Community Health Nursing PDF

COMMUNITY HEALTH NURSING ❖ It is synthesis of nursing practice and public health applied to promoting and preserving the health of populations. ❖ Focus of the community health nursing is the community as a whole, with nursing care of individuals, families and groups being provided within t...

COMMUNITY HEALTH NURSING ❖ It is synthesis of nursing practice and public health applied to promoting and preserving the health of populations. ❖ Focus of the community health nursing is the community as a whole, with nursing care of individuals, families and groups being provided within the context of promoting and preserving the health of the community. ❖ According to Ruth B. Freeman, it refers to a service rendered by a professional nurse with communities, group, families, individuals at home, in health centers, in clinics, in schools, in places of work for the: Promotion of health Prevention of illness Care of the sick at home and rehabilitation Four Levels of Clientele: Individuals Family Population Community Subspecialties: School Nursing Occupational Health Nursing Community Mental Health Nursing Public Health Nursing  PUBLIC HEALTH NURSING It is a special field of nursing that combines the skills of nursing, public health and some phases of social assistance (World Health Organization) Functions as part of the total public health program for the promotion of health, the improvement of the conditions, in the social and physical environment, rehabilitation of illness and disability. According to Dr. C.E Winslow, public health is the science and art of: Preventing diseases Prolonging life Promoting health and efficiency PUBLIC HEALTH NURSE Refers to the nurses in the local/national health departments or public schools whether their official position title is public Health Nurse or Nurse school nurse Starts with a Salary Grade 15  Roles & Functions Planner/Programmer Identifies the health needs, priorities and problems of individuals, families, and community Nursing Care Provider Provides nursing care to the sick, disabled in the home, clinic, school, or place of work Manager/Supervisor Formulates and implements nursing plan for individual, family, group, community Leads and encourages them to address their health needs and solve their health problems Community Organizer Motivates and enhances community participation Initiates and participates in community development activities Service Coordinator Collaborates with individuals, families, and groups for health and health services  Health Educator/Counselor/Trainer Conducts health teaching, training and counseling Trains and educates rural health midwives Acts as a resource speaker on health and health related services Health Monitor Monitors the status of the individuals, families and groups through various contacts Role Model Sets as good example of healthful, living to the individuals, families, and community Change Agent Motivates changes in the health behavior of individual, families and community Reported/ Recorder/Statistician Records every nursing interventions Updates existing data base Makes statistical analysis of data for interpretation Researcher Uses observation, interview, survey questionnaire, physical exam, and other methods in the assessment of individuals, families, and community PHILIPPINE HEALTH CARE DELIVERY SYSTEM DEPARTMENT OF HEALTH PUBLIC SECTOR 1. Leadership in Health 2. Enabler and Capacity 3. Administrator of specific Services ❖ VISION Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040 ❖ MISSION To lead the country in the development of a productive, resilient, equitable and people-centered health system ❖ GOAL Health Sector Reform Agenda (HSRA) Health Sector reform is the overriding goal of DOH FRAMEWORK FOR THE IMPLEMENTATION OF HSRA FOURmula ONE for Health (2005-2010) Goals of the FOURmula One of Health ✓ Better Health Outcomes ✓ More responsive health systems ✓ Equitable health care financing Four Elements of the Strategy 1. Health Financing- To foster greater, better and sustained investments in health (PHILHEALTH) 2. Health Regulation- To ensure the quality and affordability of health goods and services 3. Health Service Delivery- To improve and ensure the accessibility and availability of basic and essential health care 4. Good Governance- To enhance health system performance at the national and local levels  PRIMARY HEALTH CARE (PHC) ❖ Adopted in the Philippines through: Letter of instruction (LOI) 949 -Signed by President Marcos on October 19, 1979 Underlying theme: “Health in the Hands of the People by 2020” ❖ Characterized by partnership and empowerment of the people that shall permeate as the core strategy in the effective provision of essential health services that are community- based, accessible, acceptable, and