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Iba, Hagonoy, Bulacan
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INITIAL DATABASE
A. FAMILY STRACTURE CHARACTERISTICS & DYNAMICS HEAD OF THE FAMILY : Ernesto Faustino ADDRESS : Iba, Hagonoy Bulacan CONTACT NO. : 09157002913 TYPE OF FAMILY : Extended INTERVIEWEE : Florencia De Guzman and Ernesto Faustino DATE OF INTERVIEW : July 08, 2009 at Brgy Iba, Hagonoy bulacan
FAMILY
MEMBERS
RELATION TO HEAD OF THE
FAMILY
GENDER
BIRTHDATE
STATUS
RELIGION
Ernesto Head of the family Male March 04, 1930 Married Roman CatholicFlorencia Daughter Female June 17, 1964 Married Roman CatholicFroilan Son In Law Male April 11, 1962 Married Roman CatholicJeffrey Grandson Male September 12, 1983 Single Roman CatholicJeric Grandson Male October 25, 1992 Single Roman CatholicJanile Granddaughter Female March 09, 1994 Single Roman Catholic
As Tatay Ernesto said “ simula nung bata ako dito na ako nakatira, taga dito kasi ang ama ko” which made their family as
patrilocal in location. When we ask about who will make most of the decision in the family, especially in health care tatay Ernesto verbalized “ ako at ang asawa ng anak ko na si froilan, siya kasi ang nagtatrabaho samin”. They do not belong in an ethnic group. Tatay Ernesto, Florencia and his 3 grandchildren originally resides from Iba and Froilan from Calumpit. Froilan transfer in Iba for almost 5 years. The primary dialect they used is Tagalog. As we ask if there is any problem in their family regardless of what cause, he answered mostly simple misunderstanding and they handle it by means of having open forum. Their family is considered patriarchal because Tatay Ernesto is considered the Head of the Family. There is no problem in communication with each member of the family, in exception to Froilan which is in Saudi Arabia, But they call him thru the used of cell phone about 3-4 times a week. And their family is considered a simple and happy family. B. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS
Tatay Ernesto is a high school graduate, he was a former farmer at his time, then Florencia is a BS Commerce graduate, she spends her time mostly at home. Froilan highest educational attainment is a high school graduate and working as a family driver in Riyadh, Kingdom of Saudi Arabia earning of approximately P 15 000 per month. The eldest son, Jeffrey is a college graduate and working as a sales clerk in a mall at Pullilan and earning of approximately P 10 000per month. Then Jeric is a 2 nd year BS Industrial Technology student at Bulacan State University while Janile, the youngest is a 4rth year high school student at Iba National High School. All of the members of their family are Roman Catholic, and they go to church every Sunday and they consider it as form of recollection and a bonding moment. Florencia is a member of “ Samahan ng mga Kababaihan” which is a small local cooperative in their community. There is no problem in their participation in the community work or task like the program “ Tapat mo Linis mo” and they considered it as a form of helping their own community.
When we asked if their monthly income is enough to sustain their family needs, they verbalized “ Oo naman, pero paminsan minsan pag may hindi inaasahang gastos na dumarating tulad ng sakit, nakakautang pa kami” If they encounter this specific condition they borrow money to Ate Maricar, as they call her, which is the oldest cousin of Froilan and originally resides in Sapang Bayan, Calumpit Bulacan.
MONTHLY BREAKDOWN OF EXPENSES
EXPENSES AMMOUNT
ELECTRIC BILL P 180 – P 250WATER BILL P 350FOOD P 10 000 (ESTIMATED)EDUCATION
P 500 – P 1 000 (JANILE) P 1 000 – P 2 000 (JERIC)
TOTAL P 12 030 – P 13 600
NAME INCOME PER MONTHFroilan P 10 000 was sent here in the
Philippines in his total income of P 15 000 per month.
Jeric P 4 000 was given to his family in his total income of P 10 000.
