You are on page 1of 33

Liceo de Cagayan University

College of Nursing
RNP Blvd. Carmen Cagayan de Oro City

In partial fulfillment of
NCM501205
Related Learning Experience RLE

Submitted by :

Submitted to:
Clinical Instructor
INTRODUCTION

The family is the basic unit of a society. As a universal social institution, it


may be defined according to Burgess, as a group of persons united by ties of
marriage, blood or adoption; constituting a single household unit, interacting and
communicating with each other in their respective social rules of husband and
wife, mother and father, son and daughter, and creating and maintaining a
common culture. Based on his definition, the nature of family will be affected by
several modifications foremost of which is the socio-cultural factor. The family
will inevitably be affected by the changes that occur within the society of which it
is a part. Society is never static. It is constantly changing. Changes that may
occur will be reflected in family life. Considering the impact of the family in
molding the personality of its members, one cannot overemphasize the
importance of knowing the interrelationship of family and socio-cultural forces.
A family may also be “two or more people who live in the same household
(usually), share a common emotional bond, and perform certain interrelated
tasks. Spradley (1990, p. 100). The second definition is more favorable for
healthcare providers because it gives emphasis on the fact that there are
different types of families. Many types of families exist, and a family will change
over time as it is affected by birth, work, death, divorce and growth of each family
member.
A family represents a certain group in a community, and as a group, each
member must have a certain role to play or complete a certain task. Majority of
the roles people view as appropriate are the roles they see their parents fulfill.
Each generation takes on the values and traditions of the past generation,
handing down tradition and culture from one generation to the next.
Some of the main tasks that essentially should be carried down or passed
on from one family to the next are basically norms in society pertaining to family,
which are: A family must provide food, shelter, clothing and health care for its
members; prepare children to live in the community and interact with people
outside the family; determine which family needs will be met and their order of
priority; open an effective means of communication between family members,
establish family values and enforce common regulations for all members; apply
division of labor; place members of the family into different sectors of society
such as school, religious affiliations, or political groups; and maintain motivation
and morale. The stability of the family is a delicate thing made up of the interplay
and exchange between members. Crisis occur when change in role is necessary
and the emotional balance within the family is disturbed. Illness of an individual
member often creates a difficult change in role and a crisis occurs. As with the
individual, the stage of development of which illness is interjected affects the
nature and severity of the crisis of the family.
The family as a group has the dual task of attaining its goals and meeting
the needs of its individual members. Within the constraints of its social roles,
each family develops its own set of values, its own patterns of behavior, or no
communication between husband and wife and between parents and children are
among the tasks.
By fulfilling these tasks through the developmental stages, each family
member must work with every other member and play his designated role.
Through positive means, in effect the family structure will be healthy resulting in
each member’s successful growth and development.

As a requirement of NCM501205, we the students were required to conduct a family


care study of Zone 4- Igpit Misamis Oriental. In relation to this, I have chosen the
Cahatian Family for my family care study for they poses the criteria for the need of
family care. Thus, education on health and health teachings regarding possible
diseases at risk was emphasized. Referral to medical heath team as well as intervention
of their sufficient condition was done in accordance to care.

A. Objective of the Study


At the end of two (2) weeks of Community Health Exposure Group B-17
will be able to impart to the Cahatian Family the health programs of the
Department of Health (DOH) for the promotion of health and prevention of
illnesses and the improvement of the conditions in the social and physical
environment. The group aims to provide nursing interventions to identified health
problems affecting the family. Information on Integrated Management for
Childhood Illnesses (IMCI) will be imparted to the family since they have two (2)
kids that belong to the 0-5 year’s bracket. I aim to participate in the family in the
over-all health plan affecting the family, in its implementation and evaluation.

B. Scope and Limitation of the Study


This Family Health Care Study provides information and additional
knowledge to the family concerned. By this, I am focusing only on the Cahatian
Family, on its health problems, on the prevention of illnesses, and health
promotion. We give emphasis on DOH programs that is most beneficial to the
family and the availability of health care services offered by the Department of
Health through our Health Centers. Most importantly the child with aged 0-5
years old will be thoroughly assessed and monitored on its health condition.
I will to implement health teachings according to the knowledge they have
gained from nursing theories and its application on the community health setting.
Family care study covers only two (2) weeks of Community Health Nursing. This
is also limited to the family's capabilities to participate and cooperate with the
nursing interventions. It is also limited to the financial capabilities of the family.

SPOT MAP
FAMILY PROFILE

Father of the Family


No Available Photo

Age

Occupation
Date of Birth
Educational Attainment
Birth Place
Height
Weight

Mother of the Family:

Age
Occupation
Date of Birth
Educational Attainment
Birth Place
Height
Weight
Family Information
Religion : Roman Catholic
Nationality : Filipino
Family Income : ↑↓ Ρ 5,000/month
Source of Income : Father – as a Jeepney Driver

Children’s:

Name :

Age
Sex
Date of Birth
Birth Place
Height
Weight
Name :

Age
Sex
Date of Birth
Birth Place
Height
Weight
HEALTH HISTORY

Diabetes mellitus is one of the underling problems which a certain people


in the community setting have. In the case of the Cahatian Family, they are very
much predisposed to the illness for both the maternal parents have the said
illness. It may seem presumptive as of now that they would manifest such
diabetes symptoms yet the genetic or hereditary factor is present.
In most Filipinos Hypertension or the abnormal increase in the blood
pressure is evident 60-75 percent in a certain age group (Medical Surgical by
Black). The paternal side of the Cahatian family had a history of mild to moderate
hypertension and familial heart problem. Both parents of the father had
hypertension. Mr. x is 33 years of age, who came from the province of Bukidnon
and is presently residing now in x. He is a father of two children with ages from 8
mos. to 1 year and 8 mos. old. He works as a Jeepney driver of a x with an
average monthly income of Php 5,000.00 a month which is not totally enough to
support the family’s basic needs. He works from Sunday to Saturday from 6am-
10pm the most, where he finds no time to rest and stay with his family for the
weekend. But he manages to provide food for the family so they can eat at least
three square meals a day which is considered his most important target to
accomplish for the family. No hospital record for him so far.

