COMMUNITY HEALTH NURSING Storage of Vaccines

Lincoln T. Sumaylo, MAN, RN o Regional – 6 months

o City\Municipality – 3 months
Primary Goal: o Health Center – 1 month
o Health in the hands of the people.
Note: Check vaccine temperature twice a day,
Ultimate Goal: once in the morning and once in the evening
o To raise the level of health of the citizen.
12 Cranial Nerves
Community:
 Group of people interacting with each 1 O Olfactory Sensory
other. 2 O Optic Sensory
 Sharing common values, interests, and 3 O Oculomotor Motor
goals. 4 T Trochlear Motor
Health: 5 T Trigeminal MIXED
 Optimum level of functioning. 6 A Abducens Motor
 State of complete physical, mental, and 7 F Facial MIXED
social well-being. 8 A Auditory Sensory
Nursing: 9 G Glossopharyngeal MIXED
 Art and science of rendering care. 10 V Vagus MIXED
– An act of assisting the sick and the 11 A Spinal Accessory Motor
well. 12 H Hypoglossal Motor
3 Types of Community
VACCINES
 Urban = High View of Health
 Rural = Agricultural community
Bacillus Calmette–Guerin Vaccine (BCG)
 Suburban = Mixed type
- At birth (1st 2 months of life)
- Intradermal (Deltoid) (10° - 15° degree angle
EPI\NIP Needle Position)
- <12 months = 0.05mL
RA 10152: Mandatory Infants and children health - >12 months = 0.1mL
immunization act of 2011.
 All vaccines are free for children <5 years Purified Protein Derivative (PPD) skin test
old. - 48 – 72 hours (2 – 3 days)
Results:
PD 996: To provide basic immunization services  5mm (+) Positive
to all preschool and primary school entrants who  10mm High-Risk (+) Positive
have not received such immunization  15mm Low Risk (+) Positive
COLD CHAIN LOGISTICS Drug of Choice
- To preserve the potency of the Vaccines.
Drugs Side Effects
MOST SENSITIVE TO LESS SENSITIVE R Rifampicin Red-orange urine
HEAT TO HEAT I Isoniazid Peripheral Neuropathy
Measles Tetanus Toxoid
OPV DPT P Pyrazinamide Hepatotoxic
Put on freezer = -15°C E Ethambutol Optic Neuritis
Hepa B
to -25°C
S Streptomycin Ototoxic
BCG
Body of refrigerator =
+2°C to +8°C TB (Tuberculosis)
Causative Agent: Mycobacterium TB
Formula: Mode of Transmission:
o PNLE / Droplet
 C° - (1.8 X C°+32=)
o NCLEX / Airborne Droplet
 F° - (32-F°/1.8=)
Diagnostic Tests for TB:
Schedules
o PPD
 Every WEDNESDAY is Immunization Day.
 Every THURSDAY is TT Day. o X-Ray
o Sputum Smear – Confirmatory Test
Hepatitis B Vaccine (Hepa B) Measles Vaccine
- At birth (1st 24 hours) - At 9 months (2nd dose – after 6 months)
- Intramuscular (Vastus Lateralis) - Subcutaneous (Outer Portion of Upper
- (90° degree angle Needle Position) Arm)
- Dose = 0.5mL - Dose = 0.5Ml
- Give HBIG the first 12hrs. (0.5mL) if the - 85% Protected
mother is Hepa B positive.
Japanese Encephalitis Vaccine
Pentavalent Vaccine 1 - At 9 months (Booster dose – after 12
- At 6 weeks years)
- Intramuscular (Vastus Lateralis) - Subcutaneous (Outer Portion of Upper
- Dose = 0.5mL Arm)
- Diphtheria, Pertussis, Tetanus, Hepatitis B - Dose = 0.5mL
(DPTH) - 9 to 17 yrs, old (Primary Dose)
- Hemophilus influenzae type B - 18 yrs. Old and above (Single Dose Only)

Pneumococcal Conjugate Vaccine 1 Mumps, Measles, Rubella Vaccine (MMR)

