University of Bohol

GRADUATE SCHOOL
Terminal Requirements for CNH-II
Family Health Nursing
SUBMITTED TO :

BONNIBELLA L. JAMORA, DScN

SUBMITTED BY:

BALLOBAN, NEIL LANSANG

CENIZA, LYN
MORALLES, WENDY
SIMPORIOS, MARK NICHOLZ
TAPA, MARLOU
 FAMILY ASSESSMENT GUIDE

FAMILY NAME: ALFARERO ADDRESS: 154 SAN ISIDRO DISTRICT TAGB. CITY

I. DEMOGRAPHIC DATA

HOUSEHOLD NUMBER: 2 BARANGAY HOUSE NO. : 01

II. FAMILY DATA

LENGHT OF RESIDENCY: 82 years

PLACE OF ORIGIN: SAN ISIDRO, TAGBILARAN, CITY

FAMILY SIZE: 1

RELIGION: Husband : Roman Catholic

Wife : Roman Catholic (deceased)

FAMILY MEMBER’S CHART

FAMILY AGE SEX CIVIL POSITION IN

RELATIONSHIPTO EDUCATIONAL OCCUPATION
MEMBERS STATUS THE FAMILY
THE FAMILY ATTAINMENT
HEAD
OBDOLIO 82 M WIDOWER HEAD COLLEGE CARPENTER
GRADUATE (retired)
JUSTINA 45 F SINGLE DAUGHTER DAUGHTER COLLEGE NUN
GRADUATE
RYAN 25 M SINGLE GRANDCHILD GRANDSON COLLEGE MONEY
GRADUATE SORTER
III. FAMILY CHARACTERISTICS

TYPE OF FAMILY STRUCTURE

A. Extended ____

B. Matriarchal __

C. Dominant Family Member ___

D. Nuclear ______

E. Patriarchal__✓__

GENERAL FAMILY RELATIONSHIP/DYNAMICS

CRITERIA ADDITIONAL INFORMATION

Observable conflicts between family Sibling Issues/ Rivalry
members
Characteristics of Communication Slightly loud due to hearing problems of the
client.
Interaction patterns among members Passive

FAMILY DIETARY HABITS

What did you eat yesterday? ( 24 hours dietary recall)

Breakfast: Fish, Rice
Lunch : Fish, Rice, Vegetables
Supper : Fish, Rice

MONTHLY FAMILY INCOME SOURCE

Husband : Pension
Wife :______
Others :______
MONTHLY FAMILY INCOME

TOTAL (check bracket)

Below P5,000. 00 ___✓__ Above P20,000.00 – 30,000.00 ______

Above P5,000.00 – 10, 000.00_______ Above P30,000.00 – 40, 000.00______

Above P10,000.00 – 15, 000.00______ Above P40,000.00 – 50,000.00______

Above P15,000.00 – 20,000.00______ More than P50,000.00 ____________

FAMILY HEALTH STATUS / HEALTH HISTORY

Father : Arthritis , Fever

Mother: ____________

Children: ___________

FFELT FAMILY NEEDS (Identify and rank according to priority)

