BSN2A CHN Clinical Group 2

Republic of the Philippines
Tarlac State University

College of Science
Department of Nursing
Lucinda Campus, Brgy. Ungot, Tarlac City Philippines 2300
Accredited Level 3 Status by the Accrediting Agency of Chartered Colleges and Universities in
the Philippines (AACUP), Inc.
A Family Case Study Presented to the Faculty of the

Tarlac State University
College of Science, Department of Nursing
In Partial Fulfillment of the Requirements of the Subject

Community Health Nursing
Presented by:
Abad, Liah Nicole V.
Dantes, Maria Cristina C.
De Guzman, Renzo James S.
Domingo, Kurt John B.
Espinosa, Jan Carlo M.
Estoesta, Denzel Mark G.
Facun, Jessabel V.
Gallego, Queenie B.
Gavino, Christine Claire D.
Hernandez, Gladys Mae O.
Januche, Grace Kelly Adrianna V.
Manuel, Paolo P.
Primero, Arianne Pearl R.
Puntilar, Shekinah M.
Presented to:
Mr. Jomer V. Manalang, RN, MAN
Presented on
(December 2021)
TABLE OF CONTENTS
I. INTRODUCTION ............................................................................................................... 1
II. OBJECTIVES .................................................................................................................... 4
III. INTIAL DATA BASE ......................................................................................................... 6
a. Family Structure, Characteristics, and Dynamics ............................................ 6
b. Genogram .............................................................................................................. 8
c. Socio- Economic and Cultural Characteristics ................................................ 9
d. Home Environment ............................................................................................ 12
e. Health Status of Each Family Member ........................................................... 17
A. 13 Areas of Assessments ......................................................... 23
f. Nutritional Assessment ..................................................................................... 62
g. Values, Habits, Practices on Health Promotion, Maintenance and Disease

Prevention ........................................................................................................... 64
IV. FAMILY COPING INDEX ................................................................................................ 69
V. TYPOLOGY OF NURSING PROBLEMS ....................................................................... 80
VI. RANKING OF PRIORITIZATION OF IDENTIFIED

HEALTH PROBLEMS ..................................................................................................... 81
VII. FAMILY NURSING CARE PLAN .................................................................................... 89
VIII. SUMMARY, EVALUATION, AND RECOMMENDATION ............................................ 133
IX. DOCUMENTATION ....................................................................................................... 137
X. GROUP PROFILE ......................................................................................................... 147
XI. BIBLIOGRAPHY ........................................................................................................... 163

I. INTRODUCTION
Community Health Nursing is one of the two major domains in the setting of the
nursing profession (Rajan, 2019). The World Health Organization (2018) defined
Community Health Nursing as a particular field of nursing that combines skills of nursing,
public health, and some phases of social assistance. It functions as a part of the total
public health program for promoting health, improving the conditions in the social and
physical environment, and rehabilitating illness and disability. Therefore, Community
Health Nursing is an exceptional pattern of health care practices. It is being implemented
into the public because it has a significant impact on the well-being of individuals when it
is appropriately presented and executed. It can also help people and avoid diseases that
might be contagious and improve public health.
One of the three words used to formulate Community Health Nursing is the word
community. A community gathers individuals who share a personality framing story,
something in common, and interact with one another. Those individuals fabricate the
standard story models of that local area into their feeling of themselves; they incorporate
the historical backdrop of those networks into their very own set of experiences, and they
see the world through the viewpoint of those familiar stories. (Toby Lowe, 2021-).
Community is a common word they will hear almost every day, especially from politicians,
officials, or people holding microphones. A community is a group of people who think they
belong and have similarities and feel they fit in. Community is a powerful word that
contains many different meanings. Anderson and McFarlane (2016) strengthen the idea
as it stated that the function of any community includes its members’ collective sense of
belonging and their shared identity, values, norms, communication, shared interests, and
concerns.
On the other hand, a part of the community is the family. A family is known to be
the basic unit of society. According to Rector (2018), the definition of a family varies by
organization, discipline, and individual. One of its definitions is, a family means any person
who plays a significant role in an individual’s life, such as a spouse, domestic partners,
relative, etc. (Human Rights Campaign, 2017). They define family as not just blood-related
but also as a bond of a group of people that shares the same interest and that has one
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goal. Family does not just circle in the definition of they must be blood-related or married
or engaged because the description of the family goes a long way.
The chosen household of the student nurses is the Gavino Family, who currently
lives in the Melting Pot of The Philippines, Tarlac. It Is a landlocked area in Central Luzon
(Region III). It is limited on the north by the territory of Pangasinan, Nueva Ecija on the
east, Zambales on the west, and Pampanga in the south.Tarlac comprises 305,325 land
areas which are subdivided into 17 municipalities, one city, and 511 barangays. Back in
the day, Tarlac was a thickly forested area where nomadic Aetas could be found. The
Tarlac is also known as a multicultural province as Tarlaquenos are a mixture of
Kapampangan, Ilocano, Tagalog, and Pangasinense. Its economy is mainly agriculture as
it is known for vast sugar (sugarcane) and rice plantation. At the same time, Roman
Catholicism is most Tarlaquenos (Department of the Interior and Local Government,
2017). Its numerous eye-catching destinations, good food varieties, massive sugar, and
rice plantations, and a delightfully finished fairway in addition to such countless different
attractions all make the territory of Tarlac probably the best spot to visit in Central Luzon.
The Gavino Family specifically resides in Barangay Tibag, one of the barangays
in Tarlac City which is headed by Barangay Captain Hon. Tito D. Mallari. The Barangay
Tibag has a total population of 17,800 in the year 2020 and has a household of 3,675
during 2015 with an average of 4.44 members per household.
The student nurses chose the Gavino Family as the respondent of this family case
study due to the reason that the family acquires the criteria that the student nurses find.
The chosen family is located in the rice field area of Tibag and can be considered rural
because it is one of the unrecognized barrios of Tibag. The family has six members and
an extended type of family, other relatives are living in the same household. Furthermore,
upon visiting the family, it was found that they are far away from the barangay health
center of Tibag, raising a notion that the family were not able to have regular consultation
about their health status. It was also found that the family were not knowledgeable
regarding health care and interventions that they can perform to themselves or other
members of the family in case of an emergency. With all these motives, the student nurses
are fully determined to help and bring an uplift in the health status by means of performing
assessments and nursing care plans that may indicate the health status of each member
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of the family, as well as to give an understanding and awareness about health education.
Preceding in this study, the student nurses will incorporate the four main goals of nursing
to the family which are, to promote health, to prevent illness, to treat human responses to
health, and to advocate. With all the combined plans, the student nurses will be able to
improve the health condition and understanding regarding health of the chosen family.
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I. OBJECTIVES
General:
After the completion of the Family Case Study, the student nurses will be able to
develop their critical thinking, understanding, and skills with regards to the appropriate
nursing response, such as establishing nursing care plans and executing effective
nursing actions with the health care needs and improvement of the family. Furthermore,
the student nurses will be able to extend their awareness and good judgment with respect
to the community and to the current societal situation which gives rise to the health of
each member of the family.
Specific:
1. To establish rapport and build trust between the family and the student nurses.
2. To provide a quality assessment to the health of the chosen family.
3. To identify problems that affect the health of the family as well as the factors that
correlate to the problems.
4. To cater nursing interventions pertaining to the health problems and needs of the
chosen family.
5. To create a nursing care plan for improving the health of the family.
6. To assess the health status improvements of each member of the family.
7. To evaluate each family members’ knowledge regarding the importance of
maintaining good health.
Family Based:
During the Family Case Study, the family should be able to:
1. Develop trust in the student nurses.
2. Demonstrate the willingness to cooperate during the interviews and
assessments that will be executed.
3. Be honest in the interviews to be produced by the student nurses.
4. Respond positively with the employed assessment and health teaching.
5
By the end of the Family Case Study, the family would be able to:
1. Develop their consciousness about their health condition and maintenance.

2. Demonstrate and apply to oneself the health teaching and interventions
taught by the student nurses.
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II. INITIAL DATA BASE
A. Family Structure, Characteristics, and Dynamics

Family Position in Educational
Sex Age Civil Status
Member the Family Attainment
Highschool
Roderick C. Gavino Father M 46 y/o Married
Graduate
Highschool
Mary Grace D. Gavino Mother F 44 y/o Married
Graduate
2nd year
Christine Claire D. Gavino Daughter F 19 y/o Single
College
Kasandra Chloe D. Gavino Daughter F 13 y/o Single Grade 8
High school
Angelica Camille D. Espinosa Niece F 20 y/o Single
Graduate
Sophia D. Espinosa Niece F 6 y/o Single Grade 1
Table 1: Family Structure, Characteristics, and Dynamics of Gavino Family
Interpretation:
The family structure of the Gavino Family is known to be an Extended Type of Family. In
their household, the family comprises only five (5) members consisting of the head of the family,
the mother, living together with two (2) of her daughters, and two nieces (2) from her eldest sister.
Mr. Roderick D. Gavino was meant to be the head of the family. However, because he had to
provide for his family, he left the Philippines to work abroad. By then, Mrs. Mary Grace D. Gavino
became the head of the family who takes care of the household, is responsible for budgeting all
expenditures in the household, and a provider of emotional support of the family.
The married couple has two (2) daughters named Kasandra Chloe D. Gavino and
Christine Claire D. Gavino, who are expected to adhere to the supervision of their parents.
Furthermore, the Gavino Family also lived with two (2) relatives, Angelica Camille D. Espinosa
and Sophia D. Espinosa, Mrs. Gavino’s nieces from her eldest sister, who is separated from her
husband, unemployed, and unable to provide for her children. The two (2) relatives chose to be
with the family due to financial reasons.
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For five (5) years, they have been residing at Sitio Pag-Asa, Barangay Tibag, Tarlac City.
Each member of the family has different responsibilities in the household, however, when it comes
to decision-making and finances, the couple decides for the family.
Norms:
An extended family is a type of family unit that consists of a nuclear family living with other
family members such as the grandparents, aunts, uncles, and cousins. This type of family
provides practical and emotional support to each member inside a household (NSW Pediatric,
2016). According to M. Meleen (2019), most extended families thrive due to economic/financial,
health, and marital reasons. In some cases of Filipinos, family is what they consider a foundation
of social life. Thus, they have a tight bond with their family. Moreover, Filipinos believe that every
member of a household/family has a responsibility in the household. (C. Scroope, 2017)
Analysis:
The Gavino family is an extended family as the member comprises a nuclear family living
with blood relatives. The husband who works abroad is the one who provides financial needs for
the family while the wife is in charge of the household responsibilities. They have relatives living
with them due to financial reasons that the relatives’ family cannot provide. In terms of decision
making, both husband and wife consider their opinions while each family member is expected to
have different household duties.
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B. Genogram
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C. Socio-Economic and Cultural Characteristics

Educational Ethnic
Family Member Occupation Religion
Attainment Background
Roderick C. Highschool
Salesman Kapampangan Roman Catholic
Gavino Graduate
Mary Grace D. Highschool
Housewife Kapampangan Roman Catholic
Gavino Graduate
Christine Claire
2nd Year College N/A Kapampangan Roman Catholic
D. Gavino
Kasandra Chloe
Grade 8 N/A Kapampangan Roman Catholic
D. Gavino
Angelica Camille High School
N/A Kapampangan Roman Catholic
D. Espinosa Graduate
Sophia D.
Grade 1 N/A Kapampangan Roman Catholic
Espinosa
Table 2: Socio-Economic and Cultural Characteristics of Gavino Family
Interpretation:
Mr. Roderick Gavino is a high school graduate and the breadwinner of the Gavino
Extended Family. He is a Salesman who currently works in a mall in Doha, Qatar. On the other
hand, his wife, Mrs. Mary Grace Gavino, is also a high school graduate, a full-time housewife,
and the one who manages the expenditures of the Gavino Family. Furthermore, both of the
couple’s daughter and one (1) niece are currently studying while the other niece chooses not to
because of the pandemic. All family members have the same ethnic background––
Kapampangan––one of the largest ethnic groups in the Philippines. In religion, they have all been
Roman Catholic since birth. They rarely visit the church because of the COVID 19 Pandemic.
However, they regularly pray together before meals and before going to bed.
Norms:
Tarlac City is a multicultural province in the region of Central Luzon. It comprises four distinct
groups namely: Pampango (Kapampangan), Ilocano, Pangasinenses, and Tagalogs. The religion
is mostly Roman Catholic and even celebrated feasts such as The Feast of Immaculate
Conception of Concepcion (Department of Tourism, 2017).
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Analysis:
Upon the analysis, it was found that even though they are an extended family, all the family
members share the same ethnic background of Tarlaquenos, Kapampangan, and the same
religion, Roman Catholic.
Estimated Monthly Allotted

Expenditures Prioritization
Budget
Groceries (Food & Beverage) ₱ 4,500 1.5
Groceries (Cleaners–such
detergents and Personal Care ₱ 500 1.5
such –shampoo, soap)
Electricity & Water Bill ₱ 1,700 4
Internet ₱ 1,300 5
Savings ₱ 5,000 3
Transportation ₱ 500 10
LPG Gas ₱ 650 9
Medical/Health-Related (such
₱ 1,000 6
as medicines, consultation)
Monthly School Tuition Fees ₱ 2,200 7
School Requirement Fees ₱ 2,000 8
Other Minimal Expenses ₱ 350 11
Vices ₱ 300 12
TOTAL: ₱ 20,000
Table 3: Monthly Expenditures of the Gavino Family
Interpretation:
Mrs. Gavino is the one in charge of the monthly expenditures of the Gavino family. The
estimated monthly income in this year––2021, from Mr. Gavino’s remittance is ₱ 20,000. Her least
priorities are the minimal expenses as she stated that these expenses frequently appear in their
monthly expenditures. On the other hand, her most priority is the food groceries of the family as
she believes that it is okay even if there will be nothing left in the allowance for as long as her
daughters and nieces eat enough food a day.
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Total Monthly Income of the family

Roderick’s remittances → ₱ 20,000
Total: ₱ 20,000
Total Annual/Household Income = Total Monthly Income x 12 months

₱ 20,000 x 12 months = ₱ 240,000
Per Capita Income = Total Annual Family Income / Number of the Members of the Family
in the Household
₱ 240,000 / 5 = ₱ 48,000
Estimated Monthly Income – Estimated Total Monthly Expenditures

