VI.

COURSE OF VISIT
Home visit

1st Day - Establish rapport

Before going to the client’s house, the nurse made sure that all the needed materials for
the visit is already prepared. On November 18, 2021 at exactly 1:00 in the afternoon, the
student nurse arrived at the home of the client. The client already knew of this visit. The client
greeted the student with a smile which the student nurse returned while still maintaining a
respectful distance between them. Although the client was smiling, the student nurse noticed
that the mother is quite anxious, and concern was written all over her face. The student nurse
then introduced herself, stated the purpose of the visit and then confirmed the identity of the
client. The mother then asked the student nurse to come inside their house but before entering,
the student nurse asked if she needs to remove her shoes to which the mother replied, “okay
lang po isuot at ipasok niyo na lang po”.
Upon entering, the student nurse noticed the house to be clean and neat and there were
face masks, face shield as well as alcohol located near their door. She noticed that the
television was turned on and there were papers on the table. The client asked the student nurse
to sit down and offered her something to drink to which the student nurse accepted. When they
were now settled in the living room, the student nurse asked what the mother was currently
doing. The client stated that she was checking some activities of her students as she did not
finish it when she was in her workplace because she rushed to come home. The student nurse
then asked whether she could help her check the activities to which the mother declined. But
due to the determination of the student nurse to help, the mother then agreed in the end, but
she said that she will only help in sorting the activities. While helping the mother sort the papers,
the nurse then proceeded to have a small talk with the mother. the nurse asked about the
picture located near the television.
The mother smiled then stated that the picture was a family photo with her husband and
daughter. She shared that it was taken during an outing in Baguio City, and it was one of the
happiest days of her life. The mother then briefly asked the student nurse how she finds doing
home visits to different people and the student nurse stated that she finds it enjoyable as she is
able to socialize with different people and be friend with them in a home-based setting. The
student nurse then asked if she has a companion at home right now. She stated that her
husband is currently not home as he was working while her daughter is in her room, resting.
The student nurse then asked if there was a problem and the mother shared that her daughter
is not feeling quite well due to her menstruation, that is also the reason why she went home
early. The nurse then asked if her daughter is still feeling unwell and the mother replied that she
still feels cramps in her lower abdomen. The nurse then asked if there is anyone in their family
that has any health issues and the mother stated that all of them are healthy since they have a
healthy lifestyle except for her daughter who is feeling unwell. The student nurse then asked if
she could meet her daughter. The mother first went to the room of her daughter to ask her.
 Upon arriving back to the living room, the mother stated that her daughter agreed. The
mother then brought her daughter to the living room. After the student nurse introduced herself,
she then asked the client if she would like to have her mother beside her while they were
talking. The client then stated that it is okay for her even though her mother is not around thus,
the mother left and went to the kitchen to prepare a snack, but she can still see the living room
area from where she is. The student nurse then asked the client for her name to which the client
answered. The student nurse then proceeded asking some basic information such as her age
and birthday. The student nurse then assessed the vital signs of the client, and it was recorded
that her temperature is 36.3 °C, her respiratory rate is 18 bpm, pulse pressure is 73 bpm while
her blood pressure is 120/80 mmHg. Afterwards, the student nurse asked the client how she is
feeling today. The client stated that she is feeling cramps in her lower abdomen, her breast
suddenly feels sore, she suddenly has bloodstains on her underwear, she also feels
immediately irritated just for small things and she stated that she feels bloated after eating. She
was confused because it was her first time experiencing these things. She then stated that
according to her mother, what she was currently feeling is due to her experiencing her first
menstruation.
This was confirmed by the student nurse based on what she said, and she stated that
she is indeed having her first menstrual period. The nurse also observed a breakout on the
client’s face. The student nurse then assured the client that what she is experiencing is normal,
since her body is undergoing changes, and this signifies that she can now already get pregnant
as menstruating is the body’s way of preparing for pregnancy. The student nurse then briefly
explained that feeling bloated is normal and her change in mood as well as soreness in her
breast is due to hormonal changes. She then proceeded to teaching the client how to alleviate
menstrual cramps using relaxation techniques. The student nurse stated that applying heating
pads or hot water bottle on her lower back or abdomen can ease the pain she’s feeling and help
her feel relaxed. The student nurse then emphasized the importance of proper hygiene such as
changing her sanitary napkin every 4-6 hours, thoroughly cleaning her vagina, as well as
properly discarding her sanitary napkin. She was then advised to avoid drinking caffeine as this
may worsen her menstrual cramps. The student nurse then noted all findings and observations
before thanking the client of her participation. Afterwards, the student nurse talked with the
mother and informed her that she will come back again tomorrow. It was then agreed upon that
the time for the next visit on November 19, 2021 is exactly 10:00 in the morning. The student
nurse thanked the mother for her warm welcome as well as for her participation.