- At 6 weeks - At 12 months (2nd dose – after 4-6 yrs. old)
- Intramuscular (Vastus Lateralis) - Subcutaneous (Outer Portion of Upper
- Dose = 0.5mL Arm)
- Dose = 0.5mL
Inactive Polio Vaccine
- At 6 weeks Varicella Vaccine
- Intramuscular (Vastus Lateralis) - At 12 months (2nd dose – after 4-6 years
- Dose = 0.5mL old)
- Subcutaneous (Outer Portion of Upper
Rotavirus Vaccine 1 Arm)
- At 6 weeks - Dose = 0.5mL
- Oral
- 2 types: RV1, RV5 Hepatitis A Vaccine (Hepa A)
 RV1: Rotarix - At 12 months (2nd dose – after 6 months)
o 2 doses - Intramuscular (Vastus Lateralis)
o 1mL\ dose - Dose = 0.5mL
o Give an additional 1 dose if the
patient vomited
 RV5: Rota Teq LIVE ATTENUATED INACTIVATED
o 2 doses
o 2mL\ dose BCG Hepa B Vaccine
o No additional dose if the patient Rotavirus Vaccine Pentavalent Vaccine
vomited
Measles Vaccine PCV
Pentavalent Vaccine 2 JEV IPV
Pneumococcal Conjugate Vaccine 2 MMR Vaccine Influenza Vaccine
Inactive Polio Vaccine Varicella Vaccine Hepa A Vaccine
Rotavirus Vaccine 2
- At 10 weeks (Same Considerations)
Pentavalent Vaccine 3 MATERNAL SUPPLEMENTATIONS
Pneumococcal Conjugate Vaccine 3
Inactive Polio Vaccine Tetanus Toxoid
Rotavirus Vaccine 3 % of Yrs. Of
Vaccine Interval
- At 14 weeks (Same Considerations) Protection Protection
ASAP
Influenza Vaccine 1 TT1 (During 0% 0
- At 6 months Pregnancy)
- Intramuscular, Subcutaneous (Vastus
TT2 1 month 80% 3 years
Lateralis)
- Trivalent (Both) TT3 6 months 95% 5 years
- Quadrivalent (Intramuscular) TT4 1 year 99% 10 years
- Dose = 6 months – 35 months: 0.25mL TT5 1 year 99% Lifetime
= 36 months – 18 years: 0.5mL
 o Dyad
Vitamin A Supplementation Community
Pregnant: – Primary client in the community.
 Dose = 10,000 IU X 2\ week – Focus of CHN
 Start 4 months from pregnancy until
delivery.  Municipal – Mayor
 Vitamin A = Retinol  Provincial – Governor