Mrs. Y is 21 years of age, her family originated from Y. She met Mr. X
during a Barangay Dance “disco” and consequently got married and settled. She
is a plain housewife and stays most of the time at home. Both parents of the
maternal side, had diabetes mellitus that is why she is utmost predisposed to
acquiring diabetes. She has been hospitalized twice in X due to Maternal delivery
with her first baby and the second baby.

C, 1 year and 9 months is the eldest of two children. When Mr. X stopped
using condom since it was costly for them, C became the product of their
marriage. He was breastfed when she was an infant and he has completed his
Hepatitis vaccination. No records of hospitalization were revealed by the mother
upon interview except common colds, fever and cough which was just confined
at home.
Baby V, 8 months old is the second child. She came out to this world as a
result when Mrs. Y experienced headache when using Depo (injectibles) and
stopped using it. The mother breastfed her but was not successful due to mixed
feeding or bottle fed. She has not yet completed her Hepatitis vaccination. She
too had not been hospitalized. Once she was sick due to colds, she was just
confined at home.

PRESENT HEALTH STATUS

The father of the family X, who is currently 33 years old is a Jeepney


Driver of X with the danger in the road as always. During my one day encounter
with him due to his unavailability, he appeared to be physically fit. His vital signs
are all in normal BP(120/90mmHg). He has a normal respiration = 16 cpm. He
complains back pain recently due to prlonged sitting in the drivers sit. He drinks
beverages of hard liquor from around 3 bottles per week and smokes
occasionally, approximately 4 – 5 sticks per week according to him. He
eliminates waste 5 to 7 times per week. Usually he eats vegetables and fish as
well as “sinugba” which is usually the ”pulutan” of choice.
The light or “ilaw” of the house is Mrs. Y, 21 years old and is the mother of
2 children. She is a High School Undergrad. She is said to have completed her
immunization schedule. Her blood pressure is 110/80mmHg and has a
respiration of 19 cpm which is believed to be normal. She was prone to have
Diabetes Mellitus because both of her parents has DM. She currently does not
smoke and drink hard liquors. She has no allergies as stated by the client.
Eliminates once daily on a day to day biases, her usual food intake are
vegetables and soups because according to her vegetables are very cheap and
affordable yet nutritious.
The eldest child, C is 1 year and 8 months old He is physically and
emotionally stable. He is said to be allergic to shrimps. Both the eldest and the
second child were immunized with Hepa doses. They usually eat vegetables and
loves fishes in there usual day to day diet.
.
The youngest child, Baby V who is currently 8 months old. During my
assessment, I observed the client manifesting runny nose, she is calm, a
temperature with an afebrile state T = 37° C. The mother complained that baby
Jean is having colds for 3 days already and baby Jean is in her process of
teething
Nursing System Review Chart
NURSING SYSTEM REVIEW CHART
Name X__________________________ Date: _________
Vital Signs:
Pulse: 89 bpm__ BP: 120/80 mmHg Temp: 37.1۫C___ Height: 5’4’’______ Weight: 58 kg____
EENT:
� Impaired vision � blind
� pain � reddened � drainage
� gums � hard of hearing � deaf
� burning � edema � lesion � teeth
Asses eyes, ears, nose
Throat for abnormality � no problem
RESP.
�asymmetric � tachypnea
� apnea � rales � cough � barrel chest
� bradypnea � shallow � rhonchi
� sputum � diminished � dyspnea
� orthopnea � labored � wheezing
� pain � cyanotic
Asses resp. rate, rhythm, depth, pattern
breath sounds, comfort � no problem
CARDIO VASCULAR
� arrhythmia � tachycardia � numbness
� diminished pulses � edema � fatigue
� irregular � bradycardia � murmur
� tingling � absent pulses � pain
Assess heart sounds, rate, rhythm, pulse, blood
pressure, etc., fluid retention, comfort
� no problem
GASTRO INTESTINAL TRACT
� obese � distention � mass
� dysphagia � rigidity � pain
Asses abdomen, bowel habits, swallowing,
bowel sounds, comfort � no problem
GENITO-URINARY and GYNE
� pain � urine color � vaginal bleeding
� hematuria � discharge � nocturia
Assess urine freq., control, color, odor, comfort/
Gyn-bleeding, discharge � no problem
NEURO
� paralysis � stuporous � unsteady � seizures
� lethargic � comatose � vertigo � tremors Complained of mild
� confused � vision � grip back pain
Assess motor function, sensation, LOC, strength,
grip, galt, coordination, orientation, speech.
� no problem
MUSCULOSKELETAL and SKIN
� appliance � stiffness � itching � petechiae
� hot � drainage � prosthesis � swelling
� lesion � poor turgor � cool � deformity
� wound � rash � skin color � flushed
� atrophy � pain � ecchymosis
� diaphoretic � moist
Asses mobility, motion, galt, alignment, joint function
/skin color, texture, turgor, integrity � no problem

