Latest Fca Revsion (march 9'08)

I. Introduction

“Where does the family start? It starts with a young man falling in love with a girl - no superior alternative has yet been found”. --Winston Churchill Indeed, it is a lovely start to find a man falling in-love with a young lady. It is where the growth of a fruitful family is rooted. Nourishing that love between the family members, it is heart-melting to reminisce that once, in the life of both this parents, they were plainly in-love. Eventually, as the love grows, lives were added. More love binds the relationship as a whole. More love stands as the walls that protect. More love holds them up. More love binds them together. Taking a simple look, you will see that the mother of the adopted family is seriously committed to this love. No greater fulfillment is going to even the feeling of being a part of this family even just for a while. As nurses, being under the same roof with the clients, gave the student nurses in this study a glimpse of their life as a family—their whole being. Family as the client has been the main concern of this Family Case Analysis (FCA). It is one basic principle of Community Health Nursing (CHN) where it is stated that the family is the unit of care, for an individual would always belong to a family. Thus, Family Health Nursing is the basic and core component of CHN practice (Bailon-Reyes, 2006, p.8) Family is the basic unit of the society. Moreover, the society is the public. By that, it is clear that Public health is the main concern of CHN. Winslow defined public health as the science and art of preventing disease, prolonging life, and promoting physical and mental and efficiency through organized community efforts towards a sanitary environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing service for the early diagnosis and treatment of disease and the development of social machinery which will ensure to every individual in the

community a standard of living adequate for the maintenance of health” (p.30 Winslow, 1989). The people that builds up the country and the world at large, and the same persons who are potential of being ill or healthy makes up this “public”—the community. Therefore, promoting a healthy community is the main goal of CHN. Employed CHN is a synthesis of nursing practice and public health practice applied to promoting and preserving the health of the populations. The practice is general and comprehensive. It is not limited to a particular age group or diagnosis, and is continuing, not episodic. The dominant responsibility is to the population as a whole; nursing directed to individuals, families, or groups contributes to the health of the total population. Health promotion, health maintenance, health education, and management, coordination, and continuity of care are utilized in a holistic approach to the management of health care of individual, family, and group in a community. (ANA, 1980, p.2) Throughout the course of this FCA, the adopted family had been assisted in identifying their existing problems as they were taught to cope with it and eradicate unnecessary conditions and factors to improve their health and quality of life as a whole. As to maintain the privacy of the adopted family, they were assigned with pseudonames that would be used for the whole activity. Namely: Mr. Lorenzo for the father, Mother Mae for the mother, Anthony for the youngest (son), and Ann for the eldest (daughter). The student nurses involved in this study aim to help the said family as far as they can to add another piece of experience to their student lives. Also, to give back the love lavished upon them though they were not lawfully part of this family. Most especially, it helped them nourish the love and compassion found in being Christ’s servant as nurses while their future careers is fast approach.

A. Objectives a. Short Term (Student-centered) After one to two days of home visits, the student nurses will be able to: ♥ Introduce the purpose of their family case analysis. ♥ Establish rapport with all or at least some of the family members as evidenced by (AEB) light conversations. ♥ Gain their trust and the necessary cooperativeness AEB answering interview-questions honestly. ♥ Assess the history and health status of all or at least some of the members. ♥ Perform physical assessment of the present members of the family cephalo-caudally ♥ Identify potential problems that might exist or actually existing related to hygiene, sanitation, or health condition. ♥ Initiate planning of the possible interventions. (Family-centered) After one to two days of home visits, the family will be able to: ♥ Accept and understand the underlying purpose of the family analysis AEB accepting the offer of making them the subjects and showing cooperativeness. ♥ Establish rapport with all the student nurses AEB light conversations. ♥ Trust to the student nurses AEB allowing them to join in their side-line job. ♥ Show enthusiasm in physical assessment done to them.

♥ Cooperatively respond to the questions asked such as regarding history and health status of the members. ♥ Honestly mention

the

reason

behind

some

recognized

problems related to hygiene, sanitation, and health condition. b. Long Term (Student-centered) After four to five days of home visits, the student nurses will be able to: ♥ Gather the necessary information to formulate the appropriate nursing intervention. ♥ Identify all the existing problems and properly provide immediate interventions and plan for long term interventions such as maintenance of good sanitation. ♥ Establish stability with regards to the family’s health status AEB normal vital signs and decreased risk factors. ♥ Supply or advice the family to supply lacking materials in the house that cause problems to arise. ♥ Achieve the goals they have set like gaining the family’s trust. (Family centered) After four to five days of home visits, the family will be able to: ♥ Manifest enthusiasm in resolving the existing problems AEB inquiry and initiative in management of the problem ♥ Participate in care provided to them by student nurses like physical examination and interventions in sanitation. ♥ Initiate lifestyle changes necessary to obtain improvement in health status. ♥ Comply with the habit modifications carefully provided to them by the student nurses.

♥ Switch to the proper treatment or utilize community health center before consultation to herbolarios ♥ Seek health care from authorized providers of care and utilize community resources. A. Early Climate and Acceptance, First few words, Number of visits “Immersion” is the best way to describe the bustle of home visit. The group felt very excited before they are immersed in the community and meet the chosen family. On the 21st day of February, 2009 was the start of the group to be in the community. They are assigned in zone 2 of Macapagal Village, Clark Field, Pampanga. The student nurses have criteria in choosing a family in which the family should be classified as poor where in the allowance of the each of the family members are less than P2, 768.00, family member of five and above, a living children less than 7 years old, and the most Important of all is that they are willing to cooperate. The family is very supportive and very warm, very cooperative and they are very friendly, they are also very accommodating to the point that whenever they do something, they stop it or do it while entertaining us, multi-tasking it is. They also always see to it that nobody stands and gives everyone a very comfortable chair to seat to. They even thought us the barbecue stick making, the mother’s sideline. They have a very cheerful aura. 1st Home Visit – January 21, 2009 It was a very hot day when the student nurses met the chosen family at around 10:30 in the morning. On the same day the student nurses stated their purpose of visiting the family. The group was overwhelmed with the hospitality shown by the family. “Good morning pu ate! Pwede da kayu pu ainterview?” said by the student nurses. “Uwa sige, gawan yu kaming family yu!” said by the mother. The group explained the purpose saying “taga AUF kami pu, ikayu pu ing apili mi para keng Family Case Analysis mi. Bali mga two to three weeks kami pu kanyan mumunta keni.” “uwa ok mu pu itamupin pu mamako kung 11 am ne?”

we were struck because of the response of the mother saying “uwa gawan yu kaming family yu!” and gave as the thought of them being a subject of a previous FCA subject, and true, they were used as the subject with a preceding FCA. Never the less, that did not gave the group a negative notion and continued the purpose. At that moment the student nurses established rapport and had light conversations with the family and able to take their 1st vital signs and did physical assessment to the few members present. 2nd Home Visit – January 22, 2009 It was a hot Monday morning when the student nurses conducted their second home visit. They went to the chosen family at around 10:00 p.m. in the morning. The groups were very much welcomed by the family with hospitality while the mother is doing her “sideline”, making barbeque sticks. On the second day of interview, the student nurses interviewed the family regarding their demographic data. They were able to take the history of past and present illness of the family as well. Mentioning the death of Mother Mae to be caused by cancer, they wee able to explain that the heredity factor can predispose her to the said disease. They also assessed the problem is experienced by the family experiencing and classified them. They were also thought of the barbeque stick making and had a wonderful experience, not mentioning the sticks we have broken. 3rd Home Visit –January 23, 2009 A sunny morning around 10am when the member of the group went to the chosen family and the mother is not at home; her sister who’s living in the left side of their family subject’s house entertained them. She told them that mother is on the PTA meeting with her children at school. On that day, the student nurses made an ocular inspection of the house, of course with the consent and supervision of the sister of mother Mae. On that said day, they have also identified problems that the family is experiencing like the inside of the house having improper disposal of garbage and some exposed wires. While some of

the group outside noticed the poor drainage system. Also the practice of the burning garbage where ashes where ashes are found scattered outside. 4th Home Visit – January 27, 2008 For a change, it was a very cloudy morning when the student nurses went to the family and welcomed them again with hospitality and it was the very first time for the group to see the youngest and the big sister who were preparing for school. With a limited time, they took their physical assessment for not to soil the oppurtunity. It was around 10:30 a.m. when the group arrived in the family with a rushing behavior because they are avoiding the mother to be disturbed, as to her kindness, she asked them to stay for a while and wait for her as she took her children to school. Patiently waiting, mother Mae arrived and she urgently entertained the group with her apologies of waiting for her. As usual, they made an interview and conducted a physical assessment to mother, and this time, they made is as comprehensive as they can. They also pointed out the problems they identified during the previous home visit. Mother Mae interestingly showed enthusiasm in resolving the problems. They cleaned the house and threw the garbage. They also advised her to refrain from burning the garbage outside. 5th Home Visit –January 28, 2009 It is a Wednesday morning as they arrived in their family and mother gave them a big “HELLOOOOOOOO” and a smile on her face showing her enthusiasm as they arrive. Immediately they conducted the interview completing the requirements and asking the left questions unasked. As they come deeper with their rapport to the mother, they have come to the point of asking their favorite foods, past time etc, there then the mother asked the group if they are eating the famous “native adobo” and that craved the appetite of the group. They also begun giving health teachings to Mother Mae such as visiting the health center. They also evaluated the coping of the family with regards to the changes being applied like the garbage disposal and such. As time pass by, the conversation went. When the group were about to go, mother Mae said, ”Sandali

lang may papabaon ako sainyo, ulamin nyo masarap ito.” The group reluctantly took the plastic bag not knowing what is inside. As they arrived at the heath center, they checked the plastic bag seeing a hot freshly cooked native adobo. How thoughtful their family was. 6th Home Visit –January 29, 2009 It is the last day of home visits and the group and stayed for a while, they helped the mother make barbecue sticks and had a meaningful conversation while doing the chores. This was also the time for them to evaluate the changes in behavior that took place on the part of the subjected family. They also performed final physical assessment to compare the progress with the initial data. This served as an over-all evaluation of the family’s health status. As the clock waved goodbye, the group gave tokens to the family as a sign of their gratitude for the kindness the family gave to them. The families were so happy for the things that the group gave them that the mother said a million of thanks. It was a happy satisfying overwhelming experience that the group will possibly remember forever. II. Family Constellation NAME

AGE

SEX

POSITION IN THE FAMILY

EDUCATIONAL ATTAINMENT

GENERAL APPEARANCE

Mr. Lorenzo

37y/o

male

father

Elementary graduate

(Referring from pictures) He is approximately the same or slightly taller than Mother Mae and not too fat and not too skinny. He has thinning hair on the front part of his head. He has light brown-colored skin. According to Mrs. Mae, Mr. Lorenzo works in a company (junkshop). He goes to his work by means of a bicycle. Mrs. Mae told the group that his husband is a smoker he consumes 1 pack of cigarette every day. He seldom experience cough and colds.

Mrs. Mae

30y/o

Female

Mother

High

school

graduate

On the group’s initial visit Mrs. Mae was wearing a yellow tshirt and blue pajamas and her hair was pony tailed. Mrs. Mae is 30 years old who weight 49kg and has a height of 152 cm. her vital signs were taken and recorded as follow; T = 36.1°C/axilla PR = 55cpm RR =20bpm BP = 110/70mHg Height: 152cm Weight: 49kg BMI: 21.21 Nutritional status: normal

Ann

9y/o

female

Eldest child

Still Elementary

in Upon initial visit Ann wearing a clean school uniform, and black shoes. She is alert and awake. Ann 9year old. Her vital sign are as follow: T = 36.5°C/axilla PR = 83bpm RR =17 cpm Height: 125cm Weight:31 kg BMI: 19.84 Nutritional status: normal

Anthony

5 y/o

Male

Youngest

Still Kindergarten

in During the initial visit Anthony was seen clean white sando and blue short. He has black complexion with short nails. Anthony is a 5 year old who weight 15 kg and has height 111 cm. temperature: 36 *C: Pulse Rate: 120 bpm: Respiratory Rate: 23 cpm.. T = 36°C/axilla PR =120bpm RR =23cpm Height: 111 cm Weight: 15 kg FNRI= normal weight should be 14.4 to 23.5

III. Health Assessment (IPPA-CEPHALOCAUDAL)

Mother: Mae Macapagal Physical Examination First Home Visit (January 23, 2009) A. General appearance and Behavior On the group’s visit Mother Mae Macapagal was wearing a yellow t-shirt and blue pajamas and her hair was tied up. Mother Mae Macapagal is 30 years old who weighs 49kg and has a height of 152 cm. Her vital signs were taken and recorded as follow; temperature: 36.1°C: Pulse Rate:55 pm: Respiratory Rate:20cpm: blood pressure 110/70 mmHg Physical Assessment Mental Status • Client is alert and awake with eyes open and looking at the student nurse. • She established eye contact when asked questions. • She also smiles and frowns appropriately without difficulty. • The client is cooperative, when asked, can answer properly. • The client was able to express free-flowing thoughts and expresses realistic perceptions. • She is aware of self, other, time, home address and current location.

• • •

She listens and can follow directions without difficulty. She was able to recall recent event without difficulty. She recalls her birthday and answer information correctly.

Motor Function -Walking gait – has slouched posture with opposing arm swing upon walking; maintaining balance Integumentary System: • Skin is brown in complexion, no odor, and uniform in color. Her skin turgor is normal because when her skin was pinched, it go back to previous state immediately. The skin is not edematous and is in normal temperature. With sensation to touch, pain & temperature. Skull & Face (Head) • She has a round skull, no contusions, bruises noted nodules and masses, and no tenderness palpated. She has symmetrical facial movements as evidenced by client’s ability to smile, frown, raise his forehead & eyebrows & shows his teeth. Facial features and facial movements are symmetrical. Hair • Hair is long, dry, straight, thick, black and evenly distributed hair. There is no dandruff, no area of loss of hair and no infection/infestation. Nails • Her nails are untrimmed and dirty as well. She has light brown, smooth, epidermis is intact, has convex curve nails, no discoloration of the nail beds, no clubbing of nails, normal capillary refill (<2-3 sec), and no edema. Eyes and Vision • Eyebrows are symmetrically aligned, evenly distributed and has equal movements. • Her eyelashes are evenly distributed, upper eyelashes are slightly curled upward and lower eyelashes are slightly curled downward. • Eyelids are intact and closed symmetrically, bilateral blinking. In her bulbar conjunctiva capillaries are slightly visible and sclera appears white. • Her palpebral conjunctiva is shiny and pink in color. • Lacrimal gland, lacrimal sac and nasolacrimal duct has no edema or tenderness. • Cornea upon inspection for clarity it is shiny and transparent. When checked for corneal sensitivity test it has positive blinking reflex because her eyes blink when it is touched by the cotton. • Her pupils are equally round and reactive to light and accommodation. The student nurse holds an object from the nose of the client and asked the client to look object then to a distant object. Upon looking, the client’s pupils constricts when looking at near objects, and dilates at far objects

• • •

The client can see objects at the periphery by letting her cover her right eye and look directly to the student nurse’s nose. Holding the penlight in the periphery, the client was able to spot the moving object. Holding a penlight, the student nurse asked the client to follow the movement of the penlight with the eyes only to test for extraocular muscle test. The nurse then moved the penlight using the 6 cardinal movements. The client’s eyes have coordinated movements.

