A Family Case Study

Presented to the

College of Nursing

Title Page
Table of Contents Acknowledgment
Introduction…………………………………………………………………………….1
The objective of the Study (General and Specific)……………………………………..2
Identification of the Family (Initial Data Base)……………………………………...…3
- Spot Mapping
- Family Structure
- Socio-Economic and Cultural Factors
- Family Home and Environmental Factors
- Family Health Assessment of each Member
- Valued Place on Prevention of Disease
- ECOGRAM
- GENOGRAM
 - APGAR
- Family Coping Index
First and Second Level of Assessment …………………………………………………20
- Identification of Problem(s)
- Prioritization of the Problem(s) with solution

Problem List (Maslow’s Hierarchy)…………………………………………………….24

Problem Identification (Health Threat/ Deficit/ Foreseeable Crisis Situation)………….25
Planning………………………………………………………………………………….26
- Establishing goals and objective based on the prioritize problems
Intervention and Implementation……………………………………………………..26-27
- Nursing Intervention (based on type and category of intervention and level of
prevention)
- Nursing care implementation
- Health teachings, medical management, home management
Evaluation of Care……………………………………………………………………….30
- Client’s behavioral response
- Comparing client’s response with predetermined outcome
Family Nursing Care Process (FNCP)………………………………………………..31-33
Referrals…………………………………………………………………………………34
Summary…………………………………………………………………………………34
Reflection………………………………………………………………………………...35
Recommendation……………………………………………………………………...…35
Health Updates…………………………………………………………………...…..36-37
References…………………………………………………………………………….….38
Appendices………………………………………………………………………...…….39

ACKNOWLEDGMENT
We, the Group three (3) would like to express our heartfelt gratitude and appreciation to the
persons who, in their different ways, have supported us leading to the realization and fulfillment
of this case study:

To God, our Almighty Father, for being our true source of strength, inspiration, and
enlightenment in everything;

To our dear clinical instructresses, Ms. Koren May M. Campo, Ms. Lorna S. Baliwis, Ms.
Joycelyn F. Dalendeg and all nursing instructresses for their full support in imparting their
knowledge to us accomplish this study.

Our beloved parents, relatives, and friends, who had always been very encouraging and
understanding of our endeavors;

Our host family, and the whole community, for being very accommodating and cooperative
during our stay in the area;

And to everyone who has helped make this case study possible. Thank you!
INTRODUCTION

GENERAL OBJECTIVES

SPECIFIC OBJECTIVES

IDENTIFICATION OF THE FAMILY

Family Structure

The C Family household is located in Purok Bagong Buhay, Bancao Bancao Puerto Princesa
City. The family is composed of five (5) members: M.C, J.C, JM.C, MA.C, and Ja.C. The father,
Mr. M.C, is 33 years old and the head of the family. He is married to J.C, 23 years old. JM.C (3
years old), MA.C (2 years old), and Ja.C (4 months old) are Mr. & Mrs. C. children.

The C Family is a nuclear family and is living all together in one house wherein the mother and the
father both provide the needs of the family.

Socio-Economic and Cultural Factors

Name Age Sex Civil Status Position in Relationship

the family to the Head of
the Family

1
 M.C 33 M Father Husband
J.C 23 F Mother Wife
JM.C 3 M Single 1st child Son
MA.C 2 M Single 2nd Child Son
Ja.C 4 months F Single 3rd Child Daughter

1. Occupation, place of work, and income of each working member

Name Educational Occupation Place of Work Monthly Income

Attainment
M.C Under Construction Brgy. Bancao P 5, 000
Graduate worker Bancao
J.C High School Online Seller House P 1, 500
Graduate
JM.C - - -

MA.C - - -

Ja.C - -

2. Adequacy to meet necessities

The income of both provider are enough for the food and bills of the family. Mr. M.C works
are contractual, so there are times the need of the family doesn’t meet. Ms. J.C are online seller and
sometimes send money to his father in municipality. So there’s no budget for the other necessities
like for clothes and visual learning's for the cognitive development of the children like books, and
charts. The husband and wife income in a month if they both work is P 6,500 and it will sustain all
the needs of the members of the family.

2
 Things where money is spent Amount
Food 3000/month
Electric Bill 700/month
Water Bill 300/month
Health Medicines 100/month
Others -

3. Who makes decisions about money and how it is spent?

The head of the family, Mr. M.C are the one who pay the bills and budget for
the needs of the family. In terms of health Ms. J.C provide medications such
vitamins, and medicines for fever for the children.

FAMILY HOME AND ENVIRONMENTAL FACTORS

1. Adequacy of living space

The C Family owns the house they live on, the house is made up of wood and light
materials. The walls are made up of bamboo strips, and plywood for division. Their house and lot
are 4 meters by 8 meters. The house is divided into 3 areas: a living room, kitchen and dining
area, 1 room, and 1 bathroom.

