Republic of the Philippines

CEBU TECHNOLOGICAL UNIVERSITY

Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

NCM 215:
Community Health Nursing

MODULE 4A:
IMPLEMENTING THE
COMMUNITY HEALTH
NURSING SERVICES

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

Overview of the lesson:

Often referred to as the action phase, implementation is the most exciting phase
for most health workers. Aside from being able to deal with the recognized priority health
concern, the entire process is intended to enhance the community’s capability in dealing
with common health conditions/problems. The nurse’s role therefore may be to facilitate
the process rather than directly implement the planned interventions. Implementation also
entails coordination of the plan with the community and the other members of the health
team. This requires a common understanding of the goals, objectives, and planned
interventions among the members of the implementing group. Collaboration with other
sectors such as the local government and other agencies may also be necessary.

Desired Learning Outcomes:

At the end of the module students should be able to:
1. describe the current maternal and child health situation in the Philippines;
2. explain the components of the core package of services in the Maternal, Newborn, and
Child Health and Nutrition (MNCHN) Strategy;
3. explain on the MNCHN Service Delivery Network;
4. recognize the role of the nurse in the delivery of the core package of services in the
MNCHN Strategy; and
5. appreciate the impact of MNCHN Strategy on national component.

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

Lesson Content:
HOME VISIT
-Is a PROFESSIONAL contact between PHN & the family
-The services provided is an extension of the Health Service Agency (Health Center)
OBJECTIVES OF HOME VISIT
✓ Assessment
✓ Nursing Care
✓ Treatment
✓ Health Education
✓ Referral (if care fails)
PRIORITIES (IN THE CARE): TO PREVENT CROSS CONTAMINATION
1. Newborn
2. Post-partum
3. Pregnant mothers
4. Morbid cases
- The families need the assistance of the health center that’s why home visit was done to the family
- The person who makes the home visit is rendering services on behalf of the health center
PHASES OF HOME VISIT:
1. Planning
✓ Starts at the health center
✓ Makes a study on the status of the family
✓ Statement of the problem
✓ Formation of objective
2. Socialization –first activity is to establish rapport & to gain the trust of the family
3. Activity
✓ Intervention/Professional Phase
✓ Opportunity to provide or extend health services
✓ Standard Role of the Nurse: Independent, Dependent and Interdependent
✓ To be effective, come in complete uniform (also bring a long umbrella with pointed end which
serve as protection)
4. Summarization - ability to put into record & report (orally) about the outcome of the activity

A. PUBLIC HEALTH BAG:

- Indispensable tool that should be organize to save time & effort and to prevent cross infection &
contamination

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

GUIDING PRINCIPLES IN THE USE OF PUBLIC HEALTH BAG

▪ Content -should be prepared by the one who will make home visit
Note: BP Apparatus is kept separately from PHN bag
▪ Cleaning
✓ The inner part of the bag should be clean & sterile
✓ Should be done every after home visit
✓ Never endorse the bag
▪ Contamination
Note: The less one opens the bag, the lesser chance of contamination
▪ In general, the bag is open 3x:
✓ Putting out materials for hand washing
✓ Putting out materials used for nursing care
✓ Returning all what have been used
Care of Communicable Case(s)
- Should be disinfected with the use of 70% isopropyl alcohol or Lysol which should be done at
the health center and not at home

B. FAMILY HEALTH SERVICES

FAMILY HEALTH PROGRAMS
• The DOH – Family Health Office is tasked to operationalized health programs geared towards
the health of the family. It is responsible for the creation, implementation and evaluation of health
family programs.
• The summary of its objective is to improve the survival, health and well-being of each members
of the family as well as the reduction of morbidity and mortality rates in the family and community.
The following are the family health programs:
1. Maternal Health Program
2. Family Planning Program
3. Child Health Program
4. Expanded Program of Immunization
5. Nutrition Program
6. Oral Health Program
7. Other Health Program
MATERNAL & CHILD HEALTH PROGRAM
• WHO Philippines MCH Program works with local public health departments, community based
organizations, statewide organizations and other providers to provide and/or assure quality
health services are delivered to mothers, children, and families in the country.
The primary areas of work focus are:
• Increasing healthy birth outcomes;
• Promoting and assuring comprehensive primary care for children, from birth to 21 year olds,
including children with special health care needs;

