INTEGRATED MANAGEMENT OF  Requires appropriate antibiotic, oral

CHILDHOOD ILLNESS medication or any specific treatment

 As strategy deals with the management of Green
common childhood illnesses done in an  Mild classification
integrated manner.  Home treatment
 Includes preventive interventions, adjusts
curative interventions to the capacity and COUGH
functions of the health system (evidence – Three (3) Possible Classifications
based syndromic approach) and it involves the  Severe pneumonia or very Severe Disease
family members and the community in the  Pneumonia
health care process.  No pneumonia: Cough or Cold
Objectives Duration: Acute or Chronic
 To significantly reduce global mortality and  If it is more than 30 days; it is chronic
morbidity associated with major causes of  Fast breathing
disease in children. Age in months Respiratory rate
 To contribute to healthy growth and Less than two (2) months 60 bpm or more
development of children. Two (2) months to less 50 bpm or more
Case Management Process than 12 months
 Assess the child or infant 12 months to 5 years 40 bpm or more
 Classify the illness Stridor
 Identify treatment • Harsh noise when the child breathes IN
 Treat the child/ Refer Chest Indrawing
 Counsel the mother • When the lower chest wall goes IN when the
 Give follow up care child breathes IN
Assessing the child or Young Infant Any general danger SEVERE
 What should always be your first question to signs or PNEUMONIA OR
the mother? Chest indrawing or VERY SEVERE
- What is the child’s problem? Stridor DISEASE (PINK)
 What is the next question? Fast breathing PNEUMONA
- How old is the child? (YELLOW)
Age Group Classification No signs of pneumonia NO PNEUMONIA
 Young Infant or very severe disease COUGH OR COLD
- Childbirth to less than two (2) months (GREEN)
 Young child
- Two (2) months to less than five (5) years DIARRHEA
Check for general danger signs • 3 times or more watery/ loose stools
 Sleeping abnormally or lethargic • Duration
 Inability to feed  If it is more than 14 days, it is
 Vomiting PERSISTENT DIARRHEA
 Convulsions  If it is Persistent Diarrhea, with signs of
Assess main symptoms dehydration, it is SEVERE
 Cough PERSISTENT DIARRHEA
 Diarrhea • Blood in the stool
 Fever  DYSENTERY
NOTE: there should be at least 2 or more signs
 Ear problem
before you can classify
Classification
Assessing and classifying the illness of a young
Severe dehydration (Pink)
child
• Lethargic or unconscious
Color coding
Pink • Sunken eyes
• Drinking poorly
 Severe classification
• Skin goes back very slowly
 Needs referral
Some Dehydration (Yellow)
 Requires parenteral medications as initial • Restless and irritable
treatment prior to referral. • Sunken eyes
• Drinking eagerly
Yellow • Skin goes back slowly
 Moderate classification No Dehydration (green)
 RHU Health center treatment

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 • Not enough signs to classify as some or In the mouth
severe dehydration.  Mouth ulcers
 Are they deep and extensive?
FEVER
Criteria for Fever Any general dangers SEVERE
• By history signs, or COMPLICATED
• Feels hot Clouding of the MEASLES (Pink)
• Axillary temp is 37.5 C or above cornea, or
Three (3) possible illnesses Deep extensive
• Malaria mouth ulcers
• Measles Pus draining out of MEASLES WITH EYE
• Dengue Hemorrhagic Fever the eye, or OR MOUTH
Mouth ulcers COMPLICATIONS
MALARIA (Yellow)
Risk
• Resident of a malaria risk area Measles now or MEASLES (Green)
• Travelled and stayed overnight in a within the last 3
malaria risk area for the past 4 weeks months
Stiff neck DENGUE HEMORRHAGIC FEVER
Blood smear, if not available Bleeding from nose or
Other causes of fever gums, or
• Runny nose Bleeding in stools or SEVERE DENGUE
• Measles vomitus, or HEMORRHAGIC
FIVE POSSIBLE CLASSIFICATIONS Skin petechiae, or FEVER (Pink)
MALARIA RISK Cold and clammy
• Very Severe Febrile Disease/ Malaria extremities, or
• Malaria Capillary refill more
• Fever: no malaria than 3 seconds, or
NO MALARIA RISK persistent abdominal
• Very Severe Febrile Disease pain, or
• Fever: no malaria Persistent vomiting, or
MALARIA RISK Positive tourniquet
Any general danger VERY SEVERE test
signs, or FEBRILE DISEASE/ No signs of very FEVER: NO MALARIA
Stiff neck MALARIA (Pink) febrile disease (Green)
Blood smear (+) MALARIA (Yellow)
Blood smear (-), or FEVER: MALARIA
Measles, or UNLIKELY (Green) Bleeding from the following areas:
Other causes of fever  Nose
NO MALARIA RISK  Gums
Any general danger VERY SEVERE  Vomitus (is it black?)
signs, or FEBRILE DISEASE  Stools (is it black?)
Stiff neck (Pink)  Skin petechiae
Signs of shock
No signs of very severe FEVER: NO  Cold clammy extremities
febrile disease MALARIA  Slow capillary refill
(Green)
 Tourniquet test
o Take BP using pediatric cuff.
MEASLES
o Calculate the average between systolic
• Now or within the last 3 months
and diastolic pressure.
• Signs of measles
o Inflate the cuff to the calculated average
 Fever
 Generalized rash and keep the pressure for 5 minutes.
 Cough o Release the pressure and draw a one sized
 Runny nose inch square of the forearm.
 Red eyes o Count the number of petechiae inside the
• Check for complications square. If there are 20 or more, the test is
In the eyes positive.
 Pus draining  Persistent abdominal pain
 Clouding of the cornea  Persistent vomiting

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 Follow up: 5 days
EAR PROBLEM
• Ear pain DIARRHEA
• Ear discharge Severe Dehydration (PINK)
• Duration: Acute or Chronic – if it is more Plan C
than 14 days it is chronic 100ml/kg Ringer’s Lactate Solution
• Swelling behind the ear.
Tender Swelling behind MASTOIDITIS (Pink)
the ear
Pus is seen draining ACUTE EAR
from the ear and INFECTION (Yellow)
discharge is reported
for less than 14 days
Pus is seen draining CHRONIC EAR
from the ear and INFECTION (Yellow)
discharge and reported
for 14 days or more
No ear pain and NO EAR NFECTION
(Green)
No pus is seen draining
from the ear Some Dehydration (Yellow)
PLAN B
Oral rehydration salt
Give for 4 hours
 Use the child’s age when you don’t know the
weight.
 The approximate amount of ORS required
( in ml) can be also calculated by multiplying
IDENTIFYNG THE TREATMENT AND the child’s weight in kg x 75.
TREATING THE YOUNG CHILD  If the child wants more ORS than shown give
COUGH more.
Severe Pneumonia or Very Severe Disease (Pink)
 If the child vomits wait 10 mins then
 Give first dose of antibiotic continue but slowly.
 (Gentamycin and Penicillin)  For infants below 6 mos. who are not
 Give Vitamin A breastfed also give 100-200ml clean water
 Treat the child to prevent low blood sugar during this period.
 Refer URGENTLY to the hospital  After 4 hours of treatment REASSESS AND
PNEUMONIA (Yellow) RECLASSIFY the child.
Give appropriate oral antibiotic 2x a day for 3 days ORESOL measurement for Plan B
 1st line: Amoxicillin
 2nd line: Co-trimoxazole
 If wheezing, give inhaled bronchodilator
for 5 days: Salbutamol
 Soothe the throat and relieve cough with
safe remedy
 Breast milk for exclusively for breastfed
infant
 Calamansi juice
 Advise mother when to return immediately
Fast breathing
Difficulty breathing
Any danger signs
Follow up: 2 days
NO PNEUMONIA: COUGH OR COLD (Green)
If wheezing, give an inhaled bronchodilator for 5 No dehydration (Green)
days (Salbutamol) Plan A
Soothe the throat and relieve cough with safe
remedy
Advise mother when to return immediately