The house are congested where it lacks ventilation, poor lightning, and hear noises from
their neighbor. As well floor are not furnished; the floor mat is ruined.

TFA 32 SQM

TSA 2(15) + 2(8) = 46

Interpretation: 32 (TFA) < 46 (TSA) (crowded)

2. Sleeping Arrangement

The family sleeps in three (1) rooms. One room for Mr. & Mrs. Mars, one room for Mr. Daniel
and Ms. Jenny Mars, one room for Ms. Maymay Mars and Ms. Julia Mars. They sleep on the bed
with mosquito nets, pillows, and blankets.

3
 3. Communication and transportation facilities are available

Tricycles, Jeepneys are major means of transportation in Brgy. San Miguel. The family has
an electric line or Cellular phones.

4. Water Supply

They use Puerto Princesa Water District for their daily consumption such as cooking,
dishwashing, doing laundry, bathing. They just bought water in a water refilling station for their
drinking water also, they practice boiling their drinking water if mineral water is not available.

5. Toilet Facility

The family has a buhos toilet.

6. Sewerage System

Open drainage

7. Garbage/refuse disposal

Garbage Collection is the way on how they disposed their garbage.

FAMILY HEALTH ASSESSMENT OF EACH MEMBER

4
According to Mrs. Mars, she has a family history of hereditary disease. Mrs. Mars, children, and
daughter-in-law have asthma. They did not engage in some vices like smoking and drinking
liquor.

VALUED PLACE ON PREVENTION OF DISEASE

The family practiced storing medicines at home. They do not have their herbal plants in
their house but still, they utilize herbal medicine by sharing the plant owned by their neighbor such
as lagundi. The family is aware of the government health services like flu-vaccine, covid vaccine,
etc. Mrs. Mars actively participates in community activities such as gift-giving for the Victims of
the Odette Typhoon.

ECOMAP

GENOGRAM

APGAR

5
MS. J.C

APGAR ASSESSMENT Almost always Some of the time Hardly ever

(2) (1) (0)

/
A I am satisfied that can turn
to my family for help when
something is troubling me

/
P I am satisfied with the way
my family talks about things
with me and shares problems
with me

/
G I am satisfied that my family
accepts and supports my
wishes to take on new
activities or directions

/
A I am satisfied with the way
my family expresses affection
and responds to my emotions
such as anger, sorrow, and
love

/
R I am satisfied with the way
my family and I share time
together

6
 COMPONENT SCORE JUSTIFCATION
ADAPTATION 1 Daniel Mars & Jenny Mars feel that their family is not giving
enough, in times of need.
PARTNERSHIP 1 The Eldest child is not sharing problems with r family because
she is working in the other country and don’t want her family to
worry her.

Also, the middle child and his wife are not sharing problems
with their family, for they want privacy also, according to them
they are big enough to handle problems without the help of their
family.
GROWTH 1 Daniel Mars feels that his family is not supporting him in every
decision that he makes.

AFFECTION 1 Daniel Mars and his wife don’t want to listen to the advice of
their parents nor accept anger from their family.
RESOLVE 1 Due to their occupation, they barely share their time.
Total 5 Highly Functional Family

Interpretation and Analysis:

7
FAMILY COPING INDEX

1. No competence 3. Moderate competence 5. Complete competence

CATEGORY EXIT JUSTIFICATION

1. Physical Independe 5 Due to additional health teachings of

nce Nursing students regarding daily walking
and grooming, they had improved their
(This category is concerned
façade and gained knowledge as well.
with the ability to move
about, to get out of bed, to
take care of daily grooming,
walking, etc.)

8
 2. Therapeutic 4 After several home visitations and nursing
Competence interventions, the family is now aware of
the use of herbal medicines that can be
(This category includes all
used to cure common illnesses. The
procedures or
students had also given pamphlets
treatments prescribed for
regarding herbal medicines.
the case of illness such as:
giving medication, using an
appliance, dressing,
exercise, relaxation, special
diets, etc.

3. Knowledge of Health 3.5 The Mars Family is now aware that

Condition common illnesses can be prevented.
Presently, the family members do their
(This category is concerned
best and follow the steps in preventing
with the particular health
such illnesses.
condition that is the
occasion for
care.)

9
 4. Application 3.5 Due to nurse-client interaction, the family
now finds time to have their schedule of
of
exercise. They also find time to take a nap
Principles of General
or sleep at least 8 hours a day.
hygiene

(This is concerned with

family action in relation to
maintaining family
nutrition, securing
relaxation for family
members carrying out
accepted preventive
measures such as
immunization, medical
appraisal, homemaking
habits about storing and
preparing food.
5. Health Attitudes 3.5 The Family appreciates the presence of
student-nurses in the perimeter and even
(Concerned with the way
avails such as BP taking. When one of
the family feels about health
care in general,

10
including preventive them is sick, they immediately avail the
services, care of illness, and services offered.
public health measures.)

