I. INTRODUCTION: The devotion of such titans of spirit as Lenin to an Ideal must bear fruit.

The nobility of his selflessness will be an example through centuries to come, and his Ideal will reach perfection -Mahatma Gandhi Mahatma Gandhis quotation stated above means change should start within you. Just like the great leader Lenin, his ideals were able to bear fruit. Likewise in the field of Nursing, a nurses devotion and passion for change, particularly on disease prevention and health promotion, will help her to achieve the change she wants. When this happens, everything else follows- a fruit will bear eventually, and the ideals or actions brought about by the initiation of nurse to change will serve as an inspiration and example for others to imitate. Gradually, the fruit of the nurses ideals will reach perfection which means, the change will manifest on others and on the community. Community is considered as the recipient of service wherein it comprises a group of people sharing common geographical boundaries, values, interest and characteristics. It also refers to a limited geographic area in which the residents relate to and interact among them, thus in Community Health Nursing, community is not the sole central foundation in assessing the health status. In order to properly observe and assess the community, its integral parts must be given attention. The family, which is the basic unit that makes up the community, should be considered. No social group has the potential to provide the same level of support and long lasting emotional ties as ones own family. Family is a factor in bringing the change necessary in promoting wellness among people because it carries a common purpose which is to promote the physical, mental, emotional, and social development of each of its members. With same extent, every member of the family contributes to the wholeness of the community. Since no one lives in isolation, the individuals ability to maintain good relationship with his/her family members and ability to be proactive for the welfare of the whole community should be regarded in the study of Community Health Nursing.
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Hence, a healthy community is rooted from the participation of functional families that of, through the assembly of active and productive individuals (Pillitteri, 2007). Furthermore, community health nursing is a field of nursing that renders community, groups, families and individuals at home, in health centers, in clinics, in school, in places of work for the promotion of health, prevention of illness, care of the sick at home and rehabilitation. Community health nursing indeed, has a breadth that is beyond a medical model approach. Public Health Nurses work with many different client groups, community settings and types of agencies, and they often possess additional areas of specialty knowledge. They are the one who facilitates preventive measures inside the community. (Keleher, 2007) However, public health nurses and the other health care teams in the community are being challenged because they are faced with barriers that stop them from promoting health and preventing illness. One relatable example is the rising unemployment and poverty in the Philippines. The official estimate for unemployment in 2008 was 7.4 percent or 2.7 millionan increase of 0.1 percent from 2007. The government defines the unemployed as those who are simultaneously without work, looking for work and immediately available for work. Added to this, in another survey, Social Weather Station reported a record 23.7 percent increase in the number of families experiencing hunger at least once in three months, to 4.3 million families or more than 20 million people. And with these situations, Family Case Analysis (FCA) tries to find out the relationship of a certain family to the community at large; to find out risk problems and find ways to alleviate these dilemmas that would benefit the family and the community. It is a combined process of assessing, interacting, and interviewing a family. It is a means by which the Nursing Practices is focused on the family as the recipient of care, health as the goal and nursing as the medium for providing care.

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The group criteria in choosing their adopted family for the Family Case Analysis are as follows: A family that will easily be identified to be depressed or deprived A family with 4 or more children, with at least 1 child who belongs to 0-6 A family with visible poor environmental condition. A family that gives permission to be taken as case for the FCA project.

age bracket.

With these criteria established and met, the group chose the Fruit Family. Our adopted family is deprived from adequate resources to sustain their health and lives in a poor environmental condition in the Barangay Virgen delos Remedios. The family is composed of eight family members, where the two of its members are the couple and six of them are their children. The student nurses had three home visits all in all, from December 3, 2009 to December 10, 2009. With the comprehensive physical assessments done, the student nurses were able to determine some threats and deficits that can affect the health of the Fruit Family. Thus, the group will try to determine health related problems and solve them through planned actions. A. Objectives The Family Case Analysis (FCA) aims to examine and assess carefully the general health status of the family, identify their health needs and problems and intervene for the problems encountered. It also aims to promote changes and selfreliance within the family. Student- Centered: a. Short-term: After the initial home visits, the student nurses shall have:
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 Chosen the family for FCA as based from the set criteria. Introduced themselves with the family members. Established rapport with the family members. Explained the purpose of home visit and established contract about their available time. Utilized therapeutic communication technique in dealing with the family. Familiarized each family member. Conducted a physical assessment on each member of the family. Described the family as to type, composition and structure. Determined different factors (environmental and socio-cultural factors) that can affect their health. Identified needs and problems and eventually formulate a plan of action in order to meet their needs with the family. Determined the strengths and weaknesses of the family. Guided the adopted family in eliminating actual and potential problem which could affect achieving an optimum health. Formulated interventions for the problems identified considering also the student nurses and familys resources. Provided health teachings to rule out existing health conditions. b. Long-term: After the last day of home visit, the student nurses shall have: Gained the trust of the family regarding health. Assessed and explained to the adopted family the actual and potential problems identified. Encouraged the family members in taking part in the implementation process.
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 Coordinated and cooperated with the family in solving the identified problems. Guided the family in recognizing their medical and health needs and given health teachings appropriate to the situation. Provided information and assisted the adopted family in availing health services from the Barangay Health Center. Evaluated the interventions made to solve the problems. Client-centered a. Short-term: At the end of the first home visit, the family shall have: Established rapport with the students. Cooperated and coordinated well with the students. Identified the existing actual and potential problems within their family and environment together with the group. Determined the factors that contribute to the existing problems of their family. Discussed these problems with the group as well as with the rest of the members of their family. b. Long-term: After the end of the last home visit the group shall have: Verbalized understanding of the rationale behind each intervention that the student nurses have planned to implement.

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 Participated in the implementation phase of nursing interventions the family members and student nurses agreed upon. Carried out planned interventions. Cooperated well with the student nurses in carrying out planned interventions. Realized the sole significance of these interventions in achieving their full health potential. Research-Centered This Family Case Analysis aims to answer the following questions: 1. How may the profile of each member of the family be described as to: a. Sex b. Age c. Educational status d. Position in the family e. Present health status 2. How may the family be described as to: a. Structure b. Composition c. Socioeconomic status d. Cultural and religious beliefs 3. How the family may be graded in the family coping index regarding to: a. Physical independence b. Therapeutic Competence c. Knowledge of health condition d. Application of principles of general and personal hygiene e. Health care attitudes
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f. Emotional competence g. Family living patterns h. Physical environment i. Use of community facilities 4. How may the health of the family be assessed and described as to: a. Physical assessment b. Neurological assessment c. History of past and present illness d. Activity of daily living e. Obstetrical history f. Growth and development g. Immunization status 5. How may the problems identified in the family be classifies as to: a. Wellness condition b. Health deficit c. Health threat d. Foreseeable crisis 6. How may the problems identified be prioritized and ranked as to: a. Nature of the problem b. Modifiability c. Preventive potential d. Salience B. Entry, Climate of Acceptance, First Few Words, Number of Home Visits The student nurses were tasked to find for a family that will be subjected for a Family Case Analysis that was scheduled 3rd of December, 2009. After one rejection, the group were finally able to find for a family, and they were tagged the Fruit Family.
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The family that group adopted is located at Sur Luisa Street of Barangay Virgen de los Remedios. The following are the interaction of the student nurses with the Fruit Family in three home visits: First Home Visit (December 03, 2009) The first exposure of the group on the community, Virgen Delos Remedios (VDR) was on December 03, 2009 (Thursday). The group met in the main building of the AUF in front of the bookstore at 7:30 in the morning. The group first had an orientation about the community and they were divided into two subgroups. The group rides on a jeepney going to the community. The group started to find the appropriate family after that the group went to the health center for a brief introduction about VDR. The groups clinical instructor helped them to look for their designated family. After the second try looking for a family, the subgroup A chose the Fruit family. The first subgroup first met Mommy Orange and her three children who are tagged as Mango, Banana, and Avocado. The group first saw Mango standing in front of their house while Banana and Avocado are playing with their other playmates. The group first greeted Mommy Orange by saying Good morning po mommy and the group introduces their selves one by one. The group asked the name of the mother and Mommy Orange replied as well. The group established rapport with the family. The student nurses asked Mommy Orange if the group can assess them, and Mommy Orange replied, ok lang. The group started asking some questions beginning from their personal data took their vital signs and assess their general condition. After the group completed their task for that day, the group bid the Fruit Family goodbye and said, Mommy salamat po. Babalik na lang po kami bukas. Salamat po ulit. Mommy Orange smiled back and said, ok. Second Home Visit (December 04, 2009) At the second home visit, the group was tasked to get the house measurements of the family. The group only met Watermelon, Banana and Avocado. Watermelon said,
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umalis po yung nanay ko, pero babalik din po siya mayamaya lang. The student nurses replied, a, ganun ba, ok lang susukatin lang namin yung bahay nyo, ok lang ba?, pero pagkauwi nya dun namin siya parang ch-check up Watermelon said yes so the group proceeded on their task. The student nurses took the measurements like total floor area, total window opening. The group also assessed the familys housing condition and the members final assessments due to the groups shorten rotation. The group decided to give the Fruit family a lugaw and bread as a token of appreciation for welcoming us into their family wholeheartedly. The group helped the Fruit family in preparing their breakfast. The group also helped the family to clean their dishes, and their whole house. The group talked to Watermelon, Sabihin mo sa mommy mo, salamat ha, magbabalik pa rin kami next week. Watermelon smiled backed and the family and student nurses parted ways. Afterwards the group returned to check if Mommy Orange is at their home already. When the group saw Mommy Orange, the group performed final assessment to Mommy Orange and took her vital signs. Third Home Visit (December 10, 2009) On the third home visit, the group didnt met Mommy Orange and Mango at first few hours of interaction but the group already had their final assessment to these two family members on the groups second home visit. On the third home visit the group did some of their interventions to the Fruit family, since Mommy Orange isnt around the group helped the Fruit family in cleaning their house like washing their dishes, sweeping the floor and arranging the familys furniture. As one of the groups problem is poor hygiene, the student nurses implemented their planned actions by bathing the children especially Avocado and trimming their nails. The group had all of their needed information so the group told the family that this can be their final home visit. The group gave thanks to the family, their hospitality and their willingness to be part of our Family Case Analysis. After some conversation, the group took pictures with the family and left some tokens of appreciation and greeted, Merry Christmas. The family replied, salamat sa tulong nyo. Then, the student nurses bid goodbye. After few hours,

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Mommy Orange and Mango went home so the group took the two family members final assessment of their vital signs. C. Family Constellation Family Constellation includes the family profile of all the members of the family, regarding with the given name of the member of the family, their age, ordinal position, sex, educational status and their present health status. This chapter may aid the reader in knowing all the necessary information about the family members.

POSITION NAME AGE IN THE FAMILY SEX

EDUCATIONAL ATTAINMENT

PRESENT HEALTH STATUS Physical assessment was not done because Mr.

49 years Daddy APPLE old July 21, 1960 Father M

Vocational Graduate

Apple was not present during the home visits because he works as a jeepney driver from 5am to 9pm.

Mommy ORANGE

44 years old June 22, 1965

Mother

Elementary Graduate Upon the initial assessment, mother was seen cleaning the house. She
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has a large built size which shows that she is OVERWEIGHT. She is observantly alert, with coordinated and steady gait. She was cooperative, exhibited thought association and has sense of reality. Her medium length hair is dirty and presence of dandruff was noted. Mommy Orange has also a knocked upper tooth and has dental caries. She has a trimmed neat fingernails and toenails. No abnormal spine
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curvatures were observed. The following vital signs were noted: T: 36.5C PR: 65bpm RR: 19cpm BP: 120/80 Height: 162 cm. Weight: 62 kg BMI: 23.66 m2/kg Upon the final assessment, Mommy Orange is wearing white shirt and black shorts upon the interaction. She was seen feeding her children. It was observed that she is conscious and coherent. She appears more
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clean and tidy. She managed to have a clean and combed hair. Still, she has an intact long term and short term memory. However, she still has a knocked tooth but reduced tooth decay was observed. The following vital signs were noted: T: 35.9C PR: 75bpm RR: 20 cpm BP: 110/90 Height: 162 cm Weight: 62kg BMI: 23.66 m2/kg GRAPES 26 years old February First Child M Elementary Graduate He was not present during
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the initial and final assessment 13, 1983 because he works everyday from 7 am to 5 pm. She was not 20 years STRAWBERRY old August 21, 1989 Second Child F Elementary Graduate assessed because she is now living with her own family in Manila. 14 years old May 25, 1995 Third Child M Going to School (Grade 5) Upon the initial home visit, He was seen wearing a white sleeveless shirt and brown short with no MANGO slippers, he was seen playing with his friends. After performing physical assessment, presence of minimal scars
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on both hands and feet were observed and dirty long nails were noted. He has also colds. The following vital signs were noted: T: 35.4C RR: 24 cpm PR: 57 bpm BP: 120/70 mmHg Height: 149 cm Weight: 41 kg BMI: 18.47 kg/m2 Upon the final home visit, Mango, who is 14 years old, was seen wearing an orange sando shirt and black short. Upon the visit, he was seen playing
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with his friends. His speech, reasoning, and actions were appropriate for his age. After performing the final assessment, the scars on his hands and feet were lessened and he has a clean and trimmed fingernails and toenails. His colds disappeared already. The following vital signs were noted: T: 36.2C RR: 22 cpm PR: 60 bpm BP: 110/80 mmHg Height: 149 cm Weight: 41 kg
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BMI: 18.47 m2/kg WATERMELON 12 years old May 22, 1997 Fourth Child F Going to School (Grade 5) Upon the initial home visit, she was seen wearing a black shirt and maong short. It was observed that she is cooperative with the examiners instructions. Her affect and mood is appropriate to the situation. Her speech is understandable and in moderate pace. The following vital signs were noted: T: 35.7C RR: 19 cpm PR: 73 bpm BP: 110/60
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mmHg Height: 150 cm Weight: 47 kg BMI: 20.89 kg/m2 Upon the final assessment, Watermelon who is 12 years old was seen wearing a sleeveless top with blue shorts. Her speech, actions, and reasoning were for his age. She has a steady gait and an erect posture. Short and clean fingernails and toenails were noted. The following vital signs were noted: T: 36.2C RR: 17 cpm
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PR: 80 bpm BP: 90/60 mmHg Height: 150 cm Weight: 47 kg BMI: 20.89 kg/m2 BANANA 8 years old September, 18 2001 Fifth Child M Going to School (Grade 2) Upon initial home visit, Banana who is 8 years old was seen wearing a Spiderman shirt and gray soiled short without slippers. He has dry cerumen on both ears and has long, dirty fingernails and toenails. When physical assessment was done, it was observed that he has discharges coming from
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the nose which shows that he has colds. There were also rashes noted on his eye brows. He has an obvious wound on his left thumb and minimal scars were observed on his hands and feet. There is also presence of tooth decay. More so, body odor was noted. He has a poor hygiene. The following vital signs were noted: T: 35.9 C RR: 20 cpm PR: 85 bpm Height: 113 cm Weight: 16 kg BMI: 12.5 kg/m2
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Upon the final home visit, Banana who is 8 years old was seen wearing a green shirt and white shorts with slippers. He has dry cerumen on both ears and clean, trimmed fingernails and toenails were noted. When physical assessment was done, it was observed that his colds were managed. The rashes noted on his eye brows lessened. The wound on his left thumb is already healed. Over-all, his hygiene shows
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improvement. The following vital signs were noted: T: 36.2 C RR: 18 cpm PR: 80 bpm Height: 113 cm Weight: 16 kg BMI: 12.5 kg/m2 Upon the initial home visit, Avocado was AVOCADO 6 years old November 26, 2003 Sixth Child F Going to School (Preparatory) seen wearing a green shirt and red short. During the observation, she was seen having erected and relaxed body posture. She has no abnormal spine curvatures. She has rhythmic and coordinated movements.
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She has a dry hair and lice infestations were seen. Her teeth have dental caries. Observantly, she has a thin psyche. Dirty, long fingernails and toenails were also noted. She also has a cough and colds. The following vital signs were noted: T: 36.5C PR: 72 bpm RR: 28 cpm Height: 107 cm Weight: 15 kg BMI: 13.16 kg/m2 Upon the final home visit, Avocado was seen wearing a
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pink shirt and brown shorts. She has an erected and relaxed body posture. She has no abnormal spine curvatures. She has rhythmic and coordinated movements. Her hair is neatly combed and clean fingernails and toenails were noted. The following vital signs were noted: T: 36.3C PR: 78 bpm RR: 25 cpm Height: 107 cm Weight: 15 kg BMI: 13.16 kg/m2 II. HEALTH ASSESSMENT
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Health Assessment or Physical Assessment is a systematic and efficient manner of evaluating the body and its functions. Some purpose of this includes obtaining baseline data about the familys functional abilities and to identify areas of health promotion and disease prevention. Listed below are the health assessments of the family members: A. INITIAL ASSESSMENT Daddy Apple The student nurses havent met Daddy Apple throughout the home visits because he is getting out for work as early as 5 am. Mommy Orange General Appearance Mommy Orange is 44 years old. He has long, black hair with some grayish and white discoloration. She is chubby and small. She is conscious and coherent while the group interviews her. At our initial home visit, she was wearing blouse and short jeans with slippers on. Her nails are trimmed and clean. She has steady gait and posture and no signs of distress observed. She stands 162 cm. and weighs 62 kg. Mommy Oranges vital signs were taken and recorded as follows: Vital Signs Blood Pressure Temperature Respiratory Rate Pulse Rate 1st home visit 120/80 mmHg 36.5 C 19 cpm 65 bpm 2nd home visit 120/90 mmHg 36.9 C 20 cpm 72 bpm 3rd home visit 110/90 mmHg 35.9 C 21 cpm 75 bpm

SKIN, HAIR AND NAIL ASSESSMENT

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Skin:
Light brown in color.

Warm, and dry to touch. No signs of dehydration noted.

Skin folded over the forearm returned after 2 seconds.

No redness or edema noted.

Has no presence of scars noted.

Hair:
Hair is in medium length. Hair is black in color with some grayish and white strands. There is the presence of dandruff noted.

Nails: Pinkish nail beds.

Capillary refill return after 2 seconds. No inflammation noted. No clubbing or abnormal curvature of the nails.

Nails are trimmed and neat. HEAD AND NECK ASSESSMENT Head:
Round in shape and symmetrical on sides. No tenderness noted.

No lumps noted upon palpation There are no fractures noted. Neck: There are no lumps palpated.
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 Lymph nodes are non-palpable. Trachea is on the midline position. Range of Movement is appropriate. EYE ASSESSMENT Hair on eyebrow, eyelashes, and eyelids are evenly distributed.

No discharge on the eyelids upon inspection.

Sclera appears white.

Bulbar and Palpebral conjunctivas are light brown to pinkish in color. No edema and lumps observed on nasolacrimal duct upon palpation.

Pupils are equal in size. PERRLA (Pupils equally round and reactive to light and accommodation.) Both irises are brown in color.
Mommy Orange was able to read newsprint 14 inches far.

Has a coordinated eye movement. EAR ASSESSMENT

No lumps palpated on both ears. No lesions or signs of inflammation noted.

Ear folded return after 1 second.

The ear contains yellowish cerumen but not dry.

Both ears are responsive to whisper test. Mastoid process is non-tender. Color of the ear is same with the facial skin. There is mild swaying upon Rombergs test.

NOSE AND SINUS ASSESSMENT

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 No presence of colds or nasal discharges.

Nasal septum is in midline position.

No tenderness noted upon palpation.

Can distinguish different smell. No lumps palpated. No obstruction observed upon deep inhalation. MOUTH AND PHARYNX ASSESSMENT
The lips have small cracks but no lesion noted.

The lips are light to pinkish in color. Buccal mucosa is pink in color and moist without discoloration or increased pigmentation.
No presence of aphthous stomatitis. No ulcers or nodules observed.

Frontal teeth are evulsed.

Mommy Orange has 28 teeth with the absence of frontal teeth and some

premolars.
No bleeding observed on the buccal mucosa and the gums. Gums are light brown in color but no lesions observed.

There is no presence of lesions on the tongue. Mommy Orange can distinguish different taste. Uvula is in midline position and elevates upon saying ah.
There is no inflammation of the tonsils observed.

CARDIAC ASSESSMENT
No irregular sounds heard upon auscultation.

Apical pulse is in normal rate.

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 There are no palpitations observed. PERIPHERAL AND VASCULAR ASSESSMENT Arms:

Equal in size and symmetrical in shape.

No presence of edema, lesions and redness noted. Skin complexion is brown, warm to touch. Radial pulse is in normal value.
There are no lumps noted upon palpation.

Legs: Legs large in size but symmetrical.

Skin on legs and thigh is intact. Skin is light brown in color. Skin on legs and thigh is warm and dry to touch without edema noted.

Tibial pulse can slightly be palpated. There are no presence of lesions, lumps and bruising noted.
Legs have smooth coordinated movements.

THORAX AND LUNG ASSESSMENT There is presence of rales on exhalation upon auscultation. Chest expansion is symmetrical. There is no presence of lesions, redness or edema. Respirations are quite labored because of smoking. BREAST ASSESSMENT Upon the permission of Mommy Orange, one girl from the group palpated Mommys breast and the results are as follows:
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 Breast moderate in size, round in shape, and symmetrical bilaterally. There are no lumps palpated on both breast.

There is no tenderness felt upon movement.

