Home Visit

• Is a PROFESSIONAL contact between PHN (with 8 manpower) & the family
• The services provided is an extension of the Health Service Agency (Health Center)

Objectives:

1. Assessment
2. Nursing Care
3. Treatment: under RA 6675
4. Health Education
5. Referral (if care fails)

Priorities (in the care): to prevent cross contamination

1. Newborn
2. Post partum
3. Pregnant mothers
4. Morbid cases
• The families need the assistance of the health center that’s why home visit was done to the family
• The person who makes the home visit is rendering services on behalf of the health center

Public Health Bag:

• Indispensable tool that should be organize to save time & effort and to prevent cross infection & contamination
• Guiding Principles in the use of Public Health Bag:
1. Content-should be prepared by the one who will make home visit
2. Cleaning
• The inner part of the bag should be clean & sterile
• Should be done every after home visit
• Never endorse the bag
3. Contamination
• The less one opens the bag, the lesser chance of contamination
• In general, the bag is open 3x:
1. Putting out materials for hand washing
2. Putting out materials used for nursing care
3. Returning all what have been used
4. Care of Communicable Case(s)-should be disinfected with the use of 70% isopropyl alcohol or Lysol which should be done at the health center and not at home

Phases of Home Visit:

1. 1.Planning
• Starts at the health center
• Makes a study on the status of the family
• Statement of the problem
• Formation of objective
2. Socialization-first activity is to establish rapport & to gain the trust of the family
3. Activity
• Intervention/Professional Phase
• Opportunity to provide or extend health services
• Standard Role of the Nurse: Independent, Dependent and Interdependent
• To be effective, come in complete uniform (also bring a long umbrella with pointed end which serve as protection)
4. Summarization-ability to put into record & report (orally) about the outcome of the activity

LOCAL ENDEMIC DISEASES: 2 Available Programs of DOH

1. Schistosomiasis Control Program (SCP)

Policies for Schistosomiasis Control Program (SCP): CHES C ase Finding H ealth Education E nvironmental Sanitation S nail Eradication Case Finding: 6 Aspects or Thing to Know

