Nle Notes Chn

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  • 8/13/2019 Nle Notes Chn




    Act No. 157- Creation of Board of Health of the Philippine (BON)

    Act No. 147- A!olish BOH "#$%

    1&1& 'rs. Caren "el osario * 1st+ilipino N,rse ,perisor

    1&&-1&&/ * $ocal eol,tionary Code of 1&&10 A 71 eol,tion Code

    National to local


    Health * (2HO) state of coplete physical0 ental and social 3ell !ein0 not erely

    the a!sence of disease or infirity

    P,!lic health * ("r. C.. 2inslo3) the science and art of preentin disease0

    prolonin life0 prootin health and efficiency thro,h orani6ed

    co,nity effeort.

    Co,nity Health N,rsin (aco!son)- is a learned practice discipline 3ith the

    ,ltiate oal of contri!,tin as indiid,al and in colla!oration 3ith others to

    the prootion of clients opti, leel of f,nction thro,h teachin and

    deliery of care.

    +actors affectin Opti, $eel of +,nction (O$O+)

    1. Political

    /. Behaioral

    8. hereditary

    4. Health Care "eliery yste

    5. nironental #nfl,ences

    . ocio econoic #nfl,ences


    1. 9he priary foc,s of co,nity health n,rsin practice is on health


    /. Co,nity health n,rses are eneralist in ter of their practice thro,h life

    !,t the 3hole co,nity.

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    8. Co,nity health n,rses are eneralist in ters of their practice thro,h

    life contin,ity in its f,ll rane of health pro!les and needs.

    4. 9he nat,re of CHN practice re:,ires that c,rrent ;no3lede deried fro

    the !ioloical0 social science0 ecoloy0 clinical n,rsin and co,nity health

    orani6ations !e ,tili6ed

    5. Contact 3ith the client and or faily ay contin,e oer a lon period of tie3hich incl,des all aes and all types of health care.

    . 9he dynaic process of assessin0 plannin0 ipleentin and interenin

    proide eas,reents of proress0 eal,ation and a contin,, of the cycle

    ,ntil the terination of n,rsin is iplicit in the practice of co,nity

    health n,rsin.


    1. CHN is !ased on reconi6ed needs of co,nities0 failies0 ro,ps and

    indiid,als./. 9he co,nity health n,rse ,st ,nderstand f,lly the o!s eal,ation of co,nity health tea.

    ?. Opport,nities for contin,ation staff ed,cation proras n,rses ,st !e

    proided !y the CHN aency. 9he co,nity health n,rse also has a

    responsi!ility for [email protected] o3n professional ro3th.

    &. 9he co,nity health n,rse a;es ,se of aaila!le co,nity health


    1. 9he co,nity health n,rse ,tili6es the already eistin actie orani6ed

    ro,ps in the co,nity.

    11. 9here ,st !e proision for ed,catie s,perision CHN

    1/. 9here sho,ld !e acc,rate recordin and reportin in CHN.

    P,!lic Health N,rse

    1. [email protected]

    /. Proide of N,rsin [email protected]

    8. '[email protected],perisor

    4. Co,nity Orani6er

    5. Coordinator of erice

    . [email protected] Health d,[email protected] Co,nselor

    7. Health onitor

    ?. ole 'odel

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    &. Chane Aent

    1. [email protected] [email protected] tatistician

    11. esearcher

    Co,nity Health Process

    AssessentCollection of data0 collected fro faily0 ro,ps and co,nity.