sustainable at a cost, which the community and the government can afford. ❖ Elements/Components of PHC E ducation for health L ocally Endemic and Communicable Disease Control and Treatment E xpanded Program on Immunization M aternal and Child Health and Family Planning E ssential Drugs N Utrition T reatment (Medical and Emergency Care, Non Communicable Diseases and Mental Health) S anitation of the Environment ❖ Four Cornerstones/Pillars in Primary Health Care Active community participation Intra and inter-sectoral linkages Use of appropriate technology Support mechanism made available ❖ Levels of Primary Health Care Worker 1. Village/Barangay Health Workers Refers to trained community health workers or health auxiliary volunteer or a traditional birth attendant or healer 2. Intermediate Level Health Workers General medical practitioners or their assistants. E.g. Public Health Nurse, Rural Sanitary Inspectors and Midwives, Rural Health Physician ❖ Levels of Health Care and Health Referral System 1. Primary Level of care Devolved to the cities and municipalities Health care provided by center physicians, public health nurses, rural health midwives, barangay health workers, traditional healers. EXAMPLES 1. Barangay Health Stations 2. Rural Health Unit 3. Community Hospitals 4. Health Centers 5. Puericulture Center 2. Secondary Level of Care Secondary care is given by physicians with basic health training Serves as a referral center for the primary health facilities Capable of performing minor surgeries and perform some simple laboratory examinations EXAMPLES 1. Emergency/District Hospitals 2. Provincial/City Health Services 3. Provincial/City Hospitals 3. Tertiary Level of Care Tertiary care is rendered by specialists in health facilities Referral center for the secondary care facilities Complicated cases and intensive care requires tertiary care EXAMPLES 1. Regional Health Services 2. Regional Medical Centers and Training Hospitals 3. National Health Services 4. Medical Centers 5. Teaching and Training Hospitals ❖ Levels of Prevention 1. Primary Prevention – Prevent the transmission of the disease Target population- At risk Strategies ✓ Vector control ✓ Counselling ✓ Educational programs ✓ Immunization ✓ Isolation ✓ Lifestyle Modification Responsible sector 1. Public health 2. Primary health care 2. Secondary Prevention- Prevent or inhibit disease in cases where infection has occurred. Focuses on early detection of disease and prompt treatment for individual experiencing health problems. Strategies ✓ Screening ✓ Periodic health examination ✓ Case finding ✓ Early Intervention ✓ Early diagnosis Responsible sectors ✓ Public health ✓ Primary health care 3. Tertiary Prevention- prevent morbidity and mortality once disease is established. Rehabilitation (prevent further disability) Restore client’s optimum level of functioning Strategies ✓ Symptomatic treatment ✓ Pharmacological interventions ✓ Management of complications ✓ Continuing care Responsible sectors ✓ Specialist services ✓ Hospital care FIELD HEALTH SERVICES AND INFORMATION SYSTEM (FHSIS) OBJECTIVES To provide summary of data on health services delivery and selected program accomplished indicators at the barangay, municipality/city, district, provincial, regional and national levels. To provide data which when combined with data from other sources, can be used for program monitoring and evaluation purposes. To provide a standardized, facility level data base which can be accessed for a more in-depth studies To ensure that the data reported to the FHSIS are useful and accurate and are disseminated in a timely and easy to use fashion To minimize the recording and reporting burden at the service delivery level in order to allow more time for patient care and promotive activities. Components 1. Family Treatment Record 2. Target Client List 3. Reporting Forms 4. Output Reports 1. Family Treatment Record- the fundamental building block or foundation of the Field Health Service Information System. It is the document, form or pieces of paper upon which the presenting symptoms or complaints of the patient on consultation and the diagnosis (if available), treatment and date of treatment is recorded. 2. Target Client List- the second “building block” of the FHSIS. It is intended to serve four purposes. To plan and carry out patient care and service delivery. To facilitate the monitoring and supervision for services. To report services delivered.- The objective is to avoid having to go back to individual/family records in order to complete the FHSIS Reporting forms.  