INITIAL DATA BASE (1)

I. CHARACTERS:
A. What is the type of family structures?
_______ Nuclear _______ Patriarchal ___X__ Single Parent
______ Extended _______ Matriarchal
B. Who makes decision regarding health care? __________Mother________
C. What is the present family relationship?
_________________ with conflicts between members
_______X__________ without conflicts between family members
D. Activities of daily living:
1. Sleeping pattern:
Retiring/getting up hours ______10pm/8am_______
Nap during the day __________3pm________
Do members sleep together ______No_____
2. Eating pattern
How many meals each day? ____5______
Who appears overweight? _______None____
Who appears underweight? ______None_____
3. Leisure time activities
How does each member spend leisure hours? _Normally spend time watching movies
individually
Is it appropriate for the sex and age group? ____YES_______________________
What is the effect to the family? __It works well with our setup___
Any joint activity for leisure? _We normally spend time eating home cooked meals together

II. FAMILY INFORMATION

Head of the family: ________Myrna G. Bagang_______
Address: ______324_Purok 4 _Lanang Candaba Pampanga_____________
Members of the household: ______4_______

NAME RELATIONSHIP AGE EDUCATIONAL ATTAINMENT

Myrna G. Bagang Mother 65 High School Graduate
Jessie Rey G. Bagang Son 31 College Graduate
Jessiemyr G. Bagang Daughter 36 College Graduate
Rhodel G. Bagang Son 47 College Level

III. SOCIO-ECONOMIC AND CULTURAL FACTORS

A. Income

NAME OCCUPATION PLACE INCOME

Jessiemyr G. Bagang Dental Nurse Kuwait 30,000-40,000
Rhodel G. Bagang Carpenter Candaba 10,000-15,000

1. Does the working family member meet the basic necessities?

__X____ Yes _____ No
2. Who makes decisions regarding money matters? _______Mother_____________
3. Religious affiliation: _______Roman Catholic______________
 4. What roles does the family play in the community? It is the basic unit of the society_____

IV. ENVIRONMENTAL FACTORS

A. Housing
1. Ownership
____X_____ Owned ________ Rented ___________ Rent-Free
2. Construction materials used
_________ Light ________ Mixed _____X______ Strong
3. Living space
_____X____ Adequate ________ Inadequate
4. Sleeping arrangement: ___________ Individual Rooms ________X__________
5. Adequacy in furniture
_____X____ Adequate ________ Inadequate
6. Water source
_____X___ Private ________ Public
7. Food storage
_____X__ Refrigerator ________ Jars/container
8. Cooking facility
_________ Electric stove ________ Firewood
_____X___ Gas Stove ________ Kerosene
9. Drainage facility
_________ Open drainage ____X____ Blind drainage ________ None
10. Toilet facilities/type
_____X____ Flushed ___________ Over hung latrine
_________ Bored-hole latrine ___________ Water-sealed latrine
_________ Pail system ___________ None
11. Sanitary condition
_________ Fair _____X______ Good ________ Poor
12. Neighborhood
_________ Congested ___________ Slum ____X____ Other
13. Availability of Health Care Facility
Describe briefly: ___________None – no evident health care support from the baranggay_
14. Garbage disposal
__________ Dumped at street corner _______X_____ Picked up by garbage
collector
__________ Buried ____________ Burned then buried
V. HEALTH MEDICAL HISTORY
A. Presence of illness
___X____ Diagnosed _________ Undiagnosed _______ None

NAME PAST ILLNESS ILLNESS STATE HEALTH ACTION

TAKEN

Myra Bagang Hypertension Ongoing ● Lifetime

(Mother) Maintenance
using
prescription
drugs
● Regular
monitoring of
Blood Pressure

Diabetes Ongoing ● Regular

monitoring of
blood sugar
levels using
glucometer
● Avoid sweet
foods and
monitor other
food intake
● Regular monthly
check up with
assigned
physician

VI. VALUE PLACED ON PREVENTION OF DISEASE

NAME AGE COMPLETE INCOMPLETE

Myrna G. Bagang 65 ●

Jessie Rey G. Bagang 31 ●

Rhodel G. Bagang 47 ●

Jessiemyr G. Bagang 36 ●

Preventive practices employed by the family: _Yearly Check up________

Sources of Health Care:
_________ Health Center ____________ Government Hospital
____X_____ Private Hospital ____________ Others
 Scale for Ranking Health Problems According to Priorities