TOTAL P 14 000
C. HOME AND ENVIRONMENT
The family of Tatay Ernesto is living in their ancestral house composed of 3 bedrooms, 1 kitchen, 1 bathroom, a living room and a storage area. On 1 room Florencia and Froilan sleep, the 2nd room is for Tatay Ernesto and Jeffrey and the last room is for Jeric and Janile. The house has 10 windows, the 2 windows are in the front of their house, the 4 windows are in the second floor of their house the other 1 is in the kitchen, 1 in the CR, 1 window in the storage area and 1 in the roon which is in the main fool of their house. According to them there is no problem in ventilation. They used manual or “ dibuhos” system in their bathroom. They have 2 florescent lamps and 2 incandescent bulbs. They often walk barefoot inside their house. As they verbalized “ pag mainit electric fan ang gamit namin, gumagamit din kami ng katol o di kaya baygon spray para bugawin ang mga lamok”. Because some stagnant water outside their house can be a good reservoir of Dengue Carrying Mosquito.
They used LPG in cooking, their source of clean water is through their faucets and the water is come from a public water station ( NAWASA ). The clean their house about once a week every Sunday. Their family garbage was often collected by a truck and sometimes they just burn it. Those garbage are came from everyday life ( eg. Cooking, Biodegradable waste like dried leaves etc, ) They have open free drainage at the back of their house. The stair is considered hazardous to Tatay Ernesto because of his old age and sometimes this carelessness. As we ask if they are having check up in the Barangay Center , they verbalized “ pag may free immunization lang, kasi pag nagkakasakit kami, kung di naman malala kadalasan self medication lang ang ginagawa naming”. They used tricycle, jeeps and bicycle as their means of transportation and cell phone for communication.
FLOOR PLAN
FIRST FLOOR:
Washing Area
CR
Storage Area stairs
Door
Sofa
Sofa Sofa
window window
door
SECOND FLOOR:
Downstairs
BedBed
windowwindow
windowwindow
D. HEALTH STATUS OF EACH FAMILY MEMBER
As Tatay Ernesto verbalized “ di ako naniniala sa mga doctor lalo lang akong magkakasakit pag dinala ako sa ospital” “dati nung nasugat ang mata ko binigyan ko lang ng dinurog na asin, tapos hinugasan ko ng tubig, sa awa ng diyos gumaling naman” In order to maintain good health they just eat nutritious foods like plenty of fruits ( banana, mango), vegetables and take vitamin supplement every day. The only form of exercise of Jeric & Jeffrey is by playing basketball, tatay Ernesto, Florencia and Janile are no fun of having exercise. If they have health problems they often go to “ manghihilot” or “ mananawas” as their primary source of care. Or just having self medication if there is no serious medical problem. They often encounter fever, flu, cough and some benign skin allergies like not so serious dermatophytes infection. There is no mention case of Tineas and Pediculus Humanus Capitis infection in any of their family member.
None of the family experience serious accidents in exception in some minor bicycle accidents. At present none of their family member is sick. They also believed in effects and benefits of some herbal medication like the use of lagundi to treat cough and guava leaves as an antibiotic agent. And if one of their family members is sick and not responding in herbal meds and folk remedies, they just go directly to hospital and seek for some scientific explanation. Tatay Ernesto is a hard smoker as well as Froilan each of them can consume about 2 cases of cigarette every day. They also drink alcohol beverages occasionally.
E. HABITS, PRACTICES ON HEALTH PROMOTION, MAINTENANCE AND DISEASE PREVENTION
According to Tatay Ernesto he do not received any immunization required for then at his time. Then as Florencia verbalized “ kumpleto sa vaccine ang mga anak ko” These vaccines are BCG, DPT, OPV, HEPATITIS B and AMV. But she does not have any records of immunization. Their healthy lifestyle practices are eating nutritious foods, maintain proper hygiene and clean the surroundings. They sleep about 7-8 hours at night and take household chores as a form of exercise. There are no deviations in sleeping. As a form of relaxation they just watch television. They take vitamins as a promotive or preventive health care.