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

• Promoting healthy lifestyles among school-age youth, ages 6-21, including children with special
health care needs;
• Promoting access to safe, healthy child care, including children with special health care needs;
and
• Caring for the mother from pre-conception.
•STRATEGIES
1. Provision of Regular and Quality Maternal Care Services
o Regular and quality pre-natal care
✓ hx-taking, utilization of HBMR (Home-Based Mother’s Record) as a guide in the identification of
risk factors
✓ PE: weight, height, BP-taking
✓ Perform head-to-toe assessment, abdominal exam
✓ Tetanus Toxoid Immunization§  Fe supplementation: given from 5th mo. of pregnancy to two
months postpartum (100-120 mg orally/day for 210 days)
✓ Laboratory exam: Heat-acetic acid test. Benedict’s test
✓ Oral/Dental exam
o Pre-natal counseling
o Provision of safe, delivery care
✓ All birth attendants shall ensure clean and safe deliveries at the faciltiies (RHUs/hospitals)
✓ At-risk pregnancies and mothers must be immediately referred to the nearest institution
o Provision of quality postpartum care
o Proper schedule of follow-up must be followed
✓ 1st postpartum visit for home deliveries must be done within 24 hours after delivery
✓ 2nd, done at least 1 week after delivery
✓ 3rd, done 2-4 weeks thereafter
o Attendants must be aware of the early signs, symptoms and complications. They should follow
the 3 CLEANS:
✓ CLEAN Hands
✓ CLEAN Surface
✓ CLEAN Cord
2. Improvement of the health personnel’s capabilities on newborn care, midwifery thru trainings.
o All deliveries should be done in health care facilities ONLY
3. Improvement on the quality of care at the First Referral Level
o Orientation, training should be done on the use of proper filling-up of HBMR card
o Proper referrals/endorsements must be done for future If-ups
4. Prevention of unwanted pregnancies through family planning services
5. Prevention and management of STDs
6. Promotion of Appropriate health practices
7. Upgrade reporting services
8. Mobilize political commitment and community involvement to provide support to basic health care
delivery

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

MATERNAL HEALTH PROGRAM OBJECTIVE:

To improve the survival, health and well-being of mothers and unborn child.
MATERNAL HEALTH SERVICES:
1. Antenatal Registration - pregnant women can avail the free prenatal services at their respective health
center.
2. Tetanus Toxoid Immunization - A series of 2 doses of tetanus toxoid vaccination must be received by
a pregnant women one month before delivery and 3 booster doses after childbirth
3. Micronutrient Supplementation - Vitamin A and Iron supplement for the prevention of anemia and Vit.
A deficiency.
4. Treatment of diseases and other conditions - These is for the women who is diagnosed as under the
high risk
Ideal Frequency of Prenatal Visits During the Duration of Pregnancy
Prenatal Visits Period of Pregnancy
FIRST VISIT As early as possible before 4 months or during 1st
trimester
SECOND VISIT During the second trimester

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

THIRD VISIT During the third trimester

EVERY 2 WEEKS After 8 months until birth

FAMILY PLANNING PROGRAM

Brief Description of Program
-A national mandated priority public health program to attain the country's national health development:
a health intervention program and an important tool for the improvement of the health and welfare of
mothers, children and other members of the family. It also provides information and services for the
couples of reproductive age to plan their family according to their beliefs and circumstances through
legally and medically acceptable family planning methods.

The program is anchored on the following basic principles.

1. Responsible Parenthood which means that each family has the right and duty to determine the
desired number of children they might have and when they might have them. And beyond
responsible parenthood is Responsible Parenting which is the proper upbringing and education
of children so that they grow up to be upright, productive and civic-minded citizens.
2. Respect for Life. The 1987 Constitution states that the government protects the sanctity of life.
Abortion is NOT a FP method.
3. Birth Spacing refers to interval between pregnancies (which is ideally 3 to 5 years) from recent
pregnancy. It enables women to recover their health improves women's potential to be more
productive and to realize their personal aspirations and allows more time to care for children and
spouse/husband.
4. Informed Choice that is upholding and ensuring the rights of couples to determine the number
and spacing of their children according to their life's aspirations and reminding couples that
planning size of their families have a direct bearing on the quality of life.

