Family Nursing Process

Initial Database



GROUP 3-Cluster 1
Anwar Jan Garaza
Mariz Joy Guillermo
Richard James Oamil
Lyka Mae Imbat
Ellen Gaye Domingo

Mrs. Christine B. Alcoy, RN
Instructor
7/9/2009

FAMILY NURSING PROCESS
INITIAL DATABASE

A. FAMILY STRUCTURE, CHARACTERISTICS AND DYNAMICS

Table 1. Demographic Data of the Members of Fuerte Family

Name Relationship
to the Head
of the Family
Position Age Sex Educational
Attainment
Occupation Place of
Residence
Religion
Bernardo
Navarrete
Fuerte
Head Father 78 M High School
Graduate
Pensioner Quiling Sur,
Batac
Jesus
Miracle
Crusade,
Inc

Ester Castillo
Fuerte

Wife Mother 47 F High School
Graduate
University
Helper
-do- -do-
Ezrael Castillo
Fuerte

Son 1
st
Child 20 M 3
rd
year High
School
Construction
Worker
-do- -do-
Michelle
Castillo Fuerte
Daughter 2
nd
Child 17 F Presently 2
nd

year College,
BSBA-MA,
MMSU

Student -do- -do-

Based on internal organization, Fuerte Family is a nuclear type of family consisting of the father,
mother, and children. The size of their family is small and ideal. Mr. Bernardo Fuerte is 78 years old and
regarded as the head of their family. Mrs. Ester Fuerte is the wife and the breadwinner of the family.
They are blessed with 2 children namely, Ezrael and Michelle. Ezrael, 20, hangs-out with his friends most
of the time, not studying and works as construction worker once a week; and Michelle, 17, is a second
year student of MMSU-CBEA taking up Business Administration Major in Management Accounting.
Fuerte Family is neolocal based on residence; they neither reside with any of their parents. Mr.
Fuerte was born and raised at Gov. Ablan Avenue, Brgy. 5, Laoag City while Mrs. Fuerte originally came
from San Jose, Mindoro. The Fuerte Family had migrated 8 times already, at first, they reside at Laoag
City near Mr. Fuertes Father, then they planned to transfer to Manila for Mr. Fuerte to find a better job,
luckily he found one as a security guard. They stayed in Manila for only less than a year in 1987 due to
the rampant killings of security guards at that time so Mr. Fuerte decided to resign from his job and
return to Ilocos Norte. Mr. Fuerte then found a job in Mariano Marcos State University, also as a security
guard, and then he decided that it is much better for the whole family if they live near his job so they
moved to Bacocang Daya at the same year. However they are again subjected to move because of a
typhoon which destroyed their house so they moved to another house, they had rented, but still in the
same sitio in the same year (1987), however they again needed to move because the owner of the
house which they had rented wanted the house to be developed, so the family immediately moved to
Poblacion, Batac near the Marcos Museum at the year 1988, however they needed again to move
because the owner of the house needed to sell the house due to his financial problems. On the same
year (1988) the family moved to Ablan, Batac then stayed there for a few months until the owner of
their residence decided to turn their house into a Tobacco Warehouse so the family is again forced to
find a new place to stay. For the sixth time, they moved to Tabug, Batac (1989) and stayed there for 10
years until they had enough money to build their own house. For the seventh time they moved to
Quiling Sur, Batac at the year 1999, they built a house in a vacant lot owned by a relative, the family had
again resided at that area for another 10 years. However they again needed to move because their
relative decided to sell the land due to financial problems. And for the last time they again migrated to
their present location, still in Quiling Sur, their house is located in a cliff near the Quiaoit River because it
is the only place available for them. It was suggested by their Barangay Captain Nalundasan, since no
one is using the lot, it is owned by a kind-hearted family (Rubio Family) who gave them permission to
build their house and inhabit the land.
Based on descent, the family is considered to have a patrilineal descent interaction since they
mingle with their relatives in the father side most of the time because the family of orientation of Mrs.
Fuerte is in Mindoro and they have never been there for a visit or formal introduction of their family.
When it comes to decision making, both Mr. and Mrs. Fuerte makes decision, thus they are
egalitarian when basing it on authority. They also said that before deciding on things regarding family
welfare, health care and other family matters and affairs, they must first seek or consult the other
members of the family.
There are no observable conflicts in the family as manifested by their good family ties and
interaction. When we asked Mr. Fuerte if there are misunderstandings or conflicts that run with the
family, he verbalized that they dont have serious fights but admitted that they also have conflicts
common to any family.

B. SOCIOECONOMIC AND CULTURAL CHARACTERISTICS
The monthly income of the family is coming from the pension of Mr. Fuerte, the salary of Mrs.
Fuerte and their son, Ezrael.
Mr. Fuerte is a former employee of MMSU as a security guard for almost four years from year
1987-1991. He is now jobless and stays at home. Mr. Fuerte receives his monthly pension from SSS
which amounts Php4217.00 and serves as one of the sources of income.
Mrs. Fuerte is now the breadwinner of the family. She works as an employee of MMSU-CAF. She
helps in gardening and maintaining the cleanliness of the college. She works five days a week; her
income is php135/day, receiving a monthly income of Php2700.00 per month.
Ezrael works occasionally if a job is offered to him. He works as a construction worker at an
average of 4 days a month, earning about php700/month (php175/day)
SOURCES OF INCOME:
Mr. Fuerte- Php4217.00/month (from SSS pension)
Mrs. Fuerte- Php2700.00/month (wage as University Helper)
Ezrael- Php700.00/month (wage as construction worker)
Total: Php7617.00/month
ALLOCATION OF INCOME:
Medicine- Php1095.00 (14%)
Education- Php2400.00 (31%)
Food- Php2804.00 (37 %)
Miscellaneous- Php500.00 (7%)

Transportation- Php468.00 (6 %)
Clothing- Php350.00 (5%)
Total: Php7617.00 (100%)









