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I.

INTRODUCTION

a. OVERVIEW

A famous web-based dictionary defines that a family denotes a group of people


affiliated by consanguinity, affinity, and co-residence. Although the concept of
consanguinity originally referred to relations by "blood," many anthropologists have
argued that one must understand the notion of "blood" metaphorically, and that many
societies understand 'family' through other concepts rather than through genetic
distance.

Many sociologists and anthropologists believe the primary function of the family is to
reproduce society, either biologically, socially, or both. Thus, one's experience of one's
family shifts over time. From the perspective of children, the family is a family of
orientation: the family serves to locate children socially, and plays a major role in their
enculturation and socialization. From the point of view of the parent(s), the family is a
family of procreation the goal of which is to produce and enculturation and socializes
children. However, producing children is not the only function of the family; in societies
with a sexual division of labor, marriage, and the resulting relationship between two
people, is necessary for the formation of an economically productive household.

After how many days of duty as a community health nurse, we were able to
identify a family for a family care study. These provided us a knowledge,
understanding, and information on basic community health approaches basing on actual
care. It also improves the health condition of the individual family members, through
providing information.

Sili-Sili Kisol, Pagatpat was our community; the people residing there are mostly
farmers and who earn from their farm for a living.

We choose family “ Caliso ” as our family case study because its status in terms
of health status, income which should be below 8thousand pesos and a child for IMCI
fits in the criterion that was given as our guide in choosing a family, and because they

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are suitable to be given with attention, since they have a member in their family which is
Mr. W. Caliso, who is the head of the family needs further care and management
because of the health problem he has.

B. Objectives of the Study

It is the objective of this study to present the highlights of the community exposure Sili-sili
Kisol, Pagatpat, Cagayan de Oro City. More importantly, it aims to:

● Introduce the condition of the family chosen as the subject for care which are
focused on Children below 5 years old--- their health problems, the family’s
available resources and their attitude towards change.

● It also aims to present the various interventions employed by the student


nurses with every discovered and observed health concern.

● Furthermore, it is its goal that the family care plan formulated and constructed
for the family may meet the family’s needs, priorities and resources well so
that it may cause the greatest possible improvement in both the health and
home condition of the family.

C. Scope and Limitations


The scopes of the study are as follows:

• The family must be a resident Sili-sili Kisol, Pagatpat, Cagayan de Oro City.
• The family must be assessed and cared for by the group for at least 5 visits.
• The group must have the consent coming from the family to make them the subject of
the study.
• The scope of the study includes the family member’s personal and health profile and
spot map of their residence, the chief complaint of the family member with a health
problem and the family members, the history of present illness of the member with a
health problem, the nursing assessment, the family coping index, the schematic
diagram of the family health problem, the integrated management of childhood illness,

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the family health plans, the nursing care plans for the member with a health problem
and the actual implementation of different interventions given to the family.
• The different references were also part of this study, which encompasses the use of the
different community health nursing books, nursing care plan books and other sources
which served as guide throughout the study.

The limitations of the study are as follows:

• Interaction with the family was limited to 5 days only.


• The interaction was limited only within the community and the residence of the family.
• The information gathered were based on the testimonies of the informants, and the
client which may be subject for further critique in terms of its validity and reliability

• The information gathered were based on the testimonies of the informants, and the
client which may be subject for further critique in terms of its validity and reliability

II. Spot Map

We, the NCM501205 students, had the community duty in the different areas
of Pagatpat Cagayan de Oro Cty. Our Group, Group10 under the supervision of
Ma’am Dao-ayan, had the community exposure in Sili-sili Kisol, Pagatpat, Cagayan
De Oro City. Since the area of our exposure is away from the school we rented the
jeepney in an amount of Php 700.00. Group10 is composed of 15 members, each
group member paid Php 46/day for three days per week (every Thursday, Friday
and saturday). From our meeting place at LDCU, it took about 30 minutes by way of
chartered jeepney. We left the said area at exactly 7:30 am so that we will arrive at
the community area before 8:00 am.

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N

W E
Macajalar Bay

To Tagoloan Proper
Sugbongcogon

Liceo U Mindanao International Container Port,


Tagoloan Misamis Oriental

To Butuan City 

LEGEND

School Del Monte Phils, Inc. Bugo, CDO


Client’s house

Company National Road 4

Cell phone (Smart) Barangay Road

Transmitter
III. Family Service and Progress Records

Head of the Family: Sano Family Number: 3 members Monthly Income: Php 2,000

Address: Zone 3, Sugbongcogon, Tagoloan, Misamis Oriental

MEMBERS OF THE HOUSEHOLD

Family Names Relation Sex Birthdate Marital Educational Occupation


Membe to Head Month Da Year Status Attainment Work Place
r y
Numbe
r
1 Grandmot Female February 20 1948 Widowed High School none Not
her Graduate Applicable
Flaviana
(Mrs. Edna
Yanez
Ebanalo’s
Aunt)
2 Pepe Husband Male August 02 1951 Married College Worker at CDOC
Undergraduate DPWH
Ebanalo
Birthdate Marital Educational Occupation
Month Da Status Attainment Work Place
y
1 Grandmot Female February 20 1948 Widowed High School none Not
her Graduate Applicable
Flaviana
(Mrs. Edna
Yanez
Ebanalo’s
Aunt)
2 Pepe Husband Male August 02 1951 Married College graduate Factory Gusa CDOC
Worker
Ebanalo

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I. FAMILY PROFILE

Husband: Mr. W.C

Age: 42 years old

Sex: Male

Permanent Address: Sili-sili Kisol, Pagatpat, Cagayan de Oro City


Birthday: April 14, 1968

Birth Place: Cagayan de Oro City

Height: 5 Ft. 3 inches

Weight: 64 kgs.