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

✓ In 2003, there are about 84 million Filipinos to grow annually at 2.36 percent and expected to
double in 29 years.
✓ The total fertility rate is at 3.5 children/ women
✓ The use of contraceptive increases gradually from 15.4% (1996) to 48.9% (2003)
✓ 44% of women got pregnant with their first child at the age of 20-24.
✓ In 2003, among married women, 48.8% use any form of contraceptive method and 51.1% do not
use any form of contraceptive method at all.
GOAL:
• To provide universal access to family planning information and services wherever and whenever
these are needed. It aims to contribute to Reduce neonatal, infant, under-five and maternal
deaths.
OBJECTIVES:
• To help couples and individuals achieve their desired family size within the context of responsible
parenthood and to improve their reproductive health to attain sustainable growth.
• Ensure that quality FP services are available in DOH retained hospitals, LGU managed health
facilities and private sector.
TYPES OF FAMILY PLANNING:
1. Natural
• Standard Days Method
• Lactational Amenorrhea Method
• Basal Body Temperature
• Billings Ovulation/Cervical Mucus Method
• Symptothermal
2. Artificial
• Condom
• Injectables
• Oral Contraceptive Pills
• Intrauterine Device
3. Permanent
• Vasectomy
• Bilateral Tubal Ligation

❖ STANDARD DAYS METHOD

-Is the most appropriate for women who usually have cycles between 26 and 32 days long.
-95% effective
-Uses cycle beads to determine fertile days.
Steps:
1. Count the first day of your menstrual bleeding as DAY 1.
2. On days 1 to 7, you can have unprotected intercourse.
3. On days 8 to 19, you should use a barrier method or avoid intercourse.
4. From day 20 through the end of the cycle, you can have unprotected intercourse.

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

❖ LACTATIONAL AMENORRHEA METHOD (LAM)

-A temporary postpartum method of postponing pregnancy based on the physiological infertility
experienced by breast-feeding mothers.
-The mother may ovulate but not menstruate while breast-feeding.
-N A T U R A L
-Advantage: Easily accomplished by all postpartum lactating mothers
-99.5% effective

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

❖ BASAL BODY TEMPERATURE

-It is used to identify the fertile and infertile period of a woman’s cycle by daily taking and recording the
rise and fall in body temperature during and after ovulation.
-99% effective
-Based on the fact that:
◦ Before the day of ovulation, a woman’s BBT falls about half a degree.
◦ At the time of ovulation, her BBT rises a full degree because of the influence of progesterone. This is
maintained for the rest of her menstrual cycle.
-N A T U R A L

❖ BILLINGS OVULATION / CERVICAL MUCUS METHOD

-Abstaining from sexual intercourse during fertile (wet) days of spinnbarkeit mucus and 3 days after the
peak day.
-97% effective
-Advantage: Can be used by healthy women with no known diseases
-Disadvantage: Not so reliable
-N A T U R A L
-During ovulation, cervical mucus is copious, thin, watery, transparent, feels slippery and stretches at
least 1 in before strand breaks. The stretchability of the mucus is described by its spinnbarkeit, having
the raw egg white quality that is easier for sperm to penetrate.
-After ovulation, the character of cervical mucus changes, and under the influence of progesterone it
becomes thick, scant, and tacky; mucus doesn’t stretch when pulled between the thumb and finger.

❖ SYMPTOTHERMAL METHOD
-It is the combination of Basal Body Temperature and Billings method.
-98% effective
-N A T U R A L

❖ Calendar method
-It is abstaining from coitus 3 or 4 days before ovulation until 3 or 4 days after ovulation.
-The woman determines the number of days per menstrual cycle for 6 cycles.
-N A T U R A L
Calculation:
• Subtract 18 from the shortest cycle – first fertile day
• Subtract 11 from the longest cycle – last fertile day
• Ex. Range from 25 to 29 days
25 29
- 18 - 11
= 7th to = 18th day – fertile days (12)
1 to 6 day; 19 to 29 day – non fertile days
st th th th

