The Nature of CHN Practice Requires That Current Knowledge Derived From The
The Nature of CHN Practice Requires That Current Knowledge Derived From The
History
Definition
Health – (WHO) state of complete physical, mental and social well being, not merely
the absence of disease or infirmity
Public health – (Dr. C.E. Winslow) the science and art of preventing disease, prolonging
life, promoting health and efficiency through organized community effeort.
Concepts
1. The primary focus of community health nursing practice is on health promotion.
2. Community health nurses are generalist in term of their practice through life but
the whole community.
3. Community health nurses are generalist in terms of their practice through life
continuity in its full range of health problems and needs.
4. The nature of CHN practice requires that current knowledge derived from the
biological, social science, ecology, clinical nursing and community health
organizations be utilized
5. Contact with the client and or family may continue over a long period of time which
includes all ages and all types of health care.
6. The dynamic process of assessing, planning, implementing and intervening provide
measurements of progress, evaluation and a continuum of the cycle until the
termination of nursing is implicit in the practice of community health nursing.
Principles
1. CHN is based on recognized needs of communities, families, groups and individuals.
2. The community health nurse must understand fully the objectives and policies of
the agency she represents.
3. In CHN, the family is the Unit of services.
4. CHN must be available to all regardless of race, creed and socioeconomic status
5. Health teaching is a primary responsibility of the CHN.
6. The community health nurse works as a member of the health team.
7. There must be a provision for period’s evaluation of community health team.
8. Opportunities for continuation staff education programs nurses must be provided
by the CHN agency. The community health nurse also has a responsibility for
his/her own professional growth.
9. The community health nurse makes use of available community health resources.
10. The community health nurse utilizes the already existing active organized groups in
the community.
11. There must be provision for educative supervision CHN
12. There should be accurate recording and reporting in CHN.
Health Treat (HT)- conditions conducive to dse, accidents or failure to realize one’s
health potential
ö healthy people
ö ex. Family hx of illness- hereditary like DM, HPN
nutritional problems- eating salty foods
personal behavior- smoking, self-medication, sexual practices, drugs,
excessive drinking
inherent personality char- short temperedness, short attn span
short cross infectx
poor home envi
lack/inadequate immunization
hazards- fire, falls, or accidents
family size beyond what resources can provide
ö Foreseeable Crisis (FC)- anticipated periods of unusual demand on indiv or fam
in terms of adjustment or family resources ( nature situatxs)
ö ex. Entrance in school
adolescents (circumcision, menarchs, pubarche
courtship (falling in love, breaking up)
marriage, pregnancy, abortion, puerperium
death
unemployment, transfer or relocation
graduation, board exam
Identify the ff:
Ex: Active TB- HD
45 yr, old male smoke- HT
Sedimentary health style- Ht
Early pregnancy- FC
Father of family losses his job FC
Death in the family- FC
Patient is sick due to pneumonia- HD
Children who are not immunized- HT
Lack of prenatal check – up- HT
Eclampsia- HD
Working hazard- HT
Hypertensive- HD
With measles “child”- HD
Family members has liprosy (microbactria liporea)- HD
Marriage- FC
Community diagnosis
A. Physical Characteristics
B. Population Characteristics
C. Environmental factors
D. Knowledge, attitude, practices of the people
E. Community resources and facilities
Planning: Based on the actual and potential problems that were identified and
prioritized
Implementation:
Carries out nursing procedures which are consistent with nursing with nursing care
plans.
Involve the patient with his/her family
Utilized support system
Evaluation
Frame works
a. Structural elements
b. Process elements
c. Outcome elements
Nursing Procedures
Clinic Visit
1. Pre-consultation conference
2. Medical examination
3. Nursing intervention
4. Post consultation conference
Principles
1. A home visit should have a purpose or objective
2. Planning for a home visit should use every available information about the family,
and individual
3. Planning should revolve around the essential needs of the individual
4. Planning of a continuing care involve the individual or family
5. Planning should be flexible and practical
Principles
Principles
1. Nursing care utilizes a medical plan of care and treatment.
2. Performance of nursing care utilities skills that would give maximum comfort and
security.
