 Vitamin A treatment of Xeropthalmia and

NP1 BULLETS Measles

 Primary Health Care and CHN  BP cuff , Paper lining must be OUT of
 MDG target- reduction of maternal the PHN bag
mortality by 80/100,000 live births (mdg5)
 Tuberculosis / PTB- a highly infectious
 2/3- reduction of child mortality rate
chronic disease that usually affects the
(mdg4)
lungs.
 Mdg 5- TARGET 2015
Causative Agent: Mycobacterium
 SDG 3– HEALTH and WELL being Centered
Tuberculosis (acid fast bacteria)
( disease focus : HIV/AIDS , Malaria)
 SDG 6 – SANITATION centered
 Robert Koch- German physician and
2030 Agenda for Sustainable Development. scientist, presented his discovery of
“Transforming our world” Mycobacterium tuberculosis
 Sign/Symptoms:
17 goals target year is 2030  cough for more than 2 weeks
 afternoon fever
 Goal 3: Good Health and Well-
o Swelling lyphnodes
being (health centered)  weight loss
 Goal 6: Clean Water and  night sweat
Sanitation(sanitation centered)  blood stain sputum - hemoptysis -
***late sign
 Goal 11: Sustainable Cities and Preventing Tuberculosis  BCG
Communities vaccination
 Case finding – Direct Sputum Smear
 Spacing of pregnancy - 3-5 years Microscopy and X-ray examination of TB
 iron- prevent anemia of pregnancy- liver symptomatics who are negative after 2 or
products, red meat and internal organs, more sputum exams
munggo, green leafy vegetables  Sputum smear and culture or DSSM -
 Vit.D for calcium absorption prevents confirms the diagnosis
RICKETS in children and osteomalasia in  Tuberculin test (Mantoux test- detects the
adult- sources dairy products ,cod liver oil, presence of antibodies
fish, milk, cheese , anchovies, salmon, (Results read within 48-72 hours from skin
sardines testing, posistive if within duration of
 VIT C prevents SCURVY(increase intake of 10mm or more.
fruits) Below 5 y/o - > or = 10 mm is positive,
 Solutions like alcohol must be must be Older than 5 y/o > or = to 5 mm is positive)
placed in the BACK of the Public health Bag  Mantoux test- A positive reaction means
 IRON- 60 mg per tablet once a day and 400 that the client has been
mcg of folic acid for 6 months exposed to TB
 Vitamin A for postpartum – 200,00 IU one  DOTS- declared in 1996
dose  Inhale or deep breath then cough up 3-5ml
 Vitamin A for pregnant– 10,00 IU 2x a week sputum proper way to collect
starts at 4 months  Hemoptysis is contraindication of sputum
 Vitamin A for Children 12 months and collection
above – 200,00 IU dose every 6 months  3x in a month – collection of sputum for
case finding
 Bcg – do not give to immunosuppressed younger because they cannot reliably
baby- with leukemia and hiv monitor vision –
 A positive reaction consists of palpable
swelling and induration of  Streptomycin causes- tinnitus and auditory
- 10mm and above for normal impairment/ OTOTOXICITY.
- 5mm and above for
immunocompromised.  FDC – Fixed Dose Combination
 Chest x-ray - determines the presence and  4 FDC or 4 drugs combined in a blister pack
extent of disease – R.I.P.E
 the primary diagnostic tool in TB case  3 FDC or 3 drugs combined i a blister packs
finding is DSSM – R.I.P or the new drug R.I.E.
 The only contraindication for sputum  2 FDC or 2 drugs combined i a blister packs
collection is hemoptysis – I.E or the new drug R.I.
 Direct Observed Treatment Short Course –  Streptomycin – only TB drug in Vial
comprehensive strategy to detect and cure
TB patients.  Leprosy
 DOTS (Direct Observed Treatment Short  RA 4073- Liberization and Treatment of
Course) Leprosy (February as Leprosy Month)
 Category I - 6 months treatment  Hansen's disease - BACTERIA
o -new smear (+) PTB  SSS – slit skin smear is the diagnostic test
-new smear (-) PTB with extensive • Multi-Drug-Therapy (MDT)
lesions on CXR • LEPROMATOUS TYPE is the most
-EPTB disfiguring type of LEPROSY
-Severe concominant HIV disease 2
o -DOTS: 2months RIPE
maintenance: 4months RI
CHOLERA
 In August of 1854 Soho, a suburb of
 II -treatment failure
London, was hit hard by a terrible outbreak
-relapse
of cholera.
-return after default
-intensive: 2 months RIPES/1 month RIPE  John Snow to be the pioneer of
Maintenance: 5 months RIE public health research in a field known as
father of MODERN EPIDEMIOLOGY in part
 III -new smear (-) PTB with minimal lesion because of his work in tracing the source
on CXR of a cholera outbreak in Soho, London, in
o -DOTS: 2months RIPE 1854
maintenance: 4months RI
 Cholera is an acute diarrhoeal infection
caused by the bacterium Vibrio cholera
 IV -chronic Refer to specialized facility or
DOTS Plus Center  Humans are the only relevant reservoir,
Refer to Provincial/City NTP Coordinator
 VERY common in RAINY SEASON
 Rifampicin causes urine discoloration.  Rice watery stool – sign of cholera
Isoniazid give Vit. B6 or pyridoxine to
prevent peripheral neuropathy
Pyrazinamide - causes G.I upset. BUBONIC PLAQUE – BLACK DEATH
Ethambutol causes-  Describe the definition of the Black Death- A
-not given to children under 6 years or
widespread epidemic of the Bubonic Plague
 the occurred in the 14th century, killing millions  Give active vaccine
- Observe dog for 14 days
of people “DARK AGE of EUROPE”.
 CATEGORY III
 What type of flea carried the Disease?- The
 Abrasion, laceration on upper
oriental rat flea extremities, head and neck.
