CHN RLE

IMMUNIZATION

Expanded Program On Immunization

-established in 1976
-ensure that infants/children and mothers have access to routinely recommended
infant/childhood vaccines.

Six vaccine-preventable diseases

1. Tuberculosis
2. Poliomyelitis
3. Diphtheria
4. Tetanus
5. Pertussis
6. Measles

Over-all Goal
To reduce the morbidity and mortality among children against the most common vaccine-
preventable diseases.

Specific Goals

1. To immunize all infants/children against the most common vaccine-preventable diseases.

2. To sustain the polio-free status of the Philippines.

3. To eliminate measles infection.

4. To eliminate maternal and neonatal tetanus

5. To control diphtheria, pertussis, hepatitis b and German measles.

6. To prevent extra pulmonary tuberculosis among children.

Republic Act No. 10152

-“Mandatory Infants and Children Health Immunization Act of 2011”
-President Benigno Aquino III
-July 26, 2010
-Basic immunization for children under 5 including other types that will be determined by the
Secretary of Health.
STRATEGIES

1. Conduct of Routine Immunization for Infants/Children/Women through the Reaching Every

Barangay (REB) strategy

2. Supplemental Immunization Activity (SIA)

3. Strengthening Vaccine-Preventable Diseases Surveillance

4. Procurement of adequate and potent vaccines and needles and syringes to all health facilities
nationwide.

Polio -poliomyelitis
-caused by poliovirus
-crippling and potentially infectious
-infects the person’s brain and spinal cord causing paralysis

Diphtheria
-bacterial infection
-affects the nose and throat
-cause breathing problems and swallowing

Measles
-caused by a virus
-airborne
-infects the respiratory tract

Neonatal Tetanus
-infection occurs at unhealed umbilical stump (non-sterile equipment)

Pertussis
-whooping cough
- “100 day cough”
- Highly contagious respiratory disease

Tuberculosis
-affects the lungs
-airborne

Hepatitis B
-viral infection
-attacks the liver
-transmitted through blood or other body fluids
Poliomyelitis
-OPV (Oral Polio Vaccination)
-6 weeks old
-3 doses (2-3 drops)
-4 weeks
- Oral
- The extent of protection against polio is increased the earlier the OPV is given

Measles
-MCV
-Measles-Containing Vaccine
-MMR=measles, mumps, and rubella combination vaccine
-9 months old
-2 dose (0.5 mL)
- Subcutaneous
- Upper outer portion of the arms
- At least 85% of measles can be prevented by immunization at this age

Hepatitis B
-HEPATITIS
- At birth
-3 doses (3 doses)
-4 weeks interval
- Intramuscular
- Upper outer portion of the thigh
- Prevents liver cirrhosis and liver cancer

Diphtheria-Pertussis-Tetanus
-DPT
-6 weeks old
-3 doses (0.5 mL)
-6 weeks(DPT 1), 10 weeks (DPT 2), 14 weeks (DPT 3)
- Intramuscular
- Upper outer portion of the thigh
- An early start with DPT reduces the chance of severe pertussis

Tuberculosis
-BCG (Bacillus Calmette-Guérin)
-at birth
-1 dose (0.05 mL)
- none
- Intradermal
- Right deltoid region of the arm
- BCG given at earliest possible age protects the possibility of TB meningitis and other TB
infections in which infants are prone

Vaccine Minimum Percent Duration of Protection

Age/ Interval Protecte
d

TTI At 20th weeks AOG 0% · protection for the mother for the first
delivery

TT2 At least 4 weeks 80% · infants born to the mother will be

later protected from neonatal tetanus

· gives 3 years protection for the mother

TT3 At least 6 months 95% · infants born to the mother will be

later protected from neonatal tetanus
· gives 5 years protection for the mother

TT4 At least 1 year later 99% · gives lifetime protection for the mother
· all infants born to that mother will be
protected

TT5 At least 1 year later 99% · gives lifetime protection for the mother
· gives 10 years protection for the mother
Vaccine Minimum Number Minimum Reason
Age at 1st of doses interval
dose between
doses

BCG Birth or 1 BCG given at earliest possible age

anytime protects the possibility of TB
after birth meningitis & other Tb infectious in
which infants are prone.