1. Food 5. Television

2. Clothing 6. _______

3. Money 7. _______

4. Vehicle 8. _______
IV. HOME and ENVIRONMENT

A. Is your lot owned?

_✓__ Yes ____No

B. Is your house owned?

__✓__Yes ____No

C. Type of housing materials?

_____Wood _____ Makeshift

_____Concrete _____Others,specify

__✓___Mixed

D. Is the living space adequate? __✓___Yes _____No

E. What are the appliances owned by the family?

___✓__Radio

___✓__Refrigerator

___✓__Electric Fan

___✓__Gas Range / Oven

F. Type of garbage disposal?

______Collected ____✓__Burning

______Waste Segregation ____✓__Burying

______Feeding to animals ______Throw in the River / Sewer

______Open Dumping ______Others, specify

G. Type of waste disposal?

______Flush _______Pit privy

______Wrap and Throw _______Others, Specify

__✓__Water Sealed

H. Type of drainage system? _____ Open ___✓___Close

I. Type of water supply?

_____Owned _______Shared

__✓__Bought _______Others, Specify

J. Drinking water storage?

_____Refrigerated

_____Uncovered

__✓__Covered
K. Containers used?

___✓_Plastic Pitchers ______ Jars, Clay pots

___✓_Bottles __✓__ Others, Specify : water jug

L. Food storage / Cooking Facilities?

___✓___Covered ______Uncovered

___✓___Refrigerator __✓__Cabinet

______Pots/Pans, etc. __✓__Stove

M. Common household pest found at home?

___✓__Mice __✓___Flies

___✓__Cockroach __✓___Mosquitoes

N. Are there breeding sites of insects, rodents, etc, present?

__✓__Yes ______No

O. Pets / animals kept in the yard/home?

__✓__Cats

P. Are there accident hazard present?

__✓__Yes ______No
V. HEALTH and HEALTH PRACTICE

A. Common illness encountered for the last six months and treatment applied?

FEVER – Paracetamol and Water

ARTHRITIS – medication prescribed by the Doctor

B. Whom do you consult for health-related problems?

________Manghihilot ________Albularyo

________Midwife ________Nurse

____✓__Doctor ___✓____Health Center

____✓__Barangay Health Worker ________Others, Specify

C. For problems other than health, whom do you consult?

___✓___Family members _______Relatives

_______Friends _______Barangay Officials

_______Priest _______Others, Specify

D. Immunization status of the family members?

Vaccinated of COVID 19 Vaccine

 E. Have you had adequate?

1. Rest and sleep? ______Yes _____No

2. Exercise? ______Yes _____No

3. Relaxation activities ___Yes _____No

4. Stress management activities? ____Yes ___No

VI. ENVIRONMENT

1. Kind of neighborhood Peaceful urban

2. Social and Health facilities available Health Center, Church, Basketball Court

3. Communication and Transportation Trucking, Tricycle, Multicab, “Habal-Habal”

facilities

VII. AWARENESS of COMMUNITY ORAGANIZATION?

A. Are you aware of the existing organizations in the community?

___✓___Yes _____No

B. Name all the organizations you know?

Senior Citizen
C. Are you member of any these organizations?

___✓___Yes ______No

D. Are you aware of its activities and projects?

______Yes ___✓___No

E. Are you involved in its activities?

_____Attend meetings _____Give donations

_____Planning _____Evaluation

_____Implementation _x____Others, Specify: N/A

F. Name 5 formal and non-formal leaders of the community whom you think can lead the people?

1. Barangay Captain

2. Barangay Health Workers

3. School Principal/Teachers

4. Mayor

5. Municipal Health Officer

Family No.

Name of the Family Head: OBDOLIO ALFARERO

Address : 154 SAN ISIDRO DISTRICT, TAGBILARAN, CITY

LIST OF HEALTH PROBLEMS: NATURE OF PROBLEM:

1. Arthritis as diagnosed by the physician. > HEALTH DEFICIT

2. Weakness or “Naluya” (as verbalized) > HEALTH DEFICIT

3. Respiratory health problems, difficulty of

Breathing. > HEALTH DEFICIT

4. Disorganize/Untamed environment or

Sanitation Problems. > HEALTH THREAT

5. Insufficient intake of proper nutrients. > HEALTH THREAT

Family No.
Problem: ARTHRITIS AS DIAGNOSED BY THE PHYSICIAN
CRITERIA STANDARD SCORE WEIGHT ACTUAL JUSTIFICATION
SCORE
1. Nature of the >Health Deficit 3 1 He does not have a
problem proper diet & an
>Health Threat 2 1 2/3 adequate exercise.

>Foreseeable Crisis 1 1/3

2. Modifiability of the >Removeable 2 2 When the
problem >Partially patient/client feels in
Modifiable 1 2 1 pain, medication
given by the
>Not Modifiable 0 0 Physician are taken
thus, subsiding the
pain felt by the
patient.

3. Preventive Potential >High 3 1 Medicine is needed

>Moderate 2 1 2/3 to subside the pain &
>Low 1 1/3 the kind of diet the
client is eating is not
that good.

4. Salience of the >Needs immediate 2 1 My client says that a

Problem attention proper exercise is
>Does not need needed & a healthy
immediate 1 1 ½ & balance diet would
attention be helpful.

>Not a problem 0 0
TOTAL SCORE: 3 1/3
Family No.
Problem : WEAKNESS
CRITERIA STANDARD SCORE WEIGHT ACTUAL JUSTIFICATION
SCORE

1. Nature of the >Health Deficit 3 1 He does not have a

problem >Health Threat balance diet. He is
>Foreseeable Crisis 2 1 2/3 alone most of the
time, And lacks of
1 1/3 exercise due to
mobility problems.

2. Modifiability of the >Removeable 2 2 His weakness may be

problem >Partially due to boredom
Modifiable 1 2 1 which can be
remedied when a
>Not Modifiable 0 0 member of a family is
there to talk to him &
cheer him up. Also
when good food/meal
is given to him he may
be active again.
3. Preventive Potential >High 3 1 Though Mr. Alfarero’s
>Moderate 2 1 2/3 weakness problem is
>Low 1 1/3 of no high priority,
prevention of it may
be done through
communicating &
interacting with him
accompanied by
supplying him proper
nutrients.
 4. Salience of the >Needs immediate 2 1 According to Mr.
Problem attention Alfarero his weakness
>Does not need is due to his arthritis
immediate 1 1 ½ & only present during
attention daytime but it is of
less importance.

