COMMUNITY HEALTH NURSING (LEC)​ ​ ​ transcribed by: Shiane Viloria

1st Sem:MIDTERM | A.Y 2024-2025 ​ ​ ​ ​ ​ Prof: Bryan Savellano, RN MAN

WEEK 7 : is temporary, often lasting a few weeks or
EXPANDED PROGRAM ON IMMUNIZATION months. It prompts our body to produce
(EPI) antibodies gradually (e.g., COVID-19 vaccines)
●​ was launched in the Philippines by the Natural: Breastmilk (IgA) and Placenta (IgG)
Department of Health (DOH), World Health TYPES OF VACCINES
Organization (WHO), and UNICEF in July ●​ Life-attenuated vaccines– Contain weakened
1976 with the goal of reducing morbidity and forms of the disease-causing microorganism.
mortality among infants and children caused by Because they’re still able to replicate in the
six immunizable diseases. body, they can sometimes cause mild symptoms.
KEY LAWS and POLICIES (e.g., BCG, OPV, MMR vaccines).
●​ Inactivated vaccines– Contain killed
●​ Presidential Decree (PD) No. 996 (Sept. 16, microorganisms (e.g., Inactivated Polio
1976) – Mandated vaccination for children Vaccine).
below 8 years of age and included six vaccines: ●​ Whole virus inactivated vaccines– Contain
tuberculosis (BCG), diphtheria, tetanus, entire viruses that are inactivated (e.g., Flu,
pertussis, poliomyelitis, and measles. Rabies, Pertussis vaccines).
●​ R.A. 7846 (Dec. 30, 1994) add. Hepa B ●​ Fractional vaccines– Use parts of the
Immunization — 7 vaccines microorganism (e.g., Hepatitis B, Tetanus
●​ R.A. 10152 - Known as the "Mandatory Infants toxoids).
and Children Health Immunization Act of
2011," a total of 11 mandatory vaccines. For tetanus toxoids, five doses are administered
●​ PD No. 6 (April 3, 1996) throughout life to provide both the mother and the
Implementing a United Nations goal on Universal baby with effective protection.
Child Immunization by 1990
Wednesday = Immunization day: a specific day TETANUS TOXOID IMMUNIZATION
for routine immunization activities in health centers SCHEDULE
(2001-2020) Decade of Vaccines– envision a world
of which all individuals and communities enjoy ●​ 1st dose: as early as possible during pregnancy
lives from vaccine-preventable diseases (WHO) ●​ 2nd dose: Administered 4 weeks after the 1st
dose, providing 80% protection for the
IMMUNITY TYPES mother and 3 years for the baby.
●​ Active Immunity– It is developed by our own ●​ 3rd Dose: Administered 6 months after the 2nd
immune system. When exposed to an antigen, dose, increasing protection to 90-95% for the
our body generates antibodies specific to that mother and 5 years for the baby.
antigen. If a person recovers from an illness ●​ 4th Dose: Given 1 year after the 3rd dose,
naturally, their body typically produces ensuring 99% protection for the mother and
antibodies, resulting in long-lasting or even 10 years of CPAB protection for the baby.
permanent immunity. (e.g., measles, polio vax) ●​ 5th Dose: Provides 99% protection for the
●​ Passive Immunity– This is typically acquired mother and lifetime CPAB protection for all
through external sources, like immunization or infants you’re going to have.
inoculation. Since it is artificial, the protection
PRINCIPLES OF EPI SCHEDULE FOR IMMUNIZATION
1.​ Epidemiological situation: the schedule for the
EPI is usually based on the occurrence or the Age Vaccine Dosage Route & Notes
Site
characteristic, how grave the disease is, the
affectation to the community. Supplemental BCG 0.05 mL ID at right Given in
upper hospital; before
Immunization Activities. Vaccination schedules deltoid only 14 days
are based on disease patterns, and children are grace period
vaccinated up to 8 years old. (baby might be
At Birth exposed to
2.​ Mass approach: Vaccination services are tubercle bacilli),
integrated into Barangay Health Centers and now within 1
year.
hospitals.
3.​ Target Setting: immunizing all children before Hepa B 0.5 mL IM at Given in
1 year old. Target population is 95% of this age Vastus hospital; 7 days
Lateralis grace period
group in the community. (thigh)
4.​ Information, Education, and Communication
(IEC): raising awareness about immunization 𝑂𝑃𝑉1 2 drops / Oral
0.1 mL
5.​ Surveillance, Studies, and Research: (Oral
Polio
Monitoring and evaluating the program to
6,10,14 Vaccine)
improve effectiveness. weeks
Penta- 0.5 mL IM at left
CHILD IMMUNIZATION valent vastus
(DPT- lateralis
●​ Fully Immunized Child (FIC): A child who HepB- (upper outer
Hib) thigh)
has received all vaccines by 1 year old.
●​ Completely Immunized Child (CIC): A child (In- 0.5 mL IM at
4 activated Vastus
who has received all vaccines, but after or more months lateralis
Polio
than 1 year old. (thigh)
Vaccine)
●​ CPAB- Child Protected at Birth → TT
MR / 0.5 mL SC at left 𝐴𝑀𝑉1→ 𝐼𝑃𝑉2
9 𝐴𝑀𝑉1 outer arm
1 vial = 10 infants
months