    aples "eoraphic "ata

    ital Health tatistics

    Co,nity "ynaics

    Health tat,s


    'ethods Co,nity ,rey


    tatistics pideioloical st,dies

    Coon indicators of health stat,s



    Cateories of Health Pro!les

    1. Health "eficit (H")- instances of fail,re in health aintenance ( dse0

    disa!ility0 de>tl la) -e. "[email protected] illness- =9#0 aras,s0 sca!ies0 edea

    disa!ilities- !lindness0 polio0 color!lindness0 deafness

    de>tl pro!les li;e ental retardat0 iantis0 horonal0


    Health 9reat (H9)- conditions cond,cie to dse0 accidents or fail,re to reali6e

    one>s health potential

    healthy people

    e. +aily h of illness- hereditary li;e "'0 HPN

    n,tritional pro!les- eatin salty foods

    personal !ehaior- so;in0 self-edication0 se,al practices0dr,s0 ecessie drin;in

    inherent personality char- short teperedness0 short attn span

    short cross infect

    poor hoe eni

    lac;@inade:,ate i,ni6ation

    ha6ards- fire0 falls0 or accidents

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    faily si6e !eyond 3hat reso,rces can proide

    +oreseea!le Crisis (+C)- anticipated periods of ,n,s,al deand on indi

    or fa in ters of ad

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    =tili6ed s,pport syste


    +rae 3or;s

    a. tr,ct,ral eleents

    !. Process eleents

    c. O,tcoe eleents

    N,rsin Proced,res

    Clinic isit

    1. Pre-cons,ltation conference

    /. 'edical eaination

    8. N,rsin interention4. Post cons,ltation conference

    Hoe isit- face to face contact 3ith the client


    1. A hoe isit sho,ld hae a p,rpose or o!

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    /. Perforance of n,rsin care ,tilities s;ills that 3o,ld ie ai,

    cofort and sec,rity.

    8. N,rsin care at hoe sho,ld !e ,sed as a teachin opport,nity.

    4. Perforance of n,rsin care sho,ld reconi6ed daners in the patients> oer-

    proloned acceptance of s,pport and cofort.

    5. N,rsin care is an opport,nity for detectin a!noral sins and syptos.

    #solation 9echni:,es

    All Articles ,sed !y the patient sho,ld not !e ied 3ith the articles ,sed !y

    the rest of the e!ers of the ho,sehold.

    +re:,ent 3ashin and airin of !eddins and other articles and disinfectants

    of roo are iperatie

    9he one carin for the sic; e!er sho,ld !e proided 3ith a protectie

    o3n that sho,ld !e ,se 3ith in the roo of the sic;.

    All dischares0 especially fro the nose and throat of a co,nica!le

    disease patient sho,ld !e caref,lly dischared. Articles 3ith dischares sho,ld !e first !oiled for 8 in,tes !efore

    la,nderin. 9hos co,ld !e !,rned0 sho,ld !e !,rned.


    ision HA$9H +O A$$ B / I HA$9H #N 9H HAN" O+ 9H

    POP$ B //

    'ission ns,re accessi!ility and :,ality of health care to iproe the :,ality of

    life of all +ilipinos0 especially the Poor.

    National O!

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    a. #ncrease inestent for priary health care

    !. "eelopent of national standards and o!

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    B aya!as- "iarrhea

    er!a B,ena- arthritis0 toothache0 s3ollen ,s0 co,h I colds

    a!on- co,h and colds0 renal stones

    A palaya- "'

    N iy,-nyoan- ascariasis

    9 saan ,!at- diarrheaA cap,lco- f,nal infection0 sca!ies

    A ?4/8- ,tili6ation of edicinal plants as alternatie for hih cost edications.

    pideioloy- st,dy of distri!,tion and dynaic of disease occ,rrence in h,an


    ndeic- constant presence of disease or infection aent 3ith in a ien eoraphic


    pideic- occ,rrence in a co,nity or reion of cases of an illness clearly in

    ecess of epectancy

    Pandeic- epideic so 3idely spread that ast n,!ers of people in different

    co,ntries are affected

    poradic- disease that occ,rs only occasionally or in a fe3 isolated places

    ,reillance- a contin,in scr,tiny of all aspects of occ,rrence and spread of a

    disease that is pertinent to effectie control ( prootion0 preentie

    patient and reha!ilitatie)

    entinel sites- are health facilities 3hich are selectie as representaties of 3hat is

    happenin in areas 3hose reports are acc,rate0 coplete and propt

    (health center)

    tatistics- that science inoled in the collection0 orani6ation0 analysis and

    interpretation of n,erical data

    Biostatistics- the scientific discipline concerned 3ith the application of statistical

    ethods to pro!les in !ioloical and edicine.

