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RATIONALE _ CHN _PREBOARDS


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Prioritizing Family Nursing Problems

Nature of theproblem

Wellness, HD HT, FC

Modifiabilityof the Problem

the probability of success in minimizing, alleviating or totally eradicatingthe problem

PreventivePotential

the nature and magnitude of future problems that can be minimized ortotally preventedif intervention is done on the problem under consideration

Salience

the familys perception and evaluation of the problem in terms ofseriousness and urgency of attention needed


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#1 Factors Affecting MODIFIABILITY

OF THE PROBLEM

Current knowledge,technology andinterventions to

manage the problem

Resources of thefamily

Resources of thenurse

Resources of thecommunity


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# 2 Factors in Considering the

Preventive Potential

Progress and extentGravity and

severity

Length of timeDuration

Presence and appropriatenessCurrent

management

Increases the PPExposure to anyhigh risk group


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# 3 Nature of the Problem

1. WELLNESS

2. HEALTH DEFICIT

3.

HEALTH THREAT4. FORESEEABLE CRISIS / STRESS POINT


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# 5 HOME VISIT Guidelines

1) Greet and introduceself.

2) Explain the purpose.

3) Ask about healthstatus.

4) Inquire about healthand welfare of the ct

and other familymembers.

5) Place PHN bag in aconvenient place.

7. Perform PA well toinfectious member.

8. Provide health

teachings / counselling.9. Make appropriate

referral.

10. Do cleansing of

equipment.11. Make an appointment.

12. Record.


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#7 TOILET FACILITIES

LEVEL 1 LEVEL 2 LEVEL 3

A. Non water carriage

toilet facility

-NO WATER IS USED

TO FLUSH!!!

-EX: PIT LATRINES

B. Small amount ofwater required to flush

the waste

-EX: POOR FLUSH

TOILET, AQUA PRIVIES

On site toilet facilities

of the water carriage

type

With water sealed and

flush type

With septic tank

disposal system

Water carriage types of

toilets

Connected to sewerage

system to plant for tx


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#8 WATER FACILITIES (from PD 856)

LEVEL 1 (Point Source) LEVEL 2 (CommunalFaucet System /

Standpost)

LEVEL 3 (WaterworksSystem or Individual

House Connection)

Protected well or a

developed spring with an

outlet but without adistribution system

Rural areas

15 25 households,

outreach must not be

more than 250m from

farthest user

40 140 L/min

Composed of a

source/reservoir, piped

distribution network andcommunal faucets,

located not more than 25

m from the farthest

house

Rural area

40 80 L/ head / day :

1faucet: 4-6household

With source, reservoir,

piped distribution

network and householdtaps

Quality water


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RA 9275

CLEAN WATER ACT 2004

Unapproved type of water facilities: Open dug wells

Unimproved springs and wells

Examination of drinking H2O: performed only by LABS acc. ByDOH

Certification of Potability of wells as source: granted/issuedby Sec. of DOH/representative

Construction of WELLS: comply with standards of DOH

No booster pump shall be allowed to boost water fromdistribution pipe

LEVEL 3: preferred


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#9 Solid Waste Management RA

9003

Sec. 21.

Mandatory Segregation of Solid Wastes. - The LGUsshall evaluate alternative roles for the public and

private sectors in providing collection services, type ofcollection system, or combination of systems, that bestmeet their needs: Provided, That segregation of wastesshall primarily be conducted at the source, to includehousehold, institutional, industrial, commercial and

agricultural sources: Provided, further; That wastes shallbe segregated into the categories provided in Sec. 22of this Act.


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(a) provide for the residents a designated area and

containers in which to accumulate source separated

recyclable materials to be collected by the

municipality or private center; and

(b) notify the occupants of each buildings of the

requirements of this Act and the regulations

promulgated pursuant thereto.


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Sec. 22. Requirements for the Segregation andStorage of Solid Waste. - The following shall bethe minimum standards and requirements forsegregation and storage of solid waste pendingcollection:

(a) There shall be a separate container for eachtype of waste from all sources: Provided, That in

the case of bulky waste, it will suffice that thesame be collected and placed in a separatedesignated area; and

(b) The solid waste container depending on its

use shall be properly marked or identified for on-site collection as compostable, non-recyclable, recyclable or special waste, orany other classification as may be determined bythe Commission.