Educational Attainment: College Undergraduate

Civil Status: Married

Nationality: Filipino

Religion: Roman Catholic

Occupation: Driver

BP: 130/100 mmHg

RR: 20 cpm
Baseline Vital Signs:
PR: 84 bpm

Temp.: 36 . 7˚ C

Wife: Ms. R.C

Age: 39 years old

Sex: Female

Permanent Address: Sili-sili Kisol, Pagatpat, Cagayan de Oro City


Birthday: August 5, 1971

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Birth Place: Pagatpat, Cagayan de Oro City

Weight: 59 kgs.

Civil Status: Married

Nationality: Filipino

Religion: Roman Catholic

Occupation: Housewife

BP: 110/80 mmHg

RR: 19 cpm
Baseline Vital Signs:
PR: 79 bpm

Temp.: 36.6 ˚ C

Son: E.C

Age: 19 years old

Sex: Male

Permanent Address: Sili-sili Kisol, Pagatpat, Cagayan de Oro City


Birthday: June 30, 1991

Birth Place: Cagayan de Oro City

Height: 5’3”

Weight: 65 kgs.

Educational Attainment: High School Graduate

Civil Status: Married

Nationality: Filipino

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Religion: Roman Catholic

Occupation: Driver

BP: 120/90 mmHg

RR: 19 cpm
Baseline Vital Signs:
PR: 81 bpm

Temp.: 36.7 ˚ C

Daughter: I.C

Age: 17

Sex: Female

Permanent Address: Sili-sili Kisol, Pagatpat, Cagayan de Oro City


Birthday: July 14, 1993

Birth Place: Home delivery

Height: 5 Ft. 1 inches

Weight: 75 kgs.

Educational Attainment: 4th year High School

Civil Status: Single

Nationality: Filipino

Religion: Roman Catholic

Occupation: Student

BP: 110/60 mmHg

RR: 20 cpm
Baseline Vital Signs:
PR: 79 bpm

Temp.: 36 . 7˚ C

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Son: W.C Jr.

Age: 8 years old

Sex: Male

Permanent Address: Sili-sili Kisol, Pagatpat, Cagayan de Oro City


Birthday: February 16, 2003

Birth Place: Home delivery

Height: 4’3”

Weight: 31 kgs.

Educational Attainment: Grade 2

Civil Status: Single

Nationality: Filipino

Religion: Roman Catholic

Occupation: None

BP: 100/60 mmHg

RR: 19 cpm
Baseline Vital Signs:
PR: 90 bpm

Temp.: 36.7 ˚ C

Son: S.C

Age: 3 years old

Sex: Male

Permanent Address: Sili-sili Kisol, Pagatpat, Cagayan de Oro City

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Birthday: March 11, 2007

Birth Place: Home Delivey

Weight: 14 kgs.

Civil Status: Married

Nationality: Filipino

Religion: Roman Catholic

Occupation: None

RR: 19 cpm

Baseline Vital Signs: PR: 79 bpm

Temp.: 36.6 ˚ C

IV. PAST HEALTH HISTORY

Father

Mr. W.C was born through normal spontaneous vaginal delivery. He is the sixth child
among the seven siblings. As of his immunization, he was not able to recall it. He related to us
that he has been hospitalized due to his Hypertension at NMMC for 5 days last April 2001; he
haven’t had donated blood and received blood in the past. He admitted that his family has a
history of hypertension in his maternal side. He drinks occasionally and does smoke a minimum
of one pack a day. Mr. W.C has no known allergy to any food and drug.

Mother

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Mrs. R.C, 39 years-old, gravida 4, parity 4, abortion 0, was born at home through normal
spontaneous vaginal delivery (August 5, 1971). Mrs. R.C was not able also to recall if she had
any immunizations during her childhood years. She gave birth to her first child at NMMC and
her second, third and fourth child at home through normal spontaneous vaginal delivery
assisted with “Mananabang (hilot)”. She was never been hospitalized, nor donated blood. Mrs.
R.C has no known allergy to any food and drug.

Son (1)

E.C is the first child in the family. He was born through normal spontaneous vaginal
delivery at NMMC. According to her mother E.C is a sickly child while he was young, he easily
gets colds and cough. At 3 years old he was admitted at JR Borja Hospital due to his asthma.
According to Mrs. R.C he received complete Immunization from their health center and she
even has a record of it on her keeping.

Daughter (2)

I.C is the Second child in the family. She was born through normal spontaneous vaginal
delivery at home assisted by a “mananabang”. I.C grew up on the care of her Grandmother at
Zone 3 Pagatpat and is also complete with her Immunization from their health center. When she
was young she was not a sickly child unlike her older brother. I.C doesn’t have any food and
drug allergies and haven’t received blood or any blood products from the past.

Son (3)

W.C J.R is the third child in the family. He was born also through normal spontaneous
vaginal delivery at home assisted by the same “mananabang” who helped her mother give birth
to her second child. W.C J.R was also a healthy child; he does not easily get sick. He was never
admitted and never had any serious health problem. He is also complete with his immunization
and doesn’t have any food and drug allergies.