CRITERIA WEIGHT
1. Nature of the problem

Scale: Health Deficit 3 1

Health Threat 2

Foreseeable Crisis 1

2. Modifiability of the problem

Scale: Easily Modifiable 2 2

Partially Modifiable 1

Not Modifiable 0

3. Preventive potential

Scale: High 3 1

Moderate 2

Low 1

4. Salience

Scale: A serious problem, immediate attention needed 2 1

A problem but not needing immediate attention 1

Not a felt/need problem 0

Scoring
1. Decide on score for each criteria
2. Drive the score by the highest possible score and multiply by weight
Score X Weight
Highest Score
3. Sum up the scores for all criteria. The highest score is 5, equivalent to the total weight
 PROBLEM: Rampant presence of mosquitoes in the community as a potential health threat
1. Nature of the Problem
2. Modifiability of the Problem
3. Preventive Potential
4. Salience
Computation: Justification:
High Score: 3 The presence of the mosquitoes in
Actual Score: 2 the community poses a threat
Weight: 1 specially for toddlers and infants as
it can bring common diseases
Score x Weight = 2 x 1 (such as dengue) which can be a
Highest Score = 3 threat to the low immunity of these
children.
Result: 0.67
Computation: Justification:
High Score: 2 This is partially modifiable given
Actual Score: 1 the condition that the problem is
Weight: 2 nature-bound. But efforts of the
local barangay have provided
Score x Weight = 1x 2 necessary measures to prevent
Highest Score = 2 chances of dengue outbreak.
Result: 1
Computation: Justification:
High Score: 3 Rampant presence of mosquitoes
Actual Score: 1 has been in the community for
Weight: 1 decades as it is located near a
river which can no longer prevent
Score x Weight = 1 x 1 such conditions given the current
Highest Score = 3 location of the community.
Result: 0.33
Computation: Justification:
High Score:2 The family views this as a problem,
Actual Score: 1 not needing immediate attention as
Weight: 1 there have been recent local
government projects addressing
Score x Weight = 1 x 1 this concern.
Highest Score = 2
Result: 0.5
Nature of the Problem: 0.66
TOTAL Modifiability of the Problem: 1
Preventive Potential: 0.33
Salience: 0.5
Result: 2.5
 PROBLEM: Hypertension as health deficit
1. Nature of the Problem Computation: Justification:
High Score: 3 It is a health deficit that requires
Actual Score: 3 immediate attention and adequate
Weight: 1 management.

Score x Weight = 3x 1
Highest Score = 3

Result: 1
2. Modifiability of the Problem Computation: Justification:
Partially modifiable. There are
High Score: 2 self-management behaviors,
Actual Score: 1 including medication adherence,
Weight: 2 self-blood pressure monitoring and
lifestyle modifications involving diet
Score x Weight = 1 x 2 and exercise.
Highest Score = 2

Result: 1
3. Preventive Potential Computation: Justification:
Hypertension is frequently
High Score: 3 managed through eating properly,
Actual Score: 2 maintaining a healthy weight, and
Weight: 1 exercising regularly.

Score x Weight = 2 x 1
Highest Score = 3

Result: 0.67
4. Salience Computation: Justification:
The family views hypertension as a
High Score:2 serious problem and it needs
Actual Score: 2 immediate action.
Weight: 1

Score x Weight = 2x 1
Highest Score = 2

Result: 1
Nature of the Problem: 1
TOTAL Modifiability of the Problem: 1
Preventive Potential: 0.67
Salience: 1

Result: 3.67
 PROBLEM: Diabetes as health deficit
1. Nature of the Problem Computation: Justification:

High Score: 3 It is a health deficit that requires

Actual Score: 3 urgent and appropriate attention.
Weight: 1

Score x Weight = 3x 1
Highest Score = 3

Result: 1
2. Modifiability of the Problem Computation: Justification:
Diabetes cannot be cured but it
High Score: 2 can be reversed through diet
Actual Score: 0 changes and weight loss.
Weight: 2 Interventions are not feasible.

