INTRODUCTION ‘A work like this present realistic situation, alowing us to balance theary with practice. Family Nursing Diagnosis reprasants the clnical judgment about ‘actual or potential health problems and life process occurring with the family. Its validated when itis claerly identity and lirk to the defining characteristics, elated factors and risk factors found vithin the assessment The planning process is characterized by logical thinking whereby relationships are put togethar to avrive al rallonal decisions. This study involves the family heath needs and problerrs, in establishing priorites, selecting appropiate course of action, implementing them and evaluating outcomes. The use of tne family nursing process wil result in a care plan describing the needs avd care for each client It is a set of action a nurse decides an Implementation thet are chasen from among alternatves after careful analysis land weighing options to be able to resaive identified family health and nursing problems, This study focuses on Crisostomo family, a residence of Stio Asana 2, Barangay Santisima Cruz, Sta, Cruz, Laguna. We chose this family as wo. identifed their problems that would affect their health and give solutons for them. to cope up by rendering health teachings and interventions, the family wil be able to understand ang lear about existingipotential health problems and will toke appropriate actions to solve their problem on their own. Through our antcipetory planning, It gives the famly feeling that 1s dignity anc integity are preserved because of the realzation that its nat tolally helptess and can stil do ‘something about the problem situation, Indeed, for us to fully understand the specific problems of the famly and identify how nurses chould werk with @ patint or family to improve thoir health: we provided information 2s we set their prionties for care. In this Family Diagnosis we attained additional knowladge and skills aout the problems that is presented here, where we gathered health information regarding to the fail.CHAPTER I INITIAL DATA BASE A. Family Structure and Characteristics Family Name: Crisostomo Family Type of Family: Extended Fllipino families enjoy close kin bonds, and extended families living together are the norm. Blood bonds are so important, traditionally, that a person ‘can be judged on the basis of who her or his relatives are. It follows that parents ‘and children share an exceptionally strong and intimate bond. They give each cother much mutual affection and respect, According to Castilo, G., and Pua, J. (1963) - Research Notes on the Contemporary Filipino Findings in a Tagalog Area, an extended family is 2 family that extends beyond the immediate family, consisting of grandparents, ‘aunts, uncles, and cousins all living nearby or in the same household. An example is a’ married couple that lives with either the husband or the wife's parents. The family changes from immediate household to extended household. ‘An example would be an elderly parent who moves in with his or her children due to an old age. This places large demands on the caregivers, particularly on the female relatives who choose to perform these duties for their extended family CU ed eee Sn) George Crisostomo —65ylo|-M married husband Irma Policarpio Crisestomo | 60yio| F married wite Angelita Magpili Policarpio | 84 ylo | F widowed | mother of the wife ‘This type of family Is extended which the married couple Mrs. ima risostomo (60 years old) and Mr. George Crisostomo (65 years old) lives with the wife's parents Mrs. Angelita Policarpio, 84 year old widowed woman, where 2they lived at Sitio Asana Il, Barangay Santisima Cruz, Sta. Cruz Laguna. Based (on our interview, the couple decided to live with Mrs. Angelita since their two children had their own family and separated with them that’s why they had no ‘companion anymore in their house. Based on The Importance of Extended Family to Building Strong, Healthy Families; this research shown that there are advantages living In extended families. One good benefit is that extended families help to prevent elderly people live alone. Also, it has disadvantages that sometimes there is no privacy \when there are so many problems that can cause conflict and meddling in other members of the family According to Gelia Castilo and Juanito Pua (1963, p. 116) classify the Filipino family as “residentially nuciear but functionally extended." This means that the household tends to be nuclear in form, but the family is extended in so far as relationships among members of the wider kin group are concerned Members of the same kin group assist one another in times of need, and they participate in joint family activities even if they do not live together in the same househovdB. Socio-Economic and Cultural Factors Socioeconomic and cultural factors have long been thought to influence an individual's health. It determinants the conditions of people's live; where they {are born, grow up, live, work, and age. These determinants or things that make people healthy or not include the following factors: Income and social status - higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health Education — low education levels are linked with poor health, more stress and lower self-confidence. Physical environment — safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions — people in employment are healthier. particularly those who have more control over their working conditions, Social support networks ~ greater support from families, friends and Communities is inked to better health, Culture - customs and traditions, and the beliefs of the family and community all affect health Genetics - inhestance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses, Personal behavior and coping skills ~ balanced eating, keeping active, smoking, drinking, and how we deal with life's stresses and challenges all affect health, Health services - access and use of services that prevent and treat disease influences health Gender - Men and women suffer from different types of