Place an (X) in the area of abnormality. Comment at the


space provided. Indicate the location of the problem in
the figure if appropriate, using (x)
Name: Y Date: _______
Vital Signs:
Pulse: 69bpm___ BP: 110/80 mmHg__ Temp: 36.6۫C_____ Height:5’3__ Weight: 56 kg________
EENT:
� Impaired vision � blind
� pain � reddened � drainage
� gums � hard of hearing � deaf
� burning � edema � lesion � teeth
Asses eyes, ears, nose
Throat for abnormality � no problem
RESP.
�asymmetric � tachypnea
� apnea � rales � cough � barrel chest
� bradypnea � shallow � rhonchi
� sputum � diminished � dyspnea
� orthopnea � labored � wheezing
� pain � cyanotic
Asses resp. rate, rhythm, depth, pattern
breath sounds, comfort � no problem
CARDIO VASCULAR
� arrhythmia � tachycardia � numbness
� diminished pulses � edema � fatigue
� irregular � bradycardia � murmur
� tingling � absent pulses � pain
Assess heart sounds, rate, rhythm, pulse, blood
pressure, etc., fluid retention, comfort
� no problem
GASTRO INTESTINAL TRACT
� obese � distention � mass
� dysphagia � rigidity � pain
Asses abdomen, bowel habits, swallowing,
bowel sounds, comfort � no problem
GENITO-URINARY and GYNE
� pain � urine color � vaginal bleeding
� hematuria � discharge � nocturia
Assess urine freq., control, color, odor, comfort/
Gyn-bleeding, discharge � no problem
NEURO
� paralysis � stuporous � unsteady � seizures
� lethargic � comatose � vertigo � tremors
� confused � vision � grip
Assess motor function, sensation, LOC, strength,
grip, galt, coordination, orientation, speech.
� no problem
MUSCULOSKELETAL and SKIN
� appliance � stiffness � itching � petechiae
� hot � drainage � prosthesis � swelling
� lesion � poor turgor � cool � deformity
� wound � rash � skin color � flushed
� atrophy � pain � ecchymosis
� diaphoretic � moist
Asses mobility, motion, galt, alignment, joint function
/skin color, texture, turgor, integrity � no problem

Place an (X) in the area of abnormality. Comment at the


space provided. Indicate the location of the problem in
the figure if appropriate, using (x)
Name: C_______________________________ Date: C__________
Vital Signs:
Pulse: 89bpm_____ BP: _--__ Temp: 37 ۫C_____ Height: 78 cm___ Weight:10 kg__
EENT:
� Impaired vision � blind
� pain � reddened � drainage
� gums � hard of hearing � deaf
� burning � edema � lesion � teeth
Asses eyes, ears, nose
Throat for abnormality � no problem
RESP.
�asymmetric � tachypnea
� apnea � rales � cough � barrel chest
� bradypnea � shallow � rhonchi
� sputum � diminished � dyspnea
� orthopnea � labored � wheezing
� pain � cyanotic
Asses resp. rate, rhythm, depth, pattern
breath sounds, comfort � no problem
CARDIO VASCULAR
� arrhythmia � tachycardia � numbness
� diminished pulses � edema � fatigue
� irregular � bradycardia � murmur
� tingling � absent pulses � pain
Assess heart sounds, rate, rhythm, pulse, blood
pressure, etc., fluid retention, comfort
� no problem
GASTRO INTESTINAL TRACT
� obese � distention � mass
� dysphagia � rigidity � pain
Asses abdomen, bowel habits, swallowing,
bowel sounds, comfort � no problem
GENITO-URINARY and GYNE
� pain � urine color � vaginal bleeding
� hematuria � discharge � nocturia
Assess urine freq., control, color, odor, comfort/
Gyn-bleeding, discharge � no problem
NEURO
� paralysis � stuporous � unsteady � seizures
� lethargic � comatose � vertigo � tremors
� confused � vision � grip
Assess motor function, sensation, LOC, strength,
grip, galt, coordination, orientation, speech.
� no problem
MUSCULOSKELETAL and SKIN
� appliance � stiffness � itching � petechiae
� hot � drainage � prosthesis � swelling
� lesion � poor turgor � cool � deformity
� wound � rash � skin color � flushed
� atrophy � pain � ecchymosis
� diaphoretic � moist
Asses mobility, motion, galt, alignment, joint function
/skin color, texture, turgor, integrity � no problem

Place an (X) in the area of abnormality. Comment at the


space provided. Indicate the location of the problem in
the figure if appropriate, using (x)
Name: Baby V_______________________________ DateV__________
Vital Signs:
Pulse: 92bpm_____ BP: _--__ Temp: 38.5۫C_____ Height: 68 cm___ Weight:7 kg__

EENT:
� Impaired vision � blind
� pain � reddened � drainage
� gums � hard of hearing � deaf Teething process
� burning � edema � lesion � teeth
Asses eyes, ears, nose
Throat for abnormality � no problem Colds
RESP.
�asymmetric � tachypnea
� apnea � rales � cough � barrel chest
� bradypnea � shallow � rhonchi
� sputum � diminished � dyspnea
� orthopnea � labored � wheezing
� pain � cyanotic
Asses resp. rate, rhythm, depth, pattern
breath sounds, comfort � no problem
CARDIO VASCULAR
� arrhythmia � tachycardia � numbness
� diminished pulses � edema � fatigue
� irregular � bradycardia � murmur
� tingling � absent pulses � pain
Assess heart sounds, rate, rhythm, pulse, blood
pressure, etc., fluid retention, comfort
� no problem
GASTRO INTESTINAL TRACT
� obese � distention � mass
� dysphagia � rigidity � pain
Asses abdomen, bowel habits, swallowing,
bowel sounds, comfort � no problem
GENITO-URINARY and GYNE
� pain � urine color � vaginal bleeding
� hematuria � discharge � nocturia
Assess urine freq., control, color, odor, comfort/
Gyn-bleeding, discharge � no problem
NEURO
� paralysis � stuporous � unsteady � seizures
� lethargic � comatose � vertigo � tremors
� confused � vision � grip
Assess motor function, sensation, LOC, strength,
grip, galt, coordination, orientation, speech.
� no problem
MUSCULOSKELETAL and SKIN
� appliance � stiffness � itching � petechiae
� hot � drainage � prosthesis � swelling
� lesion � poor turgor � cool � deformity
� wound � rash � skin color � flushed
� atrophy � pain � ecchymosis
� diaphoretic � moist
Asses mobility, motion, galt, alignment, joint function
/skin color, texture, turgor, integrity � no problem