= ₱ 20,000 – ₱ 20,000
= ₱ 0 {not lacking}
As seen in the computation provided above, Mr. and Mrs. Gavino were able to provide an
adequate amount in the monthly expenditures of the family. It was shown in one computation that
the estimated expenses for each family member are sufficient.
Norms:
According to Philippine Statistics Authority (2020), the 2018 average annual income of five
family members in a household must be around Php 345,000, while the average annual
expenditures must be around Php 286,000. Thus, the average savings of a Filipino household
must be around Php 75,000.
Analysis:
In the case of the Gavino Family, their average monthly income from Mr. Gavino’s
remittance is Php 20,000 only and annually is Php 240,000. Their estimated expenditure for a
whole month is Php 19,000, which is around Php 228,000 in a year. On the other hand, adding
the amount of monthly savings, which is Php 5000 a month, the family has an estimated Php
60,000 of savings annually. Therefore, upon the analysis of the family’s income, expenditure, and
savings, it was shown that the family did not meet the approved annual income of each household
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in the year 2018. Thus, it indicates that they are below the average income and expenditures of
a Filipino household.
D. Home Environment
House Surrounding Rice Field
House Ownership Owned
Type of House Concrete
Roof Type Corrugated Metal Roof
Lighting Adequate
Overcrowding Not Overcrowded
Ventilation Fair Ventilation
Drainage Surface Drainage System
Living Room Filipino Sala
Bedroom 2 ; Area: 270 x 160
Bathroom 1; Owned Three-Quarter Bathroom
Kitchen Area/Type 1; L – Shaped Kitchen
Appliances 1 Television
3 Electric Fan
1 Refrigerator
1 Washing Machine
1 Kettle
3 Cooker Pot
1 Stove
Source of Drinking Mineral Water
Fuel Used Liquefied Petroleum Gas (LPG)
Power Source Electricity
Water Supply Water Pump
Excreta Disposal Non-Service Type (Sanitary Latrines)
Garbage Disposal Composed in a sack which will then be
collected once in 1-2 weeks by a barangay
garbage collector
Vectors Flies, cockroaches, mice, mosquitoes
Table 4: Environmental Aspect of Gavino Family
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Interpretation:
The Gavino Family is currently residing in one of the unrecognized barrios in Barangay
Tibag. The house is surrounded by rice fields, and the area has a surface drainage system.
According to Mrs. Gavino, the lot of their house was bought by her when she was still a maiden.
When she married her husband, Mr. Roderick Gavino, they decided to build their dream house
on the lot that she bought. However, due to insufficient budget, they were not able to finish the
house until 2016. After this, they decided to move into their newly built house in Sitio Pag-Asa,
Barangay Tibag, Tarlac City. Therefore, they have been living in this house for five years.
The house of the Gavino family is made of concrete and has a corrugated metal roof.
Upon entering the house, a Filipino-themed sala will spring up to visitors. Their chairs in the living
room consist of one (1) long sofa and two (2) sofa chairs. The house is also composed of two (2)
bedrooms in which Mrs. Gavino and her daughters share a room while the other two (2) relatives
share in the other room. Their owned bathroom used for both toilet and bathing is a three-quarter
bath located inside their house
In terms of appliances, the family owns a television placed in the living room, three (3)
electric fans placed in the living room, one (1) each in the two bedrooms, and a refrigerator near
the dining table. According to Mrs. Gavino, the refrigerator functions as a storage for the meal
supply of the family, especially for meat products, wet ingredients, and vegetables. Their dry
foods, such as canned goods and noodles, are stored in a cabinet near the refrigerator. At the
same time, the snacks are placed in the middle of the dining table. Appliances such as a washing
machine, kettle, and cooking pot, were placed in the kitchen area.
The kitchen area of the family is located at the back of their house. It comprises one (1)
sink used to wash their hands and other cleaning procedures. Their mineral water, which is the
source of drinking water, is located near the sink. The sack of rice and cooking area, which
comprises the kitchen equipment, is also located in the kitchen area. The kitchen is also free from
smoke generated when the family is cooking as they use the traditional way, which includes the
usage of Liquified Petroleum Gas (LPG) as the fuel for cooking. However, the student nurses
noticed that their eating equipment, such as plates, forks, spoons, and glasses, was also placed
in the kitchen area.
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With regards to their power source, their main supply is electricity. On the other hand, their
water supply is from a Water pump powered by electricity. The excreta disposal is a non-service
type (sanitary latrines). Their garbage is stored in a sack placed outside the kitchen area and will
then be collected by a barangay garbage collector. On the topic, Mrs. Gavino raised a sudden
concern as one of their neighbors burned waste every afternoon, causing a thick smoke with an
unpleasant smell from the burnt waste. Through inspection, cockroaches were present inside their
house, specifically on cabinets and dark areas. Flies are seen in the garbage pile, while mosquitos
are also spotted outside the house near plants. The student nurses also noticed mice from the
neighbor moving out of the family’s kitchen area.
Lastly, the means of transportation of the family is through a public jeepney or tricycle from
the Sitio Pag-Asa Toda.
CROWDING SPACE
STANDARD: (Concepts and guidelines in COPAR ,1ST edition, 2005 by UNTALAN)
FORMULA:
TOTAL FLOOR AREA (TFA)
TFA = Length x Width of the house
TFA = 7m x 11.5m = 80.5 sq. m
TOTAL SPACE REQUIREMENTS (TSR)

Standard:
Adults- 3.0 sq. m
Children- 1.5 sq. m
Infant- 0 sq. m
No. of adults in Gavino family= 4 x 3.0 sq. m = 12 sq. m

No. of children in Gavino family= 1 x 1.5 sq. m = 1.5 sq. m
TSR = 13.5 sq. m
INTERPRETATION
TFA>TSR = Not overcrowded
TSR>TFA = Overcrowded
TFA (80.5 sq. m) > TSR (13.5 sq. m) Not overcrowded
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VENTILATION
Interpretation:
20% - Satisfactory
18% - 19% - Fair
Below 18% - Poor
TFA= 97.5 sq. m

Total No. of windows: 8
Formula:
Ventilation: TWO/TFA X 100
TWO: Total area of windows (L X W)
COMPUTATION:
WO (Window Openings)
W1= 0.94 m x 1.24 m = 1.16 m
W2= 0.94 m x 1.24 m = 1.16 m
W3= 0.94 m x 1.24 m = 1.16 m
W4= 0.94 m x 1.24 m = 1.16 m
W5= 0.94 m x 1.24 m = 1.16 m
W6= 0.94 m x 1.24 m = 1.16 m
W7= 1.24 m x 1.524 m = 1.9 m
W8= 1.24 m x 1.524 m = 1.9 m
W9= 0.91 m x 1.22 m = 1.11 m
W10= 0.91 m x 1.22 m = 1.11 m
W11= 0.60 m x 1.52 m = 0.91 m
W12 = 0.30 m x 0.30 m = 0.6
Total Window Opening (TWO) = 14.5 sq. m
Ventilation = TWO/TFA x 100

=14.5 sq. m ÷ 80.5 sq. m x 100
=0.180 sq. m x 100
=18 = Fair Ventilation
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Norms:
Environmental quality has a major impact on health and disease (K. Koehler et. al.,
2017). A child’s home plays a vital key in developing and maintaining their dietary and physical
activity (A.C. Lindsay et. al., 2018).
Proper ventilation keeps the air fresh and makes it healthy indoors. It also helps in reducing
air pollution (American Lung Association, 2020). In areas such as houses and establishments
where people performed their daily activities, the environment has a significant effect on the health
and safety of the population. An environment with improved ventilation provides comfort and
improvement for a person (P. Taculao, 2018).
Analysis:
The Gavino family owns the house and lot where they are residing. The house comprises
a living room, two (2) bedrooms, a comfort room, and a kitchen area near the dining table. Three
(3) people share one of the bedrooms while the other only has two (2) people. Mrs. Gavino shares
a room with her daughters, while the two (2) relatives share on the other. Their comfort room is
located inside their house, which they also owned. On the other hand, the kitchen area is located
at the back of their house. It was found that there are vectors such as flies, cockroaches, mice,
and mosquitos, which can also influence a significant factor in the health of each family member.
Through computation, it was identified that the Gavino family has a total floor area of 80.5
square meters, a total space requirement of 10.5 square meters, and a total window area of 14.5
square meters. To sum it all, the family is not overcrowded, which means that they have enough
house space for each family member. Moreover, the result of ventilation was 18, which indicates
that the ventilation of the family is within the fair range. Thus, it is in need to meet the satisfactory
range of a properly ventilated house.
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E. Health Status of Each Family Member

a. Physical Assessment
Sophia D. Espinosa
6 y/o
Area/Region Findings Norms Analysis
>Skin Upon inspection, the skin color In performing a skin Upon the result of the findings,
- Inspection of the client is brown. There is assessment, inspection and the skin of the client is normal
no presence of open wounds, palpation must be included. even though there are small
pressure injuries, and lesions; This exam must indicate the scars due to light accidents
however, there is a small, skin color, texture, turgor, and if when playing.
rounded scar on her knee which there is a presence of lesions.
she stated to have obtained The following are the normal
when she stumbled from findings in a skin assessment:
playing. ● Exposed skins are
normally dry than the
unexposed skins.
- Palpation Through palpation, the skin of ● A skin must return in
the client is smooth, soft, warm place with minimal
to the touch, and the elasticity of markings. If so,
the skin when pinching can go dehydration must be a
back in place within two possible indication.
seconds. (Nurse Key, 2016)
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>Hair and Nails

- Inspection Upon inspection of the head A scalp hair may be straight, Upon the analysis, the hair of
hair of the client, the hair color curly, and kinky. It is usually the client is in normal condition;
is black; the distributions are shiny, silky, and strong while its even when the hair is thin, it
equal, but her hair is thin. It is a colors differ genetically (Nurse does not indicate alopecia. In
little curly and shiny. There are Key, 2016). terms of the nails, they are
no lice, thick, or dandruff found normal in color, intact, and
on the hair. It was also noticed capillary refill test, however, it
that the client had vellus hair on had small wounds due to nail-
her arms and back. biting.
On inspection of the nails, the A normal nail is pinkish in color

client had short nails with small and flat or slightly convex on its
wounds and was reported to surface (Nurse Key, 2016).
have a nail bite. The nail plate is Capillary Refill Test is an
pinkish in color and the cuticles assessment done on nail beds
were intact. The inspection to monitor a patient’s hydration
followed a capillary refill test and amount of blood flow to
where the blood was refilled tissue (MedlinePlus, 2019).
within 2 seconds.
>Head
- Inspection Through inspection of the head, A head circumference can Through findings, the head
there are no wounds, lesions, or increase up to 3.5 centimeters circumference and overall
19
scars found. The head is in an over two years from being a features of the client were found
upright posture, 55cm in size, newborn (E. Graber, 2021). to be normal. There are no
and has a normal shape. Moreover, normal findings of a indications of possible
head assessment must include inflammation or diseases with
- Palpation Upon palpation, there are no the symmetry and balance of the head of the client.
deformities found. There are no the features of the head and
masses and inflammation in the face (M. Belleza, 2017).
skull and nodules. Through
exercises such as rotating, the
client did not feel any pain or
discomfort.
>Eye
- Inspection The eyes are symmetric in There are various results that In the findings, the inspection
place and shape, and their color must be evaluated in an eye results indicate that the eye of
is black. The eyelids of the client assessment. These findings the client is normal.
curls away from the eyes. Its must be noted for the alignment
eyebrows and hair were evenly of the eye, color of the palpebral
distributed. Upon inspection of conjunctiva and sclera,
the pupil, it was positive to presence of nodules, opacities
PERRLA (Pupils are equal, of the cornea and symmetry of
round, reactive to light and palpebral fissure. Furthermore,
accommodation). pupils must be 3-5mm in size,
symmetric and reactive in light
(Access Pharmacy, 2016).
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>Ears
- Inspection Upon inspection, the ears are The ear canal, pinna, and Based on the findings, the ear
symmetric in shape and tragus must be non-tender and structure and features of the
position. There are no presence non-swelling. A normal client are normal. While there is
of lesions, inflammations, and tympanic membrane must be a presence of minimal earwax
wounds found in the external gray pearl while the hearing on their ear canal.
ear. However, there is a must have a good acuity in
presence of earwax inside the hearing whispered voices
ear canal. (ThriveAP, 2016).
- Palpation Upon palpation, there are no

masses and pain found.
>Nose
- Inspection The nose of the client has the Nasal mucosa is pink and Upon the inspection of the
same color as her face. It is a moist. The nasal septum is nose, there are no
patent. There is the presence of midline and nares are patent abnormalities found.
discharge and foreign bodies. bilaterally (ThriveAP, 2016).
- Palpation Upon palpation, there is no

tenderness and masses.
>Mouth
- Inspection The client has pinkish lips in The appearance of a normal Based on the findings of the
color. Symmetric. Smooth. No oral mucosa is pink and moist. inspection, there are no
presence of dryness and A normal tongue must appear abnormalities in the mouth
21
fissures. The tongue is pinkish free from lesions with a while the decayed teeth are
in color while her teeth have proportioned movement while a yellowish in color and have an
decayed teeth; some are normal pharynx appears as oral cavity which will be needed
yellowish in color and have an non-swelling (ThriveAP, 2016). for health teaching.
oral cavity.
>Thorax, Lungs, and
Abdomen
- Inspection Upon inspection, there are no A normal finding in thorax and The results of the assessment
seen masses, pressure injuries, lungs must indicate a symmetric in inspection, palpation, and
or inflammation on the said chest wall and appearance of percussion of the thorax, lungs,
areas. atraumatic. There must be no and abdomen are normal. While
presence of tenderness and in the auscultation, there are
signs of distress in the wheezing sounds while
respiratory system. A normal breathing out air which
- Auscultation Through auscultation, the client lung sound must not include a indicates abnormality.
has effortless breath and has rales, rhonchi, and wheezes.
wheezing breathing sounds, During percussion, resonance
especially when breathing out must be heard (ThriveAP,
air. The bowel sounds are 2016).
normal.
Soft, symmetric, and non-
tender are indications of a
- Palpation Upon palpation, there are no normal abdomen. The aortic
pain indications in the area. pulse must not be visible and
22
Pulsations can be felt in the normoactive bowel sounds

abdomen area. Non-tender. must be heard in the four
Soft. The chest wall was intact. quadrants. Parts such as the
liver and spleen must be non-
- Percussion Resonant percussion was palpable. (ThriveAP, 2016).
noted.
>Extremities
- Inspection Upon inspection, there are no The normal extremities must be The findings of the client’s
deformities found. The atraumatic with no tenderness, extremities were normal. The
extremities are normal in deformities, swelling, and skin under the feet shows
position, length, size, and no erythema. All joints must note a dryness and cracking due to
presence of swelling. There are full range of motion (ThriveAP, playing outside barefoot, which
presence of dryness and 2016). indicates further health
cracking of skin under the feet teaching.
due to playing outside barefoot.
- Palpation The joints are movable. No

tenderness and no soft tissue
swelling were found.
23
b. 13 Areas of Assessment
Mary Grace D. Gavino
44 y/o
Areas of Assessment Findings Norms Analysis
Social Status Mary Grace D. Gavino is the Social Status is a position that Mrs. Gavino has a good
Head of The Gavino family. She each individual handles with the relationship and bond with her
is 44 years and was born on the rights, duties, and lifestyle in the husband, children, and nieces.
st
21 of March, year 1977 in social hierarchy. It also Even when there are times that
Tarlac City. She is presently indicates the age, sex, family, she has minimal displeasure
residing at Sitio Pag-Asa, education, and other factors to with her husband. Despite that
Tibag, Tarlac City. She is a full- include the social of a person she is timid to talk with people,
time housewife and the one (Britannica, 2019). Socialization she still has a harmonious
responsible for the involves social structure and relationship with their
expenditures of the Gavino interpersonal relations. (N.L. neighborhood and keeps in
family. Cole, 2020). touch with her high school
friends.
Upon the interview, she stated
to have a good relationship with
her husband; however, she also
admits that her marriage and
family is not perfect; there are
times that she and her husband
get into minimal fights because
24
of tolerating wrongdoings (such

as going home late) of the
children in their household.
Upon her relationship with her
daughter and nieces, she
believes that all of them are
open to her and have a friend-
like bond. However, she also
stated that she is still the mother
and head of the family; that is
why she is a little strict about
some things. In their
neighborhood, she is friends
with the Bay couple near their
house. There are times that
they get invited to some
occasions in their
neighborhood.
In terms of socialization, she

admitted that she is the reason
to talk on people, but she is also
easy to get along with. During
her high school years, she had
25
friends who are still her close