Score x Weight = 0x 2
Highest Score = 2

Result: 0
3. Preventive Potential Computation: Justification:
This health deficit can be
High Score: 3 prevented and minimized if
Actual Score: 3 interventions are done properly.
Weight: 1 This chronic disease can be
inherited but environmental factors
Score x Weight = 3x 1 play a role.
Highest Score = 3

Result: 1
4. Salience Computation: Justification:
The family recognize diabetes as a
High Score:2 serious problem and it needs
Actual Score: 2 immediate action.
Weight: 1

Score x Weight = 2x 1
Highest Score = 2

Result: 1
Nature of the Problem: 1
TOTAL Modifiability of the Problem: 0
Preventive Potential:1
Salience: 1
Result: 3
 INITIAL DATA BASE (2)
FAMILY SERVICE AND PROGRESS RECORD

HEAD OF THE FAMILY Myrna G. Bagang

FAMILY NUMBER: 4
ADDRESS: 324 Purok 4 Lanang Candaba Pampanga

I. Assessment of the Family, Home and Environmental Conditions:

A. Members of the Household

HIGHEST REMAR
RELATI MARIT
S EDUC KsS/
ON TO AL
FAMILY MEMBER E BIRTHDATE COMPLE OCCUPATION DATE
THE STATU
X TED ENTER
HEAD S
ED

N Name Month Year Type Place

o of
work

1 Myrna G. Bagang Mother F Septe 195 Married High None None 3/14/22
mber 5 School
Graduate

2 Jessie Rey G. Son M April 199 Single College None None 3/14/22
Bagang 9 Graduate

3 Jessiemyr G. Daughter F Augus 200 Single College Dental Kuwai 3/14/22

Bagamg t 1 Graduate Nurse t

4 Rhodel G. Son F March 201 Single College Carpe None 3/14/22

Bagang 3 Level nter

B. Home and Environment

Date Assessed: __March 14, 2022___________________________________________
1. Home
a. Ownership ( X ) Owned ( ) Rented ( ) Rent-Free
b. Construction Materials used: ( ) Light ( ) Mixed ( X ) Strong
c. Number of rooms for sleeping: ______2____________________
d. Lighting facilities (X ) Electricity ( ) Kerosene ( ) Others Specify
e. General sanitary condition:
___________GOOD_________________________________

2. Drinking water supply _____FILTERED______________________________________

 Source: ( X ) Private ( ) Public Potability:
________________________________________
Distance from house:
____60METERS______________________________________________
Storage: ( X ) None (Direct from faucet or pipe)
( ) Large covered container with faucet
( ) Large uncovered container without faucet
( ) Others, Specify
____________________________________________________
3. Kitchen
Cooking facility: ( ) Electric stove ( X) Gas Stove ( ) Firewood/charcoal
Sanitary condition:
_______GOOD_________________________________________________
Drainage Facility: ( X ) Open drainage ( ) Blind drainage ( ) None

4. Waste Disposal
a. Refuse and Garbage
Container: ( X ) Covered ( ) Open
Method of disposal:
( ) Hog feeding ( X ) Composting
( ) Open dumping ( ) Open burning
( ) Burial in pit ( ) Others, specify:
_________________________
b. Toilet
Type: ( ) None ( ) Pail system
( ) Overhung latrine ( ) Antipolo
( ) Open pit privy ( ) Water sealed latrine
( ) Closed pit privy ( X ) Flush type
( ) Bored-hole latrine
( ) Others, specify: ______________________
Distance from house: _____INSIDE THE HOUSE_______________
Sanitary condition: ________GOOD________________________
5. Domestic Animals:

KIND NUMBER WHERE KEPT

DOG 2 OUTSIDE THE HOUSE WITH CAGE

6. The Community in General

a. General sanitary condition:
_________GOOD___________________________________________
b. Housing congestion: ( X ) Yes ( ) No
c. Recreational Facilities:
______________COURT__________________________________________
 d. Availability of health care services (describe briefly): ______HEALTH CENTER
PROVIDED BY THE CITY OF CANDABA
_______________________________________________
e. Distance of house from nearest health care facility:
____________300METERS_____________________

