Primary Health Care (PHC) in the Philippines, Exams of Nursing

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PHC accord who - correct answer ✔✔an essential care made universally accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country can afford at every stage of development. the First International Conference - correct answer ✔✔Primary Health Care (PHC) was declared during Alma Ata, Russia on September 6-12, 1978 by the World Health Organization (WHO). The goal was " Health for All by the Year 2000 ". - correct answer ✔✔Primary Health Care (PHC) was declared during the First International Conference on Primary Health Care held in Legal basis PHC - correct answer ✔✔Letter of Instruction 949 signed by President Marcos on October 19, 1979 and has an underlying theme of " Health in the Hands of the People by 2020 ." PHC MISSION - correct answer ✔✔To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care PHC concept - correct answer ✔✔Partnership and empowerment of the people towards the development of Self -Reliance Elements/ Components of PHC - correct answer ✔✔✓ Education for Health ✓ Locally endemic diseases control ✓ EPI ✓ Maternal & Child Health & Family Planning. ✓ Mental Health ✓ Essential Drugs ✓ Nutrition ✓ Treatment of CD and NCD ✓ Safe water/ Environmental sanitation

KEY PRINCIPLES OF PHC - correct answer ✔✔✓Accessibility, Availability, Affordability & Acceptability of health services ✓Social Mobilization ✓People are the center, object and subject of development ✓Self- reliance ✓Recognition of interrelationship between the health and development ✓Decentralization ✓Community Participation ✓Partnership between the community and the health agencies in the provision of quality of life. FOUR CORNERSTONES/ PILLARS IN PHC - correct answer ✔✔1. Community Participation

2. Inter- sectoral coordination
3. Appropriate Technology
4. Support mechanism made available
5. Grassroots/ Village or Barangay Health Workers (V/BHWs)- - correct answer ✔✔refers to trained community health workers of health auxiliary volunteer or a traditional birth attendant or healer. Intermediate level health workers - correct answer ✔✔general medicine practitioners or their assistants. PHN, Rural Sanitary Inspectors and Midwives may compose these groups. Primary Prevention - correct answer ✔✔relates to activities directed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals. Examples: Quit smoking, avoid/ limit alcohol intake, exercise regularly, complete immunization Secondary Prevention - correct answer ✔✔refers to early detection and prompt intervention during the period of early disease pathogenesis. Examples: annual PE, regular Pap's test for women, sputum examination for TB. Tertiary Prevention- - correct answer ✔✔targets populations that have experienced disease or injury and focuses on limitation of disability and rehabilitation. Example: self- monitoring of blood glucose among diabetics, physical therapy after CVA (stroke), undergoing speech therapy after laryngectomy. Primary Level Facilities - correct answer ✔✔Health services offered to individuals with fair health & to clients with diseases in early symptomatic stages. Include RHU, Community Hospitals, Health Centers, Private Practitioners, Puericulture Center, Brgy. Health Stations.

Secondary Level Facilities - correct answer ✔✔Offer services to clients with symptomatic stages of disease which require moderately specialized knowledge & technical resources for adequate treatment. Include emergency/ district hospitals, Provincial/ City Health services & facilities Tertiary Level Facilities - correct answer ✔✔-Include highly technological and sophisticated services offered by medical centers and large hospital. These are specialized hospitals/ institution. National & regional Health Services, Medical Centers, Teaching & Training Hospitals commnity health nursing - correct answer ✔✔Is a service rendered by professional nurse with the Community, Groups, Families, and Individuals at home, in health centers, clinics, schools, place of work for the promotion of health, prevention of illness, care of the sick at home and rehabilitation. chnursing objectives - correct answer ✔✔✓ To participate in the development of an over all health plan for the community. ✓To provide quality nursing services to individuals, families & communities. ✓To coordinate nursing services with various members of health team. ✓To participate in and/or conduct researches relevant to community health and community health nursing services and disseminate their results for improvement of health. chn Philosophy: - correct answer ✔✔Worth and dignity of man chn *Ultimate Goal - correct answer ✔✔To raise the level of health of the citizenry chn *Primary focus - correct answer ✔✔Health promotion and disease prevention chn Primary Goal - correct answer ✔✔Self-reliance in health chn Principles - correct answer ✔✔✓Is based on recognized needs of communities, families, groups and individuals. ✓Knowledge and understanding of the objectives and policies of the agency facilities goal achievement. ✓CHN considers the family as the unit of service. ✓Respect for the values, customs and beliefs ✓CHN integrated health education and counseling as vital parts of functions. ✓Collaborative work relationships with the co-workers and members of the health team facilities accomplishments of goals. ✓Periodic and continuing evaluation provides the means for assessing the degree to which CHN goals and objectives are being attained. ✓Continuing staff education program quality services to client and are essential to upgrade and maintain sound nursing practices in their setting. ✓ Utilization of indigenous