friends, and they have been
keeping in touch until now.
Mental Status
- General Appearance and - Upon the interview, Mrs. Researchers have found that an During the interview, it was
Behavior Gavino is wearing a black individual’s appearance has seen that the client prepared for
blouse with her hair tied. huge and definable capabilities the discussion as she well-
While she verbally answers on life experiences and presented herself by dressing
questions, she maintains opportunities (K. Gruys, 2019). properly, having her hair tied,
eye contact. Looking at her Furthermore, the appearance of and cutting nails. She also
hands, her skin is looking a person can tell how he/she is showed her professionalism
smooth, and it seems she as facial cues are powerful in and interest during the interview
has cut her nails. interaction and obtaining as she makes eye-to-eye
information (V. Zayas, 2016.) contact throughout.
- Level of Consciousness and - Mrs. Gavino is aware of the The organ responsible for a The client was conscious and
Orientation interview and assessments person’s consciousness is the aware of the interview being
that she and her family will brain. According to S. Han performed. She was also well-
be doing. During all the (2019), consciousness is the oriented and cooperative as she
assessments, she is well- awareness, alertness, and answered the questions
oriented and cooperative. ability of a person to be awake. provided by the interviewee.
When she is unfamiliar with the
terms being said by the
26
interviewee, she asks for similar

words of the said word.
- Speech - At the beginning of the The sounds being produced in She answers very well
interview, she stutters a lot, the vocal cords are turning into throughout the interview. She
especially when talking words and this refers to speech has a calm and clear voice while
about the problems or which is the articulated phrases answering questions. Despite
minimal fights that the family during communication. the provided explanation
encounters. Her tone is (Bilingual Kid, 2019). According regarding the interview content,
moderate, and she has a to Harappa (2020), a good there are times that she shows
medium range of speech characteristic of a speech introversions, especially for
when speaking. includes a clear message and personal questions.
key ideas, impact in oral
delivery, informative, and has a
nonverbal cue.
Emotional Status The most feared by the client is According to the American Mrs. Gavino has a fear of losing
losing her family and failing her Psychological Association and failing. She does not want
duty as an aunt to her nieces. (2019), emotion is a complex to disappoint the people around
She also admitted that she may pattern of reaction which her. Despite that, she has a
look cool in her way of involves experience, behavior, strong support system in her
disciplining the children in her and physiological elements. family. She views the children
household; it is because she is This also refers to how a person as her stress reliever.
afraid that the children may turn handles events that have a
away from her. In addition, her significant impact in their lives.
27
support system is also her Emotional Support can be

family. She views the children, shown through encouraging,
especially the 6-year-old, as her reassuring, and showing
stress reliever. sympathy to the person. These
can be provided by family,
friends, and others (C. Raypole,
2020).
Sensory Perception
- Sense of Sight - Based on observation, the The normal vision acuity of an The external structure of the
eye color of the patient is individual must be grade 20/20. eyes of the client has no
brown. There are no A 20/20 vision indicates that a presence of abnormalities.
presence of scars, lesions, person can clearly see a “thing” However, the client cannot read
and discharge around her at a 20 feet distance (J. Roland, with the readings (such as
external eye. Her eyebrows 2019). magazines) near her, which can
& eyelashes are equally be a possible indication of
distributed while the lashes farsightedness – a condition
are curled away from her where an individual can see far
eyes. There is also no objects but has trouble seeing
presence of masses and close objects.
tenderness on the eye
ducts. Upon inspection of
the eyes constricts and
dilates and the pupils,
PERRLA was noted. Mrs.
28
Gavino cannot read

letters/words near her, so
she had to put the magazine
a little away from her.
- Sense of Taste - When a Taste Test was The taste reacts to particles The client was able to
performed, she was able to dissolved in liquid. Every taste determine the different taste
determine the sweetness of receptor responds in the five that was tested on her. These
sugar, sour of vinegar, and basic tastes which are sweet, results indicate that the
saltiness of salt. As well as sour, bitter, salty, and umami. gustatory sense of the client is
the taste of milk and coffee. (Sherman, 2019). normal and functioning.
- Sense of Hearing - The auricles of the client are Hearing is a mechanical sense The external ear structure of the
symmetric in size and that can turn physical patient is normal. No presence
position and have the same movement into the electrical of pus, lesions, or blood, but
color. Her ear canal has signals that make up the presence of earwax was
some wax but no presence language of the brain, detected. Upon tests, the
of lesions, pus, or blood. translating these vibrations into auditory sense indicates
Upon watching the tick test, what we experience as the functioning.
she was able to note when world of sound (Sherman,
the ticking sounds appeared 2019).
and disappeared.
29
- Sense of Smell - There is no discharge, The olfactory system is the There are no complications
flaring, tenderness, sensory system used for the found on the nose structure of
masses, and displacement sense of smell (Physiopedia, the patient. The sense of smell
of cartilage. The nasal 2021). Jarvis (2016) signifies is functioning very well as the
cavity has no presence of the importance of the nose, the client was able to identify
mucus. And the client was one who provides moisture, scents.
able to identify the scent of filtration, and inhalation of
cucumber and the aroma of oxygen.
pandan leaves.
- Tactile - While the client’s eyes are Touch is a perception resulting The client was able to feel the
covered with a from the activation of neural object that was touched by her
handkerchief. She was able receptors in the skin, including skin. This indicates that she has
to know the difference the hair follicles, tongue, throat, a well-functioning sense of
between the texture of a and mucosa (Physiopedia, touch.
smooth paper and the rough 2021).
texture of a water bottle.
She can also differentiate
between objects such as
round and rectangular. And
was able to feel the hotness
and coldness of the water.
Motor Stability It was observed in the Balance is a system which The client was able to perform a
assessment that the client could allows an individual to maintain motor stability test without
30
stand and sit without its desired position. A normal having difficulty doing so. She
assistance. She was also able balance may depend on the has a complete set of
to move from one place to inner ear, sense of sight and extremities and was able to
another. In Romberg’s test, the touch as well as muscle perform a range of motion
client did not show any signs of movement (M.C. Stoppler, (ROM).
a positive Romberg. 2021).
Body Temperature Temperature is taken in the A body temperature and its The body temperature of the
axillary, and they are as follows: normal range depends on which client is within the normal range.
part of the body was the
1st Visit: 36.4OC temperature taken. The
following are the normal body
2nd Visit: 36.8 OC temperature of individuals ages
11-65 years old:
3rd Visit: 37 OC ⮚ Oral: 36.4OC–37.6OC
⮚ Rectal: 37.1OC–38.1OC
⮚ Armpit: 35.2OC–36.9 OC
⮚ Ear: 35.9OC – 37.6OC
(R. Nall, 2020)
st
Respiratory Status 1 Visit: 15cpm Respiration Rates is an The respiration rate of the client
individual’s total amount of is within the normal range. The
2nd Visit: 18cpm breaths in a minute. It varies on client also did not show any
the activity factors of a person. difficulty in breathing.
rd
3 Visit: 17cpm A normal breaths per minute of
31
The chest wall is well-intact. adults are in the range of 12cpm

Shoulders both rise at the same to 20cpm (G. Whitworth, 2019).
level. The client experiences no
difficulty in breathing. There is
no presence of abnormal
breathing sounds.
Circulatory Status 1st Visit: The normal pulse rate of a child The circulatory status of the
● PR: 90bpm is within the range 70-100 beats client indicates that the pulse
● BP: 130/90 mmHg per minute while in adults, it rate and blood pressure is
ranges from 60-100 beats per within its normal range. During
2nd Visit: minute (Cleveland Clinic, 2018). the first visit, the blood pressure
● PR: 88bpm In reading of blood pressure, it is elevated that indicates
● BP: 110/80 mmHg needs to show a top number prehypertension
(systolic pressure) that’s
3rd Visit: between 90 and less than 120
● PR: 90bpm and a bottom number (diastolic
● BP: 120/90 mmHg pressure) that’s between 60
and less than 80 to be said
normal. (Kozier, 2017)
Nutritional Status Mrs. Gavino eats 3x a day with Nutritional Status refers to the The diet of the family is normal
minimal meat products only. presence or absence of as the head provides nutrients
Furthermore, she always malnutrition in an individual that can help in growth and
makes sure to include (M.B. Huhmann, 2017). A good development of each member
vegetables in the meal plan that nutritional status indicates a of the family. The daily water
32
she makes to influence her balanced diet and its ability to intake is also in the normal
daughter and nieces to eat supply essential nutrients in the range in glasses of water. The
plenty of vegetables. She also body requirements of an client has no vices, and its BMI
makes sure to consume 10-12 individual (Food Science, is within a normal state.
glasses of water a day. 2016).
The client has no vices. She is Fluid intake varies with the
58kg, standing at 162.256 cm. person, the recommended fluid
Therefore, her body mass index intake average for men is 3.7L
(BMI) is 22. (15 cups) a day while 2.7L (11
cups) is recommended for
women (Mayo Clinic, 2017).
Elimination Status The client urinates 4-6 times a Urination is a term to describe According to the norms and
day, no burning or pain feeling. the process of emptying the results of Mrs. Gavino’s
She defecates at least twice a bladder. A bladder can fill for elimination status, it was found
day, specifically, morning and in approximately 400 to 600ml of that her frequency and
the evening. As per her, she is urine until an individual urges to appearance of urine and stool
having a hard time defecating avoid it. In addition, the average were normal in a healthy
when she has eaten a lot of frequency of a person to void is individual. There are
meat. Her urine color is usually at least 5 or more in a day abnormalities when the client
yellow or light yellow and does (Potter & Perry, 2020). eats a lot of meat resulting in
not contain any foul odor. According to Kozier (2017), having a hard time to defecate.
normal urine appears to be
yellow in color.
33
A regular elimination of waste

products is important for proper
functioning in the body (Potter &
Perry, Fundamentals of
Nursing, 2020). There is no
generally accepted number of
times a person may defecate as
individuals have a similar
frequency on what they
accustomed (R. Nall, 2018). A
normal stool is brown in color
and has a well-formed
appearance (Kozier, 2017),
Reproductive Status According to Mrs. Gavino, her Menarche refers to the first The menarche of the client
first menstruation (menarche) menstruation of females which occurred in the range of normal
started when she was only 9 occurs at the average onset age age. The reproductive status is
years old. She started to be of 12 years old, but menarche normal and has no history of
sexually active when she was can occur between ranges 9-17 STI/STDs.
26 years old and in a years old. GTPAL refers to the
relationship with her husband. records pertaining to
She has an OB score of pregnancies and outcomes. It
G2T2P0A0L2 and has no consists numbers of:
34
history of sexually transmitted Gravida/Gravidity– number of

infection/diseases. pregnancies,
Term pregnancies;
Preterm deliveries;
Abortion– spontaneous and
induced, and;
Living children
Sleep-rest Pattern The client sleeps at 9 pm and Sleep is a process that alters Mrs. Gavino has 8-9 hours of
wakes up between 5 am to 6 am with longer periods of sleep a day, which indicates
to watch the everyday morning wakefulness. The sleep-wake that she has a good and enough
mass through Facebook live. In cycle influences and regulates sleeping pattern.
the morning, she starts by physiological function and
cooking breakfast for her behavior (Potter & Perry, 2020).
daughter and nieces and According to Huether et al.
continuing some household (2017), sleep provides healing
chores. In the afternoon, she and restoration. Moreover, the
either spends time with the American Academy of Sleep
children in her household or Medicine prescribed those
rests with her 6-year-old niece. teenagers ages 13-17 years old
must have at least 8-10 hours of
sleep while adults ages 18 and
above must have at least 7
hours of sleep.
35
State of Skin Appendages She has fair skin, warm to the The state of skin appendages In relation to the norms and
touch, and has no presence of includes the skin itself, sweat findings through assessment of
allergies, redness, infections, glands, and nails (H. Yousef et the skin appendages, it was
masses, lesions, and wounds. al., 2021). found that she was within the
However, she has scars that normal state of skin
she got from her younger years A normal skin color depends appendages.
through playing volleyball. Her genetically. The moisture of the
skin has vellus hairs. skin can either be smooth or dry
depending on the location such
that the axillary is usually moist
while hands may be dry due to
exposure. A skin must also be
with same temperature in touch,
smooth and soft or wrinkled in
leathery for older people, non-
edematous, no presence of
lesions and has a normal
elasticity
Her hair is black in color, thin, A hair color also depends on the
and has an equal distribution. ethnicity of an individual. Its
She is also free from dandruff, distribution and thickness must
louse, and ticks. There is no be equal with a shiny and
smooth texture. There must
36
presence of open wounds and also be no presence of lesions.

scars. Furthermore, most adult hair
has dull gray, white or yellow in
color.
(Potter & Perry, 2020).
A normal nail is pinkish in color

Upon assessing the fingernails and flat or slightly convex on its
and toenails of the client, they surface (Nurse Key, 2016).
are trimmed and cleaned. The Capillary Refill Test is an
nail plate is pinkish in color with assessment done on nail beds
an intact nail bed. Has the to monitor patient’s hydration
presence of lunula while the and amount of blood flow to
cuticle is intact. tissue (MedlinePlus, 2019).
Kasandra Chloe D. Gavino

13 y/o
Social Status Kasandra Chloe is the first-born Social Status is a position that Kasandra Chloe is a 13-year-
child of Mr. and Mrs. Gavino. each individual handles with the old lady who has a good
She is 13 years old and was rights, duties, and lifestyle in the relationship with each member
th
born on the 14 of March 2008 social hierarchy. It also of the family. However, in terms
in Tarlac City. She is presently indicates the age, sex, family, of socialization with peers, she
residing with her parents at Sitio education, and other factors to
37
Pag-Asa, Tibag, Tarlac City. include the social of a person is selective and has standards
She does not have a job; (Britannica, 2019). Socialization in choosing.
however, she is currently a involves social structure and
Grade 8 student. interpersonal relations. (N.L.
Cole, 2020).
Upon the interview, she stated Most adolescents seek peers in

that her relationship with her need of self-esteem and
parents was good as both acceptance. Peer Groups
members of the family provide a sense of belonging,
understood each other. She is approval, and learned behavior.
also close to her cousins as she A supportive peer group can
grows up along with them. She result in a positive influence in
admits that she may be busy the health choice while a poor
with her school workload; she peer group selection results
still makes time for her family. vice versa (Potter & Perry,
Their neighbors were also kind 2020).
to them and sometimes offered
them vegetables from their
neighbors’ own tanim.
considered herself a social
introvert. She stated that
although she may be talkative;
38
she still enjoys being with small

groups and being accompanied
by quiet or non-talkative friends.
Mental Status
- General Appearance and - Upon the interview, she is Researchers have found that an Through the interview, the client
Behavior wearing a white t-shirt. Her individual’s appearance has a presented a well-appearance
hair is tied very well. She huge and definable capabilities and behavior. She has a gentle
has a gentle gesture, and on life experiences and gesture and is cooperative
she cooperates very well opportunities (K. Gruys, 2019). throughout the assessments.
during assessments. Furthermore, the appearance of
a person can tell how he/she is
as facial cues are powerful in
interaction and obtaining
information (V. Zayas, 2016.)
- Level of Consciousness and - She is well-oriented, The organ responsible for a During the interview, the client
Orientation cooperative and was able to person’s consciousness is the was conscious and aware of the
respond to all the questions brain. According to S. Han event. She is also well-oriented
asked of her. (2019), consciousness is the and was able to answer all
awareness, alertness, and questions.
ability of a person to be awake.
- Speech - Upon talking to the client, The sounds being produced in

