System Plus Computer College Foundation San Fernando Inc.

B. Mendoza St, Sto Rosario City Of San Fernando Philippines

Diploma in Health Care Technology

FAMILY CASE ANALYSIS

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INTRODUCTION

Family-oriented intervention differs from individual intervention and requires more

involvement and participation from each family member. Community health nursing serves
communities by providing health services, preventive care, intervention, and health
education. The service will be provided directly to the individual family based on their needs
and the student nurse will visit the situation several times to observe how it affects the family.

Each family, will be taught about safety and cleanliness in their home, to promote
physical and mental health, and keep the environment clean. The student nurse also
accompanies the community nurse or the public health nurse during the first visit to the
family’s home so that they can see the situation in order to provide medical care for each
individual in the family. It also aims to see how the general community can do safety until it
leads to the reduction or prevention of diseases, to provide a long life, more fewer
complications.

As a student nurse assigned to help the families of the community, following the learning
phase will ensure a positive result for the health care provided to the individual family. This
is one of the very important tasks of the student nurse in the related learning experience so
that each student nurse can practice and be prepared for real life and different scenarios that
they will face in the community. Community health workers play a very important role in
society because they provide individuals and families with direct treatment and prevention of
diseases.

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 a. Objectives ( Student - Centered )
i. Cognitive
 This Family Case Study aims to analyze the case of the “Rosario’’
family
 Analyze the family problems and health conditions.
ii. Affective
 In a family visit, the student nurse simultaneously practice the role
of moderator, judge, empathic listener, and role model.
 Locate the family genogram to identify family history
iii. Psychomotor
 Articulated the theory to define relational structures and dynamics,
family strengths, ecological resources, and limitations.
 Set clear treatment, goals, and develop effective intervention
strategies.
b. Entry and climate of acceptance

i. Identify the entry

- Carmen Rosario

ii. Describe the general appearance of the entry (the first responsible member whom you
had interacted with)

- Carmen Rosario, a 28 years old, a G2P1 is living with his husband Eric
Rosario, her in-laws Sergio and Magdalena Rosario, and her nephew Gedion
Rosario. Eric was considered as the head of their family. Her husband is 34
years old, her father-in-law is 72 years old, mother-in-law 74 years old and
nephews age is a one-year-old. Magdalena and Serio are also married.

iii. Climate of acceptance

- Whenever problems occur within their family, they see to it that everyone is
part of the discussion because for them that’s what families are for. According
to her, there are no significant conflicts between them and as I can see, they
talk to each other very well.

c. Number of Actual Home Visits : 3 times

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 GENOGRAM OF THE FAMILY ROSARIO

II. FAMILY CONSTELLATION

Name Age Position Sex Civil Status Educational

Attainment
Eric Rosario 35 Head of the Male Married Undergraduate
Family in Nautical
Carmen Rosario 28 Wife Female Married College
Graduate
Serio Rosario 73 Father Male Married Elementary
Undergraduate
Magdalena 74 Mother Female Married Elementary

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 Rosario Undergraduate
Gedion Rosario 2 Nephew Male

i. Start w/ the head of the family - For extended family: should be written after
the core family.
ii. Age: as of last birthday
iii. Position: Relationship to the head of the family
iv. Civil status: applicable for extended family and individuals 15 y/o and above.

III. HEALTH ASSESSMENT

a. General Description/appearance
b. Vital Signs (T, P, R, BP, Height, and Weight)

- The client is conscious, well-oriented of her present condition and showed

interest with the interview by answering every question instantaneously.

- The client Vital Signs are normal with a temperature of 37.3 centigrade, pulse
rate of 90 beats per minute, respiration rate of 20 breaths per minute and blood
pressure of 120/80. The client’s weight is 139 pounds and her height is 5’3 her
BMI is 26.71 which is slightly above the normal range of 19.0 – 26.0

Upon visiting the client in their house, the client was not pale-looking she
complained of pain in abdomen sometimes. But at the moment, the client is
looking good with no complaints of pain at all.

The client has no obvious physical deformities or abnormalities.