PHYSICAL ASSESSMENT
DONE ON July 09, 2009 AT BRGY IBA, HAGONOY BULACAN
NAME : ERNESTO FAUSTINO VITAL SIGN:AGE : 79 YEARS OLD T = 36.4oCWEIGHT : 72 Kg P = 69bpmHEIGHT : 1.7 m R = 17cpmBMI : 25.5 ( NORMAL ) BP = 70/100 mmHg
GENERAL SURVEY As we observed the pt. body built, height & weight there is no deviation from normal it is all appropriate in his age and lifestyle. He has a relaxed, erect posture with coordinated body movements. The pt. overall hygiene is clean and neat, there no presence of unpleasant body odor and no distress noted upon the entire physical examination. The pt. attitude is cooperative, have understandable and moderate tone of voice, there is relevance and organization of thoughts and pt. mood is appropriate to situation.
ASSESSMENT
TECHNIQUE NORMAL FINDINGS
ACTUAL FINDINGS
ANALYSIS
SKIN
1. Inspected skin colorInspection
Varies from light to deep brown or Yellow overtone to Olive
Yellow overtone to Olive normal
2. Inspected uniformity of skin color.
Inspection
Generally uniform except in
areas exposed to the sun; area of
Generally uniform except in areas
exposed to the sun.
normal
lighter pigmentation.3. Assessed edema, if present (location, color, temperature, shape)
Inspection, palpation No edema No edema present normal
4. Inspected, palpated, and described skin lesions. Inspection, palpation
Freckles, some birthmarks, some flat and raised nevi, no abrasions
or lesions.Presence of moles normal
5. Palpated skin moisture.Palpation
Moisture in skin folds and the axillae
Presence of moisture in skin folds normal
6. Palpated skin temperature.Palpation Uniform, within normal range Warm and even temperature normal
7. Noted skin turgorInspection
Skin springs back to previous state
Springs back to previous state normal
HAIR
1. Inspected evenness of growth over the scalp. Inspection Evenly distributed hair Evenly distributed hair normal
2. Inspected hair thickness or thinness. Inspection Thick hair Thin hair normal
3. Inspected hair texture and oiliness.
Inspection Silky, resilient hair Dry hair
Deviation from normal due to inadequate vitamins
REFERENCE: FUNDAMENTALS OF
NURSING 8TH EDITION, KOSIER, ERB & SNYDER
4. Noted presence of infections or infestations by parting the hair in several areas, checking behind the ears and along the hairline at the
Inspection No infection No infection noted. normal
neck.5. Inspected amount of body hair.
Inspection Variable Variable normal
ASSESSMENT
TECHNIQUE
NORMAL FINDINGS
ACTUAL FINDINGS
ANALYSIS
NAILS
1. Inspected fingernail plate to determine its curvature and angle. Inspection
Angle of nail plate about 160 degrees
Nail plate angle of 160 degrees normal
2. Palpated fingernail and toenail texture. Inspection Smooth texture Smooth texture normal
3. Inspected fingernail and toenail bed color. Inspection Highly vascularized Vascularized normal
4. Inspected tissues surrounding nails. Inspection Intact epidermis Intact epidermis normal
5. Checked capillary refillInspection
Prompt return of usual color (generally less than 4 sec)
Return of usual color (generally less than 4 sec)
normal
SKULL AND FACE
1. Inspected skull for size, shape, and symmetry. Inspection
Rounded, symmetrical, smooth skull contour
Normocephalic and symmetrical normal
2. Palpated the skull for nodules or masses and depressions. Palpation Absence of nodules and masses. No nodules or masses normal
3. Inspected the facial featuresInspection Symmetric facial features Symmetrical normal
ASSESSMENT
TECHNIQUE NORMAL FINDINGS ACTUAL FINDINGS
ANALYSIS
4. Noted symmetry of facial movements Inspection Symmetric facial movements Symmetric facial movements normal
EYES
1. Inspected eyebrows for hair distribution and alignment and skin quality and movement. Inspection Hair evenly distributed Evenly distributed hair normal
2. Inspected eyelashes for evenness of distribution. Inspection
Equally distributed; curled slightly outward
Equally distributed; curled slightly outward
normal
3. Inspected eyelids, ability to blink. Inspection
Lids close symmetrically 15-20 involuntary blinks/min
Lids close symmetrically 15-20 involuntary blinks/min
normal