DPT 6 weeks 3 4 weeks An early start with DPT reduces the

chance of severe pertussis

OPV 6 weeks 3 4 weeks The extent of protection against polio

is increased the earlier the OPV is
given. Keep the Philippine polio free.

Hepatitis B At birth 3 6 weeks An early start Hep B reduces the

interval from chance of being infected and
1st dose to becoming a carrier. Prevent liver
2nd dose, and cirrhosis and liver cancer.
8 weeks
interval from
2nd dose to
3rd dose.

Measles 9 months At least 85% of measles can be

prevented by immunization at this age.
Prevent deaths, malnutrition,
pneumonia, diarrhea get these
complications.
 Type/ Form of vaccines Storage Temperature

Most Sensitive to Heat Oral Polio (live attenuated) -15 °C to -25°C (at freezer)
Measles (freeze dried) -15 °C to -25°C (at freezer)

Least Sensitive DPT/ Hep B + 2 °C to 8°C (in the body of

the refrigerator)
“D” Toxoid which is a
weakened toxin
“P” killed bacteria
“T” Toxoid which is a
weakened toxin
+ 2 °C to 8°C (in the body of
Hep B the refrigerator)

+ 2 °C to 8°C (in the body of

BCG (freeze dried) the refrigerator)

Tetanus Taxoid
Procedures in giving the vaccines:
Reconstituting the freeze BCG Vaccine

A. Always keep the diluent cold by sustaining with BCG vaccine ampules in refrigerator or
vaccine carrier.
B. Using 5 mL syringe fitted with long needle, aspirate 2 mL of saline solution from the
opened ampule or diluent.
C. Inject 2mL saline into the ampule of freeze-dried BCG.
D. Thoroughly mix the diluent and vaccine by drawing the mixture back into the syringe and
expel it slowly into the ampule several times.
E. Return the reconstituted vaccine on the slit of the foam provided in the vaccine carrier.

Hepatitis B and DPT

Giving Hep B/ DPT vaccine
1. Ask the mother to hold the child across her knees so that his thigh is facing upwards.
Ask. Ask her to hold child’s leg.
2. Clean the skin a cotton ball, moistened with alcohol and let it dry.
3. Place your thumb and index finger on each side of the injection site and grasp the
muscles slightly. The best injection site is the outer part of the child’s mid-thigh.
4. Quickly push the needle into the space between your fingers, going deep in the muscle.
5. Slightly pull the plunger back before injecting to be sure that the vaccine is not injected
into the vein. (If using disposable syringes and needles
6. Inject the vaccine. Withdraw the needle and press the injection spot quickly with a piece
of cotton.
SCHEDULE NG PAGBIBIGAY NG BAKUNA
PARA SA MGA BATANG ISANG TAON PABABA

BAKUNA PAGKA- 1½ 2½ 3½ 9 1
PANGAN BUWA BUWA BUWA BUWA TAO
AK N N N N N

BCG Tuberkulosis ü

HEPATITIS B Hepatitis B ü

PENTAVELENT Dipterya, ü ü ü
VACCINE Tetano, Hep
(DPT- Hep B-HiB) B,
Pertussis,
Pulmonya,
Meningitis

ORAL POLIO Polio ü ü ü

VACCINE
(OPV)

INACTIVATED Polio ü
POLIO
VACCINE (IPV)

PNEUMOCOCCA Pulmonya, ü ü ü
L Meningitis
CONJUGATE
VACCINE (PCV)

MEASLES, (Tigdas, ü ü
MUMPS, Beke,
RUBELLA (MMR) German
Measles
FAMILY PLANNING

Family planning is the planning of when to have children. And the use of birth control and other
techniques to implement such plans.