Pregnant with Xeropthalmia:  Primary Focus– Health Promotion

 Dose 10,000 IU\ week  Primary responsibility– Health
 Give once a day for 4 weeks. Education
 Fundamental Hallmark of Nursing
Post-Partum: Responsibility– Right documentation
– Dose = 200,000 IU (one dose)  Role– Facilitator
– Give within 4 weeks after delivery.  Population
 Group of people with distinct ways or
Iron Supplementation patterns of life.
- To prevent neural tube defects - folic acid  e.g., elderly, adolescents, toddlers, etc.
Pregnant
– Dose = 60mg with 400mg Folic Acid
– Give 1 tablet once a day for 6 months PUBLIC HEALTH NURSING
Goal:
Lactating: - To enable every citizen to realize his
– Dose = 60mg with 400mg Folic Acid birthright of health and longevity.
– Give 1 tablet once a day for 3 months
Schedule of Clinical Visits 3P’s
 ASAP after a missed period (1st visit) - Promote health
 4 weeks to 28 weeks (Once a week) - Prevent disease
 28 weeks to 36 weeks (Every 2 weeks) - Prolong life
 37 weeks to delivery (Every week)
Objectives of PHN
BREAST FEEDING o C – Control of communicable disease
– Colostrum is rich in secretory o O – Organization of Medical and Nursing
immunoglobulin A (IgA), which helps to services
protect the infant from infection. Colostrum o D – Development of social machinery
also helps to establish a normal gut o E – Education of individual, family, and
microbiome in the infant. The bowel is community
considered sterile at birth. o S – Sanitation of the environment
– Breastfeeding can help protect babies
against some short- and long-term Criteria for Prioritization of Health
illnesses and diseases. Breastfed babies  Nature of the problem
have a lower risk of asthma, obesity, type  Modifiability of the problem
1 diabetes, and sudden infant death  Preventive potential
syndrome (SIDS).  Salience of the problem
LEVELS OF CLIENTELE Nature of the Problem
o Health deficit =3
 Individual: Point of entry in the community.
- Existing problem
 Family: Bounded by birth, marriage, blood,
- Disability; a gap between actual and
adoption, and emotions.
achievable health status.
B – Basic unit of the society
o Health threat =2
F – Focus of care
- Risk or potential problem
U – Unit of service
- Conditions conducive to acquiring
the disease.
Types of Family
o Foreseeable crisis = 1
o Nuclear
- Anticipated period of unusual
o Extended
demand.
o Blended
- Needs adaptation or adjustment
o Intergenerational within the family circle.
o Cohabitational
 - Identify, plan, and solve the
problem
Modifiability of the Problem Participatory Action Research:
- Easily modifiable =2 - Approach: “Active participation”
- Partially modifiable =1 - Investigation of the Problem
- Not modifiable =0 Role of a nurse: Facilitator
Preventive Potential Role of the people: Leaders
- High =3
- Moderately =2 Phases of COPAR
- Low =1  Pre-entry
Salience of the Problem  Entry
- Serious problem =2  Study\diagnosing
- A problem =1  Organizing
- Not a felt problem =0  Action
 Sustenance and Strengthening
 Turn over
EPIDEMIOLOGY
 Study of health and illness Pre-Entry Phase
 Backbones in the prevention of the - “Site selection”
disease - Preliminary social investigation
- Community consultations
 Sporadic - Community assembly
- Seasonal Criteria for Site Selection
- Occasional (On\Off) D – Depressed
- Intermittent O – Oppressed
P – Poor
 Endemic E – Exploited
- Constant S – Struggling, Safe
- Continuous Entry Phase
Example: - “Core group formation”
DENGUE MALARIA - Courtesy call (Leaders)
- Information campaigns
Day Biting Night Biting
- Continuing social investigation
Low Flying High Flying - SALT
Stagnant Running o Characteristics of Leaders
Urban Rural P – Poor
R – Respected
C – Communicator
 Epidemic D – Desire for change
- Sudden increase in numbers O – Open-minded
- Outbreak C – Charismatic
- Location-based
Study\Diagnosis Phase
 Pandemic - “Data\Study\Research”
- Worldwide epidemic - Research phase
- Start of PAR
- Community profiling
COPAR - Data analysis
- Community diagnosis
 C – Community - Prioritization of community needs
 O – Organizing. Organization Phase
 P – Participatory - “Form community health
 A – Action organization”
 R – Research. - Capability phase
- Election of officers
Goal of COPAR: - Training of officers
o Social transformation - Plan a solution for the problem
o Active Participation Action Phase
- “Form Community Health
Community Organizing: Workers”
 -Activities to solve the problem
-Exercise people’s power Considerations: 3C
-Setting up for linkages\network - Content
referral system - Cleanliness
- PIME - Contamination
Sustenance\Strengthening Phase Work field – Paper-lining touch
- Formalization of linkages  Inner surface: CLEAN
- Continue training and education  Outer surface: UNCLEAN
- Develop and maintain medium
and long-term CHD plans HOME VISIT
Turn-over Phase o Purposeful, professional nurse-client face-to-
- Check the structure face interaction for the provision of various
- Monitor development health care and nursing services.
- Phase out o It is the best method of evaluating long-term
care.
LAWS
Principles: PIN+O
Traditional & Alternative
R.A. 8423 P – Plans must be flexible \ practical
Medicine Act (TAMA 1997)
I – Information available must be utilized
Universal Accessible Cheaper
N – Needs of the family should be the priority
R.A. 9502 and Quality Medicines Act of
+ – Add or involve the family
2008
O – Objectives and purpose must be present
Philippine AIDS Prevention and
R.A. 8504
Control Act of 1998 Purpose:
Act on Salt Iodization Nationwide  Give nursing care
R.A. 8172
(ASIN LAW) - Newborn
R.A. 9211 Tobacco Regulation Act of 2003 - Post-partum
Code on Sanitation of the - Pregnant
P.D. 856
Philippines - Sick individuals
Anti-Violence Against Women  To assess the living conditions
R.A. 9262
and their Children Act of 2004  To establish close-relationships
R.A. 9482 Anti-Rabies Act of 2007  To promote the utilization of community
Comprehensive Dangerous Drug services
R.A. 6425
Act of 2002
Mandatory Reporting of Steps in Home visit:
Notifiable Diseases and Health 1. Extend courtesy through a greeting.
R.A. 3573
Events of Public Health Concern 2. Introduce yourself.
Act 3. Provide an overview of the purpose of
visit.
4. Look for the client and observe.
CHN BAG
5. Explore the health needs.
6. Place the bag in a convenient place.
Bag Technique
7. Perform nursing procedure
- An indispensable tool used by
- Bag technique
the nurse with ease and deftness.
- Health assessment
Public Health Bag
- Provide health teaching
- Essential and indispensable
8. Wash hands thoroughly and
equipment of a public health
9. Documentation.
nurse.
10. Set an appointment for the next visit.
Principles:
 Minimize, if not, prevent the spread of
infection.
BENEDICT’S TEST:
 Effectivity of total care must be shown.
– To test simple carbohydrates and glucose
 Save time and effort.
in uric.
 Avoid contamination.
 Handwashing.
Steps – Get the tube
– Mix 8-10 drops of urine and 5mL
RATIONALE: To render total and effective
of Benedict’s solution.
nursing care.
– Heat the mixture with the alcohol
lamp.
 – Interpret the results.

