FAMILY NURSING CARE PLAN

AS HEALTH ADVOCATES IN THE SOCIETY, WE ARE OBLIGED TO MAINTAIN OR RESTORE THE OPTIMUM HEALTH OF THE PEOPLE WITHIN THE COMMUNITY AND THAT AIM WE HAVE AS ACTIVELY PARTICIPATING STUDENT NURSES OF THIS GENERATION, WE ADHERE TO THE PROBLEMS OF OUR FAMILY, WHICH IS THE BASIC UNIT OF THE SOCIETY AND THE MOST IMPORTANT COMPONENT OF OUR COUNTRY. WE MET THE FAMILY FOR THE FIRST TIME LAST JANUARY 15, 2010 AT SAN ROQUE SEASIDE, LAPASAN, CAGAYAN DE ORO CITY. THEIR GEOGRAPHICAL LOCATION IS READILY ACCESSIBLE BECAUSE YOU DON’T TO RIDE A “TRISIKAD” IN ORDER FOR YOU TO LOCATE THE PLACE; INSTEAD, WE TOOK A WALK IN ORDER FOR TO REACH THE PLACE. THE HEAD OF THE FAMILY IS MR. EUSEBIO AGBONG, A 48 YEAR OLD ORIGINAL RESIDENT OF BARANGAY LAPASAN. HE IS LIVING TOGETHER WITH HIS WIFE, MRS. FLORDELIZA AGBONG, 39 YEAR OLD NATIVE FROM TALAKAG, BUKIDNON AND HIS FIVE CHILDREN. THE HEAD OF THE FAMILY IS A SECURITY GUARD FROM THE SAGITTARIUS AGENCY AND CURRENTLY WORKING AT GUSA, MINDANAO TRACKING CORPORATION AND EARNS AT APPROXIMATELY PHP 7,000 PER MONTH REGARDLESS WITH THE EXPENSES AT HOME AND DAILY NEEDS. THE HUSBAND SELDOM DRINKS AND SMOKE BECAUSE OF HIS NIGHT DUTY SHIFT WHILE FLORDELIZA IS A PLAIN HOUSEWIFE WHO’S FOCUS IS TO TAKE CARE OF THE CHILDREN ESPECIALLY THEIR YOUNGEST SON WHO ALWAYS ACQUIRES SUCH ILLNESSES. AS THE REAL AIM OF THE NURSING PROFESSION WHICH IS TO GIVE CARE TO THE PEOPLE, WE TOOK IT AS A STEPPING STONE IN HELPING THE FAMILY IN MAKING THEM REALIZE THE ESSENCE OF A SIMPLE YET HEALTHY LIFE THROUGH MANY WAYS OF LIVING. WE ARE ALSO RESPONSIBLE FOR GIVING OUR FAMILY THE IMPORTANCE OF PRIORITIZING SUCH HEALTH PROBLEMS WHETHER A HEALTH DEFICIT OR THREAT IN ORDER TO GIVE SPECIFIC ACTIONS FOR US, TOGETHER WITH THE COOPERATION OF THE FAMILY, TO ACHIEVE, SOLVE, REDUCE AND/OR COMPLETELY ELIMINATE THE DIFFERENT KINDS OF PROBLEMS THROUGH ESTABLISHING A GOOD FOUNDATION OF PRIORITIZING ACTIONS AND CARE TO PROMOTE, PREVENT OR KEEP