6. Emotional Competenc 3.5 The family becomes stronger in solving

conflicts and problems. The mother gave
e
us subjective data which states that what
(Has to do with the maturity
makes them stronger each day are the
and integrity with which the
problems that come their way.
members of the family are
able to meet the usual stress
and problems of life, and to
plan for
happy living.)

7. Family Living
(This category is concerned
with the interpersonal or
3.5 All of them give enough love and care to
each other which makes them emotionally
strong. They strive hard to meet their
necessities.

11
group aspects of
family life.)

8. Physical Environme 3 After sharing health teachings, the family

and the community now plan to clean their
nt
surroundings by schedule and stop
(This category is concerned
burning their garbage’s outside their
with the house, community
backyard.
and the work environment,
its effects to the
family.)

9. Use of 4 Through the verbal health

teachings/instructions/explanati ons, the
Communit
family is presently aware and uses the
y Facilities
facility offered by the city health office.
(This category has to do
The family has improved awareness of the
with the degree of the family
person's
use and awareness of the

12
 available community
facilities for health approach when problems arise in the
education and family.
welfare)

TOTAL EXIT=33.5/9=3.72

Interpretation:

FIRST AND SECOND LEVEL OF ASSESSMENT

First Level of Assessment

CUES FAMILY HEALTH PROBLEM

No. of Rooms =1 rooms Inadequate living Space

Members of the family sleep in three rooms

of the house
• scattered containers, galloons, and Poor Home Environmental Sanitation
pieces of wood at the car garage.

• Some garbage is stocked inside the

hidden corners of the house.

• Neighbors are burning their garbage’s

outside their backyard.

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Second Level of Assessment

Cues/Data Family Nursing Diagnosis

• “tatlo lang ang kwarto naming.Bale Inadequate living Space
anim kami lahat”. As verbalized by the
Inability to recognize the presence of the
mother.
condition due to:

a. Denial about its existence, severity,

specifically economical cost implication
• “Sa sobrang daming bayarin hindi na Malnutrition
sapat ang aming kinkain kung ano lang
Inability to recognize the problem of
ang meron sa bahay yun lang
malnutrition due to:
inihahaiin naming sa araw-araw “. As
a. Ignorance of facts that some of the
verbalized by the mother.
family members are malnourished.

b. Low Salience of the family about the

existing problem of malnutrition.
• “ Dahil busy kami saaming trabaho Poor Home Environmental Sanitation
minsan lang kami nakakalinis sa loob
at labas ng aming bahay at malayo ang
Inability to provide a home environment
tapunan ng basura kaya sinusunog ng
conducive to health maintenance and personal
kapitbahay ang kanilang basura sa
development due to inadequate knowledge of
tapat ng aming bahay,pagnaamoy ko
the importance of hygiene and sanitation.
ang kanilang pagsusunog ay
sinusumpong ako ng hika”.as
verbalized by the mother.

14
 SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS ACCORDING TO
PRIORITIES

Problem #1 INADEQUATE LIVING SPACE

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

1. Nature of the 2/3x1 .67 It is a health threat
Problem because the family are at
risk of being affected of
cross infection.
2. Modifiability of the 1/2x2 1 Increasing the living space
problem will require quite a
financial expenditure.
3. Preventive Potential 3/3x1 1 Increasing the living space
will reduce the possibility
of cross infection from the
communicable diseases.
4. Salience 0/2x1 0 The family doesn’t
perceive their living space
as problem.
2.67
Total Score

15
 Problem #2 Malnutrition

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

1. Nature of the 3/3x1 1 It is a health deficit that
Problem may affect the health
condition of the family.
2. Modifiability of the 1/2x2 1 -Resources may be
problem present in the family.
-Student nurses: health
teaching on proper
nutrition.
-But these resources -may
not be used properly (lack
of time and their financial
capability.)
3. Preventive Potential 3/3x1 1 It has a high preventive
potential because if
appropriate actions will be
given it will be solved.
4. Salience 2/2x1 1 The Family recognizes it
is a problem.
4
Total Score

Problem #3 Poor Home Environmental Sanitation

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

1. Nature of the 2/3x1 .67 It is a health threat that
Problem needs immediate action.
2. Modifiability of the 2/2x2 2 -Resources may be
problem present in the family.
-Students can give

16
 suggestions and conduct
health teaching.
3. Preventive Potential 3/3x1 1 Occurrence of diseases
due to poor environmental
situation can be reduced
4. Salience 1/2x1 .5 The Family knows about
the problem but does not
give immediate attention
4.17
Total Score

PRIORITIZATION OF HEALTH PROBLEM

PROBLEM IDENTIFIED SCORE RANK

POOR HOME 4.17 1
ENVIRONMENTAL
SANITATION
MALNUTRITION 4 2
INADEQUATE LIVING SPACE 2.67 3

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PROBLEM LIST (MASLOW’S HIERARCHY)

An interpretation of Maslow’s hierarchy of needs is represented as a pyramid with the more basic
needs at the bottoms. As one moves to higher levels of the pyramid the needs are more complex.