Figure 1.Monthly Expenses of Fuerte Family

Mrs. Fuerte is in charge in budgeting the money of the family. According to Mr. Fuerte, their
monthly expenses mostly fall on his medicines, allowance of their daughter in going to school and their
food.
The Fuerte Family, as other normal families, eat 3 times a day excluding their snacks in the
morning and in the afternoon. Their meals consist mainly of vegetable dishes such as pinakbet,
dinengdeng and vegetable salad (talbos ng kamote) which they buy in the market and some are
harvested from their vegetable garden consisting of papaya, horseradish, sweet potato and atis. They
sometimes buy meat, of either pig or chicken, for their meals. But there are times wherein the food for
the family is not enough especially the ulam, for example their vegetable plants are not yet ready for
harvest or there is a financial crisis. A cavan of rice is bought monthly after receiving the pension of Mr.
Fuerte and is consumed for more than a month. The eating time of the family is as follow: around 5:30-7
14%
31%
37%
7%
6%
5%
Monthly Expenses of Fuerte Family
Medicine
Education
Food
Miscellaneous
Transportatiion
Clothing
AM for breakfast, 12-1 PM for lunch except for Ezrael who eat late most of the time (at around 1:30-
2:30 PM) and dinner at around 6-7 PM.
The educational attainment of the family is as follows: Mr. Fuerte is a high school graduate and
took up Commerce at Northwestern University but finished only 1 year due to financial problems while
Mrs. Fuerte is a High School Graduate in a Secondary School in Mindoro; Ezrael only finished up to third
year high school in Batac Junior College; Michelle on the other hand is a high school graduate and
currently taking up BSBA-MA at MMSU-CBEA as a second year student.
The Fuerte family is religiously affiliated to the Jesus Miracle Crusade, Inc. since 1999 located in
Laoag City, through the invitation of their neighbor in Tabug, Batac. They were previously affiliated in
the Roman Catholic Church. They go to church three times a week on Wednesdays, Fridays and Sundays.
They go to church via a jeepney provided by the same institution for free (back and forth), they only
expend money when they go to Ricarte Park as their meeting place. They go to church usually to repent
for their sins, thank and praise God for all the blessings they receive and to ask for guidance, strength,
health and good luck. They also say that they regularly pray three times a day before meals to thank God
for the foods they are consuming in everyday life.
Fuerte family actively participates in their community. They participate regularly in the activities
mandated in their barangay. They help in the Clean and Green Program of the barangay, like
participating in their monthly YCAP, and other programs regarding the improvement of their place.
They send Michelle to school for her to be educated, have a better living in the future and in
general to help the whole family, they also said that they consider her education as their only savings.
They also want Ezrael to go to school, but he refuses to study. Mr. Fuerte verbalized that their son
became too preoccupied with his peers thus they decided for him to stop.
The family enjoys the benefit of low-priced medicines and free health care facilities because Mr.
Fuerte is a member of Medicare and Senior Citizens of the Philippines since 1996. They sometimes go to
Rural Health Unit of Batac for check-up and public hospitals just like the MMMH & MC for further
consultations if ever needed.
They sometimes go to their relatives who reside in the same Barangay when they have time
while Ezrael often go there for a visit. They also have relatives in Laoag but only go there when there are
special occasions.
The family is living peacefully with a lot of friends who help the in times of need and crises. They
have harmonious relationship with their neighbors as shown by the absence of conflicts and
misunderstanding.
The members of Family Fuerte changes clothes when they know it is already dirty. They dont
usually buy clothes because they said that they have adequate clothing except for Michelle who buys
clothes when needed or if there is any occasion. Mrs. Fuerte is the usual person who sews their clothes
if simple tear is made on them but brings it to the tailors in their neighborhood if it needs further or
more serious repair. The members of the family usually do their washing during their vacant hours. No
one in their family regularly wash clothes for the whole family. Instead, they do their washing
individually. The members of the family usually wash clothes once a week except for Mr. Fuerte who
does the chore every 15 days.




Figure 2.Eco-map of Fuerte Family














C. HOME AND ENVIRONMENT
Fuerte Familys House is located at #16 Quiling Sur, Batac, at the edge of a cliff near the river.
The house of the Fuerte family is a small bungalow type about 4.5m x 7.5m. Its walls and roof were
made of galvanized iron sheets, plywood and cloth, only the northern part of their wall is made of
pure tolda mostly from the remains of their old house. Most of their flooring is made of sand and
embedded pieces of cement also from the remains of their old house thus making it unequally leveled.
They made use of tolda and sacks for the roofing of their kitchen and their receiving area. Their
bedroom, dining room and living room are located inside their house and only separated by curtains;
they have two beds, a dinner table, a cabinet and boxes for their clothes. There are also clothes hanging
Health Care
Facilities

FUERTE
FAMILY
Organizations
Relatives
Friends
Neighbors
School
Church
and lying around their house, and these clothes cant be distinguished whether clean or used clothes. A
lot of spider webs are present all over the house.
The familys sleeping arrangement is like this: Ezrael and Michelle sleeps at the biggest bed, Mr.
Fuerte sleeps at a smaller bed near the door and bed of their children and Mrs. Fuerte sleeps in a small
bed outside the house at the receiving area because she complains that she is not comfortable inside
their house due to the hot weather. Mr. Fuerte would insist that he would be the one to sleep outside
but Mrs. Fuerte is concerned that his cough might get worse if they exchange places
Breeding sites for vectors of diseases, especially mosquitoes, are widely present around. They
are near the river which has stagnant water and they also have water stored on their basins which we
observed bunch of mosquito larvae. The family also complained of large, black mosquitoes at night
thats why they use mosquito nets. There are cockroaches and rodents that stay and breed inside their
house because their house is not kept well. Used clothes and laundry were hanging and lying around.
Their personal things, such as shoes and belts, were also scattered around their floor. Their beds were
also left unkempt and uncleaned before they leave.
The house doesnt have a door and window lids, they would only use curtains to cover their
doorways and window openings. The level of their flooring was not flat thats why there is also a risk for
tripping especially while walking there at night, and Mrs. Fuerte would wake up at 4:00 in the morning
to cook their food and to prepare in going to her job.
They dont have electricity so they make use of candles as lightings at night. They dont also
have a refrigerator so they immediately consume the meat products they buy and for the vegetables,
Mrs. Fuerte would keep if on a cellophane then hang it at their kitchen ceiling. They have a steel ladle,
aluminum cooking pots and an improvised cooking stove made of three stones. Their cooking utensils
and eating paraphernalia are kept inside a dish rack and some are not kept well.
The familys water supply would come from the jetmatic pump of their neighbor across the
road. They use this water for drinking, cooking, washing and bathing purposes. The distance of the
pump from the toilet is approximately 7-8 meters away. Mrs. Rubio also offered their comfort room to
the Fuertes temporarily. Mr. Fuerte is making a pit privy near the rivers bank but whenever he makes
one, the pit is immediately filled with water because of the rains the past days. The Fuerte family would
dispose of their wastes at a pit, dug by Mr. Fuerte and his son, also near the rivers edge. The water
coming from their bathroom and water for dishwashing would drain directly to the river, thus producing
a foul odor aside from the garbage that are stocked near the river.
The house of the family is near the barangay road where a lot of vehicles pass by causing noise
pollution and air pollution in their area.The family lives alone at a side of the road and their nearest
neighbor were the Rubio family at about 10 meters from them across the road. The family owns a cell
phone which is used by Michelle; she would recharge the cell phone at Mrs. Rubios house.
The familys house cannot withstand the strong wind and rain during rainy and stormy seasons
and even earthquakes because it is only made of tolda and galvanized iron sheets, producing a very
weak foundation. It is also prone to landslides because the house is situated near the edge of the river
going straight to the Quaioit River. It is also prone to fire because of the tolda and pieces of cloth they
used in their house especially that the family only uses candles at night as the source of light.
The family doesnt keep any first aid kit or any equipment for emergency health needs; even
medicines for usual health complications such as common colds, body aches and fever are not available
in their house. Readily accessible pharmacy or any health facility and office are present in their place.
The nearest hospital, MMMH & MC, and pharmacies are situated approximately 150 - 200 meters away
from their house.
They communicate with the other members of the family courteously and with due respect,
they talk in a nice and properly toned voice most of the time except when there are conflicts. They
communicate with their relatives far from them with Michelles cell phone. They also have good
interaction with their neighbors and friends as proved by the help and assistance they receive from
them specifically the Rubio Family and other concerned neighbors.