NOT CONTRAINDICATIONS 12 𝐴𝑀𝑉2 / 0.5 mL SC, any Same dosage as

months arm MMR.
MMR
1.​ Fever (deltoid)
(Measles-
2.​ Simple or mild acute respiratory infection Mumps-
3.​ Simple diarrhea without dehydration Rubella)
4.​ Malnutrition – an indication for immunization
BACILLUS CALMETTE GUERRIN
Herd Immunity occurs when an enough portion of
a population is immune to a specific disease, ●​ Infant BCG
protecting individuals who have not developed -​ 0-11 months or 0-1 year
immunity. The greater the population that is -​ Freeze-dried and must be reconstituted with
immune, the lower the probability that a susceptible diluent (plain NSS/ sterile water) before
person will meet an infectious person. administration
-​ Against Tuberculosis and Meningitis
●​ BCG Effects PENTAVALENT
-​ Wheal lasts for 30 minutes to 1 hour
●​ DPT, Hib (flu), Hepa B
-​ Inflammatory response lasts from 2 weeks to
●​ 3 doses, 4 weeks, or 1 month interval
12 weeks → scar
●​ Target age– 6, 10, 14 weeks
-​ Administer COLD compress on the site of
●​ Reduces chance of acquiring pneumonia and
injection
meningitis
-​ Fever → Antipyretic every 4 hours
●​ Effects:
-​ SC Abscess– Marble-like mass present on
-​ Fever → Antipyretic every 4 hours
the site of injection. With persistent fever.
-​ Local tenderness → do not massage site
Management– I/D (Incision and Drainage)
-​ Convulsion → allergic to the vaccine
HEPA B VACCINE
MEASLES
●​ Target age:
●​ 9-11 months
-​ 𝐻𝐵𝑉1
In cases of epidemics– can be given at 6 months
-​ At birth (Health Facility) SIA
-​ For more than 7 days (home) ●​ 0.5 mL, SC, any arm (outer part of the upper
●​ Effects: arm, preferably left)
-​ No fever ●​ Fever and measles rash lasting for 1-3 days
-​ Local tenderness → do not massage; apply within 2 weeks after immunization (modified
cold compress measles)
●​ Vitamin A is given with measles– 100, 000 IU
ORAL POLIO VACCINE
(Blue)
●​ Keep Philippines Polio Free ●​ Freeze-dried then reconstituted with diluent
●​ Pathognomonic sign water
-​ tightening and spasms of hamstring muscles ●​ Effects:
(indicating the disease’s severe form) -​ Fever→ Antipyretic every 4 hrs
●​ 3 doses, 4 weeks/1 month -​ Rashes within 2 weeks and lasts for 3
●​ Target population– children with eligibility for days→ subside naturally
catch-up vaccination up to Grade 6 (12 yrs. old)
●​ 2-3 drops, oral route MEASLES, MUMPS, RUBELLA (MMR)
●​ 1st drop of OPV, Rota, then Penta ●​ 9 and 12 months
●​ Color– clear pink or pale orange liquid ●​ Mumps– enlargement front and below the ear
●​ Effects: do not feed child for 30 mins after ●​ 0.5 mL, SC, any arm (deltoid)
administration to ensure proper absorption ●​ Vitamin A is given with MMR, 200, 000 IU
(red)
ROTAVIRUS
●​ Freeze-dried then reconstituted with diluent
●​ 2 doses, 8 weeks interval water
-​ 6 and 14 weeks → give 1.5 mL, PO
1st dose: 6 to 15 weeks Remember!
2nd dose: not more than 32 weeks ●​ Check expiration dates - FEFO - first expiry,
●​ Reduces chance of acquiring diarrhea first out principle
●​ Effects: Soft stool ●​ Shake ( should have no residual left )
●​ Place refrigerator at least 3 ft. away from the
Note: Rota vaccine is not given in health centers window
ENSURING POTENCY -​ Attenuated vaccines: immune deficiency
Heat Type of Storage -​ Clinical AIDS – Infant BCG (do not
Sensitivity Vaccine Temperature administer live attenuated vaccines)
-​ Immunosuppression
OPV WEEK 8 :
Most sensitive − 15°𝐶 to
to heat AMV − 25°𝐶 INTEGRATED MANAGEMENT OF
(Freeze-dried) Freezer CHILDHOOD ILLNESS
-​ A case management process for a first-level
DPT facility such as clinics, a health center,
RHU, OPD of the hospital
Less sensitive Hepa B 2°𝐶 to 8°𝐶
CAUSES OF DEATH AMONG CHILDREN
to heat Refrigerator
BCG UNDER 5 YEARS OLD
-​ Malaria
Rotavirus
-​ Diarrhea
Sensitive to heat - OPV, MMR/AMV2 -​ Measles
Sensitive to light- BCG, Measles (brown/amber -​ Pneumonia
bottle) -​ Perinatal
-​ Nutritional disorders
MAXIMUM STORAGE AND TRANSPORT
PERIOD
FEATURES OF IMCI
●​ Regional Health Office – 6 months -​ Not necessarily dependent on the use of
●​ Provincial/District Health Office – 3 months sophisticated and expensive technologies
●​ Rural Health Unit – 1 month -​ A more integrated approach to managing
●​ Maximum transport period (with cold packs) – 5 sick children
days -​ Move beyond addressing single diseases to
addressing the overall health and well-being
DISCARDING UNUSED BIOLOGICALS
of the child
●​ Vaccine Vial Monitor - round disc of heat -​ Careful and systematic assessment of
sensitive material to register cumulative heat common symptoms and specific clinical
exposure. The lower the temperature the slower signs to guide rational and effective actions
the color change and vice versa. -​ Integrates management of most common
○​ If square is lighter than circle (safe to childhood problems (pneumonia, diarrhea,
use) measles, malaria, dengue hemorrhagic fever,
○​ If square is darker than circle (should malnutrition and anemia, ear problems).
be discarded) -​ Includes preventive interventions
●​ Shake the vial -​ Adjusts curative interventions to the
●​ Discard unused portion of BCG and AMV capacity and functions of the health system
(evidence-based syndromic approach)
CONTRAINDICATIONS
-​ Involves family members and the
●​ General: Any serious condition that needs community in the health care process
hospitalization
●​ Specific: OBJECTIVES OF IMCI
-​ DPT 2 and 3: a history of seizure(s) within 3 -​ Reduce deaths and the frequency and
days after DPT severity of illness and disability; and
 -​ Contribute to improved growth and Ask:
development Focused Assessment
- Danger signs (CANS)
IMCI COMPONENTS - Main symptoms
1. Improve case management skills of health - Nutritional Status
workers - Immunization Status
- standard guidelines - other problems
- training (pre-service/in-service)
- follow-up after training Classification
- role of private providers - pink: need to refer (severe illness)
- yellow: medical treatment and advice (moderate
2. Improving the health system to deliver IMCI illness)
- essential drug supply and management - green: simple advice on home management (mild
- organization of work in health facilities illness)
- management and supervision
- referral system Identify
-​ If the child requires urgent referral, give
3. Improving family and community practices essential treatment before the patient is
●​ For physical growth and mental development transferred.
- breastfeeding -​ If the child needs treatment at home,
- complementary feeding develop an integrated treatment plan for the
- micronutrient supplementation child and give the first dose of the
- psychosocial stimulation medication in the clinic.
●​ for disease prevention -​ If a child should be immunized, provide
- immunization immunization.
- handwashing
- sanitary disposal of feces Treatment
- use of insecticide-treated bed nets -​ Provide practical management instruction
- dengue prevention and control -​ Ask the caregiver to return for follow-up on
●​ for appropriate home care a specific date and teach her how to
- continue feeding recognize signs that indicate the child should
- increase fluid intake return immediately to the health facility.
- appropriate home treatment
●​ for seeking care Counsel caretakers
- follow health workers advice -​ Assess feeding, including assessment of
- when to seek care breastfeeding practices, and counsel to solve
- prenatal consultation any feeding problem found. Then counsel
- postnatal (postpartum consultation) the mother about her own health