Physiologic Needs

Food

The family has inadequate intake of nutritious food due to financial income and busy at
work that has no time to prepare nutritious food, they eat food that is only available at home also,
the market is far from their home.

Shelter

The Mars Family owns the lot they live on, their house is made up of strong materials.
The walls are made up of cement.

Safety and Security

18
Prone to Fire, Air, and Noise Pollution

The house is congested where it lacks ventilation, hears a noise from other houses and every
morning neighbors are burning their garbage so Mrs. Mars having an asthma attack. Burning is
the way of their neighbors how they disposed of their garbage.

Financial Security

The client is a simple High School Teacher. She earns P 23,000.00 but is not sufficient for their
daily living because of her past loan. Her husband is a Senior Citizen and works as a selfemployed
but now stops working because of Covid-19. Now their eldest child is a breadwinner in the family.

Love and Belongingness

Family

Closely knit relationship with the family but readily conflict with members.

Self-Esteem

When we conduct our interview with the Family, they welcomed us and did not hesitate to let us
know about the condition of their house, we observed the family has adequate self-confidence.

Self-Actualization

The ongoing process to reach this stage

PROBLEM IDENTIFICATION (HEALTH THREAT/ DEFICIT/ FORESEEABLE CRISIS

SITUATION)

Health Threat

• Lack of Food-Lack of Food due to work schedules and being far from the marketplace

Due to their busy work schedules, they often cook meal foods and bought food in a fast-food
restaurant.

19
 • Inadequate living space
Three-room for a family of six is a substandard space for the family

• Prone to Fire, Noise, and Air Pollution

Their house is congested where it lacks ventilation, hears a noise from other houses and
every morning neighbors are burning their garbage so Mrs. Mars has an asthma attack.
Burning is the way of their neighbors how they disposed of their garbage.

Health Deficit

• Malnutrition
-Food prepared is lack Nutrients because of busy work schedules and accessibility of the
marketplace.

Foreseeable Crisis
The family has no time to go health center because of their busy schedule.

PLANNING

1. To establish rapport with the family members

2. Help the client by making nursing interventions that may be useful to apply to their health
problems.

3. Put the nursing interventions into action

4. To develop self-reliance in sustaining and managing their health without the help of other
people.

5. Continuous monitoring and frequent performance of home visitations.

6. To recognize the importance of having adequate living space.

7. To have the knowledge on how the malnutrition occur in one person.

8. The client will able to know the effects of poor sanitation to their health and well-being.

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NURSING INTERVENTION (THREE LEVELS OF PREVENTION)

Primary Prevention

1. Health Promotion
-Health Education Program to the Family as well as in the Community.
-Promoting child and family nutrition.
-Promoting physical activity (example: Zumba)
- Stress management, sleep hygiene, healthy relationships

2. Specific Protection
-Specific nutrients or supplementations
-Control of environmental hazards (Ex. Air Pollution, avoid neighbors burning their
garbage’s instead told them the proper way to throw their garbage’s).
-Immunization

Secondary prevention: early diagnosis and adequate treatment

1. Check body mass index (BMI) at every checkup to identify individuals who
are underweight in the family.
2. Periodic Health Examination
Tertiary prevention: nutritional rehabilitation
1. Visit Hospital at the Out-Patient for a follow-up check-up
2. Follow up cases

NURSING CARE IMPLEMENTATION

21
The nursing care implementation is a careful and thorough analysis in the study of health, social
and personal problems in the family. It guides us the student nurse in giving care needed by the
family and helping them teach and guidance to every member in the family.

Through the nursing care implementation, we were able to determine the health status of the
family through assessment and critical inspection because of this, health-related problems are
identified which indicates to us how to intervene just to give holistic care and improve the
deficiency.

The Following are the Nursing Care Implementation:

1. Inadequate living space

-Discuss the worth of having enough space for living

- Inform the client regarding the easy transmission of disease due to inadequate living
space

2. Malnutrition

- Teach the client about nutritional requirements, and plan an eating program that includes
healthy foods, high-calorie, high-protein foods, and supplements and reflects their food
preferences.

