Community Health Nursing PDF

Community Health Nursing COMMUNITY HEALTH NURSING Community Health Nursing  … direct, goal-orie...

Community Health Nursing COMMUNITY HEALTH NURSING Community Health Nursing  … direct, goal-oriented, and adaptable to the needs Key Concepts: of the individual, the family, and community during health and illness - ANA (1973)  Community  Client  … an area of human services directed toward  Health  Goal developing and enhancing the health capabilities of  Nursing  Means people – either singly, as individuals, or collectively as groups and communities. – Ruth Freeman & Janet Community Heinrich (1981)  Group of people sharing common geographic location, institution where they are organized into Public Health population aggregate concept (age group), common  Philosophy—health and longevity as birthright values or interest  Objectives: o Prevent disease Levels of Clientele o Prolong life  Individual o Promote health and efficiency  Family – focus of care (CHN)  Through: organized community effort  Community – group of families; CHN directs its services  “The application for science in the context of politics to to the community because the client is the community remove inequalities in health and deliver the best  Population Groups – common health needs health for the greatest number” – WHO Health Public Health Nursing  Complete state of physical, mental and social well-  Public health + Nursing + Social Assistance being and not merely the absence of disease or infirmity (WHO) 1. Promotion of health  Soundness and wholeness of human structures and 2. Improvement of the physical & social environment bodily and mental functions (Orem) 3. Rehabilitation  Dynamic fluctuating from patterns of death or OLOF 4. Prevention of illness and disability (Optimum level of functioning) (Dunn) - WHO Expert Committee on o Modern concept of health Nursing  Right of every individual o Art. 25 Sec 1 of Universal Declaration of human Community health nursing focuses on the community. (Freeman Rights: Health is a basic right of every individual & Heinrich)  Setting: Natural environments of people  General Philosophy of CHN  Home  PHN o Community health nursing is based on the worth School  SHN and dignity of man. – Margaret Shetland Workplace CHN ----------------------------------  Health as a Right 3 fields of CHN Practice o Art. 25, Sec. 1 (Universal Declaration of Human Rights) Health Care Delivery System  Everyone has the right to a standard of  Primary living adequate for the health and o Prevention wellbeing of himself and of his family o Management of prevalent conditions  Dual responsibility of the government and o Out-patient services the individuals o Providers: o Art. 2, Sec. 15  Barangay Health Station  The state shall protect and promote the  Rural Health Units right to health of the people and instill  Secondary health consciousness among them. o Hospitalization o Art. 13, Sec. 11 o Providers:  The state shall adopt an integrated and  Provincial Hospitals comprehensive approach to health  District Hospitals development  DOH  Tertiary  o Rehabilitation Nursing – Means o Specialized care  “Assisting an individual, sick or well, in the performance o Highly trained personnel of those activities contributing to health or its recovery o Highly departmentalized (or to peaceful death) that he would perform if he o Sophisticated equipment head the necessary strength, will, or knowledge, and to o Providers: do this in such a way as to help him gain  Regional Hospital independence as rapidly as possible.” - Virginia  National Hospitals Henderson (1964)  DOH national office  Art - skills  Medical Centers  Science – involves a process in taking care of the  University Hospital patients; systematic  RITM University of Santo Tomas – College of Nursing / JSV  Community Health Nursing Two-way Referral System 1. Accessible – to the people in the catchment of  Communication among facilities the barangay  Competent care 2. Available  Efficiency of health care delivery 3. Appropriate – to the needs of the people o Least possible cost 4. Affordable o Maximize resources  Acceptable – does not conflict their values and beliefs in the locality year 2020. RA 7160 - Devolution Code Local Government Code  Aim: to transform local government units into:  PHN Cornerstones/Pillars o Self-reliant communities o Active Community Participation o Active partnership with the people o Intra and inter-sectoral linkages o Responsive government representatives  within and between the community o Accountable government representatives o Use of appropriate technology o Decentralization system of health decision  Focus on indigenous resources available making in the community (eg. Herbal medicines) o Support mechanisms made available  Provided by the DoH DOH  Primary Health Workers o Village/BHWs—trained community health works, Chair: health Secretary (Janet Garin) health auxiliary volunteers, traditional birth attendants, healers (Grassroots Levels) o Intermediate Level—Professional group Provincial Health Board  Primary Chair: Governor; Vice-Chair: Provincial health Officer; o Rural Health Midwife (1:5,000) Members: Chairman, NGO, DOH  Secondary o Public Health Nurse (1:20,000) – WHO 1:10,000 Municipal Health Board o Dentists (1:50,000) o Rural Sanitary