>Not a problem 0 0

TOTAL SCORE: 2 5/6

Family No.
Problem: RESPIRATORY BREATHING PROBLEM
CRITERIA STANDARD SCORE WEIGHT ACTUAL JUSTIFICATION
SCORE
1. Nature of the >Health Deficit 3 1 In his younger days,
problem he had an wealthy
>Health Threat 2 1 2/3 lifestyle such as
smoking & drinking in
>Foreseeable Crisis 1 1/3 which the effect of it
is now observable.

2. Modifiability of the >Removeable 2 2 Due to the factors of

problem >Partially aging& his wealthy
Modifiable 1 2 1 lifestyle during his
youth the problem
>Not Modifiable 0 0 can’t be corrected
since it is the after
effect of it.
3. Preventive Potential >High 3 1 Though medication of
>Moderate 2 1 2/3 this problem is not
>Low 1 1/3 needed, the
damage/effects
doesn’t have a
remedy because in the
first place the client
did not stop his
unhealthy lifestyle
until he did not reach
his age when other
problem arises.
4. Salience of the >Needs immediate 2 1 My client state that it
Problem attention is of not that grave
>Does not need problem since his
immediate 1 1 ½ main concern is his
attention arthritis.

>Not a problem 0 0

TOTAL SCORE: 1 5/6

Family No.
Problem: DISORGANIZE / UNTAME ENVIRONMENT OR SANITATION PROBLEM
CRITERIA STANDARD SCORE WEIGHT ACTUAL JUSTIFICATION
SCORE
1. Nature of the >Health Deficit 3 1 Poor environmental/sanitation
problem management may lead to accident
>Health Threat 2 1 2/3 & may also cause illness & diseases
because pest will thrive on unclean
>Foreseeable Crisis 1 1/3 environment.

2. Modifiability of the >Removeable 2 2 Other members of the family can

problem >Partially help him clean the environment to
Modifiable 1 2 1 prevent pest from breeding &
>Not Modifiable spreading diseases.
0 0

3. Preventive Potential >High 3 1 The prevention of the problem is

>Moderate 2 1 2/3 attainable. Since the mobility
>Low 1 1/3 problem exist, the ability of Mr.
Alfarero to do the chores has been
lessened. But with the help of the
others he can obtain a clean &
disease-free environment.

4. Salience of the >Needs immediate 2 1 Mr. Alfarero state that a clean

Problem attention environment is very important to
>Does not need prevent the pest from thriving it &
immediate 1 1 ½ carrying infectious/harmful
attention diseases that affects not only the
>Not a problem 0 0 client but to his neighbors too.

TOTAL SCORE: 4 2/3

Family No.

Problem: INSUFFICIENT INTAKE OF PROPER NUTRIENTS

CRITERIA STANDARD SCORE WEIGHT ACTUAL JUSTIFICATION

SCORE
1. Nature of the >Health Deficit 3 1 Insufficient intake of
problem nutrients since the
>Health Threat 2 1 2/3 client diet relies on
the food given by his
>Foreseeable Crisis 1 1/3 daughter resulting to
imbalance diet.

2. Modifiability of the >Removeable 2 2 Monitoring of Mr.

problem Alfarero’s diet from
>Partially 1 2 1 his daughter may
Modifiable correct the problem
>Not Modifiable 0 0 on his nutrition &
may make him
become better.

3. Preventive Potential >High 3 1 The prevention of

>Moderate 2 1 2/3 the problem can be
>Low 1 1/3 prevented if basing
only on the current
situation of the
client’s unhealthy
lifestyle during his
younger days will be
considered if can be
or not be prevented.
 4. Salience of the >Needs immediate 2 1 A healthy balance
Problem attention diet should be served
especially for
>Does not need 1 1 ½ geriatric like him
immediate since there is
attention deficiency in
nutrients from the
>Not a problem 0 0 food given to him
from his immediate
family. Also, vitamin
supplements should
also be given in order
for him to become
healthy.