II. Problem Sheet

HEALTH DATE
NURSING SUPPORTING DATA
CONDITIONS AND IDENTIFIE RESOLVED
PROBLEMS CUES
PROBLEMS D

Diabetes - Deficient knowledge - Unfamiliarity with Year 2014 No :

regarding disease the disease,
- History of Lifetime Health
process, treatment, misinterpretation and
hypertension; acute Condition
and individual care lack of recall
myocardial infarction
needs
- Blood glucose
- Delayed Wound
- Risk for Unstable levels below or
Healing
Blood Glucose above normal levels
- Sleep disturbances
- Risk for infection – Circulatory
& fatigue
changes due to high
- Muscle Cramps & blood glucose levels
Dec. Muscle Strength

Hypertension - Risk for Decreased - Alteration in heart Year 2014 No:

Cardiac Output rate, rhythm, and
- Elevated Heart Rate
conduction
and Blood Pressure - Activity Intolerance
Lifetime Health
- Generalized
- Weakness and - Acute pain / Condition
Weakness /
Fatigue increased cerebral
Sedentary Lifestyle
vascular pressure
- Fainting spells /
- Abnormal Heart
dizziness - Imbalanced Nutrition:
rate or BP response
More than Body
to activity
Requirements
- Reports of stiffness
- Risk for metabolic
of neck, dizziness,
imbalance syndrome
blurred vision,
nausea, and vomiting
- Signs of Obesity /
Excessive intake in
relation to metabolic
need
III. Nursing Care Plan

HEALTH EVALUATION
CONDITIONS AND
OBJECTIVE OF PLAN OF OUTCOME
PROBLEMS AND METHOD /
NURSING CARE INTERVENTION CRITERIA/
FAMILY NURSING TOOLS
PROBLEMS INDICATORS

Diabetes - To provide familiarity -Educate family - Full - Education :

with the health members about the awareness all family
- History of
condition and give health condition and members to
hypertension; acute
preventive measures and provide ways familiarity of participate in
myocardial infarction
to other family on how to manage every the learning
- Delayed Wound members the condition member process
Healing regarding the
- To monitor blood - Assess for signs - Use of
condition
- Sleep disturbances sugar levels and blood of hyperglycemia / glucometer
& fatigue pressure Assess risks and - Identifies and interpret
contributing factors factors that results
- Muscle Cramps & - To avoid / prevent risk
to unstable blood may lead to properly and
Dec. Muscle Strength of wound infection.
glucose levels unstable accurately.
blood
glucose
- Assess and levels
Family Nursing document skin
- Maintain
Problems condition around
blood
the wound – assess
glucose
- Deficient knowledge for necrotic tissues
levels within - Use of
regarding disease present on the
the normal bandages to
process, treatment, wound
range clean the
and individual care
needs -Ensures wound
timely wound
- Risk for Unstable
healing free
Blood Glucose
from purulent
- Risk for infection discharges
and necrosis

Hypertension - To lower or control - Monitor and - Patient will - Blood

blood pressure record BP. Measure maintain BP pressure Kit
- Elevated Heart Rate
in both arms and within an
and Blood Pressure - To adhere to the - Laboratory
thighs three times, individually
therapeutic regimen, tests results
- Weakness and 3–5 min apart while acceptable
lifestyle modifications
Fatigue the patient is at range.
rest, then sitting,
- Fainting spells / - To prevent then standing for - Patient will - Stress
dizziness complications of the initial evaluation. demonstrate management
disease. Use correct cuff stable activities
Family Nursing
size and accurate cardiac
Problems:
technique rhythm and
- Risk for Decreased rate within
- Check laboratory
Cardiac Output the patient's
data (cardiac
normal
- Activity Intolerance markers, complete
range.
blood cell count,
- Acute pain / electrolytes, ABGs, - Patients will
increased cerebral blood urea nitrogen participate in
vascular pressure and creatinine, activities that
- Imbalanced cardiac enzymes, will prevent
Nutrition: More than and cultures, such stress (stress
Body Requirement as blood, wound or management,
secretions). balanced
-Risk for metabolic activities and
imbalance syndrome - Provide calm,
rest plan).
restful
surroundings,
minimize
environmental
activity and noise.
Limit the number of
visitors and length
of stay.
IV. Service and Progress Notes