1. Disease: Schistosomiasis
2. Other name: Bilhariasis or Snail Fever
3. Causative agent: Schistosoma-a blood fluke (parasite)
• 3 Types of Species:
1. Schistosoma japonicum-endemic in the Philippines & affecting Indonesia, China, Japan, Korea
   Vector: Oncomelania quadrasi-a tiny snail that serves as an intermediate host responsible to transmit the disease to man
2. Schistosoma mansoni---------affects African nations
3. Schistosoma haematobium---
• 3 Forms of Parasite:
1. Nematodes-pinworm
2. Trematodes-Schistosoma, Flatworms (Paragonimiasis)
3. Cestodes
4. d. Laboratory Procedures to rule out Schistosomiasis:
1. Blood Examination: ↑ eosinophil level indicates parasitism
2. Fecalysis: Kato katz (plain stool exam that uses a special apparatus resembling a feeding bottle sterilizer)
• Procedure:
1. Collect specimen
2. Have the test tube undergo centrifugation for 20 minutes
3. Get specimen from precipitate & swab it on glass slide
4. Observe it on microscope
5. e. Signs & Symptoms (Pathognomonic=specific s/sxs identifiable for a disease:
• CNS: High grade fever→ cerebral convulsion
• GIT: Nausea & vomiting, Diarrhea→ Chronic dysentery (prolonged diarrhea of more than 2 weeks & consistency is mucoid & bloody (with streaks of blood) Liver: Presence of infection manifested by jaundice & hepatomegaly
• Parts of Hepa B Virus: Serologic Tests
1. HBsAg-Hepatitis B Surface Antigen
2. HBcAg-Hepatitis B Core Antigen
• (+) HBsAg or HBcAg indicates Hepatitis B not Schistosomiasis
• Spleen: Infection of spleen→ inflammation→ enlargement of organ (Splenomegaly)→ abdominal distension→ abdominal pain on the right upper quadrant
• Blood: Anemia & weakness 39
6. f. Treatment: Drug of Choice-Praziquantel (Biltricide)60 mg/KBW/day
• Example: If patient is 50 kg, 50 kg x 60 mg/KBW/day=3000 mg/day
• Available Preparation: 100 mg/tablet
• 3000 mg/day ÷ 100 mg/tablet=30 tablets/day, so 10 tablets in a.m. 10 tablets in noon 10 tablets in p.m.
• Initial treatment: 1st 2 weeks=3000 mg/day, then do stool exam after 2 weeks→ if still (+), extend treatment for another 2 weeks. Repeat stool exam, if still (+) after the extended week, continue treatment for 2 weeks again. No adverse effect or over dosage even if extended for a year.
• Length of Treatment: takes months to a year
• Health Education: It affects mostly farmers so educate them to wear rubber boots
• Environmental Sanitation: Source of disease=snail is the 1st concern Water=where snail thrives is the 2nd concern Toilet=3rd concern Food Garbage
• Snail Eradication: Use molluscicides-treat the entire suspected soil with chemical solution that kills snails
2. Malarial Control Program (MCP): 2 Available Program of DOH for MCP
1. BICEP
• Biological Method: Bio (refers to something which has life=living organism) build fish ponds with tilapia (only fish that eats mosquito eggs) Insecticide=kill/spray source of disease at night time (7 pm) with Baygon/Raid (Bayothrin, Permithrin, Propoxur)→ “After 4 o’clock Habit” of DOH for Malaria & Dengue: 4 p.m.-remove possible venue for mosquitoes to thrive (stagnant waters) 5-5:30 p.m.-start spraying insecticide Malaria (FAM) Dengue (AA) Night Biting Day Biting High Flying Low Flying Running/Free Flowing Stagnant Water Rural Urban
• Case Finding: 6 Concerns for Surveillance
1. 1) Disease: Malaria
2. 2) Other name: Ague
3. 3) Causative Agent: Plasmodium-a protozoa
• 4 Types of Species:
1. Plasmodium falciparum-more fatal that affects the Philippine Vector: Female Anopheles Mosquito (FAM)
2. Plasmodium vivax-------population
3. Plasmodium ovale
4. Plasmodium malariae
4. Laboratory Procedure: Malarial smear-extract blood at the height of fever because plasmodium is very active & ruptures at this period
5. Signs & Symptoms of Malaria:
• 1st Stage=Cold: Chilling sensation for 1-2 hours
• 2nd Stage=Hot: High grade fever lasting for 3-4 hours
• 3rd Stage=Wet: Diaphoresis (excessive sweating/perspiration) Signs & Symptoms of Dengue:
1. Hot
2. Bleeding Tendencies
1. Epistaxis-nose bleeding
2. Hematamesis-vomiting fresh blood
3. Melena
4. Hematochezia
3. Recovery: if bleeding is controlled
4. Circulatory Collapse: if bleeding is not controlled→ Shock→ Death
6. Treatment: Drug of Choice-Quinine
• 2 Forms:
1. Chloroquine (Aralen)-BQ
2. Primaquine
• If Quinine is not available, may use Sulfadoxime-an antibacterial drug paired with pyrinthamine Environmental Sanitation: Source of Disease=1st concern + FAM Water=where mosquitoes thrive Garbage=3rd concern Food Toilet
• Personal Protection:
1. Sleep under a mosquito net
2. Sleep in a screened room
3. Sleep with long sleeve attire
4. Use repellents that contains DET (diethyl toluamide or toluene which has a pungent odor that drives away mosquitoes & an irritant to mucous membrane of respiratory tract when inhaled
1. a) Vaseline oil, off lotion, “katol”, autan
2. b) Anti-mosquito soap has anti-histamine (provides cooling effect), anti-allergy, anti-itchiness, anti-inflammatory & repellent effect:
1. Basil
2. Citronelle-resembles mentholated & eucalyptic smells
3. Vick vaporab-has mentholated smell
4. Oil of Winter Green, omega, efficascent oil
5. Zest soap-effective because the green bar has anti-histamine effect and the yellow bar acts as a repellent
3. c) Dry skin of lanzones, dried banana trunk (saha ng saging)
5. Plant a Neem Tree using the leaves
2. CLEAN:
• Chemical Method=insecticide spraying at night
• Larvae eating fish=Tilapia
• Environmental Sanitation & Health Education=insect, water, trash
• Anti-mosquito soap=basil citronelli
• Neem tree=banana, banaba, gabi, eucalyptus provide repellent effect