Ears and Hearing • Her ears (auricles) are symmetrical in size and auricles aligned with the outer canthus of the eye. No lesions or masses noted. • Pinnas are elastic recoils after folded, firm and without tenderness upon palpation. • Internal ear has no lesions and with a presence of dy cerumen, Nose and Facial Sinuses • Her nose is symmetrical and uniform in color; there is no discharge or flaring, no lesions or tenderness. • Air moves freely as the client breathes through nares by asking client to exert pressure on the nares, and breathe through the opposite. • Her facial sinuses are not tender. Mouth and Throat • Her teeth are incomplete; she has 33 set and all have dental carries. Her teeth are yellowish in color. • Her tongue is pinkish in color, moves without restraint, no tenderness and no lesions. • Soft palate is light pink in color and it is smooth. Her hard palate is lighter pink in color compared to the soft palate. • Uvula is positioned in the middle of the soft palate. • Oropharynx and tonsils are pink and smooth, no discharge and are not inflamed. Chest and Back • Skin at the back is intact with uniform in temperature. • Chest is symmetric in volume, no tenderness and masses, full and symmetric lung expansion, and resonant sound upon percussion over the lungs and no adventitious breath sounds. • Breathing pattern is normal with symmetrical chest movement noted on anterior thorax. She has a regular heart beat pattern. • Spinal cord is vertically aligned. She has a slouched posture, with right and left shoulders at the same height.

Abdomen • Uniform in color, not distended, rounded symmetric contour and movements upon by respiration and with audible bowel sounds every 5 to 20 seconds, No lesions noted, no tenderness, relaxed abdomen with smooth and consistent tension.

Thorax and Lungs • Posterior thorax is chest symmetric. Regarding her spinal alignment, her spine is vertically aligned; slouched postures, left and right shoulders and hips is at the same height. • Jugular veins are not visible. Upper Extremities • There are firm with coordinated movements; • Her bones and joints have no deformities, tenderness nor swelling noted. • She can sense touch, pain and temperature. • The client is able to repeatedly and rhythmically touch the nose during the “finger to nose test”. Lower Extremities • The muscles in the lower extremities are symmetrical. • The client can resist against the pressure given by the student nurse and elicited fine coordinated movements. • The bones and joints in the lower extremities have no deformities and pain, temperature and touch is felt. • The client’s gait and balance is stable. She can walk in straight line and can maintain balance. B. CRANIAL NERVES CN 1: OLFACTORY Type: Sensory Function: Smell Tests perform: The student nurse asked the client to close her yes and identify different aromas such as perfume and coffee. Expected result: She is expected to identify the different aromas such as perfume and coffee presented with hers closed. Actual Result: Mother Mae was able to identify the aromas of perfumes and coffee. CN ||: OPTICS

Types; sensory Function: vision and visual fields Tests perform: the student nurse asked her to read on the newspapers Expected result: the client will be able to read the newspapers Actual result: Mother. Mae was able to read at a distance of 14” CN |||: OCULOMOTOR Types: motor Function: Extra ocular movements of the eyes, movement of the sphincter of the pupils. Tests performed: the student nurse made use of a penlight at a distance of 1 foot in front of the client’s eyes and asked the client to hold the head in a fixed position facing the student and followed the movement of the penlight with eyes only. The student nurses assess the 6 ocular movement and pupil reaction. Expected result: client is expected to move her eyes though the cranial fields of gaze that is from the center to the upper right, upper left lower right, lower left and medially. Actual result: Mother Mae was able to move her eyes though the cranial fields of gaze that is from the center to the upper right, upper left lower right, lower left and medially. CN|V: TOCHLEAR Types: motor Function: extra ocular eye movements specifically nerve eyeball downward and laterally Tests perform: the student nurse asked to asses the 6 ocular movements using the penlight at distance or 1 foot and followed the penlight with the eyes only Expected result: Mother Mae will be able to move her eyes downward obliquely Actual result: Mother Mae was able to move her eyes downward obliquely without moving hid head. CN V: TRIGEMINAL Type: motor Function: jaw movement and mastication, Sensation of cornea, skin of face, and nasal mucosa Tests perform: The student asked the client to look upward, lightly touch lateral sclera at eye to elicit blink reflex. To test light sensation, the student ask the client to close eyes then wipe a wisp of cotton over the client’s forehead To test deep sensation, use alternating blunt and sharp ends of the cap of a pen over the same area. Allow the client to chew, open, and clench her jaw, while palpating the jaw muscles. Actual result: The client was able to blink after the sclera is touched The client was able to identify the light and deep sensations through the objects presented. The client was able to open and clench her jaw without extra effort.

CN V|: ABDUCEN Type: motor Function: lateral movement of the eyes Tests perform: the student nurse stand directly in front of the lint and hold penlight at a distance of 1 foot and asked client to hold head follow the movement of the penlight with her yes only. Expected result: She will be able to follow the lateral movement of the penlight. Actual result: She was able to follow the lateral movement of the penlight. CN V||: FACIAL Type: motor Function: facial expression, taste (anterior or 2/3 of tongue) Tests perform: she was asked to raise her eyebrows, smile, show teeth and puff out cheeks. Expected result: she is expected to raise her eyebrows, smile, show teeth and puff out cheeks. Actual result: she was able to raise her eyebrows, smile, show teeth and puff out cheeks The client was able to identify the different tastes placed on the anterior twothirds of the tongue. CN V|||: VESTIBULOCOCHLEAR Type: sensory Function: sense of hearing and balanced Tests perform: whispered few words at the client back and allow repeating client back. Expected result: Mother Mae will be able to hear the words that the student nurse whispered to the client. Actual result: Mother Mae was able to hear the words that the student nurse whispered to the client. CNIX: GLOSSOPHARYGEAL Type: motor and sensory Function: pharyngeal movement and swallowing ability Tests perform: whispered few words at the client back and allow repeating client back. Expected result: When asked to say “ah”, she will be able to say it and she will be able to elicit the gag reflex. And she will be able to move the tongue from side to side and up and down. Actual result: Mother Mae was able to move the tongue foam side to side and up and down and was able to say “ah” when asked. She also elicited gag reflex. CN X: VAGUS Type: motor and sensory

Function: swallowing and speaking Tests perform: assess with cranial nerve IX, assess client speech for hoarseness and ask the client to swallow and speech Expected result: she will be able to state her name without hoarseness voice and was able to swallowing. Actual result: she was able to state her name without hoarseness voice and was able to perform swallowing. CN XI: ACCESORY Type: motor Function: head movement and movement of shoulders muscle Tests perform: the student nurse asked the client to shrug her shoulder against resistance of the student nurse’s hand and turn head side against resistance. Repeat both sides. Expected result: she must be able to shrug her shoulder against resistance of the student nurse’s hand and turn head side against resistance. Actual result: She was able to shrug her shoulder against resistance of the student nurse’s hand and turn head side against resistance. CN XII: HYPOGLOSSAL Type: motor Function: movement of the tongue and stretch of the tongue Tests perform: She was asked to protrude her tongue at midline, and then move it side to side. Expected Result: She should be able to protrude her tongue at midline, and then move it side to side Actual result: She was able to protrude her tongue at midline, and then move it side to side. B. Obstetrical History: Mrs.Mae obstetric record is G5P2T2P0A3L2M0.She had her first menstrual period when she was 12 years old. She has a regular menstrual cycle. Mrs. Mae and Mr.Lorenzo were married for ten years now.. She consulted the midwife after her delivery to her youngest child. Mrs. Mae usually takes note of her last menstrual period for her to be aware of it. All of the deliveries of Mrs. Mae were done in the hospital via Normal Spontaneous Delivery with the aid of the midwife. After being confirmed that Mrs. Mae is positive for pregnancy test she has her frequent prenatal checkups that started for her two months of pregnancy.. She had her frequent check-ups; her check up for the 2nd to 6th month is every month, for 7th and 8th month, twice a month, and for the 9th month every week. Mrs. Mae had her Tetanus Toxoid vaccine in her early pregnancy and after giving birth.

During her pregnancies she experienced morning sickness that usually last for a weeks According to her, she craved for mangoes,oranges, and Tamarind. According to her, she believes in some superstitions regarding pregnancy like not eating twin bananas because it may bring about twin babies and not wearing necklace because it might choke the baby. She also avoid taking a bath after delivering a baby, she only takes a bath after three days. C.Nutritional Status Nutritional Status BMI= Weight in Kilograms (Height in meters)2 = 49 kg = 49kg (1.52 m2) 2.31 = 21.21 (normal) Age: 30 y/o Height: 152cm Weight: 49 Kg BMI Range

Classification

Below 15

Emaciated

15-18.9

Underweight

19-24.9

Normal

25-29.9

Overweight

30-39.9

Obese

40-more

Morbidly Obese

E. History of past and present illness Mother Mae mentioned that she did not experience any major illnesses or hospitalizations before. She only had occasional fever, cough and colds. . But when further asked, she made mention of her mother who died of brain cancer. At present, she is complaining of frequent headaches. The group provided health teachings such as increasing fluid intake and eating nutritious foods as a form of protection for her to increase her resistance to pathogenic microorganisms and to consult the midwife regarding her condition. F. Activities of daily living Mother Mae wakes up between 5 to 6 am and prepares breakfast for her family especially the meal for her children who are about to go to school. She cooks for about 30 minutes between 6 to 6:30 am. She joins them in eating from 6:30 up to 7 am. Then she sends them to school. While waiting, she performs her daily activities like watching television or cleaning the house. Then she cooks

their lunch at around 11am to 12noon. Then she prepares it as her children arrive at around 12noon. Then they eat lunch for about an hour or so from 12noon to 1pm. After lunch, she does her sideline, sharpening BBQ sticks. All her family chores including her side-line she spends from 1pm to 6pm. She prepares food at 6pm and they eat at 7pm. Then she sleeps at 8pm. Health Assessment (IPPA-CEPHALOCAUDAL) Ann (daughter) Physical Examination First Home Visit (January 23,2009) A. General Appearance and Behavior Upon initial visit Ann is wearing school uniform and black shoes. She is alert and awake. Ann is 9 year old. Her vital sign are as follow: temperature: 36.5˚C: Pulse Rate: 83 BPM: Respiratory Rate: 17 CPM. Her weight is 46 lbs. and her height is 125cm. Physical Assessment Mental Status • Client is alert and awake with eyes open and looking at the student nurse. • She is aware of self, other, time, home address and current location. • She established eye contact when asked questions. • The client is cooperative, when asked, can answer properly. • The client was able to express free-flowing thoughts and expresses realistic perceptions. • She also smiles and frowns appropriately without difficulty. • She listens and can follow directions without difficulty. • She recalls her birthday and answer information correctly. • She was able to recall recent event without difficulty Motor Function • Walking gait –coordinated movement, sitting Integumentary System: • Skin is brown in complexion, no odor, and uniform in color. Her skin turgor is normal because when her skin was pinched, it goes back to previous state immediately. The skin is not edematous and is in normal temperature. With sensation to touch, pain & temperature. Skull & Face (Head) • She has a round skull, no contusions, bruises noted nodules and masses, and no tenderness palpated. She has symmetrical facial movements as

evidenced by client’s ability to smile, frown, raise his forehead & eyebrows & shows his teeth. Facial features and facial movements are symmetrical. Hair • Hair is long, dry, straight, thick, black and evenly distributed hair. No area of loss of hair and no infection/infestation. Nails • Her nails are untrimmed and dirty as well. She has light brown, smooth, epidermis is intact, has convex curve nails, no discoloration of the nail beds, no clubbing of nails, normal capillary refill (<2-3 sec), and no edema. Eyes and Vision • Eyebrows are symmetrically aligned, evenly distributed and has equal movements. • Her eyelashes are evenly distributed, upper eyelashes are slightly curled upward and lower eyelashes are slightly curled downward. • Eyelids are intact and closed symmetrically, bilateral blinking. In her bulbar conjunctiva capillaries are slightly visible and sclera appears white. • Her palpebral conjunctiva is shiny and pink in color. • Lacrimal gland, lacrimal sac and nasolacrimal duct has no edema or tenderness. • Cornea upon inspection for clarity it is shiny and transparent. When checked for corneal sensitivity test it has positive blinking reflex because her eyes blink when it is touched by the cotton. • Her pupils are equally round and reactive to light and accommodation. The student nurse holds an object from the nose of the client and asked the client to look object then to a distant object. Upon looking, the client’s pupils constricts when looking at near objects, and dilates at far objects • The client can see objects at the periphery by letting her cover her right eye and look directly to the student nurse’s nose. • Holding the penlight in the periphery, the client was able to spot the moving object. • Holding a penlight, the student nurse asked the client to follow the movement of the penlight with the eyes only to test for extraocular muscle test. The nurse then moved the penlight using the 6 cardinal movements. The client’s eyes have coordinated movements. Ears and Hearing • Her ears (auricles) are symmetrical in size and auricles aligned with the outer canthus of the eye. No lesions or masses noted. • Pinnas are elastic recoils after folded, firm and without tenderness upon palpation. • Internal ear has no lesions and with a presence of cerumen.

•

In hearing acuity test by determining the function of 8th (acoustics) cranial nerve, normal tone voice is audible. The client was able to hear on both ears when the student nurse whispered.

Nose and Facial Sinuses • Her nose is symmetrical and uniform in color; there is no discharge or flaring, no lesions or tenderness. • Air moves freely as the client breathes through nares by asking client to exert pressure on the nares, and breathe through the opposite. • Her facial sinuses are not tender. Mouth and Throat • Her teeth are incomplete; she has 30set and all have dental carries. Her teeth are yellowish in color.. • Her tongue is pinkish in color, moves without restraint, no tenderness and no lesions. • Soft palate is light pink in color and it is smooth. Her hard palate is lighter pink in color compared to the soft palate. • Uvula is positioned in the middle of the soft palate. • Oropharynx and tonsils are pink and smooth, no discharge and are not inflamed. • Gag reflex is present by using a spoon and pressed in the posterior tongue Chest and Back • Skin at the back is intact with uniform in temperature. • Chest is symmetric in volume, no tenderness and masses, full and symmetric lung expansion, and resonant sound upon percussion over the lungs and no adventitious breath sounds. • Breathing pattern is normal with symmetrical chest movement noted on anterior thorax. She has a regular heart beat pattern. • Spinal cord is vertically aligned, with right and left shoulders at the same height. Abdomen • Uniform in color, not distended, rounded symmetric contour and movements upon by respiration and with audible bowel sounds every 5 to 20 seconds, No lesions noted, no tenderness, and relaxed abdomen with smooth and consistent tension. Thorax and Lungs • Posterior thorax is chest symmetric. Regarding her spinal alignment, her spine is vertically aligned; left and right shoulders and hips is at the same height.

• •

When chest was palpated for vocal fremitus there is bilateral symmetry of vocal fremitus by placing nurse’s hands on the back of the client and letting her say the word “ninety-nine”. Jugular veins are not visible.