Inspector (1:20,000) Chair: Mayor; Vice-Chair: Municipal Health Officer;  Tertiary Members: Chairman, NGO, DOH Representative o Municipal Health Officer - Physician (1:20,000) Traditional Alternative Medicine Act (RA 8423) Department Of Health  National hospitals/DOH, national office, Medical  Respiratory Centers  Cough/Cold Lagundi Sambong  Diuretic  Rheumatis  Chair: Health Secretary  Asthma  Lowers uric acid Ulasimang Bato Ampalaya  Diabetes Provincial Health Board in the blood Bawang - after  Hypertension  Regular hospitals/RHO meals  Toothache Niyog-niyogan  Anti-helminthic  Provincial Hospital/PHO  Abdominal  District Hospital Bayabas  Anti-septic Tsaang Gubat pain  Diarrhea  Chair: governor  Menstrual pain  Skin infections  Vice chair: PHO Yerba Buena  Bites Akapulko  Fungal  Members: Chairman, NGO, DOH  Bleeding infection Municipal Health Board Things to remember:  RHU/BHS o Boiling—Remove cover  Chair: Mayor o One kind of plant for each type of symptom – may alter  Vice Chair: MHO the therapeutic effect of other herbs  Members: Chairman, NGO, DOH representative o No insecticides o Use clay pot and plant part advocated DOH: standards, training and funding o Stop in case of untoward reactions; seek consultation if LGU: policies, implementation signs and symptoms not relieved after 2–3 doses Primary Health Care (PHC) o Herbal medicines may be prepared by decoction (boil  Legal Basis—LOI 949 part), infusion (tea), or poultice (topical). o October 1979 by Ferdinand Marcos, one (1) year o Hard parts—Decoction – Bark, stem, roots after the First International Conference on o Soft parts—Infusion/ Poultice – Leaves, flowers Primary Health Care in Alma Ata (Russia) sponsored by WHO & UNICEF Health Promotion  Is the process of enabling people to increase control  Goal - Health for all Filipinos & Health in the Hands of over, and to improve their health the People by the  A behavior motivated by the desire to increase well-  Mission - To strengthen the health care system by being and actualize human health potential. It is an increasing opportunities and supporting the conditions approach to wellness wherein people will manage their own health care  Essential health care made universally:  Ottawa Charter University of Santo Tomas – College of Nursing / JSV  Community Health Nursing o Output of the first international conference on  Halt and begin to reverse the spread of HIV/AIDS health promotion, meeting in Ottawa this 21st  Achieve by 2010, universal access to treatment for day of November, 1986 HIV/AIDS for all those who need it o A call for action to achieve health for all by the  Halt and begin to reverse the incidence year 2000 and beyond 1. Building healthy public policies – Goal 7: Ensure environmental sustainability Breastfeeding Law, Rooming-in  Integrate the principles of sustainable development 2. Create a supportive environment into country politics and programs; reverse loss of 3. Strengthen community action environmental resources 4. Develop personal skills  NGPs – 1.5 billion trees 5. Reorient health services Goal 8: A global partnership for development  Prerequisites for Health  Develop an open, rule-based, predictable, non- o Advocate discriminatory trading and financial system o Enable the community of health education o Mediate – facilitate decision making process Department of Health  Vision - Leader, staunch advocate and model in Millennium Development Goals promoting health for all in the Philippines  The 3 day summit held on 6–8 September, 200 @ NY  Mission - guarantee equitable, sustainable and quality was the largest ever gathering of world leader health for all Filipinos, especially the poor, and to lead  They agreed to achieve a set of concrete, measurable the quest for excellence in health  The millennium development goals are the world’s time-bound and quantified targets  History o Spanish Era - “Medicos Titulares” Goal 1: Eradicate extreme poverty and hunger o Japanese Era – services were interrupted  Reduce by half the proportion of people living on less o American – services resumed than a dollar a day o Proportion of population below $1/day  Standards – same for all facilities; developed by DOH o Poverty gap ratio  Policies – institutional; developed by RHUs o Share of poorest quintile in national consumption FOURmula One for Health as Implementation Framework Goal 2: Achieve Universal Primary Education  Goals:  Ensure that all boys and girls complete a full course of o Better health outcomes primary schooling o More responsive health system o Net enrollment ratio in primary education o Equitable health care financing o Proportion of pupils starting grade 1 who reach  Four Thrusts: lest grade of primary o Financing (increased, better and sustained) o Literacy rate of 15–24 year–olds, women and o Regulation (assured quality & affordability) men o Service Delivery (access & availability) o Good Governance (improves performance) Goal 3: Promote Gender Equality and Empower Women  Eliminate gender disparity in primary and secondary Sentrong Sigla Movement education preferable by 2005, and at all levels by 2015  Goal - Quality Health o Ratios of girls to boys in primary, secondary and  Objective - Better and more effective collaboration tertiary education between the DoH and LGUs o Share of women in wage