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

❖ COITUS INTERRUPTUS
-Method of contraception where couple proceeds with coitus until moment of ejaculation and the man
withdraws so that the spermatozoa are emitted outside the vagina.
-NATURAL
-Disadvantages:
• Presence of few spermatozoa in preejaculation fluid
• Lack of control

❖ CONDOM
-A thin sheath of latex rubber made to fit on a man’s erected penis, it prevent the passage of sperm into
the internal vagina
-98% effective
-A R T I F I C I A L •
Advantages:
Safe and has no hormonal effect
✓ Protects against microorganims
✓ Easily accessible
✓ Used in managing premature ejaculation
Disadvantages:
✓ May cause allergy to latex
✓ May decrease sensation
✓ Interrupts the sexual act
✓ Requires man’s cooperation

❖ INJECTABLES
-A R T I F I C I A L
-It contains synthetic hormone, progestin which suppresses ovulation; thickens the cervical mucus thus
making it difficult for sperm to pass through
Advantages:
✓ Reversible and no daily intake
✓ No sexual inference
✓ No estrogen related effects
✓ Doesn’t affect breastfeeding
✓ 99.95% effective

❖ ORAL CONTRACEPTIVE PILLS

-A R T I F I C I A L
-Pill contains hormones: estrogen and progesterone, taken daily to prevent conception.
-99.7% effective
Advantages:
✓ Safe, convenient and easy to use, 3% failure

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

✓ Reduces gynecological symptoms like painful menstruation and reduce the risk of ovarian and
endometrial cancers
Disadvantages:
✓ Has side effects like: nausea, dizziness, breast tenderness, blurring of vision
✓ Suppresses lactation

❖ INTRAUTERINE DEVICE
-A long term birth control method that is a small, Tshaped plastic device that is wrapped in copper or
contains hormones.
-A plastic string is tied to the end of the IUD hangs down through the cervix into the vagina.
-99.4% effective and can last up to 10 years.
-A R T I F I C I A L

❖ VASECTOMY
-The vas deferens is blocked or cut, to prevent the passage of sperm.
-99.9% effective
-Birth control should be used until two negative sperm reports have been examined
-P E R M A N E N T

❖ BILATERAL TUBAL LIGATION (BTL)

-P E R M A N E N T
-Involves the cutting or blocking of the 2 fallopian tubes. 99.5% effective
Advantages:
✓ Permanent method of contraception
✓ No repeated clinic visits
✓ Does not interfere with sex – result to increase enjoyment
✓ No known side effects

CHILD HEALTH PROGRAM

-Newborns, infants and children are vulnerable age group for common childhood diseases.
-To address problems, child health programs have been created and available in all health facilities which
includes:
Infant and Young Child Feeding
Newborn Screening (NBS)
Expanded Program on Immunization (EPI)
Management of Childhood Illnesses
Micronutrient Supplementation
Dental Health
Early Child Development
Child Health Injuries
GOAL: Reduce morbidity and mortality rates for children 0 – 9 years with the strategies necessary for
program

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

INFANT AND YOUNG CHILD FEEDING

✓ There is global evidence that good nutrition in the early months and years of life plays a very
significant role, affecting not only the health and survival of infants and children but also their
intellectual and social development, resulting in life-long impact on school performance and
overall productivity.
✓ Breastfeeding, especially exclusive breastfeeding during the first half-year of life is an important
factor that can prevent infant and childhood morbidity and mortality.
✓ Timely, adequate, safe and proper complementary feeding will prevent childhood malnutrition.
BREASTFEEDING
Importance of Breast feeding:
Exclusive breast feeding is giving only breast milk to infants.
This is recommended up to 6 months and can be extended up to 2 years.
BENEFITS FOR THE INFANT:
• A complete food for the infants
• Strengthen immune system thus preventing infections
• Increases IQ points
BENEFITS FOR THE MOTHERS:
• Reduces excessive blood loss after birth
• Natural method of delaying pregnancies
• Reduces the risk of ovarian and breast cancers
Laws that protects infant and young child feeding:
• Milk code (EO 51)
-Products covered by milk code consist of breast milk substitute, e.g. infant formula, other milk products,
bottlefed complementary foods
• Rooming-In Breastfeeding Act of 1992 (RA 7600)
-Requires both public and private institution to promote rooming-in, it encourage and support the practice
of breastfeeding
• Food Fortification Law (RA 8976)
-An act establishing the Philippine food fortification Program and for other purpose

