Family Case Analysis

Angeles University Foundation Angeles City College of Nursing

In partial fulfillment of the requirements in Related Learning Experience

“Family Case Analysis”

Submitted to: Ms. Kristine Joy Villarosa R.N.

Submitted by: Ano, Carl Elexer C Group Leader BSN III-7

I. Introduction “The family is the nucleus of civilization.” -Ariel and Will Durant: Wisdomquotes.com

The family is smallest unit of the society and the natural fundamental core of the community and consequently, it is considered as the primordial recipient of the nursing effort, which is contributory to the development, and progress of the community through active involvement and self – responsibilities of each constituent. It is composed of Father, Mother and children and it is being molded to be as one, working hand in hand to maintain a good atmosphere among the family members. On the other hand, a nucleus controls the functions of the entire cell and can be thought as the “command center” of the cell. The nucleus as well has different components which are all needed in order for it and the cell to function well. The impression or status of each family will always affect the status of the community as a whole. Community health nursing is a response to the health needs of the people. It does not focus on a particular class or family. It is comprehensive and general in approach. Community health service is not episodic as it requires continuous observation and monitoring of the community as a whole. Promotion and preservation of the health of its different clients (individual, family, group or community) is the primary goal of community health nursing. It is just to say that community health nursing has a big role in nursing education. It is in the community where the student nurse learns nursing apart from the hospital setting as she was exposed to different level of orientation. It is in the community where the saying “nursing is an art” can be applied as student nurse tries to give quality service using the available resources in the health center.

The community is a group of people sharing geographic boundaries and/or values and interests. (Maglaya, 2004) No two communities are alike. A nurse exposed in the community learns how to interact and adapt to different kinds of people. The family is considered as the basic unit of care in the community health nursing. It is in the family where a member develops his health values, beliefs and practices. The family is a major influence in the health behaviors of an individual. With this, it is important that families in a community are aware of the things and practices pertaining to their health. ` Family Case Analysis (FCA) is a means by which student nurse reaches and feel the community through its basic structure – the family. It is a tool in determining the health status of a family through assessment and critical inspection. Through this, health related problems are identified, thus giving the student nurse a hint on where to act and how to intervene. It is also a means towards improving the health of the community people, making them more productive. To come up with a FCA gives a sense of fulfillment to student nurse as she was given the opportunity to share their skills, knowledge and time to alleviate and uplift the living condition of a family.

The family that was assigned to the nurses is a picture of the majority of the family here in our country. Imagine you living in a poor environmental condition without enough resources and experiencing lack of knowledge including health information and other socio-economic related problems. In behalf of the students accomplishing this, though it is tiring, this makes them feel the sense of fulfillment as they share their knowledge, skill and time to take action to uplift the condition of the family.

A. Objective a. Short Term  Student Nurse Centered After 2 days of home visits, the student nurses will be able to: •

Familiarize ourselves with the community and its people.

•

Established rapport and be familiar with the family members.

•

Introduce the students to the adopted family.

•

Explain the purpose of conducting home visits.

•

Assess the house and the sanitary condition of their environment.

•

Understand the means of living of the chosen family.

•

Assess the health condition of each member of the family.

•

To give advice concerning the health of the family.

 Client Centered After 2 days of home visits, the adopted family shall be able to: •

Have trust and confidence to the student nurse.

•

Cooperate with the student nurse.

•

Tell the student nurse whether he or she understands the instruction given.

•

Acquire knowledge from the health teaching given and know the importance on having a good health.

b. Long Term  Student Centered After 4 days home visits, the Student nurses shall be able to: •

Impart knowledge to the family to make them self reliant.

•

Educated the family regarding the importance of proper hygiene.

•

Guide the family in identifying actual and potential problems which may be a hindrance in attaining optimum health.

•

Generate interventions considering the nurses, community and the family’s resources.

•

Enhance their ability to interact and communicate with people as learning from the exposure to the community.

•

Evaluate changes in condition after giving interventions.

 Client Centered After 4 days of home visits, the family shall be able to: •

Apply some of the health teaching that the student nurse had imparted.

•

Become self reliant especially when it comes to health matters.

•

Attain a level of proper hygiene.

•

Maximize the use of resources as needed.

•

Identify health problems that can be a threat in attaining optimum health.

B. Entry, Climate of acceptance, First few words, Number of home visit The student nurses were assigned at San Jose, Angeles City. On the first day of the community exposure, July 14, 2008 Monday, the student nurses had a tour and familiarize their selves around the community and went to the Barangay Health Center later on under the supervision of their clinical instructor. July 15, 2008, a rainy Tuesday morning, the student nurses were tasked to look for the appropriate family that will qualify under their study. They must be near poverty level, with existing health problems or threats, and families who are in need of assistance and health teachings.

Fortunately, they were able to find a family that is accommodating, responsive, and of course accepted to be the subject of their study, the Chocolate Family. First Home Visit (July 15, 2008, Tuesday) On their first home visit, it was a rainy afternoon then; Mrs. Kisses was sleeping with ChocoBaby while Snickers and Kitkat were found playing outside their house in front of their Lola Tootsie Roll’s store. Mrs. Kisses was awakened by Kitkat because of the arrival of the student nurses. They warmly welcomed the student nurses inside their house. After settling down at Chocolate’s Residence, the student nurses briefly introduced their selves and explained to the family their purpose and said, “Ate pwede dakayu po bang ainterview? Para ya keng Family Case Analysis mi kailangan ya keng skwela ita.” Mrs. Kisses then replied, “Wa sige ok muh, para nokarin ya wari yan?” The student nurses further introduced themselves to the family. They explained thoroughly the purpose of their study. Unfortunately, they only met Mrs. Kisses, Kitkat, the eldest child, and Snickers, the second eldest. ChocoBaby Ruth, the youngest was still sleeping that time while the other members of the family are not around. Lola Tootsie Roll stays in her sari-sari store outside most of the time, as well as Mr. Ferrero who works as a tricycle driver the whole day. Brother Crunch, sibling of Mrs. Kisses, and Uncle Butterfinger, sibling of Lola Tootsie Roll were not present that time. They left the house before the arrival of Student Nurses said Mrs. Kisses because they shy to be interviewed. Anyway, the student nurses were able to establish rapport with the present family members and were able to interview the mother regarding their socioeconomic status, environmental sanitation and the like. They were able to acquire some information and even exchanged light-hearted conversations with Mrs. Kisses. The vital signs of the present members were also assessed and

recorded. After an hour or two, the student nurses bid the Chocolate Family goodbye and told them that they will be back the next day. Second Home Visit (July 16, 2008, Wednesday) The groups arrived on their respective families on a rainy afternoon, at around 2:00 pm. Mrs. Kisses gladly welcomed the student nurses and offered them chairs to sit on. The group assessed the kids, Kisses and Snickers followed by their mother, Mrs. Kisses. ChocoBaby that time was asleep but still the student nurses were able to assess her vital signs. On that day, the group had only completely assessed the mother and the two kids. Unfortunately, the other members of the family were not around again due to the same reason. Mr. Ferrero and Lola Tootsie Roll are both busy with their job while Uncle Butterfinger and Brother Crunch left the house before the arrival of the student nurses. The group was able to explain thoroughly how they can help the family regarding their present condition, in terms of proper hygiene, their home sanitation, and the presence of health problems like malnutrition that may hinder them from attaining optimum level of wellness. The group was also able to gain the mother’s trust and her children’s. After assessing, the group bid the family farewell. Third Home Visit (July 21, 2008, Monday) The following visit was a sunny morning. The group decided to go to their assigned family during morning for them to assess ChocoBaby, the youngest child of Mr. and Mrs. Chocolate, because she usually sleeps every afternoon said Mrs. Kisses. That day, the only members that the student nurses met were Mrs. Kisses and ChocoBaby. Kitkat and Snickers at that time were at school. The group finished assessing ChocoBaby and further interviewed Mrs. Kisses regarding their health, like the children’s immunization and nutrition status, her obstetrical history and their history of past and present illness. It is on this day too that they discussed about the potential and actual problems of the family. Some

of these problems are the presence of accident hazards in their house, malnutrition, faulty eating habits, etc. After the assessment, the group bid goodbye to Mrs. Kisses and ChocoBaby.

Fourth Home Visit (July 22, 2008, Tuesday) The group visited the Chocolate Family about 11:00 am. It was a hot morning then. When they arrived at the Chocolate’s Residence, it was brownout so Mrs. Kisses requested the group to be back after lunch. The student nurses returned around 2:30 pm as requested by Mrs. Kisses. Kitkat was seen playing outside while Snickers and ChocoBaby were sleeping. They were awakened after few minutes by their sister Kitkat. Mrs. Kisses bid the group and the kids goodbye because she needs to deliver the “merienda” ordered by their customers and promised to be back after few minutes. The group started to assess the kids at the same time the group started some of their implementations regarding the problems noted. The group trimmed the children’s long fingernails and asks them to wash their hands properly to remove the dirt. They also told the children to wear slippers every time the go out of the house. We told Mrs. Kisses to assure the cleanliness of Choco Baby’s pacifier before giving it to her and not to allow her to use it after it fell on the floor. The family’s and the group’s relationship by now is very much established. They are both comfortable with each other now and the student nurses are at ease in doing their assessment and interview. .

Fifth Home Visit (July 29, 2008, Tuesday) This time, the student nurses arrived at the house of the Chocolate Family around 1:45 pm. The weather that time is unpredictable because there are episodes of rainy and hot weather that day. Upon the arrival of the group, all of the family members present are sleeping. They were just awakened by their neighboring relatives. That day, the student nurses continued the final assessment. They also continued their nursing interventions and implementations. The implementations done were focused on the sanitation of the house and regarding the hygiene of the kids.

Health teachings were given also for the family to understand the

group’s interventions. The group told the family again about how essential hygiene is in attaining an optimum level of health, the advantages of having a good environmental sanitation and how rodents and insects can affect their health. Sixth Home Visit (July 30, 2008, Wednesday) This home visit is the last and final one that was conducted. The student nurses are just finalizing every data that they have obtained starting from their initial home visit until the very last. They are making sure that they have the complete data and information needed. The group also reminded the family about the health teachings that they told them during the recent home visits. The group also told the family about the potential and actual problems that had been identified by the student nurses and how to control and avoid them. The family’s response upon the student nurses is very good and they show much appreciation towards the student nurses which made the group feel good.

Until the last day of home visit, the group did not have the chance to meet and assess Mr. Ferrero, Lola Tootsie Roll, Uncle Butterfinger and Brother Crunch. The group thanked the Chocolate Family for allowing them to conduct their study.

II. Family Constellation Name

Age

Ordinal position

Sex

Educational Status

Present Health Status

Mr. Ferrero Chocolate

34 y/o

Father

M

Not going to Mr. Ferrero was not school: assessed by the College group because he is working the whole day.

Mrs. Kisses Chocolate

30 y/o

Mother

F

Not going to Mrs. Kisses has a school: thick, long, black hair Grade which is tied up. school She was wearing white sleeveless top and floral shorts with no sleepers on. She was conscious then but a bit sleepy. Her fingernails were untrimmed and dirty. A palpable mass on her right cheek was noted. She also has pallor paplebral conjunctiva. Her teeth are yellowish in color with presence of tartar and plaque. 2 teeth are extracted on lower teeth and minimal dental caries on molars and pre molars. 2 extracted teeth, 1 excess tooth, and dental caries on molars on the upper teeth. Stretch marks were noted on left and right lower quadrant on her

abdomen. Her toenails were untrimmed and dirty. There are also scars present on her both lower extremities. Stretch marks were noted both on her hips. Her vital signs are as follows: T- 36.6 °C PR- 76 bpm RR- 24 cpm BP- 90/70

Kitkat Chocolate

9 y/o

Eldest daughter

F

Going school: Grade 4

BMI = 20.97 (Normal) to Kitkat was wearing green shirt and shorts with slippers on. She was conscious, coherent and awake. Her shirt is dirty as well as her hands and feet. She was sweaty also because she was playing outside. She has a short, thick and frizzy hair with pediculosis noted. She has untrimmed and dirty fingernails and with presence of scars on both her upper extremities. Her palpebral conjunctiva on her right eye is reddish in color. She complains that she is experiencing pricking

pain on her right eye and it was red. It was noted during the third home visit of the student nurses and it started during weekends. With yellowish color of teeth and with presence of plaque, tartar and cavities. With untrimmed and dirty toenails and noted scars on lower extremities and dry skin. Her vital signs are as follows: T- 36.9 °C PR- 80 bpm RR- 23 cpm BMI=17.59 (Underweight) Snickers Chocolate

7 y/o

Eldest son (2nd child)

M

Going school: Grade 1

to Snickers was seen playing outside the house with his elder sister, cousin and some playmates before the initial assessment and was catching dragon fly. He was wearing gray shirt and red shorts with no slippers on. His shirt, shorts, as well as his arms and feet are dirty. He also has dirty and untrimmed finger nails. He was

conscious, coherent and awake during the first visit. His hair was short, frizzy and there were some lice noted. He has a pallor palpebral conjunctiva and with presence of tartar, plaque cavities on molars on upper teeth and 1 tooth is extracted on both upper and lower teeth due to cavities. He has dirty and untrimmed toenails. He also has scars on both lower extremities. His vital signs are as follows:

ChocoBaby Chocolate

27 mos

Youngest daughter

F

T- 36.9 °C PR- 72 bpm RR- 21 cpm Never been During the initial visit, to school icy was in the room, sleeping. She was wearing white sando and yellow shorts. She has dirty and untrimmed fingernails, with lesion noted above her left eyebrow. She has dry skin and allergies on the left fore arm and above the left knee which appears to be fresh, palpable and reddish in color. It was noted during the initial assessment and

started during weekends, Saturday prior to the home visits of the student nurses according to Mrs. Kisses and managed it with Calamine lotion. Her toenails are untrimmed and dirty and with dirty soles of feet. She also has scars on both lower extremities. Her vital signs are as follows: T- 36.7°C PR- 72 bpm RR- 23 cpm FNRI= 12 kg normal (9.9-15.6 kg) Lola Tootsie Roll

50

Grandmother

F

Uncle Butterfinger

31

Uncle

M

Brother Crunch

34

Brother

M

Not going to Lola Tootsie Roll school: wasn’t able to be Highschool assessed by the group because she is working the whole day. Not going to Uncle Butterfinger school: wasn’t able to be Highschool assessed because he wasn’t around during the home visits. Not going to Brother Crunch school: wasn’t able to be Highschool assessed because he wasn’t around during the home visits.

III. HEALTH ASSESSMENT (IPPA-CEPHALOCAUDAL) MR. FERRERO CHOCOLATE The student nurses were not able to assess Mr. Ferrero because he is working the whole day starting from 6:00 am to 10:00 pm. The group didn’t even saw him throughout their home visit. MRS. KISSES CHOCOLATE INITIAL ASSESSMENT General Appearance Mrs. Kisses is 30 y/o. She has a thick, long, black hair which is neatly tied up. She was wearing white sleeveless top and floral shorts with no sleepers on. She was conscious during the assessment. Her fingernails and toenails were untrimmed and a dirty. She stands 163 cm and weighs 56 kg. Mrs. Kisses has dark complexion and normal gait. Mrs. Kisses’ vital signs were taken and recorder as follow: Temp: 36.6° C RR: 24 cycles/min. PR: 76 breaths/min. BP : 90/70 mmHg Physical Assessment  HEAD ⇒ Hair and Scalp: evenly distributed, long, thick, black hair, no presence of pediculosis ⇒ Skull and Face: symmetrical, smooth uniform consistency, symmetrical facial features, palpebral fissures equal in size, symmetrical facial movements, palpable mass noted on her right cheek

⇒ Eyes and Vision ⇒ External Eye Structures •

Eyebrows: hair evenly distributed, thin eyebrows

and are

symmetrically aligned, equal movement •

Eyelashes: equally distributed and slightly curled outward

•

Eyelids: skin intact with no discharge noted, lids close symmetrically, bilaterally blinking

•

Bulbar Conjunctiva: transparent, sclera appears white and pinkish bulbar conjunctiva

•

Palpebral Conjunctiva: shiny, smooth. Pallor noted.

•

Lacrimal Sac and Nasolacrimal Duct: no edema or tearing

•

Cornea: transparent, shiny and smooth, details of iris are visible

•

Corneal Sensitivity: client blinks when the cornea is touched on its side by a wisp of cotton which indicates that cranial nerve no. 5 (trigeminal nerve) is intact

•

Pupils: black in color, PERRLA (pupils equally round respond to light accommodation) when a penlight pass through at about 6 inches far the pupils constrict upon illumination, smooth border, iris flat and round, pupils converge when near object is move towards the nose

•

Visual Fields: the client has a normal visual field as evidence by the ability to see object in the periphery even when looking straight ahead which was done by asking the person to close one eye then a pen or the index finger in the periphery and ask if the person can see it without moving his head on the side direction.

•

Visual Acuity: able to read a newspaper 14 inches away with an unaided eye

⇒ Ears and Hearing •

Auricles: the color of the auricle skin which is dark brown is same as the facial skin, they are symmetrical, aligned with the outer canthus of the eye, it is firm not tender, pinna recoils after it is folded

•

External Ear Canal and Tympanic Membrane: with dry cerumen

•

Gross Hearing Acuity: normal voice tones audible

•

Watch Tick Test: able to hear on the tick of the watch in both ears with a distance of 3 cm.