TARGET GROUPS Follow-up care

- Sick young infant (1 week up to 2 months) -​ When a child is brought back to the clinic as
- Sick young children (2 months up to 5 years) requested, give follow-up care, and if
necessary, reassess the child for new
IMCI CASE MANAGEMENT problems.
ASSESSMENT: DANGER SIGNS -​ Refer child
Convulsions → Referral Facility
Abnormally sleepy -​ Emergency triage and treatment
Not able to drink or eat -​ Diagnosis
Severe vomiting - need to refer (except in severe -​ Treatment
dehydration) -​ Monitoring and follow-up
(CANS is always/matic PINK)
Convulsion
- ask the mother if the child had episodes of YELLOW
unconsciousness even if eyes are open → Treatment at outpatient health facility
- unable to follow or respond with accompanied -​ Treat local infection
muscle contracting or arms and legs are stiff -​ Give oral drugs
-​ Advise and teach caretaker
Abnormally sleepy -​ Follow-up
- the child is not awake or alert when he should be
- the child is drowsy and does not show interest at GREEN
all → Home management
- he does not look at his mother or watch your face Caretaker is counseled on:
when you talk -​ Refer child
- does not respond when she is touched, shaken, or -​ Home treatments
spoken to. -​ Feeding and fluids
-​ When to return immediately
Not able to drink or breastfeed -​ Follow-up
- the child cannot suck or swallow any fluid or
breastmilk because they are too weak
- ask the mother to describe it. Then if not
convinced, observe the child as the mother offers a
drink

Severe vomiting
- child is not able to hold anything down at all
- no food, fluid, or drugs

Ask about the MAIN SYMPTOMS

- Cough or difficulty in breathing
- Diarrhea
- Ear problem
- Fever
- Malnutrition and anemia