she is detailed and tells the vocal cords are turning into
39
stories based on her words and this refers to speech She is detailed with her
answers. Her voice is soft, which are the articulated answers and has a soft, clear,
and she delivered all her phrases during communication. and audible voice.
answers clearly and audibly. (Bilingual Kid, 2018). According
to Harappa (2020), a good
characteristic of a speech
includes clear message and key
ideas, impact in oral delivery,
informative, and has a
nonverbal cue.
Emotional Status The client admitted that she According to the American Kasandra Chloe has developed
frequently had anxiety attacks Psychological Association anxiety since the pandemic
ever since the pandemic (2019), emotion is a complex started due to unexpected life
started. She was vocal about pattern of reaction which events, she sees on people
how she viewed things involves experience, behavior, around her. Moreover, her
happening very fast. She also and physiological elements. support system is strong, and
included that her anxiety This also refers to how a person her family is her inspiration to
specifically started when she handles events that have a continue persevering.
found out that most of her high significant impact on their lives.
school classmates’ parents died Emotional Support can be
at this time. On the brighter shown through encouraging,
side, she also stated that her reassuring, and showing
support system is strong. She sympathy to the person. These
grew up being vocal about her can be provided by family,
40
feelings and at the same time friends, and others (C. Raypole,
being sensitive to how others 2020).
may feel about it.
Furthermore, she also admits
that she is having a hard time
with all the life challenges she
faces as she grows, but for as
long as she thinks of her family,
she feels strong and
perseveres.
Sensory Perception
- Sense of Sight - Upon the assessment, the The normal vision acuity of an There are no abnormalities
eyebrows of the client were individual must be grade 20/20. found in the external eye
symmetric, and her hair was A 20/20 vision indicates that a structure of the client. She also
well distributed. Her eyelids person can clearly see a “thing” has good eyesight as she can
curl away from her eyes. at a 20 feet distance (J. Roland, read 14 inches away from the
There is no edema present 2019). readings.
on the lacrimal gland as well
as tearing on the lacrimal
duct and nasolacrimal duct.
Upon inspection, the eyes
constrict and dilate.
PERRLA was noted. On
assessing her vision, she
41
can read letters even 14

inches away from her; she
has a vision of 20/20.
- Through a taste test

- Sense of Taste performed, she was able to The taste reacts to particles The client was able to
determine the sweetness of dissolved in liquid. Every taste determine the different taste
sugar, sour of vinegar, and receptor responds in the five that was tested on her. These
saltiness of salt. As well as basic tastes which are sweet, results indicate that the
the taste of milk and coffee. sour, bitter, salty, and umami. gustatory sense of the client is
(Sherman, 2019). normal and functioning.
position and also have the movement into the electrical of pus, lesions, or blood, but the
same color. Her ear canal signals that make up the presence of earwax was
has some wax but no language of the brain, detected. Upon tests, the
presence of lesions, pus, or translating these vibrations into auditory sense indicates
blood. Upon watching the what we experience as the functioning.
tick test, she was able to world of sound (Sherman,
note when the ticking 2019).
sounds appeared and
disappeared.
42
masses, or displacement of sense of smell (Physiopedia, the patient. The sense of smell
cartilage. The nasal cavity 2021). Jarvis (2016) signifies is functioning very well as the
has no presence of mucus. the importance of the nose, the client was able to identify
And the client was able to one who provides moisture, scents.
identify the scent of filtration, and inhalation of
pandan leaves.
between the texture of and mucosa (Physiopedia, touch.
43
positive Romberg. 2021).
Body Temperature Temperature is taken in the The body temperature readings The body temperature of the
axillary, and they are as follows: of an individual vary on where client is within the normal range.
part of the body the
1st Visit: 36.8OC measurement takes place.
The following are the normal
2nd Visit: 36.5 OC body temperature of individuals
ages 11-65 years old:
3rd Visit: 36.6 OC ⮚ Oral: 36.4OC–37.6OC
⮚ Ear: 35.9OC – 37.6OC
(R. Nall, 2020)
st
Respiratory Status 1 Visit: 17cpm Respiration Rates is an The respiration rate of the client
the activity factors of a person. difficulty in breathing. There are
rd
3 Visit: 18cpm A normal breaths per minute of wheezing sounds while
44
The chest wall is well-intact. adults are in the range of 12cpm breathing out air which
Shoulders both rise at the same to 20cpm (G. Whitworth, 2019). indicates abnormality.
difficulty in breathing. There is a
presence of wheezing breathing
sounds, especially when
breathing out air.
Circulatory Status 1st Visit: The normal pulse rate of a child The circulatory status result of
● PR: 88bpm is within the range 70-100 beats the client indicates that the
● BP: 110/80 mmHg per minute while in adults, it pulse rate and blood pressure
ranges from 60-100 beats per are within their normal range.
2nd Visit: minute (Cleveland Clinic, 2018).
● PR: 86bpm In reading of blood pressure, it
● BP: 120/80 mmHg needs to show a top number
Nutritional Status Upon the interview, the client Nutritional Status refers to the The diet of the family is normal
revealed that she eats meals 2- presence or absence of as the head provides nutrients
3 times a day. Her diet depends malnutrition in an individual that can help in the growth and
on the food that she eats. If the (M.B. Huhmann, 2017). A good development of each member
45
meal contains fish, she eats nutritional status indicates a of the family. The daily water
less as she prefers chicken and balanced diet and its ability to intake is also in the normal
vegetables only. Her average supply essential nutrients in the range in glasses of water. The
water intake was said to be 10- body requirements of an client has no vices, and her BMI
12 glasses a day. At night, she individual (Food Science, is within a normal state.
also admits eating snacks, 2016).
especially when she is doing
school workloads. In terms of Daily Water Intake,
She also confirmed that she The United States National
does not have any vices other Academies of Sciences,
than being wakeful. She weighs Engineering, and Medicine
62kg, standing at 160.02cm. have determined that the
Therefore, her body mass index average fluid intake of a man is
(BMI) is 24.2 15 cups a day while 11 cups a
day for a woman (Mayo Clinic,
2020).
Elimination Status As stated by the client, she Urination is a term to describe According to the norms and
defecates at least twice and the process of emptying the results of the client’s elimination
voids at a range of 6-8 times a bladder. A bladder can fill for status, it was found that the
day depending on her fluid approximately 400 to 600ml of frequency and appearance of
intake amount. Moreover, she urine until an individual urges to her urine and stool were normal
confirmed to not have trouble avoid it. In addition, the average in a healthy individual.
with voiding and defecating. frequency of a person to void is
at least 5 or more in a day
46

According to Kozier (2017),
yellow in color.

appearance (Kozier, 2017),
Reproductive Status The first menstruation for the Menarche refers to the first The menarche of the client
client happened last year when menstruation of females which occurred in the range of normal
she was 12 years old. She has occurs at the average onset age age. The reproductive status is
not been sexually active, and of 12 years old but menarche normal and has no history of
thus, has no history of sexually can occur between ranges 9-17 STI/STDs.
years old. GTPAL refers to the
47
transmitted diseases and records pertaining to

GTPAL. pregnancies and outcomes. It
consists numbers of:
Gravida/Gravidity– number of
pregnancies,
Term pregnancies;
Preterm deliveries;
induced, and;
Living children
Sleep-rest Pattern Her sleep-rest pattern depends Sleep is a process that alters The client has 7-8 hours of
on her school workload. She with longer periods of sleep in a day, which indicates
stated that there are a lot of wakefulness. The sleep-wake that she is within the range of a
activities that must be cycle influences and regulates prescribed sleeping pattern for
accomplished on time due to physiological function and individuals ages 13-17 years
her school’s mode of learning behavior (Potter & Perry, 2020). old.
(Modular blended with According to Huether et al.
Synchronous). She sleeps (2017), sleep provides healing
around 11:00 pm or 12:00 am. and restoration. Moreover, the
And waking up at 7:30 am to American Academy of Sleep
prepare for class. During the Medicine prescribed those
afternoon, she uses that time to teenagers ages 13-17 years old
take a 45mns. to 1hr. nap. must have at least 8-10 hours of
48

hours of sleep.
State of Skin Appendages The state of skin appendages In relation to the norms and
includes the skin itself, sweat findings through assessment of
glands, and nails (H. Yousef et the skin appendages, it was
al., 2021). found that the client is within the
normal state of skin
She has fair skin, warm to A normal skin color depends appendages.
touch, no presence of scars, genetically. The moisture of the
allergies, redness, infections, skin can either be smooth or dry
masses, lesions, and wounds. depending on the location such
that the axillary is usually moist
while hands may be dry due to
exposure. A skin must also be
elasticity
Her hair color is black, thick, A hair color also depends on the
and equal in distribution. There ethnicity of an individual. Its
is no presence of dandruff, distribution and thickness must
49
ticks, and louse as well as be equal with a shiny and

wounds and scars. smooth texture. There must
also be no presence of lesions.
Furthermore, most adult hair
color. (Potter & Perry, 2020).
A normal nail is pinkish in color

The nails of the client are and flat or slightly convex on its
trimmed and cleaned. Her nail surface (Nurse Key, 2016).
plates are pinkish in color with Capillary Refill Test is an
an intact nail bed. It has the assessment done on nail beds
presence of a lunula while its to monitor patient’s hydration
cuticles are intact. and amount of blood flow to
tissue (MedlinePlus, 2019).
Angelica Camille D. Espinosa

20 y/o
Social Status Angelica Camille D. Espinosa is Social Status is a position that It was found that the client had
one of the nieces of Mrs. each individual handles with the a good relationship with each
Gavino. She is 20 years old and rights, duties, and lifestyle in the member of the extended family.
was born on May 16, 2001. She social hierarchy. It also She is an extrovert and has a lot
currently resides with her aunt indicates the age, sex, family,
50
in Sitio Pag-Asa, Tibag, Tarlac education, and other factors to of friends in school and the
City. She is not currently include the social of a person neighborhood.
studying due to the pandemic. (Britannica, 2019). Socialization
Also, she helps her aunt with involves social structure and
the household chores/activities. interpersonal relations. (N.L.
Cole, 2020).
Upon the interview, she admits
to having a good relationship
with her aunt and uncle. She is
also close to her aunt’s
daughter and mostly to her
sister. She also knows and is
friends with a lot of people in the
neighborhood as she is usually
the out-goer in the family.

admits having friends during her
high school years. She is easy
to be close to and talk with.
Mental Status
- General Appearance and - Upon the interview, the Researchers have found that an During the interview, the client
Behavior client is wearing a t-shirt individual’s appearance has a was well in appearance and
with her hair down. She huge and definable capabilities
51
answers all questions; her on life experiences and behavior. She was also able to
fingers are interlaced with opportunities (K. Gruys, 2019). answer all questions.
each other. Furthermore, the appearance of
a person can tell how he/she is
as facial cues are powerful in
interaction and obtaining
information (V. Zayas, 2016.)
- Level of Consciousness and - The client was aware and The organ responsible for a The client was conscious
Orientation conscious regarding the person’s consciousness is the throughout the interview. She
interview. She was well- brain. According to S. Han was well-oriented and
oriented and cooperative. (2019), consciousness is the cooperative. She asks for
awareness, alertness, and unfamiliar terms before
ability of a person to be awake. answering or performing
assessments.
- Speech - She had a low tone of voice The sounds being produced in It was difficult to listen to her at
which was difficult to listen the vocal cords are turning into first due to her low tone of voice.
to at first. However, as the words and this refers to speech But as the interview went on,
interview goes, she which are the articulated she managed to answer clearly.
managed to answer in a phrases during communication.
normal tone and frequency (Bilingual Kid, 2018). According
of the voice. to Harappa (2020), a good
characteristic of a speech
52
includes clear message and key

ideas, impact in oral delivery,
informative, and has a
nonverbal cue.
Emotional Status The client feared having a According to the American The client is afraid of separation
family, losing a child, separation Psychological Association from a loved one and losing a
from her husband due to her (2019), emotion is a complex child due to her experience.
own experience where her pattern of reaction which Regardless of her experience,
parents had parted ways. Even involves experience, behavior, she was able to feel love and
so, she stated that she was and physiological elements. have a complete family. She
thankful that her aunt was able This also refers to how a person also has a strong support
to let her, and her sister feels handles events that have a system through her extended
like a complete family. Her significant impact in their lives. family and boyfriend.
emotional support was from her Emotional Support can be
extended family and boyfriend. shown through encouraging,
She also added that when she reassuring, and showing
is stressed, she either shares sympathy to the person. These
her thoughts with her aunt or can be provided by family,
boyfriend. friends, and others (C. Raypole,
2020).
Sensory Perception
- Sense of Sight - Upon the assessment, the The normal vision acuity of an There are no abnormalities
eyebrows of the client were individual must be grade 20/20. found in the external eye
symmetric, and hair was A 20/20 vision indicates that a structure of the client. She also
53
well distributed. Her eyelids person can clearly see a “thing” has good eyesight as she can
curl away from her eyes. at a 20 feet distance (J. Roland, read 14 inches away from the
There is no edema present 2019). readings.
on the lacrimal gland as well
as tearing on the lacrimal
duct and nasolacrimal duct.
Upon inspection, the eyes
constrict and dilate.
PERRLA was noted. On
assessing her vision, she
can read letters even 14
inches away from her; she
has a vision of 20/20.
- Sense of Taste - Through a taste test The taste reacts to particles The client was able to
performed, she was able to dissolved in liquid. Every taste determine the different taste
determine the sweetness of receptor responds in the five that was tested on her. These
sugar, sour of vinegar, and basic tastes which are sweet, results indicate that the
saltiness of salt. As well as sour, bitter, salty, and umami. gustatory sense of the client is
the taste of milk and coffee. (Sherman, 2019). normal and functioning.
position and have the same movement into the electrical of pus, lesions, or blood, but the
54
color. Her ear canal has signals that make up the presence of earwax was
some wax but no presence language of the brain, detected. Upon tests, the
of lesions, pus, or blood. translating these vibrations into auditory sense indicates
Upon watching the tick test, what we experience as the functioning.
she was able to note when world of sound (Sherman,
the ticking sounds appeared 2019).
and disappeared.
masses, or displacement of sense of smell (Physiopedia, the patient. The sense of smell
cartilage. The nasal cavity 2021). Jarvis (2016) signifies is functioning very well as the
has no presence of mucus. the importance of the nose, the client was able to identify
And the client was able to one who provides moisture, scents.
identify the scent of filtration, and inhalation of
pandan leaves.
between the texture of and mucosa (Physiopedia, touch.
55

positive Romberg. 2021).
Body Temperature Temperature is taken in the A body temperature and its The body temperature of the
axillary, and they are as follows: normal range depends on which client is within the normal range.
part of the body was the
1st Visit: 37OC temperature taken. The
following are the normal body
2nd Visit: 36.6 OC temperature of individuals ages
11-65 years old:
3rd Visit: 38 OC ⮚ Oral: 36.4OC–37.6OC
56
⮚ Ear: 35.9OC – 37.6OC

(R. Nall, 2020)
Respiratory Status 1st Visit: 20cpm Respiration Rates is an The respiration rate of the client
the activity factors of a person. difficulty in breathing.
3rd Visit: 18cpm A normal breaths per minute of
adults are in the range of 12cpm
The chest wall is well-intact. to 20cpm (G. Whitworth, 2019).
Shoulders both rise at the same
difficulty in breathing. There is
no presence of abnormal
breathing sounds.
Circulatory Status 1st Visit: The normal pulse rate of a child The circulatory status result of
● PR: 75bpm is within the range 70-100 beats the client indicates that the
● BP: 120/80 mmHg per minute while in adults, it pulse rate and blood pressure
ranges from 60-100 beats per are within their normal range.
nd
2 Visit: minute (Cleveland Clinic, 2018).
● PR: 80pm In reading of blood pressure, it
● BP: 120/80 mmHg needs to show a top number
57