⇒ Nose and Sinuses •

Nose: symmetric, straight, no discharge or flaring noted; uniform in color; not tender and without lesions, air moves freely when she breaths through the nares, which was done by asking the person to occlude one of the nares then check for airway patency on the unoccluded nares (done alternately), the mucosa is pink, nasal septum intact in midline

•

Facial Sinuses: not tender

⇒ Mouth and Oropharynx •

Mouth:

•

Lip and Buccal Mucosa: uniform pink color soft, moist, smooth texture, ability to purse lips

•

Teeth and Gums: yellowish color of teeth, with presence of tartar and plaque noted, cavities are also present; 12 lower teeth, where in 2 are extracted, minimal dental carries on pre molars and molars; 14 upper teeth, where in there is 2 extracted teeth, 1 excess tooth, and dental carries on molars

•

Tongue and Floor of Mouth: in central position, pink in color, moist with thin whitish coating, smooth lateral margins, no

lesions upon observation, raised papillae, tongue moves freely with no tenderness by asking the person to move her tongue in different direction, smooth floor of the mouth •

Salivary Glands: same as the color of the buccal mucosa and the floor of the mouth

•

Palates and Uvula: light pink smooth soft palate, lighter pink hard palate with irregular texture, the uvula is on the midline of the soft palate

•

Oropharynx and Tonsils: pink and smooth posterior wall of oropharynx , pink tonsils without discharge

 NECK ⇒ Neck Muscles: muscles equal in size, head movement are coordinated and smooth with no discomfort able to flex 45 degrees hyper extend at 60 degrees; head laterally flexes at 40 degrees and laterally rotates at 70 degrees, muscles strength are equal by turning the head to one side and shrugging the shoulder against the resistance of hands of the student nurse which was done by asking the person to resist the pressure of the hands of the student nurse by shrugging her shoulders ⇒ Lymph Nodes ( posterior and below the jaw): not palpable ⇒ Trachea: central placement of the midline of neck by palpation or by asking the person to swallow ⇒ Thyroid Gland: it is symmetrical and masses are not visible, absence of bruit ⇒ Neck Veins: not distended (ask the person to turn his head side to side then check for the neck veins if distended or bloated)  UPPER EXTREMITIES

⇒ Skin and Nails: skin warm to touch, good skin turgor, nails are smooth, colorless, untrimmed and dirty, and in capillary refill result is normal because it returns to its usual color less than 4 seconds. ⇒ Muscle Strength and Tone: symmetrical muscle size, no contractures, no presence of tremor and it is normally firm smooth coordinated movements. ⇒ Brachial and Radial Pulse: palpable ⇒ Fine Motor Test: repeated and rhythmical touches the nose, can altenately supinate and pronate hands at rapid phase performs with coordination and rapidity to the finger nose and to the nurse finger  CHEST and BACK ⇒ Skin: evenly distributed skin color skin intact with uniform temperature ⇒ Chest Shape and Size: anterior-posterior to transverse diameter in ratio of 1:2 symmetrical in shape, spine is vertically aligned, chest wall intact ⇒ Lungs: full and symmetric chest expansion, quiet rhythmic and effortless respiration, full symmetric excursion with bronchial & tubular breathe sounds ⇒ Heart: no pulsation, symmetric pulse volume ⇒ Spinal Column: straight, right and left shoulders and hips are at the same height  ABDOMEN ⇒ Skin: unblemished skin, symmetric movements caused by respiration, stretch marks were noted on left and right lower quadrant ⇒ Abdominal Sounds: audible bowel sound, tympany over the stomach and gas filled bowels ⇒ Specific Organs: not palpable  LOWER EXTREMITIES ⇒ Skin and Toenails: uniform skin temperature, convex curve and colorless nail plates, presence of smooth nail texture, highly vascular

nail bed, stretch marks on left and right hips, untrimmed toenails and intact epidermis ⇒ Gait and Balance: was able to perform all the gait and balance without any discomfort Cranial Nerves Assessment Cranial Nerve

Assessment Technique

Normal Response

I. Olfactory

Ask the client to smell and identify the smell of cologne with each nostril separately and with the eyes closed.

Client is able to identify different smell with each nostril separately and with eyes closed unless such condition like colds is present.

II. Optic

Provide adequate lighting and ask client to read from a reading material held at a distance of 36 cm. (14 in.). Reaction to light: Using a penlight and approaching from the side, shine a light on the pupil. Observe the response of the illuminated pupil. Shine the light on the pupil again, and observe the response of the other pupil.

The client should be able to read with each eye and both eyes.

She was able to read with each eye and both eyes.

Illuminated and non-illuminated pupil should constrict.

The illuminated and nonilluminated pupil of Mrs. Kisses constricted.

Reaction to accommodation: Ask client to look at a near object and then at a distant object. Alternate the gaze from the near to the far object. Next, move an object towards the

Pupils constrict when looking at a near object, dilate when looking at a distant object, converge when near object is moved towards the

Her pupils constricted when asked to looked at a near object, dilated at a far object, and when an object is moved towards

III. Oculomotor

Client’s Response Mrs. Kisses was able to identify the different scents (coffee and alcohol) that she had smelled.

client’s nose. IV. Trochlear

V. Trigeminal

VI. Abducens

VII. Facial

VIII. Vestibulocochlear

Hold a penlight 1 ft. in front of the client’s eyes. Ask the client to follow the movements of the penlight with the eyes only. Move the penlight upward, downward, sideward and diagonally. While client looks upward, lightly touch lateral sclera of eye to elicit blink reflex. To test light sensation, have client close eyes, wipe a wisp of cotton over client’s forehead. To test deep sensation, use alternating blunt and sharp ends of an object. Determine sensation to warm and cold object by asking client to identify warmth and coldness. Hold a penlight 1 ft. in front of the client’s eyes. Ask the client to follow the movements of the penlight with the eyes only. Move the penlight through the six cardinal fields of gaze. Ask client to smile, raise the eyebrows, frown, puff out cheeks, close eyes tightly. Ask client to identify various tastes placed on tip and sides of tongue. Have the client occlude one ear. Out of the client’s sight, place a tickling watch 2 to 3 cm. ask what the client can

nose.

the nose, the iris converged. Client’s eyes should Both eyes are be able to follow the able to move as penlight as it necessary. moves.

Client should have a positive corneal reflex, able to respond to light and deep sensation and able to differentiate hot from cold.

Mrs. Kisses was able to elicit corneal reflex, sensitive to pain stimuli and distinguish hot from cold.

Both eyes Both eyes move coordinated, move in coordination. in unison with parallel alignment.

Client should be able to smile, raise eyebrows, puff out cheeks and close eyes without any difficulty. The client should also be able to distinguish different tastes. Client should be able to hear the tickling of the watch in both ears.

She performed various facial expressions without any difficulty and able to distinguish varied tastes (coffee, sugar, salt). Mrs. Kisses was able to hear tickling in both ears.

hear and repeat with the other ear. The client should Ask the client to walk have upright across the room and back posture and steady and assess the client’s gait and able to gait. maintain balance. IX. Glossopharyngeal Ask the client to say “ah” and have the patient yawn to observe upward movement of the soft palate. Elicit gag response. Note ability to swallow. X. Vagus Ask the patient to swallow and speak (note hoarseness) XI. Accessory

XII. Hypoglossal

She was able to stand and walk in an upright position and able to maintain balance.

Client should be able to elicit gag reflex and swallow without any difficulty.

She was able to elicit gag reflex and able to swallow without difficulty.

The client should be able to swallow without difficulty and speak audibly. Client should be able to shrug shoulders and turn head from side to side.

She was able to swallow without difficulty and speak audibly. She was able to shrug her shoulders and turn her head from one side to the other.

Ask client to shrug shoulders against resistance from your hands and turn head to side against resistance from your hand (repeat for other side). Ask client to protrude The client should tongue at midline and be able to move then move it side to side. tongue without any difficulty.

She was able to move tongue in different directions.

FINAL ASSESSMENT General Appearance Mrs. Kisses has a thick, long, black untied hair. She was wearing blue tank top and blue denim shorts with no sleepers on. She was conscious during the assessment. Her fingernails and toenails were trimmed and a bit dirty. She stands 163 cm and weighs 56 kg. Mrs. Kisses has dark complexion and normal gait.

Physical Assessment Mrs. Kisses’ vital signs were taken and recorded as follow: Temp: 36.9° C RR: 21 cycles/min. PR: 72 breaths/min. BP : 100/60 mmHg  HEAD ⇒ Hair and Scalp: evenly distributed, slightly thin, black hair, with no presence of lice ⇒ Skull and Face: symmetrical, smooth uniform consistency, symmetrical facial features, palpebral fissures equal in size, symmetrical facial movements, palpable mass noted on her right cheek ⇒ Eyes and Vision ⇒ External Eye Structures •

Eyebrows: hair evenly distributed, thin eyebrows and are symmetrically aligned, equal movement

•

Eyelashes: equally distributed and slightly curled outward

•

Eyelids: skin intact with no discharge noted, lids close symmetrically, bilaterally blinking

•

Bulbar Conjunctiva: transparent, sclera appears white and pinkish bulbar conjunctiva

•

Palpebral Conjunctiva: shiny, smooth. Pallor noted.

•

Lacrimal Sac and Nasolacrimal Duct: no edema or tearing

•

Cornea: transparent, shiny and smooth, details of iris are visible

•

Corneal Sensitivity: client blinks when the cornea is touched on its side by a wisp of cotton which indicates that cranial nerve no. 5 (trigeminal nerve) is intact

•

Pupils: black in color, PERRLA (pupils equally round respond to light accommodation) when a penlight pass through at about 6

inches far the pupils constrict upon illumination, smooth border, iris flat and round, pupils converge when near object is move towards the nose •

Visual Fields: the client has a normal visual field as evidence by the ability to see object in the periphery even when looking straight ahead which was done by asking the person to close one eye then a pen or the index finger in the periphery and ask if the person can see it without moving his head on the side direction.

⇒ Ears and Hearing •

Auricles: the color of the auricle skin is same as the facial skin, they are symmetrical, aligned with the outer canthus of the eye, it is firm not tender, pinna recoils after it is folded

•

External Ear Canal and Tympanic Membrane: with dry cerumen

•

Gross Hearing Acuity: normal voice tones audible

•

Watch Tick Test: able to hear on the tick of the watch in both ears with a distance of 3 cm.

⇒ Nose and Sinuses •

Nose: symmetric, straight, no discharge; uniform in color; not tender and without lesions, air moves freely when he breaths through the nares, which was done by asking the person to occlude one of the nares then check for airway patency on the unoccluded nares (done alternately), the mucosa is pink, nasal septum intact in midline

•

Facial Sinuses: not tender

⇒ Mouth and Oropharynx •

Mouth:

•

Lip and Buccal Mucosa: uniform pink color soft, moist, smooth texture, ability to purse lips

•

Teeth and Gums: yellowish color of teeth, with presence of tartar and plaque noted, cavities are also present; 12 lower teeth, where in 2 are extracted, minimal dental carries on pre molars and molars; 14 upper teeth, where in there is 2 extracted teeth, 1 excess tooth, and dental carries on molars

•

Tongue and Floor of Mouth: in central position, pink in color, moist with thin whitish coating, smooth lateral margins, no lesions upon observation, raised papillae, tongue moves freely with no tenderness by asking the person to move her tongue in different direction, smooth floor of the mouth

•

Salivary Glands: same as the color of the buccal mucosa and the floor of the mouth

•

Palates and Uvula: light pink smooth soft palate, lighter pink hard palate with irregular texture, the uvula is on the midline of the soft palate

•

Oropharynx and Tonsils: pink and smooth posterior wall of oropharynx , pink tonsils without discharge

 NECK ⇒ Neck Muscles: muscles equal in size, head movement are coordinated and smooth with no discomfort able to flex 45 degrees hyper extend at 60 degrees; head laterally flexes at 40 degrees and laterally rotates at 70 degrees, muscles strength are equal by turning the head to one side and shrugging the shoulder against the resistance of hands of the student nurse which was done by asking the person to resist the pressure of the hands of the student nurse by shrugging her shoulders ⇒ Lymph Nodes ( posterior and below the jaw): not palpable ⇒ Trachea: central placement of the midline of neck by palpation or by asking the person to swallow

⇒ Thyroid Gland: it is symmetrical and masses are not visible, absence of bruit ⇒ Neck Veins: not distended (ask the person to turn his head side to side then check for the neck veins if distended or bloated)  UPPER EXTREMITIES ⇒ Skin and Nails: skin warm to touch, dry to moist, with good skin turgor, nails are smooth, colorless, trimmed and a bit dirty, and in capillary refill result is normal because it returns to its usual color less than 4 seconds. ⇒ Muscle Strength and Tone: symmetrical muscle size, no contractures, no presence of tremor and it is normally firm smooth coordinated movements. ⇒ Brachial and Radial Pulse: palpable ⇒ Fine Motor Test: repeated and rhythmical touches the nose, can altenately supinate and pronate hands at rapid phase performs with coordination and rapidity to the finger nose and to the nurse finger  CHEST and BACK ⇒ Skin: evenly distributed skin color skin intact with uniform temperature ⇒ Chest Shape and Size: anterior-posterior to transverse diameter in ratio of 1:2 symmetrical in shape, spine is vertically aligned, chest wall intact ⇒ Lungs: full and symmetric chest expansion, quiet rhythmic and effortless respiration, full symmetric excursion with bronchial & tubular breathe sounds ⇒ Heart: no pulsation, symmetric pulse volume ⇒ Spinal Column: straight, right and left shoulders and hips are at the same height  ABDOMEN

⇒ Skin: unblemished skin, symmetric movements caused by respiration, slightly distended abdomen, stretch marks were noted on the left and right lower quadrant ⇒ Abdominal Sounds: audible bowel sound, tympany over the stomach and gas filled bowels

 LOWER EXTREMITIES ⇒ Skin and Toenails: uniform skin temperature, convex curve and colorless nail plates, presence of smooth nail texture, highly vascular nail bed,stretch marks on both hips untrimmed and dirty toenails and intact epidermis, with presence of scars on both extremities ⇒ Gait and Balance: was able to perform all the gait and balance without any discomfort ⇒ With presence of stretch marks on both extremities ⇒ Fine Motor Test: able to perform normally the fine motor test

Obstetrical Record Mrs. Kisses got married by the age of 20 and was able to bear three children in the years 1998, 2001 and 2006. She had her menarche when she was 11. Currently, her menstrual cycle is a 28-day cycle due to the pills she is taking. She delivered all her children via normal spontaneous delivery (NSD), vertex presentation at home. A “madrona” was the one who delivered the baby. According to her obstetrical record, she has G3P3T3P0A0L3. She stated that she had all the necessary prenatal check-ups with all her pregnancies at the health center and no complications were noted. She continued her usual activities even though she is pregnant and told the group that she experienced nausea and vomiting during the first trimester of pregnancy.

When she was pregnant, she does not have any unusual belief. She was able to obtain 2 shots of Tetanus Toxoid vaccine. She is still in her reproductive age however; she resorted to artificial family planning with the use of oral contraceptives (Pills) as a form family planning method to prevent further pregnancies. She started to take pills in the year 1999. The main reason for this is for proper spacing of her children.

Nutritional Status

Emaciated Underweight Normal Overweight Obese Morbidly Obese

Body Mass Index Below 15 15 – 18.9 19 – 24.9 25 – 29 30 – 39.9 40 and above

Age: 30 yrs. old Height: 163 cm Weight: 56 kg BMI = Wt. in kg Ht in m2 = 56 kg . 2.67m2 = 20.97 (Normal) History of Past and Present Illness Mrs. Kisses is presently in a good health condition and does not have any health problems. During the interview, she stated that she had not been hospitalized because of severe illness. However, she had fever, coughs and colds but had not experienced any serious illness. She told the group that her management on fever is by means of over the counter medications usually paracetamol. Whenever her skin is warm to touch and she is feeling dizzy, she assumes that she has a fever and usually takes a paracetamol tablet. She also told the group that she does not have any management for cough and colds.

Activities of Daily Living 3:00 am

Wake up

3:30- 5:00

Cook foods for the store

5:00- 6:00

Prepare foods for breakfast (Wake up kids during school days)

6:00- 8:00

Chores

8:00- 12:30

Wash clothes; Take care of ChocoBaby

12:30- 1:00

LUNCH

1:00- 4:00

Sleeping

4:00- 7:00

Stays at the sari-sari store

6:00/7:00- 8:00

DINNER

8:00- 10:00

Watch TV

10:00 pm

Sleeping

KITKAT General Appearance Kitkat is 9y/o, born on September 30, 1998. She has a thick, black and oily untied hair. She was wearing green shirt and shorts with no sleepers on. She was conscious during the assessment. Her fingernails and toenails were untrimmed and dirty. She stands 141 cm and weighs 35 kg. Kitkat has dark complexion and normal gait. INITIAL ASSESSMENT Temp: 36.9 ° C RR: 23 cycles/min. PR: 80 breaths/min.  HEAD ⇒ Hair and Scalp: evenly distributed, thick, black hair, shoulder length, with presence of lice and hair is frizzy. ⇒ Skull and Face: symmetrical, smooth uniform consistency, symmetrical facial features, palpebral fissures equal in size, symmetrical facial movements ⇒ Eyes and Vision ⇒ External Eye Structures •

Eyebrows: hair evenly distributed, thin eyebrows

and are

symmetrically aligned, equal movement •

Eyelashes: equally distributed and slightly curled outward

•

Eyelids: skin intact with no discharge noted, lids close symmetrically, bilaterally blinking

•

Bulbar Conjunctiva: transparent, sclera appears white and pinkish bulbar conjunctiva

•

Palpebral Conjunctiva: shiny, smooth, reddish.