Place an (X) in the area of abnormality. Comment at the


space provided. Indicate the location of the problem in
the figure if appropriate, using (x)
HOME AND ENVIRONMENT
The X family resides at X. Their house is made up of mixed wood and cement. It
is about 10.5 feet wide in front view and 6.5 feet tall when standing inside the
house. With due respect, I do observe that the family has a limited budget on
extra materials from the house. Inside the house you will see the unfinished
clippings of plywood. Nails are not well hammered which is a sign of insufficient
foundation. According to Mrs. Y, her husband earns about P5000/month. Their
total earnings only benefit their day to day basic needs primarily the foods they
eat.
Their house is composed of two sections. This said section is partially closed
with three walls. One section is utilized as the dining room and living room. The
other section of the house is the bedroom which is elevated from the living room.
I was also able to observe that the area has a poor sanitary condition, so as to
find a soil formed flooring where in times of rainy season, the area is very much
prone to flooding if not muddy.
They get their electricity tapped from their parents house. Aside from the radio,
TV and the 3 electric lights, they don’t have any other home or electrical
appliances. The Cahatian family makes use of mosquito nets as protection from
the mosquito bites.
The X family gets their drinking water supply primarily from buying just next
house and they also store water in Water containers. They use this water for
daily purposes, such use includes in washing of clothes, taking a bath, washing
dishes, and many other functions. The drummed water which is said to be for
drinking is not boiled anymore.
The kitchen is primarily a dirty kitchen type, located at the back of the house.
They use firewood to make fire or to keep fire burning. Dust or ashes from
firewood is all over the area. Cooking the food through a kittle has been practiced
since then. The house has no sink; accordingly they drain or wash plates at the
back of the house. Piles of used kitchen utensils and plates were observed. They
don’t clean the dishes until needed because accordingly they save water by
washing plates at one time.
The drainage system is quite poor, they don’t have a sink and proper sewage
water could be displaced. During rainy seasons, it was almost flooding in the
area since the water is stagnant in the area. The family does not observe proper
garbage segregation. They only dump all their garbage regardless of whether
biodegradable or non-biodegradable in one side of the house. They also burn
their trash.
The X family doesn’t have any domesticated animals because according to them,
they don’t have extra budget for feedings. Although cats and dogs are quite
visible in the area, they do not own one for its maintenance still cost few amount.
Knowing that their budget for there day to day expenses may be affected as well
as other means. Having a pet means you have to find a way to feed them this
explains why they don’t have a pet aside from the pig.
The family does have a toilet of their own, antipolo type situated at back of the
house which is exclusively for disposal only; taking a bath is done outside the
house. The toilet upon my observation is not proper clean and maintained well.
Most of the area in the community of X is owned by Boy Sabo. Therefore, the
residents do not have titled lot. And by this statement, they are at risk for being
evacuated or ask to abandon the place. In the said area we I had observed that
the people don’t really participate on particular activities or is not active in team
building activities. Likewise the Cahatian family is not fully aware on the services
or resources in the community.
FAMILY COPING INDEX
Legend:
1 – No competence
3 – Moderate competence
5 – Complete competence

CATEGORY SCALE JUSTIFICATION


1. Physical Independence 5 All family members are physically fit and physically
capable of performing independently.
The family provides needs to its members.
The father works as a construction worker to
provide the needs of his family. The mother takes
care of the children and she cooks for the family.
2. Therapeutic 3 The family use herbal medication to treat existing
diseases instead of consulting to physician
Competence
because of lack of money. Listen to hearsay
instead of consulting professional medical help.
They do not seek medical advice, for they don’t
even go to the barangay health center if one of the
family members gets sick.
3. Knowledge of Health 3 Has some general knowledge of the disease or
condition, but has not grasped the underlying
Condition
principles, or is only partially informed and does not
know how to listen & prevent the disease.
4. Application of In terms of hygiene, the family was not consciously
practicing/ applying hygiene principle as part of
Principles of General 3
their lifestyle. Based on the objective observation,
Hygiene as well as assessment gathered such as garbage
disposal and also their lifestyle condition & absence
of drainage.
5. Health Attitudes 3 Accept healthcare in some degree but with
reservations. Understand the importance of eating
well and the need of healthy living but they don’t
practice or observe healthy lifestyle.
6. Emotional Competence 3 The family was able to maintain a reasonable
degree of emotional calm face up to illness
realistically and hopefully; but they were not able to
discuss family problems because of the absence of
the presence of the head of the family.
7. Family Living 3 Family’s does things together and act for the good
of the family as a whole and they have good
interpersonal relationship but unfortunately the
father does not have quality time for his family
because of his work as a construction worker.
8. Physical Environment 1 House needs major repair. It is poor in condition,
unscreened and windows. There is an unattended
open drainage and presence of flies which are
potential to spread and cause diseases.
9. Use of Community 3 Family is aware of and uses of the health services
offered in their barangay health center but were not
Facilities
able to fully avail the services.
FAMILY HEALTH PLAN