employment in the non-agricultural sector  DOH - Technical and financial assistance o Proportion of seats held by women in national  LGUs - Developers of health systems and implementer parliament  Pillars Goal 4: Reduce Child Mortality o Quality assurance – ongoing process of  Reduce y 2/3 the mortality rate among children under improving health care services 5 o Grants and technical assistance o Under 5 mortality rate o Awards – Sentrong Sigla Movement seal o Infant mortality rate o Health promotion – health education o Proportion of 1 year old children immunized against measles Goal 5: Improve Maternal Health Aquino Health Agenda  Reduce by ¾ the maternal mortality ratio  Achieving universal health care (UHC) for all Filipinos o Maternal mortality ratio  Kalusugan Pangkalahatan (KP) o Proportion of births attended by skilled health  AO No. 2010-0036 personnel  Objective:  Achieve by 2015, universal access to reproductive o To achieve universal healthcare health Goal 6: Combat HIV/AIDS, malaria, and other diseases University of Santo Tomas – College of Nursing / JSV  Community Health Nursing Obstacles Thrust Strategy oEndemic – persistently present oEpidemic – sudden increase  Enrollment of poor families  Point source – one sourse is NHIP (RA 7857)  Propagated - spread o Deployment of CHTs and Rapid expansion o Vector-borne The DOH and LGU RNs to serve poor budgets, and the in NHIP enrollment families o Human and benefit o Pandemic – present worldwide NHIP not able to o Procurement of budget delivery using o RA 3573 – report presence of infectious diseases adequately provide for medicines and national subsidies financial risk supplies of DOH-retained  Weekly monitoring – measles, polio, for the poorest protection for poor hospitals for the neonatal tetanus, rabies, AIDs families implementation of the  Eradicate – measles, polio, neonatal “no balance billing” tetanus, rabies, AIDs policy o Cash subsidy of Php 2400  Community Organizer to poor families Home Visit  Professional face to face contact made by the nurse to Improved access Poor households the family to quality have inadequate hospitals and  LGU health facilities and  Purpose: access to quality o To provide necessary health care activities health care DOH retained hospitals shall outpatient and o To further attain an objective of the agency facilities through be upgraded using Health inpatient care from accelerated Facilities Enhancement health care facilities upgrading of Fund (HFEP)  Principles in Planning for a Home Visit: public health 1. Have a purpose or objective facilities 2. Make use of all available information 3. Focus on essential needs of the individual and Failure of the  Procurement and family but prioritize needs recognized by the financing and distribution of medicines family health care delivery Attainment of the and supplies to RHUs for 4Ps 4. Should involve the individual and family systems to address health-related beneficiaries 5. Flexible and practical the needs of poor MDGs by o Focusing efforts and Filipinos, it is applying resources in areas with: unlikely that the additional effort  Highest Bag Technique Philippines will meet and resources in concentration of  Equipment - Public Health Bag its MDG localities peer  Opened 3 times commitments by  Women with o Hand washing 2015 unmet need for FP o Gather materials o Return items Roles of Public Health Nurse  Principles  Health Care Provider – provides direct care 1. Minimize & Prevent spread of infection  Health Educator – process of changing undesirable  All articles from the family are considered knowledge, skills and attitude as contaminated o Phases:  Well to Sick  Unfreezing  Hold the lining on the outside  Changing  Clean technique  Refreezing 2. Save time & effort of nurse o Elements: 3. Effectiveness of car—not overshadow  Information 4. Performed in variety of ways—do not spread  Communication – teaching strategy infection  Education – change in knowledge, skills Types of Problems in the Community and attitude  Leader/Manager o Planning – budgeting, mission, vision Family Community o Organizing – members of health team – duties Wellness Condition Health Status and responsibilities Health Resources Directing – members of the health team Health Deficit o (facilities, manpower) o Controlling – ensuring that all resources are Health Related available Health Threat (political, environmental,  Advocate – promotion of health and prevention of diseases social, economical)  Counselor Foreseeable Crisis or  Researcher Stress o 5 Phases  Conceptual Evaluation of Nursing Care  Design and Planning  Effectiveness - Measures attainment of objectives  Empirical  Efficiency - Cost, time, and resources  Analytic  Appropriateness - the ability of the intervention to solve  Dissemination the problem  Epidemiologist  Adequacy - Comprehensiveness or the number of o Sporadic – on and off solutions to solve the problems University of Santo Tomas – College of Nursing / JSV  Community Health Nursing  Without co-existing disease Department of Health Programs  No history of complications/abnormalities in present  Public Health Problems and previous pregnancies and deliveries  Tulong-Sulong Sa Kalusugan  Imminent delivery - no choice but to deliver the baby o Developed to achieve empowered, insured, at Home satisfied and