Far Eastern University

Institute of Nursing

Case Scenario:

The community health nurse in Barangay Disiplina decided to visit the family of Mr. and Mrs.
A.  Before visiting the family she checked the family records in the health center.   Mrs.  A, is 37 years
old and is a fish vendor.  Mr. A, 40 years old is a construction worker.  They have six (6) children.  They
are, Manuel, 14 years old, in Grade 7; Karl, 12 years old, in Grade 6; Cita, 10 years old, in Grade 4; and
Nieves, eight (8) years old and not yet in school, Andres, six (6) years old, Lita, four and a half (4 ½)
years old and Rina, three (3) years  old.

She also read the clinical records of the other members of the family who have gone to the clinic for
consultation. She noted down the following data:

 Rina, three years old, got sick of bronchopneumonia three months ago; weight - 10kgs.

 Lita, four and a half years old, and Andres, six years old were brought to the clinic a month ago
for scabies; management included personal hygiene and Benzyl Benzoate in two applications
12 hours apart and followed by a shower after 12-24 hours.

The Assessment Process

The available data gathered during this first-level assessment reflected the following possible health
condition or problems:

1. Scabies which may not have been fully cured

    Supporting Cues: two preschoolers brought to the center for scabies one month ago

2. Malnutrition which may not have been successfully managed

    Supporting Cues: 3 year-old daughter weighed 10 kgs., 3 months ago

3. Family size beyond what family resources can adequately provide

    Supporting Cues: A family with six (6) children, mother, 37 years old and presently pregnant

 
The nurse decided to do a home follow-up on this family. As part of her preparation for the home
visit, she specified the important points that are needed to be able to do an in-depth second-level
assessment on the list of possible health condition or problems gathered form the individual clinical
records of the family members. By going through the following questions, she aims to determine the
family's ability to perform the health tasks on the health condition or problems identified earlier:

1. How is Rina now? Does the family recognize the existence of malnutrition in Rina? If no, why
not? If yes, what has the family done about it? Were the solutions effective?

To be able to do an adequate assessment on the other aspects of family life, the nurse decided to also
inquire about the following during the home visit:

2. How are Lita and and Andres? What has the family done about the scabies? Were the
solutions effective?

3. How are the three family members? How do the members relate with or affect each other?

4. What are the goals or plans of the family for its members and/for itself as a functioning unit?

5. How are the conditions in the home and the community environment?

The afternoon of the next day, the nurse made her home visit and obtained the following data:

 The family lives in a two-room house of light materials situated in a congested urban
community about 3 km from the health center.

 Lita and Andres have varying degrees of infected and healed skin eruptions and scabs on their
hands and feet.

 Rina looks pale, lethargic and apathetic; with scabies, too; markedly underweight and
undernourished.

 
  Mrs. A is a fish vendor in the community's market and earns a profit of P300.00/day. Mrs. A
verbalized, "With the meager daily income of P400.00 my husband earns, I need to help
increase the family's income through selling fish. I am so busy that I cannot find the time to
visit the health center.

 ... I have such a lot of things to attend to as a fish vendor that i could hardly see to the needs
of the children. The children are usually left at home by themselves everyday, except for
Manuel. Karl and Cita who go to school. Nieves is the only older child who is left to take care
of the three younger ones when we are not around. But I can't expect her to do everything.
That's the reason why the scabies of Andres and Lita have not improved. However, it was
quite expensive that i was not able to buy another one when it is consumed. This 'galis aso'
(scabies) must be due to the weather. Quite a lot of children in the neighborhood have this.
See, even Rina got it, too.

 ... Rina is really small in built since she was a baby. She is not fond of eating too...

 ... my husband and i would like to give the children a better future. We would like them to
finish even just a vocational education. With a higher educational attainment they would not
have to experience the kind of life we have now -a meager income despite hard work. We
can't really expect to earn much since we are just elementary school graduates. We have such
a goal for our children that's why we don't want additional children anymore. We have
decided on this since I have delivered my fifth child, Andres. However, we have been hearing a
lot of things about the methods of family planning that cause abortion, cancer or othe
problems. We can't decide on a method because of fear of possible side effects. We might
have more problems to worry about due to any of these methods... "

 All the other children help in the household chores after school work. They fetch water form a
public artesian well about half a kilometer from the house.

 Mrs. A has the major responsibility in so far as the health of the family is concerned.

 The other data that the nurse observed in so far as the conditions or resources in the home
include:

 Dimensions of each room is 3 meters by 3 meters

 Small screened cabinet for food storage

 One-burner gas stove for cooking purposes

 Plastic container with cover for drinking water supply

 Dining table with two benches

 Lighting: electricity

 Toilet facility: closed pit privy type situated beside the garbage pit; foul smelling and with
plenty of flies all over.

 Garbage disposal: dumping in open pit situated at the back of the house two meters away;
with plenty of flies.