 What was the most common strain of the Black  Dog is killed, lost died, stray
Death?- The Bubonic Plague  Give active vaccine plus Passive vaccine
ACTIVE IMMUNIZATION –
 In what season were the fleas most active?-
PCEC (Purified Chick Embryo Vaccine),
Summer RABIPUR and the new cheap drug
VEROWELL
 Helminths - most common is ascariasis ,  Viral Infection
hookworm ,trichuris (whipworm) **** Varicella (Chicken Pox)
EXCEPT = Taeniasis - Varicella Virus
 Beef tapeworm - Taenia saginata- ingestion Communicable 1 day before eruption of
of undercooked beef vesicles to 6 days after first crop of vesicles
 Ancylostomiasis/Hookworm – causes have formed
anemia - penetration of skin - walking • Antiviral agents – acyclovir
barefooted  Fifth’s Disease
 Pinworms/ enterobiasis .- best way to  Symptoms
diagnose this infection is through a tape  Classic rash of erythema on face (cheeks),
test “slapped face appearance”
 PARAGONIMUS WESTERMANI  Rubeola (measles)
(Paragonimiasis) is a lung fluke which is • Viral infection
sometimes mistakenly diagnosed as PTB • RNA virus of the genus Morbillivirus
 Hepatitis A , E or Infectious Hepatitis: oral- within the family Paramyxoviridae
fecal route • Communicable just before the rash
 Hepatitis B or Serum Hepatitis: blood- appears
borne, oral-oral, sex  Pre-Eruptive Stage:
 Hepatitis C: blood-borne, • fever, coughing, sneezing, and running of
 Red tide poisoning/Paralytic shellfish nose and redness of eyes.
poisoning- first aid Drinking pure coconut • Koplik spots—bluish-gray specks or
milk “grains of sand” on a red base—develop on
 Rabies/ Lysa Mgt. the buccal mucosa
 observe the dog for 14 days. If it dies or  Mumps - PAROTITIS
shows signs suggestive of rabies, consult a • Viral infection
physician. • Transmitted by direct contact of saliva
and respiratory droplet
 Rabies - hydrophobia, a morbid fear of
• Communicable immediately before
water
swelling begins
 Category I
 Rubella(German measles)
 Licking of intact skin (wash skin
• Viral Infection
immediately)
• Communicable 7 days before to 5 days
 Observe the dog for 14 days
after rash
 CATEGORY II
**Pregnant people must avoid infected
 Abrasion, laceration, punctured wound child=fetal death
on the lower extremities(wash the wound
 Pertussis (whooping cough)
immediately)
• Bacterial infection
 Diptheria- bacterial cause-  NIYOG NIYOGAN – traditional medicine act
corynebacterium diphtheria- as ANTIHELMINTHIC, to expel worms and
pseudomembrane parasites
 Zika virus  LEVEL 2 WATER FACILITY – STAND POST and
• a virus transmitted by Aedes mosquitoes. communal faucet
 Causes microcephaly baby in pregancy  HBMR – home based mothers record
 Census- mass population collection of data  HBMR – is a tool used to render prenatal
 9 cotton balls – thermometer technique care consisting the risk factors and danger
 IPV – IM signs of pregnancy
 IPV- killed bacteria  PANEL 2 of HBMR – contains the risk factor
 Measles route – SQ and danger signs of pregnancy
 Measles insertion 40-50 degree  OPV-- SABIN VACCINE
 Give every child a dose of Vitamin A every  ORESOL is administered EVERY 4 HOURS
six months from the age of 6 months. PLAN C in dehydration treatment --
 Give every child mebendazole every 6 insertion of IVF
months from the age of one year.  IVF – for severe dehydration
 COURTESY CALL is done in -- PRE ENTRY
 6 weeks DPT+HIB-1** Hep B1 OPV1 PHASE of COPAR
RTV1**** PCV1*****  HYDROCEPHALUS and mental retardation is
 10 weeks DPT+HIB-2 Hep B2 OPV2 RTV2 a form of HEALTH DEFICIT –
PCV2  POSTPARTUM BLUES- common normal 2-3
 14 weeks DPT+HIB-3 Hep B3 OPV3 RTV3 days postpartum,
PCV3  Oxytocin- uterine contraction, given after
 Pneumococcal conjugate vaccine (PCV) – 3rd stage of labor
start to be given at 6 weeks  CATEGORY1 - NO RESTRICTION....NO
 9 months Measles *** CONDITION WHICH CONTRADICTS THE USE
 12 months MMR OF THE METHOD...