CUES HEALTH FAMILY GOAL OF OBJECTIVES INTERVENTION PLAN


PROBLEM NURSING CARE OF CARE Nursing Method Resources EVALUATION
PROBLEM Interventions of Required
Nurse-
Family
Contact
Subjective: Cough and 1. Inability to At the end At the end of 1. Taught the Home Material Goal partially
“Kani lagi si colds as make of nursing nursing mother the ways Visit resources: met
decisions to soothe the
Bb. Jean health about taking intervention, interventions, throat and
-tamarind, At the end of
sip-on,” as deficit appropriate the child’s the family will: relieve cough calamnasi or nursing
verbalized action due to: cough and a. gain with a safe ginger interventions,
by the a. failure to colds will be knowledge on remedy such as the family:
comprehend tamarind,
mother the nature and
relieved. the Time and a. gained
calamansi and
magnitude of management ginger. effort of the knowledge on
Objective: the problem. of cough and 3. Instructed the nurse and the the
-non b. Fear of colds; mother not to family management
consequences b. bring the use cough of cough and
productive of action, syrups and other
cough specifically child to the decongestants if Expenses for colds;
- colds economic health center not prescribed by transportation ;
- RR 48 consequences for the doctor. of the student b. was able to
cpm . consultation; 4. Accompanied carry out
2. Inability to
nurses and
c. be able to the mother and appropriate
provide child to the family to the
adequate carry out health center for health center interventions
nursing care to appropriate consultation. and back. to relieve the
a member interventions 5. Instructed the child’s cough
suffering from to relieve the mother to and colds.
cough and increase the
colds due to: child’s cough child’s fluid
a. inadequate and colds; intake.
knowledge 6. Instructed the
regarding the mother to keep
health the child’s back
condition; dry.
b. lack of 7. Placed the
knowledge on patient on
the nature and moderate high
extent of back rest.
nursing care 8. Performed
needed; chest tapping.
CUES HEALTH RESOURCES EVALUATION
PROBLEM FAMILY GOAL OF OBJECTIVES INTERVENTION METHODS REQUIRED
NURSING CARE OF CARE MEASURES OF NURSE-
PROBLEM FAMILY
CONTACT

Subjective: Environment • Inability to After nursing After nursing 1. Discussed with the Home visit After the nursing
“Medyo hugaw al sanitation maintain intervention, intervention, family the importance Material intervention, the
gyud ang among as health sanitary the family will the family will of keeping resources: family was able to:
palibot threat environment be able to be able to environment clean and 1. Practiced of
gakapoyan due to recognize the • identify sanitary. keeping
naman gud ko environmental importance of causes or root 2. Explained to the environment or
kay daghan condition such keeping of problem family that keeping Visual aids surroundings clean
pakog buhaton” as flooding of environment regarding environment and sanitary.
as verbalized by water in these clean and environmental conducive for health 2. eradicates /
Mrs. Genevieve areas. sanitary and sanitation helps in the disease Time and effort control of insects,
Rayos •Inability to appreciate the • Will be able prevention. aids and vermins, and
control insects effects. to keep and 3. Encouraged / transportation rodents (if any).
Objective: and vermin due maintain a advised to screen of the student
• House to lack of sanitary windows and doors to nurse.
surrounded by knowledge on environment prevent / avoid insects
murky and importance of conducive for such as mosquitoes
stagnant water eradicating health. and flies to enter the
Expenses for
• Flooding often them. • will be able house and advised to
teaching aids
occurs during to eradicate or kill roaches and other
rainy seasons minimize insects.
• Compost pits presence of 4. Encouraged to
are often insects and properly segregate
dugged shallow vermin on and dispose garbage
leaving garbage surroundings according to kind, and
to over flow. especially in practice it religiously
• Presence of the house. for health promotion
flies and and disease
mosquitoes preventive measures.
flying the house. 5. Made the family
aware of the risks and
effects of not keeping
environment sanitary.
CUES HEALTH RESOURCES EVALUATION
PROBLEM FAMILY GOAL OF OBJECTIVES INTERVENTION METHODS REQUIRED
NURSING CARE OF CARE MEASURES OF NURSE-
PROBLEM FAMILY
CONTACT

Improper • Inability to After the After the 1. Emphasized to Home visit After the nursing
Subjective: Garbage segregate nursing nursing the family the Material intervention, the
Disposal as a garbage due to intervention, intervention, importance of resources: family was able to:
“ Na, wala man health threat lack of the family will the family will throwing their trash 1. Resolutes the
awareness on be able to be able to: in a garbage bag importance of
me kabalo
proper waste appreciate the rather throwing it throwing their trash
unsaun na pag Visual aids
disposal. importance of • Identify and anywhere. in garbage bag
lain-lain ug mga
garbage classify waste rather throwing it
basura”, as
• Inability to segregation. and 2. Educates the anywhere.
verbalized by
the mother appreciate biodegradable, family how to cover Time and effort
garbage non- the trash bags to aids and 2. Classified the
Objective:
segregation biodegradable, minimize the flies. transportation of non- biodegradable,
• Saw empty soft
and recycle. the student biodegradable
drink bottles,
nurse. waste
uncovered • Inability to
containers of decide 3. Reinforced the 2. Practices the
water, and regarding ways •Will be able to family about their proper covering of
leaves which for garbage dispose subdivision rules on Expenses for
garbage can.
could be disposal garbage proper segregation teaching aids
breeding properly. garbage.
grounds for
vectors
• Peeled skin of • Will be able
fruits seen all to identify 4. Increased
over the waste in awareness
backyard practicing regarding of the
proper risks and effects of
disposal. improper disposal.
METHODS OF
FAMILY
HEALTH GOAL OF OBJECTIVES INTERVENTION NURSE- RESOURCES
CUES NURSING EVALUATION
PROBLEM CARE OF CARE MEASURES FAMILY REQUIRED
PROBLEM
CONTACT