TOTAL SCORE: 4 1/3

RANKING HEALTH PROBLEMS

Name of the Family : ALFARERO
PRIORITY PROBLEM SCORE
1 DISORGANIZE/UNTAME ENVIRONMENT OR SANITATION PROBLEM 4 2/3

2 INSUFFICIENT INTAKE OF PROPER NUTRIENTS 4 1/3

3 ARHTRITIS AS DIAGNOSED BY THE PHYSICIAN 3 1/3
4 WEAKNESS 2 5/6
5 RESPIRATORY BREATHING PROBLEM 1 5/6
 FAMILY NURSING CARE PLAN
HEALTH PROBLEM FAMILY NURSING PROBLEM GOAL OF OBJECTIVES INTERVENTIONS METHOD OF RESOURCES EVALUATION
CARE MEASURES NURSE REQUIRED
DISORGANIZE/UNTAME Inability to recognize presence After 1 week After 2-3 hours -Discuss or -Home Visit -Visual aids Goals not
ENVIRONMENT or of a problem due to: of rendering of nursing reorient the -Group -Time & met/partially
SANITATION PROBLEM A. Ignorance of facts nursing intervention family members Interaction effort or not.
B. Attitude/philosophy in intervention, through lecture on the client or cooperation
the family
life. on the proper about the Conversation for both the
member’s or
C. Lack of knowledge as to way to sanitized importance of nurse & the
the client
what might the effects itself will & clean the knowing the client& his
of the problem for the take environment necessary family
health. necessary the following information members.
actions in should be done: about the - Cleaning
Inability to provide a home order to 1)Awareness of health problem. Utensils
environment which is lessen the the concerned -Teach the
conducive to health problem if about the importance of
maintenance and personal not to arising problem clean
development due to: eliminate it. in the environment to
A. Inadequate family household. the client & his
resources 2)Immediate family.
a. Responsible/competent action &
family members planning
b. Physical – e.g. client’s concerning on
health status the action to be
B. Ignorance of done on
importance of hygiene disposing the
& sanitation garbage.
C. Presence of preventive 3)Enlightenment
measures among the
a. Jealousy/rivalry members about
D. Family Disunity the effect of
a. Self-oriented unclean
behavior of environment to
members the health of
the family.
HEALTH PROBLEM FAMILY NURSING PROBLEM GOAL OF CARE OBJECTIVES INTERVENTI METHOD RESOURCES EVALUATION
ON OF NURSE REQUIRED
MEASURES
INSUFFICIENT INTAKE -Inability to recognize the - After a week - After a day - Encourage - Home -Visual aids Goal not met.
OF PROPER NUTRIENTS presence of problem due to: of nursing of nursing the client to visit -Time for both
A. Ignorance of facts intervention intervention eat -Health the nurse, the
-Inability to make decisions the client to the client nutritious Teachings client, & the
with respect to seeking should be able with regards foods & client’s family-
appropriate health care due to recognize to the proper vitamins. Cooperation
to: the nutrition - Teach food on all concerns
A. Ignorance of importance of intake the preparation for the
community resources of care balance diet & client should on the intervention to
-Inability to provide nursing proper be aware & immediate work.
care to sick/disabled or nutrition with eat a balance family
dependent member of the regards to the diet to members.
family due to: problem & become - Discuss
A. Ignorance of the facts. other health healthy. Also about
B. Ignorance of the problems. the family exercise &
nature & extent of the should know good rest
nursing the for
treatment/procedures/care. consequences resistance
C. Inadequate family of eating an of illnesses
resources for care. imbalance & diseases.
1. Responsible family diet & should
member take proper
D. Presence of action on the
personnel/Psychological problem to be
conflicts corrected.
HEALTH FAMILY NURSING PROBLEM GOAL OF CARE OBJECTIVES INTERVENTION METHOD RESOURCES EVALUATION
PROBLEM MEASURES OF NURSE REQUIRED
ARTHRITIS -Inability to make decisions with -After a week of -After 2-3 hours - Discuss to the - Home visit -Visual aids Goal not met.
(AS respect to seeking appropriate nursing of nursing family members -Health - Time,
DIAGNOSED health care due to: intervention, intervention, & clients about teaching Cooperation
BY THE A. Ignorance of community the client should the client should the health -Use of of the nurse,
DOCTOR) resources for care. have knowledge have proper problem & it’s other client, &
B. Fear of consequences of on proper action on arising possible alternative client’s
action: management on problem/pain or intervention or e.g. Herbal family
1. Social pain bought by discomfort management. medicine -Herbal
2.Physical/ Psychological the problem: bought by the - Teach the Plants
C. Negative attitude -The family client. importance of
towards health problems. members should -The family pain
D. Inaccessibility of also be aware & members should management to
appropriate resources of care: be have a plan on the client.
1. Physical- location knowledgeable what to do - Teach the
2. Cost on the pain when the importance of
- Inability to provide nursing care management problem arises. eating nutritious
to the sick/disabled or dependent suffered by the - Both the client food & it’s
members of the family due to: patient. & his family effect on the
A. Ignorance of the nature & should be aware problem.
extent of the nursing care needed. & be - Provide health
B. Lack of necessary knowledgeable teaching on
facilities. after the health alternative
C. Inadequate family teaching are medicine
resources of care: given. (herbal) for the
1. Responsible family member client.
2. Financial

D. Presence of
personnel/psychological
conflicts.