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 Follow up: 2 days
Measles (Green)
Give Vitamin A
Advise mother when to return immediately
DENGUE HEMORRHAGIC FEVER
Severe DHF (Pink)
If the only positive signs are the following, GIVE
ORS (PLAN B)
Persistent vomiting
Persistent abdominal pain
Skin petechiae
Positive tourniquet test
If any other signs of bleeding are present GIVE
FLUIDS RAPIDLY
(PLAN C)
Refer URGENTLY. DO NOT GIVE ASPIRIN
Fever: DHF unlikely (Green)
Advise mother when to return immediately
Follow up: 2 days
DO NOT GIVE ASPIRIN
 Counsel mother on the 4 rules of home
treatment EAR PROBLEM
 Give extra fluid Mastoiditis (Pink)
 Continue feeding Give 1st dose of an appropriate antibiotic
Give 1st dose of paracetamol
 Advise the mother when to returnn
Refer URGENTLY
Acute Ear Infection(yellow)
FEVER
Give an antibiotic for 5 days TID
MALARIA RISK
Very Severe Febrile Disease/ Malaria (Pink) 1st line: Amoxicillin
 Give 1st dose of quinine 2nd line: Co- trimoxazole
 Give 1st dose of appropriate antibiotic Give paracetamol for pain
 Treat to prevent low blood sugar Dry the ear by wicking
 Give 1 dose of paracetamol in health center for Follow up: 5 days
high fever (38.5C or above) Chronic Ear Infection (yellow)
 Refer URGENTLY Dry the ear by wicking
MALARIA (Yellow) Instill quinolone otic drops for 2 weeks
Treat with oral antimalarial Follow up: 5 days
1st line: Artemether – Lumefantrine 2x day on No Ear Infection (Green)
Days 1- 3 No additional treatment
Advise mother when to return immediately
2nd line: Primaquine single dose on Day 4
Give 1 dose of paracetamol in health center for Other important notes about treatment
high fever (38.5C or above)  If coughing for more than 30 days, refer for
Follow up: 2 days assessment.
FEVER: MALARIA UNLIKELY (GREEN)  If the child has Pneumonia and he has cough
Give 1 dose of paracetamol n health center for high for more than 3 weeks or recurrent wheezing
fever (38.5 C or above) refer for assessment for TB or asthma
Treat other causes of fever  IM antibiotic Gentamycin and Benzyl
Follow up: 2 days Penicillin are given to all children that are
MEASLES being referred urgently.
Severe Complicated Measles (Pink)
 If fever is present every day for more than 7
Give Vitamin A
days, refer for assessment.
Give appropriate antibiotic
 Repeat quinine injection at 4 – 8 hours later,
Refer URGENTLY
then every 12 hours until the child is able to
Measles with Eye or Mouth Complications
take an oral antimalarial
(YELLOW)
Give Vitamin A
CHECKING FOR MALNUTRITION AND
Eye complication: Tetracycline Ointment 3x daily
ANEMIA
Mouth complication: Gentian Violet 2x daily
MALNUTRITION

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  Determine weight for age
 Edema of both feet: KWASHIORKOR ANEMIA (yellow)
 Positive if a dent remains in the child’s If the child is less than 2 years old assess the
foot when you press it using your thumb child’s feeding and counsel the mother on feeding
and lift it. Give IRON one dose daily for 14 days
Kwashiorkor is a form of severe protein–energy Give Albendazole / Mebendazole if child is 1 year
malnutrition characterized by edema, irritability, older and has not had a dose in the previous 6
ulcerating dermatoses, and an enlarged liver with months
fatty infiltrates. Follow up 14 days
Visible severe wasting No Anemia (green)
MARASMUS If the child is less than two years old, asses the
“Baggy pants” many folds of skins on the buttocks child's feeding and counsel th mother on feeding.
and thigh, abdomen may be large or distended If feeding is a problem, follow up: 5 days
 Mid upper arm circumference (MUAC) Advise the mother when to return immediately
should not be less than 115 mm Dosages for Vitamin A and Mebendazole /
 If age up to 6 months Albendazole
and When to return immediately
 Visible severe SEVERE
wasting MALNUTRITION
 Edema of both feet (Pink)
 If age 6 months and
above and
 MUAC is less than
115 mm
 Edema of both feet
 Visible severe
wasting
 Very low weight VERY LOW
for age WEIGHT (Yellow)

 Not very low NOT VERY LOW

weight for age WEIGHT (Green)
and no other signs
of malnutrition

Severe Malnutrition (pink)

 Treat to prevent low blood sugar
 Give VITAMIN A
 Refer URGENTLY
Very Low Weight (yellow)
 Assess child’s feeding and counsel the
mother on feeding
 If feeding is a problem, Follow up: 5 days
 Give VITAMIN A When to return immediately
 Follow up: 30 days Any sick child
Not Very Low Weight (green)  Not able to drink or breastfeed
 If the child is less than 2 years old, assess  Becomes sicker
the child’s feeding and counsel the mother  Develops fever
on feeding  No pneumonia cough or cold
 If feeding is a problem, follow up: 5 days  Fast breathing
 Advise mother when to return  Difficulty breathing
immediately  Diarrhea
 Blood in the stool
ANEMIA  Drinking poorly
Palmar pallor
Severe Anemia (pink) Fever: DHF unlikely
Refer URGENTLY Any sign of bleeding

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PAHUNAO, REYZEL MAE
 Persistent abdominal pain Any jaundice if age is SEVERE JAUNDICE
Persistent vomiting less than 24 hours
Skin petechiae /rash Yellow palms and
ASSESSING, CLASSIFYING AND TREATING soles at any age
THE YOUNG INFANT Jaundice appearing JAUNDICE
Very Severe Disease and Local Infection after 24 hours of age
Any of the following signs: VERY Palms and soles not
 Not feeding well SEVERE yellow
 Convulsions DISEASE No jaundice NO JAUNDICE
 Fast breathing (60 bpm) (PINK)
 Severe chest indrawing Severe Jaundice (pink)
 Fever Treat to prevent low blood sugar
 Low body temp (less Refer URGENTLY
than 35C) Keep the infant warm
 Movement only when Jaundice (yellow)
stimulated or no Advise mother to give home care
movement at all. Advise mother to return immediately if palms and
 Umbilicus red or LOCAL soles appear yellow
draining pus BACTERIA If the young infant is older than 14 days refer for
L assessment
 Skin pustules
INFECTIO Assess & counsel the mother on care for
N development
(YELLOW Follow up: 1 day
None of the signs of very severe SEVERE No Jaundice (green)
disease or local infection DISEASE Advise mother to give home care
OR LOCAL Assess and counsel mother on care for
INFECTIO development
N
UNLIKELY CHECKING FOR FEEDING PROBLEMS OR
(GREEN) LOW WEIGHT FOR AGE (FOR BREAST FED
INFANTS)
Very Severe Disease (PINK) Good attachment
Give first dose of antibiotic (Ampicillin &  Chin touching the breast
Gentamicin)  Mouth wide open
Treat to prevent low blood sugar  Lower lip turned outward
Refer URGENTLY  More areola above than below the mouth
Keep the infant warm NOTE: All of the signs should be present if the
NOTE: Referral is the best option for a young attachment is good.
infant classified with VERY SEVERE DISEASE.  Not well attached FEEDNG PROBLEM
If referral not possible, continue to give Ampicillin to breast FOR AGE (yellow)
and Gentamicin for at least 5 days. give Ampicillin  Not sucking
2 times daily to infants less than one week of age effectively
and 3 times daily to infants one week or older. Give  Less than 8
Gentamicin once daily. breastfeeds n 24
Local Bacterial Infection(yellow) hours
Give an appropriate oral antibiotic  Low Weight for
1st line: Amoxicillin Age
 Thrush (ulcers or
2nd line: Cotrimoxazole
white patches in
Teach mother how to treat local infections at home
the mouth)
Follow up: 2 days
 Not low weight for NO FEEDNG
age and no other PROBLEM (green)
Severe Disease or Local Infection Unlikely (green)
Advise mother to give home care for the young signs of inadequate
infant feeding
Assess and counsel the mother on care for
development Feeding problem or Low Weight for Age
(yellow)
 Teach correct positioning and attachment.
JAUNDICE

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  If less frequently less than 8 times every 24
hours, advise to increase frequency of
breastfeeding.
 If mother gives infant other foods or drinks
counsel further about breastfeeding and
instruct her to reduce other foods and drinks
and to use a cup.
 Advise the mother how to feed and keep the
low weight infant warm at home.
 If thrush, teach mother to treat thrush at
home - use 0.25% Gentian Violet
 Advise mother to give home care
 Follow up (any feeding problem or thrush) 2
days
 Follow up (low weight): 14 days
 Assess and counsel the mother on care for
development.
No Feeding Problem (Green)
 Assess and counsel the mother on care for
development.
 Advise mother to give home care
 Praise the mother for feeding the infant well.