Motor Function Walking gait • Opposing arm swing upon walking; maintaining balance Upper Extremities • There are firm with coordinated movements; • Her bones and joints have no deformities, tenderness nor swelling noted. • She can sense touch, pain and temperature. • The client is able to repeatedly and rhythmically touch the nose during the “finger to nose test”. Lower Extremities • The muscles in the lower extremities are symmetrical. • The client can resist against the pressure given by the student nurse and elicited fine coordinated movements. • The bones and joints in the lower extremities have no deformities and pain, temperature and touch is felt. • The client’s gait and balance is stable. She can walk in straight line and can maintain balance. CRANIAL NERVES CN 1: OLFACTORY Type: Sensory Function: Smell Tests perform: The student nurse asked the client to close her yes and identify different aromas such as perfume and coffee. Expected result: She is expected to identify the different aromas such as perfume and coffee presented with hers closed. Actual Result: Mother Mae was able to identify the aromas of perfumes and coffee. CN ||: OPTICS Types; sensory Function: vision and visual fields Tests perform: the student nurse asked her to read on the newspapers Expected result: the client will be able to read the newspapers Actual result: Mother. Mae was able to read at a distance of 14”

CN |||: OCULOMOTOR Types: motor Function: Extra ocular movements of the eyes, movement of the sphincter of the pupils. Tests performed: the student nurse made use of a penlight at a distance of 1 foot in front of the client’s eyes and asked the client to hold the head in a fixed position facing the student and followed the movement of the penlight with eyes only. The student nurses assess the 6 ocular movement and pupil reaction. Expected result: client is expected to move her eyes though the cranial fields of gaze that is from the center to the upper right, upper left lower right, lower left and medially. Actual result: Mother Mae was able to move her eyes though the cranial fields of gaze that is from the center to the upper right, upper left lower right, lower left and medially. CN|V: TOCHLEAR Types: motor Function: extra ocular eye movements specifically nerve eyeball downward and laterally Tests perform: the student nurse asked to asses the 6 ocular movements using the penlight at distance or 1 foot and followed the penlight with the eyes only Expected result: Mother Mae will be able to move her eyes downward obliquely Actual result: Mother Mae was able to move her eyes downward obliquely without moving hid head. CN V: TRIGEMINAL Type: motor Function: jaw movement and mastication, Sensation of cornea, skin of face, and nasal mucosa Tests perform: The student asked the client to look upward, lightly touch lateral sclera at eye to elicit blink reflex. To test light sensation, the student ask the client to close eyes then wipe a wisp of cotton over the client’s forehead To test deep sensation, use alternating blunt and sharp ends of the cap of a pen over the same area. Allow the client to chew, open, and clench her jaw, while palpating the jaw muscles. Actual result: The client was able to blink after the sclera is touched The client was able to identify the light and deep sensations through the objects presented. The client was able to open and clench her jaw without extra effort. CN V|: ABDUCEN Type: motor Function: lateral movement of the eyes

Tests perform: the student nurse stand directly in front of the lint and hold penlight at a distance of 1 foot and asked client to hold head follow the movement of the penlight with her yes only. Expected result: She will be able to follow the lateral movement of the penlight. Actual result: She was able to follow the lateral movement of the penlight. CN V||: FACIAL Type: motor Function: facial expression, taste (anterior or 2/3 of tongue) Tests perform: she was asked to raise her eyebrows, smile, show teeth and puff out cheeks. Expected result: she is expected to raise her eyebrows, smile, show teeth and puff out cheeks. Actual result: she was able to raise her eyebrows, smile, show teeth and puff out cheeks The client was able to identify the different tastes placed on the anterior twothirds of the tongue. CN V|||: VESTIBULOCOCHLEAR Type: sensory Function: sense of hearing and balanced Tests perform: whispered few words at the client back and allow repeating client back. Expected result: Mother Mae will be able to hear the words that the student nurse whispered to the client. Actual result: Mother Mae was able to hear the words that the student nurse whispered to the client. CNIX: GLOSSOPHARYGEAL Type: motor and sensory Function: pharyngeal movement and swallowing ability Tests perform: whispered few words at the client back and allow repeating client back. Expected result: When asked to say “ah”, she will be able to say it and she will be able to elicit the gag reflex. And she will be able to move the tongue from side to side and up and down. Actual result: Mother Mae was able to move the tongue foam side to side and up and down and was able to say “ah” when asked. She also elicited gag reflex. CN X: VAGUS Type: motor and sensory Function: swallowing and speaking Tests perform: assess with cranial nerve IX, assess client speech for hoarseness and ask the client to swallow and speech Expected result: she will be able to state her name without hoarseness voice and was able to swallowing.

Actual result: she was able to state her name without hoarseness voice and was able to perform swallowing. CN XI: ACCESORY Type: motor Function: head movement and movement of shoulders muscle Tests perform: the student nurse asked the client to shrug her shoulder against resistance of the student nurse’s hand and turn head side against resistance. Repeat both sides. Expected result: she must be able to shrug her shoulder against resistance of the student nurse’s hand and turn head side against resistance. Actual result: She was able to shrug her shoulder against resistance of the student nurse’s hand and turn head side against resistance. CN XII: HYPOGLOSSAL Type: motor Function: movement of the tongue and stretch of the tongue Tests perform: She was asked to protrude her tongue at midline, and then move it side to side. Expected Result: She should be able to protrude her tongue at midline, and then move it side to side Actual result: She was able to protrude her tongue at midline, and then move it side to side. Nutritional Status BMI= Weight in Kilograms (Height in meters)2 31kg = 31kg (1.25 m2) 1.5625 = 19.84 (normal) BMI Range

Classification

Below 15

Emaciated

15-18.9

Underweight

19-24.9

Normal

25-29.9

Overweight

30-39.9

Obese

40-more

Morbidly Obese

F. History of past and present illness

Ann, as mentioned by her mother, was hospitalized last 2005 due to convulsion at a private hospital. Her present health status shows that she has coughs. G. Activities of daily living Anne wakes up at 7am and prepares for school. She’s at school from 711am. She walks home at 11 and arrives at 12. She eats at 12noon and goes back to school at 12:45. Her afternoon class starts at 1pm and ends at 4. She walks home at 4pm and arrives at 4:15. She plays for about an hour up to 5:15. She does her homework until 6pm and eats at 6:30. She sleeps at 8pm. Health Assessment (IPPA-CEPHALOCAUDAL) Anthony (Son) Physical Examination First Home Visit (January 23,2009 A. General Appearance and Behavior During the initial visit Anthony was seen clean white sando and blue short. He has black complexion with short nails. Anthony is a 5 year old who weight 15 kg and has height 111 cm. temperature: 36˚C: Pulse Rate: 120 BPM. Respiratory Rate: 23 CPM. Physical Assessment Mental Status • Client is alert and awake with eyes open and looking at the student nurse. • She is aware of self, other, time, home address and current location. • She established eye contact when asked questions. • The client is cooperative, when asked, can answer properly. • The client was able to express free-flowing thoughts and expresses realistic perceptions. • She also smiles and frowns appropriately without difficulty. • She listens and can follow directions without difficulty. • She recalls her birthday and answer information correctly. • She was able to recall recent event without difficulty Motor Function • Walking gait –coordinated movement, sitting Integumentary System: • Skin is brown in complexion, no odor, and uniform in color. Her skin turgor is normal because when her skin was pinched, it go back to previous state immediately. The skin is not edematous and is in normal temperature. With sensation to touch, pain & temperature.

Skull & Face (Head) • She has a round skull, no contusions, bruises noted nodules and masses, and no tenderness palpated. She has symmetrical facial movements as evidenced by client’s ability to smile, frown, raise his forehead & eyebrows & shows his teeth. Facial features and facial movements are symmetrical. Hair • Hair is long, dry, straight, thick, black and evenly distributed hair. No area of loss of hair and no infection/infestation. Nails • Her nails are untrimmed and dirty as well. She has light brown, smooth, epidermis is intact, has convex curve nails, no discoloration of the nail beds, no clubbing of nails, normal capillary refill (<2-3 sec), and no edema. Eyes and Vision • Eyebrows are symmetrically aligned, evenly distributed and has equal movements. • Her eyelashes are evenly distributed, upper eyelashes are slightly curled upward and lower eyelashes are slightly curled downward. • Eyelids are intact and closed symmetrically, bilateral blinking. In her bulbar conjunctiva capillaries are slightly visible and sclera appears white. • Her palpebral conjunctiva is shiny and pink in color. • Lacrimal gland, lacrimal sac and nasolacrimal duct has no edema or tenderness. • Cornea upon inspection for clarity it is shiny and transparent. When checked for corneal sensitivity test it has positive blinking reflex because her eyes blink when it is touched by the cotton. • Her pupils are equally round and reactive to light and accommodation. The student nurse holds an object from the nose of the client and asked the client to look object then to a distant object. Upon looking, the client’s pupils constricts when looking at near objects, and dilates at far objects • The client can see objects at the periphery by letting her cover her right eye and look directly to the student nurse’s nose. • Holding the penlight in the periphery, the client was able to spot the moving object. • Holding a penlight, the student nurse asked the client to follow the movement of the penlight with the eyes only to test for extraocular muscle test. The nurse then moved the penlight using the 6 cardinal movements. The client’s eyes have coordinated movements. Ears and Hearing • Her ears (auricles) are symmetrical in size and auricles aligned with the outer canthus of the eye. No lesions or masses noted.

• • •

Pinnas are elastic recoils after folded, firm and without tenderness upon palpation. Internal ear has no lesions and with a presence of cerumen. In hearing acuity test by determining the function of 8th (acoustics) cranial nerve, normal tone voice is audible. The client was able to hear on both ears when the student nurse whispered.

Nose and Facial Sinuses • Her nose is symmetrical and uniform in color; there is no discharge or flaring, no lesions or tenderness. • Air moves freely as the client breathes through nares by asking client to exert pressure on the nares, and breathe through the opposite. • Her facial sinuses are not tender. Mouth and Throat • Her teeth are incomplete; she has 30set and all have dental carries. Her teeth are yellowish in color.. • Her tongue is pinkish in color, moves without restraint, no tenderness and no lesions. • Soft palate is light pink in color and it is smooth. Her hard palate is lighter pink in color compared to the soft palate. • Uvula is positioned in the middle of the soft palate. • Oropharynx and tonsils are pink and smooth, no discharge and are not inflamed. • Gag reflex is present by using a spoon and pressed in the posterior tongue Chest and Back • Skin is intact with uniform in temperature. • Chest is symmetric in volume, no tenderness and masses, full and symmetric lung expansion, and resonant sound upon percussion over the lungs and no adventitious breath sounds. • Breathing pattern is normal with symmetrical chest movement noted on anterior thorax. She has a regular heart beat pattern. • Spinal cord is vertically aligned, with right and left shoulders at the same height. Abdomen • Uniform in color, not distended, rounded symmetric contour and movements upon by respiration and with audible bowel sounds every 5 to 20 seconds, No lesions noted, no tenderness, relaxed abdomen with smooth and consistent tension. Thorax and Lungs

• • •

Posterior thorax is chest symmetric. Regarding her spinal alignment, her spine is vertically aligned; left and right shoulders and hips is at the same height. When chest was palpated for vocal fremitus there is bilateral symmetry of vocal fremitus by placing nurse’s hands on the back of the client and letting her say the word “ninety-nine”. Jugular veins are not visible.

Motor Function Walking gait • Opposing arm swing upon walking; maintaining balance Upper Extremities • There are firm with coordinated movements; • Her bones and joints have no deformities, tenderness nor swelling noted. • She can sense touch, pain and temperature. • The client is able to repeatedly and rhythmically touch the nose during the “finger to nose test”. Lower Extremities • The muscles in the lower extremities are symmetrical. • The client can resist against the pressure given by the student nurse and elicited fine coordinated movements. • The bones and joints in the lower extremities have no deformities and pain, temperature and touch is felt. • The client’s gait and balance is stable. She can walk in straight line and can maintain balance. CRANIAL NERVES CN 1: OLFACTORY Type: Sensory Function: Smell Tests perform: The student nurse asked the client to close her yes and identify different aromas such as perfume and coffee. Expected result: She is expected to identify the different aromas such as perfume and coffee presented with hers closed. Actual Result: Mother Mae was able to identify the aromas of perfumes and coffee. CN ||: OPTICS Types; sensory Function: vision and visual fields Tests perform: the student nurse asked her to read on the newspapers

Expected result: the client will be able to read the newspapers Actual result: Mother. Mae was able to read at a distance of 14” CN |||: OCULOMOTOR Types: motor Function: Extra ocular movements of the eyes, movement of the sphincter of the pupils. Tests performed: the student nurse made use of a penlight at a distance of 1 foot in front of the client’s eyes and asked the client to hold the head in a fixed position facing the student and followed the movement of the penlight with eyes only. The student nurses assess the 6 ocular movement and pupil reaction. Expected result: client is expected to move her eyes though the cranial fields of gaze that is from the center to the upper right, upper left lower right, lower left and medially. Actual result: Mother Mae was able to move her eyes though the cranial fields of gaze that is from the center to the upper right, upper left lower right, lower left and medially. CN|V: TOCHLEAR Types: motor Function: extra ocular eye movements specifically nerve eyeball downward and laterally Tests perform: the student nurse asked to asses the 6 ocular movements using the penlight at distance or 1 foot and followed the penlight with the eyes only Expected result: Mother Mae will be able to move her eyes downward obliquely Actual result: Mother Mae was able to move her eyes downward obliquely without moving hid head. CN V: TRIGEMINAL Type: motor Function: jaw movement and mastication, Sensation of cornea, skin of face, and nasal mucosa Tests perform: The student asked the client to look upward, lightly touch lateral sclera at eye to elicit blink reflex. To test light sensation, the student ask the client to close eyes then wipe a wisp of cotton over the client’s forehead To test deep sensation, use alternating blunt and sharp ends of the cap of a pen over the same area. Allow the client to chew, open, and clench her jaw, while palpating the jaw muscles. Actual result: The client was able to blink after the sclera is touched The client was able to identify the light and deep sensations through the objects presented. The client was able to open and clench her jaw without extra effort. CN V|: ABDUCEN Type: motor

Function: lateral movement of the eyes Tests perform: the student nurse stand directly in front of the lint and hold penlight at a distance of 1 foot and asked client to hold head follow the movement of the penlight with her yes only. Expected result: She will be able to follow the lateral movement of the penlight. Actual result: She was able to follow the lateral movement of the penlight. CN V||: FACIAL Type: motor Function: facial expression, taste (anterior or 2/3 of tongue) Tests perform: she was asked to raise her eyebrows, smile, show teeth and puff out cheeks. Expected result: she is expected to raise her eyebrows, smile, show teeth and puff out cheeks. Actual result: she was able to raise her eyebrows, smile, show teeth and puff out cheeks The client was able to identify the different tastes placed on the anterior twothirds of the tongue. CN V|||: VESTIBULOCOCHLEAR Type: sensory Function: sense of hearing and balanced Tests perform: whispered few words at the client back and allow repeating client back. Expected result: Mother Mae will be able to hear the words that the student nurse whispered to the client. Actual result: Mother Mae was able to hear the words that the student nurse whispered to the client. CNIX: GLOSSOPHARYGEAL Type: motor and sensory Function: pharyngeal movement and swallowing ability Tests perform: whispered few words at the client back and allow repeating client back. Expected result: When asked to say “ah”, she will be able to say it and she will be able to elicit the gag reflex. And she will be able to move the tongue from side to side and up and down. Actual result: Mother Mae was able to move the tongue foam side to side and up and down and was able to say “ah” when asked. She also elicited gag reflex. CN X: VAGUS Type: motor and sensory Function: swallowing and speaking Tests perform: assess with cranial nerve IX, assess client speech for hoarseness and ask the client to swallow and speech Expected result: she will be able to state her name without hoarseness voice and was able to swallowing.