PINK
→ Urgent referral, Outpatient health facility
-​ Pre referral treatment
-​ Advise parents
DOH issues Administered Order 2008-0029 interpretations in the implementation of
“Implementing health reforms for the rapid guidelines
reduction of maternal and neonatal mortality” -​ Decrease in the number of philhealth
accredited maternal and child program
The Maternal Newborn Child Health and (MCP) facilities
Nutrition (MNCHN) strategy guides the -​ Antenatal postpartum care services lag
implementation of various programs aimed at -​ Measles and polio outbreaks and increased
improving the health of women, mothers, and in measles-related mortalities
children, with the goal of rapidly reducing maternal
and neonatal mortality in the country. All women are considered at risk for pregnancy and
childbirth complications. Bringing establishment of
For each stage of life: prepregnancy, pregnancy, Basic Emergency Obstetrics Care (BEmONC) –
delivery, postpartum, newborn, and childcare Comprehensive Emergency Obstetrics Care
(CEmONC) network within the bigger service
Women dying from pregnancy-related delivery network (SDN)
complications including hemorrhage, hypertension,
and infection. Integration of cervical cancer, syphilis, hepatitis b,
and HIV screening into the antenatal care protocols
Perinatal and Infant health perinatal mortality -
fetal deaths of 22 weeks or more and newborns Health providers part of the MNCHN Service
dying under seven days of life. Delivery Network
Antenatal care - should commence in the first 1.​ Community health team or community
trimester of pregnancy level service providers
- pregnant women who failed to visit during this -​ Comprise out-patient departments
term are automatically not counted in the ANC -​ Barangay health station
indicator -​ Rural health unit
- women usually seek prenatal care when -​ Private clinic
quickening is felt, usually 20 weeks AOG or at the Manned by community health volunteers and led by
second trimester of pregnancy a midwife
-​ Conduct health risks and needs assessment
Postpartum Visit (PPV)/ Post-natal check-up -​ Basic service delivery functions (Birth
- conducted within 24 hours and within seven days spacing and counselling)
post delivery 2.​ BEmONC-Capable Facility
- low postpartum visits due to inability of mothers -​ Barangay health station, lying-in
to seek care as they are mostly preoccupied with -​ Should be reached within 30 minutes from
childcare homes using the most common mode of
- Postpartum visits are important as most maternal transportation
and newborn deaths occur during or immediately -​ Provide parenteral administration of
after delivery. oxytocin
Challenges in delivery of maternal and child -​ Loading anticonvulsant, assisted imminent
health services breech deliveries, removal of retained
-​ Low utilization of family planning packages products or placenta
of philhealth. May arise from confusion -​ Neonatal resuscitation, sepsis, oxygen
between patients and providers, differing treatment
 3.​ CEmONC-Capable Facilities 12.​Provision of oral health services
-​ Provide all services rendered in BEmONC
facilities ANTENATAL CARE SERVICES (first 270
-​ Cesarean section, blood banking, blood days) package
transfusion R.A. 11148 “Kalusugan at Nutrisyon ng
-​ Low birthweight and preterm babies Mag-Nanay Act”
management -​ Focuses on scaling up the natural and local
-​ Intrauterine device insertion, vasectomy nutrition programs through a strengthened
An itinerant team integrated strategy for maternal, neonatal
-​ Physician, nurse, midwife child health and nutrition in the first one
-​ 1 CEmONC facility for at least 500,000 thousand (1,000) days of life.
population 1.​ Pregnancy tracking and enrollment to
-​ Should be reached within an hour from each Antenatal Care (ANC)
BEmONC-capable facility Components of ANC
-​ Risk identification, prevention and
PRE PREGNANCY SERVICES (package) management of pregnancy related or
-​ Provision of iron and folate supplementation concurrent diseases, health education and
-​ Counseling and provision of family planning promotion
methods 8 ANC Visits to achieve a positive pregnancy
-​ Prevention and management of infection and experience.
lifestyle-related diseases Interventions include:
1.​ Micronutrient supplementation -​ Women-held case notes
2.​ Iron folate: 60mg elemental iron with 400 -​ Midwife-led continuity of care
microgram folic acid tablet daily for 3-6 -​ Group antenatal care
monthts -​ Community based interventions to improve
3.​ Iodized oil capsule with 200mg Iodine 1 communications and support
capsule for 1 year (women age 15-45) -​ Task shifting components of antenatal care
4.​ Promotion of the use of iodized salts delivery
5.​ Nutrition counseling -​ Recruitment and retention of staff in rural
6.​ Promotion of healthy lifestyle including and remote areas
advice relative to smoking cessation, healthy -​ Antenatal care contact schedules
diet, regular exercise and moderation Tracking of pregnancy while in the community
alcohol intake by BARANGAY HEALTH WORKERS (BHWs)
7.​ Advice on family planning and provision of -​ Provide both navigation and basic service
family planning services delivery functions assist pregnant women in
8.​ Prevention and management of developing birth plans, and help families
