CHN&CD

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

PART 3: COMMUNITY HEALTH NURSING

POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING DECEMBER 2012 PNLE
*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE students
on the possible topics that might be part of the upcoming Dec. 2012 PNLE
A. DOH Vision 2030

A Global Leader for attaining better health outcomes,
competitive and responsive health care systems, and
equitable health financing.

B. DOH Mission

To guarantee EQUITABLE, SUSTAINABLE and QUALITY
health for all Filipinos, especially the poor and to lead the
quest for excellence in health.

C. Levels of Prevention

PRIMARY
LEVEL
Health
Promotion and
Illness
Prevention

SECONDARY
LEVEL
Prevention of
Complications
thru Early Dx
and Tx
TERTIARY
LEVEL
Prevention of
Disability, etc.
Provided at –
Health
care/RHU
Brgy. Health
Stations
Main Health
Center
Community
Hospital and
Health Center
Private and
Semi-private
agencies
When
hospitalization
is deemed
necessary and
referral is
made to
emergency
(now district),
provincial or
regional or
private
hospitals
When highly-
specialized
medical care is
necessary
referrals are
made to
hospitals and
medical center
such as PGH,
PHC, POC,
National Center
for Mental
Health, and other
gov’t private
hospitals at the
municipal level


D. 8 Common Generic Drugs (Botika sa Baranggay)

1. Co-Trimoxazole : GUT/GIT/URT Infection
2. Amoxicillin / Ampicillin
3. Rifampicin
4. Isoniazid
5. Pyrazinamide
6. Paracetamol
7. Oresol
8. Nifidipine: HPN

E. Herbal Plants

Plant Name Scientific Name Indications
Lagundi Vitex negundo Asthma, cough,
colds & fever
Pain and
inflammation
Ulasimang Bato Peperonia
pellucida
Gout
Arthritis
Rheumatism
Bayabas Psidium quajava Diarrhea
Toothache
Mouth and wound
wash
Bawang Allium sativum HPN
Toothache
Yerta Buena Mentha cordifelia Same as Lagundi
except asthma
Sambong Blumea
balsanifera
Edema
Diuretic
Akapulko Cassia alata All forms of skin
diseases
Niyog niyogan Quisqualis indica Intestinal
Parasitism
(Nematodes)
Tsaang Gubat Carmona resuta Diarrhea
Infantile colic
(Kabag)
Dental caries
Ampalaya Mamordica
charantia
Type II Diabetes
(NIDDM)


F. Homemade Oresol

A volume or one liter
homemade oresol
Smaller volume or a glass
homemade oresol
Water 1000 ml. or 1 liter 250 ml.
Sugar 8 teaspoon 2 teaspoon
Salt 1 teaspoon ¼ teaspoon or a pinch of
salt=10-12 granules of rock
salt: iodized salt=tips of thumb
& index finger are penetrated
with salt

G. Millennium Goal Development (MDG)

1. ERADICATE EXTREME POVERTY AND HUNGER
2. ACHIEVE UNIVERSAL PRIMARY EDUCATION
3. PROMOTE GENDER EQUALITY AND EMPOWER
WOMEN
4. REDUCE CHILD MORTALITY (Phil. focus)
5. IMPROVE MATERNAL HEALTH (Phil. focus)
6. COMBAT HIV/AIDS, MALARIA AND OTHER
DISEASES
7. ENSURE ENVIRONMENTAL SUSTAINABILITY
8. DEVELOP A GLOBAL PARTNERSHIP FOR
DEVELOPMENT

H. Field Health Service Information System ( FHSIS)

 Individual Treatment Record (ITR)
 Fundamental building block or foundation
FHSIS.
 Target Client List (TCL)
 Such lists will be of considerable value to
midwives/nurses in monitoring service
delivery to clients in general and in
particular to groups of patients identified as
“targets” or “eligibles” for one or another
program of the Department

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

PART 3: COMMUNITY HEALTH NURSING

POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING DECEMBER 2012 PNLE
*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE students
on the possible topics that might be part of the upcoming Dec. 2012 PNLE
 Summary Table
 Composed of Health Program Accomplish
and Morbidity Diseases
 The Monthly Consolidation Table (MCT)

