WORKSHOP

on
TEACHERS AS
HEALTH PARTNERS
APRIL 28-29, 2009
SAN JUAN, BATANGAS
 INTRODUCTION
• School health of school-aged children is
not only a responsibility of the health
professionals but as well as teachers.
 INTRODUCTION
• We need to understand that health and
education are closely intertwined”
– Blum et.al, 2003

• “Only when students are healthy will

schools be able to fully meet their goals”
- Health is academic,1998
 INTRODUCTION
• This may be an overwhelming task for
teachers BUT this is not the case.
• Partnership following a structured system
is the KEY.
• This workshop is the 1st step towards this
partnership.
 INTRODUCTION
• Role of teachers in health care:
1. Recognize problems related to health
of a student
2. Identify common illnesses that warrants

referral to a health care specialist

3. Help achieve the 7 goals of a school
health program
 7 Goals of a School Health
Program
• Assure access to primary care
• Provide a system for dealing with crisis medical
situations
• Provide mandated screening and immunization
monitoring
• Provide a system for identification and
solution of students’ health and emotional
problems
 7 Goals of a School Health
Program
1. Provide comprehensive and appropriate health
education
2. Provide a healthful and safe school
environment that facilitates learning
3. Provide a system of evaluation of the
effectiveness of the school health program
 GENERAL OBJECTIVE OF THE
WORKSHOP

• Provide a system for identification and solution

of students’ health problems
 SPECIFIC OBJECTIVES
• 1. To identify the component information
included in the DepEd circulated school
health record
• 2. To recognize the medical signs and
symptoms included in the school health
record
• 3. To formulate a referral system for
identified health problems of students
 EXPECTED OUTCOME
• Public school elementary teachers in San Juan,
Batangas who are included in the workshop
should have:

– 70% increase in knowledge in recognizing

abnormalities that warrants referral to a health care
provider
 EXPECTED OUTCOME
• Public school elementary teachers in San
Juan, Batangas who are included in the
workshop should have:

– Serve as front-liners in identifying

communicable and non-communicable
disease, thereby decreasing morbidity and
mortality in elementary school children
 FLOW CHART OF REFERRAL

NORMAL ACCOMPLISH FORM

TEACHERS
(SCREENING) NORMAL
ABNORMAL NURSE
ABNORMAL

Important:
If emergency or need immediate attention, DOCTOR
refer directly to a Doctor.
 MECHANICS OF THE WORKSHOP
• General Mechanics
> 200 participants will be divided into 8
groups (25 teachers/group)
> Each group will be assigned to one
Facilitator, who will be their mentor for the day.
> Each group will be given an adequately
ventilated and appropriately sized room.
 MECHANICS OF THE WORKSHOP
• General Mechanics
> A total of 3 hours will be given to each facilitator to
lecture the 5 modules, namely:

– Introduction to School Health Program

– Vital Signs and Antropometrics
– Skin/Scalp/Head (Eyes/Ears/Nose/Mouth/Throat)
– Chest/Abdomen/Spine/Extremities
– Filling up the School Health Record Form

> It is up to the facilitator to allot more time to

modules they think need more attention in their
group.
 MECHANICS OF THE WORKSHOP
• Part I: Introduction
• Part II: Module presentation
• Part III: Demo-Return Demo
- each group will be divided further into 4 subgroups.

- each subgroup will be assigned a child/student for them

to examine.

- each teacher will then fill up the school health record

form, which can be found in their kit, after applying what
they’ve learned.

- the facilitator, together with 2 interns, will check their

work and teach or correct them as necessary.
SCHEDULE OF ACTIVITIES
8:00 - 8:30 AM Registration
8:30 - 10:00 AM Lecture
10:00 -10:30 AM SNACKS
10:30 - 12:00 NN Lecture
12:00 - 1:00 PM Lunch
1:00 - 3:00 PM Demo-Return Demo
3:00 - 3:30 PM SNACKS
3:30 - 4:00 PM Awarding of Certificates/
Closing Remarks
VITAL SIGNS
What are Vital Signs?