Purpose:
- Raising a child requires significant amounts of resources: time, social, financial, and
environmental. Planning can help assure that resources are available.
- To improve the health of the mother and child
- Helping to prevent HIV/AIDS
Contraception:
- There are many types of contraception widely used nowadays for family planning purposes.
- Each method has its advantages and suits special cases and not necessarily suits others and the
choice of contraception depends on different needs of the patients like the period of
contraception and also doctors should decide which method suits needs more.
- No method of contraception is completely effective and failure rates for most reversible methods
are strongly influenced by compliance.
- Types:
1. Natural contraception
2. Mechanical contraception
3. Hormonal contraception
4. Surgical contraception

Characteristics of ideal contraceptive:

- Safe
- 100%
- Free of side effects
- Easily obtainable
- Affordable
- Acceptable to the user and sexual partner
- Free of effects on future pregnancies

Conditions of family planning:

- Pregnancy
- Lactation
- Before puberty
- After menopause
- Abstinence

Natural Family planning methods

- These methods involves finding out when a woman is at her most fertile, so that she can be extra
careful or avoid sex altogether during these times. This can be done by using techniques such as
the woman keeping a daily record of her body temperature using a special fertility thermometer.
- A combination of techniques is recommended to increase the effectiveness of these methods.
- These are a natural alternative to hormonal and barrier methods but the techniques used require
a significant level of motivation and a clear understanding of how to monitor fertility. Natural
methods of contraception also do not take into account fluctuations in the menstrual cycle.

They include:
- Calendar (Rhythm) method
- Basal body temperature
- Cervical mucus method
- Symptothermal method
- Ovulation awareness method
- Lactational amenorrhea method
- Withdrawal (Coitus interruption)
Rhythm method
- This method can be used for patients with regular cycles only.
- This is done depending on the exact knowledge of ovulation day and avoiding intercourse during
the days before and after ovulation.
- For example in a regular period that occurs every 28 days the exact day of ovulation should by
the day 14 so intercourse should be avoided 4-5 days before and after this days.
- There are many methods to detect ovulation days;
1- Increase in body temperature by about 0.5 C.
2- Change in type cervical mucous
3- Ovulation kits nowadays are available for ovulation day detection by measuring LH surge

Withdrawal method
- When having sex, the man has to take his penis out of the vagina before ejaculation.
- This is intended to stop sperm from entering the woman.
 - This method frequently fails as drops of sperm can already escape from the penis into the vagina
before the man ejaculates.
- Effectiveness: Failure rate can be as high as 15% (15 pregnancies per 100 women)
- More reliable methods are advised.

Mechanical family planning methods

- Male condoms
- Female condoms
- Diaphragms
- Spermicidal
- Intrauterine devices (IUD)
- Sponge

Male condom
- It’s a thin latex or plastic sheath placed over a man’s erect penis during sex to trap sperm at the
point of ejaculation. It must be put on the penis as soon as it becomes erect and before any
contact takes place with the vagina. Men should withdraw as soon as they have ejaculated and
take care not to spill any semen.
- Condoms must be used with care as they can slip off or split. They should never be used with oil-
based products such as petroleum jelly or suntan oil as these will damage the rubber.
- Advantages: easily available; offers protection against sexually transmitted infections including
HIV/AIDS.
- Effectiveness: 94%-98% depending on correct use. Only use condoms that have been
manufactured.

Contraceptive skin patch

- The Contraceptive Patch looks like a square band-aid. It is applied to the abdomen, buttocks,
upper arm, or upper torso. The Patch is changed each week for a schedule of 3 weeks on and 1
week off.
- It works by slowly releasing a combination of estrogen and progestin hormones through the skin.
These hormones prevent and thicken the cervical mucus, creating a barrier to prevent sperm from
entering the uterus.
- Effectiveness: When used correctly, it’s about 99% effective as birth control except for women
weighing 90 kg or more when it is only about 92% effective.

