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