To provide a clinic-level data base which can be accessed for further studies – It is maintained in hard-bound cover to result in permanent records of facility health care delivery activities which can be served as a facility level data base. The complete set of Target Client List will be collected periodically at the end of each year of every two years and stored in a central location such as the Provincial Health Office to facilitate the maintenance of such a data base. 3. Reporting forms- FHSIS Reports constitute the only mechanism through which data are routinely transmitted from one facility to another in the revised FHSIS. The majority of FHSIS reports are prepared and submitted either monthly or quarterly. One report is prepared weekly, several annually, and in some instance, every few minutes as relevant event s occur, e.g. maternal and neonatal deaths. 4. Output Reports- Output Reports or Table will be produced at the PHO or (alternate date processing site in the province) from the data reported in FHSIS disseminated down to the RHU/MHC and up through the DOH system to the Regional Health Office.  PUBLIC HEALTH PROGRAMS FAMILY HEALTH Maternal Health Program 1. Antenatal Registration- Every woman has to visit the nearest health facility for antenatal registration and to avail prenatal services. This is the only way to guide her in pregnancy care to make her prepare for childbirth. The standard prenatal visits that a woman has to receive during pregnancy are as follows: PRENATAL VISITS PERIOD OF PREGNANCY 1st Visit As early in pregnancy as possible 2nd Visit During 2nd trimester 3rd Visit During 3rd trimester Every 2 weeks After 8th month of pregnancy until delivery 2. Tetanus Toxoid Immunization- Neonatal Tetanus is one of the public health concerns that we need to address among newborns. To protect them from deadly disease, tetanus toxoid immunization is important for pregnant women and child bearing age women. A series of 2 doses of Tetanus Toxoid vaccination must be received by a woman one month before delivery to protect baby from neonatal tetanus. And the 3 booster dose shots to complete the five doses following the recommended schedule provides full protection for both mother and child. The mother is then called as a “Fully Immunized Mother”. VACCINE INTERVAL PROTECTION DURATION TT1 As early as possible during __________ ___________ pregnancy TT2 After 4 weeks 80% 3 years TT3 After 6 months 95% 5 years TT4 After 1 year 99% 10 years TT5 After 1 year 99% Lifetime 3. Micronutrient Supplementation- is vital for pregnant women. These are necessary to prevent anemia, Vitamin A deficiency and other nutritional disorders. VITAMINS DOSE SCHEDULE Vitamins 10,000 IU Twice a week starting on the 4th month of pregnancy Iron/Folic acid 60mg/400ug Daily (Starting 5th month of pregnancy up 2 tablet months postpartum) 4. Treatment of Disease and Other Conditions- There are other conditions that may occur among pregnant women. These conditions may endanger her health and complication could occur. Follow first ai 4. Treatment of Diseases and Other Conditions 5. Clean and Safe Delivery 6. Health Teachings: Birth registration Importance of breastfeeding Newborn screening between 48 hours up 2 weeks after birth Schedule when to return for consultation for post-partum visits ✓ 1st Visit – 1st week postpartum preferably 3-5 days ✓ 2nd Visit – 6 weeks postpartum 7. Support to Breastfeeding 8. Family Planning Counseling Proper spacing of birth (3 to 5 years interval)  EPI LAW (PD (996) ❖ Principles: It is safe and immunologically effective to administer all EPI vaccines on the same day at different sites of the body Measles Vaccine should be given as soon as the child is 9 months old. If the child is living in an endemic area, give the vaccine as early as 6 months. If given at 9 months = 85% protection; if given at one year and older = 95% Giving doses less than the recommended interval may lessen the antibody response No extra must be given to children/ mother who missed a dose of DPT/Hepa-B/OPV/TT Strictly follow the principle of never, ever reconstituting the freeze dried vaccines other than the diluents supplied One Syringe, One Needle per child during vaccination RA 10152 (2011) An act providing for mandatory basic immunization services for infants and children. False Contraindications: Malnutrition Low Grade Fever Mild Respiratory Infections Cough Diarrhea Vomiting Absolute Contraindications: DPT 2 or DPT 3 to a child who has had convulsions or shock within 3 days the previous dose. Patients with neurologic disease should not be given vaccines containing whole cell pertussis Live vaccines like BCG vaccine must not be given to individuals who are immunosuppressed due to a malignant disease.  