and existing community resources maximizing the success of the efforts of the Community Health Nurses. ✓Active participation of the individual, family and community in planning and making decisions for their health care needs, determine, to a large extent, the success of the CHN programs. ✓Supervision of nursing services by qualified by CHN personnel provides guidance and direction to the work to be done. ✓Accurate recording and reporting serve as the basis for evaluation of the progress of planned programs and activities and as a guide for the future actions. Health Promotion - correct answer ✔✔actions related to lifestyles and choices that maintains / enhances a population's health. ✓Health Protection - correct answer ✔✔includes activities designed to detect or prevent illness or alter disease processes. *Health Balance - correct answer ✔✔state of well being that results from a healthy interaction between a person's body, mind, spirit and environment. Disease Prevention - correct answer ✔✔activities designed to protect people from disease and its consequence Social Justice - - correct answer ✔✔all people have a right to certain "basics" of life and health protection INDIVIDUAL (sick or well) - correct answer ✔✔Can be considered as entry point in working with the whole family. ✓FAMILY Health task - correct answer ✔✔❑ Recognizing interruptions of health or development ❑Seeking health care ❑ Managing health & non health crises ❑ Providing care to the sick, disabled & dependent member of the family ❑ Maintaining a home environment conducive to good health & development ❑ Maintaining good relationship with community & health institution. POPULATION GROUP - correct answer ✔✔A group of people who share common characteristics, developmental stage or common exposure to particular environmental factors & consequently common health problems:(Children, Elderly)

✓COMMUNITY - correct answer ✔✔Group of people sharing common geographic boundaries, values & interests population- or aggregate-focused - correct answer ✔✔The hallmark of community health nursing is that it is Health - correct answer ✔✔WHO defines health as "a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity. Illness - correct answer ✔✔Highly personal state in which the person's physical, emotional, intellectual, social, developmental or spiritual functioning is thought to be diminished. Diseases - correct answer ✔✔alteration in body functions resulting in reduction of capacities or a shortening of normal life span. Determinants of Health - correct answer ✔✔The range of personal, social, economic and environmental factors that influence health status. ● Factors that make a person healthy or not. Political factors - correct answer ✔✔refers to one's leadership, how he rules, manages and how other people concerned are followed to actively participate in the decision making process. Political factors Keywords - correct answer ✔✔o Social Justice o Human rights o Equity o Decision- making o Leadership & Governance Economic Factors - correct answer ✔✔Production, distribution and consumption of goods and services and how these affect health and development.

Economic factors Keywords - correct answer ✔✔Health and development ( relationship) ● Higher income and social status are linked to better health. ● Elevated death rates for the poor. ● Inequitable distribution of income and wealth may itself cause poor health. Socio-cultural factors - correct answer ✔✔Influence a client's health practices, dynamics of health care and the client-care provider relationship. Socio-cultural factors Keywords: - correct answer ✔✔o Culture o Beliefs o Traditions Example: Jehovah's witnesses, Iglesia Ni Cristo, Biological/ Genetics - correct answer ✔✔❖ Permanent and cannot be altered. ❖ Based on the genes of the parents. ● Ex: ✓ Hypertension ✓ Diabetes Mellitus ✓ Cancer EDUCATION - correct answer ✔✔❖ Low education levels are linked with poor health, more stress and lower self-confidence. ● Example: Women who are educated are more likely to seek medical consultation during pregnancy. ( nutrition for the family, immunization) Physical Environment - correct answer ✔✔For an individual to be healthy, there should be: ● Safe water ● Clean Air ● Healthy workplaces ● Safe houses, communities and roads Deviation in health may follow if: ● Hazardous waste/ Toxic chemicals ● Noise ● Residential Crowding ( Ex: Tuberculosis, diarrhea- causing virus & bacteria, fungal and skin diseases) Employment and working conditions - correct answer ✔✔❖ People in employment are healthier particularly those who have more control over their working conditions. Example: Hot tempered or impatient supervisor may affect his/ her subordinates. ✓ Learn to see the good side. Think positive. Social support networks - correct answer ✔✔● Greater support from families, friends and communities are linked to better health. ● Those who have weak support system are more prone to mental illness, substance abuse and depression. Double burden of disease- Triple burden of disease