The client showed no sign or potential signs of distress.

Physically, the client nutritional status and body built/stature is appropriate to

her age and gestational age as she is pregnant.

The client is relaxed, has an erect posture and coordinated by body

movements, can freely move, flex and extend his extremities, doesn’t use any
assistive device and can voluntarily move.

The client has a good facial expression without grimacing. The client mood is
appropriate to the situation, has an appropriate response, comfortable and
calm. The patient is understandable, and moderate in pace. The client
physically looks clean and neat.

c. Review of Systems/Physical Assessment

 Skin : Is Light brown in color without scars and no lesions noted. Skin
is moist to touch, and the texture is smooth with capillary refill time of
2seconds. Hair is black, long with thick strand evenly distributed with
an Oily scalp. Nails are properly trimmed.
 Head : Face and Skull are symmetrical in shape. Carmen can rotate
head from midline to sides, up and down. Eyes : The color of the eyes
is brown the eyelids is pink, no redness and discharge noted.
Conjunctiva and sclera appears moist and smooth. No drainage on

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 nasolacrimal duct when palpated. Irises are round and pupils are equal
in size and reactive to light
 Ears : Ears are equal in size bilaterally. Auricles are aligned with the
corner on each eye and color same as the facial skin. No discharges
and free of lesions upon assessment the eardrum is seen in color of
shiny pearly white.
 Nose and sinuses : Uniform in color and nasal structures is symmetric
and straight. No tenderness and discharge upon assessment
 Mouth and throat : Carmen lip color is pale and symmetrical, 32 teeth
are present, smooth, white and yellowish. Tongue is smooth and move
freely.
 Neck : is within centered position and no bulging masses noted. Neck
has smooth, controlled and full range of motion as observed.
 Chest/lungs : Thorax is normal and elliptical in shape, full and
symmetrical chest expansion when client takes a deep breath. Lungs
are normal and no adventitious sounds during interview.
 Heart : The external chest is normal in appearance without lifts,
heaves, or thrills. PMI (point of maximal impulse) is not visible and is
palpated in the 5th intercostal space at the midclavicular line. Heart rate
and rhythm are normal.
 Breast and axilla : Breast is unequal which is normal with a
symmetrical shape, nipples are everted, dark brown in color with
increased vein. Carmen notice a tingling sensation in her breasts. And
feeling of tender and sore. Due to milk production. No lumps palpated
in axilla.
 Gastrointestinal : Measure Fundal Height of 28cms, there’s a
presence of linea Nigra and some striaes.
 Genitourinary : pale yellow urine Absence of pain upon palpation of
bladder. Increased in frequency, Nondistended bladder.
Female: age of menarche : 14 y/o regularity of menstruation : Every
28 – 30days amount of bleeding : 2-4 days : 3-5 Tablespoons LMP :
August 28, 2011 history of STI : None dyspareunia : None

d. Health History (Past and Present Illness)

- The client is now on her 25th week of gestation and she feels sleepy often
and also her appetite increases. Sometimes, she feels pain in the abdomen.

e. Obstetrical History
 GP (TPALM) : Trimester : 2nd Trimester G2 P1 T0 P1 A0 L0 M0
 LMP : August 28 2011 EDD : May 04, 2012 AOG : 25 weeks 3/7 day

 Past/present history of any OB or gynecological condition

Pregnant and family with an infant: type of delivery, place of delivery

 Regarding the past gynecological history of Mrs. Carmen Rosario.

Her last smear test was in 2008, it was normal, and all her smear tests
were normal.

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 In her first pregnancy, she had a preterm vaginal delivery to a
preterm baby at 21 weeks, due to early contraction and placental
abruptio. The baby delivered in a weight of 350grams, dies after an
hour of delivery.

Carmen Rosario is now on her 25th week of gestation in her 2nd

pregnancy to a Baby Boy.

