86639440 Sample Family Care Study N107

N107- Family Case Study 2012

S a m p l e b y : T o r r e g o s a , C y r u s D a n A .

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I. INTRODUCTION

A. OVERVIEW

Community refers to a group of people who interact with each other; it is a social group

determined by geographic boundaries, common values and interest. It functions within a social

structure, exhibits and creates norms, values, and social institution. (Microsoft Encarta,

2009)

In Community health nursing, one of the two major fields of nursing in the Philippines,

nursing practice in the community means different things to different nurses. Its primary goal is

the promotion and preservation of health of its client that could be in the individual, family,

population, group and community. In community health nursing practice includes nursing

directed to individuals, families, groups; the dominant responsibility is the population as a

whole. With these, the health of the people is a reflection of the communities of which they live,

play, work and learn. Communities shape the lifestyle that people adopt and their livelihood of

living safe, fulfilling and productive lives.

Family, basic social group united through bonds of kinship or marriage, present in all

communities. Ideally, the family provides its members with protection, companionship, security,

and socialization. The structure of the family, and the needs that the family fulfills vary from

society to society. The nuclear familytwo adults and their childrenis the main unit in some

societies. In others, it is a subordinate part of an extended family, which also consists of

grandparents and other relatives. In a community, the family is considered to be its basic unit.

(Microsoft Encarta, 2009)

Our community experience has been founded on the above principle. This exposure did

not only provide an avenue to apply what we have acquired in the classroom but also provided

an opportunity to serve our fellowmen. Because being in the community is more than meeting

the requirements in the Related Learning Experience (RLE), it is being experience the real

world, making real memories and rendering service with competence, conscience, commitment

and care.

This paper presents a case of a nuclear family of five (5) members at The Tent City,

Calaanan, Cagayan de Oro City. As a community health student nurse assigned in the area, I

was given a chance to care for a certain family. After initial survey of the place, I came across

to the XX family.

The objective of the study is to smooth the progress of putting into practice the concept

of family-oriented nursing care and make certain an organized approach in the delivery of the

nursing services to the families in the community, purposely in the application of the nursing

process. It aims to identify the health problem of a family within the community. As student

nurse, I could give and apply some nursing interventions that are applicable and attainable

within the community health services.



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At the end of two (4) weeks of Community Health Exposure, I will be able to provide to

the XX family nursing interventions to the identified health problems affecting the family. The

health programs of the Department of Health (DOH) for the promotion of health and prevention

of illnesses and the improvement of the conditions in the social and physical environment will

also be imparted to the family, and also to participate with the family in the over-all health plan

affecting the family, in its implementation and evaluation.

B. SCOPE AND LIMITATION OF THE STUDY

This Family Health Care Study provides information and additional knowledge about

health to the family concerned. The student is focusing only on the XX family, on their health

promotion, prevention of illness and possible ways of alleviating health problems.

The student also rendered health teachings according to our knowledge of health care

concepts as well as through the culminating and microteaching last March 01, 2012. The

student also emphasized DOH programs offered by the Department of Health and the services

they offered at Barangay Health Centers. Family care study covers only four (4) weeks of

Community Health Nursing. This is also limited to the family's capabilities and willingness to

participate and cooperate with the nursing interventions.



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II. SPOT MAP

A. NARRATIVE DESCRIPTION

Tent City, Calaanan Relocation Site, Canitoan Cagayan de Oro City, Misamis Oriental is

located Southwest and 7.5 kilometers away from Cagayan de Oro City proper. Our reference

point is from Liceo de Cagayan University-main campus to Tent City, Calaanan Relocation Site,

Canitoan Cagayan de Oro City. From here the students have to charter a jeepney to transport

the group to and from with the fare of 43 pesos. From the school, the jeepney should turn right

on the intersection going to Patag, passing through the SSS building, GSIS building, Highschool

Department, National Grid of the Philippines. The jeepney will then turn left with the House of

Bulalo as the landmark then going to the Villarin street passing through the establishments of

Department of Telecommunication and National Irrigational Administration, straight passing the

St. Marys Academy and Mt. Carmel Church. Then turn left from the intersection between

Macanhan and Upper Carmen passing Immanuel Mission School and Landfill Zayas, Upper

Carmen going downward passing the Silver Creek Subdivision and St. Therese Chapel. Upon

arriving on the Canitoan Road, the jeepney must turn left to P.N Roa area, going straight

passing to the P.N Roa Elementary school then finally to the Tent City. The Tent were

numbered and arranged by five, the tent of our family is # 273.

B. ALTERNATIVE ROUTE

One may ride a jeepney going to Cogon Market where you will stop near Petron

Gasoline Station facing south you will go then to the street leading to National Bookstore. At the

back of the National Bookstore is where you will the find the jeepney going to the P.N Roa

including Calaanan. Upon riding on that jeepney, you can pass by the Rotonda circle and Upper

Carmen passing Immanuel Mission School and Landfill Zayas, Upper Carmen going downward

passing the Silver Creek Subdivision and St. Therese Chapel. Upon arriving on the Canitoan

Road, turn left to P.N Roa area, going straight passing to the P.N Roa Elementary school then

finally the Tent City.The Tent were numbered and arranged by five, the tent of our family is #

273.


