FAMILY NURSING PROCESS

Our Lady of Fatima University

College of Nursing
Case Scenario:
Janina Dela Cruz is a public health nurse at the Rural Health Unit. She met 26-year-old

Rebecca Villanueva, married, 6 months pregnant with her first child, in a Garantisadong Pambata

(outreach health services) visit at an ambulatory clinic in the barangay where the Villanueva family was residing. Janina found out that Rebecca
never had a prenatal consultation. She also noted that Rebecca was underweight, with a weight of only 48 kg and a height of 155 cm. When
Janina asked her where she plans to deliver her baby, she replied that she would probably have a home delivery under the care of the local
“hilot” because professional attendance would be too expensive for them. Rebecca explained that she came to the ambulatory clinic upon
the prodding of her husband who heard about the health workers’ visit to the
barangay. To assess the Villanueva’s home situation and to teach Rebecca health practices related to her pregnancy, Janina
asked Rebecca if she could make a home visit. Seemingly pleased with Janina’s attention, Rebecca agreed with Janina on a
home visit schedule, stating that she wanted to learn more from Janina to prevent problems with her pregnancy and delivery.
When Janina made the home visit, she noted that Rebecca live with her 32-year-old husband Marion, who was at work at the time of visit. He
was the sole breadwinner of his family – a construction worker earning the daily minimum wage. Rebecca described her husband as
hardworking. They lived in a rented shack of mixed materials with a bedroom, a bathroom and toilet, and a small multi-purpose room (living
and dining room and kitchen). Rebecca’s activities consisted mainly of household chores. Sometimes,
Rebecca would spend time at the homes of some friends and relatives residing in the neighborhood. In the course of the
interview, Janina found out that Rebecca had inadequate knowledge about community health services, prenatal nutrition, preparation for
childbirth, and infant care. Rebecca said that she and her friends and relatives sometimes talk about such matters, but the information given was
confusing and conflicting. Aside from palmar pallor and underweight, other findings during physical examination were normal. When asked
about her diet, Rebecca told Janina that she limited her food intake because she did not want to have a cesarean section, which may be needed
if the baby grew too big.
Family Nursing Care Plan
 Cues Family Nursing Goal Objectives Interventions Rationale Evaluation
Diagnosis

.
Objective: Inability to provide Short term goal Cognitive: Independent Independent
adequate care due to Rebecca will visit •to determine the • Establish rapport Establishing rapport At the end of the
Normal Vital Signs lack of knowledge the health center of importance of • Assess clients helps in building a home visited,
Palmar pallor about pregnancy their barangay for having enough vital signs and connection with Rebecca went at the
Weight: 48kg management prenatal care within knowledge to ensure data weekly your patients, it health center for her
Height: 155cm a week after the a healthy pregnancy. • Health teaching allows you to first personal clinic
home visit. •to be informed about proper food communicate well cosultation as
She will also about important intake and nutrients and build a pleasant scheduled and
Subjective : participate in steps they can take consumptions relationship with attended mother
The client is activities in to prevent them. class.
experiencing preparation for her complication and Assessing vital She also gain
knowledge deficit delivery within a protect their infant. signs provide knowledge about
about the prenatal week after home results with specific proper food intake
nutrition as visit. information that that can help
verbalized by the Rebecca will gain can be used to Rebecca
client "I limit my weight according to determine a Rebecca delivered
food intake because the weight of the person's general her baby withour
I don't want to have pregnant woman at health. evidence of
cesarean section" her age at least 2kg maternal or fetal
. per month before complication.
her delivery.
Cues Family Nursing Goal Objectives Interventions Rationale Evaluation
Diagnosis

Long term goal Affective: DEPENDENT Vital signs are also

After the nursing •values having •Administer essential for
intervention, knowledge about prescribe vitamins making correct
Rebecca will give prenatal care, child such as follic acid diagnosis and the
birth to her full bearing and child and iron as ordered appropriate action
term baby without rearing needed.
evidence of Health teaching
maternal or fetal •verbalize in her educates individual
complication. own to live healthier by
understanding improving their
abput the overall health by
therapeutic becoming more
sevices in their knowledgeable and
community influencing their
attitudes on caring
for herself and her
baby. .
Cues Family Nursing Goal Objectives Interventions Rationale Evaluation
Diagnosis

Psychomotor: COLLABORATIVE Health teaching .

•Practice new • refer to a ob-gyne also helps in
helath-related for weekly preventing preventable
behavior and improvement of the health problems,
lifestyle regarding infant growth and receiving
prenatal care to development comprehensive
ensure health and health teaching
safety of both the • refer to a helps the patient
mother and the nutritionist for to make safer and
baby proper food intake more informed
for underweight choices.
pregnant women