Immunization – indicate when and where administered and availed

TT1 TT2 TT3 TT4 TT5
November December
30 2011, 28 2011,
Received Received
first dose of Second
a TT Dose of TT
Vaccine at Vaccine in
BHC in San BHC San
Isidro Isidro

f. Growth and Development

i. Erik Erickson’s Psychosocial Theory : Generativity vs Stagnation – In
this Stage shows the client’s desire to have a good future for her family
and develop her child for the better
ii. Sigmund Freud’s Psychosexual Theory : Genital Stage - the client is
now in her second Pregnancy
iii. Jean Piaget’s Theory of Cognitive Development : Formal Operational
Stage – the client has her own family and was able to think abstractly
and logically to be able to support them
iv. Lawrence Kohlberg’s Theory of Moral Development : Conventional
Stage - the client knows what is right from wrong that shows effective
moral reasoning

g. IMMUNIZATION STATUS (Children 5 years old and below) include the

following: WHAT: vaccine, age, WHEN and WHERE administered and
availed
- The client’s nephew Gedion Rosario, is a 1 year old child. He was given a
vaccine of BCG after birth at the hospital, and completed all the following
immunization in Barangay Health Center in San Isidro Pampanga. Dated and
listed the following vaccination below :

BCG DPT OPV Hepatitis Hib Measles MMR Immunization

-B Status

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 1 2 3 1 2 3 1 2 3 1 2 3
August ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ First First Complete
2010 dose : dose : Immunization
9 month 9 month
old - old -
May May
2010 2010

Second Second
dose : dose :
1 year 1 year
old - old –
August August
11, 2011 11, 2011

h. Activities of daily living (Routine Activities and lifestyle)

- Diet and food preferences
The client eats 3 x a day regularly with 5-8glasses of water for
her drinks, she also eats her miriendas like, sweet mangoes and
bread. usually she eats mixed prepared foods ( fish and
vegetables ) its what she prefers. Meat Is her second choice of
food. She prefer mixed foods because she thinks its balanced
and Healthy.
- Rest and sleep :
The client usually sleeps 10pm to 6am she always taking a
siesta time after eating miryenda.
- exercise/activities :
The client doesn’t have a regular exercise routine, for her,
doing households chores and taking care of their store is her
exercise.
- relaxation and other stress management activities :
She love watching TV programs as relaxation time while taking
care of their store.
- practice of protective measures – e.g. adequate footwear in
parasite-infested areas; use of mosquito nets, etc.
They practice cleaning the yard everyday as a control and
preventive measures for vector diseases.

IV. SOCIO-ECONOMIC, CULTURAL, and ENVIRONMENTAL ASSESSMENT

a. Family Structure, Characteristics and Dynamics

i. Members of the household and relationship to the head of the family.

ii. Demographic profile of each member – age, birth date, and birth place.

Relationship
Member’s Name
to the Head Age Sex Birth Date Birthplace
Eric Rosario Head of the 35 M March San Isidro
Family 1977

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 Carmen Rosario Wife 28 F October San Isidro
1938
Sergio Rosario Father 73 M August San Isidro
1940
Magdalena Rosario Mother 74 F October San Isidro
1938
Gedion Rosario Nephew 2 M August San Isidro
2010

iii. Place of residence of each member – whether living with the family or
elsewhere.
- Their Family Is Native of San Isidro, San Fernando Pampanga.

iv. Type of family structure – e.g. matriarchal or patriarchal, nuclear or

extended.
- The family is considered as extended and patriarchal

v. Dominant family members in terms of decision-making, especially in

matters of health care.
- In terms of decision making pertaining in health matters Eric
Rosario is the dominant one as he is the head of the family,
considering also that the income of the family comes from the
store business which he manages.

vi. General family relationship/dynamics – presence of any obvious/readily

observable conflict between members; characteristic
communication/interaction patterns among member.
- Whenever problems occur within their family they see to it that
everyone is part of the discussion because for them that’s what
families are for according to her there are no significant conflict
between them and as I can see they talked to each other very
well.

b. Socio-economic and Cultural Characteristics

i. Educational attainment of each member
MEMBER’S NAME EDUCATIONAL ATTAINMENT
Eric Rosario Undergraduate in Nautical
Carmen Rosario BS Tourism Management
Sergio Rosario Elementary Undergraduate
Magdalena Rosario Elementary Undergraduate
Gedion Rosario N/A

ii. Significant others – role(s) they play in family’s life

- Eric Rosario Husband of Carmen Rosario

iii. Relationship of the family to larger community – nature and extent of

participation of the family in community activities.
- The family has a harmonious relationship with the
neighborhood. Sometimes the family practice local cultural

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 practices about health manners. They also actively join fiestas
and local cultural practices.

