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A FAMILY CASE ANALYSIS
Presented to the College of Nursing
In partial fulfillment Of the requirements in Nursing Care Management 102 – Related Learning Experience
Submitted by N-306/ Group 3
Submitted to Marilyn B. Punsalan, RN, MSN Clinical Instructor
January 15, 2009
I. INTRODUCTION 1. Objectives (student-centered) After 3 weeks of accomplishing the family case analysis, the student nurses shall have: Cognitive: • • • • • • Collected facts regarding the demographic data of the family Performed physical assessment for each member of the family Determined existing problems with the family Formulated nursing diagnosis related to family problems Explained existing problems identified to family Implemented some activities that will make the home conducive for health development and improvement Psychomotor • • Practiced therapeutic communication Gained knowledge as they interact with family
Affective • • • • Introduced to one’s self the family and emphasized the purpose of the home visit in order to establish rapport Built a harmonious working relationship with the family members Discussed the problems identified and pointed out solutions to prevent the problem Perform interventions associated with the diagnosis of the family to promote wellness
2. Entry “What you leave behind is not what is engraved in stone monuments, but what is woven into the lives of others” -Anonymous Simple deeds that are done by student nurses may be left behind or remembered but it won’t mean anything if it didn’t affect the people. It’s hard to change how the world is but trying to improve how one lives and giving hope in little ways can affect the way people choose to live and their perspective in life. For this Family Case Analysis, the mission is not how student nurses are going to help them but it should be how the student nurses are going to help the family help themselves. For this rotation, the Family Case Analysis was conducted in the area of Pandacaqui Resettlement, Mexico, Pampanga specifically in district-5. The researchers had the freedom to choose who the respondent would be as long as it follows the criteria given. Group 3 were clueless of who they were going to interview and render services to since it was their first time being at that community. This may be a way to train the student nurses to give services to people they don’t know and how to earn trust and cooperation by the residents. The criteria that were given for choosing a family for the subjected Family Case Analysis are as follows: The family must consist of at least five members (three children), there must be a member who belongs to the vulnerable groups (pregnant women, children, and old-age adults) and the youngest child must be at least 1 year old. At first, the Group 3 of section N-306 had a prospective family per student. They each interviewed a family and assessed the family members and noted down present problems. Trying to figure out who would best fit the criterions, they discussed their adopted family to the other group mates and mentioned why their family adopted would
be fascinating to study. After talking and analyzing who they should interview, consultation with their instructor occurred. Given the advice of choosing a family with evident health problems and interventions that can be carried out, Group 3 found the family that would be excellent to study and entailed all the criteria, Mr. and Mrs. Cuayan. After the discussion between the researchers, simple preparations such as questions ready written down and reviews of how to do assessment were gathered; they then went to the house of Mr. and Mrs. Cuayan. They saw the children wearing no footwear, shorts, had running nose and the mother pregnant caring an infant. The researchers then without hesitation introduced themselves and stated their purpose. To their surprise, the mother agreed to be the family involved for their Family Case Analysis and showed some interest in learning. All members got up and started doing something. Data collection and assessments were then being started.
II. Family Constellation Name Age Position Sex Civil Status Educational Attainment
High School Under Graduate
Not yet in studying
Not yet studying
III. Health Assessment Mr. Cuayan a. General Description Mr. Cuayan is the head of the family. He has brown skin; his hair is above shoulder, poorly shaved mustache. Upon initial contact, the student nurses observed that the father was hungry because of his work. He is kind and approachable. He wears a blue t-shirt and denim shorts; he does not wear any footwear, or any other accessories. b. Vital Signs Final home visit – January 10, 2009 T: 36.5 °C P: 67 bpm R: 17 bpm BP: 120/70 mmHg (Due to his work, we only met the father once.) c. Physical Assessment Skin • • • • • • Head • • Hair is shoulder length, black and equally distributed With unshaved mustache Dark Brown skin complexion Dry Presence of tattoo on the right lower leg and back Presence of scar on left arm and right leg Dirty and long nails Good capillary refill test (2 seconds)
Eyes • • • • With dark brown iris White sclera Pupils equally round and reactive to light accommodation (PERRLA) With pink palpebral conjunctiva
Ears and Hearing • • • Ears recoils after folding No discharge Without any obstructions
Nose and Sinuses • • • With thick nasal hair No presence of scar No discharge
Mouth and Throat • • • • • Neck • • Breast • Symmetrical in size No masses No presence of swelling With tartar Seven dentures With dark lips With slightly dark pink gums With halitosis
Brown nipple Slightly protruded
Thorax and Lungs • Symmetrical in size
Abdomen • Flat in contour
Upper and Lower Extremities • • • Blood vessels on his arms are prominent Toenails and fingernails are long and dirty Presence of tattoo in the right lower leg
d. Health History
Mr. Cuayan was never been hospitalized. He previously had coughs, colds, fever and diarrhea. When feeling sick, he usually gets enough rest and his wife gave him adequate water. And if illness does not subside in three days, he usually goes to the health center to avail of medicines. Mr. Cuayan is at high risk of having heart disease since hypertension runs in their family. He has allergies on grass and other type of grassy plants. Presently, he has no illness.