Subjective: Low family Inability to At the end of At the end of 1. Discussed to Home visit Material At the end of
“ Gamay ra income as make decisions nursing nursing the family the resources: nursing
among kita , Dili foreseeable with respect to interventions interventions importance of Visual aids, interventions, the
maigo sa among cirisis. taking the family will the family will finding additional examples of food family was able to
upat”, as appropriate find enough be able to ways to earn stuffs for identify some ways
verbalized by health action resources that identify ways money. demonstrating to utilize their
the mother and inability to could sustain to utilize family 2. Explained to preparation of income and was
Objective: decide which family health income wisely the family to learn low-cost menus, able to understand
• Father earns action to take needs. and earn to prioritize needs for cooking the proper way of
5,000 from among a money for of the family. demonstrations. spending or saving
Php/month list of health 3. Educated the Time and effort even just a little
• Mother has no alternatives. civilization. family to aids and amount of money
job to support minimize transportation of everyday.
the basic family unnecessary the nurse.
needs. spending. Expenses for
 Absence of 4. Teaches to teaching aids and
basic practice proper transportation of
necessities and budgeting of their the nurse.
other materials income
for first aid 5. Emphasized to
include in their
budget the
money needed
for their health
SOCIAL

CULTURAL ECONOMIC POLITICAL

>Close Family Ties. >Unstable Job: husband >Dependency on Husband

>they have superstitious > Belongs to the low economic > do not own the lot.
belief status

>Believes on Herbal rather > both parents did not graduate


than medicine in High school.

> Would not go to Physician > shows no improvement in the


until severe symptoms are economic status.
observed.

Unstable income
generating source
VIII. SCHEMATIC PRESENTATION OF THE FAMILY HEALTH PROBLEM

BIOLOGICAL

GENETIC PHYSICAL

>DM (+) on both


parents of the > Back/joint mild pains
maternal side experienced by father.
> History of unknown > Laborious job of the
heart problem on the father
paternal side

>hypertension (+) on
paternal sid3e

Risk for acquiring further


diseases in the future

Health Threat: Sanitation, Low family income, Improper


Garbage Disposal.
Health Deficit: presence of colds
ENVIRONMENT

HOME WATTER GARBAGE DRAINAGE COMMUNITY


SUPPLY DISPOSAL

> no own water > no proper


> Unconcrete house > Do not segregate drainage.
supply Garbage. >Do not make use
> Less Privacy > Presece of of resources
(presence of holes) > Stores dinking > Piles & Burns garbage’s
H2O in Drums. Stagnant H20 in
on one side of the house. the area.
> Piled pieces of
woods used as a >gather dishes when >Presence of mosquitoes
washing. > Inconsistent
wall. and flies in the area. Drainage system
> Do not boil H20 for
drinking. Risk for community
evacuation.
Prone to flooding and (abandonment)
mud formation
Risk for infection,
Diarrhea etc.
ACTUAL IMPLEMENTATION

Day 1
X
Orientation Phase
On the very first day of duty in the community, it took us the hard time to find our
own patient and at the same time choosing our family care study patient that will be
visited and assessed by the group. Basically, we have to follow on the criteria given to
us that will qualify a family to be our respective patients. If we are to base on the
problems the family has, the community has less problems that concerns on health
related areas since more of the identified dilemmas were environmentally traces.
Despite of this fact, we patiently took the time in finding our patients that can be of help
to us and we can be a help to them as well as a change agent or an educator in their
humiliating health conditions.
So, as we have tried to move on and grabbed some learning that skillfully
enhances our knowledge in close contact to people and showing them of how to be a
people to people, we were able to select the family based on their needs. Through this
manner, prioritization is being practiced and sharpened.

Day 2
X
Working Phase

As finally decided, I am able to choose the patient that bests seek my support in
their living. Most likely, the need to establish rapport and gauging their interest and
participation is my main goal at this moment of time. Determination of their effort to
participate and sincerest approval to our presence is also a great deal to be cleared and
promoted throughout the entire visit that we are to take with them.
As I begin this contact with them, I initiatively took the step to have personal
contact; I visit them in their households and take some part of their time. I took the step
in taking their data, which in this way, collection of data is performing the procedures
that will be more sharpened as the more we do it.
Day 3
X
Working Phase
Since I have partially collected data by interviews or physical assessment, I
immediately interpret and investigate data by being inquisitive to the family in order to
answer my questions in my mind that will help me increase my critical thinking and
judgment to the data I have on hand. It is indeed necessary to take extra careful in
dealing with what I have collected that perhaps confirmation should be rechecked and
appropriately managed.
All senses were being improved to find flaws and comprehend the application of
learned theories in actual setting by doing health teachings and giving guidelines to be
followed by them. This task took me responsible to what I could bring to the family in so
many ways I can as student nurse.

Day 4
X
Working Phase
This is the step for me to intervene to my patient that requires great skill and
knowledge. As most of us, this activity is believed to take a closer connection to the
family that applications of needed activities require thorough study to prevent errors and
faulty nursing practices. The building of trust may be noticed in time towards the end of
the actual performances.
In response to their short responses, I believe that this has captured and
enlightened their function as a human of their own. Helping them enrich their lives calls
a sense of responsibility and accountability to their selves.

Day 5
X
Termination Phase
On this last visit, everyone wish to help our individual family clients, addressing
their needs and giving them care to what they wish. It is my chance to share my
knowledge through giving health teachings and imparting information for their own
benefits. Most likely, my tasks as student nurse are primarily focused on the basic areas
to be implanted to them in action and words. This may be appreciated once the taught
knowledge will be applied and inhibited. I gladly thank my patients in giving their time
and may they be able to find their position in life as a person.

