Chn review march 1 2011 complete - Presentation
Transcript
1. COMMUNITY HEALTH NURSING ROMEO D. PIANSAY, JR., R.N., M.A.N. 2. o CHN ??? o Boring?? o Verbose?? o Confusing?? o Repetitive?? 3. 9 PRIMARY QUALITIES OF CHN
4. Promotion of OLOF thru health teaching and delivery of care 1 Primary GOAL 5. Health Teaching 2 Primary DUTY
6. 3 Health care for the ENTIRE community Primary PRINCIPLE 7. Health Promotion 4 Primary FOCUS
8. Nursing Process 5 Primary METHODOLOGY
9. Population-focused care (MASS – BASED) 6 Primary TYPE of CARE DELIVERY 10. Recognized Needs of Clients 7 Primary BASIS
11. Family 8 Primary UNIT of SERVICE
12. 9 Primary CLIENT & SETTING Community 13.
o Linguistic Origin
o [L. communitas, fellowship]
o [MOSBY] a group of species who reside in a designated geographic area and who
share common interests or bonds
o [STEDMAN] a group of persons united by some common feature or shared
interest COMMUNITY
14.◊Qualities of a Healthy Community 4) Awareness community ◊health status 5) Independence people & ◊leaders 6) Role Models parents & ◊guardians 7) Active Concern health threats 8) ◊Sustainability environment & ◊needs 9) Accessibilty health ◊services 1) Resources open & ◊controlled 2) Empowerment ◊active participation 3) People ◊healthy citizenry 10) Politics mass-based & respected (REPAIR ASAP) 15. Classification of a Community
16.
o Rural or Open lands o Agricultural / fishing o less dense
o more spacious
1
o Urban or the City o non-agricultural
o dense & highly populated o highly industrialized
2
18. Rurban or the Capitals - mixed type of rural & urban 3 19. COMPONENTS OF A COMMUNITY
o THE CORE
o People ◊ demographics, values & beliefs
20.B. 8 subsystems of the community 4) ◊Economics livelihood projects 5) ◊Recreation community activities 6) ◊Fire and safety bldg. & house check 7) Politics & ◊gov’t selection of leaders 8) ◊Health health services & programs 1) ◊Communication open all channels 2) ◊Housing adequate shelter & security 3) ◊Education health teachings, seminar (CHEER for public health)
21. APPROACHES TO COMMUNITY DEVELOPMENT
o A. Welfare approach
the immediate & spontaneous response to ameliorate poverty assumes that poverty is God-given
poverty is destiny must accept fate◊ just reward in heaven
22.
o B. Modernization approach
aka “project development approach” introduces lacking resources
o C. Transformatory/participatory approach
involves people empowerment & transformation of the poor assumes that poverty is not God-given
poverty ◊ historical past ◊ existence of oppressive structures in society
23.
o State of complete physical, mental and social well-being, not merely the absence
of disease or infirmity
o WORLD HEALTH ORGANIZATION
o OLOF of individuals, families & communities being influenced by several factors
in the eco-system
o MODERN CONCEPT OF HEALTH o [NLPGN, CHN committee, 2000]
HEALTH
24. ECO-SYSTEM FACTORS THAT AFFECT COMMUNITY HEALTH (OLOF) 25.
o This factor pertains to the power and authority to regulate the environment o EXAMPLES:
o Safety o Oppression
o People empowerment
P O L I T I C A L 26.
o One component of this factor is the primary health care which is a partnership
approach
o GOAL: effective provision of health services that are community-based and
accessible
o COMPONENTS:
o Promotive, Preventive, Curative & Rehabilitative
HEALTH CARE DELIVERY SYSTEM 27. o COMPONENTS o Culture o Habits o Ethnic customs o EXAMPLES o Smoking
o Intake of alcoholic drinks o Substance abuse o Lack of exercise B E H A V I O R A L 28. o COMPONENTS o Employment o Education o Housing
SOCIO ECONOMIC INFLUENCES 29. o COMPONENTS o Air o Food o Water waste o Urban/rural noise o Radiation o Pollution
ENVIRONMENTAL INFLUENCES 30. o COMPONENTS o Genetic endowment o Defects o Strengths o Risks: Familial Ethnic Racial H E R E D I T Y
31.◊4) Environment air, food, ◊water, noise 5) Behavior culture, habits, customs 6) Health care ◊delivery system ◊promotive, preventive, curative, rehab 1) Political safety, oppression, gov’t. 2 ) ◊Socio-economic employment, educ. ◊3) Heredity genetics, race, ancestry ECO-SYSTEM FACTORS THAT AFFECT CH Physician Sometimes Heals Everyone But Himself
32.
o Public health as the science and art of preventing disease, prolonging life and
efficiency to enable every citizen to realize his birthright of health and longevity. DEFINITIONS W I N S L O W
33.
o Public health is dedicated to the common attainment of the highest level of
physical, mental and social well-being and longevity
o GOAL: contribute to the most effective total development and life of the
individual and his society H A N L O N
34.
o Community health nursing is a learned practice discipline
o Ultimate goal : contribute to the promotion of client’s optimum level of
functioning
o Through teaching and delivery of care
J A C O B S O N 35.
o CHN is a service rendered by a professional nurse with the community, groups,
families and individuals
o GOAL: promotion of health, prevention of illness, care of the sick at home and
F R E E M A N 36.
o Philosophy of community health nursing is based on the worth and dignity of man
S H E T L A N D
37. 5 Core Business of Public Health
o Disease control o Injury prevention o Health protection o Health public policy
o Promotion of health and equitable health gain
38. MIND GAMES – HOW MANY FACES CAN YOU SEE? 39.
o [MOSBY] the practice in which a nurse assists the individual, sick or well, in the
performance of those activities contributing to health or its recovery ( or to a peaceful death)…
o - adaptation from Virginia Henderson
NURSING
40. PUBLIC HEALTH NURSING
o Lillian Wald coined the term “public o health nursing” to denote “ a service o that was available to all people” o PHN ◊ Public/gov’t agency o ◊ care of poor people
o CHN -> nursing for the health of the
o ENTIRE public/community, NOT ONLY for the o public who are poor
o PHN & CHN have been used interchangeably in the Philippines by both foreign
and local authors 41.
o Public Health Nurses (PHNs) – refer to nurses in the local /national health dept or
public schools whether their official position title is Public Health Nurse or Nurse or School Nurse
PHN ACCORDING TO NLPGN, 2005 42. PHN ACCORDING TO NLPGN, 2005
o Public Health Nursing – refers to the practice of nursing in national and local govt
health dept. and public schools. IT IS CHN PRACTICED IN THE PUBLIC SECTOR.
43.FIVE FOLD MISSION OF CHN / PHN: 4) Disease Prevention – avoid consequences Primary prevention ◊ immunizations Secondary prevention ◊ screenings Tertiary
Prevention ◊ rehabilitation 5) Social Justice – right to “basics of life” 1) Health
Promotion – lifestyles / choices 2) Health Protection – alter community dses 3) Health Balance – biopsychosocial homeo Holding Hands, Hugs, Don’t Smack
44. 8 Millenium Dev’t Goals (2015) 4) Gender equality and women empowerment 5) Environmental sustainability 6) Universal primary education 7) Combat HIV/AIDS, malaria & other dses 8) Global partnership for development 1) Extreme poverty and hunger eradication 2) Maternal health improvement 3) Child mortality reduction Every Married Cool Guy Eyeballs Underage Cool Girls
45.
o APIE over-all community health plan o Provide quality nursing services
o Coordinate the health team, NGO’s & gov’t. agencies o Researches relevant to PHN services
o Continuing education & professional growth
OBJECTIVES OF CHN: ALL PUBLIC COMFORT ROOMS CONTAMINATED 46.
o SPECIALIZED FIELDS OF CHN:
o COMMUNITY MENTAL HEALTH NURSING
A unique clinical process which includes an integration of concepts from
nursing, mental health, social psychology, community networks & the basic sciences
FOCUS: mental health promotion
47.
o OCCUPATIONAL HEALTH NURSING
The application of nursing principles & procedures in conserving the
health of workers in all occupations
AIMS: Health promotion Prevention of diseases Risk reduction Safe workplace 48.
o SCHOOL HEALTH NURSING
Application of nursing theories & principles in the care of the school
population
COMPONENTS:
School Health services Health instruction Healthful school living School-community linkage
49. LEADING AILMENTS/DEFECTS AMONG SCHOOL CHILDREN
o Dental Caries
o Intestinal Helminthiasis o Colds
o Pediculosis
o Upper respiratory tract infection
50.
o 1) Individual - Not the main client in CHN, but receives CHN care through the
family
o Family - the basic unit of care o Population group
o Community
o The ultimate patient is the COMMUNITY .