    +ertility ate

    1. CB (Cr,de !irth rate)- relatie pop d,e to !irths

    9otal n,!er of !irths in a calendar year

    CBM Birth 1

    Pop e. /5.?M CB

    9here are / !irths in eery 1 pop

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    /. %eneral +ertility ate (%+) - tr,e fertility rate * specific seents of pop that is



    Pop of 3oen (15 to 44 yo)

    . %+M8/ 9here are 8/ !irths in eery 3oan in 15-44

    'ortality ates

    1.Cr,de "eath ate JJJJ 1

    "ecrease in pop d,e to death

    C"M death 1


    . C"M there are in eery 1 pop

    /. pecific 'ortality ate- can apply to any pop rp' M death fro or partic,lare rp 1

    Pop of that rp

    a. '(ales) M death (ales) 1

    pop of ales

    !. ' (feales) M death of feales 15-44

    pop of feales 15-44

    #nfant 'ortality ate #'M "eath -1 year 1


    Neonatal 'ortality ate N'M deaths -/? days 1


    Post Neonatal 'ortality ate PN' M deaths /? days to 1 year 1 Births

    N' PN' M #'

    Neonatal deaths Post neonatal deathsM #nfant deaths

    . Birth /

    N'M /

    "eath * /? to 1

    N' PN' M #'

    / 1 M 8 (AN)

    / J 1 M 1 M 1

    / 1

    'aternal 'ortality ate ('')

    ''M death of 3oen [email protected] prenancy0 deliery0 I p,erperi, 1


    . #' M 8 9here are 8 infant deaths in eery 1 !irths

    N' M / 9here are / neonatal deaths in eery 1 !irths

    PN' M 1

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    '' M .&/

    Proportionate 'ortality ate M P' ( for any rp)

    P'M death fro a partic,lar rp 1

    total death

    . 5/ P' of ales M deaths of ales 1total deaths

    #n eery 1 death0 5/ are ales

    P' M deaths -1 1

    .1 total deaths

    POPO9#ONA9 'O9A$#9 #N"#CA9O

    A. 3aroop>s #nde M #

    # M death of 5 yrs I ,p 1

    total deaths

    9he #0 the !etter the sit,ation is

    B. elatie iportance of a ;iller ( 9B0 heart dse0 diarrhea)

    "eath d,e to 9B 1

    total deaths

    P' M 8


    --#n eery 1 deaths0 8 are d,e to 9B

    Case +atality ate (C+)

    Ho3 is s,rial rate0 ho3 stron is ;illin po3er0 pronosisC+M death d,e to part ca,se 1

    total cases

    . C+ M &?


    JJJdeath H#JJJ 1

    9otal cases of 9B

    #n eery 1 cases of H#0 there are &? deaths

    Ca,se-of-death ate (ortality rate)

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    an; as a ;iller

    C of "M death d,e to partic,lar ca,se 10

    total pop

    . C of " M8/ 9B

    #n eery 10 pop there are 8/ deaths d,e to 9B

    Prealence ate M ('or!idity rate)

    an; as a coon dise

    P M old and ne3 case of 9B 10

    9B total pop

    . P M old I ne3 case of 9B 10

    9B. P M 8/


    9here are 8/ cases of 9B o,t of 10 pop,lation.

    #ncidence ate

    #M JJJne3 casesJJJ 10

    pop at ris;

    3aroff>s #nde

    9otal death of a person ain a!oe 5 Q 19otal n,!er of deaths of all aes

    it,ation Baranay Q has a total pop,lation of 18/ for the year 1&&&-/ !ases

    on the follo3in date0 sole for the s3aroff>s inde0 infant ortality rate0 cr,de

    death rate and the aternal ortality rate

    3arrof>s indeM [email protected] 1M 1/.?