lifestyle-related diseases like diabetes and facilitate access to critical health services
cardiovascular diseases “Bantay Buntis” practice at the regional level by
9.​ Counseling, prevention, and management of communities with indigenous people, ensure
infection including STIs and HIV/AIDS pregnant women avail of professional assistance
10.​Adolescent health services throughout pregnancy, delivery and postpartum
11.​Deworming women of reproductive age to Recommended prenatal (ANC) visits in the PH
reduce other causes from iron deficiency 1st visit – as early as possible
anemia 2nd visit – 2nd trimester
3rd visit – 3rd trimester Danger signs of pregnancy
Every 2 weeks – after 8 month of pregnancy until -​ Headache
delivery -​ Blurring of vision
-​ Dangerous fever (temperature ≥38°C)
PRENATAL VISIT ACTIVITIES: -​ Severe DOB
a.​ Health history- primarily done to determine -​ Abdominal pain
obstetric profile -​ Burning on urination
GPTPAL -​ Vaginal bleeding
Gravida c.​ Birth Preparation and Emergency Plans
Parity -​ Focuses on promoting birth planning and
Term facility-based delivery. The Mother Baby
Preterm Booklet and Birth PLan should be used to
Abortion indicate the mother’s plan of care during
Living labor and delivery, including her preferences
Expected Date of Confinement (EDC) of birth attendant and available resources for
Age of Gestation (AOG) childbirth and newborn care.
Potential risk factors: Basic contents of birth plan:
-​ Age <18 years old or >35 years old -​ Place of delivery and method of
-​ Height less than 145 cm (4’9”) transportations
-​ Multiparous women (having fourth or more -​ Person or personnel to assist her during
baby) delivery
-​ One or more of the following: previous CS, -​ Expectations during labor and delivery
3 consecutive miscarriages or stillborn baby, -​ Materials to prepare and estimated cost of
and/or postpartum hemorrhage delivery
-​ One or more of the following medical -​ Possible blood donors and where the mother
conditions: tuberculosis, heart disease, will be referred in case of emergency
diabetes, bronchial asthma, or goiter 2.​ Diphtheria Tetanus Toxoid immunization
If the mother has any of these factors, she should be -​ DPT toxoid immunization involves the
closely monitored by the midwife or referred to a intrramuscular administration of 0.50 mL
physician and probably need to deliver the baby in diphtheria tetanus toxoid at the deltoid
the hospital muscle. Two doses of the toxoid provide
b.​ Prenatal Assessment- the physical protection to the baby against neonatal
examination includes GPTPAL, EDC, AOG, tetanus through natural passive immunity,
weight and height, fundic height while a single dose offers protection only to
measurement, leopold’s maneuver, fetal the mother by artificial active immunity. A
heart tone and fetal movement. Likewise, mother who received the complete five
laboratory examinations are conducted like doses of it is called fully immunized
complete blood count with platelet, blood mother
typing and Rh factor determination, 3.​ Consumption of iodized salt
urinalysis, screening tests for STIs, blood 4.​ Micronutrient and macronutrient
sugar screening, pregnancy test, ultrasound, supplementation
cervical screening test using acetic acid -​ Primarily focus on addressing nutrition
wash, and papanicolau smear. deficiencies:
 a.​ Iron deficiency anemia- a risk factor for Children of 200 mg of Iodized oil 1 cap per year
neural tube defect such as spina bifida and school age capsule
anencephaly.
Women 200 mg iodized oil 1 cap per year
-​ Prevented through ingestion of both 15-20 yrs old capsule
supplemental iron and folic acid alongside
Adult males 200 mg iodized oil 1 cap per year
vitamin c-rich food for better absorption. capsule
Side effects: teeth and stool discoloration
Natural sources of iron and folate should be
d.​ Macronutrient supplementation
ingested: red meat, liver, and green leafy
-​ Calcium supplementation is recommended
vegetables.
for the prevention of preeclampsia in
Recommended dose of iron and folic acid supplementation pregnant women, particularly among those
Target Preparation Dose/Duration at risk of developing hypertension.
-​ Should be taken at mealtime from 20 week
Pregnant 60 mg elemental iron 1 tab/day for 6 months gestation until the end of pregnancy
women w/ 400 mcg folic acid or 2 tabs/day if prenatal
consultation starts on Risk factors of developing gestational hypertension
the 2nd & 3rd trimester and preeclampsia:
Lactating 60 mg elemental iron 1 tab/day for 3 months
-​ Obesity, previous preeclampsia, diabetes,
women w/ 400 mcg folic acid or 90 days chronic hypertension, renal disease,
autoimmune disease, nulliparity, advanced
b.​ Vitamin A deficiency (xeropthalmia)- maternal age, adolescent pregnancy, and
mitigated through the ingestion of conditions leading to hyper placentation and
supplemental vitamin a at the start of the large placentas (twin pregnancies)
second trimester until postpartal period. This Recommended dose of calcium supplementation
is not given during the first trimester since it
Target Preparation Dose/Duration
is a teratogen and may lead to fetal
deformities or even death. Pregnant 1.0–2.0 g elemental calcium Three divided doses