4 Levels of Clients / patients 51. 4 Major Functions of the Family
o Physical Function o Economic Function o Reproductive Function o Socialization Function
52. KINDS OF FAMILY STRUCTURE
o A) Traditional Family
nuclear family Extended family o B) Alternate Family Structure
Single-Parent Families Cohabitating families
53.
The beginning family
The early child-bearing family The family with pre-school children The family with school-age children The family with teen-agers
The Family as Launching Center The middle-aged family
The aging family
Stages of Family Development 54.
Infants & young children School age
Adolescents Mothers Elderly Males *
55. CHN ROLES OF THE NURSE Facilitate & empower people 3) COLLABORATOR Coordinates community resources 1) CLINICIAN Focus on the health of individuals 2) COMMUNITY ORGANIZER
56. CHN ROLES OF THE NURSE Gives KSA, better informed choices a) INFORMATION – provision of knowledge b) EDUCATION – change thru KSA 4) COUNSELOR
Listening, give feedback & support 5) EDUCATOR c) COMMUNICATION – exchange of info 3 ASPECTS OF HEALTH TEACHING
57. CHN ROLES OF THE NURSE Shows examples of good behavior 8) CHANGE AGENT Influences & motivate others good behavior 6)
RESEARCHER/STATISTICIAN/RECORDER Analyzes data to predict future
phenomenon 7) ROLE MODEL 9) HEALTH ADVOCATE Aids people in asserting their rights; promotes self-care and self-determination
58. CHN ROLES OF THE NURSE providing nursing care skills in a home setting 10) CASE MANAGER oversees all aspects of care to facilitate delivery of cost-efficient care; to individualize and coordinate care 11) HOSPICE CARE
59. 7 FUNCTIONS OF PHN
o Management function o Supervisory function o Nursing care function
o Collaborating & coordinating function o Health promotion & education function o Training function
o Research function
60. Sample Questions:
o The community health nurse acting in a role of clinician would be more likely to: A) Work to articulate the special needs of a population such as homeless
people
B) Focus on reducing the incidence of disease in a population C) Address the spiritual needs of a group without performing any
screening or treatment
D) Coordinate the various components of care in different areas of the
health system
o Answer: B
61.
o The CHN acting in the role of advocate would be o most likely to promote:
Self-care & self-determination for the population
Telling the people in a community that the medical experts know what is
best for them.
Smoking cessation
That health care options should be pursued without the influence of
friends or families
o Answer: A
62.
o Which of the following is not a role for the nurse o providing hospice or end-of-life care?
o Providing resources for caregivers to prevent burnout
o Ensuring that the client is given every reasonable chance to extend life and is
encouraged not to give up too easily
o Working as part of a multidisciplinary team to meet client’s needs. o Promoting & coordinating palliative care
Answer: B
63.
64. Philippine Herbal Medicine 65. T.A.M.A. OF 1997
o REPUBLIC ACT NO. 8423
o (TRADITIONAL & ALTERNATIVE MEDICINE ACT)
o Created PITAHC (Phil. Institute of Traditional & Alternative Health Care)
o - scientific research & development of traditional & alternative health care system
that have impact on public health care.
66. Phil. Institute of Traditional & Alternative Health Care (PITAHC)
o BACKGROUND:
o Administrative Order No. 12 (1992)- Traditional Medicine Program, through
former Health Secretary / Senator Juan M. Flavier
o This special program was tasked to promote and advocate traditional medicine
nationwide. 67.
o Vision
o "Traditional and alternative health care in the hands of the people" o Mission
o "PITAHC upholds the right of every Filipino for better health through the
provision of safe, effective and affordable traditional and alternative health care products, services and technologies."
68. Products of PITAHC
69. Handling Tips on Medicinal Plants / Herbs
o If possible, buy herbs that are grown organically - without pesticides.
o Medicinal parts of plants are best harvested on sunny mornings. Avoid picking
leaves, fruits or nuts during and after heavy rainfall.
o Leaves, fruits, flowers or nuts must be mature before harvesting. Less medicinal
substances are found on young parts.
70. Tips on Preparation for Intake of Herbal Medicines:
o Use only half the dosage prescribed for fresh parts like leaves when using dried
parts.
o Do not use stainless steel utensils when boiling decoctions. Only use earthen,
enameled, glass or alike utensils.
o As a rule of thumb, when boiling leaves and other plant parts, do not cover the
pot, and boil in low flame. 71.
o Reminders:
o One kind of plant for each type of s/s o No insecticides
o Stop in case of untoward reactions; seek consultation if signs/symptoms not
relieved after 2-3 doses 72. QUESTION
o In preparing herbal medicines, which of the following is incorrect? o A) When boiling, cover the pot well to preserve the nutrients. o B) You must boil them in low flame.
o C) One kind of plant for each type of symptom o D) Use a clay pots.
o ANSWER: A
73. QUESTION
o In the use of herbal medicine, one should remember to o a. use all parts of the plant in making decoction. o b. boil leaves sprayed with insecticide.
o c. stop giving herbal medicine if allergy occurs.
o d. continue giving decoction even if signs and symptoms persist. o ANSWER : C
74. QUESTION
o Which of the following is a correct statement?
o a) local plants and herbs in the Philippine backyard are all effective in treatment
of ailments
o b) since they are readily available at no cost, you may use 2 or more for kinds for
faster cure
o c) no side effects or untoward reactions
o d) not recommended for everyone to use herbal medicines o ANSWER : D
75. QUESTION
o The Traditional & Alternative Medicine Act of 1997 is also known as: o A) PD #8243
o B) RA # 8342 o C) PD # 8432 o D) RA # 8423 o ANSWER: D
76. 10 DOH herbal medicines ( AUNTY LABS B )
o A AMPALAYA o U ULASIMANG BATO o N NIYOG-NIYUGAN o T TSAANG GUBAT o Y YERBA BUENA o L LAGUNDI o A AKAPULKO o B BAWANG o S SAMBONG o B BAYABAS
77. Ten (10) Herbal Medicines in the Philippines Approved by the Department of Health (DOH)
78. 1. Ampalaya (Mamordica charantia) - "bitter gourd" or "bitter melon" in English, - treatment of diabetes (diabetes mellitus), for the non-insulin dependent patients.