BLUE 0 Sources of Data

GREEN 0.5% - Population census
YELLOW 1% - Registration of Vital data
ORANGE 1.5% - Health survey
BRICK RED 2% OR MORE - Studies and research

HEAT ACETIC ACID TEST: Crude Birth rate – Measure of natural growth
increase in population.
- To check albumin protein in urine.
Steps – Get the tube. Total # of births
– Fill with 1\3 Acetic acid and 2\3 urine. --------------------- X 1,000
– Heat the mixture with the alcohol lamp. Population
– Interpret the results.
Crude Death rate – Measure of mortality from all
No cloud (-) causes decrease in population.
Faint cloud (+1)
Heavy cloud (+2) Total # of Deaths
Opaque cloud (+3) ----------------------- X 1,000
Population

LEVELS OF HEALTHCARE FACILITIES Infant Mortality rate – Measure of risk of dying

during the 1st year of life.
Primary – Barangay Health Station – To assess general health
– Rural Health Unit condition of a community.
– Puericulture Center
– Community Hospital Total # of deaths under 1 year
– Lying-in ---------------------------------------- X 1,000
– City Health Office Live births

Secondary – Public Hospital Maternal Mortality rate – Measure of risk of

– Emergency Hospital dying from pregnancy, childbirth and puerperia.
– District Hospital – To assess obstetrical
– City Hospital care needed and received
by women.
Tertiary – General Hospital
– Regional Hospital Total # of deaths from maternal causes
– Medical Center ---------------------------------------------------- X
– National and Trading Hospital 1,000 Live Births
– Teaching Hospital
– Specialized Unit Fetal Death rate – Measure of pregnancy
wastage.
Types of Public Health Workers
Total # of fetal deaths
 Village \ Barangay Health Worker
----------------------------- X 1,000
- Grassroot
Live births
- Trained individuals
 Intermediate Health Worker
Neonatal Death rate – Measure of risk of dying
- Professional individuals
1st month of life.
Total # of deaths under 28 days
------------------------------------------ X 1,000
VITAL STATISTICS Live births
Systematic study of vital elements
Attack rate – a more accurate measure of risk of
 Births exposure.
 Deaths Total # persons acquiring a disease
 Marriages ------------------------------------------------ X 100
 Divorce # Of exposed to same disease
 Illness
Case Fatality ratio – measure of killing power of HISTORY
a disease.
Total # deaths on specific disease 1st International Conference of PHC
---------------------------------------------- X 100 Venue – Alma Ata, USSR
# Of case from same disease Date – September 6-12, 1978
Sponsor – World Health Organization, UNICEF
Representative – Dr. Dizon
DEPARTMENT OF HEALTH – Dr. Villar

Roles and Function LEGAL BASIS

 Leadership in Health
 Enabler and capacity builder. Letter of Instruction 949
 Administrator of specific services. Signed by: President Ferdinand Marcos Sr.
Date: October 19, 1979
Primary function – Promotion of health for the
people. GOAL – Health for all Filipinos and Health in the
Vision Hands of the people by the year 2020.
- Filipinos are among the healthiest people
in the Southeast Asia by 2022 and Asia by MISSION -
2040. - To strengthen the health care system
Mission wherein people will manage their own
- To lead the country in the development of a healthcare.
productive, resilient, equitable and people- Concept \ Strategies
centered health system. - Partnership and empowerment towards
self-reliance.
Overrides Goal – Health sector reform agenda
Describes the Major SOP: 7 Principles of PHN
 S – Strategies o Decentralization
 O – Organization o Social participation
 P – Policies o Community participation
Framework for implementation of HSRA – o Recognition between health and
FOURmula ONE for Health government
GOALS – Better health outcomes o Accessibility and availability of health
– Equitable health care financing service
– More responsive health systems o Provision of quality basic health services
o Self-reliance
4 Elements of Strategy
1. Health Financing Elements
- To foster greater, better, and sustained  Treatment of locally endemic diseases.
investments in health.  Immunization
- Philippine Health Insurance Corporation  Maternal and Child health and family
and Department of Health. planning.
2. Health Regulation  Environmental sanitation
- To ensure the quality and affordability of  Control of communicable disease
health goods and services.  Health Education
3. Health Service Delivery  Adequate food and proper nutrition
- To ensure the accessibility and availability  Provision of medical care and emergency
of basic health services. treatment
4. Good Governance  Provision of essential drugs
- To enhance health system performance at
the national and local levels. 4 Pillars \ Cornerstone
Primary health care  Active community participation
- Is essential health care made universally  Intra and Inter-sectoral linkages
accessible to individuals and families.  Use of appropriate technology
 Support mechanism unavailable