I. INTRODUCTION

AS HEALTH PROVIDERS OF THIS SOCIETY, WE OUGHT TO GIVE OUR ALL IN ORDER TO HELP THE PEOPLE IN THIS COMMUNITY ACHIEVE THEIR MAIN GOAL--- THE HEALTH YET JOYFUL LIFE. A BIG AND UNENDING THANKS TO OUR CLINICAL INSTRUCTOR, MS. DOREEN GRACE CONTRERAS, RN, WHO BROUGHT OUR IDEAS AND OUR CLINICAL EXPERIENCES INTO MORE PRODUCTIVE YET HELPFUL TO ALL THE PEOPLE IN THE COMMUNITY BECAUSE THROUGH HR FUN-FILLED WAY OF TEACHING, WE ARE ABLE TO INCULCATE IN OUR MINDS AND MOST ESPECIALLY TO OUR HEARTS THE IMPORTANCE OF HELPING FAMILY IN A CERTAIN COMMUNITY TO ACHIEVE THEIR OPTIMUM HEALTH WHICH IS PREDOMINANTLY THE AIM OF THIS PROJECT. SHE ENHANCED OUR CAPABILITIES IN GIVING CARE TO THE PEOPLE WHO NEEDED THE MOST OUT OF IT. IN ADDITION, WE CAN’T ALSO FORGET THE ENDLESS EFFORT OF THE HEALTH CARE PROVIDER RESIDING AT SAN JUAN LAPASAN HEALTH CENTER AS WELL AS TO THE BARANGAY HEALTH WORKERS AND MOST ESPECIALLY TO THE PUBLIC HEALTH NURSE OF THE BARANGAY, MR. REX RANILE, RN, WHO TAUGHT US HOW TO GIVE IMPORTANCE TO THE FAMILIES ESPECIALLY TO THOSE INDIGENT PEOPLE. THE SAID ACTION WILL NEVER BE ATTAINED WITHOUT THE COURAGE AND SELFLESS EFFORT OF MY GROUP MATES: LYRA, RIEZEL, CRYSTAL, IRISH, HANNAH AND JAIRUS, WHO TOOK THIS CHALLENGE SERIOUSLY AND DID IT WITHOUT ANY HESITATIONS TO HELP A FAMILY WHO NEEDED MUCH CARE FROM US TROUGH THE SLEEPLESS NIGHTS THAT WE HAD, AND THE MONEY, TIME, AND EFFORT THAT WE EXERTED, SHARED AND SACRIFICED, THE PROJECT BECAME POSSIBLE THAT I CAN SAY, IT ALL WORTH IT. WE WOULD NEVER FORGET THE BIG HELP OF OUR ALMIGHTY GOD, THE CREATOR OF ALL LIVING AND NON-LIVING THINGS AND WHO PROVIDED ALL THE RESOURCES THAT WE NEED IN ORDER TO GIVE THE NECESSARY CARE TO OUR CHOSEN FAMILY. HE MIRACULOUSLY MADE THINGS POSSIBLE THROUGH GIVING US KNOWLEDGE, THE ABILITIES AND THE RESOURCES THAT WE NEED. HE HELPED US IN MANY WAYS AND WE UNDOUBTLY APPRECIATE IT AND WE GIVE HIM ALL OUR PRAISES. IN ACCORDANCE TO THE VISION OF THE DEPARTMENT OF HEALTH IN THE PHILIPPINES: “THE LEADER OF HEALTH IN ALL FILIPINOS IN THE PHILIPPINES”, WE, IN THE LEAST THAT WE DID, CONTRIBUTED TO ITS VISION THROUGH GIVING OUR WILLINGNESS AND DETERMINATION TO DEVOUT OURSELVES IN GIVING CARE TO OUR FILIPINO COUNTRYMEN AND SOMEDAY, AS WE GO ON WITH OUR CHOSEN PROFESSION, WE WILL BE ABLE TO GIVE CARE ALSO TO ALL THE PEOPLE IN THE WORLD NOT JUST FILIPINOS REGARDLESS WITH THEIR

II. ACKNOWLEDGEMENT

BIOGRAPHICA L DATA

A. FAMILY STRUCTURE AND HARACTERISTICS HEAD OF THE FAMILY AGBONG EUSEBIO FIRST NAME

   

  48

LAST NAME AGE ADDRESS:

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  SEASIDE SAN ROQUE, LAPASAN, CAGAYAN DE ORO CITY

NAME

MEMBERS OF THE FAMILY
AGE SEX CIVIL STATUS Married POSITION IN RELATIONSHIP THE FAMILY TO THE FAMILY Wife Wife PLACE OF RESIDENCE 39 F Seaside, San Roque, Lapazan Seaside, San Roque, Lapazan Seaside, San Roque, Lapazan Seaside, San Roque, Lapazan Seaside, San Roque, Lapazan Seaside, San Roque, Lapazan

Flordeliza Agbong Marlon Agbong

18

M

Single

Eldest Son

Son

Candy Agbong17

F

Single

2nd child

Daughter

Cindy Agbong 16

F

Single

3rd child

Daughter

Mary Jane Agbong Aldren Agbong

8

F

Single

4th child

Daughter

2

Single

5th child

Son

B. BIOLOGICAL AND SOCIOCULTURAL FACTORS
1. What is the family’s source of income?  The family’s source of income is from the husband only. The husband works as a security guard at Gusa, Mindanao Tracking Corporation from the Sagittarius Agency. He works about an average of 8 hours/day. His monthly income averages Php 7,000 per month.   2. What is their ethnic background? Their religious affiliation?  When it comes to their ethnic background, the husband is purely Kagay-anon while the wife is from Talakag, Bukidnon. They are currently residing at San Roque Seaside, Lapasan Cagayan de Oro City. The rest of the members of the family speak Visayan. They are “Philippinista” but their first born son separately goes to church at United Christian Church of the Philippines (UCCP). 

