St.

Paul University Philippines

Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences

College of Nursing
1st Semester, AY 2021-2022

NCM 109 - CARE FOR MOTHER, CHILD AT RISK OR WITH PROBLEM

ACUTE AND CHRONIC

HEALTH HISTORY

I. BIOGRAPHIC DATA
- Name:
- Address:
- Age:
- Gender:
- Date of Birth:
- Place of Birth:
- Race/ Ethnic Background:
- Language Spoken:
- Civil Status:
- Religion:
- Educational Attainment:
- Occupation:
- Blood type:
- GTPAL Score:

II. CHIEF COMPLAINT

III. HISTORY OF PRESENT ILLNESS

- What are the signs and symptoms that you’ve experienced?

Characteristics- (describe the feeling + pain level)

Onset- (when did it begin? is it constant or recurrent?)

Location- (where on body? where does the pain radiates)

Duration- (how long did it last?)

Severity- ( how bad is it?)

Pattern – (what makes it worse, what makes it better?

Associated Factors- ( what other symptoms occur?)

 St. Paul University Philippines
Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences

College of Nursing
1st Semester, AY 2021-2022

NCM 109 - CARE FOR MOTHER, CHILD AT RISK OR WITH PROBLEM

ACUTE AND CHRONIC

- What aggravates this health concern? (what makes it worse)

- What alleviates the symptoms? (anong ginagawa niya to make it bearable)

- What caused the health concern to occur? How has the concern affected her
daily activities?

- Previous history and episodes of this condition (ngayon lang ba niya na

experience yun, pang ilan na, gaano kadalas)

IV. HISTORY OF PAST ILLNESS

- Do you have any serious illness during childhood and teenage years?

- During your childhood, did you receive any immunizations like vaccines?

- Have you gone through any injuries/accidents? If yes, what kind of injury?
What body part was affected? When did it happen? What were the treatments
that you received?

- Have you been hospitalized before?

- Did you have surgeries in the past?

- Do you have any allergies?

 St. Paul University Philippines
Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences

College of Nursing
1st Semester, AY 2021-2022

NCM 109 - CARE FOR MOTHER, CHILD AT RISK OR WITH PROBLEM

ACUTE AND CHRONIC

- Do you take any medications?

- Have they ever undergone any procedures, X-Rays, CAT scans, MRIs or other
special testing?

- Have you ever smoked?

- Do you drink alcohol?
- Do you take illegal drugs?
- Have you been pregnant before? If so, how many times?
- Do you have any heritable illnesses in your family?

V. FAMILY HEALTH HISTORY

- Does your family have any genetic condition/illness?

- Do you have any relatives who are suffering or have suffered from any of the
following? (if meron sinu sino, anong side mother or father)
- Does any of your family smoke or are alcoholic?

GORDON’S TYPOLOGY OF 11 FUNCTIONAL HEALTH PATTERN

I. HEALTH PERCEPTION MANAGEMENT

- What is your opinion about your own health

- What do you do to improve/maintain your health?

- Do you see yourself healthy? If yes how, if not why?

 St. Paul University Philippines
Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences

College of Nursing
1st Semester, AY 2021-2022

NCM 109 - CARE FOR MOTHER, CHILD AT RISK OR WITH PROBLEM

ACUTE AND CHRONIC

- How do your lifestyle choices affect your health?

- What are the things you think that makes you healthy? What do you do to
keep yourself feeling healthy?

- How do you manage sickness?

- Do you consult a doctor when you feel unwell?

- How often do you have medical check-ups or physical examinations?

- Do you self-medicate/diagnose?

- How do you manage your health?

- NUTRITIONAL - METABOLIC
- What do you usually eat on a typical day?

- Do you take snacks? How many snacks do you eat most days?
- What are your food preferences?

- How often and how much do you eat throughout the day?
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences

College of Nursing
1st Semester, AY 2021-2022

NCM 109 - CARE FOR MOTHER, CHILD AT RISK OR WITH PROBLEM

ACUTE AND CHRONIC

- Do you have a habit of skipping meals?

- What do you drink during a typical day?

- What kind of drinks do you prefer?

- How often and how much do you drink throughout the day?