79. 2. Ulasimang Bato (Peperomia pellucida) - also known as "pansit-pansitan" - for arthritis and gout
80. 3. Niyog-niyogan (Quisqualis indica L.) - is a vine known as "Chinese honey suckle“ - for intestinal worms, particularly the Ascaris and Trichina
81. 4. Tsaang Gubat (Ehretia microphylla Lam.) - enhance intestinal motility - mouth wash (high fluoride content)
82. 5. Yerba Buena (Clinopodium douglasii) - commonly known as Peppermint - an analgesic to relieve body aches and pain
83. 6. Lagundi (Vitex negundo) - "5-leaved chaste tree“ - for the relief of cough & asthma
84. 7. Akapulko (Cassia alata) - also known as "bayabas-bayabasan" and
"ringworm bush" in English - Antifungal: Tinea Flava, ringworms, athlete’s foot and scabies
85. 8. Bawang (Allium sativum) - popularly known as "garlic“ - reduces cholesterol in the blood - helps control blood pressure
86. 9. Sambong (Blumea balsamifera) - English name: Blumea camphora - A diuretic for excretion of urinary stones - anti-edema
87. 10. Bayabas (Psidium guajava) - "guava" in English an antiseptic - to disinfect wounds - mouth wash to treat tooth decay and gum infection
88. QUESTION a. lagundi. b. akapulko. c. niyog-niyogan. d. bawang. ANSWER: D Allium sativum is the scientific name of:
89. QUESTION a. lagundi. b. bayabas. c. niyog-niyogan. d. tsaang gubat. ANSWER: C A vine which acts as an anti-helminthic is
90. QUESTION a. lower cholesterol levels. b. wash wounds. c. treat diabetes mellitus. d. lower uric acid. ANSWER: A The use of bawang is advocated in order to
91. QUESTION a. lagundi. b. bayabas. c. niyog-niyogan. d. tsaang gubat. ANSWER: A WHICH OF THE FF. IS MAINLY USED FOR THE RELIEF OF COUGH AND ASTHMA?
92. QUESTION A) Clinopodium douglasii B) Allium sativum C) Mamordica charantia D) Shigella bordetella ANSWER: C The scientific name of ampalaya is:
93. QUESTION a. lower cholesterol levels. b. wash wounds. c. treat diabetes mellitus. d. lower uric acid. ANSWER: C Which of the ff is an indication for ampalaya?
94. Narra Pterocarpus indicus
o NARRA o USES: o DIARRHEA o HEADACHE o PRICKLY HEAT
95. Lansones Lansium domesticum Correa
o LANSONES o USES: o DIARRHEA
o FEVER
96. Mani Arachis hypogaea Linn. PEANUT
o MANI o USES:
o BLADDER INFECTIONS o OILS & LINIMENTS
97. Luya Zingiber officinale Rose. GINGER
o LUYA o USES:
o ANTISEPTIC o RHEUMATISM
o SORE THROAT/ HOARSENESS o COUGH
o HANGOVERS o HEADACHES
98. Makahiya Mimosa pudica Linn. BASHFUL MIMOSA, SENSITIVE PLANT
o MAKAHIYA o USES: o ASTHMA o EXPECTORANT o SORE THROAT o WOUNDS
99. Makopa Syzygium malaccense MALAY APPLE, TERSANA ROSE APPLE
o MAKOPA o USES:
o DYSENTERY o AMENORRHEA
100. Oregano Coleus aromaticus Benth.
o OREGANO o USES: o ASTHMA o CHRONIC COUGH o BRONCHITIS 101. Kauayan BAMBOO o KAWAYAN o USES:
o INDUCE LOCHIA AFTER C.B. o ANTIHELMINTHIC
o ANURIA
102. Mangga Mangifera indica
o MANGGA o USES: o DIURETIC o ASTRINGENT o STOMATITIS
103. Mangostan Garcinia mangostana MANGOSTEEN o MANGOSTEEN o USES: o ABDOMINAL PAIN o DIARRHEA o DYSMENORRHEA
104. Malunggay Moringa oleifera BEN OIL TREE
o MALUNGGAY o USES:
o INTESTINAL PARASITISM o CONSTIPATION
o WOUNDS & CUTS
105. Niyog Cocos nucifera COCONUT
o NIYOG o USES: o DANDRUFF o DRY SKIN o SCABIES
106. Okra Abelmoschus escuclentus Linn. Hibiscus esculentis Linn.
o OKRA o USES:
o URINARY INFECTIONS o SORE THROAT
o WOUNDS
107. Mais Zea mays CORN
o MAIS o USES: o DIURETIC o DYSURIA
o URINARY TRACT INFECTION
108. QUESTION
o It is also known as “ BEAN OIL TREE”. o NARRA o NIYOG o MAKOPA o MALUNGGAY o ANSWER: D 109. QUESTION
o WHICH OF THE FOLLOWING IS EFFECTIVE FOR DYSMENORRHEA? o OREGANO o OKRA o MAIS o MANGOSTEEN o ANSWER: D 110. QUESTION
o It is also known as “ MALAY APPLE”. o LANSONES o MANGA o MAKOPA o OREGANO o ANSWER: C 111. QUESTION
o WHICH OF THE FOLLOWING IS EFFECTIVE o FOR INDUCING LOCHIA AFTER CHILD BIRTH? o MAKAHIYA
o KAUAYAN o NIYOG
o MALUNGGAY o ANSWER: B
112. Talong Solanum melogena L.
o TALONG o USES:
o SORE THROAT o ABSCESS
o CRACKED NIPPLES
113. Sibuyas Allium cepa L. True onion
o SIBUYAS o USES:
o STIMULANT o DIURETIC o EXPECTORANT
114. Patatas Solanum tuberosum
o PATATAS o USES:
o GENTLE LAXATIVE o GOUTY ARTHRITIS o HYPERTENSION
115. Sabila Aloe vera
o SABILA o USES: o DANDRUFF
o SCALDS AND BURNS o SPRAINS
o BRUISES
116. Siling-labuyo Capsicum frutescens CHILE PEPPER, SPANISH PEPPER CAYENNE
o SILING-LABUYO o USES:
o ARTHRITIS / RHEUMATISM o DYSPEPSIA
o FLATULENCE
117. Sampalok Tamarindus indica Linn. TAMARIND
o SAMPALOK o USES: o FEVER o LAXATIVE o ASTHMA
118. Sampagita Jasminum sambac Linn. JASMINE
o SAMPAGUITA o USES:
o FEVER o COUGH o DIARRHEA
119. Tanglad Andropogon citratus Lemon Grass, Ginger grass
o TANGLAD o USES: o DIARRHEA o FEVER
120. Papaya Carica papaya MELON TREE
o PAPAYA o USES: o LAXATIVE o ACNE
o STOMACH ACHE
121. Saging Musa sapientum Linn. BANANA
o SAGING o USES: o COOL DRESSING o THINNING HAIR o HEADACHES 122. Pito-Pito
o Pito-Pito is a blend of seven seeds or leaves of seven traditional herbal medicinal
plants , usually prepared as a decoction
o It is used in a wide variety of applications: headaches, fever, cough, colds,
migraine, asthma, abdominal pains, diarrhea, etc. 123. Pito-Pito
o The ingredients vary according to availability and intended use. Seven (pito) is
believed to be numerologically essential to the efficacy of the eventual formulation.
124.
o A traditional combination is seven leaves of: o alagaw,
o banaba, o bayabas, o pandan,
o mangga,
o with half a teaspoon each of anis and cilantro o boiled for 30 minutes, strained and drained.
125. Pito-Pito
o In the urban and suburban areas, it has become part of alternative new-age menu
as a herbal tea blend. Commercial tea preparations substitute one or two ingredients with other herbal medicinal components.
126.
127. QUESTION
o It is also known as “ MELON TREE”. o PATATAS o NIYOG o PAPAYA o PIPINO o ANSWER: C 128. QUESTION
o WHICH OF THE FOLLOWING IS EFFECTIVE FOR CRACKED NIPPLES? o SILING-LABUYO o SABILA o PANDAN o TALONG o ANSWER: D 129. QUESTION
o It is also known scietifically as “ MUSA SAPIENTUM”. o SAGING o PATOLA o PATATAS o TANGLAD o ANSWER: A 130. QUESTION
o WHICH OF THE FOLLOWING IS NOT PART OF PITO-PITO? o BANABA o BAYABAS o AMPALAYA o MANGGA o ANSWER: C 131. VITAL STATISTICS 132. o POPULATION STRUCTURE o POPULATION SEX RATIO o = M / F x 100%
o ex: 12,349 M / 12,413 F x 100 = 99% o ( for every 99 males, there are 100 females)
133.