NURSING INTERVENTIONS, ACTIONS AND

DATE NURSING PROBLEMS SIGNATURE
PROGRESS

- Educate family members about the health

condition and provide ways on how to manage
Diabetes the condition

- Deficient knowledge - Assess for signs of hyperglycemia / Assess

March regarding disease risks and contributing factors to unstable blood
14, 2022 process, treatment, and glucose levels
individual care needs - Assess and document skin condition around
- Risk for Unstable Blood the wound – assess for necrotic tissues
Glucose present on the wound

- Risk for infection

PROGRESS: Patient currently has a stable
Blood sugar with an average of 120 – 150 daily

- Monitor and record BP. Measure in both arms

Hypertension and thighs three times, 3–5 min apart while the
- Risk for Decreased patient is at rest, then sitting, then standing for
Cardiac Output initial evaluation. Use correct cuff size and
accurate technique
- Activity Intolerance
- Check laboratory data (cardiac markers,
- Acute pain / increased complete blood cell count, electrolytes, ABGs,
March cerebral vascular blood urea nitrogen and creatinine, cardiac
14, 2022 pressure enzymes, and cultures, such as blood, wound
- Imbalanced Nutrition: or secretions).
More than Body - Provide calm, restful surroundings, minimize
Requirement environmental activity and noise. Limit the
-Risk for metabolic number of visitors and length of stay.
imbalance syndrome PROGRESS: Patient currently has an average
of 160 over 90 blood pressure for the past few
months
 The list of health problems ranked according to priorities is presented:

HEALTH PROBLEMS SCORING RANK

Hypertension 3.67 1

Rampant presence of 3.17 2

mosquitoes in the community

Diabetes 3 3

FNCP
PROBLEM: Hypertension as health deficit

HEALTH NURSIN GOAL OBJECTI INTERVE RATIONALE METHO RESOU EVALUA

PROBLE G OF VES NTIONS DS OF RCES TION
M DIAGNO CARE NURSE REQUIR
IDENTIFI SIS FAMILY ED/USE
ED CONTA D
(ASSESS CT
MENT)

Hyperten After -Maintain -Less Home -Material

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health metabolic interventi Term: restriction stress and 1. PHN Term:
deficit. imbalanc ons, the s tension that bag
client will -After 4-5 (bedrest affect blood 2.Initial -The
e
SUBJEC display hours of or chair pressure and Databas client
syndrome nursing was able
TIVE behaviors rest); the course of e
DATA: as and interventi schedule hypertension. 3. to
evidence lifestyle on, the uninterru Ballpen understa
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client manifesta to periods; -Time health
verbalize prevent 1. able to assist and teachings
tions of
d feeling complicat understa patients effort of offered,
high nd the
of: ions of with both which
blood the importanc self-care public included
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Weaknes due to making as nurse importan
s and unstable some needed. and ce of
Fatigue blood dietary family. making
modificati -Monitor -Response to some
glucose,
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spells / namely: as food changes
to (usually
dizziness selection medicatio consisting of as well
and/or ns to several as how to
quantity, control drugs, develop a
Weaknes in order plan for
- Sleep s and to blood including regular
disturban fatigue accompli pressure. diuretics, exercise
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Dizziness healthier onverting physical
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Cramps Sleep weight [ACE] order to
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diabetes, the decrease about the
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can e of workload complicat
threaten relative ions.
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the family g and support
Referenc future. members of family and
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Prioritize the information
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ons, and g eating individualized
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s. (15th that need instruction
Ed.) to be related to the
modified. clinical
pg. 560. condition that
contributes to
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blood
glucose
levels.

-Discuss -Exercise
the balances
importanc glucose
e of levels by
balance facilitating
exercise uptake of
with food glucose into
intake. cells. The
patient needs
to understand
the
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of exercise,
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glucose
levels.
 INTERVIEW DOCUMENTATION

INTERVIEWER : Jessie Rey Bagang

INTERVIEWEE: Myrna Bagang
GROUP MEMBERS:
1. Ivan Dan Allen
2. Kathleen Arceo
3. Lovely Sophia Arcibal
4. Jessie Rey Bagang
5. Aldrin Lumawig Berber
6. Kaizly Cabuso
7. Icha Casabar
8. Paolo Catama
9. Kristine Cruz
10. Sofia Bianca Dantes
11. Charles Rudy Dela Cruz