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GREEN BLACK YELLOW ORANGE

WET NON PATHOLOGIC

WASTES

DRY NON -PATHOLOGIC

WASTES

INFECTIOUS /PATHOLOGIC

WASTES

TOXIC /HAZARDOUS!


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#10 SENTRONG SIGLA

MOVEMENT

a certification recognition program which develops

and promotes standards for health facilities

CENTER FOR HEALTH VITALITY

- Joint effort bet.:

1.DOH provides technical and financial assistancepackages for health care

2. LGUs direct implementers of health programs &prime developers of health centers and hospitalsmaking services accessible to every Filipino


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Pillars of SSM

1. Quality Assurance

2. Grant and Technical Assistance

3.

Health Promotion4. Awards


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Expected Outcome: SSM

Empowered individuals adopting healthy lifestyle,

improved health-seeking behavior and well-being

& increased demand for quality health services

Institutions will develop policies, provide quality

services , institute system for surveillance/ merits

and advocate for laws


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Programs: SSM

EPI

Disease Surveillance

CARI

CDD

Nutrition/ Micronutrient Supplementation-

*Food Fortification :

Rice iron; Oil and sugar Vit. A;Flour-Vit. A & iron; Salt- iodine


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#13 Botika ng Barangay

A.O # 23-a, July 5, 1996

Outlines the guidelines in establishing the BnB

BnB drug outlet managed by legitimate community

organization, NGO and the LGU with a trained

operator and a supervising pharmacist.

Licensed by BFAD to sell, distribute OTC or generics

2000 = pharma 50 = cutting the prices into 50%


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Goal of BnB

Promote equity in health by ensuring the

availability and accessibility of AHSE

medicines with priority for marginalized,underserved, critical and hard to reach

areas.


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CBQ tips CRITERIA

1) Managed by: CO or Cooperative duly recognized bya judicial body

2) Coverage: 1-more adjacent brgys, far-flung, no

licensed drug stores3) Source of funds: 1/3 = community funded

4) LGU = 1/3

5) Master list of indigents

6) Commitment from a licensed pharmacist7) 2 accredited BHWs

8) Available space


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#14 Bag Technique

a tool making use of public health bag throughwhich the nurse, during his/her home visit, canperform nursing procedures with ease and deftness,

saving time and effort with the end in view ofrendering effective nursing care.

Public health bag

is an essential and indispensable equipment of the

public health nurse which he/she has to carry alongwhen he/she goes out home visiting. It contains basicmedications and articles which are necessary for givingcare.


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Rationale

To render effective nursing care to clients and /or

members of the family during home visit.


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Principles

1. The use of the bag technique should minimize if nottotally prevent the spread of infection from individuals tofamilies, hence, to the community.

2. Bag technique should save time and effort on the part ofthe nurse in the performance of nursing procedures.

3. Bag technique should not overshadow concern for thepatient rather should show the effectiveness of totalcare given to an individual or family.

4. Bag technique can be performed in a variety of waysdepending upon agency policies, actual home situation,etc., as long as principles of avoiding transfer of infectionis carried out.


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STEPS IN BAGTECHNIQUECBQs

Place bag lined with cleanpaper clean side out (foldedpart touching the table). Putthe bags handles or strapbeneath the bag.

Ask for basin of water Open bag, take out soap

and towel. Wash hands.Leave the plastic wrappersof the towel in a soap dish inthe bag.

Put on apron right side out andwrong side with crease touchingthe body, sliding the head into theneck strap. Neatly tie the strapsat the back.Put out allnecessary articles

Close the bag, place it inone corner of the workingarea

Perform NSG Care/tx Clean all things after usage Open bag, return all things Remove apron folding

away from the body, withsoiled sidefolded inwards,andthe clean side out. Placeit in the bag.