healthy families Maternal Health Program CMMNC Framework  No woman should die giving life  The center is the pregnant women  Every woman has a right to a safe pregnancy and  Transportation/ Communication childbirth o Ambulance  Provide care and support  Three Delays Model o Partner/spouse o Family members o Accompany the mother in the hospital  Key Elements o Organized mothers, families, communities and barangay with maternal and newborn health plans and programs o Supportive barangay captains Perinatal Care Prenatal/ Antenatal visits  Home-based mother’s records  Encourage all women to deliver in the health facility NUMBER OF WHO/UNICEF/DOH CPG PHN 2007 BOOK VISITS 2005/2006  Paradigm Shift Before the 4th month of First 1st Trimester pregnancy Identifies high rish Second Between 6th to 7th 2nd Trimester Risk pregnancies month of pregnancy Third 8th month of pregnancy 3rd Trimester Approach For referral during Fourth 9th month of pregnancy After 8th month; the prenatal period every 2 weeks Pre-natal Check-up Considers  Age  LMP EmOC all pregannt women to  Family history be at risk of  Fundic Height Approach complications at  Leopold’s Manuever childbirth  Blood Pressure  Tetamus ToxoidImmunization  Laboratory Tests o CBC – Anemia Basic Emergency Obstetric Care (Bemoc) Services o Glucose Tolerance Test – 24 to 28th week AOG  Are upgraded enhanced BHS, RHU, lying-in clinics or – if with hx of DM birthing homes, District and Community hospitals that o Blood Typing – ABO Rh Incompatibility provide o UA – Proteinuria, UTI, STIs  6 Basic Obstetric Functions o Administer Parenteral antibiotics Leopold’s Maneuver o Parenteral Uterotonic drugs (Oxytocin)  Void first o Parenteral Anticonvulsants  Position: supine or dorsal recumbent o Manual Removal of Placenta  Palm not fingertips o Removal of Retained Placental Products  Provide privacy o Perform assisted vaginal delivery 1. 1st Maneuver (Upper pole) Comprehensive Emergency Obstetric Care (CEmoc) Services  Fundal grip – find out what is occupying the  Are end-referral facilities capable of managing uterus complicated deliveries and newborn emergencies  Fetal presentation  It should be able to perform 6 basic OB functions as 2. 2nd Maneuver (sides of maternal abdomen) well as to provide  Umbilical grip o CS services  Fetal back o Blood banking and transfusion services 3. 3rd Maneuver (Lower pole) Domiciliary Obstetrical Service: Qualifications  Paulick grip  Full term  Assess for fetal engagement  Not a primigravida with less than 5 pregnancies University of Santo Tomas – College of Nursing / JSV  Community Health Nursing  Floating or engaged school age w/ 200 mg iodine  Primi: 2 weeks before labor (engagement) Women 15 – 45 Iodized oil capsule  Multi: during labor 1 cap for 1 year yrs old w/ 200 mg iodine Iodized oil capsule 4. 4th Maneuver (presenting part evaluation) Adult males 1 cap for 1 year w/ 200 mg iodine  Pelvic grip  Fetal position Postnatal Visits  Fetal attitude WHO/UNICEF/DOH CPG Tetanus Toxoids Number of Visits PHN 2007 BOOK 2005/2006  Mother - Artificial Active First 24 to 48 hrs after  Baby – Natural Passive First Within 3-5 days delivery 6 weeks after Schedule of Tetanus Toxoid as per AO # 15 Second 6 weeks after delivery delivery Duration of % Protection of  Uterus will return to pre-pregnancy state after 6 weeks Dose Schedule Protection the Mother Post-Partum Care 1st Anytime At any point Immediate  Breast 2nd After 1 month 3 yrs. 80%  Uterus After 6  Bowel 3rd 5 yrs. 95% months  Bladder 4th After 1 year 10 yrs. 99%  Lochia – rubra, serosa, alba 5th After 1 year Lifetime 99%  Episiotomy  Mother is protected after 1 dose  Skin  Baby is protected after 2 doses  Homan’s Sign  IM – 0.5 mL – deltoid  Emotions Micronutrient Supplementation Family Planning Program  Iron Deficiency – can cause neural tube defects  Reproductive Health Program (Responsible Parenthood  Anemia – presence of pallor, N = 11g/dl Program)  Ideal: Prior to marriage  Four Pillars: Iron Supplementation o Responsible Parenthood  They can have as many child as they want Targets Preparations Dose/ Duration provided that they can support their needs 1 tab OD for 6  PD 965 Tab containing 60 months o mandates all couples prior to Pregnant Women mg el with 400 mcg or marriage must attend family planning Folic Acid 2 tabs/day if 2nd seminar or 3rd trimester o done at the local municipal office Tab containing 60 o Child Spacing – at least 3 to 5 years interval 1 tab OD for 3 Respect for life – anti-abortion Lactating Women mg el with 400 mcg o mos or 90 days Informed Choice Folic Acid o  The right of every couple to be Vitamin A Supplementation knowledgeable of the different family  Plant sources: Carotene planning methods, its advantages and  Animal sources: Retinol disadvantages  Vit A Deficiency – can cause congenital problems  All health care workers must inform them of  Do not give Vit. A if woman is taking multivitamins its contraindications  2nd trimester – teratogenic  Before they can teach, must attend a  Blue – 100,000 IU training seminar (PD 791) Targets Preparations Dose/Duration  Family Planning Priorities 1 cap/tab 2x/wk o Couples in the reproductive age: 20 to 44 years 10,000 IU o 3 or more children Pregnant Women (4th mo. until (Colorless) o Close interval pregnancies delivery) Postpartum 200,000 