4. Inspected conjunctiva and sclera
InspectionConjunctiva in pink color,
sclera appears whiteYellowish conjunctiva
Deviation from normal due to aging or present of
unknown diseases
REFERENCE: FUNDAMENTALS OF
NURSING 8TH EDITION, KOSIER, ERB & SNYDER
5. Inspected cornea and iris Inspection Transparent, shiny and smooth; iris is flat and
symmetrical
Cloudy, iris is flat and symmetrical
Deviation from normal due to aging
REFERENCE: FUNDAMENTALS OF
NURSING 8TH EDITION, KOSIER, ERB & SNYDER
6. Inspected pupils for color, shape and symmetry of size. Inspection
Brown to black in color, round, equal in size
Brown, equal in size, round normal
7. Tested visual acuity
Inspection Can read newsprintCan read newsprint w/o use of
eye glassesnormal
EARS
1. Inspected auricles for color Inspection Color same as facial skin Color same as facial skin normal2. Tested hearing acuity
InspectionNormal voice tones audible, able to hear ticking in both
ears
Normal voice tones audible, able to hear ticking in both
earsnormal
NOSE
1. Inspected external nose for any deviations in size, shape or color
InspectionSymmetric and straight, no
dischargeSymmetric and straight, no
dischargenormal
2. Inspected the nasal cavities for the presence of redness, swelling, growths and discharge, using the flashlight
InspectionMucosa pink in color, clear watery discharge, no lesions
Mucosa pink in color, clear watery discharge, no lesions
normal
3. Inspected the nasal septum between chambers
InspectionNasal septum intact and in
midlineIntact and in midline normal
4. Tested patency of both nasal cavities
InspectionAir moves freely as the client
breathes through the noseAir moves freely as the client
breathes through the nosenormal
5. Lightly palpated for areas of tenderness, masses
Palpation No tenderness, no lesions No lesions and tenderness normal
MOUTH
1. Inspected outer lips from symmetry, color and texture
InspectionPink in color, moist,
symmetricLight pink in color
Deviation from normal due to inadequate vitamin used
REFERENCE: FUNDAMENTALS OF
NURSING 8TH EDITION, KOSIER, ERB & SNYDER
2. Inspected buccal mucosa for color, moisture, texture and presence of lesions
InspectionMoist, smooth, soft and elastic
textureMoist and smooth normal
TEETH
Inspected for color, number, condition and presence of dentures
Inspection32 adult teeth, white and shiny
tooth enamel1 adult teeth, light yellow and
shiny tooth enamel
Deviation from normal due to missing teeth
REFERENCE: FUNDAMENTALS OF
NURSING 8TH EDITION, KOSIER, ERB & SNYDER
GUMS
Inspected for the color and conditions
InspectionPink gums; moist and no
retraction of gumsPink gums normal
ASSESSMENT
TECHNIQUE
NORMAL FINDINGS
ACTUAL FINDINGS
ANALYSIS
TONGUE/FLOOR OF THE MOUTH
1. Inspected for color and texture of the mouth floor and frenulum
InspectionSmooth tongue base with
prominent veinsSmooth tongue normal
2. Inspected and palpated the position, color and texture, movement and base of the tongue
Inspection, palpation Moves freely, no tenderness Moves freely normal
3. Palpated for any nodules, lumps or excoriated areas
PalpationSmooth with no palpable
nodulesSmooth no nodules normal
NECK
1. Located/palpated lymph nodes and note for tenderness
Palpation No tenderness No tenderness normal
2. Inspected and palpated trachea for placement
Inspection, palpationCentral placement in midline, spaces are equal for both sides
Central placement in midline of the neck.
Normal
3. Inspected symmetry and visible masses
InspectionGlands ascends during swallowing; not visible
Glands not visible Normal
ASSESSMENT
TECHNIQUE NORMAL FINDINGS ACTUAL FINDINGS
ANALYSIS
4. Palpated for smoothness and areas of enlargement, masses or nodules
Palpation Not palpable Not palpable Normal
POSTERIOR THORAX
1. Inspected the shape, symmetry, and compared the diameter of anteroposterior thorax to transverse diameter
InspectionAnteroposterior to transverse
diameter is 1:2 ratio, chest symmetric
Anteroposterior to transverse diameter is 1:2 ratio
Normal
2. Inspected the spinal alignment Inspection Spine vertically aligned Spine vertically aligned Normal3. Palpated for temperature, tenderness, masses.