•

Lacrimal Sac and Nasolacrimal Duct: no edema or tearing

•

Cornea: transparent, shiny and smooth, details of iris are visible

•

Corneal Sensitivity: client blinks when the cornea is touched on its side by a wisp of cotton which indicates that cranial nerve no. 5 (trigeminal nerve) is intact

•

Pupils: black in color, PERRLA (pupils equally round respond to light accommodation) when a penlight pass through at about 6 inches far the pupils constrict upon illumination, smooth border, iris flat and round, pupils converge when near object is move towards the nose

•

Visual Fields: the client has a normal visual field as evidence by the ability to see object in the periphery even when looking straight ahead which was done by asking the person to close one eye then a pen or the index finger in the periphery and ask if the person can see it without moving his head on the side direction.

⇒ Ears and Hearing •

Auricles: the color of the auricle skin is same as the facial skin, they are symmetrical, aligned with the outer canthus of the eye, it is firm not tender, pinna recoils after it is folded

•

External Ear Canal and Tympanic Membrane: with dry cerumen

•

Gross Hearing Acuity: normal voice tones audible

•

Watch Tick Test: able to hear on the tick of the watch in both ears with a distance of 3 cm.

⇒ Nose and Sinuses •

Nose: symmetric, straight, no discharge or flaring noted; uniform in color; not tender and without lesions, air moves freely when he breaths through the nares, which was done by asking the person to occlude one of the nares then check for airway

patency on the unoccluded nares (done alternately), the mucosa is pink, nasal septum intact in midline •

Facial Sinuses: not tender

⇒ Mouth and Oropharynx •

Mouth:

•

Lip and Buccal Mucosa: uniform pink color soft, moist, smooth texture, ability to purse lips

•

Teeth and Gums: yellowish color of teeth, with presence of tartar and plaque noted, with cavities present

•

Tongue and Floor of Mouth: in central position, pink in color, moist with thin whitish coating, smooth lateral margins, no lesions upon observation, raised papillae, tongue moves freely with no tenderness by asking the person to move her tongue in different direction, smooth floor of the mouth

•

Salivary Glands: same as the color of the buccal mucosa and the floor of the mouth

•

Palates and Uvula: light pink smooth soft palate, lighter pink hard palate with irregular texture, the uvula is on the midline of the soft palate

•

Oropharynx and Tonsils: pink and smooth posterior wall of oropharynx , pink tonsils without discharge

 NECK ⇒ Neck Muscles: muscles equal in size, head movement are coordinated and smooth with no discomfort able to flex 45 degrees hyper extend at 60 degrees; head laterally flexes at 40 degrees and laterally rotates at 70 degrees, muscles strength are equal by turning the head to one side and shrugging the shoulder against the resistance of hands of the student nurse which was done by asking the person to resist the pressure of the hands of the student nurse by shrugging her shoulders

⇒ Lymph Nodes ( posterior and below the jaw): not palpable ⇒ Trachea: central placement of the midline of neck by palpation or by asking the person to swallow ⇒ Thyroid Gland: it is symmetrical and masses are not visible, absence of bruit ⇒ Neck Veins: not distended (ask the person to turn his head side to side then check for the neck veins if distended or bloated)  UPPER EXTREMITIES ⇒ Skin and Nails: skin warm to touch, good skin turgor, nails are smooth, colorless, untrimmed and dirty, and in capillary refill result is normal because it returns to its usual color less than 4 seconds. ⇒ Muscle Strength and Tone: symmetrical muscle size, no contractures, no presence of tremor and it is normally firm smooth coordinated movements. ⇒ Brachial and Radial Pulse: palpable ⇒ Fine Motor Test: repeated and rhythmical touches the nose, can altenately supinate and pronate hands at rapid phase performs with coordination and rapidity to the finger nose and to the nurse finger  CHEST and BACK ⇒ Skin: evenly distributed skin color skin intact with uniform temperature ⇒ Chest Shape and Size: anterior-posterior to transverse diameter in ratio of 1:2 symmetrical in shape, spine is vertically aligned, chest wall intact ⇒ Lungs: full and symmetric chest expansion, quiet rhythmic and effortless respiration, full symmetric excursion with bronchial & tubular breathe sounds ⇒ With presence of productive cough, rales upon auscultation ⇒ Heart: no pulsation, symmetric pulse volume ⇒ Spinal Column: straight, right and left shoulders and hips are at the same height

 ABDOMEN ⇒ Skin: unblemished skin, symmetric movements caused by respiration ⇒ Abdominal Sounds: audible bowel sound, tympany over the stomach and gas filled bowels ⇒ Specific Organs: not palpable  LOWER EXTREMITIES ⇒ Skin and Toenails: uniform skin temperature, convex curve and colorless nail plates, presence of smooth nail texture, highly vascular nail bed, trimmed and dirty toenails and intact epidermis, with presence of scars on both extremities ⇒ Gait and Balance: was able to perform all the gait and balance without any discomfort ⇒ Presence of Tendon of Achilles reflex ⇒ Presence of Patellar reflex

FINAL ASSESSMENT General Appearance Kitkat has a thick, black, frizzy, and untied hair. She was wearing green shirt and shorts with no sleepers on. She was conscious during the assessment. Her fingernails and toenails were trimmed but a bit dirty. She stands 141 cm and weighs 35 kg. Mrs. Kisses has dark complexion and normal gait. Physical Assessment Temp: 37 ° C RR: 22 cycles/min. PR: 98 breaths/min.

 HEAD ⇒ Hair and Scalp: evenly distributed, thick, black hair, shoulder length, with presence of lice and hair is frizzy ⇒ Skull and Face: symmetrical, smooth uniform consistency, symmetrical facial features, palpebral fissures equal in size, symmetrical facial movements ⇒ Eyes and Vision ⇒ External Eye Structures •

Eyebrows: hair evenly distributed, thin eyebrows

and are

symmetrically aligned, equal movement •

Eyelashes: equally distributed and slightly curled outward

•

Eyelids: skin intact with no discharge noted, lids close symmetrically, bilaterally blinking

•

Bulbar Conjunctiva: transparent, sclera appears white and pinkish bulbar conjunctiva

•

Palpebral Conjunctiva: shiny, smooth.

•

Lacrimal Sac and Nasolacrimal Duct: no edema or tearing

•

Cornea: transparent, shiny and smooth, details of iris are visible

•

Corneal Sensitivity: client blinks when the cornea is touched on its side by a wisp of cotton which indicates that cranial nerve no. 5 (trigeminal nerve) is intact

•

Pupils: black in color, PERRLA (pupils equally round respond to light accommodation) when a penlight pass through at about 6 inches far the pupils constrict upon illumination, smooth border, iris flat and round, pupils converge when near object is move towards the nose

•

Visual Fields: the client has a normal visual field as evidence by the ability to see object in the periphery even when looking straight ahead which was done by asking the person to close one eye then a pen or the index finger in the periphery and ask

if the person can see it without moving his head on the side direction.

⇒ Ears and Hearing •

Auricles: the color of the auricle skin is same as the facial skin, they are symmetrical, aligned with the outer canthus of the eye, it is firm not tender, pinna recoils after it is folded

•

External Ear Canal and Tympanic Membrane: with dry cerumen

•

Gross Hearing Acuity: normal voice tones audible

•

Watch Tick Test: able to hear on the tick of the watch in both ears with a distance of 3 cm.

⇒ Nose and Sinuses •

Nose: symmetric, straight, no discharge or flaring noted; uniform in color; not tender and without lesions, air moves freely when he breaths through the nares, which was done by asking the person to occlude one of the nares then check for airway patency on the unoccluded nares (done alternately), the mucosa is pink, nasal septum intact in midline

•

Facial Sinuses: not tender

⇒ Mouth and Oropharynx •

Mouth:

•

Lip and Buccal Mucosa: uniform pink color soft, moist, smooth texture, ability to purse lips

•

Teeth and Gums: yellowish color of teeth, with presence of tartar and plaque noted, with cavities present

•

Tongue and Floor of Mouth: in central position, pink in color, moist with thin whitish coating, smooth lateral margins, no lesions upon observation, raised papillae, tongue moves freely

with no tenderness by asking the person to move her tongue in different direction, smooth floor of the mouth •

Salivary Glands: same as the color of the buccal mucosa and the floor of the mouth

•

Palates and Uvula: light pink smooth soft palate, lighter pink hard palate with irregular texture, the uvula is on the midline of the soft palate

•

Oropharynx and Tonsils: pink and smooth posterior wall of oropharynx , inflamed tonsils without discharge

 NECK ⇒ Neck Muscles: muscles equal in size, head movement are coordinated and smooth with no discomfort able to flex 45 degrees hyper extend at 60 degrees; head laterally flexes at 40 degrees and laterally rotates at 70 degrees, muscles strength are equal by turning the head to one side and shrugging the shoulder against the resistance of hands of the student nurse which was done by asking the person to resist the pressure of the hands of the student nurse by shrugging her shoulders ⇒ Lymph Nodes ( posterior and below the jaw): not palpable ⇒ Trachea: central placement of the midline of neck by palpation or by asking the person to swallow ⇒ Thyroid Gland: it is symmetrical and masses are not visible, absence of bruit ⇒ Neck Veins: not distended (ask the person to turn his head side to side then check for the neck veins if distended or bloated)  UPPER EXTREMITIES ⇒ Skin and Nails: skin warm to touch, good skin turgor, nails are smooth, colorless, trimmed and a bit dirty, and in capillary refill result is normal because it returns to its usual color less than 4 seconds.

⇒ Muscle Strength and Tone: symmetrical muscle size, no contractures, no presence of tremor and it is normally firm smooth coordinated movements. ⇒ Brachial and Radial Pulse: palpable ⇒ Fine Motor Test: repeated and rhythmical touches the nose, can altenately supinate and pronate hands at rapid phase performs with coordination and rapidity to the finger nose and to the nurse finger  CHEST and BACK ⇒ Skin: evenly distributed skin color skin intact with uniform temperature ⇒ Chest Shape and Size: anterior-posterior to transverse diameter in ratio of 1:2 symmetrical in shape, spine is vertically aligned, chest wall intact ⇒ Lungs: full and symmetric chest expansion, presence of rales on both lung fields upon auscultation. ⇒ With presence of productive cough ⇒ Heart: no pulsation, symmetric pulse volume ⇒ Spinal Column: straight, right and left shoulders and hips are at the same height  ABDOMEN ⇒ Skin: unblemished skin, symmetric movements caused by respiration ⇒ Abdominal Sounds: audible bowel sound, tympany over the stomach and gas filled bowels ⇒ Specific Organs: not palpable  LOWER EXTREMITIES ⇒ Skin and Toenails: uniform skin temperature, convex curve and colorless nail plates, presence of smooth nail texture, highly vascular nail bed, trimmed and slightly dirty toenails and intact epidermis, with presence of scars on both extremities ⇒ Gait and Balance: was able to perform all the gait and balance without any discomfort

⇒ Presence of Tendon of Achilles reflex ⇒ Presence of Patellar reflex

Nutritional Status

Emaciated Underweight Normal Overweight Obese Morbidly Obese

Body Mass Index Below 15 15 – 18.9 19 – 24.9 25 – 29 30 – 39.9 40 and above

Age: 9 yrs. old Height: 141 cm Weight: 35 kg BMI = Wt. in kg Ht in m2 = 35 kg . 1.99 m2 = 17.59 (Underweight) Kitkat stands 141 cm and weighs 35 kg. Her BMI is 17.59 which is considered as underweight,

History of Past and Present Illness Kitkat experienced fever, cough and colds, and diarrhea that can be managed by means of “over the counter” medications. Mrs. Kisses usually gives her Tempra Syrup for fever and packet oresol for diarrhea. She does not have any management for cough and colds. Kitkat also had chicken pox, rubella and mumps. Mrs. Kisses mentioned that she already forgot the date when Kitkat experienced them because she told the group that it was already a long time ago. Two years ago, last September; Kitkat had a minor surgery at ONA (Ospital ning Angeles). She complained for pain in her right ear while her mom fixes her hair. Her mother assessed the affected ear and observed some swelling present on the inner canal. With Kitkat’s complaint, they brought her at ONA where she had the operation and was only confined there overnight. Both Mrs. Kisses and Kitkat forgot what the diagnosis is. For home management, she was prescribed with an ear dropper which they cannot remember what exact medication it is and was ask to comply for antibiotic therapy. Recently, during the home visits of the student nurses, Kitkat complained that she is having sore eyes on her right eye followed by sore throat. The group assessed Kitkat and noted that the palpebral conjunctiva is reddish in color. This was noted during the 3rd home visit and she told the group the student nurses that it started during the weekends. She did not have any management for this. They also Kitkat’s tonsils and noted that they are inflamed and Kitkat verbalized that it is painful everytime she swallows. She took Strepsils as management for the sore throat.

Activities of daily living 5:00 am 5:00- 5:30 5:30- 6:00 6:00- 7:00 7:00- 7:10 7:10- 10:00 10:00- 10:45 10:45- 12:00 noon 12:00-12:30 12:30- 1:00 1:00- 1:30 1:30- 3:00 3:00- 4:00 4:00- 6:00 6:00- 7:00 7:00

Waking up Breakfast Bathing Grooming Arrival to school First half of school Recess Second half of school Arrival at home Lunch Stays at Lola Tootsie Roll's sari-sari store Watching t.v/ playing Taking a nap Stays at Lola Tootsie Roll's sari-sari store Dinner Sleeping time

SNICKERS INITIAL ASSESSMENT General Appearance Snickers a seven- year old boy, wearing a gray shirt and red shorts with no slippers on. He was seen playing outside the house with his elder sister, cousin and some playmates before the initial assessment. His shirt, shorts, as well as his arms and feet, are dirty. His fingernails and toenails are also long and untrimmed. He was conscious, coherent and awake during the first visit. His hair was short and there are some lice noted. Physical Assessment T- 36.9 °C PR- 72 bpm RR- 21 cpm  HEAD ⇒ Hair and Scalp: evenly distributed, slightly thin, short, black hair, with presence of lice, hair is frizzy ⇒ Skull and Face: smooth uniform consistency, symmetrical facial features,

palpebral

fissures

equal

in

size,

symmetrical

facial

movements ⇒ Eyes and Vision ⇒ External Eye Structures •

Eyebrows: hair evenly distributed, thin eyebrows

and are

symmetrically aligned, equal movement •

Eyelashes: equally distributed and slightly curled outward

•

Eyelids: skin intact with no discharge noted, lids close symmetrically, bilaterally blinking

•

Bulbar Conjunctiva: transparent, sclera appears white and pinkish bulbar conjunctiva

•

Palpebral Conjunctiva: shiny, smooth. Pallor noted.

•

Lacrimal Sac and Nasolacrimal Duct: no edema or tearing

•

Cornea: transparent, shiny and smooth, details of iris are visible

•

Corneal Sensitivity: client blinks when the cornea is touched on its side by a wisp of cotton which indicates that cranial nerve no. 5 (trigeminal nerve) is intact

•

Pupils: black in color, PERRLA (pupils equally round respond to light accommodation) when a penlight pass through at about 6 inches far the pupils constrict upon illumination, smooth border, iris flat and round, pupils converge when near object is move towards the nose

•

Visual Fields: the client has a normal visual field as evidence by the ability to see object in the periphery even when looking straight ahead which was done by asking the person to close one eye then a pen or the index finger in the periphery and ask if the person can see it without moving his head on the side direction.

⇒ Ears and Hearing •

Auricles: the color of the auricle skin is same as the facial skin, they are symmetrical, aligned with the outer canthus of the eye, it is firm not tender, pinna recoils after it is folded

•

External Ear Canal and Tympanic Membrane: with dry cerumen

•

Gross Hearing Acuity: normal voice tones audible

•

Watch Tick Test: able to hear on the tick of the watch in both ears with a distance of 3 cm.