Actual result: she was able to state her name without hoarseness voice and was able to perform swallowing. CN XI: ACCESORY Type: motor Function: head movement and movement of shoulders muscle Tests perform: the student nurse asked the client to shrug her shoulder against resistance of the student nurse’s hand and turn head side against resistance. Repeat both sides. Expected result: she must be able to shrug her shoulder against resistance of the student nurse’s hand and turn head side against resistance. Actual result: She was able to shrug her shoulder against resistance of the student nurse’s hand and turn head side against resistance. CN XII: HYPOGLOSSAL Type: motor Function: movement of the tongue and stretch of the tongue Tests perform: She was asked to protrude her tongue at midline, and then move it side to side. Expected Result: She should be able to protrude her tongue at midline, and then move it side to side Actual result: She was able to protrude her tongue at midline, and then move it side to side. B. Immunization Status 1st dose BCG

2nd dose

3rd dose

Error! Bookmark _______ not defined.

_______

_______

_______

DPT OPV HEPA B MEASLES

Anthony is fully immunized before he turns 1 y/o in their health center. C. Growth and Development Erik Erickson’s Psychological Stages Initiative vs. Guilt During this stage, a child should learn to do socially acceptable behavior and this is the time when a child learns to set his own goals. As for Anthony he

actively socializes with other people especially those who are within his age group but he’s very shy with older people like the student nurses. He doesn’t cooperate well in the first two days of student nurses and family interaction Initiative in doing even basic things such as wearing of shoes. Her mother is consistent in disciplining him. He does what satisfies him because in this stage a child becomes more eager in adventures. There are no distinct limitations that are set for him by her mother. Sigmund Freud’s Psychosexual Stages Phallic Stage In this period the child focuses feelings chiefly on the parent of the opposite sex. And during the group’s home visit, they had observed that he is close to his mother. The group did not observe any sexual diversion on his part. D. Nutritional Status Ht: 111cm Wt: 15 kg (normal) FNRI= Normal weight 14.4-23.5

Age: 60months Therefore, Anthony is Normal

E. History of past and present illness Anthony, as mentioned by her mother was hospitalized due to BPN (bronchopneumonia) last 2005 at a public hospital. His present health status reveals that he has no presence of illness. G. Activities of daily living Anthony wakes up at 7am and prepares for school. He’s at school from 710am. He walks home at 10 and arrives at 10:15. He eats at 110:30am up to 11am. He plays at 12noon up to 5pm. He does his homework until 6pm and eats at 6:30. He sleeps at 8pm. TYPE OF FAMILY STRUCTURE The chosen family, the Macapagal family is of a nuclear type. The nuclear family consists of a father, mother and child living together. This type of family structure is found in almost societies, although the length of time in which the

family remains in this form varies even within the same society. The family consists of Mr. Lorenzo, Mrs. Mae & their 2 children namely: Ann and Anthony. Mr. Lorenzo is a junkshop worker in a company in Clark field, Pampanga while Mother Mae, is a full time house wife and she is responsible in taking care of the families needs and health. The type of residence is bilocal since they live separately from their parents. Two of their children are going to school. In spite of the problems that they are facing, their relationship with each other is good because they have a positive outlook in life and really loves each other. ETHNIC BACKGROUND AND RELIGIOUS AFFILIATIONS Originally, Mr. Lorenzo is from Surigao while Mrs. Mae is originally from Macapagal village. The religion of the family is Catholic Mrs. Mae honestly told us that they seldom go to church because they have no time to go and also the church is far from their village. DOMINANT FAMILY MEMBERS IN DECISION MAKING The family can be classified under the Matriarchal type of family when it comes to the authority exercised w/in the household since Mr. Lorenzo is always out for work the mother is considered the head of the family and has power in decision-making. She told us that also because Mr. Lorenzo is poor in decision making and just follows Mrs. Mae’s orders. She is the one who decide for the family especially when its money matters. As well as, in terms of discipline and with the health of the children Mrs. Mae is the one who dominates. SOURCES OF INCOME, EXPENSES AND OCCUPATION The family’s main source of income is Mr. Lorenzo’s work at the junkshop. According to Mrs. Mae, Mr. Lorenzo earns 7,500 a month. While Mr. Lorenzo is at work Mrs. Mae is sharpening BBQ sticks as a form of sideline for their monthly expenses. She earns 8 pesos for every 1,000 pcs of BBQ sticks. According to them, their funds are enough to meet their basic needs such as food, clothing and shelter although there are times when they are not able to pay their monthly

expenses like the electric & water bills in due to the time given & so they are left with no choice but to borrow from their relatives or even from their neighbors. As soon as they save enough money, they would pay the people they have borrowed money from. They do not have excess money for medical-related needs, activities and leisure. The family has no financial assets available in case of emergency. If there is an emergency, however, they are able to borrow money from their neighbors and relatives. Source of income 1Junkshop worker Usual profit P7,500 a month The following is the family expenditures: (Monthly) Rice

P1120.00

Fish, meats, Vegetables

P1, 050.00

Electric bill

P550.00

Water bill

P400.00

Kid’s allowance” (P20/day)

P1,240.00

Extra Expenses (soap, toothpaste, shampoo,etc)

P300.00 Total: P4,660/month

NATURE OF WORK, WORKING HOURS Mr. Lorenzo is a regular junkshop worker he regularly goes to work at 7:00am and comes back at 5-6pm. His schedule of work is from Monday to Saturday. The reason the student nurses were not able to meet him. SIGNIFICANT OTHERS/RELATIVES ROLE IN FAMILY’S LIFE They live in the vicinity close to other relatives on the side of his wife’s family. Although there are some relatives in that area, their relatives do not interfere with the affairs and businesses of the Macapagal family.

FAMILY HEALTH HABITS, BELIEFS, PRACTICES AND SUPERSTITIONS The Macapagal family believes in albularyos(herbolarios). They also make use of herbal medicines (like oregano, lagundi, kalamansi, bayabas, & ampalaya) when they have minor illnesses like cough, colds & fever. However, Mrs. Mae cleared that they have nothing against the credibility of the medical doctors. In fact, they seek for medical advice when their diseases can no longer be cured by the albularyos & the herbal medicines they use. On the other hand, cleanliness is quite practiced in their home but, sometimes the children, after going to school usually play with their friends and go home dirty. The family believes that some diseases like cough and colds are brought about by the sudden change of temperature and climate. They make use of kalamansi as a remedy such diseases. COMMUNITY,

SOCIAL

AND

HEALTH

RESOURCES

AND

FAMILY’S

UTILIZATION OF THESE RESOURCES The community has a Barangay Health Center located near their house wherein they barely utilize any of the services given by the Barangay Health Center; where in the BHC is only giving free medical missions and feeding programs only when student nurses are around to facilitate the said activity. The BHC (barangay health center) is also giving such services (Vaccines, medical mission, Family Planning Programs, Pregnant Care, feeding programs etc.) but this services are only given when the midwife is around (every Tuesday). LIVING CONDITION The house structure is made of hollow blocks, concrete cement and cut wood. There is a gap between the walls and roofing, allowing entrance of cold and hot air and insects. During the day, they are lighted by artificial lighting because sunlight cannot light the house due to some environmental factors such, as their house is covered by big trees; Also the location of their windows do not provide entry for the light to come in. The house is not stable

and has many threats. The wires are exposed since they do not have a ceiling and during rainy season water flows to their house making them at risk for some diseases like Leptospirosis. It has a bedroom, kitchen, toilet, and a living room. There are 6 windows throughout the house which measures 93.98cmX60.96cm

(living

room),

75.2cmX86.36cm

(bedroom),

60.96cmX71.12cm (kitchen). Their windows do not have screens w/c allows the entry of mosquitoes and flies. Also they have an incandescent light bulb which is located in the bathroom (60watts) 1 fluorescent(40watts) in the living room, 1 fluorescent in the bedroom(18watts), 1 fluorescent outside near the door(18watts). The household was also positive from mice & cockroaches due to the garbage exposed in front of their house. According to the mother their house has approximately 11m2 TFA [total floor area]: 11m2 Total surface requirement per individual is as follows: -Adult: 13 y/o above = 3m² -Child: 1 y/o (0-12 y/o) = 1.5 m²

Member

Age

TSR

Father

37 y/o

3m²

Mother

30 y/o

3m²

Child 1

5 y/o

1.5m²

Child 2

9 y/o

1.5m² = 9m2

Therefore the living space is adequate. The computation of ventilation is as follows: Living room: 93.98 X 60.96cm =0.94m X 0.61m

total window size=living

bed

room + room + kitchen

=0.5734m X 2 windows

=1.15m2 +1.31+0.87m2

= 1.15m2

=3.33m2

Bedroom:

76.2 X 86.36 cm =0.76m X 0.86m =0.6536 X 2 windows =1.31m2

Kitchen:

=60.96 X 71.12 =0.61 X 0.71 =0.4331 X 2 windows =0.87m2

Adequate= required window size is 10% of TFA TFA =11m2 X 10% =1.1m2 3.33m2 (total window size) > 1.1m2 Therefore, there is adequate ventilation The computation for lighting is as follows: Adequacy of lighting= 50watts incandescent bulb or 20-40watts fluorescent bulb =60watts incandescent bulb + 40watts fluorescent light + 18watts +18watts =136watts Therefore, there is adequate lighting both daytime and nighttime. FOOD STORAGE, SOURCE & COOKING The kitchen consists of a small table sink and cooking (charcoal) facility where the 4 family members eat altogether. The size of the house appears adequate for the size of the family. Their appliances consist of radio, electric fan, television, VCD player and stove (but not used). Their food resources are bought on daily basis. Mrs. Mae buys and brings home the food to be prepared for the day. They cook the food with charcoal. The family also, do not have a refrigerator where they could store their food & so when there are left over food, they have no choice but to place it on the dining

table & cover it w/ another plate to be eaten for the next meal or hang it in a casserole just above the cooking facility. TOILET FACILITY They have a small bathroom near the kitchen. They use plastic container as a dipper in flushing the toilet. The toilet is fairly clean because there is some urine smell but there is no fecal stains observed in the toilet bowl. The roof also has small holes on it. WATER SUPPLY They obtain their water supply from jetmatic, which is owned by their neighbor. According to them, they pay 2 pesos per pale. They drink the water from the jetmatic and store it in a pitcher. The family regularly boils the water before drinking it. This provides them to have a potable drinking water.

DRAINAGE SYSTEM They have an open type of drainage system. It is man-made type of drainage system in which they dug pits where water can flow and will not be directed towards their house in case of heavy rains or typhoons; since their house is located at a slope of the village. This is a man-made drainage facility where they dug pits to make flood-water and the like to be in free flowing when it is raining while the water usually dries up and absorbed by the soil when the rain stops. GARBAGE DISPOSAL They do no have proper ways of throwing their garbage. Their garbage is placed outside of the house and is burned. All the waste materials including bamboo waste, plastic, leftover foods etc. are burned all together. Sometimes they just place it in an area and leave it there where it is exposed to chickens,

ducks, and, flies, cockroaches and other insects w/c is a threat to the health of the family. The collection of garbage in their community is irregular.

COMMUNICATION AND TRANSPORTATION The family has 2 cellular phones, which belong to Mr. Lorenzo and Mrs. Mae. According to them, these were bought for them to be able to contact their relatives in case of emergency. On the other hand, the family doesn’t own any vehicle Mr. Lorenzo uses his bike to go to work. While the children walks to school every morning since the school is just near their house. The family commutes if they go to other place such as malls or visiting their relatives and other sorts of things.

A. PROBLEM IDENTIFICATION Problem #

Problem

Score

Problem #1:

Presence of Coughs (Ann) as a Health Deficit

4.67

Problem #2:

Unhealthful Lifestyle and Personal Habits or Practices: CIGARETTE SMOKING as a Health Threat

4.34

Inappropriate role Assumption (Mrs. Mae has the power to decide) as a Health Threat

3.84

Presence of Rodents and Cockroach as a Health Threat

3.84

Inadequate/Insufficient Family Resources as Health Threat

3.34

Lack of food storage facilities as a Health Threat

2.84

Poor Environment Sanitation: Improper Drainage System as a health threat

2.84

Problem #8:

Improper Garbage Disposal as a Health threat

2.50

Problem #9:

Risk for Cross-infection as a health threat

2.5

Problem #11:

Presence of Accident Hazards (Exposed Electrical wires) as a Health Threat

2

Poor environmental Sanitation: Air Pollution as a Health Threat

2

Risk for injury as a Health threat

2

Problem #3:

Problem #4:

Problem #5:

Problem #6.5:

Problem #6.5:

Problem #11: Problem #11:

B. Priority Setting Problem #1: Presence of Coughs (Ann) as a Health Deficit CRITERIA COMPUTATION SCORE JUSTIFICATION A. Nature problem

the 3 / 3 x 1

1

The problem is a health deficit because one of the members needs immediate care to prevent the pass of infection from one member to another. It alters the normal health status of one of the members that may alter the proper functioning of the family as a whole.

B. Modifiability of the 2 / 2 x 2 problem

2

The problem is easily modifiable because:

Current Knowledge Resources of the Family Resources of the Nurses Resources of the Community

of





Current Knowledge The family recognizes the presence of coughs of Ann and the need for her to be properly taken care of AEB the verbalization of the problem by mother Mae



Resources of the Family The family has adequate resources to make a particular intervention to the problem since they have and are knowledgeable of the use of some herbal medicines useful for treating the cough like Lagundi.



Resources of the Nurses Knowledge and time of the student nurses are available to establish awareness and recognition of the problem. Also, they have proper know-how to perform independent nursing intervention to help treat or

  

soothe the cough. Resources of the Community The community resources are also available to assist the family in terms of consulting about the disease condition. The problem is moderately preventable. 

C. Preventive 2/ 3 x 1 Potential (PP) Severity or Gravity  Duration  Current Manage ment  Exposur e to any high risk group 

0.67

 =PP

=PP =PP 

=PP





D. Salience

2/2x1

1

Severity or gravity of the problem. The problem has high gravity because it can affect the health status of the other members. Also it can alter the functioning of Ann in the family making the role assumptions within the family altered too. Duration of the Problem The problem has existed approximately two days before the student nurses arrived. Current Management Since the supposed provider of care Mother Mae knows some herbal medicines that can be a remedy to the cough, it is currently managed. Exposure to any high risk group Since the brother of Ann is younger and spends most of the time with Ann, he is at risk to be infected in case the cough is caused by infection.