Son (4)

S.C is the youngest child in the family. He was born through normal spontaneous vaginal
delivery at home assisted by the same “mananabang”. S.C is also a healthy child; he does not
easily get sick. He only has minor problems like fever and cough but maybe only due to our
climate today especially that he always play outside with their neighbors. He is also complete
with his immunization and doesn’t have any food and drug allergies.

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II. PRESENT HEALTH STATUS

a. Immunization
All of their children are completely immunized at the Health Center.

b. Family Planning

The couple uses pills as a method for birth control. Mrs. R.C uses Trust pills because of
its affordability and sees to it that she will never miss to take the pill as scheduled.

c. Smoking

The husband is a chain smoker since his teen age life. He was 17 when he
started to smoke. Regardless of their financial instability, he managed to consume 1

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pack everyday or even more by chance. He mentioned that he has difficulty on quitting
this kind of vices.

d. Allergy

Mrs. R.C states that all of them has no food or drug allergies.

e. Heredo Familial Disease

When ask about any hereditary diseases, Mrs. R.C answered that Hypertension
is present on her husband’s side.

g. Alcoholic Beverages

EENT: Mr. W.C drinks alcoholic beverages but only on occasions.

� Impaired vision � blind


� pain � reddened � drainage
d. Food and Diet
� gums � hard of hearing � deaf
The family is not that cautious when it comes to meal preparation and proper
� burning � edema � lesion � teeth
nutrition. Mrs R.C shared that she goes for any kinds of foods and that they are fond of
Asses eyes, ears, nose
eating vegetables because of its availability and that it can be seen immediately on their
Throat for abnormality (X) no problem
suroundings.
RESPIRATION
�asymmetric � tachypnea
� apnea � rales � cough � barrel chest
� bradypnea � shallow � rhonchi
� sputum � diminished � dyspnea
� orthopnea � labored ( ) wheezing
� pain � cyanotic
Asses resp. rate, rhythm, depth, pattern
NURSING
breath sounds, comfort SYSTEM
� no problem REVIEW CHART
CARDIO VASCULAR
� arrhythmia � tachycardia � numbness
� diminished pulses � edema � fatigue
Name: Mr. W.C Date: ______
� irregular � bradycardia � murmur
Vital Signs:
� tingling � absent pulses � pain
Assess heart sounds, rate, rhythm, pulse, blood
pressure, etc., fluid retention, comfort
(X) no problem
GASTRO INTESTINAL TRACT
� obese � distention � mass
� dysphagia � rigidity � pain
Asses abdomen, bowel habits, swallowing,
(x )bowel sounds, comfort ( ) no problem 13
GENITO-URINARY and GYNE
� pain � urine color � vaginal bleeding
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NURSING SYSTEM REVIEW CHART

Name: _ Mr. Caliso Date: _____

Vital Signs:

EENT:
� Impaired vision � blind
� pain � reddened � drainage
� gums � hard of hearing � deaf
� burning � edema � lesion � teeth
Asses eyes, ears, nose
Throat for abnormality (X) no problem
RESPIRATION
�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
(X) no problem
GASTRO INTESTINAL TRACT
� obese � distention � mass
� dysphagia � rigidity � pain
Asses abdomen, bowel habits, swallowing,
(x )bowel sounds, comfort ( ) no problem
GENITO-URINARY and GYNE
� pain � urine color � vaginal bleeding

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NURSING SYSTEM REVIEW CHART

Name: _ Mrs. Caliso Date: ____

Vital Signs:

EENT:
� Impaired vision � blind
� pain � reddened � drainage
� gums � hard of hearing � deaf
� burning � edema � lesion � teeth
Asses eyes, ears, nose
Throat for abnormality (X) no problem
RESPIRATION
�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
(X) no problem
GASTRO INTESTINAL TRACT
� obese � distention � mass
� dysphagia � rigidity � pain
Asses abdomen, bowel habits, swallowing,
(x )bowel sounds, comfort ( ) no problem
GENITO-URINARY and GYNE
� pain � urine color � vaginal bleeding

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NURSING SYSTEM REVIEW CHART

Name: _ Mrs. Caliso Date:____

Vital Signs:

EENT:
� Impaired vision � blind
� pain � reddened � drainage
� gums � hard of hearing � deaf
� burning � edema � lesion � teeth
Asses eyes, ears, nose
Throat for abnormality (X) no problem
RESPIRATION
�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
(X) no problem
GASTRO INTESTINAL TRACT
� obese � distention � mass
� dysphagia � rigidity � pain
Asses abdomen, bowel habits, swallowing,
(x )bowel sounds, comfort ( ) no problem
GENITO-URINARY and GYNE
� pain � urine color � vaginal bleeding

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NURSING SYSTEM REVIEW CHART

Name: _ Erwin Caliso Date: _____

Vital Signs:

EENT:
� Impaired vision � blind
� pain � reddened � drainage
� gums � hard of hearing � deaf
� burning � edema � lesion � teeth
Asses eyes, ears, nose
Throat for abnormality (X) no problem
RESPIRATION
�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
(X) no problem
GASTRO INTESTINAL TRACT
� obese � distention � mass
� dysphagia � rigidity � pain
Asses abdomen, bowel habits, swallowing,
(x )bowel sounds, comfort ( ) no problem
GENITO-URINARY and GYNE
� pain � urine color � vaginal bleeding

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NURSING SYSTEM REVIEW CHART

Name: _ Erwin Caliso Date: ______

Vital Signs:

EENT:
� Impaired vision � blind
� pain � reddened � drainage
� gums � hard of hearing � deaf
� burning � edema � lesion � teeth
Asses eyes, ears, nose
Throat for abnormality (X) no problem
RESPIRATION
�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
(X) no problem
GASTRO INTESTINAL TRACT
� obese � distention � mass
� dysphagia � rigidity � pain
Asses abdomen, bowel habits, swallowing,
(x )bowel sounds, comfort ( ) no problem
GENITO-URINARY and GYNE
� pain � urine color � vaginal bleeding

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NURSING SYSTEM REVIEW CHART

Name: _ Irene Caliso Date: ______

Vital Signs:

EENT:
� Impaired vision � blind
� pain � reddened � drainage
� gums � hard of hearing � deaf
� burning � edema � lesion � teeth
Asses eyes, ears, nose
Throat for abnormality (X) no problem
RESPIRATION
�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
(X) no problem
GASTRO INTESTINAL TRACT
� obese � distention � mass
� dysphagia � rigidity � pain
Asses abdomen, bowel habits, swallowing,
(x )bowel sounds, comfort ( ) no problem
GENITO-URINARY and GYNE
� pain � urine color � vaginal bleeding

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NURSING SYSTEM REVIEW CHART

Name: _ Irene Caliso Date: ______

Vital Signs:

EENT:
� Impaired vision � blind
� pain � reddened � drainage
� gums � hard of hearing � deaf
� burning � edema � lesion � teeth
Asses eyes, ears, nose
Throat for abnormality (X) no problem
RESPIRATION
�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
(X) no problem
GASTRO INTESTINAL TRACT
� obese � distention � mass
� dysphagia � rigidity � pain
Asses abdomen, bowel habits, swallowing,
(x )bowel sounds, comfort ( ) no problem
GENITO-URINARY and GYNE
� pain � urine color � vaginal bleeding

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NURSING SYSTEM REVIEW CHART

Name: _Winston Caliso Date: _____

Vital Signs:

EENT:
� Impaired vision � blind
� pain � reddened � drainage
� gums � hard of hearing � deaf
� burning � edema � lesion � teeth
Asses eyes, ears, nose
Throat for abnormality (X) no problem
RESPIRATION
�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
(X) no problem
GASTRO INTESTINAL TRACT
� obese � distention � mass
� dysphagia � rigidity � pain
Asses abdomen, bowel habits, swallowing,
(x )bowel sounds, comfort ( ) no problem
GENITO-URINARY and GYNE
� pain � urine color � vaginal bleeding

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NURSING SYSTEM REVIEW CHART

Name: _ Winston Caliso Date:____

Vital Signs:

EENT:
� Impaired vision � blind
� pain � reddened � drainage
� gums � hard of hearing � deaf
� burning � edema � lesion � teeth
Asses eyes, ears, nose
Throat for abnormality (X) no problem
RESPIRATION
�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
(X) no problem
GASTRO INTESTINAL TRACT
� obese � distention � mass
� dysphagia � rigidity � pain
Asses abdomen, bowel habits, swallowing,
(x )bowel sounds, comfort ( ) no problem
GENITO-URINARY and GYNE
� pain � urine color � vaginal bleeding

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Integrated Management of Childhood Illness (0-5 years of age)

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES

Date:July 8, 2010

Child’s Name: Sherwin Caliso Age: 40 mo. old Sex: Male Weight: 14kgs
Temperature 37. 8º C Initial Visit?  Follow-up Visit________

ASK: What are the child’s problems? COUGH, FEVER

ASSESS (Encircle all signs present)


CLASSIFICATION

CHECK FOR GENERAL DANGER SIGNS


NOT ABLE TO DRINK OR BREASTFEED YES____

VOMITS EVERYTHING ABNORMALLY SLEEPY OR NO 


DIFFICULT TO AWAKEN

CONVULSIONS

DOES THE CHILD HAVE COUGH OR DIFFICULT


BREATHING? YesNo_

- For how long? 5 days - Count the breaths in


one minute

RR: 28 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 - Look at the child’s


general condition.

Abnormally sleepy or difficult to awaken?

Restless or irritable; Look for sunken

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eyes.

- Offer the child fluid. Is the child:

Not able to drink or drinking 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/ temp


37.8ºC or above)

Yes _No 

Decide Malaria Risk

- Does the child live in a malaria risk area? - Look


or feel for stiff neck.

- Has the child visited a malaria are in the past 4 weeks? - Look
for runny nose.

If malaria risk, obtain a blood smear

( + ) ( Pf ) ( Pv) ( - ) Not done

- For how long has the child had fever? _1 Day - Look
for signs of MEASLES

- If more than 7 days, has fever been present every day? -


Generalized rash

- Has the child has measles within the last 3 months? -


One of these:

Cough, runny nose,

or red eyes.

If the child has measles now or - Look for mouth


ulcers

within the last 3 months If yes, are they


deep and extensive?

- Look for pus draining from the


eye.

25
- Look for clouding of the cornea.

Decide Dengue risk: YES__ NO __

If dengue risk then ask:

- Has the child had any bleeding from the nose or gums or -
Look for bleeding from

in the vomitus or stools?


nose or gums

-
Look for skin petechiae

- Has the child had black vomitus or black stool? - Feel for cold &
clammy extremities

- Has the child had abdominal pain? - Check capillary refill


___ seconds

- Has he child been vomiting? - 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? - Look for pus


draining from the ear

- Is there ear discharge? - Feel for


tender swelling behind

the ear.

26
If yes, for how long? ____ days

THEN CHECK FOR MALNUTRITION AND ANEMIA Very Low


- Look for visible severe weight
wasting.

- Look for edema of both feet.