 ****Rotavirus Vaccine – 2-3 doses  CATEGORY 4--- Method not to be used- A
antidiarrheal condition which represents an unacceptable
 Cholera- tetracycline- Cotrimoxazole health risk if the contraceptive method is
 Tetracycline: permanent green teeth used ( may sakit)
staining of baby if used by pregnancy  DEPO PROVERA – 3 months injectables,
 Pneumonia, Acute ear infection, assess weight gain
Mastoiditis (Drug: Amoxicillin – 1st line,  feso4- 1 gram per singleton pregnancy-
Cotrimoxazole – 2nd line) start at 5 months to 2 months postpartum
 in IMCI standard for fever is > 38.5oC or  site of bbt – AXILLARY
hot to touch - give Paracetamol evry 4-5  Hand washing/ hand hygiene – 40-60
hours- analgesic and antipyretic seconds
 Census is for gathering data in mass  Scurvy – Vit C
population or groups  Dpt interval. – 4 weeks
 COPAR - Community Organizing  Post Partum homevisit – home delivery is
Participatory Action Research within 24 hours….. hospital delivery- within
 BAWANG – Cholesterol and hypertension 1st week or between 3-5 days after delivery
 LAGUNDI – cough , colds fever, and  vitamin A,deficiency –Xeropthalmia and
dysentery bitots spot
 BP cuff not included inside PHN/ OB bag
 7160 LGU – DEVOLUTION CODE
 Vibrio cholera or El tor – common in rainy  PTB – Koch disease
season  BREASTFEEDING – the 3 E (Early, Exclusive,
 vit. A IU postpartum mother – 200,000 IU.. Extended)
 Sabin – OPV – live attenuated virus  Aqua privies is level 1
 Defrost freezer if ice build up of refrigerator Breast self exam is a secondary level of
is 2-3 cm or 1inch or more prevention
 Bcg – 0.05 (.05ml) – ID  Cretinism is iodine deficiency
 TB - SCC means short course  Iron must be with vit. C
chemotherapy  Calcium is with vit D
 Einc protocol 3x- Drying thoroughly  IRON is in chicken liver and MONGO
 Cretinism – iodine deficiency  brown vials of vaccines protects against
 Measles – infectious before rashes appear – sunlight to maintain potency
4th day  Thick creamy cheese substance –
 TT1 protection - no protection candidiasis
 6000 TOTAL POPULATION TARGET FOR EPI  *Breastmilk stool-mashy,golden yellow –
– 180 sweet sour smell
 Sabin - opv  *lactalbumin- breastmilk easily digestible
 Blindness – Vit. A protein
 Ampalaya – DM type 2  *Content of colostrum - antibody IgA
 Endometrial cancer s/s – unusual discharges (immunoglubolin antibody A)
or vaginal bleeding  *Tetanus neonaturum- cord care
 CBR Crude birth rate mangement - alcohol and hand hygiene or
 koplik spots – measles handwashin
 Unang yakap- dry the baby  -hand hygiene - to break chain of infection
 BMI- Obese- ≥30.00--------Normal range -  *Dosages of immunization- Dpt Opv ,Hep.b-
18.50 - 24.99--------Overweight - ≥25.00 3 doses
 Vaccines must be exposed only in room
 Cheesy discharges and pruritus vulva –
temperature up to 3 x
candidiasis, moniliasis
 3rd exposure – discard vaccine
 Cauliflower cells – condylomata – HPV
 FEFO- First expiry first out
 Clue cells – bacterial vaginosis
 Cold chain by dictrict level – 3 months
 Strawberry cervix – trichominasis
 Half life packs shelve of measles- 6 hours
 Foul fishy discharges – bacterial vaginosis
 Half life packs shelve of Dpt, opv, bcg- 4
 FROTHY DISCHARGES – TRICHOMONIASIS
hours
 PID – CAUSED BY GONORRHEA AND
 Half life packs shelve of Tt, heap b- 8 hours
CHLAMYDIA
– discard if not used up within the end of
 Hiv – attacks CD4 cells
your shift
 And HIV/AIDS .– attacks immune sytem
 Dosages- 0.5 ml IM( DPT,HEP. Penta, PCV)
 Family Planning
 0.5 ml SQ(Measles)
 VIT.D- RICKETS
 0.05 ml ID(BCG)
 Family Planning – PD 965 – july 20 1976
 2 DROPS ORAL ( ROTA & OPV)
 RH bill – 10354
 4 months or a 16 months baby completed
 IUD – REVERSESSIBLE LONG TERM
the doses of 1 bcg dpt1-3 opv1-3 hepb1-3
 T cu 380 – 10 YEARS PROTECTION
 *Crude birthrate- TOTAL LIVEBIRTHS
 COLD CHAIN – a system that maintains ÷TOTAL POPULATION x 1000
potency of vaccine
 *Crude death rate - Total deaths ÷total
 RABIES – saliva of rabid animal population x1000
 Rabies – is known as lysa
 *Chain of infection- handwashing  *Prenatal visit- at least 4 visits
 Weakest link- mode of transmission  36 weeks to term is everyweek
 Benedict's and acid test – performed in  Home based mothers record - panel 1-
community to pregnant mothers in home maternal obstetrical history and info
visit to test glycosuria and proteinuria Panel 2- present pregnancy, danger signs,
 Roll over test- Sims or sidelying TT, FESO4, LAB RESULTS
 Severe abdominal pain - 90 degree angle or  *BSE- 7 DAYS AFTER MENSTRUATION
Fowler's also  (COPAR) - Community Organizing
 Feeding in bed - 90 degree or fowlers Participatory Action Research
 2nd degree burn - painful and blister Pre-entry /Preparatory Phase
 Syphilis bacteria is in the painless ulcers or  Profiling of community
sores  Ocular survey/ Site selection
 *Iron- chicken liver, monggo  PAy courtesy call to community leaders.
