II. Permanent (surgical/irreversible)A. Tubal LigationB. Vasectomy

III. Behavioral Method

B. BREASTFEEDINGII - CHILD CARE

A. UNDER FIVE CARE PROGRAMA package of child health-related services focused to the 0-59 months old children to

assure their wellness and survival

GROWTH MONITORING CHART (GMC)A standard tool used in health centers to record vital information related to child growth

and development, to assess signs of malnutrition.

B. EXPANDED PROGRAM ON IMMUNIZATIONLEGAL BASISPD #996 Compulsory basicPP #147 National Immunization DayPP #773 Knock out Polio DaysPP # 1064 polio eradication campaignPP #4 - Ligtas Tigdas month

MENTAL HEALTH

a state of well-being where a person can realize his or her own abilities, to cope with thenormal stresses of life and work productively

COMPONENETS OF MENTAL HEALTH PROGRAMStress Management and Crisis Intervention

Drugs and Alcohol Abuse Rehabilitation

Treatment and Rehabilitation of Mentally-Ill Patients 23131Special Project for Vulnerable Groups

SENTRONG SIGLA MOVEMENT


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AIM: to promote availability of quality health services4 PILLARS:

Quality assurance

Grants & technical assistance

Health promotion

Award

COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH

COMMUNITY ORGANIZINGa continuous and sustained process ofEDUCATING THE PEOPLE,CRITICAL AWARENESSMOBILIZING

PARTICIPATORY ACTION RESEARCHA combination of education, research and action.

The purpose is the EMPOWERMENT of people

4 PHASES:Pre entryEntryOrganizational BuildingSustenance and Strengthening

LAWS AFFECTING CHN IMPLEMENTATION:

RA 8749 - Clean Air Act (2000)

RA 6425 Dangerous Drug Act: sale, administration and distribution of prohibited drugs

is punishable by law

RA 9173

RA 2382 Philippines Medical Act: define the practice of medicine in the Philippines

RA 1082 Rural Health Act: employment of more physicians, nurses, midwives who willlive in the rural areas to help raise the health condition.

RA 3573 - Reporting of Communicable DiseaseRA 6675 Generic Act: promotes, requires and ensures the production of an adequate

supply, distribution, use of drugs identified by their generic names.


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RA 7305 Magna Carta for Public Health Workers (approved by Pres. Corazon C.Aquino): aims to promote and improve the social and economic well being ofhealth workers, their living and conditions.

RA 7160 Local Government Code: responsibility for the delivery of basic services of

the national government

I CHRONIC COMMUNICABLE DISEASES

I - TUBERCULOSIS

TB is a highly infectious chronic disease that usually affects the lungs.

Causative Agent: Mycobacterium TuberculosisS/S:

Cough

afternoon fever

weight loss

night sweat

blood stain sputum

Prevalence/Incidence:

ranks sixth in the leading causes of morbidity (with 114,221 cases) in thePhilippines

sixth leading cause of mortality (with 28507 cases) in the Philippines.

Nursing and Medical Management

Ventilation systems

Ultraviolet lighting

Vaccines, such as the bacillus Calmette Guerin (BCG) vaccine

drug therapyPreventing Tuberculosis

BCG vaccination

Adequate rest

Balanced diet

Fresh air

Adequate exercise

Good personal Hygiene

DOTS (Direct Observed Treatment Short Course)


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Regimen Type of TB Patient

Regimen I

2RIPE / 4RI

New pulmonary smear (+) cases

New seriously ill pulmonary smear (-)cases w/ extensive lung lesions

New severely ill extra-pulmo TB

Regimen II

2RIPES/1RIPE / 5RIE

New pulmonary smear (+) case

New seriously ill pulmonary smear (-)cases w/ extensive lung lesions

New severely ill extra-pulmo TB

Regimen III

2RIP / 4RI

New smear(-) but with minimalpulmonary TB on radiography asconfirmed by a medical officer

New extra-pulmo TB (not serious)