VACCINES ROUTE DOSE SCHEDULE BCG ID 0.05ml At birth HEPA B IM 0.5ml At birth PENTAVALENT IM 0.5ml 6 weeks 6, 10, 14 OPV PO 2-3gtts 6 weeks 6, 10, 14 MMR SUBQ 0.5ml 9 months → 1 year (12m- 15m) IPV IM 0.5ml 14 weeks →9 months PCV IM 0.5ml 6 weeks 6, 10, 14  FAMILY PLANNING ❖ Overall Goal: To provide universal access of family planning information and services wherever and whenever these are needed ❖ Aims to reduce: Infant deaths Neonatal deaths Under-five deaths Maternal deaths ❖ Objectives Addresses the need to help couples and individuals achieved their desired family size within context of responsible parenthood. Ensure that quality FP services are available in DOH retained hospitals, LGU managed health facilities, NGOs and private sector Family Planning Methods 1. Female Sterilization Also known as Bilateral Tubal Ligation Safe and simple surgical procedure which provides permanent contraception for women who do not want more children Involves cutting or blocking of two fallopian tubes. Advantages ✓ Permanent method of contraception ✓ Does not interfere with sex ✓ Results in increased sexual enjoyment ✓ No effect on breastfeeding ✓ No known long term side effects or health risks Disadvantages Uncommon complications of surgery: ✓ Infection or bleeding ✓ Increase risk for ectopic pregnancy ✓ Requires physical examination ✓ Reversal surgery is difficult ✓ Do not protect against sexually transmitted diseases 2. Male Sterilization Also known as Vasectomy Permanent method wherein the vas deferens is tied and cut o blocked through a small opening in the scrotal skin Advantages ✓ Very effective in 3 months after the procedure ✓ Permanent, safe, simple and easy to perform ✓ Can be performed in a clinic ✓ Person will not lose his sexual ability and ejaculation Disadvantages ✓ May be uncomfortable due to slight pain and swelling 2-3 days after the procedure ✓ Reversibility is difficult and expensive ✓ Bleeding may result in hematoma formation 3. Pill Contains hormones – estrogen and progesterone Advantages ✓ Safe as proven through extensive studies ✓ Convenient and easy to use ✓ Reduces gynecologic symptoms such as painful menses and endometriosis ✓ Does not interfere with sexual intercourse Disadvantages ✓ Often not used correctly and consistently, lowering its effectiveness ✓ Has side effects such as nausea, dizziness or breast tenderness ✓ Can suppress lactation 4. Male Condom Thin sheath of latex rubber made to fit on a man’s erect penis to prevent the passage of sperm cells and sexually transmitted disease into the vagina Advantages ✓ Safe and has no hormonal effect ✓ Protects against microorganisms during intercourse ✓ Encourages male participation in family planning Disadvantages ✓ May cause allergy for people who are sensitive to latex or lubricant ✓ May decrease sensation, making sex less enjoyable 5. Injectables Contain synthetic hormone, progestin that suppresses ovulation, thickens cervical mucus and changes uterine lining. Advantages ✓ Reversible ✓ No need for daily intake ✓ Does not interfere with sexual intercourse ✓ Has no estrogen-related side effects 6. Lactating Amenorrhea Method/LAM Temporary introductory postpartum method of postponing pregnancy based on physiological infertility experienced by Breastfeeding women Advantages ✓ LAM is universally available to all postpartum breastfeeding women ✓ No other FP commodities are required ✓ ü It contributes to improve maternal and child health and nutrition Disadvantages ✓ Short term FP method which is effective only for a maximum of 6 months ✓ The effectiveness of LAM may decrease if a mother and child are separated for extended periods ✓ Full or nearly full BF may be difficult to maintain up to 6 month 7. Mucus/Billing Methods Abstaining from sexual intercourse during fertile days prevents pregnancy Advantages ✓ Can be used by any woman of reproductive age as long as she is not suffering from an unusual disease or condition that results in extraordinary vaginal discharge Disadvantages ✓ Cannot be used by woman with medical conditions that would make pregnancy dangerous 8. Basal Body Temperature Identifies the fertile and infertile period of a woman’s cycle by daily taking and recording of the rise in body temperature during and after ovulation. Before Ovulation: Temperature decreases 0.5 °F During Ovulation: Temperature increases 1.0°F 9. Sympto-thermal Method Identifies the fertile and infertile days of the menstrual cycle as determined through a combination of observations made on the cervical mucus, basal body temperature recording and other signs of ovulation. 