 *Vit A- squash, papaya, yellow camote,
yellow corn, banana  Entry Phase
 *Cretinism or mental retardation / Iodine Integration with the community
 *TB - intensive phase category 1&2  Self Awareness Leadership T raining
 *COPAR - courtesy call at pre entry,  Organization phase
(immersion or integration at ENTRY,)  core group formation
 IFR* individual funding request. social preparation
 *IMCI/ danger signs – Convusion, Unable to spotting & developing potential leaders
drink or breastfed, Vomits everything,  A-R-A-S (Action- Reflection- Action-
Abnormally sleepy or difficult to awaken) Session)
 Stridor/chest indrawing - severe pneumonia  community diagnosis
 Fast breathing (0-2 mos= 60cpm ,, 2-12 mos
= 50 ,, 12-5 years old = 40 ** pneumonia  Action Phase
 Pneumonia first line antibiotics - amoxicillin  Organization and training of (BHWs):
 Cholera- vibrio eltor and cholerae in rainy  PIME of health services (Project
season- Dirty water Implementation Monitoring and
 Salmonellosis – caused by food poisoning in Evaluation)
canned goods Or spoiled proteins  Setting up of linkages/ network/ referral
 HIV attacks CD4 T helper cells in immune systems
system
 Measles* cough, runny nose, conjunctivitis
and maculopapular rashes  Sustenance and Strengthening Phase
 Koplik spots also in buccal mucusa  Formulation of by-laws
 Airborne transmission - measles  Identification and development of “
 *Post partum management/ *foul lochial secondary” leaders
discharge- puerperal sepsis or endometritis  Setting up of a financing scheme
 *Cold chain- system to maintain potency of
vaccine
 *Colustrum – rich in maternal antibodies –  Rates- relationship between a vital event
thick yellow or dirty white and those persons exposed to event
 *Storage of breastmilk-4-6hours if room  Ratio- relationship between two (2)
temperature numerical quantities
 *Prolactin - hormone that influences  Infant Mortality Rate- good index of the
milk production general health condition of a community
 Swaroops index- is the proportion of  Chronic pelvic pain, fever, flu-like
deaths of people aged 50 years and up. symptoms, pain during or after
 3 CRITERIA FOR LAM use: intercourse(CBQ), vaginal bleeding, foul
 Amenorrhea smelling discharge, tenderness in lower
 Fully or nearly fully breast feeding her abdomen, and chills
infant  Can cause ectopic pregnancies, infertility
 BF on demand basis (evey 2-4 hrs during and abscesses in the pelvis. Can be life
the day, 4-6 hrs at night threatening - very serious.
 Infant is less than 6 mos  8. Candidacies
 Gonorrhea  Yeast infection
Male:  With white cheesy patches
purulent yellow penile discharge (moniliasis)(CBQ)
 Females: - Greenish vaginal discharge  Oral trush in the newborn (CBQ)
 Genital Human Papillomavirus Medications:
HPV  Nystatin
 condylomata, cauliflower-like warts  Trichomoniasis
 Acetic acid swabbing (will whiten lesion) strawberry cervix
 Condylomata acuminata frothy, foul-smelling ("fishy" smell
 Hepatitis B ) vaginal discharge
 Spread through infected blood and bodily  Trichomona vaginalis, single cell
fluids such as semen protozoan
 HIV – AIDS S/sx: Females: Yellow gray frothy
 Retrovirus (HIV1 & HIV2) discharge
 Attacks and kills CD4+ lymphocytes (T- Dx:
helper) - elevated vaginal pH 5.5+ ( alkaline
 Sexual intercourse (anal and vaginal) Mgmt: Metronidazole (Flagyl);
 Exposure to contaminated blood, semen,  Bacterial vaginosis
breast milk foul, fishy smelling, thin gray vaginal
discharge
 Needlestick injuries
 presence of CLUE CELLS (CBQ)
 HIGH RISK GROUP – BLACK and HISPANIC
LOI 949 - legal basis of PHC
(MEN)
 Goal of PHC:
 Homosexual or bisexual
 Health for ALL Filipinos and Health in the
 Sexual contact with HIV+
Hands of the People by the Year 2020
 Intravenous drug users
Mission of PHC: SELF RELIANCE
 HIV TEST
 PHC- is universal and it extends even to
 Elisa – Enzyme Link Immunosorbent Assay
people in the hospital, both sick and well.
( first test conducted)
-Accessible
 Western Blot - confirmatory test
-Available
  HIV+ -Affordable
2 consecutive positive ELISA and -Acceptable
1 positive Western Blot Test -Appropriatene
  Full blown AIDS- CD4 is less than 200/ml  Four Cornerstones/Pillars in Primary Health
 Pelvic Inflammatory Disease Care
 Cause by CHLAMYDIA – primary agent  Intra and Inter-sectoral Linkages
 Gonorrhea is also secondary agent  Use of Appropriate Technology
 Most common affected – OVIDUCTS or  Support mechanism made available
Fallopian tube
 Department of Health (DOH)  Expanded Program for Immunization (EPI)
 Active Community Participation Wednesday - immunization day
 FULLY IMMUNIZED CHILD
 Primary level- Villagers/Grassroots workers  before the child's first birthday.
- BHW - frontline worker in community  fully immunized child must have
- Traditional birth attendants – traditional completed
Hilots- traditionally acceptable to deliver  BCG 1
pregnancy in community  DPT 3
- Arbularyo or healers – uses herbs for  OPV 3
treatment of illnesses  HB 3
 measles vaccines to complete FIC
 Secondary- Intermediate workers
Public Health Nurse – supervisor of the  Bacillus Calmette-Guérin - Birth or anytime
midwife in RHU after birth
Midwives – frontline worker in RHU level  Diphtheria-Pertussis-Tetanus Vaccine
6 weeks(DPT 1)
 Health deficits- TB, DM, hydrocephalus, 10 weeks (DPT 2)
polio,leprosy 14 weeks (DPT 3)
 Health Threats – lack of immunization, no
or lack prenatals   Oral Polio Vaccine – SABIN -
 Foreseeable crisis – Abortion - Divorce or  6 weeks(OPV 1)
separation Marriage -Entrance at school –  10 weeks (OPV2)
newborn - Death of a family member  14 weeks (OPV3)

 Malaria
Causative Agent: - PLASMODIUM (protozoa)  OPV- Number of doses per vial/amp: 20
P. Falciparum (most fatal)
 HEPA B , Measles & BCG
Vector
Number of doses per vial/amp: 10
 Anopheles female mosquito
 Hepatitis B Vaccine - At birth – RNA
 Signs & Symptoms: RECUMBINANT, PLASMA
 Chills to convulsion,  Upper outer portion of the thigh, Vastus
 Elevated temperature Lateralis (R-L-R)
Treatment: chloroquine   Measles Vaccine - 9 months old – SQ -
 Schistosomiasis Upper outer portion of the arms, Right
Causative Agent: Schistosoma japonicum deltoid
Snail : oncomelania quadrasi  85% of measles can be prevented by
Signs & Symptoms: Bulging abdomen, immunization at 9 MOS.