There are no peau d orange or abnormal skin appearance upon interview to

Mommy Orange.
Upon interview to Mommy Orange, she stated that she hasnt observed any dark

spots. ABDOMINAL ASSESSMENT Umbilicus is in midline position. Number of bowel sounds is normal at the rate of 10 sounds per minute. There is no tenderness felt on all quadrants. There is no presence of abdominal hair. GENITOURINARY-REPRODUCTIVE ASSESSMENT Upon interview to Mommy Orange, she stated that: There is no pain upon urination and fecal excretion.
There is the presence of episiorrhaphy or tahi as verbalized by Mommy

Orange. MUSCULOSKELEAL ASSESMENT Posture and Gait is steady, stable, coordinated and smooth.
Shrugs shoulders and moves head to right and left against resistance. Upper and lower extremities have full ROM. Muscles moderately firm bilaterally. No deviations, inflammations, or bony deformities.

Moves upper and lower extremities freely against gravity and resistance.

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NEUROLOGIC ASSESSMENT Mental status: Mommy Orange is conscious and coherent. Facial expressions symmetrically and correlate with mood and topic discussed. Speech is clear and intonation is appropriate. Follows assessment instructions. Oriented to person, place, time, and events. Enjoys joking. Cerebellar and motor function: There are no involuntary movements. Alternates finger to nose with eyes closed, occasionally tends to hit opposite side of nose. Sensory status: Superficial light and deep- touch sensation intact on arms, legs, neck, chest, and back. Identifies point localization correctly. Motor status: Muscle tone firm at rest. Muscles are not a bit prominent because of fat deposition. No involuntary movements noted. Muscle strength moderately strong and equal bilaterally. CRANIAL NERVES ASSESSMENT Cranial Nerve Assessment Normal Actual Finding
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I. Olfactory

Technique Ask the client to smell and identify the scent presented with each nostril separately and with the eyes closed.

Finding Client is able to identify the different scents with each nostril separately and with eyes closed unless such conditions like colds is present. The client should be able to read with each eye and both eyes. Illuminated and non-illuminated pupil should constrict.

Mommy Orange was able to identify different scents presented to her.

II. Optic

Provide adequate lighting and ask client to read from a reading material held at a distance of 36cm (14 in.) Reaction to light: Using a penlight and approaching from the side, shine a light on the pupil. Observe the response of the illuminated pupil. Shine the light on the pupil again and observe the response of the other pupil. Reaction to accommodation: Ask client to look at a near object and then at a distant object. Alternate the gaze from the near to the far object. Next, move an object towards the clients nose.

Mommy Orange was able to read with each eye and both eyes.

III. Oculomotor

Mommy Orange pupils (Both the illuminated and non- illuminated) constricted.

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

Her pupils constricted when looking at a near object and dilated when looking at a far object.

IV. Trochlear

Hold a penlight 1 ft. Clients

eyes Mommy
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in front of the clients eyes, ask the client to follow the movements of the penlight with the eyes only. Move the penlight upward, downward, sideward and diagonally. V. Trigeminal While client looks upward, lightly touch lateral sclera of eye to elicit blink reflex. To test light sensation, have client close eyes, wipe a wisp of cotton over clients forehead. To test deep sensation, use alternating blunt and sharp ends of an object. Determine sensation to warm and cold object by asking client to identify warmth and coldness. Hold a penlight 1 ft. in front of the clients eyes only. Move the penlight through the six cardinal fields of gaze. Ask client to smile, raise the eyebrows, frown, puff out cheeks, and close eyes tightly. Ask client to identify

should be able to follow the penlight as it moves.

Oranges eyes were able to follow the penlight upward, downward, sideward and diagonally.

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

Mommy Orange was able to elicit corneal reflex, responded to sharp and dull objects and was able to differentiate hot from cold.

VI. Abducens

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

VII.

Facial

Client should be able to smile, raise eyebrows, puff out cheeks, and close eyes without any

She was able to demonstrate various facial expressions, and was able to differentiate
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VIII.

Vestibulocochlear

various tastes difficulty. The between the placed on tip and client should taste of sweet sides of tongue. also be able to and sour. distinguish different tastes. Have a client Client should be Mommy Orange occlude one ear. able to hear the was able to hear Out of the clients ticking of the ticking in both sight, place a ticking watch in both ears. watch 2 to 3 cm, ears. ask what the client can hear and repeat with the other ear. Ask the client to walk across the room and back and assess the clients gait. The client should have upright posture and steady gait and able to maintain balance. Client should be able to elicit gag reflex and swallow without any difficulty and the uvula must elevate when the client says ah. She was able to stand and walk in an upright position and able to maintain balance. Mommy Orange was able to elicit gag reflex and was able to swallow without any difficulty. The uvula elevated when she said ah. Mommy Orange can swallow without difficulty and can speak audibly. Mommy Orange was able to shrug her shoulders and turn her head from side to side.
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IX. Glossopharyngeal

Ask the client to say ah and observe upward movement of the uvula. Elicit gag reflex. Note ability to swallow.

X. Vagus

Ask the patient to The client swallow and speak should be able (note hoarseness) to swallow without difficulty and speak audibly. Ask client to shrug shoulders against resistance from your hand (repeat for other side). Client should be able to shrug shoulders and turn head from side to side.

XI. Accessory

XII.

Hypoglossal

Ask client to protrude tongue at midline and then move it side to side.

Client should be able to move tongue without any difficulty.

Mommy Orange was able to move her tongue in different directions.

Nutritional Status Mommy Orange, age 44, has a height of 162 cm and weighs 62 kilograms. BMI = Weight in kilograms__ _ Height in square meters = 62 kilograms__ _ (1.62 meters) 2 = 62 kg__ _

Asia-Pacific Obesity Guidelines BMI <18.5 18.6 22.9 > 23.0 23.0 24.9 25.0 29.9 > 30.0 2.62 m2 = 23.66 kg/m2 Interpretation Underweight Healthy Weight Overweight At risk Obese I Obese II

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Therefore, Mommy Orange is said to be within overweight range based on AsiaPacific Obesity Guidelines. CLINICAL THRESHOLDS MEN WOMEN Waist Circumference: 75 cm. (NORMAL) WHR INTERPRETATIONS WHR NORMAL CENTRAL OBESITY WHR= waist circumference hip circumference = = 29.25 inches 31 inches 0.94 (CENTRAL OBESITY) MEN < 1.0 1.0 WOMEN <0.85 0.85 < 90 cm (35 inches) < 80 cm (31.5 inches)

Obstetrical History:

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Mommy Orange started a family when she was 18 years old. She has six children. She had her menarche when she was 12. She has a regular menstrual cycle of 28 days. She delivered all her children via normal spontaneous delivery (NSD). According to her, she never experienced any complication in all her children. She regularly follows prenatal check-up when she was pregnant and had a complete vaccination of Tetanus Toxoid. She has some superstition like the pregnant should sleep in straight posture and she must not take a bath in the evening to prevent neurologic disorders. She is nearing the menopausal age but according to her, she does not want to have further children. Her obstetric history is G6P6T6P0A0L6M0.

History of Past and Present Illness Mommy Orange has no serious diseases experience except for cough and colds, fever and headache. Activities of Daily Living Mommy Oranges day starts at 6:00 a.m. she prepares breakfast for Daddy Apple and their children. From the whole day, Mommy Orange is mostly at home except for some leisure hours at 3:00 p.m. to 4:00 p.m.; she is playing Bingo and she is smoking near their neighbor. After dinner commonly at 7:00 p.m. Mommy Orange watch television up to 10:00 p.m. and sleeps afterwards. Grapes Due to his work from 7:00 a.m. to 6:00 p.m., the group wasnt able to assess Grapes. Strawberry

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Strawberry has already build a family in Manila and she is not staying anymore in the familys house so the group was not able to assess her. Mango General Appearance Client is alert and cooperative. Smiling but with mild anxiety. Dress is slightly dirty. Walks steadily with posture slightly stooped.

Mangos vital signs were taken and recorded as follows: Vital Signs Blood Pressure Temperature Respiratory Rate Pulse Rate 1st home visit 120/70 mmHg 35.4 C 24 cpm 57 bpm 2nd home visit 110/70 mmHg 36.2 C 25 cpm 64 bpm 3rd home visit 110/80 mmHg 36.1 C 22 cpm 60 bpm

SKIN, HAIR AND NAILS ASSESSMENT Skin:

Skin is dark brown in color. Skin is also warm, and dry to touch. Skin fold return to place after 1 second when lifted over arm. Minimal scars and lesions on upper and lower extremities were noted. There is no presence of edema observed.

No redness observed. Hair:

Mango has short-length hair. 38 | P a g e

 Hair is black in color, straight, clean, medium textured. Hair is evenly distributed on head.

No scalp lesions or flaking. There is the presence of dandruff. Nails: Fingernails are long and not trimmed.
Fingernails are dirty and in medium thickness. No clubbing or abnormal curving of the nails. Capillary refill return after 2 seconds.

HEAD AND NECK ASSESSMENT Head: Head is symmetrically rounded. No edema, lumps noted upon palpation. Skull is intact and no presence of head fractures observed. Neck:
Neck is non-tender with full Range of Movement. Neck is symmetrical without masses, scars, and lesions.

Lymph nodes are non-palpable.

Trachea is in midline position. Thyroid gland or Adams apple is not quite prominent.

EYE ASSESSMENT Hair on eyebrow, eyelashes are intact and equally distributed. There are no secretions felt on eyelids. There are no tenderness, edema and lesions noted on the eyelids.
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 There is no edema noted on nasolacrimal duct upon palpation. Sclera is white in color without dark spots. Palpebral and bulbar conjunctivas are pinkish in color but without lesions noted. Both irises are brown in color.

PERRLA (Pupil is equally rounded and reactive to light and accommodation. EAR ASSESSMENT
Auricles are without deformities, lumps, or lesions noted and palpated. Mastoid process is non-tender.

Auditory canals contain moderate amount of dark-brown cerumen. Ear color is same with facial skin. Ear folded returned after 1 second. No edema and redness noted on both ears. Mango is responsive to watch tick test. There is mild swaying upon Rombergs test. NOSE AND SINUSES ASSESSMENT There is no presence of lumps, edema lesions noted upon palpation. Nasal septum is in midline position. Presence of nasal discharges was observed. Sense of smell was quite affected by nasal discharges. Sinuses are non-palpable MOUTH AND PHARYNX ASSESSMENT
Lips are moist with no lesions or ulcerations observed. Buccal mucosa is pink in color and moist without discoloration or increased

pigmentation.
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 There is no presence of aphthous stomatitis, lesions on buccal mucosa upon inspection.

Upper and lower teeth are secured.

There is the presence of dental carries.

Gums are pink in color and moist without inflammation, bleeding, or discoloration.

Hard and soft palates smooth without lesions or masses.

Tongue is in midline position and has a full range of motion.

Gag reflex is present intact. Uvula is in midline position and elevated upon speaking. Mango identified different taste presented. Tonsils are not inflamed or enlarged. CARDIAC ASSESSMENT No abnormal sounds heard upon auscultation Apical pulse is in normal value. PERIPHERAL AND VASCULAR ASSESSMENT Arms:
Equal in size and symmetrical bilaterally. Skin on arms is dark brown in color. Skin is warm and dry to touch. There is no presence of edema, bruising noted. Minimal lesions and marks of chickenpox were observed. Radial pulses normal in rate, and strong.

Legs:
Legs size is appropriate for Mangos weight.

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 Legs are symmetrical in size and shape. Skin on legs and thigh is intact, light brown in color. Skin on legs is warm and dry to touch without edema.

Minimal lesions and marks of chickenpox were observed. Lymph nodes are non-palpable. Tibial pulse can be slightly palpated. Toenails are dirty and not trimmed. Feet are dirty. THORAX AND LUNG ASSESSMENT
Thorax skin is light brown in color with mark of chickenpox noted.

There is no chest hair observed. There are no abnormal sounds heard upon auscultation except for some sounds of cough. There is the presence of cough. Chest expansion is symmetrical. No edema, lesion, bulging or retraction observed on the skin. Breathing is not labored. ABDOMINAL ASSESSMENT Umbilicus is in midline position. No abdominal hair observed. There is no edema, lesions noted. There is no tenderness on all abdominal quadrants upon palpation. Bowel sounds are in normal value of 15 sounds per minute. GENITO-URINARY AND REPRODUCTIVE ASSESSMENT

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Upon interview to Mango, he verbalized that he doesnt feel any pain upon urination and fecal excretion. MUSCULOSKELETAL ASSESSMENT
Posture is slightly stooped. Gait steady, smooth, and has coordinated movements. Shrugs shoulders and moves head to right and left against resistance. Upper and lower extremities have full Range of Motion (ROM).

Muscles moderately firm bilaterally.

No deviations, inflammations, or bony deformities.

Moves upper and lower extremities freely against gravity and resistance.

NEUROLOGIC ASSESSMENT Mental status:

Moody and short-tempered.

Facial expressions symmetrically and correlate with mood and topic discussed. Oriented to person, place, time, and events. Vocabulary suitable to educational level.
Gives semiabstract answers but are appropriate.

Cerebellar and motor function: Touches nose with fingers with eyes closed. Alternates supination, pronation, adduction and abduction properly.
No involuntary movements noted.

Sensory status:
Superficial light and deep- touch sensation are clearly identified on arms, legs,

neck, chest, and back.

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 Identifies point localization correctly. Motor status: Muscle tone firm at rest. Muscle size adequate for age. No fasciculation or involuntary movements noted. Muscle strength moderately strong and equal bilaterally. CRANIAL NERVES ASSESSMENT CRANIAL NERVE I. Olfactory TYPE AND FUNCTION >Sensory *Carries smell impulses mucous membrane to brain II. Optic >Sensory *Visual impulses brain III. Oculomotor >Motor *Contracts the muscle control > The client is > eye penlight, to examiner eye check for The clients >Mangos pupils should constricted >She was asked >The for about 14 print ASSESSMENT EXPECTED ACTUAL

PROCEDURE RESULT RESULT >Asked her to >The client >Mango smell vinegar the should identify correctly the sauce scent of vinegar, soy sauce even with presence of nasal discharges. . client > Mango read properly with no difficulty while the vinegar and identified presented correctly

her eyes were soy

from natural closed

to read a print should read the the print properly with no difficulty

from eyes to inches away

seated, using a pupil the constrict will the

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movements, constricts pupils elevates eyelid IV. Trochlear >Motor *Contracts to eye V. Trigeminal movement >Sensory *Sensory touch, and temperature from face to the brain >Motor *Influences clenching and jaw movements VI. Abducens >Motor *Controls lateral control and

eye/pupil constriction

>Instruct to follow

client >The

clients >Mangos pattern all movement

eye Hwith

the eye should have followed coordinated movements/moti on in direction

eye muscle penlight inferomedial

coordinated eye

>the client was > instructed

The

client >Mangos identify correctly the being

to should

impulses of close her eyes & correctly the part identified pain identify which where she felt part touched correctly part of her face touched is being touched

> The client was >Contraction of >Mangos asked to bite, to masseter palpate and temporal lobes. and muscle contracted temporal muscle

lateral masseter

>Instructed to move eye laterally

her > eyes eye

The

clients > Mangos eye should moved laterally with no difficulty

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move laterally

movements VII. Facial >Sensory *Contains sensory fibers taste thirds stimulated secretions from salivary glands >Motor *Supplies the >The client >Mango was > The client is > instructed taste for identify of and of The client >Mango salt was and

to should

identify able to identify vinegar

and vinegar and salt the vinegar correctly salt

anterior two- correctly tongue and

> The client is should be able able to perform instructions show instructions with with no signs of raise no difficulty and difficulty

facial asked to smile, to perform the the

muscles and frown, affects facial teeth, expressions eyebrows

blow her cheeks VIII. Acoustic >Sensory *Contains fiber balance >Asked for the the >The repeat client >Mango the the words was

client to repeat should be able able to repeat whispered to whispered correctly slight

hearing and words and after whispered that, asked the words client to stand and straight and balance standing closed eyes close her eyes

correctly and

perform swaying resulted while while she was with standing eyes closed.
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with

IX. eal

>Sensory fibers taste posterior third tongue sensory fibers of the pharynx that result in the gag when reflex &

>The for identify

client

is >

The

client >Mango taste with reflex

Glossopharyng *Contains

instructed of introduced salt

to should be able correctly taste to identify taste identified like and gag reflex presented and should present be gag present

of calamansi juice

X. Vagus

stimulated >Sensory *Carries sensation from throat, larynx, bronchi, gastrointesti nal tract and abdominal viscera >Motor *Innervates that promotes

>The ah,

client

is >The

clients > Mangos soft

instructed to say soft palate and palate and uvula swallow uvula should be symmetrically a tongue symmetrical is rising difficulty swallowing elicit gag reflex in rise, and swallowed she with the and

depressor introduced

for should have no no difficulty and in she was able to and elicit gag reflex

heart, lungs, gag reflex

XI.Spinal accessory

>Palpate strength toid trapezius

>The of trapezius muscle and be

clients >Mango symmetrical

have

neck muscle sternocleidomas

should trapezius muscle slight

symmetrical with

and with strong contraction,

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movement of and shoulders rotations

muscles.

Ask contraction

of same with

results her

the the client to turn sternocleidomas head examiners hand opposite & ask the client the to shoulders >Instructed tongue it different directions head shrug turned her > and to The move

head against the toid muscles on sternocleidomas side toid muscle was

XII. Hypoglossal

>Motor *Innervates tongue promotes the movement of food and talking.

client >Mango her tongue on different directions with no difficulty

was in with

to protrude her should be able able to move her on tongue different directions no difficulty

muscle that move

Growth and Development (Adolescents, 13 to 19 years) Erik Eriksons Psychosocial Stages Fidelity: Identity vs. Role Confusion (Adolescents, 13 to 19 years) Ego Quality: Fidelity Related elements in Society: Ideology The adolescent is newly concerned with how they appear to others. Superego identity is the accrued confidence that the outer sameness and continuity prepared in the future are matched by the sameness and continuity of one's meaning for oneself, as evidenced in the promise of a career. The ability to settle on a school or occupational identity is pleasant. In later stages of Adolescence, the child develops a sense of sexual identity.
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As they make the transition from childhood to adulthood, adolescents ponder the roles they will play in the adult world. Initially, He is apt to experience some role confusion- mixed ideas and feelings about the specific ways in which they will fit into society- and may experiment with a variety of behaviors and activities. Most adolescents achieve a sense of identity regarding whom they are and where their lives are headed. Mango at this age is becoming more aware of his identity. Makes transition from childhood to adulthood as he verbalized dapat mas maging mature nako ngayon na tumatanda na ko. Ponder out the roles that he will play in the adult world. He is apt to experience some role confusion- mixed ideas and feelings about the specific ways in which they will fit into society- and may experiment with a variety of behaviors and activities. Most likely Mango is already achieving a sense of identity regarding who he is and where his life is headed. Sigmund Freuds Psychosexual Stages Genital Phase The genital phase lasts from puberty, about the twelfth year of age, and onwards. It actually continues until development stops; which is ideally in the eighteenth year of age when adulthood starts. This phase represents the major portion of life, and the basic task for the individual is the detachment from the parents. In this phase the focus is again on the genitals but this time the energy is expressed with adult sexuality. The ego in the genital phase is well-developed, and so uses secondary process thinking, which allows symbolic gratification. The symbolic gratification may include the formation of love relationships and families, or acceptance of responsibilities associated with adulthood. Now, Mangos pleasure is mostly related to secondary process thinking. Her drive energy is redirected to symbolic gratification, mainly related to love relationships and families, or acceptance of responsibilities associated with adulthood. Mango can
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think independently and makes choices based on his priority and not of his parents. Problems however might occur during this phase because it is also the time when the individual tries to come in terms with unresolved residues of the early childhood. Nutrition Status by Age, Weight and Height Mango, age 13, has a height of 149 cm and weighs 41 kilograms. BMI = = = Weight in kilograms__ _ Height in square meters 41 kilograms__ _ (2.22 meters) 2 41 kg.__ _ 2.22 m2 = 18.47 kg/m2 Asia-Pacific Obesity Guidelines BMI <18.5 18.6 22.9 > 23.0 23.0 24.9 25.0 29.9 > 30.0 Interpretation Underweight Healthy Weight Overweight At risk Obese I Obese II

Therefore, Mango is said to be within underweight range based on Asia-Pacific Obesity Guidelines. History of Past Illness According to Mommy Orange, Mango has already experienced minor illnesses such as headache, fever, colds, cough and diarrhea due to infection or decreased immunity. Mommy orange used Oregano to relieve the cough of Mango. For treating fever and colds, sometimes Mommy orange gave him Bioflu and Biogesic without doctors prescription while for stopping diarrhea, Mommy orange sometimes gave him
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Diatabs or Lomotil even if he did not consult her physician or barangay health center. But most often, he does not take any medication. He has never been hospitalized. He was also exposed to chickenpox. History of Present Illness Upon the assessment to Mango, he experiences cough and colds that occurs intermittently. The only medication he uses is Oregano. Activities of Daily Living Mangos day starts at 6:00 AM he takes a bath and goes to Remedian School (Grade 6) at 7:00AM At 12:00 noon, he would take his lunch with his family. Around 1:00 PM, he would go back to school. At 4:30 PM, he would go home. When he is already at home he would take a nap and afterwards do all his assignments, after that he will go and spend time with their neighbor and peers, which has the same age, like his. At 7:00PM up to 9:00PM he and his family would have their dinner. After having their dinner Mango would usually watch TV together with his family. After watching TV he will go to sleep. Watermelon General Appearance Client is alert and cooperative with the student nurses. She is smiling with mild anxiety towards the physical assessment done to her by the group. Dress is dirty and soiled. Watermelon walks steadily. Her posture and gait is firm. Watermelons vital signs were taken and recorded as follows: Vital Signs Blood Pressure Temperature Respiratory Rate 1st home visit 110/60 mmHg 35.7 C 19 cpm 2nd home visit 110/70 mmHg 36.4 C 20 cpm 3rd home visit 90/60 mmHg 36.2 C 17 cpm
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Pulse Rate

73 bpm

76 bpm

80 bpm

SKIN, HAIR AND NAIL ASSESSMENT Skin:

Skin is light brown in color. Skin is warm, and dry to touch. Skin fold return to place after 1 second when lifted over forearm.