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C. ILLUSTRATION/DIAGRAM OF THE MAP

Spot Map of The Tent City, Calaanan Relocation Site, Canitoan, Cagayan de Oro City, Misamis Oriental


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III. FAMILY PROFILE

Clients Name: Mr. XX

Position in the Family: Head

Gender: Male

Age: 27 years old

Civil Status: Married

Birth date: April 08, 1984

Birth place: Punong, Gingoog City

Citizenship: Filipino

Religion: Roman Catholic

Occupation: Motor- rela driver

Monthly income: P 1,500.00

Clients Name: Mrs. XX

Position in the Family: Wife

Gender: Female

Age: 22 years old

Civil Status: Married

Birth date: May 14, 1989

Birth place: Punong, Gingoog City



Occupation: Housewife

Monthly income: None

NO PICTURE TAKEN


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Clients Name: XX1

Position in the Family: 1st Child

Gender: Female

Age: 4 years old

Civil Status: Child

Birth date: January 23, 2008

Birth place: Northern Mindanao

Medical Center, CDOC



Clients Name: XX2

Position in the Family: 2nd Child

Gender: Female

Age: 2 years old

Civil Status: Child

Birth date: May 07, 2009






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Clients Name: XX3

Position in the Family: 3rd Child

Gender: Male

Age: 1 year old

Civil Status: Child

Birth date: October 26, 2010





IV. FAMILY HEALTH HISTORY

1. Client Mr. XX Mr. XX is 27 years of age, and is presently residing with his whole family now at the

Tent City, Calaanan Relocation Site, CDO; Tent No. 273. He had common colds and cough last

month and doesnt have any chronic illness as claimed. He was fully immunized during his

childhood days since his mother was a BHW in their place. Last 2005, he suffered from Urinary

Tract Infection thus consulted and admitted at NMMC which lasted for 5 days. He had

heredofamilial diseases of asthma, diabetes mellitus II and hypertension. No known food and

drug allergy.

2. Client Mrs. XX Mrs. XX is 22 years of age, a housewife. She had her first menstruation at the age of 12

years old and had a regular monthly period. She was immunized completely during childhood.

She claimed that she was positive for Hepatitis B when she was carrying her 2nd child on her

womb (4 years ago) after a blood test was performed. She was in denial at that time, she did

request another test but the result was still the same. She had no idea where she got the

dreadful disease. She knows how the disease was transmitted. Now shes in a stage of

acceptance as she claimed.


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She has no known food and drug allergy and dont have any history of diseases in their

family line. She delivered her children through normal spontaneous vaginal delivery at Northern

Mindanao Medical Center. She had her prenatal check-up at same institution. So far she had no

complications experienced for her past pregnancy.

Gynecology History

Menarche at 12 y.o. regular subsequent menses, 5 days (-) dysmenorrhea

Obstetric History

G1- (January 23, 2008) XX1- NSVD, NMMC

G2- (May 07, 2009) XX2- NSVD, NMMC

G3- (October 26, 2010) XX3- NSVD, NMMC

Hospital Confinement

UTI admitted at NMMC for 4 days (2008)

3. Client XX1 Client XX1, a 4 year old female child, was delivered through normal spontaneous vaginal

delivery at Northern Mindanao Medical Center. She was fully immunized. The child was

hospitalized when she was about 6 months old at NMMC for a week due to Acute

Gastroenteritis with Moderate Dehydration.

4. Client XX2 Client XX2, a 2 year old female child, was delivered through normal spontaneous vaginal

delivery at Northern Mindanao Medical Center. She was fully immunized. Like her older sister,

she was hospitalized when she was about 6 months old at NMMC for 4 days due to Acute

Gastroenteritis with Moderate Dehydration.

5. Client XX3 Client XX3, a 1 year old male child, was delivered through normal spontaneous vaginal

delivery at Northern Mindanao Medical Center. He was fully immunized now. Like his older

sisters, again he was hospitalized when he was about 6 months old at NMMC for just 4 hours

for hydration purposes due to severe dehydration. Their mother did say that her children

experienced the same disease when they were about 6 months old. Coincidence?


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V. PRESENT HEALTH STATUS

A.

1. Client Mr. XX

Mr. XX claimed that he doesnt have any illnesses at the moment. His cough and colds

subsided a month ago. He works as a motor-rela driver. No history of drinking alcoholic

beverages and non-smoker. Vital signs was taken last February 02, 2012 with a Pulse: 88 bpm

RR: 21cpm BP: 130/80 mmHg Temp: 36.2 oC.

2. Client Mrs. XX

Mrs. XX claimed that he doesnt have any illnesses but do have troubled sleeping at

night when they transferred at their tent. Shes a housewife and always taking care of their

young ones, making sure that theyre safe and sound. No history of drinking alcoholic

beverages and non-smoker as claimed. Vital signs was taken last January 20, 2012 with a

Pulse: 78 bpm RR: 23cpm BP: 110/80 mmHg Temp: 36.5

3. Client XX1

During assessment, cough and colds with whitish sputum was noted with client XX1. Her

mother said that her cough and colds was intermittent for the past 4 weeks. The child does

take Vitamin C and Multivitamins given by the clinic for free after consultation. Vital signs:

Pulse: 97 bpm RR: 25cpm BP: no pedia cuff avail, Temp: 36.30C

4. Client XX2

No illness was noted with client XX2. Shes playful, energetic and cheerful during the

course of assessment. The child also takes Vitamin C and Multivitamins. Vital signs: Pulse: 89

bpm RR: 23cpm BP: no pedia cuff avail. Temp: 36.3oC

5. Client XX3

Cough and colds with whitish sputum was noted with client XX3 with no respiratory

distress, just like her eldest sister. The mother said that his cough and colds was intermittent

for the past 2 weeks and was given Vitamin C and Multivitamins after consulting the clinic. Vital

signs: Pulse: 94 bpm RR: 24cpm BP: no pedia cuff avail. Temp: 36.2 oC


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B. NURSING ASSESSMENT (SYSTEM REWIEW CHART)

LEGEND:

EENT:

Impaired vision blind

pain reddened drainage

gums hard of hearing deaf

burning edema lesion teeth

Asses eyes, ears, nose Throat for abnormality no problem RESP.