3. Who are the family’s significant others? What roles do they play in the family’s life?  The family’s significant others are their inlaws, siblings of the husband and their children who lived next to their home. The role of their significant others is to help them in times of need just like emotional and most especially during financial problems.

4. Does the family participate in the activities of the community? If yes what are these activities. If no, what are the reasons why they do not participate?  Yes, family participates in the activities of the community like feeding programs; outreach programs and community clean up of the

C. ENVIRONMENTAL FACTORS
1. Housing  a. Is the family’s living space adequate for their number?  The family’s living space is inadequate for their number. It has one room in near their kitchen for the couple and small portion upstairs for their five children. All the children sleep together in one room including the 2 year old boy.


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b. Is their furniture adequate for them? Is it enough for their needs? The family’s furniture is enough for their needs. They have one table, small cabinet for their TV and DVD and small sofa for their visitors but their kitchen utensils do not sustain their needs. c. Are their insects and rodents in their house?

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d. Are their accident hazards in and around the house? If yes, please enumerate.  The house is made of light materials. They cooked their foods inside the house using liquefied petroleum gas (LPG) but sometimes if they ran out of LPG, they used to cook their food inside the house using the “kahoy” located in the ground beside the wall. This can cause fire and considered as hazardous to well being of all the members of the family. The wirings are too close to each other that might result to a short circuit that will eventually lead to fir The house is always affected by flood due to its location and structure since their house is not elevated, thus, causes the water to go inside and flood their things inside.  e. What are their cooking utensils? What is their storage?  Their cooking utensils include only of one small frying pan and pots. They use plastic ware for their food. They don’t have enough storage for their utensils because some utensils are just place in the anywhere. In addition, they have poor food storage because they don’t have the refrigerator, thus, their food must be all consumed in order for the food not to become spoiled. 

f. What is their water supply? Where is the source? Is it potable?  They do not have their own water supply. The source of their drinking water is from the Cagayan de Oro Water District (COWD), government own free for the residents in their place. They wake up early and gather some water and store it in the plastic container, which is slightly dirty.    g. What is their toilet facility? What is its condition? Is it sanitary?  The family does have a toilet of their own but it somewhat unsanitary. It is open and located at the corner of their kitchen beside the unprotected stairs. It is water –sealed type of toilet with black dirt surrounded on it. The only barrier to their toilet from the other parts of the house is the bathroom curtains only, thus, when someone defecates, all the family members will know because they can

h. What is the type of their garbage and refuse disposal system? Is it sanitary?  They use sack for their garbage, which is collected by the garbage truck every Tuesday. It has no cover and the flies are all around but as we go on with our assessment we found out that there are scattered trashes at the back of their house situated beside the toilet.

i. Describe their drainage system. Is it sanitary?  The drainage system is closely sealed but still it is smelly and unsanitary since they do not have the willingness to clean their drainage.

2. What type of neighborhood does the family belong to? Describe.  The type of their neighborhood is like squatter’s area. They belong in a low-income level family. It is noisy, crowded and cannot accessed by vehicles especially fire trucks.   3. Are their social and health facilities in the neighborhood? If yes, please enumerate and describe each?  In terms of their social facilities, they have basketball court 30 meters away from their house. They also have a Catholic Church in the area. As to health facilities, there is a health center which is approximately 45 meters away from their house   4. What is the family’s mean of communication and transportation?  The family has a television and a radio as a means of communication. His oldest son has a cell phone for emergency cases. Their means of

D. HEALTH AND MEDICAL HISTORY
1. Medical and health history of each family member.  The children of the Agbong Family already completed their immunization as evidenced by immunization record situated at the San Roque Health Center that was provided by the Barangay Health Worker (BHW). Vaccines given were one dose of BCG, 3 doses of OPV, 3 doses of Hepa B, 1 dose of measles. The youngest son of the family, Aldren experienced hospitalization during the year 2008 because of diarrhea. There is no further passed hospitalization experienced by the children of the said family. Currently, Aldren is suffering from diarrhea but they did not consult yet any doctors because according to the mother it is not yet severe and the child is still responding effectively.   2. Value placed on disease prevention.  a. Are the children immunized? What is their immunization status?  All of the five children were fully immunized because they availed the immunization program

IMMUNIZATIONS RECEIVED BY THE CHILDREN OF THE SAID FAMILY:
Child’s Name Marlon Agbong Candy Agbong Cindy Agbong Mary Jane Agbong Aldren Agbong DPT BCG OPV Hepatitis B Measles

b. Does the family utilize other preventive actions? If yes, what are they?  The family does not have other preventive actions.   3. What is the family’s source of medication?  The family’s source of medication is from their health center. These medications include paracetamol (biogesic) and amoxicillin. If and when that one of their family members will get severe illness they often borrow money with the siblings of the husband.

