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 Head Position Age Sex Educational Attainment High School Graduate Occupation Place of Residence Quiling Sur, Batac Religion

Bernardo Navarrete Fuerte

Father

78

M

Pensioner

Jesus Miracle Crusade, Inc -do-

Ester Castillo Fuerte Ezrael Castillo Fuerte Michelle Castillo Fuerte

Wife

Mother

47

F

High School Graduate 3rd year High School Presently 2nd year College, BSBA-MA, MMSU

University Helper Construction Worker Student

-do-

Son

1st Child

20

M

-do-

-do-

Daughter

2nd Child

17

F

-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. Fuerte s 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 don t 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. FuerteMrs. FuerteEzraelPhp4217.00/month (from SSS pension) Php2700.00/month (wage as University Helper) Php700.00/month (wage as construction worker) Total: Php7617.00/month ALLOCATION OF INCOME: MedicineEducationFoodPhp1095.00 (14%) Php2400.00 (31%) Php2804.00 (37 %)

Miscellaneous- Php500.00 (7%)

Transportation- Php468.00 (6 %) ClothingPhp350.00 (5%)

Total: Php7617.00 (100%)

Figure 1.Monthly Expenses of Fuerte Family

Monthly Expenses of Fuerte Family

7%

6%

5%

14% Medicine Education 31% Food Miscellaneous Transportatiion Clothing

37%

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

AM for breakfast, 12-1 PM for lunch except for Ezrael who eat late most of the time (at around 1:302:30 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 don t 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

Health Care Facilities Organizations Neighbors

FUERTE FAMILY Relatives

Friends

Church School

C. HOME AND ENVIRONMENT
Fuerte Family s 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

and lying around their house, and these clothes can t be distinguished whether clean or used clothes. A lot of spider webs are present all over the house. The family s 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 that s 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 doesn t 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 that s 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 don t have electricity so they make use of candles as lightings at night. They don t 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 family s 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 river s 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 river s 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. Rubio s house. The family s 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 doesn t 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 Michelle s 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

Justo Fuerte(+) 55 Murdered

Andrea Fuerte (+)50 Heart Attack (Hypertensive)

Raymundo Castillo

Enriqueta Castillo

Soledad Fuertedela Cruz 50

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

Dominador Fuerte 76 Hypertensive

Bernardo Fuerte 78 Asthmatic and Hypertensive

Esther CastilloFuerte 46

Legend: --Female --Male Ezrael Fuerte 20 Michelle Fuerte 17

+

-- 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 wasn t 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 don t 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 4th and 5th 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 didn t 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) Bernardo Fuerte Ester Fuerte Ezrael Fuerte Michelle Fuerte 15.31 152.4 35.38 20.32 60.96 63.82 0.96 17.52 176.78 54.88 23.86 72.34 78.59 0.92 16.55 148.59 36.74 20.32 60.96 64.15 0.95 12.88 174.74 39.46 19.05 Waist Circumference (cm) 71.12 75.24 0.95 Hip Circumference Waist Hip Rotation

Body Mass Index = weight (kg) height2 (m2)

Waist Hip Rotation = Waist Circumference Hip Circumference

Table 3.Body Mass Index Classifications Classification BMI 18.5 or less 18.5-24.9 25.0-29.9 30.0-34.9 35.0-39.9 40 or greater Description Underweight Normal Overweight Obese I Obese II 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 don t 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 that s why they only buy the food their budget can accommodate. Table 4.Dietary History of Fuerte Family THREE-DAY MEAL Meal Breakfast Day 1 (06/27/09) 1 fried egg 2-3 pieces of pandesal/ ½ cup rice 16 oz coffee/milo 16 oz water 16 oz water 16 oz water Day 2 (06/28/09) 1 cup of rice ½ cup camote sprouts 16 oz coffee/milo Day 3 (06/29/09) 1 cup of rice 200 ml sinigang 16 oz coffee/milo

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

240 ml coke

240 ml juice 1 biscuit

240 ml coke 1 biscuit

240 ml juice Afternoon

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 family s 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. Fuerte s 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 don t 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 don t 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. 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. The family is very religious, attending church gathering 3 times a week and prays regularly before meals.

B. Healthy Lifestyle
Supporting cues:

C. Spiritual Well-being
Supporting cues:

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. Fuerte s cough brings a threat to the other member s health since they live in a small house, sleep very close with each other and have poor ventilation. 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.

