S a n Pe d ro C o l e g e l

1 2 C . G u sm a n S t., D a va o C i ty

Family Case Study
Yvanne Ronald A. Agno Kevin Van Eric O. Saballo Roselle E. Anino Hannah Berry T. Alegado Phoebe Lyn S. Brusas
Tu e sd a y , 1 0 A u g u st 2 0 1 0

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INTRODUCT

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Introduction
“The family is the corner stone of our society. More than any other force it shapes the attitude, the hopes, the ambitions, and the values of the child. And when the family collapses it is the children that are usually damaged. When it happens on a massive scale the community itself is crippled. So, unless we work to strengthen the family, to create conditions under which most parents will stay together, all the rest - schools, playgrounds, and public assistance, and private concern- will never be enough”  -Lyndon Baines Johnson

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Introduction

The FAMILY: This is the core and unit of service in Community Health Nursing (CHN). As student nurses, we focus on the optimum health of the family as a whole and provide our holistic health teachings as a teaching role of each student nurses, that imparting information, bombarding those inputs with them and reinforcing changes in behavior.


What is family? According to Burgees and Locke, the family is a group of persons united by ties of marriage, blood or adoption, constituting a single household, interacting and communicating with each other in their respective social roles of husband and wife, mother and father, son and daughter, brother and sister and creating a common culture. This, we would regard as a fundamental description of a family.


Where does a family starts? For Winston Churchill, it starts with a young man falling in love with a girl and no superior alternative has yet been found. Yes, that may be proper. But in this modern world, family may become more intricate than just the nuclear basis. Families are too intimate as close tied to stick with the trouble-free definition. It is more about nurturing one another and respecting each other’s lives. The family and the home basically is the only Vou g h place where one truly belongs.

Introduction

Health: The World Health Organization (WHO) defines health as a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. And this definition of health was been clearly modified to include the ability to lead a “socially and economically productive life”. Individuals need to function at its optimum level and as its best, even with such disease and infirmity, if one is able to manage and tolerate such stressors and continue to function at the highest possible level he could attain, the one is considered to be healthy. A family must indeed be healthy to function properly their role. Thus, making each member of the family contributes through role functioning for the welfare, goodness and effectiveness of the family as unit of service in the community and basic unit of society. Vou g h

Introduction

As student nurses, we are active not only in the hospital setup but also in health promotion in the community. We not only play the roles of providing care, applying nursing procedures for the practice of our profession but also to create a big impact through rendering out our health teachings for them to generate knowledge and acquire in alleviating such problems occurring in their family and in the community. We help them to achieve optimum wellness and provide continuous care for physical and social environment. It somehow adds to the development of the nation since there are some people cannot afford private health services. By means of the community health nurses and public health centers, health services are now accessible and affordable. We reach out to the community in order to be of assistance to them. The only factor that would probably turn the world around is the client’s volition and enthusiasm to participate. Vou g h

Introduction
This case study focuses on the Basco Family. They belong to the traditional family structure. Thus, they are a nuclear family. According to Evelyn Duvall’s family stage, they belong to the family with preschool children. They have three children. The husband, the head of the family works as a messenger at BPI while the wife is a full-time housewife. The family is slightly able to meet the needs for physical survival and security.   The reason that the group has chosen the Basco Family as the client for the case study is first, they are very hospitable and accommodating. Their willingness was very astounding. They have exhibited enthusiasm when we were informing them about the things we are going to do for them. They have appreciated our purpose a lot. They were also able to understand our situation and presented themselves to help us. Second, through ocular observation, they are not well-off and that they are living in a nonconducive environment. Lastly, the group wants to help the family improve and enhance holistically their lifestyle and activities of daily living.

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Introduction
Through the FNCP’s and implementations that we have designed, we expect that our client’s overall health status will improve and alleviate all the problems they had. And through this case study, we look forward to a more extensive understanding about the family with a pregnant mother, not only for our own benefit but also for the subject of this study. Finally, we anticipate learning from the student nurses and the client. That learning may not end at this point; that this case study will mark the beginning of a new knowledge that will hopefully pass on through generations in the field of Community health Nursing.

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OBJECTIVE

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General Objective

This study aims to allow the student nurses to apply the different concepts, practices and principles of family health care process.

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Specific Objectives
Specifically, this study aims to: • Find a family in the area of exposure as our subject for the case study; • Establish rapport with the family members and their significant persons to gain cooperation and trust; • Gather systematically the pertinent information in relation to their health status and other significant matters; • Present the introduction related to the condition being studied; • Formulate specific, measurable, attainable, realistic and time-bounded objectives; • Acquire the necessary information about the client Vou g h and formulate the family initial database;

Specific Objectives
• • Identify the family’s developmental stage and compare the task attained by the family and expected task to be achieved base on the theory of Evelyn Millis Duvall; Present a comprehensive family genogram and trace the family web and to make a corresponding legend that will show the status, hereditary diseases, present and past condition of the family; Rate the family’s coping index to provide a basis for estimating the nursing needs of the particular family; Prioritize the health problems observed upon assessment; Formulate therapeutic family nursing care plans on the described problems; Enumerate and give appropriate health teachings to the family involved; Identify the implications of this case study to nursing research, education and practice; and List down the references used in the making of this case study. Vou g h

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INITIAL

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Demographic Data

The Basco family is currently living in a rented house for nine months already since May of this year. It is located at Blk. 49 Barangay 21-C, Piapi Boulevard.

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Family Data

The Basco Family has been living here in Davao for 33 years already while in their current house, they only have 9 months length of residency. They are originally from Davao City. They are four of them in the family with a father, mother and two children. The family is Roman Catholic and they belong to the Bisayan tribe.
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Family Data
Name: Basco, Marlou Age: 33 years old Civil Status: Married Position: Head of the Family • Educational Attainment: High school Graduate • • • •

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Family Data
• Name: Angelita AblasBasco • Age: 33 years old • Civil Status: Married • Position: Wife • Educational Attainment: High school Level

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Family Data

X

• • • • •

Name: Basco, Angelito Age: Deceased Civil Status: Position: Eldest Educational Attainment: -

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Family Data
• Name: Basco, John Marco • Age: 5 years old • Civil Status: Single • Position: Second Child • Educational Attainment: Kinder 2

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Family Data
• Name: Basco, Janna Mae • Age: 4 years old • Civil Status: Single • Position: Third Child

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Family Data
• • • • Name: Basco, Jenna Age: 2 months Civil Status: Single Position: Youngest Child

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Family Data

The BascoFamily belongs to the Nuclear family structure. They are Roman Catholic. Mr. Marlou Basco is the head of the family. He is 33 years old and he was born on March 07, 1976. He was able to finish high school. He is presently working as a messenger in Bank of the Philippine Islands or BPI. His wife is Mrs. Angelita Basco a 30 – year old and was born on March 15, 1979. She has 3 beautiful living children. The couple has been living together for 5 years. The eldest child unfortunately died few minutes after giving birth due to over dosage of the prescribed drug that was taken by Mrs. Angelita during her pregnancy because she was diagnosed of having weak lungs during her pregnancy then. John Marco Basco is the second child and 5 years of age. He was born at July 24, 2004. He is studying at the Day Care Center as kinder 1 student. The second child is Janna Mae Basco. She is 4 years old and was born on July 19, 2005. She is not yet in school but her parents are planning to send her the next school year. Their youngest child is Jenna Marie who is 2 month old. She was born on Vou g h

Family Characteristics
C R IT E R I A STA TU S A D D IT IO N A L IN FO R M A T IO N

Observabl We weren’t able to ask Mr. Basco about e conflicts their usual conflicts since he needs to go between to work. However, Mrs. Basco, his wife is family members the one who openly shared about their

Before, Mrs. Basco has part time job as a sales lady at Korean store in Uyanguren. Through this, she can help her family issues. She told us that they are husband to provide additional arguing mostly about money. Since the income to support their needs. salary of Mr. Basco is sometimes not But since she got pregnant she enough to sustain and provide the needs needs to stop the work in of the family. When this problem exists, order to prevent complications both couples would talk about the matter during pregnancy. Last and would come up a mutual decision to December 24, 2009 she gave solve such conflict. Mr. Basco has the birth to a lovely baby girl responsibility to hand the money to his named Jenna. And still not able Vough

Family Characteristics
C R IT E R I A STA TU S A D D IT IO N A L IN FO R M A T IO N

C h a ra cte ri c T h e y h a ve i fo rm a l co m m u n i ti n A s sta te d b y M rs. B a sco , sti n ca o s of to w a rd s e a ch o th e r b u t n o t to th e th e y w i lo n l b o rro w ce l l y l co m m u n i ti e xte n t th a t th e y b l rt o u t b a d & fo u lp h o n e a n d a sk fa vo r to ca u on w o rd s e sp e ci l y w h e n th e y a re al te xt fro m th e i cl se r o h a vi g a n a rg u m e n t. T h e y d o n ’ t n n e i h b o r i ca se o f g n h a ve ce l p h o n e fo r d i n ce l sta e m e rg e n cy . co m m u n i ti n a n d e m e rg e n cy ca o p u rp o se s.