4. What are their perception of the role of the health professional and their services? What are their expectations of the services of the community health? Nurse?  They have high respect for the health professionals. They were contented with the free services given by the health workers since they were treated very well regardless of their economic status.   5. Do they have previous experience with the health professionals? If yes, were they satisfied with the results?  Yes, They have previous experience with the health professionals. It was when they consulted at the health center and their youngest son was hospitalized in NMMC. So far all health professionals they have encountered treated them well. They were satisfied of the services.

E. TYPE OF FAMILY STRUCTURE
 Patriarchal  Extended  Matriarchal  Single Parent  Nuclear  Alternate Family  1. Dominant family members in terms of decision making, especially in health care.  The husband and wife often share the obligation of making decisions relative to health care. The father predominantly makes the decision regarding with the activities of the family. But when it comes to caring the sick family member it is the mother who take good care of them.   2. Describe the general family relationship.  As what we have observed, the family has a good, harmonious relationship. The husband does not have any vices but drinks occasionally like during fiestas and birthdays. The husband is responsible enough to provide the family’s needs while the wife is taking good

IV. ACTIVITIES FOR DAILY LIVING A. SLEEPING PATTERN   1. Are there hours for retiring and getting up?
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All of the family members wake up at 5 am because they have their own chores to do and they prepare themselves for school. 2. Do the family nap during the day? Only the mother and her youngest son can nap during the day because the husband is working while the rest are at school. They usually nap at around 2 pm of the day after house hold chores and after watching noon time show. 3. Do the members of the family sleep together? The couple sleep together in their bed beside the kitchen while the children sleeps together also in the other

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B. EATING PATTERN 1. How many meals do the family have each day? The family can eat three meals a day. Their meals usually consist of vegetables, sardines and dried fish. They eat snacks sometimes during afternoon. But sometimes when they are out of budget, they take their meals twice only. 2. Does anyone of the family appear over weight or under weight? Who they are?

 

Members

Age

Weight

Height

BMI

Classific ation

Eusebio (father)

48

61 kg

160 cm

23.82

Normal

Flordeliza (wife)

39

52kg

158 cm

20.82

Normal

Marlon

18

48kg

157cm

19.47

Normal

Candy

17

39kg

155cm

16.23

Underwe ight Underwe ight Underwe ight underwei ght

Cindy

12

26 kg

138cm

13.65

Mary Jane

8

24 kg

133cm

13.56

Aldren

2

10kg

82cm

14.87

C. LEISURE TIME ACTIVITIES  1. How does each member spend his/ her leisure hours? Is the leisure time appropriate for the sex and age group of the individual?  The father does not have leisure time because he is at work and when if it’s his off day he spent it by resting in the house. He leaves early for work and went home late. The mother does not also have leisure time because she’s so busy doing laundry and giving care to the children.    2. Does any member have an all- consuming hobby? If yes, What affects does this on the family.  Any of the family does not have any all- consuming hobbies because they prioritized their work rather than their hobbies.


3. Does the family have any joint activity for leisure? What is it? How often do they do this limited activity? The family’s joint activity includes attending church

WHAT ARE THE PROBLEMS THAT WERE IDENTIFIED?

1. UNSANITARY TOILET

2. PRESENCE OF BREEDING PLACES OF INSECTS AND RODENTS

3. MALNUTRITION
 

4. IMPROPER GARBAGE DISPOSAL

5.

FAMILY HISTORY OF SPECIFIC CONDITION (HYPERTENSION)

6. INADEQUATE LIVING SPACE

7. ACCIDENTAL HAZARDS

8. FAMILY BEYOND WHAT FAMILY RESOURCES CAN ADEQUATELY PROVIDE

9. LACK OF FOOD STORAGE FACILITIES
 

10. INADEQUATE PERSONAL BELONGINGS UTENSILS

RANK 1

VIII. RANKING OF THE 10 FAMILY HEALTH PROBLEMS
SCORE 4.17 4.17 FAMILY HEALTH PROBLEMS UNSANITARY TOILET PRESENCE OF BREEDING PLACES OF INSECTS AND RODENTS MALNUTRITION IMPROPER GARBAGE DISPOSAL FAMILY HISTORY OF SPECIFIC CONDITION (HYPERTENSION) INADEQUATE LIVING SPACE ACCIDENTAL HAZARDS FAMLY BEYONG WHAT FAMILY RESOURCES CAN ADEQUATELY PROVIDE LACK OF FOOD STORAGE FACILITIES INADEQUATE PERSONAL BELONGINGS UTENSILS