FHSIS Reporting
 Monthly Form
1. Program report (M1)
2. Morbidity report (M2)
 Prepare by Midwife
 Every 2
nd
week of the month is the
submission
 Quarterly Form
1. Program report (Q1)
2. Morbidity report (Q2)
 Prepared by Nurse
 Every 3
rd
week of the succeeding quarter
month is the submission
 Annual Form
1. ABHS report
 Contains data on demographic,
environmental and natality.
 Prepare by Midwife
 Every 2
nd
week of January is the
submission
2. A1: Report on vital statistics: demographic,
environmental, natality and mortality.
3. A2: Lists all diseases and their occurrence in
the municipality/city. The report is broken
down by age and sex.
4. A3: All deaths occurred in the
municipality/city. The report is also broken
down by age and sex
 Prepared by Nurse
 Every 3
rd
week of January is the
submission

I. Health Indicators

Crude Birth Rate (CBR): Overall total reported births per
1000 population

CBR=overall total reported births x 1000
Population

Incidence Rate (IR): Reported new cases of disease per
percent (100/population) population

IR=new cases of disease x 100
Population

Prevalence rate (PR): Reported new cases of disease + old
cases of disease per percent of population

PR=new cases + old cases x 100
Population

Crude Death Rate (CDR): Overall total reported deaths per
1000 population

CDR=overall total deaths x 1000
Population
Maternal Mortality Rate (MMR): Reported maternal deaths
per 1000 registered live births (RLB)

MMR= # of maternal deaths x 1000
RLB

Infant Mortality Rate (IMR): Reported # of infant (0 to 12
months of age) deaths per 1000 RLB

IMR=# of infant deaths x 1000
RLB

Neonatal Mortality Rate (NMR): Reported # of neonatal (0
to 28 days or <1 month) deaths per 1000 RLB

NMR=# of neonatal deaths x 1000
RLB

Swaroop’s Index (SI): Reported # of deaths among
individuals> 50 years old over total deaths

SI=# of deaths (individual >50 years old) x 100
Total Deaths


J. Nature of the Family Problem

 Health Deficit (HD): if identified problem is an
abnormality, illness or disease, there’s a
gap/difference between normal status (ideal,
desirable, expected) & actual status (the
outcome/result/problem encountered on that
actual day)

 Health Threat (HT): any condition or situation
which will be conducive to health alteration, health
interference & health disturbance.

 Foreseeable Crisis (FC): stress points, anything
which is anticipated/ expected to become a
problem.

K. Community Organizing (COPAR)

Preparatory Phase
1. Area of Selection
 It should be DOPE Community: Depressed,
Oppressed, Poor & Exploited, a new criteria for
community organization
2. Entry Phase
 The 1
st
thing to do upon entering the community is
to have a courtesy call with the Barangay Captain,
introduce self & group, purpose, present the project,
activities, etc.
3. Integration/Immersion (CIP)
 Immersion is imbibing the life situation/condition
of the community .
4. Community Study: Diagnosis of Community-COPAR
 Makes use of the Nursing Process/Problem Solving
Approach
 Prioritized which among the problems identified is
to be attended 1
st
like in nature, magnitude,
modifiability, preventive potential, salience
WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS

PART 3: COMMUNITY HEALTH NURSING

POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING DECEMBER 2012 PNLE
*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE students
on the possible topics that might be part of the upcoming Dec. 2012 PNLE

L. Epidemiology

 Epidemic: a situation when there is a high
incidence of new cases of a specific disease in excess
of the expected.
 Endemic : habitual presence of a disease in a given
geographic location accounting for the low number
of both immunes and susceptibles
 Sporadic : disease occurs every now and then
affecting only a small number of people relative to
the total population
 Pandemic: global occurrence of a disease

M . Approve Water Facilities
Level I
Point
Source
Level II
Communal faucet
system or stand
posts
Level III
Waterworks
system or
individual house
connections
A protected
well or a
developed
spring with
an outlet but
without a
distribution
system for
rural areas
where
houses are
thinly
scattered.
A system composed
of a source, a
reservoir, a piped
distribution network
and communal
faucets, located at
not more than 25
meters from the
farthest house in
rural areas where
houses are clustered
densely.
A system with a
source, a reservoir,
a piped distributor
network and
household taps
that is suited for
densely populated
urban areas.

N. Approved Toilet Facilities
Level 1 Level 2 Level 3
Non-water
carriage toilet
facility:
- Pit latrines
- Reed Odorless
Earth Closet
- Bored-hole
- Compost
- Ventilated
improved pit

Toilets requiring
small amount of
water to wash
waste into
receiving space
- Pour flush
- Aqua privies
On site toilet
facilities of the
water carriage
type with water
sealed and
flushed type with
septic vault/tank
disposal
facilities.
Water carriage
types of toilet
facilities
connected to
septic tanks
an/or to
sewerage
system to
treatment
plant.