e. Growth and Development Mr. Cuayan is twenty-nine years old. Under Sigmund Freud’s Theory of
Psychosexual Development, he is in Genital Stage, wherein his sexual interest should be
matured already and show or establish satisfactory with his opposite sex. The studentnurses think that Mr. Cuayan achieved it. For Erik Erikson’s Theory of Psychosocial Development, he is in the stage of Generativity vs. Stagnation. Generative adult is a type of person that concerned to his own family, community, and country. Due to their situation in life, Mr. Cuayan as we observed is only focusing on his family, on how they survive and give a better life to his family. f. Activities of Daily Living Mr. Cuayan works as a construction worker. He wakes up five in the morning, eats breakfast, takes a bath and goes to work by 7:00 a.m. By eight o’ clock, he arrives at the construction site and works until five in the afternoon with a 1-hour break in between. After work, he then go home and play with his children. Then, he, together with his family, spends the night watching television after dinner and sleeps by ten in the evening. This is Mr. Cuayan’s routine for the whole week except for Sunday which is his only day-off. Mrs. Cuayan a. General Description Mrs. Cuayan is the wife of the head of the family. She has brown skin, her hair is shoulder level, and well combed. Upon initial contact, the student nurses observed that the mother is busy watching her child, because she’s alone at that time. She’ so kind and hospitable, she entertained the different questions that the student-nurses asked. He wears a white t-shirt and denim shorts; she does not wear any footwear, or any other accessories. b. Vital Signs
Final home visit – January 10, 2009 T: 35.3 °C P: 80 bpm R: 21 bpm BP: 90/60 mmHg
c. Physical Assessment Skin • • • • Head • • • Eyes • • • • With dark brown iris White sclera Pupils equally round and reactive to light accommodation (PERRLA) With pink palpebral conjunctiva Hair is shoulder length, black and equally distributed No abnormal palpable lumps Well combed hair Dark Brown skin complexion Dry and warm to touch Clean and short nails Good capillary refill test (2 seconds)
Ears and Hearing • • • • Ears recoils after folding No discharge Without any obstructions Has ear piercing
Nose and Sinuses
• • • •
With thick nasal hair No presence of scar No discharge Symmetrical with the midline
Mouth and Throat • • • • Neck • • • • Breast • • • • Symmetrical in size Brown nipple No palpable Lumps Lactating No masses No presence of swelling No stiffness present No swollen lymph nodes With tartar With dark pinkish lips With slightly dark pink gums With halitosis
Thorax and Lungs • Symmetrical in size
Upper and Lower Extremities • Toenails and fingernails are short and clean
d. Health History Mrs. Cuayan had never been hospitalized or acquired any serious illness in the past except for Urinary Tract Infection. She had experienced simple cough and colds some years ago but was resolved through home remedies such as taking more fluids and citrus fruits and sometimes over-the-counter medicines. At present, she has no known disease. e. Obstetrical History Mrs. Cuayan is 29 years old, within the reproductive age and is still capable of childbearing as evidence by she is pregnant at the moment. According to her, she did not use any family planning method because during those times, it is still not widely known. Her Obstetric score is G4P3 and T3P0A0L3. All of her children were born via home delivery assisted by a midwife. She got pregnant with her first child in the year 2000. By then, she was only 21 years old. She had an initial check up in the public hospital or sometimes in the health center. She gave birth on her first child on the twenty seventh of September. According to her, she really had difficulty on her labor. On her following pregnancies, she no longer experienced difficulty because her labor takes only about 2 to 4 hours. Succeeding deliveries were dated, 2006, and 2007 respectively. All her pregnancies did not have any complications or abnormalities. She strictly adheres to the instructions of the health care providers regarding the proper foods to eat, taking of vitamins and managing stress. She also follows some superstitious beliefs such as eating two bananas that are adjacent will result to twins. Mrs. Cuayan has a regular 28-day cycle menstruation ever since. She had her menarche at the age of 12 or 13 (as far as she can remember).
Immunization Status (Tetanus Toxoid)
f. Growth and Development Mrs. Cuayan is twenty-nine years old. Under Sigmund Freud’s Theory of
Psychosexual Development, she is in Genital Stage, wherein her sexual interest should be matured already and show or establish satisfactory with his opposite sex. The studentnurses think that Mrs. Cuayan achieved it. For Erik Erikson’s Theory of Psychosocial Development, she is in the stage of Generativity vs. Stagnation. Generative adult is a type of person that concerned to his own family, community, and country. Due to their situation in life, Mr. Cuayan as we observed is only focusing on his family, on how they survive and give a better life to his family. g. Activities of Daily Living Mrs. Cuayan starts her day at around Six o’clock in the morning. Upon rising, she will go to buy for their breakfast at the sari-sari store near their house. She will then prepare for their food and also prepare the uniform of her eldest daughter in going to school. After the daughter and her husband had left, she will do her usual routines— washing the dishes, sweeping the floor and washing the clothes (usually every three days) and watching her two children. At around eleven o’clock, she will start to prepare for their lunch. She will serve the lunch at twelve noon. After eating, she will rest for a while together with two children. Upon waking up she will look for merienda for her two youngest children. When the clock strikes at six o’clock, she will then prepare for their dinner. At seven or eight, the family will eat their dinner and watch their favorite primetime show. Mrs. Cuayan, together with her husband sleeps at around ten o’clock after watching TV.