The family recognizes the need to intervene with the problem the moment they knew it is existing AEB Mother Mae being worried

of the condition of her daughter. TOTAL SCORE

4.67

Problem #2: Unhealthful Lifestyle and Personal Habits or Practices: CIGARETTE SMOKING as a Health Threat CRITERIA COMPUTATION SCORE JUSTIFICATION A. Nature problem

of

the 2 / 3 x 1

B. Modifiability of the 2 / 2 x 2 problem Current Knowledge Resources of the Family Resources of the Nurses Resources of the Community



0.67

The problem is a health threat because the presence of a smoker within the family can affect both the smoker and the other family members not smoking. They can be active and passive smokers who will have both affectations in their health status and state of equilibrium.

2

The problem is easily modifiable because: 

Current Knowledge The family recognizes the problem existing AEB mother Mae verbalizing that her husband smokes even when he is still single till now that he’s married even with the advices of mother Mae to stop it.



Resources of the Family The family has basic know-how as to what are the possible effects of smoking specifically the ill effects such as possible development of respiratory diseases.



Resources of the Nurses Knowledge and time of the student nurses are available to establish awareness and recognition of the problem. They are

  

also knowledgeable for the teachings to help the family expand their knowledge of the ill effects of smoking. Resources of the Community The community resources are also available where they could provide teachings and early diagnosis of possibly occurring disease. 

C. Preventive 2 / 3 x 1 Potential (PP) Severity or Gravity  Duration  Current Manage ment  Exposur e to any high risk group 

0.67

=PP

The problem has preventability because: 

=PP 

=PP =PP





D. Salience

2/2x1

1

low

Severity or gravity of the problem. The problem has high gravity because it can affect the whole family once as active and passive smokers. Duration of the Problem The problem has existed even before the student nurses arrived long before the couple was married. Current Management Mother Mae constantly advices Mr. Lorenzo to stop smoking yet it is not effective since Mr. Lorenzo still engages into it. Exposure to any high risk group Since the whole family is residing in the house, they are all belonging to the high risk group because all of them can inhale the smoke either passively or actively.

The

mother

recognizes

the

existence of the problem that requires prompt intervention because it might cause her husband or her and her children respiratory diseases. TOTAL SCORE

4.34

Problem #3: Inappropriate role Assumption (Mrs. Mae has the power to decide) as a Health Threat CRITERIA COMPUTATION SCORE JUSTIFICATION A. Nature problem

of

the 2 / 3 x 1

B. Modifiability of the 2 / 2 x 2 problem Current Knowledge Resources of the Family Resources of the Nurses Resources of the Community



0.67

The problem is a health threat because if the mother takes all the responsibility in decisionmaking, she can make unlikely decisions that may affect the family as a whole. But if the parents share in the responsibilities of making decisions, they are more able to make wise choices.

2

The problem is easily modifiable because: 

   



Current Knowledge The mother recognizes the problem existing AEB mother Mae verbalizing that her husband is a calm person, the reason she assumes to be the maker of decisions. Also, that Mr. Lorenzo is always not at home. Resources of the Family The couple can have talks to share the problems with each other that each may contribute to its solution. Resources of the Nurses Knowledge and time of the student nurses are available to establish awareness and recognition

of the problem. They are also knowledgeable for the teachings to help the family make wise choices.  Resources of the Community The community resources are also available where they could provide counseling. C. Preventive 2 / 3 x 1 Potential (PP) Severity or Gravity  Duration  Current Manage ment  Exposur e to any high risk group 

D. Salience

0.67

The problem is moderately preventable because:  Severity or gravity of the problem. The problem has low gravity because it can only affect the whole family once the primary decision-maker —Mrs. Mae—has taken a wrong choice.  Duration of the Problem The problem has existed even before the student nurses arrived.  Current Management Mother Mae makes the decision because her husband is not present at all times. Therefore there is no management undertaken to share the decision-making responsibilities between both parents.  Exposure to any high risk group Since the family is taken holistically, once Mrs. Mae took a wrong decision, it can affect the whole family.

0.50

The family recognizes the existence of the problem but does not require prompt intervention since Mother Mae still manages to do decisionmaking while her husband is at

=PP

=PP =PP =PP

1/2x1

work and they have been used to this kind of role assumptions. TOTAL SCORE

3.84

Problem #4: Presence of Rodents and Cockroach as a Health Threat CRITERIA COMPUTATION SCORE JUSTIFICATION A. Nature problem

of

the 2 / 3 x 1

B. Modifiability of the 2 / 2 x 2 problem Current Knowledge Resources of the Family Resources of the Nurses Resources of the Community



0.67

The problem is a health threat because the presence of breeding sites of insects and rodents are usual vectors of microorganisms causing fatal diseases to the family such as leptospirosis.

2

The problem is easily modifiable because: 

   



Current Knowledge The family recognizes the problem existing AEB mother Mae verbalizing that even Anthony recognized the occurrence of the rodents and insects esp. cockroach in their house AEB their manual eradication of these. Resources of the Family The family has no adequate resources to make the best intervention to the problem. But they have manpower to manually eradicate the insects and rodents. Resources of the Nurses Knowledge and time of the student nurses are available to establish awareness and recognition of the problem. They are also knowledgeable for the teachings to help the family think of how to effective

eradicate or totally prevent their growth and multiplication.  Resources of the Community The community resources are also available where they could provide teachings and manpower. They can also have fumigations and programs like general community cleaning. C. Preventive 2 / 3 x 1 Potential (PP) Severity or Gravity  Duration  Current Manage ment  Exposur e to any high risk group 

D. Salience

0.67

The problem is moderately preventable because:  Severity or gravity of the problem. The problem has high gravity because it can affect the whole family once these rodents and insects contaminate their food or bring about infection to them.  Duration of the Problem The problem has existed even before the student nurses arrived.  Current Management Since a there is careful prioritization of income, they are not using the most effective way of killing the insects or totally destroying their breeding site. However, they manage the problem by manual eradication of the insects. But this is still inefficient  Exposure to any high risk group Since the whole family is residing in the house, they are all belonging to the high risk group.

0.50

The family recognizes the existence of the problem but it

=PP

=PP =PP =PP

1/2x1

does not require prompt intervention for them because they already became used to its occurrence and it does not cause them harm at the moment. TOTAL SCORE

3.5

Problem #5: Inadequate/Insufficient Family Resources as Health Threat CRITERIA COMPUTATION SCORE JUSTIFICATION A. Nature problem

of

the 2 / 3 x 1

B. Modifiability of the 1 / 2 x 2 problem Current Knowledge Resources of the Family Resources of the Nurses Resources of the Community

x

0.67

The problem is a health threat because if the family is not able to suffice the needs of the individual member, each can have decreased ability to cope with life’s processes. Food, for example, is lacking, the children may have decreased energy level to cope with the pressures in their studies.

1

The problem is modifiable because: 

x

 



partially

Current Knowledge The family does not recognize the problem existing because Mother Mae—the provider of care— is carefully prioritizing the most immediate needs. However, in doing this, she neglects the other needs which may also contribute to the total necessities of the individual members. They also do not feel the insufficiency because they have been deprived of being provided with the secondary necessities in life such as own water supply, storage facilities and the like. Resources of the Family

The family has no adequate resources to make the best intervention to the problem. The sideline of Mrs. Mae is still not sufficient. They also do not have the knowledge to put up a business or plant a vegetable garden, and the like.  Resources of the Nurses Knowledge and time of the student nurses are available to establish awareness and recognition of the problem. They are also knowledgeable for the teachings to help the family think of other profitable livelihood or handicraft.  Resources of the Community The community resources are also available where they could provide teachings and encourage vegetable planting or attend mothers’ classes that. At times. Teach about livelihood. C. Preventive 2 / 3 x 1 Potential (PP) Severity or Gravity  Duration  Current Manage ment  Exposur e to any high risk group 

0.67

The problem has moderately preventable because: 

=PP

=PP =PP =PP 

Severity or gravity of the problem. The problem has low gravity because it cannot affect the whole family immediately and effects will only occur if the there happened to be an immediate expenditure which is not as expected or is not included in the usual budget. Duration of the Problem The problem has





D. Salience

2/2x1

TOTAL SCORE

1

existed even before the student nurses arrived. Current Management Mr. Lorenzo is currently working to earn a living But since there is an insufficient income, Mother Mae tries to add up to their income by sharpening BBQ sticks. However it is still insufficient to make their income above poverty line. Exposure to any high risk group Since the whole family is residing in the house and all of them have individual needs, they are all belonging to the high risk group.

The family recognizes the existence of the problem and it requires prompt intervention. The reason Mrs. Mae is trying her best to earn as well.

3.34

Problem #6.5: Lack of food storage facilities as a Health Threat CRITERIA COMPUTATION SCORE JUSTIFICATION A. Nature problem

of

the 2 / 3 x 1

0.67

The problem is a health threat because improperly stored food can lead to food spoilage and eventually malnutrition (less than body requirements) because it will be wasted rather than be eaten to provide nourishment for the children. It will also allow for the growth of pathogenic microorganisms that when eaten, will affect the health of the family members like the ill effects of molds and the like.

B. Modifiability of the 1 / 2 x 2 problem Current Knowledge Resources of the Family Resources of the Nurses Resources of the Community

1

x

partially

Current Knowledge The family does not recognize the existence of the problem and its bad effects since they had been used to not having food storage (e.g. refrigerator) and they do not recognize the need of such. They have been used to using casserole as food storage.  Resources of the Family The family has no adequate resources to make the best intervention to the problem and alternatives are not known to them like use of air-tight containers.  Resources of the Nurses Knowledge and time of the student nurses are available to establish awareness and recognition of the problem. They are also knowledgeable for the teachings to help the family choose alternative food storages that will aid in proper storing of food.  Resources of the Community The community resources are also available where they could provide health teachings for the proper storing of food and the possible risk of improperly stored food. 

x

 

C. Preventive 2 / 3 x 1 Potential (PP)

The problem is modifiable because:

0.67

The problem has moderately preventable because: 

Severity or gravity of the

Severity or Gravity  Duration  Current Manage ment  Exposur e to any high risk group 

=PP

=PP =PP



=PP 



D. Salience

1/2x1

TOTAL SCORE

0.50

problem. The problem has low gravity because it cannot affect the whole family immediately and effects will only occur if the food cooked will not be all consumed. Duration of the Problem The problem has existed even before the student nurses arrived and is unknown to the members. Current Management Since a there is a lack of proper food storage for the family, the management they do is to consume all the food cooked and to dispose the left over so that it the possible ingestion of spoiled food and growth of pathogenic microorganisms may be lessen. Exposure to any high risk group Since the whole family is residing in the house and eating the same food prepared, all the members are at risk of ingesting contaminated food and spoiled food.

The family does recognize the existence of the problem but it does not require prompt intervention for them since they are used to utilizing casseroles as container for food leftovers.

2.84

Problem #6.5: Poor Environment Sanitation: Improper Drainage System as a health threat CRITERIA COMPUTATION SCORE JUSTIFICATION A.

Nature

of

the 2 / 3 x 1

0.67

The problem is a health threat

problem

because if the drainage remains inefficient, water may flow into the house during rainy days and it may pose some flood-borne (like leptospirosis) disease to the family or may serve as a breeding site for mosquitoes.

B. Modifiability of the 1 / 2 x 2 problem Current Knowledge Resources of the Family Resources of the Nurses Resources of the Community



1

The problem is modifiable because: 

x

 





partially

Current Knowledge The family recognizes the problem existing because they are worried of the possible entry of water into their house especially that rainy season is fast approaching. Mother Mae— the provider of care—is carefully keeping the water to be directed on to another way during rains. Resources of the Family The family has no adequate resources to make the best intervention to the problem. It is costly in terms of money, time, and manpower to construct a proper drainage in their vicinity. Also, the father who can think and do alternative is not always present. Resources of the Nurses Knowledge and time of the student nurses are available to establish awareness and recognition of the problem. They are also knowledgeable for the teachings to help the family think of another alternative or precautions during the rainy season.

Resources of the Community The community resources are also available where they could provide teachings and manpower. They can also help in providing alternatives like sand bagging and the like. 

C. Preventive 2 / 3 x 1 Potential (PP) Severity or Gravity  Duration  Current Manage ment  Exposur e to any high risk group 

0.67

=PP

The problem is moderately preventable because: 

=PP =PP  =PP 



D. Salience

1/2x1

0.50

Severity or gravity of the problem. The problem has low gravity because it cannot affect the whole family immediately and effects will only occur when the rainy season arrives. Duration of the Problem The problem has existed even before the student nurses arrived. Current Management Since a there is an insufficient income, Mother Mae does not prioritize the construction of a drainage system to be included in their expenses. Therefore instead, they dug a pit that will direct the flow of water to deviate away from towards their house to another way Constructing a man-madelike-drainage system. . Exposure to any high risk group Since the whole family is residing in the house, they are all belonging to the high risk group.

The family recognizes the existence of the problem but it

does not require prompt intervention for them because the effects only occur whenever there are heavy rains. TOTAL SCORE

2.84

Problem #8: Improper Garbage Disposal as a Health threat CRITERIA COMPUTATION SCORE JUSTIFICATION A. Nature problem

of

the 2 / 3 x 1

B. Modifiability of the 1 / 2 x 2 problem Current Knowledge Resources of the Family Resources of the Nurses Resources of the Community

x

0.67

The problem is a health threat because once the garbage became a breeding site for vectors or other insects that bring about transmission of infective agents; it can be a threat to the healthy functioning of the family per individual member and as a whole such as vector-borne diseases like dengue and malaria.

1

The problem is modifiable because: 

  



partially

Current Knowledge The family does not recognize the risk of leaving the garbage near their sink. Moreover, they are not aware of the benefits of keeping garbage in a more appropriate place. Resources of the Family The family has adequate resources to make a particular intervention to the problem since they can throw their garbage outside in a can where in the garbage collectors can collect or they can dig holes that they can bury the biodegradable trash.



Resources of the Nurses Knowledge and time of the student nurses are available to establish awareness and recognition of the problem. Also, they have proper know-how to perform independent nursing intervention like health education.

Resources of the Community The community resources are also available to assist the family in terms of regular garbage collection or garbage cans provided all through out the community vicinity. 

C. Preventive 1 / 3 x 1 Potential (PP) Severity or Gravity  Duration  Current Manage ment  Exposur e to any high risk group 

0.33

The problem preventability. 

=PP

=PP =PP =PP





has

low

Severity or gravity of the problem. The problem has high gravity because it can affect the health status of all of the members. If it progresses to a more severe problem like becoming a breeding site for infectious agents, it can pose danger to the family’s health. Duration of the Problem The problem has existed even before the student nurses arrived and is unknown to the family. Current Management Current management is absent since the family does not see the disadvantages of putting the garbage in a plastic hanging near their sink and cooking facility and the supposed



D. Salience

1/2x1

TOTAL SCORE

0.50

provider of a healthy environment is not knowledgeable of it too. Exposure to any high risk group Since the children are fond of playing, they can have contact with the garbage that may possibly have infectious agents and may cause them infection altering their normal health status.