D. Faulty/Unhealthful nutritional/Eating Habits
Supporting cues:

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 don t 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 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)

B. Presence of Adolescent
Supporting cues:

Scale for Ranking Family Health Problem According to Priorities
Presence of Breeding Sites of Vectors of Diseases Criteria Nature of the Problem (Threat) Computation 2/3 x 1 Actual Score 0.67 Justification 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 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. 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. The family perceived the problem as a problem needing immediate attention or resolution because it threatens the health of the members of the family

Modifiability of the Problem (Partially Modifiable)

1/ 2 x 2

1

Preventive Potential (Moderate)

2/3 x 1

0.67

Salience of the Problem (Needing Immediate Attention)

2/2 x 1

1

TOTAL 3.34

Poor Lighting Criteria Nature of the Problem (Health Threat) Computation 2/3 x 1 Actual Score 0.67 Justification 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. The problem cannot be modified because of the lack of resources available (financial) The problem has a low preventive potential because of the unavailability of financial resources to support the electrical connection. The family considers it as a condition /problem not needing immediate attention because they are more focusing on things like Mr. Fuerte s medicines, for Michelle s schooling and the food for the whole family.

Modifiability of the Problem (Not Modifiable) Preventive Potential (Low)

0/ 2 x 2

0

1/3 x 1

0.33

Salience of the Problem (A condition or problem not needing immediate attention)

1/2 x 1

0.5

TOTAL 1.5

Poor Ventilation Criteria Nature of the Problem (Threat)

Computation 2/3 x 1

Actual Score 0.67

Justification 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. 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

Modifiability of the Problem (Easily Modifiable)

2/ 2 x 2

2

Preventive Potential (High)

3/3 x 1

1

Salience of the Problem (Not Needing Immediate Attention)

1/2 x 1

0.5

of their house. It has a high preventive potential since they have human resources and does not need a big amount of money to solve the problem. 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 Nature of the Problem (Threat) Computation 2/3 x 1 Actual Score 0.67 Justification 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. The problem is not modifiable since they don t know the importance of segregating garbages, no one in the family has the time to segregate garbage and make a good drainage system. They have inadequate knowledge regarding the problem and no one in the family has the time to resolve the problem. 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.

Modifiability of the Problem (Not Modifiable)

0/ 2 x 2

0

Preventive Potential (Low)

1/3 x 1

0.33

Salience of the Problem (Not Needing Immediate Attention)

1/2 x 1

0.5

TOTAL 1.5

Fire Hazards Criteria Nature of the Problem (Threat) Computation 2/3 x 1 Actual Score 0.67 Justification The problem is a threat to the family s 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). 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. Prevention of fire would be moderate because the family can be extra careful when using candles despite the combustible materials around them. 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.

Modifiability of the Problem (Partially Modifiable)

1/ 2 x 2

0.5

Preventive Potential (Moderate)

2/3 x 1

0.67

Salience of the Problem ( Needing Immediate Attention)

2/2 x 1

1

TOTAL 3.17

Noise and Air Pollution Criteria Nature of the Problem (Threat) Computation 2/3 x 1 Actual Score 0.67 Justification 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

Preventive Potential (Low)

1/3 x 1

0.33

Salience of the Problem ( Needing Immediate Attention)

2/2 x 1

1

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. 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. The family is also concerned with their present situation and considers the problem to have immediate attention .

TOTAL 2

Fall and Trip Hazards Criteria Nature of the Problem (Threat) Computation 2/3 x 1 Actual Score 0.67 Justification 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. Not modifiable since they don t have any means of reconstructing their flooring due to financial deficiency and the lack of human resources. The problem has a low preventive potential since they don t have the manpower as well as the money to make some modifications on their flooring. The family consider it as a problem not needing an immediate attention since they are prioritizing

Modifiability of the Problem (Not Modifiable) Preventive Potential (Low)

0/ 2 x 2

0

1/3 x 1

0.33

Salience of the Problem ( Not Needing

1/2 x 1

0.5

Immediate Attention) TOTAL 1.5

the food for the family, medicine of Mr. Fuerte and the education of Michelle.

Pointed Sharp Objects Criteria Computation Nature of the Problem (Threat) 2/3 x 1

Actual Score 0.67

Justification 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. It is not modifiable because they don t have money to reconstruct or repair their house. The problem has a low preventive potential because of insufficient budget for the repair of the house. The family perceives it as a problem although they don t give necessary action to it such as its repair because there are more important things needed by the family that they must attend first.