diseases at different ages.ee et CO Le Om) Crammed ead George College | Retired Chief Aglipay | 35,000 up Crisostiomo Graduate | Police 10.45,000 Irma | High Schoo! |__ None: Aalipay | None Policarpio Graduate Crisostomo Angelita | Grade 2 None Aglipay | None ‘Magpt Policarpio SOCIOECONOMIC STATUS Family Crisostomo depends on the monthly pension of Mr. George, he hhas a Bachelor's degree in Criminal Justice and becomes Chief Police, and now at the age of 65 he is a pension. They have no problem when it comes to financial; where he received a monthly income of 35,000 to 45,000 that is exact for their foods and expenses a month. It is known that education leads to a better jobs and higher incomes. ‘According to the researchers, better-edueated individuals live longer, has a healthier lives than those with less education, and their children are more likely to thrive, But however, with that good thing people able to live in everything they want; some of tham can affect their health and result to anillness in torms of their lifestyle such as their food eating habit (high-fat and high-salt intake), etc.C. Environmental Factors World Health Organization indicates that environmental health ‘addresses all the physical, chemical and biological factors extemal to a person. It encompasses the assessment and control of those environmental factors that can potentially affect health. It is targeted towards preventing disease and creating health-supportive environments. Environmental factors affect human health in important ways, both positive ‘and negative. Positive environmental factors sustain health, and promoting them is preventive medicine. Negative environmental factors are threats to health, and controling them is public environmental health, ‘These are the following environmental factors that found to Crisostomo Family Boe Home Structure - concrete (owned) | Garbage disposal - open and burning Adequate living space Food intake — improper balanced diet Excreta disposal ~ lush type with Animals dog septic tank Drinking water ~ mineral Pest Insect - mosquitoD. Health Assessment of Each Family Family member: Angelita Magpil Policarpio Date of birth: February 6, 1930 ‘Age: 84 years old Gender: Female HISTORY Mrs. Angolita M. Policarpio is an 84 year old widowed woman with no known history of childhood liness, accidents or injuries, Her husband died 20, years ago because of stroke. There is a positive family history of Hypertension, where her father died on heart attack. She had her first menstruation (menarche) at the age of 14 and she was menopause at the age of 55 year old. She has a total of 8 pregnancies with a 4 children living. ‘When she was 45 year old, she was diagnosed having kidney stone and ‘she was hospitalized for almost 1 month at the Hospital of Manila area since she experienced nausea and vomiting with an intense pain on her back, abdomen, {goin and genital. On that time of her hospitalization she undergone on operation {0 remove all her kidney stone. At the age of 60 year old she was diagnosed of Arthritis and Hypertension since she experienced dizziness, headache, back and knees pain with swelling land tendemess in joints. She had medication which is prescribed by her physician ‘+ Voltaren (emulgel) 75 ml — it is used for the local treatment of traumatic inflammation of tendons, ligaments, muscles & joints. Localized forms of soft tissue rheumatism & rheumatic disease. ‘+ Diclofenal NA (voren) 50 mg BID ~ it is used to relieve pain, swelling (inflammation), and joint stiffness caused by arthritis! osteoarthritis, ‘+ Amlodipine besylate (calcium channel blocker) ~ used in the treatment of high blood pressure.Family member: Angelita Magpili Policarpio Date of birth: February 6, 1930 ‘Age: 84 years old Gender: Female GORDON’S 11 FUNCTIONAL HEALTH PATTERNS Health Perception and Health ‘Management ‘when sick she used to go in private hospital for the General Check-up. ‘Nutrition and Metabolism eats her meal three times a day, often times to eat frults and vegetables only ‘once in a week, she loves to eat meats and frozen food. Take 4 to 6 glass of water a day. Elimination Pattern Mrs. Policarpio had 6 to 8 times of urination. She had at least 1 bowel ‘movement every second or third of the day. Yellowish color of urine. Activity and Exercise Pattern she has no regular exercise, she just staying at home most of the day. Cognition and Perception speech well and clear, doesn't have any sensory deficit, facial expression ‘appropriate to situation. Sleep and Rest Pattern she sleep 10:30 in the evening after watching television and awaken 5:00 in the morning. Sleeps with one pillow. ‘Self- Perception and Self ConceptRoles and Relationship she had good relationship with her daughter Irma, well-supported by her daughter and son-in-law. ‘Sexuality and reproduction she has a total of 8 pregnancy with a 4 children living, Coping and Stress Tolerance cope up with stress by just staying at home and taking a nap or sleep and Watching television, Values and Bellet Religion; Aglipay, believes in God but doesn't goin the church,DATA BASE: PHYSICAL EXAMINATION (Head-to-Toe Assessment) Family member: Angelita Magpili Policarpio Date of birth: February 6, 1930 ‘Age: 84 years old Gender: Female VITAL SIGNS + Temperature: 35.8 °c + Pulse Rate: 72 beats per minute + Respiratory Rate: 16 breaths per minute Blood Pressure: 140/90 mmHg Tranter) Crile) Inspection Skin color is tan. and Has an equally palpation warm _ temperature fon both arms and legs. Poor Skin turgor. Absence of lesions and masses con the surface of the skin 10 INTERPRETATION Normal Presence of poor skin turgor is normal during of old age According to the Family Resource Center, Elderly individuals are at a heightened risk for dehydration because their bodies have a lower water content than younger people. Because of visual, cognitive, or motor impairments, elderly persons. may have difficulty getting fluids for themselves. They ‘also may have only a muted perception of thirst.Reference: Nursing ‘and Rehabilitation