Dipsie a. General Description Dipsie is the eldest child in the family. She has fair skin, her hair is long. Upon initial contact, the student nurses observed that Dipsie was eating. She is kind and shy-type person. She wears a black t-shirt and shorts; she does not wear any footwear, or any other accessories. b. Vital Signs Final home visit – January 10, 2009 T: 36.7 °C P: 71 bpm R: 17 bpm BP: 90/60mmHg
c. Physical Assessment Skin • • • • • Head • • Eyes Hair is long, black and equally distributed Well combed hair Dark Brown skin complexion Dry and warm to touch Dirty and long nails Good capillary refill test (2 seconds)
• • • • • • • •
With dark brown iris White sclera Pupils equally round and reactive to light accommodation (PERRLA) With pink palpebral conjunctiva Ears recoils after folding No discharge Without any obstructions With ear piercing
Ears and Hearing
Nose and Sinuses • • • • With thick nasal hair No presence of scar With nasal discharge Symmetrical in midline
Mouth and Throat • • • Neck • • Breast • • Symmetrical in size Brown nipple No masses No presence of swelling With tartar With pinkish lips With slightly pink gums
Thorax and Lungs
Symmetrical in size Presence of wheezing upon auscultation
Abdomen • Flat in contour
Upper and Lower Extremities • • Blood vessels on his arms are not prominent Toenails and fingernails are long and dirty
d. Health History Dipsie had not acquired any serious disease or illness in the past and had not been confined in a hospital. At present, she is experiencing cough and colds which begun in the last week of December. e. Growth and Development Dipsie is eight years old. assess this. For Erik Erikson’s Theory of Psychosocial Development, she is in the stage of Industry vs. Inferiority. In this stage the children is in the phase of doing things right or observing if what she is doing can give her accomplishment. Dipsie showed some of the characteristics of this phase. Under Sigmund Freud’s Theory of Psychosexual Development, she is in Latent phase, the student-nurses failed to
f. Activities of Daily Living
Dipsie is currently studying, so she wakes up at seven o’clock in the morning and prepares her self going to school. By twelve o’clock she will arrive in their house to eat for her lunch, and goes back in school by one o’clock. That’s her daily routine for Monday to Friday. By Saturday and Sunday she helps her mother in household chores, also in cooking and in taking good care of Po.
Teletubbies a. General Description Teletubbies is the second child of the family. He has fair skin, his hair is blonde and at the shoulder level. Upon initial contact, the student-nurses observed that the child was dirty and that there is presence of nasal discharge. He is kind and approachable. He was wearing a red t-shirt, that alone. He was not wearing any footwear. He was shy and timid. b. Vital Signs First home visit – January 8, 2009 T: 36.7 °C T: 34.9 °C T: 35.6 °C P: 89 bpm P: 87 bpm P: 90 bpm R: 21 breaths/min R: 19 breaths/min R: 20 breaths/min Second home visit – January 9, 2009 Final home visit – January 10, 2009
c. Physical Assessment Skin
• • • • • • Head • Eyes • • • • •
Brown skin complexion Dry and warm Presence of rashes on the hip and buttocks Presence of abrasion on right knee Dirty and long nails Good capillary refill: 2 sec
Hair is shoulder length, blonde and equally distributed
With dark brown iris White sclera Pupils equally round and reactive to light accommodation (PERRLA) With pale palpebral conjunctiva Blurred lenses
Ears and Hearing • • • Ears recoil after folding Presence of dirt and cerumen Late response when being called
Nose and Sinuses • • Presence of discharge, green in color Nasal septum in midline
Mouth and Throat • • • Pink mucous membranes Presence of seventeen teeth Yellowish tooth enamel
• Neck • • • • • Breast • • •
Presence of tooth cavities
Chin can touch the anterior chest No masses No presence of swelling No difficulty in swallowing Lymph nodes not palpable
Symmetrical in size Brown nipples and areola Slightly inverted nipples
Thorax and Lungs • Symmetrical in size
Abdomen • • Round and protuberant Umbilicus in midline
Upper and Lower Extremities • • • Toenails and fingernails are long and dirty Presence of abrasion on right knee Good capillary refill
d. Health History
Teletubbies has allergies to grass and weeds like his father. Presently, he has cough and colds and it has been present since the first week of December. Nasal discharge is already green in color and has a thick consistency. e. Growth and Development Teletubbies is two years of age. Under Sigmund Freud’s Theory of Psychosexual Development, he is on the Anal Stage, wherein his sexual interest should be focused on the anal region and must have begun toilet training which Teletubbies gets interested with. He also shows signs of independence. According to Erik Erikson’s Theory of Psychosocial Development, his developmental task is Autonomy vs. Shame and Doubt wherein he learns to be independent in his own little ways such as buying from the store, eating by himself and taking pride in things he does. f. Activities of Daily Living Teletubbies usually wakes up by seven or eight in the morning and eats breakfast. For the rest of the day he would only be seen playing inside or outside of the house with other children in the neighborhood. He takes a bath with the assistance of his mother by midday, and then sleeps in the afternoon. He wakes up again by three or four and plays again. He takes his meals with his family and eats without his parents’ assistance. After watching television with the whole family in the evening, he sleeps by 8 or 9 p.m. g. Immunization Status VACCINE BCG DPT OPV HEPATITIS B FIRST DOSE SECOND DOSE THIRD DOSE