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PAHUNAO, REYZEL MAE
 STEPS IN INTEGRATED CASE home;
MANAGEMENT • provides advice on the home management of sick
STEP 1. ASSESS children at home;
 Good communication with mother of child • if needed, asks the mother or other caregiver to
 Screen for general danger signs, which would return with the child for follow-up on a specific
indicate any life-threatening condition date.
 Specific questions about the most common STEP 5. COUNSEL
conditions affecting a child's health (diarrhea, If the follow-up care is indicated the health-care
pneumonia, fever, etc.) provider teaches the mother when to return to the
 If the answers are positive, focused physical clinic, the health worker also teaches the mother
exam to identify life-threatening illness how to recognize signs indicating that the child
 Evaluation of the child's nutrition and should be brought back to the clinic immediately.
immunization status. The assessment includes When indicated, a health-care provider assesses
checking the child for other health problems. feeding, including breastfeeding practice, and
STEP 2. CLASSIFY provides counselling to solve any feeding problems
Based on the results of the assessment a health-care found. This also includes counseling the mother
provider classifies a child's illnesses using a about her own health.
specially developed color-coded triage system. STEP 6. FOLLOW-UP
Because many children have more than one Some children need to be seen more than once for a
condition, each condition is classified according to current episode of illness. The IMCI case
whether it requires: management process helps to identify those
Urgent pre-referral treatment and referral, or children who require additional follow-up visits.
Specific medical treatment and advice, or When such children are brought back to the clinic,
Simple advice on home management a health-care provider gives appropriate follow-up
STEP 3. IDENTIFY TREATMENT care, as indicated in IMCI guidelines, and if
After classifying all the conditions present, a necessary, reassess the child for any new problems.
health-care provider identifies specific treatments
for the sick child or the sick young infant.
• If a child requires urgent referral (pink
classification), essential treatment to be given
before referral is identified.
• If a child needs specific treatment (yellow
classification), a treatment plan is developed, and
the drugs to be
administered at the clinic are identified. The
content of the advice to be given to the mother is
decided on.
• If no serious conditions have been found (green
classification), the mother should be correctly
advised on the appropriate actions to be taken for
care of the child at home.

STEP 4. TREAT
After identifying appropriate treatment, a health-
care provider carries out the necessary procedures
relevant to the child's conditions.

• gives pre-referral treatment for sick children

being referred;
• gives the first dose of relevant drugs to the
children who are in need of specific treatment, and
teaches the mother how to give oral drugs, how to
feed and give fluids during illness, and how to treat
local infections at

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 Environmental Sanitation 4. Biological examination- the kind and
Defined as the study of all factors in man’s amount of microscopic life are determined
physical environment which may affect his health, using appropriate lab. Techniques and
well-being and survival apparatus
Household Treatment of Water
Major Fields of Activity  Chlorine – powerful germicide
 Water supply sanitation  8 to 10 drops of iodine per gallon of water
 Excreta and sewage disposal  Potassium permanganate
 Control of rodents and insects Characteristics of a suitable water supply
 Refuse storage, collection and disposal  Physically, chemically and
 Food sanitation bacteriologically safe.
 Reasonably soft and neither scale forming
 Environment and Occupational Health Office nor corrosive
(EOHO) – under the DOH which is  Low in cost so that all or at least the
responsible for the promotion of healthy majority of the people can afford to be
environmental conditions and prevention of connected to it.
environmental related diseases  Plentiful, since shortage of supply will
 EOHO promotes and provides technical force all or part of the population to secure
assistance on sanitation programs through water from sources of doubtful quality
DOH Centers for Health and Development in Excreta and Sewage Disposal
the different regions of the Philippines Objectives:
1. To help prevent gastrointestinal infections
Major Environmental Health and Sanitation including parasitism.
Programs: 2. To help and protect and conserve the
Water Supply and Sanitation Program nation’s water resources.
Approved types of water supply facilities: 3. To promote health and wellbeing which
• Level I (Point Source) – a protected well or a are conducive to further socio-economic
developed spring with an outlet but without a development.
distribution system. Serves around 15 to 25 Proper Excreta and Sewage Disposal Program
households. Not more than 250 meters from Approved type of toilet facilities:
the farthest user. Level I
• Level II (Communal Faucet System or Stand-  Non-water carriage toilet facility – no
post) – composed of a source reservoir, a piped water is necessary to wash the waste. Ex.
distribution network and communal faucets. Pit Latrines
Located not more than 25 meters from the  Toilet facilities requiring small water to
farthest house. Can serve an average of 100 wash Ex. Aqua privy
household and with one faucets per 4 to 6
household. Level II – toilet facilities of the water carriage type
• Level III (Waterworks system or individual with water-sealed and flush type with septic tank
house connections) – a system with a source, a disposal facilities.
reservoir, a piped distributor network and
household taps. Suited for densely populated Level III – water carriage types of toilet facilities
urban areas. Requires minimum treatment or connected to septic tanks and/or sewerage system
disinfection to treatment plant.
Refuse Storage, Collection and Disposal
Examination of Water Refuse- is a general term applied to solid and semi-
1. Physical examination- to find out the solid waste materials other than human excreta.
physical attributes of water, turbidity, Types of waste materials
color, taste and odor. 1. Garbage- left over vegetables, animal and
2. Chemical examination- measures the pH, fish from kitchen and food establishments.
alkalinity, total solids, chloride, hardness The material tends to decay giving off foul
and iron odors.
3. Bacteriological examination- finds out if 2. Rubbish -waste materials such as bottles,
the water is potentially dangerous and broken glass, tin cans, waste papers,
whether or not the kind and number of discarded porcelain wares, pieces of metal
bacteria present constitute a health hazard. and other wrapping materials.
Water for human consumption should not 3. Ashes- left over from burning of wood and
contain any pathogenic or disease-causing coal. Ashes may become a nuisance
germs. because of the dust associated with them.
4. Dead animals-

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PAHUNAO, REYZEL MAE
 5. Street sweepings- dust, manure, leaves, - Avoid buying canned foods with dent,
cigarette butts, waste papers and others bulges, deformation and broken seals
that are swept from the streets. - Use clean water only from safe source
6. Night soil- human waste wrapped and - When in doubt of the water source boil for
thrown in sidewalk and streets at least 5 minutes
Refuse disposal methods in the home 2. Right Preparation
1. burial- deposited in pits covered with soil - Avoid contact between raw foods and
2. Burning – cooked foods
3. Feeding to animals - Always buy pasteurized milk and fruit
4. Composting- the materials are used as soil juices
conditioner and fertilizer - Wash vegetables well if to be eaten raw
5. Grinding and disposal to sewers - Always wash hands and kitchen utensils
Community Refuse Disposal - Sweep kitchen floors to remove food
1. Dumping on land droppings
2. Sanitary land fill 3. Right Cooking
3. Composting - Cook food properly and ensure
4. Incineration temperature on all parts of the food should
5. Reduction and salvage reach 70 degrees centigrade
- Eat cooked food immediately
- Wash hands thoroughly before and after
eating
4. Right storage
- Keep food at room temperature for not
more than 2 hours to prevent
multiplication of bacteria
- Use slightly sealed containers for storing
food
4. Right storage
- Store food under hot conditions (at least
60 degrees centigrade) or cold food
conditions (below or equal to 10 degrees
centigrade). Vital if you plan to store food
for 4 to 5 hours in order to prevent
multiplication of bacteria
- Foods for infants should always be freshly
prepared and not to be stored at all
- Do not overburden the refrigerator by
filling it with too large quantities of warm
food
- Reheat stored food at least 70 degrees
centigrade before eating
- Rule in food safety; “When in doubt,
throw it out!”

National and International Environmental Laws

and DOH Policies affecting Environmental
Food Sanitation Program Health and Sanitation
 Another program by the DOH to prevent RA 6969
food-borne infection due to unsanitary  “Toxic Substances and Hazardous and
handling of food Nuclear Waste Control Act of 1990”
 Banning of shellfish consumption during  Regulating the importation, use,
red tide to prevent shellfish poisoning movement, treatment and disposal of toxic
 Regulation and monitoring of vendors to chemicals and hazardous and nuclear
comply for health certificates wastes in the Philippines
Four Rights in Food Safety RA 8749
1. Right Source  “Clean Air Act of 1999”
- always buy fresh foods (meat, fish, fruits,  Provides a comprehensive air pollution
etc) management and control program to
- Always look at the expiry dates achieve and maintain healthy air.