Percentage of a specified age group in comparison to the total
number of population
EXAMPLE:
total population = 50
specified age group=children 1– 4 = 30 o 30 / 50 x 100 = 60%
134.
o DEPENDENCY RATIO
Refers to the very young & old population FORMULA:
Population (0-14) + (65 & above) / (15 – 64) x 100
135.
EXAMPLE:
Population 0 – 14 + 65 & above = 500 Population 15 – 64 y.o. = 500
500 / 500 x 100 = 100 (ratio 1:1)
136.
o MEASURES OF DISTRIBUTION
o DENSITY (D) – shows the number of persons dwelling upon a unit area of land o D = Population / area
137.
o EXAMPLE:
o land area = 20,000 square meters o population = 1000
o 1,000 / 20, 000 sq. m = 0.05 sq. m
o THUS: for every 100 sq. m, there are 5 persons living on it
138.
o MEASURES OF MIGRATION MIGRATION
CRUDE IN – MIGRATION RATE (CMIR) no. of in – migrants / population x 100
139.
CRUDE OUT – MIGRATION RATE (CMOR) no. of out – migrants / population x 100
NET MIGRATION RATE
CMIR – CMOR = net migration rate
140.
o MEASURES OF POPULATION GROWTH o RATE OF NATURAL INCREASE
o CBR – CDR per 1000 population
141.
o AVERAGE ANNUAL PERCENTAGE INCREASE o Pt / Po – 1 / t x 100
o Where: Pt – population at a later date o Po – population at an earlier date o t – time interval between dates t & o
142. o EXAMPLE: o Population in 1977 = 5,000 o Population in 1972 = 1,000 o 5,000 / 1,000 – 1 / 5 x 100 = 80% 143.
o ZERO GROWTH RATE
o BIRTH RATE = DEATH RATE
144.
o RATIO
o A relative number expressing the magnitude of one occurrence or condition in
relation to another 145.
o RATE
o Measures the probability of occurrence of some particular events
o A relation indicating the number of times a certain number of exposures to the
risks of occurrence is present in a given period of time 146.
o MID-YEAR POPULATION
o Population of the area under study as of JULY 1 o POPULATION AT RISK
o Population capable of acquiring the disease
147.
148.
o FERTILITY / NATALITY RATES o CRUDE BIRTH RATE
o Total live births in a calendar year / MP x 1,000
149.
o GEN. FERTILITY RATE
o Total live births in a calendar year / mid-year population of women of
child-bearing age (15 – 44) x 1,000 150.
o MORTALITY RATES o A. CRUDE DEATH RATE
o Total deaths in a calendar year from all causes / MP x 1,000 o CAUSE – SPECIFIC DEATH RATE
o Deaths from a particular cause / MP x 100,000
151.
o PROPORTIONAL MORTALITY RATE
o Deaths from a particular cause / deaths from all causes x 100 o SWAROOP’S INDEX
o Deaths in persons 50 yrs & above / total no. of deaths x 100 = % (no. of persons
who died at 50 yrs. & above) 152.
o CASE FATALITY RATE
o INFANT MORTALITY RATE
o Deaths in 1 year of age / total live births in same year x 1,000
153.
o NEONATAL MORTALITY RATE
o Deaths below 28 days of age / total no. of live births x 1,000 o MATERNAL MORTALITY RATE
o Deaths from women directly due to pregnancy, labor or puerperium (90 days after
delivery) / total no. of live births x 1,000 154.
o MORBIDITY RATES
Measures the frequency of illness or disability
For groups of allied illnesses within specific populations
155.
o GENERAL MORBIDITY RATE
o Total no. of sick persons / MP x 100,000 o INCIDENCE RATE
It answers how frequently the disease occur within a given period of time o No. of new cases of a specified disease during a given time / population at risk in
the area during that time x 100,000 156.
o ATTACK RATE
A measure of incidence during outbreaks or epidemics
o No. of new cases of a disease in a time period / population at risk during that time
x 100 157.
o PREVALENCE RATE
Measure of the status of a particular disease within a given point or
interval in time
It answers what proportion of the population or group of persons are
actually ill with the particular disease or are infected with a particular agent at a given point in time
158.
no. of new and old cases of a certain diseases registered at a given time
PR = ___________________________________ x 100 total number of person examined
at same given time
159. MIND GAMES - WHAT DO YOU SEE? 160. COPAR
161. COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH
o DEFINITIONS:
a social development approach that aims to transform the apathetic ,
individualistic, and voiceless poor into dynamic, participatory and politically responsive community
162. IMPORTANCE OF COPAR
to generate community participation in development activities.
COPAR prepares people/clients to eventually take over the management of a development program in the future.
163.
COPAR maximizes community participation and involvement; community resources are mobilized for community services
164. PRINCIPLES OF COPAR
People, especially the most oppressed, exploited and deprived sectors are
open to change, have the capacity to change, and are able to bring about change
COPAR should be based on the interests of the poorest sectors of society COPAR should lead to a self-reliant community and society
165. PROCESSES / METHODS USED
o PROGRESSIVE CYCLE OF ACTION-REFLECTION- ACTION
o – begins with small, local and concrete issues identified by the people and the
evaluation and reflection of and on the action taken by them 166.
o CONSCIOUSNESS-RAISING THROUGH EXPERIENTIAL LEARNING o - placing an emphasis on learning that emerges from concrete action and which
enriches succeeding action 167.
o C. PARTICIPATORY & MASS-BASED – it is primarily directed towards and
biased in favor of the poor, the powerless and the oppressed 168.
o D. GROUP-CENTERED and NOT LEADER ORIENTED
o – leaders are identified, emerge and are tested through action rather than
appointed or selected by some external force or entity. 169. PHASES OF THE COPAR PROCESS
o 1. Pre-entry phase
o - is the initial phase of the organizing process where the community organizer
looks for communities to serve or help
o - it is considered the simplest in terms of actual outputs, activities, and strategies
and time spent for it 170.
o Activities include:
o designing a plan for community development, including all its activities and
strategies for care/development
o designing criteria for the selection of site o Methods for site selection:
Coordination with community leaders Ocular observation
Informal interviews
o actually selecting the site for community care
171.
o 2. ENTRY PHASE
o - called the social preparation phase o - activities are the following:
o a) sensitization of the people on the critical events in their life
o b) motivating them to share their dreams and ideas on how to manage their
concerns
o c) mobilizing them to take collective action
172.
o signals the actual entry of the community worker/organizer into the community. o Guidelines for entry:
o “ courtesy call” - recognize the role of local authorities by paying them visits to
inform them of your presence & activities
o “ when in Rome, be a Roman” appearance, speech, behavior and lifestyle should
be in keeping with those of the community residents without disregard of being role the model
o adopt a low-key profile
173.
o - look for potential leaders & core-group members Criteria for potential leaders:
Mass based or from poor sector Directly engaged in production Respectable & trustworthy Charismatic
Pro - active & change agent Conscientious & resourceful Effective communication skills
174.
o 3. Organization-building phase
o - entails the formation of more formal structures
o - It is at this phase where the organized leaders or groups are being given trainings
( OJT, formal or informal )
o - wider participation & collective community action
175.
o 4. Sustenance and strengthening phase
o - occurs when the community organization has already been established and the
community members are already actively participating in community-wide undertakings.