Abdominal pain, Loose bowel
  VVM or Vaccine vial monitor - a
movement(black tarry), Low grade fever,
thermochromic label put on vials which
Seizure
gives a visual indication of vaccine potency
 Preventive measures
 Cold Chain  is a system used to maintain
Proper excreta disposal
potency of a vaccine from that of
Agricultural & vegetation improvement
manufacture to the time it is given to child
Let water stand 2-3 days before usage
or pregnant woman.
Mollucides use
  Timeframes for the storage of vaccines
Educate in Hand hygiene
◦ 6months- Regional Level
Rubber boots use
 Treatment: Praziquantel (drug of choice)
 ◦ Not more than 5days - Health centers  Level I - pit latrines , pour flush toilet &
using transport boxes. . aqua privies
  “Eligible population”  Level II - with septic vault/tank disposal -
- group of people targeted for specific water-sealed and flush type
immunizations susceptible to EPI diseases.”  Level III - connected to septic tanks and/or
 Rotavirus vaccine- 6 WEEKS – ORAL to sewerage system to treatment plant.
 -GIVEN BEFORE 8 MOS 2 DOSES  Bag technique-a tool making use of public
 PENTA – 6 WEEKS – IM health bag (open bag 3x only)
 MMR- 12 MOS-SQ  Public health bag - is an essential and
 Maternal and child health indispensable equipment of the public
 Home Based Mother’s Record (HBMR) health nurse
Tool used when rendering prenatal care Removed BP Cuff inside bag
containing risk factors and danger signs  Home visit - is a family-midwife contact
- guide in the identification of risk factors which allows the health worker to assess
 Fe supplementation: 60 mg with 400 mcg the home and family situations in order to
of Folic Acid once a day provide the necessary nursing care and
 Postpartum visit- Home deliveries health related activities
- 1st visit - 24 hours after delivery *****cleanest to dirtiest dapat
 Health care facility ****priority sunod sunod na to – pregnant
1st- within 1 week – newborn – postpartum – last ang may
  3 C of Home delivery mga sakit
CLEAN Hands  Epidemiology - the study of disease
CLEAN Surface occurrence and distribution
CLEAN Cord  Infection- entry and development or
  Vitamin A Supplement to Infants, multiplication of an infectious agent in the
Preschoolers (6mos – 7 yeas and Mothers body of man or animals.
 Pregnant women - 10, 000 IU 2x a week  Contamination- presence of an infectious
starting on the 4th month of pregnancy agent on a body surface, on or in clothes,
 Do not give vit. A supplementation before beddings, toys, surgical instruments or
the 4th month of pregnancy. It might dressings, or other articles or substances
congenital problems in the baby. including water and food
 Postpartum women - 200, 000 IU - 1 cap; 1  4 types of disease distribution
dose only within 4 weeks after delivery  1. Epidemic- “The unusual occurrence in a
 Viamin A Deficiency (CBQ) - XEropthalmia – community of disease- sudden outbreak of
night blindness a disease in a short period of time
 Water Supply 2. Endemic- constant presence of a disease
 Level 1 (Point Source) - protected well or or infectious agent within a given
developed spring geographic area or population group.
 Level II - With a source, reservoir, piped 3. Pandemic- worlwide
distribution network and communal distribution….geographic area such as a
faucets section of a nation, the entire nation, a
 Level III - Individual House Connections or continent or the world
Waterworks System - With a source, 4. Sporadic- “scattered about”. The cases
reservoir, piped distributor network and occur irregularly, The cases are few and
household taps separated widely in time and place
- On and off scattered cases –habitual
occurence
 Toilet or sewerage
 Nosocomial (hospital acquired) - urinary 
tract infections.  Hepatitis viruses are the most common
 Carriers- “an infected person or animal that cause of hepatitis in the world but other
harbors a specific infectious agent in the infections, toxic substances (e.g. alcohol,
absence of discernible (visible) clinical certain drugs), and autoimmune diseases
disease and serves as a potential source of can also cause hepatitis.
infection to others.
 Leptospirosis – Vector is Rat  There are 5 main hepatitis viruses,
Causative Agent: - bacteria--- Leptospira referred to as types A, B, C, D and E.
interrogans
 Sign/Symptoms: High fever, Chills,  B and C - most common cause of liver
Vomiting, Red/ orange eyes, Diarrhea, cirrhosis and cancer.
Severe headache, muscle aches, may  Hepatitis A and E are typically caused by
include jaundice (yellow skin and eyes), ingestion of contaminated food or
abdominal pain water.
Treatment: PET - Penicillins G,  Hepatitis B, C and D usually occur as a
Erythromycin, Tetracycline, Doxycycline as result of parenteral contact with
prophylactic drug infected body fluids.
 Dengue - mosquito-borne infection  Common modes of transmission for
 Vector is female aedes aegypti mosquito, these viruses include receipt of
day biting, low flying, satagnant clear contaminated blood or blood products,
water,stripes black white body. invasive medical procedures using
 Agent is a Virus.. dengue virus 1,2,3,4 contaminated equipment and for
- female aedes aegypti in stagnant water hepatitis B transmission from mother to
treatment is supportive therapy. baby at birth, from family member to
 Intravenous fluids child, and also by sexual contact.