3. Poor Home Environmental Sanitation

-Provide health teaching about the importance of a clean and healthy environment.

HEALTH TEACHING

• Encourage the family members to eat healthy meals, minimizing the fast food. Explain to
the community about risk factors and causes of burning waste to their health.

22
 • Encourage the family and community on the importance of exercise or any physical activity
like Zumba or walking which promotes proper blood circulation. Regular exercise has been
shown powerful tool to enhance our life.

• Encourage the client to get the whole family involved in the care plan as well as to remind
the other family members how important it is to be sensitive to the client’s situation.

• Encourage the family to always make the surroundings clean

MANAGEMENT

A. Medical

Malnutrition- refers to deficiencies, excesses, or imbalances in a person’s intake of

energy and/or nutrients. The term malnutrition addresses three (3) broad groups of
conditions:

• undernutrition, which includes wasting (low weight-for-height), stunting (low

height-for-age) and underweight (low weight-for-age);

• micronutrient-related malnutrition, which includes micronutrient deficiencies (a

lack of important vitamins and minerals) or micronutrient excess; and

• overweight, obesity, and diet-related non-communicable diseases (such as heart

disease, stroke, diabetes, and some cancers).

Common signs of malnutrition include:

• unintentional weight loss – losing 5% to 10% or more of weight over 3 to 6 months

is one of the main signs of malnutrition

23
• a low body weight – people with a body mass index (BMI) under 18.5 are at risk of
being malnourished (use the BMI calculator to work out your BMI)
• a lack of interest in eating and drinking
• feeling tired all the time
• feeling weak
• getting ill often and taking a long time to recover
• in children, not growing or not putting on weight at the expected rate

Who is at risk?

Every country in the world is affected by one or more forms of malnutrition.

Combating malnutrition in all its forms is one of the greatest global health challenges.

Women, infants, children, and adolescents are at particular risk of malnutrition.

Optimizing nutrition early in life—including the 1000 days from conception to a
child’s second birthday—ensures the best possible start in life, with long-term
benefits.

Poverty amplifies the risk of and risks from, malnutrition. People who are poor are
more likely to be affected by different forms of malnutrition. Also, malnutrition
increases health care costs, reduces productivity, and slows economic growth, which
can perpetuate a cycle of poverty and ill-health.

Causes

Malnutrition (undernutrition) is caused by a lack of nutrients, either as a result of a poor

diet or problems absorbing nutrients from food.

Physical and Social factors

24
The following factors can also contribute to malnutrition:
• teeth that are in poor condition, or dentures that do not fit properly, which can
make eating difficult or painful
• a physical disability or other impairment that makes it difficult to move around,
cook or shop for food
• living alone and being socially isolated
• having limited knowledge about nutrition or cooking
• alcohol or drug dependency
• low income or poverty
• lifestyle
• loneliness
• isolation
• marital status
• educational level
• socioeconomic level
• place of residence.

Treatment for malnutrition depends on the general health of the family.

The first dietary advice is to:

• eat “fortified" foods that are high in calories and protein

• snack between meals

• have drinks that contain lots of calories

• Some people also need support with underlying issues such as limited mobility.

For example, care at home or occupational therapy.

• taking extra nutrients in the form of nutritional drinks or supplements.

25
 • If the family has difficulty eating and this cannot be managed by making
changes such as eating soft or liquid foods, other treatments may be
recommended.

HOME MANAGEMENT

Inadequate living space

The home management for adequate living space are the following:

1. Health Teaching

2. Use environmental resources as part of materials in improving adequate living space

3. Buy only things that are needed to maximize the space of their house

4. Fix or arrange furniture that would maximize the house space

Poor Home Environmental Sanitation

The home management for Poor Home Environmental Sanitation are the following:

1. Health Teaching

2. Encourage the Mars Family to establish a regular schedule of cleaning their house

3. Disseminate information in the Community regarding proper waste disposal

EVALUATION OF CARE

We identified some health-related problems. These are poor environment, malnutrition,

inadequate living space, presence of air pollution, thus we base our nursing interventions on
health teachings, basic health services, and frequent home visitation.

26
 Moreover, continuous motivation is done to modify their behavior. Improvements of the family
Mars and the community were noted in terms of poor environment and air pollution such as
burning waste in their backyard. Other problems identified such as malnutrition, and inadequate
living space is still needed to be followed up and explore ways to arrange for time and schedule.

