Family Case Study For Hydrocephalus

INTRODUCTION A family is a primary social group, a small community, in any society, typically consisting of a man and a woman, or any two individuals who wish to share their lives together in a long-term committed relationship with one another, raising offspring and usually resides in the same dwelling. It is the main building block of a community; family structure and upbringing determines the social character and personality of any given society. it is also the place where we all learn: love, caring, compassion,

ethics,

honesty,

fairness,

common

sense,

reason,

peaceful conflict resolution and respect for ourselves and others, which are the vital fundamental skills, and family values, necessary to live an honorable and prospers life in harmony, in the world community. During our community exposure at Barangay Pala-o, Iligan City, we had our home visitation where we chose to have the family with most cases to assess with for our presentation. Among the families, we chose the family with a unique case. Thus, we chose Salic Family, in which one of their family members is suffering from a wretched condition, a condition called hydrocephalus. Hydrocephalus is a condition caused by an imbalanced in the production and absorption of CSF in the ventricular system. When production is greater than absorption, CSF accumulates within the ventricular system, usually under increased pressure, producing passive dilation of ventricles. However, there are two classifications of hydrocephalus namely communicating and non-community hydrocephalus. Communicating hydrocephalus is also known as non-obstructive hydrocephalus.

It

is

caused

by

impaired

cerebrospinal

fluid

reabsorption in the absence of any CSF-flow obstruction. On the other hand, non communicating hydrocephalus also known as obstructive hydrocephalus is caused by a CSF –flow

obstruction (either due to external compression or intraventricular mass lesions). We believed that the youngest member of the Salic Family who is a

39

days

old

infant

is

manifesting

the

said

condition

upon

assessment. The infant manifests abnormal reflexes (no rooting, and moro reflexes), a bulging forehead with prominent fontanel, a slowed heartbeat and respiratory rate, and a thin transparent scalp. Besides from the emerging problem of the infant, other members of the family, the mother of the infant and the second child also manifests some chronic condition like asthma.

FAMILY CASE STUDY I. FAMILY STRUCTURE, CHARACTERISTICS AND DYNAMICS

NAME

AGE

SEX

CIVIL

EDUCATIONAL

STATUS

ATTAINMENT

MARRIED

COLLEGE GRADUTE

RELIGION

FATHER: Jaffar Salic

39

M

ISLAM

(BS CRIMINOLOGY)

MOTHER: 37

F

Abdul Jabar Salic

10

M

Jehan Salic

7

F

Jirah Salic

3

F

Abdul Raffy Salic

39 days old

M

Edna Salic

MARRIED

COLLEGE GRADUTE (BS BIOLOGY)

ISLAM

GRADE 5

I S L A M

CHILDREN:

S I N G L E

GRADE 2 N/A N/A

TYPE OF FAMILY STRUCTURE:

The type of family structure is said to be extended, since the family with their other relatives, specifically the mother, live together within the same household sharing a common goal and interest. DOMINANT FAMILY MEMBERS IN TERMS OF DECISION MAKING ESPECIALLY IN MATTERS OF HEALTHGCARE:

Since the father is away, the mother takes the responsibility and is dominant in the entire decision making especially in matters of health care. GENERAL FAMILY RELATIONSHIP/DYNAM ICS:

The Salic family lives in the same household peacefully. Whenever there is a problem in their family member, they make an immediate response to it. When it comes to money matters, the mother is the one who decide and in terms of physical aspect, both husband and wife decide together Ergo. Their family share common interests and goals as well. II. SOCIO-ECONOMIC The father is a policeman and is currently working at Ramayan and sometimes somewhere in Cotabato City. The mother is a fulltime housewife. The father earns 22,000 pesos every month. But the family only receives 1,500 pesos every fifteenth day of the month because of the deduction such as loans and debt. Fortunately the mother verbalized that the income is adequate to meet the basic necessities of the family. Since the mother is the who is dominant in the family, she is also the one who makes decision about money matters and how it is spent. Also, the mother of Mrs. Salic, who is living with them, supervises her daughter