• Vital signs are measurements of the body's most basic functions.

• Vital signs are indicators of one's overall health. They offer clues to
diseases and help evaluate progress toward recovery.
• The four main vital signs routinely monitored by medical
professionals and healthcare providers include:

* Body Temperature
* Pulse Rate
* Respiration Rate (rate of breathing)
* Blood Pressure

• Vital signs should be taken at rest.

• Any abnormal findings should be repeated in order to verify the
findings.
•Vital signs can be measured in a medical setting, at the site of a
medical emergency, at home, or even in school.
Temperature
TEMPERATURE
What is Body Temperature?

• The normal body temperature of a person

varies depending on:
• gender,
• recent activity,
• food and fluid consumption,
• time of day, and,
• in women, the stage of the menstrual
cycle.
• For example: body temperature is lower
in the morning than it is in late afternoon
and evening.

• Normal body temperature range

from 36.5ºC - 37.5ºC
• Acceptable range: 36.0ºC - 37.8ºC
• Body temperature is taken with a thermometer.
• The most common places to measure temperature include:
• the mouth (oral temperature),

• under the arm (axillary temperature),

• the anus (rectal temperature), and

• the ear (tympanic temperature).

Axillary method 
3. Axilla must be clean and free from
perspiration.

2. Place the thermometer horizontally in the

axilla.
Leave it for 2 minutes.

3. Check the temperature.

4. Replace the thermometer after cleaning.

REMINDERS:
• Should be immersed in antiseptic solution to prevent infection.
• Shake it before using it to bring the mercury down. 
• Never hold the thermometer at the bulb, because the hand
may cause inaccurate reading. 
HOW TO READ TEMPERATURE
 Try this!

Temperature Reading: 38.7ºC

 ABNORMAL
• An elevated
temperature is known as
a fever or hyperthermia,
and
• A low body temperature
is referred to as
hypothermia.
• Unless otherwise directed
by your own health care
provider, temperatures
greater than 38ºC and
lower than 36ºC need
immediate intervention;
PULSE RATE
 PULSE RATE
• Your pulse is the rate at which your heart
beats.
• Your pulse is usually called your heart
rate, which is the number of times your
heart beats each minute (bpm).
• Pulse rates vary from person to person.
• Your pulse is lower when you are at rest
and increases when you exercise (because
more oxygen-rich blood is needed by the
body when you exercise).
 PULSE RATE
• The pulse varies with age:
• For resting pulse rate:

* Newborn infants:
100 - 160 beats per minute
* Children 1 to 10 years:
70 - 120 beats per minute
* Children over 10 and adults
(including seniors):
60 - 100 beats per minute
* Well-trained athletes:
40 - 60 beats per minute
 RADIAL
PULSE
• Pulse is often taken at the wrist (radial pulse).
• The index and middle finger are used for this. You
should not use a thumb as the thumb has a pulse as
well and could give false readings.
• Press your index and middle finger into the groove
along the inside of the wrist.
• You may need to move your fingers up or down the
arm a few centimeters until you find the best spot to
feel the pulse.
• You may have to press a little harder if you don't feel
it. But don't press so hard that you obliterate the
pulse.
• Once you find the pulse in the wrist, using a watch or
clock with a second hand, begin counting the beats
 Heart / Pulse Rate
Abnormalities
TACHYCARDIA
• is a resting heart rate more than 100 beats per
minute.
• This number can vary as smaller people and
children have faster heart rates than average
adults.
 Heart / Pulse Rate
Abnormalities
BRADYCARDIA
• is defined as a heart rate less than 60 beats per
minute although it is seldom symptomatic until below
50 bpm when a human is at total rest.
• Trained athletes tend to have slow resting heart rates,
and resting bradycardia in athletes should not be
considered abnormal if the individual has no
symptoms associated with it.
• Again, this number can vary as smaller people and
children have faster heart rates than adults.
RESPIRATORY RATE
 RESPIRATORY RATE
• The respiration rate is the number of
breaths a person takes per minute.
• The rate is usually measured when a person
is at rest and simply involves counting the
number of breaths for one minute by
counting how many times the chest rises.
• Respiration rates may increase with fever,
illness, and with other medical conditions.
• When checking respiration, it is important
to also note whether a person has any
difficulty breathing.
 RESPIRATORY
RATE
• Average respiratory rates by age:
* Newborns: average 44 breaths per minute
* Infants: 20–40 breaths per minute
* Preschool children: 20–30 breaths per
minute
* Older children: 16–25 breaths per minute
* Adults: 12–20 breaths per minute
* Adults during strenuous exercise:
35–45 breaths per minute
* Athletes' peak: 60–70 breaths per
minute[6]
 RESPIRATORY RATE
Method on checking respiration:
• Student should be relaxed in a comfortable position.
• Since respiration can be controlled voluntarily to
some extent, as far as possible, the patient's
respiration may be counted without making him
aware of it. So after taking the pulse, count the
respiration rate keeping the fingers in the student’s
wrist.
• Count the rise and fall of chest wall for 60 seconds
(one minute) by using a watch.
• Also note the depth and regularity of respiration,
expansion of the chest on both sides and student’s
color. 
 RESPIRATORY RATE
• The aim is to determine if the respirations
are:
– normal
– abnormally fast (tachypnea)
• usually >30 cycles per minute in children at rest
– abnormally slow (bradypnea)
• <12 cycles per minute
– or nonexistent (apnea)
• Abnormal respiration 
– Dyspnea: difficult or painful breathing 
– Orthopnea: inability to breathe in a horizontal
position. It is relieved by sitting position. 
 HEIGHT
• Height is, like other phenotypic
traits, determined by a
combination of genetics and
environmental factors.
• Genetic potential plus nutrition
minus stressors is a basic formula.
• Humans grow fastest as infants
and toddlers (birth to roughly age
2) and then during the pubertal
growth spurt.
• A slower steady growth velocity
occurs throughout childhood
between these periods;
Measuring Height Accurately

1. Remove the child's shoes, bulky

clothing, and hair ornaments, and
unbraid hair that interferes with the
measurement.
2. Take the height measurement on
flooring that is not carpeted and
against a flat surface such as a wall
with no molding.
3. Have the child stand with feet flat,
together, and against the wall. Make
sure legs are straight, arms are at
sides, and shoulders are level.
4. Make sure the child is looking straight
ahead and that the line of sight is
parallel with the floor.
5. Take the measurement while the
child stands with head, shoulders,
buttocks, and heels touching the flat
Measuring Height
Accurately

6. Use a flat headpiece to form a right

angle with the wall and lower the
headpiece until it firmly touches
the crown of the head.
7. Make sure the measurer's eyes are
at the same level as the headpiece.
8. Lightly mark where the bottom of
the headpiece meets the wall.
Then, use a metal tape to measure
from the base on the floor to the
marked measurement on the wall
to get the height measurement.
9. Accurately record the height to the
nearest 1/8th inch or 0.1
centimeter.
• Most intra-population variance of height is genetic.
• Short and tall stature are usually not a health concern.
• If the degree of deviation from normal is significant,
confirmation that exceptional height is normal for a
respective person can be ascertained from comparing
stature of family members and analyzing growth
trends for abrupt changes, among others.
• There are, however, various diseases and disorders
that cause growth abnormalities.
• Most notably, extreme height may be pathological,
such as gigantism (very rare) resulting from childhood
hyperpituitarism, and dwarfism which has various
causes.
 WEIGHT