Nutritional Status Angelica Camille usually eats 2 Nutritional Status refers to the The diet of the family is normal
to 3 times a day. She is not presence or absence of as the head provides nutrients
picky about meals. She prefers malnutrition in an individual that can help in the growth and
to eat more vegetables than (M.B. Huhmann, 2017). A good development of each member
meat products. Her daily water nutritional status indicates a of the family. However, the daily
intake is in the range of 8-10 balanced diet and its ability to water intake of the client does
glasses a day. supply essential nutrients in the not meet the recommended
She has no vices. Her weight is body requirements of an fluid intake. The client has no
60kg standing at 165.1cm. On individual (Food Science, vices, and her BMI is within the
the other hand, her body mass 2016). normal state.
index (BMI) is 22.
Fluid intake varies with the
person, the recommended fluid
intake average for men is 3.7L
(15 cups) a day while 2.7L (11
cups) is recommended for
women (Mayo Clinic, 2017).
Elimination Status The client urinates 5-7 times a Urination is a term to describe According to the norms and
day; no burning, pain, or the process of emptying the results of the client, her
difficulty felt. Her urine color is bladder. A bladder can fill for elimination status was found to
usually yellow and does not approximately 400 to 600ml of be normal as her frequency and
58
contain any foul odor. While she urine until an individual urges to appearance of urine and stool
defecates at least once a day, avoid it. In addition, the average were within the normal range of
specifically in the morning. frequency of a person to void is a healthy individual.
at least 5 or more in a day
According to Kozier (2017),
yellow in color.

appearance (Kozier, 2017).
Reproductive Status The client remembered having Menarche refers to the first The menarche of the client
her first menstruation when she menstruation of females which occurred when she was 15
59
was 15 years old. She started occurs at the average onset age years old (in the normal range of
being sexually active at the age of 12 years old, but menarche menarche occurrence). She
of 17 years old with can occur between ranges 9-17 had 1 Preterm Delivery, where
G1P1T0A0L0. She has no years old. GTPAL refers to the she lost her 26-week-old fetus.
history of sexually transmitted records pertaining to Her reproductive status is
illnesses/diseases. pregnancies and outcomes. It normal, and she has no history
consists numbers of: of STI/STDs.
Gravida/Gravidity– number of
pregnancies,
Term pregnancies;
Preterm deliveries;
induced, and;
Living children
Sleep-rest Pattern The client usually sleeps Sleep is a process that alters The client has 7-8 hours of
between 10 pm to 11 pm and with longer periods of sleep, which means that she
wakes up at 6 am to help her wakefulness. The sleep-wake has achieved enough sleep.
aunt do household chores. cycle influences and regulates
When her sister is awake, she physiological function and
teaches and helps in doing her behavior (Potter & Perry, 2020).
sister’s module. According to Huether et al.
(2017), sleep provides healing
and restoration. Moreover, the
American Academy of Sleep
60
Medicine prescribed those

teenagers ages 13-17 years old
must have at least 8-10 hours of
hours of sleep.
State of Skin Appendages The state of skin appendages In relation to the norms and
includes the skin itself, sweat findings through assessment of
glands, and nails (H. Yousef et the skin appendages, it was
al., 2021). found that Angelica Camille is
within the normal state of skin
appendages. There is a
presence of dandruff that
The client has dark skin, warm A normal skin color depends indicates abnormality and
to touch; there is no presence of genetically. The moisture of the health teaching.
allergies, redness, infections, skin can either be smooth or dry
masses, lesions, and wounds. depending on the location such
She has a scar in her elbow that the axillary is usually moist
which she stated she got when while hands may be dry due to
she was young. exposure. A skin must also be
61

elasticity
The client has black hair; A hair color also depends on the
however, she used hair ethnicity of an individual. Its
chemicals to dye her hair. She distribution and thickness must
has dandruff, no wounds, scars, be equal with a shiny and
ticks, or louse. smooth texture. There must
also be no presence of lesions.
Furthermore, most adult hair
color. (Potter & Perry, 2020).
Both toenails and fingernails A normal nail is pinkish in color

have long and clean nails. Her and flat or slightly convex on its
nail plate is pinkish in color, surface (Nurse Key, 2016).
which is intact with the nail bed. Capillary Refill Test is an
There are also presences of a assessment done on nail beds
lunula with the cuticle intact. to monitor patient’s hydration
and amount of blood flow to
tissue (MedlinePlus, 2019).
62
F. Nutritional Assessment
Family Member Height Weight Body Mass Index (BMI)
Roderick C. Gavino 178 cm 78 kg 24.0
Mary Grace D. Gavino 162.256 cm 58 kg 22
Christine Claire D. Gavino 155 cm 58 kg 24
Kasandra Chloe D. Gavino 160.02 cm 62 kg 24.2
Angelica Camille D. Espinosa 165.1 cm 60 kg 22
Sophia D. Espinosa 114.3 cm 26 kg 19.9
Table 5: Body Mass Index (BMI) of each member of the Family
Interpretation:
It was found in the Body Mass Index (BMI) of each family member that no one has any
signs of malnutrition. All of them are within the normal state of body mass index (BMI). Other than
that, all members of the family do not have maintenance medications, though Mrs. Gavino is
hypertensive, she admitted that she is no longer taking her hypertension medicine, Losartan.
Furthermore, only Kasandra Chloe and Sophia use a nebulizer, when needed. Since the
pandemic has started, Mrs. Gavino instructs each member of her family to take at least one
ascorbic acid (Vitamin C) per day to boost their immune system.
With regards to the meal plan of the family, according to Mrs. Gavino, she always makes
sure that her family will be able to eat three (3) times a day and has a sufficient water intake. The
food that is usually being prepared is Filipino dishes depending on what the children wanted to
63
eat for as long as it is not pork meat. The meals that she usually prepares are composed of rice
and either fish or chicken mixed with any kind of vegetables. For dessert, she prepares fruits such
as bananas or apples. The family also has snack supplies such as flavored bread, crackers, and
peanut bars that the children consume whenever they want.
Norms:
Nutrition is one of the components of health and has an important role in the growth and
development, maintenance, repair, metabolism, and organ function of an individual’s body.
Household food security is critical for all members in need of proper, safe, and nutritious food in
maintaining their lifestyle. One of the important aspects of a physical examination is the nutritional
assessment. This assessment provides data regarding the nutrition of a client which can affect
the functioning of all body stems (Potter & Perry, 2020).
One of the components of a nutritional assessment is the anthropometric measurement

which evaluates the height, weight, and body mass index (BMI) of a client. According to Potter &
Perry (2020), body mass index (BMI) measures the correctness of the weight of an individual on
its own height. A normal body mass index is within the range of 18.5 to 24.9.
Analysis:
Each member of the family undergoes anthropometric measurements to determine their
body mass index (BMI). It was found in the result that the body mass index (BMI) of each member
of the family was within the normal state. Each member was also mandated to have at least one
vitamin c in a day. Furthermore, the family has a good diet with regards to meals and can eat an
adequate amount of nutritious food in their everyday living.
Each Member of the Household Daily Fluid Intake
Roderick C. Gavino 8 glasses
Mary Grace D. Gavino 10-12 glasses
Christine Claire D. Gavino 12 glasses

64
Kasandra Chloe D. Gavino 10-12 glasses
Angelica Camille D. Espinosa 8-10 glasses
Sophia D. Espinosa 10 glasses

Table 6: Daily Fluid Intake of the Gavino Family
Interpretation:
Each member of the family has a different range in daily fluid intake. Mrs. Gavino and her
daughter are drinking an average of 10-12 glasses of water a day. While Christine Claire has only
12 glasses of water in a day. On the other hand, Mr. Gavino and Angelica Camille have 8-10
glasses of water in a day. The youngest of the family usually has 10 glasses of water in a day.
Norms:
The daily fluid intake refers to the total amount of water being consumed in 24 hours. Its
recommendations vary by age, sex, and condition of a client (Center for Disease Control and
Prevention, 2021). Fluid intake varies with the person, the recommended fluid intake average for
men is 3.7L (15 cups) a day while 2.7L (11 cups) is recommended for women (Mayo Clinic, 2017).
Analysis:
Mrs. Gavino, Kasandra Chloe, and Christine Claire are within the normal range of fluid
intake in the family. While Angelica Camille and Sophia do not meet the average, which will
therefore need health teaching.
G. Values, Habits, Practices on Health Promotion
With regards to values, habits, and practices regarding health promotion, Mrs. Gavino admits
that up until today she still seeking help in albularyo to perform pagtatawas whenever someone
in the family is sick. She also uses herbal medicines such as turmeric for fever, calamansi, and
oregano leaves for cough. Even so, it was also stated that all of the members of the family were
completely vaccinated from birth until now. Recently, to make sure that the family gets protection
from the COVID-19 Pandemic, Mrs. Gavino together with Christine Claire and Angelica Camille
were vaccinated for the COVID-19 virus, while Kasandra Chloe and Sophia were vaccinated for
65
flu and pneumococcal. To treat each member of the family with unexpected sickness, the family
also stores supplies of Over-The-Counter medicines such as Bioflu for fever with minor respiratory
tract infection, Ibuprofen for pain, Aspirin for children’s fever, and Neozep for colds.
All members of the family were able to achieve 7-9 hours of sleep a day. While Christine Claire
does not have enough sleep due to school activity. Their sleeping pattern differs at the time they
go to bed and wake up. The head of the family together, with the youngest, has at least 9 hours
of sleep. Other family members are between the range of 7-8 hours. while Christine Claire has
only 4-5 hours of sleep. Thus, all family members attain the adequate amount of rest they need
except for Christine Claire.
According to Mrs. Gavino, the healthy lifestyle practices of the family include eating nutritious
meals and avoidance of eating pork, taking multivitamin supplements, avoidance of vices, and
regularly drinking warm/Luke-warm water. They also used to do walking every 6 in the morning,
however, due to safety precautions that we must follow due to COVID-19, the family finds its way
to exercise inside their house or during household chores.
In terms of protective measures, other than taking vitamin c once a day, the family also
practiced the proper handwashing from the World Health Organization as well as taking
precautions such as wearing masks and following social distancing when going outside.
When the family deals with their own stress management, Mrs. Gavino stated that she taught
all her family members to be vocal with each other regarding their stresses. One of the examples
she specified was relationship problems, all the members are open to listen to each and every
one in order to know or suggest any improvements with regards to the problem that one of the
members is experiencing. She and her husband are aware of not only the importance of physical
health but also mental health especially in the situation they are experiencing today. Both parents
wanted their daughter and nieces to grow in a family where all are open and vocal to each other.
They motivate each member of the family to strive harder in life and be the good person they
wanted to be.
66
Norms:
The modern technology and medical science may seem to pave their ways through the
years, Filipinos still have not obliterated their faith with regards to their health healing traditions
such as albularyos (M.A. Limos, 2020). According to N.R. Rebuya (2020), Albularyos are
considered as a folk general practitioner which uses medicine herbs, rituals, and supernatural
interventions when healing an individual. One of the rituals being performed is what they called
orasyon (tawas) which enables them to know if a spiritual being was the one causing a
disease/illness to a living person.
Sleep is a process that alters with longer periods of wakefulness. The sleep-wake cycle
influences and regulates physiological function and behavior (Potter & Perry, 2020). According to
Huether et al. (2017), sleep provides healing and restoration. Moreover, the American Academy
of Sleep Medicine prescribed those teenagers ages 13-17 years old must have at least 8-10 hours
of sleep while adults ages 18 and above must have at least 7 hours of sleep.
Life in COVID-19 is what most Filipinos call the “life in a new normal”. According to the
Department of Health (2020), a person can protect oneself against the noble corona virus through
ways such as proper handwashing, practice of cough etiquette, maintain social distancing, avoid
going into crowded places, and ensure an adequate diet meal.
In the article titled “Managing Stress for a Healthy Family” by the American Psychological
Association (2019), the APA offered a health path regarding stress management to track down
by members of the household. The health path suggests evaluating lifestyle, talking about the
problem, creating a healthy environment, focusing on oneself, and changes of habit can help in
reducing the stress in the family. Moreover, a support system is considered as a network of people
that provides emotional support to an individual. A support system team may include family and
peers (J. Hood, 2020)
Analysis:
The Filipino health concept of albularyo and pagtatawas was still being used by the family.
Even so, all members of the family are completely vaccinated and have over-the-counter supplies
of medicines in their house. In terms of sleep, all members were able to get enough rest. With
regards to the COVID-19 Pandemic, all families are completely aware and practice safety
67
precautions with the noble virus. Lastly, their family support system is strong as the family is
unafraid to open up with each member of the household.
Roderick Angelica Sophia

Mary Christine Kasandra
C. Camille D.
VACCINES Grace D. Claire D. Chloe D.
Gavino D. Espinos
Gavino Gavino Gavino
Espinosa a
Vitamin K ✅ ✅ ✅ ✅ ✅ ✅
Hepatitis B ✅ ✅ ✅ ✅ ✅ ✅
BCG ✅ ✅ ✅ ✅ ✅ ✅
DTAP ✅ ✅ ✅ ✅ ✅ ✅
IPV ✅ ✅ ✅ ✅ ✅ ✅
Measles ✅ ✅ ✅ ✅ ✅ ✅
Flu Vaccine
✅ ✅ ✅ ✅ ✅ ✅
(Annual Vaccination)
Pneumococcal
- - - ✅ - ✅
(Every 5 years)
Covid-19 ✅ ✅ ✅ - ✅ -
Table 7: Immunizations of Each Member of the Family
Interpretation:
The table above are the vaccines of each family member that shows the family is
completed and continues to get vaccinated annually and every five years. As confirmed by Mrs.
Gavino, vaccination is very important to her and her husband as this prevents their family from
getting the actual disease or severe signs and symptoms. Therefore, she maintains the complete
vaccination needed by each member of her family.
68
Norms:
A program named Expanded Programme on Immunization in the Philippines (EPI) or also
known now as the National Immunization Programme (NIP) is the provider of framework with
regards to the health policies for Filipinos. EPI/NIP includes prevention of diseases, disabilities,
and death through proper vaccination of children and adults (P. Attito et al, 2018).
Analysis:
Each member of the family was completely vaccinated from birth. They also have an
annual flu vaccination for protection against flu viruses and every five years pneumococcal
vaccination for different types of pneumococcal bacteria
69
III. FAMILY COPING INDEX
Legend:
1 – No Competence
2 – Moderate Competence
3 – Complete Competence
Categories 1 2 3 Justification
1) PHYSICAL INDEPENDENCE 1st Visit: During the first visit of the
Nursing Students, the family showed their
This category is capacity in doing their daily living such as
concerned with the ability to move about taking a bath and household activity. The
to get out of bed, to take care daily family is also presentable with how they
grooming, walking and other things which dress. However, there is still a member of
involves the daily activities the family who has untrimmed nails,
dandruff hair and uses strong chemical
products to dye their hair resulting in
irritation. Moreover, one member of the
family has an ineffective oral hygiene as
evidenced by her tooth decay and
cavities. It was all given focus through
70
health teaching as well as the other

teachable health practice that can be
performed by the family.
2nd Visit: On the second visit, the family

is presentable and one of the members of
the family has more neat-looking hair and
nails than the last visit. The health
teaching was applied to all family
members.
3rd Visit: The family continued doing the

health teaching taught by the Nursing
Students. They can perform proper
hygiene such as hand washing and
wound cleaning.
2)THERAPEUTIC COMPONENT 1st Visit: Upon the interview, it was found

that the family has annual vaccination
This category includes all which is also carried out with check-up by
the procedures or treatment prescribed a physician. Even so, during a strike of
for the care of ill, such as giving disease/illness, Filipino folk medicine has
medication, dressings, exercise, and never been removed from the belief of the
relaxation, special diets. family. Mrs. Gavino admitted that she
71
goes first with Albularyo to perform

pagtatawas as it is more convenient, and
the fee is cheaper than going to a
physician. Furthermore, the family has
over-the-counter medicine such as
paracetamol, bio flu, and neozep in their
home.
2nd Visit: It was explained in the family

that their health practice is very good
however their Albularyo belief needed
further advice. It was given a focus to the
family how important it is to consult a
physician especially at this time of the
pandemic.
3rd Visit: The Nursing Student randomly

asked the head of the family on what they
are going to do in case one family
member is sick, she stated to perform
intervention first and go to a physician for
further examination.
72
3) KNOWLEDGE OF HEALTH 1st Visit: The family was asked about

