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WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 3: COMMUNITY HEALTH NURSING
POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING DECEMBER 2012 PNLE *Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE students on the possible topics that might be part of the upcoming Dec. 2012 PNLE
A. DOH Vision 2030
A Global Leader for attaining better health outcomes, competitive and responsive health care systems, and
equitable health financing. B. DOH Mission
To guarantee EQUITABLE, SUSTAINABLE and QUALITY health for all Filipinos, especially the poor and to lead the
quest for excellence in health. C. Levels of Prevention
PRIMARY LEVEL
Health Promotion and
Illness Prevention
SECONDARY LEVEL
Prevention of Complications thru Early Dx
and Tx
TERTIARY LEVEL
Prevention of Disability, etc.
Provided at –
Health care/RHU
Brgy. Health Stations
Main Health Center
Community Hospital and Health Center
Private and Semi-private agencies
When hospitalization is deemed necessary and referral is made to emergency (now district), provincial or regional or private hospitals
When highly-specialized medical care is necessary referrals are made to hospitals and medical center such as PGH, PHC, POC, National Center for Mental Health, and other gov’t private hospitals at the municipal level
D. 8 Common Generic Drugs (Botika sa Baranggay)
1. Co-Trimoxazole : GUT/GIT/URT Infection 2. Amoxicillin / Ampicillin 3. Rifampicin 4. Isoniazid 5. Pyrazinamide 6. Paracetamol 7. Oresol 8. Nifidipine: HPN
E. Herbal Plants
Plant Name Scientific Name Indications Lagundi Vitex negundo Asthma, cough,
colds & fever Pain and inflammation
Ulasimang Bato Peperonia pellucida
Gout Arthritis Rheumatism
Bayabas Psidium quajava Diarrhea Toothache Mouth and wound wash
Bawang Allium sativum HPN Toothache
Yerta Buena Mentha cordifelia Same as Lagundi except asthma
Sambong Blumea balsanifera
Edema Diuretic
Akapulko Cassia alata All forms of skin diseases
Niyog niyogan Quisqualis indica Intestinal Parasitism (Nematodes)
Tsaang Gubat Carmona resuta Diarrhea Infantile colic (Kabag) Dental caries
Ampalaya Mamordica charantia
Type II Diabetes (NIDDM)
F. Homemade Oresol A volume or one liter homemade oresol
Smaller volume or a glass homemade oresol
Water 1000 ml. or 1 liter 250 ml. Sugar 8 teaspoon 2 teaspoon Salt 1 teaspoon ¼ teaspoon or a pinch of
salt=10-12 granules of rock salt: iodized salt=tips of thumb & index finger are penetrated with salt
G. Millennium Goal Development (MDG)
1. ERADICATE EXTREME POVERTY AND HUNGER 2. ACHIEVE UNIVERSAL PRIMARY EDUCATION 3. PROMOTE GENDER EQUALITY AND EMPOWER
WOMEN 4. REDUCE CHILD MORTALITY (Phil. focus) 5. IMPROVE MATERNAL HEALTH (Phil. focus) 6. COMBAT HIV/AIDS, MALARIA AND OTHER
DISEASES 7. ENSURE ENVIRONMENTAL SUSTAINABILITY 8. DEVELOP A GLOBAL PARTNERSHIP FOR
DEVELOPMENT H. Field Health Service Information System ( FHSIS)
Individual Treatment Record (ITR) Fundamental building block or foundation
FHSIS. Target Client List (TCL)
Such lists will be of considerable value to midwives/nurses in monitoring service delivery to clients in general and in particular to groups of patients identified as “targets” or “eligibles” for one or another program of the Department
WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 3: COMMUNITY HEALTH NURSING
POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING DECEMBER 2012 PNLE *Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE students on the possible topics that might be part of the upcoming Dec. 2012 PNLE
Summary Table Composed of Health Program Accomplish
and Morbidity Diseases The Monthly Consolidation Table (MCT) FHSIS Reporting Monthly Form
1. Program report (M1) 2. Morbidity report (M2) Prepare by Midwife Every 2nd week of the month is the
submission Quarterly Form
1. Program report (Q1) 2. Morbidity report (Q2) Prepared by Nurse Every 3rd week of the succeeding quarter
month is the submission Annual Form
1. ABHS report Contains data on demographic,
environmental and natality. Prepare by Midwife Every 2nd week of January is the
submission 2. A1: Report on vital statistics: demographic,
environmental, natality and mortality. 3. A2: Lists all diseases and their occurrence in
the municipality/city. The report is broken down by age and sex.