Some scars on upper and lower extremities. No signs of dehydration noted upon inspection. No edema and redness observed. There is no presence of lumps palpated. Hair:
Hair is shoulder-length, black in color, straight, clean, medium textured. Hair is evenly distributed on head.

No patches of hair loss observed. No scalp lesions or flaking. No dandruff noted upon inspection. Nails:
Fingernails are short, neat and properly trimmed.

There is no presence of clubbing or abnormal curving of the nails. Capillary refill return after 2 seconds upon Blanchs test. HEAD AND NECK ASSESSMENT Head:
Head is symmetrically rounded.

No tenderness palpated on the head. No lumps or irregular masses and lesions noted.
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 Skull has no fractures upon inspection. Neck:

Neck is non-tender upon palpation with full Range of Motion.

Neck is symmetrical.
No lumps, abnormal masses observed upon palpation.

No lesions noted.
Trachea is in midline position Thyroid gland is non-palpable.

Lymph nodes are non-palpable. EYE ASSESSMENT Hair on eyebrows, eyelashes is evenly distributed. No lesions or secretions noted on eyelids. No edema or lumps palpated on the nasolacrimal duct. The color of bulbar and palpebral conjunctivas is light brown to pinkish. Color of the sclera appears white. Both irises are brown in color. Pupil is equally round and reactive to light and accommodation. No lesions observed around the eye. Eyes have coordinated movement. Watermelon can read newsprint 14 inches far. EAR ASSESMENT Color of the ear is same with facial skin. Ear folded return after 1 second. No tenderness, lumps or irregular masses palpated. Auditory canal contains yellowish cerumen.
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 Mastoid process is non-tender. Watermelon was responsive to watch tick test. Mild swaying upon Rombergs test. No presence of tinnitus or tingling sound in the ears. Watermelon can hear and repeat whispered word.

NOSE AND SINUSES ASSESSMENT

External structure of the nose is without deformity.

Nose symmetrical. No nodules, lumps and edema observed upon palpation. Nasal septum is in midline position. No nasal discharges observed Watermelon can clearly identify different scents. There was no obstruction heard upon deep inhalation. MOUTH AND PHARYNX ASSESSMENT
Lips are moist and free from cracks or any sign of dehydration. No lesions or ulcerations observed on the lips. Buccal mucosa is pinkish in color and moist without discoloration or increased

pigmentation.
No ulcers or nodules observed on the buccal mucosa.

Watermelon has a complete 28 teeth for her age. No dental caries noted upon inspection.
Gums are pinkish in color.

Uvula is in midline position and elevates upon saying ah. Hard and soft palates are free from lumps, lesions or ulcerations. Tongue has a full range of motion.
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 Watermelon can distinguish different flavor. Gag reflex is present upon inspection. Tonsils are not inflamed or enlarged. CARDIAC ASSESSMENT Apical pulse is in normal range. No abnormal sounds heard upon auscultation.
No pulsations are visible.

PERIPHERAL AND VASCULAR ASSESSMENT Arms:

Arms are equal in size and symmetrical. Watermelon has light brown complexion. Skin on the arm is warm and dry to touch. No edema, bruising, or lesions noted upon inspection.

Radial pulse is palpable and in normal rate. Brachial pulse can be slightly palpated. Legs: Legs size is appropriate and symmetrical with Watermelons weight. Skin is intact with no lesions, ulceration, redness or lumps inspected. Skin on legs is light brown to white in color. Skin over the legs is warm and dry to touch. Tibial pulse can be slightly felt.
Toenails are thick but not dirty.

THORAX AND LUNG ASSESSMENT

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 Skin on chest is pale pink in color but without any lesions, lumps or birth mark

observed. No hair noted on the chest. No abnormal bulging or retractions on skin above the ribcage.
No coughs and colds observed.

Respirations are in normal range. Respirations are not labored. Bilateral chest expansion is symmetrical. ABDOMINAL ASSESSMENT Bowel sounds heard upon auscultation in normal value of 12 sounds per minute. Abdomen is free from hair, bruising, and lumps. No tenderness felt on all abdominal quadrants upon palpation. There is no skin discoloration noted. Umbilicus is in midline position. GENITOURINARY-REPRODUCTIVE ASSESSMENT Upon interview to Watermelon she verbalized that she doesnt feel any pain upon urination and fecal excretion. MUSCULOSKELETAL ASSESSMENT
Posture and gait is steady and coordinated. Shrugs shoulders and moves head to right and left against resistance. Upper and lower extremities have full Range of Motion.

Muscles moderately firm bilaterally.

No deviations, inflammations, or bony deformities observed.

Moves upper and lower extremities freely against gravity and resistance.
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NEUROLOGICAL ASSESSMENT Mental status: Pleasant and friendly. Slightly and appropriately dressed for weather with matching colors and patterns. Facial expressions symmetrically and correlate with mood and topic discussed. Speech clear and appropriate. Carefully chooses words to convey feelings and ideas. Oriented to person, place, time, and events. Vocabulary suitable to educational level. Cerebellar and motor function: Alternates finger to nose with eyes closed,
Watermelons pronation, supination abduction and adduction of hands are in

coordination and without difficulty. No involuntary movements noted. Sensory status: Superficial light and deep- touch sensation intact on arms, legs, neck, chest, and back. Identifies point localization correctly. Motor status: Muscle tone firm at rest. Muscle size adequate for age. No fasciculation or involuntary movements noted. Muscle strength moderately strong and equal bilaterally.

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CRANIAL NERVES ASSESSMENT CRANIAL NERVE I. Olfactory TYPE AND FUNCTION >Sensory *Carries smell impulses mucous membrane II. Optic to brain. >Sensory *Visual impulses brain. III. Oculomotor >Motor *Contracts the muscle control > The client is > eye penlight, to examiner eye check for eye/pupil constriction. The clients >Watermelons should pupils constricted. >She was asked >The for about 14 print client >Watermelon the print properly properly with no difficulty. ASSESSMENT EXPECTED ACTUAL

PROCEDURE RESULT RESULT >Asked her to >The client >Watermelon smell vinegar the should while the correctly. identify correctly vinegar identified the scent of vinegar.

her eyes were presented

from natural closed.

to read a print should read the read with no difficulty.

from eyes to inches away.

seated, using a pupil the constrict. will the

movements, constricts pupils elevates eyelid. IV. Trochlear >Motor *Contracts and

>Instruct to follow

client >The

clients >Watermelons pattern with

the eye should have eye followed Hcoordinated

eye muscle penlight.

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to eye

control

movements/moti on in direction.

coordinated eye

inferomedial movement. V. Trigeminal >Sensory *Sensory touch, and temperature the brain. >Motor *Influences clenching and jaw movements. VI. Abducens >Motor *Controls lateral movements. VII. Facial >Sensory *Contains sensory fibers taste

all movement.

>the client was > instructed

The

client >Watermelon identify correctly the being

to should

impulses of close her eyes & correctly the part identified pain identify is which where she felt part touched. being correctly. part of her face touched

from face to touched.

>Contraction of >Watermelons > The client was masseter asked to bite, to temporal muscle. and masseter and muscle contracted.

lateral palpate temporal lobes. >Instructed to move eye laterally.

her > eyes eye

The

clients >Watermelons should eyes difficulty. moved laterally with no

move laterally.

> The client is > instructed taste for identify of and

The

client >Watermelon identify was able to

to should

and vinegar and salt identify the salt vinegar correctly. salt and vinegar.

anterior two- correctly.

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thirds stimulated secretions

of

tongue and

from salivary glands. >Motor *Supplies the >The client >Watermelon able to the of

> The client is should be able was

facial asked to smile, to perform the perform raise no difficulty. and her the >The repeat client >Watermelon able no signs

muscles and frown, affects facial teeth, expressions. eyebrows blow VIII. Acoustic >Sensory *Contains fiber balance. cheeks. >Asked for the

show instructions with instructions with difficulty.

client to repeat should be able was whispered to the repeat

to the and

hearing and words and after whispered that, asked the words client to stand and straight and balance standing closed eyes. close her eyes.

whispered words swaying while was with

correctly correctly perform slight while resulted with she standing eyes closed.

IX. eal

>Sensory fibers taste posterior third

>The for identify

client

is >

The

client >Watermelon taste with reflex

Glossopharyng *Contains

instructed of introduced salt

to should be able correctly taste to identify taste identified like and gag reflex presented and should present. be gag present.
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of calamansi juice.

tongue sensory

&

fibers of the pharynx that result in the gag when stimulated X. Vagus >Sensory *Carries sensation from throat, larynx, bronchi, gastrointesti nal tract and abdominal viscera. XI.Spinal accessory >Motor *Innervates that promotes movement of and shoulders rotations. >Palpate strength toid trapezius muscles. >The of trapezius muscle and be clients >Watermelon have should symmetrical slight results her >The ah, the and a client is >The clients >Watermelons reflex

instructed to say soft palate and soft palate and swallow uvula should be uvula tongue symmetrical is rising difficulty swallowing in symmetrically and rise, she with

depressor introduced

for should have no swallowed

heart, lungs, gag reflex.

in no difficulty and and she was able to elicit gag reflex.

elicit gag reflex.

neck muscle sternocleidomas

symmetrical trapezius muscle of contraction, same

and with strong with Ask contraction

the the client to turn sternocleidomas head examiners hand opposite & ask the client the head

head against the toid muscles on with was toid muscle.

side sternocleidomas

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to shoulders. XII. Hypoglossal >Motor *Innervates tongue promotes the movement of food and talking. >Instructed tongue it different directions.

shrug turned.

her > and to

The move

client >Watermelon able to her move her tongue on in different with directions with no difficulty.

to protrude her should be able was on tongue different directions no difficulty.

muscle that move

Growth and Development School Age (6 years to 12) Erik Eriksons Psychosocial Stages Psychosocial Crisis: Industry vs. Inferiority Ego Quality: Competence Related Elements in Society: Division of labor To bring a productive situation to completion is an aim which gradually supersedes the whims and wishes of play. The fundamentals of technology are developed. To lose the hope of such industrious association may pull the child back to the more isolated, less conscious familial rivalry of the oedipal time. Watermelon at this age is becoming more aware of herself as an individual. She works hard at being responsible, being good and doing it right. She is now more reasonable to share and cooperate. Some perceptual cognitive developmental traits specific for this age group: Watermelon understands the concepts of space and time, in
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more logical, practical ways, beginning to grasp, eager to learn and accomplish more skills; reading, writing, telling time. She also gets to form moral values, recognize cultural and individual differences and is able to manage most of her personal need and grooming with minimal assistance. At her age, Watermelon might express her independence by being disobedient, using back talk and being rebellious. Learns to include values and skills of school, neighborhood, and peers. Peer relationships important. Focuses more on reality, less on fantasy. Family is main base of security and identity. Sensitive to reactions of others. Seeks approval and recognition. Enthusiastic, noisy, imaginative, desires to explore. Likes to complete a task. Enjoys helping others. Sigmund Freuds Psychosexual Stages Latency Phase The latency phase is typified by a solidifying of the habits that the child developed in the earlier stages. Whether the Oedipal conflict is successfully resolved or not, the drives of the id are not accessible to the ego during this stage of development, since they have been repressed during the phallic stage. Hence the drives are seen as dormant and hidden (latent) and the gratification the child receives is not as immediate as it was during the three previous stages. Now, Watermelons pleasure is mostly related to secondary process thinking. Her drive energy is redirected to new activities, mainly related to schooling, hobbies and friends. Problems however might occur during this stage, and this is attributed to inadequate repression of the Oedipal conflict, or to the inability of the ego to redirect the drive energy to activities accepted by the social environment. Nutrition Status by Age, Weight and Height

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Watermelon, age 12, has a height of 150 cm and weighs 47 kilograms. BMI = = = Weight in kilograms__ _ Height in square meters 47 kilograms__ _ (2.25 meters) 2 47 kg__ _ 2.25 m2 = 20.89 kg/m2 Asia-Pacific Obesity Guidelines BMI Interpretation <18.5 Underweight 18.6 22.9 Healthy Weight > 23.0 Overweight 23.0 24.9 At risk 25.0 29.9 Obese I > 30.0 Obese II Therefore, Watermelon is said to be within health weight range based on AsiaPacific Obesity Guidelines. History of Past Illness According to Mommy Orange, Watermelon has already experienced minor illnesses such as headache, fever, colds, cough and diarrhea but hasnt experience any serious illness. Mommy Orange used Oregano to relieve cough of Watermelon. For treating fever and colds, sometimes Mommy Orange gave her Bioflu and Biogesic without doctors prescription. History of Present Illness Upon the assessment to Watermelon, she doesnt experience cough and colds unlike her siblings. She does not take any medications like vitamin supplements.
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Activities of Daily Living Watermelons day starts at 6:00 AM she takes a bath and goes to Remedian School (Grade 6) at 7:00AM At 12:00 noon, she would take her lunch with her family. Around 1:00 PM, he would go back to school. At 4:30 PM, she would go home. When she is already at home she would take a nap and afterwards do all her assignments and study her lessons after that she will go and spend time to their neighbor, which has the same age, like her. At 7:00PM up to 9:00PM she and his family would have their dinner. After having their dinner Watermelon would usually watch TV together with her family. After watching TV she will go to sleep together with the rest of the family. Banana General Appearance Client is alert and cooperative but has no idea what the student nurses are doing. Smiling but with mild anxiety towards the student nurses. Dress is dirty and soiled. Banana walks steadily but with posture slightly stooped. Bananas vital signs were taken and recorded as follows: Vital Signs Temperature Respiratory Rate Pulse Rate 1st home visit 35.9 C 20 cpm 85 bpm 2nd home visit 36.5 C 21 cpm 86 bpm 3rd home visit 36.2 C 18 cpm 80 bpm

SKIN, HAIR AND NAILS ASSESSMENT Skin:

Skin is dark to light brown in color. Skin is also warm, and dry to touch.

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 There is no presence of edema observed. Skin fold return to place after 1 second when lifted over arm.

Minimal wounds were noted on upper extremities. No redness observed. Hair:

Banana has short-length hair. Hair is black in color, straight, clean. There is the presence of dandruff upon inspection. Hair is evenly distributed on head.

No scalp lesions or flaking. Nails: Fingernails are long and not trimmed.
No clubbing or abnormal curving of the nails. Capillary refill return after 3 seconds. Fingernails are dirty and in medium thickness.

HEAD AND NECK ASSESSMENT Head: Head is symmetrically rounded. No edema, lumps noted upon palpation. Skull is intact. No presence of head fractures observed. Neck:
Neck is non-tender upon palpation with full Range of Movement. Neck is symmetrical without lumps, scars, and lesions.

Lymph nodes are non-palpable.

Trachea is in midline position.

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EYE ASSESSMENT There are no tenderness, edema and lesions noted on the eyelids.
Palpebral and bulbar conjunctivas are pinkish in color but without lesions noted.

There are no secretions felt on eyelids. Hair on eyebrow, eyelashes are intact and equally distributed.
There is no edema or any obstruction noted on nasolacrimal duct upon palpation. Sclera is white in color and without dark spots.

PERRLA (Pupil is equally rounded and reactive to light and accommodation.

Both irises are brown in color.

EAR ASSESSMENT Ear folded returned after 1 second.

Mastoid process is non-tender.

Ear color is same with facial skin.

Auricles are without deformities, lumps, or lesions noted and palpated. Auditory canals contain moderate amount of light brown color of cerumen.

No edema and redness noted on both ears. Banana is responsive to watch tick test. There is mild swaying upon Rombergs test. NOSE AND SINUSES ASSESSMENT Presence of nasal discharges was observed. Nasal septum is in midline position. There is no presence of lumps, edema lesions noted upon palpation.
Sense of smell is affected by nasal discharges but can slightly detect

different scents.
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 Sinuses are non-palpable MOUTH AND PHARYNX ASSESSMENT

Lips are moist with no lesions or ulcerations observed.

There is no presence of aphthous stomatitis, lesions on buccal mucosa upon inspection.

Buccal mucosa is pink in color and moist without discoloration or increased

pigmentation. Malocclusion of the upper frontal teeth was observed. Banana has dental stains but without dental carries.
Gums are pink in color and moist without inflammation, bleeding, or discoloration. Tongue is in midline position and has a full range of motion.

Mango identified different taste presented. Tonsils are not inflamed or enlarged. Hard and soft palates smooth without lesions or masses. Gag reflex is present intact. Uvula is in midline position and elevated upon speaking. CARDIAC ASSESSMENT No feeling of chest pain. No abnormal sounds heard upon auscultation Apical pulse is in normal value. PERIPHERAL AND VASCULAR ASSESSMENT Arms:
Skin is warm and dry to touch. Skin on arms is dark to light brown in color. 68 | P a g e

 Arms are equal in size and symmetrical bilaterally. There is no presence of edema, bruising noted. Radial pulses are normal in rate, and strong.

Legs:
Skin on legs and thigh is intact, light brown in color. Skin on legs is warm and dry to touch without edema. Legs size is appropriate for Bananas weight. Legs are symmetrical in size and shape.

Lymph nodes are non-palpable. Tibial pulse can be slightly palpated.

Toenails are noted dirty and not trimmed.

Feet of Banana are dirty as well. THORAX AND LUNG ASSESSMENT There is no chest hair observed. No edema, lesion, bulging or retraction observed on the skin.
Thorax skin is light brown in color with mark of chickenpox noted. There is the presence of cough and colds.

There are no abnormal sounds heard upon auscultation except for some sounds of cough. Chest expansion is symmetrical. Breathing is not labored. ABDOMINAL ASSESSMENT There is no edema, lesions noted. No abdominal hair observed. There is no tenderness on all abdominal quadrants upon palpation.
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 Umbilicus is in midline position. Bowel sounds are in normal value of 13 sounds per minute. MUSCULOSKELETAL ASSESSMENT
Posture is slightly stooped. Upper and lower extremities have full Range of Motion (ROM).

Moves upper and lower extremities freely against gravity and resistance.
Gait steady, smooth, and has coordinated movements. Shrugs shoulders and moves head to right and left against resistance.

Muscles moderately firm bilaterally.

No deviations, inflammations, or bony deformities.

NEUROLOGIC ASSESSMENT Mental status:

Facial expressions are subjective to Bananas feelings towards the entry of the

student nurses.
Banana is not quite oriented to person, place, time, and events.

Banana cannot verbalized own feelings due to his young age and state of mind. Cerebellar and motor function: No involuntary movements noted. Touches nose with fingers with eyes closed. Alternates supination, pronation, adduction and abduction properly. Sensory status: Identifies point localization correctly.
Superficial light and deep- touch sensation are clearly identified on arms, legs,

neck, chest, and back.

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Motor status: No fasciculation or involuntary movements noted. Muscle tone firm at rest. Muscle size adequate for age. Muscle strength moderately strong and equal bilaterally.

CRANIAL NERVES ASSESSMENT CRANIAL NERVE I. Olfactory TYPE AND FUNCTION >Sensory *Carries smell impulses mucous membrane to brain. II. Optic >Sensory *Visual impulses brain. >She was asked >The for about 14 print client >Banana properly newsprint doesnt know read. III. Oculomotor >Motor *Contracts the muscle > The client is > eye penlight, to examiner The clients >Bananas should pupils constricted. how can the but slightly to ASSESSMENT EXPECTED ACTUAL

PROCEDURE RESULT RESULT >Asked her to >The client >Banana smell vinegar the should while the correctly. identify correctly vinegar identified the scent of vinegar.

her eyes were presented

from natural closed.

to read a print should read the see with no difficulty.

from eyes to inches away

seated, using a pupil the constrict. will

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control

eye check

for

the

movements, constricts pupils elevates eyelid. IV. Trochlear >Motor *Contracts to eye movement. V. Trigeminal >Sensory *Sensory touch, and temperature from face to the brain >Motor *Influences clenching and jaw movements VI. Abducens >Motor control and

eye/pupil constriction.

>Instruct to follow

client >The

clients >Bananas pattern all movement.

eye Hwith

the eye should have followed coordinated movements/moti on in direction.

eye muscle penlight. inferomedial

coordinated eye

>the client was >The instructed to should

client >Banana identify correctly the being

impulses of close her eyes & correctly the part identified pain identify which where she felt part touched correctly part of her face touched is being touched

> The client was >Contraction of >Bananas asked to bite, to masseter palpate temporal lobes. temporal and muscle. and masseter contracted. and temporal muscle

lateral masseter

>Instructed

her >

The

clients >Bananas eyes

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*Controls lateral movements. VII. Facial >Sensory *Contains sensory fibers taste thirds stimulated secretions from salivary glands. *Supplies the

to

move

eyes eye

should moved

laterally

eye laterally.

move laterally.

with no difficulty.