Personal Behavior and Coping Skills - correct answer ✔✔To be healthy, a person must: ● Balanced eating ● Active lifestyle ● Do not smoke and drink ● Successfully deal with life stresses and challenges Ex: Personal habits- smoking, Lifestyle- obesity ( Americans because of their diets) Health Services - correct answer ✔✔❖ Access and use of services that prevent and treat disease influence health. Ex: Presence of Barangay Health Station per barangay. Services must be: ✓ Accessible ✓ Affordable ✓ Available ✓ Appropriate Gender - correct answer ✔✔❖ Men and women suffer from different types of diseases at different ages. ❖ Life expectancy: Male- 67, female- 72 ● Ex: More men suffer from CVD than women. Public HealthAccording to Dr. C.E. Winslow - correct answer ✔✔"science and art of preventing disease, prolonging life, promoting health and efficiency." Public Health Goals - correct answer ✔✔To enable every citizen to realize his birthright of health and longevity. • Achieved through community effort Public Health Nursing acc to WHO - correct answer ✔✔special field of nursing that combines the skills of nursing public health and some phases of social assistance and functions as part of the total public health program for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability. Standards of Public Health Nursing in the Philippines - correct answer ✔✔01 BSN graduate Registered Nurse Member of PNA Good moral character Management Function - correct answer ✔✔• The management function of the public health nurse is inherent in her practice.

• This function is performed when she organizes the "nursing service" of the local health agency
• A program manager

Supervisory Function - correct answer ✔✔• PHN is the supervisor of the midwives and other auxillary health workers in the catchment area. • Formulates a supervisory plan and conducts supervisory visits to implement plan. • Conducts supervisory visits using a supervisory checklist • During the visit the PHN identifies together with the supervisee any issue or problem encountered and addresses them accordingly Nursing Function - correct answer ✔✔• An inherent function of the nurse • Her practice as a nurse is based on the science and art of caring • Public health nursing is caring for individuals, families and communities toward health promotion and disease prevention • PHN are expected to provide nursing care • PHN uses her knowledge and skill in the nursing process. She does assessment, plans, and implements care, and evaluates outcomes. • Establishes rapport with her client: individual, family or community • Home visits • Referral of patients to appropriate levels of care Collaborating and Coordinating Function - correct answer ✔✔• Brings activities or group activities systematically into proper relation or harmony with each other. • Care coordinators for communities and their members • Actively involved both socially and politically to empower individuals, families and communities as an entity to initiate and maintain health promoting environments Health Promotion and Education Function - correct answer ✔✔• Activities goes beyond health teachings and health information campaigns. • Understanding the multidimensional nature of health will enable her to plan and implement health promoting interventions for individuals and communities. • Uses her skills in advocacy for the creating of a supportive environment through policies and reengineering of the physical environment for healthier actions. Training Function - correct answer ✔✔• Initiates the formulation of staff development and training programs for midwives and other auxiliary workers • Does training needs assessment for these health workers, designs the training program and conducts them in collaboration with other resource persons.

• Also does evaluation of training. • PHN participates in the training of nursing and midwifery affiliates in coordination with the faculty of colleges of nursing and midwifery Research Function - correct answer ✔✔• Participates in the conduct of research and utilizes research findings. • PHN function is disease surveillance. Purposes of disease surveillance: To measure the magnitude of the problem To measure the effect of the control program • It is important in monitoring the progress of the disease reduction initiatives: Poliomyelitis, Neonatal Tetanus Elimination, Measles Control, NCD risk factors, etc. CLINIC VISIT - correct answer ✔✔It is a process of checking the client's health condition in a medical clinic.