Centers. Retrieved from: (October 28, 2014) hitp:nursinghome.org ‘amifam_018, html Hair Inspection Hair color is gray Normal with smooth and fine hair strands. Gray hairis accepted Absence of as a normal part of alopecia ‘and elderly people. (a sign birsutism, of aging) Nails Inspection Nail bed texture is Normal soft and pinkish. Capilary refit time <4 sec. There is no presence of nail ‘clubbing. ‘HEAD Inspection Head is of a reguiar and shape with no ‘Skull and Face palpation apparent _ lesions, Normal ‘masses or foreign bodies. Scalp no evidence of skin condition or infestation, and exhibited no tenderness on palpation. Cheeks fare sunken, facial ‘movements ara all equal Eyes and Vision Inspection Eyes _are aligned, Normal nEars and Hearing Inspection eyebrow is free of scaling, pinkish conjunctiva and White selera that is normal Extra ‘ocular movement {EOM) are intact. There is no presence of edema ‘and hollowness. No evidence of increased tearing. Pupis equally rounded, reactive to light and ‘accommodation. ‘Symmetrical ears ‘and equal in size aligned on the outer canthus of the eye. No presence of tenderness, masses and drainage clogged! cerumen. Pinna recoils immediately. Normal Mouth and Oropharynx Inspection and palpation Inspection ‘Nose is midline on the face without swelling, bleeding (or lesions. Patient can breathe normally in both nostil No presence of discharge, bumps and tenderness; no pain reported. Lips is smooth, symmetrical, pinkish and tree of cracks. No suspected lesions Normal Normal 2and rises as patient swallows. Breast Inspection Symmetrical breast Normal and and nipple. No palpation presence of ‘masses, lesions or discharge in nipple. Chest Inspection Symmetrical Normal respiratory effort without use of ‘accessory muscles. Lungs Percussion Thorax rise and fall Normal and with inspiration and palpation expiration. Resonant percussion throughout. Breath ‘sounds normal with ro extra sounds. Cardiovascular Palpation No extra heart System and sounds and no Normal auscultation murmurs heard, No jugular vein distention at 45 degree. Point of maximal impulse (PMI) palpable in 5 ICS, MCL left border of sternum, ‘Aortic pulsation normal, no bruits sounds. PULSE RADIAL POPLITEAL DORSALIS PEDIS POSTERIOR Ss TIBALIS Right | 2tnormal 2+ normal 1* weak and 2+normal 1thread pulse Left weak and 2+ normal 2+ normal 1+ weak and thread pulse thread pulse AREA METHOD FINDINGS INTERPRETATION ‘Abdomen Inspection, Abdomen fat Normal auscultation, contour. Negative percussion and spleen palpation percussion, no masses or ‘organomegaly. No tenderness to palpation. Kidney ‘and spleen are ‘non-palpable. Normal bowel ssounds with findings of; RLQ: 15 soft clicks! min RUQ: 12 soft clicks min LUG: 14 soft clicks! min La: 12 soft clicks/ min Genitals! = = Inguinal Roctum/ Anus (client refused to ‘assess on this, ‘area) 5MUSCULOSKELETAL, Head and neck Left Upper Extremity Right Upper Extremity Spine It appears regular with no evident masses, lesions, foreign bodies or other abnormalities. No tendemess to palpation. Neck and shoulder are stable. Range of motion and tone are within normal limits. Strength is 5/5 means muscle is functioning normally and is able to maintain its position evan when maximum resistance is applied. Itappears regular and symmetric withthe Right Upper Extremity. No evident masses, lesions, foreign bodies or other abnormalities. No apparent muscle wasting. No tendemess to palpation. Joints are stable. Range of motion, strength and tone within normal limits. Strength is 4/5 indicates that the muscle yields to maximum resistance but when presses on the body part it is unable to maintain contraction. It appears regular and symmetric with the Left Upper Extremity. No evident masses, lesions, foreign bodies or other abnormalities. No apparent muscle wasting. No tendemess to palpation. Joints are stable. Range of motion, strength and tone are within normal limits, Strengths is 4/5 indicates that the muscle yields to maximum resistance but when presses on the body part itis Unable to maintain contraction, It runs midiine and straight, without abnormal thoracic kyphosis or lumbar lordosis, and there are no evident masses, lesions, foreign bodies or other abnormaiies. Spinal processes are prominent. No tenderness to palpation range of ‘motion, strength and tone are within normal limits. Ribs and pelvisihips are regular, with no evident masses, lesions, foreign bodies or other 16Right Lower Extremity Loft Lower Extremity ‘abnormalities. Ribs are prominent. No tendemess to palpation. No costal vertebral tenderness. Range of motion and tone of hip muscles are ‘within normal limits. It appears regular and symmetric with the Left Lower Extremity. Presence of sweling and tenderness in joints due to arthritis. Strength is 4/6 indicates that the muscle yields to maximum resistance but when presses on the body part itis Unable to maintain contraction, It appears regular and symmetric with the right Lower Extremity. Presence of swelling and tendemess in joints due to arthritis. Strength is 4/5, indicates that the muscle yields to maximum resistance but when presses on the body part itis. tunable to maintain contraction, vFamily member: Irma Policarpio Crisostomo Date of birth: Apri 28, 1954 ‘Age: 60 years old Gender: Female HISTORY Mrs. Irma P. Crisostomo a 60 year old woman who experienced typhoid fever when she was 9 year old. She has no history of accidentinjury and sseriousichronic illness. She never hospitalized. She had her frst menstruation (menarche) at the age of 12 and was menopause at the age of 47. There is a positive family history of Stroke and Hypertension, where her father died of stroke and her mother had Hypertension. She has 2 chiléren who lives healthy. [At the age of 45 she was diagnosed of Hypertension where she takes her ‘maintenance before Amlodipine besylate (calcium channel blocker) ~ used in the treatment of high blood pressure. ‘There is no current medication taken, 18Family member: Irma Policarpio Crisostomo Date of birth: April 28, 1954 ‘Age: 60 years old Gender: Female GORDON’S 11 FUNCTIONAL HEALTH PATTERNS Health Perception and Health ‘Management when sick she used to go in private hospital for the Check-up. ‘Nutrition and Metabolism Eats her meal 3 times a day, eat fruits and vegetables, she loves to eat rice and meat, Take 5-8 glass of water a day. Elimination Pattern 6 to 8 times of urination in just one day, she had bowel movement 3 10.4 times in one week. Yellowish color of urine, Activity and Exercise Pattern ‘She just staying at home and consider doing household chores is, her exercise every day. Cognition and Perception speech well and clear, doesn't have any sensory deficit, facial expression ‘appropriate to situation, Sleep and Rest Pattern sleep at 8:30 in the evening and ‘awaken 5:30 in the moming. Sleeps with one pillow, sometimes taking a ‘nap during afternoon. ‘Self Perception and Seif Concept 19Roles and Relationship had a good relationship with her husband and mother, well-supported by her husband, ‘Sexuality and reproduction believe it is normal and natural aspect of personality related to attraction between sexes. Coping and Stress Tolerance cope up with stress by having a conversation with her husband about the problem. Values and Belief Religion; Aglipay, believes in God and she attend mass once a week 0DATA BASE: PHYSICAL EXAMINATION (Head-to-Toe Assessment) Family member: Irma Policarpio Crisostomo Date of birth: Apri 28, 1954 ‘Age: 60 years old Gender: Female VITAL SIGNS + Temperature: 35.8 -¢ + Pulse Rate: 74 beats per minute + Respiratory Rate: 16 breaths per minute Blood Pressure: 130/90 mmHg AREA METHOD FINDINGS INTERPRETATION. Inspection Skin color is tan. Has Normal Skin and ‘an equally warm palpation temperature_on both ‘ams and legs. Good skin turgor. Absence of lesions and masses fon the surface of the skin. Normal Hair Inspection Hair coloris black with ‘smooth and fine hair strands. Absence of alopecia and birsutism, Nails Inspection Nail bed texture is soft Normal and pinkish. Capillary refill ime < 3 sec. There is no presence of nail clubbing. aNose and Sinuses and ‘Nose is midline on the Normal palpation face without swelling, bleeding or lesions. Patient can breathe normally in both ‘nostril. No presence of discharge, bumps and tendemess; no pain reported. Mouth and inspection Lips is smooth, Normal Oropharynx symmetrical, pinkish and free of cracks. No suspected lesions or masses on tongue, gums, hard and soft palate and tonsils. Uvua is in the middle, tonsils is pink without hhypertrophy. Tongue easily move in all directions, pinkish with presence of whitish ‘spots, moist and with ‘gag reflex. NECK Neck Muscles Inspection Symmetrical with Normal and head in central palpation position. Symmetrical movement of neck muscles. Movement through full range of ‘mation without ‘complaint of discomfort. Active ROM; flexion, extension, lateral rotation and titing, Lymph nodes Palpation Lymph nodes are non- Normal palpable, 2thyroid gland Palpation In midline position, Normal ‘non- palpable lobes, not enlarged and rises 2s patient swallows, Chest Inspection Symmetrical Normal respiratory effort without use of, accessory muscles. Lungs Percussion Thorax rises and fall Normal and with inspiration and palpation expiration. Resonant percussion throughout, Breath sounds normal with no extra sounds. Cardiovascular Palpation No extra heart sounds Normal ‘System and and no murmurs ‘uscultatio heard. No jugular vein n distention at 45 degree. Point of, maximal impulse (PMI) palpable in 5" ICS, MCL left border of sternum, Aortic pulsation nomal. no bits sounds over the aorta, femoral or rental arteries. PULSES RADIAL POPLITEAL DORSALISPEDIS POSTERIOR, TIBALIS Right 2*normal_—2*nonmal-1* weak and 1* woak and thread pulse thread pulse Left 1+ weak and 2+normal 2+ normal 2+ normal thread pulse 2AREA METHOD FINDINGS INTERPRETATION ‘Abdomen Inspection, Abdomen flat Normal auscultation, contour. Negative percussion and spleen palpation percussion, no masses or ‘organomegely. No tenderness to palpation. Kidney ‘and spleen are ‘non-palpable. Normal bowel sounds with findings of; RLQ: 14 soft clicks! min RUG: 12 soft clicks! min LUG: 11 soft clicks min LO: 13 soft licks min Genitals! ~ 7 Inguinal ‘assess on this ‘area) 6Head and neck Left Upper Extremity MUSCULOSKELETAL It appears regular with no evident masses, lesions, foreign bodies or other abnormalities. No tendemess 10 palpation. Neck and shoulder are stable. Range of motion and tone are within normal limits. ‘Strength is 515 means muscle is functioning normally and is able to maintain its position even when maximum resistance is applied. It appears regular and symmetric with the Right Upper Extremity. No evident masses, lesions, foreign bodies or other abnormalities. Joints are stable. Range of motion, strength and tone within normal limits. Strength is 5/5 means muscle is functioning normaly and is able to maintain its position even when maximum resistance is applied. It appears regular and symmetric with the Left Upper Extremity. No evident masses, lesions, foreign bodies or other abnormalities. No apparent muscle Right Upper Extremity wasting. No tendemess to palpation. Joints are Spine stable. Range of motion, strength and tone are within formal limits. Strengths is 5/5 means muscle is functioning normally and is able to maintain its "position even when maximum resistance is applied. It runs midline and straight, without abnormal thoracic kyphosis or lumbar lordasis, and there are no evident masses, lesions, foreign bodies or other abnormalities. No tendemess to palpation range of motion, strength and tone are within normal limits, Ribs and pebisihips are regular, with no evident masses, lesions, foreign bodies or other abnormalities. Ribs are prominent. No tenderness to palpation. Range of motion and tone of hip muscles: ‘are within normal limits. appears regular and symmetric with the Left Lower Extremity. No evident masses, lesions, foreign Right Lower Extremity bodies or any abnormalities. No\ tenderness to Left Lower