10. Two Day Method Simple fertility awareness based method of FP that involves: ✓ Cervical secretions as an indicator of fertility ✓ Women checking the presence of secretions everyday Advantages ✓ Can be used by women with any cycle length ✓ No health related side effects associated ✓ Incurs very little or no cost ✓ Immediately reversible ✓ Promote male partner involvement in FP Disadvantages ✓ Needs cooperation of the husband ✓ Can become unreliable for women who have conditions that cause abnormal cervical secretions 11. Standard Days Method Couples use color coded cycle beads to mark the fertile and infertile days of the menstrual cycle Advantages ✓ No health related side effects associated with its use ✓ Increases self-awareness and knowledge of human reproduction ✓ Can be used either to avoid or achieve pregnancy ✓ Enhances self-discipline, mutual respect ✓ Can be integrated in health and family planning services Disadvantage ✓ Cannot be used by women who usually have menstrual cycle between 26 and 32 days long  ENVIRONMENTAL HEALTH AND SANITATION ENVIRONMENTAL HEALTH AND SANITATION ❖ Environmental Health- It is a branch of public health that deals with the study of preventing illness by managing the environment and changing people’s behavior to reduce exposure to biological and non-biological agents of disease or injury ❖ Health and Sanitation Laws PD 856 – Sanitation Code of the Philippines RA 6969- toxic Substances and hazardous and Nuclear Waste Control Act of 1990 RA 8749- Clean Air Act of 1999 RA 9003- Ecological Solid Waste Management Act of 2000 RA 9275- Clean Water Act 2004 Environmental Sanitation ❖ Study of all factors in man’s physical environment, which may exercise a deleterious effect on his health well-being and survival ❖ The Development of Health through the Environment and Occupation Health Office (EOHO) has set some policies on the following areas: 1. Approved Types of Water Supply Facilities LEVEL 1 (Point Source) ✓ Protect well or developed spring with an outlet but without a distribution system ✓ Serves around 15 to 25 households ✓ Outreach must not be more than 250 meters from the farthest user ✓ Yield or discharge is generally from 40 to 140 liters per minute ✓ Generally adaptable for rural areas where the houses are thinly scattered  LEVEL II (Communal Faucet System or Stand –posts) ✓ System composed of a source of reservoir, a piped distribution network and communal faucets ✓ Located not more than 25 meters from the farthest house ✓ Designed to deliver 40-80 liters of water per capital per day ✓ Average households: 100 ✓ One faucet per 4 to 6 households ✓ Suitable for rural areas where houses are clustered densely to justify a simple-piped system LEVEL III (Waterworks System or Individual House Connections) ✓ NAWASA, Maynilad 2. Unapproved type of water facility Open drug wells Unimproved springs Wells that need priming 3. Access to sage and potable drinking water 4. Water quality and monitoring surveillance Disinfection of water supply sources is required on the following: Newly constructed water supply facilities Water supply facility that has been repaired/improve 5. Waterworks/water system and well construction Well sites shall require the prior approval of the Secretary of Health or his duly authorized representative Well construction shall comply with sanitary requirements of the Department of Health Water supply system shall supply safe and potable water in adequate quantity PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM APPROVED TYPE OF TOILET FACILITY LEVEL 1 1. Non-water Carriage Toilet Facility ✓ Pit Latrines ✓ Reed Odorless Earth Closet 2. Toilet Facilities requiring small amount of water ✓ Poor Flush Toilet ✓ Aqua Privies  LEVEL II ✓ Water carriage type with Water Flush type with septic vault/tank disposal facilities LEVEL III ✓ Water carriage types of toilet facilities connected to septic tanks and/or sewerage system to treatment plant  FOOD SANITATION PROGRAM ❖ Food Establishments shall be appraised as to the following sanitary conditions: Inspection/approval of all food source, containers, transport vehicles Compliance to sanitary permit requirements for all food establishment Provision of updated Health certificate for food handlers, cooks and cook helpers ❖ DOH’s Administrative Order no.1 – 2006 requires all laboratories to use Formalin Ether Concentration. Technique (FECT) instead of the direct fecal smear in the analysis of stools of food handlers. ❖ Food Establishment shall be rated as follows: ✓ CLASS A – Excellent ✓ CLASS B – Very Satisfactory ✓ CLASS C – Satisfactory Four Rights in Food Safety 1. Right Source ✓ Always buy fresh meat, fish fruits & vegetables ✓ Look at the expiry dates of processed food ✓ Avoid buying canned goods with dents, bulges, deformation, broken seals and improper seams ✓ Boil water for at least 2 minutes (running boiling) 2. Right Preparation ✓ Avoid contact between raw food and cooked food ✓ Always buy pasteurized mild and fruit juices ✓ Wash vegetables well if to be eaten raw such as lettuce, cucumber, tomatoes & carrots ✓ Wash hands kitchen utensils before and after preparing foods ✓ Sweep kitchen floors to remove food droppings 3. Right Cooking ✓ Cook food thoroughly (temperature on all parts of the food should reach 70 degrees centigrade ✓ Eat cooked food immediately ✓ Wash hands thoroughly before and after eating 4. Right Storage ✓ All cooked food should be left at room temperature for not more than two hours ✓ Use tightly sealed containers for storing food ✓ Store food under hot conditions (at least or above 60°C) or in cold conditions (below or equal to 10°C) if you ✓ can plan to store it for more than 4 to 5 hours ✓ Do not overburden the refrigerator by filing it with too large quantities of warm food ✓ Food should be reheated to at least 70 degrees centigrade ✓ Rule in Food Safety: “When in doubt, throw it out!”  