D. HEALTH STATUS OF EACH FAMILY MEMBER
Genogram:
Figure 3.Genogram






Legend:



Justo Fuerte(+) 55
Murdered


Andrea Fuerte (+)50
Heart Attack
(Hypertensive)
Raymundo
Castillo
Enriqueta
Castillo
Soledad
Fuerte-
dela Cruz
50


Amador
Fuerte (+)
17
Pneumonia
Juanita
Fuerte (+) 39
Accident
(Slipped)


Dominador
Fuerte 76
Hypertensive

Bernardo
Fuerte 78
Asthmatic
and
Hypertensive

Esther Castillo-
Fuerte 46

Ezrael Fuerte 20

Michelle Fuerte 17

--Female

--Male

+ -- Deceased

Mr. Bernardo Fuerte is the eldest child of Mr. Justo Fuerte and Mrs. Andrea Fuerte. His father,
Mr. Justo Fuerte was killed by Japanese soldier during the Japanese occupation at the age of 55 while
Mrs. Andrea Fuerte died at the age of 50 due to heart attack. Next to Mr. Bernardo Fuerte is Mr.
Dominador Fuerte, 76 y/o, who is also hypertensive as diagnosed by a doctor, but failed to name the
doctor. The third child is Mrs. Juanita Fuerte , 39 years old, who was 6 months pregnant at that time
when she died due to slipping in their stairs with loosed steps. Mr. Bernardo Fuerte said that she
experience excessive bleeding and was not able to survive. Next to Juanita is Mr. Amador Fuerte who
died at the age of 17. Mr. Bernardo Fuerte said that Amador was playing basketball in their school then
suddenly a heavy rain came and due to their excitement they went home very tired despite the heavy
rain. The morning after the incident, Amador feel sick as manifested by his high fever, he was diagnosed
by Dr. Ofelia Flor of having pneumonia at the provincial hospital. Treatments include blood transfusion
and other medication but wasnt able to recall them. And the youngest among the children is Mrs.
Soledad Fuerte, 50 years old, was claimed of not experiencing serious illnesses.
Mrs. Ester Fuerte is the daughter of Mr. Raymundo Castillo and Mrs. Enriqueta Castillo.
Mrs. Fuerte can no longer remember the names of her siblings because she said that she went to Manila
at the age of 17 and dont have connections with her family since then.
Bernardo, the head of the family was diagnosed before of having hypertension by Dr. Ma.
Christina Dulay. His blood pressure then was 150/120 mm/hg. He was prescribed with medicine for his
high blood, Atenolol 50 mg (2x a day). He stopped his medication since he has now normal blood
pressure. At present he is suffering from cough and was diagnosed with asthma last December 2008 by
Dr. Dulay. He is currently taking medicines such as Medifortan- As (Multivitamins + Buclizine Hcl) capsule
for his cough, he take them once a day. He will take these medicines until he feel better. He has also a
Salbutamol Ventolin Rotacap and Rotahaler which can accommodate 200mcg/capsule to use whenever
his asthma attacks. He inserts a capsule, Salbutamol Guaifenesin (SGx) 2mg/100mg, in the Rotahaler.
Mrs. Fuerte has suffered from an unknown disease when she was 26 y/o, but they never go to a
doctor for consultation. Tenderness of the whole body, pain all over the body and falling of hair was
experienced as manifestation of her condition. Paracetamol 500mg, thrice a day, is given to her to ease
the pain she is feeling. By that time she never ate rice, vegetable and meat for she totally loss her
appetite. She only drinks water and juice. Instead of consulting to a physician, they went to a faith
healer. They believed in faith healing and its effectiveness in curing her illness. Truly her illness
disappeared and was cured.
When Ezrael was in Grade 1, he was diagnosed to have meningitis by Dr. Dulay at the MMMH &
MC as manifested by dizziness and headache. Dr. Dulay said that it is caused by the bumping of head by
Ezrael and was immediately supported by Mr. Bernardo idi ngamin ubing ket mamin-ano nga matnag
ken maitumeg. He was prescribed with antibiotics and medicines for his headaches and dizziness. Mr.
Fuerte said that Ezrael was bitten by a dog five times. First, at the left gastrocnemius muscle, second is
in the right pectoralis major, third is at the left knee, and right vastus lateralis muscle for the 4
th
and 5
th