176.
o - strategies used may include: o a) education & training o b) networking and linkaging
o c) conduct of mobilization on health and development concerns o d) implementation of livelihood projects
o e) developing secondary leaders
177. RECORDS & REPORTS
o Records
o – refer to forms on which information pertaining the client is noted o Reports
o – refers to periodic summaries of services /activities of an organization/ unit or
the analysis of certain phases of its work 178.
o Purposes of records and reports:
o a) measure service / program directed to the clients o b) provide basis for future planning
o c) interpret the work to the public and other agencies o d) aid in studying the conditions of the community o e) contribute to client care
179.
o Sample Questions
o One of the primary tasks of the community health nurses during the pre-entry
phase is the selection of the Barangay to become the initial site for their
organizing efforts. The following are the steps in the selection of the project site by the team, except:
o Developing criteria for site selection
o Identifying potential barangays and choosing the final project village o Identification of potential leaders
o Identification of the host family o Answer: C (under entry phase)
180.
o 2. It is considered the simplest in terms of actual outputs, activities, and strategies
and time spent for it.
o Organizing-building phase o Pre-entry phase o Sustenance phase o Strengthening phase o Answer: B 181.
o 3. For potential leaders to perform their roles effectively, they have to possess
certain characteristics. Among these are the following, except:
o They must belong to the poor sector
o They must be respected members of the community o Preferably informal leaders
o Formal leaders with many community responsibilities
o Answer: D (They do not have time to perform additional duties)
182.
o 4. This phase signals the start of community self-management of any development
program.
o Pre-entry phase o Integration phase
o Entry phase
o Organization-building phase
o Answer: D (a community organization facilitates in the participation in health and
other development activities)
183. APPLICATION OF COPAR IN COMMUNITY HEALTH CARE PROCESS 184.
o NURSING PROCESS
o A systematic, scientific, dynamic, on-going interpersonal process
o The nurses & the clients are viewed as a system, with each affecting the other &
both being affected by the factors within the behavior 185. o 4 STEPS IN CHN PROCESS: o A ssessment o P lanning o I mplementation o E valuation 186. Community competence
o refers to the community’s ability to: o - identify needs
o - achieve working consensus
o - agree and work together to meet goals
187. COMMUNITY ASSESSMENT
o Process of examining the community
o strategies that improve health and quality of life for the community o Systematic & continuous
188.
o Identifies specific deficiencies or guidance needed o Estimates possible effects of the nursing interventions o getting to know the community client
o - this includes:
o a) decide what data to be gathered o b) plan the process of data gathering
189.
DATA TO BE COLLECTED Demographic data
Vital health statistics Community dynamics
Education, socio-cultural, religious & occupational
background
Family dynamics
Environment & patterns of coping
190. THREE DIMENSIONS OF COMMUNITY ASSESMENT
o Status - information about morbidity and mortality, life expectancy, crime rates
and education.
Structure – socioeconomic, age, gender, resources
191.
o Planning for a Program of Action
o a) determining objectives for care / action
o - identify what is to be done and what outcomes might be expected from the
program/project/services implemented 192.
o Criteria for setting objectives:
o they should be realistically be achievable o should be specifically stated
o should be flexible enough to allow for change
o should be closely related to the problems and needs identified and felt by the
client
o should be closely coordinated with those of the entire health care team
193.
o b) select activities and methods / o strategies for achieving the objectives o a. home visits
o b. conferences / demonstrations o c. health service delivery o d. group discussion
o e. information dissemination
194.
o Factors in selecting activities: o a. need / capabilities of the client o b. identify target clientele
o c. review traditional activities and select only those not detrimental to health, life
and limb
o d. bear in mind that a balanced program is far more effective than in those which
are unbalanced or biased 195. Program Implementation
o refers to the actual carrying out of the plan
o refers to the mobilization of resources to meet objectives o must include active participation of the people
196. Program Monitoring & Evaluation
o Monitoring
o – is an internal project/intervention/ care activity concerned to assess whether
resources are being used as intended and whether they are producing the intended outputs
197.
o Evaluation
is a process that is designed to show the relationship between services
rendered and the objectives or purposes of the service / unit / care provider
not a record nor count of what was done but of what DIFFERENCE the
doing made
198. CATEGORIES OF HEALTH PROBLEMS 199.
o A gap between actual and achievable health status o Instances of failure in health maintenance
o Possible precursors of health deficit:
History of repeated infections or miscarriages No regular health check-up
HEALTH DEFICIT 200.
o EXAMPLES
o ILLNESS states, diagnosed or undiagnosed o Failure to thrive/develop
o Disability
Transient (aphasia or temporary paralysis after a CVA)
Permanent (leg amputation secondary to diabetes, blindness from measles,
lameness from polio) 201.
o Conditions that are conducive to disease, accident or failure to realize one’s
potential
o EXAMPLES:
o Family history of hereditary disease o Threat of cross infection
o Accident hazards o Faulty eating habits
o Poor environmental sanitation o Unhealthy lifestyle/personal habits
HEALTH THREAT 202.
o Anticipated periods of unusual demand on the individual or family in terms of
adjustment/family resources o EXAMPLES: o Marriage o Pregnancy o Parenthood o Divorce or separation o Loss of job o Menopause o Death FORESEEABLE CRISIS 203.
o NATURE OF THE PROBLEM – categorized into health deficit, health threat and
o Health deficit 3 o Health threat 2 o Foreseeable crisis 1
PRIORITIZING HEALTH PROBLEMS 204.
o MODIFIABILITY OF THE PROBLEM – refers to the probability of success in
minimizing, alleviating or totally eradicating the problem through intervention
o Easily modifiable 2 o Partially modifiable 1 o Not modifiable 0
205.
o PREVENTIVE POTENTIAL –refers to the nature and magnitude of future
problems that can be minimized or totally prevented if intervention is done on the problem under consideration
o High 3 o Moderate 2 o Low 1
206.
o SALIENCE – refers to the family’s perception and evaluation of the problem in
terms of seriousness and urgency of attention needed
o A serious problem, immediate attention needed 2 o A problem, but not needing immediate attention 1 o Not a felt need / problem 0
207. NURSING PROCEDURES 208.
o ____ Take clinical history
o ___ Write findings on client records o ___ Perform physical assessment o ___ Greet and make client at ease o ___ Do laboratory examinations
o ___ Take temperature, blood pressure, height and weight
PRE-CONSULTATION CONFERENCE 1 2 3 4 5 6 209.
o ___ Inform physician of relevant findings gathered in pre-conference o ___ Observe confidentiality of examination results
o ___ Ensure privacy, safety and comfort of patient throughout procedure o ___ Work with the physician during the examination
o ___ Assist client before, during and after examination by physician
MEDICAL EXAMINATION 1 2 3 4 5 210.
o ___ Counseling
o ___ Seek information regarding health status of other family members o ___ Explain and reinforce physician’s orders and advises
o ___ Teach patient measures to promote and maintain health as proper diet,
exercise and personal hygiene
o ___ Carry out physician’s orders as giving medication or injection
NURSING INTERVENTION 1 2 3 4 5 211.
o ____ Make appointment for next clinic/home visit o ____ Refer patient to other health worker/agency o ____ Explain findings and needed care or intervention
POST-CONSULTATION CONFERENCE 1 2 3
212. ACIVITIES OF THE COMMUNITY HEALTH NURSE 213.
o Made to a client or a responsible member of the family
o GOAL : provide necessary health care activities and further attain an objective of
the agency
o A professional face-to-face contact made by a nurse to the patient or the family
H O M E V I S I T
214. PHASES OF A HOME VISIT
o PREPARATORY PHASE
Review existing records or referral data Notifies family of intention
Introduce self and explains purpose o HOME VISIT PHASE
Actual visit to the patient
Assessment, planning, and health teaching o POST-VISIT PHASE
Records data in the chart Plan for next visit
Referral to other health professionals
215. STEPS IN A HOME VISIT
o 1.Greet client and introduce self. o 2. Explain purpose.
o 3. Inquire about health and welfare. o 4. Place bag in a convenient place. o 5. Wash hands and wear apron.
o 6. Perform physical assessment & nursing care. o 7. Give necessary health teaching.
o 9. Record findings.
o 10. Make appointment for clinic or home visit.
216.