FAMILY NURSING CARE PLAN

Health Family Nursing Goal of Objectives Nursing Intervention Method Resources Evaluation
Problem Problem Care of Care of Required
Family
Contract
Inadequate Inability to recognize At the end of At the end of 2 1. Suggests use of Home Visit -human Mother
living space the presence of the the Nursing weeks Nursing environment resources; - verbalized
as condition due to: Interventions, Intervention, resources as part of Time and recognition of
health threat the family will the family will materials in improving effort of their existing
to the family. take necessary be able to: adequate health care condition and
a. Denial
measure to living space provider. - corresponding
about its
improve (to use existing Effort of the solutions.
Subjective: existence, -recognize the
adequate resources in the family to find
severity, existing
living space community) ways to
specifically problem. Goals met.
“tatlo lang resolve the
economical
ang kwarto problem.
cost 2. Conduct
naming.Bale -identify ways
implication health
anim kami to resolve
teaching or possible
lahat”. As problem.
susceptibility to
verbalized by
communicable
the mother. At the end of 3
disease due to inadequate

27
 weeks living space.
Community (to instill
Exposure, the knowledge of existing
Objective: 6
family will be problems).
members in
able to:
the family
3. Encourage proper
sleep in the 3
-provide budgeting of daily
rooms of the
measures to expenses.
house.
improve (to enhance the
existing proper budgeting).
condition.

2. Nursing Care Plan

Health Family Nursing Goal of Objectives Nursing Method of Resources Evaluation

Problem Problem Care of Care Intervention Family Required
Contract

28
 Malnutrition Inability to recognize After the After 3 weeks -Emphasize Home Visit -human Goals partially
the problem of nursing of Nursing the resources; - met.
malnutrition due to: intervention, intervention, importance of Time and
Subjective:
the family will the family will proper effort of health
-They can
be able to: be able to nutrition. care provider. -
a. Ignorance of perform the
“Sa sobrang
Effort of the
facts is that importance of
daming
family to find
some of the -Perform the -Improve the -Teach the nutrition
bayarin hindi
ways to resolve
family importance of weight of family about through
na sapat ang
the problem.
members are nutrition malnourished proper food abstaining from
aming kinkain
malnourished. among the in the family preparation. unnecessary
kung ano lang
b. Low Salience family with the help food and being
ang meron sa
of the family members of the health able to identify
bahay yun -Enumerate the
about the through their teachings being cheaper
lang inihahaiin advantages
existing actions of taught to eat nutritious food.
naming sa and
problem of abstaining various kinds
araw-araw “. disadvantages
malnutrition. from of food.
As verbalized of
unhealthy food.
by the mother malnutrition.
-Demonstrate
-Identify the proper way
-Identify
affordable of preparing
cheaper
Objective:
foods yet affordable
nutritious and
nutritious and nutritious food.
healthy foods.
Underweight healthy foods.
BMI of the
following
family
members:

Katherine
Mars (57 years
old)=14.6
underweight

Maymay Mars
(25 years old)
= 15.1
underweight

29
Jenny Mars
(29 years old)

=15.4
underweights

3. Nursing Care Plan

Health Family Nursing Goal of Care Objectives Nursing Method of Resources Evaluation
Problem Problem of Care Intervention Family Required
Contract

30
Poor Home Inability to After 1 week of After 5 days -Establish Home Visit -human Goals partially
Environmental provide a nursing of nursing Rapport with resources; - met.
Sanitation home intervention, the intervention, the Time and
environment family will be the family will family effort of
conducive to able to make time be able to: health care
Subjective: “
After 5 days of
health to clean provider. -
Dahil busy kami -Assess the
nursing
maintenance their house and Effort of the
saaming trabaho - explain the location of
intervention,
and personal their neighbors family to find
minsan lang kami importance of the family’s the family was
development will be able to ways to
nakakalinis sa a clean house. able to:
due to gain enough resolve the
loob at labas ng environment to -Enhance
inadequate knowledge about problem.
aming bahay at their health. the family’s
knowledge the disadvantages - explain the
malayo ang ability to
of the of burning importance of a
tapunan ng basura recognize
-the neighbors
importance trashes/garbage’s clean
kaya sinusunog ng their needs
will be able to
of hygiene in their health. environment to
kapitbahay ang and
improve their
and their health.
kanilang basura sa problems by
knowledge of
sanitation
tapat ng aming teaching the
proper ways to
bahay,pagnaamoy family and -the neighbors
dispose
ko ang kanilang the was able to
garbage.
pagsusunog ay community improve
sinusumpong ako on the knowledge in
ng hika”.as nature cause proper ways to
verbalized by the of the dispose
mother. problem garbage
.

Objective: - -Explore
scattered with the
containers, community
galloons and the different
pieces of woods at ways to
the car garage. improve
garbage

-Some garbage is disposal

stocked inside the

hidden corners of
the house.

31
REFERRALS

After we conduct health teaching to the family, we encourage the Mars Family to cooperate with
the Barangay Health Clinic to know their health status and acquire free supplements.