HERBAL MEDICINE ❖ General guidelines for the use of medicinal plants Be sure that the right king of plant is used according to the intended purpose Use the plant part suggested Use according to the dosage and direction recommended Use only one kind of medicinal plant at a time Stop the use of the plant if there is any untoward reaction or if side effects occur If there are no signs of improvement after two or three administration of the drug, consult a physician In boiling the plants, use enamel were or clay pots, not aluminum ware. Clean the pots very well before and after boiling the plant Use only the prescribed part of the plant Avoid the use of insecticides Herbal Plants 1. Lagundi (Vitex negundo) For cough and asthma Preparations ✓ Clean the leaves thoroughly and chop ✓ Measure two cups of water and boil on a low fire for 15 minutes ✓ Use the table on the amount of leaves to be used LEAVES AGE FRESH DRIED Adult 6 tbsp 4 tbsp 7 – 12 y/o 3 tbsp 2 tbsp 2 – 6 y/o 1 ½ tbsp 1 tbsp Dosage ✓ Divide the solution into three parts. Drink one part each in the morning, noon and night For fever, drink each part every four hours 2. Ulasimang bato (Peperomia pellucida) Lower uric skin; for arthritis or gout Preparations ✓ Salad: Clean leaves thoroughly, Eat three times a day with meals ✓ Decoction: Clean leaves thoroughly and boil 1 ½ glasses of leaves in two glasses of water for 15 minutes. Divide into three parts and take three times a day 3. Bayabas (Psidium guajava) For cleansing or wounds, mouth infections and swollen gums Preparations ✓ Clean thoroughly and chop leaves ✓ Boil two glasses of leaves in four glasses of water on a low fire Administration ✓ Clean wounds with the solution two times a day. To use as a mouthwash, use a lukewarm solution 4. Bawang (Allium sativum) To lower cholesterol level Preparation ✓ Saute or boil; may be infused (five minutes); be mixed with vinegar Administration and Dosage ✓ Eat two clove of garlic with meals three times a day 5. Yerba Buena (Mentha cordifolia Opiz ex Fresen) For pains of the body Preparations ✓ Cleanse thoroughly and chop the leaves, then boil in two glasses of water for 15 minutes. ✓ Do not cover the pot; allow to cool and strain ✓ For adults, six tbsp. of fresh leaves or four tbsp. of dried leaves should be used ✓ For patients 7-12 years old, use half the adult dose Dosage ✓ Divide the boiled solution into three parts and drink on part each in the morning, afternoon and evening, Squeeze the fresh leaves and place on the painful part 6. Sambong (Blumea balsamifera) For swelling. Diuresis, anti-urolithiasis Preparations ✓ Cleanse thoroughly and chop leaves, boil in two glasses of water for 15 minutes ✓ Do not cover the pot; keep boiling and strain ✓ For adults, use six tbsp. fresh leaves or four tbsp. dried leaves Dosage ✓ Divide the boiled solution into three parts and drink one part each in the morning, afternoon and evening, Squeeze the fresh leaves and place on the painful part. 7. Ampalaya (Momordica charantia) For diabetes mellitus (mild-insulin dependent) Preparation ✓ Clean the leaves thoroughly and chop. Measure two cups of leaves in two glasses of water, Boil for 15 minutes on low fire. Drink ½ glass three times a day before eating 8. Niyug-niyugan (Quisqualis indica) For ascaris Preparation ✓ Use newly-opened, mature and dried nuts Administration ✓ Eat the seeds two hours after supper Dosage ADULT 8 – 10 seeds 7 – 12 y/o 6 – 7 seeds 6 – 8 y/o 5 – 6 seeds 4 – 5 y/o 4 – 5 seeds 9. Tsaang Gubat (Ehretia microphylla Lam) For stomachache Preparations ✓ Cleanse thoroughly and chop leaves and boil in two glasses of water for 15 minutes ✓ Do not cover the pot; keep cooking and strain ✓ For adults, six tbsp. of fresh leaves or four tbsp. of dried leaves should be used ✓ For patients 7-12 years old, use half the adult dose Dosage ✓ Divide in two parts and drink one part every four hours 10. AKapulko (Cassia alata) Infected skin, skin irritation and scabies Preparation ✓ Squeeze enough leaves Administration ✓ Apply the juice of the leaves on affected parts twice a day THANK YOU!