IU 1 cap 1x (within 4 o (+) chronic disease Women (Red) wks after delivery)  Family Planning Counseling Iodine Supplementation o Greet – warmly and politely  Iodine deficiency – can cause congenital o Ask – about him/herself hypothyroidism or cretinism o Tell – health center and the services provided  Sources: seafood o Help – make the decision that is best for him/her  Avoid goitrogenic foods – cabbage, broccoli, potato, o Explain – relevant information about the signs, peanuts, cauliflower - inhibit the absorption of iodine in diagnosis, treatment the body o Return – schedule a return visit Targets Preparations Dose/Duration Early Childhood Care and Development (ECCD)  RA 8980 Children of Iodized oil capsule 1 cap for 1 year o Refers to the full range of health, nutrition, early University of Santo Tomas – College of Nursing / JSV  Community Health Nursing education and social services programs that Intervention Act of 2009 provide for the basic holistic needs of young o Early detection of congenital hearing loss and children from birth to 6 years of age, to promote referral for early interventions for infants (under 3 their optimum growth and development months of age) o Newborn Hearing Screening Reference Center at  Center-based Programs the National Institute of Health o Day-care Service (RA 6972) o BAAH Test – to detect initially whether the child o Public and Private Pre-schools has hearing loss o Kindergarten  Say the phrase “BAAH”  child will respond through o Community or school-based early childhood nodding o Child-minding centers  Mobile Application o Health centers and stations o On any healthcare practitioner who delivers, or  Home-based Programs assists in the delivery of a baby in the Philippines o Neighborhood-based play groups the obligation to inform the parents or legal  Supervised by the barangay captain guardian of the newborn of the availability, o Family day care programs nature and benefits of hearing loss screening  Supervised by the public schools among newborns or infants THREE (3) MONTHS o Parent education AND BELOW. o Home visiting Programs Breastfeeding Campaign Essential Intrapartal Newborn Care – Unang Yakap  The first step to raising a bright child  DOH Administrative Order 2009 – 0025 Breastfeeding “Tsek”  Four Core Steps in EINC  Tama Sapat EKsklusibo o Immediate and thorough drying  Launched on Feb. 23, 2011  2 towels  Target: new and expectant mothers in urban areas: o Early skin to skin contact  Aim:  To prevent hyperthermia o Encourages mothers to exclusively breastfeed o Properly timed clamping and cutting of the cord their babies from birth up to 6 months  To prevent intraventricular hemorrhages o Establish a supportive community, as well as to and anemia promote public consciousness on the health o Non-separation of the newborn and the mother benefits of breastfeeding in lowering the risk of thru initiation of early breastfeeding diarrhea, pneumonia and chronic illnesses.  Within 90 minutes after birth Promoting Breastfeeding Newborn Screening  RA 7600  RA 9288—Newborn Screening Act of 2004 o Rooming in and Breastfeeding Act of 1992  Detect congenital metabolic disorder that may lead to o Breastfeeding week: August 1-7 mental retardation or even death if left untreated  EO 51 o Milk Code  6 diseases: o Avoid formula milk o Congenital Adrenal Hyperplasia o Do not give incentives who use formula milk o Congenital Hypothyroidism  RA 10028 o PKU o Expanded Breastfeeding Promotion Act of the o Galactosemia Philippines o G6PD o Promotes that each facilities (if they have female o Maple Syrup Purine Disease employees) should have a breastfeeding station  April 2014  Can now detect 28 diseases  1,600 pesos o Must include refrigerators (rate) and can now be charged to Phil Health  AO 2006 – 0012 o Revised Implementing Rules and regulations in  1cc of blood  in the blood filter  dry for 4 hours  the EO 51 within 24 hours  send to Newborn screening facility  AO 2005-0014 (UP-PGH; National Institute of Health) o National Policies on Infant  Initial results after 7 working days  negative (no Breastfeeding Practices: problem)  if positive  confirmatory test  positive again  refer to specialist for management  Exclusive Breastfeeding Practices o Allows ORS, drops, syrups (vitamins, minerals,  Recommended: Get specimen after 48 – 72 hours after medicines) birth  because PKU cannot be detected as early as 24 hours  Predominant Breastfeeding o May also have water and water-based drinks,  Advocacy: education of the mother about the benefits fruit juice, ritual fluids and ORS – drops or syrups of Newborn Screening Test (as early as pregnancy such as vitamins, minerals and medicines stage) and ask to prepare said amount  Complementary Feeding Universal Newborn Hearing Screening Program o Interval of 1 week to check for food allergies  RA 9709 o Giving the infant foods and liquids along with o Universal Newborn Hearing Screening and breast milk University of Santo Tomas – College of Nursing / JSV  Community Health Nursing o When breast milk is no longer sufficient to  Carrier o Attenuated – nutritional requirements  Sick of the BCG, OPV,  Bottle feeding disease AMV, Rotavirus o Child is given food or drink (including breast milk) o Killed – P. HBV from a bottle with a nipple  Weakened toxins  Breast milk  