CHN Rationale

Community Health Nursing

Pre Test Rationale

Jaypee G. Valenzuela, RN

RA 8423

Philippine Institute of Traditional and Alternative Health Care

Herbal medicinesAcupressureAcupuncture

Herbal plants used as medicines

Lagundi – ascof forte Yerba Buena – headache, stomach ache,

rheumatism arthritis Sambong – anti edema, diuretic, anti urolithiasis Tsaang Gubat – anti spasmodic, stomach ache,

diarrhea Niyug-niyogan – anti helmintic

- should not be given 4 years old and below

Bayabas – washing wounds, diarrhea, gargle for toothache

Akapulko – anti fungalUlasimang Bato (pansit pansitan) –

lowers uric acid, gouty arthritisBawang – lowers cholesterol, HPN,

toothacheAmpalaya – mild DM non insulin

dependent

Salient points:

Avoid use of insecticidesIn preparation, use clay pot and remove

cover while boiling at low heatUse only the part of the plant advocatedFollow accurate dose of suggested

preparation

Use one kind of herbal plant for each type of symptom or disease

Stop giving herbal medication if untoward reaction occurs

If signs and symptoms are not relieved in 2 – 3 doses, consult physician

Acupressure

-a method of maintaining health, treating disease, and alleviating pain by applying pressure or massaging center points on the body surfaces.

Salient points:

Qi- life energy

2 aspects: Yin- negative and feminine forceYang- positive and masculine force

***Imbalance indicates illness

Application Of AcupressurePosture: lying or sittingManipulation: thumb pressure (small

circular movements, 2-3 cycles per second)

Precautions:

-room should be warm and well ventilated

clean and warm practitioner’s hand never done with full stomach, pregnant, and

cardiac patients foods to avoid: iced drink or food

Sour foodAlcohol drinkSpicy foodsSeafoodsPeanuts and salty

Selection of acupressure points: use of prescribed points use of Ashi points

Location of acupressure points: use of anatomical landmarks use of Tsun measurement.

Control of Diarrheal Diseases (CDD)

Diarrhea – unusual frequency of bowel movements more than 3x a day

3 classifications: mild: 5 – 9 moderate: 10 – 15 severe: > 15

Types: Acute: 3 loose stools; less than 2 weeks Chronic: LBM on and off for more than 2 weeks

Management: Fluids

Oral Rehydration Therapy Fruit juice, “AM” Home made soup

Frequent Feeding continue breastfeeding - 6 month old - Cal

CHO – 6x a day If subsided, additional feeding for 2 weeks

Fast Referral

Treatment plans

PLAN A (no dehydration) home treatment follow up after 5 days

PLAN B (some dehydration) two of the following signs:

restless, irritable sunken eyes poor skin turgor

Treatment: 1st day: home care / ORS 2nd day: refer

PLAN C (severe dehydration) two of the following:

abnormally sleepy, difficult to awake sunken eyes unable to drink poor skin turgor

Treatment: Refer Give ORS (frequent sips) along the way

ORS

1 pack : 1 L water Good for 24 hours Boiled water

Contents: glucose for Na absorption NaCl for fluid retention NaHCO3 – buffer system KCl for smooth muscle/cardio contraction***STOP giving ORS if there is puffiness in eyelids

already

Measures of Diarrhea Prevention:

Breast feed infants Provide appropriate supplemental feeding Handwashing Utilize clean and portable water Clean toilet and observe proper feces disposal Immunize the child with measles No to antibiotic unless with cholera, thyroid,

or amoebiasis

Tuberculosis

-a highly infectious chronic disease caused by the tubercle bacilli.

S/S: Cough of two weeks or more low grade afternoon fever Chest back pains Hemoptysis Significant weight loss Sweating, Fatigue, Body malaise SOB

Modes of transmission:Airborne droplet (coughing, singing,

sneezing)Direct invasion through mucous

membranes or breaks in the skinIngestion of unpasteurized cattle milk

Methods of controlPromotion:

Health education regarding disease Improvement of social conditions

Prevention: BCG immunization Prompt diagnosis and treatment

DOH Program: National Tuberculosis Control Program

Vision: A country where TB is no longer a public health problem

Mission: Ensure that TB DOTS services are available, accessible and affordable to communities in collaboration with the LGUs and other partner

Goal: To reduce prevalence and mortality from TB by the year 2015

Targets:cure at least 85% of TB positive patientsdetect at least 70% of the estimated new

TB infected individuals.