CONDITION their health history of family illness. It was
later indicated that 1 member is
This system is concerned hypertensive while the other 2 are
with the particular health condition that is asthmatic. Even so, each family member
the occasion of care. does not use their maintenance
medications as they only prefer to use it
when the disease has
attacked/encountered again. The family
was given health lessons regarding this
issue.
2nd Visit: The family were still not

persuaded with regards to their
knowledge regarding their health
condition. The Nursing Students again
gave proper health teaching and detailed
explanation regarding their diseases as
well as possible illnesses they may have
caught due to their environment and
other unnecessary health practice.
Furthermore, the family was able to
understand and recognize the main
73
concern of the Nursing Student regarding

their health.
3rd Visit: The Nursing Student observed

that the family is able to adjust and
change their practice regarding their
illness such as the hypertensive now
takes regular medication. They were also
able to eliminate unnecessary things in
their environment which may cause
possible illness or complications
regarding their health.
4) APPLICATION OF THE 1st Visit: Each member of the family

PRINCIPLES OF THE GENERAL consumes meals at least 2-3 times a day.
HYGIENE Their diet includes rice and meals cooked
with fish, poultry products, and
This is concerned with the vegetables only. Their dessert is fruits
family action in relation to maintaining such as bananas. However, the children
family nutrition, securing adequate rest in the family have available snacks such
and relaxation for family members, as biscuits that they consume whenever
they want. All the family members are
74
carrying out accepted preventive able to sleep more than 7 hours and
measures, such as immunization. perform exercise through doing
household chores.
With regards to COVID-19 preventive
measures, the family always makes sure
to follow all government protocols.
Furthermore, the three adults in the
family are vaccinated with COVID-19
Vaccine while the two children were
vaccinated with Flu and Pneumococcal.
2nd Visit: The family members are able to

maintain their general hygiene practice.
3rd Visit: The family members are able to

maintain their general hygiene practice.
5) HEALTH ATTITUDES 1st Visit: Upon the interview, the family

first goes to Albularyo before going to a
This category is physician. At this time of pandemic, they
concerned with the way the family feels fear going to the hospital, health center,
about health care in general, including and any other crowded areas. Mrs.
Gavino also revealed one of the reasons
75
preventive services, care of illness and for not going immediately to the physician
public health measures. is because, at this time of pandemic, it is
very hard to trust doctors and other health
care staff. Based on stories and
experiences she had with her friends,
where-in dead family members are
considered as COVID-19 positive even
when they are not. Other than that, being
swabbed while you have a cough or cold
will automatically be considered as
COVID-19 positive. She also sees the
public health service in the Philippines is
very poor as the government does not
provide enough for our health care
facilities and workers.
2nd Visit: Upon expounding the

importance and benefit of going to a
trusted physician, the head of the family
promised to go to a trusted clinic other
than going to Albularyo that may cause
risks in the health of the family.
76
3rd Visit: The perspective and

understanding of the family regarding the
health care system in the Philippines
became wide. Mrs. Gavino assured to be
considerate with public health service as
there are other patients being taken care
of by the health care workers.
6) FAMILY LIVING 1st Visit: Upon the first day of visit, the
family showed an openness, good
This category is communication and relationship with one
concerned with the interpersonal or another. The husband and wife admitted
group aspects of the family get along that they practice with their children by
with one another, the ways in which being open and transparent to each
they take decisions affecting the family as member of the family as well as sharing
a whole. thoughts and explanations to avoid being
misunderstood.
2nd Visit: Each member of the family

going through assessment is being
cheered by other members of the family.
They help each member, especially the
youngest to not be afraid of the Nursing
Students.
77
3rd Visit: The family continues to show

harmony in their home.
7) PHYSICAL ENVIRONMENT 1st Visit: Through observation on the

outside area of the Gavino Family’s
This is concerned with house, it was noticed that there are
the home, the community, and the presence of mosquitos living on their
work environment as it affects family shrub plants. Inside their house, vectors
health. such as cockroaches were noticed in
their food cabinet. The house ventilation
is fair. On the other hand, in the open
kitchen area, it was noticed that their
kitchen utensils are only placed on the
sink while small mice are running around
the kitchen roof gutter. Their garbage
disposal is located at the side of the
kitchen area where it is composed of
biodegradable and non-biodegradable
waste placed in one sack. Furthermore,
Mrs. Gavino also raised a concern as one
of their neighbors burns waste every
afternoon, causing a thick smoke and
78
unpleasant smell which must be given a

focus. The family were given health
teachings regarding their physical
environment.
2nd Visit: Through health teaching, the

family is aware of the possible disease
they may get through their surroundings.
They created a way to lessen mosquitoes
since mosquitos are roaming on their
shrub plants. Mrs. Gavino requested a
citronella plant for her next-door
neighbor, which is known to repel
mosquitos. They also cleaned their
cabinets and placed a trap in the cabinet
and kitchen to catch vectors such as
mosquitos and mice. However, the
neighbor who always burns garbage was
still uncooperative regarding the
wrongdoing.
79
3rd Visit: The physical environment of the

family has improved as they use all the
creative ways from the health teaching
taught by the Nursing Students. The
neighbor was now cooperative, however
he only promised to limit burning waste
garbage.
80
IV. TYPOLOGY OF NURSING PROBLEM
This Chapter discusses the problems that were identified during the assessment and interview
with the family. It includes the cues/data, the family nursing problem and the nursing diagnosis.
The problems identified are categorized into the presence of wellness state, health deficits, health
threats, and foreseeable crisis and stress points.
Scoring:
1. Decide on a score for each of the criteria Score Weight

A. Nature of the problem Weight
a. Wellness state 3
b. Health deficit 3 1
c. Health Threat 2
d. Foreseeable Crisis 1
B. Modifiability of the problem
a. Easily Modifiable 2
b. Partially Modifiable 1 2
c. Not Modifiable 0
C. Preventive potential
a. High 3
b. Moderate 2 1
c. Low 1
D. Salience scale
a. A condition needing immediate attention 2
b. A condition does not need immediate attention 1 1
c. Not perceive as problem 0
2. Divide the score by the highest possible score and multiply by the weight
3. Sum of the scores for all the criteria. The highest score is 5, equivalent to the total weight
Source: (Nursing Practice in the community Fourth Edition by Arceli S. Maglaya)

81
V. RANKING OF PRIORITIZATION OF IDENTIFIED HEALTH PROBLEM
Rank Problems Score

1 Ineffective health maintenance related to difficulty in managing 5
treatment regimen as evidenced by discontinued maintenance
medication
2 Presence of health threats due to poor environmental sanitation as 4.67
evidenced by presence of breeding and resting sites of vectors
causing diseases
3 Presence of health threats due to unhealthy personal habits as 4.67
evidence by nail biting mannerism and walking barefoot outside and
inside the house
4 Respiratory health threat associated with incineration activity 4.34
5 Presence of stress points due to family anxiety related to parental 4.33
separation
6 Family deficient knowledge related to misinformation presented by others 4
7 Ineffective health management related to difficulty navigating complex 3.67
healthcare system
8 Risk for fluid deficit volume related to insufficient fluid intake as evidenced 3
by verbalized report of daily fluid intake
9 Impaired dentition related to inadequate oral hygiene as characterized by 2.33
presence of dental caries
10 Grieving characterized by maintaining a connection to the deceased 2.17
The table presented above shows the top 10 priority health problems identified in the
Gavino Family. The computation of the top 5 priorities will be shown below using a table containing
the corresponding justification. The top 5 priority problems in the family are the following:
82
INEFFECTIVE HEALTH MAINTENANCE RELATED TO PERCEIVED BEHAVIORAL

CONTROL AS EVIDENCED BY FAILURE TO INCLUDE TREATMENT REGIMEN IN DAILY
LIVING
CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

1) Nature of the 3/3 x 1 1 One member of the
problem family is hypertensive
while the other two are
asthmatic. Due to lack
of guidance and poor
reminders, it resulted
in a health deficit. The
family are no longer
taking their
maintenance medicine
as their diseases’ signs
and symptoms are not
being experienced or
manifested.
2) Modifiability of 2/2 x 2 2 The problem is easy to
the problem modify through proper
health teaching and
guidance that will be
provided by the
Nursing Student.
3) Preventive 3/3 x 1 1 The problem is highly
potential preventive as the
family shows
cooperativeness and
willingness to listen,
understand and follow
the health teaching
being provided.
83
4) Salience of the 2/2 x 1 1 The head of the family

problem stated that it needed
immediate attention if
there is really a
potential complication
of disregarding
maintenance
medicine.
Total: 5
PRESENCE OF HEALTH THREATS DUE TO POOR ENVIRONMENTAL SANITATION AS

EVIDENCED BY PRESENCE OF BREEDING AND RESTING SITES OF VECTORS CAUSING
DISEASES

1) Nature of the 2/3 x 1 0.67 Vectors present in the
problem food cabinet and
kitchen area are a
health threat to the
family as these
vectors can bring
different vector-borne
diseases.
2) Modifiability of 2/2 x 2 2 The problem is easy
the problem to be modified by
helping the family
through executing
proper disinfection
and relocating food
items and kitchen
utensils.
84
3) Preventive 2/3 x 1 0.67 The problem is

potential moderately
preventive as the
vectors present in the
open roof gutter
cannot 100% be
eliminated. However,
the family are willing
and aware of the
possible outcome, so
they promise to
always clean for the
health safety of each
family member.
4) Salience of the 2/2 x 1 1 The problem needed
problem immediate attention
as these vectors may
cause more serious
complications in the
health of each
member of the family.
Total: 4.67
QPRESENCE OF HEALTH THREAT DUE TO UNHEALTHY PERSONAL HABITS AS

EVIDENCE BY NAIL BITING MANNERISM AND WALKING BAREFOOT INSIDE AND
OUTSIDE THE HOUSE

1) Nature of the 2/3 x 1 0.67 The youngest
problem member of the family
has a nail-biting habit.
This disorder can be a
health threat to her as
85
nail-biting can result in

a possible infection
due to mistreatment
and lack of proper
care in broken
tissues.
2) Modifiability of 2/2 x 2 2 It is easy to modify as
the problem the Nursing Student
will provide a health
teaching, cite
examples about the
outcome of the
problem as well as
demonstrate a proper
wound care for
infected hangnails.
client is only a child
which is easy to
persuade and can be
teachable by the
Nursing Student.
4) Salience of the 2/2 x 1 1 The nail-biting habit of
problem the child needed
immediate attention
as it can still be
prevented at her very
young age.
Complications such
as infection resulting
from contamination of
bacteria in the teeth
and mouth may
86
happen if it will not be

treated well.
Total: 4.67
RESPIRATORY HEALTH THREAT ASSOCIATED WITH INCINERATION ACTIVITY

1) Nature of the 2/3 x 1 0.67 Incineration is a
problem method which
involves combustion
of any waste
materials. It is a health
threat to each
member of the family
and neighborhood as
the smoke from
incineration activity
may harm their
respiratory systems.
2) Modifiability of 2/2 x 1 2 The problem is easily
the problem modifiable through
health teaching and
the Nursing Student
will help the family in
executing a friendly
communication to the
neighbor who
performs this activity.
3) Preventive 2/3 x 1 0.67 The problem is
potential moderately
preventive as the
neighbor is not
cooperative towards
the health threat he is
87
causing in the
neighborhood.
4) Salience of the 2/2 x 1 1 The problem is in
problem need of immediate
attention as if it will be
neglected and
ignored, the family
and neighborhood
may suffer from
respiratory illness
especially the ones
with an asthma
condition.
Total: 4.34
PRESENCE OF STRESS POINTS OR FORESEEABLE CRISIS SITUATION DUE TO FAMILY

ANXIETY RELATED TO PARENTAL SEPARATION

1) Nature of the 1/3 x 1 0.33 Foreseeable crises
problem such as pregnancy,
having a family, being
separate/apart with
family member and
any other life event
pertaining to “family”
causes an anxiety to
the Gavino Family
due to their close
bond/tie and strong
support system with
each other.
88
2) Modifiability of 2/2 x 1 2 The problem is easy

the problem to modify through
opening the minds of
the family regarding
changes that may
occur in each member
when an unexpected
life event may come.
family is willing to
cooperate and adjust
with the health
teaching and practice
provided by the
Nursing student.
4) Salience of the 2/2 x 1 1 The problem is in
problem need of immediate
attention because of
the age of each
member of the family.
It is indeed that
sooner or later some
members may enter
into marriage and
build their own family
or other new life
events may happen.
Each member of the
family must be
prepared to go out of
their comfort zone.
Total: 4.33
89
VI. FAMILY NURSING CARE PLAN

FNCP #1: INEFFECTIVE HEALTH MANAGEMENT RELATED TO DIFFICULTY IN MANAGING TREATMENT REGIMEN AS
EVIDENCED BY DISCONTINUED MAINTENANCE MEDICATION
Methods of
Health Family Nursing Objectives of Nursing Resources
Goal of Care Nurse Family
Problems Problem Care Interventions Required
Contact
Ineffective Inability of the Within three After three days Independent - Home visits Family
Interventions: Resources:
health family to fulfill days of of the home visits
1. Availability of
managemen their health performing with the
1. Assess family’s the medication in
t related to responsibility in appropriate application of
knowledge and the household.
difficulty in continuing their nursing appropriate
understanding of the
managing maintenance interventions nursing
need for maintenance 2. Understanding,
treatment medicines due through home interventions, the
medication. effort, and
regimen as to: visits, the family will be able
Rationale: Provides intellectual
evidenced by a. Failure in family will be to:
opportunities to clarify capacity of the
discontinued recognizing the able to - Participate in
viewpoints or family member to
maintenance importance of understand the the provided misconceptions. achieve the
medication is taking their sense of need set of Verifies that client and desired practice
a health maintenance in continuing developmenta to have accurate and and outcome.
deficit medicines. their respective l goals and
information with
among b. Continuous medications. treatment which to make 3. Ability of the
members of practice in plans. informed choices family to provide
the family forgetting the - Verbalize (Doenges et. al, the maintenance
especially expected time in accurate Nursing Care Plan, medications of
the ones taking the knowledge of 10th Edition, 2019).
under medication. disease,
90
maintenance c. Lack of prognosis, member’s who are

medication. knowledge with and potential 2. Assess the client's in need.
regards to the complications feelings, values, and
possible if medication reasons for not
outcome of a is not taken. following prescribed Community
health deficit. - Demonstrate plans of care and see Resources:
d. Habitual belief behaviors or related factors. 1. Availability of
to only take changes in Rationale: A factor to the maintenance
maintenance lifestyle assess when medication in the
medicines when necessary to examining client community health
it is needed such incorporate or responsibility is the center.
as manifestation to maintain level of dissatisfaction
illnesses starts therapeutic with current lifestyle Nurse
to occur. effect of the and readiness for Resources:
regimen change, (Clark, 1. Time in
through daily 2018). providing health
intake. teaching.
- Identify and 3. Assess for family
use available patterns, economic 2. Skills,
resources. issues, and cultural knowledge, and
patterns that attitude (SKA) in
influence compliance providing
with a given medical information and
regimen. learning with
91
Rationale: regards to family