2nd Day- Assessment

On November 19, 2021 at exactly 10:00 in the morning, the student nurse arrived at the
home of the client. The mother welcomed and greeted the student nurse when she arrived. After
settling in the living room, the student nurse noticed that the mother is currently watching
television. The student nurse then explained the reason for her visit today which is to assess
and interview her child. When the student nurse asked where her child is, the mother stated that
she is accomplishing her schoolworks inside her room. The mother then went to call her child
and ask whether it was convenient for her to come out to be assessed by the student nurse to
which the child agreed. While waiting, the nurse first asked the mother where she can wash her
hands before the mother left to get her daughter. The student nurse then prepared all the
materials needed for the assessment. Upon arriving in the living room, the nurse first then
explained to the client about the following assessment that will be conducted. Afterwards, the
student nurse asked how the client is feeling and she stated that the pain she felt in her
abdomen decreased as compared to the menstrual cramps she experienced yesterday. She
then verbalized that she noticed that there was an increase in the flow of blood in her second
day of menstruation. The student nurse then proceeded to take the vital signs of the client and it
was recorded that her temperature was 36.5 °C, her respiratory rate was 19 bpm, her pulse rate
is 80 bpm while her blood pressure is 120/80 mmHg. The nurse then explained the assessment
that will be done to the client such as PERSON assessment, pediatric assessment specifically
for adolescence, physical assessment as well as to check whether the child is receiving
adequate nutrition. During the assessment, the mother stayed beside the client, and she also
answered some questions that the client was not able to answer.
For the PERSON Assessment, it has 6 categories which are Psychosocial, Elimination,
Rest and Activity, Safety and Environment, Oxygenation, and lastly, Nutrition. For psychosocial,
the client stated that they have a nuclear family and then she stated the name of her parents.
She then stated that she’s used to talking and sharing to her parents whenever she feels down.
She then stated that her religion id Roman Catholic and that the language they use at home is
Tagalog and English. Their primary source for healthcare is the Salubris Medical Center at
Solano. The mother then stated their financial resources. The client stated that she does not
have an occupation as she is currently studying. After that, her general appearance, level of
consciousness, affect, and orientation was then assessed by the student nurse, and everything
was noted to be normal. Her memory, speech and nonverbal behavior was also assessed by
the nurse which was recorded as normal. For the Elimination of the client, her stool, urine and
toileting ability were assessed, and all result came out normal. The nurse then proceeded to
assess the rest and activity of the client. The client then stated that for her current activity level,
she was not able to do some activities due to her abdominal cramps. It was also noted that
aside from a slight change on her movement, the client was able to groom, feed, and
communicate by herself. The client shared she usually has an average sleep of 8 hours. It was
then recorded that the client’s body frame is mesomorph, she has a weight of 45 kg, height of 5
feet (152.4 cm), and her BMI is 19.4 which is normal. The nurse then observed that the posture
of the client is slouched. Her coordination, gait, balance, and muscle were also normal. For
motor function, it was noticed that the client is able to walk but slowly and client was also able to
hold anything with strong grip. Her range of motion is also normal, for pain relief measures, she
usually sleeps and rest and finally, the client does not use any mobility and assistive devices.
For safety and environment, the client shared that she does not have any allergies on certain
medication, food, as well as environment. Her vision, hearing, temperature, and mucous
membrane were also all normal. For oxygenation, she does not have any activity intolerance,
her airway clearance and skin integrity were also normal. Lung sounds, respiration, capillary
refill, pulse rate, and blood pressure were all normal. It was also observed by the nurse that the
client shows no presence of edema. Lastly, for the client’s nutrition, the client does not have any
diet restriction and her fluid intake, skin turgor and ability were all normal.
The student nurse then proceeded to the Pediatric assessment, specifically for
adolescents. for safety, specifically on vehicles, sports and abuse, the client stated that she
always wears a seatbelt when riding a car and she also stated that she never tried drunk
driving. She also said that she does not paly any sports and that she never experienced any
abuse such as bullying. For the educational progress of the client, the nurse asked about the
studies of the client. The client stated that she is currently in her 8 th grade in Junior High School.
Additionally, the client shared that her grades were all great and that she was happy with it
since she was making progress. For substance use of exposure, the client was asked if she was
drinking any alcoholic beverage and if she was smoking and she stated that she have not tried
drinking alcoholic beverages as well as smoking. She also shared that none of her friends have
tried it and no one was urging her to try drinking and smoking. For sexuality, the client was
asked if she was comfortable with her gender to which she answered yes. She was also asked
if she was already in a romantic relationship with someone and the client answered that she had
never entered any romantic relationship since birth since she knows that she’s still young.
Furthermore, the client was also asked if she has any idea regarding sexual reproduction and
the client said yes because it was taught to them by their teacher. She also shared that she
never experiences feeling uncomfortable or disrespected by something that a person did. Lastly,
for the developmental milestone, the client is currently in her puberty where she experiences
changes on her body, emotions as well as the way she interacts with other people. Additionally,
for the behavior and social history of the client, the client stated that she is aware about her
sexuality and that she has a habit of taping her fingers when thinking. She also shared that she
is quite outgoing, and she also interact with other children like her classmates. Although she
was not able to meet her classmates personally due to the virus, she was still able to get to
know her classmates.
After all the assessment was done, the nurse then proceeded to thank the client for her
cooperation during the whole process. The nurse also thanked the mother for her warm
welcome. They then agreed to have the last home visit on November 20, 2021 at 10:00 in the
morning. The student nurse then thanked them for the last time before leaving.