 A platelet transfusion
 DENGUE DIAGNOSIS:
- Tourniquet test (capillary fragility test or  FHSIS/Record & Report:
Rumpel Leads Test), a presumptive test Objective:
which is positive in the presence of more 1.Provide summary of data on health
than 20 petechiae within an inch square, service delivery & selective program.
after 5 minutes of test 2. Provides data w/c combined w/data from
 TOURNIQUET TEST - (BP Cuff): other sources.
o fluids (most important treatment) like 3. to provide standardized facility level data
oresol and IV base
o paracetamol ( do not give aspirin) 4. to ensure data reported is useful &
o for nose bleeding, flex the neck lean accurate;timely & easy to use fashion.
forward to prevent aspiration 5. minimize recording & reporting
o avoid unnecessary movement burdens;to
o assist in the management of shock. allow more time for patient care and
Dorsal recumbent to trendelenburg promotive activities.
position  Components:
1. Family tx record = Daily
 What is hepatitis?
2. Target Client list = weekly
 Hepatitis is an inflammation of the liver.
3. Reporting forms = monthly
The condition can be self-limiting or can
4. Output reports = quarterly;annually
progress to fibrosis (scarring), cirrhosis or
liver cancer.
 *Family tx record - fundamental building  Method of Survey: tool is Questionnaire
block; foundation of FHSIS • Census (100%) : Most ideal,
*Target client list - 2nd building block enumeratx of data
 The Primary focus of CHN is Health conducted 6 mos.
Promotion & Disease Prevention • Sample Survey : Most
 Primary goal - self reliance in health or practical study
enhanced capabilities representative of a comm.
 Ultimate goal - raise level of # of citizenry Size matters in terms of
 Philosophy of CHN- Worth and dignity of validity
man • Interview method
 CHN practices -to benefit the individual, • Instrument- interview guide/
family, special groups & community schedule
 The comm. is the patient in CHN,  Records review •
 the family is the unit of care and the Instrument: checklist
 ROLES OF THE PHN  Ocular inspection/
 ❖ Clinician who is a health care provider, observation •
taking care of the sick people at home or in Instrument: checklist
the RHU.  Participant
 ❖ Health educator, who aims towards observation
health promo & illness prevention thru • Finalize sampling design &
dissemination of correct info; educating methods
people  Probability: Equal
 ❖ Facilitator, who establishes multi- chances- random- (
sectoral linkages by referral system simple, stratified,
 ❖ Supervisor, who monitors & supervises cluster)
the performance of midwives  Non- probability:
Everyone will not
have equal chances
 Community Diagnosis:
o Descriptive research  STATISTICS - A science- collection,
o Profile general picture of comm., a organization, analysis, interpretation of
direct health indicator numerical data. Biostatistics: refers to the
o Process by which the people in the application of statistical method to the life
conn & H team assess the comm. H science like biology, medicine.
problems & needs as bases for H  Demography: Study of pop size,
programs devt. composition & spatial distribution as
o A learning process for the comm. to affected by births, deaths & migration.
identify their own H problems &  Phenomenon of Variation - Tendency of a
needs measurable character to change from 1
o A profile that deposits the H individual or 1 setting to another or from 1
problems & potentials of the comm. instant of time to another within the same
 2 Types of Community Dx individual or setting
• Comprehensive- provides the  Types of Data:
general health profile of the • Constant- value remains the
comm. same from person to person,
• Specific or problem oriented- time to time, place to place
yields a comprehensive Ex. Minutes/ hour, speed
profile of a particular H • Variable- Ex. Temperature
problem. Qualitative- categories are
 simply used to label to Severe headache, muscle aches, may
distinguish & group to include jaundice (yellow skin and eyes),
another, rather than a basis abdominal pain
for saying that 1 group is  Treatment: PET - Penicillins G,
greater, higher than the Erythromycin, Tetracycline
other. Ex. Sex, Religion, Color  Doxycycline as prophylactic drug
 Quantitative- numerical • Can be measured  Dengue - mosquito-borne infection
• Discrete- whole number or integral values  Vector is female aedes aegypti mosquito,
• Continuous- fractions, decimals, can day biting, low flying, satagnant clear
attain any decimal water,stripes black white body.
 Common Epidemiologic Studies:  Agent is a Virus.. dengue virus 1,2,3,4
 Retrospective (Past) - female aedes aegypti in stagnant water
 Cross- Sectional (Present) treatment is supportive therapy.
 Prospective Cohort (future)  Intravenous fluids
 *Independent variable (Cause) - The one to  A platelet transfusion
be manipulated ( symbol is “y”)  DENGUE DIAGNOSIS:
 *Dependent (Effect) - Will always be the - Tourniquet test (capillary fragility test or
interest of the researcher ( symbol is “X”) Rumpel Leads Test), a presumptive test
 Bag technique-a tool making use of public which is positive in the presence of more
health bag (open bag 3x only) than 20 petechiae within an inch square,
 Public health bag - is an essential and after 5 minutes of test
indispensable equipment of the public  DENGUE ns1 – ANTIGEN CAPTURE -
health nurse CONFIRMATORY
Removed BP Cuff inside bag  TOURNIQUET TEST - (BP Cuff):
 Home visit - is a family-midwife contact o fluids (most important treatment) like
which allows the health worker to assess oresol and IV
the home and family situations in order to o paracetamol ( do not give aspirin)
provide the necessary nursing care and o for nose bleeding, flex the neck lean
health related activities forward to prevent aspiration
*****cleanest to dirtiest case o avoid unnecessary movement
o assist in the management of shock.
 Epidemiology - the study of disease Dorsal recumbent to trendelenburg
occurrence and distribution position
 Epidemic- “The unusual occurrence in a  Leading Cancer Cases in 2010 ----Breast
community of disease- sudden outbreak of cancer
a disease – IN A SHORT PERIOD OF TIME  lung cancer was the most common cancer
 Nosocomial (hospital acquired) - urinary in men
tract infections.  In Females, breast cancer was the most
 Carriers- “an infected person or animal that common
harbors a specific infectious agent in the ****Smoking (including passive smoking) is
absence of discernible (visible) clinical the most important factor.
disease and serves as a potential source of  The Philippine Health Agenda Framework
infection to others. 2016-2022
 Leptospirosis – Vector is Rat  Financial Protection: Filipinos, especially the
Causative Agent: - bacteria--- Leptospira poor are protected from high cost of health
interrogans care.