Prepared by  Early Initiation of breastfeeding (IgA) Laboratories Initiating breastfeeding of the newborn after birth Passive o  Placenta within 90 minutes of life in accordance to the (IgG) essential newborn care protocol Positions  Launched by DOH, WHO, & UNICEF last July 1976  Cradle Hold/Madonna/Cross chest  Objective - reduce morbidity and mortality among o NSD infants and children caused by the 6 childhood o Father is beside mother immunizable diseases  Football hold/clutch position o SGA, twins  PD No. 996 (Sept. 16, 1976)  Side lying position o Providing for compulsory basic immunization for o Delivered via CS infants and children below 8  Kangaroo Position o 6 vaccines o Promotes nutrition and warmth  RA 10152 o Inclusion of new vaccines How to get baby “latch on” o Mandatory Infants and Children Health 1. The mother holds her breast in a C-hold position Immunization Act of 2011 o To anchor the breast o 11 vaccines 2. Stimulate the baby’s rooting reflex  RA 7846 (Dec. 30, 1994) o Striking the cheek of the child o Hep. B immunization o Stimulate the sucking reflex using the nipple o 7 vaccines 3. When the baby’s mouth opens wide, put the nipple  PP No. 6 (April 3, 1996) and as much of the areola as possible into his mouth o Implementing a United Nations goal on Universal o Chin and breast must be in contact Child Immunization by 1990  Wednesday—Immunization day How to make baby let go of the breast without hurting the  (2001-2020) Decade of Vaccines – envision a world of mother which all individuals and communities enjoy lives free 1. Press down on the breast near his mouth from vaccine-preventable diseases (WHO) 2. Pull down on his chin and insert a small finger in the corner of his mouth. This will break his seal on the nipple Principles of EPI 3. Then remove him from the breast  Epidemiological Situation o Schedules are drawn on the basis of occurrence *Swollen nipple – withhold feeding on the affected side; advice and characteristic feature of the disease warm compress o Applicable to children below 8 *Inverted nipple – nipple rolling or nipple stretching exercise  o Goal is to complete vaccines before 1 year press the base of the nipple (“Fully Immunized Child”) o If achieved after 1 year—“Completely Signs that the baby has latched on properly to the breast: Immunized” 1. The baby’s mouth is widely open 2. The baby and the mother are into tummy-to-tummy Antigen Route Site position BCG (Bacillus 3. Much of the areola is inside the baby’s mouth Calmette- ID R deltoid 4. The mother does not feel nipple pain Guerin) 5. Baby is relaxed and happy Anterolateral Hep B vaccine IM thigh DPT-HepB-Hib Breastfeeding Campaign (Pentavalent IM Anterolateral  Storage of breast milk thigh vaccine) o If at room temp – 8 hours Oral Polio ORAL Mouth o If refrigerated – 24 hours Vaccine o If frozen – 1 month Attenuated Outer part of SUBCUTANEOUS  Galactogen Measles Vaccine the upper arm o Malunggay (mammolactin) MMR – measles- Outer part of o Soups, Broths, Shellfish mumps-rubella, SUBCUTANEOUS the upper arm AMV2  Breastfeeding should be fed on demand – at least 8x a Rotavirus day vaccine ORAL Mouth  No coffee, alcohol, drugs, smoking  Mass approach o If taken coffee, withhold feeding after 24 hours  Integrated to the health services of the unit Expanded Program on Immunization Elements of EPI  Target setting—all children before 1 year old Natural Artificial  Cold chain logistics Active  Exposure  Antigens o PHN—Cold chain officer University of Santo Tomas – College of Nursing / JSV  Community Health Nursing o Vaccines must be stored in a cold place o With persistent fever  Freezer (–15–25ºC) - OPV & Measles o Management—I/D  Refrigerator Compartment (2–8ºC) - BCG & DPT  Hepatitis B Vaccine o BCG—Light sensitive o 3 doses, 2 types (Plasma derived and o Measles/MMR—Heat sensitive recombinant Hep B surface antigen)  Information, Education, and Communication (IEC) o Target age:  Assessment and evaluation of the program overall  HBV 1 performance o At birth (Health Facility) o Target: 95% every month o For more than 7 days (home)  Surveillance, studies and research  HBV 2 & HBV o 3—6 weeks o 14 weeks Supplementary Immunization Activities (SIAs)  “Catch up” or “speed up” campaigns for the new  Pentavelent vaccine to rapidly increase immunity in older age o 6, 10, 14 weeks groups that are outside of the immunization schedule o 0.5 m, IM, Vastus Lateralis  Intended to reduce or interrupt transmission of the o Effects: targeted disease with the goal of elimination or  No fever eradication  Local tenderness  Do not massage; apply Contraindications cold compress 1. History of seizures/convulsions for DPT 1 o If convulsions last for 3 days—DT  Pentavalent o If convulsions > 3 days—Do not give succeeding o DPT, Hib, Hep. B doses o 3 doses, 4 weeks or 1 month interval 2. Clinical AIDS—Infant BCG o Target age—6, 10, 14 3. Immunosuppression o 0.5 mL, IM, vastus lateralis (upper outer thigh) Not Contraindications o Reduces chance of acquiring pneumonia and 1. Fever up to 28.5ºC meningitis 2. Simple or mild acute respiratory infection o Effects: 3. Simple diarrhea without dehydration  Fever  Antipyretic every 4º 4. Malnutrition (it is indication for immunization)  Local tenderness  do not massage site Schedule for Immunization  OPV Antigen Age Dose o Against