⇒ Nose and Sinuses •

Nose: symmetric, straight, no discharge or flaring noted; uniform in color; not tender and without lesions, air moves freely when

he breaths through the nares, which was done by asking the person to occlude one of the nares then check for airway patency on the unoccluded nares (done alternately), the mucosa is pink, nasal septum intact in midline •

Facial Sinuses: not tender

⇒ Mouth and Oropharynx •

Mouth:

•

Lip and Buccal Mucosa: uniform pink color soft, moist, smooth texture, ability to purse lips

•

Teeth and Gums: yellowish color of teeth, with presence of tartar and plaque noted, with cavities present

•

12 lower teeth, where in 1 is extracted (premolar) due to caivities 12 upper teeth, where in there is also 1 tooth extracted (premolar) due to cavities , and cavities on both upper and lower molars, and dental caries on molars

•

Tongue and Floor of Mouth: in central position, pink in color, moist with thin whitish coating, smooth lateral margins, no lesions upon observation, raised papillae, tongue moves freely with no tenderness by asking the person to move her tongue in different direction, smooth floor of the mouth

•

Salivary Glands: same as the color of the buccal mucosa and the floor of the mouth

•

Palates and Uvula: light pink smooth soft palate, lighter pink hard palate with irregular texture, the uvula is on the midline of the soft palate

•

Oropharynx and Tonsils: pink and smooth posterior wall of oropharynx , pink tonsils without discharge

 NECK ⇒ Neck Muscles: muscles equal in size, head movement are coordinated and smooth with no discomfort able to flex 45 degrees hyper extend at 60 degrees; head laterally flexes at 40 degrees and laterally rotates at 70 degrees, muscles strength are equal by turning the head to one side and shrugging the shoulder against the resistance of hands of the student nurse which was done by asking the person to resist the pressure of the hands of the student nurse by shrugging her shoulders ⇒ Lymph Nodes ( posterior and below the jaw): not palpable ⇒ Trachea: central placement of the midline of neck by palpation or by asking the person to swallow ⇒ Thyroid Gland: it is symmetrical and masses are not visible, absence of bruit ⇒ Neck Veins: not distended (ask the person to turn his head side to side then check for the neck veins if distended or bloated)  UPPER EXTREMITIES ⇒ Skin and Nails: skin warm to touch, good skin turgor, nails are smooth, colorless, untrimmed and dirty, and in capillary refill result is normal because it returns to its usual color less than 4 seconds. ⇒ Muscle Strength and Tone: symmetrical muscle size, no contractures, no presence of tremor and it is normally firm smooth coordinated movements. ⇒ Brachial and Radial Pulse: palpable  CHEST and BACK ⇒ Skin: evenly distributed skin color skin intact with uniform temperature ⇒ Chest Shape and Size: anterior-posterior to transverse diameter in ratio of 1:2 symmetrical in shape, spine is vertically aligned, chest wall intact

⇒ Lungs: full and symmetric chest expansion, quiet rhythmic and effortless respiration, full symmetric excursion with bronchial & tubular breathe sounds ⇒ Heart: no pulsation, symmetric pulse volume ⇒ Spinal Column: straight, right and left shoulders and hips are at the same height  ABDOMEN ⇒ Skin: unblemished skin, symmetric movements caused by respiration ⇒ Abdominal Sounds: audible bowel sound, tympany over the stomach and gas filled bowels ⇒ Specific Organs: not palpable  LOWER EXTREMITIES ⇒ Skin and Toenails: uniform skin temperature, convex curve and colorless nail plates, presence of smooth nail texture, highly vascular nail bed, untrimmed and dirty toenails and intact epidermis, with presence of scars on both lower extremities ⇒ Presence of Tendon of Achilles reflex ⇒ Presence of Patellar reflex

FINAL ASSESSMENT General Appearance Snickers is a seven year-old boy white shirt and blue shorts with no slippers on. His fingernails now are quite cleaner compared before. His feet are clean as well. He was conscious, coherent and awake during the final assessment. His hair was short and the presence of lice were still noted. He has an abrasion on left face, below the outer canthus. Physical Assessment T- 37.1 °C

PR- 78 bpm RR- 21 cpm

 HEAD ⇒ Hair and Scalp: evenly distributed, thin, short, brownish color of hair, with presence of lice and hair is not clean because he was playing with his chick in the soil outside their house prior to the assessment. ⇒ Skull and Face: smooth uniform consistency, absence of nodules, symmetrical

facial

features,

palpebral

fissures

equal

in

size,

symmetrical nasolabial folds, symmetrical facial movements ⇒ Eyes and Vision ⇒ External Eye Structures ⇒ With abrasion on left face, below the outer canthus •

Eyebrows: hair evenly distributed, thin eyebrows

and are

symmetrically aligned, equal movement •

Eyelashes: equally distributed and slightly curled outward

•

Eyelids: skin intact with no discharge and discoloration, lids close symmetrically, bilaterally blinking

•

Bulbar Conjunctiva: transparent, sclera appears white and pinkish bulbar conjunctiva

•

Palpebral Conjunctiva: shiny, smooth and pinkish in color

•

Lacrimal Sac and Nasolacrimal Duct: no edema or tearing

•

Cornea: transparent, shiny and smooth, details of iris are visible

•

Pupils: black in color, PERRLA (pupils equally round respond to light accommodation) when a penlight pass through at about 6 inches far the pupils constrict upon illumination, smooth border, iris flat and round, pupils converge when near object is move towards the nose

•

Visual Fields: the client has a normal visual field as evidence by the ability to see object in the periphery even when looking straight ahead which was done by asking the person to close one eye then a pen or the index finger in the periphery and ask if the person can see it without moving his head on the side direction.

⇒ Ears and Hearing •

Auricles: the color of the auricle skin is same as the facial skin, they are symmetrical, aligned with the outer canthus of the eye, it is firm not tender, pinna recoils after it is folded

•

External Ear Canal and Tympanic Membrane: with presence of dry cerumen, in grayish in color

•

Gross Hearing Acuity: normal voice tones audible

•

Watch Tick Test: able to hear on the tick of the watch in both ears with a distance of 3 cm.

⇒ Nose and Sinuses •

Nose: symmetric, straight, no discharge or flaring uniform in color not tender and without lesions, air moves freely when he breaths through the nares, which was done by asking the person to occlude one of the nares then check for airway patency on the unoccluded nares (done alternately) ,the mucosa is pink, nasal septum intact in midline

•

Facial Sinuses: not tender

⇒ Mouth and Oropharynx •

Mouth: with

presence of dental caries like plaque and

tartar •

Lip and Buccal Mucosa: uniform pink color soft, moist, smooth texture, ability to purse lips

•

Teeth and Gums: yellowish color of teeth, with presence of tartar and plaque noted, with cavities present; 12 lower

teeth, where in 1 is extracted (premolar) due to cavities; 12 upper teeth, where in there is also 1 tooth extracted (premolar)due to cavities as well, and cavities on both upper and lower molars, and dental caries on molars •

Tongue and Floor of Mouth: in central position, pink in color, moist with thin whitish coating, smooth lateral margins, no lesions upon observation, raised papillae, tongue moves freely with no tenderness by asking the person to move her tongue in different direction, smooth floor of the mouth

•

Salivary Glands: same as the color of the buccal mucosa and the floor of the mouth

•

Palates and Uvula: light pink smooth soft palate, lighter pink hard palate with irregular texture, the uvula is on the midline of the soft palate

•

Oropharynx and Tonsils: pink and smooth posterior wall of oropharynx , pink tonsils without discharge

 NECK ⇒ Neck Muscles: muscles equal in size, head movement are coordinated and smooth with no discomfort able to flex 45 degrees hyper extend at 60 degrees; head laterally flexes at 40 degrees and laterally rotates at 70 degrees, muscles strength are equal by turning the head to one side and shrugging the shoulder against the resistance of hands of the student nurse which was done by asking the person to resist the pressure of the hands of the student nurse by shrugging her shoulders ⇒ Lymph Nodes ( posterior and below the jaw): not palpable ⇒ Trachea: central placement of the midline of neck by palpation or by asking the person to swallow ⇒ Thyroid Gland: it is symmetrical and masses are not visible, absence of bruit

⇒ Neck Veins: not distended (ask the person to turn his head side to side then check for the neck veins if distended or bloated)  UPPER EXTREMITIES ⇒ Skin and Nails: skin warm to touch, good skin turgor, nails are smooth, colorless, trimmed, and in capillary refill result is normal because it returns to its usual color less than 4 seconds. ⇒ Muscle Strength and Tone: symmetrical muscle size, no contractures, no presence of tremor and it is normally firm smooth coordinated movements. ⇒ Brachial and Radial Pulse: palpable  CHEST and BACK ⇒ Skin: evenly distributed skin color skin intact with uniform temperature ⇒ Chest Shape and Size: anterior-posterior to transverse diameter in ratio of 1:2 symmetrical in shape, spine is vertically aligned, chest wall intact ⇒ Lungs: full and symmetric chest expansion, quiet rhythmic and effortless respiration, full symmetric excursion with bronchial & tubular breathe sounds ⇒ Heart: no pulsation, symmetric pulse volume ⇒ Spinal Column: straight, right and left shoulders and hips are at the same height  ABDOMEN ⇒ Skin: unblemished skin, symmetric movements caused by respiration ⇒ Abdominal Sounds: audible bowel sound, tympany over the stomach and gas filled bowels ⇒ Specific Organs: not palpable  LOWER EXTREMITIES ⇒ Skin and Toenails: uniform skin temperature, convex curve and colorless nail plates, presence of smooth nail texture, highly vascular

nail bed, trimmed and intact epidermis, with presence of scars on both lower extremities ⇒ Presence of Achilles reflex ⇒ Presence of Patellar reflex

Growth and Development Erik Erikson’s Psychosocial Stage – Industry vs. Inferiority At the school-going stage, the child extends beyond the home to the school and the emphasis is on academic performance. There is a movement from play to work. If before the child could play at activities with little or almost no attention given to the quality of results, now he needs to perform and produce good results. The child learns that he can gain recognition from parents, teachers and peers by being efficient in his school work. The attitudes and opinions of others become important. If children are praised for doing their best and encouraged to finish tasks then work enjoyment and industry may result. Children's efforts to master school work help them to grow and form a positive self-concept and find themselves, who they really are. Source: psychology.about.com Upon arriving from school, Snickers will do his assignments or homework if there are and will play if there are none. If before, he plays the moment he arrives home, now he does his school works first. During his play time with his siblings, cousins or play mates, his learning increases by giving attention to the results of his moves and gaining knowledge from it as well. He now aims for good results as he strives to win in any game that he plays. Parents and teachers are also the important persons in his life at this stage. He listens and

acknowledges his parents especially his mother. He follows what his mother tells him, goes whenever he is called and eats and sleep whenever he is being told. And in school, he listens attentively to his teacher and would not want to be scolded. He gives these people importance in his life and the opinions of others become important to him as well. What he does in school and at home and the people around him most importantly his parents and teachers help him to grow and develop and mold him to become a good person and find himself, him as a person. Sigmund Freud’s Psychosexual Stage- Latency Stage During the latent period, the child begins around the time that children enter into school and become more concerned with peer relationships, hobbies, and other interests. The latent period is a time of exploration in which the sexual energy is directed into other areas such as intellectual pursuits and social interactions. This stage is important in the development of social and communication skills and self-confidence. Source: psychology.about.com

Snicker’s attention is diverted to his school mates, play mated and other activities and interests. He is focused and attentive on things that matters his school and the people around him. This stage is important because through these, his social skills, communication, and self-confidence are developed. The people around him will determine who he will be in the future.

Nutritional Status

Emaciated Underweight Normal Overweight Obese Morbidly Obese

Body Mass Index Below 15 15 – 18.9 19 – 24.9 25 – 29 30 – 39.9 40 and above

Age: 9 yrs. old Height: 141 cm Weight: 35 kg BMI = Wt. in kg Ht in m2 = 18 kg . 1.33 m2 = 13.53 (emaciated)

History of Past and Present Illness Snickers did not experience any major illness aside from fever, cough and colds and diarrhea. The management that Mrs. Kisses usually do is just the same with Kitkat. Tempra and Oresol are usual management given for fever and diarrhea respectively. Mrs. Kitkat does not have any management when Snickers is having cough and colds. He also had chicken pox, rubella and mumps before. Right now, Snickers has an abrasion on left face, below the outer canthus but does not have any complains of discomfort or pain because of it. . Activities of Daily Living

5:00 am 5:00- 5:30 am 5:30- 6:00 6:00- 7:00 7:00- 7:10 7:10- 10:00 10:00- 10:45 10:45- 12:00 12:00-12:30 12:30- 1:00 1:00- 4:00 4:00- 6:00 6:00- 7:00 7:00- 8:00 8:00 pm

Waking up Breakfast Bathing Grooming Arrival to school First half of school Recess Second half of school Arrival at home Lunch Playing time/ Studying time Taking a nap Dinner Playing time Sleeping time

CHOCOBABY INITIAL ASSESSMENT General Appearance Choco Baby, two years of age, was asleep during the initial visit. She was wearing a white sando and yellow shorts. She has dirty and long fingernails and toenails. The soles of her feet were dirty as well. She also has dry skin. There are also presence of allergies on her left fore arm and above the left knee. They appear red and palpable.

Physical Assessment Temp: 36.7° C RR: 23 cycles/min. CR: 72 breaths/min.  HEAD ⇒ Hair and Scalp: evenly distributed, slightly thin, black hair, with no presence of lice ⇒ Skull and Face: smooth uniform consistency, symmetrical facial features,

palpebral

fissures

equal

in

size,

symmetrical

facial

movements ⇒ Eyes and Vision ⇒ External Eye Structures •

Eyebrows: hair evenly distributed, thin eyebrows

and are

symmetrically aligned, equal movement, lesion seen above the left eyebrow •

Eyelashes: equally distributed and slightly curled outward

•

Eyelids: skin intact with no discharge noted, lids close symmetrically, bilaterally blinking

•

Bulbar Conjunctiva: transparent, sclera appears white and pinkish bulbar conjunctiva

•

Palpebral Conjunctiva: shiny, smooth.

•

Lacrimal Sac and Nasolacrimal Duct: no edema or tearing

•

Cornea: transparent, shiny and smooth, details of iris are visible

•

Corneal Sensitivity: client blinks when the cornea is touched on its side by a wisp of cotton which indicates that cranial nerve no. 5 (trigeminal nerve) is intact

•

Pupils: black in color, PERRLA (pupils equally round respond to light accommodation) when a penlight pass through at about 6 inches far the pupils constrict upon illumination, smooth border, iris flat and round, pupils converge when near object is move towards the nose

⇒ Ears and Hearing •

Auricles: the color of the auricle skin is same as the facial skin, they are symmetrical, aligned with the outer canthus of the eye, it is firm not tender, pinna recoils after it is folded

•

External Ear Canal and Tympanic Membrane: with dry cerumen

⇒ Nose and Sinuses •

Nose: symmetric, straight, no discharge or flaring noted; uniform in color; not tender and without lesions, air moves freely when he breaths through the nares, which was done by asking the person to occlude one of the nares then check for airway patency on the unoccluded nares (done alternately), the mucosa is pink, nasal septum intact in midline

•

Facial Sinuses: not tender

⇒ Mouth and Oropharynx •

Mouth:

•

Lip and Buccal Mucosa: uniform pink color soft, moist, smooth texture

•

Teeth and Gums: yellowish color of teeth, no cavities present

•

8 teeth on the upper and 8 on the lower

•

Tongue and Floor of Mouth: in central position, pink in color, moist, smooth lateral margins, no lesions upon observation, raised papillae, tongue moves freely with no tenderness by asking the person to move her tongue in different direction, smooth floor of the mouth

•

Salivary Glands: same as the color of the buccal mucosa and the floor of the mouth

•

Palates and Uvula: light pink smooth soft palate, lighter pink hard palate with irregular texture, the uvula is on the midline of the soft palate

•

Oropharynx and Tonsils: pink and smooth posterior wall of oropharynx , pink tonsils without discharge

 NECK ⇒ Neck Muscles: head movement are coordinated and smooth with no discomfort ⇒ Lymph Nodes ( posterior and below the jaw): not palpable ⇒ Trachea: central placement of the midline of neck by palpation or by asking the person to swallow ⇒ Thyroid Gland: it is symmetrical and masses are not visible, absence of bruit ⇒ Neck Veins: not distended (ask the person to turn his head side to side then check for the neck veins if distended or bloated)  UPPER EXTREMITIES

⇒ Skin and Nails: skin warm and dry, good skin turgor, nails are smooth, colorless, untrimmed and dirty, and in capillary refill result is normal because it returns to its usual color less than 4 seconds. ⇒ With allergies present on the left fore arm, fresh and reddish in color ⇒ Muscle Strength and Tone: symmetrical muscle size, no contractures, no presence of tremor and it is normally firm smooth coordinated movements. ⇒ Brachial and Radial Pulse: palpable  CHEST and BACK ⇒ Skin: evenly distributed skin color skin intact with uniform temperature ⇒ Chest Shape and Size: anterior-posterior to transverse diameter in ratio of 1:2 symmetrical in shape, spine is vertically aligned, chest wall intact ⇒ Lungs: full and symmetric chest expansion, quiet rhythmic and effortless respiration, full symmetric excursion with bronchial & tubular breathe sounds ⇒ Spinal Column: straight, right and left shoulders and hips are at the same height  ABDOMEN ⇒ Skin: unblemished skin, symmetric movements caused by respiration ⇒ Abdominal Sounds: audible bowel sound, tympany over the stomach and gas filled bowels ⇒ Specific Organs: not palpable  LOWER EXTREMITIES ⇒ Skin and Toenails: uniform skin temperature, dry to touch, convex curve and colorless nail plates, presence of smooth nail texture, highly vascular nail bed, untrimmed and dirty toenails and intact epidermis, with presence of scars on both lower extremities ⇒ With allergies above the left knee, fresh and reddish in color

⇒ Presence of Tendon of Achilles reflex ⇒ Presence of Patellar reflex

Final Assessment General Appearance ChocoBaby was conscious, coherent and awake during the final assessment. She wears a blue sando and a maong shorts. Her fingernails and toenails are clean as well as his feet. The allergies noted on her left fore arm and above the left knee are now dry and doesn’t appear red. Physical Assessment Temp: 36.9° C RR: 22 cycles/min. CR: 76 breaths/min.  HEAD ⇒ Hair and Scalp: evenly distributed, slightly thin, black hair, with no presence of lice ⇒ Skull and Face: symmetrical, smooth uniform consistency, symmetrical facial features, palpebral fissures equal in size, symmetrical facial movements ⇒ Eyes and Vision ⇒ External Eye Structures •

Eyebrows: hair evenly distributed, thin eyebrows

and are

symmetrically aligned, equal movement, lesion above the left eyebrow

•

Eyelashes: equally distributed and slightly curled outward

•

Eyelids: skin intact with no discharge noted, lids close symmetrically, bilaterally blinking

•

Bulbar Conjunctiva: transparent, sclera appears white and pinkish bulbar conjunctiva

•

Palpebral Conjunctiva: shiny, smooth.