time. Most of the dogs that had bitten him were owned by their neighbors and once is their own dog.
They treat it with the traditional way called suma. Ezrael also experienced some childhood illnesses
like chicken pox. They fed him with crabs because the family believes that it will make the chickenpox
appear rapidly and fast, thus healing would occur immediately after all the chickenpox has appeared.
On the other hand, Michelle didnt experience any serious illnesses. All the members of the
family have experienced common cough and colds, which are managed by increase fluid intake, oral
intake of calamansi juice and taking rest and sleep. And fever and body aches which are also manage by
increase fluid intake, intake of medicine such as Paracetamol 500 mg (thrice a day) tablet and taking a
lot of rest and sleep.
Table 2.Anthropometric Data of Fuerte Family
Name Body Mass
Index (BMI)
Height
(cm)
Weight
(kg)
Mid-upper arm
circumference
(cm)
Waist
Circumference
(cm)
Hip
Circumference
Waist Hip
Rotation
Bernardo
Fuerte
12.88 174.74 39.46 19.05 71.12 75.24 0.95
Ester
Fuerte
16.55 148.59 36.74 20.32 60.96 64.15 0.95
Ezrael
Fuerte
17.52 176.78 54.88 23.86 72.34 78.59 0.92
Michelle
Fuerte
15.31 152.4 35.38 20.32 60.96 63.82 0.96

Body Mass Index = weight (kg)
height
2
(m
2
)

Waist Hip Rotation = Waist Circumference
Hip Circumference

Table 3.Body Mass Index Classifications

Classification
BMI Description
18.5 or less Underweight
18.5-24.9 Normal
25.0-29.9 Overweight
30.0-34.9 Obese I
35.0-39.9 Obese II
40 or greater Obese III
All the members of the Fuerte Family are considered underweight because their Body Mass
Indices did not reach the range scale for normal. The low BMIs of the family could mean that they dont
receive the sufficient amount and quality of food every day. This can be due to the inadequate resources
of the family especially financial resources, their budget for the food is only limited thats why they only
buy the food their budget can accommodate.
Table 4.Dietary History of Fuerte Family
THREE-DAY MEAL
Meal Day 1 (06/27/09) Day 2 (06/28/09) Day 3 (06/29/09)
Breakfast 1 fried egg
2-3 pieces of pandesal/
cup rice
16 oz coffee/milo
16 oz water

1 cup of rice
cup camote sprouts
16 oz coffee/milo
16 oz water
1 cup of rice
200 ml sinigang
16 oz coffee/milo
16 oz water
Lunch 200 ml inabraw
1-2 cup(s) of rice
16 oz of water

1-2 cup(s) rice
1 cup pinakbet
16 oz water
1 cup of rice
200 ml sinigang
16 oz water

Dinner 200 ml dinengdeng
1-2 cup(s) of rice
16 oz water

1-2 cup(s) rice
1 cup pinakbet
16 oz water
1 cup of rice
200 ml sinigang
16 oz water

Snacks:
Morning

Afternoon
240 ml coke


240 ml juice
1 biscuit
240 ml coke
1 biscuit
240 ml juice 240 ml coke 240 ml juice
1 biscuit

1 biscuit

The other members of the family eat at the right time except for Ezrael who delays his intake of
lunch to 1:30-2:30 in the afternoon. Sometimes, the Fuerte family does not have the enough or required
quantity of food or the viand thus inhibiting them from getting the nutrients needed by their body. The
familys most usual meal would compose of vegetables; they only have meat once a week due to the
absence of storage facility (refrigerator).

E. VALUES, HABITS, PRACTICES ON HEALTH PROMOTION, MAINTENANCE AND
DISEASE PREVENTION
Mr. Fuerte and his wife are not sure if they have received complete immunization when they
were kids but they showed their scar in the right deltoid muscle with approximately 5mm in diameter
which is a proof of their BCG vaccine, however they claimed that Ezrael and Michelle have completed
their required immunizations administered by the Rural Health Unit of Batac: 1 BCG, 3 DPT, 3 OPD, 1
Antimeasles and 3 Anti-Hepa B vaccines. Mrs. Fuerte was not able to show us the yellow card of her
children as a record of their vaccination. Every pregnancy, Mrs. Fuerte has received 2 injections of
tetanus toxoid before and after giving birth. They usually go to public hospital or rural health units
because they cannot afford to go in a private hospital.
The family eats three times a day with intervening snacks in between those meals. They eat
vegetable almost every day in a week and said that they also buy either pig or chicken meat once a
week. They get their food either at the market or from their backyard. They go to the market after
getting Mr. Fuertes pension and buy their food. The family has sources of vegetables and fruits from
their backyards and neighbors. Available plants in their surrounding include papaya, horse radish, sweet
potato and atis. Their leftovers are usually left in their table and Mrs. Fuerte packs their uncooked
vegetables in plastics and sprinkles it with water to prevent it from wilting, then hangs it in their kitchen
ceiling. No one smoke or drink alcohol in the family.
The Fuerte family has no specific ways of relaxation. If they dont have something to do, they
just sit or sleep to relieve stress from their daily works. Added to that, Ezrael often goes out to play
basketball with his friends as his way of recreation. An activity like watching television is only available if
their neighbor, Rubio Family, is at home. They dont have electric current so Michelle needs to go to
their neighbor to recharge her cell phone.
The members of the family do not have regular exercises except for Mr. Fuerte who said he
would walk from their house until the end of the cemented road of their area which is approximately
500 meters and goes back and he does it every morning for at least 15 minutes. Ezrael often plays
basketball as his way of exercise.
According to Mr. Fuerte, they regularly sleep at night at around 7-8 in the evening and wake up
early in the morning, usually at 5:00-6:30 except for his wife who wakes up earlier than them. Mrs.
Fuerte wakes up at 4:00 in the morning to prepare their food and the needs of their family. In
weekends, they just wake up anytime they want. Mr. Fuerte sleeps after dinner at 6:30 in the afternoon
while Michelle sleeps when she is already done with her homework, on the other hand, Ezrael sleeps
usually at the same time with his sister while Mrs. Fuerte at about 9:30 in the evening when everybody
has already settled in their beds. Mr. Fuerte and their children sleep inside their house while Mrs. Fuerte
sleeps outside because she is not comfortable with the heat inside their house. They use mosquito nets
in sleeping to protect them from mosquitoes and other insects that might bite them.
Each member in their family owns a pair of slippers they use when they are inside and outside
their house. According to Mr. Fuerte, no one of them walks around barefooted.
They go to Rural Health Units and Public Hospitals for consultations and check-up. The family
utilizes health care services such as the Medicare account owned by Mr. Fuerte and his senior citizens
membership card which they use to avail discounts in medical services.















