ECONOMIC CONDITION

Mr Samar Sai is belongs to a low class family. He is the head and he’s a farmer. They used to
cultivate paddy and other vegetables according to the season. He reports that estimately
1500/- he used to earn from the farming. As his family has BPL card the government is
providing the rice and other food items.

Sl .no. Items Total amount spend (in rupees) % of total expenditure

1 Food 150/- 10%
2 Agriculture 500/- 33.3%
3 Transportation 200/- 13.3%
4 Electricity 150/- 10%
5 Others 150/- 10%
6 Education 100/- 6.7%
7 Savings 250/- 16.7%

LEISURE TIME ACTIVITIES

They were not having any special lesuire activities after completing their work from the field
they assemble together and have talk with the members of family. They are not having any
television or radio for the leisure activities.

TRANSPORTATION AND COMMUNICATION

As transportation aids they are having a bike and a bicycle. They are communicating with
others by using mobile phone.

ENVIOURNMENTAL SANITATION

 HOUSING CONDITION: Mr.Samal Sai is having own kacha house with 5 rooms. There
is two windows and having four doors. The house is having poor ventilation.
 SOURCE OF LIGHT: they are having electricity connection for the light facility
 WATER SUPPLY: They are having the water supply from bore well.
 KITCHEN CONDITION: they are having the separate kitchen in the house itself. They
are maintaining a good hygiene in the kitchen
 DRAINAGE SYSTEM: they are having an open drainage system where the disposal of
water n refuse directly opened in the paddy field and they are practicing open defecation.
 Presence of domestic animal: they are not having any domestic animals.
MENUPLANNING
One day menu planning for Mrs Savitri Bai

Sl.no. Time Item

1 Break fast 3 Rotti
1 cup of vegetable
curry
I cup of tea
2 Lunch 1 cup of rice
1 cup of Dal
1 cup of Vegetable
curry
3 Evening 1 cup of tea with 4
biscuts
4 Dinner 1 cup of rice
1 cup of dal
1 cup of vegetable

PHYSICAL EXAMINATION
GENERAL APPERANCE
Mrs Savitri Bai is looks lesser body built person is conscious oriented and having
good hygiene.shes moderately nourished and able to do her activities.

VITAL SIGNS

Sl.no. Parameters Normal value Patients value

1 Temperature 98.20f 98.40f
2 Pulse 72 beats / mt 68 beats/mt
3 Respiration 18-20 breaths/mt 24 breaths/mt
4 Blood pressure 120/80 mmHg 150/100mmHg

INTEGUMENTARY SYSTEM

Skin: Mrs. Savitri Bai’s skin colour is dark and having wrinkles present due to increased age.
She’s having decreased skin turgour and elasticity and her skin is dry. No other special
complaints are present.

Head: she is having normocephalus. No other complaints are present

Hair: she’s having moderate hair with black and white complexion. Hair is dry and scalp is
clean and no dandruff is present. She’s having the complaints of alopecia.
 Eye: her eyes are symmetrical and pupils are black in colour. Sclera is slight yellowish in
colour. Eye brows eye lids and eye lashes are symmetrical and equally distributed. Shes
having the complaints of short sight.

Ear: ears are symmetrical and cerumen is present. Has no other complaint.

Nose : her nose is in midline. Nasal pathway is clean and has no other complaints.

Mouth: her mouth is clean no odours are present. Her teeth are in irregular and not clean and
dental carries are present and yellow in colour. Tongue is in midline and has no other
complaints

Neck: range of motion is normal. Tonsils and limp nodes are not enlarged. Jugular vein is not
distended and has no other complaints

Respiratory system: chest expansion is normal. Lung sounds are normal. There are no any
complaints of dyspnoea

Cardiovascular system: heart rate is normal and heart sounds (s1 s2) is audible. Blood pressure
is 150/100mm Hg

Abdomen: abdomen is flat. Bowel sounds are present and normal, umbilicus is clean and no
other special complaints are present

Musculoskeletal system: upper and lower extremities are symmetrical and no deformities are
present. Capillary refill is normal with in 2 sec. She is having the complaints of pain in leg
after doing any activities. Her posture and gait is normal

Central nervous system: all the reflexes are normal .has complaints of memory power she’s
having less memory power. No other special complaints are present.