4. A3: All deaths occurred in the municipality/city. The report is also broken down by age and sex Prepared by Nurse Every 3rd week of January is the
submission
I. Health Indicators Crude Birth Rate (CBR): Overall total reported births per 1000 population
CBR=overall total reported births x 1000 Population
Incidence Rate (IR): Reported new cases of disease per percent (100/population) population
IR=new cases of disease x 100 Population
Prevalence rate (PR): Reported new cases of disease + old cases of disease per percent of population
PR=new cases + old cases x 100 Population
Crude Death Rate (CDR): Overall total reported deaths per 1000 population
CDR=overall total deaths x 1000 Population
Maternal Mortality Rate (MMR): Reported maternal deaths per 1000 registered live births (RLB)
MMR= # of maternal deaths x 1000
RLB
Infant Mortality Rate (IMR): Reported # of infant (0 to 12 months of age) deaths per 1000 RLB
IMR=# of infant deaths x 1000 RLB
Neonatal Mortality Rate (NMR): Reported # of neonatal (0 to 28 days or <1 month) deaths per 1000 RLB
NMR=# of neonatal deaths x 1000 RLB
Swaroop’s Index (SI): Reported # of deaths among individuals> 50 years old over total deaths SI=# of deaths (individual >50 years old) x 100
Total Deaths J. Nature of the Family Problem
Health Deficit (HD): if identified problem is an abnormality, illness or disease, there’s a gap/difference between normal status (ideal, desirable, expected) & actual status (the outcome/result/problem encountered on that actual day)
Health Threat (HT): any condition or situation
which will be conducive to health alteration, health interference & health disturbance.
Foreseeable Crisis (FC): stress points, anything
which is anticipated/ expected to become a problem.
K. Community Organizing (COPAR) Preparatory Phase 1. Area of Selection
It should be DOPE Community: Depressed, Oppressed, Poor & Exploited, a new criteria for community organization
2. Entry Phase The 1st thing to do upon entering the community is
to have a courtesy call with the Barangay Captain, introduce self & group, purpose, present the project, activities, etc.
3. Integration/Immersion (CIP) Immersion is imbibing the life situation/condition
of the community . 4. Community Study: Diagnosis of Community-COPAR
Makes use of the Nursing Process/Problem Solving Approach
Prioritized which among the problems identified is to be attended 1st like in nature, magnitude, modifiability, preventive potential, salience
WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 3: COMMUNITY HEALTH NURSING
POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING DECEMBER 2012 PNLE *Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE students on the possible topics that might be part of the upcoming Dec. 2012 PNLE
L. Epidemiology
Epidemic: a situation when there is a high incidence of new cases of a specific disease in excess of the expected.
Endemic : habitual presence of a disease in a given geographic location accounting for the low number of both immunes and susceptibles
Sporadic : disease occurs every now and then affecting only a small number of people relative to the total population
Pandemic: global occurrence of a disease
M . Approve Water Facilities
Level I Point Source
Level II Communal faucet system or stand posts
Level III Waterworks system or individual house connections
A protected well or a developed spring with an outlet but without a distribution system for rural areas where houses are thinly scattered.
A system composed of a source, a reservoir, a piped distribution network and communal faucets, located at not more than 25 meters from the farthest house in rural areas where houses are clustered densely.
A system with a source, a reservoir, a piped distributor network and household taps that is suited for densely populated urban areas.
N. Approved Toilet Facilities
Level 1 Level 2 Level 3 Non-water carriage toilet facility: - Pit latrines - Reed Odorless Earth Closet - Bored-hole - Compost - Ventilated improved pit Toilets requiring small amount of water to wash waste into receiving space - Pour flush - Aqua privies
On site toilet facilities of the water carriage type with water sealed and flushed type with septic vault/tank disposal facilities.