asymmetric tachypnea

apnea rales cough barrel chest

bradypnea shallow rhonchi

sputum diminished dyspnea

orthopnea labored wheezing

pain cyanotic

Asses resp. rate, rhythm, depth, pattern breath sounds, comfort no problem CARDIO VASCULAR

arrhythmia tachycardia numbness

diminished pulses edema fatigue

irregular bradycardia murmur

tingling absent pulses pain

Assess heart sounds, rate, rhythm, pulse, blood pressure, etc., fluid retention, comfort no problem GASTRO INTESTINAL TRACT

obese distention mass

dysphagia rigidity pain

Asses abdomen, bowel habits, swallowing, bowel sounds, comfort no problem GENITO-URINARY and GYNE pain urine color vaginal bleeding hematuria discharge nocturia Assess urine freq., control, color, odor, comfort/ Gyn-bleeding, discharge no problem NEURO paralysis stuporous unsteady seizures lethargic comatose vertigo tremors confused vision grip Assess motor function, sensation, LOC, strength, grip, galt, coordination, orientation, speech no problem MUSCULOSKELETAL and SKIN appliance stiffness itching petechiae hot drainage prosthesis swelling lesion poor turgor cool deformity wound rash skin color flushed atrophy pain ecchymosis diaphoretic moist Asses mobility, motion, galt, alignment, joint function /skin color, texture, turgor, integrity no problem

-slightly elevated blood pressure of 130/80 mmHg -dirty fingernails

-dirty toenails

Name: XX, Mr. XX Date: February 02, 2012 Vital Signs: Pulse: 88 bpm BP: 130/80 mmHg Temp: 36.2 oC Height: 55 Weight: 77 kg

Place an () in the area of abnormality. Comment at the space provided. Indicate the location of the problem in the figure if appropriate, using ()

1ST WEEK

2ND WEEK 4TH WEEK

3RD WEEK


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LEGEND:

EENT:











pain cyanotic










-pale in appearance

-difficulty sleeping -(+) Hep. B

Name: XX, Mrs. XX Date: January 20, 2012 Vital Signs: Pulse: 78 bpm BP: 110/80 mmHg Temp: 36.5 oC Height: 52 Weight: 58 kg


1ST WEEK

2ND WEEK 4TH WEEK

3RD WEEK


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LEGEND:

EENT:











pain cyanotic










- tooth decay all throughout the assessment

-cough and colds with whitish sputum in minimal amount

- Moderate personal hygiene

- Dirty nails

Name: XX, XX1 Date: January 26, 2012 Vital Signs: Pulse: 97 bpm BP: no pedia cuff avail, Temp: 36.3 oC Height: 103 cm Weight: 13.2 kg


1ST WEEK

2ND WEEK 4TH WEEK

3RD WEEK


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LEGEND:

EENT:











pain cyanotic










-tooth decay all throughout the assessment

-moderate personal hygiene -dirty fingernails

Name: XX, XX2 Date: January 26, 2012 Vital Signs: Pulse: 89 bpm BP: no pedia cuff avail. Temp: 36.3oC Height: 97cm Weight: 14 kg


1ST WEEK

2ND WEEK 4TH WEEK

3RD WEEK


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LEGEND:

EENT:











pain cyanotic










-cough and colds with whitish sputum in minimal amount

-moderate personal hygiene -dirty fingernails

Name: XX, XX3 Date: January 26, 2012 Vital Signs: Pulse: 94 bpm BP: no pedia cuff avail. Temp: 36.2 oC Height: 79cm Weight: 49 kg


1ST WEEK

2ND WEEK 4TH WEEK

3RD WEEK


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VI. INTERGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)

MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS

Date: January 26, 2012

Childs name: XX3 Age: 1 year old Sex: Male Weight: 9.5 kg Temp: 36.2C

ASK: What are the childs problem? Cough and colds all throughout the assessment

(WEEK 2-WEEK4)

Initial visit and Follow-up Visit

ASSESS CLASSIFY

CHECK FOR GENERAL DANGER SIGNS

NOT ABLE TO DRINK OR BREASTFEED

VOMITS EVERYTHING

CONVULSIONS

ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN

YES___

NO__

DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING?

Yes__ No___

For how long?

Count the breaths for one minute. _26_breaths per minute. Fast breathing? Look for chest indrawing? Look and listen for stridor.

No

Pneumonia

: Cough

and Cold

DOES THE CHILD HAVE DIARRHEA?

Yes___ No__

For how long? ___days

Is there blood in the stools?

Look at the childs general condition. Abnormally sleepy or difficult to awaken?

Restless or irritable?

Look for sunken eyes. Offer the child fluid. Is the child: Not able to drink or drink poorly?

Drinking eagerly, thirsty?

Pinch the skin of the abdomen. Does it go back: Very slowly (longer than 2 seconds)?

Slowly?

No

Dehydratio

n

DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37.5C or

above) Yes__ No___

Decide Malaria Risk

Does the child live in malaria area? No Has the child visited a malaria area in the past 4 weeks? No


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If malaria risk, obtain a blood smear.

Look or feel for stiff neck. Look for runny nose. + Pf Pv - Not done

For how long has the child had fever? __days If more than 7 days, has fever been present every day? Has the child had measles within the last 3 months? Look for signs of MEASLES

Generalized rash and One of these: cough, runny nose. Or red eyes.

.

If the child has measles now or within the last 3 months:

Look for mouth ulcers If yes, are they deep and extensive?

Look for pus draining from the eye Look for clouding of the cornea.

.

Decide Dengue Risk:

Yes__ N o___

If dengue risk, then ask:

Has the child had any bleeding form the nose or gums or in the vomitus or stools? No

Has the child had black vomitus or black stool? No Has the child had abdominal pain? No Has the child been vomiting? No Look for bleeding from nose or gums. None Look for skin petechiae. None Feels for cold and clammy extremitites. None Check capillary refill ___seconds. Perform tourniquet test if child is 6 months or older and has no other signs

and has fever for

more than 3 days.


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DOES THE CHILD HAVE AN EAR PROBLEM?

Yes___ No___

Is there ear pain? No Is there ear discharge? No

If yes, for how long? ___days

Look for pus draining from the ear. None Feel for tender swelling behind the ear. None

No Ear

Infection

THEN CHECK FOR MALNUTRITION AND ANEMIA

Look for visible severe wasting. Yes. Look for edema of both feet. No. Look for palmar pallor. Severe palmar pallor? Some palmar pallor? None

Determine weight for age Very Low? Low.