LEPROSY

Sometimes known as Hansen's disease

is an infectious disease caused by , an aerobic, acid fast, rod-shapedmycobacterium

Gerhard Armauer Hansen

Historically, leprosy was an incurable and disfiguring disease

Today, leprosy is easily curable by multi-drug antibiotic therapy

Signs & Symptoms

Early stage(CLUMP) Late Stage(GMISC)

Change in skin color GynocomastiaLoss in sensation Madarosis(loss of eyebrows)Ulcers that do not heal Inability to close eyelids (Lagopthalmos)Muscle weakness Sinking nosebridgePainful nerves Clawing/contractures of fingers & nose


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Prevalence RateMetro Manila, the prevalence rate ranged from 0.40 3.01 per one thousand population.

MANAGEMENT:

Dapsone, Lamprene

clofazimine and rifampin

Multi-Drug-Therapy (MDT)

six month course of tablets for the milder form of leprosy and two years for themore severe form

Vector Borne Communicable Disease

LEPTOSPIROSI

an infectious disease that affects humans and animals, is considered the most commonzoonosis in the world

Causative Agent: Leptospira interrogans

S/S:-high fever -severe headache

-chills -muscle aches-vomiting -may include jaundice (yellow skin and eyes)-red eyes -abdominal pain-diarrhea

TREATMENT:

PET - > Penicillins , Erythromycin, Tetracycline

MALARIA

Malaria (from Medieval Italian: mala aria - "bad air"; formerly called ague or marsh fever)is an infectious disease that is widespread in many tropical and subtropical regions.

Causative Agent: Anopheles female mosquitoSigns & Symptoms:

Chills to convulsionHepatomegalyAnemiaSweats profusely


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Elevated temperatureTreatment: Chemoprophylaxis chloroquine taken at weekly interval, starting from 1-2weeks before entering the endemic area.

Preventive Measures: (CLEAN)Chemically treated mosquito nets

Larvae eating fishEnvironmental clean upAnti mosquito soap/lotionNeem trees/eucalyptus tree

FILIARIASIS

name for a group of tropical diseases caused by various thread-like parasiticround worms (nematodes) and their larvae

larvae transmit the disease to humans through a mosquito bite can progress to include gross enlargement of the limbs and genitalia in a

condition called elephantiasis

S/S:

Asymptomatic Stage

Characterized by the presence of microfilariae in the peripheral blood

No clinical signs and symptoms of the disease

Some remain asymptomatic for years and in some instances for life

Acute Stage

Lymphadenitis (inflammation of lymph nodes)

Lymphangitis (inflammation of lymph vessels)

In some cases the male genitalia is affected leading to orchitis (redness, painfuland tender scrotum)

Chronic Stage

Hydrocoele (swelling of the scrotum)

Lyphedema (temporary swelling of the upper and lower extremities

Elephantiasis (enlargement and thickening of the skin of the lower and / or upperextremities, scrotum, breast)

MANAGEMENT:

Diethylcarbamazine Ivermectin,

Albendazolethe

No treatment can reverse elephantiasis

VI SCHISTOSOMIASIS

parasitic disease caused by a larvae


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Causative Agent: Schistosoma intercalatum, Schistosoma japonicum, Schistosomamansoni

Signs & Symptoms: (BALLIPS)Bulging abdomen

Abdominal painLoose bowel movementLow grade feverInflammation of liver & spleenPallorSeizure

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

DENGUE

DENGUEis a mosquito-borne infection which in recent years has become a

major international public health concern.. It is found in tropical and sub-tropical regions around the world, predominantly in

urban and semi-urban areas.

S/S: (VLINOSPARD) Vomiting Low platelet Nausea Onset of fever Severe headache

Pain of the muscle and joint Abdominal pain Rashes Diarhhea

TREATMENT:The mainstay of treatment is supportive therapy.

- intravenous fluids- A platelet transfusion
http://en.wikipedia.org/wiki/Intravenous_driphttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Intravenous_driphttp://en.wikipedia.org/wiki/Blood_transfusion

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