For the Father

S
“Sakit ang akong likod og mga kabukogan panalagsa ilabi na kun
gikan og hago na trabaho“ as verbalized by the father

O
Facial Grimace, Guarding, Restlessness,

A
Pain related to exacerbation of muscular strength.

P
At the end of 15 to 30 minutes, the patient will be able to
verbalized comfort and pain is reduced to manageable level.
• Placed on a position of comfort.
I
-to relieve pain.
• Encouraged Deep Breathing Exercises.
-for relaxation purposes.
• Applied Ice Cap on the abdominal area PRN.
-to promote comfort and reduce pain.
• Talked to the patient.
-to divert patients attention with regards to pain.
• Administer pain reliever e.g. tramaadol
-to relieve pain and promote muscle relaxation.
At the end of the intervention, the patient cooperated and
E
decreased pain as evidenced by absence of grimace and
guarding, and showed comfortable aura.
EVALUATION

Although some short comings were not thoroughly anticipated during the
care of the family as well as referral was not very successful due to the
unavailability of the family members to be referred. Still I was able to care to the
concerned family.
There were no difficulties encountered as to the family member’s attitude
because they were participative and accommodating throughout the care
rendered to them. Furthermore, as of other aspects was difficult to plan because
it was not anticipated, such mentioned difficulty was encountered with the father
of the family because of his unavailability during the process of care. The said
father leaves at 6 am and comes home at 7-10pm that is why he was only cared
once because during that day he did not go to work.
Even though the family relies more on herbal treatment rather than
medical treatment, they still go to the nearby health center that is if they
experienced unusualities in their bodies lasting more than 5 days accordingly.
In the client care process, several interventions were done as well as
health teachings. This includes the appropriate care for the disease conditioned,
information drive or further research and education which concerns of health care
and health related conditions. As well as other health tips were emphasized to
the concerned family, these were discussed as to anticipate the care of the
individual and the family as a whole.
Bibliography

 Maglaya, A., & Earnshaw, R., Nursing Practice in the Community.

 Community Health Nursing by DOH

 Kozier, et al. Fundamentals of Nursing. Singapore: Pearson Education Asia Ltd.,

2004

 Smeltzer, S. Medical-Surgical Nursing. Manila, 1996.

 Reyala, A. et al. Community Health Services in the Philippines. Manila: National

 League of the Philippine Government Nurses, Inc., 2000

 Maglaya, A. Nursing Practice in the Community. Philippines: Argonauta Corp.


MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS
Date:_X
Child’s name: C Age: 1 year and 8 mos. old Sex: male_ Weight: 10 kgs Temp: 37 ˚C_
ASK: What are the child’s problem? Presence of rashes (symptoms of scabies)
Initial visit? _____ Follow-up visit? ____√______

ASSESS CLASSIFY
CHECK FOR GENERAL DANGER SIGNS
NOT ABLE TO DRINK OR BREASTFEED
VOMITS EVERYTHING YES___ NO_√_
CONVULSIONS
ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN
DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? Yes__ No_√__
For how long? _5_days No Pneumonia: Cough
and Cold
• Count the breaths for one minute. _32_breaths per minute. Fast breathing?

• Look for chest indrawing?


• Look and listen for stridor.
DOES THE CHILD HAVE DIARRHEA? Yes___ No_√_
For how long? ___days
Is there blood in the stools?
• Look at the child’s general condition.
No Dehydration
Abnormally sleepy or difficult to awaken?
Restless or irritable?
• Look for sunken eyes.
• Offer the child fluid. Is the child:
Not able to drink or drink poorly?
Drinking eagerly, thirsty?
• Pinch the skin of the abdomen. Does it go back:
Very slowly (longer than 2 seconds)?
Slowly?
DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37.5C or above) Yes__ No_√__
Decide Malaria Risk
• Does the child live in malaria area? No
• Has the child visited a malaria area in the past 4 weeks? No
If malaria risk, obtain a blood smear.
• Look or feel for stiff neck.
• Look for runny nose.
+ Pf Pv - Not done
• For how long has the child had fever? __days
• If more than 7 days, has fever been present every day?
• Has the child had measles within the last 3 months?
Look for signs of MEASLES
• Generalized rash and
• One of these: cough, runny nose. Or red eyes.
……………………………………………………………………………………………………………………………….
If the child has measles now or within the last 3 months:
• Look for mouth ulcers
If yes, are they deep and extensive?
• Look for pus draining from the eye

Look for clouding of the cornea.
……………………………………………………………………………………………………………………………….
Decide Dengue Risk: Yes__ No__√_
If dengue risk, then ask:
• Has the child had any bleeding form the nose or gums or in the vomitus or stools? No
• Has the child had black vomitus or black stool? No
• Has the child had abdominal pain? No
• Has the child been vomiting? No
• Look for bleeding from nose or gums. None
• Look for skin petechiae. None
• Feels for cold and clammy extremitites. None
• Check capillary refill ___seconds.
• Perform tourniquet test if child is 6 months or older and has no other signs and has fever for
• more than 3 days.
DOES THE CHILD HAVE AN EAR PROBLEM? Yes___ No__√_
• Is there ear pain? No
• Is there ear discharge? No No Ear Infection
If yes, for how long? ___days
• Look for pus draining from the ear. None
• Feel for tender swelling behind the ear. None

THEN CHECK FOR MALNUTRITION AND ANEMIA


• Look for visible severe wasting. Yes.
No Anemia and low
weight
• Look for edema of both feet. No.
• Look for palmar pallor.
Severe palmar pallor? Some palmar pallor? None
• Determine weight for age
Very Low? Low.