- Do you drink Alcoholic Beverages? How often?- No

- How many times do you drink coffee in a day?- 1-2 times
- 24 hr recall of food intake-
- Breakfast: Pritong talong, dried fish, egg, and rice, 1 cup of coffee and
1 glass of water
- Lunch: Pinakbet (4 tbsp.), 2 cups of rice, 1 ½ glass of water
- Snack- 2 loves of bread, 1 cup of coffee, 1 glass of water
- Dinner: Tinolang manok (1 bowl), 1 cup of rice, 1 glass of water
- Describe your diet plan eg. low carb n balanced DIET- Balance diet, more on
gulay
- Are you taking vitamins or any food supplements? - No
- Do you have any food restrictions/allergies? If yes, what kind? - None
- Do you believe your body is getting the nutrition it needs? – Oo naman
- Did you gain or lose weight lately? How many pounds? – Lose weight after
pregnancy of 13 kgs
- Before pregnancy: 48 kgs
- During pregnancy: 68 kgs
- Recent after pregnancy: 55 kgs
- Do you gain weight fast? No
- Having trouble gaining weight? No
- Do you love eating street foods? Fast food? How often? No
- How many times do you drink milk or eat yogurt or cheese in a day? During
pregnancy: 1-2 times a day (Milk and Hot choco)
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences

College of Nursing
1st Semester, AY 2021-2022

NCM 109 - CARE FOR MOTHER, CHILD AT RISK OR WITH PROBLEM

ACUTE AND CHRONIC

- Is your appetite usually: (Good, Fair, Poor)- Good

- Are you on a special diet (prescribed by your doctor)? If yes, what kind?- No
- How many times a week do you eat Fast Food- N/A

II. ELIMINATION PATTERN

- How many times do you urinate in a day? – 5 times
- Can you describe the usual color, amount and smell of your urine?- Color –
clear yellow, moderate, normal smell
- Do you feel a burning sensation whenever you urinate? - No
- Do you observe any discharge? What color, smell, consistency- No
- How many times do you move your bowels in a day?- Isang beses sa isang
araw
- Do you have any discomfort during elimination?- No
- What is the usual color of your stools? – Brown, hard stools
- Do you use any laxative? - No
- Is there any food that can affect your elimination pattern? -None
- Are you experiencing excessive perspiration?- No

III. ACTIVITY EXERCISE

- How do you spend the majority of your time?- Nagluluto, nag aalaga kay
baby, minsan naglilinis ng bahay
- Do you have any exercise routine? Do you follow an exercise plan? – No
- Do you exercise? If yes: What type of exercise? – No
- Do you encounter any problems while working out? No
- Do you feel pale during or after working out? No
- Do you do house chores or walk for at least 15 mins? Yes
- How many hours do you stay in your bed? 3 hours during breastfeeding, 6
hours of sleep
- Are you an active person? No
- Do you think you have a sedentary lifestyle? Yes
- Do you have any disease that affects the cardio-respiratory system or
musculoskeletal system? No
- Do you have any breathing problems? (apnea, hypoxia, hypoxemia,
hypercapnia) No
- Do you experience a massive change in heartbeat during exercise? How about
breathing?- No
- Having difficulty doing ADL?- No
- Do you have allotted time for rest or leisure?- Yes
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences

College of Nursing
1st Semester, AY 2021-2022

NCM 109 - CARE FOR MOTHER, CHILD AT RISK OR WITH PROBLEM

ACUTE AND CHRONIC

- Is your work time and rest time balanced?- No, lalo na kasi iba ang body clock
ni baby
- What do you do for leisure? – Chatting with baby and family members,
Babysitting

IV. COGNITIVE PERCEPTUAL

- How do you spend the majority of your time?- Nagluluto, nag aalaga kay
baby, minsan naglilinis ng bahay
- Have you experienced loss of memory? (Ask questions that can test the
patient's remembering capability.) – No
- Do you experience any change, difficulty or problem in your senses?
(eyesight, hearing etc.)- No
- Do you have difficulty focusing your attention?- No
- Do you find it difficult to remember things? Sometimes, after my cesarean
operation
- How do you manage any discomfort (e.g. deep breathings)? – Deep breathing,
nagrerelax lang ako, babysitting
- Having a hard time making decisions? Especially in critical situations?- No
- What is the easiest and best way for you to learn (e.g. social media/internet,
books, articles/news, tv/phone/laptop)? Do you have any trouble processing
information?– Searching the words, writing, reading -No
- Is difficulty in sentence making observed? (Based on observation)- No
- Does the person express herself clearly and logically? (Based on observation)-
yes
- Does the patient think and act according to his developmental level?- Yes

V. SLEEP - REST
- How many hours do you sleep in a day? - 6 hours
- What is your sleeping hour? – Evening
- Do you follow any sleeping schedule? - No
- What time do you usually sleep?- 9 or 10 in the evening
- What time do you usually wake up? – 6 or 7 am
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences

College of Nursing
1st Semester, AY 2021-2022

NCM 109 - CARE FOR MOTHER, CHILD AT RISK OR WITH PROBLEM

ACUTE AND CHRONIC

- Do you have any difficulties sleeping? What do you do about it?- None
- Is there anything that helps you to sleep or relax? – Watching television or
videos
- What methods or actions do you do to induce sleep?- Watching television or
videos
- Do you experience oversleeping?- No
- Do you take sleeping pills?- No
- Do you wake up during your sleep?- Yes, kapag nagigising na si baby or pag
need magbreast feed
- Describe your sleep-wake cycle (hours of wake and sleep time).- in a typical
day, 5 hours awake and 2/ 3 hours of nap, 6 hours of complete sleep
- Have you noticed any change in your sleeping pattern? - No
- Do you experience any trouble in falling asleep? If yes, what and how do you
attend to it?- No
- Do you take power naps?-Yes Is it effective?-Yes Do you feel rested after the
nap?-Yes
- Do you feel content with the amount of rest you have everyday? Yes
- How do you feel when waking up? (Fresh, drowsy, headache, or any
discomforts)- Puyat parin

VI. SELF PERCEPTION AND SELF CONCEPT PATTERN

- What is your self-perception about yourself? How would you describe
yourself?- “ Healthy naman, walang sakit at di gaanong stress, yun lang puyat
lang ang kalaban.”
- Are you satisfied with your status right now?- yes
- Are you satisfied with your self-body image?- yes
- Do you like grooming?- No
- What are the things you do to boost your self-esteem?- Ayos lang ng konti and
be positive lang
- How do you build your character? – Nakikisalamuha sa ibang tao at minsan
nagtatanong ako kung okay lang ba ang ugali ko sa kanila
- Do you have any insecurities? - No
- What are your edges? – Positivity, Good relationship with others, happiness
- What gender are you attracted to?- Male
- Have you lost/gained weight lately? How do you feel about this?- Pumayat
ako after ko manganak okay lang naman sakin kasi normal naman yun
- Are there changes in the way you feel about yourself or your body while you
are pregnant?-Nag iiba yung mood ko, minsan okay, minsan naiinis ako bigla,
parang Mood swings kumbaga.
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences

College of Nursing
1st Semester, AY 2021-2022

NCM 109 - CARE FOR MOTHER, CHILD AT RISK OR WITH PROBLEM

ACUTE AND CHRONIC

- Is there a change in how you view yourself after you got pregnant?- Wala kasi
ready na ako noon talaga maging nanay. Tanggap ko naman lahat.

VII. ROLE RELATIONSHIP

- What is your role in the family?- “ Masunurin akong anak na babae at pag
kaya ko tumutulong ako sa kanila.”
- What responsibilities do you have for the day-to-day at home?- Nagluluto at
naglilinis sa bahay
- Who takes over your role when you are sick? – Youngest sister
- Are you assuming your role?- No
- What are the things that can hinder you from accomplishing your role? – Ang
pamilya ko kasi nag-aalala sila na baka daw mabinat ako, saka nagkukusa
yung kapatid ko na babae na gawin yung trabaho
- Who do you live with?- Mama, Papa, Sister, Husband and Baby
- Do you provide for your family?- Yes, pero noong nabuntis ako hindi na ako
nagtrabaho kasi bawal sa pinasukan ko ang buntis
- Can you describe your relationship with your family? – Okay naman kaming
lahat, mabuti yung relasyon namin sa bawat isa
- How is your relationship with your family? – Mabuti naman
- How do you and the people you live with usually handle problems?- Tulungan
lang kami, kung anong maoffer ng isa tatanggapin.
- Is everyone in your family close to you? – Lahat kami
- Who makes the major decisions in your family?- Mother and Father
- How does your family or others feel about your pregnancy? Does your
pregnancy affect your relationship with your family? *Positively in a way that
it brought our closer/ bond improved- Masaya sila noong nabuntis ako,
naapektuhan in a way na sobra yung pag-aalaga nila sakin tapos mas tumibay
yung bonding at relationship namin
- How is your relationship with people within your social circle? - Okay
naman, walang nagbago
- Do you join any activities in your community? - Yes
- What social groups do you belong to?- Wala naman, friendships ganun lang
- What is the most important relationship for you at the present? Yung samahan
namin magkakapamilya, lalo na si baby at daddy niya.
- Are you going through a big change in role or relationship at the moment?
Yes, lalo na sa pagiging mommy.
- Are you happy with your current relationships? Yes
- Is there any relationship you want to cut off? None
- How is your social life? Are you satisfied with it? Yes, okay naman kasi
kaibigan ko parin yung mga dati kong kaibigan
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences

College of Nursing
1st Semester, AY 2021-2022

NCM 109 - CARE FOR MOTHER, CHILD AT RISK OR WITH PROBLEM

ACUTE AND CHRONIC

- Are you satisfied with your relationship with the people around you? Oo
naman

VIII. SEXUALITY - REPRODUCTIVE

- How would you describe your sexual relationship? Mabuti naman, masaya
kami pareho
- Are you satisfied with your situation related to sexuality?- Yes
- Did you feel any changes in your sexual desire?- No
- Do you engage in sexual activities?- Yes
- Do you have an active sex life?- Wala
- When was the last time you had intercourse? January 2021
- Do you feel discomfort when doing sexual activities? - No
- Do you feel any confusion with regards to your sexual identity? - No
- Do you use any contraceptives? – Contraceptive pills (over-the-counter)
- Do you have any disease or do you observe any dysfunction of the
reproductive system? - No
- Do you have any problem with your menstruation cycle? (frequency, changes,
discharges, abnormalities)- Wala naman, regular ako, monthly
- When did your menstruation start?- 14 years old (2nd year high school) When
was your last menstrual period? – November 18, 2020 (25 years old)
- How many times have you been pregnant? Once
- Describe the outcome of pregnancy? – Normal naman, pero dahil dun sa
nangyari kay baby at sa matagal na labor ko na-cesarean ako
- How have your plan and experience matched regarding having children? – 5
years from now iniisip namin sundan si baby, okay na kami sa dalawang
anak.

IX. COPING STRESS AND COPING TOLERANCE

- Have you been stressed lately? - No
- What usually causes/triggers your stress?- Noon, school and work
- What do you usually do when you’re stressed?- Jamming with friends and
family
- What do you do about it? How do you cope with it? Does it help or make
things worse?- Yun nga nakikipagbond lang sa friends at family, umookay
naman ako.
- Do you have any family, relatives or friends you can talk to when you are
stressed?- Meron, yung kapatid ko at friends
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences

College of Nursing
1st Semester, AY 2021-2022

NCM 109 - CARE FOR MOTHER, CHILD AT RISK OR WITH PROBLEM

ACUTE AND CHRONIC

- How does stress affect your daily activities?- Nawawala ako sa concentration
ko sa paggawa ng mga gawain kung minsan naapektohan niya ang trabaho ko
- How do you process your emotions? – Tinitimbang ko muna yung emosyon
ko pag hindi ko kaya sinasabi ko sa kapatid ko or kaibigan yung problema ko
kung minsan din iniiyak ko nalang
- Have you been to any treatment for emotional distress? Hindi pa naman
- Do you take some medicine to ease or prevent stress?- No
- Do you have someone that can help you in times of distress? (support system)-
Meron, yung pamilya ko at mga kaibigan

X. VALUE - BELIEF
- What is your belief about health? – “Health is wealth. Importante ang
kalusugan higit sa lahat.”
- Do you have any religious affiliations? - No
- Do you have any special religious practices? – Oo.
- Do you offer a prayer? Yes
- Do you regularly go to church? Hindi, paminsan minsan lang
- What religious and cultural practices are important to you- Sunday
obligations, Bedtime and meal praying, pag may mga celebrations naghahanda
kami, tapos pag may padasal nakikiparticipate kami, pag araw ng mga patay
dumadalaw kami sa mga yumao namin.
- Do you have specific practices when it comes to health? - Wala
- What are the things you consider as important and valuable in life? – Family
and love
- What gives you strength and hope? – Family ko
- Do you believe in the use of herbal medicines? Why? – Yes, walang halong
chemicals or ano saka ginagamit mostly noon pag walang ibang gamot na
pwede
- Do you believe in superstition? Like? – Hindi sa lahat, naniniwala ako sa mga
pamahiin
- Is Religion Important in life? Does this help when difficulties arise?- Oo
naman
- What is the most important lesson that you have learned during your
childhood that is still relevant until now?- Rumespeto sa mga matatanda,
huwag makikipag away, maging mabait sa ibang tao at pagiging masunurin.
 St. Paul University Philippines
Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences

College of Nursing
1st Semester, AY 2021-2022

NCM 109 - CARE FOR MOTHER, CHILD AT RISK OR WITH PROBLEM

ACUTE AND CHRONIC