 Sign/Symptoms: High fever, Chills,
Vomiting, Red/ orange eyes, Diarrhea,
 Better Health Outcomes: Filipinos attain  RESTV or EBOR (ebola reston) species,
the best possible health outcome with no found in Philippines and the People's
disparity. Republic of China, have been found to
 Responsiveness: Filipinos feel respected, infect humans but they do not cause illness
valued and empowered in all of their or death
interaction with the health system.  ***antibody-capture enzyme-linked
 RH Law, otherwise known as Republic Act immunosorbent assay (ELISA) is the
10354 or the Responsible Parenthood and diagnostic test
Reproductive Health Act
 Herbal Medicine  USES
 RA 9482 or “The Rabies Act of 2007”,  Niog Niogan  Anti-helminthic
rabies control ordinances shall be strictly (Quisqualis Indica) every 6 months
implemented. 2 hours p supper
 99 % of cases is from DOG BITE  No to less than 4
 Saliva of infected animals is the reservoir y/o
 *Head (NERVOUS SYSTEM)- most affected  Tsaang Gubat  Diarrhea
part and most fatal or dangerous site for (Carmona Retusa)
dog bite
 Ampalaya  DM Type 2-
 EQUINE rabies vaccine is derived from
(Momordica obesity
HORSE
Charantia)
 HRIG is from human serum Rabies vaccine
is an artificial active
 Sambong as anti urolithiasis
 given on days 0, 3, 7, 14, 30, and 90,
 Akapulko for fungal parasites
 avoid gluteal area
 Rabies vaccine should be administered in
 OPV (Oral Polio Vaccine) is “Sabin vaccine”
the deltoid muscle
 Measles- Subcutaneous
 In both pre-exposure and post-exposure
immunization, the full 1.0 mL dose should  Cold Chain under EPI
be given 9 intramuscularly o 6months- Regional Level
o Not more than 5days- Health
 Ebola: Mapping the outbreak centers using transport boxes.
From the section of WEST Africa  Most sensitive to heat: Freezer (-15 to -25
 Primary source = fruit bats or flying foxes , degrees C)
old world bats o OPV
 Other sources: o Measles
o Chimpanzees  Rubeola (measles)
o Gorillas  Communicable just before the rash
o fruit bats appears to 4-5 days after rash
o monkeys appears=highly contagious
o antelope
o porcupines  The first sign of measles is usually a high
o symptomatic humans fever (often >104o F [40o C]) that typically
 Ebola largest outbreak in West Africa was lasts 4-7 days.
first reported in March 2014,  Koplik spots—bluish-gray specks or “grains
 Virus is named after the ebola river of sand” on a red base—develop on the
 There are 5 strains of EBOLA virus buccal mucosa opposite the second molars
 EBOZ or ebola ZAIRRE strain is the most  First 24 hours
deadliest strain
 o Fever, malaise, cough, coryza,  Bacillus anthracis.
conjunctivitis  most common in wild and domestic
 In 48 hours herbivores (eg, cattle, sheep, goats, camels,
o “Koplik spots” (small, irregular, red antelopes)
spots with minute bluish-white  B anthracis spores can remain viable in soil
center) first seen on buccal mucosa for many years.
 Diphtheria  Raw or poorly cooked contaminated meat is
 Diphtheria is an acute infection caused by a source of infection for zoo carnivores and
 bacteria Corynebacterium diphtheriae. omnivores; anthrax resulting from
 The throat infection causes a gray to black, contaminated meat consumption has been
tough, fiber-like covering, which can reported in pigs, dogs, cats, mink, wild
block your airways carnivores, and people
 Shick test for susceptibility to diphtheria: A  diagnostic tests include bacterial culture,
+ shicks means no immunity or suceptible; PCR tests, and fluorescent antibody stains
(antigen test) to demonstrate the agent in blood films or
 Moloney test – for sensitivity of diptheria tissues
 Tetanus  Treatment
 caused by the bacterium Clostridium tetani,  Oxytetracycline given daily in divided doses
the spores of which are widespread in the also is effective.
environment  Ciprofloxacin,Amoxicillin, Gentamicin,
 present with trismus (“lockjaw”), which is ,Erythromycin Doxycycline, Streptomycin,
the inability to open the mouth secondary
to masseter muscle spasm.  Middle East respiratory syndrome
 Nuchal rigidity and dysphagia are also early coronavirus (MERS-CoV)
complaints that cause risus sardonicus, the - CAMEL FLU or SARS of MIDDLE EAST
scornful smile of tetanus, resulting from
 a viral respiratory disease caused by a novel
facial muscle involvement
coronavirus (MERS‐CoV) that was first
 generalized muscle rigidity with
identified in Saudi Arabia in 2012.
intermittent reflex spasms in response to
stimuli (eg, noise, touch).  1st case - april 2012
 Tonic contractions cause opisthotonos (ie, 2nd case - sept. 2012
flexion and adduction of the arms,  1st Outbreak
clenching of the fists, and extension of the - SAUDI ARABIAN PENINSULA
lower extremities).
 MERS COV IS A CLADES "B" VIRUS
 ZIKA-
 The Zika virus was detected for the first  Republic of South Korea is the largest
time in a rhesus monkey outbreak outside of the Middle East year
 Virus was named after a forest 2015
in Uganda in 1947. A year later, it was  camels - major reservoir host for MERS-
isolated in an Aedes mosquito from the CoV and an animal source of MERS infection
same region. in humans
 The first human cases appeared in 1952
 Highest Risk : IMMUNOSUPRESSION
(CANCER)

Anthrax  Symptoms- Mild-severe respiratory illness

 (Splenic fever, Siberian ulcer, Charbon, Gastrointestinal symptoms
Milzbrand)  Complications-pneumonia, kidney failure
  NO drugs or a vaccine for SARS,
 control of this disease relies on the rapid
 Signs and symptoms identification of cases and their appropriate
A- airway problems management, including the isolation of
B- breathing difficulty suspect and probable cases and the
C- cough and colds management of their close contacts.