Extremity palpation. Strength is 5/5 means muscle is functioning normally and is able to maintain its position even when maximum resistance is applied. I appears regular and symmetric with the right Lower, Extremity. No evident masses, lesions, foreign bodies or any abnormalities. No tenderness to palpation. Range of mation and tone are within normal limits, 26palpation. Range of motion and tone are within normal limits. Stength is 5/5 means muscle is functioning normally and is able. E. Health Status of Each Family Member OUT eC Pass George None = Crisostomo Irma Policarpio | High Blood | Hypertension | Consultedio a Crisostomo Pressure physician ‘Angelita Magpili | High Blood —|-Hypertension | Consulted to a Policarpio Pressure physician Axthaiis Swelling and tendomess in joints 5CHAPTER I FIRST LEVEL OF ASSESSMENT Identifying health threats, health deficit and foreseeable crisis/ stress points: ‘A Health Threat conditions that promote disease or injury and prevent people ‘rom realizing health potential. (conducive to disease) Improper balanced diet consider as 2 health threat because it may cause possible illnesses or diseases to a person. ‘The National Institutes of Health reports that hypertension is one of the possible outcomes of improper balanced diet. Hypertension, also known as high blood pressure, is called the silent killer, because it frequently remains undetected and thus untreated until damage to the body has been done. Eating too much junk food, fried food, salt, sugar, dairy products, caffeine and refined food can cause hypertension. Diabetes also can be linked to improper balanced diet and some forms of the disease can result from consuming a sugar- and fat- Jaden diet, leading to weight gain, Stroke may also occur that is caused by plaque that builds up in a blood vessel, then breaks free as a clot that travels to brain and creates a blockage can be linked to poor nutrition an improper balanced diet. Strokes damage the brain 36and impair functioning, sometimes leading to death. Foods high in salt, fat and cholesterol increase the risk for stroke Gout may also develop, with gout uric acid buildup results in the formation of crystals in your joints. The painful swalling associated with gout can lead to permanent joint damage. A diet that is high in fat or cholesterol can cause gout. ‘Some seafood-sardines, mussels, oysters and scallops—as well as red meat, poultry, pork, butter, whole mik, ice cream and cheese can increase the amount of uric acid in your body, causing gout. Several types of cancer, including bladder, colon and breast cancers, may be partially caused by poor dietary habits and improper balanced diet. Limit intake of foods that contains refined sugars, nitrates and hydrogenated oils, including hot dogs, processed meats, bacon, doughnuts and french fries. 2Improper garbage disposal its also consider as a health threat because It may cause possible illnesses or diseases to a person. It may cause several problems nat only in the health of people but also to the Environment like the ‘open-buming type of way in garbage disposal. Based on the Environmental Programs and Strategies. the greatest health ‘Fisk from the open burning of garbage at a waste disposal ground would be to those closest to the fire who may inhale the smoke. Other individuals on-site and offsite may also be affected, depending on factors such as the distance to the fire, exposure duration, amount and type of material burned, individual sensitivity, etc. The pollutants are all toxic to humans, depending on their concentration, and may cause irritation, skin and respiratory problems; some are carcinogenic. ‘Those individuals with respiratory problems such as asthma or with allergies may 'be even more sensitive to the smoke, ‘The smoke from open buming may be @ major source of complaints from the public because of Its odor and its effects on visibility and the ash, which may be dispersed by the wind or leached by water, may contain toxic contaminants Toxins may be leached from any ash remaining which could lead to the ‘contamination of surface water or ground water that can harm to people's health. 38B. Health Deficits occurs when there is a gap between actual and achievable health status. Hypertension is consider as a heath deficit because itis already present toa person. Doctors have long called high blood pressure “the silent kiler” because a person can have high blood pressure and never have any symptoms. If left untreated, high blood pressure can lead to life-threatening medical problems such as stroke, heart attack or kidney failure. High blood pressure is one of the most common causes of stroke because It puts unnecessary stress on blood vessel walls, causing them to thicken and deteriorate, which can eventually lead to a stroke. It can also speed up several ‘common forms of heart disease. When blood vessel walls thicken with increased blood pressure, cholesterol or other fatsike substances may break off of artery walls and block @ brain artery. In other instances, the increased stress can weaken blood vessel walls, leading to a vessel breakage and a brain hemorrhage. There are factors that have been linked to high blood pressure including ‘A family history of high blood pressure. Age: The incidence of high blood pressure rises in men after age 35 and in women after age 45. Gender: Men are ‘more likely to have high blood pressure than women until age 45. From ages 45 to 64, men and women have similar risk. After that, women are more likely 10 have high blood pressure. Other factors that can lead to high blood pressure 38include excess weight, excessive alcohol consumption, diabetes, lack of exercise and a high-salt diet In most people, high blood pressure can be controlled through diet, exercise, medication or a combination of all three. A diet that is low in salt and rich in vegetables, fruits and low-fat dairy products may help lower blood pressure. Recent studies have also shown that increasing potassium intake, (for ‘example, eating fresh fruits and vegetables), may