    #'M [email protected]/&4 10 M 18 #M @18/ 10M 4&

    CBM 1/&[email protected]/ 10 M &5

    C"M [email protected]/ 10M 4/

    ''M [email protected]/&4 10 M /.88

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    ssential Health erices

    ($'N9) of PHC

    - d,cation on ethods of preentin and controllin health pro!les

    $- $ocal endeic disease preention and control

    '- 'aternal and child care incl,din faily plannin- ssential dr,s

    N- N,trition

    9. 9reatent

    - anitation and H/O s,pply

    +o,r Corner [email protected] Pillar in PHC

    1. Actie co,nity participation

    /. #ntra and inter sectoral lin;aes

    8. =se of appropriate technoloy

    4. ,pport echanis ade aaila!le

    $eels Health Care

    Priary- Branay D district [email protected] trained health 3or;ersE

    econdary- [email protected]"istrict DN=E

    9ertiary- Hearth Center0 $,n Center etc. - doctor

    eprod,ctie Health (H)

    ision reprod,ctie health practices as a 3ay of life for eer an and 3oan

    thro,ho,t life


    a. arried co,ples has the capa!ility to reprod,ce

    !. reprod,ctie health is eercise of reprod,ctie riht

    c. p,rpose of enhanceent of life and personal relation

    d. safe prenancy0 safe deliery

    e. protection fro ,n3anted prenancy

    f. protection fro harf,l reprod,ctie practice and iolence

    . ass,res access to inforation on se,ality to achiee se,al


    "eterinants of H

    1. socio- econoic

    /. stat,s of 3oen

    8. social and ender iss,es

    4. !ioloical0 c,lt,ral and psycho-social factors

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    %OA$ 'CH AN" N=9#9#ON

    R eery prenancy sho,ld !e intended

    R eery !irth sho,ld !e healthy

    R eery se act sho,ld !e free of co erection and infectionR achiee desired faily si6e

    9en leents of H

    1. 'aternal and child health n,trition

    /. +aily plannin

    8. Preention and anaeent of a!ortion coplication

    4. Preention and treatent of reprod,ctie tract infection0 respiratory

    infection and 9"0 H#@ A#"

    5. d,cation and co,nselin on se,ality and se health

    . Breast and reprod,ctie tract cancer7. Other ynecoloical condition

    ?. 'en>s H

    &. Adolescent H

    1. Preention and treatent of infertility

    9etan,s 9oiod

    91- anytie d,rin prenancy

    9/- 4 3ee;s of prenancy

    98- [email protected] /44 3ee;s of prenancy

    94- 1 year old

    95- a!oe 1 year

    SPP" && i,ni6ation prora

    accine o,te "osae +re:,ency

    BC% half life 4ho,rs

    $ie atten,ated !acteria

    Dstored T /-?deree Celsi,s



    $ "eltoid

    [email protected]

    [email protected]

    At !irth

    chool entrance

    "P9 half life ? ho,rs

    2ea;ened toin

    ;illed !acteria stored T/

    2ea;ened toin to ? deree



    [email protected] [email protected]


    [email protected] "P9 1- th3ee;s

    "P9 /- 1 3ee;s

    "P9 8- 8 U onths

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    OP Oral /-8 tts 3ee;sT 8 doses

    Hepa B #' anterior


    [email protected]@


    [email protected] 3ee;s/ 8 doses 4th



    'easles V o,terpart of the


    .5l & onths

    ide effects

    1. Foch>s phenoenon- /-4 days after accines

    - ac,te inflaation

    deep a!scess- deeper in

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    $eprosy Control Prora

    - ',lti "r, therapy 1&?? A 478

    - Chronic disease of the s;in and peripheral neres ca,sed !y 'yco!acteri,

    $eprea or Han>s Bacill,s

    arly [email protected]

    Chane in s;in color- reddish or 3hite

    $oss of sensation

    "ecrease hair ro3th- deris

    $oss of s3eatin- eocrine

    ',scle 3ea;ness- neres

    9hic;[email protected] painf,l neres

    =lcer that do not heal

    $ate [email protected]


    $aophthalos- ina!ility to close the eye lids

    Cla3in of finers and toes


    in;in of nose !ride


    Chronic ,lcers



    +ast !reathin

    Chest in dra3in


    A!norally sleepy

    eere ,nder n,trition

    Not a!le to drin;

    tridor ,pon inhalation- a,sc,ltation

    2hee6in- ,pon ehalation

    +eer or lo3 !ody tep.