- Look for palmar pallor.

Severe palmar pallor?


Some palmar pallor?

- Determine weight for age.

Very low?

CHECK THE CHILD’S IMMUNIZATION STATUS Return for


next
Encircle immunizations
immunization
on:

_____ ____ _____ _________

BCG DPT1 OPV1 HEP B1

____ _____ _________ Dec.17,2008


______
(Date)
DPT2 OPV2 HEP B2
Measles

____ _____ _______

DPT3 OPV3 HEP B3

CHECK THE VITAMIN A SUPPLEMENTATION STATUS for Vitamin A


children 6 months or older. needed today

Is the child six months of age or older? Yes Yes __ No


___ No ____

Has the child received vitamin A in the past six months? Yes
___ No ____

27
ASSESS CHILD’S FEEDING if child has ANEMIA OR VERY
Feeding
LOW WEIGHT or is less than 2 years old.
problems:
- Do you breastfeed the child? Yes __ No
___

If yes, how many times in 24 hours? _4_ 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? __Formula Milk_____

How many times per day? _4_ Times. What do you use to
feed the child? Infant Bottle

If very low weight for age: how large are servings? __small_

Does the child receive his/her own serving? Yes


Who feeds the child and how?

_______
_____Mother__________

- During illness, has the child’s feeding changed? Yes  No ___

If yes, how? Does not like to drink milk.

28
III. HOME AND ENVIRONMENT

FACTORS DESCRIPTION SIGNIFICANCE

Type of house Wooden Fire hazard

Source of electricity CEPALCO Electricity provide


convenience to every family in
the society

Distance of water source Common source and shared First come first served basis
but can delay other routinely
with other families located 50 household chores

meters away from the house

Type of water source Deep well Shared with neighbors by the


means of deep wheel

Distance/location of kitchen Within the household Can save time and effort since
it’s inside the house

Way of cooking Firewood Fire hazard

Ways of garbage disposal Burning/ burying Not good for one of her child
has asthma.

Type of toilet Water sealed Provide comfort to the entire


family

Drainage system No drainage system Breeding sites of vector


diseases carrier like Dengue
Fever

Domesticated animals Pig and Dog Risky if not immunized with


anti rabies vaccines and the
Pig would also be a cause of
diff. diseases.

Distance of health center 200 meters Accessible for emergencies

Relationship to the neighbors Good Harmonious relationship

1.) Housing

29
The family is living in a poorly constructed house where there was no organization of
settlement inside the vicinity. Construction materials used were light materials – made of wood.
The family with 5 members has 2 bedrooms. Sherwin sleeps with his father and mother and
Irene and Winston shares the other room. They are prone to accidents since I observed that
there were nails left not fully hammered; their dirty kitchen’s roof is too short that, if they were
not careful enough, they might be in jeopardy. Their floor is made up of soil that makes them
more prone to any types of infection especially that it will be muddy if it is raining. They used
electricity as their lighting facility.

2.) Water supply

Their water source is the Deep Well used by the community. They used it for washing their
clothes and watering their plants. But when it comes to drinking water, they have to buy it in the
sari-sari store for 30 pesos per gallon. At times the water is contaminated and prone to cholera
disease and even among other water-borne disease. Their storage is through the use of galloon
that is covered, and stocked for 3 days or more approximately.

30
3.) Kitchen

The family used woods when cooking their foods, their kitchen was slightly cluttered with

the presence of unwashed dishes and soiled clothing, and they have a proper drainage facility.

Initially the main problem of the barangay was water supply and source. The people were used

with deep well. Even though the outbreak of diarrhea was rare still their health is at risk.

4.) Sanitation Condition

The community does not have proper drainage system and even garbage disposal.

During rainy season their surroundings is muddy and impassable and that can lead to skin

diseases. They have a pig and is smelly especially if Mrs. Racquel forgets to clean the area

because sometimes she is busy.

5.) Toilet System

31
It’s a water sealed type of toilet facility. It is connected to their house at the back portion,

the walls are made out of coconut lumber and the base is concrete. Sanitary condition is poor

since there is no direct water supply.

6.) Garbage System

Their only means of disposing their garbage is to burn it or burry it to the hole which they

dig up. But it overflows with water during rainy days.

7.) Drainage System

32
The community has a poor drainage system. As the student nurses assess the entire

community, they had find out that their existing drainage backs flow and causes the garbage to

spread anywhere. It is basically their problem especially during rainy season.

8.) Kinds of Neighborhood

The family has a good relationship to their neighbor. But they had a neighbor who had a

piggery fronting their house and the smells was not good and they can’t complain about it

because they were avoiding a possible conflicts.

IV. FAMILY COPING INDEX

The objective of this indicator is to present a benchmark for approximating the nursing

needs of a particular family, thus Family Coping Index. It is the coping capacity and not the

underlying problem that is being rated, and it is designed to record family rather than individual

coping capacity. In public health nursing, the family cannot be seen only factor that affects

health; rather, the family is the patient.

Legend:

5 – Complete Competence

33
3 – Moderate Competence

1 – No Competence

Family Coping Index

AREA RATE JUSTIFICATION

• The family had able to fully provide


1. Physical independence — the necessary needs of each
5 family members.
Ability to move about, get out of bed
• The eldest son E.C suffers from
perform daily activities
asthma ,but despite of that they
had able to deal with their daily
activities
• Mr. W.C is hypertensive, he has a
maintenance medication to be
2. Therapeutic Independence—
taken daily, but unfortunately the
Includes procedure or treatment 3 family cannot provide the said
prescribed knowledge to condition medications and for them food is
still their major priority.