> The client is > instructed taste for identify of and of

The

client >Banana salt

was and

to should

identify able to identify vinegar.

and vinegar and salt the vinegar correctly. salt

anterior two- correctly. tongue and

>The

client >Banana

was

facial > The client is should be able able to perform instructions show instructions with with no signs of raise no difficulty. and her difficulty.

muscles and asked to smile, to perform the the affects facial frown, expressions. teeth, eyebrows blow cheeks. VIII. Acoustic >Sensory *Contains fiber balance. >Asked for the the >The repeat

client >Banana the the words

was

client to repeat should be able able to repeat whispered to whispered correctly slight

hearing and words and after whispered that, asked the words client to stand and

correctly and

perform swaying resulted

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straight

and balance standing

while while she was with standing with

close her eyes. IX. eal >Sensory fibers taste posterior third tongue sensory fibers of the pharynx that result in the gag when stimulated. X. Vagus >Sensory *Carries sensation from throat, larynx, bronchi, gastrointesti nal tract and abdominal viscera. XI.Spinal >Motor >Palpate >The ah, the and a client reflex & >The for identify of introduced salt client

closed eyes. eyes closed. is > The client >Banana to should be able correctly taste with reflex

Glossopharyng *Contains

instructed

taste to identify taste identified like and gag reflex presented and should present. be gag present.

of calamansi juice.

is >The

clients >Bananas

soft

instructed to say soft palate and palate and uvula swallow uvula should be symmetrically tongue symmetrical is rising difficulty swallowing in rise, and swallowed she with

depressor introduced

for should have no no difficulty and in she was able to and elicit gag reflex.

heart, lungs, gag reflex.

elicit gag reflex.

>The

clients >Banana

has

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accessory

*Innervates that promotes movement of and shoulders rotations.

strength toid trapezius muscles.

of trapezius muscle and be

symmetrical should trapezius muscle slight results her

neck muscle sternocleidomas

symmetrical with of same with

and with strong contraction, Ask contraction

the the client to turn sternocleidomas head examiners hand opposite & ask the client the to shoulders. head shrug turned.

head against the toid muscles on sternocleidomas side toid muscle. was

XII. Hypoglossal

>Motor *Innervates tongue promotes the movement of food and talking.

>Instructed tongue it different directions.

her > and to

The move

client >Banana her tongue on different directions with no difficulty.

was in with

to protrude her should be able able to move her on tongue different directions no difficulty.

muscle that move

Growth and Development School Age (6 years to 12) Erik Eriksons Psychosocial Stages Psychosocial Crisis: Industry vs. Inferiority Ego Quality: Competence Related Elements in Society: Division of labor

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To bring a productive situation to completion is an aim which gradually supersedes the whims and wishes of play. The fundamentals of technology are developed. To lose the hope of such industrious association may pull the child back to the more isolated, less conscious familial rivalry of the oedipal time. Banana at this age works hard at being responsible, being good and doing it right. Banana can follow some command from her mother. He is now more reasonable to share and cooperate. Some perceptual cognitive developmental traits specific for this age group: Banana understands the concepts of space and time, in more logical, practical ways, beginning to grasp, eager to learn and accomplish more skills; reading, writing, telling time. He also gets to form moral values, recognize cultural and individual differences and is able to manage most of his personal need and grooming with minimal assistance. Banana can independently walk, think and act on his own. The group has seen him play whenever he wants. He can also think logically about simple issues like if he will take a bath or not. Sigmund Freuds Psychosexual Stages Latency Phase The latency phase is typified by a solidifying of the habits that the child developed in the earlier stages. Whether the Oedipal conflict is successfully resolved or not, the drives of the id are not accessible to the ego during this stage of development, since they have been repressed during the phallic stage. Hence the drives are seen as dormant and hidden (latent) and the gratification the child receives is not as immediate as it was during the three previous stages. Now, Bananas pleasure is mostly related to secondary process thinking. His drive energy is redirected to new activities, mainly related to schooling, hobbies and friends. Problems however might occur during this stage, and this is attributed to
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inadequate repression of the oedipal conflict, or to the inability of the ego to redirect the drive energy to activities accepted by the social environment.

Nutrition Status by Age, Weight and Height Banana, age 8, has a height of 113 cm and weighs 16 kilograms. BMI = = = Weight in kilograms__ _ Height in square meters 16 kilograms__ _ (1.28 meters) 2 16 kgs__ _ 1.28 m2 = 12.5 kg/m2 Asia-Pacific Obesity Guidelines BMI Interpretation <18.5 Underweight 18.6 22.9 Healthy Weight > 23.0 Overweight 23.0 24.9 At risk 25.0 29.9 Obese I > 30.0 Obese II Therefore, Banana is said to be within underweight range based on Asia-Pacific Obesity Guidelines. History of Past Illness According to Mommy Orange, Banana had not experience any serious illness. The common problem for him and his siblings is cough and colds. The treatment of Mommy Orange for that is via boiling of Oregano. Banana has never been hospitalized. He has exposed to mumps virus earlier in his life.
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History of Present Illness Upon the assessment to Banana, He experiences cough and colds. He does not take any medications. Activities of Daily Living Banana wakes up at around 6:00 AM and takes a bath and goes to Remedian School at 7:00AM. When the clock reads at 12:00 noon, he would take his lunch with his family. Around 1:00 PM, he would go back to school. At 4:00 PM, He would go home. At 5:00 PM he will go outside and play with his playmates. Afterwards, he would do his assignments. And at 7:00PM to 9:00PM he and his family would have their dinner. After having their dinner Banana would usually watch TV together with his family. After watching TV he will go to sleep. Avocado General Appearance Client is alert but sometimes uncooperative towards the student nurses but is understandable because of his young age. Avocado sometimes feels scared towards the student nurses action. Different expressions of smiling and frowning were observed. Dress is dirty and soiled. Posture and gait is steady. Avocados vital signs were taken and recorded as follows: Vital Signs Temperature Respiratory Rate Pulse Rate 1st home visit 36.5 C 28 cpm 72 bpm 2nd home visit 36.2 C 26 cpm 75 bpm 3rd home visit 36.3 C 25 cpm 78 bpm
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SKIN, HAIR AND NAIL ASSESSMENT Skin:

Skin is warm, and dry to touch. Skin is light brown in complexion.

No edema and redness observed.

There is no presence of lumps palpated. Skin fold return to place after 1 second when lifted over forearm.

No signs of dehydration noted upon inspection. Some scars on upper and lower extremities. Hair:
Hair is shoulder-length, black in color, straight but not properly groomed. Hair is evenly distributed on head.

No patches of hair loss observed. No scalp lesions or flaking. Presence of dandruff was noted. Nails: There is no presence of clubbing or abnormal curving of the nails. Fingernails are long, dirty and not trimmed. Capillary refill return after 2 seconds upon Blanchs test. HEAD AND NECK ASSESSMENT Head:
Head is symmetrically rounded.

Skull has no fractures upon inspection. No tenderness palpated on the head.

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 No lumps or irregular masses and lesions noted. Neck: Neck is symmetrical.

Trachea is in midline position

No lesions noted.
No lumps, abnormal masses observed upon palpation. Neck is non-tender upon palpation with full Range of Motion. Thyroid gland is non-palpable.

Lymph nodes are non-palpable. EYE ASSESSMENT No lesions or secretions noted on eyelids. No edema or lumps palpated on the nasolacrimal duct. Hair on eyebrows, eyelashes is evenly distributed. The color of bulbar and palpebral conjunctivas is light brown to pinkish. Color of the sclera appears white. Both irises are brown in color. Pupil is equally round and reactive to light and accommodation. No lesions observed around the eye. Eyes have coordinated movement. Avocado doesnt know how read newsprint 14 inches far. EAR ASSESMENT Color of the ear is same with facial skin. Mastoid process is non-tender. No tenderness, lumps or irregular masses palpated. Ear folded return after 1 second.
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 Auditory canals contain dark-brown color of cerumen. Avocado was responsive to watch tick test. Mild swaying upon Rombergs test. No presence of tinnitus or tingling sound in the ears. NOSE AND SINUSES ASSESSMENT Nostrils are symmetrical.
External structure of the nose is without deformity.

No nodules, lumps and edema observed upon palpation. Nasal septum is in midline position. Presence of nasal discharges was observed. Avocado can clearly identify different scents. There was no obstruction heard upon deep inhalation. MOUTH AND PHARYNX ASSESSMENT
No lesions or ulcerations observed on the lips. Lips are moist and free from cracks or any sign of dehydration. No ulcers or nodules observed on the buccal mucosa. Buccal mucosa is pinkish in color and moist without discoloration or increased

pigmentation. Avocado has a 22 set of teeth; some milk teeth are still intact. Presence of dental carries was evident on the frontal teeth.
Gums are pinkish in color.

Uvula is in midline position and elevates upon saying ah. Hard and soft palates are free from lumps, lesions or ulcerations. Tongue has a full range of motion. Avocado can distinguish different flavor. Gag reflex is present upon inspection.
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 Tonsils are not inflamed or enlarged.

CARDIAC ASSESSMENT Apical pulse is in normal range.

No pulsations are visible.

No abnormal sounds heard upon auscultation. PERIPHERAL AND VASCULAR ASSESSMENT Arms:
Skin on the arm is warm and dry to touch. Avocado has light brown complexion. Arms are equal in size and symmetrical. No edema, bruising, or lesions noted upon inspection.

Radial pulse is palpable and in normal rate. Brachial pulse can be slightly palpated. Legs: Skin on legs is light brown to white in color. Legs size is appropriate and symmetrical with Avocados weight. Skin is intact with no lesions, ulceration, redness or lumps inspected. Skin over the legs is warm and dry to touch. Tibial pulse can be slightly felt. Toenails are dirty and not trimmed. Feet of Avocado were also dirty due to walking barefooted. THORAX AND LUNG ASSESSMENT
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 Skin on chest is pale pink in color but without any lesions, lumps or birth mark

observed. No hair noted on the chest. No abnormal bulging or retractions on skin above the ribcage. Respirations are in normal range.
No coughs and colds observed.

Respirations are not labored. Bilateral chest expansion is symmetrical. ABDOMINAL ASSESSMENT There is no skin discoloration noted. Umbilicus is in midline position. Abdomen is free from hair, bruising, and lumps. Bowel sounds heard upon auscultation in normal value of 9 sounds per minute. No tenderness felt on all abdominal quadrants upon palpation. MUSCULOSKELETAL ASSESSMENT
No deviations, inflammations, or bony deformities observed. Posture and gait is steady and coordinated. Upper and lower extremities have full Range of Motion. Shrugs shoulders and moves head to right and left against resistance.

Muscles moderately firm bilaterally. Moves upper and lower extremities freely against gravity and resistance. NEUROLOGICAL ASSESSMENT Mental status:
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 Pleasant but sometimes unruly towards the assessment.

Slightly and appropriately dressed for weather with matching colors and patterns. Facial expressions symmetrically and correlate with mood and topic discussed. Speech clear and appropriate. Carefully chooses words to convey feelings and ideas. Oriented to person, place, time, and events. Vocabulary suitable to educational level. Cerebellar and motor function: Alternates finger to nose with eyes closed,
Watermelons pronation, supination abduction and adduction of hands are in

coordination and without difficulty. No involuntary movements noted. Sensory status: Superficial light and deep- touch sensation intact on arms, legs, neck, chest, and back. Identifies point localization correctly. Motor status: Muscle tone firm at rest. Muscle size adequate for age. No fasciculation or involuntary movements noted. Muscle strength moderately strong and equal bilaterally. CRANIAL NERVES ASSESSMENT CRANIAL NERVE I. Olfactory TYPE AND FUNCTION >Sensory ASSESSMENT EXPECTED ACTUAL

PROCEDURE RESULT RESULT >Asked her to >The client >Avocado

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*Carries smell impulses mucous membrane II. Optic to brain. >Sensory *Visual impulses brain.

smell vinegar

the should while the correctly.

identify correctly vinegar identified the scent of vinegar.

her eyes were presented

from natural closed.

>She was asked >The for about 14 print

client >Avocado know was properly how to read so she this test. unresponsive to

to read a print should read the doesnt with no difficulty.

from eyes to inches away.

III. Oculomotor

>Motor *Contracts the muscle control

> The client is > eye penlight, to examiner eye check for eye/pupil constriction.

The

clients >Avocados should pupils constricted.

seated, using a pupil the constrict. will the

movements, constricts pupils elevates eyelid. IV. Trochlear >Motor *Contracts to eye movement. control and

>Instruct to follow

client >The

clients >Avocados eye Hwith pattern all movement.

the eye should have followed coordinated movements/moti on in direction.

eye muscle penlight. inferomedial

coordinated eye

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V. Trigeminal

>Sensory *Sensory touch, and temperature the brain. >Motor *Influences clenching and jaw movements.

>the client was > instructed

The

client >Avocado identify correctly the being

to should

impulses of close her eyes & correctly the part identified pain identify is which where she felt part touched. being correctly. part of her face touched

from face to touched.

>Contraction of >Avocados > The client was masseter asked to bite, to temporal muscle. and masseter and masseter contracted. and temporal muscle

lateral palpate temporal lobes. >Instructed to move eye laterally.

VI. Abducens

>Motor *Controls lateral movements.

her > eyes eye

The

clients >Avocados eye should moved laterally with no difficulty.

move laterally.

VII. Facial

>Sensory *Contains sensory fibers taste thirds stimulated secretions

> The client is > instructed taste for identify of and of

The

client >Avocado salt

was and

to should

identify able to identify vinegar.

and vinegar and salt the vinegar correctly. salt

anterior two- correctly. tongue and

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from salivary glands. >Motor *Supplies the >The client >Avocado was

> The client is should be able able to perform instructions show instructions with with no signs of raise no difficulty. and her difficulty.

facial asked to smile, to perform the the

muscles and frown, affects facial teeth, expressions. eyebrows blow cheeks. VIII. Acoustic >Sensory *Contains fiber balance. >Asked for the

the >The repeat

client >Avocado the the words

was

client to repeat should be able able to repeat whispered to whispered correctly slight

hearing and words and after whispered that, asked the words client to stand and straight and balance standing closed eyes. IX. eal >Sensory fibers taste posterior third tongue sensory fibers of the pharynx that & >The for identify of introduced salt client is > The close her eyes.

correctly and

perform swaying resulted while while she was with standing eyes closed. with

client >Avocado taste with reflex

Glossopharyng *Contains

instructed

to should be able correctly taste to identify taste identified like and gag reflex presented and should present. be gag present.

of calamansi juice.

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result in the gag when stimulated. X. Vagus >Sensory *Carries sensation from throat, larynx, bronchi, gastrointesti nal tract and abdominal viscera. XI.Spinal accessory >Motor *Innervates that promotes movement of and shoulders rotations. >Palpate strength toid trapezius muscles. >The of trapezius muscle and be clients >Avocado have symmetrical should trapezius muscle slight results her >The ah, the and a client is >The clients >Avocado soft reflex

instructed to say soft palate and palate and uvula swallow uvula should be symmetrically tongue symmetrical is rising difficulty swallowing in rise, and swallowed she with

depressor introduced

for should have no no difficulty and in she was able to and elicit gag reflex.

heart, lungs, gag reflex.

elicit gag reflex.

neck muscle sternocleidomas

symmetrical with of same with

and with strong contraction, Ask contraction

the the client to turn sternocleidomas head examiners hand opposite & ask the client the to shoulders. head shrug turned.

head against the toid muscles on sternocleidomas side toid muscle. was

XII.

>Motor

>Instructed

her >

The

client >Avocado

was

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Hypoglossal

*Innervates tongue promotes the movement of food and talking.

to protrude her should be able able to move her tongue it different directions and to move her tongue on different directions with no difficulty with in on tongue different directions no difficulty

muscle that move

Growth and Development School Age (6 years to 12) Erik Eriksons Psychosocial Stages Psychosocial Crisis: Industry vs. Inferiority Ego Quality: Competence Related Elements in Society: Division of labor To bring a productive situation to completion is an aim which gradually supersedes the whims and wishes of play. The fundamentals of technology are developed. To lose the hope of such industrious association may pull the child back to the more isolated, less conscious familial rivalry of the oedipal time. Avocado at this age is becoming more aware of herself as an individual. She works hard at being responsible, being good and doing it right. She is now more reasonable to share and cooperate. Some perceptual cognitive developmental traits specific for this age group: Avocado understands the concepts of space and time, in more logical, practical ways, beginning to grasp, eager to learn and accomplish more skills; reading, writing, telling time. She also gets to form moral values, recognize cultural and individual differences and is able to manage most of her personal need and
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grooming with minimal assistance. At her age, Avocado might express her independence by being disobedient. She is enthusiastic, noisy, imaginative, desires to explore. Avocado likes to complete a task and she enjoys helping others.

Sigmund Freuds Psychosexual Stages Phallic Stage The pleasure zone switches to the genitals. Freud believed that during this stage girl develops unconscious sexual desires for their father. Because of this, she becomes rivals with her mother and sees her as competition for the fathers affection. During this time, girls also develop a fear that their mother will punish them for these feelings, such as by castrating them. This group of feelings is known as Electrica Complex According to Freud, out of fear of castration and due to the strong competition of her mother, boys eventually decide to identify with her rather than fight her. By identifying with her mother, the boy develops feminine characteristics and identifies herself as a female, and represses his sexual feelings toward her father. Now, According to Mommy Orange, Avocado is very close to her father. She always wants to hug and catch the attention of her father. Earlier in her life she doesnt know how to follow her mothers command; but now that she is getting older, Avocado develops closeness to her mother. Nutrition Status by Age, Weight and Height Avocado, age 6, has a height of 107 cm and weighs 15 kilograms. BMI = Weight in kilograms__ _ Height in square meters
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= =

15 kilograms__ _ (1.14 meters) 2 15 kgs__ _ 1.14 m2 = 13.16 kg/m2

Asia-Pacific Obesity Guidelines BMI <18.5 18.6 22.9 > 23.0 23.0 24.9 25.0 29.9 > 30.0

Interpretation Underweight Healthy Weight Overweight At risk Obese I Obese II

Therefore, Avocado is said to be within underweight range based on Asia-Pacific Obesity Guidelines. History of Past Illness According to Mommy Orange, Avocados primary problem is cough and colds but doesnt she doesnt develop any complication because of this condition. Mommy Orange treatment for this is by boiling Oregano leaves. Avocado also have felt tooth ache earlier in her life. History of Present Illness Upon the assessment to Avocado, she experiences cough and colds. She does not take any medications. Activities of Daily Living Avocados day starts at 7:00 AM. She plays with her siblings at their backyard at around 8:00 AM. Also, she would help her mother in doing household chores. She would take a bath at 8:30 AM and will go to school at day care center (prep). At 12:00
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noon, she would go home and take her lunch with her family. When it is 1:00 PM already, she would take her afternoon sleep. Around 4:00 PM, she would wake up and play with her siblings again. She would take a rest at 6:00 PM she would play outside together with her playmates. Then, she would take her dinner with her family. When the clock reads at around 7:00 PM, she and her brothers and sister would watch TV until 9:00 and then after watching she would usually go to sleep. B. FINAL ASSESSMENT Daddy Apple The student nurses havent met Daddy Apple throughout the home visits because he is getting out for work as early as 5 am. Mommy Orange General Appearance Mommy Orange is 44 years old. He has long, black hair with some grayish and white discoloration. She is chubby and small. She is conscious and coherent while the group interviews her. At our initial home visit, she was wearing blouse and short jeans with slippers on. Her nails are trimmed and clean. She has steady gait and posture and no signs of distress observed. She stands 162 cm. and weighs 62 kg. Mommy Oranges vital signs were taken and recorded as follows: Vital Signs Blood Pressure Temperature Respiratory Rate Pulse Rate 1st home visit 120/80 mmHg 36.5 C 19 cpm 65 bpm 2nd home visit 120/90 mmHg 36.9 C 20 cpm 72 bpm 3rd home visit 110/90 mmHg 35.9 C 21 cpm 75 bpm

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SKIN, HAIR AND NAIL ASSESSMENT Skin:

Light brown in color.

Warm, and dry to touch. No signs of dehydration noted.

Skin folded over the forearm returned after 2 seconds.

No redness or edema noted.

Has no presence of scars noted.

Hair:
Hair is in medium length. Hair is black in color with some grayish and white strands.

Scalp is free from dandruff. Nails: Pinkish nail beds.

Capillary refill return after 2 seconds. No inflammation noted. No clubbing or abnormal curvature of the nails.

Nails are trimmed and neat. HEAD AND NECK ASSESSMENT Head:
Round in shape and symmetrical on sides. No tenderness noted.

No lumps noted upon palpation There are no fractures noted.

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Neck: There are no lumps palpated. Lymph nodes are non-palpable. Trachea is on the midline position. Range of Movement is appropriate. EYE ASSESSMENT Hair on eyebrow, eyelashes, and eyelids are evenly distributed.

No discharge on the eyelids upon inspection.

Sclera appears white.

Bulbar and Palpebral conjunctivas are light brown to pinkish in color. No edema and lumps observed on nasolacrimal duct upon palpation.

Pupils are equal in size. PERRLA (Pupils equally round and reactive to light and accommodation.) Both irises are brown in color.
Mommy Orange was able to read newsprint 14 inches far.

Has a coordinated eye movement. EAR ASSESSMENT

No lumps palpated on both ears. No lesions or signs of inflammation noted.

Ear folded return after 1 second.

The ear contains yellowish cerumen but not dry.

Both ears are responsive to whisper test. Mastoid process is non-tender. Color of the ear is same with the facial skin. There is mild swaying upon Rombergs test.
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NOSE AND SINUS ASSESSMENT

No presence of colds or nasal discharges.

Nasal septum is in midline position.

No tenderness noted upon palpation.

Can distinguish different smell. No lumps palpated. No obstruction observed upon deep inhalation. MOUTH AND PHARYNX ASSESSMENT
The lips have small cracks but no lesion noted.