•

Lacrimal Sac and Nasolacrimal Duct: no edema or tearing

•

Cornea: transparent, shiny and smooth, details of iris are visible

•

Corneal Sensitivity: client blinks when the cornea is touched on its side by a wisp of cotton which indicates that cranial nerve no. 5 (trigeminal nerve) is intact

•

Pupils: black in color, PERRLA (pupils equally round respond to light accommodation) when a penlight pass through at about 6 inches far the pupils constrict upon illumination, smooth border, iris flat and round, pupils converge when near object is move towards the nose

⇒ Ears and Hearing •

Auricles: the color of the auricle skin is same as the facial skin, they are symmetrical, aligned with the outer canthus of the eye, it is firm not tender, pinna recoils after it is folded

•

External Ear Canal and Tympanic Membrane: with dry cerumen

•

Gross Hearing Acuity: normal voice tones audible

⇒ Nose and Sinuses •

Nose: symmetric, straight, no discharge or flaring noted; uniform in color; not tender and without lesions

•

Facial Sinuses: not tender

⇒ Mouth and Oropharynx •

Mouth:

•

Lip and Buccal Mucosa: uniform pink color soft, moist, smooth texture, ability to purse lips

•

Teeth and Gums: yellowish color of teeth, no cavities present

•

8 teeth on the upper and 8 on the lower

•

Tongue and Floor of Mouth: in central position, pink in color, moist with thin whitish coating, smooth lateral margins, no lesions upon observation, raised papillae

•

Salivary Glands: same as the color of the buccal mucosa and the floor of the mouth

•

Palates and Uvula: light pink smooth soft palate, lighter pink hard palate with irregular texture, the uvula is on the midline of the soft palate

•

Oropharynx and Tonsils: pink and smooth posterior wall of oropharynx , pink tonsils without discharge

 NECK ⇒ Neck Muscles: muscles equal in size, head movement are coordinated and smooth ⇒ Lymph Nodes ( posterior and below the jaw): not palpable ⇒ Trachea: central placement of the midline of neck by palpation or by asking the person to swallow ⇒ Thyroid Gland: it is symmetrical and masses are not visible, absence of bruit ⇒ Neck Veins: not distended (ask the person to turn his head side to side then check for the neck veins if distended or bloated)  UPPER EXTREMITIES ⇒ Skin and Nails: skin warm and dry, good skin turgor, nails are smooth, colorless, trimmed and clean, and in capillary refill result is normal because it returns to its usual color less than 4 seconds.

⇒ With allergies present on the left fore arm, dry and grayish in color ⇒ Muscle Strength and Tone: symmetrical muscle size, no contractures, no presence of tremor and it is normally firm smooth coordinated movements. ⇒ Brachial and Radial Pulse: palpable  CHEST and BACK ⇒ Skin: evenly distributed skin color skin intact with uniform temperature ⇒ Chest Shape and Size: anterior-posterior to transverse diameter in ratio of 1:2 symmetrical in shape, spine is vertically aligned, chest wall intact ⇒ Lungs: full and symmetric chest expansion, quiet rhythmic and effortless respiration, full symmetric excursion with bronchial & tubular breathe sounds ⇒ Heart: no pulsation, symmetric pulse volume ⇒ Spinal Column: straight, right and left shoulders and hips are at the same height  ABDOMEN ⇒ Skin: unblemished skin, symmetric movements caused by respiration ⇒ Abdominal Sounds: audible bowel sound, tympany over the stomach and gas filled bowels ⇒ Specific Organs: not palpable  LOWER EXTREMITIES ⇒ Skin and Toenails: uniform skin temperature, dry to touch, convex curve and colorless nail plates, presence of smooth nail texture, highly vascular nail bed, trimmed and clean toenails and intact epidermis, with presence of scars on both lower extremities ⇒ With allergies above the left knee, dry and grayish in color ⇒ Gait and Balance: was able to perform all the gait and balance without any discomfort

 Presence of Tendon of Achilles reflex  Presence of Patellar reflex

Growth and Development Erik Erikson’s Psychosocial Stage – Autonomy vs. Shame and Doubt In this stage, the toddler wants to do things for himself without help or hindrance from other people. The toddler's favorite word is "No". It is a declaration of independence. It reflects his personality with the ability to make choices. Autonomy is enhanced as toddlers try to use their developing muscles to walk, climb, hop and jump and to explore their environment. Thus, toddlers can get into dangerous situations. Therefore, parents have to balance their being strict and too lenient. If a toddler is restricted to do things on his own by overprotective parents then he may not have many opportunities to develop autonomy. On the other hand, if a toddler was harshly criticized for accidents like wetting, soiling, spilling or breaking things, then he may develop doubt about his own abilities and might not able to have the chance to tackle new challenges and explore the world and the things around him. Source: psychology.about.com

Chocobaby is fond of climbing up to high tables, chairs and drawers. She likes to explore the things around her and is not afraid to try new things or even get hurt. Mrs. Kisses on the other hand allows her to do things like climbing tables and other high things at their home that she knows Chocobaby can climb.

She witnessed her child doing that and saw how her child would do as her strategy in climbing up in elevated things and is aware that her child would know what to do. Of course there is still supervision from Mrs. Kisses but she allows her child to be able to grow and stand on her own. Sigmund Freud’s Psychosexual Stage- Anal Stage During the anal stage, the primary focus of the libido was on controlling bladder and bowel movements and toilet training. The child has to learn to control his or her bodily needs. And with this, the child leads to a sense of accomplishment and independence. The success at this stage depends on how parents would train their children. If parents would praise and give rewards to their children for using the toilet properly, there would be a positive outcome and it will help the children to feel capable and productive. If positive outcomes is achieved in this stage, it will help the child to become a competent and productive adults. However, if parents would punish or embarrass their child for accidents, negative outcome will result. If parents would become too lenient to their children, the child would become a messy and wasteful individual. And if parents are too strict or began the toilet training too early, the individual will become orderly and rigid. psychology.about.com

In this stage, the role of the parents is of importance. Mrs. Kisses trained Chocobaby in the toiletry at the right age. She is no longer wearing her diapers and uses the toilet properly and whenever needed. Mrs. Kisses was neither too strict nor too lenient that is why Chocobaby was trained properly that she knows the right time for using the toilet.

Immunization Status

ChocoBaby is considered as a fully immunized child because she had 1 dose of BCG, 3 doses DPT, 3 doses of OPV, 3 doses Hepa B and 1 dose of Measle Vaccine before her first birthday at the Barangay Health Center. Nutritional Status Age: 27 months Weight: 12 kg FNRI= normal (9.9-15.6)

History of Past and Present Illness ChocoBaby only experienced fever, cough and colds and diarrhea. Mrs Kisses gives her some Tempra when she has fever and Oresol for diarrhea and does not have any management for cough and colds. She also had rubella and mumps. Right now, she had allergies on her left fore arm and above her left knee. During the initial assessment they were fresh, itchy and reddish in color. Mrs. Kisses managed it with Calamine lotion and during the final assessment they already appeared dry and grayish in color and were no longer itchy as verbalized by Mrs. Kisses.

Activities of Daily Living 8:00 am 8:00- 8:10 10-10:15 10:15- 12:30 12:30- 1:00 1:00- 5:00 5:00- 6:00 6:00- 8:00 8:00- 8:30 8:30- 10:00 10:00 pm

Waking up Breakfast Bathing Watching tv Lunch Sleeping time Eating snacks Playing time Dinner Playing time Sleeping time

LOLA TOOTSIE ROLL The student nurses were not able to assess Lola Tootsie Roll because she stays in her sari-sari store the whole day starting from 5:00 am to 8:00 pm. UNCLE BUTTERFINGER The student nurses was not able to assess uncle butterfinger because he is not around during the house visits BROTHER CRUNCH The student nurses was not able to assess brother crunch because he is not around during the house visits

IV. SOCIO ECONOMIC, CULTURAL AND ENVIRONMENTAL ASSESSMENT A. Type of Family The Chocolate Family is considered as an extended type of family. An extended type is a family having another kin outside the nuclear family. In their case, aside from the Chocolate Family in one house lives with them Lola Tootsie Roll, Uncle Butterfinger, and Brother Crunch. B. Dominant family member/s in terms of decision-making especially to health care Mr. Ferrero and Mrs. Kisses Chocolate goes hand in hand in terms of decision-making, they consult each other in terms of planning and budgeting for their family, they also discuss matters concerning their children’s schooling financially and emotionally. When problem arises, they make sure that both of them will handle and solve the problem. But then, in terms of matter concerning health Mrs. Kisses is more dominant. She makes sure that she will comply with the appropriate regimen regarding the condition that arises and she has greater awareness regarding health matters compared to Mr. Ferrero. An example of health matters wherein Mrs. Kisses is more responsible for is immunization. This is so because Mr. Ferrero is also busy at his work giving Mrs. Kisses to decide on matters that needs an urgent decision. C. Source of income and expenditures

The Chocolate family’s main source of income is coming from Mr. Ferrero. Lola Tootsie Roll does have contributions as well in the house expenses. Sometimes, Uncle Butterfinger shares some in the budget only when he has work.

On a daily basis, Mr. Ferrero gives Mrs. Kisses Php 200.00. This amount is for the utilization of their daily needs like foods and allowances of the children. It is used in buying over the counter medications when necessary. Lola Tootsie Roll’s contribution was not specified but as stated by Mrs. Kisses, she told the student nurses that Lola Tootsie Roll is the one who pays the Electric bills and sometimes buys for the food they eat. Their monthly electric bill is about Php 600 to Php 700, and water bill costing about Php 300. Mrs Kisses also told the group that Mr. Ferrero is still paying for his tricycle every month but she does not know how much is the exact amount.

But with Mr. Ferrero’s daily income, the group can say that this is not enough to shoulder every expense they have in the household. According to NEDA, each individual should at least have Php 2768.60 when the total monthly income of the family is divided among the total family members. The total monthly income of Mr. Ferrero is about Php 5,200 and when divided among the 8 members, it is only Php 650. With these, they were considered poor. Mrs. Kisses also told the student nurses that they do not have any financial assets at hand in case of emergency; they just usually borrow money from their relatives, neighbors or sometimes “five, six”.

D. Working Hours

Mr. Ferrero works as a tricycle driver, he works from 5 am until 10 pm from Mondays to Saturdays. He seldom works every Sunday. Lola Tootsie Roll stays on her sari-sari store from 5 am until around 7 and 8 pm. Mrs. Kisses doesn’t

usually work rather she stays at home as housewife and usually helps her mother at the sari-sari store. Uncle Butterfinger has an unstable job schedule. Usually, he works from 7 am until 5 pm as a painter and he usually do not work during rainy days.

E. Ethnic background and religious affiliation

The Chocolate family resides and all grew up in Barangay San Jose, Angeles City. All of them are affiliates of Roman Catholic. Mrs. Kisses even mention that they do not attend the Holy Mass every Sunday but she told the student nurses too that Kitkat usually attends mass with her cousin and go to mall afterwards.

F. Significant other’s roles in the family life

The most significant persons involved in their lives are the aunt of Mrs. Kisses living just beside their house, some close family friends which resides within the vicinity area, and in some cases where in there is no one they can turn to, they borrow money from the “five, six”.

G. Health habits/beliefs

The family still believes in the power of tawas or hilot. They first consult in a mananawas or manghihilot whenever a family member gets sick. If the situation gets worse, they go to their barangay health center and in severe cases, they go to Ospital Ning Angeles and seek for help.

H. Family’s involvement in community activities

The family participates in the community activities such as celebrating fiesta and watching different affairs such as amateur singing contest and Ms. Teen San Jose. They also find time to go to carnivals accessible.

I. Family’s utilization of community resources

The Chocolate Family enjoys the facilities available in the community like the basketball court; the barangay health center, where in the children had their immunization and where Mrs. Kisses avails her contraceptive pills. Kitkat and Snickers also studied in the Day Care Center in their Barangay. They also consult the Barangay Captain or any official in the Barangay Hall in times of problems.

J. Housing condition

The house is made of concrete wood. It has a floor area of 5.76m x 4.70m. Its total floor area is 23.62 m2. In order for the house to be considered as adequate, the total floor area should be divided among the total members of the family and each should at least have 3.5 m2. In the case of the Chocolate Family, each of them would only have at least 2.95 m2. With this, the house is considered inadequate for them.

The house only has 2 windows which basically does not sustain the adequate ventilation needed by the family. The reason why the group considered the ventilation of the family as inadequate is because the windows are obstructed and air is not free flowing inside the house. Some clothes are also hanged in front of the windows blocking the passage of air.

The house has 2 rooms with bed. Mr. Ferrero and Mrs. Kisses together with Choco Baby sleeps on the room at the left side while Uncle Butterfinger sleeps on the right room. Lola Tootsie Roll, Brother Crunch, Kisses and Snickers sleeps at the sala. They use mattress and “banig.”

The Chocolate Family have different appliances such as television, radio, and 2 electric fans which they use in their daily living. There are present accident hazards too. Some faulty wiring was noted as well as the presence of rodents and insects. In terms of garbage disposal, they just use plastic bags or sack which is hanged at the back of their house near the comfort room. The sack or plastic used is usually left untied.

K. Food sources, storage and cooking facilities

Lola Tootsie Roll goes to the market for their food every day. Though they have a stove, they prefer to use charcoal because they cannot avail the Liquid Petroleum Gas. Mrs. Kisses and Lola Tootsie Roll were the ones who usually prepares the food. They cook at the back of their house beside the comfort room. It is where their “dirty kitchen” is located. The food that they usually eat is sardines and other canned goods. They also eat the leftovers from the merienda that they cooked. When it comes to storing their food, they just cover their left over with plate. But in some cases, they ask their relatives to let their leftovers store in their refrigerator. In terms of cooking facilities the family is equip with casserole, “sandok”, frying pan and knives.

L. Water Supply

NAWASA is the family’s source of water. They use a jar, which is covered to store their drinking water. According to them the water is very much potable.

M. Toilet Facility

Chocolate Family owns their Comfort room. It is located outside their house. Its toilet does not have any water carriage. It has a fair sanitation and it is newly painted. The toilet bowl itself is clean, there are no fecal materials noted but the smell of the comfort room is stinky that is why the group considered it as having a fair sanitation.

N. Drainage System

The drainage system of the family is open type. It is dirty and has a stinky smell. There are some rice grains noted on the drainage. Molds are also noted. There is no obstruction present at the drainage system, which makes the flow continuous.

O. Social and health facilities available

The family benefits from the services offered by the Barangay Health Center; this is where their children, Kitkat, Snickers and Choco Baby received their full immunizations. Mrs. Kisses also avails her free contraceptive pills at the center. The other facilities within the community are the recreational facilities like basketball court.

P. Communication and transportation facilities The family does not own any cell phones or telephone. They usually borrow their neighbor’s or relatives’ cell phone if they need to text someone. Mr. Ferrero has a tricycle which until now is not fully paid. He pays for it at installment basis. Mrs. Kisses did not specify the amount regarding how much Mr. Ferrero pays for the tricycle because she too does not know. It is their main mode of transportation other than the public utility jeepneys.

V. PROBLEM IDENTIFICATION A. List of Problem Identified

No.