• Purpose: measuring body mass/weight

can be valuable for monitoring hydration
and nutritional level, or for monitoring
body fat or muscle mass changes.
• Equipment required: Scales, which
should be routinely calibrated for accuracy.
• Procedure: the person stands with
minimal movement and with hands by
their side. Shoes and excess clothing
should be removed. Body weight is
measured in kilograms mostly throughout
 Underweight
• is the most common
assessment of child nutrition
status.
• Weight for age (WFA) is a
simple index, but this index
does not take height into
account.
• Children who are taller would be
expected to weigh more than
other children, just as children
who are shorter would be
expected to weigh a little less
and still be healthy.
• is a measure of linear growth.
• refers to shortness, and reflects linear
growth achieved pre- and postnatal
• with its deficits it is generally assumed to
indicate long-term, cumulative effects of
inadequate nutrition and poor health status
• Height for age (HFA) is considered a
measure of past nutrition, because a child
who is short today, maybe did not have
adequate nutritional intake at some point in
• A measure of acute or short-term
exposure to a negative environment.
• It is sensitive to changes in calorie intake
or the effects of disease.
• Wasting can be calculated without
knowing the age of a child.
• Weight for height (WFH) is a measure of
current body mass.
– It is the best index to use to reflect wasting
malnutrition, when it is difficult to determine the exact
ages of the children being measured.
• are defined as abnormal or excessive fat
accumulation that presents a risk to health.
• A crude population measure of obesity is the
body mass index (BMI): a person’s weight (in
kilograms) divided by the square of his or her
height (in meters).
• A person with a BMI of 30 or more is generally
considered obese. A person with a BMI equal
to or more than 25 is considered overweight
 VISUAL ACUITY
• By history:
– “May panlalabo ba ng
mata?”
– “Saan mas gusto umupo? Sa
harap o sa likod?”
– “Sumasakit ba ang ulo o
mata pagkatapos
magbasa?”
– “Hindi makakita sa gabi?”
• Activity:
– Let the student read a
paragraph in a book.
– This way, the teacher not
only assess vision, but also
Hearing Evaluation
• By
History/Observation:
– “May problema ba sa
pandinig?”
– “Saan mas gusto
umupo? Sa harap o sa
likod?”
– “Kinakailangan bang
ilakas ang boses bago
maintindihan ang
sinasabi?”
 Hearing
impairment
• A hearing impairment is a full or
partial decrease in the ability to
detect or understand sounds.
• Caused by a wide range of biological
and environmental factors
• "Hearing impaired" is often used to
refer to those who have hearing
problems and those who are deaf.
SKIN
Normal
Skin
 Tinea
Flava
• is a superficial, chronic fungal infection
• Usually starts as small pale patches
• Appear on the chest, neck, or upper arms and sometimes
spreads to the abdomen, thighs, and back.
• Affected skin may become slightly scaly.
• The rash is usually pale, and is barely noticeable if you are
fair-skinned. (Sometimes the rash is darker than the skin in fair-
skinned people, and it looks like brown marks.)
• The pale patches are more obvious if you have dark skinned.
• Sometimes it is slightly itchy.
Tinea
Flava
Tinea Corporis / Ringworm
• is usually a mild fungal infection of the
skin that causes a red circular lesion with
central area of healing and a scaly border.
• affects persons of all age groups, but
prevalence is highest in preadolescents.
• Ringworm acquired from animals is more
common in children
Tinea Corporis / Ringworm
IMPETIGO
• a bacterial skin infection.
• often called "school sores" because it most often affects
children.
• It is quite contagious.
• presents with pustules and round, oozing patches which
grow larger day by day.
• there may be clear blisters (bullous impetigo) or golden
yellow crusts.
• It most often occurs on exposed areas such as the
hands and face, or in skin folds particularly the armpits.
Impetig Impetig Impetig
 Boils / Furunculosis
• A boil or a furuncle is a bacterial abscess or collection of
pus and dead tissues that starts in the hair follicles.

• Symptoms of boils include:

* Red, shiny, and swollen lump filled with pus
* Tenderness, the sensation of warmth and/or pain
* When the lump is ready to rupture, a pointy white or
yellow central area is noticed

• Boils can occur in any part of the body, however, they are
mostly found on the scalp, back, underarms, and buttocks.
 Boils /
Furunculosis
 Bruise / Hematoma

• A bruise is an area of skin discoloration.