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Family Characteristics
C R IT E R I A STA TU S A D D IT IO N A L IN FO R M A T IO N

I te ra cti n n o p a tte rn s am ong m e m b e rs

W h e n i co m e s to fa m i y i te ra cti n s, t l n o I th e ch i d re n co m m i f l t o u r g ro u p o b se rve d th a t th e y a re so m i ke s, th e fa th e r w i l sta l cl se a n d i se e m s th e y a re co n te n te d ta l to h i ch i d re n a n d o t k s l w i w h a t th e y h a ve . T h e p a re n ts th so m e ti e s sp a n k th e m . m d i p l n e th e i ch i d re n i a p ro p e r w a y . T h i i th e w a y th e y sci i r l n s s T h e y w a n t to b e re sp e cte d b y th e i r d i p l n e th e i ch i d re n . sci i r l ch i d re n . I te rm s o f fa m i y b o n d i g , th e T h e ch i d re n ca l e i l n l n l lth r fa m i y sp e n d s th e i sp a re ti e o n l i l r m y n p a re n ts m a m a & p a p a . th e i h o u se w a tch i g t. v . sh o w s. T o r n ti h te n th e i fa m i y b o n d i g , th e y g r l n so m e ti e s g o to P e o p l ’ s P a rk a n d m e M a g sa ysa y P a rk . T h e m o th e r i th e o n e s w h o sp e n d s m o st o f th e ti e w i h e r m th ch i d re n si ce h e r h u sb a n d i w o rki g l n s n fro m M o n d a y to S a tu rd a y . O n l S u n d a y y Vou g h i h i d a y -o ff. s s

Nutritional Status
Fa m i y M e m b e rs W e i h t H e i h t l g g B a sco , M a rl u o Angelita Marco Mae Marie 6 5 kg 53kg John 19kg Janna 14.5kg Jenna 5kg 1 .7 0 m 1.50m 1.07m 1.00m 0.46m R e su l ts N =2 2 . 4 9 kg / m 2 N=24.44 kg/m2 19.8-26 kg/m2 N=16.60 kg/m2 14.4-20.2 kg/m2 N=14.50 kg/m2 12.6-17.9 kg/m2 NO RM AL RANG E 2 20-25 kg/m

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Nutritional Status
• All of the family members we have assessed in getting the nutritional status because of the time availability of the family members coincide with the time we have done gathering our data for this assessment. • Mr. Marlou Basco has a weight of 65kg and a height of 1.70m. His BMI result is N=22.49 kg/m2 which interpret as normal. • Mrs. Angelita Basco has a weight of 55kg and a height of 1.50m. Her BMI result is N=24.44 kg/m2 which interpret as normal. • Jhon Marco has a weight of 19kg and a height of 1.07m. His BMI result is N=16.60 kg/m2 which interpret as normal. • Janna Mae has a weight of 14.5kg and a height of 1.00m. Her BMI result is N=14.50 kg/m2 which interpret as normal. Vou g h

ACTIVITIES OF DAILY LIVING
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Sleeping Pattern

The entire family has an average of 6-8 hours of sleep per day. The Family usually retires to bed at between 8:00-10:00 p.m. after they watch TV shows. Their wake up time depends upon the members of the family. For Mr. Marlou and Mrs. Angelita, they usually wake up at 4:00 a.m – 4:30 a.m. as Mr. Marlou will go to work at 6:00 am and Mrs. Angelita will prepare food for the family. Their children will wake up at 6:00 am in preparation for school. The whims of retiring and getting up of the family members are dependent on each individual. g h Vou

Eating Pattern
• The family is able to eat three times a day. As we ask them of their 24 hour dietary recall, their usual breakfast is dried fish or fried fish. • Mr. Basco has enough income fitted only for their basic needs like food. Mrs. Basco reported that even though they cannot provide for house resources like appliances, they try to make sure that they will prioritize the nutritional status of their family as evidence on the Body Mass Index which all results were normal.

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Diatary Habbits
Dinner Lunch Breakfast Tinolang 18 Fried fish, rice champorado, Bread, milk, Februaryisda February 19 milo Februarydried rice. Dried fish and fish, rice Rice and 20 fish, Fried fish and and rice. milo juice. (Thursday) or coffee. (Friday) rice.legume and coffee. soup. (Saturday) coffee. milk, milo or

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Leisure Time Activities

Watching TV shows and the children play jolen outside the house after their school. They also spend time listening to music and also taking time in chatting with neighbors. The kids are free to play outside the house but they are always reminded not to play with harmful objects such as sticks, wires etc. Sometimes if there is extra money, they also go to amusement parks and malls. These are the activities that Vou V promote relaxation to the entire family. ou g h

Monthly Family Income
Members of the family w/ 1) Marlou income Basco (father) EducationalOccupation Nature of Work Place of Attainment work High schoolMessenger An employee who graduate of BPI delivers bills of BPI clients directly to their offices or homes Monthly income P4,800

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Monthly Family Income

The family’s breadwinner is the father who is Mr. Marlou Basco. He is a high school graduate who works as a messenger of BPI. He is an employee who delivers bills of BPI clients directly to their offices or homes here in Davao City. He earns approximately P4,800 monthly.
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FAMILY HEALTH STATUS
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Mr. Marlou Basco

When we interviewed Mr. Marlou, he said that he didn’t experience any serious illness when he was young. He also verbalized that he had a complete immunization during his childhood. He experienced common illnesses such as colds, cough and fever. He can consume at least 3-5 sticks per day of ‘Fortune’ cigarettes. These results served as evidences for presence of a health threat. He mentioned that their family on his mother’s side has a past health history of hypertension. He is also hypertensive.
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Mrs. Angelita Basco

Mrs. Angelita just recently gave birth a live baby girl via Normal Spontaneous Vaginal Delivery last December 24, 2009 namely Jenna Marie. She also verbalized that she had complete immunization during her childhood and she didn’t experience any serious illness when she was young. She experienced Vou g h common illnesses such as colds,

John Marco Basco

As verbalized by the mother and through observation, John Marco experienced cough, colds and fever. Also he is presently experiencing colds and cough that’s why her mother verbalized that there is a need for medical consultation.
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Janna Mae Basco

Presently, Janna Mae experiences cough and colds. That’s why her mother verbalized that there is a need for medical consultation.

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Jenna Marie Basco

She is 2 months old and she was just recently immunized with BCG, DPT, OPV and Hepatitis B. Fortunately Jenna has not yet experience any illness.