Vaginal Ring
- A soft, flexible vaginal ring, which is about 2 inches in diameter, delivers low doses of estrogen
and progestin into the body. This helps prevent pregnancy by suppressing ovulation and
thickening the cervical mucus, which helps block sperm from entering the uterus. The ring is
inserted into vagina and left for 3 weeks. It is then removed for 1 week, during which a woman
menstruates, and a new ring is inserted after the 1-week “break”
- The vaginal ring is at least 98% effective with perfect use, which refers to always correct and
consistent use.
Combined pill
- This is the most common type. It contains two hormones - estrogen and progesterone which
prevent an egg from being released from a woman’s ovary each month.
- The combined pill can reduce premenstrual syndrome (PMS) and period pain. There is evidence
that it also offers some protection against cancer of the uterus and ovaries.
- Advantages: the pill does not interfere with the spontaneity of sex.
- A full medical history is essential as this pill is not suitable for women who have certain conditions
such as high blood pressure, circulatory disease or diabetes. Women over 35 who smoke or are
very overweight may be advised to choose another method of contraception. There are several
different types of pill so if one does not suit then another might.
- The combined pill is not reliable if taken over 12 hours late or if have vomiting and diarrhea, when
extra protection is required. Some drugs like antibiotics can also affect its reliability.
- Effectiveness: 99% if taken correctly.

Progesterone-only pill (mini pill)

- Unlike the combined pill, this only contains the hormone progesterone. It works by thickening the
cervical mucus, which acts as a barrier to stop sperm entering the womb. It also makes the lining
of the womb thinner, to prevent it accepting a fertilized egg. This type of pill is good for women
who are breast-feeding, older women, smokers and others who cannot use the combined pill. It
can also help with premenstrual syndrome (PMS) and painful periods.
- Advantages: the pill does not interfere with the spontaneity of sex.
- It must be taken at the same time each day or at most within three hours of that time. It will not
work if taken over three hours late, or if have vomiting and diarrhea, in these cases extra
protection is needed. It can cause irregular bleeding and periods may stop altogether while are
taking it.
- Effectiveness: 98% if taken correctly

Contraceptive injection
- It’s an injection of hormones that provides a longer-acting alternative to the pill. It works by slowly
releasing the hormone progesterone into the body to stop ovulation. Each injection lasts for 8-12
weeks. Injections may reduce heavy or painful periods and may give some protection against
cancer of the uterus.
- Advantages: unlike the pill, don’t need to remember to take a tablet every day.
- Periods can become irregular or stop altogether. It can take over a year for fertility to return to
normal after stopping contraceptive injections, so if patient is planning to start a family in the near
future, it may not suitable.
- Effectiveness: 99%
- E.g. . DEPO (5 cc. or 3 cc for some mother)

Contraceptive implant
 - It’s small stick containing the hormone progesterone which is inserted under the skin in the arm.
The hormone is slowly released into the body, preventing eggs from being released from the
ovaries, sperm from reaching an egg or an egg settling in the womb.
- Advantages: implants are a good method for women who want a long-term contraceptive, as
each implant lasts for three years.
- Periods can become irregular or stop altogether
- Effectiveness: 99%

Side effects of Hormonal family planning methods

● Nausea
● Weight gain
● Headache
● Breast tenderness
● Breakthrough bleeding
● Vaginal infections
● Mild hypertension
● Depression

Absolute Contraindication of Hormonal family planning methods.