MEASLES - administered - not administered
Po a. General Description Po is the third child of the family. He has fair skin, his hair is blonde and above the shoulders. Upon initial contact, the student-nurses observed that he was not wearing undergarments and that there is presence of rashes on his hips and buttocks. He was wearing a white sando and had a pacifier put into his mouth. b. Vital Signs First home visit – January 8, 2009 T: 35.7 °C T: 36.5 °C T: 36.6 °C P: 114 bpm P: 110bpm P: 114 bpm R: 20 breaths/min R: 25 breaths/min R: 25 breaths/min Second home visit – January 9, 2009 Final home visit – January 10, 2009
c. Physical Assessment Skin • • • • • Head • Hair-length is above the shoulders, blonde and equally distributed Fair skin complexion Dry and smooth Presence of rashes on the hips and buttocks Dirty and long nails Good capillary refill: 2 sec
Eyes • • • • With dark brown iris White sclera Pupils equally round and reactive to light accommodation (PERRLA) With pink palpebral conjunctiva
Ears and Hearing • • • Ears recoil after folding No discharge Without any obstructions
Nose and Sinuses • • No presence of scar No discharge
Mouth and Throat • • • Neck • • Breast • • • Symmetrical in size Brown nipples and areola Slightly inverted No masses No presence of swelling With moist and pink mucous membranes Presence of four teeth With sucking reflexes
Thorax and Lungs • Symmetrical in size
Abdomen • Slightly protuberant
Upper and Lower Extremities • • Toenails and fingernails are long and dirty Good capillary refill
d. Health History Po was rushed to the hospital when he was months old because of a chief complaint of convulsion. Besides that, he has not yet experienced any severe forms of childhood illnesses. e. Growth and Development Po is one year and two months old. Under Sigmund Freud’s Theory of
Psychosexual Development, he is at the Oral Stage, wherein the mouth is the center of gratification. It has been evident enough that with his pacifier on his mouth, he gains satisfaction since he does not have cries and tantrums while it is put on. According to Erik Erikson’s Theory of Psychosocial Development, he is in the stage of Trust vs. Mistrust. Since Po is being taken cared of, he renders trust even to strangers, but with ample visual stimulation for a more active child involvement. When he is being cuddled, his discomforts are easily and/or quickly removed.
f. Activities of Daily Living Po wakes up anytime in the morning, usually at seven or eight. When his mother does not have to wash their clothes, he stays at home and was cared by his mother. When his mother has a lot of chores to finish, he was left on his grandmother’s home. What he does all day is to suck his pacifier, be bottle-fed, sleep, and be carried by his mother or his father, and at times, by his grandmother. g. Immunization Status VACCINE BCG DPT OPV HEPATITIS B MEASLES - administered - not administered FIRST DOSE SECOND DOSE THIRD DOSE
IV. SOCIO-ECONOMIC, CULTURAL, and ENVIRONMENT ASSESSMENT A. Family Structure, Characteristics, and Dynamics i. Members of the household and relationship to the head of the family Mr. Cuayan is the man of the house, breadwinner and head of the family. He is married to Mrs. Cuayan and blessed with three children. A girl is the eldest then followed by two boys. Mrs. Cuayan is now 5 months pregnant.
ii. Demographic profile of each member-age, birth date, and birth place
Member Mr. Cuayan Mrs. Cuayan Dipsie Teletubbies Po 29 29 8 2
Birthday August 16, 1979 August 3, 1979 September 27, 2000 September 25, 2006 October 26, 2007
Birth place Montalban, Rizal Lubao, Pampanga Quezon City Quezon City Cuayan, Angeles City
1 and 2 mos
iii. Place of residence of each member –whether living with family or elsewhere All of the family members live together at Gawad Kalinga Center, Purok 5, Brgy. Cuayan, Angeles City.
Type of family structure The type of family they have is a nuclear type. Consisting of the mother, father,
and their 3 children. They are practicing traditional Filipino family. v. Dominant family members in terms of decision making, especially in matters of health care The dominant family members that are responsible for decision-making are both of the parents. The father makes decision regarding economic aspects of family life while the mother manages the home and care for the children and also budgets their daily expenses. Whenever there are emergency cases, they usually go to the health center. vi. General family relationship/dynamics-presence of any obvious/readily observable conflict between members, characteristic communication/interaction patterns among member Mr. and Mrs. Cuayan try to keep a good relationship with the members of their family. Like other families they also encounter problems but they try their best to manage and don’t let it affect the relationship with each other. Whenever the family is complete, they bond together in simple ways such as watching television, playing with their children and going to mass regularly. When Mr. Cuayan saves extra cash he treats his family out by taking them to the malls. B. Socio-economic and Cultural Characteristics i. Educational attainment of each member
Mr. Cuayan finished elementary while Mrs. Cuayan finished third high school due to financial constraints. Dipsie is currently a 3rd grade student at Cuayan Elementary. ii. Significant others / relatives roles in the family’s life The significant other who plays a major role in the family’s life is Mr. Cuayan. Mrs. Cuayan cannot turn to her brothers and sisters for the reason of being so far away from them, except for her one sister. But when a problem occurs, the family takes action first and when all fails, they ask for help from the mother’s sister.