and helps in the expenses of the family through a small sari-sari store and with the help of her pension as well. III. HOME ENVIRONMENT. 1. HOUSING A. LIVING SPACE The house consists of 5 bedrooms, adequate for a family of 7 members. It measures 71 sq. meters. The living room has adequate space for the members to move. Things inside the room are organized, but some things like the plates and other cooking utensils are placed in the sink unwashed. B. SLEEPING ARRANGEMENT The family, as well as their mother and brother has their own room. Mrs. Salic sleeps together with her three children in their room. C. PRESENCE OR BREEDING/RESTING SITES OF VECTORS Upon our observation at the house, it is well cleaned and there is no noticeable areas where rodents and other vectors could reside in. D. PRESENCE OF ACCIDENTAL HAZARDS The house is located in a safe place, away from the busy streets of highways nor near or under the coconut trees. Sometimes, the mother left the house with his 10 year old child. But the mother verbalizes that the child could be trusted because she had done it many times with the child left alone at home. Unfortunately, the house has stairs made of concrete with no hand drills and some are stiff particularly when going to the rooftop where the family hangs in their clothes. E. FOOD STORAGE The family has 2 refrigerators enough for their uncooked and cooked foods to be stored. F. COOKING FACILITIES The family uses charcoal as their main cooking facility. Other than that, they also have enough cooking utensils such as cooking pot, frying pans, plates, drinking glasses, spoons, forks and etc. Their cooking area is located outside the house near their room. G. WATER SUPPLY The family has its own water supply via faucet. Unfortunately, the water supply at their area is not doing well. The water flow sometimes for

two hours at most time. As verbalized by the mother, the water is well chlorinated. As for drinking water, they bought from a near water refilling station. H. TOILET FACILITY The family has 3 toilet facilities, one for the family, one for the other members and one for the visitors and with good sanitary condition. I. GARBAGE DISPOSAL The family has their own trashcan capable of storing garbages for 1 week at most, and it is at good sanitary condition. J. DRAINAGE SYTEM The kind of drainage system the family have is blind and it is at good sanitary condition. 2. KIND OF NEIGHBORHOOD The Salic family is situated at Barangay Pala-o, and it is a rural area, approximately 2-3 kilometers away from the city. 3. SOCIAL AND HEALTH FACILITIES AVAILABLE The family benefits from the services offered by the Barangay Health Center; this is where their children received their full immunizations except the youngest son due to anxiety of the mother. The other facilities within the community are the recreational facilities like basketball court and volleyball court.

4. COMMUNICATION FACILITIES AVAILABLE Salic family does not have a telephone connection. They only use cellphone as a means of communication. 5. TRANSPORT FACILITIES AVAILABLE The Salic family owns one “sikad” but “jeepney” is their main transportation going to the city. III. HEALTH STATUS OF EACH FAMILY MEMBER 1. Medical history & Past illness Medication hereditary diseases taken/treatment done No hospitalization Aspilet Father: experienced Hypertension

Mother: Allergy(crabs) Children: 1) No past illness

No hospitalization Herbal Plants experienced

No hospitalization experienced

2) Allergy(crab), asthma

Check-up (City Hospital Allerkid (syrup) under Dr. Gomez)

3) No past illness

no

4) Hydrocephalus

Aug. 30, 2009 (City Tiki-tiki( Hospital under Dr. Lim, Dr. supplementation) Gomez, Dr. Bilario

for

2. BELIEF AND PRACTICES RELATED TO HEALTH AND ILLNESSES They usually self-medicate for themselves using their stored knowledge to treat a certain disease. They used herbal plants such as “tawa-tawa”, ”bugayana”, guava leaves, etc.

3. NUTRITIONAL ASSESSMENT A. Anthropometric Data

CHILD 1 (10yrs old) CHILD 2 (7yrs old) CHILD 3 (3yrs old) CHILD 4 (39 days old)

HEIGHT

WEIGHT

137cm 110cm 92cm 49cm

25kg 18kg 14kg

UPPER ARM CIRCUMFERENCE

B. Dietary History indicating quality and quantity of food intake per day They usually eat three (3) times a day. They usually eat fish, vegetables as viands but sometimes they will just buy to the neighborhood or the ready made viands like vegetables etc. Since the family is Maranaos, they don’t it pork.

C. EATING/ FEEDING HABITS PRACTICES They usually eat three (3) times a day with the typical meal. They used to have snacks between meals and the grandmother is very strict in implementing no junk foods during snacks. The family consumed about ½ galloon of water everyday. 4. DEVELOPMENTAL ASSESSMENT OF INFANT, TODDLERS, AND PRESCHOOLERS