Palpation Uniform temperature, chest wall intact, no lumps masses
and areas of tenderness
Uniform temperature, no masses or tenderness
Normal
4. Assessed respiratory excursion.
InspectionThumb separation at
inspirationThumb separates at inspiration Normal
5. Palpated vocal fremitus.Inspection
Bilateral symmetry of vocal fremitus
Bilateral symmetrric normal
6. Percussed the posterior thorax.
Percussion Resonant sound Resonant sound Normal
7. Auscultated the posterior thorax.
Auscultation No adventitious sound No adventitious sound Normal
ANTERIOR THORAX
1. Inspected breathing patterns.Inspection
Quiet rhythmic and effortless respiration
Quiet and effortless respiration Normal
2. Palpated for temperature, Palpation Uniform temperature, no Uniform temperature, no Normal
tenderness, masses.tenderness and masses
tenderness and masses upon palpation
3. Assessed respiratory excursion.
InspectionThumb separation at
inspirationThumb separates at inspiration Normal
4. Palpated vocal fremitus.
Bilateral symmetry of vocal fremitus
Bilateral and symmetric Normal
5. Percussed the anterior thporax. Percussion Resonant sound Resonant sound Normal
6. Auscultated the trachea.Auscultation
Bronchial/tubular breath sounds
Bronchial/tubular breath sounds
Normal
7. Auscultated the anterior thorax.
Auscultation No adventitious sound No adventitious sound Normal
ASSESSMENT
TECHNIQUE
NORMAL FINDINGS
ACTUAL FINDINGS
ANALYSIS
CARDIOVASCULAR
1. Aortic and pulmonic areas. Auscultation No pulsations No pulsations Normal2. Tricuspid area. Auscultation No pulsations No pulsations Normal3. Aspical area.
AuscultationPulsations visible, no lifts or
heavesPulsations visible, no lifts or
heavesNormal
4. Epigastric area. Auscultation Aortic pulsations Aortic pulsations Normal
CAROTID ARTERIES
1. Palpated carotid artery with extreme caution.
Palpation Symmetric pulse volume Symmetric pulse volume Normal
2. Auscultated the carotid arteries.
AuscultationNo sounds heard on
auscultationsNo sounds heard Normal
JUGULAR VEINS
1. Inspected jugular veins. Inspection Veins not visible Veins not distended Normal
UPPER EXTREMITIES
1. Motor strength InspectionEqual strength on each body
sideNot equal strength on each
body side
Normal(decreased muscle strength is normal due
aging)
REFERENCE: FUNDAMENTALS OF
NURSING 8TH EDITION, KOSIER, ERB &
SNYDER.
2. Muscle tone Palpation Firm, uniform tonicity slug, not uniform tonicity
Normal(decreased muscle tonicity and firmity is
normal due aging)
REFERENCE: FUNDAMENTALS OF
NURSING 8TH EDITION, KOSIER, ERB &
SNYDER.3. Presence of lesions, deformities, and varicosities
InspectionNo lesions; no deformities; no
tendernessNo lesions; no deformities;
tendernessNormal
LOWER EXTREMITIES
1. Motor strength InspectionEqual strength on each body
sideEqual strength Normal
2. Muscle tone Palpation Firm, uniform tonicity slug, not uniform tonicity
Normal(decreased muscle strength is normal due
aging)
REFERENCE: FUNDAMENTALS OF
NURSING 8TH EDITION, KOSIER, ERB & SNYDER
3. Presence of lesions, deformities, and varicosities
InspectionNo lesions; no deformities; no
tendernessNo lesions; no deformities;
tendernessNormal
JOINTS
1. Range of motion Inspection
Varies to some degree in accordance with person’s
genetic makeup and physical activity
Some smooth joint movements, moderate range of
motionNormal
NOTE: ONLY TATAY ERNESTO WAS AVAILABLE WHEN WE CONDUCTED THE PHYSICAL EXAMINATION, 2 OF HIS GRANDCHILDREN
WERE IN SCHOOL, JERIC WHICH IS THE ELDESTS WERE IN THE HIS WORK, FROILAN IS IN SAUDI ARABIA AND FLORENCIA IS NOT AVAILABLE IN THAT TIME BECAUSE OF SO MANY HOUSE HOLD CHORES NEEDED TO BE FINISHED.