● Breast feeding
● Family history of CVA or CAD
● History of thromboembolic disease
● History of liver disease
● Undiagnosed vaginal bleeding

Possible Contraindications of Hormonal family planning methods

- Age > 40 years
- Breast or reproductive tract malignancy
- Diabetes mellitus (DM)
- Elevated cholesterol and triglyceride
- High blood pressure
- Mental depression
- Migraine and other types of vascular headache
- Obesity
- Pregnancy
- Seizure disorders
- Sickle cell and or other hemoglobinopathies
- Smoking
- Use of medication or drug with drug interaction effect

Surgical family planning methods (STERILIZATION)

- Vasectomy (Male)
- Tubal ligation (Female)
 - Minilaparotomy
- Laparoscopy
- Essure

Male sterilization
- Vasectomy - division or occlusion of the vas deferens prevents the passage of sperms.
- Methods:
1. Clips
2. Diathermy
3. Percutaneous injection of sclerosing agents or occlusive substances.
- The success of the procedure is verified by the absence of sperms from two consecutive samples of
ejaculate collected at least 4 weeks apart.
- Contraception must be continued until confirmation of two negative semen results has been
achieved and this is achieved after 16-18 weeks of performing the vasectomy

Female sterilization
- Female sterilization is done surgically by blocking both fallopian tubes by three ways:
1. Laparotomy
2. Minilaparotomy
3. Laparoscopy
- Laparotomy : Bilateral salpingectomy or hysterectomy may be preferable when there is a
coexistent pathology while the other two ways are more preferable, safe and effective.
- A number of chemical agents have been tested for their ability to occlude the fallopian tube when
installed into the tube either directly or transcervically via the uterus. Inflammation and fibrosis
result and occlude the tubes. However, safety of quinacrine sterilization has not yet been
determined so surgical method is safer.
- Method of tubal occlusions:
- Ligation by absorbable or non-absorbable sutures the ends left free or buried in the
broad ligament or uterine cornue.
- Electrocautery: Bipolar diathermy allows only the tissue held between the jaws of the
forceps to be cauterized.
- Falope ring: Ring of silicone or rubber is placed over a loop of the tube with a specially
designed applicator. This destroys 2-3 cm of tube.
- Clips: A variety of clips are available to lukla-clemens clip (stainless steel and
polycarbonate and filshie clip) (titanium lined with silicon rubber). Smaller length of the
tube is destroyed via this method.
- Laser: CO2 laser divides tube very cleanly but may allow a high incidence of
recanalization.
SCALE FOR RANKING FAMILY HEALTH PROBLEMS ACCDG TO PRIORITIES

Criteria Weight

1. Nature of the Problem 1

Health Deficit 3

Health Threat 2

Foreseeable Crisis 1

2. Modifiability of the Problem 2

Easily Modifiable 2

Partially modifiable 1

Low 0

3. Preventive Potential 1

High 3
 Moderate 2

Low 1

4. Salience 1

Serious px, imm. Attn 2

Px, not needing imm. Attn 1

Not a felt need 0

Scoring
1. Decide on a score for each of the criteria.
2. Divide the score by the highest possible score and multiply by the weight.
Score
X Weight
Highest Score
3. Sum up the scores for all the criteria. The highest score is 5, equivalent to the total weight.
4. The higher the score (near 5 and above) of a given problem, the more likely it is taken as a
PRIORITY.
5. With the available scores, the nurse then RANKS health problems accordingly.

SAMPLE
Examples of computation
1. Intestinal infestation/parasitism (PRIORITY)
Criteria
 1. Nature of the problem 3/3 x 1 1
Health Deficit

2. Modifiability of the problem 1/2x2 1

Partially modifiable

3. Preventive Potential 2/3x1 0.67

Moderate

4. Salience 2 /2 x 1
A serious problem, immediate 1
attention

TOTAL 3.67

2. Inadequate nutrition

Criteria

1. Nature of the problem 2/3 x 1 0.67

Health threat

2. Modifiability of the problem 1/2x2 1

Partially modifiable

3. Preventive Potential 1/3x1 0.33

Low

4. Salience 2 /2 x 1
A serious problem, immediate 1
attention

TOTAL 3
 3. Poor environmental sanitation
Criteria

1. Nature of the problem 2/3 x 1 0.67

Health threat

2. Modifiability of the problem 1/2x2 1

Partially modifiable

3. Preventive Potential 1/3x1

Low 0.33

4. Salience 1/2x1
A problem but not needing 0.5
immediate attention

TOTAL 2.5

BAG TECHNIQUE

- A tool making use of public health bag through which the nurse during his/her
home visit can perform nursing interventions/procedures with ease, saving time
and effort with the end view of rendering effective nursing care.