Problems Identified

Score

Rank

1

Presence of vector of diseases e.g. rodents, mosquitoes, flies, roaches

4.34

1

2

Presence of Pediculosis

4.17

2.5

3

Presence of Dental Caries

4.17

2.5

4

Poor Lighting Condition

3.84

4.5

5

Poor Ventilation Condition

3.84

4.5

6

Family size beyond what family resources can adequately provide

3.34

6

7

Presence of Health Deficit: Malnutrition

2.67

7

8

Poor Home Sanitation: Inadequate Living Space

2.5

8

9

Inadequate Immunization Status: Mrs. Kisses and Snickers

2

11

10

Poor Personal Hygiene

2

11

11

Faulty eating habits

2

11

12

Poor Environmental Sanitation: Lack of Food Storage Facilities

2

11

13

Improper Garbage Disposal

2

11

14

Accident Hazard: Fire hazard due to faulty wirings

1

14

B. Priority Setting Problem# 1: Presence of vector of diseases e.g. rodents, mosquitoes, flies, roaches Actual Criteria Computation Justification score The problem is considered to be a health threat since it predisposes 1. Nature of the 2/3 x 1 .67 the family to acquire vector borne problem diseases such as Dengue, leptospirosis, and the like. 2/2 x 2 2 The problem is highly modifiable 2.Modifiability of the AEB the following criteria problem observed:

Current knowledge  Family Resources  SN Resources  Community Resources 

> The family has a current knowledge of the problem as during the interview the Mrs. Kisses was able to verbalize the presence of the problem "wa ating dagis keni daramadaman mila kening bubungan, egana gana atang insekto atin keni"(yes there are rats her in the house we can here them from the roof, I think most of the insect are present on this house) > The family's manpower and physical resources are available AEB the family's willingness to cooperate and comply with the Student Nurses health teachings and as verbalized by Mrs. Kisses they have insecticides such as Baygon which they use to eradicate those insects. > The Student Nurses are well informed and knowledgeable about vector borne diseases and the management to be done to prevent the occurrence of these diseases and on how to eradicate those rodents and insects, thus

making them enable to impart these knowledge to the family, another thing is the Student Nurses willingness to help the family to minimize if not to eradicate this problem.

3. Preventive Potential Severity ▲ Duration ▼ Current Management ▲ High -risk Group ▲

2/3 x 1

.67

> The Barangay Health Center offers Mother's Class and conducts information dissemination on how to prevent the multiplication of these vectors and insecticides are also available in the community. Prevention of these vectors has a moderate potentiality as reflected by the criteria the Student Nurses have observed: > The problem is not yet severe since no one on the family was affected by the problem, the rodents bit no one, no one has acquired any of the vector borne diseases. >The problem has existed for a long time ago, this has already existed approximately for almost 30 years as verbalized by Mrs. Kisses that there were already rodents and insects on their house even when she was a child. >The family has a current management on the problem, "Manispray kami mu ning kayi minsan keng parumingu" (we used to spray insecticides every week) as verbalized by Mrs. Kisses upon interview. > The children and even Mr. Mrs. Chocolate and the other family members are all at risk to be affected of the problem, since they

4. Salience of the problem

Total Score

Criteria

1. Nature of the problem

2.Modifiability of the problem Current knowledge

 Family Resources

 SN Resources

 Community Resources



2/2 x 1

1

all live on the house. Prior to the interventions and health teachings, the family has already viewed this as a problem, which needs an immediate action.

4.34

Problem# 2 Presence of Pediculosis Actual Computation Justification score Pediculosis is considered to be a health deficit brought about by the infestations of these parasites wherein they feed themselves by 3/3 x 1 1 getting the nutrients from the host. In the Chocolate family’s case, Kitkat and Snickers are affected by the said infestation. 2/2 x 2 2 The Chocolate Family’s problem regarding Pediculosis has a high modifiability status as reflected by the following criteria below.

> The family has a current knowledge about the problem as Mrs. Kisses was able to verbalized the existence of this problem as evidenced by the statement below: “ay makutu ya i Hershey[Kitkat]” (Hershey [Kitkat} really ahs a lot of lice) > The family has manpower resources that the family can use to minimize Kitkat’s lice by removing them; the family also has a comb that they use to remove Kitkat and Snickers lice. >The students nurses knowledge and initiative will enable the student nurses to provide health education

for the family on how to minimize if not to eradicate their problem regarding pediculosis such as the use of shampoos that kills the lice.

3. Preventive Potential Severity

▼ Duration

▼ Current Management

▲ High -risk Group

▲

2/3 x 1

.67

>The Barangay Health Center is open for consultations every Tuesday in which Mrs. Kisses can come to the Health Center and asked for necessary actions she can do to manage Kitkat and Snickers problem regarding pediculosis. After the student nurses have considered the criteria on determining the Preventive Potential of the Chocolate Family’s problem on Pediculosis, it shows that the problem has a moderate preventive potential as evidenced by the following criteria. > The problem is considered to be severe since two of the family (Kitkat and Snickers) is infected by lice infestation wherein there are some cases where Choco Baby was also infected by the said infestation. > The problem is approximately existing for almost 5 years, as reported by Mrs. Kisses: “anyang anak ya pa i Hershey [Kitkat] atin neng kutu, I Ivan [Snickers] mehawa yamu kaya.”(Hershey [Kitkat] have those lice even when she was a child, Ivan [Snickers] just his lice from her.) > The family has current management on the problem as Mrs. Kisses remove Kitkat’s lice whenever she has free time.

4. Salience of the problem

1/2 x 1

Total Score

Criteria

1. Nature of the problem

2.Modifiability of the problem Current knowledge

 Family Resources

 SN Resources

 Community Resources



.5

> Mrs. Kisses, Choco baby and the rest of the family are the high- risk group, as these parasites are easily transferred from one person to another. > Prior to the student nurses’ interventions Mrs. Kisses was aware of the problem but does not need immediate action.

4.17

Problem# 3 Presence of Dental Caries Actual Computation Justification score Dental Caries are health deficits brought about by poor personal hygiene wherein the structure of 3/3 x 1 1 the teeth are being damaged, thus, leading to toothache, tooth loss, and infection. 2/2 x 2 2 As reflected by the criteria below, it shows that the problem on dental caries has a high modifiability status.

> The family is fully aware that the problem exist on their family as Mrs. Kisses and Kitkat was able to verbalize the problem as evidenced by the statement below: Mrs. Kisses- “ay sira sira la reng ipan ku”(I have dental caries) Kitkat- “sira la rin pu deng ipan ng Ivan [Snickers]” (Ivan [Snickers] also have dental caries) > The family has physical resources specifically tooth cleaning articles such as toothbrushes and toothpaste. > With the student nurses knowledge and anatomical background about dental caries, the student nurses can provide the

family health teachings about the importance of maintaining the integrity of their teeth such as the teeth are vital part of the Gastrointestinal System especially on food grinding. > The Angeles City Municipal Hall houses public dentists wherein the Chocolate Family could avail the dental services offered by the municipality. The problem of the Chocolate family regarding Dental Caries has a moderate preventive potential after the student nurses has considered the following criteria presented below.

3. Preventive Potential Severity

▼ Duration

▼

> The problem is severe as Mrs. Kisses and her three children all have dental caries.

Current Management

▲ High -risk Group

▲

2/3 x 1

.67

> The problem approximately exists for almost 10 years, as Mrs. Kisses was only a teenager when she had her dental caries, and Kitkat, Choco Baby, and Snickers had their dental caries when they were still young. > As a management to the problem, they brush their teeth as verbalize by Mrs. Kisses: “…magtoothbrush na kami man” (We do brush our teeth) > Mrs. Kisses and her children are exposed to the problem.

4. Salience of the problem Total Score

1/2 x 1

.5

4.17

Prior to the student nurses verbalizing the problem to the family, the family is already aware of this but for them it does not need an immediate action.

Problem# 4 Poor Lighting Condition Actual Criteria Computation Justification score The family’s problem on poor lighting is considered to be a health threat to the family, since with poor lighting condition, it may bring strain on the eyes which may lead to eye problem such as 1. Nature of the blurring of the vision, another thing 2/3 x 1 .67 problem is this may lead to accidents since without the use of enhancement for lighting condition such as lamps the family member cannot see their home environment clearly thus may lead to accidents such as sliding and the like. 2/2 x 2 2 After considering the criteria 2.Modifiability of the below, the Student Nurses have problem arrived to a result that shows that the problem of the Chocolate Family is highly modifiable. Current knowledge > The family has a current  knowledge on the problem as shown with the behavior of Mrs. Family Kisses wherein the student nurses Resources have observed Mrs. Kisses turn on  the light whenever the student nurses arrived for their home visits SN and as evidenced by her Resources statement  “sindyan ke mu ing sulu madalumdum eh”(I will just turn on Community the lights, it is so dark) Resources  > The family has their physical resources such as light bulbs and fluorescent lamps. > The student nurses are well equipped of the knowledge about having a good lighting condition thus, the student nurses can

provide the family some health teachings to the family regarding the importance of having a good lighting condition such as it prevent straining the eye and making their environment more visible, they can also pinpoint some articles that contribute to the problem such as the clothes they hang at the window. > The community has hardware stores wherein the family could buy fluorescent lamps and light bulbs. The Chocolate Family’s problem on poor lighting condition has a moderate preventive potential as reflected by the criteria shown below:

3. Preventive Potential Severity ▼

> The problem is severe as evidenced by upon entering the house the student nurse have observed that it is impossible to see without the aid of electricity, the house is so dark.

Duration ▼ Current Management ▲ High -risk Group ▲

2/3 x 1

.67

>The problem has exist for approximately about almost 30 years, as stated by Mrs. Kisses: “dati neng madalumdum ing bale, anyang anak ku pa makanini ne” (this situation was the same even when I was a child, it is really dim inside the house) >The family uses light bulbs and fluorescent lamps to manage the problem.

4. Salience of the

1/2 x 1

.5

> All of the family members of the chocolate family are exposed to this problem as they were all living on that house. Mrs. Kisses was able to verbalize

their problem about poor lighting condition and it does not need any immediate intervention.

problem Total Score

3.84

Problem# 5 Poor Ventilation Condition Actual Criteria Computation Justification score The problem is basically a health threat to the Chocolate family as poor ventilation condition predisposes cross contamination since there is an inadequate air circulating on their home 1. Nature of the 2/3 x 1 .67 problem environment, another thing is that with poor ventilation condition, the family members may suffer to respiratory problems since there is minimal amount of air circulating on their house. 2/2 x 2 2 After the student nurses have 2.Modifiability of the considered the following criteria problem below, it reflected that the problem is highly modifiable. Current knowledge

 Family Resources

 SN Resources

 Community Resources



> The family has a current knowledge of the problem as Mrs. Kisses was able to verbalize the problem during the interview conducted by the student nurses: “ay malisangan keni alang hangin lulub” (it is so hot in here, probably there are no air coming inside the house) > The family has physical resources such as electric fan; they also have manpower resources that will enable the family to make prior actions in clearing their windows. > With the skills, initiative and knowledge of the student nurses, the student nurses can provide the family with health teachings

3. Preventive Potential Severity

▼ Duration

▼ Current Management

▲ High -risk Group

▲

2/3 x 1

.67

regarding the importance of having a good ventilation condition such as it will promote relaxation and prevent cross contamination of diseases; the student nurses could also demonstrate with the family some necessary actions that the family can apply such as clearing their window by removing the hanged clothes on their window. > The community has City Engineers whom the family can consult on what they can do to improve their ventilation condition. After the student nurses have considered the following criteria below, it reflected that the problem has a moderate preventive potential. > The measurement of the windows of the house of the chocolate family have passed the standard of the National Building code of the Philippines R.A 6541 as evidenced by the total measurement of the windows of the house yield _______ which is more than 1/10th of the total floor area of the house, but majority of the windows of the house is being covered by the adjacent house located at their vicinity making their ventilation condition poor. > The problem on poor ventilation condition of the Chocolate Family existed for approximately almost 30 years ago, as verbalized by Mrs. Kisses on her statement: “malwat ne yan, anyang anak ku pa makanyan ne yan matatakpan ne keng harap mi” (oh that existed a long time ago, because when I was still a child that house on our front covers our window)

> The family uses electric fan to minimize the problem.

4. Salience of the problem Total Score

1/2 x 1

.5

> All of the family members are all affected of the problem since all of them are living together on that house. Mrs. Kisses views it as a problem but does not need an immediate action; this is as evidenced by Mrs. Kisses was able to verbalize the problem.

3.84

Problem# 6 Family size beyond what family resources can adequately provide Actual Criteria Computation Justification score The problem is a health threat, inadequacy of the family resources to suffice their daily needs may result to serious health problems if 1. Nature of the 2/3 x 1 .67 problem not corrected e.g. malnutrition which is now actually evident in the family since Snickers is considered to be Malnourished. 1/2 x 2 1 The problem is partially modifiable 2.Modifiability of the as reflected by the criteria being problem considered: > The family has a current knowledge of the problem, as Mrs. Kisses was able to verbalize this problem during the interview when the Student Nurses asked her of what are their problems in their house "…ay pera apin yan ing pinakproblema mi...” (Financial problem is our worst problem) as verbalized by Mrs. Kisses. > Family's physical and manpower

resources are not enough to correct the problem. Mr. Ferrero's income is not enough to suffice their needs.

Current knowledge

 Family Resources

SN Resources

 Community Resources



3. Preventive Potential

2/3 x 1

.67

>The Student Nurses can pinpoint some tips on how they are going to minimize their water and electric consumption and enumerate some foods that are nutritious yet cheap which may help in lowering their expenses. Examples of this are:  Use fluorescent lamp instead of light bulbs.  Close the faucet when not in use  Remove barriers on the windows to let the sunlight enter the house so that they may minimize the use of electricity for lighting.  Foods such as vegetables, tofu and the like. > Community Resources are available, as these vegetables, tofu's and cheap and nutritious foods are available on the market, and fluorescent lamps are also available in the community. The problem has a moderate preventive potential as reflected by the following criteria: > The family's monthly income is really small and would not suffice their needs and if to compare with the NEDA prescribed share amount of money that each of the family members must have it is really far behind. NEDA- P2, 768.60 Chocolate family- P600 (P1200 x 4 = P4800, P4800/8 = P600) >The problem existed when they transferred to Mrs. Kisses' mother that was approximately a year

already.

Severity

▼

> The family has a current management on the problem since Mrs. Kisses helps Lola Tootsie Roll's store which help them to suffice their daily needs on food.

Duration

▼ Current Management

▲

> All of the family members are exposed to this problem.

High -risk Group

▲

4. Salience of the problem

Total Score

2/2 x 1

1

The family sees this as a problem, which is for them, needs an immediate action AEB when the Student Nurses did their interview Mrs. Kisses was able to verbalize their problem financially.

3.34

Problem# 7: Presence of Health Deficit: Malnutrition Actual Criteria Computation Justification score The problem is a health deficit; malnutrition is an alteration on the client's health due to inadequacy of the nutrients needed by the body. 1. Nature of the 3/3 x 1 1 This can be verified by using the problem FNRI chart or through BMI calculation. Malnutrition if not managed may lead to much serious health problems. 1/2 x 2 1 The problem is partially modifiable 2.Modifiability of the as reflected by the following criteria: problem > The family does not have any current knowledge on the problem, AEB the Mrs. Kisses is not aware that Snickers is malnourished.

> Family's financial resources are not adequate to correct the problem.

Current knowledge

Family Resources

> Student Nurses skills and knowledge will enable them to provide health teachings regarding proper nutrition and can enumerate foods that are nutritious and cheap that could replace/ substitute those expensive one, like instead of meat, the family can buy "tokwa"(tofu) as a substitute.

SN Resources

 Community Resources



> Community resources are available; AEB the Health Center conducts Mother's Class, which Mrs. Kisses may attend. The problem is moderately preventable as reflected by the following criteria:

3. Preventive Potential Severity

>The problem is not severe, due to the following reasons:  Only one member of the family is affected of the problem. (Snickers)

▲ Duration

▼ Current Management

▼ High -risk Group

▲

2/3 x 1

.67

 The problem can be corrected by proper motivation and compliance. > The problem exists for about 3 months already. > The family does not have any current management on the problem AEB the family is not even aware that the problem exists. > High-risk group are present, AEB other family could also be susceptible to this problem if proper nutrition will be ignored.

4. Salience of the problem

0/2 x 1

0

The family does not view malnutrition as a problem at all until the Student Nurses has informed them of the existence of this problem on their family.

2.67

Total Score

Problem# 8 Poor Home Sanitation: Inadequate Living Space Criteria

1. Nature of the problem

2.Modifiability of the problem Current knowledge

 Family Resources

SN Resources

 Community Resources

Computation

Actual score

2/3 x 1

.67

1/2 x 2

1

Justification

The problem is considered to be a health threat to the family, inadequacy on the living space denotes a crowd home environment, which is a very favorable environment for easy transfer of infections. The family’s problem regarding inadequacy of living space has a partial modifiability status as reflected by the criteria that the Student Nurses have observed: > The family has a current knowledge of the problem as Mrs. Kisses was able to verbalize the problem during the interview and stated: “maskup na kami keni, ning kayi reng anak keni lang sala matudtud magfoam la mu” (we are really crowded here, that is why my children used to sleep here at the living room) > The family’s resources are not available especially their financial resources, as shown on their problem regarding “Family size beyond what family resources can adequately provide” it reflects that their monthly income is really not enough to suffice their daily needs

therefore they cannot also suffice the expenses they need for increasing their living space to make it adequate for them. > The Student Nurses skills and knowledge can help the Chocolate family by planning on how to arrange their furniture so that they may increase somehow their living space, at least to minimize the problem if not to fix it totally.

3. Preventive Potential Severity

▼ Duration

▼ Current Management

▼ High -risk Group

▲

1/3 x 1

.33

> The community’s resources are not available since the community must implement any actions they will do to the family to the other family who has the same problem. Upon consideration of the following factors below, it shows that the problem has a low preventive potential. >The problem is considered to be severe AEB after computing the share of each family member on their living space it shows that upon dividing the whole floor area of the Chocolate Family’s house, each of the family member yields only _________ showing that the total floor area of the house is inadequate as to compare with the prescribed by the National Building code of the Philippines R.A 6541 that each of the family must have at least a share of 3 m2, therefore if it will be further divided considering the space occupied by their furniture it will yield a more lower results. > The problem was already occurring for almost a year now; it started when Mrs. Kisses family has transferred to the house.