Responsiveness to health problems.
clients enables the
nurse to gain an 3. Ability to
understanding of provide support
client’s lives and to and motivation to
cultivate their the clients.
connections to a
responsive
community,
encouraging clients to
not get into
“receiving” factors,
(Smith-Battle, 2017).
4. Assess for the

influence of cultural
beliefs, norms, and
values on the client’s
ability to modify
health behavior.
Rationale: What the
client considers
normal and abnormal
92
health behavior may

be based on cultural
perceptions,
(Leininger, 2017).
5. Note the
developmental and
chronological age.
Rationale: Impacts
ability to understand
own needs and
incorporate
into treatment
regimen (Doenges et.
al, Nursing Care Plan,
10th Edition, 2019).
6. Review the
maintenance
medication plan and
pattern of the client.
Rationale: Provides
opportunities to
93
exchange accurate
information and
to clarify viewpoints or
misconceptions
(Doenges et. al,
Nursing Care Plan,
7. Determine
problems that may, or
do, interfere with
treatment, including
lack of financial or
personal resources or
lack of availability of
providers. Assess
level of anxiety,
focus of control, and
sense of
powerlessness.
Rationale: Many
factors may be
involved in behavior
that is disruptive
94
to the treatment
regimen, such as fear
(Doenges et. al,
Nursing Care Plan,
8. Note length of
illness and prognosis.
Rationale: Clients
tend to become
passive and
dependent on long-
term, debilitating
illness (Doenges et.
9. Help the client to

self-manage their
health and
maintenance
medications.
Rationale: Provides
a sense of control;
95
enables clients to
follow their own
progress and make
informed choices
(Doenges et. al,
Nursing Care Plan,
10. Discuss with the

client those aspects
of their health
behavior/lifestyle that
will remain that will
remain unchanged by
their health status.
Rationale: Aspects of
the client’s life that
are meaningful and
valuable to her should
be understood and
preserved without
change, (Leininger,
2017).
96
11.Provide aids to
assist with
compliance such as
prepare medication
schedules and put a
week’s medication in
a daily container.
Rationale: Cues play
a significant role in
stimulating
completion of desired
health actions.
(Leininger, 2017).
Collaborative
Interventions:
1. Nurse-Family
- Establish graduated
goals or modified
regimen as
necessary.
Rationale: Promotes
client involvement
and independence.
97
Client participation in
setting goals,
encourages
Cooperation and
willingness to follow
through with the
program (Doenges et.
- Actively listen
client’s reports and
comments.
Rationale: Conveys
message of concern
and belief in
individual’s
capabilities to resolve
situations in a positive
manner (Doenges et.
98
FNCP #2: PRESENCE OF HEALTH THREAT DUE TO POOR ENVIRONMENTAL SANITATION AS EVIDENCED BY PRESENCE
OF BREEDING SITES OF VECTORS SUCH AS RODENTS AND INSECTS CAUSING DISEASE
Family Methods of
Health Objectives of Nursing Resources
Nursing Goal of Care Nurse Family
Problems Care Interventions Required
Problem Contact
Presence of Failure of the Within the days After the conduct Independent - Home visits Family
health threat family to be of executing of the home visits Interventions: Resources:
due to poor responsible and proper nursing and providing 1. Initiation and
environmental take action in interventions nursing 1. Ascertain the type cooperation of
sanitation as their home and health interventions, the of contaminants such the family in
evidenced by environment teaching, the family will be: as microbial. promoting
presence of sanitation for family will be - Able to extend Rationale: To sanitation.
breeding sites the reason: able to take their determine the
of vectors such proper actions knowledge potential health 2.
as rodents and a. Lack of in eliminating with regards in hazard of the family Understanding
insects knowledge of vector breeding health threat (Doenges et. al, of the family
causing the family to sites and due to poor Nurse’s Pocket with regards to
disease. scale and find reduce environmental Guide, 2019). sanitation.
importance presence of sanitation as
regarding the vectors in their evidenced by 2. Determine manner 3. Availability of
magnitude of environment presence of of exposure, when repellents in the
the problem. with the use of vectors on possible, household.
99
b. Impotence of available their contamination Community

the family to resources. environment occurred. Resources:
relocate and Rationale: To 1. Free
organize - Give determine the course pesticides in the
articles. importance to of action to be taken household.
the magnitude by all emergencies
c. Availability of the (Doenges et. al,
and schedule of problem. Nurse’s Pocket Nurse
the family in Guide, 2019). Resources:
taking action on - Learn nursing 1. Time in
the sanitation interventions 3. Assist the family in providing health
problem. such as developing a plan to teaching.
cleaning address each family
measures. member's safety and 2. Skills,
needs. knowledge, and
- Demonstrate Rationale: To attitude (SKA) in
correct usage address what must providing
and proper be done effectively information and
ways of and to identify the learning with
cleaning needs and gaps in regards to
measures environmental health family health
such as (Hygiene and problems.
relocating Environmental
food supply. Health)
100
3. Visual aids
4. Discuss general and
safety concerns with demonstrations
the family. to conduct in the
Rationale: To ensure discussion of
their knowledge food sanitation.
about potential risks
and ways in
managing risks
(Doenges et. al,
Nurse’s Pocket
Guide, 2019).
5. Demonstrate to the
family the proper
hand washing,
utensils cleaning,
food refrigerating and
correct food
temperature.
Rationale: Without
thoroughly washing
their hands, from
food that touches
101
surfaces or utensils
contaminated by
pathogens in raw
food, and improper
refrigeration or
heating of food (B.
Ackley et. al, Nursing
Diagnosis Handbook,
2016).
6. Provide truthful
information for topics
such as signs and
symptoms of
contamination and
decontamination
protocols.
Rationale: Well-
managed efforts at
communication of
contamination
information ensure
that messages are
correctly formulated,
102
transmitted, and
received and that
they result in
meaningful actions
(B. Ackley et. al,
Nursing Diagnosis
Handbook, 2016).
7. Emphasize the
importance of pre-
and post-exposure
treatment of
contamination.
Rationale: Early
treatment decreases
associated
complications related
to contamination (B.
Ackley et. al, Nursing
Diagnosis Handbook,
2016).
8. Provide parents
with actionable
103
information to reduce
environmental
contamination in the
home.
Rationale: A
randomized
educational
intervention to reduce
contamination in the
home demonstrated
significant reduction
in biomarker levels
and improved
environmental health
self-efficacy and
precaution adoption
(B. Ackley et. al,
Nursing Diagnosis
Handbook, 2016).
Collaborative
Interventions:
1. Healthcare Team:
104
Collaborate with a
comprehensive
disaster plan on the
community which
includes change of
command,
equipment,
communication,
training, and
decontamination.
Rationale: To ensure
an effective response
to any health
emergency
pertaining to
exposure caused by
poor environmental
sanitation ((Doenges
et. al, Nurse’s Pocket
Guide, 2019).
2. Nurse-Family
Collaboration:
105
Help the family to

cope up with
contamination by
providing accurate
information on risks
involved and
preventive measures.
Rationale: Well-
managed efforts at
communication of
contamination
information ensure
that messages are
correctly
formulated,
transmitted, and
received and that
they result in
meaningful actions
(B. Ackley et. al,
Nursing Diagnosis
Handbook, 2016).
106
FNCP #3: PRESENCE OF HEALTH THREATS DUE TO UNHEALTHY PERSONAL HABITS AS EVIDENCED BY NAIL BITING
MANNER AND WALKING BARE-FOOTED OUTSIDE AND INSIDE THE HOUSE
Methods of
Health Family Nursing Objectives of Nursing Resources
Goal of Care Nurse Family
Problems Problem Care Interventions Required
Contact
Failure of the After 2 hours of After the third Independent - Home visits Family
Presence of
family to be providing an home visit, the Interventions: Resources:
health
responsible and effective child and family 1. Initiation and
threats due
take action in therapeutic will be: 1. Conduct mutual goal cooperation of the
to unhealthy
their unhealthy nursing setting with the person. family in improving
personal a. Express
personal habits intervention, Rationale: Self-care unhealthy
habits as desire to
for the reason: the family will levels are mainly personal habits
evidenced enhance
be able to take dependent on the
by nail biting a. Lack of independence
necessary duration of the disease 2. Understanding
manner and knowledge of the with life, health,
family to scale measures to and nursing care of the family with
walking bare personal
and find properly and should be planned with regards to
footed importance development, or
adequately the client accordingly. unhealthy
outside and regarding the well-being
magnitude of the manage (B. Ackley et. al, personal habits
inside the
problem. unhealthy Nursing Diagnosis
house
personal habits Handbook, 2016). Community
b. Failure to
b. Express Resources:
identify and use
desire to 1. Utilization of the
resources
enhance self- 2. Encourage patient barangay health
appropriately.
care, knowledge to voice feelings and center to promote
107
c. Failure to for strategies for concerns about self- awareness

remain free of self-care care deficits regarding self-
preventable
care between
complications.
c. Able to show Rationale: To help
families.
interest and patient achieve the
demonstrate highest functional level
Nurse
techniques to possible. (M. Doenges,
Resources:
improve et al., Nurse’s Pocket
1. Availability of
unhealthy Guide, 2018)
the nurse to make
personal habits
3. Provide supportive time in providing
measures, as health teaching.
indicated:
2. Skills,
– Assist with knowledge, and
general hygiene attitude (SKA) in
and comfort providing
measures information and
learning with
Rationale: To promote
regards to family
comfort and sense of
health problems.
well-being. (M.
Doenges, et al.,
3. Visual aids
Nurse’s Pocket Guide,
about self-care
2018)
and its outcomes.
108
– Administer
pain
medication and
monitor its
effectiveness.
Rationale: Patient
needs pain relief to
maintain health. (M.
Doenges, et al.,
2018)
– Maintain
proper environmental
conditions
Rationale: To promote
patient’s sense of well-
being. (M. Doenges, et
109
al., Nurse’s Pocket

Guide, 2018)
– Maintain
infection control
standards
Rationale: To reduce
the risk of spreading
disease. (M. Doenges,
et al., Nurse’s Pocket
Guide, 2018)
4. Assess patient with

failing self-care for
changes in cognitive
function
Rationale: Because
neglected self-care
may be the first
noticeable sign of
diminishing cognitive
function. (M. Doenges,
110

Guide, 2018)
5. Involve patient’s
family in care activities
as appropriate
Rationale: To improve
the chance that the
patient will incorporate
recommended
regimens into lifestyle
as long-term choice.
(M. Doenges, et al.,
2018)
6. Determine individual
strengths and skills of
the client
Rationale: To
incorporate into a plan
of care, enhancing
likelihood of achieving
outcomes. (M.
111
Doenges, et al.,
2018)
7. Note availability and

use of resources,
supportive person/s
assistive devices
Rationale: To
ascertain that client
has means for sharing
common concerns,
needs, and wishes as
well as has access to
social support and
approval (e.g., support
group participants,
family members,
professionals). (M.
Doenges, et al.,
2018)
112
8. Support client in
making health-related
decisions and pursuits
of self-care practices
that promote health
Rationale: To foster
self-esteem and
support positive self-
concept. (M. Doenges,
Guide, 2018)
9. Identify reliable
reference sources
regarding individual
needs and strategies
for self-care
Rationale: Reinforces
learning and promotes
self-paced review. (M.
Doenges, et al.,
2018)
113
10. Provide for ongoing

evaluation of self-care
program
Rationale: To identify
progress and needed
changes for
continuation of health,
adaptation in
management of
limiting conditions. (M.
Doenges, et al.,
2018)
Collaborative
Interventions:
1. Healthcare Team:
Collaborate with
barangay health
workers for referral to a
psychiatrist or
psychologist if the
114
progress is
unimproved.
2. Nursing-Family
The student-nurse and
family will develop
strategic plans to
eliminate the
unhealthy habit of the
family.
115
FNCP #4: RESPIRATORY HEALTH THREAT ASSOCIATED WITH INCINERATION ACTIVITY
Health Family Nursing Goal of Care Objectives of Nursing Methods of Resources

Problems Care Problem Care Interventions Family Contact Required
Respiratory Inability Within 3 days After 3 days of Independent Home Visits Family
health threat of of the home the home Interventions: Resources:
associated with the visits, the visits, family 1.Availability of
incineration family nurse will will be able to: 1.Establish the resources
activity to execute - Understand rapport needed for
provide a proper nursing the risks of Rationale: practicing the
healthy interventions burning waste Good rapport alternative
environment where the materials. creates a close ways to burn
due to family will - Know the and harmonious waste.
incineration reconsider importance of relationship with 2.
activity such about taking maintaining a patients. It Understanding
as burning appropriate healthy allows you to of the family.
their waste action(s) in environment. understand your 3. Ability of the
preventing - Participate in family to provide
materials patient's feelings
the materials
a.Failure incineration the and and cooperation
activity and will development of needed.
in communicate
recognizing be able goals in well with them. It Community
to providing a Resources:
the connects you to
understand healthier Utilization of
importance your patients
the sense environment. the barangay
of the and can improve
of - Explain to their health center to
environment in patient care
116
their health providing a neighbors the (Mills, 2020) promote

b.Lack healthy alternative awareness on
of environment. ways in getting 2. Explain the the punishment
knowledge rid of the waste diseases that regarding non-
with the risks materials might occur to compliance of
of incineration properly. the family due to the legal law
activity - Explain to their incineration about
c. Insufficient neighbors the activity. incineration
knowledge possible Rationale: activity.
about the respiratory Health risks can
Nurse
proper way of health threat sometimes be
Resources:
getting rid of associated with confusing, but
1. Time in
their waste incineration they're important
providing health
materials. activity calmly. to understand.
teaching.
d. Habitual Explain to your Knowing the 2. Accurate
belief to only neighbors the risks, you and knowledge and
burn the waste legal law your family may data from the
materials for regarding face can help student nurses
cleaner incineration. you find ways to to relay to the
environment. avoid health family.
problems. It can 3. Visual aids
Convince their also keep you and
neighbors to from fretting demonstrations
practice proper over unlikely
117
waste disposal. threats. to conduct

(Bethesda, in the
2016) discussion.
3. Demonstrate
to the family the
proper ways of
getting rid of
their waste
materials.
Rationale: It is a
way to confirm
that you have
explained to
your patient
what they need
to know in an
understandable
way. This
method can also
help you identify
the strategies
that are most
helpful for
118
patient
understanding
4. Discuss to the
family the
advantage in
having a clean
environment.
Rationale: It
promotes human
health and well-
being; and
fosters healthy
and safe
communities.
(Benjamin,
2021)
5. Teach parents
how to properly
communicate
with their
neighbors about
their incineration
119
activities.
Rationale:
When
communication
is effective, it
leaves all parties
involved
satisfied and
feeling
accomplished.
By delivering
messages
clearly, there is
no room for
misunderstandin
g or alteration of
messages,
which decreases
the potential for
conflict.
(Faleti, 2017)
Collaborative
120
Intervention
Barangay Team
Collaborate with
your local
barangay about
your rights on
the incineration
activity
happening in
your
neighborhood
especially if this
activity
jeopardize the
client's health
status
Rationale:
Incinerators
pollute nearby
communities
and diminish the
health of the
population at
121
large. Burning
our waste poses
considerable
risks to the
health and
environment of
nearby
communities as
well as the
broader public.
(Maxey, 2018)
Healthcare
Team
Be updated
about the
different
programs or
activities your
local health
teams has for
you. Rationale:
Collaboration is
the process that
122
makes it
possible to
reach a goal that
cannot be
achieved by one
person or
agency alone.
This implies a
need for
negotiation and
agreement
about the goal
and strategies.
Partners work
together by
sharing
expertise,
resources, and
responsibility for
achieving the
goal. (Youth
Development in
Communities)
123
Nurse-Family.
Talk to your
client about the
possible
outcomes of
incineration to
their respiratory
health and and
give them ways
on how they can
deal with it
properly.
Rationale
Incineration
contributes to air
pollution and like
many other
forms of air
pollution, it
seems toxic
fumes from
incinerators are
likely to affect
deprived areas,
124
as well as areas
with high
populations of
people of colour
the most. (Client
Earth, 2021)
125
FNCP#5 FAMILY ANXIETY RELATED TO LIFE EVENTS
Health Family Nursing Goal of Care Objectives of Nursing Methods of Resources