FOOD FORTIFICATION
-Food fortification law is vital in the promotion of optimal health and to compensate for the loss of nutrients
during processing and storage of food.
-The law requires a mandatory food fortification of staple foods – rice, flour, edible oil, and sugar and
voluntary food fortification of processed food and food products. (Vitamin A, Iron, Iodine)
-Fortification is “the addition of one or more essential nutrients to food, whether or not it is normally
contained in the food, for the purpose of preventing or correcting a demonstrated deficiency of one or
more nutrients in the population or specific population groups”

NEWBORN SCREENING
-Newborn Screening Act of 2004 (RA 9288).

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

-Newborn screening (NBS) is a public health program aimed at the early identification of infants who are
affected by certain genetic/ metabolic/ infectious conditions.
-Early identification and timely intervention can lead to significant reduction of morbidity, mortality, and
associated disabilities in affected infants.
-Newborn screening is ideally done on the 48th – 72nd hour of life. However, it may also be done after
24 hours from birth.
-A few drops of blood are taken from the baby’s heel, blotted on a special absorbent filter card and then
sent to Newborn Screening Center (NSC).
DISORDERS TESTED FOR NEWBORN SCREENING
1. CH (Congenital Hypothyroidism)
2. CAH (Congenital Adrenal Hyperplasia)
3. GAL (Galactosemia)
4. PKU (Phenylketonuria)
5. G6PD (Glucose-6-Phosphate Dehydrogenase)
6. MSUD (Maple Syrup Urine Disease)
1. CH – results from lack or absence of thyroid hormone which is essential for the physical and
mental development of a child.
2. CAH – is an endocrine disorder that causes severe salt loss, dehydration and abnormally high
levels of male sex hormones in both boys and girls. If not detected and treated early, babies with
CAH may die within 7-14 days.
3. GAL – is a condition in which babies are unable to process galactose, the sugar present in milk.
Accumulation of excessive galactose in the body can cause many problems, including liver
damage, brain damage and cataracts.
4. PKU – is a rare condition in which the baby cannot properly use one of the building blocks of
protein called phenylalanine. Excessive accumulation of phenylalanine in the blood causes brain
damage.
5. G6PD – is a condition where the body lacks the enzyme called G6PD. Babies with this deficiency
may have hemolytic anemia resulting from exposure to oxidative substances found in drugs,
foods and chemicals.
6. MSUD – a genetic defect in which a person is unable to break down the amino acids leucine,
isoleucine, and valine; urine of affected persons smells like maple syrup.

DISORDERS SCREENED Effect if NOT SCREENED Effect if SCREENED and Managed

CH Severe Mental Retardation Normal
CAH Death Alive and normal
GAL Death or Cataracts Alive and normal
PKU Severe Menta Retardation Normal
G6PD Deficiency Severe Anemia, Kernicterus Normal
Maple Syrup Urine Death Normal
EXPANDED PROGRAM ON IMMUNIZATION
-The EPI was launched in July 1976 by the DOH in cooperation with WHO and UNICEF.

