Family Health Care

Plan
Capol, Tender
Guevara, Maria Dorina
Pantojan, Mara
Objectives:
• This paper aims to present the family dynamics of patient Catao using
several family tools. The presentor’s specifically aim to:

A) Identify demographic data and history of the patient;

B) Assess family's response to illness by completing her family

genogram, lifeline, life cycle, profiles, and the like;

C) Educate the patient and her family in how to deal with the disease.
 MERITS OF THE STUDY
• The family agreed to be interviewed and consented to be part of the
report

• The family is openly conversant to the condition of the patient and

that of the family ties

• There is easy access to the patient and her family, lessening expenses
and time spent in travel given that the patient is admitted
Patient’s Profile
•Name: C.J
•Age: 26
•Sex: Female
•Religion: Roman Catholic
•Civil Status: Single
•Occupation: Call center agent
•Address: Cabantian Davao City
Chief Complaint:
Fever
History of Present Illness
2 DAYS PTA 1 DAY PTA HOURS PTA
Undocumented fever Symptoms persisted. Sought Repeat CBC:
Body malaise consult Leukocytopenia 3.84, Neutropenia:
Periorbital pain 0.42, Lymphocytosis: 0.42,
Headache CBC - Hb: 141, Hct: 0.43, RBC: 5.13, Monocytosis: 0.14, and
WBC: 6.0 with predominance of Thrombocytopenia: 144
Self medicated: Paracetamol Monocyte: 0.10, Dengue IgG test: Positive
500mg/tab, q4 Thrombocytes: 169
U/A: unremarkable VS: BP 100/60, HR 96, RR 21, Temp
36.8, O2 Sat 97%

Discharged as OPD
Advised to repeat CBC Admitted
Past Medical History:
• Non-hypertensive, Non-diabetic, Non asthmatic
• (+) Dengue (2008)
• (+) UTI (2010)
Personal/Social History
• Non smoker
• Non alcoholic beverage drinker
OB-GYNE History
• Age of Menarche: 12 y/o
• Regular
• 7 days
• 5-6 pads/ day, fully soaked
• (-) dysmenorrhea
• (-) light headedness
Review of Systems:
• General: (-) weight loss
• Skin: (-) jaundice
• EENT: (-) icteric sclera (-) redness (-) lacrimation
• Cardiovascular: (-) palpitations (-) chest pain
• Gastrointestinal: (-) constipation (-) diarrhea
• Renal & Urinary: (-) hematuria (-) dysuria (-) frequency (-) ugency
• Gynecological: (-) discharge (-)itchiness
• Musculoskeletal: (-) joint pain
• Hematological: (-) easy bruising
• Nervous System: (-) seizure (-) tremors
Physical Examination:
• General Appearance: Awake, alert, NIRD
• Vital Signs:
BP: 100/60 mmHg
HR: 96 bpm
RR: 21 cpm
Temp: 36.8 C
• Anthropometric Measurement:
Weight: 49 kg Height: 158 cm
BMI:19.6 kg/m2, normal
• Skin:
Fair complexion, (-) jaundice
Warm to touch, With good skin turgor
• Head:
Normocephalic, (-) depressions, (-) lesions
• Eyes:
Anicteric sclera, Pale palpebral conjunctiva,
(-) periorbital tenderness
• Ears:
(-) depressions, (-) lesions
• Nose:
Nasal septum at midline, Both nares were patent, (-) discharge
• Mouth:
Moist lips and oral mucosa, Tongue was at the midline
Tonsils were not inflamed, Uvula was at the midline
• Neck:
Neck was supple, Trachea was at the midline
No palpable lymph nodes, Jugular veins were not distended
• Chest/Thorax:
(-) retractions, Equal chest expansion, Clear breath sounds
• Cardiovascular:
Adynamic precordium, Distinct heart sounds, (-)murmurs
• Abdomen:
Flabby, Normoactive bowel sounds, 14 clicks per minute
soft, flabby, nontender abdomen
• Genital/Rectum:
Not assessed
• Extremities:
(-) edema, symmetrical, Full range of motion
Full pulses, CRT < 3 sec
•Neurologic Examination:
GCS 15 (E4 V5 M6), Oriented to time, place and person

•CRANIAL NERVES:
CN I: Able to identify tested substance
CN II: Pupils equally round and reactive to light and accommodation
CN III IV VI: Extraocular muscles intact, moves in all direction
CN V: Perceived light touch on his face; able to clench jaw
CN VII: Able to raise eyebrows, puff cheeks, smile, frown and close eyes with symmetry
CN VIII: Intact gross hearing
CN IX X: Able to swallow without difficulty; Able to speak spontaneously, (+) gag reflex
CN XI: Able to shrug shoulder against resistance; able to turn head side to side with
resistance:
CN XII: Tongue was at the midline, able to stick it out and move form side to side

•Motor Strength:
5/5 on all extremities
Dengue Fever
• Dengue is one of the most important arthropod-borne viral diseases in terms
of public health problem with high morbidity and mortality.

• It is cause by a mosquito-borne flavivirus and transmitted by Aedes aegyti

and Aedes albopictus.