    'anaeent of pne,onia ost pne,onia deaths are preenta!le if treated


    9 is !ased

    early reconition of pne,onia

    propt treatent of non seere cases at hoe 3ith standard

    anti!iotics and ood s,pportie care

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    :,ic; identification if seere cases and :,ic; referral to the

    hospitals- preent death

    9reatent ay incl,de


    adisin others to ie hoe care treatin feer and 3hee6in

    Hoe Care (child 3ith co,h and colds)

    no anti!iotics needed

    feed the child

    increase fl,id inta;e

    clear nose

    ;eep child 3ar and coforta!le

    @ that the child ,st !e !ro,ht to health care facility

    fast !reathin

    diffic,lty !reathin

    ,na!le to drin;

    feedin pro!le

    ole of "r,s in control of infection

    children 3ith co,h and colds 3ith no pne,onia ,st not !e

    ien anti!iotics

    anti!iotics sho,ld only !e ien to cases pne,onia0 seere

    pne,onia and ery seere disease


    Aaila!ity of "r,s

    1. Cotrioa6ole

    /. in

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    7. Practicin ood hyiene

    Control of "iarrhea "isease

    'anaeent of patient 3ith diarrhea

    ,se this chart for patients 3itha. loose 3atery stools

    !. loose stools 3ith !lood

    tep 1- Asses yo,r patient for dehydration

    tep /- Asses for other pro!les

    1. $oo; at condition 3ell alert

    ye noral

    9ears present

    'o,th and ton,e oist

    9hirst drin;s norally0 not thirsty

    /. +eel- ;in Pinch oes !ac; :,ic;ly

    8. "ecide No dehydration

    4. 9reatent treatent A

    9reatent Plan A

    R to treat diarrhea at hoe

    R ,se this plan to teach the other to

    1. Contin,e to treat at hoe her child>s c,rrent episode of diarrhea

    /. ie early treatent for f,t,re episode of diarrhea

    9reatent Plan C

    (eer dehydration)

    Can yo, ie #+ ------------es-------tart #+ iediately DPN and .& NaCl


    #s # net aaila!le-----------es-------end patient 3ithin 8 in,tes


    Are yo, trained 9o------------es------tart 3ith O

    =se N%9 for



    Can the patient-----------------es------tart 3ith O per ore



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    end the patient for # or N%9

    2ater "econtaination

    Boilin /-8 in,tes

    Chlorine 1 drop of 5 Na Hypo chloride in 1 $ H/O

    tat for /-8 in,tes



    PB non infectio,s 'B- infectio,s

    9,!erc,loid $praato,[email protected] Borderline


    -& onths /4-8 onths

    "ay [email protected] /-? "ay [email protected] /-/?

    [email protected]"apsone ifapicin



    O'- ifapicin. Ofloacin0 'inocyclinc

    Preention- BC%

    Pne,oniaery eere eere Pne,onia No Pne,onia

    =na!le to drin; +ast !reath +ast !reathin No fast !reathin

    Con,lsion Chest indra3in No chest indra3in No chest indra3in

    "iffic,lt to 3a;e


    9! Net3or; N,rse


    'id3iesarly case 'ed 9ech


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    Cateory 1 Cateory / Cateory 8

    Ne3 () cases P9B

    erio,sly #$$

    a. #ntensie PhaseAdance p,lonary 9B

    !. tra p,lonary 9B

    / onths


    # sonia6id

    P yra6inaide

    tha!,tol Dsho,ld

    not ,sed years old

    !elo3 !eca,se of is,al


    4 onths


    # sonia6id

    /-? onths aintenance

    9reatent replaces


    / onths 8 onths

    # #

    P P

    - streptoycin D#'E

    5 onths


    P9B inial(-) 8

    sp,t, sear

    -ray P9B inialtra 9PB (not serio,s)

    /onths / onths

    # #



    Environmental Sanitationis defined as the study of all factors in mans physical environment,which may exercise a deleterious effect on his health, well-being and survival.