Problems Care Problem Care Interventions Family Contact Required
Presence of Vague uneasy After providing Within the three Independent Home Visits Family
Interventions:
stress points feeling of effective nursing (3) home visits Resource
due to family discomfort or interventions conducted by 1. Build rapport
anxiety related dread such as the nurse. The with your client 1. The
to parental accompanied by providing family will Rationale: willingness of
separation an autonomic reassurance and achieve: Good rapport the family to
response which comfort - reduction in creates a close seek a
causes: measures, the worrisome and harmonious psychologist to
a. stress and client will be - openness relationship with better deal with
anxiety to each able to reduce about how they patients. It the condition
family members its anxiety and feel and the allows you to 2. Family
b. possibility of worry level, be effect of this life understand your activities that
members to able to identify event to them patient's feelings serve as their
display low self- healthy ways to -to know some and coping
esteem and deal and coping communicate mechanisms
mistrust to other express anxiety mechanisms the well with them. such as traveling
people. and appear client can use (Nurse Choice, and eating/going
c. client may relaxed, and once an event 2020) out
experience lack report that such as
of motivation or anxiety is at a marriage may 2. Be available
126
focus manageable occur. to the client for Community

d. neglect on state. listening and Resources
client’s physical talking 1. Utilization of
self-such as Rationale: the community’s
client’s absence Promotes resources such
of exercise and expression of as the
self-care feelings and availability of
helps DSWD and
client/significant other healthcare
other look at teams.
realities of the
illness of Nurse
treatment Resources
without 1. Nursing
confronting paraphernalia
issues they are (CHN bag and
not ready to deal other nursing
with. equipment such
(F.A Davis, as thermometer,
Nurse’s Pocket BP apparatus
Guide, 2018) and such)
2. Pen and
3. Acknowledge ballpen
client’s 3. Visual aids
127
anxiety/fear used for health

Rationale: teaching
Validates reality
of feelings.
False
reassurance
may be
interpreted as
lack of
understanding
or dishonesty,
further isolating
client.
(F.A Davis,
Nurse’s Pocket
Guide, 2018)
4. Assist client in
developing self-
awareness of
verbal and
nonverbal
behaviors.
Rationale:
128
Becoming aware
helps client to
control those
behaviors and
begin to deal
with issues that
are causing
anxiety
(F.A Davis,
Nurse’s Pocket
Guide, 2018)
5. Monitor
client’s vital sign
Rationale:
To identify
physical
responses
associated with
both medical
and emotional
conditions.
(F.A Davis,
Nurse’s Pocket
129
Guide, 2018)
Dependent
Intervention:
Refer the client
to Psychologist
to better ensure
proper
assessment and
treatment
Rationale:
Psychologists
help patients
learn to identify
and manage the
factors that
contribute to
their anxiety.
(American
Psychological
Association,
2016)
Collaborative
130
Intervention:
Healthcare
Team:
Collaborate with
your local
Barangay Health
Center to be
updated with the
different
activities related
to your case.
Rationale:
Collaboration
Collaboration is
the process that
makes it
possible to
reach a goal that
cannot be
achieved by one
person or
agency alone.
This implies a
need for
131
negotiation and
agreement
about the goal
and strategies.
Partners work
together by
sharing
expertise,
resources, and
responsibility for
achieving the
goal. (Youth
Development in
Communities)
Nurse-Family
Encourage the
family to attend
counselling that
will help them
deal with their
current condition
Rationale:
There is a direct
link between
132
physical and
mental health.
Often, when
individuals treat
underlying
mental health
conditions or
receive
counseling to
help regulate
emotions and
improve mood,
physical health
improves as
well. (Madeson,
2021)
133
VII. SUMMARY, EVALUATION, AND RECOMMENDATION
The family case study of the Gavino family consisted of different parts containing all the
information as the initial baseline data regarding each member of the family’s unique
characteristics and health conditions. The contents included in this case study are the family
background, family structure, characteristics, and dynamics, family genogram, socio-economic
and cultural characteristics, home environment, physical assessment, nutritional status, and
values, habits, and practices on health promotion. There are top ten found problems in the Gavino
family, only five were given specific computation in the prioritization. In the family nursing care
plan, the top five priorities of the family health problems were given focus which was prepared by
the student nurses who handled the case of the Gavino family.
Summary
The Gavino Family comprises the father (working abroad), mother, daughter, and two
nieces in which their type of family is one of the most well-known in the Philippines, extended
type. The mother in the Gavino family is considered to be the head of the family as her husband
is currently working abroad. They are currently living in Sitio Pag-Asa, Tibag, Tarlac City. The
Province of Tarlac is well-known as the “Melting Pot of the Philippines” due to the unique and
variety of ethnicity living in the province. Despite this, each member of the family has the same
faith and ethnic origin. The genogram of the family also revealed that some of the family members
are currently suffering from health problems such as astigmatism, asthma, and cardiovascular
disease. In terms of financial aid, the father is the family’s provider, while the mother is responsible
for managing and budgeting the family’s monthly expenses as well as caring for the children. In
the home environment, the house comprises two rooms that were shared by two people and one
comfort room that they owned. The family’s total space requirement was also calculated and turns
out to be not overcrowded. Their ventilation, on the other hand, is fairly ventilated. There have
been issues discovered, such as the presence of vectors in food storage and external
environment in the kitchen. As well as disorganized waste disposal, which poses health threats
to the household.
In terms of each family member’s health, each has displayed normal health status/findings
with minimal and solvable problems. The minimal health problems discovered are related to poor
hygiene, unhealthy habits, emotional state, and maintenance medications deficit. Three members
134
of the family were under maintenance medications but refused to take them because they did not
feel comforted. The body mass index of each member of the family is within the normal state.
They can also eat at least twice to thrice in a day and obtain enough nutrients from vegetables
and protein meat, as well as drinking largely lukewarm water. Everyone in the family gets at least
7-9 hours of sleep every day, however, one family member does not receive enough sleep due
to schoolwork. Furthermore, whenever a member of the Gavino family becomes ill, they continue
to practice pagtatawas and make their own herbal medicines. Nonetheless, if herbal remedies
are ineffective, the family has access to over-the-counter drugs. All members of the family are
also completely vaccinated and have an annual vaccination of flu due to the COVID-19 pandemic.
Sharing views and being open with each other was also discovered to be their coping
mechanism/stress management.
At the end of the assessment in the family as a whole and individually, the student nurses
found both family and individual health problems which occur in the external and internal
household of the Gavino family. These problems include deficient knowledge in maintenance
medication and independent health interventions, presence of vectors in the internal and external
surroundings, respiratory health threat associated with incineration activity, family anxiety, and
sanitation. Despite this, the Gavino family was able to make progress, understand, and overcome
their incorrect perceptions about their health issues. Within the three days of home visits, the
student nurses were able to provide camaraderie, proper assessment, discussion, and
interventions related to the health conditions of each member of the family and the family as a
whole. Within the three days, the family was able to make room for improvement and were able
to establish their competence towards health. Each nursing intervention and health teaching were
evaluated by asking each family member what they had learnt throughout the course of the
assessment’s days and visits.
Evaluation
With regards to the general objective after the completion of this family case study, the
student nurses were able to develop their critical thinking, understanding, and skills relating to the
suitable response, such as nursing interventions and family nursing care plans. The student
nurses were able to extend their awareness and good judgement with respect to the community
and current situation which contributes to the general health of the family.
135
At the beginning of the home visit, the student nurses were able to establish rapport and
trust to the Gavino family by applying therapeutic communications throughout the assessments
of the family. By conducting all parts of the initial data base, the student nurses were able to
provide a quality assessment to the family which leads in identifying problems that affect the
health of the family and factors it correlates. Through this, the student nurses catered to nursing
interventions pertaining to the health problems and needs of the family. Furthermore, to achieve
a focused and well-planned health improvement, the student nurses created a family nursing care
plan to improve the overall health status and knowledge of the family. All provided nursing
interventions were conducted and demonstrated correctly by the student nurses. Lastly, to
evaluate the learning of the Gavino family throughout the three-days home visits, observations
and question and answer was conducted to show the positive improvement and personnel of the
family with regards to their health condition. Throughout the home visits, the family was able to
actively participate, cooperate, and respond positively to the student nurses' assessments for their
health.
To sum it all up, all objectives in the family case study were able to be accomplished by
student nurses and family. The Gavino family were also able to improve and give wider knowledge
regarding their persona in health and health conditions as well.
Recommendation
Throughout the assessment and prioritization conducted by the student nurses, there are
plans made to focus on health-related problems in the Gavino family. These plans were made to
give a series of visits and to provide an improvement with regards to the health conditions of each
member of the family. Thus, the following are the recommendations for all individuals and groups
included in this case study.
For the Family:

● The family must be required to keep in mind and apply all learnings that have been taught
throughout the home visit of the student nurses.
● The family should have a duty to continue to practice health promotion even without the
presence of the student nurses.
136
● The family should be knowledgeable with their own responses to each member’s general
and specific health condition.
● The family ought to be aware and think of their health actions and possible consequences.
● Each member of the family must encourage and support one another with regards to their
treatment and other health and family related situations.
For the Student-Nurse:

● The student nurses must preserve and ignite the knowledge used and learned throughout
the conduct of the family case study.
● The student-nurses should continue to develop proper conduct of information,
assessments, prioritization, and family nursing care plan.
● The student-nurses are obliged to improve their skills, knowledge, and attitude.
● To promote a harmonious health related case study, the student nurses must continue to
practice their confidence, critical thinking, professional relationship, and leadership.
● The student-nurses have a duty to preserve the family case study in use for academic and
health related references only.
For Healthcare Providers:

● The health care providers ought to improve and have their strategic plan with regards to
promoting health and wellness.
● The health care providers must encourage individuals and households to also focus their
attention on health and not only for their daily living.
● The health care providers must be prepared for unforeseen circumstances and conditions
in their specific area.
● The health care providers should reach and maintain the demands of people regarding
health interventions and services.
● The health care providers must broaden their skills, knowledge, and attitude related to the
widespread changes of science and health.
137
DOCUMENTATION
138
GAVINO’S FAMILY HOUSE
OUTSIDE APPEARANCE KITCHEN 1
KITCHEN 2 LIVING ROOM
BATHROOM BEDROOM 1
(For mother and daughter)
139
BEDROOM 2
(Neice’s Room)
140
IDENTIFIED HEALTH PROBLEMS UPON INSPECTION OF THE HOME

ENVIRONMENT
Unsanitary Waste Disposal 1 Unsanitary Waste Disposal 2
Unsanitary Waste Disposal 3 Unsanitary Waste Disposal 4
High Risk of food borne disease in open area 1 High Risk of food borne disease in
open area 2
141
High Risk of food borne disease in open area 3 High Risk of food borne disease in
open area 4
Presence of mice in the open gutter Presence of wound

142
HOME VISITS AND INTERVENTIONS DONE
Physical assessment (e.g. Taking the blood

pressure and body temperature of Angelica Camille)
Interview Session with Angelica Camille Physical Assessment (taking the

body temperature of Mrs. Mary Grace
143
Physical Assessment (Taking blood Interview Session with Mrs. Mary grace
pressure of Mrs. Mary Grace)
Physical Assessment (taking body Physical Assessment (Taking blood

Temperature of Ms. Kasandra Chloe) pressure of Ms. Kasandra Chloe)
144
Interview Session with Physical Assessment (Inspection)

Ms. Kassandra Chloe with Ms. Sophie
Interview Session with Ms. Sophia

145
Health Teaching supplemented Resolving the Problem regarding

after the assessment the Unsanitary waste disposal
146
The GAVINO FAMILY

GROUP PROFILE 147
148
PERSONAL PROFILE
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
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BSN2A CHN Clinical Group 2

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BSN2A CHN Clinical Group 2

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Republic of the Philippines

Tarlac State University

A Family Case Study Presented to the Faculty of the

In Partial Fulfillment of the Requirements of the Subject

II. OBJECTIVES .................................................................................................................... 4

III. INTIAL DATA BASE ......................................................................................................... 6

a. Family Structure, Characteristics, and Dynamics ............................................ 6

c. Socio- Economic and Cultural Characteristics ................................................ 9

d. Home Environment ............................................................................................ 12

e. Health Status of Each Family Member ........................................................... 17

A. 13 Areas of Assessments ......................................................... 23

f. Nutritional Assessment ..................................................................................... 62

g. Values, Habits, Practices on Health Promotion, Maintenance and Disease

IV. FAMILY COPING INDEX ................................................................................................ 69

V. TYPOLOGY OF NURSING PROBLEMS ....................................................................... 80

VI. RANKING OF PRIORITIZATION OF IDENTIFIED

VIII. SUMMARY, EVALUATION, AND RECOMMENDATION ............................................ 133

IX. DOCUMENTATION ....................................................................................................... 137

X. GROUP PROFILE ......................................................................................................... 147

XI. BIBLIOGRAPHY ........................................................................................................... 163

1. Develop their consciousness about their health condition and maintenance.

II. INITIAL DATA BASE

A. Family Structure, Characteristics, and Dynamics

C. Socio-Economic and Cultural Characteristics

Estimated Monthly Allotted

Total Monthly Income of the family

Total Annual/Household Income = Total Monthly Income x 12 months

Estimated Monthly Income – Estimated Total Monthly Expenditures

TOTAL SPACE REQUIREMENTS (TSR)

No. of adults in Gavino family= 4 x 3.0 sq. m = 12 sq. m

TFA= 97.5 sq. m

Ventilation = TWO/TFA x 100

E. Health Status of Each Family Member

>Hair and Nails

On inspection of the nails, the A normal nail is pinkish in color

- Palpation Upon palpation, there are no

- Palpation Upon palpation, there is no

Pulsations can be felt in the normoactive bowel sounds

- Palpation The joints are movable. No

of tolerating wrongdoings (such

In terms of socialization, she

friends who are still her close

interviewee, she asks for similar

support system is also her Emotional Support can be

Gavino cannot read

The chest wall is well-intact. adults are in the range of 12cpm

A regular elimination of waste

history of sexually transmitted Gravida/Gravidity– number of

presence of open wounds and also be no presence of lesions.

A normal nail is pinkish in color

Kasandra Chloe D. Gavino

Upon the interview, she stated Most adolescents seek peers in

she still enjoys being with small

- Speech - Upon talking to the client, The sounds being produced in

can read letters even 14

- Through a taste test

(Potter & Perry, 2020).

A regular elimination of waste

transmitted diseases and records pertaining to

above must have at least 7

ticks, and louse as well as be equal with a shiny and

A normal nail is pinkish in color

Angelica Camille D. Espinosa

In terms of socialization, she