> The family does not have any current management on their problem regarding Inadequate living space as evidenced by Mrs. Kisses statement when the student nurses asked her about their management to the problem: “ala, ala na sane na kami”(nothing, we are used to it)

4. Salience of the problem Total Score

1/2 x 1

.5

> All of the family members of the Chocolate Family are exposed to the problem as they all live on that house. Inadequacy of Living space is viewed by the family as a problem and does not need immediate action prior to the student nurses conduct their health teachings.

2.5

Problem# 9: Inadequate Immunization Status: Mrs. Kisses and Snickers Actual Criteria Computation Justification score The problem is a health threat; inadequacy of immunization status denotes inadequacy of antibodies against those specific diseases, thus it imposes possibility of acquiring those diseases when the client came into contact with these 1. Nature of the 2/3 x 1 .67 microorganism, on the Chocolate problem family's case, Mrs. Kisses has inadequate immunization on her Tetanus Toxoid which brings her to a risk of acquiring tetanus, while Snickers lacks immunization on Hepa B, which brings him at risk to acquire Hepatitis B. 1/2 x 2 1 The problem is partially modifiable 2.Modifiability of the upon the consideration of the problem following criteria:

>The family does not have any current knowledge on the problem AEB Mrs. Kisses was not aware that she lacks 3 doses of her Tetanus Toxoid vaccine and at the same time she is not aware that Snickers does not have any shots of Hepa B vaccine.

Current knowledge

Family Resources

 SN Resources



> Family manpower resources are available; the family can go to the Barangay Health Center to avail those vaccines.

Community Resources



> Student Nurses are well equipped with knowledge and skills enabling them to impart information about the importance of having a fully immunized status and the importance of each vaccine the Barangay Health Center offers.

3. Preventive Potential Severity

▼ Duration

▼ Current Management

▼ High -risk Group

1/3 x 1

.33

> Community resources are available; the Barangay Health Center offers the EPI program of the Department of Health (DOH). The problem has a low preventive potential as reflected on the following criteria the Student Nurses considered: > The problem is considered to be severe due to the following reasons:  The awareness of the family to this problem is not evident.  2 of the family member are affected by the problem.

▲

>The problem exists years before since the Snickers is now 7 years old wherein ideally he must completed the vaccine for Hepa B when he was only 1 year old. With Mrs. Kisses years have already passed and she did not got her

third dose vaccine.

of

Tetanus

Toxoid

>They family do not have any management on this problem since their awareness to this problem is not evident.

4. Salience of the problem

Total Score

Criteria 1. Nature of the problem

2.Modifiability of the problem

0/2 x 1

0

>Snickers is at risk to acquire Hepa B, AEB the disease is prevalent in the country, another thing is Snickers nutritional status is below the normal range and considered to be malnourished. The family does not view inadequacy of the immunization status of Mrs. Kisses and Snickers as a problem since they are not aware of the existence of this problem prior to the Student Nurses informing them about this problem.

2

Problem# 10 Poor Personal Hygiene Actual Computation Justification score Poor Personal hygiene is a health threat to the family as this problem 2/3 x 1 .67 predisposes to health deficits such as dental caries, pediculosis, and skin diseases. 1/2 x 2 1 After the Student nurses have observed the criteria on determining the modifiability status of the problem, it suggests that the problem is partially modifiable.

> The family does not have any knowledge that they have a poor personal hygiene as evidenced by the observations of the student nurses wherein they have observed that Mrs. Kisses does not care even her children has a dirty

fingernails and clothing because even her has a dirty clothing too.

Current knowledge

> The family has physical resources specifically cleaning articles such as soap, shampoo and the like.

Family Resources

 SN Resources



> The student nurses knowledge will enable them to provide the family with health teachings regarding personal hygiene such as cutting their finger and toenails, washing their hands and the like.

Community Resources



3. Preventive Potential Severity

▼ Duration

▼ Current Management

▼ High -risk Group

▲

1/3 x 1

.33

>The community offers Mother’s Class where the family could learn about good personal hygiene. After the Student nurses have observed the criteria on determining the Preventive Potential of the problem, it suggests that the problem has a low preventive potential. > The problem is already severe as the almost of the family members are observed to have a poor personal hygiene. > The problem on poor personal hygiene approximately exists for about a year already as Mrs. Kisses have been so busy on helping Lola Tootsie Roll on the store and often neglected her hygiene including her children. > The family does not have any current management on the problem as observed by the student nurses that Mrs. Kisses just let her children be dirty. >Mrs. Kisses, Kitkat, Snickers, and Choco Baby are all exposed to this

4. Salience of the problem

0/2 x 1

Total Score

Criteria

1. Nature of the problem

2.Modifiability of the problem Current knowledge Family Resources  SN Resources  Community Resources 

0

problem. Prior to the student nurses do their interventions; the family does not see their poor personal hygiene as a problem at all.

2

Problem# 11 Faulty Eating Habits Actual Computation Justification score Faulty eating habits is considered to be a health threat as it predisposes health problems 2/3 x 1 .67 related to Gastrointestinal system such as Acute Gastroenteritis which is very common among children. 1/2 x 2 1 The problem of the Chocolate family regarding faulty eating habits is said to be partially modifiable after the student nurses has considered the following criteria presented below.

> The family is not aware of the problem, as evidenced by the observations of the student nurses during their home visits wherein Mrs. Kisses was not able to guide her children regarding their eating pattern as she just let her children eat too much junk foods and foods that were left alone on the table. > Family’s manpower resources are available as evidenced by; Mrs. Kisses is very capable enough to educate her child about correct eating habits such as limiting the children’s consumption of junk foods. Only, Mrs. Kisses still needs motivation by the

student nurses to do this. > The student nurses with their knowledge and skills can motivate Mrs. Kisses to limit her children’s consumption of junk foods, the student nurses can also provide the family on health teaching regarding good eating habits such as instead of junk foods the children can be offered of foods that are rich in minerals and vitamins such as fruits and vegetables.

3. Preventive Potential Severity ▼ Duration ▼ Current Management ▼ High -risk Group ▲

1/3 x 1

.33

> The Barangay Health Center offers Mother’s Class that disseminates information regarding good eating habits and proper nutrition. The problem of the Chocolate family regarding faulty eating habits has a low preventive potential after the student nurses has considered the following criteria presented below. > The problem is considered to be severe as the behavior on faulty eating habits is present among the three children; Kitkat, Snickers, and Choco Baby. > The problem approximately exists for almost 9 years as evidenced by from Kitkat until Choco Baby behaviors regarding faulty eating habits is evident. > The family does not have any management on the problem as evidenced by the family is not aware that the problem exists on their family. >

The

three

children,

Kitkat,

4. Salience of the problem Total Score

0/2 x 1

0

Snickers and Choco Baby are all exposed and affected of the problem. Mrs. Kisses was not able to verbalize the existence of the problem prior to the student nurses interventions.

2

Problem# 12 Poor Environmental Sanitation: Lack of Food Storage Facilities Actual Criteria Computation Justification score The Chocolate Family’s problem on lack of food storage facilities is considered to be a health threat as it predisposes the family to Gastrointestinal problems such as 1. Nature of the 2/3 x 1 .67 diarrhea, Acute Gastroenteritis and problem other food borne diseases, since improper storage of food predisposes contamination of the food thus leading to the said Gastrointestinal problems. 1/2 x 2 1 The problem is partially modifiable 2.Modifiability of upon the consideration of the the problem following criteria:

> The family does not have any current knowledge of the problem prior to the student nurses interventions as evidenced by the behavior of the family as observed by the student nurses it shows that the family are used into that situation wherein their food are confined on a single container and mixed together. > The family does not have any physical resources such as articles like Tupperware that they can use to store their foods, and also the family does not have enough financial resources to suffice the

expenses they need for them to b able to buy those storage facilities mentioned.

Current knowledge

Family Resources

> With the equipped knowledge that the student nurses have, the student nurses are capable enough to provide health teachings to the family such as the consequences that may arise due to lack of food storage facilities such as contamination of the food they eat ant the ingredients they use in cooking.

SN Resources

 Community Resources



3. Preventive Potential Severity

▼ Duration

▼ Current Management

▼ High -risk Group

▲

1/3 x 1

.33

> Within the community vicinity, there are a lot of stores that bargains storage facilities such as Tupperware that the family can avail. Upon the assessment of the following criteria mentioned below, the problem on lack of storage facilities yields a low preventive potential. > The problem of the family on lack of food storage facilities is considered to be severe as evidenced by the observations of the student nurses upon the assessment of the housing and environmental sanitation of the house the student nurses was able to observe that the storage facility that the family uses is very dirty as evidenced by soil particles and flies present on the storage facility. > Upon the interview with Mrs. Kisses about their sanitation Mrs. Kisses was able to verbalize the following: “ah ken mi lang gulut kakabit deng pemalengki mi, ken keng dukanan

a yan, dati pa ken mi nala talaga kakabit, kasi maglutu yang lutung ulam I ma ku” (we used to put the foods that we have bought there at the back on that Tupperware, we are practicing that for a long time already, since my mom used to sell readily cooked dishes). Approximately it exists for more than a year already. > The family doe not have any management of the problem since they are not aware of the existence of the problem.

4. Salience of the problem Total Score

0/2 x 1

0

> High- risk group are all the family members of the chocolate family and their neighborhoods that tends to buy on their readily cooked dishes since the ingredients they use for cooking are all the same. The family does not see this as a problem prior to the student nurses interventions.

2

Problem# 13 Improper Garbage Disposal Actual Criteria Computation Justification score Improper garbage disposal is a health threat to the family as it predisposes a good breeding 1. Nature of the 2/3 x 1 .67 ground for vectors of disease such problem as rodents and insects which could bring about diseases such as leptospirosis, dengue and the like. 1/2 x 2 1 The problem is partially modifiable 2.Modifiability of upon the consideration of the the problem following criteria:

> The family does not have any current management of the problem as evidenced by the trash observed on their dirty kitchen.

Current knowledge

> The family has physical resources such as brooms and broomstick, Mrs. Kisses has also the capability to clean their house and environment.

Family Resources

 SN Resources

Community Resources

>The Student nurses could give the family health teachings regarding proper garbage disposal such as segregating their trash to biodegradable and nonbiodegradable.

3. Preventive Potential

> The barangay has a garbage truck which collects the garbage of the barangay. Upon the assessment of the following criteria mentioned below, the problem on lack of storage facilities yields a low preventive potential.





Severity

▼ Duration

> The problem is severe as evidenced by the observations of the student nurse on the family’s dirty kitchen wherein their trash are scattered despite the fact that they are used to store their food articles at that place.

▼ Current Management

▼ High -risk Group

▲ 1/3 x 1

.33

> The problem approximately exists for about more than a year, as Mrs. Kisses have verbalized it during the interview. “disnan mi neng makanyan ing gulut nyang linipat kami keni” (that place have that situation already when we have transferred here)

> The family does not have any current management on the problem as they just let the trash scattered on their dirty kitchen. > All of the family members are exposed to this problem since all of them live on the same house.

4. Salience of the problem Total Score

0/2 x 1

0

Prior to the student nurses do their interventions; the family does not see this a problem at all.

2

Problem# 14 Accident hazard: Fire hazard due to faulty wirings Actual Criteria Computation Justification score Accident hazards are health threat to the family; on the chocolate family’s case their faulty wirings are 1. Nature of the 2/3 x 1 .67 fire hazards wherein if fire happens problem on their house brought about by this faulty wirings, fatality is mostly to occur. 0/2 x 2 0 After the student nurses have 2.Modifiability of considered the following criteria the problem below, it reflected that the problem is not modifiable. Current knowledge

Family Resources

SN Resources

> The family does not have any current knowledge of their problem regarding faulty wirings as evidenced by ignoring the problem as stated by Mrs. Kisses upon the interview. “ah ok ya mu yan”(that is just ok)

 Community Resources

> The family’s financial resources will not be able to suffice the expenses needed to fix the problem, since they are already experiencing financial shortage for their daily needs. > The student nurses could inform the family about the existence of the problem and site some possible consequences that may arise brought about by faulty wirings such as fire. >

There

are

no

available

community resources since if the community will do something about the problem they also have to do the same actions they have done to the Chocolate family. After the student nurses have considered the following criteria below, it reflected that the problem has a low preventive potential.

3. Preventive Potential Severity

▼

> The problem is severe as observed by the student nurses as majority of the electrical wiring are exposed.

Duration

▼ Current Management

▼ High -risk Group

▲

1/3 x 1

.33

> The problem approximately exists for about 30 years since the problem have existed when Mrs. Kisses was still a child. “malwat ne yan, anak ku pa kanta makanyan ne” (that exists for a long time ago, I was still a child then...) > The family does not have any current management to the problem.

4. Salience of the problem Total Score

0/2 x 1

0 1

> All of the family members are all exposed to the problem since all of them reside on that house. Prior to the student nurses conduct their interventions; the family does not see it as a problem at all.

VI. FAMILY NURSING CARE PLAN (in order of priority) Problem# 1 Presence of vector of diseases e.g. rodents, mosquitoes, flies, roaches INTERVENTION PLAN CUES

S> "wa ating dagis keni daramadama n mila kening bubungan, egana gana atang insekto atin keni" as verbalized by Mrs. Kisses O> The student nurses have observed the following: >Presence of breeding ground of cockroach.

ANALYSIS OF THE PROBLEM

Inability to provide a home environment, which is conducive to health maintenance due to inadequate knowledge of the other means of controlling the proliferation of rodents and insects.

OBJECTIVES NSG. INTERVENTIONS

Short Term: After 2° of NI the family will be able to recall the other methods of controlling the proliferation of rodents and insects presented to them via health teaching, as evidenced by the family will enumerate the methods

RATIONALE

>Explore the family’s ideas on rodents and insect control through interview.

> To obtain a baseline data for the health teachings to be given to the family.

>Discuss with the family the causes and consequences of different vector- borne diseases.

>To increase the family’s awareness about vectorborne diseases.

>Reinforce the family’s knowledge on rodent’s and insect control through health teachings such

> To increase/ suffice the inadequacy of the family’s knowledge about rodents and insect

METHOD OF FAMILY CONTACT

H O M E V I S I T S

RESOURCES REQUIRED

Family Resources: >Manpower resources such as time and effort. >Physical and chemical resources such as insecticides, cleaning articles such as broom and broomsticks and dustpan.

EXPECTED OUTCOME

The family shall have recalled the other methods of controlling the proliferation of rodents and insects presented to them via health teaching, as evidenced by the family will enumerate the methods presented. The family shall have demonstrated

>Presence of mosquitoes and flies.

presented.

as maintaining a good Long Term: sanitation condition of the After 4 days environment. of NI the family will be >Inform the able to family about demonstrate proper handling the methods of insecticides. of rodents and insect control presented to them. >Explore the family’s reaction about the health teachings given.

control.

> To avoid accidents due to improper handling of insecticides such as poisoning. > To measure the understanding of the health teachings presented.

Student Nurses Resources: >Knowledge, skills, time and effort of the student nurses.

the methods of rodents and insect control presented to them.

Problem# 2 Presence of Pediculosis INTERVENTION PLAN CUES

S> Mrs. Kisses have verbalized the following: “ay makutu ya i Hershey [Kitkat]” “anyang anak ya pa

ANALYSIS OF THE PROBLEM

Inability to provide adequate nursing care to the infected member of the family due to inadequacy of time r/t Mrs. Kisses ADL.

Inability to provide a i Hershey home environment [Kitkat] atin conducive to personal neng kutu, I development due to Ivan inadequate

OBJECTIVES

Short Term After 2° of NI the family will be able to demonstrate understanding of the health teachings given about Pediculosis such as methods to control pediculosis as evidenced by Mrs. Kisses will be able to restate the health teachings given according to

NSG. INTERVENTIONS

RATIONALE

>Explore the family’s idea of how pediculosis occurs and their management to control it.

> To obtain a baseline data for the health teachings to be given to the family.

> Provide the family with the information regarding Pediculosis including the management that could be done to control the disease.

> to increase/ suffice the inadequacy of knowledge of the family regarding pediculosis.

>Provide the family with

> To promote personal hygiene

METHOD OF FAMILY CONTACT

H O M E V I S I T S

RESOURCES REQUIRED

Family Resources: >Manpower resources such as time and effort. >Physical resources such as cleaning and grooming article e.g. shampoo, comb, soap and the like. Student Nurses Resources:

EXPECTED OUTCOME

The family shall have demonstrated understanding of the health teachings given about Pediculosis such as methods to control pediculosis as evidenced by Mrs. Kisses will be able to restate the health teachings given according to her understanding.

[Snickers] mehawa

knowledge about hygiene and sanitation.

her understanding .

yamu

Long Term:

kaya.”

After 2 days of NI the family will be able to practice the methods of controlling pediculosis.

O> The student nurse have observed the following: > Presence of pediculosis upon inspection of Kitkat and Snickers hair.

