Dec 2012 NLE TIPS CHD and CD

WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS

PART 3: COMMUNITY HEALTH NURSING

A. DOH Vision 2030 Bayabas Psidium quajava Diarrhea
Toothache
A Global Leader for attaining better health outcomes, Mouth and wound
competitive and responsive health care systems, and wash
equitable health financing. Bawang Allium sativum HPN
Toothache
B. DOH Mission Yerta Buena Mentha cordifelia Same as Lagundi
except asthma
To guarantee EQUITABLE, SUSTAINABLE and QUALITY Sambong Blumea Edema
health for all Filipinos, especially the poor and to lead the balsanifera Diuretic
quest for excellence in health. Akapulko Cassia alata All forms of skin
diseases
C. Levels of Prevention Niyog niyogan Quisqualis indica Intestinal
Parasitism
PRIMARY SECONDARY TERTIARY (Nematodes)
LEVEL LEVEL LEVEL Tsaang Gubat Carmona resuta Diarrhea
Health Prevention of Prevention of Infantile colic
Promotion and Complications Disability, etc. (Kabag)
Illness thru Early Dx Dental caries
Prevention and Tx Ampalaya Mamordica Type II Diabetes
charantia (NIDDM)

Provided at – When When highly-
hospitalization specialized F. Homemade Oresol
Health
is deemed medical care is
care/RHU A volume or one liter Smaller volume or a glass
necessary and necessary
referral is referrals are homemade oresol homemade oresol
Brgy. Health
Stations made to made to Water 1000 ml. or 1 liter 250 ml.
emergency hospitals and Sugar 8 teaspoon 2 teaspoon
Main Health (now district), medical center Salt 1 teaspoon ¼ teaspoon or a pinch of
Center provincial or such as PGH, salt=10-12 granules of rock
regional or PHC, POC, salt: iodized salt=tips of thumb
Community
private National Center & index finger are penetrated
Hospital and
hospitals for Mental with salt
Health Center
Health, and other
Private and gov’t private G. Millennium Goal Development (MDG)
Semi-private hospitals at the
agencies municipal level 1. ERADICATE EXTREME POVERTY AND HUNGER
2. ACHIEVE UNIVERSAL PRIMARY EDUCATION
3. PROMOTE GENDER EQUALITY AND EMPOWER
WOMEN
D. 8 Common Generic Drugs (Botika sa Baranggay) 4. REDUCE CHILD MORTALITY (Phil. focus)
5. IMPROVE MATERNAL HEALTH (Phil. focus)
1. Co-Trimoxazole : GUT/GIT/URT Infection 6. COMBAT HIV/AIDS, MALARIA AND OTHER
2. Amoxicillin / Ampicillin DISEASES
3. Rifampicin 7. ENSURE ENVIRONMENTAL SUSTAINABILITY
4. Isoniazid 8. DEVELOP A GLOBAL PARTNERSHIP FOR
5. Pyrazinamide DEVELOPMENT
6. Paracetamol
7. Oresol H. Field Health Service Information System ( FHSIS)
8. Nifidipine: HPN
 Individual Treatment Record (ITR)
E. Herbal Plants  Fundamental building block or foundation
FHSIS.
Plant Name Scientific Name Indications  Target Client List (TCL)
Lagundi Vitex negundo Asthma, cough,  Such lists will be of considerable value to
colds & fever midwives/nurses in monitoring service
Pain and delivery to clients in general and in
inflammation particular to groups of patients identified as
Ulasimang Bato Peperonia Gout “targets” or “eligibles” for one or another
pellucida Arthritis program of the Department
Rheumatism