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

- The original objective was to reduce the morbidity and mortality among infants and children caused by
the seven childhood diseases.
- Every Wednesday is designated as immunization day in all parts of the country.
-A fully immunized child: receives one dose of BCG, 3 doses of OPV, DPT, HB and one dose measles
vaccine before the child’s 1st
Republic Act No. 10152
-“Mandatory Infants and Children Health Immunization Act of 2011 signed by President Benigno Aquino
III in July 26, 2010.
-The mandatory includes basic immunization for children under 5 including other types that will be
determined by the Secretary of Health.
Four major strategies:
◦ Sustaining high routine FIC coverage of atleast 90%
◦ Sustaining polio free country for global certification
◦ Eliminating measles by 2008
◦ Eliminating neonatal tetanus by 2008
-Immunization is the process by which vaccines are introduced into the body before injection sets in. --
-Vaccines are administered to induce immunity
GUIDELINES:
-It is safe and immunologically effective to administer all EPI vaccines on the same day at different sites
of the body.
-Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not
contraindicated to vaccination.
-DPT2 and DPT3 are contraindicated to a child who has had convulsion or shock within 3 days the
previous dose.
-Live vaccines like BCG must not be given to individuals who are immunosuppressed due to malignant
disease, therapy with immunosuppressive agents or irradiation.
-It is safe and effective with mild side effects after vaccination. (Ex: Local reaction, fever)
-Repeat BCG vaccination if the child does not develop a scar after the first injection.
-BCG immunization shall be given to all school entrants both in private and public schools regardless of
the presence or absence of BCG scar.
Vaccine Minimum Age at Number of Minimum Reason
1st dose Doses Interval Between
Doses
BCG Birth or any time 1 BCG protects the
after birth infant from
possibility of TB
meningitis & other
TB infections.
DPT 6 weeks 3 4 weeks Reduces the
chance of
pertussis

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

OPV 6 weeks 3 4 weeks Protection against

Polio Disease
Hepatitis B At Birth 3 6 weeks interval Reduces the
from 1 dose to
st chance of being
2nd dose; 8 weeks infected and
interval from 2nd becoming a
to 3 dose
rd carrier
Measles 9 months 1 Prevents deaths,
malnutrition and
protection from
measles

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

NUTRITION PROGRAM
-Malnutrition continues to be a public health concerns in the country.
-The common nutritional deficiencies are Vitamin A, Iron and Iodine.
-GOAL: To improve quality of life of Filipinos through better nutrition, improved health and increased
productivity.
-Programs and projects are: Micronutrient supplementation, food fortification, nutrition information,
communication and education, home, school and community food production and food assistance.
POLICIES
•Nutritional Surveillance (NS): to determine victims of malnutrition
A. Anthropometric Measurement: study of measurements of human dimensions
▪ Age for Weight-if weight is not appropriate with the age
•Stunting: growth retardation
•Wasting: connotes malnutrition

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

▪ Age for Height-if height is not appropriate with the age: Stunting
▪ Weight for Height
RULE MALE FEMALE
Every height og 5ft 110 lbs 105 lbs
Every increment of an inch +6 +5
above 5ft ADD
Every decrement of an inch -6 -5
below 5ft. SUBTRACT
▪ Skin Folds Test
-Pinch the external oblique muscle (“bilbil”) with your palm
•Normal: 1 inch
•Overweight: > 1 inch
▪ Middle Upper Arm Circumference (MUAC) - used in children below 5 years old by measuring the
middle upper arm with a tape measure
-Normal: 13 cms. & above
-Malnutrition: <13 cms
B. Biochemical Method
▪ Micronutrient Malnutrition -available in small amount in the body
• Vitamin A Deficiency
O Deficiency: Xeropthalmia - opacity of cornea leading to night blindnes
-Infants (6-12 months) : Give 100,000 IU
-Pre-schoolers (12-83 months) : 200,000 IU
-Post-partum: 200,000 IU
O Never give Vitamin A to infants less than 6 months & pregnant women because it is toxic
• Anemia: Iron Deficiency Anemia
-Target age group: 0-59 months (less than 5 years)
-Give 3-6 mg/kbw/day
-Always give the maximum
-Example: Child weighs 8 kg 8 x 6=48 mg/day for the 1st 3 months then monitor
-If still anemic, continue giving but compute again 6 mg/kbw
•Goiter: Iodine Deficiency Disease (endemic in uphill)
-Target age group: 0-59 months
-Give 1 capsule (200 mg) of potassium iodate in oil once a year
-For a child < 5 years old, empty contents of capsule in a cup with warm water because he can’t tolerate
it
-Adverse Effect of Iodine Deficiency Disease that must be avoided:
▪ -Mental retardation-intelligence quotient: idiot, moron & imbecile
▪ Growth retardation- cretinism (pedia) & dwarfism (adult)
▪ Macronutrient Malnutrition - available in large amount in the body (Protein Energy Malnutrition or
PEM)
•Kwashiorkor-protein deficiency