Water carriage types of toilet facilities connected to septic tanks an/or to sewerage system to treatment plant.
O. Excreta Disposal
Household Community ○ Burial
► Deposited in 1m x 1m deep pits covered with soil, located 25 m. away from water supply
○ Open burning Animal feeding Composting Grinding and
disposal sewer
○ Sanitary landfill or controlled tipping ► Excavation of soil deposition of refuse and compacting with a solid cover of 2 feet ○ Incineration
DOH PROGRAMS
EXPANDED PROGRAM ON IMMUNIZATION Law: PD 996
Vaccine Dosage # of Doses to complete immunization
BCG 1. I 2. SE
.05 ml .1 ml
1 dose 1 dose
DPT .5 ml 3 doses OPV 2-3 gtts 3 doses HBV <10 y/o: .5
>10 y/o: 1 3 doses
MV .5 ml 1 dose It is safe and immunologically effective to administer all
EPI vaccines on the same day at different sites of the body.
The vaccination schedule should not be restarted from the beginning even if the interval between doses exceeded the recommended interval by months or year.
DPT2 or DPT3 is not given to a child who has convulsions or shock within 3 days after DPT1. V
Do not give live vaccines like BCG to a individuals who are immunosuppressed due to malignant disease (child with AIDS) , going therapy with immunosuppressive agents or radiation.
Repeat BCG vaccination if the child does not develop a scar after first injection
Type of Vaccine Storage Temp. Hours of Life after
opening OPV -15 to -25 C Measles At the freezer Hepa B 8 hours DPT 2 to 8 C Tetox Body of BCG refrigerator 4 hours
WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 3: COMMUNITY HEALTH NURSING
POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING DECEMBER 2012 PNLE *Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE students on the possible topics that might be part of the upcoming Dec. 2012 PNLE
NATIONAL TB PROGRAM
Disease Causative Agent Mode of Transmission
Clinical Manifestation
Reservoir Diagnostic Exam
Treatment Nursing Implication
Tuberculosis “Primary Complex” is less than 3 years old - any child who does not return to normal health after measles or whooping cough. Most
hazardous period: first 6-12 months after infection
Highest in risk of developing: under 3 years old
Mycobacterium
Tuberculosis
Droplet Infection
( inhalation of bacilli from patient
who coughs and sneeze)
General
weakness Loss of
weight, cough and wheeze which does not respond to antibiotic therapy.
Fever and night sweat
Abdominal swelling with a hard painless mass and free fluid
Hemoptysis and chest pain
Painful firm or soft swelling in a group of superficial lymph nodes.
Man And
Diseased Cattle
(Bovine TB)
Sputum
Exam 3 sample are taken with 24 hrs: - spot sample (1st visit) - early morning specimen - spot sample (2nd visit) Note: at least 2 sample are positive Chest
Xray Mantoux
Test - .1 cc injection of PDD and 48-72 hours reading * 10 mm + 5 mm + (HIV pt.)
DOTS
- patient is required to take the Ant-Tb drugs in the presence of
a health care provider to
ensure compliance to
treatment regimen
Anti-TB drugs: (RIPES) Rifampicin Isoniazid Pyrazinamide Ethambutol Streptomycin
Pointers for teaching on Anti-TB drugs: Rifampicin: taken befor meals, causes red urine urine Isoniazide: causes peripheral neuritis, given with Vit.B6 Pyrazinamide: cause hyperurucemia Ethambutol: causes optic neuritis/ blurring of vision Streptomycin: cause tinnitus, loss of hearing balance, damage to 8th cranial nerve Note: After 2-4 weeks of treatment, patient is no longer contagious
RECOMMENDED CATEGORY OF TREATMENT REGIMEN
Category Type of TB Patient Treatment Regimen Intensive Phase Continuation
Phase Total Period
I
New smear positive PTB New smear positive PTB
with extensive parenchymal lesion
EPTB and Severe concomitant HIV disease
2 RIPE
4 RI
6 mos.
II
Treatment Failure Relapse Return after default
2 RIPES /1 RIPE
5 RIE
8 mos.
III
New smear-negative PTB With minimal parenchymal
lession
2 RIP
4 RI
6
mos.