• The family consider themselves in


good health and doesn’t seem to be
3. Knowledge of health condition aware of the health threats that the
family is experiencing towards poor
1 sanitation, & accidental hazards.

• Family have poor hygiene.


• Untrimmed finger nails were
observed
• Unclean kitchen and improper
storage of food that leads to the
1
4. Application of principles of presence of flies all over the area.
personal General Hygiene • Inadequate living space and the
surrounding are unkempt and dirty.
5. Health attitude— • Accepts health care in some
degree but with reservations.
The way of the family feels about
• Most of the time, the family does
health care in general
not seek the help of medical

34
3
professionals during times of illness
and prefer to self medicate.

6. Emotinal competence— • The family admittedly said that,


their income is not enough for daily
Maturity and integrity with which the
living. They are contented as long
members of the family are able to
as they can eat 3 times a day. They
meet usual stresses and problems of
consider themselves as poor
life and to plan for a happy and 3
though hopeful that someday their
fruitful living.
condition will improve.
• The family has a smooth
relationship towards other members
7. Family Living—
of the family. The mother and father
How well the family members get 5 assume their roles. The husband
along with another in an interpersonal being the breadwinner of the family
relationship. and the wife do the household
chores and take good care of the
family members.
• The house is generally in poor
condition, unsafe, and has
8. Physical Environment— scattered garbage around the

Home, community and work vicinity.

environment. • The community does not practice


3
proper garbage disposal.

• The family often utilized the health


9. Use of the community facilities— care services.

Degree of the family us and • Lack of recreational activities.


3 • Deficient awareness about new
awareness of available community
facilities for health education and ways of preventing & promoting

welfare to physician good health.

Schematic Presentation of Family Health Problem

Environment Biological

No Unclean Unsanitary Dusty House made


proper kitchen; toilet surround- of35
garbage unwashed dings combustible
disposal plates materials
Garbage was No
scattered proper
around the drainage Presence of
house insect
Wood
breeding
places like

Open
container

Easy
transmission of
harmful vector
within family
members.

Increased Environmental Risk

Health Threats: Improper garbage disposal; Presence of breeding places of insects


and rodents; Poor personal hygiene;

Health Deficit: Insect mosquito bite, colds and cough

Social Behavioral

Economic Political Culture


Low educational
attainment:

Father: Elementary Poor information


graduate 36
campaign of the
Mother: High school health care services
Graduate l
The mother does No family
not practice planning
general preventive method
measures. Does used
not look for
medical
assistance in
presence of illness
Both the mother The mother is
and father has on not active in
and off income zonal activities.

Unsafe
The monthly practice of
income is Php utilization of
2500 water: drinking
without boiling

Health Threats: Low Family Income; Poor


Possible to the Continue of
Home and environment, malnutrition
Wrong Practices

Health Threats: Poor Hygiene, Poor home


and environment

Biological
Psychological

Low Self - esteem Family history of Physical


hypertension
paternal side.
37
Lack of Motivation Poor Personal
Hygiene

Lack of Knowledge in Father’s BP is 120/80


Prone to
importance of general
Mother’s BP is 110/70 diseases/illnesses
preventive and curative
measures

Affected ability to cause change


Health Threats: Poor Hygiene, Poor home and
environment, Malnutrition,
Faulty eating habits, improper
garbage disposal
Health Threats: Poor Hygiene, Poor Home
and environment
Health Deficit: Colds and cough;
Insects/Mosquito bites

38
Health Goal of Care Objectives of Intervention Method of Nurse- Resources
Family Nursing
Cues Problems care Measures family contact Required

Accident At the end of 1. Discuss with the Home visit Material


Inability to
hazards as a the nursing family: resources
• Breedin provide a home
health threat intervention, such as
g sites for environment After nursing a. Ways of budgeting
the family visual
vector conductive to intervention, the family’s income
will aids,
health the family will:
• Kitchen implement b. Other possible equipmen
maintenance
’s roof is interventions alternative resources t for
and personal a. Be able to
short that will for the improvement demonstr
development allocate budget
develop an of home and ation
according to
• Poor due to: environment.
environment family’s capacity
lighting for improvement Time and
a. Lack of conductive 2. Discuss with the
and of the home and effort of
knowledge on for good family the
ventilation environment the
importance of health of the importance of a students
• Knowle safe home family. b. Know the home with a and
dge deficit environment
importance of safe and
regarding family
b. Inadequate having a safe and accident free
incomplet members.
family resources accident free environment.
e home
immunizat c. Inability to environment. 3. Help the family
ion identify materials in promoting an Expenses
prone to accidents
accident free for
d. Lack of home teaching
knowledge with environment. materials
regards to and
preventive transporta
measures tion

39
Cues Health Problems Family Nursing Goal of Care Objectives of Intervention Methods of nurse- Resources required Evaluation
Problems care Measure family contact

Subjective: Insufficient funds Inability to At the end of At the end of 30 1. Encourage the Home visit Money, time and At the end
of 30
as a health make decisions 30 minutes to minutes to 1 hour patient the effort of the student
“Kaisa ra ko minutes to
threat with respect to hour, the the patient will be importance of nurse and family 1 hour, the
naka-anha sa objective
taking patient will be able to: regular check-up.
health center was met,
appropriate able to the patient
namo, katong 1. Recognized 2. Discuss the was able
health action verbalize the
nag cholera the importance of benefits of to report
related to: importance of the
ako bana, pero acquiring health saving money for importance
health check-
sa ako baby 1. Lack of care. emergency of
up. acquiring
wala pa kay financial purposes. of health
2. Improves her
wala mi kwarta resources. care.
attitude towards 3. make the
lagi.” As
2. Far from maintaining patient aware of
verbalized by
health care regular check-up. the possible
the patient.
institution. outcome of
irregular check-
3. inadeuquate
up.
knowledge of
community
resources
(Barangay
Health Center)