Genitourinary system: she’s having normal bladder and bowel elimination pattern and has no
other complaints

Anus and rectum: has no special complaint.

Application of Nightingales theory

The environment affects the human condition with nursing with nursing having the role of
affecting that environment, so that health/ disease becomes a reparative process.

Each of the major concepts imparts on the others. Nursing function to influence the
human environment to affect health. The individual is affected by the environment and by the
nurse who influence his/her health. Society/ environment has an impact on the nurse and on
the health of the individual. Health is a process affected by nursing and by environment and
human conditions.

The following list reflects nightingale view of the major concepts.

 Human or individual
  Nursing
 Environment
 Health

HUMAN OR INDIVIDUAL
 Refferred to by nightingale as the patient in most of her writings.
 Person is a human being acted upon by a nurse or affectd by the environment.
 Nightingale envisioned the persons as comprising physical, intellectual,
social and spiritual components.
 Person has reparative powers to deal with disease; recovery is within the patient’s power as
long as a safe environment for recuperation exists.
 NURSING
 Is a discipline distinct from medicine focusing on the persons experiencing a reparative
process rather than on the disease of an anatomical structure or the person’s physiology.
 Nightingale believed nursing to be a spiritual calling. She saw nursing as the “science of
environmental management.”
 Aims to provide fresh air, light, warmth, cleanliness, quiet and a proper diet.

ENVIRONMENT
 Defined as an anything that can be manipulated to place a patient in the best possible
condition for nature to act. Involve those external condition that affect life and development
of the individual. The focusis on ventilated, warmth, odors, noise and light.
I. Serve as the foundation of night theory.
II. Includes everything from person’s foods to a nurses verbal and non verbal interaction in the
person.

HEALTH

Is maintained by controllimg environmental factors to prevent disease; health and disease

are the focus of the nurse, who heps a person through the healing process.

Nightingale wrote “health is not to be well, but to be able to use well every power
we have”.

From this statement, we can inter that she belived in prevention and health
promotion to nursing patients from illness to health.

PROBLEM IDENTIFIED
COMMON PROBLEMS

1. Lack of knowledge regarding the government facilities foe health

2. Cough and cold
 INDIVIDUAL PROBLEMS

 MRS SAVITRI BAI

1. Hypertension
2. Joint pain
3. Stomach ache
 MR. SAMAL SAI
1. Itching over body

NURSING PROCESS
Nursing diagnosis
1. Acute pain in joints related to old age as evidenced by verbalisation and facial expression
of mrs Savitri bai
2. Acute pain in stomach related to ulcer characterized by the mild pain after the intake of
food
3. Impaired blood pressure hypertension related to systemic changes in old age
characterised by the increase blood pressure showed by sypgmomanometer
4. Acute discomfort, pruritis in upper and lower extrimities related to allergy characterized
by the itching over upper and lower extremities
5. Cold and cough related to seasonal changes characterised by the rhinorhea and weakness
6. Knowledge deficit related to the government facilities related to health characterised by
the doubts of family members
Short term goal
1. Mrs savitri will be relieved from pain as evidenced by verbalisation
2. Mrs savitri will be relieved from pain as evidenced by verbalisation
3. Mrs savitri will be able to maintain her blood pressure as evidenced by the normal level
shown by the sypgmomanometer
4. Mr Samalsai relieved from itching as evidenced by his verbalisation
5. The family members will be relived from cough and cold as evidenced by the diminished
level of symptoms
6. The family members will have adequate knowledge as evidenced by the good response of
them
Long term goal
1. The family members will have adequate knowledge regarding the government facilities
regarding health and they will have maximum use
2. They will have a good health
 HOME VISIT
1st DAY

OBJECTIVES

 To visit the family and make a good rapport between the family members
 To assess the health status of family members
 To find the health problems of the family members.
ACTIVITIES
On the first day I have visited the family and introduced myself and they have showed a
good hospitality. I have collected the information regarding the family members their family
status and health status. They were not having any health problems and have given all the in
formations about themselves. I have also assessed the environmental conditions and physical
setup of the house. They have kept their house and surroundings neat and tidy and i have
appreciated them for their act.
EVALUATION
At the end of my home visit I have collected family history and health history of family
members. They have good cooperation with me.