217.
o A tool using a public health bag done during a home visit
o The nurse can perform nursing procedures with ease and deftness o Saving time and effort in view of rendering effective nursing care
B A G T E C H N I Q U E 218.
o Use of bag technique should minimize, if not totally prevent, the spread of
infection
o Should save time and effort in the performance of nursing procedures o Should not overshadow concern for the patient
o Show the effectiveness of total care given to individual or family
PRINCIPLES OF BAG TECHNIQUE 219.
o Should contain all necessary articles and equipments o Bag and contents should be cleaned as often as possible
o Should be protected from contact with any article in the home of the patient o Arrangement of the contents should be convenient
o Handwashing should be done frequently
o When used in a communicable case, should be thoroughly cleaned and disinfected
before keeping and re-using SPECIAL CONSIDERATIONS
220.
o thermometers in case (1 oral & 1 rectal) o syringes o alcohol lamp o sputum cup o medicine dropper o zephiran solution o benedict solution o tape measure o hypodermic needles
CONTENTS OF THE PHN BAG 221.
o Essential health care made universally acceptable to individuals and families in
the community
o By means acceptable to them and through their full participation o At a cost that the community and country can afford at every stage of
development
P R I M A R Y H E A L T H C A R E 223.
o GOAL : Health for all Filipinos and Health in the Hands of the People by the year
2020
o MISSION : To strengthen the health care system wherein people will manage
their own health care
o CONCEPT : partnership and empowerment of the people o LEGAL BASIS:
Letter of Instruction 949 President Ferdinand Marcos October 19, 1979
224.
o First International Conference on Primary Health care Alma Ata, USSR
September 6-12, 1978
Sponsored by the World Health Organization and UNICEF
225. ELEMENTS/COMPONENTS of PHC
o Education for Health
o Locally Endemic Disease Control o Expanded Program on Immunization o Maternal and Child Health
o Essential Drugs and Elderly Care o Nutrition
o Treatment of CD and Non-CD o Sanitation: Water & Environment
ELEMENTS 226.
o Framework for meeting the goal of primary health care
o Calls for active and continuing partnership among the communities, private and
government agencies in health development O R G A N I Z A T I O N A L S T R A T E G Y 227. LEVELS OF HEALTH CARE SERVICES
o PRIMARY
Barangay Health Station Private Practitioners
Community Hospitals Rural Health Unit o SECONDARY
Emergency/District Hospitals Provincial/City Hospitals
228. LEVELS OF HEALTH CARE SERVICES
o TERTIARY
Regional Medical Centers and Training Hospitals National Medical Centers
Teaching and Training Hospital
229.
o VILLAGE / BARANGAY HEALTH WORKERS (V/BHWs) o - Trained community health workers
o - Health auxiliary volunteer
o - Traditional birth attendant or healer
o INTERMEDIATE LEVEL HEALTH WORKERS - General medical practitioner
- Public health nurse - Rural sanitary inspector - Midwives
TWO LEVELS OF PHC WORKERS 230.
o DOH PROGRAMS
231.
o ental health program o steoporosis prevention
o ealth education & community organizing o rimary health care
o eproductive health
o lder persons health service o uidelines for good nutrition o espiratory Infection Control o lternative health care o aternal and child care o entrong Sigla Movement
DOH PROGRAMS 232.
o DENTAL HEALTH PROGRAM
233.
o VISION: A lifetime of oral health & no tooth decay for the next generation o STRATEGIES
Coordination and partnership with sectoral groups Networking
Capacity building and work value formation
DENTAL HEALTH PROGRAM 234.
o Project for Social Mobilization o AIM:
Emphasize the importance of oral health in relation to total body health Increase public awareness on the prevention of common dental diseases Solicit one million new toothbrushes from concerned citizens
"Sang Milyong Sepilyo"
235. EXPANDED PROGRAM ON IMMUNIZATION (EPI) 236.
o EXPANDED PROGRAM ON IMMUNIZATION
o A program implemented under PD no. 996 signed on September 16, 1976 which
provides for compulsory basic immunization for infants & children below 8 years old
237. ELEMENTS OF EPI (SACIT)
o Surveillance, studies & research
o Assessment & evaluation of the program’s overall performance o Cold chain logistic management
o Information, Education & Communication o Target setting
238. Principles & Legal Basis
o Based on EPIDEMIOLOGICAL SITUATION o Mass Approach
o basic health service (it is integrated into the health system)
o P.D. 996 – compulsory basic immunization for infants and children below 8 years
old
o R.A. 7846 – compulsory Hep B immunization for infants and children below 8
years old 239.
o 2 IMPORTANT GOALS OF THE PROGRAM:
o To reduce the morbidity & mortality rates of the 7 EPI diseases
o To reduce the incidence of neonatal tetanus by providing pregnant women with
TT immunization 240.
o APRIL 6, 1986 – PP no. 6 – enjoin all gov’t. as well as NGOs to achieve the goal
of immunizing every Filipino against the 6 EPI diseases:
o Poliomyelitis o Measles o Diptheria
o Pertussis o Tetanus o Tuberculosis
o Hepatitis B – added recently
241. The seven target EPI Diseases
o 1) Tuberculosis
o A specific, chronic, infectious disease caused by Mycobacterium tuberculosis,
characterized by the formation of tubercles in the tissues. 242.
o 2) Diphtheria
o An acute, specific, highly infectious, epidemic and endemic disease caused by
Corynebacterium diphtheria; transmitted by direct and indirect contact and carrier. 243.
o 3) Pertussis
o Whooping cough. A highly communicable infectious disease of children with
paroxysms of coughing that reach a peak of violence ending in a long-drawn inspiration that produces a characteristic “whoop”.
244.
o 4) Tetanus
o An acute infectious disease induced by the toxin of Clostridium tetani, an
anaerobic organism growing at the site of injury to body tissue. Is characterized by painful muscular contractions, chiefly of the face and neck, hence the
appellation “lockjaw”. 245.
o 5) Poliomyelitis
o Inflammation of the grey matter of the spinal cord; an acute epidemic viral
disease
o most commonly affecting children; marked by fever, headache, sore throat, stiff
neck, gastrointestinal symptoms. 246.
o 6) Measles
o Rubeola. An acute, highly contagious, febrile, exanthematous viral disease;
spread by droplets; characterized by fever, blotchy rash, and catarrhal inflammation of the mucous membranes; associated with high rate of complications.
247.
o 7) Hepatitis B
o May be transmitted by contaminated needles, blood mucous membranes (sexual
intercourse), or ingestion of contaminated food; characterized by increase in aspartate transaminase and alanine transaminase level and increased bilirubin in the blood.
248. Fully immunized Child (Revised in 1996)
o A child who has received the following vaccines o 1 BCG, 3 DPT, 3 OPV, 3 Hep B, 1 MV
o At the right intervals
249. Dosage, route & site of administration Deltoid region, upper arm Intramuscular 0.5 ml TT Outer part of the upper arm Subcutaneous 0.5 ml Measles Upper outer portion thigh Deep IM 0.5 ml DPT Upper outer portion thigh Intramuscular 0.5 ml Hep B Mouth Oral 2 drops OPV Deltoid region right arm Intradermal Infants 0.05 ml BCG Site of Adm. Route of Adm. Dose Vaccine
250. Routine Immunization Schedule for Infants Vaccine Min Age, 1st Dose No. of Doses Min Interval Bet. Doses Reason BCG Birth, anytime after birth 1 - BCG given early protects infants against TB meningitis infection from family members
251. Routine Immunization Schedule for Infants Vaccine Min Age, 1st Dose No. of Doses Min Interval Bet. Doses Reason OPV 6 weeks 3 4 weeks When given early increases extent of protection against polio
252. Routine Immunization Schedule for Infants Vaccine Min Age, 1st Dose No. of Doses Minimum Interval Bet. Doses Reason Hep B w/in 24 hrs of birth 3 6 weeks from 1 st dose to 2 nd dose, and; 8 weeks interval from 2 nd dose to 3 rd dose - Early start reduces chance of infection & becoming a carrier - Eliminate HB before 2012 ( a western regional goal)
253. Routine Immunization Schedule for Infants Vaccine Min Age, 1st Dose No. of Doses Min Interval Bet. Doses Reason DPT 6 weeks 3 4 weeks Early start reduces chance of severe pertussis
254. Routine Immunization Schedule for Infants Vaccine Min Age, 1st Dose No. of Doses Min Interval Bet. Doses Reason Measles 9 months 1 -
o At least 85% of measles cases can be prevented by immunizing at this age o - Eliminate measles by 2008
255. Immunization schedule for mothers Vaccine Minimum interval Percent protection Duration of Protection TT 1 As early as possible during pregnancy
256. Immunization schedule for mothers Vaccine Minimum interval Percent protection Duration of Protection TT 2 At least 4 weeks after TT 1 80 % Infants protected from neonatal tetanus, 3 years protection for the mother against tetanus
257. Immunization schedule for mothers Vaccine Minimum interval Percent protection Duration of Protection TT 3 At least 6 months after TT 2 95% Infants protected from neonatal tetanus, 5 years protection for the mother against tetanus
258. Immunization schedule for mothers Vaccine Minimum interval Percent protection Duration of Protection TT 4 At least 1 year after TT 3 99% Infants protected from
neonatal tetanus, 10 years protection for the mother against tetanus
259. Immunization schedule for mothers Vaccine Minimum interval Percent protection Duration of Protection TT 5 At least 1 year after TT 4 99% Infants protected from
neonatal tetanus, lifetime protection for the mother against tetanus 260.