Problem# 3 Presence of Dental Caries

health teachings regarding personal hygiene especially hair care.

to the family. >Knowledge, skills, time and effort of the student nurses.

> Instruct the family to visit the health center for consultation.

> To have a proper pharmacological management of the problem.

>Explore the family’s reaction about the health teachings given.

> To measure the understanding of the health teachings presented.

Community resources: Availability of the Barangay health center for consultation.

The family shall have practiced the methods of controlling pediculosis.

INTERVENTION PLAN CUES

S> “ay sira sira la reng ipan ku” as verbalized by Mrs. Kisses “sira la rin pu deng ipan ng Ivan[Snickers] ” as verbalized by Kitkat O> The student nurse have observed the following: > Presence of dental caries upon the inspection of Mrs. Kisses and her three children’s mouth.

ANALYSIS OF THE PROBLEM

Inability to provide a home environment conducive to personal development due to inadequate knowledge about personal hygiene.

OBJECTIVES

Short Term After 2° of NI the family will be able to demonstrate understanding of the health teachings given about Dental Caries such as its cause, methods to control and prevent dental caries as evidenced by Mrs. Kisses will be able to restate the health teachings given according to

NSG. INTERVENTIONS

RATIONALE

>Explore the family’s idea of how dental caries occurs, their knowledge of the consequences of having a dental caries and their management to control it.

> To obtain a baseline data for the health teachings to be given to the family.

> Provide the family with the information regarding Dental Caries including the management that could be done to control the disease, and

> To increase/ suffice the inadequacy of knowledge of the family regarding Dental Caries.

METHOD OF FAMILY CONTACT

H O M E V I S I T S

RESOURCES REQUIRED

EXPECTED OUTCOME

The family shall have demonstrated understanding >Manpower of the health resources teachings such as time given about and effort. Dental Caries such as its >Physical cause; resources methods to such as control and tooth prevent dental brushes and caries as toothpaste. evidenced by Mrs. Kisses will be able to Student restate the Nurses health Resources: teachings given >Knowledge, according to skills, time her and effort of understanding. the student Family Resources:

her understanding . Long Term: After 2 days of NI the family will be able to perform methods of controlling and preventing dental caries such as proper cleaning of teeth.

the consequences that may arise such as tooth loss and infection.

nurses.

>Provide the family with health teachings regarding personal hygiene especially mouth care, the frequency of cleaning the teeth.

> To promote personal hygiene to the family.

> Instruct the family to visit the health center for consultation. >Explore the family’s reaction about the health teachings given.

> To have a proper medical management of the dental caries. > To measure the understanding of the health teachings

The family shall have performed Community methods of Resources: controlling and preventing Availability of dental caries the such as proper Barangay cleaning of Health teeth. Center for consultation.

presented. Problem# 4 Poor Lighting Condition INTERVENTION PLAN CUES

S> Mrs. Kisses have verbalized the following: “dati neng madalumdum ing bale, anyang anak ku pa makanini ne” “sindyan ke mu ing sulu madalumdum eh” O> The student nurses have observed the following:

ANALYSIS OF THE PROBLEM

Inability to make decisions with respect to taking appropriate action due to negative attitude towards the problem.

OBJECTIVES NSG. INTERVENTIONS

Short Term: After 2° of NI Mrs. Kisses will be able to restate actions that could be done to improve their lighting condition as evidenced by Mrs. Kisses will be able to repeat the teachings given according to her own understanding .

RATIONALE

>Explore the family’s ideas about a good lighting condition

> To obtain a baseline data for the health teachings to be given to the family.

>Discuss with the family the importance of having a good lighting condition its benefits such as it prevents straining of the eye, and also the consequences of having a poor lighted house.

>To increase the family’s awareness about good lighting condition and promote a good attitude towards the problem.

METHOD OF FAMILY CONTACT

RESOURCES REQUIRED

Family Resources: H O M E

V I S I T S

>Manpower resources such as time and effort. >Physical resources such as fluorescent lamps. Student Nurses Resources: >Knowledge, skills, time and effort of

EXPECTED OUTCOME

Mrs. Kisses shall have restated actions that could be done to improve their lighting condition as evidenced by Mrs. Kisses will be able to repeat the teachings given according to her own understanding. The family shall have showed an improvement

Long Term: > Dark lit rooms (living room, and bedrooms) > Obstructed window

After 6 days of NI the family will be able to show an improvement on their lighting condition as evidenced by removal of the clothes that obstruct the windows and changing their light bulbs with fluorescent lamps.

>Reinforce the family’s knowledge on ways on how to provide a well lighted house

> To increase/ suffice the inadequacy of the family’s knowledge about other ways of improving their lighting condition.

>Explore the family’s reaction about the health teachings given.

> To measure the understanding of the health teachings presented.

the student nurses.

on their lighting condition as evidenced by removal of the clothes that obstruct the windows and changing their light bulbs with fluorescent lamps.

Problem# 5 Poor Ventilation Condition INTERVENTION PLAN CUES

S> Mrs. Kisses have verbalized the following: “ay malisangan keni alang hangin lulub” “malwat ne yan, anyang anak ku pa makanyan ne yan matatakpan ne keng harap mi” O> The student nurses have

ANALYSIS OF THE PROBLEM

Inability to make decisions with respect to taking appropriate action due to negative attitude towards the problem.

OBJECTIVES NSG. INTERVENTIONS

Short Term: After 2° of NI Mrs. Kisses will be able to restate actions that could be done to improve their ventilation condition as evidenced by Mrs. Kisses will be able to repeat the teachings given according to her own understanding . Long Term:

RATIONALE

>Explore the family’s ideas about a good ventilation condition.

> To obtain a baseline data for the health teachings to be given to the family.

>Discuss with the family the importance of having a good ventilation condition its benefits such as it prevents easy transfer of diseases, and also the consequences of having a poor ventilation condition.

>To increase the family’s awareness about good ventilation condition and promote a good attitude towards the problem.

METHOD OF FAMILY CONTACT

RESOURCES REQUIRED

Family Resources: H O M E

V I S I T S

>Manpower resources such as time and effort. Student Nurses Resources: >Knowledge, skills, time and effort of the student nurses.

EXPECTED OUTCOME

Mrs. Kisses shall have restated actions that could be done to improve their ventilation condition as evidenced by Mrs. Kisses will be able to repeat the teachings given according to her own understanding. The family shall have showed an improvement on their

observed the following: > Obstructed window

After 6 days of NI the family will be able to show an improvement on their ventilation condition as evidenced by removal of the clothes that obstruct the windows.

>Reinforce the family’s knowledge on ways on how to provide a well ventilated house

> To increase/ suffice the inadequacy of the family’s knowledge about other ways of improving their ventilation condition.

>Explore the family’s reaction about the health teachings given.

> To measure the understanding of the health teachings presented.

ventilation condition as evidenced by removal of the clothes that obstruct the windows.

VII. FAMILY COPING INDEX

Category 1. PHYSICAL INDEPENDENCE This category is concerned with the ability to move about, to get out of bed, to take care of daily grooming, walking, etc. Note that it is the family competence that is measured- even though an individual is independent, if the family is able to compensate for this. The family is importanthence, if the focus of care is poor, for instance, if the mother is giving care to a handicapped child that she shared with other members of the family, the independence might be considered incomplete. The causes of independence may vary however. Lack of independence in the family may be due to actual physical incapacity, the inability of “know-how”, the willingness or fear of doing necessary tasks.

Initial

Final

Justification

1 3 5 1 3 5

Initial Visit:



During the initial visit, the group had observed that Mrs. Kisses has failed to provide required personal care for herself and her children as evidenced by the presence of lice infestation, poor hair care and long fingernails of the children. The clothes of her children too are soiled with sweat and dirt.



Final Visit: The Student nurse had given them health teachings about the importance of proper hygiene; the family was cooperative to fully comply with it. The mother has allotted time and effort to manage the hygiene of herself and her children. The fingernails of her children were trimmed and they were also seen wearing their slippers most of the time especially when they are outside the house.

2. THERAPEUTIC COMPETENCE



Initial Visit: The group gave the family a score of three because Mrs. Kisses gives some over the counter medications to her children or other family members when needed. She sometimes asks for the opinions of health workers at the health center. They are not able to provide other therapeutic measures to some illness like cough and colds because of their financial limitation and lack of knowledge as well.

This category includes all the procedures or treatment prescribed for the care of illness, such as giving medications and using appliances, dressings, exercises, and relaxation and special diets.

Final Visit:

 The family has recognized their role in health maintenance and improved seeking medical assistance from a physician or from the barangay health center in order to avoid further complication or aggravation of minor illnesses. 3. KNOWLEDGE ON HEALTH CONDITION This category is concerned with the particular health condition that is the occasion for care, knowledge of the disease or disability, understanding of communicability of diseases and modes of transmission, understanding of general patterns of development of a newborn baby and the



Initial Visit: Mrs. Kisses has very limited understanding regarding disease conditions. She recognizes presence of disease but has limited knowledge about what are the causes of each. She is not aware about what further complication a certain disease can bring.

basic needs of infants for physical care and tender loving care.

 Final Visit: The student nurse provided health teachings to the family, the family did practice what was taught to them. Mrs. Kisses’ knowledge on diseases is well enough so as to take actions on the health needs of her family. They are able to go to the Health Center to consult for their condition.

4. APPLICATION OF PRINCIPLES OF GENERAL HYGIENE

Initial Visit:



This is concerned with family action in relation to maintaining family nutrition, securing adequate rest and relaxation for family members and carrying out accepted preventive measures such as immunizations, medical appraisal and safe homemaking habits in relation to storing and preparing food.

The family’s hygiene is not prioritized at the Chocolate’s Residence. This was evidenced by the lice infestation in the children, dirty fingernails and toenails, and dirty soles of the feet. The children were also seen playing outside the house without any slippers on. Choco Baby was seen sucking her pacifier even though if fell on the floor without washing it. The environment around the house as well is unorganized and leftover foods are just left on top of the table covered with plate.



Final Visit: There are some improvements noted on the appearance of the children as evidenced by the

trimmed nails of the children and wearing of slippers outside the house.

5. HEALTH ATTITUDES This category is concerned with the way the family feels about health care in general, including preventive services, care of illness and public health measures.

Initial Visit:



Mrs. Kisses benefits from the services offered by the Barangay Health Center. She never fails to seek medical advice whenever her children need it.

 Final Visit: The family maintains their positive attitude towards health. They seek medical advices as recommended. 6. EMOTIONAL COMPETENCE This category has to do with the maturity and integrity with which the members of the family are able to meet the usual stresses and problems of life, and to plan for happy and fruitful living. This involves the degree to which individuals accept the necessary disciplines imposed by one’s family and culture; the development and maintenance of individual responsibility and decision; and willingness to meet reasonable obligations, to

Initial Visit:





In times of family crisis, the family provides emotional support to each other as their means coping with their problems. The parents play a major role in providing their children with guidance. They maintain an open communication to facilitate family solidarity. However, there times when they are not able to solve other problems especially when the nature of the problem is financial. Final Visit: The family’s emotional competence remains the same. Despite of their low economic status were able to cope up on the problems they encountered and think of ways

accept adversity with fortitude, and to consider the needs of others as well as one’s own.

where in they can provide their need such as food for the day.

7. FAMILY LIVING This category is concerned largely with the interpersonal or group aspects of family life- how well the members of the family get along with one another, the ways in which they make decisions affecting the family as a whole, the degree to which they support one another and do things as a family, the degree of respect and affection the show for one another, the ways in which the manage the family budget, the kind of discipline that prevails.

8. PHYSICAL ENVIRONMENT This category is concerned with the home and community or work environment as it affects family health. This includes the conditions for housing, presence of accident hazards, screening, plumbing, facilities of cooking and for privacy;

Initial Visit:



All of the members of the family get along. However, sibling rivalry cannot be eliminated in the family. Mrs. Kisses told the group also that she and Mr. Ferrero also experiences petty fights but managed to solve them immediately.

Final Visit:

 The group taught the children that petite fights may be normal but they should know that they should be patient with each other especially the older ones. Kitkat as the eldest agreed to what the student nurses said.



Initial Visit: The Chocolate Family’s house condition is poor in nature because it is poorly ventilated and there is some presence of accident hazards that is not recognize by either Mr. or Mrs. Ferrero Chocolate. One of their problems is the presence of the faulty wirings. Some big rats were also noted on the nearby drainage which can threaten their health. The

level of community (deteriorated or modern, presence of social hazards such as bars, street gangs, delinquency, pest such as rats, etc.), availability and conditions of schools and transportation.

9. USE OF COMMUNITY FACILITIES This category has to do with the degree to which family members know about and the wisdom with which they use available community resources for health, education, and welfare. The coping ability does not indicate the level of the need for services, but rather the degree to which they can cope when they must seek such aid.

clothes are also hanged inside the house unorganized. The children are often found playing on streets.

Final Visit:





The family improved the cleanliness of the interior of the house but the surrounding environment still needs more interventions. This was evidenced by the cleaner environment. Clothes are hanged properly and the floor was properly swept.

Initial Visit: The Chocolate Family knows or uses some available community resources that are needed. Mrs. Kisses is aware of the programs offered by the Barangay Health Center but sometimes fails to attend or comply with it. They also attend or join some community activities like town fiesta and the like. Despite their awareness, they still lack knowledge regarding other free benefits that they can avail.

 Final Visit: The family acknowledges the programs available at the health center and agrees to seek advice as necessary. VIII. LEARNING DERIVED

I personally learned the importance of the family in the society, as the basic unit of the society, it is important to maintain the health of the family. Comparing the family with the human body, as when one part of the body is infected, later on the whole body will be affected systemically, just like with the family and society, when a family is considered ill, later on the society will be systemically affected. I also learned the importance of good communicating skill. With the absence of a good communicating skill the student nurse will not be able to establish rapport with his/ her client, thus affecting the assessment process, making the problem identification and prioritization be difficult, thus, altering the maximum care you may give to the family. Assessment is the very crucial part of doing the family case analysis, with all the data that you will gather throughout the assessment process, there you will derived the problems you will intervene to correct this problems. The most important thing that a student nurse must have is the initiative, time, effort, and patience, without those things you will not be able to gather all the information you need, the client’s cooperation and compliance is also a vital ingredients for the success of making a family case analysis. CARL ELIXER ANO

IX. SOCIOGRAM This chapter illustrates graphic representation of the several home visits made, including the interactions of the student nurses with the families, the assessment, planning, interventions and evaluation done.

Legends:

Student Nurses

Chocolate Family

Home

Implementations

Health Teachings

Satisfaction

Assessment & Nursing Interventions

Rapport

First Home Visit (July 15, 2008, Tuesday)

During the initial home visit, the student nurses went to the Chocolate’s Residence for the first time and they have a vague feeling about meeting them because they don’t know what to expect towards the response of the family upon their arrival. Upon meeting them, they started to establish rapport and told the family about the purpose of their study. The family responded towards the student nurse’s request though it is obvious that they were not that comfortable with each other yet.

Second Home Visit (July 16, 2008, Wednesday)

At the second home visit, the student nurses started the thorough assessment of the two kids, Kitkat and Toblerone. They also imparted initial health teaching regarding the existence of potential and actual problems that may threaten the health of each family member. During this home visit, the group is not yet that confident regarding their relationship with the family.

Third Home Visit (July 21, 2008, Monday)

During this home visit, the group assessed Mrs. Kisses and Baby Ruth. They also imparted more health teachings to the family. This time the group is more at ease with the family.

Fourth Home Visit (July 22, 2008, Tuesday)

During the 4th home visit, this time, the student nurses started their final assessment at the same time they started implementing the plan of actions regarding the problems diagnosed during the earlier home visits. The family’s and the group’s relationship by now is very much established.

Fifth Home Visit (July 29, 2008, Tuesday)

During the 5th home visit, the student nurses continued assessing the family and put their plan into action by means of implementation. They also gave some health teachings that day.

Sixth Home Visit (July 30, 2008, Wednesday)

This is the last and final home visit conducted. The student nurses this time assured that all data needed are complete and they gave further health teachings regarding the potential and actual problems that may threaten their health. During this time, the family showed satisfaction and appreciation for what the student nurses are doing. The group as well gave them a positive feedback and thanks them for allowing the group to conduct the study with their participation.

X. SPOT MAP AND DOCUMENTATION

Sto Rosario. St.

F. Lazatin

St. Jude

San Fabian

Chocolate’s Residence Barangay Health Center

DOCUMENTATION:

CHOCOLATE FAMILY

Kitkat, Mrs. Kisses, Snickers ChocoBaby

Snickers, ChocoBaby, Kitkat

THE STUDENTS NURSES with THE CHOCOLATE FAMILY

XI. BIBLIOGRAPHY

Untalan, A. Concepts and Guidelines in COPAR. 1st ed. Manila: Educational Publishing House, 2005. Maglaya, A. Nursing Practice in the Community. Marikina City: Argonauta Corp., 2004. Cuevas, F. et. al. Public Health Nursing in the Philippines. 10th ed. Philippines: 2007 http://wisdomquotes.com http://psychology.about.com/od/theoriesofpersonality/ss/psychosexualdev.htm http://psychology.about.com/od/theoriesofpersonality/a/psychosocial.htm

Handouts from: Primary Health Care II (2007-2008)