- The nurses' health bag is the vehicle for carrying the tools needed during a home
visit
- The public health nurse bag is designed in carrying the equipment and materials
needed during a visit to the home, school, and factory. Equipment and
medications, urine testing and to demonstrate 4 patient care.
- The bag can be carried by the hand or on the shoulder.

IMPORTANCE OF BAG TECHNIQUE

1. The public health bag is needed during home, school. or industrial visit. The bag is
needed to keep everything inside that are needed to do the procedures in the home.
2. Demonstration of nursing care required essential materials ready for use which are
carried in the bag.
3. Cleanliness: The bag and its contents are all designed for efficiency and
cleanliness.
4. Placing the articles to proper place.

PRINCIPLES:
1. Cleanliness: The bag and its contents are all designed for efficiency and
cleanliness
2. The hand must be washed with soap and water each time before touching the bag.
The nurse must avoid touching dirty or contaminated things after or in between
time of washing.
3. The bag should be kept in clean and without danger of being contaminated and the
children or pet animals.
4. Place the bag over the newspaper or plastic to protect the bog getting dirty and
contaminated. Limit the opening of bag to most of 3 times to prevent
contamination of the contents.
5. Clean or boil the articles after use and replace it safely.
6. Avoid unnecessary exposure while doing the procedure.
7. Secure the bag by often cleaning and should be covered properly when it is not in
use.
8. The use of the bag by technique should be minimized if not. totally prevent the
spread of infection from the individuals. to families; hence to the community.
9. Bag technique should serve time and effort on the part of the nurse in the
performance of nursing procedures.
10. Bag technique should not overshadow concern for the patient rather should show
the effectiveness of total care given to an individual or family.

BAG TECHNIQUE PROCEDURE:

1. Upon arrival at the patient’s home. Place the bag on the table lined with a clean
paper. The clean side must be out touching the table.

2. Ask for the basin of water or glass of drinking water if tap water is not available.

3. Open the bag and take out the towel and soap.

4. Wash hands using soap and water. Wipe to dry.

5. Take out the apron from the bag and put it on with the right side out.

6. Put out all necessary articles needed for the specific care.

7. Close the bag and put it in one corner of the working area.

8. Proceed in performing the necessary nursing care and treatment.

9. After giving the treatment, clean all things that were used and perform
handwashing.

10. Open the bag and return all things that were used in their proper places after
cleaning them.

11. Remove the apron, folding it away from the person, the soiled side in and clean
side out. Place it in the bag.

12. Fold the lining, place it inside the bag and close the bag.

13. Take the record and have a talk with the mother. Write down all the necessary data
that were gathered, observations, nursing care and treatment rendered. Give
instructions for care of patients in absence of the nurse.

14. Make appointment for the next (either home or clinic) taking note of date and
time.
 15. Take time to thank the family for the opportunity given.

First Level Assessment

I. Presence of Wellness Condition-stated as potential or Readiness-a clinical or nursing

judgment about a client in transition from a specific level of wellness or capability to a
higher level. Wellness potential is a nursing judgment on wellness state or condition
based on client’s performance, current competencies, or performance, clinical data or
explicit expression of desire to achieve a higher level of state or function in a specific
area on health promotion and maintenance.
Examples of this are the following:

A. Potential for Enhanced Capability for:

Healthy lifestyle-e.g. nutrition/diet, exercise/activity

Healthy maintenance/health management
Parenting
Breastfeeding
Spiritual well-being-process of client’s developing/unfolding of mystery through
harmonious interconnectedness that comes from inner strength/sacred source/God
(NANDA 2001)
Others. Specify.

