FAMILY ASSESSMENT

CRITERIA:
1. Head of family
2. Income below poverty line

Family Name: C a d o r n a Address: Blk 8 L21 Everlasting Homes Las Pinas City

I. DEMOGRAPHIC DATA
Household No.: 1 Barangay House No: Talon IV

II. FAMILY DATA

Length of Residency: 4 years Place of Origin: Cebu Family Size: 6 Religion: Born again

FAMILY MEMBER’S CHART

Family Age Sex Civil Position Relationship Educational Occupation

members status in the to the family Attainment
family head

Cirilo 48 M Married Father Head/Husband Undergrad Production

Worker

Madelyn 42 F Married Mother Wife Undergrad Production

Worker

Ma. CJ 17 F Single 1st born Daughter In gr.12 Student

Roxanne

Ma. Iris Mae 14 F Single 2nd born Daughter In gr.8 Student

Ma. CJ 12 F Single 3rd born Daughter In gr.6 Student

Charmaine

CJ Loy 7 M single 4th born Son Not

studying
due to CHD

III. FAMILYCHARACTERISTI
C
Type of family structure
A. Extended
B. Matriarchal
C. Dominant Family Member
D. Nuclear ✓
E. Patriarchal ✓
GENERAL FAMILY STRUCTURE

Criteria Structure Additional Information

Observable conflicts between (-) Verbally, physical discipline to children when not following
family members parents that end up quarrels.

Characteristics of (-) There are miscommunications that happen because

communication some of the children are stubborn.

Interaction patterns among ( +) They go to church as bonding and they are all close to each
members other.

FAMILY DIETARY HABITS

What did you eat yesterday? (24-hour dietary
recall)
Breakfast: bread
Lunch: rice and vegetable
Dinner: rice and vegetable

MONTHLY FAMILY INCOME SOURCE:

Husband: work

Wife: work, “nagtatahi ng basahan at

binebenta
Others: ( - )

MONTHLY FAMILY INCOME:

Total (check bracket)
Below 5,000 php
Above 5,000 – 10,000 php ✓
Above 15,000 – 20,000 php
Above 20,000 – 30,000 php
Above 30,000 – 40,000 php
Above 40,000 – 50,000 php
More than 50,000 php

FAMILY HEALTH STATUS / HEALTH HISTORY

Father: (-)

Mother: (-)
Children: CJ Loy: Diagnose with Congenital Heart Disease
Grandfather: (-)

FAMILY FELT NEEDS (Identify and rank according to priority)

1. Food
2. Money
3. House
IV. HOME AND ENVIRONMENT
A. Is your lot owned? Yes No ✓
B. Is your house owned? Yes No ✓
C. Type of housing materials
Wood Mixed
✓ Concrete Makeshift
Others, specify _

D. Is the living house adequate? Yes No ✓

E. What are the appliances owned by the family?

✓ Flat screen TV
✓ Electric fans
Rrefrigerator
F. Type of garbage disposal
✓ collected burning
waste segregation burying
feeding to animals throw in the river/sewer
open dumping others, specify

G. Types of waste disposal

✓ flush water sealed
Wrap and throw pit privy
others, specify

H. Type of drainage system

✓ open closed

I. Source of water supply

owned shared
✓ bought others, specify

J. Drinking water storage

refrigerated ✓ covered
uncovered

K. Containers used
✓ plastic pitchers jars, claypots
bottles others, specify

L. Common household pests found at home

✓ Cockroaches
✓ Rats
fleas and ticks
✓ ants
✓ houseflies
✓ Mosquito
M. Are there breeding sites of insects, rodents, etc, present? Yes ✓ None

N. Pets/animals kept in the yard/home Yes None ✓

O. Are there accident hazards present? Yes ✓ None

V. HEALTH AND HEALTH PRACTICES

A. Common illness encountered for the last six months and the treatment applied.
Illness encountered: Treatment applied:

CJ Loy: Congenital Heart Disease Consulted to a doctor but not yet treated by surgery
because needed to wait for the right age.

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

manghihilot albularyo midwife
nurse doctor ✓ Health center
Barangay health worker others, specify

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

family members ✓ relatives friends
Barangay officials priest others, specify

D. Immunization status of the family members

 All children had their complete immunizations from the health center of their respective barangay.

