Community Health Nursing: Primary Health Care

COMMUNITY HEALTH NURSING SUPPORT MECHANISM PRIMARY HEALTH CARE § There are 3 major entities: o People...

COMMUNITY HEALTH NURSING SUPPORT MECHANISM PRIMARY HEALTH CARE § There are 3 major entities: o People Essential and universal health care o Government Started in September 1978, through o Private sectors (NGO’s, Socio-civic the Alma Ata Conference. It was and Faith Groups) attended by different world health leaders to represent each nation. PILLARS / CORNERSTONES: Aside from the devolution, we use the primary health care approach. 1. Active Community Participation 2. Multi – Sectoral Approach CRITICAL POINTS OF PRIMARY HEALTH CARE 3. Equitable distribution of health resources 4. Appropriate Technology 1. Universal goal Use of appropriate technology Health for all RA 8423 – PITACC/TEMA 2. Goal of PHC-Philippines Use of indigenous resources available in Health for all and health in the hands of the community the people by year 2020 Philippine Institute of Traditional and 3. Mission: Alternative Health Care Let the people manage their Traditional and Alternative Medicines own healthcare (self-reliance) Act “use of herbal medications” To strengthen the health care system by increasing opportunities & supporting the Alma Ata Declaration listed essential health conditions wherein people will manage services using the acronym ELEMENTS their own health care. E- Education for health 4. Concept or strategy L- Locally endemic disease control Partnership E- Expanded program for immunization Empowerment of people M- Maternal & Child Health including responsible parenthood HISTORY OF PRIMARY HEALTH CARE E- Essential drugs N- Nutrition 1. First International Conference T- Treatment of communicable and non-communicable of PHC diseases When: September 6 to 12, S- Safe water and sanitation 1978 Where: Alma Ata, USSR Rationale (why there is a need of PHC) Goal: Health for all by year 2000 Magnitude of health problems. Inadequate and unequal distribution 2. PHC Adoption in the Philippines of health resources. o Legal basis: LOI 949 signed by Increasing cost of medical care. President Ferdinand Marcos last Isolation of health care activities from October 19, 1979 other developments. o The Philippines is the first in Asia to implement primary health care E L E M E N T S IN P H C approach. Health education KEY PRINCIPLES OF PHC o I – Information (input/theory) o E – Education (change of lifestyle) o C – Communication (transmission A – Accessible of information) A – Available A – Acceptable A – Affordable A – Attainable/Achievable  Locally Endemic Diseases Control 2. Hep B o Focuses on the prevention of the When: within 24 hours after birth, at birth/ first week of occurrence of continually present life diseases in a certain locality. (@birth – 6 weeks – 14 weeks) No. of doses: 3 doses, interval: Expanded Program on Immunization 6 weeks à 1st dose – 2nd dose - Launched: July 1976 8 weeks à 2nd dose – 3rd dose - Basis: Epidemiological Situation (increased cases of immunizable diseases) 0.5 ml IM Vastus Lateralis - Goal: Reduce the number of immunizable S/E: local soreness, NO fever diseases/cases MGT: warm compress, do not massage, continue Laws breastfeeding 1. PD 996 – compulsory immunization below 8 years old 3. DPT 2. RA 7846 – compulsory Hep B immunization When: 6 weeks (6th week-10th week-14th week) 3. RA 10152 – Mandatory Infant & Children Health No. of doses: 3 doses, interval: 4 weeks Immunization Act of 2011 0.5 ml IM Vastus Lateralis (upper outer thigh) (Note: Do not administer in Vastus Medialis because Give the meaning of the following acronyms: there is sciatic nerve) S/E: local soreness, fever, do not massage ü FIC (Note: ALL vaccines should not be massaged) ü CIC MGT: warm compress, antipyretics, continue ü CPAB breastfeeding, do not massage the site 5 Elements of EPI 4. OPV When: 6 weeks (6th week-10th week-14th week) 1. Surveillance 1-2 drops PO Mouth (Directly to tongue) 2. IEC S/E: no known SE 3. Cold Chain & Logistic Management MGT: Withhold breastfeeding for 30 minutes after 4. Assessment and Evaluation vaccination 5. Target Setting VACCINES 5. Measles When: 9 months old No. of doses: 1 dose only OLD VACCINES 0.5 ml SQ Deltoid S/E: local soreness, fever, mild rashes (expected, 1. BCG educate client not to worry because this will When: Any time after birth disappear 3-5 days after) For: Infant 0.05 ml ID Deltoid MGT: warm compress, antipyretics, continue School Entrants 0.1 ml ID Deltoid breastfeeding, do not massage the site S/E: local soreness, fever, Koch’s phenomenon, Wheal formation, permanent scar formation NEW VACCINE UPDATES: MGT: warm compress, antipyretics, continue BF, do not massage 1. Pentavaccine BCG 5 in 1 (Hep B, Diptheria, Pertussis, Tetanus, o Add 2 to 3 ml of diluent Haemophilus Influenza B) o Use 5 ml syringe When: 6 weeks (6th week-10th week-14th week) o Discard 4 hours after No. of doses: 3 doses, interval: 4 weeks 0.5 ml IM Vastus Lateralis S/E: local soreness, fever MGT: warm compress, antipyretics, continue breastfeeding, do not massage the site  2. Rota Vaccine MMR When: 6th week and 10th week (Before 34 weeks Vaccines that need to be consumed when diluted: old/ 8 months) BCG No. of doses: 2 doses, interval: minimum 4 weeks MMR 1.5 ml PO Mouth (in between gum & check) Vaccine given per orem: S/E: Mild allergic reaction OPV MGT: Benadryl/Antihistamine Vaccine (monodose): Pentavalent 3. MMR Vaccine (multidose): When: 12-15 months old Hepa B Measles/MMR 0.5 ml SQ Deltoid S/E: local soreness, fever, mild rashes MGT: warm compress, antipyretics, continue NATIONAL IMMUNIZATION PROGRAM (NIP) breastfeeding, do not massage the site Contraindications: Vitamin A is given with MMR, 200,000 IU 1. History of seizures/convulsions – for at 9 months Pentavalent Must be consumed within 4-6 hours; Pentavalent (5 in 1) - most common discard if it has not been consumed vaccine with adverse reaction which is Can be given as early as 6 months (if presence of convulsions there is an outbreak) Convulsions for more than 3 days is a sign of neurological condition > succeeding PNEUMOCOCCAL CONJUGATE VACCINE (PCV) doses are not given 3 doses (6, 10. 14 weeks) Less than 3 days - pertussis is not given 0.5 ml (pertussis is an antitoxin) IM 2. Clinical AIDS – infant BCG Protect children from meningitis 3. Immunosuppression Multidose (5 doses/vial) Not a Contraindication: Healthy children aged 2-5 years old may be 1. Fever up to 38.5°C given: 2. Simple or mild acute respiratory infection o 1 dose of PCV 13, or 3. Simple diarrhea without dehydration o 2 doses of PCV BCG at least 8 weeks apart 4. Malnutrition (it is indication for immunization) Given to protect the child against Old Vaccines pneumonia which may cause meningitis BCG brought about by pneumococcal DPT organism HepB Multidose: 1 vial is equivalent to 5 doses OPV No need to dilute prior to administration Measles Updated Vaccines Vaccines that cause fever: ROTA BCG Penta Pentavalent MMR IPV PCV Measles/MMR MATERNAL HEALTH PROGRAM Vaccines that do not cause fever: Hepa B RA 9173 – states that the practice of nursing includes but OPV not limited to “nursing care during conception, labor, Vaccines that cause Local Tenderness: delivery, infancy…As independent nurse practitioners, BCG nurses are primarily responsible for the promotion of Hepa B health, prevention of illness.” This sets the basis for the Pentavalent practice of the nurse on maternal care. IPV PCV Home Base Maternal Record Measles/MMR - Shall be used in rendering prenatal care as a Vaccines that need to be diluted: guide in the identification of risk factors, danger BCG signs and do appropriate measures.  - Recommended Schedule for Healthy Pregnancy TETANUS TOXOID IMMUNIZATIONS Prenatal visits: Ø 4-28 weeks: 1 prenatal visit every month Protects the mother and the baby Ø 28 – 36 weeks: 1 prenatal visit every 2 against tetanus weeks Fully Immunized Mother (FIM) Ø 36 – 40 weeks: 1 prenatal visit every week o 5 TT 3 doses of DPT = 2 doses of TT Provides artificial active immunity – mother PRENATAL CHECKUP Provides natural passive immunity – baby Age For determining the amount of TT to LMP be requested: 3.5% of the population Family History Fundic Height Dosage: 0.5mL IM Leopold’s Maneuver Given at the non-dominant hand, Blood Pressure Deltoid Region Tetanus Toxoid Immunization May cause tenderness at injection site, give Laboratory Tests compress o CBC – Anemia o Glucose tolerance test – 24th to Schedule of tetanus toxoid and diphtheria as 28th week AOG per AO#15 § If with history of DM o Blood typing – ABO Rh Incompatibility o UA – Proteinuria, UTI, STI’s Benedict’s Test: test for sugar in the urine; test for diabetes Heat test tube with 5 cc of benedicts solution (blue) in the burner then add 3-5 gtts of urine (amber yellow then heat again. Observe for the change in MICRONUTRIENT SUPPLEMENTATION color IRON SUPPLEMENTATION Blue – (-) sugar in urine Given at 1st trimester Green – trace of sugar in urine [+1, +] Iron deficiency – can cause neural tube defects Yellow - trace of sugar in urine [+2, ++] Anemia -presence of pallor, N = 11g/dL Orange- more traces of sugar in urine [+3, +++] Brick red- surely diabetic [+4,++++] Acetic Acid Test test for albumin in urine; test for pregnancy induced HPN Collect urine in test tube, heat it in burner then add 3-5gtts acetic solution (clear white). Observe for change in color: a. If it remains clear: (-) CHON or albumin in urine b. If it turns cloudy: (+) = proteinuria Side effects of Iron Supplements Constipation Black or discoloration of stools Metallic taste Should be taken with Vitamin C to enhance absorption VITAMIN A SUPPLEMENTATION Given at 2nd trimester (due to its teratogenic effects) Plant sources: carotene Animal sources: Retinol Vitamin A Deficiency – can cause congenital problems Do not give vitamin A to a woman taking multivitamins Blue – 100,000 IU Red – 200,000 IU POST PARTUM Ø postpartum check for conditions such as bleeding or infection. Ø Micronutrient supplementation à Iron and folate (60mg./400 mcg) once a day for 3 months or 90 tablets à Vitamin A 200,000 IU within 4 weeks after delivery Counseling on nutrition, child care, family planning, and other available services EO No. 51 or Milk Code o Prohibits the advertising, promotion, marketing of bottle feeding as equivalent or superior to breastfeeding. RA 7600 or Rooming – In and Breastfeeding Act Newborns must be put into the breast of the mother immediately after birth and roomed -in within 30 minutes after NSVD and within 3-4 hours after caesarian delivery