FIRST LEVEL ASSESSMENT
I. PRESENCE OF WELLNESS CONDITION
Readiness for enhanced capability for:
A. Health Maintenance and Management
Supporting cues: Ezrael and Michelle had their complete immunization: 1 BCG, 3 DPT, 3
OPD, 1Antimeasles and 3 Anti-Hepa B vaccines from the Rural Health
Unit of Batac, thus boosting their immunity and lowers the possibility to
be infected with diseases. All members wear slippers inside and outside
the house and use mosquito nets when sleeping.
B. Healthy Lifestyle
Supporting cues: The family eats more vegetables which are very nutritious. The family
members perform some exercises just like Mr. Fuerte who do his
routine walk every morning for at least 15 minutes and Ezrael often
goes out to play basketball.
C. Spiritual Well-being
Supporting cues: The family is very religious, attending church gathering 3 times a week
and prays regularly before meals.

II. PRESENCE OF HEALTH THREAT
A. Poor Environmental Sanitation
1. Improper garbage disposal and drainage system
Supporting cues: Their house is situated near the river with a lot of garbage and has a foul
odor and added to that their garbage is not properly segregated and
they also have an improper drainage system because their canal directly
drains to the river.

2. Presence of Breeding Sites of Vectors of Diseases
Supporting cues: They are prone to having dengue and malaria because they live near the
river with stagnant water and they have basins with water which are
not drained and these are all breeding sites for mosquitoes. Their things
inside their house are not kept properly and can be breeding places for
cockroaches that can cause diseases.

3. Poor Lighting
Supporting Cues: Poor lighting is experienced by the family as seen by the absence of
electricity in their home.



4. Poor Ventilation
Supporting Cues: Their house is congested because their things are not organized so there
is poor ventilation.

5. Air and Noise Pollution
Supporting Cues: They are beside the barangay road where many vehicles pass by,
causing noise pollution that can disturb the family especially during
resting hours and air pollution coming from their engines which can lead
to respiratory diseases.

B. Presence of Hereditary Diseases
Supporting cues: The children have risks of hypertension since Mr. Fuerte and his mother
have histories of hypertension

C. Threat of Cross-infection from a Communicable Disease
Supporting cues: Mr. Fuertes cough brings a threat to the other members health since
they live in a small house, sleep very close with each other and have
poor ventilation.
D. Faulty/Unhealthful nutritional/Eating Habits
Supporting cues: The other members of the family eats at the right time except for Ezrael
who delays his intake of lunch to 1:30-2:30 in the afternoon, his attitude
towards eating on time may affect his health and lead him to develop
gastritis, ulcer and the like. Sometimes, the Fuerte family does not have
the enough or required quantity of food or the viand thus inhibiting
them from getting the nutrients needed by their body.
E. Accident Hazards
1. Fire Hazards
Supporting cues: The family uses candle at night because they do not have electric
connection. Since their house is mainly made up of combustible
materials (unorganized galvanized iron sheets, plywood, tolda, and
some pieces of clothes), high probability of fire is expected.
2. Fall/Trip Hazards
Supporting cues: The flooring of their house is not leveled equally because it is only made
up of sand with embedded cement which they got from their old house.
They also dont have electricity and only use candles at night making
them prone to falling or tripping.
3. Pointed Sharp Objects
Supporting cues: Their walls and roof which are not high enough and are made of
galvanized iron sheets and woods/bamboo which are not properly
arranged are very pointed and sharp. These objects can cause injuries to
the members of the family.
4. Collapse of the House
Supporting cues: The house is not resistant to earthquakes and typhoon making it prone
to collapsing due to its poor foundation. Another is their house is
located in a cliff of the river and is very dangerous due to records of
landslide and soil erosion.


III. PRESENCE OF HEALTH DEFICITS
Supporting cues: The head of the family is suffering from chronic cough as diagnosed by a doctor.

IV. PRESENCE OF FORSEEABLE CRISIS SITUATIONS
A. Financial Constraints
Supporting cues: The monthly income of the family amounts just enough to meet the
basic needs of all its members. Unexpected expenses like needs of
Michelle in schooling may affect all the other needs of the family
B. Presence of Adolescent
Supporting cues: The presence of adolescent in the family hand-in-hand includes new
needs and further stretching of their budget, time and effort.
Misunderstandings between parents and children may occur and needs
of the child as an adolescent may add to the expenses (e.g. personal
hygienic needs)
















Scale for Ranking Family Health Problem According to Priorities

Presence of Breeding Sites of Vectors of Diseases
Criteria

Computation Actual Score Justification
Nature of the
Problem
(Threat)
2/3 x 1 0.67 Their house is located near the river
with stagnant water and there are
also basins full of water inside the
house and was found out to have
mosquito larvae, the family is prone
of having dengue and malaria. Their
house is not kept well so
cockroaches are present and may
cause diseases
Modifiability of
the Problem
(Partially
Modifiable)
1/ 2 x 2 1 Partially Modifiable because there
is no other place available for them
to stay except near the river, so
even they drain the possible
breeding sites of mosquitoes such
as their basins and they clean their
house, still there is the stagnant
water of the river as nests for
mosquitoes and the garbage in the
river as home for cockroaches.
Preventive
Potential
(Moderate)
2/3 x 1 0.67 The problem has only moderate
preventive potential because future
problems such as malaria, dengue
and other diseases caused by
mosquitoes, cockroaches and
rodents cannot be totally
prevented but can only be
minimized.
Salience of the
Problem
(Needing
Immediate
Attention)
2/2 x 1 1 The family perceived the problem
as a problem needing immediate
attention or resolution because it
threatens the health of the
members of the family
TOTAL 3.34