• Occurs when small blood vessels break and leak their
contents into the soft tissue beneath the skin.
• Often caused by falls, sports injuries, car accidents, or
blows received by other people or objects.
• Begins as a pinkish red color that can be very tender to
touch and eventually, changes to a bluish color, then
greenish-yellow, and finally returns to the normal skin
color as it heals.
 Bruise /
Hematoma
 Cut / Incision and
Laceration
• Incisions or incised wounds or cuts
• caused by a clean, sharp-edged object such as a
knife, a razor or a glass splinter.

• Lacerations:
• irregular tear-like wounds caused by some blunt
trauma. The term laceration is commonly misused in
reference to incisions.
 Cut /
Laceratio
n
 Eczem
• a forma
of dermatitis,or inflammation of the epidermis.
• The term eczema is broadly applied to a range of persistent skin
conditions.
• These include dryness and recurring skin rashes which can be:
redness, skin edema (swelling), itching and dryness, crusting, flaking,
blistering, cracking, oozing, or bleeding.
• Factors that can cause eczema include other diseases, irritating
substances, allergies and your genetic makeup. Eczema is not
contagious.
• Eczema cannot be cured, but you can prevent some types of
eczema by avoiding irritants, stress and the things you are allergic to.
Eczem
ALLERGY
• Allergy is the term given to a reaction by a small number
of people to a substance (known as the allergen) which is
harmless to those who are not allergic to it.

• Contact allergy occurs predominantly from the allergen

on the skin rather than from internal sources or food.

• The dermatitis is generally confined to the site of contact

with the allergen.

•The affected skin may be red, swollen and blistered or dry

and bumpy.
Allergic Contact
Dermatitis Dermatitis
Important Note:
• REFER if ABNORMAL
• Only your doctor can diagnose the various
skin lesions mentioned.
• The features described above can appear in
many types.
• Diagnosis is based on a combination of the
patient's recent medical history and family
history, in addition to a physical
examination.
Pediculosis
• Refers to lice infestation of the human head.

• Most frequent on children aged 3-10.

• Females get head lice more often than males.

• Head lice are spread through direct head-to-head contact

with an infested person.

• Lice feed on blood once or more often each day by piercing

the skin with their tiny needle-like mouthparts. Lice cannot
burrow into the skin.
Pediculosis
 SQUINTING

• a condition in which the eyes are not properly

aligned with each other.

• It typically involves a lack of coordination between

the eye muscles that prevents bringing the gaze of
each eye to the same point in space and preventing
proper binocular vision
SQUINTING
 Normal conjunctiva. Pale conjunctiva.
Note the full reddness of the anterior Note that the color of the pale
rim and its dissimilarity to the anterior rim and the posterior part of
posterior aspect of the conjunctiva. the conjunctiva are the same.
Normal EAR
 Ear Discharge
• Ear discharge is drainage of blood, ear wax, pus, or fluid
from the ear.

• Most of the time, any fluid leaking out of an ear is ear wax.

• However, discharge may also be caused by a minor

irritation or infection.

• A ruptured eardrum can cause a white, slightly bloody, or

yellow discharge from the ear.

• Bleeding from the ear may also be due to:

* Cancer
* Foreign object in the ear canal
* Injury
Ear Discharge
Normal NOSE
 Nasal Discharge
• Any mucus-like material that comes out of the nose

• Drainage from swollen or infected sinuses may be thick or

discolored.

• Excess mucus may run down the back of your throat (postnasal
drip) or cause a cough that is usually worse at night.

• A sore throat may also result from too much mucus drainage.

• The mucus drainage may plug up the eustachian tube between the
nose and the ear, causing an ear infection and pain.

• The mucus drip may also plug the sinus passages, causing sinus
infection and pain.
Nasal Discharge
Septal Deviation
• Nasal septum deviation is a common physical disorder of
the nose, involving a displacement of the nasal septum.

• The septum that separates the two sides of the nose is

usually straight. If the septum is not straight but shifted to
one side it is known as a deviated septum.

• A deviation in the septum of the nose can cause narrowing

of the nasal passage, lessening the amount of secretions
that can drain, sometimes leading to sinus infections.

