Community Health Nursing PDF

COMMUNITY HEALTH NURSING Tsaang gubat (Tsaan – TIYAN = abdominal pain) PART 2 – PHC (ELEMENTS) Alkapulko (antifungal) ESSENT...

COMMUNITY HEALTH NURSING Tsaang gubat (Tsaan – TIYAN = abdominal pain) PART 2 – PHC (ELEMENTS) Alkapulko (antifungal) ESSENTIAL DRUGS MEDICINAL PLANT PREPARATION Botika ng Barangay/ Botika ng Bayan § Decoction Government – run drugstores distribute, sell, or - Boiling the plant material in water for 20 make available low-priced generic home mins. remedies, over the counter drugs and selected, § Infusion publicly known prescription antibiotic drugs. - Plant material is soaked in hot water for 10- RA 6675: Generics Act of 1988 15 mins. § Poultice Implementing “Oplan Walang Reseta Program” – - Directly apply plant material on the affected solution to the absence of a medical officer who part, usually in bruises, wounds, and rashes. prescribed the medicines so PHN are given the § Tincture responsibility to prescribe generic medicines and “Walong Wastong Gamot Program” – available - Mix the plant material in alcohol generics in Botika sa Baryo” and Health Center. Father of Generics Act: Dr. ALFREDO BENGZON NUTRITION ü Food is one of the basic needs of the family; if food is properly prepared, on may be assured of o To make the drugs affordable and accessible by people, there is a local manufacturer healthy family. which is given intellectual property right in the ü Malnutrition is one of the problems in the country. manufacture of common locally used drugs in the Philippines. Macronutrient Malnutrition >> foods taken in large amounts every day o Carbohydrates (CHO) & Proteins (CHON) DOH RECOMMENDED HERBAL MEDICINES o Conditions: Mnemonic: LUBBY SANTA o Marasmus § Lack of carbs § Lack of proteins o Manifestations: - Skin & bones - “old man” face - Wrinkled skin - Prominent ribs o Kwashiorkor § Normal carbs § Lack of proteins o Manifestations: Lagundi (alleviate respiratory issues) - Thin extremities Ulasimang Bato (U – Uric acid) - Edema >> moon face Bawang (HPN & and toothache) - Ascites Bayabas (used for cleaning wounds) - Thin sparse hair Yerba Buena (B – Bites and Bleeding) Sambong (Sambong without S and G is AMBON; aambon ng ihi) Ampalaya (opposite of bitter is sweet = diabetes) Niyogniyogan (intestinal parasites = roundworms and pinworms)  o Treatment Ex. Child weighs 8 kgs. o RUTF (ready – to – use therapeutic food) 8 x 6 = 48mg/day for the 1st. 3 mos. then monitor – peanut butter “amplified” § Has complete nutrients If sAll anemic, conAnue giving but compute again 6 § Amount depends on the weight mg/kbw of the child § Iodine Deficiency Disease o MUAC (Mid upper arm circumference) >> used in o Target age group: 0-59 months children below 5 years old by measuring the o Give 1 capsule (200mg) of potassium iodate middle upper arm with a tape measure oil once a year § Determines severity of malnutrition For a child foods taken in small avoided: Ø Mental retardation amounts every day Ø Growth retardation (cretinism pedia) & o Vitamins and minerals (dwarfism – adult) o Children who eat junk foods often are at risk § Junk foods “empty calories” RA 8172 >> Asin Law: Fidel Salt (ForAficaAon of (calories present but no Iodine Deficiency EliminaAon) vitamins and minerals Ø Iodized salt “PATAK” sa ASIN by sec. o Treatment: Flavier on Dec. 1-5, 2003 § Food Fortification Program Ø Where the DOH workers go to market to check is - Fortification: added nutrients salt sold contains iodine by placing a few drops of - RA 8976: Food Fortification reagent: Law >> commercial foods à If the color turns to blue violet >>> must be fortified with fortified with iodine micronutrients. à If the color show no change >>> not Sangkap Pinoy fortified with iodine Types of Seal: RA 832 (Rice fortification) FVR (Fortified Vitamin Rice) A. Salt iodization B. Staple food mandatory fortification TREATMENT OF COMMUNICABLE DISEASE a. Rice – iron b. Flour – iron & vitamin A TUBERCULOSIS Sugar & cooking oil – vitamin A CAUSATIVE MODE OF INCUBATION Supplements given by Health Centers: AGENT TRANSMISSION PERIOD Vitamin A (ReAnol) – most commonly given Gram (+) acid