No Anemia

and low

weight

CHECK THE CHILDS IMMUNIZATION STATUS Circle immunization needed

today

___ ___ ___ ____

BCG DPT1 OPV1 HEPB1

____ ___ ___ _______

DPT2 OPV2 HEPB2 MEASLES

____ ____ _____

DPT3 OPV3 HEPB3

Return for

next

immunizat

ion on:

(date)

CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older

Is the child six months of age or older? Yes__ NO___

Has the child received Vitamin A in the past six months? Yes____ No___

Vitamin A

needed

today

Yes___

No___

ASSESS CHILDS FEEDING if child has ANEMIA OR VERY LOW WEIGHT or is

less than 2 years old.

Do you breastfeed your child? Yes__ No____ If Yes, how many times in 24 hours? _n/a__ times. Do you breastfeed during

the night? Yes___ No_n/a__

Does the child take any other food or fluids? Yes___ No___ If Yes, what food or fluids? _Bear brand milk, fruits, noodles, canned

goods, rice


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How many times per day?_3__ times. What do you use to feed the child?

_spoon and fork_

If very low weight for age: How large are servings?___child is within

normal weight___

Does the child receive his/her own serving? yes__ Who feeds the child and

how?_mother, spoonfeeding; child feeds on his own most of the time

During the illness, has the childs feeding changed? Yes ___ No___ If yes, how? Fair appetite

ASSESS OTHER PROBLEMS: Moderate personal hygiene


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Childs name: XX2 Age: 2yrs Sex: Female Weight: 14 kg Temp: 36.3C

ASK: What are the childs problem? None all though out the assessment (WEEK 2-

WEEK 4)

Initial visit and Follow-up visit

ASSESS CLASSIFY



VOMITS EVERYTHING

CONVULSIONS


YES___

NO__

DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? Yes__

No___

For how long?


No

Pneumonia


Yes___ No__








Slowly?

No

Dehydratio

n


above) Yes__ No___

Decide Malaria Risk



Page 23





.




.

Decide Dengue Risk: Yes__ N o___



Has the child had black vomitus or black stool? No Has the child had abdominal pain? No Has the child been vomiting? No Look for bleeding from nose or gums. None Look for skin petechiae. None Feels for cold and clammy extremitites. None

Check capillary refill ___seconds. Perform tourniquet test if child is 6 months or older and has no other signs

and has fever for more than 3 days.


Yes___ No___


No Ear


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Infection




No Anemia

and low

weight


today

___ ___ ___ ____

BCG DPT1 OPV1 HEPB1

____ ___ ___ _______


____ ____ _____

DPT3 OPV3 HEPB3

Return for

next

immunizat

ion on:

(date)




Vitamin A

needed

today

Yes___

No___

ASSESS CHILDS FEEDING if child has ANEMIA OR VERY LOW WEIGHT or


Do you breastfeed your child? Yes_ _ No____ If Yes, how many times in 24 hours? _n/a__ times. Do you breastfeed during

the night? Yes___ No_n/a

Does the child take any other food or fluids? Yes___ No___ If Yes, what food or fluids? _noodles, milk, fruits, rice and canned goods


_spoon and fork_

If very low weight for age: How large are servings?_n/a_____



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how?_child herself, spoonfeeding


ASSESS OTHER PROBLEMS: Tooth decay and moderate personal hygiene


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Childs name: XX1 Age: 4yrs Sex: Female Weight: 13.2 kg Temp: 36.7C

ASK: What are the childs problem? Cough and colds all throughout the assessment

(WEEK 2-WEEK4)

Initial visit and Follow-up visit

ASSESS CLASSIFY



VOMITS EVERYTHING

CONVULSIONS


YES___

NO__

DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? Yes__

No___

For how long?


No

Pneumonia

: Cough

and Cold


Yes___ No__








Slowly?

No

Dehydratio

n


above) Yes__ No___

Decide Malaria Risk



Page 27





.




.

Decide Dengue Risk: Yes__ N o___



Has the child had black vomitus or black stool? No Has the child had abdominal pain? No Has the child been vomiting? No Look for bleeding from nose or gums. None Look for skin petechiae. None Feels for cold and clammy extremitites. None

Check capillary refill ___seconds. Perform tourniquet test if child is 6 months or older and has no other signs

and has fever for more than 3 days.


Yes___ No___


No Ear


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Infection




No Anemia

and low

weight


today

___ ___ ___ ____

BCG DPT1 OPV1 HEPB1

____ ___ ___ _______


____ ____ _____

DPT3 OPV3 HEPB3

Return for

next

immunizat

ion on:

(date)




Vitamin A

needed

today

Yes___

No___

ASSESS CHILDS FEEDING if child has ANEMIA OR VERY LOW WEIGHT or


Do you breastfeed your child? Yes_ _ No____ If Yes, how many times in 24 hours? _n/a__ times. Do you breastfeed during

the night? Yes___ No_n/a

Does the child take any other food or fluids? Yes___ No___ If Yes, what food or fluids? _noodles, fruits, rice and canned goods_


_spoon and fork_

If very low weight for age: How large are servings?_n/a



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how?_the child herself, spoonfeeding


ASSESS OTHER PROBLEMS: Tooth decay and moderate personal hygiene


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VII. HOME AND ENVIRONMENT

1. Housing

All families who were victims of the typhoon Sendong, including family XX were

sent at Calaan Relocation Site, Canitoan, Cagayan de Oro City (known as the Tent

City) and were also given a tent (known as the Shelter box) by the government

where they will

temporarily reside. The

family was on Tent No.

273.

The whole covering

(doors, flooring, and

small windows) of the

Tent is made up of

polyester cloth which is

a specialized kind of

cloth that can stand

heat and rain, and cant

be easily tear or damage. They were given a special mat additional for their flooring

inside the tent. Two doors, the back and front have a pair of zippers used to lock

their houses when theyre not around. Windows are widely open at night time. The

family said that when its day to noontime (around 9am-3pm) its totally hot inside

the tent, and very cold at nighttime to dawn (around 10pm-5am).