SUMMARY

The Mars Family is a combination of a traditional and modern family composed of a father, a
mother, children, and a daughter-in-law. They are residents of Brgy. San Miguel, Wescom Road
Puerto Princesa City. The Father, Mr. Mars stays at home while the youngest is a student and the
other members of the family are working. The family’s monthly income is affected because of the
past loans. This has a significant impact on the family’s quality of life because they are on the
verge of being unable to meet their basic needs.

This problem has also resulted in a slew of other issues, including malnutrition, inadequate living
space, improper waste management of the community, unhealthy lifestyle, personal practices, and
habits. The family will be able to understand the importance of promoting their family’s health
and preventing illness after a series of health teachings. However, due to constraints such as the
lack of a waste collection system in the community, they had trouble implementing the necessary
improvements to fix their difficulties.

32
REFLECTION

First, every morning we observed that our neighbors are burning their garbage’s outside their
backyard but burning waste has a bad impact on our health. It is usually an environmental poor
waste management option because potential resources are lost and it can cause air, land, and
water pollution. In some cases, burning waste is forbidden.

Open burning garbage poses a health risk to those exposed directly to the smoke. It especially
affects people with a sensitive respiratory system as well as children and the elderly. In short,
exposure to smoke can cause headaches, nausea, asthma, and rashes.

Also, when organic waste decomposes, carbon dioxide and methane gas are created. Both carbon
dioxide and methane are greenhouse gases, which contribute to warming and climate change.

Second, Poverty is a primary cause of malnutrition that mediates through inadequate dietary
intake, lack of medical care, lack of access to sanitation and hygiene, inadequate living space, and
poor environment, through our studies we will be able to guide the community in giving care
what they are needed to improve their conditions.

33
 Being the student nurse of our client’s family has allowed us to open our eyes about our
environment, not also the family but the whole community through continuous health
assessments and interactions with them, we were able to identify their health problems. As a
result, a nursing intervention was given specifically giving health education to correct their
lifestyle practices.

RECOMMENDATION

We recommend to the next nursing students who will be handling the Mars Family to
effectively establish rapport with the family members. There should be continuous facilitation,
monitoring, frequent home visitations, and thorough motivations to the family.

HEALTH UPDATES

Toward Zero Waste Without Burning

By: Joey C. Papa, Ana Celia Ver-Papa ; Philippine Daily Inquirer / 05:01 AM November 27,
2021

The first Global Day of Action against Incineration was celebrated on June 17, 2002. The Global
Alliance against Incinerators/Global Anti-Incineration Alternatives (GAIA) secretariat in

the Philippines presented to then President Gloria Macapagal Arroyo a citizens’ appeal endorsed
by more than 80 groups from 34 countries for the phaseout of medical waste incinerators in the
country and for their replacement with safer, non-burn technologies in accord with the Clean Air
Act of 1999 (Republic Act No. 8749). The Act bans incineration and mandates local government
units “to promote, encourage, and implement… a comprehensive ecological waste management
that includes waste segregation, recycling, and composting.”

34
 Almost two decades later, the country finds itself in the midst of the COVID-19 pandemic,
besieged not only by widespread illness and death among the population but also by a crushed
economy and by climate disasters aggravated by environmental degradation, the exploitation of
natural resources, tons of medical waste from hospitals, unchecked consumerism resulting in all
other sorts of waste ending up in dumpsites—all of which the Department of Environment and
Natural Resources (DENR), through local government units, intends to burn.

On Nov. 26, 2019, the DENR issued Department Administrative Order No. 2019-21 which
decreed the building and operation of so-called waste-to-energy (WTE) facilities or incinerators
to deal with municipal solid waste. Congress is reportedly also amending the Clean Air Act to
accommodate WTE facilities, while the Department of Science and Technology is supporting the
25-kilowatt (kW) WTE facility in Los Baños, Laguna.

Incineration, a burn technology, will not solve the waste problem. Instead, it will gravely pollute
air, land, and water resources, and cause illnesses among the population.

In her book “Toward Zero Waste,” the late Luz Escalante Sabas or “Manang Luz,” our country’s
pioneer zero waste advocate (since 1979), cited Madeline Hoffman of Stop Incineration

Now (SIN) who said that incinerators in the United States and other countries emit dioxins, which
are components of Agent Orange, a “powerful mixture of chemical defoliants used by US military
forces during the Vietnam War to eliminate forest cover for North Vietnamese and Viet Cong
troops as well as crops that might be used to feed them…. (The) chemical dioxin… was later
revealed to cause serious health issues—including tumors, birth defects, rashes, psychological
symptoms and cancer—among returning US servicemen and their families as well as among the

Vietnamese population.”

Also, she said, incinerators generate hazardous ash more toxic than unburned waste, and that “for
every three tons of trash burned, one ton of very toxic ash is produced.”

