I.

Family Assessment

A. STRUCTURE AND CHARACTERISTICS Members Relationship to Date of of the head of the birth family family/position

Age

Sex

Civil status

Place of residence

Educational attainment

Occupation and place of work

income

Other sources of income

y

Type of family structure:

y

Family member who decides on matter in health:

y

General family relationship (presence of any obvious/readily observable conflict between members:

B. SOCIO-ECONOMIC AND CULTURAL CHARACTERSITICS: 1. Monthly family expenditure: a. Food b. Clothing c. Shelter d. Education e. Utility f. Others

2. Ethnic background (migrants/natives/member of cultural minority groups)

3. Religious affiliations

4. Nature & level of participation in community affairs (socio-civic, cultural, etc.)

C. HOME & ENVIRONMENTAL y Housing a. Adequacy of living space

b. Sleeping arrangement

c. Presence of breeding or resting sites of insect, rodents or other vectors

d. Presence of accidental hazards

e. Food storage &cooking facilities

f. Water supply(source, ownership, potability)

g. Toilet facility (type, ownership, sanitary considerations)

h. Garbage disposal ( type, sanitary conditions)

i.

Drainage system (type, sanitary conditions)

y

Kinds of neighborhood

y

Social and health facilities available

y

Communication and transportation

D. HEALTH STATUS OF EACH FAMILY MEMBER 1. Medical & nursing history indicating current or past significant illness or beliefs & practices conducive to heath and illness

2. Nutritional assessment (specially for vulnerable or at risk members) a. Anthopometric data (BMI, weight, height, mid-arm circumference)

b. Dietary history

c. Eating/feeding habits & practices

3. Screen for risk factors leading to cardiovascular diseases, diabetes, cancer and respiratory conditions. a. Smoking (frequency, no. of sticks/packs per day)

b. Nutrition/diet (number of servings of vegetables per day and usual types of vegetables eaten, number of servings of fruits per day, number of servings of meat and poultry, frequency of eating fried foods, frequency of visiting fast food/restaurants, frequency of eating preserved, canned and instant foods per week, amount of salt added when cooking food)

c. Physical inactivity (types of physical activities indulged including duration/day and frequency per week)

d. Obesity (body mass index)

e. Alcohol (type, amount, frequency of intake)

f. Raised blood pressure (BP)

g. Blood glucose (indicate recent result)

h. Blood lipids (indicate recent results)

i.

others

4. physical assessment indicating the presence of illness state (only the affected system)

5. results of laboratory/diagnostic &other screening procedures supportive of assessment findings

E. VALUES, HABITS, PRACTICES ON HEALTH PROMOTION AND DISEASE PREVENTION 1. immunization status of family members

2. health lifestyle practices. Specify.

3. Adequacy of: a. Rest and sleep

b. Exercise/activities

c. Use of protective devices

d. Relaxation & stress management

4. Use of promotive-preventive health services

IV. FORMULATION OF FAMILY NURSING PROBLEMS BASED ON FAMILY S PERFORMANCE OF THEIR HEALTH TASKS 1. Does the family recognize the presence of wellness state or health condition or problem identified?

2. Does the family make decisions about taking appropriate health actions to maintain wellness or manage the problem identified?

3. Does the family provide nursing care to the sick, disabled, dependent or at risk members?

4. Does the family maintain a home environment conducive to health maintenance and personal development?

5. Does the family utilize community resources for health care?

V. FAMILY NURSING CARE PLAN HEALTH PROBLEM FAMILY NURSING PROBLEM GOAL OF CARE OBJECTIVE OF CARE INTERVENTIONS METHOD/S OF NURSE-FAMILY CONTACT RESOURCES REQUIRED EVALUATION

II.

SUMMARY OF HEALTH PROBLEMS CUES

HEALTH PROBLEMS

CLASSIFICATION

III.

SCALE FOR RANKING HEALTH CONDITIONS & PROBLEMS ACCORDING TP PRIORITIES CRITERIA NATURE OF THE PROBLEM MODIFIABILITY OF THE PROBLEM COMPUTATION ACTUAL SCORE JUSTIFICATION

PREVENTIVE POTENTIAL SALIENCE OF THE PROBLEM TOTAL SCORE

CRITERIA NATURE OF THE PROBLEM MODIFIABILITY OF THE PROBLEM

COMPUTATION

ACTUAL SCORE

JUSTIFICATION

PREVENTIVE POTENTIAL SALIENCE OF THE PROBLEM TOTAL SCORE

UNIVERSITY OF SAN CARLOS COLLEGE OF NURSING CEBU CITY, PHILIPPINES HEALTH TEACHING PLAN

TOPIC: GOALS/OBJECTIVES CONTENT

DATE: TEACHING STRATEGIES TIME ALLOTMENT PERSONS INVOLVED

VENUE: RESOURCES EVALUATION

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