Poliomyelitis BCG (Bacillus o Pathognomonic—Tightening and spasms of At birth 0.05ml Calmette-Guerin) Hamstring Hep B vaccine At birth 0.5ml o 3 doses, 4 weeks/1 month DPT-HepB-Hib o Target population—same as above, eligibility until (Pentavalent 6,10, 14 weeks 0.5ml vaccine) Grade 6 (12 years) Oral Polio Vaccine 6,10,14 weeks 2 drops o 2–3 drops, oral route Attenuated o Color—clear pink or pale orange liquid 9 months 0.5ml o Keep Philippines Polio Free Measles Vaccine MMR – measles- o Effects: mumps-rubella, 12-15 months 0.5ml  Vomiting—if after 30 minutes, do not re- AMV2 administer 6-15 weeks (1st  Do not feed child for 30 minutes dose) Rotavirus vaccine 1.5ml 10-32 weeks (2nd dose)  Rotavirus o 2 doses, 8 weeks interval  Infant BCG o Target age: 6 and 14 weeks o 0–11 months or 0_1 years o 1.5 mL, PO o At birth o 1st – 6 to 15 weeks o 0.05 mL (dose)—ID, right upper deltoid o 2nd – not more than 32 weeks o Freeze dried then reconstituted with diluent o Reduces chance of acquiring diarrhea  School Entrance BCG o Effects: o When the child enters Grade 1 with or without  Soft stool scar in the right arm then still go on with the  Dispose diapers – virus is there vaccination except if he is repeating grade 1  Wash cloth diapers separately o 0.1 mL OPV  Rotarix  Pentavalent o Effects  Wheal lasts for 30 minutes to 1 hour  Inflammatory response lasts from 2 weeks - 12 weeks  Scar  Measles o Administer warm compress on the o 9–11 months site of injection o In cases of epidemics—can be given at 6 months  Fever  Antipyretic every 4º o 0.5 mL, subcutaneous, any arm (outer part of the  SQ Abscess - Marble-like mass present on upper arm, preferably left) the site of injection o Fever and measles rash lasting for 1–3 days within University of Santo Tomas – College of Nursing / JSV  Community Health Nursing 2 weeks after immunization (modified measles)  3 doses—Hepa, OPV, DPT, Penta o Vitamin A is given with measles—100,000 IU (Blue)  2 doses—Rota – boost immune system  1 dose – BCG, AMV, MMR o At least 85% can be prevent by immunization at  IM—Penta, Hepa B this age  Orem—OPV, Rota o Freeze dried then reconstituted with diluent water  0.5—MMR, AMV, Penta, Hepa o Effects:  1.5 rota  Fever – Antipyretic every 4º  UE—BCG MMR, OPV, Rota  Rashes within 2 weeks and lasts for 3 days –  LE—Hepa, Penta subside naturally  Fever—Penta, Measles, MMR, BCG  1 Mo—Penta, OPV  Measles, Mumps, Rubella (MMR)  Freezer—OPV, Measles o 12–15 months  Diluted—BCG, AMV, MMR o Mumps - enlargement front and below the ear  SQ—AMV, MMR o 0.5 mL, SC, any arm (deltoid)  Rashes—AMV, MMR o Vitamin A is given with MMR, 200,000 IU (red)  Local Tenderness—Hepa, Penta o Freeze dried then reconstituted with diluent water  All IM—LE with local tenderness  All not IM—UE  BGC, AMV, MMR  All Vaccines are 0.5, except for BCG, Rota o Diluted – cold temperature o Must be consumed within 4 to 6 hrs Nutrition Program  Goal: Improve quality of life through better nutrition, Ensuring Potency improved health and increased productivity Nutritional Programs  Nutritional assessment  Micronutrient supplementation  Food fortification  Maternal and child health service packages  Nutrition information communication, education  Home, school and community food production  Food assistance  Livelihood assistance  Check expiration date  Treatment of conditions associated with malnutrition  Vaccine Vial Monitor (VVM)—Square should be lighter than the circle Legislations Affecting the Philippine Nutrition Program  Shake – discard if with residual  PD No. 491 - declared July as the Nutrition Month and  Place refrigerator at least 3 ft. away from the window creation of National Nutrition Council  LOI 441 - Integration of Nutrition Education in the school Maximum Storage and Transport Period curriculum  Regional Health Office—6 months  Provincial/District Health Office—3 months Common Intestinal Parasites  Rural Health Unit—1 month  Maximum transport period (With cold packs) — 5 days  Ascaris (giant roundworm)  For determining the amount of vaccines to be o Nutritional competition requested—3 to 2.7% o Source: Soil, fecal-oral  FEFO: First expiry, first out o Vomit worms  Ancylostomiasis/Hookworm Discarding Unused Biologicals o Blood sucker  VVM – vaccine vial monitor o Heavy infestation is seen as severe anemia  Discard unused portion of BCG and AMV 6 hours after o Enters the human body by skin penetration, abd. reconstitution or at the end of the immunization session Pain whichever comes first  Enterobius (pinworm)  If square is lighter than circle: may use the vaccine o Habitat is the rectum  If square is darker than circle: discard o Major symptom is pruritis ani  Shake the vial o Highly contagious o Mixture between the solid and liquid content – o Source: fingernails may use  Taenia saginata/ solium (tapeworm) o The longest intestinal parasite (average adult Contraindications length is about 15 to 25 meters)  General: Any serious condition that needs hospitalization  Specific: Deworming o DPT 2 and 3: a history of seizures within 3 days  Anti-helminthic drugs every 6 months after DPT  Together with vitamin A o Attenuated vaccines: immune deficiency  Albendazole/Mebendazole  Done 2x a year Other Considerations: University of Santo Tomas – College of Nursing / JSV  Community Health Nursing Albendazole