O. Excreta Disposal
Household Community
○ Burial
► Deposited in 1m x
1m deep pits covered
with soil, located 25
m. away from water
supply

○ Open burning
Animal feeding
Composting
Grinding and
disposal sewer
○ Sanitary landfill or
controlled tipping
► Excavation of soil
deposition of refuse and
compacting with a solid
cover of 2 feet

○ Incineration


DOH PROGRAMS

EXPANDED PROGRAM ON IMMUNIZATION
 Law: PD 996

Vaccine Dosage # of Doses to
complete
immunization
BCG
1. I
2. SE

.05 ml
.1 ml

1 dose
1 dose
DPT .5 ml 3 doses
OPV 2-3 gtts 3 doses
HBV <10 y/o: .5
>10 y/o: 1
3 doses
MV .5 ml 1 dose

 It is safe and immunologically effective to administer all
EPI vaccines on the same day at different sites of the
body.
 The vaccination schedule should not be restarted from
the beginning even if the interval between doses
exceeded the recommended interval by months or year.
 DPT2 or DPT3 is not given to a child who has
convulsions or shock within 3 days after DPT1. V
 Do not give live vaccines like BCG to a individuals who
are immunosuppressed due to malignant disease (child
with AIDS) , going therapy with immunosuppressive
agents or radiation.
 Repeat BCG vaccination if the child does not develop a
scar after first injection


Type of Vaccine Storage Temp. Hours of Life after
opening
OPV -15 to -25 C
Measles At the freezer
Hepa B 8 hours
DPT 2 to 8 C
Tetox Body of
BCG refrigerator 4 hours


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

PART 3: COMMUNITY HEALTH NURSING

POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING DECEMBER 2012 PNLE
*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE students
on the possible topics that might be part of the upcoming Dec. 2012 PNLE
NATIONAL TB PROGRAM

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

Tuberculosis
“Primary
Complex” is
less than 3
years old

- any child
who does not
return to
normal health
after measles
or whooping
cough.

Most
hazardous
period:
first 6-12
months
after
infection
Highest in
risk of
developin
g: under 3
years old

Mycobacterium
Tuberculosis

Droplet Infection
( inhalation of
bacilli from patient
who coughs and
sneeze)



General
weakness
Loss of
weight,
cough and
wheeze
which does
not respond
to antibiotic
therapy.
Fever and
night sweat
Abdominal
swelling
with a hard
painless
mass and
free fluid
Hemoptysis
and chest
pain
Painful firm
or soft
swelling in a
group of
superficial
lymph
nodes.


Man
And
Diseased
Cattle
(Bovine
TB)

Sputum
Exam
3 sample
are taken
with 24 hrs:
- spot
sample (1
st

visit)
- early
morning
specimen
- spot
sample
(2
nd
visit)
Note: at
least 2
sample are
positive

Chest
Xray
Mantoux
Test
- .1 cc
injection of
PDD and
48-72 hours
reading
* 10 mm +
5 mm +
(HIV pt.)



DOTS
- patient is
required to take
the Ant-Tb drugs
in the presence of
a health care
provider to
ensure
compliance to
treatment
regimen

Anti-TB drugs:
(RIPES)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Streptomycin

Pointers for
teaching on
Anti-TB drugs:

Rifampicin:
taken befor
meals, causes
red urine urine
Isoniazide:
causes
peripheral
neuritis, given
with Vit.B6
Pyrazinamide:
cause
hyperurucemia
Ethambutol:
causes optic
neuritis/
blurring of
vision
Streptomycin:
cause tinnitus,
loss of hearing
balance, damage
to 8
th
cranial
nerve

Note: After 2-4
weeks of
treatment,
patient is no
longer
contagious

RECOMMENDED CATEGORY OF TREATMENT REGIMEN

Category Type of TB Patient Treatment Regimen
Intensive Phase Continuation
Phase
Total Period


I
New smear positive PTB
New smear positive PTB
with extensive
parenchymal lesion
EPTB and Severe
concomitant HIV disease


2 RIPE


4 RI


6 mos.

II
Treatment Failure
Relapse
Return after default


2 RIPES /1 RIPE

5 RIE

8 mos.