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Immunization Status
3 Jenna Marie 2 Janna Mae 1.) John Marco Child’s name Basco C BCG 2doses C DPT 2doses C OPV C HEP. B X C MEASLES

Legend: C- Complete

X- Not immunized

√- Done

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Immunization Status
• There are three children in the Basco family. Each child has taken such immunization for the goodness of their health. • John Marco, the eldest child has 1 BCG, 3 DPT, 3 OPV, 3 HEPA B and 1 MEASLES immunization and is considered a fully immunized child. • Janna Mae has 1 BCG, 3 DPT, 3 OPV, 3 HEPA B and 1 MEASLES immunization and is considered a fully immunized child. • Jenna Marie the youngest child has 1 BCG, 2 DPT, 2 OPV, 3 HEPA B and no MEASLES immunization and she is not considered a Vou g h

HOME AND ENVIRONMENT
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Flooring
• Brown- Kitchen • GraySleeping/Eating Area • Violet-Door • Sky Blue- Windows

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Total Floor Area
2.31m

3.15m

• TFA = (length of the house’s floor) x (width of the house’s floor)


= (2.31m) x (3.15m) = 7.28sqm


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Total Window Opening
0.72m

• TWO = (length in meters) x (width in meters) = (0.66m) x (0.76m) = 0.50sqm x 2windows = 1.00sqm

0.66m


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0.68m

Door Opening
• Door Opening = (length of the door) x (width of the door) = (1.07m) x (0.68m) = 0.73sqm

1.07m


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Ventilation
• Ventilation = (TWO/TFA) x 100 = (1.0032sqm + 0.73sqm) / (7.28sqm) x 100 = 13.07% = Poor Ventilation • Scale: 20% - satisfactory / good ventilation 18-19% - fair 17% below – poor ventilation


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Comparison of TFA and TSR

Number of family members currently living in the house: 4

Client Adult Children Infant

Multi- Purpose room Single-Purpose room

3sq.m 1.5sq.m 0

2.50sq.m 1.26sq.m 0

Category of members: adults (2) children (2) Room Category: MultiPurpose room •

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Comparison of TFA and TSR
Computation: Adult: 3sq.m x 2 adults = 6sq.m Child: 1.5sq.m x 2 children = 3sq.m Infant: 0 x 1 = 0sqm TSR = 6sqm + 3sqm = 9sqm TFA = 7.28sqm 7.78sqm<9sqm = overcrowded Condition: TFA > TSR = not overcrowded  TFA < TSR = overcrowded

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Comparison of TFA and TSR

The Family rents a house where they are currently residing. The house is a mixed type; it’s made up of the combination of wood and cement. Their house is a multipurpose room with two windows and one door. The length of their house measures 2.31m and the width is 3.15m resulting to a TFA of 7.28sqm. They have two windows measuring 0.50sqm each resulting to a TWO of 1sqm. The door’s length is 1.07m and has a width of 0.68m resulting to a Door Opening of 0.73sqm. Their TSR is 9sqm and their TFA is 7.28sqm. Because of this, they are overcrowded. We divided the TWO by the TFA and multiplied to 100 resulting to 13.07% ventilation. Normal vent is 17%. So, they have poor ventilation in their current house.
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Comparison of TFA and TSR
• As soon as we entered the house of our client, we observed that the family has the following appliances: 1 TV and 1 small electric fan. We also noticed that there is a small multi-purposed room with only 1 small bulb light as their light. They don’t pay their electric and water bills since its part of the money that they’re paying for their rent. • Their garbage is being dumped in a place in their barangay where garbage men collect the trash daily. • Their toilet system is water sealed latrine, a toilet similar to flush type but without the flushing system. Their source of water is Davao City Water District. • They do not have a gas stove; they only use charcoal for cooking. Finally, we noticed that they have a hazardous environment because of the sharp objects such as knives, nails and other dangerous object lying anywhere inside their house. Vou g h

Health and Health Practices

The family has no specific principle or practice with regards to infirmity. They don’t believe in the healing powers of quack doctors. If they experience colds, cough or fever, they seek medical advice from the barangay health worker or go to the health center.
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ENVIRONMENT
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Kind of Neighborhood

Since the family is living in a community where houses are built close to each other, it’s expected that almost everyone knows each other and are close to each other. The neighborhood’s environment is quite dirty because trash, spit and left over food are seen everywhere. Almost all houses are at risk for fire hazards since most of the houses in barangay 21-C are made of wood. The presence of rats and other Vou g h rodents are also noticeable.

The community has a Health Center where they could have their immunizations done, pre-natal check up, dental and health check up. The Health Center is so accessible to them since it’s strategically located in a place near to everyone.
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Social and Health Facilities Available

Communication and Transportation Facilities

Almost everyone in barangay 21-C have cell phones. So, it is the basic means of communication in the community aside from personally speaking to the person. For their transportation, tricycles are the basic means of transportation in barangay 21-C because it’s cheap, easily accessible and travels faster than walking. Jeepneys could also be used when trying to go to other places outside the community.

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The family is aware of some organization in the community such as the GKK and the Barangay Officials, but they aren’t members of any of these organizations. In fact, the family isn’t even aware and involved in any activities in their community.
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Awareness to Comunity Organization

FAMILY DEVELOPMENTAL

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Level

Ideal

Actual

Family with °Adjusting to the - The family are Preschool Children costs of family life budgeting their   money for the different expenses every month.   °Adapting to needs - The eldest child of preschool is Kinder 1 and goes children to to school at the stimulate growth Piapi Day Care

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Level

Ideal

Actual

°Coping with - The parents are parental loss of adjusting to the energy and privacy high energies of the children. They constantly play without ceasing. They also want to cling always to their parents leaving them with less privacy.
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 

Based on their classification, the Basco family belongs to the family with preschool children. The developmental tasks at this stage are adapting to the critical needs and interest of preschool children in stimulating, growth-promoting ways and coping with energy depletion and lack of privacy as parents. Through our observation, all of these developmental tasks were evident in the Basco Family. This is a good sign that the family is responding really well to family life. They have been adjusting and coping to the different tasks under the criteria. Thus, each new development crisis necessitates new adaptations and imposes new Vough

GENOGRAM
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Tiborcio Basco, 60

Carmelita Basco, 60

Rosalita, 58

Nicolas Ablas, 59

X

X

Rita Basco, 25

Jhong Basco, 28

Marlou Basco, 33

Angelita,30

Janna Mae Basco, 4

Angelito Basco,

X (still

birth)

John Marco Basco, 5

Jenna Basco, 2mo

Legend: Hypertension X deceased

Male Female

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Genogram

The genogram shows the three generation of hereditary disease from the grandfathers and grandmothers of our client Janna Mae Basco. Janna’s grandmother, Carmelita Basco has hypertension and so does her father.
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ECO-MAP
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MARKET

Rarely ou Often lita

Legend :

a Mae

o

John

SCHOOL
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Eco-map
• As shown above, the family specifically Mrs. Basco usually goes to the market where their basic needs are being brought. Since the family do not have refrigerator to store their perishable, thus explain the frequent trip to the market. • Furthermore, Mr. and Mrs. Basco submits their selves along with their children for any services offered in the health center such as free vaccinations and medicines, they utilize the services being offered at the health center. However, Mr. Carlos and Mrs. Rosalitatend to drop by at the health center when certain medical conditions are being Vough

EcoMap
• The family is considered to be a member of the Roman Catholic Church, however, they does not involve themselves in any activities related to their religion such as attending the so called “kasaulugan” during Saturdays. Nonetheless, Mr Mr. and Mrs. Basco are trying to find time to attend the activities structured by their religion. The family sometimes goes to Gaisano Mall or People’s Park to relax and enjoy when there is extra money. Mr. Basco always go to work every weekdays, his son John Marco is attending Vough daycare every morning.

• •

Admission: February 20, 2010

FAMILY
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ADMISSION DISCHARGE 9 JUSTIFICATIO RATING CATEGORIES RATING N
1. Physical Independence
     

JUSTIFICATION
-Still, some family members are able to move independently. But, Jenna is still too young to take care of herself. -Manage common illnesses fairly. The mother encourages the children to drink lots of water when having cough and give them “BIOGESIC” when they have fever.

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2. Therapeutic Competence

3

- Some family 3 members are able to move in and out of bed and some weren’t able to take care of grooming - Can carry out 3 some treatments such as managing fever by taking “BIOGESIC” and can only do exercise sometimes

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9 CATEGO RIES

ADMISSION DISCHARGE RATING JUSTIFICATION RATING JUSTIFICATION

3. 3 Knowledge and Health Condition

- Has some general 5 knowledge about their health and sanitation and is only partially informed. Has not understand fully because of low educational attainment - Takes a bath only 5 once a day. Does not wash hands regularly

-Has fully understood the concept of cleanliness & sanitation. They have been well-informed. They were able to keep their house clean.