➢ The patient visits the health center/ clinic to avail of the services thereto offered by the facility primarily for consultation on matters that ailed them physically Pre-consultation conference - correct answer ✔✔A pre-clinic lecture is usually conducted prior to the admission of patients, which is one way of providing health education Standard Procedures Performed during Clinic Visits - correct answer ✔✔I. Registration/ Admission II. Waiting time III. Triaging IV. Clinical Evaluation V. Laboratory and other diagnostic examinations VI. Referral System VII. Prescription/ Dispensing VII. Health Education I. Registration/ Admission - correct answer ✔✔1. Greet the client upon entry and established rapport.

2. Prepare the family record of new patients or retrieve records of old clients.
3. Elicit and record the client's chief complaint and clinical history.
4. Perform physical examination on the client and record it accordingly II. Waiting time - correct answer ✔✔1. Give priority numbers to clients.
5. Implement the "first come, first serve" policy except for emergency/ urgent cases. III. Triaging - correct answer ✔✔1. Manage program- based cases.
6. Refer all non- program based cases to the physician.
7. Provide first- aid treatment to emergency cases and refer when necessary to the next level care. IV. Clinical Evaluation - correct answer ✔✔1. Validate clinical history and physical examination
8. The nurse arrives at evidence- based diagnosis and provides rational treatment based on DOH programs. a. Identify the patient's problem b. formulate/ write the nursing diagnosis and validate c. give/

perform the nursing intervention d. evaluate the intervention if it has enabled the patient to achieve this desired outcome

3. Inform the client on the nature of the illness, the appropriate treatment and prevention and control measures. V. Laboratory and other diagnostic examinations - correct answer ✔✔1. Identify a designated referral laboratory when needed. VI. Referral System - correct answer ✔✔1. Refer the patient if he needs further management following the two- way referral system (BHS to RHU, RHU to RHU, RHU to Hospital).
4. Accompany the patient when an emergency referral is needed. HOME VISIT - correct answer ✔✔Is a family- nurse contact which allow the health worker to assess the home and family situations in order to provide the necessary nursing care and health related activities. PURPOSE OF HOME VISIT - correct answer ✔✔1. To give nursing care to the sick, to a post partum mother and her newborn with the view to teach a responsible family member to give the subsequent care. 2. To assess the living condition of the patient and his family and their health practices in order to provide the appropriate health teaching. 3. To give health teachings regarding the prevention and control diseases. 4. To establish close relationship between the health agencies and the public for the promotion of health 5. To make use of the inter- referral system and to promote the utilization of community services. PRINCIPLES INVOLVED IN PREPARING FOR A HOME VISIT - correct answer ✔✔1. A home visit must have a purpose or objective. 2. Planning for a home visit should make use of all available information about the patient and his family through family records. 3. In planning for a visit, we should consider and give priority to the essential needs of the individual and his family. 4. Planning and delivery of care should involve the individual and family. 5. The plan should be flexible GUIDELINES TO CONSIDER REGARDING THE FREQUENCY OF HOME VISITS - correct answer ✔✔1. The physical needs, psychological needs and educational needs of the individual and family. 2. The acceptance of the family for the services to be rendered, their interest and the willingness to cooperate.
5. The policy of a specific agency and the emphasis given towards their health programs. 4. Take into account other health agencies and the number of health personnel already involved in the care of a specific family. 5. Careful evaluation of past services given to a family and how the family avail of the nursing services. 6. The ability of the patient and his family to recognize their own needs, their knowledge of available resources and their ability to make use of their resources for their benefits.