Airborne, 4 to 6 weeks Normal: 100, 000 IU (6-11months) fast bacilli droplet, or (adults), 2 to 10 200, 000 IU (12-60 months) contact weeks (latent) Vitamin A deficiency (night blindness, bitot’s spot (children) Pathognomonic Sign: Hemoptysis (blood-tinged (bubbles in the eye), Xerophthalmia sputum) o 100, 000 IU (6-11months) o 200, 000 IU (12-63 months) Mycobacterium tuberculosis (humans) Note: never give vitamin A to infants less than 6 mos. Mycobacterium africanum (humans) & pregnant women because its toxic. Mycobacterium bovis (cattle or animals) à When the organism comes from nose, the § Iron Deficiency Anemia MTB will attack alveoli and parenchymal o Target age group: 0-59 months (less cells of the respiratory tact causing than 5 years) inflammatory process manifesting as tubercule lesions in the lungs. o Give 3-6mg/kbw/day o Always give the maximum  à One of the problems also in TB is that, the DIRECTLY – OBSERVED TREATMENT SHORT inflammation will travel to different parts of COURSE (DOTS) the body causing extrapulmonary tuberculosis such as TB of the bones. Shift: single – dose formulations (SDF) to fixed – dose combination (FDC) drugs ASSESSMENT OF PATIENTS WITH TB SDF (1 tablet + 1 TB drug); FDC (1 tablet, there is several of anti-TB drugs) Low – grade fever in the late afternoon FDC drugs depends on the weight of the Loss of appetite (thin appearance) patient. Easy fatigability Night sweats 2 types of FDC Dry cough, later productive with hemoptysis (blood- tinged sputum) 1. FDC – A (4 drug combination) Chest pain (occasionally) 2 months § Rifampicin PUBLIC HEALTH TB DIAGNOSIS § Isoniazid § Pyrazinamide § Ethambutol 1. Direct sputum microscopy (+) Acid Fast 2. FDC – B (2 drug combination) Smear, 3 specimen 4 months Specimen = 1 specimen (+) doubtful then § Rifampacin repeat; 2 specimens (+) treated § Isoniazid 1st. specimen: consultation § taken during the maintenance phase 2nd. specimen: following day Nursing interventions include ensuring that patient take the anti-TB drugs for compliance and instruct them the 3rd. specimen: upon return side effects of the anti-TB drug and the management of it. 2. Spot Specimen During Early Morning Collection ANTI-TB DRUGS Ask the patient to breathe in deeply At the height of inspiration, ask the Are hepatotoxic drugs patient to cough strongly and spit the Advise the patient to increase fluid intake and it sputum in the container should be taken in the morning before meals. Supervise the patient during the procedure and observe contamination A. ISONAIZID (INH) precautions. § Peripheral neuritis o Tingling sensation in the distal 3. (+) Tuberculin Test part of the extremities Mantaux – can be done to children; § Management includes intake of Vitamin B6 (5 mg/day) or Pryridoxine is given PPD (purified protein derivative), ID at because INH interferes with natural the inner aspect of the arm, after 48 to vitamin synthesis 72 hours, observe for induration. + 10 mm = healthy individuals B. ETHAMBUTOL 5 mm = immunocompromised § Optic neuritis If positive, prophylactic treatment for at o Blurring of vision or pain behind least 2 weeks the eyes. If positive, confirmed with other C. RIFAMPICIN § Orange to red urine output/tears diagnostic tests (x-ray or sputum smear o Discoloration and bad odor so test) and correlate with signs and advise patients to increase fluid symptoms of TB. intake. D. STREPTOMYCIN § 8th. Cranial nerve damage (Tinnitus) o Ringing of the ears.  E. PYRAZINAMIDE NURSING CARE MANAGEMENT § Joint pains and occasional attacks of Cover mouth and nose when coughing and gout (Hyperuricemia) when sneezing § Increase uric acid Proper disposal f secretions Advise patients to wear masks MANAGEMENT OF CHILDREN WITH TB iDOTS (INTEGRATED DIRECTLY OBSERVED 1. TB suspect (any 3) TREATMENT FOR SHORT COURSE § Cough / wheezing 2 weeks or more § Unexplained fever 2 weeks or more § Loss of appetite/ weight/ failure to gain § Address poor access to programmatic weight management of drug-resistant TB services as § Failure to respond to 2 weeks of well as sustainability of these services following antibiotic treatment for lower respiratory the exit