R.L.

T Community Health Nursing

Behaviours Indicating a Well barangay health station, or in
Family ambulatory clinic
1. Able to provide for physical ADVANTAGE:
emotional and spiritual needs of ✔ family initiates visit
family members ✔ allows nurse to maximize
2. Able to be sensitive to the resources (material, human)
needs of the family members ✔ greater control on environment
3. Able to communicate thought DISADVANTAGE:
and feelings effectively ✔ may feel less confident to
4. Able to provide support, discuss family health concerns
security and encouragement
5. Able to initiate and maintain HOME VISIT
growth producing relationship - a professional contact between CHN
6. Maintain and create & the family
constructive and responsible at the family residence
community relationships ADVANTAGE:
7. Able to grow with and through ✔ allow first hand assessments
children ✔ seeking out previously
8. Ability to perform family roles unidentified needs
flexibly ✔ promotes family participation
9. Able to help oneself and to ✔ easier and personalized
accept help when appropriate
[Link] mutual respect for GROUP CONFERENCE
the individuality of family - conference of the mothers in the
members neighbourhood
[Link] to use a crisis ADVANTAGE:
experience as a means of ✔ develops cooperation,
growth leadership, self-reliancce and
[Link] concern of family community awareness
unity, loyalty and interfamily ✔ sharing of experiences
cooperation ✔ sharing of practical solutions
DISADVANTAGE:
FAMILY - NURSE CONTACTS ✔ attendance in a group requires
❖ family - nurse relationship is motivation
developed through family - ✔ unavailability of some target
nurse contacts families
❖ depending on the most suitable
to the purpose or situation at TELEPHONE CALLS
hand - use of landline or mobile phones
ADVANTAGE:
a. Clinic Visit ✔ easy access (distant
b. Home Visit households)
c. Group Conference ✔ less burden on the part of the
d. Telephone Calls family to share their concerns
e. Written Communications DISADVANTAGE:
✔ limited transmission of
CLINIC VISIT information
- in a private clinic, health center, ✔ less accurate assessments
R.L.T Community Health Nursing
WRITTEN COMMUNICATION - Health Resource Development
- used for giving specific instructions Personnel
to families - Relief and Disaster Management
ADVANTAGE: - Networking
✔ time - saving
DISADVANTAGE: Government Organizations
✔ requires literacy and interest a. DSWD
✔ it might not reach intended b. Nutritional Council
recipients c. Population Commission
*d. NAPC
Interprofessional
Care in the Community Department of Social Welfare and
Development
Private Sector • responsible for the protection of
the social welfare of rights of
Commercial / Business Filipinos and to promote the
Profit – oriented social development.
► Manufacturing companies • formed on November 1, 1939
► Advertising agencies • Incumbent: LtGen Rolando
► Private practitioners Joselito D Bautista, PA
► Private institutions (Ret) (since October 17, 2018)