STEPS IN CONDUCTING HOME VISITS - correct answer ✔✔1. Greet the patient and introduce yourself 2. State the purpose of the visit 3. Observe the patient and determine the health needs 4. Put the bag in a convenient place then proceed to perform the bag technique 5. Perform the nursing care needed and give health teachings 6. Record all important data, observation and care rendered 7. Make appointment for a return visit PHN SPANISH REGIME - correct answer ✔✔Bro. Juan Clemente started health services through a dispensary in Intramuros. Start of water sanitation Introduction of small pox vaccine. AMERICAN REGIME 1898 - correct answer ✔✔Creation of the Board of Health for Physicians 1901 - correct answer ✔✔Creation of Board of Health for City of Manila, Provincial and Municipal Boards of Health 1905 - correct answer ✔✔abolished Board of Health, activities were taken over by the bureau of health under Department of Interior 1906 - correct answer ✔✔abolition of Board of Health; creation of Bureau of Health 1912 - correct answer ✔✔Creation of Sanitary Divisions 1915 - correct answer ✔✔- BOH was renamed Philippine Health Service with Director of Health as head. 1928 - correct answer ✔✔First convention of Nurses was held 1930 - correct answer ✔✔Section of PHN was converted to Section of Nursing 1933 - correct answer ✔✔Reorganization act 4007 - Division of Maternal & Child Health of the office of Public welfare commission was transferred to Bureau Of Health 1947 - correct answer ✔✔Bureau of Public welfare was renamed DOH

June 1957 - correct answer ✔✔- Rep Act 1891 (An act Strengthening Health and dental Services in the Rural Areas) 1975 - correct answer ✔✔Formulation of the National Health Plan and the restructured Health Care delivery system 1982 - correct answer ✔✔E.O 851 reorganized the DOH to synchronize health structures and operations with the shift to parliamentary form of government whence it became known as the Ministry of Health (later, under the presidential form, as Department of Health). Significant Changed: - correct answer ✔✔• Branching out of the office of Public health services to form the office of special concern.

• National Immunization Day • National Micronutrient Campaign (Araw ng Sangkap Pinoy)
• Disaster Management Urban Health and Nutrition Project ● Traditional Medicine Doctors to the Barrios Program Let's DOH it! became a national battle cry. 1996 - correct answer ✔✔- Primary Health Care as strategy to attain Health for All by the year 2000 1999 - correct answer ✔✔Creation of the National Health Planning Committee (NHPC) And establishment of Inter-Local Health Zone 1999 2004 - correct answer ✔✔- Health Sector Reform Agenda of the Philippines was launched 2005 - correct answer ✔✔DOH launched Fourmula One for Health to ensure speed, precision and effective coordination towards improving the efficiency, effectiveness and equity of Health Care delivery ROLE - correct answer ✔✔It refers to a set of behavior patterns that are deemed appropriate for and expected of a person by virtue of his status in society and/or a position he occupies in an organization. roles of community health nurse - correct answer ✔✔1.) Provider of nursing care

2.) Health monitor 3.) health teacher 4.) counselor 5.) client/patient advocate 6.) change agent 7.) community organizer 8.) team member 9.)trainer supervisors and manager 10.) coordinator of health and related services 11.)researcher 12.)role moodel FUNCTION - correct answer ✔✔It is a set of activities and tasks expected of a person to perform by virtue of his position or role in society. FUNCTION of chn - correct answer ✔✔1. Initiates contact, establishes and maintains an effective working relationship with individual clients/patients, families, specific population groups, other social units and organizations in the community. 2. Assesses and detects deviations from health among individuals, families, specific groups and the community as a whole with the use of appropriate, valid and reliable methods and tools. 3. Provides skilled nursing care to the sick and disabled patients requiring part-time professional nursing service in various settings 4. Administers prescribed medications, treatments or emergency care to the individual 5. Follows up complicated or problematic cases, including communicable and noncommunicable chronic/long-term diseases/cases in the community, provides appropriate nursing care, health teachings and referral, as needed. 6. Provides health teachings/education to individual clients/patients, families and specific population groups during every appropriate opportunity in various settings. 7. Provides guidance and counselling to individuals, families and groups with specific health or healthrelated problems. 8. Assesses the environment in the home, school, workplaces and the community as a whole to identify risks and hazards to health; works with other members of the health and intersectoral teams to reduce, modify or eliminate the hazards in

order to prevent diseases or accidental injuries. 9. Plans properly and conducts home visit follow-ups of high-risk or priority families in the community with the ultimate objective of enhancing the families' capabilities for self-care and to effectively cope with health and health-related problems. 10. Initiates and/or participates actively in the planning, organization and conduct of screening/casefinding program for specific diseases, or in special health-promotive and preven