help lower blood pressure.Arthritis is consider as a health deficit because itis already present to @ person, According to the Centers for Disease Control and Prevention, arthritis is more common in women than men and in thase that are overweight (CDC). ‘Acthitis is inflammation of the joints (the points where bones meet) in one or ‘more areas of the body. There are more than 100 differant types of arthritis, all of whieh have different causes and treatment methods. The symptoms of arthrtis usually appear gradually but they may also occur suddenly. Arthritis is most ‘commonly seen in adulis aver the age of 65 but it can also develop in children and teens. ‘The most comman symptoms of arthritis involve the joints. Joint pain and stiffness, mostly in the moming, are typical signs, along with swelling of the joints. You may also experience @ decrease in range of motion of your joints or redness of the skin around the joint. ‘There are certain herbs may have ant-inlammatory properties that can help with arthritis as well as the ability to reduce pain in all forms of the disease. Aloe vera is one of the most commonly used herbs in altemative medicine, Known for its healing properties, it is popular for treating small skin abrasions. You may already have a bottle of aloe vera gel in the medicine cabinet from a past experience with sunburn for pain relief. This same type of product may be applied topically to soothe achy joints. This hetb is also available in whole form {rom the leaves of the plant. The National Center for Complementary and Alternative Modicine (NCCAM) says that oral aloe vera can cause decreased blood sugar ‘and gastrointestinal side effects, such as diarthea. Topical aloe vera, on the cother hand, does not cause any side effects. Boswellia is praised by alternative medicine practtioners for its anti- Inflammatory capabilities, It's derived from the gum of boswellia trees, which are aindigenous to India. Also called frankincense, this herb is thought to work by blocking leukotrienes. Leukotrienes are substances that can _altack healthy joints in autoimmune diseases such as rheumatoid arthritis, ‘The NCCAM acknowledges promising evidence of boswelia in animal studies, but notes a lack of human trials. Boswellia is available in tablet form, as well as topical creams. You may have ginger in your spice cabinet for cooking, but this herb is, ‘also a staple in many alternative medicine cabinets, The same compounds that give ginger its strong flavor are also the same ones that have ant-inflammatory properties. The NCCAM says that early studies in reducing joint swelling with singer in RA are promising. However, limited human trials have yet to prove the effectiveness of this treatment. Green tea is one of the most popular beverages in the world, and has ‘even been used to reduce inflammation in the body. It is possible that green tea can be used to treat arthritis inflammation in the form of beverages, tablets, or tinctures. The NCCAM found ina 2012 study that green tea might help both osteoarthritis and RA patients. Many more studies are needed to prove the potential benefits of green tea, ©. Foreseeable Crisis/Stress Point anticipated periods of unusual demand on the individual or family in terms of adjustment or family resources. ‘Thore is no identified Foreseeable crisis or stress point to Crisostomo Family 2CHAPTER Second Level of Assessment LIST OF PROBLEM IDENTIFIEDPte a ae oe ST Family Crisostomo usually eat meat land frozen foods, they often times to ‘eat fruit and vegetables. "Sa dami ng basurang naiipon minsan sinusunog namin ito 0 di kaya hinahayaannalang nakatambak sa abas ng gid gaming bahay hhanggang sa kunin ito ng garbage collector,” as quoted by one of the member of fail. The way of the family in garbage disposal is open burning and sometimes it is place in an open container Name: Irma Policarpio Crisostomo ‘Age: 60 year old BP: 130/00 mmHg -loves to eat meat and frozen foods -once a week to eat vegetables has a family history of Hypertension fruits and Name: Angelita Magpili Poicarpio ‘Age: 84 year old BP: 140/00 mmHg -loves to eat meal and frozen foods once a week to eat fruits and vegetables = has a maintenance of Amlodipine besylate Inability to balanced nutrition due to lack of knowledge about the problem Inability to decide about taking ‘appropriate actions due to failure ‘to comprehend the nature and ‘scope of the problem, Inabilty to recognize the presence ‘of health problem due to: 3) Lack of or inadequate knowledge. 5) Failure to comprehend the nnature/ magnitude of the problem Inability of the patient to continue taking her medication prescribed due to 2) Unable to remind herself for taking due medication. 5) Inadequate knowledge on preventive measures, ¢} Inability of patient to visit RHUiclinie for regularCHAPTER IV SCALE FOR RANKING A. Criteria Tsay Fofo) Sch 1 Nature of the problem 3 Health Deficit 2 1 Health Threat 1 Foreseeable Crisis 2Modifiability 2 2 Easily 1 Moderate 0 Not modifiable 3 Preventive/potential 3 High 2 Moderate 1 C Low 4 Salience of the problem Problem needing urgent attention 2 Problem not needing urgent attention 1 a Not perceive as a problem 0 5B. Scoring 1. Decide on a score for each of the eniteria, 2.Divide the score by the highest possible score and muliply by the ‘weight. Score een ait Highest Score 3.Sum up the scores for all the criteria. The highest score is 5, equivalent to the total weight. 4.The higher the score (near § and above) of a given problem, the more likely tis taken as a PRIORITY. 