As we had our assessment regarding the infant growth and development manifested the following sectors. , the infant First we had assessed the child and noticed that he is a hydrocephalic child. In the physical development, his weight and height are below normal. His head and chest circumference are not also developing. During the reflexes, the infant doll’s eye and dance reflex are fading. The infant’s posterior fontanels are closed, and the crawling reflex also disappears. Abdomen when prone, can even turn his head side to side when prone, and lifts head momentarily from bed. The infant has marked head lag, especially when his pulled from lying to sitting position but cannot hold head momentarily parallel and in mid-line when suspended in prone position. When held in standing position, the body is limped to his knees and hips. But when placed in sitting position, the back is not uniformly rounded with absence of head control. During the fine motor assessment, the infant’s hands are predominantly close with strong grasp reflex and hard clenches on the contact of the rattle. In his sensory development, the infant wasn’t able to fixate on moving object in range of 45 degrees. When held at a distance of 20-25cm. The infant also follows light to mid-line and quiet when hears a voice. In his vocalization development, the infant cannot able to cry to express his displeasure. But can make comfort sounds during feeding. In his socialization development, the infant was not in sensorimotor stage and can’t able to watch the patient face intently as she talks to the infant. During the reflex assessment, the infant was able to perform the grasp, babinsky, sucking, stepping but not in moro reflex. As we assess Jairah, a three year old daughter of Mrs. Salic, she also manifested different sectors. In her physical development, she gain weight normally and stands 92cm. In her gross motor development, she could jump of bottom step, and stands on one foot in a few seconds. She could also goes upstairs using alternate feet.In her fine motor, she couldn’t build a tower of 9-10 cubes, but could build bridge with 3 cubes. In drawing, she could copy a circle, imitates a cross and names of what has been drawn. In her language development, she doesn’t have a vocabulary of 900 words. She can’t also complete a sentence from 3-4 words. However, she could repeat sentences with 6 syllables and even asks many questions. In her socialization development, she dresses herself almost completely. And she even could feed herself completely. She could also prepare simple

meals such as cereals and milk. She also has fears especially in dark when going to bed. She knows her own gender, and also the gender of others and engaged to learn simple games, but she often follows her own rules. In her cognitive development, she is in preconceptual phase, has beginning to understand time, has improved her concept of space and has the beginning ability to view concepts from another perspective. When it regards to her family relation, she always attempts to please her parents, and conform to their expectations. She is less jealous to her younger siblings, she’s aware of family relationships and even in sex role functions. She has an increased the ability to separate easily to her parents for short period. As we have assessed Jehan, the elder sister of Jairah, shows a gain in her weight as well as her height also. Her maxillary incisors and lateral mandibular incisors erupt. Her jaw begins to expand to accommodate permanent teeth. Her mental development, she could easily notice that certain items are missing from pictures. She can also copy a diamond, repeats 3 numbers background, develops concepts of time and more mechanical in reading. She can also attends second grade. In her adaptive development, she knows how to use a knife for cutting. She can also brush and comb her hair acceptably without help. She also likes to help and have a choice. In her personal-social development, she’s becoming a real member of the family group, always takes part in group play, spends a lot of time alone. Abdul Jabbar is a 9 year old child. He also shows a gain in height and weight. In his mental development, he attend fifth grade. Could write short letters to friends or relatives on his initiative. Uses telephone for a practical purposes and respond to magazine, radio, and other advertising. He also reads for practical information or own enjoyment. In his adaptive development, could make useful articles or does repair work, also cook or sew in small way, washes and dry own hair. Also responsible for a thorough job of cleaning hair, but may need reminding to so. He is also sometimes left alone in home for an hour. However, he is successful in looking after own needs or those of other children left in his/her care. In his personal-social development, he loves friends and talks about them constantly, chooses friends more selectively and enjoys a conversations. He also develops interest in opposite sex, likes family, and likes mother who wants to please her. Also demonstrate affection, likes his father who is admired and may be idolized and respect his parents. 5. PHYSICAL ASSESSMENT INDICATING PRESENCE OF ILLNESS STATES 6. LABORATORY/ DIAGNOSTIC RESULTS

V. VALUES, PRACTICES, ON HEALTH PROMOTION/ MAINTENANCE AND DISCUSS PREVENTION A. IMMUNIZATION According to Mrs. Salic, her children had undergone complete immunization including BCG, OPV, DPT, Measles, Hepatitis immunization except for the youngest son due to his condition. B. EXERCISE The daily activities of the family members serve as a form of exercise. C. PROPER DIET The Salic family have a balanced meal regarding their diet. D. STRESS MANAGEMENT The mother has an effective stress management due to the condition of her baby. She has only 2 hours of sleep. E. SMOKING/ALCHOLIC DRINKS The father is the only one who smokes and drinks in the family but he is always not around. Therefore, the family is not directly exposed to second hand smoke. No one in the family uses drugs. F. SLEEP AND REST The mother has only 2 hours of sleep. The children sleeps at least 10 hours every day and they don’t manifest problems with their sleeping habits.