CHECK THE CHILD’S IMMUNIZATION STATUS Circle immunization needed today Return for next
_√__ _√__ __√_ __√__ immunization on:
BCG DPT1 OPV1 HEPB1
__√__ _√__ __√_ _______ (IMMEDIATELY)
DPT2 OPV2 HEPB2 MEASLES (date)
_√___ __√__ __√___
DPT3 OPV3 HEPB3

CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older Vitamin A needed
Is the child six months of age or older? Yes_√_ NO___ today
Has the child received Vitamin A in the past six months? Yes___ No_√___ Yes_√__ No___

ASSESS CHILD’S FEEDING if child has ANEMIA OR VERY LOW WEIGHT or less than 2
years old.
• Do you breastfeed your child? Yes_ _ No__√__
If Yes, how many times in 24 hours? _n/a__ times. Do you breastfeed during the night? Yes_ __
No_√

• Does the child take any other food or fluids? Yes_√__ No___
If Yes, what food or fluids? _noodles, vegetables, fruits rice and fish_
How many times per day?_3__ times. What do you use to feed the child? _spoon and fork_
If very low weight for age: How large are servings?_minute servings_____
Does the child receive his/her own serving? yes__ Who feeds the child and how?_mother,
spoonfeeding
• During the illness, has the child’s feeding changed? Yes _ _ No_√__
If yes, how?

ASSESS OTHER PROBLEMS: scabies


Date:_X
Child’s name: Baby V Age: 8 mos. old Sex: female_ Weight: 7 kgs Temp: 37 ˚C_
ASK: What are the child’s problem? Presence of rashes (symptoms of scabies)
Initial visit? _____ Follow-up visit? ____√______

ASSESS CLASSIFY
CHECK FOR GENERAL DANGER SIGNS
NOT ABLE TO DRINK OR BREASTFEED
VOMITS EVERYTHING YES___ NO_√_
CONVULSIONS
ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN
DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? Yes__ No_√__
For how long? _5_days No Pneumonia: Cough
and Cold
• Count the breaths for one minute. _32_breaths per minute. Fast breathing?
• Look for chest indrawing?
• Look and listen for stridor.
DOES THE CHILD HAVE DIARRHEA? Yes___ No_√_
For how long? ___days
Is there blood in the stools?
• Look at the child’s general condition. No Dehydration
Abnormally sleepy or difficult to awaken?
Restless or irritable?
• Look for sunken eyes.
•Offer the child fluid. Is the child:
Not able to drink or drink poorly?
Drinking eagerly, thirsty?
• Pinch the skin of the abdomen. Does it go back:
Very slowly (longer than 2 seconds)?
Slowly?
DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37.5C or above) Yes__ No_√__
Decide Malaria Risk
• Does the child live in malaria area? No
• Has the child visited a malaria area in the past 4 weeks? No
If malaria risk, obtain a blood smear.
• Look or feel for stiff neck.
• Look for runny nose.
+ Pf Pv - Not done
• For how long has the child had fever? __days
• If more than 7 days, has fever been present every day?
• Has the child had measles within the last 3 months?
Look for signs of MEASLES
• Generalized rash and
• One of these: cough, runny nose. Or red eyes.
……………………………………………………………………………………………………………………………….
If the child has measles now or within the last 3 months:
• Look for mouth ulcers
If yes, are they deep and extensive?
• Look for pus draining from the eye

Look for clouding of the cornea.
……………………………………………………………………………………………………………………………….
Decide Dengue Risk: Yes__ No__√_
If dengue risk, then ask:
• Has the child had any bleeding form the nose or gums or in the vomitus or stools? No
• Has the child had black vomitus or black stool? No
• Has the child had abdominal pain? No
• Has the child been vomiting? No
• Look for bleeding from nose or gums. None
• Look for skin petechiae. None
• Feels for cold and clammy extremitites. None
• Check capillary refill ___seconds.
• Perform tourniquet test if child is 6 months or older and has no other signs and has fever for
• more than 3 days.
DOES THE CHILD HAVE AN EAR PROBLEM? Yes___ No__√_
• Is there ear pain? No
• Is there ear discharge? No No Ear Infection
If yes, for how long? ___days
• Look for pus draining from the ear. None
• Feel for tender swelling behind the ear. None

THEN CHECK FOR MALNUTRITION AND ANEMIA


• Look for visible severe wasting. Yes.
No Anemia and low
weight
• Look for edema of both feet. No.
• Look for palmar pallor.
Severe palmar pallor? Some palmar pallor? None
• Determine weight for age
Very Low? Low.

CHECK THE CHILD’S IMMUNIZATION STATUS Circle immunization needed today Return for next
_√__ _√__ __√_ __√__ immunization on:
BCG DPT1 OPV1 HEPB1
__√__ _√__ __√_ _______ (IMMEDIATELY)
DPT2 OPV2 HEPB2 MEASLES (date)
_√___ __√__ __√___
DPT3 OPV3 HEPB3

CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older Vitamin A needed
Is the child six months of age or older? Yes_√_ NO___ today
Has the child received Vitamin A in the past six months? Yes___ No_√___ Yes_√__ No___

ASSESS CHILD’S FEEDING if child has ANEMIA OR VERY LOW WEIGHT or less than 2
years old.
• Do you breastfeed your child? Yes_ _ No__√__
If Yes, how many times in 24 hours? _n/a__ times. Do you breastfeed during the night? Yes_ __
No_√

• Does the child take any other food or fluids? Yes_√__ No___
If Yes, what food or fluids? Milk formula and breast milk _
How many times per day?_per demand__ times. What do you use to feed the child? _bottle fed &
breast fed_
If very low weight for age: How large are servings?_minute servings_____
Does the child receive his/her own serving? yes__ Who feeds the child and how?_mother,
breastfeeding & bottle feesing
• During the illness, has the child’s feeding changed? Yes _ _ No_√__
If yes, how?
ASSESS OTHER PROBLEMS: scabies