Recommended dose of Vitamin A for women

5.​ Early identification and management of
Target Preparation Dose/Duration
nutritionally at-risk pregnant client
Pregnant 10, 000 IU 1 cap 2x/week (4 months until -​ P.D. No. 491 - July as the nutrition month
women delivery) and created the national nutrition council
Postpartum 200,000 IU 1 cap once after delivery (may -​ LOI 441 or the integration of nutrition
women be given within 4 weeks) education in the school curriculum.
-​ Anthropometric measurements:
c.​ Iodine deficiency disorder- may lead to
Weight-for-age (WFA) - used to evaluate the
congenital hypothyroidism and cretinism if 𝐴𝑐𝑡𝑢𝑎𝑙 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡
degree of undernutrition. 𝑒𝑥𝑝𝑒𝑐𝑡𝑒𝑑 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡 × 100
not prevented.
-​ Children should receive supplementation at
Height-for-age (HFA) - an indicator of child
least once a year growth used to assess stunting depending on the
-​ Palmar pallor is a major sign patient’s sec
Recommended dose of Iodine supplementation
Weight-for-height (WFH)- indicator of child
Target Preparation Dose/Duration growth used to assess wasting depending on the
patient’s sex
 𝑤𝑒𝑖𝑔ℎ𝑡 (𝑘𝑔)
Body Mass Index (BMI)- 2
INTRAPARTAL SERVICES (childbirth
(ℎ𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑚𝑒𝑡𝑒𝑟𝑠)
package)
Mid-Upper Arm Circumference (MUAC)- used 1.​ Antenatal Corticosteroids
as a rapid screening for malnutrition for children -​ Given to all pregnant women risk for
1-4 y.o preterm delivery (labor within 24-34 weeks
Skin-Fold Thickness- estimates the percentage of AOG) or has any of the following prior to
body fat at specific locations of the body (femoral, term:
abdominal, triceps). This depends on the body part. - Antenatal hemorrhage or bleeding
- Hypertension
6.​ Counselling on maternal nutrition, - Preterm rupture of membranes
breastfeeding and rooming-in, → Betamethasone - 12 mg, IM, every 24 hrs for 2
appropriate infant and young child doses
feeding practices → Dexamethasone - 6 mg (1.50 mL). IM, every 12
7.​ Assessment of risk for parasitism and hrs for 4 doses
provision of anthelmintic medicines -​ These corticosteroids must be readily
8.​ Provision of oral health services including available in ER, DR, OPD, and ward.
oral health assessment 2.​ Essential Intrapartal Newborn Care
9.​ Counselling on proper handwashing, (EINC)
environmental sanitation and personal A.​ Dilatation Stage
hygiene Recommended:
10.​Counselling on nutrition, smoking -​ Admit only when the px is in active phase
cessation, and adoption of healthy -​ Continuous maternal support
lifestyle practices -​ Upright position during 1st stage of labor
11.​Philippine Health Insurance Corporation -​ Routine use of WHO partograph to
(PhilHealth) enrollment and linkages to monitor progress of labor
facility and community-based health and -​ Limit total number of IE to 5 or less
nutrition workers and volunteers Not recommended:
12.​Social welfare support to improve access -​ Routine perineal shaving on admission
to health and nutrition services -​ Routine enema
-​ Dietary supplementation -​ Routine NPO
-​ Healthy food products and commodities for -​ Routine IVF
nutritionally at risk women belonging to the -​ Routine vaginal douching
poorest of the poor families including those -​ Routine amniotomy
with disabilities. -​ Routine oxytocin augmentation
13.​Maternity protection during pregnancy Partograph - tool that guides birth attendant to
14.​Counselling and support to parents and identify women whose labor is delayed
caregivers on parent/caregiver-infant/child Conditions that do not need partograph
interaction for responsive care and early -​ Antepartum hemorrhage
stimulation for early childhood -​ Severe preeclampsia, eclampsia
development. -​ Fetal distress
15.​Provision of counselling and psychosocial -​ Previous CS
support to parents and caregivers -​ Multiple pregnancy
-​ Malpresentation
 -​ Very premature baby
-​ Obvious obstructed labor
Parts of partograph E.​ Immediate essential care of the newborn
1.​ Progress of labor - alert and action line Four Core Steps
(parallel) where plotting of cervical a.​ Immediate and thorough drying (first 30s)
dilatation is done b.​ Skin-to-skin contact (1 min to 3 mins)
2.​ Maternal and fetal well being c.​ Properly timed cord clamping
Maternal - bp, rr, temp., pr, urine d.​ Nonseparation of newborn from mother for
Fetal well-being- fetal heart rate, status and early breastfeeding (15-90 mins)
color of amniotic fluid DO NOT:
B.​ Fetal Expulsion Stage -​ Ventilate unless the baby is floppy/limp and
Recommended: not breathing
-​ Upright position during delivery -​ Suction unless the mouth/nose are blocked
-​ Double gloving with secretions
-​ Selective episiotomy -​ Wipe off vernix
Not recommended: -​ Bathe the newborn
-​ Perineal massage / “plantsa” -​ Get footprint
-​ Fundal pressure -​ Slap
C.​ Placental expulsion stage -​ Hang upside-down
