A Family Case Study

Presented to the
College of Nursing

In Partial Fulfillment of the Requirements

In
CHN/ 1075

FAMILY CASE STUDY

Mr. Sedfrey C. Pascua, RN, MAN

Ms. Arlene D. Layupan, RN, MAN

Submitted by:
Cecille Juan
Mohaimen Macaocom
Regin Magallanes
Jesybell Reyes
Jerry Ann Sumarinas
II. TABLE OF CONTENTS

Title Page……………………………………………………………………………………..1
Table of Contents…………………………………………………………………………….2
Acknowledgement……………………………………………………………………………3
Introduction……………………………………………………………………………………4
Objectives of the Study………………………………………………………………………5
Identification of the Case…………………………………………………………………….6
Family Background…………………………………………………………………………..7
Socio-economic Background………………………………………………………………..8
Family Medical & Health History……………………………………………………………9
Genogram…………………………………………………………………………………….10
Family Apgar………………………………………………………………………………....11
Family Coping Index…………………………………………………………………………12
Family Nursing Assessment Tool………………………………………………………….13
Nursing Theory………………………………………………………………………………14
Management…………………………………………………………………………………15
A. Medical
B. Nursing Management
B.1 Problem List ( Maslow’s Hierarchy)
B.2 Problem identification (Health Threat/ Deficit/ Foreseeable Crisis Situation)
B.3 Family Nursing Care Plan
B.4 Health Teachings (Three Levels of Prevention)
Referrals……………………………………………………………………………………...22
Summary/ Evaluation……………………………………………………………………….23
Implication…………………………………………………………………………………...24
Health Updates……………………………………………………………………………...25
References……………………………………………………………………………….….26
Appendices………………………………………………………………………………..…27
AKNOWLEDGEMENT

The study has provided our group opportunities to know the different problems
and needs of the family in order for them to develop more in terms of their environment and
especially with their health status. But all of these could not be done without the help of those
significant people that help us throughout the study.

The group would like to thank the following:

First of all, To the Lord Almighty, we thank you for giving us a chance to live
and experience this opportunity. Thank you for making all things possible, for giving us all
we needed, a n d f o r m a k i n g u s e a r n i n s i g h t s i n t h i s w a y k n ow i n g t h e w o r t h
of our life. For His guidance  and safety which He gives every
d a y ,   f o r   a l l   t h e   b l e s s i n g s   t h a t   H e   h a s showered upon us, and for giving us the
strength to pursue everything.
 Next To our loving parents, family and supporters, thank you so much for helping us with
your prayers, for allowing us to be exposed in the community, and for helping us  with our
needs especially financial matters.
To our dear Clinical Instructors Mr. Rexie G. Bagnol, RN, RM, MAN, Mrs
Arlene D. Layupan, RN, MAN, Mrs. Norma Mendez, RN, MAN and Mr. Sedfrey C. Pascua,
RN, MAN who were always there to help and support us especially in our activities and
programs, and in making our case presentation successful. We are grateful for the encouragement you
gave us every time we feel discouraged especially for the outcome of our activities, for
the patience, for understanding our differences, for the concern, and for the guidance you
gave us. We appreciate it and it inspires us more to continue and pursue and we are
happy and blessed to have you as our clinical instructors.
We would also like to thank the Barangay Officials in 76-A Bucana including
PHN Ma’am Leah, PHM and the Barangay Health Workers that organized and find a proper
and appropriate place for us to have our community exposure.
We would also like to extend our gratitude to the family of Mrs.
No Space for accommodating, welcoming, and for trusting us to share
their basic and personal information that made our case study successful.
Introduction

Children in their middle years treasure their families and feel they are special and
irreplaceable. Family is not just define as two or more people who live in the same
household, share a common emotional bond, and perform certain interrelated social tasks
(Allender & Spradley, 2008) but it is also a source of emotional support, comfort, warmth,
nurturing, protection and as well as security. It is composed of a male and a female being
molded to be as one, working hand in hand to have a good atmosphere among the family
members. Almost all families, regardless of type, share common activities (Cherlin, 2008).

The status of each family will always affect the status of the community as a whole.
Community health nursing is a response to the health needs of the people. It does not focus
on a particular class or family. It is a comprehensive and general approach. Community
health service is not an episodic as it requires continuous observation and monitoring of the
community as a whole. Promotion and preservation of different clients (individuals, families,
population groups and community) is the primary goal of community health nursing.