35
The Bible verse John 3:16—“Gather the fragments left over, so that nothing will be wasted”—
was Manang Luz’s inspiration for her work. Dr. Metodio Palaypay, the late Odette Alcantara
(who proudly stated “we are Manang Luz’s students”), the authors of this article, and others, have
followed Manang Luz’s advocacy.

Government support, however, has been greatly wanting, despite the passage of the Ecological
Solid Waste Management Act (RA 9003).

Due to the high cost of building, operating, and maintaining incinerators, existing facilities are
being shut down. So why put up one here? The Ecology Center System, which is a household-
and community-based endeavor, promotes environment-friendly products and the practices of
recycling, and composting for livelihood and organic/ecological farming, thus transforming waste
into useful resources. Medical and infectious waste can be sterilized through autoclaving, which
uses steam. Single-use plastics must be banned because fish and seashells mistake such materials
for plankton.

About 60 percent of total waste generated is biodegradable. We return them to the earth through
composting to regenerate, cultivate, reforest, and protect our land. Lupa: Cover the biowaste with
soil. Araw: Ensure the mixture gets heat from the sun, but not from direct sunlight. Hangin:
Aerate the mixture. Tubig: Sprinkle with some water to moisten the mixture. Repeat the process
until the container is full. Wait for a month for the mixture to turn into compost. “LAHaT”: Very
Pinoy.

REFERENCES

Internet Sources:

https://www.bestrongfamilies.org/news/2018/9/28/what-does-family-mean-to-you
https://opinion.inquirer.net/146897/toward-zero-waste-without-burning
https://www.hopkinsmedicine.org/health/conditions-anddiseases/malnutrition#:~:text=Malnutrition
%20is%20the%20condition%20that,are%20either%2 0undernourished%20or%20overnourished.

36
Public Health Nursing In The Philippines by Frances Prescilla L Cuevas
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4951875/

https://www.euro.who.int/__data/assets/pdf_file/0017/121832/E90676.pdf

37
 APPENDICES

6 / / /
Jake Mars 23/ 61 60 M MarriedCollege Grad.n/a Yes / Christian
09/
Katherine Mars07/ 64 57 F MarriedCollege Grad Teacher Yes N/A N/A Christian
12/
Julia Mars 01/01/91 31 F Single College Grad. Nurse Yes N/A N/A Christian

Daniel Mars 21/01/93 29 M Married College Grad Seaman Yes N/A N/A Christian

Jenny Mars 10/04/199

3 29 F Married College Grad Secretary Yes N/A N/A Christian

Maymay Mars 11/30/96 25 F Single Student None Yes N/A N/A Christian

38
 Jake Mars
Male
August 23, 1961

/ /

Flu Vaccine , Measles Vaccine

/
/
/

/
/
/

N/A
N/A

/
/
/
/
/
/
/
/
/
/
/
/

/
/
/
/

5’8
70 KG
23.5
120/70
17 CPM
70 BPM

Normal Normal
Normal 39 Normal
Normal Normal
Normal Normal
 Katherine Mars
Female
December 7, 1964

/ / /

Flu Vaccine, Measles Vaccine

/ Anti -allergy Seafood

/
/
/
/
/
/

N/A
Child Birth Hospitalization

/
/
/
/

/
/
/
/

/
/
Seafood
/
3 3

5’ 1
35 KG
14.6
90/60 mmHg
15 CPM
69 BPM

Normal Normal
Normal Normal
Normal 40 Normal
Normal Normal
 Daniel Mars
Male
January 21, 1993

/ / /

Flu Vaccine, Measles Vaccine

/
/
/
/
/
/
/

N/A
N/A

/
/
/
/
/
/
/
/
/
/
/
/

/
/
/
/

5’ 5
65 KG
23.8
115/80 mmHg
17 CPM
73 BPM

Normal Normal
Normal Normal
Normal Normal
41
Normal Normal
 Jenny Mars
Female
April 10, 1993

/ / /

Flu Vaccine, Measles Vaccine

/
/
/
/
/
/
/

N/A
N/A

/
/
/
/
/
/
/
/
/
/
/
/

/
/
/
/

5’1
37 KG
15.4
120/80
20 CPM
75 BPM

Normal Normal
Normal Normal
Normal Normal
Normal
42 Normal
 Maymay Mars
Female
November 30,1996

/ / /

Flu Vaccine, Measles Vaccine

/
/
/
/
/
/
/

N/A
N/A

/
/
/
/
/
/
/
/
/
/
/
/

/
/
/
/

5’0
35 KG
15.1
120/80
20 CPM
65 BPM

Normal Normal
Normal Normal
Normal Normal
43
Normal Normal