E. Have you had adequate

1. Rest and sleep? Yes ✓ No

2. Exercise? Yes No ✓

3. Relaxation activities? Yes ✓ No

4. Stress management activities? Yes ✓ No

VI. ENVIRONMENT
1. Kind of neighborhood Urban, Compound
2. Social and health facilities WIFI, Health
available
center,
3. Communication and transportation Cellphone, Jeepney, tricycle
facilities
VII. AWARENESS OF COMMUNITY ORGANIZATION
A. Are you aware of existing organizations in the
community? Yes__✓__ No

B. Name the organizations you know.

• Kalipi, SK

C. Are you a member of any of these organizations?

Yes_✓_ No

D. Are you aware of its activities and projects?

Yes ✓ No

F. How are you involved on its activities?

✓ attended meetings ✓ give donations ✓ planning
evaluation ✓ implementation others, specify N/A

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

1. Kapitan
2. kagawad
3. President sa asosasyoon
4. Mayor

5. SK

IDENTIFYING FAMILY HEALTH PROBLEMS

Student name: Princess A. Barron

Family No.: 6
Name of family head: Cadorna Family
Address: Everlasting Homes Talon IV

List of Health Problems Nature of the Problem

Congenital Heart Disease (Youngest Child) Health Deficit

Inadequate of food intake in quality and quantity Health Threat

Presence of breeding/resting sights of vector disease Health Threat

Inadequate exercise/healthy lifestyle Health Threat

COMPUTING AND JUSTIFYING SCORES OF HEALTH PROBLEMS
Cadorna Family
Problem: Congenital Heart Disease
Criteria Standard Score Weight Actual Justification
Score

1. Nature of the 2 1 0.66

It’s a health deficit since it is an illness
Problem Health Deficit
& it was medically diagnosed by a
doctor.
2. Modifiability Easily Modifiable 2 2 2 It’s easily modifiable since it has
of the Problem objective signs.

3. Preventive Moderate 2 1 0.66 It can be prevented by surgery

potential treatment but after that there are
still risk that needs precautions.
4. Salience of A condition 1 1 0.5 According to their doctor, the child will
the problem not needing just have surgery if he is in the right age.
immediate
attention
Total score: 3.82

Cadorna Family
Problem: Inadequate of Food intake in quality and quantity
Criteria Standard Score Weight Actual Justification
Score

1. Nature of the It’s a health threat because it causes

Problem Health Threat 1 1 0.33
malnutrition to the children and
increases the likelihood of disease.
2. Modifiability It’s easily modifiable with the right
of the Problem Easily Modifiable 2 2 2 budgeting of their money and
healthy food choices for the family.
3. Preventive For me, preventive potential is high
potential High 3 1 1 because we may avoid the problem
with correct financial management,
food choices, proper nutritional
intake.
4. Salience of A serious problem It is a major problem that requires
the problem needing immediate 2 1 1 immediate because the health of
attention family depends on it.

Total score: 4.33

Cadorna Family
Problem: Presence of breeding/resting sights of vector disease
Criteria Standard Score Weight Actual Justification
Score

1. Nature of the It poses a health risk given that there

Problem Health Threat 1 1 0.33
are infestations and breeding of
rodents and flies in the area many
organisms that can cause diseases.
2. Modifiability It’s partially modifiable since there
of the Problem Partially 1 2 1 are some areas that are tight and
Modifiable need proper sanitation. There are
also “tambak & drum”
3. Preventive If interventions and preventive
potential Moderate 2 1 0.66 measures are implemented, they
will be reduced but not fully
removed because of the location of
their house.
4. Salience of A serious problem It is a serious problem that needs
the problem needing immediate 2 1 1 attention because it poses health
attention risk to the children. Given
infestations and breeding rodents in
the area which is home to many
microbe & diseases like dengue.
Total score: 2.99

Cadorna Family
Problem: Inadequate exercise/health lifestyle
Criteria Standard Score Weight Actual Justification
Score

1. Nature of the It is a health threat because your body

Problem Health Threat 1 1 0.33
can be prone to diseases and possible
risk factors due to lack of exercise.
2. Modifiability Partially They mostly use their gadgets for
of the Problem Modifiable 1 2 1 relaxation and free time.

3. Preventive It can be prevented by devoting a

potential High 3 1 1 small portion of their time to 15-30
minutes of exercise, which is
beneficial to their health and has
numerous advantages.
4. Salience of A serious problem It is a serious problem that needs
the problem needing immediate 2 1 1 immediate attention because
attention exercising is a great way to protect
from a variety of diseases and
sickness because it makes our body
and immune system stronger,
regulated blood flow and improves
our brain and growth development.
 Total score: 3.33

RANKING HEALTH PROBLEMS OF Cadorna FAMILY

Priority Problem Score

1 Inadequate of food intake in quality and quantity 4.33

2 Congenital Heart Disease 3.82

3 Inadequate exercise/healthy lifestyle 3.33

4 Presence of breeding/resting sights of vector disease 2.99

TOP 3 PRIORITY HEALTH PROBLEMS OF Cadorna FAMILY

Priority Problem Score

1 Inadequate of food intake in quality and quantity 4.33

2 Congenital Heart Disease 3.82

3 Inadequate exercise/healthy lifestyle 3.33

DETERMINING FAMILY NURSING PROBLEMS

Family Nursing
Health Problems
Problems First level Second level Assessment
Assessment
Inadequate of food intake in Health Threat Inability to provide home environment
quantity and quality conducive to health maintenance and
personal development due to inadequate
family resources and financial
constraints/limited financial resources