4. 3 Applicatio n of Principles of General

-Family members already are taking a bath twice a day & they wash hands regularly.

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ADMISSION DISCHARGE 9 JUSTIFICATION RATING CATEGORIES RATING
5. Health Attitudes 5 Understands and 5 recognizes the need for medical care during illnesses. When the mother was still pregnant, she goes to the health 3 center for prenatal visit. -Family is doing fairly well. The mother sometimes acts immature because she giggles a lot when being asked about

JUSTIFICATION
-The family still understands and recognizes the need for medical care during illnesses. Ma’am Angelita ensures that Jenna Marie has complete immunization to prevent diseases. -The family is still somewhat immature. Only the parents are capable of making decisions and handling problems within family.

6. Emotional Competence

3

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ADMISSION DISCHARGE 9 JUSTIFICATIO RATING CATEGORIES RATING N
7. Family Living 3 - Family gets 3 along but has problem adjusting to maintenance of open communication. Husband is only available at Sundays and rarely gets day offs. No cell phones for constant and easy Communication

JUSTIFICATION -Though the family is trying to adjust living together, there is still a problem in maintaining open communication.

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ADMISSION DISCHARGE 9 JUSTIFICATIO RATING CATEGORIES RATING N
8. Physical Environment         9. Use of Community Facilities  

JUSTIFICATION
-Even though the house has inadequate living space, the house now has good environmental sanitation. It is now clean.   -Still, the mother regularly goes to the health center for the scheduled vaccinations of Jenna Marie. John Marco also goes to the Day Care Center in the barangay.

 1
        5

- House is in poor condition with inadequate living space and poor environmental sanitation.   - When the mother was still pregnant, she goes to the Health Center regularly for Prenatal Checkup. The eldest child goes to

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    5

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Physical Assessment
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Physical Assessment General Survey : Our client is Jana Mae A. Basco a 4-year old female. On February 20,2010, we had conducted a thorough physical assessment on her. She had just finished taking a bath. She was well-groomed and neat. Has an mesomorphicbody built with height of 100.33 cm and weight of 14kgs. Has an erect posture with coordinated movements. No signs of distress. Cooperative. Responds appropriately to the situation. Talks clearly and is understandable. Vital Signs : T= 36.3 0C PR= 75 bpm RR= 18 cpm CR=78 bpm Skin Assessment : General uniformity. No edema. Moderate moisture. Uniform temperature on both hands and feet. Good skin turgor. Hair Assessment : Evenly distributed. Silky and resilient.No infection and infestations. Variable amount of body hair.

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Nails Assessment : Has a convex shape and with no clubbing. Smooth fingernail and toenail texture. Pinkish and has an intact epidermis. Capillary refill time of 2 seconds. Well trimmed finger and toe nails. Skull and Face Assessment : Normocephalic with symmetr ical facial features. No edema and hollowness noted. Symmetrical facial movements. No presence of nodules or masses. Eye Structure Assessment : E yebrows evenly distributed and skin intact. Equal and outward curl of eyelashes. Eyelids intact with 17 blinks per minute bilateral. Palpebral conjunctiva has pinkishpeach color with minimal blood vessels visible. Bulbar conjunctiva are clear with few underlying blood vessels. White sclera visible. Upon palpation of lacrimal duct, no edema or tenderness noted. Shiny and smooth cornea. Pupil is black in color, equal in size and 3mm in diameter. Illuminated pupil constricts(direct response). Non-illuminated pupil constricts(consensual response). Aligned and coordinated eyes. Visual Acuity Assessment : Has good visual acuity.

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Ears Assessment : Color is same as facial color and auricles are symmetrically aligned with outer canthus. Elastic and firm auricles. Presence of cerumen in the external ear. No difficulty hearing. Nose Assessment : Symmetrical external nosewith no flaring. No tenderness and no lesions. Pinkish with nasal catarrh. Nasal septum intact and maxillary and frontal sinuses non-tender. Mouth and Oropharynx Assessment : Symmetric contour of outer lips. Has the ability to purse lips. Pinkish and moist inner lips and absence of skin lesions. No lumps and excoriations on tongue noted. Tongue in midline. No swelling and redness noted on salivary duct. Light pink and smooth soft palate. Lighter pink and more irregular texture of hard palate. Uvula in midline of soft palate. Pink and smooth posterior wall of oropharynx. Tonsils pink, smooth and with no discharge. Grade 1+ tonsils. Present gag reflex. Assessment of the Neck : Muscles equal in size and head centered. Coordinated and smooth movements with no discomfort. Equal strength of muscles. Lymph nodes not palpable. Trachea on central placement in midline of neck. Thyroid gland not visible upon inspection. Upon palpation, lobes are small, smooth, centrally located and rises freely with swallowing

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Lungs and Thorax : Transverse to anteroposterior diameter is 1:2 in ratio. Symmetrical chest expansion observed. Spine aligned and no deformation noted. Not in respiratory distress. Skin is intact. Chest wall intact, no tenderness and no masses noted upon palpation. Bilateral and symmetrical vocal fremitus. Absence of adventitious sounds such as crackles wheezing. Breathing pattern is regular with a respirstory rate of 18 cycles per minute. With clear breath sounds on both lung fields noted upon auscultation. Heart and central Vessels : Point of maximal impulse was heard on the left midclavicular line at the 5th intercostal space with 78 beats per minute. No abnormalities of the heart rate noted. No murmurs were heard during auscultation of the cardiac rhythm. Carotid Artery : Symmetrical pulse volumes, full pulsations, thrusting quality noted. No sound heard during auscultation. Jugular veins : Veins are not visible, its presence indicates advanced cardiopulmonary disease.

ral Pulses : c pulse volumes and bilaterally full pulsations noted upon palpation except for carotid pul

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Peripheral Veins : No distended veins at lower limbs. limbs not tender and symmetrical in size. Peripheral Perfusion : Skin color is pink, skin temperature not excessively warm or cold, no edema and has moist skin texture during inspection. Using Buerger’s test in the limbs and lower limbs, original color returned after 15seconds and 10 seconds respectively. Breast and axillae : Breasts are not yet mature. Not yet developed secondary sex characteristics. No hair in axilla. No foul odor. Abdomen : Skin uniform in color. Flat abdomen. No enlargement noted. Umbilicus is clean without any discharges, foul smelling odor, and signs of inflammation. Has 20 bowel sounds per minute. Musculoskeletal System : Muscles equal in size. No contractures or deformities. No tremors noted. Firm and tonic muscles with smooth, coordinated movement. Active movement against full resistance.

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Bones: No skeletal deformities. No edema or tenderness noted upon palpation. Joints: No swelling. Joints move smoothly. Neurologic Assessment : Oriented. RLS-GCS of 1/15.