of development partners. tract infection § Decentralized PMDT (programmatic management § Failure to regain previous state of health of drug resistant TB) service delivery from 2 weeks after viral infection or measles. treatment centers and satellite treatment centers 2. TB confirmation (any 3) to health centers and rural health units § (+) history of exposure to adult/adolescent ENVIRONMENTAL SANITATION § Signs and symptoms of TB § (+) tuberculin test Health and Sanitation Laws: § Abnormal chest x-ray results PD 856 – Sanitation Code of the Philippines § Laboratory (+) sputum RA 6969 – Toxic Substances and hazardous and Nuclear Waste Control Act of 1990 PTB MANAGEMENT FOR CHILDREN – LASTING RA 8749 – Clean Air Act of 1999 FOR 6 MONTHS RA 9003 – Ecological Solid Waste Management Act of 2000 1. INTENSIVE (2 MONTHS) RA 9275 – Clean Water Act 2004 § Isoniazid § Rifampicin Environmental Health § Pyrazinamide - It is a branch of public health that deals with the 2. MAINTENANCE (4 MONTHS) study of preventing illness by managing the § Isoniazid environment and changing people’s behavior to § Rifampicin reduce exposure to biological and non-biological agents of disease or injury. EPTB (EXTRAPUMONARY TB MANAGEMENT FOR CHILDREN) LASTING MONTHS OR 1 YEAR Environmental Sanitation - Study of all factors in man’s physical 1. INTENSIVE (2 MONTHS) environment, which may exercise a deleterious § Isoniazid effect on his health well-being and survival. § Rifampicin § Pyrazinamide The development of health through the Environment § Streptomycin and Occupation Health Office (EOHO) has set some 2. MAINTENANCE (10 MONTHS) policies on the following areas: § Isoniazid § Rifampicin APPROVED TYPES OF WATER SUPPLY FACILITIES PREVENTION BCG vaccination of newborn infants 1. Level 1 – Point Source Health education Improve social conditions There is an outlet but no pipe distribution Make available facilities for examination Volume – 40 to 140 L/minute Provide public health nursing and outreach Serves – 15 to 25 households services for home supervision of patients. Distance – not more than 250 meters away Generally adaptable for rural areas where the houses are thinly scattered 2. Level 2 – Communal Faucet/ Stand Post FOOD SAFETY There is an outlet and pipe distribution 4 Rights of Food Safety but no individual faucet connection 1. Right Source Volume – 40 to 80 L/capital/ day Buy fresh Check expiry dates One faucet per 4 to 6 households If canned goods, check for dents or Serve – 1oo households bulging Distance – not more than 25 meters away 2. Right Preparation from the farthest house. Handwashing is a must Avoid contact between the raw 3. Level 3 – Waterworks system or individual and cooked foods house connections 3. Right Cooking With individual faucet connection Ideal temperature is 70 degrees Celcius Maynilad, NAWASA, Prime Water, 4. Right Storage MCWD, ORWASA Must be placed and kept in an air- tight sealed containers UNAPPROVED TYPE OF WATER FACILITY If food is placed in a room temperature, - Open dug wells do not leave it more than 4 hours or - Unimproved springs more - Wells that need priming In cold temperature, for more than 4 to 6 hours, reheat at 70 degrees Water quality and monitoring surveillance Celcius Disinfection of water supply sources is required FOOD SANITATION PROGRAM on the following: o Newly constructed water supply facilities Food Establishments shall be appraised as to the o Water supply facility that has been following sanitary conditions: repaired / improved Inspection / approval of all food source, containers, transport vehicles Compliance to sanitary permit requirements for TOILET FACILITY all food establishment 1. Type 1 Provision of updated health certificate for food No water needed handlers, cooks and cook helpers. o Reed-odorless Earth closet – FOOD ESTABLISHMENT SHALL BE RATED AS defecating with a soil then cover FOLLOWS: the feces with it Less water needed ü CLASS A – Excellent o Aqua privies ü CLASS B – Very Satisfactory Poor flush toilet ü CLASS C – Satisfactory 2. Type 2 Flush type With septic tank Water-sealed 3. Type 3 Treatment plant Sewerage system Such as in malls