The family recognizes the need to intervene with the yet it does not need immediate attention for them since the disadvantages are not immediately seen too like the occurrence of diseases and such.

2.50

Problem #9 Risk for Cross infection as a health threat CRITERIA COMPUTATION SCORE JUSTIFICATION A. Nature problem

of

the 2 / 3 x 1

B. Modifiability of the 1 / 2 x 2 problem

0.67

The problem is a health threat because spread of the infection may cause illness to the family members and may impair their role assumptions.

1

The problem is modifiable because: 



partially

Current Knowledge The family does not recognize the problem existing because they are not aware of the possible routes of spreading the infection. Resources of the Family The family can have

Current Knowledge Resources of the Family Resources of the Nurses Resources of the Community

  

C. Preventive 1 / 3 x 1 Potential (PP) Severity or Gravity  Duration  Current Manage ment  Exposur e to any high risk group 

herbal medicines to treat the sick member and they can have precautions in interacting with the sick individual like frequent handwashing.  Resources of the Nurses Knowledge and time of the student nurses are available to establish awareness and recognition of the problem. They are also knowledgeable for the teachings to help the family expand their knowledge of the possible modes of transmission of the infection.  Resources of the Community The community resources are also available where they could provide teachings. Furthermore, it can provide medications for the ill person to treat underlying disease.

X

=PP

0.33

The problem has preventability because: 

=PP =PP  =PP 

low

Severity or gravity of the problem. The problem has high gravity because it can affect the whole family when they inhale the microorganism suspended in the sick person’s secretions. Duration of the Problem The problem has existed even before the student nurses arrived. Current Management The mother does not know how to treat the sick person. And she does not intend to bring her to the



D. Salience

1/2x1

TOTAL SCORE

0.5

health center. Exposure to any high risk group Since the whole family is residing in the house, they are all belonging to the high risk group because all of them can inhale the pathogen suspended or contained in the secretion of the sick person.

The family does not recognize the existence of the problem because they are not aware of the disease’s mode of transmission and how to manage cross infection But if so, they would treat it as requiring prompt intervention because it can entail their health as a family.

2.5

Problem #11: Presence of Accident Hazards (Exposed electrical wires) as a Health Threat CRITERIA COMPUTATION SCORE JUSTIFICATION A. Nature problem

of

the 2 / 3 x 1

B. Modifiability of the 1 / 2 x 2 problem

0.67

The problem is a health threat because it poses danger for the family once they accidentally touch the exposed electrical wire. Once they do, level of functioning may decrease or the family may suffer from loss a member or total impaired functioning of one of the members.

1

The problem is modifiable because: 

partially

Current Knowledge The family does not

Current Knowledge Resources of the Family Resources of the Nurses Resources of the Community

recognize the presence of the exposed electrical wires and the danger it may bring.  Resources of the Family The family has adequate resources to make a particular intervention to the problem especially that father Lorenzo is an allaround laborer. However, they do not know the existence of the problem and so they do not make use of their resources.  Resources of the Nurses Knowledge and time of the student nurses are available to establish awareness and recognition of the problem. Also, they have proper know-how to perform independent nursing intervention like help the family fix the exposed wires with electric tapes.  Resources of the Community The community resources are also available to assist the family in terms of available tools and manpower.

x x

 

C. Preventive 1/ 3 x 1 Potential (PP)

0.33

The problem has low preventive potential. 

Severity or gravity of the problem. The problem has high gravity because it can affect cause an unlikely accident to any of the members and may impair his/her functioning in the family. Duration of the Problem The problem has existed even before the

Severity or Gravity  Duration  Current Manage ment  Exposur e to any high risk group 

=PP  =PP =PP =PP 

D. Salience

0/2x1

TOTAL SCORE

0

student nurses arrived. However, its existence was not known by the family. Current Management Since the supposed member—father Lorenzo— should be the rightful person to fix the problem is always not around, there is no current management being undertaken. Exposure to any high risk group Since all of them are prone to electrical accident, they all belong to the high risk group esp. the children who are curious of many things, explorative, and playful.

The family does not recognize the problem and therefore has low salience because the exposed wires have been there ever since and no family member yet had been affected.

2

Problem #11: Poor environmental Sanitation: Air Pollution as a Health Threat CRITERIA COMPUTATION SCORE JUSTIFICATION A. Nature problem

of

the 2 / 3 x 1

B. Modifiability of the 1 / 2 x 2 problem

0.67

The problem is a health threat because the presence of smoke upon burning of the plastic and other materials can be harmful and irritating to the lungs.

1

The problem is modifiable because: 

partially

Current Knowledge The family does not

Current Knowledge Resources of the Family Resources of the Nurses Resources of the Community

recognize the problem existing AEB mother Mae verbalizing that they utilize this process to eliminate their wastes. Yet, she did not made mention some questions of its ill effects.  Resources of the Family The family either can dig a hole where they can burry these wastes. Or they can collect them in a plastic bag and wait for the collectors to get it. Yet they do not utilize any of these.  Resources of the Nurses Knowledge and time of the student nurses are available to establish awareness and recognition of the problem. They are also knowledgeable for the teachings to help the family expand their knowledge of the ill effects of air pollution through burning of plastic.  Resources of the Community The community resources are also available where they could provide teachings. Furthermore, the garbage collection occurs at times.

X X

 

C. Preventive 1 / 3 x 1 Potential (PP)

0.33

The problem has preventability because: 



low

Severity or gravity of the problem. The problem has high gravity because it can affect the whole family when they inhale the smoke. Duration of the Problem The problem has existed even before the

Severity or Gravity  Duration  Current Manage ment  Exposur e to any high risk group 

=PP  =PP =PP =PP

D. Salience



0/2x1

TOTAL SCORE

0

student nurses arrived because it has been the family’s practice. Current Management The family does not know that there is a problem occurring with regards to the ill effects of burning their garbage. Therefore, interventions are absent. Exposure to any high risk group Since the whole family is residing in the house, they are all belonging to the high risk group because all of them can inhale the smoke either passively.

The family does not recognize the existence of the problem so it does not require prompt intervention because no yet became sick of their practice of burning garbage and it is their most convenient way of disposing their garbage.

2

Problem # 11: Risk for Injury as a health threat CRITERIA COMPUTATION SCORE JUSTIFICATION A. Nature problem

of

the 2 / 3 x 1

B. Modifiability of the 1 / 2 x 2 problem

0.67

The problem is a health threat because injury caused by the accident hazards can impair the proper functioning of the family member that will be injured.

1

The problem is modifiable because: 

partially

Current Knowledge The family does not

Current Knowledge Resources of the Family Resources of the Nurses Resources of the Community

recognize the problem existing because they are not aware of the accident hazards.  Resources of the Family The family can fix the exposed wires especially that the father is an allaround laborer and is knowledgeable of fixing it..  Resources of the Nurses Knowledge and time of the student nurses are available to establish awareness and recognition of the problem. They are also knowledgeable for the teachings to help the family expand their knowledge of regarding the danger of the exposed wires and the injury it may cause.  Resources of the Community The community resources are also available where they could provide teachings. Furthermore, it can provide manpower to help in fixing the accident hazards.

X   

C. Preventive 1 / 3 x 1 Potential (PP)

0.33

The problem has preventability because: 



low

Severity or gravity of the problem. The problem has high gravity because it can affect the whole family when they are injured of the accident hazards such as the exposed wires of electricity. Duration of the Problem The problem has existed even before the student nurses arrived.

Severity or Gravity  Duration  Current Manage ment  Exposur e to any high risk group 

=PP



=PP  =PP =PP

D. Salience

TOTAL SCORE

1/2x1

0

2.

Current Management The mother does not know that the problem is existing long ago and no management is done. Exposure to any high risk group Since the whole family is residing in the house, they are all belonging to the high risk group because all of them is at risk of the injury the accident hazards can bring.

The family does not recognize the existence of the problem because they are not aware of the danger it is bringing. Furthermore, the risk for injury of their members is not also known.

VI. Family Nursing Care Plans Problem 1 First Level of Assessment: Presence of Coughs (Ann) as a Health Deficit Second Level of Assessment:

Inability of the family to provide nursing care to its sick member due to: a. Lack of knowledge and skill in carrying out the necessary treatment/procedure/care b. Ignorance of facts about the disease and health condition

Cues S > “Mga 2 days ne manguku. Balamu pin mimika ya eh!” as verbalized by mother Mae. O > The client manifested: > non productive coughing

Analysis of the Problem Inability of the family to provide nursing care to its sick member due to: a. Lack of knowledge and skill in carrying out the necessary treatment/procedur e/careb. Ignorance of facts about the disease and health condition

Objectives Short Term: After 1-2 days of home visits, the family will be able to recognize the necessity of intervention in the relieving the coughs Long Term: After 4-5 days of home visits, the family will use safe and effective ways in treating or alleviating the disease condition like increasing fluid intake or taking herbal medications.

Nursing Interventions >Identify reasons behind acquiring the disease > Discuss the mode of transmission with the family. > Encourage increase fluid intake. > provide warm versus cold liquids as appropriate. > Provide gentle back rubbing > Always check child’s back for sweat. Wipe the back for sweat. > Encourage to take in Vitamin C regularly. > Advise mother to seek medical advice.

Rationale -to provide baseline data to which treatment will be directed - to prevent transfer of disease - to relieve itchy throat or liquefy possible secretions To mobilize secretions.

- to provide comfort -to limit or rule out aggravating factors. - To increase body’s resistance to microorganism - To identify proper treatment and interventions.

Method of Family Contact Home visits

Resources Required >Family’s cooperation >Student Nurse’s time, effort, skills and knowledge >Community resources: Health center’s free medication

Expected Outcome Short Term: The family shall have been able to recognize the necessity of intervention in the relieving the coughs and colds Long Term: The family shall have used safe and effective ways in treating or alleviating the disease condition like increasing fluid intake or taking herbal medications.

Problem 2 First level Assessment: Unhealthful Lifestyle and Personal Habits or Practices: CIGARETTE SMOKING as a Health Threat Second level Assessment: Inability to recognize existence of the problem due to: a. Ignorance of facts or inadequate knowledge of ill effects of smoking b. Attitude in life which hinders recognition of the problem Cues

Analysis Of The Problem

Objectives

S = “Bayung tawu ya pa sisindi ne. Kayari na ning metung, makasindi ne ing katuki.” As verbalized by Mother Mae

Inability to recognize existence of the problem due to:

Short term: After 2 home visits, the family will verbalize understanding of the ill effects of smoking both on the smoker and those who inhale the second hand smoke.

O= > lips of Mr. Lorenzo are dark in color [seen on pictures] >consumption of 1 pack per day as stated by Mother Mae

a. Ignorance of facts or inadequate knowledge of ill effects of smoking b. Attitude in life which hinders recognition of the problem

Long Term: After 6 days of home visits, Mr. Lorenzo will make efforts to reduce by about 1-2 sticks the number of cigar sticks he smokes in a day.

Nursing Interventions > Establish rapport > Provide health teachings about smoking and its effects > Encourage the family member who smokes to lessen the number of sticks he lights in a day. > Encourage the smoker to smoke outside the house. > Keep away smokers.

children from

Rationale -To gain the cooperation of the client -To help the family be aware of the negative effects of smoking. -To lessen the habit of smoking and eventually stopping its use. -To avoid affectation of children to inhale the second hand smoke. -To avoid inhaling the smoke that could cause respiratory problems.

Method Of Family Contact Home visits

Resources Required

Expected Outcomes

> Time and interest of the family

Short term: The family shall have verbalized understanding of the ill effects of smoking both on the smoker & those who inhale the second hand smoke.

> Participation and cooperation of the family > Knowledge, skills and attitude of the student nurses

Long Term: The family, esp. Mr. Lorenzo shall have done efforts to reduce by about 1-2 sticks the number of cigarette he smokes a day.

Problem 3 First level Assessment: Inappropriate role Assumption (Mrs. Mae has the power to decide) as a Health Threat Second level Assessment: Inability to recognize existence of the problem due to: a. Ignorance of facts or inadequate knowledge b. Attitude/philosophy in life which hinders recognition of the problem Cues S =Ø O= Mrs. Mae stressed out that she makes the decisions at home because her husband is always not around. Furthermore, she described her husband as nondominating and calm&quiet.

Analysis Of The Problem Inability to recognize existence of the problem due to: a. Ignorance of facts or inadequate knowledge b. Attitude/philosophy in life which hinders recognition of the problem

Objectives Short term: After 2 home visits, Mrs. Mae will be able to understand the importance of consulting her husband in decisionmaking. Long Term: After 6 days of home visits, Mr. Lorenzo will be able to give his part in the decisionmaking process whenever he is around or in making major decisions for the family.

Nursing Interventions > Establish rapport > Provide health teachings about the negative effects of leaving the decision on one parent alone >Stressed out benefits of having combined opinions before deciding. > Encourage the family member to always assume their roles with responsibility and be not dominating or inferior but only fair. > Discourage the weak authoritarian attitude of Mr. Lorenzo and encourage him to take part in making choices for their family. > Include the children in tackling the decisions and options.

Rationale -To gain the cooperation of the client -To help the family be aware of the negativity of their practice. -For them to weigh the advantages and disadvantages of sharing in decision-making tasks. -To remind them that equality in authority is needed to gain mutual respect. -To develop a strengthened and confident authority in him esp. that he is the head of the family. . To make them feel belongingness and let them voice out themselves.

Method Of Family Contact Home visits

Resources Required

Expected Outcomes

> Time and interest of the family

Short term: The family shall have verbalized understand the importance of consulting her husband in decision-making Long Term: Mr. Lorenzo shall then be able to give his part in the decision-making process whenever he is around or in making major decisions for the family.

> Participation and cooperation of the family > Knowledge, skills and attitude of the student nurses

Problem 4 First level Assessment: Presence of Rodents and Cockroach as a Health Threat Second level Assessment: Inability to provide a home environment that is conducive to health maintenance due to: a. inadequate knowledge of preventive measures b. inadequate financial family resources Inability to make decisions with respect to taking appropriate action due to: a. failure to comprehend the nature, magnitude/scope of the problem. b. Low salience of the problem Cues S =”Dacal ipas keni bale. Bahay-ipis ne pin awus ing anak ku keng bale mi eh.” O = The following were observed: > Presence cockroach >manual eradication of cockroaches > temporary disposal of garbage inappropriately .

Analysis Of The Problem Inability to provide a home environment that is conducive to health maintenance due to: a. inadequate knowledge of preventive measures b. inadequate financial family resources Inability to make decisions with respect to taking appropriate action due to: a. failure to comprehend the nature, magnitude/scope of the problem. b. Low salience of the problem

Objectives Short term: After the initial home visit, the family will be able to verbalize understanding of the harmful effects o insects and rodents inside their house. Long-term: After 5 days of home visits, the family will be able to perform and demonstrate compliance of health teachings and effective eradication of the rodents.