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Cranial Nerve

Function
Sensory

I - Olfactory

Physiologic Function

Actual Test Done

Result

II - Optic

Sensory

III - Oculomotor Motor

We instructed the patient Identification of mild to close her eyes, smell, aromas: and identify the different She was able to mild aroma we which we identify mild aromas will be placing near her like that of the sweet nose candy and soap. Transmit visual We checked the patient’s Rosenbaum test: information to the near vision through The patient was able brain; Rosenbaum test (asked the to read at 14 cm patient to read at a distance distance of about 14 cm) Visual Fields: and we checked for her The patient has a good visual fields as well. peripheral vision. Innervates levator Extraocular movements: We asked the patient to palpebrae superioris, follow the penlight we are All the extraocular superior rectus, medial holding in every direction muscles were functioning well and she was able to rectus, which we will be pointing and we follow the penlight on 6 collectively perform also assessed for the directions most eye movements, pupil reaction of the eyes Pupilreaction: The patient’s pupil was inferior rectus, and of our patient. briskly reactive to light, inferior oblique

Smelling

constricts when looking at near objects, and dilates to far objects

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Cranial Nerve IV-Trochlear

Function Motor

Physiologic Function Innervates the superior oblique muscle, which depresses, rotates laterally (around the optic axis), and intorts the eyeball Receives sensation from the face and innervates the muscles of mastication

Actual Test Done

Result

We asked the patient to Extraocular movements: follow the penlight we All the extraocular muscles were are holding in every functioning well direction we will be and she was able to pointing follow the penlight on 6 directions We used a light object like cotton to check for the blink reflex of the patient by touching the sclera of the eye and also we assessed the patient’s ability to detect light touch/sensation by wiping a wisp of cotton on the patient’s forehead Blink reflex: Our patient was able to elicit active blinking reflex Light and deep sensation:She was able to detect light touch and differentiate it with a deep touch

V-Trigeminal

Both

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Cranial Nerve

Function

VI - Abducens Motor

Physiologic Function

Actual Test Done

Result

Innervates the lateral rectus, which abducts the eye

We asked the patient Extraocular to follow the movements: penlight we are All the holding in every extraocular direction we will be muscles were pointing and we also functioning well observed the and she was able directions of her to follow the gazes penlight on 6 directions Direction of Gaze: The patient was able to gaze laterally.

Vough

Nerve VII - Facial Both

Function Provides motor We asked our patient innervations to the to smile, raise her muscles of facial eyebrows, frown, puff expression and out her cheeks, close stapedius, receives her eyes tightly. And, the special sense of we asked the client to taste from the identify various anterior 2/3 of the tastes like little tongue, and provides amount of sugar, salt secretomotor and a sip of her innervations to the calamansi juice with salivary glands her eyes closed (except parotid) and the lacrimal gland

Facial Movements: Our patient was able to smile, raise her eyebrows, frown, puff out her cheeks and close her eyes tightly. Identification of tastes: Our patient was able to identify sweet & salty tastes

Cranial Function Nerve VIII Sensory Vestibulococ hlear

Physiologic Actual Test Done Function Senses around, We checked for the rotation and gravity ability of the patient (essential for to hear spoken words balance and movement)

Result

IX Both Glossopharynge al

Receives taste from the posterior 1/3 of the tongue, provides secretomotor innervations to the parotid gland Motor innervations to the stylopharyngeus (essential for tactile , pain, and thermal sensation)

Hearing Acuity: The patient was able to hear us and the words we had spoken like “Ma’am”, “Excuse Me”, and “Smile” as evidenced by her appropriate responses We asked the client to Tongue movements: move tongue from side Our patient was to side and up and able to move tongue down from side to side, up and down

Cranial Nerve
X - Vagus

Function
Both

Physiologic Function

Actual Test Done

Result

Supplies branchiomotor We observed the patient’s Speech: innervations to most speech for hoarseness Our patient’s voice is laryngeal and not hoarse pharyngeal muscles Controls muscles for voice and resonance and the soft palate

XI - Accessory

Motor

Controls muscles of the neck and overlaps with functions of the vagus

We asked the client to Shoulder resistance: shrug her shoulders Our patient was able against the resistance to resist the force of from our hands and to turn the hand on both her head to side against shoulders our resistance Face resistance: Our patient was able to resist force of the hand on every other side of the face

Cranial Nerve XII Hypoglossal

Function Motor

Physiologic Function Provides motor innervations to the muscles of the tongue and other glossal muscles Important for swallowing (bolus formation) and speech articulation.

Actual Test Done We asked the client to protrude her tongue at midline by saying “aahhh” then move it side to side

Result Tongue movements: The patient was able to protrude tongue at midline, then moved it side to side

Finger’s to Nose and to the nurse’s finger:
When instructed to touch her nose and to touch the nurse’s fingers alternately, she is able to perform it rapidly.

Finger to Fingers:
Can perform rapidly, able to touch fingers consistently.


Pain Sensation:
Can determine if the object used for testing is dull or sharp. (Tip of the ballpen for sharp and the cover of the ballpen for dull)

Kinesthetic Sensation:
Can determine her finger’s position if it is up or down.

 

Vough

Muscle strength:  Sternocleidomastoid
             

- She was able to turn her head strongly when I tried to push it.

Trapezius
- Able to shrugs her shoulder strongly against my resistance.

Deltoid
- She can raised her both arms strongly against resistance.

Biceps
- Able to flex her arms against my resistance.

Triceps
- She can extend her arms strongly when I tried to push it.

Hip Abduction
- Can abduct her leg to the side strongly against resistance.

Hip Adduction
- Can adduct her legs back to the position against my resistance.

Vough

IMCI Assessment
• No pneumonia, cough or cold •

PRIORITIZATION OF HEALTH PROBLEMS
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TOP 10 PROBLEMS

Problem Walking Barefooted Pointed/Sharp Objects Poor Personal Hygiene Tobacco/Cigarette Smoking Lack of Food Storage Facilities
Family Size beyond what Family Resources Can Adequately Provide

Inadequate Living Space Poor Lighting and Ventilation Family History Fire Hazard

Score 4 1/6 4 1/6 4 1/6 4 1/6 2 5/6 2½ 2½ 2½ 2 1/3 1

K

10 Health Problems
•Fire Hazard Criteria

Rating 1. Nature of the Problem 2/3 x 1 2. Modifiability of the Problem 0 /2 x 2

3. Preventive Potential 4. Salience Total Score

1 /3 x 1 0 /2 x 1

Actual Score Justification 2/3 It is a threat against the family’s safety and welfare. 0 Not modifiable because it is impossible to change the structure of the house because they are just renting. Future problems cannot be 1/3 0 1
totally prevented. They can’t restructure the house. Only Not perceived as a problem renting or social concern of the family.

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Inadequate Living Space

Criteria 1. Nature of the Problem

Rating 2/3 x 1

Actual Score Justification 2/3 It poses a threat to the inadequacy of space for the family members. Not modifiable because of the lack of financial resources. Problems cannot be totally alleviated be cause of financial constraint to rent a bigger space. Not needing immediate attention as believed by the family.

2. Modifiability of the Problem 3. Preventive Potential

0/2 x 2

0

1/3 x 1

1/3

4. Salience

1/2 x 1

½

Total Score

1 1/2

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Family History

Criteria 1. Nature of the Problem

Rating 2/3 x 1

Actual Score Justification 2/3 Hypertension imposes a threat to the health of the family members especially the father. 2 The problem can be potentially managed by avoiding triggering factors of increase in HBP. Low preventive potential because of passiveness of the client. And hereditaryillnesses can’t The family most especially totally be eradicated. the husband does not see HPN as a problem.

2. Modifiability of the Problem

2/2 x 2

3. Preventive Potential

1/3 x 1

1/3

4. Salience

0/2 x 1

0

Total Score

21/3

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Pointed / sharp objects

Criteria 1. Nature of the Problem

Rating 2/3 x 1

Actual Score Justification 2/3 It would be harmful especially to the children and be a cause of an accident. 2 Can be modified easily because the thing to be done is to cover or hammer protruding nails. The problem is not that difficult to handle. Knives can b e kept and nails can Nothammered. immediate be needing attention as believed by the family.

2. Modifiability of the Problem

2/2 x 2

3. Preventive Potential 4. Salience

3/3 x 1 ½ x 1

1 1/2

Total Score

4 1/6

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oor lighting & ventilation

Criteria 1. Nature of the Problem

Rating 2/3 x 1

Actual Score Justification 2/3 Contribute to difficulty of breathing and blurring of visions. 0 Not modifiable because it is impossible to aid about poor ventilation because it involves renovation of the house. Low preventive potential because they are just renting. They can’t do Is not the major concern renovation on the of the family because of ventilation. financial aspects and they are a lot of problems to solved.

2. Modifiability of the Problem

0/2 x 2

3. Preventive Potential 4. Salience

1/3 x 1 ½ x 1

1/3 1/2

Total Score

1 1/2

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ck of food storage facilities

Criteria 1. Nature of the Problem

Rating 2/3 x 1

Actual Score Justification 2/3 It could be the cause of death due to poisoning which is a big threat. 1 Partially modifiable because of lack of financial resource like buying a refrigerator or other containers. But,it can be modifiable. Moderate preventive potential because base on their financial status. They usually buy ready made foods and it is usually consumed.