40
Cues Health Problems Family Nursing Goal of Care Objectives of Intervention Methods of nurse- Resources required Evaluation
Problems care Measure family contact

Subjective: Improper 1. Inability to After the After nursing 1. Provide Home visit Money, time and At the end
of 30
garbage properly nursing intervention, the teachings about effort of the student
“Gausahon ra minutes to 1
disposal as a segregate and intervention, patient will be the correct ways nurse and family hour the
namo among objective
health threat. dispose due to the patient will able to: in garbage
basura tapos was met,
lack of be able to segregation. the patient
inigkapuno na 1. Identify and was able to
awareness on demonstrate
laugan dayon classify types of 2. Educate the demonstrate
proper waste proper garbage proper
nako.” As waste as patient about the garbage
disposal. disposal.
verbalized by biodegradable risks and effects disposal.

the patient. 2. Inability to and non- of improper


appreciate biodegradable. garbage disposal
Objective:
importance of to promote
2. Practice
-Waste are not garbage effective
proper method of
segrated. disposal. compliance.
waste
management. 3. Encourage the
patient to
maintain a clean
environment by
utilizing proper
disposal.

41
Cues Health Family Nursing Goal of Care Objectives of Intervention Methods of Resources required Evaluation
Problems Problems care Measure nurse-family
contact

Subjective: Presence of Presence of health At the end of After nursing 1. Discuss with Home visit Money, time and At the end of
30 minutes
breeding sites theats related to: 30 minutes to 1 intervention, the the patient the effort of the student
“Primi lagi ulan to 1 hour the
of insects and hour the patient will be importance of nurse and family objective
sa amo lugar, 1. Poor was met, the
vector as a patient will be able to: maintaining
problema gyud home/environemental patient was
health threat. able to clean able to
inig ulan kay condition/sanitation 1. Identify and demonstrate
improves surroundings.
grabe ka lapok specifically presence classify types the
environmental of waste as importance
ug dugay of breeding or resting 2. Educate the of clean
condition to biodegradable
muhubas ang sites of vectors of and non- patient about the environment.
eliminate risk
tubig.” As diseases, biodegradable possible
of vector borne .
verbalized by breeding sites of
2 Absence of and carrier
the patient. 2. Practice insects and
drainage system. diseases. proper other vectors.
Objective: method of
waste 3. Demonstrate
-inaccessible management.
method of
passageway-
3. Identify and eliminating
visible mud at demonstrate
breeding sites.
the backyard. ways of
eliminating
breeding sites
of insects and

42
other vectors

43
IX. PRIORITIZING FAMILY PROBLEM:

Accident Hazard

Criteria Computation Actual score Justification

Nature of problem 2/3 x 1 0.66 Accident hazard is categorized as a


health threat and does not require
immediate action

Modifiability of the ½x2 1 Removing the causes of accident hazard


problem which are mentioned in the FCP would
require financial expenditure. The
family’s resources are not adequate
considering their other problems.

Preventive Potential 3/3 x 1 1 The problem is preventable because the


family could do something about the
problem if they have the adequate
resources to solve the problem.

Salience of the problem 0/2 x 1 0 The Family does not recognize the
mentioned problem.

Total Score 2.66

Family size beyond what family resources can adequately provide

Criteria Computation Actual Score Justification

Nature of the problem 2/3 x 1 0.66 This is considered threat because


inadequate resource would mean that the
family doesn’t have enough resources
allocated for their basic needs which
include health maintenance.

Modifiability of the 2/3x2 2 Current knowledge, interventions and


problem resources are available to solve the
problem.

Preventive Potential 3/3x1 1 The available family resources can be


utilized to encourage growth promoting
experiences for members.

Salience of the problem 2/2 x1 5 The family perceives it as a serious


problem needing attention to ensure that
the family’s basic needs could be
properly and adequately compensated.

Total Score 4.16

44
Poor home and environmental condition

Criteria Computation Actual Score Justification

Nature of the problem 2/3 x 1 0.66 This problem is Considered as health


threat because the presence of
environmental insanitation could lead to
possible diseases related poor
environment.

Modifiability of the 2/2 x 2 2 The problem is highly modifiable because


problem there are available resources to address
to mentioned problem.

Preventive Potential 3/3 x 1 1 The problem is preventable because


there are ways to address to this
problem.

Salience of the problem ½x1 1 The family recognized the presence of


the problem yet they don’t do appropriate
actions to solve the problem cited.

Total Score 4.66

The prioritized health problems

The list of health condition or problems ranked according to priorities is presented:

• Poor home and environmental sanitation 4.66

• Family size beyond family resources 4.16

• Accidental hazard 2.66

X. Actual Implementation

On the first day of our exposure at Brgy. Sili-sili Pagatpat, we conducted a courtesy call
and followed by ocular survey. In view of the fact, we have still enough time to scout a family in
which we can make our family case study.

45
At the time in which we had selected our family, we followed the standard protocol of
home visit, which we had introduced ourselves, we state the purpose of our visit and thus
rapport was initially established. We gathered data through interview by asking the name of the
family members including individual profile, observed the area and the surroundings that may be
cause of disease.