IV
Chronic ( still smear-positive after supervised re-treatment )
Refer to or DOTS
to City
Specialized Plus Center Provincial
Coordinator
facility refer NTP
WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 3: COMMUNITY HEALTH NURSING
POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING DECEMBER 2012 PNLE *Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE students on the possible topics that might be part of the upcoming Dec. 2012 PNLE
INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)
Danger Sign
MAIN SYMPTOM: Cough and Difficulty Breathing
Pneumonia Classification
MAIN SYMPTOM: Diarrhea
Dehydration Classification
A child who has had diarrhea for 14 days or more and who has no signs of dehydration is classified as having PERSISTENT DIARRHOEA
Classify a child with diarrhea and blood in the stool as having DYSENTERY. A child with dysentery should be treated for dehydration
WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 3: COMMUNITY HEALTH NURSING
POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING DECEMBER 2012 PNLE *Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE students on the possible topics that might be part of the upcoming Dec. 2012 PNLE
MAIN SYMPTOM: Fever
High Malaria Risk Classification
Low Malaria Risk Classification
No Malaria Risk Classification
MAIN SYMPTOM: Ear Problem
Ear Problem Classifications
WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 3: COMMUNITY HEALTH NURSING
POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING DECEMBER 2012 PNLE *Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE students on the possible topics that might be part of the upcoming Dec. 2012 PNLE
MAIN SYMPTOM: Malnutrition and Anemia
Malnutrition and Anemia Classification
COMMUNICABLE DISEASES
Cholera
Other names:El tor
Fecal-oral route 5 Fs
Incubation Period: Few hours to 5 days; Usually 3
days
Pathognomonic Sign: Rice watery stool
Diagnostic Test: Stool culture
Treatment:Oral rehydration solution (ORESOL) IVF
Drug-of-Choice: tetracycline (use straw; can cause
staining of teeth). Oral tetracycline should be
administered with meals or after milk.
Shistosomiasis
Other Names: Snail Fever Bilharziasis
Endemic in 10 regions and 24 provinces High
prevalence: Regions 5, 8, 11
Contact with the infected freshwater with cercaria and
penetrates the skin
Diarrhea Bloody stools (on and off dysentery)
Enlargement of abdomen Splenomegaly
Hepatomegaly Anemia / pallor weakness
Diagnostic Test: COPT or cercum ova precipitin test
(stool exam)
Drug-of-Choice: PRAZIQUANTEL (Biltracide)
Oxamniquine for S. mansoni Metrifonate for S.
haematobium *Death is often due to hepatic
complication
Dispose the feces properly not reaching body of water
Use molluscides Prevent exposure to contaminated
water (e.g. use rubber boots)
Apply 70% alcohol immediately to skin to kill surface
cercariae
Allow water to stand 48-72 hours before use
Malaria
Plasmodium Parasites: Vivax Falciparum (most fatal;
most common in the Philippines)
Bite of infected anopheles mosquito Night time biting
High-flying
Rural areas Clear running water
Malarial Smear – best time to get the specimen is at
height of fever because the microorganisms are very
active and easily identified
Chemoprophylaxis: only chloroquine should be given
(taken at weekly intervals starting from 1-2 weeks
before entering the endemic area). In pregnant women,
it is given throughout the duration of pregnancy.
Treatment:
1. QUININE – oldest drug used to treat malaria; from
the bark of Cinchona tree; ALERT: Cinchonism –
quinine toxicity
2. CHLOROQUINE
3. PRIMAQUINE – sometimes can also be given as
chemoprophylaxis
4. FANSIDAR – combination of pyrimethamine and
sulfadoxine
CLEAN Technique
*Insecticide – treatment of mosquito net
*House Spraying (night time fumigation)
*On Stream Seeding – construction of bio-ponds for
fish propagation (2-4 fishes/m2 for immediate impact;
200-400/ha. for a delayed effect)
*On Stream Clearing – cutting of vegetation
overhanging along stream banks
*Avoid outdoor night activities (9pm – 3am)
*Wearing of clothing that covers arms and legs in the
evening*Use mosquito repellents
*Zooprophylaxis – typing of domestic animals like the
carabao, cow, etc near human dwellings to deviate
mosquito bites from man to these animals Intensive
IEC campaign