o QUESTION:
o If a woman received 3 doses of DPT during infancy, what will be her current TT
immunization schedule?
o A) TT1, previous 3 DPT doses not significant o B) TT2, 3 doses of DPT equals TT1
o C) TT3, 3 doses of DPT considered TT1 & TT2 o D) TT4, 3 doses of DPT equals 3 TT shots o ANSWER: C
261. Discard point of OPV using the VVM Constant Temperature, Day and Night Length of Time VVM Reaches “Discard Point” At room temperature + 25 ˚C 8 days At room temperature + 20 ˚C 20 days At room temperature + 4 ˚C 180 days At room temperature - 20 ˚C Over 2 years
262. Proper stocking of Vaccines (refrigerator)
o Neatly arrange the vaccines (segregated by type) o Domestic refrigerator
o - freezer compartment -OPV, AMV o - body - BCG, DPT, Hep B, TT, Diluent o Modified refrigerator
o - freezer compartment - ice packs o - Body
Top - OPV, AMV
Middle - BCG, DPT, Hep B, TT, Diluent Lower - Bottles/ ice packs with water
263. How to Maintain Cold Chain
o Stocking of Vaccines in the Transport Box Vaccine Carrier o Make sure you have enough ice packs
o transport box – 24 pcs o Vaccine carrier – 4 pcs
o Place OPV, AMV in contact with frozen ice packs o Wrap DPT, Hep B, TT with paper
o Place BCG in between AMV, OPV and wrapped vaccines
264. What to do with Opened vials of Vaccines?
o I. Continue to use opened vials in the subsequent sessions if all these conditions
are met:
Expiry date has not passed
Vaccines are stored appropriately (+2 to +8 ˚C) Sterile procedures have been fully observed Opened vial has not been contaminated
265.
o NOTE:
o Discard opened BCG and MV after 6 hours of reconstitution.
o Opened vials of DPT, Hep B, TT can still be used for 4 weeks provided condition
1-4 in the previous slide are met. 266.
o II. Discard an opened vial immediately if any of the following conditions apply: o Sterile procedures have not been fully observed
o + Suspicion of contamination of the opened vial
o + Visible evidence of contamination (e.g. change in appearance or presence of
floating particles) 267.
o If the label has come off, or
o If the VVM has reached discard point the inner square matches, or is darker than the circle
o Reconstituted vaccines (BCG, AMV) after 6 hours of reconstitution
268.
o What is reconstitution?
o To restore to the original state by adding water; To build up again by putting back
together the original pieces.
o What is a diluent?
o An inert substance that dilutes the strength of a solution or mixture.
269. What is thermal shock?
o It is the process of damage to the vaccine resulting from the use of diluent that is
at too high a temperature (above +8°C).
o It results in the death of some or all of the essential live organisms in the vaccine.
270.
271. How to read a vaccine vial monitor The inner square is lighter than the outer circle. If the expiry date has not passed, USE the vaccine. As time passes the inner square is still lighter than the outer circle. If the expiry date has not passed, USE the vaccine. Discard point: the colour of the inner square matches that of the outer circle. DO NOT USE the vaccine. Beyond the discard point: inner square is darker than the outer circle. DO NOT USE the vaccine.
272. POINTS to REMEMBER:
o Only diluent supplied by the manufacturer, specific for the vaccine, should be
used. No other diluent may be used.
o Distilled water for injection should NOT be used as a vaccine diluent.
273.
o Oral vaccine diluents should never be injected.
o To ensure the correct quantities are available, diluents must be shipped and
distributed together with the vaccine vials that it will be used to reconstitute. 274. During the Reconstitution process:
o Only the diluent supplied by the manufacturer should be used to reconstitute a
freeze-dried vaccine.
o A sterile needle and sterile syringe must be used for each vial for adding the
diluent to the powder in a single vial or ampoule of freeze dried vaccine.
o Special care must be taken in opening ampules to avoid loss of the dry vaccine.
275. Vaccinators and store keepers should always:
o Include diluents in stock control and ensure adequate supplies.
o Check that the vaccines have been supplied with the right diluent. If any error is
noted, the vaccine should not be used and the supervisor must be notified immeditely.
o Use only the diluent that is indicated for each type of vaccine and manufacturer.
276.
Ensure the volume of diluent used is correct so that the proper number of
doses per vial is obtained.
Ensure that no other medication or substance which might be confused
with the vaccine or its diluent is stored in the refrigerator of the immunization centre.
Reconstituted vaccine should be kept on ice to preserve its potency (by
maintaining the maximum possible number of live organisms in each dose).
277.
A sterile needle and sterile syringe must be used for each separate dose of
reconstituted vaccine drawn from the vial.
The reconstituted vaccine must be kept cool and any remaining liquid
must be discarded after 6 hours.
278. Sizes of syringe and Needle to use During Vaccination DPT, MV and TT - use 2-3 ml syringe with 25 or 2-30 mm 22-3 or 25 gauge needle BCG - use 1 ml tuberculin syringe with 10 mm 26 gauge needle In mixing vaccines - use 5 or 10 ml syringe with 18 gauge needle
279. Proper ways of handling syringes and needles
o Disposal of used syringes and needles o Immediately after use
Do not recap the needle
Place them in a safety collector box o Disposal options
Burn in pit, bury Collect and incinerate
280.
o Absolute Contraindications to Immunization: o BCG to a baby born from a mother with AIDS
o DPT2 and DPT3 to a child who develops convulsion within 3 days of giving DPT o Infants and children with active neurologic disease
o Relative contraindication
o Any illness which warrants admission to the hospital.
281. "first expiry and first out" (FEFO)
o A "first expiry and first out" (FEFO) vaccine system is practiced to
assure that all vaccines are utilized before its expiry date. Proper arrangement of vaccines and/or labeling of expiry dates are done to identify those close to expiring.
o Vaccine temperature is monitored twice a day (early in the morning and in the
afternoon) in all health facilities and plotted to monitor break in the cold chain. 282. MIND GAMES – WHAT ARE INSIDE THE BOTTLE?
283.
o Implementing guidelines on Hepatitis B Immunization for Infants
284.
o Rationale
hepatitis B is the major health problem in the Philippines 10-12 % of the total population are chronically infected
No affordable and effective drug treatment are currently available 90% of chronic carriers of infection acquire their infection at birth or in
early childhood 285. Objectives
o To improve effectiveness of management in the provision of 3 doses of routine
Hepatitis B vaccine among infants including a birth dose.
o Specific:
o To provide new guidelines & procedures for Hepatitis B vaccination for infants at
all types of health facilities.
o To provide instructions for administration of birth dose Hepatitis B vaccine accdg
to the settings where the birth takes place.