INTEGRATED MANAGEMENT OF CHILDHOOD

ILLNESS (IMCI)
 – 2 months – 5 years FOUR RIGHTS IN FOOD SAFETY:
General Danger Signs 1. Right source
 C – Convulsions - always buy fresh meat, fish, fruits and
 U – Unable to drink or breastfeed vegetables
 V – Vomiting - check for expiry dates of processed foods
 A – Abnormally Sleeping - avoid buying canned foods with dents, bulges,
deformation, broken seals and improper seams
- use clean and safe water
WATER SUPPLY SANITATION PROGRAM - if doubt of water source – boil water for at least
2 minutes
Approved type of water supply facilities:
LEVEL I (Point Source) 2. Right preparation
- a protected well or a developed spring - avoid contact between raw and cooked foods
with an outlet but without a distribution - always buy pasteurized milk and fruit juices
system. - wash vegetables well if eaten raw
- serves 15 to 25 households - wash hands and kitchen utensils before and
- outreach must not be more than 250 after preparing food
meters from the farthest user - sweep kitchen floors to remove food droppings

LEVEL II (Communal Faucet System or Stand- 3. Right cooking

Posts) - cook food thoroughly and ensure that
- a system composed of a source, a reservoir, a temperature on all parts of the food should reach
piped distribution network and communal faucets. 70 degrees centigrade
With one faucet per 4-6 households - eat cooked food immediately
- located at not more than 25 meters from the - wash hands thoroughly before and after
farthest house
4. Right storage
LEVEL III (Waterworks System or Individual - cooked foods should not left at room
House Connections) temperature for NOT more than 2 hours
- a system with a source, a reservoir, a piped - store foods carefully: 4 -5 hours hot conditions:
distributor network and household taps, generally at least or above 60 degrees centigrade cold
suited for densely populated urban areas requires conditions: below or equal to 10 degrees
minimum treatment or disinfection centigrade
- do not overburden the refrigerator
PROPER EXCRETA AND SEWAGE - reheat stored food before eating
DISPOSAL PROGRAM -at least 70 degrees centigrade
Approved types of toilet facilities:
Rule in Food Safety:
LEVEL I - Non-water carriage toilet facility – no “WHEN IN DOUBT, THROW IT OUT”
water is necessary to wash the waste into the
receiving space.

Ex. Pit latrines, Reed odorless earth closet Toilet

facility requiring a small amount of water to wash
the waste into the receiving space.
Ex. Pour flush toilet, Aqua privies

LEVEL II - on site toilet facilities of the carriage

type with water-sealed and flushed type with
septic tank/vault disposal facilities

LEVEL III - water carriage types of toilet facilities

connected to septic and/or to sewerage system to
treatment plant

FOOD SANITATION PROGRAM

MEDICINAL PLANT- SANTA LUBBY
 S- Sambong
– Anti-edema
– Diuretic
– Anti-urolithiasis

 Ampalaya
– Diabetes Mellitus

 N- Niyug-niyogan
– Anti-helminthic

 T- Tsaang Gubat
– Stomachache
– Tsaang gubat
– Diarrhea

 Akapulko
– Anti-fungal

 L- lagundi (Vitex Negundo)

– S-kin diseases
– H-eadache
– A-sthma, cough and fever
– R-heumatism, sprain, insect bites
– E-czema
– Dysentery

 U-Ulasimang bato
– Uric acid excretion

 B- Bawang
– Hypertension
(to lower cholesterol levels in the blood)
– Toothache

 B- Bayabas/ Guavas
– Diarrhea
– Washing of wounds
– Gargle to relieve toothache

 Y- Yerba Buena
– S-wollen gums
– P-ain
– I-nsect bites
– T-oothache
– M-enstrual and gas pain
– A-rthritis
– N-ausea and fainting
– D-iarrhea