Poor Lighting
Criteria

Computation Actual Score Justification
Nature of the
Problem
(Health Threat)
2/3 x 1 0.67 The problem in poor lighting as
seen with the absence of electricity
is a health threat because having
poor lighting might lead to bumping
or tripping accidents for the family
or may lead to eye problems.
Modifiability of
the Problem
(Not
Modifiable)
0/ 2 x 2 0 The problem cannot be modified
because of the lack of resources
available (financial)
Preventive
Potential (Low)
1/3 x 1 0.33 The problem has a low preventive
potential because of the
unavailability of financial resources
to support the electrical
connection.
Salience of the
Problem (A
condition or
problem not
needing
immediate
attention)
1/2 x 1 0.5 The family considers it as a
condition /problem not needing
immediate attention because they
are more focusing on things like
Mr. Fuertes medicines, for
Michelles schooling and the food
for the whole family.
TOTAL 1.5




Poor Ventilation
Criteria

Computation Actual Score Justification
Nature of the
Problem
(Threat)
2/3 x 1 0.67 Poor ventilation is a health threat
as evident with their congested
house due to unorganized things,
and it may cause difficulty in
breathing and due to poor air
circulation heat stroke are very
prone to happen.
Modifiability of
the Problem
(Easily
Modifiable)
2/ 2 x 2 2 The problem is easily modifiable
since they have the human
resources and they have the
knowledge on how cleaning and
organizing their house could
improve the circulation/ventilation
of their house.
Preventive
Potential (High)
3/3 x 1 1 It has a high preventive potential
since they have human resources
and does not need a big amount of
money to solve the problem.
Salience of the
Problem (Not
Needing
Immediate
Attention)
1/2 x 1 0.5 The family perceived the problem
as a problem not needing
immediate attention or resolution
because there is no time for them
to clean and organize their things in
the house.
TOTAL 4.17



Improper Garbage Disposal and Drainage System
Criteria

Computation Actual Score Justification
Nature of the
Problem
(Threat)
2/3 x 1 0.67 The problem is a health threat
because it may cause certain
diseases that would come from the
improperly segregated garbage and
from the improper drainage system
of the family. Some of these
diseases are respiratory diseases
which are cause by the foul odor of
the garbage and the water from
their drainage system.
Modifiability of
the Problem
(Not
Modifiable)
0/ 2 x 2 0 The problem is not modifiable since
they dont know the importance of
segregating garbages, no one in the
family has the time to segregate
garbage and make a good drainage
system.
Preventive
Potential (Low)
1/3 x 1 0.33 They have inadequate knowledge
regarding the problem and no one
in the family has the time to resolve
the problem.
Salience of the
Problem (Not
Needing
Immediate
Attention)
1/2 x 1 0.5 The family perceived the problem
as a problem not needing
immediate attention or resolution
because there is no time for them
to segregate garbage and make a
good drainage system.
TOTAL 1.5
Fire Hazards
Criteria

Computation Actual Score Justification
Nature of the
Problem
(Threat)
2/3 x 1 0.67 The problem is a threat to the
familys safety and health. This is
because their house is mainly made
up of combustible materials
(unorganized galvanized iron
sheets, plywood, tolda and pieces
of clothes).
Modifiability of
the Problem
(Partially
Modifiable)
1/ 2 x 2 0.5 Partially Modifiable because they
have enough knowledge in the
prevention of fire, the only problem
is inadequate resources of the
family and financial constraints in
changing the composition of the
house.
Preventive
Potential
(Moderate)
2/3 x 1 0.67 Prevention of fire would be
moderate because the family can
be extra careful when using candles
despite the combustible materials
around them.
Salience of the
Problem (
Needing
Immediate
Attention)
2/2 x 1 1 The family considers it as a problem
needing an immediate action
because they believe that fire is
very dangerous that can cause
accident to the members of the
family and even death.
TOTAL 3.17



Noise and Air Pollution
Criteria

Computation Actual Score Justification
Nature of the
Problem
(Threat)
2/3 x 1 0.67 The vehicles that pass by their area
are sources of noise and air
pollution as they emit loud sounds
and smokes so it is a threat to the
family health because air pollution
can cause illnesses in the
respiratory system and noise
pollution disturbs the family when
resting or relaxing especially when
they are sleeping.
Modifiability of
the Problem
(Not
Modifiable)
0/ 2 x 2 0 Not modifiable because they
cannot do anything with regards to
the vehicles that are passing by in
their area and they cannot find any
place that is available and far from
pollution.
Preventive
Potential (Low)
1/3 x 1 0.33 The problem has a low preventive
potential since the family cannot
find any place where they can
transfer temporarily and lacks
financial resources for them to
build their own house which will be
far from pollution.
Salience of the
Problem (
Needing
Immediate
Attention)
2/2 x 1 1 The family is also concerned with
their present situation and
considers the problem to have
immediate attention .
TOTAL 2




Fall and Trip Hazards
Criteria

Computation Actual Score Justification
Nature of the
Problem
(Threat)
2/3 x 1 0.67 Their flooring is not leveled equally
because it is made up of sand and
embedded pieces of brocken
cements and this increases the risk
for tripping and falling and is
considered as threatening to their
health.
Modifiability of
the Problem
(Not
Modifiable)
0/ 2 x 2 0 Not modifiable since they dont
have any means of reconstructing
their flooring due to financial
deficiency and the lack of human
resources.
Preventive
Potential (Low)
1/3 x 1 0.33 The problem has a low preventive
potential since they dont have the
manpower as well as the money to
make some modifications on their
flooring.
Salience of the
Problem ( Not
Needing
1/2 x 1 0.5 The family consider it as a problem
not needing an immediate
attention since they are prioritizing
Immediate
Attention)
the food for the family, medicine of
Mr. Fuerte and the education of
Michelle.
TOTAL 1.5




Pointed Sharp Objects
Criteria

Computation Actual Score Justification
Nature of the
Problem
(Threat)
2/3 x 1 0.67 While standing, reaching for an
object and specially walking, there
is a high risk of bumping to the very
sharp galvanized iron sheets and
not well-arranged woods of the
walls and not those high roofs. The
embedded cements of the floor are
also very sharp and may also cause
injuries to the legs and feet.
Modifiability of
the Problem
(Not
Modifiable)
0/ 2 x 2 0 It is not modifiable because they
dont have money to reconstruct or
repair their house.
Preventive
Potential (Low)
1/3 x 1 0.33 The problem has a low preventive
potential because of insufficient
budget for the repair of the house.
Salience of the
Problem ( Not
Needing
Immediate
Attention)
1/2 x 1 0.5 The family perceives it as a problem
although they dont give necessary
action to it such as its repair
because there are more important
things needed by the family that
they must attend first.
TOTAL 1.5