Nursing Interventions > Explain present environmental condition

Rationale the

> Advise the family to regularly clean the surroundings of their house > Instruct the mother to cover their kitchen utensils or store in the cabinet > Instruct the mother regularly to cover their water > Instructed the mother to properly throw their garbage and cover it

-To inform the family about the present condition of the surrounding of the house -To have a clean and healthy environment that is conducive to health -To prevent them from being contaminated by the cockroaches -To prevent it from becoming a breeding for insects and rodents > Rooting out the cause of the problem serves as one of the best solutions in problem coping

Method Of Family Contact Home visits Observations Interview

Resources Required > Time and interest of the family > Participation and cooperation of the family > Knowledge, skills and attitude of the student nurses > Cleaning materials like broom and soap or insecticides

Expected Outcomes Short term: The family shall have verbalized understanding of the harmful effects of insects and rodents inside their house. Long-term: The family shall perform and demonstrate compliance of health teachings and effective eradication of the rodents.

Problem 5 First Level: Inadequate/Insufficient Family Resources as Health Threat Second Level: Inability to provide food storage facilities conducive to health maintenance due to: a. inadequate family resources specifically limited physical resources b. failure to see benefits of investments in home environment improvement Inability to make decisions with respect to taking appropriate health action due to: a. lack of knowledge as to alternative courses of action open to them b. low salience of the problem Method of Cues Analysis of the Objectives Nursing Rationale Family Problem Interventions Contact > Compute for - to provide Home visits S= “Manakitan Inability to Short Term: After 1-2 days the family’s comparison and yamung sustain and and identify 7,500php ing meet their basic of home visits, expenses bulan in asawa needs due to the family will be salary. deficiency when able to plan ku. eh” as lack of family means it comes to to verbalized by resources, financial status improve their the mother. especially condition such as >Give the family income. - to give the intake of information O = The family family an idea nutritious yet regarding the cheaper food. income per on how to earn different ways month is only P on earning extra extra income Long Term: 7,500 divided After 5-6 days income. into 4 of them. of home visits, > Encourage the They are the family will be family to plant considered - to earn extra able to recognize vegetables. poor since only to effective ways to > Provide tips on money; P 1,875 is provide for food proper increase and allotted per - to maximize maximize their budgeting. income or > Encourage the family member. use of minimize their them to buy money expenses like prioritizing promotion of health to avoid expenses due to illness.

cheaper but nutritious foods such as cheaper meats or vegetables.

- to meet the nutritional needs without compromising health needs

Resources Required Determination and hard work of the family. Time and effort for both the family and the student. Health Teachings provided by the student nurse is necessary.

Expected Outcome Short Term: The family shall have planned means to improve their condition such as intake of nutritious yet cheaper food. Long Term: The family shall have been able to recognize effective ways to increase and maximize their income or minimize their expenses like prioritizing promotion of health to avoid expenses due to illness.

Problem 6.5 First Level: Lack of food storage facilities as a Health Threat Second Level: Inability to provide food storage facilities conducive to health maintenance due to: a. inadequate family resources specifically limited physical resources (e.g. Lack of space to facility) b. failure to see benefits of investments in home environment improvement Inability to make decisions with respect to taking appropriate health action due to: a. lack of knowledge as to alternative courses of action open to them b. low salience of the problem Cues

Analysis Problem

of

the

S> Ø O> left overs were stored on casserole >lack of refrigerat or that prevents food spoilage

>Inability to provide food storage facilities conducive to health maintenance due to: a. inadequate family resources specifically limited physical resources (e.g. Lack of space to construct facility) b. failure to see benefits of investments in home environment improvement >Inability to make decisions with respect to taking appropriate health action due to: a. lack of knowledge as to alternative courses of action open to them b. low salience of the problem

Objectives

Nursing Intervention

Rationale

Short Term: After 1-2 days of home visit, the family will be able to demonstrate proper storage of food and understand the rationale and possible consequences of improper food storage

>Assess the presence methods utilized by the family to store food

-To differentiate present situation to the ideal for determination on the focus of intervention >To help the family recognize the current problems as well as its effect to their health >To encourage participation from the family in changing inappropriate habits

Long Term: After 5 days of home visit, the family will be able to promote and apply proper food storage in their everyday living as evidence by presence of covered food stored or avoiding left overs.

>Discuss with the family the existence of the problem >Stress importance of giving appropriate attention to proper storage of food and its benefits >Advice the family to maintain open communication and discuss about obtaining equipments that will be conducive to their health maintenance >Advice the family to consider alternative food storage to prevent food spoilage and contamination (e.g. Tupperware)

>To promote equal authority in decision making each responsibilities for the rest

>To meet the family’s financial capabilities

Method of Family Contact Home Visit

Resource s Required >Student nurse’s, time, effort and skills >Family’s time, cooperati on and decision making competen ce >Commu nity’s material resources food storage equipmen ts (e.g. refrigerato r, food cover, Tupperwa re)

construct

Expected Outcome Short Term: The family shall have demonstrated proper storage of food and understand the rationale and possible consequences of improper food storage Long Term: The family shall have promoted and apply proper food storage in their everyday living as evidence by presence of covered food

Problem 6.5 First level Assessment: Poor Environment Sanitation: Improper Drainage System as a health threat Second level Assessment: Inability to make decisions with respect to taking appropriate health action due to: a. Failure to comprehend the nature, magnitude/scope of the problem. Inability to provide a home environment which is conducive to health maintenance due to: a. Limited physical resources like lack of space to construct facility b. Lack of knowledge on preventive measures. c. Inadequate family resources specifically financial constraints and manpower. Cues

Analysis problem

of

the

S = “Pag mumuran, lulub keni bale ing danum. Atin kasi siwang eh!” O = drainage system is only a constructed pit that allows flow of water be deviated from the house towards another direction; still this is ineffective during rainy days. =there is a hole beneath the door that allows passage of water into the house.

Inability to make decisions with respect to taking appropriate health action due to: a. Failure to comprehend the nature, magnitude/scope of the problem. Inability to provide a home environment which is conducive to health maintenance due to: a. Limited physical resources like lack of space to construct facility b. Lack of knowledge on preventive measures. c. Inadequate family resources specifically financial constraints and manpower.

Objectives Short term: After 1-2 days of home visits the family will verbalize understanding of the importance of it and its possible effects to health such as the water can enter the house and soaked-wet all their house appliances. Long term: After 4 days of home visits, the family will be able to demonstrate proper efforts to construct a proper drainage system.

Nursing Intervention >Discuss the importance of good environmental sanitation. >Encourage cleaning of the area where most flies or mosquito breed. >Inspire the family to clean their surroundings so that when water floods out, the water that will enter their house will be less dirty. >Provide health teachings regarding the benefits of having a good drainage system.

Rationale - To know the complication & provide baseline information & acknowledge the presence of the problem. - To control the spread of disease or cause of dengue. - To promote good environmental sanitation.

- To inform the family of the benefits of having a good drainage system.

Method contact -Home visits -Interview -Observation

of

Resources required Human resources: Family’s cooperation and time student’s knowledge time and effort.

Evaluation Short term: The family shall have verbalized understanding of the importance of sanitation & its effects to health such as the water can enter the house and soaked-wet all their house appliances. . Long term: The family shall have been able to properly demonstrate proper efforts to construct a proper drainage system.

Problem 8 First Level of Assessment: Second Level of Assessment:

Cues S> O O> garbage placed on a plastic bag was seen hanging near the cooking facility.

Improper Garbage Disposal as a Health threat Inability to provide a home environment which is conducive to health maintenance and personal development due to: a. Failure to see benefits of investment in home environment improvement b. Lack of knowledge of importance of hygiene and sanitation c. Ignorance of preventive measures Analysis of the Objectives Nursing Rationale Method of Resources problem Intervention contact required Inability to Short term: >Assess the -to obtain a -Home visits -student nurses’ provide a home After 2-3 days of general housing baseline data -Interview time, effort, and home visit, the condition environment -to determine skill -Observation which is family will develop >Identify the degree of -family’s time awareness on the conducive unsanitary nursing and cooperation, importance of health garbage disposal intervention compliance, good maintenance >Assess the needed participation and environmental and personal sanitation provide understanding as reasons of the -to development >community evidenced by failure to dispose background disposing the garbage properly information for due to: waste containers a. Failure to garbage properly >Discuss with the nurses to and garbage see benefits of and implementing the family the know which collection investment in cleanliness possible health habit to correct Long term: home consequences of -to encourage After 5 days of environment initiative to home visit, the improper improvement a family will be able garbage disposal maintain b. Lack of to maintain a -Help the family clean knowledge of clean environment find the environment by importance of that is conducive appropriate place a proper health where to dispose disposal hygiene and to of maintenance as or sanitation temporarily waste by place the house -to initiate the c. Ignorance of evidenced disposing the preventive wastes family’s garbage in a more nature compliance to appropriate teachings container like can. about sanitation that were given.

Evaluation Short term: The family shall have developed awareness on the importance of good environmental sanitation as evidenced by disposing the garbage properly and implementing cleanliness Long term: The family shall have maintained a clean environment that is conducive to health maintenance as evidenced by disposing the garbage in a more appropriate container like can.

Problem 9: First Level of Assessment: Risk for Infection as a Health Threat Second Level of Assessment: Inability to recognize the presence of the problem due to: a. Ignorance of facts/lack of knowledge Inability to provide adequate nursing care to the at risk member of the family due to: a. Ignorance of facts about health condition b. Lack of knowledge in carrying out necessary precaution Cues S> “Mga 2 days ne manguku” O> Ann coughs colds

has and

Analysis of the problem Inability to recognize the presence of the problem due to: a. Ignorance of facts/lack of knowledge Inability to provide adequate nursing care to the at risk member of the family due to: a. Ignorance of facts about health condition b. Lack of knowledge in carrying out necessary precautions

Objectives

Nursing Intervention

Rationale

Short term: After 2-3 days of home visit, the family will develop awareness about contributing factors that might increase risk for spread of infection like contact to droplet secretions.

>Identify reasons behind acquiring the disease

-to provide baseline data to which treatment will be directed - to prevent transfer of disease

Long term: After 5 days of home visit, the family will be able to hinder the spread of infection AEB treating the primary ill individual.

> Discuss the mode of transmission with the family. > provide warm versus cold liquids as appropriate. > Provide gentle back rubbing for the ill individual > Always check child’s back for sweat. Wipe the back for sweat. > Encourage to take in Vitamin C regularly. >Advise other members to avoid contact with secretions of ill individual. >Advise ill individual to cover mouth and nose when coughing or sneezing > Advise mother to seek medical advice.

To mobilize secretions. - to provide comfort -to limit or rule out aggravating factors. - To increase body’s resistance to microorganism - contact with it is a route for transmission of pathogen -to avoid inhalation of secretion by other members - To identify proper treatment and interventions.

Method of contact -Home visits -Interview -Observatio n

Resources required -student nurses’ time, effort, and skill -family’s time and cooperation, compliance, participation and understanding >community waste containers and garbage collection

Evaluation Short term: After 2-3 days of home visit, the family shall have developed awareness about contributing factors that might increase risk for spread of infection like contact to droplet secretions. Long term: After 5 days of home visit, the family shall have been able to hinder the spread of infection AEB treating the primary ill individual.

Problem 11

Cues S> Ø O> exposed electrical wires were seen hanging close to the doorway in and out of the house. >Mr. Lorenzo is not always around to help fix the exposed wires

First Level: Presence of Accident Hazards (Exposed electrical wires) as a Health Threat Second Level: Inability to provide a home environment, which is conducive to health maintenance and personal development due to: a. Ignorance of preventive measures b. Failure to see benefits of investment in home environment improvement. c. Lack of skills in carrying out measures to improve home environment Analysis of the Problem >Inability to provide a home environment, which is conducive to health maintenance and personal development due to: a. ignorance of preventive measures b. Failure to see benefits of investment in home environment improvemen t. c. Lack of skills in carrying out measures to improve home environment

Objectives Short Term: After 1 day of home visit, the family will be able to recognize and identify dangers in the presence of accident hazards and know the importance and long term benefits of having an accident free environment as evidence by the efforts made to keep the family aware of the danger of the exposed wires. Long Term: After 5 days of home visit, the family will manifest application of the teachings given AEB elimination of accident hazards like properly kept cables and wires.

Nursing Intervention >Assess the general housing condition >Help the family identify and recognize accident hazards existing in their house >Discuss to the family the importance of having an accidents free environment and its long term benefits. >Discuss to the family the possible consequences of the presence of accident hazards >Help the family eliminate accident hazards existing and provide ways on how to tape them and prevent them being exposed.

Rationale -To assess degree of nursing intervention to be given; obtain baseline data -To involve the family in the achievement of their accident free environment -To increase the family’s knowledge and encourage them to maintain an accident free environment -To provide background knowledge of what to expect in a failure of maintaining an accident free environment >To make the family think and make ways on improving their housing condition.

Method of Family Contact Home Visit

Resources Required >Student nurse’s knowledge, time, effort and skills in maintaining the family’s environment safe and accident free >Family’s time, compliance and cooperation as well as skills in maintaining an accident hazard free environment >Community’s material resources like storages facility, divider, etc.

Expected Outcome Short Term: The family shall have been able to recognize and identify dangers in the presence of accident hazards and know the importance and long term benefits of having an accident free environment as evidence by efforts made to keep the family aware of the danger of the exposed wires. Long Term: The family shall have manifested application of the teachings given AEB elimination of accident hazards like properly kept cables and wires.

Problem 11 First level Assessment: Poor environmental Sanitation: Air Pollution as a Health Threat Second level Assessment: Inability to recognize existence of the problem due to: a. Ignorance of facts or inadequate knowledge of ill effects of gas emissions in burning plastics and other materials b. Attitude in life which hinders recognition of the problem Inability to provide a home environment, which is conducive to health maintenance due to: a. failure to see benefits of investment in home environment improvement b. ignorance of preventive and alternative measures. Cues S = “Sisilaban mi ngan ing basura mi ken. Pati plastic.” as verbalized by Mother Mae O= >presence of ashes and burnt materials piled up on their front yard.

Problem 11

Analysis Of The Problem Inability to recognize existence of the problem due to: a. Ignorance of facts or inadequate knowledge of ill effects of gas emissions in burning plastics and other materials b. Attitude in life which hinders recognition of the problem Inability to provide a home environment, which is conducive to health maintenance due to: a. failure to see benefits of investment in home environment improvement b. ignorance of preventive and alternative measures.

Objectives Short term: After 2 home visits, the family will verbalize understanding of the ill effects of burning the garbage including plastic materials outside. Long Term: After 6 days of home visits, the family will make efforts think of another way of disposing or getting rid of their garbage instead of burning.

Nursing Interventions > Establish rapport > Provide health teachings about the ill effects of burning the garbage outside like dangerous gas emissions > Encourage the family member to shift to another way of getting rid of their waste like burying biodegradable materials. > Discourage the practice of burning the plastic in case they do not want to shift to digging & burying. > Keep children away from the flame.

First Level of Assessment: Risk for Injury as a Health Threat

Rationale -To gain the cooperation of the client -To help the family be aware of the negative of their practice of burning the garbage and possible air pollution. -To lessen the danger of inhaling the smoke emitted by the burning process. -To avoid affectation of children to inhale the gas emitted by the plastic. And to provide decision or choice for the family. -To avoid accidents like burns especially for the playful children. .