2. Modifiability of the Problem

½ x 2

3. Preventive Potential

2/3 x 1

2/3

4. Salience

½ x 1

1/2

Total Score

2 5/6

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Cigarette / tobacco smoking

Criteria Rating 1. Nature of the 2/3 x 1 Problem 2. Modifiability 2/2 x 2 of the Problem 3. Preventive Potential 3 /3 x 1

Actual Score 2/3

Justification Tobacco smoking would lead to lung complications so it’s a big threat to the bread winner of the family. Easily modifiable because it can be eradicate through simple counseling and therapeutic approach. High preventive potential especially with a person which is not really involved in smoking and it can easily be prevented. The father is the only one smoking. The family are not aware about the consequences of secondary smoking but the family knows the disadvantages of smoking alone.

2

1

4. Salience

½ x 1

½

Total Score

4 1/6

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Walking barefooted

Criteria

Rating

Actual Score 2/3 2 1

Justification It promotes threat to health due to high risk for contamination and injury. Easily modifiable problem and it can be solved easily suck purchasing sleepers. High preventive potential and to superficial problem and problems are easily prevented. Rated 1 for social concern because this problem for the family would not make them dying.

1. Nature of the 2/3 x1 Problem 2. Modifiability 2/2 x 2 of the Problem 3. Preventive Potential 3 /3 x 1

4. Salience

½ x 1

1/2

Total Score

4 1/6

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Poor personal hygiene

Criteria

Rating

Actual Score 2/3 2

Justification When there is untidiness, dieases can be easily acquired. Easy modifiable and interventions can be render easily such medical hand washing. High preventive potential problem because the root of the problem are easily identified. Not needing immediate attention as believed by the family and too dependent on government program.

1. Nature of the 2/3 x 1 Problem 2. Modifiability 2/2 x 2 of the Problem

3. Preventive Potential

3 /3 x 1

1

4. Salience

½ x 1

1/2

Total Score

4 1/6

y Size beyond what family resources can adequately provide . Criteria 1. Nature of the Problem 2. Modifiability of the Problem Rating 2/3 x 1 Actual Score 2/3 Justification It is a health threat because it poses a risk in providing for the needs of the members. Financial problems arise. Partially modifiable because the family could still apply family planning or the couple could plan the number of children they really want to have without compromising their financial stability. Low preventive potential because base on the monthly salary which is P4, 800, it is impossible to provide all their needs especially now, commodities are expensive. Their social concern is one because they are still being passive about it, though they already knew that indeed it is one of their problems.

½ x 2

1

3. Preventive Potential

1/3 x 1

1/3

4. Salience

½ x 1

1/2

Total Score

2 1/2

Top 5 prioritized health problems
1 . Walking barefooted 2 . Pointed / sharp objects 3 . Poor personal hygiene 4 . Cigarette / tobacco smoking 5 . Lack of food storage facilities

NURSING
Vaugh

Roselle E. Anino, St. N

WALKING BAREFOOTED
FE B R U A R Y 2 0 , 2 0 1 0 @  9 : 0 0 A M Vaugh

Cues
Subjective: • “Ana jud na sila gang, magtiniil” , as verbalized by the patient   Objective: • walking without slippers • with long nails which is not properly trimmed • dirty sole

Vaugh

Family Nursing Problem
• Unhealthful lifestyle and personal habits/practices specifically : Walking barefooted or inadequate foot wear as health threat

Vaugh

Family Health Problem
• Inability to make decisions with respect to taking appropriate health action due to: failure to comprehend the nature/magnitude of the problem •
Vaugh

Goal of Care
• At the end of nursing interventions, the family will be able to practice proper foot care and foot hygiene.

Vaugh

Objectives
At the end of nursing interventions, the family would be able to: • identify the importance of proper foot care, foot hygiene and foot wear for sustaining healthy foot; • follows hygienic and other interventions such as proper foot wear to maintain skin integrity and prevent infection; • demonstrate optimal foot hygiene as evidenced by intact, pink, smooth, hydrated and warm skin, intact cuticles Vaugh and skin surrounding nails.

Nursing Interventions
1. Establish rapport with our client and apply therapeutic communication. ® To facilitate trust and cooperation 2. Provide client information on how to manage foot care and foot hygiene ® To prevent potential foot problems. 3.Discuss the risk for infection and impaired skin integrity related to walking barefoot ® For the client to be able to gained knowledge 4. Explain thoroughly nursing interventions that will help the client to maintain healthy foot care practices 5. Instruct the patient to wear slippers every time they go outside the house ® To avoid contracting athlete’s foot and other infections Vaugh

Nursing Interventions
6. Render health teachings such as wearing correctly fitting size of shoes neither restrict the foot nor rub on any area ®To prevent corn and calluses. 7. Encourage client wash the feet daily and dry them well especially between the toes, trim nails and make use of creams or lotions ® To moisten the skin that reduces dryness. 8.Give positive remarks or compliments ®To enhance self-esteem 9. Ensure that responsible individual are wearing slippers especially the parents ® They serve as role models for children to follow Vaugh

Methods of Family Contact
• Home visit

Vaugh

Resources
• Human Resources, time and effort of the nurse and family • Teaching aid

Vaugh

Evaluation
 

“GOAL MET”    March 05, 2010  @  9:00am

At the end of nursing interventions, the family was able to: • identify the importance of proper foot care, foot hygiene and foot wear; • follows hygienic and other interventions such as proper foot wear to maintain skin integrity and prevent infection; • demonstrated optimal foot hygiene as evidenced by intact, pink, smooth, hydrated and warm skin, intact cuticles and skin surrounding nails. Vaugh  

Yvanne Ronald A. Agno St.N

POINTED/SHARP OBJECTS
FE B R U A R Y 2 0 , 2 0 1 0 @  9 : 0 0 A M Vaugh

Cues
Subjective: • “Ah kanang mga lansang daan naman na diri,katong bago pami nagrent” , as verbalized the wife   Objectives: • presence of nails in the floor • protruded nails on the wall • protruded sharp parts of the wall (made up Vaugh of wood)

Family Nursing Problem
• Accident hazard: pointed/sharp objects as a health threat

Vaugh

Family Health Problem
• Inability to make decisions with respect to taking appropriate health action due to low salience of the problem

Vaugh

Goal of Care
• At the end of nursing interventions the family would be able to enhanced social concern towards safety precautionary measures

Vaugh

Objectives
At the end of nursing interventions, the family would be able to: • Identify pointed and sharp objects as a health threat • Verbalizes3-5 steps to eradicate pointed and sharp objects • Demonstrate accurately preventive steps or actions to eliminate pointed/ sharps object such as: • wearing foot ware like slippers; • Daily general cleaning; • Vaccination of Tetanus toxoid.