Non- Commercial Programs and Services of DSWD

Orientation to social development,
relief and rehabilitation, community 1. The Pantawid Pamilyang
organizing Pilipino Program or "4Ps"
► Socio - civic groups - a human development program that
► Religious organizations / invests in the health and education of
foundations poor families, primarily those with
children aged 0 – 18.
Local Government Units - conditional cash transfer
⮚ are divided into three levels:
1. Provinces and independent 2. Sustainable Livelihood
cities; Program (SLP)
2. Component cities and - a community-based capacity
municipalities; and building effort that seeks to improve
3. Barangays the program participants’ socio-
economic status through two tracks:
Non - Government Organizations ✔ Micro-enterprise Development
- Organizations which are ✔ Employment Facilitation.
independent of government
involvement 3. Supplemental Feeding
- usually non - profit and are founded Program
by citizens - Provision of food in addition to the
Assumes the following roles: regular meals, to target children as
- Policy and Legislative Advocates part of the DSWD's Early Childhood
- Organizers, Human Rights Care and Development (ECCD)
Advocates program of the government.
- Research and Documentation
R.L.T Community Health Nursing
4. Disaster Response Operations • Conduct and / or assist other
- Life-saving emergency relief and health personnel in outbreak
long- term response. investigation.
• Assist in the conduct of rapid
5. Adoption and Foster Care surveys and surveillance during
- The act of adoption, of permanently disasters.
placing a minor with a parent or • Assist in the conduct of
parents other than the birth parents in surveys, program evaluations,
the Philippines. and other epidemiologic
studies.
• Assist in the conduct of training
EPIDEMIOLOGY course in epidemiology.
⮚ From Greek word • Assist the epidemiologist in
• “epi” = upon preparing the annual reports
• “demos” = people and financial plan.
• “logos” = study • Responsible for inventory and
⮚ the study of the distribution and maintenance of epidemiology
determinants of health-related and surveillance unit (ESU)
states or events in specified equipment.
populations, and the application
of this study to the prevention EPIDEMIC
and control of health problems. ⮚ Greater than 50% of
(Last, 1988) populations are susceptible or
less immune individual
Practical Applications of ⮚ Greater % of the population is
Epidemiology affected by the occurring
1. Assessment of Health status of disease
the community or community Example:
diagnosis. Health worker reports that
2. Elucidation of the natural Community Lanting has an epidemic
history of the disease. of measles affecting children less than
3. Determination of the disease 7 years old
causation. Total susceptible population: 3000
4. Prevention and control of the Children affected by measles: 1750
disease.
5. Monitoring and evaluation of ENDEMIC
health. ⮚ The disease occurs regularly,
6. Provision of evidence for habitually, constantly affecting
policy formulation. the population group
⮚ 2 Local Endemic Diseases:
FUNCTIONS OF where causative agent is
EPIDEMIOLOGY NURSE
• Implement Public Health available on those
Surveillance. places
• Monitor local health personnel ❑ Schistosomiasis: Samar,
conducting disease Leyte, Mindoro, Davao
surveillance. ❑ Malaria: Palawan & Mindanao
- reasons why it’s prevalent
✔ Forested areas
R.L.T Community Health Nursing
✔ Surrounded by bodies of water the mother are no longer
effective.
SPORADIC
⮚ The pattern of occurrence is on Target diseases
& off where: There are many infectious diseases
On = available causative agent that can result in the death or
Off = no available causative disability of infants and young
agent children. Some of the most dangerous
⮚ It’s intermittent (unpredictable) of these are:
in occurrence ⚫ poliomyelitis
⮚ Disease occurs only if there’s a ⚫ measles
susceptible host like in rabies ⚫ diphtheria
⚫ whooping cough
PANDEMIC ⚫ tetanus
⮚ Worldwide, international, ⚫ tuberculosis
universal, global in occurrence ⚫ hepatitis B
like in AIDS, Hepatitis B, PTB, ⚫ Mumps
measles, mumps, diphtheria, These diseases have one thing in
pneumonia common - they can all be prevented
⮚ SARS is categorized by WHO by immunization.
as an OUTBREAK only
because out of 191 nations, 33 • Immunization is achieved by
countries are reported to have the administration of a vaccine,
it. produced from an attenuated,
inactivated or killed form of the
OVERVIEW OF IMMUNITY virus or bacteria.
Immunity
• If you have had measles you Vaccine
will never contract this disease • A vaccine is normally injected,
again, since your body has or in some cases may be given
acquired immunity to measles. orally.
• Whenever you contract some • The vaccine will provoke the
infection your body starts development of antibodies in
developing antibodies to the the infant, who thus acquires
virus or bacteria. immunity without suffering the
• These antibodies kill the disease.
microorganisms and afterwards • Vaccines are produced from the
remain in the body to prevent same microorganisms or toxins
recurrence of the disease. that cause disease, but in either
• During the first months of life, case are modified so as to be
an infant is protected against harmless to humans.
many infections by antibodies Vaccine stability
acquired from the mother • All vaccines are sensitive
before its birth. biological substances that
• The infant will retain these progressively lose their potency
maternal antibodies for several (i.e., their ability to give
months, but normally by the protection against disease).
time the child reaches 1 year of • This loss of potency is much
age, antibodies acquired from faster when the vaccine is
R.L.T Community Health Nursing
exposed to temperatures technologies, e.g. recombinant DNA
outside the recommended Hepatitis B vaccine.
storage range.
• Once vaccine potency has been Expanded program on
lost, returning the vaccine to immunization
correct storage condition The Expanded Program on
cannot restore it. Immunization was launched in July
• Any loss of potency is 1976 by the Department of Health in
permanent and irreversible. cooperation with the World Health
• Thus, storage of vaccines at the Organization and the UNICEF.
correct recommended It aims to control the
temperature conditions is occurrence of preventable diseases
vitally important in order that especially of the children.
full vaccine potency is retained Furthermore its original
up to the moment of objective was to reduce the morbidity
administration. and mortality among infants and
children caused by the six childhood
immunizable diseases: Tuberculosis,
Diptheria, Pertussis, Tetanus,
Hepatitis B, and Measles (Polio can
also be added).