The lips are light to pinkish in color. Buccal mucosa is pink in color and moist without discoloration or increased pigmentation.
No presence of aphthous stomatitis. No ulcers or nodules observed. Frontal teeth are evulsed. She hasnt visited a dentist to check for possible

solution to the problem.

Mommy Orange has 28 teeth with the absence of frontal teeth and some

premolars.
No bleeding observed on the buccal mucosa and the gums. Gums are light brown in color but no lesions observed.

There is no presence of lesions on the tongue. Mommy Orange can distinguish different taste. Uvula is in midline position and elevates upon saying ah.
There is no inflammation of the tonsils observed.

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CARDIAC ASSESSMENT
No irregular sounds heard upon auscultation.

Apical pulse is in normal rate. There are no palpitations observed. PERIPHERAL AND VASCULAR ASSESSMENT Arms:
Equal in size and symmetrical in shape.

No presence of edema, lesions and redness noted. Skin complexion is brown, warm to touch. Radial pulse is in normal value.
There are no lumps noted upon palpation.

Legs: Legs large in size but symmetrical.

Skin on legs and thigh is intact. Skin is light brown in color. Skin on legs and thigh is warm and dry to touch without edema noted.

Tibial pulse can slightly be palpated. There are no presence of lesions, lumps and bruising noted.
Legs have smooth coordinated movements.

THORAX AND LUNG ASSESSMENT

There is still the presence of rales on exhalation upon auscultation.

Chest expansion is symmetrical. There is no presence of lesions, redness or edema.

Respirations are still labored because of smoking. 96 | P a g e

BREAST ASSESSMENT Upon the permission of Mommy Orange, one girl from the group palpated Mommys breast and the results are as follows:
Breast moderate in size, round in shape, and symmetrical bilaterally. There are no lumps palpated on both breast.

There is no tenderness felt upon movement.

There are no peau d orange or abnormal skin appearance upon interview to

Mommy Orange.
Upon interview to Mommy Orange, she stated that she hasnt observed any dark

spots. ABDOMINAL ASSESSMENT Umbilicus is in midline position.

Number of bowel sounds is normal at the rate of 12 sounds per minute.

There is no tenderness felt on all quadrants. There is no presence of abdominal hair. GENITOURINARY-REPRODUCTIVE ASSESSMENT Upon interview to Mommy Orange, she stated that: There is no pain upon urination and fecal excretion.
There is the presence of episiorrhaphy or stitches from vaginal birth.

MUSCULOSKELEAL ASSESMENT Posture and Gait is steady, stable, coordinated and smooth.
Shrugs shoulders and moves head to right and left against resistance. Upper and lower extremities have full ROM. 97 | P a g e

 Muscles moderately firm bilaterally. No deviations, inflammations, or bony deformities.

Moves upper and lower extremities freely against gravity and resistance.

NEUROLOGIC ASSESSMENT Mental status: Mommy Orange is conscious and coherent. Facial expressions symmetrically and correlate with mood and topic discussed. Speech is clear and intonation is appropriate. Follows assessment instructions. Oriented to person, place, time, and events. Enjoys joking. Cerebellar and motor function: There are no involuntary movements. Alternates finger to nose with eyes closed, occasionally tends to hit opposite side of nose. Sensory status: Superficial light and deep- touch sensation intact on arms, legs, neck, chest, and back. Identifies point localization correctly. Motor status: Muscle tone firm at rest. Muscles are not a bit prominent because of fat deposition. No involuntary movements noted. Muscle strength moderately strong and equal bilaterally.
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Grapes Due to his work from 7:00 a.m. to 6:00 p.m., the group wasnt able to assess Grapes.

Strawberry Strawberry has already built a family in Manila and she is not staying anymore in the familys house so the group was not able to assess her. Mango General Appearance Client is alert and cooperative. Smiling but with mild anxiety. Dress is clean and neat. Mango is properly groomed. Mango can walk steadily. Mangos vital signs were taken and recorded as follows: Vital Signs Blood Pressure Temperature Respiratory Rate Pulse Rate 1st home visit 120/70 mmHg 35.4 C 24 cpm 57 bpm 2nd home visit 110/70 mmHg 36.2 C 25 cpm 64 bpm 3rd home visit 110/80 mmHg 36.1 C 22 cpm 60 bpm

SKIN, HAIR AND NAILS ASSESSMENT Skin:

Skin is dark brown in color. Skin is also warm, and dry to touch. Skin fold return to place after 1 second when lifted over arm. There is no presence of edema observed. 99 | P a g e

 No redness observed. Hair:

Mango has short-length hair. Hair is black in color, straight, clean, medium textured. Hair is evenly distributed on head.

No scalp lesions or flaking.

Presence of dandruff was reduced due to family and student nurses

interventions. Nails: Fingernails are short and properly trimmed. Fingernails are clean.
No clubbing or abnormal curving of the nails. Capillary refill return after 2 seconds.

HEAD AND NECK ASSESSMENT Head: Head is symmetrically rounded. No edema, lumps noted upon palpation. Skull is intact and no presence of head fractures observed. Neck:
Neck is non-tender with full Range of Movement. Neck is symmetrical without masses, scars, and lesions.

Lymph nodes are non-palpable.

Trachea is in midline position. Thyroid gland or Adams apple is not quite prominent.

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EYE ASSESSMENT Hair on eyebrow, eyelashes are intact and equally distributed. There are no secretions felt on eyelids. There are no tenderness, edema and lesions noted on the eyelids.
There is no edema noted on nasolacrimal duct upon palpation. Sclera is white in color without dark spots. Palpebral and bulbar conjunctivas are pinkish in color but without lesions noted. Both irises are brown in color.

PERRLA (Pupil is equally rounded and reactive to light and accommodation. EAR ASSESSMENT
Auricles are without deformities, lumps, or lesions noted and palpated. Mastoid process is non-tender.

Auditory canals contain moderate amount of yellowish cerumen. Ear color is same with facial skin. Ear folded returned after 1 second. No edema and redness noted on both ears. Mango is responsive to watch tick test. There is mild swaying upon Rombergs test. NOSE AND SINUSES ASSESSMENT There is no presence of lumps, edema lesions noted upon palpation. Nasal septum is in midline position. Nasal discharge was relieved. Can distinguish different scents. Sinuses are non-palpable

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MOUTH AND PHARYNX ASSESSMENT

Lips are moist with no lesions or ulcerations observed. Buccal mucosa is pink in color and moist without discoloration or increased

pigmentation. There is no presence of aphthous stomatitis, lesions on buccal mucosa upon inspection.
Upper and lower teeth are secured. Gums are pink in color and moist without inflammation, bleeding, or discoloration.

Hard and soft palates smooth without lesions or masses.

Tongue is in midline position and has a full range of motion.

Gag reflex is present intact. Uvula is in midline position and elevated upon speaking. Mango identified different taste presented. Tonsils are not inflamed or enlarged. CARDIAC ASSESSMENT No abnormal sounds heard upon auscultation Apical pulse is in normal value. PERIPHERAL AND VASCULAR ASSESSMENT Arms:
Equal in size and symmetrical bilaterally. Skin on arms is dark brown in color. Skin is warm and dry to touch. There is no presence of edema, bruising noted. Minimal lesions and marks of chickenpox were observed. Radial pulses normal in rate, and strong.

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Legs:
Legs size is appropriate for Mangos weight. Legs are symmetrical in size and shape. Skin on legs and thigh is intact, light brown in color. Skin on legs is warm and dry to touch without edema.

Minimal lesions and marks of chickenpox were observed. Lymph nodes are non-palpable. Tibial pulse can be slightly palpated. Toenails are clean and properly trimmed. Feet are clean. THORAX AND LUNG ASSESSMENT
Thorax skin is light brown in color with mark of chickenpox noted.

There is no chest hair observed. There are no abnormal sounds heard upon auscultation except for some sounds of cough. Cough was relieved. Chest expansion is symmetrical. No edema, lesion, bulging or retraction observed on the skin. Breathing is not labored. ABDOMINAL ASSESSMENT Umbilicus is in midline position. No abdominal hair observed. There is no edema, lesions noted. There is no tenderness on all abdominal quadrants upon palpation. Bowel sounds are in normal value of 16 sounds per minute.
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GENITO-URINARY AND REPRODUCTIVE ASSESSMENT Upon interview to Mango, he verbalized that he doesnt feel any pain upon urination and fecal excretion.

MUSCULOSKELETAL ASSESSMENT
Posture is slightly stooped. Gait steady, smooth, and has coordinated movements. Shrugs shoulders and moves head to right and left against resistance. Upper and lower extremities have full Range of Motion (ROM).

Muscles moderately firm bilaterally.

No deviations, inflammations, or bony deformities.

Moves upper and lower extremities freely against gravity and resistance. NEUROLOGIC ASSESSMENT Mental status:
Moody and short-tempered.

Facial expressions symmetrically and correlate with mood and topic discussed. Oriented to person, place, time, and events. Vocabulary suitable to educational level.
Gives semiabstract answers but are appropriate.

Cerebellar and motor function: Touches nose with fingers with eyes closed. Alternates supination, pronation, adduction and abduction properly.
No involuntary movements noted.

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Sensory status:
Superficial light and deep- touch sensation are clearly identified on arms, legs,

neck, chest, and back. Identifies point localization correctly. Motor status: Muscle tone firm at rest. Muscle size adequate for age. No fasciculation or involuntary movements noted. Muscle strength moderately strong and equal bilaterally. Watermelon General Appearance Client is alert and cooperative with the student nurses. She is smiling with minimal anxiety towards the student nurses. Dress is clean and properly groomed. Watermelon walks steadily. Her posture and gait is firm. Watermelons vital signs were taken and recorded as follows: Vital Signs Blood Pressure Temperature Respiratory Rate Pulse Rate 1st home visit 110/60 mmHg 35.7 C 19 cpm 73 bpm 2nd home visit 110/70 mmHg 36.4 C 20 cpm 76 bpm 3rd home visit 90/60 mmHg 36.2 C 17 cpm 80 bpm

SKIN, HAIR AND NAIL ASSESSMENT Skin:

Skin is light brown in color. Skin is warm, and dry to touch. Skin fold return to place after 1 second when lifted over forearm. 105 | P a g e

 Some scars on upper and lower extremities. No signs of dehydration noted upon inspection. No edema and redness observed. There is no presence of lumps palpated. Hair:
Hair is shoulder-length, black in color, straight, clean, medium textured. Hair is evenly distributed on head.

No patches of hair loss observed. No scalp lesions or flaking. No dandruff noted upon inspection. Nails:
Fingernails are short, neat and properly trimmed.

There is no presence of clubbing or abnormal curving of the nails. Capillary refill return after 2 seconds upon Blanchs test. HEAD AND NECK ASSESSMENT Head:
Head is symmetrically rounded.

No tenderness palpated on the head. No lumps or irregular masses and lesions noted. Skull has no fractures upon inspection. Neck:
Neck is non-tender upon palpation with full Range of Motion.

Neck is symmetrical.
No lumps, abnormal masses observed upon palpation.

No lesions noted.
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 Trachea is in midline position Thyroid gland is non-palpable.

Lymph nodes are non-palpable.

EYE ASSESSMENT Hair on eyebrows, eyelashes is evenly distributed. No lesions or secretions noted on eyelids. No edema or lumps palpated on the nasolacrimal duct. The color of bulbar and palpebral conjunctivas is light brown to pinkish. Color of the sclera appears white. Both irises are brown in color. Pupil is equally round and reactive to light and accommodation. No lesions observed around the eye. Eyes have coordinated movement. Watermelon can read newsprint 14 inches far. EAR ASSESMENT Color of the ear is same with facial skin. Ear folded return after 1 second. No tenderness, lumps or irregular masses palpated. Auditory canal contains yellowish cerumen. Mastoid process is non-tender. Watermelon was responsive to watch tick test. Mild swaying upon Rombergs test. No presence of tinnitus or tingling sound in the ears. Watermelon can hear and repeat whispered word.
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NOSE AND SINUSES ASSESSMENT

External structure of the nose is without deformity.

Nose symmetrical. No nodules, lumps and edema observed upon palpation. Nasal septum is in midline position. No nasal discharges observed Watermelon can clearly identify different scents. There was no obstruction heard upon deep inhalation. MOUTH AND PHARYNX ASSESSMENT
Lips are moist and free from cracks or any sign of dehydration. No lesions or ulcerations observed on the lips. Buccal mucosa is pinkish in color and moist without discoloration or increased

pigmentation.
No ulcers or nodules observed on the buccal mucosa.

Watermelon has a complete 28 teeth for her age. No dental caries noted upon inspection.
Gums are pinkish in color.

Uvula is in midline position and elevates upon saying ah. Hard and soft palates are free from lumps, lesions or ulcerations. Tongue has a full range of motion. Watermelon can distinguish different flavor. Gag reflex is present upon inspection. Tonsils are not inflamed or enlarged. CARDIAC ASSESSMENT

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 Apical pulse is in normal range. No abnormal sounds heard upon auscultation.

No pulsations are visible.

PERIPHERAL AND VASCULAR ASSESSMENT Arms:

Arms are equal in size and symmetrical. Watermelon has light brown complexion. Skin on the arm is warm and dry to touch. No edema, bruising, or lesions noted upon inspection.

Radial pulse is palpable and in normal rate. Brachial pulse can be slightly palpated. Legs: Legs size is appropriate and symmetrical with Watermelons weight. Skin is intact with no lesions, ulceration, redness or lumps inspected. Skin on legs is light brown to white in color. Skin over the legs is warm and dry to touch. Tibial pulse can be slightly felt.
Toenails are thick but not dirty.

THORAX AND LUNG ASSESSMENT

Skin on chest is pale pink in color but without any lesions, lumps or birth mark

observed. No hair noted on the chest. No abnormal bulging or retractions on skin above the ribcage.
No coughs and colds observed.

Respirations are in normal range.

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 Respirations are not labored. Bilateral chest expansion is symmetrical. ABDOMINAL ASSESSMENT Bowel sounds heard upon auscultation in normal value of 11 sounds per minute. Abdomen is free from hair, bruising, and lumps. No tenderness felt on all abdominal quadrants upon palpation. There is no skin discoloration noted. Umbilicus is in midline position. GENITOURINARY-REPRODUCTIVE ASSESSMENT Upon interview to Watermelon she verbalized that she doesnt feel any pain upon urination and fecal excretion. MUSCULOSKELETAL ASSESSMENT
Posture and gait is steady and coordinated. Shrugs shoulders and moves head to right and left against resistance. Upper and lower extremities have full Range of Motion.

Muscles moderately firm bilaterally.

No deviations, inflammations, or bony deformities observed.

Moves upper and lower extremities freely against gravity and resistance. NEUROLOGICAL ASSESSMENT Mental status: Pleasant and friendly. Slightly and appropriately dressed for weather with matching colors and patterns.
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Facial expressions symmetrically and correlate with mood and topic discussed. Speech clear and appropriate.

Carefully chooses words to convey feelings and ideas. Oriented to person, place, time, and events. Vocabulary suitable to educational level. Cerebellar and motor function: Alternates finger to nose with eyes closed,
Watermelons pronation, supination abduction and adduction of hands are in

coordination and without difficulty. No involuntary movements noted. Sensory status: Superficial light and deep- touch sensation intact on arms, legs, neck, chest, and back. Identifies point localization correctly. Motor status: Muscle tone firm at rest. Muscle size adequate for age. No fasciculation or involuntary movements noted. Muscle strength moderately strong and equal bilaterally. Banana General Appearance Client is alert and cooperative but has no idea what the student nurses are doing. Smiling but with mild anxiety towards the student nurses. Dress is clean and he is properly groomed. Banana walks steadily.
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Bananas vital signs were taken and recorded as follows: Vital Signs Temperature Respiratory Rate Pulse Rate 1st home visit 35.9 C 20 cpm 85 bpm 2nd home visit 36.5 C 21 cpm 86 bpm 3rd home visit 36.2 C 18 cpm 80 bpm

SKIN, HAIR AND NAILS ASSESSMENT Skin:

Skin is dark to light brown in color. Skin is also warm, and dry to touch. There is no presence of edema observed. Skin fold return to place after 1 second when lifted over arm.

Minimal wounds were healing. No redness observed. Hair:

Banana has short-length hair. Hair is black in color, straight, clean.

Dandruff was reduced upon interventions.

Hair is evenly distributed on head.

No scalp lesions or flaking. Nails:

Fingernails are short and properly trimmed. No clubbing or abnormal curving of the nails. Capillary refill return after 3 seconds. 112 | P a g e

 Fingernails are clean and in medium thickness. HEAD AND NECK ASSESSMENT Head: Head is symmetrically rounded. No edema, lumps noted upon palpation. Skull is intact. No presence of head fractures observed. Neck:
Neck is non-tender upon palpation with full Range of Movement. Neck is symmetrical without lumps, scars, and lesions.

Lymph nodes are non-palpable.

Trachea is in midline position.

EYE ASSESSMENT There are no tenderness, edema and lesions noted on the eyelids.
Palpebral and bulbar conjunctivas are pinkish in color but without lesions noted.

There are no secretions felt on eyelids. Hair on eyebrow, eyelashes are intact and equally distributed.
There is no edema or any obstruction noted on nasolacrimal duct upon palpation. Sclera is white in color and without dark spots.

PERRLA (Pupil is equally rounded and reactive to light and accommodation.

Both irises are brown in color.

EAR ASSESSMENT Ear folded returned after 1 second.

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 Mastoid process is non-tender.

Ear color is same with facial skin.

Auricles are without deformities, lumps, or lesions noted and palpated. Auditory canals contain moderate amount of light brown color of cerumen.

No edema and redness noted on both ears. Banana is responsive to watch tick test. There is mild swaying upon Rombergs test. NOSE AND SINUSES ASSESSMENT Nasal discharges were relieved. Nasal septum is in midline position. There is no presence of lumps, edema lesions noted upon palpation. Banana can now distinguish different scents presented to him. Sinuses are non-palpable MOUTH AND PHARYNX ASSESSMENT
Lips are moist with no lesions or ulcerations observed.

There is no presence of aphthous stomatitis, lesions on buccal mucosa upon inspection.

Buccal mucosa is pink in color and moist without discoloration or increased

pigmentation. Malocclusion of the upper frontal teeth was still evident. Banana has dental stains but without dental carries.
Gums are pink in color and moist without inflammation, bleeding, or discoloration. Tongue is in midline position and has a full range of motion.

Mango identified different taste presented. Tonsils are not inflamed or enlarged. Hard and soft palates smooth without lesions or masses.
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 Gag reflex is present intact. Uvula is in midline position and elevated upon speaking. CARDIAC ASSESSMENT No feeling of chest pain. No abnormal sounds heard upon auscultation Apical pulse is in normal value.

PERIPHERAL AND VASCULAR ASSESSMENT Arms:

Skin is warm and dry to touch. Skin on arms is dark to light brown in color. Arms are equal in size and symmetrical bilaterally. There is no presence of edema, bruising noted. Radial pulses are normal in rate, and strong.

Legs:
Skin on legs and thigh is intact, light brown in color. Skin on legs is warm and dry to touch without edema. Legs size is appropriate for Bananas weight. Legs are symmetrical in size and shape.

Lymph nodes are non-palpable. Tibial pulse can be slightly palpated. Toenails are noted clean and properly trimmed. Feet of Banana are clean and free from bruises as well.
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THORAX AND LUNG ASSESSMENT There is no chest hair observed. No edema, lesion, bulging or retraction observed on the skin.
Thorax skin is light brown in color with mark of chickenpox noted.

Cough and Colds were relieved. There are no abnormal sounds heard upon auscultation except for some sounds of cough. Chest expansion is symmetrical. Breathing is not labored.

ABDOMINAL ASSESSMENT There is no edema, lesions noted. No abdominal hair observed. There is no tenderness on all abdominal quadrants upon palpation. Umbilicus is in midline position. Bowel sounds are in normal value of 14 sounds per minute. MUSCULOSKELETAL ASSESSMENT
Posture is slightly stooped. Upper and lower extremities have full Range of Motion (ROM).

Moves upper and lower extremities freely against gravity and resistance.
Gait steady, smooth, and has coordinated movements. Shrugs shoulders and moves head to right and left against resistance.

Muscles moderately firm bilaterally.

No deviations, inflammations, or bony deformities. 116 | P a g e

NEUROLOGIC ASSESSMENT Mental status:

Facial expressions are subjective to Bananas feelings towards the entry of the

student nurses.
Banana is not quite oriented to person, place, time, and events.

Banana cannot verbalized own feelings due to his young age and state of mind. Cerebellar and motor function: No involuntary movements noted. Touches nose with fingers with eyes closed. Alternates supination, pronation, adduction and abduction properly. Sensory status: Identifies point localization correctly.
Superficial light and deep- touch sensation are clearly identified on arms, legs,

neck, chest, and back. Motor status: No fasciculation or involuntary movements noted. Muscle tone firm at rest. Muscle size adequate for age. Muscle strength moderately strong and equal bilaterally. Avocado General Appearance

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Client is alert but still slightly uncooperative towards the student nurses but is understandable because of his young age. Avocado sometimes feels scared towards the student nurses action. Different expressions of smiling and frowning were observed. Dress is now cleaned and properly groomed. Posture and gait is steady. Avocados vital signs were taken and recorded as follows: Vital Signs Temperature Respiratory Rate Pulse Rate 1st home visit 36.5 C 28 cpm 72 bpm 2nd home visit 36.2 C 26 cpm 75 bpm 3rd home visit 36.3 C 25 cpm 78 bpm

SKIN, HAIR AND NAIL ASSESSMENT Skin:

Skin is warm, and dry to touch. Skin is light brown in complexion.