Congenital Heart Disease
Health Deficit Inability to provide adequate nursing care to
the sick, disabled, dependent or
vulnerable/at risk member due to lack of
inadequate knowledge about child
development and care lack of necessary
facilities equipment and supplies of care,
inadequate family resources for
care/financial constraints

Inadequate exercise/healthy Inability to recognize the presence of the

life style Health Threat condition or problem due to lack of
knowledge/inadequate knowledge
 FAMILY HEALTH CARE PLAN
Name of Family: Cadorna
INTERVENTION PLAN
Health Family Nursing Goals Objectives Intervention Methods of Nursing Res
problems Problems Outcomes Family Contact
Inadequate of Inability to provide After nursing At the end of the Assess the family Home visit Tim
food intake in home intervention, the nursing about how they nur
quality and environment family will be able intervention budget their
quantity conducive to to understand the food/financial needs. Bud
health and importance of the family will be ade
personal proper nutritional able to Assist the family in
development due food intake. acknowledge the developing their Hea
to inadequate factors that may food meal plan.
family resources The family will be lead to sickness
and financial able to provide and diseases that
constraints/limite adequate nutritional cause inadequate
d financial food intake. food intake.
resources
Understand the
needs of energy in
the body.

Family NCP # 1
 Family NCP #2:

INTERVENTION PLAN
Health Family Nursing Goals Objectives Intervention Methods of Nursing Resources Required Evaluation
problems Problems Outcomes Family Contact
Congenital After nursing At the end of Explain the problem Home visit Time and effort by the Criteria
Inability to provide
Heart Disease adequate nursing intervention, the nursing in greater detail (in nurse and family The family is
care to the sick, family will be able intervention layman’s terms) to expected to:
disabled, dependent to gain understand it deeply Health teaching
or vulnerable/at risk knowledge and The family will be and work to improve Understand and
member due to lack recognize the able to the child's needs. verbalize the
of inadequate presence of the understand the information about
knowledge about problem. presence of the Assist the family in the problem
child development problem. formulating a
and care lack of
Teach the child to teaching plan and Perform the
necessary facilities,
continue his or The family will be developmentally lesson plan they
equipment and
supplies of care, her education able to teach the appropriate provided.
inadequate family despite a health child so that he is activities for the
resources for deficit. not left behind by child. Let the child
care/financial others. execute the list
constraints Provide health provided by the
The family will be teaching on ways family of home
able to develop how to teach the stimulation and
home stimulation child and healthy life developmentally
and style. appropriate
developmentally activities for the
appropriate child.
activities for the
child.
 INTERVENTION PLAN
Health problems Family Nursing Goals Objectives Evaluati
Problems Intervention Methods of Nursing Resources Required
Outcomes Family Contact

Inadequate After nursing At the end of the Discuss the Home visit Time and effort by the Criteria
Inability to recognize
exercise/health the presence of the intervention, the nursing importance of nurse and the family The family is
y lifestyle condition or problem family will be able intervention the adequate exercise expected to:
due to lack of to gain knowledge family will be able with the family. Health teaching
knowledge/inadequa and understand to: Explain the
te knowledge the importance of Assess on how they significance o
adequate exercise. Perform different will perform the daily exercise and
kinds of exercise. exercise routine to incorporat
into your dai
All members will routine.
carry out daily
routine exercise. Perform the
different kind
exercise.

Continuing th
daily routine
exercise
Legal Documents of the Family
Name of Student: Princess A. Barron
NCM 21104L
Year and Section: 2B
Group No and Clinical Instructor: Group 1, Ms. Broqueza

JOURNAL ENTRY
FAMILY: CADORNA
CRITERIA:
 Head of the family
 Income below poverty line



ESTABLISHING A WORKING RELATIONSHIP WITH THE ADOPTED FAMILY

CRITERIA CHECK IF DONE (DATE)

1. Initiate contact through home visit ✓

2. Introduce yourself and the agency ✓

3. Communicate interest in the family welfare ✓

4. Maintain two-way communication ✓

5. Show willingness to help with expressed needs ✓

HEALTH PROBLEMS IDENTIFIED

1. Inadequate of food intake in quality and quantity

2. congenital heart disease
3. Inadequate exercise/healthy life style
4. presence of breeding sights of vector disease
5.
First Home Visit: 23 October 2022

The Cadorna Family lives in a compound, and their family size is 6. All of them are healthy and fully vaccinated, but their fourth child is currently diagnosed with congenital heart disease.
According to the doctor, he needs to be treated with surgery at the right age. The child has a speech defect due to his deficit condition; he is also not studying in school. The presence of
breeding vectors that could potentially cause disease also limits their home environment. 

Second Home Visit: (Date)

Narrative entry of the details of home visit

Third Home Visit: (Date)

Narrative entry of the details of home visit