FAMILY NURSING CARE PLAN
HEALTH PROBLEM
FAMILIY NURSING PROBLEM
GOAL OF CARE
OBJECTIVE
OF CARE
NURSING
INTERVENTION
METHOD OF
NURSE-FAMILY
CONTACT
RESOURCE S REQUIRED
@ Knowledge deficit related to unfamiliarity with information or resources
@ Lack of specific information necessary for patient and S.O to make informed choices regarding of what condition, therapies or treatment.
@ After nursing intervention the family will be able to understand the importance of medical intervention rather than the used of wrong folk remedies.
@After 1 hour of nursing intervention the family:
a. Will participate in learning process.
b. Will verbalized understanding of condition, disease process or treatment.
a. Discuss the importance of receiving right medical intervention in a particular health problem.
b. Discuss the consequences or practicing wrong folk remedies.
c. Discuss some nursing intervention which is applicable in
a. Home visit
b. Health teaching
Material resources:
a. Visual aid
b. Maglaya and Cuevas books
Human resources:
a. Participation of every family member.
b. Time & effort of health care provider.
c. And will initiate necessary lifestyle changes.
their everyday life.
Financial resources:
a. Teaching aid
b. Transportation fees
FIRST LEVEL ASSESSMENT
Cues/Data Family Nursing Problem
FIRST LEVEL ASSESSMENT
The hazardous place for the client is the stairs because they are at risk for fall.
“Malakas kaming magkape lalo na si Tatay halos nakaka-anim na beses sya isang araw” as verbalized by the client.
The house of the client is near the highway wherein a lot of vehicles are passing day by day and it cause air and noise pollution that may cause psychological stress.
I. Presence of Health Treats
A. Accident Hazard
Stairs
B. Faulty and Unhealthy Nutrition
Excessive intake of coffee
C. Poor environmental condition
Air and noise pollution
“Si tatay malakas manigarilyo siguro nakaka dalawang pakete sya sa isang araw.” as verbalized by the client.
“Wala lagi lang si tatay nakaupo dyan sa me labas, minsan nakikipagkuwentohan” as verbalized by the client.
“Marunong akong mag-alis ng katarata, lalagyan ko lang ng tubig na may asin tapos, lilinaw na yung paningin ko, kaya lang mahapdi nga lang” as verbalized by the client.
D. Unhealthful lifestyle and Personal Habits
Excessive consumption of cigarettes
Lack of exercise
“Eh, nung araw hindi pa naman uso ung mga bakuna na yan eh. Pero kumpleto naman ng bakuna ung mga anak ko.” as verbalized by the client.
“Eh, parang napansin ko lang habang tumatagal parang lumalabo ung mata ko, pero nakakabasa pa din naman ako.” as verbalized by the client.
Self medication
E. Inadequate immunization
II. Presence of Health Deficits
Sometimes feeling of loneliness.
“ Kasi si Tatay madalas nagse-self medicate lang.” as verbalized by the client.
The family have different point of views regarding medical care for
Lolo he uses the traditional way of medication.
Aging
III. Presence of stress points/ foreseeable crisis situation
Death of the member
SECOND LEVEL ASSESSMENT
I. Inability to make decisions with respect to taking appropriate health actions due to:
A. Conflicting opinions among family members or significant
“Hindi naman kami kumukunsulta sa center pagdating sa mga check-up check-up eh, umiinom na lang kami ng gamot.” as verbalized by the client.
“Bihira kaming kumunsulta sa doctor, kasi nga magastos pa. ” as verbalized by the client.
others regarding action to take.
II. Failure to utilize community resources
A. Failure to perceived the benefits of health care
B. Unavailability of required care/ service
HOW COULD IT BE, THAT YOU WERE ABLE TO FORMULATE THE FNCP, WITHOUT DOING THE PROBLEM IDENTIFICATION, THEN THE TYPOLOGY AND PRIORITIZAION?