Vaugh

Nursing Interventions
1. Assess the level of understanding of the client. *to know anticipatory measures on how to interact with the client 2.Discuss the nature and magnitude of the problem *knowing the nature and magnitude of the problem would open the client for any nursing interventions 3.Explain the significance of having a hazard free environment *to encourage the family to participate in nursing interventions 4. Discuss the dangers of improper storage of sharps and pointed objects. *to emphasize said problem 5. Encourage the family to remove protruded nails and pointed objects if possible. Vaugh

Nursing Interventions
6.Advice the parents to cover the protruded nails which are not removable. *to protect family from injury Advice parents to instruct children to keep away from object *children are hyperactive in playing, this is o prevent them from harm and injuries 7. Advice parents to instruct children to keep away from object *children are hyperactive in playing, this is o prevent them from harm and injuries 8.advice the family to have daily general cleaning *to avoid presence of pointed/sharps object 9. Advice the parents to wear always slippers especially their children. *Slippers would lessen the incidents of stepping sharp objects which causes injury Vaugh
 

Methods of Family Contact
• Home visit • Group Aproach

Vaugh

Resources
1. Human Resources:  - Time and effort of the student and the family 2. Financial Resources:  -Money for transportation

Vaugh

Evaluation

“GOAL MET” March 05, 2010 @ 9:30am
 

At the end of nursing interventions the family was able to: Identified pointed and sharp objects as a health threat; “ Maka-tetanus diay ng mga lansang noh. Cge lang himuon naku to tanan.” As verbalization by the wife. Verbalized 3 steps to eradicate pointed and sharp objects;  1.“Bukbukon nako ni ug martilyo kung madala ning naglabaw na mga lansang” as verbalized of the wife.  2. “ Ang dili madala tabunan nalang naku ni ug kahoy napud or fly wood” as verbalized by the wife.  3. “Lagi, kumpleto maning mga bata ug ako basta bakuna ug ako” as verbalized by the wife. c. Demonstrated accurately preventive steps to eliminate pointed/sharps object such as; wearing foot ware like slippers, daily general cleaning, vaccination of Tetanus toxoid. Vaugh  

Hannah Berry Alegado, St.N

POOR PERSONAL HYGIENE
FE B R U A R Y 2 0 , 2 0 1 0 @  9 : 0 0 A M Vaugh

Cues
Subjective: •  “ Pasensya namo ha….baho pa baya mi. Wla pa man gud mi kaligo.” As verbalized by Ma’am Angelita

Objectives: • Excessive sweating of the family members • Faint odor from the mother’s axilla • Unpleasant odor from father’s mouth • Nails untrimmed • unclean clothes • hair is unkept • Fingers & feet are dirty

Vaugh

Family Nursing Problem
• Unhealthful lifestyle and personal habits/practices; Poor personal hygiene as a health threat

Vaugh

Family Health Problem
• Inability to make decisions with respect to taking appropriate health action due to: Low salience of the problem and condition

Vaugh

Goal of Care
• At the end of nursing interventions the family will be able to realize and explain the importance of good personal hygiene

Vaugh

Objectives
At the end of nursing interventions, the family would be able to: • Identify the importance of personal hygiene. • Appreciate the benefits of practicing good personal hygiene • Return demonstrate the general practices of proper personal hygiene. Vaugh

Nursing Interventions
1.Recognize with the family factors that contribute to poor personal hygiene ®To identify causes of poor hygiene. 2. Encourage joint decision making between the nurse and the family to handle the problem. ®To encourage the family’s participation. 3.Explain the importance of practicing good personal hygiene ®To promote awareness of its significance 4. Discuss with the client the effects of poor hygiene ®To inform about the consequences of not caring for personal hygiene. 5. Encourage to take a bath regularly at least twice a day. ®To facilitate cleanliness 6. Encourage to rush teeth at least three times a day Vaugh ®To facilitate fresh breath and clean teeth

Nursing Interventions
7. Encourage to clean and wash perineal area regularly. ®To prevent infection 8. Wash hands regularly especially before and after eating ®To prevent the spread of microorganisms 9. Encourage to cut nails at least once a week. ®To prevent accumulation of dirt underneath which cause diseases. 10. Demonstrate the appropriate ways of good personal hygiene such as: a. taking a bath b. brushing teeth c. washing hands 11. Return demonstrate the different techniques taught.
 

Vaugh

Methods of Family Contact
• Home visit • Group Approach

Vaugh

Resources
1. Human Resources:  - Time and effort of the student and the family 2. Financial Resources:  -Money for transportation

Vaugh

Evaluation

“GOAL MET” March 05, 2010 @ 9:30am
 

At the end of nursing interventions the family was able to: -verbalized the importance of having good personal hygiene. “Kailangan dyud manlimpyo sa lawas para makaiwas sa sakit.: -verbalized appreciation. “Mas mayo dyud diay kung mag-alaga dyud sa atong lawas kada isa.”   -family member were able to take a bath twice a day, brush teeth thrice & wash hands regularly. -family has clean & trimmed nails. -family members have a presentable appearance.  Hannah Berry Alegado, St.N
 

Vaugh

Kevin Van Eric O. Saballo, St. N

TOBACCO/ CIGARRETE FE B R U A R Y 2 0 , 2 0 1 SMOKING0 @  1 0 :0 0 A M
Vaugh

Cues
Subjective: • “Dili man jud naku malikayan gang uy. Dili magbaba tulo ka sticks nga fortune akoang mahurot usaka adlaw..”as verbalized by Mr. Basco. • “Sige gud siya naga sigarilyo, makaubos gud na siya ug tulo usahay makaabot ug lima nga stick sa isa ka adlaw” as verbalize by Mrs. Basco

Objective: • consumed not less than 3-5 sticks of fortune cigarettes per day • yellowish teeth noted • bluish discoloration of lips Vaugh • smoking during the conversation

Family Nursing Problem
• Unhealthful lifestyle and personal habits/practices due to cigarette smoking as a health threat

Vaugh

Family Health Problem
• Inability to recognize the presence of condition or problem due to lack of or inadequate knowledge about cigarette smoking.

Vaugh

Goal of Care
• After the nursing intervention the family specifically, Mr. Basco will be able to lessen the consumption of cigarette from 3 to 2.

Vaugh

Objectives
At the end of nursing interventions, the family will be able to: • identify at least 2 of harmful effects cigarette smoking such as cancer and ; • appreciate the benefits of preventing the use of cigarette; • identify at least 3 substitute for cigarette such as candies, lollipop and Vaugh gums.

Nursing Interventions
• Discuss with the family the:
– The nature of the problem*to promote awareness and know how the patient view the situation or the identified problem – The effects and possible complication of cigarette smoking – The effect and possible complication that may appear on passive smokers

• Identify situations that trigger the urge to smoke. *avoiding the certain situation may or will reduce the urge to smoke
Vaugh

Nursing Interventions
• Encourage the family specially Mr. Basco to: – Have a support person or group *someone you can call for those times when you feel like you are having a weak moment and might smoke a cigarette – Keep candies, Toothpicks, sunflower seed or Lollipops handy *it can be used as a substitute for cigarette – Use diversionary activities such as eating candies, gums or food* – Brush his teeth regularly *reduce the presence of tartar – To buy food instead of buying cigar * – Client to remind their children not to smoke and what are the effects of smoking*to encourage their children not to smoke To smoke away from other person if smoking cannot be avoided*to Vaugh avoid second hand smoking

Methods of Family Contact
• Home visit

Vaugh

Resources
• Human resources: time, and effort of the nurse and the family • Financial resources: Fare for transportation • Teaching aids

Vaugh

Evaluation
 

“GOAL MET”    March 05, 2010  @  9:30am

At the end of nursing interventions, the family was able to verblize: • “duha nalang na sticks ang nahurot nako gahapon…plano na gani nako magundang na ko pagsigarilyo” as verbalized by Mr. Basco. • “kanser,ubo na dugay mayo” • “mas maayo jud ang dili na mag sigarilyo para makalikay sa sakit ” Vaugh • “pwede kendi, lollipop ug bubble gum ang pwede ipuli sa pagsigarilyo” 

Phoebe Lyn S. Brusas, St. N

LACK OF FOOD STORAGE FE B R U A R Y 2 0 , 2 FACILITY0 1 0 @  1 0 :0 0 A M
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Cues
Subjective: • “Lage, wala mi butanganan para sa among pagkaon kay wala man pud gud mi ref gang’’, as verbalized by Mrs. Angelita Basco.


Objectives: • -no water container; • -observable leftover food with presence of ants; • -grocery items such as milk, noodles and condiments are unkept at one side near the sink; • -no refrigerator or cabinet for food storage purposes.

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Family Nursing Problem
• Poor home condition specifically lack of food storage facilities as a health threat.

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Family Health Problem
• . Inability to provide home environment conducive to health maintenance due to: limited physical resources such as lack of food storage facilities.