• 4 serotypes: DENV -1 , 2, 3 and 4

• Each episode of infection induces a life long protective immunity to the

homologous serotype but confers only a partial and transient protection
against other serotypes.
CPG, 2015
Clinical Presentation

CPG, 2015
Investigation
Disease Monitoring Test:
CBC with platelets
Diagnostic Tests:
Rapid Combo Test (RCT)
Dengue Antigen and Serology Tests by ELISA
Nonstructural Protein-1 (NS1 Antigen)
Dengue IgM test
Dengue IgG test
Dengue Viral RNA Detection (Real time-PCR)
CPG, 2015
Treatme
nt

WHO, 2014
Group A Group B Group C WHO, 2014
WHO, 2014
WHO, 2014
Discharge Criteria
• No fever for 48 hours
• Improvement in clinical picture
• Increasing trend of platelet count
• No respiratory distress
• Stable hematocrit without intravenous fluids

WHO, 2014
Family Profile
Name Age/Sex Education Attainment Occupation
Economic Profile
• Total monthly income: 28,000
• Total monthly expenses: 7,100
Food: 4,000
Water: 600
Electricity: 1,500
Education: 500 (government school)
Medications: 500
Savings: 10,000/month
Environmental Profile
• Water supply – Water District
• Garbage disposal – once a week
• Pets: none
Family Structure and Function
• Type of Family: Nuclear

• Roles of family members:

• Breadwinner: father
• Decision maker: mother and father
• Caregiver: mother
Family Genogram
Family Lifeline
Family Map
ECO Map
Biopsychosocial Issue in the Family
• I. BIOMEDICAL:
• Grandfather - diagnosed with Hypertension, Diabetes
Mellitus Type II and Chronic Kidney Disease (2016)

• Grandmother – with hypertension

• Patient – admitted last 2008 because of Dengue and UTI last

2010
Psychological
Children – No learning deficiency, developmental delay and no child
abuse.

No communication problems in the family.

Siblings communicate openly to their parents.

Social
• Patient is a call center agent.

• Currently with no financial difficulties in the family.

• Mother is a housewife and father is a bus driver.

• Her younger sister is a Gr. 5 student

Family Life Cycle
UNATTACHED YOUNG ADULT
Hallmarks Description

a) Establishing financial ▪ Patient already have a stable job with enough salary that could help the needs
independence from the of the family
parents

b) Discovered autonomy ▪Patient’s parents cultivate and nurture autonomy by showing interest and
and living an independent caring about the independent decisions and actions their child (patient) makes.
life

c) Intimate peer ▪Patient had a lot of friends which she could share her problems.
relationships
Jonathan Catao
Areas of APGAR Almost Always Sometimes Hardly Ever

A: I am satisfied I can turn to my family for help when 2

something is troubling me?

P: I am satisfied with the way my family takes over 2

things with me and shares problems with me

G: I am satisfied that my family accepts and supports 2

my wishes to take in new activities or directions

A: I am satisfied with the way my family responds to 2

my emotions such as anger, sorrow or love

R: I am satisfied with the way my family and I share 2

together

Overall Assessment 10
Jocelyn Ramirez
Areas of APGAR Almost Always Sometimes Hardly Ever

A: I am satisfied I can turn to my family for help when 2

something is troubling me?

P: I am satisfied with the way my family takes over 2

things with me and shares problems with me

G: I am satisfied that my family accepts and supports 2

my wishes to take in new activities or directions

A: I am satisfied with the way my family responds to 2

my emotions such as anger, sorrow or love

R: I am satisfied with the way my family and I share 2

together

Overall Assessment 10
 SCREEM
Parameters Strength Weakness Intervention
SOCIAL Well-balanced communications with the Don’t have good communications Family should advised to join any
family and relatives. with neighbors Barangay activities that can boost
bonding towards their neighbors.

CULTURAL The cultural group of the family as a None

Dabawenyos is well adapted by them.

RELIGIOUS The family has a tight-knit relationship in the None

church. The family is active on their church:
Roman Catholic

EDUCATIONAL High school graduate – both father and Mother is a housewife which spends Mother should advised to put a little
mother most of her time doing household business (sari-sari store) that could
chores add to their family’s monthly savings.
ECONOMIC Father is a bus driver and patient had a None
stable job with a salary enough to support
the needs of the family

MEDICAL The family directly sought consult to their The family doesn’t go to nearby The family should be advised to seek
AP whenever health problems arise. medical health facility such as consult first to a nearby health center
Barangay Health Centers. to avail primary care prior to going to
their AP
Wellness Plan
  MEDICAL RISKS MEDICAL PSYCHOSOCIAL
CONDITION
 Bleeding  Assessment for
Dengue Fever  Proper hydration Depression
JEC with Warning  Depression  Proper Nutritional Support
Signs
26/F
 Annual Physical Exam  Smoking cessation
JMC NONE NONE


Healthy Diet
Blood pressure monitoring
45/M  Cholesterol monitoring
 Diabetes screening
 Annual Physical Exam
 Healthy Diet
JFC NONE NONE  Breast exam
43/F  Blood pressure monitoring
 Cholesterol monitoring
 Diabetes screening
 Papsmear

 Limit screen time  Regularly go to

NONE NONE  Eat vegetables school
JJC  Encourage physical activity  Assist parents with
sports household chores
10/F
 Insight
According to Berman, a FAMILY is a small social system made up of
individuals related to each other by reason of strong reciprocal affections
and loyalties and comprising a permanent household. Being a family
entails making decisions based on the opinion of everyone in the family.
Death due to Dengue Fever has increased this year and it implicates fear
to patients. As a physician, we should clearly explain to our patients what
their disease is all about including its risks and harm.