3. Nursing care at home should be used as a teaching opportunity.
4. Performance of nursing care should recognized dangers in the patients’ over-
prolonged acceptance of support and comfort.
5. Nursing care is an opportunity for detecting abnormal signs and symptoms.
Isolation Techniques
All Articles used by the patient should not be mixed with the articles used by the
rest of the members of the household.
Frequent washing and airing of beddings and other articles and disinfectants of
room are imperative
The one caring for the sick member should be provided with a protective gown that
should be use with in the room of the sick.
All discharges, especially from the nose and throat of a communicable disease
patient should be carefully discharged.
Articles with discharges should be first boiled for 30 minutes before laundering.
Thos could be burned, should be burned.
DOH
Vision: HEALTH FOR ALL BY 2000 & HEALTH IN THE HANDS OF THE
PEOPLE BY 2020
Mission: Ensure accessibility and quality of health care to improve the quality of life of
all Filipinos, especially the Poor.
National Objectives
Basic Principles
Herbal Medicine
1. aromatic- has volatile oil for tx of fever, cough, colds, itchiness and gas pain. Luya,
bawang, sibuyas, yerba Buena, oregano, manzanilla, tanglad, sambong, lagundi, ___ or
petals of sampaguita, jasmine & rosal
Luya- shd not be taken on an empty stomach
Elixir- ______
3. bitter-tasting
a. skin problems--Acapulco, kalachuchi, malunggay, kakawati, inakabuhay
b. depressants- to put hyper people to sleep--dapdap, dita, makabuhay, makahiya
c. anti-cancer drug-- tsitsirika
d. aches & pains-- sambong, damong arya
e. asthma- talampugay- can cause psychosis
4. seeds- fixed oils, anti-helmentics- niyug-niyogan (urine), patola, ipil-ipil, betel nut or
bunga, balanyog, squash seeds, lanzones- do not throw peelings instead, burn it—good
insect repellant
10 Medicinal Plants:
L agundi- asthma, cough, colds
U lasimang bato- uric acid, HPN
B awang- HPN
B ayabas- Diarrhea
Y erba Buena- arthritis, toothache, swollen gums, cough & colds
S ambong- cough and colds, renal stones
A mpalaya- DM
N iyug-nyogan- ascariasis
T saang gubat- diarrhea
A capulco- fungal infection, scabies
Endemic- constant presence of disease or infection agent with in a given geographic area
Surveillance- a continuing scrutiny of all aspects of occurrence and spread of a disease that
is pertinent to effective control ( promotion, preventive patient & rehabilitative)
Sentinel sites- are health facilities which are selective as representatives of what is
happening in areas whose reports are accurate, complete and prompt
(health center)
Fertility Rate
1. CBR (Crude birth rate)- relative pop due to births
Total number of births in a calendar year
CBR= Birth x 1000
Pop ex. 25.8= CBR
There are 26 births in every 1000 pop
2. General Fertility Rate (GFR) - true fertility rate – specific segments of pop that is fertile
Mortality Rates
1.Crude Death Rate ____ x 1000
Decrease in pop due to death
CDR= death x 1000
Pop
Ex. CDR= 6 there are 6 in every 1000 pop
PMR = 30%
TB
--In every 100 deaths, 30 are due to TB
Ex. CFR = 98
HIV
Ex. C of DR =320
TB
Incidence Rate
IR= ___new cases___ x 100,000
pop at risk
Swaroff’s Index
Situation: Barangay X has a total population of 1362 for the year 1999-2000 bases on the
following date, solve for the swaroff’s index, infant mortality rate, crude death rate and the
maternal mortality rate
Determinants of RH:
1. socio- economic
2. status of women
3. social and gender issues
4. biological, cultural and psycho-social factors
GOALS: MCH AND NUTRITION
Ten Elements of RH
Tetanus Toxiod
Side effects
1. Koch’s phenomenon- 2-4 days after vaccines
- acute inflammation
3. Salk – IM
NO SIDE EFFECTS
Sabin – Oral
Early s/s:
Change in skin color- reddish or white
Loss of sensation
Decrease hair growth- dermis
Loss of sweating- exocrine
Muscle weakness- nerves
Thickened/ painful nerves
Ulcer that do not heal
Late s/s
Madarosis
Lagophthalmos- inability to close the eye lids
Clawing of fingers and toes
Contractures
Sinking of nose bridge
Gynecomastia
Chronic ulcers
Pneumonia
Signs
Fast breathing
Chest in drawing
Convulsion
Abnormally sleepy
Severe under nutrition
Not able to drink
Stridor upon inhalation- auscultation
Wheezing- upon exhalation
Fever or low body temp.