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

- None of the family members has a job or work but they have a
sari-sari store as the source of their income.

v. Income (Members who financially contribute)

- Eric Rosario is the one who managing the Sari-sari store. The
monthly family income is between 5000 to 10,000 pesos.

vi. Mode of Expenditure

- The priorities and expenditures are as follows :
- Food, Utilities, Clothing, Health, Recreation, Savings,
Education.
- As for the financial aspect Eric and Carmen decide on how to
manage their income

vii. Ethnic background and religious affiliation.

- The client’s family has two different religions Carmen Eric and
Gideon are Roman Catholics. While Rosario and Magdalena
are Pentecostals. This does not make any conflict between them
they just don't talk about their religious beliefs when they are
together

viii. Health beliefs and practices.

- The family believe that illness is caused by physiologic factors,
punishment by god and supernatural phenomena. They also
believe that the health can be restored by god and supernatural
powers like Hilot. but they seek health personnel whenever
they are health problems in the family.

c. Home and Environment

i. Housing
1. Adequacy of living space : the family has adequacy of space for
living as they have their own house which is made of mixed
materials.
2. Sleeping arrangement : the house of the family have four
bedroom available for sleeping
3. Breeding or resting sites of vectors of diseases ( e.g.
mosquitoes, roaches, flies, rodents) : there are present breeding
site like bird cages, specially bird waste. There are also exposed
canal at the side of their house.
4. Accident hazards : the drainage system might cause them harm
due to its unpleasable smell and dirty water
5. Food storage and cooking facilities : the store their food in a
refrigerator, sometimes they just cover their left and reheat them
for the next meal. The use of gas stove for cooking and the
sanitary condition is good

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 6. Water supply – source, ownership, potability : They owned a
waterline from the local water district. The water from the faucet
is not portable.
7. Water storage : Gallons
8. Type of drinking water facility : the water from the faucet is
not potable that’s why they often buy mineral water.
9. Toilet facility – type, ownership, hygienic status : the family
have their own toilet facility with water flush the location of the
water source is less than 20 feet they also have a septic tank.
10. Garbage/refuse disposal – type of garbage disposal container ,
sanitary condition : for waste disposal they placed their garbage
in a plastic bag and they practice proper segregation for
compliance and environmental benefits.
11. Drainage system – type, sanitary condition : The drainage
system is just near their house since they are located on the
barrio. Sanitary Condition: unpleasable smell and dirty.

ii. Kind of neighborhood, e.g. congested, slum. : The family has a

harmonious relationship with the neighborhood even though they’re
living in a congested area.

iii. Available social and health facilities, type of communication and

transportation facilities : BHC is available for the community. they
have their own tricycle for their transportation and use cellular phone for
communication.

V. PROBLEM IDENTIFICATION
a. List of problems identified with cues (Prioritized)
b. Priority setting

PROBLEM : RISK FOR DISEASES DUE TO EXPOSED CANAL NEAR THEIR HOUSE
Criteria Computatio Score Justification
n
1. Nature of the Problem 2÷3x1 0.67 It is a threat because it can cause
any diseases for the family, there
will possibility that this can cause
dengue.
2. Modifiability of the 2÷2x2 2 This will be easily modifiable
problem because we can prevent it by
proper cleaning of the surrounding.
3. Preventive potential 3÷3x1 1 It is high preventative because we
can prevent it by teaching the
family about cleanliness
4. Salience 2÷2x1 1 This problem should need an
immediate attention. This has many
threats to the family.
Total: 4.67