Inside the tent, at the center of it is where their little sala is seen, and the left and

right compartments serve as the rooms where they usually sleep, change clothes

and for the privacy of the couple.

Clothes hanging inside are noticeable also (resting sites of vectors of diseases such

as mosquitoes).

Uses no electricity for their lighting facilities and other electrical devices ( cell phone

charger, electric flashlight, electric fan, radio)

Has proper ventilation when the doors and windows are widely open


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2. Water supply

Water comes from the common

source where they usually have to

walk and fetch from the water

station (25 meters away from

their tent- washing clothes and

dishes, taking baths)

They use pail and plastic

containers as storage of water for

washing the dishes.

Uses plastic gallons as storage for

purified drinking water where its

usually free and delivered by DUAL

NARRA. If their supply is already

consume, they then usually buy purified drinking water at the nearest drinking

water system.

3. Toilet facility

The LGUs, NGOs and other

private sectors donated these

portalette, a portable toilet

where the people urinates and

expel their wastes. Every day it

is cleaned by a poso negro

personnels.

The walls are made up of

special concrete plastic thing.

Antipolo type

After three weeks of visit, the toilet facility was changed from a portalet into a water sealed

type for a better and more sanitized toilet for all.


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4. Kitchen

Doesnt have sink, they usually wash dishes at the

water station 25 meters away from their tent

Uses firewood/charcoal for cooking

Washes their dishes using pail as storage of water

Foods are placed on the table outside the tent;

leftovers are covered with plates only and a special

covering device was noted

5. Garbage/waste disposal

The family does not segregate their

wastes.

Uses plastic cellophane container then

throws it when its already full at the big

barrel for garbage collection

6. Domestic Animals

They dont have any domesticated animals and pets in their tent.

7. Neighborhood

Their neighbors are composed

mostly of low-income families

and all of them were victims of

the typhoon Sendong. Most of

these families are friendly and

show concern for one another

especially when there is a

problem among them.

The health center is near and

no need to spend money for

fare

No fresh air and trees that give shade to the surrounding


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VIII. FAMILY COPING INDEX

The objective of this indicator is to present a benchmark for approximating the nursing

needs of the particular family, thus Family Coping Index. It is the coping capacity and not

the underlying problem that is being rated, and it is designed to record family rather than

individual coping capacity. The family cannot be seen only as a factor that affects health;

rather, the family is the patient.

Legend:

1 No competence

3 Moderate competence

5 Complete competence

CATEGORY SCALE JUSTIFICATION

1. Physical Independence 5 All family members are physically fit and physically

capable of performing independently. The family

provides needs to its members. The father works as a

motor-rela driver to provide the needs of his family. The

mother takes care of the children and is responsible for

bathing, grooming and making their children clean and

safe.

2. Therapeutic Competence

3 The familys initial treatment was the use of herbal

medication to treat existing diseases. They consult to

the physician only if referred from the barangay health

center and if immediate medical attention is required

due to financial problems.

3. Knowledge of Health Condition

3 Has some general knowledge of the disease or

condition, but has not grasped the underlying principles,

or is only partially informed and does not know how to

lessen & prevent the disease.

4. Application of Principles of General Hygiene

5

In terms of hygiene, the family was consciously

practicing and applying hygiene principle as part of their

lifestyle. Based on the objective observation, as well as

assessment gathered. They usually attends seminars

about health and hygiene as stated by the mother when

there is time.

5. Health Attitudes 3 Accepts health care in some degree but with

reservations. Most of the time, the family does not seek

the help of medical professionals only if symptoms

persists and intensifies.

6. Emotional Competence 3 The family was able to maintain a fair degree of

emotional calm, face up to illness realistically and


Page 34

hopefully; their problem was only lack of financial

support that was not able to sustain what are those

family needs.

7. Family Living 3 Familys does things together and act for the good of the

family as a whole and they have good interpersonal

relationship. The children do respect their parents as

what Ive observed.

8. Physical Environment 3 The house is generally in good condition and safe. But

they dont have a proper drainage. The environment

possibly has vectors that can cause diseases such as

dengue or filariasis.

9. Use of Community Facilities

3 Family is aware of and uses of the health services

offered in their place. Their children had received

already full immunization.


Page 35

IX. SCHEMATIC PRESENTATION OF THE FAMILY HEALTH PROBLEM

SOCIO-CULTURAL FACTORS

Economic Political

FATHER MOTHER

High school undergraduate

High School

undergraduate

Motor- rela

driver

Housewife

Financially unstable with a monthly income of

Php 1, 500

HEALTH THREAT:

- Family size beyond what family resources can adequately provide (financially unstable)

No other additional expense

for the Family

Cultural

NONE NONE


Page 36

BIOLOGICAL FACTORS

Psychosocial

Physical

Genetic

- Typhoon

Sendong took

away so many

things from them,

but they were able

to adjust in the

new environment

they have. Theyre

in the stage of

acceptance

-Express anxiety

over budget

compensation for

additional budgets

Father Mother Children

- Long dirty fingernails and toenails

- Slightly elevated BP of 130/80mmhg

- Difficulty sleeping

- Lack of sleep

- (+) Hep. B


- Dirty nails - Tooth decay - Cough and colds

Hypertension.

DM II and

asthma on

paternal side

HEALTH THREAT


- Heredito-familial diseases: hypertension, asthma and DM II

- Dirty nails - Tooth decay

HEALTH DEFICIT

- Lack of sleep - Hepatitis B

disease - Elevated blood

pressure - cough and colds

FORESEEABLE CRISIS

- infection - hospitalization - death


Page 37

ENVIRONMENTAL

Home and

Sanitation Condition

TENTS: -No proper division. - No privacy. -Fire Hazard (made up polyester cloth)

Water Supply

Water Source is 25 meters

away from the tent.

Community faucets used

for bathing and washing

dishes and clothes.