Every family is unique. Nurses that are exposed to the community learn how to
interact and adapt to the different kind of people living in a community. It is in the family
who develop health values, beliefs and practices. Family influences the health and activities
of their member (Chen, Shiao, & Gau, 2007). With this, it is important that families in the
community are aware of the things and practices pertaining to their health.

Conducting a case study is a way where student nurse improve and apply all the
concepts. It is a tool in determining the health status of family through assessment and critical
inspection because of this, health related problems are identified which gives an indication to
the student nurse on how to intervene just to give a holistic care and improve the deficiency.

The family that was chosen by the researcher is one of the important concerns of the
Philippines – Malnutrition. Malnutrition now a day is rampant and it is one of the problems
identified in the community. A family living in a poor environmental condition without
enough resources and lack of knowledge on vital health information and also experiences
socio – economic related problems. Tiring as it is, but reaching out to this family and
mingling with them makes the researcher feel the sense of fulfillment as they share
knowledge, skills and time to support in uplifting the condition of family.
GENERAL OBJECTIVES
At the end of the student – family relationship, the adopted family
will be able to improve their health status and become self – reliant in
maintaining their health through appropriate interventions in a given time
frame.

SPECIFIC OBJECTIVES
After 1 month of home visits and student nurse – family interaction, the student will
be able to:

1. Establish rapport and trust with the family

2. Trace the family medical and health history
3. Illustrate the genogram of Mrs. No Space that will help visualize hereditary pattern
4. Explain the family Apgar score that shows the relationship of family function
5. Determine the different nursing theories that are related to Mrs. No Space condition,
concerns, and problems
6. Give health teachings about possible risk factors
7. Identify actual and potential problems which may be a hindrance in attaining optimum
health
8. Categorize the identified health problems as health threat, health deficit or foreseeable
crisis
9. Plan possible solutions or nursing actions to the prioritizes health problems
IDENTIFICATION OF THE CASE

Patient’s Code Name: Mrs. No Space

Age: 29 years old
Nationality: Filipino
Civil Status: Single
Occupation: Vendor
Date of Last Admission: year 1994 due to Asthma
Sources of Information: Mrs. No Space

FAMILY BACKGROUND

Mr. and Mrs. No Space living together for 13 years without a benefit of a legal
marriage. They have 5 children, 3 girls and 2 boys, 4 were studying and she is six month
pregnant. They are currently living at Purok 8 Brgy. 76 - A Bucana, Davao City. Mrs. No
Space is a High School Graduate same as with her husband. She is a vendor and her husband
is a “trisikad” driver.
As what she said, her pregnancy is unwanted and they were facing financial problem
due to the school expenses of their children. They were only depending on her small income,
support coming from her mother-in-law and her husband.
Mrs. No Space experienced varicella infection (chicken pox) when she was three
months pregnant. She never submitted herself for medical check-up and even never visited
the health center for prenatal check up due to financial constraints and unwanted pregnancy.

SOCIO – ECONOMIC BACKGROUND

No Space is 29 years old, she is a vendor and her husband is a “trisikad” driver. They
have combined daily income of Php250 and combined estimated monthly income of
Php7000.
Mrs. No Space’s mother in – law was sometimes helping them in terms of financial
needs. The money coming from her mother-in-law & their own income is budgeted by her.
But according to Mrs. No Space it is not enough for them but she managed it appropriately so
that they can eat at least thrice a day.
 They don’t own the house but they managed to rent it. Their house is made up of
mixed materials like a bamboo and plywood and their house is an inadequate space for them
all.
Furthermore, her house is prone to fire because it is made of light materials. They are
using a charcoal for cooking in their common kitchen. The foundation of their house is not
good or strong, since it is made of wood and bamboo. So, when we are to describe it, it could
not stand by strong winds when there is typhoon. There is a high possibility that their house
might damaged during strong typhoon.