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  Ban smoking in enclosed public places
including public transport in order to
prevent indoor pollution due to second
hand smoke
RA 9003
 “Ecological Solid Waste Management Act
of 2000”
 It declares the adoption of a systematic,
comprehensive, and ecological solid waste
management program as policy of the
State.
 Mandates waste diversion through
composting and recycling
RA 9275
 “Clean Water Act of 2004”
 Aims to establish wastewater facilities that
will clean wastewater before releasing into
the bodies of water like the rivers and
seas.
Nursing Responsibilities and Activities
 Health education
 Actively participate in the training component
of the service like in Food Handler’s Class,
and attend training/ workshops related to
environmental health
 Assist in the deworming activities for the
school children and targeted groups.
 Effectively and efficiently coordinate
programs/ projects/ activities with other
government and non-government agencies
 Act as an advocate or facilitator to families in
the community in matters of programs/
projects/ activities on environmental health in
coordination with other members of RHU
especially the Rural Sanitary Inspector
 Actively participate in environmental
sanitation campaigns and projects in the
community.
 Be a role model for others in the community to
emulate in terms of cleanliness in the home
and surrounding
 Participate in research/ studies to be conducted
in their respective area of assignment.
 Help in the interpretation and implementation
of P.D. 856 commonly known as Sanitation
Code of the Philippines
 Assist in the Disaster Management, which will
be implemented at all levels

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Information Technology and Community Health 2. Enhancing quality of care
What is eHealth  increasing efficiency involves not
 eHealth is the use of ICT for health (World only reducing costs, but at the same
Health Organization, 2012). time improving quality. E-health may
 On May 25, 2005, during the Fifty-Eighth enhance the quality of health care for
World Health Assembly (WHA), a resolution example by allowing comparisons
was adopted by the World Health Organization between different providers, involving
(WHO) member states recognizing eHealth as consumers as additional power for
then cost-effective way of using ICT in health quality assurance, and directing
care Services, health surveillance, health patient streams to the best quality
literature health education, and research providers
(WHA, 2005) 3. Evidence based
 e-health is an emerging field in the intersection  e-health interventions should be
of medical informatics, public health and evidence-based in a sense that their
business, referring to health services and effectiveness and efficiency should
information delivered or enhanced through the not be assumed but proven by
Internet and related technologies. rigorous scientific evaluation. Much
work still has to be done in this area.
Given the extensive capabilities of ICT eHealth can 4. Empowerment of consumers and
be considered in any of, but not limited to, the patients
following,  by making the knowledge bases of
 Communicating with a patient through a medicine and personal electronic
teleconference, electronic mail (e-mail), records accessible to consumers over
short message service (SMS). the Internet, e-health opens new
 Recording retrieving, and mining data in avenues for patient-centered
an electronic medical record (EMR) medicine, and enables evidence-based
 Providing patient teachings with the aid of patient choice
electronic tools such as radio, television, 5. Encouragement of a new relationship
computers, smartphones, and tablets. between the patient and health
professional, towards a true partnership,
eHealth, often confused with telehealth of where decisions are made in a shared
telemedicine, is the overall, umbrella term manner.
According to the WHO, eHealth encompasses three 6. Education of physicians through online
main areas: sources (continuing medical education)
 The delivery of health information for and consumers (health education, tailored
health professionals and health consumers, preventive information for consumers)
through the Internet and 7. Enabling information exchange and
telecommunications. communication in a standardized way
 Using the power of information between health care establishments.
technology (IT) and e-commerce to 8. Extending the scope of health care
improve public health services, for beyond its conventional boundaries.
example, through the education and This is meant in both a geographical sense
training of health workers. as well as in a conceptual sense. e-health
 The use of e-commerce and e-business enables consumers to easily obtain health
practices in health systems management services online from global providers.
These services can range from simple
advice to more complex interventions or
products such a pharmaceutical.
The 10 e's in "e-health" 9. Ethics
1. Efficiency  e-health involves new forms of
 one of the promises of e-health is to patient-physician interaction and
increase efficiency in health care, poses new challenges and threats to
thereby decreasing costs. One ethical issues such as online
possible way of decreasing costs professional practice, informed
would be by avoiding duplicative or consent, privacy and equity issues.
unnecessary diagnostic or therapeutic 10. Equity
interventions, through enhanced  to make health care more equitable is
communication possibilities between one of the promises of e-health, but at
health care establishments, and the same time there is a considerable
through patient involvement threat that e-health may deepen the

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 gap between the "haves" and "have- compromised as information is not readily
nots". People, who do not have the available and up-to-date on a daily basis.
money, skills, and access to 5. Actual time for patient care gets limited.
computers and networks, cannot use Time spent by the community health worker
computers effectively. As a result, searching for a paper-based record is time lost
these patient patient populations for actual care.
(which would actually benefit the
most from health information) are Well-managed patient information system can
those who are the least likely to have the following Benefits
benefit from advances in information 1. Data are readily mapped, enabling more
technology, unless political measures targeted interventions and feedback. Through
ensure equitable access for all. The a system that delivers real- time and accurate
digital divide currently runs between patient and community information, health
rural vs. urban populations, rich vs. care providers are able to deliver patient-
poor, young vs. old, male vs. female centered care and targeted disease prevention
people, and between neglected/rare and management programs. The facility and
vs. common diseases. staff are also provided feedback on their
performance through computer alerts, enabling
them to continually comply with standard
In addition to these 10-essential e's, e-health should guidelines and monitor monthly, quarterly, or
also be yearly health targets
 easy-to-use 2. Data can be easily retrieved and recovered. In
 entertaining (no-one will use something the event of force majeure, retrieval of patient
that is boring!) and information is not a problem since data are
 exciting automatically backed-up periodically in a
and it should definitely exist! secure server.
3. Redundancy of data is minimized. Patient data
Paper- based methods may bring inconvenience that are frequently required in various health
especially when it comes to interoperability of forms such as unique identifying information
health services, information backup and instant (e.g. name, birthday, age, gender) need to be
data access. A number of bigger problems may recorded only once. These can be linked and
also emerge: organized automatically into related record
1. Continuity and interoperability of care stops types through a database, allowing a better
in the unlikely event that a record gets record management and ease-of use
misplaced if the patient suffers from a chronic 4. Data for clinical research becomes more
condition, previous findings supporting this available. The potential impact of health
diagnosis, drug allergies, pre-existing research in the country is often hindered by the
conditions, or even past accounts of the lack of quality data. Whenever data is
patient's previous visits may no longer be gathered, it is often not communicated to the
accessed unless the health providers have rest of the research community Having quality
made several copies of the same record. The data stored in databases provides faster and
patient may also need to recount his/her more reliable research outputs that may
condition for every transfer of care eventually be translated to health care
2. Illegible handwriting poses misinterpretation innovations and actual interventions.
of data. A direct observational study of 5. Resources are used efficiently. By making
medication administration found opportunities patient information more readily available,
for errors associated with incomplete or EMRs reduce costs related to chart pulls as
illegible prescriptions. well as supplies needed to maintain paper
3. Patient privacy is compromised. Traditional, charts. Studies have also shown that having an
paper-based records are vulnerable to EMR as opposed to a paper file can result in
unauthorized patient viewing since there is no reduced transcription costs through point of
audit trail of the usage of the chart. The care documentation and other structured
disclosure of highly private information arising documentation procedures.
from such an incident can lead to los of trust in
the health facility or even legal risks Accuracy
4. Data are difficult to aggregate. Manual data  This ensures that documentation reflects the
recording and tallying significantly delays event as it happened.
implementation of interventions and targeted  All values should be correct and valid.
health programs. Health care monitoring is  In a computerized system, a computer can be
instructed to check specific fields for validity