Management of pneumonia: most pneumonia deaths are preventable if treated
early
Tx is based :
early recognition of pneumonia
prompt treatment of non severe cases at home with standard
antibiotics and good supportive care
quick identification if severe cases and quick referral to the hospitals-
prevent death
• no antibiotics needed
• feed the child
• increase fluid intake
• clear nose
• keep child warm and comfortable
• fast breathing
• difficulty breathing
• unable to drink
• feeding problem
Availabity of Drugs
1. Cotrimoxazole
2. injectable penicillin
3. others: O2 may be delivered as a life saving measure
cough suppressant- antitussive
antihistamine- bronchodilator
Prevention of Pneumonia
1. Timely immunization against measles and pertussis
2. Exclusive BF for the 1st 4-6 months of life
3. Good nutrition
4. Vit. A supplementation
5. Reduce exposure to house smoke from cooking/tobacco
6. Keeping young infants warm- prevent O2 loss
7. Practicing good hygiene
Treatment Plan A
> to treat diarrhea at home
> use this plan to teach the mother to
1. Continue to treat at home her child’s current episode of diarrhea
2. give early treatment for future episode of diarrhea
Treatment Plan C
(Sever dehydration)
Can you give IVF ------------Yes-------Start IVF immediately “PNSS and 0.9 % NaCl
NO
Is IV next available-----------Yes-------Send patient within 30 minutes
NO
Are you trained To------------Yes------Start with ORS
Use NGT for
Rehydration
NO
Can the patient-----------------Yes------Start with ORS per orem
Drink
Rehydration
URGENT!
Send the patient for IV or NGT
Water Decontamination
Boiling 2-3 minutes
Chlorine
• 1 drop of 5% Na Hypo chloride in 10 L H2O
• Stat for 20-30 minutes
• Aerate
MDT
PB non infectious MB- infectious
Tuberculoid LEpramatous/ Borderline
Indetermidiate
6-9 months 24-30 months
Day 1/ 2-8 Day 1/ 2-28
Rifampicin/Dapsone Rifampicin
Clofazimine
Dapsone
Pneumonia
Very Severe Severe Pneumonia No Pneumonia
Unable to drink Fast breath Fast breathing No fast breathing
Convulsion Chest indrawing No chest indrawing No chest indrawing
Difficult to wake
stridor
Tb Network: Nurse
Physician
Midwives
Early case Med Tech
Findings
ENVIRONMENTAL SANITATION
Environmental Sanitation is defined as the study of all factors in man’s physical environment, which may
exercise a deleterious effect on his health, well-being and survival.
Goal: to eradicate and control environmental factors in dse transmission through the provision of basic
services and facilities to all households.
Household Community
-Burial -Sanitary landfill or controlled tipping
> deposited in 1m x 1m deep pits covered with soil, > excavation of soil deposition of refuse and
located 25m away from water supply compacting with a solid cover of 2 feet
- open burning - Incineration
- animal feeding
- composting
- grinding and disposal sewer
Program components:
Case-finding
Case management
Training
Monitoring
Reporting system
Operations research
MENTAL HEALTH
- A state of well-being where a person can realize his or her own abilities, to cope with the
normal stresses of life and work productively
- The emotional adjustment the person achieve in which he can live with reasonable comfort,
functioning, acceptably in the community where he/she lives
- Involves the promotion of a healthy state of mind amont the whole pop through
♥ Developing positive outlook in life
♥ Strengthening coping mechanisms
Stresses in the environment of children such as times of disasters and natural calamities, disintegration of
the values, structure and functions of the family and urbanization, migration, drugs, and physical and
sexual abuse and poverty have direct effects on physical and mental health.
GOOD LUCK!
Prnster