Uncovered water

containers and

storage

Toilet

Communal toilet

Antipolo Portalet

and Water

sealed type of

toilet

Garbage

Disposal

Waste segregation not

practiced. The family

hangs a plastic bag

adjacent to the tent for

their garbage and

throws it when full at a

big barrel of garbage

- presence of vectors for diseases such as mosquitoes and flies

Kitchen

Dirty kitchen

adjacent to their

tent

Prone to fire

accdients

HEALTH THREAT

- presence of breeding or resting sites of vectors of diseases

- improper garbage disposal - making fire at childrens reach may cause burns and

injuries - inadequate living space

The family is given a

galloon of purified

drinking water Inadequate living

space, no proper

sleeping grounds,

room for

contamination is of

high risk

FORESEEABLE CRISIS

- infection - hospitalization - death


Page 38

X. FAMILY HEALTH PLAN

CUES HEALTH PROBLEM

FAMILY NURSING PROBLEM

GOAL OF CARE

OBJECTIVES OF CARE

INTERVENTION PLAN EVALUATION

Nursing

Interventions

Method

of Nurse-

Family

Contact

Resources

Required

Subjective:

Kani lagi sila

akong mga

anak kay

gipang ubo ug

sip on, as

verbalized by

the wife

Objective:

-productive

cough with

whitish sputum

in minimal

amount

- colds

Cough and

colds as

health deficit

1. Inability to

make decisions

about taking

appropriate

action due to:

a. failure to

comprehend

the nature and

magnitude of

the problem.

b. Fear of

consequences

of action,

specifically

economic

consequences.

2. Inability to

provide

At the end of

nursing

intervention,

The children in

the family with

cough and

colds will be

relieved.

At the end of

nursing

interventions, the

family will:

a. gain

knowledge on the

management of

cough and colds;

b. bring the child

to the health

center for

consultation;

c. be able to

carry out

appropriate

interventions to

relieve the childs

cough and colds;

1. Taught the

mother the ways

to soothe the

throat and relieve

cough with a safe

remedy such as

tamarind,

calamansi and

ginger.

2. Instructed the

mother not to

use cough syrups

and other

decongestants if

not prescribed by

the doctor.

3. Instructed the

mother to

increase the

Home Visit Material

resources:

-tamarind,

calamansi or

ginger

Time and effort

of the nurse and

the family

Expenses for

transportation of

the student

nurses

Goal partially met

At the end of

nursing

interventions, the

family:

a. gained

knowledge on the

management of

cough and colds;

;

b. was able to

carry out

appropriate

interventions to

relieve the childs

cough and colds.


Page 39

- not in

respiratory

distress

adequate

nursing care to

a member

suffering from

cough and

colds due to:

a. inadequate

knowledge

regarding the

health

condition;

b. lack of

knowledge on

the nature and

extent of

nursing care

needed;

childs fluid

intake.

4. Instructed the

mother to keep

the childs back

dry.


Page 40

CUES HEALTH PROBLEM

FAMILY NURSING

CARE

GOAL OF CARE

OBJECTIVES OF CARE

INTERVENTION MEASURES

MODE OF NURSE-FAMILY

CONTACT

RESOURCES NEEDED

EVALUATIONS

Subjective: Gaibutang ra namo among mga pagkaon sa lamesa dayon takluban ug palto as verbalized by the wife Objective: -no other storage facilities to secure their uncooked and left over foods

Presence of health threat due to poor condition as evidenced by lack of food storage facilities

-Inability to provide a home environment conducive to health maintenance and personal development due to: a. inadequate family resources specially financial constraints or limited financial resources

At the end 30 minutes of nursing interventions, the family will be able to: a. Verbalize understanding about the importance of having better food storage. b. Place their food in a safe place away from pests.

After the nursing intervention carried out, the family will at least have better containers or cover to secure their foods and from contamination.

1.Assess knowledge of the family towards the pending problem. 2.Discuss possible threats to the familys health due to these containers. 3.Discuss the advantages which will bring about the partial solution to their problem. 4.Plan appropriate action to the problem.

Home visit

Food storage Time and effort of the nurse and actual participation and empowerment of the family Financial Resources

After 30 minutes of nursing interventions, the family was able to: a.Verbalized understanding about the importance of having better food storage. b. Placed their food in a safe place away from pests.


Page 41

CUES HEALTH PROBLEM

FAMILY NURSING

PROBLEMS

GOAL OF CARE

OBJECTIVES OF CARE

INTERVENTION MEASURES

METHODS OF FAMILY-

NURSE CONTACT

RESOURCES REQUIRED

EVALUATION

Subjective:

Wala lage me saktong butanganan sa mga plato ug uban pang materyles sa pagpreparar sa pagkaon as verbalized by the wife

Objective:

Unwashed utensils

Unorganized placements of utensils

Exposed stencils to pest and rodents

Improper food storage and

Unsanitary food handling as a health threat

Inability to decide about taking appropriate actions due to failure to comprehend the identified problem as a health threat

After 4 weeks of rendering nursing interventions, the family will be able to practice the proper ways on handling food and recognize the importance of proper food handling

After 4 weeks of rendering nursing interventions, the family members will be able to:

1. Recognize the risk factors that will contribute to the identified problems;

2. identify the different measures to prevent the arousal of the risk factors of the problem

3. determine the importance of

1. Assess the family concerning their practices on handling and preparing the food

2. Discuss with the family the health problems that will occur if improper food handling will persist and lead to undesirable illnesses such as diarrhea

3. Teach the family to do proper hand washing and encourage them to perform it before and after handling foods

arise

4. Discuss to the family on how to handle the food properly:

5. Encourage the

Home visit Participation and empowerment of the family

Time and effort of the nurse and family member

At the end of 4 weeks, the family was able to practice proper ways about handling food and recognized the importance of proper food preparation and food handling


Page 42

handling, foods exposed to flies

preparing and handling the food properly;

4. practice and apply the techniques of food handling and preparation;