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 and alert the user to a potential data collection  Unified Health Management Information
error System
 In electronic systems, format requirements Factors affecting eHealth in the country
must be followed (e.g. if date required is mm-  Limited health budget, the budget allocation
dd-yyyy, then it should be presented as 03-24- for health care is relatively small. This is one
1989). of the many reasons advancements in eHealth
Accessibility are postponed. ICT projects usually require a
 This is a data characteristic which ascertains huge budget, take a long period to implement,
data availability should the patient or any and are occasionally seen as risky endeavors.
member of the health care staff needs it.  The emergence of free and open source
 An example is readily available reports or software in eHealth, the cost of software
statistics when needed by decision makers. procurement or development often takes up a
Comprehensiveness huge portion of the budget. In addition, using
 Data inputted should be complete. This is done ready-made proprietary software can be
by making sure that all required fields in the limiting at times, especially when users want to
patient's record are properly filled up. modify the software to fit their workflow
Consistency/Reliability better.
 Having Discrepancies in data recorded makes  Decentralized government. Under RA 7160 or
it consistent. This means that when John Lloyd the Local Government Code of 1991, local
Dela Cruz is written on the first page of the government units (LGUS) are autonomous,
patient record, it should not be Jon Loyd Dela and therefore in control of their own basic
Cruz in the next. This potential error is reduced health services, including the budget.
through error detection and alerts by the  Target users are unfamiliar with the technology
computer. eHealth is not only about technology. Along
Currency with software development and hardware
 All data must be up-to-date and timely. This is procurement, staff training and maintenance of
exemplified when the community health nurse the system are key factors in determining its
records data at the point-of-care or when it effectiveness. Recognition of the cultural
happened. aspects of community life is important in
Definition starting them off into a new direction such as
 Data should be properly labelled and computerization and automation
clearly defined. For example 36 is just an  One possible pitfall of eHealth
ordinary number unless it is labelled as an implementations is focusing on software
age of a person. development before accomplishing an
assessment of the needs of health professionals
eHEALTH SITUATION IN THE PHILIPPINES in the field.
 The developing world suffers from  Most health center personnel are not familiar
inadequate health care and medical with the use of computers. Implementing an
services. eHealth system requires training of health
 Lack of health care professionals and personnel on basic computer skills, use of
Infrastructure contributes to this problem, software, and maintenance of the equipment.
making it more difficult to deliver health care
to people in rural and remote communities of  A term coined by educator and writer
the developing world Marc Prensky (2001). Digital native
 The ubiquity of mobile technologies and describes a person who grew up and is
availability of Internet services in the familiar with digital technologies, and
Philippines create a promising ground for who uses them in daily living.
eHealth access.  The entry of digital native nurses into the
 ICT has changed how Filipinos access profession and their nationwide
information and how the government has deployment to communities may
utilized this to inform its citizenry. potentially aid the implementation of
 The health sector has also begun utilizing ICT various ICT projects in health care
to improve its services. The DOH has  Overall, the Philippines is progressing in
introduced a number of health information the use of eHealth for the benefit of its
systems that aim to improve the access of citizens
health data, such as the Electronic Field Health
Service Information System USING eHEALTH IN THE COMMUNITY
 Online National Electronic Injury Surveillance Electronic medical records
System  EMRs are basically comprehensive patient
 The Philippine Health Atlas records that are stored and accessed from a

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 computer or server. Community health centers 3. It involves the use of various types of ICT.
have the capacity to rapidly adapt EMRs 4. Its goal is to improve health outcomes.
because they utilize a standard process  Telemedicine has the capacity to bridge the
nationwide. gaps in the health referral system. It is
 In contrast, EMRs are more difficult to understandable that this is not a universal
implement in hospitals because each hospital solution and may be applicable only in
has its own set of protocols coupled with Its specific scenarios. The goal of a patient
Own system of documentation. Even receiving the best care as soon as possible
government-owned hospitals do not have a despite an unfavorable location or other
Standard system of health service provision adverse circumstances may be reached
and of maintaining patient records. through telemedicine
 Implementing information difficulty systems in ELearning
the health sector highlights the importance of  Health education, which is essential in
creating standards health promotion and maintenance, can be
 Another reason in EMRs are vital to facilitated by 1CT.
community health centers is that each patient  eLearning is basically the use of electronic
record is usually used more frequently. Ideally, tools to aid in teaching. It can be done
a person can utilize health center services from synchronously, asynchronously, or in a
womb to tomb. This ideal scenario is made combination of both. This can be in the
more likely if each patient encounter is form of simple instructional videos and
properly documented and the patient recording information text blasts to social network
system is set up with accuracy and efficiency help groups and interactive simulations.
in mind.  eLearning can be especially useful in
 Vital statistical indicators such as mortality and correcting misconceptions about health
morbidity rates must come from reliable data, and health care. It permits access to
which can be derived from accurate and reliable information about health. For
thorough EMRs. EMR systems also allow example, control of communicable
computerized processing of indicators, making diseases frequently requires community
it easier for nurses to focus on other important participation.
aspects of health care.  With the use of eLearning technology,
Telemedicine community can elicit community interest
 One of the five strategic goals of the by showing instructional videos on
DOH's National eHealth Strategic measures to control a health nurses’
Framework for 2010-2016 is to capitalize particular disease.
on ICT. This in order to reach and provide
better health services to geographically ROLES OF COMMUNITY HEALTH NURSES
isolated and disadvantaged areas (GIDAs), IN eHEALTH
to support disseminate MDG attainment,  Community health nurses’ roles are
and to information to citizens and significantly diversified by eHealth. With the
providers through telemedicine and advent of eHealth, nurses are made available to
mobile health (eHealth). several clients at a single time, making health
 The WHO defines telemedicine as, "the care delivery more efficient.
delivery of health care services, where  Advances in IT may also help the nurse in
distance is a critical factor, by all health optimizing efforts towards maintaining an
care professionals using information and open line of communication with clients,
communications technologies for paving the way for establishing and
 The exchange of valid information for maintaining rapport.
diagnosis, treatment and prevention of  IT literally at the fingertips of the nurse
disease and injuries, research and provides greater opportunity to learn more
evaluation, and for the continuing about clients and their conditions; eHealth,
education of health care providers, all in however, cannot be a replacement for actual
the interests of advancing the health of patient care. It is best viewed as a powerful
individuals and their communities tool for nurses-bridging gaps and improving
access especially in a resource-constrained
WHO further underscores four elements that are country like the Philippines.
specific to telemedicine: Major roles of an eHealth nurse in the Philippine
1. Its purpose is to provide clinical support. community setting
2. It is intended to overcome geographical Data and records manager
barriers, connecting users who are not in the Community health nurses monitor the trends of
same physical location. diseases through the EMR, allowing for targeted

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interventions for health promotion, disease collection, storage, and transmission) is well
prevention, curative services, or rehabilitation. explained.
Nurses also maintain the quality of data inputs in  Clients must sign an informed Consent, if
the EMRs, making sure that information is necessary. Nurses must also guarantee that all
accurate, complete, consistent, correct, and current. eHealth interventions are performed in a safe
Nurses also participate in regular data audits. and ethical manner making sure that the
Change agent personnel in the ehealth are competent and
 Nurses act as change agents by working have received ehealth training and certification
closely implementing eHealth with them and Researcher
not for them. Change agents do not force  Using eHealth tools (e.g., EMRs), patient
technology on the community, but inform and records can easily be retrieved and
guide the community in selecting and applying analysed retrospectively by community
appropriate ICT tools. eHealth nurses. They are responsible for
 Change agents also collaborate with health identifying possible points for research
leaders, policy makers, stakeholders, and other and developing a framework, based on
community health professionals to determine data aggregated by the system.
their knowledge and awareness on eHealth and  An eHealth nurse researcher also pursues
appropriate ICT tools. Nurses then build on the continuing nursing informatics education,
baseline eHealth knowledge and help develop with the goal of developing a research
appropriate eHealth tools to the community. framework which will be beneficial to the
Educator community.
 Nurses provide individuals and families
through ICT tools health education to (e-g.,
teleconference, SMS, e-mail, and virtual/
simulated environment). Philippine Health Information Exchange serves
 Nurses may also use scheduled text messages the following purposes:
to patients among the catchment population to  Ease the unification and integration of health
send important reminders, etc. health data and processes across different health
information, facilities employing disparate electronic
 They may also participate in making eLearning medical record systems;
videos on specific diseases (eg., diabetes  Promote interoperability by providing means
mellitus, tuberculosis), which the patients can for communication and coordination of
watch during their waiting time at health electronic health data among the various health
centers. Such videos may also be installed in domains (i.e. disparate clinic information
the clients personal phones (if supported) and systems, and applications) without loss of
watched at a time convenient to them. semantics;
 Increase accountability for the proper
management of health information;
 Harmonize and optimize eHealth processes
Telepresenter and workflows;
In the event that a patient needs to be referred to a  Serve as reference in the development of
remote medical specialist through telemedicine, integrated information systems
nurses may function as a tele presenter. This means  Promote the implementation and use of
that the nurse may need to present the patient's case interoperability standards.
to a remote medical specialist, noting salient for
case assessment, evaluation, and treatment. This PHIE aims to achieve integrated healthcare
usually occurs via a teleconference. services and delivery thru:
Client advocate  Enabling secured data sharing between
 As client advocates, community health nurses authorized healthcare providers and
must safeguard patient records, ensuring that consequently, supporting protected access to
security, confidentiality, and privacy of all clients’ health data record across providers in
patient information are being upheld. This many geographic areas of the country;
becomes more challenging especially because  Providing a single unified view of clients’
with technology, transfer of information can health data record across health facilities
happen instantly. whether a hospital or clinic through an
 The client must also be well informed about interface that is accessible anywhere and
the benefits and challenges of EMRs, anytime; thereby, enhancing client care
telemedicine, and other eHealth tools. Nurses collaboration;
must ensure that personal and health  Facilitating aggregation of health data into a
information handling through eHealth (i.e., longitudinal electronic medical record

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 Generating accurate and real-time health
statistical reports for monitoring and
evaluation, with subsequent development of
appropriate interventions, policies, and
protocols.