FAMILY MEDICAL & HEALTH HISTORY

The parents of Mrs. No Space are still both alive. According to Mrs. No Space, her 5
children already completed their vaccination. The fourth (4th) child of the family, Ms. O
experienced hospitalization for 1 week at Southern Philippines Medical Center due to
Pneumonia. And also her husband was confined for two (2) days at Southern Philippines
Medical Center due to ulcer.
On 1994, Mrs. No Space stated that she experienced asthma and she was only 10
years old back then. On April, 2014 she also experienced varicella infection (chicken pox)
and she was three (3) months pregnant at that time and she only took it for granted and does
not seek for health care provider or having prenatal check – up to know if there is any
complication, because according to her, her pregnancy is unwanted.
Furthermore, Mrs. No Space also stated that during labor she experienced
preeclampsia and severe bleeding after delivery. This occurrence started to happen from
giving birth of their first child up to their fifth child.
X.GENOGRAM
FAMILY APGAR
Component Score Definition Justification
Adaptation Use of intra and extra familial No enough resources. Needs
1 resources for problem solving assistance coming from both
when family equilibrium is parents if occurrence of
under stress. unexpected financial matters.
Sharing of decision making Client always insists that her
Partnership 1 and nurturing responsibilities own idea is right.
by family members.
Physical and emotional The client herself wishes to do
1 maturation and self- something for herself like
Growth fulfillment achieved by family working DH abroad.
members through natural
support and guidance.
Caring or loving relationship Caring and loving in the family
Affection 2 among family members. can be witnessed.
Commitment to devote time Both spouses are pre occupied
to other members of the on ways to earn a living.
family for physical and
Resolve 1 emotional nurturing; usually
involves a decision to share
wealth and space.
Total Score 5
Moderatel -Inadequate coping or decision making skills
Interpretatio y -Emotional Immaturity
n Dysfunctio
nal

Legend: Total Score:

1- Hardly Even 0-3 Severely dysfunctional family
 2- Sometimes 4-6 Moderately dysfunctional family
3- Almost Always 7-10 Highly functional family
Analysis and Interpretation

A healthy family unit is considered by Smilkstein to be a nurturing unit that

demonstrates integrity in five components. Adaptation, Partnership, Growth, Affection and
Resolve. This tool is useful in suggesting areas to be assessed relative to family functioning
and potential areas of family strengths and resources. Various types of family strengths which
are scored as follows: “Almost always” (2 points), “Sometimes of the time” (1 point’0, or
“Hardly even” (0 point). The scores for each of the components are totaled; a score 7-10
suggests a highly functional family. 4-6 points a moderately dysfunctional family; and 0-3
points a severely dysfunctional family. This helps determine the family’s ability to acquire
resources and productive use of money or social support, the ability to communicate in depth
with each other with openness and support and consensual decision making; the presence of
encouragement, support, prairie recognition, respect for individuality and flexibility of family
functions and roles.(David, E.et.al,2007)
With regards to our client’s family, in terms of adaptation the score is 1, this means
that family don’t have intra- and extra familial resources for problem solving when family
equilibrium is under stress. Mrs. No Space mentioned that whenever they have financial
problems, her parents or mother in-law sometimes help them if there’s a need to. In terms of
partnership, the family scored 1 because sharing of decision making and nurturing
responsibilities by family members are merely observed because usually Mrs. No Space
always insist that her own idea is right. Third component is Growth, the family scored 1
because physical and emotional maturation and self-fulfillment achieved by family members
through mutual support and guidance is occasionally observed. Fourth component is
Affection; the family is scored 2 because caring or loving relationship among family member
can be witnessed. The last component is resolve the family scored 1 maybe, there is no
commitment to devote time to other members because they are preoccupied on ways to earn a
living. The total score is 6 which mean their family is moderately dysfunctional; this implies
that the family needs to improve their sense of adaptation, partnership, growth, and
commitment to devote time to other members of the family.
FAMILY COPING INDEX
Family Coping Areas Point Scale
Physical Independence
Therapeutic
Component
Knowledge of Health
Condition
Application of Principle
of General Hygiene
Health Attitudes
Emotional Competence
Family Living
Physical Environment
Assessed Problems Justification System
No Problem “Ako may mulihok sa tanan
5 diri sa balay ug mag asikaso
sa mga bata”
Lack of Financial “Dili ko ganahan mag pa
2 resources to seek check-up kay wala ko
medication kwarta”
Able to identify “Kabalo ko na delikado mag
2 health status but chicken pox ang buntis pero
don’t have any action dili ko ganahan magpa
check-up”
Taken improper “wala mi basura diri, dili
2 garbage disposal & pud mi naga segregate”
segragation
Failure to visit HC “Naga adto ko ug Health
for current prenatal Center sauna pero karon
3 check up due to lang ko na pag buntis na
idleness and wala koy adto-adto sa
unwillingness. hospital”
Good relationship “Magkasinabot man mi sa
between the family akong pamilya pag may
3 members; but client problema, Panagsa maglagot
always insist what ko sa akong asawa”
she thought is right
Client is sometimes “Lagot ko niya nga sige
moody with husband pugos patsek up, di man ko
3 because of her ganahan pa”
pregnancy
1 Inadequate space Based on our observation, a
family of seven with 1 room
is not adequate for them to
 live toghether. And they
shared the kitchen and
comfort room with the other
renters as well.
They are aware of Based on our observation,
Use of Community avail ability of they house is near in the
Response 3 community lesomes Health Center but they don’t
but they are not utilize the resources that
utilizing it health center offered
Comments:

They are friendly, cooperative, willing to open up or share information regarding their family
status and health.

Analysis & Justification

This table presents the Family Coping Index of “No Space”. The coping capacity of
the family correspond a point scale according to the family level of competence. 1 No
Competence, 3 Moderate Competence and 5 Complete Competence. As the result the family
coping area which is Physical Independence is scaled 3. This means not all the family
members are able to do their activity of daily living independently, on the other hand physical
environment scaled 1 which means that the family has no competence in relation to work
environment because they have inadequate living space, knowledge of health condition,
application of principles of general hygiene and therapeutic competence scale 2, this means
that in this area the family coping is poorly competent in terms of their health condition.
Emotional competence, Family Living is scaled 4 it implies that the family is close knit to
each other. They support each other in terms of decision making but in sometimes they do not
understand each other. On the other hand, Health Attitudes is scaled 3 this means that in this
area of family coping capacity they are moderately competent because the pregnant woman is
not going to the health center for prenatal check up. Use of Community Facilities- is scaled
3, this means that the coping capacity of the family is moderately competent because the
family is not utilizing the community facilities.
XIII. FNAT
XIV. NURSING THEORY

The following nursing theories are applicable in their client family:

 The Nightingale’s Environment model where in, Nightingale viewed the manipulation
of the physical environment as a major component of nursing care. She identified ventilation
and warmth light, noise, variety, bed and beddings, cleanliness of rooms and walls, and
nutrition as major areas of the environment the client could control. When one or more
aspects of the environment are out of balance, the client must are use increased energy to
counter the environmental stress. In Nightingale notes in nursing, she discussed the
importance of the health of homes as being closely related to the presence of pure air, pure
water, efficient drainage, and cleanliness that it’s an adequate space for their family,
sufficient lighting, and pure clean air are what they are experiencing now.

Dorothea Orem’s combination of three theories, theory of self care, theory of self
care deficit and theory of nursing system also applies. In the self care theory, it explains the
activities carried out by the individual to maintain their own health. While self care deficit is
the inadequacy of the self care requisites.
According to Orem’s Theory, these areas are important for prioritizing nursing
diagnosis:

-Air
-Water
-Food
-Elimination
-Solitude/Interaction
-Prevention of hazards
-Promotion of normality
-Maintain a developmental environment
-Prevent or manage the developmental threats
-Maintenance of health status
-Awareness and management of the disease process
-Adherence to the medical regimen
-Awareness of potential problem
-Modify self image
-Adjust life style to accommodate health status changes
XV. MANAGEMENT

A. Medical

MALNUTRITION

Malnutrition is a serious condition that occurs when a person’s diet does not contain the
right amount of nutrients.

It means "poor nutrition" and can refer to:

 undernutrition – when you don't get enough nutrients

 overnutrition – when you get more nutrients than you need

Signs of Malnutrition

- Most common symptom of malnutrition is unplanned and unexplained weight

loss.

Signs of Malnutrition in Adults

 feeling tired all the time and lacking energy

 taking a long time to recover from infections
 delayed wound healing
 irritability
 poor concentration
 finding it hard to keep warm
 persistent diarrhea
 depression

Signs of Malnutrition in Children

 failure to grow at the expected rate, both in terms of weight and height (known as
"failure to thrive")
 changes in behavior such as appearing unusually irritable, sluggish or anxious
  changes in hair and skin color

Causes

- lack of nutrients in your diet

Social factors

Social factors that can contribute to malnutrition include:

 living alone and being socially isolated

 limited knowledge about nutrition or cooking
 reduced mobility
 alcohol or drug dependency
 low income or poverty

Physical factors

Physical factors can contribute to malnutrition. For example:

 If your teeth are in a poor condition, or if dentures don't fit properly, eating can
be difficult or painful. 
 You may lose your appetite as a result of losing your sense of smell and taste.