2nd DAY
OBJECTIVES
 To visit the family members
 To find out the health problems
 To give health education regarding the old age problems and management
ACTIVITIES
I have visited the family and wished them. They also wished me back. Mr Samal Sai the head
of the family was available on that day. So I have collected the rest information regarding the
family. I have assembled the family members and i have given health education regarding old
age problems and its management. The family members having good response and they have
gained knowledge regarding the topic and the daughterin law of the family revealed a good
response in the care of Mr. Samal Sai and Mrs. Savitri Bai. Also I told them that next day I
will assess the health status of them individually.

EVALUATION
At the end of my home visit I have collected the rest information of family members and
given health education regarding old age problems and its management. They gained
knowledge regarding the topic and having good IPR with me.

3rd DAY

OBJECTIVES
 To visit the family members
 To do the health assessment

ACTIVITIES
I have visited the family and wished them. They also wished me back. As i have told earlier
for health assessment. They were ready for the health assessment. I have checked the vitals
and blood pressure of every family member and done the physical assessment. All others in
the family are having good health except Mr. and Mrs. Samal Sai. Mr. Samal sai is having the
complaint of itching in the body and Mrs. Samal Sai is having the blood pressure of 150/100
mmof Hg and having the complaints of gastric problem. I have admired them that i will
explain how to manage the health problems on next day.
EVALUATION
At the end of my home visit I have done the health assessment of family members and find
out their health.

4 th DAY
OBJECTIVES
 To visit the family members
 To give health education regarding hypertension and its management
 To give health education regarding skin disease and its management

ACTIVITIES

I have visited the family and wished them. They also wished me back. I have talked with
them and find out the other problems. They revealed that they are poor and they are not
having the ability to have the good treatment. I have explained briefly regarding the health
facilities provide by government. And also I have given health education regarding
hypertension its management and skin disease its management. They were very happy to
have the knowledge and they inspired me that they will follow the management.

EVALUATION

At the end of my home visit I have health education regarding hypertension its management
and skin disease its management. They were very happy to have the knowledge about they
admired me that they will follow the management

5 th DAY
OBJECTIVES
 To visit the family members
 To give health education regarding the health facilities provided by the government

ACTIVITIES

I have visited the family and wished them. They also wished me back. I have talked with
them. Then I told them that today is the last day of my home visit. I have showed my
gratitude them for the help and support. They also have given thanks to me for all my help. I
also give a brief explanation regarding swine flu and its management and invited them for the
role play which we have arranged for them. I have also given the health education regarding
the government facilities like smart card facility, ambulance number for emergency, for
obstetrical emergency, different schemes for old age and also for widows.
EVALUATION

At the end of my home visit I have health education regarding the health facilities provided
by the government. They were very happy to have the knowledge. As it was my last day of
home visit we have a pool of gratitude and happiest atmosphere and also I felt success full
that I can fulfil my objectives of home visit at an extent.

CONCLUSION
As a part of my academic performance in Advance nursing practice I have posted in
Chandoridhar, Sambalpur village. by this positing I have improve my ability in the health
assessment, health education, social credibility , and able to understand the culture and belief
of the people in respected village. Also by this posting i have earned the knowledge in the
field of community health nursing.

I am always grateful to Sr. Caroline Joseph, Principal Holy cross college of Nursing for
arrainging this opportunity for improving our experience. I am also grateful to Sr. Asha, , Mrs
Deepika Lecturers Community Health Nursing department, Ms Nancy Lecturer, guide of
Advanced nursing practice, for their guidance, supervision and support, Ms. Stephy,
Ms.Anita, Clinical instructors for their support. Mr. Samal Sai and the family members for
their support and cooperation. At last but not least am surrendering the boquets of grateful to
almight god for all his blessings.