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PROBLEM : RISK FOR HYPERTENSION
Criteria Computatio Score Justification
n
1. Nature of the Problem 2÷3x1 0.67 It is a threat because there will be
possibility that they will acquire
hypertension because they have
sedentary life and since their
parents have hypertension.
2. Modifiability of the 1÷2x2 1 This will be moderate modifiable
problem because we can prevent it by health
teaching but its on them if they will
do the health teachings
3. Preventive potential 2÷3x1 0.67 It can be moderate preventative if
the family will do necessary
precaution.
4. Salience 2÷2x1 1 This will be needing immediate
action because hypertension has
many possible complication, and
they have family history of
hypertension.
Total: 3.34

PROBLEM : THE FAMILY HAS NO PROPER DIET AND EXERCISE.

Criteria Computatio Score Justification
n
1. Nature of the Problem 2÷3x1 0.67 It is a health threat because having
inadequate nutrition can cause
diseases like DM and Hypertension
to the family.
2. Modifiability of the 1÷2x2 1 This will be moderate modifiable
problem because we can prevent it by health
teaching regarding having proper
diet and exercise, but it depends if
the family will accept it.
3. Preventive potential 2÷3x1 0.67 It can be moderate preventive if the
family will accept the health
teaching
4. Salience 2÷2x1 1 This will need an immediate action
because this family has history of
diseases like hypertension, and they
have sedentary life.
Total: 3.34

VI. FAMILY NURSING CARE PLAN

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 Health Family Objective(s) Nursing Method of Resources
Problem Nursing Goal of of care Interventions Nurse Required
Problems Care Family
Contact

VII. FAMILY COPING INDEX

Category Initial Justification Final Justification

Visit
1 3 5
1. Physical ✓ The Rosario’s Family
Independence are all well and no
disabilities
2. Therapeutic ✓ The family believe
Competence that health can be
restored by god and
supernatural powers,
like Hilot.
3. Knowledge of ✓ They only go to the
Health Condition hospital if the illness
is severe as they
don’t know the signs
and symptoms
4. Application of ✓ The family Rosario’s
Principles of house is clean and
Personal Hygiene neat inside. Sanitary
Visit
1 3 5
✓ The Rosario’s Family are
all well and no
disabilities
✓ The family Rosario
believes that the person
who must be consulted at
times of illnesses is the
doctor
✓ They learned to go in
Barangay Health Center
for checkup in regular
basis for prevention of
illnesses. And when
they’re not feeling well.
✓ The family Rosario
house is clean and neat
inside and outside.

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 condition is fine. Sanitary Condition is
They practice a good, they practice
proper grooming and cleaning the yard every
they have a very good day as a prevention
personal hygiene measure for vector
diseases. They practice
proper hand washing and
sanitation.
5. Health Attitudes ✓ For common coughs, 5 They buy medication as
cold and fever they prescribed by the
self medicate only. physician but they also
consider those over the
counter medications.
They also use herbals,
like oregano for cough.
6. Emotional ✓ The Rosario’s family ✓ The Rosario’s family
Competence practicing to lived in maintains a happy living
a happy and positive with a positive
perspective. perspective.

7. Family Living ✓ None of the family ✓ The monthly family

members has a job income is 5001-1000php,
but they have sari sari and according to client, it
store as the source of is also the range of their
income family needs. Such as :
food, utilities, clothing,
health, recreation,
savings and education.
8. Physical ✓ The client’s family ✓ The client’s family house
Environment house has 4 bedroom has 4 bedroom available
available for sleeping for sleeping and has
and has adequate adequate space and
space and ventilation. ventilation. Sanitary
Sanitary Condition is Condition is fine. They
fine. practice proper garbage
segregation for
compliance and
environmental benefits.
9. Use of ✓ They don’t usually ✓ The family Rosario
Community visit the barangay Often visiting the
Resources health clinic barangay health clinic
now for checkups,
immunization and free
medications and
vitamins. As BHC is
available for all the
community.

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VIII. LEARNING DERIVED
- Conclusion, Difficulties encountered with Recommendations

IX. APPENDICES
Sociogram
Spotmap and documentation

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