No edema and redness observed. There is no presence of lumps palpated.

Skin fold return to place after 1 second when lifted over forearm.

No signs of dehydration noted upon inspection. Some scars on upper and lower extremities. Hair:
Hair is shoulder-length, black in color, straight but not properly groomed. Hair is evenly distributed on head.

No patches of hair loss observed. No scalp lesions or flaking. Dandruff was reduced upon interventions. Nails: There is no presence of clubbing or abnormal curving of the nails.
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 Fingernails are short, clean and properly trimmed.

Capillary refill return after 2 seconds upon Blanchs test. HEAD AND NECK ASSESSMENT Head:
Head is symmetrically rounded.

Skull has no fractures upon inspection. No tenderness palpated on the head. No lumps or irregular masses and lesions noted. Neck: Neck is symmetrical.
Trachea is in midline position

No lesions noted.
No lumps, abnormal masses observed upon palpation. Neck is non-tender upon palpation with full Range of Motion. Thyroid gland is non-palpable.

Lymph nodes are non-palpable. EYE ASSESSMENT No lesions or secretions noted on eyelids. No edema or lumps palpated on the nasolacrimal duct. Hair on eyebrows, eyelashes is evenly distributed. The color of bulbar and palpebral conjunctivas is light brown to pinkish. Color of the sclera appears white. Both irises are brown in color. Pupil is equally round and reactive to light and accommodation. No lesions observed around the eye.
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 Eyes have coordinated movement. Avocado doesnt know how read newsprint 14 inches far. EAR ASSESMENT Color of the ear is same with facial skin. Mastoid process is non-tender. No tenderness, lumps or irregular masses palpated. Ear folded return after 1 second. Auditory canals contain minimal amount of yellowish cerumen. Avocado was responsive to watch tick test. Mild swaying upon Rombergs test. No presence of tinnitus or tingling sound in the ears.

NOSE AND SINUSES ASSESSMENT Nostrils are symmetrical.

External structure of the nose is without deformity.

No nodules, lumps and edema observed upon palpation. Nasal septum is in midline position. Nasal discharges were relieved upon student nurses and familys interventions. Avocado can clearly identify different scents. There was no obstruction heard upon deep inhalation. MOUTH AND PHARYNX ASSESSMENT
No lesions or ulcerations observed on the lips. Lips are moist and free from cracks or any sign of dehydration. 120 | P a g e

 No ulcers or nodules observed on the buccal mucosa. Buccal mucosa is pinkish in color and moist without discoloration or increased

pigmentation. Avocado has a 22 set of teeth; some milk teeth are still intact.
Gums are pinkish in color.

Uvula is in midline position and elevates upon saying ah. Hard and soft palates are free from lumps, lesions or ulcerations. Tongue has a full range of motion. Avocado can distinguish different flavor. Gag reflex is present upon inspection. Tonsils are not inflamed or enlarged. CARDIAC ASSESSMENT Apical pulse is in normal range.
No pulsations are visible.

No abnormal sounds heard upon auscultation. PERIPHERAL AND VASCULAR ASSESSMENT Arms:
Skin on the arm is warm and dry to touch. Avocado has light brown complexion. Arms are equal in size and symmetrical. No edema, bruising, or lesions noted upon inspection.

Radial pulse is palpable and in normal rate. Brachial pulse can be slightly palpated. Legs: Skin on legs is light brown to white in color. Legs size is appropriate and symmetrical with Avocados weight.
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 Skin is intact with no lesions, ulceration, redness or lumps inspected. Skin over the legs is warm and dry to touch. Tibial pulse can be slightly felt. Toenails are short and properly trimmed. Feet of Avocado were clean. THORAX AND LUNG ASSESSMENT
Skin on chest is pale pink in color but without any lesions, lumps or birth mark

observed. No hair noted on the chest. No abnormal bulging or retractions on skin above the ribcage. Respirations are in normal range.
No coughs and colds observed.

Respirations are not labored. Bilateral chest expansion is symmetrical.

ABDOMINAL ASSESSMENT There is no skin discoloration noted. Umbilicus is in midline position. Abdomen is free from hair, bruising, and lumps. Bowel sounds heard upon auscultation in normal value of 10 sounds per minute. No tenderness felt on all abdominal quadrants upon palpation. MUSCULOSKELETAL ASSESSMENT
No deviations, inflammations, or bony deformities observed. Posture and gait is steady and coordinated. 122 | P a g e

 Upper and lower extremities have full Range of Motion. Shrugs shoulders and moves head to right and left against resistance.

Muscles moderately firm bilaterally. Moves upper and lower extremities freely against gravity and resistance. NEUROLOGICAL ASSESSMENT Mental status:
Pleasant but sometimes unruly towards the assessment.

Slightly and appropriately dressed for weather with matching colors and patterns. Facial expressions symmetrically and correlate with mood and topic discussed. Speech clear and appropriate. Carefully chooses words to convey feelings and ideas. Oriented to person, place, time, and events. Vocabulary suitable to educational level. Cerebellar and motor function: Alternates finger to nose with eyes closed,
Watermelons pronation, supination abduction and adduction of hands are in

coordination and without difficulty. No involuntary movements noted. Sensory status: Superficial light and deep- touch sensation intact on arms, legs, neck, chest, and back. Identifies point localization correctly. Motor status: Muscle tone firm at rest. Muscle size adequate for age.
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 No fasciculation or involuntary movements noted. Muscle strength moderately strong and equal bilaterally. III. Socio-economic, Cultural and Environmental Assessment A. Type of Family The type of Family that the group has adopted is a nuclear family. It consist only of a father, a mother and children. The Fruit family consist of Daddy Apple, Mommy Orange, they have six children but Strawberry doesnt live with them because she has now a separate family in Manila. Grapes, Mango, Watermelon, Banana, Avocado are the only children left living in the familys house. B. Dominant family member/s in terms of decision-making especially to health care In terms of decision-making, both of the couple decide for the management of their financial needs. But in terms of health care needs, the primary decision-maker is Mommy Orange, because she knows more of the health care available in the community than Daddy Apple. Mommy Orange is more concerned with the health condition of each member because she knows more of her familys need in terms of health; she is also with her children most of the time unlike Daddy Apple who works as a jeepney driver for the whole day. C. Source of Income and Expenditures

INCOME Daddy Apples jeepney driving 10,000 Php/month

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Grapes job Total

4,000 Php/month 14000 Php/month

The Fruit Familys only source of income is Daddy Apple and Grapes. Mommy Orange is a plain housewife. Strawberry, the eldest daughter, doesnt live with them and the family do not receive any remittence from her. While the other children are still studying. In terms of NEDAs requirement of Php 2,768.60 per month per individual, the familys income is insufficient for them; they only have Php 2,000 per individual. Monthly IncomeNumber of Individuals14, 000 Php 7______ 2, 000 Php/month/individual

EXPENDITURE Jeepney Boundary and Gas Expenses Utilities Food, Groceries Childrens School Expenses Vices TOTAL 1,500 Php/month 13, 500 Php/month 3,500 Php/month 2, 500 Php/month 1,500 Php/month 4,000 Php/month

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The major expense of the family is the jeepney business because the vehicle is only rented, they have an additional burden for that added with the gas expenses. Next is their source of water and electricity, their house needs, their childrens school expenses and the couples vices like alcohol, cigarette and bingo game.

Total Income Total Expenses Savings

14, 000 Php/month 13, 500 Php/ month 500 Php/month

In case of emergency, the family has only 500 Php/ monthly savings. Their other source of money if there is an emergency need is their neighbors. D. Working Hours Daddy Apple usually wakes up and prepares for work at 5 in the morning. He is going home for lunch at 12 nn.- 1 p.m. According to Mommy Orange, her husband usually go home after work at 9 in the evening. Grapes, the oldest son starts work at 7 in the morning and go home at 5 in the afternoon. E. Ethnic Background and Religious Affiliation None of the couple is native at Angeles City. Daddy Apple originates from San Luis, Pampanga while Mommy Orange originates from Eastern Samar. As for their religion,the whole family are currently Roman Catholics. According to Mommy Orange, they sometimes attend Sunday masses, all of their children are baptized in the church. The family doesnt practice their faith that much, they dont often go to masses.
F.

Significant others role/s in the family life.

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The individuals who serve as their significant others are their neighbors, their neighbors arent related to them by blood. Their S.O. mostly serve as an emotional support for them. In times of sadness, Mommy Orange play bingo with them. The Fruit family dont rely on them much on financial support because just like them, their S.O. also finds difficulty in earning money. The familys relatives are far away from them so they are not receiving any form of support coming from their relatives. G. Health habits and beliefs The group learned the health habits and beliefs of the family from Mommy Orange. According to her, they believe on herbolarios, but they still go to the health center if the problem worsen. They also self-medicate like using herbal medicines like oregano, sambong, pandan and the like. They believe sambong, pandan, ugat ng ilib treats kidney problems while oregano treat cough and colds. According to Mommy Orange, some of the superstitious belief they believe are: when a person is pregnant, she must refrain from taking bath in the night and she must sleep on straight position to prevent the risk for craziness. They also believe that if a black cat pass on their way, their day will be unlucky. H. Familys involvement in community activities The Fruit Family involves themselves mostly on heath-related activities. The immunization of all the children, which was conducted in the health center, are complete. Mommy Orange also attends the mothers class conducted by the student nurses regularly. I. Familys utilization of community resources The Fruit Familys only community resource utilized is the school. And the children benefit from that. But sometimes, they dont go to school because their lazy according to their mother.
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J. Housing Condition The house of the family is a concrete-wood type. The walls are concrete, while their roof is made up of wood materials. The house of the family is a rented apartment.

*for better view of the TFA, a bigger copy is provided in the appendices (page 199).

a.

Adequacy of living Space Adults Children Infants

Normal Requirement 3 m2 1.5 m2 0 m2

TOTAL FLOOR AREA= 4.21m. X 2.29 m. = 9.64 m2 ADEQUACY OF LIVING SPACE= 9.64 m2 / 7(# of family members) = 1.38 m2 (inadequate)

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ADEQUACY OF VENTILATION < 18 % 18-19 % > 19 %

INTERPRETATION Poor Ventilation Fair Adequate Ventilation

TOTAL WINDOW OPENING= 1.12 m X .58m = .65 m2 ADEQUACY OF VENTILATION= TOTAL WINDOW OPENING X100 TOTAL FLOOR AREA .65 m2 X 100 9.64 m2 = 7 % poor ventilation Sleeping Arrangement- The Fruit family has only one bed, their bed is a wooden-type. = Only Grapes sleeps in the Bed; while the rest of the family sleeps on the floor. Adequacy of Furniture- The Fruit family has a bed, a cabinette, a drawer box for their clothes, a long chair, a kitchen table, they also have T.V. but it is dysfunctional. The furniture of the family almost occupy the whole floor area, the furnitures are adequate for their daily survival but the free space is inadequate for them. Presence of insects and rodents- According to Mommy Orange, there is the presence of mosquitoes and cockroaches. The possible breeding site for these vectors is the bathroom and drainage. Their problem of rodents was releived after housing a cat. Accident Hazards- The student nurses observe some of the accident hazards of the Fruit family like: the familys LPG tank is near their bed. This problem can aggreviate because Mommy Orange and Daddy Apple smokes. The roof is damaged which can be a fall hazard. Their free space is also inadequate which can be a risk for injuries especially for children. b. Food sources, storage and cooking facilities
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Their store their food by means of a covered casserole. According to Mommy Orange, they are the one who prepare for their food. As for their cooking facility, they have a gas stove. The group observed that the familys cooking facilities are dirty which can be a source for infection; the group also observed that the family do not practice proper handwashing before and after meals. c. Water supply

The familys source of water supply is the Angeles Water District. As for their drinking supply, sometimes they buy distilled water. The water of the family is potable for drinking but needs further boiling to assure safetiness of the drinking water. d. Toilet facility The toilet of the Fruit family is a septic tank but without a water carriage. They owned their toilet facility and the group oberserved that the familys toilet is in good condition. e. Drainage system

The drainage system of the family is uncovered and stagnant. The group observed that the drainage is dirty and can be a breeding site for mosquitoes and other vectors of diseases. f. Social and health facilities available

Barangay Virgen de los Remedios has a basketball court, a health center and a barangay hall. The family utilize mostly the health center for consultation. g. Communication and transportation facilities
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The family communicate with each other especially the working individuals via their cellular phones. While the family transports from one place to another by the jeepney that Daddy Apple use in his work.

IV. PROBLEM IDENTIFICATION A. List of Problem Identified No. 1 2 3 4 5 6 7 8 Problems Identified Poor Home Condition: Presence of vector of diseases e.g. rodents, mosquitoes, flies, roaches Presence of Health Deficit: Cough and Colds Family size beyond what family resources can adequately provide Unhealthful lifestyle and Personal Habits: Poor Personal Hygiene Unhealthful lifestyle and Personal Habits: Walking Barefooted Poor Home Condition: Inadequate Lighting Poor Home Condition: Inadequate Living Space Presence of Health Deficit: Malnutrition Score 4.34 4.17 3.34 3.34 2.84 2.50 2.17 2 Rank 1 2 3.5 3.5 5 6 7 8

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Unhealthful lifestyle and Personal Habits: Cigarette Smoking

1.5

B. Priority Setting Problem # 1 Presence of Breeding Sites of Vectors of Diseases

CRITERIA COMPUTATION SCORE JUSTIFICATION

1. NATURE OF THE PROBLEM 3 = Health deficit 2 = Health threat 1 = Foreseeable crisis

2/3= X 1

0.67

Presence of breeding sites of vectors of diseases is a health threat because it can pose a greater risk of acquiring infection. The risk for infection can be aggravated by unsanitary lifestyle. Rodents can cause leptospirosis; cockroaches can lead to sepsis while mosquitoes can be a great risk for acquiring dengue.

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2. MODIFIABILITY OF THE PROBLEM 2 = Easily modifiable 1 = Partially modifiable 0 = Not Modifiable

Current knowledge, technology and interventions Family Resources SN Resources Community Resources

2/2= X 2

The problem is easily modifiable: Current technology intervention: knowledge, and

> The family are knowledgeable about the problem and as part of their intervention they often use insecticides. The family also has a cat for the belief that cats favorite meal is a rat. Family resources: > The family has insecticide in the home as part of their intervention in eradicating the problem. Student nurse resources: > The primary resource that the student nurses can give to the family is health teachings. The student nurses can teach the family about proper cleaning of the house to prevent breeding sites of these vectors of diseases. Community Resources: > The community can have seminars on how to clean the house especially the corners and the drainage. They can have a campaign fighting for the existence of dengue, leptospirosis and infection brought about by these
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vectors of diseases.

3. PREVENTIVE POTENTIAL 3=High 2=Moderate 1=Low

Severity Duration Current Management High -risk Group

2/3 X 1=

0.67

The problem has moderate preventive potential due to the following criteria: Severity of the problem: > The problem is not severe because none of the members of the family has acquired any diseases caused by these vectors of diseases. Duration of the Problem: > The duration of the problem is long because it has been existing since the couple transferred to the present apartment 26 years ago. . Current Management: > The family has a management in dealing with
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this problem. They often use insecticide as the primary intervention. They also housing a cat. Exposure group: of high-risk

> All of the family members are exposed to this problem since they all live in a same house except for Strawberry who now has a separate family in Manila. 4. SALIENCE 2 = A serious problem needing immediate attention 1 = A problem not needing immediate attention 0 = Not perceived as a problem TOTAL SCORE 4.34 2/2 x 1= 1 The family is aware of the existence of the problem and they think that this needs an immediate attention to prevent the infestation of these vectors to their food, clothes and other belongings.

Problem # 2 Presence of Cough and Colds

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CRITERIA

COMPUTATION

SCORE

JUSTIFICATION

1. NATURE OF THE PROBLEM 3 = Health deficit 2 = Health threat 1 = Foreseeable crisis 2. MODIFIABILITY OF THE PROBLEM 2 = Easily modifiable 1 = Partially modifiable 0 = Not Modifiable
Current knowledge, technology and interventions Family Resources SN Resources Community Resources

3/3= X 1

Cough and Colds is a health deficit because there is already the existence of the problem and failure in maintenance of health even before the entry of the nurses with the family. The problem is easily modifiable: Current technology intervention: knowledge, and

2/2= X 2

> The familys current intervention in eradicating the problem is by drinking boiled Oregano leaves. Though Oregano is not one of the ten recommended herbal medicine of the DOH; it is still proven to be safe and effective against cough. Family resources: > The familys resource is the herbal medicine Oregano, boiling facilities like casserole, LPG stove among others. Student nurse resources: > The primary resource that the student nurses can give to the family is health teachings. The student nurses can teach the family about interventions to prevent the presence and the
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re-occurrence of the problem like proper hygiene and protection. Community Resources: > The community can have a backyard herbal planting to prevent large cost of factorymanufactured medicines. They can plant lagundi and oregano.

3. PREVENTIVE POTENTIAL 3=High 2=Moderate 1=Low

Severity Duration Current Management High -risk Group

2/3 X 1=

0.67

The problem has moderate preventive potential due to the following criteria: Severity of the problem: > The problem is severe because it is aggravated by poor ventilation and inadequate living space. There is the presence of cross-infection between the family members. Duration of the Problem: > The problem of cough and cold is intermittent and is not present every day because of the familys intervention. . Current Management: > The familys current management is by boiling Oregano. According to different research sites, Oregano is indeed use in treating cough.

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Exposure group:

of

high-risk

> Only three among the seven members living in the house had acquired such condition so the potential of the problem to be prevented is increase. 4. SALIENCE 2 = A serious problem needing immediate attention 1 = A problem not needing immediate attention 0 = Not perceived as a problem TOTAL SCORE 4.17 1/2 x 1= 0.5 The family is aware of the existence of the problem but doesnt need any immediate attention to this problem. They are aware of the problem as evidence by the presence of interventions like boiling Oregano leaves.

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Problem # 3.5: Family Size beyond what family resources can adequately provide
CRITERIA COMPUTATION SCORE JUSTIFICATION

1. NATURE OF THE PROBLEM 3 = Health deficit 2 = Health threat 1 = Foreseeable crisis

2/3= X 1

0.67

The problem is a health threat, inadequacy of the family resources to suffice their daily needs may result to serious health problems if not corrected e.g. malnutrition which is now actually evident in the family since Mango, Banana and Avocado are considered to be undernourished. The family will find it also difficult to manage health problem like buying medications. The problem is partially modifiable for the following criteria: Current technology intervention: knowledge, and

2. MODIFIABILITY OF THE PROBLEM 2 = Easily modifiable 1 = Partially modifiable 0 = Not Modifiable

1/2= X 2

> The family are aware of the problem and they are doing everything they can especially Daddy Apple and Grapes to increase their income. Daddy Apple is extending his working hours. Family resources: > The familys manpower is inadequate since only two of the family is working and the non-working members of the family are still young and still
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studying. While Mommy Orange cant find a job since she is busy providing care to her studying children Student nurse resources: > The Student Nurses can pinpoint some tips on how they are going to minimize their water and electric consumption and enumerate some foods that are nutritious yet cheap which may help in lowering their expenses. Examples of this are: Use fluorescent lamp instead of light bulbs. Close the faucet when not in use Remove or even just decreasing the familys vices like alcohol, cigarette and bingo game. Foods such as vegetables, tofu and the like. Community Resources: > The community has no resources to totally eradicate the problem but they can have seminars to teach the family about proper budgeting, they can also build cooperative to increase the profit of each family. The problem has moderate preventive potential due to the following criteria:

3. PREVENTIVE POTENTIAL

2/3 X 1=

0.67

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3=High 2=Moderate 1=Low

Severity of the problem: > The family's monthly income is small and would not suffice their needs compare with the NEDA prescribed share amount of money that each of the family members must have: NEDA- P2, 768.60 Fruit family has 7 current members-P14,000 (P14,000/7 = P2,000) Duration of the Problem: > The problem of the family existed after the birth of the fourth to sixth child. The problem aggravates because of increase in members of the family. . Current Management: > The family has current management; Daddy Apple is lengthening his working hours to increase his income. Exposure group: of high-risk

> All of the family members of the Fruit Family are exposed to the problem of inadequate resources. .

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4. SALIENCE
2 = A serious problem needing immediate attention 1 = A problem not needing immediate attention 0 = Not perceived as a problem

2/2 x 1=

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

TOTAL SCORE

3.34

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PROBLEM # 3.5 Unhealthful lifestyle and personal practices: Poor personal hygiene
CRITERIA COMPUTATION SCORE JUSTIFICATION

1. NATURE OF THE PROBLEM 3 = Health deficit 2 = Health threat 1 = Foreseeable crisis

2. MODIFIABILITY

2/3 x 1

0.67

The problem is categorized as health threat. Poor personal hygiene may precipitate or predispose the family members to acquire certain diseases if not solved immediately. The problem is easily modifiable: Current technology intervention: knowledge, and

OF THE PROBLEM 2 = Easily modifiable 1 = Partially modifiable 0 = Not Modifiable

Current knowledge, technology and interventions Family Resources SN Resources Community Resources

2/2x2

> Current knowledge and technology in eradicating the problem is present and applicable. Family knows that having poor personal hygiene can lead to different kinds of diseases especially to children. Family resources: > The family has their own toothbrush, toothpaste, soap and soap that they can use to maintain themselves clean. Student nurse resources: > The student nurses are able to provide measures in solving the problem and demonstrate interventions to
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promote good personal hygiene. Student nurse work hand in hand to help the family comply with proper hygiene and must teach the family members on how to take care of the body to promote wellness among its members. Community Resources: > The community health center together the barangay officials implement program, seminars with regards to the proper hygiene to avoid cross contamination of diseases and microorganisms, there are also stores available within the community where they can buy all necessary things they needed to provide the body to be cleansed.