iii. Relationship of the family to larger community The house of Nallatan family is lies a little far for the Barangay Hall and Barangay Health Center. However, they still utilizes the program of the Barangay such as the Elementary School and immuzation program of Barangay Health Center. iv. Occupation, place of work and income of each working member The father starts his day by waking up around 6am, and works at the construction site from 8:00-5:00pm. As stated by the mother, she watches their children and does the household chores whole day. v. Source of income Mr. Cuayan is a construction worker who earns 9,000 pesos a month while the mother is a housewife. vi. Mode of expenditure
Mrs. Cuayan gives the eldest kid 10 pesos each day for her allowance. Regarding expenses for their food, they buy ready made food at the carinderia as a medium for food with a budget of 150 pesos a day. For their water and electricity resources, they spend an amount of 9000 pesos a month. vii. Ethnic background and religious affiliation Mrs. Cuayan is from Lubao Pampanga, while Mr. Cuayan grew up in Rizal, Manila. After their marriage, they decided to reside at Quezon City and then moved to Pampanga in 2007. Within the members of the family, they use Tagalog more often as their medium of communication. The family goes to a Catholic church regularly, and they usually spend the whole Sunday together. viii. Family health habits, beliefs and practices, superstitions The family believes in modern medicine with regards to its effect. However, due to financial constraints, they often leave diseases untreated and remain quite prolonged and if the sickness doesn’t disappear they result to self-medication. C. Home and Environment i. Housing 1. Adequacy of living space The family stays inside the house most of the time and usually in front of the house which is also covered, resembles a patio when looking at it. But when looking at the 8 members of the family in the house, there is an obvious evidence of inadequate living space. It is hard to understand how they can all manage to live in such a limited
space of area. But seeing that they do not have too much furniture and appliances, you’ll slightly see that they can move around the house. LIVING SPACE FORMULA: TFA (IN SQM) = LENGTH ON THE HOUSE x WIDTH OF THE HOUSE TSR = NUMBER OF HOUSEHOLD MEMBERS x CORRESPONDING SPACE REQUIRED FOR THAT MEMBER CONSIDER: ADULTS (13 Y/O AND ABOVE) = 15 SQM CHILDREN (1 Y/O TO 12 Y/O) = 8 SQM INFANTS ( BELOW 12 MONTHS) = 0 SQM COMPARE THE TFA (TOTAL FLOOR AREA) WITH THE TSA (TOTAL SPACE REQUIREMENT) CROWDED IF: TFA < TSR NOT CROWDED IF: TFA > TSR TFA = 21 SQM TSR = 2 (15) + 3 (8) = 30 + 24 = 54 INTERPRETATION: TFA< TSR (CROWDED)
2. Sleeping pattern The family usually wakes up at 6am to get ready for work and school for Dipsie. When Mr. Cuayan and Dipsie aren’t at the house, Mrs. Cuayan is busy doing her household chores. They usually take a nap in the afternoon and just wait for the two to come home. At night, they bond while watching their favorite television shows and after that they go to bed by 10:00 p.m.
3. Breeding or resting sites of vectors of diseases They also found that there are a lot of mosquitoes present at the house which can be a source of dengue fever. The mother doesn’t use any precautions to prevent diseases caused by mosquitoes and other insects. Protective clothing for the children was not observed by the researchers. The two boys weren’t wearing footwear also shorts. 4. Accident hazards Even though the children are young and love to play, safety precautions aren’t given attention by the parents. The researchers observed that the children are prone to accidents because of evident risk hazards such as sharp objects within the reach of the children, cooking facilities placed on the ground.
5. Food storage and cooking facilities Mrs. Cuayan cooks outside the patio, they do not have a refrigerator, and as stated they do not need one for what they cook is just enough for the whole family. But in cases of leftovers, they simply cover the food with another plate, and leave it on the table. All their cooking utensils are kept away for the children to reach. But there are other tools lying around the house which could be an accident hazard to the children. 6. Water Supply Their water is supplied by a water faucet (gripo). This serves as their source for water needs such as in taking a bath and cooking as well as their source of drinking water. 7. Water storage For drinking water it is placed in a plastic jar and water for taking baths or others purposes are stored in a big plastic container with no cover. 8. Toilet facility
The family uses a private toilet facility. They make use of pail system when it comes to the use of their toilet. 9. Garbage/refusal disposal Family Cuayan disposes their garbage in a sack that is not covered. When the sack is filled, every week they dispose it at the public garbage trucks. 10. Drainage system They have an open and stagnant drainage. There are no canals which are present. The water just goes to the soil and dirt of the lot.
ii. Social and health facilities communication and transportation facilities The family hardly goes out of their barangay except for Sundays. The father uses a bicycle as a source of transportation to work, and when it’s Sunday, they all commute to visit the mall and walk around, or walk around the market for the kids to see. They do not have any cellphone or any source of communication, but in cases of emergency they would use a payphone.