The PHIE is composed of six (6) interacting

components, namely:
a. Client Registry manages the unique
identification of citizens receiving
healthcare services.
b. Provider Registry - manages the unique
identification of healthcare providers.
c. Health Facility Registry manages the
unique identification of places where
health services are administered.
d. Standards Terminology Service
manages the unique identification of
clinical activities, standard health data
sets, terminologies and formats.
e. Shared Health Record a repository of
clients records with information in the
exchange.
f. Interoperability Layer receives
communication from various application
systems being used by the health facilities,
and orchestrates message processing.

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 GASTROINTESTINAL DISEASES  Hydronephrosis and recurrent urinary tract
A. Schistosomiasis (Bilharziasis or snail fever) infections
 Bilharzia is a common name for  Pale and marked muscle wasting
schistosomiasis infection. Complications
 It is named after Theodor Bilharz, a 19th  Liver cirrhosis and portal hypertension
century German zoologist.  Bleeding esophageal varices
Description  Bladder cancer
 Tropical disease  Pulmonary hypertension
 Caused by blood fluke, Schistosoma  Heart failure
Japonicum that is transmitted by a tiny snail  Ascites (abnormal accumulation of fluid in the
oncomelania quadrasi (intermediary host) abdominal –peritoneal cavity)
 High prevalence of schistosomiasis in Region  Renal failure
5 (Bicol), Region 8 (Samar and Leyte), Region  Cerebral schistosomiasis
11 (Davao) Diagnostic Procedure
Causative Agent  Fecalysis
 Schistosoma Japonicum- endemic in the  Liver and rectal biopsy
Philippines and China  ELISA
 Schistosoma Mansoni- South America, the  Circumoval precipitation test (COPT)-
Middle East and Caribbean confirmatory test
 Schistosoma Haematobium- Africa and Middle  The circumoval precipitin test (COPT) is
East based on patient serum precipitation with
Sources of Infection lyophilized eggs or purified live eggs
 Stool and urine of the infected persons or identified under microscope. This method is
animals useful for the diagnosis of S. mansoni and S.
Mode of Transmission japonicum due to its high sensitivity (92-
 Infection occurs when skin comes in contact 100%) and specificity (96-100%)
with contaminated fresh water in which certain Nursing Interventions
types of snails that carry schistosomes are  TSB
living  Skin Care
 It is a free-swimming larval forms (cercariae)  Provide comfort
of the parasite that penetrate the skin  Proper nutrition
 Ingestion of contaminated water Methods of Control
Incubation Period a. Preventive Measures
 At least 2 months  Educate the public in endemic areas regarding
Clinical Manifestations the mode of transmission and methods of
1st Stage protection
 Pruritic rash known as ‘swimming itch’  Dispose of feces and urine so that viable eggs
occurs24 hours after penetration of cercariae will not reach bodies of fresh water containing
in the skin intermediate snail host
2nd Stage  improve irrigation and agriculture practices:
 Bloody mucoid stools (on and off for 2 reduce snail habitats by removing vegetation or
weeks) by draining and filling
 Katayama fever- clinical constellation of the  Treat snail-breeding sites with molluscicides.
following  Provide water for drinking, bathing and
Fever, headache washing clothes from sources free of cercariae
Cough, chills and sweating or treatment to kill them. Water treatment
Lymphadenopathy and using chlorine and iodine.
hepatosplenomegaly  Treat patients in endemic areas to prevent
3rd Stage (Chronic Stage) disease progression and to reduce transmission
 Granulomatous reactions to egg deposition in by reducing egg passage.
the intestine, liver, bladder  Travelers visiting endemic areas should be
 Inflammation of the liver advised of the risks and informed about
Icteric and jaundice preventing measures.
 Bulging of the abdomen b. Control of patient, contacts and the
 Enlargement of the spleen immediate environment.
 Sometimes the brain is affected that caused  Isolation: none
epilepsy  Report to local health authority in selected
 Eggs are deposited in the bladder wall endemic areas
leading to hematuria, bladder obstruction  Concurrent disinfection: sanitary disposal of
feces and urine

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 Quarantine: none  Antibiotics
 Immunization of contacts: None  Tetracycline
c. Investigation of contacts and source of  Furazolidone
infection  Chloramphenicol
 Specific treatment: Praziquantel (Biltricide) is  Cotrimoxazole
the drug of choice against all species. Nursing Management
Alternative drugs are Oxamniquine for S.  Hand washing
mansoni and Metrifonate for haematobium.  Enteric isolation
 Epidemic measures: examine for  Vital signs
schistosomiasis and treat all who are infected,  I and O monitoring
but especially those with moderate to heavy  Personal hygiene
intensities of egg passage; pay particular  Proper excreta disposal
attention to children  Environmental sanitation
 Motivate people in these areas to have annual Susceptibility, Resistance and Occurrence
stool exam.  Susceptibility and resistance general although
 PHN in endemic areas participates actively in variable. Frank clinical attack confers a
the above preventive and control measures. temporary immunity which may afford some
protection, for several years.
B. Cholera (El Tor)  Immunity artificially induced by vaccines of
Description variable and uncertain duration.
 It is an acute bacterial enteric disease  Appears occasionally in epidemic form in the
characterized by profuse diarrhea, vomiting, Philippines
massive loss of fluid and electrolytes that can
result to hypovolemic shock, acidosis and
death. Methods of Prevention and Control
Etiologic Agent  Food and water supply must be protected from
 Vibrio El Tor fecal contamination
Sources of Infection  Water should be boiled and chlorinated
 Vomitus and feces of infected persons and  Milk should be pasteurized
feces of convalescent or healthy carriers  Sanitary disposal of human excreta is a must
 Contacts may be temporary carriers  Report case at once to Health Officer
 Bring patient to hospital for proper isolation
Mode of Transmission and prompt and competent medical care.
 Food and water contaminated with  All contacts of the cases should submit
vomitus and stools of patients and carriers themselves for stool examination and be
Incubation Period treated accordingly if found or discovered
 From few hours to 5 days; usually 3 days positive.
Period of Communicability PHN Responsibilities
 7-14 days after onset, occasionally 2-3  Assist family and patient to make arrangement
months for immediate hospitalization
Clinical Manifestations  Give necessary measures to control spread of
 Rice-watery stools disease
 Washer-woman’s hands  Share with patient and family the nature of the
 Vomiting treatment Rehydration/ replacement of lost
 Diarrhea fluids and electrolytes (Sodium chloride,
 Deep rapid breathing bicarbonate and potassium)
 Oliguria
Diagnostic Tests C. Typhoid Fever
 Rectal swab Description
 Darkfield orphase microscopy  A systemic infection characterized by
 Stool exam continued fever, malaise, anorexia, slow pulse,
 Blood test involvement of lymphoid tissues, especially
 Elevated BUN and creatinine level ulceration of Peyer’s patches, enlargement of
 Increase in serum lactate, protein and spleen, rose spots on trunk and diarrhea.
phosphate levels  Many mild typical infections are often
Treatment Modalities unrecognized.
 IV Treatment  A usual fatality of 10% is reduced to 2 or 3%
 Oral Therapy Rehydration by antibiotic therapy
 Coconut water Etiologic Agent
 Give ORESOL  Salmonella Typhosa