3. PREVENTIVE POTENTIAL 3=High 2=Moderate 1=Low

Severity Duration Current Management High -risk Group

2/3x1

0.67

The problem has low preventive potential due to the following criteria: Severity of the problem: > The problem is severe since all members of the family are seen with untrimmed and dirty fingers which may be a source of different diseases. Duration of the Problem: > The problem exists for a long period of time as evidenced by demonstration
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of poor personal hygiene among members of the family. Current Management: > There is a current management being performed by the family to eradicate the presence of the problem such as taking a bath and brushing their teeth but not on a regularly basis. Other members of the family seldom clean and trim their nails. Exposure group: of high-risk

> Since there is no occurrence of disease caused by poor personal hygiene among family members there is an increased chance in preventing acquisition of diseases. 4. SALIENCE 2 = A serious problem needing immediate attention 1 = A problem not needing immediate attention 0 = Not perceived as a problem TOTAL SCORE 3.34 0/2 x 1= 0 The family perceived the problem as a felt need not requiring immediate change. The family thinks it is normal since they are used to it.

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PROBLEM # 5 Unhealthful lifestyle and personal practices: Walking barefooted

CRITERIA COMPUTATION SCORE JUSTIFICATION

1. NATURE OF THE PROBLEM 3 = Health deficit 2 = Health threat 1 = Foreseeable crisis

2/3= X 1

0.67

The problem is categorized as health threat. The problem imposes risk on children if not resolved immediately. Walking barefooted increase the risk of children to develop parasitism which can eventually lead to malnutrition another is that they might step on some pointed objects which can place them at risk for injury. The problem is easily modifiable for the following criteria: Current technology intervention: knowledge, and

2. MODIFIABILITY OF THE PROBLEM 2 = Easily modifiable 1 = Partially modifiable 0 = Not Modifiable

Current knowledge, technology and interventions Family Resources SN Resources Community Resources

2/2= X 2

> Current knowledge and technology in eradicating the problem is present and applicable. The family is aware of the presence of the problem. Mother instructs children about wearing slippers to avoid accidents and prevent acquisition of dirt but doesnt know that not wearing slippers puts her children at risk for parasitism
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. Family resources: > The family has their own slippers but not usually wearing them when going outside or even when they are inside the house. Mother instructs children about wearing slippers to avoid accidents and prevent acquisition of dirt. Student nurse resources: > The student nurses are able to reinforced to the children the advantage of wearing slippers and encourage them o comply with health teachings given. Student nurses also discussed the consequences of not wearing slippers and encouraged the mother to always keep an eye on her children. Community Resources: > The community health center provides information about disease prevention such as parasitism this also gives information about proper hygiene as part of promotion of health. The problem has moderate preventive potential due to the following criteria: Severity of the problem:
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3. PREVENTIVE POTENTIAL
3=High 2=Moderate

2/3x1

0.67

1=Low
Severity Duration Current Management High -risk Group

> The problem is not severe since all members of the family did not yet experienced presence of severe parasitism. Duration of the Problem: > The problem exists for a long period of time since the toddler years of the children because the members of the family were used not to wear slippers when going outside or even inside the house. Current Management: > There is a current management being performed by the family to eradicate the presence of the problem. Mother instructs her children to wear slippers but since they were not used to it they dont continue to practice it. Exposure group: of high-risk

> All of the children are exposed to the problem and the possible complication that it can bring like parasitism.

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4. SALIENCE
2 = A serious problem needing immediate attention 1 = A problem not needing immediate attention 0 = Not perceived as a problem

1/2 x 1=

0.5

Family perceives the problem but not needing immediate attention since they havent experience any problem such as parasitism or any injury from walking barefooted.

TOTAL SCORE

2.84

Problem # 6: Poor home condition: Inadequate Lighting

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CRITERIA 1. NATURE OF THE PROBLEM 3 = Health deficit 2 = Health threat 1 = Foreseeable crisis 2. MODIFIABILITY OF THE PROBLEM 2 = Easily modifiable 1 = Partially modifiable 0 = Not Modifiable Family Resources Community Resources Student Resources Knowledge, Technology and Interventions to manage the problem

COMPUTATION 2/3 x 1

SCORE 0.67

JUSTIFICATION Inadequate lighting is considered as a health threat because the family could not perform their activities and tasks well due to inadequate lighting during morning and especially at nighttime. The problem is partially modifiable. Current knowledge, technology and intervention: > The family is aware that such problem exists but they cannot do such measures to solve the problem due to lack of financial resources. Family resources:

1/2x2

> Since the family is financially incapable of buying the prescribed bulb to use, they just make use of what they have. Student Nurses Resources: > Through the knowledge and skills, the student nurses provided health teachings such as during daytime to clear curtains so that light may pass. Also they helped family to clear the floor from accidental hazards; they are prone to accidents because they cannot see things clearly. Community resources: > Certain stores in the vicinity sell higher wattage-bulbs that are enough to provide adequate lighting especially at night. But due150 | financial to P a g e constraints, they cannot avail of this.

Problem # 7: Poor home condition: Inadequate living space

CRITERIA COMPUTATION SCORE JUSTIFICATION

1. NATURE OF THE PROBLEM 3 = Health deficit 2 = Health threat 1 = Foreseeable crisis

2/3= X 1

0.67

Inadequate living space is a health threat since it can be a risk for injury especially for Avocado and Banana who love to play and run within the house. The inadequacy of living space is also a threat for communicability of diseases such as coughs and colds.

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2. MODIFIABILITY

OF THE PROBLEM 2 = Easily modifiable 1 = Partially modifiable 0 = Not Modifiable

Current knowledge, technology and interventions Family Resources SN Resources Community Resources

0/2= X 2

The problem is not modifiable for the following criteria: Current technology intervention: knowledge, and

> The family are aware of the problem but dont have any interventions done to manage the problem such as proper positioning and proper number of furniture that must be only allotted to their house. They have no current technology since they only rented their apartment so they cant increase their living space. Family resources: > The family has inadequate financial resources to find for an apartment bigger and more adequate for the number of family members.

Student nurse resources: > The Student Nurses skills and knowledge can help the Fruit family by planning on how to arrange their furniture so that they may increase somehow their living space, at least to minimize the problem if not to fix it totally Community Resources: > The community has

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inadequate resources to manage the problem since most of the houses in Barangay Virgen de los Remedios are inadequate for the number of family numbers. If most of the families in the community have this problem, then the community has inadequate financial supply because of greater cost needed.

3. PREVENTIVE POTENTIAL
3=High 2=Moderate 1=Low
Severity Duration Current Management High -risk Group

1/3 X 1=

The problem has moderate preventive potential due to the following criteria: Severity of the problem: > The problem is considered to be severe AEB after computing the share of each family member on their living space it shows that upon dividing the whole floor area of the Fruit Familys house, each of the family member yields only 1.38 m2 showing that the total floor area of the house is inadequate as to compare with the prescribed by the National Building code of the Philippines R.A 6541 that each of the family must have at least a share of 3 m2, therefore if it will be further divided considering the space occupied by their furniture it will yield a more lower results. Furthermore,
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there is also the communicability of cough and colds among family member. Duration of the Problem: > The problem of inadequate living space has been existing for a long time approximately 26 years after the couple married and transferred to their present house. . Current Management: > The family does not have any current management on their problem regarding Inadequate living space as evidenced by Mommy Orange statement when the student nurses asked her about their management to the problem: wala, wala na sanay na kami. Exposure group: of high-risk

> All of the family members of the Fruit Family are exposed to the problem as they all live on that house except for one member which is Strawberry who separately lives with her own family in Manila.

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4. SALIENCE 2 = A serious problem needing immediate attention 1 = A problem not needing immediate attention 0 = Not perceived as a problem

1/2 x 1=

0.5

Inadequacy of Living Space is viewed by the family as a serious problem. Though this problem needs an immediate action, because the family lacks resources; they treat this problem not needing immediate action.

TOTAL SCORE

2.17

Problem # 8:

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Malnutrition
CRITERIA COMPUTATION SCORE JUSTIFICATION

1. NATURE OF THE PROBLEM 3 = Health deficit 2 = Health threat 1 = Foreseeable crisis 2. MODIFIABILITY OF THE PROBLEM 2 = Easily modifiable 1 = Partially modifiable 0 = Not Modifiable
Current knowledge, technology and interventions Family Resources SN Resources Community Resources

3/3= X 1

Malnutrition is a health deficit because there is already the existence of the problem and failure in maintenance of health even before the entry of the nurses with the family.

1/2= X 2

The problem is partially modifiable: Current technology intervention: knowledge, and

> The family doesnt seem to have knowledge in managing the problem because it is existing for a long time and there seems no improvement of their condition, they dont also know the proper food they can serve to the family. Family resources: > The family has the proper resources because they can buy nutritious yet cheap food like vegetables like malunggay, monggo. Or as substitute for meat the family can buy tokwa. Student nurse resources: > The primary resource that the student nurses can give to the family is health teachings. The student
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nurses can teach the family about proper food to eat without compromising their inadequate financial resource. Community Resources: > The community has adequate financial resources and Barangay Virgen de los Remedios has a small population for them to have feeding programs and deworming especially for the children. The health center can allocate micronutrient supplementation to the children to supply their inadequacies. The problem has low preventive potential due to the following criteria: Severity of the problem: > The problem is severe because three of the family members are below normal values which can affect their mental status in school while Mommy Orange is overweight which can be a risk for hypertension and other cardiovascular diseases. Duration of the Problem: > The problem of malnutrition for the children has long been existed since their earlier years. While Mommy Oranges problem started
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3. PREVENTIVE POTENTIAL 3=High 2=Moderate 1=Low

Severity Duration Current Management High -risk Group

0/3 X 1=

since she gave birth to her second child 20 years ago. . Current Management: > The family has no current management to solve this problem. The student nurses havent seen any vegetable or any nutritious food in the familys home. The children are also walking barefooted which can be a cause of infestations of worms that can aggravate the problem. Exposure group: of high-risk

> This factor lowers the preventive potential of the problem for the family since four of them are already malnourished. The number of family members acquiring the condition is greater than those who did not acquire the said condition 4. SALIENCE 2 = A serious problem needing immediate attention 1 = A problem not needing immediate attention 0 = Not perceived as a problem TOTAL SCORE 2 0/2 x 1= 0 The family is unaware of the problem and even though the student nurses told them their problem they dont seem alerted with the complication and the condition itself.

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Problem # 9: Unhealthy lifestyle: Cigarette Smoking

CRITERIA COMPUTATION SCORE JUSTIFICATION

1. NATURE OF THE PROBLEM 3 = Health deficit 2 = Health threat 1 = Foreseeable crisis

2/3 x 1

0.67

The problem is considered as a health threat since smoking can greatly affect the health of other members of the family. Cigarette smoking contributes to a remarkable number of diseases, including coronary heart disease, stroke, chronic obstructive pulmonary disease, peripheral vascular disease, peptic ulcer disease, and many types of cancer. The problem modifiable. Current technology intervention: is not

2. MODIFIABILITY OF THE PROBLEM 2 = Easily modifiable 1 = Partially modifiable 0 = Not Modifiable

Current knowledge, technology and interventions Family Resources SN Resources Community Resources

0/2 x 2

knowledge, and

> The family is aware of the problem but they opt not to change or do something about it. They are also not knowledgeable about the conditions that can be acquired because of it. Family resources: > Daddy Apple and Mommy Orange are the smokers in the family. They do not have any resources in solving the problem because they lack
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the initiative to change this habit. Furthermore, they are not aware of the possible health consequences of smoking. Student nurses resources: > Student nurses knowledge about smoking can be considered as student resources since they can share to the family what smoking is and its complications. Health teachings can be provided by the student nurses. Community resources: >The community does not have any resources which can help the family solve the problem. There are no programs or seminars regarding the effect of smoking in ones health.

3. PREVENTIVE POTENTIAL 3=High 2=Moderate 1=Low Severity Duration

1/3 x 1

0.33

The problem has preventive potential. Severity of the problem:

low

> The problem is severe because both the father and the mother are affected. Mommy Orange verbalized that Daddy Apple has cough which further aggravate the possibility of acquiring
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Current Management Presence of High risk groups

communicable diseases within the family because the other children also developed cough. Duration of the problem: > The problem has long existed inside the family, since Daddy Apple started to smoke when he was 15, and Mommy Orange started to smoke when he was 17. Current Management: > There was no current management noted. Both dont have any interventions or apt measures to remove their smoking habit. Presence groups: of High Risk

> The whole family is at risk for developing illnesses, particularly respiratory illness since they are living in the same house and they can inhale the smoke. 4. SALIENCE 2 = A serious problem needing immediate attention 1 = A problem not needing immediate attention 0 = Not perceived as a problem 1/2 x 1 0.5 The family recognizes it as a problem but not needing immediate attention.

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TOTAL SCORE

1.5

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V. Family Nursing Care Plan Problem # 1 Presence of Breeding Sites of Vectors of Diseases

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Cues

Analysis of the problem Inability to provide a home environment conducive to health maintenance due to:

Objectives

Interventions

Rationale

Method of Family Contact H O M E V I S I T S

Resources Required Family Resources: >Manpower resources such as time and effort >Financial resources Student Nurses Resources: >Knowledge and health teachings in proper sanitation and precautionary measure in using pesticide

Expected Outcome Short-term: The family shall have verbalized the importance of a clean environment and the riskfactors of the presence of vectors.

S> madami mga ipis dito, pati lamok, buti nga yung mga daga nabawasan

Short term: After 2 hours of nursing intervention, the family will be able to verbalize the O> Presence importance of of a clean mosquitoes a. Failure to environment in the see benefits and the riskbathroom. factors of the b. Inadequate presence of > Presence knowledge of vectors. of importance of cockroaches sanitation. especially Long term: below the c. Lack of skill After 2-3 cabinet. in carrying out home visits, measures to the family will improve home be able to environment. participate in the cleaning of their environment to prevent multiplication of the vectors.

> Assess the presence of vectors > Encourage to check the every corner of the house > Encourage to use properly the insecticide > Provide health teachings to the family about the proper use of insecticide. > Encourage to eat nutritious food especially food rich in Vitamin C > Evaluate the familys reaction about the health teachings.

>To provide appropriate interventions >To prevent the generation time of the vectors >To prevent the vectors from multiplying >To prevent poisoning and further problems to arise.

> To increase their immune system and to protect their selves from having disease >To measure if the family understands the health teachings presented.

Long Term: The family shall have participated in the cleaning of their environment to prevent >Community multiplication resources: of the Seminars and vectors. programs . about proper sanitation.

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Problem # 2: Presence of Cough and Colds

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Cues

Analysis of the problem Inability to provide adequate nursing care to the sick, member of the family due to:

Objectives

Interventions

Rationale

Method of Family Contact H O M E V I S I T S

Resources Required Family Resources: >Manpower resources such as time and effort >Herbal medicines Student Nurses Resources: >Knowledge and health teachings in proper prevention of the occurrence and reoccurrence of cough and colds. >Community resources: Backyard Herbal planting of Lagundi to manage the high cost of factorymedicines.

Expected Outcome Short-term: The family shall have understood the disease itself and the mode of transmission.

S> ayan, yung madalas nilang sakit, ubo tsaka sipon as verbalized by Mommy Orange O>two of the family members (Banana and Avocado) have nasal discharges, cough and colds >Bananas vital signs: T: 35.9 C RR: 20 cpm PR: 85 bpm >Avocados vital signs: T: 36.5C PR: 72 bpm RR: 28 cpm

Short term: After 2-3 hours of nursing intervention, the family will be able to understand a. Inadequate the disease knowledge itself and the about the mode of severity, transmission. complications, prognosis of the condition. Long term: After 2 home b. Inadequate visits, the knowledge of family will be the nature and able to extent of demonstrate measurements nursing care to prevent the needed disease from worsening c. Inadequate family resources for care, specifically: lack of physical resources and financial constraints.

> Assess > To provide presence of appropriate coughs and interventions colds > Explain what is cough and colds > For the family to understand further the meaning of the disease and the mode of transmission

> Encouraged > It helps increase fluid loosening intake secretions > Encourage to eat nutritious foods especially foods rich in Vitamin C > Encourage to cover mouth and nose when sneezing > Encourage not to share clothing > to increase bodys resistance and immune system . > To prevent transmission of
microorganisms

Long Term: The family shall have demonstrated measurement s to prevent the disease from worsening.

> Because it is an easy way for the microorganism s to transfer. >To measure

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> Evaluate the

Problem # 3.5 Family size beyond what family resources can adequately provide

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Cues

Analysis of the problem Inability to make decisions with respect to taking appropriate health action due to:

Objectives

Interventions

Rationale

Method of Family Contact H O M E V I S I T S

Resources Required Family Resources: >Manpower resources such as time and effort Student Nurses Resources: >Knowledge and health teachings in proper management of allotted financial resources. Skills, time and effort. >Community resources: Seminars about proper management of resources.

Expected Outcome Short-term: The family shall have verbalized their emotional competence in their exposure of the problem.

S>

Short term: After 2 hours O> The of nursing family's intervention, monthly the family will income is be able to small and verbalize would not their suffice their emotional needs a. Feeling of competence compare with helplessness in their the NEDA brought about exposure of prescribed by perceived the problem. share magnitude of amount of the problem. money that Long term: each of the b. Lack of After 2 home family insight as to visits, the members alternative family will be must have: courses of able to action open to verbalize and NEDA- P2, them demonstrate 768.60 proper use Fruit Familyand P14,000 budgeting of available (P14,000/7 = financial P2,000) resources >the familys expenses is estimated 13, 500. Therefore the family only has 500 Php savings per month.

> Explore the familys perception of the severity of the problem > Pinpoint some tips on how they are going to minimize their water and electric consumption and enumerate some foods that are nutritious yet cheap which may help in lowering their expenses. Examples of this are: 1. Use fluorescent lamp instead of light bulbs. 2. Close the faucet when not in use 3. Remove or even just decreasing the familys vices like alcohol, cigarette and

> To evaluate how the familys emotion is affected by the problem. > To lessen the familys expenditures and to allocate the financial resources to only important things.

Long Term: The family shall have verbalized and demonstrated proper use and budgeting of available financial resources.

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Problem # 3.5 Unhealthy Lifestyle and Personal Habits: Poor Personal Hygiene

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Cues

Analysis of the problem >Inability to recognize presence of problem due to lack of adequate knowledge >Inability to make decisions with respect to taking appropriate health actions due to failure to comprehend the nature, magnitude and scope of possible consequences of the problem

Objectives

Interventions

Rationale

Method of Family Contact H O M E V I S I T S

Resources Required Family resources: >Manpower resources: trust and openness to nursing interventions Cooperation health teachings given >NonHuman resources: soap shampoo nail cutter toothbrush toothpaste towel comb Student nurses resources:: Therapeutic communicati on Time and effort and knowledge about

Expected Outcome Short-term: After 2-3 hours of home visit, the family shall have able to verbalized
understanding

S> pag minsan kasi nakakalimuta n kasi nila na putulan yung mga kuko nila kahit mahaba na As verbalized by the Mommy Orange O>Untidy look of the member of the family >Having long and dirty fingernails on both hands and feet

Short-term:

> Assessed each member After 2-3 of the family hours of regarding home visit, personal the family will hygiene be able to verbalize >Educate the understanding family about on proper the hygienic importance of measure to personal maintain hygiene and healthy ways to lifestyle. promote good personal hygiene Long-term: >Explain the After 3 days consequences of home that they can visits, the get with poor family will be personal able to hygiene manifest progress >Initiate the regarding the maintenance right practice of proper of having hygiene proper among the hygiene family members >Instruct the family to clean their nails when nails are long

>To gather baseline data needed for planning implementation >For the family to gain knowledge about practice of good hygiene and gain their participation

on proper hygienic measure to maintain healthy lifestyle. Long-term: After 3 days of home visits, the family shall have manifested progress regarding the right practice of having proper hygiene

>Increase familys awareness

>Motivate the mother to take the responsibility of grooming her children >Prevent microorganism s to stay in nails which may cause diseases

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Problem # 5 Unhealthful lifestyle and Personal Habits: Walking Barefooted

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Cues

Analysis of the problem >Inability of the family to recognize presence of problem due to a. lack of adequate knowledge. b. failure to see the complication of the problem.

Objectives

Interventions

Rationale

Method of Family Contact H O M E V I S I T S

Resources Required Family resources: trust and openness to nursing interventions Cooperation on health teachings given >NonHuman resources: slippers Student nurses resources: Therapeutic
communication

Expected Outcome Short-term: After 2-3 hours of home visit, the family shall have verbalized
understanding

S> Sinasabihin ko nga sila na magsuot ng tsinelas pero nasanay na kasi sila kaya minsan wala sila tsinelas pag nasa labas ng bahay As verbalized by the Mommy Orange O>The group noticed that the children do not wear slippers when walking outside the house

Short-term: After 2-3 hours of home visit, the family will be able to verbalize
understanding

> Assessed family knowledge about the severity of the problem >Discuss the importance of wearing slippers

> To gather

baseline data needed for planning implementation

>Proper

on how to abide with simple instructions. Long-term: After 4-5 days of home visits, the family will strictly abide with the simple instructions that the group have provide and will be fee from the risk of parasitism.

wearing of slippers will lessen the occurrence of soil transmitted helminthiasis > So that they will be encourage to wear slippers all the time >If the mother will take a look always if the children are wearing slippers. They will practice it as a habit. > The health center may provide information about the disease prevention

on how to abide with simple instructions. Long-term: After 4-5 days of home visits, the family shall have strictly abided with the simple instructions that the group have provide and will be fee from the risk of parasitism

> Explain the consequences that they can get with of walking barefooted. > Encourage mother to always have an eye to the children so that they will abide with wearing slippers >Suggest to go to health center

Time and effort and knowledge about possible consequenc es of the problem

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Problem # 6 Poor Home Condition: Inadequate Lighting

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Cues

Analysis of the problem > Inability to provide a home environment w/c is conducive to health maintenance and personal development due to:

Objectives

Interventions

Rationale

Method of Family Contact H O M E V I S I T S

Resources Required >Knowledge, time and perseverant of student nurses.