3rd Day- Health Teaching

Arriving at the house of the client on November 20, 2021 on the same time as the
second visit, the student nurse was welcomed by the mother. Upon entering their home, the
student nurse noticed that the client is in the living room watching television. As the client is now
present, the student nurse proceeded in explaining the reason for the home visit to both the
mother and her child. The student nurse informed them that she will conduct a health teaching
regarding menstruation and dysmenorrhea. The nurse then started by explaining what
menstruation is. She explained that menstruation is the periodic discharge of blood, mucus and
epithelial cells from uterus which occurs every month which is an important landmark in the
process of growth and maturation and prepares the client for motherhood. Even though
menstruation is a physiological process, many females face various types of menstrual
problems among which dysmenorrhea is the commonest one. The student nurse then shared
that dysmenorrhea is one of the common menstrual problems among adolescent girls which
affects their daily activities and academic activities. Hence, preventing and managing
dysmenorrhea is a crucial aspect of adolescent reproductive health. Providing health education
is an ideal method to bring about awareness regarding the management of dysmenorrhea which
further can help the client to improve her reproductive health.
Additionally, the student nurse identified some menstrual disorder such as stomach pain,
headaches, depression, mood swings, anxiety, and even irregular period. The student nurse
then taught informed the client about the menstrual cycle. After that, the nurse proceeded in
teaching the client ways on how to lessen abdominal cramps during menstruation. Like what the
student nurse taught during her first visit, using heat pads and warm water in a bottle can help
lessen the pain. She was also reminded of the importance of proper hygiene. The student nurse
then taught the client how to do self- breast examination. After teaching the client, the student
nurse asked the client to state the ways on how to alleviate the pain of abdominal cramps
explained before. She was then asked to demonstrate how to perform self- breast examination.
Afterwards, the student nurse asked if the client as well as her mother for any queries and
clarifications that they want to ask. Both mother and child stated that they do not have any
question. The student nurse then thanks the client for their participation for the home visit that
was conducted. She then informed the mother and her child that if they have any queries, they
could ask the Rural Health Unit near them as well as the place which is their source for
healthcare. The student nurse then said her gratefulness for the acceptance of the client before
leaving.