5.WWith the available scores, the nurse then RANKS health problems accordingly, 46CHAPTER V RANKING AND SCORING OF EACH HEALTH PROBLEM List of Health Problems Ranked According to Priorities tata Co) -6 aU} SCORE 4. Nutritional imbalanced 4.16 2, Improper garbage Disposal 3.66 3. Hypertension 3.16 4, Arthritis 35A.Imbalanced Nutrition CRITERIA SCORE JUSTIFICATION It is considered as a health threat because it can contribute 1 Nature of the problem ae complication! problem 10. the Heatth Deficit heath status ofthe far; with Health Threat th imbalanced ution thoy Foreseeable Crisis, lake, ‘always. eating high-sak and highslat foods may cause an increased biood pressure. Wt Is intermediate mediate ema 1.x2=2 | Because we informed them the 2 Importance of proper food intake in daily ving such as in eating fruits and vegetables. The family recognized what are the risks to their health status of eating an imbalance nutrition through our nutritional health education an |3.x1=1 | itis highty preventive because re) era 3 as we observed our chosen re family they practiced on how to ea keep. thei thing becomes ee healthy by lowering their salty {and fatty foods intake. 4 Salience of the problem The family is oriented on the problem of eating an unhealthyProblem needing urgent [2 ‘ood and sil they considered it attention ‘8s a problem not needing an Problem not needing urgent attention. urgent attention Not perceive as a problem TOTAL SCORE: 4.16 B. Improper Garbage Disposal CN ete) UU a(or Tod | 4 Nature of the problem It is considered as @ health threat because with an Health Deficit improper garbage disposal Health Threat insectavectors has a chance to Foreseeable Crisis breed and may cause disease to a person like dengue. And ‘also ‘tho smoke from open burring may cause respiratory problems to an individual such ae asthma itis easily modifiable since the peMedinabtity 2 family is cooperative and follow Easily health education in proper Intermediate garbage disposal Not modifiable 3X1=1 | itis highly preventive since we |2er0 tential saan 3 had health teaching to the High family about the Importance of Moderate proper garbage disposal they es Practiced on how to segregate on-biodearable ‘and biodegrable materials. itis not perceived as a problem lo: of the family because they can Problem needing urgent (2 ‘manage fo lve in t and stl no 8‘attention Problem not needing urgent attention Not perceive as a problem ‘one Fad an liness because of that problem. C.Hypertension ues |4Nature of the problem Health Deficit Health Threat Foreseeable Crisis TOTAL SCORE: 3.66 JUSTIFICATION It is considered as a health deficit since that there is a presence of problem. |_2Modifiability Easily Intermediate Not modifiable It is intermediate _modiftabiity because the family able to practice balanced nutrition since we emphasized them on how to deal with low-salt and low-fat diet during our health education. |2Preventivefpotential 2 X1=0.68 High Moderate Low It is considered as a moderate preventive because the family practiced the proper balanced rutrtion by eating fruits and vegetables. |_ 1X1=05 4 Salience of the 2 problem Problem needing urgent attention Problem not needing The family recognized this as 2 problem not needing an urgent aitention, because they can stil ‘manage their health condition. urgent attention 50Not perceive as a problem TOTAL SCORE: D. Arthritis CRITERIA SCORE JUSTIFICATION 1 Nature of the problem aXxt=1 Health Deficit 3 Health Threat Foreseeable Crisis It is considered as a health dofcit since that there is a presence of problem. |_2Modifiabitity Easily Moderate Not modifiable It is intermediate modifiable because Mrs. Angelia M. Policarpio is cooperative. We educate her on how to relieve! minimize pain such as apply warm, moist compresses 10 affected joints, 3Preventivefpotentiah == |-2.X1= 1 High Moderate Low It is considered as a high preventive since Mrs. Angelita M. Policarpio has medication on this problem. Voltaren (emulge!) 75m! -Diclofenal NA (voren) 50mg 81D 4 Salience of the problem Problem needing urgent attention Problem not needing urgent attention Not perceive as a problem The family recognized this as 2 problem not needing an urgent aitention since Mrs. Angolita M. Policarpio has medication on this problem. stTOTAL SCORE: 35 CHAPTER VI Family Nursing Care Pian Chapter HeaLTa GOAL OF OBJECTIVE OF INTERVENTION PLAN. expecteD PROBLEM ARE ‘ouTcOME Heath Treat Fariy Too famiy wit| Assen tofomiys Estaoheg —vissl at |The tay Loam Toe NY WE Secaptens” apaatincigh & acuasen | be ae Intatanond Practice enely no | amd ae vat,” ett) | practon Mastin fase” tat are, Nittone! Bonced (make good taking yance,| haan such 8 ray conor ard Lead reper the veneabies| icone and rutiton by Gict) and its 3) Eespeton Heath eacng cating sts fey vl be abe ated and {0 bracice fe | cee feniy's National Vegeabios Picper feed | percptons tine, ‘Baenend De prevent Fake tp, lneded det ot posse prevent one cris ‘Seeace Fibamced | Ber auteok po nati porbobnes et‘Seon such cps ancora ae ae ‘Taedegate ‘Sader heath Sagupeeny {dtr fot.Hearn Oak OF PROBL Heat Test, ‘th | tary Tea can | zee he ais i feo remgranthe | pape ‘pope \o'afernme pocobeefece | era Game Sigmoge | eer gntaoe Osco umn” | soe for | eee ‘my concurs and on "Poteet undersondng | oder pnae Tainfde st Stowers | Rosse Gate pera ot Sena. pactong. | Oeste wth ne Frovervnte | fy canta Gaps | fan eow at Soa repre pobem thse, pad tay ‘emeesonat Srgropeann ‘uarrononm te Bsegogate the non Bocegable nd Fiosogabie mataeae ee ‘ae rurengcere to the ery sndon UBkng ions sive pobim, ini anly aoe ‘wate pos eich Bosagresbie em ansogrdate waste dope Emphasize ne me ‘anes et pete Eten roo Tratth i sesh ‘tare n tat ese rmeatton Greapclng ‘ecme rater Daelingof ‘aban ke fara bette sds Family member ima Polcario CristaDate of bith: Ao 28, 1954, ‘age: 80 years id ener Heatn GOM.OF _ OBJECTIVE OF INTERVENTION PLAN expecren PROBLEM Surcone Heath Det “The palin wi Ateeinopant Exava | The ptt Davo | cistundasie: mepotrgh Veusag” | wit ate Hypertension Scqrgaingbts fonevat trakcursn | vera 2) Caste hor) hex podem Tosedoye (oanpned |e! fomiy meD8W eS oo ec ye cane Uderand- Boat ce TM sas and ype Heath tachi ag importance of Stdconpleaion rogadng. fond eqior check at mey arse sue yporerion process and o terypetonsen Seament room. byesaain mpatance of pleper et or fot nae, JEnumerate fhe Seeaeoe that ght serio it Fypartenson i sol proventes Fist, age, ano ea nae for ‘he auereners of fe patent Porter era‘alae Tear anbatons| Totase | dato pated on he Bos and