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 Maternal Mortality Rate (MMR): Reported maternal deaths
 Composed of Health Program Accomplish per 1000 registered live births (RLB)
and Morbidity Diseases
 The Monthly Consolidation Table (MCT) MMR= # of maternal deaths x 1000
RLB
FHSIS Reporting
 Monthly Form Infant Mortality Rate (IMR): Reported # of infant (0 to 12
1. Program report (M1) months of age) deaths per 1000 RLB
2. Morbidity report (M2)
 Prepare by Midwife IMR=# of infant deaths x 1000
 Every 2nd week of the month is the RLB
submission
 Quarterly Form Neonatal Mortality Rate (NMR): Reported # of neonatal (0
1. Program report (Q1) to 28 days or <1 month) deaths per 1000 RLB
2. Morbidity report (Q2)
 Prepared by Nurse NMR=# of neonatal deaths x 1000
 Every 3rd week of the succeeding quarter RLB
month is the submission
 Annual Form Swaroop’s Index (SI): Reported # of deaths among
1. ABHS report individuals> 50 years old over total deaths
 Contains data on demographic,
environmental and natality. SI=# of deaths (individual >50 years old) x 100
 Prepare by Midwife Total Deaths
 Every 2nd week of January is the
submission
2. A1: Report on vital statistics: demographic, J. Nature of the Family Problem
environmental, natality and mortality.
3. A2: Lists all diseases and their occurrence in  Health Deficit (HD): if identified problem is an
the municipality/city. The report is broken abnormality, illness or disease, there’s a
down by age and sex. gap/difference between normal status (ideal,
4. A3: All deaths occurred in the desirable, expected) & actual status (the
municipality/city. The report is also broken outcome/result/problem encountered on that
down by age and sex actual day)
 Prepared by Nurse
 Every 3rd week of January is the  Health Threat (HT): any condition or situation
submission which will be conducive to health alteration, health
interference & health disturbance.
I. Health Indicators
 Foreseeable Crisis (FC): stress points, anything
Crude Birth Rate (CBR): Overall total reported births per which is anticipated/ expected to become a
1000 population problem.

CBR=overall total reported births x 1000 K. Community Organizing (COPAR)
Population
Preparatory Phase
Incidence Rate (IR): Reported new cases of disease per 1. Area of Selection
percent (100/population) population  It should be DOPE Community: Depressed,
Oppressed, Poor & Exploited, a new criteria for
IR=new cases of disease x 100 community organization
Population 2. Entry Phase
 The 1st thing to do upon entering the community is
Prevalence rate (PR): Reported new cases of disease + old to have a courtesy call with the Barangay Captain,
cases of disease per percent of population introduce self & group, purpose, present the project,
activities, etc.
PR=new cases + old cases x 100 3. Integration/Immersion (CIP)
Population  Immersion is imbibing the life situation/condition
of the community .
Crude Death Rate (CDR): Overall total reported deaths per 4. Community Study: Diagnosis of Community-COPAR
1000 population  Makes use of the Nursing Process/Problem Solving
Approach
CDR=overall total deaths x 1000  Prioritized which among the problems identified is
Population to be attended 1st like in nature, magnitude,
modifiability, preventive potential, salience



O. Excreta Disposal
L. Epidemiology
Household Community
 Epidemic: a situation when there is a high ○ Burial ○ Sanitary landfill or
incidence of new cases of a specific disease in excess ► Deposited in 1m x controlled tipping
of the expected. 1m deep pits covered ► Excavation of soil
with soil, located 25 deposition of refuse and
 Endemic : habitual presence of a disease in a given m. away from water compacting with a solid
geographic location accounting for the low number supply cover of 2 feet
of both immunes and susceptibles
○ Incineration
 Sporadic : disease occurs every now and then
affecting only a small number of people relative to ○ Open burning
the total population Animal feeding
Composting
 Pandemic: global occurrence of a disease Grinding and
disposal sewer

M . Approve Water Facilities
Level I Level II Level III
Point Communal faucet Waterworks DOH PROGRAMS
Source system or stand system or
posts individual house EXPANDED PROGRAM ON IMMUNIZATION
connections  Law: PD 996
A protected A system composed A system with a
well or a of a source, a source, a reservoir, Vaccine Dosage # of Doses to
developed reservoir, a piped a piped distributor complete
spring with distribution network network and immunization
an outlet but and communal household taps BCG
without a faucets, located at that is suited for 1. I .05 ml 1 dose
distribution not more than 25 densely populated 2. SE .1 ml 1 dose
system for meters from the urban areas. DPT .5 ml 3 doses
rural areas farthest house in OPV 2-3 gtts 3 doses
where rural areas where HBV <10 y/o: .5 3 doses
houses are houses are clustered >10 y/o: 1
thinly densely. MV .5 ml 1 dose
scattered.
 It is safe and immunologically effective to administer all
EPI vaccines on the same day at different sites of the
N. Approved Toilet Facilities body.
Level 1 Level 2 Level 3  The vaccination schedule should not be restarted from
Non-water On site toilet Water carriage the beginning even if the interval between doses
carriage toilet facilities of the types of toilet exceeded the recommended interval by months or year.
facility: water carriage facilities  DPT2 or DPT3 is not given to a child who has
- Pit latrines type with water connected to convulsions or shock within 3 days after DPT1. V
- Reed Odorless sealed and septic tanks  Do not give live vaccines like BCG to a individuals who
Earth Closet flushed type with an/or to are immunosuppressed due to malignant disease (child
- Bored-hole septic vault/tank sewerage with AIDS) , going therapy with immunosuppressive
- Compost disposal system to agents or radiation.
- Ventilated facilities. treatment  Repeat BCG vaccination if the child does not develop a
improved pit plant. scar after first injection