Expected Outcome

S> Medyo madilim ang bahay namin, as verbalized by the mother. O> Only 2 light bulbs were used by the family; each for the living room and another in the bedroom each having only 10 watts.

Short term: After 3 hours of home visit, the family will be able to recognize importance of having adequate lighting.

>Assess lighting Condition >Discuss to family the importance of having adequate lighting

>To have a baseline data > To make the family aware that good lighting can make their activities of daily living easier

Long term: a. Inadequate After 3-4 family days of home resources visits, the specifically family will be financial able to constraints comply w/ the health b. Lack of reaching > Windows adequate given as are blocked knowledge in evidenced by by curtains the importance opening of and there is a of having the windows house in front adequate of their house lighting w/c blocks the sunlight. c. Lack of knowledge > No regarding the fluorescent or effect and any bulb light importance of inside the lighting comfort room.

> Help and > To promote assist family to passage of open window. light > Encourage family to avail bulb >Clean the light bulbs >To allow for proper lighting > To allow adequate supply light inside

Short term: After 3 hours of home visit, the family shall have > Familys recognized understanding the , cooperation importance of and having participation adequate and their lighting financial resources Long term: After 3-4 days of home visits, the family shall have complied with the health teachings given as evidenced by opening of their windows

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Problem # 7 Inadequate Living Space

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Cues

Analysis of the problem Inability to provide a home environment conducive to health maintenance and personal development due to:

Objectives

Interventions

Rationale

Method of Family Contact H O M E V I S I T S

Resources Required Family Resources: >Manpower resources such as time and effort Student Nurses Resources: >Knowledge and health teachings in proper nutrition. Skills, time and effort.

Expected Outcome Short-term: The family shall have verbalized the importance of adequate living space and the hazards that a poor space can give.

S> pasensya na maliit ang bahay namen O> upon dividing the whole floor area of the Fruit Familys house, each of the family member yields only 1.38 m2 showing that the total floor area of the house is inadequate as to compare with the prescribed by the National Building code of the Philippines R.A 6541 that each of the family must have at least a share of 3 m2, >presence of too many furniture compare to

Short term: After 2 hours of nursing intervention, the family will be able to verbalize the importance of adequate living space and the a. Inadequate hazards that family a poor space resources, can give. specifically: 1. financial constraints Long term: 2.lack of space After 2 home to construct visits, the facility family will be able to b. Failure to demonstrate see benefits of proper investment in arrangement home of furniture to environment lessen their improvement. problem of inadequate c. Lack of skill living space. in carrying out measures to improve home environment.

> Explore the familys perception of the magnitude of the problem. > Provide general knowledge on how communicable diseases could be easily transmitted in a limited space. > Assist the family in arranging and organizing their things such as furniture and appliances. > Advise the family to remove things that are unnecessary and not needed. > Evaluate the familys reaction about

> to analyze how far the family is affected with the problem. > to increase the familys awareness of the problem and to provide them the importance of having an adequate living space. > To maximize the space of house.

Long Term: The family shall have demonstrated >Community proper resources: arrangement Seminars of furniture to about how to lessen their maximize problem of the allotted inadequate living space. living space.

>To lessen the waste and obstruction causing inadequate space.

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>To measure if the family

Problem # 8: Presence of Health Deficit: Malnutrition

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Cues

Analysis of the problem Inability to make decisions with respect to taking appropriate health action due to:

Objectives

Interventions

Rationale

Method of Family Contact H O M E V I S I T S

Resources Required Family Resources: >Manpower resources such as time and effort >Financial resources Student Nurses Resources: >Knowledge and health teachings in proper nutrition. Skills, time and effort. >Community resources: Deworming, feeding programs and seminars in preparing nutritious and cheap meals.

Expected Outcome Short-term: The family shall have recognized the importance of nutrition, proper eating habits.

S>

Short term: After 2 hours O>BMI of the of nursing following intervention, family the family will members: be able to recognize the >Mommy importance of Orange: nutrition, 23.66 kg/m2 a. Failure to proper eating (overweight) comprehend habits. the nature and >Mango: magnitude of 18.47 kg/m2 the problem. (underweight) Long term: b. Low After 2 home >Banana: salience of the visits, the 12.5 kg/m2 problem family will be (underweight) able to c. Fear of demonstrate >Avocado: consequences effectively 13.16 kg/m2 of action, and in (underweight) specifically: consistency economic how to consequences prepare cheap but nutritious food, proper interventions to prevent aggravation of the problem.

> Explore the salience of the family and how much they are alerted with the problem.

> to obtain a baseline data so the student nurses can prepare appropriate health teachings based on the familys perception of the problem. > to increase the familys awareness and importance in proper nutrition > To allocate nutritious foods without suppressing the familys budget for food. >To inform the family that they can have proper nutrition from food without suppressing their income. > To prevent aggravation of the problem such as

> Discuss with the family the possible complication of malnutrition > Ask the family about their budget for food

> Inform the family about nutritious but cheap food like malunggay, monggo and tokwa. > Teach the family about proper precautions

Long Term: The family shall have demonstrated effectively and in consistency how to prepare cheap but nutritious food, proper interventions to prevent aggravation of the problem. .

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Problem # 9 Unhealthful lifestyle and Personal Habits: Cigarette Smoking

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Cues

Analysis of the problem

Objectives

Intervention s

Rationale

Metho d of Family Contac t H O M E V I S I T S

Resources Required

Expected Outcome

S> 15 palang naninigarilo na asawa ko pati ako nagsimula ako manigarilyo nung 17 ako;as verbalized by Mommy Orange O> >mother was seen smoking upon entry of the student nurses in their house > a pack of cigarette was seen in the living room >Mother has dark brown gums and yellowish teeth. >Smell of a smoke was noted inside the house >pack years= (Number of stick per day/ 20) multiplied by the number of years

VI. Family Coping Index > Inability to Short Term: make decisions After 3 with respect hours, of to taking home visit, appropriate Mommy health action Orange will due to verbalize addiction the effects caused by of smoking chronic and second smoking hand habits smoking. Long Term: After 3-4 days of home visits, Mommy Orange will be able to share her understandi ng about the effects of smoking to Daddy Apple and will reduce her craving to cigarettes.

> Check the lifestyle and personal habits of each member of the family > Discuss with the family the side effects of cigarette smoking

> To determine if they have healthful lifestyle and personal practices > To make each members of the family be aware of the bad effects of smoking, especially in their health status. >To prevent further complications of smoking

Family Resources: >Manpowe r resources such as time and effort >Financial resources Student Nurses Resources: >Knowledg e and health teachings about the dangers of smoking >Communit y resources: Seminars about the effects of smoking in the human body.

Short term: After 3 hours, of home visit, Mommy Orange shall have verbalized the effects of smoking and second hand smoking. Long Term: After 3-4 days of home visits, Mommy Orange shall have shared her
understandin g about the

> Encourage mother to reduce her cravings to cigarettes and advise her to challenge her husband to reduce cigarette intake. > Instruct the family to eat nutritious foods and to have regular exercises everyday >Instruct the mother to gradually withdraw from smoking > Encourage diversion

>To reduce the risk of having heart diseases and high blood pressure brought about by smoking > To avoid withdrawal symptoms.

effects of smoking to Daddy Apple and shall have reduced her craving to cigarettes.

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> To divert their attention away from

Initial Visit CRITERIA 1 3 5

Final Visit 1 3 5 JUSTIFICATION

1. PHYSICAL INDEPENDENCE

At the Initial Home Visit, the Physical independence of the family was scored as 3 for the following reasons: All family members including the children can get in and out of their bed, they can walk without any support person or equipment. However Avocado, does not know how to bath on her own. And Mrs. Orange is very busy doing household chores to compensate for her daughter.

At the final home visit, the Physical Independence of the family was scored as 5 for the following reasons: all family members especially the children can walk and act on their own without any support. After the student nurses interventions, Avocado can illustrate proper bathing techniques one step at a time like proper use of the soap, shampoo and toothbrush.

Initial Visit

Final Visit
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CRITERIA

JUSTIFICATION

2. THERAPEUTIC COMPETENCE

At the initial home visit, the Therapeutic Competence of the family was scored as 3 for the following reasons: The family use interventions in treating certain conditions. They are using herbal medicines like Sambong, Pandan ang Ugat ng Ilib for kidney problems; Oregano for cough and colds. The uses of some of these medicines are appropriate. However, they do not do some precautions to prevent the re-occurrence of such condition. The group saw Mango, Watermelon, Mango, Banana and Avocado walking barefooted, eating using their dirty hands which can promote infections. After the final home visit, the Therapeutic Competence of the Family was still scored as 3 for the following reasons: The family is now doing some precautionary measures to prevent diseases like their now walking with slippers on. However, the student nurses have known that they drink factory manufactured medicines without any prescription from the doctor. The proper use of medicine to a specific disease needs further instruction from the HCP. Initial Visit Final Visit
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CRITERIA

JUSTIFICATION

3. KNOWLEDGE OF HEALTH CONDITION

At the initial home visit, the Knowledge of the Health Condition of the family was scored as 3 for the following reasons: they know some salient facts about some of their disease experienced well enough to take interventions necessary. However, Mrs. Orange does not know that 2 of her children (Avocado and Banana) are underweight and doesnt seem to be alerted with the possible complication of malnutrition. At the final home visit, the Knowledge of Health Condition was still scored as 3 for the following reasons: after knowing that some of the children are malnourished, Mommy Orange doesnt still seem to see this as a major problem. The family doesnt much give importance to proper nutrition. The Children are still insisting to eat junk foods and drink carbonated beverages which are unhealthy especially for Avocado, Mango and Banana who are undernourished.

Initial Visit

Final Visit
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CRITERIA

JUSTIFICATION

4. APPLICATION OF PRINCIPLES OF PERSONAL AND GENERAL HYGIENE

At the initial home visit, the Application of Principles of Personal and General Hygiene were scored as 1 for the following reasons: All children have very dirty clothes, unkempt appearance and dirty nails. Their pet which is a cat is sleeping in their bed, this could result to lice transmission and allergic reaction to cats fur. Their toilet is also the site where they wash their dishes which could result to cross contamination of bacteria. At the final home visit, the Application of Personal and General Hygiene were scored as 3 for the following reasons: there is the improvement in the appearance of the Family, they dress are clean and neatly. Their nails are clean and trimmed. Their walking with slippers on. But these improvements need consistency. The only problem which seems to be difficult to solve for them is their washing of dishes in the comfort room.

Initial Visit

Final Visit
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CRITERIA

JUSTIFICATION

5. HEALTH CARE ATTITUDES

At the initial home visit, the Health Care Attitudes of the family was scored as 3 for the following reasons: they accept health care in some degree but with reservations. Example to that is their use of quack doctors in treating fever; they will only go to the doctor if the symptoms did not subside. In short, they assume doctors and health center only as a second choice in treating their condition. And one more thing, they seem not to care much on their dental care. At the final home visit, the Health Care Attitudes of the family was still scored as 3 for the following reasons: their problem of dental carries is slowly degrading because of the student nurses interventions. The children have learned how to use their toothbrush and what is the proper brushing of teeth. However, no change in score given, because their first priority to go when disease occurs are still quack doctors because of low cost.

Initial Visit

Final Visit
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CRITERIA

JUSTIFICATION

6. EMOTIONAL COMPETENCE

At the initial home visit, the Emotional Competence of the family was scored as 1 for the following reasons: Daddy Apple is relieving the stresses of their life by drinking alcohol. While Mommy Orange plays Bingo to forget her problem. Mommy Orange is lacking some sort of responsibility because she leaves her children unattended. Mango lacks emotional calmness because he frequently scolds his younger siblings and his temper is a bit short. Avocado which is already 6 years old still drinks from a bottle. At the final home visit, the Emotional Competence of the family was scored as 3 for the following reasons: the group has seen Mango to be more calm and hospitable in his attitude towards the student nurses and especially to his siblings. The group had practice Avocado not to drink from her bottle. It is was only scored as 3 because Mommy Orange finds quitting cigarette smoking a hard task and needs further interventions from student nurses and longer home visits to alleviate that problem. Initial Visit Final Visit
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CRITERIA

JUSTIFICATION

7. FAMILY LIVING PATTERNS

At the initial visit, the Family Living Patterns of the family was scored as 1 for the following reasons: the children do not want to go to school that day and yet the mother didnt motivate them the importance of schooling. Banana, Avocado and Mango do not want to take a bath because of the cold water but the mother does not do interventions to solve this problem. One more thing, the activities of each family member is different from the other so they dont have much time to get along with each other. At the final home visit, the Family Living Patterns of the family was scored as 3 for the following reasons: the family has shown the group how they go along with each other. There is no sense of tension felt between the family members. Mommy Orange do interventions to the children to take a bath like boiling the water. The degree of respect of some of the children for Mommy Orange is high except for Mango who doesnt seem to follow his mothers advices. Initial Visit Final Visit
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CRITERIA

JUSTIFICATION

8. PHYSICAL ENVIRONMENT

At the initial home visit, the Physical Environment of the family was scored as 1 for the following reasons: there is the presence of health hazards like their LPG tank is near their bed. They have poor ventilation because they do not have windows. They have poor lighting. There is no play space for the children except the streets. There is the presence of vectors of diseases like mosquito and cockroaches. At the final home visit, the Physical Environment of the family was scored as 3 for the following reasons: the presence of poor lighting and poor ventilation is not solved because of the congestion of the familys home. However, the problem of dirty home is alleviating through the student nurses intervention and health teachings. The presence of vectors of diseases is managed by insecticides. The student nurses imparted health teachings to the family for proper use of insecticides.

Initial Visit

Final Visit
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CRITERIA

JUSTIFICATION

9. USE OF COMMUNITY FACILITIES

At the initial home visit, the Use of Community Facilities of the family was scored as 3 for the following reasons: they have utilized the health center well especially for Mrs. Orange whom she uses for her past prenatal checkups; she also attends mother class conducted by nurses. However, the other family members dont seem to be cognizant with different community facilities; what they are only utilizing is their school. They dont know about the other facilities of the community like the barangay hall for counseling when the family has problems. The Use of Community Facilities was scored as 5 for the following reasons: the family is very cooperative to the communitys facilities evident to that is their presence in the mothers class conducted by the student nurses. Through the interventions of the student nurses, they also become cognizant of the facilities that the barangay hall can offer.

VII. LEARNING DERIVED:

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I personally learned the importance of the family in the society, as the basic unit of the society, it is important to maintain the health of the family. Comparing the family with the human body, as when one part of the body is infected, later on the whole body will be affected systemically, just like with the family and society, when a family is considered ill, later on the society will be systemically affected.

I also learned the importance of good communicating skill. With the absence of a good communicating skill the student nurse will not be able to establish rapport with his/ her client, thus affecting the assessment process, making the problem identification and prioritization be difficult, thus, altering the maximum care you may give to the family.

Assessment is the very crucial part of doing the family case analysis, with all the data that you will gather throughout the assessment process, there you will derived the problems you will intervene to correct this problems.

The most important thing that a student nurse must have is the initiative, time, effort, and patience, without those things you will not be able to gather all the information you need, the clients cooperation and compliance is also a vital ingredients for the success of making a family case analysis.

- SUNSHINE ARIZALA

LEARNING DERIVED:
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Before the actual encounter between the student nurses and the family, I always find doing Family Case Analysis as non sense and boring. But doing the FCA for the second time makes me realize more that the main purpose of this project is touching lives. I never expect that I will enjoy doing Family Case Analysis, but I did. Ive learned different values. In finding for the data to be gathered in our family case analysis, I learned teamwork. You cant do all things on your own. You have to cooperate to your group mates to occupy what you lack of. In dealing with our family you must show empathy. You must be in their foot to realize what they feel. Developing a good working relationship is important to elicit quality exchange of information. At the start I assumed that this was just a task. But at the end of the day you will realize that you have not lost anything instead you have gain a lot. You have gain lessons and realization that will remain in your heart for a long time. Socially, we were able to develop better therapeutic communication skills, physically, we finally had time to exercise by going up to the familys house, psychologically, we used our minds to come up with possible writings and emotionally, we learned how to be thankful of what we have and share our blessings with other people who are in need.

- JOHN AUFER D. DAVID LEARNING DERIVED:

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We all know that the Family is the Basic need of Society, meaning if there is no Family, there is no society. We never expected to learn this much from a family whom were just strangers at one point as well as from one another.

This FCA proved to show that this isnt just a report that is required to pass. But a report where you get so caught up and so involved, you tend to find yourself understanding the real reason. This project has given us the meaning why communication and interacting is so important. Communicating takes place so much in everyday life but this time it felt different. Those words became actions and actions made a difference.

The Family Case Analysis has taught us so many things. It taught us how to really get involved in work, and take it seriously and of course emotionally. You cannot just work without any feelings, what would that make you, numb? We all wanted to be a reason for hope for a better life of this family and that being too serious isnt enough, loving and enjoying what you are doing will make the work more meaningful. We all struggled to make this report possible but if you look deeper, this just proves to show that cooperation, dedication and unity were combined.

- KRISTEL PAULA DELA PEA

LEARNING DERIVED:

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The community is just not a place where they live in, but a place where many people are affected as one and being there with the family made us feel that we too gained something

We learned that there are a lot of people who are less fortunate and health education can teach them important information to help prevent certain infections, diseases or unwanted outcomes. We can make a difference in peoples actions and it is possible to change the way they perceive life.

With this report, it enhanced our social skills, and getting all the information weve acquired showed that we can get along with people. How many people can go up and ask all these questions, not to mention when some of them are very personal. We were able to gain the familys trust, and that gave us a plus factor feeling knowing that were doing a good job with them, and that they enjoy our company.

- MA. TIFFANY FLORES

LEARNING DERIVED:

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Community exposure has given me a lot of realizations in life. This exposure needs a lot of energy, both mentally and physically. This exposure was really tiring in which we have realized that community health nursing is one of the most tiring aspect of nursing. This exposure has strengthened the bond within our group and especially with the family. Rapport was built within us, likewise within the family which is important in community health nursing to elicit exchange of quality information.

After the exposure, we realized that we are fortunate; we can eat three full meals a day plus the in-between snacks while they cant even have a full meal. We can buy whatever we want even if we dont really need it while they cant even buy all their necessities. We have this much while they have that little but still they learn to live contented, we realized that we almost always take things for granted which should not be.

- ERIKA JOY ISIDRO

VIII. SOCIOGRAM

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

NURSES

MEASUREMENT SS

FAMILY

VITAL SIGNS TAKING

INTERVENTIONS

HEALTH TEACHINGS

HEALTH ASSESSMENT

FIRST HOME VISIT

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The group visited the family and introduces their selves to the family. The student nurses were able to established rapport with the family and started their tasks. The group first assessed the health status of each family member. Then the group assessed for their initial vital signs. While assessing for their Vital signs someone in the group assessed for the Fruit Familys house, and its conduciveness for health.

SECOND HOME VISIT

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On the second home visit the group brought a breakfast for the Fruit family as one of their interventions. In addition, the group also took the measurement of the house like total floor area, window opening and door opening. The group also advise the children especially Avocado the importance of proper hygienic care. THIRD HOME VISIT

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On the third home visit the group performed their final assessment to the family. The group also performed interventions like cleaning the house, sweeping the floor, bathing the children, washing the dishes. And as a token of appreciation, the group gave them some things that they can use for their house.
IX. SPOT MAP and TOTAL FLOOR AREA

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WIDTH= 90 INCHES

L E N G T H = 1 6 6 I N C H E S

WI DT H= 41 INC HE S

C.R.
LENGTH= 46.2 INCHES WIDTH= 26 IN

WIDTH= 23 INCHES L= 44 INC HES

WINDOW

L= 70 IN C H E S

DOOR

TOTAL FLOOR AREA

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X. DOCUMENTATION

THE FRUIT FAMILY (Mommy Orange, Mango, Watermelon, Banana and Avocado)

THE FRUIT FAMILYS HOUSE:

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NURSE-FAMILY INTERACTION:

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ASSESSMENT:

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NURSING INTERVENTIONS:

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XI. BIBLIOGRAPHY

Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing & Childrearing Family 5th ed. Manila: C&E Publishing Inc, 2007

Webber & Kelly Health Assessment in Nursing 3rd ed. Manila: C&E Publishing Inc, 2007

Untalan, A. Concepts and Guidelines in COPAR. 1st ed. Manila: Educational Publishing House, 2005. Maglaya, A. Nursing Practice in the Community. Marikina City: Argonauta Corp., 2004. Cuevas, F. et. al. Public Health Nursing in the Philippines. 10th ed. Manila: C&E Publishing Inc, Handouts in Nursing Care Management 101- Family Nursing Care Plan, Problem Prioritization Handouts in Health Assessment

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