Fold lining, place inside thebag

Record Set appointment


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#15 OHN

Based in commercial and industrial establishments

Concerned with the promotion of health and

prevention of disease among adult workers and

their families in the commercial and industrial

establishments

CONCENTRATION:

Health and wellbeing of the employees


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ACTIVITIES OF OHN

1) Observation / assessment of worker and workingenvt

2) Interpretation and evaluation of the workers medicaland occupational hx, PE, industrial hygiene and

personal exposure3) Interpretation of medical dx

4) Appraisal of working envt for potential exposures

5) Identification of abnormalities

6) Description of workers response to exposures7) Occupational and non occupational injuries

8) Documentation


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# 17 10 ELEMENTS OF RH

1) MCH nutrition

2) FP

3) Abortion

complication mgt

4) RTI mgt

5) Sexual HE

6) Breast Ca & gyne

7) Mens RH

8) VAWC

9) Infertility & sexual

dse tx

10) Adolescent Health


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#19 IV

RA 9173

ARTICLE VI Nursing Practice

Section 28. cope of Nursing. - A person shall be deemed to be practicingnursing within the meaning of this Act when he/she singly or incollaboration with another, initiates and performs nursing services to

individuals, families and communities in any health care setting. Itincludes, but not limited to, nursing care during conception, labor,delivery, infancy, childhood, toddler, preschool, school age, adolescence,adulthood, and old age. As independent practitioners, nurses areprimarily responsible for the promotion of health and prevention ofillness. A members of the health team, nurses shall collaborate with otherhealth care providers for the curative, preventive, and rehabilitative

aspects of care, restoration of health, alleviation of suffering, and whenrecovery is not possible, towards a peaceful death. It shall be the dutyof the nurse to:


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(a) Provide nursing care through the utilization of thenursing process. Nursing care includes, but not limited to,traditional and innovative approaches, therapeutic useof self, executing health care techniques and

procedures, essential primary health care, comfortmeasures, health teachings, and administration ofwritten prescription for treatment, therapies, oraltopical and parenteral medications, internalexamination during labor in the absence of antenatal

bleeding and delivery. In case of suturing of perineallaceration, special training shall be provided accordingto protocol established;


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(b) establish linkages with community resources andcoordination with the health team;

(c) Provide health education to individuals, families andcommunities;

(d) Teach, guide and supervise students in nursing educationprograms including the administration of nursing services invaried settings such as hospitals and clinics; undertakeconsultation services; engage in such activities that requirethe utilization of knowledge and decision-making skills of a

registered nurse; and (e) Undertake nursing and health human resource

development training and research, which shall include, butnot limited to, the development of advance nursing practice;


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# 20 LEPROSY Treatment

EtiologyEtiology MOTMOT IPIP DxcDxc S/SxS/Sx

M. lepraeM. leprae

//

HANSENSHANSENSBACILLUSBACILLUS

RespiRespi

dropletdroplet

SkinSkin--toto--skinskin

MonthsMonths --

yearsyears

TissueTissue

biopsybiopsy

BloodBlood

worksworks

EARLYEARLY

Skin colorSkin color

Loss of hairLoss of hair

Skin lesionSkin lesion

ParesthesiaParesthesia

Ulcers thatUlcers that

does not healdoes not heal

LATELATE

LagopthalmosLagopthalmosMadarosisMadarosis

Clawing ofClawing of

fingersfingers

Saddle NoseSaddle Nose

ContracturesContractures


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10/18/2010 32

WHO CLASSIFICATION OF LEPROSY

PAUCIBACILLARY

Non infectious

Tuberculoid

6 9 mos

MULTIBACILLARY /

BORDERLINE

Infectious

Lepromatous

24 30 mos


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PAUCIBACILLARY 6 9 mos.

MEDSMEDS ADULTADULT 1010 14 Y/O14 Y/O < 10 Y/O< 10 Y/O

Monthly TxMonthly Tx

DAY 1 (SD)DAY 1 (SD)

RifampicinRifampicin 600 mg600 mg 450 mg450 mg 300 mg300 mg

DapsoneDapsone 100 mg100 mg 50 mg50 mg 25 mg25 mg

Daily TxDaily Tx

DAY 2DAY 2 2828

(SAD)(SAD)



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MEDSMEDS ADULTADULT 1010 14 Y/O14 Y/O

RifampicinRifampicin 600 mg600 mg 300 mg300 mg

OfloxacinOfloxacin 400 mg400 mg 200 mg200 mg

MinocyclineMinocycline 100 mg100 mg 50 mg50 mg


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MULTIBACILLARY 24 30 mosMEDSMEDS ADULTADULT 1010 14 Y/O14 Y/O < 10 Y/O< 10 Y/O

Monthly TxMonthly Tx

DAY 1 (SD)DAY 1 (SD)