V. Problem Identification a. List of the problems identified with cues Health Problem Score
1. Presence of Accidental
3. Presence of Cough and Colds
4. Inadequate Living Space
5. Inadequate Ventilation
6. Poor Personal Hygiene
b. Priority Setting
Presence of Accidental Hazards CRITERIA Nature of Problem COMPUTATION 2/3 x 1 SCORE 0.67 JUSTIFICATION This is a health threat because there is an improper placement of sharps and cooking equipment within the reach of the children. It may cause harm and burn to the members of the family especially to Modifiability 1x2 2 children. The problem is partially modifiable. The family does not have adequate knowledge on the remedy of the problem. They are somehow aware to the problem, but do not recognize it as a felt need. And through the health teachings, knowledge about the interventions, of the student nurses the family had come to realize such interventions in minimizing the problem. No financial
resources are needed for them to resolve the problem. Willingness and cooperation by the family is very vital. Also, no community resources are needed to Preventive Potential 3/3 x 1 1 solve the problem The problem is highly preventable. Sharp objects can lead to accidents and injury of the members of family mostly to the children. The problem is not that severe and it exists in a short duration. Management to the problem is currently Salience 1/2 x 1 0.5 available. The family recognizes the problem but they do not feel it needs immediate action. Total 4.17
Malnutrition CRITERIA 1. Nature of the problem COMPUTATION 2/3X1 SCORE 0.67 JUSTIFICATION The problem is considered as health deficit. Malnutrition is also a contributing factor in acquiring diseases easily. Lack of vitamins and minerals which are essential to our body weakens the immune system, thus harmful bacteria and microorganisms could easily get through the body’s immune system causing diseases and infections. Also, a malnourished individual cannot function well with his/her outermost potential since he/she lacks energy to sustain his/her desired activities.
2. Modifiability of the Problem
The problem is partially modifiable due to: Knowledge of the Family: The family is knowledgeable about the effects of the situation but due to their financial problems, the family could not sustain adequate nutritional needs. Family's Resources: Mr. and Mrs. Cuayan make
certain that their children, as much as possible, will be able to have a complete meal for everyday to prevent from being sick. Nurse's Resources: The student nurses provided health teachings and recommend alternative foods which are nutritious and affordable.
Community Resources: The community provides program concerning about proper nutrition in order to alleviate the occurrence of some health problems within the community.
3. Preventive Potential
The problem has a moderate preventive potential because of the extent of the problem shows that 3 out of 4 of the children in the family are already malnourished. The condition has already occurred even before the student nurses have their home visits.
Management: Student nurse must be able to teach parents on preparing an appetizing meal with their resources available. Also encourage adequate rest and exercise. Exposure: There is the exposure of some members since there’s no sufficient food to accommodate all their needs.
The family considered it as a condition needing an immediate attention AEB Mrs. Cuayan’s verbalization, “di nga sila nakakaen tatlong beses sa isang araw, kya nangangayayat sila”
Presence of Cough and Colds
CRITERIA Nature of Problem
COMPUTATION 3/ 3 x 1
JUSTIFICATION This is a health deficit because Dipsy, and Telatubbies were experiencing runny and clogged noses with the presence of nasal discharges. This problem is partially modifiable because the nurse’s skill is limited and is not sufficient to solve it. Also, many problems cause this and this condition is selflimiting. The sudden changes of weather may also be a cause.
1/ 2 x 2
2/ 3 x 1
The preventive potential is moderate since the problem exists for about 2 weeks. Resources of the health center as well as the health teachings provided by the student nurses are available. Complications such as pneumonia can be prevented if proper interventions are given. The mother sees this as a problem but does not continue medications due to the lack of financial resources.
Inadequate Living Space CRITERIA Nature of Problem COMPUTATION 2/ 3 x 1 SCORE 0.67 JUSTIFICATION The problem is a health threat because it makes communicable diseases easily Modifiability 1/ 2 x 2 1 transmitted. It is not possible to widen their area. The family can be taught of how to arrange and organize their things in the house to Preventive Potential 1/ 3 x 1 0.33 widen the space. The problem has a low preventive potential since the family had adapted to the place and they have no plans in transferring to another place that is Salience 1/ 2 x 1 .5 more spacious. According to the mother, they are already used of that kind of living space. She said they don’t have other choice but to leave there.
Poor Ventilation INADEQUATE VENTILATION CRITERIA 1. Nature of the Problem COMPUTATION SCORE 2/3x1 0.67 JUSTIFICATION The problem is considered as a health threat because improper ventilation makes it easier for communicable diseases, specifically those transmitted via air-borne, to be transferred if a member of the family gets infected.
2. Modifiability of the Problem
The problem is partially modifiable with the use of the following: Knowledge of the Family: The family is not aware about the problem because as verbalized by them, they got used to hanging thick curtains unaware that it adds gloom and makes their house impermeable to air. Family Resources: The family may open the windows during the day thus allowing a free flow of air in the house. They may also open the door to add fresh air exchange. Student Resources: The students may provide health
teachings on ways to prevent the possible occurrence of the effects of the problem. Community Resources: The BHC can provide a seminar on the effects of inadequate ventilation to health.
3. Preventive Potential
The problem has moderate preventive potential because the family can make remedies in order to solve the problem but may only be limited to opening their windows and door present in the house. Management: The family may open the windows and the door to facilitate entry of air and may use thin curtains. Exposure:
All the family members are exposed since they all reside in that area. The family are not aware to this 4. Salience 0/2x1 TOTAL SCORE 0 2.01 problem.
Poor Personal Hygiene
CRITERIA Nature of Problem
COMPUTATION 2/3 x 1
JUSTIFICATION The problem is a health threat as it could cause certain disease condition such as parasitism to the family especially to the children. The problem is not modifiable since the family does not have the knowledge of how communicable diseases are transmitted and resources of the family and community with the limited knowledge of the nurse is not sufficient to solve the problem.
0/2 x 2
2/3 x 1
The problem has moderate preventive potential since the student nurse is there to give some interventions that can help the family improve their personal hygiene.