EPI principles:
1. The program is based on
epidemiological situation; schedules
are drawn on the basis of the
occurrence and characteristic
epidemiological features of the
disease.
2. The whole community rather than
just the individual is to be protected,
thus mass approached is utilized.
3. Immunization is a basic health
service and such it is integrated in to
the health services being provided for
by the Rural Health Unit.
Three main substances are used for
the production of vaccines: Other general EPI principles
⚫ LIVE microorganisms, e.g., • It is safe and immunologically
weakened measles and polio effective to administer all EPI
viruses or tuberculosis bacteria; vaccines on the same day at
⚫ KILLED microorganisms, different site of the body.
e.g., pertussis microorganisms • Measles should be given as
used in DPT production; and soon as the child is 9 months
⚫ TOXOIDS, e.g., inactivated old, regardless of whether other
toxins such as tetanus toxoid vaccines will be given on that
and diphtheria toxoid. day.
In addition, some vaccines are • The vaccination schedule
produced using genetic engineering should not be restarted from the
R.L.T Community Health Nursing
beginning even if the interval • Use one syringe, one needle per
between the doses exceeded the child during vaccination.
recommended interval by
months or years. Elements of EPI
• Moderate fever, malnutrition, 1. Target setting
mild respiratory infection, 2. Cold chain logistic management
cough, diarrhea and vomiting 3. Information, Education and
are NOT contraindication for Communication
vaccination. Generally, one 4. Assessment and evaluation of the
should immunize unless the program’s overall performance
child is so sick that he needs to 5. Surveillance, studies and research
be hospitalized.
The EPI target diseases
CONTRAINDICATIONS: • Tuberculosis
• DPT2 or DPT3 is • Diptheria
contraindicated to the child • Pertussis
who had convulsions or shock • Tetanus
within 3 days the previous • Hepatitis B
dose. • Measles
• Live vaccines like BCG • Poliomyelitis
vaccine must NOT be given to
individuals who are a child is said to be “Fully
immunosuppressed due to Immunized Child” when the child
malignant disease, therapy with receives one dose of BCG, 3 doses
immunosuppressive drugs, or OPV, 3 doses DPT, 3 doses HB,
radiation. and one dose of measles before the
• It is safe and effective with child’s first birth day.
mild side effects after
vaccination.
• Giving doses of a vaccine at
less than the recommended 4
weeks interval may lessen the
antibody response. Lengthening
the interval between the doses
may lead to higher antibody
level.
• NO extra doses must be given
to children/mother who missed
a dose of DPT/HB/OPV/TT.
The vaccination must be
continued as if no time had
elapsed between the doses. Correct administration of vaccines
• NEVER, EVER reconstitute the Oral polio vaccine (OPV)
freeze dried vaccines in ❖ The vaccine most commonly
anything other than the diluent used is made from a LIVE
supplied with them. ATTENUATED POLIO
• Repeat BCG vaccination if the VIRUS, which is administered
child does not develop a scar orally as a liquid.
after the 1st injection.
R.L.T Community Health Nursing
❖ The vaccine is quickly must be used within 6 hours.
destroyed by temperatures This is also very important
above +8o C and of the because this vaccine does not
commonly used childhood contain a preservative to
vaccines, OPV is the most prevent contamination.
sensitive to heat. • Administration: Vaccine is
❖ It is not damaged by freezing given by subcutaneous
however, and can be safely injection
frozen, thawed and re-frozen • Doses needed: 1 dose to
any number of times without complete primary
damage. immunization (before 1 year, or
❖ The vaccine should not be older if national immunization
refrozen or used, however, if schedule specifies)
the Vaccine Vial Monitor • Storage conditions: -15 to -25o
indicates that the vaccine is at C (central, oblast and rayon
the discard point). levels) 0 to +8 o C (heath
❖ Administration: Vaccine is facility levels)
given orally (NEVER give by
injection) DPT vaccine
❖ Doses needed: 4 doses to • DPT, sometimes called a
complete primary “triple” vaccine, contains 3
immunization (before 1 year) components, DIPHTHERIA
❖ Storage conditions: -15 to -25o TOXOID, inactivated
C (central, oblast and rayon PERTUSSIS VACCINE and
TETANUS TOXOID.
Measles vaccine • It is a liquid vaccine, which is
• Measles vaccine is made from a administered by deep
LIVE ATTENUATED intramuscular injection.
MEASLES VIRUS. It is a • The vaccine is heat-sensitive,
freeze dried powder, which although to a lesser extent than