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Goal of Care
• At the end of nursing interventions, the family would be able to recognize the importance of proper storage of food for health maintenance. Thus, take appropriate actions to solve the existing problem.
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Objectives
At the end of nursing interventions, the family would be able to:  1. enumerate at least two effects of unprotected and non-stored food such as:  a. possible contamination of other substances or microorganisms;  b. easy spoilage of food.  2. appreciate the benefits of having proper food storage facilities.  3. demonstrate proper ways of storing food such as:  a. placing in properly sealed containers;  b. labeling the containers; Vaugh

Nursing Interventions
1. Assess the salience of the family regarding the presence of the problem. ®to know whether the family think it as a problem or not 2. Inform them about the existing problem. ® to promote awareness about the problem 3. Explain to the family the good effects of proper storing of food such as: a. prevention of rapid spoilage; b. possible contamination may be avoided. ® to provide information about the benefits of proper food storage. 4. Enumerate ways and means on how to improve food storage such as : a. placing food in clean and properly sealed containers: b. labeling the containers according to use. ® to prevent contamination

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Nursing Interventions
5. Instruct the family to cover drinking containers with caps or clean plastic or cellophane which can be sealed by rubber bands. ® to ensure it is clean and is safe to drink 6. Encourage the family to wash and clean the containers from time to time. ® this promotes health maintenance and wellness 7. Persuade the family to find other ways in storing food. ® resourcefulness and creativity are also solutions on the existing problem. 8. Encourage the client to buy food enough only for the meals. ® to prevent food wasting and spoilage since they don’t have refrigerator 9. Instruct parents to put food containers away from children’s reach. Vaugh ® to avoid accidental spilling and food wasting

Methods of Family Contact
• Home visit

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Resources
1. Human resources: Time and effort of the nurse and the family. 2. Financial resources: fare for transportation and money for the grocery items 3. Teaching aids

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Evaluation

“GOAL MET” March 05, 2010@ 9:30am

1. enumerated two effects of unprotected and non-stored food such as:  a. possible contamination if not properly sealed and kept;  b. easy spoilage of food. 2. “ Bitaw no..dapat jud diay nato ibutang sa limpyo na butang anan ug kanang nay taklob ang pagkaon para dili madapuan ug mga ok-ok ug langaw . Para makaiwas pud ta sa sakit”, as verbalized by Mrs. Angelita Basco. 3. demonstrated proper way of storing food such as:  a. the condiments, milk and noodles are placed inside a container with cover;  b. labeled the containers as for the salt, vinegar and sugar. Vaugh  c. provided container for the leftovers.

Implications Of The Study

o r e ve n t w h i i th e ca se . I p ro vi e s a syste m a ti w a y o f l o ki g a t e ve n ts, ch s t d c o n co l e cti g d a ta , a n a l n g i fo rm a ti n a n d re p o rti g th e re su l . T h u s, th i l n yzi n o n ts s ca se stu d y i d i cte d to w a rd s a co m p re h e n si stu d y m a d e o f th e fa m i y to s re ve l b ri g a fu l e r u n d e rsta n d i g o f th e n e e d e d n u rsi g ca re to th e m . T h i stu d y n l n n s ca n a l b ri g a b o u t i p ro ve m e n t i th e fi l o f N u rsi g e d u ca ti n , N u rsi g so n m n ed n o n Pra cti a n d N u rsi g R e se a rch . ce n N u rsi g e d u ca ti n i fo cu se d o n te a ch i g th e kn o w l d g e a n d ski l th a t n o s n e ls w o u l e n a b l a n u rse to p ra cti d e ce i th e h o sp i l se tti g . I i co n ti u a l y n ta n t s n l re vi d to m e e t th e n e e d s o f n u rse s w o rki g i a ch a n g i g e n vi n m e n t. A s se n n n ro stu d e n ts i a h e a l d i p l n e , w e ca n u se th i stu d y a s a n e d u ca ti n a l to o l n th sci i s o . T h i ca n se rve a s a g u i e i d o i g a co m p re h e n si re vi w o f th e cl e n t, th e s d n n ve e i p ro b l m s, e ffi e n t i te rve n ti n stra te g i s a n d fa cto rs th a t a ffe ct th e e ci n o e o u tco m e o f th e p ro b l m s. e A p p a re n tl , N u rsi g Pra cti a s w e a l kn o w i fl b l a n d d yn a m i . I y n ce l s exi e c t ca n ch a n g e a n d i p ro ve d u ri g th e co u rse o f ti e . T h e i p l ca ti n s o f th i m n m m i o s ca se stu d y i N u rsi g Pra cti i th a t, i ca n h e l i cl n i l d e ci o n m a ki g n n ce s t p n i ca si n a n d ca n a ssi i se l cti g a p p ro p ri te i te rve n ti n s. I re a l y m a ke s g o o d st n e n a n o t l se n se to i p l m e n t a n e w i n o va ti n i th e i p ro ve d p ra cti se tti g . m e n o n m ce n

h a p p e n e d a s i d i a n d w h a t m i h t b e co m e i p o rta n t to l o k a t m o re t d g m o exte n si l i fu tu re re se a rch . C a se stu d y i a l ve y n s so d e fi e d a s a re se a rch n stra te g y , a n e m p i ca l i q u i th a t i ve sti a te s a p h e n o m e n o n w i i i re a l ri n ry n g th n ts l fe co n text. T h i stu d y ca n b e a va l a b l so u rce o f d a ta fo r re se a rch . T h e i s u e m a j r g o a lo f n u rsi g re se a rch i to i p ro ve cl e n t ca re . o n s m i T h e u l m a te g o a l o f a n y p ro fe ssi n i to i p ro ve th e p ra cti ti o s m ce o f i ts m e m b e rs so th a t th e se rvi s p ro vi e d to i cl e n t w i l b e m a xi a l y ce d ts i l m l e ffe cti . A p ro fe ssi n se e ki g to e n h a n ce i p ro fe ssi n a l sta tu re stri s fo r ve o n ts o ve th e co n ti u e d d e ve l p m e n t o f a sci n ti c b o d y o f kn o w l d g e fu n d a m e n ta l to n o e fi e p ra cti . T h e e m e rg e n ce o f su ch a b o d y o f sci n ti c kn o w l d g e ca n b e ce e fi e i stru m e n ta l i n n fo ste ri g a co m m i e n t a n d a cco u n ta b i i n tm l ty to th e p ro fe ssi n ’ s cl e n ts. o i A b o ve a l , th i stu d y i co n d u cte d fo r th e i p ro ve m e n t o f ca ri g a n d l s s m n m a n a g i g ch i d h o o d i l e sse s to re d u ce th e m o rta l ty a n d m o rb i i n l ln i d ty i n ch i d re n u n d e r 5 ye a rs o l . T h e co m m u n i -I C I i to exp a n d a cce ss a n d th e l d ty M s co n ti u u m o f ca re fro m cl n i to h o u se h o l / co m m u n i e s. T h i a l fo cu se s n i cs d ti s so o n th e co m m u n i -b a se d i te rve n ti n s to i p ro ve n e w b o rn a n d ch i d h e a l . ty n o m l th T h e co m m u n i -I C I h e l s a sp i n t n u rse s to fa ci i te a ctu a l a sse ssm e n t to ty M p ra l ta ch i d re n w i p o o r h e a l co n d i o n s. T h u s, th ro u g h p ro p e r cl ssi ca ti n w e l th th ti a fi o

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Ackn ow ledg em en t...
W e w o u l l ke a l d i so to th a n k o u r sp o n so rs: S TA R ki s d Tu to ri l C e n te r, A n i o a n d B ru sa s re si e n ce a n d th e S a n a n d Pe d ro C o l e g e Li ra ry fo r m a ki g th i ca se stu d y l b n s p o ssi l . b e   A n d m o st o f a l , w e w o u l l ke to th a n k th e A l i h ty l d i m g Fa th e r fo r g u i i g u s, e n l g h te n i g u s a n d p ro te cti g u s d n i n n fro m a l h a rm . H e h a s b e e n w i l th u s fro m th e ve ry b e g i n i g . W e o w e th i re m a rka b l b l ssi g to H i . n n s e e n m   To a l th o se w h o w e re n o t m e n ti n e d b u t co n tri u te d a l o b l t to th i su cce ss, o u r d e e p e st g ra ti d e a n d th a n ks to o s tu a l f yo u . T h a n k yo u ve ry m u ch ! lo

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