2 3 4 5 6

4 3.84 3.83 3.17 2.84 2.84

7

2.67 2.67

NURSING CARE PLAN

Health Problems

Family Nursing Problem

Goal of Care (General)

Objective of care (specific)

Intervention Measures

Method of Resources Nurse-Family Required Contact -Time -Effort -Money -Camera -Weighing Scale -Tape Measure (for BMI) -Notebook -Pen -BMI chart

Evaluation

Malnutrition Underweight BMI of the following family members: = Candy (17 years old) -

- Inability to recognize - After the nursing -After a month of nursing Home Visit the problem of intervention, the family will intervention, the family -Emphasize the malnutrition due to: be able to: will be able to: importance of Ignorance of facts that • Perform the • Improve the weight proper nutrition some of the family -Teach the family importance of nutrition of the malnourished members are on proper food among the family child with the help of malnourished preparation members through their the health teachings Fear of Consequences - Enumerate the actions of abstaining being taught to eat 16.23 of diagnosis of problem unhealthy food. various kinds of food. advantages and =Cindy (12 related to economic. • Identify cheaper yet • Demonstrate the disadvantages of years old) - Inability to make nutritious and healthy proper way of preparingmalnutrition 13.65 decisions with respect to foods - Identify cheaper nutritious food. =Mary Jane (8 taking appropriate health nutritious and years old) actions due to: healthy foods 13.56 Low salience of the =Aldren (2 family about the existing years old) problem of malnutrition 14.87 in the family. Inability to decide which action action to take among the list alternatives I order to be healthy. Fear of consequences of action related to economic.

Goals partially met: -They are able to perform the importance of nutrition through abstaining unnecessary food like “junk” foods. and able to identify cheaper nutritious and healthy foods but fail to demonstrate the importance of food preparation due to the location of their kitchen and the lack of necessary utensils.

Health Problems

Family Nursing Problem

Goal of Care (General) Objective of care (specific)

Intervention Measures

Method of Resources Nurse-Family Required Contact -Time -Effort -Money -Camera -Weighing Scale -Tape Measure (for BMI) -Notebook -Pen -BMI chart

Evaluation

Unsanitary Toilet

- Inability to make decisions with respect to taking appropriate health action due to: Fear of consequences of action secondary to economic -Inability to recognize the presence of a problem due to: Ignorance of facts that unsanitary toilet might cause the spread of any kinds of infection.

- After the nursing -After an hour of -Provide proper Home Visit intervention, the family nursing intervention, Health teachings will be able to: the family will be able in maintaining good hygiene • To demonstrate the to: within their effects of unsanitary • To perform scope of toilet to the health of the proper waste family. disposal (feces and environment. -provide • To perform the urine) proper use of toilet • To identify and effective information facility and keeping it differentiate the clean and therapeutic to advantages of proper about the various diseases that the all the family members. waste disposal in preventing the spreadfamily can acquire with of communicable unsanitary toilet diseases. -d

Goals partially met: -They are able to verbalize the importance of nutrition and able to identify cheaper nutritious and healthy foods but fail to demonstrate the importance of food preparation due to the location of there kitchen.

Health Problems

Family Nursing Problem

Goal of Care (General)

Objective of care (specific)

Intervention Measures

Method of Resources Nurse-Family Required Contact -Time -Effort -Money -Camera (for Documentation) -Good sound Conversation

Evaluation

Presence of Breeding Places of Rodents and Insects

- Inability to recognize - After the nursing the problem of having intervention, the family will breeding places of be able to: rodents and insects due • To to: demonstrate on how to Ignorance of facts that prevent the numbers of these rodents could rodents and insects in cause different kinds their house. of disease. • To know what Fear of consequences diseases will be acquired of diagnosis of in having these insects problem secondary to and rodents. economic. -Inability to make decisions with respect to taking appropriate health actions due to: Inability to decide which action to take among the list of alternatives. Fear of consequence of action secondary to economic.

-After an hour of nursing -Perform to the Home Visit intervention, the family family the various will be able to: yet very effective • Earn a sufficient strategies in eliminating these knowledge on what rodents and insects things to be done in order for these rodents through promoting a clean to be eliminated. environment. • identify the advantages of having a -Provide proper clean environment in health teaching about the relation to the advantages and elimination of these. disadvantages of having breeding places of insects and rodents.

Goals met: -Each of the family members were able to demonstrate correctly the ways in preventing the increase of these rodents as well as able to know the disadvantages of having these rodents around.

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