0/2 x 1
The family does not perceive this as a problem needing immediate change
VI. Family Case Analysis Presence of Accident Hazards Cues Family Nursing Objectives Subjective: Ø Problem 1. Inadequate Short Term: knowledge Objective: near the of 2. Attitude in life in interaction hinders nursing of a intervention, to recognize family will be able the >Instruct the family >This will prevent of to place keep sharp injuries such as Inadequate importance responsible environment Long Term: After 2-3 weeks of home to visits the >Advise the family >To provide safety place far sharp and prevent the risk from of injury family will be able to table, recognition >Sharps are placed which where it is reached problem of children. >cooking area is in 3. the ground. >tools of the father (i.e. placed anywhere. Inability recognize presence of problem due to the the financial to constraints) Interventions >Provide Rationale Evaluation
>This will help the Short Term: about family to realize the The family shall be of able to recognize pointed the importance of environment pointed keeping accidents
After 2 home visits information and having the of children
nursing the consequences of importance
objects upon reach objects to prevent having a safe home
resources for care having a safe home objects in a safer cuts, accidental fall of sharp objects that can possibly hit the children
in construction is family member and
compliance on the children’s reach health given. teachings >Encourage the >prevent burns family to place the among children and cooking area out of fire. reached of children and out to fire hazard. Malnutrition Cues Analysis of the Problem S> 1. Inability to provide “nangangaya adequate nursing care yat nga sila to dependent and di kasi vulnerable at risk kumakaen members of the family minsan” resources for care, O>Dipsy specifically financial Wt: 22kg constraints. BMI: 15.28 >Telatabies 2. Inability to Wt: 12 kg recognize presence of BMI:17.41 the problem due to lack >Po of knowledge of Wt: 7.7kg present condition. BMI:15.26 3. Inability to decide
Objectives Short Term: After 2 hours of nursing interventions, the family will be able to verbalize understanding of health teachings and is able to give causes and effects and prevention of malnutrition.
> Assess each members > To have present nutritional status baseline data
> Discuss with the family >To make the presence of malnutrition family aware of the presence of such problem > Discuss with the family a list of suggested nutritious food > To correct faulty food habits > Discuss and identify causes and effects of > To increase malnutrition like having knowledge; low body wt., decrease
Expected Outcomes Short Term: The family shall have verbalized understanding of health teachings and able to give causes and effects and prevention of malnutrition.
about taking appropriate action due to failure to comprehend the nature, magnitude & scope of the problem.
resistance to diseases and stimulate family easy fatigue to attend the situation as soon > Emphasize the as possible importance of having ideal body weight to become healthy > To serve as a gauge for the family in identifying their > Encourage mother to current nutritional make use of community heath status and resources like ampalaya, be able to monitor talbos-kamote etc. it effectively > For low-cost > Explain to them what food alternatives specific vitamins and having the same minerals they need for nutritional value their respective ailments and health. > To be able to inform the family > Discourage eating junk what deficiency food in between meals they could acquire, if there is a lack on these vitamins and minerals > To encourage > Considered criteria in proper food planning meals by intake, prevent involving mother in loss of appetite
planning meals in prior to meals and accordance to available promote healthy resources in the eating habits community > To guide family in preparation of meals without sacrificing nutritional value
Presence of Cough and Colds Cues Analysis Problem Subjective : “sinipon The mother
is After 2 home visits >Suggest to the mother to >Rest will decrease Family would be
chances of able to perform nga aware that this is of student nurse- provide enough rest for the a problem but family interaction, the children and increase lowering body the health halos sila e” lacks knowledge the family will be their fluid intake. resistance and the teachings given Objective: >The on how to cure able to verbalize fluid secretions promotes and eliminate the of the and its on the disease occurrence. that children and prevent it understanding experience runny from occurring the present condition noses expulsion of mucus presence respiratory minimize
upper and frequently. She is a problem needing also does not immediate action and >Encourage the mother to tract.
presence discharges. >Dipsy wheezes auscultation.
the conform of health
the feed the children with C will like oranges, guava and increase the body’s fruit juices. >Demonstrate mouth when when to the resistance infection. children in covering their >This will prevent coughing the spread of the are better and wiping the nasal area infection. secretions flowing out. >Encourage the children >For to drink plenty of water. expectoration of the mucus secretion. > Advise the mother to >This Health Center for a check- have up and to seek regarding medications will help against
teachings foods rich in vitamin C >Vitamin
the given. has spreading upon infection easily and the possible complications it may cause such as pneumonia.
bring her children to the them for when they problems health,
they can confide to the Health Center to
seek medication and have daily checkups
Inadequate Living Space Cues Analysis of Subjective: “Pasensya na ang bahay naming.” Objective: Total floor area= 21sqm Their desired TFA must be 54m2. This means that the Problem The family is not aware of the could arise from this condition due to lack of knowledge about communicable diseases.
Objectives After 2 home visits of Student nurse family-interaction, the family will be convinced that this may lead to health problems.
Nursing Intervention >Provide general knowledge on how communicable diseases could be easily transmitted in a limited space.
Rationale >To increase awareness of the family about possible illness they could acquire. > To maximize the
Evaluation After 2 home visits of Student nurse family-interaction, the family will become aware and be cautious enough in prevention of illness.
kayo maliit lang problem that
> Assist the family in arranging and organizing their things such as furnitures and appliances. > Advise the family to remove thing that are
space of house.