Active Management of Third Stage of Labor -​ Squeeze chest
(AMTSL) -​ Milk the cord towards the baby
-​ Give oxytocin within 1 minute after -​ Use abdominal binder or “bigkis”
delivery of the baby Do AFTER first full breastfeeding
-​ Controlled cord traction with countertraction -​ Eye ointment (erythromycin)
on uterus -​ Stethoscope to symbolize physical
-​ Uterine massage after placenta is delivered examination
D.​ Immediate postpartum or recovery -​ Vitamin K
period -​ Hepatitis B vaccine
Recommended: -​ BCG vaccine (+ cotton balls)
-​ Use of dyad monitoring sheet 3.​ Health education
-​ Routine inspection of birth canal for -​ Republic Act No. 10028 “Expanded
lacerations breastfeeding promotion of 2009”
-​ Inspect placenta for completeness -​ Executive order no. 51 “Milk code”
-​ Early resumption of feeding -​ Republic act no. 10354 “the responsible
-​ Massaging the uterus parenthood and reproductive health act of
-​ Prophylactic antibiotics for women with a 2012”
3rd or 4th degree perineal tear
-​ Early postpartum discharge POSTPARTAL SERVICES (package)
Not recommended: 1.​ Postpartum visit
-​ Manual exploration of uterus 1st visit within 24 hrs
-​ Routine use of ice packs over the 2nd visit within 1 week after delivery
hypogastrium Postpartum assessment:
-​ Routine oral methergine Breast– engorgement, inverted nipples
Uterus– involution, contracted
Bladder– within 4-6 hrs B- est for baby
Bowel– may be given laxative especially if with R- educe allergy
deep laceration E- motional bonding
Lochia– rubra, serosa, and alba A- antibody present – IgA
Episiotomy– MIDAS- diaphoresis S- tool inoffensive
Homan’s sign– (+) calf pain – deep vein thrombosis T- temperature always right
(DVT) F- resh always
Emotion– taking-in, taking-hold, letting-go E- conomical
2.​ Micronutrient supplementation E- asy once established
3.​ Birth registration D- igested easily
4.​ Lactation support and counselling from I- immediately available
birth up to 2 years and beyond N- utritious
5.​ Nutrition assessment to meet the demands G- gastroenteritis is avoided
of lactation in health facilities and
workplaces To the child:
-​ Breastmilk contains antibodies that help
6.​ Identification and management of
combat disease. It is present in colostrum,
malnutrition of chronically energy
the yellowish fluid secreted by the
deficient (CED) and nutritionally-at-risk
mammary glands in the first few days after
postpartum and lactating women, including
birth. It is rich in immunoglobulin A (IgA)
adolescent mothers and provision of Ready
and WBC to protect the baby against
to Use Supplementary Food (RUSF)
infection
7.​ Organization of community-based mother
-​ It prevents diarrhea. IgA protects the
support groups for breastfeeding w/ other
mucosal membrane in the baby’s gut against
health and nutrition workers
pathogens
-​ Breastmilk protects the child against chronic
BIRTH and NEWBORN SERVICES (28 days)
conditions: allergies, asthma, obesity,
R.A. 8980 “Early Childhood Care development” -
diabetes, heart diease
full range of health, nutrition, and education and
-​ Promotes intellectual and motor
social services programs that provide for holistic
development
needs of young children from birth to 6 years of
age to promote their optimum growth and To the mother:
development. -​ Promotes the release of oxytocin that keeps
Administrative order 2004-0014 the uterus contracted preventing postpartum
a.​ Early initiation of breastfeeding hemorrhage
-​ Helps in the return of prepregnancy weight
b.​ Exclusive breastfeeding for the first 6
-​ Delays the return of fertility
months -​ Lowers risk for premenopausal breast and
c.​ Extended breastfeeding for 2 years and ovarian cancer
beyond -​ Promotes early uterine involution
d.​ Appropriate complementary feeding
e.​ Micronutrient supplementation
f.​ Universal salt iodization Techniques of breastfeeding
g.​ Food fortification A.​ Cradle hold (paduyan or pahele)- the
mother sits her arms supported and using her
Benefits of breastfeeding
 arm on the same side as the nursing breast, -​ Newborns in the ICU may be tested within
cradles the infant in front of her body 7 days of age
B.​ Cross-cradle hold - mother cradles her 6 disorders covered by PhilHealth
infant with the arm on the opposite side of Disorders Effect if not screened Best Time to
the nursing breast & treated treat
C.​ Football, Clutch or underarm hold
Congenital Severe growth and Before 2
(salukimkip) - the mother holds the infant
Hypothyroidism mental retardation weeks
between her flexed arm and body, positions (CH)
the infant facing her, and supports the
infant’s head with her open hand. Maybe Congenital Death 7 days
Adrenal
used for twins hyperplasia
D.​ Side-lying hold (pahigang nakatagilid)- (CAH)
mother lies on her side with arm supporting
Galactosemia Death or cataracts, 7 days
her head. The infant lies beside the mother,
(GAL) liver failure
facing the breast.
Phenylketonuria Severe mental Before 2
(PKU) retardation, seizures, weeks
coma or death