D- diarrhea
 Supportive care is of primary importance.
E- elevated temperature
Immunomodulation by steroid treatment
 Treatment: No specific treatment may be important
 No vaccine or specific treatment is currently  Symptoms of SARS
available.  SARS begins with a high fever
(temperature greater than 100.4°F
 avoid contact with camels, drinking raw
[>38.0°C]).
camel milk or camel urine, or eating meat
 headache, an overall feeling of discomfort,
that has not been properly cooked.
and body aches.
 Avoid contact to camel droplets  Some people also have mild respiratory
 Cover your nose and mouth with a tissue symptoms at the outset. About 10 percent
when you cough or sneeze, then throw the to 20 percent of patients have diarrhea.
tissue in the trash.  After 2 to 7 days, SARS patients may
develop a dry cough. Most patients
 Avoid touching your eyes, nose and mouth
develop pneumonia.
with unwashed hands.
 Examples of close contact include kissing or
 Avoid personal contact, such as kissing, or hugging, sharing eating or drinking utensils,
sharing cups or eating utensils, with sick talking to someone within 3 feet, and
people. touching someone directly. Close contact
does not include activities like walking by a
 Severe Acute Respiratory Syndrome (SARS) person or briefly sitting across a waiting
is an acute respiratory illness caused by room or office.
infection with the SARS virus.
 Fever followed by a rapidly progressive
respiratory compromise is the key complex  Global warming
of signs and symptoms, which also include The most important greenhouse gas which
chills, muscular aches, headache and loss of is released whenever people burn fossil
appetite. fuels to do everyday activities like driving
 greater than 50% in persons aged 65 years cars, heating buildings, and making
and older (WHO Update ). – mostly affected electricity.
 The etiologic agent of SARS is a coronavirus Answer: Carbon dioxide
which was identified in March 2003. The
initial clusters of cases in hotel and  Among which is not a gas produce by green
apartment buildings in Hong Kong houses
 Attack rates in excess of 50% have been Answer: oxygen and Carbon monoxide
reported.
 virus is predominantly spread by droplets  What can we do to stop climate change?
or by direct and indirect contact. Shedding Answer: Plant more trees and prevent
in feces and urine also occurs. deforestations.
 Medical personnel, physicians, nurses, and  What are the disease commonly seen
hospital workers are among those because of climate change
commonly infected.
 Answer: mosquito borne, vector borne and 2. State the purpose of the visit (Question after
food borne diseases Greeting the patient and introducing yourself
what is your next action? = State the purpose
 What are the important actions in the fight
of the visit)
against global warming. 3. Assess or Observe the patient and determine
 Answer: Preventing deforestation as well the health needs.
as planting trees, through reforestation 4. Put the bag in a convenient place and then
and afforestation proceed to perform the bag technique.
 The main feedback greenhouse gas is: 5. Perform the nursing care needed and give
health teachings.
Water vapor
6. Record all important date, observation and
care rendered.
 Greenhouse effect refers to 7. Make appointment for a return visit.
B ability of certain atmospheric gases to BAG TECHNIQUE is a tool by which the nurse,
trap heat and keep the planet relatively during her visit will enable her to perform a
warm nursing procedure with ease and deftness, to save
time and effort with the end view of rendering
HOME VISIT is a family-nurse contact which
effective nursing care to clients.
allows the health worker to assess the home and
family situations in order to provide the necessary
PUBLIC HEALTH BAG is an essential and
nursing care and health related activities. indispensable equipment of a public health nurse
which she has to carry along during her home
Purposes
1. To give care to the sick, to
visits.
a postpartum mother and her newborn with Principles
the view teach a responsible family member to  will minimize, if not, prevent the spread
give the subsequent care. of any infection.- most important central
2. To assess the living condition of the patient feature
and his family and their health practices in  It saves time and effort in the
order to provide the appropriate health performance of nursing procedures.
teaching.
 The bag technique can be performed in a
3. To give health teachings regarding the
prevention and control of diseases. variety of ways depending on the
4. To establish close relationship between the agency’s policy, the home situation, or as
health agencies and the public for the long as principles of avoiding transfer
promotion of health. of infection is always observed.
5. To make use of the inter-referral system and *BP apparatus and stethoscope are carried
to promote the utilization of community separately and are never placed in the bag.
services
4 C Points to consider
Principles COMPLETE- contain all the necessary
The following principles are involved when performing a articles, supplies and equipment that will
home visit:
be used to answer the emergency needs
1. A home visit must have a purpose or
objective. CLEAN - contents should be cleaned very
2. Planning for a home visit should make use of often, the supplies replaced and ready
all available information about the patient for use anytime.
and his family through family records. CONTENT protection- contents should
3. In planning for a home visit, we should be well protected from contact with any
consider and give priority to the essential article in the patient’s home.
needs of the individual and his family.
*Consider the bag and its contents clean
4. Planning and delivery of care should involve
the individual and family. and sterile, while articles that belong to the
5. The plan should be FLEXIBLE. patients as dirty and contaminated.
Steps CONVENIENT- arrangement of the
1. Greet the patient and introduce yourself. contents of the bag should be the one
 most convenient to the user, to facilitate
efficiency and avoid confusion.
Initial step in bag technique : Upon arrival at the
patient’s home, place the bag on the table lined
with a clean paper. The clean side must be out and
the folder part, touching the table Steps