5. keep their kitchen clean and free from insects an rodents

family to keep the house clean specially the kitchen area


Page 43

CUES HEALTH

PROBLEM

FAMILY

NURSING PROBLEMS

GOAL OF

CARE

OBJECTIVES

OF CARE

INTERVENTION

MEASURES

METHODS OF

FAMILY-NURSE

CONTACT

RESOURCES

REQUIRED

EVALUATION

Subjective:

Hugaw jud

ang amu

palibot, cge

man ko

panlimpyo pero

mahugaw ra

jpon as

verbalized by

the wife

Objective:

-unclean

environment

-clothes

hanging inside

the tent

-Presence of

flies and

mosquitoes

flying the

house

Poor home

environment

al condition

as a health

threat

Inability to provide a home environment conducive to health maintenance and personal development due to failure to comprehend the identified problem as a health threat

After 4 weeks

of rendering

nursing

interventions,

the family will

be able to

recognize the

problem as a

threat and will

be able to

recognize the

importance

keeping the

home clean

After 4 weeks

of rendering

nursing

interventions,

the family

members will

be able to take

action in

cleaning their

tent area and

maintaining its

cleanliness.

1. Encourage the every

family member to

participate in cleaning

2. Discuss the

importance of keeping

the home/tent clean

3. Discuss the possible

health condition that

may arise

4. Encourage the

family members to

maintain the

cleanliness in their

home/tent

Home visit Participation and

empowerment of

the family

Time and effort

of the nurse and

family member

At the end of 4

weeks, the

family was able

to:

a. Recognize

the importance

of home

environmental

sanitation

B. Family

members

participated in

maintain the

cleanliness of

their place


Page 44

CUES

HEALTH

PROBLEM

FAMILY

NURSING

PROBLEMS

GOAL OF

CARE

OBJECTIVES

OF CARE

INTERVENTION

MEASURES

METHODS

OF FAMILY-

NURSE

CONTACT

RESOURCES

REQUIRED

EVALUATION

Subjective cue:

Sa cellopane

nalang namu

ginatambak

tanan, then

amu gnalabay

sa barrel nga

basurahan,

kwaon raman

daun sa

mangulekta ug

basura as

verbalized by

the wife.

Objective cues:

Presence of

flies and

Improper

garbage

disposal as a

health threat

Inability to

provide home

environment

conducive to

health

maintenance

and personal

development

due lack of

knowledge of

proper

garbage

disposal

At the end of

nursing

interventions,

the family will

be able to

realize the

harmful

effects of

improper

garbage

disposal and

benefits of

clean and

healthy

environment

Short term

objectives:

At the end of 15

minutes, the

family will

receive health

teachings about

importance of

proper waste

disposal

Long term

objectives:

At the end of 4

weeks , the

family will be

able to adopt

proper waste

Health teachings with

emphasis on the

importance of waste

management.

Human waste and

diseases. It is very

important to keep

human waste out of

water supplies.

Human waste (faeces,

poo, kuma, urine,

wee) contains

diseases that make

people sick. Human

waste can get into the

local water supplies

from leaking septic

tanks, releasing

contaminated water

Home

visitations of

the student

for six visits

within 6

weeks

Family

Interaction

Time and effort

of the student

and the family

members

Fare for the

students

At the end of

4 weeks ,the

goal partially

met. The

family was not

able to apply

the proper

waste

disposal. But

the family

intermittently

followed the

waste

management.


Page 45

mosquitoes

Unsegregated

way of

garbage

disposal and

dumping in a

cellophane bag

mangement

from sewerage

treatment plants, dirty

nappies, leaking

sewerage pipes and

people using local

creeks as a toilet.

Injury and disease.

People can get

diseases like tetanus

and leptospirosis if

they cut or scratch

themselves on pieces

of metal, nails or

glass. Children can be

seriously hurt by

playing with old car

batteries or household

cleaners that they find

lying around.

Litter can be a

problem. Broken

bottles and tins, for

example, can cause

injury. Mosquitoes and

other vectors can

breed in water

trapped in old tyres

and bottles.


Page 46

CUES

HEALTH

PROBLEM

FAMILY

NURSING

PROBLEMS

GOAL OF

CARE

OBJECTIVES

OF CARE

INTERVENTION

MEASURES

METHODS

OF FAMILY-

NURSE

CONTACT

RESOURCES

REQUIRED

EVALUATION

Subjective

cue:

Dili jud

maigo ang

sweldo sa

akong bana,

gamay

kaayo. as

verbalized

by the wife.

Wala pod

ko trabaho

as

verbalized

by the wife

Low family

income as a

health threat

Inability to

provide home

environment

conducive to

health

maintenance

and personal

development

due to

inadequate

family

resources

specifically

financial

constraints/fina

ncial resources

At the end of

nursing

interventions,

the family will

be able to

recognize or

realize ways

that will help

in maximizing

their money.

Short term

objectives:

At the end of 20

minutes, the

family will be

able to

recognize ways

in saving money

through giving

adequate

information.

Long term

objectives:

At the end of 4

weeks , the

family will be

able to apply

measures in

saving money.

Establish a family

budget.

Spend Less.Try to

never waste money

and make every

purchase a

considered purchase.

Use less. If could all

use and consume

less there would be

less waste, less

power consumption,

and the benefits for

you are SAVING

MONEY.

Save Money.Each

week or each month

get into the habit of

putting an amount,

Home

visitations of

the student

for six visits

within six

weeks

Family

Interaction

Time and effort

of the student

and the family

members

Fare for the

student

At the end of 4

weeks , the

goal was

partially met.

The family

recognized

ways in saving

their money but

needs to be

applied in

longer duration

for sufficient

results.


Page 47

Objective

cues:

Father

P1,500/mon

th income

Poor family

living

however small into

your savings. Start by

saving a very small

fixed amount each

time and then move to

putting in larger

amounts once you

begin to save money

from your other

money saving

strategies.

Shop Wisely.

Consider markets,

superstores, farmer's

markets, local shops,

marts and stores.