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

•Marasmus-carbohydrate deficiency (energy giving food)

Kwashiorkor Marasmus
Etiology Disease experienced by an elder Muscle wasting
child upon the birth of a new baby
Deficiency CHON CHO
Age Toddlers (1 – 3 years old) All ages
Major Signs and Facial edema, moon facie Muscle wasting, old man’s face
Symptoms
Hair Changes (+) color changes from black to (-) hair changes
brown or from brown to golden
yellow
(+) sparse “flag sign”
Skin Dermatosis: dryness, peeling off (-)
of the skin, desquamation
Behavior Irritable Apathetic
Management High CHON diet High CHO diet
Hospital Setting Total Parenteral Nutrition
Hyperalimentation
IV infusion with CHON, CHO regulated by a machine

•Food Production
A. Fortification-products without any nutrient are added with nutrients
▪ RA 8172 (Asin Law): Fidel Salt (Fortification of Iodine Deficiency Elimination)=Iodized Salt-
“Patak” sa Asin” by Secretary Flavier on December 1-5, 2003where DOH workers go to market
to check if salt sold contains iodine byplacing few drops of reagent
•If salt color turns to blue violet→ fortified with iodine
•If salt color show no change→ not fortified with iodine
▪ RA 832 (Rice Fortification): FVR (Fortified Vitamin Rice) by Secretary Flavierunder FVR, Erap
Rice under Erap, Gloria Rice or “Bigas ni Gloria” under PGMA

MICRONUTRIENT SUPPLEMENTATION
-It is one of the interventions to address the health and nutritional need of infants and children and improve
their growth and survival.
-The twice-a-year distribution of Vitamin A capsules through the “Araw ng Sangkap Pinoy” (ASAP), known
as Garantisadong Pambata or Child Health Week is the approach adopted to provide micronutrient
supplements to 6-71 months old preschoolers on a nationwide scale.
DENTAL HEALTH
-Oral disease continues to be a serious public health problem in the Philippines. The prevalence of dental
caries on permanent teeth has generally remained above 90% throughout the years. About 92.4% of
Filipinos have tooth decay (dental caries) and 78% have gum diseases (periodontal diseases)

19 | P a g e
 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

-Although preventable, these diseases affect almost every Filipino at one point or another in his or her
lifetime.
Goal: Attainment of improved quality of life through promotion of oral health and quality
Dental Health Objectives:
✓ The prevalence of dental caries is reduce
✓ The prevalence of periodontal disease is reduced
✓ Dental caries experience is reduced
✓ The proportion of Orally Fit Children (OFC) 12-71 months old is increased

NAME:
Learning Activities:_ YEAR & SECTION:

SUBJECT/AREA: WEEK & DATE:

A. Directions: In your area of residence, select a particular program/strategy and make a report that
contains:
1. The health situation of the community or the rationale for the selected MNCHN
program/strategy. (Must be at least 7 sentences but not more than 10.)
2. The goals and or objectives of the program or strategy.
Pass it via our CHN Google Classroom on November 25 at 12NN. Save it on a PDF format using
the file name: Last name, ID number underscore subject-Implementation, year and section
(Francisco157_CHN-Implementation/2A/B).

References and Supplementary References:

Textbooks:
Cuevas, F. P. L. (Ed.). (2017). Public health nursing in the Philippines. Manila: Publications Committee,
National League of Philippine Government Nurses, Inc.

Gesmundo, M. H. et. al. (2017). PNLE fundamentals review compilation – A collection of review notes for
the local nursing board exams. Manila: Center for Excellence in Nursing Education, Inc.

Famorca, Z.et. al. (2013). Nursing Care of the Community. Singapore: Elsevier Pte Ltd.

Rayela, J.P. et al. (2000) Community health nursing services in the Philippine department of health.
Manila: Educational Publishing House.

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 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

21 | P a g e
 Republic of the Philippines
CEBU TECHNOLOGICAL UNIVERSITY
Main Campus
in consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Avenue corner Panganiban Street, Cebu City, Cebu, 6000 Philippines
Tel. Nos. +63-032 – 3161987 or 3165128
Email address: [email protected]

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