Mebendazole  1” TSF is normal Age 400 mg/tab 500mg/tab - Biochemical or Lab exams 12-23 months ½ 1 - Clinical Exams 24-59 months 1 1 - Dietary History - Health History Mebendazole/ Albendazole  Given every 6 months Macronutrient Deficiencies  Start giving at 1 year old 1. Kwashiorkor o Qualitative Deficiency Nutritional Methods of Assessment o Manifestations:  A – anthropometry  Edema  B – biochemical or lab exams  Ascites  C – clinical exam  Irritable  D – dietary history  Alternating black or black hair – Flag Sign –  H – health history discoloration of hair - Anthropometry  Skin desquamation  Weight for age  Normal weight – edema  Height for age 2. Marasmus  Body mass index o Quantitative Deficiency  Mid upper arm circumference o Protein, Carbohydrates, Fats o Manifestations:  Muscle Wasting 1. Weight for age  Normal hair and skin  Under 5 - Operation Timbang  Skin and bones  Not used when patient has edema  Weight between 2nd to 3rd degree  Used in diagnosis of: malnutrition o Acute (current) malnutrition  Overweight – obesity Point of  Underweight – wasting Kwashiorkor Marasmus difference Afr. “The Gomez classification of nutritional status sickness of the Formula for computation of % of IBW Etymology older child Gr. “Wasting” when the next 𝑎𝑐𝑡𝑢𝑎𝑙 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡 baby is born” × 100 𝑒𝑥𝑝𝑒𝑐𝑡𝑒𝑑 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡 Condition that Severe results from  >110 % = overweight energy  91-110 %= normal severe CHON Definition deficiency =  76-90 % = 1° under nutrition (mild) – education deficiency = quantitative  61-75 % = 2° under nutrition (moderate) – qualitative def. def. condition education condition  ≤60 % = 3° under nutrition (severe) – Various age hospitalization Weaning age: Age/group group even toddler infant 2. Height for age 3. Body mass index Starvation  Normal 18-24 Improper (famine, Health history weaning; extreme 4. Mid Upper Arm Circumference diarrhea poverty, child  Only for children under 5 years old (1-4 years abuse) old) Present but may Present and is  Rapid screening for malnutrition Wasting not be obvious very obvious  Procedure: a. Determine midpoint between acromion Wasting – skin Edema; ascites and olecranon Major feature and bones pedal b. Measure circumference at midpoint appearance c. Interpretation: Abnormal = o ≥13 cm = normal nutritional status 2nd or 3rd o 2 secs) Then give 70ml/kg Age First 30 ml/kg in:  Some dehydration - 2 of the following symptoms in: o Restless, irritable Infants under 1 y/o 1 hour 5 hours o Sunken eyes Children 1 y/o and o Drinks eagerly, thirsty 30 minutes 2 ½ hours above o Skin pinch goes back slowly 2. If no health facility, use NGT  No dehydration 3. Or if the child can drink, give ORS by mouth o Not enough signs 4. If any of the above steps not possible, bring child immediately to the hospital for IVF or NGT Classification of Chronic Diarrhea treatment  If lasts for 14 days or more 5. Give antibiotic if 2 years older or cholera o Severe persistent diarrhea epidemic  Dehydration present o Persistent diarrhea *If the age of the child is 2 y/o and above or there is cholera  No dehydration epidemic, administer 1st dose of antibiotic as prophylaxis o Blood in stool - Dysentery o Rice water stool – Cholera  Severe Persistent Diarrhea (less than 2 months and with * If the child is less than 2 mos w/ diarrhea lasting for 14 days or chronic diarrhea) more = SEVERE PERSISTENT DIARRHEA o Treat dehydration o Give Vitamin A if not given last 30 days Management o Refer to hospital  Plan A - No dehydration (XZB5) o 4 rules  Persistent Diarrhea 1. Give extra fluid and food (soup, rice o Advise feeding water, or buko juice or ORS) every o Give Vitamin A if not given last 30 days after loose stool o Give Zinc supplements for 14 days o Below 2 yrs. = 50–100 mL o Follow-up - 5 days o 2–5 yrs. = 100–200 mL o Advise when to return 2. Zinc Supplements for 14 days o 2 - 6 months = 10 mg/day  Antibiotics o 6 months - 5 yrs. = 20 o Dysentery - Ciprofloxacin for 3 days, BID (15 mg/day mg/kgBW) 3. Continue breastfeeding o Cholera - Tetracycline (250mg) or Erythromycin 4. Follow-up in 5 days if not improving (250mg) BID for 3 days  Plan B - Some Dehydration  Vitamin A – Severe malnutrition, Very low weight, 1. Give reformulate ORS within the first 4º severe dehydration, pneumonia, severe persistent  Amount of ORS = weight in kg x 75 diarrhea, persistent diarrhea mL/kg BW  Homemade Oresol  IV fluids – D5W & D10W (prevent low blood sugar), PLRS o 1L water + 1 tsp. salt + 4 tsp. and PNSS (Severe DHN) sugar  ORS – 1 L water + 1tsp NaCL + 4 tsp. sugar o 1 glass of water + 1 pinch of  Sugar water – 200 mL H20 + 4 tsp sugar salt + 1 tsp. of sugar  Follow-up  For under 6 months—give 100–200 o Antibiotics – 2 days mL in the first 4º o Bronchodilator (Salbutamol) – 2 days 1. Advise mother to continue breastfeeding o Very low weight - 30 days 2. After 4º - continue feeding and give zinc o Anemia – 14 days  If mother must leave before o No DHN, Anemia, Pneumonia, not very low treatment - explain 4 rules of home weight – 5 days mgt  Soothe throat – Calamansi except codeine, cough 3. Follow-up - 5 days if not improving syrup and decongestant Amount (ml) in 4 Age Weight hours Prevention and Management of Abortion Complications (PMAC) Below 4 months