B.Nursing Management

Treatment usually consists of replacing missing nutrients, treating symptoms as

needed, and treating any underlying medical condition.

B.1 PROBLEM LIST (MASLOW’s)

 Deficits

The Maslow’s Hierarchy of needs comprises of five (5) stages including Physiologic
needs, Safety needs, Belongingness and Lobe needs, Esteem needs and self – actualization.

A. Physiologic Needs
 Food – insufficient nutrients due to financial constraints
 Shelter – inadequate living space for a family of seven members sharing one room
B. Safety and Security
 Unstable employment – leads to inadequate family resources
 Cohabitation family – situation of the couple is not in a legal basis that put their
family at risk in terms of legality
 Prone to fire – the materials of the house used are made of light materials
C. Self – esteem
 Inferior – having low self-esteem
D. Self – actualization
 Unfulfilled- client verbalized the need to earn more than what they currently have
B.2 PROBLEM IDENTIFICATION

Health Threat
● Lack of Food Storage- Lack of Food Storage
- They don’t have refrigerator that would keep their food safe from microorganism.
● Inadequate Living Space
- One room for a family of seven is a substandard space for the family
● Prone to Fire
- Their house is made of light materials like wood and bamboo.
● Possible Pregnant Complication
- Because Mrs. No Space never seek medical help even when she was having varicella virus
during her 3 months gestation.

Health Deficit
● Malnutrition
- Food prepared is lack of nutrients

Foreseeable Crisis
● Unwanted pregnancy
- Interest of taking maternal and child health is at risk
● Unwillingness to go to the health center
- Possible complications may occur during pregnancy until child birth
B.3 FAMILY NURSING CARE PLAN
 B.4 HEALTH TEACHING

Pregnancy Management
- Instruct to take proper nutrition
- Advice to have Prenatal Check-up
- Instruct the importance of doing light exercise

Medical Management
- Adherence to the medical regimen
- Awareness of potential problem
- Promotion of normalcy
- Awareness and management of the disease process

Malnutrition
- Need to have guidelines to proper nutrition
- Encourage to buy nutritious foods that the family can afford

Home Management
- Maintain a developmental environment t
- Teach the importance of an adequate space
- Prevention of hazards

3 LEVELS OF PREVENTION

Primary Prevention
1. Health Promotion

- Health education to mothers about good nutrition and food hygiene health
workers
- Distribution of supplements (distribution of iron , folic acid and vitamin a).
 - Promotion of breastfeeding
- Development of low cost weaning foods
- Measures to improve family diet
- Nutritional education
- `Home economics
- Family planning and birth spacing
- Family environment

2.     Specific Protection

- Specific protein diet, eggs, milk, fresh fruit
- Immunization
- Fortification of food
Secondary prevention; early diagnosis and adequate treatment
1. Periodic nutrition surveillance.
2. Early diagnosis of any lag of growth.
3.  Early diagnosis and treatment of infection including diarrhea.
4.  Developing the program for early dehydration of children with diarrhea.
5.  Developing supplementary feeding program during epidemics.
6. Regular deworming of school and preschool children.

Tertiary prevention; nutritional rehabilitation

1. Nutritional rehabilitation services.
2. Hospital treatment
3. Follow up of cases
XVI. SUMMARY / EVALUATION
XVII. IMPLICATION
XVIII. HEALTH UPDATE

More than half million Pinoy kids suffer from severe malnutrition
By: CLAIRE DELFIN ; February 27, 2013 1:43pm

CALUYA ISLAND, Antique – The drizzle halted, and the sun finally took over. As it
shone higher and brighter, it made the sea even more inviting. Its clear waters glittered like
fine diamonds and its white sands offered an immaculate, spectacular landscape equivalent to
what people call paradise. Undeniably, it’s a good morning to dip. And brothers Adrian and
Arvin Malano rushed to the sea as soon the school bell rang to signal the start of lunch break.
They went farther and farther from the coastline, lingering at the part where the water was
deep enough for them to swim, gyrate and even whirl underneath. At first glance, the brothers
aged 12 and 7 seemed to be simply enjoying the moment, frolicking underwater. But playing
and having fun is not exactly the reason why they were there in the sea at a time when they
should be eating lunch and resting before going back to school for the afternoon sessions.