B. Readiness for Enhanced Capability for:

Healthy lifestyle
Health maintenance/health management
Parenting
Breastfeeding
Spiritual well-being
Others. Specify.
II. Presence of Health Threats-conditions that are conducive to disease and accident, or
may result to failure to maintain wellness or realize health potential. Examples of this are
the following:

A. Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic

syndrome)

B. Threat of cross infection from communicable disease case

C. Family size beyond what family resources can adequately provide

D. Accident hazards specify.

Pointed /sharp objects, poisons and medicines improperly kept

Fire hazards
Fall hazards
Others specify.

E. Faulty/unhealthful nutritional/eating habits or feeding techniques/practices.

Specify.

Broken chairs
Inadequate food intake both in quality and quantity
Excessive intake of certain nutrients
Faulty eating habits
Ineffective breastfeeding
Faulty feeding techniques
F. Stress Provoking Factors. Specify.

Strained marital relationship

Strained parent-sibling relationship
Interpersonal conflicts between family members
Care-giving burden
G. Poor Home/Environmental Condition/Sanitation. Specify.

Inadequate living space

Lack of food storage facilities
Polluted water supply
Presence of breeding or resting sights of vectors of diseases
Improper garbage/refuse disposal
Unsanitary waste disposal
Improper drainage system
Poor lightning and ventilation
Noise pollution
Air pollution

H. Unsanitary Food Handling and Preparation

I. Unhealthy Lifestyle and Personal Habits/Practices. Specify.

Alcohol drinking
Cigarette/tobacco smoking
Walking barefooted or inadequate footwear
Eating raw meat or fish
Poor personal hygiene
Self medication/substance abuse
Sexual promiscuity
Engaging in dangerous sports
Inadequate rest or sleep
Lack of /inadequate exercise/physical activity
Lack of/relaxation activities
Non use of self-protection measures (e.g. non use of bed nets in malaria and filariasis
endemic areas).
J. Inherent Personal Characteristics-e.g. poor impulse control

K. Health History, which may Participate/Induce the Occurrence of Health Deficit,

e.g. previous history of difficult labor.

L. Inappropriate Role Assumption-

e.g. child assuming mother’s role, father not assuming his role.

M. Lack of Immunization/Inadequate Immunization Status Specially of Children

N. Family Disunity-e.g.
Self-oriented behavior of member(s)
Unresolved conflicts of member(s)
Intolerable disagreement
O. Others. Specify._________

III. Presence of health deficits-instances of failure in health maintenance.

Examples include:

A. Illness states, regardless of whether it is diagnosed or undiagnosed by a medical

practitioner.

B. Failure to thrive/develop according to normal rate

C. Disability-whether congenital or arising from illness; transient/temporary (e.g.

aphasia or temporary paralysis after a CVA) or permanent (e.g. leg amputation
secondary to diabetes, blindness from measles, lameness from polio)

IV. Presence of stress points/foreseeable crisis situations-anticipated periods of

unusual demand on the individual or family in terms of adjustment/family
resources. Examples of this include:

A. Marriage

B. Pregnancy, labor, puerperium

C. Parenthood

D. Additional member-e.g. newborn, lodger

E. Abortion

F. Entrance at school

G. Adolescence
H. Divorce or separation

I. Menopause

J. Loss of job

K. Hospitalization of a family member

L. Death of a member

M. Resettlement in a new community

N. Illegitimacy

O. Others, specify.___________

IN ADDITION LANG MAHALS, MAYBE IAPIL SA TEST TOM. DIKO KA INSERT

SA FORMS KAY DIJUD SIYA MAKLARO KAY SA PHONE RA GAGMAY
KAAYO