RifampicinRifampicin 600 mg600 mg 450 mg450 mg 300 mg300 mg

ClofazimineClofazimine 300 mg300 mg 150150 100 (1x/mo)100 (1x/mo)


Daily TxDaily Tx

DAY 2DAY 2 28 (SAD)28 (SAD)

ClofazimineClofazimine 50 mg50 mg 50 mg qod50 mg qod 50 mg (2x/mo)50 mg (2x/mo)



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# 21-23 MINORITY FAMILY

Transcultural Nursing - A humanistic and scientific

area of formal study and practice in nursing which

is focused upon differences and similarities among

cultures with respect to human care, health, andillness based upon the people's cultural values,

beliefs, and practices, and to use this knowledge to

provide cultural specific or culturally congruent

nursing care to people ... Leininger


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Culture

Culture is made up of the values, beliefs,

underlying assumptions, attitudes, and behaviors

shared by a group of people. Culture is the

behavior that results when a group arrives at a setof - generally unspoken and unwritten - rules for

working together.


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Seven (7) characteristics of culture

Ken Thompson & Fred Luthans

1. Culture = Behavior.

2. Culture is Learned.

3. Culture is Learned Through Interaction.

4.Sub-cultures Form

Through

Rewards - People Shapethe Culture, Culture is Negotiated, Culture is Difficult to

Change.

5. Your work culture is often interpreted differently bydiverse people.

6. Your culture may be strong or weak.7. Ideally, organizational culture supports a positive,

productive, environment.


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Boyle and Andrews proposed measures in

assessing cultural variations

1. History of the origins of the patients' culture.

2. Value orientations, including view of the world, ethics, and normsand standards of behavior as well as attitudes about time, work,money, education, beauty, strength, and change.

3. Interpersonal relationships, including family patterns, demeanor,and roles and relationships.

4. Communication patterns and forms.

5. Religion and magic.

6. Social systems, including economic values, political systems, andeducational patterns.

7. Diet and food habits.

8. Health and illness belief systems, including behaviors, decisionmaking, and use of healthcare providers.


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Consider the ff in working with

MINORITIES

Familiarize your self with the customs, values, laws and health of thecountry you will work in.

Try the food, listen to the music and if possible talk with people ofthat culture before leaving home.

Learn the language, you can't provide adequate care if you can notcommunicate with your patients.

Learn about the organization under who you will work - purpose,goals, philosophy, policies

Remember you will be under other's rules, laws, value system,customs.

Can you cope with lack of structure, boredom, change and danger ? The right experience may enrich your life immeasurably.


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Most important factor to consider in

working with minorities

Communication

Space

Social organizations

Time

Environmental control

Biological variation


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# 28 COMPLEMENTARY FEEDING

Readiness to feed

good rule of thumb is to "Watch the Baby - Not theCalendar

beginning to awaken more often at night or eat moreoften than "usual"

Loss of extrusion reflex 32 oz of formula a day or 960 ml and does not seem

satisfied

nursing q 3-4 hrs and does not seem satisfied

always consult your babys pediatrician beforeintroducing new foods


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WHO recommends that infants start receiving

complementary foods at 6 months of age in

addition to breastmilk, initially 2-3 times a day

between 6-8 months, increasing to 3-4 times dailybetween 9-11 months and 12-24 months with

additional nutritious snacks offered 1-2 times per

day, as desired


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Guidelines

Start out slowly - tablespoon sized portion, one

food at a time 5-7 days b/w items

using their (clean and washed) finger as a spoon

eat 1/2 of the tablespoon sized portion the very

first times you begin solids

Introduce when hungry

Salt and sugar?


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FOODS TO INTRODUCE

1ST CEREALS (5-6MOS), Fe-fortifiedcereal mixed with

breast milk, orangejuice, or formula

2nd VEGETABLES(7MOS), FRUITS

(8MOS) 3RD MEAT (9MOS)

4TH EGGS (10MOS)

Prevents IDA, lessallergenic, easilydigested

VIT.A

VIT. C, A

CHON, Fe and B

Fe


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CEREALS

Rice and Oatmeal cereals are the least of the

allergenic grains and thus most babies are started

out with those cereals.