    Goal: to eradicate and control environmental factors in dse transmission through the provision ofbasic services and facilities to all households.

    1. Water upply anitation !rogram

    1 types of "pproved Water upply #acilities

    $evel 1!oint ource

    $evel %%&ommunal #aucet system or standposts

    $evel %%%Waterwor's system orindividual houseconnections

    " protected well of adeveloped sprung with anoutlet but without a

    distribution system for ruralareas where houses arethinly scattered.

    " system composed of a source, areservoir, a piped distributionnetwor' and communal faucets,

    located at not more than () metersfrom the farthest house in rural areaswhere houses are clustered densely.

    " system with a source, areservoir, a piped distributornetwor' and household

    taps that is suited fordensely populated urbanareas.

    Water must pass the *ational tandards for +rin'ing Water set by the +.

    (. !roper xcreta and ewage +isposal ystem

    / types of "pproved 0oilet #acilities

    $evel 1 $evel ( $evel /

    *on- water carriage toilet facility: n site toilet facilities of Water carriage types

  • 8/13/2019 Nle Notes Chn


    - !it $atrines

    - eed dorless arth &loset

    - 2ored-ole

    - &ompost

    - 3entilated improved pit

    0oilets re4uiring small amount of water towash waste into receiving space-pour flush-a4ua privies

    the water carriage typewith water sealed andflushed type with septicvault5tan' disposalfacilities.

    of toilet facilitiesconnected to septictan's and5or tosewerage system totreatment plant.

    ural "reas- 6blind drainage7 type of wastewater collection and disposal facilities shall beemphasi8ed until such time that sewer facilities and off-site treatment facilities are available.

    /. !roper olid Waste 9anagement

    - refers to satisfactory methods of storage, collection and f inal disposal of solid wastes.


    ( ways to efuse +isposal

    ousehold &ommunity

    -2urial deposited in 1m x 1m deep pits covered withsoil, located ()m away from water supply- open burning- animal feeding- composting- grinding and disposal sewer

    -anitary landfill or controlled tipping excavation of soil deposition of refuse andcompacting with a solid cover of ( feet- %ncineration

    ;. #ood anitation !rogram!olicies:

    #ood establishment are sub

    &omply with sanitary permit re4uirement

    &omply with updated health certificates for food handlers, helpers, coo's

    "ll ambulant vendors must submit a health cert to det presence of intestinal parasiteand bacterial infection.

    / points of contamination

    !lace of production processing and source of supply

    0ransportation and storage

    etail and distribution points

    ). ospital Waste 9anagementGoal:

    0o prevent the ris' of contraction contracting nosocomial infection from type disposal ofinfectious, pathological and other wastes from hospital

    ?. !rograms related to health-ris' minimi8ation secondary to environmental pollution0hese include the following:

    "nti-smo'e 2elching campaign and "ir !ollution &ampaign

  • 8/13/2019 Nle Notes Chn


    @ero olid Waste 9anagement

    0oxic, chemical and a8ardous Waste 9anagement

    ed tide &ontrol and 9onitoring

    %ntegrated !est 9anagement and ustainable "griculture

    !asig iver ehabilitation 9anagement

    A. ducation of prevailing health problems"ccepted activitiy at all levels of public health used as a means of improving the health ofthe people through techni4ues which may influence peoples thought motivation,

  • 8/13/2019 Nle Notes Chn


    3ulnerable group to the dev of 9ental %llness:


    treet children

    3ictims of torture or violence

    %nternal refugees

    3ictims of armed conflicts 3ictims of natural and man-made disasters

    &omponents of 9ental ealth !rogram". tress2. +rugs and "lcohol "buse ehabilitation&. 0reatment and ehabilitation of 9entally-ill !atients+. pecial !ro