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  Typhoid bacillus  Cefixime/ Azithromycin
Sources of Infection  Ceftriaxone (recommended for
 Feces and urine of infected persons complicated cases)
 Family contacts may be transient carrier Fluoroquinolones -
 Carrier state is common among persons  Fluoroquinolones are a class of broad-
over 40 years of age especially females spectrum antibiotic and are the direct
Mode of Transmission inhibitors of bacterial DNA synthesis
 Direct or indirect contact with patient or  Ciprofloxacin and ofloxacin are currently
carrier the drugs of choice for most cases of
 Principal vehicles are food and water typhoid fever.
 Contamination is usually by hands of  These fluoroquinolones have become
carrier affordable for use in many resource-
 Flies are vectors limited areas.
Incubation Period  FDA-approved fluoroquinolones include
 Variable; average 2 weeks, usual range 1 to 3 levofloxacin (Levaquin), ciprofloxacin
weeks (Cipro), ciprofloxacin extended-release
Period of Communicability tablets, moxifloxacin (Avelox), ofloxacin,
 As long as typhoid bacilli appear in excreta; gemifloxacin (Factive) and delafloxacin
usually from appearance of prodromal (Baxdela).
symptoms from first week throughout Nursing Management
convalescence  Isolation
Clinical Manifestations  Monitor V/S
 Onset  Give nourishing fluids in small quantities
 Headache at frequent intervals
 Ladder-like fever  Maintain standard precautions or in
 Rose spots on the abdomen diapers or if an outbreak develops in an
 Typhoid state institution
 Coma vigil – is state of coma in which the  Prevent further injury
patient lies unconscious but with eyes open  Provide good skin and mouth care
 Subsultus tendinum- an involuntary Prevention and Control
twitching of the muscles esp. of those of  Sanitary and proper disposal of excreta
the arms and feet causing movement of the  Proper supervision of food sanitation
tendons (Hallmark of Typhoid fever)  Enteric precaution
 Carphologia – the action of picking or  Provision of safe water supply
grasping at imaginary objects, as well as  Detection and supervision of typhoid
the patient’s own clothes or bed linens. carriers
 Delirium- is a serious disturbance in mental Susceptibility, Resistance and Occurrence
abilities that results in confused thinking  Susceptibility is general although many
and reduced awareness of the environment adults appear to acquire immunity through
Complications unrecognized infections
 Hemorrhage/ perforation (most dreaded  Attack rates decline with age after second
complication) or third decades.
 Peritonitis  A high degree of resistance usually
 Bronchitis and pneumonia follows recovery.
 Typhoid spine
 Septicemia D. Bacillary Dysentery (Shigellosis, Bloody Flux)
 Reiter’s syndrome- joint pains and eye Description
irritation  An acute bacterial infection of the
Diagnostic tests intestine characterized by diarrhea, fever,
 Typhidot- confirmatory tenesmus and in severe cases bloody and
 ELISA mucoid stools.
 Widal  Patients with mild undiagnosed infections
 Rectal swab have only transient diarrhea or no
 Bone marrow aspiration (identifies S. intestinal symptoms.
Typhi)  Severe infections are frequent in infants
Treatment Modalities and in elderly debilitated persons
 Chloramphenicol- drug of choice Etiologic Agent
 Ampicillin  Shigella sonnei (most common specie in
 Co-trimoxazole western Europe
 Ciprofloxacin

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 Shigella flexneri -is a species of Gram-  Maintain fluid and electrolyte balance
negative bacteria in the genus Shigella that can  Keep the patient warm and comfortable
cause diarrhea in humans.  Restrict food until nausea and vomiting
 Shigella boydii - is a Gram-negative subsides
bacterium of the genus Shigella. Like other  Isolation precaution
members of the genus, S. boydii is a  Low fiber, plenty of fluids; easily
nonmotile, nonsporeforming, rod-shaped digestible foods
bacterium which can cause dysentery in  Use a disposable warming pad to relieve
humans through fecal-oral contamination. abdominal discomfort, and schedule care
 Sh-dysenteriae - spreads through to conserve patient strength
contaminated water and food, causes minor Susceptibility, Resistance and Occurrence
dysentery because of its Shiga toxin, but other  Disease is more common and more severe
species may also be dysentery agents. in children than in adults.
Incubation Period  A relative and transitory strain-specific
 1 day, usually less than 4 days immunity follows recovery
Sources of Infection Methods of Prevention and Control
 Feces of infected persons, many in  Sanitary disposal of human feces
apparent mild and unrecognized infections  Sanitary supervision of processing,
Mode of Transmission preparation and serving of food
 Ingestion of contaminated food particularly those eaten raw
 Drinking contaminated water and milk  Adequate provision of safe washing
 Fecal-oral transmission facilities
Period of Communicability  Fly control and screening to protect foods
 During acute infection and until against fly contamination
microorganism is absent from feces  Protection of purified water supplies and
usually within a few weeks even without construction of safe privy
specified therapy.  Control of infected individual contacts and
 A few individuals become carriers for a environment
year or two and rarely longer  Reporting to local health officer
Clinical Manifestations  Isolation of patient during acute illness
 Fever  Rigid personal precautions by attendants
 Tenesmus- straining to defecate
 Headache E. Hepatitis A (Infectious hepatitis, epidemic
 Colicky or cramping abdominal pain hepatitis, catarrhal jaundice)
associated with anorexia and body Etiology
weakness  Hepatitis A virus
 Bloody-mucoid stool Predisposing Factors
 Rapid dehydration  Poor sanitation
Diagnostic Tests  Contaminated water supplies
 Microscopic examination of fresh stool  Unsanitary method of preparing and
specimen may reveal mucus, red blood serving food
cells, and polymorphonuclear leukocytes  Malnutrition
 Direct immunofluorescence with specific  Disaster and war time conditions
antisera will demonstrate shigella Incubation Period
 Sigmoidoscopy or proctoscopy may reveal  15 to 50 days, depending on dose
typical superficial ulcerations Signs and Symptoms
 Stool cultures must rule out other causes  Influenza-like such as headache
of diarrhea  Malaise and easy fatigability
Treatment Modalities  Anorexia and abdominal discomfort/ pain
 Antibiotics  Nausea and vomiting
 Ampicillin  Fever
 Ceftriaxone  Lymphadenopathy
 Trimethoprim-sulfamethoxazole  Jaundice accompanied by pruritus and
 Ciprofloxacin urticaria
 IV therapy  Bilirubinemia with clay-colored stools
 Low residue diet Management/ Treatment
 Contraindicated: antidiarrheal drugs (they  Prophylaxis –”IM” injection of gamma
may delay fecal excretion that can lead to globulin
prolong fever)  Complete bed rest
Nursing Management  Low fat diet but high in sugar

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  Serum Amylase Determination (most
Prevention and Control useful test) in making early presumptive
 Ensure safe water for drinking diagnosis for mumps): elevated amylase
 Sanitary method in preparing, handling level
and serving food  Complement Fixation test- is a blood test
 Proper disposal of feces and urine in which a sample of serum is exposed to a
 Washing hands very well before eating particular antigen and complement in
and after using the toilet order to determine whether or not
 Separate and proper cleaning of articles antibodies to that particular antigen are
used by patient present. The nature of complement is to
react in combination with antigen–
F. Epidemic parotitis (Mumps, infectious antibody complexes.
parotitis)  Hemo-agglutination Inhibition Test- Used
Description to determine the immune status
 It is an acute viral disease manifested by  Neutralization Test- Determines immunity
swelling of one or both parotid glands, to mumps
with occasional involvement of other  Viral culture
glandular structures, particularly the testes Treatment Modalities
in male.  Analgesics for pain
Etiologic Agent  Antipyretics for fever
 Mumps virus, a member of the family  IV fluid replacement
Paramyxomviridae, genus paramyxovirus,  Hot and cold application
is antigenically related to the Nursing Management
parainfluenza viruses  Medical aseptic protective care
Source of Infection  Single-occupancy room
 Secretion of the mouth and nose  Oral care and personal hygiene (warm
Mode of Transmission salt-water gargles)
 Direct contact  General management of the disease
 Indirect contact with the articles freshly  Bed rest
soiled with secretion from the  Diversional activities
nasopharynx  Eye care
Incubation Period  Provide extra fluids
 12- 26 days, usually 18 days  Diet
Period of Communicability  No restriction of food
 Cases are infectious for up to a week  Soft bland and semi-solid is easily
(normally 2 days) before parotid swelling managed
until 9 days after  Acid foods (fruit juices) increases
 48-hour period immediately preceding discomfort
onset of swelling is considered the time of Prevention and Control
highest communicability  Active immunization (MMR)
Clinical manifestations  Reporting cases to health authorities
 Painful swelling in front of the ear, angle  Isolation of patient
of jaws and down the neck Disinfection
 Fever  All materials contaminated by nose and
 Malaise mouth secretions should be properly
 Loss of appetite boiled.
 Swelling of one or both testicles (orchitis)  Paper handkerchiefs should be burned
in some boys Terminal Disinfection
Complications  The usual method of cleaning a room or
 Orchitis- unit should be used.
 Oophoritis  The room should be aired for 6 to 8 hours
 Mastitis
 Nuchal rigidity G. Paralytic Shellfish Poisoning (PSP I Red Tide
 Deafness Poisoning)
 Meningoencephalitis  A syndrome of characteristic symptoms
 Pancreatitis predominantly neurologic which occur
 Myocarditis within minutes or several hours after
 Nephritis ingestion of poisonous shellfish
Diagnostic Tests