>lessen the waste and obstruction causing inadequate space.
family has crowded living space. Poor Ventilation Cues S> “sinara nga namen yung bintanang yan. Di na nga nabuksan” O> There are presence of: >the inside of the house is hot and with thick curtains
unnecessary and not being use.
> one of their window is covered with plywood. 2. Inability to recognize the >Window are presence of always close. congestion and its probable/possible effects to each member of the family
Analysis of the Problem 1. Inability to provide a home environment which is adequately ventilated for health maintenance, growth and development due to financial problems.
Objectives Short term: After 2 hours of nursing interventions the family will be able to verbalize understanding about the effect of having poor ventilation such as poor circulation of air and prone in cross infection of communicable diseases.
Nursing Intervention > Assess the environmental condition of the family > Provide health information regarding the necessity of adequate ventilation at home
> To obtain base line Short term: data The family was able > To inform the family verbalize how ventilation helps understanding about improve our health effect of having poor ventilation. > Improve ventilation > Explain to the family inside the house by the need for more supply providing open of air for proper windows circulation on the house > To make the family > Inform family about aware and for the possible complications or family to act on it risk for a congested place, such as easy transmission of disease >For better circulation >Instruct the family to of air remove the cover in their window.
Poor Personal Hygiene Cues Analysis of the Objective(s) Problem S> O Inability to Short term: After 2 hours of O> Children have recognize the nursing soiled skin because presence of the interventions, the family will be able they don’t take a problem due to lack to verbalize bath everyday of knowledge on the understanding on the importance of >Long and dirty causes and effects having a good nails presence in of such. Personal personal hygiene AEB bathing the father and children hygiene is important children everyday > Children wearing as a it is a and cutting of finger and toenails. rugged clothes. contributing factor >Telatabies and Po to being healthy and don’t wear shorts or keeping any underwear the seen bare-footed during resistance our against
Nursing Interventions > Explain to the family the importance of maintaining proper hygiene.
> To encourage the The family shall family to comply have understood the with the instructions given. importance of
walking infection stronger
the home visit
having a good > To motivate the family in personal hygiene. > Discuss to the maintaining proper family the relevance hygiene of having good hygiene in maintaining a > Nails are good source of healthy life. contamination and > Instruct them to can be a reservoir cut nails regularly for microbes and prevent nails from becoming > To avoid injury as dirty well as to prevent parasitism > Instruct the children to wear > To prevent dental slippers inside and carries and promote outside of the house healthy gums and teeth
> Encourage family to brush teeth at > To prevent food least 2 times a day. borne diseases and contamination of > Encourage family food. to wash hands before and after > To have a clearer meal. picture and knowledge as to > Demonstrate hand washing proper hand technique. washing technique to the members of the family.
VII. Family Coping Index Initial Category 1 1. Physical Independence Visit 3 5 x Justification 1 All family member are well and no disabilities. Sometimes the mother cannot do all household chores because she’s taking care of her 2 children that are 2. Therapeutic Competence x dependent to her. The 2nd son is experiencing cold and flu since December and there is no medication 3. Knowledge of Health Condition x given by the parents. The mother knows the complication and consequences of colds and flu. But there is know medication that given or any preventive measures that was 4. Application of Principles of Personal Hygiene x observed The house is partially clean, but there are some area in the house that needs to be improve. The children takes a bath once a day, but because of playing outside they turn out x The family gained more knowledge about the importance of clean environment and proper hygiene. x x Health teachings were done and the studentnurses saw the changes on the condition of the 2nd son. Health teachings were done, the family is now more knowledgeable about colds and flu. Final Visit 3 5 x Justification Same on what studentnurse observed on the initial interview.
Health Care Attitudes
dirty. The student- nurses observed that the family have knowledge about the importance of health care but its quite not enough.
The family gained more knowledge about seeking health providers in dealing with different illnesses. The family knows now different interventions in dealing health problems. The family failed to comply with the health teachings done of student- nurses because of lack of resources and at the same time because of the condition of the mother. But we saw a willingness of the family to comply with the teaching.
6. Emotional Competence
Sometimes family with different communities is lacking of security and maturity maybe because of their unstable life due to financial and family problem that they are facing. The mother is not enough watching her two small children because she is pregnant and she have a lot of household chores that should be done. The father is making all the majority decision in the family, he is the bread winner of the family. And the mother is the light of the house who’s making all the household works. This
7. Family Living Patterns
As what we saw in the initial visit. The family doesn’t have any problem with each other.
family is an example of a traditional Filipino family. Each of the children is dependent to 8. Physical Environment x the parents. The house of the family is partially clean that needs improvement. There is a part of the house that is hazardous to the family and can 9. Use of Community Resources x cause illness. The family is aware of the different services offered by the barangay health center. But because of limited time and the location of their house, they cannot avail those services. x x The family complied with the health teaching, but because of financial factor, some of the problem that observed are still present. After the health teaching the mother knows the importance of visiting the health center once a week because of her condition.
VIII. Learning Derived 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 on another. This FCA proved to show that this isn’t 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 isn’t 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. 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 people’s 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 we’ve acquired showed that we can get along with people. How many people can go up and ask all theses questions, not to mention when some of them are very personal. We were able to gain the family’s trust, and that gave us a plus factor feeling knowing that we’re doing a good job with them, and that they enjoy our company. Socially, we were able to develop better therapeutic communication skills, physically, we finally had time to exercise by going up to the family’s 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.