286. New Schedule of Hep. B, DPT & OPV Note: Hep B1 was 6 weeks (old DOH book ); now AT BIRTH (p. 149 new DOH book) Age Hep B DPT OPV At Birth (within 24 hours) Hep B 1 6 weeks Hep B 2 DPT 1 OPV 1 10 weeks DPT 2 OPV 2 14 weeks Hep B 3 DPT 3 OPV 3
287.
o Type of Vaccine
o - Recombinant or genetically engineered vaccine using HBsAg (10mg dose) o - Synthesized in yeast or mammalion cells into which HBsAg gene has been
inserted.
o Formulation
o - Monovalent Hepatitis B vaccine/ univalent o Protects only against Hepatitis B
o Single antigen formulation o Used for birth dose
o - Combination vaccines (multivalent) o Protects against Hepatitis B & other dse o (DPT-Hep B, DPT-Hep B +HiB, Hib-Hep B) o Combination with other vaccine
o Used for subsequent doses
288.
o Dosage
o Standard pediatric dose is 0.5 ml o Sites of administration
o - Recommended series of 3 doses of hepatitis B vaccine shall be given
intramuscularly only in the anterolateral thigh muscle .
o - Hepatitis B vaccine
o Shouldn’t be given in the buttocks o Risk of injury to the sciatic nerve o Shouldn’t be given intradermal
o It doesn’t produce adequate antibody response to children o Shouldn’t be mixed in the same syringe with other vaccine
289.
o Vaccine storage and handling Hep B vaccine
o Stored in refrigerators provided solely for vaccine storage at +2 to +8 ˚C o Transported properly in once-packed containers with cold chain monitors or
thermometer
o Should never be frozen or allowed to come into direct contact with ice because it
will be inactivated and will no longer be potent.
290.
o Indication and Contraindication
o No contraindication for the administration of Hep B vaccine to a newborn within
24 hours of birth. Used to protect against Hepatitis B virus.
o Vaccine side effects and adverse Reaction o Hep B vaccine is one of the safest vaccines. o Mild reaction include:
o Soreness & fever at the injection site o Serious reaction: Anaphylaxis
o – risk for anaphylaxis is estimated at 1/600,000 doses
291.
o Administration of Hep B vaccine birth dose
o While 2nd dose and 3rd dose of Hep b vaccine shall be administered along with
1st and 3rd dose of DPT and OPV, administration of the 1st dose within 24 hour of birth.
o Hospitals and lying-in Clinics
o A) No mother/child should be discharged from the hospital without providing the
birth dose of Hepatitis b vaccine to the newborn.
o B) Provision of birth dose of Hep B vaccine as part of the standing order for the
routine care of medically stable infants weighing equal to or more than 2000 grams at birth.
292.
o Health centers & Barangay Health Stations
o All infants attended at birth by midwives from the health center/BHS shall be
given the monovalent Hepatitis B vaccine within 24 hours after birth . 293.
o Birth taking place outside health facilities o attended by traditional birth attendants or o other non-trained providers
o A) TBA or mother should be advised to inform the nearest health facility either by
phone or by personal visit for the provision of the Hep B and BCG
o B) Or bring the newborn to the health facility for vaccination
o C) Or the midwife will give immunization during house visit within 7 days after
delivery 294.
o Calculation of Hepatitis B Vaccine Needs o (Steps for Calculating Hep B requirement) o 1) Identify the important data for computation:
Eligible Population (EP) of infants o EP= Total Population (TP) x 3%
Wastage Multiplier : 1.2 o National:
o Reserve stock :25%
o Reserve stock multiplier: 1.25 o Region/ province/city:
o Reserve Stock Multiplier : 1.125 o Municipality
o Reserve Stock: 12.5%
o Reserve Stock multiplier: 1.1
295.
o 2) Formula
o Hep B requirements of National/Provincial/city level
o =EPx no. of doses x wastage multiplier x reserve stock multiplier o Hep B requirements of lower level
o = EP x no. of doses x wastage multiplier x reserve stock multiplier
296.
o SEATWORK:
o Given: Province A with a total population of 2,000,000 for 2006.Compute for the
annual requirements for hepatitis B
o Compute for the eligible population infants for Province A o Calculate for the annual needs (in doses) for Province A o Calculate for annual needs (in vials) for Province A.
297.
o Sample Computation
o Given: Province A with a total population of 2,000,000 for 2006.Compute for the
annual requirements for hepatitis B
o Compute for the eligible population infants for Province A o 2,000,000 x 0.03 = 60,000 infants
o Calculate for the annual needs (in doses) for Province A o 60,000 x 3 doses x 1.2 x 1.125= 243,000 doses
o Calculate for annual needs (in vials) for Province A. o 243,000 doses / 10 doses per vial = 24,300 vials
298.
o QUESTION:
o 1) It refers to a protein which can stimulate the production of antibodies and react
specifically with those antibodies.
o A) glycoprotein o B) vaccines o C) toxoids o D) antigen o ANSWER: D 299. o QUESTION:
o It is a class of specific protein substances in the blood that destroy or render
inactive certain foreign substances, particularly bacteria.
o A) antigen o B) anti-toxin o C) toxoids o D) antibody o ANSWER: D
300.
o QUESTION:
o Which of the following is NOT an element of EPI? o A) Information, Education & Communication o B) Surveillance, studies & research
o C) Target setting o D) Vaccine safety o ANSWER: D
301.
o QUESTION:
o The law which requires compulsory basic immunization for infants and children
below 8 years old.
o A) R.A.7846 o B) P.D. 996 o C) R.A. 8746 o D) P.D. 966 o ANSWER: B 302. o QUESTION:
o Which of the following does not belong to the 7 target EPI diseases? o A) diphtheria o B) tuberculosis o C) diabetes o D) tetanus o ANSWER: C 303. o QUESTION:
o It is a highly communicable infectious disease of children with paroxysms of
coughing that reach a peak of violence ending in a long-drawn inspiration that produces a characteristic “whoop”.
o A) emphysema o B) pertussis o C) tuberculosis o D) bronchial asthma o ANSWER: B 304. o QUESTION:
o Which of the following is a fully immunized child?
o A) a 7 month old child who has received 1 MV, 1 BCG, 1 Hep B, 3 DPT and 3
OPV
o B) an 18 month old child who had just completed his 1 BCG, 1 Hep B, 1MV, 3
DPT and 3 OPV
o C) a 1 yr old child who had just completed his 1 BCG, 1MV, 3 Hep B, 3 DPT and
3 OPV
o ANSWER: C
305.
o QUESTION:
o When is the recommended schedule for Hep B2? o A) within 24 hours o B) together with DPT1 o C) together with DPT2 o D) 14 weeks o ANSWER: B 306. o QUESTION:
o Hepatitis B vaccine should not be given in the buttocks because of: o A) gluteal muscle irritation and pain
o B) inadequate antibody production response to children in that area o C) risk of hematoma formation
o D) potential injury to the sciatic nerve o ANSWER: D
307.
o QUESTION:
o Which of the following is an inappropriate nursing intervention about Hepatitis B
vaccine?
o A) Shouldn’t be given intradermal
o B) Should be given in the anterolateral thigh muscle
o C) Should do shake test to determine if the vaccine has been damaged by heat o D) Shouldn’t be frozen to preserve its potency
o ANSWER: C
308.
o QUESTION:
o Which of the following is appropriate?
o A) No mother/child should be discharged from the hospital without providing the
mother the required Hepatitis b vaccine.
o B) Provision of birth dose of Hepatitis B vaccine to infants weighing equal to or
more than 1000 grams at birth.
o C) Infants attended at birth by midwives shall be given the combination Hepatitis
B vaccine within 24 hours after birth.
o D) If birth is attended by TBA outside regular health facilities, the midwife will
give immunization during house visit within 7 days after delivery
o ANSWER: D
309.
o QUESTION:
o It assure that all vaccines are utilized before its expiry date ? o A) vaccine vial monitoring
o B) FEFO system
o C) cold chain management o D) ECCD monitoring