Collapse of the House
Criteria

Computation Actual Score Justification
Nature of the
Problem
(Threat)
2/3 x 1 0.67 Their house is made up of scraps
from their old house producing a
very weak foundation against
strong rains and winds during a
typhoon and during earthquakes. It
is also near the cliff of the river so
there is a high risk of soil erosion
and landslide thus very hazardous
on the part of the family.
Modifiability of
the Problem
(Not
Modifiable)
0/ 2 x 2 0 It is not modifiable because they
dont have money to reconstruct or
repair their house.
Preventive
Potential (Low)
1/3 x 1 0.33 The problem has a low preventive
potential because of insufficient
budget for the repair of the house
and for the construction of their
house in a different place.
Salience of the
Problem ( Not
Needing
Immediate
Attention)
1/2 x 1 0.5 The family perceives it as a problem
although they dont give necessary
action to it such as its repair and
reconstruction because there are
more important things needed by
the family that they must attend
first.
TOTAL 1.5




Hereditary Diseases
Criteria

Computation Actual Score Justification
Nature of the
Problem
(Threat)
2/3 x 1 0.67 Their family shows a history of
hypertension so Ezrael and
Michelle are at risk of inheriting this
disease.
Modifiability of
the Problem
(Partially
Modifiable)
1/ 2 x 2 1 It is partially modifiable because
they have a knowledge on what is
hypertension and its causes so they
can do precautionary measures to
lessen the occurrence of
hypertensions, this include their
healthy lifestyle.
Preventive
Potential
(Moderate)
2/3 x 1 0.67 The problem has a low preventive
potential because of insufficient
budget for the repair of the house
and for the construction of their
house in a different place.
Salience of the
Problem ( Not
perceive as a
problem
needing a
change)
0/2 x 1 0 The family doesnt perceive it as a
problem since they said that it is
not present yet.
TOTAL 2.34



Threat of Cross Infection from a Communicable Disease
Criteria

Computation Actual Score Justification
Nature of the
Problem (Threat)
2/3 x 1 0.67 The problem is a threat to the
health of the family since cough can
be easily transferred from one
person to another.
Modifiability of
the Problem
(Partially
Modifiable)
1/ 2 x 2 1 The condition is partially modifiable
because the family has a positive
attitude in improving their
ventilation to lessen the risk for
cross-infection. They can achieve a
well-ventilated house through
willingness and effort to clean their
house. The only problem is the
close interaction they engage in,
which cannot be avoided.
Preventive
Potential
(Moderate)
2/3 x 1 0.67 Preventive potential is moderate
since they have human resource
and manpower available for them
to do the task of cleaning their
house to improve their ventilation.
Salience of the
Problem (A
condition/problem
not needing
immediate
attention)
1/2 x 1 0.5 The family considers the condition
as a problem but is not giving much
attention to it because they think
they could easily treat it.
TOTAL 2.84

Faulty Nutritional Habits and Unhealthful Eating Habits
Criteria

Computation Actual Score Justification
Nature of the
Problem
(Threat)
2/3 x 1 0.67 The family dont have enough food
sometimes and Ezrael eats late
during lunch time, so it is a health
threat because it may cause
malnutrition among the members
of the family and may cause
gastritis and ulcer respectively.
Furthermore it may aggravate their
present illnesses and affect their
work and activities of daily living
Modifiability of
the Problem
(Partially
Modifiable)
1/ 2 x 2 1 The problem is partially modifiable
because they know the effects of
eating nutritious foods and not
eating on time but their only
problem is financial.
Preventive
Potential
(Moderate)
2/3 x 1 0.67 The preventive potential of the
problem is moderate since they
have the knowledge regarding the
right nutrition they must get from
the food they eat and the effects of
not eating on time.
Salience of the
Problem
(Needing
Immediate
Attention)
2/2 x 1 1 The family perceived the problem
as a problem needing immediate
attention or resolution because it
threatens the health of the
members of the family.
TOTAL 3.34




Presence of Cough
Criteria

Computation Actual Score Justification
Nature of the
Problem(Health
Deficit)
3/3 x 1 1 The problem is a health deficit
because it already exists and affects
the functioning of Mr. Fuerte who
is suffering from the disease. It
affects the way he lives and his
activities such that he can no longer
perform tasks he need to do for his
family.
Modifiability of 1/ 2 x 2 1 The condition can only be modified
the Problem
(Partially
Modifiable)
partially because although Mr.
Fuerte religiously takes his
medicine, their environment takes
a great role in his recovery of the
illness.
Preventive
Potential
(Moderate)
2/3 x 1 0.67 The condition may be moderately
prevented since Mr. Fuerten is
taking his medicines to treat the
illness.
Salience of the
Problem
(Needing
Immediate
Attention)
2/2 x 1 1 They perceive it as a problem
needing immediate attention
because it makes Mr. Fuerte suffer
too much.
TOTAL 3.67




Financial Constraints
Criteria

Computation Actual Score Justification
Nature of the
Problem(Foreseeable
crisis)
1/3 x 1 0.33 The problem is a foreseeable crisis
because the monthly income of the
family amounts just enough to
meet the expenses of the whole
family. It may be a problem in the
future if there are emergencies the
family would meet.
Modifiability of the
Problem (Not
Modifiable)
0/ 2 x 2 0 It is not modifiable since they
cannot avoid the different
expenses of the family and there
are no other income generating
activities of the family.
Preventive
Potential(low)
1/3 x 1 0.33 The problem has a low preventive
potential because the family
cannot make their financial
resources to be stretched because
of the many expenses of the
family.
Salience of the
Problem (Needing
Immediate
Attention)
2/2 x 1 1 The family perceives it as a
problem needing an immediate
attention because they are very
much bothered with the times that
they have no meals and if they
dont have any money when
emergency arises.
TOTAL 1.66