Each time they rose up fast from the seabed, their hands were full with long lines of
green seaweed. Some tattered shanks of styrofoam were afloat, waiting for the fill of their
harvest. This is a usual day for the young brothers. A kilogram of seaweed will sell eight
pesos.

For a 30-minute harvest, they both would usually gather up to three kilograms, which
will earn them about P24 or a little over half a US dollar. There are bad days, though, when
they get no harvest. “We want to help our parents. It’s for our food,” said 12-year-old Arvin.

At home, the Malano brothers joined their parents and three other siblings for lunch,
their first meal for that day. The entire family only had five small pieces of dried fish and rice
to share. Their parents would rather have the five kids take the fish. They would have to
satisfy themselves with sprinkling their rice with salt to give it flavor.

Rovelyn and her husband earn a living also by harvesting and selling seaweed. They
said they would not want their children to work, but they claimed that they are left with no
better options. The choices to make have always just been either hunger or extreme hunger,
they said.
 “Hunger has always been with us since I was a kid. And now that I am a mother, I still
experience it. My kids are still experiencing it, and it’s even worse,” a tearful Rovelyn said as
she looked at her children eating. “There are nights when they would just go to sleep with
empty stomachs. Sometimes, they wake up in the middle of the night with their stomachs
aching,” she added. It may be weird, but she couldn’t help but feel relieved whenever she
would think of one of her children who died and another one whom she gave up for a
childless couple to adopt. “At least, they do not suffer the same hard fate we are having,”
Rovelyn sighed.

REFERENCE

http://www.gmanetwork.com/news/story/296884/news/specialreports/more-than-half-million-
pinoy-kids-suffer-from-severe-malnutrition

SUMMARY

Adrian is 7 years old and Arvin Malano is 12 years old. They live in Caluya Island,
Antique. At the very young age they usually rushed to the sea as soon as the bell rang to
signal the start of lunch break. They went farther and farther where the water was deep
enough for them to swim and even whirl underneath. At first, you will just think that they are
just simply playing and enjoying the moment but playing and having fun is not exactly the
reason why they were there in the sea at a time of lunch and when they should be eating
lunch and resting before going to school for the afternoon sessions. But instead they were
there to harvest green seaweed where a kilogram of seaweed will sell 8 pesos.

For 30 minutes harvest, they both usually gather up to 3 kilograms which will earn
them for about 24 pesos. As what Arvin said “we want to help our parents. It’s for our food.”
The entire family has 5 small pieces of dried fish and rice to share. Rovelyn and her husband
earn a living also by harvesting and selling seaweed. As they said they don’t want their
children to work but they claimed that they are left with better options.

Their mother said “Hunger has always been with us since I was a kid. And now that I
am a mother, I still experience it. My kids are still experiencing it, and it’s even worse.”
There are nights when they would just go to sleep with empty stomachs. Sometimes, they
wake up in the middle of the night with their stomachs aching,” she added.

REFLECTION

World has always been facing poverty. Health status of every child here in the
universe is at risk. Innocent children suffered from different illnesses due to poverty or
financial constraints. Do they deserve to experience this kind of problem or it is their fate or
destiny to have this kind of problem.

Malnutrition is one of the problems of Philippines. Many people say that money is the
only solution. Do you think that money is the only solution to fight against malnutrition? I
guess not, money is just one of the factors that help to eliminate malnutrition but the most
important thing is education. Money can’t buy the education we have because if people are
just educated it seems that they already have the idea how to handle things and at least this
problem will be lessen. But we can’t blame them because of the poverty, lot of people are
lack of education.

As what the story of Adrian and Arvin, I can’t imagine that at the very young age they
already working and harvesting green seaweed at the sea for their meal while studying. It
only shows that not all people are lucky enough to eat at least thrice a day. In their situation, I
can’t take it that they would just go to sleep with empty stomach. And I guess, hunger will
affect children’s education. How they suppose to focus their attention to their lesson if they
are hungry?

And now, one thing come up into my mind, as long as we are fully supported by our
loved ones don’t waste any chances because it is one of the reason to avoid this situation and
always put into our mind be responsible in our studies.
REFERENCES:

http://www.nhs.uk/Conditions/Malnutrition/Pages/Causes.aspx

http://www.nhs.uk/Conditions/Malnutrition/Pages/Symptoms.aspx

http://www.nhs.uk/Conditions/Malnutrition/Pages/Introduction.aspx
- http://raystudent.blogspot.com/2011/12/prevention-of-malnutrition.html