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Causative Organism  It is an illness of descending paralysis and
 Single celled organism called autonomic dysfunction due to neurotoxin
dinoflagellates Causative Agent: Clostridium botulinum
 It is commonly referred to as plankton  Foodborne botulism
 Pyromidium bahamense var. compressum  Wound botulism
(Manila Bay, Samar, Bataan and  Infant botulism
Zambales) Sources of Infection
Plankton  Untreated water
(singular plankter) are the diverse collection  Undercooked and improperly preserved
of organisms that live in the water column of large canned foods, especially those with a low
bodies of water and are unable to swim against a acid content
current.  Home-canned vegetables
These organisms  Cured pork and ham
include bacteria, archaea, algae, protozoa and  Smoked and raw fish
drifting or floating animals that inhabit the seas  Honey and corn syrup
and ocean Mode of Transmission
Mode of Transmission  Ingestion (or injection) of preformed toxin
 Ingestion of raw or inadequately cooked  Spores may resist 100 degrees Celsius for
seafood usually bivalve shellfish or mollusks many hours
during red tide season (clams, mussels,  Inhalation of toxin may also cause disease
oysters, and scallops)  Ingestion of spores
Incubation Period  Introduction of spores into the wound
 Varies from about 30 minutes to several hours Incubation Period
after ingestion of poisonous shellfish  12 to 72 hours but extremes of 2 hours to
Signs and Symptoms 10 days are reported
 Numbness of the face especially around the Clinical Manifestations
mouth  Double or blurred vision
 Vomiting and dizziness  Droopy eyelids
 Headache  Dry mouth
 Tingling sensation, paresthesia and eventual  Difficulty swallowing or talking
paralysis of hands and feet  Difficulty breathing
 Floating sensation and weakness  Flaccid paralysis (Descending)
 Rapid pulse  Deep tendon reflexes are decrease or
 Difficulty of speech (aphasia) and difficulty of absent
swallowing (Dysphagia) Initial vomiting or diarrhea followed by
 Total muscle paralysis with respiratory arrest constipation
and death occur in several cases  Botulism toxin inhibits acetylcholine release
 Poison victims who survive the first 12 hours from the presynaptic nerve terminal, causing
after ingestion of the toxic shellfish have a flaccid paralysis.
greater chance of survival  Death in botulism exposure is generally due to
Management and Control Measures respiratory failure.
 No definite medication indicated  Tonic paralysis is the cause of respiratory
 Induce vomiting arrest in other toxicity exposures, such as
 Drinking pure coconut milk weakens the toxic exposure to tetanus toxin.
effect of red tide. Diagnostic Tests
 Sodium bicarbonate (25 grams in ½ glass of  A toxicology screen may identify C.
water may be taken) Botulinum
 Drinking of coconut milk and sodium bicar  Stool culture may identify C. Botulinum
sol. Is advised during the early stage of  The suspected food may also be cultured to
poisoning only. If given during the late stage, isolate C. botulinum
they may make the condition of the patient  Electromyography will show little response to
worse. nerve stimulation in the presence of botulism
 Shellfish affected by red tide must NOT be  Diagnostic tests should be conducted as
cooked with vinegar as the toxin of needed to rule out diseases that maybe
Pyromidium increases when mixed with acid confused with botulism, such as myasthenia
H. Botulism gravis and Guillain-Barre syndrome
Description  A mouse- inoculation test will be positive and
 Rare but severe form of poisoning caused is the most direct way to confirm a diagnosis
by gram-positive, anaerobic bacteria. of botulism
myasthenia gravis

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 Myasthenia gravis (MG) is a  Cyst- considered to be the infective stage and
long-term neuromuscular disease that leads to the resistance to environmental conditions and
varying degrees of skeletal muscle can survive for few days outside of the body
weakness.  Trophozoites/ vegetative form- facultative
The most commonly affected muscles are parasites that invade the tissue
those of the eyes, face, and swallowing. It can Sources of Infection
result in double vision, drooping eyelids, trouble  Contaminated food and water
talking, and trouble walking.  Flies
Guillain-Barre syndrome is a rare disorder in Mode of Transmission
which your body's immune system attacks your  Fecal-oral
nerves. Weakness and tingling in your  Oral-anal
extremities are usually the first symptoms. These Incubation Period
sensations can quickly spread, eventually  Severe infection-3 days
paralyzing your whole body.  Average 2-4 weeks
Complications
 Aspiration
 Weakness and nervous system problems can
be permanent Period of Communicability
 Death  Communicable for the entire duration of the
Treatment Modalities illness or until cysts are present in the stool
 Botulinus antitoxin- IV, IM Clinical Manifestations
 Infants- inducing vomiting or giving enema  Acute amoebic dysentery
 IV fluid can be administered  Slight attack of diarrhea altered with
 Nasogastric tube constipation
 Endotracheal intubation- respiratory distress  Watery foul-smelling stools containing
Nursing Considerations blood-streaked mucus
 Obtain a careful history of foods eaten in the  Gaseous distention of the lower abdomen
past few days  Nausea, flatulence
 Monitor respiratory and cardiac function  Tenderness in the right iliac region
carefully  Chronic amoebic dysentery
 Perform frequent neurologic checks  Diarrhea for several days, succeeded by
 Purge the GI tract as ordered constipation
 If giving the botulinus antitoxin, check the  Anorexia, weight loss, weakness and fatigue
patient’s allergies, perform a skin test first  Watery, bloody, mucoid stool
 Educate the patient and family about the  Flatulence and irregular bowel movement
importance of proper hand hygiene  Abdomen loses its elasticity
 Teach the patient and family to cook food  Severe cases- scattered ulceration is seen
thoroughly before ingesting through sigmoidoscopy
 Instruct the patient who eats home canned food Diagnostic Procedures
to boil the food for 10 minutes before eating to  Stool exam- cyst (plenty of amoeba on the
ensure that it is safe to consume stool)
 Teach patient and families to see their doctors  Blood exams- leukocytosis
promptly for infected wounds and to avoid  Sigmoidoscopy
injectable street drugs Management
Suggested on-call action  Metronidazole (Flagyl) 800 mg. TID for 5
 Ensure that the case is admitted in the days
hospital  Tetracycline, ampicillin, streptomycin,
 Obtain food history as a matter of urgency chloramphenicol
 Obtain suspect food Nursing Interventions
 Identify others at risk • Observe isolation and enteric precautions
 Inform appropriate local and national • Proper collection of stool specimen
authorities • No oil prep for 48 hours
I. Amoebiasis • Large portion of stool containing blood mucus
Description • Label specimen properly
 Protozoal infection that initially involves the • Send specimen immediately to the laboratory
colon but may spread into the liver and lungs • Provide skin care and hygiene
by lymphatic dissemination • Provide optimum comfort- dysenteric patient
Etiologic Agent should never be allowed to feel cold
 Entamoeba Histolytica • Diet-fluids should be forced
2 stages • Cereal and strained meat broths without fats

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• Bland diet without cellulose of bulk producing
foods
• Chicken and fish maybe added when
convalescence is established
Prevention
• Health education and fly control
• Sanitary disposal of feces
• Safe drinking water
• Proper food preparation and food handling
• Detection and treatment of carriers
J. Paragonimiasis
• is an infection with parasitic worms
• It is caused by eating undercooked crab or
crayfish.
• Paragonimiasis can cause illness resembling
pneumonia or stomach flu.
• The infection can last for years.
Etiologic Agents
• Lung Fluke
 Paragonimus westermani
 Paragonimus siamenses
In the lungs
 After swallowing the tiny (microscopic)
ascariasis eggs, they hatch in the small
intestine and the larvae migrate through the
bloodstream or lymphatic system into the
lungs. At this stage, the client may experience
signs and symptoms similar to asthma or
pneumonia, including: Persistent cough.
Shortness and others
Mode of Transmission
 Ingestion of raw/ uncooked crabs
 Contamination of food
 Using meat/ juice of infected animals
Reservoir of Hosts
 Cats
 Dogs
 Rats
 Pigs
Clinical Manifestations
 Cough of long duration
 Recurrent blood-streaked sputum
 Chest-back pain
 PTB-like signs and symptoms not
responding to anti-TB medications
Diagnostic test
 Sputum examination
 Immunology
 Cerebral paragonimiasis
Treatment
 Praziquantel (Biltrizide)
Prevention and control
 Treatment of infected person
 Anti-mollusk campaigns
 Education of the population
 Avoid eating infected foods

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