• It is most frequently caused by impact trauma, such as by a

blow to the face.
Septal Deviation
Mouth
NORMAL
 Fever Blisters / Cold sores
• Definition
– is the name for the appearance
of an open sore in the
epithelium on the lips or
surrounding the mouth.
Fever Blisters / Cold sores
Oral Ulcers / Aphtous Ulcers
• Definition
– is the name for the appearance
of an open sore inside the
mouth caused by a break in the
mucous membranes or the
epithelium on the lips or
surrounding the mouth.
Oral Ulcers
Throat
Normal
 Tonsillar Hypertrophy
• Definition
– The tonsils are small pieces of tissue in
the back of the throat, on the right and
left side
– They produce antibodies against
infection. 
– Frequently, the tonsils enlarge in
response to infection in and about the
throat area. 
– When they enlarge, this is called
tonsillar hypertrophy.
Enlarged Tonsils
without exudates
Enlarged Tonsils with
Exudates
Enlarged Tonsils with
Exudates
 Pharyngitis/Inflammed
• Definition Pharynx
– is an inflammation of the throat or
pharynx.
– is often referred to as a sore throat. It
can result in very large tonsils which
cause trouble swallowing and breathing.
– Some are accompanied by a cough or
fever.
– Most cases are caused by
• Viral infection (40%-60%)
• Bacterial infections,
• Fungal infections, or
Inflammed Pharynx
Infammed Pharynx
Chest
Normal
 Pectus Excavatum
• Definition
– is the most common congenital
deformity of the anterior wall of the
chest
– several ribs and the sternum grow
abnormally.
– a caved-in or sunken appearance of the
chest.
– present at birth and progresses during
the time of rapid bone growth in the
early teenage years.
Pectus Excavatum
 Pectus Carinatum
• Definition
– also called pigeon chest, is a deformity
of the chest characterized by a
protrusion of the sternum and ribs.
Pectus Carinatum
Abdomen
Normal
 Scaphoid Abdomen

• Definition
– A condition in which the
anterior abdominal wall is
sunken, having a concave
rather than a convex contour.
Scaphoid Abdomen
Distended Abdomen
or “Malaking Tiyan”
Spin
e
Normal
 Scoliosis
• Definition
– is a medical condition in which a
person's spine is curved from side to
side, shaped like "s", and may also be
rotated. To adults it can be very painful.
It is an abnormal lateral curvature of the
spine
Scoliosis
Scoliosis
 Kyphosis
• Definition
– also called "hunch back" or
"hunchbackism" or "hunchbackedness",
in general terms, is a common condition
of a curvature of the upper (thoracic)
spine.

– “K” for “Kuba”

Kyphosis
 Lordosis
• Definition

– is a medical term used to describe an

inward curvature of a portion of the
vertebral column.

– “L” for “Liyad”

Lordosis
Extremities
Normal
 Genu Varus/Bowlegs
• (also called bow-leggedness or
bandiness), is a deformity marked
by medial angualtion of the leg in
relation to the thigh, an outward
bowing of the legs, giving the
appearance of a bow.
Genu Varus/Bowlegs
Genu Valgum/Knock-knees
• Definition
– Commonly called "knock-
knees", is a condition where
the knees angle in and touch
one another when the legs are
straightened.
Genu Valgum/Knock-knees
Feet
Normal
 Pes Planus/Flatfeet
• Definition
– also called pes planus or fallen
arches, is an informal reference to a
medical condition in which the arch of
the foot collapses, with the entire sole of
the foot coming into complete or near-
complete contact with the ground.
Flatfoot
 Talipes
Equinovarus/Clubfoot
• Definition
– The common ("classic") form of clubfoot.
Talipes is made up of the Latin talus
(ankle) + pes (foot). Equino- indicates
the heel is elevated (like a horse's) and
-varus indicates it is turned inward. With
this type of clubfoot, the foot is turned
in sharply and the person seems to be
walking on their ankle.
 Talipes
Equinovarus/Clubfoot