Presence of Adolescents
Criteria

Computation Actual Score Justification
Nature of the
Problem(Foreseeable
crisis)
1/3 x 1 0.33 The problem is a foreseeable crisis
because the presence of
adolescents in the family hand-in-
hand includes new needs and
further stretching of their budget,
time and effort. Misunderstandings
between parents and children may
occur and needs of the child as an
adolescent may add to the
expenses of the family.
Modifiability of the
Problem (Partially
Modifiable)
1/ 2 x 2 1 The problem cannot be changed or
modified completely but the family
effects of it can only be minimized
through getting ready for its
possible effects.
Preventive
Potential(moderate)
2/3 x 1 0.67 The problem in only moderately
prevented because adolescence is
a stage of human life that is really
critical and faces a lot of problem
that may include the family but
considering the effects before it
happens is very important.
Salience of the
Problem (Not
perceived as a
problem)
0/2 x 1 0 The family does not perceives it as
a problem needing attention
because they said that they will
thick of it when the time that the
presence of adolescent will give
them a problem.
TOTAL 2





Ranking of Health Problems
Problem

Poor Ventilation

Health Deficit

Faulty Nutritional Habits and Unhealthful
Eating Habits

Presence of Breeding Sites of Vectors of
Diseases

Fire Hazards

Threat of Cross Infection from a Communicable
Disease

Hereditary Diseases

Noise and Air Pollution

Presence of Adolescents

Financial Constraints

Collapse of the House

Pointed Sharp Objects

Fall and Trip Hazards

Poor Lighting

Improper Garbage Disposal and Drainage
System





Total Score

4.17

3.67

3.34


3.34


3.17

2.84


2.34

2

2

2

1.5

1.5

1.5

1.5

1.5




Second Level Assessment
Poor ventilation
-Inability of the family to provide a home environment conducive to health maintenance and personal
development due to inadequate family resources for house maintenance and the absence of human
resources (responsible member who can maintain a clean environment)as manifested by the
unorganized condition of their house which adds to the congestive situation of their house thus
preventing proper ventilation of the house.
Presence of Breeding Sites of Vectors of Diseases
-inability of the family to provide a home environment conducive to the health maintenance and
personal development due to members preoccupied with their own concerns/interests and absence of
good place to build a house and lack of knowledge of importance of hygiene and sanitation as
manifested by the unorganized condition of the house which can be resting sites for cockroaches and
the river that could be breeding sites of mosquitoes
Presence of Poor Lighting
-Inability of the family to provide a home environment conducive to health maintenance and personal
development due to inadequate family resources specifically financial resources as manifested by the
use of candles for lighting purposes by the family at night time and inability to provide an electrical
connection at their house.
Presence of Air and Noise Pollution
-Inability to provide a home environment conducive to health maintenance and personal development
due to lack of knowledge of the importance of hygiene and sanitation as manifested by the windows
without cover for them to minimize the air and noise pollutants that enters the house that are produced
by vehicles passing by their place and the garbage that are in the river.
Faulty nutritional Habits and Unhealthful Eating Habits
-Inability to meet bodys daily nutritional requirement due to lack of resources and faulty eating time as
manifested by their body size and condition and their low BMI.
Fire Hazards
-inability to provide a home environment conducive to health maintenance and personal development
due to the risk of fire in their house as manifested by the combustible materials that make up the house
and the use of candles at night.


Pointed Sharp Objects
-inability to provide a home environment conducive to health maintenance and personal development
due to lack of skill in carrying out measures to improve home environment as manifested by the
unarranged galvanized iron sheets and woods for their walls and not high roofs.
Financial Constraints
-Inability to earn enough money to support and provide for the familys basic needs due to a lot of
expenses shouldered by the family as manifested by the absence of meals(sometimes), absence of
electricity and own water supply.
Fall/Trip Hazards
-Inability to provide a home environment conducive to health maintenance and personal development
due to inadequate resources specifically financial resources that can be used for the
repair/reconstruction of the house as manifested by unequally leveled floor due to its components: sand
with embedded pieces of cements.
Cross Infection of Communicable Disease (Cough)
-Inability to provide a home environment conducive to health maintenance and personal development
due to insufficient knowledge to avoid exposure to infected persons as manifested by the close contact
of the other members of the family to Mr. Fuerte who is suffering from cough.
Presence of Adolescent
-Inability to make decisions with respect to taking appropriate health action due to low salience of the
problem/condition as manifested by the low attention given to the adolescent.









Family Coping Index
AREA

RATE JUSTIFICATION
Physical Independence 5 All the family members have the
ability to meet all their needs
independently without
interruption or undue delay
They are able to do their ADL
and are able to provide care to
themselves and other members
of the family.

Therapeutic Competence 5 The family members are able to
carry out prescribed treatments
safely and efficiently with the
understanding of the principles
involved as shown by knowledge
of proper intake of medications
prescribed to him and takes
them on time at the right
amount; he is also able to
manipulate the Rotahaler given
to him.

Knowledge of Health Condition 3 The family knows general
information regarding their
health condition yet there are
necessary data they do not know
about that certain condition.
Their cultural backgrounds how
they look at their health
conditions especially the reason
behind it.

Application Of Principles of
General Hygiene
3 The family is able to meet some
of the principles of proper
hygiene but generally they did
not meet the necessary hygiene
measures.
The Fuerte family cant meet or
provide the balanced diet and
adequate amount of nutrients,
they also do not practice proper
handling of food, and however
the family had secured a
complete immunization for the
children.

Health Attitude 5 Understand and recognizes
needs for medical care in illness
is for the usual preventive
services; accepts illness calmly
and recognizes the limits it
impose while doing all possible
to effect recovery and
rehabilitation.
The family their need for
assistance and consultations
from health care facilities and
thus all the possible measures:
limiting themselves from
harmful practices so as to
promote wellness.

Emotional Competence 3 Almost all the members of the
family shows a degree of
integrity and maturity yet not all
of them have the same string of
emotional integrity because of
peer influence. Mr. and Mrs.
Fuerte aspire for their children
to have a happy and fruitful
living.

Family Living 3 The family interacts with each
other with enough respect for
each member; they can
understand one another but do
not do everything together.
Ezrael, the son, do not usually
participate in the family affairs
and has habits, specifically
always going out with friends,
which interfere with the unity of
the family.

Physical Environment 1 The family resides in a weak
house with a weak foundation
and poor sanitation. They do not
have an environment suited for a
wellness condition. It actually
one of the aggravating factors of
their poor health conditions; it
has poor ventilation, poor
lighting, improper drainage,
improper waste management
and the like.

Use of Community Facilities 3 The family is aware of and uses
some but not all of the available
community resources that they
need. The family is aware of
community resources and health
care facilities and makes use of
these facilities in case of health
problems.