FRUITS

May be served raw after 8 months old bananasand avocados do NOT need to be cooked ever


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VEGGIES

Always serve cooked until after 12 months old or

when baby can chew well enough so that no

choking hazard is present

PROTEIN

Always serve cooked with no pink areas NEVERgive a small baby/child raw meat or fish


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DAIRY

NEVER replace breast milk or formula until after 12

months of age serious health risks are possible.

Never give a child under the age of 2yrs

old low fat or skim milk products; whole milk is

necessary.


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Suggested Daily "Milk" Intakes

0-3 Months of age:Breastfeed every 1-3 hours or Formula 18-40 ounces

4-5 Months of age:

Breastfeed every 2-4 hours or Formula 24-45 ounces 6-8 Months of age:

Breastfeed every 3-4 hours or Formula 24-37 ounces

9-12 Months of age:Breastfeed every 4-5 hours or Formula 24-31 ounces

Whole Cow Milk, as a drink, should not be introduceduntil 12 months of age!


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# 29: IMCI General Danger Signs

1. Not able to drink orbreastfeed

2. Vomits everything3. Convulsions (during this illness)4. Abnormally sleepy or difficult

to awaken


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MAIN SYMPTOMS

Cough / DOB Diarrhea

Fever

Ear Problems

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Ask the childs name and

age

Decide which age group the

child is in

Child is 2 mos - 5 yrs:

ASSESS AND CLASSIFY THE

SICK CHILD AGE 2 MONTHS

UP TO 5 YEARS

Child is not yet 2 mos,ASSESS, CLASSIFY AND

TREAT THE SICK YOUNG

INFANT

Ask the mother aboutthe childs problem

Check GENERALDANGER SIGNS

Ask for FOUR MAINSYMPTOMS

When the main symptomis present

Assess the child further(main sx)

Classify according to theillness

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Check for the signs of malnutrition and anemia and

classifying

Check for childs immunization status and decide

Check for the childs Vit. A status

Assess any other problems


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# 34 IMCI FEVER

Fever is a very common condition and is often the

main reason for bringing children to the health

center

Minor infections, life threatening disease

Children are considered to have fever if their body

temperature is above 37.5C axillary (38C rectal).


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Assess for:

Stiffed neck

Risk of malaria and other endemic diseases

Runny nose

Duration of fever

Measles


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Classifications of fever

Any danger sign or

Stiff neck

very severe febriledisease

REFER

In a high malaria risk area or season, children

with fever and no general danger sign or stiffneck should be classified as having MALARIA.

All children with fever and any general danger

sign or stiff neck are classified as having VERYSEVERE FEBRILE DISEASE and should be urgently

referred to a hospital after pre-referral

treatment with antibiotics (the same choice as

for severe pneumonia or very severe disease).

Fever (by history or feels hotor temperature 37.5C or

above)malaria

In a low malarial risk area or season, children

with fever (or history of fever) and no generaldanger sign or stiff neck are classified as

having MALARIA and given an antimalarial only

if they have no runny nose (a sign of ARI), no

measles, and no other obvious cause of fever(pneumonia, sore throat, etc.).

NO runny nose and NO measles

and NO other causes of fevermalaria


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.In a low malaria risk area or season,

children with runny nose, measles or

clinical signs of other possible infectionare classified as having FEVER

MALARIA UNLIKELY. These children need

follow-up. If their fever lasts more than

five days, they should be referred for

further assessment to determine causesof prolonged pyrexia. If possible, in

low malaria risk settings, a simplemalaria laboratory test is highly

advisable.

Runny nose PRESENT or

Measles PRESENT or

Other causes of feverPRESENT

fever malaria

unlikely

In a no malaria risk area or season an attempt

should be made to distinguish cases of possiblebacterial infection, which require antibiotic

treatment, from cases of non-complicated viralinfection. Presence of a runny nose in such

situations has no or very little diagnostic value.

Obvious causes of feverpossible bacterial

infection


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In a no malaria risk area or season, if no

clinical signs of obvious infection are found, the

working classification becomes UNCOMPLICATEDFEVER.

NO obvious causes of fever uncomplicated fever


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# 44 Does not have ear problem

Communicating- History Taking

General Danger Signs

Main Symptoms

Cough or Difficult Breathing

Diarrhoea

Fever

Ear Problems

Nutritional Status

Immunization Status

Other Problems

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