Toilets requiring
small amount of Type of Vaccine Storage Temp. Hours of Life after
water to wash opening
waste into OPV -15 to -25 C
receiving space Measles At the freezer
- Pour flush Hepa B 8 hours
- Aqua privies DPT 2 to 8 C
Tetox Body of
BCG refrigerator 4 hours




NATIONAL TB PROGRAM

Disease Causative Agent Mode of Clinical Reservoir Diagnostic Treatment Nursing
Transmission Manifestation Exam Implication

Tuberculosis Mycobacterium Droplet Infection General Man Sputum DOTS Pointers for
“Primary Tuberculosis ( inhalation of weakness And Exam - patient is teaching on
Complex” is bacilli from patient Loss of Diseased 3 sample required to take Anti-TB drugs:
less than 3 who coughs and weight, Cattle are taken the Ant-Tb drugs
years old sneeze) cough and (Bovine with 24 hrs: in the presence of Rifampicin:
wheeze TB) - spot a health care taken befor
- any child which does sample (1st provider to meals, causes
who does not not respond visit) ensure red urine urine
return to to antibiotic - early compliance to Isoniazide:
normal health therapy. morning treatment causes
after measles Fever and specimen regimen peripheral
or whooping night sweat - spot neuritis, given
cough. Abdominal sample Anti-TB drugs: with Vit.B6
swelling (2nd visit) (RIPES) Pyrazinamide:
Most with a hard Note: at Rifampicin cause
hazardous painless least 2 Isoniazid hyperurucemia
period: mass and sample are Pyrazinamide Ethambutol:
first 6-12 free fluid positive Ethambutol causes optic
months Hemoptysis Streptomycin neuritis/
after and chest Chest blurring of
infection pain Xray vision
Highest in Painful firm Mantoux Streptomycin:
risk of or soft Test cause tinnitus,
developin swelling in a - .1 cc loss of hearing
g: under 3 group of injection of balance, damage
years old superficial PDD and to 8th cranial
lymph 48-72 hours nerve
nodes. reading
* 10 mm + Note: After 2-4
5 mm + weeks of
(HIV pt.) treatment,
patient is no
longer
contagious

RECOMMENDED CATEGORY OF TREATMENT REGIMEN

Category Type of TB Patient Treatment Regimen
Intensive Phase Continuation Total Period
Phase
New smear positive PTB
New smear positive PTB
I with extensive 2 RIPE 4 RI 6 mos.
parenchymal lesion
EPTB and Severe
concomitant HIV disease
Treatment Failure
II Relapse 2 RIPES /1 RIPE 5 RIE 8 mos.
Return after default

New smear-negative PTB
III With minimal parenchymal 2 RIP 4 RI 6
lession mos.
Chronic ( still smear- Refer to Specialized facility
IV positive after supervised or DOTS Plus Center refer
re-treatment ) to City Provincial NTP
Coordinator




INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS
(IMCI) MAIN SYMPTOM: Diarrhea

Danger Sign

MAIN SYMPTOM: Cough and Difficulty Breathing

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
Pneumonia Classification

Classify a child with diarrhea and blood in the stool as
having DYSENTERY. A child with dysentery should be
treated for dehydration




MAIN SYMPTOM: Fever
No Malaria Risk Classification

MAIN SYMPTOM: Ear Problem

High Malaria Risk Classification

Ear Problem Classifications
Low Malaria Risk Classification




Enlargement of abdomen Splenomegaly
MAIN SYMPTOM: Malnutrition and Anemia 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
Malnutrition and Anemia Classification
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)
COMMUNICABLE DISEASES *On Stream Clearing – cutting of vegetation
overhanging along stream banks
*Avoid outdoor night activities (9pm – 3am)
 Cholera
*Wearing of clothing that covers arms and legs in the
 Other names:El tor
evening*Use mosquito repellents
 Fecal-oral route 5 Fs
*Zooprophylaxis – typing of domestic animals like the
 Incubation Period: Few hours to 5 days; Usually 3
carabao, cow, etc near human dwellings to deviate
days
mosquito bites from man to these animals Intensive
 Pathognomonic Sign: Rice watery stool
IEC campaign
 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)

Dec 2012 NLE TIPS CHD and CD

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Dec 2012 NLE TIPS CHD and CD