must be reconstituted before OPV and measles, but is
use. immediately destroyed by
• Reconstitution is only with freezing.
diluent from the manufacturer • The freezing temperature is
of the vaccine in use. approximately -3o C, so storage
Administration is by temperatures should never be
subcutaneous injection. less than 0o C to allow a
• The dry frozen vaccine remains margin for safety.
potent for a long period if • When DPT is at rest the liquid
stored under frozen conditions. is clear, with a white sediment
Like OPV, it can be safely forming at the bottom of the
frozen, thawed and re-frozen vial. Shaking of the vial makes
any number of times without the vaccine a white, uniformly
damage. turbid liquid, with no granules.
• The diluent however, must • Administration: Vaccine is
never be frozen. After re- given by deep intramuscular
constitution, the vaccine injection in the thigh; do NOT
becomes very heat-sensitive, give DPT in the buttock
with rapid loss of potency so it
R.L.T Community Health Nursing
• Doses needed: 4 doses to Mumps vaccine
complete primary • Mumps vaccine is a freeze-
immunization; dried powder, which must be
• 3 doses before one year and the re-constituted with diluent
4th dose at 16 - 18 months before use.
• Storage conditions: 0 to +8 o C • Reconstitution must be only
(at all levels of the cold chain) with diluent from the
manufacturer of the vaccine in
BCG vaccine use.
• BCG is a LIVE BACTERIAL • Administration is by deep
VACCINE. It is a freeze-dried intramuscular injection. The
powder which must be dry frozen vaccine retains
reconstituted before use. potency for a long time if
• Reconstitution is only with stored under frozen conditions
diluent from the manufacturer and can be frozen, thawed and
of the vaccine in use. re-frozen without damage.
• Administration is by • The diluent however, must
intradermal injection. The dry never be frozen. After
frozen vaccine retains potency reconstitution, the vaccine
for a long time if stored under rapidly loses potency and must
frozen conditions, but is readily be used within 6 hours.
destroyed by sunlight and is • Administration: Vaccine is
thus supplied in dark brown given by deep intramuscular
glass ampoules to reduce light injection in the thigh; do NOT
penetration. giveMumps vaccine in the
• The vaccine is not damaged by buttock
freezing and can be frozen, • Doses needed: 1 dose given
thawed and re-frozen without between 12 and 18 months
damage. The diluent however, • Storage conditions: -15 to -25
must never be frozen. C (central, oblast and rayon
• In practice however, BCG levels)
vaccine is not normally stored • 0 to +8 C (health facility level)
in the frozen state. After
reconstitution, :+2(3,/+,6 the IMPORTANT!
vaccine rapidly loses potency • Measles, BCG and mumps
and must be used within 6 vaccines must be reconstituted
hours. This is very important only with the diluent provided
because the vaccine does not by the manufacturer of the
contain a preservative to vaccine in use.
prevent contamination. • Never use other diluent.
• Administration: Vaccine is • Diluent must be cold, between
given by intradermal injection 0 and 8 degrees Celsius, before
• Doses needed: 1 dose to being mixed with the vaccine.
complete primary • When reconstituted, the vaccine
immunization (before 1 year) must be used within 6 hours,
• Storage conditions: 0 to +8 o C and any remainder discarded.
(at all levels of the cold chain)
R.L.T Community Health Nursing
Hepatitis B vaccine
• Hepatitis B Vaccine is a liquid
vaccine available as a
recombinant yeast or as a
plasma derived preparation.
• It is administered in a deep
intramuscular injection.
• The vaccine is about as
sensitive to heat as DPT
vaccine, and is destroyed
immediately if frozen. The
storage temperature should
therefore never be below 0°C. IMPORTANT:
• Administration: Vaccine is • All vaccines lose potency
given by deep intramuscular gradually, even at correct.
injection in the thigh; do NOT • Storage temperatures - observe
give hepatitis B vaccine in the expiry dates.
buttock • All vaccines suffer much faster
• Doses needed: 3 doses to loss of potency when exposed
complete primary to temperatures above +8
immunization (before 1 year) degrees C.
• Storage conditions: 0 to +8 C • Any loss of vaccine potency is
(at all levels of the cold chain) irreversible.
• Damage due to successive
EPI VACCINE TYPES, exposures to heat or light is
CONTENTS & FORM cumulative.
• Hepatitis B, DPT, DT, Td and
TT are destroyed by freezing.
• BCG and measles vaccines are
damaged by exposure to strong
light as well as heat.