Method Of Family Contact Home visits

Resources Required

Expected Outcomes

> Time and interest of the family

Short term: The family shall have verbalized understanding of the ill effects of burning the garbage including plastic materials outside

> Participation and cooperation of the family > Knowledge, skills and attitude of the student nurses

Long Term: The family shall have done efforts to think of another way of disposing or getting rid of their garbage instead of burning.

Second Level of Assessment: Inability to provide a home environment which is conducive to health maintenance and personal development due to: a. Failure to see benefits of investment in home environment improvement b. Ignorance of Preventive measures Cues S> Ø O> exposed electrical wires were seen hanging close to the doorway in and out of the house. >Mr. Lorenzo is not always around to help fix the exposed wires

Analysis of the Problem >Inability to provide a home environment, which is conducive to health maintenance and personal development due to: a. Failure to see benefits of investment in home environment improvement. b. ignorance of preventive measures

Objectives Short Term: After 1-2 days of home visit, the family will be able to recognize risk for injury brought about by the presence of accident hazards such as the exposed wires. Long Term: After 5 days of home visit, the family will manifest application of the teachings given AEB elimination of accident hazards like properly kept cables and wires.

Nursing Intervention >Assess the general housing condition >Help the family identify and recognize accident hazards existing in their house >Explain possible injury for the members >Discuss to the family the importance of having an accidents free environment and its long term benefits. >Discuss to the family the possible consequences of the presence of accident hazards >Help the family eliminate accident hazards existing and provide ways on how to tape them and prevent them being exposed.

Rationale -To assess degree of nursing intervention to be given; obtain baseline data -To involve the family in the achievement of their accident free environment to help increase level of awareness -to encourage them to maintain an accident free environment -To provide background knowledge of what to expect in a failure of maintaining an accident free environment >To make the family think and make ways on improving their housing condition.

Method of Family Contact Home Visit

Resources Required >Student nurse’s knowledge, time, effort and skills in maintaining the family’s environment safe and accident free >Family’s time, compliance and cooperation as well as skills in maintaining an accident hazard free environment >Community’s material resources like storages facility, divider, etc.

Expected Outcome Short Term: The family shall have been able to recognize risk for injury brought about by the presence of accident hazards such as the exposed wires. Long Term: The family shall have manifested application of the teachings given AEB elimination of accident hazards like properly kept cables and wires.

VIII. FAMILY COPING INDEX

CATEGORY

INTIAL

FINAL

SCORE

SCORE

Therapeutic

1 3 5

1 3

Competence

♥

This

5

JUSTIFICATION

Initial: On the initial visit, during the interview, Mother Mae stated that she uses (OTC) over-the-

category

includes

all

counter drugs without consulting a doctor or even just in the health center. She also

procedures

or

mentioned that she prefers to go to herbolarios rather than doctors. But though she consults doctors when her children are the ones that are ill.

treatment prescribed the

for

care

of

illness, such as giving

Final: ♥ After giving advices to Mother Mae about the necessity of seeking professional (medical)

medications and

assistance when encountering sickness within the family, she demonstrated willingness to

using

visit the clinic and consult to the authorized provider of care. She also mentioned that she

appliances,

is willing to participate in the up-coming activities and seminars that will be held at the

dressings,

health center where in her presence was recognized by the student nurses after the course

exercises

and

relaxation,

and

special diets.

of the FCA.

CATEGORY

INTIAL

FINAL

SCORE

SCORE

Knowledge of 1 3 5 Health

1 3

♥

5

JUSTIFICATION

Initial: Before the student nurses made the necessary interventions or give teachings, Mrs. Mae

Condition

showed confusion in the condition of Ann’s cough. Also, when asked about her history, she

This category is

refused to include the cancer of her mother where in it should be included.

concerned with the

particular

health condition that

is

the

occasion

for

care

(e.g.

knowledge the

of

disease,

understanding communicability of diseases and transmission)

Final: After thoroughly explaining the disease condition and possible reasons of its occurrence, Mrs. Mae showed enthusiasm in knowing the disease. She also manifested a clear acceptance of the new knowledge learned.

of

modes

♥

of

CATEGORY

INTIAL

FINAL

SCORE

SCORE

Application

of 1

3 5

Principles

of

♥

Personal

1 3

and

Initial: During the initial visit, the student nurses observed the some practices that do not

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

5

JUSTIFICATION

contribute to proper hygiene and sanitation of the house. Anne was not well groomed. And they place their garbage hanging next to their cooking facility. They also burn their garbage instead of burying or waiting for the collectors.

♥

Final: During the final visit, and the visits after the student nurses initiated activities to improve the family’s hygiene, the house started to be observed clean and in order. Mother Mae also showed change in wanting her child Ann be presentable. She also explained to Anthony that he needs to wear his shoes in going to school.

CATEGORY

Health

is

FINAL

SCORE

SCORE

Care 1 3 5

Attitudes This

INTIAL

1 3

During the initial visit, Mother Mae verbalized that she consults to doctors only for sometime. She prefers to go to herbolarios because she believes it would be more

concerned

effective. She seldom goes to the health center because she thought services are not

with the way

available. She does the same with her children because she is the primary provider of care

the family feels

in the house.

health

care

Initial:

♥

category

about

5

JUSTIFICATION

in

general,

Final: ♥

including

After the health teachings and advices given to the family, Mother Mae started to seek

preventive

medical assistance from authorized provider of care before self-medicating. She also

services, care

begun to understand the need fro check-ups fro the proper preventive and curative

of illness, and

measures for her family. She also showed enthusiasm in visiting the health center.

public

health

measures.

CATEGORY

INTIAL

FINAL

SCORE

SCORE

Emotional 1 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 necessary disciplines imposed by one’s family culture; the development and maintenance of individual responsibility and decision; and willingness to meet reasonable obligations.

3 5

1 3

5

JUSTIFICATION

Initial:

♥ During the initial home visit, the family members do fairly well but sometimes the children were left unattended. Mother Mae and her husband are seldom seen together. And a neighbor commented that she would always shout at her husband.

Final: ♥ After interventions, Mrs. Mae verbalized that though she shouts at Mr. Lorenzo, it would not mean or start a fight. This shows that though they are misinterpreted at times, they are strongly bonded with love and emotional security with one another. And she does not regret of marrying at a young age.

CATEGORY

INTIAL

FINAL

SCORE

SCORE

Family Living 1 Patterns This category is concerned largely with the interpersonal or group aspects of family–how well the family members get along together, the ways in which they make decision affecting the family as a whole, the degree to which they support one another and do things as a family, the respect and affection they show for one another, the ways in which they manage the family budget, the kind of discipline that prevails.

3 5

1 3

♥

5

JUSTIFICATION

Initial: During the initial visit, Mother Mae was the primary decision-maker. She clearly stated that it was she that makes most of the decisions because her husband is a quiet type of person and would not want to intervene with such tasks. .

♥

Final: After encouraging Mother Mae involve in Mr. Lorenzo in activities for their health’s improvement, she showed concern for her husband and decided to include him in decisionmaking.

CATEGORY

Physical

INTIAL

FINAL

SCORE

SCORE

1 3 5

1 3

5

JUSTIFICATION

Initial:

Environment ♥ This category is concerned with the home and community or work environment as it affects family health. This includes condition for housing, presence of accidence hazards, screening, plumbing, facilities for cooking and for privacy, level of community, availability and conditions of schools and transportation.

During the initial visit, the house of the family was in poor condition. It has accident hazards, poor cooking facilities and improperly disposed garbage. Added to this are the garbage burned outside and the electrical wires exposed. There are also breeding sites for insects and the improper drainage system. ♥

Final: After the Nursing Intervention, the house’s condition improved. The student nurses advised the family to throw their garbage outside instead of keeping in hanging near their cooking facility. They were also advised to get rid of their burning practices and start eliminating hazards in their home.

CATEGORY

Use

INTIAL

FINAL

SCORE

SCORE

of 1 3 5

Community

1 3

Initial:

♥ During the initial visit, the family sends their son and daughter Ann and Anthony to the

facilities This category has to do with which family members know about 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.

5

JUSTIFICATION

community’s elementary school. Thus, it indicates that they know some of the community facilities and services. However, they do not make use of the medical services provided in the health center because of lack of confidence and their self-medicating habits. Further more, they seek herbolarios first.

♥

Final: After the information were given that provided awareness to the family by the student nurses, the family started to seek medical privileges provided in the community health center. They used the facilities they need appropriately and promptly (e.g. free medications); knows when to call for help and whom to call. The student nurses also noticed her participation in mothers’ classes.

VIII. Learning Derived The family case analysis made me realized a lot of things and gave me experiences that I can cherish in my life. I enhanced my social ability in doing our family case analysis because we need to interact with them in gathering information. I realized that doing this project we have helped the family enhance their knowledge about health. The family helped me realized to be thankful with the blessing I receive everyday, to be satisfied with the things that I have in my life. God bless. Clefanny Ann M. Bayani BSN III-5 “The first duty of a human being is to assume right functional relationship to society–more briefly, to find your real job and do it.” –Charlotte Perkins Gilman Working is biblical. Jesus even emphasized that whosesoever not being fruitful must be cut off from His people. The fig tree that it did not bear fruit causing it to die and to wither exemplified this gigantic responsibility for us to be productive and be of help to others. As a Christian, I want to live out this benevolent task. As a nurse I want to extend my helping hand to my patients. Moreover, as a student I want to take part in making our group works satisfactory. Gladly, this activity molded me the way I wanted. I developed the “working attitude” that made me a step further towards nursing competence and sense of responsibility. Also, I developed persistence just to finish the part assigned to me and to pursue perfection to honor our Lord and to benefit my group mates. Most importantly, I found the essence of this career and the big part it contributes to society. I learned the lessons I need to gain to be more Christ-like– a compassionate heart. I discovered the purpose behind this God-led journey–to channel His foremost care to the least of His people. And I realized the fullness of life by being able to observe life in different views.

Generally, you can’t just be someone roaming around while watching others make a difference in this world. You have to be in practice and stand up for God and humanity. Think of this: the work will never be finished unless you’ve started. Glory to God, that’s the same thought I had ‘till I made it to the end. Blando, Sherida Mae R., SN BSN III-5 Group 18 Community Health Nursing is both applications of Nursing and public Health which gives human service to every member in the community. It had made great contributions in the health of people providing health services and health teachings. It extends individuals and families in their homes, place of work and schools. Community health Nurses are very significant in providing health services in different places of the community and they give health teachings on how to prevent certain diseases and cure them from their illness. Family Case Analysis is a task of the community health nurses in assessing the family to identify their abnormalities. It helps the family conscious of health dilemmas to resolve their problem using the community resources. I’ve learned many things during our duty in the community. In every place we go, many things we discover. One of these is learning. We learned based from our experiences. There is a big difference between knowledge and skills. Upon exposure you really need energy to do things. You also apply the knowledge that you have learned unlike knowledge you just understand or memorize certain rational without any application. The hardest part in the community requirement is this FCA but I learned a lot. I learned how to establish rapport effectively and to be patient upon assessing them especially tequila. I learned how to interview therapeutically and assess their physical assessment and know their abnormalities; providing health teachings concerning their health and environment. I learned that teamwork really matters. In this FCA it enhanced my grammar in English. I realized upon this FCA that I am fortunate in my life. Upon seeing or experiencing the family that we assess regarding their status in life. I appreciate now the blessing that

God have given to me, with this FCA serve as reflector of life in me and as an application to all the knowledge I learned during my second year as a nursing student. -

-Rajah Lorenzo Sotelo, S.N

I, as a student nurse, have used my skills and knowledge based from my learning from school. On continuing community nursing compilation of data and identifying different problems within a certain community. Upon analyzing such gathered data, I may come up with the corresponding management. The case analysis further increased my knowledge not only as a community health nurse but also as a human. This did not only quench my thirst for knowledge but also my urge to render service especially to the ones needing. We give comfort and care to the family by rendering care, providing information and interventions. I realized, as a future nurse, I myself must not wait for a patient or one who needs. Instead, I must be the one searching for them. To sum up, CHN our profession, truly is a honorable one. - Anthony Riel San Diego

IX Sociogram

Legend: Ape= family before interventions Modern Man= Family after interventions Gadgets= resources including student nurses’ efforts Men in between ape and modern man= process of FCA

X. Spot map and Documentation Spot map Legend: -Health Center

-Adopted Family’s house

- Macapagal Village Grade School

Main door

(Floor plan)

Living room

Masters bedroom

kitchen

Bathroom

Documentation After having found the family to be adopted, the student nurses went back the next day and they were welcomed warmly as though they were known long before. This is the house of the adopted family. This shows the history taking that took place days prior to interventions. This shows the presence of exposed electrical wires inside and outside the house. This is near the door.

One of the problems recognized was the danger of burning the garbage practiced by the family.

The student nurses helped in maintaining the house clean like sweeping the floor.

They also extended a helping hand in hanging-dry the laundry.

This is the cooking facility of the Macapagal Family. They say it’s cheaper.

This is the toilet facility. Though it does not have a water carriage, it looks clean and tidy. This is the inside of their house. The house looks small but it has the appliances they need.

They seem to be ready in accommodating a lot of visitors because they a have enough number of chairs. The outside of the house and the front yard would suggest that life is quiet and peaceful in this community.

Upon actual assessment. Vital signs taking.

The sideline of Mrs. Mae and her neighbors is sharpening BBQ sticks. It is hard way to earn money. Just 8 pesos per 1000 pieces.

Striking a pose with the family is something that will never be out-scheduled.

APPENDIX

BMI = Weight in kilograms Height in (m)² Interpretation: <13

=

emaciated

13 – 18.5

=

underweight

18.5 – 24.9

=

normal

25 – 29

=

overweight

30 and above =

obese

*REFERENCE: Rodolfo F. Florentino, M.D. et. Al. FNRI-PPS Anthropometric Tables and Charts for Filipino Children (Based on the suggested marginal cut-off points), Manila, Philippines, 1992. The anthropometric method of measuring the nutrition status of an individual may reveal the condition of his body that results from the utilization of essential nutrients made available from his daily diet. (Serraon – Claudio, Basic Nutrition for Filipinos, 2002

Formula in Inadequate Living space: TSR: Adult: 13 y/o above = 3m² Child: 1 y/o (0-12 y/o) = 1.5m²

= Summation of TSR/per member TSR> TSA = inadequate TSR
Untalan, A, (2005). CONCEPTS and guidelines in Copar 1st Edition.

Educational Publishing House, United Nations ave., Ermita, metro manila

Weight (KG) for Age‡ of Boys and Girls, 0-72 Months

International Reference Standards (IRS), NCHS/WHO Reference Data, 1978 Age as of last birthday The age of the child is computed to the nearest month as of his/her last birth date, thus, the number of days is not included in the computation of age-in-months. For example, a child born on 01 October 1998 and weighed on 31 August 2001 is 2 years, 10 months and 30 days. So multiplying 2 years by 12 and adding 10 months, the month is 34 months since we disregard the number of days. NOTE: The symbol "<" means less than; and ">"greater than. FOOD AND NUTRITION RESEARCH INSTITUTE D

epartment of Science and Technology

Gen.

Santos Ave., Bicutan, Taguig