Dore ofhyperterson Enon porns Take roses natty enor Bast an Arprosctes te Sopp parr) eo type obestyoinh emectarra Sangam csi toate Family member: Anglia Mago PuicarpoDate of birth: Fetruay 61990 pacers Sener farce wean on. oF | onsecrwe oF INTERVENTION PLAN exeecteo raeat Soa Meat ott The [pate The part wi] sxebpatns_ eeminirg ap apesen | mo ptt ttt ga i eget Repth Vantaa | tet i Sree aaa” Some wane _ 12) Edscate her| PION (mareagoos Gama) | fn farily MeOSUES | aesecs pavents contact) understand sot te | See, gee importance of! abity io pararm fealth teaching vmod region “check: Sateeberavor. Tagua process ona ° eon fener oe en sacri | ME te Metso nents pecan or osm hi ‘Discuss the nature citnmoran | Seeenagere guborpte| ante a chen Same tyenesen SoeSisn |menenany ma rot prevented wnmee eater ¢) nabity cate Statin! pated on he vise Bos and Dore Feline ofhyperterson fo requir checkup Eno por 'oos Tako roses natty ener ee Bast an Arprosceste Sopp panera type obesty Moin emectarra rungearaan son toate Family member: Anglia Mago PuicarpoDate ot ith: Fatruay 6 1930 Sea ol Sheer Parse eam | FAY — GoALoF _ossECTIVE OF INTERVENTION PLAN Beecte poole Surcoue ‘esha netn eee \ eat oer | nef |The [slater Te pant wih | Eas eppot sting Vila | To patnt ete. "ate. “e rmpatewon ‘dawson | mise ai ee ee 0 a Fm ap fev frorentere vo| emiatwniee ere ere itenenten 5 of|rokevopan. | herons bee to onl ‘estas indicated. Health teach experiance | vag gradual relief ncumge toga Sat Spann ae ferneatny oomee pom ‘ori meri Soper tons aadra eneaeae patents ows go iain ec ‘Sede saver ‘ences 09. Eoteeapa vealCHAPTER VII SUMMARY, CONCLUSION AND RECOMMENDATION A. Summary ‘Sitio Asana Il, Barangay Santisima Cruz, Sta. Cruz Laguna is the area where Grisostomo Family resides. They are composed of three members (Mrs. Angelita Policarpio- wife's mother, Mrs. Irma Crisostomo- the wife and Mr. George Crisostomo- the husband); considered as a type of extended family that couple lives to the wife's parent. This family has no problem in financial since Mr. George is @ Retired Chief Police which he received a monthly income of 36,000 — 45,000. ‘As we visited them during Community Health Service, first thing we did is to recognize those factors that affects their health with the use of survey form. ‘Therefore, we found out the potential problem that may occur in this family such 1s the way they dispose their garbage which they prefer in an open-buming and sometimes just place it in an open container. On the other hand, in terms of their nutrtion we recognized they had an imbalanced intake of it as verbalized by one of the member of family “Minsanan lang kami Kumain ng gulay al prutas.” In this, data, it fs @ health threat to the health status of the family that may result 10 possible disease. When we interviewed each member of the family for the history taking, we recognized the present illness of them; Mrs. Angelita had arthritis and hypertension while Mrs. Irma also had hypertension which is health defi. ‘Through our findings and thorough assessment, we implemented interventions that wil help this family in providing good quality of health in prevent disease/ ilhess. We had health education to them about in proper disposal of garbage by ‘segregating non-biodegrable and biodegrable materials or selling some waste materials like cans, bottles and plastics. Then also, we educate them on how to balanced nutrition by having a low-salt and low-fat diet and emphasized to them about the importance of fruits and vegetables in order to prevent disease such as hypertension, diabetes, stroke, etc 6B. Conclusion ‘As we handle our chosen family and identified their health problem, itis tue that all problems has its solution and it is always need a change for a better condition We concluded that this Community Health Nursing Service has a great impact, in every lives of an individual that promotes good health and prolonging life. We observed that Crisostomo Family was practiced those health education that we've said to them such as in proper disposal of garbage. They had different ‘options on it ke by using a compost pit with cover, segregating non-biodegrable ‘and biodegrable materials, recycling or selling of the cans, bottles or plastics, Also, especially when it comes to a balanced nutrition the family had a realization that those food with high cholesterol can make their life shorter. They {are aware on the diseases may get and with that they practiced on how to eat vegetables. fruits and low their salty and fatty foods intake.C. Recommendation ‘We all know it isr't easy to change someone's perception when you know ‘it becomes as their habit. But through our health education during home visit, we ‘gave them an important information on how to adopt @ healthy diet. We ‘emphasized the importance of lifestyle treatments have the potential to improve blood pressure and prevent taking such as medication, We advised to the Crisostomo family to prevent salty foods. It is really important to read nutrition labels; almost all packaged foods contain sodium ‘especially with those foods with more than 150 mg of sodium in each portion and every time they will prepare or eat a packaged food, know how much sodium is in ‘one serving. We told them that eating a dist that is rich in whole grains, fruits, vegetables and low-fat dairy products and skimps on saturated fat and Cholesterol can lower their blood pressure by up to 14 mm Hg and this eating plan is part of the Dietary Approaches to Stop Hypertension (DASH) diet. We instructed the family on how to recognize signs and symptoms of high blood pressure, although it is frequently asymptomatic, ike blurring of vision, fatigue, dizziness or headache; for them to know of monitoring their health condition We suggested that the low-salt and low-fat diet is the very useful to do to prevent increase blood pressure of the individual. Eating a heart-healthy diet, Including potassium and fiber will help to control the blood pressure and have a high chanee to live with a healthy ving, APPENDICES 65