G6PD hemolytic anemia, Avoid trigger

deficiency kernicterus agents for
hemolysis

Maple Syrup Mental retardation, Before 5

Disease seizures, coma or death days
(MSUD) from metabolic crisis

Legal basis
-​ Administrative order no. 2018-0025 known
as “National Policy and strategic framework
on expanded newborn screening for 2017”
ADMINISTRATION OF NEWBORN -​ Administrative order no. 2014-0045 or
SCREENING & NEWBORN HEARING “Guidelines on the implementation of the
SCREENING expanded newborn screening program”
Newborn screening procedure
a.​ Expanded newborn screening test -​ Using the heel prick method, a few drops
-​ Republic Act. no 9288 known as Newborn of blood are taken from the baby’s heel and
Screening Act of 2004 blotted on special absorbent filter card
-​ Early detection and management of several (Guthrie card). Blood is dried 4 hours and
congenital metabolic disorders, which if left send to NBS center.
untreated, may lead to mental retardation -​ Blood should never be collected from:
and/or death. - arch of the foot
-​ Done as early as after 24 hours after initial - the fingers
breastfeeding but not later than three days - the earlobes
from the time of delivery. - a swollen or previous punctured site
 - IV lines containing other substances
(blood, drugs, TPN, etc.)

b.​ Newborn hearing screening test

-​ Republic Act 9709 “Universal newborn
hearing screening and intervention act of
2009” aims for early detection of congenital
hearing loss and referral for early
intervention.
-​ All newborns should be screened prior to
discharge from the hospital
-​ If was not screened due to circumstances,
they may seek hearing screening within the
first three months after birth in the nearest
facility available.