Buy used. There are

huge money savings

to be made in buying

used


Page 48

XI. ACTUAL IMPLEMENTATION

WEEK 1: January 19-21, 2012 (Orientation Phase)

The first encounter with my family was last

January 20, 2012 when we started our family profiling

and somehow after gathering data, this family fitted the

criteria for the family case study. As always, I greeted

Mrs. XX and introduced myself. I stated the purpose of

the visit and eventually asked permission using a consent

letter if it is okay for them to be a part for the family

case study. Then, I explained to her the whole course of

the study, its purposes, benefits and all: family profile,

assessment for 4 weeks, implementation of care and

health teachings and documentations.

I also assessed the family about their coping as

for what had happen during the typhoon Sendong. We talked a lot. She did express her feelings

and verbalized her thoughts.

WEEK 2: January 26-28, 2012 (Working Phase)

During this week I continued my assessment and

put my attention to their 3 children. I assessed them

individually using my nursing skills and with the used of

the IMCI booklet. Problems were identified and made me

plan for the succeeding days to come. Same with Mrs.

XX, problems were raised and explanations of such

diseases were discussed. The whole week,

implementations done and health teachings were

imparted to the family. The importance of hygiene to

achieve a healthy well being was emphasized; bathing,

grooming and cutting long and dirty fingernails were

performed with the family members.


Page 49

WEEK 3: February 02-04, 2012 (Working Phase)

The third week of the exposure

here at the Tent City, I finally assessed

the head of the family Mr. XX. Hes not

always at their tent since hes the only

one working as a motor- rela driver for

the needs and provision of his family.

After the assessment and interview,

health teachings were again imparted

to him since he has an elevated blood

pressure. He also claimed that they do

have a family history of hypertension,

asthma and DM II which makes him

more at risk.

Cleanliness not only to their bodies but also to their environment was stressed out. The

disease conditions that one can get from improper handling of food, improper garbage disposal,

and uncleanliness made the family more conscious about their health and hygiene. The family

did raise many questions and I did answer them based on the books I read.

WEEK 4: February 17-18, 2012 (Termination Phase)

The fourth week and termination phase has already come. Together with the family, we

evaluated the course of home visits and asked the family what theyve learned for the past

weeks. Same with them, I thanked the family for the hospitality and time they had given to me.

Finally, I invited them to come and join the income generating activity and microteaching this

coming March 01, 2012.


Page 50

XII. EVALUATION AND RECOMMENDATION

Community Health Nursing has been a part of every student nurses life. It is a nurses

duty to bring to the people the health programs of the government. To provide immediate

health care to the community peoples health problems before going to the higher health care

facilities. Prevention is our primary task so it is our duty to do every means in order to educate

the people.

After four weeks of visitation, I had identified several family health problems and

environmental problems as well. As included in the whole process of assessing, imparting health

teachings and rendering care to the family members, I recommend that the family should give

first priority to their health and avail the services offered by the local government at the Tent

City for proper referrals and further intervention of their disease conditions in which they are

not familiar with. I am hoping and looking forward that the XX family will apply the things that

the student nurse imparted to promote health and well being.

Overall, the intervention that was implemented to family made a difference on their

perception towards promoting health, and preventing illness. As a practicing health care giver,

the experience that I have gain during the rotation had improved my understanding about

community health nursing, not only that I have implemented interventions but the feeling of

being accepted as a health care provider and helped in the improvement of others lives is very

heartwarming and gave me a sense of accomplishment. For me, the concept of Community

Health Nursing is not all about fulfilling the requirements to pass or just intervening the

problems identified, its how the health care giver touches others lives and be one of them in

attaining the solution of the problem, its about empathy and motivation towards one self and

the community to perform such task pertaining to promoting health and preventing disease.

This exposure inculcates to us lots of learning and values which would eventually help us to

become competent health care providers as future nurses.


Page 51

XIII. BIBLIOGRAPHY

Maglaya, A., & Earnshaw, R., Nursing Practice in the Community.

Community Health Nursing by DOH

Kozier, et al. Fundamentals of Nursing. Singapore: Pearson Education Asia Ltd., 2004

Smeltzer, S. Medical-Surgical Nursing. Manila, 1996.

Reyala, A. et al. Community Health Services in the Philippines. Manila: National

League of the Philippine Government Nurses, Inc., 2000

Maglaya, A. Nursing Practice in the Community. Philippines: Argonauta Corp.

Microsoft Encarta 2009. 1993-2008 Microsoft Corporation.


Page 52

XIV. APPENDICES

A. LETTER OF CONSENT FOR CARE STUDY AND TAKING OF PICTURES


Page 53

B. PRIORITIZING HEALTH CONDITION AND PROBLEMS (ACTUAL COMPUTATION)

RANK 1

Problem: Cold and Cough as health deficit

Criteria Computation Actual Score Justification

Nature of the condition or problem presented

3/ 3 x 1 = 1 1 Health deficit problem

Modifiability of the condition or problem

2/ 2 x 2 = 2 2 Easily modifiable

Preventive potential 3/ 3 x 1 = 1 1 Highly preventable

Salience 2/ 2 x 1 = 1 1 Needing immediate attention

Total Score and Rank 5 Highest weight

RANK 2

Problem: Presence of health threats due to poor food sanitation as evidenced by lack

of food storage facilities



2/ 3 x 1 = 0.66 0.66 Health threat problem





Total Score and Rank 4.66 Highest weight

RANK 3

Problem: Unsanitary food handling as health threat



2/ 3 x 1 = .66 0.66 Health threat problem







Page 54

RANK 4

Problem: Poor home and environmental condition as health threat







Salience 1/ 2 x 1 = 0.5 0.5 Problem not really perceived needing change

Total Score and Rank 4.16

RANK 5

Problem: Improper garbage disposal as a health threat







Salience 1/ 2 x 1 = 0.5 .5 Not needing immediate attention


RANK 6

Problem: Low family income as a health threat





1/ 2 x 2 = 2 1 Partially modifiable

Preventive potential 1/ 3 x 1 = 0.33 0.33 Low preventable



Documents

86639440 Sample Family Care Study N107