Direct Observed Treatment Shortcourse (DOTS)

DOTS strategy:sustained political commitmentaccess to quality-assumed sputum

microscopystandardized short-course chemotherapy

for all cases of TBuninterrupted supply of quality-assured

drugsproper recording and reporting system

TB drugs

Rifampicin R Isoniazid IPyrazinamide PEthambutol EStreptomycin S

TB drugs

Rifampicin R Isoniazid HPyrazinamide ZEthambutol EStreptomycin S

TB drugs

FDC (Fixed-Dose Formulation)

CATEGORIES I &III

Body weight

Intensive phase No. of tabs per

day

2 months

Continuation phase

No. of tabs per day

4 months

30 – 37 2 2

38 – 54 3 3

55 – 70 4 4

> 70 5 5

CATEGORY II

BODY WEIGHT

INTENSIVE PHASE CONTINUATION

PHASE

First 2 months 3rd mo FDC-B

HR

E

400mgFDC-A

HRZE S HRZE

30 - 37 2 0.75g 2 2 1

38 - 54 3 0.75g 3 3 2

55 –70 4 0.75g 4 4 3

> 70 5 0.75g 5 5 3

SDF (Single Drug Formulation)

I II III

Intensive HRZE2 months

HRZES 2

HRZE 1

HRZE2 months

Continuation HR4 months

HRE5 months

HR4 months

Control of Acute Respiratory Infection

Classifications:Very Severe DiseaseSevere PneumoniaPneumoniaNo Pneumonia

Very Severe Disease (2 months up to 5 years)Danger signs:o Not able to drinko Convulsionso Abnormally sleepy or difficult to wakeo Stridoro Severe under-nutrition***Urgent referral!!!

Very Severe Disease(age less than 2 months)Danger signs:o Stopped feeding wello Convulsionso Abnormally sleepy or difficult to wakeo Stridor or wheezingo Fever ***Urgent referral!!!

Severe Pneumonia

Signs:

-fast breathing with chest indrawing

***urgent referral!!!

Pneumonia

Signs:

-Fast breathing

-cough and colds

Management: Give CMZ twice a day for 5 consecutive days Monitor for danger signs Follow up after 5 days or asap

No Pneumonia: cough and cold

-no chest indrawing or danger signs

Management: Increase feeding and fluid intake Home care with monitoring for 2 days

Expanded Program on Immunization

-to decrease the morbidity and mortality of the six immunizable diseases.

PD 996 - basic compulsory immunization PP 6 – universal child immunization lawPP 46 – reaffirmation of the Universal

mother and child Immunization lawSB 642 - inclusion of Hepa B in the

immunization program

Four major strategies:Sustaining high routine FIC coverage of at

least 90% in all provinces and citiesSustaining the polio free country for global

certificationEliminating measles by 2008Eliminating neonatal tetanus by 2008

Contraindications: If the child was born with clinical AIDS If the child is with serious illness needing

immediate hospitalization If the child has fever with temperature

higher than 38.5ºC***moderate fever, malnutrition, mild

respiratory infection, cough, diarrhea and vomiting are not contraindications.

BCG-live attenuated bacteria-for prevention of PTB1st dose: anytime after birth but not later

than 11 months 0.05cc ID at right deltoid2nd dose: school entrance 0.1cc ID

DPT 1st dose: 6 weeks old 2nd dose: 10 weeks old 3r dose: 14 weeks old

Dose: 0.5 cc Route: IM Site: Vastus lateralis SE: fever for one day

Pain and swelling for 3 – 4 days

Nursing instructions: Do not massage site Apply warm compress If the child had convulsion, bring back

immediately to the health center

OPV

-live attenuated virus

-sabin vac (pinkish or orange but never colorless)

1st dose: 6 weeks old 2nd dose: 10 weeks old 3r dose: 14 weeks old

Dose:2 – 3 drops Route: PO

Nursing instruction: Child should be on NPO for 30 minutes If child vomited, repeat giving the dose

AMV

-live attenuated virus Age: 9 months old (Dept Circular # 60) Dose:0.5cc Route: Subcutaneous Site: left deltoid SE: may have fever 5 – 7 days after

immunization accompanied by mild rashes for 1 – 3 days

HEPA B

-RNA recombinants

-easily destroyed by heating and freezing 1st dose: 6 weeks old 2nd dose: 10 weeks old 3r dose: 14 weeks old

Dose: 0.5cc Route: IM (Z-track) Site: vastus lateralis SE: pain and swelling

Salient points:

Cold Chain – maintains potency of vaccine

Regional: 6 months Provincial: 3 months Municipal: 1 month RHU: 5 days BHS: 3 days