On the second day of visit, the student nurse conducted direct physical assessment to
include the immunization records, vital signs taking, height and weight. We had also conducted
interview including the present and history of health of each member, and we also observed the
nonverbal cues of the mother. There are several health problems and family nursing problems
identified as mentioned above.

On our third day of duty we went to the family and assess further on their health and
environmental conditions and at the same time conduct preliminary health and environmental
teachings. We shared different health teachings in terms of promotions, preventions, and cure in
order for them to cope up with their daily problems that had able to affect their health. The
following health teaching we had given includes maintenance of cleanliness of their house as
will as their environment, screening of doors and windows and using nets or long clothing
covering the body when sleeping, cover water containers to prevent breeding sites of victors
and proper waste segregations. On the other hand we stressed the importance of following
treatment such as strict compliance of medications. If not so the use of alternative medicines
such as “bawang” could somehow health control hypertension.

During our fourth and last visit we do our termination phase, we thank the family for
letting us have them as our family care study.

RECOMMENDATIOIN AND REFFERAL

During our visits with our chosen family for our family care study we have known that Mr.
W.C. was hypertensive and has maintenance medication prescribe by the physician, but
unfortunately he was not able to take the medications due to financial problems. We discuss to
them the importance of therapeutic regimen including the different foods that needs to be

46
avoided, and encouraged him as well to have a monthly checked of his blood pressure. Other
than that we also found out that E.C had occasional asthma. We discouraged him to play with
pets specially cats and dogs ,and those pets with feathers, that can trigger the attack of his
asthma. Other health teachings imparted were about proper environmental and personal
hygiene. We recommended them to give priority with their health maintenance by taking a bath
everyday , cleaning the environment , disposing their garbage accordingly, proper toilet and
proper drainage system because an individual cannot perform task effectively if they are sick
due to health problem.

EVALUATION

The study and activity served as an eye opener for the families that we have chosen. We
are one of the strangers that had come to their lives and then we became part of it. And as part
of it we became involved with their lives especially when it comes to their health and present
conditions in which we want to modify change and enhance.

With the knowledge that we had acquired from our AHSE 2 up to the present,
techniques were developed to identify health problems and threats, family problems as well as
social and political problems. Some of those aspects are poorly handled, and that’s the time that
we started to intervene to give guidance and interventions that could help their family become
better as well as a role model to their community. And with those interventions and health
teachings, slowly we can see the change that we want to see from them. The problem now is
their maintenance, but we think that if they like the result of the change that they went through,
they’ll surely practice and maintain a healthy living.

On our part, the study gave as the opportunity to explore more ways on how to be
effective in giving health teachings to our family. Patient was also our foundation. And most of
all it help us to be more mature and wise in terms of dealing with our daily lives.

47
XII. Evaluation

At the end of 6 weeks CHN exposures and 5-7 days of nursing interventions, the Amerol
Family was very accommodating to us. They appreciate our efforts on emphasizing health
teachings and encourage them to visit or seek medical assistance as soon as possible for their
son. The baby is possible for hydrocephalus illness as discuss above. This is to prevent further
complications of the baby since his immunization is not yet complete due to altered immune
system.

PROGNOSIS, REFERRALS AND FOLLOW-UP


Prognosis varies depending on how long the condition has been
identified and what other underlying conditions that already occur already
prior to admission. Early detection plays an important role on the treatment
and recovery of a sick individual. No matter what type of illness it may be,

48
for as long as it has been detected immediately and therefore managed
properly, complications maybe prevented.

In connection with our patient, H.M has indeed a good prognosis; as a


matter of fact she already had orders of discharged from her attending
physician. She stayed in the hospital for quite some time. During her hospital
days she had able to underwent a series of painful laboratory test like
complete blood count ( CBC ) to be specific, in order to monitor her platelet
count, and as well as other medications that needs to be given
intravenously.

Fortunately she had able to surpass all the treatments and


medications that are necessary for her to fully recover from the illness. It is
not the first time that she have had dengue fever, it’s definitely her third
time, so we had emphasized on our health teaching specifically to the
mother, the essence of prevention, of how relevant it is specially for those
disease that are preventable, just like dengue fever.

DISCHARGED PLAN

49
MEDICATION We had instructed the mother to strictly follow therapeutic
regimen even if the patient was already discharged, and as
well as the importance of complying home medications with
right dosage, right timing of administration with
precautionary measures including the side effects of the
medications that were prescribed by the physician.

EXERCISE In her age exercising is not a problem, since the patient is


still a child, but we still reminded the mother to be extra
careful with the type of environment the child is exposed,
especially that she had already been infected with dengue
not just once but three times already. And more importantly
to set limits with the activities of the child nowadays that
she have had just came from the hospital and as well as the
importance of rest periods in order to fully recover from the
illness.

TREATMENT During our health teaching with the mother, we specifically


emphasized to take preventive measures regarding the
causative agent of the disease. That environment is one of
the factors that contributed a lot with the illness. Dengue
fever is a preventable disease; it is therefore can be
avoided.

OUT-PATIENT We instructed the mother of the child to be back on the


scheduled follow up checked up with the physician in order
to prevent any possible complications and that full recovery
of the child will be achieved.

DIET We encouraged the mother to prepare foods that are rich in


proteins, vitamins and minerals such as green leafy
vegetables, fruits and eggs and other meat and poultry
products in order to regain patient’s health and therefore
can back with her normal life before hospitalization
happened.

50