III
New smear-negative PTB
With minimal parenchymal
lession

2 RIP

4 RI

6
mos.

IV
Chronic ( still smear-
positive after supervised
re-treatment )
Refer to
or DOTS
to City

Specialized
Plus Center
Provincial
Coordinator

facility
refer
NTP




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

PART 3: COMMUNITY HEALTH NURSING

POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING DECEMBER 2012 PNLE
*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE students
on the possible topics that might be part of the upcoming Dec. 2012 PNLE
INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS
(IMCI)

Danger Sign



MAIN SYMPTOM: Cough and Difficulty Breathing



Pneumonia Classification








MAIN SYMPTOM: Diarrhea



Dehydration Classification



A child who has had diarrhea for 14 days or more and
who has no signs of dehydration is classified as having
PERSISTENT DIARRHOEA



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






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

PART 3: COMMUNITY HEALTH NURSING

POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING DECEMBER 2012 PNLE
*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE students
on the possible topics that might be part of the upcoming Dec. 2012 PNLE
MAIN SYMPTOM: Fever



High Malaria Risk Classification



Low Malaria Risk Classification





No Malaria Risk Classification




MAIN SYMPTOM: Ear Problem



Ear Problem Classifications






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

PART 3: COMMUNITY HEALTH NURSING

POSSIBLE TOPICS ON COMMUNITY HEALTH NURSING FOR THE UPCOMING DECEMBER 2012 PNLE
*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE students
on the possible topics that might be part of the upcoming Dec. 2012 PNLE

MAIN SYMPTOM: Malnutrition and Anemia




Malnutrition and Anemia Classification




COMMUNICABLE DISEASES

 Cholera
 Other names:El tor
 Fecal-oral route 5 Fs
 Incubation Period: Few hours to 5 days; Usually 3
days
 Pathognomonic Sign: Rice watery stool
 Diagnostic Test: Stool culture
 Treatment:Oral rehydration solution (ORESOL) IVF
 Drug-of-Choice: tetracycline (use straw; can cause
staining of teeth). Oral tetracycline should be
administered with meals or after milk.

 Shistosomiasis
 Other Names: Snail Fever Bilharziasis
 Endemic in 10 regions and 24 provinces High
prevalence: Regions 5, 8, 11
 Contact with the infected freshwater with cercaria and
penetrates the skin
 Diarrhea Bloody stools (on and off dysentery)
Enlargement of abdomen Splenomegaly
Hepatomegaly Anemia / pallor weakness
 Diagnostic Test: COPT or cercum ova precipitin test
(stool exam)
 Drug-of-Choice: PRAZIQUANTEL (Biltracide)
Oxamniquine for S. mansoni Metrifonate for S.
haematobium *Death is often due to hepatic
complication
 Dispose the feces properly not reaching body of water
Use molluscides Prevent exposure to contaminated
water (e.g. use rubber boots)
 Apply 70% alcohol immediately to skin to kill surface
cercariae
 Allow water to stand 48-72 hours before use

 Malaria
 Plasmodium Parasites: Vivax Falciparum (most fatal;
most common in the Philippines)
 Bite of infected anopheles mosquito Night time biting
High-flying
 Rural areas Clear running water
 Malarial Smear – best time to get the specimen is at
height of fever because the microorganisms are very
active and easily identified
 Chemoprophylaxis: only chloroquine should be given
(taken at weekly intervals starting from 1-2 weeks
before entering the endemic area). In pregnant women,
it is given throughout the duration of pregnancy.
 Treatment:
1. QUININE – oldest drug used to treat malaria; from
the bark of Cinchona tree; ALERT: Cinchonism –
quinine toxicity
2. CHLOROQUINE
3. PRIMAQUINE – sometimes can also be given as
chemoprophylaxis
4. FANSIDAR – combination of pyrimethamine and
sulfadoxine
 CLEAN Technique
*Insecticide – treatment of mosquito net
*House Spraying (night time fumigation)
*On Stream Seeding – construction of bio-ponds for
fish propagation (2-4 fishes/m2 for immediate impact;
200-400/ha. for a delayed effect)
*On Stream Clearing – cutting of vegetation
overhanging along stream banks
*Avoid outdoor night activities (9pm – 3am)
*Wearing of clothing that covers arms and legs in the
evening*Use mosquito repellents
*Zooprophylaxis – typing of domestic animals like the
carabao, cow, etc near human dwellings to deviate
mosquito bites from man to these animals Intensive
IEC campaign