Cold Dog – transport of vaccines

OPV, Measles most sensitive to heat put to coldest

Hepa B, Tetanus Toxoid least sensitive to heat sensitive to cold

Fully Immunized ChildCompletely Immunized ChildEPI defaulter

Needles

Route Length Gauge

ID 3/8 - 5/8 26 – 27

SC 5/8 – ½ 25 – 26

IM ½ - 1 ½ C: 24 – 25

A: 23 – 24

VITAMIN A supplementation-for better eyesight

Sources: retinol and carotene

Complications of Vitamin A deficiency: xeropthalmia- night blindness bitot’s spot corneal ulceration- leading to permanent

blindness keratomalasia- softening of the cornes

PreventionVit A 200,000iu through GP program

Treatment: (6 months to 11 months) 100,000iu of retinol today 100,000iu of retinol tomorrow 100,000iu of retinol after 2 weeks 100,000iu of retinol after 6 months

*double dosage for clients older than 11 months old

PATTERNS OF DISEASE OCCURRENCE

SPORADIC – intermittent in occurrence appearing here and there few, isolated and unrelated cases in given

locality

ex: PSP, leptospirosis, etc

ENDEMIC- continues in occurrence through out a period of time of the usual number of causes in a given locality

ex: malaria in palawan

EPIDEMIC- occurrence of unusual large cases in a relatively short period of time

-with death records

ex: meninggococcemia

PANDEMIC- simultaneous occurrence of a global phenomenon epidemics in the same countries

ex: Avian Flu (2004)

SARS (2002)

AIDS (1992)

Anthrax

Bulbonic plague

Types of Crisis

Situational

Ex: death of spouseMaturational

Ex: menarcheAdventitious

Ex: tsunami

DENGUE HEMORRHAGIC FEVER

-first reported in 1953

-became a notifiable disease in 1958Causative agent: Dengue Virus types 1, 2,

3 and 4

Chikungunya virusMode of transmission: vector borne

(aedes aegypti)

Stages:First 4 days: febrile or massive stage

Fever higher than 39ºC4th to 7th days: toxic or hemorrhagic stage

-lowering of temp-bleeding starts

7th to 10th days:convalescent or recovery stage

S/S:Febrile stage:high feverabdominal pain and vomitingheadacheepixtaxisconjunctival infection

Toxic stage:PetechiaePain behind eyesMelenaUnstable BP, narrow pulse pressureShock

Diagnostic Test: Rumpel leeds’s test

Nursing care:monitor for bleedingmonitor VSbleeding precautionsin case of shock, position client to

Trendelenburg and fluid challenge

MALARIA

Causative agent: Plasmodium Falciparum Plasmodium Vivax Plasmodium Ovale Plasmodium Malariae

Mode of Transmission: vector borme (female Anopheles mosquito) Anopheles Flavirossus: thrives in clear, slow

flowing body of water Anopheles Mangyamos: near forrest Anopheles Maculatus: exposed to sunlight Anopheles Litorales: blackish water Anopheles Balabasensis: inside forrest

Incubation period: 6 – 14 days

S/S-recurrent chills-profuse sweating-fever-malaise-hepatomegaly-spleenomegaly

*complication: Blackwater fever

-mahogany-colored urine

-hemoglobinuriaDiagnostic test:

Blood smear Malarial IFAT

DOC: Chloroquine

Preventive measureshealth education regarding diseasechemoprophylaxis

use of plants, animals, and drugs

insecticide

CLEAN UP Drive Chemically treated mosquito nets Larvae eating fish Environmental cleaning Anti-mosquito soap Neem trees

SCHISTOSOMIASIS

(Bilhariasis, snail fever, occupational disease) Causative agent: Schistosoma japonicum Mode of transmission: vector borne

(oncomolenia quadrasi) Incubation period: 4 – 6 weeks Diagnostic test:

Kato kutz COPT

S/S:DiarrheaBloody stoolEnlargement of the abdomenWeaknessInflamed liverSwimmer’s itch

Prevention measures education to endemic areas regarding disease education on proper waste disposal water chlorination ( 3- 5 ml per 1L of water)

DOC: praziquantel

Protein Energy Malnutrition (PEM)

MARASMUS – deficiency in calorie and protein

muscle wasting disease S/S: old man’s face Very emaciated Skin and bone appearance Apathetic and quiet

***referral for 3rd level of prevention

KWASIORKOR- deficiency in proteinS/S: edema Bloated appearance Mooning of the face Hair is very fine, thin, straight and reddish Under nourished Always crying, moaning and irritable

***referral for 3rd level of prevention