Modifiability of the Problem (Not Modifiable) Preventive Potential (Low) Salience of the Problem ( Not Needing Immediate Attention)

0/ 2 x 2

0

1/3 x 1

0.33

1/2 x 1

0.5

TOTAL 1.5

Collapse of the House Criteria Nature of the Problem (Threat) Computation 2/3 x 1 Actual Score 0.67 Justification 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. It is not modifiable because they don t have money to reconstruct or repair their house. 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. The family perceives it as a problem although they don t 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.

Modifiability of the Problem (Not Modifiable) Preventive Potential (Low)

0/ 2 x 2

0

1/3 x 1

0.33

Salience of the Problem ( Not Needing Immediate Attention)

1/2 x 1

0.5

TOTAL 1.5

Hereditary Diseases Criteria Nature of the Problem (Threat) Modifiability of the Problem (Partially Modifiable) Computation 2/3 x 1 Actual Score 0.67 Justification Their family shows a history of hypertension so Ezrael and Michelle are at risk of inheriting this disease. 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

1/ 2 x 2

1

Preventive Potential (Moderate)

2/3 x 1

0.67

Salience of the Problem ( Not perceive as a problem needing a change)

0/2 x 1

0

healthy lifestyle. 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. The family doesn t 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 Nature of the Problem (Threat) 2/3 x 1 0.67

Justification The problem is a threat to the health of the family since cough can be easily transferred from one person to another. 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 is moderate since they have human resource and manpower available for them to do the task of cleaning their house to improve their ventilation. The family considers the condition as a problem but is not giving much attention to it because they think they could easily treat it.

Modifiability of the Problem (Partially Modifiable)

1/ 2 x 2

1

Preventive Potential (Moderate)

2/3 x 1

0.67

Salience of the Problem (A condition/problem not needing immediate attention)

1/2 x 1

0.5

TOTAL 2.84

Faulty Nutritional Habits and Unhealthful Eating Habits Criteria Nature of the Problem (Threat) Computation 2/3 x 1 Actual Score 0.67 Justification The family don t 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 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. 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. The family perceived the problem as a problem needing immediate attention or resolution because it threatens the health of the members of the family.

Modifiability of the Problem (Partially Modifiable) Preventive Potential (Moderate)

1/ 2 x 2

1

2/3 x 1

0.67

Salience of the Problem (Needing Immediate Attention)

2/2 x 1

1

TOTAL 3.34

Presence of Cough Criteria Nature of the Problem(Health Deficit) Computation 3/3 x 1 Actual Score 1 Justification 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. The condition can only be modified

Modifiability of

1/ 2 x 2

1

the Problem (Partially Modifiable)

Preventive Potential (Moderate) Salience of the Problem (Needing Immediate Attention)

2/3 x 1

0.67

2/2 x 1

1

partially because although Mr. Fuerte religiously takes his medicine, their environment takes a great role in his recovery of the illness. The condition may be moderately prevented since Mr. Fuerten is taking his medicines to treat the illness. They perceive it as a problem needing immediate attention because it makes Mr. Fuerte suffer too much.

TOTAL 3.67

Financial Constraints Criteria Nature of the Problem(Foreseeable crisis) Computation 1/3 x 1 Actual Score 0.33 Justification 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. 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. 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. 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 don t have any money when

Modifiability of the Problem (Not Modifiable)

0/ 2 x 2

0

Preventive Potential(low)

1/3 x 1

0.33

Salience of the Problem (Needing Immediate Attention)

2/2 x 1

1

emergency arises. TOTAL 1.66

Presence of Adolescents Criteria Nature of the Problem(Foreseeable crisis) Computation 1/3 x 1 Actual Score 0.33 Justification The problem is a foreseeable crisis because the presence of adolescents in the family hand-inhand 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. 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. 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. 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.

Modifiability of the Problem (Partially Modifiable)

1/ 2 x 2

1

Preventive Potential(moderate)

2/3 x 1

0.67

Salience of the Problem (Not perceived as a problem)

0/2 x 1

0

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 body s 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 family s 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 Physical Independence RATE 5 JUSTIFICATION 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. 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. 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. 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 can t 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

Therapeutic Competence

5

Knowledge of Health Condition

3

Application Of Principles of General Hygiene

3

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. 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. 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. 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

Emotional Competence

3

Family Living

3

Physical Environment

1

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.

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