Policy on use of opened vials of

vaccine
Global policy on this matter
used to be that opened vials of all
vaccines were discarded at the end of
each working day. In 1995, WHO
recommended a changed global
policy on the use of opened vials of
vaccine as follows:
(1) Opened vials of OPV, DPT, DT,
Dosage and administration of EPI TT and hepatitis B vaccines may be
vaccines used in subsequent immunization
sessions until a new shipment of
vaccine arrives, provided that each of
the following 3 conditions are met:
✔ the expiry date has not passed;
R.L.T Community Health Nursing
✔ the vaccines are stored under • Equipment for safe storage and
appropriate conditions (0 to +8 transportation of vaccines; and
C), and • Procedures to manage the
✔ opened vials of vaccine which programme and control
have been taken out of the distribution and use of the
health facility for immunization vaccines. (management
activities (e.g. outreach, NIDs) process)
are discarded at the end of the • Competent personnel and
day. efficient procedures are a
(2) Opened vials of measles, vitally important part of the
yellow fever and BCG vaccines cold chain system.
must be discarded within six
hours. Notes:
(3) An opened vial must be (1) If freezers are not available at
discarded immediately if any of rayon level these vaccines may be
the following conditions apply: stored at 0 to + 8 C.
• if sterile procedures have not (2) This table shows maximum
been fully observed, or storage times at each level. Maximum
• if there is even a suspicion that times are based on the relative
the opened vial has been security of storage expected at each
contaminated, or level, and together ensure that any
• if there is visible evidence of vaccine will take at most one year to
contamination, such as a be sent through the cold chain and be
change in appearance, floating used. Normally you would expect to
• particles, etc. use most vaccine stocks before the
maximum time is reached.
COLD CHAIN (3) Remember to check the expiry
• a system for ensuring the dates of all vaccines and ensure that
potency of vaccines from the they will not expire during storage or
time of manufacture to the time before they can be distributed and
they are given to an elligible used.
child or woman. (4) Rotate vaccine stock: vaccine
• It is necessary because vaccines received first should be distributed or
are delicate substances that lose used first
potency if they are exposed to (“First In, First Out”) unless a
temperatures that are too warm Vaccine Vial Monitor (VVM) shows
or too cold. that another batch should be
distributed or used first (see Section
Major task for health workers 5.5).
Attention to maintaining correct
temperatures during storage and IMPORTANT!
transport of vaccine. • Vaccine must always be
transported in insulated boxes
The cold chain system comprises with sufficient ice to ensure it
three major elements: • Remains between 0 and +8 C.
• Personnel, who use and Never use un-insulated boxes,
maintain the equipment and or forget the ice!
provide the health service;
Fertility
R.L.T Community Health Nursing
❑ Crude Birth Rate (CBR) ❑ Swaroops Index (SI)
- Overall total reported births - deaths among individual in the age
- a measure of one characteristic of group of 50 and above
the natural growth or increase of a
population.

Morbidity-Illnesses affecting the

population group
❑ Incidence Rate (IR)
- reported new cases affecting the
population group
- measures the fequency of occurrence
of the phenomenon duringa given
period of time
❑ Prevalence Rate (PR)
- determine sum total of new + old
cases of diseases per percent
population
- measures the proportion of the
population which exhibits a particular
time.

Mortality - Reports causes of deaths

❑ Crude Death Rate (CDR)
- overall total reported death
- measure of one mortality from all
causes which may result in the
decrease of population
❑ Maternal Mortality Rate
(MMR)
- maternal deaths due to maternal
causes like preganancy, childbirth,
and puerperium
- index of the obstetrical care needed
and received by women in the
community.
❑ Infant Mortality Rate (IMR)
- measures the risk of dying during
the 1st year of life
- good index of the general health of
the condition of a community since it
reflects the changes in the
environment and medical conditions
of a community.
❑ Neonatal Mortality Rate
(NMR)
- measures the risk of deaths among
neonates (newborn 0-28 days, < 1
month)